Plainview Standard - Freedom Behavioral

facility	tax_id	update_date	version
allegiance-behavioral-health-center-of-plainview	201871394	4/1/2023	1.0.0

SERVICE DESCRIPTION	CDM CODE	BILLING CODE	ITEM/SERVICE DESCRIPTION	BILLING REVENUE CODE	GROSS CHARGE	BCBS of Texas (Commercial)	Beacon Health Options	Cigna Behavioral Health (Commercial)	Medicare (Traditional)	Optum (United Healthcare/United Behavioral Health)	TriWest (VCP)	Vantage Health Plan	Wellcare (Harmony Health Plan)	Zellis PPO	De-Identified Minimum Negotiated Rate	De-Identified Maximum Negotiated Rate	DISCOUNTED CASH PRICE
Inpatient Psychiatric Services	110002		Private Room	114	1208	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	110001		Semi-Private Room	124	1050	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	23926026		Wound Care	239	568	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000007		A/B Otic Drops	250	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000018		Abilify 10mg	250	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000019		Abilify 15 Mg	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000020		Abilify 2 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000022		Abilify 20mg Tablet	250	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000023		Abilify 30 Mg	250	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000024		Abilify 5 Mg	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000031		Acarbose 50 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000032		Accolate 20 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000033		Accu Check Cmfrt Curv 100	250	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000034		Accupril 20mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000041		Acebutolol 400 Mg	250	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000042		Acetaminophen	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000044		Acetaminophen 325mg	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000046		Acetaminophen 500	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000054		Acetazolamide 250 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000061		Acidophillus	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000062		Aciphex 20 Mg	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000063		Acto Plus 15/850mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000065		Actonel 35 Mg	250	143	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000066		Actos 15 Mg	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000067		Actos 30 Mg	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000068		Actos 45mg	250	182	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000069		Acular Opth Sol'n 5m	250	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000073		Acyclovir 400 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000079		Add Fee-Ivp-B	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000084		Advair	250	408	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000085		Advair Discus 250/50	250	294	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000088		Advair Diskus Inh	250	819	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000090	80053	Advanced Eye Relief	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000091		Advil 200mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000094		Aerobid	250	651	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000095		Aerochamber	250	225	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000097	80156	Aggremox Cap	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000099		Aggrenox ER Caps	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000100	86762	Akwa Tears	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000106		Albuterol .83mg/ML 75	250	151	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000111	89300	Albuterol 200 Metered 17 Gm	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000115	82003	Albuterol 90mcg Inh 17gm	250	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000124		Aldactone 25mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000128	83874	Alendronate 35mg	250	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000129	82480	Alendronate 70 Mg	250	143	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000132		Aleve	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000136	86710	Align	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000139		Allegra 180 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000141		Allegra 600 Mg	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000143		Allegra-D	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000144		Allopurin0l 100 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000145		Allopurinal 300mg/Shein	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000150		Alocromil 2% 5ml Eye	250	453	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000154		Alphagan P O. 15% 5 ML	250	358	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000159		Alprazolam 0.25mg/Purepac	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000160		Alprazolam 0.5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000165		Altace 2.5 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000166		Altace 5 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000170	83020	Amantadine 100 Mg Tab	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000174		Amaryl 2 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000175		Amaryl 4 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000176		Ambien 10mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000178		Ambien 5mg	250	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000179		Ambien Cr 12.5 Mg	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000181		Ambilify 10 Mg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000182		Amblify 15 Mg	250	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000200		Amiodarone HCL 200 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000201		Amitiza 24 Mcg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000207		Amitriptyline 25 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000210	80076	Amitriptyline HCL 10x21	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000214		Amlodipine (Norvasc) 5mg Tab	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000216		Amlodipine Besylate 10 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000218		Amlodipine Besylate 5mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000226		Amlopidine-Benaz	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000230	84402	Ammonium Lactate 2% 400gm	250	128	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000240		Amoxicillin 500mg	250	12.45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000244		Amoxicillin/Clav K. 875/125	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000264		Anafranil 25 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000265	82435	Analgestic Creme Rub	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000266		Anaspaz Tab	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000268	86870	Anastrozole 1 Mg	250	50	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000271		Antacid Susp Plus	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000274		Antioxidant Vitamins	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000278		Anusol Hc Supp	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000279	84132	Apap 500 Mg X-Str Ca	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000284		Aplrazolam 0.5 Mg/Greenstone	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000289		Aquaphor 3.5mg Oint	250	213	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000296		Aricept 10 Mg Tablet	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000298		Aricept 5 Mg Tablet	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000299		Arimidex 1 Mg	250	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000307	82382	Arthrotec 75 Tablet	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000312		Asacol 400 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000313		Ascensia Elite #50	250	218	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000316		Ascorbic Acid 500 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000317	87207	Asmanex Twisthaler	250	168	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000320		Aspercreme 10%	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000322		Aspirin 325mg Tab	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000323		Aspirin 81mg Chewable Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000325		Aspirin Ec (Ecotrin) 325mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000327	80198	Asprin 81mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000330		Atacand 16 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000331	86756	Atacand 32 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000333		Atarex 25mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000335		Atenolol (Tenormin) 25mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000336		Atenolol (Tenormin) 50mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000337		Atenolol 100mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000339		Atenolol 25mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000340		Atenolol 50 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000342		Ativan 0.25 Mg Tab	250	4.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000344		Ativan 0.5 Mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000346		Ativan 1mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000347		Ativan 2 Mg Injectable	250	233	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000348		Ativan 2mg/ML	250	115	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000363		Atrovent Inhalation	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000364		Atrovent Inhaler	250	380	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000371		Augmentin 875 Mg Tab	250	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000373		Avalide 150/12.5 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000374		Avandia 2mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000375		Avandia 4mg	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000377		Avapro 150mg	250	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000381		Avelox 400mg	250	118	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000382		Avodart 0.5 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000383		Awka Tears 1.4%-15ml	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000395	86157	Azithromycin 250 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000397		Azma Cprt Inhaler	250	434	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000400		Azo Tabs	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000405		B-1	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000409		Bacitracin 15 Gm	250	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000415		Baclofen 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000421		Bactrim Ds	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000423		Bactroban Oint. 2% 22 Gm	250	401	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000429		Beconase Aq Nasal Spray	250	458	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000434		Benadryl 25 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000436		Benadryl 50 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000443	82040	Benazepril Hctz 20/1	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000445		Benefiber Sugar Feee	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000447		Benicar 20mg Tab	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000448		Benicar 40 Mg	250	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000450	82164	Benicar 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000457		Benztrop 1 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000458	J0515	Benztropine (Cogentin) 1mg Tab	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000461		Benztropine 0.5 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000462		Benztropine 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000474		Betapace 80 Mg	250	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000476		Bethameth Driprop .5	250	499	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000482	84165	Bethanechol 50mg	250	95	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000485		Biaxin 500 Mg	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000498		Bisacodyl (Dulcolax) 5mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000500		Bisacodyl 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000501	85044	Biscolax	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000502		Bismo 20 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000504	80194	Bisoprolol	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000508	84432	Black Cohosh	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000510		Blistex Lip Medex	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000511	85046	Boniva Tab 150	250	145	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000512		Boost	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000515		Brimonidine 0.2%	250	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000516	86707	Brimonidine 0.2% Eye	250	213	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000517	86706	Brimonidine Tartrate 5 ML	250	262	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000526	86777	Budesonide 0.5 Mg	250	192	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000532	83002	Bumetanide 1 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000533	85032	Bumetanide 2 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000535		Bumex 1mg	250	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000545	80190	Bupropion HCL Xl 300 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000547		Bupropion Sr N200 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000548		Buspar 15 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000549		Buspar 5mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000552		Buspirone 10 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000553		Buspirone 15 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000555		Buspirone 30 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000556		Buspirone 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000562	83825	Butalbital/Apap/Caff	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000568	86320	Bystolic 5 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000570	82565	Caduet 5 Mg/42mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000573		Calan 120 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000575		Calan Sr 180mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000580		Calcitrate 600 + D	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000583		Calcitriol 0.25 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000588		Calcium 500mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000590		Calcium 600+d	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000593	82465	Calcium Antacid 150 Tab	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000599	82340	Calcium Carbonate 60	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000612		Caltrate 600 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000615		Caltrol 0.25 Mg	250	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000616		Campral 333 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000619		Capoten 25mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000622		Captopril 50mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000625		Captoril 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000626		Carafate 1 Gm Tab	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000637		Carbamazepine 100mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000638		Carbamazepine 200mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000654		Carbidopal/Levodopa 25/250mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000657		Cardina 2 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000660		Cardizem CD 120 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000661		Cardizem CD 180mg	250	46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000662		Cardizem CD 240 Mg	250	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000664		Cardura 2 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000669		Carisoprodol 350mg Tab	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000677	82952	Carvedilol 12.5 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000678		Carvedilol 25mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000679		Carvedilol 3.125 Mg	250	4.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000680	86038	Carvedilol 3.25 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000682	93225	Carvedilol 6.25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000688		Catapress Tts 0.3 Patch	250	536	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000689		Cecon Bottle	250	513	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000697	86880	Cefdinar 300 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000709		Ceftin 250mg	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000714	87075	Ceftriaxone 1 Gm	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000715	82693	Ceftriaxone 1 Gm Vial	250	101	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000724		Celebrex 100 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000725		Celebrex 200 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000733		Celexa 20 Mg	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000735		Cellcept 250mg	250	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000737		Centrum Silver Tab	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000738		Century 50 Plus	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000739		Century Senior Tabs	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000742		Cepacol Lozenges	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000746		Cephalexin 500 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000756	82247	Cetirizine 10 Mg	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000761		Chantix .5 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000762		Chantix 1 Mg	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000765	85018	Chlestyramine Packet	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000767		Chloraseptic Spray	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000772	82977	Chlordiazepoxide 25mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000775		Chlorex-A Tablets	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000778	84481	Chlorhexidine 0.12% 473 ML	250	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000780	83018	Chlorophyll 3mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000785		Chlorpromazine HCL	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000790		Chlorthalidone 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000794		Cholestyramine Packs	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000803		Cilostazol 50 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000806		Ciloxan Opth Drops	250	318	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000807	86703	Cimetidine 800 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000810		Cipro 500mg Tablet	250	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000814		Ciprofloxacin (Cipro) 0.3% Oph	250	131	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000819		Ciprofloxacin 250 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000820		Ciprofloxacin 500 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000821	81050	Ciprofloxacin HCL	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000822	82668	Ciprofloxacin Opht S 5 ML	250	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000827	82671	Citalopram 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000828		Citalopram 20mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000829	82677	Citalopram 40 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000831		Citracal Plus W/ Mag	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000834		Cl0nidine 0.1 Mg	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000835		Clarinex 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000839		Claritin	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000842		Cleocin 150 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000843		Climara 0.1 Mg Patch	250	50	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000860		Clobenzaprine HCL	250	46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000867		Clonazepam 1 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000875		Clonidine .2 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000876		Clonidine 0.1	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000878		Clonidine 0.3mg Tablet	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000880		Clonidine Tts Patch 0.1 Mg	250	447	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000881		Clonidine Tts Patch 0.2mg	250	349	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000882		Clonidine Tts Patch 0.3 Mg	250	185	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000883		Clonozapam 0.5 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000887	80185	Clorazepate 7.5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000891		Clotrim Antifungal	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000903		Clozaril 25 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000911		Coenzyme Q10 50 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000916		Cogentin 2 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000918	87270	Cogentin1 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000919		Colace 100mg	250	6.81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000921		Colace Liquid 10 Cc	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000923		Col-Benemid	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000924		Colcace Liquid 5ml	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000925		Colchicine 0.6mg Tab	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000931	87491	Colestipol HCL 1gm	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000936		Combigan Eye Drops	250	233	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000938		Combivent Inhaler 14.7gm	250	430	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000941		Compazine 10 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000945	84450	Compound Rx 30gm	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000946		Comtan 200 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000949		Copaxone 20mg	250	390	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000952		Cordarone 200mg	250	126	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000959		Corgard 40mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000960		Corge 12.5 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000961		Corona Ointment	250	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000962	84460	Correc Cr 40mg	250	84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000967		Cosopt Eye Drops	250	312	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000972		Coumadin 2.5 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000973		Coumadin 3.5 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000974		Coumadin 5 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000976		Coumadin 7.5mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000978		Cozaar 100 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000979	86304	Cozaar 25 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000980		Cozaar 50 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000984		Crestor 10 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000991		Cyanocobalamin (Vit B12) 1000m	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25000997		Cyclobenzarine HCL	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001006		Cyclosporine Opth 0.4%	250	99	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001007		Cymbalta 20mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001008		Cymbalta 30mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001009		Cymbalta 60 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001014		Cytotec 100 Mcg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001016		Cytra K 5ml	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001047		Darvocet N 100mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001049		Darvon 65mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001059		Demadex Non-Frm 20mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001062		Depakene 250 Mg/5ml	250	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001079		Depakote 1000 Mg	250	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001081		Depakote 125 Mg Sprinkles	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001083		Depakote 250 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001084	84153	Depakote 250mg/5ml S 140ml	250	240	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001085		Depakote 500mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001086		Depakote 750 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001089	83615	Deplin 7.5 Mg Tab	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001090		Depo Provera	250	729	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001091		Depomedrol 80 Mg	250	157	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001093	84134	Desipramine 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001107		Desyrel 100mg	250	92	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001108	86063	Detrol La 2 Mg Tab	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001109		Detrol La 4 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001117		Dexamrth 1mg/ML	250	123	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001136		Diabeta 5 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001145		Diazepam 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001152	85008	Diclofenac Sod	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001158		Dicyclomine 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001159		Dicyclomine HCL 20 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001163		Diflucan 150 Mg	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001171		Digoxin 0.125mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001173		Digoxin 0.25mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001174	82950	Digoxin 250mcg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001177		Dilacor XR 180mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001178		Dilantin 100mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001184		Dilantin 50mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001204		Diltiazem CD 180mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001205		Diltiazem CD 30 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001207		Diltiazem ER 120	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001210		Diltiazem HCL CD (Cardizem) Ca	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001216		Diovan 160 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001221		Diovan 80 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001222		Diovan Hct 80/12.5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001223		Diovan Hctz 160/12.5 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001226	85025	Diphedryl Sod	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001227	84234	Diphenhist 25 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001228		Diphenhist Elixer Rugby	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001232		Diphenhydramine 25 (Rug)	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001233		Diphenhydramine 50(Rug)	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001235	85014	Diphenoxyl/Atropine	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001239		Dipyridamole 25 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001247		Ditropan Xl 5mg	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001255	86618	Divalproex Sod 500 M	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001256	86609	Divalproex Sod Dr 25	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001257	83970	Divalproex Sod ER 50	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001261		Divan 40mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001271		Docusate Calcium	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001274		Docusate Sodium 100mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001277		Donepezil HCL 10 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001280		Donnatel/Maalox	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001288	83519	Dorzolamide-Timolol	250	386	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001294	82533	Doxazosin Mesylate	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001298	82951	Doxepin 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001299		Doxepin 100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001300		Doxepin 25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001303		Doxepin HCL 25mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001309		Doxycycline 100mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001315	Q0167	Dronabinol (Marinol) 2.5mg Cap	250	16.28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001316	87802	Dronedarone 400 Mg	250	92	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001317	85730	Droperidol 2.5 Mg/ML 20	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001320		Dss 100mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001321		Dss W/Casan	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001322		Dulcolax	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001332		Duoneb 2.5	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001336		Duragesic 50 Mcg/Hr 5's	250	152	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001339		Dyazide	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001343		Dynacirc Cr 5mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001344		Dynapen 250mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001346		Dytan 25 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001352		Ees Filmtb 400 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001356		Effexor 37.5 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001358		Effexor XR 150mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001359		Effexor XR 75 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001360	89051	Effient 10 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001362		Elavil 50mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001367		Elidel 1% 60 Gr Cream	250	235	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001368		Elidel 1% Cream 30 Gram	250	443	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001371		Eliquis 5 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001373		Elnorm 6mg	250	73	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001378		Enablex 7.5 Mg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001382		Enalapril 10mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001384		Enalapril 20 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001385	83718	Enalapril Maleate	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001408		Enteric Coated Aspirin	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001429		Epogen 20,000 Units	250	1408	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001437	87045	Ergocalciferol 50,000	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001440		Eryped 200mg/5ml	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001444		Erythromycin 500 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001453		Esidrix 25 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001454		Eskalith Cr	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001457		Estazolam 1 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001465		Estradiol 2mg Tablet	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001476	86316	Estropipate 0.625	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001477		Estropipate 0.75mg Tab	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001488		Etodolac 600 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001495		E-Vista 60 Mg	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001496	86787	Evoxac 30 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001497		Exelon 1.5 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001498		Exelon 3mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001499		Exelon 4.5 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001500	84479	Exelon 4.6 /24hr P 30	250	264	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001501		Exelon 6 Mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001504	86317	Exelon Patch 9.5 Mg	250	37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001509	85048	Exforge 5 320mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001512		Eye Stream 30ml	250	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001517		Famotidine 20 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001528	84439	Felodipine ER 5mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001531		Femera 25mg	250	122	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001535	82085	Fenofibrate 200 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001545		Fentanyl 75mcg/Hr Pathc	250	279	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001554	84703	Feosol	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001555	87070	Fergon	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001558		Ferrex 150mg Cap	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001559		Ferro Sulf 325mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001578	83498	Fexofenadine HCL	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001579	87102	Fiber Laxative 625	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001580		Fiber Powder	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001581		Fibercon 500mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001582	80178	Fibercon 625 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001586	82374	Finasteride 5mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001588		Fioricet 1 Tab	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001590		Fiorinal/Cod #3	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001596		Flagyl 500 Mg	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001600		Flax Seed Oil 1000 Mg Softgel	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001605		Fleets Phospho-Soda 3oz.	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001606		Flexeril 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001609		Flomax 0.4 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001610		Flonase Nasal Spray	250	140	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001613		Floranex Tab	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001616		Florinef 0.1 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001622		Flovent 44 Mcg Inhaler	250	515	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001624	82010	Flovent Hfa 100 Mcg	250	230	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001625		Flu Vaccine	250	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001626		Flu Vaccube .05 ML	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001638	86593	Fludrocortisone Ace	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001642		Fluocinolone .01% 60	250	263	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001647		Fluoprazine 2mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001652		Fluoxetine	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001656	84295	Fluoxetine 20 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001668	82270	Fluphenazine Dec 25m	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001670		Flurazepam	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001684	84080	Fluticasone 50mcg	250	90	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001685		Fluticasone Nasal Spray	250	70	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001686		Fluticasone P Cr 15	250	90	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001691	83090	Fluvoxamine Laleate	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001693	83036	Fluzone	250	237	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001695	82365	Folamin Tablet	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001699		Folic Acid 1mg Tab	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001707		Foltx Tabs	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001709		Foradil 12ud Inhaler	250	399	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001710	86664	Foradil Aerolizer 12mcg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001714	86235	Fortical Nasal Spray	250	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001716		Fosamax 70 Mg	250	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001721		Fosinopril/Hctz	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001733		Furosemide 20mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001734		Furosemide 40 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001737		Furosemide 80mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001744		Gabapentin 100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001747		Gabapentin 300 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001749		Gabapentin 600 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001752	84484	Gabitril 12mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001757	85362	Galantamine Hb 212 M	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001767		Gaviscon 20-80 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001770		Gemfibrozil 600 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001772		Genasyme 80mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001773	81003	Genebs 500mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001774		Generlac Soln 10g/15ml	250	219	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001775		Gentacidin 3mg/ML	250	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001783		Gentamicin Opth Sol 5ml	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001785	86677	Genteal Drops	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001790		Geodon 20 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001791		Geodon 20 Mg/Inj	250	654	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001793		Geodon 40 Mg	250	37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001796		Geodon 60 Mg Tab	250	61	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001797		Geodon 80 Mg	250	44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001798	83605	Geritol Complete	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001799	86334	Ginko Biloba 60 Mg	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001802	84244	Glimepiride 2 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001804	82310	Glimepiride 40 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001806		Glipizide 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001810		Glipizide E-R 5mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001814	82595	Glucagon 1 Mg Emer Kit	250	183	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001818		Glucophage 500 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001820		Glucophage XR 500mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001823		Glucosamine Complex 500 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001824		Glucosamine/Chondroiton	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001829		Glucotrol 5mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001831		Glucovance 2.5/500	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001833		Glucovance 5/500 Tab	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001840		Glyburide 2.5 Mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001843	80299	Glyburide 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001850		Glycolax 255 Gram	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001855		Glynase 3mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001879		Gualfensin Dm 10cc	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001883		Guanfucine 2mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001886		Gwatuss 100mg/5ml	250	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001889		Haldol 1 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001890		Haldol 10 Mg Tab	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001894		Haldol 5 Mg	250	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001896		Haldol 5mg/ML	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001901		Haldol Liq 2/1 5ml	250	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001902	80074	Halls Mentolyptus (60)	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001906		Haloperidol 0.5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001908		Haloperidol 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001911		Haloperidol 2 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001914		Haloperidol 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001918		Haloperidol ML 120	250	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001919		Haloperidol Oral Sol 60 ML	250	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001921		Hcts 1% 30gm	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001922	82438	Hctz 12.5 Capsule	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001925		Hemmorrhoidal Cr	250	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001927	86160	Hemocyte Plus Cap	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001928		Hemorrhoidal Hc Supp	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001930		Hep Lock 100u/ML 30 ML	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001943		Humalog Ins Inj	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001944		Humalog Insulin U-100 1oml	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001946	85660	Humira 40 Mg/0.8 ML	250	1016	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001947		Humulin 70/30	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001950		Humulin R Insulin U 100	250	140	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001951		Hyazzr 50-12.5 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001956		Hydralazine 10 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001959	86803	Hydralazine 25mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001960		Hydralazine 50 Mg	250	4.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001961		Hydralazine 75 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001962		Hydrea 500 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001963		Hydro Valerate 0.2%	250	251	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001969		Hydrocholorothiazide 25mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001973		Hydrocodone Apap 7.5/500 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001978		Hydrocodone/Apap 10/325 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001984		Hydrocodone/Apap 5/500 Wt	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25001990	87177	Hydrocodone-Apap 5/3	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002001	86645	Hydrocortisone 5 Mg Tab	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002010		Hydrocotisone 1% Cr 1oz	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002016	84403	Hydroxychloroquine 2	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002028		Hydroxyzine HCL 25mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002030		Hydroxyzine Pam 25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002031		Hydroxyzome 50 Mg	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002035		Hyoscyamine S/L.125 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002038		Hypotears Eye Drops	250	73	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002039		Hytrin	250	224	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002042	86318	I Caps Plus	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002047	84436	Ibuprofen 100 Mg/5 ML	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002048	81001	Ibuprofen 200mg Tab	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002050		Ibuprofen 400mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002052		Ibuprofen 800 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002058		Imdur 30 Mg	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002062	80150	Imipramine HCL 50mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002063		Immitrex 50 Mg	250	226	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002064		Immodium 2mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002070		Inderal 10mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002072		Inderal 40 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002073		Inderal La 120 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002084		Indomothacin 25 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002087		Innopran Xl 120 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002088		Inspra 25 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002100		Insulin Humulin R	250	126	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002106	87899	Invega 3 Mg	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002110	81015	Ipratr-Albuterol 0.5 90	250	116	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002117		Ipratropoim 0.02% 05mg/2.5ml	250	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002127		Ismo 20 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002133		Isopto Tears	250	175	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002134		Isordil 10mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002136	83898	Isosorbide 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002137		Isosorbide 20mg Oral Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002144		Isosorbide Mon 30mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002153		IV Nacl	250	204	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002158	84585	Janumet 50-1,000 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002159		Januvia 100 Mg	250	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002160		Januvia 25 Mg	250	50	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002161	84066	Januvia 50 Mg	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002162		Jevity 1.5	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002164	89060	Juven	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002169		K Dur 20 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002177		Kaolin Pectin 30 ML	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002190		Kcl Sol'n 10% 20meq/15ml	250	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002191	87536	Keflex 250 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002192		Keflex 500mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002193	87190	Kenalog	250	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002194		Kenalog Cm 80gm Tube	250	431	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002195		Kenalog Lotion 1%	250	461	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002196		Keppra 1000 Mg Tab	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002199		Keppra 500 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002204	85300	Ketocanazole Cr 2%	250	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002211		Ketorolac (Toradol) 10mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002217		Klonopin 0.5 Mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002218		Klonopin 1 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002224	86663	Konsyl Powder	250	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002225		Kristalose 10mng Pckt	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002226		Kwell Lotion 60ml	250	304	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002235		Labetalol HCL	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002237		Labetalol HCL 200 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002238		Lacri-Lube 7gm	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002241	82945	Lactaid Fast Act	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002250		Lactulose 30 ML Voc	250	146	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002251	84550	Lactulose Sol 473ml	250	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002252		Lamictal 100mg	250	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002253		Lamictal 150mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002256		Lamictal 25mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002257		Lamictal Tablets 100 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002265	86900	Lamotrigine 100 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002272		Lanoxin .125 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002280		Lantus Insulin 100	250	147	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002281		Lantus Insulin Inj	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002284		Latanoprost Drp 0.005%	250	209	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002287	87186	Latuda 40 Mg	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002288		Latuda 80 Mg	250	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002289		Laxative Suppository	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002290		Lecithin 120 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002293		Lescol 20 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002294		Lescol Xl 80mg	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002300	87621	Levaquin 250 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002301		Levaquin 500mg	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002303		Levbid ER 0.375mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002307	86709	Levemir Vl	250	519	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002316	85049	Levetiracetam 500 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002329		Levothroid .05 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002331		Levothroid 0.1 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002332		Levothroid 0.125	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002333		Levothroid 100 Mcg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002335		Levothroid 75mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002337		Levothyroid 25mcg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002340		Levothyroxine (Synthroid) 112m	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002346	83880	Levothyroxine 100 Mcg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002347	80164	Levothyroxine 125mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002348	87081	Levothyroxine 150 Mcg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002349	84154	Levothyroxine 175mcg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002351	80168	Levothyroxine 25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002352	80170	Levothyroxine 50 Mcg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002353	83655	Levothyroxine 75mcg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002354	87535	Levothyroxine 88 Mcg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002357		Levothyroxine Sod 150 Mcg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002365		Levoxyl 75 Mcg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002366	80061	Levthyroxine	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002367		Lexapro 10 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002369		Lexapro 20mg Tablet	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002372		Lexapro 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002379		Lidex .05% 15 Gu	250	269	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002384		Lidocaine 1% 20 ML	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002402		Lidoderm 5% Patch	250	263	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002404		Limbrel 500 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002408	J2020	Linezolid (Zyvox) 600mg Tab	250	453	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002409		Lioresal 10mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002418		Lipitor 10 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002419		Lipitor 20 Mg	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002420		Lipitor 40mg	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002421		Lipitor 80 Mg	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002424	80162	Lisinopril 10mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002425	82948	Lisinopril 2.5 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002426		Lisinopril 20 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002429		Lisinopril 40 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002430		Lisinopril 5mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002431		Lisinopril/Hctz 12.5	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002440		Lithium 300 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002443		Lithium Carbonate 150 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002446		Lithium Carbonate ER 450 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002449		Lodine 500 Mg	250	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002450		Lodosyn 25 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002452	83550	Lofibra	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002453		Lomotil 2.5 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002454	83525	Lomox Tablet	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002455		Loniten 2.5mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002459	82785	Loperamide Hci Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002460		Lopid 600 Mg	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002462		Lopressor 25mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002466		Loratadine 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002472		Lorazepam 0.5 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002476		Lorazepam 2mg/ML Inj 1ml	250	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002478	84146	Lorazepam Intensol 2 (30ml)	250	279	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002479		Lorazepam Tab : 1mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002483		Lortab 10/500 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002493		Lortab 7.5 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002498		Lortab-5	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002506	86403	Lotemax 0.55 Eye	250	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002508		Lotensin 10mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002514		Lotrel 10/20 Mg Capsule	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002516		Lotrel 5/10 Cap	250	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002518		Lotrimin 1% Cr. 30 Gm	250	189	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002520		Lotycin Oint 1gm	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002521		Lovastatin 10 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002522	80051	Lovastatin 20mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002527	84443	Lovaza 1 Gm	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002531		Lovenox 40mg	250	210	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002540		Loxitane 25mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002543		Lozol Tab 2.5mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002545	87522	Lubricant Eye Ointment	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002546		Lumigan Eye Drops	250	425	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002549		Lunesta 1 Mg	250	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002550		Lunesta 2 Mg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002551		Lunesta 3 Mg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002552	82575	Lyrica 100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002555		Lyrica 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002556	84681	Lyrica 300 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002560		Maalox 0	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002561		Maalox 30 Cc	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002562		Macrobid 100mg	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002564		Macrodantin 50 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002568		Mag Ox 400	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002576		Magnesium Citrate	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002581	86225	Magnesium Oxide 241	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002588		Mandelamne 1 Gm	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002595		Mavik 1 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002600		Maxzide 75/50	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002602		Meclizine 12.5 Mg	250	4.14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002603		Meclizine 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002606		Medrol Dose Pak	250	132	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002608	84133	Medroxyprogesterone 7	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002636		Megace Susp. 5ml	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002639		Megestrol Acetate 40 Mg	250	129	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002644		Melatonin 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002646		Melatonin 3mg Tab	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002650	82550	Meloxicam 7.5 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002660		Mephyton 5 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002674		Metaformin 500mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002678		Metamucil Pkt	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002685		Metformin 1000 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002687		Metformin 500 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002690	87210	Metformin 850 Mg	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002691	80201	Metformin HCL 500mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002699	86694	Methadone 5 Mg Tab	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002700	86689	Methadone HCL 10mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002703		Methenamine Mandelate 1 Gm	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002707		Methocarbamol (Robaxin) 500mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002709	85613	Methocarbamol 750 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002713	86778	Methotrexate 2.5mg Tab	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002714		Methotrexate 25mg	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002739		Metoclopramide 10mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002740		Metoclopramide 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002744		Metolazone 2.5 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002745	84702	Metolazone 5 Mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002749		Metoprolol 12.5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002750		Metoprolol 25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002753	85610	Metoprolol Succ	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002754		Metoprolol Succ ER 25 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002755		Metoprolol Succ ER 50 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002762		Metoprolol Tartrate Tab : 25mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002764		Metoprolol Xl 50mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002767	82232	Metronidazole 500mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002770		Mevacor 20 Mg	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002774		Miacalcin 200 U Dose	250	226	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002775		Miacalcin Nasal Spray 3.7	250	458	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002776		Miacalin 200u Dose	250	226	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002777	86765	Mi-Acid Gas	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002779		Micardis 40 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002788	84155	Micro-K 8 Meq Extenca	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002797	87205	Midorine HCL 5 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002799		Migrazone Capsules	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002803		Milk of Magnesia 30 Cc	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002806		Mineral Oil 30 Cc	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002811		Minocin 100mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002815	84999	Minoxidil 10 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002820		Miralax Packet	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002821		Miralex 255 Gm	250	154	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002825		Mirapex 0.5 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002829		Mirtazapine 15 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002830		Mirtazapine 30 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002832		Mirtazapine 7.5 Mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002837	83661	Moban 25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002838		Moban 50 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002840		Mobic 7.5 Mg	250	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002845	86000	Moexpril HCL 15mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002849		Mometasone 0.1% Cream 15 Gr	250	226	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002850		Monistat 7 Vag Supp	250	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002852		Monopril 20mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002868	82106	Morphine Sulf ER 30	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002871		Motrin 120ml	250	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002872		Motrin 600mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002873		Motrin Susp 5ml	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002877		Ms Contin 30 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002881		Mucinex 600 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002888	85379	Multigen Plus Caplet	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002894		Multivitamin With Mineral	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002898		Murine Tears Plus	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002909		Mylicon 80	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002912	84233	Mysoline 50mg Tab	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002914		Nabumetone 500mg Tab	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002915		Nabumetone 750 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002920		Nacl 4 Meq/ML 250 ML	250	266	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002922	86301	Nadolol 20 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002931		Namenda 10mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002932		Namenda 5 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002940		Naphcon-A 5ml	250	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002946		Naproxen 250 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002948		Naproxen 500 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002952	78267	Naproxen Sod	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002957		Nasacort Aq	250	424	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002960		Nasal Solutions	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002961	83010	Nasalcrom 4% Spray	250	107	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002962		Nasonex Nasal Spray	250	557	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002965	86336	Nature Tear Drops	250	46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002967		Navane 5 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002968	85651	Nb Valerian Root	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002978	82044	Neo/Polymyxin/Hc Ear 10ml	250	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002989		Neosporin Ung Pk	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002993		Nep-Synephrine 1%	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25002998		Neurontin 100mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003000		Neurontin 300 Mg	250	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003007		Nexium 20 Mg	250	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003008		Nexium 40 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003009	84478	Niacin 250 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003013	85007	Niaspin 1,000 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003016		Nicoderm Patch 21mg	250	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003023		Nicotine Patch 14mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003024		Nicotine Patch 21 Mg	250	18.75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003025		Nicotine Patch 7 Mg	250	12.63	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003027		Nifediac Cc 60 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003029		Nifedipine 15 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003030	83721	Nifedipine 60mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003032		Nifedipine ER 30 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003034		Nifedipine ER 90 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003035		Niferex 150mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003036		Nilandon 150 Mg	250	143	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003039		Nirovam 0.25 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003044		Nitro Dur 0.4mg	250	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003046		Nitro Tab 0.4 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003047	86022	Nitro Transderm 0.2 M	250	194	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003055		Nitrofurantoin Mono. 100mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003058	82150	Nitrofurantoin-Macro 7	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003065		Nitroglycerin Patch T 0.2	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003068		Nitroglycerin ST 6.5	250	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003079		Nitroquick	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003080		Nitrostat 0.4mg/25	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003081	82627	Nizatidine 150 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003082		Nolvadex 10 Mg	250	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003084		Norco 10/325 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003086		Norco 5/325 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003092		Norpramin 25mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003094		Nortriptyline 50 Mg	250	4.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003097		Norvasac 5mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003098		Norvasc 10mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003099		Norvasc 2.5 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003102		Novolin 70/30	250	75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003105	85220	Novolin N 100/U/ML	250	123	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003107	83935	Novolin R 100 Units	250	271	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003114		Novolog Mix 70/30	250	368	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003129		Nuedexta 10/5 Mg	250	46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003130		Nuedexta 20/10	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003141		Nystatin Cream 15gm	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003144	86903	Nystatin Oral Susp 75ml	250	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003146		Nystatin Powder 30 Gms	250	155	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003159		Occuvite	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003168		Ogen 1.25 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003170		Olanzapine (Zyprexa) 10mg Inj	250	142	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003171		Olanzapine (Zyprexa) 5mg Tab	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003188		Omacor 1 Gm	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003189		Omega 3fa 1000mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003190	80152	Omega-3 Fish Oil	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003192		Omeprazole 20mg Caps	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003194		Omnicef 300mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003200	87425	Ondansetron HCL 4 Mg	250	86	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003202	80202	One A Day	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003204	84520	One-A-Day Mens	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003207	89320	Opana ER 10 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003212		Orabase-B 20% Paste	250	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003213		Orajel	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003214		Orap 2 Mg	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003217	86781	Orphenadrine ER 100 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003221		Os Cal 500d	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003226	82436	Osteo Bi Flex	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003229		Oxandrin 2 Mg	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003232		Oxazepam Cap : 10mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003233	82105	Oxazepam Cap : 15mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003235	80101	Oxcarbazepine 150mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003238		Oxybutynin (Ditropan Xl) 5mg T	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003240		Oxybutynin 10 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003243		Oxybutynin Choloride 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003253	85240	Oxycodone HCL 40 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003263		Oxytrol Patch	250	75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003265		Oyster Shell Calcium	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003269		Pain Reliever Tab 325mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003273		Pancrease Ec Caps	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003284		Pantroprazol 40 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003285	80188	Paoxetine HCL 40mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003290		Parcopa 25/100 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003295		Parlodel 2.5 Mg	250	46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003300		Paroxetine HCL 10mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003301		Paroxetine HCL 20 Mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003302		Paroxetine HCL 30 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003309		Patanol Opth Soln 0.1% 5ml	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003310		Paxil 10 Mg	250	14.37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003311		Paxil 20 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003313		Paxil 40 Mg	250	7.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003316		Paxil Cr 12.5	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003317		Paxil Cr 25 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003318		Paxil Mcr 37.5	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003319		Pc Tar 6 Oz. Shampoo	250	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003324		Pehnytoin Na Extended 100 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003331		Penicillin Vk 250mg Tab	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003339		Pentoxifyllin 400mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003340		Pepcid Complete	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003354		Periactin 4 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003355		Peridex 473ml Sol	250	179	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003358		Perparation-H Ointment	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003360		Perphenazine	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003364		Perphenazine 4 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003372		Phenazopyridine 200 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003373		Phenazopyridine HCL 100mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003374		Phenazopyrodome 100m	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003375		Phenergan 25mg/1cc	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003382		Phenergan Supp	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003384		Phenobarb 30 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003385		Phenobarbital 15mg Pd	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003403		Phenytek 300mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003408		Phenytoin 125mg/5 M237	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003413		Phoslo 667mg Gelcap	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003419	87206	Pindolol 10 Mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003420		Pindolol Tab : 5mg	250	4.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003431		Plaquenil 200mg	250	44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003434		Plavix 75mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003437		Pletac 50mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003438		Pletal 100mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003442		Pneumovac 23 Vaccine	250	224	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003446	80158	Polyethylene Glycol 255	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003449		Potass Cl Meq	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003451		Potassium 20mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003456		Potassium Ch 10meq	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003479		Potassium Cl 10% Liq 105 ML	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003488	87220	Pradaxa 150 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003501		Pravachol 10mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003502		Pravachol 20 Mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003503		Pravachol 40 Mg	250	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003511		Prazosin 1 Mg	250	12.81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003515		Precose 50mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003518	83930	Prednisolone Acetate	250	122	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003520		Prednisolone Opth 1% 5ml	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003523		Prednisone 10 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003527		Prednisone 20mg Tab	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003537		Prelone 5mg/ML	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003540		Premarin 0.45 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003541		Premarin 0.625 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003542		Premarin 1.25 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003544		Premarin Vag Cream	250	167	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003546		Prenatal Vitamin	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003550	83001	Preservision Softgel	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003551		Prevacid 15mg	250	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003552		Prevacid 30mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003554	82330	Prevastatin Sod	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003559		Primidone 250 Mg Tablet	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003561		Prinivil 2.5 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003562		Prisolec Otc	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003564	80048	Pristiq 50 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003566	82784	Proair Hfa 90mcg Inh 8.50 Gm	250	200	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003574		Procardia Xl 30 Mg 1 Tab	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003575	80196	Procardia Xl 60 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003578	Q0164	Prochlorperazine (Compazine) 5	250	2.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003579		Prochlorperazine Supp 25mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003580		Procrit 10,000 Units	250	1002	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003581		Procrit 20,000 U/ML	250	1815	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003582		Procrit 2000 U/ML 6-1ml	250	90	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003583		Procrit 3,000 Unites/ML	250	278	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003585		Procrit Epoetin Alfa 4000	250	278	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003588	86901	Proctozone-Hc 2.5 Cream	250	137	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003593		Promethazine 25mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003598		Promethazine Supp	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003600		Promethegan 25 Mg Supp.	250	44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003607		Propoxyphene N Apap 100/650	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003610		Propranolol 10 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003611		Propranolol 40 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003622		Proscar 5 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003625	86920	Prostate Formula	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003628		Protocream Hc 30gm	250	440	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003629		Protonix 20 Mg	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003631		Protonix 40mg Tab	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003633		Provera 5 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003635		Provigil 200 Mg	250	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003636	82491	Proxy-N/Apap 100	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003637		Prozac 10 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003638		Prozac 20 Mg	250	78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003642		Prozac Weekly 90 Mg	250	345	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003650		Pulmicort 0.5 Mg	250	126	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003660		Pyridoxine 100mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003662		Qualfenesin Dm 10cc	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003666		Questran Pckt 9g	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003678		Quinapril 10mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003679		Quinapril 20mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003680	83520	Quinapril 40 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003684		Quinidine 200mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003693		Quintine Sulfate 260m	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003695	82746	Qvar 80 Mcg Inhaler	250	516	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003705	82941	Ramipril 2.5 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003706	82507	Ramipril 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003707	87116	Rampipril 10 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003709		Ranexa 500 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003715		Ranitidine Tab : 150mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003718		Rapamune 1 Mg	250	167	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003720		Razadyne 12 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003723		Razadyne 8 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003724		Recaltrol 0.25 Mcg	250	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003725		Refresh Eye Drops	250	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003729		Relafen 500 Mg	250	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003730	82103	Reliable Gentle Laxative	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003731		Remeron 15 Mg	250	73	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003732		Remeron 30 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003734		Remeron 7.5 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003735		Remifemin Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003736		Reminyl 12mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003744		Requip .25 Mg	250	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003747		Requip 1mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003755	87340	Restasis 0.05% Eye Emulsion	250	179	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003757		Restoril 15mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003759		Restoril 7.5 Mg	250	14.37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003761		Rezadyne 4mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003762		Rhinocort Agua	250	378	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003774		Risperdal Lig 30 ML	250	932	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003775		Risperdal 0.25 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003776		Risperdal 0.5mg Tab	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003778		Risperdal 1mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003780		Risperdal 2 Mg	250	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003781		Risperdal 3 Mg	250	54	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003782		Risperdal 4 Mg	250	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003785		Risperdal Consta 25mg	250	946	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003789	85060	Risperdone 1mg/ML	250	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003790	82747	Risperidone .25 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003791	81099	Risperidone .5 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003792		Risperidone 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003796	87086	Risperidone 4 Mg	250	44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003798		Ritalan 5 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003813		Robitussin 5ml	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003814		Robitussin Dm	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003817		Rocaltrol 0.25mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003820		Rocephin 500mg Vial	250	152	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003822	36415	Ropinirol 0.5 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003825		Ropinirole .25mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003827		Ropinirole HCL	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003834		Rozerem 8mg	250	75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003835		Rythmol 150 Mg Tab	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003837		Saline Nasal Spray 1.5 Oz	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003846	84588	Sanctura XR 60mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003848	86886	Saphris 10 Mg	250	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003849	86850	Saphris 5 Mg	250	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003851	83625	Sb 12hr Nasal 0.5%	250	162	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003860		Senna 8.6mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003861		Senna Gen Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003862		Senna Plus	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003867		Sennalax-S Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003868		Senokot 187mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003871		Septra Ds	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003873		Serevent Disl Inh	250	548	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003874	82088	Seroguel 400 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003875		Seroquel 100 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003878		Seroquel 200mg Tablet	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003879		Seroquel 25 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003880		Seroquel 300 Mg	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003882	80069	Seroquel 50mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003893	82553	Sertraline HCL 100 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003894	82552	Sertraline HCL 25 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003895	80102	Sertraline Hyc 50 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003896		Serzone 100mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003898		Sherrous Sulfate Ltq	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003899		Shopax 100 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003914		Simvastatin 20 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003915	80055	Simvastatin 40 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003918		Sinemet 10/100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003920		Sinemet 25/100	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003921		Sinemet 25/250	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003923		Sinemet Cr 50/200	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003925		Singulair 10 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003928		Skelaxin 800mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003929		Slo-Niacin 250mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003930		Slow Fe 160mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003932		Slow K-8 Meq	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003933	86738	Slow Mag 64 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003934	85384	Smz/Tmp Ds 800/160 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003945		Sodium Bicarnonate 10gr	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003947		Sodium Chloride	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003974		Solu Medrol 125 Mg Vial	250	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003978		Sonata 10mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003979		Sonata 5mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003988	80182	Spiriva 18mcg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003990		Spiriva Handihaler	250	429	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003992		Spiriva Refill	250	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003993		Spirono/Hctz 2/25	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003997		Spironolactone 25 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25003998		Spironolactone 50 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004000		Sporanox 25mg Inj	250	660	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004005		Ssystane Eye Drops	250	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004006	84466	ST John's Wart	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004012		Starlix 120mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004014		Starttera 40 Mg	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004020	82670	Stomahesive Paste 60gm	250	129	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004021		Stool Softner	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004022		Strattera 25 Mg	250	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004024		Stress W/Zinc	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004029		Sucralfate 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004042	82055	Sulfamethoxazole/Tmp	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004047	86860	Sulindac Tab : 150mg	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004052	84144	Sumatriptan Succ	250	101	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004056	84120	Super Thera Vite Mt	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004059		Sustane Lubricant Eye Drops	250	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004061	86922	Symbicort 80 4.5	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004063	82390	Symbyax 6/25mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004064		Symmetrel 100mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004066		Symmetrel 50 Mg/5ml	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004068		Synthroid .05 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004069		Synthroid .2 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004071		Synthroid 0.075 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004072		Synthroid 0.125mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004075		Synthroid 0.1mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004090		Tamoxifen 10mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004097		Tapazole 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004098		Tarka 2/240	250	50	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004102	84300	Tbc Spray 113.40 ML	250	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004103		Tears Pure	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004106		Tegretol 200mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004112		Tekurna 150 Mg	250	40	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004117		Temazepam 15 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004118		Temazepam 30 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004123		Tenex 1 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004125		Tenormin 25mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004126		Tenormin 50mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004127		Terazosin	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004131		Terazosin 5mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004137	80100	Terbinafine HCL 250	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004143		Tessalon Perls 100 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004149	80200	Tetanus Toxoid Adsor 5ml	250	418	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004156		Theo-24 200 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004157		Theo-Dur 300mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004160	82570	Theophylline 300mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004163		Thera Tears Nutrition Tabs	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004164		Theragran M	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004165		Therapeutic M	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004167		Theravite Liquid 4oz	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004168		Thermotab	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004170	84100	Thiamin 100 Mg/ML V 2	250	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004171	84081	Thiamin 100 Mg/ML V8	250	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004172		Thiamin 50 Mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004174		Thiamine (Vit B1) 100mg Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004175		Thiamine 100 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004176		Thiamine 100 Mg/ML Inj	250	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004183		Thiothixene Cap : 5mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004188		Thyroid 2 Gr	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004189		Thyroid 30 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004190		Thyroid 60 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004191		Thyroid Tab : 1grain	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004199	86430	Tikosyn 250 Mcg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004203	86325	Timolol 0.5% Eye Drops	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004209		Timoptic .5% 5ml	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004213		Tizanidine 2 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004229		Tofranil 25mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004230		Tofranil 50mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004236		Topamax 100 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004244	85002	Topiramate 100 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004247		Toprol Xl	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004253		Torsemide 10 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004254		Torsemide 20 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004264		Tramadol 50mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004265	80184	Tramadol HCL /Acet	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004267		Tramadol HCL Tab 50 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004269		Tramadol/Apap 37.5/325 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004275		Tranxene 3.75 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004277		Traqzadone HCL	250	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004279		Travatan 0.004% Eye Drops	250	323	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004282		Trazadone 150 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004283		Trazadone HCL	250	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004285		Trazodone 100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004287		Trazodone 20 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004289		Trazodone 25 Mg	250	12.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004290		Trazodone 50 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004292	86308	Trental 400mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004297		Triamcinolone Cr .1 80gm	250	118	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004300	85097	Triamter/Hctz 37.5	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004301		Triamterene Hctz 37.5/25	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004302		Triamterene Hctz 75/50	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004305		Tricor 145mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004309		Trifluoperazine 2mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004313		Trihexyphenidyl 5 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004319		Trileptal 300 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004324	86704	Trilipix 45 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004327		Trimethobenzamide 200mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004331		Trimethsulfa 160/800	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004332		Trimpex 100 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004335		Triple Antibiiotic Oint 15 Gr	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004349		Tums 750 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004353		Tussin Cough 8oz	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004354		Tussin Dm 8 Oz	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004358		Tylenol	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004361		Tylenol 325 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004363		Tylenol 650 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004364	82140	Tylenol Ex Str 500 Mg (84 Tabs	250	37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004367		Tylenol W/Codine #3	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004370	87040	Uloric 40 Mg	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004372		Ultracet 37.5/325	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004373		Ultram 50mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004374		Uniphyl 400mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004375		Uniretic 15 Mg/25 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004376		Univasc 15mg	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004378		Urecholine 25mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004386		Uroxatral 10mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004389	82728	Ursodiol 300 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004413		Valprotic Acid 250 Mg	250	129	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004421	87324	Valturna 300-320 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004422		Vanamide Cream 8.5 Gm	250	299	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004433		Vantin 200 Mg	250	54	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004437		Vasotec 10mg	250	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004438		Vasotec 5mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004443		Venlafaxine (Effexor) 75mg Cap	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004444	85302	Venlafaxine HCL 37.5 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004445	82947	Venlafaxine HCL 75mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004447		Ventol Ud 0.083%	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004448		Ventolin 0.5 ML	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004449		Ventolin 17mg Inh	250	252	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004452		Ventonlin 1gm Inhaler	250	504	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004455	82248	Verapamil 180 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004467		Vesicare 5mg	250	96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004469		Viactiv Chew Tab	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004473		Vicon C	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004478	86684	Vigamox Drops	250	192	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004486		Visken 5mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004488		Vistaril 25mg	250	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004492		Vitamin A	250	16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004499		Vitamin B-1	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004502		Vitamin B-12 1000 Mc	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004503		Vitamin B12 1000 Mcg Tablet	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004504		Vitamin B12 1000 Mcg/ML	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004511	82607	Vitamin B6 100 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004515		Vitamin C 500 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004516		Vitamin D 1000 Units-Tablet	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004517		Vitamin D 400 U	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004525		Vitamin E 400 Unit Cap	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004536	86665	Volaren 1% Gel	250	222	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004538		Voltaren 75mg	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004541		Vytorin 10/10 Mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004542		Vytorin 10/20 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004554	85013	Warfarin 6 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004555		Warfarin Sod 1mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004556		Warfarin Sod 2.5 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004557		Warfarin Sod 3 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004558		Warfarin Sod 4mg	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004559		Warfarin Sod 5 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004561	85540	Warfarin Sodium 7.5mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004562		Water 45 M	250	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004563		Welchol 625 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004564		Wellbutrin 300 Mg	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004567		Wellbutrin Xl 150mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004570		Women's One A Day	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004571		Xalatan Ophth Solution	250	368	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004573		Xanax 0.25 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004574		Xanax 0.5 Mg	250	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004575	87800	Xarelto 10 Mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004581		Xifaxan 550 Mg	250	141	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004583		Xopenex 1.25 Mg/10.5 ML	250	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004586		Xopenex Inh Sol'n 0.63 Mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004588		Xylocaine 1% 20ml	250	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004591		Z0cor 20mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004595	84560	Zaleplon 10 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004596		Zanaflex 4mg	250	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004597		Zantac 150 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004598		Zaroxalyn 5mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004599	87590	Zaroxolyn 2.5 Mg	250	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004600		Zegerid 40mg Osus Pw	250	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004601		Zelform 6 Mg	250	37	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004602		Zelnorm 2 Mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004605		Zestril 10 Mg	250	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004606		Zestril 20mg	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004607		Zestril 5mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004608		Zetia 10 Mg	250	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004610		Ziac 5 Mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004614		Zinc 50mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004616	83497	Zinc Gluconate	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004620	86140	Zinc Sulfate 220 Mg	250	4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004629		Zithromax 250 Mg	250	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004631		Zocor 10 Mg	250	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004633		Zocor 40mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004634		Zocor 80 Mg	250	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004636		Zofran 4mg Tab	250	158	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004641		Zoloft 100 Mg	250	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004644		Zoloft 25 Mg	250	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004645		Zoloft 50mg	250	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004649		Zolpidem 10 Mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004653	84075	Zolpidem Tartrate	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004654		Zonegran 100 Mg	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004657		Zonisamide 100mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004660		Zovirax	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004664	83540	Zylet 5ml Opth Sol	250	264	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004665		Zyloprim 100mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004666		Zyloprim 300mg	250	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004669		Zyprexa 10mg	250	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004670		Zyprexa 10mg/ML (Injec)	250	163	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004671		Zyprexa 15mg	250	84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004672		Zyprexa 2.5 Mg	250	48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004674		Zyprexa 5 Mg	250	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004676		Zyprexa 7.5 Mg	250	61	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004677		Zyprexa Zydis 10 Mg	250	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004678		Zyprexa Zydis 15mg	250	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004681		Zyprexa Zydis 5mg	250	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004682		Zyprexia 10mg	250	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004683		Zyrtec 10mg	250	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004684		Zyrtec 5mg	250	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004711		Norvasc 5 Mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004714		Aripiprazole 2 Mg	250	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004715		Nbl Balance B 100 Tab	250	2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004739		Simbrinza Eye Drops	250	631	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004742		Breo Ellipta Inh 100/25	250	406.15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004751		Kaopectate 30 Cc	250	3.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004752		Tolterodine Tart ER 4 Mg	250	25	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004753		Durezol Opth Emulsn 0.05%	250	728	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004754		Toujeo Insulin 1 Unit	250	1.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004766		Rivastigmine 4.6 Patch	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004767		Rivastigmine 9.5 Patch	250	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004768		Vraylar 3 Mg	250	167	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004802		Janumet 50/500 Mg	250	25.71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004833		Eliquis 2.5 Mg Tab. (Apixaban)	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004841		Namzaric 14/10 Mg	250	63	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004849		Breo Ellipta 200/25 Mcg Inh	250	1538	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004892		Namzaric 28/10 Mg	250	63	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004911		Entresto 24-26 Mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004921		Trintellix 10 Mg	250	45.3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004929		Albuterol 2.5mg Hhn	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004930		Amiodarone HCL 100mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004931		Arginaid Powder	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004932		Breo Ellipta 100/25mcg (Puff)	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004933		Bydueron 2mg (Dose)	250	525	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004934		Bydueron 2mg (Pen)	250	1992.4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004935		Carafate 100mg/1ml	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004936		Clotrimazole 1% Per App	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004937		Clotrimazole 1% Tube	250	111	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004938		Coban	250	10.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004939		Debrox Solution 6.5% (Bottle)	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004940		Debrox Solution 6.5% (Drop)	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004941		Descovy 200 25 Mg	250	192	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004942		Diltiazem ER 300mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004943		Estradiol 0.1% (Treatment)	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004944		Estradiol 0.1% Cream (Tube)	250	291.18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004945		Estroven 1 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004946		Lamicatal 200 Mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004947		Lisinopril 15 Mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004948		Megace 100 ML Bottle	250	51.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004949		Demeclocycline 300 Mg	250	33.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004950		Metoprolol Tartate 150mg	250	7.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004951		Metoprolol Tartate 200mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004952		Metoprolol 100 Mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004953		Metronidazole 0.75% (Appl)	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004954		Metronidazole 0.75% (Tube)	250	165.7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004955		Mylanta 30ml (Bottle)	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004956		Mylanta 30ml (Dose)	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004957		Nebivolol 10mg	250	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004958		Pataday 2% (Bottle)	250	594	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004959		Pataday 2% (Drop)	250	19.8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004960		Phenobarbital 64.8 Mg	250	3.75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004961		Potassium 10mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004962		Potassium 40mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004963		Potassium Cl 10% 20 Meq/15ml	250	11.7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004964		Prasugrel HCL 10mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004965		Primidone 150mg	250	10.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004966		Propranolol 20mg	250	4.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004967		Requip 3mg	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004968		Salagen 5mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004969		Synthroid 0.25 Mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004970		Tivicay 50 Mg	250	195	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004971		Toprol 100mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004972		Torsemide 40mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004973		Tresiba (Unit)	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004974		Vitamin D-3 5000mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004975		Vitiamin D 600 Mg	250	3	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004976		Warfarin 40mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004977		Wellbutrin Sr 200mg	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004978		Zocor 20mg	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004979		Zocor 5mg	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004980		Zoloft 200mg	250	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004981		Zonisamide 75mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004982		Naproxen 220mg	250	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004983		Sinemet 50/200mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004986		Vitrase (Hyaluronidase)	250	540	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004987		Lice Treatment 1% Cream Rinse	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004988		Tandem Plus Capsule	250	6.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004989		Memantin HCL ER 21 Mg	250	18.4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004990		Docusate Sodium 240 ML Bottle	250	28.28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004991		Vitamin B12-Folic Acid	250	2.8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004992		Latuda 10 Mg	250	99.91	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004993		Multilex	250	1.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004995		Fentanyl Patch 37.5 Mcg	250	202.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004996		Olopatadine HCL 0.2% Eye Drops	250	195.8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004997		Irbesartan 75 Mg	250	1.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004998		Ventolin Hfa 90 Mcg Inhaler	250	13.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25004999		Liothyronine Sod 50 Mcg	250	7.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005000		Lidocaine 1% Vial 50 ML	250	31.64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005001		Promethazine Syr 16 Oz	250	26.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005002		Warfarin 3.75 Mg	250	9.28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005003		Vraylar 1.5 Mg	250	188.88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005004		Ferrous Gluconate 324 Mg	250	1.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005005		Linzess 290 Mcg	250	63	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005006		Rosuvastatin Calcium 5 Mg	250	2.72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005007		Iron 100-Vitamin C	250	3.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005009		Depo Testosterone 200mg/1ml Vi	250	113.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005010		Memantin ER 14 Mg	250	18.4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005011		Liquitears 1.4%	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005013		Belbuca 75 Mcg	250	24.04	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005014		Belbuca 300 Mcg	250	37.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005022		Belbuca 150 Mcg	250	24.04	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005023		Viibryd 10 Mg	250	43.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005024		Memantin HCL ER 7 Mg	250	17.84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005025		Basaglar 100unit/ML Kwikpen	250	1548.76	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005026		Pentasa 500 Mg	250	29.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005027		Centratex	250	4.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005028		Amoxapine 100 Mg	250	11.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005029		Amoxapine 50 Mg	250	5.68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005030		Disulfiram 250 Mg	250	9.24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005031		Paliperidone ER 6 Mg	250	55.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005032		Rexulti 4 Mg	250	184.68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005033		Armodafinil 150 Mg	250	8.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005034		Lucemyra 0.18 Mg	250	148.72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005035		Citalopram 5 Mg	250	2.44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005036		Paliperidone ER 3 Mg	250	58.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005037		Venlafaxine HCL 100 Mg	250	1.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005038		Carbamazepine ER 300 Mg	250	8.52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005039		Armodafinil 250 Mg	250	6.88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005040		Ropinirole 3 Mg	250	3.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005041		Haloperidol Dec 50 Mg/ML	250	172.6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005047		Acidophilus Capsule	250	15.18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005048		Nuplazid 34 Mg	250	304.74	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005049		Bevespi Aeros 9-4.8 Mcg Hfa Ad	250	1108	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005050		Fetzima ER 20 Mg Capsule	250	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005051		Clorazepate 15mg Tablet	250	8.29	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005052		Tolterodine Tartrate 1mg Tab	250	5.4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005053		Aricept 15mg	250	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005054		Butalbital Acet 50-325 Mg	250	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005055		Precedex 200 W/Saline 100	250	447.24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005056		Precedex 4 Mcg/ML Vl 20x50 ML	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005057		Aptiom 800mg Tablet	250	122.61	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005058		Mirtazapine 22.5	250	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005059		Vortioxetine 20mg	250	70	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005060		Remeron 22.5 Mg	250	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005062		Famvir 500 Mg	250	75.39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005063		Coumadin 2 Mg	250	12.57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005064		Albuterol Sul Hfa 108mcg/Act	250	78.63	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005065		Chlorzoxazone 500 Mg	250	8.67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005066		Bactrium Ds 800mg/160	250	13.05	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005067		Trulicity 1.5mg/0.5ml	250	645.27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005068		Liothyronine Sodium 5mcg	250	3.42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005069		Carbidopal/Levodopa 25-100mg	250	12.78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005070		Ferrous Gluconate 240mg	250	6.21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005071		Prolixin 5mg	250	13.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005072		Namenda 28mg	250	13.68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005073		Risperadol Consta 50mg/2mls	250	3209.67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005074		Risperadol Consta 25mg/2mls	250	1610.73	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005075		Austedo 6mg Tab	250	338.84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005076		Austedo 9mg Tab	250	381.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005077		Janumet XR 100/1000	250	79.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005078		Janumet Xr50/1000	250	39.96	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	25005079		Capylta 42	250	227.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000002		Vancocin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000003		Symbyax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000004		Cymbalta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000005		Cymbalta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000006		Cymbalta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000007		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000008		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000009		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000010		Evista	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000011		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000012		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000013		ZyPREXA Zydis	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000014		Effient	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000015		HumaLOG	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000016		HumaLOG Mix 75-25	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000017		ZyPREXA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000018		Glucagon Emergency Kit	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000019		Capoten	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000020		Mycolog 15g	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000021		Hydrea	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000022		Eliquis	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000023		Eliquis	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000024		Prolixin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000025		Azactam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000026		Azactam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000027		Reyataz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000028		Reyataz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000029		Onglyza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000030		Onglyza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000031		Kombiglyze XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000032		PravachoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000033		KlonoPIN	250	6.12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000034		KlonoPIN	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000035		Cellcept	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000036		Cellcept	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000037		Cellcept	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000038		Demadex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000039		Tamiflu	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000040		Bactrim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000041		Bumex	250	1.8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000045		Fosamax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000046		Mephyton	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000047		Proscar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000048		Januvia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000049		Singulair	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000050		Januvia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000051		Isentress	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000052		Maxalt	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000053		Singulair	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000054		Januvia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000055		Hyzaar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000056		Zocor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000057		Mevacor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000058		Mevacor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000059		Zocor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000060		Zocor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000061		Hyzaar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000062		Hyzaar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000063		Fosamax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000064		Cozaar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000065		Cozaar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000066		Pepcid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000067		Isentress Hd	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000068		Timoptic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000069		Vasotec I.V.	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000070		PriMAXin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000071		Pepcid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000072		Timoptic-Xe	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000073		Cosopt	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000074		Cancidas	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000075		Cancidas	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000076		INVanz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000077		Pneumovax 23	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000078		Arixtra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000079		Compazine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000080		Coreg Cr	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000081		Dyazide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000082		Coreg	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000083		Coreg	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000084		Coreg	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000085		argatroban	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000086		Requip Xl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000087		Requip	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000088		Requip	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000089		Requip	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000090		Requip	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000091		Effexor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000092		Cordarone I.V.	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000093		Effexor XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000094		Protonix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000095		Protonix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000096		Protonix IV	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000097		Pristiq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000098		IsordiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000099		IsordiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000100		TygaciL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000101		Mirapex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000102		Mirapex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000103		Solu-CORTEF	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000104		Cortef	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000105		Solu-CORTEF	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000106		Medrol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000107		Xanax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000108		SOLU-MedroL	250	3.84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000109		Loniten	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000110		SOLU-MedroL	250	11.66	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000111		Colestid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000112		SOLU-MedroL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000113		DEPO-MedroL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000114		Cleocin Phosphate In D5w	250	41.86	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000115		Cleocin Phosphate In D5w	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000116		Cleocin Phosphate In D5w	250	51.14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000117		Glynase	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000118		DEPO-MedroL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000119		Corvert	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000121		Zyvox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000122		Linezolid In Dextrose 5%	250	14.26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000123		Detrol La	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000124		Detrol La	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000125		Aromasin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000126		Xalatan	250	538.18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000127		Stadol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000128		Ampicillin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000129		Ampicillin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000131		Acular	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000132		Lumigan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000134		Restasis	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000135		Alphagan P	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000136		Lumigan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000137		Combigan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000138		Alphagan P	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000139		Sanctura XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000140		Demerol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000141		diazePAM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000142		PrimaCOR IN 5% DEXTROSE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000144		Plaquenil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000145		verapamil HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000146		Ferrlecit	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000147		Multaq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000148		Ambien	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000149		Lomotil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000150		Aldactone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000151		Aldactone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000152		CeleBREX	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000153		CeleBREX	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000154		CeleBREX	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000155		Inspra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000156		FlagyL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000157		Calan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000158		Calan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000159		Calan Sr	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000160		Mycelex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000161		Avandia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000162		PaxiL CR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000163		PaxiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000164		PaxiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000165		Relafen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000166		Augmentin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000167		Augmentin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000168		Reglan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000169		Reglan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000170		Robitussin A-C	250	1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000171		Creon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000172		Rowasa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000173		MS Contin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000174		MS Contin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000175		Soma	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000176		Demadex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000177		Zestoretic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000178		Claforan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000179		TRENtaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000180		AmaryL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000181		AmaryL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000182		Rythmol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000183		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000184		Children's Motrin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000185		Parafon Forte Dsc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000186		Topamax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000187		Topamax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000188		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000189		Fluor-I-Strip at	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000190		Premarin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000191		Premarin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000192		Premarin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000193		Unasyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000194		Unasyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000195		Eraxis (Water Diluent)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000196		Glucotrol XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000197		Glucotrol XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000198		Cardura	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000199		Cardura	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000200		Cardura	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000201		Vfend	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000202		Vfend IV	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000203		Diflucan IN SALINE	250	375.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000204		Diflucan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000205		Geodon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000206		Geodon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000207		Geodon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000208		Geodon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000209		Geodon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000210		Zoloft	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000211		Zoloft	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000212		Marinol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000213		Remeron	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000214		Remeron	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000215		Remeron	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000216		Norcuron	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000217		Albuminar-5	250	216	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000218		calcitrioL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000219		Flecainide Acetate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000220		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000221		cilostazoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000222		Zidovudine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000223		Sodium Polystyrene Sulfonate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000224		morphine SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000225		lithium carbonate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000226		lidocaine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000227		dexAMETHasone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000228		dexAMETHasone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000229		Dolophine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000230		Dolophine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000231		megestroL ACETATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000232		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000233		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000234		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000235		azaTHIOprine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000236		Lactulose	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000237		lithium carbonate	250	0.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000239		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000240		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000241		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000242		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000243		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000244		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000245		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000246		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000247		Coumadin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000248		Sustiva	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000249		Sinemet CR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000250		Sinemet CR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000251		Sinemet-25/100	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000252		Xenaderm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000253		Santyl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000255		Betoptic S	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000256		Travatan Z	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000257		PatanoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000258		Pataday	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000259		Azopt	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000261		Maxitrol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000262		Tobrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000263		Tobradex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000264		Tobradex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000266		Vigamox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000267		Simbrinza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000268		Ciprodex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000269		Benefiber	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000271		Transderm-Scop	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000273		Voltaren	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000274		Hiprex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000275		Flumazenil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000276		Sutent	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000277		Xeljanz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000278		Norvasc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000279		Norvasc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000280		Procardia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000281		Procardia XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000282		Procardia XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000283		Procardia XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000284		Zithromax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000285		Zithromax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000286		Revatio	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000287		Viagra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000288		Viagra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000289		VistariL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000290		VistariL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000291		Dilantin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000292		Lipitor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000293		Lipitor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000294		Lipitor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000295		Dilantin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000296		Nitrostat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000297		Neurontin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000298		Lopid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000299		Neurontin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000300		Lyrica	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000301		Lyrica	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000302		Lyrica	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000303		Lyrica	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000304		Tucks	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000305		Dilantin-125	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000306		Cerebyx	250	172.66	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000307		naloxone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000308		heparin LOCK FLUSH	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000309		Phenytoin Sodium	250	1.26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000310		Isuprel	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000311		Levophed Bitartrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000312		Depacon	250	76.12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000313		Zemplar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000314		Norvir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000315		thiamine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000316		Mavik	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000317		Dilaudid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000318		Dobutamine HCL In Dextrose 5 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000319		Dilaudid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000320		Biaxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000321		Cardizem LA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000322		Niaspan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000323		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000324		Omnicef	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000325		Omnicef	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000326		Hytrin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000327		Potassium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000328		Kaletra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000329		Water for Injection,sterile	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000330		Aminosyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000331		Zemplar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000332		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000333		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000334		EPINEPHrine	250	19.7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000335		Depakene	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000336		Depakote Sprinkle	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000337		Tricor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000338		Depakote	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000339		Depakote	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000340		Depakote	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000341		Ery-Tab	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000342		E.e.s. 400	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000343		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000344		Norvir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000345		Kaletra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000346		Oretic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000347		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000348		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000349		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000350		Dextrose In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000351		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000352		Heparin Sodium (porcine)/D5W	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000353		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000355		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000356		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000357		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000358		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000359		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000360		Lozol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000361		Nasacort Aq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000362		Ddavp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000363		Ddavp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000364		Lovenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000365		Miacalcin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000367		SandoSTATIN	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000368		NeoraL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000369		Femara	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000370		Diovan HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000371		Diovan HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000372		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000373		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000374		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000375		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000376		TrileptaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000377		Starlix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000378		Starlix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000379		Lescol Xl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000380		Diovan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000381		Diovan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000382		Lotrel	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000383		Lotrel	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000384		Diovan HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000385		Myfortic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000386		Lotrel	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000387		Enablex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000388		Diovan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000389		Gleevec	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000390		Ritalin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000391		Ritalin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000392		Lopressor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000393		Aredia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000394		Tekturna	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000395		Tekturna	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000396		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000397		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000398		Exelon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000399		TEGretoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000400		TEGretol XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000401		Gilenya	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000402		Entresto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000403		Rydapt	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000404		Entresto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000405		Lotensin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000406		Normodyne	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000407		Normodyne	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000408		Eulexin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000409		Diprolene	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000410		Lotrisone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000411		Trilafon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000412		Intron A	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000413		Claritin-D 24 HOUR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000414		Imdur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000415		Cipro I.V.	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000416		Cipro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000417		Cipro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000418		Imdur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000419		Nitro-Dur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000420		Nitro-Dur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000421		Nitro-Dur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000422		Nitro-Dur	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000423		Dulera	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000424		Dulera	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000427		K-Lyte-Cl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000428		DesyreL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000429		Avapro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000430		Avapro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000431		Glucophage XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000432		Glucophage	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000433		Glucovance	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000434		Copaxone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000435		Ditropan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000436		Cardizem CD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000437		Cardizem CD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000438		Arava	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000439		Lantus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000440		Apidra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000441		Theolair-Sr	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000442		Robaxin-750	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000443		traMADoL HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000444		Naproxen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000445		Acetaminophen With Codeine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000446		Venlafaxine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000447		buPROPion HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000448		Carbidopa/Levodopa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000449		traZODone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000450		calcitrioL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000451		niCARdipine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000452		Ketoconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000453		Lisinopril/Hydrochlorothiazide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000454		Lisinopril/Hydrochlorothiazide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000455		Gabapentin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000456		FLUoxetine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000457		Sucralfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000458		Amoxicillin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000459		clindamycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000460		cefaDROXiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000461		Prazosin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000462		levalbuterol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000463		Amoxicillin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000464		cephALEXin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000465		Bumetanide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000466		Citalopram Hydrobromide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000467		LORazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000468		Ampicillin Trihydrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000469		busPIRone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000470		Glyburide/Metformin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000471		FLUoxetine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000472		Azithromycin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000473		metOLazone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000474		cilostazoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000475		ramipriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000476		Mexiletine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000477		Mexiletine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000478		Acyclovir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000479		Lortab	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000480		Terbutaline Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000482		Lactulose	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000484		Sucralfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000487		megestroL ACETATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000488		Vimpat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000489		Vimpat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000490		Vimpat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000491		Vimpat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000499		Valium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000500		lisinopriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000501		Trihexyphenidyl HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000502		Trihexyphenidyl HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000503		niCARdipine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000504		Phenytoin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000506		ActoneL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000507		Macrobid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000509		Triamcinolone Acetonide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000510		Triamcinolone Acetonide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000511		Triamcinolone Acetonide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000512		Bacitracin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000513		Betamethasone Valerate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000514		gentamicin SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000516		Betamethasone Dipropionate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000517		Fluocinolone Acetonide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000519		Neomycin/Polymyxin B/Dexametha	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000520		Prandin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000524		NovoLOG Mix 70-30	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000525		Levemir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000526		NovoLOG Mix 70-30 FlexPen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000527		Tetracycline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000528		Oxazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000529		hydroCHLOROthiazide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000530		Fluconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000531		Cortisporin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000532		Digibind	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000533		Lanoxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000534		Lanoxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000535		Lanoxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000536		Lanoxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000537		Fortaz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000538		Fortaz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000539		Ceftin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000540		Zofran	250	26.92	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000541		Flonase	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000542		Valtrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000543		Zofran Odt	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000544		Combivir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000545		LaMICtaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000546		LaMICtaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000547		LaMICtaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000548		LaMICtaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000549		Ziagen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000550		Ventolin Hfa 18g	250	136.84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000551		Advair DISKUS	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000552		Advair DISKUS	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000553		Advair DISKUS	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000554		Avodart	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000555		Flovent HFA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000556		LaMICtaL XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000557		Lovaza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000558		Votrient	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000559		Anoro Ellipta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000560		Valtrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000561		Zovirax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000562		Wellbutrin SR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000563		Zovirax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000566		Citracal + D	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000569		chlorproMAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000570		Pyridoxine HCL (Vitamin B6)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000571		hydrALAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000572		hydroCHLOROthiazide	250	0.28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000573		methocarbamoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000574		Isosorbide Dinitrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000575		penicillin V POTASSIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000576		Cdp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000577		haloperidoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000578		Loxapine Succinate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000580		NIFEdipine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000581		minoxidiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000582		Hyoscyamine Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000583		HYDROcodone/acetaminophen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000584		megestroL ACETATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000589		methIMAzole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000590		Atacand	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000591		Atacand	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000592		Xylocaine Viscous	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000593		Symbicort	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000594		Symbicort	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000595		DOPamine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000596		Brilinta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000597		Brilinta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000598		Pulmicort Flexhaler	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000599		Pulmicort Flexhaler	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000600		Emla	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000601		Pulmicort	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000602		Pulmicort	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000603		NexIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000605		Zovirax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000606		Mestinon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000607		Ancobon	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000608		Zosyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000609		Zosyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000610		Zosyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000611		hydrOXYzine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000612		Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000613		Oxymetazoline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000614		Procainamide HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000615		diphenhydrAMINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000616		Diclofenac Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000617		Hibiclens	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000618		Amlactin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000619		Klor-Con	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000620		Prevalite	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000621		Klor-Con 10	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000622		Klor-Con M20	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000625		midodrine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000626		midodrine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000628		Nephrocaps	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000629		Procalamine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000630		Meropenem-0.9% Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000631		mannitoL	250	71.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000632		Dextrose 10 % and 0.45 % Nacl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000633		Nitro-Bid 1g	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000634		Nitro-Bid 30g	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000635		Prevacid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000636		Tenormin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000637		ZestriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000638		Arimidex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000639		SEROqueL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000640		SEROqueL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000641		SEROqueL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000642		SEROqueL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000643		SEROqueL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000644		SEROquel XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000645		SEROquel XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000646		Diprivan	250	1.86	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000647		Diprivan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000648		Merrem	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000649		Accolate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000650		Casodex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000651		Crestor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000652		Crestor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000653		Lokelma	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000654		Movantik	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000655		Farxiga	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000656		Xigduo XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000657		Bydureon Pen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000658		Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000659		Dextrose 5 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000660		Dextrose 5 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000661		Dextrose 5 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000662		Dextrose 10 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000663		Dextrose 20 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000665		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000667		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000668		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000669		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000670		Sodium Chloride 3 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000671		Dextrose 5 %-0.2 % Sod Chlorid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000672		Norepinephrine Bitartrate/D5w	250	84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000673		Dextrose 5 % In Ringer's	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000674		Ringer's Solution,lactated	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000675		Lidocaine HCL/Dextrose 5 %/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000676		Intralipid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000677		Gentamicin In Nacl, Iso-Osm	250	8.78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000678		Gentamicin In Nacl, Iso-Osm	250	9.4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000679		Gentamicin In Nacl, Iso-Osm	250	8.42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000680		Gentamicin In Nacl, Iso-Osm	250	9.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000681		Intralipid	250	83.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000682		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000683		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000685		TravasoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000686		acetic acid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000687		Potassium Chloride/D5-0.45nacl	250	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000688		Potassium Chloride In D5w	250	22.54	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000689		Potassium Chloride In 0.9%nacl	250	24.22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000690		Potassium Chloride 20 mEq / Wa	250	9	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000691		Potassium Chloride 10 mEq / Wa	250	8.68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000692		Dextrose 70 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000693		Potassium Chloride/D5-0.9%nacl	250	21.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000694		Potassium Chloride/D5-0.9%nacl	250	19.88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000695		Dopamine HCL In Dextrose 5 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000696		Dopamine HCL In Dextrose 5 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000697		Nitroglycerin In 5 % Dextrose	250	49.64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000698		Metronidazole/Sodium Chloride	250	5.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000699		Clinimix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000700		Clinimix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000701		Clinimix E	250	96.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000702		Clinimix E	250	102.26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000703		Clinimix E	250	101.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000704		Clinimix E	250	99.58	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000705		Cefazolin Sodium/Dextrose,iso	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000706		Famotidine In Nacl,iso-Osm/Pf	250	12.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000707		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000708		Dextrose 5 %-0.45 % Sod Chlord	250	0.02	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000709		Dextrose 10 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000710		Sodium Chloride 0.9 % (Flush)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000712		quiNIDine GLUCONATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000713		penicillin G POTASSIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000714		metoprolol tartrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000715		Tamoxifen Citrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000716		Indomethacin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000717		propranolol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000718		cloNIDine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000719		penicillin V POTASSIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000720		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000721		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000722		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000723		Bumetanide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000724		Acyclovir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000725		quinapril HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000726		Ketoconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000727		Perphenazine/Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000728		haloperidoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000729		diazePAM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000730		Methyldopa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000731		buPROPion HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000732		Perphenazine/Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000733		benazepril HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000734		Maxzide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000735		bisoproloL FUMARATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000736		Perphenazine/Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000737		Amiloride/Hydrochlorothiazide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000738		Methyldopa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000739		Thioridazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000740		Cyclobenzaprine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000741		Cyclobenzaprine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000742		verapamil HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000743		ketorolac TROMETHAMINE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000744		busPIRone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000745		lithium carbonate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000746		Dicyclomine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000747		Nitrofurantoin Macrocrystal	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000748		Citalopram Hydrobromide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000749		Bromocriptine Mesylate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000750		Terazosin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000751		Fluconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000752		Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000753		Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000754		Baclofen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000755		Baclofen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000756		Fenofibrate Nanocrystallized	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000757		Doxepin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000758		Nitrofurantoin Monohyd/M-Cryst	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000759		ALPRAZolam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000760		ALPRAZolam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000761		Temazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000762		Doxepin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000763		Venlafaxine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000764		Felodipine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000765		Prochlorperazine Maleate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000766		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000767		rOPINIRole HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000768		buPROPion HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000769		cephALEXin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000770		fluPHENAZine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000771		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000772		Diclofenac Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000773		Albuterol Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000774		Albuterol Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000775		levalbuterol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000776		PARoxetine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000777		quiNINE SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000778		Peppermint Oil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000779		Mineral Oil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000780		HYDROcodone/acetaminophen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000781		Pamelor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000782		Azithromycin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000783		ceFAZolin SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000784		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000785		Demerol	250	5.38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000786		morphine SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000787		Water for Injection,sterile	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000788		Atropine Sulfate	250	22.02	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000789		morphine SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000790		metoprolol tartrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000791		amikacin SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000792		Buprenorphine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000793		Lidocaine HCL/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000794		Dobutamine HCL In Dextrose 5 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000795		Heparin Sodium,porcine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000796		Milrinone Lactate/D5w	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000797		Cenolate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000798		sodium acetate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000799		Corlopam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000800		Tobramycin Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000801		ketorolac TROMETHAMINE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000802		Water for Injection,sterile	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000803		Aminosyn-Rf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000804		Aminosyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000805		lidocaine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000806		lidocaine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000807		vancomycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000808		Fluconazole In Nacl,iso-Osm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000809		Fluconazole In Nacl,iso-Osm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000810		Ciprofloxacin In 5 % Dextrose	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000811		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000812		Dextrose 50 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000813		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000814		Erythrocin Lactobionate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000815		vancomycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000816		vancomycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000817		Sodium Bicarbonate	250	26.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000818		Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000819		Amidate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000820		Potassium Chloride In 0.9%nacl	250	16.46	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000821		Potassium Chloride/D5-0.45nacl	250	5.62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000822		Dextrose 5 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000823		Sodium Chloride 0.45 %	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000824		Phytonadione (Vit K1)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000825		Potassium Chloride-0.45% Nacl	250	6.34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000826		Pyridium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000827		AsacoL HD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000828		Dakin's	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000829		Dakin's	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000830		Dakin's	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000831		Daliresp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000832		Teflaro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000833		Armour Thyroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000834		Armour Thyroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000835		Teflaro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000836		Linzess	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000837		Linzess	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000838		Namzaric	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000839		Levothroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000840		Levothroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000841		Bystolic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000842		Lexapro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000843		Lexapro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000844		Saphris	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000845		Avycaz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000846		Namenda	250	17.78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000847		Namenda	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000848		Namenda XR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000849		Temovate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000850		Temovate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000851		Testro La	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000852		Xtandi	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000853		Prograf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000855		Ambisome	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000856		Mycamine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000857		Mycamine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000858		Acyclovir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000859		nystatin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000860		Phenazopyridine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000862		Sulfatrim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000863		nystatin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000866		K-Phos Original	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000868		Analpram Hc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000869		Recticare	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000871		Anusol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000872		Cyanocobalamin (Vitamin B-12)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000873		Atropine Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000874		Sodium Bicarbonate	250	0.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000875		Vasopressin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000876		EPINEPHrine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000877		potassium acetate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000878		sodium acetate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000879		Potassium Phos,m-Basic-D-Basic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000880		Venofer	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000881		Magnesium Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000882		Calcium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000883		Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000884		Sod Phosphate,monobasic-Dibas	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000885		Calcium Gluconate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000886		dexAMETHasone SODIUM PHOSPHATE	250	2.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000887		hydrOXYzine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000888		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000889		Furosemide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000890		Multitrace-4	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000891		Multitrace-4	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000892		Acetylcysteine	250	4.98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000893		Acetylcysteine	250	7.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000894		Multitrace-5	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000895		Foltx	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000896		rifAMPin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000897		probenecid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000898		Loxapine Succinate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000899		Loxapine Succinate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000910		methazolAMIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000914		morphine SULFATE	250	0.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000915		Isoniazid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000916		ethambutoL HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000917		niMODipine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000918		Fludrocortisone Acetate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000921		Midazolam HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000922		Colistin (Colistimethate Na)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000923		esmolol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000924		Nystop	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000925		Phenadoz	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000926		Zaroxolyn	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000927		Doxycycline Monohydrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000928		metoprolol tartrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000929		Propafenone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000930		labetalol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000931		busPIRone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000932		glipiZIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000933		Tamoxifen Citrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000934		clindamycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000935		Albuterol Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000936		Primidone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000937		propranolol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000938		Trimethoprim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000939		Atenolol/Chlorthalidone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000940		Aggrenox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000941		Combivent Respimat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000942		Mobic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000943		Catapres-Tts 1	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000944		Catapres-Tts 2	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000945		Catapres-Tts 3	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000946		Flomax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000947		Spiriva	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000948		Spiriva	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000949		Atrovent Hfa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000950		Pradaxa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000951		Pradaxa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000952		Tradjenta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000953		Jardiance	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000954		Jardiance	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000955		Stiolto Respimat	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000956		Mirapex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000957		Mirapex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000958		PHENobarbitaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000959		Promethazine HCL/Codeine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000960		Tussiden Dm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000961		acetaZOLAMIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000962		Hydrocortisone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000963		PHENobarbitaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000964		PHENobarbitaL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000965		folic acid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000966		morphine SULFATE	250	1.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000967		morphine SULFATE	250	1.52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000968		diphenhydrAMINE HCL	250	2.82	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000969		gentamicin SULFATE	250	1.14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000970		Promethazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000971		Dipyridamole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000972		chlorproMAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000973		Oxazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000974		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000975		Ibuprofen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000976		Prenatal Plus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000977		Metoclopramide HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000978		haloperidoL LACTATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000979		hydrALAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000980		Sulfamethoxazole/Trimethoprim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000982		Anucort-Hc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000984		Keflex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000985		PROzac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000986		PROzac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000987		Trifluoperazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000988		Trifluoperazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000989		Cyproheptadine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000990		haloperidoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000991		Amitriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000992		atenoloL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000993		Promethazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000994		chlordiazePOXIDE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000995		Ampicillin Trihydrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000996		Temazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000997		Anectine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000998		Oxacillin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000999		Nafcillin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001000		methylPREDNISolone ACETATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001001		cefTRIAXone SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001002		cefTRIAXone SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001003		Cefepime HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001004		Meropenem	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001005		Ampicillin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001006		metFORMIN HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001008		chlorproMAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001009		Calcitonin,salmon,synthetic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001011		Ty-Pap W/Codeine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001012		Ergocalciferol (Vitamin D2)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001013		hydrOXYzine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001014		Doxycycline Hyclate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001015		Doxycycline Hyclate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001019		Nitroglycerin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001020		cloNIDine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001021		Benztropine Mesylate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001022		sulfaSALAzine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001023		Indameth	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001028		aMILoride HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001029		propylthiouraciL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001030		hydrALAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001031		hydrALAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001033		Amoxicillin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001034		gentamicin SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001035		Sulfamethoxazole/Trimethoprim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001037		carBAMazepine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001043		Ibuprofen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001044		Ibuprofen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001046		Zinc Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001047		Terazosin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001048		Enalapril Maleate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001049		Enalapril Maleate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001050		cloNIDine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001051		Cholecalciferol (Vitamin D3)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001052		labetalol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001053		Indomethacin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001054		Gabapentin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001055		pravastatin SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001056		Carbidopa/Levodopa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001060		Benzonatate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001062		Buminate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001063		Isopto Carpine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001064		Isopto Carpine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001066		propofoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001067		Midazolam HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001068		Fentanyl Citrate/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001069		Nitroprusside Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001070		propranolol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001071		Meperidine HCL/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001072		morphine SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001073		cefOXitin SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001074		Ampyra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001075		Cetacaine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001076		Orajel 3x Toothache-Gum	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001077		Vitamin E	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001078		Magnesium Citrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001079		Entereg	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001082		Blephamide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001083		Pred Mild	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001084		Fml	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001085		Ocuflox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001086		Lantiseptic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001087		Silver Nitrate Applicator	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001089		Bidil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001090		Colcrys	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001091		Bactrim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001092		Optiflex-G	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001093		Minocin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001094		Atripla	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001095		Domeboro	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001096		timoloL MALEATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001097		Lunesta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001098		Wellbutrin XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001100		Bicitra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001103		levoFLOXacin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001104		Pilocarpine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001105		gentamicin SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001106		lidocaine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001107		Ciprofloxacin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001109		Centrum	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001110		Abilify	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001111		Razadyne	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001112		Mupirocin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001113		Tobrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001114		Albuterol Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001115		Miconazole Nitrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001116		Docusate Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001117		Miconazole Nitrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001118		Roxicodone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001119		Chloraseptic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001120		InderaL LA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001121		InderaL LA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001122		Flunisolide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001123		Ocuvite With Lutein	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001124		Brimonidine Tartrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001125		dexAMETHasone SODIUM PHOSPHATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001126		Erythromycin Base	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001127		Erythromycin Base	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001128		Eryped 200	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001129		Edecrin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001130		Timoptic-Xe	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001131		Acetylcysteine	250	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001132		Aleve	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001133		Pro-Stat Sugar Free	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001134		Arginine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001135		Q-Sorb Co Q-10	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001136		Vitamin A	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001137		hydrALAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001138		Finasteride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001139		Suboxone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001140		Truvada	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001141		Viread	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001142		Prezista	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001143		Synthroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001145		Optimoist	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001146		Aspercreme Max	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001147		Allegra-D 24 HOUR	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001148		dexmedeTOMIDine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001149		Cometriq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001150		Flucytosine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001151		Ivermectin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001152		Zenpep	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001153		Nexterone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001154		Nexterone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001155		miSOPROStoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001156		Levetiracetam In Nacl (Iso-Os)	250	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001157		Rebif	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001158		Midazolam HCL In 0.9 % Nacl/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001159		Calcium Gluc In Nacl, Iso-Osm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001160		Betamethasone Dipropionate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001161		Selenium Sulfide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001162		Triamcinolone Acetonide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001163		Alogliptin Benzoate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001164		Peridex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001165		Culturelle	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001166		Phoslo	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001167		Phoslyra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001169		FluZONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001174		Nitro-Time	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001175		Perforomist	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001176		Duoneb	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001177		Ipratropium Bromide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001178		Yupelri	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001179		Sodium Chloride for Inhalation	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001181		Epivir	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001182		Juluca	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001183		Isosorbide Dinitrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001184		Imipramine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001185		ALPRAZolam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001186		ALPRAZolam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001187		clonazePAM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001188		Capoten	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001189		Dapsone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001190		Relafen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001191		Albuterol	250	69	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001192		Plavix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001193		Toprol XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001194		Benicar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001195		Altace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001196		Depakote ER	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001197		Cathflo Activase	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001198		Tarceva	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001199		Venlafaxine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001200		Venlafaxine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001201		Cholecalciferol (Vitamin D3)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001203		Dorzolamide HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001204		Albuterol Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001205		Betapace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001206		Betapace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001207		Precose	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001208		Tussin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001209		Duragesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001210		Duragesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001211		Duragesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001212		Duragesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001213		Duragesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001214		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001215		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001216		Sporanox	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001217		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001218		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001219		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001220		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001221		RisperDAL CONSTA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001222		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001223		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001224		RisperDAL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001225		Terazol 7	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001226		Invega	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001227		Invega	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001228		Invega SUSTENNA	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001229		Xarelto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001230		Xarelto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001231		Xarelto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001232		Xarelto	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001233		Ditropan XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001234		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001235		Levaquin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001236		Keppra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001237		Keppra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001238		Theo-24	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001239		Theo-24	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001240		Keppra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001241		Keppra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001242		Keppra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001244		Neomycin Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001245		cefUROXime axetiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001246		Chlorthalidone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001247		diphenhydrAMINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001248		Mirtazapine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001249		Meclizine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001250		metroNIDAZOLE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001251		allopurinoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001252		Ciprofloxacin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001253		lithium carbonate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001254		propranolol HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001255		LORazepam	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001257		Benztropine Mesylate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001258		Glimepiride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001259		Doxepin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001260		simvastatin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001261		amantadine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001262		chlorproMAZINE HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001263		Thioridazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001264		Trifluoperazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001265		Thioridazine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001267		Prazosin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001268		Loperamide HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001269		Oxybutynin Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001270		haloperidoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001271		haloperidoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001272		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001273		Losartan Potassium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001274		atenoloL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001275		pravastatin SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001276		Naproxen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001277		glipiZIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001278		verapamil HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001279		glyBURIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001280		amiodarone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001281		dilTIAZem HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001282		carvediloL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001283		lisinopriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001284		lisinopriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001285		tiZANidine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001286		Vesicare	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001287		Ziac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001288		Ziac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001289		Zebeta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001290		Urecholine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001291		Diamox SEQUELS	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001292		traZODone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001293		Nystatin/Triamcin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001294		nystatin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001297		Nortriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001298		Nortriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001299		Nortriptyline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001300		Effer-K	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001302		Ferrex 150	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001303		Golytely	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001304		selegiline HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001305		Rapaflo	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001306		Norco	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001307		Norco	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001308		Oxytrol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001309		Actigall	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001310		Fioricet	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001311		Imitrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001312		Nasonex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001313		Tussionex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001314		Tobi	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001315		Pentasa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001316		Pentasa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001317		Fosrenol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001318		Cholecalciferol (Vitamin D3)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001319		Prednisol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001320		Sulfac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001321		Zoloft	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001322		Allegra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001323		Lidoderm	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001324		Toprol XL	250	2.16	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001325		OLANZapine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001326		Buprenorphine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001327		Midazolam HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001328		Fluconazole In Nacl,iso-Osm	250	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001329		folic acid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001330		haloperidoL DECANOATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001331		Acyclovir Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001332		Aranesp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001333		Aranesp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001334		Aranesp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001335		Aranesp	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001336		Sensipar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001337		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001338		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001339		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001340		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001341		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001342		Neupogen	250	1203.2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001343		Epogen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001344		Terconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001345		Abelcet	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001346		Adipex-P	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001347		Salagen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001349		metoprolol succinate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001350		Hectorol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001351		Renvela	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001352		Renvela	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001353		Renvela	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001354		Bentyl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001355		Bentyl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001356		Venelex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001357		OxyCONTIN	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001358		OxyCONTIN	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001359		OxyCONTIN	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001360		MS Contin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001361		Abilify	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001362		Abilify	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001363		Abilify	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001364		Abilify	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001365		Rexulti	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001366		Qvar	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001367		Biofreeze-Ilex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001368		Revlimid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001369		Revlimid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001370		RobinuL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001371		Prezista	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001372		Prezista	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001373		Prezcobix	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001374		Mesalamine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001375		donepezil HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001376		miSOPROStoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001377		Juven	250	4.56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001378		Auryxia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001381		captopriL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001382		cefTRIAXone SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001383		Cefepime HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001384		midodrine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001385		PaxiL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001386		Pyrazinamide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001388		Posaconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001389		Guaifenesin/Dextromethorphan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001390		Tapazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001391		Cytomel	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001392		Skelaxin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001393		Ativan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001394		Ofloxacin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001395		Atropine Sulfate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001396		Vancomycin/0.9 % Sod Chloride	250	70.52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001397		Ephedrine Sulfate/0.9% Nacl/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001398		Morphine Sulfate In 0.9 % Nacl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001399		Quibron-T	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001400		Proctocort	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001401		Cortisporin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001402		Viroptic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001403		Neosporin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001404		Neosporin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001405		Altace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001406		Altace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001407		Silvadene	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001408		Silvadene	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001409		Bicillin C-R	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001410		Corgard	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001411		Anusol-Hc 30g	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001412		Albumin Human	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001413		Albumin Human	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001414		Letairis	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001415		Ranexa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001416		Complera	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001417		Harvoni	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001418		Descovy	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001419		Biktarvy	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001420		Veklury	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001421		Isosorbide Mononitrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001422		Glycolax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001423		Didanosine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001424		Zonisamide	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001425		Maxzide-25 MG	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001426		Aricept	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001427		Aricept	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001428		Fragmin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001429		Lusedra	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001430		Fragmin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001431		Dermoplast	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001432		0.9 % Sodium Chloride	250	2.14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001433		protamine SULFATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001434		Diprivan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001435		fluPHENAZine DECANOATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001436		Fosphenytoin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001437		Xylocaine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001438		Dexamethasone Sodium Phosp/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001439		Heparin Sodium (porcine)	250	1.74	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001440		levothyroxine SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001441		levothyroxine SODIUM	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001442		Adenosine	250	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001443		Latuda	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001444		Latuda	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001445		Latuda	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001446		Latuda	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001447		Xopenex Hfa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001448		Xopenex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001449		Brovana	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001450		Provigil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001451		Percocet	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001452		Hycodan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001453		Percocet	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001455		predniSONE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001458		Fe C Plus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001459		Vasotec	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001460		Vasotec	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001461		Wellbutrin XL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001462		Cardizem	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001463		Cardizem	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001464		Cardizem CD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001465		Cardizem CD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001466		Cardizem CD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001467		Zovirax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001468		Zovirax	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001469		Nuedexta	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001470		Amitiza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001471		Actos	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001472		Amitiza	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001473		Actos	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001474		Nesina	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001475		Uloric	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001476		Phospha 250 Neutral	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001477		Risanoid Plus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001478		Proctozone-Hc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001479		Trandate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001480		Entocort Ec	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001481		Zyloprim	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001482		Benicar HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001483		Benicar HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001484		Benicar HCT	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001485		WelChoL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001486		Firvanq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001487		Xifaxan	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001488		Amoxicillin/Potassium Clav	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001490		Donnatal	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001491		Ultracet	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001492		Elimite	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001493		Roxicodone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001494		Mysoline	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001495		Zetia	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001496		M.v.i. 12	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001497		Vancocin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001498		Dorzolamide HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001499		Ascor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001500		Rheumatrex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001501		Ismo	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001502		Tranxene T-Tab	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001503		Cogentin	250	280.36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001504		Vitrase	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001505		vancomycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001506		vancomycin HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001507		Norvasc	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001509		Cubicin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001510		Zerbaxa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001511		glipiZIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001512		lovastatin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001513		Albumin Human	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001514		Chlordiazepoxide/Clidinium Br	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001515		Ensure Plus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001516		Jevity 1.2 Cal	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001517		Ensure Enlive	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001518		Promod	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001519		Ensure Enlive	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001520		Glucerna	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001521		Dipyridamole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001522		Dexmedetomidine In 0.9 % Nacl	250	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001523		Dexmedetomidine In 0.9 % Nacl	250	144	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001524		Aquaphor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001525		Eucerin Plus	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001526		Cholecalciferol (Vitamin D3)	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001527		Biotin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001528		Percogesic	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001530		Prosource No Carb	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001531		Lidex	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001533		NovoLOG	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001535		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001536		Clinimix E	250	106.68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001537		Clinimix E	250	98.88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001538		Intralipid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001539		0.9 % Sodium Chloride	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001540		Dextrose 5 % In Water	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001543		Ketoconazole	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001544		Motegrity	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001545		Dantrium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001546		Divalproex Sodium	250	1.86	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001547		Pioglitazone HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001548		dexAMETHasone	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001549		Magic Mouthwash	250	75	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001550		MVI	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001551		Lidocaine HCL/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001552		Aplisol	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001553		Dextrose 5 % and 0.9 % Nacl	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001554		Doxycycline Hyclate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001555		Meperidine HCL/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001556		glipiZIDE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001557		Hylenex	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001558		Myrbetriq	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001559		Asenapine Maleate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001560		Doxycycline Hyclate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001561		Veltassa	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001562		Veltassa	250	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001563		Non-Formulary Medication	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001564		Calcium Carb 600mg / Vit D3 40	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001565		TofraniL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001566		Lozol	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001567		LamISIL	250	27.88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001568		TrileptaL	250	2.7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001569		Estrace	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001570		hydrOXYzine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001572		Advair HFA	250	65.66	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001573		Myrbetriq	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001576		Preparation H	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001577		Calmoseptine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001578		Calcium Citrate/Vitamin D3	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001580		Metamucil Fiber Singles	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001581		Nac	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001582		Mineral Oil	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001583		Armour Thyroid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001584		Fycompa	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001585		Mupirocin	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001586		Lactobacillus Acidophilus	250	1.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001587		Calcium Citrate	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001589		Meperidine HCL/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001590		fluPHENAZine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001591		Abacavir/Dolutegravir/Lamivudi	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001592		Crestor	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001593		Nuplazid	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001594		OLANZapine	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001595		Memantine HCL	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001597		Phenytoin Sodium	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001601		diphenhydrAMINE HCL - UD	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001602		Prazosin HCL	250	8.62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001603		Famotidine/Pf	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001604		fluvoxaMINE MALEATE	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001605		Acetaminophen	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001606		Clinimix E	250	107.78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001607		Sod Phos Di, Mono/K Phos Mono	250	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000042		Fibercon	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000044		Caltrate 600 Plus D3	257	0.24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000120		Cortaid 28g	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000130		Refresh Lacri-Lube	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000133		Refresh Celluvisc	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000143		Nasal Moisturizer	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000238		Loperamide HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000254		Naphcon-A	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000260		Tears Naturale Forte	257	16.78	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000265		Systane Balance	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000270		Maalox Advanced	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000272		Nicotine	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000426		Colace	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000481		Ferrous Sulfate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000483		Phenol/Sodium Phenolate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000485		Potassium Chloride	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000486		guaiFENesin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000492		Adult Glycerin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000493		Enema	257	0.02	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000494		Mineral Oil Enema	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000495		Tums	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000496		Debrox	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000497		Nicoderm Cq	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000498		Abreva	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000505		Sarna OriginaL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000508		Magox	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000515		Petrolatum,white	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000518		Zinc Oxide	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000521		NovoLIN R	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000522		RELION NovoLIN N	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000523		NovoLIN 70-30	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000564		Magtrate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000565		Citracal-Vitamin D	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000567		Vitamin E	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000568		Aspirin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000579		Acetaminophen	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000585		Eye Wash	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000586		Vitamin E	257	0.18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000587		Aspirin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000588		Senna S	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000604		Insta-Glucose	257	0.28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000623		Ferrous Gluconate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000624		bisacodyL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000627		Ocean	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000861		Antifungal Cream 14g	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000864		Ed A-Hist	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000865		Rynex Dm	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000867		S-2	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000870		Benadryl Itch Stopping	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000900		Artificial Tears	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000901		Calcium Carbonate	257	0.12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000902		Cyanocobalamin (Vitamin B-12)	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000903		Cyanocobalamin (Vitamin B-12)	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000904		Docusate Calcium	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000905		Meclizine HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000906		Pyridoxine HCL (Vitamin B6)	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000907		Sodium Bicarbonate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000908		thiamine HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000909		Vitabee W-C	257	0.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000911		L. Acidophilus/Pectin, Citrus	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000912		Nephro-Vite	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000913		Oysco 500-Vit D3	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000919		Preparation H	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000920		Acetaminophen	257	0.08	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000981		Acephen	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH000983		Nicoderm Cq	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001007		Loratadine	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001010		Bacitracin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001016		Pyridoxine HCL (Vitamin B6)	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001017		Ascorbic Acid	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001018		Thera-M	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001024		Bismatrol	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001025		Ibu-200	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001026		Calcium Carbonate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001027		Vitamin A	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001032		Calamine/Zinc Oxide	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001036		Selenium	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001038		Beta-Carotene	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001039		Liquitears	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001040		Mi-Acid	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001041		Pain Reliever Plus	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001042		Senna	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001045		Banophen	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001057		Magnesium Hydroxide	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001058		Ferosul	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001059		Aspir-Low	257	0.06	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001061		bisacodyL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001065		Isopto Tears	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001080		Chlor-Trimeton	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001081		Baza Protect	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001088		Calcio Del Mar	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001099		Neutra-Phos	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001102		Artificial Tears	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001108		Ketotifen Fumarate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001144		omeprazole	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001170		Triple Antibiotic	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001171		Selenium	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001172		Antifungal 30g	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001173		Fexofenadine HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001180		Ecotrin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001202		Ascorbic Acid	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001243		Tylenol Arthritis	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001256		Acetaminophen	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001266		cetirizine HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001295		Hydrocortisone/Aloe Vera	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001296		Hydrocortisone	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001301		Melatonin	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001348		dilTIAZem HCL	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001379		Mag-Sr	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001380		Ferrous Fumarate	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001454		Icar-C	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001456		Mucinex	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001457		Delsym	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001508		Betadine	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001529		Ergocalciferol (Vitamin D2)	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001534		Cyanocobalamin	257	0.38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001541		Vicks Vaporub	257	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001542		T-Gel	257	5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001571		Mag-Al Plus	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001574		Ed A-Hist Dm	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001575		Zinc Oxide	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001579		Arthricream	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001600		Colloidal Oatmeal	257	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000019		4x4 Alldress Dressing	270	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000028		Acticoat Burn Dressing (3 Day)	270	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000042		Adult Wipes	270	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000056		Alcohol Preps	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000058		Alldress Dressing	270	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000059		Allevyn 4x4 Foam Dressing	270	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000060		Allevyn 4x4 Thin Dressing	270	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000061		Aloe Vesta Protective Ointment	270	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000063		Angio Catheter	270	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000071		Arm Sling	270	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000073		Baby Powder	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000095		Bandaid	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000128		Briefs	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000159		Cath Tray W/O Bag	270	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000198		Comb	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000202		Connecting Tube	270	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000221		Denture Adhesive	270	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000224		Denture Cup	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000225		Deodorant	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000227		Dermal Wound Cleaner 1 Bottle	270	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000228		Dermal Wound Cleanser	270	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000246		Dressing Change Charge	270	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000257		Duoderm Dressing	270	12	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000260		E Cylinders	270	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000263		Efferdent(Denture Cleaner Tab)	270	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000264		Egg Crate/Mattress Pad	270	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000269		Enema Bag With Soap	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000270		Ensure	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000278		Extension Set	270	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000281		Feeding Set	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000285		Fleets Enema	270	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000309		Gauze Kerlix Roll	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000313		Gauze Sponge (2x2)	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000314		Gauze Sponge (4x4)	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000326		Glucerna	270	13	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000329		Glucose Strip	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000333		Graduated Container	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000334		Grav Set W/Rate Flow Reg	270	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000335		Gt Bag	270	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000336		Hair and Body Shampoo	270	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000347		Hair Brush	270	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000353		Heel Protectors	270	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000358		Hibiclens	270	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000373		Hose, Care Knee	270	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000383		Hydrogen Peroxide	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000384		Hypafix Tape (1 Roll)	270	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000392		Introcan 22g 1 In	270	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000393		Introcan 24g 3/4 In	270	31	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000397		Irrigation Tray W/Syringe	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000406		IV Start Kit	270	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000410		Kerlix	270	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000431		Kleenex	270	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000436		Lancet	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000437		Lanciceptic Protective Barrier	270	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000441		Lemon Glycerin Swabs	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000442		Lice Treatment	270	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000444		Lip Balm	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000446		Lotion Hand/Body	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000479		Messengile Douche	270	23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000481		Mouthwash	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000484		Nacl 4 Meq/ML 250ml	270	266	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000486		Nail File	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000487		Nail Polish Removwer Pad	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000489		Nasal Cannula	270	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000491		Nebulizer	270	33	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000506		No Rinse Shampoo	270	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000509		O2 Concentrator	270	19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000527		Perineal Cleaner	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000539		Posie Pads	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000551		Q-Tips	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000552		Razors	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000567		Seabond Denture Adhesive	270	22	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000577		Shave Cream	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000586		Skin Prep Pad	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000593		Slipper Socks	270	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000596		Smart-Site Vital Adapter	270	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000597		Soap Bar	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000600		Solo Site Wound Gel (1 Tube)	270	77	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000605		Speci-Hat	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000606		Specimen Container (Sterile)	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000611		Splint, Cock-Up Wrist	270	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000614		Staple Remover Kit	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000622		Sterile Water/Normal Saline	270	7	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000631		Suture Removal Kit	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000638		Syringe	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000655		Syringe With Needle	270	17	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000667		Tega Derm Transparent Dressing	270	26	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000673		Telfa Dressing	270	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000684		Thick It	270	27	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000690		Toothbrush	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000691		Toothette	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000692		Toothpaste	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000714		Tubing	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000723		Ultrasite Valve-Pos Pres	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000725		Underpads	270	11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000727		Urinal	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000737		Vaseline	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000747		Vial Adapter	270	51	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000750		Vista Pump	270	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000751		Vista Pump Set	270	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000754		Wash Basin	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000757		Water Pitcher	270	8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000767		Wound Cleaner	270	43	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000769		Wound Gel	270	417	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000781		Emery Board	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000783		Emesis Basin	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000796		Periph Insert Cent Cath 4 Fr	270	2713	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000797		B.d. Neelde	270	4.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000798		Distilled Water	270	11.19	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000799		Steri Strips	270	10.5	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000800		Eucerin Repair Cream 4oz	270	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000801		Sling Arm Large	270	28.18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000802		Splint Wrist Forearm Left	270	28.72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000808		Dentips Oral Swabsticks	270	10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000813		Biotine Drymouth Rinse	270	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000814		Decannulation Plug	270	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000815		Phytoplex N/Rense 8oz Cleanser	270	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000816		Bladder Irrigation Set Cysto	270	20	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000817		Bladder Irrigation Y-Type Tur	270	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000818		Catheter IV Insyte 20gx1.16	270	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000819		Ear Protector E-Z Wrap	270	6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000841		Sacrum Foam Dressing Each	270	16.35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000842		Normal Saline 100 Precedex 200	270	447.24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000843		Bougie Endotrach Tube Intro	270	24.8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	27000877		Sars Antigen Test #20387	270	24.32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000001		24 Hour Abp Monitor	300	161	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000002		340 Measure Volume	300	14	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000004		Afb Culture	300	112	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000005		Afb Sensitivity	300	184	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000006		Aldosterone Bld	300	401	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000007		Amitriptyline	300	122	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000008		ANA Titer & Pattern	300	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000010		Anti Scl 70	300	184	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000012		Antigen Type	300	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000013		Aso Titer	300	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000016		Bld Type Abo/Rh	300	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000017		Bld Type Du	300	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000019		Bone Marrow Studies	300	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000024		CBC With Auto Diff	300	118	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000025		Cell Count Csf	300	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000026		Chlamydia by Probe	300	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000027		Chlamydia Group Ab	300	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000028		Clonazepam/Clozaril	300	549	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000029		Cmv Igm Ql	300	368	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000033		Crystal ID Synovial	300	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000034		Directogen Serum	300	345	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000036		Dsdna Auto Ab's	300	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000037		Drug Screen With Alcohol	300	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000039		Eosinphhil Count	300	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000040		Epstein Barr Ea	300	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000041		Epstein Barr Ebna	300	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000042		Epstein Barr Vca	300	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000043		Era	300	911	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000046		Febrile Agglut Each	300	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000047		Fecal Fat	300	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000048		Fibren Split Product	300	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000049		Fibrinogen Quan	300	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000050		Flow Cytometry Dna	300	294	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000052		H Pylori	300	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000053		Handling Fee	300	15	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000055		Hemo Influenza	300	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000056		Hep C Viral Rna/Dna	300	647	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000057		Hepatitis B Core Ab	300	128	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000058		Hepatitis B Surf Ab	300	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000059		Hepatitis C, Ab	300	139	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000060		Hepatitis E, Ab	300	73	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000061		Hepatitus B Srfce Ag	300	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000062		Herpes Virus Non Spe	300	348	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000063		Hiv	300	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000064		Hiv Dna by Pcr	300	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000065		Hiv Viral Load	300	286	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000066		Hiv Western Blot	300	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000069		Holter Monitor 24hr	300	414	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000070		Hpv Culture	300	115	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000071		Iep Except Serum	300	139	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000072		Iep Serum	300	126	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000073		Kell Ag Titer	300	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000076		Lupus Anticoagulant	300	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000078		Manuel Diff	300	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000079		Metanephrines Urine	300	128	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000080		Microalbumin Urine	300	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000081		Misc Immun Proc	300	393	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000083		Ob Screen	300	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000084		Occult Blood	300	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000085		Ova Paras Smears	300	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000090		Pertussis Smears	300	162	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000091		Phelebotomy Theraputi	300	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000093		Platelet Cnt	300	54	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000094		Platelet Count Auto	300	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000096		Pra	300	911	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000098		Protein Electrophore	300	309	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000099		Protime	300	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000101		Rapid Group A Strep	300	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000102		Rapid Group B Strep	300	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000103		Retic Absolute	300	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000104		Rheumatoid Arthritis Panel	300	397	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000105		Rocky Mountain Igg	300	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000106		RPR	300	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000107		RPR Titer	300	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000108		RSV	300	218	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000109		SED Rate	300	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000111		Semen Analysis Compl	300	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000112		Semen Post Vasectomy	300	18	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000113		Sickle Cell Prep	300	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000115		Smear Review by Path	300	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000117		Toxoplasma Ig6 Ab	300	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000118		Urea Breath Collect	300	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000119		Urinalysis	300	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000120		Urinalysis Chem Only	300	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000124		Urine Immun Fixation	300	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000125		Urine Microscopic	300	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000126		Urobilinogen Urn Qua	300	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000127		Varicella	300	147	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000128		Venipuncture	300	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000129		WBC	300	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000131		West Nile Igm	300	118	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000133		Wet Mount	300	32	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30000136		Abbott Covid 19 ID Rapid Test	300	73.23	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100001		Acetone, Quant	301	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100002		Acetylcholine Recep	301	157	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100005		Actaminophen	301	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100009		Albumin Serum	301	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100011		Alcohol Urine	301	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100012		Aldolase	301	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100013		Alk Phos Isoenzymes	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100015		Alkaline Phosphatas	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100016		Alpha-1-Antitrypsiniphe	301	194	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100017		Alpha-Fetoprotein Amnio	301	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100018		Alpha-Fetoprotein Serum	301	327	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100019		Amikacin	301	106	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100021		Ammonia Blood	301	166	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100022		Amniostat	301	84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100026		Amylase Serum	301	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100029		Angiotensin Conv Enzyme	301	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100030		Antidiuretic Hormone	301	143	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100032		Anti-Histone Abs	301	49	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100036		B Naturetic Peptide	301	126	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100037		Barbiturates Confir	301	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100039		Basic Metabolic Panel	301	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100040		Beta 2 Macroglobulin	301	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100041		Beta Hcg Quant Serum	301	163	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100042		Bilirubin Direct	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100043		Bilirubin Total	301	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100048		C Peptide	301	45	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100049		Calcium Blood	301	69	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100050		Calcium Ionized	301	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100051		Calcium Urine 24	301	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100052		Carbamazepine (Tegretol)	301	133	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100053		Carbon Diox Co2	301	77	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100058		Catecholamines Total Urin	301	135	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100059		CEA	301	198	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100060		Ceruloplasmin	301	35	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100062		Chloride Blood	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100064		Chloride Spinal Fluid	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100065		Chloride Urine	301	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100066		Cholesterol Hdl	301	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100067		Cholesterol Total	301	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100068		Cholinesterase	301	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100072		Comp Metabolic Panel	301	401	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100077		Cortisol Serum	301	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100078		CPK Isoenzymes	301	124	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100079		CPK-Mb	301	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100080		Creatine Kinase CPK Total	301	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100082		Creatinine Clearance	301	162	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100083		Creatinine Serum	301	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100084		Creatinine Urine	301	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100086		Cryoglobulin	301	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100088		Cyclosporine Level	301	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100090		Dhea S Serum	301	186	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100092		Digoxin Lab	301	206	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100093		Dimeric Inhibin A	301	112	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100095		Drug Screen Urine	301	42	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100099		Electrolyte Panel	301	38	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100102		Erythropoietin	301	71	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100103		Estradiol Serum	301	278	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100104		Estriol Unconjugate	301	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100105		Estrogen Level	301	242	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100108		Eth0suximide	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100109		Ethylene Glycol	301	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100112		Ferritin	301	157	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100114		Folic Acid Rbc	301	132	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100115		Folic Acid, Serum	301	132	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100116		FSH Follicle Stim-Ho	301	122	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100118		Gastrin Serum	301	163	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100120		Gentamicin Level	301	149	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100121		Ggt	301	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100122		Gloucose Body Fluid	301	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100124		Glucose	301	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100125		Glucose 5 Hr	301	253	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100132		Glucose Tol 2 Hr	301	140	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100134		Glucose Whole Blood	301	24	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100136		Glyconhemoglobin A1c	301	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100139		Haptoglobin Quant	301	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100140		Heavy Metal Qt Each	301	57	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100141		Hemoglobin Electroph	301	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100146		Hep C Pcr,quant	301	285	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100148		Hepatitus Panel	301	248	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100149		Hiaa Urine	301	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100150		Homocystine Serum	301	334	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100154		Hydroxyprogesterone 17-D	301	323	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100156		Immunoglobulin E	301	130	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100157		Immunoglobulin Iga Only	301	69	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100163		Insulin Total	301	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100166		Iron Binding Capacity	301	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100167		Iron Serum	301	95	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100173		L/S Ratio	301	252	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100175		Lactic Acid	301	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100177		LDH	301	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100179		LDH Isoenzymes	301	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100181		Ldl Measured	301	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100182		Lead Blood	301	144	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100184		Lipase	301	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100185		Lipid Profile	301	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100186		Lithium Quan	301	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100188		Liver Profile	301	521	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100191		Luteinizing Hormone	301	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100192		Magnesium	301	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100193		Mercury	301	56	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100196		Methylmalonic Acid	301	346	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100200		Misc Chem/Tox	301	208	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100205		Myoglobin Urine	301	130	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100208		Noratriptyline	301	84	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100220		Osmolality Blood	301	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100221		Osmolality Urine	301	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100222		Osullivan	301	41	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100223		Parathyroid Hormone	301	162	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100226		Ph Body Fluid	301	44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100227		Phenobarbital	301	128	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100229		Phenytoin/Dilantin	301	143	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100233		Phosphorus Serum	301	67	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100237		Porphyrins Urine 24hr	301	151	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100240		Potassium Serum	301	77	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100241		Potassium Urine	301	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100242		Pre Albumin	301	95	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100243		Preg Test Quan Bhcg	301	122	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100245		Primidone (Mysoline)	301	166	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100246		Procainamide	301	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100247		Proclactin	301	149	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100248		Progesterone	301	163	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100249		Prostatic Acid Phosphatas	301	106	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100254		Protein S Antigen	301	472	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100256		Protein Total	301	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100259		PSA Free	301	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100260		PSA Total	301	95	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100262		Quinidine Level	301	120	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100264		Renal Function Panel	301	254	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100265		Salicylate	301	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100267		Sgot or AST	301	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100268		Sgpt or ALT	301	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100271		Sodium Serum	301	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100272		Sodium Urine	301	69	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100275		Stone Analysis	301	729	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100277		Stone Rosk Citrate	301	396	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100279		T-3 Free	301	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100280		T-3 Resin Uptake	301	895	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100283		Testosterone Free	301	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100284		Testosterone Total	301	72	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100285		Theophylline Level	301	124	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100286		Thiamine Vit B1	301	226	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100287		Thyroglobulin Antibody	301	519	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100288		Thyroxine Free T4	301	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100289		Thyroxine Total T4	301	68	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100291		Tobramycin Test	301	192	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100292		Topiramate Quant	301	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100293		Transferrin	301	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100296		Triglycerides	301	105	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100297		Troponin Quantitative	301	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100300		TSH Thyroid Stim Hormone	301	282	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100302		Urea Nitrogen BUN	301	64	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100305		Uric Acid Serum	301	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100306		Uric Acid Urine	301	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100309		Valproic Ac (Dapakene) Tot&or	301	172	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100313		Vitamin B12	301	151	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100314		Vitamin B12 Bind Cap	301	243	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100319		Vitamin D Level	301	1085.44	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100321		Vma Urine	301	157	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30100325		Renin	301	218	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200015		Antibody Elution	302	104	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200020		Antibody ID	302	147	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200022		Antibody Influenza Virus B	302	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200026		Antibody Screen	302	112	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200034		Aso Screen	302	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200042		C Reactive Protein	302	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200044		Ca 125	302	161	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200045		Ca 15-3	302	147	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200046		Ca 19-9	302	162	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200047		Ca 27-29	302	132	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200054		Clotest/Culture Urine	302	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200055		Cold Agglutinins Titer	302	69	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200058		Complement C3 Antigen	302	89	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200062		Crossmatch Ahg/Unit	302	94	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200063		Crossmatch is	302	79	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200065		Cryptococcal Antigen	302	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200068		Direct Coombs	302	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200088		Fta-Abs	302	105	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200093		Hepatitis A Antibody Igm	302	114	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200113		Lyme Disease Antibody	302	152	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200115		Mitochondrial Antibody	302	83	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200116		Mono Test	302	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200118		Mycoplasma Latex Antibody	302	150	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200119		Platelet Antibody	302	216	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200128		Rotavirus	302	128	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200131		Rubella Titer	302	53	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200137		Toxoplasma Igm Ab	302	109	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30200140		Rubeola Titer	302	132	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500001		Antithrombin Iii As	305	147	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500004		Aptt	305	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500006		Bleeding Time	305	60	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500009		D Dimer	305	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500012		Factor 8 Level	305	380	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500015		Factor V Clotting	305	264	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500023		Hematocrit	305	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500024		Hematocrit Spun	305	28	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500025		Hemoglobin	305	36	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500027		Hemogram/Platelet Automated	305	80	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500029		Leukocyte Alkaline Phos	305	81	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500036		Protein C Antigen	305	216	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500042		Reticulocyte Count	305	39	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500121		Hemoglobin A1c	305	114	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500056		Clostridium Diff Tox	306	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500058		Cult Fungi Other	306	109	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500059		Cult Grp B Strep	306	605	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500060		Culture Anaerobic	306	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500061		Culture Blood	306	205	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500075		Culture Sputum	306	100	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500076		Culture Stool Routine	306	109	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500082		Culture Viral	306	256	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500086		Gondrrhea by Ona Prose	306	34	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500087		Gram Stain	306	62	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500105		Koh Prep	306	30	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500113		Pinworm Prep	306	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	30500116		Sensitivity Mic	306	106	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000001	74150	A/C Joints Bilateral	320	205	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000007		Abdomen One View	320	263	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000011	97124	Ankle Ap & Lat	320	167	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000012	71100	Ankle Complete	320	248	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000033	90847	Cerv Spine Comp I/F	320	52	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000039	97150	Cholecysto Oral Contrast	320	337	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000042	72193	Coccyx	320	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000043		Colon Barium	320	504	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000044	94761	Colon Barium W/Air	320	536	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000047	97110	Cystogram S&i	320	471	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000050	93970	Abdomen Complete	320	411	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000053	97112	Elbow Ap & Lat	320	161	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000054	72052	Elbow Complete	320	337	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000055	90853	Elbow Complete I/F	320	337	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000061	73030	Foot Complete	320	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000063	90801	Foot Complete I/F	320	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000065	71010	Forearm 1 Joint	320	209	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000067	90853	Forearm 2 Views I/F	320	264	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000069	73140	Hand Complete	320	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000071		Hand Complete I/F	320	299	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000073	73650	Hand Two Views	320	95	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000075	G0129	Hip 2 Views I/F	320	405	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000076	73090	Hip Ini Limited	320	248	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000077	73120	Hip Uni Two Views	320	323	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000083	73221	Esophagus	320	356	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000086	74220	Facial Bones Comp	320	306	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000088	73510	Femur	320	240	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000091	90853	Finger 2 Views Min I/F	320	247	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000092	73630	Fingers	320	198	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000103	97140	Foot Ap & Lat	320	176	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000104	74170	Humerus	320	209	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000117	90818	Knee 2 Views I/F	320	307	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000119	73660	Knee Ap and Lateral	320	172	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000120	70100	Knee Completed	320	247	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000122		Kub	320	239	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000125	74000	Mandible Complete	320	265	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000126	G0176	Mandible Copl I/F	320	265	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000127	74000	Mandible Limited	320	209	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000129	74020	Mastoid Complete	320	268	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000137	74246	Nasal Bones Only	320	209	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000146	70250	Os Calcis	320	202	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000147	G0177	Os Calcis 2 Views I/F	320	202	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000152	70486	Pelvis 2 Views	320	311	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000153	71260	Pelvis Min 3 Views	320	311	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000157		Pyelogram Retro	320	1762	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000163	73620	Ribs Bilateral	320	369	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000165	90832	Ribs Unilat 2 Views I/F	320	369	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000166	73600	Ribs Unilateral	320	252	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000167	71250	Sacroiliac	320	294	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000169	71270	Sacrum	320	311	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000171	72192	Scapula	320	216	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000177	70492	Shoulder 3 Views	320	335	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000178	90834	Shoulder Compl I/F	320	247	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000180	72194	Shoulder Limited	320	163	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000184	74270	Sinuses Complete	320	358	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000185	70540	Sinuses Limited	320	218	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000188	74290	Skull Complete	320	405	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000189	90816	Skull Complete I/F	320	405	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000190	74280	Skull Limited	320	261	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000194	71030	Spine Cerv 3 Views	320	330	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000197	70460	Spine Cervical Compl	320	443	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000201	70470	Spine Lumb Complete	320	425	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000204	70450	Spine Thoracic 2 Views	320	299	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000208	75820	Sternaclavc Jnts	320	218	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000210	74249	Sternum	320	269	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000215	74420	Tempmndublr Jnts	320	269	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000217	73650	Tibia and Fibula	320	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000228	93307	Upper Gi Series	320	609	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000229	97150	Upper Gi Small Bowel	320	593	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000240	97532	Venogram Unilateral	320	3111	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000242	90899	Venous Doppler of The Legs	320	1016	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000245	97113	Wrist Ap & Lat	320	172	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000246	73085	Wrist Complete	320	247	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32000250	73560	Xray Le Toes Min 2 Views	320	184	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32200001	74160	Artho Shoulder	322	647	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32400001	90846	Chest 1 View I/F	324	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32400003	97535	Chest Complate 4 Views	324	352	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32400006	74430	Chest One View	324	221	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32400010	73100	Chest Three Views	324	271	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	32400011	73070	Chest Two Views	324	278	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000002		CT Chest W/Con	350	1974	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000003		CT Chest W/O Contrast	350	1798	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000004		CT Chest W/Wo Contrast	350	4460	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000006		CT Facial W/O	350	1693	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000011		CT Neck W/Wo Con	350	4131	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000012		CT Pelvis W/Con	350	2733	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000013		CT Pelvis W/O Con	350	1749	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000014		CT Pelvis W/Wo Con	350	3333	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35000015		CT Scan Arm/Shoulder	350	2254	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35100003		CT Head W/Contrast	351	2373	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35100004		CT Head W/O Contrast	351	2456	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35100005		CT Head W/Wo Contrast	351	3380	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35200005		CT Abd W/Con	352	2539	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35200006		CT Abd W/O Con	352	2356	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	35200007		CT Abd W/Wo Con	352	4460	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	40000001		Renal Sonogram	400	1749	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	40000003	78806	Ultrasound Extremity	400	1598.48	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	40200013	93971	U/S Doppler Vendous Extrem Uni	402	1800	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	40200014	93970	U/S Doppler Venous Bil	402	2040	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	41000036	73090	Resp Ther/Nebulizer Tx	410	294	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	41200006	73110	Ventolin Breathing Treatment	412	294	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	41900001	73130	Pulse Oximeter	419	268	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	42000005	73020	Gait Training 15 Min	420	271	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	42000006	73010	Kinetic Excercises	420	92	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	42000012	73030	Therapy Exercises Ea 15 Min	420	88	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	42000019	73040	PT Evaluation	420	98	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	42000037	72040	Therap Group 15 Min	420	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	43300001	73060	Therapeutic Grp 15 Min	433	113	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	44200002	73550	Speech Therapy	442	340	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	44400003	73562	Speech Therapy Eval	444	557	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	48300001		Echo Cardiogram	483	4562	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	61000018		MRI Shoulder, Upr Ext Joint	610	3007	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	61100004		MRI Brain Wo Cont	611	3007	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	61200004		MRI L-Spine W&wo Cont	612	3876	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	61400001		MRI Add'l Levels	614	835	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	61400002		MRI Head	614	3007	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001596		FluZONE QUAD 2022-2023	636	34.58	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001598		Phenytoin Sodium	636	0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	PH001599		Calcium Chloride	636	21	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	73000001		EKG	730	369	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	90000001	90899	Patient Education Group Sessio	900	390	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	90000002	90899	Educational 60 Mi	900	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	90000003	90899	Nursing Assessment	900	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	90000004		Bio Psychosocial Assess 45-60	900	247	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91500006	90791	Psych Eval W/O Medical Exam	900	435	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	90400001	G0176	Activity Therapy 45 or More	904	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91300001	G0177	Training Education 45 or More	913	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91400001	90832	Individual Psychotherapy 30 Mi	914	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91400002	90834	Individual Psychotherapy 45-50	914	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91400003	90834	Individual Psychotherapy 60 Mi	914	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91500001	90853	Group Psychotherapy	915	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91500002	90853	Group Psychotherapy 45-50 Mi	915	350	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91500003	90853	Group Psychotherapy 60 Mi	915	390	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91500004	90853	Interactive Grp Psy 45 to 50	915	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91600001	90847	Cojoint (Couple Therapy 60 Mi	916	154	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91600002	90847	Cojoint (Couple) Therapy	916	392	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91600003	90847	Cojoint (Couple) Therapy 90 Mi	916	233	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91600004	90846	Family Psychotherapy W/O PT	916	418	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	91600005	90847	Family Psychotherapy W/PT	916	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	94100001	73050	Therapuetic Proc 15 Min Exer	941	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Inpatient Psychiatric Services	94100002	73080	Rec Therapy 15 Min	941	136	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91400001	90832	Individual Psychotherapy 30 Mi	914	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91400002	90834	Individual Psychotherapy 45-50	914	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91400003	90834	Individual Psychotherapy 60 Mi	914	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91500001	90853	Group Psychotherapy	915	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91500002	90853	Group Psychotherapy 45-50 Mi	915	350	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91500003	90853	Group Psychotherapy 60 Mi	915	390	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91500004	90853	Interactive Grp Psy 45 to 50	915	326	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91600001	90847	Cojoint (Couple Therapy 60 Mi	916	154	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91600002	90847	Cojoint (Couple) Therapy	916	392	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91600003	90847	Cojoint (Couple) Therapy 90 Mi	916	233	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91600004	90846	Family Psychotherapy W/O PT	916	418	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Intensive Outpatient Services	91600005	90847	Family Psychotherapy W/PT	916	500	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A