Plainview Standard - Freedom Behavioral

hospital_name	last_updated_on	version	location_name	hospital_address	license_number\|TX	type_2_npi	To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.	attester_name	general_contract_provisions
ALLEGIANCE BEHAVIORAL HEALTH CENTER OF PLAINVIEW	12/1/25	3.0.0	ALLEGIANCE BEHAVIORAL HEALTH CENTER OF PLAINVIEW	2601 Dimmit, Ste 400, Plainview, TX, 79072	8160	1386691046	TRUE	Tara Reed
description	code\|1	code\|1\|type	setting	drug_unit_of_measurement	drug_type_of_measurement	standard_charge\|gross	standard_charge\|discounted_cash	modifiers	standard_charge\|min	standard_charge\|max	additional_generic_notes	standard_charge\|Medicare\|PPO\|negotiated_dollar	standard_charge\|Medicare\|PPO\|negotiated_percentage	standard_charge\|Medicare\|PPO\|negotiated_algorithm	median_amount\|Medicare\|PPO	10th_percentile\|Medicare\|PPO	90th_percentile\|Medicare\|PPO	count\|Medicare\|PPO	estimated_amount\|Medicare\|PPO	standard_charge\|Medicare\|PPO\|methodology	additional_payer_notes\|Medicare\|PPO	standard_charge\|BCBS_of_Texas\|PPO\|negotiated_dollar	standard_charge\|BCBS_of_Texas\|PPO\|negotiated_percentage	standard_charge\|BCBS_of_Texas\|PPO\|negotiated_algorithm	median_amount\|BCBS_of_Texas\|PPO	10th_percentile\|BCBS_of_Texas\|PPO	90th_percentile\|BCBS_of_Texas\|PPO	count\|BCBS_of_Texas\|PPO	estimated_amount\|BCBS_of_Texas\|PPO	standard_charge\|BCBS_of_Texas\|PPO\|methodology	additional_payer_notes\|BCBS_of_Texas\|PPO	standard_charge\|Beacon_Health_Options\|PPO\|negotiated_dollar	standard_charge\|Beacon_Health_Options\|PPO\|negotiated_percentage	standard_charge\|Beacon_Health_Options\|PPO\|negotiated_algorithm	median_amount\|Beacon_Health_Options\|PPO	10th_percentile\|Beacon_Health_Options\|PPO	90th_percentile\|Beacon_Health_Options\|PPO	count\|Beacon_Health_Options\|PPO	estimated_amount\|Beacon_Health_Options\|PPO	standard_charge\|Beacon_Health_Options\|PPO\|methodology	additional_payer_notes\|Beacon_Health_Options\|PPO	standard_charge\|Cigna\|PPO\|negotiated_dollar	standard_charge\|Cigna\|PPO\|negotiated_percentage	standard_charge\|Cigna\|PPO\|negotiated_algorithm	median_amount\|Cigna\|PPO	10th_percentile\|Cigna\|PPO	90th_percentile\|Cigna\|PPO	count\|Cigna\|PPO	estimated_amount\|Cigna\|PPO	standard_charge\|Cigna\|PPO\|methodology	additional_payer_notes\|Cigna\|PPO	standard_charge\|Optum\|PPO\|negotiated_dollar	standard_charge\|Optum\|PPO\|negotiated_percentage	standard_charge\|Optum\|PPO\|negotiated_algorithm	median_amount\|Optum\|PPO	10th_percentile\|Optum\|PPO	90th_percentile\|Optum\|PPO	count\|Optum\|PPO	estimated_amount\|Optum\|PPO	standard_charge\|Optum\|PPO\|methodology	additional_payer_notes\|Optum\|PPO	standard_charge\|Triwest\|PPO\|negotiated_dollar	standard_charge\|Triwest\|PPO\|negotiated_percentage	standard_charge\|Triwest\|PPO\|negotiated_algorithm	median_amount\|Triwest\|PPO	10th_percentile\|Triwest\|PPO	90th_percentile\|Triwest\|PPO	count\|Triwest\|PPO	estimated_amount\|Triwest\|PPO	standard_charge\|Triwest\|PPO\|methodology	additional_payer_notes\|Triwest\|PPO	standard_charge\|Vantage_Health_Plan\|PPO\|negotiated_dollar	standard_charge\|Vantage_Health_Plan\|PPO\|negotiated_percentage	standard_charge\|Vantage_Health_Plan\|PPO\|negotiated_algorithm	median_amount\|Vantage_Health_Plan\|PPO	10th_percentile\|Vantage_Health_Plan\|PPO	90th_percentile\|Vantage_Health_Plan\|PPO	count\|Vantage_Health_Plan\|PPO	estimated_amount\|Vantage_Health_Plan\|PPO	standard_charge\|Vantage_Health_Plan\|PPO\|methodology	additional_payer_notes\|Vantage_Health_Plan\|PPO	standard_charge\|Wellcare_(Harmony_Health_Plan)\|PPO\|negotiated_dollar	standard_charge\|Wellcare_(Harmony_Health_Plan)\|PPO\|negotiated_percentage	standard_charge\|Wellcare_(Harmony_Health_Plan)\|PPO\|negotiated_algorithm	median_amount\|Wellcare_(Harmony_Health_Plan)\|PPO	10th_percentile\|Wellcare_(Harmony_Health_Plan)\|PPO	90th_percentile\|Wellcare_(Harmony_Health_Plan)\|PPO	count\|Wellcare_(Harmony_Health_Plan)\|PPO	estimated_amount\|Wellcare_(Harmony_Health_Plan)\|PPO	standard_charge\|Wellcare_(Harmony_Health_Plan)\|PPO\|methodology	additional_payer_notes\|Wellcare_(Harmony_Health_Plan)\|PPO	standard_charge\|Zelis_PPO\|PPO\|negotiated_dollar	standard_charge\|Zelis_PPO\|PPO\|negotiated_percentage	standard_charge\|Zelis_PPO\|PPO\|negotiated_algorithm	median_amount\|Zelis_PPO\|PPO	10th_percentile\|Zelis_PPO\|PPO	90th_percentile\|Zelis_PPO\|PPO	count\|Zelis_PPO\|PPO	estimated_amount\|Zelis_PPO\|PPO	standard_charge\|Zelis_PPO\|PPO\|methodology	additional_payer_notes\|Zelis_PPO\|PPO
Semi-Private Room	110001	CDM	Inpatient			1050			1050	1050				Per Diem Rate x Length of Stay	23295.41	11089.583	35290.172	160	23485.9	Per Diem				Per Diem Rate x Length of Stay	17625.67	17625.67	17625.67	1 through 10	17625.67	Per Diem				Per Diem Rate x Length of Stay	15936.17	11382.9786	22765.9571	1 through 10	15936.17	Per Diem				Per Diem Rate x Length of Stay	15936.17	11382.9786	22765.9571	1 through 10	15936.17	Per Diem				Per Diem Rate x Length of Stay	16944.67	4663.84	38013.418	25	19542.98	Per Diem				Per Diem Rate x Length of Stay	33076	33076	33076	1 through 10	33076	Per Diem				Per Diem Rate x Length of Stay	12470.58	9383.06	12084.64	1 through 10	12444.59	Per Diem				Per Diem Rate x Length of Stay	18123.05	6192.852	25253.722	1 through 10	16073.01	Per Diem				Per Diem Rate x Length of Stay	15501.45	12712.57	15152.84	1 through 10	15712.61	Per Diem
Private Room	110002	CDM	Inpatient			1050			1050	1050				Per Diem Rate x Length of Stay	23295.41	11089.583	35290.172	160	23485.9	Per Diem				Per Diem Rate x Length of Stay	17625.67	17625.67	17625.67	1 through 10	17625.67	Per Diem				Per Diem Rate x Length of Stay	15936.17	11382.9786	22765.9571	1 through 10	15936.17	Per Diem				Per Diem Rate x Length of Stay	15936.17	11382.9786	22765.9571	1 through 10	15936.17	Per Diem				Per Diem Rate x Length of Stay	16944.67	4663.84	38013.418	25	19542.98	Per Diem				Per Diem Rate x Length of Stay	33076	33076	33076	1 through 10	33076	Per Diem				Per Diem Rate x Length of Stay	12470.58	9383.06	12084.64	1 through 10	12444.59	Per Diem				Per Diem Rate x Length of Stay	18123.05	6192.852	25253.722	1 through 10	16073.01	Per Diem				Per Diem Rate x Length of Stay	15501.45	12712.57	15152.84	1 through 10	15712.61	Per Diem
Wound Care	23926026	CDM	Inpatient			568			568	568
8 Hour Er 650 Mg Caplet	25000001	CDM	Inpatient	650	ME	80			80	80
Abilify Maintena Er 400 Mg Vl	25000002	CDM	Inpatient	400	ME	10			10	10
Acamprosate Calc Dr 333 Mg Tab	25000003	CDM	Inpatient	333	ME	5			5	5
Acarbose 25 Mg Tablet	25000004	CDM	Inpatient	25	ME	4			4	4
Acarbose 50 Mg Tablet	25000005	CDM	Inpatient	50	ME	4			4	4
Acebutolol 200 Mg Capsule	25000006	CDM	Inpatient	200	ME	72			72	72
Acetaminophen 325 Mg Tablet	25000007	CDM	Inpatient	325	ME	3			3	3
Acetaminophen 500 Mg Caplet	25000008	CDM	Inpatient	500	ME	6			6	6
Acetaminophen 650 Mg Suppos	25000009	CDM	Inpatient	650	ME	6			6	6
Acetaminophen Pm Caplet	25000010	CDM	Inpatient	1	EA	3			3	3
Acetaminophen-Cod #3 Tablet	25000011	CDM	Inpatient	1	EA	3			3	3
Acetaminophen-Cod #4 Tablet	25000012	CDM	Inpatient	1	EA	3			3	3
Acetazolamide 250 Mg Tablet	25000013	CDM	Inpatient	250	ME	30			30	30
Acid Reducer 20 Mg Tablet	25000014	CDM	Inpatient	20	ME	3			3	3
Acidophilus Caplet	25000015	CDM	Inpatient	1	EA	6			6	6
Acidophilus X-Str Captab	25000016	CDM	Inpatient	1	EA	6			6	6
Acidophilus-Pectin Capsule	25000017	CDM	Inpatient	1	EA	15.18			15.18	15.18
ACYCLOVIR TAB 400MG	25000018	CDM	Inpatient	400	ME	10			10	10
Admelog 100 Unit/ml Vial	25000019	CDM	Inpatient	100	UN	4.5			4.5	4.5
ADVAIR 250/50 DISKUS	25000020	CDM	Inpatient	1	UN	819			819	819
Advil Cold & Sinus Caplet	25000021	CDM	Inpatient	1	EA	8.74			8.74	8.74
Alaway Eye 10ml	25000022	CDM	Inpatient	1	UN	20			20	20
Alb. 0.083% 3ml Ud	25000023	CDM	Inpatient	2.5	ME	151			151	151
Albuterol 0.083% Inhal Soln	25000024	CDM	Inpatient	2.5	ME	151			151	151
Albuterol Sul 1.25 Mg/3 Ml Sol	25000025	CDM	Inpatient	1.25	ME	9			9	9
Albuterol Sul 2.5 Mg/3 Ml Soln	25000026	CDM	Inpatient	2.5	ME	9			9	9
Albuterol Sul Hfa 90 Mcg Inh	25000027	CDM	Inpatient	1	UN	9			9	9
Alclometasone Dipro 0.05% Crm	25000028	CDM	Inpatient	1	UN	8.74			8.74	8.74
Alendronate Sodium 70 Mg Tab	25000029	CDM	Inpatient	70	ME	143			143	143
Alfuzosin Hcl Er 10 Mg Tablet	25000030	CDM	Inpatient	10	ME	8.74			8.74	8.74
All Day Allergy 10 Mg Tablet	25000031	CDM	Inpatient	10	ME	26			26	26
Allergy Relief 180 Mg Tablet	25000032	CDM	Inpatient	180	ME	26			26	26
Allopurinol 100 Mg Tablet	25000033	CDM	Inpatient	100	ME	8			8	8
Allopurinol 300 Mg Tablet	25000034	CDM	Inpatient	300	ME	8			8	8
Alphagan P 0.1% Drops	25000035	CDM	Inpatient	1	UN	358			358	358
Alprazolam 0.25 Mg Tablet	25000036	CDM	Inpatient	0.25	ME	6			6	6
Alprazolam 0.5 Mg Tablet	25000037	CDM	Inpatient	0.5	ME	6			6	6
Alprazolam 1 Mg Tablet	25000038	CDM	Inpatient	1	ME	6			6	6
Alprazolam 2 Mg Tablet	25000039	CDM	Inpatient	2	ME	6			6	6
Alprazolam Xr 0.5 Mg Tablet	25000040	CDM	Inpatient	0.5	ME	6			6	6
Alprazolam Xr 1 Mg Tablet	25000041	CDM	Inpatient	1	ME	6			6	6
Amantadine 100 Mg Capsule	25000042	CDM	Inpatient	100	ME	10			10	10
Amantadine 100 Mg Tablet	25000043	CDM	Inpatient	100	ME	10			10	10
Amantadine 50 Mg/5 Ml Solution	25000044	CDM	Inpatient	5	ML	10			10	10
Amiloride Hcl 5 Mg Tablet	25000045	CDM	Inpatient	5	ME	10			10	10
Amiodarone Hcl 200 Mg Tab	25000046	CDM	Inpatient	200	ME	27			27	27
Amiodarone Hcl 200 Mg Tablet	25000047	CDM	Inpatient	200	ME	27			27	27
Amitriptyline Hcl 10 Mg Tab	25000048	CDM	Inpatient	10	ME	6			6	6
Amitriptyline Hcl 100 Mg Tab	25000049	CDM	Inpatient	100	ME	6			6	6
Amitriptyline Hcl 25 Mg Tab	25000050	CDM	Inpatient	25	ME	6			6	6
Amitriptyline Hcl 50 Mg Tab	25000051	CDM	Inpatient	50	ME	6			6	6
Amitriptyline Hcl 75 Mg Tab	25000052	CDM	Inpatient	75	ME	6			6	6
Amlodipine Besylate 10 Mg Tab	25000053	CDM	Inpatient	10	ME	3			3	3
Amlodipine Besylate 2.5 Mg Tab	25000054	CDM	Inpatient	2.5	ME	3			3	3
Amlodipine Besylate 5 Mg Tab	25000055	CDM	Inpatient	5	ME	3			3	3
Amlodipine-Benazepril 5-10 Mg	25000056	CDM	Inpatient	1	EA	6			6	6
Amox Tr-K Clv 875-125 Mg Tab	25000057	CDM	Inpatient	1	EA	10			10	10
Amoxapine 50 Mg Tablet	25000058	CDM	Inpatient	50	ME	5.68			5.68	5.68
Amox-Clav 500-125 Mg Tablet	25000059	CDM	Inpatient	1	EA	6			6	6
Amox-Clav 875-125 Mg Tablet	25000060	CDM	Inpatient	1	EA	6			6	6
Amoxicillin 250 Mg Capsule	25000061	CDM	Inpatient	250	ME	6			6	6
Amoxicillin 500 Mg Capsule	25000062	CDM	Inpatient	500	ME	6			6	6
Amphetamine Salts 15 Mg Tab	25000063	CDM	Inpatient	15	ME	10			10	10
Amphetamine Salts 15 Mg Tablet	25000064	CDM	Inpatient	15	ME	10			10	10
Amphetamine Salts 20 Mg Tablet	25000065	CDM	Inpatient	20	ME	10			10	10
Amphetamine Salts 30 Mg Tab	25000066	CDM	Inpatient	30	ME	10			10	10
Ampicillin Tr 500 Mg Capsule	25000067	CDM	Inpatient	500	ME	10			10	10
Anecream 4% Cream	25000068	CDM	Inpatient	4	EA	10			10	10
Anoro Ellipta 62.5-25 Mcg Inh	25000069	CDM	Inpatient	1	UN	10			10	10
Antacid 500 Mg Chewable Tablet	25000070	CDM	Inpatient	1	EA	23			23	23
Anti-Diarrheal 2 Mg Caplet	25000071	CDM	Inpatient	2	ME	10			10	10
Antifungal 1% Cream	25000072	CDM	Inpatient	1	EA	10			10	10
Aptiom 800 Mg Tablet	25000073	CDM	Inpatient	800	ME	10			10	10
Aquaphor W-Nat Heal Oint	25000074	CDM	Inpatient	1	EA	213			213	213
Aripiprazole 10 Mg Tablet	25000075	CDM	Inpatient	10	ME	89			89	89
Aripiprazole 15 Mg Tablet	25000076	CDM	Inpatient	15	ME	89			89	89
Aripiprazole 2 Mg Tablet	25000077	CDM	Inpatient	2	ME	89			89	89
Aripiprazole 20 Mg Tablet	25000078	CDM	Inpatient	20	ME	89			89	89
Aripiprazole 30 Mg Tablet	25000079	CDM	Inpatient	30	ME	89			89	89
Aripiprazole 5 Mg Tablet	25000080	CDM	Inpatient	5	ME	89			89	89
Aristada Er 662 Mg/2.4 Ml Syrn	25000081	CDM	Inpatient	662	ME	10			10	10
Aristada Er 882 Mg/3.2 Ml Syrn	25000082	CDM	Inpatient	882	ME	10			10	10
Aristada Initio Er 675 Mg/2.4	25000083	CDM	Inpatient	675	ME	10			10	10
Arthritis Pain Er 650 Mg Caplt	25000084	CDM	Inpatient	650	ME	10			10	10
Arthritis Pain Relief Er 650 Mg Caplet	25000085	CDM	Inpatient	650	ME	10			10	10
Artificial Tears Drops	25000086	CDM	Inpatient	0.5	EA	10			10	10
Aspercreme Lidocaine 4% Cream	25000087	CDM	Inpatient	1	EA	30			30	30
Aspirin 325 Mg Tablet	25000088	CDM	Inpatient	325	ME	4			4	4
Aspirin Ec 325 Mg Tablet	25000089	CDM	Inpatient	325	ME	4			4	4
Aspirin Ec 81 Mg Tablet	25000090	CDM	Inpatient	81	ME	4			4	4
Aspir-Low Ec 81 Mg Tablet	25000091	CDM	Inpatient	81	ME	4			4	4
Atenolol 100 Mg Tablet	25000092	CDM	Inpatient	100	ME	11			11	11
Atenolol 25 Mg Tablet	25000093	CDM	Inpatient	25	ME	6			6	6
Atenolol 50 Mg Tablet	25000094	CDM	Inpatient	50	ME	4.5			4.5	4.5
Atorvastatin 10 Mg Tablet	25000095	CDM	Inpatient	10	ME	10			10	10
Atorvastatin 20 Mg Tablet	25000096	CDM	Inpatient	20	ME	10			10	10
Atorvastatin 40 Mg Tablet	25000097	CDM	Inpatient	40	ME	10			10	10
Atorvastatin 80 Mg Tablet	25000098	CDM	Inpatient	80	ME	10			10	10
Atropine 1% Eye Drops	25000099	CDM	Inpatient	1	EA	133			133	133
Atrovent Hfa Inhaler	25000100	CDM	Inpatient	17	EA	380			380	380
Ayr Saline 0.65% Nose Spray	25000101	CDM	Inpatient	0.65	EA	5			5	5
Ayr Saline Gel	25000102	CDM	Inpatient	1	EA	5			5	5
Azathioprine 50 Mg Tablet	25000103	CDM	Inpatient	50	ME	5			5	5
Azelastine 0.1% (137 Mcg) Spry	25000104	CDM	Inpatient	137	EA	5			5	5
Azelastine 0.15% Nasal Spray	25000105	CDM	Inpatient	205.5	EA	5			5	5
Azithromycin 250 Mg Tab	25000106	CDM	Inpatient	250	ME	31			31	31
Azithromycin 250 Mg Tablet	25000107	CDM	Inpatient	250	ME	31			31	31
Azo Standard 30 95mg Tab	25000108	CDM	Inpatient	95	ME	6			6	6
B-12 1,000 Mcg Tablet	25000109	CDM	Inpatient	1000	EA	23			23	23
B-12 Er 1,000 Mcg Tab	25000110	CDM	Inpatient	1000	EA	23			23	23
Bacid Capsules 50ct	25000111	CDM	Inpatient	1	EA	10			10	10
Bacitracin 500 Unit/gm Ointmnt	25000112	CDM	Inpatient	500	UN	68			68	68
Bacitracin Zn 500 Unit/gm Oint	25000113	CDM	Inpatient	500	UN	68			68	68
Baclofen 10 Mg Tablet	25000114	CDM	Inpatient	10	ME	6			6	6
Baclofen 20 Mg Tablet	25000115	CDM	Inpatient	20	ME	6			6	6
Banophen 25 Mg Capsule	25000116	CDM	Inpatient	25	ME	10			10	10
Basaglar 100 Unit/ml Kwikpen	25000117	CDM	Inpatient	100	UN	1548.76			1548.76	1548.76
Bd Uf Mini Pen Needle 5mmx31g	25000118	CDM	Inpatient	1	EA	10			10	10
Belbuca 150 Mcg Film	25000119	CDM	Inpatient	150	EA	24.04			24.04	24.04
Belbuca 75 Mcg Film	25000120	CDM	Inpatient	75	EA	24.04			24.04	24.04
Belsomra 20 Mg Tablet	25000121	CDM	Inpatient	20	ME	10			10	10
Benazepril Hcl 10 Mg Tablet	25000122	CDM	Inpatient	10	ME	6			6	6
Benazepril Hcl 20 Mg Tablet	25000123	CDM	Inpatient	20	ME	6			6	6
Benazepril Hcl 40 Mg Tablet	25000124	CDM	Inpatient	40	ME	6			6	6
Benazepril Hcl 5 Mg Tablet	25000125	CDM	Inpatient	5	ME	6			6	6
Bengay Vanishing Scent Gel	25000126	CDM	Inpatient	1	EA	10			10	10
Benzodent Denture Pain Cr 1oz	25000127	CDM	Inpatient	1	EA	10			10	10
Benzonatate 100 Mg Capsule	25000128	CDM	Inpatient	100	ME	10			10	10
Benzonatate 200 Mg Capsule	25000129	CDM	Inpatient	200	ME	10			10	10
Benztropine Mes 0.5 Mg Tab	25000130	CDM	Inpatient	0.5	ME	23			23	23
Benztropine Mes 1 Mg Tablet	25000131	CDM	Inpatient	1	ME	6			6	6
Benztropine Mes 2 Mg Tablet	25000132	CDM	Inpatient	2	ME	5			5	5
Best Fiber Powder	25000133	CDM	Inpatient	3	GM	10			10	10
Betamethasone Dp 0.05% Crm	25000134	CDM	Inpatient	0.05	EA	499			499	499
Betamethasone Dp 0.05% Lot	25000135	CDM	Inpatient	0.05	EA	499			499	499
Bethanechol 25 Mg Tablet	25000136	CDM	Inpatient	25	ME	95			95	95
Bicalutamide 50 Mg Tablet	25000137	CDM	Inpatient	50	ME	10			10	10
Biofreeze Gel 8oz Pump Green	25000138	CDM	Inpatient	1	EA	10			10	10
Biofreeze Pain Relief Gel Pump 8oz	25000139	CDM	Inpatient	1	EA	10			10	10
Biofreeze Pain Rellieving Gel Tube 3oz	25000140	CDM	Inpatient	1	EA	10			10	10
Biofreeze Roll-On 2.5oz	25000141	CDM	Inpatient	1	EA	10			10	10
Biotene M/wsh 16oz Liq	25000142	CDM	Inpatient	1	EA	20			20	20
Biotene Moisturizing Mouth Spr	25000143	CDM	Inpatient	1	EA	20			20	20
Biotin 1000mcg Tablet 60ct Windmill	25000144	CDM	Inpatient	1000	EA	10			10	10
Bisac-Evac 10 Mg Suppository	25000145	CDM	Inpatient	10	ME	10			10	10
Bisacodyl 10 Mg Sup 12	25000146	CDM	Inpatient	1	EA	6			6	6
Bisacodyl 10 Mg Suppository	25000147	CDM	Inpatient	10	ME	6			6	6
Bisacodyl Ec 5 Mg Tablet	25000148	CDM	Inpatient	5	ME	6			6	6
BISOPRL/HCTZ TAB 2.5/6.25	25000149	CDM	Inpatient	1	EA	10			10	10
Bisoprolol-Hydrochlorothiazide 10-6.25 Mg Tab	25000150	CDM	Inpatient	1	EA	6			6	6
Breo Ellipta 200-25	25000151	CDM	Inpatient	1	UN	1538			1538	1538
Brilinta 90 Mg Tablet	25000152	CDM	Inpatient	90	ME	10			10	10
Brimonidine 0.2% Eye Drop	25000153	CDM	Inpatient	0.2	EA	213			213	213
Brovana 15 Mcg/2 Ml Solution	25000154	CDM	Inpatient	15	EA	10			10	10
Budesonide 0.5 Mg/2 Ml Susp	25000155	CDM	Inpatient	0.5	ME	192			192	192
Budesonide Inh Susp. 0.25mg/2ml	25000156	CDM	Inpatient	0.25	ME	192			192	192
Bumetanide 1 Mg Tablet	25000157	CDM	Inpatient	1	ME	7			7	7
Bumetanide 2 Mg Tablet	25000158	CDM	Inpatient	2	ME	8			8	8
Buprenorphine-Naloxone 2-0.5 Mg Sl Tablet	25000159	CDM	Inpatient	1	EA	10			10	10
Buprenorphine-Naloxone 8-2 Mg Sl Tablet	25000160	CDM	Inpatient	1	EA	10			10	10
Bupropion Hcl 100 Mg Tablet	25000161	CDM	Inpatient	100	ME	8			8	8
Bupropion Hcl 75 Mg Tablet	25000162	CDM	Inpatient	75	ME	8			8	8
Bupropion Hcl Sr 100 Mg Tablet	25000163	CDM	Inpatient	100	ME	8			8	8
Bupropion Hcl Sr 150 Mg Tab	25000164	CDM	Inpatient	150	ME	8			8	8
Bupropion Hcl Sr 150 Mg Tablet	25000165	CDM	Inpatient	150	ME	8			8	8
Bupropion Hcl Xl 150 Mg Tablet	25000166	CDM	Inpatient	150	ME	8			8	8
Bupropion Hcl Xl 300 Mg Tablet	25000167	CDM	Inpatient	300	ME	8			8	8
Buspirone Hcl 10 Mg Tablet	25000168	CDM	Inpatient	10	ME	7			7	7
Buspirone Hcl 15 Mg Tablet	25000169	CDM	Inpatient	15	ME	7			7	7
Buspirone Hcl 30 Mg Tablet	25000170	CDM	Inpatient	30	ME	12			12	12
Buspirone Hcl 5 Mg Tablet	25000171	CDM	Inpatient	5	ME	6			6	6
Buspirone Hcl 7.5 Mg Tablet	25000172	CDM	Inpatient	7.5	ME	7			7	7
Butalb-Acetamin-Caff 50-300-40	25000173	CDM	Inpatient	1	EA	6			6	6
Butalb-Acetaminophen-Caff 50-325-40 Tab	25000174	CDM	Inpatient	1	EA	6			6	6
Butalbital-Asa-Caffeine Cap	25000175	CDM	Inpatient	1	EA	6			6	6
Bystolic 10 Mg Tablet	25000176	CDM	Inpatient	10	ME	5			5	5
Bystolic 5 Mg Tablet	25000177	CDM	Inpatient	5	ME	5			5	5
C-500 Mg Tablet	25000178	CDM	Inpatient	500	ME	10			10	10
Calcitonin-Salmon 200 Units Sp	25000179	CDM	Inpatient	200	UN	10			10	10
Calcitriol 0.25 Mcg Capsule	25000180	CDM	Inpatient	0.25	EA	15			15	15
Calcitriol 0.5 Mcg Capsule	25000181	CDM	Inpatient	0.5	EA	15			15	15
Calcium 250-Vit D3 125 Tablet	25000182	CDM	Inpatient	1	EA	6			6	6
Calcium 500+vit D 400 Tab	25000183	CDM	Inpatient	1	EA	6			6	6
Calcium 600 + Vit D 400 Tablet	25000184	CDM	Inpatient	1	EA	6			6	6
Calcium 600 + Vit D Tablet	25000185	CDM	Inpatient	1	EA	6			6	6
Calcium 600 Mg Tablet	25000186	CDM	Inpatient	1	EA	6			6	6
Calcium Antacid 500 Mg Chw Tab	25000187	CDM	Inpatient	1	EA	6			6	6
Calcium Citrate-Vit D Tab	25000188	CDM	Inpatient	1	EA	6			6	6
Calmoseptine Ointment	25000189	CDM	Inpatient	0.44	EA	10			10	10
Candesartan Cilexetil 8 Mg Tab	25000190	CDM	Inpatient	8	ME	10			10	10
Captopril 25 Mg Tablet	25000191	CDM	Inpatient	25	ME	6			6	6
Carafate 1 Gm/10 Ml Susp	25000192	CDM	Inpatient	1	GM	33			33	33
Carbamazepine 100 Mg Tab Chew	25000193	CDM	Inpatient	100	ME	18			18	18
Carbamazepine 100 Mg/5 Ml Susp	25000194	CDM	Inpatient	100	ME	18			18	18
Carbamazepine 200 Mg Tablet	25000195	CDM	Inpatient	200	ME	6			6	6
Carbamazepine Er 100 Mg Cap	25000196	CDM	Inpatient	100	ME	8.52			8.52	8.52
Carbamazepine Er 100 Mg Tablet	25000197	CDM	Inpatient	100	ME	8.52			8.52	8.52
Carbidopa-Levo Er 25-100 Tab	25000198	CDM	Inpatient	1	EA	6			6	6
Carbidopa-Levo Er 50-200 Tab	25000199	CDM	Inpatient	1	EA	6			6	6
Carbidopa-Levodopa 10-100 Tab	25000200	CDM	Inpatient	1	EA	6			6	6
Carbidopa-Levodopa 25-100 Tab	25000201	CDM	Inpatient	1	EA	6			6	6
Carbidopa-Levodopa 25-250 Tab	25000202	CDM	Inpatient	1	EA	6			6	6
Carbidopa-Levodopa-Enta 100 Mg	25000203	CDM	Inpatient	25	ME	6			6	6
Carbidopa-Levodopa-Entacapone 50-200-200 Mg	25000204	CDM	Inpatient	50	ME	6			6	6
Carefine Pen Needles 6mm 32g	25000205	CDM	Inpatient	1	EA	10			10	10
Carmex Squeez 0.35oz	25000206	CDM	Inpatient	1	EA	10			10	10
Carvedilol 12.5 Mg Tablet	25000207	CDM	Inpatient	12.5	ME	10			10	10
Carvedilol 25 Mg Tablet	25000208	CDM	Inpatient	25	ME	9			9	9
Carvedilol 3.125 Mg Tablet	25000209	CDM	Inpatient	3.125	ME	4.5			4.5	4.5
Carvedilol 6.25 Mg Tablet	25000210	CDM	Inpatient	6.25	ME	6			6	6
Cefdinir 300 Mg Capsule	25000211	CDM	Inpatient	300	ME	20			20	20
Cefpodoxime 100 Mg Tablet	25000212	CDM	Inpatient	100	ME	10			10	10
Cefpodoxime 200 Mg Tablet	25000213	CDM	Inpatient	200	ME	10			10	10
Ceftriaxone 1 Gm Vial	25000214	CDM	Inpatient	1	GM	62			62	62
Ceftriaxone 500 Mg Vial	25000215	CDM	Inpatient	500	ME	101			101	101
Cefuroxime Axetil 250 Mg Tab	25000216	CDM	Inpatient	250	ME	10			10	10
Cefuroxime Axetil 500 Mg Tab	25000217	CDM	Inpatient	500	ME	10			10	10
Celecoxib 100 Mg Capsule	25000218	CDM	Inpatient	100	ME	10			10	10
Celecoxib 200 Mg Capsule	25000219	CDM	Inpatient	200	ME	10			10	10
Celecoxib 50 Mg Capsule	25000220	CDM	Inpatient	50	ME	10			10	10
Centratex Capsule	25000221	CDM	Inpatient	1	EA	4.48			4.48	4.48
Cephalexin 250 Mg Capsule	25000222	CDM	Inpatient	250	ME	6			6	6
Cephalexin 500 Mg Capsule	25000223	CDM	Inpatient	500	ME	6			6	6
Cetirizine Hcl 10 Mg Tablet	25000224	CDM	Inpatient	10	ME	32			32	32
Chantix 1 Mg Tablet	25000225	CDM	Inpatient	1	ME	34			34	34
Chest Congestion Relief Tab	25000226	CDM	Inpatient	400	ME	10			10	10
Child Aspirin 81 Mg Chew Tab	25000227	CDM	Inpatient	81	ME	10			10	10
Children'S Chewables	25000228	CDM	Inpatient	1	EA	10			10	10
CHLORHEXIDINE 0.12%	25000229	CDM	Inpatient	0.12	EA	64			64	64
Chlorhexidine 0.12% Rinse	25000230	CDM	Inpatient	0.12	EA	64			64	64
Chlorpromazine 50 Mg Tablet	25000231	CDM	Inpatient	50	ME	10			10	10
Chlorthalidone 25 Mg Tablet	25000232	CDM	Inpatient	25	ME	6			6	6
Cholestyramine Light Packet	25000233	CDM	Inpatient	4	GM	6			6	6
Cholestyramine Packet	25000234	CDM	Inpatient	4	GM	6			6	6
Ciclopirox 8% Solution	25000235	CDM	Inpatient	8	EA	10			10	10
Cilostazol 100 Mg Tablet	25000236	CDM	Inpatient	100	ME	28			28	28
Cimetidine 300 Mg Tablet	25000237	CDM	Inpatient	300	ME	7			7	7
Ciprofloxacin 0.3% Eye Drop	25000238	CDM	Inpatient	0.3	EA	131			131	131
Ciprofloxacin Hcl 250 Mg Tab	25000239	CDM	Inpatient	250	ME	7			7	7
Ciprofloxacin Hcl 500 Mg Tab	25000240	CDM	Inpatient	500	ME	18			18	18
Citalopram Hbr 10 Mg Tablet	25000241	CDM	Inpatient	10	ME	6			6	6
Citalopram Hbr 20 Mg Tablet	25000242	CDM	Inpatient	20	ME	13			13	13
Citalopram Hbr 20 Mg TB UD	25000243	CDM	Inpatient	20	ME	13			13	13
Citalopram Hbr 40 Mg Tablet	25000244	CDM	Inpatient	40	ME	14			14	14
Citrate Of Magnesia Soln	25000245	CDM	Inpatient	1	EA	13			13	13
Citroma Solution	25000246	CDM	Inpatient	1	EA	10			10	10
Clarithromycin 500 Mg Tablet	25000247	CDM	Inpatient	500	ME	10			10	10
Clear Eyes Natural Tears Drop	25000248	CDM	Inpatient	1	EA	10			10	10
Clearlax Powder	25000249	CDM	Inpatient	17	GM	10			10	10
Clindamycin Hcl 150 Mg Capsule	25000250	CDM	Inpatient	150	ME	10			10	10
Clindamycin Hcl 300 Mg Capsule	25000251	CDM	Inpatient	300	ME	10			10	10
Clonazepam 0.25 Mg Odt	25000252	CDM	Inpatient	0.25	ME	20			20	20
Clonazepam 0.5 Mg Tablet	25000253	CDM	Inpatient	0.5	ME	20			20	20
Clonazepam 0.5 Mg Tablet fs	25000254	CDM	Inpatient	0.5	ME	20			20	20
Clonazepam 1 Mg Tablet	25000255	CDM	Inpatient	1	ME	20			20	20
Clonazepam 1 Mg Tablet fs	25000256	CDM	Inpatient	1	ME	20			20	20
Clonazepam 2 Mg Tablet	25000257	CDM	Inpatient	0.5	ME	20			20	20
Clonidine 0.1 Mg/day Patch	25000258	CDM	Inpatient	1	EA	447			447	447
Clonidine 0.2 Mg/day Patch	25000259	CDM	Inpatient	1	EA	349			349	349
Clonidine 0.3 Mg/day Patch	25000260	CDM	Inpatient	1	EA	185			185	185
Clonidine Hcl 0.1 Mg Tablet	25000261	CDM	Inpatient	0.1	ME	12			12	12
Clonidine Hcl 0.2 Mg Tablet	25000262	CDM	Inpatient	0.2	ME	6			6	6
Clonidine Hcl 0.3 Mg Tablet	25000263	CDM	Inpatient	0.3	ME	6			6	6
Clopidogrel 75 Mg Tablet	25000264	CDM	Inpatient	75	ME	10			10	10
Clorazepate 15 Mg Tablet	25000265	CDM	Inpatient	15	ME	8.29			8.29	8.29
Clotrimazole 1% Cream	25000266	CDM	Inpatient	1	EA	111			111	111
Clotrimazole-Betamethasone Crm	25000267	CDM	Inpatient	1	EA	9			9	9
Clozapine 100 Mg Tablet	25000268	CDM	Inpatient	100	ME	10			10	10
Clozapine 200 Mg Tablet	25000269	CDM	Inpatient	200	ME	10			10	10
Clozapine 25 Mg Tablet	25000270	CDM	Inpatient	25	ME	10			10	10
Clozapine 50 Mg Tablet	25000271	CDM	Inpatient	50	ME	10			10	10
Co Q-10 50 Mg Capsule	25000272	CDM	Inpatient	50	ME	10			10	10
Colchicine 0.6 Mg Tablet	25000273	CDM	Inpatient	0.6	ME	2			2	2
Colesevelam 625 Mg Tablet	25000274	CDM	Inpatient	625	ME	10			10	10
Colesevelam Hcl 625 Mg Tab 180	25000275	CDM	Inpatient	625	ME	10			10	10
Colestipol Micronized 1 Gm Tab	25000276	CDM	Inpatient	1	GM	10			10	10
Combigan Eye Drops	25000277	CDM	Inpatient	0.2	EA	233			233	233
Corlanor 5 Mg Tablet	25000278	CDM	Inpatient	5	ME	10			10	10
Cranberry 450 Mg Tablet	25000279	CDM	Inpatient	450	ME	10			10	10
Cranberry Concentrate 500 Mg	25000280	CDM	Inpatient	500	ME	10			10	10
Cromolyn 4% Eye Drops	25000281	CDM	Inpatient	1	EA	10			10	10
Cyanocobalamin 1,000 Mcg/ml	25000282	CDM	Inpatient	1000	EA	32			32	32
Cyclobenzaprine 10 Mg Tablet	25000283	CDM	Inpatient	10	ME	7			7	7
Cyclobenzaprine 5 Mg Tablet	25000284	CDM	Inpatient	5	ME	7			7	7
Cyproheptadine 4 Mg Tablet	25000285	CDM	Inpatient	4	ME	10			10	10
Cyproheptadine HCL 4mg	25000286	CDM	Inpatient	4	ME	10			10	10
Daliresp 500 Mcg Tablet	25000287	CDM	Inpatient	500	EA	10			10	10
Darifenacin Er 15 Mg Tablet	25000288	CDM	Inpatient	15	ME	10			10	10
Darifenacin Er 7.5 Mg Tablet	25000289	CDM	Inpatient	7.5	ME	10			10	10
Debrox 6.5% Ear Drops	25000290	CDM	Inpatient	1	EA	3			3	3
Decara 50,000 Unit Softgel	25000291	CDM	Inpatient	1	EA	10			10	10
Desenex 2% Powder	25000292	CDM	Inpatient	2	EA	10			10	10
Desipramine 25 Mg Tablet	25000293	CDM	Inpatient	25	ME	6			6	6
Desipramine 50 Mg Tablet	25000294	CDM	Inpatient	50	ME	6			6	6
Desmopressin Acetate 0.2 Mg Tb	25000295	CDM	Inpatient	0.2	ME	10			10	10
Desonide 0.05% Cream	25000296	CDM	Inpatient	0.05	EA	10			10	10
Desonide 0.05% Ointment	25000297	CDM	Inpatient	0.05	EA	10			10	10
Desvenlafaxine Suc Er 25 Mg Tb	25000298	CDM	Inpatient	25	ME	10			10	10
Desvenlafaxine Suc Er 50 Mg Tb	25000299	CDM	Inpatient	50	ME	10			10	10
Dexilant Dr 60 Mg Capsule	25000300	CDM	Inpatient	60	ME	10			10	10
Dextroamp-Amphet Er 15 Mg Cap	25000301	CDM	Inpatient	15	ME	10			10	10
Dextroamp-Amphet Er 20 Mg Cap	25000302	CDM	Inpatient	20	ME	10			10	10
Dextroamp-Amphetamin 10 Mg Tab	25000303	CDM	Inpatient	10	ME	10			10	10
Dextroamp-Amphetamin 15 Mg Tab	25000304	CDM	Inpatient	15	ME	10			10	10
Dextroamp-Amphetamin 20 Mg Tab	25000305	CDM	Inpatient	20	ME	10			10	10
Dextroamp-Amphetamin 30 Mg Tab	25000306	CDM	Inpatient	30	ME	10			10	10
Diazepam 2 Mg Tablet	25000307	CDM	Inpatient	2	ME	6			6	6
Diazepam 5 Mg Tablet	25000308	CDM	Inpatient	5	ME	6			6	6
Diclofenac Sod Dr 50 Mg Tab	25000309	CDM	Inpatient	50	ME	10			10	10
Diclofenac Sod Dr 75 Mg Tab	25000310	CDM	Inpatient	75	ME	10			10	10
Diclofenac Sodium 1% Gel	25000311	CDM	Inpatient	1	EA	10			10	10
Dicyclomine 10 Mg Capsule	25000312	CDM	Inpatient	10	ME	6			6	6
Dicyclomine 20 Mg Tablet	25000313	CDM	Inpatient	20	ME	6			6	6
Digoxin 125 Mcg Tablet	25000314	CDM	Inpatient	125	EA	6			6	6
Dilt Xr 180 Mg Capsule	25000315	CDM	Inpatient	180	ME	20			20	20
Diltiazem 24h Er(cd) 120 Mg Cp	25000316	CDM	Inpatient	120	ME	17			17	17
Diltiazem 24h Er(cd) 180 Mg Cp	25000317	CDM	Inpatient	180	ME	17			17	17
Diltiazem 24h Er(cd) 240 Mg Cp	25000318	CDM	Inpatient	240	ME	17			17	17
Diltiazem 24hr Er 120 Mg Cap	25000319	CDM	Inpatient	120	ME	14			14	14
Diltiazem 24hr Er 180 Mg Cap	25000320	CDM	Inpatient	180	ME	14			14	14
Diltiazem 24hr Er 240 Mg Cap	25000321	CDM	Inpatient	240	ME	14			14	14
Diltiazem 30 Mg Tablet	25000322	CDM	Inpatient	30	ME	14			14	14
Diltiazem 60 Mg Tablet	25000323	CDM	Inpatient	60	ME	14			14	14
Diphedryl 12.5 Mg/5 Ml Elixir	25000324	CDM	Inpatient	12.5	ME	1			1	1
Diphedryl 25 Mg Tablet	25000325	CDM	Inpatient	25	ME	1			1	1
Diphenhydramine 50 Mg/ml Vial	25000326	CDM	Inpatient	50	ME	6			6	6
Diphenoxylate-Atropine 2.5-0.025 Mg Tablet	25000327	CDM	Inpatient	1	EA	7			7	7
Divalproex Dr 125 Mg Cap Sprnk	25000328	CDM	Inpatient	125	ME	15			15	15
Divalproex Sod Dr 125 Mg Tab	25000329	CDM	Inpatient	125	ME	15			15	15
Divalproex Sod Dr 250 Mg Tab	25000330	CDM	Inpatient	250	ME	10			10	10
Divalproex Sod Dr 500 Mg Tab	25000331	CDM	Inpatient	500	ME	14			14	14
Divalproex Sod Er 250 Mg Tab	25000332	CDM	Inpatient	250	ME	15			15	15
Divalproex Sod Er 500 Mg Tab	25000333	CDM	Inpatient	500	ME	15			15	15
Divalproex Sodium 125 Mg Cap	25000334	CDM	Inpatient	125	ME	15			15	15
DIVALPROEX TAB 500MG ER	25000335	CDM	Inpatient	500	ME	15			15	15
D-MANNOSE	25000336	CDM	Inpatient	1	EA	10			10	10
Docu Liquid 50 Mg/5 Ml	25000337	CDM	Inpatient	50	ME	10			10	10
Docusate Sodium 100 Mg Capsule	25000338	CDM	Inpatient	100	ME	6			6	6
Docusate Sodium 100 Mg Softgel	25000339	CDM	Inpatient	100	ME	6			6	6
Dok 100 Mg Softgel	25000340	CDM	Inpatient	100	ME	10			10	10
Dok 100 Mg Tablet	25000341	CDM	Inpatient	100	ME	10			10	10
Donepezil Hcl 10 Mg Tablet	25000342	CDM	Inpatient	10	ME	10			10	10
Donepezil Hcl 5 Mg Tablet	25000343	CDM	Inpatient	5	ME	10			10	10
Donepezil Hcl Odt 5 Mg Tablet	25000344	CDM	Inpatient	5	ME	10			10	10
Dorzolamide Hcl 2% Eye Drops	25000345	CDM	Inpatient	2	EA	386			386	386
Dorzolamide-Timolol Eye Drops	25000346	CDM	Inpatient	2	EA	386			386	386
Doxazosin Mesylate 1 Mg Tab	25000347	CDM	Inpatient	1	ME	6			6	6
Doxazosin Mesylate 2 Mg Tab	25000348	CDM	Inpatient	2	ME	6			6	6
Doxazosin Mesylate 4 Mg Tab	25000349	CDM	Inpatient	4	ME	6			6	6
Doxazosin Mesylate 8 Mg Tab	25000350	CDM	Inpatient	8	ME	6			6	6
Doxepin 10 Mg Capsule	25000351	CDM	Inpatient	10	ME	6			6	6
Doxepin 150 Mg Capsule	25000352	CDM	Inpatient	150	ME	6			6	6
Doxepin 25 Mg Capsule	25000353	CDM	Inpatient	25	ME	6			6	6
Doxepin 50 Mg Capsule	25000354	CDM	Inpatient	50	ME	6			6	6
Doxycycline Hyclate 100 Mg Cap	25000355	CDM	Inpatient	100	ME	17			17	17
Doxycycline Hyclate 100 Mg Tab	25000356	CDM	Inpatient	100	ME	17			17	17
Doxycycline Hyclate 50 Mg Cap	25000357	CDM	Inpatient	50	ME	17			17	17
Doxycycline Mono 100 Mg Cap	25000358	CDM	Inpatient	100	ME	17			17	17
Doxycycline Mono 100 Mg Tablet	25000359	CDM	Inpatient	100	ME	17			17	17
Dronabinol 2.5 Mg Capsule	25000360	CDM	Inpatient	2.5	ME	16.28			16.28	16.28
Duloxetine Hcl Dr 20 Mg Cap	25000361	CDM	Inpatient	20	ME	10			10	10
Duloxetine Hcl Dr 30 Mg Cap	25000362	CDM	Inpatient	30	ME	10			10	10
Duloxetine Hcl Dr 60 Mg Cap	25000363	CDM	Inpatient	60	ME	10			10	10
Dutasteride 0.5 Mg Capsule	25000364	CDM	Inpatient	0.5	ME	10			10	10
Dyrenium 50 Mg Capsule	25000365	CDM	Inpatient	50	ME	10			10	10
Ear Wax Removal 6.5% Drop	25000366	CDM	Inpatient	6.5	EA	10			10	10
Easy Touch Glucose Monitor Sys	25000367	CDM	Inpatient	1	EA	10			10	10
Easy Touch High-Low Ctrl Soln	25000368	CDM	Inpatient	1	EA	10			10	10
Easy Touch Pen Needle 32gx3/16	25000369	CDM	Inpatient	1	EA	10			10	10
Effer-K 25 Meq Tablet Eff	25000370	CDM	Inpatient	25	EA	10			10	10
Eliquis 2.5 Mg Tablet	25000371	CDM	Inpatient	2.5	ME	10			10	10
Eliquis 5 Mg Tablet	25000372	CDM	Inpatient	5	ME	10			10	10
Emsam 6 Mg/24 Hours Patch	25000373	CDM	Inpatient	1	EA	10			10	10
Enalapril Maleate 2.5 Mg Tab	25000374	CDM	Inpatient	2.5	ME	6			6	6
Enema Ready To Use	25000375	CDM	Inpatient	19	GM	6			6	6
Enoxaparin 30 Mg/0.3 Ml Syr	25000376	CDM	Inpatient	30	ME	10			10	10
Enoxaparin 40 Mg/0.4 Ml Syr	25000377	CDM	Inpatient	40	ME	10			10	10
Entacapone 200 Mg Tablet	25000378	CDM	Inpatient	200	ME	10			10	10
Entresto 24 Mg-26 Mg Tablet	25000379	CDM	Inpatient	1	EA	10			10	10
Entresto 49 Mg-51 Mg Tablet%	25000380	CDM	Inpatient	1	EA	10			10	10
Enulose 10 Gm/15 Ml Solution	25000381	CDM	Inpatient	10	GM	10			10	10
Erythromycin 0.5% Eye Ointment	25000382	CDM	Inpatient	5	ME	6			6	6
Escitalopram 10 Mg Tablet	25000383	CDM	Inpatient	10	ME	10			10	10
Escitalopram 20 Mg Tablet	25000384	CDM	Inpatient	20	ME	10			10	10
Escitalopram 5 Mg Tablet	25000385	CDM	Inpatient	5	ME	10			10	10
Esomeprazole Mag Dr 20 Mg Cap	25000386	CDM	Inpatient	20	ME	10			10	10
Esomeprazole Mag Dr 40 Mg Cap	25000387	CDM	Inpatient	40	ME	10			10	10
Estradiol 0.05 Mg/day Patch	25000388	CDM	Inpatient	1	EA	12			12	12
Estradiol 0.5 Mg Tablet	25000389	CDM	Inpatient	0.5	ME	7			7	7
Estradiol 1 Mg Tablet	25000390	CDM	Inpatient	1	ME	7			7	7
Estradiol 2 Mg Tablet	25000391	CDM	Inpatient	2	ME	7			7	7
Estradiol Tds 0.025 Mg/day	25000392	CDM	Inpatient	0.025	ME	12			12	12
Estradiol Tds 0.0375 Mg/day	25000393	CDM	Inpatient	0.0375	ME	12			12	12
Eszopiclone 2 Mg Tablet	25000394	CDM	Inpatient	2	ME	10			10	10
Eszopiclone 3 Mg Tablet	25000395	CDM	Inpatient	3	ME	10			10	10
Eucerin Intensive Repair Cream	25000396	CDM	Inpatient	1	EA	45			45	45
Eye Itch Relief 0.025% Drops	25000397	CDM	Inpatient	0.025	EA	10			10	10
Ezetimibe 10 Mg Tablet	25000398	CDM	Inpatient	10	ME	10			10	10
Famotidine 20 Mg Tablet	25000399	CDM	Inpatient	20	ME	8			8	8
Famotidine 40 Mg Tablet	25000400	CDM	Inpatient	40	ME	8			8	8
Fanapt 2 Mg Tablet	25000401	CDM	Inpatient	2	ME	10			10	10
Farxiga 5 Mg Tablet	25000402	CDM	Inpatient	5	ME	10			10	10
Felbamate 400 Mg Tablet	25000403	CDM	Inpatient	400	ME	10			10	10
Felbamate 600 Mg Tablet	25000404	CDM	Inpatient	600	ME	10			10	10
Felodipine Er 5 Mg Tablet	25000405	CDM	Inpatient	5	ME	10			10	10
Fenofibrate 145 Mg Tablet	25000406	CDM	Inpatient	145	ME	6			6	6
Fenofibrate 160 Mg Tablet	25000407	CDM	Inpatient	160	ME	6			6	6
Fenofibrate 48 Mg Tablet	25000408	CDM	Inpatient	48	ME	6			6	6
Fentanyl 100 Mcg/hr Patch	25000409	CDM	Inpatient	1	EA	279			279	279
Fentanyl 12 Mcg/hr Patch	25000410	CDM	Inpatient	1	EA	279			279	279
Fentanyl 25 Mcg/hr Patch	25000411	CDM	Inpatient	1	EA	279			279	279
Fentanyl 50 Mcg/hr Patch	25000412	CDM	Inpatient	1	EA	279			279	279
Fentanyl 75 Mcg/hr Patch	25000413	CDM	Inpatient	1	EA	279			279	279
Ferrous Fumarate 324 Mg Tab	25000414	CDM	Inpatient	324	ME	1.48			1.48	1.48
Ferrous Gluconate 324 Mg Tab	25000415	CDM	Inpatient	324	ME	1.48			1.48	1.48
Ferrous Sulf 44 Mg Iron/5 Ml Lq	25000416	CDM	Inpatient	220	ME	1.48			1.48	1.48
Ferrous Sulfate 325 Mg Tablet	25000417	CDM	Inpatient	1	EA	1.48			1.48	1.48
Fetzima Er 120 Mg Capsule	25000418	CDM	Inpatient	120	ME	14			14	14
Fetzima Er 20 Mg Capsule	25000419	CDM	Inpatient	20	ME	14			14	14
Fetzima Er 40 Mg Capsule	25000420	CDM	Inpatient	40	ME	14			14	14
Fetzima Er 80 Mg Capsule	25000421	CDM	Inpatient	80	ME	14			14	14
Fexofenadine Hcl 180 Mg Tablet	25000422	CDM	Inpatient	180	ME	14			14	14
Finasteride 5 Mg Tablet	25000423	CDM	Inpatient	5	ME	7			7	7
Fish Oil 1,000 Mg Softgel	25000424	CDM	Inpatient	1000	ME	10			10	10
Fixodent Cream Free 2.4oz	25000425	CDM	Inpatient	1	EA	5			5	5
Flecainide Acetate 100 Mg Tab	25000426	CDM	Inpatient	100	ME	5			5	5
Flecainide Acetate 50 Mg Tab	25000427	CDM	Inpatient	50	ME	5			5	5
Fleet Enema	25000428	CDM	Inpatient	19	GM	20			20	20
Fleet Glycerin Adult Suppos	25000429	CDM	Inpatient	1	EA	31			31	31
Flonase Allergy Rlf 50 Mcg Spr	25000430	CDM	Inpatient	50	EA	140			140	140
Floranex Granules Packet	25000431	CDM	Inpatient	1	EA	10			10	10
Floranex Tablet	25000432	CDM	Inpatient	1	EA	10			10	10
Florastor 250 Mg Cap	25000433	CDM	Inpatient	250	ME	10			10	10
Fluconazole 100 Mg Tablet	25000434	CDM	Inpatient	100	ME	10			10	10
Fluconazole 150 Mg Tablet	25000435	CDM	Inpatient	150	ME	10			10	10
Fluconazole 200 Mg Tablet	25000436	CDM	Inpatient	200	ME	10			10	10
Fludrocortisone 0.1 Mg Tablet	25000437	CDM	Inpatient	0.1	ME	45			45	45
Fluocinolone Oil 0.01% Ear Drp	25000438	CDM	Inpatient	0.01	EA	263			263	263
Fluoxetine Hcl 10 Mg Capsule	25000439	CDM	Inpatient	10	ME	15			15	15
Fluoxetine Hcl 10 Mg Tablet	25000440	CDM	Inpatient	10	ME	15			15	15
Fluoxetine Hcl 20 Mg Cap	25000441	CDM	Inpatient	20	ME	15			15	15
Fluoxetine Hcl 20 Mg Capsule	25000442	CDM	Inpatient	20	ME	15			15	15
Fluoxetine Hcl 40 Mg Capsule	25000443	CDM	Inpatient	40	ME	15			15	15
Fluphenazine 10 Mg Tablet	25000444	CDM	Inpatient	10	ME	34			34	34
Fluphenazine Dec 125 Mg/5 Ml	25000445	CDM	Inpatient	25	ME	34			34	34
Fluticasone 9.9ml/ 50mcg	25000446	CDM	Inpatient	50	EA	90			90	90
Fluticasone Prop 50 Mcg Spray	25000447	CDM	Inpatient	50	EA	70			70	70
Fluvoxamine Maleate 100 Mg Tab	25000448	CDM	Inpatient	100	ME	18			18	18
Fluvoxamine Maleate 50 Mg Tab	25000449	CDM	Inpatient	50	ME	18			18	18
Folbic Rf Tablet	25000450	CDM	Inpatient	1	EA	10			10	10
Folic Acid 1 Mg Tablet	25000451	CDM	Inpatient	1	ME	7			7	7
Furosemide 20 Mg Tablet	25000452	CDM	Inpatient	20	ME	6			6	6
Furosemide 40 Mg Tablet	25000453	CDM	Inpatient	40	ME	6			6	6
Furosemide 40 Mg/4 Ml Vial	25000454	CDM	Inpatient	10	ME	6			6	6
Furosemide 80 Mg Tablet	25000455	CDM	Inpatient	80	ME	8			8	8
Fycompa 8 Mg Tablet	25000456	CDM	Inpatient	8	ME	10			10	10
Gabapentin 100 Mg Capsule	25000457	CDM	Inpatient	100	ME	6			6	6
Gabapentin 300 Mg Capsule	25000458	CDM	Inpatient	300	ME	8			8	8
Gabapentin 400 Mg Capsule	25000459	CDM	Inpatient	400	ME	23			23	23
Gabapentin 600 Mg Tablet	25000460	CDM	Inpatient	600	ME	23			23	23
Gabapentin 800 Mg Tablet	25000461	CDM	Inpatient	800	ME	23			23	23
Galantamine Hbr 4 Mg Tablet	25000462	CDM	Inpatient	4	ME	15			15	15
Gas Relief 125 Mg Chew Tablet	25000463	CDM	Inpatient	125	ME	10			10	10
Gas Relief 80 Tablet Chew	25000464	CDM	Inpatient	80	ME	10			10	10
Gaviscon Liquid	25000465	CDM	Inpatient	1	EA	16			16	16
Gemfibrozil 600 Mg Tablet	25000466	CDM	Inpatient	600	ME	8			8	8
Geodon 20 Mg/ml Vial	25000467	CDM	Inpatient	20	ME	654			654	654
GEODON 20MG/ML	25000468	CDM	Inpatient	20	ME	36			36	36
Geri-Kot 8.6 Mg Tablet	25000469	CDM	Inpatient	8.6	ME	10			10	10
Geri-Lanta Liquid	25000470	CDM	Inpatient	200	ME	10			10	10
Geritol Complete Tablet	25000471	CDM	Inpatient	1	EA	10			10	10
Ginkgo Biloba 60 Mg Capsule	25000472	CDM	Inpatient	60	ME	1			1	1
Glimepiride 1 Mg Tablet	25000473	CDM	Inpatient	1	ME	7			7	7
Glimepiride 2 Mg Tablet	25000474	CDM	Inpatient	2	ME	7			7	7
Glimepiride 4 Mg Tablet	25000475	CDM	Inpatient	4	ME	7			7	7
Glipizide 10 Mg Tablet	25000476	CDM	Inpatient	10	ME	6			6	6
Glipizide 5 Mg Tablet	25000477	CDM	Inpatient	5	ME	6			6	6
Glipizide Er 10 Mg Tablet	25000478	CDM	Inpatient	10	ME	10			10	10
Glipizide Er 2.5 Mg Tablet	25000479	CDM	Inpatient	2.5	ME	10			10	10
Glipizide Er 5 Mg Tablet	25000480	CDM	Inpatient	5	ME	10			10	10
Glucosamine 500 Mg Capsule	25000481	CDM	Inpatient	500	ME	6			6	6
Glucosamine-Chondroitin Cap	25000482	CDM	Inpatient	1	EA	6			6	6
Glutose 15 Gel	25000483	CDM	Inpatient	40	EA	60			60	60
Glyburide 5 Mg Tablet	25000484	CDM	Inpatient	5	ME	6			6	6
Gnp Acetaminophen Pm 500mg Cap 50ct	25000485	CDM	Inpatient	500	ME	10			10	10
Gnp Adlt Mv Gmy	25000486	CDM	Inpatient	1	EA	10			10	10
Gnp Allergy Chlorpheniramine 4mg Tab 100	25000487	CDM	Inpatient	1	EA	10			10	10
Gnp Antacid Max Strgth Orig Liq 12oz	25000488	CDM	Inpatient	1	EA	10			10	10
Gnp Apap 650mg Caplet Clr Botl Er 225ct	25000489	CDM	Inpatient	1	EA	10			10	10
Gnp B-100 Complex Tablet	25000490	CDM	Inpatient	1	EA	10			10	10
Gnp B-Complex Tablet plus vitamin c	25000491	CDM	Inpatient	1	EA	10			10	10
Gnp Calcium 600 Mg Tablet	25000492	CDM	Inpatient	600	ME	10			10	10
Gnp Calcium 600 Mg-D3 800 Unit	25000493	CDM	Inpatient	600	ME	10			10	10
Gnp Calcium Citrate-Vit D3 Tab	25000494	CDM	Inpatient	1	EA	10			10	10
Gnp Clr Lax 10x0.5 Oz Pwd	25000495	CDM	Inpatient	1	EA	10			10	10
Gnp Co Q-10 100 Mg Capsule	25000496	CDM	Inpatient	100	ME	10			10	10
Gnp Co Q-10 200 Mg Capsule	25000497	CDM	Inpatient	200	ME	10			10	10
Gnp Cranberry 200 Mg Capsule	25000498	CDM	Inpatient	200	ME	10			10	10
Gnp Diclofenac Pain Relieving Gel 100gm	25000499	CDM	Inpatient	1	EA	10			10	10
Gnp Diphedryl 25 Mg Cap 24ct	25000500	CDM	Inpatient	25	ME	10			10	10
Gnp Dry Eye Therapy 0.5oz	25000501	CDM	Inpatient	1	EA	10			10	10
Gnp Easy Touch Gluc Test Strip	25000502	CDM	Inpatient	1	EA	10			10	10
Gnp Eye Drops 15 Ml Drp	25000503	CDM	Inpatient	1	EA	10			10	10
Gnp Fexofenadine Hcl 180mg Tab 90ct	25000504	CDM	Inpatient	180	ME	10			10	10
Gnp Fish Oil 1,000 Mg Softgel	25000505	CDM	Inpatient	1000	ME	10			10	10
Gnp Fish Oil Ec 1,000 Mg Sftgl	25000506	CDM	Inpatient	1000	ME	10			10	10
Gnp Fluticasn 15.8 Ml 50 Mcg Spy	25000507	CDM	Inpatient	1	EA	10			10	10
Gnp Folic Acid 400 Mcg Tablet	25000508	CDM	Inpatient	400	EA	10			10	10
Gnp Glucosamine-Chondr-Msm Tab	25000509	CDM	Inpatient	1	EA	10			10	10
Gnp Ibuprofen 200mg Clear Botl Tab 500ct	25000510	CDM	Inpatient	1	EA	10			10	10
Gnp Magnesium 250 Mg Tablet	25000511	CDM	Inpatient	250	ME	10			10	10
Gnp Melatonin 10MG TAB	25000512	CDM	Inpatient	10	ME	10			10	10
Gnp Melatonin 3 Mg Tablet	25000513	CDM	Inpatient	3	ME	10			10	10
Gnp Melatonin 5 Mg Tablet	25000514	CDM	Inpatient	5	ME	10			10	10
Gnp Milk Of Magnesia Mint Liq 12oz	25000515	CDM	Inpatient	1	EA	10			10	10
Gnp Naproxen 220 Mg Cpl	25000516	CDM	Inpatient	220	ME	10			10	10
Gnp Naproxen 220mg Tablet 50ct	25000517	CDM	Inpatient	1	EA	10			10	10
Gnp Niacin 500 MG	25000518	CDM	Inpatient	500	ME	10			10	10
Gnp Pain Rlf Arthritis 650mg Cpl 200ct	25000519	CDM	Inpatient	650	ME	10			10	10
Gnp Potassium 99 Mg Tablet	25000520	CDM	Inpatient	99	ME	10			10	10
Gnp Povidone 8oz Liq	25000521	CDM	Inpatient	1	EA	10			10	10
Gnp Red Yeast Rice 600 Mg Cap	25000522	CDM	Inpatient	600	ME	10			10	10
GNP STOMACH RELIEF	25000523	CDM	Inpatient	1	EA	10			10	10
GNP STOOL SOFT/LAX	25000524	CDM	Inpatient	8.6	ME	10			10	10
Gnp Triple Antibiotic Ointment 0.5oz	25000525	CDM	Inpatient	1	EA	10			10	10
Gnp Triple Antibiotic Ointment 1oz	25000526	CDM	Inpatient	1	EA	10			10	10
Gnp Triple Omega Complex 3-6-9	25000527	CDM	Inpatient	1	EA	10			10	10
Gnp Urin Hlth 50tab	25000528	CDM	Inpatient	1	EA	10			10	10
Gnp Urinary 95 Mg	25000529	CDM	Inpatient	95	ME	10			10	10
Gnp Vit B-12 Er 1,000 Mcg Tab	25000530	CDM	Inpatient	1000	EA	10			10	10
Gnp Vitamin B-1 100 Mg Tablet	25000531	CDM	Inpatient	1000	ME	10			10	10
Gnp Vitamin B-12 500 Mcg Tab	25000532	CDM	Inpatient	500	EA	10			10	10
Gnp Vitamin B-6 100 Mg Tablet	25000533	CDM	Inpatient	100	ME	10			10	10
Gnp Vitamin C 250 Mg Tablet	25000534	CDM	Inpatient	250	ME	10			10	10
Gnp Vitamin C 500 Mg Tab Chew	25000535	CDM	Inpatient	500	ME	10			10	10
Gnp Vitamin C 500 Mg Tablet	25000536	CDM	Inpatient	500	ME	10			10	10
Gnp Vitamin D 1,000 Unit Tab	25000537	CDM	Inpatient	1000	UN	10			10	10
Gnp Vitamin D 2,000 Unit Tab	25000538	CDM	Inpatient	2000	UN	10			10	10
Gnp Vitamin D 5,000 Unit Tab	25000539	CDM	Inpatient	5000	UN	10			10	10
Gnp Vitamin E 200 Unit Softgel	25000540	CDM	Inpatient	200	UN	10			10	10
Gnp Vitamin E 400 Unit Softgel	25000541	CDM	Inpatient	400	UN	10			10	10
Guanfacine 1 Mg Tablet	25000542	CDM	Inpatient	1	ME	6			6	6
Haloperidol 0.5 Mg Tablet	25000543	CDM	Inpatient	0.5	ME	6			6	6
Haloperidol 10 Mg Tablet	25000544	CDM	Inpatient	10	ME	6			6	6
Haloperidol 2 Mg Tablet	25000545	CDM	Inpatient	2	ME	6			6	6
Haloperidol 5 Mg Tablet	25000546	CDM	Inpatient	5	ME	6			6	6
Haloperidol Dec 100 Mg/ml Vial	25000547	CDM	Inpatient	100	ME	6			6	6
Haloperidol Dec 50 Mg/ml Vial	25000548	CDM	Inpatient	50	ME	6			6	6
Haloperidol Dec 500 Mg/5 Ml Vl	25000549	CDM	Inpatient	100	ME	6			6	6
Haloperidol Lac 2 Mg/ml Conc	25000550	CDM	Inpatient	2	ME	6			6	6
Haloperidol Lac 5 Mg/ml Vial	25000551	CDM	Inpatient	5	ME	6			6	6
Healthy Eyes Tablet	25000552	CDM	Inpatient	1	EA	10			10	10
Healthylax Powder Packet	25000553	CDM	Inpatient	17	GM	10			10	10
Heartburn Relief 10 Mg Tablet	25000554	CDM	Inpatient	10	ME	10			10	10
HEARTBURN RELIEF 10MG	25000555	CDM	Inpatient	10	ME	10			10	10
Hemocyte Plus Capsule	25000556	CDM	Inpatient	1	EA	3			3	3
Hemorrhoidal Ointment	25000557	CDM	Inpatient	1	EA	10			10	10
Hemorrhoidal Suppositories	25000558	CDM	Inpatient	0.25	EA	10			10	10
Humalog 100 Units/ml Kwikpen	25000559	CDM	Inpatient	100	UN	135			135	135
Humalog 100 Units/ml Vial	25000560	CDM	Inpatient	100	UN	135			135	135
Humulin 70-30 Vial	25000561	CDM	Inpatient	100	UN	34			34	34
Humulin R 100 Units/ml Vial	25000562	CDM	Inpatient	100	UN	140			140	140
Hydralazine 10 Mg Tablet	25000563	CDM	Inpatient	10	ME	18			18	18
Hydralazine 100 Mg Tablet	25000564	CDM	Inpatient	100	ME	6			6	6
Hydralazine 25 Mg Tablet	25000565	CDM	Inpatient	25	ME	3			3	3
Hydralazine 50 Mg Tablet	25000566	CDM	Inpatient	50	ME	4.5			4.5	4.5
Hydrochlorothiazide 12.5 Mg Cp	25000567	CDM	Inpatient	12.5	ME	10			10	10
Hydrochlorothiazide 12.5 Mg Tb	25000568	CDM	Inpatient	12.5	ME	10			10	10
Hydrochlorothiazide 25 Mg Tab	25000569	CDM	Inpatient	25	ME	10			10	10
Hydrochlorothiazide 50 Mg Tab	25000570	CDM	Inpatient	50	ME	10			10	10
Hydrocodone-Acetaminophen 10-325 Mg Tablet	25000571	CDM	Inpatient	1	EA	7			7	7
Hydrocodone-Acetaminophen 7.5-325 Mg Tablet	25000572	CDM	Inpatient	1	EA	7			7	7
Hydrocodone-APAP 5-325 Mg Tablet	25000573	CDM	Inpatient	1	EA	7			7	7
Hydrocortisone 0.5% Cream	25000574	CDM	Inpatient	0.5	EA	24			24	24
Hydrocortisone 1% Cream	25000575	CDM	Inpatient	1	EA	24			24	24
Hydrocortisone 10 Mg Tablet	25000576	CDM	Inpatient	10	ME	2			2	2
Hydrocortisone 2.5% Cream	25000577	CDM	Inpatient	2.5	EA	24			24	24
Hydrocortisone 2.5% Ointment	25000578	CDM	Inpatient	2.5	EA	24			24	24
Hydrocortisone Ac 25 Mg Supp	25000579	CDM	Inpatient	25	ME	2			2	2
Hydroxychloroquine 200 Mg Tab	25000580	CDM	Inpatient	200	ME	6			6	6
Hydroxyurea 500 Mg Capsule	25000581	CDM	Inpatient	500	ME	10			10	10
Hydroxyzine 25 Mg/ml Vial	25000582	CDM	Inpatient	25	ME	135			135	135
Hydroxyzine Hcl 10 Mg Tablet	25000583	CDM	Inpatient	10	ME	7			7	7
Hydroxyzine Hcl 25 Mg Tablet	25000584	CDM	Inpatient	25	ME	7			7	7
Hydroxyzine Hcl 50 Mg Tablet	25000585	CDM	Inpatient	50	ME	7			7	7
Hydroxyzine Pam 25 Mg Cap	25000586	CDM	Inpatient	25	ME	6			6	6
Hydroxyzine Pam 50 Mg Cap	25000587	CDM	Inpatient	50	ME	6			6	6
Hyoscyamine Sulf 0.125 Mg Tab	25000588	CDM	Inpatient	0.125	ME	6			6	6
Hysept 0.50% Solution	25000589	CDM	Inpatient	0.5	EA	10			10	10
Ibuprofen 200 Mg Tablet	25000590	CDM	Inpatient	200	ME	21			21	21
Ibuprofen 400 Mg Tablet	25000591	CDM	Inpatient	400	ME	6			6	6
Ibuprofen 600 Mg Tablet	25000592	CDM	Inpatient	600	ME	6			6	6
Ibuprofen 800 Mg Tablet	25000593	CDM	Inpatient	800	ME	6			6	6
Icar-C Tablet	25000594	CDM	Inpatient	1	EA	10			10	10
Icy Hot 4%-1% Patch	25000595	CDM	Inpatient	1	EA	10			10	10
Indapamide 1.25 Mg Tablet	25000596	CDM	Inpatient	1.25	ME	10			10	10
Ingrezza 40 Mg Capsule	25000597	CDM	Inpatient	40	ME	10			10	10
Ingrezza 80 Mg Capsule	25000598	CDM	Inpatient	80	ME	10			10	10
Insta-Glucose Gel	25000599	CDM	Inpatient	24	GM	10			10	10
Insulin Lispro 100 Unit/ml Kwikpen	25000600	CDM	Inpatient	100	UN	120			120	120
Invega Er 3 Mg Tablet	25000601	CDM	Inpatient	3	ME	43			43	43
Ipratropium 0.03% Spray	25000602	CDM	Inpatient	21	EA	239			239	239
Ipratropium Br 0.02% Soln	25000603	CDM	Inpatient	0.2	ME	236			236	236
Ipratropium-Albuterol 0.5-3(2.5) Mg/3 Ml	25000604	CDM	Inpatient	0.5	ME	116			116	116
Irbesartan 150 Mg Tablet	25000605	CDM	Inpatient	150	ME	1.6			1.6	1.6
Irbesartan 300 Mg Tablet	25000606	CDM	Inpatient	300	ME	1.6			1.6	1.6
Irbesartan-Hydrochlorothiazide 300-12.5 Mg Tb	25000607	CDM	Inpatient	1	EA	1.6			1.6	1.6
Iron 65 Mg Tablet	25000608	CDM	Inpatient	65	ME	3.32			3.32	3.32
Isosorbide Dinitrate 10 Mg Tab	25000609	CDM	Inpatient	10	ME	6			6	6
ISOSORBIDE DINITRATE 20MG TAB	25000610	CDM	Inpatient	20	ME	6			6	6
Isosorbide Dinitrate 30 Mg Tab	25000611	CDM	Inpatient	30	ME	6			6	6
Isosorbide Dn 10 Mg Tablet	25000612	CDM	Inpatient	10	ME	6			6	6
Isosorbide Mn 20 Mg Tablet	25000613	CDM	Inpatient	20	ME	10			10	10
Isosorbide Mn Er 30 Mg Tablet	25000614	CDM	Inpatient	30	ME	10			10	10
Isosorbide Mn Er 60 Mg Tablet	25000615	CDM	Inpatient	60	ME	10			10	10
Isosorbide Mononit Er 30 Mg Tb	25000616	CDM	Inpatient	30	ME	10			10	10
Isosorbide Mononit Er 60 Mg Tb	25000617	CDM	Inpatient	60	ME	10			10	10
Ivermectin 3 Mg Tablet	25000618	CDM	Inpatient	3	ME	10			10	10
Januvia 100 Mg Tablet	25000619	CDM	Inpatient	100	ME	5			5	5
Januvia 100 Mg Tablet%	25000620	CDM	Inpatient	100	ME	60			60	60
Januvia 25 Mg Tablet	25000621	CDM	Inpatient	25	ME	50			50	50
Januvia 50 Mg Tablet	25000622	CDM	Inpatient	50	ME	45			45	45
Jardiance 10 Mg Tablet%	25000623	CDM	Inpatient	10	ME	10			10	10
Jardiance 25 Mg Tablet%	25000624	CDM	Inpatient	25	ME	10			10	10
Juven Orange Pwd Packet 30x27.5gm	25000625	CDM	Inpatient	27.5	GM	6			6	6
Juven Packet	25000626	CDM	Inpatient	1	EA	6			6	6
K2 Plus D3 Tablet	25000627	CDM	Inpatient	1	EA	10			10	10
Kaopectate	25000628	CDM	Inpatient	1	EA	3.6			3.6	3.6
Kao-Tin 240 Mg Softgel	25000629	CDM	Inpatient	240	ME	27			27	27
Ketoconazole 2% Shampoo	25000630	CDM	Inpatient	2	EA	53			53	53
Ketorolac 10 Mg Tablet	25000631	CDM	Inpatient	10	ME	6			6	6
Ketotifen Fum 0.025% Eye Drops	25000632	CDM	Inpatient	0.025	EA	10			10	10
Labetalol Hcl 100 Mg Tablet	25000633	CDM	Inpatient	100	ME	6			6	6
Labetalol Hcl 200 Mg Tablet	25000634	CDM	Inpatient	200	ME	6			6	6
Lactase 3,000 Unit Caplet	25000635	CDM	Inpatient	3000	UN	10			10	10
Lactulose 10 Gm/15 Ml Solution	25000636	CDM	Inpatient	10	GM	72			72	72
Lamotrigine 100 Mg Tablet	25000637	CDM	Inpatient	100	ME	16			16	16
Lamotrigine 150 Mg Tablet	25000638	CDM	Inpatient	150	ME	16			16	16
Lamotrigine 200 Mg Tablet	25000639	CDM	Inpatient	200	ME	16			16	16
Lamotrigine 25 Mg Tablet	25000640	CDM	Inpatient	25	ME	16			16	16
Lansoprazole Dr 30 Mg Capsule	25000641	CDM	Inpatient	30	ME	10			10	10
Lantus 100 Units/ml Vial	25000642	CDM	Inpatient	100	UN	34			34	34
Lantus Solostar 100 Units/ml	25000643	CDM	Inpatient	100	UN	147			147	147
Latanoprost 0.005% Eye Drops	25000644	CDM	Inpatient	0.005	EA	10			10	10
Latuda 120 Mg Tablet%	25000645	CDM	Inpatient	120	ME	99.91			99.91	99.91
Latuda 20 Mg Tablet%	25000646	CDM	Inpatient	20	ME	78			78	78
Latuda 40 Mg Tablet%	25000647	CDM	Inpatient	40	ME	78			78	78
Latuda 60 Mg Tablet%	25000648	CDM	Inpatient	60	ME	80			80	80
Latuda 80 Mg Tablet%	25000649	CDM	Inpatient	80	ME	80			80	80
Laxative Ec 5 Mg Tablet	25000650	CDM	Inpatient	5	ME	14			14	14
Letrozole 2.5 Mg Tablet	25000651	CDM	Inpatient	2.5	ME	10			10	10
Levalbuterol 0.63 Mg/3 Ml Sol	25000652	CDM	Inpatient	0.63	ME	10			10	10
Levalbuterol 1.25 Mg/3 Ml Sol	25000653	CDM	Inpatient	1.25	ME	10			10	10
Levemir 100 Units/ml Vial	25000654	CDM	Inpatient	1	UN	519			519	519
Levemir Flextouch 100 Units/ml	25000655	CDM	Inpatient	100	UN	519			519	519
Levetiracetam 1,000 Mg Tablet	25000656	CDM	Inpatient	1000	ME	14			14	14
Levetiracetam 100 Mg/ml Soln	25000657	CDM	Inpatient	100	ME	14			14	14
Levetiracetam 250 Mg Tablet	25000658	CDM	Inpatient	250	ME	14			14	14
Levetiracetam 500 Mg Tablet	25000659	CDM	Inpatient	500	ME	14			14	14
Levetiracetam 750 Mg Tablet	25000660	CDM	Inpatient	750	ME	14			14	14
Levocetirizine 5 Mg Tablet	25000661	CDM	Inpatient	5	ME	10			10	10
Levofloxacin 250 Mg Tablet	25000662	CDM	Inpatient	250	ME	10			10	10
Levofloxacin 500 Mg Tablet	25000663	CDM	Inpatient	500	ME	10			10	10
Levofloxacin 750 Mg Tablet	25000664	CDM	Inpatient	750	ME	10			10	10
Levothyroxine 100 Mcg Tablet	25000665	CDM	Inpatient	100	EA	6			6	6
Levothyroxine 112 Mcg Tablet	25000666	CDM	Inpatient	112	EA	6			6	6
Levothyroxine 125 Mcg Tablet	25000667	CDM	Inpatient	125	EA	6			6	6
Levothyroxine 137 Mcg Tablet	25000668	CDM	Inpatient	137	EA	5			5	5
Levothyroxine 150 Mcg Tablet	25000669	CDM	Inpatient	150	EA	5			5	5
Levothyroxine 175 Mcg Tablet	25000670	CDM	Inpatient	175	EA	6			6	6
Levothyroxine 200 Mcg Tablet	25000671	CDM	Inpatient	200	EA	6			6	6
Levothyroxine 25 Mcg Tablet	25000672	CDM	Inpatient	25	EA	6			6	6
Levothyroxine 50 Mcg Tablet	25000673	CDM	Inpatient	50	EA	6			6	6
Levothyroxine 75 Mcg Tablet	25000674	CDM	Inpatient	75	EA	6			6	6
Levothyroxine 88 Mcg Tablet	25000675	CDM	Inpatient	88	EA	6			6	6
Lexapro 10 Mg Tablet	25000676	CDM	Inpatient	10	ME	19			19	19
Lidocaine Hcl 1% 50 Mg/5 Ml Vl	25000677	CDM	Inpatient	10	ME	5			5	5
Lidocaine Hcl 1% Vial	25000678	CDM	Inpatient	10	ME	31.64			31.64	31.64
Lidocaine Hcl 2% Vial	25000679	CDM	Inpatient	20	ME	31.64			31.64	31.64
Lidocaine Pain Relief 4% Patch	25000680	CDM	Inpatient	4	EA	5			5	5
Lidocaine Patch 5% Bx/30	25000681	CDM	Inpatient	5	EA	5			5	5
Linezolid 600 Mg Tablet	25000682	CDM	Inpatient	600	ME	453			453	453
Linzess 145 Mcg Capsule	25000683	CDM	Inpatient	145	EA	63			63	63
Linzess 290 Mcg Capsule	25000684	CDM	Inpatient	290	EA	63			63	63
Linzess 72 Mcg Capsule	25000685	CDM	Inpatient	72	EA	63			63	63
Liothyronine Sod 25 Mcg Tab	25000686	CDM	Inpatient	25	EA	7.96			7.96	7.96
Lisinopril 10 Mg Tablet	25000687	CDM	Inpatient	10	ME	6			6	6
Lisinopril 2.5 Mg Tablet	25000688	CDM	Inpatient	2.5	ME	9			9	9
Lisinopril 20 Mg Tablet	25000689	CDM	Inpatient	20	ME	13			13	13
Lisinopril 30 Mg Tablet	25000690	CDM	Inpatient	30	ME	14			14	14
Lisinopril 40 Mg Tablet	25000691	CDM	Inpatient	40	ME	14			14	14
Lisinopril 5 Mg Tablet	25000692	CDM	Inpatient	5	ME	10			10	10
Lisinopril-Hctz 10-12.5 Mg Tab	25000693	CDM	Inpatient	1	EA	6			6	6
Lisinopril-Hydrochlorothiazide 20-12.5 Mg Tab	25000694	CDM	Inpatient	1	EA	10			10	10
Lisinopril-Hydrochlorothiazide 20-25 Mg Tab	25000695	CDM	Inpatient	1	EA	10			10	10
LITHIUM CARB CAP 300MG	25000696	CDM	Inpatient	300	ME	6			6	6
Lithium Carbonate 150 Mg Cap	25000697	CDM	Inpatient	150	ME	7			7	7
Lithium Carbonate 300 Mg Cap	25000698	CDM	Inpatient	300	ME	7			7	7
Lithium Carbonate Er 300 Mg Tb	25000699	CDM	Inpatient	300	ME	7			7	7
Lithium Carbonate Er 450 Mg Tb	25000700	CDM	Inpatient	450	ME	7			7	7
L-Methylfolate 15 Mg Caplet	25000701	CDM	Inpatient	15	ME	10			10	10
L-Methylfolate 15 Mg Capsule	25000702	CDM	Inpatient	15	ME	10			10	10
L-Methylfolate Calcium 15 Mg	25000703	CDM	Inpatient	15	ME	10			10	10
L-Methylfolate Forte 7.5 Mg Cp	25000704	CDM	Inpatient	7.5	ME	10			10	10
Loratadine 10 Mg Tablet	25000705	CDM	Inpatient	10	ME	6			6	6
Lorazepam 0.5 Mg Tablet	25000706	CDM	Inpatient	0.5	ME	5			5	5
Lorazepam 1 Mg Tablet	25000707	CDM	Inpatient	1	ME	13			13	13
Lorazepam 2 Mg Tablet	25000708	CDM	Inpatient	2	ME	13			13	13
Lorazepam 2 Mg/ml Vial	25000709	CDM	Inpatient	2	ME	38			38	38
Losartan Potassium 100 Mg Tab	25000710	CDM	Inpatient	100	ME	10			10	10
Losartan Potassium 25 Mg Tab	25000711	CDM	Inpatient	25	ME	10			10	10
Losartan Potassium 50 Mg Tab	25000712	CDM	Inpatient	50	ME	10			10	10
Losartan-Hydrochlorothiazide 100-12.5 Mg Tab	25000713	CDM	Inpatient	1	EA	10			10	10
Losartan-Hydrochlorothiazide 100-25 Mg Tab	25000714	CDM	Inpatient	1	EA	10			10	10
Losartan-Hydrochlorothiazide 50-12.5 Mg Tab	25000715	CDM	Inpatient	1	EA	10			10	10
Lovastatin 20 Mg Tablet	25000716	CDM	Inpatient	20	ME	13			13	13
Lovastatin 40 Mg Tablet	25000717	CDM	Inpatient	40	ME	13			13	13
Loxapine 10 Mg Capsule	25000718	CDM	Inpatient	10	ME	13			13	13
Lubriderm Daily Moisture Lot	25000719	CDM	Inpatient	1	EA	10			10	10
Lumigan 0.01% Eye Drops	25000720	CDM	Inpatient	0.01	EA	425			425	425
Lyrica 100 Mg Capsule	25000721	CDM	Inpatient	100	ME	6			6	6
Lyrica 150 Mg Capsule	25000722	CDM	Inpatient	150	ME	6			6	6
Lyrica 200 Mg Capsule	25000723	CDM	Inpatient	200	ME	16			16	16
Lyrica 25 Mg Capsule	25000724	CDM	Inpatient	25	ME	6			6	6
Lyrica 50 Mg Capsule	25000725	CDM	Inpatient	50	ME	6			6	6
Lyrica 75 Mg Capsule	25000726	CDM	Inpatient	75	ME	6			6	6
Magnesium Citrate Solution	25000727	CDM	Inpatient	1	EA	33			33	33
Magnesium Gluc 500 Mg Tablet	25000728	CDM	Inpatient	500	ME	4			4	4
Magnesium Oxide 400 Mg Tablet	25000729	CDM	Inpatient	400	ME	4			4	4
Magnesium Sulfate 50% Vial	25000730	CDM	Inpatient	4	EA	81			81	81
Mapap 500 Mg Tablet	25000731	CDM	Inpatient	500	ME	10			10	10
Meclizine 12.5 Mg Tablet	25000732	CDM	Inpatient	12.5	ME	6			6	6
Meclizine 25 Mg Tablet	25000733	CDM	Inpatient	25	ME	6			6	6
Medihoney 100% Paste	25000734	CDM	Inpatient	1	EA	10			10	10
Medroxyprogesterone 10 Mg Tab	25000735	CDM	Inpatient	10	ME	6			6	6
Megestrol 40 Mg Tablet	25000736	CDM	Inpatient	40	ME	129			129	129
Megestrol Acet 40 Mg/ml Susp	25000737	CDM	Inpatient	400	ME	129			129	129
Megestrol Acet 400 Mg/10 Ml	25000738	CDM	Inpatient	400	ME	129			129	129
Melatonin 1 Mg Tablet	25000739	CDM	Inpatient	1	ME	6			6	6
Melatonin 10 Mg Tablet Sl	25000740	CDM	Inpatient	10	ME	7			7	7
Melatonin 3 Mg Tablet	25000741	CDM	Inpatient	3	ME	13			13	13
Melatonin 5 Mg Tablet	25000742	CDM	Inpatient	5	ME	7			7	7
Melatonin Cr 10 Mg Tablet	25000743	CDM	Inpatient	10	ME	7			7	7
Meloxicam 15 Mg Tablet	25000744	CDM	Inpatient	15	ME	7			7	7
Meloxicam 7.5 Mg Tablet	25000745	CDM	Inpatient	7.5	ME	7			7	7
Memantine Hcl 10 Mg Tablet	25000746	CDM	Inpatient	10	ME	18.4			18.4	18.4
Memantine Hcl 28 Mg Er Cap 30	25000747	CDM	Inpatient	28	ME	18.4			18.4	18.4
Memantine Hcl 5 Mg Tablet	25000748	CDM	Inpatient	5	ME	18.4			18.4	18.4
Metafolbic Plus Rf Caplet	25000749	CDM	Inpatient	1	EA	10			10	10
Metafolbic Tablet	25000750	CDM	Inpatient	1	EA	10			10	10
Metamucil Fiber Singles Packet	25000751	CDM	Inpatient	3.4	GM	15			15	15
Metamucil Powder	25000752	CDM	Inpatient	1	EA	15			15	15
Metaxalone 800 Mg Tablet	25000753	CDM	Inpatient	800	ME	10			10	10
Metformin Hcl 1,000 Mg Tab	25000754	CDM	Inpatient	1000	ME	10			10	10
Metformin Hcl 1,000 Mg Tablet	25000755	CDM	Inpatient	1000	ME	10			10	10
Metformin Hcl 500 Mg Tab	25000756	CDM	Inpatient	500	ME	3			3	3
Metformin Hcl 500 Mg Tablet	25000757	CDM	Inpatient	500	ME	3			3	3
Metformin Hcl Er 500 Mg Tablet	25000758	CDM	Inpatient	500	ME	3			3	3
METFORMIN TAB 1000MG	25000759	CDM	Inpatient	1000	ME	6			6	6
METFORMIN TAB 500MG	25000760	CDM	Inpatient	500	ME	6			6	6
Methenamine Hipp 1 Gm Tablet	25000761	CDM	Inpatient	1	GM	12			12	12
Methenamine Md 1 Gm Tablet	25000762	CDM	Inpatient	1	GM	12			12	12
Methocarbamol 500 Mg Tab	25000763	CDM	Inpatient	500	ME	3			3	3
Methocarbamol 750 Mg Tablet	25000764	CDM	Inpatient	750	ME	3			3	3
Methotrexate 2.5 Mg Tablet	25000765	CDM	Inpatient	2.5	ME	19			19	19
Methotrexate 50 Mg/2 Ml Vial	25000766	CDM	Inpatient	25	ME	35			35	35
Methylphenidate 10 Mg Tablet	25000767	CDM	Inpatient	10	ME	10			10	10
Methylphenidate 20 Mg Tablet	25000768	CDM	Inpatient	20	ME	10			10	10
Methylphenidate 5 Mg Tablet	25000769	CDM	Inpatient	5	ME	10			10	10
Methylphenidate Er 10 Mg Tab	25000770	CDM	Inpatient	10	ME	10			10	10
Methylprednisolone 4 Mg Dosepk	25000771	CDM	Inpatient	4	ME	10			10	10
Metoclopramide 10 Mg Tablet	25000772	CDM	Inpatient	10	ME	18			18	18
Metoclopramide 5 Mg Tablet	25000773	CDM	Inpatient	5	ME	6			6	6
Metolazone 2.5 Mg Tablet	25000774	CDM	Inpatient	2.5	ME	15			15	15
Metolazone 5 Mg Tablet	25000775	CDM	Inpatient	5	ME	15			15	15
Metoprolol Succ Er 100 Mg Tab	25000776	CDM	Inpatient	100	ME	5			5	5
Metoprolol Succ Er 200 Mg Tab	25000777	CDM	Inpatient	200	ME	5			5	5
Metoprolol Succ Er 25 Mg Tab	25000778	CDM	Inpatient	25	ME	5			5	5
Metoprolol Succ Er 50 Mg Tab	25000779	CDM	Inpatient	50	ME	5			5	5
Metoprolol Succinate ER 50	25000780	CDM	Inpatient	50	ME	5			5	5
Metoprolol Tartrate 100 Mg Tab	25000781	CDM	Inpatient	100	ME	7			7	7
Metoprolol Tartrate 25 Mg Tab	25000782	CDM	Inpatient	25	ME	7			7	7
Metoprolol Tartrate 50 Mg Tab	25000783	CDM	Inpatient	50	ME	7			7	7
Metronidazole 500 Mg Tablet	25000784	CDM	Inpatient	500	ME	9			9	9
Mexiletine 150 Mg Capsule	25000785	CDM	Inpatient	150	ME	10			10	10
Mi Acid Suspension	25000786	CDM	Inpatient	200	ME	1			1	1
Miconazole 7 Cream	25000787	CDM	Inpatient	2	EA	10			10	10
Midodrine Hcl 10 Mg Tablet	25000788	CDM	Inpatient	10	ME	11			11	11
Midodrine Hcl 2.5 Mg Tablet	25000789	CDM	Inpatient	2.5	ME	11			11	11
Midodrine Hcl 5 Mg Tablet	25000790	CDM	Inpatient	5	ME	11			11	11
Milk Of Magnesia Suspension	25000791	CDM	Inpatient	400	ME	6			6	6
Mintox Maximum Strength Susp	25000792	CDM	Inpatient	400	ME	10			10	10
Miralax Powder Packet	25000793	CDM	Inpatient	17	GM	7			7	7
Mirtazapine 15 Mg Odt	25000794	CDM	Inpatient	15	ME	8			8	8
Mirtazapine 15 Mg Tablet	25000795	CDM	Inpatient	15	ME	8			8	8
Mirtazapine 30 Mg Odt	25000796	CDM	Inpatient	30	ME	26			26	26
Mirtazapine 30 Mg Tablet	25000797	CDM	Inpatient	30	ME	26			26	26
Mirtazapine 7.5 Mg Tablet	25000798	CDM	Inpatient	7.5	ME	9			9	9
Misoprostol 100 Mcg Tablet	25000799	CDM	Inpatient	100	EA	10			10	10
Misoprostol 200 Mcg Tablet	25000800	CDM	Inpatient	200	EA	10			10	10
Mobisyl 10% Cream	25000801	CDM	Inpatient	10	EA	10			10	10
Modafinil 100 Mg Tablet	25000802	CDM	Inpatient	100	ME	10			10	10
Modafinil 200 Mg Tablet	25000803	CDM	Inpatient	200	ME	10			10	10
Mometasone Furoate 0.1% Cream	25000804	CDM	Inpatient	0.1	EA	226			226	226
Mometasone Furoate 50 mcg	25000805	CDM	Inpatient	50	EA	226			226	226
MOMETASONE OIN 0.1%	25000806	CDM	Inpatient	0.1	EA	226			226	226
Montelukast Sod 10 Mg Tab	25000807	CDM	Inpatient	10	ME	10			10	10
Montelukast Sod 10 Mg Tablet	25000808	CDM	Inpatient	10	ME	10			10	10
Morphine Sulf Er 15 Mg Tablet	25000809	CDM	Inpatient	15	ME	6			6	6
Morphine Sulf Er 30 Mg Tablet	25000810	CDM	Inpatient	30	ME	6			6	6
Motion Sickness 50 Mg Tablet	25000811	CDM	Inpatient	50	ME	10			10	10
Mucinex Dm Er 600-30 Mg Tablet	25000812	CDM	Inpatient	1	EA	17			17	17
Mucinex Er 600 Mg Tablet	25000813	CDM	Inpatient	600	ME	17			17	17
Multaq 400 Mg Tablet	25000814	CDM	Inpatient	400	ME	10			10	10
Mupirocin 2% Ointment	25000815	CDM	Inpatient	2	EA	10			10	10
Muro-128 2% Eye Drops	25000816	CDM	Inpatient	2	EA	10			10	10
Muscle Rub Cream	25000817	CDM	Inpatient	15	EA	10			10	10
Myrbetriq Er 25 Mg Tablet	25000818	CDM	Inpatient	25	ME	10			10	10
Myrbetriq Er 50 Mg Tablet	25000819	CDM	Inpatient	50	ME	10			10	10
Nabumetone 500 Mg Tablet	25000820	CDM	Inpatient	500	ME	12			12	12
Nac 500 Mg Capsule	25000821	CDM	Inpatient	500	ME	10			10	10
Nac 600 Mg Capsule	25000822	CDM	Inpatient	600	ME	10			10	10
Nadolol 20 Mg Tablet	25000823	CDM	Inpatient	20	ME	7			7	7
Naltrexone 50 Mg Tablet	25000824	CDM	Inpatient	50	ME	10			10	10
Namenda 10 Mg Tablet	25000825	CDM	Inpatient	10	ME	15			15	15
Namenda 5 Mg Tablet	25000826	CDM	Inpatient	5	ME	20			20	20
Namenda Xr 14 Mg Capsule	25000827	CDM	Inpatient	14	ME	20			20	20
Namenda Xr 7 Mg Capsule	25000828	CDM	Inpatient	7	ME	20			20	20
Namzaric 28 Mg-10 Mg Capsule%	25000829	CDM	Inpatient	28	ME	63			63	63
Naproxen 375 Mg Tablet	25000830	CDM	Inpatient	375	ME	27			27	27
Naproxen 500 Mg Tablet	25000831	CDM	Inpatient	500	ME	21			21	21
NAPROXEN TAB 250MG	25000832	CDM	Inpatient	250	ME	27			27	27
Nasal Moisturizing 0.65% Spray	25000833	CDM	Inpatient	0.65	EA	107			107	107
Nasal Spray Original 0.05%	25000834	CDM	Inpatient	0.05	EA	107			107	107
Natural Fiber Laxative Capsule	25000835	CDM	Inpatient	0.52	GM	10			10	10
Nb Garlic O/f 1000 Sg 100	25000836	CDM	Inpatient	1	EA	2			2	2
Nefazodone Hcl 100 Mg Tablet	25000837	CDM	Inpatient	100	ME	10			10	10
Neomycin-Polymyxin-Hc Ear Soln	25000838	CDM	Inpatient	3.5	ME	10			10	10
Neomyc-Polym-Dexameth Eye Drop	25000839	CDM	Inpatient	3.5	ME	10			10	10
Neosporin Ointment	25000840	CDM	Inpatient	1	EA	17			17	17
Nesina 12.5 Mg Tablet	25000841	CDM	Inpatient	12.5	ME	10			10	10
Nexcare Tega 4 4x4-3/4drs	25000842	CDM	Inpatient	1	EA	10			10	10
Nicotine 14 Mg/24hr Patch	25000843	CDM	Inpatient	1	EA	19			19	19
Nicotine 2 Mg Chewing Gum	25000844	CDM	Inpatient	2	ME	19			19	19
Nicotine 21 Mg/24hr Patch	25000845	CDM	Inpatient	1	EA	19			19	19
Nicotine 4 Mg Chewing Gum	25000846	CDM	Inpatient	4	ME	19			19	19
Nicotine 7 Mg/24hr Patch	25000847	CDM	Inpatient	1	EA	19			19	19
Nicotine Patch Step-2 14 Mg 14	25000848	CDM	Inpatient	14	ME	19			19	19
Nifedipine Er 30 Mg Tablet	25000849	CDM	Inpatient	30	ME	22			22	22
Nifedipine Er 60 Mg Tablet	25000850	CDM	Inpatient	60	ME	14			14	14
Nifedipine Er 90 Mg Tablet	25000851	CDM	Inpatient	90	ME	23			23	23
Nitrofurantoin Mcr 100 Mg Cap	25000852	CDM	Inpatient	100	ME	16			16	16
Nitrofurantoin Mcr 50 Mg Cap	25000853	CDM	Inpatient	50	ME	6			6	6
Nitrofurantoin Mono-Mcr 100 Mg	25000854	CDM	Inpatient	100	ME	16			16	16
Nitroglycerin 0.4 Mg Tab	25000855	CDM	Inpatient	0.4	ME	12			12	12
Nitroglycerin 0.4 Mg Tablet Sl	25000856	CDM	Inpatient	0.4	ME	62			62	62
Nortriptyline Hcl 10 Mg Cap	25000857	CDM	Inpatient	10	ME	84			84	84
Novolin N 100 Units/ml Vial	25000858	CDM	Inpatient	100	UN	123			123	123
Novolin R 100 Units/ml Vial	25000859	CDM	Inpatient	100	UN	271			271	271
Novolog Flexpen Syringe	25000860	CDM	Inpatient	100	UN	368			368	368
Novolog Mix 70-30 Flexpen Syrn	25000861	CDM	Inpatient	100	UN	368			368	368
NUEDEXTA 20-10 CAP%	25000862	CDM	Inpatient	1	EA	56			56	56
Nuedexta 20-10 Mg Capsule	25000863	CDM	Inpatient	10	ME	56			56	56
NUPLAZID 10MG TAB	25000864	CDM	Inpatient	10	ME	304.74			304.74	304.74
Nuplazid 17 Mg Tablet	25000865	CDM	Inpatient	17	ME	304.74			304.74	304.74
Nuplazid 34 Mg Capsule	25000866	CDM	Inpatient	34	ME	304.74			304.74	304.74
Nystatin 100,000 Unit/gm Cream	25000867	CDM	Inpatient	100000	UN	31			31	31
Nystatin 100,000 Unit/gm Oint	25000868	CDM	Inpatient	100000	UN	31			31	31
Nystatin 100,000 Unit/gm Powd	25000869	CDM	Inpatient	100000	UN	155			155	155
NYSTATIN 100,000 UNIT/GRAM TOPICAL	25000870	CDM	Inpatient	100000	UN	31			31	31
Nystatin 100,000 Unit/ml Susp	25000871	CDM	Inpatient	100000	UN	89			89	89
Nystop 100,000 Units/gm Powder	25000872	CDM	Inpatient	100000	UN	155			155	155
Ocuvite Blue Light 25-5 Mg Sfg	25000873	CDM	Inpatient	5	ME	6			6	6
Ofloxacin 0.3% Eye Drops	25000874	CDM	Inpatient	0.3	EA	10			10	10
Olanzapine 10 Mg Tablet	25000875	CDM	Inpatient	10	ME	48			48	48
Olanzapine 10 Mg Vial	25000876	CDM	Inpatient	10	ME	142			142	142
Olanzapine 15 Mg Tablet	25000877	CDM	Inpatient	15	ME	48			48	48
Olanzapine 2.5 Mg Tablet	25000878	CDM	Inpatient	2.5	ME	48			48	48
Olanzapine 20 Mg Tablet	25000879	CDM	Inpatient	20	ME	48			48	48
Olanzapine 5 Mg Tablet	25000880	CDM	Inpatient	5	ME	48			48	48
Olanzapine 7.5 Mg Tablet	25000881	CDM	Inpatient	7.5	ME	48			48	48
Olanzapine Odt 10 Mg Tablet	25000882	CDM	Inpatient	10	ME	48			48	48
Olanzapine Odt 5 Mg Tablet	25000883	CDM	Inpatient	5	ME	48			48	48
OLMESA MEDOX TAB 40MG	25000884	CDM	Inpatient	40	ME	10			10	10
Olmesartan Medoxomil 40 Mg Tab	25000885	CDM	Inpatient	40	ME	10			10	10
Olopatadine 0.2 % O/S	25000886	CDM	Inpatient	1	EA	195.8			195.8	195.8
Olopatadine Hcl 0.1% Eye Drops	25000887	CDM	Inpatient	0.1	EA	195.8			195.8	195.8
Omega-3 Ethyl Esters 1 Gm Cap	25000888	CDM	Inpatient	1	GM	6			6	6
Omega-3 Fish Oil 1,760 Mg Stgl	25000889	CDM	Inpatient	1760	ME	6			6	6
Omeprazole Dr 10 Mg Capsule	25000890	CDM	Inpatient	10	ME	23			23	23
Omeprazole Dr 20 Mg Capsule	25000891	CDM	Inpatient	20	ME	23			23	23
Omeprazole Dr 20 Mg Tablet	25000892	CDM	Inpatient	20	ME	23			23	23
Omeprazole Dr 40 Mg Capsule	25000893	CDM	Inpatient	40	ME	23			23	23
Ondansetron Hcl 4 Mg Tablet	25000894	CDM	Inpatient	4	ME	86			86	86
Ondansetron Hcl 4 Mg/2 Ml Vial	25000895	CDM	Inpatient	4	ME	86			86	86
Ondansetron Hcl 8 Mg Tablet	25000896	CDM	Inpatient	8	ME	86			86	86
Ondansetron Odt 4 Mg Tablet	25000897	CDM	Inpatient	4	ME	86			86	86
One Daily Essential Tablet	25000898	CDM	Inpatient	1	EA	4			4	4
One Daily Maximum Tablet	25000899	CDM	Inpatient	1	EA	4			4	4
One Daily Men'S 50+ Tablet	25000900	CDM	Inpatient	1	EA	30			30	30
One Daily Women'S 50+ Tablet	25000901	CDM	Inpatient	1	EA	30			30	30
One-Daily Multi-Vitamin Tab	25000902	CDM	Inpatient	1	EA	4			4	4
Oseltamivir Phos 75 Mg Capsule	25000903	CDM	Inpatient	75	ME	10			10	10
Osteo Bi-Flex Tablet	25000904	CDM	Inpatient	1	EA	6			6	6
Oxazepam 10 Mg Capsule	25000905	CDM	Inpatient	10	ME	7			7	7
Oxcarbazepine 150 Mg Tablet	25000906	CDM	Inpatient	150	ME	6			6	6
Oxcarbazepine 300 Mg Tablet	25000907	CDM	Inpatient	300	ME	6			6	6
Oxcarbazepine 600 Mg Tablet	25000908	CDM	Inpatient	600	ME	6			6	6
Oxybutynin 5 Mg Tablet	25000909	CDM	Inpatient	5	ME	6			6	6
Oxybutynin Chloride 5 Mg Tab 100	25000910	CDM	Inpatient	5	ME	6			6	6
Oxybutynin Cl Er 10 Mg Tablet	25000911	CDM	Inpatient	10	ME	15			15	15
Oxybutynin Cl Er 5 Mg Tablet	25000912	CDM	Inpatient	5	ME	6			6	6
Oxycodone Hcl 10 Mg Tablet	25000913	CDM	Inpatient	10	ME	23			23	23
Oxycodone Hcl 5 Mg Tablet	25000914	CDM	Inpatient	5	ME	23			23	23
Oxycodone-Acetaminophen 10-325	25000915	CDM	Inpatient	1	EA	23			23	23
Oxycodone-Acetaminophen 10-325 Mg Tab	25000916	CDM	Inpatient	1	EA	23			23	23
Oxycodone-Acetaminophen 5-325 Mg Tablet	25000917	CDM	Inpatient	1	EA	23			23	23
Oxycodone-Acetaminophen 7.5-325 Mg Tablet	25000918	CDM	Inpatient	1	EA	23			23	23
Oxycodone-APAP 10-325 Mg Tab	25000919	CDM	Inpatient	1	EA	23			23	23
Oxycodone-Apap 5-325	25000920	CDM	Inpatient	1	EA	23			23	23
Oyster Shell 500-Vit D3 200 Tb	25000921	CDM	Inpatient	1	EA	18			18	18
Oyster Shell Calcium 500 Mg Tb	25000922	CDM	Inpatient	1	EA	18			18	18
Pain Reliever 500 Mg Caplet	25000923	CDM	Inpatient	500	ME	6			6	6
Paliperidone Er 3 Mg Tablet	25000924	CDM	Inpatient	3	ME	58.2			58.2	58.2
Paliperidone Er 6 Mg Tablet	25000925	CDM	Inpatient	6	ME	55.56			55.56	55.56
Pantoprazole Sod Dr 20 Mg Tab	25000926	CDM	Inpatient	20	ME	5			5	5
Pantoprazole Sod Dr 40 Mg Tab	25000927	CDM	Inpatient	40	ME	5			5	5
PAROXETINE HCL	25000928	CDM	Inpatient	10	ME	20			20	20
Paroxetine Hcl 10 Mg Tablet	25000929	CDM	Inpatient	10	ME	20			20	20
Paroxetine Hcl 20 Mg Tablet	25000930	CDM	Inpatient	20	ME	24			24	24
Paroxetine Hcl 30 Mg Tablet	25000931	CDM	Inpatient	30	ME	26			26	26
PAROXETINE TAB 10MG	25000932	CDM	Inpatient	10	ME	7			7	7
PAROXETINE TAB 40MG	25000933	CDM	Inpatient	40	ME	7			7	7
Pedialyte Solution	25000934	CDM	Inpatient	1	EA	10			10	10
Penicillin Vk 500 Mg Tablet	25000935	CDM	Inpatient	500	ME	13			13	13
Pentasa 250 Mg Capsule	25000936	CDM	Inpatient	250	ME	29.32			29.32	29.32
Pentasa 500 Mg Capsule	25000937	CDM	Inpatient	500	ME	29.32			29.32	29.32
Pentoxifylline Er 400 Mg Tab	25000938	CDM	Inpatient	400	ME	6			6	6
Pepcid Ac 10 Mg Tablet	25000939	CDM	Inpatient	10	ME	2			2	2
Pepto-Bismol Suspension	25000940	CDM	Inpatient	262	ME	10			10	10
Permethrin 5% Cream	25000941	CDM	Inpatient	5	EA	10			10	10
Perphenazine 8 Mg Tablet	25000942	CDM	Inpatient	8	ME	6			6	6
Phenazopyridine 100 Mg Tab	25000943	CDM	Inpatient	100	ME	11			11	11
Phenazopyridine 200 Mg Tab	25000944	CDM	Inpatient	200	ME	17			17	17
Phenobarbital 32.4 Mg Tablet	25000945	CDM	Inpatient	32.4	ME	128			128	128
Phenobarbital 64.8 Mg Tablet	25000946	CDM	Inpatient	64.8	ME	128			128	128
Phenytoin 125 Mg/5 Ml Susp	25000947	CDM	Inpatient	125	ME	143			143	143
Phenytoin Sod Ext 100 Mg Cap	25000948	CDM	Inpatient	100	ME	143			143	143
Phospho-Trin 250 Neutral Tab	25000949	CDM	Inpatient	1	EA	67			67	67
Pilocarpine 2% Eye Drops	25000950	CDM	Inpatient	2	EA	10			10	10
Pilocarpine Hcl 5 Mg Tablet	25000951	CDM	Inpatient	5	ME	10			10	10
Pimozide 1Mg Tab	25000952	CDM	Inpatient	1	ME	10			10	10
Pindolol 10 Mg Tablet	25000953	CDM	Inpatient	10	ME	5			5	5
Pindolol 5 Mg Tablet	25000954	CDM	Inpatient	5	ME	5			5	5
Pink Bismuth Tablet Chew	25000955	CDM	Inpatient	262	ME	10			10	10
Pioglitazone Hcl 15 Mg Tablet	25000956	CDM	Inpatient	15	ME	10			10	10
Pioglitazone Hcl 30 Mg Tablet	25000957	CDM	Inpatient	30	ME	10			10	10
Pioglitazone Hcl 45 Mg Tablet	25000958	CDM	Inpatient	45	ME	10			10	10
Polyethylene Glycol 3350 Powd	25000959	CDM	Inpatient	17	GM	48			48	48
Polymyxin B-Tmp Eye Drops	25000960	CDM	Inpatient	10000	UN	10			10	10
Potassium 25 Meq Tablet Eff	25000961	CDM	Inpatient	25	EA	6			6	6
Potassium Citrate Er 10 Meq Tb	25000962	CDM	Inpatient	10	EA	6			6	6
Potassium Cl 10% (20 Meq/15 Ml) Liquid	25000963	CDM	Inpatient	20	EA	6			6	6
Potassium Cl 20 Meq Packet	25000964	CDM	Inpatient	20	EA	6			6	6
Potassium Cl 20% (40 Meq/15 Ml) Liquid	25000965	CDM	Inpatient	40	EA	6			6	6
Potassium Cl Er 10 Meq Capsule	25000966	CDM	Inpatient	10	EA	6			6	6
Potassium Cl Er 10 Meq Tablet	25000967	CDM	Inpatient	10	EA	6			6	6
Potassium Cl Er 20 Meq Tablet	25000968	CDM	Inpatient	20	EA	6			6	6
Potassium Cl Er 8 Meq Tablet	25000969	CDM	Inpatient	8	EA	6			6	6
Pradaxa 75 Mg Capsule	25000970	CDM	Inpatient	75	ME	20			20	20
Pramipexole 0.125 Mg Tablet	25000971	CDM	Inpatient	0.125	ME	10			10	10
Pramipexole 0.25 Mg Tablet	25000972	CDM	Inpatient	0.25	ME	10			10	10
Pramipexole 0.5 Mg Tablet	25000973	CDM	Inpatient	0.5	ME	10			10	10
Pramipexole 1 Mg Tablet	25000974	CDM	Inpatient	1	ME	10			10	10
Pramipexole 1.5 Mg Tablet	25000975	CDM	Inpatient	1.5	ME	10			10	10
Pravastatin Sodium 10 Mg Tab	25000976	CDM	Inpatient	10	ME	10			10	10
Pravastatin Sodium 20 Mg Tab	25000977	CDM	Inpatient	20	ME	10			10	10
Pravastatin Sodium 40 Mg Tab	25000978	CDM	Inpatient	40	ME	10			10	10
Pravastatin Sodium 80 Mg Tab	25000979	CDM	Inpatient	80	ME	10			10	10
Prazosin 1 Mg Capsule	25000980	CDM	Inpatient	1	ME	10			10	10
Prazosin 2 Mg Capsule	25000981	CDM	Inpatient	2	ME	10			10	10
Prazosin 5 Mg Capsule	25000982	CDM	Inpatient	5	ME	10			10	10
Prednisolone Ac 1% Eye Drop	25000983	CDM	Inpatient	1	UN	122			122	122
Prednisone 1 Mg Tablet	25000984	CDM	Inpatient	1	ME	8			8	8
Prednisone 10 Mg Tablet	25000985	CDM	Inpatient	10	ME	18			18	18
Prednisone 2.5 Mg Tablet	25000986	CDM	Inpatient	2.5	ME	8			8	8
Prednisone 20 Mg Tablet	25000987	CDM	Inpatient	20	ME	8			8	8
Prednisone 5 Mg Tablet	25000988	CDM	Inpatient	5	ME	8			8	8
Pregabalin 100 Mg Cap 90	25000989	CDM	Inpatient	100	ME	10			10	10
Pregabalin 150 Mg Cap 90	25000990	CDM	Inpatient	150	ME	10			10	10
Pregabalin 25 Mg Capsule	25000991	CDM	Inpatient	25	ME	10			10	10
Pregabalin 300 Mg Cap 90	25000992	CDM	Inpatient	300	ME	10			10	10
Pregabalin 50 Mg Cap 90	25000993	CDM	Inpatient	50	ME	10			10	10
Pregabalin 50 Mg Capsule	25000994	CDM	Inpatient	50	ME	10			10	10
Pregabalin 75 Mg Cap 90	25000995	CDM	Inpatient	75	ME	10			10	10
Pregabalin 75 Mg Capsule	25000996	CDM	Inpatient	75	ME	10			10	10
Premarin 0.3 Mg Tablet	25000997	CDM	Inpatient	0.3	ME	8			8	8
Premarin 0.45 Mg Tablet	25000998	CDM	Inpatient	0.45	ME	8			8	8
Premarin 0.625 Mg Tablet	25000999	CDM	Inpatient	0.625	ME	20			20	20
Premarin Vaginal Cream-Appl	25001000	CDM	Inpatient	0.625	ME	167			167	167
Prenatal Vitamin Plus Low Iron	25001001	CDM	Inpatient	1	EA	15			15	15
Preparation H M/s Cream 0.9 Oz	25001002	CDM	Inpatient	1	EA	10			10	10
Preparation H Suppository	25001003	CDM	Inpatient	0.25	UN	10			10	10
PreserVision Areds 2 Formula	25001004	CDM	Inpatient	1	EA	6			6	6
Preservision Areds Tablet	25001005	CDM	Inpatient	1	EA	6			6	6
Primidone 50 Mg Tablet	25001006	CDM	Inpatient	50	ME	10.5			10.5	10.5
Primidone 50mg	25001007	CDM	Inpatient	50	ME	10.5			10.5	10.5
Probenecid-Colchicine Tabs	25001008	CDM	Inpatient	1	EA	10			10	10
Prodigy No Coding Test Strips	25001009	CDM	Inpatient	1	EA	10			10	10
Prodigy Tst Strps 100ct W/meter Value Pk	25001010	CDM	Inpatient	1	EA	10			10	10
Promethazine 12.5 Mg Tablet	25001011	CDM	Inpatient	12.5	ME	5			5	5
Promethazine 25 Mg Tablet	25001012	CDM	Inpatient	25	ME	7			7	7
Promethazine 25 Mg/ml Vial	25001013	CDM	Inpatient	25	ME	26			26	26
Promethazine 50 Mg/ml Vial	25001014	CDM	Inpatient	50	ME	23			23	23
Propranolol 10 Mg Tablet	25001015	CDM	Inpatient	10	ME	6			6	6
Propranolol 20 Mg Tablet	25001016	CDM	Inpatient	20	ME	4.5			4.5	4.5
Propranolol 40 Mg Tablet	25001017	CDM	Inpatient	40	ME	6			6	6
Propranolol Er 80 Mg Capsule	25001018	CDM	Inpatient	80	ME	6			6	6
Pro-Stat Sugar Free Liquid Pkt	25001019	CDM	Inpatient	1	EA	2			2	2
Proteinex Liquid	25001020	CDM	Inpatient	1	EA	11			11	11
Protonix 40 Mg Suspension	25001021	CDM	Inpatient	40	ME	26			26	26
Pseudoephedrine 30 Mg Tablet	25001022	CDM	Inpatient	30	ME	10			10	10
Quetiapine Er 150 Mg Tablet	25001023	CDM	Inpatient	150	ME	10			10	10
Quetiapine Er 200 Mg Tablet	25001024	CDM	Inpatient	200	ME	10			10	10
Quetiapine Er 300 Mg Tablet	25001025	CDM	Inpatient	300	ME	10			10	10
Quetiapine Er 400 Mg Tablet	25001026	CDM	Inpatient	400	ME	10			10	10
Quetiapine Er 50 Mg Tablet	25001027	CDM	Inpatient	50	ME	10			10	10
Quetiapine Fumarate 100 Mg Tab	25001028	CDM	Inpatient	100	ME	10			10	10
Quetiapine Fumarate 200 Mg Tab	25001029	CDM	Inpatient	200	ME	10			10	10
Quetiapine Fumarate 200 Mg Tab fs	25001030	CDM	Inpatient	200	ME	10			10	10
Quetiapine Fumarate 25 Mg Tab	25001031	CDM	Inpatient	25	ME	10			10	10
Quetiapine Fumarate 300 Mg Tab	25001032	CDM	Inpatient	300	ME	10			10	10
Quetiapine Fumarate 400 Mg Tab	25001033	CDM	Inpatient	400	ME	10			10	10
Quetiapine Fumarate 50 Mg Tab	25001034	CDM	Inpatient	50	ME	10			10	10
Quinapril 20 Mg Tablet	25001035	CDM	Inpatient	20	ME	15			15	15
Raloxifene Hcl 60 Mg Tablet	25001036	CDM	Inpatient	60	ME	10			10	10
Ramelteon 8 Mg Tab 30	25001037	CDM	Inpatient	8	ME	10			10	10
Ramipril 10 Mg Capsule	25001038	CDM	Inpatient	10	ME	13			13	13
Ramipril 2.5 Mg Capsule	25001039	CDM	Inpatient	2.5	ME	12			12	12
Ramipril 5 Mg Capsule	25001040	CDM	Inpatient	5	ME	6			6	6
Ranexa Er 1,000 Mg Tablet	25001041	CDM	Inpatient	1000	ME	22			22	22
Ranexa Er 500 Mg Tablet	25001042	CDM	Inpatient	500	ME	22			22	22
Ranitidine 150 Mg Tablet	25001043	CDM	Inpatient	150	ME	6			6	6
Ranitidine 300 Mg Tablet	25001044	CDM	Inpatient	300	ME	6			6	6
Ranitidine 75 Mg Tablet	25001045	CDM	Inpatient	75	ME	6			6	6
Ranolazine 500 Mg Er Tab 60	25001046	CDM	Inpatient	500	ME	10			10	10
Rasagiline 1mg Tab	25001047	CDM	Inpatient	1	ME	10			10	10
Rasagiline Mesylate 1 Mg Tab	25001048	CDM	Inpatient	1	ME	10			10	10
Refresh Tears 0.5% Eye Drops	25001049	CDM	Inpatient	0.5	EA	57			57	57
Rexulti 0.5 Mg Tablet%	25001050	CDM	Inpatient	0.5	ME	184.68			184.68	184.68
Rexulti 1 Mg Tablet%	25001051	CDM	Inpatient	1	ME	184.68			184.68	184.68
Rexulti 2 Mg Tablet%	25001052	CDM	Inpatient	2	ME	184.68			184.68	184.68
Rexulti 3 Mg Tablet	25001053	CDM	Inpatient	3	ME	184.68			184.68	184.68
Rexulti 4 Mg Tablet%	25001054	CDM	Inpatient	4	ME	184.68			184.68	184.68
Rifampin 150 Mg Capsule	25001055	CDM	Inpatient	150	ME	10			10	10
Risperdal Consta Im Susp 12.5mg	25001056	CDM	Inpatient	12.5	ME	946			946	946
Risperidone 0.25 Mg Tablet	25001057	CDM	Inpatient	0.25	ME	18			18	18
Risperidone 0.5 Mg Odt	25001058	CDM	Inpatient	0.5	ME	7			7	7
Risperidone 0.5 Mg Tablet	25001059	CDM	Inpatient	0.5	ME	7			7	7
Risperidone 1 Mg Odt	25001060	CDM	Inpatient	1	ME	6			6	6
Risperidone 1 Mg Tablet	25001061	CDM	Inpatient	1	ME	6			6	6
Risperidone 2 Mg Tablet	25001062	CDM	Inpatient	2	ME	6			6	6
Risperidone 3 Mg Tablet	25001063	CDM	Inpatient	3	ME	6			6	6
Risperidone 4 Mg Tablet	25001064	CDM	Inpatient	4	ME	6			6	6
Rivastigimine 4.6 Mg Sys	25001065	CDM	Inpatient	4.6	ME	33			33	33
Rivastigimine 13.3mg Sys	25001066	CDM	Inpatient	13.3	ME	33			33	33
Rivastigimine 9.5 mg Transdermal Sys	25001067	CDM	Inpatient	9.5	ME	33			33	33
Rivastigmine 1.5 Mg Capsule	25001068	CDM	Inpatient	1.5	ME	33			33	33
Rivastigmine 3 Mg Capsule	25001069	CDM	Inpatient	3	ME	33			33	33
Rivastigmine 4.5 Mg Capsule	25001070	CDM	Inpatient	4.5	ME	33			33	33
Rivastigmine 6 Mg Capsule	25001071	CDM	Inpatient	6	ME	33			33	33
Robafen 200 Mg/10 Ml Syrup	25001072	CDM	Inpatient	100	ME	10			10	10
Ropinirole Hcl 0.25 Mg Tablet	25001073	CDM	Inpatient	0.25	ME	6			6	6
Ropinirole Hcl 0.5 Mg Tablet	25001074	CDM	Inpatient	0.5	ME	6			6	6
Ropinirole Hcl 1 Mg Tablet	25001075	CDM	Inpatient	1	ME	6			6	6
Ropinirole Hcl 2 Mg Tablet	25001076	CDM	Inpatient	2	ME	6			6	6
Ropinirole Hcl 3 Mg Tablet	25001077	CDM	Inpatient	3	ME	6			6	6
Rosuvastatin 20 mg tab	25001078	CDM	Inpatient	20	ME	2.72			2.72	2.72
Rosuvastatin 5 mg tab	25001079	CDM	Inpatient	5	ME	2.72			2.72	2.72
Rosuvastatin Calcium 10 Mg Tab	25001080	CDM	Inpatient	10	ME	2.72			2.72	2.72
Rosuvastatin Calcium 20 Mg Tab	25001081	CDM	Inpatient	20	ME	2.72			2.72	2.72
Rosuvastatin Calcium 40 Mg Tab	25001082	CDM	Inpatient	40	ME	2.72			2.72	2.72
Rosuvastatin Calcium 5 Mg Tab	25001083	CDM	Inpatient	5	ME	2.72			2.72	2.72
ROSUVASTATIN TAB 20MG	25001084	CDM	Inpatient	20	ME	2.72			2.72	2.72
Rozerem 8 Mg Tablet	25001085	CDM	Inpatient	8	ME	75			75	75
Saline 0.65% Nose Spray	25001086	CDM	Inpatient	0.65	EA	23			23	23
Salonpas Lido 4 % Pat	25001087	CDM	Inpatient	1	EA	10			10	10
Salsalate 750 Mg Tablet	25001088	CDM	Inpatient	750	ME	10			10	10
Santyl Ointment	25001089	CDM	Inpatient	250	UN	10			10	10
Selegiline Hcl 5 Mg Tablet	25001090	CDM	Inpatient	5	ME	10			10	10
Senna Lax 8.6 Mg Tablet	25001091	CDM	Inpatient	8.6	ME	6			6	6
Senna Plus 8.6mg/doc Sod 50mg Tab 100ct	25001092	CDM	Inpatient	50	ME	6			6	6
Senna Plus Tablet	25001093	CDM	Inpatient	1	EA	6			6	6
Sensipar 30 Mg Tablet	25001094	CDM	Inpatient	30	ME	10			10	10
Sertraline Hcl 100 Mg Tablet	25001095	CDM	Inpatient	100	ME	7			7	7
Sertraline Hcl 25 Mg Tablet	25001096	CDM	Inpatient	25	ME	7			7	7
Sertraline Hcl 50 Mg Tablet	25001097	CDM	Inpatient	50	ME	7			7	7
Sildenafil 20 Mg Tablet	25001098	CDM	Inpatient	20	ME	10			10	10
Silodosin 8 Mg Capsule	25001099	CDM	Inpatient	8	ME	10			10	10
Silver Sulfadiazine 1% Cream	25001100	CDM	Inpatient	1	EA	10			10	10
Simvastatin 10 Mg Tablet	25001101	CDM	Inpatient	10	ME	10			10	10
Simvastatin 20 Mg Tablet	25001102	CDM	Inpatient	20	ME	10			10	10
Simvastatin 40 Mg Tablet	25001103	CDM	Inpatient	40	ME	10			10	10
Simvastatin 80 Mg Tablet	25001104	CDM	Inpatient	80	ME	10			10	10
Sodium Bicarb 10 Grain Tablet	25001105	CDM	Inpatient	650	ME	6			6	6
Sodium Bicarb 325 Mg Tablet	25001106	CDM	Inpatient	325	ME	6			6	6
Sodium Bicarb 650 Mg Tablet	25001107	CDM	Inpatient	650	ME	6			6	6
Sodium Chloride 1 Gm Tablet	25001108	CDM	Inpatient	1	GM	6			6	6
Sodium Chloride 5% Eye Oint	25001109	CDM	Inpatient	5	EA	6			6	6
Solifenacin Succinate 10 Mg Tab 30	25001110	CDM	Inpatient	10	ME	10			10	10
Solifenacin Succinate 5 Mg Tab 30	25001111	CDM	Inpatient	5	ME	10			10	10
Sore Throat 1.4% Spray	25001112	CDM	Inpatient	1.4	EA	10			10	10
Sotalol 80 Mg Tablet	25001113	CDM	Inpatient	80	ME	10			10	10
Spiriva 18 Mcg Cp-Handihaler	25001114	CDM	Inpatient	18	EA	10			10	10
Spiriva Respimat Inhal Spray	25001115	CDM	Inpatient	2.5	EA	429			429	429
Spironolactone 25 Mg Tablet	25001116	CDM	Inpatient	25	ME	10			10	10
Spironolactone 50 Mg Tablet	25001117	CDM	Inpatient	50	ME	6			6	6
Sps 15 Gm/60 Ml Suspension	25001118	CDM	Inpatient	15	GM	10			10	10
Ssd 1% Cream	25001119	CDM	Inpatient	1	EA	10			10	10
Stimulant Laxative Plus Tablet	25001120	CDM	Inpatient	1	EA	10			10	10
Sucralfate 1 Gm Tablet	25001121	CDM	Inpatient	1	GM	6			6	6
Sulfacetamide 10% Eye Drops	25001122	CDM	Inpatient	10	EA	10			10	10
Sulfamethoxazole-Tmp Ds TaB	25001123	CDM	Inpatient	1	EA	6			6	6
Sulfamethoxazole-Tmp Ds Tablet	25001124	CDM	Inpatient	1	EA	6			6	6
Sulfamethoxazole-Tmp Ss Tablet	25001125	CDM	Inpatient	1	EA	6			6	6
Sulfasalazine 500 Mg Tablet	25001126	CDM	Inpatient	500	ME	10			10	10
Sulfatrim Pediatric Suspension	25001127	CDM	Inpatient	200	ME	10			10	10
Sumatriptan Succ 50 Mg Tablet	25001128	CDM	Inpatient	50	ME	101			101	101
Suphedrin 30 Mg Tablet	25001129	CDM	Inpatient	30	ME	10			10	10
Sure Comfort Pen Ndl 31gx3/16"	25001130	CDM	Inpatient	31	GM	10			10	10
Symbicort 160-4.5 Mcg Inhaler	25001131	CDM	Inpatient	1	UN	36			36	36
Symbicort 80-4.5 Mcg Inhaler	25001132	CDM	Inpatient	1	UN	36			36	36
Synthroid 50 Mcg Tablet	25001133	CDM	Inpatient	50	EA	10			10	10
Synthroid 88 Mcg Tablet	25001134	CDM	Inpatient	88	EA	10			10	10
Systane 0.3-0.4% Eye Drops	25001135	CDM	Inpatient	0.3	EA	10			10	10
Systane Balance 0.6% Eye Drop	25001136	CDM	Inpatient	0.6	EA	10			10	10
Systane Complete 0.6% Eye Drop	25001137	CDM	Inpatient	1	EA	10			10	10
Systane Gel Eye Drops	25001138	CDM	Inpatient	0.3	EA	10			10	10
Tab-A-Vite Multivit With Iron	25001139	CDM	Inpatient	1	EA	10			10	10
Tacrolimus 1 Mg Capsule	25001140	CDM	Inpatient	1	ME	10			10	10
Tamsulosin Hcl 0.4 Mg Capsule	25001141	CDM	Inpatient	0.4	ME	10			10	10
Temazepam 15 Mg Capsule	25001142	CDM	Inpatient	15	ME	18			18	18
Temazepam 30 Mg Capsule	25001143	CDM	Inpatient	30	ME	18			18	18
Temazepam 7.5 Mg Capsule	25001144	CDM	Inpatient	7.5	ME	18			18	18
Terazosin 1 Mg Capsule	25001145	CDM	Inpatient	1	ME	11			11	11
Terazosin 5 Mg Capsule	25001146	CDM	Inpatient	5	ME	20			20	20
Terbinafine Hcl 250 Mg Tablet	25001147	CDM	Inpatient	250	ME	22			22	22
Theo-24 Er 100 Mg Capsule	25001148	CDM	Inpatient	100	ME	28			28	28
Theophylline Er 300 Mg Tab	25001149	CDM	Inpatient	300	ME	300			300	300
Thera Tears 0.25% Eye Drops	25001150	CDM	Inpatient	0.25	EA	6			6	6
Thera-M Tablet	25001151	CDM	Inpatient	1	EA	6			6	6
Therapeutic-M Caplet	25001152	CDM	Inpatient	1	EA	6			6	6
Thermotabs Tablet	25001153	CDM	Inpatient	1	EA	7			7	7
Thiamine 200 Mg/2 Ml Vial	25001154	CDM	Inpatient	100	ME	81			81	81
Thick-It Powder	25001155	CDM	Inpatient	1	EA	27			27	27
Timolol 0.25% Eye Drops	25001156	CDM	Inpatient	0.25	EA	4			4	4
Timolol 0.5% Eye Drops	25001157	CDM	Inpatient	0.5	EA	4			4	4
Tizanidine Hcl 2 Mg Tablet	25001158	CDM	Inpatient	2	ME	10			10	10
Tizanidine Hcl 4 Mg Tablet	25001159	CDM	Inpatient	4	ME	10			10	10
Tobramycin 0.3% Eye Drops	25001160	CDM	Inpatient	0.3	EA	10			10	10
Tolterodine Tart Er 2 Mg Cap	25001161	CDM	Inpatient	2	ME	25			25	25
Tolterodine Tart Er 4 Mg Cap	25001162	CDM	Inpatient	4	ME	25			25	25
Tolterodine Tartrate 1 Mg Tab	25001163	CDM	Inpatient	1	ME	5.4			5.4	5.4
Tolterodine Tartrate 2 Mg Tab	25001164	CDM	Inpatient	2	ME	5.4			5.4	5.4
Topamax 100 Mg Tablet	25001165	CDM	Inpatient	100	ME	12			12	12
Topiramate 100 Mg Tab	25001166	CDM	Inpatient	100	ME	26			26	26
Topiramate 100 Mg Tablet	25001167	CDM	Inpatient	100	ME	26			26	26
Topiramate 200 Mg Tablet	25001168	CDM	Inpatient	200	ME	26			26	26
Topiramate 25 Mg Tablet	25001169	CDM	Inpatient	25	ME	26			26	26
Topiramate 50 Mg Tablet	25001170	CDM	Inpatient	50	ME	26			26	26
Torsemide 20 Mg Tablet	25001171	CDM	Inpatient	20	ME	12			12	12
Toujeo Solostar 300 Units/ml	25001172	CDM	Inpatient	300	UN	1.2			1.2	1.2
Toviaz Er 4 Mg Tablet	25001173	CDM	Inpatient	4	ME	10			10	10
Tradjenta 5 Mg Tablet	25001174	CDM	Inpatient	5	ME	10			10	10
Tradjenta 5 Mg Tablet%	25001175	CDM	Inpatient	5	ME	10			10	10
Tramadol Hcl 50 Mg Tab	25001176	CDM	Inpatient	50	ME	3			3	3
Tramadol Hcl 50 Mg Tablet	25001177	CDM	Inpatient	50	ME	3			3	3
Tramadol-Acetaminophen 37.5-325 Mg Tab	25001178	CDM	Inpatient	1	EA	5			5	5
Travatan Z 0.004% Eye Drop	25001179	CDM	Inpatient	0.004	EA	323			323	323
Trazodone 100 Mg Tablet	25001180	CDM	Inpatient	100	ME	6			6	6
Trazodone 150 Mg Tablet	25001181	CDM	Inpatient	150	ME	8			8	8
Trazodone 50 Mg Tablet	25001182	CDM	Inpatient	50	ME	8			8	8
Tresiba Flextouch 100 Units/ml	25001183	CDM	Inpatient	100	UN	3			3	3
Tresiba Flextouch 200 Units/ml	25001184	CDM	Inpatient	200	UN	3			3	3
Triamcinolone 0.025% Cream	25001185	CDM	Inpatient	0.025	EA	118			118	118
Triamcinolone 0.1% Cream	25001186	CDM	Inpatient	0.1	EA	118			118	118
Triamcinolone Acet 40 Mg/ml Vl	25001187	CDM	Inpatient	40	ME	118			118	118
Triamterene-Hydrochlorothiazide 37.5-25 Mg Cp	25001188	CDM	Inpatient	25	ME	10			10	10
Triamterene-Hydrochlorothiazide 37.5-25 Mg Tb	25001189	CDM	Inpatient	1	EA	10			10	10
Triazolam 0.25 Mg Tablet	25001190	CDM	Inpatient	0.25	ME	10			10	10
Trimethoprim 100 Mg Tablet	25001191	CDM	Inpatient	100	ME	10			10	10
Trintellix 10 Mg Tablet	25001192	CDM	Inpatient	10	ME	10			10	10
Trintellix 20 Mg Tablet	25001193	CDM	Inpatient	20	ME	10			10	10
Trintellix 5 Mg Tablet%	25001194	CDM	Inpatient	5	ME	10			10	10
Triple Antibiotic Plus Oint	25001195	CDM	Inpatient	3.5	ME	31			31	31
Trueplus Ultra Thin 30g Lancet	25001196	CDM	Inpatient	30	GM	10			10	10
Tubersol 5t Units/0.1 Ml Vial	25001197	CDM	Inpatient	0.1	ML	10			10	10
Tucks Pad 40ct	25001198	CDM	Inpatient	1	EA	10			10	10
Turmeric 538 Mg Capsule	25001199	CDM	Inpatient	538	ME	10			10	10
Tussin Dm Syrup	25001200	CDM	Inpatient	100	ME	31			31	31
Tylenol 325 Mg Tablet	25001201	CDM	Inpatient	325	ME	6			6	6
Tylenol Arthritis Er 650 Mg Tb	25001202	CDM	Inpatient	650	ME	13			13	13
Tylenol Ex-Str 500 Mg Caplet	25001203	CDM	Inpatient	500	ME	37			37	37
Uti-Stat Liquid	25001204	CDM	Inpatient	1	EA	10			10	10
Valacyclovir Hcl 1 Gram Tab	25001205	CDM	Inpatient	1000	ME	10			10	10
Valacyclovir Hcl 1 Gram Tablet	25001206	CDM	Inpatient	1000	ME	10			10	10
Valacyclovir Hcl 500 Mg Tablet	25001207	CDM	Inpatient	500	ME	10			10	10
Valproic Acid 250 Mg Capsule	25001208	CDM	Inpatient	250	ME	172			172	172
Valproic Acid 250 Mg/5 Ml Soln	25001209	CDM	Inpatient	250	ME	172			172	172
Valsartan 160 Mg Tablet	25001210	CDM	Inpatient	160	ME	10			10	10
Valsartan 320 Mg Tablet	25001211	CDM	Inpatient	320	ME	10			10	10
Valsartan 80 Mg Tablet	25001212	CDM	Inpatient	80	ME	10			10	10
Valsartan-Hydrochlorothiazide 160-12.5 Mg Tab	25001213	CDM	Inpatient	1	EA	10			10	10
Valsartan-Hydrochlorothiazide 160-25 Mg Tab	25001214	CDM	Inpatient	1	EA	10			10	10
Vancomycin 500 Mg Vial	25001215	CDM	Inpatient	500	ME	10			10	10
Vancomycin Hcl 125 Mg Capsule	25001216	CDM	Inpatient	125	ME	10			10	10
Vancomycin Hcl 250 Mg Capsule	25001217	CDM	Inpatient	250	ME	10			10	10
Vaseline Petro Jelly Jar 13oz	25001218	CDM	Inpatient	1	EA	6			6	6
Venlafaxine Hcl 37.5 Mg Tablet	25001219	CDM	Inpatient	37.5	ME	14			14	14
Venlafaxine Hcl 75 Mg Tablet	25001220	CDM	Inpatient	75	ME	14			14	14
Venlafaxine Hcl Er 150 Mg Cap	25001221	CDM	Inpatient	150	ME	14			14	14
Venlafaxine Hcl Er 37.5 Mg Cap	25001222	CDM	Inpatient	37.5	ME	14			14	14
Venlafaxine Hcl Er 75 Mg Cap	25001223	CDM	Inpatient	75	ME	14			14	14
Ventolin Hfa 90 Mcg Inhaler	25001224	CDM	Inpatient	90	EA	252			252	252
Verapamil 120 Mg Tablet	25001225	CDM	Inpatient	120	ME	6			6	6
Verapamil Er 180 Mg Tablet	25001226	CDM	Inpatient	180	ME	6			6	6
Verapamil Sr 120 Mg Capsule	25001227	CDM	Inpatient	120	ME	6			6	6
Verapamil Sr 240 Mg Capsule	25001228	CDM	Inpatient	240	ME	6			6	6
Victoza 2-Pak 18 Mg/3 Ml Pen	25001229	CDM	Inpatient	0.6	ME	10			10	10
Vimpat 100 Mg Tablet	25001230	CDM	Inpatient	100	ME	10			10	10
Vimpat 200 Mg Tablet	25001231	CDM	Inpatient	200	ME	10			10	10
Vimpat 50 Mg Tablet	25001232	CDM	Inpatient	50	ME	10			10	10
Visine Tears 0.5oz Drp	25001233	CDM	Inpatient	1	EA	10			10	10
Vit D2 1.25 Mg (50,000 Unit)	25001234	CDM	Inpatient	50000	UN	3			3	3
Vitamin A 10,000 Unit Sfgl	25001235	CDM	Inpatient	10000	UN	16			16	16
Vitamin A And D Ointment	25001236	CDM	Inpatient	1	EA	16			16	16
Vitamin B-1 50 Mg Tablet	25001237	CDM	Inpatient	50	ME	13			13	13
Vitamin B-12 1,000 Mcg Tab Sl	25001238	CDM	Inpatient	1000	EA	56			56	56
Vitamin B-12 1,000 Mcg Tablet	25001239	CDM	Inpatient	1000	EA	13			13	13
Vitamin B-12 100 Mcg Tablet	25001240	CDM	Inpatient	100	EA	13			13	13
Vitamin B-6 250 Mg Tablet	25001241	CDM	Inpatient	250	ME	6			6	6
Vitamin B-6 50 Mg Tablet	25001242	CDM	Inpatient	50	ME	6			6	6
Vitamin C 250 Mg Tablet Chew	25001243	CDM	Inpatient	250	ME	6			6	6
Vitamin C 500 Mg Tablet	25001244	CDM	Inpatient	500	ME	6			6	6
Vitamin D 1,000 Units Softgel	25001245	CDM	Inpatient	1000	UN	3			3	3
Vitamin D 2,000 Unit Softgel	25001246	CDM	Inpatient	2000	UN	3			3	3
VITAMIN D2 50,000 UNIT CAPSULE	25001247	CDM	Inpatient	50000	UN	15			15	15
Vitamin D3 125 Mcg (5000 Unit)	25001248	CDM	Inpatient	125	EA	15			15	15
Vitamin D3 125 Mcg Capsule	25001249	CDM	Inpatient	125	EA	15			15	15
Vitamin D3 2,000 Unit Softgel	25001250	CDM	Inpatient	2000	UN	15			15	15
Vitamin D3 400 Unit Tablet	25001251	CDM	Inpatient	400	UN	15			15	15
Vitamin D3 5,000 Unit Capsule	25001252	CDM	Inpatient	5000	UN	15			15	15
VITAMIN D3 50,000 UNIT CAPSULE	25001253	CDM	Inpatient	50000	UN	15			15	15
Voltaren Topical Gel 1% 50g	25001254	CDM	Inpatient	50	GM	43			43	43
Vraylar 1.5 Mg Capsule%	25001255	CDM	Inpatient	1.5	ME	188.88			188.88	188.88
Vraylar 3 Mg Capsule%	25001256	CDM	Inpatient	3	ME	167			167	167
Vraylar 4.5 Mg Capsule%	25001257	CDM	Inpatient	4.5	ME	10			10	10
Vraylar 6 Mg Capsule	25001258	CDM	Inpatient	6	ME	10			10	10
Warfarin Sodium 1 Mg Tablet	25001259	CDM	Inpatient	1	ME	11			11	11
Warfarin Sodium 10 Mg Tablet	25001260	CDM	Inpatient	10	ME	8			8	8
Warfarin Sodium 2 Mg Tablet	25001261	CDM	Inpatient	2	ME	10			10	10
Warfarin Sodium 2.5 Mg Tablet	25001262	CDM	Inpatient	2.5	ME	10			10	10
Warfarin Sodium 3 Mg Tablet	25001263	CDM	Inpatient	3	ME	28			28	28
Warfarin Sodium 4 Mg Tablet	25001264	CDM	Inpatient	4	ME	13			13	13
Warfarin Sodium 5 Mg Tablet	25001265	CDM	Inpatient	5	ME	10			10	10
Warfarin Sodium 6 Mg Tablet	25001266	CDM	Inpatient	6	ME	8			8	8
Warfarin Sodium 7.5 Mg Tablet	25001267	CDM	Inpatient	7.5	ME	7			7	7
Water For Injection Vial	25001268	CDM	Inpatient	1	EA	10			10	10
Xarelto 10 Mg Tablet	25001269	CDM	Inpatient	10	ME	11			11	11
Xarelto 15 Mg Tablet	25001270	CDM	Inpatient	15	ME	11			11	11
Xarelto 2.5 Mg Tablet	25001271	CDM	Inpatient	2.5	ME	11			11	11
Xarelto 20 Mg Tablet	25001272	CDM	Inpatient	20	ME	11			11	11
Zaditor Eye Drop	25001273	CDM	Inpatient	1	EA	10			10	10
Zaleplon 10 Mg Capsule	25001274	CDM	Inpatient	10	ME	17			17	17
Zegerid Otc 20-1,100 Mg Cap	25001275	CDM	Inpatient	1100	ME	34			34	34
Zenpep Dr 10,000 Unit Capsule	25001276	CDM	Inpatient	10000	UN	10			10	10
Zinc 50 Mg Caplet	25001277	CDM	Inpatient	50	ME	15			15	15
Zinc 50 Mg Tablet	25001278	CDM	Inpatient	50	ME	15			15	15
Zinc Oxide 20% Ointment	25001279	CDM	Inpatient	20	EA	10			10	10
Zinc Sulfate 220 Mg (50 Mg) Cap	25001280	CDM	Inpatient	220	ME	4			4	4
Zinc Sulfate 220 Mg Capsule	25001281	CDM	Inpatient	220	ME	4			4	4
Ziprasidone Hcl 20 Mg Capsule	25001282	CDM	Inpatient	20	ME	10			10	10
Ziprasidone Hcl 40 Mg Capsule	25001283	CDM	Inpatient	40	ME	10			10	10
Ziprasidone Hcl 60 Mg Capsule	25001284	CDM	Inpatient	60	ME	10			10	10
Ziprasidone Hcl 80 Mg Capsule	25001285	CDM	Inpatient	80	ME	10			10	10
Ziprasidone Hcl Cap 40mg 60	25001286	CDM	Inpatient	40	ME	10			10	10
Zolpidem Tart Er 12.5 Mg Tab	25001287	CDM	Inpatient	12.5	ME	22			22	22
Zolpidem Tartrate 10 Mg Tab	25001288	CDM	Inpatient	10	ME	22			22	22
Zolpidem Tartrate 5 Mg Tablet	25001289	CDM	Inpatient	5	ME	22			22	22
Zonisamide 100 Mg Capsule	25001290	CDM	Inpatient	100	ME	6			6	6
Zonisamide 25 Mg Capsule	25001291	CDM	Inpatient	25	ME	6			6	6
Zonisamide 50 Mg Capsule	25001292	CDM	Inpatient	50	ME	6			6	6
Insulin Glargine	25001293	CDM	Inpatient	1	UN	5			5	5
QUETIAPINE FUMARATE 100 MG TAB	2501028	CDM	Inpatient	100	ME	5			5	5
4x4 Alldress Dressing	27000019	CDM	Inpatient			5			5	5
Acticoat Burn Dressing (3 Day)	27000028	CDM	Inpatient			5			5	5
Adult Wipes	27000042	CDM	Inpatient			22			22	22
Alcohol Preps	27000056	CDM	Inpatient			6			6	6
Alldress Dressing	27000058	CDM	Inpatient			5			5	5
Allevyn 4x4 Foam Dressing	27000059	CDM	Inpatient			5			5	5
Allevyn 4x4 Thin Dressing	27000060	CDM	Inpatient			5			5	5
Aloe Vesta Protective Ointment	27000061	CDM	Inpatient			5			5	5
Angio Catheter	27000063	CDM	Inpatient			5			5	5
Arm Sling	27000071	CDM	Inpatient			5			5	5
Baby Powder	27000073	CDM	Inpatient			5			5	5
Bandaid	27000095	CDM	Inpatient			5			5	5
Briefs	27000128	CDM	Inpatient			6			6	6
Briefs - X Large	27000129	CDM	Inpatient			6			6	6
Briefs - Large	27000130	CDM	Inpatient			6			6	6
Briefs - Medium	27000131	CDM	Inpatient			6			6	6
Briefs - Small	27000132	CDM	Inpatient			6			6	6
CATH TRAY W/BAG 16 FR	27000158	CDM	Inpatient			5			5	5
Cath Tray W/O Bag	27000159	CDM	Inpatient			5			5	5
COLOSTOMY POUCH	27000195	CDM	Inpatient			11.2			11.2	11.2
Comb	27000198	CDM	Inpatient			5			5	5
Connecting Tube	27000202	CDM	Inpatient			5			5	5
Denture Adhesive	27000221	CDM	Inpatient			5			5	5
Denture Cup	27000224	CDM	Inpatient			5			5	5
Deodorant	27000225	CDM	Inpatient			6			6	6
Dermal Wound Cleaner 1 Bottle	27000227	CDM	Inpatient			5			5	5
Dermal Wound Cleanser	27000228	CDM	Inpatient			5			5	5
DRAIN SPONGE 4X4 STERILE	27000240	CDM	Inpatient			5			5	5
Dressing Change Charge	27000246	CDM	Inpatient			5			5	5
Duoderm Dressing	27000257	CDM	Inpatient			5			5	5
E Cylinders	27000260	CDM	Inpatient			5			5	5
Efferdent(denture Cleaner Tab)	27000263	CDM	Inpatient			5			5	5
Egg Crate/Mattress Pad	27000264	CDM	Inpatient			5			5	5
Enema Bag With Soap	27000269	CDM	Inpatient			5			5	5
Ensure	27000270	CDM	Inpatient			5			5	5
Extension Set	27000278	CDM	Inpatient			5			5	5
Feeding Set	27000281	CDM	Inpatient			5			5	5
Fleets Enema	27000285	CDM	Inpatient			5			5	5
GAUZE 4X4 10 PK	27000304	CDM	Inpatient			6			6	6
Gauze Kerlix Roll	27000309	CDM	Inpatient			5			5	5
Gauze Sponge (2x2)	27000313	CDM	Inpatient			5			5	5
Gauze Sponge (4x4)	27000314	CDM	Inpatient			5			5	5
Glucerna	27000326	CDM	Inpatient			5			5	5
Glucose Strip	27000329	CDM	Inpatient			5			5	5
Graduated Container	27000333	CDM	Inpatient			5			5	5
Grav Set W/Rate Flow Reg	27000334	CDM	Inpatient			5			5	5
Gt Bag	27000335	CDM	Inpatient			5			5	5
Hair and Body Shampoo	27000336	CDM	Inpatient			22			22	22
Hair Brush	27000347	CDM	Inpatient			5			5	5
Heel Protectors	27000353	CDM	Inpatient			5			5	5
Hibiclens	27000358	CDM	Inpatient			5			5	5
Hose, Care Knee	27000373	CDM	Inpatient			5			5	5
Hydrogen Peroxide	27000383	CDM	Inpatient			5			5	5
Hypafix Tape (1 Roll)	27000384	CDM	Inpatient			5			5	5
INSULATED WATER CARAFE	27000389	CDM	Inpatient			5			5	5
Introcan 22g 1 In	27000392	CDM	Inpatient			5			5	5
Introcan 24g 3/4 In	27000393	CDM	Inpatient			5			5	5
Irrigation Tray W/Syringe	27000397	CDM	Inpatient			5			5	5
Iv Start Kit	27000406	CDM	Inpatient			5			5	5
Kerlix	27000410	CDM	Inpatient			5			5	5
Kleenex	27000431	CDM	Inpatient			5			5	5
Lancet	27000436	CDM	Inpatient			5			5	5
Lanciceptic Protective Barrier	27000437	CDM	Inpatient			5			5	5
Lemon Glycerin Swabs	27000441	CDM	Inpatient			5			5	5
Lice Treatment	27000442	CDM	Inpatient			5			5	5
Lip Balm	27000444	CDM	Inpatient			5			5	5
Lotion Hand/Body	27000446	CDM	Inpatient			5			5	5
LUBRICATING JELLY	27000450	CDM	Inpatient			5			5	5
Messengile Douche	27000479	CDM	Inpatient			5			5	5
Mouthwash	27000481	CDM	Inpatient			5			5	5
Nacl 4 Meq/Ml 250ml	27000484	CDM	Inpatient			5			5	5
Nail File	27000486	CDM	Inpatient			5			5	5
Nail Polish Removwer Pad	27000487	CDM	Inpatient			5			5	5
Nasal Cannula	27000489	CDM	Inpatient			5			5	5
Nebulizer	27000491	CDM	Inpatient			5			5	5
NEEDLE	27000496	CDM	Inpatient			5			5	5
No Rinse Shampoo	27000506	CDM	Inpatient			5			5	5
O2 Concentrator	27000509	CDM	Inpatient			5			5	5
Perineal Cleaner	27000527	CDM	Inpatient			5			5	5
Posie Pads	27000539	CDM	Inpatient			5			5	5
Q-Tips	27000551	CDM	Inpatient			5			5	5
Razors	27000552	CDM	Inpatient			5			5	5
Seabond Denture Adhesive	27000567	CDM	Inpatient			5			5	5
Shave Cream	27000577	CDM	Inpatient			5			5	5
Skin Prep Pad	27000586	CDM	Inpatient			5			5	5
Slipper Socks	27000593	CDM	Inpatient			5			5	5
Smart-Site Vital Adapter	27000596	CDM	Inpatient			5			5	5
Soap Bar	27000597	CDM	Inpatient			5			5	5
Solo Site Wound Gel (1 Tube)	27000600	CDM	Inpatient			5			5	5
Speci-Hat	27000605	CDM	Inpatient			6			6	6
Specimen Container (sterile)	27000606	CDM	Inpatient			6			6	6
Splint, Cock-Up Wrist	27000611	CDM	Inpatient			28.72			28.72	28.72
Staple Remover Kit	27000614	CDM	Inpatient			6			6	6
Sterile Water/Normal Saline	27000622	CDM	Inpatient			5			5	5
STERILE WATER/NORMAL SALINEINJ	27000623	CDM	Inpatient			7			7	7
STRAIGHT CATHETER	27000626	CDM	Inpatient			5			5	5
Suture Removal Kit	27000631	CDM	Inpatient			5			5	5
Syringe	27000638	CDM	Inpatient			5			5	5
Syringe 3cc	27000644	CDM	Inpatient			6			6	6
Syringe With Needle	27000655	CDM	Inpatient			5			5	5
SYRINGE/ALLERGY/INSULIN/TB	27000658	CDM	Inpatient			6			6	6
Tega Derm Transparent Dressing	27000667	CDM	Inpatient			5			5	5
Telfa Dressing	27000673	CDM	Inpatient			5			5	5
Thick It	27000684	CDM	Inpatient			5			5	5
Toothbrush	27000690	CDM	Inpatient			5			5	5
Toothette	27000691	CDM	Inpatient			5			5	5
Toothpaste	27000692	CDM	Inpatient			3			3	3
Tubing	27000714	CDM	Inpatient			5			5	5
Ultrasite Valve-Pos Pres	27000723	CDM	Inpatient			5			5	5
Underpads	27000725	CDM	Inpatient			5			5	5
Urinal	27000727	CDM	Inpatient			5			5	5
Vaseline	27000737	CDM	Inpatient			5			5	5
Vial Adapter	27000747	CDM	Inpatient			5			5	5
Vista Pump	27000750	CDM	Inpatient			5			5	5
Vista Pump Set	27000751	CDM	Inpatient			5			5	5
Wash Basin	27000754	CDM	Inpatient			5			5	5
Water Pitcher	27000757	CDM	Inpatient			8			8	8
Wound Cleaner	27000767	CDM	Inpatient			5			5	5
Wound Gel	27000769	CDM	Inpatient			5			5	5
Emery Board	27000781	CDM	Inpatient			5			5	5
Emesis Basin	27000783	CDM	Inpatient			5			5	5
Periph Insert Cent Cath 4 Fr	27000796	CDM	Inpatient			5			5	5
B.D. Neelde	27000797	CDM	Inpatient			5			5	5
Distilled Water	27000798	CDM	Inpatient			5			5	5
Steri Strips	27000799	CDM	Inpatient			5			5	5
Eucerin Repair Cream 4oz	27000800	CDM	Inpatient			5			5	5
Sling Arm Large	27000801	CDM	Inpatient			5			5	5
Splint Wrist Forearm Left	27000802	CDM	Inpatient			5			5	5
Dentips Oral Swabsticks	27000808	CDM	Inpatient			5			5	5
Biotine Drymouth Rinse	27000813	CDM	Inpatient			5			5	5
Decannulation Plug	27000814	CDM	Inpatient			5			5	5
Phytoplex N/Rense 8oz cleanser	27000815	CDM	Inpatient			5			5	5
Bladder Irrigation Set Cysto	27000816	CDM	Inpatient			5			5	5
Bladder Irrigation Y-Type Tur	27000817	CDM	Inpatient			5			5	5
Catheter Iv Insyte 20gx1.16	27000818	CDM	Inpatient			5			5	5
Ear Protector E-Z Wrap	27000819	CDM	Inpatient			5			5	5
Briefs-XXL	27000820	CDM	Inpatient			5			5	5
Sacrum Foam Dressing Each	27000841	CDM	Inpatient			5			5	5
Bougie Endotrach Tube Intro	27000843	CDM	Inpatient			5			5	5
24 Hour Abp Monitor	30000001	CDM	Inpatient			5			5	5
340 Measure Volume	30000002	CDM	Inpatient			5			5	5
Afb Culture	30000004	CDM	Inpatient			5			5	5
Afb Sensitivity	30000005	CDM	Inpatient			5			5	5
Aldosterone Bld	30000006	CDM	Inpatient			5			5	5
Amitriptyline	30000007	CDM	Inpatient			5			5	5
Ana Titer & Pattern	30000008	CDM	Inpatient			5			5	5
Anti Scl 70	30000010	CDM	Inpatient			5			5	5
Antigen Type	30000012	CDM	Inpatient			5			5	5
Aso Titer	30000013	CDM	Inpatient			5			5	5
Bld Type Abo/Rh	30000016	CDM	Inpatient			5			5	5
Bld Type Du	30000017	CDM	Inpatient			5			5	5
Bone Marrow Studies	30000019	CDM	Inpatient			5			5	5
Cbc With Auto Diff	30000024	CDM	Inpatient			5			5	5
Cell Count Csf	30000025	CDM	Inpatient			5			5	5
Chlamydia by Probe	30000026	CDM	Inpatient			5			5	5
Chlamydia Group Ab	30000027	CDM	Inpatient			5			5	5
Clonazepam/Clozaril	30000028	CDM	Inpatient			5			5	5
Cmv Igm Ql	30000029	CDM	Inpatient			5			5	5
Crystal Id Synovial	30000033	CDM	Inpatient			5			5	5
Directogen Serum	30000034	CDM	Inpatient			5			5	5
Dsdna Auto Ab's	30000036	CDM	Inpatient			5			5	5
Drug Screen With Alcohol	30000037	CDM	Inpatient			5			5	5
Eosinphhil Count	30000039	CDM	Inpatient			5			5	5
Epstein Barr Ea	30000040	CDM	Inpatient			5			5	5
Epstein Barr Ebna	30000041	CDM	Inpatient			5			5	5
Epstein Barr Vca	30000042	CDM	Inpatient			5			5	5
Era	30000043	CDM	Inpatient			5			5	5
Febrile Agglut Each	30000046	CDM	Inpatient			5			5	5
Fecal Fat	30000047	CDM	Inpatient			5			5	5
Fibren Split Product	30000048	CDM	Inpatient			5			5	5
Fibrinogen Quan	30000049	CDM	Inpatient			5			5	5
Flow Cytometry Dna	30000050	CDM	Inpatient			5			5	5
H Pylori	30000052	CDM	Inpatient			5			5	5
Handling Fee	30000053	CDM	Inpatient			5			5	5
Hemo Influenza	30000055	CDM	Inpatient			5			5	5
Hep C Viral Rna/Dna	30000056	CDM	Inpatient			5			5	5
Hepatitis B Core Ab	30000057	CDM	Inpatient			5			5	5
Hepatitis B Surf Ab	30000058	CDM	Inpatient			5			5	5
Hepatitis C, Ab	30000059	CDM	Inpatient			5			5	5
Hepatitis E, Ab	30000060	CDM	Inpatient			5			5	5
Hepatitus B Srfce Ag	30000061	CDM	Inpatient			5			5	5
Herpes Virus Non Spe	30000062	CDM	Inpatient			5			5	5
Hiv	30000063	CDM	Inpatient			5			5	5
Hiv Dna by Pcr	30000064	CDM	Inpatient			5			5	5
Hiv Viral Load	30000065	CDM	Inpatient			5			5	5
Hiv Western Blot	30000066	CDM	Inpatient			5			5	5
Holter Monitor 24hr	30000069	CDM	Inpatient			5			5	5
Hpv Culture	30000070	CDM	Inpatient			5			5	5
Iep Except Serum	30000071	CDM	Inpatient			5			5	5
Iep Serum	30000072	CDM	Inpatient			5			5	5
Kell Ag Titer	30000073	CDM	Inpatient			5			5	5
Lupus Anticoagulant	30000076	CDM	Inpatient			5			5	5
Manuel Diff	30000078	CDM	Inpatient			5			5	5
Metanephrines Urine	30000079	CDM	Inpatient			5			5	5
Microalbumin Urine	30000080	CDM	Inpatient			5			5	5
Misc Immun Proc	30000081	CDM	Inpatient			5			5	5
Ob Screen	30000083	CDM	Inpatient			5			5	5
Occult Blood	30000084	CDM	Inpatient			5			5	5
Ova Paras Smears	30000085	CDM	Inpatient			5			5	5
Pertussis Smears	30000090	CDM	Inpatient			5			5	5
Phelebotomy Theraputi	30000091	CDM	Inpatient			5			5	5
Platelet Cnt	30000093	CDM	Inpatient			5			5	5
Platelet Count Auto	30000094	CDM	Inpatient			5			5	5
Pra	30000096	CDM	Inpatient			5			5	5
Protein Electrophore	30000098	CDM	Inpatient			5			5	5
Protime	30000099	CDM	Inpatient			5			5	5
Rapid Group A Strep	30000101	CDM	Inpatient			5			5	5
Rapid Group B Strep	30000102	CDM	Inpatient			5			5	5
Retic Absolute	30000103	CDM	Inpatient			5			5	5
Rheumatoid Arthritis Panel	30000104	CDM	Inpatient			5			5	5
Rocky Mountain Igg	30000105	CDM	Inpatient			5			5	5
Rpr	30000106	CDM	Inpatient			5			5	5
Rpr Titer	30000107	CDM	Inpatient			5			5	5
Rsv	30000108	CDM	Inpatient			5			5	5
Sed Rate	30000109	CDM	Inpatient			5			5	5
Semen Analysis Compl	30000111	CDM	Inpatient			5			5	5
Semen Post Vasectomy	30000112	CDM	Inpatient			5			5	5
Sickle Cell Prep	30000113	CDM	Inpatient			5			5	5
Smear Review by Path	30000115	CDM	Inpatient			5			5	5
Toxoplasma Ig6 Ab	30000117	CDM	Inpatient			5			5	5
Urea Breath Collect	30000118	CDM	Inpatient			5			5	5
Urinalysis	30000119	CDM	Inpatient			5			5	5
Urinalysis Chem Only	30000120	CDM	Inpatient			5			5	5
Urine Immun Fixation	30000124	CDM	Inpatient			5			5	5
Urine Microscopic	30000125	CDM	Inpatient			5			5	5
Urobilinogen Urn Qua	30000126	CDM	Inpatient			5			5	5
Varicella	30000127	CDM	Inpatient			5			5	5
Venipuncture	30000128	CDM	Inpatient			5			5	5
Wbc	30000129	CDM	Inpatient			5			5	5
West Nile Igm	30000131	CDM	Inpatient			5			5	5
Wet Mount	30000133	CDM	Inpatient			5			5	5
Abbott Covid 19 Id Rapid Test	30000136	CDM	Inpatient			5			5	5
BASIC METABOLIC	30080049	CDM	Inpatient			83			83	83
COMPREHENSIVE METABOLIC	30080054	CDM	Inpatient			401			401	401
LIPID PANEL, Fasting	30080061	CDM	Inpatient			100			100	100
DRUG SCREEN, URINE 1	30080101	CDM	Inpatient			5			5	5
DIGOXIN	30080162	CDM	Inpatient			5			5	5
Depakote Level	30080164	CDM	Inpatient			97			97	97
LITHIUM, SERUM	30080178	CDM	Inpatient			44			44	44
PHENOBARB	30080184	CDM	Inpatient			5			5	5
U/A w/MICROSCOPIC (UA)	30081000	CDM	Inpatient			81			81	81
URINE MICROSCOPIC ONLY	30081015	CDM	Inpatient			42			42	42
AMMONIA	30082140	CDM	Inpatient			166			166	166
HEMOCCULT X 1	30082270	CDM	Inpatient			5			5	5
KEPPRA	30082491	CDM	Inpatient			5			5	5
Accu Check	30082948	CDM	Inpatient			30			30	30
HEMOGLOBIN A1C	30083036	CDM	Inpatient			5			5	5
BNP	300835191	CDM	Inpatient			5			5	5
MAGNESIUM	300837352	CDM	Inpatient			5			5	5
PARATHYROID HORMONE	30083970	CDM	Inpatient			5			5	5
PHOSPHORUS	30084100	CDM	Inpatient			5			5	5
T4- THYROXINE	30084436	CDM	Inpatient			5			5	5
URIC ACID	30084550	CDM	Inpatient			5			5	5
CBC with automated Diff	30085025	CDM	Inpatient			118			118	118
CBC NO DIFF	30085027	CDM	Inpatient			5			5	5
PT W/INR	30085610	CDM	Inpatient			5			5	5
SED RATE	30085651	CDM	Inpatient			5			5	5
HIGH SENSITIVITY CRP	30086141	CDM	Inpatient			5			5	5
RPR	30086592	CDM	Inpatient			5			5	5
BLOOD CULTURE	30087040	CDM	Inpatient			5			5	5
URINE CULTURE	30087086	CDM	Inpatient			62			62	62
C. DIFFICILE, STOOL	30087324	CDM	Inpatient			52			52	52
INFLUENZA A&B (SWAB	30087804	CDM	Inpatient			5			5	5
Acetone, Quant	30100001	CDM	Inpatient			5			5	5
Acetylcholine Recep	30100002	CDM	Inpatient			5			5	5
Actaminophen	30100005	CDM	Inpatient			5			5	5
Albumin Serum	30100009	CDM	Inpatient			5			5	5
Alcohol Urine	30100011	CDM	Inpatient			5			5	5
Aldolase	30100012	CDM	Inpatient			5			5	5
Alk Phos Isoenzymes	30100013	CDM	Inpatient			5			5	5
Alkaline Phosphatas	30100015	CDM	Inpatient			5			5	5
Alpha-1-Antitrypsiniphe	30100016	CDM	Inpatient			5			5	5
Alpha-Fetoprotein Amnio	30100017	CDM	Inpatient			5			5	5
Alpha-Fetoprotein Serum	30100018	CDM	Inpatient			5			5	5
Amikacin	30100019	CDM	Inpatient			5			5	5
Ammonia Blood	30100021	CDM	Inpatient			5			5	5
Amniostat	30100022	CDM	Inpatient			5			5	5
Amylase Serum	30100026	CDM	Inpatient			5			5	5
Angiotensin Conv Enzyme	30100029	CDM	Inpatient			5			5	5
Antidiuretic Hormone	30100030	CDM	Inpatient			5			5	5
Anti-Histone Abs	30100032	CDM	Inpatient			5			5	5
B Naturetic Peptide	30100036	CDM	Inpatient			5			5	5
Barbiturates Confir	30100037	CDM	Inpatient			5			5	5
Basic Metabolic Panel	30100039	CDM	Inpatient			5			5	5
Beta 2 Macroglobulin	30100040	CDM	Inpatient			5			5	5
Beta Hcg Quant Serum	30100041	CDM	Inpatient			5			5	5
Bilirubin Direct	30100042	CDM	Inpatient			5			5	5
Bilirubin Total	30100043	CDM	Inpatient			5			5	5
C Peptide	30100048	CDM	Inpatient			5			5	5
Calcium Blood	30100049	CDM	Inpatient			5			5	5
Calcium Ionized	30100050	CDM	Inpatient			5			5	5
Calcium Urine 24	30100051	CDM	Inpatient			5			5	5
Carbamazepine (tegretol)	30100052	CDM	Inpatient			5			5	5
Carbon Diox Co2	30100053	CDM	Inpatient			5			5	5
Catecholamines Total Urin	30100058	CDM	Inpatient			5			5	5
Cea	30100059	CDM	Inpatient			5			5	5
Ceruloplasmin	30100060	CDM	Inpatient			5			5	5
Chloride Blood	30100062	CDM	Inpatient			5			5	5
Chloride Spinal Fluid	30100064	CDM	Inpatient			5			5	5
Chloride Urine	30100065	CDM	Inpatient			5			5	5
Cholesterol Hdl	30100066	CDM	Inpatient			5			5	5
Cholesterol Total	30100067	CDM	Inpatient			5			5	5
Cholinesterase	30100068	CDM	Inpatient			5			5	5
Comp Metabolic Panel	30100072	CDM	Inpatient			5			5	5
Cortisol Serum	30100077	CDM	Inpatient			5			5	5
Cpk Isoenzymes	30100078	CDM	Inpatient			5			5	5
Cpk-Mb	30100079	CDM	Inpatient			5			5	5
Creatine Kinase Cpk Total	30100080	CDM	Inpatient			5			5	5
Creatinine Clearance	30100082	CDM	Inpatient			5			5	5
Creatinine Serum	30100083	CDM	Inpatient			5			5	5
Creatinine Urine	30100084	CDM	Inpatient			5			5	5
Cryoglobulin	30100086	CDM	Inpatient			5			5	5
Cyclosporine Level	30100088	CDM	Inpatient			5			5	5
Dhea S Serum	30100090	CDM	Inpatient			5			5	5
Digoxin Lab	30100092	CDM	Inpatient			5			5	5
Dimeric Inhibin A	30100093	CDM	Inpatient			5			5	5
Drug Screen Urine	30100095	CDM	Inpatient			5			5	5
Electrolyte Panel	30100099	CDM	Inpatient			5			5	5
Erythropoietin	30100102	CDM	Inpatient			5			5	5
Estradiol Serum	30100103	CDM	Inpatient			5			5	5
Estriol Unconjugate	30100104	CDM	Inpatient			5			5	5
Estrogen Level	30100105	CDM	Inpatient			5			5	5
Eth0suximide	30100108	CDM	Inpatient			5			5	5
Ethylene Glycol	30100109	CDM	Inpatient			5			5	5
Ferritin	30100112	CDM	Inpatient			5			5	5
Folic Acid Rbc	30100114	CDM	Inpatient			5			5	5
Folic Acid, Serum	30100115	CDM	Inpatient			5			5	5
Fsh Follicle Stim-Ho	30100116	CDM	Inpatient			5			5	5
Gastrin Serum	30100118	CDM	Inpatient			5			5	5
Gentamicin Level	30100120	CDM	Inpatient			5			5	5
Ggt	30100121	CDM	Inpatient			5			5	5
Gloucose Body Fluid	30100122	CDM	Inpatient			5			5	5
Glucose	30100124	CDM	Inpatient			5			5	5
Glucose 5 Hr	30100125	CDM	Inpatient			5			5	5
Glucose Tol 2 Hr	30100132	CDM	Inpatient			5			5	5
Glucose Whole Blood	30100134	CDM	Inpatient			5			5	5
Glyconhemoglobin A1c	30100136	CDM	Inpatient			5			5	5
Haptoglobin Quant	30100139	CDM	Inpatient			5			5	5
Heavy Metal Qt Each	30100140	CDM	Inpatient			5			5	5
Hemoglobin Electroph	30100141	CDM	Inpatient			5			5	5
Hep C Pcr,quant	30100146	CDM	Inpatient			5			5	5
Hepatitus Panel	30100148	CDM	Inpatient			5			5	5
Hiaa Urine	30100149	CDM	Inpatient			5			5	5
Homocystine Serum	30100150	CDM	Inpatient			5			5	5
Hydroxyprogesterone 17-D	30100154	CDM	Inpatient			5			5	5
Immunoglobulin E	30100156	CDM	Inpatient			5			5	5
Immunoglobulin Iga Only	30100157	CDM	Inpatient			5			5	5
Insulin Total	30100163	CDM	Inpatient			5			5	5
Iron Binding Capacity	30100166	CDM	Inpatient			5			5	5
Iron Serum	30100167	CDM	Inpatient			5			5	5
L/S Ratio	30100173	CDM	Inpatient			5			5	5
Lactic Acid	30100175	CDM	Inpatient			5			5	5
Ldh	30100177	CDM	Inpatient			5			5	5
Ldh Isoenzymes	30100179	CDM	Inpatient			5			5	5
Ldl Measured	30100181	CDM	Inpatient			5			5	5
Lead Blood	30100182	CDM	Inpatient			5			5	5
Lipase	30100184	CDM	Inpatient			5			5	5
Lipid Profile	30100185	CDM	Inpatient			5			5	5
Lithium Quan	30100186	CDM	Inpatient			44			44	44
Liver Profile	30100188	CDM	Inpatient			5			5	5
Luteinizing Hormone	30100191	CDM	Inpatient			5			5	5
Magnesium	30100192	CDM	Inpatient			5			5	5
Mercury	30100193	CDM	Inpatient			5			5	5
Methylmalonic Acid	30100196	CDM	Inpatient			5			5	5
Misc Chem/Tox	30100200	CDM	Inpatient			5			5	5
Myoglobin Urine	30100205	CDM	Inpatient			5			5	5
Noratriptyline	30100208	CDM	Inpatient			5			5	5
Osmolality Blood	30100220	CDM	Inpatient			5			5	5
Osmolality Urine	30100221	CDM	Inpatient			5			5	5
Osullivan	30100222	CDM	Inpatient			5			5	5
Parathyroid Hormone	30100223	CDM	Inpatient			5			5	5
Ph Body Fluid	30100226	CDM	Inpatient			5			5	5
Phenobarbital	30100227	CDM	Inpatient			5			5	5
Phenytoin/Dilantin	30100229	CDM	Inpatient			5			5	5
Phosphorus Serum	30100233	CDM	Inpatient			5			5	5
Porphyrins Urine 24hr	30100237	CDM	Inpatient			5			5	5
Potassium Serum	30100240	CDM	Inpatient			5			5	5
Potassium Urine	30100241	CDM	Inpatient			5			5	5
Pre Albumin	30100242	CDM	Inpatient			5			5	5
Preg Test Quan Bhcg	30100243	CDM	Inpatient			5			5	5