
In 2017 the Senate spent a lot of time discussing ways to increase transparency in healthcare. Senate Bill (SB) 17-065 passed, which ensures that “self-pay” prices of common health care services are accessible to the public. We at Lincoln Health actively supported this bill because it aligns with our principle of providing the highest level of quality healthcare to our community at the lowest price possible.
IF YOU ARE COVERED BY HEALTH INSURANCE, YOU ARE STRONGLY ENCOURAGED TO CONSULT WITH YOUR HEALTH INSURER TO DETERMINE ACCURATE INFORMATION ABOUT YOUR FINANCIAL RESPONSIBILITY FOR A PARTICULAR HEALTH CARE SERVICE PROVIDED AT LINCOLN COMMUNITY HOSPITAL, CLINICS OR CARE CENTER. IF YOU ARE NOT COVERED BY HEALTH INSURANCE, YOU ARE STRONGLY ENCOURAGED TO CONTACT OUR BUSINESS OFFICE AT 719-743-2421 ext 3222 TO DISCUSS PAYMENT OPTIONS PRIOR TO RECEIVING A HEALTH CARE SERVICE FROM THIS HEALTH CARE FACILITY SINCE POSTED HEALTH CARE PRICES MAY NOT REFLECT THE ACTUAL AMOUNT OF YOUR FINANCIAL RESPONSIBILITY.
In-Patient Charges
36415 | Lab- Veinpuncture | $20.00 |
---|---|---|
85025 | Lab-Complete Blood Count | $43.00 |
80048 | Lab-Basic Metabolic Panel | $125.00 |
80053 | Lab-Comprehensive Metabolic Panel | $145.00 |
97162 | Physical Therapy- PT Evaluation Moderate | $150.00 |
71020 | Radiology- Chest 2 View X-Ray | $295.00 |
97110 | Physical Therapy- Therapeutic Exercise 15 minute session | $70.00 |
97530 | Physical Therapy- Functional Evaluation 15 minute session | $70.00 |
83880 | Lab-B Type Natriuretic Peptide (BNP) | $85.00 |
81001 | Lab-Routine UA | $18.00 |
93005 | Radiology-Electrocardiogram (EKG) | $225.00 |
85610 | Lab-Protime | $45.00 |
97116 | Physical Therapy-Gait Training (Complex) 15 minute session | $70.00 |
97165 | Occupational Therapy-Evaluation Low Complexity | $150.00 |
97166 | Occupational Therapy-Evaluation Moderate Complexity | $150.00 |
97535 | Physical Therapy-Activites/ Daily Living Evaluation | $70.00 |
84512 | Lab- Troponin | $155.00 |
83735 | Lab- Magnesium Test | $45.00 |
97161 | Physical Therapy- PT Evaluation Low Complexity | $150.00 |
87086 | Lab-Urine Culture | $29.70 |
84443 | Lab-Thyroid Stimulating Hormone (THS) | $65.00 |
87040 | Lab-Aerobic/ Anaerobic Blood Culture | $145.00 |
82270 | Lab-Hemoculture | $30.00 |
80202 | Lab-Vancomycin Peak Test | $0.00 |
36592 | Lab-IV PICC Line Insertion | $125.00 |
83605 | Lab-Lactate | $110.00 |
93307 | Radiology-Echocardiogram Complete | $1575.00 |
94762 | Respiratory Therapy-Pulse Ox/O2 Saturation | $21.60 |
85379 | Lab-D-Dimer | $165.00 |
83036 | Lab-Hemoglobin A1c | $125.00 |
Out-Patient Charges
99214 | Clinic – Office Visit Established Patient, Level 2 | $210.00 |
---|---|---|
85025 | Lab-Complete Blood Count | $43.00 |
80053 | Lab – Comprehensive Metabolic Panel | $145.00 |
99213 | Clinic – Office Visit Established Patient, Level 3 | $135.00 |
99211 | Clinic – Office Visit Established Patient, Level 1 | $150.00 |
85610 | Lab – Protime | $45.00 |
80061 | Lap Lipid Profile | $65.00 |
96372 | ER Injection | $27.00 |
99283 | ER Level 3 ER Visit | $805.00 |
90471 | Clinic-Immunization Administration Fee | $8.00 |
90832 | Behavioral Health- 30 minute Individual Session | $70.00 |
93005 | Radiology- Diagnostic Electrocardiogram (EKG) | $225.00 |
36592 | Lab- Blood Draw | $125.00 |
71020 | Radiology- Chest Tube View X-Ray | $295.00 |
99284 | ER- Level 4 ER Visit | $1314.00 |
99201 | Clinic-Office Visit New Patient Level 1 | $100.00 |
90656 | Pharmacy- Flu Vaccination | $25.00 |
96365 | ER-IV Infusion First Hour | $343.00 |
97140 | Physical Therapy- Manual Therapeutic Exercise 15 minute session | $70.00 |
96374 | ER-IV Push-initial | $65.00 |
99080 | Clinic-Office Visit- CDL Physical | $50.00 |
81003 | Lab-Dipstick-UA Only | $8.00 |
99336 | Office Visit – Assisted Care Established Patient Moderate Complexity | $80.00 |
97162 | Physical Therapy- Evaluation Moderate Complexity | $150.00 |
99282 | ER-Level 2 ER Visit | $404.00 |
90853 | Behavioral Health- Group Counseling Session | $31.00 |
G0103 | Lab-Prostate Specific Antigen Screening (Annually) | $62.00 |
87430 | Lab-Rapid Group A | $18.00 |
96375 | ER-IV Infuison Additional After First Hour | $27.00 |
Our goal is to provide meaningful and reliable information to help you understand prices in advance of your procedure. We have put together the top inpatient and outpatient procedure costs for self-pay individuals to give you an estimate of the expected pricing for commonly provided health care services at Lincoln Health.
Actual prices on your final bill may vary from this information based on the patient’s medical condition, unknown circumstances or complications, final diagnosis, and recommended treatment ordered by the attending physician(s). Please be advised that while the hospital/clinic attempts to estimate the prices of care as accurately as possible, there may be significant variations between the prices listed and the actual price reflected on your final bill.
Use the tool below to create an estimate
Chargemaster
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | |
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1 | CDM Item Number | Revenue Code | Service ID | Service Description | Gross Charge | Discounted Cash Price | Minimum Negotiated Charge | Maximum Negotiated Charge | Payer Negotiated Charge: Aetna (Plan: Default) | Payer Negotiated Charge: Blue Cross Blue Shield of CO (Plan: Default) | Payer Negotiated Charge: Bright Health Plan (Plan: Default) | Payer Negotiated Charge: Cigna (Plan: Default) | Payer Negotiated Charge: Friday Health Plans of Colorado Inc (Plan: Default) | Payer Negotiated Charge: Great West Healthcare (Plan: Default) | Payer Negotiated Charge: Humana (Plan: Default) | Payer Negotiated Charge: Humana (Plan: Medicare Advantage) | Payer Negotiated Charge: Rocky Mountain Health Plan (Plan: Default) | Payer Negotiated Charge: Rocky Mountain Health Plan (Plan: Medicare Advantage) | Payer Negotiated Charge: United Healthcare (Plan: Default) | Payer Negotiated Charge: United Healthcare (Plan: Medicare Advantage) | ||
2 | 3010007 | 270 | TOURNIQUET | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
3 | 3010008 | 276 | INTRAOCULAR LENS (IOL) | 289 | 289 | |||||||||||||||||
4 | 3010009 | 270 | CHEST TUBE INSERTION TRAY | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
5 | 3010010 | 270 | BATH SPONGE W/HANDLE | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
6 | 3010011 | 270 | COMPRESSION DEVICE | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
7 | 3010012 | 270 | SEALEASY KIT | 91 | 91 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
8 | 3010013 | 270 | YANKAUER VENTED | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
9 | 3010014 | 270 | MEDSYSTEM TUBING | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
10 | 3010018 | 270 | PROTIME STRIP | 48 | 48 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
11 | 3010019 | 270 | A6456 | UNNA BOOT | 69 | 69 | ||||||||||||||||
12 | 3010020 | 270 | PROBE DISP | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
13 | 3010021 | 270 | HYBRESIS PATCH | 90 | 90 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
14 | 3010025 | 270 | L4350 | AIR STIRRUP | 237 | 237 | ||||||||||||||||
15 | 3010029 | 270 | A4565 | ARM SLING MD | 38 | 38 | 23.56 | 23.56 | 23.56 | |||||||||||||
16 | 3010030 | 270 | MECONIUM ASPIRATOR | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
17 | 3010031 | 270 | MASK C-PAP MD 1/2 | 492 | 492 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
18 | 3010033 | 270 | THUMB SPICA RIGHT | 69 | 69 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
19 | 3010034 | 270 | DUPEL ELECTRODES | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
20 | 3010035 | 270 | PEAK FLOW METER | 100 | 100 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
21 | 3010036 | 278 | C1751 | POWER PICC | 1279 | 1279 | ||||||||||||||||
22 | 3010038 | 270 | ENDO SPATULA | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
23 | 3010039 | 270 | ENDO PISTOL | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
24 | 3010040 | 270 | THERACANE | 126 | 126 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
25 | 3010041 | 270 | THERABAND | 9 | 9 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
26 | 3010042 | 270 | MAX CORE | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
27 | 3010043 | 270 | WAFFLE BOOT | 182 | 182 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
28 | 3010044 | 270 | DECLOGGER 18-24FR | 50 | 50 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
29 | 3010045 | 270 | DECLOGGER 20-22FR | 63 | 63 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
30 | 3010046 | 270 | DINAMAP | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
31 | 3010047 | 270 | BITE STICK | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
32 | 3010048 | 270 | TOURNIQUET/ 15 MINUTES | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
33 | 3010049 | 270 | OSTOMY WAFER | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
34 | 3010050 | 279 | REACHER/ GRABBER | 74 | 74 | 0 | 0 | 0 | ||||||||||||||
35 | 3010051 | 270 | STOMAHESIVE PASTE [20 OZ] | 51 | 51 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
36 | 3010052 | 270 | POLYDERM | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
37 | 3010053 | 270 | EPISTAXIS KIT | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
38 | 3010054 | 270 | CERVICAL TRACTION UNIT | 226 | 226 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
39 | 3010055 | 271 | KNUCKLE BENDER | 223 | 223 | 38.86 | 38.86 | 38.86 | ||||||||||||||
40 | 3010056 | 270 | ACAPELLA | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
41 | 3010057 | 270 | MEPILEX/BORDER 4X4 | 48 | 48 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
42 | 3010058 | 270 | MEPILEX 4X4 | 44 | 44 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
43 | 3010059 | 270 | PLEURX DRAIN | 447 | 447 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
44 | 3010060 | 270 | ENDO FAN 10MM | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
45 | 3010061 | 270 | PNEUMOTHORAX 14G | 88 | 88 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
46 | 3010062 | 270 | AED PED PAD | 466 | 466 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
47 | 3010063 | 270 | CPAP AMBULANCE | 265 | 265 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
48 | 3010064 | 270 | A4629 | TRACHEOSTOMY CARE KIT | 31 | 31 | ||||||||||||||||
49 | 3010065 | 270 | DRAPE MINOR PROCEDURE | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
50 | 3010066 | 270 | A4649 | SUTURE CHROM 5-0 687G | 70 | 70 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
51 | 3010067 | 270 | A4649 | SUTURE VICRYL O J978 | 19 | 19 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
52 | 3010068 | 270 | A4649 | SUTURE VICRYL 2-0 J269-87 | 18 | 18 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
53 | 3010070 | 270 | A4649 | SUTURE VICRYL 5-0 J495 | 39 | 39 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
54 | 3010071 | 270 | A4649 | SUTURE ETHILON 3-0 669 | 19 | 19 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
55 | 3010072 | 270 | A4649 | SUTURE ETHILON 3-0 663 | 19 | 19 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
56 | 3010073 | 270 | A4649 | SUTURE PROLENE 0 8434 | 23 | 23 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
57 | 3010074 | 270 | A4649 | SUTURE PROLENE 5-0 8605 | 37 | 37 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
58 | 3010075 | 270 | A4649 | SUTURE ETHILON 3-0 669H | 18 | 18 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
59 | 3010076 | 270 | A4649 | SUTURE ETHILON 3-0 663H | 69 | 69 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
60 | 3010077 | 270 | A4649 | SUTURE PROLENE 0 8434H | 24 | 24 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
61 | 3010078 | 270 | A4649 | SUTURE VICRYL 0 J978H | 18 | 18 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
62 | 3010079 | 270 | A4649 | SUTURE VICRYL 2-0 J269H | 17 | 17 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
63 | 3010081 | 270 | A4649 | SUTURE CHROMIC 687G | 63 | 63 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
64 | 3010082 | 270 | TOE CAP/ VISCO (GEL) | 29 | 29 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
65 | 3010083 | 270 | INSOLE/ FULL LENGTH GEL | 182 | 182 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
66 | 3010084 | 270 | EXTENSION SET (MICRO) | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
67 | 3010085 | 270 | ELECTRODE/ STANDRD NEEDLE | 37 | 37 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
68 | 3010086 | 270 | DRAPE/ FENESTRATION | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
69 | 3010087 | 270 | CATH CLEAN | 25 | 25 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
70 | 3010088 | 270 | TENDER GRIP | 14 | 14 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
71 | 3010089 | 270 | DEPENDS SLIP-ON MEDIUM | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
72 | 3010090 | 270 | CANNULA- ENDOBIOPSY | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
73 | 3010091 | 270 | EAKIN SEAL 4" | 40 | 40 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
74 | 3010092 | 270 | L3480 | TULLI HEEL CUP REG | 130 | 130 | ||||||||||||||||
75 | 3010093 | 270 | STOMACH TUBE SUMP 10FR | 48 | 48 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
76 | 3010094 | 270 | ALLEVYN 4X4 | 59 | 59 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
77 | 3010095 | 270 | A4649 | SUTURE ETHILON 5.0 1666 | 69 | 69 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
78 | 3010096 | 270 | SAM PELVIC SLING | 486 | 486 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
79 | 3010097 | 270 | Q4051 | SAM SPLINT 36" | 191 | 191 | ||||||||||||||||
80 | 3010098 | 270 | SAM SPLINT 18" | 158 | 158 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
81 | 3010099 | 270 | MAXORB DRESSING 2X2 | 27 | 27 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
82 | 3010100 | 270 | A4649 | SUTURE PROLENE 4.0 8634 | 69 | 69 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
83 | 3010102 | 270 | KATZ EXTRACTOR | 552 | 552 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
84 | 3010103 | 270 | COTTON TIP APPLICATOR | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
85 | 3010104 | 270 | DEPENDS - INDIVIDUAL | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
86 | 3010107 | 270 | MEDIFIX (BOX) | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
87 | 3010116 | 270 | CATH KIT UNIVERSAL | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
88 | 3010117 | 270 | ALLEVYN HEEL 9X9 | 132 | 132 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
89 | 3010118 | 270 | A6212 | MEPILEX - SACRUM | 90 | 90 | ||||||||||||||||
90 | 3010119 | 270 | MEPILEX/BORDER 3X3 | 48 | 48 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
91 | 3010120 | 270 | ANTI REFLUX VALVE | 121 | 121 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
92 | 3010121 | 270 | URINAL/FEMALE | 4 | 4 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
93 | 3010122 | 270 | A4649 | SUTURE VICRYL 4-0 J392H | 69 | 69 | 0 | 135.04 | 0 | 0 | 135.04 | |||||||||||
94 | 3010123 | 270 | MEPILEX/BORDER 1.6X2 | 48 | 48 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
95 | 3010125 | 270 | GLIDE SCOPE SZ 3 | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
96 | 3010126 | 270 | HEEL LIFT | 45 | 45 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
97 | 3010127 | 270 | ESMARK 3" | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
98 | 3010128 | 270 | OB INSTRUMENT TRAY | 0 | 0 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
99 | 3010131 | 270 | INFANT WARMER | 30 | 30 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 | ||||||||
100 | 3010132 | 270 | MINOR CLINIC SET | 27 | 27 | 0 | 55.2 | 0 | 21.48 | 55.2 | 23.59 | 15.61 | 27.39 | 15.39 |