Information Effective As of 01/09/2023 "FacilityCode","FacilityName","PayerName","Term Group Name","Standard Patient Type","Term Type","Reimbursement Method","Chargemaster Fields_Gross Charge (IPFee)","Chargemaster Fields_ChargeItemCode","Chargemaster Fields_Description","Chargemaster Fields_Default CPT Code","Fee Schedule Fields_Code","Fee Schedule Fields_Rate","Fee Schedule Fields_Name","Fee Schedule Fields_Method","Fee Schedule Fields_Rate Multiplier","Fee Schedule Fields_Non-Facility Total Amt","Fee Schedule Fields_Blended Rate","LTACH PPS Fields_LTACH PPS Reimbursement","LTACH PPS Fields_LTACH PPS Reimbursement %","Term Criteria (Includes Advanced)","% of Charge Reimbursement","Per Case Rate Reimbursement","Per Diem Reimbursement","Tiered Per Diem Fields_Tiered Per Diem Start Day","Tiered Per Diem Fields_Tiered Per Diem End Day","Tiered Per Diem Fields_Method","Tiered Per Diem Fields_Rate","Level of Care Fields_LOC Service","Level of Care Fields_LOC Rate","Per Day of Service Fields_Tier","Per Day of Service Fields_Rate","Per Day of Service Fields_Method","Per Day of Service Fields_Start Day","Per Day of Service Fields_End Day","Per Day of Service Fields_By Service Date","Per Day of Service Fields_By Unit Within Service Date","Per Day of Service Fields_Apply Maximum Stop Cap","Per Day of Service Fields_Maximum Stop Cap","Medicare Inpatient Fields_DRG Labor Portion","Medicare Inpatient Fields_DRG Non-Labor Portion","Medicare Inpatient Fields_Blended Rate","Medicare Inpatient Fields_Area Wage Index","Medicare Inpatient Fields_Geographical Adjustment Factor","Medicare Inpatient Rehab Fields_CMG Labor Portion","Medicare Inpatient Rehab Fields_CMG Non-Labor Portion","Medicare Inpatient Rehab Fields_Facility Standard Rate","Medicare Inpatient Rehab Fields_Wage Index Factor","Professional Percent of Charge Fields_Percent","Medicare Inpatient Psych Fields_Rate Multiplier","Medicare Inpatient SNF Fields_AIDS Adjustment Factor","Advance Criteria Calculation FIELDS_Formula","Discounted Cash Price" "4851","Kindred Hospital Lima","AARP","HD Med Sup","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","AARP","HD Med Sup","I","Standard Term","Combo-PercentOfChargeRM",,,,,,,,,,,,,," AND AND Accumulated Daily Charges > 0","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4500'","28",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4500' AND [Admission Date] >= '01/01/2018'","25",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4500'","28",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Aetna Better Health Ohio","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4500' AND [Admission Date] >= '01/01/2018'","25",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","American Health Holding","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","American Health Holding","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","85",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Americas Choice Provider Network LLC","Commercial","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Americas Choice Provider Network LLC","Commercial","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Americas Choice Provider Network LLC","Workers Comp","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Americas Choice Provider Network LLC","Workers Comp","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","90",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Dialysis Rate","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","1969.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","1969.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bluegrass Family Health Inc","HD All","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","1350.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0350","459.00","CT Scan - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0351","459.00","CT Scan - Head","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0352","459.00","CT Scan - Body","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0359","459.00","CT Scan - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0636","35.00","Pharmacy-Extension of 025X - Drugs Requiring Detailed Coding","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 1000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0800","408.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0801","408.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0802","408.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0803","408.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0804","408.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Carve Out Term","UB92RM",,,,,"0809","408.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","2728.50",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","2728.50",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","3182.40",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","3182.40",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","2728.50",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","994.50",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1530.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Comm","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","765.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Medicare","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Medicare","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Bright Health","HD Medicare","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] <= '12/31/2016'","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] >= '01/01/2017' AND [Admission Date] <= '12/31/2017' AND [Facility Code] = '4835'","19",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] >= '01/01/2017' AND [Admission Date] <= '12/31/2017' AND [Facility Code] = '4851'","17",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] >= '01/01/2018'","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] <= '12/31/2016'","23",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] >= '01/01/2017'","21",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCR","I","Adjustment Term","AdvanceCriteriaCalculationRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Total Payments + 0.05 OR Calculated Reimbursement < Total Payments - 0.05 AND Calculated Reimbursement > 0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"((([Calculated Reimbursement] - [835 Patient Responsibility]) * -0.02 ) ) ", "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCR","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCR","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Buckeye Community Health Plan Lima","HD MCR","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD Exchange","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD Exchange","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","105","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD MA","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD MA","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD MCD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4500'","26.84",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Caresource Ohio","HD MCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] = '4851'","22.67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"0.01","36099999","OTHER RT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92210396","BETHANECHOL CL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92212887","TICLOPIDINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92213550","OXYCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92213656","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92214475","AMYLASE/LIPASE/PROTEASE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92215058","DELAVIRDINE MESYLATE 200MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92216311","ESTRADIOL ACETATE 0.45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92217538","LOPERAMIDE HCL 1MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.00","92220516","SODIUM CHLORIDE NASAL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92213247","SERTRALINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92214686","DIPHENHYDRAMINE HCL 25MG/10ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92214860","MIRTAZAPINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92215054","CILOSTAZOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92216434","CILOSTAZOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.05","92220032","SULFAMETHXZL/TMP 800-160MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.10","92211248","HYDROCODONE APAP 10-650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.10","92214853","MIRTAZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.10","92219020","CLONAZEPAM 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.10","92219356","BETHANECHOL CHLORIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.15","92214025","CARBIDOPA/LEVO 50/200 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.15","92215002","QUINAPRIL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.15","92218539","FIRST-VANCOMYCIN 2525 MG/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.15","92218786","POLYETH GLYCOL3350 17GM/PKTPWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.15","92219578","CAPTOPRIL 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.20","92210818","NITROGLYCERIN 0.1MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.20","92211162","ENALAPRIL MALEATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.20","92216659","BUPROPION HCL 100MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.20","92217121","TERBUTALINE SULF 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.20","92218292","MORPHINE SULFATE 15MG ER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.25","92211389","CAPTOPRIL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.25","92214867","CODEINE SULF 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.25","92215216","CILOSTAZOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.25","92215355","CILOSTAZOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.25","92219706","DOXYCYCLINEMONOHYDRATE100MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92210088","WARFARIN NA 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92210147","NITROGLYCERIN 0.2MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92211545","LOSARTAN POTASSIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92215698","MORPHINE 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92216580","BUPROPION HCL 100MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92216606","BUPROPION HCL 150MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.30","92219944","POLYETH GLYCOL 17GM/DOSE PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92210188","ATENOLOL CHLORTHAL 50-25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92211002","LORAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92214984","WARFARIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92215482","TAMOXIFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92217077","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92217590","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.35","92218386","POLYETH GLYCOL 17 GM/DOSE PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.37","92215474","TAMOXIFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92210392","RAMIPRIL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92210904","TAMOXIFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92211178","TAMOXIFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92212671","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92212991","DILTIAZEM HCL 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92213017","OXYCODONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92215498","RAMIPRIL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92216999","PROPRANOLOL HCL 80MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.40","92217419","ALPRAZOLAM 0.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.44","92211186","SALSALATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92210824","DIGOXIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92210934","CARBIDOPA/LEVO 50/200 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92211675","VERAPAMIL HCL 180MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92212412","BUPROPION HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92217178","RAMIPRIL 1.25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92218666","PEG 3350 17 GM/DOSE PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.45","92219651","SOLIFENACIN SUCCINATE 5 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92210675","KETOROLAC 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92213428","AMITRIPTYLINE HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92215794","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92217593","ERGOCALCIFEROL 50000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92217818","HYDROCORTISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92218099","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92218102","FENOFIBRATE 48MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92218168","CREON 15000-3000-9500U DR CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.50","92220108","FENOFIBRATE 48 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.55","92210284","TETRAHYDROZOLINE HCL 0.05% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.57","74020008","LOCM 200-299MG/ML IODINE/1ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92211021","LOXAPINE SUCCINATE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92211602","LOXAPINE SUCCINATE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92213519","PREDNISOLONE 15MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92216582","BUPROPION HCL 150MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92217527","PREDNISOLONE 15MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.60","92218326","NICOTINE 21MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.65","92217089","RAMIPRIL 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.65","92217359","DANTROLENE NA 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.65","92218783","BUPROPION 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.65","92219170","RAMIPRIL 1.25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92210184","ENALAPRIL MALEATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92210314","ENALAPRIL MALEATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92211163","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92214736","VENLAFAXINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92217820","ERGOCALCIFEROL 50000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.70","92218892","CARVEDILOL 3.125 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92211398","ACYCLOVIR 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92213077","FENOFIBRATE 134MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92216798","ZOLPIDEM TARTRATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92217129","OXYCODONE HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92217816","NATEGLINIDE 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92218258","ATORVASTATIN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92218886","METHYLPREDNISOLONE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92219032","OXYCODONE HCL CR 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.75","92219252","GUANFACINE HCL 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92210206","DIGOXIN 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92210746","CARBAMAZEPINE 200MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92212096","THEOPHYLLINE 600MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92212481","CARBAMAZEPINE 300MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92212792","ALBUTEROL SULF 4MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92214790","VERAPAMIL HCL 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.80","92216148","CARBAMAZEPINE 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92212020","DOXEPIN HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92212455","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92216380","ZONISAMIDE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92217766","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92218276","VICODIN 300-5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.85","92219613","ERGOCALCIFEROL 50000 UNITS CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92210114","CEFACLOR 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92210925","SODIUM CL NASAL SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92211663","FLECAINIDE ACETATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92212903","NITROFURANTOIN MCR 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92213670","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92217606","RIFAMPIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.95","92219804","BETALB/APAP/CAFF 50/325/40 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10.99","74020009","LOCM 300-399MG/ML IODINE/1ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.00","92214619","PARICALCITOL 5MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.01","38386449","HISTOPLASMA AB ","86698",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.05","92213952","NITROGLYCERIN 100MG/250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.05","92214337","ESTRADIOL 0.025MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.10","92216334","BUPRENORPHINE HCL 0.3MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.15","92216805","TIOTROPIUM BROMIDE 18MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.15","92220085","TIOTROPIUM 18 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.20","92204047","IV ADMIXTURE 47 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.20","92213590","SODIUM CL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.20","92217130","CIPROFLOXACIN 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.25","92212613","ESTRADIOL 0.075MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.25","92212621","ESTRADIOL 0.1MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.25","92219206","OSELTAMIVIR PHOSPH 75 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.50","92213392","MILRINONE D5W 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.50","92216409","PIPERACIL TAZOBACT 2.25GM/50 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.50","92217743","ASENAPINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.50","92220439","SODIUM PHOSPHATE 3MMOLE/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.60","92217021","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.60","92217532","SAXAGLIPTIN HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.60","92217539","SAXAGLIPTIN HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.60","92220275","HYDROCORTISONE 25 MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.70","92217756","OXYCODONE HCL 40MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.90","92212418","CASTOR/PERU BALSAM/TRYPSIN SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.90","92213335","TIMOLOL MALEATE 0.5% GFS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"100.92","38303110","HERPES SIMPLEX TYPE 1 ABY ","86695",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1001.45","92217319","ADVAIR 100-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1001.45","92217321","ADVAIR 250-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1002.00","33110587","KIT GJ MICKEY LOW PROFILE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1002.00","33114984","TUBE TRANSGAST JEJUN22FR3.0X45"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1002.05","92211257","FLUOCINONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1002.45","92219488","OSELTAMIVIR PHOS 6 MG/ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1003.25","92216565","ADVAIR HFA 45-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1004.55","92218047","ACTIVASE 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10040.80","92218804","PROTHROMBIN CMPLX-HUMAN500UKIT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1005.20","92215520","NITROGLYCERIN 0.4MG/ACT SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1006.00","73510030","SOMATOSENS EVOK POT LWR LIMBS ","95926",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1006.00","92211519","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1006.36","74000220","CYSTOGRAM 3+ VIEWS ","74430",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1007.00","72060006","RBC WASHED-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1007.00","92215039","FLUCONAZOLE 400MG/200 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1008.00","92201017","OPHTHALMICS 17 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1008.05","92212181","DOXEPIN HCL 5%CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1008.20","92219505","GENTAMICIN/PREDNIS 0.3%-1% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1009.76","74000880","IVP INTRAVENOUS W/WO KUB ","74400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.00","92215597","ATAZANAVIR SULF 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.00","92218213","EFFIENT 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.00","92218503","EFFIENT 5 MG Tablet "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.05","92220475","LINZOLID 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.10","38300686","SACCHAROMYCES CEREVISIAE AB ","86671",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.10","92213181","MORPHINE 200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.15","92213715","VENLAFAXINE HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.15","92215727","FOSAMPRENAVIR CALCIUM 700MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.25","92218036","EXALGO 16MG ER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.30","92217424","DONEPEZIL HCL 5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.35","92213685","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.35","92215411","LAMOTRIGINE 25MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.45","38303030","FUNGI MOLD ID ","87106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.45","38303747","FUNGUS/YEAST IDENTIFICATION ","87106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.45","92211348","KETOTIFEN FUMARATE 0.025% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.75","92210730","TICARCILLIN CLV K 3.1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.75","92215529","NEOMYCIN SULF/POLYMYX B/HC SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.75","92216352","PROPAFENONE HCL 325MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.85","92218117","FANAPT 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.88","38300007","IGG SUBCLASSES (EACH) ","82787",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.90","92210916","PIPERACIL TAZOBACT 3.375GM INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.90","92214108","NALOXONE HCL 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"101.95","92211066","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1010.20","92218843","LINEZOLID 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1014.61","34010290","NEG PRESS WOUND THER >50SQCM ","97606GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1019.05","34010286","NPWT DISP EQUIP >50 SQ CM ","97608GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.00","92204011","IV ADMIXTURE 12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.05","92214232","FENTANYL 25MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.10","92211445","BICALUTAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.15","38200845","AEROBIC ORGANISM ID ","87077",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.25","92218200","MEMANTINE 28MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.25","92218262","NAMENDA XR 14MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.62","38300146","INFLUENZA A ANTIGEN ","87804",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.62","38300147","INFLUENZA B ANTIGEN ","87804",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.62","38300326","INF AG DET BY IA INFLUENZA ","87804",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.70","92217446","FOSPHENYTOIN NA 75MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.73","38300157","ANGIOTENSIN CONVERT ENZYME ","82164",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.90","92213013","DOPAMINE HCL 400MG/D5W 500ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.90","92219338","NIMODIPINE 30 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"102.95","92215550","ORPHENADRINE CITRATE 30MG/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10216.80","92215333","DARBEPOETIN A 200MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10216.80","92215579","DARBEPOETIN A 200MCG/0.4ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1022.00","33199684","CATH TESIO DUAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1024.54","74001192","FLUORO EXAM GASTRO/COLON TUBE ","49465",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.00","92215399","ACTIV CHARCOAL POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.10","92210726","SULF-PRED 0.25-10% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.10","92216900","MARAVIROC 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.15","92212854","BICALUTAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.26","38201181","FECAL HGB IMMUNOASSAY ","82274",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.35","92216838","DEFEROXAMINE MESYLATE 500MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.40","92216592","ACTIQ 200MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38300016","GAMMAGLOBULIN IGM ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38300500","GAMMAGLOBULIN IGD FLUID ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38300501","GAMMAGLOBULIN IGD SERUM ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38300502","GAMMAGLOBULIN IGD URINE ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38303150","GAMMAGLOBULIN IGG ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.44","38303155","GAMMAGLOBULIN IGA ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.45","92210487","BELLADONNA/PHENOBARB ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.49","38302145","RUBELLA ANTIBODY ","86762",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.68","38307034","HIV-2 ANTIBODY ","86702",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.70","92210220","VANCOMYCIN HCL 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.75","92210362","BSS EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.75","92218751","ALFENTANIL HCL 2500MCG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.75","92219005","LIDO HYDRO/EPI 2%-1:200000 SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.90","38305091","THYROXINE BINDING GLOBULIN ","84442",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"103.90","92214582","UREA 10% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1030.35","92216312","MOMETASONE FUROATE 0.22MG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1031.97","75010015","EXT VEIN DUPLEX STUDY LIMIT RT","93971RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1031.97","75010016","EXT VEIN DUPLEX STUDY LIMIT LT","93971LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1034.95","92213803","DESMOPRESSIN ACET 0.01% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1035.49","73500090","AUDITORY EVOKED POTENTIAL ","92585",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1036.03","75000120","US VASC LTD-ABD/PELV/RETRPERI ","93976",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1036.55","92210361","HYDROCORTISONE BUTYR 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.02","38301547","PROTOZOA AB ","86753",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.10","92218716","OPANA ER 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.12","38300688","BORDETELLA PERTUSSIS AB ","86615",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.14","38301630","LACTIC ACID ","83605",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.22","38301720","LIPASE ","83690",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.40","92210316","METHYLPREDNISOLONE ACET 80MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.40","92217294","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.50","92216048","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.50","92218553","GLYCERIN . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.57","38300096","ALPHA 2 ANTIPLASMIN ","85410",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.68","38303812","CALCULUS (STONE) SPECTROSCOPY ","82365",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.73","38302146","RUBEOLA ANTIBODY ","86765",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"104.74","38305069","VITAMIN A LEVEL ","84590",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1040.00","92212800","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1041.50","92219799","OLOPATADINE 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1044.00","33152341","PORT VASC POWER PORT MRI 8FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1047.09","72000900","TRANSFUSION BLOOD/COMPONENT ","36430",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1047.10","92214234","PENTAMIDINE ISETHIONATE 300 PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.00","92216455","RISPERIDONE 4MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.05","38302303","T3 TOTAL ","84480",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.11","38303330","OXALATE ","83945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.15","92216802","TIOTROPIUM BROMIDE 18MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.15","92217915","MAGNESIUM CL 200MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.15","92219775","TIOTROPIUM BROM INH 18MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.15","92219780","TIOTROPIUM BROM INH 18MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.20","92218647","M.V.I.-12 W/O VITAMIN K SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.30","92215108","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.40","92214928","ZOLPIDEM TARTRATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.54","38300505","SEX HORMONE BINDING GLOBULIN ","84270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.60","92210219","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.60","92216925","CLOZAPINE 100MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.60","92219603","VANCOMYCIN HCL 1 GM/200 ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.70","92212454","ALUM AMMONIUM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.80","92210490","NALOXONE HCL 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.90","92216514","NAFCILLIN 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.90","92217149","OXACILLIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"105.98","38303586","CRYPTOCOCCUS LATEX AG SER ","86403",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1051.00","33104019","CATH HMDIAL 14.5FR25CM 19CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1051.00","33110387","CATH DIAL STRSYMTIP50CMX14.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1051.00","33152367","CATH DIAL TPRTIPSTR27CMx14.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1051.00","33152368","CATH DIAL TPRTIPSTR23CMx14.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1052.69","74000870","URETHA BLADDER VOIDING CYSTO ","74455",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10520.40","92217061","IMMUNE GLOBULIN 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1054.25","92214794","BACITRACIN/HC/NEO/POLY B EYE O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1057.75","74000975","ARTHROGRAM SHOULDER BILATERAL ","7304050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1057.75","74010017","ARTHROGRAM SHOULDER RT ","73040RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1057.75","74010018","ARTHROGRAM SHOULDER LT ","73040LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10579.80","92218343","VELCADE 3.5 MG VIAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1058.65","92212009","BLEPHAMIDE 0.2-10% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1058.65","92213002","PREDNISOLONE ACETATE 0.12% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1058.65","92213287","FLUOROMETHOLONE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1059.60","92212911","FLUOCINONIDE 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.00","92211960","LEVOFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.10","92214509","LEVOFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.24","38302965","ETHOSUXIMIDE ","80168",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.60","92215451","VASOPRESSIN 20U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.63","38300133","TTG TISSUETRANSGLUTAMINASE IGG","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.63","38300691","TISSUE TRANSGLUTAMINASE AB ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.63","38300697","GASTRIC PARIETAL CELL AB ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.63","38301929","GLIADIN ANTIBODIES ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.63","38399303","ANALYTE QUAL/SEMI QNT MULTI ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.65","92215470","TESTOSTERONE 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.69","38304121","D-DIMER SEMI QUANT ","85378",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.70","92211230","MEROPENEM 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.70","92215224","MODAFINIL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.75","38388700","DRUG DEFIN QUAL/QUANT NOS 1-3 ","80375",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.75","92215354","CASTOR/PERU BALSAM/TRYPSIN SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.75","92216812","CASTOR/PERU BALSAM/TRYPSIN SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.78","38301415","HELICOBACTER PYLORI AB ","86677",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"106.95","38303265","MUMPS ANTIBODY ","86735",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1060.70","92213093","ALTEPLASE RECOMB 2MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1062.35","92215422","LINZOLID 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.10","92216832","QUETIAPINE FUMARATE 200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.10","92216840","QUETIAPINE FUMARATE 200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.10","92217553","SEVELAMER CARBONATE 2.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.27","38300801","CRYPTOCOCCUS ANTIGEN (CSF) ","87327",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.40","92212728","OLANZAPINE 5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.40","92215282","OXANDROLONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.40","92216935","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.45","92218702","MEROPENEM/NS 500 MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.52","38307022","ANTIGEN DETECT NOS EIA SINGLE ","87450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.58","38399306","LACTOFERRIN FECAL QUAL ","83630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.67","38301541","HERPES SIMPLEX TYPE 2 ABY ","86696",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.69","34000560","TRACTION ","97012GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.71","38202470","URINALYSIS AUTO W/MICROSCOPIC ","81001",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.75","38300521","LIPOPROTEINS FRACTION ","83701",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.95","92218071","LINZESS 290MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.95","92218140","LINZESS 145MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.95","92219053","LINACLOTIDE 72 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"107.97","38303640","5 HIAA ","83497",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1071.62","76000113","NM THYROID UPDATE SGL/MULT ","78012",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1073.36","75094000","US CAROTID UNILAT STUDY LT ","93882LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1073.36","75094001","US CAROTID UNILAT STUDY RT ","93882RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1079.80","92212439","PRAMOXINE HCL HC 1%-1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.00","92212554","CARTEOLOL HCL 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.00","92216401","CEFOXITIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.10","92214756","COLESTIPOL HCL 5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.13","38300670","COOMBS INDIRECT QUAL ","86885",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.13","72000100","COOMBS INDIRECT ","86885",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.15","92216520","RASAGILINE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.15","92217682","FENTANYL 12MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.20","92213879","MUPIROCIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.82","38201650","LDH ","83615",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.82","38243605","PROTEIN URINE ","84156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.90","92211782","DOBUTAMINE HCL 1GM/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.90","92212952","SELENIUM SULFIDE 2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.90","92213293","LACTIC ACID 10% VIT E 3500U C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.90","92214316","RANITIDINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.90","92215994","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"108.94","38393923","INTRINSIC FACTOR ANTIBODY ","86340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1080.00","33111584","SET TRACH PERCUTANEOUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1080.00","33112669","STPLR RELOAD SPU GIA 60-3.5 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1087.00","33113057","TRAY TRCH 8FR SHLYCGLBRHN PERC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1087.75","92213257","NITROGLYCERIN 0.4MG/ACT SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1087.91","74001158","URETHRA/BLADDER RETROGRADE ","74450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"10883.40","92216576","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1089.00","61010200","INSERT CENT VEN CATH NONTUNL ","36556",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1089.25","92218840","EXENATIDE EXT REL 2 MG SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.10","92217107","PANTOPRAZOLE NA 40MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.35","92212951","PYRIDOXINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.35","92213962","NITROGLYCERIN 50MG/250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.35","92219390","SPIRONOLACTONE 25 MG/5 ML SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.35","92220086","TIOTROPIUM 18 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.45","92210991","UREA 20% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.60","92219480","QUETIAPINE FUMARATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.68","38303890","EPSTEIN BARR ANTIBODY VCA ","86665",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.70","92213426","ERYTHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.70","92219079","IBANDRONATE SODIUM 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.80","92217469","LACOSAMIDE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.95","92212990","PIPERONYL BUTO PYRETHRUN EXT K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"109.95","92220444","AMMONIA ALUM PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1090.40","92211689","TIMOLOL MALEATE 0.25% GFS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1090.80","34010287","NPWT DISP EQUIP <=50 SQ CM ","97607GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1091.80","92211045","CLARITHROMYCIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1093.30","92218366","OLOPATADINE HCI 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1094.30","92215197","EPOETIN ALFA 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1094.50","92218221","TALC STERILE 5GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1094.50","92218499","TALC . POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1095.80","92210464","DESOXIMETASONE 0.25% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1097.85","92219370","MOXIFLOXACIN HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1099.00","79600020","HYPERBARIC ADD'L 30 MIN. "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92210009","SELEGILINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92211287","NORTRIPTYLINE HCL 10MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92211462","TRIFLUOPERAZINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92212283","HYDROCODONE APAP 10-660MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92212773","VENLAFAXINE HCL 37.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92213313","FLUTAMIDE 125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92213541","ISRADIPINE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92213777","NEOSTIGMINE BR 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92213806","TICLOPIDINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92213987","LACTULOSE 10GM/15ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92214506","VENLAFAXINE HCL 37.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92214601","VERAPAMIL HCL 360MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92215014","QUINAPRIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92215037","LIOTHYRONINE NA 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92215389","RAMIPRIL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216254","BETHANECHOL CL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216293","CLONAZEPAM 2MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216309","CLONAZEPAM 2MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216365","ZONISAMIDE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216907","CARVEDILOL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216927","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216928","CARVEDILOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92216931","CARVEDILOL 3.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92217189","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92217208","VENLAFAXINE HCL 37.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92217360","GLYCOPYRROLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92218021","VISINE ADV RELIEF SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92219004","METHYLPHENIDATE HCl 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92219557","BUMETANIDE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92219793","VENLAFAXINE 37.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.00","92219801","ACETAMINOPHEN 650MG/20.3MLSUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92211233","ACYCLOVIR 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92211376","DOXAZOSIN MESYLATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92211430","HALOPERIDOL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92212950","METHYLPREDNISOLONE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92216975","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.05","92218226","LOPERAMIDE 1MG/7.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92210647","ZIDOVUDINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92210783","FOSINOPRIL NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92210801","BUMETANIDE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92213465","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92214525","FOSINOPRIL NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92215497","FLECAINIDE ACETATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92217461","AMANTADINE HCL 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92218536","LOPERAMIDE 2MG/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.10","92219110","FLECAINIDE ACETATE 50 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92211096","DONEPEZIL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92211187","CLORAZEPATE 3.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92211327","CLORAZEPATE 3.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92212614","LEUCOVORIN CALCIUM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92215844","CYCLOSPORINE MOD 25MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92217240","LACTOBACILLUS 5MG GRA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92218504","FLORANEX GRANULES 1 GM GRA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.15","92220030","TOPAMAX 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.20","92217078","RAMIPRIL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.20","92220206","MAGNES HYDROXIDE 2400MG/30ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.20","92220405","ACETAMINOPHEN 650 MG/20.3 ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.25","92210395","LEUCOVORIN CALCIUM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.25","92210942","BENZONATATE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.25","92212763","ZAFIRLUKAST 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.25","92214075","OXYCODONE APAP 2.5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.25","92214717","ZAFIRLUKAST 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92210224","CIMETIDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92211456","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92212885","PROPRANOLOL HCL 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92213064","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92213180","ISOSORBIDE MN 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92216946","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92217144","MIDODRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92217338","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92218538","FOLTANXRF3M2MG35MG90.314MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.30","92219083","CLONAZEPAM 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92210070","VERAPAMIL HCL 240MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92210583","DIFLUNISAL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92214251","VENLAFAXINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92216257","OMEGA 3 ETHYL ESTERS 1GM SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92217817","NATEGLINIDE 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92219067","SODIUM CHLORIDE NASAL0.65%SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92219806","DIPHENHYDRAMINE 12.5MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92219809","VENLAFAXINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92220036","VENLAFAXINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.35","92220394","BUMETANIDE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.40","92213719","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.40","92214008","ORPHENADRINE CITRATE 100MG TER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.40","92216526","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.40","92217747","ANASTROZOLE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92215533","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92216910","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92216913","CARVEDILOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92216943","CARVEDILOL 3.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92217357","HYDROCORTISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92217592","WARFARIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92218025","MERCAPTOPURINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.45","92219182","GABAPENTIN 250 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38300048","ANALGESICS NON-OPIOD 6+ ","80331",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38300106","ANTIDEPRESSANTS TRICYC 6+ ","80337",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38300126","ANTIDEPRESSANTS NOS ","80338",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38302643","AMPHETAMINES SCRN 5+ ","80326",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38303529","ANTIPSYCHOTICS NOS 7+ ","80344",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","38305676","STIMULANTS SYNTHETIC ","80371",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","92211764","FLUTAMIDE 125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","92213299","FLUTAMIDE 125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","92214977","SIMVASTATIN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","92216662","SIMVASTATIN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.50","92219556","OMEGA-3 FATTY ACIDS 1 GM CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92210368","NITROFURANTOIN MCR 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92210822","PERPHENAZINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92211406","PERPHENAZINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92211973","BUMETANIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92213065","VERAPAMIL HCL 240MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92213779","SIMVASTATIN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92214830","VERAPAMIL HCL 180MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92217762","LOSARTAN POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.55","92218521","PROGESTERONE 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.60","92210204","TRAZODONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.60","92214832","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.60","92216947","CARVEDILOL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.60","92216948","CARVEDILOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92210077","SERTRALINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92210910","ACETAZOLAMIDE 125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92216292","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92216879","MINOXIDIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92216967","LACTOBACILLUS COMBO 450BU PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92217457","TOPIRAMATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92219154","MINOXIDIL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92219958","BUPROPION HYDROCHL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92220402","ACETAMINOPHEN 650MG/20.3ML SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.65","92220448","ACETAMINOPHEN 650MG/20.3ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.69","74020007","LOCM 100-199MG/ML IODINE/1ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.70","92211496","METOPROLOL SUCC 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.70","92211555","NICOTINE 7MG/24 HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92211023","BUMETANIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92211050","THYROID 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92211794","NICOTINE 14MG/24 HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92211881","NITROGLYCERIN 0.4MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92212211","NICOTINE 21MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92216915","CARVEDILOL 3.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92219159","NICOTINE 7 MG/24 HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92219409","CHLORHEXIDINE GLUC 0.12% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.75","92220535","NICOTINE 7 MG/24 HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.80","92210734","GLYBURIDE MICRO 1.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.80","92211753","DILTIAZEM HCL 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.80","92211849","DILTIAZEM HCL 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.80","92215016","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.80","92220285","NICOTINE 21 MG/24 HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92210484","DIGOXIN 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92213527","MIDAZOLAM HCL 2MG/ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92213674","LACTULOSE 10GM/15ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92215220","IPRATR-ALBUTEROL 0.5-3MG/3ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92217807","CALCIUM ACETATE 667MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.85","92220209","DEXTRO/GUAIFEN 10MG-100MG/5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.90","92214873","DANTROLENE NA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.90","92217406","LANOLIN OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.90","92218277","VICODIN ES 7.5-300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11.95","92218286","AMANTADINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.00","92212137","ESTRADIOL 0.05MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.00","92212900","ALCLOMETASONE DIPRO 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.10","92220160","SUCROFERRIC OXYHYDR 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.24","38300017","AEROBIC CULTURE QUANT ","87071",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.30","92216427","DOBUTAMINE HCL D5W 500-500ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.38","34000090","VASOPNEUMATIC DEVICES ","97016GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.38","34210380","VASOPNEUMATIC DEVICES ","97016GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.43","38301400","HAPTOGLOBIN ","83010",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.60","92217116","HEPARIN 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.61","38300835","CULTURE MYCOPLASMA ANY SOURCE ","87109",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.91","38302670","ARSENIC ","82175",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"110.95","92219448","INFLUENZA VACCINE '19-20 SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1101.45","92217869","PENTAMIDINE ISETHIONATE 300 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1107.70","92212078","ACETIC ACID HC 2%-1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.00","34010185","ASSISTIVE TECH ASSESS 15 MIN ","97755GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.00","34210000","ASSISTIVE TECH ASSESS 15 MIN ","97755GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.00","34600500","ASSISTIVE TECH ASSESS 15 MIN ","97755GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.00","38202073","CMV BY PCR ","87496",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.00","92214122","IRON DEXTRAN 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.04","38200138","HDL (DIRECT) ","83718",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.04","38200980","CULTURE URINE ","87088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.04","38243603","CREATININE RANDOM URINE ","82570",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.05","92215198","SIROLIMUS 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.05","92217983","TRDJENTA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.05","92219265","LINAGLIPTIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.10","92220432","SCOPOLAMINE 0.33MG/24HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.30","38200452","FUNGAL SENSITIVITY ","87186",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.30","92215542","RISPERIDONE 2MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.35","92210324","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.35","92211970","DONEPEZIL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.40","92212444","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.45","92218491","ONDANSETRON 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.50","38300013","BETA 2 MICROGLOBULIN ","82232",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.50","38305525","BETA 2 MICROGLOBULIN URINE ","82232",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.55","92217676","EVEROLIMUS 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.58","38300790","REPTILASE TIME TEST ","85635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.60","92213948","MINERAL OIL PETROLATUM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.65","92217684","FENTANYL 12MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.65","92220370","FENTANYL 12 MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.80","92215469","CEFEPIME HCL 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.80","92219807","FLUTICASONE PROPIONATE50MCGSPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"111.85","92214158","NALOXONE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1110.00","33113068","SET INT 24FR 26FR CGL BRHN EZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1110.00","33113069","SET INT 24-26-28FR CGL BRHN G2"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1110.00","33168053","TRAY PERC TRACH INTRODUCER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1110.67","38307027","GI PATHOGEN 12-25 TARGETS ","87507",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1112.00","33103843","CEMENT BONE REFOBACIN/GENTAMIC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1112.14","74000660","IVP RETROGRADE ","74420",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1113.85","92218042","BROMDAY 0.09% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1114.80","92216342","DEFERASIROX 500MG TBS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1117.00","92211869","SUMATRIPTAN SUCC 6MG/0.5ML KIT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1118.52","75005076","US SPINAL CANAL ","76800",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1118.60","92214932","CLONIDINE HCL 0.3MG TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.00","92204015","IV ADMIXTURE 16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.00","92214722","POTASSIUM PH 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.05","92211107","RIFABUTIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.05","92219124","ALENDRONATE SODIUM 70 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.10","92214829","TERBINAFINE HCL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.20","92218500","TRANSDERM SCOP 0.33MG/24HR TDM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.20","92219184","NEOSTIGMINE 0.5 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.25","92213431","ETOMIDATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.30","92211440","OLANZAPINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.35","92216917","CEFTRIAXONE NA 1GM/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.35","92217707","CEFEPIME HCL 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.40","92212277","BICALUTAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.40","92213015","ENOXAPARIN NA 60MG/0.6ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.55","92217238","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.55","92217243","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.65","92214382","MUPIROCIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.65","92217097","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.65","92217902","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.65","92219217","ALENDRONATE SODIUM 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.69","38303425","RICKETTSIA ANTIBODY ","86757",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","38399313","HERPES SIMPLEX NON-SPEC TYPE ","86694",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92214024","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92214327","ALENDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92214919","ALENDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92217225","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92217227","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92217235","ALENDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92217236","ALENDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.70","92219948","ALENDRONATE 70 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.75","92214406","HETASTARCH 6GM/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.75","92216688","ARIPIPRAZOLE 9.7MG/1.3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"112.85","38303290","MYELIN BASIC CSF ","83873",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1120.30","92211914","KETOROLAC 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1120.82","74000210","BARIUM ENEMA AIR W/WO KUB ","74280",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1122.00","92219520","INDOMETHACIN 50 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1123.00","92213973","AZELAIC ACID 20% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1124.25","92219187","TIOTROPIUM BROM 2.5MCG/ACT INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1125.00","92205003","TPN/TNA 3 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1126.28","75093924","US LOWEXTART RST/STRSS COMPBIL","93924",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1127.80","92218534","RECOMBIVAX HB 40 MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.00","38301880","PHENOBARBITAL QUANT ","80184",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.00","92211522","CA CL/KCL/NA CL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.07","76020010","TC-99M OXIDRONATE <30 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.25","34050140","AQUATIC THERAPY W/EXER 15 MIN ","97113GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.25","34210345","AQUATIC THERAPY W/EXER 15 MIN ","97113GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.27","38303275","MYCOPLASMA ANTIBODY ","86738",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.45","92220498","METHOCARBAMOL 100 MG/1 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.50","38201990","PROLACTIN ","84146",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.60","38302693","MERCURY QUANTITATIVE ","83825",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.61","38301600","IRONSERUMCHEMICAL ","83540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92217823","RIVAROXABAN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92217850","RIVAROXABAN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92217950","RIVAROXABAN 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92218008","XARELTO 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92219050","SUBVIRION 36 MCG/0.1 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92219072","RIVAROXABAN 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.65","92219073","RIVAROXABAN 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.66","38000500","SURGICAL PATH LEVEL I ","88300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.71","38305657","CULTURE YEAST ONLY ","87101",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.71","38399328","CULTURE FUNGUS SKIN ","87101",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"113.95","38303700","GAMMAGLOBULIN IGE ","82785",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1130.15","92213363","DORZOLAMIDE HCL TIMOLOR MAL SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1130.60","92215563","MOXIFLOXACIN HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1132.55","92213752","GLUCAGEN HCL 1MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1132.55","92214335","GLUCAGEN HCL 1MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1132.55","92219609","GLUCAGON 1 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1133.00","92218195","SULFACETAMIDE SOD 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1133.28","74000360","ABSCESS FISTULA SINUS TRACT ST","76080",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1134.70","92211950","CLOBETASOL PROP 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1134.70","92212681","CLOBETASOL PROP 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1138.36","73500110","EEG AWAKE AND DROWSY ","95816",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1139.77","76000114","NM THYROID IMAGING ","78013",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.00","33111265","PROTECTOR BOOT HEEL PSR RELIEF"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.00","92215613","AMINO ACIDS 8.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.00","92216944","ATORVASTATIN CALCIUM 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.00","92217458","AMLEXANOX 5% PAS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.05","38300094","ALPHA I ANTITRYPSIN PHENO ","82104",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.20","92202006","TOPICALS 06 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.25","92212514","MICONAZOLE NITRATE 2% TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.25","92214002","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.33","38301051","FREE DILANTIN ","80186",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.35","92214748","ZIPRASIDONE HCL 60MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.40","92219125","ALENDRONATE SODIUM 35 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.50","92215367","IMIPENEM CILASTATIN NA 250MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216594","SITAGLIPTIN PHOSPHATE 25MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216595","SITAGLIPTIN PHOSPHATE 100MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216596","SITAGLIPTIN PHOSPHATE 50MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216597","SITAGLIPTIN PHOSPHATE 100MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216598","SITAGLIPTIN PHOSPHATE 25MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216599","SITAGLIPTIN PHOSPHATE 100MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216600","SITAGLIPTIN PHOSPHATE 50MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216921","SITAGLIPTIN PHOSPHATE 50MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.70","92216923","SITAGLIPTIN PHOSPHATE 25MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.75","92210105","ALBUTEROL SULF 5MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.75","92214555","HEPARIN 5000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.90","92210017","BETAMETHASONE VA 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"114.92","76020008","TC-99M MEDRONATE <30 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.00","92214924","OLANZAPINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.25","92214482","CLINDAMYCIN PHOS 900MG/D5W INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.35","92217846","OLANZAPINE 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.35","92218267","OLANZAPINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.40","92214254","INSULIN HUM ISOP 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.40","92215141","INSULIN HUM REGULAR 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.40","92215984","PROCHLORPERAZINE EDI 5MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.50","92213682","METHADONE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.50","92220274","NEOSTIGMINE 1 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.77","38300140","ANA SCREEN ","86038",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.77","72000535","ANTIBODY ID/ENZYMES ","86971",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.90","38399327","CULTURE TISSUE ADDL STUDIES ","87253",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"115.90","92215372","MODAFINIL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1150.37","74001072","PERC TUBE/DRAIN CATH CHANGE ","75984",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1154.65","92217693","GATIFLOXACIN 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1155.00","33119956","STAPLER SINGLE USE RELOAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1157.50","92220343","DIAZEPAM TOPICAL 10 MG GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1157.50","92220456","DIAZEPAM RECTAL KIT 20 MG GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1157.67","73500328","NRV COND STUDIES 7-8 STUDIES ","95910",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","38299341","HERPES SIMP VIRUSPCR ","87529",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","92211947","DIFLORASONE DIACETATE 0.05% CR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","92212390","PENTAZOCINE LACTATE 30MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","92213805","CA ACE/K ACE/KCL/MG ACE/NA INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","92216707","ERYTHROMYCIN LAC 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.00","92217552","NAFCILLIN 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.02","38300471","BETA 2 GLYCOPROTEIN AB ","86146",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.15","92213617","CEFOTAXIME NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.20","92211425","AMMONIUM LACTATE 12% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.25","92219499","ETHAN/IOD/NA IOD47%-2%-2.4%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.29","38300205","ANTI-THYROGLOBIN ","86800",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.29","38302620","ALK PHOS ISOENZYMES ","84080",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.30","92217464","LACOSAMIDE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.35","92217463","LACOSAMIDE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.52","38303380","PRIMIDONE ","80188",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.53","38302673","CADMIUM ","82300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.54","72000090","COOMBS DIRECT ","86880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.56","38300014","VARICELLA ZOSTER ANTIBODY ","86787",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.59","38200491","CELL COUNT FLUIDS W/ DIFF ","89051",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.59","38202410","TRIGLYCERIDES ","84478",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.65","92212649","PIPERACIL TAZOBACT 4.5/0.5GM I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.80","38300150","ANA TITER ","86039",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.80","38300357","ANTI CENTROMERE ANTIBODY ","86039",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.80","92219905","FORMOTEROL 20 MCG/2 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.90","92214557","ALENDRONATE NA 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.90","92215860","VENLAFAXINE HCL 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"116.95","92217369","DEMECLOCYCLINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1161.70","92220182","UPADACITINIB 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1162.85","92215911","ACETYLCYSTEINE 200MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1168.70","92212749","KETOROLAC 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.00","92212603","GENTAMICIN SULF 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.00","92215776","INFLUENZA VACC LIVE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.05","92204029","IV ADMIXTURE 30 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.05","92219290","MEROPENEM 500 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.25","38393950","C DIFFICILE TOXIN A/B ","87324",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.25","92219096","PERAMPANEL 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.58","34010076","PT EDUCAT/TRAINING 30/MIN ","98960GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.58","34299985","PT/FAMILY TRAINING EA 30 MIN ","98960GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.58","34699985","PT/FAMILY TRAINING EA 30 MIN ","98960GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.62","38301181","FECAL HGB IMMUNOASSAY ","82274",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.70","38202140","RPR ","86592",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.70","92210847","SCOPOLAMINE 0.33MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.75","38300190","ANTIBODY SCREEN ","86850",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.75","72000025","ANTIBODY SCREEN ","86850",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"117.80","92216267","PROPOFOL 1% EMULSION INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1170.30","92215188","BRIMONIDINE TARTRATE 0.15% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11729.90","92219340","CLINDAMYCIN PHOS 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11759.90","92216796","IMMUNE GLOBULIN 5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1177.50","92217652","MINOCYCLINE HCL 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1177.58","73500070","EEG COMA OR SLEEP ONLY ","95822",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1179.00","92210173","SUMATRIPTAN SUCC 6MG/0.5ML KIT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.05","92215598","EMTRICITABINE 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.35","92210944","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.36","38301455","HEPATITIS A ANTIBODY IGM ","86709",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.50","92219339","BENZOYL PEROXIDE 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.53","38302304","REVERSE T3 ","84482",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.60","92213366","DOPAMINE HCL 800MG/D5W 500ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.65","38302650","ANAEROBIC ORGANISM ID ","87076",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.70","92214683","FAMOTIDINE 40MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.70","92214696","FLUMAZENIL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.70","92215386","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.75","92216003","TERBUTALINE SULF 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.80","38000040","CYTO-SMEAR ANY-SOURCE ","88160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.80","92211902","SODIUM THIOSULFATE 25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.80","92212928","KETAMINE HCL 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.81","38200346","CRP (HIGH SENSITIVITY) ","86141",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.84","38307035","HIV-1 AG W/HIV-1 & HIV-2 AB ","87389",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"118.97","38303270","MURAMIDASE ","85549",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1182.50","92217619","BACLOFEN 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1184.80","92214628","BIMATOPROST 0.03% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1188.00","92216974","ANIDULAFUNGIN 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1189.90","92212639","HALOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.00","92214125","ACTIV CHARCOAL 25GM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.00","92215517","DTAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.00","92217196","ALBUTEROL SULF 90MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.00","92220088","SPIRIVA HANDIHALER 18 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.05","92210246","VANCOMYCIN HCL 5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.17","38303470","MUSCLE FIBER-FECES ","89160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.30","92210544","CROMOLYN NA 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.38","38300403","CARBOXYHEMOGLOBIN ","82375",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.45","92216336","EMTRICITABINE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.55","92212312","HAEMOPHILUS B VACC 10MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.55","92217805","OLANZAPINE 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.55","92218318","INVOKANA 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.55","92219774","OLANZAPINE ODT 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.63","38302545","VMA (URINE) ","84585",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.80","92210048","TRIMETHOBENZAMIDE HCL 100MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.80","92213039","DOPAMINE HCL 800MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.80","92218049","FIRST-MOUTHWASH BLM KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.90","92210496","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"119.90","92213801","HYDROMORPHONE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1191.13","76020019","F-18 FDG PER STUDY DOSE <45MCI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1191.25","92217601","ADVAIR HFA 45-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1191.25","92217895","ADVAIR HFA 115-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1195.00","92212389","TIMOLOL MALEATE 0.5% GFS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1195.40","92212144","ECONAZOLE NITRATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1197.00","36000675","INTUBATION ","31500",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"11979.00","92215649","GOSERELIN ACET 10.8MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1199.45","92217387","FLUTICASONE PROP 100MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92210257","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92210923","DIGOXIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92211492","PROPRANOLOL HCL 80MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92212061","CARISOPRODOL ASPIRIN 200-325 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92212190","CARISOPRODOL ASPIRIN 200-325 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92212474","VENLAFAXINE HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92212526","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92213513","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92213537","VENLAFAXINE HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92214020","ALPRAZOLAM 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92214268","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92214349","WARFARIN NA 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92214939","PREMPRO 0.625/2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92215676","BENZOYL ERYTHROMYCIN 5%-3% GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92216031","MESALAMINE 400MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92216929","CLOZAPINE 25MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92216998","PROPRANOLOL HCL 120MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92217147","CLOZAPINE 25MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92217211","VENLAFAXINE HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92217958","PROPRANOLOL HCL 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92220146","PRAZOSIN 5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.00","92220208","VENLAFAXINE 75MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.05","92214011","SPIRONOLACTONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.05","92216855","IPRATR-ALBUTEROL 0.5-3MG/3ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.05","92219868","RISPERIDONE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.10","92215491","GLYCOPYRROLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.15","92214626","LOVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.15","92218198","METHYPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.20","92214749","DIAZEPAM 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.20","92217195","RAMIPRIL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.20","92217741","TACROLIMUS 0.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.20","92218251","FOLTX 2-1.13-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.25","92210607","SELEGILINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.25","92216932","CLOZAPINE 12.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92211730","FLUVOXAMINE MAL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92211871","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92214941","METOLAZONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92216766","ACYCLOVIR 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92216979","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.30","92219883","CILOSTAZOL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.35","92211834","BUMETANIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.35","92217977","PURALUBE 15-85% OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.39","38203690","GLUCOSE QUANTITATIVE ","82947",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92211012","DOXYCYCLINE HYCLATE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92211035","PHENAZOPYRIDINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92211957","CASTOR OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92212185","HALOPERIDOL 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92213010","PRAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92217906","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92219054","CILOSTAZOL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92220315","BISOPROLOL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.40","92220460","BISOPROLOL FUMARATE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92210266","BACLOFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92210479","BETHANECHOL CL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92210501","LOSARTAN POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92211619","CAPTOPRIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92212226","BACLOFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92213375","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92215230","LOSARTAN POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92217510","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.45","92217511","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.50","92211298","NIFEDIPINE 20MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.50","92213036","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.55","92211565","DOXEPIN HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.55","92211621","DIPYRIDAMOLE 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.55","92214169","AMANTADINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.55","92215455","OXYCODONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.55","92220409","CHLORHEXIDINE GLUC 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92210585","SALSALATE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92211142","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92211713","DIPYRIDAMOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92212297","ENALAPRIL MALEATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92215210","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92216097","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.60","92219527","MAGNESIUM CIT 1.745GM/30ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.65","92213666","CHLORTHALIDONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.65","92213724","SELEGILINE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.65","92219246","AMYL/LIPAS/PROTS 24K-5K-17K U "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.65","92219352","CASTOR OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.70","92212452","VERAPAMIL HCL 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.70","92212625","ORPHENADRINE CITRATE 100MG TER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.75","92210593","HYDROXYZINE PAM 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.75","92211285","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.75","92213515","VENLAFAXINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.75","92216499","CITALOPRAM HBR 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.75","92219752","METHYLPHENIDATE HCL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.80","92213007","PROPAFENONE HCL 225MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92210751","DIGOXIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92211214","DEXTROSE FRUCTOSE PHOS ACID SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92213580","PRIMAQUINE PH 26.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92217141","CITALOPRAM HBR 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92217721","AZATHIOPRINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92218312","MASTISOL LIQ ADHES "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.90","92219363","CALAMINE/ZINC OXIDE8%-8%LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.95","92210694","NAPROXEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.95","92216731","MORPHINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12.95","92219965","CHLORTHALIDONE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.00","92204018","IV ADMIXTURE 19 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.00","92214970","NEOMYIN SULF/POLYMYX B SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.02","38300675","COPPER ","82525",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.17","38300093","ALPHA I ANTITRYPSIN LEVEL ","82103",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.30","92212161","LETROZOLE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.30","92217737","ARMODAFINIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.31","38301050","DILANTIN (PHENYTOIN-TOTAL) ","80185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.41","38300630","COMPLEMENT C-3 ","86160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.41","38300640","COMPLEMENT C-4 ","86160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.41","38302840","COMPLEMENT C-1 ","86160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.44","38300302","PROSTATE SPECIFIC ATG (FREE) ","84154",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.50","92212599","LEVOFLOXACIN 250MG/50ML D5W IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.50","92215974","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.75","92218570","DAPAGLIFLOZIN PROPANEDIOL 10MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.75","92219011","DAPAGLIFLOZIN PROPANEDL5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.80","92210748","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.80","92215797","NOREPINEPHRINE BIT 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.80","92218778","LACOSAMIDE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.87","34000465","IONTOPHORESIS 15 MIN ","97033GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"120.87","34210035","IONTOPHORESIS 15 MIN ","97033GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1200.15","92218364","ENTEREG 12 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1201.75","92217993","DERMOTIC OIL 0.01% OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1203.06","39200301","CARDIOVASCULAR STRESS TEST ","93017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1209.30","92211749","MUPIROCIN 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1209.57","75000280","DUPLEX AORTA/IVC/GRAFT COMPL ","93978",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.00","92211843","DTAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.00","92214275","AMINO ACIDS 4.25% D10W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.00","92218565","MODAFINIL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.03","38201439","CBC AUTO W/O DIFF ","85027",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.15","92217946","RUFINAMIDE 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.45","92215061","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.50","92210908","TIMOLOL MALEATE 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.60","92219057","LIDOCAINE 4% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.63","38302892","CYCSTATIN C ","82610",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.65","92211986","METHYLPREDNISOLONE 80MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.65","92212827","CHLORPROMAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.75","92217671","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.75","92218300","FLUARIX QUADRIVALENT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.82","38302990","FECAL FAT TOTAL QUANT ","82710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.90","92214426","SELENIUM 40MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"121.97","38300346","CRP (HIGH SENSITIVITY) ","86141",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1213.00","92215182","FLUOROURACIL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1213.10","92220141","EXENATIDE 2 MG PEN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1214.64","74000581","MYELOGRAM THORACIC ","72255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.00","92212694","ACTIV CHARCOAL 25GM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.00","92217474","COAL TAR MINERAL OIL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.00","92217734","ACTIV CHARCOAL SORBITOL 50GM S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.10","92214661","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.14","38200070","ALDOLASE ","82085",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.15","92219014","HYDROCRT NA SUCCINATE 100MGSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.15","92219015","HYDROCRT NA SUCCINATE 100MGSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.20","92212628","IMIQUIMOD 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.30","92220055","FLU VAC PED 20-21 30MCG/0.25ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.40","92212212","FLUTICASONE PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.40","92219070","EVEROLIMUS 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.60","38301040","DIGOXIN ","80162",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.60","92216761","ONDANSETRON HCL 4MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.60","92220053","FLU VAC QUAD 20-21 60MCG/0.5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.65","92216909","FORMOTEROL FUM 20MCG/2ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.70","92219841","FORMOTEROL FUMERATE 20 MCG INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.75","92215425","TACROLIMUS 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.75","92216245","OLANZAPINE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.78","38301350","GLUCOSE TOL - 3 SPECIMENS ","82951",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"122.88","38302778","PLASMINOGEN ","85420",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1222.20","92216470","BRIMONIDINE TARTRATE 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1222.41","38303652","RESPIRATORY VIRUS 12-25 TARG ","87633",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1223.20","92212054","FLUOROMETHOLONE 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1224.00","74000840","TOMOGRAMS ","76100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1226.05","92210093","ERYTHROMYCIN 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1226.15","92212123","TRIFLURIDINE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1228.15","92220477","MOMETASONE FUROATE 110 MCG POW"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1228.35","92213204","BOSENTAN 125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.00","38200215","PROTEIN C ANTIGEN ","85302",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.00","92216617","FENTANYL CITRATE 400MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.08","38302015","PROTEIN ELECTROPHORESIS ","84165",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.08","38303860","PROTEIN-ELECTROPHOR-SERUM ","84165",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.15","92215985","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.25","38399317","DTT CELL TREATMENT ","86970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.25","72000554","RBC PRETX INCUBAT W/CHEMICAL ","86970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.25","72000775","DTT CELL TREATMENT ","86970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.27","38302610","ADENOVIRUS AB ","86603",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.40","92212787","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.45","92212217","OXYCODONE HCL 80MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.55","92217608","COLESEVELAM HCL 3.75GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.60","38302797","INF AGT AG DET EIA RSV ","87807",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.60","92218893","SCOPOLAMINE 1.5 MG PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.61","38343631","PARVOVIRUS ANTIBODY ","86747",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.66","38200223","NT-PRO BNP ","83880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.75","92216022","ORPHENADRINE CITRATE 30MG/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.80","92216777","ARFORMOTEROL TARTRATE 15MCG SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.80","92217099","ARFORMOTEROL TARTRATE 15MCG SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.81","38301280","GASTRIN ","82941",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.90","92218351","DRONABINOL 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"123.95","92218992","AMINOCARPROIC ACID 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1230.00","33106421","HARVESTER CELLUTOME 5.0CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1232.95","92214039","METRONIDAZOLE 0.75% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1234.20","92216641","MICAFUNGIN NA 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1235.60","92217584","TELAVANCIN HCL 750MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1236.00","92211617","CEFUROXIME NA 1.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1237.50","92213107","FOSCARNET NA 24MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.00","92210476","SULF-PRED 0.25-10% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.00","92215430","SAFFLOWER SOYBEAN 10%-10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.00","92218135","SUTENT 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.04","38399315","DTT SERUM TREATMENT ","86977",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.04","72000361","RBC SERUM PRETX INCUB/INHIBIT ","86977",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.04","72099982","NEUTRALIZATION ","86977",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.05","92212890","NITROGLYCERIN 50MG/250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.10","92213158","ACYCLOVIR NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.15","92212445","POTASSIUM IODIDE 1GM/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.27","38301171","ESTRIOL ","82677",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.40","92217764","ARMODAFINIL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.50","92204006","IV ADMIXTURE 07 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.60","92219886","HYDROCORTISONE 25 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.65","38300216","CRYPTOCOCCUS ANTIGEN SERUM ","87899",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.65","38300224","INFECT AGENT AMP PROBE TECH ","87899",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.65","38307003","RSV-NASAL WASH/ASPIRATE ","87899",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.70","38307004","HIV1 & HIV2 SINGLE ASSSAY ","86703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.75","92215450","ETOMIDATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"124.95","92219074","TIOTROPIUM BROMIDE 18 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1244.40","92218279","HEPARIN-D5W 4000U/500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12442.75","92220175","RISPERIDONE 90 MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1245.10","92216797","FLUTICASONE FUROATE 27.5MCG SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1246.50","92216567","ADVAIR HFA 115-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1246.80","92212632","DOXEPIN HCL 5%CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1247.24","74001074","IVP ANTEGRADE ","74425",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1248.00","92215124","CICLOPIROX 0.77% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1249.85","92216676","PENICILLIN G BENZ 0.6MMU/ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.00","92210645","TRIAMCINOLONE 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.00","92210722","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.00","92213765","MOMETASONE FUROATE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.05","92214670","DEXTROSE 70%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.12","38300569","CLOZAPINE/CLOZARIL ","80159",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.34","38303804","AB EXTRACT NUC ANTIGEN EACH ","86235",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.34","38306630","HISTONE ANTIBODY ","86235",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.40","92217069","GRANISETRON HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.40","92217844","BUDESONIDE 3MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.40","92218336","INVOKANA 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.40","92220089","VANCOMYCIN 1.25 GM/250 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.47","38201600","IRONSERUMCHEMICAL ","83540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92211977","BRIMONIDINE TARTRATE 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92219245","EMPAGLIFLOZIN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92219930","POTASSIUM CHLORIDE 20MEQ/15ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92220178","EMPAGLIFLOZIN 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92220324","EMPAGLIFLOZIN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92220419","EMPAGLIFLOZIN 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.50","92220534","EMPAGLIFLOZIN 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.65","92210140","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.65","92211172","CHLORPROMAZINE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.75","92214061","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"125.90","92215589","OLANZAPINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1250.00","38300995","COAG TIME OTHER METHOD ","85348",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1250.00","38312030","COAG TIME OTHER METHOD ","85348",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1250.15","92211623","NYSTATIN/TRIAMCINOLONE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1250.15","92212512","NYSTATIN/TRIAMCINOLONE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1252.00","33111020","SET INTRO PERCUT TRACH SZ6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1254.00","92217421","DEXTROSE NICARDIPINE HCL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1254.00","92217422","NICARDIPINE/NACL 40MG/200ML IV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1256.60","92216017","FLUOROURACIL 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1258.75","92218721","SIMBRINZA 1%-0.2% OPHTH SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1258.90","92212650","MEDROXYPROGESTERONE 150MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1259.00","92216170","PRAMLINTIDE ACETATE 0.6MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1259.60","76078587","NM LUNG VENT AEROSOL MULTI ","78587",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1259.60","76078593","NM LUNG VENT GASEOUS W/WASHOUT","78579",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1259.90","92217578","ANIDULAFUNGIN 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108410","CATH PHILLIPS FOLLOWER 10FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108411","CATH PHILLIPS FOLLOWER 12FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108412","CATH PHILLIPS FOLLOWER 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108413","CATH PHILLIPS FOLLOWER 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108414","CATH PHILLIPS FOLLOWER 20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108415","CATH PHILLIPS FOLLOWER 22FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108416","CATH PHILLIPS FOLLOWER 24FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33108417","CATH PHILLIPS FOLLOWER 8FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","33109192",""CATH URET 14FR/CH 4.L7MM 16"" ""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","92204020","IV ADMIXTURE 21 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","92213280","SILDENAFIL CITRATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","92213394","SILDENAFIL CITRATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.00","92213998","SILDENAFIL CITRATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.06","38301499","HEPATITIS DELTA VIRUS AB ","86692",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.06","38302350","THEOPHYLLINE ","80198",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.25","38300024","LIPID PANEL ","80061",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.27","38300091","ALPHA-FETOPROTEIN SERUM ","82105",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.27","38302500","VALPROIC ACID ","80164",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.35","92219840","SCOPOLAMINE 0.33MG/24HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.35","92220433","SCOPOLAMINE 1MG/3DAY PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.35","92220435","SCOPOLAMINE 1MG/3DAY PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.35","92220436","SCOPOLAMINE 1MG/3DAY PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.35","92220437","SCOPOLAMINE 1MG/3DAY PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.40","92216244","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.50","92219740","SCOPOLAMINE TD 0.33MG/24HR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.50","92219787","SCOPOLAMINE TD 0.33MG/24HPATCH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.50","92220434","SCOPOLAMINE 1MG/3DAY PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.50","92220438","SCOPOLAMINE TD0.33MG/24HRPATCH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.58","38200021","HCG SERUM QUALITATIVE ","84703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.58","38200580","C02 CONTENT ","82374",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"126.75","92213664","FLUPHENAZINE HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1260.25","92216156","IBANDRONATE NA 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1260.60","92211679","BETAMETHASONE DP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1261.36","75010032"," US DUP SCAN HEMO COMPL BILAT ","93985",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1264.08","73510001","EEG MONITORING 1 HR ","95812",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1264.70","92219230","MENINGOCOCCAL B175MCG/0.5MLSUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1266.15","92216852","BUDESONIDE 90MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1267.00","92215737","TALC 4GM SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1268.49","75010001","US UP EXT ART DUPLEX COMP BIL ","93930",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.00","92214079","AMOXICILLIN CLV K 200-28.5/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.12","38300730","CPK-MB ","82553",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.12","38302790","CK-MB PANEL ","82553",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.40","92215514","OCTREOTIDE ACET 100MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.43","38399353","ANTIPHOSPHOLIPID AB ","86148",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.55","92210936","CALCIUM CL 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","38301695","LEUKOCYTE ALK.PHOS ","85540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92212263","ESTRADIOL 0.1MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92212562","DESONIDE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92212780","ESTRADIOL 0.05MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92216184","ESTRADIOL 0.025MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92216186","ESTRADIOL 0.075MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.65","92217925","ESTRADIOL 0.05MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.70","92213579","ONDANSETRON HCL 4MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.70","92215601","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.71","38380030","THYROGLOBULIN LEVEL ","84432",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.80","92218512","TRANSDERM SCOP 0.33MG/24HR TDM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.85","92212196","SUCCINYLCHOLINE CL 20MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.90","92216410","QUETIAPINE FUMARATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"127.95","92219529","LACOSAMIDE 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1273.00","92216534","METRONIDAZOLE 0.75% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1275.00","33106442","BLUE RHINO G2-MULTI PERC TRACH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1275.00","33113080","TRAY TRCH 24-28FR SHLY CGLBRHN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1275.00","33129511","INTRODUCER PERCUTANEOUS 13F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1276.85","92211868","CLOBETASOL PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1277.10","92214386","DARBEPOETIN A 25MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1277.10","92215834","DARBEPOETIN A 25MCG/0.42ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1278.65","92212880","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.00","33129575","SPLINT OCL ROLL II 3x15FT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.00","92219590","LACOSAMIDE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.01","38300689","OXCARBAZEPINE (TRILEPTAL) ","80183",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.25","92211711","CIPROFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.25","92217341","DARUNAVIR ETHANOLATE 400MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.35","92215045","PHENYLEPHRINE HCL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.37","38303555","TOXOPLASM AB (IGG) ","86777",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.45","34000650","TEST PHYSICAL PERFORM 15 MIN ","97750GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.45","34210355","PHYSICAL PERFORM TEST 15MIN ","97750GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.60","92214201","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.65","38300005","17-HYDROXYPREGNENOLONE ","84143",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.75","38393928","GABAPENTIN ","80171",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.75","92217013","ENOXAPARIN NA 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.77","38300491","CELL COUNT FLUIDS W/ DIFF ","89051",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"128.95","92210630","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1280.00","92216826","FLUTICASONE PROP 50MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1280.30","92216593","TRAVOPROST 0.004% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1281.01","73500100","EEG AWAKE AND ASLEEP ","95819",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1282.25","92217164","RISEDRONATE NA 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1282.80","92219738","PROCAINAMIDE HCL 100 MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1282.85","92218360","GILENYA 0.5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1284.60","92219262","DAPTOMYCIN 350 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1287.55","92204051","IV ADMIXTURE 51 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.00","33103279","KIT SIMPULSE VARICARE WOUND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.00","33171341","GUIDEWIRENITNOL.035STFTIP150CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.00","92215073","DTAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.05","92210747","ACETYLCYSTEINE 20% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.10","92216689","PEG ELCTROLYTE LAVAGE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.45","92213353","DOPAMINE HCL 800MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.49","38307018","PNEUMOCYSTIS CARINII ","87281",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.55","38300117","CA 27.29 ","86300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.55","38300350","CA 15-3 ","86300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.59","38301985","PROGESTERONE ","84144",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.70","92211910","DPT TOX-PED SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.75","92220025","BRIVARACETAM 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.85","38301978","PREALBUMIN ","84134",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.90","92218890","DOXYCYCLINE HYCLATE 100 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"129.91","38200470","CBC W/ AUTO DIFF ","85025",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"12936.35","92217549","PALIPERIDONE PALMITATE 156MG S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1295.00","33109971","STPLR ENDOGIA ROTIC DLU45-3.5 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1295.00","33170395","KIT CATH DIAL PALIN 55CMX14FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92210212","PIROXICAM 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92210555","PROPRANOLOL HCL 160MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92211416","PROPRANOLOL HCL 120MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92211825","IRBESARTAN 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92212040","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92212482","VENLAFAXINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92212608","CEPHALEXIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92213074","FLUVOXAMINE MAL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92213234","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92213459","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92214087","METRORMIN ROSIG MAL 500-2MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92214725","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92214746","HCTZ LOSARTAN K 12.5-50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92215086","PERINDOPRIL ERBUMINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92215229","FEXOFENADINE HCL 180MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92215804","CITALOPRAM HBR 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92216096","NIFEDIPINE 90MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92216736","TAMOXIFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92216904","VERAPAMIL HCL 200MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.00","92217412","ALPRAZOLAM 1MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92210286","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92212591","FLUPHENAZINE HCL 2.5MG/5ML ELI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92212605","FLUPHENAZINE HCL 2.5MG/5ML ELI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92213729","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92216848","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92217007","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92217080","RAMIPRIL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92219735","METHENAMINE MANDELATE 1 GM TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.05","92220100","GUAIFN/DXTMTH200MG20MG/10MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92210430","SULFASALAZINE 500MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92211263","THIOTHIXENE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92211610","METOLAZONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92213044","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92216816","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.10","92219867","GABAPENTIN 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92210385","THIOTHIXENE 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92210677","CARBAMIDE PEROXIDE 6.5% EAR SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92211417","SODIUM CL 0.65% NASAL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92212852","SODIUM CL 0.65% NASAL SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92214058","PHENYTOIN NA 50MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92215326","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92220060","GABAPENTIN 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92220465","NICOTINE 7 MG/24 HR PATCH ER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92220466","NICOTINE 14 MG/24 HR PATCH ER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.15","92220467","NICOTINE 21 MG/24 HR PATCH ER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92210637","NITROGLYCERIN 0.6MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92211876","VENLAFAXINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92212546","LOSARTAN POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92214497","PHENAZOPYRIDINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92216110","GABAPENTIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92217003","CLOZAPINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92219068","MAGNESIUM HYDROX400 MG/5 MLLIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.20","92220194","DOXYCYCLINE 100MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.25","92210588","BACLOFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.25","92211705","PROPRANOLOL HCL 80MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.25","92214507","PREDNISOLONE 15MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.25","92215042","LIOTHYRONINE NA 5MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.30","92212925","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.30","92214896","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.30","92215143","ASCORBIC ACID 100MG/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.30","92215307","TOPIRAMATE 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.30","92215724","MIDODRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.32","38299356","OCCULT BLOOD 1-3 DETERM ","82272",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.35","92214338","FEXOFENADINE HCL 180MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.35","92216495","CITALOPRAM HBR 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.35","92216863","FEXOFENADINE HCL 180MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.35","92218798","LOPERAMIDE 2MG/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.40","92213004","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.40","92216079","CITALOPRAM HBR 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.40","92216558","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.40","92216709","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.40","92218139","DOXYCYCLINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.44","38203705","SED RATE (MANUAL) ","85651",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.44","38203753","EOS SMEAR (URINE) ","87205",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92213736","RAMIPRIL 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92213912","LOSARTAN POTASSIUM 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92214012","CITALOPRAM HBR 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92214044","POTASSIUM CL 20MEQ SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92214283","DOXAZOSIN MESYLATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.45","92216080","CITALOPRAM HBR 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92211267","NORTRIPTYLINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92212629","DONEPEZIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92217434","DIVALPROEX NA 250MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92219911","BUPRENORPHINE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92219972","PROPANOLOL 80 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.50","92220029","DIVALPROEX ER 250 MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.55","92212296","SOTALOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.55","92213298","RAMIPRIL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.55","92215568","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.55","92218317","FUROSEMIDE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.55","92219689","FUROSEMIDE 40 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.60","92212511","VENLAFAXINE HCL 37.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.60","92213056","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.60","92214596","NICOTINE 7MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.60","92216811","CETIRIZINE HCL 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.60","92217067","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.65","92217312","DIVALPROEX NA 500MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.65","92217496","MYCOPHENOLATE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.65","92218865","GLYCERIN/LANOLIN/MIN OIL TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.65","92219423","DIVALPROEX SODIUM 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.65","92220365","GUAIFENESIN/DM 200MG-20MG/10ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92211060","PRAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92212067","VERAPAMIL HCL 180MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92212995","DOXAZOSIN MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92214176","GUAIFENESIN DM 100-10MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92215412","CETIRIZINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92217056","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92218111","CHLOROQUINE PHOSPHATE 250MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.70","92220401","NIFEDIPINE 90 MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92211094","TROLAMINE SALICYLATE 10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92212064","HYDROCORTISONE 0.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92213172","ROPINIROLE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92213587","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92213798","HCTZ TRIAMTERENE 25-37.5MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92214719","BISACODYL 10MG NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92216350","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92217316","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92217397","MINERAL OIL NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.75","92219989","GABAPENTIN 300 MG/6 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.80","92213964","DICLOXACILLIN NA 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.80","92214810","NICOTINE 21MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.80","92216502","CITALOPRAM HBR 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92210423","LOSARTAN POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92213109","GUAIFENESIN DM 100-10MG/5ML LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92215653","DIVALPROEX NA 250MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92217559","CARBAMAZEPINE 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92217882","NICOTINE 14MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92219160","NICOTINE 7 MG/24 HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.85","92219594","ALUM/MAG/SIMETHICONE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.90","92211380","SULFAMETHOXAZOLE/TMP SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.90","92214553","VERAPAMIL HCL 200MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92210612","MEXILETINE HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92212132","VERAPAMIL HCL 240MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92212240","FLUVOXAMINE MAL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92212985","AMITRIPTYLINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92213003","AMITRIPTYLINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13.95","92219261","DILTIAZEM HCL ER 300 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.00","92215854","COCAINE 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.10","92219655","ACT CHARC/SORBITOL25GM/120MLPW"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.27","38302095","FOLIC ACID RBC ","82747",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.28","38301760","MAGNESIUM ","83735",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.28","38303250","MAGNESIUM URINE ","83735",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.30","92218165","NUCYNTA ER 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.35","92219407","CALCIUM GLUC/NACL 1000 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.43","38301439","CBC AUTO W/O DIFF ","85027",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.60","92210557","CEPHALEXIN 125MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.67","38000070","INTRA-OPERATIVE CONSULTATION ","88329",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"130.69","38302776","STONE QUANT ","82360",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13038.95","92219434","VASOPRESSIN 20 UNITS/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1305.00","33113049","TRAY TRCH SHLY CGL BRHN PERC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1306.80","92220507","ARGATROBAN 0.9%NACL 50MG/50ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1307.00","92212391","CALCIPOTRIENE 0.005% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1308.40","92217027","ACETIC ACID EAR SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1308.55","92214644","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1309.75","75000030","US EXTRACRANIAL STUDY COMP BIL","93880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1309.75","75094002","US CAROTID BILATERAL ","93880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.02","38202010","PROTEIN TOTAL ","84155",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.05","92216590","ACTIQ 400MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.15","38302576","WEST NILE VIRUS AB IGM ","86788",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.17","38303195","LEPTOSPIRA ANTIBODY ","86720",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.40","38305405","BENZ0DIAZEPINES 1-12 ","80346",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.41","38303683","PHOSPH NEUTRALIZE PLATELET ","85597",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.45","92215157","ONDANSETRON HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.45","92217118","NISOLDIPINE 8.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.46","72000575","IRRADIATION OF BLOOD ","86945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.55","92218620","CHARCOAL ACTIVATED PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.68","38301501","RUSSELL VIPER VNM TIME-DIL ","85613",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.85","38000050","CYTO-SMEAR PREP/SCREENING ","88161",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.92","38302575","WEST NILE VIRUS TITER ","86789",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.93","38301639","LAMICTAL/LAMOTRIGINE ","80175",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"131.95","92212916","TESTOSTERONE 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1310.15","92212149","FLUOCINONIDE 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1311.00","76000791","NM GASTRIC EMPTY W/SM BOWEL ","78265",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1312.00","33170069","TRACH PERC SETIN BLURHNO G2MLT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1314.00","33111585","SET TRACH PERCUT BLURHINODIL28"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1314.95","92220280","CEFIDEROCOL 1 GM PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1315.00","92214979","NEOMYIN SULF/POLYMYX B SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1315.88","74000982","HYSTEROSALPINGOGRAPHY ","74740",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1316.00","33195412","BRONCHOSCOPE ASCOPE 4 LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1316.60","92219508","ESTRADIOL VALERATE 40MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","38300516","CHLAMYDIA DNA PROBE (DIRECT) ","87490",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","38300571","CMV IGM ANTIBODY ","86645",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92211526","CEFIXIME 100MG/5ML PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92215426","LEUCOVORIN CALCIUM 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92216713","HYALURONIDASE 150U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92218479","ANECREAM 0.04 TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92218591","CAFFEINE CITRATE 20 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92218955","RISPERDONE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.00","92219354","VITAMIN A/VITAMIN D OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.04","38303365","PORPHYRIN (QUANTITATIVE) ","84120",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.10","92217744","ASENAPINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.13","38200692","TISSUE HOMOGENIZATION ","87176",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.65","92219387","VANCOMYCIN HCL 1.25 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.66","38307006","CHROMIUM ","82495",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.71","38300400","CANDIDA AB ","86628",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.74","38303533","MICROSOMAL ANTIBODIES ","86376",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.88","38301977","PREGNENOLONE LEVEL ","84140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"132.95","92212497","SODIUM FLORIDE 1.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1320.00","92218206","ALOXI 0.05MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1322.20","92212489","DESONIDE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1324.64","72060012","PLATELETS PHER IRRAD-PROC ONLY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1327.75","92218055","PROMACTA 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1329.00","11600115","INSERTION MID LINE CATH ","36410",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1329.00","61010211","INSERT MIDLINE CATH (NO PORT) ","36410",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.04","38300700","C-PEPTIDE ","84681",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.10","38000735","FLOW CYTOMETRY-EA ADD MKR-TECH","88185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.10","92218842","SCOPOLAMINE 1.5 MG PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.10","92219500","HYPROMELLOSE OPTH 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.15","92212935","PIOGLITAZONE HCL 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.25","38201270","GAMMA GT (GGT) ","82977",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.25","38202160","SENSITIVITY (MIC) ","87186",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.25","92211007","ISOSORBIDE DN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.27","38300120","AMMONIA ","82140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.36","34000270","WHIRLPOOL ","97022GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.36","34210005","WHIRLPOOL ","97022GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.36","38302390","TOBRAMYCIN ","80200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.50","92215261","COPPER CL 4MG/10ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.50","92219287","MULTIVITAMIN . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.55","92216322","MESALAMINE 4GM/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.62","38303413","INHIBIN A ","86336",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.63","38302000","PROSTATE SPECIFIC ATG (TOTAL) ","84153",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.73","38302539","VITAMIN B1 (THIAMINE) ","84425",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.89","38303865","PROTEIN-ELECTROPHOR-OTH FLUID ","84166",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"133.90","92217728","ENOXAPARIN NA 30MG/0.3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1331.30","92217508","BESIFLOXACIN HCL 0.6% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.00","92216407","PIPERACIL TAZOBACT 3.375GM INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.06","38300131","DNA SINGLE STRAND ANTIBODY ","86226",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.10","38302330","TEGRETOL-TOTAL ","80156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.15","38301155","ERYTHROPOIETIN ","82668",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.15","92217290","HYDROCODONE APAP 10-325/15ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.30","92220346","MESALAMINE 4 GM/60 ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.36","38207014","CULTURE FUNGUS BLOOD ","87103",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.40","92217904","MESALAMINE 4GM/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.40","92218401","MESALAMINE 4 GM/60 ML KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.41","34600200","TYMPANOMETRY ","92567GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.66","38300572","CMV IGG ANTIBODY ","86644",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.80","92218137","ONFI 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.85","38343628","ETHYLENE GLYCOL ","82693",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.85","92219960","MODAFINIL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"134.93","92216205","PARICALCITOL 4MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1341.64","75000198","US LOW EXT ART DUPLEX COMP BIL","93925",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1342.20","92218383","COPAXONE 20 MG/ML IV SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1343.90","92210980","LATANOPROST 0.005% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1346.40","92215293","DOPAMINE HCL 800MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1347.30","92216978","BRIMONIDINE TIMOLOL 0.2-0.5% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.00","33110983","BRACE KNEE HINGE WRAPRND XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.00","92216355","MOMETASONE FUROATE 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.24","38306600","THROMBOPLASTIN SUBSTITUTION ","85732",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.25","92212037","CICLOPIROX 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.30","92216516","CEFOXITIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.30","92218294","NITROPRESS 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.34","38301750","LYME DISEASE TITER ","86618",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.34","38302905","DELTA ALA ","82135",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.34","38305591","LYME DISEASE ANTIBODY ","86618",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.35","92210018","PEPPERMINT OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.35","92211901","LEUCOVORIN CALCIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.36","38301190","FDP (FSP) ","85362",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.40","92217377","BUDESONIDE 1MG/2ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.40","92218577","MODAFINIL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.42","38302420","TSH ","84443",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.45","92204001","IV ADMIXTURE 02 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.47","38201820","OSMOLALITY URINE ","83935",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.50","92217849","TESTOSTERONE 4MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.51","38302290","T3 FREE ","84481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.65","92210078","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.65","92212234","TESTOSTERONE CYPI 200MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.75","92215353","RIBAVIRIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.90","92214665","SODIUM CL 5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.95","38302855","COXSACKIE B ","86658",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.95","38302860","COXSACKIE A ","86658",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"135.95","92212033","DOBUTAMINE HCL D5W 250-250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1350.00","92217711","FLUTICASONE PROP 44MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1354.00","92219107","MEROPENEM/VARORBACTAM 2GM VIAL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1354.40","92215675","DESMOPRESSIN ACET 0.1MG/ML SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1356.00","33113081","TRAY INTRO CGL BRHN G2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1356.65","92215530","ACYCLOVIR 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1357.00","92214305","LOTEPREDNOL ETABONATE 0.2% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1358.60","92215416","TACROLIMUS 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.05","92219425","METHOCARBAMOL 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.15","92218112","MD-GASTROVIEW 66%-10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.20","92218396","SODIUM BICARBONATE 4.2% IV SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.25","92215119","ONDANSETRON HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.35","92214609","PHENYLEPHRINE HCL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.38","38300800","CRYPTOCOCCUS AB ","86641",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.39","38302750","CA-19-9 ","86301",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.45","92218037","MESTINON TIMESPAN 180MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.56","38343630","METHYL ALCOHOL ","84600",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.67","38303295","MYOGLOBIN ","83874",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.70","92218190","TRIAD WOUND CARE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.70","92219118","BUDESONIDE 3 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.85","92210656","GENTAMICIN SULF 3MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.90","92214752","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"136.95","92214175","OCTREOTIDE ACET 200MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1361.00","92216837","AZITHROMYCIN 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1364.20","92213512","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1364.61","75000115","US VASCULAR DUP VISCERAL COMP ","93975",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1366.92","38301508","RESP PATHOGEN PROFILE PCR ","0099U ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.00","92212693","ISOPROPYL ALCOHOL 99% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.05","92218193","ANDROGEL 1.62% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.20","92217554","NAFCILLIN 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.28","38301480","HEPATITIS C AB ","86803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.29","38302151","PSA SCREENING "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.35","92215987","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.50","92219158","NARATRIPTAN HYDROCHL 2.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.50","92219782","NARATRIPTAN 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.69","38200710","CPK-TOTAL ","82550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.75","38306754","HTLV I ","86687",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.85","92210417","PILOCARPINE HCL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"137.95","92216699","MULTIVITAMIN AQUADEKS 2MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1370.55","92215837","EPINASTINE HCL 0.05% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1371.65","92204043","IV ADMIXTURE 43 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1372.20","92219833","TACROLIMUS 5 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1373.10","92219612","GLUCAGON KIT 1 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1374.60","92217379","LIDOCAINE HCL 5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1378.15","92219510","EPINEPHRINE HCL 1 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.00","33181905","CATH SUPRAPUBIC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.00","38303805","ACETYLCHOLINESTERASE ","82013",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.00","92211954","METIPRANOLOL 0.3% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.00","92214890","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.14","38302415","TROPONIN (QUANTITATIVE) ","84484",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.14","38302416","TROPONIN T (QUANTITATIVE) ","84484",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.20","92216937","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.25","92218954","SUMATRIPTAN 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.25","92219173","SUMATRIPTAN SUCCINATE 50MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.30","92219163","SUMATRIPTAN SUCCINATE100MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.33","38303560","TOXOPLASM AB (IGM) ","86778",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.36","38000930","PAP SMEAR THIN PREP ","88142",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.45","92213487","GLYCOPYRROLATE 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.60","92213661","MILRINONE LACTATE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.75","38202892","CYCSTATIN C ","82610",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.80","92217691","LEVOFLOXACIN D5W 500MG/100ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.86","38301012","CHLAMYDIA. PNEUMONIA (IGM) ","86632",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.86","38301019","C TRACHOMATIS IGM ","86632",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.86","38301021","C PNEUMONIAE IGM ","86632",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.86","38301022","C PSITTACI IGM ","86632",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.90","92212776","ITRACONAZOLE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"138.95","92216360","CITRATE PHOS DEXTROSE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1381.80","92218185","REVATIO 10MG/12.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1386.00","92220317","DEXMEDETOMID/NACL 4MCG/ML0.9% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1388.71","74001421","UGI W/AIR & SMALL BOWEL ","74249",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1389.15","92214312","TEMOZOLOMIDE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1389.30","92211787","ACYCLOVIR 5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.00","92213014","ISOPROTERENOL HCL 0.2MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.15","92217065","GRAMICIDIN NEOMYCIN POLY SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.15","92217768","DORIPENEN 250MG PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.15","92218502","TRANSDERM SCOP 0.33MG/24HR TDM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.25","92216036","NITAZOXANIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.35","92215305","ZINC CL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.60","92212984","DOPAMINE HCL 800MG/D5W 500ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.83","38301010","FIBRIN-D-DIMER QUANT ","85379",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.90","38302115","RENIN-PLASMA ","84244",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.91","38200016","GAMMAGLOBULIN IGM ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.91","38202130","RHEUMATOID FACTOR QUAL ","86430",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.95","92219218","ALENDRONATE SODIUM 70 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.96","38300144","CORTISOL BASELINE ","82533",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.96","38300145","CORTISOL 1 HOUR POST DOSE ","82533",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"139.96","38300680","CORTISOL TOTAL ","82533",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1391.25","92218040","MOMET/FORMOTEROL 100MCG5MCGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1391.60","92218164","DULERA INHALER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13927.60","92217954","IMMUNE GLOBULIN 1GM/10/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1393.65","92218443","LEVOTHROXINE 200 MCG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"13976.15","92218483","FLEBOGAMMA 5 GM/100 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92204004","IV ADMIXTURE 05 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92211183","ACETAMINOPHEN 325MG/10.15ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92211262","RANITIDINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92211429","AMOXICILLIN CLV K 125-31.25 PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92211433","TRIFLUOPERAZINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92211644","CHLORDIAZEPOXIDE CLIDINM BR CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92212017","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92212158","KETOPROFEN 200MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92212720","RANITIDINE HCL 300MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92212873","AMMONIA AROMATIC SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92212882","ISOPROPYL ALCOHOL 70% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92214247","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92214257","FLUVOXAMINE MAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92214374","AZATHIOPRINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92214637","CITALOPRAM HBR 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215135","FLUOXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215562","ORTHO TRI-CYCLEN LO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215609","HCTZ OLMESARTAN MED 12.5-20 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215644","MIRTAZAPINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215824","HCTZ VALSARTAN 12.5-80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215881","DOCUSATE NA 100MG/10ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92215989","NA PHOS DIBASIC/MONOBASIC TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92216191","PROPOXYPHEN APAP 100-325MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92217154","FELODIPINE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92217499","MYCOPHENOLATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92217520","CHLORHEXIDINE GLUC GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92217604","SUMATRIPTAN SUCC 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92217929","FENOFIBRATE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.00","92218106","SUMATRIPTAN SUCCINATE 100MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.05","92210911","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.05","92216069","CITALOPRAM HBR 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.05","92217138","CITALOPRAM HBR 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92212586","METHENAMINE HIPP 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92212878","POTASSIUM CITRATE 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92213430","SOTALOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92213860","CITALOPRAM HBR 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92215087","NIFEDIPINE 90MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92215526","NIFEDIPINE 90MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92216094","SOTALOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.10","92217909","NIFEDIPINE 90MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92210581","LOXAPINE SUCCINATE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92211688","FLUVOXAMINE MAL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92212361","LOXAPINE SUCCINATE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92213554","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92217857","PETROLATUM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.15","92218385","WHITE PETROLATUM . OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","38202212","BLOOD COUNT-PLATELET AUTO ","85049",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92211727","WARFARIN NA 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92212147","SOTALOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92216649","GABAPENTIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92217697","BELLADONNA ALK ANALGESICS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92218498","SERTRALINE HYDROCHL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.20","92220265","AMANTADINE 50 MG/5 ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.25","92217220","DAPSONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.25","92217354","LEVETIRACETAM 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.25","92220300","DEXTROSE 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.30","92214443","DIVALPROEX NA 250MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.30","92215561","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.30","92216054","MIRTAZAPINE 15MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.30","92216438","OXYBUTYNIN CL 5MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.35","92210384","PIROXICAM 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.35","92210897","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.35","92211875","PRIMIDONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.35","92212967","DOXAZOSIN MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.35","92215464","SOTALOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.40","92212982","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.40","92214322","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.40","92215665","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.43","38299301","URINALYS QUAL/SEMIQNT XCPT IA ","81005",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.45","92213312","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92211463","FLUVOXAMINE MAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92211584","FLUVOXAMINE MAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92211951","LIDOCAINE HCL 2% VISCOUS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92212148","DILTIAZEM HCL 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92215908","MIRTAZAPINE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.50","92217053","OXCARBAZEPINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.55","92211426","NORETHINDRONE ACET 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.60","92210037","SODIUM CL 0.65% NASAL SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.60","92210146","AMANTADINE HCL 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.60","92215268","DILTIAZEM HCL 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.65","92210531","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.65","92211333","HYOSCYAMINE SULF 0.125MG/ML LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.65","92213149","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.65","92218612","MORPHINE SULFATE 10MG/0.5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92214328","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92215717","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92216056","MIRTAZAPINE 30MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92216258","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92216260","BETHANECHOL CL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92217749","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.70","92220027","TROLAMINE SALICYLATE 10% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.75","92214791","CLOTRIMAZOLE 10MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.75","92220309","URSODIOL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.80","92210914","HYDROXYCHLOROQUINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.80","92214120","CITALOPRAM HBR 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.85","92211514","IRBESARTAN 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.85","92215990","TROSPIUM CL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.85","92216581","MIDODRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.85","92219881","DIPHENHYDRAMINE 25MG/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.85","92220486","MAGNESIUM HYDRO 2400MG/30MLSUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.90","92215656","MIRTAZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.90","92218845","ACAMPROSATE CALCIUM 333MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92211642","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92211946","PIROXICAM 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92214515","DOXAZOSIN MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92214630","FELODIPINE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92216575","SERTRALINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92217226","MIRTAZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92219428","OXYCODONE/APAP 7.5MG-325MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14.95","92220403","BACLOFEN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.00","92210032","LEVOBUNOLOL 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.00","92211512","ITRACONAZOLE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.00","92214905","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.24","38300219","CANDIDA DNA AMP PROBE ","87481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.24","38300225","C AURIS SCREEN ","87481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.25","92214732","VANCOMYCIN HCL 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.29","38399314","ANTIGEN SCRN W/PT SERUM EA ","86904",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.29","72000551","BLD TYPE PATIENT SERUM ","86904",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.40","92218031","VAGIFEM 10MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.40","92218848","ESTRADIOL 10 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.45","92216836","QUETIAPINE FUMARATE 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.45","92216841","QUETIAPINE FUMARATE 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.50","92216936","ISONIAZID 300MG/30ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.55","92215523","SCOPOLAMINE 0.33MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.55","92215966","SCOPOLAMINE 0.33MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.65","92219452","CHLOROPROCAINE HCL 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"140.89","38300197","ANTI-DNA ANTIBODY ","86225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1401.70","92218467","VASOSTRICT 20 UNITS/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1401.70","92220167","VASOPRESSIN 20 Units/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1401.70","92220506","VASOPRESSIN 0.2 UNITS/1 ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1401.70","92220522","VASOPRESSIN 20 UNITS/ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1402.30","92218403","ADVAIR HFA 45 MCG/21 MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1405.85","92220142","TAFLUPROST 0.000015 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1409.00","92217992","SYMLINPEN 1000MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1409.35","92216078","ERLOTINIB 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.00","33105663","PACK MAJOR OR PROCEDURE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.00","92213476","RISEDRONATE NA 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.00","92215036","ALOSETRON HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.02","38299318","T CELL TOTAL COUNT ","86359",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.18","38303055","GROWTH HORMONE ","83003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.20","92219035","NITROGLYCERIN 0.4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.35","92218820","ALBUTEROL SULF 0.09MG/ACT INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.45","92213607","DEXMEDETOMIDINE HCL 200MCG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.55","92217193","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.83","38301540","HIV-1 ANTIBODY ","86701",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.90","92215789","ESTRADIOL LEVONORGEST 45MCG TD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"141.90","92220056","CU/MANGANESE/SELENIUM/ZN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1410.75","92220284","OLOPATADINE 0.1%SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1411.44","76000029","NM LUNG PERFUSION ONLY ","78580",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1413.51","38200220","HEP C GENOTYPE DNA/RNA ","87902",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1414.40","92218514","LOTEMAX 0.5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1414.75","92211631","TOBRAMYCIN 0.3% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1414.75","92213021","CIPROFLOXACIN 0.3% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.00","92211734","PHENYLEPHRINE HCL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.13","38200004","PROCALCITONIN ","84145",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.13","38300057","ACTIVATED PROTEIN C RESISTANCE","85307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.20","92217942","LEVETIRACETAM 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.50","92216442","PROPOFOL 1% EMULSION INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.65","92217755","OXYCODONE HCL 60 MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.80","92213256","NYSTATIN 100000U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.85","92219410","BRIVARACETAM 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.95","92215267","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"142.95","92219199","NAFCILLIN SODIUM 2GM/100 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1421.00","92212601","IRINOTECAN HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1423.45","92219608","GLUCAGON KIT 1 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1427.15","76000015","NM BONE/JOINT LIMITED ","78300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1427.65","92211824","IPRATR-ALBUTEROL 200ACT ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1428.60","92210915","CLOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1429.00","33113070","SET INT 24FR 26FR CGL BRHN EZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.00","92214085","DEXTROSE 70%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.11","76020000","GALLIUM GA-67 PER MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.15","92218180","EXELON ER 13.3MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.40","92217528","IBUPROFEN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.50","92217350","ANTACID COMBINATION SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.55","92210683","BETAMETHASONE VA 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.58","38301740","HEPATIC FUNCTION PANEL ","80076",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.65","92218744","PHENYLEPH HYDCHL 50MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.68","38301290","GENTAMICIN ","80170",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"143.82","38399354","CYCLIC CITRULLINATD PEPTIDE AB","86200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1431.00","33113050","TRAY TRCH CGL BRHN SHLY PERC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1433.00","33102022","SUPPORT BACK ULTRALIGN TLSO XL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14345.30","92213619","LEUPROLIDE ACET 22.5MG KIT PI3"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1437.25","92220412","INSULIN GLAR RECOM 100U/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.00","92211641","ZOLMITRIPTAN 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.00","92211712","BENZOYL PEROXIDE 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.00","92212094","FLUOCINONIDE 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.00","92216389","LOTION MULTI INGREDIENT LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.04","34600280","MOD OF PROSTH COMMUN DEVICE ","92507GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.04","34600290","SPEECH LANGUAGE TREATMENT ","92507GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.20","92215319","DALTEPARIN NA 2500U/0.2ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.25","38300022","HCG SERUM QUANTITATIVE ","84702",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.25","92220268","ENTECAVIR 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.32","38300845","AEROBIC ORGANISM ID ","87077",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.40","92212110","NYSTATIN 100000U/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.55","92216224","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.90","92217008","ENOXAPARIN NA 80MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"144.90","92219254","ELUXADOLINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1441.97","77000360","CT GUIDANCE RAD THERAPY FIELDS","77014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"14430.90","92217241","ROMIPLOSTIM 250MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1444.35","92218380","ADVAIR HFA 115MCG-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1445.40","92219315","FILGRASTIM-AAFI300MCG/0.5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1445.40","92219316","FILGRASTIM-AAFI300MCG/0.5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1445.61","73500180","EEG OVER 1 HR ","95813",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1446.00","75000220","US EXT VEIN DUPLEX COMPLETE BI","93970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1447.55","77000280","CT UPPER EXT W/O CONTRAST BIL ","7320050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1447.55","77010013","CT UPPER EXT W/O CONTRAST RT ","73200RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1447.55","77010014","CT UPPER EXT W/O CONTRAST LT ","73200LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92210901","CEFACLOR 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92212534","HALOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92212557","ONDANSETRON HCL 4MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92216878","RISEDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92217024","FENTANYL 50MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.00","92220038","LEVETIR/NACL .9%500MG/100MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.02","38300088","P-ANCA ATYPICAL TITER ","86256",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.02","38300089","PERINUCLEAR AB TITER ","86256",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.02","38305590","ANTISMOOTH MUSCLE TITER ","86256",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.02","38306680","FLUORESCENT ANTIBODY TITER ","86256",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.15","92218824","CEFTAZIDIME/DEX 5% 2GM/50MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.20","92214892","CYCLOSPORINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.20","92218701","MEROPENEM/NS 1000 MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.20","92220077","LIPIDS -FISH/PLANTBASE 20% EMU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.46","38200130","AMYLASE ","82150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.46","38243604","PHOSPHOROUS URINE ","84105",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.50","92212258","ONDANSETRON HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.60","92219693","PHENYLEPHRINE HCL 10/MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.60","92220344","EPOETIN ALFA-EPBX 2000U/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.85","92214286","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.95","92212527","HYDROXYZINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"145.95","92218530","TRANEXAMIC ACID 1000MG/10MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1450.45","92217159","GLATIRAMER ACET 20MG/ML KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1452.08","76078070","NM PARATHYROID ","78070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1455.30","92217659","MULTIVATAMIN 10 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1456.73","76000370","NM INTESTINAL IMAGING ","78290",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.00","74001153","PHARYNX W/FLUORO ","70370",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.10","92219496","LIDOCAINE HCL OPTH 3.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.20","92212563","AK-PENTOLATE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.50","92211510","ROCURONIUM BROMIDE 10MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.57","38200572","CMV IGG ANTIBODY ","86644",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.67","38301315","GLUCAGON ","82943",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.75","92213643","LEVOFLOXACIN 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.77","38300128","HANTAVIRUS IGG ","86790",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"146.77","38300129","HANTAVIRUS IGM ","86790",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1462.80","92219708","DULAGLUTIDE 0.75 MG/0.5 ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1462.80","92220059","DULAGLUTIDE 1.5 MG/0.5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1463.50","92215167","MALATHION 0.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1464.00","33177830","TRAY CATH DIAL PALINDRM 28CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1464.00","33177831","TRAY CATH DIAL PALINDRM 23CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1464.89","74000600","IVP INFUSION W/ TOMOGRAMS ","74415",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1465.95","92212593","SALMETEROL XINAFOATE 46MCG AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1465.95","92219240","SALMETEROL XINAFOATE0.046MGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1467.85","92217776","CERTAROLINE FOSAMIL 600MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1467.85","92217777","CERTAROLINE FOSAMIL 400MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1468.66","77000195","CT MAXILLOFACIAL W/O CONTRAST ","70486",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.00","33102630","PAD VISTA T REPLACEMENT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.00","92215328","ORPHENADRINE CITRATE 30MG/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.00","92215968","LANSOPRAZOLE 30MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.01","38300166","SARS-COV-2 NAA UNIT PERFORMED ","87635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.40","92213245","HYDROGEN PEROXIDE 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.40","92219016","HYDROGEN PEROXIDE 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.45","92214260","CEFTAZIDIME DEXTROSE 1GM/50 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.60","92212164","CLOTRIMAZOLE BETAMETH 1-0.05 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.65","92211345","BETAMETHASONE DP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.67","38301130","ELECTROPHORESIS HEMOGLOBLIN ","83020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.67","38399330","CULTURE ANAEROBIC ","87073",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.75","92219682","CHLOROPROCAINE 3% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.95","92219736","METHYLNALTREXONE BROM 150MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"147.98","38306815","STREP A AMP PROBE TECH ","87651",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1470.00","33168376","TRACH PERCUT BL RHN G2-MLT7.5"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1472.55","92218314","ZOSTAVAX 19400UN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1472.55","92219190","ZOSTER VACCINE . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1476.00","92216074","ERLOTINIB 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1476.80","92217812","FIDAXOMICIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1478.00","92216920","BUDESONIDE FORMOTRL 80/4.5 AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1479.20","77000160","CT INTRACRANIAL STRUC WO CON ","70480",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1479.90","38000540","ELECTRON MICROSCOPY ","88348",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.11","38393921","PLATELET AGGREGATION EA AGENT ","85576",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.27","38300498","CH50 TOTAL COMPLEMENT ","86162",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.30","92215889","LIPIDS 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.40","92219942","SOD ZIRCON CYCLOSIL 10GM/ PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.50","92215996","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.55","38302260","STONE ANALYSIS ","82355",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.69","38307013","HELICOBACTER PYLORI STOOL ","87338",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.75","92215331","ENOXAPARIN NA 80MG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.79","38200380","CALCIUM (IONIZED) ","82330",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.80","92217550","SUMATRIPTAN SUCC 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.80","92220254","SUMATRIPTAN 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"148.85","92219164","SUMATRIPTAN SUCCINATE 25MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1480.98","77000320","CT SOFT TISSUE NECK WO CONT ","70490",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1481.76","77000120","CT BRAIN/HEAD WO CONTRAST ","70450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1484.35","92219892","MOMETASONE 200MCG/ACTUATN ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.00","92217645","DIANEAL 2.5% PD-2 DEXTROSE IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.10","92210493","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.18","38300300","TETANUS AB IGG ","86774",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.30","92217201","MESALAMINE 4GM/60ML NMA KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.71","38300136","FREE KAPPA LT CHAINS S ","83883",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.71","38300137","FREE LAMBDA LT CHAINS S ","83883",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.71","38300315","NEPHELOMETRY ","83883",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.80","92212462","ROPIVACAINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.80","92219037","HYDROCRT NA SUCCINATE250MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.90","38200930","CULTURE SCREEN MRSA ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.90","38201720","LIPASE ","83690",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"149.95","92218735","ALBUTEROL SULFATE 0.09 MG INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1492.00","33113093","TRAY TRCH 24-28FR CGLBRHNG2PRC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1492.00","33152631","KIT STARTER PLEURAL ASPIRA 2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1493.60","92218056","PREVNAR 13 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1495.95","92218341","QVAR 0.08 MG/ACTUATION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1496.63","73500329","NRV COND STUDIES 9-10 STUDIES ","95911",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1496.75","92212790","CEFUROXIME AXETIL 250MG/5ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1498.95","92210177","CLOBETASOL PROP 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1499.85","92219796","LATANOPROSTENE BUNOD 0.024%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","34000565","ULTRAVIOLET ","97028GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92211865","RANITIDINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92211905","ISRADIPINE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92211915","GLYCERIN LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92212198","CLOTRIMAZOLE 10MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92212532","DICLOFENAC NA MISOPRO 50-0.2 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92212542","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92212933","MIRTAZAPINE 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92214203","MISOPROSTOL 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92214267","PHENOL 1.4% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92214910","PERINDOPRIL ERBUMINE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215176","ERGOCALCIFEROL 50000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215343","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215350","CIPROFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215419","OXYCODONE APAP 7.5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215511","NICARDIPINE HCL 45MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215607","HCTZ OLMESARTAN MED 12.5-20 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215657","MIRTAZAPINE 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215664","PAROXETINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215670","PAROXETINE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92215858","PAROXETINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92216313","MIRTAZAPINE 45MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92216767","LOVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92217044","LANOLIN PETROLATUM 15.5-53.4 O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92217216","LEVETIRACETAM 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92217355","LEVETIRACETAM 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92218116","LIMBREL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.00","92218869","MULTI INGREDIENT LOTION LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92211683","BUTALBITAL COMP/COD #3 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92212667","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92215667","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92216207","CYCLOSPORINE MOD 50MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92216571","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92216574","SERTRALINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92217202","ROPINIROLE HCL 2MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92217203","ROPINIROLE HCL 2MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92218207","ZARAH 3MG-0.03MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92218492","POLY GLYCOL 17 GM/DOSE POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.05","92220195","CYCLOSPORINE MODIFIED 50MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.10","92210236","TRIAZOLAM 0.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.10","92210448","TOLNAFTATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.10","92216871","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.10","92219712","AMANTADINE HCL 100 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92211141","NAPROXEN 375MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92217001","OXCARBAZEPINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92217471","NITROGLYCERIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92217969","LEVETIRACETAM 100MG/ML 5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92218540","FIRST-VANCOMYCIN 25 25 MG/MLSO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.15","92219497","ISOPROPYL ALCOHOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.20","92210632","ENALAPRIL MALEATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.20","92211367","NORTRIPTYLINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.20","92212083","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.20","92214891","TACROLIMUS 0.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.20","92218873","DICLOFENAC POTASSIUM 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.25","92211307","PERPHENAZINE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.25","92219140","CETIRIZINE HYDROCHLOR 5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92211017","HCTZ LOSARTAN K 12.5-50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92212205","RISPERIDONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92213795","CITALOPRAM HBR 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92214855","CYCLOPHOSPHAMIDE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92214929","ETHOSUXIMIDE 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92218877","POLYET GLYC3350 17 GM/DOSE PKT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92218941","PAROXETINE 30 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.30","92219865","POLYETH GLYC 3350 17GM/DS PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.35","92215720","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.35","92216536","SIMVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.35","92218302","ZOLOFT 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.40","92214618","MIRTAZAPINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.40","92217232","MIRTAZAPINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.45","92216369","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.45","92218519","DICLOFENAC SODIUM 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.50","92211133","PAROXETINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.50","92214820","PIMOZIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.50","92218229","VANCOMYCIN HCI 50MG/ML ORAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.60","92213925","FELODIPINE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92210409","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92210927","SERTRALINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92211595","SERTRALINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92212208","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92212718","CLORAZEPATE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92213405","SERTRALINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92215976","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92216723","SERTRALINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92216725","SERTRALINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.65","92217168","NITROGLYCERIN 0.1MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.70","92211505","RANITIDINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.70","92212236","FLUPHENAZINE HCL 5MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.70","92215626","MIRTAZAPINE 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.70","92216058","MIRTAZAPINE 45MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.70","92218966","MIRTAZAPINE 45 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.75","92213610","FLUOXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.75","92213963","FLUOXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.80","92210564","SELEGILINE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.80","92215725","PAROXETINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.80","92215859","PAROXETINE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.85","92211608","DILTIAZEM HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.85","92214005","RIFAMPIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.85","92216111","GABAPENTIN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.85","92216991","PROPRANOLOL HCL 160MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.90","92219286","TORSEMIDE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.90","92220118","POTASSIUM CITRATE 10 MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.95","92211691","DEXTROAMPHETAMINE SULF 5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.95","92211793","CAPTOPRIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.95","92213040","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15.95","92216678","PHENELZINE SULF 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","33113097","VALVE RBR PLS CHST DRN SEAL FL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","33113098","VALVE RBR PLS CHST DRN SEAL FL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","33130891","TUBE GASTROSTOMY 28FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","33130897","TUBE GASTROSTOMY 20F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","33130901","TUBE GASTROSTOMY 24F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","92214289","DOXYCYCLINE HYCLATE 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","92216591","ACTIQ 600MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.00","92216614","FENTANYL CITRATE 600MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.03","38201498","HEPATITIS PANEL (ACUTE) ","80074",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.05","92210364","BACITRACIN/POLYMYXIN B OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.15","92210794","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.25","92214745","ZIPRASIDONE HCL 80MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.40","92216265","MODAFINIL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.43","38306700","CARDIOLIPIN ANTIBODY ","86147",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.60","92215566","NITROGLYCERIN 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.61","38300006","17 OH PROGESTERONE 17-D ","83498",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.90","92216861","RIVASTIGMINE 9.5MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.90","92216864","RIVASTIGMINE 4.6MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"150.97","38300985","CYCLOSPORINE ","80158",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1501.50","76000350","NM KIDNEY SPECT ","78710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1502.00","92215537","PIMECROLIMUS 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1504.00","33168060","TRACH BLUE RHINO G2-MULTI PERC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1504.90","92217750","BIMATOPROST 0.01% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1505.00","33113092","TRAY TRCH 24-26-28FR CGLBRHNG2"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1506.20","92210547","TOBRAMYCIN DEX 0.3-0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1508.00","92212744","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.00","33102614","NEEDLE SET BIOPSY 18-9.0-20T "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.00","33111019","DRSG WOUND SILVASORB GEL 8OZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.00","33111705","IMMOBILIZER KNEE LG 24 IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.25","92218746","SONAFINE TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.26","38301700","LUTEINIZING HORMONE ","83002",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.35","92219398","BELLADONNA/OPIUM 16.2-30MGSUPP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.41","38300830","CULTURE-FUNGUS-OTHER SOURCE ","87102",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.50","92217767","DORIPENEM 250MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.52","38300470","CBC W/ AUTO DIFF ","85025",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.67","38307014","CULTURE FUNGUS BLOOD ","87103",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.79","38300671","TEGRETOL-FREE ","80157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"151.80","92219551","VANCOMYCIN 1.5 GM/300 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1512.50","92218095","ARGATROBAN 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.00","33103267","PILLOW HIP ABDUCT CONTOUR MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.00","33103610","COLLAR VISTA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.00","36000380","IPPB-SUBSEQ/EZPAP ","9464076",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.00","92215734","ETHINYL ESTRADIOL NORT 35-1 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.00","92216727","MESTRANOL NORETHIND 0.05-1MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.01","34210375","TX SWALLOWING/ORAL DYSFUN ","92526GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.01","34600120","TX SWALLOWING/ORAL DYSFUN ","92526GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.09","38343621","SOMATOMEDIN ","84305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.15","92214135","NYSTATIN 100000U/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.20","92218151","SUPRAX 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.25","92216958","RANITIDINE HCL 150MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.31","38303645","5 NUCLEOTIDASE ","83915",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.40","92217644","DIANEAL 4.25% PD-2 DEXTROSE IV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.77","38301610","IRON BINDING CAPACITY ","83550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.90","92215592","ATAZANAVIR SULF 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.95","92215030","CR CU MN SE ZN TRACE ELEMENT I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"152.97","38302080","RAPAMYCIN (SIROLIMUS) ","80195",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15218.30","92218310","ACTEMRA 20MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1522.10","92218404","TARCEVA 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1523.85","92213559","PAMIDRONATE DISOD 30MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1523.95","92210668","IMMUNE GLOBULIN 5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1524.24","77000091","CT LOWER EXT W/O CONTRAST BIL ","7370050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1524.24","77010005","CT LOWER EXT W/O CONTRAST RT ","73700RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1524.24","77010006","CT LOWER EXT W/O CONTRAST LT ","73700LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1524.95","92216441","METRONIDAZOLE 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1529.05","77000070","CT THORAX W/O CONTRAST ","71250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.00","33179697","SPLINT HAND DEVATION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.00","92214449","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.07","38300472","LEVITIRACETAM ","80177",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.10","38393953","ESTRONE ","82679",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.10","92216860","RIZATRIPTAN BENZOATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.23","38200730","CPK-MBCOLORIMETRIC ","82553",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.30","92218142","ZORTRESS 0.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.65","92204028","IV ADMIXTURE 29 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.86","38303806","AMINO ACID QUANT EA ","82131",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.87","38300850","CULTURE ANAEROBIC ","87075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.87","38300885","C. DIFF. CULTURE (STOOL) ","87075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.90","92218376","LATUDA 40 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"153.95","92211444","OXACILLIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15325.20","92215043","DARBEPOETIN A 300MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"15325.20","92215574","DARBEPOETIN A 300MCG/0.6ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1535.00","92213650","FLUOROURACIL 0.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33111909","MOUTHPIECE ACAPELLA BLUE LOW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33112885","PROTECTOR HEEL BOOT PRESS REL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33139770","MIDLINE MAX PG 5F DL-20cm w/GW"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33141516","SYS MOUTH ACAP GRN HIFLO 15LPM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33161388","TUBE 80MM 10MM7MM UNCF LO TRMA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","33171888","SLING GIVMOHR SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.00","92216214","MOMETASONE FUROATE 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.10","38300061","HALOPERIDOL ","80173",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.10","92212799","OLANZAPINE 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.15","92212677","NAFCILLIN 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.16","38001900","PERIPH SMEAR REPT & INTERP ","85060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.34","38200780","C-REACTIVE PROTEIN ","86140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.35","38300213","PROTEIN S ANTIGEN (TOTAL) ","85305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.45","92215203","DEXTROSE 5%-1/3NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.59","38300132","STRONGYLIODES ANTIBODY ","86682",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.59","38300175","ANTIBODY CYSTICERCOSIS ","86682",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.60","92219457","BUSULFAN 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.80","92216430","CASTOR/PERU BALSAM/TRYPSINOIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"154.90","92210094","AMPICILLIN NA 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1540.35","92219060","PNEUMOCOCCAL13-VALENT VACC SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1541.20","92220099","OLODATEROL 2.5 MCG/ACT ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1543.22","77000260","CT UPPER EXT W/WO CONTRAST BIL","7320250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1543.22","77010009","CT UPPER EXT W/WO CONTRAST RT ","73202RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1543.22","77010010","CT UPPER EXT W/WO CONTRAST LT ","73202LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1545.70","92215329","NICARDIPINE HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1547.00","33103819","DRSG MESH PROLENE SOFT 2x4 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1548.02","77000100","CT BRAIN/HEAD W/CONTRAST ","70460",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1549.55","92212081","AMYLASE/LIPASE/PROTEASE POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.00","33103242","SET MICROPUNCTURE INTRUDER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.00","33109229","SUT 05-2 ETHIBOND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.00","33109799","DRSG SURGICEL 2X14 STRL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.00","33152349","TRAY LAP CUSTOM 4807 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.00","33199356","DRAIN CHEST AQUASEAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300840","CULTURE-ROUTINE ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300895","CULTURE CATH-TIP ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300910","CULTURE CSF ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300923","CULTURE NARES ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300940","CULTURE SPUTUM ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300970","CULTURE THROAT ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38300975","CULTURE WOUND ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38302885","CULTURE FLUID/OTHER (NON CSF) ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305086","NOCARDIA CULTURE ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305087","CULTURE- EAR ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305088","CULTURE- EYE ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305089","CULTURE- GENITAL ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305090","CULTURE- TISSUE ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305100","CULTURE- RESPIRATORY ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.17","38305624","CULTURE AEROBIC ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.32","38300509","CULT TYP DNA AMP PROBE EA ORG ","87150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38300020","PURKINJE CELL CYTOPLASMA ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38300196","ANTI NEUTROPHILIC ANTIBODY ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38300198","ANTI-MITOCHONDRIAL ANTIB ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38300199","ANTI-SMOOTH MUSCLE ANTIBODY ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38301790","FLUORESCENT AB SCREEN ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38301850","PARIETAL CELL ANTIBODY ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38302118","RETICULIN ANTIBODY ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38303823","IGA ENDOMYSIAL AB ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38304200","ANTI PROTEINASE-3 ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.36","38380045","GBM-GLOMERULAR BASEMENT (IFA) ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.45","38202415","TROPONIN (QUANTITATIVE) ","84484",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.45","92214823","NYSTATIN 100000U/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.56","38300010","ACETYCHOLINE RECEPTOR AB ","84238",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.56","38307005","SOLUBLE TRANSFERRIN RECEPTOR ","84238",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.75","92211132","HEPATITIS B VACC 10MCG/0.5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.85","92219633","SOD ZIRCON CYCLOSI 10GM/PACPDR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.85","92220395","SOD ZIRCON CYCLOSIL 10GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.85","92220396","SOD ZIRCON CYCLOSIL 5 GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"155.90","92210216","AMIKACIN SULF 250MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1559.00","92213862","INSULIN GLARG RECMB 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33111095","TUBE TRACH XL CFLS DIST 6.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33111564","KIT MICROINT PTFE SAFETY 4.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33111594","SYSTEM WOUND MGT FISTULA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33113071",""OST SYS 4 1/8-6.25"" MINI 2 LYR""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33113072",""OST SYS 4 1/8-6.25"" MINI 2 LYR""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33131075","DRAIN CHEST DRY SUC DUAL CHAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33142176","KIT CATH 3LUM BLUEFLEX TIP 7FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161377","TUBE 90MM9.6MM5MM CUF DIST XTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161379","TUBE 90MM9.6MM5MM UNCF DISTXTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161380","TUBE 90MM9.6MM5MM UNCF PROXXTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161393","TUBE 95MM11MM6MM UNCF PROX XTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161408","TUBE 100MM12.3MM7MM UNCUF DIST"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161409","TUBE 100MM12.3MM7MM UNCUF PROX"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161418","TUBE 105MM13.3MM8MM UNCUF DIST"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","33161419","TUBE 105MM13.3MM8MM UNCUF PROX"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.00","38200057","ACTIVATED PROTEIN C RESISTANCE","85307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.01","34000042","PT EVALUATION LOW COMPLEXITY ","97161GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.20","92218818","INFLUENZA VAC 60MCG/0.5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.30","92210401","TROPICAMIDE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.47","38300155","ANDROSTENEDIONE LEVEL ","82157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.56","38201120","ELECTROLYTE PANEL ","80051",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.61","38304150","FOLLICLE STIMULATING HORMONE ","83001",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.70","92214430","ZIPRASIDONE HCL 60MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.75","92217943","DEXTROAMPHETAMINE HBR QUIN CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.75","92218181","NEUPRO ER 8MG/24 HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.75","92218188","NEUPRO 6MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"156.75","92219203","ROTIGOTINE 1 MG/24 HRPatch "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1563.20","92214518","LOTEPREDNOL ETABONATE 0.5% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","33131050","ORTHOSIS HAND THERA+ TA LT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","33131051","ORTHOSIS HAND THERA+ TA LT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","33131171","TUBE TRACH BIV UNCUFF 6.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","92213641","ALFENTANIL HCL 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","92213648","FLUTICASONE PROP 0.005% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","92218807","VANCO/NACL.9% 1000MG/200ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.00","92219167","VANCO/NACL 0.9%1000MG/200MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.05","92213101","CIPROFLOXACIN 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.10","92218637","HALOPERIDOLDECANOATE50MG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.25","92212509","HEPATITIS B VACC 5MCG/0.5ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.25","92218985","POTASSIUM CHLOR 40MEQ/30ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.40","92214104","MOXIFLOXACIN HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.66","38303217","MANGANESE ","83785",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.67","38202310","T-4 TOTAL (THYROXINE) ","84436",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.67","38243626","GIARDIA ANTIGEN ","87329",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"157.80","92214130","FENTANYL 50MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1572.00","33170063","SPHNTM 20MM450CM4.4FRDREAMTOME"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1575.75","76000112","NM THYROID IMG W UPTK SGL/MULT","78014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1577.40","92218819","TIROFIBAN/NACL.9% 12.5MG/250ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1578.35","92212972","LOTEPREDNOL ETABONATE 0.2% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.00","33129522","KIT INTRO INTROFLEX PERCUT8.5F"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.00","33194468","CANISTER W/O GEL INFOVAC 500ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.10","92210277","CEPHALEXIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.25","92215012","PHENOBARBITAL NA 65MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.30","92211146","SODIUM PHOSPHATE 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.30","92215031","ISOFLURANE 99.9% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.35","92217982","INTELENCE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.40","38302340","TESTOSTERONE TOTAL ","84403",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.40","92214943","LEVOCARNITINE 200MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38300002","THERAP DRUG ASSAY QUANT NEC ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38300112","AMIODARONE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38300141","POSACONAZOLE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38300158","ITRACONAZOLE SERUM/PLASMA ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38300804","PREGABALIN ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38301030","DIGITOXIN ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38301992","PROLIXIN LEVEL ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38302533","VENLAFAXINE LEVEL ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38302536","VORICONAZOLE QNT ","80285",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38302800","CLOMIPRAMINE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38302920","DISOPYRAMIDE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303000","FLECAINIDE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303010","FLUOXETINE- PROZAC ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303170","KANAMYCIN ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303206","LIBRIUM (CHLORDIAZEPOXIDE) ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303207","CHLORPROMAZINE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303208","FLUOXETINE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303209","PENTOBARBITAL AND THIOPENTAL ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303240","METHOTREXATE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303245","MEXILETINE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303742","NEURONTIN (GABAPENTIN) ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38303900","CARBIDOPA ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38305076","FELBAMATE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38343617","ALPROZOLAM (XANAX) ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38343619","SULFAMETHOSAZOLE HPLC ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38399309","DEPAKOTE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.41","38399351","DILANTIN ASSAY ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.48","38300522","LIPOPROTEIN PARTICLE QUANT ","83704",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.71","38300210","ANTITHROMBIN III ","85300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"158.75","38306434","CLOTTING FACTOR XIII ","85291",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1580.00","92212461","DESOXIMETASONE 0.25% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1583.95","92214422","INTERFERON ALFA-2B 10MM U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1587.00","33102024","HANDPIECE VERSAJET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1589.30","92216331","EXENATIDE 250MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1589.30","92218529","CLOBETASOL PROPIONATE 0.05%TOP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33102082","ORTHOSIS AIRHAND ROLL W FINGR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111092","TUBE TRACH XL CFLS PROX 5.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111096","TUBE TRACH XL CFLS PROX 6.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111099","TUBE TRACH XL CFLS DIST 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111100","TUBE TRACH XL CFLS PROX 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111104","TUBE TRACH XL CFLS DIST 8.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33111105","TUBE TRACH XL CFLS PROX 8.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33112278","DRSG VAC FOAM WHITE SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33113062","TUBE 95MM11MM6MM UNCUF DISTXTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33177667","TUBE TRACHEAL JACKSON #4 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33177669","TUBE TRACHEAL JACKSON 5 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","33177671","TUBE TRACHEAL JACKSON #6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.00","36000620","PULSE OXIMETRY-SINGLE ","94760",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.10","38302615","ACID FAST BACILLI CULTURE ","87116",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.10","38399344","CULTURE TB ","87116",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.10","92219156","MOXIFLOXACIN 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.15","92204045","IV ADMIXTURE 45 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.17","38393920","HEPB CORE AB IGM (HBCIGM) ","86705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.20","92213675","LIDOCAINE HCL 5% TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.20","92219386","VANCOMYCIN HCL 1.5 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.35","92212929","ABACAVIR SULF LAMI ZIDO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"159.55","92216373","GASTROGRAFIN 66/10 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1590.39","72060010","PLATELETS PHER-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1593.44","77000201","CT THORACIC SPINE W/O CONTRAST","72128",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","33171349","PACK PROCEDURE PLEURX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","38200095","ALKALINE PHOSPHATASE TOTAL ","84075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92211655","INDINAVIR SULF 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92212068","HCTZ LOSARTAN K 12.5-50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92212805","DOXEPIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92213956","RISPERIDONE 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92214052","INDINAVIR SULF 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92214698","KETOCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92214754","INDINAVIR SULF 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92215240","ROSIGLITAZONE MALEATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92215496","CANDESARTAN CILEXETIL 16MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92215519","NICARDIPINE HCL 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92216129","HYDROCODONE APAP 2.5-167/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92216642","CHLORPHEN/DM/PHEN 1-3-1.5MG SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92216648","GABAPENTIN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92217171","CETIRIZINE HCL PSE 5MG/120MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92217571","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92217607","BENZOCAINE DOCUSATE NA 20MG NM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92217609","DOCUSATE NA 283MG NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.00","92220229","GABAPENTIN 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.05","92214566","DOXAZOSIN MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.05","92217246","ALENDRONATE NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.05","92219126","ALENDRONATE SODIUM 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92210883","DEXTRAN HYPROMELLOSE 0.1-0.3 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92210941","RANITIDINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92211482","ALENDRONATE NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92212235","ALENDRONATE NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92212386","PRAVASTATIN NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92212404","ROPINIROLE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92212564","ALENDRONATE NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92212666","ALENDRONATE NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.10","92219143","DESMOPRESSIN ACETATE 0.2MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.15","92210609","CAPTOPRIL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.15","92214177","URSODIOL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.15","92218146","FIORICET 300-50-40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.15","92220348","MINOIL/PET/PHNHCL14-74.9-0.25%"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92210273","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92212016","PRAMIPEXOLE DIHCL 1.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92212814","ROPINIROLE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92212996","PRAMIPEXOLE DIHCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92214799","VERAPAMIL HCL 240MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92216971","PRAMIPEXOLE DIHCL 0.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.20","92217769","PRAMIPEXOLE DIHCL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.25","92219377","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.25","92220314","SERTRALINE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.30","92211653","ALBENDAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.30","92211805","ACETAZOLAMIDE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.30","92216510","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.30","92219362","LEVOMEFOLATE CALCIUM7.5 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.32","38202170","SGOT (AST) ","84450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.35","92213016","ZIDOVUDINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.35","92214380","PAROXETINE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.35","92220311","PROPAFENONE 300 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.40","92211635","PROPRANOLOL HCL 120MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.40","92217381","HYDROMORPHONE 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.40","92219824","LACTULOSE 20 GM/30 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.40","92219829","LACTULOSE 10 GM/15 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92210044","ROPINIROLE HCL 0.W5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92211861","PRAVASTATIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92212369","HYDROCORTISONE ACET 0.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92216815","NA PHOS DIBASIC/MONOBASIC SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92217686","TOLNAFTATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92220358","DEXTROSE 15 GM/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.45","92220523","DEXTROSE/VITD3 15GM-400U/60ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92211638","INDOMETHACIN 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92211971","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92212059","INDOMETHACIN 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92214362","PROPANTHELINE BR 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92219554","PILOCARPINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.50","92220006","PILOCARPINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.55","92210777","ESTRIFIED ESTROGENS 0.625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.55","92211796","HYDROCODONE IBU 7.5-200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.55","92216874","POLYETHYLENE GLYCOL 3350 POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.60","92211754","BENZOYL PEROXIDE 5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.60","92214625","MEPERIDINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.60","92215941","CALCIUM CARB 1250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.60","92216938","CITRIC ACID NA CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.60","92218073","DESMOPRESSIN ACETATE 0.1MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.65","92210433","MEXILETINE HCL 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.65","92214437","MINERAL OIL NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.65","92220082","DAPSONE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.70","92213062","FENOFIBRATE 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.70","92213640","TORSEMIDE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.70","92215718","PAROXETINE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.70","92216394","CEREFOLIN NAC TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.70","92219744","ICOSAPENT ETHYL 1 GM CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.75","92211168","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.75","92214308","HCTZ VALSARTAN 12.5-160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.80","92210623","CPM PLOY HYDROCODONE SER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.80","92214570","CANDESARTAN CILEXETIL 16MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.85","92213155","CORTISONE ACETATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.85","92217970","ATORVASTATIN CAL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.90","92211706","IRBESARTAN 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.90","92211807","IRBESARTAN 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.90","92213058","AMLODIPINE BESYLATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.95","92211074","ANTIPYRINE/BENZOCAINE EAR SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.95","92211731","TRIFLUOPERAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.95","92212382","ALOE VERA/GLYCERIN GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.95","92218331","INDOMETHACIN 75MG ER CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16.98","38203816","FLUROCHROME STAIN ","87206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","33110299","DRAINAGE CHEST THORA-SEAL III "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","33111091","TUBE TRACH XL CFLS DIST 5.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","33111122","TUBE TRACH XL CFFD DIST 5.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","33178023","DRAIN CHEST THORA-SEAL III "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","92213847","PARICALCITOL 2MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.00","92214142","ALCLOMETASONE DIPRO 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.20","38202384","THYROID STIMULATING IMM GLOB ","84445",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.25","92211390","METHYLPREDNISOLONE 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.26","38300900","CULTURE CHLAMYDIA ","87110",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.27","38302760","CATECHOLAMINES URINE ","82382",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.30","34020003","VESTIBULAR REHAB ","95992",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.30","92218461","CEFEPIME 2 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.40","92212726","MOMETASONE FUROATE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.42","34250127","OT EVALUATION LOW COMPLEXITY ","97165GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.45","38303303","MYELOPEROXIDAST (MPO) AB ","83876",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.50","92219329","SOD ZIR CYCLOSILICATE 10GM/PKT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.50","92219632","SOD ZIRCON CYCLOSI 5GM/PAC PDR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.50","92219634","SOD ZIRCON CYCLOSI 5GM/PAC PDR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.65","92216912","CEFTRIAXONE NA 2GM/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.95","92212923","HYDROXYZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"160.95","92215593","ATAZANAVIR SULF 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1600.69","76000020","NM LIVER/SPLEEN IMAGING ","78215",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1601.28","77000180","CT PELVIS W/O CONTRAST ","72192",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1605.89","77000030","CT ABDOMEN W/O CONTRAST ","74150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","33103473","IMMBOLIZER KNEE 20 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","33107270","IMMOBILIZER KNEE MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","33116193","BLADE DERMATONE ZIMMER STRT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","33176505",""IMMOBILIZER KNEE 24"" ""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","38200120","AMMONIA ","82140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","38203275","MYCOPLASMA ANTIBODY ","86738",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.00","92212940","INSULIN HUM ISOP/REG 70U-30U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.08","34000043","PT EVALUATION MOD COMPLEXITY ","97162GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.15","38302850","CORTISOL FREE ","82530",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.15","92215195","IMIPENEM CILASTATIN NA 500MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.17","38302510","VANCOMYCIN ","80202",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.25","92211690","OXACILLIN NA 2GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.40","38000655","TISSUE BLOCK FROZEN SECT ADD ","88332",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.55","92216646","OPRELVEKIN 5MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.63","38301915","PKU ","84030",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.75","34600445","EVAL SPEECH DEVICE ADDL 30 MIN","92608GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"161.90","92218255","VIREAD 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1613.00","92214369","CLOBETASOL PROP 0.05% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1618.30","92213875","COLLAGENASE 250U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","33101128","TRAY MAHUKKAR CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","33103448","TRAY CATH SFTCENT NO LIDOCN6FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","33153007","TRAY THORANCENTESIS W/C "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","33170449","BOOT PODUS W/TSFR PAD/STRAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","38305406","BENZODIAZEPIINES 13+ ","80347",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.00","92215194","AMINO ACIDS 4.25% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.05","34010260","STRAPPING TOES ","29550GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.20","92218163","NARATRIPTAN 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.30","92216862","RIZATRIPTAN BENZOATE 10MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"162.95","92214968","ETHYL CHLORIDE SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1628.55","92214908","DESONIDE 0.05% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16288.00","92211207","CALCITONIN 200U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1629.05","92215629","CIPROFLOXACIN DEX 0.3%-0.1% SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33101840","BOOT FTHLD WAFL SPLT SEC MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33111093","TUBE TRACH XL CFFD DIST 6.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33111094","TUBE TRACH XL CFFD PROX 6.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33111097","TUBE TRACH XL CFFD DIST 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33113059","TUBE 95MM11MM6MM CUFDISTXTNXTD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33113955","TUBE TRACH CFF PROX EXT XLT 8 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33153640","TUBE TRACH XLT CUFDIST8.0MM ID"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33153641","TUBE TRACH XLT CUFPROX7.0MM ID"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33161378","TUBE 90MM9.6MM5MM CUF PROX XTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33170451","BOOT PODUS W/TSFR PAD/STRAP XL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","33177674","TUBE TRACHEAL JACKSON #7 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","92214147","ETOMIDATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.00","92217613","HEXACHLOROPHENE 3% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.20","92219994","PHYTONADIONE 1 MG/0.5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.23","38201040","DIGOXIN ","80162",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.23","38201380","GLYCOHEMOGLOBIN (HGB A1) ","83036",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.23","38203700","GAMMAGLOBULIN IGE ","82785",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.25","38300405","CARCINOEMBRYONIC-(CEA) ","82378",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.27","38300901","CULTURE VIRAL ","87252",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.27","38302820","CMV CULTURE (TISSUE) ","87252",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.55","92211615","TOBRAMYCIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.60","92218745","VENELEX 87MG-788MG/GM TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.63","34250128","OT EVALUATION MOD COMPLEXITY ","97166GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.77","72000905","COOMBS INDIRECT TITER ","86886",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.85","92217274","NICARDIPINE HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.85","92219289","MEROPENEM 1 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"163.85","92220327","MEROPENEM 1 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1631.40","92212848","TRETINOIN 0.01% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1632.20","92217322","ADVAIR 500-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1637.35","92220376","ENOXAPARIN 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1638.17","77000270","CT UPPER EXT W/ CONTRAST BIL ","7320150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1638.17","77010011","CT UPPER EXT W/CONTRAST RT ","73201RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1638.17","77010012","CT UPPER EXT W/CONTRAST LT ","73201LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.00","33151316","UNIT CHEST DRAINAGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.00","92212344","CHLORPROMAZINE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.00","92212868","NYSTATIN/TRIAMCINOLONE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.16","38305067","VITAMIN B6 LEVEL ","84207",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.20","92212347","MILRINONE D5W 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.30","92218760","OLANZAPINE 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.60","92217391","RUFINAMIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.60","92220442","ARIPIPRAZOLE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"164.71","38300360","CA 125 ANTIBODY ","86304",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1640.10","92219294","HYDROPHILIC PASTE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1640.34","77000040","CT CERVICAL SPINE W/O CONTRAST","72125",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1641.20","92219179","EPINEPHRINE 1 MG/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1647.65","92211590","TRETINOIN 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1649.05","92218763","TBO FILGRASTIM 300MCG/0.5MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1649.10","92218980","TBO-FILGRASTIM300 MCG/0.5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1649.10","92219320","TBO-FILGRASTIM 300MCG/1ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.00","92220384","NOREPINEPHRINE D5W 4 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.05","92213005","METHYLPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.05","92218291","METHYLPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.10","92210346","METHYLPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.12","38303500","TESTOSTERONE FREE ","84402",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.31","38399334","ANTIGEN RSV ","87420",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.33","72000355","RBC PRETREAT DIFF RED CELL ABS","86978",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.34","38301928","TOPUMAX-TOPIRAMATE ","80201",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.45","38200571","CMV IGM ANTIBODY ","86645",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.50","92215619","ARIPIPRAZOLE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.57","72000300","ANTIGEN TYPE (RBC) ","86905",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.63","38302734","C. DIFF. TOXIN B CYTOTOX ASSAY","87230",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.63","38302735","C. DIFF. CULT. ","87230",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.63","38305210","ASSAY TOXIN OR ANTITOXIN ","87230",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"165.84","38300214","THROMBOPLASTIN INHIBITION ","85705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1650.00","92219462","AZATHIOPRINE SODIUM 100 MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1657.00","76000012","NM BONE/JOINT MULT AREAS ","78305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1657.00","92214353","ISONIAZID 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1657.01","72060011","PLATELETS PHER LR-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1659.45","92211544","MOMETASONE FUROATE 50MCG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"16590.40","92220174","RISPERIDONE 120 MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33111090","TUBE TRACH XL CFFD PROX 5.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33111098","TUBE TRACH XL CFFD PROX 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33111101","TUBE TRACH XL CFFD DIST 8.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33111103","TUBE TRACH XL CFFD PROX 8.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33111809","SYSTEM WND MGT FISTULA MID "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33112452","ORTHOSIS WHFO REST LEFT SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33112453","ORTHOSIS WHFO REST RT SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33112772","CANISTER KCI VAC LG 1000ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33112904","DRSG VAC SIMPLACE MEDIUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33113060","TUBE 95MM11MM6MM CUFDISTXTNXTD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33113061","TUBE 95MM11MM6MM CUFPROXXTNXTD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33113063","TUBE 100MM12.3MM7MM CUFDISTXTN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33114975","TRAY INSERTION CHEST TUBE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33198077","STK JOB KNEE 15-20MMHG US LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","33198535","STOCK COMPR KNEE HI OP TOE XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","38301565","HYDROXYPROLINE URINE (FREE) ","83500",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","92210718","HYDROCORTISONE VAL 0.2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.00","92214100","CLOBETASOL PROP 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.03","38380100","RIBOFLAVIN VIT B-2 ","84252",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.05","92211424","KETOCONAZOLE 2% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.05","92214391","BENZOCAINE 20% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.06","38300361","CALCITONIN ","82308",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.30","38300037","CITRATE ","82507",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.35","92216674","PALIPERIDONE 3MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.56","38201810","OSMOLALITY SERUM ","83930",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.56","38205100","CULTURE- RESPIRATORY ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.56","38243614","RHEUMATOID FACTOR QUANT ","86431",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.80","92219476","THIOGUANINE 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.85","38306590","PROTHROMBIN SUBSTITUTION ","85611",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.89","38300218","C DIFFICILE ANTIGEN ","87449",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.89","38302537","FUNGITELL QUAL/SEMIQNT ","87449",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.89","38380010","BACTERIAL ANTIGEN ","87449",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.90","92211575","IMIPRAMINE PAMOATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"166.98","38301482","HEPATITIS C AB CONFIRM ","86804",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1666.50","92213129","IMMUNE GLOBULIN 3GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1668.00","92216117","CLINDAMYCIN PHOS 1% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1668.96","76000862","NM GI ACUTE BLOOD LOSS IMAGING","78278",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.00","33153115","BOOT TRACTION UNIVERSAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.00","92212746","MEPERIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.00","92214741","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.02","38306757","HOMOCYSTINE ","83090",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.08","38300517","CHLAMYDIA TRACHOMATIS(AMP) ","87491",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.15","92218127","IMIPENEM AND CILASTATIN 500 MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.20","92218001","COAL TAR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.21","38302960","ESTROGEN ","82672",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.40","92217758","OXYCODONE HCL 80MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.50","92215094","PIPERACIL TAZOBACT 4.5/100ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.55","92214021","OLANZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.55","92217991","NEUPRO 4MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.55","92218064","NEUPRO 2MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.65","92217796","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.67","38200981","CULTURE URINE W/COLONY COUNT ","87086",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.85","92216573","GABAPENTIN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.90","92216740","PALIPERIDONE 3MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"167.90","92216746","PALIPERIDONE 6MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1670.70","92219516","DASATINIB 70 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1671.90","92211458","PREDNISOLONE ACETATE 0.12% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1678.30","92214912","PRAMOXINE HCL HC 1%-2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1679.00","33103839","LIGASURE SMALLJAW CURV 18.8CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1679.35","92218372","AUVI-Q 0.3 MG/0.3 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.00","33109919","RELOAD CUTTER PROX LIN BLU75MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.00","33178029","HEM ABS SURGICEL 4X8 STERILE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.00","92214766","SOYBEAN OIL 30% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.07","38302774","CHEMILUMINES ","82397",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.10","92215887","SILVER ANTIMICROBIAL WOUND GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.10","92216681","PALIPERIDONE 6MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.23","72000845","CROSSMATCH ELECTRONIC ","86923",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.60","92220259","CINACALCET 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.65","92216374","ARIPIPRAZOLE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"168.85","92217299","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1684.00","33168399","TRAY TRCH MULTI PERC BRHN G2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1684.60","92214208","TACROLIMUS 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33103574","ORTHOSIS HAND REST SM RT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33103581","ORTHOSIS HAND REST SM LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33109715","ORTHOSIS REST HAND XL LEFT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33113083","TUBE 10CM 18FR BLN RTNT INTGRT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33152480","SET GASTRO FDG INT THRIVE 20FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33168136","TUBE FD 16FR BLN RTNT ENTUIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33168137","TUBE GSTRM 22FR BLN ENTUIT 10 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","33168138","TUBE FD 24FR BLN ENTUIT THRIVE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.00","92215023","AMINO ACIDS 4.25% M-D10W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.07","38000635","CYTOPATH WASH/BRUSH NON-GYN ","88104",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.14","38343613","PROINSULIN ","84206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.40","92214539","HEPARIN 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.55","92215855","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.67","38300086","MONONUC CELL AG QUANT EA AG ","86356",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"169.89","38201630","LACTIC ACID ","83605",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1694.05","92220526","PNEUMOCOCCAL 20 CONJ VACC SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1695.50","92216853","BUDESONIDE 180MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1697.10","92216964","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","76020018","GADOFOSVESET TRISODIUM 1ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92212317","PRAVASTATIN NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92212339","DOXYCYCLINE CALCIUM 50MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92212734","FAMOTIDINE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92213315","FLUVASTATIN NA 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92213458","FLUVASTATIN NA 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92213766","PRAMIPEXOLE DIHCL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92214180","FLUVASTATIN NA 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92216632","PRAVASTATIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92216634","PRAVASTATIN NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92216922","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92218171","TOLAZAMIDE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.00","92218482","EYE WASH 99.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.05","92213152","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.05","92218602","MELOXICAM 7.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.10","92211929","NITROFURANTOIN MCR 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.10","92216306","VALSARTAN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.10","92216657","OXYBUTYNIN CL 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.15","92219628","CLOBAZAM 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.20","92211856","NITROFURANTOIN MCR 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.20","92215068","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.20","92216550","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.25","92216559","MELOXICAM 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.30","92211577","DEXTROAMPHETAMINE SUL 10MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.30","92211826","OXAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.30","92214444","METOLAZONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.30","92216388","BELLADONNA ALK ANALGESICS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.30","92218287","BETHANECHOL CHLOR 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.35","92213060","FENOFIBRATE 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.35","92215048","LIOTHYRONINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.35","92219322","METHYLPHENIDATE HCL 2.5 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.35","92220243","PETROLATUM 100% OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.40","92210084","KETOCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.40","92212449","KETOCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.40","92217880","HYDROCODONE APAP 5-325/10ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.40","92219696","OXYBUTYNIN CHLORIDE 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92210889","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92211356","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92212768","DILTIAZEM HCL 60MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92213063","MORPHINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92215461","URSODIOL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.45","92219877","PANTOPRAZOLE DR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.47","34010275","ELECTROMAGNETIC TX ULCERS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.50","92213654","GALANTAMINE HBR 12MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.50","92216983","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.50","92217320","GALANTAMINE HBR 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.50","92218827","VANCOMYCIN HCL 50 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.50","92219040","CARBI/LEVDOPA23.75MG/95MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.52","38202480","UREA NITROGEN (URINE) ","84540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.55","38202217","RETIC COUNT AUTO W DIR MEAS ","85046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.55","92214069","PROGESTERONE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.55","92215410","NICARDIPINE HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.60","92216463","PRAMIPEXOLE DIHCL 0.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.60","92216726","PRAVASTATIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.60","92219411","CHLORHEXIDINE GLUC 0.12% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.60","92220067","CHLORHEXIDINE GLUC 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92210120","OXYMETAZOLINE HCL 0.05% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92210128","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92211250","OXCARBAZEPINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92212046","VALSARTAN 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92218663","NITROFURANTOIN 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.65","92218665","NITROFURANTOIN 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.70","92212307","PRAVASTATIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.70","92212657","VALSARTAN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.70","92213135","ZIND OXIDE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.70","92215524","VITAMIN A/D OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.70","92219353","VITAMIN A/VITAMIN D OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.80","92212463","CLOZAPINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.80","92216535","OXYMORPHONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.80","92219455","CHOLECALC/VIT D3 400 IU/ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.80","92219725","DOXYCYCLINE HYCLATE100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92212438","IRBESARTAN 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92213041","OXYBUTYNIN CL 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92213446","CARBAMAZEPINE 200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92214218","RIMANTADINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92214281","RIFAMPIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92214639","MIRTAZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.85","92217305","DIVALPROEX NA 500MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.90","92212969","LEUCOVORIN CALCIUM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.95","92212618","PERPHENAZINE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"17.95","92216537","PRAVASTATIN NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.00","33122465","ORTHO HAND FING EXT ADLT 8.25I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.00","92214045","AMINO ACIDS 4.25% D20W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.00","92217852","EPINEPHRINE HCL 0.3MG/0.3ML KI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.10","92217224","OLANZAPINE 15MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.10","92219743","OLANZAPINE ODT 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.10","92219819","OLANZAPINE15 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.15","92213820","ARIPIPRAZOLE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.50","92219950","CINACALCET 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.80","92212399","TRIAMCINOLONE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"170.80","92217068","DPT TOX-PED SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1700.20","92216919","BUDESONIDE FORMOTRL 160/4.5 AE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1703.60","92219658","APREPITANT CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.00","33103300","CARRIER SKIN GRAFT STERILE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.00","33107162","ORTHO WRIST/HND/FIN BLU ADLT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.00","33112711","KIT PLEUREX DRAINAGE 500ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.00","33194467","CANISTER W/GEL INFOVAC 500ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.20","92216898","MARAVIROC 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.25","92214751","PAMIDRONATE DISOD 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.27","38000750","FLOW CYTOMETRY-16> MRK-INTERP ","88189",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92211693","ROPIVACAINE HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92213022","INSULIN HUM ISOP 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92213110","INSULIN HUM REGULAR 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92217233","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92220016","ACITRETIN 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92220168","LIPIDS-FISH/PLANT BASE 20% EMU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.60","92220386","VANCOMYCIN HCL 1.75GM/350MLIVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.65","92204005","IV ADMIXTURE 06 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.75","92218019","SUMATRIPTAN SUCC 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"171.90","92218640","HALOPERIDOLDECANOATE50MG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1710.00","92217110","IRINOTECAN HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1710.70","77000200","CT THORACIC SPINE W/CONTRAST ","72129",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1716.46","77000090","CT LOWER EXT W/CONTRAST BIL ","7370150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1716.46","77010003","CT LOWER EXT W/CONTRAST RT ","73701RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1716.46","77010004","CT LOWER EXT W/CONTRAST LT ","73701LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.00","33110350","WEDGE FOAM CG 16X15X4.5IN XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.00","33154440","BOOT MULTIPURP 3IN1 SOFT ADULT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.00","92214519","METHYLPREDNISOLONE ACET 40MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.11","38201978","PREALBUMIN ","84134",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.11","38202350","THEOPHYLLINE ","80198",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.20","92219251","VANCOMYCIN HCL 125 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.27","38300380","CALCIUM (IONIZED) ","82330",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.29","38000715","STAIN GROUP-II ","88313",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.29","38303730","TRICHROME STAIN ","88313",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"172.70","92219544","METFORMIN ER 1000 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1720.97","77000377","CT INTRACRANIAL STRUC W CONT ","70481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1721.55","92216564","ADVAIR HFA 230-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1722.00","77000130","CT LUMBAR SPINE W/O CONTRAST ","72131",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1725.00","33153430","KIT CATH PERITONEAL PLEURX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33103692","POSITIONER FLUID COVER SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33103705","POSITIONER PATIENT w/COVER LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33109881","COLLAR CERVICAL MIAMI J STOUT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33111767","SYSTEM WOUND MGT FISTULA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33112267","ORTHOSIS WHFO REST HAND RT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33112275","ORTHOSIS WHFO REST HAND LFT LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33112714","ORTHOSIS WHFO REST HAND LT MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33112715","ORTHOSIS WHFO REST HAND RT MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.00","33113045","TUBE 20FR BLN REPL BLSTR STDPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.25","92215518","SIROLIMUS 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.25","92218261","CYCLOMYDRIL 0.2-1% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.30","92210267","TRIAMCINOLONE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.30","92211518","TRIAMCINOLONE 0.025% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.40","92214569","FENTANYL 50MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.50","38206806","CARNITINE ","82379",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.62","38300215","PROTEIN C ANTIGEN ","85302",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.80","92215501","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"173.92","38303315","OLIGOCLONAL BANDS ","83916",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1730.00","92217987","LAZANDA 100MCG SPRAY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1730.33","74000995","FLUORO GUIDE FOR PERCUT DRAIN ","75989",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1730.33","75075989","US GUIDE FOR PERCUT DRAINAGE ","75989",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1730.33","77000366","CT GUIDE FOR PERCUT DRAINAGE ","75989",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1737.00","33152645","TRAY INTRODUCER G2 PERC8 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1737.00","33168056","TRAY INTRODUCER X RX PERC 6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.00","33109767","BOOT ANKLE CONTRACTURE LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.00","36000530","PASSY MUIR VALVE ASSIST ","92507",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.00","92215876","CINACALCET HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.17","34000140","PHYSICAL THERAPY RE-EVALUATION","97164GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.30","92216277","CLOMIPRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"174.40","92213432","ARIPIPRAZOLE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1746.80","92220333","AMPICILLIN SODIUM 2 GM IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1747.20","92214237","TACROLIMUS 0.035% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1748.51","77000310","CT SOFT TISSUE NECK W/CONTRAST","70491",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.00","33110345","SHEET REPOSITION CG 42x78IN XL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.00","33152459","SET COPE GASTRO SUTURE ANCHOR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.00","92218447","PRECEDEX 4 MCG/ML-0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.25","92211269","AZITHROMYCIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.30","92217303","CEFEPIME HCL 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.75","92213698","CEFTRIAXONE NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.80","92210143","HYPROMELLOSE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.82","38301015","DHEA-S ","82627",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"175.92","38303779","HIV WESTERN BLOT ","86689",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1752.20","92219210","RISEDRONATE SODIUM 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1752.20","92219235","RISEDRONATE SODIUM 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1754.30","92214956","TROPICAMIDE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1754.60","92217388","FLUTICASONE PROP 250MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.00","33109127","TRAY INTRO SUPRAPUBIC FOLEY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.00","33111617","DRSG VAC GRANUFOAM SOLV SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.00","33170070","AIRVO AIRSPIRAL TUBE+CHAMBR KI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.00","33170071","AIRVO AIRSPIRAL TUBE+CHAMBR KI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.15","92216684","K CL/NABCRB/NACL/PEG 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.20","76020001","I-123 PER 100MCI DX USE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.36","38301990","PROLACTIN ","84146",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.40","92220021","ARIPIPRAZOLE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.40","92220135","ARIPIPRAZOLE 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.45","38301170","ESTRADIOL ","82670",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.67","38302185","CHALMYDOPHILIA PNEUMONIAE ","87486",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"176.95","92212321","DOBUTAMINE HCL 1GM/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1761.00","92212710","PODOFILOX 0.5% TOPICAL GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1763.80","92215456","EPOETIN ALFA 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1763.85","92214182","EPOETIN ALFA 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1764.90","92219577","BECLOMETHASONE INH 0.08 MG AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1766.25","92210754","DESONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1766.35","92218395","TARCEVA 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1766.70","92217602","ADVAIR HFA 230-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","33111860","KIT PLEURX DRAINAGE 1000ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","33112903","DRSG VAC GRANUFOAM BRIDGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","33117503","TRAY THORACENTESIS PLEURA-SEAL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","33117513","TRAY 20CM 3 LUM ARROWGARD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","33195251","AQUALINER GUIDEWIRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","92214650","OLANZAPINE 15MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.00","92215567","DPT TOX-PED SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.03","38000745","FLOW CYTOMETRY-9-15 MRK-INTERP","88188",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.39","38301470","HEPATITIS B SURFACE AG (HBSAG)","87340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.55","92214849","LIPIDS 20% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.80","92218051","FANAPT 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.85","92212758","PYSLLIUM 6GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.85","92215622","DTAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.90","92212034","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"177.90","92215825","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1772.00","33103663","KIT CATH PLEURX RX REQUIRED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1775.00","75000265","US TEE 2D W/O PROBE PLACEMENT ","93314",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1778.73","77000300","CT MAXILLOFACIAL W/ CONTRAST ","70487",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.00","33189002","TUBE TRACH JACKSON IMPV METL 6"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.00","92216613","FENTANYL CITRATE 800MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.15","38303656","T2SA STAPHLOCOCCUS AUREUS ","87640",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.40","92218649","MEPERIDINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.60","92217730","ENOXAPARIN NA 40MG/0.4ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.70","92214758","VANCOMYCIN 1G/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.73","38307007","CLOTTING FACTOR II ","85210",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.77","38201050","DILANTIN (PHENYTOIN-TOTAL) ","80185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.77","38202920","DISOPYRAMIDE ","80299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"178.85","92218615","CYTARABINE 20 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1781.40","92217221","INSULIN GLULISINE 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1782.00","92219229","LETERMOVIR 20 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1782.00","92219233","LETERMOVIR 20 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1784.41","39200258","ECHO 2-D&M-MODE W/O DOPPLER ","93307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1784.41","75000050","US ECHO TRANSTHORACIC 2D COMPL","93307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.00","33103847","GUIDE WIRE COONS INTRVNSTR15CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.00","33115290","TRAY CVC 7FR20CM TL INTRO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.00","33152435","SLING HOYER FULL BACK DISP LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.00","92211311","VITAMIN B COMPLEX 100 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.06","38393960","COLLAGEN CROSS LINKS ","82523",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.12","38300072","PORPHYRINS STOOL ","84126",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.21","38300770","IMMEDIATE SPIN CROSSMATCH ","86920",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.21","38399312","IMMUNOASSAY FOR TUMOR ANTIGEN ","86316",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.21","72000765","CROSSMATCH IMMEDIATE SPIN ","86920",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.28","72000140","FFP THAWING PREP ","86927",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.35","92219012","HYDROCORT NA SUCCINATE250MGSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.40","38301100","ALCOHOLS SCREENING ","80320",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.73","38399980","EVEROLIMUS LEVEL ","80169",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.78","38301385","GONORRHEA DNA PROBE ","87590",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.85","92220505","VITC/BROM/CRAN/INUL/MAN/PHOS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.95","92204026","IV ADMIXTURE 27 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.95","92220288","SEMAGLUTIDE 3 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"179.96","34000044","PT EVALUATION HIGH COMPLEXITY ","97163GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1792.80","92216307","NEPAFENAC 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1795.20","92219263","IVERMECTIN 0.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1795.80","92211358","OLOPATADINE HCL 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1798.53","76000790","NM GASTRIC EMPTYING STUDY ","78264",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","38200513","MICROALBUMIN 24 HOUR URINE ","82043",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","38202370","THROMBIN TIME ","85670",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92202009","TOPICALS 09 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92212174","ICHTHAMMOL 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92213577","AMOXICILLIN CLV K 400-57 CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214036","HCTZ VALSARTAN 25-160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214111","HCTZ IRBESARTAN 12.5-150MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214159","HYDROCORTISONE ACET 30MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214284","NAPROXEN NA 375MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214467","HCTZ LOSARTAN K 25-100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92214488","AMOXICILLIN CLV K 400-57 CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92215678","MENTHOL METHYL SALICYL 3-14% L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92215731","HCTZ LOSARTAN K 25-100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92215822","HCTZ VALSARTAN 25-160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216125","HYDROCODONE APAP 2.5-167/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216259","BETHANECHOL CL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216328","HCTZ LOSARTAN K 12.5-100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216329","HCTZ LOSARTAN K 12.5-100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216330","HCTZ LOSARTAN K 12.5-100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216479","DIGOXIN 50MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92216817","VARENICLIINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92217071","ATORVASTATIN CALCIUM 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92217072","ATORVASTATIN CALCIUM 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92217173","PAROXETINE HCL 12.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92217223","DAPSONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.00","92217574","NEOMYCIN SULF 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92210780","TOPIRAMATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92215089","METOLAZONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92215949","CIPROFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92216179","METOLAZONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92216945","BENZOCAINE GLYCERIN 5-33% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.05","92219943","CREAM MULTI INGREDIENT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.10","92213133","OXYBUTYNIN CL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.10","92216484","L-METHYLFOLATE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.10","92216660","OXYBUTYNIN CL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.10","92220216","OXYBUTYNIN 10MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.15","92213342","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.15","92216323","GLIMEPIRIDE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.20","92212570","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.20","92214951","TOLTERODINE TARTRATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.20","92215040","TOLTERODINE TARTRATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.20","92219342","CARISOPRODOL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.24","38206009","EOS SMEAR (NASAL) ","89190",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.25","92211507","ROPINIROLE HCL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.25","92216739","DILTIAZEM HCL 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.25","92218561","WATER IRRIGATION STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.30","92210590","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.30","92212506","CLOZAPINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.30","92212584","DOXEPIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.30","92215226","OXCARBAZEPINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.35","92211829","MIDODRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.35","92212889","ALENDRONATE NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.35","92213560","AMINOCAPROIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.35","92219333","PETROLATUM 33% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.40","92212664","TAMOXIFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.40","92213573","FAMOTIDINE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.40","92213588","FAMOTIDINE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.40","92218058","HYDROCOD/CHLORPHEN POLIST SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.45","92210238","THIOTHIXENE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.45","92211452","CHOLESTYRAMINE LIGHT 4/5.7GM P"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.45","92212934","OXYBUTYNIN CL 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.45","92218826","OXYBUTYNIN CHLORIDE ER 5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.50","92220008","PROPYLTHIOURACIL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.55","92210565","CHOLESTYRAMINE 4GM/9GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.55","92212177","DISOPYRAMIDE PHOS 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.55","92213349","BISOPROLOL/HCTZ 10/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.55","92218929","MORPHINE SULFATE 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.60","92214026","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.60","92214324","CLINDAMYCIN HCL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.60","92215707","MORPHINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.60","92217098","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.65","92210497","NADOLOL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.65","92216521","VARENICLINE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.70","92210356","HYDROCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.70","92210763","MINOCYCLINE HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.70","92210895","ACYCLOVIR 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.70","92211224","DOXEPIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.70","92218550","EYE WAS 99.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.75","92211443","BELLADONNA OPIUM 16.2-30MG SUP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.75","92211766","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.75","92212117","PRAVASTATIN NA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.75","92219766","PANTOPRAZOLE 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.75","92219876","PANTOPRAZOLE DR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.80","92213812","SOTALOL HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.80","92214685","EYE WASH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.80","92217101","NEBIVOLOL HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.80","92217105","NEBIVOLOL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.80","92217106","NEBIVOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.85","92210052","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.85","92212363","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.85","92218068","TOLTERODINE TART 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.85","92219528","LEVALBUTEROL 0.63 MG/3 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.90","92214131","CLOZAPINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.90","92214146","SOTALOL HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.90","92215997","CLOTRIMAZOLE 10MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.90","92219103","DORZOLAMDE HCL/TIMOLOL2-0.5%OP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18.95","92219907","NITROFURANTOIN MAC 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33117130",""POSIT HEEL MRG GEO-MATTLYR 29""""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33131205","MULTIBOOD STD MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33152960","TRACH 6.5MM SHILEY FLEX CFLS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33152962","TRACH 7.5MM SHILEY FLEX CFLS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33152963","TRACH 8.5MM SHILEY FLEX CFLS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","33152967","TRACH 8.0MM SHILEY FLEX CFLS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","92211813","AZITHROMYCIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.00","92217888","ALBUMIN HUMAN 25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.38","38000065","CHROM ANAL ADD KARYOTYPE EA ","88280",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.65","92217137","ZILEUTON 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.65","92218062","ZYFLO 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"180.67","72000540","ANTIGEN SCREENING (REAGENT) ","86902",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1800.00","38200170","BIOFIRE GI PATHOGEN STOOL PCR ","0097U ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1800.00","61010031","CHEST TUBE INSERTION ","32551",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1807.30","92217713","FLUTICASONE PROP 110MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1808.00","33168398","TRAY TRCH MULTI BRHN G2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.00","33178199","SPLINT HAND OPPOSIT RT ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.00","33178200","SPLINT HAND OPPOSIT LT ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.35","92218487","LARYNG-O-JET 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.40","92212420","CA CL/KCL/NA CL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.55","92213747","MILRINONE D5W 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.57","38300212","PROTEIN C ACTIVITY ","85303",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.69","38301722","PROGRAF LEVEL (TACROLIMUS) ","80197",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.80","38243613","PROINSULIN ","84206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.95","92213119","ZINC SULF 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"181.98","38303741","METHYLMALONIC ACID ","83921",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18115.80","92220165","ARIPIPR LAUR 882MG/3.2ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1813.00","92215132","INSULIN LISPRO RCMB 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1813.00","92219399","INSUL LISPRO REC100UNITS/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1819.35","92219275","FILGRSTM-SNDZ 300 MCG/0.5 MLSO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.00","33112297","ORTHOSIS HAND/WRIST GRAD LEFT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.00","33117520","TRAY CVC 20CM MAX BARR PRSARGD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.00","33178209","BOOT SOFPRO AMB AFO FLC XLG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.00","33194422","BOOT SOFPRO AMB AFO FLC LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.10","38200830","CULTURE-FUNGUS-OTHER SOURCE ","87102",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.11","38343615","DHEA (DEHYDROEPIANDROSTERONE) ","82626",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.14","38300035","ANTIDIURETIC HORMONE ","84588",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.15","92219300","CLONIDINE TRANSDRML 0.1MG/24HR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.16","38000710","SPECIAL STAIN GROUP-1 ","88312",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.17","38305568","UNFRACTIONATED HEPARIN ","85520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.17","38393939","HEPARIN LEVEL ","85520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.85","92216145","MOXIFLOXACIN HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"182.90","92220180","RIZATRIPTAN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1822.55","92213544","NAFTINE HCL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1823.29","77000050","CT THORAX W/CONTRAST ","71260",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.00","33113053",""SPLINT LG13X3.5-3.75""HND LT ""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.00","33113054","SPLINT MED 11.5X3-3.5IN HND LT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.00","33113055","SUPPORT LG 13IN KYDX HNDTHB RT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.00","33113056",""SUPPORT MD11.5"" KYDX HNDTHB RT""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.00","33115296","TRAY CVC WFR20CM TL WINTROD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.17","38301570","IMMUNOELEC SERUM ","86334",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.17","38303160","IMMUNOFIXATION ELECTROPHORESIS","86334",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.17","38303870","IMMUNOFIX ELECTROPHOR-SERUM ","86334",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.25","92219253","MODAFINIL 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.55","92211302","DIAZEPAM 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"183.60","92219071","EVEROLIMUS 0.75 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.00","33109757","TRAY THORACENT TURKEL SAFE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.00","33111751","DRSG ATS TRAC 10X7.5 LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.00","33114977","DRSG AQUACEL AG SURGICAL COVER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.00","92219394","BELLADONNA/OPIUM 16.2-60MGSUPP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.32","38201240","FOLIC ACID ","82746",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.32","38203295","MYOGLOBIN ","83874",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.50","92217685","LEVOFLOXACIN 750MG/150ML D5W I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.69","38303326","OPIATES 1 OR MORE ","80361",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.69","38307039","HEROIN METABOLITE CONFIRM ","80356",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.80","92217806","COLISTIMETHATE NA 150MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.80","92217928","COLISTIMETHATE NA 150MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.80","92219629","VANCOMYCIN 2GM/400ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.80","92219908","CEFTRIAXONE 10 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.86","38386433","CLOTTING FACTOR VII ","85230",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.87","34250129","OT EVALUATION HIGH COMPLEXITY ","97167GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.92","34010295","BIOFEEDBACK TRAINING ","90901GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"184.92","34250085","BIOFEEDBACK TRAINING ","90901GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1840.35","92214998","CHLOROTHIAZIDE 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1844.90","92216803","RISPERIDONE 12.5MG GER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1845.70","74000580","MYLEOGRAM LUMBAR ","72265",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1846.70","92219258","GLUCAGON HYDROCHLORIDE 1MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33112084","SLEEVE SCD BARI CALF TO 28 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33113067","DRSG VAC GRANUFOAM w/SILVER LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33115284","RESUSCITATOR AUTO GO2VENT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33122467","BOOT SOFPRO AMB AFO FLC SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33122468","BOOT SOFPRO AMB AFO FLC MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33161355","PLUG DCAN WHT 4 FULL TRCH TUBE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33161356","PLUG DCAN WHT 6 FULL CLSR TRCH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","33194423","BOOT SOFPRO GAIT TR AFO FLC LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","92211628","TRETINOIN 0.025% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.00","92214248","CHLORAMPHEN NA SUCC 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.35","92214636","HALOPERIDOL DEC 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.35","92218639","HALOPERIDOLDECANOATE50MG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.40","92219350","CASTOR/BALSAM 87-788MG/GM OINT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.40","92219975","BALSAM PERU/CASTOR OIL OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.43","38200691","TISSUE TRANSGLUTAMINASE AB ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.43","38200840","CULTURE-ROUTINE ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.43","38201200","FERRITIN ","82728",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.64","38300436","CATECHOLAMINES BLOOD FRACT ","82384",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.75","38303410","RAJI CELL ","86332",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.75","92211848","FLUOCINOLONE ACET 0.025% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.75","92211984","FLUOCINOLONE ACET 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"185.95","92218859","ACYCLOVIR SOD 1000MG/20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1850.79","76000059","NM HEPATOBILIARY ","78226",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1855.03","77000170","CT PELVIS W/CONTRAST ","72193",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1855.43","77000369","CT CERVICAL SPINE W/CONTRAST ","72126",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"186.00","33113031","AMNIOBAND MTRX TISS 14MM PLCNT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"186.22","38307023","CULTURE TYPE NUCLEIC ACID ","87149",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"186.54","38206710","ASPERGILLUS ANTIBODY ","86606",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"186.85","92213259","GENTAMICIN SULF 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1860.00","33117522","SET CATH HEMO ANTRGRADE15FRX23"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1860.00","92217910","HYLAN PLOYMERS A B 8MG/1ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1868.15","92211557","AMPHOTERICIN B LIPOSOME 50MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1868.80","92215695","KETOROLAC 0.4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.00","33112216","KIT DRAINAGE PLEURX 500CC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.00","33113075","KIT DRN VAC BTL PLEURX 500ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.00","33153616","KIT PLEURX DRAINAGE 1000ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.00","92219442","NORFLURANE/PENTAFLUOROPR SPY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.14","38300435","CATECHOLAMINES PLASMA ","82383",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"187.15","92215202","FLUCONAZOLE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1871.10","92217334","DAPSONE 5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1873.10","92220282","IMIPEN/CILAS/RELEBAC 1.25GMPDS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1879.00","92212946","INSULIN LISPRO RCMB 75/25U INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1879.00","92216653","INSULIN LISO/LISO PROT 50/50 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"18795.80","92211086","LEUPROLIDE ACET 30MG KIT PI4 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33114987","ORTHOSIS HAND COMFYREST ADL RT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33114988","ORTHOSIS HAND COMFYREST ADL LT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33116112","ORTHOSIS RESTING HAND SM LEFT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33116113","ORTHOSIS RESTING HAND ADULT LT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33116114","ORTHOSIS RESTING HAND SM RIGHT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33116115","ORTHOSIS RESTING HAND ADULT RT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33152632","SPLINT FOOT CUB NIGHT LEFT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","33152638","SPLINT NIGHT CUB LEFT MEDIUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","36000180","CHEST WALL MANIPULATION SUBSEQ","94668",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","36200171","CHEST WALL MANIP-SUBSEQ ","94668",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","76020015","XENON XE-133 GAS PER 10 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.00","92215339","BEXAROTENE 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.14","34600427","TYMPANOMETRY & REFLEX THRESH ","92550GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.50","92218864","ESTRADIOL 0.025 MG/24 HR PATCH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.60","92213540","ERYTHROMYCIN ES 400MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.65","92212115","FLUTICASONE PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.72","38300899","CULTURE MYCOBACT EA ISOL ","87118",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"188.85","92213808","COLISTIMETHATE NA 150MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1880.33","77000110","CT BRAIN/HEAD W/WO CONTRAST ","70470",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33112639","ORTHOSIS HAND LEFT SML SPU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189010","SPLINT HAND REST 11IN LT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189011","SPLINT HAND REST 13IN LG LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189013","SPLINT HAD REST 13IN RT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189014","SPLINT HAND REST 11.75IN RT MD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189016","SPLINT HAND REST 11IN RT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.00","33189018","SPLINT HAND REST 11.75IN LT MD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.10","92218205","FLUOROURACIL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"189.75","92214112","PAMIDRONATE DISOD 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1893.00","33113058","TRAY TRCH 8FR SHLYCGLBRHN PERC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1894.85","92218837","INSULIN HUMAN REG 500U/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1895.38","38300242","INFECT AGENT PHENOTYPE HIV1 ","87903",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","38202745","CALCIUM URINE ","82340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92210471","THEOPHYLLINE 100MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92210909","TOLNAFTATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92212093","OMEPRAZOLE 10MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92212345","DESIPRAMINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92213511","METHYLPREDNISOLONE 16MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92213826","HCTZ IRBESARTAN 12.5-300MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92213968","MERCAPTOPURINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92214250","LOVASTATIN NIACIN20-500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92215081","DICLOFENAC NA MISOPRO 50-0.2 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92215383","EZETIMIBE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92215805","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92216086","METHYLPHENIDATE HCL 10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92216384","ISOFLURANE 99.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92216905","VERAPAMIL HCL 300MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.00","92219962","NITROFURAN MACCRYS 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.05","92210293","OXYMETAZOLINE HCL 0.05% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.05","92215057","OXYCODONE HCL 20MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.05","92219348","SOTALOL HYDROCHLORIDE 120MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.05","92220211","SEVELAMER 800MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.10","92213307","MIRTAZAPINE 15MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.10","92214720","MAGNESIUM HYDROXIDE 1200MG SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.10","92215599","HYDROCORTISONE ACET 30MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.10","92218598","LEVETIRACETAM 100 MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92210195","NITROFURANTOIN MCR 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92210946","PHENAZOPYRIDINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92217045","NEBIVOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92217828","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92219717","AMANTADINE HCL 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92220154","OXYBUTYNIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.15","92220513","HYDROCORTISONE W/ALOE 1% EA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.20","92212779","QUETIAPINE FUMARATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.20","92214105","CITALOPRAM HBR 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.20","92218749","LEVOCARNITINE 1GM/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.20","92219849","SODIUM CHLORIDE 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92210169","MEXILETINE HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92215714","CYCLOSPORINE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92216620","SIMETHICONE 40MG/0.6ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92216771","MIRTAZAPINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92217631","ZIND OXIDE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92218220","VASCULERA 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.25","92218730","DIOSMIN COMPLEX 630 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.30","92212502","ERGOCALCIFEROL 8000U/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.35","92217318","GALANTAMINE HBR 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.35","92217348","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.35","92217349","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.40","92214193","NITROFURANTOIN MCR 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.40","92215746","LOSARTAN POTASSIUM 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.40","92218664","NITROFURANTOIN MACROC100MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.45","92220224","OXYCOD/ACETAMIN 10MG/325MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.50","92211809","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.50","92215555","ALPRAZOLAM 2MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.50","92215591","CELLULOSE TALC 71GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.50","92216686","PHENYLEPHRINE HCL 0.25%-3% CRE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92212443","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92212883","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92213668","GALANTAMINE HBR 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92213982","CITRIC ACID K CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92215413","OXYCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92215439","OXYCODONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92216511","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92218182","AMOXICILLIN 125MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92220240","MOUTHWASH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.60","92220277","BENZOCAINE 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.70","92214263","FLECAINIDE ACETATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.70","92215808","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.70","92218562","FLECAINIDE ACETATE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.70","92218971","FLECAINIDE ACETATE100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.70","92220217","SODIUM CHLORIDE 0.9% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92212989","OXYCODONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92213687","PAREGORIC 2MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92214869","MINOCYCLINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92214914","DICLOFENAC NA MISOPRO 75-0.2 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92218546","BUPROPION SR 200 MG TAB SR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.75","92218556","PEPTO BISMOL 262 MG/15 ML SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92211306","CEFADROXIL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92211823","ESTRIFIED ESTROGENS METHY TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92213538","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92214701","NATEGLINIDE 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92217509","DIVALPROEX NA 500MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92217705","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92219192","PANCREAZE 10 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92219565","ESTROG-METHYLTEST1.25MG-2.5MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.80","92219992","LANOLIN 50% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.85","92213461","CHOLESTYRAMINE 4GM/5.5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.85","92213897","TRANYLCYPROMINE SULF 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.90","92214975","FELBAMATE 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.90","92219568","MIGLITOL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92211013","THIOTHIXENE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92211830","DILTIAZEM HCL 90MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92213586","DANAZOL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92216720","CARBAMAZEPINE 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92218228","VANCOMYCIN HCI 50MG/ML ORAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19.95","92219727","FLUOXETINE HCL40 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.00","33111570","ORTHOSIS COMFYHANDTHUMB ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.00","33122463","ORTHOSIS HAND GRIP RT SM 7IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.00","92218016","MAXALT 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.00","92218898","LIPIDS 20% EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.00","92220169","LIPIDS-PLANT BASED 20% EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.15","92219812","POLYVINYL OH/POVIDN 2.7%-2%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.40","92217190","CABERGOLINE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.50","92219773","METHYLPREDNISOLONE 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.65","92213385","CHLORPROMAZINE HCL 25MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.70","92210315","ATROPINE SULF 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"190.98","38200750","CREATININE CLEARANCE ","82575",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1906.75","92220532","FLUTIC/UMEC/VIL200/62.5/25 MCG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1909.63","76000880","NM KIDNEY W/FLOW&FUNC W/O PH ","78707",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1909.75","92214301","INSULIN ASPART RECMB 100U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1909.75","92220321","INSULIN ASPART RECOMB 100U/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.00","33110331","TRAY KNEE ARTHROSCOPY 4576 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.00","33115281","SET TUBE DUO V.A.C. VERATRAC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.00","33131045","ORTH HAND SPT CMFY DORS RT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.00","33131315","ORTHOSIS HND DORSL COMFY AD LT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.00","92212738","HYDROCORTISONE VAL 0.2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.15","92215381","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.15","92217911","MORPHINE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.35","92213634","TENOFOVIR DISOPRXL FU 300MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.55","92216217","VANCOMYCIN HCL 125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34210365","EVAL OF SWALLOWING BLUE DYE ","92610GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600419","CLINICAL/BEDSIDE EVALUATION ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600420","EVAL SWALLOW/ORAL FUNCTION ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600421","EVAL OF SWALLOWING BLUE DYE ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600431","EVAL SWALLOW/ORAL FUNC 30 MIN ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600432","EVAL SWALLOW/ORAL FUNC 45 MIN ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.64","34600433","EVAL SWALLOW/ORAL FUNC 60 MIN ","92610GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.65","92219714","EPHEDRINE SULFATE 50 MG/MLINJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.69","38399318","T CELL TOTAL COUNT ","86359",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.85","92214692","PRAMOXINE HCL HC 1%-1% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"191.85","92219461","AZITHROMYCIN 100 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1910.00","74001042","FLUORESCENT VASC ANGIO NONOPTH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1914.11","77000384","CT LUMBAR SPINE W/CONTRAST ","72132",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.00","33102167","SPLINT HAND WRIST FNG ADLTNAVY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.00","33117506","SET WIRE SIMPLICITY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.00","33163760","ORTHOSIS H/W/F BRDCLTH AD SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.00","92211351","SUMATRIPTAN SUCC 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.09","38202303","T3 TOTAL ","84480",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.57","38307016","PROTEIN S FUNCTIONAL ","85306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.57","38307017","PROTEIN S FREE ","85306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.65","92219237","DROXIDOPA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.77","34010255","STRAPPING ANKLE AND/OR FOOT ","29540GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.90","92219837","CEFOXITIN/DEX 2 GM/50 ML IVPB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.95","38300693","HISTAMINE URINE 24HR ","83088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"192.95","92219630","SIROLIMUS 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1920.47","77000010","CT ABDOMEN W/CONTRAST ","74160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1922.00","36000132","BIPAP DAILY ","94660",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1924.40","92217188","THROMBIN 20000U PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","33110590",""CUSHION GELFOAM DELUX 18X18X3""""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","33114985","BOOT WALKER LOW FIXED ANK MEDM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","33167520","TUBE MIC FDG JEJUN LO V 12FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","33189572","WALKER AIR STABIL HIGH PROF XL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","92213481","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","92216546","SIROLIMUS 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.00","92217335","LIDOCAINE HCL 3.5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.10","72000120","CROSSMATCH ANTIGLOBIN ","86922",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.15","92217940","LEVETIRACETAM 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.21","38202304","REVERSE T3 ","84482",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.60","92213453","NALBUPHINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.80","92211659","CEFOTETAN DISODIUM 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.80","92217803","NULECIT 62.5MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"193.90","92215175","FIBER PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1933.42","76000010","NM BONE/JOINT WHOLE BODY ","78306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1934.64","73500330","NRV COND STUDIES 11-12 STUDIES","95912",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1936.15","92211687","BECLOMETHASONE DIPRO 42MCG SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33109278","KIT FDGTUBE MIC PULL PEG20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33110342","KIT FDTUBE MICPULLMETH PEG24FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33112713","ORTHOSIS HAND LEFT MED 9IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33112914","ORTHOSIS HANDGRIP RT MED 6.25-"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33129582","KIT PEG MIC PUSH 20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33131055","ORTHOSIS HAND GRIP RT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","33131056","ORTHOSIS HAND GRIP LT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","38300750","CREATININE CLEARANCE ","82575",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.00","92215207","METHYLDOPATE HCL 250MG/5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.30","92216118","ARIPIPRAZOLE 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.32","38200150","ANA TITER ","86039",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.50","92218203","CALCIDOL 480000IU/60ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.70","92212116","HYDROCORTISONE 2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"194.70","92217995","TEMAZEPAM 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19404.05","92218081","INVEGA SUSTENNA 234MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33103808","KIT DRAINAGE ASEPT SGLBTL600mL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33111206","SHOE PRESSURE RELIEF MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33114275","SUPP WHFO ANTIMIC HANZ RT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33114277","SUPPP WHFO ANTIMIC HANZ RT XS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33115291","TRAY CVC 7FR20CM TL INTERLINK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","33174245","COLLAR SET ASPEN W/PAD AD REG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","38301724","LIPOPROTEIN ELECTROPHORESIS ","83700",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.00","92214673","ALCLOMETASONE DIPRO 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.25","92212986","CARBIDOPA 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.35","92220279","INSULIN GLARGINE 100 U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.46","38380053","COMPREHEN METABOLIC PANEL ","80053",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.65","92213357","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.70","92212977","TACROLIMUS 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.70","92214735","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38300154","VZV QN PCR ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38300159","JC VIRUS DNA PCR (WHOLE BLOOD)","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38302208","RSV PCR QUALITATIVE ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38302209","PARVOVIRUS B19 ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38303286","C DIFFICILE PCR ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38303653","T2EF ENTEROCOCCUS FAECIUM ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38303654","T2KP KLEBSIELLA PNEUMONIAE ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38303655","T2PA PSEUDOMONAS AERUGINOSA ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38303657","T2EC ESCHERICHIA COLI ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.84","38399326","AMPLIFIED PROBE TECH EA ORG ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"195.90","92214985","FLUCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1950.00","33119988","KIT POEUREX PLEURAL CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1951.76","76000045","NM CARDIAC MUGA ","78472",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1952.00","33105678","BRACE VISTA TLSO 464 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.00","33191083","PROTECTOR HEELMEDIX XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.05","92218072","MODAFINIL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.10","92212553","HYDROCORTISONE ACET 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.20","92215620","ARIPIPRAZOLE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.20","92215624","ARIPIPRAZOLE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.20","92215631","ARIPIPRAZOLE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.25","92220536","SEMAGLUTIDE 14 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.30","92204048","IV ADMIXTURE 48 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.35","92213810","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.50","92218834","LEVET/NACL0.9% 1000MG/100MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.54","38200024","LIPID PANEL ","80061",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.54","38280069","RENAL FUNCTION PANEL ","80069",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.70","92211972","PROMETHAZINE HCL 50MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.75","92219795","ENOXAPARIN 150 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"196.75","92220377","ENOXAPARIN 150 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1960.20","92213108","CISATRACURUIM BESYL 10MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1960.85","92219388","NETARSUDIL 0.002% 0.002% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1963.98","72060013","PLATELETS PHER LR IRRAD-PROC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1963.98","72060023","PLATELETS PHER PATHOGN REDUCED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.00","33100903","COLLAR CERVICAL TOT ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.00","33105620","BOOT WALKER ANK LO P FIX LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.00","33112317","TRAY PARACENT NDL 15GX3.25IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.00","33112531","BOOT WLK LOW FIX ANKLE SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.00","33112758","TRAY PARACENT RX 18GX3.25IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.43","38000501","SURGICAL PATH LEVEL II ","88302",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.43","38301590","ASPERGILLUS ","87305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.43","38301591","GALACTOMANNAN ANTIGEN ","87305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.45","92215995","FLUCONAZOLE 10MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.75","92210429","CLINDAMYCIN PHOS 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.75","92215233","SIROLIMUS 1MG/ML ORAL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"197.95","92220399","MIDAZOLAM 100 MG/100 ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1974.20","92219842","ESTRADIOL 0.01% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33100765","BOOT 3D ROM SH WALKER MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33111922","CATH NIAGARA SLIMDL 12FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33111923","CATH NIAGARA SLIMDL 12FRX24CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33114271","SUPP WHFO ANTIMIC HANZ LT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33114272","SUPP WHFO ANTIMIC HANZ LT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33114273","SUPP WHFO ANTIMIC HANZ LT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33114274","SUPP WHFO ANTMIC HANZ RT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33114276","SUPP WHFO ANTIMIC HANZ RT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","33116145","CROWN WOUND FISTULA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","92204039","IV ADMIXTURE 39 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","92215532","LACTIC ACID 10% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.00","92217131","CIPROFLOXACIN 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.35","92213413","CLOTRIMAZOLE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.45","92215819","LEVOFLOXACIN 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.76","38202540","VITAMIN B-12 ","82607",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"198.95","92211786","AMOXICILLIN CLV K 200-28.5/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1980.75","92215484","INSULIN AS/AS PROT 70-30U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1983.20","92215773","CALCITONIN 200U SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1983.37","77000145","CT LOWER EXT W/WO CONTRAST BIL","7370250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1983.37","77010007","CT LOWER EXT W/WO CONTRAST RT ","73702RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1983.37","77010008","CT LOWER EXT W/WO CONTRAST LT ","73702LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1985.15","92215838","DAPTOMYCIN 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1985.50","92210813","EPOETIN ALFA 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.00","33103249","ZIPWIRE STRT .035X150X3CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.00","33114320","BOOT TCC-EZ REG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.00","33194448","ORTH WHF NAVY ADLT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.00","92211165","HYDROCORTISONE VAL 0.2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.09","72000085","COMPONENT POOLING ","86965",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.10","92215192","FLUCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.55","92212775","ATOVAQUONE 750MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.70","92218125","LMX 5% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"199.90","34250130","OCCUPAT THERAPY RE-EVAL ","97168GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1990.40","92218533","CALCIPOTRIENE 0.005% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1992.01","76078833","NM KIDNEY W/FLOW & FUNC W/PH ","78708",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1995.34","38299326","AMPLIFIED PROBE TECH EA ORG ","87798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"19959.35","92219335","TREPROSTINIL 2.5 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1997.80","92216792","TEMOZOLOMIDE 140MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"1998.78","77000311","CT SOFT TISSUE NECK W/WO CONT ","70492",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","38206600","THROMBOPLASTIN SUBSTITUTION ","85732",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92211816","SOTALOL HCL 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92214114","BUSPIRONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92214652","HYDROCODONE APAP 7.5-500MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92214721","ISONIZAID RIFAMPIN 150-300MG C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92215610","HCTZ OLMESARTAN MED 12.5-40 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92216035","BUSPIRONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92216513","HCTZ VALSARTAN 12.5-320MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92218173","FENOFIBRIC ACID 45MG DR CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92218912","BUSPIRONE HCL 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.00","92220417","BISACODYL 10 MG/1.25 OZ SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.05","92211126","GLYBURIDE MICRO 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.05","92214363","MESALAMINE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.10","92215096","CANDESARTAN CILEXETIL 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.10","92218907","OMEGA3ACID ETHYL ESTR 1GM CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.10","92220192","SODIUM CHLORIDE 0.9% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.15","92211300","TRIAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.15","92214621","REPAGLINIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.15","92219111","NADOLOL 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.20","92212111","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.20","92214336","VERAPAMIL HCL 300MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.20","92219056","TRIAZOLAM 0.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.20","92219694","NIFEDIPINE 20 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.20","92220484","ZIPRASIDONE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.25","92212072","AMOXICILLIN CLV K 500-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.25","92212879","FLECAINIDE ACETATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.30","92213327","ZALEPLON 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.30","92220212","FERROUS SULFATE 400MG/5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.35","92215147","ZONISAMIDE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.35","92217718","OPIUM 10MG/ML TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.40","92214578","LEVETIRACETAM 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.45","92212027","CEFADROXIL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.45","92213582","FLUOXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.45","92213623","CLINDAMYCIN HCL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.45","92220530","CARBAMAZEPINE ER 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.50","92210251","CHLORHEXIDINE GLUC 4% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.55","92213665","DILTIAZEM HCL 420MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.55","92216157","METOLAZONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.55","92218032","THEOPHYLLINE 80MG/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92210488","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92217945","CLOBAZAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92217960","ACYCLOVIR 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92218433","LANTISEPTIC SKIN PROTECT TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92218785","HYDROCOD/HOMOTROP 5MG-1.5MGSYR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.60","92219615","NIFEDIPINE ER 90 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.65","92212539","FLECAINIDE ACETATE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.65","92218593","HYDCOD BIT-HMTRP 1.5MG-5MG/5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.67","74200031","CONTRAST GADOLINIUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.67","74200035","GADOLINIUM PER ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.67","76020023","MAGNEVIST PER ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.70","92219098","BNZCN/BNZALK/ZNC20-0.02-0.1TOP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.75","92211489","HYDROCORTISONE 0.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.75","92215480","TAMOXIFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.80","92214723","METOLAZONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.80","92215880","MAG-AL PLUS XS SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.80","92216168","AMOXICILLIN CLV K 500-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.80","92218295","QUETIAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.85","92213716","ALUMINA MAGNESIA SIM LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.85","92215477","TAMOXIFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.85","92218523","ZALEPLON 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.88","38200099","CLOTEST ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.90","92215748","LEVETIRACETAM 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.90","92215852","DIPHENHYDRAMINE HCL Z ACE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.90","92219485","PHENYLEPHRINE HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.90","92219700","PANTOPRAZOLE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.90","92219874","PANTOPRAZOLE DR 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.95","92210189","TOLNAFTATE 1% POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20.95","92213286","AMITRIPTYLINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33106928","BRACE-HINGED KNEE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33110366","TUBE TRACHEAL JACKSON #6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33115289","TRAY CVC 7FR20CM 3LUMEN CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33152417","TUBE TRACH CUFFTPRGRD SHLY7.5 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33152961","TRACH 6.5MM SHILEY FLEX CUFFED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33152964","TRACH 8.5MM SHILEY FLEX CUFFED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","33152966","TRACH 7.0MM SHILEY FLEX CUFFED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","38300156","LEGIONELLA PNEUMOPHILIA ","87541",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","92211662","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.00","92214225","FLUOCINONIDE 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.30","92210654","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.30","92211952","SCOPOLAMINE HBR 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.40","38301460","HEPATITIS B SURFACE AB ","86706",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.40","38301476","HEP B SURF ANTIBODY QUALITATIV","86706",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.40","92216957","RALTEGRAVIR K 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.44","38300085","NK (NATL KILLR) CELLS TOTAL ","86357",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.90","92219922","DOLUTEGRAVIR 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.95","92217894","MOXIFLOXACIN HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"200.98","38202420","TSH ","84443",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2000.00","79600015","HYPERBARIC OXYGEN PER 30 MIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2000.26","77000378","CT INTRACRANIAL STRUC W/WO CON","70482",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2004.25","92215581","IMATINIB MESYLATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2008.00","92217998","FLUTICASONE 0.05% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2008.40","92217851","EPINEPHRINE HCL 1MG/ML KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2008.45","92219572","EPINEPHRINE PED 0.15MG(0.15ML)"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.15","38303888","MASS SPECT NOS QUANT EA ","83789",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.20","92210658","EPINEPHRINE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.37","38386601","ANTI 1-A2 (ISLET CELL AB) ","86341",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.41","92212888","NEOMYIN SULF/POLYMYX B SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.59","38000560","MOLECULAR CYTOGENETICS ","88271",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.60","92210741","CABERGOLINE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.75","92218452","CELLCEPT 200 MG/ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"201.79","34050180","STRAPPING HAND OR FINGER ","29280GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2016.00","92215306","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.00","33112444","KIT PEG PONSKY 20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.00","33195278","KIT PONSKY PEG 24FR RETEN DOME"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.00","92216046","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.09","38200073","ACID FAST BACILLI SMEAR ","87206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.09","38207024","DRUG TEST PRSMV CHEM ANLYZR ","80307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.10","38380047","METABOLIC PANEL IONIZED CA ","80047",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.24","38302188","MYCOPLASMA PNEUMONIAE ","87581",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.24","38302890","CYSTINE/HOMO ","83090",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.80","92217783","LURASIDONE HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"202.90","92214017","LEFLUNOMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2023.46","77000181","CT PELVIS W/WO CONTRAST ","72194",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.00","33112067","DILATOR ESOPH BALLOON 15MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.00","33118621","DILATOR ESOPH BALLOON 12MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.00","33118623","DILATOR ESOPH BALLOON 20MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.00","92213927","ALCLOMETASONE DIPRO 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.75","92211037","FLUPHENAZINE DEC 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.90","92212516","CARTEOLOL HCL 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"203.98","38300982","ANTI-PLATELET ANTIBODY-DIRECT ","86023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2033.75","92216386","INSULIN DETEMIR 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2035.57","74000582","MYELOGRAM CERVICAL ","72240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.00","33103593","SPLINT REST FUNCT RT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.00","33112445","KIT CHEST TB INSERT PLEURGUIDE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.05","92204035","IV ADMIXTURE 36 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.20","92216339","ONDANSETRON 8MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.27","34600031","EVAL SPEECH SOUND PRODUCTION ","92522GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.27","34600145","SPEECH/HEARING EVAL 15 MIN ","92522GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.27","34600146","SPEECH/HEARING EVAL 30 MIN ","92522GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.27","34600147","SPEECH/HEARING EVAL 45 MIN ","92522GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.27","34600148","SPEECH/HEARING EVAL 60 MIN ","92522GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.31","38200700","C-PEPTIDE ","84681",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.31","38202500","VALPROIC ACID ","80164",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.60","92211958","CROMOLYN NA 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"204.60","92214246","PAMIDRONATE DISOD 6MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2043.35","92214373","DARBEPOETIN A 40MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2043.35","92215811","DARBEPOETIN A 40MCG/0.4ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2043.49","76000240","NM BONE IMAGING 3 PHASE ","78315",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2045.60","92213329","DIAZOXIDE 50MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2049.50","92211238","BETAXOLOL HCL 0.25% EYE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2049.65","92216167","AZELAIC ACID 15% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"20491.70","92217838","IMMUNE GLOBULIN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.00","33111515","DRSG TAC FOAM THIN BLACK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.00","33133096","ORTHOSIS HAND THERA+ TA RT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.25","72060001","CRYOPRECIPITATE-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.30","92204046","IV ADMIXTURE 46 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.40","92211943","WARFARIN NA 5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.40","92216603","NAFCILLIN 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.40","92217150","OXACILLIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.45","92214777","TRETINOIN 10MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.60","92217926","EPOPROSTENOL NA 0.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"205.76","38306806","CARNITINE ","82379",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2052.21","74001193","PARACENTESIS W IMAGE GUIDANCE ","49083",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2052.21","75000014","PARACENTESIS US NEEDLE PLCMT ","49083",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2054.90","92219276","FORMOTEROL/MOMET 5MCG200MCGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2055.40","92218509","MOMETASON/FORMOTEROL100MCG5MCG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.00","33113085","COLLAR CERV VISTA UNIV ADLT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.00","33139738","GUIDEWIRE HYDROPH NIT0.18X80CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.10","92215246","NALOXONE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.25","92211349","SULFACETAMIDE NA 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.25","92218698","BALPERUCASTOIL87MG-788MG/GMTOP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.25","92218989","FLUCYTOSINE 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.38","38300152","HSV 1 BY PCR ","87529",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.38","38300153","HSV 2 BY PCR ","87529",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.38","38399341","HERPES SIMP VIRUSPCR ","87529",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.41","38301571","IMMUNOELEC FLUIDS ","86325",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.50","92215211","ENOXAPARIN NA 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.53","38201450","HEPATITIS A ANTIBODY ","86708",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.75","92219903","LEVETIRA/NACL 1500MG/100ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"206.97","38301545","T-CELLS-CD4COUNT ","86361",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2061.76","76000390","NM MYOCARDIAL INFARCT SPECT ","78469",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2065.00","74010043","VENOGRAM EXT UNIL RT ","75820RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2065.00","74010044","VENOGRAM EXT UNIL LT ","75820LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2068.00","92217230","SAGRAMOSTIM 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.00","33113225","TUBE TRACH UNPER ADJ CFF 7.0 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.00","38280100","RIBOFLAVIN VIT B-2 ","84252",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.00","38287000","F2 GENE ANALYSIS ","81240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.00","92218130","CYCLOPENTOLATE HCL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.16","38300880","CULTURE BLOOD ","87040",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.25","92213290","HEXACHLOROPHENE HBR 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.33","38399338","WESTERN BLOT ","84181",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.43","38300119","VON WILLEBRAND ANTIGEN ","85246",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.60","92214041","AMOXICILLIN CLV K 400-57/5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.60","92216568","LEVETIRACETAM 500MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.64","38201220","FIBRINOGEN ","85384",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.85","92211472","TRIAMCINOLONE 0.025% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"207.95","92211432","MEROPENEM 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2074.95","92220045","NETARSUDIL/LATANO 0.005%-0.02%"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2077.90","92212450","FILGRASTIM 300MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2078.97","76000115","NM RADIOPHARM TX-ORAL ADMIN ","79005",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33103592","SPLINT REST FUNCT LT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33103597","SPLINT REST FUNCT LT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33114282","SPLINT REST FUNCT RT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33161394","TUBE 60MM7.4MM5MM CF CLIPINOBT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33161397","TUBE 80MM10.5MM7.5MM CFPRTXBVN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33161398","TUBE 88MM11MM8MM CLIPIN OBTTWL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","33161400","TUBE 98MM12.3MM9MM CUF CLIP IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.00","92215692","ZOLMITRIPTAN 5MG NASAL SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.39","38302400","TRANSFERRIN SERUM ","84466",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.40","92214214","ADEFOVIR DIPIVOXIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.50","38306560","CLOTTING FACTOR V ","85220",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.70","92214378","AMINO ACIDS 5% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.75","38201790","FLUORESCENT AB SCREEN ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"208.75","38299331","SHIGA-LIKE TOXIN ","87427",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2080.15","39200259","ECHO 2-D&M-MODE W/IMAGE ","93350",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2084.70","92213718","CIPROFLOXACIN HC 0.2%-0.1% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2086.73","77000411","ASPIRATION NDL W CT 1ST LESION","10009",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2089.61","77000035","CT MAXILLOFACIAL W/WO CONTRAST","70488",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.00","33103805","BOOT ANKLE ORTHOTIC LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.00","33161395","TUBE 70MM8.8MM6MM CF CLIPINOBT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.00","33161396","TUBE 80MM10MM7MM CF CLIPIN OBT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.00","33170360","COLLAR VISTA UNIT ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.05","92220151","CLINOLIPID 20% EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.45","38000640","CYTOSPIN ","88108",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.65","92219090","AMMONIUM LACTATE 12% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.86","38202510","VANCOMYCIN ","80202",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.86","38202750","CA-19-9 ","86301",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"209.90","92214788","FERRLECIT 62.5MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2092.55","92214942","ADVAIR 100-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2093.60","92211798","TOBRAMYCIN DEX 0.3-0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2095.10","92214584","LIDOCAINE HCL 5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2096.20","92218532","PROLENSA 0.07% OPHTH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2097.56","76000011","NM BONE IMAGING SPECT ","78320",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92203022","ORALS 22 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92211776","DEXTROAMPHETAMINE SULF 5MG CER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92212904","DICLOFENAC NA MISOPRO 75-0.2 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92213340","CLINDAMYCIN HCL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92214063","NAPROXEN NA 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92215611","HCTZ OLMESARTAN MED 12.5-40 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92216153","TIZANIDINE HCL 4MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.00","92217231","EPLERENONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.05","92213612","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.10","38201320","GLUCOSE BLOOD REAGENT STRIP ","82948",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.10","92213706","BROMOCRIPTINE MESYLATE 2.5MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.10","92217206","RISPERIDONE 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.15","92218607","PIOGLITAZONE HCL 15 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.20","92211205","AMANTADINE HCL 50MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.20","92211815","PROVIDONE IODINE 10% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.20","92216587","VITAMIN A/D OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.25","38303819","MICROHEMATOCRIT-SPUN ","85013",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.25","92216039","LEVOCARNITINE 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.25","92217489","ARMODAFINIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.25","92218301","VOIKACE 39150-10440-39150U TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.25","92218347","ZORVOLEX 35 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.35","92212045","HYDROXYCHLOROQUINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.35","92215500","CANDESARTAN CILEXETIL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.35","92215522","AMOXICILLIN CLV K 1000-62.5 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.35","92218324","ATACAND 16MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.40","92214329","NITROFURAN MONO/MCR 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.40","92215431","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.40","92215633","PROMETHAZINE HCL 12.5MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.40","92218315","MIDODRINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.45","92211420","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.45","92214713","RISPERIDONE 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.45","92215648","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.45","92217052","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.45","92218377","PERPHENAZINE 16 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.50","92211003","AMOXICILLIN CLV K 500-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.55","92217877","BENZOCAINE DOCUSATE NA 20MG NM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.55","92217892","DOCUSATE NA 283MG NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.60","92211111","CLORAZEPATE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.65","92211331","CARVEDILOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.65","92212731","TROLAMINE SALICYLATE 10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.69","38201190","FDP (FSP) ","85362",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92213572","DEXTROSE 40% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92215228","ATORVASTATIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92216572","DEXTROSE 15GM GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92219441","DEXTROSE ORAL 40% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92219443","DEXTROSE ORAL 40% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.70","92219800","METHYL SAL 15% MENTHOL 10% CRE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.75","92219384","GLUCOSE ORAL GET 40% 1GM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.80","92212997","HYDROCORTISONE 0.5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.80","92215483","ESCITALOPRAM OXALATE 5MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.85","92210223","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.85","92211517","DILTIAZEM HCL 60MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.85","92212576","NADOLOL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.85","92218987","LEVALBUT HYDROCHL1.25MG/3MLINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.85","92220451","CETYLPYRIDINIUM CHLOR 0.05%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.90","92217810","VENLAFAXINE HCL 37.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.90","92219523","PANTOPRAZOLE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.90","92219872","PANTOPRAZOLE DR 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92211883","CALAMINE LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92212594","PRAMIPEXOLE DIHCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92212717","COLESEVELAM HCL 625MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92213764","HYDROCORTISONE ACET 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92214372","HCTZ VALSARTAN 12.5-80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92216640","LANOLIN PETROLATUM 15.5-53.4 O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21.95","92220201","COLESEVELAM 625MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33112088","STPLR PROX TX LIN RELD 30MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33116014","SYSTEM BED STD WEDGE & SHEET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33117160","ORTHOSIS H/T COMFY SPLNT AD SM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33117162","ORTHOSIS H/T COMFY SPLINT AD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33139847","PICC BIOFLO NV 5F DL-55cm "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33160868","KIT ARTERIAL CATH 18G 16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","33177676","TUBE TRACHEAL JACKSON #8 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","38300650","COMPLEMENT FIXATION EA ANTIGEN","86171",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.00","92204052","IV ADMIXTURE 52 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.10","92219847","MESALAMINE 1000 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.26","38300161","COVID-19 CORONAVIRUS ","87635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.50","38303495","TEICHOIC ACID ","86329",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.65","92213903","CLONIDINE HCL 0.1MG TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"210.97","38201010","FIBRIN-D-DIMER QUANT ","85379",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2101.00","92219770","IBANDRONATE 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21040.80","92217060","IMMUNE GLOBULIN 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2106.40","92211811","EPOETIN ALFA 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.00","33103622","BOOT ANKLE CONTRACT WO SOLE MD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.00","33114872","BOOT STAB AIR WALK LO MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.10","92213169","AMOXICILLIN CLV K 600-42.9/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.15","92216424","MILRINONE D5W 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.20","92215888","PYRIDOSTIGMINE BR 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.25","92212104","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.25","92214659","RILUZOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.25","92214666","LOPINAVIR RITONAVIR 80-20MG SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.35","92219996","CADEXOMER IODINE 0.9% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.55","92218044","SORIATANE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"211.81","74000740","SELLA TURCICA ","70240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2114.02","76000190","NM ABSCESS LOCAL LIMITED STUDY","78805",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2114.51","77000374","CT GUIDANCE NEEDLE BIOPSY ","77012",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2115.80","92211101","CLOBETASOL PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21152.45","92214994","ADALIMUMAB 40MG/0.8ML KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2117.35","92210651","BLEPHAMIDE 0.2-10% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.00","33110577","SYS SKIN CLOS DERMABAND PRINEO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.08","38202000","PROSTATE SPECIFIC ATG (TOTAL) ","84153",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38300063","GM1 ANTIBODIES ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38300358","ANTI RNA POL-3 ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38300512","IGFBP-3 ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38300698","PLATELET FACTOR 4 ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38303721","INTERLEUKIN 6 ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.13","38303825","IMMUNOASSAY NONANTIBODY ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.30","92215677","LIDOCAINE HCL/HC 3%-0.05% CRE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.32","38307025","DRUG TEST PRSMV INSTRMNT ","80306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.50","92219255","PATIROMER 16.8 GM PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.50","92219522","PATIROMER 8.4 GM/Packet PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.50","92219860","PATIROMER 25.2 GM/PACKET PWDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.90","92213734","DALTEPARIN NA 5000U/0.2ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"212.95","92218357","ONFI 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2128.00","92218006","EXTIA 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2128.60","39200425","TILT TABLE EVAL ","93660",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33107170","TUBE TRACH BIV MID AIR-CF 6.0 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33109763","TUBE TRACH MID AIRECUF 7X80MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33111930","TUBE TRACH BIV 5MMX60MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33117508","TRAY CVC 12R-16CM 3LUM CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33171809","TRACH BIVONA AIR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33175828","CANN INN 8.0 PERC TRACH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.00","33183647","TUBE ENDOTRACH 9.0 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.19","38200094","ALPHA I ANTITRYPSIN PHENO ","82104",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.49","38301120","ELECTROLYTE PANEL ","80051",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"213.50","92215863","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2130.93","77000202","CT THORACIC SPINE W/WO CONT ","72130",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.00","33106962","STAPLER LIN RELOAD 60MM-3.5MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.00","33108844","TUBE TRCH SIL 7MMIDX10MMODX80M"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.00","33108863","TUBE TRACH TTS 6MMIDX70MM LONG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.00","92215117","CICLOPIROX 0.77% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.15","92214164","EFAVIRENZ 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.20","92211159","GENTAMICIN SULF 3MG/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.30","38201740","HEPATIC FUNCTION PANEL ","80076",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.35","92217177","DARUNAVIR ETHANOLATE 600MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.60","92211275","DICLOFENAC NA 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.66","38399350","C DIFFICILE AMP PROBE ","87493",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"214.90","92218348","MYCOPHENOLATE 200 MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2142.10","92218381","ADVAIR HFA 230MCG-21MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2144.00","92215394","DROTRECOGIN ALFA 5MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2146.00","92216806","BUDESONIDE FORMOTRL 80/4.5 AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33102583","TRAY MAHURKAR DL CRV125FRx13CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33103183","TRAY CATH MAHURRX 11.5FX19.5CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33106402","TRAY CATH MAHURKAR DL 12FR16CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33108379","TRAY CATH 11.5CMX 9.5CM HEMOD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33108380","TRAY CATH HEMO MUHU 11.5X13.5C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33109194","TRAY URETHRAL 11.5FRX19.5CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33111435","TRAY CATH QUINT MAHUR11.5X19FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33111461","CATH MAHURKAR RX QUINTON "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33113205","TRAY CATH MAHUR ELT 12F X 20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33114324","BOOT COMFY ADJ W AMB PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33116201","BOOT COMFY ANTIMIC PAD ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","33117532","TRAY ENTAKE PEG PULL20FRNODRUG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","92210971","CEFPROZIL 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.00","92218082","GENOTROPIN MINIQUICK 0.4MG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.15","92218906","ALBUMIN HUMAN 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.41","38200680","CORTISOL TOTAL ","82533",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.45","92218524","LAMOTRIGINE 300 MG TAB ER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.50","92215348","IMIPENEM CILASTATIN NA 500MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.92","72060022"," PLASMA CRYOPRECIPITATE REDUCE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"215.99","38302217","RETIC COUNT AUTO W DIR MEAS ","85046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2158.70","92219277","TEDIZOLID PHOSPHATE 200 MG PWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33109672","SPLINT EZ FLEX LEGT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33109787","SPLINT EZ FLEX RIGHT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33111408","TUBE TRACH JACKSON XL#5 METAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33116011","TAP SHEET GLIDE PREVALON 2.0 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33118625","DILATOR PYL/COL BALLOON 10MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33118626","DILATOR PYL/COL BALLOON 12MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33118627","DILATOR PYL/COL BALLOON 15MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.00","33177673","TUBE TRACHEAL JACKSON #6 LONG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.50","38399311","PSA ","84152",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.52","38200315","NEPHELOMETRY ","83883",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.52","38299306","LACTOFERRIN FECAL QUAL ","83630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"216.71","38301472","HEPATITIS B CORE ANTIBODY ","86704",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2161.19","74200409","MRI TMJ ","70336",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"217.00","33113084","COLLAR CERV UNV VST PD ST RGD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"217.00","38202539","VITAMIN B1 (THIAMINE) ","84425",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"217.20","92216519","RASAGILINE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"217.30","38303625","17-HYDROXYCORTICOSTEROID ","83491",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"217.45","92220483","DIAZEPAM 10 MG/2 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2170.35","92214418","CLOBETASOL PROP 0.05% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2172.50","92218086","NATACYN 5% OPHTH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2175.00","33105831","SET HD STEP LG-TRM ACCESS 23CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2175.00","33105832","SET HD STEP LG-TRM ACCESS 19CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2176.92","77000020","CT ABDOMEN W/WO CONTRAST ","74170",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2177.14","76000360","NM LIVER IMAGING SPECT ","78205",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2178.05","92213787","TAZAROTENE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2178.14","74200070","MRI CHEST WO CONTRAST ","71550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","33101014","KIT CVC TRIPLE-LUMEN+ 7FRX16CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","33101251","KIT TRIPLE LUME POL CVC 12FRX6"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","33112037","SYSTEM PEP ACAPELLA VIB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","33129531","COLLAR CERV ADLT TRACH 16-18IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","92215973","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.00","92216891","TDAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.15","92219077","SIROLIMUS 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.28","39200302","PACEMAKER CHECK DUAL LEAD ","93280",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.45","92214642","CHLORPROMAZINE HCL 25MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.48","38300590","CLOTTING FACTOR VIII ","85240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.60","92211643","CHLORDIAZEPOXIDE CLIDINIUM CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.70","92210512","NEOMYIN SULF/POLYMYX B/DEXAM O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.75","92218118","FANAPT 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"218.85","92215191","EPOETIN ALFA 2000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2181.36","77000060","CT THORAX W/WO CONTRAST ","71270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2181.80","92215892","TRAVOPROST 0.004% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2182.75","92217972","LEVOFLOXACIN/D5W 500MG/100ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2185.00","92212501","APRACLONIDINE 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"21854.00","92220164","ARIPIPR LAUR 1064MG/3.9ML SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2187.60","72060021","PLT PHER CMV NEG LR IRR-PROC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2188.55","92211592","EPOETIN ALFA 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.00","33106400","KIT CVC TL ARRGD FLXTP 7FX20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.00","33122464","ORTHO H/T COMFY SPLNT PED LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.00","33152642","PROTECTOR HEEL TRUVUELITE XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.02","38300076","ACHR BINDING AB SERUM ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.02","38300077","ACHR BLOCKING AB SERUM ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.02","38300078","ACHR MODULATING AB SERUM ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.02","38300474","TRYPSIN ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.02","38304300","PTH RELATED TOTAL PROTEIN ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.05","92214916","OLANZAPINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.05","92216249","OLANZAPINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.09","72000305","RETICULOCYTE SEPARATION ","86972",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.10","92211210","SUMATRIPTAN SUCC 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.10","92219487","PENIC G PRO 600000UNITS/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.15","38399352","ASSAY VITAMIN K ","84597",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.20","92217016","ENOXAPARIN NA 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.35","92217449","DICLOFENAC NA 0.1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.42","38000609","CYTOPATH NON-GYN CELL PREP ","88112",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.50","92214494","ATOVAQUONE 750MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.55","92212698","AZTREONAM 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.55","92216318","AZTREONAM 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.80","92217222","INSULIN GLULISINE 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.85","38201470","HEPATITIS B SURFACE AG (HBSAG)","87340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.85","38203015","T4 FREE (THYROXINE) ","84439",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.85","38293920","HEPB CORE AB IGM (HBCIGM) ","86705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"219.95","92210062","ACETIC ACID 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2198.45","92217834","IMMUNE GLOBULIN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2199.00","74200411","MRA HEAD WITHOUT CONTRAST ","70544",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92210129","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92210982","NADOLOL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92211614","VISINE FOR CONTACTS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92211710","PREDNISONE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92211898","DIPHENHYDRAMINE HCL Z ACE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92213207","LOVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92213817","METRORMIN ROSIG MAL 500-4MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92214126","SOTALOL HCL 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92214503","LOVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92214532","HCTZ LOSARTAN K 25-100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92214655","FLUVASTATIN NA XL 80MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215088","NORFLOXACIN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215193","DESLORATADINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215576","QUETIAPINE FUMARATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215623","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215680","ZINC OXIDE MENTHOL OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215684","ZINC OXIDE MENTHOL OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92215826","HCTZ VALSARTAN 12.5-160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92216261","SIBUTRAMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92216784","METRORMIN SITAG PH 500-50MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92217175","MONTELUKAST NA 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92217215","SULFAMETHOXAZOLE/TMP SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92217297","HCTZ LOSARTAN K 12.5-100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92217416","ALPRAZOLAM 2MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92219813","POTASSIUM CHLORIDE ER 10MEQCER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.00","92220515","PROGESTERONE MICRONIZ 200MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.05","92213567","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.10","92212723","SEVELAMER HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92210860","CHLORPROMAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92212976","CIPROFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92212994","AMIODARONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92217963","ALUMINUM OH/MG OH 355ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92218997","PANTOPRAZOLE SODIUM 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.15","92219873","PANTOPRAZOLE DR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.20","92211185","QUETIAPINE FUMARATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.20","92217199","RALOXIFENE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.20","92219456","CARBAMAZEPINE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.25","92211109","AMOXICILLIN CLV K 250-125 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.25","92212314","PAROXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.30","92210391","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.30","92212355","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.30","92217771","PRADAXA 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.30","92218162","UROGESIC BLUE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.30","92220001","FLECAINIDE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.35","92210301","PRAMOXINE HCL Z ACET 1%-0.1% L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.35","92217868","HYDROCODONE APAP 7.5-500/15ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.40","92215098","FERROUS SULF 300MG/5ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.40","92217881","HYDROCODONE APAP 2.5-167/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.45","92212154","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.45","92217356","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.45","92218838","DIGOXIN 0.125 MG/2.5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92213611","PREDNISOLONE NA POS 5MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92214781","PANTOPRAZOLE NA 20MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92215136","PANTOPRAZOLE NA 40MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92215857","MERCAPTOPURINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92216370","HYDROMORPHONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92217200","DRONABINOL 2.5MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.50","92217426","LAMOTRIGINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.55","92210802","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.55","92214796","OXCARBAZEPINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.55","92218748","LEVOCARNITINE1GM/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.60","92210311","AMOXICILLIN 125MG/5ML PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.60","92219616","MONTELUKAST CHW 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.65","92217323","VENLAFAXINE HCL 37.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.65","92217324","VENLAFAXINE HCL 37.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.65","92218002","FENOFIBRIC ACID 105MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.70","92217681","TAMSULOSIN HCL 0.4MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.70","92219646","CEFUROXIME AXETIL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.70","92219762","CEFUROXIME AXETIL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.75","92212475","DOXYCYCLINE 25MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.75","92217582","HYPROMELLOSE 0.3% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.75","92218841","FINASTERIDE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.75","92220190","MULTIVITAMIN & MINERALS LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.80","92212654","AMOXICILLIN CLV K 250-125 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.80","92213418","DIPHENHYDRAMINE HCL Z ACE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.84","38307002","HEELSTICK ","36416",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.85","92213697","RIVASTIGMINE TARTRATE 6MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.85","92213710","RIVASTIGMINE TARTRATE 4.5MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.85","92217863","RIVASTIGMINE TARTRATE 1.5MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.90","92214210","CANDESARTAN CILEXETIL 32MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.90","92215761","EPLERENONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.90","92215787","VENLAFAXINE HCL 37.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.90","92217329","VENLAFAXINE HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.95","92211717","NEOMYCIN SULF/POLYMYX B/PRAM C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.95","92214590","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.95","92216016","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.95","92217210","RISPERIDONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"22.95","92219650","NAFTIFINE HCL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.00","33111764","DRSG VAC GRANUFOAM MED W/SLVR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.00","33113074","KIT DRSG 18X12.5CM GRANFM SLVR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.00","33151843","SPLINT HAND/THUMB BROADCLOTHLG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.00","92210699","CEPHALEXIN 125MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.00","92219553","LEPTOSEPERMUM HONEY 1 TUBE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.20","92217252","AMINO ACIDS 4.25% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.25","92218951","SUMATRIPTAN 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.45","92212631","FLUOCINOLONE ACET 0.01% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.65","38000740","FLOW CYTOMETRY-2-8 MRK-INTERP ","88187",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"220.79","38300046","ANALGESICS NON-OPIOD 1-2 ","80329",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2200.59","74200414","MRA NECK WITHOUT CONTRAST ","70547",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2202.45","92212491","FILGRASTIM 300MCG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2206.05","92215312","ESTRADIOL 0.01% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.00","33109294","CATH AIRWAY EXCHG 14FR83CM LNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.00","33117514","TRAY 3 LUM CATH 7FR 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.00","92216834","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.10","92216262","MEGESTROL ACET 625MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.19","38300122","VON WILLEBRAND FACTOR MULTIMET","85247",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.25","38300125","ABG ANALYSIS ","82803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.35","92214560","FENTANYL 75MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.35","92217010","FENTANYL 75MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.75","92219732","MESALAMINE 1000 MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"221.85","92213796","CEFTRIAXONE NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2211.00","92211399","CYANIDE ANTIDOTE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2218.00","92211891","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33103234","SET NEFF PERCUTANEOUS ACCESS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33103286","ORTH COMFYPRENE ELBOW NAVY SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33108399",""TRAY THORCENT W/17GX6""""ASPIRTR""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33152471","CATH MULTPURP MACLOC DRN 8.5F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33152472","CATH MULTPURP MACLOC DRN 10.2F"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33152473","CATH MULTPURP MACLOC DRN 12F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","33152474","CATH MULTPURP MACLOC DRN 14F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.00","92215465","CEFEPIME HCL 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.08","38200950","CULTURE STOOL ","87045",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.25","92215982","DOXERCALCIFEROL 2.5MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.59","38300796","TB AG RESPONSE T CELL SUSP ","86481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.70","92214747","COLESTIPOL HCL 5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.70","92219472","VITAMIN E 15 IU/0.3 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"222.75","92215204","PHYTONADIONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2223.20","92210073","FLUOROMETHOLONE 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2224.31","77000019","CTA CHEST (NONCORONARY) WO/W ","71275",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2228.90","92215004","CASPOFUNGIN ACETATE 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.00","36000980","MAX BREATHING CAPACITY ","94200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.05","38303220","METANEPHRINES (FRACTION) ","83835",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.10","38302780","CHLAMYDIA IFA ","87270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.32","38300211","PLASMINOGEN ACTIVATOR ","85415",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.45","92213690","PHENYLEPHRINE HCL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"223.49","38399324","INF AGT NAP AMP PRB TECH MRSA ","87641",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2231.66","77000015","CTA LOWER EXT W/WO CONTRAST ","73706",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2232.10","76000066","NM HEPATOBILIARY W PHARM ","78227",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2237.05","92219797","INSULIN DEGLUDEC 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2237.59","74200240","MRI UP EXT JOINT W/O CONT BIL ","7322150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2237.59","74210019","MRI UP EXT JOINT W/O CONT RT ","73221RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2237.59","74210020","MRI UP EXT JOINT W/O CONT LT ","73221LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.00","33116098","STOCKING SCD COMFORT KNEE LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.00","92213978","TINZAPARIN NA 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.00","92214249","TINZAPARIN NA 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.30","92212545","AZTREONAM 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.40","92218857","NORFLURANE/PENTAGLUOROPROPN SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.70","92214634","LEVOCARNITINE 200MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.70","92215660","MODAFINIL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"224.90","92219044","OLANZAPINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2242.00","36000148","PERCUTANEOUS TRACHEOSTOMY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2242.70","92214318","PRAMOXINE HCL HC 1%-1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2244.22","77000023","CTA NECK WO/W CONTRAST ","70498",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2246.05","92213953","CONJUCATED ESTROGENS 25MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"225.00","33111409","TUBE TRACH JACKSON XL#7 METAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"225.00","33117066","GUIDEWIRE NIT-VU HIGH PERFORM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"225.00","33152498","31Accustick II "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"225.00","92213479","FLUOCINONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"225.10","92211114","TERCONAZOLE 0.8% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.00","33111271","PLEUREVAC SAHARA ADLT W/VLV "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.00","33112009","TUBE TRACH JACK 8X5.8X72MM SZ4"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.00","33113823","KIT PLEURA GUIDE CHEST TUBE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.45","92213185","ONDANSETRON 8MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.52","38200093","ALPHA I ANTITRYPSIN LEVEL ","82103",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.52","38203804","AB EXTRACT NUC ANTIGEN EACH ","86235",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.62","38306818","PHOSPHOLIPID NEUT HEX PHOS ","85598",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"226.95","92214934","ONDANSETRON HCL 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2261.74","77000024","CTA PELVIS W/WO CONTRAST ","72191",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2265.35","92214660","BRINZOLAMIDE 1% EYE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2266.15","92218616","CYCLOPHOSPHAMIDE 500 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.00","92216889","TDAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.15","92220064","ATOVAQUONE 750 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.55","92213642","AMINO ACIDS W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.63","38202400","TRANSFERRIN SERUM ","84466",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.80","92218726","MYCOPHEN MOFETIL1000MG/5MLSUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.85","92213636","MYCOPHENOLATE 1000MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.88","38399305","OXYGEN SATURATION CHECK ","82805",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"227.95","92210505","POLYMYXIN B/TMP 10000U/1MG SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2270.50","92218446","CRESEMBA 372 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2271.45","92217615","PROVIDONE IODINE 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2273.19","77000386","CT CERVICAL SPINE W&W/O CONT ","72127",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2275.00","92217658","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.00","92214930","EXEMESTANE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.17","75000011","US BLADDER POSTVOID RESIDUAL ","51798",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.40","92210074","BETAMETHASONE VA 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.70","92214864","LIPIDS 20% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.95","92217813","AMIODARONE HCL 150MG/100ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"228.97","38300060","ACTH ","82024",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2283.60","92210550","CLOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"229.00","92212504","ETHANOL 98% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"229.50","38301245","FDP (FSP) PARACOAGULATION ","85366",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"229.75","92211201","AK-PENTOLATE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"229.75","92219059","AMINO ACIDS/DEXT 2.75%-5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"229.85","38200110","AMIKACIN ","80150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2290.68","76000030","NM VENTILATION/PERFUSION QUANT","78598",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2299.40","76000046","NM CEREBROSPINAL FLUID FLOW ","78630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","38200230","ANTI STREP O TITER ","86060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92211072","CEPHALEXIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92212075","CEFPROZIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92213421","CELECOXIB 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92213496","SALICYLIC ACID 2%-2% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92213689","ORLISTAT 120MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92214139","CEFUROXIME AXETIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92215044","DESLORATADINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92215916","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92217031","CARVEDILOL 40MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92217032","CARVEDILOL 20MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92217035","CARVEDILOL 80MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92217037","CARVEDILOL 10MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.00","92219196","CALAMINE 8%-8% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.05","92211547","PROVIDONE IODINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.05","92211741","HALOPERIDOL LAC 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.05","92215492","TRIAMTERENE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.05","92219123","ACETAZOLAMIDE 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.05","92219298","LIDOCAINE PATCH 4% PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92211767","FLUOXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92212290","DESIPRAMINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92217373","HYDROXYCHLOROQUINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92219041","CARBI/LEVDOPA48.75MG-195MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92219901","UREA POWDER 15 GM PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.10","92220355","UREA POWDER 15 GM PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.15","92212737","PETROLATUM SHARK LIVER OIL OIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.15","92216882","CEFUROXIME AXETIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.15","92219741","TAMSULOSIN HCL 0.4 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92214178","PHENYLEPHRINE HCL 0.25% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92217120","OXYCODONE HCL 20MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92217317","GALANTAMINE HBR 12MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92217577","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92218063","NORTRIPTYLINE HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92218806","ALFUZOSIN HCL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92219023","OXYCODONE HCL CR 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.20","92220331","ACYCLOVIR 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92211350","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92212540","DIVALPROEX NA 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92213474","METOCLOPRAMIDE 10MG/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92215452","GABAPENTIN 250MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92215962","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92217390","RUFINAMIDE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.25","92219657","ACETAZOLAMIDE 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.35","92211570","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.35","92218069","LEVALBUTEROL HCL 0.63MG/3ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.35","92218453","MATZIM LA 360 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.35","92218648","MEGESTROL ACETATE 40MG/ML SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.40","92211596","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.40","92211773","DEXTRAN HYPROMELLOSE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.40","92215279","ETIDRONATE DISODIUM 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.40","92217342","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.50","92210149","BETHANECHOL CL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.50","92213087","NALTREXONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.50","92213124","NALTREXONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.50","92213196","LOVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.50","92215448","RIVASTIGMINE TARTRATE 3MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.55","92214870","RISPERIDONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.55","92216708","MENTHOL METHYL SALICYL 1-15 CR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.60","92213938","ACETAZOLAMIDE 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.60","92215961","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.60","92219939","NITROFURANTOIN MONOMAC100MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.65","92212342","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.65","92218839","THEOPHYLLINE ER 300 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.65","92219856","VANCOMYCIN 25 MG/ML SOLN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.70","38201410","HCG QUAL URINE ","84703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.70","92210947","PRAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.70","92218293","NALTREXONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.70","92218996","ZINC OXIDE 20% OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.70","92219349","SOTALOL HYDROCHLORIDE 160MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.75","92210678","ANTIBACTERIAL/ANESTHETIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.75","92218270","ESCITALOPRAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.85","92218124","ARTHRICREAM 10% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.85","92220382","TELMISARTAN 80 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.90","92211907","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.90","92212659","POTASSIUM CL 40MEQ/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.90","92215495","FLECAINIDE ACETATE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.95","92216542","OXYMORPHONE HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23.95","92216754","ACYCLOVIR 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33101769","STOCKING THIGH 20-30MMHG MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33111255","VALVE AQUA SPEAKING MIN PURCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33111509","KIT DRSG SLV ATS VAC LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33113066","DRSG LG VAC GRANUFOAM SLVR FOM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33113832","VALVE PASSY MUIR SPEAK TRACH/V"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33114972","SET INTRO PED TRANSITLS4FR10CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33171456","VALVE CHEST DRAIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","33198897","TRACH PURPLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","92212157","HYDROCORTISONE VAL 0.2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.00","92215065","MOMETASONE FUROATE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.35","92216203","ESOMEPRAXOLE NA 20MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.40","92216685","PEG ELCTROLYTE LAVAGE PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.60","92210310","BETAMETHASONE DP 0.05% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.61","38399316","B CELL TOTAL COUNT ","86355",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"230.96","38200140","ANA SCREEN ","86038",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2300.50","74200160","MRI ORBIT-FAC-NECK W/O CONT ","70540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2301.00","76099985","NM ESOPHAGEAL MOTILITY ","78258",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2304.82","77000022","CTA HEAD WO/W CONTRAST ","70496",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","33112166","BRACE KNEE WRAP LG HINGED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92210760","TIMOLOL MALEATE 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92213843","LIDOCAINE HCL 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92214775","CITRIC ACID GLUC MG CARBONAT S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92214825","ACYCLOVIR NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92214957","ETHYL CHLORIDE SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92216338","OCTREOTIDE ACET 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92219648","INSUL HUM REG100UNITS/100MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.00","92220383","NOREPINEPHRINE D5W 8 MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.52","38303455","SEROTONIN ","84260",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.60","92210891","PROPARACAINE HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.65","92211328","AMMONIUM LACTATE 12% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.75","39200140","ECG RHYTHM STRIP 1-3 LEAD ","93041",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"231.93","38300687","ANTIBODY ID LEUKOCYTE ","86021",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2310.00","92220473","ZOLEDRONIC ACID 5MG/100ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2310.42","76000028","NM LUNG VENT & PERFUS IMG ","78582",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2311.50","74200120","MRI LOW EXT JOINT W/O CONT BIL","7372150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2311.50","74210011","MRI LOW EXT JOINT W/O CONT RT ","73721RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2311.50","74210012","MRI LOW EXT JOINT W/O CONT LT ","73721LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2312.65","92219313","FILGRASTIM-AAFI480MCG/0.8MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2312.65","92219314","FILGRASTIM-AAFI480MCG/0.8MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2312.65","92220478","FILGRASTIM-AAFI 480MCG/0.8ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2315.11","74200180","MRI PELVIS W/O CONTRAST ","72195",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2315.85","92214981","CASPOFUNGIN ACETATE 70MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2316.86","74210037","MRA CHEST W/O CONT. "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.00","33112420","KIT PULL PEG SAFETY 20FR STRL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.00","36201050","MAXIMUM BREATHING CAPACITY ","94200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.00","92210011","BUTORPHANOL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.00","92216612","FENTANYL CITRATE 1200MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.03","34210340","STANDARD COGNITIVE TEST PER HR","96125GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.03","34600530","STANDARD COGNITIVE TEST PER HR","96125GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.40","92215662","NYSTATIN 150MMU POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.55","92215710","UREA 40% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.60","38301200","FERRITIN ","82728",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"232.65","92216317","AZTREONAM 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2320.19","74200230","MRI UPPER EXT W/O CONTRAST BIL","7321850",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2320.19","74200305","MRI UPPER EXT W/O CONTRAST LT ","73218LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2320.19","74200306","MRI UPPER EXT W/O CONTRAST RT ","73218RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2321.67","74200060","MRI CERVICAL WO CONTRAST ","72141",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2323.90","92212125","SULFACETAMIDE NA S 10%-5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.00","33103447","DRN BLAKE HUBLESS15FR3/16TROC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.00","33114330","SUPT H/W SOFPRO LT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.00","33152832","SOFTPRO WHFO RIGHT SMALL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.00","33177677","TUBE TRACHEAL JACKSON #8 ADP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.18","38201290","GENTAMICIN ","80170",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.25","92213175","HYDROXYZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.55","92216667","ARIPIPRAZOLE 15MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.60","92217254","AMINO ACIDS 4.25% D5W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.70","92218626","AMMONIUM LACTATE 12% TOPICAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"233.90","92218449","APTIOM 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2334.10","92214627","MORPHINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2337.05","92218742","UMECLIDINIUM 62.5 MCG/ACT NH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2339.57","74200014","MRI LUMBAR SPINE WO CONTRAST ","72148",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2339.59","74200412","MRA HEAD WITH CONTRAST ","70545",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","33113064","KIT CATH 20CM12.5FR LG PUMHRKR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","33135890","KIT CATH TL MAHURKAR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","33183945","SPLINT KWK FM FUNC REST RT M/L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","33183946","SPLINT KWK FM FUNC REST LT M/L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","36000140","CHEST WALL MANIPULATION INIT ","94667",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.00","36200180","CHEST WALL MANIP-INITIAL ","94667",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.13","38310002","PROTEIN C INHIBITOR ACTIVATED ","85335",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.16","38300004","PROCALCITONIN ","84145",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.25","92217472","NITROGLYCERIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.29","38201460","HEPATITIS B SURFACE AB ","86706",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.45","92217253","AMINO ACIDS 4.25% D20W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.71","38300092","ALDOSTERONE SERUM ","82088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.94","76020022","TC-99M MEBROFENIN<15MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"234.98","38300795","QUANTIFERON TB GOLD ","86480",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2342.15","92218057","VICTOZA 6MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2342.54","77000135","CT LUMBAR SPINE W/WO CONTRAST ","72133",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2343.00","33105809","KIT ASPIRA DRAINAGE PLEURAL 1L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2347.79","77000025","CTA ABD AORTA/FEMORAL W/WO CON","75635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2348.67","74200040","MRI BRAIN W/O CONTRAST ","70551",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.00","92210312","DIPIVEFRIN HCL 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.40","92217720","CYANOCOBALAMIN 1000MCG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.60","92213011","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.85","34010245","STRAPPING HIP ","29520GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.85","92213170","ENOXAPARIN NA 120MG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"235.95","92217255","AMINO ACIDS 4.25% D10W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2350.20","92218074","TUDORZA PRESSAIR 400MCG/ACT IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2350.53","77000028","CTA ABDOMEN W/WO CONTRAST ","74175",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2359.31","74010002","VENOGRAM SUPERIOR CAVAL ","75827",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"236.00","33113041","ALLOPATCH PLBL 2.0CMX0.4-0.8MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"236.00","33168051","CHEST TUBE KIT PLEURAGUIDE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"236.00","33183149","BOOT E-Z "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"236.00","33190901","COLLAR MIAMI J XTRA PAD XS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"236.85","92219640","LINEZOLID 600 MG/300 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2361.80","92214992","SUMATRIPTAN SUCC 6MG/0.5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2365.00","92217623","BACLOFEN 10MG/20ML KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2368.15","92218421","AVYCAZ 2GM/0.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.00","33113042","ALLOPATCH PLBL 1.5CMX0.4-0.8MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.00","33114321","BOOT TCC-EZ LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.15","92215713","DIAZEPAM 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.40","92214785","CLOMIPRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.53","38303767","CLOTTING FACTOR XI ","85270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.55","92216788","RETAPAMULIN 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.60","92219326","DEXMEDETOMI HCL400MCG/100MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.60","92219588","TETRACAINE OPHTH 0.5 % SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"237.80","92212146","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2370.70","92219402","IMMUNE GLOB 10% 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"23707.20","92219404","IMMUNE GLOB 10% 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2372.98","77000412","ASPIRATION NDL W CT ADD LESION","10010",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.00","33103840","DRAIN BLAKE FLAT FULL FLUT7MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.00","33106425","KIT PEG CORFLO MAX CONICL 20FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.00","33142188","SPLINT FOOTHOLD WAFFLE AFO LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.00","92213345","AMINO ACIDS 7% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.20","92213947","PAMIDRONATE DISOD 30MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.30","92216693","PRAMOXINE HCL 1% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.90","92211784","HEXACHLOROPHENE HBR 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"238.90","92215417","LINZOLID 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2380.97","74200100","MRI LOWER EXT W/O CONTRAST BIL","7371850",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2380.97","74200303","MRI LOWER EXT W/O CONTRAST RT ","73718RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2380.97","74200304","MRI LOWER EXT W/O CONTRAST LT ","73718LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2382.00","36000676","CARDIOPULMONARY RESUSCITATION ","92950",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2385.25","92218624","FLUTICASONE/SALMETREROLHFA INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33103579","ORTHOSIS HAND REST LG LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33103580","ORTHOSIS HAND REST LG RT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33103586","ORTHOSIS HAND REST MD LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33103588","ORTHOSIS HAND REST MD RT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33103784","BRACE ORTHOPEDIC AFO ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.00","33139915","COLLAR CERV ADJ WIRE FRAME MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.08","34600450","THERAPY SPEECH GEN DEVICE ","92609GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.46","72000280","RH PHENOTYPING ","86906",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"239.80","92214064","FENTANYL 75MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2390.00","38501221","THORACENTESIS W/IMG GD ","32555",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2390.85","92212186","ECONAZOLE NITRATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2394.90","92216807","BUDESONIDE FORMOTRL 160/4.5 AE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","38207015","KB SENSITIVITY ","87184",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92210929","AMOXICILLIN CLV K 250-62.5 CTB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92214277","ROSIGLITAZONE MALEATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92214682","AMOXICILLIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92215502","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92216451","ROSIGLITAZONE MALEATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92216639","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.00","92217096","NIACIN 750MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92211603","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92215360","DESMOPRESSIN ACET 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92217627","POTASSIUM CITRATE 15MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92217770","PRADAXA 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92218289","FENOFIBRATE 145MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92218994","HYDROXYCHLOROQUINE SUL200MGTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.05","92220196","CELECOXIB 100MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.10","92219895","MICONAZOLE 2% PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.15","92211412","FLUPHENAZINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.15","92212927","RIVASTIGMINE TARTRATE 1.5MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.20","92211251","NORFLOXACIN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.25","92215080","FINASTERIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.25","92216712","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.25","92220461","FENOFIBRATE MICRO 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.30","92211988","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.30","92214615","MICONAZOLE NITRATE 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.30","92215441","ATORVASTATIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.30","92219345","LOPERAMIDE HCL 1MG/7.5ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.30","92220308","NITROFURANTOIN MACRO 50MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.31","92216213","MINERAL OIL PRAMOX HCL ZINC OI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.35","92210329","COLCHICINE 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.35","92211506","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.35","92218674","SALICYLIC ACID/SULFUR 2%-2%TOP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.45","92217298","LEVETIRACETAM 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.45","92218225","BUPRENORPHINE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.46","38303818","HEMOGLOBIN URINE ","83069",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.50","92210586","TRIAMCINOLONE 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.50","92215391","OXYCODONE HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.55","92211081","VERAPAMIL HCL 240MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.55","92216087","METHYLPHENIDATE HCL 5MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.55","92217485","TOPIRAMATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.55","92220519","FERROUS SULFATE 300MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92211175","CIPROFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92212320","ACYCLOVIR 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92212394","METHAZOLAMIDE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92212610","CHOLESTYRAMINE 4GM/5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92214772","MORPHINE 20MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.60","92214999","MELOXICAM 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.65","92218542","RISPERIDONE 0.25 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.65","92219075","RISPERIDONE 0.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.70","92211206","PHENYLEPHRINE HCL 0.25% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.70","92216083","MIDODRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.70","92218245","CIPROFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.75","92210626","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.75","92212761","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.75","92214330","NELFINAVIR MESYLATE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.75","92214693","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.75","92218088","DELZICOL 400MG DR CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.80","92214447","RISPERIDONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.80","92217829","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.80","92218333","ESCITALOPRAM 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.80","92219008","DIPHENHYDRAMINEHCL25MG/10MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.85","92212293","BARIUM SULF 2.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.85","92216195","CLARITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.85","92217512","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.90","92218093","DOXYCYCLINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.90","92218265","PREZISTA 100MG/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24.90","92219188","VANCOMYCIN HCL 50 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","33111510","KIT ABD PARACENTESIS LG RX VOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","33152427","DRAIN PLEURVAC PED/ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","33190902","COLLAR MIAMI J XTRA PAD SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","33190903","COLLAR MIAMI J XTRA PAD MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","33190904","COLLAR MIAMI J XTRA PAD LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.00","36000090","IPPB-INITIAL/EZPAP ","94640",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.05","38300456","ACTH STIMULATION PANEL ","80400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.10","92215318","LIPIDS 20% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.50","92217944","ENOXAPARIN NA 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"240.95","38202390","TOBRAMYCIN ","80200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.00","92212624","LEVOFLOXACIN 500MG/100ML D5W I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.16","39200210","EKG TRACING ONLY ","93005",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.16","74001015","EKG TRACING ONLY (RAD) ","93005",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.34","38303769","CLOTTING FACTOR IX ","85250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.67","38000730","FLOW CYTOMETRY-1ST MKR-TECH ","88184",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"241.85","92218993","AMINOCAPROIC ACID 1000 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2411.25","92214903","DESONIDE 0.05% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33100819","TUBE JEJUNAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33100862","SLING HEMI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33103108","SUPPORT SKATEBOARD FOREARM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33108750","SLING HEMI GIVMOHR LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33171887","SLING GIVMOHR XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33177675","TUBE TRACHEAL JACKSON #7 ADP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","33199922","TUBE TRACH - JACKSON 6 FEN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.00","92214490","DEXTROSE 50%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.06","38299350","C DIFFICILE AMP PROBE ","87493",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"242.70","92218810","XULANE 150MCG-35MCG/24HR PATCH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2427.07","74200050","MRI CERVICAL W/CONTRAST ","72142",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24287.10","92217507","CERTOLIZUMAB PEGOL 200MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.00","33170515","HELMET SOFT TOP GREY SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.17","38200590","CLOTTING FACTOR VIII ","85240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.17","38293921","PLATELET AGGREGATION EA AGENT ","85576",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.45","92214948","ONDANSETRON HCL 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.45","92218369","ACETAZOLAMIDE 500 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.75","92218463","FYCOPA4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.75","92218470","FYCOMPA 8 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"243.75","92219097","PERAMPANEL 6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2430.05","92212568","CALCIPOTRIENE 0.005% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2432.00","33110283","KIT CATH PLEURX W4 1000ML BTLS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33102174","BRACE WRIST W/BOA LEFT LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33109807","HELMET SOFTSHELL TAN SMALL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33109870","HELMET SOFTSHELL TAN LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33112141","HELMET SOFTSHL TAN MD22-22.751"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33113094","HELMET SFSHLL PINK SM21-21 3/4"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33113095","HELMET SFSHLL SM RYBL21-21 3/4"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33117515","TRAY CENTRAL VENOUS AKP1A "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33187061","HELMET SOFT SHELL MEDIUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33187062","HELMET SOFT SHELL LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189545","CORGRIP NG/NI TUBE RETN 8FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189546","CORGRIP NG/NI TUBE RETN 10FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189547","CORGRIP NG/NI TUBE RETN 12FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189548","CORGRIP NG/NI TUBE RETN 14FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189549","CORGRIP NG/NI TUBE RETN 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.00","33189550","CORGRIP NG/NI TUBE RETN 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.20","92215738","MINERAL OIL PETROLATUM 15-18 O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.25","92220260","ACETAMINOPHEN 1000MG/100ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.75","92212197","ACETAZOLAMIDE 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"244.95","92217782","LURASIDONE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2443.25","92216466","BRIMONIDINE TARTRATE 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2444.91","74200010","MRI ABDOMEN W/O CONT ","74181",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2447.70","92213986","DESMOPRESSIN ACET 0.1MG/ML SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.00","33131091","WALKER ROM LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.00","36000880","AEROSOL/VAPOR INHALE SUBSEQ ","9464076",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.00","92215650","CA CL/ICODX/MGCL/NACL/NALACT S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.00","92216341","DEFERASIROX 250MG TBS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.15","92210537","FLUOCINOLONE ACET 0.01% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.45","92210671","ATROPINE SULF 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.78","38303140","HLA-B27 ","86812",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"245.79","38207035","HIV-1 AG W/HIV-1 & HIV-2 AB ","87389",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2451.90","92212188","ACYCLOVIR NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2452.40","92217994","TYVASO 0.6MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2454.40","73500331","NRV COND STUDIES 13+ STUDIES ","95913",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2456.65","92213194","BOSENTAN 62.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2458.42","75000009","THORACENTESIS US NEEDLE PLCMT ","32555",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.05","92212641","LEVOFLOXACIN 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.05","92220307","DEXT/KCL/NACL 5%-0.15%-0.45%IV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.25","92217103","DICLOFENAC NA 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.40","92212359","DOBUTAMINE HCL D5W 500-250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.50","92218531","APTIOM 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.50","92218991","ESLICARBAZEPINE ACET 800MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.80","92214001","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"246.85","92211559","BETAMETHASONE ACE/NA 6MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2461.70","92217948","NAFTINE HCL 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2468.00","76000019","NM LIVER IMAGING ONLY ","78201",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2469.95","92214936","ADVAIR 250-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.00","33110582","BOOT PODUS AMB ATCH STD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.00","92216300","CEFTRIAXONE NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.14","38303885","COLUMN CHROMATOG/MASS SPECT QT","82542",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.50","92211864","DOXEPIN HCL 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.50","92211894","IRON DEXTRAN 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.50","92215295","ARIPIPRAZOLE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.50","92219574","CALCIUM GLUCONATE 2.5%GEL (25G"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.60","92215432","ARIPIPRAZOLE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.61","38201400","HAPTOGLOBIN ","83010",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"247.61","38280048","METABOLIC PANEL TOTAL CA ","80048",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2475.33","74200292","MRI ORBIT-FACE-NECK W/CONT ","70542",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2477.85","92218506","IMITREX STATDOSE 6MG/0.5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2478.65","92211396","IMMUNE GLOBULIN 5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2479.34","74200302","MRI UPPER EXT W/CONTRAST RT ","73219RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2479.34","74200402","MRI UPPER EXT W/CONTRAST BIL ","7321950",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2479.34","74200419","MRI UPPER EXT W/CONTRAST LT ","73219LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.00","33103542","PROTECTOR PALM WR SPT LT 1IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.00","33142187","SPLINT FOOTHOLD WAFFLE AFO MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.00","33178917","SPLINT FUNCTIONAL HAND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.00","92215242","FLUTICASONE PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.50","92217086","LIDOCAINE HCL 4% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"248.71","38303766","CLOTTING FACTOR XII ","85280",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2481.00","92214194","FLUVESTRANT 125MG/2.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2483.20","92210536","SALMETEROL XINAFOATE 46MCG DSK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2483.20","92219239","SALMETEROL XINAFOATE0.046MGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2486.82","74200281","MRI ABDOMEN W/CONTRAST ","74182",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2487.07","74200220","MRI THORACIC WO CONTRAST ","72146",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","33105807","BOOT CASTING XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","33116015","BRACE KNEE COMFYPRENE CHILD LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","33152500","RADIO JAW 4 PULMONARY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","38399307","THYROID PANEL WITH TSH ","80438",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","92210161","SULFAMETHOXAZOLE/TMP INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.00","92217244","HYDROQUINONE 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.60","92217158","ANTIBACTERIAL/ANTI-INFLAM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"249.90","92214658","OLANZAPINE 20MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2491.40","92214298","LOTEPREDNOL ETABONATE 0.5% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"24932.95","92217325","TERIPARATIDE 600MCG/2.4ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2494.80","92214212","BRIMONIDINE TARTRATE 0.15% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","38200007","IgG SUBCLASSES (EACH) ","82787",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210002","DIPHENHYDRAMINE HCL 50MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210054","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210102","SODIUM BICARB 7.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210123","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210218","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210229","TOBRAMYCIN 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210265","CEFOTAXIME NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210290","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210335","MORPHINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210341","SODIUM CL CONC 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210405","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210424","PHENYLEPHRINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210443","CEFAZOLIN 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210451","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210486","ENALAPRILAT 1.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210595","TOBRAMYCIN 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210633","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210655","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210674","SELENIUM SULFIDE 1% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210723","CEFUROXIME NA 750MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210752","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210796","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210806","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210808","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210809","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210817","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210862","DILTIAZEM HCL 25MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92210959","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211049","CEFTRIAXONE NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211078","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211100","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211117","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211190","SODIUM CL 2.5MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211195","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211216","SODIUM ACETATE 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211241","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211264","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211322","MORPHINE 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211360","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211369","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211386","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211397","SODIUM BICARB 4.2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211479","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211538","ENALAPRILAT 1.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211591","AMPICILLIN NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211611","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211762","GENTAMICIN SULF 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211827","TOBRAMYCIN 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211839","KETOROLAC 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211841","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211857","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211938","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211975","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92211999","EPINEPHRINE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212003","LORAZEPAM 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212029","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212084","TOBRAMYCIN 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212089","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212097","LIDOCAINE 2%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212100","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212103","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212105","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212187","CEFAZOLIN 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212213","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212221","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212229","PROMETHAZINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212230","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212241","CEFAZOLIN 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212243","DIPHENHYDRAMINE HCL 50MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212269","VASOPRESSIN 10U/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212289","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212300","VANCOMYCIN HCL 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212326","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212346","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212350","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212400","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212416","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212428","MORPHINE 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212435","MEPERIDINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212467","MEPERIDINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212531","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212538","TUBERCULIN 5TU/0.1ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212572","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212590","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212597","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212612","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212623","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212627","HALOPERIDOL LACTATE 5MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212637","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212651","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212653","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212660","PHENYTOIN NA 100MG/2ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212665","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212673","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212676","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212714","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212748","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212756","NALBUPHINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212777","TRIMETHOBENZAMIDE HCL 100MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212788","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212837","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212839","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212858","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212892","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212926","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212936","GENTAMICIN SULF 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212938","MORPHINE 8MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212957","HYDROMORPHONE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212960","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212980","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212983","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92212999","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213023","HEPARIN 5000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213030","HEPARIN 10U/ML-NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213049","MORPHINE 8MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213059","EPINEPHRINE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213104","ASCORBIC ACID 500MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213128","EPINEPHRINE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213147","DIGOXIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213183","GENTAMICIN SULF 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213188","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213191","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213213","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213218","INFLUENZA VACC 2011-2012 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213222","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213239","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213243","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213274","HEPARIN 5000U/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213282","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213296","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213302","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213311","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213320","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213336","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213351","LIDOCAINE 0.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213361","D5W KCL 0.224% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213364","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213368","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213376","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213378","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213398","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213415","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213427","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213438","HYDROMORPHONE 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213448","HYDROMORPHONE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213449","LORAZEPAM 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213454","CISATRACURIUM BESYL 2MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213470","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213497","DOPAMINE HCL 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213500","OFLOXACIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213501","HYDROMORPHONE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213505","CISATRACURIUM BESYL 2MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213516","HYDROMORPHONE 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213526","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213529","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213551","DILTIAZEM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213555","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213561","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213600","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213604","HYDROMORPHONE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213630","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213686","GENTAMICIN 100MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213693","CEFAZOLIN 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213714","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213738","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213739","EPHEDRINE SU 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213750","D5W KCL 0.15% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213761","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213767","SODIUM CL 2.5MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213774","HYDROMORPHONE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213782","HEPARIN 1000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213785","HYDROMORPHONE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213792","GENTAMICIN 80MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213800","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213802","DOPAMINE HCL 80MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213807","GENTAMICIN 60MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213815","TOLTERODINE TARTRATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213818","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213821","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213823","GENTAMICIN 80MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213836","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213852","DOPAMINE HCL 80MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213859","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213898","KCL 40MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213900","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213913","METOPROLOL TART 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213915","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213919","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213926","KCL 20MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213950","MANNITOL 25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213951","GENTAMICIN 1.6MG/ML NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213961","GENTAMICIN 60MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213971","D5W-NS/KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213972","D5W NS KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213975","POTASSIUM ACET 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213979","GENTAMICIN 80MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92213984","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214004","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214028","DEXTROSE 5%-NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214030","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214034","KETOROLAC 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214054","INSULIN HUM ISOP/REG 70U-30U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214059","DOPAMINE HCL 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214082","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214096","D5W-1/2NS/KCL 10MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214115","DEXTROSE 50%/WATER INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214150","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214165","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214195","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214197","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214204","MANNITOL 25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214205","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214223","METRONIDAZOLE 500MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214236","EPHEDRINE SU 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214240","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214255","HYDROCORTISONE NA SUCC 100MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214274","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214285","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214307","SODIUM CL 3% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214323","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214358","DEXTROSE 5%-1/3NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214390","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214393","DIPHENHYDRAMINE HCL 50MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214407","HYDRALAZINE HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214408","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214433","SODIUM CL 2.5MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214434","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214456","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214516","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214521","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214522","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214533","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214538","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214554","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214558","LIDOCAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214576","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214588","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214591","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214599","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214614","D5W-1/2NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214617","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214622","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214632","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214654","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214664","PROMETHAZINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214679","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214680","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214706","GENTAMICIN 80MG/NS 50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214707","HEPARIN 100U/ML-NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214710","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214753","HEPARIN 5000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214760","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214769","D5W-1/4NS KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214771","DILTIAZEM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214787","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214801","POTASSIUM CL 10MEQ/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214804","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214813","DEXAMETHASONE NA PH 10MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214824","DIDANOSINE 125MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214843","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214857","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214879","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214882","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214888","HEPARIN 100U/ML-NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214921","METRONIDAZOLE 500MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214940","DIGOXIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214949","BUMETANIDE 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214958","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214962","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214982","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92214991","ATROPINE SULF 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215007","MEPERIDINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215034","MEPERIDINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215051","HYDROMORPHONE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215053","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215055","PROMETHAZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215060","MEPERIDINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215076","MORPHINE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215101","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215120","FLUOXETINE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215128","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215130","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215150","ATROPINE SULF 0.4MG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215156","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215199","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215208","METRONIDAZOLE 500MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215238","LIDOCAINE 2%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215239","KCL 20MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215249","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215254","METRONIDAZOLE 500MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215258","HYDROMORPHONE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215259","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215270","HYDROMORPHONE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215275","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215278","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215286","POTASSIUM CL 40MEQ/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215316","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215342","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215358","D5W KCL 0.3% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215362","CA CL/KCL/MGCL/NA ACE/NACL INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215377","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215380","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215382","ASCORBIC ACID 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215392","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215404","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215406","ASCORBIC ACID 500MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215409","TIAGAINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215444","HYDROXYZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215466","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215467","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215473","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215475","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215554","HYDROMORPHONE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215558","AMIODARONE HCL 150MG/3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215605","HEPARIN 5000U/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215679","METOPROLOL TART 5MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215719","ATORVASTATIN CALCIUM 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215732","ATORVASTATIN CALCIUM 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215780","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215846","OFLOXACIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215956","CARBAMAZEPINE 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92215981","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216057","BENAZEPRIL HCL AMLODIP BESYL C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216061","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216166","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216246","MORPHINE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216275","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216377","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216426","D5W-1/2NS/KCL 30MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216517","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216529","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216530","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216531","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216543","POTASSIUM CL 30MEQ/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216577","CIPROFLOXACIN 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216636","PRAVASTATIN NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216650","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216654","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216663","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216666","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216718","METOPROLOL TART 5MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216801","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216813","CLINDAMYCIN PHOS 9G/60ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216825","DIPHENHYDRAMINE HCL 50MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216851","PRAVASTATIN NA 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216865","CEFAZOLIN 1GM A-V INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216876","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216880","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216896","FOSPHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92216897","FOSPHENYTOIN NA 75MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217015","HEPARIN 5000U/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217136","CIPROFLOXACIN 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217169","PROPRANOLOL HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217198","METOPROLOL TART 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217315","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217385","METRONIDAZOLE 500MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217392","KCL 20MEQ/0.45% NA IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217402","HALOPERIDOL DEC 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217467","HEPARIN 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217524","METHYLPREDNISOLONE NA 40MG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217624","METOPROLOL TART 5MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217648","LIDOCAINE HCL 1% 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217702","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217732","PROPOFOL 1% EMULSION INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217780","HYDROMORPHONE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217785","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217804","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217809","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217845","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217875","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217898","HEPARIN 5000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217935","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217936","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217965","MORPHINE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217976","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92217997","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218079","MORPHINE SULFATE 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218084","MORPHINE SULFATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218091","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218288","DEXAMETHASONE 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218325","MORPHINE SULF 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218365","ONDANSETRON 2MG/ML IV "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218384","LIDOCAINE 2% IV SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218402","LIDOCAINE 1% IV SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218441","HEPARIN LOCK FLUSH 10 U/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218442","HEPARIN LOCK FLUSH 100U/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218471","LIDOCAIN HCL 0.01 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218548","CALCIUM CHLORIDE 0.1 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218660","PHENYTOIN SODIUM 250MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218661","PHENYTOIN SODIUM 250MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218700","MORPHINE SULFATE 4 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218724","MORPHINE SULFATE 10 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218727","MORPHINE SULFATE 10 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218729","ELECTROLYTE CONCENTRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218747","FLUZONE QUADVLNT60MCG/0.5MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218761","FENTANYL CITRATE 100MCG/2MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218822","HYDROMORPHONHCL 0.5MG/0.5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218935","LIDOCAINE HCL PF 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92218995","MORPHINE SULFATE 8 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219002","MORPHINE SULFATE 2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219003","MORPHINE SULFATE 5 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219007","HYDROMORPHONE HCL 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219033","HALOPERIDOL LACTATE 5MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219047","CAMPH/EUC/MENTH4.2%1.2%2.6%ONT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219281","AMY/LIP/PRO 42K-10K-32K UCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219311","LIDOCAINE HCL 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219312","HYDROMORPHONE HCL 1 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219458","BUPIVACA/EPI 0.5%-1:200000 SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219502","HEPA 100 UNITS/ML 0.9% NACLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219503","HEPARIN SOD 5 UNITS/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219512","DOXERCALCIFEROL 2 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219513","DEXTROSE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219514","D5%/NACL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219598","DIPHENHYDRAMINE12.5 MG/5 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219601","PHENYLEPHRINE HCL 10/MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219627","LIDOCAINE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219681","HYDROMORPHONEHCL0.5MG/0.5MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219704","MORPHINE SULFATE 4 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219705","MORPHINE SULFATE 4 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219723","DEXAMETHASONE SODPHOS4MG/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219737","MORPHINE SULFATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219751","MIDAZOLAM HCL/PF 2 MG/2ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219821","FENTANYL50 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219825","LIDOCAINE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219852","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219853","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219910","MORPHINE 2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92219973","HEPARIN SODIUM 10 UNITS/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220015","LIDOCAINE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220050","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220101","COVID-19 VACC100 MCG/0.5 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220148","LIDOCAINE 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220177","DEXTROSE 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220263","COVID-19 VACCINE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220267","KETORLAC TROMETHAM 30MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220371","HYDROMORPHONE 2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220380","FENTANYL CITRATE 50 MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220391","D5/NACL 5%-0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220404","HYDROMORPHONE HCL 2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220440","LIDOCAINE HCL/EPI1%-1:100000IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220502","PROPOFOL 10 MG/1 ML EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220503","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.00","92220517","LIDOCAINE HYDROCHLORIDE 1% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.05","92210378","HYDROMORPHONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.05","92213248","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.10","92214132","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.10","92214230","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.15","92210935","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.15","92213504","GENTAMICIN 2MG/ML NS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.15","92215879","MAG-AL SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.15","92217876","SELENIUM SULFIDE 1% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.20","92211967","TOBRAMYCIN 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.20","92214955","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.20","92216263","GENTAMICIN 120MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.20","92219119","Bupropion XL 300 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.25","92212791","CARVEDILOL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.25","92214292","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.25","92214579","ROPINIROLE HCL 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.25","92219956","MONTELUKAST 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.30","92210535","TOLNAFTATE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.30","92211090","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.30","92216248","HYDRALZAINE HCL ISORBIDE DIN T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.30","92218155","VESTURA 3MG-0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.35","92211604","VITAMIN E OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.35","92216064","FENOFIBRATE 145MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.40","92214196","PROMETHAZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.40","92219039","CARBI/LEVDOPA36.25MG/145MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.45","92214387","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.45","92215442","METHYLPREDNISOLONE 32MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.45","92216637","ZOLPIDEM TARTRATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.45","92217599","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.50","92214945","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.55","92211213","CYCLOSPORINE 25MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.60","92210071","MENTHOL METHYL SALICYL 10-15 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.60","92211775","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.60","92213621","ZOLPIDEM TARTRATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.60","92213872","GABAPENTIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.60","92216268","PROPOFOL 1% EMULSION INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.65","92211068","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.65","92215437","RIVASTIGMINE TARTRATE 4.5MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.65","92219583","MELOXICAM 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.70","92211266","CLORAZEPATE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.70","92211449","DILTIAZEM HCL 90MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.70","92214773","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.70","92219467","ALBENDAZOLE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.70","92220125","BENZOCAINE 20%SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.75","92213583","EPINEPHRINE HCL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.75","92217257","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.75","92217427","LAMOTRIGINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.75","92219879","PANTOPRAZOLE DR 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.80","92213692","GALANTAMINE HBR 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.85","92211227","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.85","92218237","PRAVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.85","92219783","CHOLECALCIF/VITD3 400 U/ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.90","92213493","GENTAMICIN 100MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.90","92214922","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.90","92216395","TRAMADOL HCL 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.95","92211847","MENTHOL METHYL SALICYL 8-30% C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.95","92211918","GANCICLOVIR 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.95","92212426","BUPROPION HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25.95","92216868","PRAMOXINE HCL HC 1%-2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"250.00","33103009","KIT FEEDINGTUBE MICPULLPEG20FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"250.00","33110006","SPLINT HAND PROG MED/LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"250.42","38303875","IMMUNOFIX ELECTROPHOR-FLUID ","86335",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"250.50","92211022","FLUOCINONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2504.00","92215078","PIMECROLIMUS 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2506.25","92216833","AMBRISENTAN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.00","33106263","CUSHION W/C ANTI THRUST 18X16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.00","33111282","BOOT ANK CONTRACT MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.00","33111676","BOOT ANK CONTRACT W/SOLE XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.00","33112050","BOOT ANK CONTRACT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.00","33142186","SPLINT FOOTHOLD WAFFLE AFO SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.59","38302481","HISTOPLASMA ANTIGEN ","87385",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.73","38000022","FINE NEEDLE ASP EVAL ","88172",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.90","92217832","VORICONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"251.95","92216007","ABACAVIR SULF LAMI 600-300MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2511.00","61010201","INSERT CENT VEN CATH TUNNELED ","36558",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2511.80","74200289","MRI CHEST W/CONTRAST ","71551",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2511.85","92218304","NAFTIFINE HCL 1% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2512.20","92214293","NICOTINE 4MG/ACT DEV "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.00","33171345","RASP SMALL TEAR 11X5MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.00","92215886","LIPIDS 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.10","38300222","BNP (B NATRIURETIC PEPTIDE) ","83880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.10","38300223","NT-PRO BNP ","83880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.15","92216679","PALIPERIDONE 9MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.19","38300071","NIACIN LEVEL ","84591",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.25","92218477","ABILIFY 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"252.45","92215099","CLINDAMYCIN PHOS 1% PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2524.00","92213472","AMINO ACIDS 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2524.30","92213146","CLOBETASOL 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","33103316","PROTECTOR PALM WR SPT RT 1IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","33103540","PROTECTOR PALM WR SPT RT 2IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","33111735","CUTTER PROX LIN RELD 100MM GRN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","33131155","PROTECTR PALM W/WRIST SPT LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","36000400","AEROSOL/VAPOR INHALE INITIAL ","94640",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","92212008","CEFTRIAXONE NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.00","92216956","DORIPENEM 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.15","38302073","CMV BY PCR ","87496",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.23","73570058","EMG NON-EXTREM MUSC(S) ","95887",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.55","92211949","CIPROFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.70","92210168","CLINDAMYCIN PHOS 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"253.90","92212689","CEFOTETAN DISODIUM 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2533.35","92218718","BREO ELLIPTA 200MCG-25MCG INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.00","92211921","DESOXIMETASONE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.00","92218090","FLUMIST NASAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.15","92217256","AMINO ACIDS 2.75% D5W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.28","38202015","PROTEIN ELECTROPHORESIS ","84165",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.35","92211317","DICLOFENAC NA 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.55","38000564","MOL CYT IN SITU HYBRD 100-300 ","88275",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"254.80","92214840","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2542.02","74200030","MRI BRAIN W/CONTRAST ","70552",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2542.69","75000260","US TEE 2D W/PROBE PLACE COMP ","93312",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2549.80","92218762","TEDIZOLID PHOSPHATE 200 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.00","33110645","COLLAR CERV VISTA XTRA PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.00","33115280","FUNNEL FISTULA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.00","33152529","PICC NV IR 5F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.05","92220351","REVEFENACIN 175 MCG/3 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.15","92214536","EPOETIN ALFA 2000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.45","92218740","PIRFENIDONE 267 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.60","92216112","MESALAMINE 1000MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.60","92217057","MESALAMINE 1000MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.65","92214959","ONDANSETRON HCL 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.90","92216223","OCTREOTIDE ACET 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"255.96","38301240","FOLIC ACID ","82746",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2550.00","33103464","VENA CAVA FILTER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"25542.00","92215810","DARBEPOETIN A 500MCG/1ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2555.00","68000100","RENAL-HEMODIALYSIS ","90935",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2555.00","68000300","PERITONEAL DIALYSIS ","90945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2555.00","68000370","CAPD-CONT AMB PERITONEAL DIALY","90945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.00","92215235","THIOPENTAL NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.45","92217264","AMINO ACIDS 2.75% D10W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.85","92218568","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.90","92218897","LIPIDS 20% EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.90","92219638","FAT EMU/OLIVE/SOY/PHOS 20% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.90","92220170","LIPIDS-PLANT BASED 20% EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"256.90","92220172","CLINILIPID 20% EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2561.20","92212201","PENICILLIN G BENZ 0.6MMU/ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2566.30","92218101","COMBIGAN 0.2%-0.5% INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"257.00","33117517","KIT MULTI-LUMEN CVC 7FR 16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"257.10","92213219","NYSTATIN 100000U/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"257.60","92212801","PRILOCAINE LIDOCAINE 2.5-2.5 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"257.90","92219884","IOHEXOL 51.8% 240 MG/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2577.80","39200257","ECHO 2-D&M-MODE W/DOPPLER ","93306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2577.80","75000052","US 2D ECHO DOPPLER/COLOR FLOW ","93306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.00","33118476","BOOT MULT PODUS SYS AD MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.00","33118477","BOOT MULT PODUS SYS AD LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.00","92216354","MOMETASONE FUROATE 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.00","92217791","VORICONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.10","92214902","CYCLOSPORINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.26","38305040","OBSTETRIC PANEL ","80055",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.55","92210222","LEVOBUNOLOL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"258.72","38207016","PROTEIN S FUNCTIONAL ","85306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.00","33112625","CATH DIAL Q MAHUR 13.5FR16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.00","92212364","TRETINOIN 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.05","92215005","NITROGLYCERIN 0.3MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.15","34600030","EVAL SPEECH FLUENCY ","92521GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.25","38300056","ACID PHOS SERUM TOTAL ","84060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.46","38000502","SURGICAL PATH LEVEL III ","88304",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.83","38202330","TEGRETOL-TOTAL ","80156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"259.91","38300685","T CELLS CD4 & CD8 W/RATIO ","86360",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201001","OPHTHALMICS 01 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201002","OPHTHALMICS 02 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201003","OPHTHALMICS 03 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201004","OPHTHALMICS 04 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201005","OPHTHALMICS 05 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201006","OPHTHALMICS 06 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201013","OPHTHALMICS 13 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92201016","OPHTHALMICS 16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209004","ARANESP 125MCG (100+25) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209005","ARANESP 140MCG (100+40) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209006","ARANESP 160MCG (100+60) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209018","EPOETIN A 125MCG (100+25) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209019","EPOETIN A 140MCG (100+40) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209020","EPOETIN A 160MCG (100+60) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209024","EPOETIN A 12000U(10K+2K) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209025","EPOETIN A 5000U (2K+3K) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209033","EPOETIN A 12000U(10K+2K) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209034","EPOETIN A 5000U (2K+3K) INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209062","EPOETIN A 30000U (20K+10K) IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92209074","EPOETIN A 15000U(10K+2K+3K) I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210374","MUMPS VIRUS VACCINE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210470","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210561","NUTRILYTE 20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210636","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210716","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92210778","CEFOTAXIME NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211000","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211043","PIPERONYL BUTO PYRETHRUN EXT L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211085","CEFTRIAXONE NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211119","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211301","AMIKACIN SULF 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211572","DROPERIDOL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211607","DILTIAZEM HCL 120MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211739","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211828","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211879","MEPERIDINE 75MG/1.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211906","AMPICILLIN NA 250MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92211911","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212069","BUPRENORPHINE HCL 0.3MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212176","SODIUM CL 2.5MEQ/ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212223","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212301","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212357","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212374","CAPTOPRIL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212448","DEXTROSE 40% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212472","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212494","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212672","HEPARIN 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212700","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212725","CYANOCOBALAMIN 1000MCG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212896","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212906","MEPERIDINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212921","D5W-1/4NS/KCL 30MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92212963","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213072","CA CL/DEX/NACL/NALACT IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213199","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213215","PANCURONIUM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213233","KETOROLAC 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213270","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213291","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213310","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213324","DEXTROSE 2.5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213331","D5W-1/4NS/KCL 10MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213373","D5W-1/3NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213410","D5W-1/3NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213423","D5W KCL 0.3% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213477","ARGININE 4.5GM/9.2GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213478","HYDROMORPHONE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213498","PHENOBARBITAL NA 130MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213575","CODEINE PH 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213627","MORPHINE 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213662","MITOTANE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213669","MORPHINE 8MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213683","D5W-1/2NS/KCL 30MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213691","CHROMIUM CL 4MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213717","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213743","MEPERIDINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213771","D5W-NS KCL 40MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213935","DEXTROSE 25%/WATER INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92213988","MORPHINE 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214038","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214072","PHENOBARBITAL NA 60MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214099","CA CL/KCL/NA CL IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214113","D5W-1/4NS/KCL 40MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214138","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214160","CA CL/DEX/NACL/NALACT IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214282","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214296","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214366","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214428","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214452","DEXPANTHENOL 250MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214469","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214523","HEPARIN 1000U/NS 500 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214545","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214551","LIDOCAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214565","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214585","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214635","MEPERIDINE 75MG/1.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214656","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214688","PANCURONIUM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214716","PANCURONIUM 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214802","AMMONIUM CL 5MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214850","D5W-1/4NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214877","D5W-1/2NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214972","DEXTROSE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214990","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92214996","LEUCOVORIN CALCIUM 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215019","MEPERIDINE 75MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215041","KETOROLAC 15MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215121","SODIUM CL 0.45% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215165","THEOPHYLLINE 800MG/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215171","D5W LR KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215379","DROPERIDOL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215397","AMPICILLIN-SULBACTAM 15GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215449","TOLNAFTATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215671","PAPAVERINE HCL 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215799","FAMOTIDINE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215868","PAPAVERINE HCL 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215901","HEPARIN FLUSH 1U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92215905","HEPARIN FLUSH 1U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216093","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216164","HEPARIN FLUSH 10U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216165","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216393","HEPARIN FLUSH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216467","DEXTROSE 5%/WATER INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216481","PROCAINE HCL 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216525","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216710","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216980","HEPARIN FLUSH 1U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92216982","HEPARIN 2U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92217172","EPINEPHRINE/LIDOCAINE HCL INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92217400","MENTHOL METHYL SALICYL 10-15 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92217429","LAMOTRIGINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92217600","ENALAPRILAT 1.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92217617","HYPROMELLOSE PROPY CLYCERIN SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92218018","BD POSIFLUSH 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92218045","GRANISETRON 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92218149","SIMULECT 20MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.00","92218480","ARGINAID 4.5 GM/9.2 GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.05","92215142","POTASSIUM CL 10MEQ/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.05","92216926","MORPHINE 10MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.05","92218494","SMOOTHBERY 2.1%W/V SUS2.1%SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.10","92214571","POTASSIUM CL 20MEQ/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.15","92210738","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.15","92213272","TACROLIMUS 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.15","92220157","BUPREN/NALOXONE 2MG-0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.20","92212825","FAMOTIDINE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.20","92213594","CHLORAMBUCIL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.20","92215290","LEVETIRACETAM 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.20","92217186","BUPROPION HCL 300MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.20","92217352","LEVETIRACETAM 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.25","92211979","BUPROPION HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.25","92212705","SOD CITRATE/CITRIC ACID LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.25","92216729","PRAVASTATIN NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.25","92218643","ESTRO/METHYLTEST0.625MG-1.25MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92211568","BROMOCRIPTINE MESYLATE 2.5MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92212829","NALOXONE HCL 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92214235","LABETALOL HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92216023","BARRIER SKIN PROTECTANT OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92218307","OXYMORPHONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.30","92219418","MELOXICAM 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.35","92210162","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.35","92210739","ACYCLOVIR 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.35","92214623","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.35","92215222","PRAVASTATIN NA 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.35","92216555","MELOXICAM 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92211504","NEFAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92211935","PROPOFOL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92211976","PHYTONADIONE 1MG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92215215","DEXAMETHASONE NA PH 10MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92216055","TERBUTALINE SULF 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92219385","PARICALCITOL 0.002MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92219431","OCTREOTIDE ACETATE 50MCG/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92219845","RIFAPENTINE 150 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92220023","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92220191","HALOPERIDOL LACTATE 5MG/ML SYG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.40","92220226","BENZOCAINE 10% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.45","92210281","NEOMYIN SULF/POLYMYX B/BAC Z O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.45","92217111","HEPARIN 1000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.50","92211536","BUTALB CAFF APAP 50-40-325 CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.50","92217362","DANAZOL 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.50","92218590","SALIVA SUBSTITUTE . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.55","92202007","TOPICALS 07 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.55","92210322","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.55","92216444","SENNA LEAF EXT 176MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.55","92217055","OXCARBAZEPINE 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.60","92211147","MICONAZOLE NITRATE 2% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.60","92214574","MICONAZOLE NITRATE 2% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.60","92217827","VENLAFAXINE HCL 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.65","92214834","OXCARBAZEPINE 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.70","92212585","HYDROCORTISONE NA SUCC 100MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.70","92217594","MENTHOL Z OXIDE .44%-20.625% O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.75","92212306","TIAGAINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.75","92213769","RIVASTIGMINE TARTRATE 1.5MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.75","92214013","PHYSOSTIGMINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.75","92215645","FORMOTEROL FUMARATE 12MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.85","92212634","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.90","92211282","NEFAZODONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.90","92212222","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.90","92214901","HYDROMORPHONE HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.90","92216661","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.90","92217698","ACETAZOLAMIDE 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.95","92214613","CITALOPRAM HBR 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.95","92214876","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26.95","92216615","FLUOXETINE HCL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.00","33100946","SPLINT HAND DYNAPRO FLEX LEFT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.00","33100948","SPLINT HAND DYNAPRO FLEX RIGHT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.00","33117531","KIT INTAKE PULL PEG 20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.00","92215979","DOXAPRAM HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.70","92220489","CALCIUM GLUCON-NACL 2000MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.80","92215359","VORICONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"260.94","38200880","CULTURE BLOOD ","87040",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"26025.55","92218596","TRASTUZUMAB 440 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.00","33111207","SHOE PRESSURE RELIEF SML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.00","33111208","SHOE PRESSURE RELIEF XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.00","33152382","COLLAR CERVICAL MIAMI JR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.00","38201055","SELENIUM ","84255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.35","92216459","TETANUS TOXOID 5LFU/0.5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.54","38000547","IMMUNOHISTO AB EA ADDL SLIDE ","88341",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.70","38300503","ELASTASE PANCREATIC(EL-1)FECAL","82656",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.70","92214542","LOTEPREDNOL ETABONATE 0.5% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.75","92215263","ACTIV CHARCOAL POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.75","92218621","CHARCOAL ACTIVATED PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"261.80","92219346","ICODEXTRIN PERITONEAL DIAL.SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.00","33170454","BOOT WALK II BDY ARM DARCO LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.00","33170455","BOOT WALK II BDY ARM DARCO XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.00","92217856","OCTREOTIDE ACET 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.05","38200850","CULTURE ANAEROBIC ","87075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.20","92217269","AMINO ACIDS 5% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.65","92211297","METHYLPREDNISOLONE 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"262.72","38343620","CLOTTING FACTOR X ","85260",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2625.00","33102675","FILTER VENA CAVA TRAPEASE 55CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"263.25","92219463","ATROPINE SULFATE 1% OPTH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2639.25","92219319","TBO-FILGRASTIM480MCG/1.6MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2639.30","92218232","GRANIX 480MCG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2639.30","92219321","TBO-FILGRASTIM 480MCG/0.8MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","33102545","TRAY PNEUMOTHORAX 8FRX3.5IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","33103307","SPLING ORTHO FING FLX RT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","33161401","TUBE 100MM9.2MM6MM KNK RST HLW"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","33161402","TUBE 110MM10.6MM7MM X LGTH KNK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","92213076","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","92214228","MILRINONE LACTATE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","92217038","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","92218485","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.00","92220469","AA2.36%/D6.8W/FAT/LYTES KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.40","92218488","LIDOCREAM 4% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.60","92211188","PRILOCAINE LIDOCAINE 2.5-2.5 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"264.90","92212910","FLUOCINONIDE 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"265.15","38302540","VITAMIN B-12 ","82607",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"265.15","92219641","DALFAMPRIDINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"265.38","38203500","TESTOSTERONE FREE ","84402",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"265.55","92219045","AA DEX ELEC 4.25%-5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"266.00","33195300","KIT CVC 3L 7FR X 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"266.35","92213321","PROTAMINE SULF 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"266.41","38000765","FISH EA ADDL SGL PROBE STAIN ","88369",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"266.50","92203028","ORALS 28 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"266.50","92219713","DALFAMPRIDINE ER 10 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2666.45","92219234","CONJUGATED ESTRGN0.625MG/GMCRM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.00","33114976","TRAY PICC 2L NITINOL 5FR-55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.00","33198081","STK JOB KNEE 20-30MMHG US LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.00","33198082","STK JOB KNEE 20-30MMHG US XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.00","33198609","KIT TRIPLE LUMEN ARROWGARD BLU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.00","92210317","CEFACLOR 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"267.01","38300696","VASOACTIVE INTESTINAL PEPTIDE ","84586",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2677.50","92213435","DALFOPRISTIN QUINU 350-150MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2678.00","92215668","POLYMYXIN B SULF 100MMU POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.00","92212600","KETOROLAC 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.10","92211342","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.10","92211707","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.15","92220492","DICYCLOMINE 10MG/1ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.25","38300124","LIPOPROTEIN ELECTROPHORESIS ","82664",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.25","92217729","ENOXAPARIN NA 60MG/0.6ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.28","38307036","LACTOFERRIN FECAL (QUANT) ","83631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.28","38399358","LACTOFERRIN FECAL QUANT ","83631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.30","92214826","INSULIN HUM ISOP/REG 50U-50U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.64","34010220","STRAPPING THORAX ","29200GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"268.71","38200405","CARCINOEMBRYONIC-(CEA) ","82378",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2686.00","92218959","GLYCOPYR/FORM FUM9MCG-4.8MGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.00","33112259","BOOT ORTHOSIS COMFY UNIVERSAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.00","33139789","PICC BIOFLOMST45VALVED5FDL20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.00","92211842","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.00","92214056","CLOBETASOL PROP 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.20","92213954","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"269.55","92211316","MINOCYCLINE HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2699.05","92211411","BETAXOLOL HCL 0.25% EYE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92203021","ORALS 21 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92212274","AMOXICILLIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92213484","THEOPHYLLINE 400MG/500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214029","DIAZEPAM 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214186","PENICILLAMINE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214215","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214677","AMOXICILLIN CLV K 875-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214690","MENTHOL METHYL SALICY 7.6-29 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214852","CYCLOPHOSPHAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92214917","TETRACAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92215032","MORPHINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92216085","URSODIOL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92216635","CARVEDILOL 40MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92217135","CIPROFLOXACIN 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92217336","OPIUM 10MG/ML TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.00","92217891","CHLORPHEN/HYDROCODONE 8-20 CER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92211992","HCTZ LOSARTAN K 12.5-50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92212471","CAMPHOR MENTHOL 0.5%-0.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92214770","SIMVASTATIN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92214792","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92215118","ESCITALOPRAM OXALATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92216538","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92216539","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92218520","FLUOXETINE 20 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92219183","RISPERIDONE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92220138","RISPERIDONE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.05","92220261","HYDRCD/APAP7.5MG-325MG/15MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.10","92214520","FLUOXETINE HCL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.15","38205089","CULTURE- GENITAL ","87070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.15","92215114","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.15","92219878","PANTOPRAZOLE DR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.17","38301320","GLUCOSE BLOOD REAGENT STRIP ","82948",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.20","92214191","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.25","92214500","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.30","92213244","HYDROCORTISONE 2.5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.30","92215750","LOSARTAN POTASSIUM 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.30","92218741","MINOIL/PETRO OPHTH 15%-83%OINT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.35","92216533","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.35","92217556","BUPROPION HCL 150MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92212431","NEFAZODONE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92212595","SAQUINAVIR MESYLATE 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92214398","MISOPROSTOL 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92218644","FAMOTIDINE 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92219909","HYDROMORPHONE 0.5 MG/0.5 ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.40","92220458","HYDROMORPH HCL 0.5MG/0.5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.45","92212772","PRAVASTATIN NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.45","92214093","HEPARIN 2000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.45","92215712","ORAJEL MOUTH SORE GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.45","92215840","ESCITALOPRAM OXALATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.45","92220000","MYCOPHENOLATE SODIUM 180MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.50","92214878","NEOSTIGMINE MS 0.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.50","92216193","NEOSTIGMINE MS 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.50","92218092","MONTELUKAST SOD 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.50","92218541","VALSARTAN 160 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.50","92220007","EPLERENONE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.54","38201610","IRON BINDING CAPACITY ","83550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.55","92213700","CLARITHROMYCIN 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.55","92215110","ACETIC ACID 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.60","92214290","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.60","92217526","DIPHENHYDRAMINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.65","92217182","AMOXICILLIN CLV K 875-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.65","92219100","BARIUM SULFATE 2% SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.70","92212583","THEOPHYLLINE 200MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.70","92215173","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.70","92219822","PARICALCITOL2 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.75","92210023","SULFADIAZINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.75","92215062","RISPERIDONE 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.80","92219038","CARBI/LEVDOPA61.25MG/245MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.85","92212817","OXCARBAZEPINE 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.85","92214734","DEXTROAMPHETAMINE SULF 10MG CE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.85","92216412","OXCARBAZEPINE 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.85","92218731","CLINDAMYCIN 150 MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.85","92219961","MYCOPHENOLATE SODIUM 180MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.90","92214947","FLUOXETINE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.90","92219267","PHYTONADIONE 1 MG/0.5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.90","92220258","CYCLOSPORINE 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.95","92214510","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27.95","92216151","VENLAFAXINE HCL 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33103167","SET GASTRO INITPLCMT ENTUIT LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33103751",""ISOLATOR STR FISTULA14X1.1X13""""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33112136","KIT DRAIN PLEURAL COMPLETE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33113082","SET GSTRM 16-18FR 18-20FR SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33152478","SET GASTRO 1ST PLCMT 16&18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33198505","TRACH BIV TTS HYPRF 6MMX9.2MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33198506","TRACH BIV TTS HYPRF 7MMX10.6MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.00","33198507","TRACH BIV TTS HYPRF 8MMX10.6MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.50","92217042","CICLOPIROX OLAMINE 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.55","92215906","OLANZAPINE 10MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"270.93","38200125","ABG ANALYSIS ","82803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2705.40","92217050","PRAMLINTIDE ACETATE 1MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2705.95","74075970","TRANSCATHETER BIOPSY ","75970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.00","92211493","DESOXIMETASONE 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.25","92217140","DICLOFENAC NA 0.1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.35","92217273","AMINO ACIDS 5% D15W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.39","38307032","HLA I B27 PHENOTYPING ","81374",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.60","92214007","CEFTAZIDIME DEXTROSE 2GM/50 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.90","92216465","DEFEROXAMINE MESYLATE 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"271.90","92220098","POLYETHYLENE GLY3350/KCL/NACL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2712.60","92215245","LEUPROLIDE ACET 7.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2718.96","76020005","TC-99M CERETEC <25 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.00","33116016","BRACE KNEE COMFYPRENE LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.00","92211701","CLONIDINE HCL 0.1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.00","92212863","DIDANOSINE 10MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.25","92212812","DESMOPRESSIN ACET 4MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.70","92217632","PRILOCAINE LIDOCAINE 2.5-2.5 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"272.95","92213888","METHOCARBAMOL 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2721.13","74200415","MRA NECK WITH CONTRAST ","70548",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27277.80","92214015","DIGOXIN IMMUNE FAB OV 40MG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33103760","DRAIN BLAKE FLAT3/4FLUT3/16TRO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33107082","PEG SAFETY 16FR DOBBHOFF ENFIT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33107083","PEG SAFETY 20FR DOBBHOFF ENFIT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33108865","DRAIN PLEUREVAC AD/PED WATER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33113027","KIT PEG 20FR SIL PUL FEN DRP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33160006","TRAY JEJUNAL WILSON COOK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33161421","KIT TRCH 80MM10MM7MM PRTX BVN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33161422","KIT TRCH 88MM11MM8MM PRTX BVN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","33176579","KIT PEG 20FR BASIC O-T-W "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.00","92212646","AMINO ACIDS 6% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.85","92217282","AMINO ACIDS 5% D25W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.90","92213339","AMOXICILLIN CLV K 400-57/5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"273.90","92217418","ACETAZOLAMIDE 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33101763","TUBE FEED MIC-KEY 5.0CM 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33107199","TUBE FDG GAS MIC-KY 1.7CM 14F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33113980","TUBE FDG GAS MIC-KEY 3.0CM 24F"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33114260","KIT GAST MIC-KEY LP 4CM 16F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33117546","SYSTEM FECAL MGMT/DIGNISHIELD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33118458","TUBE FDG GAST MIC-KY 3.5CM 20F"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33170465","KIT GASTROS MIC-KY 2.3CM 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.00","33198515","TUBE FDG GAS MIC-KY 2.5CM 20FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.15","92220360","IOHEXOL 64.7% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.20","92218722","BREXPIPRAZOLE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.35","92212770","INSULIN LISPRO RCMB 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.54","72060020","FFP 8-24HRS-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"274.57","72060003","FFP<8HRS-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.00","92213676","LACTATED RINGERS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.00","92214643","GRANISETRON HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.00","92214675","ACETYCHOLINE CL 20MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.00","92215011","METHYLDOPATE 250MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.01","34600034","BEH QUAL ANALYSIS VOICE/RESON ","92524GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.37","38201472","HEPATITIS B CORE ANTIBODY ","86704",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"275.55","92215105","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2752.25","92215489","MAFENIDE ACET 85MG/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2754.64","74210028","MRA ABDOMEN W/O CONT ","74185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2756.90","92214966","HYDROCORTISONE ACET 10% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.00","33110332","TRAY SHOULDER ARTHROSCOPY 4576"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.26","72000228","TRANS-REACTION INVESTIGAT ","86078",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.30","92213854","GELATIN SPONGE SPG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.36","34600032","EVAL SOUND PROD/LANG COMP EXP ","92523GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.70","92217260","AMINO ACIDS 5% D20W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"276.75","92219940","ATOVAQUONE 750 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2761.15","92217949","GANCICLOVIR 0.15% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.00","92217170","SULFACETAMIDE NA S 10%-5% SOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.05","92217275","AMINO ACIDS 5% D15W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.20","92214088","LEUCOVORIN CALCIUM 10MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.50","92215627","ARIPIPRAZOLE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.50","92216161","ENTECAVIR 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.50","92218280","ABILIFY 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.50","92219249","LIPIDS 20% 0.2 EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"277.85","92214604","TEMOZOLOMIDE 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2770.51","74200130","MRI LUMBAR SP W/CONTRAST ","72149",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33103304","SPLINT ORTHO FING FLX RT LT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33103305","SPLINT ORTHO FING FLX LT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33103306","SPLING ORTHO FING FLX LT MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33103308","SPLINT ORTHO FING FLX LT SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33114180","SPLINT FINGER RT ADLT SMD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33153644","BOOT ANKLE CONTRACTURE SMALL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.00","33153645","BOOT ANKLE CONTRACTURE LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.20","92212459","CLINDAMYCIN PHOS 1% PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.31","38302384","THYROID STIMULATING IMM GLOB ","84445",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.35","92217344","PRENATAL VITAMINS KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.70","38000580","IMMUNOFLUORESCENCE ","88346",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.70","38200495","CERULOPLASMIN ","82390",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.80","92214294","AMINO ACIDS 15% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.90","92219707","CARIPRAZINE HCL 1.5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"278.90","92220359","CARIPRAZINE 6 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2781.73","74210036","MRA CHEST W/CONT ","71555",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"27855.25","92218511","GAMUNEX-C 1 GM/10 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2788.61","74200408","MRI LOW EXT JOINT W/CONT BIL ","7372250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2788.61","74200423","MRI LOW EXT JOINT W/CONT RT ","73722RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2788.61","74200550","MRI LOW EXT JOINT W/CONT LT ","73722LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.00","33102766","KIT DRSG VAC SIMP EX GRNFM MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.00","33111084","TUBE TRACH FOAM CUFF 7MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.00","33111086","TUBE TRACH FOAM CUFF 9MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.00","33111921","TUBE TRACH BIV FMCUF ADL9.5MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.30","92217265","AMINO ACIDS 5% D20W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.45","92210475","LEVOTHYROXINE NA 0.2MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"279.75","92214783","LIDOCAINE HCL 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","38201540","HIV-1 ANTIBODY ","86701",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92211469","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92214629","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92216092","FLUOXETINE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92216266","CETIRIZINE HCL 10MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92216287","DESLORATADINE 5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92216544","THEOPHYLLINE 800MG/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92217399","HALOPERIDOL DEC 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92218083","SUBOXONE 2MG-0.5MG SL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.00","92218191","DROS/ETH ESTRAD 3MG-0.03MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92211806","CITRIC ACID NA CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92214886","PHYTONADIONE 1MG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92215853","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92216721","NITROFURAN MONO/MCR 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92218109","APRISO 0.375GM ER CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.05","92218942","NITROFUR MONOHYD 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92210294","THIOTHIXENE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92210518","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92211511","SODIUM CL 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92212088","CHOLESTYRAMINE 4GM/5.5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92213277","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92216673","SALICYLIC ACID 3%SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.10","92220106","CEFDINIR 300 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.15","92211310","SERTRALINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.15","92216810","CEFDINIR 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.15","92217036","LOPINAVIR RITONAVIR 100-25MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.15","92217569","SEVELAMER CARBONATE 0.8GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.15","92218107","DOXYCYCLINE HYCLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.20","92210180","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.20","92213865","DESLORATADINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.20","92220132","FENOFIBRATE 145 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.20","92220256","FENOFIBRATE 160 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.30","92211329","CHLORPROMAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.30","92212604","AMOXICILLIN CLV K 875-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.35","92211525","LOVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.35","92214361","CELECOXIB 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.35","92215453","RIVASTIGMINE TARTRATE 6MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.35","92218563","ACETEC ACID 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.45","92210882","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.45","92211204","PHYTONADIONE 1MG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.45","92216032","DULOXETINE HCL 60MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.46","38300111","URINALYSIS NONAUTO W/O MICROSC","81002",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.50","92213749","RIVASTIGMINE TARTRATE 3MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.55","92211020","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.55","92212533","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.55","92213793","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.55","92216356","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.60","92212716","DILTIAZEM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.60","92213009","TACROLIMUS 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.60","92213824","DEXTROSE 5%-NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.60","92214368","PREDNISONE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.65","92214170","PHENYLEPHRINE HCL 0.25% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.65","92218495","READI-CAT 22.1%SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92210174","CALAMINE PRZMOXINE HCL 8%-1% L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92212253","MEPERIDINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92213305","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92217380","BUPROPION HCL 150MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92217687","BACITRACIN 500U/30GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.70","92218743","TRANEXAMIC ACID 650 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.71","38302623","ALK PHOS HEAT STABLE ","84078",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.80","92215186","IVERMECTIN 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.80","92219507","IRON 15 MG/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.85","92212227","ATORVASTATIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.85","92214124","DIVALPROEX NA 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.87","76020017","GAB DIMEGLUMINE MULTIHANCE 1ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.90","92215311","POTASSIUM CL 20MEQ/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.95","92211244","BUTORPHANOL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28.95","92213981","CEFDINIR 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"280.00","33130929","DRAIN CHEST 14FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"280.00","92212954","HALOPERIDOL DEC 50 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"280.20","92210707","DESONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"280.92","38200060","ACTH ","82024",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2807.20","92217712","FLUTICASONE PROP 220MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.00","33105623","BRACE KNEE DEF PO COOL XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.00","33105626","BRACE KNEE DEF PO COOL REG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.05","92213906","CICLOPIROX 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.05","92217306","CEFEPIME HCL 2GM/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.20","92217247","AMINO ACIDS 4.25% D25W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.90","92211087","CEPHALEXIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.96","38300143","HUMAN HERPES VIRUS 6 PCR ","87532",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"281.96","38307038","HUMAN HERPES VIRUS 6 DNA AMP ","87532",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2810.17","74210038","MRA CHEST W/O FOL W/CONT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2810.30","92220269","SEMAGLUTIDE 2 MG/1.5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2811.77","77010015","CT ABD & PELVIS WO CONTRAST ","74176",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28130.50","92220328","FIDAXOMICIN 40 MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28147.30","92217176","OCTREOTIDE ACET 20MG PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"282.00","33103688","INTRO HEMOSTASIS VLV16.5FR13CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"282.00","92211415","CEFPODOXIME PROSETIL 100MG SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"282.90","92218160","EDURANT 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2825.53","74200210","MRI THORACIC W CONTRAST ","72147",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2829.75","92215020","ARGATROBAN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"283.80","92215107","LIDOCAINE HCL 3% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"283.80","92219439","LIDOCAINE HYDROCHLORIDE 3% SPY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"283.80","92219838","DEXMEDETOM/NACL200MCG/50MLIVPB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"283.80","92220264","DEXMEDETOMIDINE HCL4MCG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"283.95","92218705","PATIROMER 8.4 GM/PACKET POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2837.60","74200022","MRI UP EXT JOINT W/CONT RT ","73222RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2837.60","74200023","MRI UP EXT JOINT W/CONT LT ","73222LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2837.60","74200024","MRI UP EXT JOINT W/CONT BIL ","7322250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2837.86","74210029","MRA ABDOMEN W/WO CONTRAST ","74185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"284.22","34650005","EVAL APHASIA PER HR ","96105GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"284.25","92219579","CYANOCOBALAMIN 1000MCG/1ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"284.26","38201480","HEPATITIS C AB ","86803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"284.45","92218399","DERMA PHOR . TOPICAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"284.76","38300107","ANTIEPILEPTICS NOS 1-3 ","80339",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2848.80","92219477","TEMOZOLOMIDE 180 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.00","33103831","LARYNGOSC OPTICALAIRTRAQ SZ 3 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.00","33103832","LARYNGOSC OPTICALAIRTRAQ SZ 2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.50","92219109","TENOFOVIR ALAFENAMIDE 25MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.65","92204016","IV ADMIXTURE 17 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.65","92210755","TRIAMCINOLONE 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"285.95","92216185","ALENDRONATE NA 70MG/2800U TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2851.15","92213869","INTERFERON ALFA-2B 18MM U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28537.50","92218595","PERTUZUMAB 30 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2857.25","92212232","CLOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"286.71","74000006","ABDOMEN SINGLE AP VIEW ","74018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33102985","TRAY CATH MAHURKAR 3L 12F 20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33103046","TRAY CATH MAHRKR 3LUM12FRX13CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33103048","TRAY CATH MAHRKR 3LUM12FRX20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33111840","TUBE TRACH JACKSON SZ4 8ODX5.8"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33113051","TRAY CATH GRN 16CM12.5FR MHRKR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33113052","TRAY CATH GRN 16CM12.5FR MHRKR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","33152350","TRAY CATH MAHKAR 3LUM12FRx16CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.00","92210194","CHOLESTYRAMINE 4GM/9GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.10","92217731","CYANOCOBALAMIN 1000MCG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.20","92214404","FONDAPARINUX NA 2.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.50","92213089","NALBUPHINE HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.59","38201455","HEPATITIS A ANTIBODY IGM ","86709",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"287.62","76020011","TC-99M PENTETATE <25 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2877.60","74200416","MRA NECK W/WO CONTRAST ","70549",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.20","92218406","FIRST-MOUTHWASH BLM . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.35","92220119","PRAMOXINE 1% FOAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.50","92219637","PHYTONADIONE 10 MG/ML EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.65","92219034","CARIPRAZINE 3 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.65","92220509","CARIPRAZINE 3 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.75","92219475","TOLCAPONE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"288.90","92210627","BETAMETHASONE DP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2883.65","92220079","GLATIRAMER ACETATE 40MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28861.75","92217953","ROMIPLOSTIM 500MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"28890.75","92217475","LEUPROLIDE ACET 22.5MG KIT PI3"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"289.00","33133950","SYS ENT ACC SET TELE 24FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"289.00","92204019","IV ADMIXTURE 20 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"289.50","92217905","TDAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"289.81","38202290","T3 FREE ","84481",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2895.70","92212803","DIFLORASONE DIACETATE 0.05% CR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2897.30","92219273","FILGRSTM-SNDZ 480MCG/0.8MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2898.45","92217800","IBANDRONATE NA 3MG/3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","38203155","GAMMAGLOBULIN IGA ","82784",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92212832","CEFUROXIME AXETIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92212941","MEPIVACAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92213148","OFLOXACIN 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92214060","LIDOCAINE HCL 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92214091","METOCLOPRAMIDE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92215848","OFLOXACIN 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92217197","ROPINIROLE HCL 4MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.00","92220242","OXYMETAZOLINE 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.05","92213456","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.05","92217494","MOUTHWASH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.05","92219465","ASCORBICACID/ASCOR500mg/5mlSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.05","92220338","CHLORHEXIDINE GLUCONATE 4% LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.10","92216144","AMOXICILLIN CLV K 875-125MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.10","92219728","LEVALBUTEROL HCL0.63MG/3ML INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.20","92213186","DISOPYRAMIDE PHOS 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.20","92214153","QUINAPRIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.20","92216005","FLUCONAZOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.20","92218921","FLUCONAZOLE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.30","92211457","CIPROFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.30","92215701","MORPHINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.30","92218145","HYDROCOD/ACET 7.5/325MG 15ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.30","92218931","MORPHINE SULFATE 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.30","92220005","TACROLIMUS ER 0.75 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.35","92213647","FLUOXETINE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.40","92215741","CALCITRIOL 1MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.40","92219995","DOXYCYCLINE HYCLATE 100 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.45","92214689","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.48","38303585","URINE VOLUME MEASUREMENT ","81050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92213506","VERAPAMIL HCL 120MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92214944","FELBAMATE 600MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92217492","MOUTHWASH SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92219141","CETIRIZINE HYDROCHLOR 10MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92219663","CETIRIZINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.50","92219665","CETIRIZINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.55","92213920","PYRAZINAMIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.55","92216715","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.55","92216939","CITRIC ACID NA CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.60","92218478","ADDERALL 7.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.65","92210209","ARTIFICIAL TEARS 1.4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.65","92212732","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.65","92217699","DRONABINOL 2.5MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92210973","ACYCLOVIR 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92211851","ENALAPRILAT 1.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92213295","CEFOTAXIME NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92214129","ZOLPIDEM TARTRATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92214385","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92216337","OCTREOTIDE ACET 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92218569","CEFTAZIDIME 1 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.70","92220043","CYANOCOBALAMIN 1000 MCG/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.75","92210300","CEFUROXIME AXETIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.75","92215861","LANSOPRAZOLE 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.80","92215862","TOPIRAMATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.80","92215947","CIPROFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.80","92217270","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.82","38200885","C. DIFF. CULTURE (STOOL) ","87075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.85","92216578","BUPROPION HCL 150MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.95","92212182","CIPROFLOXACIN 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.95","92212214","TERBUTALINE SULF 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29.95","92213533","DANAZOL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.00","33155906","TRACH VALVE PASSY MUIR INLINE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.00","33155911","TRACH VALVE PASSY MUIR NONVENT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.25","92216866","EPHEDRINE SU 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.35","92210854","TERCONAZOLE 0.4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.65","92218889","LIPIDS 20% EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.65","92220171","LIPIDS-PLANT BASED 20% EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"290.65","92220173","LIPIDS-FISH/PLANT BASE 20% EMU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"29041.20","92213161","ALTEPLASE RECOMB 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2909.05","92216497","OPRELVEKIN 5MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"291.00","92216253","LACTIC ACID 10% VIT E 3500U C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"291.05","92211423","MOMETASONE FUROATE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"291.20","92214808","UREA 40% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"291.20","92217985","X-VIATE 40% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"291.90","92217587","HYDRALAZINE HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2910.51","76020003","IN-111 PENTETATE PER .5 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2912.60","74000892","VENOGRAM EXT BILATERAL ","75822",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"292.00","33153648","SET SUTURE GASTROINTEST ADJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"292.00","33167610","KIT PASS PEG SAF-T ENTRIS 16F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"292.00","33167611","KIT PASS PEG SAF-T ENTRIS 20F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2925.61","76078803","NM TUMOR LOCALIZATION SPECT ","78803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.00","33112788","KIT FECAL MGT SYS FLEXSEAL FMS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.00","33122954","DRSG VAC VERAFLOW MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.14","38280010","BACTERIAL ANTIGEN ","87449",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.15","92219062","BREXPIPRAZOLE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.15","92220319","BREXPIPRAZOLE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.35","92217248","AMINO ACIDS 4.25% D10W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.50","92214543","FENTANYL 100MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.55","92211500","TRIMETHOBENZAMIDE HCL 100MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.55","92217025","FENTANYL 100MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"293.80","92216135","ALBUTEROL SULF 90MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2931.65","92217228","INTERFERON BETA-1B 0.3MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2936.70","92216198","IPRATROPIUM BR 17MCG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161389","TUBE 110MM9.2MM 6MM UNCF FX NK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161390","TUBE 120MM10.6MM7MM UNCF FX NK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161391","TUBE 130MM11.7MM8MM UNCF FX NK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161392","TUBE 140MM12.9MM9MM UNCF FX NK"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161410","TUBE 100MM9.2MM6MM FXNKFLNGWRE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161411","TUBE 110MM10.6MM7MM FXNK FLNG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161412","TUBE 120MM11.7MM8MM FX NK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","33161413","TUBE 130MM12.9MM9MM CLIPIN OBT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.00","92216212","MOMETASONE FUROATE 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.10","92213168","HYDROCORTISONE 2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.15","92212819","FLUCONAZOLE 10MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.40","92217611","INSULIN HUM REGULAR 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.40","92217714","INSULIN HUM ISOP 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.40","92217981","INSULIN HUM ISOP/REG 70U-30U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.50","92212979","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"294.70","92216204","ESOMEPRAXOLE NA 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2940.25","92213242","INTERFERON BETA-1B 0.3MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"295.00","33101665","KIT FECAL MGMT FLEXI-SEAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"295.00","33117510","TRAY CVC 3 LUMEN 12FRX16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"295.00","92216918","THROMBIN 5000U PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"295.05","92214727","CLINDAMYCIN PHOS 1OOMG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"295.25","38300249","HIV-1 PROBE&REVERSE TRANSCRIPT","87535",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2952.08","74210101","MRI UPPER EXT W/WO CONT LEFT ","73220LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2952.08","74210102","MRI UPPER EXT W/WO CONT RT ","73220RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2952.08","74210103","MRI UPPER EXT W/WO CONT BILAT ","7322050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"296.00","92214620","CEFPROZIL 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"296.05","92218766","NYSTATIN PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"296.20","92218425","LATUDA 80 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"296.40","92216162","ENTECAVIR 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"296.45","92212802","BRIMONIDINE TARTRATE 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","33102943","ORTHOSISFOOTMPO2000 ACTIVEMED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","33108370","STPLR MULTIFIRE PREM 35W SKIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","33194447","ORTHOSIS FOOT MPO 2000 ACT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","92204040","IV ADMIXTURE 40 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","92211249","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","92219308","BACITRACIN 500 U/GM OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.00","92220139","OMEPRAZOLE 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.05","92212630","RITONAVIR 80MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.35","92215816","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.45","92212735","IOPAMIDOL 61% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.80","92217163","ENFUVIRTIDE 90MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"297.84","38303095","HEAVY METAL SCREEN ","83015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2976.90","92216443","CONIVAPTAN HCL 20MG/4ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.25","92215628","CAPECITABINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.30","92212842","CLOTRIMAZOLE BETAMETH 1-0.05 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.40","92219473","VEMURAFENIB 240 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.71","38000030","CELL BLOCK INTERP COMPLETE ","88305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.71","38000095","BONE MARROW BX INTERP ","88305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"298.71","38000503","SURGICAL PATH LEVEL IV ","88305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2980.30","76000250","NM BRAIN SPECT ","78607",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2982.77","74200400","MRI PELVIS W/ CONTRAST ","72196",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2984.95","92218588","IBUTILIDE 0.1 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.00","33117505","TRAY PNEUMOTHORAX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.00","33153002","STENT INLAY OPTIMA 6FRx28CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.00","33171337","STENT INLAY OPTIMA 6FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.00","33171338","STENT INLAY OPTIMA 6FRX22CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.00","33171339","STENT INLAY OPTIMA 6FRX24CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.10","92214841","PROPOFOL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","38300108","ANTI-PLATELET IB/IX AB ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","38300109","ANTI-PLATELET IA/IIA AB ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","38300127","ANTI-PLATELET IIB/IIA AB ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","38300200","ANTI-PLATELET ANTIB ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","38303776","HEPARIN INDUCED ANTIBODY ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.56","72000800","PLATELET ANTIBODY ID ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"299.62","34000670","LOWFREQUENCY NONTHERMAL US/DAY","97610GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"2990.00","33114970","GRAFT MATRIX DUREGEN PLUS 2X2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","38201501","RUSSELL VIPER VNM TIME-DIL ","85613",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92211908","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92213813","CA CL/KCL/MGCL/NA ACE/NACL INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92213819","CA CL/KCL/MGCL/NA ACE/NACL INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92214472","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92214806","PILOCARPINE HCL 4% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92214819","PILOCARPINE HCL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92215580","ESMOLOL HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92216303","ZOLPIDEM TARTRATE 12.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.00","92217784","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.10","92213684","NYSTATIN 100000U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.10","92217204","ROPINIROLE HCL 4MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.10","92217573","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.10","92219614","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.10","92220144","DIPHENHYDRAMINE12.5 MG/5 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.15","92214396","GENTAMICIN 80MG/NS 100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.15","92215049","FAMOTIDINE 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.20","92220341","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92212620","PRAMIPEXOLE DIHCL 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92213620","CYCLOSPORINE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92215604","BENZOCAINE 20% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92215693","ALFUZOSIN HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92216209","CYCLOSPORINE MOD 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92218176","CLINDAMYCIN 300MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92218408","CYCLOSPORINE 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92219076","RISPERIDONE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.25","92219768","RISPERIDONE ODT 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.30","92211854","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.30","92215146","LIDOCAINE 2%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.30","92215371","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.30","92216215","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.35","92212466","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.35","92219880","TELMISARTAN 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.40","92211597","DOXYCYCLINE HYCLATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.40","92213727","RISPERIDONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.42","92215100","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.45","92212305","DOXYCYCLINE HYCLATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.45","92215022","NITROGLYCERIN 0.1MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.50","92211294","SIMVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.50","92213341","SIMVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.55","92211640","CEFTAZIDIME 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.60","92216447","NIACIN 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.65","92215164","PAROXETINE HCL 12.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.65","92217899","ATORVASTATIN CALCIUM 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.70","92210348","TRIAMCINOLONE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.75","92210602","NAPHAZOLINE HCL 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.75","92211362","HYDROCORTISONE 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.75","92217653","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.75","92220335","BENZAL/BENZO/ZINC 0.02-20-0.1%"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.80","92211384","SODIUM ACETATE 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.80","92214259","OXYCODONE HCL 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.80","92215209","FLUCONAZOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.80","92220349","OXYCODONE HCL 5 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.85","92212262","QUETIAPINE FUMARATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.85","92213318","OXCARBAZEPINE 300MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.85","92219215","TELMISARTAN 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.88","38302229","SPECIFIC GRAVITY (NON-URINE) ","84315",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30.90","92218334","VALACYCLOVIR 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33101126","BIVONA HYPERFLEX ADJUST TRACH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33102905","HELMET SOFTSHELL FULL COVG MED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33103761","HELMET SOFT SHELL BLUE LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33105370","TRACHEAL AIRTUBE BIVONA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33108555","TUBE TRACH BIVONA #8 8X11MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33108737","TRACH BIV9 HYPFLX 9MMIDX12.3MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33108738","TRACH BIV6 HYPFLX 6MMIDX11MMOD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33110020","TUBE TRACH TTS 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33152834","HELMET PROT BLU SFTSHL SM FULL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33170615","HELMET SOFT SHELL FULL CVG XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","33177593","TUBE TRACHEAL AIR BIVONA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.00","92215459","EPOETIN ALFA 3000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.10","92210225","ESTRADIOL 0.0375MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"300.45","92211919","AMPHOTERICIN B 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3003.30","92220410","TOLVAPTAN 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3008.27","76000180","NM ABSCESS LOCAL WHOLE BODY ","78806",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.00","92210082","METHYLPREDNISOLONE ACET 80MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.00","92214473","BENZOYL ERYTHROMYCIN 5%-3% GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.41","38000080","TISSUE BLOCK-FROZEN SECTION ","88331",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.45","74000023","SHOULDER 1 VIEW BILATERAL ","7302050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.45","74010092","SHOULDER 1 VIEW RT ","73020RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.45","74010093","SHOULDER 1 VIEW LT ","73020LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"301.60","92217596","NICARDIPINE HCL 25MG/10ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3011.10","92219515","DASATINIB 80 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3011.10","92219518","DASATINIB 140 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3011.10","92219519","DASATINIB 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3015.89","74200413","MRA HEAD W/WO CONTRAST ","70546",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.00","33120110","TRAY CVC FLXTP ARD BLUE+ 7FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.00","33193973","TRAY CVC MULTI LUMEN 30CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.20","38300263","DONOR SPEC AG CLASS 1 ","86807",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.20","38300264","DONOR SPEC AG CLASS 2 ","86807",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.30","92216911","FLUNISOLIDE 0.025MG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.50","92218178","FIRST-BXN MOUTHWASH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"302.60","92211171","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"303.00","33103278","SYSTEM CASTING TCC-EZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"303.00","33106340","SYS TOT CON TCC-EZ NO BOOT 3IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"303.00","33108651","TRAY CVC W/12FR-20CM 3LUM CATH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"303.00","92204014","IV ADMIXTURE 15 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"303.60","92217179","METHYLNALTREXONE 12MG/0.6ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"304.00","33106307","KIT CATH CV 7FR 18GA 6IN 3 LUM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"304.00","92214592","METHYLPREDNISOLONE ACET 40MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"304.50","92217814","AMIODARONE HCL 360MG/200ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"304.80","92211783","ZOLMITRIPTAN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"304.85","92210213","LEVOTHYROXINE NA 500MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3047.95","92210372","IMMUNE GLOBULIN 5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3049.20","92218764","BACLOFEN 20000MCG/20MLINJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"305.00","33198237","TRAY CHEST TUBE INSERTION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"305.40","92218141","OMNIPAQUE 300 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3052.80","92204054","IV ADMIXTURE 54 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"306.00","33118478","BOOT MULT PODUS SYS AD XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"306.00","33189599",""CUSHION CMFRTSTRTEQUAGEL22X18""""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"306.70","92219835","CLONIDINE 0.2MG PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3065.05","92214354","DARBEPOETIN A 60MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3065.05","92215572","DARBEPOETIN A 60MCG/0.3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3065.80","77000033","CTA ABD & PELVIS W/WO CONTR ","74174",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3066.00","11600510","PIC LINE INSERTION ","36569",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3066.00","61010202","INSERT PICC LINE (NO PORT) ","36569",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3069.00","92212548","DACLIZUMAB 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3069.53","74200410","MRI ORBIT-FACE-NECK W/WO CONTR","70543",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"307.00","33113036","AMNIOBAND MEMBRANE 4CMX4CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"307.35","38301416","H.PYLORI NON-RADIO ISO ","83013",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"307.35","38303850","H.PYLORI-BREATH TEST ANALYSIS ","83013",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"307.65","92211540","LIDOCAINE HCL 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"307.95","92218378","PRECEDEX 4 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3071.31","74001124","DISCOGRAPHY LUMBAR ","72295",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3071.45","92218096","DEHYDRATED ALCOHOL 98%/3ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3079.70","74200301","MRI LOWER EXT W/CONTRAST LT ","73719LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3079.70","74200406","MRI LOWER EXT W/CONTRAST BIL ","7371950",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3079.70","74200422","MRI LOWER EXT W/CONTRAST RT ","73719RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"308.00","33117518","KIT CVC PRESSURE INJECTABLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"308.60","92217788","ACETAMINOPHEN 10MG/ML 100ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"308.70","38301685","LEGIONELLA AG-DFA ","87278",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"308.75","92213156","ENOXAPARIN NA 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"30819.40","92217181","OCTREOTIDE ACET 30MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3086.65","92217245","ESMOLOL HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.00","33113046","KIT PEG 20FR4.47MM FDTB INSWRE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.00","33122417","KIT PEG 20FR PULL METHOD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.00","92214580","AMINO ACIDS 6.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.00","92215296","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.30","92217288","AMINO ACIDS 2.75% D10W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.80","92213491","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"309.95","92218527","NITROFURANTOIN 25MG/5ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3097.48","74200307","MRI LOW EXT JNT W/WO CONT LT ","73723LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3097.48","74200424","MRI LOW EXT JNT W/WO CONT BIL ","7372350",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3097.48","74200551","MRI LOW EXT JNT W/WO CONT RT ","73723RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","38200790","REPTILASE TIME TEST ","85635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","38205068","VITAMIN C (ASCORBIC ACID) ","82180",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92210253","CEFADROXIL 250MG/5ML PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92210579","PAPAVERINE HCL 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92211019","THEOPHYLLINE 400MG/500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92212870","OFLOXACIN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92213000","OXANDROLONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92213043","GENTAMICIN SULF 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92213976","CEFDITOREN PIVOXIL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92214037","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92214066","GLYCOPYRROLATE 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92214973","DIMENHYDRINATE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92215138","FELBAMATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92215149","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92215918","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92216183","DEXTROSE 10%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.00","92218098","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.05","92212333","CHLOROQUINE PH 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.05","92213429","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.05","92215820","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92211403","MOUTHWASH 474ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92213403","MONTELUKAST NA 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92215298","OLMESARTAN MEDOXOMIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92215332","MONTELUKAST NA 4MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92217656","DEXTROSE 5%-NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92218208","PAROEX 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92219919","CARBOXYMETH/GLYC 0.5%-0.9% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.10","92219968","ITRACONAZOLE 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.15","92217597","LANSOPRAZOLE DR 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.20","92210837","LANSOPRAZOLE 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.20","92211934","LANSOPRAZOLE 15MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.20","92217428","LAMOTRIGINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.25","92210710","BENZOYL PEROXIDE 5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.25","92217490","NEBIVOLOL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.25","92217657","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.25","92217826","LEVOFLAXACIN D5W 250MG/50ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.30","92216040","MORPHINE 30MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.30","92219259","VANCOMYCIN HCL 50 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.35","92203002","ORALS 02 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.35","92210996","ZIND OXIDE MENTHOL POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.35","92213308","MONTELUKAST NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.40","92218474","ZINC 16% CASTER/BALSM/PETROLM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.45","92214174","LIDOCAINE 2%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.45","92214911","MONTELUKAST NA 4MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.50","92214133","DROPERIDOL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.50","92218614","MORPHINE SULFATE 30 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.55","92211903","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.55","92214511","OXYCHLOROSENE NA 2GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.55","92217753","OXYCODONE HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.60","92217453","RISPERIDONE 1MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.65","92203023","ORALS 23 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.65","92218738","TEMAZEPAM 7.5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.70","92211533","DOXYCYCLINE HYCLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.70","92213054","CIPROFLOXACIN 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.70","92214815","PILOCARPINE HCL 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.70","92219355","VITAMIN A/VITAMIN D OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.70","92220103","BENZOCAINE/MENTHOL20%-0.26%GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.71","34000305","DIATHERMY ","97024GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.71","34210335","DIATHERMY ","97024GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.75","92215771","EPLERENONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.75","92219823","MICONAZOLE 2% PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.80","92217566","BENZOCAINE MENTHOL 20%-0.5% SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.80","92218592","VSL#3-DS 900 BILLION ORG/PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.80","92219238","BENZO/BENZETHON CHL20%0.2%SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.85","92214839","COAL TAR 0.5% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.85","92217704","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.85","92219194","PANCREAZE 16 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.85","92219564","ARTIFICIAL TEARS0.5-0.6%(15ML)"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.90","92204027","IV ADMIXTURE 28 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.90","92216963","NAPHAZOLINE/PHEN .027- .315% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.95","92212993","BUPRENORPHINE NAOLXONE 2-0.5 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.95","92218363","DESVENLAFAXINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"31.95","92219391","VANCOMYCIN HCL 25 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.00","33149606","PACK BASIC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.00","92215792","SULFACETAMIDE NA 10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.00","92215793","SULFACETAMIDE NA 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.27","74000390","FOOT 2 VIEWS BILATERAL ","7362050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.27","74010057","FOOT 2 VIEWS RT ","73620RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.27","74010058","FOOT 2 VIEWS LT ","73620LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.75","92217043","CICLOPIROX OLAMINE 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"310.90","92213035","HALOPERIDOL DEC 50 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3101.20","74210100","MRI CHEST W/WO CONTRAST ","71552",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3106.85","92204036","IV ADMIXTURE 36 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"311.00","33117150","SLING KNEE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3117.72","74210027","MRA ABDOMEN W/CONT ","74185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3119.65","92218077","FOSCAVIR 24MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.10","92217781","LURASIDONE HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.10","92218313","LATUDA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.10","92218345","LATUDA 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.10","92218349","LATUDA 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.10","92219692","EPHEDRINE SULFATE 50 MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.23","74000060","ANKLE 2 VIEWS BILATERAL ","7360050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.23","74010003","ANKLE 2 VIEWS RT ","73600RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.23","74010004","ANKLE 2 VIEWS LT ","73600LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.55","92216219","SILDENAFIL CITRATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"312.80","92214646","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3128.80","92215781","AMINOCAPROIC ACID 25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"313.00","92214485","METHYLPREDNISOLONE ACET 80MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"313.37","38000650","FINE NEEDLE ASP INTERPRET ","88173",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"313.60","92218825","PHYTONADIONE 10 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33112087","SPLINT HAND REST AIR RT MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33112240","SPLINT HAND REST RIGHT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33112241","SPLINT HAND REST LEFT LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33131158","SPLINT AIRSOFT REST HAND SM LT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33131159","SPLINT AIRSOFT REST HAND SM RT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","33195410","KIT PNEUMOTHORAX NO HEIML VALV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.00","92212619","SULFACETAMIDE NA S 10%-5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.05","92210230","BETAMETHASONE VA 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.90","92213528","CARTEOLOL HCL 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"314.90","92215842","ALENDRONATE NA 70MG/75ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"315.00","33109917","CUTTER PROX LINEAR W/LOCK 75MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"315.00","33110333","TRAY RC SPINE 4576 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"315.00","33139776","PICC BIOFLO HY PG 6F TL-55cm "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"315.10","92210940","NITROPRUSSIDE 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"315.20","92216888","TDAP VACCINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3159.33","74200013","MRI LOW EXT W/WO CONTRAST RT ","73720RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3159.33","74200407","MRI LOW EXT W/WO CONTRAST BIL ","7372050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3159.33","74210014","MRI LOW EXT W/WO CONTRAST LT ","73720LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.00","33102530","WEDGE VALU-FORM 10X20/22 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.05","74000900","WRIST 2 VIEWS BILATERAL ","7310050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.05","74010110","WRIST 2 VIEWS RT ","73100RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.05","74010111","WRIST 2 VIEWS LT ","73100LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.65","92215131","FLUOCINONIDE 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"316.80","92214420","PENICILLIN G NA 5MMU INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"317.45","92218330","VANCOMYCIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"317.45","92219778","VANCOMYCIN 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"317.50","92219028","VANCOMYCIN HCL 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3171.30","92217871","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3178.93","74210104","MRI UP EXT JOINT W/WO CON LT ","73223LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3178.93","74210105","MRI UP EXT JOINT W/WO CON RT ","73223RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3178.93","74210106","MRI UP EXT JOINT W/WO CON BIL ","7322350",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.00","33112541","HELMET HARD SHELL BLUE LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.00","33157040","HELMET HARDSHELL BLUE XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.00","33157041","HELMET HARD SHELL BLUE MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.00","33157042","HELMET HARDSHELL BLUE SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.05","92220413","INSULIN GLAR RECOM 100U/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.40","74071010","CHEST 1 VIEW FRONTAL ","71045",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.70","92210164","ALBUTEROL SULF 5MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.75","92220076","AMINO ACIDS 6%-5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.85","92216633","ATAZANAVIR SULF 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"318.89","38302206","INFLUENZA AB PCR ","87502",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"319.00","33112086","SPLINT HAND REST AIR LEFT MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"319.40","38307024","DRUG TEST PRSMV CHEM ANLYZR ","80307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"319.90","92214530","LEVOFLOXACIN 750MG/150ML D5W I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","38303370","PORPHOBILINOGEN URINEQUAL ","84106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92211391","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92211718","TIAGAINE HCL 12MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92212311","LANSOPRAZOLE 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92212376","LANSOPRAZOLE 15MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92213317","ESOMEPRAXOLE MG 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92213334","ESOMEPRAXOLE MG 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92213773","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92213990","DEXTROSE 10%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92214127","EPHEDRINE SU 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92214817","DIDANOSINE 200MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92215172","PAROXETINE HCL 25MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92215281","OLMESARTAN MEDOXOMIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92216251","BUPROPION HCL 300MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92217143","CLOZAPINE 100MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92217205","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.00","92220293","PETROLAT/RESORCINOL 55%-2%OINT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.05","92210993","LANSOPRAZOLE 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.05","92212872","MEBENDAZOLE 100MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.05","92220345","MANNITOL 25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.10","92217491","MENTHOL METHYL SALICYL 10-15 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.10","92217819","ZIDOVUDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.10","92220462","CLARITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.15","92213265","MIRTAZAPINE 30MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.15","92215093","ESCITALOPRAM OXALATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.15","92217020","PENTOXIFYLLINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.15","92219722","CLARITHROMYCIN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.25","92211414","DIACETAZONE CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.25","92216431","ZOLPIDEM TARTRATE 6.25MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.25","92217864","QUETIAPINE FUMARATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.30","92210107","ALBUTEROL SULF 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.30","92210381","ALBUTEROL SULF 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.30","92211509","TESTOSTERONE 2.5MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.30","92211656","ALBUTEROL SULF 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.30","92211671","ALBUTEROL SULF 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.35","92211937","TETRAHYDROZOLINE HCL 0.05% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.35","92212569","FOLIC ACID 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.35","92218717","OXYMORPHONE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.40","92215953","OXYMETAZOLINE HCL 0.05% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.40","92218575","METAXALONE 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.40","92219525","METAXALONE 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.45","92214080","BENZOCAINE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.45","92217026","LANSOPRAZOLE 15MG TDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.52","38203030","FUNGI MOLD ID ","87106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.55","92213797","RANITIDINE HCL 1MG/1ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.55","92214148","LIDOCAINE 1.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.60","92210869","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.60","92220166","DULOXETINE 30 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.65","92214495","RISPERIDONE 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.65","92220122","TROLAMINE SALICYLATE 10% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.67","38303580","URINE MICRO ","81015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.70","92217655","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.75","92210520","NITROGLYCERIN 0.2MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.75","92215015","NITROGLYCERIN 0.2MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.80","92215907","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.85","92211115","THEOPHYLLINE 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.85","92213325","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.85","92219966","VALACYCLOVIR 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.85","92220058","FLECAINIDE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.90","92210112","ATROPINE SULF 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.90","92210285","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.90","92217517","LAMOTRIGINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.95","92212206","CARVEDILOL 3.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.95","92215169","PAROXETINE HCL 37.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.95","92219393","CLOTRIMAZOLE 1% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.95","92220347","MICONAZOLE NITRATE 2% PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"32.95","92220363","WOUND WASH SALINE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.00","33109647","SPLINT ELBOW KNEE MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.15","92213707","ISOPROTERENOL HCL 0.2MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.25","92214371","MEDROXYPROGESTERONE 150MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.56","92217638","DIANEAL 1.5% DEXTROSE IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.61","34010250","STRAPPING KNEE ","29530GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"320.81","72000310","RBC ELUTION ","86860",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3207.60","92218283","COPAXONE 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33103699","TURN POSITION PREVALON 2.0 PAD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33112229","CATH NIAGARA SLIM STR DL 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33112895","CATH DIAL NIAG STR DL 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33112896","CATH DIAL NIAG/SUT DL 135FRX24"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33113090","TRAY CATH 20CM14FR PU 2FLW 400"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33113091","TRAY CATH 24CM14FR2FLW400XL IJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","33177272","TRAY HEMOD MUHURKAR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.00","92212387","COCAINE 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.10","92219036","ATROPINE SULFATE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.50","74000480","KNEE 1-2 VIEWS BILATERAL ","7356050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.50","74010073","KNEE 1-2 VIEWS RT ","73560RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.50","74010074","KNEE 1-2 VIEWS LT ","73560LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.83","74076012","EYE FOR FOREIGN BODY ","70030",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"321.95","92220075","AMINO ACIDS 8%-10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3211.83","77010016","CT ABD & PELVIS W/CONTRAST ","74177",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"322.00","33105675","KIT TRACH CFFD AD 5.6MM ID "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"322.00","33152384","KIT PERTRACH 5.6MMx6.8CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"322.15","74001189","SPINE-SINGLE VIEW-SPECIFY LEVL","72020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"322.30","92213626","ZINC SULF 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3220.50","92213853","BRINZOLAMIDE 1% EYE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3222.45","92220133","TOLVAPTAN 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3223.00","36000945","VENTILATOR SUBSEQUENT DAILY ","94003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3223.75","92219264","DEGARELIX ACETATE 80 MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3228.85","74200020","MRI BRAIN W/WO CONTRAST ","70553",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"323.12","38200212","PROTEIN C ACTIVITY ","85303",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"323.20","92211170","PHYTONADIONE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"323.40","92217912","SUMATRIPTAN SUCC 6MG/0.5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"323.90","92218361","LINEZOLID 2 MG/ML IV "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.12","74000835","TOE(S) 2+ VIEWS BILATERAL ","7366050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.12","74010100","TOE(S) 2+ VIEWS LT ","73660LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.12","74010105","TOE(S) 2+ VIEWS RT ","73660RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.23","38207004","HIV1 & HIV2 SINGLE ASSSAY ","86703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.50","92214423","LEVOFLOXACIN IV 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.55","92217070","GRANISETRON HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"324.60","92217073","GRANISETRON HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3248.00","92215600","DALTEPARIN NA 25000/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"325.00","92214859","CEFADROXIL 500MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"325.05","74000350","FINGER(S) 2+ VIEWS BILATERAL ","7314050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"325.05","74010051","FINGER(S) 2+ VIEWS LT ","73140LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"325.05","74010052","FINGER(S) 2+ VIEWS RT ","73140RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"325.70","92218641","HALOPERIDOLDECANOAT100MG.MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3250.61","74200425","MRI ABDOMEN W/WO CONTRAST ","74183",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"326.00","33112702","COLLAR CERV ASPEN ADULT 3IN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"326.00","92214455","CARBACHOL 1.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"326.70","92213772","RANITIDINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3261.14","74200401","MRI PELVIS W/WO CONTRAST ","72197",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"327.00","33106365","TRAY CVC 3LUMEN 7FR VANTEX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"327.00","33114996","KIT CATH PWRGLD PRO RT18Gx10CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"327.00","33138341","DRSG MEPITEL AG 8x20 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"327.30","92217680","RIFAXIN 550MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"327.80","92219451","CITRIC ACID/POT CIT/SOD CITLIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.20","92217961","CYCLOPENTOLATE HCL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.30","92215212","EPOETIN ALFA 3000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.49","74000139","CHEST SPECIAL VIEWS ","71046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.49","74000140","CHEST 2 VIEWS FRONTAL & LAT ","71046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.80","92212210","FLUOCINONIDE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.94","74000421","HIP 1 VIEW UNILATERAL RT ","73501RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"328.94","74001411","HIP 1 VIEW UNILATERAL LT ","73500LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3280.10","92218222","BONIVA 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3280.25","92219636","OSIMERTINIB MESYLATE 80 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"329.00","33103759","HEMOSTAT SRGCLABS FIBRILLAR2x4"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3291.10","92218136","SANCUSO 301MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92211095","GLYCERIN/PHENO/NA BIC/NA BOR S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92211234","DIBUCAINE 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92213126","METHYLTESTOSTERONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92213864","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92214517","METHYLPREDNISOLONE 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92214828","FORMOTEROL FUMARATE 12MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92215919","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92216222","HYDROXOCOBALAMIN 1000MCG/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.00","92217683","DIBUCAINE 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.05","92210894","PHENOL 1.4% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.05","92218231","BUPRENORPHINE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.09","38200555","CHOLESTEROL - DIRECT LDL CHOOL","83721",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92211033","FLUPHENAZINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92211124","ZIDOVUDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92212816","CLARITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92217628","CLARITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92217675","LACTATED RINGERS D5W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.10","92218303","TAPENTADOL ER 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.20","92214419","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.20","92220425","TRIAZOLAM 0.125 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.25","92215903","DUTASTERIDE 0.5MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.30","92212368","ROPINIROLE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.31","38203585","URINE VOLUME MEASUREMENT ","81050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.35","92211553","GLYCERIN LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.35","92215187","RAMIPRIL 1.25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.35","92220184","PIPERON/PYRETH 4%-0.33% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.40","92214198","LOSARTAN POTASSIUM 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.40","92215241","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.45","92215666","BUPROPION HCL 150MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.50","92218126","PROTONIX 40MG IV "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.55","38303736","OCCULT BLOOD- OTHER SOURCES ","82271",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.55","92211709","AMOXICILLIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.55","92212729","AMOXICILLIN CLV K 500-125 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.60","92212579","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.60","92215205","LIDOCAINE 0.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.60","92220354","ZINC OXIDE 40% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92210200","TRIAMCINOLONE 0.025% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92210580","FLUVASTATIN NA 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92216304","ZOLPIDEM TARTRATE 12.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92216308","ZOLPIDEM TARTRATE 6.25MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92216933","NICOTINE POLACRILEX 4MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.65","92220283","MESALAMINE 400 MGECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.70","92211400","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.70","92212398","CARBAMAZEPINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.70","92218234","AMPHET SALT COMB 25MG ER CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.70","92218259","AMPHETAMINE SALTS 15MG ER CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.70","92220302","AMPHETAMINE SALT COMB 30MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.75","92217570","SEVELAMER CARBONATE 2.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.75","92217740","INFLUENZA VACC 2010-11 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.75","92217952","CLARITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.80","92216512","HCTZ VALSARTAN 25-320MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.80","92220102","DOXYCYCLINE HYCLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.83","38303125","HGB FRACTIONATION BY HPLC ","85461",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.85","38307001","ENZYME DETECTION PER ENZYME ","87185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.90","92214033","POTASSIUM CL 40MEQ SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.90","92218723","FAMOTIDINE/NACL 20MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.90","92219317","TACROLIMUS ER 1 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.90","92219785","BARIUM SULFATE 60% SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33.98","92216201","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"330.00","33139795","PICC BIOFLOMST45VLVDLD3FSL55CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"330.00","33199565","SET G TUBE ANCHOR W/T FASTNR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"330.25","92210691","NEOMYIN SULF/POLYMYX B/DEXAM S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"330.60","92214827","MEDROXYPROGESTERONE 150MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3308.75","92210477","FILGRASTIM 480MCG/1.6ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"33096.75","92215273","ETHACRYNATE NA 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"331.00","92216954","CICLOPIROX 8% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"331.80","74000749","SINUSES < 3 VIEWS ","70210",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"331.85","92216493","CASTOR/PERU BALSAM/TRYPSIN GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3315.85","92218773","GLYCERIN 99.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.00","38202080","RAPAMYCIN (SIROLIMUS) ","80195",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.00","38280053","COMPREHEN METABOLIC PANEL ","80053",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.10","92218199","CLOBAZAM 20MG/8ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.30","92220407","BARIUM SULFATE 40% PUD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.34","38300180","ANTIBODY IDENT EA PANEL ","86870",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.34","72000020","ANTIBODY IDENT EACH PANEL ","86870",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"332.65","92218128","BINOSTO 70MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3325.10","92215643","SUMATRIPTAN 20MG NASAL SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3326.00","92214402","LEPIRUDIN 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3327.00","92215809","PEGINTERFERON ALFA-2A 180MCG K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.00","33130409","HELMET HARD TOP COMFY CAP MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.00","33130410","HELMET HARD TOP COMFY CAP LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.09","38000621","SLIDE REFERAL W/SLD PREP-CONS ","88323",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.10","92204030","IV ADMIXTURE 31 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.25","92220278","INSULIN LISPRO 100 U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.55","92210705","SULFACETAMIDE NA 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"333.60","92220073","AMINO ACIDS 8%-10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3333.95","92214926","ADVAIR 500-50 DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3335.85","92215525","ZOLEDRONIC ACID 4MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.00","33102166","BRACE KNEE HINGED EXTRA LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.00","33113035","AMNIOBAND GRFT 16MM 2SQ CM DSC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.10","92215038","AZITHROMYCIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.41","74000513","MAMMOGRAM SCREEN UNILATERAL ","7706752",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.41","74000515","MAMMOGRAM SCREEN BILATERAL ","77067",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"334.95","92210892","AZITHROMYCIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"335.00","92217279","AMINO ACIDS 6% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"335.30","92215726","MOXIFLOXACIN HCL 400MG/250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"335.50","76020006","TC-99M DISOFENIN <15 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"336.00","33168140","SET GSTJEJ 200CM12FRPEG24 60CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"336.43","34000030","NON-SELECTIVE DEBRIDEMENT ","97602GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"336.95","92210997","GRAMICIDIN NEOMYCIN POLY SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3360.00","92215364","EPOETIN ALFA 40000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"337.00","92216102","LOTEPREDNOL ETAB TOBY .5-.3% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"337.12","74001321","FEMUR 1 VIEW BILATERAL ","7355150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"337.12","74001322","FEMUR 1 VIEW RT ","73551RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"337.12","74001323","FEMUR 1 VIEW LT ","73551LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"337.20","92215875","CINACALCET HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3370.99","76080039","MYOCARD PERF SGL SPECT ","78451",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.10","34010235","STRAPPING ELBOW OR WRIST ","29260GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.10","34210290","STRAPPING ELBOW OR WRIST ","29260GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.15","92211933","BETAMETHASONE DP 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.20","92210371","BETAMETHASONE DP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.35","74000260","ELBOW 2 VIEWS BILATERAL ","7307050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.35","74010039","ELBOW 2 VIEWS RT ","73070RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.35","74010040","ELBOW 2 VIEWS LT ","73070LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"338.73","74000596","NECK SOFT TISSUE ","70360",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.00","33102631","TRAY CATH MAHURKER 12FR 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.00","33102873","KIT CATH MAHURKER 12FR 13CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.00","33102874","KIT CATH MAHURKER 12.5FR 16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.00","33103844","CEMENT BONE BIOMET GREEN 1x40 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.55","92214231","EPOETIN ALFA 2000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.75","92213211","HALOPERIDOL DEC 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.80","92214645","HALOPERIDOL DEC 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"339.80","92218638","HALOPERIDOLDECAN0AT100MG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3397.70","92219471","ARFORMOTEROL TAR 15MCG/2ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3398.90","92219776","TOLVAPTAN 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.00","92212824","ALENDRONATE NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.00","92213408","LANOLIN MINERAL OIL PTR XINC O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.00","92213783","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.00","92215363","MAGNESIUM SULF 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.00","92215424","OLSAZSINE NA 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.05","92211652","NADOLOL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.05","92213289","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.05","92220361","QUETIAPINE FUMARATE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.10","92212348","ATROPINE SULF 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.10","92215109","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.10","92217034","CLINDAMYCIN PALMI HCL 75MG/5 P"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.10","92218382","CLORPACTIN WCS90 2 GM TOPICAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.15","92211355","HEPARIN 1000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.15","92213468","MORPHINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.15","92215234","CLOPIDOGREL HSO4 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.20","92218958","VALSARTAN 320 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.20","92218965","MIRTAZAPINE 45 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.25","92211664","CLARITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.25","92212166","LIDOCAINE 1%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.25","92214709","PANCURONIUM 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.30","92213699","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.30","92219808","TACROLIMUS 0.2 MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.33","38343616","PARAINFLUENZA VIRUS (IFA) ","87279",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.35","92211079","LANSOPRAZOLE 15MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.35","92212295","ATORVASTATIN CALCIUM 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.35","92213157","ESCITALOPRAM OXALATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.40","92216672","CALCITRIOL 1MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.40","92217166","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.40","92217811","VENLAFAXINE HCL 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.50","92213301","PYRAZINAMIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92213367","MONTELUKAST NA 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92214379","MONTELUKAST NA 4MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92215288","OLMESARTAN MEDOXOMIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92215433","MONTELUKAST NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92218771","CROMOLYN SODIUM 100MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.55","92220116","OLMESARTAN MEDOXOMIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.60","92210714","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.60","92211694","NUTRILYTE II 20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92210321","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92210828","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92211161","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92211490","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92211877","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92212141","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92212575","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92212617","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92213203","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92213781","DEXTROSE 5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92213882","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214309","D5LR 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214325","DEXTROSE 5%-1/3NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214388","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214501","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214594","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214649","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214807","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92214816","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92215069","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92215232","ACETIC ACID 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92215302","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92215356","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92216242","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92216532","LACTATED RINGERS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92217483","TOPIRAMATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92218210","DULOXETNE 20MG DR CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92218831","NORMOSOL-R PH 7.4 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92219358","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92219652","DEXTROSE 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.65","92220221","DEXTROSE 10% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.70","92216221","OCTREOTIDE ACET 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.75","38306028","URINALYSIS NONAUTO W/MICROSCOP","81000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.75","92212336","DIAZEPAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.75","92213348","PYRAZINAMIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.75","92213849","CEFAZOLIN 1GM/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.75","92217271","SODIUM CL 0.45% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.80","92218367","PHEN-MINOIL-PETO.25-14-74.9OIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.85","92211177","MEPERIDINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.85","92211579","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.85","92214144","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.85","92216197","FLUOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.85","92218967","LOSARTAN NA/HYD100MG12.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.90","92214341","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"34.95","92214376","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"340.56","38000630","BONE MARROW SMEAR INTERP ","85097",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"340.75","92220010","RISEDRONATE 35 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"341.55","92212688","HEPATITIS B VACC 20MCG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"342.00","33112678","TRAY CATH DIALYSIS CRV 20 CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"342.00","33115294","TRAY CVC 7FR20CM TL W OLIGON "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"342.00","38202456","VITAMIN D 25 HYDROXY ","82306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"342.10","92216271","FENTANYL 100MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"343.00","33112285","CUTTER LIN PROX W/LOCK 75MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"343.40","92214187","ALBUTEROL SULF 90MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"343.53","38000940","COMPREHENSIVE REVIEW ","88325",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3432.00","92220051","REMDESIVIR 100MG/20ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3432.00","92220052","REMDESIVIR 100 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3433.30","92217501","TOLVAPTAN 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3439.90","92215828","DARBEPOETIN A 25MCG/0.42ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"344.60","38399337","SOMATOSTATIN ","84307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"344.64","38000141","IMPRXDSE-INTRP 1 STAIN ","88342",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"344.64","38000545","IMMUNOHISTOCHEMISTRY EA AB ","88342",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"344.64","38000546","IMMUNOHISTO AB INITIAL SLIDE ","88342",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"344.70","92220054","FLU VAC ADJV 20-21 45MCG/0.5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.00","33110594","CARTRIDGE SNAP 125MMHG W/RESET"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.00","33189790","TUBE GAST PONSK NONBLN REP 20F"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.00","92212378","CEFUROXIME AXETIL 250MG/5ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.33","38203865","PROTEIN-ELECTROPHOR-OTH FLUID ","84166",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.45","74000610","CALCANEUS 2+ VIEWS BILATERAL ","7365050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.45","74010029","CALCANEUS 2+ VIEWS RT ","73650RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.45","74010030","CALCANEUS 2+ VIEWS LT ","73650LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.83","76020013","TC-99M SULFUR COLLOID <20MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"345.90","92219790","BTMETHNA-PHOS/BETAACE6MG/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"346.00","92216989","PREDNISOLONE ACETATE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"346.50","38301481","HEPATITIS C AMP. PROBE TECH ","87521",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"347.00","33117521","KIT CATH MULTI-LUMEN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"347.90","74000440","HAND 2 VIEWS BILATERAL ","7312050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"347.90","74010065","HAND 2 VIEWS RT ","73120RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"347.90","74010066","HAND 2 VIEWS LT ","73120LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"348.00","33118482","BOOT MULT PODUS ACT 2000 LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"348.02","34010210","APPLY SPLINT FINGER STATIC ","29130GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"348.02","34210275","APPLY SPLINT FINGER STATIC ","29130GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"348.15","92217278","AMINO ACIDS 2.75% D5W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3481.00","92216468","RHO D IMMUNE GLOBULIN 2500U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"349.00","92214965","SULFACETAMIDE NA S 10%-5% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"349.62","38300118","RISTOCETIN CO FACTOR ","85245",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"349.80","92219446","ERAVACYCLINE 50 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3492.41","74200260","MRI LUMBAR SPINE W/WO CONTRAST","72158",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3495.80","92218219","KENALOG 0.147MG/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3499.36","74200250","MRI CERVICAL W/WO CONTRAST ","72156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","33100150","CATH ADP DRAINAGE 24-507 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","38201100","ALCOHOLS SCREENING ","80320",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92213546","ESTRADIOL 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92213556","ESTRADIOL 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92214073","LIDOCAINE HCL 7.5% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92214474","AMOXICILLIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92215148","ESTRAMUSTINE PHOS NA 140MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92216194","GALANTAMINE HBR 8MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92216199","GALANTAMINE HBR 16MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.00","92216200","GALANTAMINE HBR 24MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.05","92217821","AZITHROMYCIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.10","92213142","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.10","92213452","CEFUROXIME NA 1.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.10","92213605","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.10","92213667","PERMETHRIN 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.10","92217840","LEVOFLOXACIN D5W 500MG/100ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.15","92215447","FAMCICLOVIR 125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.15","92215893","MYCOPHENOLATE 180MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.20","92218080","LEVALBUTEROL HCL 1.25MG/3ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.30","92211209","PYRAZINAMIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.30","92216142","CIPROFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.35","92215006","CLARITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.40","92211048","BUTORPHANOL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.40","92219997","LEVALBUTEROL 1.25 MG/3 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.45","92216952","ATORVASTATIN CALCIUM 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.50","92210827","AMPICILLIN-SULBACTAM 1.5GM INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.50","92213052","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.55","92213494","EPINEPHRINE HCL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.60","92218876","QUETIAPINE FUMARATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.65","92210006","PROVIDONE IODINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.65","92216418","RANOLAZINE 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.65","92217460","NEVIVOLOL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.65","92218576","QUETIAPINE FUMARATE100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.65","92219114","MICONAZOLE NITRATE 0.02 SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.70","92210154","PHENYLEPHRINE HCL 0.5% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.70","92213070","LANOLIN MINERAL OIL PETROLAT O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.70","92213201","PHENYLEPHRINE HCL 1% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.70","92213592","LIDOCAINE HCL 4% KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.75","92217051","SEVELAMER CARBONATE 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.75","92217662","D5W/NACL 0.45%/KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.75","92218354","ATOVAQUONE-PROG 250MG-100MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.75","92219846","ZINC OXIDE 16% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.80","92219108","CLOZAPINE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.83","38305450","METHYLENEDIOXYAMPHETAMINES ","80359",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.85","92215103","DILTIAZEM HCL 120MG C12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.85","92220390","AMYL/LIP/PRO63000-15000-47000U"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.90","92214206","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.93","76000064","TC-99M PERTECHNETATE PER MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35.95","92218358","COLCHICINE 0.6 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"350.00","33112179","TRAY CATH 3LUM CENT VENOUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"350.70","92216420","FONDAPARINUX NA 2.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"350.88","38202049","PARATHYROID HORMONE ","83970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3500.95","92220445","POSACONAZOLE 18 MG/ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3507.40","92211814","FILGRASTIM 480MCG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3507.45","92220512","FILGRASTIM 480 MCG/0.8 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.00","33103575","WALKER CAM II SMALL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.00","33110079","TRAY CATH 3LUMEN 12FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.00","33113047",""KIT CATH 40CM 18GA .38"" J OVL ""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.00","33113048",""KIT CATH 40CM 18GA .38"" J OVL ""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.00","33117502","KIT PNEUMOTHORAX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.40","92220521","DORAVIRINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"351.65","92210010","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3512.73","74200270","MRI THORACIC W/WO CONTRAST ","72157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"352.00","33103618","DRSG VERAFLO CLEANSE CHOICE MD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"352.00","33110078","TRAY CATH 3LUMEN 12FRX16CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"352.00","33163062","BOOT MULTIPOD W/REMV AMB SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"352.00","92213140","MIDAZOLAM HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"352.90","92216450","MESALAMINE 4GM/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3523.71","76078832","NM TUMOR LOCAL WHOLE BODY ","78802",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3527.70","92216976","EPOETIN ALFA 20000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3527.70","92217084","EPOETIN ALFA 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.00","92212547","BENZOYL ERYTHROMYCIN 5%-3% GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.05","92220041","FLU VAC QUAD20-21 180MCG/0.5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.05","92220042","FLU VAC QUAD20-21 240MCG/0.7ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.10","92216114","VANCOMYCIN HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.20","92218811","ATAZANVR/COBIC 300MG-150MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"353.59","34600422","EVAL COMP AUDIOMTY THRES ","92557GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3534.04","77010017","CT ABD & PELVIS W/WO CONTAST ","74178",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.48","74000630","PELVIS 1-2 VIEWS ","72170",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.66","38300045","*BASIC METABOLIC PROFILE ","80048",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.66","38380048","METABOLIC PANEL TOTAL CA ","80048",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.66","38380049","MET PANEL TTL CA CHEM 8+ ","80048QW ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.82","74000410","FOREARM 2 VIEWS BILATERAL ","7309050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.82","74010061","FOREARM 2 VIEWS RT ","73090RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"354.82","74010062","FOREARM 2 VIEWS LT ","73090LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"355.20","92217337","BENZOCAINE BUTA TETRA 14-2-2 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"355.32","38203875","IMMUNOFIX ELECTROPHOR-FLUID ","86335",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"355.65","72000620","THERAPEUTIC PHLEBOTOMY ","99195",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"355.75","92211421","DEXAMETHASONE 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3552.00","92215849","PEGINTERFERON ALFA-2B 50MCG KI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3556.50","92219495","MEDROXYPROG ACET 400 MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"35560.80","92220181","IMMUNE GLOBUL10% 100MG/ML VIAL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"356.00","92212846","SULFACETAMIDE NA S 10%-5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3561.65","92217505","TOLVAPTAN 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3561.65","92219777","TOLVAPTAN 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.00","33195308","KIT CVC N RX M LUM BLTP 7FRX16"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.65","92217726","ENOXAPARIN NA 80MG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.67","92217641","DIANEAL 2.5% DEXTROSE IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.80","92211413","BACITRACIN/HC/NEO/POLY B EYE O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.85","92211872","COLLAGENASE 250U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"357.85","92214950","CADEXOMER IODINE 0.9% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"358.00","33174525","KIT CVC 3L PRES INJ 7FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"358.85","38003011","F5 GENE LEIDEN VARIANT ","81241",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"358.85","38300074","FACTOR V (LEIDEN) MUTATION ","81241",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"358.85","38387001","F5 LEIDEN GENE ANALYSIS ","81241",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"359.00","33111717","DRSG ASSEMBLY EXTRA LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"359.00","33113073","KIT DRSG 60X30CM GRANUFOAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"359.64","38306802","HEPATITIS B VIRUS QUANT ","87517",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"359.75","92210640","CYCLOPENTOLATE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","38201475","HEPATITIS BE ANTIGEN EIA ","87350",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","38201580","INSULIN ","83525",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","38202590","ZINC ","84630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","38202835","COCCIDIOIDES ANTIBODY ","86635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","38299303","ANALYTE QUAL/SEMI QNT MULTI ","83516",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92210019","SUCRALFATE 1GM/10ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92211340","BUPIVACAINE HCL 0.75% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92213756","DEXTROSE 5%-1/3NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92214334","DEXTROSE 50%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92215405","CEFOTAXIME NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.00","92217836","MULTIVITAMIN MINERALS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.05","92215762","MEMANTINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.05","92216237","MICONAZOLE NITRATE 2% POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.05","92219055","LAMOTRIGINE ER 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.05","92219106","LAMOTRIGINE ER 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92214466","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92215126","PERU BALSAM/PETRO/ZINC OXIDE O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92215294","OLMESARTAN MEDOXOMIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92216411","QUETIAPINE FUMARATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92216419","QUETIAPINE FUMARATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.10","92217049","NEBIVOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.20","92203027","ORALS 27 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.25","92213825","HEPARIN 1000U/NS 500 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.25","92215113","FLUOXETINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92212793","DIGOXIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92214492","LACTATED RINGERS D5W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92216730","ALISKIREN 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92217047","NEBIVOLOL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92217048","NEBIVOLOL HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.30","92218634","DIGOXIN 250 MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.35","92216698","CHLORHEXIDINE GLUC 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.39","38202790","CK-MB PANEL ","82553",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.40","92212291","PILOCARPINE HCL 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.45","92214838","MIDODRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.45","92217980","TRECATOR 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.50","38201465","HEPATITIS BE ANTIBODY ","86707",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.50","92217493","NEBIVOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.50","92218651","HYDROCORTISONE 1% TOPICAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.55","92211661","TERBUTALINE SULF 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.65","92215091","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.65","92218932","MEMANTINE HCL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.70","92213400","NITROGLYCERIN 0.3MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.70","92214837","NITROGLYCERIN 0.4MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.70","92219687","FLUOXETINE HCL 20 MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.75","38202535","VISCOSITY ","85810",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.75","92218052","KEPPRA XR 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.85","92214035","POTASSIUM ACET 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.85","92215839","VALSARTAN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.85","92218885","MICONAZOLE NITRATE 0.02 PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.95","92211732","METHYLENE BLUE 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"36.95","92218194","DULOXETINE 30MG DR CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"360.00","33106270","SUPPORT BACK M-BRC LUM BLK LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"361.00","92216269","SULFACETAMIDE NA S 10%-5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"361.19","73500325","NRV COND STUDIES 1-2 STUDIES ","95907",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"361.85","92218625","ALBUTEROL HFA 0.09 MG/DOSE INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"361.85","92220408","BARIUM SULFATE 40% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"362.00","33111466","TRAY CATH MAHUR 3L 12FR20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"362.00","33151841","CUSHION ROHO MOSAIC 18X18 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"362.00","33176683","ORTHOSIS ELBOW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3624.00","36000940","VENTILATOR INITIAL DAILY ","94002",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","33112826","TRAY CATH MAHUR 3L 24FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","74000470","HUMERUS 2+ VIEWS BILATERAL ","7306050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","74010071","HUMERUS 2+ VIEWS RT ","73060RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","74010072","HUMERUS 2+ VIEWS LT ","73060LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","92213999","DOXAPRAM HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","92215538","MEDROXYPROGESTERONE 150MG/ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","92217637","CA CL/DEX/MGCL/NACL/NALACT SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.00","92218339","BENZTROPINE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"363.30","92211477","FLUOCINONIDE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3633.30","92214427","GOSERELIN ACET 3.6MG IMP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"364.00","33113033","AMNIOBAND MTRX TISS 4X2CMPLCNT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"364.49","38003010","F2 GENE 20210G >A VARIANT ","81240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"364.49","38387000","F2 GENE ANALYSIS ","81240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"364.50","92210069","BETAXOLOL HCL 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3649.70","92218768","LENALIDOMIDE 2.5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"365.00","33111541","BOOT AFO GONIOMETER SPRINGLD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"365.00","92214906","ZANAMIVIR 5MG/ACT DSK "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"365.58","74000190","CLAVICLE BILATERAL ","7300050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"365.58","74010035","CLAVICLE RT ","73000RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"365.58","74010036","CLAVICLE LT ","73000LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3659.44","73700190","MULTIPLE SLEEP LATENCY ","95805",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3659.44","73700195","MAINT WAKEFULNESS TEST(MVT) ","95805",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.00","33112369","KIT CVC MULTILUMEN 7FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.00","33163063","BOOT MULTIPOD W/REMV AMB MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.00","33163064","BOOT MULTIPOD W/REMV AMB LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.00","33163065","BOOT MULTIPOD W/REMV AMB XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.00","92214784","BENZOCAINE BUTA TETRA 14-2-2 K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.13","34610010","EVAL OF PROSTH COMM DEVICE ","92597GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.13","34610020","E/T ONE WAY SPK VLV W/CUFF DEF","92597GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"366.65","92218177","PRECEDEX 4MCG/ML 0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3664.65","92213390","ETANERCEPT 25MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"367.30","92219413","BRIVARACETAM 10 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"367.54","38301498","HEPATITIS PANEL (ACUTE) ","80074",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"368.03","38000548","IMMUNOHISTO AB EA MULTIPLEX AB","88344",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"368.30","92219885","HYALURONIDASE 150 UNITS/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"368.45","92220156","PHYTONADIONE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"368.45","92220533","PHYTONADIONE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3685.90","92212415","FLUCONAZOLE 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3689.50","92215785","RISPERIDONE 25MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.00","33183995","TUBE TRACH JACK FEN SS SZ 6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.00","92202010","TOPICALS 10 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.15","92214993","MOMETASONE FUROATE 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.25","92218812","ACETIC ACID 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.25","92218854","ACETIC ACID 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"369.50","92215884","VORICONAZOLE 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","38200210","ANTITHROMBIN III ","85300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","38205069","VITAMIN A LEVEL ","84590",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92210568","METHYLERGONOVINE MAL 0.2MG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92212537","LABETALOL HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92214595","ESTRADIOL NORETN 0.05/0.25MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92215160","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92216793","DONEPEZIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92217119","NISOLDIPINE 34MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92218110","JALYN 0.5MG-0.4MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92218673","PREPARATION H 0.25%-3% TOPICAL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.00","92220028","GLYCERIN/PETR/PHENYLEPH/PRAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.05","92211913","CEFPODOXIME PROXETIL 100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.05","92217040","TROSPIUM CL 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.05","92219955","POLYVIN/ALC/POV 0.5%-0.6% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.05","92220107","COLCHICINE 0.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.10","92210388","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.10","92215420","METOCLOPRAMIDE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.10","92216367","HYDROMORPHONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.15","92217046","NEBIVOLOL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.20","92212493","DOBUTAMINE HCL 12.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.20","92215832","VALSARTAN 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.21","38302460","URINALYSIS AUTO W/O MICRO ","81003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.25","92213655","CEFUROXIME NA 750MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.30","92218311","URELLE TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.35","92210170","VITAMIN E OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.35","92210949","BACITRACIN/POLYMYXIN B OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.35","92215074","POTASSIUM CL 20MEQ PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.35","92218795","LEVOFLOXACIN/D5W 250MG/50MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.40","92211682","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.40","92213200","FLUPHENAZINE HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.40","92219419","HEPARIN SOD5000UNITS/0.5 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.45","92210624","LOTION MULTI INGREDIENT LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.45","92211916","AMPICILLIN NA 1GM A-V INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.45","92219421","ENTACAPONE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.50","92213252","FLUCONAZOLE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.55","92219882","PETROLATUM 42% OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.60","92211235","METHYLPREDNISOLONE 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.60","92216347","FLUOXETINE HCL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.60","92217285","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.60","92219649","HEP SODPORC5000UNITS/0.5MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.65","92211067","AMPICILLIN-SULBACTAM 1.5GM INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.65","92212500","LAMOTRIGINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.65","92214780","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.70","92212340","QUETIAPINE FUMARATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.80","38202840","COMPLEMENT C-1 ","86160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.80","92217364","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.80","92219533","COLCHICINE 0.6 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.80","92220202","LEVETIRACETAM 100MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.85","92210318","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.85","92217930","LEVETIRACETAM 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.85","92218774","RENACIDIN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.90","92213744","PHENYTOIN NA 100MG/4ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.90","92213790","HEPARIN 25000U/D5W 500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.90","92219710","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.95","92218475","MINERAL OIL 99.9% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"37.95","92218484","GENTEAL 0.3% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"370.90","92211102","HYDROCORTISONE 2.5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3704.00","92214077","LOTEPREDNOL ETABONATE 0.5% SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3708.00","92217746","ALPHA-1 PROTEINASE 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"371.00","33180021","CUSHION W/C AMPUT RT 16X16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"371.90","92211151","KETOCONAZOLE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"372.00","92216272","PREDNISOLONE ACETATE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"372.20","92211743","TOBRAMYCIN DEX 0.3-0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"372.20","92220084","TRIGLYCERIDES OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3722.20","92215177","BRIMONIDINE TARTRATE 0.15% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"373.00","92212587","CARBACHOL 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"373.00","92212871","BSS EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"373.21","76000062","TC-99M TETROFOSMIN-STUDY DOSE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"373.40","92219236","NARATRIPTAN HYDROCHL 2.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"373.80","92210963","PREDNISOLONE ACETATE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"374.00","92217642","CA CL/DEX/MGCL/NACL/NALACT SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"374.00","92217643","CA CL/DEX/MGCL/NACL/NALACT SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"374.48","75000132","US PREG UTERUS <14 WEEKS ADD G","76802",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"374.52","38300504","M TUBERCULOSIS DNA AMP PROBE ","87556",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"374.75","92212224","CLOBETASOL PROP 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33103028","TRAY CATH DIAL DUGLIDE13FR30CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33106481","TRAY CATH DIAL DUGLDST13FR24CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33139757","MIDLINE MAXDFNIT PG 3FSL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33139759","MIDLINE MAXDFNIT PG 4FSL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33139760","MIDLINE MAXDFNIT PG 4FSL20CMGW"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33139763","MIDLINE MAXDFNIT PG 5FSL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33139775","MIDLINE MAX PGDF5FSL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33152530","MIDLINE MAX BARRIER 4F SL-20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33152532","MIDLINE MAX BARRIER 3F SL-20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33152534","MIDLINE MAX BARRIER PG 3F SL-2"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33152536","MIDLINE MAX FENDRP SL 4F20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","33180041","TRAY DIAL DUOGLD STR 13FR 20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","74000310","FEMUR 2+ VIEWS BILATERAL ","7355050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","74010045","FEMUR 2+ VIEWS RT ","73552RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","74010046","FEMUR 2+ VIEWS LT ","73552LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","92210270","CHOLESTYRAMINE 4GM/5.5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","92211896","BLEPHAMIDE 0.2-10% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.00","92217975","HALFLYTELY/BISACODYL 5 MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.75","74000700","SCAPULA BILATERAL ","7301050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.75","74010090","SCAPULA RT ","73010RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.75","74010091","SCAPULA LT ","73010LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"375.80","92213709","MILRINONE D5W 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3757.00","92211886","LEUPROLIDE ACET 3.75MG KIT PI1"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.00","92213609","BETAMETHASONE DP 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.10","92215689","UREA HC 40% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.30","92218734","ALBUTEROL SULFATE 0.09 MG INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.35","92215427","ZIPRASIDONE HCL 20MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.61","74000830","TIBIA/FIBULA 2 VIEWS BILATERAL","7359050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.61","74010096","TIBIA/FIBULA RT ","73590RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.61","74010097","TIBIA/FIBULA LT ","73590LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.81","38300142","BK VIRUS PCR QNT ","87799",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.81","38301000","INF AGENT DETEC NUC AC NOS QNT","87799",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.90","92219089","ALENDRONATE SODIUM 70 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"376.95","92220020","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3760.53","76020002","IN-111 OXYQUINOLINE PER.5MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3764.00","92218034","GAMUNEX-C 1GM/10ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"377.00","33113043","KIT CATH CV 7FR 18GA 20CM 3LUM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"377.00","33113076","KIT CVC BUNDLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"377.00","33118480","BOOT MULT PODUS ACT 2000 SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"377.60","92220074","AMINO ACIDS 8%-14% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"378.00","38302195","ALPHA-FETOPROTEIN AMNIO FLUID ","82106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3786.30","92218344","TAMOXIFEN 10 MG/5 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.00","33110072","KIT PERMACATH 14.5FRX23CM MAX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.00","33113200","KIT CATH MAHUR 14.5F 23/40CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.00","33113826","TRAY CATH MAHUR MAXID 14FR 38C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.00","33160869","KIT CATH MAHUR MAXID14.5FR28CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.00","92212018","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"379.50","92213008","HALOPERIDOL LAC 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","38200196","ANTI NEUTROPHILIC ANTIBODY ","86255",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","38206680","FLUORESCENT ANTIBODY TITER ","86256",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92212189","NIACIN 750MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92212239","MEPERIDINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92213267","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92213369","PENICILLAMINE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92213732","DEXTROSE 5%-1/4NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92214016","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92214572","LIDOCAINE 1%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92215388","ESOMEPRAXOLE MG 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92215754","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92215806","TIAGAINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92215943","PANTOPRAZOLE NA 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92216396","TRAMADOL HCL 200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92216425","DEXTROSE 10%-NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92216428","ZOLPIDEM TARTRATE 12.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.00","92217167","LANOLIN PETROLATUM 15.5-53.4 O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.05","92214207","MISOPROSTOL 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.05","92218105","CLOMIPHENE CITRATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.05","92218144","FENOFIBRATE 130 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.05","92219142","CLOMIPHENE CITRATE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.05","92219763","CLOMIPHENE CITRATE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.10","92212204","TAMSULOSIN HCL 0.4MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.10","92212635","SODIUM CL 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.10","92218580","OXANDROLONE 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92213928","METOPROLOL TART 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92217432","FENOFIBRATE 160MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92218608","OXANDROLONE 2.5 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92218759","LEVAQUIN/D5W 750MG/150ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92219832","MISOPROSTOL 200 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.15","92220037","DEXAMETH NA PHOS 10 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.20","92217009","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.20","92218067","PIOGLITAZONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.20","92219061","TAPENTADOL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.25","92213209","CLOPIDOGREL HSO4 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.25","92217019","LUBIPROSTONE 24MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.25","92217700","URSODIOL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.30","92216787","VITAMIN B COMPLEX W/C SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.30","92219721","CARBAMAZEPINE ER 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.35","92204056","IV ADMIXTURE 56 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.35","92215349","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.35","92217971","DIGOXIN 5MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.45","92210931","SODIUM CL 3% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.45","92214851","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.50","92213439","DIPHENOXYLATE HCL ATROPINE SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.50","92214885","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.50","92217649","SALIVA SUBSTITUTES SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.55","92213940","PROPOFOL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.55","92213943","PIOGLITAZONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.60","92215163","TOPIRAMATE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.60","92216335","CEFUROXIME NA 1.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.65","92204024","IV ADMIXTURE 25 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.65","92210359","SODIUM BICARB POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.70","92216477","LEVETIRACETAM 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.80","92214199","ALBUTEROL SULF 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.80","92214216","ALBUTEROL SULF 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.80","92215845","LOTION MULTI INGREDIENT LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.90","92218501","TRANSDERM SCOP 0.33MG/24HR TDM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.90","92220095","ZINC OXIDE 12.8% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"38.95","92217703","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"380.42","73570057","EMG EA EXTREM COMP 5 OR> MUSC ","95886",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"380.80","92219030","METHYLPRED NA SUCC500MG/4MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"380.90","92213069","IRON SUCROSE 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3801.60","92210811","IMMUNE GLOBULIN 6GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"381.10","92220072","AMINO ACIDS 8%-14% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"381.15","92216656","IRON SUCROSE 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"381.15","92219595","HYDROCOD/CHLOR10MG-8 MG/5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"381.76","74000688","SACROILIAC JOINTS < 3 VIEWS ","72200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"381.85","38000075","DNA ANALYSIS-FLOW CYTO ","88182",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3818.75","92219392","TELAVANCIN HCL 750 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.00","33118481","BOOT MULT PODUS ACT 2000 MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.00","33118483","BOOT MULT PODUS ACT 2000 XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.15","92214856","CASTOR/PERU BALSAM/TRYPSINOIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.18","34000031","STRAPPING UNNA BOOT ","29580GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.75","74000441","HAND 3+ VIEWS BILATERAL ","73520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.75","74010063","HAND 3+ VIEWS RT ","73130RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"382.75","74010064","HAND 3+ VIEWS LT ","73130LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"383.05","92216961","PENICILLIN G PROCAINE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"383.08","38201722","PROGRAF LEVEL (TACROLIMUS) ","80197",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"383.90","92213371","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.00","38200161","COVID-19 CORONAVIRUS ","87635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.00","92211605","HYDROCORTISONE VAL 0.2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.30","92215929","AMINOCAPROIC ACID 25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.30","92218374","FIRST-MOUTHWASH BLM . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.55","74000540","MANDIBLE PARTIAL<4 VIEWS ","70100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.55","92220389","FLU VAC ADJUV60 MCG/0.5 ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.66","74010086","RIBS UNILATERAL 2 VIEWS RT ","71100RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.66","74010087","RIBS UNILATERAL 2 VIEWS LT ","71100LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"384.71","38300595","CLOTTING FUNCTION ACTIVITY ","85397",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33103018","TUBE JEJUNAL 24FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33111898","TUBE TRANSGAST JEJUN 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33111899","TUBE TRANSGAST JEJUN 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33131300","TUBE FDG JEJUNAL 20FR 28CC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33131301","TUBE FDG JEJUNAL 22FR 28CC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"385.00","33199758","TUBE JEJUNOSTOMY 14FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.00","92211014","RIMEXOLONE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.00","92218814","ACETIC ACID 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.00","92218855","ACETIC ACID 5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.10","92219323","FONDAPARINUX SOD7.5MG/0.6MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.10","92219432","FONDAPARINUX SOD 5MG/0.4MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.10","92219624","FONDAPARINUX 7.5 MG/0.6 ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.25","92211464","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.35","92212515","DESMOPRESSIN ACET 4MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"386.95","92220150","VORICONAZOLE 40 MG/ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"387.46","34010230","STRAPPING SHOULDER ","29240GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"387.46","34210285","STRAPPING SHOULDER ","29240GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"387.52","38200456","ACTH STIMULATION PANEL ","80400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"388.00","33112131","TUBE TRACH BIV HYPERFLX 7.0MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"388.63","38203870","IMMUNOFIX ELECTROPHOR-SERUM ","86334",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.00","92215300","MANNITOL 20% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.49","74000290","FACIAL BONES < 3 VIEWS ","70140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.57","74001301","SPINE-ENTIRE 1 VIEW ","72081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.60","92218988","FLUCYTOSINE 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.74","38200213","PROTEIN S ANTIGEN (TOTAL) ","85305",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"389.90","92217014","ENOXAPARIN NA 120MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","38200675","COPPER ","82525",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","38300301","HEMAGGLUTINATION INHIBITION ","86280",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","92210899","BUTORPHANOL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","92214245","MILRINONE LACTATE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","92214767","LIDOCAINE 2%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","92216403","CEFTRIAXONE NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.00","92217870","CEFOXITIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.10","92210144","AMOXICILLIN 250MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.10","92218960","MEMANTINE HCL10 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.10","92220003","TACROLIMUS ER 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.10","92220004","TACROLIMUS ER 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.15","92217328","VENLAFAXINE HCL 75MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.20","92219938","RALOXIFENE 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.20","92220252","RALOXIFINE 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.25","92211624","MEPERIDINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.25","92215435","ATORVASTATIN CALCIUM 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.25","92219051","LIDOCAINE HYDROCHLORIDE2%JELLY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.25","92219366","MULTIVITAMIN/MINERALS LIQUID "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.30","92213323","MONTELUKAST NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.30","92217677","EVEROLIMUS 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.30","92219757","EVEROLIMUS 0.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.35","92215330","RISPERIDONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.35","92217802","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.35","92219464","ATOVAQU/PROGUAN250MG-100MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.39","92215010","MORPHINE 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.40","92210523","LAMIVUDINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.40","92211309","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.40","92213563","URSODIOL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.40","92213742","MELOXICAM 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.50","92211145","DOBUTAMINE HCL 12.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.55","92215503","CALCITRIOL 1MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.55","92216934","HALOPERIDOL LAC 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92210724","DIGOXIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92213099","HALOPERIDOL DEC 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92215334","CIPROFLOXACIN 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92216651","HYPROMELLOSE 0.3% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92217822","DEXTRAN HYPROMELLOSE 0.1-0.3 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92218043","LANOXIN PEDIATRIC 0.1 MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92218544","CEFOXITIN 1 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92218618","CEFOXITIN 1 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92218692","HALOPERIDOL DECANOATE100 MG/ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92219531","FLUCONAZOLE 200 MG/100 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92220136","DEXTRAN70/GLYC/HYPROMELLOSE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.60","92220247","HEPARIN SODIUM 5000 U/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.65","92212150","CHLORPROMAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.65","92217706","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.65","92219195","PANCREAZE 20 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.70","92219988","OMEPRAZOLE 20 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.70","92220452","BARIUM SULFATE 98% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.75","92210877","NADOLOL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.75","92217452","VANCOMYCIN HCL 5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.75","92217858","VANCOMYCIN HCL 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.80","92210245","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.80","92214987","NITROGLYCERIN 0.6MG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.80","92217914","LIDOCAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.80","92218468","NEOSTIGMINE METHSUL 1MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.85","92214938","TOLTERODINE TARTRATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.85","92217160","LUBIPROSTONE 8MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.95","92216785","METRORMIN SITAG PH 500-50MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.95","92217778","ARMODAFINIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"39.97","38203695","HEMOGLOBIN ","85018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33102908","KIT BRIDEL NG TUBE 14FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33139761","MIDLINE MAXDFNIT PG 5F DL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33139762","MIDLINE MAXDFNIT PG 5F DL20CMG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33139774","MIDLINE MAX PGDF5F DL20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33152370","KIT CRICOTHYROIDOTOMY EMERGNCY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.00","33152537","MIDLINE MAX BARR DL 5F 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"390.50","74000820","THORACIC SP 2 VIEWS ","72070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"391.00","33134455","MASK COMF GEL W/HDGR LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"391.00","33195070","MASK NASAL COM GEL HDGR SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"391.00","92212505","CEFPROZIL 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"391.00","92212869","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3918.45","92204034","IV ADMIXTURE 35 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"392.00","72070000","BLOOD SPLIT UNIT - PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"392.00","92211756","HALOBETASOL PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3928.45","92212535","DESMOPRESSIN ACET 4MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.00","33177305","CVC W/ HICKMAN CATH 9FR 2 LMN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.00","92204012","IV ADMIXTURE 13 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.58","74000690","SACRUM & COCCYX MIN 2+ VIEWS ","72220",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.78","74000070","ANKLE 3+ VIEWS BILATERAL ","7361050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.78","74010005","ANKLE 3+ VIEWS RT ","73610RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"393.78","74010006","ANKLE 3+ VIEWS LT ","73610LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"394.00","33101707","ORTHOSIS ELBOW TERRYCOVER ADLT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"394.25","92211755","DORZOLAMIDE HCL 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"394.74","74000400","FOOT 3+ VIEWS BILATERAL ","7363050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"394.74","74010059","FOOT 3+ VIEWS RT ","73630RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"394.74","74010060","FOOT 3+ VIEWS LT ","73630LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"395.65","92210740","FLUNISOLIDE 0.025MG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"395.75","76020004","TC-99M ALBUMIN AGGR <10 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3951.50","73510013","EEG SEIZURE EVAL 8 CHAN ","95950",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.00","92210743","ACETIC ACID ALUMINUM 2-0.79% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.00","92211601","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.00","92211956","HYDROCORTISONE 2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.00","92213230","HYDROCORTISONE 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.00","92215276","LINZOLID 600MG/300ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.90","74000901","WRIST 3+ VIEWS BILATERAL ","7311050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.90","74010112","WRIST 3+ VIEWS RT ","73110RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"396.90","74010113","WRIST 3+ VIEWS LT ","73110LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"397.00","92213811","HYDROQUINONE 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"397.00","92217109","BENZOCAINE 20% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"397.51","38200472","LEVITIRACETAM ","80177",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"397.80","92215308","FLUCONAZOLE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"398.40","92218733","ALBUTEROL SULFATE 0.09 MG INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"398.45","38000586","TISSUE IN SITU INTERP ","88365",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"398.90","92215991","EMITRICITABINE TENOFOVIR TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"3984.70","92215122","CICLOPIROX 8% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.00","92217616","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.10","92212794","HEPATITIS B VACC 10MCG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.10","92216859","HEPATITIS B VACC 10MCG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.13","74000160","CHEST 2VIEWS W/APICAL LORDOTIC","71047",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.35","92212615","FOSFOMYCIN TROMETHAINE 3GM PDS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.45","34600440","EVAL SPEECH DEVICE 1ST HR ","92607GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"399.60","92212675","MMR VACCINE LIVE PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4.70","74000029","CYSTOGRAFIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.00","92213483","GENTAMICIN 60MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.00","92214311","LIDOCAINE HCL 1.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.00","92214375","DEXTROSE 40%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.00","92216846","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.05","92212257","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.05","92216228","PREGABALIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.05","92219029","METHYLPRED NA SUCC 40 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.10","92215013","OXYCODONE HCL 40MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.10","92216043","MESALAMINE 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.20","38399301","URINALYS QUAL/SEMIQNT XCPT IA ","81005",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.20","92212005","LACTIC ACID UREA 5%-10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.20","92214461","METHYLPREDNISOLONE 125MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.25","92213534","HALOPERIDOL DEC 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.25","92220476","CEFAZOLIN 2 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.29","38201660","LDH ISOENZYMES ","83625",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.30","92216126","QUININE SULF 324MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.30","92217450","PETROLATUM 41%OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.50","92214616","TOLTERODINE TARTRATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.50","92220244","PHEN/MINOIL/PET0.25%-14%-74.9%"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.55","92213745","NEOSTIGMINE MS 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.55","92213814","HEPARIN 2000U/NS 1000ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.55","92214190","AMPICILLIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.60","92214270","OXYCODONE HCL 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.65","92213768","OMEPRAZOLE 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.68","38302120","RETICULOCYTE (MANUAL) ","85044",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.70","92215836","VALSARTAN 320MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.70","92217934","VENLAFAXINE HCL 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.70","92220241","OMEPRAZOLE 40 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.75","92215557","ALPRAZOLAM 0.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.75","92218197","LORTAB 10MG-300MG/15ML ELIXIR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.80","92212496","MEPERIDINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.85","92215758","AMIODARONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.85","92215759","AMIODARONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.90","92211057","TIMOLOL MALEATE 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.90","92211466","ROPIVACAINE HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.90","92214744","TOLTERODINE TARTRATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.90","92218552","LEVETIRACETAM 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.95","92212381","RALOXIFENE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.95","92215260","METAXALONE 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.95","92217865","LEVALBUTEROL 1.25MG/0.5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40.96","38300009","ALLERGEN IGE ","86003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"400.00","92215458","EPOETIN ALFA 4000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"400.15","92215494","MAFENIDE ACET 85MG/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"400.32","74000590","NASAL BONES 3+ VIEWS ","70160",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4003.50","92214081","DIGOXIN IMMUNE FAB OV 38MG INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"401.00","33113065",""TRAY CATH 16CM12FR18GA .035"" J""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"401.00","33164110","TRAY CATH MAH TLC CDC CE 12F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"401.00","33174140","TRAY MAHUR 3L 12FR 24CM CDC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"401.00","33190694","TRAY MAHUR TL HI PRS 12FRX20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4019.55","74001096","VENOGRAM INFERIOR CAVAL ","75825",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"40194.00","92218770","IMMUNE GLOBULIN 40 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"402.00","92217647","SOTALOL HCL 150MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"402.60","92220388","BENZO/BUTAM/TETRA14%/2%/2% SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"403.00","33112827","MASK TOTAL FACE BIPAP/CPAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4035.95","92220373","EDARAVONE 30 MG/100 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"404.45","92220497","LACOSAMIDE 10 MG/1 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"404.86","74000720","SHOULDER 2+ VIEWS BILATERAL ","7303050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"404.86","74010094","SHOULDER 2+ VIEWS RT ","73030RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"404.86","74010095","SHOULDER 2+ VIEWS LT ","73030LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4049.10","92213263","SOMATROPIN E-COLI DERIVE 5MG P"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33109067","TROCAR ENDO BLADELESS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33131180","TRAY CATH BREV ST DL 20CM 11FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139860","PICC MAX NSG NV PG 4F SL-55cm "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139861","PICC MAX NSG NV PG 5F DL-55cm "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139862","PICC MAXNSGNVPG5FDL55CMGW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139869","PICC MAXNSGNVPGDFDRP4FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139870","PICC MAXNSGNVPGDFDRP4FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139871","PICC MAXNSGNVPGDFDRP5FDL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139872","PICC MAXNSGNVPGDFDRP5FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33139873","PICC MAXNSGNVPGDFDRP5FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33152526","PICC BIOFLO MAX BARR 5FDL-55CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.00","33152535","PICC MAX BARRIER SL DF DRP 3F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.18","74000780","SKULL < 4 VIEWS ","70250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.43","76020007","TC-99M LABELED RBC <30 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"405.45","92213922","CLONIDINE HCL 0.2MG TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4056.00","92218030","OPTIRAY 320 20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"406.00","33168059","AIRCAST AIRSELECT STD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"406.00","92214986","AMINO ACIDS 6.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"406.05","92213273","ALBUMIN HUMAN 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"406.30","92215327","DALTEPARIN NA 7500U/0.3ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"407.00","33103191","KIT CVC QL 8.5 FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"407.10","92211723","ALBUTEROL SULF 90MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"407.37","74001311","HIP 2-3 VIEWS UNILATERAL RT ","73502RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"407.37","74001312","HIP 2-3 VIEWS UNILATERAL LT ","73502LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"407.45","92219814","HEPATITIS B VACCINE20MCG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"408.30","92218039","LANSOPRAZOLE 3MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"409.00","33133106","SPLINT ELB DYNAPRO AD LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"409.00","92211598","DOLASETRON MESYLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"409.00","92212352","DOLASETRON MESYLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"409.11","34600535","AUD ASSESS REHAB 1ST HR ","92626GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"409.73","38200010","ACETYCHOLINE RECEPTOR AB ","84238",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","38286443","BLASTOMYCES AB ","86612",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","38303231","METHADONE SCREEN ","80358",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92212750","PYRIDOSTIBMINE BR 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92213838","CEFUROXIME AXETIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92214243","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92214668","DIDANOSINE 250MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92216008","LEVALBUTEROL 1.25MG/0.5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92216088","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92216473","ROSIGLITAZONE MALEATE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.00","92217872","CEFUROXIME AXETIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.05","92217088","OXYCODONE HCL 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.05","92220219","OMEPRAZOLE 40MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.10","92216561","DIGOXIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.15","92212674","HYDROCORTISONE 2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.15","92215896","NIACIN 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.15","92216973","OXYCODONE HCL 40MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.15","92219024","OXYCODONE HCL CR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.15","92220033","CHLORPROMAZINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.20","92211200","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.20","92213601","MICONAZOLE NITRATE 2% POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.20","92219754","CANDESARTAN CILEXETIL 32MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.22","38293939","HEPARIN LEVEL ","85520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92210976","SODIUM PHOSPHATE 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92212730","SODIUM ACETATE 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92213932","POTASSIUM ACET 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92214342","PROPRANOLOL HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92215681","ZINC OXIDE MENTHOL OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92217145","IMIQUIMOD 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.25","92218861","SOD POLYSTYR SULF15GM/60MLSUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.30","92215658","KETOROLAC 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.35","92211154","CHLORHEXIDINE GLUC 0.12% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.35","92220524","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.40","92210571","SULFAMETHOXAZOLE/TMP INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.40","92212101","CHLORPROMAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.40","92216053","AMINOCAPROIC ACID 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.40","92217887","HYDROCORTISONE ACET/PRAM HCL C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.50","92211789","LIDOCAINE HCL 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.50","92213804","LIDOCAINE HCL 0.8% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.58","38306009","EOS SMEAR (NASAL) ","89190",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.60","92211873","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.60","92218153","NEPHROCAPS QT TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.70","92216877","CEFUROXIME AXETIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.70","92220039","FLUTICASONE FUROATE 100MCG EA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.72","38301420","HEMATOCRIT ","85014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.75","92213914","RISPERIDONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.80","92210434","ATROPINE SULF 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.85","92212180","RISPERIDONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.90","92217066","DESMOPRESSIN ACET 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.90","92219095","LIDOCAINE HYDROCHLORIDE2%JELLY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41.95","92216231","PREGABALIN 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.00","33100890","ORTHOSIS ELBOW COMFY ADULT SML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.00","33133105","SPLINT ELB DYNAPRO AD MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.00","33189030","SPLINT ELBOW SUPT DYNPRO AD SM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.00","92216390","AMINO ACIDS 8% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.30","92211011","HEPATITIS B VACC 10MCG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.58","76000470","CHEMO VIA IV EA ADDL HOUR ","96415",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"410.75","92215025","PHENOBARBITAL 130MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4103.00","92216413","ALPHA-1 PROTEINASE 1000MG PDS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4105.20","92217533","BOTULINUM TOXIN TYPE A 100U IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"411.00","33113039","ALLOPATCH PLBL 8.0CMX0.4-0.8MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"411.00","92210467","CLOTRIMAZOLE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"411.09","74000120","CERVICAL SP 2 OR 3 VIEWS ","72040",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"411.85","92216042","FLUMAZENIL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4112.00","92215850","PEGINTERFERON ALFA-2B 150MCG K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"41125.00","92214439","PEGFILGRASTIM 6MG/0.6ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.08","74010079","MAMMOGRAM DIAG UNIL RT ","77065RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.08","74010080","MAMMOGRAM DIAG UNIL LT ","77065LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.50","92210313","TRIAMCINOLONE 0.025% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.50","92218704","LINEZOLID 600MG/300ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.50","92220115","NALOXONE 4 MG/0.1 ML SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.75","92214868","HYOSCYAMINE SULF 0.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"412.85","92219022","ETHINYL ESTRAD/NORGEST TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4120.63","72000842","THERAPEUTIC APHERESIS PLASMA ","36514",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4123.10","92215784","RISPERIDONE 37.5MG GER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"413.00","33100767","BOOT 3D ROM SH WALKER LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"413.00","33199962","MULTIBOOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"414.39","74000010","ABD FLAT & ERECT &/OR DECUB ","74019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"414.55","92217585","TELAVANCIN HCL 250MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"414.74","76020012","TC-99M SESTAMIBI - STUDY DOSE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"414.97","34020002","SELECTIV DEBRIDE EA AD 20SQ CM","97598GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"414.97","34220002","SELECTIV DEBRIDE EA AD 20SQ CM","97598GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"415.28","38202340","TESTOSTERONE TOTAL ","84403",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"415.85","92219099","FLUOROURACIL 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"415.95","38200092","ALDOSTERONE SERUM ","82088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"416.19","38003000","HLA CL 1 TYP HI RES AL/AL GRP ","81381",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"416.50","74008100","DEXA BONE DENSITY WRIST/HEEL ","77081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"416.98","74000261","ELBOW 3+ VIEWS BILATERAL ","7308050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"416.98","74010037","ELBOW 3+ VIEWS RT ","73080RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"416.98","74010038","ELBOW 3+ VIEWS LT ","73080LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"417.00","33158310","CATH DRAIN NAV LCK PIGTL 10FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"417.00","33158311","CATH DRAIN NAV LCK PIGTL 12 FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"417.00","33158313","CATH DRAIN NAV LCK PIGTL 6FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"417.00","33199109","BOOT PRAFO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"417.46","74001307","THORACOLUMBAR MIN 2 VIEWS ","72080",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4178.95","92215564","BIVALIRUDIN 250MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.11","74000481","KNEE 3 VIEWS BILATERAL ","7356250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.11","74010077","KNEE 3 VIEWS RT ","73562RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.11","74010078","KNEE 3 VIEWS LT ","73562LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.55","92211802","SUMATRIPTAN SUCC 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.75","92210410","LEVOBUNOLOL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"418.85","92215775","TALDALFIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4185.00","33105676","EPIFIX MESH 4CM X 4.5 CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"419.00","33109974","BOOT MULTIPODUS XLARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"419.10","92219094","DIANEAL 1.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"419.55","92212074","PAMIDRONATE DISOD 90MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","38200720","CPK ISOENZYMES ","82552",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","38202460","URINALYSIS AUTO W/O MICRO ","81003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","38202481","HISTOPLASMA ANTIGEN ","87385",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92212835","DOBUTAMINE HCL 12.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92213407","RANITIDINE HCL 15MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92213832","NIFEDIPINE 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92214244","FLEET PREP KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92214370","D5W-1/2NS/KCL 40MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92215700","MORPHINE 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92215895","DRONABINOL 5MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92215955","RANITIDINE HCL 15MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92216551","HEPARIN 12500U/D5W 250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92217117","NISOLDIPINE 25.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92218930","MORPHINE SULFATE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.00","92219438","MILNACIPRAN HCL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.05","92214505","LAMIVUDINE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.05","92216984","URSODIOL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.10","92214117","PROGESTERONE 200MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92210248","CONJUCATED ESTROGENS 1.25MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92211863","CONJUCATED ESTROGENS 0.625MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92212451","CONJUGATED ESTROGENS 0.3MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92212543","CONJUCATED ESTROGENS 0.9MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92213571","CEFOXITIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92215345","CIPROFLOXACIN 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92215585","CONJUCATED ESTROGENS 0.45MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92215950","CIPROFLOXACIN 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.15","92216417","QUETIAPINE FUMARATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.20","92211352","SODIUM ACETATE 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.20","92212091","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.20","92215527","AMOXICILLIN CLV K 1000-62.5 TE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.20","92220520","MAG SULFATE DEXT 1GM/100ML IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.25","92212864","MORPHINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.25","92218714","LEVALBUTEROL1.25 MG/0.5 ML INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.28","38301890","PHOTHER BODY FLUIDS ","83986",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.30","92217028","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.30","92220418","CEFOXITIN 2 GM PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.35","92213419","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.35","92215250","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.40","92212085","COLCHICINE 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.40","92217630","DULOXETINE HCL 60MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.45","92217313","DIVALPROEX NA 500MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.55","92213946","CLOPIDOGREL HSO4 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.55","92214835","ACETIC ACID 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.55","92215851","CYCLOSPORINE MOD 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.55","92218114","GLYCERIN 99.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.60","92210569","METHYLPHENIDATE HCL 20MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.65","92211702","ETOMIDATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.70","92219951","BUPROPION ER 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.75","38302831","COCAINE SCREEN ","80353",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.75","92216357","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.75","92216480","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.75","92219684","RALOXIFENE HCL 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92211758","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92213748","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92215166","DONEPEZIL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92216363","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92216566","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92217715","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92218977","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92219116","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92219361","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92219539","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92219659","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92219660","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.80","92220097","AZITHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.85","92215647","HEPARIN 25000U/D5W 500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.85","92216247","HEPARIN 25000U/D5W 250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.85","92217775","DONEPEZIL HCL 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.85","92219021","DONEPEZIL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.85","92219297","DONEPEZIL HCL ODT 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92212894","MYCOPHENOLATE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92215292","BACITRACIN 50000U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92216340","OCTREOTIDE ACET 100MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92219466","ALOGLIPTIN BENZOATE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92220239","MAGNESIUM SULFATE 40MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92220470","ALOGLIPTIN BENZOATE 12.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.90","92220471","ALOGLIPTIN BENZOATE 6.25MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.95","92213776","DOPAMINE HCL 160MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"42.95","92220013","MAGNESIUM SULFATE 2GM/50ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.00","33113077","TRANSTRACH SCOOP CATHETER 9 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.00","33114805","CATH TRANS TRACH SCOOP 9FRX9CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.00","33119977","CATH TRANS SCOOP 9 FRX11CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.00","92216489","SELEGILINE HCL 6MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.65","92211270","DILTIAZEM HCL 300MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.70","92213608","HYDROCORTISONE 2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.75","38388702","DRUG DEFIN QUAL/QUANT NOS 7+ ","80377",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"420.85","92219587","TETRABENAZINE 12.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"421.83","74000030","A-C JOINTS BILATERAL ","73050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4215.85","92220183","ERENUMAB-AOOE 150MG/ML PFS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"422.20","92218719","MILRINONELACT/D5W40MG/200MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"422.40","92220320","DEXMEDETOMIDE 4 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4228.90","92217962","NITROGLYCERIN 4% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"423.00","33164050","SUPPORT KNEE DYNAPRO FLX SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"423.00","33164051","SUPPORT KNEE DYNAPRO FLX MD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"423.35","92218896","LIPIDS 20% EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"423.60","92216705","HEPATITIS B VACC 20MCG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"424.08","74000825","TMJ BILATERAL ","70330",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"424.30","92219889","APREMILAST 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4249.67","73510011","EEG SEIZ EVAL UNATTN 16 CHAN ","95953",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"425.00","92217551","CLONIDINE 0.3MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"425.25","92217017","ENOXAPARIN NA 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"425.47","74000810","STERNUM MIN 2 VIEW ","71120",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"425.50","92220014","CLONIDINE 0.3MG/24HR PATCH ER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"425.80","92213863","DALTEPARIN NA 10000U/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"426.00","92216589","ACTIQ 800MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"426.45","92218003","ISOVUE-M 200 40% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"427.00","38307008","ENCEPHALITIS CALIFORNIA ","86651",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"427.00","38307009","ENCEPHALITIS EASTERN EQUINE ","86652",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"427.00","38307011","ENCEPHALITIS WESTERN EQUINE ","86654",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"427.85","92216345","LEVALBUTEROL TARTRATE 45MCG AR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4279.44","74075950","IMAGE CATH PERI/RETRO ","49406",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"428.00","33119967","TRAY UROLOGIST HEYMAN SYS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"428.55","92219093","DIANEAL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"428.65","92218076","PREZISTA 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"429.00","33103429","TRAY HEMODIALYSIS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"429.30","92218065","GRISEOFULVIN 125MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"429.76","38303895","CYTOMEGALOVIRUS DNA QUANT ","87497",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","38286449","HISTOPLASMA AB ","86698",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92213370","IODINE STRONG TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92214333","PIPERACILLIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92214931","INDIGODISULFONATE NA 8MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92216159","AMINOCAPROIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92216379","ISORETINOIN 20MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92217283","DEXTROSE 2.5%-1/2NS IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.00","92217536","CASTOR/PERU BALSAM/TRYPSIN GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.05","92217558","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.10","92212057","OMEPRAZOLE 10MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.10","92219368","CARBAMIDE PEROXIDE 6.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.10","92219482","PROPAFENONE HCL 425 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.15","92216402","CEFOXITIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.30","38200197","ANTI-DNA ANTIBODY ","86225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.30","92210079","TETRACYCLINE HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.30","92219859","AMLODIPINE/VALSARTN10-320MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.33","38300560","CHOLINESTERASE ","82480",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.35","34000070","HOT/COLD PACKS APPLICATION ","97010GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.35","34200055","HOT/COLD PACKS APPLICATION ","97010GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.35","38300040","ACETONE SERUM QUAL. ","82009",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.35","38301620","KETONES (ACETONE)QUAL ","82009",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.35","92213114","VALSARTAN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.45","92210577","HYDROCORTISONE 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.55","92210870","GRISEOFLUVIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.55","92210960","VECURONIUM BROMIDE 10MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.55","92215488","RALOXIFENE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.55","92216146","CEFTAZIDIME 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.60","92204053","IV ADMIXTURE 53 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.65","92217896","TIAGAINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.79","38302980","FEBRILE AGGLUTININS ","86000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.80","92217451","KCL 20MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.85","92217420","LEVETIRACETAM 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.90","92211978","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.90","92213250","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.90","92217251","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.90","92219916","FLUCONAZOLE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.95","92211515","PIPERONYL BUTO PYRETHRUN EXT L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.95","92216073","TELMISARTAN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43.95","92216081","TELMISARTAN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"430.00","92216155","ELECTROLYTE SOLUTION 6% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"43051.80","92218223","SOLIRIS 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"432.23","74077000","KNEE STANDING-BOTH KNEES ","73565",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"433.00","33177387","TRAY PNEUMOTHORAX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"433.00","92211136","GRANISETRON HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"433.07","38303650","RESPIRATORY VIRUS 3-5 TARG ","87631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"433.66","74000800","STERNOCLAVICULAR 3+ VIEWS ","71130",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"434.00","92212090","CEFADROXIL 500MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"434.50","92214846","BENZOCAINE BUTA TETRA 14-2-2 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"434.50","92218481","CETACAINE 14%-2%-2% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"434.90","92218131","FLUOCINOLONE ACET 0.01% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"435.00","33112468","SPLINT KNEE THERAPLUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"435.00","92212680","BETAXOLOL HCL 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"436.00","92210857","TRETINOIN 0.025% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"436.50","38303813","CYANIDE ","82600",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.00","38206802","HEPATITIS B VIRUS QUANT ","87517",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.03","74000500","LUMBOSACRAL SP 2-3 VIEWS ","72100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.45","92215687","UREA 40% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.70","92210469","HALOBETASOL PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.70","92215201","EPOETIN ALFA 4000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.83","74001400","TMJ UNILATERAL LT ","70328LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"437.83","74001401","TMJ UNILATERAL RT ","70328RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4375.25","92217794","ACYCLOVIR 5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"438.00","92210805","CROMOLYN NA 0.8MG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"438.40","92215777","TALDALFIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"438.65","92216314","AZTREONAM 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"439.00","33168134","SET SUT 12CM ENTUIT SCR 3 ADJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"439.65","92216449","INSULIN DETEMIR 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"439.80","92212165","AZTREONAM 2GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"439.80","92216316","AZTREONAM 2GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.00","38202216","LEUKOCYTE COUNT FECAL ","89055",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.00","92212706","AMPICILLIN-SULBACTAM 15GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.00","92214181","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.00","92214213","ROSIGLITAZONE MALEATE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.00","92217979","PASER 4GM PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.05","92217759","PRADAXA 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.05","92217760","PRADAXA 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.10","92219202","LEVETIRACETAM 100 MG/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.15","92214641","RAMIPRIL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.20","92219185","MORPHINE SULFATE 0.5 MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.30","92207002","IRRIGATIONS 02 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.45","92212708","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.45","92213082","HYPROMELLOSE 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.45","92217410","FENOFIBRATE 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.45","92219081","FENOFIBRATE 200 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.55","92215252","OLMESARTAN MEDOXOMIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.55","92220511","ERGOLOID MESYLATES 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.60","92219805","PERMETHRIN 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.65","92215767","MEMANTINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.65","92215772","MEMANTINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.70","92215571","MONTELUKAST NA 4MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.76","34010276","DRY NEEDLING 1 OR 2 MUSCLES ","20560",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.80","92210955","ACETYLCYSTEINE 20% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.80","92213552","AMOXICILLIN CLV K 875-125 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.85","92218635","DOFETILIDE 500 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.90","92215369","VORICONAZOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.95","38303725","KOH PREP-HAIR-SKIN-NAILS ","87220",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.95","92215770","MEMANTINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"44.95","92218567","LAMIVUDINE 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"440.00","92215965","BETAMETHASONE DP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"441.00","33101732","CATH DIAL TRIALYSIS 13FRX30CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"441.00","33118105","CATH HEMO ST PWRTRL 13FX15CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"441.00","33118106","CATH HEMO ST PWRTRL 13FX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"441.00","33138334","HELMET SOFT SHELL PINK X-LARGE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"441.00","92211920","NEOSTIGMINE MS 0.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"442.00","33103608","KIT PULSAVAC PLUS FAN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"442.40","92218266","NOXAFIL 100MG DR TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"442.50","92218184","DOLUTEGRAVIR SOD 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"442.85","92216433","FLUTICASONE PROP 50MCG NASAL S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4421.29","74000008","FISTULOGRAM DIALYSIS CIRCUIT ","36901",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"443.95","92213828","CICLOPIROX 0.77% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4436.84","76078834","NM TUMOR LOC WHOLE BODY 2+DAYS","78804",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"444.85","92212375","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4442.72","76020021","IN-111 INDIUM AUTO WBC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"445.00","92210400","TRIAMCINOLONE 0.1% PAS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"445.00","92213502","SINCALIDE 5MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"445.26","38203310","VITAMIN D 1 25-DIHYDROXY ","82652",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4456.00","92215393","LINZOLID 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"446.00","33103151","SET CATH MULT DRAIN 8.5 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"446.00","33113029",""SET DRN 40CM10.2FRMCLC.038""BIL""," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"446.00","33113030","SET DRN 25CM 12FR MC LC .038IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4464.85","92213574","BECAPLERMIN 0.01% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"447.05","92217727","ENOXAPARIN NA 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"447.70","92211715","AZTREONAM 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"447.70","92215506","IPRATROPIUM BR 0.06% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"448.55","92218775","DESCOVY 200 MG-25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"448.60","92212818","ALBUMIN HUMAN 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4483.67","76080036","PET MYOCARD PERF SGL STUDY ","78491",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"449.00","33111771","CAM II WALKER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"449.60","92217267","AMINO ACIDS 4.25% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","38200800","CRYPTOCOCCUS AB ","86641",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","92213088","PIOGLITAZONE HCL 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","92213974","MERCAPTOPURINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","92214062","HEPARIN 2500U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","92216381","ISORETINOIN 20MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.00","92217383","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.10","92210498","BACITRACIN/POLYMYXIN B OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.10","92214397","VALACYCLOVIR HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.10","92219171","ROSUVASTATIN CALCIUM 10 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.25","92212865","KETAMINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.25","92220301","NACL 0.45%/KCL 20MEQ SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.30","92211629","TIAGAINE HCL 16MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.35","92211765","TOPIRAMATE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.40","92218186","CLINDAMYCIN 600MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.45","92211202","BSS EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.45","92216226","PREGABALIN 225MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.50","92216233","PREGABALIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.50","92216236","PREGABALIN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.50","92218623","CYANOCOBALAMIN 1000 MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.50","92219177","BROMOCRIPTINE MESYLAT2.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.55","92213591","AMINOCAPROIC ACID 25% SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.55","92217575","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.58","38302136","ROTAVIRUS ANTIBODY ","86759",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.58","38302550","LEUKOCYTE WBC AUTO ","85048",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.60","92213227","BENZOIN COMPOUND TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.60","92214411","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.60","92216527","AMIKACIN SULF 250MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.70","92210587","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.70","92212844","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.75","92214798","TERBINAFINE HCL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.75","92215993","FLUCONAZOLE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.75","92217441","PHENYTOIN NA 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.75","92217669","DEXTROSE 10%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.80","92214541","LEUCOVORIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.80","92214848","CELECOXIB 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.80","92216732","ALISKIREN 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.84","38203533","MICROSOMAL ANTIBODIES ","86376",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.85","92217516","GENTIAN VIOLET 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.90","92211409","TUBERCULIN 5TU/0.1ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.90","92215385","ATORVASTATIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.90","92217939","DOXERCALCIFEROL 2GM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.90","92218335","VIOKACE 20880-78300-78300U TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.90","92219695","BURPRENORPHINE/NALOXONE8MG-2MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"45.95","92214960","ENTACAPONE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.00","33102811","TRAY PEG 000331 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.00","33113026","KIT PEG 20FR SIL PSH METH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.00","38307029","HLA I A PHENOTYPING ","81373",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.00","38307030","HLA I B PHENOTYPING ","81373",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.00","38307031","HLA I C PHENOTYPING ","81373",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.30","92216050","PANTOPRAZOLE NA 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"450.50","92218982","TOFACITINIB CITRATE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4500.00","33102881","KIT FILTER VENACAVA FEM DENALI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"451.05","92212092","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"451.40","92213067","FLUCYTOSINE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"452.45","92216607","POSACONAZOLE 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"453.35","92214421","TRIAMCINOLONE 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"453.80","92214976","CICLOPIROX 0.77% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"453.95","92215669","BUPROPION HCL 300MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"454.00","33112893","CATH DIAL DL CVC POLY 12FRX16C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"455.00","92220339","CHLOROTHIAZIDE 250MG/5ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"455.25","38000300","TUMOR MORPH EA AB COMP AID ","88361",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"455.65","34010200","APPLY SPLINT SHORT ARM STATIC ","29125GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"455.65","34210265","APPLY SPLINT SHORT ARM STATIC ","29125GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4554.00","92218767","DESMOPRESSIN ACETATE 0.15MGINH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33108546","KIT PEG 20FR PONSKY PULL DELX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33113028","KIT PEG 20FR XLCN SIL PUL METH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33113044","KIT PEG 20FR13.8FR SIL PUL PLC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33168400","KIT PEG 24FR XLCN SIL PUL METH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33176581","KIT PEG 20FR BASIC PULL NE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","33190045","WIRE GUIDE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.00","92210921","CHOLESTYRAMINE 4GM/5.7GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.24","38343624","HEPATITIS C VIRUS AB RNA ","87522",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.35","92218050","FIRST-OMEPRAZOLE 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.35","92218809","LANSOPRAZOLE 3 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.50","92210572","LEVOBUNOLOL 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"456.65","92215540","AMOXICILLIN CLV K 600-42.9/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"457.03","38303310","VITAMIN D 1 25-DIHYDROXY ","82652",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"457.80","92217263","AMINO ACIDS 4.25% D5W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"458.00","33180040","TRAY DIAL DUOGLD STR 13FR 15CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"458.70","92216456","TALDALFIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"459.20","92213226","LEVOFLOXACIN 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"459.90","92215181","GASTROGRAFIN 66/10 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"459.90","92216697","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","38200157","ANGIOTENSIN CONVERT ENZYME ","82164",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","38206757","HOMOCYSTINE ","83090",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92213733","LIDOCAINE HCL 1.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92214453","NITROGLYCERIN 50MG/500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92215047","SODIUM BUPHENYL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92216643","ESTRADIOL 0.05MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92216671","MESNA 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92216694","MEPERIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.00","92220369","FERRIC CITRATE 210 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.01","38301360","GLUCOSE TOL EACH ADD SPEC ","82952",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.01","38399356","OCCULT BLOOD 1-3 DETERM ","82272",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.05","92219504","GLYCOPYRROLATE 0.2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.10","92216216","LOTREL 2.5/10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.10","92218212","ELIQUIS 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.10","92219375","SUCRALFATE 1 GM SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.15","92212753","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.15","92213659","PANTOPRAZOLE NA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.15","92213861","CAMPHOR MENTHOL 0.5%-0.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92211242","VANCOMYCIN HCL 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92211778","CROMOLYN NA 4% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92212051","VALPROATE NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92215570","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92219216","CYCLOSPORINE MOD 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.20","92219521","VANCOMYCIN 500 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.25","92214343","LEUCOVORIN CALCIUM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.30","92217340","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.30","92217479","MILNACIPRAN HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.30","92217480","MILNACIPRAN HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.30","92218246","DULOXETINE 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.30","92219647","MIN OIL/WHITE PETRO20%-80%OINT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.45","92218119","KRISTALOSE 10GM/PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.45","92218260","OXYCONTIN 15MG ER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.50","92210521","CALCIUM GLUCONATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.50","92211252","CEFPODOXIME PROXETIL 200MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.50","92211320","CEFPODOXIME PROXETIL 200MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.50","92216556","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.55","92216675","MICONAZOLE NITRATE 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.55","92217932","ZIPRASIDONE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.55","92217938","ZIPRASIDONE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.60","92210503","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.60","92220303","DIPHENHYDRAMINE 12.5MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.64","38203736","OCCULT BLOOD- OTHER SOURCES ","82271",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.70","92213535","GLYCOPYRROLATE 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.75","92216422","NITROGLYCERIN 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.75","92218121","TERBINAFINE HCL 1% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.75","92218594","MORPHINE SULFATE45 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.75","92219936","CLINDAMYPHOS300MG/50ML-0.9%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.80","92215227","LIDOCAINE 2%/EPI 1:100000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.80","92215807","VENLAFAXINE HCL 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.80","92217937","TICAGRELOR 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.80","92218218","BRILINTA 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.80","92218828","TICAGRELOR 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.85","92213125","STAVIDOME 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.85","92215395","ESOMEPRAXOLE MG 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.90","92214350","CELECOXIB 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.90","92215584","METOPROLOL TART 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.90","92218984","CALCITRIOL 1 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.95","92210172","SULFAMETHOXAZOLE/TMP SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.95","92215765","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.95","92217668","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46.96","34010270","ELEC STIM WOUND UNATTENDED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4604.30","92214481","INTERFERON BETA-1A 44MCG/0.5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"461.10","34010215","APPLY SPLINT FINGER DYNAM ","29131GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"461.10","34210280","APPLY SPLINT FINGER DYNAM ","29131GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.00","33164055","TRAY INSERT PERM CATH DL 40CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.00","92218094","LIORESAL INTRATHECAL SCRN KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.00","92220200","HYDROCORTISONE 0.025 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.45","92218053","SILVER NITRATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.45","92219498","IODINE/POTASSIUM IODIDE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"462.83","74000710","SACROILIAC JOINTS 3+ VIEWS ","72202",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4620.00","92217618","BACLOFEN 10MG/20ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4628.80","92215499","CALCIUM GLUCONATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"463.00","33116188","HELMET SOFTSHELL FULL TAN LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"464.22","34210370","EVAL OF SWALLOWIN-RADIO-OPA ","92611GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"464.22","34600181","EVAL OF SWALLOWING-RADIO-OPA ","92611GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"464.95","92213570","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4647.00","92215346","CALCIPOTRIENE 0.005% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"465.35","92217258","AMINO ACIDS 4.25% D10W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"465.90","92219617","LURASIDONE HCL 120 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.00","33170064","STENT BIL10FR10CM DDNL BND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.00","33170065","STENT BIL10FR7CM DDNL BND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.00","33170066","STENT BIL7FR7CM DDNL BND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.00","33170067","STENT BIL7FR10CM DDNL BND "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.05","92216959","FLUTICASONE PROP 50MCG NASAL S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.80","92212468","BETAMETHASONE DP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"466.90","34010240","APPLY SPLINT SHORT LEG ","29515GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4662.25","92210845","IMMUNE GLOBULIN 5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46624.10","92220143","INTERFERON BETA-1A30MCG/0.5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"46662.00","92218460","GAMUNEX-C 1 GM/10 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"467.20","92213463","TESTOSTERONE ENAN 200MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"467.65","38000665","HEMAPATH ENZYMES ","88319",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"467.95","38302456","VITAMIN D 25 HYDROXY ","82306",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4675.35","92217651","EXENATIDE 250MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"468.00","92212480","PRAMOXINE HCL HC 1%-2.5% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"468.50","92217473","NITROGLYCERIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"468.95","92210772","FLUOROMETHOLONE 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"469.00","33110343","LARYNGOSCOPE ASCOPE4RHINO SLIM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4699.15","92211027","LEUPROLIDE ACET 7.5MG KIT SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","38303832","MUCIN CLOT TEST ","83872",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","74020006","LOCM >400MG/ML IODINE/1ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92210919","SUFENTANIL CITRATE 50MCG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92211105","MORPHINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92211810","SODIUM CL 0.9% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92212913","MEPIVACAINE HCL 2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92215161","CEFPROZIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.00","92215603","OLANZAPINE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.05","92216029","DULOXETINE HCL 60MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.05","92220126","LANOLIN 50% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.10","92219755","DABIGATRAN ETEXILATE 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.15","92214340","RANITIDINE HCL 15MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.15","92219376","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.20","92211189","HYDROCORTISONE NA SUCC 250MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.20","92212640","HYDROCORTISONE NA SUCC 250MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.25","92212255","EUCERIN CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.25","92216229","PREGABALIN 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.33","38307010","ENCEPHALITIS ST. LOUIS ","86653",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92213424","MAGNESIUM SULF 1GM/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92213753","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92214448","CYANOCOBALAMIN 1000MCG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92216524","TELMISARTAN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92217688","OXYCODONE HCL 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.45","92219214","TELMISARTAN 80 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.50","92214638","ETIDRONATE DISODIUM 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.50","92215223","PHENYTOIN 100MG/4ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.50","92217468","SUCRALFATE 1GM/10ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.50","92219979","AL/CAMPH/METH/PHEN/SALIC OINT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.55","92216250","BUPROPION HCL 150MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.60","92212118","BENZOCAINE 20% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.60","92213046","HEPARIN 10000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.60","92214607","BENZOCAINE 20% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.60","92215000","DONEPEZIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.75","92217673","D5W-1/4NS/KCL 20MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.80","92212919","DISULFIRAM 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.80","92214042","LIDOCAINE 1.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.85","92212645","CHLORPROMAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.85","92216033","DULOXETINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.85","92220220","AMPHETAMINE SULFATE 10MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.95","92214211","PAROXETINE HCL 10MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"47.95","92216264","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"470.50","73700050","EMG 1 EXTERMITY ","95860",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"470.90","92211303","METRONIDAZOLE 0.75% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"471.90","92216400","HEPATITIS A VACC 1440U/ML SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"472.33","38301558","HLA ABC TYPING ","86813",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"473.10","92211191","PROCAINAMIDE HCL 500MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4730.00","92218652","LIORESAL INTRATHECAL 0.5MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"474.00","92216955","LEVOFLOXACIN 1.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"474.41","74000631","PELVIS 3+ VIEWS ","72190",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4747.60","92216972","ACITRETIN 25MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"476.00","92217947","ECHOTHIOPHATE IODIDE 0.13% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"476.85","92204000","IV ADMIXTURE 01 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4765.20","92213447","INTERFERON BETA-1A 30MCG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"477.70","92216372","PNEUMOVAX 23 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"478.00","33113034","AMNIOBAND MTRX TISS 18MM PLCNT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"478.45","92216049","BECLOMETHASONE DIPRO 40MCG AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4782.35","92217839","IMMUNE GLOBULIN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"479.00","92212798","PROPRANOLOL HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"479.05","92215535","GATIFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","38201880","PHENOBARBITAL QUANT ","80184",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","92201009","OPHTHALMICS 09 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","92211818","THEOPHYLLINE 400MG/500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","92211836","FLURBIPROFEN NA 0.03% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","92215133","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.00","92216027","DULOXETINE HCL 30MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.05","92213306","AMINOCAPROIC ACID 250MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.05","92217867","LANOLIN MINERAL OIL PETROLAT O"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.10","92212841","OMEPRAZOLE 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.10","92213365","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.10","92216076","ESMOLOL HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.15","92215999","FLUCONAZOLE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.40","92215541","ESMOLOL HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.45","92212561","MAGNESIUM SULF 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.45","92213855","LORAZEPAM 4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.50","92210030","TESTOSTERONE CYPI 100MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.50","92215843","CYCLOSPORINE MOD 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.55","92211092","ERYTHROMYCIN 250MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.55","92219369","ERYTHROMYCIN DR 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.65","92216457","PRAMIPEXOLE DIHCL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.65","92216460","PRAMIPEXOLE DIHCL 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.65","92216461","PRAMIPEXOLE DIHCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.65","92217481","MILNACIPRAN HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.65","92218813","BUPRENOR/NALOXONE 4MG-1MG FILM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.70","92213720","RISEDRONATE NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.70","92218179","XYLOCAINE MPF W/EPI 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.75","92220420","FLUCONAZOLE 200 MG/100 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.80","92212764","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.85","92216398","MICONAZOLE NITRATE 2% POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.90","92214854","LIDOCAINE HCL 0.8% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.95","92211448","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"48.95","92220290","SEVELAMER CARBONATE 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139867","PICC MAX NSG NV PG 6F TL-55cm "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139877","PICC MAXNSGNVPGNITDFDRP4FSL55C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139878","PICC MAXNSGNVPGNITDFDRP5FDL55C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139883","PICC MAXNSGVLVPG4FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139884","PICC MAXNSGVLVPG4FSL55CMGW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139893","PICC MAXNSGVLVPGDFDRP3FSL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33139895","PICC MAXNSGVLVPGDFDRP6FDL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33152525","PICC BIOFLO MAX VLV 4FSL-55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33152527","PICC BIOFLO MAX VLV 5FDL-55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.00","33161995","CATH HICKMAN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.18","72060007","PLATELETS LR-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"480.20","92217261","AMINO ACIDS 4.25% D20W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"481.05","92217259","AMINO ACIDS 5% D25W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"482.00","33106974","CUTTER PROX LIN W/LOCK 100MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"482.10","92215507","IPRATROPIUM BR 0.03% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4825.00","92211770","AMOXICILLIN CLV K 250-62.5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"483.00","33112404","TRAY MAHURKAR 3LUM 12FRX20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"485.00","92216282","CEFTRIAXONE NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"485.05","74001183","LUMBAR SPINE BEND ONLY 2-3 VWS","72120",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"485.23","38200222","BNP (B NATRIURETIC PEPTIDE) ","83880",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"485.80","92216850","INSULIN GLARG RECMB 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"486.00","33113040","ALLOPATCH PLBL 4.0CMX0.4-0.8MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"486.00","33152379","HELMET HARD SHELL TAN MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"486.00","33152380","HELMET HARD SHELL TAN LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"486.00","74001191","CHEST MIN 4 VIEWS ","71048",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"486.00","92212893","TRETINOIN 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"487.10","92217717","VITAMIN A/D OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"487.30","92211225","BRIMONIDINE TARTRATE 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"487.80","92210898","DESOXIMETASONE 0.25% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"488.00","92212358","PENTAMIDINE ISETHIONATE 300 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"488.27","74000605","ORBITS COMP 4+ VIEWS ","70200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"488.60","92217346","DORZOLAMIDE HCL TIMOLOR MAL SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"488.91","74000239","THORACIC SP 3 VIEWS ","72072",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4884.00","92214895","CIDOFOVIR 75MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"489.00","92217209","ERYTHROMYCIN 2% PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"489.23","38301555","HIV VIRAL LOAD QUANT (DNA) ","87536",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"489.60","92214269","SILDENAFIL CITRATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"489.95","92218505","PREZCOBIX 150 MG-800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4890.27","92214136","GEMCITABINE HCL 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.00","92211634","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.00","92213995","CEFUROXIME NA 750MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.00","92214097","GANCICLOVIR 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.00","92214858","ISORETINOIN 20MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.10","92210943","SEVELAMER HCL 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.10","92213300","LIDOCAINE 2%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.15","92211246","VITAMIN A/D OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.15","92212247","RISPERIDONE 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.20","92217825","LEVOFLOXACIN D5W 500MG/100ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.20","92220022","ROSUVASTATIN 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.25","92219479","ROSUVASTATIN CA 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.30","92214755","ZIPRASIDONE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.30","92215638","ROSUVASTATIN CA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.30","92217515","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.30","92217956","ZIPRASIDONE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.30","92218535","ZIPRASIDONE HCL 40 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.35","92211795","MAGNESIUM SULF 8% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.35","92214640","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.35","92220330","AML/LIP/PROT84000-20000-63000U"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.53","38302214","MAN DIFF WBC CNT BUFFY COAT ","85009",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.55","92214272","LABETALOL HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.60","92210649","NAPHAZOLINE HCL 0.025%-0.3% SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.60","92218271","MIRABEGRON 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.65","92213417","ESOMEPRAXOLE MG 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.70","92217447","SILODOSIN 8MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.70","92218472","REYATAZ 50 MG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.70","92218688","TAPENTADOL 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.80","92211174","STAVIDOME 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.80","92219172","ROSUVASTATIN CALCIUM 20 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.85","92213850","QUINIDINE GLUC 324MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.90","92211180","DANAZOL 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.90","92217907","URSODIOL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.95","92215084","METFORMIN HCL 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.95","92217920","TAPENTADOL HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"49.97","38299354","CYCLIC CITRULLINATD PEPTIDE AB","86200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.00","33106404","POSITIONER PATNT TRTS ADULT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.00","33112367","KIT GASTRFEED24FR JEJUN 57.9CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.00","33167517","TUBE FDG GASTRO 26FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.00","33170650","TUBE FDG GAST ENT 22FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.00","33170651","TUBE FDT GAST ENT 28FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.30","92217281","AMINO ACIDS 4.25% D25W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.90","75000033","US BREAST UNIL RT LIMITED ","76642RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"490.90","75000034","US BREAST UNIL LT LIMITED ","76642LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"491.46","38000620","SLIDE REFERAL-CONSULT ","88321",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"491.47","74000530","MANDIBLE 4+ VIEWS ","70110",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"492.00","33152455","TRAY TROCAR 24 FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"492.00","33152482","TRAY 20 FR TROCAR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"492.45","92210924","HYDROCORTISONE VAL 0.2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"492.90","92217286","AMINO ACIDS 4.25% D5W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4923.75","92216790","ETANERCEPT 25MG/0.5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"493.00","92214487","PILOCARPINE HCL 4% EYE GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"493.25","92219484","PRAZIQUANTEL 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"493.92","74000482","KNEE 4+ VIEWS BILATERAL ","7356450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"493.92","74010075","KNEE 4+ VIEWS RT ","73564RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"493.92","74010076","KNEE 4+ VIEWS LT ","73564LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"494.13","34200134","APPLY SPLINT LONG ARM ","29105GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"494.69","39299994","2D ECHO WITH DOPPLER ","93321",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4947.03","73700200","POLYSOMNOGRAPHY ","95810",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.00","33139868","PICC MAXNSGNVPG6FTL55CMGW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.00","33139876","PICC MAXNSGNVPGDFDRP6FTL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.00","33152528","PICC BIOFLO MAX BARR 5FTL-55CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.00","92210369","TRIAMCINOLONE 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.00","92220480","TIOTROP BR/OLOD2.5-2.5/MCG SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.11","74010088","RIBS UNILATERAL W/PA CHEST RT ","71101RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.11","74010089","RIBS UNILATERAL W/PA CHEST LT ","71101LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"495.35","92218571","INCRUSE ELLIPTA 62.5 MCG/ACTU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4957.25","92210095","IMMUNE GLOBULIN 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"496.00","92217287","AMINO ACIDS 5% D15W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"496.10","92219745","BUPRENORPHINE TRNSDRM7.5MCG/HR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"497.70","92213731","DEXAMETHASONE 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"497.95","92214803","APRACLONIDINE 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"499.00","92204007","IV ADMIXTURE 08 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"499.75","72060000","BLOOD WHOLE-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"4997.56","76080038","MYOCARD PERF MULTI SPEC ","78452",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.00","38200205","ANTI-THYROGLOBIN ","86800",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.00","92214155","BUPIVACAINE/EPI 0.75%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.00","92214431","PARICALCITOL 5MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.00","92216487","SODIUM CL 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.00","92216683","PETROLATUM 71.5%OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.05","92218900","FLUCONAZOLE 400 MG/200 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.10","92213031","PIPERACIL TAZOBACT 4.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.10","92218227","RALTEGRAVIR 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.20","92217678","TORSEMIDE 20MG/2ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.25","92213350","AMOXICILLIN 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.25","92213730","MONTELUKAST NA 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.35","92214446","SODIUM BICARB 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.35","92215159","RISPERIDONE 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.40","92212483","COAL TAR 0.5% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.40","92218628","DOFETILIDE 250 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.45","92215614","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.45","92215625","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.45","92216966","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.45","92217339","CARBIDOPA/ENTACAPONE/LEVO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.45","92219765","DABIGATRAN ETEXILATE 150MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.55","92220337","CARBAMIDE PEROXIDE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.60","92212143","ERYTHROMYCIN 250MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.60","92213393","MORPHINE 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.60","92219815","MULTIVITAMIN AND MINERALSLIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.65","92213905","PIOGLITAZONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.70","92210933","TOPIRAMATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.70","92211088","STAVIDOME 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.70","92215556","ALPRAZOLAM 1MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.70","92217529","TAPENTADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.75","92214508","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.80","92204025","IV ADMIXTURE 26 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.80","92215243","HEPARIN 1000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.80","92218728","LAMIVUDINE 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.90","92211418","MORPHINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.90","92215636","EPINEPHRINE HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.95","92218703","SACUBITRIL/VALSART24MG26MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.95","92218981","SACUBITRIL/VALSART49MG51MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"50.95","92219225","SACUBTRL/VALSRTN97MG-103MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"500.00","33113038","AMNIOBAND GRFT 3X2CM 6SQ CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"500.75","92217289","AMINO ACIDS 4.25% D10W W/E IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"501.00","33112164","TRAY CATH CENT VENOUS 3LUMEN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"501.00","33189562","KIT PWRCATH MID DLMAXBARR4FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"501.05","92211668","FLUOCINONIDE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"501.20","92216843","LATANOPROST 0.005% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"501.90","92213127","FOSCARNET NA 24MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"502.25","92217974","BUTRANS 5MCG/HR ER TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"502.90","92217268","AMINO ACIDS 5% D20W IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5025.00","33189565","KIT VENA CAVA JUGLR SUBCLAVIAN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"503.00","34050200","APPLY CYLNDR CAST THIGH-ANKLE ","29365GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"503.00","92216113","CLINDAMYCIN PHOS 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"503.55","92213701","VALGANCICLOVIR HCL 450MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"504.00","92218490","M.V.I.ADULT . INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"504.55","92214090","TRAVOPROST 0.004% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"504.74","74000750","SINUS COMP MIN 3 VIEWS ","70220",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"505.00","33152456","TRAY TROCAR 28 FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"505.80","92215874","CINACALCET HCL 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"506.61","34600400","FIBEROPTIC EVAL SWALLOWING ","92612GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.00","33161403","TUBE 110MM9.2MM6MM ADJ NK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.00","33161404","TUBE 120MM10.6MM7MM ADJNK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.00","33161405","TUBE 130MM11.7MM8MM ADJNK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.00","33161414","TUBE 110MM9.2MM6MM ADJ NK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.00","33161415","TUBE 120MM10.6MM7MM ADJNK FLNG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.15","92217280","AMINO ACIDS 5% D25W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.44","72000910","AUTOLOGOUS BLOOD COLLECTION ","86890",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.46","38000504","SURGICAL PATH LEVEL V ","88307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"507.98","34200135","APPLY SPLINT LONG LEG ","29505GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5072.00","33114971","SEALANT SPINE DURASEAL 5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"508.00","33103817","GONIOMETER ELBOW ORTHOSISCOMFY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5088.60","92219403","IMMUNE GLOB 10% 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"509.00","33152378","HELMET HARD SHELL TAN SM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"509.00","92217139","SULFACETAMIDE NA S 10%-5% SOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.00","92211757","TOBRAMYCIN 60MG/0.9% NACL INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.00","92213123","CIPROFLOXACIN 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.00","92214887","ISORETINOIN 20MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.00","92219567","PEPPERMINT OIL MG (3.5ML) BTL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.04","38302140","RPR ","86592",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.04","38303605","VDRL CSF QUALITATIVE ","86592",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.08","38299344","CULTURE TB ","87116",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.10","92217666","DEXTROSE 5%-NS-KCL 40MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.10","92219947","BACITRA/POLY B 500U-10000U/GM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.11","38300690","SED RATE (AUTO) ","85652",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.15","92216160","ITRACONAZOLE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.15","92216692","ITRACONAZOLE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.15","92217465","HEPARIN 100U/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.15","92218793","CIPROFLOXACIN 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.17","34010090","ULTRASOUND 15 MIN ","97035GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.17","34210040","ULTRASOUND 15 MIN ","97035GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.20","92214425","BROMOCRIPTINE MESYLATE 5MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.20","92214432","BROMOCRIPTINE MESYLATE 5MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.20","92219857","TACROLIMUS 1 MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.35","92213029","FLUOXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.40","92217436","LEVETIRACETAM 500MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.50","92203020","ORALS 20 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.50","92214561","LEUCOVORIN CALCIUM 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.50","92214978","LIDOCAINE HCL 0.4% D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.50","92217723","DONEPEZIL HCL 23MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.50","92218454","CYCLOPHOSPHAMIDE 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.55","92218983","CALCITROL 1 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.60","92204057","IV ADMIXTURE 57 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.60","92213708","SPIRONOLACTONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.62","92218328","DALIRESP 500MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.70","92219078","DABIGAT ETEXIL MESYL 150MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.75","92204049","IV ADMIXTURE 49 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.75","92212285","OXAPROZIN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.75","92219088","BUDESONIDE 0.25 MG/2 ML INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.80","92216652","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.80","92217415","BUDESONIDE 0.25MG/2ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.85","92218244","LIDOCAINE 5% TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.91","38300540","CHOLESTEROL (TOTAL) ","82465",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"51.95","92217368","DIDANOSINE 250MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5108.40","92215335","DARBEPOETIN A 100MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5108.40","92215577","DARBEPOETIN A 100MCG/0.5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"511.07","74000300","FACIAL BONES 3+ VIEWS ","70150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"512.37","74000510","MAMMOGRAM DIAG BILATERAL ","77066",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5123.26","74001011","ANGIO SPINAL SELECTIVE ","75705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"513.10","92216075","ERLOTINIG 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"513.60","92214057","SILDENAFIL CITRATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5133.60","92216332","EXENATIDE 250MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"514.00","33107283","CUTTER PROX LIN W/LOK 100MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"514.80","92215512","CICLOPIROX 1% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5147.82","74001052","AORTOGRAM THORACIC W/SERIAL ","75605",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"515.00","33129584","TRAY CVC DRY 7FR 20CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"515.25","92211196","CEFTRIAXONE NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"515.60","92213578","STREPTOMYCIN SULF 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5160.85","92219113","COLLAGENASE 250 UNITS/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"517.00","33174135","TRAY CATH PWRPIC TL MAX 5FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33108700","TUBE TRACH BIVONA TTS SZ 7 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33108701","TUBE TRACH BIVONIA TTS SZ 8 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33109010","KIT TRACH AIRCUFF 8MMIDX11MMOD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33109721","TUBE TRACH MIDRNG 7MMIDX10MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33111316","KIT TRACHTB MIDAIRCUF9X12.3MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33112142","TUBE TRACH BIV TTS110MML 6X8.7"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.00","33116175","KIT TRACH AIRCUFF6MMIDx8.7MMOD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.40","92213945","CIPROFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.75","92216255","CIPROFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"519.75","92218445","CYCLOGYL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.00","92210221","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.00","92214089","POTASSIUM CL 2MEQ/ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.00","92214602","KETOROLAC 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.00","92215361","ROPIVACAINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.00","92217620","HYDROCORTISONE 1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.05","92214653","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.08","38301180","FECAL FAT QUALITATIVE ","82705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.08","92215428","ESOMEPRAXOLE MG 20MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.10","92212860","CARBOXYMETHYLCELL NA 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.10","92214697","CARBOXYMETHYLCELLULOSE NA 1% G"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.10","92215421","ESOMEPRAXOLE MG 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.14","38320510","IMMFLUOR TYPE ","87140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.15","92217039","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.15","92217842","OCTREOTIDE ACET 100MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.19","38201420","HEMATOCRIT ","85014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.20","92215632","DUTASTERIDE 0.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.20","92217595","METOCLOPRAMIDE 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.20","92217629","METHYLPREDNISOLONE NA 125MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.25","92214611","DEXTROSE 20%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.25","92217696","LACOSAMIDE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.30","92216557","RIFAMPIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.30","92218564","TIKOSYN 0.125 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.35","92213595","CEFUROXIME AXETIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.35","92213646","DOFETILIDE 0.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.35","92214279","DOFETILIDE 0.25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.35","92215641","ROSUVASTATIN CA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.35","92218187","DOFETILIDE 0.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.40","92212124","ATROPINE SULF 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.40","92216405","CEFTRIAXONE NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.41","38302090","RBC COUNT AUTO ","85041",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.45","38300123","ANTIDEPRESSANTS SERO 1-2 ","80332",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.45","92214470","ZIPRASIDONE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.45","92217745","SCOPOLAMINE HBR 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.47","34050015","INFRARED ","97026GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.47","34210330","INFRARED ","97026GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.50","92218059"," SUBOXONE 8MG-2MG FILM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.55","38305559","PROTEIN TOTAL 24 HR URINE ","84156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.55","38343605","PROTEIN URINE ","84156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.55","92210764","IRBESARTAN 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.65","92214414","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.70","92213057","PIOGLITAZONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.74","38301020","BLOOD SMR W/ MAN DIFF WBC CNT ","85007",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.76","34010007","ROM TESTING HAND ","95852GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.76","34210320","ROM TESTING HAND ","95852GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.79","38301883","CHLORIDE URINE ","82436",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.80","92213121","PROPRANOLOL HCL 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"52.85","92215140","OLMESARTAN MEDOXOMIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"520.00","33152381","HELMET HARD SHELL TAN X-LG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"520.95","92216439","PROCAINAMIDE HCL 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"521.05","92220491","DEXMEDETOMIDINE MDV 100MCG/1ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"521.15","92217311","DANTROLENE NA 20MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"522.00","33181904","TRAY CVC LINE SINGLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"522.00","92210849","FLUOCINOLONE ACET 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"522.00","92210969","FLUOCINOLONE ACET 0.025% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"524.36","74001302","SPINE-ENTIRE 2 OR 3 VIEWS ","72082",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"524.70","92213113","VANCOMYCIN HCL 5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"525.00","33195360","KIT CATH PWR TRI TL CVD 15CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"526.00","92212944","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"526.00","92220176","DELAFLOXACIN 450MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"526.05","92211746","PILOCARPINE HCL 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5260.20","92217059","IMMUNE GLOBULIN 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"527.00","33114347","CART RELD CONT STAPLR REG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"527.35","92212638","NYSTATIN 100000U/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"528.00","92219724","DEXMEDETOMIDINE/NACL4MCG/MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"528.00","92220163","DEXMEDETOM HCL400MCG/100ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"528.00","92220189","DEXMEDETOMIDINE 400MCG/100ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"528.40","92217284","AMINO ACIDS 5% D15W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"528.50","92212231","VASOPRESSIN 20U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5281.55","92219292","HEPATITIS B IMMUNE GLOB . SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"529.20","92214217","EPOETIN ALFA 3000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"529.40","92218211","PRECEDEX 4MCG/ML-0.9% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"529.75","92210306","BUTORPHANOL 10MG/ML SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"529.75","92213141","BUTORPHANOL 10MG/ML SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"529.80","92212908","FLUOCINONIDE 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.00","38200091","ALPHA-FETOPROTEIN SERUM ","82105",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.00","38302970","EUGLOBULIN LYSIS ","85360",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.00","92214462","HYDROXYZINE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.05","92217634","RITONAVIR 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.15","92214651","HEPARIN 25000U-1/2NS 500ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.20","92212195","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.20","92213190","SIMVASTATIN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.20","92213266","SIMVASTATIN 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.20","92214761","SIMVASTATIN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.20","92214779","SIMVASTATIN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.25","92219831","LACTULOSE 10 GM PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.40","38203220","METANEPHRINES (FRACTION) ","83835",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.40","92219830","MIN OIL/PETROLATUM 31.9%-57.7%"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.40","92219998","PROPAFENONE 225 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.50","34050220","ELEC STIM NOT WOUND UNATTENDED","97014GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.50","34200043","ELEC STIM NOT WOUND UNATTENDED","97014GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.50","92212172","AZITHROMYCIN 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.50","92218780","METHYLPHENIDATE HCL 18MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.55","92213358","CEFAZOLIN 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.60","92217654","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.65","92211962","CHLORPROMAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.70","92215253","CEVIMELINE HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.70","92216522","VARENICLINE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.70","92216523","VARENICLINE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.70","92217670","CA CL/KCL/NA CL IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.70","92220454","ESOMEPRAZOLE MAGNESIUM 40MGPKT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.78","38305402","OXYCODNE SCREEN ","80365",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.80","92217661","D5W/NACL 0.45%/KCL 30MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.80","92220298","MINERAL OIL/PETROLAT 3%-94%OIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34000155","THERAPEUTIC PROCEDURE-GROUP ","97150GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34000156","THER PROCEDURE-GROUP 30 MIN ","97150GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34000157","THER PROCEDURE-GROUP 45 MIN ","97150GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34000158","THER PROCEDURE-GROUP 60 MIN ","97150GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34200050","THERAPEUTIC PROCEDURE-GROUP ","97150GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34200056","THER PROCEDURE-GROUP 15 MIN ","97150GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34200057","THER PROCEDURE-GROUP 45 MIN ","97150GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.82","34200058","THER PROCEDURE-GROUP 60 MIN ","97150GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.85","92212010","PHENYLEPHRINE HCL 0.25%-3% OIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.85","92213681","PERMETHRIN 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.85","92220393","METAXALONE 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.90","92210047","VANCOMYCIN HCL 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.90","92213178","ESCITALOPRAM OXALATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.90","92216034","DULOXETINE HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.90","92216227","PREGABALIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.95","92211258","ERYTHROMYCIN ES 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.95","92215640","ROSUVASTATIN CA 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"53.95","92220332","AMOXICILLIN 400 MG/5 ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"530.00","92210903","DIMERCAPROL 100MG/ML OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"530.25","92215674","NYSTATIN 100000U/GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"530.85","92215539","AMOXICILLIN CLV K 600-42.9/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"531.66","38000770","FISH EA PROBE MANUAL ","88368",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"532.00","33103197","BRACE HAND/WRST SAEBOSTR LT SM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"533.20","34020001","SELECTIV DEBRIDE 1ST 20 SQ CM ","97597GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"533.20","34220001","SELECTIV DEBRIDE 1ST 20 SQ CM ","97597GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"533.30","92217454","SUMATRIPTAN SUCC 6MG/0.5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5332.61","73700210","POLYSOMNOGRAPHY/C-PAP ","95811",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"534.00","92212437","VARICELLA VIRUS 1350PFU PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"534.25","92218120","ZYTIGA 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"534.70","92215534","OXYBUTYNIN CL 3.9MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5349.00","36000150","BRONCHOSCOPY ","31622",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"535.00","36000122","VENOUS BLOOD GAS ","82803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5351.15","92214712","FLUVESTRANT 250MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"536.00","92211218","CEFPODOXIME PROSETIL 100MG SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"536.25","92210332","CLARITHROMYCIN 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"536.60","92217266","AMINO ACIDS 5% D20W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"536.65","92217725","ENOXAPARIN NA 120MG/0.8ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"537.00","33110204","KIT CATH PERCUT CAVTY DRN CURV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"537.00","33176586","KIT PERCUTANEOUS DRAINAGE CVD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"537.50","92210614","AMOXICILLIN CLV K 250-62.5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"537.67","38390000","MOLECULAR PATHOLOGY LEVEL 2 ","81401",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"537.85","92219293","MICONAZOLE NITRATE 2% OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"538.00","33102114","TUBE JEJUNAL 12FR ENDOVIVE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"538.00","33177557","TUBE GASTROSTOMY JEJUNAL 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"538.00","33186899","TUBE JEJUNAL FEED/GASTRIC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"538.00","33195303","TUBE FDG JEJUNAL 9FR 60CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5383.40","74001051","AORTOGRAM THORACIC W/O SERIAL ","75600",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"539.15","92210838","FLUNISOLIDE 0.25MG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"539.38","38302788","IMMUKNOW CYLEX ","86352",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.00","92213960","ALFENTANIL HCL 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.00","92215938","LEVALBUTEROL 0.63MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.00","92215940","LEVALBUTEROL 1.25MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.00","92217565","INFLUENZA A H1N1 VACC 2009 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.05","92215178","CLARITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.10","92218000","CLEOCIN 300MG/50ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.15","92210203","DICLOFENAC NA MISOPRO 50-0.2 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.20","92211578","ETOMIDATE 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.20","92217443","QUETIAPINE FUMARATE 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.20","92217444","QUETIAPINE FUMARATE 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.25","92212679","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.25","92220236","FLUTICASONE FUROATE 200MCG/INH"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.35","92218371","DESVENLAFAXINE 50 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.39","38200358","ANTI RNA POL-3 ","83520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.39","38301940","POTASSIUM URINE ","84133",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.40","92219914","HEPARIN 25000U/250ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.45","92210367","ATRACURIUM BESYLATE 10MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.45","92214067","LIDOCAINE HCL 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.45","92217667","VANCOMYCIN HCL 500MG/100ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.50","92213355","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.50","92215942","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.51","38305622","PARASITE EXAM ","87015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.51","38305623","PARASITE EXAM URINE ","87015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.51","38306022","STOOL CRYPTOSPORIDIU ","87015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.51","38306570","CONCENTRATION O&P/TB ","87015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.55","92219101","SEVELAMER CARBONATE 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.60","38302213","BLOOD SMR W/O MAN DIFF WBC CNT","85008",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.60","92216799","LISDEXAMFETAMINE DIM 70MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.60","92219993","HYDRO/APAP 7.5MG-325MG/15ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.63","34010075","WHEELCHAIR TRAINING 15 MIN ","97542GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.63","34210075","WHEELCHAIR TRAINING 15 MIN ","97542GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.64","92214332","RIBAVIRIN 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.65","92214527","RIBAVIRIN 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.65","92214534","RIBAVIRIN 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.70","92218884","MICONAZOLE NITRATE 0.02 CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.75","92220296","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.85","92212850","KETAMINE HCL 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.85","92217331","VENLAFAXINE HCL 75MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.90","92213958","ATROPINE SULF 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"54.95","92213530","DOBUTAMINE HCL D5W 250-250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"541.75","92216981","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"542.03","75000031","US BREAST UNIL RT COMPLT ","76641RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"542.03","75000032","US BREAST UNIL LT COMPLT ","76641LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5427.00","73700175","SLEEP STUDY ATTENDED ","95807",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.00","33110802","LIGATION CLIPS 2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.10","92211867","GENTAMICIN SULF 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.10","92211939","GENTAMICIN SULF 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.90","92217610","INSULIN LISPRO RCMB 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.90","92219395","INSUL LISPROREC100UNITS/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"543.96","75000126","US PELVIS LIMITED OR FOLLOWUP ","76857",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5446.11","74010041","ANGIO EXTREMITY RT ","75710RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5446.11","74010042","ANGIO EXTREMITY LT ","75710LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"545.80","92215481","ENOXAPARIN NA 300MG/3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"546.50","92216280","AMINO ACIDS 15% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"546.50","92218784","AMINO ACIDS 15% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5469.00","92215752","INTERFERON BETA-1A 30MCG/0.5 K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"547.00","33119955","STAPLER SINGLE USE LOADING "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"547.00","92213866","CICLOPIROX 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"547.00","92215257","IOPAMIDOL 41% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"547.55","92213713","ERYTHROMYCIN LAC 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"549.00","33111825","KIT PEG GUIDEWIRE PONS 20FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"549.00","33177291","TRAY CHEST TUBE INSERTION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"549.10","92215340","NEDOCROMIL NA 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"549.40","92220131","BARICITINIB 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","72000920","HEMOLYSIN AGGLUTIN AUTO SCREEN","86940",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92210295","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92210701","TROPICAMIDE 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92211695","PILOCARPINE HCL 2% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92213309","DPT TOX-PED SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92213492","ABACAVIR SULF 20MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92214098","LEUCOVORIN CALCIUM 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92217082","OXYCODONE HCL 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.00","92219898","MICONAZOLE 2% OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.05","92215206","MAGNESIUM SULF 4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.05","92215487","CEFEPIME HCL 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.10","92214071","DILTIAZEM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.15","92217795","INFLUENZA VACC 2011-2012 SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.15","92220276","HEPARIN 25000U/250 ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.20","92214763","HEPARIN 12500U-1/2NS 250ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.20","92218156","METHYLIN 5MG CHW TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.20","92219593","ABACAVIR 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.25","92218320","ABACAVIR 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.40","92212403","BUPIVACAINE HCL 0.25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.41","38303705","SED RATE (MANUAL) ","85651",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.44","38300151","URIC ACID URINE ","84560",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.44","38343608","URIC ACID NON-BLOOD ","84560",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.45","92212578","CEFUROXIME AXETIL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.45","92220117","PERMETHRIN 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.50","92214167","ERYTHROMYCIN 5MG/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.52","38201800","OCCULT BLOOD FECAL ","82270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.52","38302040","PROTHROMBIN TIME ","85610",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.55","92212245","TRIAMCINOLONE 0.5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.55","92213868","ABACAVIR SULF 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.60","92216232","PREGABALIN 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.65","92214459","ZIPRASIDONE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.65","92215683","RISPERIDONE 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.65","92216397","TRAMADOL HCL 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.68","34600134","SPEECH GROUP TREATMENT ","92508GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.68","34600135","SPEECH GROUP TRTMT 30 MIN ","92508GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.68","34600136","SPEECH GROUP TRTMT 45 MIN ","92508GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.68","34600137","SPEECH GROUP TRTMT 60 MIN ","92508GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.70","92218398","HURRICAINE ONE 20% TOPICAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.75","92218899","LIFITEGRAST 5% OPHTH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"55.90","92220430","FLUTICAONE FUROATE 200MCG POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"550.00","33110681","CUSH WC ROHO AIRLT 18X16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"550.00","92212410","TOBRAMYCIN 1.2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"550.73","74001303","SPINE-ENTIRE 4 OR 5 VIEWS ","72083",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"550.74","38387003","BCR/ABL1 TRANSLOCATION MI BRK ","81207",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5501.00","92215284","INTERFERON ALFA-2B 10MMU/0.2 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5501.80","92219256","VALGANCICLOVIR HCL 50MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5505.13","76020020","TC-99M EXAMET LAB WBC PER DOSE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"551.00","33101725","DRESSING VAC VERAFLO LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"551.00","33102185","ORTHOSIS KNEE SOFT ROM COMP MD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"551.10","92213154","TOBRAMYCIN 1.2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"551.70","92218833","EMTRIC/RILPIV/TEN 200-25-300MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"552.25","92204055","IV ADMIXTURE 55 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"552.40","92218337","LANSOPRAZOLE 3MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"552.40","92218526","FIRST-OMEPRAZOLE 2 MG/ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"552.46","74001315","HIPS 2 VIEWS BILATERAL ","73521",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5529.15","92216021","CLOBETASOL PROP 0.05% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"553.00","92216588","ACTIQ 1200MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"553.44","75010029","US EXTREM LIMITED BILAT ","7688250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"553.44","75010030","US EXTREM LIMITED RT ","76882RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"553.44","75010031","US EXTREM LIMITED LT ","76882LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"553.75","92211121","NEOMYCIN SULF/POLYMYX B/HC SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"554.80","92212079","DICYCLOMINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5545.00","33114968","SEALANT TISEEL FIBRIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"555.00","92210744","AMPICILLIN NA 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"556.90","92210122","DESOXIMETASONE 0.25% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"558.20","92214953","INSULIN LISO/LISO PROT 75/25 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"559.47","74000670","RIBS BILATERAL 3 VIEWS ","71110",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.00","92210810","METHYLENE BLUE 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.00","92218340","FLUVOXAMINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.05","92213829","ENOXAPARIN NA 30MG/0.3ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92210736","OPTHALMIC LUBRICANT 3.5GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92215134","SALIVA SUBSTITUTES SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92216435","VALACYCLOVIR HCL 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92216554","CEFAZOLIN 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92218545","POTASSIUM CHLORIDE 20 MEQ PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92219474","TRIAMCINOLONE ACE 40MG/ML SUSP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.10","92219802","FENTANYL 50 MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.20","92212453","METHAZOLAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.30","92211153","CALCIUM GLUCONATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.30","92216047","PENICILLIN VK 250MG/5ML PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.35","92216333","LOPINAVIR RITONAVIR 200-50MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.40","92213759","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.40","92217636","MICONAZOLE NITRATE 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.40","92217913","MORPHINE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.45","92213632","MORPHINE D5W 1MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.45","92218159","RAPAFLO 4MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.50","92219977","LIDOCAINE 5% PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.60","92213346","DANAZOL 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.60","92215092","RITONAVIR 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.60","92215639","ROSUVASTATIN CA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.60","92216158","RITONAVIR 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.60","92219445","RITONAVIR 100 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.63","38201020","BLOOD SMR W/ MAN DIFF WBC CNT ","85007",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.65","92211680","BARRIER SKIN PROTECTANT OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.65","92218830","MYCOPHENOLATE SOD DR 360MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.80","92219049","TESTOSTERONE 25 MG/2.5 GM GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.85","92216077","MULTIVATAMIN MINERALS 10ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.85","92217889","CLINDAMYCIN PHOS 300MG/50ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.85","92217978","VALACYCLOVIR 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.85","92219330","RIVAROXABAN 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.85","92220427","RIVAROXABAN 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.90","92211882","ENALAPRILAT 1.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.90","92218046","DEXLANSOPRAZOLE 60MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"56.90","92219389","DAPAGLIFLOZ/METFORM XR5-1000MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"560.00","33111829","KIT JEJUNOSTOMY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"560.70","92211649","AMINO ACIDS 8% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5608.35","92219486","PETROLATUM GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"561.00","92218979","PROCAINAMIDE HCL1000MG/10MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"561.82","72060005","RED BLOOD CELL-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"562.60","92214821","RISEDRONATE NA 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"562.65","92211211","RIMEXOLONE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"563.18","38387004","JAK2 GENE ANALYSIS ","81270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"564.35","74000770","SKULL 4+ VIEWS ","70260",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"564.61","38380069","RENAL FUNCTION PANEL ","80069",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"564.90","92220207","PHYTONADIONE 5MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5647.93","74001016","ANGIO EXTREMITY BILATERAL ","75716",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"565.00","92215790","SULFACETAMIDE NA 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"565.00","92215791","SULFACETAMIDE NA 10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"565.85","92216804","TIOTROPIUM BROMIDE 18MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5658.85","72000840","THERAPEUTIC APHERESIS RBC ","36512",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"566.00","36000840","TRACH CHANGE ","31502",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"566.00","92215756","TRETINOIN 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"566.75","92215262","IOPAMIDOL 61% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"567.40","92212499","CLOBETASOL PROP 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"567.40","92213509","CLOBETASOL PROP 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"567.60","92220121","THROMBIN HUM RECOM 5000U PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"568.80","92213892","DILTIAZEM HCL 360MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"569.80","92217924","UREA 40% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"569.85","92214988","GANCICLOVIR NA 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92204008","IV ADMIXTURE 09 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92211164","CA CL/KCL/NA CL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92211609","IODINE 4.7% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92211728","NEOSTIGMINE MS 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92212592","METHYLPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92213581","HYDROCORTISONE BUTYR 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92214344","GELATIN SPONGE SPG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92214454","ACTIV CHARCOAL 15GM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92215314","DOPAMINE HCL 400MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92216627","HYALURONATE NA POVIDONE GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92216908","CEFUROXIME NA 750MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.00","92217398","HALOPERIDOL DEC 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.05","92210455","BELLADONNA/PHENOBARB TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.05","92211401","CHLORPROMAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.05","92212066","ANAGRELIDE HCL 0.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.05","92213198","AMOXICILLIN CLV K 200-28.5/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.18","38300810","GLUCOSE BODY FLUID ","82945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.18","38303050","GLUCOSE 24 HR URINE ","82945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.20","92218154","LIALDA DR 1.2GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.22","38302215","RETICULOCYTE (AUTO) ","85045",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.25","92218209","DONEPEZIL 23MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.25","92218791","IVABRADINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.25","92219325","IVABRADINE 7.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.30","92215347","BUPRENORPHINE NAOLXONE 8-2MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.30","92220336","BUPRENOR/NALOXONE 8MG-2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.35","92210373","NIMODIPINE 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.40","92215637","ROSUVASTATIN CA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.40","92215642","ROSUVASTATIN CA 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.40","92215764","EPLERENONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.40","92215766","EPLERENONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.42","38380040","FRUCTOSAMINE-GLYCATED PROTEIN ","82985",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.55","92213638","BUDESONIDE 0.25MG/2ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.57","38301882","SODIUM URINE ","84300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.60","92213569","ABACAVIR SULF 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.70","92219986","GUANFACINE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.75","92216953","CHLORHEXIDINE GLUC 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.75","92220188","SODIUM BICARBONATE 8.4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.77","38302470","URINALYSIS AUTO W/MICROSCOPIC ","81001",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.85","92218752","ALFENTANIL HCL 1000MCG/2ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"57.95","92210438","TETRACAINE HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.00","33139854","PICC MAXHYNSGVLVPG6FTL55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.00","33139857","PICC MAX VLVPGNITDFDRP6FTL55CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.00","33152531","PICC BIOFLO MAX VLV 6FTL-55CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.19","38301772","CYTOGENETICS 20-25 CELLS ","88264",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.63","34010285","NEG PRESS WOUND THER<=50SQCM ","97605GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.80","92210379","KETOCONAZOLE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"570.99","74001104","ABD FLAT & UPRIGHT &1V CHEST ","74022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5719.00","92214729","PEGINTERFERON ALFA-2A 180MCG K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"572.00","33111404","SURGICLIP PREM S-9.0 APPLIER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"572.35","92220501","NIMODIPINE 6 MG/1 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"572.55","38302625","ALUMINUM ","82108",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"573.00","33113818","TRAY PWR TRIALYSIS 15CM 3LM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"573.00","33113819","TRAY PWR TRIALYSIS 24CM 3LM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"574.80","92212384","HYDROCORTISONE 2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5745.75","76080037","PET MYOCARD PERF MULT STUDY ","78492",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"575.00","33192404","BUTTON TRACH 10 X 27 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"575.00","92212047","BENZOYL ERYTHROMYCIN 5%-3% GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"575.50","92216344","IMATINIB MESYLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"575.60","92210350","CREAM MULTI INGREDIENT CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"575.90","92213870","PRAMOXINE HC 1%-2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"576.00","33111913","KIT CATH GROSHONG LS CUFF8FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"576.00","92213934","CHOLESTYRAMINE 4GM/5GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"576.35","92216414","FONDAPARINUX NA 5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"576.50","92217488","LACOSAMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"576.85","92215528","NEOMYCIN SULF/POLYMYX B/HC SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"577.00","33114982","SURGICLIP PREMS-9.0LIGCLIPAPPL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"578.00","92215505","CIPROFLOXACIN 5% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"579.00","33168380","SET PNEUMOTHORAX WAYNE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"579.00","92217293","AMINO ACIDS 8% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","38200200","ANTI-PLATELET ANTIB ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","38204300","PTH RELATED TOTAL PROTEIN ","83519",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","92204002","IV ADMIXTURE 03 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","92212691","THEOPHYLLINE 800MG/D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","92214000","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.00","92216789","TEMOZOLOMIDE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.10","92213633","CEFOTAXIME NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.10","92220087","CHLORHEXIDINE GLUC 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.13","38303695","HEMOGLOBIN ","85018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.15","92210948","CALCIUM GLUCONATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.15","92219575","SODIUM ACETATE 4 MEQ/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.20","92216220","OCTREOTIDE ACET 100MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.20","92218134","ELIQUIS 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.20","92218597","APIXABAN 2.5 MG% TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.20","92218882","APIXABAN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.20","92219247","APIXABAN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.25","92219626","MEFLOQUINE HCL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.25","92219772","MEFLOQUINE 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.30","92201011","OPHTHALMICS 11 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.30","92214345","RIBAVIRIN 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.30","92218549","EEXTROSE 0.7 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.35","92218070","PIOGLITAZONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.40","92213997","AMINOPHYLLINE 500MG/20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.40","92217365","DEMECLOCYCLINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.50","92215398","EZETIMIBE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.60","92210263","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.69","38301260","WET MOUNT SMEAR ","87210",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.69","38303710","INDIA INK PREP ","87210",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.70","92204044","IV ADMIXTURE 44 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.75","92215218","ACETYLCYSTEINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.75","92217663","D5W-1/2NS/KCL 10MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.75","92218323","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.80","92213467","CELECOXIB 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.80","92214479","TOLTERODINE TARTRATE 2MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.80","92217757","OXYCODONE HCL 20MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.85","92218858","COBICISTAT 150 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.95","92213508","PIOGLITAZONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.95","92214946","DEMECLOCYCLINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"58.95","92217789","EPINEPHRINE/LIDOCAINE HCL INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"580.00","36000121","ARTERIAL BLOOD GAS ","82803",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"580.35","92211678","AMOXICILLIN CLV K 400-57/5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"581.10","92210999","BETAMETHASONE DP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"581.20","92210985","NEOMYCIN SULF/POLYMYX B/HC SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"581.30","92210534","PILOCARPINE HCL 4% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"581.35","92215396","IOPAMIDOL 61% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5821.67","76080029","PET TUMOR IMAG WHOLE BODY ","78813",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"584.00","34600505","EVAL SWALLOW/LARYN SENSORY ","92616GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"585.00","33101812","KIT SAFETY SHARPS PEG 24FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"5850.63","74001018","ANGIO PELVIC SELECTIVE ","75736",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"586.04","74001305","CERVICAL SP 4 OR 5 VIEWS ","72050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"587.00","33113032","AMNIOBAND MEMBRANE 2CMX2CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"587.85","92211419","HYDROQUINONE 4% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"588.00","33106367","SET FEEDING SET JEJUNAL 9 FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"588.00","92217165","RISEDRONATE NA 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"588.50","92218169","SOD THIOSULFATE 250MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"588.95","92215304","EPOPROSTENOL NA 1.5MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"589.00","33102789","KIT INTRO MIC KEY GASTRO 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.00","38201155","ERYTHROPOIETIN ","82668",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.00","92213924","K CL/NABCRB/NACL/NASULF/PEG PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.00","92214937","ANTIPYRINE/BENZOCAINE EAR SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.00","92219733","MESALAMINE 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.01","38302216","LEUKOCYTE COUNT FECAL ","89055",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.05","38302440","URIC ACID BLOOD ","84550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.05","92217674","KCL 20MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.05","92217859","D5W/NACL 0.9%/KCL 20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.05","92218547","POTASSIUM CHLORIDE 20 MEQ PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.07","34000100","MASSAGE 15 MIN ","97124GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.07","34200070","MASSAGE 15 MIN ","97124GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.10","92215112","RABEPRAXOLE NA 20MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.10","92219541","PEG400/PROPY GLY 0.4%-0.3% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.15","92214415","ZIPRASIDONE HCL 80MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.15","92217665","D5W/NACL 0.45%/KCL 40MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.35","92215266","OLMESARTAN MEDOXOMIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92210804","PROCHLORPERAZINE EDI 5MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92213055","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92215476","LEVALBUTEROL 0.31MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92216562","HYDROCORTISONE 2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92217477","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92218448","ROPIVACAINE HCL 2 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92219742","VANCOMYCIN 500 MG/100 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.40","92219902","MINERAL OIL/PETROL 20%-80% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.55","92217394","FENOFIBRIC ACID 135MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.60","92210028","TRIAMCINOLONE 0.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.60","92216733","ESOMEPRAZOLE MG 40MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.80","38300921","CULTURE GRP & TYP AGGL ","87147",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.80","92204010","IV ADMIXTURE 11 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.85","92212898","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.89","38380020","BLOOD CNT MAN (RBCWBCPLT)EA","85032",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.90","92211742","CALCIUM CL 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.94","38301390","GRAM/GIESMA SMEAR ","87205",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.94","38303753","EOS SMEAR (URINE) ","87205",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.95","92210139","CLOTRIMAZOLE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"59.99","38300250","BILIRUBIN DIRECT ","82248",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"592.75","92215337","HALOPERIDOL DEC 100 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.00","33108543","PORT-TITAN IMPLNT-9.6FR CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.00","33112439","HELMET HARD SHELL ROYAL MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.00","92212524","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.11","74001304","SPINE-ENTIRE MIN 6 VIEWS ","72084",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.32","72060014","RBC IRRADIATED-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"593.70","92210404","FLUOROMETHOLONE ACET 0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"594.00","92216496","ANIDULAFUNGIN 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"594.20","92217779","BUPRENORPHINE 10MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"594.42","74008000","DEXA BONE DENSITY HIP/PELV/SP ","77080",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"594.80","92213507","PODOFILOX 0.5% TOPICAL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"594.85","92218904","FOSFOMYCIN TROMETHAMINE3GM PWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"595.00","33170442","BOOT WALK AIRCAST XP MED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"596.34","75000127","US PREG UTERUS LIMITED ","76815",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"596.95","92212759","BETAMETHASONE DP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"597.30","92213816","CLINDAMYCIN PHOS 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"597.95","92212423","VARICELLA VIRUS 1350PFU PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"598.00","33103049","TRAY CATH XRX 3LCENTVEN7FR35CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"598.10","92212114","ECONAZOLE NITRATE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"598.35","92215299","IOHEXOL 64.7% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"598.50","92218405","TARCEVA 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"599.00","36000610","PULSE OXIMETRY-CONTINUOUS ","94762",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"599.30","92217347","AZELASTINE HCL 137MCG NASAL SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"599.62","38300248","DONOR SPECIFIC HLA AB CLASS 2 ","86833",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"599.62","38301302","HLA AB CL2 HI-3 ","86833",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"599.65","92219460","PENICI G BENZ600000UNITS/MLPWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","34600540","AUD ASSESS REHAB ADD 15 MIN ","92627GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92210024","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92212251","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92214242","MILRINONE LACTATE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92216835","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92217484","ARMODAFINIL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.00","92217831","VORICONAZOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.05","92212171","AMPICILLIN-SULBACTAM 3GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.07","38300241","INFECT AGENT PHENOTYP ADD HIV1","87904",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.10","92210850","TRIAMCINOLONE 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.10","92218216","LUVOX CR 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.15","92213837","NEVIRAPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.20","92215168","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.20","92218525","BUDESONIDE 0.5 MG/2 ML INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.35","38300217","PARASITE ID - SKIN SCRAPING ","87169",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.35","92219764","COLCHICINE 0.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.40","92211669","ACYCLOVIR 1000MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.45","92215951","SUCRALFATE 1GM/10ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.45","92220495","HEP SOD/D5W 25000U-5%/500 ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.50","92210665","CAPSAICIN 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.50","92210681","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.50","92213482","HYDROCORTISONE 2.5% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.51","34000050","GAIT TRAINING 15 MIN ","97116GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.55","92211735","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.55","92213402","ESOMEPRAXOLE MG 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.60","92217033","DICLOFENAC EPOLAMINE 1.3% TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.65","92211820","TETRACAINE HCL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.79","38343604","PHOSPHOROUS URINE ","84105",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.80","92210461","PIROXICAM 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.80","92211036","METHYLPREDNISOLONE ACET 40MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.80","92215280","EZETIMIBE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.80","92216099","DARIFENACIN HBR 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.80","92218709","FLUCONAZOLE 100 MG/50 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.85","92210087","THEOPHYLLINE 80MG/15ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.85","92211697","METHYLPREDNISOLONE ACET 40MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.85","92216899","RANOLAZINE 1000MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.85","92219492","MEPIVACAINE HCL 1.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.89","38301399","POST GLUCOSE DOSE (GTT) ","82950",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.95","92215516","OCTREOTIDE ACET 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.95","92217417","BUDESONIDE 0.5MG/2ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.95","92217506","TIAGAINE HCL 12MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"60.95","92219984","BUDESONIDE 0.5 MG/2 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"600.00","92205001","TPN/TNA 1 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"600.20","92212425","CLINDAMYCIN PHOS 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"601.05","92211991","GENTAMICIN SULF 3MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"603.00","33101266","TRAY CATH POWER-TRIAL CVD TRI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"603.00","33112846","TRAY PWRTRIALYSIS 24CM13FR 3LM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"603.00","33112848","TRAY PWRTRIALYSIS 15CM13FR 3LM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"603.00","33113802","TRAY PWR TRIALYSIS 12.5CM 3LM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"604.63","75000028","US GUIDE FOR VASCULAR ACCESS ","76937",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"604.65","92219899","APREPITANT 40 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"605.98","34010205","APPLY SPLINT SHORT ARM DYNAM ","29126GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"605.98","34210270","APPLY SPLINT SHORT ARM DYNAM ","29126GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"606.00","92218455","ESTROGEL 0.06% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"607.63","74000501","LUMBOSACRAL SP 4+ VIEWS ","72110",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"609.87","73700051","EMG 2 EXTERMITY ","95861",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.00","92211648","TRIENTINE HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.00","92212402","MAGNESIUM SULF 50% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.00","92215127","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.00","92217115","NISOLDIPINE 17MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.05","92215682","RISPERIDONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.05","92217011","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.05","92219844","CEFAZOLIN/D5W 2 GM/100 ML IVPB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.09","38302641","AMPHETAMINES SCRN 1-2 ","80324",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.10","92210666","TRIAMCINOLONE 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.20","92217518","ERGOCALCIFEROL 50000U/6.25ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.25","92217513","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.25","92219818","CARBOXMETHCELL/GLY0.5%/0.9%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.30","92211118","TRIAMCINOLONE 0.025% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.30","92215755","METAXALONE 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.30","92219654","COLCHICINE 0.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.35","92217534","SAXAGLIPTIN HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.40","92215162","DEXTROSE 5%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.40","92218263","HYDROMORPHONE 3MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.57","92219302","METHYLPHENIDATE HCL ER54MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.60","92210661","ACETYLCYSTEINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.60","92213445","OLANZAPINE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.60","92214923","ASPIRIN DIPYRIDAMOLE ER 25-200"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.65","92218473","PATANASE 0.6% SPRAY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.75","92215174","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.80","92218175","TOPOSAR 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.85","92210961","CLOMIPRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.85","92211840","CLOMIPRAMINE HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.85","92216278","CLOMIPRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.85","92216279","CLOMIPRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.86","38303135","HIV1 ANTIGENEIA ","87390",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.90","92215952","SUCRALFATE 1GM/10ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.90","92217407","SODIUM POLYSTYRENE SULF SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.90","92219301","DOXERCALCIFEROL 2 MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.90","92219599","SILDENAFIL20 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"61.90","92219699","RITONAVIR 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"610.10","92218257","LEVEMIR FLEXTOUCH 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"610.10","92220428","INSULIN DETEMIR 100UNITS/MLPEN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6101.20","92218202","BARIUM SULFATE 60% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"612.16","74001316","HIPS 3-4 VIEWS BILATERAL ","73522",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6127.80","92217719","CONIVAPTAN HCL 20MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"613.35","92211387","TRIAMCINOLONE 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6136.94","76080035","PET MYOCARD METABOLIC EVAL ","78459",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"615.46","72060009","PLT LR & IRRAD-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"615.65","92212567","NYSTATIN/TRIAMCINOLONE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"615.90","92216072","FONDAPARINUX NA 7.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6153.00","33106961","MESH VICRYL KNITTED 12x12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"616.00","33112403","TRAY MAHURKAR 12X20 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6165.18","74001023","ANGIO VISCERAL SELECT ","75726",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6167.06","76080031","PET TUMOR W/CT SKULL-MIDTHIGH ","78815",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"617.40","92216188","MICAFUNGIN NA 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"617.90","92210731","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"618.00","92211562","BLEOMYCIN SULF 30U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"618.00","92214568","AMINO ACIDS 6.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"618.75","92211791","PHENYLEPHRINE HCL 2.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6180.76","76080027","PET TUMOR IMAG LIMITED AREA ","78811",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"619.70","92210383","FLUTICASONE PROP 0.05MG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.00","92211219","CAFFEINE SOD BENZOATE 500MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.00","92211893","ETHANOL 98% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.00","92214157","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.00","92217664","D5W/KCL 5%/20MEQ IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.05","92217497","MESALAMINE 800MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.05","92217966","TRIGLYCERIDES 2400ML OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.13","38301650","LDH ","83615",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.25","92217423","DONEPEZIL HCL 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.30","92219858","ESTRADIOL 0.0375MG/24HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.35","92218078","UREA 20% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.35","92220048","SODIUM HYPOCHLORITE 0.0125 SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.40","92213536","DEFEROXAMINE MESYLATE 500MG IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.43","72000553","HEMOLYSINS/AGGLUT-INCUBATED ","86941",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.50","92212807","CHLORPROMAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.50","92214842","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.55","92216038","MORPHINE 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.65","92212219","LAMOTRIGINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.70","92210133","BELLADONNA/PHENOBARB TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.70","92210466","TRIAMCINOLONE 40MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.70","92214315","DOFETILIDE 0.125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.70","92214537","DOFETILIDE 0.25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.70","92216218","BUPRENORPHINE HCL 0.3MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.78","38300260","BILIRUBIN TOTAL ","82247",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.78","38305527","BILIRUBIN TOTAL MISC FLUID ","82247",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.80","92213469","OLANZAPINE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.90","92217921","TAPENTADOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"62.95","92220049","FLUCONAZOLE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6200.80","92212598","RITUXAMAB 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"621.40","92218829","IOHEXOL 75.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"621.95","92214633","ALCLOMETASONE DIPRO 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"622.10","92215415","INSULIN HUM ISOP 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"622.10","92215436","INSULIN HUM ISOP/REG 70U-30U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"622.87","38000052","TISSUE CULT. NEOPLASTIC BM-BC ","88237",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"623.00","33192401","BUTTON TRACH 9 X 27 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"623.30","92214106","PAMIDRONATE DISOD 9MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"623.72","38300247","DONOR SPECIFIC HLA AB CLASS 1 ","86832",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"623.72","38301301","HLA AB CL1 HI-1 ","86832",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"624.00","33116100","KIT INTRO MIC KEY GASTRO 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"624.00","33151844","KIT TJ INTRODUCER 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6245.05","92218161","NULOJIX 250MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"625.01","74000671","RIBS BILATERAL WITH PA CHEST ","71111",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"625.07","38303758","POTASSIUM STOOL ","84999",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"625.07","38307021","OSMOLALITY STOOL ","84999",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"625.65","92218753","AMINO ACIDS 15% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"625.90","92216545","EFAVIRENZ EMTRICITABINE TENO T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"626.00","33112659","SET ORTHOSIS ELBOW/HAND ADJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6266.00","74001019","ANGIO PULMONARY SELECT BIL ","75743",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"627.00","33142195","TRACHEOSTOMY WEINMANN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"627.00","33152475","TRAY PERICARDIOCENTESIS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6271.11","73510003","EEG W/VIDEO EA 24HRS ","95951",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"628.00","33102244","TRAY CATH PWRTRIALYSIS SLM20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"628.00","33110383","TRAY CATH PRWTRIALSTR SLIM15CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"628.00","33110384","TRAY CATH PRWTRIALSTR SLIM30CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.00","92210450","BETAMETHASONE VA 0.1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.00","92212897","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.00","92214662","DIDANOSINE 400MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.00","92215291","POTASSIUM CL 30MEQ/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.03","92213332","RABEPRAXOLE NA 20MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.11","38307020","SUSCEPT STUDY AGAR (ESTRIP) ","87181",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.15","92211084","CHLORPROMAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.15","92213080","EPINEPHRINE HCL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.19","38302530","VDRL QUANTITATIVE ","86593",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.20","92215493","TRIAMTERENE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.24","38304120","RUSSELL VIPER VNM TIME-UNDIL ","85612",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.29","34010020","MANUAL THERAPY 15 MIN ","97140GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.29","34200061","MANUAL THERAPY 15 MIN ","97140GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.45","92210978","TOBRAMYCIN 80MG/0.9% NACL INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.45","92217012","ENOXAPARIN NA 30MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.45","92217708","MEROPENEM 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.50","92211961","HEPARIN 25000U/D5W 250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.60","92216202","PARICALCITOL 1MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.65","92215972","RIFAXIMIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.70","92218613","VORTIOXETINE HYDROBROM 10MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.80","92212709","FLUPHENAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.80","92215545","RISPERIDONE 0.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.85","92213490","PIOGLITAZONE HCL 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.87","38302011","PROTEIN TOTAL OTHER SOURCE ","84157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.87","38305561","PROTEIN CSF ","84157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"63.90","92217923","ROPIVACAINE HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"630.30","92218573","IODIXANOL 270 MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"630.69","38203776","HEPARIN INDUCED ANTIBODY ","86022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6314.05","92218739","DICLOFENAC SODIUM 0.03 GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"632.05","74000270","ESOPHAGUS ","74220",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"634.25","92213936","PENCICLOVIR 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6340.75","92219341","ENTECAVIR 0.05 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"635.00","92210508","BETAXOLOL HCL 0.5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"635.00","92220071","AMINO ACIDS 8%-10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6359.85","92204013","IV ADMIXTURE 14 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"637.85","92212703","FLUOCINONIDE 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"638.00","92215213","FLUTICASONE PROP 0.005% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"638.30","92219602","VALGANCICLOVIR 450 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"638.35","92219295","MICONAZOLE NITRATE 2% CREAM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"638.55","92211748","FLUOCINONIDE 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"639.74","75000255","US DOPPLER COLOR FLOW ADD-ON ","93325",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"639.85","92213896","ANTHRALIN 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6390.90","74000055","ANGIO RENAL UNILATERAL RT ","36251RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6390.90","74001022","ANGIO RENAL UNILATERAL LT ","75722LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.00","38386602","UREA NITROGEN CLEARANCE ","84545",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.00","92213184","SODIUM ACETATE 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.00","92213867","LACTATED RINGERS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.00","92214980","AMINO ACIDS W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.00","92217660","D5W-1/4NS/KCL 40MEQ/L IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.05","92218166","DESVENLAFAXINE ER 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.15","92211008","BUPIVACAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.15","92214577","HEPARIN 25000U-1/2NS 250ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.20","92216101","EXZOPICLONE 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.20","92216243","EXZOPICLONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.30","92213993","METHOTREXATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.30","92219031","METHYLPRED NA SUCC 125 MG SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.35","92217440","FEBUXOSTAT 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.40","38200116","BETA HYDROXYBUTYRATE ","82010",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.40","38202213","BLOOD SMR W/O MAN DIFF WBC CNT","85008",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.40","92218699","DRONABINOL 5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.45","92214983","RISPERIDONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.48","38399331","SHIGA-LIKE TOXIN ","87427",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.55","92212266","TESTOSTERONE 5MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.55","92212282","CHLORHEXIDINE GLUC 4% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.60","92213957","METHYLENE BLUE 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.66","38303777","ALBUMIN FLUID ","82042",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.66","38305521","ALBUMIN CSF ","82042",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.66","38305522","ALBUMIN MISC FLUID ","82042",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.70","92211676","ITRACONAZOLE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.75","92215352","BUDESONIDE 3MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.83","34210054","THER INT COG FUNC EAADDL 15MI ","97130GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.83","34600014","THER INT COG FUNC EAADDL 15MIN","97130GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.84","38303690","GLUCOSE QUANTITATIVE ","82947",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.85","92218370","DESVENLAFAXINE 50 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.88","34000120","PARAFFIN BATH ","97018GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.88","34200083","PARAFFIN BATH ","97018GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.90","92211135","ATORVASTATIN CALCIUM 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.90","92219279","LISDEXAMFETAMINE DIMES20MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"64.95","92217690","SIROLIMUS 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"640.10","92214740","BIMATOPROST 0.03% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"640.65","92216045","BECLOMETHASONE DIPRO 80MCG AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33112932","TRAY CHEST TUBE RX 1800 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33112933","TRAY CHEST TUBE RX 2000 20 FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33112934","TRAY CHEST TUBE RX 2400 24FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33113820","TRAY PWR TRIALYSIS 30CM 3LM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33113821","TRAY PWR TRIALYSIS 15CM 3LM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.00","33158322","TRAY CHEST TUBE RX 1600 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"641.54","39200255","HOLTER MONITOR - VISUAL ","93225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6413.00","76080028","PET TUMOR IMAG SKULL-MIDTHIGH ","78812",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"644.00","92212683","CEFUROXIME NA 750MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"645.00","33122488","TRAY CHST TUB RX C-T-2800 28FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"645.20","92215374","IOPAMIDOL 76% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"645.55","92216281","CALCITONIN 200U SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"646.25","92219483","PROCARBAZINE HCL 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"646.80","92220372","ERAVACYCLINE 100 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"648.65","92216408","FONDAPARINUX NA 10MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.00","33102563","TUBE TRACH PED SHILEY #1 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.00","92210132","ATROPINE SULF 1% EYE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.00","92214128","PIPERACILLIN NA 3GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.00","92216361","THIAMINE 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.10","92212457","LAMOTRIGINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.20","92213637","DEXTROSE 40% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.20","92217612","MICONAZOLE NITRATE 400MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.20","92218375","GLUTOSE 45 0.4 GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.30","92212041","OLANZAPINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.30","92218133","FULYZAQ 125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.35","92218243","VANCOMYCIN HCL 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.37","34010130","HOME MGT TRAINING 15 MIN ","97535GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.37","34210130","SELF CARE/HOME MGT 15 MIN ","97535GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.37","34600141","SELF CARE/HOME MGT 15 MIN ","97535GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.40","92216778","PREGABALIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.40","92216779","PREGABALIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.40","92216781","PREGABALIN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.40","92216782","PREGABALIN 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.55","38200360","CA 125 ANTIBODY ","86304",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.55","92216506","FUROSEMIDE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.60","92216780","MORPHINE 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.60","92220537","SMX/TMP 800MG-160MG/20ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.65","92214040","MICONAZOLE NITRATE 2% POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.65","92215376","CALCITRIOL 1MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.70","92210292","ANTIPYRINE/BENZOCAINE EAR SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.75","92212696","METHYLPREDNISOLONE 125MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.75","92217123","DESVENLAFAXINE SUCC 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.85","92211737","METHYLPREDNISOLONE 40MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.90","92220459","MENTHOL 4% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"65.95","92215370","DESMOPRESSIN ACET 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"650.00","92213344","GADOTERIDOL 279.3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"652.94","38302045","PARATHYROID HORMONES INTACT ","83970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"652.94","38302049","PARATHYROID HORMONE ","83970",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"653.00","33111865","DRSG MESH PROLENE 6X6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"653.70","92214152","OCTREOTIDE ACET 1000MCG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"654.41","75000305","US PREG UTERUS MULTI GEST COMP","76810",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6540.51","76080032","PET TUMOR W/CT WHOLE BODY ","78816",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"655.09","75000310","US FETAL BIOPHYSICAL PROFILE ","76819",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"656.00","33139748","KIT TRACH PERC SOFT INTRO7-9MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"656.43","73500326","NRV COND STUDIES 3-4 STUDIES ","95908",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"656.49","75000199","US EXT ARTERY SINGLE LEVEL BIL","93922",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"656.76","38387002","BCR/ABL1 TRANSLOCATION MAJ BRK","81206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"657.30","92211974","PREMETHRIN 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6571.40","92219489","ORITAVANCIN 400 MG PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"658.35","92218646","GEMCITABINE 2 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"658.45","92212769","DIDANOSINE 10MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"659.00","33112862","SURGICLIP TITANIUM LIG MED 11."," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"659.00","92215325","BENZOYL ERYTHROMYCIN 5%-3% GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"659.50","92217207","COSYNTROPIN 0.25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"659.66","77000191","CT 3D RENDER W/O POSTPROCESS ","76376",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92213475","ROPIVACAINE HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92213585","CEFOXITIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92215616","AMINO ACIDS 3.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92217396","ENLON-PLUS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92217626","FLUCONAZOLE 100MG/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92218451","LEUCOVORIN 50 MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92218693","CEFOXITIN 2 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92218909","CAPSAICIN 0.033% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.00","92219816","NALOXONE0.4 MG/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.01","38300890","CULTURE CAMPY ","87046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.01","38303620","YERSINIA CULT ","87046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.01","38303715","CULTURE ECOLI 0157 ","87046",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.05","38312020","D-DIMER ULTRASENS QUAL/SEMIQNT","85380",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.05","92210053","POTASSIUM CL 20MEQ/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.05","92212813","ATROPINE SULF 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.09","38307019","METHEMOGLOBIN QUANT ","83050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.10","34010040","THERAPEUTIC EXERCISE 15 MIN ","97110GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.10","34200110","THERAPEUTIC EXERCISE 15 MIN ","97110GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.10","92216121","SAQUINAVIR MESYLATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.14","34000790","NEUROMUSCULAR RE-ED 15 MIN ","97112GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.14","34200030","NEUROMUSCULAR RE-ED 15 MIN ","97112GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.14","38300290","BLEEDING TIME ","85002",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.20","92214774","TEMOZOLOMIDE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.30","92219784","TOLTERODINE TARTRATE ER 4MGCER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.30","92219862","TOLTERODINE 2 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.35","92212414","PENTOSAN POLYSULFATE NA 100 CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.35","92215079","POTASSIUM CL 20MEQ PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.55","92217646","DIANEAL 1.5% PD-2 DEXTROSE IVS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.55","92218329","LACOSAMIDE 10MG/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.60","92210816","PIPERACIL TAZOBACT 2.25GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.60","92214313","TERBINAFINE HCL 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.60","92217672","KCL 40MEQ/NS 1000ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.65","92213235","HYDROCORTISONE 100MG/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.65","92214321","HYDROCORTISONE 100MG/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.70","92213214","ERYTHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.75","92215909","NELFINAVIR MESYLATE 625MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.75","92217580","VANCOMYCIN HCL 750MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.80","92213613","DEXTROSE 50%/WATER INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.85","92216107","EXZOPICLONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"66.98","38302010","PROTEIN TOTAL ","84155",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"660.00","33189584","TRAY CATHWRTRI12FRCRVTEMP15CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"660.36","38387005","CYP2C19 GENE CMO VARIANTS ","81225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"661.00","33129520","DRSG VERAFLO CLEANSE CHOICE LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"663.00","33112213","TRAY THORACIC VENT PROCEDURE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"663.00","33139917","TRAY THORACIC VENTPROC11FR10CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"663.31","74001306","CERVICAL SP 6 OR MORE VIEWS ","72052",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"664.75","92216610","PEG ELCTROLYTE LAVAGE PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"665.10","92219400","INSU LIS REC CRT100UNITS/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"665.65","75000170","US CHEST ","76604",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"665.70","92213406","CICLOPIROX 0.77% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"666.40","92218781","ISAVUCONAZONIUM SUL 186MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"666.79","74076006","FLUORO GUIDANCE NEEDLE PLACE ","77002",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"667.45","92216429","OMEPRAZOLE NA BICARB 20MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"667.45","92216432","OMEPRAZOLE NA BICARB 20-1100 C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"668.00","33152483","TRAY PNEUMOTHORAX WIRE14FX29CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.00","92215618","AMINO ACIDS 7% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.00","92215894","MYCOPHENOLATE 360MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.00","92216856","TERBINAFINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.00","92218393","SUCRALFATE 1 GM/10 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.00","92219454","BUPIVACAI/EPI0.75%-1:200000SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.20","92215297","LIDOCAINE 1%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.25","92214356","DEXTROSE 50%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.40","92210964","PROCHLORPERAZINE MAL 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.40","92211315","ATROPINE SULF 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.40","92213916","LORAZEPAM 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.50","92211745","ANTIPYRINE/BENZOCAINE EAR SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.55","92219604","TETRACAINE OPHTH 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.70","92213624","BUDESONIDE 0.5MG/2ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.73","38207001","ENZYME DETECTION PER ENZYME ","87185",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.75","92217853","TESTOSTERONE 2MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.89","38300019","RH BLOOD TYPING ","86901",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.89","72000615","RH TYPING ","86901",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.90","92213053","LIDOCAINE 1%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.90","92213338","BUPIVACAINE/EPI 0.25%/0.0005 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"67.94","38399357","Q FEVER AB COXIELLA BURNETII ","86638",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.81","74001313","HIP 4+ VIEWS UNILATERAL RT ","73503RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.81","74001314","HIP 4+ VIEWS UNILATERAL LT ","73503LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.85","92217724","ENOXAPARIN NA 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.90","92219309","NICARDIPINE/D5W 20MG/200ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.90","92219310","NICARDIPINE/NACL 20MG/200MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"670.90","92220161","NICARDIPIN/NACL 20MG/200ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"671.10","92220140","DEGLUDEC 100 UNITS/ML PEN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6712.65","92215782","RISPERIDONE 50MG GER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6718.57","74001025","AORTOGRAM ABD&BIL FEMORAL EXT ","75630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6719.28","76080033","PET BRAIN METABOLIC EVAL ","78608",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"672.00","33111089","TUBE GASTRIC 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"672.00","33111872","TUBE TRANSGAST JEJUN 22FR FEED"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"672.00","33111901","TUBE TRANSGAST JEJUN 16FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"672.00","33119969","TUBE GASTRIC JEJUNAL 18FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"672.00","33177524","TUBE GASTOSTOMY JEJUNAL 22FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"673.00","92215569","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"674.75","92218306","TRIAMCINOLONE 55MCG/ACT INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"675.15","92216071","FONDAPARINUX NA 5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"676.15","92217854","SODIUM POLYSTYRENE SULF PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"676.35","92210061","BETAMETHASONE DP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"676.45","92217955","IMMUNE GLOBULIN 1GM/10/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"678.00","33122442","SYSTEM AIRTAP LIFT COMPTBLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"679.50","92218782","ODEFSEY 200-25-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.00","92204009","IV ADMIXTURE 10 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.00","92210917","BUPIVACAINE/EPI 0.5%/0.0005 IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.00","92211594","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.00","92212797","ALUMINUM ACETATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.10","92219162","OSELTAMIVIR PHOSPHATE 30MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.10","92219952","FLUTICA/UMECLIDIN/VILANTEROL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.20","92219917","EZETIMIBE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.25","92211571","QUETIAPINE FUMARATE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.25","92213902","HALOPERIDOL LAC 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.25","92215028","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.25","92218035","HURRICAINE ONE 20% SPRAY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.30","92213917","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.30","92214347","HYDROCORTISONE 100MG/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.31","38307015","KB SENSITIVITY ","87184",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.35","92219373","SUCCINYLCHOLINE CL 20MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.38","38301800","OCCULT BLOOD FECAL ","82270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.50","38200505","SEX HORMONE BINDING GLOBULIN ","84270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.55","92204031","IV ADMIXTURE 32 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.55","92212998","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.60","92218707","SACUBITRIL/VALSART49MG51MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.60","92218712","SACUBITRIL/VALSART24MG26MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.60","92219344","SACUBITRIL/VALSART97-103MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.75","92213090","K CL/NABCRB/NACL/NASULF/PEG PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.75","92220378","ATROPINE SULFATE .01 MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.75","92220411","BRIMONIDINE TARTRATE 0.2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.85","92214192","POTASSIUM ACET 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.85","92217345","THEOPHYLLINE 80MG/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.85","92217824","LEVOFLOXACIN D5W 750MG/150ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.90","92217300","MEGESTROL ACET 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.91","38301270","GAMMA GT (GGT) ","82977",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.95","92218629","DOFETILIDE 500 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"68.95","92218636","DOFETILIDE 125 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"682.90","92214714","RIFAMPIN 600MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"683.30","92220069","AMINO ACIDS 8%-10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"684.00","92218054","DERMA PHOR OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"685.90","92203003","ORALS 03 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"686.00","72060018","RBC/WHL BLD LR CMV-NEG-PROC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"686.20","92220070","AMINO ACIDS 8%-14% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"686.22","74000271","SWALLOW FUNCTION W/VIDEORAD ","74230",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"687.70","92217041","BARIUM SULF 2.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"687.75","92217180","METHYLNALTREXONE 12MG/0.6ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"688.45","92219334","DOLUTEGRAVIR/RILP50MG-25MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"689.00","33190683","TRAY CATH PWR TRI TL 13FRX20CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","33111222","TRAC SYS VAC CAN W/GEL 300ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","33114850","CANISTER SIMPLICITY W GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","92213333","ANTIBACTERIAL/ANESTHETIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","92213754","DOPAMINE HCL 200MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","92216540","DEXTROSE 50%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.00","92218215","DEXILANT 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.06","38302865","CRYOGLOBULIN ","82595",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.10","92219691","MESALAMINE 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.15","92217442","FEBUXOSTAT 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.15","92218697","EDOXABAN 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.20","92215774","PROCHLORPERAZINE MAL 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.25","92210761","LIDOCAINE HCL 0.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.30","38202115","RENIN-PLASMA ","84244",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.30","38302327","INF AGT AG DET EIA INFLU A/B ","87400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38300221","INFLUENZA A&B ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38305602","INFLUENZA A IGG & IGM ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38305603","INFLUENZA AB IGG & IGM ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38305604","INFLUENZA B IGG & IGM ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38393900","INFLUENZA A AB ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.34","38393905","INFLUENZA B AB ","86710",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.35","92217893","VILAZODONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.35","92218138","VIIBRYD 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.35","92218346","VIIBRYD 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.45","92218957","RISPERDONE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.50","92217006","ENOXAPARIN NA 60MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.60","92210953","HYDROCORTISONE 100MG/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.80","92219189","VORAPAXAR 2.08 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.85","92216968","DEXTROSE 70%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.91","38302745","CALCIUM URINE ","82340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.91","38343602","CALCIUM 24HR URINE ","82340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"69.95","38200921","CULTURE GRP & TYP AGGL ","87147",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"690.39","72060002","RBC LEUKOREDUCED-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"691.35","92217957","PHENTOLAMINE MESYLATE 5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"691.45","92215531","ACYCLOVIR 5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"692.00","92210766","HYALURONATE NA 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"693.00","92213387","AMPHOTERICIN B LIPID 5MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.00","33113078","KIT CATH 32CM 15.5FR PU BIOFLO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.00","33113079","KIT CATH 28CM 15.5FR DRTHN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.00","33117070","CATHETER HEMODIAL DURAMAX 32FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.00","33117071","CATHETER HEMODIAL DURAMAX 28FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.00","92217848","LEVOTHYROXINE NA 100MCG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"696.40","92210504","SUMATRIPTAN SUCC 6MG/0.5ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6963.75","92218026","GAMUNEX-C 1GM/10ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"698.50","92211501","AMOXICILLIN CLV K 250-62.5 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"6986.15","92214587","NESIRITIDE 1.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"699.10","92212249","CORTROSYN 0.25MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"699.20","92204021","IV ADMIXTURE 22 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"699.25","92204041","IV ADMIXTURE 41 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"699.25","92216070","FONDAPARINUX NA 10MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7.89","74000430","GASTROGRAFIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7.89","76020024","GASTROVIEW PER ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.00","38201015","DHEA-S ","82627",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.00","92204017","IV ADMIXTURE 18 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.00","92214302","LACTATED RINGERS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.00","92215606","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.00","92217860","D5LR KCL 1000 ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.05","92214084","CLINDAMYCIN PHOS 150MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.10","92210646","METHYLPREDNISOLONE 40MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.19","38303415","REDUCING SUBSTANCES (GLUCOSE) ","84376",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.20","92218152","VYVANSE 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.25","92214762","ZIPRASIDONE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.25","92217466","LACOSAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.35","92217692","LEVOFLOXACIN D5W 250MG/50ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.40","92219828","TADALAFIL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.46","38302212","BLOOD COUNT-PLATELET AUTO ","85049",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.50","92213401","DOPAMINE HCL 200MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.65","92214718","LEUCOVORIN CALCIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.70","92215200","FAMCICLOVIR 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.72","38300710","CPK-TOTAL ","82550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.78","34010280","COMM/WORK REINTEG 15 MIN ","97537GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.78","34210090","COMM/WORK REINTEG 15 MIN ","97537GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.78","34600525","COMM/WORK REINTEG 15 MIN ","97537GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.85","92217679","TORSEMIDE 50MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.87","34010160","THER ACT DIRECT 15 MIN ","97530GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.87","34210150","THER ACT DIRECT 15 MIN ","97530GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"70.95","92212609","CROMOLYN NA 5.2MG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"700.15","92216391","INSULIN LISO/LISO PROT 50/50 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"700.35","92218574","IODIXANOL 32O MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"700.64","74075809","SHUNTOGRAM ","75809",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"700.85","92212424","NEOMYIN SULF/POLYMYX B/HC CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"701.65","92210880","TRETINOIN 0.025% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"702.40","92212711","BETAMETHASONE DP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"705.00","33112677","TRAY CATH CVC POWELINE INT 6FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"705.00","33194432","TRAY CATH PWRLN DS SURCF 10FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"705.25","92210696","CLOBETASOL PROP 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"705.55","92214200","EPOETIN ALFA 4000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7055.40","92213073","EPOETIN ALFA 40000U/ ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"706.30","92217633","VALGANCICLOVIR HCL 50MG/ML PDS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"709.45","92214280","INSULIN ASPART RECMB 100U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"709.45","92220322","INSULIN ASPART RECOMB 100U/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"709.95","92218799","ANORO ELLIPTA 62.5MCG-25MCGPWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.00","92213275","LIDOCAINE 1%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.00","92213518","CANDIN ALBICANS ANTIGEN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.00","92217191","CYCLOSPORINE 0.05% EYE EMU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.05","92213092","DEXTROSE 50%/WATER INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.05","92214486","FLUVASTATIN NA XL 80MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.15","92212193","QUETIAPINE FUMARATE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.15","92214031","NIFEDIPINE 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.18","38303355","PINWORM PREP ","87172",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.25","38300310","BUN (UREANITROGEN) ","84520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.25","92216440","PROPOFOL 1% EMULSION INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.31","38300692","TISSUE HOMOGENIZATION ","87176",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.35","38301473","HEP B SURF AG (HBSAG) NEUTRLZN","87341",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.35","92210994","TRIAMCINOLONE 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.35","92212741","SODIUM BICARB 4.2% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.40","92211487","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.40","92216714","POLYETHYLENE GLYCOL 3350 POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.40","92217448","OINTMENT BASE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.40","92219042","ZENPEP218000-40000-136000UCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.50","92215024","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.50","92217535","SAXAGLIPTIN HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.50","92217537","SAXAGLIPTIN HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.50","92219826","PENTAFLUOROPROPANE/NORFLURANE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.70","92213566","PIOGLITAZONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.70","92218627","DOFETILIDE 250 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.70","92218630","DOFETILIDE 125 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.90","92214331","TERBINAFINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"71.90","92214822","EFAVIRENZ 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"712.38","75000133","US PREGNANT UTERUS TRANSVAGINA","76817",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"712.65","92213279","MYCOPHENOLATE 500MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7139.10","10800018","SEMI PRIVATE ROOM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"714.00","92214728","CROMOLYN NA 0.8MG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"714.12","74000502","LUMBAR SP COMP MIN 6 VIEW ","72114",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"715.00","92216416","FONDAPARINUX NA 7.5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"715.00","92219709","ENZALUTAMIDE 40 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7153.30","92216808","ZOLEDRONIC ACID 5MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7158.75","92215588","OMALIZUMAB 150MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"716.05","92211996","ALBUMIN HUMAN 25% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"717.00","33112961","CLIP RESOLUTION 2261 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"717.00","33117068","CATHETER DURAFLOW 15.5F X 28CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"717.21","74000370","FLUOROSCOPY 1HR OR LESS ","76000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"718.35","92219447","IOHEXOL 64.7% 300 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"719.00","33113037","AMNIOBAND MTRX TISS 3X4CM MEMB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"719.00","36000016","ART PUNCTURE FOR BLOOD DRAW ","36600",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"719.13","75000131","US PREG UTERUS <14 WEEKS 1ST G","76801",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"719.20","92215998","FLUCONAZOLE 40MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"719.45","92214814","AMINO ACIDS 15% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33109027","CATH FILIFORM SPIRAL TIP 3FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33109028","CATH FILIFORM SPIRAL TIP 5FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33109030","CATH FILIFORM STRAIGHT TIP 4FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33109031","CATH FILIFORM STRAIGHT TIP 5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33111555","DILATOR FILI SPRL 31.75CM4FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","33111556","DILATOR FILI STRT 31.75CM3FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","38200118","RISTOCETIN CO FACTOR ","85245",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","38200119","VON WILLEBRAND ANTIGEN ","85246",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","92204003","IV ADMIXTURE 04 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.00","92211176","MYCOPHENOLATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.04","34010105","ELEC STIM ATTENDED 15 MIN ","97032GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.04","34210215","ELEC STIM ATTENDED 15 MIN ","97032GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.04","34699980","DYS TXT W/E-STIM ATTEND 15MIN ","97032GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.04","34699981","E-STIM ATTENDED 15MIN ","97032GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.05","92213877","DRONABINOL 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.07","72000828","COLD AGGLUTIN TITER ","86157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.15","92211473","CEFTAZIDIME 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.17","38201930","POTASSIUM SERUM ","84132",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.17","38202011","PROTEIN TOTAL OTHER SOURCE ","84157",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.25","92212203","MICONAZOLE NITRATE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.31","38302410","TRIGLYCERIDES ","84478",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.31","38302412","TRIGLYCERIDE FLUID ","84478",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.38","38300600","COLD AGGLUTININ ","86156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.38","72000827","COLD AGGLUTIN SCREEN ","86156",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.40","92217586","DRONEDARONE HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.45","38300420","CAROTENE BLOOD LEVEL ","82380",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.45","92218936","LANTHANUM CARBONATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.49","92212525","MORPHINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.60","92210659","PILOCARPINE HCL 6% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.60","92212413","MORPHINE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.60","92213799","LIDOCAINE HCL 2% VISCOUS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.60","92214514","OLANZAPINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.60","92218908","CAPSAICIN 0.1% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.65","38303215","INCLUSION_BODY/PARASITE STAIN ","87207",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.70","92219430","FLUCONAZOLE 200 MG/100 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.75","92220455","ERYTHROMYCIN 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.81","38301475","HEPATITIS BE ANTIGEN EIA ","87350",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"72.95","92217295","WATER STERILE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7207.20","92218204","ERBITUX 200 MG VIAL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"721.00","92215661","APREPITANT TRIFOLD PACK CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"721.05","92220529","CHOLESTYRAMINE 4GM/9GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7214.42","10800026","PRIVATE ROOM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7215.50","92219817","ROMIPLOSTIM125 MCGPWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"722.50","92215841","ANAKINRA 100MG/0.67ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"724.18","74000035","CONTR EVAL CENT VEN ACC DEVC ","36598",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"727.50","92216421","OMEPRAZOLE NA BICARB 20MG PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"728.00","92219969","EPOETIN ALFA-EPBS 10000U/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.00","72070001","SPLITTING BLOOD PRODUCT EACH ","86985",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.00","92217291","HYDROCODONE APAP 5-163/7.5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.00","92218089","SEROMYCIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.10","92212808","ERYTHROMYCIN ES 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.20","92220457","DOCUSATE SODIUM 50 MG/5 ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.25","92214262","MILRINONE LACTATE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.35","92212785","BELLADONNA/PHENOBARB ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.35","92215655","OLANZAPINE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.40","38300555","CHOLESTEROL - DIRECT LDL CHOOL","83721",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.40","92212012","VECURONIUM BROMIDE 20MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.40","92219134","FUROSEMIDE 40 MG/4 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.43","38301805","OUCHTERLONY GEL DIFFUSION EA ","86331",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.45","92215715","OLANZAPINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.49","38301465","HEPATITIS BE ANTIBODY ","86707",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.52","34210053","THER INT COG FUNC 1ST 15 MIN ","97129GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.52","34600013","THER INT COG FUNC 1ST 15 MIN ","97129GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.55","92212302","AMIKACIN SULF 250MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.58","38300980","CULTURE URINE ","87088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.58","38380071","BACTERIAL ID URINE ","87088",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.60","92210727","BACITRACIN 50000U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.70","92216518","CEFOXITIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.75","92213382","LIDOCAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.85","92213524","CEFTRIAXONE NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.85","92214226","DEXTROSE 40% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"73.95","92212789","TEMAZEPAM 7.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"731.65","92219887","LEVOTHYROXINE 100MCG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"732.15","92220068","AMINO ACIDS 8% D14W W/E IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"732.75","92218659","OXACILLIN SODIUM 10 GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"734.00","74001423","IVP INFUSION ","74410",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"734.60","92218426","TRIUMEQ 600MG-50MG-300MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7348.62","76080030","PET TUMOR W/CT LIMITED AREA ","78814",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"735.20","92210776","FLUOCINOLONE ACET 0.01% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"735.76","75000080","US RETROPERITONEAL LIMITED ","76775",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"736.00","33106405","POSITIONER PATNT TRTS BARIATRC"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"737.65","92215351","INSULIN AS/AS PROT 70-30U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"737.65","92215485","INSULIN ASPART RECMB 100U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7373.50","92215977","DARBEPOETIN A 150MCG/0.75ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"739.20","92220496","HYDROCOD/APAP 7.5-325MG/15 ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"739.46","74001280","FLOURO NEEDLE GUIDE SPINE ","77003",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"739.85","92204032","IV ADMIXTURE 33 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"739.90","92216106","LOTEPREDNOL ETAB TOBY .5-.3% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.00","92213846","FAMOTIDINE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.00","92215964","HYDROCORTISONE BUTYR 0.1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.00","92216448","GLYCOPYRROLATE 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.15","92217736","ANASTROZOLE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.20","92204023","IV ADMIXTURE 24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.21","38300116","BETA HYDROXYBUTYRATE ","82010",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.25","92212407","POLYMYXIN B SULF 500000U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.25","92217650","SALIVA SUBSTITUTES SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.29","34010156","OTHOTIC FIT/TRAIN SUBSEQ15MIN ","97763GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.29","34250051","ORTHOTIC FIT/TRAIN SUBSEQ15MIN","97763GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.30","92215957","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.30","92219405","SODIUM POLYSTYRENE SULF SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.36","38301690","LEGIONELLA TITER ","86713",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.40","38200080","ALBUMIN SERUM ","82040",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.55","38303737","PLASMA HEMOGLOBIN ","83051",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.55","92215543","RISPERIDONE 1MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.60","92212440","VALACYCLOVIR HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.65","92211833","AMPICILLIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.68","34010155","ORTHOTIC FIT/TRAIN 15 MIN ","97760GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.68","34250050","ORTHOTIC FIT/TRAIN 15 MIN ","97760GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.70","92214954","MELPHALAN 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.85","38301810","OSMOLALITY SERUM ","83930",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.85","92215992","FLUCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.85","92218269","CREON 180000-36000-14000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.90","92216914","CEFAZOLIN 1GM-DEXTROSE INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.95","92216009","FLUCONAZOLE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"74.95","92216105","SOLIFENACIN SUCC 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"742.20","92217968","GQBAPNTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"742.45","92215490","PHENOXYBENZAMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7425.00","92218528","HARVONI 90 MG-400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7434.45","92216469","RHO D IMMUNE GLOBULIN 5000U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7449.95","10800300","INTERMEDIATE ICU ROOM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"747.00","92217276","LIPIDS 20% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"748.40","92212521","CLARITHROMYCIN 125MG/5ML PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"749.45","92212338","CLOBETASOL PROP 0.05% EMO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"749.70","92214161","TRIAMCINOLONE 55MCG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.05","92213441","AMINOPHYLLINE 250MG/10ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.10","92215400","DILTIAZEM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.14","38302370","THROMBIN TIME ","85670",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.25","92216315","KETAMINE HCL 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.30","92217622","MULTIVATAMIN INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.30","92218241","LUBRIDERM LOTION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.33","38301625","KETOSTEROIDS 17 TOTAL ","83586",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.38","38300760","CREATINE ","82540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.50","92213899","QUETIAPINE FUMARATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.55","92212327","CEFAZOLIN 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.63","38302170","SGOT (AST) ","84450",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.65","38302270","STREP A SCREEN (EIA) ","87430",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.68","38301441","HEMOSIDERIN ","83070",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.70","92215247","LIDOCAINE 1.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.75","92215438","VENLAFAXINE HCL 37.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.85","92212719","AMPICILLIN-SULBACTAM 3GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.90","92215390","EZETIMIBE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.90","92219133","EZETIMIBE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"75.95","92216452","RISPERIDONE 3MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"750.00","33117069","CATHETER TRAY HEMODIAL 36CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"750.00","92205002","TPN/TNA 2 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"750.75","92212745","CICLOPIROX OLAMINE 0.77% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"752.75","92211494","LINDANE 1% SHA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"752.75","92211530","LINDANE 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"753.85","92218543","CADEXOMER-IODINE 0.9% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"757.00","72060015","RBC DEGLYCEROLIZED-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"757.39","74001182","BREAST SURGICAL SPECIMEN ","76098",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"759.00","92219585","NAFCILLIN SODIUM 10 GM SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.15","92214355","TERBINAFINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.21","38300490","CELL COUNT FLUIDS W/O DIFF ","89050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.40","92216604","DAKINS 0.125% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.45","92214866","DAKINS 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.50","92214861","DAKINS 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.60","92218938","LANTHANUM CARBONATE 750 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.61","38301820","OSMOLALITY URINE ","83935",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.62","38200490","CELL COUNT FLUIDS W/O DIFF ","89050",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.62","38200740","CREATININE BLOOD ","82565",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.70","92213653","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.70","92218792","SODIUM HYPOCHLORITE 0.062% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.74","76020016","I-131 SOD IOD CAP PER MCI TX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.75","92214657","PROCHLORPERAZINE EDI 5MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.75","92215986","FLUCONAZOLE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.75","92217125","DESVENLAFAXINE SUCC 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.85","92214603","DEXTROSE 20%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.85","92215716","CYCLOSPORINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.90","92204022","IV ADMIXTURE 23 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.90","92215301","MORPHINE D5W 1MG/250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.95","92214559","DEXTROSE 30%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"76.95","92216001","FLUCONAZOLE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"760.20","73500050","EEG DIGITAL ANALYSIS ","95957",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"760.25","92210407","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"761.05","92218085","COMBIVENT RESPIMAT INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"761.45","92215922","AZELASTINE HCL 137MCG NASAL SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"762.30","92218894","IOHEXOL 75.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"762.30","92219913","IRON SUCROSE 20 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"762.30","92220479","IOHEXOL 75.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7623.00","92215225","VITAMIN A 50000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"763.00","92218969","IBANDRONATE SODIUM 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"763.25","92212076","NAFCILLIN 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"763.25","92212393","OXACILLIN NA 10GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"763.75","92216376","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"764.05","92212330","ESTRADIOL CYPIONATE 5MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"764.22","38000505","SURGICAL PATH LEVEL VI ","88309",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7648.40","92217522","FERUMOXYTOL 520MG/17ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"765.20","92212313","AZELASTINE HCL 0.05% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"765.25","92218407","PROSOL 20% IV SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"765.30","92212086","CLINDAMYCIN PHOS 1% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"765.75","92217989","ASTEPRO 205.5MCG/ACTUATION SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7662.60","92216115","DARBEPOETIN A 150MCG/0.3ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7669.20","92219201","RIMABOTULINUMB 5000UNITS/MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"767.85","92216795","MAFENIDE ACET 85MG/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"768.00","92217237","PIRBUTEROL ACETATE 0.2MG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.00","38320001","CRYPTOCOCCUS AG SERUM TITER ","86406",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.00","92215052","AMINO ACIDS 8.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.00","92216476","DIGOXIN 50MCG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.00","92216783","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.00","92217366","DIDANOSINE 400MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.01","34010277","DRY NEEDLING 3 OR MORE MUSCLES","20561",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.05","92210952","SUCRALFATE 1GM/10ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.15","92220441","LAMOTRIGINE ER 100 MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.20","92218868","MICONAZOLE NITRATE 2% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.25","92218551","LACOSAMIDE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.40","92216711","OXYCODONE HCL 80MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.45","92210460","AMPICILLIN NA 250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.53","38302050","PTT ","85730",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.60","92217797","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.65","92211055","ENOXAPARIN NA 40MG/0.4ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.65","92217058","ETRAVIRINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.73","38201890","PHOTHER BODY FLUIDS ","83986",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.73","38202200","SODIUM SERUM ","84295",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.75","92219570","CEFACLOR 125MG/5ML (150ML) BTL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.95","38303085","G6-PD ","82955",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.95","92217124","DESVENLAFAXINE SUCC 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"77.99","38302200","SODIUM SERUM ","84295",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"770.55","92219843","AZITHROMYCIN 500 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7707.60","92215256","INFLIXIMAB 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"771.00","92215155","BENZTROPINE MESYLATE 2MG/2ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"771.19","75000110","US PELVIC COMPLETE ","76856",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"771.45","92217239","NICARDIPINE/NACL 20MG/200ML IV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"771.65","92210790","PREDNISOLONE ACETATE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"772.75","92216378","PNEUMOVAX 23 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"772.75","92219048","PNEUMOCOCCAL VAC POLYVALNT SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"772.85","92212806","LACTIC ACID UREA 5%-10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"773.95","92217234","INFLUENZA VACC 2008-09 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"774.00","33113096","BSCP FLX 600MM 5MM 2.2MM AMBU "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"774.00","33163650","PORT PWR MRI ISP INT 8F CATH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"774.00","33189579","BRONCH ASCOPE 4 REG SINGLE USE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"774.00","33189588","BRONCHOSCOPE ASCOPE 4 SLIM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"776.00","36031730","TRANSTRACHEAL O2 THER/INC/INS ","31730",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"776.34","38300243","HIV GENOTYPE DNA/RNA ","87901",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"776.40","92214271","IPRATROPIUM BR 0.06% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"776.90","92219679","ZOLMITRIPTAN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"779.00","33114199","GLIDESCOPE BFLEX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"779.00","33171028","INNER CANNULA 7.0 PERCUTAN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"779.00","33171029","CANN INNER 8.0 PERCUT TRACH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"779.00","92215322","SULFACETAMIDE NA UREA KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"779.05","92216541","APREPITANT 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.00","92217455","RISPERIDONE 4MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.00","92219586","OSELTAMIVIR 30 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.20","92214731","POTASSIUM PH 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.20","92215317","FAMCICLOVIR 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.25","38302180","SGPT (ALT) ","84460",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.25","92211600","CEFTAZIDIME 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.25","92217219","OLANZAPINE 5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.30","92214110","ATOMEXETINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.30","92218465","CIALIS 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.40","92219781","PYRIDOSTIG BROM 60MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.43","38303723","SPEC STAIN FOR O & P ","87209",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.45","92215595","PROMETHAZINE HCL 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.50","92217847","OLANZAPINE 5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.50","92218815","OLANZAPINE ODT 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.55","92218866","HYDROGEN PEROXIDE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.61","38300475","E HISTOLYTICA-EIA ","87337",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.74","38302730","BRUCELLA ANTIBODY ","86622",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.75","92215521","LAMIVUDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.85","92215553","HYDROMORPHONE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.90","38307026","MACROSCOPIC EXAM ARTHROPOD ","87168",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.90","92213930","POTASSIUM CL 20MEQ PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.90","92218816","LEVOMILNACIPRAN 120 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"78.95","92219703","OXANDROLONE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33112102","CATH DIALYSIS HEMOSTAR 24CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33112254","KIT CATH HEMOSTAR 19CM 2LUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33112533","CATH DIALYSIS STRT 23CMX14.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33112534","CATH DIALYSIS STRT 27CMX14.5FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33139906","PORT VASCULAR PWRPORT MRI9.6FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.00","33150919","CATH DIALYSIS HEMOSTAR 28CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.50","92214512","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"780.84","74076010","FLUORO GUIDE FOR CV ACCESS ","77001",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"781.15","92220415","PRAMOXINE/HC 1%-2.5% TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"782.96","75010026","US EXTREM COMPLT BILAT ","7688150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"782.96","75010027","US EXTREM COMPLT RT ","76881RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"782.96","75010028","US EXTREM COMPLT LT ","76881LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"783.00","33177312","CVC W/GR CATH 9.5FR 2 LMN W/IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"783.20","92218075","STRIBILD TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"783.67","75000160","US SCROTUM ","76870",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"783.70","92216471","NALOXONE HCL 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"783.70","92219157","NALOXONE HYDROCHL 0.4MG/MLSOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"785.40","92218682","TETRA/BENZOCAINE/BUTAMBEN18%SP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"786.05","92212851","HYDROCORTISONE BUTYR 0.1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"787.00","92214737","SULFACETAMIDE NA 10% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"788.45","92218706","GENVOYA150MG200MG10MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"788.45","92219304","BIKTARVY 50MG-200MG-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"788.70","92218029","OPTIRAY 320 120ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"789.00","33102141","TRAY PNEUMOTH CUTRTY 1400 WAYN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.00","92210250","ERYTHROMYCIN 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.00","92214219","LIDOCAINE 2%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.08","38305400","TRAMADOL SCREEN ","80373",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","38300073","ACID FAST BACILLI SMEAR ","87206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","38303816","FLUROCHROME STAIN ","87206",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92213851","LEVOCARNITINE 1GM/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92215753","MORPHINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92216206","SUCCINYLCHOLINE CL 20MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92219571","DOXERCALCIFEROL 1MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92219584","MORPHINE SULFATE 1 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.20","92220065","VANCOMYCIN 750 MG/150 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92216560","LANTHANUM CARBONATE 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92216563","LANTHANUM CARBONATE 1000MG CT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92216626","LANTHANUM CARBONATE 750MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92218710","LANTHANUM CARBONATE 750 MG PWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92218711","LANTHANUM CARBONATE 1000MG PWD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.25","92218937","LANTHANUM CARBONATE 1000MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.30","92220381","HYDROCORTISONE 25 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.35","38301930","POTASSIUM SERUM ","84132",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.35","92213050","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.35","92220111","HYDROCORTISONE ACETATE25MGSUPP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.40","92217018","FENTANYL 25MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.40","92219415","ROFLUMILAST 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.44","38303771","CRYSTAL IDENTIFICATION ","89060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.45","92219043","ROFLUMILAST 500 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.50","92219414","ROFLUMILAST 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.55","92217023","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.55","92217393","LANSOPRAZOLE 30MG TDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.60","92217523","DRONEDARONE HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.65","92216241","RAMELTEON 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.75","92217799","VANCOMYCIN HCL 750MG/150ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.75","92218689","VANCOMYCIN 500 MG/150 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.75","92219305","VANCOMYCIN/D5W 750MG/150ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.75","92220225","LIDOCAINE 4% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.80","92210546","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79.80","92214339","TRIAMCINOLONE 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"791.10","74000791","UPPER GI W/ SMALL BOWEL ","74240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"791.10","74000860","UPPER GI STOMACH W/O KUB ","74240",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"792.10","75000250","US ABDOMEN LIMITED ","76705",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"793.70","92214805","ESTRADIOL VALERATE 20MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"7933.20","92217999","BOTOX 200 UNITS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"796.40","92214997","DORNASE ALFA 2.5MG/2.5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"797.00","33106308","MASK CPAP LG SLP FITLIFE FACE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"797.00","33106309","MASK CPAP SM SLP FITLIFE FACE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"797.00","92212281","TRIAMCINOLONE 100MCG ARO "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"797.85","92212060","KETOCONAZOLE 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"79837.20","92219337","TREPROSTINIL 10 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","38203217","MANGANESE ","83785",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","38207006","CHROMIUM ","82495",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","38288702","DRUG DEFIN QUAL/QUANT NOS 7+ ","80377",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92201010","OPHTHALMICS 10 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92201012","OPHTHALMICS 12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92201014","OPHTHALMICS 14 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92201015","OPHTHALMICS 15 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92202005","TOPICALS 05 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92202008","TOPICALS 08 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203004","ORALS 04 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203005","ORALS 05 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203006","ORALS 06 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203007","ORALS 07 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203008","ORALS 08 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203009","ORALS 09 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203010","ORALS 10 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203011","ORALS 11 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203012","ORALS 12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203014","ORALS 14 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203015","ORALS 15 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203016","ORALS 16 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92203017","ORALS 17 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92204038","IV ADMIXTURE 38 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209001","LACTOBACILLUS POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209002","PUMP REFILL MAINT SPINAL/BRAIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209003","PUMP REFILL MAINT BY DR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209007","CLONIDINE HCL 0.5MG(0.2+0.3) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209008","CLONIDINE HCL 0.5MG(0.2+0.3) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209009","CLOZAPINE 125MG (100+25) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209010","CLOZAPINE 175MG (100+75) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209011","CLOZAPINE 125MG (100+25) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209012","CLOZAPINE 175MG (100+3X25) TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209013","WARFARIN NA 7MG (4+3) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209014","WARFARIN NA 8.5MG (7.5+1) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209015","CYCLOSPORINE 125MG (100+25) SG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209016","CYCLOSPORINE 150MG (100+50) SG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209017","CYCLOSPORINE 175MG(100+3X25) S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209021","PHENYTOIN NA 130MG (100+30) CE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209022","FENTANYL 125MCG (100+25) TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209023","FENTANYL 150MCG (100+50) TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209026","FENTANYL 125MCG (100+25) TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209027","FENTANYL 150MCG (100+50) TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209028","LEVOTHYROXINE NA (200+25)MCG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209029","LEVOTHYROXINE NA (200+75)MCG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209030","NITROGLYCERIN .5MG/HR (.4+.1)T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209031","NITROGLYCERIN .5MG/HR (.4+.1)T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209032","PHENYTOIN NA 130MG (100+30) CE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209035","TACROLIMUS 4.5MG (4X1+0.5) CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209036","TACROLIMUS 6MG (1+5) CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209037","QUETIAPINE 125MG (100+25) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209038","QUETIAPINE 150MG (100+2X25) TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209039","QUETIAPINE 250MG (200+2X25) TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209040","QUETIAPINE 75MG (1/2 100+25) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209041","QUETIAPINE FUM 125MG 100+25) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209042","SERTRALINE HCL 125MG(100+25) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209043","LEVOTHYROXINE 225MCG(200+25) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209044","LEVOTHYROXINE 275MCG(200+75) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209045","TACROLIMUS 4.5MG (4X1+0.5) CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209046","TACROLIMUS 6MG (1+5) CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209047","WARFARIN NA 7MG (4+3) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209048","WARFARIN NA 8.5MG (7.5+1) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209049","SERTALINE HCL 125MG (100+25) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209050","MORPHINE SULF (100+30+30)MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209051","WARFARIN NA 12.5MG (7.5+5) TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209052","WARFARIN NA 12.5MG (7.5+5) TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209053","WARFARIN NA 11MG (5+6) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209054","WARFARIN NA 11MG (5 + 6) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209055","QUETIAPINE FUM 75MG (50+25) TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209056","QUETIAPINE 150MG (100+50) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209057","QUETIAPINE FUM 150MG(100+50) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209058","QUETIAPINE 250MG (200+50) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209059","QUETIAPINE FUM 250MG(200+50) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209060","SERTALINE HCL 75MG (50+25) TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209061","SERTRALINE HCL 75MG (50+25) TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209063","QUETIAPINE 75MG (50MG+25) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209064","PREDNISONE 25MG (20+5) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209065","PREDNISONE 7MG (5+2X1) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209066","LEVOTHYROXINE 288MCG(200+88) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209067","LEVOTHYROXINE 288MCG(200+88) T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209068","MORPHINE 130MG (100+30) CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209069","OXYCODONE HCL 50MG(40+10) TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209070","CAPTOPRIL 37.5MG (25+12.5) TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209071","PREDNISONE 7.5MG (5+2.5) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209072","METOPROLOL SUCC 75MG(50+25) TE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209073","METOPROL SUCC 75MG (50+25)TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209075","WARFARIN NA 22MG (2X10+2) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209076","WARFARIN NA 9MG (5+4) TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92209077","CHLORHEXIDINE GLUC .012% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8.00","92218143","MORPHINE SULFATE 20MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.00","92203001","ORALS 01 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.00","92210574","ATRACURIUM BESYLATE 10MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.00","92216488","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.00","92217598","DEFEROXAMINE MESYLATE 500MG PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.05","92216100","SOLIFENACIN SUCC 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.06","38302751","CANNABINOIDS NATURAL ","80349",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.11","38300070","ALDOLASE ","82085",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.15","92219087","BUPRENORPHINE HCL 0.3MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.19","38300513","MICROALBUMIN 24 HOUR URINE ","82043",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.19","38300514","MICROALBUMIN/CREATININE RATIO ","82043",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.19","38301770","MICROALBUMIN URINE QUANT ","82043",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.20","92211279","ACETYLCYSTEINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.20","92213330","TESTOSTERONE 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.20","92215179","SODIUM FLORIDE 1.1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.20","92218883","ACETYLCYSTEINE 0.2 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.25","38000660","CYTOPATH FILTER METHOD ","88106",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.29","38302130","RHEUMATOID FACTOR QUAL ","86430",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.30","92211024","NAFCILLIN 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.30","92211265","OXACILLIN NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.30","92214266","TOLTERODINE TARTRATE 4MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.30","92214450","TOLTERODINE TARTRATE 2MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.30","92216353","PROPAFENONE HCL 225MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.35","92215408","ACETYLCYSTEINE 20% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.40","92213322","PROPOFOL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.45","92213085","CIPROFLOXACIN 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.50","92210492","TESTOSTERONE CYPI 200MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.51","34010006","ROM TESTING EXTREMITY/TRUNK ","95851GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.51","34210315","ROM TESTING EXTREMITY/TRUNK ","95851GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.60","92212766","PETROLATUM ZINC OXIDE 51-20% P"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.70","92214441","TOLTERODINE TARTRATE 4MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.70","92214445","TOLTERODINE TARTRATE 4MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.70","92214471","TOLTERODINE TARTRATE 2MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.75","92214320","DEXTROSE 50%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.85","92213679","CR CU MN ZN TRACE ELEMENT INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.85","92217830","GENTIAN VIOLET 2% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.85","92218642","EPOPROSTENOLNA 94MG-73MG/50ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.90","92218572","NALOXEGOL 25 MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"80.95","92211625","POLYMYXIN B SULF 500000U INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"800.00","33139746","MASK CPAP AMARA VW HEADGEAR LG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"800.15","92219359","ESMOLOL HCL 2500 MG/250 ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"800.35","92219204","VARICELLA VIRUS VACC1350PFUSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"800.70","92219227","HYDROCORTISONE/PRAMOX1%-1%CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8004.00","92218510","AVONEX 30 MCG/0.5 ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"802.20","92215072","PIMECROLIMUS 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"803.00","92211771","HYALURONATE NA 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"803.10","75099982","SHUNT EVALUATION ","93990",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"803.95","92217988","HEPARIN LOCK 100U/ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"803.99","72060016","RBC LR IRRADIATED-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"806.89","75000040","US DOPPLER ECHO HEART COMP ADD","93320",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"807.45","92211127","NEOMYCIN SULF/POLYMYX B/HC SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"808.00","92214273","ERTAPENEM NA 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"809.00","92215423","DESOXIMETASONE 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"809.00","92216362","VERAPAMIL HCL 2.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","33111542","CATH FILI CD TIP 31.75CM 3FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","33111543","CATH FILI CD TIP 31.75CM 4FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","33111544","CATH FILI CD TIP 31.75CM 5FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","92211064","HYDROCORTISONE NA SUCC 100MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","92216482","LIPIDS 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.00","92217445","FOSPHENYTOIN NA 75MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.03","34000702","PROSTHETIC TRAIN 15 MIN ","97761GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.03","34210360","PROSTHETIC TRAIN 15 MIN ","97761GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.07","38300530","CHLORIDE BLOOD ","82435",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.10","92214258","TOLTERODINE TARTRATE 4MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.10","92214460","TOLTERODINE TARTRATE 2MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.10","92219222","TOLTERODINE TARTRATE 4 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.10","92219223","TOLTERODINE TARTRATE 2 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.15","92215971","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.15","92218956","RISPERDONE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.25","92214699","SODIUM CL 5% EYE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.29","38302211","SODIUM NON-URINE/NON-BLOOD ","84302",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.45","92218172","POT PHOS 3MMOLE/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.60","92220297","CLIN PHOS/DEX 600MG/50ML-5%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.69","38307012","BARTONELLA/CAT SCRATCH DISEASE","86611",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.80","92213471","GLYCOPYRROLATE 0.2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.80","92217754","OXYCODONE HCL 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.85","92212058","LEVOFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.90","92211237","CHLORPROMAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"81.90","92216238","TIPRANAVIR 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"810.55","92217967","TRESPROSTINIL 1MG/ML 20ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"810.73","75000018","US TRANSVAGINAL ","76830",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"812.00","72060019","PLT HLA LR-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"812.10","92210890","MENINGOCOCCAL POLY VACC INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"812.40","39200450","HOLTER MONITOR SCAN/INTERP ","93226",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"812.50","92218756","DALTEPARIN SOD15000IU/0.6MLINJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"815.70","92214319","FLUMAZENIL 0.1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"816.55","92220186","DIMETHYL FUMARATE 240MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"817.10","92213258","CLOTRIMAZOLE BETAMETH 1-0.05 L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"818.40","92216415","BROMFENAC 0.09% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"819.00","33103294","BRONCHOSCOPE5.0/2.2FLEX SGLUSE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"819.00","33105671","KIT CATH HEMO XK ACRV 16F 28CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.00","92211363","ATROPINE SULF 0.05MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.00","92212559","ERYTHROMYCIN ES/SULFISOX SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.05","92218800","NALOXEGOL 12.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.05","92220299","VIT B COMP/IRON/VIT C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.08","38300230","ANTI STREP O TITER ","86060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.10","92212401","ATROPINE SULF 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.14","38301730","LITHIUM ","80178",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.15","92207004","IRRIGATIONS 04 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.17","38202040","PROTHROMBIN TIME ","85610",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.17","38299322","FIBRIN DEGREDATION PROD QUANT ","85370",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.20","92211551","UREA 10% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.40","92220253","MESALAMINE 1.2 GM TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.43","38300055","ACID PHOS PROSTATIC ","84066",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.46","38302310","T-4 TOTAL (THYROXINE) ","84436",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.49","38300294","COAGULATION TIME ACTIVATED ","85347",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.50","92217382","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.50","92220392","BRIMONIDINE TARTRATE 0.20% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.51","38300018","ABO BLOOD TYPING ","86900",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.51","72000525","BLOOD TYPING ABO ","86900",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.70","92211917","SILVER SULFADIAZINE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.80","92215768","EPLERENONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.85","92211427","ESTRADIOL 0.05MG/DAY TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.85","92217430","FESOTERODINE FUMARATE 4MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.85","92217431","FESOTERODINE FUMARATE 8MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.90","92210029","SULFAMETHOXAZOLE/TMP INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.90","92219284","QUETIAPINE FUMARATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"82.95","92216631","CYCLOSPORINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"825.00","92213145","SODIUM CL 4MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"825.04","74000790","SMALL BOWEL ","74250",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"826.12","38300220","HEP C GENOTYPE DNA/RNA ","87902",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"826.45","92218466","ZERBAXA 1 GM-0.5 GM PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"828.28","75000175","US HEAD/NECK SOFT TISSUE ","76536",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.00","92213751","CEFUROXIME NA 1.5GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.04","38300080","ALBUMIN SERUM ","82040",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.10","92213876","NIMODIPINE 30MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.12","38399329","ANTIGEN SCREENING ","87299",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.15","92217709","MEROPENEM 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.28","38202215","RETICULOCYTE (AUTO) ","85045",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.28","38203777","ALBUMIN FLUID ","82042",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.30","92216621","CASTOR/PERU BALSAM/TRYPSIN SPR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.38","38303581","URINE PREGNANCY TEST ","81025",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.40","92216842","SCOPOLAMINE 0.33MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.40","92219025","RISPERIDONE 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.41","38303305","PROCAINAMIDE & NAPA LEVEL ","80192",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.49","38302795","CHLORIDE OTHER SOURCE ","82438",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.50","72000556","RBC SERUM PRETX ID DILUTION ","86976",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.55","92216507","ZINC OXIDE 20% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.55","92216528","AMINO ACIDS 8.5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.60","92213603","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.65","92210058","HYDROCORTISONE 2.5% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.80","92219282","MGCL/KCL/NAAC/NACL/NAGLUC.SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.85","92214608","ATORVASTATIN CALCIUM 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.85","92216095","DARIFENACIN HBR 7.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.89","38300138","HDL (DIRECT) ","83718",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.90","92213166","DOBUTAMINE HCL D5W 500-250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.90","92215180","FIBER PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.95","92216680","MICONAZOLE NITRATE 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.95","92217127","DESVENLAFAXINE SUCC 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.95","92217128","DESVENLAFAXINE SUCC 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.95","92219811","PENICILLIN G POTASSIUM 5MU INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"83.96","38343614","RHEUMATOID FACTOR QUANT ","86431",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"831.00","73700052","EMG 3 EXTERMITY ","95863",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"831.80","92214778","DEFEROXAMINE MESYLATE 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"833.76","73700220","SLEEP STUDY UNATTENDED ","95806",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"833.84","74000760","SKELETAL SURVEY COMPLETE ","77075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"834.25","92218041","DUREZOL 0.05% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"834.30","38303651","RESPIRATORY VIRUS 6-11 TARG ","87632",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"834.90","92219803","HEP B VACCINE 20MCG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"835.35","92219517","DASATINIB 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"838.00","92211069","CEFIXIME 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"838.58","76020009","TC-99M MERTIATIDE <15 MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"839.45","92218515","DIANEAL LOW CA W/DEXT 2.5% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.00","38201545","T-CELLS-CD4COUNT ","86361",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.00","92210876","TERCONAZOLE 80MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.00","92213187","BENZOYL PEROXIDE 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.05","92220134","MEMANTINE 14 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.15","92213228","CEFOXITIN NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.20","92214092","DEXTROSE 70%/WATER IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.25","92217900","CEFAZOLIN 2GM-D5W INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.25","92219437","ROFLUMILAST 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.32","38303180","LEAD LEVEL ","83655",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.40","38200361","CALCITONIN ","82308",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.40","92219540","ACETYLCYSTEINE 20% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.45","92211832","PENICILLIN GK 5MMU INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.55","92220500","NALOXEGOL 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.70","92218732","CETAPHIL COMPND VEHICLE TOP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.80","92216103","SOLIFENACIN SUCC 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.80","92216108","SOLIFENACIN SUCC 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.80","92216109","SOLIFENACIN SUCC 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.85","92210137","MORPHINE 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.85","92211936","SODIUM CL 5% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"84.90","92217808","ROFLUMILAST 500MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"842.00","33151442","KIT CATHETER PLEURX STARTER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"843.05","92211630","TOBRAMYCIN DEX 0.3-0.1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"843.57","72099983","BLOOD LEUKORED CMV NEG IRR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8430.68","74001021","ANGIO RENAL SELECT BIL ","36252",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"844.00","33198021","PROBE HEMOSTASIS BIPOLAR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"845.40","92218390","TOBI 300 MG/5 ML INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"845.78","76000471","CHEMO VIA IV UP TO 1 HOUR ","96413",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"846.65","77000373","CT LIMITED OR FOLLOWUP STUDY ","76380",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"847.30","92213174","IOPAMIDOL 61% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"848.00","33103697","SYSTEM TURN POSITION 800LB2XL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"848.55","92216962","OFLOXACIN 0.3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.00","92213933","LIDOCAINE 1.5%/EPI 1:200000 I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.00","92214357","OSELTAMIVIR PHOSPHATE 75MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.00","92219064","OSELTAMIVIR PHOSPHATE 75MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.10","92219509","ESTRADIOL 0.025 MG/24HR PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.15","92213171","CEFUROXIME NA 1.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.20","92215414","NICARDIPINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.20","92215612","CAPECITABINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.20","92220149","MENTHOL 4% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.25","92212191","RISPERIDONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.50","38200685","T CELLS CD4 & CD8 W/RATIO ","86360",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.50","38200810","GLUCOSE BODY FLUID ","82945",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.50","38201910","PHOSPHOROUS SERUM ","84100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.50","92212822","LAMIVUDINE ZIDOVUDIN 150-300 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.53","38302300","T-3 UPTAKE ","84479",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.60","92216359","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.60","92216368","AZITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.60","92219105","AZITHROMYCIN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.60","92219662","AZITHROMYCIN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.80","92212833","WATER STERILE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.80","92215190","FAMCICLOVIR 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.80","92216004","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"85.95","92213261","CR CU MN SE ZN TRACE ELEMENT I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"850.00","38303822","HLA DR/DQ TYPING (MULTIPLE) ","86817",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"852.05","92216010","IMMUNE GLOBULIN 5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"854.30","92213584","ALBUMIN HUMAN 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"854.55","92215513","OCTREOTIDE ACET 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"854.80","92210775","ERYTHROMYCIN 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"854.88","72060004","PLATELETS-PROC ONLY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"855.00","92211040","CLOBETASOL PROP 0.05% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"855.20","92218776","TOUJEO 300 UNITS/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8570.45","92220508","BRIVARACETAM 10 MG/ML IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8574.00","92215387","DROTRECOGIN ALFA 20MG PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"858.32","38201555","HIV VIRAL LOAD QUANT (DNA) ","87536",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"858.32","38243624","HEPATITIS C VIRUS AB RNA ","87522",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92211442","ACTIV CHARCOAL 25GM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92213380","DOPAMINE HCL 400MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92214003","ACTIV CHARCOAL 25GM SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92214074","PIPERACILLIN NA 4GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92214477","OLANZAPINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92216858","LIPIDS 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.00","92217733","ACTIV CHARCOAL SORBITOL 25GM S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.01","38300740","CREATININE BLOOD ","82565",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.15","92219935","CLINDAMYPHOS900MG/50ML-0.9%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.39","38301910","PHOSPHOROUS SERUM ","84100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.40","92212121","LEVOFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.45","92215366","LIDOCAINE 2%/EPI 1:200000 INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.50","38303910","CROSSMATCH INCUBATION ","86921",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.50","72000769","CROSSMATCH INCUBATION ","86921",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.50","92212684","LEVOFLOXACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.59","38302207","INFLUENZA SUBTYPES PCR ","87503",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.60","92210199","TETRACYCLINE HCL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.60","92213923","LIDOCAINE HCL 4% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.75","92213702","DOPAMINE HCL 400MG/D5W 250ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.75","92218355","NEVIRAPINE 50MG/5 ML SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.75","92220468","LANSOPRAZOLE 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.85","92214552","ANAGRELIDE HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"86.95","92219327","SODIUM POLYSTYRENE SUL PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"860.72","74076002","UPPER GI STOMACH W/ KUB ","74241",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"861.00","33101248","KIT TRACH PERCUT W/CONN 7X15MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"861.00","33101249","KIT TRACH PERCUT W/CONN 8X15MM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"861.45","74001057","ERCP (ENDO CATH BIL DUCT) ","74328",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"863.05","92211645","METRONIDAZOLE 0.75% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"864.35","92204042","IV ADMIXTURE 42 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"864.40","92214547","PRAMOXINE HCL HC 1%-1% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"864.80","92217108","TOBRAMYCIN 300MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"866.00","92215509","APREPITANT 125MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"866.90","92215615","DIHYDROERGOTAMINE 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"867.00","11600110","CENTRAL LINE INSERTION ","36569",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"869.30","92220306","SODIUM POLYSTYRENE SULFON PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.00","92210873","MEPIVACAINE HCL 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.00","92212288","DEXAMETHASONE NA PH 4MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.00","92212331","LEVOBUNOLOL 0.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.00","92212924","HALOPERIDOL DEC 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.00","92214297","ATOMEXETINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.30","92213095","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.35","92216695","MESALAMINE 4GM/60ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.35","92219406","KETOTIFEN FUMARATE 0.025% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.40","92211431","BENZOYL PEROXIDE 5% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.45","92213845","RANITIDINE HCL 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.50","38302455","PORPHYRINS (URINE QUAL) ","84119",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.50","92216687","MAGNESIUM SULF 2GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.60","92211576","CAPSAICIN 0.075% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.60","92213878","CR CU MN SE ZN TRACE ELEMENT I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.65","34000176","SENSORY STIMULATION 15 MIN ","97533GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.65","34200011","SENSORY STIMULATION 15 MIN ","97533GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.65","34600019","SENSORY STIMULATION 15 MIN ","97533GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.72","38200530","CHLORIDE BLOOD ","82435",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.72","38200690","SED RATE (AUTO) ","85652",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.79","38343651","GIARDIA IMMUNOFLUOR ","87269",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.80","38305068","VITAMIN C (ASCORBIC ACID) ","82180",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.85","92216273","FENTANYL 25MCG/HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"87.90","92218281","IODOFLEX 0.9% TOP PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"872.00","92217984","OMNIPAQUE 300 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"872.60","92212432","SEVOFLURANE LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"873.45","92218132","FLUCYTOSINE 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"875.82","74000081","BARIUM ENEMA W/WO KUB ","74270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"875.82","74000082","GASTROGRAFIN ENEMA W/WO KUB ","74270",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"876.05","92214797","ESTRADIOL VALERATE 10MG/ML OIL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"877.35","92210110","NYSTATIN/TRIAMCINOLONE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"877.35","92211684","NYSTATIN/TRIAMCINOLONE CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"877.75","92214162","FLUMORMETHOLONE 0.25% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"878.10","92211169","PREDNISOLONE ACETATE 1% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"879.00","33116068","SYSTEM TURN&POSITION MATTRESS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"879.00","92211138","DESOXIMETASONE 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"879.40","92210291","CEFUROXIME AXETIL 125MG/5ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.00","92210611","TICARCILLIN CLV K 3.1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.00","92213791","METIPRANOLOL 0.3% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.00","92218986","ACYCLOVIR SODIUM 500MG/10MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.05","38302480","UREA NITROGEN (URINE) ","84540",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.05","92213297","GABAPENTIN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.17","38300694","CREATININE URINE 24HR ","82570",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.17","38305534","CREATININE MISC FLUID ","82570",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.17","38343603","CREATININE RANDOM URINE ","82570",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.20","92214101","ATOMEXETINE HCL 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.20","92216349","RIFAMPIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.36","38300130","AMYLASE ","82150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.36","38300135","AMYLASE URINE ","82150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.36","38302645","AMYLASE FLD ","82150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.50","92210835","SUCROSE SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.50","92220493","DOLUTEGRAVIR SODIUM 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.60","92215551","DILTIAZEM HCL 100MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.70","92218284","REQUIP XL 12MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.70","92220504","SUVOREXANT 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.75","92220295","GLYCINE 1.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.80","92216794","GLYCINE NACL 94-73.3MG/50ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.80","92216969","INFLUENZA VACC 2011-2012 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.83","38200250","BILIRUBIN DIRECT ","82248",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.83","38200260","BILIRUBIN TOTAL ","82247",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.83","38201882","SODIUM URINE ","84300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.85","92217085","PROTAMINE SULF 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.90","92211990","CYCLOSPORINE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.91","38343626","GIARDIA ANTIGEN ","87329",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.95","92214742","POTASSIUM PH 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"88.95","92218750","MULTIVITAMIN FOR INVUSION SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8804.40","92217837","IMMUNE GLOBULIN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"882.00","33101935","PROBE F. 03801000098 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8825.08","92217544","PALIPERIDONE PALMITATE 117MG S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"884.35","92216682","MAFENIDE ACET 50GM PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"885.60","92215315","UREA 40% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"885.60","92219542","UREA 40% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"887.51","74001422","CHOLANGIOGRAM INTRAOP ADDL SET","74301",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"888.60","92217063","NITAZOXANIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"889.00","33110801","LIGATION CLIPS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.00","38205067","VITAMIN B6 LEVEL ","84207",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.00","92212845","CALCIUM GLUCONATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.10","92220447","BUDESONIDE EC 3 MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.15","92211377","HYDRALAZINE HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.21","38386437","APOLIPOPROTEIN ","82172",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.39","38343650","CRYPTOSPORIDIUM IMMUNOFLUOR ","87272",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301011","CHLAMYDIA. PNEUMONIA (IGG) ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301013","CHLAMYDIA PNEUMONIAE (IGA) ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301014","C TRACHOMATIS IGG ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301016","C PNEUMONIAE IGG ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301017","C PSITTACI IGG ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.57","38301018","CHLAMYDIA ANTIBODIES IGG ","86631",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.60","92216677","PETROLATUM 71.5%OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.65","38386443","BLASTOMYCES AB ","86612",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.68","38302505","VALPROIC ACID FREE ","80165",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.80","92216839","QUETIAPINE FUMARATE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.86","38300780","C-REACTIVE PROTEIN ","86140",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"89.94","38203910","CROSSMATCH INCUBATION ","86921",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"890.60","92212422","MUPIROCIN 2% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"892.11","75000025","US GUIDE FOR NEEDLE PLACEMENT ","76942",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33102672","KIT CATH HEMSPLTAIRGRD29CM16FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33102673","KIT CATH HEMSPLTAIRGRD25CM16FR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33103356","CATH HEMOSPLIT 14.5FR 35CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33111550","CATH HEMODIAL 14.5FR 19CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33111551","CATH HEMODIAL 14.5FR 23CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33111552","CATH HEMODIAL 14.5FR 27CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33116086","KIT CATH HEMSPLT ST DL16FR19CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"893.00","33178154","KIT CATH HEMOSPLT STR DL 42CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"894.00","33189589","BRONCHOSCOPE ASCOPE 4 LARGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"894.70","74000180","CHOLANGIOGRAM INTRAOP ","74300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"8943.45","92220093","LEUPROLIDE 22.5 MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"896.30","92211221","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"897.38","77000192","CT 3D RENDER W/POSTPROCESS ","76377",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"897.60","92217277","SEVOFLURANE LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"899.63","74000945","UPPER GI W/AIR WO KUB ","74246",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92203024","ORALS 24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92203025","ORALS 25 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92203026","ORALS 26 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210001","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210003","THIORIDAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210004","CYANOCABALAMIN 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210005","MULTIVITAMIN MULTIMINERAL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210007","FERROUS SULF 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210008","NAPROXEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210012","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210014","TRIMETHOPRIM 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210015","DIPHENHYDRAMINE HCL 12.5MG/5 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210016","THEOPHYLLINE 300MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210021","THYROID 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210022","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210025","VITAMIN E 100U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210026","TETRACYCLINE HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210027","NITROGLYCERIN 0.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210031","GUANFACINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210033","THIORIDAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210034","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210035","THIOTHIXENE 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210036","TRAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210038","ATENOLOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210039","SODIUM CL 3% INH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210040","TRAZODONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210041","ENALAPRIL MALEATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210042","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210043","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210045","TRIHEXYPHENIDYL HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210046","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210049","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210050","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210051","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210055","CITRIC ACID NA CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210056","NAPROXEN NA 220MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210057","NA PHOS DIBASIC/MONOBASIC NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210059","ASPIRIN 81MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210060","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210063","TOLMETIN NA 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210064","VITAMIN B COMPLEX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210065","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210066","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210067","BETA CAROTENE 10000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210068","INDAPAMIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210072","DIMENHYDRINATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210075","SULFASALAZINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210076","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210080","THIORIDAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210081","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210083","ACETAMINOPHEN 80MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210085","PRAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210089","CHROMIUM PICO 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210091","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210092","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210096","HYDROXYZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210097","ESTRADIOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210098","BENZTROPINE MESYLATE 0.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210099","THIORIDAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210100","PHENDIMETRAZINE 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210101","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210103","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210104","PHENAZOPYRIDINE 95MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210106","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210108","SALSALATE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210109","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210111","ACETAMINOPHEN 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210113","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210115","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210116","DIPYRIDAMOLE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210118","DESIPRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210119","ACETAMINOPHEN ASPIRIN CAFF TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210121","TEMAZEPAM 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210124","DICYCLOMINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210125","MULTIVITAMIN MULTIMINERAL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210126","VERAPAMIL HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210127","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210130","CALCIUM CARB 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210131","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210134","DOXYCYCLINE HYCLATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210135","GUAIFENESIN DM 100-10MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210136","CAPTOPRIL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210138","BUTALB CAFF APAP 50-40-325 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210141","SULFAMETHOXAZOLE/TMP 400/80 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210142","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210145","TEMAZEPAM 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210148","CAPTOPRIL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210150","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210151","ALAMAG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210153","BUMETANIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210155","HCTZ TRIAMTERENE 25-50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210156","PSEUDOEPHEDRINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210157","WARFARIN NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210158","SIMETHICONE 20MG/0.3ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210159","DICLOFENAC NA 50MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210160","ATENOLOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210163","AMILORIDE HCL HCTZ 5-50 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210165","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210166","MULTIVITAMIN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210167","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210171","LEVOTHYROXINE NA 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210175","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210178","TRAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210181","LEVOTHYROXINE NA 75MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210182","TEMAZEPAM 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210183","MULTIVITAMIN ZINC SULF TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210185","LEVOTHYROXINE NA 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210186","LABETALOL HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210187","CLOZAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210190","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210191","THIORIDAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210192","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210196","METOCLOPRAMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210197","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210198","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210201","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210202","HYDROXYZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210205","TRAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210207","BUTALB CAFF APAP 50-40-325 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210208","DISOPYRAMIDE PHOS 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210210","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210211","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210214","VITAMIN E 200U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210215","LORAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210217","THEOPHYLLINE 200MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210226","CEPHALEXIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210227","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210228","THIORIDAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210231","TETRACYCLINE HCL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210232","CYANOCABALAMIN 1000MCG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210233","ISOSORBIDE DN 40MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210234","LEVOTHYROXINE NA 150MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210235","BUTALB CAFF APAP 50-40-325 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210237","THIORIDAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210239","HALOPERIDOL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210240","QUINIDINE GLUC 324MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210241","WARFARIN NA 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210242","NIFEDIPINE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210243","BACLOFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210244","LORAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210247","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210249","ACETAMINOPHEN COD 300MG-60MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210252","ACETAMINOPHEN COD 300MG-30MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210254","CARBAMAZEPINE 100MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210255","CHLORPHENIRAMINE PSE 8-120MG C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210256","TRAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210258","PYRIDOXINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210259","ALMACONE-2 SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210260","TRIFLUOPERAZINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210261","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210262","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210264","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210269","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210271","CLINDAMYCIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210272","SODIUM CL 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210274","DIPHENHYDRAMINE HCL 12.5MG/5 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210275","LABETALOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210276","LITHIUM CARBONATE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210278","GLIPIZIDE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210279","FAMOTIDINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210280","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210282","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210283","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210287","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210288","SULFAMETHOXAZOLE/TMP 400/80 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210289","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210297","LEVOTHYROXINE NA 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210298","DIPHENOXYLATE HCL ATROPINE TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210299","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210302","METOPROLOL TART 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210303","ALENIC ALKA SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210304","CEPHALEXIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210305","AMOXICILLIN 250MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210307","BETA CAROTENE 25000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210308","THYROLAR-3 STRENGTH TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210309","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210319","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210320","ENALAPRIL MALEATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210323","LOPERAMIDE HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210325","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210326","PHENOBARBITAL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210327","THEOPHYLLINE 100MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210328","AMITRIP PERPHEN 10-4 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210330","HCTZ TRIAMTERENE 25-50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210331","VALPROIC ACID 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210333","THEOPHYLLINE 300MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210334","ATENOLOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210336","MEDROXYPROGESTERONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210337","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210338","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210339","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210340","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210342","ETODOLAC 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210343","ALMACONE SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210344","PHENOBARBITAL 15MG/ML TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210345","LOPERAMIDE HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210347","THYROID 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210349","MAGNESIUM HYDROXIDE 400MG SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210351","ESTROPIPATE 1.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210352","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210353","TEMAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210354","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210355","GUAIFENESIN DM 100-10MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210357","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210358","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210360","FLUPHENAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210363","HYDROXYZINE PAM 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210365","VITAMIN B COMPLEX CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210366","ASCORBIC ACID 250MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210370","GUAIFENESIN 100MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210375","ACYCLOVIR 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210376","ACETAMINOPHEN 160MG/5ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210377","MISOPROSTOL 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210380","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210382","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210386","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210387","ERGOCALCIFEROL 50000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210389","SODIUM BICARB 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210390","CIMETIDINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210393","AMOXICILLIN 250MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210394","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210397","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210398","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210399","TRAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210402","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210403","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210406","NAPROXEN NA 275MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210408","TEMAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210411","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210413","GLYBURIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210414","TRIHEXYPHENIDYL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210415","CALCIUM CARB 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210416","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210418","GUAIFENESIN DM 100-10MG/5ML LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210420","VITAMIN E 1000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210421","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210422","DIAZEPAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210425","LEVOTHYROXINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210426","LEVOTHYROXINE NA 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210427","ETODOLAC 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210428","PYRIDOXINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210431","AMITRIPTYLINE HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210432","DOCUSATE NA 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210435","THEOPHYLLINE 450MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210436","ASCORBIC ACID 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210437","DIGOXIN 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210439","THIOTHIXENE 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210441","METHYLPHENIDATE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210442","OXYCODONE/ASA 4.88/325 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210444","THIORIDAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210445","DIPHENHYDRAMINE HCL 12.5MG/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210446","CALCIUM CARB 250 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210447","OXYCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210449","ATENOLOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210452","MULTIVITAMIN MULTIMINERAL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210453","SULINDAC 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210454","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210456","NAPROXEN NA 220MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210457","QUINIDINE SULF 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210458","THEOPHYLLINE 200MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210459","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210462","ASCORBIC ACID 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210463","TRAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210465","TRAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210468","HYDROCODONE APAP 7.5-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210472","THIORIDAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210474","CALCIUM CITRATE 950MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210478","HCTZ TRIAMTERENE 50-75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210480","DILTIAZEM HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210481","MEDROXYPROGESTERONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210482","METOCLOPRAMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210483","SALSALATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210485","LEVOTHYROXINE NA 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210491","CASTOR OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210494","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210495","WARFARIN NA 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210499","VERAPAMIL HCL 180MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210502","ATENOLOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210506","FLURBIPROFEN 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210507","CALCIUM CARB 600 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210509","NAPROXEN 375MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210510","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210511","PSEUDOEPHEDRINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210513","MECLIZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210514","POTASSIUM CL 8MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210515","GUANFACINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210516","CALCIUM GLUCONATE 650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210517","ASCORBIC ACID 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210519","DIFLUNISAL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210522","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210524","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210525","VERAPAMIL HCL 240MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210526","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210528","BENZONATATE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210529","SULFAMETHOXAZOLE/TMP 800/160 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210530","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210532","ESTRADIOL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210533","MAGNESIUM CITR 1.75GM/30ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210538","PROPRANOLOL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210539","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210540","PROMETHAZINE COD 6.25-10/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210541","INDAPAMIDE 1.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210542","CYANOCABALAMIN 1000MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210543","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210545","NAPROXEN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210548","BUPROPION HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210549","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210551","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210552","HYOSCYAMINE SULF 0.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210553","BENZTROPINE MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210554","POTASSIUM IODIDE 1GM/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210556","AMPICILLIN NA 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210558","LEVOTHYROXINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210559","LITHIUM CARBONATE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210560","CYCLOBENZAPRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210562","IMIPRAMINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210563","TRIHEXYPHENIDYL HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210566","METHYLPHENIDATE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210567","ISOSORBIDE DN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210570","ATENOLOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210573","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210575","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210576","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210578","AMITRIPTYLINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210582","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210584","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210589","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210591","VITAMIN A 10000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210592","LEVOTHYROXINE NA 88MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210594","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210596","AMITRIP PERPHEN 25-2 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210597","ESTAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210598","NAPROXEN NA 220MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210599","SULFAMETHOXAZOLE/TMP 800/160 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210600","TRAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210601","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210603","CAPTOPRIL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210604","ISOSORBIDE DN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210605","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210606","DIPYRIDAMOLE 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210608","TRIHEXYPHENIDYL HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210610","HCTZ TRIAMTERENE 50-75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210613","VALPROIC ACID 250MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210615","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210616","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210617","LORAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210618","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210619","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210620","LOPERAMIDE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210621","ALPRAZOLAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210622","NICARDIPINE HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210625","THYROLAR-2 STRENGTH TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210628","MORPHINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210631","FERROUS SULF 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210634","PYRIDOXINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210635","TEMAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210638","ATENOLOL CHLORTHAL 100-25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210639","PYRIDOXINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210641","CALAMINE LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210642","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210643","WARFARIN NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210644","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210648","NAPROXEN 375MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210650","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210652","THEOPHYLLINE 200MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210653","IMIPRAMINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210657","CHLORDIAZEPOXIDE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210660","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210662","SULINDAC 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210663","ISOSORBIDE DN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210664","CIMETIDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210667","ZINC CHELATED 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210669","LOPERAMIDE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210670","NITROGLYCERIN 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210672","NORTRIPTYLINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210673","ASCORBIC ACID 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210676","PROMETHAZINE COD 6.25-10/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210680","PYRIDOXINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210682","DOCUSATE NA 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210684","ZINC GLUCONATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210685","DIPHENHYDRAMINE APAP 25-500 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210686","IMIPRAMINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210687","METHADONE HCL 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210688","BISMUTH SUBSALICYLATE 262MG SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210689","LEVOTHYROXINE NA 150MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210690","ASCORBIC ACID 1000MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210692","ASCORBIC ACID 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210695","PENICILLIN VK 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210697","LEVOTHYROXINE NA 300MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210698","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210700","VERAPAMIL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210702","DIPHENOXYLATE HCL ATROPINE TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210703","DICYCLOMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210704","MEDROXYPROGESTERONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210706","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210708","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210709","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210711","ETODOLAC 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210712","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210713","IMIPRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210715","CARBIDOPA/LEVO 25/250 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210717","VERAPAMIL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210719","PENICILLIN VK 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210720","ACETAMINOPHEN COD 300MG-60MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210721","AMITRIP PERPHEN 10-2 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210725","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210728","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210732","ENALAPRIL/HCTZ 10-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210733","PROBENECID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210735","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210742","ASPIRIN 81MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210745","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210749","PYRIDOXINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210750","VERAPAMIL HCL 180MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210753","CHLORDIAZEPOXIDE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210756","HYDROXYZINE HCL 10MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210757","ALLOPURINOL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210758","CYANOCABALAMIN 500MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210762","LEVOTHYROXINE NA 75MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210765","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210767","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210768","CALCIUM CARB 750MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210770","ESTROPIPATE 0.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210771","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210773","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210774","AMPICILLIN NA 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210779","AMOXICILLIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210781","HCTZ TRIAMTERENE 50-75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210782","CYPROHEPTADINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210784","PROMETHAZINE HCL VC/COD SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210785","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210787","COENZYME Q10 30MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210788","NICARDIPINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210789","CALCIUM GLUCONATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210791","METHOCARBAMOL 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210792","HCTZ 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210793","ENALAPRIL MALEATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210795","CYANOCABALAMIN 1000MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210797","CARBIDOPA/LEVO 10/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210798","PYRIDOXINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210800","CEPHALEXIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210803","MULTIVITAMIN W/F 0.5MG/ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210807","TRIFLUOPERAZINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210812","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210814","GUAIFENESIN DM 100-10MG/5ML LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210815","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210819","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210820","HYDROXYZINE PAM 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210821","ACETAMINOPHEN COD 300MG-15MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210823","SULINDAC 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210825","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210826","FOSINOPRIL NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210829","HYOSCYAMINE SULF 0.375MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210830","THIORIDAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210831","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210832","ASCRIPTIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210833","VITAMIN E 1000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210836","MELATONIN 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210839","THEOPHYLLINE 300MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210840","LEVOTHYROXINE NA 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210841","TRIHEXYPHENIDYL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210842","THYROLAR-1/2 STRENGTH TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210843","BETHANECHOL CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210844","BUPROPION HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210846","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210848","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210851","PHENOBARBITAL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210852","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210855","NAPROXEN 375MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210856","ATENOLOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210858","SULFASALAZINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210859","VERAPAMIL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210861","INDOMETHACIN 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210863","PROPRANOLOL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210864","CALCIUM CARB 500 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210865","PSEUDOEPHEDRINE HCL 30MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210866","LEVOTHYROXINE NA 88MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210868","HYDROXYZINE PAM 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210871","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210872","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210874","MULTIVITAMIN MINERALS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210875","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210878","BUMETANIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210879","CIMETIDINE HCL 300MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210881","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210884","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210885","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210886","NAPROXEN 375MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210887","MEGESTROL ACET 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210888","DOXEPIN HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210893","LYSINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210896","LORAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210900","SULINDAC 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210902","METHYLPHENIDATE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210905","DIPHENHYDRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210906","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210907","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210912","CYCLOBENZAPRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210913","ETODOLAC 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210918","INDOMETHACIN 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210920","CEPHALEXIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210922","NIACIN 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210926","LOPERAMIDE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210928","HYDROCODONE APAP 7.5-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210930","PYRIDOXINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210932","RANITIDINE HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210937","DYPHYLLINE GG 200-200 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210938","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210939","AMOXICILLIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210945","HYDROXYZINE PAM 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210950","DOXEPIN HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210951","DILTIAZEM HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210954","METRONIDAZOLE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210956","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210957","CYANOCABALAMIN 500MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210962","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210965","PENTOXIFYLLINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210966","CARBIDOPA/LEVO 25/250 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210967","NAPROXEN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210968","LEVOTHYROXINE NA 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210970","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210972","TIMOLOL MALEATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210974","LACTASE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210975","CALCIUM CARB 250 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210977","MEGESTROL ACET 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210979","PENTOXIFYLLINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210981","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210983","SULFAMETHOXAZOLE/TMP 800/160 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210984","BENZTROPINE MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210986","ISOSORBIDE DN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210987","HYDROCODONE APAP 7.5-750MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210988","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210989","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210990","IMIPRAMINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210992","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210995","MICONAZOLE NITRATE 100MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92210998","NIACINAMIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211001","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211004","TOLMETIN NA 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211005","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211006","AMOXICILLIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211009","DIMENHYDRINATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211010","ENALAPRIL MALEATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211015","BUSPIRONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211016","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211018","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211025","ACETAMINOPHEN COD 300MG-30MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211026","HYDROCODONE APAP 7.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211028","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211029","SUCRALFATE 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211030","ALBUTEROL SULF 2MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211031","CARBIDOPA/LEVO 10/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211032","HCTZ 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211034","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211038","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211039","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211041","DILTIAZEM HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211042","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211044","HCTZ TRIAMTERENE 25-37.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211046","CALCIUM CITRATE 950MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211047","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211051","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211052","CLOMIPRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211053","SULFASALAZINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211054","DIMENHYDRINATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211056","HYDROCODONE APAP 10-650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211058","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211059","CYANOCABALAMIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211061","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211062","MISOPROSTOL 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211063","CAPTOPRIL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211065","HYDROCODONE APAP 10-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211070","VERAPAMIL HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211071","FISH OIL VITAMIN E SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211073","IMIPRAMINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211075","DICLOFENAC NA 50MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211076","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211077","METHYLPHENIDATE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211080","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211082","METHYLDOPA 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211083","DOXEPIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211089","BREWERS YEAST 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211091","VERAPAMIL HCL 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211093","HYDROCODONE APAP 7.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211098","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211099","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211103","HYDRALAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211104","METRONIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211106","NIACIN 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211110","FLURBIPROFEN 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211112","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211113","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211116","HYOSCYAMINE SULF 125MCG/5ML EL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211120","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211122","VERAPAMIL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211123","ACETAMINOPHEN COD 300MG-30MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211125","TIMOLOL MALEATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211128","SODIUM BICARB 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211129","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211130","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211131","OXYCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211134","BENZTROPINE MESYLATE 0.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211137","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211140","VERAPAMIL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211143","CLONIDINE HCL 0.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211144","FISH OIL 1000MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211148","CLONAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211149","GUAIFENESIN 100MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211150","DIGOXIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211152","DOXEPIN HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211155","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211156","MULTIVITAMIN MINERALS LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211157","ALBUTEROL SULF 0.83MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211158","AMYLASE/LIPASE/PROTEASE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211160","HYDROCODONE APAP 7.5-750MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211166","CLINDAMYCIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211167","HYOSCYAMINE SULF 0.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211173","COENZYME Q10 60MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211179","DEXTROSE 4GM CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211181","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211182","TROPICAMIDE 1% EYE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211184","METOPROLOL SUCC 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211192","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211194","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211197","PROMETHAZINE HCL 6.25MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211198","ACETAMINOPHEN COD 300MG-30MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211199","POTASSIUM CL 8MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211203","ACYCLOVIR 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211208","TETRACYCLINE HCL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211212","CARBIDOPA/LEVO 25/250 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211215","MEDROXYPROGESTERONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211217","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211222","ATENOLOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211223","BISMUTH SUBSALICYLATE 262MG CT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211226","DICYCLOMINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211228","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211229","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211231","HYDROCODONE APAP 7.5-750MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211232","METHYLPHENIDATE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211236","DOXEPIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211239","SODIUM BICARB 650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211240","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211243","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211245","HALOPERIDOL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211247","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211253","HALOPERIDOL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211254","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211255","GUAIFENESIN 100MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211256","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211259","NIACIN 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211260","HCTZ TRIAMTERENE 25-37.5MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211261","PROMETHAZINE DM 6.25-15MG/5 SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211268","DIPHENHYDRAMINE HCL 12.5MG/5 S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211271","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211272","THIAMINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211273","HYDROXYZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211274","WARFARIN NA 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211276","DICLOXACILLIN NA 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211277","SULINDAC 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211278","POTASSIUM CL 8MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211281","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211283","BENZTROPINE MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211284","OXYCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211288","BISMUTH SUBSALICYLATE 262MG LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211289","THIOTHIXENE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211290","POTASSIUM CL 10MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211291","HYDROXYZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211292","HYDRALAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211293","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211295","HCTZ SPIRONOLACT 25-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211296","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211299","LECITHIN 19GR SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211304","CHLORDIAZEPOXIDE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211305","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211308","TERAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211312","GUAIFENESIN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211313","PROPRANOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211314","ESTRADIOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211318","HALOPERIDOL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211319","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211321","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211323","NAPROXEN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211324","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211325","HYDROXYZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211326","SIMETHICONE 125MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211330","HALOPERIDOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211332","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211334","SELENIUM 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211335","TERAZOSIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211336","NORTRIPTYLINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211337","MULTIVITAMIN MULTIMINERAL LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211338","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211339","DICYCLOMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211341","WARFARIN NA 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211343","TERAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211344","HCTZ TRIAMTERENE 50-75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211346","OXYCODONE APAP 5-500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211347","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211353","AMOXICILLIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211354","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211357","CALCIUM GLUCONATE 975MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211359","MEDROXYPROGESTERONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211361","BENAZEPRIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211364","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211365","CIMETIDINE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211366","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211368","TERAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211370","OXYCODONE APAP 5-500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211371","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211373","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211374","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211375","PROPRANOLOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211378","GUAIFENESIN DM 100-10MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211379","TRIHEXYPHENIDYL HCL 2MG/5ML EL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211381","CYCLOBENZAPRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211382","MULTIVITAMIN MULTIMINERAL LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211388","SIMETHICONE 80MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211392","WARFARIN NA 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211393","METOPROLOL TART 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211394","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211395","CHOLINE MAG TRISAL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211402","THIOTHIXENE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211404","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211405","NABUMETONE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211407","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211408","DIPHENHYDRAMINE HCL 12.5MG/5 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211410","OXYCODONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211422","PENICILLIN VK 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211428","MEDROXYPROGESTERONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211434","PRIMIDONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211435","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211436","DOXEPIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211437","WARFARIN NA 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211438","ENALAPRIL MALEATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211439","VALPROIC ACID 250MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211441","PROPYLTHIOURACIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211446","DIPHENHYDRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211447","METHYLDOPA 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211450","POTASSIUM CL 10MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211451","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211453","WARFARIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211454","WARFARIN NA 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211455","CARISOPRODOL 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211459","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211460","MULTIVITAMIN MINERALS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211461","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211465","NAPROXEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211467","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211468","TERAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211470","CALCIUM CARB 250 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211471","ESTRADIOL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211474","HCTZ 12.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211475","MECLIZINE HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211476","CHONDROITIN GLUCOSAMINE CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211478","FERROUS SULF 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211480","POTASSIUM CL 8MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211481","CHLORPROPAMIDE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211483","MORPHINE 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211484","ALLOPURINOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211485","PROMETHAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211486","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211488","ACYCLOVIR 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211491","IMIPRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211495","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211497","CYCLOBENZAPRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211498","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211499","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211502","PHENYTOIN NA 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211503","VITAMIN D 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211508","PHENYTOLOXAMINE CIT APAP TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211513","HCTZ 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211516","BELLADONNA/PHENOBARB TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211520","ISONIAZID 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211521","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211523","HYDROXYZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211524","COLCHICINE 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211527","LORAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211528","NAPROXEN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211529","PENICILLIN VK 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211531","DIAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211532","CYPROHEPTADINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211534","BISMUTH SUBSALICYLATE 262MG SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211535","FERROUS SULF 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211537","DOXEPIN HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211539","THEOPHYLLINE 100MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211542","DOXYCYCLINE HYCLATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211543","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211546","DOCUSATE NA 100MG/10ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211548","HCTZ TRIAMTERENE 25-37.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211550","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211552","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211554","LEVOTHYROXINE NA 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211556","PENICILLIN VK 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211560","ACYCLOVIR 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211561","CLONAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211563","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211564","FERROUS GLUCONATE 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211566","NORTRIPTYLINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211567","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211573","NICARDIPINE HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211574","AMOXICILLIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211580","LABETALOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211581","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211582","METRONIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211583","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211585","ISOSORBIDE MN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211586","PROCHLORPERAZINE MAL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211587","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211588","WARFARIN NA 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211589","MORPHINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211593","MAGNESIUM OXIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211599","DIAZEPAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211606","FA CYAN IRON POLYSACCHARIDE CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211612","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211613","GLYBURIDE 1.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211616","LOPERAMIDE HCL 1MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211618","ALLOPURINOL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211620","CHLORPROPAMIDE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211622","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211626","METOCLOPRAMIDE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211627","DIAZEPAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211632","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211633","LEVOTHYROXINE NA 175MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211636","PROMETHAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211637","ERYTHROMYCIN ST 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211639","MELATONIN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211647","LABETALOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211650","WARFARIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211657","CARBAMAZEPINE 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211658","METHYLPHENIDATE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211660","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211665","DOXEPIN HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211666","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211667","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211670","HYDRALAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211673","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211674","PROCHLORPERAZINE MAL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211677","FLURAZEPAM HCL 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211681","ALLOPURINOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211685","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211686","HYDROXYZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211692","THYROLAR-1/4 STRENGTH TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211696","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211698","METHYLPREDNISOLONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211699","AMITRIPTYLINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211700","LOXAPINE SUCCINATE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211704","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211708","METRONIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211714","AMITRIP PERPHEN 25-4 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211716","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211719","NALOXONE PENTAXOCINE 0.5-50 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211720","PRIMIDONE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211721","NA PHOS DIBASIC/MONOBASIC NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211722","MECLIZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211724","THYROLAR-1 STRENGTH TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211725","CHOLINE MAG TRISAL 500MG/5ML L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211726","ACARBOSE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211729","CALCIUM CARB 650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211733","DIPYRIDAMOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211736","NIACIN 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211738","MORPHINE 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211740","ISOSORBIDE DN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211744","HYDROMORPHONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211747","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211751","INDOMETHACIN 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211752","NORTRIPTYLINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211759","CETIRIZINE HCL 1MG/ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211761","TETRACYCLINE HCL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211763","AMPICILLIN NA 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211768","HYDROXYZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211769","PROMETHAZINE DM 6.25-15MG/5 SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211772","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211774","NAPROXEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211777","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211779","INDOMETHACIN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211780","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211785","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211788","METOCLOPRAMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211790","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211792","HALOPERIDOL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211797","ASPIRIN 81MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211799","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211800","MULTIVITAMIN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211801","DIAZEPAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211804","CYCLOBENZAPRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211808","CHLORAL HYDRATE 500MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211812","MEGESTROL ACET 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211817","ACETAMINOPHEN 500MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211819","LORAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211821","PSEUDOEPHEDRINE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211822","BISOPROLOL FUMARATE/HCTZ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211831","CASTOR OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211835","OXYBUTYNIN CL 5MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211837","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211838","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211846","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211850","AMITRIPTYLINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211852","BISACODYL 10MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211853","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211855","MIDODRINE HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211858","ISOSORBIDE DN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211859","SUCRALFATE 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211860","INDAPAMIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211862","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211866","METRONIDAZOLE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211870","METHYLDOPA 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211874","ISOSORBIDE DN 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211878","CALCIUM CARB 250 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211880","FLURAZEPAM HCL 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211884","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211885","METOPROLOL TART 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211887","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211888","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211889","BUMETANIDE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211890","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211892","PINDOLOL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211895","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211897","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211899","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211900","BISOPROLOL/HCTZ 2.5/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211904","DICYCLOMINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211909","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211912","FAMOTIDINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211922","CHLORDIAZEPOXIDE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211923","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211924","DICLOFENAC NA 25MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211925","LOXAPINE SUCCINATE 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211926","DOXAZOSIN MESYLATE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211928","HYDROXYZINE PAM 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211930","LOPERAMIDE HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211931","FOLIC ACID 0.8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211932","BUMETANIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211940","METHADONE HCL 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211941","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211942","DOXEPIN HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211944","CYANOCABALAMIN 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211945","LEVOTHYROXINE NA 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211948","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211953","HYDROCODONE APAP 10-660MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211955","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211963","SODIUM BICARB 650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211964","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211965","PIROXICAM 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211966","MULTIVITAMIN W/F 0.25MG/ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211968","ISOSORBIDE DN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211969","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211980","FERROUS SULF 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211981","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211983","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211985","BUSPIRONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211987","GUAIFENESIN DM 600MG-30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211989","MINTOX MAXIMUM STRENGTH SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211993","METRONIDAZOLE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211994","SODIUM CL 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211995","GLYBURIDE MICRO 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211997","HYDROXYUREA 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92211998","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212000","HYDROCODONE APAP 10-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212001","NIACIN 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212002","PSEUDOEPHEDRINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212004","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212006","CHLORDIAZEPOXIDE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212007","FOLTRIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212011","LEVOTHYROXINE NA 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212013","MEGESTROL ACET 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212014","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212015","POTASSIUM CL 8MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212021","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212022","DICYCLOMINE HCL 10MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212023","QUINIDINE SULF 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212024","DILTIAZEM HCL 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212025","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212026","ATROPINE SULF 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212028","PRIMIDONE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212030","MECLIZINE HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212031","NIACIN 1000MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212032","THEOPHYLLINE 400MG T24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212035","ISONIAZID 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212036","CLONAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212038","QUINAPRIL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212039","ALLOPURINOL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212043","HYDROXYUREA 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212044","PENTOXIFYLLINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212048","HCTZ 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212049","HYDROXYZINE HCL 10MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212050","CHLOROPHYLLIN COPPER 100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212052","FERROUS SULF 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212053","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212055","CHLORDIAZEPOXIDE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212056","NIACIN 250MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212062","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212063","VITAMIN B COMPLEX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212065","DILTIAZEM HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212070","FERROUS SULF 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212071","ERYTHROMYCIN ST 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212073","GUAIFENESIN DM 600MG-30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212077","HYDROCODONE APAP 7.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212080","METHOCARBAMOL 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212082","BENZTROPINE MESYLATE 0.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212087","FLAVOXATE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212095","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212098","LORAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212099","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212102","PHENOBARBITAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212106","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212107","CARISOPRODOL 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212108","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212112","IMIPRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212113","BIOTIN 1000MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212119","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212122","VALPROIC ACID 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212126","PROPRANOLOL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212127","ALMACONE CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212128","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212131","ATENOLOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212133","GLIPIZIDE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212134","PROMETHAZINE HCL 6.25MG/5ML SY"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212135","ISOSORBIDE DN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212138","CHLOROTHIAZIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212139","GLYBURIDE 1.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212140","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212142","PROMETHAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212145","CHLORZOXAZONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212151","GLYBURIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212153","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212155","CHLORPROMAZINE HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212156","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212159","NIACIN TD 250MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212160","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212162","OXYCODONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212163","BUSPIRONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212167","AMOXICILLIN 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212168","SALSALATE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212169","CALCIUM GLUBIONATE 1.8GM/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212170","MAGNESIUM GLUCONATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212173","CARBAMAZEPINE 100MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212175","ISONIAZID 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212179","CHLOROTHIAZIDE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212183","ISONIAZID 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212184","MAGNESIUM CL 64MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212192","PROPRANOLOL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212194","ACETAMINOPHEN 325MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212199","HALOPERIDOL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212200","CARISOPRODOL 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212202","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212207","ENALAPRIL MALEATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212209","AMOXICILLIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212215","LABETALOL HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212216","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212218","ENALAPRIL MALEATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212220","GLYBURIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212225","FEXOFENADINE HCL 180MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212228","NICARDIPINE HCL 20MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212233","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212237","DIPHENHYDRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212238","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212242","LEVOTHYROXINE NA 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212244","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212246","BELLADONNA/PHENOBARB TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212248","PHENAZOPYRIDINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212250","HYDROCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212252","POTASSIUM CL 10MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212254","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212256","HYDROCODONE APAP 2.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212259","PREDNISOLONE 15MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212260","DIPYRIDAMOLE 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212261","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212264","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212265","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212267","CARBOXYMETHYLCELLULOSE NA SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212268","GLYBURIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212271","ALLOPURINOL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212272","METHADONE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212273","LEVOTHYROXINE NA 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212275","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212276","LEVOTHYROXINE NA 150MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212278","FERROUS SULF 300MG/6.8ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212279","WARFARIN NA 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212280","BUPROPION HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212284","VITAMIN B COMPLEX SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212286","NIACIN 500MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212287","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212292","DILTIAZEM HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212294","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212298","METHYLDOPA 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212299","DIPHENHYDRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212303","THIOTHIXENE 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212304","MAGNESIUM CL 64MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212308","DIPYRIDAMOLE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212309","VERAPAMIL HCL 240MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212310","MEGESTROL ACET 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212315","NAPROXEN 500MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212316","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212318","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212319","OXAZEPAM 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212322","INDAPAMIDE 1.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212324","LOXAPINE SUCCINATE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212325","SUCRALFATE 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212328","PROCHLORPERAZINE MAL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212329","NITROGLYCERIN 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212332","TRIFLUOPERAZINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212335","CALCIUM CARB 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212337","NIACIN 250MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212341","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212343","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212349","DILTIAZEM HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212351","PROMETHAZINE HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212353","HYDROXYZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212354","SALSALATE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212356","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212360","MECLIZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212362","RESERPINE 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212365","LEVOTHYROXINE NA 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212366","WARFARIN NA 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212367","FERROUS SULF 75MG/0.6ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212370","CHLORDIAZEPOXIDE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212371","DIPYRIDAMOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212372","CALCIUM CARB 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212373","VERAPAMIL HCL 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212377","IRON POLYSACCH 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212379","ERYTHROMYCIN 5MG/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212383","METHYLDOPA 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212385","DOXYCYCLINE HYCLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212388","ACETAMINOPHEN 325MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212392","HCTZ 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212395","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212396","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212397","IRON POLYSACCH 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212405","DOXYCYCLINE HYCLATE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212406","ASCORBIC ACID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212408","DIAZEPAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212411","HYDROCODONE IBU 7.5-200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212417","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212421","SALSALATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212427","CETIRIZINE HCL 1MG/ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212429","DIAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212430","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212433","CLEMASTINE FUMARATE 1.34MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212434","ZINC SULF 220MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212436","DEXAMETHASONE 0.5MG/5ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212441","HOMATROP HYDROCODONE BIT TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212442","METHOCARBAMOL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212446","LEVOTHYROXINE NA 100MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212447","LABETALOL HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212456","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212458","DIAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212460","HYDROCODONE APAP 10-650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212464","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212465","ATENOLOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212470","FLUPHENAZINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212473","HALOPERIDOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212476","FOLIC ACID 0.8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212477","METHOCARBAMOL 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212478","PHENDIMETRAZINE 35MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212479","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212484","NYSTATIN 500000U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212485","ETODOLAC 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212486","DIPYRIDAMOLE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212487","NITROGLYCERIN 6.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212490","SODIUM CL 1.07GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212492","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212495","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212498","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212503","BUTALB CAFF APAP 50-40-500 CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212508","NABUMETONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212510","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212513","ZOLPIDEM TARTRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212517","DOXYCYCLINE HYCLATE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212518","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212519","HALOPERIDOL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212520","SUCRALFATE 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212522","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212523","CALCIUM ACETATE 667MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212528","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212529","ATENOLOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212530","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212536","CLONAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212541","METOPROLOL TART 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212544","HCTZ 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212550","LABETALOL HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212551","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212552","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212555","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212556","AMITRIPTYLINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212558","BUPROPION HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212560","AMANTADINE HCL 50MG LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212565","METHIMAZOLE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212566","LABETALOL HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212571","MOEXIPRIL HCL 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212573","GLYBURIDE MICRO 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212574","ASCORBIC ACID 500MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212577","BUMETANIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212580","LOPERAMIDE HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212581","FLUPHENAZINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212582","HYDROXYZINE PAM 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212588","ISOSORBIDE DN 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212589","ENALAPRIL MALEATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212596","ISOSORBIDE DN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212602","CALCIUM CARB 600MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212606","METHENAMINE MAND/NAPH BASIC TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212607","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212611","MORPHINE 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212616","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212622","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212626","DYPHYLLINE GG 100/5-100/5 LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212633","FLUPHENAZINE HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212636","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212642","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212643","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212644","PROPRANOLOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212647","CARISOPRODOL 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212648","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212652","METHIMAZOLE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212655","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212656","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212658","FERROUS SULF 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212662","PRAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212668","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212669","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212670","PHENYLEPHRINE HCL 0.25% SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212678","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212682","PILOCARPINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212685","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212686","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212687","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212690","MULTIVITAMIN LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212692","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212695","MORPHINE 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212697","DOXEPIN HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212699","LEVOTHYROXINE NA 175MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212701","SULFASALAZINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212702","ACEBUTOLOL HCL 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212704","MINOXIDIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212712","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212713","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212715","METRONIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212721","DESIPRAMINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212722","ACEBUTOLOL HCL 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212724","LEVOTHYROXINE NA 75MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212727","PREDNISONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212733","MEPERIDINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212736","METHOCARBAMOL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212740","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212742","DIPHENHYDRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212743","CHLORTHALIDONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212751","RANITIDINE HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212752","PHENYTOLOXAMINE CIT APAP TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212754","LEVOTHYROXINE NA 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212755","TRIAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212757","MINTOX PLUS CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212760","GLYBURIDE METFORMIN 5/500MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212762","WARFARIN NA 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212767","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212771","FLUPHENAZINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212774","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212778","FOLIC ACID 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212781","HALOPERIDOL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212782","DOCUSATE NA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212783","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212784","SILVER NITRATE KNO3 75-25% SWA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212786","PROPRANOLOL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212795","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212796","ESTRADIOL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212804","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212809","PROCHLORPERAZINE MAL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212810","ENALAPRIL MALEATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212811","INDAPAMIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212815","METRONIDAZOLE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212820","PSEUDOEPHEDRINE HCL 30MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212821","GLIMEPIRIDE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212823","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212826","ISRADIPINE 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212828","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212830","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212831","METHYLDOPA 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212838","PHENOBARBITAL 15MG/ML TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212840","PHENOBARBITAL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212843","OXCARBAZEPINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212849","FLUPHENAZINE HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212853","CLINDAMYCIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212855","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212856","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212857","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212859","SIMETHICONE 80MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212861","DILTIAZEM HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212862","GLUCOSAMINE 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212866","SODIUM CL 10% INH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212867","LITHIUM CARBONATE 450MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212874","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212875","WARFARIN NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212876","ETHAMBUTOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212877","ERGOTAMINE CAFFEINE 100/1 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212884","MECLIZINE HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212886","ALLOPURINOL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212895","ISOSORBIDE MN 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212899","MECLIZINE HCL 25MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212901","CLOZAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212902","ACETAMINOPHEN 325MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212905","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212907","SULFASALAZINE 500MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212909","TRIAZOLAM 0.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212912","DOXAZOSIN MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212914","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212915","CALCIUM CARB 500 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212917","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212918","OXAZEPAM 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212920","HYDRALAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212922","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212930","PROPRANOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212931","ZIDOVUDINE 50MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212932","LACTULOSE 10GM/15ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212937","CYPROHEPTADINE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212939","CLONIDINE HCL 0.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212942","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212943","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212947","MAALOX SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212949","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212953","NITROGLYCERIN 2.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212955","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212956","AMITRIPTYLINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212958","HEMORRHOID SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212959","METRONIDAZOLE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212961","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212962","ALLOPURINOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212964","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212965","METAPROTERENOL SULF 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212966","NITROGLYCERIN 2.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212968","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212970","OXAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212971","NEOMYCIN SULF 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212973","HYDRALAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212974","NITROGLYCERIN 6.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212975","AMITRIPTYLINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212978","HYDROMORPHONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212981","METRONIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212987","PROPRANOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92212988","BISOPROLOL FUMARATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213001","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213006","HYDRALAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213018","AMOXAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213020","DOXAZOSIN MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213024","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213026","DEXAMETHASONE 0.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213027","VERAPAMIL HCL 180MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213032","HYDRALAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213033","DEXAMETHASONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213037","PRAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213038","DIAZEPAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213045","DIFLUNISAL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213047","AMITRIPTYLINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213048","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213051","NAPROXEN NA 220MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213061","DICYCLOMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213066","CHLORDIAZEPOXIDE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213068","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213071","DIAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213075","PHENOBARBITAL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213078","CARBIDOPA/LEVO 25/100 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213079","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213081","FENOFIBRATE 54MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213083","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213084","MIGLITOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213086","FEXOFENADINE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213091","PHENOBARBITAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213094","AMITRIPTYLINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213096","PROPYLTHIOURACIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213097","SALSALATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213098","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213100","MINOXIDIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213102","THYROID 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213103","DIPHENOXYLATE HCL ATROPINE TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213106","POTASSIUM BICARB 25MEQ TEF "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213111","CARBIDOPA/LEVO 25/100 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213112","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213115","INDOMETHACIN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213116","FOAMING ANTACID CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213117","CU SE VITA VITB VITC Z TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213118","METHOCARBAMOL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213120","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213122","GLIMEPIRIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213130","METAPROTERENOL SULF 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213131","MINOXIDIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213132","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213134","PHENOBARBITAL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213136","BENAZEPRIL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213137","AMINOPHYLLINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213139","LIOTHYRONINE NA 50MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213143","PROPOXYPHENE HCL 65MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213144","TRANDOLAPRIL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213150","PROMETHAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213151","PROMETHAZINE COD 6.25-10/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213153","AMOXICILLIN 875MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213159","POTASSIUM BICARB KCL 25MEQ TEF"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213160","DIPHENHYDRAMINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213162","HOMATROP HYDROCODONE BIT SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213163","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213164","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213165","PHENOBARBITAL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213167","CHLORTHALIDONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213173","LIOTHYRONINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213176","FLUPHENAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213177","PROPRANOLOL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213179","ACETAMINOPHEN 120MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213182","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213189","HYDRALAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213192","HYDRALAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213193","AMOXAPINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213195","HALOPERIDOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213202","POLYVINYL ALCOHOL POVIDONE SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213205","PROPOXYPHENE HCL 65MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213206","PRAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213208","TORSEMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213210","HYDROXYUREA 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213212","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213216","MEPROBAMATE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213217","QUINIDINE SULF 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213220","BUSPIRONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213221","POLYVINYL ALCOHOL POVIDONE SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213223","RAMIPRIL 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213224","PROPOXYPHENE HCL 65MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213225","MAGNESIUM OXIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213229","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213231","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213232","LACTO ACIDOPH/PECTIN 25MMU TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213236","APAP/BUTALBITAL/CAFF/COD CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213237","TRAMADOL HCL APAP 37.5-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213238","HYDRALAZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213240","ISONIAZID 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213241","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213246","COLCHICINE PROBENECID .5-500 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213249","QUINIDINE SULF 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213253","BUSPIRONE HCL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213255","ALLOPURINOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213260","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213262","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213264","PHOS K NA PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213268","POTASSIUM BICARB 25MEQ TEF "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213269","CHLORDIAZEPOXIDE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213271","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213276","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213278","DOCUSATE NA SENNA 50MG-8.6MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213281","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213285","PROPOXYPHEN APAP 50-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213288","ISONIAZID 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213294","DIAZEPAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213303","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213314","AMILORIDE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213316","PREDNISOLONE NA POS 15MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213319","ISONIAZID 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213326","SIMVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213328","CALCIUM CITRATE 315 W/D 200U T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213337","AMITRIPTYLINE HCL CDP 25-10 TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213343","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213347","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213352","PROPRANOLOL HCL 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213354","HALOPERIDOL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213356","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213359","ISOSORBIDE DN 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213360","OXAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213372","CHLOROPHYLLIN THYMOL 3-0.6MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213374","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213377","AMOXICILLIN 200MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213381","INDOMETHACIN 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213383","MAPROTILINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213384","CYPROHEPTADINE 2MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213386","TERAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213388","HCTZ 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213389","FLUPHENAZINE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213391","SPIRONOLACTONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213395","IBUPROFEN 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213396","ARGININE HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213397","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213399","HYDROMORPHONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213404","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213409","ISOSORBIDE DN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213411","LOPERAMIDE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213412","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213414","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213416","HALOPERIDOL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213420","HCTZ TRIAMTERENE 37.5-25MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213422","FLURAZEPAM HCL 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213425","HYDRALAZINE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213433","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213434","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213436","WARFARIN NA 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213437","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213442","BETAXOLOL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213443","TERAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213444","MAALOX PLUS SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213450","PETROLATUM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213455","SIMVASTATIN 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213457","PRAZOSIN HCL 2MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213460","BISOPROLOL/HCTZ 10/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213462","ETHINYL ESTRADIOL NORGESTIM TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213464","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213466","ISOSORBIDE MN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213473","DOXAZOSIN MESYLATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213480","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213485","AMITRIPTYLINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213486","NEOMYCIN SULF 125MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213489","LITHIUM CARBONATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213495","PREDNISONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213499","DEXTROAMPHETAMINE SULF 30/5 SE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213503","BISOPROLOL/HCTZ 2.5/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213510","BISOPROLOL/HCTZ 5/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213514","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213517","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213520","BUTALB CAFF APAP 50-40-500 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213521","MYLANTA SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213522","BISOPROLOL/HCTZ 2.5/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213523","HYDROCORTISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213525","ORPHENADRINE CITRATE 100MG TER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213531","DOCUSATE NA 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213532","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213539","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213542","ISOSORBIDE MN 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213543","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213545","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213547","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213548","CARBIDOPA/LEVO 25/250 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213549","MAGNESIUM OXIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213553","DIAZEPAM 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213557","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213558","TORSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213562","LOVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213564","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213565","THYROID 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213568","POTASSIUM BICARB 25MEQ TEF "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213576","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213589","METHADONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213593","ISOSORBIDE MN 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213596","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213598","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213599","HYDROCODONE APAP 7.5-325MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213602","DEXAMETHASONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213606","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213614","METHADONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213618","COD LIVER OIL CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213622","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213625","FAMOTIDINE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213628","INDOMETHACIN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213629","NABUMETONE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213631","POTASSIUM BICARB K CIT 25MEQ T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213635","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213639","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213645","POTASSIUM BICARB K CIT 25MEQ T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213649","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213651","AMINOPHYLLINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213652","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213658","BENZOCAINE MENTHOL 6-10MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213660","AMOXICILLIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213663","CYCLOSPORINE 25MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213672","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213673","AMOXICILLIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213677","PROBENECID 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213678","AMINO ACIDS MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213680","ERYTHROMYCIN 333MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213688","HYDROCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213694","LITHIUM CARBONATE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213696","NITROGLYCERIN 9MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213703","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213704","HYDROCODONE APAP 7.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213705","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213711","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213712","IRON POLYSACCH 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213721","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213722","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213723","DEXAMETHASONE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213725","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213726","CARBIDOPA/LEVO 10/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213728","GLUTAMINE 10GM PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213737","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213740","AMOXICILLIN 875MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213741","OXYCODONE HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213746","TERAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213755","CARBAMAZEPINE 100MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213757","MEPHOBARBITAL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213758","MULTIVATAMIN LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213760","ZINC SULF 220MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213770","OXYCODONE APAP 7.5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213775","ETHAMBUTOL HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213778","ALBUTEROL SULF 1.25MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213780","ACETAMINOPHEN 80MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213784","LIDOCAINE HCL 2% VISCOUS SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213786","AMOXICILLIN 875MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213788","AMITRIPTYLINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213789","POTASSIUM CL 10MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213794","SPIRONOLACTONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213809","DYPHYLLINE GG 100/15-100/15 EL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213822","FENOFIBRATE 67MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213830","AMOXICILLIN 250MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213831","MAGNESIUM 27MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213833","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213834","BISACODYL 5MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213835","MAGNEBIND 400 RX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213839","ALUMINUM HYDROXIDE 320MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213840","BUMETANIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213841","QUINIDINE GLUC 324MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213842","POTASSIUM CL 8MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213844","CARBAMAZEPINE 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213848","ALUMINUM HYDROXIDE 320MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213856","ACARBOSE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213857","ALUMINUM HYDROXIDE 320MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213858","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213871","ZINC OXIDE MENTHOL OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213873","HYOSCYAMINE SULF 0.125MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213874","OXYCODONE HCL 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213880","QUINIDINE GLUC 324MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213881","ISOSORBIDE DN 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213883","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213884","DOCUSATE NA 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213885","MAGNESIUM LACTATE 84MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213886","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213887","TRANDOLAPRIL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213889","FUROSEMIDE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213890","NABUMETONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213891","THYROID 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213893","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213894","TRIPLE ANTIBIOTIC OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213895","TORSEMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213901","SPIRONOLACTONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213904","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213907","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213908","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213909","HYDROXYZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213911","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213918","POTASSIUM CL 25MEQ PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213929","MECLIZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213931","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213937","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213939","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213942","LITHIUM CARBONATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213955","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213959","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213965","FUROSEMIDE 40MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213966","GENATON CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213967","SENNOSIDES A B 8.6MG5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213969","RISPERIDONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213970","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213977","DOCUSATE NA 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213980","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213983","MINOXIDIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213985","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213989","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213991","AMYL NITRITE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213992","ISOSORBIDE MN 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213994","LISINOPRIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92213996","ISOSORBIDE MN 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214006","LITHIUM CITRATE 8MEQ/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214009","LOPERAMIDE HCL 1MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214019","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214023","ERYTHROMYCIN 500MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214027","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214032","CALCITRIOL 0.25MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214043","CALCITRIOL 0.25MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214046","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214047","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214048","VITAMIN B COMPLEX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214049","OXYCODONE APAP 7.5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214050","LISINOPRIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214051","MULTIVITAMIN MINERALS LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214053","DOCUSATE NA 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214055","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214065","LISINOPRIL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214068","OXYCODONE HCL 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214070","LISINOPRIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214076","PSEUDOEPHEDRINE HCL 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214078","FOLTRIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214083","PHENYTOIN NA 50MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214094","MEDROXYPROGESTERONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214095","SPIRONOLACTONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214102","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214103","ALBUTEROL SULF 0.83MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214107","TIZANIDINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214109","HYDROMORPHONE 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214116","CHLORAL HYDRATE 500MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214118","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214119","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214121","NIACIN 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214123","PHENYTOIN NA EXT 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214134","LITHIUM CARBONATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214137","PHENYTOIN NA 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214140","FUROSEMIDE 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214141","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214143","FLUDROCORTISONE ACET 0.1MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214145","ETHAMBUTOL HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214149","MEDROXYPROGESTERONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214151","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214154","ESTRADIOL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214163","MEDROXYPROGESTERONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214166","LACTOBACILLUS ACIDOPH 100MG WA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214168","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214171","POTASSIUM PH 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214172","DICYCLOMINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214173","ASCORBIC ACID 500MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214179","K PHOS MONO/NA PHOS MONO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214183","MULTIVITAMIN MINERALS LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214188","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214189","CLOZAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214202","METHIMAZOLE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214209","CAPTOPRIL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214220","METHIMAZOLE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214221","ISOSORBIDE MN 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214222","MISOPROSTOL 200MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214224","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214229","DICYCLOMINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214233","MINERAL OIL PETROLATUM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214238","HYDROCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214239","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214241","LEVOCARNITINE 330MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214252","CHONDROITIN GLUCOSAMINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214253","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214256","CHLORAL HYDRATE 500MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214261","DIGOXIN 250MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214264","OXAZEPAM 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214265","ACARBOSE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214276","LORATADINE 5MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214278","OXYCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214287","LITHIUM CARBONATE 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214288","SIMETHICONE 40 MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214295","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214299","OXYCODONE APAP 5-325MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214300","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214303","BIOTIN 300MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214304","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214306","CALCIUM POLYCARBOPHIL 625MG CT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214310","PRAMIPEXOLE DIHCL 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214314","OXYCODONE APAP 5-325MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214317","PHENYTOIN NA 30MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214326","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214346","BISOPROLOL FUMARATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214348","PREDNISONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214351","ACETAMINOPHEN 650MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214352","CALTRATE PLUS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214359","PREDNISONE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214360","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214364","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214365","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214367","HYDROCORTISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214377","PREDNISONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214381","AZATHIOPRINE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214383","K PHOS/NA PH DB/NA PH MONO TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214384","PREDNISONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214389","QUINIDINE SULF 300MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214392","ACETAMINOPHEN 650MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214394","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214395","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214399","K PHOS MONO/NA PHOS MONO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214400","PREDNISONE 5MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214401","PYRIMETHAMINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214403","ASCORBIC ACID 500MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214409","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214412","ASPIRIN 81MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214416","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214417","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214424","DOCUSATE NA 50MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214429","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214435","PHENYTOIN NA EXT 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214436","CARBIDOPA/LEVO 25/100 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214438","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214440","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214442","ASPIRIN 325MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214451","BACITRACIN/POLYMYXIN B OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214457","TIZANIDINE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214458","HCTZ LISINOPRIL 12.5-10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214463","FERROUS GLUCONATE 240MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214464","BELLADONNA OPIUM 16.2-60MG SUP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214465","MAGNESIUM HYDROXIDE 400MG SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214468","LEVOTHYROXINE NA 137MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214476","LEVOTHYROXINE NA 137MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214478","GLIPIZIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214480","DIVALPROEX NA 125MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214483","SELENIUM 200MCG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214484","BIOTIN 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214489","OXYCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214491","CALCIUM ACETATE 667MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214493","DIPHENHYDRAMINE HCL 12.5MG/5 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214496","OLANZAPINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214498","DOCUSATE NA 150MG/15ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214504","DIVALPROEX NA 125MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214513","METOPROLOL SUCC 50MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214526","METOPROLOL SUCC 25MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214529","DILTIAZEM HCL 180MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214531","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214535","DOCUSATE NA 100MG/10ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214544","FOLIC ACID 0.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214546","HYDROCODONE APAP 10-400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214548","LEVOCARNITINE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214549","DILTIAZEM HCL 240MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214550","FAMOTIDINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214556","LEVOTHYROXINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214562","DILTIAZEM HCL 120MG C24 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214563","BENAZEPRIL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214564","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214567","OCUVITE LUTEIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214573","HYDROCODONE APAP 10-650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214575","ALBUTEROL SULF 0.83MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214581","QUINAPRIL HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214583","POTASSIUM CL 10MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214586","PREDNISONE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214589","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214593","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214597","BENZONATATE 200MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214598","REPAGLINIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214600","HYDROCODONE APAP 10-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214605","CHONDROITIN GLUCOSAMINE CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214606","ALAMAG PLUS SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214610","LOPERAMIDE HCL 1MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214612","CA CL/KCL/NA CL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214624","REPAGLINIDE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214631","VITAMIN B COMPLEX W/C SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214647","PYSLLIUM 3.4GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214648","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214669","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214671","DOCUSATE CAL 240MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214676","VITAMIN B COMPLEX W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214678","PROPRANOLOL HCL 40MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214681","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214687","ATTAPULGITE 600MG/15ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214694","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214695","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214700","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214702","CODEINE SULF 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214703","FA CYANCOBA PYRIDOXINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214704","PROPRANOLOL HCL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214705","HYDRALAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214711","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214715","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214724","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214726","DIAZEPAM 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214730","DIGOXIN 125MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214733","WARFARIN NA 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214738","CALCIUM CARB 500MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214739","DIAZEPAM 5MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214743","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214750","HYDROCODONE APAP 10-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214757","AMYLASE/LIPASE/PROTEASE CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214759","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214764","FERROUS FUMARATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214765","CALCIUM CARB 600MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214768","BENAZEPRIL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214776","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214782","HYDROCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214786","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214789","FELODIPINE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214793","FELODIPINE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214795","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214800","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214809","METOPROLOL SUCC 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214811","GLUCOSAMINE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214812","ALBUTEROL SULF 0.83MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214818","HYDROCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214831","NAPROXEN 125MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214833","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214845","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214847","BISACODYL 5MG KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214862","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214863","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214865","HYDROCODONE APAP 2.5-167/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214871","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214872","GLUTAMINE 15GM PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214874","LISINOPRIL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214875","CODEINE SULF 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214880","LISINOPRIL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214883","CALCIUM LACTO ACIDOPHILUS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214884","BACLOFEN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214889","MULTIVITAMIN MINERALS CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214893","BALSALAZIDE DISODIUM 750MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214894","IRON POLYSACCH 100MG/5ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214897","CODEINE SULF 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214898","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214899","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214900","LISINOPRIL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214904","CALCIUM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214907","LISINOPRIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214909","ALAMAG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214913","ATENOLOL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214915","TERAZOSIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214918","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214920","ALLOPURINOL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214925","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214927","HCTZ 12.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214933","PSEUDOEPHEDRINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214935","SIMETHICONE 80MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214952","VITAMIN B COMPLEX W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214961","FA CYANCOBA PYRIDOXINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214963","WARFARIN NA 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214964","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214969","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214971","VALPROIC ACID 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214974","VITAMIN B COMPLEX W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214989","NABUMETONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92214995","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215001","MORPHINE 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215003","ETHINYL ESTRADIOL NORT 35 .5 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215008","TRIAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215017","MULTIMINERAL VIT B ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215021","METHADONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215026","CHLORPHENIRAMINE MALEATE 4MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215027","QUINAPRIL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215029","METHADONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215035","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215046","METHADONE INTENSOL 10MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215050","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215056","METHADONE HCL 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215059","DEXAMETHASONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215063","LITHIUM CARBONATE 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215064","METHADONE HCL 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215066","FOSINOPRIL NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215067","DEXAMETHASONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215070","SENNA 8.8MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215071","LITHIUM CARBONATE 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215075","PYSLLIUM 6GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215077","HYDROMORPHONE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215082","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215083","COLESTIPOL HCL 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215085","DEXAMETHASONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215090","DEXAMETHASONE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215095","MULTIVATAMIN CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215097","DEXAMETHASONE 0.75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215102","LACTOBACILLUS ACIDOPH 250MM CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215104","COLCHICINE 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215111","METHIMAZOLE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215115","FERROUS SULF 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215116","DILTIAZEM HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215123","FERROUS SULF 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215125","LEVOTHYROXINE NA 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215137","ALUMINUM ACETATE PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215139","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215151","SPIRONOLACTONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215152","FA CYANCOBA PYRIDOXINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215153","TRIMETHOBENZAMIDE HCL 300MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215154","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215158","EPIDRIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215184","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215185","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215189","LORAZEPAM INTENSOL 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215196","CLINDAMYCIN PHOS 1% PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215214","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215217","ACETAMINOPHEN 325MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215221","POTASSIUM CL 40MEQ/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215231","FOLIC ACID 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215236","FEXOFENADINE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215237","DEXAMETHASONE 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215244","DEXAMETHASONE 1MG/1ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215248","FISH OIL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215251","MAGNESIUM OXIDE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215255","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215264","DEXAMETHASONE 0.5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215265","ACETAMINOPHEN COD 300MG-30MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215269","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215271","NORTRIPTYLINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215272","DANTROLENE NA 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215274","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215277","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215285","PREPARATION H SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215287","TRANDOLAPRIL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215289","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215303","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215309","VITAMIN B COMPLEX W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215310","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215313","SPIRONOLACTONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215320","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215321","MAGNESIUM CALCIUM CHLORIDE ECT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215323","BISOPROLOL/HCTZ 10/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215324","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215336","ACETAMINOPHEN 80MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215338","BISOPROLOL/HCTZ 2.5/6.25 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215341","FEXOFENADINE HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215344","FELODIPINE 2.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215357","LACTRASE 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215365","LEVOTHYROXINE NA 150MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215368","METHYLPHENIDATE HCL 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215378","DOCUSATE NA 50MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215384","GLIMEPIRIDE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215402","MULTIVITAMIN W/FE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215403","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215407","CALCIUM PHOS DIBASIC W/D TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215418","DIPHENHYDRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215429","FERROUS GLUC LIVER VIT B LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215434","HYDROCODONE APAP 7.5-500MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215440","CALCIUM CARB 500 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215443","CALCIUM CARB 250 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215445","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215446","CALCIUM CARB 500 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215457","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215460","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215463","ALUMINUM HYDROXIDE 600MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215468","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215471","TRANDOLAPRIL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215478","OXYCODONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215486","GLYCOPYRROLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215508","POTASSIUM CL 8MEQ CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215536","METFORMIN HCL 750MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215544","CHLORPHEN/DM/PHEN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215546","OXYCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215547","DYPHYLLINE GG 200-300 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215548","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215552","DOCUSATE NA 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215559","GLIPIZIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215560","GLIPIZIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215565","HYDROCODONE APAP 7.5-750MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215573","POTASSIUM CL 15MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215575","POTASSIUM CL 15MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215578","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215582","BUPROPION HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215583","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215586","CRANBERRY 405MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215590","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215596","DOCUSATE NA 100MG/25ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215602","NICOTINAMIDE TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215608","LACTOBACILLUS ACIDOPH 500MM CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215617","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215621","DOCUSATE NA SENNA 50MG-8.6MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215630","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215634","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215635","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215646","AMMONIA AROMATIC SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215651","AMMONIA AROMATIC SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215652","CARBOXYMETHYLCELL NA 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215654","CARBOXYMETHYLCELLULOSE NA 1% S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215659","ALBUTEROL SULF 5MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215663","FOLGARD OS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215672","NEFAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215673","MULTIVITAMIN SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215686","HCTZ 12.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215688","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215690","HEMATOGEN FORTE SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215691","NIFEREX CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215694","FERROUS SULF 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215696","BENZOCAINE 10% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215697","FERROUS SULF 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215699","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215702","HYDROCODONE APAP 7.5-750MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215703","CLONIDINE HCL 0.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215704","CAPTOPRIL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215705","CAPTOPRIL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215706","BETHANECHOL CL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215708","CAPTOPRIL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215709","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215711","VITAMIN D 400U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215721","ENALAPRIL MALEATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215722","TERAZOSIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215723","TERAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215728","ENALAPRIL MALEATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215729","RANITIDINE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215730","ENALAPRIL MALEATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215733","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215735","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215736","FEROCON CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215739","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215740","CALCIUM PH W/D 105-81MG 120U T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215742","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215743","CLONAZEPAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215744","FOLITAB 500 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215745","NA PHOS DIBASIC/MONOBASIC NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215747","CALCIUM CARB 500 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215749","CETIRIZINE HCL PSE 5MG/120MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215757","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215760","METHADONE HCL 40MG TBS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215763","TORSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215769","TORSEMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215778","OCUVITE PRESERVISION TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215779","LEVOTHYROXINE NA 150MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215783","ZONISAMIDE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215786","ZONISAMIDE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215795","DOXAZOSIN MESYLATE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215796","NAPROXEN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215798","NAPROXEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215800","DOXAZOSIN MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215801","DIPHENHYDRAMINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215802","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215803","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215813","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215814","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215815","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215817","LISINOPRIL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215818","LISINOPRIL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215821","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215823","CLONAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215827","CLONAZEPAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215829","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215830","BUPROPION HCL 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215831","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215833","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215835","DOCUSATE NA SENNA 50MG-8.6MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215856","NICOTINE POLACRILEX 2MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215864","NICOTINE POLACRILEX 4MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215865","VITAMIN B COMPLEX FE W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215866","GLIPIZIDE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215869","MAGNESIUM OXIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215870","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215871","LACTOBACILLUS COMBO CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215872","SORBITOL 70% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215873","GLIPIZIDE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215877","SODIUM BICARB 650MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215878","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215882","GLYCERIN 1.2GM SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215883","ENALAPRIL MALEATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215885","BUPROPION HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215890","SACCHAROMYCES BOULARDI 250MG C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215891","METFORMIN HCL 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215897","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215898","TRAMADOL HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215899","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215900","PHENYTOIN NA EXT 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215902","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215910","CHLORPHEN/DM/PHEN 8-30-20MG TE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215912","WARFARIN NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215913","WARFARIN NA 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215914","WARFARIN NA 3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215915","WARFARIN NA 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215917","WARFARIN NA 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215920","WARFARIN NA 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215921","GLYBURIDE METFORMIN 5/500MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215923","WARFARIN NA 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215924","WARFARIN NA 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215925","WARFARIN NA 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215927","BENAZEPRIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215928","BENAZEPRIL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215930","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215931","CALCIUM CARB 1.25GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215932","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215934","VITAMIN B COMPLEX W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215935","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215936","PSEUDOEPHEDRINE HCL 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215937","CALCIUM CARB 1.25GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215939","CALCIUM CARB 500MG/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215945","LORATADINE PSE SULF 10-240MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215946","CYAN FA B6 2-2.5-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215948","MAGNESIUM OXIDE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215954","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215959","VALPROIC ACID 250MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215963","VALPROIC ACID 250MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215969","NORTRIPTYLINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215970","RIFAMPIN 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215975","NORTRIPTYLINE HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215978","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92215980","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216000","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216002","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216006","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216011","WARFARIN NA 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216012","WARFARIN NA 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216013","VITAMIN B COMPLX MINERAL W/C T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216014","WARFARIN NA 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216015","LABETALOL HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216018","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216019","ALBUTEROL SULF 1.25MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216020","LABETALOL HCL 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216024","CARBIDOPA/LEVO 25/100 ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216026","CARBIDOPA/LEVO 10/100 ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216028","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216030","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216037","NAPROXEN 375MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216041","DOXAZOSIN MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216044","LACTO ACIDOPH/LACTO SPORO TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216051","ETHAMBUTOL HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216059","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216060","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216062","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216063","FENOFIBRATE 48MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216065","PREDNISONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216066","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216067","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216068","IRON 160MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216082","VITAMIN B COMPLX MINERAL W/C T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216084","MULTIVITAMIN MINERALS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216090","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216091","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216098","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216104","OMEPRAZOLE 2OMG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216116","LEVOTHYROXINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216119","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216120","LITHIUM CARBONATE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216122","FERROUS FUMARATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216123","FERROUS SULF 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216124","ASPIRIN 300MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216127","PHENOBARBITAL 32.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216128","FERROUS GLUCONATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216130","FERROUS GLUCONATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216131","PHENOBARBITAL 32.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216132","FERROUS FUMARATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216133","ASPIRIN 600MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216134","FERROUS SULF 324MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216136","FERROUS GLUCONATE 324MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216137","FERROUS SULF 324MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216138","FERROUS SULF 324MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216139","ACETAMINOPHEN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216140","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216141","ACETAMINOPHEN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216147","MAGNESIUM ASPRTATE HCL 615MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216149","ALBUTEROL SULFATE 2.5MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216154","LORAZEPAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216163","COLCHICINE 0.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216169","TORSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216171","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216172","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216173","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216174","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216175","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216176","TRAMADOL HCL APAP 37.5-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216177","LITHIUM CARBONATE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216178","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216180","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216181","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216182","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216187","BUPROPION HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216189","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216190","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216192","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216196","CLARITHROMYCIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216208","CYCLOSPORINE MOD 25MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216210","HCTZ 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216211","HCTZ 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216234","NUTRICEUTICAL 175-260-880MG SG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216235","LEVOCARNITINE 330MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216239","NICOTINE POLACRILEX 2MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216240","NICOTINE POLACRILEX 4MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216252","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216256","OMEGA 3 ETHYL ESTERS 1GM SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216270","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216274","CLOMIPRAMINE HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216276","CLOMIPRAMINE HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216283","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216284","CLONAZEPAM 0.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216285","CLONIDINE HCL 0.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216286","CLONAZEPAM 0.125MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216288","BUSPIRONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216289","CARBIDOPA/LEVO 10/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216290","METOCLOPRAMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216291","CLONAZEPAM 0.25MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216294","CARBIDOPA/LEVO 25/250 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216295","CARBIDOPA/LEVO 25/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216296","CLONIDINE HCL 0.3MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216297","MULTIVITAMIN MINERALS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216298","RECEPINEPHRINE HCL 2.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216299","CLONIDINE HCL 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216301","CLONAZEPAM 1MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216302","CLONAZEPAM 0.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216305","CLONAZEPAM 1MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216319","IPRATR-ALBUTEROL 0.5-3MG/3ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216320","GLIMEPIRIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216321","GLIMEPIRIDE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216324","CLONAZEPAM 0.25MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216325","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216326","CLONAZEPAM 0.125MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216327","HCTZ 12.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216343","LEVOCARNITINE 330MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216346","ACAMPROSATE 333MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216348","BALSALAZIDE DISODIUM 750MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216351","FA CYANCOBA PYRIDOXINE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216364","METFORMIN HCL 750MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216366","PAROXETINE HCL 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216371","TRAMADOL HCL APAP 37.5-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216375","GUAIFENESIN 200MG/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216382","LACTO ACIDOPH/LACTO BULG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216383","CARBIDOPA/LEVO 25/100 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216385","CARBIDOPA/LEVO 50/200 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216387","DEXTROAMPHETAMINE SULF 30/5 SE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216392","GUAIFENESIN 100MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216399","DOCUSATE NA 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216404","CHLORPHEN/DM/PHEN SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216406","OXCARBAZEPINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216423","ASPIRIN 81MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216436","GUAIFENESIN 100MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216437","GUAIFENESIN 100MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216445","GLYBURIDE METFORMIN 5/500MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216446","METHADONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216453","GLIMEPIRIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216454","GLIMEPIRIDE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216458","TERAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216462","TERAZOSIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216464","METHADONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216472","LITHIUM CARBONATE 8MEQ/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216474","MEPERIDINE 50MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216483","MULTIVITAMIN MULTIMINERAL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216485","TRAMADOL HCL APAP 37.5-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216486","BACITRACIN 500U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216490","SELEGILINE 12MG/24HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216491","OXYCODONE ASPIRIN 4.83-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216492","MEGESTROL ACET 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216494","LISINOPRIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216498","METOCLOPRAMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216500","GEMFIBROZIL 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216501","METFORMIN HCL 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216503","METFORMIN HCL 850MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216504","VERAPAMIL HCL 120MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216505","VERAPAMIL HCL 240MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216508","VERAPAMIL HCL 180MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216509","TRAZODONE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216515","LEVOTHYROXINE NA 88MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216547","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216548","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216549","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216552","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216553","METFORMIN HCL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216569","MORPHINE 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216570","LACTO ACIDOPH/LACTO BULG GRA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216583","VITAMIN B COMPLEX FE W/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216584","VITAMIN B COMPLEX FE W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216585","VITAMIN B COMPLEX FE W/C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216586","COENZYME Q10 W/E 100MG-10U SGL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216601","HYDROCODONE APAP 5-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216602","HYDROCODONE APAP 7.5-325MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216605","METOCLOPRAMIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216608","LORATADINE 10MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216609","CARBAMAZEPINE 100MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216611","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216616","GUAIFENESIN DM 100-10MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216619","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216622","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216623","DIPHENHYDRAMINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216624","MAGNESIUM 54MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216625","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216628","GUAIFENESIN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216629","CHLORPHEN/DM/PHEN/APAP TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216630","GUAIFENESIN COD 100-10MG/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216644","IBUPROFEN 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216645","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216647","LEVOTHYROXINE NA 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216655","GUAIFENESIN PSE 600-30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216658","CALCIUM W/D 600MG-400U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216664","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216665","TIZANIDINE HCL 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216668","GUAIFENESIN 100MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216669","GUAIFENESIN PSE COD SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216670","CALCIUM CARB 1250MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216691","MORPHINE 20MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216696","NA PHOS DIBASIC/MONOBASIC NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216700","VALPROIC ACID 500MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216701","VALPROIC ACID 500MG/10ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216702","CALCIUM W/D 200MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216703","ACETYLCYSTEINE 600MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216704","CALCIUM W/D 200MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216706","HCTZ 12.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216716","CHOLECALCIFEROL 1000U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216717","RAMIPRIL 1.25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216719","IRON 45MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216722","GABAPENTIN 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216724","MAGNESIUM OXIDE PYRID HCL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216728","BETHANECHOL CL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216734","ACYCLOVIR 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216735","METHYLPREDNISOLONE ACET 4MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216737","DILTIAZEM HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216738","GLYBURIDE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216741","HALOPERIDOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216742","IBUPROFEN 800MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216743","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216744","BUPROPION HCL 75MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216745","IBUPROFEN 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216747","SPIRONOLACTONE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216748","PROMETHAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216749","BACLOFEN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216750","HALOPERIDOL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216751","CARBAMAZEPINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216752","BENZTROPINE MESYLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216753","GLYBURIDE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216755","FUROSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216756","ATENOLOL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216757","ALPRAZOLAM 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216758","BUPROPION HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216759","PHENOBARBITAL 16.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216762","TEMAZEPAM 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216763","CARISOPRODOL 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216764","OXYBUTYNIN CL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216765","BENZTROPINE MESYLATE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216768","TRAZODONE HCL 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216769","NORTRIPTYLINE HCL 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216770","ALPRAZOLAM 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216772","DILTIAZEM HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216773","ALPRAZOLAM 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216774","FUROSEMIDE 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216775","BENZTROPINE MESYLATE 0.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216776","TORSEMIDE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216786","AMLODIPINE BESYLATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216800","ICAPS PLUS SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216809","CALCIUM CARB 500 W/D 125U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216818","PREDNISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216819","PREDNISONE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216820","PROPOXYPHEN APAP 100-650MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216821","PHENAZOPYRIDINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216822","PREDNISONE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216824","POTASSIUM CL 20MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216827","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216828","SUCRALFATE 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216829","SIMETHICONE 80MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216830","PHENAZOPYRIDINE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216831","POTASSIUM CL 10MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216844","THEOPHYLLINE 400MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216845","THEOPHYLLINE 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216849","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216867","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216869","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216870","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216872","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216873","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216875","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216881","ZONISAMIDE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216883","ZONISAMIDE 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216884","PRIMIDONE 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216886","ZONISAMIDE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216887","METOPROLOL SUCC 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216890","PRIMIDONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216892","GUAIFENESIN 1200MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216893","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216894","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216895","GUAIFENESIN DM 1200MG-60MG TE"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216901","IBUPROFEN 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216902","GABAPENTIN 400MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216903","GABAPENTIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216924","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216930","CARVEDILOL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216940","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216941","DOCUSATE NA SENNO A B 50-8.6 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216942","CLOTRIMAZOLE 10MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216949","ASPIRIN 81MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216950","ASPIRIN 81MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216951","SENNOSIDES A B 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216960","GUAIFENESIN DM 100-10MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216965","QUINAPRIL HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216970","METOCLOPRAMIDE 5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216977","SODIUM CL 7% INH SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216985","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216986","SULFAMETHOXAZOLE/TMP 800/160 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216987","SPIRONOLACTONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216988","LITHIUM CARBONATE 450MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216990","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216992","SALSALATE 750MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216994","HYDROCODONE IBU 7.5-200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216995","SPIRONOLACTONE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216996","AMLODIPINE BESYLATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92216997","CLOZAPINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217000","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217002","METOPROLOL TART 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217004","SALSALATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217005","METOPROLOL TART 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217022","LACTOBACILLUS COMBO 1.4MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217029","NITROFURANTOIN MCR 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217030","VALPROIC ACID 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217054","OXCARBAZEPINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217062","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217064","CETIRIZINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217074","OMEPRAZOLE 20MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217075","PHENOBARBITAL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217076","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217079","ACETAMINOPHEN 650MG/20.3ML SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217081","PHENOBARBITAL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217083","PHENOBARBITAL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217087","ACETAMINOPHEN 325MG/10.15ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217090","GUAIFENESIN 100MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217091","CALCIUM W/D 600MG-400U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217092","NABUMETONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217093","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217094","ACETAMINOPHEN 160MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217095","CALCIUM POLYCARBOPHIL 625MG TA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217100","LACTOBACILLUS COMBO CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217102","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217104","CALCIUM W/D 315MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217112","OXYCODONE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217114","OXYCODONE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217122","TERBUTALINE SULF 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217126","BENZONATATE 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217132","HYDRALAZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217133","HYDRALAZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217134","METOPROLOL SUCC 25MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217142","MIDODRINE HCL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217146","CETIRIZINE HCL PSE 5MG/120MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217148","BENZOCAINE MENTHOL 15-2.5MG LO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217151","CETIRIZINE HCL 5MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217152","CETIRIZINE HCL 10MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217153","PHENYLEPHRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217155","FELODIPINE 2.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217156","FELODIPINE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217157","CETIRIZINE HCL 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217161","CLINDAMYCIN HCL 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217162","CLINDAMYCIN HCL 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217184","METOPROLOL TART 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217185","TERAZOSIN HCL 5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217187","HYOSCYAMINE SULF 0.125MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217192","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217194","AMITRIPTYLINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217212","MULTIVITAMIN MINERALS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217213","MORPHINE 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217214","MORPHINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217217","PRENATAL VITAMINS KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217218","FERROUS FUMARATE 350MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217229","DEXAMETHASONE 0.5MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217242","PHENYLEPHRINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217249","MULTIVITAMIN MINERALS NUTRIC T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217262","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217272","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217292","NIFEREX-150 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217296","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217307","DIVALPROEX NA 125MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217308","DIVALPROEX NA 125MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217309","DIVALPROEX NA 125MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217310","DIVALPROEX NA 250MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217314","VITAMIN D 2000U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217326","THEOPHYLLINE 200MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217327","WJEST DEXTRIN PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217330","THEOPHYLLINE 300MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217332","BENZOCAINE MENTHOL 15-4MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217333","CARBIDOPA/LEVO 10/100 TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217343","SERTRALINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217351","LEVETIRACETAM 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217353","LEVETIRACETAM 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217358","ROPINIROLE HCL 0.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217361","FLUDROCORTISONE ACET 0.1MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217363","GLYCOPYRROLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217370","PROMETHAZINE HCL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217371","GLIPIZIDE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217372","ROPINIROLE HCL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217374","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217375","ROPINIROLE HCL 0.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217376","GLIPIZIDE 10MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217378","GLIPIZIDE 2.5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217384","FERROUS SULF 75MG/0.6ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217386","ISOSORBIDE MN 60MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217389","ISOSORBIDE MN 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217395","ASPIRIN 81MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217401","MAGNESIUM GLUCONATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217403","CARVEDILOL 6.25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217404","CARVEDILOL 3.125MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217405","CARVEDILOL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217408","THEOPHYLLINE 100MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217409","HYDROXYZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217411","HYDROXYZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217413","ALPRAZOLAM 0.25MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217414","LEVETIRACETAM 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217425","DEXTROSE 4GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217433","LAMOTRIGINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217435","LAMOTRIGINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217437","HYDROCODONE APAP 5-500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217456","TOPIRAMATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217459","CHOLECALCIFEROL 50000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217462","AMANTADINE HCL 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217470","LIOTHYRONINE NA 5MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217482","CALCIUM CHOLECALCIFRL 1000U T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217486","TOPIRAMATE 200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217487","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217495","PHENOBARBITAL 32.4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217498","MULTIVITAMIN MINERALS NUTRIC T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217500","LACTASE 9000U CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217502","CALCIUM W/D 500MG-400U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217503","MENTOHO 5.4MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217504","CARBOCYSTEINE 750MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217514","VITAMIN E 400U SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217519","CALCIUM CARB 500 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217521","CALCIUM CARB 500 W/D 200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217530","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217531","LOPERAMIDE HCL 1MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217540","LOPERAMIDE HCL 1MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217541","HEPARIN 10U/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217542","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217545","HYDROCODONE APAP 10-325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217546","LAMOTRIGINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217547","LAMOTRIGINE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217548","DIAZEPAM 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217557","LANSOPRAZOLE 15MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217560","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217561","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217562","GUAIFENESIN DM 600MG-30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217563","GUAIFENESIN 600MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217564","INFLUENZA A H1N1 VACC 2009 SUS"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217567","MAALOX ADVANCED SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217572","LACTOBACILLUS RHAMNOSUS GG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217576","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217579","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217581","CALCIUM W/D 500MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217583","FUROSEMIDE 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217588","GLIMEPIRIDE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217589","GLIMEPIRIDE 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217591","CALCIUM W/D 315MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217603","TRIHEXYPHENIDYL HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217605","SUMATRIPTAN SUCC 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217614","CITRIC ACID NA CITRATE SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217621","NICOTINE POLACRILEX 4MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217625","TETRACYCLINE HCL 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217640","CA CL/DEX/MGCL/NACL/NALACT SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217689","LORATADINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217701","GLYCOPYRROLATE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217710","PHENOBARBITAL 20MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217716","VITAMIN A/D OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217722","PYSLLIUM 5.8GM POW "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217738","CALCIUM W/D 500MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217739","CALCIUM W/D 500MG-200U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217742","HYDROXYZINE HCL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217748","POLYETHYLENE GLYCOL 3350 PDS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217751","ERGOCALCIFEROL 50000U CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217752","CALCIUM CARB 750MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217761","LOSARTAN POTASSIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217763","NICOTINE POLACRILEX 4MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217765","METANX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217772","DOCUSATE NA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217773","DOCUSATE NA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217774","CHLORHEXIDINE GLUC 0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217786","CHOLECALCIFEROL 1000U TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217787","PANTOPRAZOLE NA 40MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217790","CALCIUM CARB 600MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217792","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217793","MULTIVITAMIN MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217801","LAMOTRIGINE 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217815","COENZYME Q10 100MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217833","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217841","NIACIN 500MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217843","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217855","BUSPIRONE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217861","PAROXETINE HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217862","PAROXETINE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217866","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217873","PHENOBARBITAL 64.8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217878","NIACIN 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217879","MULTIVITAMIN MINERALS LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217883","PHENOBARBITAL 64.8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217884","NIACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217885","PHENOBARBITAL 97.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217886","PHENOBARBITAL 97.2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217890","PROVIDONE IODINE 10% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217897","PYRIDOSTIBMINE BR 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217901","LACTOBACILLUS ACIDOPH CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217903","BELLADONNA ALK ANALGESICS ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217908","VALPROIC ACID 250MG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217916","LOVASTATIN 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217917","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217918","DOCUSATE NA 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217919","OMEPRAZOLE 40MG ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217922","HYDROXYZINE HCL 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217927","BECLOMETHASONE DIPRO 40MCG AER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217931","MAGNESIUM SULF INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217933","AMYLASE/LIPASE/PROTEASE ECC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217951","SODIUM CL 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217964","KETOPROFEN 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217986","CLARAVIS 40MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92217996","CEPACOL LOZENGE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218004","NIFEREX-150 FORTE CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218005","ISRADIPINE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218007","ACIDOPHILUS 100MIL UN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218009","ALAVERT D 12 HR TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218012","THER-M ENHANCED TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218014","ACETAMIN/PENTAZOCIN 650-25 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218015","GUAIFEN/PSEUDOEPHED 600-60 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218017","FLORASTOR 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218020","ASPIRIN 325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218022","DHEA 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218023","LOPERAMIDE 1MG/5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218027","CHLORZOXAZONE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218028","DOXEPIN HCL 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218033","DOXYCYCLINE HYCLATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218038","PHENTERMINE HCL 15MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218048","ETODOLAC 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218060","DIPYRIDAMOLE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218061","DOXYCYCLINE MONOHYDRATE 50MG C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218066","HYPERSAL 7% SOLN INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218087","EPHEDRINE SULF 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218097","LORATADINE-D 5MG-120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218100","CHILDRENS LORATADINE 5MG/ML SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218103","NATURE THYROID 32.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218108","IBUDONE 10MG-200MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218113","NATURE'S BLEND VIT D3 5000IU/M"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218122","GABAPENTINE 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218123","CEPASTAT 14.5MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218129","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218147","MUCINEX DM 30-800MG ER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218148","CARBIDOP/LEVODOP 25-100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218157","NATURES BLEND MULTI-VIT/MIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218158","SENOKOT 8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218167","LEVOTHYROXINE SOD 0.05MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218170","FLUZONE 180MCG/0.5ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218183","COENZYME Q-10 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218189","SOD CHLORIDE 0.9% INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218192","LACTOBACILLUS COMB TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218214","HYDROCHLOROTHIAZIDE 12.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218217","LISINOPRIL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218224","DOXYLAMINE SUCCINATE 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218230","PRIMODONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218233","PHENOBARBITAL 15MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218235","ASPIRIN 81MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218238","LORATADINE-D 5MG-120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218239","SYNTHROID 0.137MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218240","ACETAMIN/COD 300-50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218242","NIFEDIPINE 10MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218247","RENO MULITVITAMIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218249","CO-ENZYME Q10 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218250","CHROMAGEN FA TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218252","DEX 4 4GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218253","AMPHOGEL 320MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218254","SYNTHROID 0.175MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218264","MELATONIN 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218273","LITHIUM CARBONATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218274","LITHIUM CARBONATE 450MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218278","SODIUM CHLORIDE 0.9% 300ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218282","HEMORRHOIDAL SUPPOSITORY "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218290","FAMOTIDINE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218296","TRIFLUOPERAZINE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218297","PROSIGHT TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218298","ASTRINGENT SOLUTION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218305","ESTRADIOL 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218308","CHLORTHALIDONE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218309","COPPER 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218316","PHENTERMINE 37.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218319","BACITRACIN 500UN/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218321","METHOCARBAMOL 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218322","FLORASTOR 33-250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218327","TRIPLE ANTIBIOTIC OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218332","MINOCYCLINE 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218338","PHENOBARBITAL 30MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218350","NEXIUM 24HR 20 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218353","DIVALPROEX 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218356","DEXAMETHASONE 1.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218359","LEVOTHYROXINE 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218362","LEVOTHYROXINE 25MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218368","LIDOCAINE HCI 2% 0.02 SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218373","ESTRADIOL 1 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218379","TRIMETHOPRIM 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218387","MIRALAX 17 GM/DOSE PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218388","MIRALAX 17 GM/Dose PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218389","NEBUSAL 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218391","LEVOTHYROXINE 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218392","LEVOTHYROXINE 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218394","FLORASTOR 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218397","CYCLOSPORINE 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218400","MULTIVITAMINS . TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218409","LEVOTHYROXINE 50 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218410","LEVOTHYROXINE 88 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218411","LEVOTHYROXINE 100 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218412","LEVOTHYROXINE 112 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218413","LEVOTHYROXINE 125 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218414","LEVOTHYROXINE 137 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218415","LEVOTHYROXINE 175 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218416","SYNTHROID 75 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218417","SYNTHROID 112 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218418","SYNTHROID 150 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218419","LEVOTHYROXINE 88 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218420","LEVOTHYROXINE 112 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218422","MILK OF MAGNESIA 1200MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218423","MILD OF MAGNESIA 1200MG/5ML SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218424","SYNTHROID 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218427","SYNTHROID 137 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218428","LEVOTHYROXINE 200 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218431","LEVOTHYROXINE 75 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218432","LEVOTHYROXINE 50 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218434","LEVOTHYROXINE 125 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218436","LEVOTHYROXINE 100 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218437","LEVOTHYROXINE 150 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218438","LEVOTHYROXINE 150 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218440","LEVOTHYROXINE 300 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218444","LEVOTHYROXINE 175 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218450","PEG 3350 17 GM/DOSE PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218456","SYNTHROID 175 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218458","LEVOTHYROXINE 100 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218459","SYNTHROID 88 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218462","HYDCOD/ACETAMIN10MG/325MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218469","VALPROIC ACID 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218476","CAFFEINE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218486","KONSYL 6 GM/Dose PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218493","PHOS-NAK . PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218496","REFRESH.SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218497","REFRESH.SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218507","BAC ZN/POLY500U/GM10000U/GMONT"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218508","BACITRACIN-NEO-POLY.OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218513","GUAIF/DEXTROM100MG-10MG/5MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218516","SELENIUM 200 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218522","VITAMIN B12 100 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218537","MELATONIN 3 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218554","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218555","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218557","ALBUTEROL SULFATE 0.083% INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218558","PINK BISMUTH 262 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218559","FUROSEMIDE 80 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218560","ALBUEROL SULFATE 0.083% INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218566","LORATADINE D 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218578","TRIPLE ANTIBIOTIC. OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218579","VITAMIN B1 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218581","LACTAID FAST ACT9000UNITS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218582","CHLORHEXIDINE0.12% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218584","METAMUCIL3.4 GM/DOSE PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218585","FERROUS SULFATE140 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218586","BENZOCN/MENTHOL15MG-3.6MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218587","CHOLECALCIFEROL 5000 IU TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218589","IRON FUM/PS/FA/VITB W C . CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218599","PSEUDOPHEDRINE HCL 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218600","FLUDROCORT ACETATE 0.1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218601","MECLIZIND HCL 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218603","SULFASALAZINE 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218605","CYANOCOBALAMIN 1000 MCG TABLET"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218609","BISOPROLOL FUMARATE 5MG TABLET"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218611","PANTOPRAZOLE SOD 40 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218619","CENTRUM SILVER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218645","FLEET GLYCERIN SUPPOSITORIES "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218654","LISINOPRIL 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218667","SANI-SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218668","SANI-SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218669","SENEXON 8.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218670","SENEXON 8.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218671","SENNA 8.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218672","PINK BISMUTH 262 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218675","SANI-SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218676","SANI-SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218686","NICOTINE LOZENGE 2 MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218687","POTASSIUM BI/CITRIC 20MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218695","LACTOBACILLUS 15BILL CFU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218696","LACTOBACILLUS 10BIL CFU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218715","VITAMIN D3 5000 IU TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218725","SENNOSIDES 8.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218736","ACETAMINOPHEN 160MG/5ML ELIXIR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218737","TORSEMIDE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218755","FINASTERIDE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218757","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218758","GUAIFENESIN 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218765","CHOLECALCIFEROL 5000 IU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218769","HYDROXYZINE HCI 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218772","DOCUSATE SODIUM 50 MG/5 ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218779","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218787","PSYLLIUM 6 GM/PKT PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218788","GLIPIZIDE 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218790","BUPROPION HCL 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218794","LISINOPRIL/HCTZ 20MG-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218796","CITRIC ACID/SODBICARB10MEQTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218797","VITAMIN B12 500 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218801","MEGESTROL ACETATE 40 MG/ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218802","LIDOCAINE 2 % SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218803","CHOLECALCIFEROL 5000 IU TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218805","GLIMEPIRIDE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218817","PRESERVISION AREDS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218821","WITCH HAZEL SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218823","VITAMIN B COMPLEX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218832","NAPROXEN 250 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218835","ISOSORBIDE DINITRATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218836","ASPIRIN CHEWABLE 81 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218844","LINEZOLID 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218846","LACTOBAC ACIDOPHIL/PECTIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218847","CHOLECALCIFEROL 2000 IU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218849","CAL CARB/VIT D 500MG-200IUTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218850","CAL CARB/VIT D 500MG-200IUTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218851","MULTIVIT W/IRON CHILDREN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218852","CHILD ACETAMINOPH 160MG/5MLLIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218853","BIOTIN 300 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218856","POTASSIUM CHLORID ER 20MEQTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218862","NORTRIPTYLINE 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218863","CEPHALEXIN 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218867","ISONIAZID 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218870","NORTRIPTYLINE HCL 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218871","NORTRIPTYLINE HCL 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218872","VIT B COMPLEX/VIT C TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218874","VALPROIC ACID 500MG/10ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218875","TORSEMIDE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218878","DIALYVITE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218879","FLECAINIDE ACETATE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218880","ASPIRIN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218887","LISINOPRIL 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218891","NORTRIPTYLINE HCL 25 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218901","SODIUM CHLORIDE INH 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218902","FERR FUM/FOL ACID324MG/1MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218903","MINERAL OIL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218905","GEMFIBROZIL 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218910","CALCIUM CARBONATE 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218911","CALCIUM CARBONATE 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218913","ASCORBICACID/CU/VITA/E/ZN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218914","ASCORBIC ACID 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218915","ACETAMINOPHEN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218916","ACETAMINOPHEN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218917","ACETAMINOPHEN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218919","LACTOBACILLUS COMBINATION TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218920","HYDROCHLOROTHIAZIDE 12.5MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218922","FISH OIL/VIT E 1000MG-1IU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218923","FERROUS SULFATE 220MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218924","FERROUS FUM/FOLIC ACID/MV CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218925","FERROUS FUM/FOLIC ACID/MV CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218926","ETHAMBUTOL HCL 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218927","CIT ACID/SODCIT334MG-500MG/5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218933","MAGNESIUM 27 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218934","MAGNESIUM OXIDE 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218939","RIFAMPIN 150 MGáCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218940","PREDNISONE 10 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218943","NIACIN 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218944","NIACIN 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218945","MULTIVIT/MINERAL/IRON TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218946","MULTIVITAMIN/MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218947","MULTIVIT/CA/IRON/FOLIC TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218949","VITAMIN B COMPLEX CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218952","SODIUM CHLORIDE 7% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218953","SODIUM CHLORIDE 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218961","MULTIVIT/MINERAL/IRON TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218962","CALCIUM/VIT D 315MG-250IU TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218963","TORSEMIDE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218964","PREDNISONE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218968","LEVOTHYROXINE SODIUM150MCGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218970","HYDRCOD BIT/ACET7.5MG750MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218972","FERR FUM/FOLACID/VITB/C CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218973","DIPHENHYD HYDCLORIDE 25MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218974","BUPROPION HYDROCHL 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218975","BENAZEPRIL HYDCHL 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218976","BENAZEPRIL HYDCHL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218978","CL/K/NA 287MG15 MG180MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218990","DIPHENHYDRAM HCL12.5MG/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92218999","MAGNESIUM CHLORIDE 71.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219001","SUCRALFATE 1 GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219006","LEVOTHYROXINE SOD 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219009","AMLODIPINE BESYLATE 2.5 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219010","DOXAZOSIN MESYLATE 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219018","ACETAMIN/COD 120MG-12MG/5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219019","BACLOFEN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219026","TIZANIDINE HCL 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219027","VALPROIC ACID 250 MG/5 ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219046","MULTIVITAMIN AND MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219052","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219058","THYROID 65 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219063","HYDROCORTISONE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219065","GUAIFEN/DEXMTHPHN100MG-10MGLIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219066","TORSEMIDE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219069","HYDROXYZINE HCL 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219080","GUAIFENESIN 100 MG/5 ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219082","CLONAZEPAM 0.125 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219084","CLONAZEPAM 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219085","CLONAZEPAM 0.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219086","CLONAZEPAM 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219092","ACETAMINOPHEN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219102","MULTIVITAMIN MIN & IRON LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219112","LACTOBACILLUS RHAMNOSUS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219115","CALCIUM POLYCARBOPHIL500MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219120","CARVEDILOL 6.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219121","CARVEDILOL 3.125 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219122","ACETAMINOPHEN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219127","ASPIRIN 81 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219128","BACLOFEN 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219129","BENZOCAINE/MENTH15MG-3.6MGLOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219130","BISACODYL 10 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219131","BISACODYL 10 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219132","SERTRALINE HYDROCHLOR 50MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219135","GUAIFENESIN ER 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219136","IBUPROFEN 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219137","IBUPROFEN 100 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219138","MIDODRINE HYROCHLOR 2.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219139","CEPHALEXIN 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219144","DILTIAZEM HCL XL 120 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219145","DIPHENHYDRAMINE HCL 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219146","DOCUSATE/SENNO 50MG-8.6MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219147","DOXYLAMINE SUCCINATE 25 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219148","PHENOBARBITAL 16.2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219149","PHENOBARBITAL 32.4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219150","PHENYLEPHRINE HCL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219151","PHENYLEPHRINE HYDROCHL10MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219152","PRIMIDONE 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219153","PRIMIDONE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219161","OMEPRAZOLE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219165","TAMOXIFEN CITRATE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219166","TRIMETHOPRIM 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219168","PSEUDOEPHEDRINE HCL 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219169","RACEPINEPHRINE HCL 2.25% INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219174","THEOPHYLLINE 300 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219175","THEOPHYLLINE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219176","THEOPHYLLINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219178","PSEUDOEPHEDRINE HCL 120 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219180","PRIMIDONE 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219181","MORPHINE SULFATE 10MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219186","SODIUM CHLORIDE 1 GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219191","CHOLECALCIFEROL 400 UNITS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219193","PANCREAZE 4 CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219197","COLESTIPOL HCLMICRO 1 GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219198","PRAMIPEXOLE DIHYDRCH 0.5MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219219","CALCIUM POLYCARBOPHIL625MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219220","CALCIUM POLYCARBOPHIL625MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219221","FERROUS SULFATE325 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219226","OMEGA3/DHA/EPA/DPA/FISHOILCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219231","PRAZOSIN HYDROCHLORIDE 1 MG CA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219241","ACETAMINOPHEN 650 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219242","ACETAMINOPHEN 650 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219243","ACETAMINOPHEN 650 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219244","LACTOBAC RHAMN GG 10B CFU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219248","LIDOCAINE 0.04 PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219250","BENZOCN/MENTH 15MG-3.6MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219260","PHOSPHORUS/POTASSIUM/SOD PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219266","EPHED SU GUAIF 25MG-400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219268","POTASSIUM BI/CITRIC 25MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219269","POTASSIUM BI/CITRIC 25MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219270","POTASSIUM BI/CITRIC 25MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219271","MORPHINE SULFATE IR 15 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219272","MORPHINE SULFATE IR 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219278","METFORMIN HCL ER 750 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219283","FOLIC ACID 0.4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219285","CARBOXYMETHYLCELL NA 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219288","PRENATAL VITAMINS . TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219299","CHOLECALCIFEROL 400 IU TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219303","CHILDREN'S MULTIVITAMIN W IRON"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219306","PROMETHAZINE DM6.25MG-15MG/5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219307","PROMETHAZINE DM6.25MG-15MG/5ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219318","BUSPIRONE HCL 7.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219324","DOCUSATE NA/SENN50MG-8.6MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219332","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219343","PRENATAL VITAMINS . TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219347","VITAMIN A/VITAMIN D OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219351","CARBOXYMETHYLCELLULOSE NA1%GEL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219357","CARBOXYMETHYLCELLULO NA0.5%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219360","CARBOXYMETHYLCELLULO NA0.5%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219364","CRANBERRY 450 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219365","THIAMINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219367","PSYLLIUM 3.4 GM/DOSE PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219371","DOXAZOSIN MESYLATE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219372","CEPPHALEXIN 350 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219374","PYRIDOXINE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219378","BIOTIN 1000 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219379","CEPHALEXIN 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219380","GUAIFEN/CODEINE 100-10MG/5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219381","CYANOCOBALAMIN 1000MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219382","UBIQUINONE 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219383","FISH OIL 1000 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219396","FISH OIL EC 1000 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219397","INDOMETHACIN 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219408","NAPROXEN/DIPHENH 25-220MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219412","DOCUSATE/SENNA 50MG- 8.6MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219416","MEMANTINE HCL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219417","LEVOTHYROXINE SOD 88 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219420","MECLIZINE HCL 12.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219422","FAMOTIDINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219424","METOPROLOL SUCC ER 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219426","CLONAZEPAM 0.25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219427","OXYCODONE HCL IR 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219429","CYCLOBENZAPRINE HCL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219433","METOPROLOL SUCCINATE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219435","LEVOTHYROXINE SOD 125 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219440","PRENATAL VITAMINS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219444","BACLOFEN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219449","LITHIUM CITRATE 8 MEQ/5 ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219450","SULFA/TRIMETH 400MG-80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219468","CA CARB/VIT D3 500MG-5MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219469","CHOLECALCIFEROL 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219470","DOCUS NA/SENN 50MG-8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219481","TRIPR/PSEUDO 2.5mg-60mg TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219490","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219491","METHADONE HYDROCHLORIDE 5MGSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219493","MELATONIN 3 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219494","MELATONIN 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219501","HYDROCHLOR/SPIR 25MG-25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219511","EFFERVESCENT DENTURE TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219524","MIDODRINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219526","MEMANTINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219530","HYDRALAZINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219532","DEXTROSE 4 GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219535","CEPHALEXIN 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219537","CALCITRIOL 0.25 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219538","BENZOCAINE/MEN 15MG-3.6MG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219545","CALCIUM CARBONATE 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219546","PREGABALIN 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219547","PREGABALIN 150 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219548","PREGABALIN 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219549","PREGABALIN 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219550","PREGABALIN 75 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219555","VIT B COMPLEX TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219558","CEPHALEXIN 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219560","ASORBICACID/CRAN 60MG-250MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219561","PHENTERMINE HCL30 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219562","SIMETHICONE 180 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219563","CENTRUM SILV 400MCG-250MCGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219566","WITCH HAZEL-GLYCERIN BOTTLE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219569","BACITRACIN 500 U/GM PACKET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219573","LANOLIN CREAM (2ML) TUBE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219580","DILTIAZEM ER 240 MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219581","LACTASE CHEW 9000 UNITS CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219582","LACTOBAC ACIDOPHIL/PECTIN CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219589","TORSEMIDE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219591","ACEBUTOLOL 200 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219592","GUAIFENESIN 200 MG/10 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219596","TRAMADOL/APAP 37.5MG-325MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219597","HYDROCODONE/APAP7.5MG-325MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219600","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219605","LACTOBA/HERM/BIFID112.5BILLCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219606","LIDOCAINE JELLY 2 % GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219607","BUPROPION 150 MG XL TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219610","FERROUS FUM/FOLIC 324MG-1MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219611","FERROUS FUMARATE 324 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219618","LABETALOL HCL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219619","NICOTINE CHW 2 MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219620","PROPRANOLOL HCL 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219621","PROPRANOLOL HCL 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219622","CHOLECALCIFEROL 5000 UNITS TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219625","PAROXETINE HCL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219631","POTASSIUM CHLORIDE 20 MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219635","HYDROCODONE/APAP 5MG-325MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219639","SENNOSIDES/DOCU 50MG-8.6MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219642","DOXAZOSIN 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219643","ALLOPURINOL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219644","DOXAZOSIN MESYLATE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219653","BUMETANIDE 0.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219656","APAP/CODEINE 300 MG-30 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219661","BACLOFEN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219664","CAFFEINE 200 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219666","DOXYLAMINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219667","DIPHENHYDRAMINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219668","FERROUS SULFATE 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219669","GUAIFENESIN ER 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219670","GUAIFENESIN ER 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219671","GUAIFENESIN/DM600MG-30MG ERTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219672","GUAIFENESIN/DM30 MG-600 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219673","GUAIFENESIN ER 600 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219674","LACTOBACILLUS ACIDOPHILUS CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219675","NICOTINE CHW 2 MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219676","PHENYLEPHRINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219678","PSEUDOEPHEDRINE 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219680","VIT A PALMITATE 10000 UNITSCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219683","METOPROLOL TARTRATE 37.5MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219685","ASCORBIC ACID 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219686","SULFAMETHOXAZOLE/TMP400MG-80MG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219688","CYCLOBENZAPRINE HCL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219690","ISOSORBIDE DINITRATE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219697","TRIAMTERENE/HCTZ37.5MG-25MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219698","CHOLECALCIFEROL 400 UNITS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219702","GLYCERIN SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219711","CALCIUM POLYCARBOPHIL 625MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219715","LEVOTHYROXINE SODIUM 175MCGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219716","FAMOTIDINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219718","BENZOCAINE/MENTH 15MG-2.6MGLOZ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219719","CALCIUM CARBONATE 500 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219726","FISH OIL1000 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219729","LIOTHYRONINE 5 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219730","MAGNESIUM CHLORIDE DR71.5MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219731","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219734","METFORMIN HCL ER 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219739","PYRIDOXINE (VIT B6) 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219746","LEVOTHYROXINE SODIUM 25MCG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219747","GLUCOSAMINE SULFATE 500 MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219750","LIOTHYRONINE SODIUM 25 MCG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219753","DIVALPROEX SODIUM 125 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219756","DILTIAZEM HCLXL ER24120MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219758","FERROUS FUMARATE 324 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219759","FERROUS FUMARATE 324 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219760","ACETAMINOPHEN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219761","BENZOCAINE/MENTH15MG-3.6MGLOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219767","PSEUDOEPHEDRINE ER 120 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219771","IRON POLYSACCHARIDE 150MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219779","SERTRALINE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219786","BUPROPRION HCL SR 150 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219788","OMEGA3/FISHOIL 360MG/1200MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219789","CHOLECALCIF (VITD3) 50000U TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219791","ATORVASTATIN 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219792","CAL CARB/VIT D 500MG-100IU TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219794","THIAMINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219798","SODIUM CHLORIDE 3.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219810","THIORIDAZINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219820","PHENOBARBITAL16.2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219827","HYDROCODONE/APAP 5MG-325MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219834","ACETAMINOPHEN 325 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219836","TRAZODONE 150 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219839","ACETAMINOPHEN 650 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219848","PREGABALIN 100 MG CAPSULE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219850","CHOLECALCIFEROL 125 MCG CAPSUL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219851","WARFARIN SODIUM 3 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219854","CYANOCOBALAMIN 1000 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219855","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219861","WARFARIN 6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219866","ATORVASTATIN 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219870","ATORVASTATIN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219875","PANTOPRAZOLE DR 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219888","FINASTERIDE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219890","EPHEDRIN/GUAIF12.5MG-200MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219891","DILTIAZEM ER 180 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219893","VITAMIN E 180 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219894","NIACIN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219896","CALCIUM ACETATE 667 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219897","LEVOTHYROXINE 200 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219900","ASCORBIC ACID 500 MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219904","ZINC SULFATE 220 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219906","TAMSULOSIN 0.4 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219912","CHOLECALCIFEROL 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219918","ASPIRIN 81 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219920","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219921","WARFARIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219923","DIVALPROEX SODIUM DR 125MG CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219924","ALLOPURINOL 300 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219925","DOCUSATE SODIUM 100MG/10ML LIQ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219926","LACTOBACILACIDOPHILUS 500M CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219927","LACTOBAC/CITRUS/PECT 25M TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219928","LACTOBACILLUS/PECTIN 75M CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219931","CYANOCOBALAMIN 500 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219932","CYANOCOBALAMIN 1000MCG-30MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219933","CHOLECALCIFEROL 125 MCGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219934","NORTRIPTYLINE 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219937","ISOSORBIDE DINITRATE 10 MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219941","SENNOSIDES 8.6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219945","PROCHLORPERAZINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219946","BUMETANIDE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219949","FAMOTIDINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219953","BISCODYL 10 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219954","BISCODYL 10 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219957","TIZANIDINE 4 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219959","BUPROPION HYDROCHL 75 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219963","TAMSULOSIN 0.4 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219964","ASCORBIC ACID 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219967","FAMOTIDINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219970","ACETAMINOPHEN 160 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219971","BISACODYL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219976","FAMOTIDINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219978","METFORMIN ER 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219980","ASPIRIN 81 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219981","ASPIRIN 81 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219982","ASPIRIN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219983","FAMOTIDINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219987","CHOLECALCIFEROL 125 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219990","PHENYTOIN 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92219999","TORSEMIDE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220002","MEMANTINE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220009","KETOROLAC 30 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220012","CALCIUM CARBONATE 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220017","FAMOTIDINE 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220019","NORTRIPTYLINE 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220024","POVIDONE IODINE 10% SWAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220026","MELATONIN 3 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220034","ACARBOSE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220035","HYDROCODONE/APAP 5MG-325MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220040","SODIUM CHLORIDE 1 GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220044","WARFARIN 7.5 MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220046","HYDROCODONE/APAP 5MG-325MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220047","CHOLECALCIFEROL 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220057","COENZYNE Q10 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220061","CHOLECALCIFEROL 1000UNITS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220063","VIT D-CALCIUM 400IU/600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220080","CALCIUM CITRATE 950 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220081","CHOLECALCIFEROL 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220083","PREGABALIN 75 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220090","TERAZOSIN 1 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220091","CYANOCOBALAMIN 1000 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220092","AMYLAS/LIP/PROT10850-2600-6200"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220094","PYRIDOSTIGMINE 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220096","CHOLECALCIFEROL 25 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220104","CALCM/CHOLECAL250MG3.12MCGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220105","CARBOXYMETHYLCELLULOSE 0.5%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220109","GLUCOSAMINE 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220110","GLUC/CONDROIT500 MG-400 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220113","LEVOTHYROXINE 137 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220114","METFORMIN ER 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220120","PREGABALIN 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220123","ZINC SULFATE 220 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220124","BENZOC/DEXTROMETH 7.5MG-5MGLOZ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220127","SODIUM BICARBONATE 650 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220128","MELATONIN 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220129","BISMUTH SUBSALICYLATE262MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220130","DILTIAZEM 30 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220145","DILTIAZEM120 MGCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220147","NICOTINE POLACRILEX 2 MG GUM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220152","I-VITE LUTEIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220158","PRAMIPEXOLE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220162","TERAZOSIN 5 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220187","LEVOTHYROXINE 112MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220193","ASPIRIN 81MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220197","COENZYME Q10 30MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220198","PHENYLEPH/COCOAB 0.25%-88.44% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220199","CRANBERRY 425MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220203","PRAMIPEXOLE 1MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220205","VITC/CHOLEC/B12/FOLIC/VITB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220213","PYRIDOSTIGMINE 60MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220214","LACT ACIDOP/BULGO.05MG-0.05MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220215","NIACIN 250MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220218","METRONIDAZOLE 500MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220223","ONDANSETRON 4MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220227","ACETAMINOPHEN 325 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220228","VITAMIN A 10000 IU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220230","ACETAMINOPHEN 160 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220231","ACETAMINOPHEN 500 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220232","BISMUTH SUBSALICYLATE262MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220233","CETIRIZINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220234","CHOLECAL/CALC 10MCG-600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220235","COENZYME Q10 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220237","GUAIFENESIN 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220238","LOSARTAN 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220245","PROPANOLOL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220246","PSYLLIUM 3.5 GM/DOSE PWD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220248","NORTRIPTYLINE 10 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220249","PYRIDOXINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220250","VITAMIN E 180 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220251","MELOXICAM 7.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220255","MULTIMINERAL 250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220257","FENOFIBRATE 54 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220262","PSEUDOEPHEDRINE 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220271","GLIMEPIRIDE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220272","BENAZEPRIL 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220273","ROSUVASTATIN 40 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220281","ACETAMINOPHEN 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220286","UBIQUINOL 200 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220287","MULTIVITAMIN W MINERALS TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220291","MAGNESIUM GLUCONATE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220292","DOXEPIN 25 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220294","CALCIUM/CHOLE 600MG-10MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220304","BENAZEPRIL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220310","FLAVOXATE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220312","WITCH HAZEL 50% PAD "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220318","LACTOBAC ACIDOPHI/PECTIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220323","GUAIFENESIN/DM 600MG/30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220325","DOCUSATE/SENNO 50MG-8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220326","DOCUSATE/SENNO 50MG-8.6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220329","ACYCLOVIR 200 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220334","BENAZEPRIL 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220342","CYANOCOBALAMIN 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220350","PYRIDOSTIGMINE BROMIDE 60MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220352","SACCHAROMYCES BOUL 250MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220353","WITCH HAZEL 50% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220357","GUIFENESIN/DM 400MG-20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220362","MULTIVITAMIN TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220364","DOCUSATE NA/SEN 50MG-8.6MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220366","HYDROGEN PEROXIDE 3% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220367","LACTOBACILLUS GRANULES "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220368","VITAMIN E 90 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220375","POTASSIUM BICARB 25 MEQ TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220379","CLONAZEPAM 0.125 MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220385","BISACODYL 10 MG SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220397","LEVOTHY/LIOTHYR 9.2MCG-2.25MCG"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220398","LIDOCAINE 4% TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220400","ROPINIROLE HYDROCHLOR 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220414","DEXTRAN70/HYPROMELL .1%-.3%SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220416","GLYCERIN SUPP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220422","ROSUVASTATIN 20 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220423","DOXYCYCLINE 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220424","PYRIDOSTIGMINE 60 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220426","ASPIRIN 81 MG CTB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220429","VITAMIN E 400 UNITS CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220443","LACTOBAC RHAMNOSUS/INULIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220446","GLIPIZIDE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220449","VALPROIC ACID 250 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220450","LACTOBAC RHAMN 15 BIL CFU CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220453","GLYCOPYRROLATE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220464","ACETAMINOPHEN 160 MG/5 ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220472","POTAS NIT/SILV NIT 25%-75% SWA"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220474","GLYCOPYROLATE 1 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220481","ROSUVASTATIN 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220482","MULTIVITAMIN CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220485","BISMUTH SUBSALICYLATE 262MGCTB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220487","BACITRACIN 500 UNITS/GM OINT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220490","CHOLECALCIFEROL 125 MCG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220494","VITC/CU/LUT/SE/VITA/VITE/ZN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220499","METHYLCELLULOSE 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220510","CYANOCOBALAMIN 1000 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220514","PHENAZOPYRIDINE 95 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220518","SACCHAROMYCES BOULARDII 250MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220527","ACETAMINOPHEN 325MG/10.15ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220528","GLIPIZIDE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.00","92220531","GUAIFENESIN 400 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.05","92211280","THYROID 90MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.05","92213440","ETHAMBUTOL HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.05","92217367","ROPINIROLE HCL 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.10","92213012","HYDROCODONE APAP 2.5-167/5ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.10","92215375","AMOXICILLIN CLV K 200-28.5 CTB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.10","92218881","ARTIFICIAL TEARS 0.2%-0.2%-1% "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.10","92219117","CLOZAPINE 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92210500","WARFARIN NA 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92211982","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92213763","ALBUTEROL SULF 0.63MG/3ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92214836","TRAMADOL HCL APAP 37.5-325MG T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92215009","AMPHETAMINE SALTS 10MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92215462","CYCLOBENZAPRINE HCL 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92216993","PROPRANOLOL HCL 60MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92217543","BICALUTAMIDE 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92217695","BUPROPION HCL 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92219645","ALBUTEROL SULF 1.25MG/3ML INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.15","92219748","DEXTROAMPHETAMINE/AMPH 20MGCAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92210412","AMANTADINE HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92211803","MEPROBAMATE 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92212042","CARBAMAZEPINE 100MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92212488","MORPHINE 15MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92212507","WARFARIN NA 4MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92214708","MINOCYCLINE HCL 100MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92215515","NICARDIPINE HCL 30MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92215549","CLONAZEPAM 0.5MG ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92218754","FINASTERIDE 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92219749","MEDROXYPROGEST ACETATE 10MGTAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92219929","POLYETH GLYCOL 17 GM/DOSE PKT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92220179","DEXTROAMP/AMPHET SALTS 5MG CER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.20","92220463","METOPROLOL SUCCINATE 100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92211760","AMPHETAMINE SALTS 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92213304","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92214524","VALPROIC ACID 250MG/5ML LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92215751","LOSARTAN POTASSIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92217476","LEVETIRACETAM 1000MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92218150","CALCIUM ACETATE 667MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92218789","BUPROPION HCL 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92219974","NYSTATIN SUSP 100000 U/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92220062","AMANTADINE 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.25","92220210","RANOLAZINE 500MG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92210013","CIMETIDINE HCL 300MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92211193","ISOXSUPRINE HCL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92212419","BUPROPION HCL 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92213138","HYDROCORTISONE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92214405","AMOXICILLIN CLV K 200-28.5 CTB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92215867","BUPROPION HCL 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92216143","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92216310","NYSTATIN 100000U/ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92216885","MINOXIDIL 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92218430","SYNTHROID 200 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92218617","BUPROPION HCL 100 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.30","92219155","MINOXIDIL 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92210176","MINOCYCLINE HCL 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92210759","BUTALB CAFF APAP 50-40-325 CAP"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92213615","PHOSPHATE 133ML NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92216690","NA PHOS DIBASIC/MONOBASIC NMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92218948","ZONISAMIDE 100 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92219701","FENOFIBRATE 54 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92219720","CAPTORIL 12.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.35","92220421","MINOCYCLINE 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.40","92210020","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.40","92210737","MEGESTROL ACET 40MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.40","92210853","TICLOPIDINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.40","92213105","TICLOPIDINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.40","92214691","DIPHENHYDRAMINE HCL 12.5MG/5 E"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92210090","CAPTOPRIL 12.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92211654","BUTALB CAFF APAP 50-40-325 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92211781","WARFARIN NA 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92212765","AMPHETAMINE SALTS 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92213034","PROPAFENONE HCL 150MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92213451","NIFEDIPINE 30MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92215454","BISMUTH SUBSALICYLATE 262MG SU"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218011","ADERALL 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218352","AMPHETAMINE SALT COMBINATION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218429","SYNTHROID 50 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218435","SYNTHROID 50 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218457","LEVOTHYROXINE 137 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92218604","ZONISAMIDE 100 MG CAPSULE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.45","92220078","AMPHETAMINE SALT COMB 15MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92210152","LACTULOSE 10GM/15ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92213944","NATEGLINIDE 120MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92214881","DANTROLENE NA 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92216638","PHENYTOIN NA 100MG/4ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92216847","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92216854","AMLODIPINE BESYLATE 2.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.50","92220305","NATEGLINIDE 120 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.55","92212891","POTASSIUM CITRATE 5MEQ TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.55","92216475","DIGOXIN 50MCG/ML ELI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92210086","TICLOPIDINE HCL 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92211750","VERAPAMIL HCL 120MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92212120","PERPHENAZINE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92212945","OXAZEPAM 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92212948","NEOMYCIN SULF 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92213254","PROPRANOLOL HCL 60MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92214184","CARBIDOPA/LEVO 50/200 TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92214185","ACETAMINOPHEN COD 120-12/5 SO"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92216025","CARBIDOPA/LEVO 25/250 ODT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92219536","CALCIUM ACETATE 667 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.60","92219623","TIZANIDINE HCL 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.65","92216089","ACAMPROSATE 333MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.65","92219017","ACETAMIN/COD 300MG30MG/12.5ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.65","92219991","CALCIUM ACETATE 667 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.65","92220066","TIZANIDINE 2 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92210117","BUTALB CAFF APAP 50-40-325 TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92216814","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92216823","COLESTIPOL HCL 1GM TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92217301","DIVALPROEX NA 250MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92217302","DIVALPROEX NA 125MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92217304","DIVALPROEX NA 250MG TCP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92218583","DIVALPROEX250 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92218610","DIVALPROEX SODIUM 250MG TABLET"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92220031","CAMPRAL 333 MG% TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.70","92220488","METOPROLOL SUCCINATE 100MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92210729","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92210769","MENTHOL METHYL SALICYL OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92210834","DICLOFENAC NA 75MG ECT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92213042","HALOPERIDOL 2MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92214499","RIFAMPIN 300MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92214967","EFAVIRENZ 50MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.75","92219869","PROCHLORPERAZINE 10 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92211569","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92213949","FUROSEMIDE 40MG/5ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92214540","ETHAMBUTOL HCL 400MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92216152","IPRATROPIUM BR 0.02% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92216791","AMLODIPINE BESYLATE 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92216906","VERAPAMIL HCL 100MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92218248","ATORVASTATIN 80MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.80","92220387","DEXAMETHASONE 6 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.85","92213644","IPRATR-ALBUTEROL 0.5-3MG/3ML S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.85","92214022","CALCITRIOL 0.5MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.85","92220316","SODIUM CHLORIDE 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92210193","GLIPIZIDE 5MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92210473","PINDOLOL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92211286","MULTIVITAMIN FE/F 0.25MG/ML LI"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92211672","LOSARTAN POTASSIUM 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92212129","PHENYTOIN NA 125MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92212707","PERPHENAZINE 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92214156","ACETOHYDROXAMIC ACID 250MG TAB"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92215944","HYDROCODONE APAP 7.5-325/15 EL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92216478","LITHIUM CARBONATE 8MEQ/5ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92219291","LITHIUM 8 MEQ/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92219296","LIDOCAINE 4% PATCH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92219453","CALAMINE/ZINC OXIDE 8%-8% LOT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92220011","PHENYTOIN 50 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.90","92220525","HYDROCOD/ACET 7.5MG-325MG/15ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92210489","BETHANECHOL CL 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92210958","PRAZOSIN HCL 1MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92211385","PROVIDONE IODINE 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92211959","AMLODIPINE BESYLATE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92212109","DOXEPIN HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92212136","DOXEPIN HCL 75MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92214291","METOPROLOL SUCC 100MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92215033","RAMIPRIL 2.5MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92215594","BUPROPION HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92217694","BUPROPION HCL 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9.95","92220266","RANOLAZINE 500 MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.00","92216916","CEFUROXIME NA 1.5GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.08","38307037","FUNGI IDENTIFICATION MOLD ","87107",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.15","92204033","IV ADMIXTURE 34 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.15","92211220","SODIUM PHOSPHATE 3MM/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.15","92217798","INFLUENZA VACC 2011-2012 SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.25","92216358","LEFLUNOMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.35","92213735","ROCURONIUM BROMIDE 10MG/ML INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.39","38300095","ALKALINE PHOSPHATASE TOTAL ","84075",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.40","92207001","IRRIGATIONS 01 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.45","92210786","ALPRAZOLAM 2MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.50","92214667","NISOLDIPINE 20MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.63","38301505","CULTURE HERPES ","87254",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.65","38300370","CALCIUM SERUM ","82310",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.65","92220340","CLEANSER LOTION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.70","92217113","HEPARIN 1000U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.80","92213284","ANASTROZOLE 1MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.80","92219104","DESVENLAFAXINE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.80","92219985","PRASUGREL 5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.82","38301780","HETEROPHILE ANTIBODY SCREEN ","86308",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.85","92211845","ERYTHROMYCIN 5MG/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.88","38302590","ZINC ","84630",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.93","34000290","CONTRAST BATH 15 MIN ","97034GP ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.93","34210385","CONTRAST BATH 15 MIN ","97034GO ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"90.95","92216579","BUPROPION HCL 200MG T12 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"903.00","33117523","KIT TUNNEL CATHETER 19CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"903.00","33117524","KIT TUNNEL CATHETER 23CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"903.00","33117525","KIT TUNNEL CATHETER 27CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"903.72","73500327","NRV COND STUDIES 5-6 STUDIES ","95909",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"904.10","92219013","HYDROCRTNA SUCCINATE1000MG/8ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"905.85","92214502","IPRATROPIUM BR 0.03% SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"907.85","92218998","ATROPINE SULFATE 1% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"908.00","92210527","HYALURONATE NA 10MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.05","38201883","CHLORIDE URINE ","82436",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.42","38302535","VISCOSITY ","85810",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.48","38300293","RETICULATED PLT ASSAY ","85055",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.85","92214086","MIDAZOLAM HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.85","92217735","ACTIV CHARCOAL SORBITOL 25GM S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.94","38300229","ANTI STREP O SCREEN ","86063",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.95","92215926","METFORMIN HCL 1000MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.95","92218013","TAMIFLU 30MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"91.95","92219677","OSELTAMIVIR 30 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"911.10","92213283","ALBUMIN HUMAN 25% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"913.05","92215373","VORICONAZOLE 200MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"914.75","92211549","ALBUMIN HUMAN 5% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"914.85","92213251","CLOBETASOL PROP 0.05% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"914.85","92217835","IMMUNE GLOBULIN 100MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"915.54","75000140","US RETROPERITONEAL COMPLETE ","76770",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"916.40","92211372","INSULIN HUM REGULAR 100U/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"916.45","92219257","BARIUM SULFATE 0.4 SUSP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"916.61","75000290","DUPLEX AORTA/IVC/GRAFT LTD ","93979",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"917.00","92214227","BETAMETHASONE VA 0.12% FOA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"917.39","75000060","US ECHO TRANSTHORACIC 2D LIMIT","93308",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"918.15","92218174","OMNIPAQUE 350 INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.00","33110059","KIT DRESSING MED VAC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.00","33111159","KIT DRESSING SM VAC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.00","33192215","KIT DRSG LGE VAC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.00","92219436","ROFLUMILAST 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.05","92219769","ROFLUMILAST 250 MCG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38200310","BUN (UREANITROGEN) ","84520",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38200370","CALCIUM SERUM ","82310",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38201390","GRAM/GIESMA SMEAR ","87205",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38201940","POTASSIUM URINE ","84133",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38202440","URIC ACID BLOOD ","84550",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.16","38206570","CONCENTRATION O&P/TB ","87015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.20","92217973","RIVAROXABAN 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.20","92218606","RIVAROXOBAN 15 MG TABLET "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.20","92220406","BARIUM SULFATE 40% NEC "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.32","76020014","THALLIUM TI-201 PER MCI "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.35","92217525","PRASUGREL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.40","92212469","LABETALOL HCL 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.40","92217478","FLUCONAZOLE 400MG/200ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.55","92215904","LEVOFLOXACIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.55","92216857","PETROLATUM 41%OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.57","38303375","PORPHOBILINOGEN URINEQNT ","84110",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.70","92212834","LIDOCAINE HCL 2% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.75","92210867","SODIUM BICARB 8.4% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.75","92211108","PHENYLEPHRINE HCL 0.25%-3% OIN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.80","92215129","HEPARIN 25000U/D5W 250ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.90","92213379","VENLAFAXINE HCL 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.90","92216150","VENLAFAXINE HCL 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.95","92218888","RIVASTIGMINE 9.5MG/24HRPTCH ER"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"92.95","92219224","RIVASTIGMINE 4.6MG/24HR Patch "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"920.40","92218489","MESALAMINE 4 GM/60 ML ENEMA "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"921.60","92215988","CLOTRIMAZOLE BETAMETH 1-0.05 L"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.00","33101292","HEMOSTATIC MATRIX FLOSEAL 10ML"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.00","33114967","MATRIX FLOSEAL FULL 10ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.00","33139910","MATRIX FLOSEAL PREP 10ML "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.40","92212152","INSULIN HUM ISOP 100U/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.53","75000130","US PREG UTERUS >14 WEEKS ","76805",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.75","74010021","BREAST DUCTOGRAM 1 DUCT RT ","77053RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"924.75","74010022","BREAST DUCTOGRAM 1 DUCT LT ","77053LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"925.17","75010009","US UP EXT ART DUPLEX COMP RT ","93931RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"925.17","75010010","US UP EXT ART DUPLEX COMP LT ","93931LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"926.00","92217990","CAPATAT SULFATE 1GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"927.00","92214663","IRINOTECAN HCL 20MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"927.15","74001317","HIPS MIN 5 VIEWS BILATERAL ","73523",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.00","92210440","ATROPINE SULF 0.4MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.00","92210629","SODIUM THIOSULFATE 10% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.00","92211139","ALCLOMETASONE DIPRO 0.05% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.05","92218275","BRINTELLIX 5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.10","92211651","AZITHROMYCIN 250MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.15","92212019","HETASTARCH 6%/NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.27","38200540","CHOLESTEROL (TOTAL) ","82465",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.30","92213910","QUETIAPINE FUMARATE 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.33","38301380","GLYCOHEMOGLOBIN (HGB A1) ","83036",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.40","92214844","CELECOXIB 200MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.40","92218201","MEMANTINE 21MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.46","38300580","C02 CONTENT ","82374",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.50","92215967","TIMOLOL MALEATE 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.55","92214672","AMIODARONE HCL 50MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.60","92218115","SILDENAFIL CITRATE 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.65","92214014","CEFTRIAXONE NA 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.65","92218518","PAZEO 0.7% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.65","92219915","LIDOCAINE/DEXTROSE 0.8%-5% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.70","92215933","DOLASETRON MESYLATE 20MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.75","92213827","PENICILLIN GK 20MMU INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.80","92213762","NEOSTIGMINE MS 0.5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.80","92219478","SENNA LEAF EXT 176MG/5ML SYR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.80","92220356","MUPIROCIN 2% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.84","38300084","ASPERGILLUS FUMIGATUS ","86606",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.84","38300097","ASPERGILLUS FLAVUS ","86606",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.84","38300098","ASPERGILLUS NIGER ","86606",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.84","38306710","ASPERGILLUS ANTIBODY ","86606",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300008","CULTURE GROUP A STREP SCR ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300099","CLOTEST ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300920","CULTURE GC ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300924","CULTURE KPC SCREEN ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300930","CULTURE SCREEN MRSA ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300935","CULTURE SCREEN ACINETOBACTER ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38300955","CULTURE VRE SCREEN ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38301680","CULTURE LEGIONELLA ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38302138","CULTURE VRE SCREEN ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38302271","CULTURE GROUP B STREP SC ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38303856","H.PYLORI RAPID UREASE TEST ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.86","38305627","BETA STREP SCREEN ","87081",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.88","38300134","TREPONEMA PALLIDUM ANTIBODY ","86780",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.88","38301256","TREPONEMA PALLIDUM ","86780",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.95","92212549","PHENYLEPHRINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.95","92215283","ETHACRYNIC ACID 25MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"93.96","92212661","HYDROCORTISONE ACET 30MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"931.00","33113086","SET CATH 52CM 10FR STD PU BFLX"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"931.00","33113087","SET CATH 52CM 10FR STR PU BFLX"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"931.05","92220137","TIMOLOL 0.5% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9320.65","92211646","CYTOGAM 2.5GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"933.00","33102989","TRAY CVC HCKMN PWRLN 9.5FR2LUM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"934.40","92217635","MENINGOCOCCAL VAC DIPTH CONJ S"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"937.55","92215510","LATANOPROST 0.005% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9393.60","74075940","PLACEMENT OF IVC FILTER ","37191",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.00","33153622","KIT DRN LINE LOCKABLE PLEURX "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.20","92214684","NITROGLYCERIN 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.20","92215960","TINIDAZOLE 500MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.25","92213657","HYDROCORTISONE 1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.30","92212130","SODIUM CL 5% EYE OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.30","92212739","NYSTATIN 100000U/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.33","38305066","VITAMIN E LEVEL ","84446",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.40","92215685","DICYCLOMINE HCL 10MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.50","92217568","PIPERACIL TAZOBACT 36-4.5GM PD"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.50","92218299","STRATTERA 60MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.50","92218517","CYCLOPHOSPHAMIDE 50 MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.55","92218268","MYRBETRIQ 25MG ER TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.55","92218272","MIRABEGRON 50MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.57","38301830","OVA AND PARASITES ","87177",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.70","92212380","CLINDAMYCIN PHOS 600MG/D5W INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.85","92218808","POTASSIUM CL 20 MEQ/15 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"94.85","92219543","METFORMIN ER 500 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"940.55","75000010","US ABDOMEN COMPLETE ","76700",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"941.00","92218196","BUTRANS 20MCG/HR ER TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"941.95","92215847","INTERFERON B-1B NS 0.3-0.54% K"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"942.30","92215401","LINEZOLID 600MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"942.59","74001194","NASAL/OROGASTRIC W/TUBE PLCMT ","43752",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"942.60","92211703","INSULIN HUM ISOP/REG 70U-30U I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"944.58","38307028","HLA I TYPING COMPLETE LOW RES ","81372",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"945.00","33106306","CATHETER ASH SPLIT 28FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"945.00","33113088","SET CATH 28CM 14FR TRNFLXSPLT3"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"945.00","33113089","SET CATH 32CM 14FR TRNFLXSPLT3"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"945.00","33177253","TRAY ASH SPLIT CATH 28CM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"945.50","92219863","UREA 40% CRM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"946.00","33199317","STAPLER CONTOUR CURVED "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"947.50","92218720","BREO ELLIPTA 200MCG-25MCG INH "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"948.40","92212178","IODOQUINOL HC 1%-1% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.00","38201473","HEP B SURF AG (HBSAG) NEUTRLZN","87341",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.00","92211558","AMMONIUM LACTATE 12% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.15","92213019","PIOGLITAZONE HCL 30MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.15","92218464","MEDIHONEY 0.8 GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.16","34600430","EVAL NONSPEECH GEN DEVICE ","92605GN ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.25","92213941","VENLAFAXINE HCL 75MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.25","92215106","DEMECLOCYCLINE HCL 300MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.25","92220289","LEVOMILNACIPRAN 40 MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.30","38301450","HEPATITIS A ANTIBODY ","86708",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.35","92212409","OXACILLIN NA 1GM/50ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.35","92218895","LIPIDS 20% EMULSION "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.49","38202050","PTT ","85730",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.50","92212663","DONEPEZIL HCL 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.55","38300162","COVID-19 ANTIBODY IGM ","86769",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.55","38300163","COVID-19 ANTIBODY IGG ","86769",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.55","38300164","COVID-19 ANTIBODY IGA ","86769",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.55","38300165","SARS COV-2 AB QUAL ","86769",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.60","92210679","UREA HC 20% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.64","38300021","HCG SERUM QUALITATIVE ","84703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.64","38301410","HCG QUAL URINE ","84703",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.95","92215983","DOXERCALCIFEROL 0.5MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"95.98","38300950","CULTURE STOOL ","87045",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"950.40","73700053","EMG 4 EXTERMITY ","95864",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9505.00","92218010","MELPHALAN HYDROCHL 40MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"954.05","92216230","TIGECYCLINE 50MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"954.90","92210799","CONJUCATED ESTROGENS 0.625MG C"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"954.90","92219459","BOSUTINIB 100 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"956.57","75000230","US EXT ARTERY COMPLETE BIL ","93923",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"957.45","92215504","CIPROFLOXACIN 10% SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"957.95","92218104","RELISTOR 8MG/0.4ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"957.95","92220313","METHYNAL BROM 12MG/0.6ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"959.00","76000050","NM KIDNEY W/FLOW ","78701",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.00","92213197","IODINE MILD TIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.00","92213292","OXYQUINOLINE SULF 0.025% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.15","38301220","FIBRINOGEN ","85384",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.17","38302190","HGB SOLUBILITY SICKLE CELL ","85660",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.25","38301710","LIDOCAINE ","80176",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.25","92219000","EPINEPHRINE 1MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.30","92212992","NYSTATIN 100000U/GM CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.30","92219091","ACYCLOVIR 800 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.35","92219871","DESVENLAFAXINE ER 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.38","38302143","RSV ANTIBODY ","86756",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.40","92211844","MICONAZOLE NITRATE 200MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.40","92212847","POTASSIUM CL 2MEQ/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.60","38201260","WET MOUNT SMEAR ","87210",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.60","38201760","MAGNESIUM ","83735",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.62","38302835","COCCIDIOIDES ANTIBODY ","86635",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.65","38302940","EBV ANTIBODY EARLY ANT (EA) ","86663",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.68","38300720","CPK ISOENZYMES ","82552",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.80","92216760","CEFTAZIDIME 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.85","92210693","METHYLENE BLUE 1% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.92","38000016","DECALCIFICATION ","88311",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.95","92212270","FENTANYL 50MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"96.95","92219280","AMY/LIP/PRO168K-40K-126K UCAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"960.25","92219506","GENTAMICIN/PREDN 0.3%-0.6% SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"960.30","92212334","HEPATITIS B IMMUNE G 312U/ML I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9604.65","92217874","INTERFERON BETA-1A KIT "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"961.58","38203895","CYTOMEGALOVIRUS DNA QUANT ","87497",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"962.09","74076003","UPPER GI W/AIR W/KUB ","74247",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"962.87","74000222","GI TUBE PLACEMENT RAD GUIDANCE","74340",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"963.30","92213488","HYDROCORTISONE BUTYR 0.1% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33103039","KIT CATH EQSTRM STR 14.5Fx27CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33106291","KIT CATH EQU XK SP TP 16FX27CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33110226","KIT CATH EQST SPLTP14.5FRx42CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33110227","KIT CATH EQST SPLTP14.5FRx35CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33152429","KIT CATH EQSTRM STR14.5FRx19CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"964.00","33194399","KIT CATH EQU SP TP 14.5FR 23CM"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"966.45","75010013","LOW EXT ART DUPLEX COMP RT ","93926RT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"966.45","75010014","LOW EXT ART DUPLEX COMP LT ","93926LT ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9680.00","92218777","AHF VIII(RECOMBINANT)1000U INJ"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"969.85","92210419","CLINDAMYCIN PHOS 1% GEL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92213695","ALFENTANIL HCL 500MCG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92215219","DOLASETRON MESYLATE 20MG/ML IN"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92215587","ALUMINUM HYDROXIDE 0.275% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92215812","RECEPINEPHRINE HCL 2.25% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92215958","ADENOSINE 3MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92216618","FENTANYL CITRATE 200MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.00","92217639","FENTANYL CITRATE 200MCG LOZ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.05","92213025","SODIUM BICARB 7.5% INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.13","38300495","CERULOPLASMIN ","82390",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.25","92218236","ALORA 0.1MG/4HR TDM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.30","92212881","LAMOTRIGINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.30","92217438","QUETIAPINE FUMARATE 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.30","92217439","QUETIAPINE FUMARATE 150MG TER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.40","92210296","PROMETHAZINE HCL 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.40","92212323","PROMETHAZINE HCL 12.5MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.40","92215145","HEPARIN 25000U/D5W 500ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.48","92218024","ROPINIROLE ER 8MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.50","92217941","LEVETIRACETAM 5MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.50","92218285","REQUIP XL 6MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.52","38300805","CRYPTOSPORIDIUM ANTIGEN ","87328",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.55","92216225","PARICALCITOL 2MCG SGL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.55","92218708","EXEMESTANE 25 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.65","92215472","CEFEPIME HCL 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.70","92218256","BRINTELLIX 20MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.70","92218713","VORTIOXETINE HYDROBROM10MGTAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.75","92217555","SEVELAMER CARBONATE 0.8GM PDR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.85","92213671","PYRIDOSTIGMINE BR 60MG/5ML SYR"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"97.95","92217174","CEFTRIAXONE NA 2GM INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"971.00","33111903","TUBE TRANSGAST JEJUNAL 22FR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"971.00","33167621","KIT MIC TR-JEJUN SURG FDG 18F "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"975.00","33117065","BIOFLO DRMX 32 CM STR DUAL VLV"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"975.00","72000614","ZIKA TESTING ON BLOOD PRODUCT ","87662",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"975.90","92218439","BREO ELLIPTA 100MCG/25MCG AER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.00","92212747","HYDROCORTISONE NA SUCC 500MG I"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.00","92213616","METHOTREXATE 25MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.00","92213921","FLUTICASONE PROP 0.005% OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.12","38300981","CULTURE URINE W/COLONY COUNT ","87086",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.13","38301580","INSULIN ","83525",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.20","92217959","DOCOSANOL 10% CRE "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.30","92211541","OLANZAPINE 7.5MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.35","92210268","PHENYLEPHRINE HCL 10% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.40","38301660","LDH ISOENZYMES ","83625",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.41","38302160","SENSITIVITY (MIC) ","87186",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.45","92215183","FLUCONAZOLE 200MG/100ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.47","38300148","TETANUS ANTIBODY ","86317",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.47","38300149","DIPTHERIA ANTIBODY ","86317",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.47","38301477","HEP B SURF ANTIBODY QUANT ","86317",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.47","38302055","IMMUNO OTHER INFECT AGENT AB ","86317",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.55","92210179","SODIUM CL 0.9% SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.70","92214674","NOREPINEPHRINE BIT 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.75","38303015","T4 FREE (THYROXINE) ","84439",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.75","92217183","EPINEPHRINE 1MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.80","92214413","ERYTHROMYCIN 5MG/GM OIN "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.82","38201730","LITHIUM ","80178",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.82","38202180","SGPT (ALT) ","84460",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.82","38203771","CRYSTAL IDENTIFICATION ","89060",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.82","38302935","EBV NUCLEAR ANTIGEN IGM (VCA) ","86664",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.82","38302955","EBV NUCLEAR ANTIGEN IGG (EBNA)","86664",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.90","92214010","LEFLUNOMIDE 10MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"98.95","92218694","SENNA 8.8 MG/5 ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"981.05","92215479","BUDESONIDE 0.032MG SPR "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"981.40","92213028","FLUCYTOSINE 500MG CAP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9847.45","92216052","ETANERCEPT 50MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"9847.85","92219401","IMMUNE GLOB 10% 100 MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.00","33187150","TUBE TRACH PERCUT SZ 6 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.00","92211927","CYCLOSPORINE 100MG/ML SOL "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.00","92213597","HETASTARCH 6%/NS INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.00","92214410","ONDANSETRON HCL 2MG/ML INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.00","92215018","AMINO ACIDS 10% IVS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.15","92215144","LAMIVUDINE ZIDOVUDIN 150-300 T"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.30","92220112","LETROZOLE 2.5 MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.35","92219200","NAFCILLIN SODIUM 1 GM/50 MLSOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.38","38300110","AMIKACIN ","80150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.40","92204050","IV ADMIXTURE 50 "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.40","92211097","HYDROCORTISONE ACET 25MG SUP "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.70","92213362","VENLAFAXINE HCL 150MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.70","92215788","VENLAFAXINE HCL 37.5MG CER "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.70","92219534","CLINDAMYCIN/D5W 900MG/50ML SOL"," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.75","92219552","LEPTOSEPERMUM HONEY 0.63 DRSG "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.85","92211383","ERYTHROMYCIN ES 200MG/5ML SUS "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.93","38200216","CRYPTOCOCCUS ANTIGEN SERUM ","87899",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"99.95","92214528","LAMIVUDINE 100MG TAB "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"990.00","92215170","PHENTOLAMINE MESYLATE 5MG INJ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"995.00","33105858","TUBE LARY PROVOX ID12MMOD15MM "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Charge Master","Charge Master",,,,"997.60","92217250","DESFLURANE 99% LIQ "," ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"" "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Adjustment Term","AdvanceCriteriaCalculationRM",,,,,,,,,,,,,,"[Facility Code] = '4628'AND Claim Billed Amount > Calculated Reimbursement + 21788",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"(([Claim Billed Amount] - ([Calculated Reimbursement] + 21788)) * (0.00 )) ", "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] > '59891.34' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')","74.25",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"ICU CCU Per Diem","2359.57",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Intermediate ICU CCU Per Diem","2359.57",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Med Surg Per Diem","2359.57",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Rehabilitation Per Diem","2359.57",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Subacute Per Diem","2359.57",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"ICU CCU Per Diem","3810.67",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Intermediate ICU CCU Per Diem","3810.67",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Med Surg Per Diem","3810.67",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Rehabilitation Per Diem","3810.67",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] IN ('2137' '4269' '4508' '4559' '4602' '4611' '4640' '4645' '4652' '4674' '4812' '4876')",,,,,,,,"Subacute Per Diem","3810.67",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","111.87","[Facility Code] IN ('4268' '4510' '4614')",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","112.86","[Facility Code] IN ('4500' '4851')",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","178.2","[Facility Code] IN ('2143' '4662')",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] IN ('2144' '4502' '4633')","30.4545",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] IN ('4207' '4261' '4262' '4635' '4649' '4653' '4654' '4685' '4818' '4840' '4846' '4874')","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Facility Code] IN ('4501' '4506' '4509')","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","TieredPerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] = '4628'",,,,"1","7","Per Diem","1912.68",,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","TieredPerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] <> 'S' AND [Facility Code] = '4628'",,,,"8","999","Per Diem","1653.30",,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","TieredPerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] = '4628'",,,,"1","7","Per Diem","2323.53",,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","I","Standard Term","TieredPerDiemRM",,,,,,,,,,,,,,"[DRG Med/Surg ID] = 'S' AND [Facility Code] = '4628'",,,,"8","999","Per Diem","2011.68",,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Employers Choice Network","Commercial","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Auto","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Auto","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Group Health","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Group Health","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Work Comp No Fee Schedule","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Equian HD","Work Comp No Fee Schedule","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Evolutions Healthcare Systems","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Evolutions Healthcare Systems","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Evolutions Healthcare Systems","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Evolutions Healthcare Systems","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","FedMed Inc","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","FedMed Inc","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","FedMed Inc","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","FedMed Inc","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Galaxy Health Network","HD and NCD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Galaxy Health Network","HD and NCD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Galaxy Health Network","HD and NCD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Galaxy Health Network","HD and NCD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Health Management Solutions","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Health Management Solutions","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","79",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthScope Benefits","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthScope Benefits","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","85",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthScope Benefits","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthScope Benefits","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","85",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0258","35.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 6000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0636","35.00","Pharmacy-Extension of 025X - Drugs Requiring Detailed Coding","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 6000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0800","450.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0801","450.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0802","450.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0803","450.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0804","450.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Carve Out Term","UB92RM",,,,,"0809","450.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Dialysis Rate","450.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","2500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","2250.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","HealthSmart Complete","LTACH","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1912.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Humana ChoiceCare OH","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Humana ChoiceCare OH","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90371","135.59","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90371","135.88","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90371","138.87","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90371","138.92","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90375","213.24","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90375","286.02","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90375","308.67","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90375","321.80","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90376","325.72","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90376","332.82","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90376","353.49","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90376","356.33","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90377","223.61","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90377","235.66","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90377","239.92","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90377","241.20","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90586","141.23","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90586","141.52","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90586","141.65","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90586","142.29","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90632","64.74","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90632","65.70","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90632","68.75","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90632","70.98","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90662","65.26","Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90662","65.26","Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90662","65.26","Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90662","69.94","VACCINE--Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90670","241.38","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90670","257.99","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90670","257.99","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90670","257.99","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90672","26.88","Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90672","26.88","Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90672","26.88","Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90672","26.88","VACCINE--Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90674","29.94","Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90674","29.94","Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90674","29.94","Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90674","32.28","VACCINE--Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90675","291.79","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90675","293.59","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90675","341.95","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90675","348.53","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90677","264.74","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90677","283.72","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90677","283.72","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90677","283.72","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90682","65.26","Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90682","65.26","Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90682","65.26","Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90682","69.94","VACCINE--Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90685","21.64","Iiv4 vacc no prsv 0.25 ml im--0.25 mL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90685","21.64","Iiv4 vacc no prsv 0.25 ml im--0.25 mL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90685","21.64","Iiv4 vacc no prsv 0.25 ml im--0.25 mL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90686","20.53","Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90686","20.53","Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90686","20.53","Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90686","21.52","VACCINE--Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90687","10.24","VACCINE--Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90687","9.95","Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90687","9.95","Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90687","9.95","Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90688","19.91","Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90688","19.91","Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90688","19.91","Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90688","20.48","VACCINE--Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90694","66.43","Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90694","66.43","Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90694","66.43","Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90694","71.68","VACCINE--Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90714","27.70","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90714","27.94","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90714","28.01","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90714","28.99","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90715","35.64","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90715","36.16","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90715","36.76","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90715","38.28","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90739","144.21","Hepb vacc 2 dose adult im--1 dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90739","144.21","Hepb vacc 2 dose adult im--1 dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90739","144.21","Hepb vacc 2 dose adult im--1 dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90739","152.08","Hepb vacc 2 dose adult im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90740","140.76","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90740","146.33","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90740","146.33","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90740","146.33","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90743","71.72","Hep b vacc adol 2 dose im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90744","28.76","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90744","29.04","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90744","29.04","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90744","29.04","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90747","140.75","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90747","140.75","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90747","140.75","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90747","140.76","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90756","28.37","Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90756","28.37","Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90756","28.37","Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90756","30.58","VACCINE--Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90759","73.82","Hep b vac 3ag 10mcg 3 dos im--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90759","74.53","Hep b vac 3ag 10mcg 3 dos im--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"90759","74.53","Hep b vac 3ag 10mcg 3 dos im--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9575","0.13","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9575","0.14","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9575","0.15","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9575","0.15","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9576","1.43","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9576","1.44","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9576","1.45","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9576","1.47","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9577","1.85","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9577","1.85","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9577","1.88","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9577","1.90","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9578","1.75","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9578","1.77","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9578","1.81","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9578","1.82","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9579","1.56","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9579","1.58","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9579","1.58","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9579","1.58","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9581","14.74","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9581","14.74","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9581","14.74","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9581","14.78","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9585","0.32","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9585","0.33","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9585","0.34","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9585","0.35","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9589","1199.10","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9589","1222.93","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9589","1225.45","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9589","1226.20","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9606","174.02","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9606","174.02","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9606","176.64","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"A9606","176.64","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0121","3.30","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0121","3.33","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0121","3.47","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0121","3.49","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0122","1.01","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0122","1.01","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0122","1.06","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0122","1.07","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0129","43.25","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0129","43.90","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0129","44.22","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0129","44.52","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0132","0.55","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0132","0.68","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0132","0.79","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0132","0.95","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0133","0.02","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0133","0.03","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0133","0.04","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0133","0.06","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0153","0.44","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0153","0.46","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0153","0.47","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0153","0.52","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0171","0.72","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0171","0.73","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0171","0.75","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0171","0.76","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0172","11.87","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0172","5.64","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0172","5.98","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0172","5.98","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0178","903.00","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0178","912.89","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0178","914.20","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0178","915.75","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0179","311.93","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0179","311.96","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0179","312.28","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0179","313.79","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0180","198.74","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0180","198.75","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0180","205.92","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0180","207.86","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0185","1.68","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0185","1.72","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0185","1.72","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0185","1.73","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0202","2129.15","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0202","2149.00","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0202","2194.49","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0202","2207.16","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0219","72.57","Inj aval alfa-nqpt 4mg--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0219","72.68","Inj aval alfa-nqpt 4mg--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0221","181.42","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0221","181.57","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0221","186.41","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0221","188.31","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0222","100.78","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0222","97.78","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0222","97.85","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0222","98.97","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0223","106.66","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0223","106.67","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0223","107.96","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0223","109.88","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0248","5.51","Inj remdesivir 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0248","5.51","Inj remdesivir 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0248","5.51","Inj remdesivir 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0256","4.54","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0256","4.55","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0256","4.57","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0256","4.61","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0257","4.97","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0257","4.98","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0257","5.15","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0257","5.18","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0278","0.80","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0278","0.83","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0278","0.91","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0278","0.91","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0280","11.57","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0280","11.71","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0280","6.14","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0280","6.82","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0285","39.34","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0285","41.00","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0285","46.32","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0285","46.32","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0287","10.20","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0287","10.31","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0287","9.60","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0287","9.70","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0289","25.90","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0289","26.36","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0289","27.38","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0289","29.47","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0290","0.65","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0290","0.71","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0290","0.75","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0290","0.76","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0291","3.10","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0291","3.13","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0291","3.14","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0291","3.23","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0295","2.24","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0295","2.41","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0295","2.63","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0295","2.73","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0348","0.54","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0348","0.55","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0348","0.57","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0348","0.61","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0360","4.42","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0360","4.44","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0360","5.35","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0360","6.65","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0401","5.99","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0401","5.99","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0401","6.31","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0401","6.41","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0456","2.53","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0456","2.63","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0456","2.83","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0456","3.12","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0461","0.07","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0461","0.08","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0461","0.09","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0461","0.09","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0475","179.65","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0475","181.57","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0475","182.02","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0475","182.29","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0476","53.47","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0476","57.22","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0476","64.40","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0476","73.06","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0480","4037.65","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0480","4062.84","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0480","4087.67","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0480","4102.57","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0485","3.78","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0485","3.78","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0485","3.78","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0485","3.79","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0490","48.23","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0490","48.25","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0490","49.44","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0490","49.47","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0491","16.16","Inj anifrolumab-fnia 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0491","16.18","Inj anifrolumab-fnia 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0491","16.21","Inj anifrolumab-fnia 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0500","25.64","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0500","26.08","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0500","27.22","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0500","30.39","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0515","14.60","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0515","18.03","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0515","18.44","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0515","19.02","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0517","165.57","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0517","167.44","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0517","168.86","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0517","169.47","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0558","11.78","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0558","11.78","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0558","12.86","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0558","13.17","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0561","15.04","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0561","15.12","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0561","16.48","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0561","16.73","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0565","39.79","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0565","39.87","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0565","39.87","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0565","39.90","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0583","0.29","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0583","0.36","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0583","0.41","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0583","0.42","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0584","380.10","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0584","380.15","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0584","401.50","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0584","402.43","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0585","6.19","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0585","6.19","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0585","6.21","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0585","6.23","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0586","8.31","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0586","8.40","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0586","8.52","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0586","8.63","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0587","12.12","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0587","12.17","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0587","12.17","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0587","12.47","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0588","5.05","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0588","5.06","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0588","5.06","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0588","5.06","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0592","4.03","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0592","4.08","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0592","4.09","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0592","4.10","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0594","1.39","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0594","1.45","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0594","1.91","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0594","2.04","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0595","2.89","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0595","2.94","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0595","2.96","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0595","2.97","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0596","30.02","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0596","30.11","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0596","31.60","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0596","31.61","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0597","57.33","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0597","57.40","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0597","60.77","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0597","60.78","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0598","58.96","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0598","58.96","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0598","60.67","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0598","60.72","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0610","3.96","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0610","4.05","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0610","4.29","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0610","4.46","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0630","1777.34","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0630","2231.39","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0630","2644.43","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0630","2841.59","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0636","0.68","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0636","0.69","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0636","0.70","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0636","0.72","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0637","5.33","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0637","5.48","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0637","6.57","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0637","8.42","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0638","115.89","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0638","116.94","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0638","118.61","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0638","118.73","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0640","3.79","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0640","4.02","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0640","4.37","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0640","4.44","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0641","0.09","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0641","0.10","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0641","0.11","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0641","0.27","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0642","1.32","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0642","1.35","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0642","1.46","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0642","1.83","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0670","2.93","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0670","2.95","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0670","3.14","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0670","3.14","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0690","0.72","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0690","0.76","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0690","0.77","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0690","1.37","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0692","1.74","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0692","1.76","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0692","1.78","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0692","1.78","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0694","4.63","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0694","4.66","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0694","4.68","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0694","5.31","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0695","6.35","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0695","6.40","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0695","6.40","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0695","6.64","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0696","0.48","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0696","0.50","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0696","0.51","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0696","0.51","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0697","1.99","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0697","2.04","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0697","2.04","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0697","2.18","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0702","6.55","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0702","6.78","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0702","6.79","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0702","6.82","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0712","3.57","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0712","3.57","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0712","3.73","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0712","3.74","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0713","1.94","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0713","1.96","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0713","1.98","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0713","2.09","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0714","91.64","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0714","91.79","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0714","91.79","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0714","92.37","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0717","5.41","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0717","5.58","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0717","5.64","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0717","6.28","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0720","33.87","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0720","35.09","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0720","35.80","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0720","35.99","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0725","22.63","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0725","23.48","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0725","24.53","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0725","24.54","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0735","22.39","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0735","26.23","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0735","26.30","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0735","33.96","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0740","546.20","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0740","567.92","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0740","583.01","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0740","617.57","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0741","20.54","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0741","20.56","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0741","21.05","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0741","21.06","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0742","2.31","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0742","2.31","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0742","2.38","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0742","2.38","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0743","6.75","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0743","7.35","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0743","8.19","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0743","8.28","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0744","0.93","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0744","0.95","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0744","1.10","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0744","1.28","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0770","14.14","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0770","14.65","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0770","15.17","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0770","15.68","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0775","56.60","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0775","58.79","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0775","58.87","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0775","62.08","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0780","3.75","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0780","4.00","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0780","4.19","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0780","4.19","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0791","124.12","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0791","124.18","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0791","124.62","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0791","125.06","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0800","3780.69","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0800","3788.22","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0800","3879.75","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0800","3932.52","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0834","26.95","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0834","31.06","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0834","32.10","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0834","32.57","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0840","2498.30","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0840","2605.39","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0840","2622.69","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0840","2636.69","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0841","1022.45","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0841","1072.21","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0841","1083.26","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0841","918.85","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0850","1525.46","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0850","1526.58","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0850","1654.66","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0850","1666.71","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0875","14.47","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0875","14.91","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0875","15.16","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0875","15.89","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0878","0.04","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0878","0.05","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0878","0.05","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0878","0.05","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0881","3.09","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0881","3.16","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0881","3.28","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0881","3.32","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0882","3.09","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0882","3.16","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0882","3.28","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0882","3.32","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0885","8.11","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0885","8.22","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0885","8.22","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0885","8.37","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0887","1.51","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0887","1.56","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0887","1.56","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0887","1.62","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0888","1.51","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0888","1.56","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0888","1.56","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0888","1.62","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0894","1.42","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0894","1.59","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0894","2.71","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0894","2.88","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0895","10.42","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0895","7.20","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0895","7.87","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0895","7.93","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0896","37.40","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0896","37.40","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0896","37.93","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0896","37.94","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0897","21.21","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0897","21.26","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0897","22.26","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J0897","22.51","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1000","23.92","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1000","23.96","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1000","26.09","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1000","26.45","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1020","1.49","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1020","3.19","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1020","3.58","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1020","4.61","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1030","5.70","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1030","5.92","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1030","6.93","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1030","7.45","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1040","10.44","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1040","10.52","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1040","11.59","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1040","11.82","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1050","0.14","Medroxyprogesterone acetate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1050","0.57","Medroxyprogesterone acetate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1050","0.57","Medroxyprogesterone acetate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1100","0.11","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1100","0.12","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1100","0.13","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1100","0.13","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1110","54.93","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1110","57.01","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1110","58.10","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1110","58.24","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1120","21.57","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1120","22.49","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1120","22.55","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1120","23.48","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1160","10.30","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1160","16.01","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1160","20.58","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1160","21.74","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1162","4128.19","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1162","4293.36","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1162","4294.08","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1162","4296.54","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1165","0.44","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1165","0.44","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1165","0.45","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1165","0.51","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1170","2.75","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1170","2.86","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1170","3.29","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1170","3.47","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1190","156.70","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1190","168.78","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1190","181.22","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1190","189.84","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1200","0.80","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1200","1.06","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1200","1.17","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1200","1.51","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1201","15.08","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1201","15.09","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1201","15.11","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1201","15.29","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1205","30.55","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1205","42.31","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1205","43.91","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1205","74.42","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1212","636.41","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1212","636.54","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1212","636.55","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1212","636.56","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1230","16.33","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1230","16.79","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1230","17.04","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1230","17.47","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1240","6.97","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1240","7.12","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1240","7.26","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1240","8.37","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1245","3.49","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1245","3.51","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1245","3.65","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1245","3.70","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1250","6.00","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1250","6.35","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1250","6.54","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1250","6.80","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1265","0.49","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1265","0.64","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1265","0.66","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1265","0.71","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1270","0.30","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1270","0.32","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1270","0.32","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1270","0.39","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1290","501.36","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1290","504.13","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1290","513.74","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1290","520.23","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1300","227.70","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1300","228.02","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1300","228.52","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1300","228.94","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1301","20.49","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1301","20.99","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1301","20.99","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1301","21.42","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1303","223.36","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1303","224.09","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1303","224.63","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1303","224.77","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1306","12.05","Injection inclisiran 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1322","250.30","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1322","250.30","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1322","262.31","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1322","262.67","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1325","15.77","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1325","15.86","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1325","16.26","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1325","16.29","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1335","15.24","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1335","17.24","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1335","20.87","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1335","24.48","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1364","73.65","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1364","75.25","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1364","77.18","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1364","82.90","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1380","10.10","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1380","10.36","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1380","10.73","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1380","9.80","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1410","341.49","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1410","341.50","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1410","353.67","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1410","355.49","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1430","444.10","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1430","454.17","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1430","456.86","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1430","457.18","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1437","22.97","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1437","23.03","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1437","24.22","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1437","24.40","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1439","1.11","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1439","1.12","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1439","1.14","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1439","1.14","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1442","0.98","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1442","0.99","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1442","0.99","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1442","1.00","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1447","0.39","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1447","0.42","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1447","0.44","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1447","0.45","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1448","4.94","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1448","4.95","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1448","4.95","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1448","5.01","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1450","2.61","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1450","2.88","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1450","3.12","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1450","3.14","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1453","0.14","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1453","0.18","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1453","0.18","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1453","0.19","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1454","430.02","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1454","464.38","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1454","466.07","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1454","503.98","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1458","411.91","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1458","411.92","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1458","432.43","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1458","432.71","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1459","45.01","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1459","45.05","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1459","46.70","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1459","46.93","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1460","45.42","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1460","46.16","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1460","46.43","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1460","46.76","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1551","12.03","Inj cutaquig 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1551","12.72","Inj cutaquig 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1555","14.74","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1555","14.75","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1555","14.90","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1555","14.97","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1557","48.34","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1557","50.73","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1557","50.80","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1557","51.07","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1558","13.30","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1558","13.57","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1558","13.66","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1558","13.78","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1559","11.79","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1559","11.79","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1559","12.35","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1559","12.36","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1560","454.19","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1560","461.64","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1560","464.27","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1560","467.56","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1561","43.04","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1561","43.39","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1561","44.67","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1561","46.51","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1566","69.59","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1566","69.93","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1566","73.18","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1566","74.00","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1568","41.61","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1568","41.82","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1568","42.02","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1568","42.10","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1569","43.88","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1569","45.00","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1569","45.23","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1569","46.67","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1570","43.72","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1570","44.67","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1570","47.15","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1570","47.37","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1571","70.60","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1571","73.60","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1571","75.14","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1571","76.11","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1572","35.89","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1572","38.72","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1572","39.87","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1572","40.52","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1575","15.25","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1575","15.42","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1575","15.89","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1575","15.89","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1580","1.41","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1580","1.56","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1580","2.37","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1580","2.66","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1602","14.08","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1602","14.69","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1602","15.01","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1602","16.10","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1610","166.77","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1610","169.74","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1610","170.33","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1610","171.60","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1626","0.31","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1626","0.34","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1626","0.35","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1626","0.39","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1627","6.07","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1627","6.45","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1627","6.57","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1627","6.71","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1630","0.73","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1630","1.09","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1630","1.25","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1630","1.62","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1631","7.76","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1631","7.78","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1631","8.16","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1631","8.75","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1640","26.63","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1640","26.63","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1640","28.92","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1640","29.03","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1642","0.01","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1642","0.02","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1642","0.02","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1642","0.02","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1644","0.23","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1644","0.24","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1644","0.25","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1644","0.26","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1645","10.01","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1645","11.62","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1645","11.73","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1645","12.69","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1650","0.76","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1650","0.79","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1650","0.80","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1650","0.84","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1652","1.16","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1652","1.22","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1652","1.24","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1652","1.47","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1670","482.08","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1670","516.49","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1670","523.73","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1670","537.77","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1720","14.74","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1720","14.76","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1720","17.57","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1720","17.87","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1740","25.85","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1740","29.27","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1740","33.79","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1740","45.64","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1743","542.61","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1743","542.76","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1743","542.82","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1743","542.94","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1745","35.02","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1745","35.71","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1745","36.51","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1745","37.88","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1746","66.25","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1746","66.49","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1746","69.73","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1746","69.76","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1750","15.77","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1750","15.83","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1750","16.37","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1750","16.53","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1756","0.20","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1756","0.20","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1756","0.22","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1756","0.22","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1786","43.88","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1786","43.97","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1786","44.15","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1786","44.28","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1815","0.90","Insulin injection--5 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1817","10.95","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1817","8.31","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1817","8.47","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1817","8.94","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1823","462.62","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1823","462.87","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1823","462.87","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1823","462.87","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1885","0.47","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1885","0.55","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1885","0.64","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1885","0.65","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1930","63.68","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1930","65.01","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1930","65.97","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1930","66.18","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1931","34.78","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1931","34.78","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1931","35.88","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1931","36.11","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1932","60.89","Inj lanreotide (cipla) 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1940","0.52","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1940","0.60","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1940","0.63","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1940","0.64","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1943","2.94","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1943","2.98","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1943","2.99","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1943","3.00","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1944","2.92","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1944","2.93","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1944","2.95","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1944","2.97","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1950","1366.01","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1950","1421.56","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1950","1477.55","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1950","1495.37","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1951","126.43","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1951","127.05","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1951","133.46","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1951","134.12","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1953","0.09","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1953","0.09","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1953","0.09","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1953","0.10","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1955","21.76","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1955","22.46","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1955","25.38","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1955","28.04","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1956","0.87","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1956","0.88","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1956","0.98","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1956","1.07","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1980","28.89","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1980","29.25","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1980","29.75","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J1980","31.62","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2001","0.02","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2001","0.02","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2001","0.03","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2001","0.03","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2010","10.10","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2010","9.48","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2010","9.59","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2010","9.91","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2020","4.19","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2020","4.86","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2020","5.87","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2020","6.25","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2060","0.72","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2060","0.73","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2060","0.74","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2060","0.96","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2150","2.59","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2150","2.60","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2150","4.35","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2150","4.63","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2175","5.99","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2175","6.11","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2175","6.22","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2175","6.66","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2182","28.69","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2182","28.75","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2182","29.11","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2182","29.31","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2185","0.69","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2185","0.70","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2185","0.73","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2185","0.74","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2210","19.38","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2210","20.20","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2210","20.32","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2210","20.40","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2248","0.48","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2248","0.79","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2248","0.81","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2248","0.86","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2250","0.11","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2250","0.13","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2250","0.17","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2250","0.18","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2260","1.60","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2260","1.61","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2260","1.71","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2260","1.79","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2270","2.94","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2270","2.97","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2270","3.17","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2270","5.13","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2274","11.53","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2274","11.83","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2274","13.89","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2274","22.34","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2278","9.00","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2278","9.05","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2278","9.07","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2278","9.08","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2280","10.10","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2280","8.32","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2280","9.53","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2280","9.67","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2300","2.61","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2300","2.78","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2300","3.07","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2300","3.14","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2310","10.79","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2310","12.14","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2310","9.59","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2310","9.98","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2315","3.52","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2315","3.54","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2315","3.54","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2315","3.74","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2323","23.06","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2323","23.25","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2323","24.03","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2323","24.17","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2350","58.49","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2350","58.91","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2350","60.08","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2350","60.49","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2353","206.56","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2353","206.96","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2353","207.43","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2353","207.51","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2354","0.82","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2354","0.85","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2354","0.97","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2354","1.12","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2356","18.01","Inj tezepelumab-ekko 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2357","37.27","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2357","37.51","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2357","38.12","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2357","38.65","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2358","2.91","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2358","2.92","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2358","2.92","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2358","2.92","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2360","4.07","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2360","4.12","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2360","4.62","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2360","5.19","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2400","29.56","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2400","30.10","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2400","30.45","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2400","30.58","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2405","0.08","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2405","0.09","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2405","0.09","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2405","0.09","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2406","41.53","Injection oritavancin 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2406","42.27","Injection oritavancin 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2406","42.38","Injection oritavancin 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2407","24.40","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2407","24.51","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2407","25.59","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2407","25.81","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2425","23.93","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2425","23.93","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2425","25.12","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2425","25.13","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2426","12.64","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2426","12.65","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2426","13.13","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2426","13.28","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2430","10.15","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2430","10.55","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2430","10.58","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2430","10.98","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2469","0.86","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2469","0.91","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2469","1.15","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2469","1.21","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2501","0.60","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2501","0.69","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2501","0.70","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2501","0.80","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2506","131.41","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2506","155.83","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2506","167.68","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2506","182.03","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2507","2968.61","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2507","2985.85","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2507","3110.56","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2507","3143.50","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2510","30.99","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2510","32.12","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2510","35.23","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2510","35.30","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2515","20.37","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2515","24.13","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2515","24.31","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2515","26.17","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2540","0.69","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2540","0.77","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2540","0.77","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2540","0.78","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2543","1.28","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2543","1.35","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2543","1.42","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2543","1.48","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2545","106.86","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2545","121.21","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2545","124.33","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2545","125.56","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2550","2.36","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2550","2.57","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2550","2.78","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2550","2.94","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2560","40.30","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2560","41.73","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2560","42.24","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2560","44.93","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2562","382.65","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2562","382.78","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2562","402.54","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2562","402.60","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2597","7.61","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2597","7.71","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2597","8.27","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2597","9.29","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2675","1.04","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2675","1.09","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2675","1.11","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2675","1.15","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2680","10.28","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2680","10.51","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2680","10.89","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2680","9.84","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2690","102.45","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2690","106.27","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2690","107.86","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2690","113.93","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2700","1.04","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2700","1.06","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2700","1.23","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2700","1.28","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2704","0.12","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2704","0.13","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2704","0.14","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2704","0.14","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2720","1.41","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2720","1.48","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2720","1.63","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2720","1.81","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2724","15.06","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2724","15.07","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2724","15.09","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2724","15.12","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2760","377.73","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2760","392.68","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2760","413.47","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2760","414.12","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2765","1.04","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2765","1.05","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2765","1.06","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2765","1.07","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2770","337.47","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2770","428.19","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2770","428.33","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2770","493.97","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2777","38.06","Inj faricimab-svoa 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2778","258.41","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2778","275.14","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2778","281.88","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2778","307.20","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2779","80.87","Inj susvimo 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2779","83.23","Inj susvimo 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2783","321.67","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2783","321.80","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2783","330.90","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2783","332.08","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2785","61.29","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2785","61.35","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2785","61.48","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2785","61.50","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2786","10.11","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2786","10.13","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2786","10.23","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2786","9.95","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2788","21.78","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2788","23.19","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2788","24.20","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2788","24.84","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2790","78.50","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2790","78.99","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2790","79.47","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2790","80.41","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2791","4.71","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2791","4.71","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2791","4.72","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2791","4.81","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2792","30.62","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2792","31.52","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2792","31.91","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2792","32.45","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2794","11.04","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2794","11.05","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2794","11.47","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2794","11.59","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2795","0.07","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2795","0.07","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2795","0.07","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2795","0.09","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2796","83.62","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2796","83.90","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2796","87.74","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2796","89.00","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2798","10.67","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2798","10.68","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2798","10.92","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2798","11.16","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2800","5.88","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2800","6.48","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2800","6.51","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2800","7.23","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2805","115.65","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2805","119.08","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2805","119.27","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2805","123.16","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2820","53.56","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2820","54.04","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2820","55.32","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2820","55.44","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2860","125.16","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2860","128.49","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2860","128.53","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2860","132.00","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2916","1.86","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2916","1.92","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2916","1.95","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2916","2.06","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2920","4.19","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2920","4.22","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2920","4.25","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2920","4.28","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2930","5.52","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2930","5.74","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2930","5.89","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2930","6.12","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2997","85.82","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2997","87.67","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2997","88.03","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J2997","88.28","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3000","32.94","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3000","33.37","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3000","38.20","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3000","39.86","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3010","0.67","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3010","0.72","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3010","0.84","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3010","0.89","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3032","16.01","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3032","16.01","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3032","16.41","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3032","16.42","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3060","40.35","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3060","41.23","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3060","41.69","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3060","41.90","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3090","1.66","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3090","1.66","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3090","1.74","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3090","1.74","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3095","6.33","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3095","6.40","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3095","6.69","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3095","7.00","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3101","134.62","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3101","134.76","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3101","139.48","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3101","143.87","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3105","1.80","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3105","12.77","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3105","2.97","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3105","3.20","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3111","9.32","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3111","9.33","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3111","9.70","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3111","9.80","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3145","1.61","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3145","1.65","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3145","1.66","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3145","1.82","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3230","31.23","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3230","31.28","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3230","32.02","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3230","34.01","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3240","1858.04","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3240","1858.66","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3240","1906.93","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3240","1926.71","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3241","315.88","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3241","315.88","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3241","321.37","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3241","321.88","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3243","0.91","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3243","0.97","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3243","1.00","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3243","1.06","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3245","133.59","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3245","137.27","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3245","138.64","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3245","139.28","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3250","42.76","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3250","42.83","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3250","42.88","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3250","43.09","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3260","2.19","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3260","2.24","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3260","2.60","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3260","4.12","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3262","5.73","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3262","5.80","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3262","5.82","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3262","6.16","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3285","55.36","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3285","55.71","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3285","56.81","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3285","57.47","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3300","3.89","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3300","3.90","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3300","3.90","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3300","3.90","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3301","1.09","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3301","1.11","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3301","1.12","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3301","1.29","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3304","16.93","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3304","16.99","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3304","17.50","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3304","17.63","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3315","337.01","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3315","347.65","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3315","363.57","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3315","373.79","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3357","162.85","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3357","166.32","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3357","170.82","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3357","174.69","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3358","11.62","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3358","11.65","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3358","12.29","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3358","12.36","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3360","5.16","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3360","6.58","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3360","6.69","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3360","7.07","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3370","2.74","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3370","2.78","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3370","2.96","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3370","3.23","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3380","21.29","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3380","21.72","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3380","22.30","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3380","22.76","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3385","358.90","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3385","359.73","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3385","359.80","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3385","359.92","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3396","11.24","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3396","11.24","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3396","11.38","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3396","11.52","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3410","10.78","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3410","11.34","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3410","8.43","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3410","9.75","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3411","2.54","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3411","2.56","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3411","2.82","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3411","2.88","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3415","10.13","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3415","10.32","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3415","5.69","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3415","9.66","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3420","1.57","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3420","1.61","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3420","1.80","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3420","1.95","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3430","3.22","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3430","3.31","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3430","3.42","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3430","3.49","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3465","1.03","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3465","1.06","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3465","1.36","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3465","1.83","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3471","0.47","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3471","0.47","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3471","0.49","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3471","0.50","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3475","0.61","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3475","0.75","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3475","0.76","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3475","0.76","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3480","0.15","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3480","0.15","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3480","0.16","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3480","0.17","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3486","10.98","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3486","11.58","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3486","12.52","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3486","13.38","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3489","5.77","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3489","6.64","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3489","8.34","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J3489","8.37","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7030","2.56","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7030","2.69","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7030","2.71","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7030","2.74","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7040","1.28","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7040","1.35","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7040","1.36","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7040","1.37","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7042","0.89","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7042","0.96","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7042","1.02","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7042","1.06","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7050","0.64","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7050","0.67","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7050","0.68","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7050","0.68","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7060","1.74","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7060","1.79","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7060","1.87","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7060","1.89","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7070","3.47","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7070","3.58","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7070","3.73","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7070","3.78","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7120","2.47","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7120","2.48","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7120","2.49","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7120","2.50","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7170","48.68","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7170","48.75","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7170","49.76","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7170","49.90","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7175","8.20","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7175","8.20","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7175","8.55","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7175","8.60","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7178","1.30","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7178","1.34","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7178","1.34","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7178","1.34","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7179","1.80","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7179","1.81","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7179","1.84","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7179","1.86","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7180","9.14","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7180","9.37","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7180","9.38","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7180","9.40","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7181","15.68","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7181","16.12","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7181","16.21","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7181","16.35","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7182","1.13","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7182","1.26","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7182","1.29","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7182","1.53","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7183","1.13","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7183","1.14","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7183","1.15","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7183","1.16","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7185","1.25","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7185","1.26","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7185","1.26","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7185","1.27","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7186","1.13","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7186","1.14","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7186","1.15","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7186","1.15","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7187","1.26","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7187","1.29","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7187","1.29","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7187","1.30","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7189","2.30","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7189","2.31","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7189","2.35","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7189","2.35","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7190","1.07","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7190","1.11","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7190","1.13","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7190","1.14","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7192","1.43","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7192","1.43","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7192","1.45","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7192","1.47","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7193","1.16","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7193","1.17","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7193","1.18","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7193","1.23","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7194","1.53","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7194","1.53","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7194","1.54","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7194","1.57","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7195","1.58","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7195","1.59","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7195","1.63","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7195","1.63","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7197","3.36","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7197","3.50","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7197","3.55","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7197","3.59","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7198","2.20","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7198","2.20","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7198","2.21","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7198","2.28","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7200","1.45","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7200","1.46","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7200","1.49","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7200","1.54","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7201","3.15","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7201","3.15","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7201","3.36","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7201","3.37","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7202","4.61","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7202","4.70","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7202","4.71","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7202","4.76","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7203","4.07","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7203","4.16","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7203","4.20","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7203","4.27","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7204","2.07","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7204","2.10","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7204","2.10","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7204","2.18","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7205","2.11","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7205","2.12","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7205","2.16","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7205","2.17","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7207","1.93","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7207","1.94","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7207","1.99","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7207","2.04","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7208","2.09","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7208","2.11","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7208","2.16","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7208","2.16","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7209","1.24","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7209","1.27","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7209","1.30","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7209","1.32","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7210","1.35","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7210","1.38","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7210","1.39","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7210","1.40","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7211","1.22","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7211","1.23","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7211","1.27","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7211","1.31","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7212","1.97","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7212","2.01","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7212","2.11","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7212","2.20","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7308","391.43","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7308","392.02","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7308","392.09","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7308","393.46","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7311","324.09","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7311","332.61","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7311","334.36","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7311","338.63","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7312","200.00","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7312","200.07","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7312","200.10","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7312","200.12","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7314","518.14","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7314","518.33","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7314","518.34","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7314","518.47","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7318","10.36","Inj durolane 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7318","9.27","Inj durolane 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7320","6.75","Genvisc 850 inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7320","7.05","Genvisc 850 inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7321","74.91","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7321","75.94","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7321","76.09","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7321","76.96","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7322","15.71","Hymovis injection 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7322","16.83","Hymovis injection 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7323","130.89","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7323","131.03","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7323","131.21","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7323","135.24","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7324","131.88","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7324","147.75","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7324","149.47","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7324","154.75","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7325","10.14","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7325","10.43","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7325","10.44","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7325","9.77","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7326","488.09","Gel-one--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7326","492.23","Gel-one--per dose","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7327","754.90","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7327","756.93","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7327","769.61","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7327","790.78","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7328","1.18","Gelsyn-3 injection 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7328","1.28","Gelsyn-3 injection 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7329","10.26","Inj trivisc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7329","13.31","Inj trivisc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7332","9.81","Inj. triluron 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7332","9.96","Inj. triluron 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7340","211.26","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7340","211.40","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7340","211.50","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7340","216.47","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7342","29.84","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7342","29.98","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7342","29.98","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7342","29.99","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7345","1.58","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7345","1.59","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7345","1.59","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7345","1.62","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7351","205.72","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7351","206.04","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7351","206.33","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7351","206.40","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7402","10.56","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7402","10.56","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7402","10.93","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7402","10.93","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7500","12.57","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7500","7.71","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7500","8.10","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7500","9.15","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7502","1.82","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7502","2.13","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7502","2.23","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7502","2.43","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7503","1.51","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7503","1.52","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7503","1.56","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7503","1.56","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7504","2355.36","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7504","2355.95","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7504","2782.17","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7504","2898.30","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7507","0.31","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7507","0.38","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7507","0.45","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7507","0.52","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7508","0.49","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7508","0.50","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7508","0.52","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7508","0.53","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7509","0.25","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7509","0.27","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7509","0.27","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7509","0.28","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7510","0.23","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7510","0.23","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7510","0.25","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7510","0.25","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7511","838.33","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7511","842.94","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7511","896.71","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7511","902.62","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7512","0.01","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7512","0.02","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7512","0.02","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7512","0.02","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7515","0.66","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7515","0.75","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7515","0.78","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7515","0.87","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7516","62.09","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7516","62.23","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7516","62.36","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7516","62.43","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7517","0.23","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7517","0.23","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7517","0.26","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7517","0.30","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7518","1.07","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7518","1.17","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7518","1.18","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7518","1.60","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7520","2.22","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7520","3.42","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7520","4.00","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7520","4.50","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7525","219.67","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7525","219.71","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7525","231.22","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7525","233.60","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7527","4.11","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7527","4.71","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7527","5.68","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7527","5.70","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7605","3.11","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7605","5.09","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7605","6.60","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7605","8.76","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7606","6.78","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7606","7.79","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7606","8.92","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7606","9.88","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7608","5.78","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7608","6.03","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7608","6.11","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7608","7.39","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7611","0.22","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7611","0.25","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7611","0.25","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7611","0.27","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7612","0.27","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7612","0.27","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7612","0.29","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7612","0.30","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7613","0.04","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7613","0.04","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7613","0.05","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7613","0.05","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7614","0.05","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7614","0.06","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7614","0.06","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7614","0.06","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7620","0.12","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7620","0.13","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7620","0.13","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7620","0.13","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7626","0.96","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7626","1.03","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7626","1.04","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7626","1.10","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7631","0.74","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7631","1.26","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7631","2.40","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7631","2.50","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7639","47.80","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7639","47.81","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7639","47.81","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7639","50.16","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7644","0.20","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7644","0.20","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7644","0.20","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7644","0.21","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7677","0.18","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7677","0.19","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7677","0.19","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7677","0.19","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7682","23.25","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7682","23.77","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7682","27.01","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7682","27.77","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7686","671.08","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7686","704.38","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7686","704.63","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J7686","704.64","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8501","3.54","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8501","3.65","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8501","3.70","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8501","4.19","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8520","0.37","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8520","0.41","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8520","0.45","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8520","0.59","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8521","0.80","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8521","0.81","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8521","0.84","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8521","1.27","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8530","0.58","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8530","0.76","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8530","0.88","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8530","0.98","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8540","0.06","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8540","0.09","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8540","0.10","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8540","0.11","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8560","75.51","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8560","75.52","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8560","76.03","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8560","76.09","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8610","0.19","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8610","0.20","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8610","0.22","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8610","0.24","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8655","322.71","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8655","355.57","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8655","379.06","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8655","396.09","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8670","1.71","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8670","1.74","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8670","1.76","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8670","1.77","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8700","0.26","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8700","0.28","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8700","0.31","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8700","0.35","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8705","104.26","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8705","104.30","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8705","104.34","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J8705","104.36","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9000","2.43","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9000","2.51","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9000","3.01","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9000","3.48","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9017","12.33","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9017","12.81","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9017","14.21","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9017","15.37","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9019","427.27","Erwinaze injection--1000 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9019","427.27","Erwinaze injection--1000 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9019","427.27","Erwinaze injection--1000 IU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9021","46.53","Inj aspara rylaze 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9021","46.53","Inj aspara rylaze 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9021","46.53","Inj aspara rylaze 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9022","79.27","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9022","79.58","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9022","82.07","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9022","82.27","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9023","87.48","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9023","87.61","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9023","88.18","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9023","88.38","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9025","0.50","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9025","0.67","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9025","0.72","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9025","0.89","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9027","28.77","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9027","48.40","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9027","49.37","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9027","61.65","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9030","2.83","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9030","2.83","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9030","2.83","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9030","2.85","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9032","43.42","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9032","44.03","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9032","44.36","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9032","44.36","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9033","16.53","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9033","17.70","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9033","19.37","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9033","20.69","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9034","17.43","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9034","17.84","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9034","18.55","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9034","19.08","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9035","67.86","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9035","69.23","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9035","69.49","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9035","69.72","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9036","17.12","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9036","19.37","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9036","21.62","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9036","22.88","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9037","43.16","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9037","43.29","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9037","44.13","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9037","44.25","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9039","124.11","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9039","124.39","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9039","129.82","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9039","131.90","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9040","24.12","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9040","24.30","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9040","25.98","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9040","26.80","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9041","24.66","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9041","44.01","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9041","44.70","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9041","44.79","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9042","196.55","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9042","196.65","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9042","205.56","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9042","205.76","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9043","190.95","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9043","191.31","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9043","195.65","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9043","196.61","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9044","14.87","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9044","15.66","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9044","16.77","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9044","8.37","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9045","2.61","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9045","2.67","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9045","2.77","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9045","2.92","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9047","41.11","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9047","41.34","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9047","43.24","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9047","44.03","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9050","1099.82","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9050","468.03","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9050","760.83","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9050","801.10","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9055","67.62","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9055","67.64","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9055","69.09","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9055","69.41","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9060","1.86","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9060","1.92","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9060","1.93","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9060","2.08","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9061","17.90","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9061","17.91","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9061","18.66","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9061","18.90","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9065","15.08","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9065","17.70","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9065","21.66","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9065","24.31","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9070","21.92","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9070","23.88","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9070","26.87","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9070","27.47","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9071","2.75","Inj cyclophosphamd auromedic--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9100","0.88","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9100","0.92","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9100","1.02","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9100","1.04","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9119","27.25","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9119","27.26","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9119","27.62","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9119","27.67","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9120","557.40","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9120","633.77","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9120","809.06","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9120","838.88","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9130","3.62","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9130","4.01","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9130","4.08","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9130","5.54","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9144","44.88","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9144","45.03","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9144","46.58","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9144","46.76","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9145","56.68","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9145","57.22","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9145","58.75","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9145","59.35","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9150","39.58","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9150","41.24","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9150","44.05","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9150","46.55","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9153","207.63","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9153","212.83","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9153","215.22","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9153","215.41","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9155","4.03","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9155","4.05","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9155","4.06","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9155","4.08","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9171","0.46","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9171","0.47","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9171","0.47","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9171","0.50","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9173","76.86","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9173","77.11","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9173","77.96","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9173","78.20","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9176","6.86","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9176","6.86","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9176","6.95","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9176","6.95","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9177","30.19","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9177","31.34","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9177","31.36","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9177","32.55","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9178","1.40","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9178","1.46","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9178","1.58","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9178","1.66","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9179","125.68","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9179","127.44","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9179","129.35","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9179","132.80","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9181","0.76","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9181","0.77","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9181","0.80","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9181","0.84","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9185","48.06","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9185","57.02","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9185","60.19","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9185","92.21","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9190","1.80","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9190","2.13","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9190","2.13","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9190","2.36","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9198","23.57","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9198","25.08","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9198","25.59","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9198","25.78","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9200","69.89","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9200","89.68","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9200","97.31","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9200","97.42","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9201","3.68","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9201","3.76","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9201","3.85","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9201","3.98","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9202","543.16","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9202","549.64","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9202","572.72","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9202","576.10","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9203","211.11","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9203","211.11","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9203","214.28","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9203","214.28","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9204","212.64","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9204","213.20","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9204","216.25","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9204","216.39","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9205","57.37","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9205","57.51","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9205","60.05","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9205","60.14","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9206","2.30","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9206","2.37","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9206","2.45","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9206","2.60","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9207","114.19","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9207","114.38","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9207","116.74","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9207","117.06","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9208","26.01","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9208","26.49","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9208","26.61","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9208","26.62","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9209","1.53","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9209","1.73","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9209","1.76","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9209","1.77","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9210","362.31","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9210","364.99","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9210","375.71","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9210","380.39","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9211","37.35","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9211","37.74","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9211","41.27","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9211","42.22","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9214","31.85","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9214","31.86","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9214","32.57","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9214","32.74","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9217","166.47","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9217","168.69","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9217","179.27","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9217","200.73","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9218","11.61","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9218","11.72","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9218","13.32","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9218","15.00","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9223","180.23","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9223","180.49","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9223","183.98","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9223","184.22","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9226","38268.92","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9226","42302.58","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9226","42802.12","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9226","43442.33","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9227","68.88","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9227","69.02","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9227","70.45","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9227","70.50","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9228","160.70","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9228","160.83","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9228","163.10","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9228","163.66","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9229","2407.20","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9229","2407.20","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9229","2443.31","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9229","2443.31","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9245","181.51","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9245","186.85","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9245","197.46","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9245","297.10","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9247","497.24","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9247","497.44","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9247","503.50","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9247","503.50","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9250","0.20","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9250","0.21","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9250","0.24","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9250","0.26","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9260","1.97","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9260","2.07","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9260","2.36","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9260","2.62","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9261","127.39","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9261","130.14","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9261","136.94","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9261","155.90","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9262","3.30","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9262","3.30","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9262","3.61","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9262","3.65","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9263","0.06","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9263","0.06","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9263","0.07","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9263","0.07","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9264","12.19","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9264","14.04","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9264","14.19","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9264","14.69","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9266","21561.05","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9266","21561.05","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9266","23554.48","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9266","23577.01","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9267","0.11","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9267","0.12","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9267","0.12","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9267","0.13","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9268","1934.45","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9268","2065.32","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9268","2076.08","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9268","2206.44","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9269","295.90","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9269","296.34","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9269","308.81","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9269","309.41","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9271","52.30","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9271","53.14","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9271","53.70","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9271","54.55","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9272","215.12","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9272","215.19","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9272","220.43","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9272","220.75","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9273","155.90","Inj tisotu vedotin-tftv 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9273","155.91","Inj tisotu vedotin-tftv 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9280","47.16","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9280","48.87","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9280","50.66","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9280","54.29","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9281","281.22","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9281","281.79","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9281","285.10","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9281","285.36","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9293","29.40","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9293","33.92","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9293","35.79","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9293","53.34","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9298","180.64","Inj nivol relatlimab 3mg-1mg--3 mg-1 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9299","29.24","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9299","29.25","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9299","29.55","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9299","29.69","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9301","63.82","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9301","64.11","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9301","66.01","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9301","67.35","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9303","130.41","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9303","130.79","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9303","136.97","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9303","139.67","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9305","47.75","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9305","76.04","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9305","76.38","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9305","78.39","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9306","13.56","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9306","13.56","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9306","14.15","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9306","14.44","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9307","319.73","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9307","321.09","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9307","321.09","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9307","321.09","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9308","63.56","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9308","63.69","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9308","65.62","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9308","65.67","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9309","113.57","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9309","113.57","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9309","117.81","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9309","118.11","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9311","37.88","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9311","37.90","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9311","37.96","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9311","38.21","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9312","82.25","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9312","84.17","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9312","85.44","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9312","85.63","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9316","69.85","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9316","70.37","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9316","70.86","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9316","71.65","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9317","31.26","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9317","31.26","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9317","32.03","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9317","32.04","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9319","32.79","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9319","33.23","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9319","33.23","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9319","33.23","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9320","332.98","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9320","347.88","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9320","348.84","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9320","349.38","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9325","57.17","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9325","57.22","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9325","59.68","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9325","60.62","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9328","10.40","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9328","10.40","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9328","10.41","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9328","10.41","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9330","31.88","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9330","32.91","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9330","34.75","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9330","35.35","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9332","31.53","Inj efgartigimod 2mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9332","31.53","Inj efgartigimod 2mg--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9340","298.19","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9340","299.07","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9340","305.45","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9340","306.84","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9349","12.78","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9349","12.80","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9349","12.97","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9349","12.97","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9351","0.83","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9351","0.90","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9351","1.11","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9351","1.12","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9352","325.03","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9352","325.03","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9352","330.18","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9352","331.85","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9353","43.68","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9353","43.76","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9353","44.03","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9353","44.17","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9354","34.14","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9354","34.15","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9354","35.62","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9354","35.70","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9355","84.40","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9355","86.41","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9355","86.61","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9355","88.60","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9356","67.81","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9356","68.73","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9356","70.96","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9356","71.49","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9357","1284.60","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9357","1412.23","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9357","1435.66","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9357","1437.85","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9358","24.60","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9358","24.62","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9358","25.17","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9358","25.21","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9359","186.83","Inj lon tesirin-lpyl 0.075mg--0.075 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9359","188.30","Inj lon tesirin-lpyl 0.075mg--0.075 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9359","188.98","Inj lon tesirin-lpyl 0.075mg--0.075 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9360","3.91","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9360","3.91","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9360","4.01","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9360","4.02","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9370","4.88","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9370","4.91","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9370","4.94","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9370","4.99","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9390","11.00","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9390","11.40","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9390","8.62","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9390","9.27","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9395","11.05","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9395","11.61","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9395","14.02","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9395","15.65","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9400","7.13","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9400","7.66","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9400","8.09","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"J9400","8.22","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0138","0.53","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0138","0.70","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0138","0.93","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0138","1.09","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0139","0.53","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0139","0.70","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0139","0.93","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0139","1.00","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0162","0.01","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0162","0.01","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0162","0.01","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0162","0.02","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0164","0.26","Prochlorperazine maleate 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0164","0.43","Prochlorperazine maleate 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0164","0.44","Prochlorperazine maleate 5mg--5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0167","0.50","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0167","0.59","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0167","0.84","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0167","0.88","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q0222","2394.00","Bebtelovimab 175 mg--175 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2043","52421.58","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2043","52916.50","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2043","53505.53","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2043","55114.75","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2050","111.99","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2050","129.99","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2050","178.82","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q2050","200.52","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q3027","54.46","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q3027","54.83","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q3027","54.84","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q3027","56.07","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4074","139.22","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4074","139.48","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4074","140.05","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4074","140.41","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4081","0.81","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4081","0.82","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4081","0.82","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4081","0.84","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4101","30.37","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4101","30.42","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4101","30.44","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4101","30.51","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4102","10.30","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4102","11.62","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4102","12.03","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4102","9.80","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4106","25.54","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4106","26.76","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4106","29.21","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4106","31.97","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4110","40.33","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4110","41.80","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4110","42.41","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4110","42.70","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4111","6.90","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4111","6.99","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4111","7.19","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4111","7.21","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4121","43.22","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4121","43.82","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4121","44.54","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4121","46.05","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4133","131.04","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4133","134.06","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4133","135.42","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4133","135.47","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4137","101.04","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4137","111.06","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4137","97.37","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4137","98.48","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4145","19.48","Epifix inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4151","127.55","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4151","131.84","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4151","133.67","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4151","134.79","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4159","470.93","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4159","534.89","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4159","535.09","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4159","535.60","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4160","91.19","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4160","92.34","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4160","93.83","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4160","95.94","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4163","148.55","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4163","150.58","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4163","90.42","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4163","97.37","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4186","154.31","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4186","155.24","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4186","156.17","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4186","156.22","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4187","223.73","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4187","232.61","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4187","235.88","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4187","237.06","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4195","71.23","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4195","71.23","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4195","73.25","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4195","83.40","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4196","108.33","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4196","109.02","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4196","109.45","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q4196","110.65","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5101","0.23","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5101","0.27","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5101","0.28","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5101","0.31","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5103","30.95","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5103","33.26","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5103","38.68","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5103","40.57","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5104","39.58","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5104","48.65","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5104","51.25","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5104","61.10","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5105","0.81","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5105","0.81","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5105","0.83","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5105","0.84","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5106","8.13","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5106","8.13","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5106","8.26","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5106","8.40","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5107","30.31","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5107","32.24","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5107","36.13","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5107","39.77","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5108","141.11","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5108","165.27","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5108","179.85","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5108","204.14","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5110","0.34","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5110","0.34","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5110","0.36","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5110","0.40","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5111","163.60","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5111","171.87","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5111","183.41","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5111","202.10","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5112","61.11","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5112","63.12","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5112","68.50","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5112","76.89","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5113","42.96","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5113","48.50","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5113","52.59","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5113","52.97","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5114","45.32","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5114","47.80","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5114","50.11","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5114","55.72","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5115","48.34","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5115","53.02","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5115","53.69","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5115","57.35","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5116","40.01","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5116","45.48","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5116","51.02","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5116","55.79","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5117","32.70","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5117","38.49","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5117","42.88","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5117","47.41","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5118","38.66","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5118","41.86","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5118","45.86","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5118","50.59","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5119","39.74","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5119","44.03","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5119","49.82","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5119","56.37","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5120","135.55","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5120","153.33","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5120","178.55","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5120","222.86","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5121","36.42","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5121","38.65","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5121","43.29","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5121","45.30","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5122","171.38","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5122","217.69","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5122","243.05","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5122","269.14","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5123","48.60","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5123","49.84","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5123","56.59","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q5123","64.33","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9950","18.49","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9950","18.60","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9950","18.93","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9950","18.97","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9956","30.44","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9956","30.50","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9956","30.57","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9956","30.77","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9957","45.66","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9957","45.75","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9957","45.85","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9957","46.15","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9958","0.07","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9958","0.07","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9958","0.07","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9958","0.08","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9961","0.24","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9961","0.24","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9961","0.24","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9961","0.25","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9963","0.18","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9963","0.19","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9963","0.19","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9963","0.23","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9965","0.78","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9965","0.81","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9965","0.82","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9965","0.89","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9966","0.32","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9966","0.34","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9966","0.34","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9966","0.35","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9991","1781.31","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9991","1787.03","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9991","1842.18","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9991","1858.61","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9992","1781.31","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '04/01/2022' AND [Claim Begin Date] <= '06/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9992","1787.03","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '01/01/2022' AND [Claim Begin Date] <= '03/31/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9992","1842.18","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '10/01/2022' AND [Claim Begin Date] <= '12/31/9999'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","CPTRM",,,,,"Q9992","1858.61","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"[Claim Begin Date] >= '07/01/2022' AND [Claim Begin Date] <= '09/30/2022'AND FS Claim-Line Unit Charge > 400",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0800","70.00","Inpatient Renal Dialysis - General","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0801","70.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0802","70.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0803","70.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0804","70.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Carve Out Term","UB92RM",,,,,"0809","70.00","Inpatient Renal Dialysis - Other","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Dialysis Rate","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","1300.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","1300.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Independent Medical Systems","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integra Group","HD All","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integra Group","HD All","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integra Group","HD All","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integra Group","HD All","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integrated Health Plan Regional","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integrated Health Plan Regional","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integrated Health Plan Regional","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Integrated Health Plan Regional","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Carve Out Term","UB92RM",,,,,"0801","450.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Carve Out Term","UB92RM",,,,,"0803","450.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Carve Out Term","UB92RM",,,,,"0804","450.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[UBRev Code] IN ('0110' '0120' '0200' '0201' '0202' '0203' '0206' '0214')",,,,,,,,"ICU CCU Per Diem","2743.16",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[UBRev Code] IN ('0110' '0120' '0200' '0201' '0202' '0203' '0206' '0214')",,,,,,,,"Intermediate ICU CCU Per Diem","2743.16",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"[UBRev Code] IN ('0110' '0120' '0200' '0201' '0202' '0203' '0206' '0214')",,,,,,,,"Med Surg Per Diem","2743.16",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","35",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","30.89",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Medical Mutual","Med Adv","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MedPartners dba Lutheran Preferred Network","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MedPartners dba Lutheran Preferred Network","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MedPartners dba Lutheran Preferred Network","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MedPartners dba Lutheran Preferred Network","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","COMM","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","COMM","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","COMM","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","110","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","MCD Lima","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","MCD Lima","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Admission Date] >= '01/01/2018'","16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","MED ADV","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","MED ADV","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Meridian Health Plan OH","MED ADV","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Molina Healthcare of Ohio Lima","Commercial Exchange","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Molina Healthcare of Ohio Lima","Commercial Exchange","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Molina Healthcare of Ohio Lima","Commercial Exchange","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","71",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","72",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","73",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","74",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","71",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","72",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","73",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","74",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD Multiplan","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 100000","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 101925","69",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102009","69",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102112","69",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102224","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102252","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102383","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102439","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102449","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102467","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102794","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102813","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 102907","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103093","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103271","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103374","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103383","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103533","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103542","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103607","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103645","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103645","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103692","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103869","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103879","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103916","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103944","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 103953","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104131","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104206","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104234","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104262","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104299","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104327","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104346","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104383","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104430","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104748","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104748","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104832","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104935","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 104953","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 105019","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 105757","66",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 107000","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 107084","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 107318","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Accumulated Daily Charges >= 115215","61",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount * 0.70","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0350","600.00","CT Scan - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0351","600.00","CT Scan - Head","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0352","600.00","CT Scan - Body","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0359","600.00","CT Scan - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0800","470.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0801","470.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0802","470.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0803","470.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0804","470.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0809","470.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0820","470.00","Hemodialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0821","470.00","Hemodialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0822","470.00","Hemodialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0823","470.00","Hemodialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0824","470.00","Hemodialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0825","470.00","Hemodialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0829","470.00","Hemodialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0830","470.00","Peritoneal Dialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0831","470.00","Peritoneal Dialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0832","470.00","Peritoneal Dialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0833","470.00","Peritoneal Dialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0834","470.00","Peritoneal Dialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0835","470.00","Peritoneal Dialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Carve Out Term","UB92RM",,,,,"0839","470.00","Peritoneal Dialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2200.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","2200.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"[UBRev Code] IN ('0114' '0124' '0134' '0144' '0154' '1000' '1001') OR [Final DRG] IN ('880' '881' '882' '883' '884' '885' '886' '887')","73",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","61",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","65",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","66",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","67",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","68",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","69",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","MultiPlan","HD PHCS","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","70",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0419","400.00",,"Case Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0636","35.00",,"Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 4000",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0800","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0801","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0802","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0803","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0804","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Carve Out Term","UB92RM",,,,,"0809","470.00",,"Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2250.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","2050.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","NaphCare OH","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1850.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Health ChoiceAccess Health Choice","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Health ChoiceAccess Health Choice","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","63.6",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Health ChoiceAccess Health Choice","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Health ChoiceAccess Health Choice","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","63.6",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Preferred Network Inc","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Preferred Network Inc","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Preferred Network Inc","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Ohio Preferred Network Inc","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0250","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0251","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0252","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0253","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0254","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0255","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0256","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0257","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0258","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0259","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0350","450.00","CT SCAN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0351","450.00","CT SCAN/HEAD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0352","450.00","CT SCAN/BODY","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0359","450.00","CT SCAN/OTHER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0413","450.00","HYPERBARIC O2","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0636","55.00",,"Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0800","400.00","RENAL DIALYSIS","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0801","400.00","DIALY/INPT","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0802","400.00","DIALY/INPT/PER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0803","400.00","DIALY/INPT/CAPD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0804","400.00","DIALY/INPT/CCPD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Carve Out Term","UB92RM",,,,,"0809","400.00","DIALY/INPT/OTHER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Dialysis Rate","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2000.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","1800.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1200.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paradigm Management Services","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","60",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0100","1500.00","All Inclusive Rate - Room & Board & Ancillary","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0101","1500.00","All Inclusive Rate - Room & Board","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0110","1500.00","Room and Board Private (one bed) - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0111","1500.00","Room and Board Private (one bed) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0112","1500.00","Room and Board Private (one bed) - OB","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0113","1500.00","Room and Board Private (one bed) - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0114","1500.00","Room and Board Private (one bed) - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0115","1500.00","Room and Board Private (one bed) - Hospice","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0116","1500.00","Room and Board Private (one bed) - Detoxification","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0117","1500.00","Room and Board Private (one bed) - Oncology","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0118","1500.00","Room and Board Private (one bed) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0119","1500.00","Room and Board Private (one bed) - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0120","1500.00","Room and Board Semiprivate (two beds) - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0121","1500.00","Room and Board Semiprivate (two beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0122","1500.00","Room and Board Semiprivate (two beds) - OB","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0123","1500.00","Room and Board Semiprivate (two beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0124","1500.00","Room and Board Semiprivate (two beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0125","1500.00","Room and Board Semiprivate (two beds) - Hospice","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0126","1500.00","Room and Board Semiprivate (two beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0127","1500.00","Room and Board Semiprivate (two beds) - Oncology","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0128","1500.00","Room and Board Semiprivate (two beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0129","1500.00","Room and Board Semiprivate (two beds) - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0130","1500.00","Room and Board (3 and 4 beds) - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0131","1500.00","Room and Board (3 and 4 beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0132","1500.00","Room and Board (3 and 4 beds) - OB","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0133","1500.00","Room and Board (3 and 4 beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0134","1500.00","Room and Board (3 and 4 beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0135","1500.00","Room and Board (3 and 4 beds) - Hospice","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0136","1500.00","Room and Board (3 and 4 beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0137","1500.00","Room and Board (3 and 4 beds) - Oncology","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0138","1500.00","Room and Board (3 and 4 beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0139","1500.00","Room and Board (3 and 4 beds) - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0140","1500.00","Room and Board Deluxe Private - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0141","1500.00","Room and Board Deluxe Private - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0142","1500.00","Room and Board Deluxe Private - OB","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0143","1500.00","Room and Board Deluxe Private - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0144","1500.00","Room and Board Deluxe Private - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0145","1500.00","Room and Board Deluxe Private - Hospice","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0146","1500.00","Room and Board Deluxe Private - Detoxification","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0147","1500.00","Room and Board Deluxe Private - Oncology","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0148","1500.00","Room and Board Deluxe Private - Rehabilitation","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0149","1500.00","Room and Board Deluxe Private - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0150","1500.00","Room and Board Ward - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0151","1500.00","Room and Board Ward - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0152","1500.00","Room and Board Ward - OB","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0153","1500.00","Room and Board Ward - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0154","1500.00","Room and Board Ward - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0155","1500.00","Room and Board Ward - Hospice","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0156","1500.00","Room and Board Ward - Detoxification","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0157","1500.00","Room and Board Ward - Oncology","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0158","1500.00","Room and Board Ward - Rehabilitation","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0159","1500.00","Room and Board Ward - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0160","1500.00","Other Room and Board - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0164","1500.00","Other Room and Board - Sterile","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0167","1500.00","Other Room and Board - Self Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0169","1500.00","Other Room and Board - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0170","1500.00","Nursery - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0171","1500.00","Nursery - Newborn Level I","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0172","1500.00","Nursery - Newborn Level II","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0173","1500.00","Nursery - Newborn Level III","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0174","1500.00","Nursery - Newborn Level IV","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0179","1500.00","Nursery - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0180","1500.00","Leave of Absence - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0182","1500.00","Leave of Absence - Patient Convience Charges Billable","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0183","1500.00","Leave of Absence - Therapeutic Leave","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0185","1500.00","Leave of Absence - Nursing Home (for Hospitalization)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0189","1500.00","Leave of Absence - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0190","1500.00","Subacute - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0191","1500.00","Subacute - Level I/Skilled Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0192","1500.00","Subacute - Level II/Comprehensive Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0193","1500.00","Subacute - Level III/Complex Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0194","1500.00","Subacute - Level IV/Intensive Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0199","1500.00","Subacute - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0200","1500.00","Intensive Care Unit - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0201","1500.00","Intensive Care Unit - Surgical","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0202","1500.00","Intensive Care Unit - Medical ","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0203","1500.00","Intensive Care Unit - Pediatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0204","1500.00","Intensive Care Unit - Psychiatric","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0206","1500.00","Intensive Care Unit - Intermediate ICU","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0207","1500.00","Intensive Care Unit - Burn care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0208","1500.00","Intensive Care Unit - Trauma","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0209","1500.00","Intensive Care Unit - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0210","1500.00","Coronary Care Unit - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0211","1500.00","Coronary Care Unit - Myocardial Infarction","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0212","1500.00","Coronary Care Unit - Pulmonary Care","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0213","1500.00","Coronary Care Unit - Heart Transplant","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0214","1500.00","Coronary Care Unit - Intermediate CCU","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Paramount Advantage","HD","I","Standard Term","UB92RM",,,,,"0219","1500.00","Coronary Care Unit - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Parkview Health Plan IN","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Parkview Health Plan IN","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Parkview Health Plan IN","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Parkview Health Plan IN","HD","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Qualcare","Combined All","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Qualcare","Combined All","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Qualcare","Combined All","L","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Qualcare","Combined All","L","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Sterling Life Insurance Company","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Sterling Life Insurance Company","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Sterling Life Insurance Company","HD","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0250","70.00","Pharmacy - General","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0251","70.00","Pharmacy - Generic Drugs","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0252","70.00","Pharmacy - Nongeneric Drugs","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0253","70.00","Pharmacy - Take Home Drugs","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0254","70.00","Pharmacy - Drugs Incident to Other Diagnostic Services","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0255","70.00","Pharmacy - Drugs Incident to Radiology","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0256","70.00","Pharmacy - Experimental Drugs","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0257","70.00","Pharmacy - Non-Prescription","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0258","70.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0259","70.00","Pharmacy - Other","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0350","450.00","CT SCAN","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0351","450.00","CT SCAN/HEAD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0352","450.00","CT SCAN/BODY","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0359","450.00","CT SCAN/OTHER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0413","450.00","HYPERBARIC O2","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0800","450.00","RENAL DIALYSIS","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0801","450.00","DIALY/INPT","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0802","450.00","DIALY/INPT/PER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0803","450.00","DIALY/INPT/CAPD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0804","450.00","DIALY/INPT/CCPD","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Carve Out Term","UB92RM",,,,,"0809","450.00","DIALY/INPT/OTHER","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Dialysis Rate","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2100.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","1900.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1500.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","The Reny Company","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Three Rivers Provider Network","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Three Rivers Provider Network","HD","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Traditional Medicare PPS","Medicare Advantage","I","Adjustment Term","AdvanceCriteriaCalculationRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Total Payments + 0.05 OR Calculated Reimbursement < Total Payments - 0.05 AND Calculated Reimbursement > 0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"((([Calculated Reimbursement] - [835 Patient Responsibility]) * -0.02 ) ) ", "4851","Kindred Hospital Lima","Traditional Medicare PPS","Medicare Advantage","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Traditional Medicare PPS","Medicare Advantage","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Tricare Humana Military Healthcare Services","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Tricare Humana Military Healthcare Services","HD","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Tricare Humana Military Healthcare Services","HD","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Total Detailed Charges] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","United Healthcare formerly Unison","Medicaid","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","United Healthcare formerly Unison","Medicaid","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","18",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","University CompCare","HD","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS/Site Neutral","114","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","VA CCN United Optum Regions 1 2 3","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","VA CCN United Optum Regions 1 2 3","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","VA CCN United Optum Regions 1 2 3","HD","I","Standard Term","MedicareInpatientLTCRM",,,,,,,,,,,,"LTCH PPS","100","",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0250","35.00","Pharmacy - General","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 7500",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0258","35.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 7500",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0419","400.00","Respiratory Services - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0636","35.00","Pharmacy-Extension of 025X - Drugs Requiring Detailed Coding","Percent of Charges","100",,,,,"AND Sum of Fee Schedule Charges > 7500",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0800","470.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0801","470.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0802","470.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0803","470.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0804","470.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Carve Out Term","UB92RM",,,,,"0809","470.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Detoxification Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Hospice Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2100.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","2100.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","1800.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery ICU Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Nursery Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Psychiatric Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1700.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Wellpath","HD KY_NJ_OH_PA_TX","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Subacute Per Diem","0.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"AND Calculated Reimbursement > Claim Billed Amount","100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0258","52.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0419","437.00","Respiratory Services - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0636","52.00","Pharmacy-Extension of 025X - Drugs Requiring Detailed Coding","Percent of Charges","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0800","600.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0801","600.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0802","600.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0803","600.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0804","600.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Carve Out Term","UB92RM",,,,,"0809","600.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"ICU CCU Per Diem","2625.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Intermediate ICU CCU Per Diem","2625.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Med Surg Per Diem","2325.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","YesCare formerly Corizon Health","HD","I","Standard Term","LevelOfCarePerDiemRM",,,,,,,,,,,,,,"",,,,,,,,"Rehabilitation Per Diem","1878.00",,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","I","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","I","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","L","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","L","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","Outpatient","Adjustment Term","PercentOfChargeRM",,,,,,,,,,,,,,"[Billed Amount] <= '0'","0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Zelis NPPN","Combined Comm","Outpatient","Standard Term","PercentOfChargeRM",,,,,,,,,,,,,,"","80",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90670","241.38","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90675","291.79","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90740","140.76","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90747","140.75","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9578","1.75","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9606","174.02","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0122","1.01","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0153","0.44","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0179","311.93","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0257","4.97","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0490","48.23","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0592","4.03","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0636","0.68","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0720","33.87","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0875","14.47","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0878","0.04","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0894","1.42","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0895","7.20","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1160","10.30","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1162","4128.19","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1240","6.97","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1325","15.77","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1450","2.61","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1454","430.02","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1627","6.07","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1650","0.76","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1720","14.74","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1745","35.02","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2001","0.02","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2150","2.59","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2182","28.69","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2250","0.11","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2270","2.94","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2274","11.53","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2300","2.61","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2353","206.56","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2501","0.60","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2506","131.41","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90682","65.26","Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90688","19.91","Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90739","144.21","Hepb vacc 2 dose adult im--1 dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90743","71.72","Hep b vacc adol 2 dose im--1 DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0185","1.68","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0222","97.78","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0285","39.34","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0291","3.10","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0475","179.65","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0491","16.16","Inj anifrolumab-fnia 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0595","2.89","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0638","115.89","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0641","0.09","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0692","1.74","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0742","2.31","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0780","3.75","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0791","124.12","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0840","2498.30","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1030","5.70","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1050","0.14","Medroxyprogesterone acetate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1165","0.44","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1170","2.75","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1265","0.49","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1300","227.70","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1306","12.05","Injection inclisiran 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1410","341.49","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1439","1.11","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1453","0.14","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1570","43.72","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1670","482.08","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1740","25.85","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1950","1366.01","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2357","37.27","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2425","23.93","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2469","0.86","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2779","80.87","Inj susvimo 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2805","115.65","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3090","1.66","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90662","65.26","Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90687","9.95","Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9581","14.74","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0180","198.74","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0480","4037.65","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0558","11.78","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0561","15.04","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0586","8.31","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0594","1.39","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0596","30.02","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0597","57.33","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0598","58.96","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0735","22.39","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0881","3.09","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0885","8.11","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0887","1.51","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0896","37.40","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0897","21.21","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1000","23.92","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1200","0.80","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1250","6.00","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1301","20.49","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1561","43.04","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1571","70.60","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1602","14.08","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1610","166.77","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1743","542.61","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1931","34.78","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1955","21.76","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2020","4.19","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2185","0.69","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2248","0.48","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2354","0.82","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2426","12.64","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2597","7.61","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2770","337.47","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90677","264.74","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90685","21.64","Iiv4 vacc no prsv 0.25 ml im--0.25 mL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0129","43.25","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0132","0.55","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0256","4.54","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0280","6.14","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0348","0.54","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0360","4.42","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0461","0.07","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0565","39.79","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0583","0.29","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0642","1.32","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0696","0.48","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0702","6.55","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0713","1.94","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0714","91.64","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0744","0.93","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1020","1.49","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1040","10.44","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1270","0.30","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1322","250.30","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1380","9.80","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1447","0.39","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1458","411.91","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1551","12.03","Inj cutaquig 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1569","43.88","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1645","10.01","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1815","0.90","Insulin injection--5 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1823","462.62","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1956","0.87","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2060","0.72","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2210","19.38","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2315","3.52","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2550","2.36","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2562","382.65","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2760","377.73","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2800","5.88","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90371","135.59","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90686","20.53","Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90694","66.43","Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90714","27.70","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90759","73.82","Hep b vac 3ag 10mcg 3 dos im--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0178","903.00","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0202","2129.15","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0476","53.47","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0517","165.57","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0588","5.05","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0610","3.96","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0640","3.79","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0690","0.72","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0694","4.63","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0695","6.35","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0717","5.41","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0725","22.63","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0740","546.20","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0841","918.85","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0888","1.51","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1190","156.70","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1212","636.41","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1303","223.36","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1430","444.10","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1442","0.98","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1555","14.74","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1557","48.34","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1558","13.30","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1640","26.63","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1786","43.88","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1932","60.89","Inj lanreotide (cipla) 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2278","9.00","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2356","18.01","Inj tezepelumab-ekko 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2360","4.07","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2405","0.08","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2430","10.15","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2515","20.37","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90376","325.72","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90377","223.61","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90586","141.23","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90744","28.76","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9575","0.13","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9579","1.56","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0133","0.02","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0171","0.72","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0221","181.42","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0223","106.66","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0278","0.80","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0289","25.90","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0585","6.19","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0587","12.12","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0630","1777.34","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0775","56.60","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1205","30.55","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1230","16.33","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1245","3.49","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1448","4.94","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1566","69.59","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1572","35.89","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1652","1.16","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2510","30.99","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2543","1.28","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2690","102.45","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2700","1.04","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2778","258.41","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2790","78.50","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2796","83.62","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2860","125.16","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3060","40.35","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3095","6.33","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3111","9.32","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3241","315.88","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3360","5.16","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3415","5.69","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90674","29.94","Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9589","1199.10","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0172","5.64","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0219","72.57","Inj aval alfa-nqpt 4mg--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0248","5.51","Inj remdesivir 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0287","9.60","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0290","0.65","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0456","2.53","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0500","25.64","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0637","5.33","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0712","3.57","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0741","20.54","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0743","6.75","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0834","26.95","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0850","1525.46","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0882","3.09","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1290","501.36","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1335","15.24","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1437","22.97","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1626","0.31","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1642","0.01","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1756","0.20","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1885","0.47","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1951","126.43","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2280","8.32","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2310","9.59","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2323","23.06","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2350","58.49","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2358","2.91","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2540","0.69","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2545","106.86","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2720","1.41","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2788","21.78","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3010","0.67","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3304","16.93","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3315","337.01","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3385","358.90","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3396","11.24","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3105","1.80","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3240","1858.04","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3465","1.03","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3475","0.61","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7060","1.74","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7180","9.14","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7192","1.43","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7193","1.16","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7200","1.45","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7204","2.07","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7308","391.43","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7312","200.00","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7318","9.27","Inj durolane 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7329","10.26","Inj trivisc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7332","9.81","Inj. triluron 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7510","0.23","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7520","2.22","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7525","219.67","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7605","3.11","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9000","2.43","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9025","0.50","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9032","43.42","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9044","8.37","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9061","17.90","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9070","21.92","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9130","3.62","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9198","23.57","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9227","68.88","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9250","0.20","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9268","1934.45","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9281","281.22","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9293","29.40","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9298","180.64","Inj nivol relatlimab 3mg-1mg--3 mg-1 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9299","29.24","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9301","63.82","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9303","130.41","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9306","13.56","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2786","9.95","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2920","4.19","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3230","31.23","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3243","0.91","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3370","2.74","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7040","1.28","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7120","2.47","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7186","1.13","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7311","324.09","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7327","754.90","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7328","1.18","Gelsyn-3 injection 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7507","0.31","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7512","0.01","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7516","62.09","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7517","0.23","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7608","5.78","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7612","0.27","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7626","0.96","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7639","47.80","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8670","1.71","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8705","104.26","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9030","2.83","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9035","67.86","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9045","2.61","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9050","468.03","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9171","0.46","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9179","125.68","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9190","1.80","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9214","31.85","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9217","166.47","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9267","0.11","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9305","47.75","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9309","113.57","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9320","332.98","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9325","57.17","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9359","186.83","Inj lon tesirin-lpyl 0.075mg--0.075 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9370","4.88","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2930","5.52","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2997","85.82","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3000","32.94","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3145","1.61","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3245","133.59","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3285","55.36","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3300","3.89","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3411","2.54","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3430","3.22","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3486","10.98","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7050","0.64","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7170","48.68","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7181","15.68","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7182","1.13","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7202","4.61","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7208","2.09","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7209","1.24","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7314","518.14","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7321","74.91","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7325","9.77","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7515","0.66","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7518","1.07","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7613","0.04","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7614","0.05","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7686","671.08","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8521","0.80","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9017","12.33","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9034","17.43","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9120","557.40","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9144","44.88","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9145","56.68","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9153","207.63","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9200","69.89","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9202","543.16","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9206","2.30","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9209","1.53","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9210","362.31","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2680","9.84","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2704","0.12","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2724","15.06","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2785","61.29","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2795","0.07","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2798","10.67","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3358","11.62","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3410","8.43","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7030","2.56","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7070","3.47","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7178","1.30","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7190","1.07","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7194","1.53","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7201","3.15","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7322","15.71","Hymovis injection 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7323","130.89","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7508","0.49","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8520","0.37","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8655","322.71","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9119","27.25","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9150","39.58","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9185","48.06","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9203","211.11","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9204","212.64","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9360","3.91","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0139","0.53","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0162","0.01","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q2050","111.99","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4101","30.37","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4133","131.04","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4159","470.93","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5112","61.11","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5116","40.01","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5120","135.55","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5121","36.42","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9965","0.78","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2675","1.04","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2777","38.06","Inj faricimab-svoa 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2791","4.71","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2794","11.04","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2820","53.56","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3032","16.01","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3262","5.73","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3301","1.09","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3357","162.85","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3380","21.29","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3420","1.57","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7179","1.80","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7185","1.25","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7187","1.26","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7197","3.36","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7203","4.07","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7340","211.26","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7345","1.58","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7504","2355.36","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7606","6.78","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7631","0.74","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7677","0.18","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9021","46.53","Inj aspara rylaze 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9036","17.12","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9039","124.11","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9055","67.62","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9155","4.03","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9205","57.37","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9207","114.19","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9247","497.24","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9316","69.85","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9317","31.26","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9328","10.40","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9330","31.88","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9332","31.53","Inj efgartigimod 2mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9352","325.03","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9354","34.14","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9356","67.81","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90375","213.24","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90632","64.74","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90672","26.88","VACCINE--Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90715","35.64","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90756","28.37","Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9576","1.43","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9577","1.85","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9585","0.32","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0121","3.30","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0295","2.24","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0401","5.99","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0485","3.78","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0515","14.60","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0584","380.10","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0670","2.93","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0697","1.99","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0770","14.14","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0800","3780.69","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1100","0.11","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1110","54.93","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1120","21.57","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1201","15.08","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1364","73.65","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1459","45.01","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1460","45.42","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1559","11.79","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1560","454.19","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1568","41.61","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1575","15.25","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1580","1.41","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1630","0.73","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1631","7.76","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1644","0.23","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1746","66.25","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4110","40.33","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4111","6.90","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4160","91.19","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5104","39.58","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5106","8.13","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5107","30.31","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5108","141.11","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9963","0.18","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9992","1781.31","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0182","1500.00","Leave of Absence - Patient Convience Charges Billable","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0191","1500.00","Subacute - Level I/Skilled Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0194","1500.00","Subacute - Level IV/Intensive Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0203","1500.00","Intensive Care Unit - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0351","450.00","CT SCAN/HEAD","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0800","70.00","Inpatient Renal Dialysis - General","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0801","400.00","DIALY/INPT","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0802","400.00","DIALY/INPT/PER","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0829","470.00","Hemodialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0833","470.00","Peritoneal Dialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9319","32.79","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0167","0.50","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4187","223.73","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5101","0.23","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5113","42.96","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5123","48.60","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9957","45.66","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9958","0.07","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0100","1500.00","All Inclusive Rate - Room & Board & Ancillary","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0101","1500.00","All Inclusive Rate - Room & Board","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0111","1500.00","Room and Board Private (one bed) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0118","1500.00","Room and Board Private (one bed) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0123","1500.00","Room and Board Semiprivate (two beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0125","1500.00","Room and Board Semiprivate (two beds) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0128","1500.00","Room and Board Semiprivate (two beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0130","1500.00","Room and Board (3 and 4 beds) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0136","1500.00","Room and Board (3 and 4 beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0139","1500.00","Room and Board (3 and 4 beds) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0140","1500.00","Room and Board Deluxe Private - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0146","1500.00","Room and Board Deluxe Private - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0156","1500.00","Room and Board Ward - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0169","1500.00","Other Room and Board - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0170","1500.00","Nursery - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0174","1500.00","Nursery - Newborn Level IV","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0202","1500.00","Intensive Care Unit - Medical ","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0207","1500.00","Intensive Care Unit - Burn care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0210","1500.00","Coronary Care Unit - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0213","1500.00","Coronary Care Unit - Heart Transplant","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0250","35.00","Pharmacy - General","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0252","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0255","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0820","470.00","Hemodialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0823","470.00","Hemodialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0835","470.00","Peritoneal Dialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3471","0.47","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3489","5.77","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7183","1.13","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7324","131.88","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7342","29.84","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7502","1.82","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7503","1.51","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7611","0.22","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7620","0.12","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8540","0.06","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8700","0.26","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9022","79.27","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9027","28.77","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9033","16.53","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9043","190.95","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9065","15.08","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9177","30.19","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9178","1.40","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9201","3.68","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9218","11.61","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9228","160.70","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9260","1.97","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9264","12.19","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9271","52.30","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9272","215.12","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9311","37.88","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9395","11.05","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0164","0.26","Prochlorperazine maleate 5mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4151","127.55","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5105","0.81","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5110","0.34","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5117","32.70","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9956","30.44","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9991","1781.31","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0110","1500.00","Room and Board Private (one bed) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0113","1500.00","Room and Board Private (one bed) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0120","1500.00","Room and Board Semiprivate (two beds) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3480","0.15","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7175","8.20","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7195","1.58","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7205","2.11","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7211","1.22","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7212","1.97","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7320","6.75","Genvisc 850 inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7500","7.71","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7511","838.33","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7527","4.11","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7682","23.25","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8501","3.54","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8560","75.51","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8610","0.19","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9023","87.48","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9037","43.16","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9040","24.12","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9041","24.66","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9042","196.55","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9047","41.11","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9173","76.86","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9211","37.35","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9261","127.39","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9263","0.06","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9280","47.16","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9353","43.68","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0222","2394.00","Bebtelovimab 175 mg--175 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4081","0.81","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4121","43.22","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4195","71.23","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5111","163.60","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5122","171.38","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9961","0.24","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9966","0.32","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9226","38268.92","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9229","2407.20","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9245","181.51","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9266","21561.05","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9269","295.90","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9351","0.83","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9355","84.40","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9400","7.13","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0138","0.53","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q2043","52421.58","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4106","25.54","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4163","90.42","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5103","30.95","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5118","38.66","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0116","1500.00","Room and Board Private (one bed) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0119","1500.00","Room and Board Private (one bed) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0138","1500.00","Room and Board (3 and 4 beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0148","1500.00","Room and Board Deluxe Private - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0159","1500.00","Room and Board Ward - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0167","1500.00","Other Room and Board - Self Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0190","1500.00","Subacute - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0253","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0258","35.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0801","70.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0802","70.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0803","400.00","DIALY/INPT/CAPD","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0809","400.00","DIALY/INPT/OTHER","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0821","470.00","Hemodialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9357","1284.60","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q3027","54.46","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4102","9.80","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4137","97.37","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4186","154.31","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4196","108.33","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5115","48.34","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5119","39.74","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0143","1500.00","Room and Board Deluxe Private - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0155","1500.00","Room and Board Ward - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0180","1500.00","Leave of Absence - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0185","1500.00","Leave of Absence - Nursing Home (for Hospitalization)","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0192","1500.00","Subacute - Level II/Comprehensive Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0199","1500.00","Subacute - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0419","400.00",,"Case Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0800","400.00","RENAL DIALYSIS","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0803","70.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0804","70.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0809","70.00","Inpatient Renal Dialysis - Other","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0834","470.00","Peritoneal Dialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0112","1500.00","Room and Board Private (one bed) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0115","1500.00","Room and Board Private (one bed) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0127","1500.00","Room and Board Semiprivate (two beds) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0129","1500.00","Room and Board Semiprivate (two beds) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0137","1500.00","Room and Board (3 and 4 beds) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0149","1500.00","Room and Board Deluxe Private - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0157","1500.00","Room and Board Ward - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0158","1500.00","Room and Board Ward - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0173","1500.00","Nursery - Newborn Level III","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0179","1500.00","Nursery - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0189","1500.00","Leave of Absence - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0251","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0257","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0352","450.00","CT SCAN/BODY","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0359","450.00","CT SCAN/OTHER","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0413","450.00","HYPERBARIC O2","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0122","1500.00","Room and Board Semiprivate (two beds) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0131","1500.00","Room and Board (3 and 4 beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0133","1500.00","Room and Board (3 and 4 beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0145","1500.00","Room and Board Deluxe Private - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0153","1500.00","Room and Board Ward - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0154","1500.00","Room and Board Ward - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0164","1500.00","Other Room and Board - Sterile","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0172","1500.00","Nursery - Newborn Level II","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0183","1500.00","Leave of Absence - Therapeutic Leave","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0193","1500.00","Subacute - Level III/Complex Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0204","1500.00","Intensive Care Unit - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0212","1500.00","Coronary Care Unit - Pulmonary Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0636","35.00","Pharmacy-Extension of 025X - Drugs Requiring Detailed Coding","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0830","470.00","Peritoneal Dialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0832","470.00","Peritoneal Dialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0114","1500.00","Room and Board Private (one bed) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0117","1500.00","Room and Board Private (one bed) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0121","1500.00","Room and Board Semiprivate (two beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0124","1500.00","Room and Board Semiprivate (two beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0126","1500.00","Room and Board Semiprivate (two beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0134","1500.00","Room and Board (3 and 4 beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0141","1500.00","Room and Board Deluxe Private - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0144","1500.00","Room and Board Deluxe Private - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0147","1500.00","Room and Board Deluxe Private - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0150","1500.00","Room and Board Ward - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0160","1500.00","Other Room and Board - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0171","1500.00","Nursery - Newborn Level I","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0208","1500.00","Intensive Care Unit - Trauma","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0209","1500.00","Intensive Care Unit - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0219","1500.00","Coronary Care Unit - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0254","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0256","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0259","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0419","400.00","Respiratory Services - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0822","470.00","Hemodialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0825","470.00","Hemodialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0839","470.00","Peritoneal Dialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1750","15.77","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1817","8.31","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1930","63.68","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1940","0.52","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1943","2.94","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1944","2.92","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1953","0.09","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1980","28.89","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2010","9.48","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2175","5.99","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2260","1.60","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2400","29.56","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2406","41.53","Injection oritavancin 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2407","24.40","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2507","2968.61","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2560","40.30","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2765","1.04","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2783","321.67","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2792","30.62","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2916","1.86","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3101","134.62","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3250","42.76","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3260","2.19","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7042","0.89","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7189","2.30","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7198","2.20","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7207","1.93","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7210","1.35","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7326","488.09","Gel-one--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7351","205.72","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7402","10.56","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7509","0.25","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7644","0.20","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8530","0.58","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9019","427.27","Erwinaze injection--1000 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9060","1.86","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9071","2.75","Inj cyclophosphamd auromedic--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9100","0.88","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9176","6.86","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9181","0.76","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9208","26.01","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9223","180.23","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9262","3.30","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9273","155.90","Inj tisotu vedotin-tftv 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9307","319.73","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9308","63.56","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9312","82.25","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9340","298.19","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9349","12.78","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9358","24.60","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9390","8.62","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4074","139.22","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4145","19.48","Epifix inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5114","45.32","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9950","18.49","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0132","1500.00","Room and Board (3 and 4 beds) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0135","1500.00","Room and Board (3 and 4 beds) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0142","1500.00","Room and Board Deluxe Private - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0151","1500.00","Room and Board Ward - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0152","1500.00","Room and Board Ward - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0200","1500.00","Intensive Care Unit - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0201","1500.00","Intensive Care Unit - Surgical","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0206","1500.00","Intensive Care Unit - Intermediate ICU","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0211","1500.00","Coronary Care Unit - Myocardial Infarction","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","UB92RM","","","","","0214","1500.00","Coronary Care Unit - Intermediate CCU","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0350","450.00","CT SCAN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0804","400.00","DIALY/INPT/CCPD","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0824","470.00","Hemodialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0831","470.00","Peritoneal Dialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","Outpatient","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","0.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","Combo-PercentOfChargeRM","","","","",,,,,,,,,,"","70.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","0.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","L","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","0.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","TieredPerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","TieredPerDiemRM","","","","",,,,,,,,,,"",,,,"","","Per Diem","1653.30",,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","MedicareInpatientLTCRM","","","","",,,,,,,,"LTCH PPS","100.00","",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","MedicareInpatientLTCRM","","","","",,,,,,,,"LTCH PPS/Site Neutral","100.00","",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Med Surg Per Diem","900.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Dialysis Rate","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Intermediate ICU CCU Per Diem","1300.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Detoxification Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Subacute Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Hospice Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"ICU CCU Per Diem","1300.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Nursery ICU Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Nursery Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Psychiatric Per Diem","0.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Minimum Negotiated Charge","Minimum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Rehabilitation Per Diem","900.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90688","20.48","VACCINE--Iiv4 vaccine splt 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90732","133.47","Ppsv23 vacc 2 yrs+ subq-im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90739","152.08","Hepb vacc 2 dose adult im--1 DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90740","146.33","Hepb vacc 3 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9589","1226.20","Insti hexaminolevulinate hcl--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0121","3.49","Inj. omadacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0153","0.52","Adenosine inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0287","10.31","Amphotericin b lipid complex--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0291","3.23","Inj. plazomicin 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0295","2.73","Ampicillin sulbactam 1.5 gm--1.5 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0584","402.43","Injection burosumab-twza 1m--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0586","8.63","Abobotulinumtoxina--5 Unit","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0588","5.06","Incobotulinumtoxin a--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0596","31.61","Injection ruconest--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0740","617.57","Cidofovir injection--375 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0744","1.28","Ciprofloxacin iv--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0840","2636.69","Crotalidae poly immune fab--UP TO 1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0881","3.32","Darbepoetin alfa non-esrd--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0888","1.62","Epoetin beta non esrd--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0897","22.51","Denosumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1303","224.77","Inj. ravulizumab-cwvz 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1364","82.90","Erythro lactobionate -500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1450","3.14","Fluconazole--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1556","70.49","Inj imm glob bivigam 500mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1602","16.10","Golimumab for iv use 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1931","36.11","Laronidase injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1940","0.64","Furosemide injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1944","2.97","Aripirazole lauroxil 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2175","6.66","Meperidine hydrochl -100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2405","0.09","Ondansetron hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2469","1.21","Palonosetron hcl--25 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2720","1.81","Inj protamine sulfate-10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2770","493.97","Quinupristin-dalfopristin--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2788","24.84","Rho d immune globulin 50 mcg--50 MCG (250 IU)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2800","7.23","Methocarbamol injection--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2820","55.44","Sargramostim injection--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3111","9.80","Inj. romosozumab-aqqg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3370","3.23","Vancomycin hcl injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90674","32.28","VACCINE--Cciiv4 vac no prsv 0.5 ml im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90682","69.94","VACCINE--Riv4 vacc recombinant dna im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90694","71.68","VACCINE--Vacc AIIV4 no prsrv 0.5ML IM--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9575","0.15","Inj gadoterate meglumi 0.1ml--0.1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9577","1.90","Inj multihance--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9578","1.82","Inj multihance multipack--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0179","313.79","Inj brolucizumab-dbll 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0180","207.86","Agalsidase beta injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0185","1.73","Inj. aprepitant 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0221","188.31","Lumizyme injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0461","0.09","Atropine sulfate injection--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0475","182.29","Baclofen 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0598","60.72","C-1 esterase cinryze--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0638","118.73","Canakinumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0702","6.82","Betamethasone acet&sod phosp--3 MG & 3 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0717","6.28","Certolizumab pegol inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0720","35.99","Chloramphenicol sodium injec--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0770","15.68","Colistimethate sodium inj--150 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0775","62.08","Collagenase clost hist inj--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0887","1.62","Epoetin beta esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0894","2.88","Decitabine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1020","4.61","Methylprednisolone 20 mg inj--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1190","189.84","Dexrazoxane hcl injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1200","1.51","Diphenhydramine hcl injectio--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1201","15.29","Inj. cetirizine hcl 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1212","636.56","Dimethyl sulfoxide 50% 50 ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1265","0.71","Dopamine injection--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1290","520.23","Ecallantide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1439","1.14","Inj ferric carboxymaltos 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1566","74.00","Immune globulin powder--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1627","6.71","Inj granisetron xr 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1630","1.62","Haloperidol injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1650","0.84","Inj enoxaparin sodium--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1745","37.88","Infliximab not biosimil 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1746","69.76","Inj. ibalizumab-uiyk 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1950","1495.37","Leuprolide acetate -3.75 mg--3.75 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2060","0.96","Lorazepam injection--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2210","20.40","Methylergonovin maleate inj--0.2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90376","356.33","Rabies ig heat treated--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90677","283.72","Pcv20 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90685","21.64","Iiv4 vacc no prsv 0.25 ml im--0.25 mL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90744","29.04","Hepb vacc 3 dose ped-adol im--1 DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90746","70.38","Hepb vaccine 3 dose adult im--20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9606","176.64","Radium ra223 dichloride ther--1 microCurie","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0133","0.06","Acyclovir injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0172","11.87","Inj aducanumab-avwa 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0178","915.75","Aflibercept injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0285","46.32","Amphotericin b--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0490","49.47","Belimumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0515","19.02","Inj benztropine mesylate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0585","6.23","Injectiononabotulinumtoxina--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0592","4.10","Buprenorphine hydrochloride--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0595","2.97","Butorphanol tartrate 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0597","60.78","C-1 esterase berinert--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0695","6.64","Inj ceftolozane tazobactam--75mg (50mg cft-25mg taz)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0714","92.37","Ceftazidime and avibactam--.625 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0741","21.06","Inj cabote rilpivir 2mg 3mg--2MG-3MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0742","2.38","Inj imip 4 cilas 4 releb 2mg--4 MG-4 MG-2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0800","3932.52","Corticotropin injection--40 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1000","26.45","Depo-estradiol cypionate inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1120","23.48","Acetazolamid sodium injectio--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1162","4296.54","Digoxin immune fab (ovine)--PER VIAL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1240","8.37","Dimenhydrinate injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1380","10.73","Estradiol valerate 10 mg inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1430","457.18","Ethanolamine oleate 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1551","12.72","Inj cutaquig 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1557","51.07","Gammaplex injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1569","46.67","Gammagard liquid injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1740","45.64","Ibandronate sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1815","0.90","Insulin injection--5 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1817","10.95","Insulin for insulin pump use--50 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1980","31.62","Hyoscyamine sulfate inj--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2280","10.10","Inj moxifloxacin 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2353","207.51","Octreotide injection depot--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2507","3143.50","Pegloticase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90371","138.92","Hep b ig im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90756","30.58","VACCINE--Cciiv4 vacc abx free im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9579","1.58","Gad-base mr contrast nos1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0278","0.91","Amikacin sulfate injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0280","11.71","Aminophyllin 250 mg inj--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0289","29.47","Amphotericin b liposome inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0587","12.47","Inj rimabotulinumtoxinb--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0610","4.46","Calcium gluconate injection--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0690","1.37","Cefazolin sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0692","1.78","Cefepime hcl for injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0713","2.09","Inj ceftazidime per 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1050","0.57","Medroxyprogesterone acetate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1250","6.80","Inj dobutamine hcl-250 mg--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1270","0.39","Injection doxercalciferol--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1325","16.29","Epoprostenol injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1410","355.49","Inj estrogen conjugate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1442","1.00","Inj filgrastim excl biosimil--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1454","503.98","Inj fosnetupitant palonoset--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1570","47.37","Ganciclovir sodium injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1645","12.69","Dalteparin sodium--2500 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1953","0.10","Levetiracetam injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2020","6.25","Linezolid injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2150","4.63","Mannitol injection--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2250","0.18","Inj midazolam hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2270","5.13","Morphine sulfate injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2274","22.34","Inj morphine pf epid ithc--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2315","3.74","Naltrexone depot form--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2501","0.80","Paricalcitol--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2778","307.20","Ranibizumab injection--0.1 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2790","80.41","Rho d immune globulin inj--300 MCG (1500 IU)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2860","132.00","Injection siltuximab--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3060","41.90","Inj taliglucerase alfa 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3121","0.05","Inj testostero enanthate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3473","0.36","Hyaluronidase recombinant--1 USP UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3486","13.38","Ziprasidone mesylate--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7050","0.68","Normal saline solution infus--250 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7192","1.47","Factor viii recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7198","2.28","Anti-inhibitor--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90375","321.80","Rabies ig im-sc--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90377","241.20","Rabies ig ht&sol human im-sc--150 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90586","142.29","Bcg vaccine intravesical--1 EACH","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90632","70.98","Hepa vaccine adult im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90686","21.52","VACCINE--Iiv4 vacc no prsv 0.5 ml im--0.5 ml","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90687","10.24","VACCINE--Iiv4 vaccine splt 0.25 ml im--0.25 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0122","1.07","Inj. eravacycline 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0129","44.52","Abatacept injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0132","0.95","Acetylcysteine injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0171","0.76","Adrenalin epinephrine inject--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0248","5.51","Inj remdesivir 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0485","3.79","Belatacept injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0558","13.17","Peng benzathine-procaine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0565","39.90","Inj bezlotoxumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0636","0.72","Inj calcitriol per 0.1 mcg--0.1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0670","3.14","Inj mepivacaine hcl-10 ml--10 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0712","3.74","Ceftaroline fosamil inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0834","32.57","Inj. cosyntropin 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0882","3.32","Darbepoetin alfa esrd use--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1165","0.51","Phenytoin sodium injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1205","74.42","Chlorothiazide sodium inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1335","24.48","Ertapenem injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1437","24.40","Inj. fe derisomaltose 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1447","0.45","Inj tbo filgrastim 1 microg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1448","5.01","Injection trilaciclib 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1453","0.19","Fosaprepitant injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1458","432.71","Galsulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1459","46.93","Inj ivig privigen 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1460","46.76","Gamma globulin 1 cc inj--1 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1558","13.78","Inj. xembify 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1610","171.60","Glucagon hydrochloride-1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1644","0.26","Inj heparin sodium per 1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1750","16.53","Inj iron dextran--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1786","44.28","Imuglucerase injection--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1943","3.00","Inj. aristada initio 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2278","9.08","Ziconotide injection--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2323","24.17","Natalizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2357","38.65","Omalizumab injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2407","25.81","Injection oritavancin--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2510","35.30","Penicillin g procaine inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2540","0.78","Penicillin g potassium inj--600000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2786","10.23","Injection reslizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2916","2.06","Na ferric gluconate complex--12.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2920","4.28","Methylprednisolone injection--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2930","6.12","Methylprednisolone injection--125 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3032","16.42","Inj. eptinezumab-jjmr 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3105","12.77","Terbutaline sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3240","1926.71","Thyrotropin injection--0.9 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3250","43.09","Trimethobenzamide hcl inj--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3301","1.29","Triamcinolone acet inj nos--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3489","8.37","Zoledronic acid 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7040","1.37","Normal saline solution infus--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7042","1.06","5% dextrose-normal saline--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7185","1.27","Xyntha inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7188","3.20","Factor viii recomb obizur--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7190","1.14","Factor viii--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7515","0.87","Cyclosporine oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7517","0.30","Mycophenolate mofetil oral--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7613","0.05","Albuterol non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7614","0.06","Levalbuterol non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7686","704.64","Treprostinil non-comp unit-- 1.74 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8501","4.19","Oral aprepitant--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9043","196.61","Cabazitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9065","24.31","Inj cladribine per 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9145","59.35","Injection daratumumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9202","576.10","Goserelin acetate implant--3.6 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9227","70.50","Inj. isatuximab-irfc 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9269","309.41","Inj. tagraxofusp-erzs 10 mcg--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9306","14.44","Injection pertuzumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9319","33.23","Inj romidepsin lyophil 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9340","306.84","Thiotepa injection--15 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9355","88.60","Inj trastuzumab excl biosimi--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9045","52.45","Albumin (human) 5% 250 ml--250 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0167","0.88","Dronabinol 2.5mg oral--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q2050","200.52","Doxorubicin inj 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4074","140.41","Iloprost non-comp unit dose--UP TO 20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2515","26.17","Pentobarbital sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2680","10.89","Fluphenazine decanoate 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2690","113.93","Procainamide hcl injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3000","39.86","Streptomycin injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3145","1.82","Testosterone undecanoate 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3243","1.06","Tigecycline injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3262","6.16","Tocilizumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3357","174.69","Ustekinumab sub cu inj 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3471","0.50","Ovine up to 999 usp units--1 UNIT","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7178","1.34","Inj human fibrinogen con nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7194","1.57","Factor ix complex--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7201","3.37","Factor ix alprolix recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7207","2.04","Factor viii pegylated recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7212","2.20","Factor viia recomb sevenfact--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7314","518.47","Inj. yutiq 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7351","206.40","Inj bimatoprost itc imp1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7509","0.28","Methylprednisolone oral--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7510","0.25","Prednisolone oral per 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7512","0.02","Prednisone ir or dr oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7520","4.50","Sirolimus oral--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7674","0.81","Methacholine chloride neb--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8530","0.98","Cyclophosphamide oral 25 mg--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8540","0.11","Oral dexamethasone--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9000","3.48","Doxorubicin hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9030","2.85","Bcg live intravesical 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9037","44.25","Inj belantamab mafodot blmf--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9040","26.80","Bleomycin sulfate injection--15 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9044","16.77","Inj bortezomib nos 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9119","27.67","Inj. cemiplimab-rwlc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9203","214.28","Gemtuzumab ozogamicin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9204","216.39","Inj mogamulizumab-kpkc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9210","380.39","Inj. emapalumab-lzsg 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9228","163.66","Ipilimumab injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9263","0.07","Oxaliplatin--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9293","53.34","Mitoxantrone hydrochl - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9301","67.35","Obinutuzumab inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9312","85.63","Inj. rituximab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9357","1437.85","Valrubicin injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9581","14.78","Gadoxetate disodium inj--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0202","2207.16","Injection alemtuzumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0222","100.78","Inj. patisiran 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0223","109.88","Inj givosiran 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0360","6.65","Hydralazine hcl injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0401","6.41","Inj aripiprazole ext rel 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0500","30.39","Dicyclomine injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0517","169.47","Inj. benralizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0594","2.04","Busulfan injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0630","2841.59","Calcitonin salmon injection--400 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0640","4.44","Leucovorin calcium injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0641","0.27","Inj levoleucovorin nos 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0642","1.83","Injection khapzory 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0691","0.72","Inj lefamulin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0697","2.18","Sterile cefuroxime injection--750 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0735","33.96","Clonidine hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0841","1083.26","Inj crotalidae im f(ab)2 eq--120 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1030","7.45","Methylprednisolone 40 mg inj--40 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1559","12.36","Hizentra injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1568","42.10","Octagam injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1571","76.11","Hepagam b im injection--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1642","0.02","Inj heparin sodium per 10 u--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1885","0.65","Ketorolac tromethamine inj--15 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1932","60.89","Inj lanreotide (cipla) 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1951","134.12","Inj fensolvi 0.25 mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2182","29.31","Injection mepolizumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2260","1.79","Inj milrinone lactate - 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2350","60.49","Injection ocrelizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2354","1.12","Octreotide inj non-depot--25 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2356","18.01","Inj tezepelumab-ekko 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2360","5.19","Orphenadrine injection--60 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2675","1.15","Inj progesterone per 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2704","0.14","Inj propofol 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2777","38.06","Inj faricimab-svoa 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2785","61.50","Regadenoson injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2791","4.81","Rhophylac injection--100 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2794","11.59","Inj risperdal consta 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2795","0.09","Ropivacaine hcl injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7209","1.32","Factor viii nuwiq recomb 1iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7326","492.23","Gel-one--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7402","10.93","Mometasone sinus sinuva--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7507","0.52","Tacrolimus imme rel oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7527","5.70","Oral everolimus--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8520","0.59","Capecitabine oral 150 mg--150 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8705","104.36","Topotecan oral--0.25 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9061","18.90","Inj amivantamab-vmjw--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9100","1.04","Cytarabine hcl 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9120","838.88","Dactinomycin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9130","5.54","Dacarbazine 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9272","220.75","Inj dostarlimab-gxly 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9273","155.91","Inj tisotu vedotin-tftv 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9295","5.74","Injection necitumumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9302","63.96","Ofatumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9356","71.49","Inj. herceptin hylecta 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9041","10.49","Albumin (human)5% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0222","2394.00","Bebtelovimab 175 mg--175 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4163","150.58","Woundex bioskin per sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4187","237.06","Epicord 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4196","110.65","Puraply am 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5101","0.31","Injection zarxio--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5106","8.40","Inj retacrit non-esrd use--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5108","204.14","Injection fulphila--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5117","47.41","Inj. kanjinti 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9950","18.97","Inj sulf hexa lipid microsph--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9958","0.08","Hocm <=149 mg-ml iodine 1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9961","0.25","Hocm 250-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0114","1500.00","Room and Board Private (one bed) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0117","1500.00","Room and Board Private (one bed) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0121","1500.00","Room and Board Semiprivate (two beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0124","1500.00","Room and Board Semiprivate (two beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0126","1500.00","Room and Board Semiprivate (two beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0134","1500.00","Room and Board (3 and 4 beds) - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0141","1500.00","Room and Board Deluxe Private - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0144","1500.00","Room and Board Deluxe Private - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0147","1500.00","Room and Board Deluxe Private - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3396","11.52","Verteporfin injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3410","11.34","Hydroxyzine hcl injection--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3411","2.88","Thiamine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3430","3.49","Vitamin k phytonadione inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3480","0.17","Inj potassium chloride--2 MEQ","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7183","1.16","Wilate injection--1 I.U. VWF:RCO","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7189","2.35","Factor viia recomb novoseven--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7205","2.17","Factor viii fc fusion recomb--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7322","16.83","Hymovis injection 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7503","1.56","Tacrol envarsus ex rel oral--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7605","8.76","Arformoterol non-comp unit--15 mcg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7608","7.39","Acetylcysteine non-comp unit--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7611","0.27","Albuterol non-comp con--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7631","2.50","Cromolyn sodium noncomp unit--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8521","1.27","Capecitabine oral 500 mg--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8670","1.77","Rolapitant oral 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9035","69.72","Bevacizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9036","22.88","Inj. belrapzo-bendamustine--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9039","131.90","Injection blinatumomab--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9060","2.08","Cisplatin 10 mg injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9153","215.41","Inj daunorubicin cytarabine--1 MG-2.27 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9190","2.36","Fluorouracil injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9225","5166.29","Vantas implant--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9245","297.10","Inj melpha hydroch nos 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9267","0.13","Paclitaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9271","54.55","Inj pembrolizumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9303","139.67","Panitumumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9308","65.67","Injection ramucirumab--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9360","4.02","Vinblastine sulfate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9390","11.40","Vinorelbine tartrate inj--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4111","7.21","Gammagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4137","111.06","Amnioexcel biodexcel 1sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4151","134.79","Amnioband guardian 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4186","156.22","Epifix 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5107","39.77","Inj mvasi 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5120","222.86","Inj pegfilgrastim-bmez 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0182","1500.00","Leave of Absence - Patient Convience Charges Billable","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0191","1500.00","Subacute - Level I/Skilled Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2406","42.38","Injection oritavancin 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2425","25.13","Palifermin injection--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2426","13.28","Paliperidone palmitate inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2545","125.56","Pentamidine non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2550","2.94","Promethazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2560","44.93","Phenobarbital sodium inj--120 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2562","402.60","Plerixafor injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2700","1.28","Oxacillin sodium injeciton--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2783","332.08","Rasburicase--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2805","123.16","Sincalide injection--5 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3095","7.00","Telavancin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3101","143.87","Tenecteplase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3358","12.36","Ustekinumab iv inject 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3385","359.92","Velaglucerase alfa--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7060","1.89","5% dextrose-water--500 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7070","3.78","D5w infusion--1000 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7170","49.90","Inj. emicizumab-kxwh 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7175","8.60","Inj factor x (human) 1iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7186","1.15","Antihemophilic viii-vwf comp--PER FACTOR VIII IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7193","1.23","Factor ix non-recombinant--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7203","4.27","Factor ix recomb gly rebinyn--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7336","3.24","Capsaicin 8% patch--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7606","9.88","Formoterol fumarate inh--20 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7612","0.30","Levalbuterol non-comp con--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9022","82.27","Inj atezolizumab10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9023","88.38","Injection avelumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9027","61.65","Clofarabine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9055","69.41","Cetuximab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9144","46.76","Daratumumab hyaluronidase--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9171","0.50","Docetaxel injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9176","6.95","Injection elotuzumab 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9200","97.42","Floxuridine injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9201","3.98","In gemcitabine hcl nos 200mg--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9205","60.14","Inj irinotecan liposome 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9206","2.60","Irinotecan injection--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9211","42.22","Idarubicin hcl injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9229","2443.31","Inj inotuzumab ozogam 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9260","2.62","Methotrexate sodium inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0150","1500.00","Room and Board Ward - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0160","1500.00","Other Room and Board - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0171","1500.00","Nursery - Newborn Level I","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0208","1500.00","Intensive Care Unit - Trauma","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0209","1500.00","Intensive Care Unit - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0219","1500.00","Coronary Care Unit - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0253","70.00","Pharmacy - Take Home Drugs","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0258","70.00","Pharmacy - IV Solutions","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0803","600.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0804","600.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0809","600.00","Inpatient Renal Dialysis - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0822","470.00","Hemodialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0825","470.00","Hemodialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0839","470.00","Peritoneal Dialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4110","42.70","Primatrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4133","135.47","Grafix stravix prime pl sqcm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4160","95.94","Nushield 1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5103","40.57","Injection inflectra--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9965","0.89","Locm 100-199mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0112","1500.00","Room and Board Private (one bed) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0115","1500.00","Room and Board Private (one bed) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0127","1500.00","Room and Board Semiprivate (two beds) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0129","1500.00","Room and Board Semiprivate (two beds) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0137","1500.00","Room and Board (3 and 4 beds) - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0149","1500.00","Room and Board Deluxe Private - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0157","1500.00","Room and Board Ward - Oncology","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0158","1500.00","Room and Board Ward - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0173","1500.00","Nursery - Newborn Level III","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0179","1500.00","Nursery - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0189","1500.00","Leave of Absence - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0255","70.00","Pharmacy - Drugs Incident to Radiology","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0351","600.00","CT Scan - Head","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0413","450.00","HYPERBARIC O2","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0801","600.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0802","600.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9370","4.99","Vincristine sulfate 1 mg inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0139","1.00","Ferumoxytol esrd use--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0162","0.02","Ondansetron oral--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q3027","56.07","Inj beta interferon im 1 mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4159","535.60","Affinity1 square cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5110","0.40","Nivestym--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5111","202.10","Injection udenyca 0.5 mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9957","46.15","Inj perflutren lip microsml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9967","0.12","Locm 300-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0116","1500.00","Room and Board Private (one bed) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0119","1500.00","Room and Board Private (one bed) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0138","1500.00","Room and Board (3 and 4 beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0148","1500.00","Room and Board Deluxe Private - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0159","1500.00","Room and Board Ward - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0167","1500.00","Other Room and Board - Self Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0190","1500.00","Subacute - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0254","70.00","Pharmacy - Drugs Incident to Other Diagnostic Services","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0259","70.00","Pharmacy - Other","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0350","600.00","CT Scan - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0419","437.00","Respiratory Services - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0800","600.00","Inpatient Renal Dialysis - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0801","70.00","Inpatient Renal Dialysis - Inpatient Hemodialysis","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0802","70.00","Inpatient Renal Dialysis - Inpatient Peritoneal Dialysis (Non CAPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0821","470.00","Hemodialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90662","69.94","VACCINE--Iiv no prsv increased ag im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90675","348.53","Rabies vaccine im--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90714","28.99","Td vacc no presv 7 yrs+ im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90743","71.72","Hep b vacc adol 2 dose im--1 DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90747","140.76","Hepb vacc 4 dose immunsup im--40 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90759","74.53","Hep b vac 3ag 10mcg 3 dos im--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9576","1.47","Inj prohance multipack--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0219","72.68","Inj aval alfa-nqpt 4mg--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0256","4.61","Alpha 1 proteinase inhibitor--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0257","5.18","Glassia injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0491","16.21","Inj anifrolumab-fnia 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0583","0.42","Bivalirudin--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0637","8.42","Caspofungin acetate--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0694","5.31","Cefoxitin sodium injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0725","24.54","Chorionic gonadotropin-1000u--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0743","8.28","Cilastatin sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0878","0.05","Daptomycin injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0895","10.42","Deferoxamine mesylate inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0896","37.94","Inj luspatercept-aamt 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1040","11.82","Methylprednisolone 80 mg inj--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1110","58.24","Inj dihydroergotamine mesylt--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1170","3.47","Hydromorphone injection--4 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1245","3.70","Dipyridamole injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1300","228.94","Eculizumab injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1306","12.05","Injection inclisiran 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1555","14.97","Inj cuvitru 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1561","46.51","Gamunex-c-gammaked--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1572","40.52","Flebogamma injection--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1575","15.89","Hyqvia 100mg immuneglobulin--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1580","2.66","Garamycin gentamicin inj--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1652","1.47","Fondaparinux sodium--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1930","66.18","Lanreotide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1956","1.07","Levofloxacin injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2001","0.03","Lidocaine injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2010","10.10","Lincomycin injection--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2300","3.14","Inj nalbuphine hydrochloride--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2310","12.14","Inj naloxone hydrochloride--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2430","10.98","Pamidronate disodium -30 mg--30 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90670","257.99","Pcv13 vaccine im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90671","246.20","PCV15 vaccine IM--1 EA","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90672","26.88","VACCINE--Laiv4 vaccine intranasal--0.2 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","90715","38.28","Tdap vaccine 7 yrs-> im--0.5 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","A9585","0.35","Gadobutrol injection--0.1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0290","0.76","Ampicillin 500 mg inj--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0348","0.61","Anidulafungin injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0456","3.12","Azithromycin--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0476","73.06","Baclofen intrathecal trial--50 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0480","4102.57","Basiliximab--20 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0561","16.73","Penicillin g benzathine inj--100000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0600","5708.59","Edetate calcium disodium inj--1000 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0696","0.51","Ceftriaxone sodium injection--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0780","4.19","Prochlorperazine injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0791","125.06","Inj crizanlizumab-tmca 5mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0850","1666.71","Cytomegalovirus imm iv -vial--PER VIAL","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0875","15.89","Injection dalbavancin--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J0885","8.37","Epoetin alfa non-esrd--1000 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1071","0.03","Inj testosterone cypionate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1100","0.13","Dexamethasone sodium phos--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1160","21.74","Digoxin injection--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1230","17.47","Methadone injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1301","21.42","Injection edaravone 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1322","262.67","Elosulfase alfa injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1554","481.77","Inj. asceniv--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1560","467.56","Gamma globulin > 10 cc inj--10 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1626","0.39","Granisetron hcl injection--100 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1631","8.75","Haloperidol decanoate inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1640","29.03","Hemin 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1670","537.77","Tetanus immune globulin inj--250 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1720","17.87","Hydrocortisone sodium succ i--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1743","542.94","Idursulfase injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1756","0.22","Iron sucrose injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1823","462.87","Inj. inebilizumab-cdon 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J1955","28.04","Inj levocarnitine per 1 gm--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2185","0.74","Meropenem--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2248","0.86","Micafungin sodium injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2358","2.92","Olanzapine long-acting inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2796","89.00","Romiplostim injection--10 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2798","11.16","Inj. perseris 0.5 mg--0.5 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3010","0.89","Fentanyl citrate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3241","321.88","Inj. teprotumumab-trbw 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3360","7.07","Diazepam injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3380","22.76","Injection vedolizumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3420","1.95","Vitamin b12 injection--1000 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7120","2.50","Ringers lactate infusion--1000 CC","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7181","16.35","Factor xiii recomb a-subunit--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7195","1.63","Factor ix recombinant nos--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7197","3.59","Antithrombin iii injection--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7211","1.31","Inj kovaltry 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7312","200.12","Dexamethasone intra implant--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7321","76.96","Hyalgan supartz visco-3 dose--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7325","10.44","Synvisc or synvisc-one--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7327","790.78","Monovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7328","1.28","Gelsyn-3 injection 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7340","216.47","Carbidopa levodopa ent 100ml--100 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7502","2.43","Cyclosporine oral 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7504","2898.30","Lymphocyte immune globulin--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7511","902.62","Antithymocyte globuln rabbit--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7620","0.13","Albuterol ipratrop non-comp--2.5 MG-0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7626","1.10","Budesonide non-comp unit--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7677","0.19","Revefenacin inh non-com 1mcg--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8610","0.24","Methotrexate oral 2.5 mg--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9021","46.53","Inj aspara rylaze 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9033","20.69","Inj. treanda 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9034","19.08","Inj. bendeka 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9150","46.55","Daunorubicin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9155","4.08","Degarelix injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9177","32.55","Inj enfort vedo-ejfv 0.25mg--0.25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9178","1.66","Inj epirubicin hcl 2 mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9198","25.78","Inj. infugem 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9207","117.06","Ixabepilone injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9209","1.77","Mesna injection--200 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9223","184.22","Inj. lurbinectedin 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9226","43442.33","Supprelin la implant--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9247","503.50","Inj melphalan flufenami 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0194","1500.00","Subacute - Level IV/Intensive Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0203","1500.00","Intensive Care Unit - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0251","70.00","Pharmacy - Generic Drugs","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0352","600.00","CT Scan - Body","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0359","600.00","CT Scan - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0800","70.00","Inpatient Renal Dialysis - General","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0829","470.00","Hemodialysis-Outpatient or Home - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0833","470.00","Peritoneal Dialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2400","30.58","Chloroprocaine hcl injection--30 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2760","414.12","Phentolaine mesylate inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2765","1.07","Metoclopramide hcl injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3245","139.28","Inj. tildrakizumab 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3260","4.12","Tobramycin sulfate injection--80 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3285","57.47","Treprostinil injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3300","3.90","Triamcinolone a inj prs-free--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3304","17.63","Inj triamcinolone ace xr 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3315","373.79","Triptorelin pamoate--3.75 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3485","1.51","Zidovudine--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7030","2.74","Normal saline solution infus--1000 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7177","1.09","Inj. fibryga 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7200","1.54","Factor ix recombinan rixubis--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7204","2.18","Inj recombin esperoct per iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7308","393.46","Aminolevulinic acid hcl top--354 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7313","490.95","Inj. iluvien 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7318","10.36","Inj durolane 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7323","135.24","Euflexxa inj per dose--per dose","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7342","29.99","Ciprofloxacin otic susp 6 mg--6 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7345","1.62","Aminolevulinic acid 10% gel--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7500","12.57","Azathioprine oral 50mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7518","1.60","Mycophenolic acid--180 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7644","0.21","Ipratropium bromide non-comp--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8655","396.09","Oral netupitant palonosetro--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8700","0.35","Temozolomide--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9017","15.37","Arsenic trioxide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9019","427.27","Erwinaze injection--1000 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9025","0.89","Azacitidine injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9042","205.76","Brentuximab vedotin inj--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9045","2.92","Carboplatin injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9050","1099.82","Carmustine injection--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9070","27.47","Cyclophosphamide 100 mg inj--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9071","2.75","Inj cyclophosphamd auromedic--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9181","0.84","Etoposide injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9264","14.69","Paclitaxel protein bound--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9307","321.09","Pralatrexate injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9320","349.38","Streptozocin injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9351","1.12","Topotecan injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9280","54.29","Mitomycin injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9305","78.39","Inj. pemetrexed nos 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9328","10.41","Temozolomide injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9332","31.53","Inj efgartigimod 2mg--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9400","8.22","Inj ziv-aflibercept 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4081","0.84","Epoetin alfa 100 units esrd--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4195","83.40","Puraply 1 sq cm--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5104","61.10","Injection renflexis--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5114","55.72","Inj ogivri 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5122","269.14","Inj nyvepria--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5123","64.33","Inj. riabni 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9966","0.35","Locm 200-299mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0143","1500.00","Room and Board Deluxe Private - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0155","1500.00","Room and Board Ward - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0180","1500.00","Leave of Absence - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0185","1500.00","Leave of Absence - Nursing Home (for Hospitalization)","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0192","1500.00","Subacute - Level II/Comprehensive Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0199","1500.00","Subacute - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0419","400.00",,"Case Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0803","70.00","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0804","70.00","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0809","70.00","Inpatient Renal Dialysis - Other","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0834","470.00","Peritoneal Dialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9352","331.85","Injection trabectedin 0.1mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9353","44.17","Inj. margetuximab-cmkb 5 mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9354","35.70","Inj ado-trastuzumab emt 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9358","25.21","Inj fam-trastu deru-nxki 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9359","188.98","Inj lon tesirin-lpyl 0.075mg--0.075 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9371","3420.78","Inj vincristine sul lip 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9046","20.98","Albumin (human) 25% 20 ml--20 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4121","46.05","Theraskin--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4145","19.48","Epifix inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9956","30.77","Inj octafluoropropane micml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0132","1500.00","Room and Board (3 and 4 beds) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0135","1500.00","Room and Board (3 and 4 beds) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0142","1500.00","Room and Board Deluxe Private - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0151","1500.00","Room and Board Ward - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0152","1500.00","Room and Board Ward - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0200","1500.00","Intensive Care Unit - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0201","1500.00","Intensive Care Unit - Surgical","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0206","1500.00","Intensive Care Unit - Intermediate ICU","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0211","1500.00","Coronary Care Unit - Myocardial Infarction","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0214","1500.00","Coronary Care Unit - Intermediate CCU","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0250","70.00","Pharmacy - General","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0256","70.00","Pharmacy - Experimental Drugs","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0824","470.00","Hemodialysis-Outpatient or Home - Home Maintenance 100%","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0831","470.00","Peritoneal Dialysis-Outpatient or Home - Composite or Other Rate","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2506","182.03","Inj pegfilgrast ex bio 0.5mg--0.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2543","1.48","Piperacillin-tazobactam--1.125 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2597","9.29","Inj desmopressin acetate--1 MCG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2724","15.12","Protein c concentrate--10 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2779","83.23","Inj susvimo 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2792","32.45","Rho(d) immune globulin h sd--100 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J2997","88.28","Alteplase recombinant--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3090","1.74","Inj tedizolid phosphate--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3230","34.01","Chlorpromazine hcl injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3415","10.32","Pyridoxine hcl 100 mg--100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3465","1.83","Injection voriconazole--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J3475","0.76","Inj magnesium sulfate--500 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7179","1.86","Vonvendi inj 1 iu vwf:rco--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7180","9.40","Factor xiii anti-hem factor--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7182","1.53","Factor viii recomb novoeight--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7187","1.30","Humate-p inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7202","4.76","Factor ix idelvion inj--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7208","2.16","Inj. jivi 1 iu--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7210","1.40","Inj afstyla 1 i.u.--1 IU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7311","338.63","Inj. retisert 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7320","7.05","Genvisc 850 inj 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7324","154.75","Orthovisc inj per dose--PER DOSE","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7329","13.31","Inj trivisc 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7332","9.96","Inj. triluron 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7508","0.53","Tacrol astagraf ex rel oral--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7516","62.43","Cyclosporin parenteral 250mg--250 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7525","233.60","Tacrolimus injection--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7639","50.16","Dornase alfa non-comp unit--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J7682","27.77","Tobramycin non-comp unit--300 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J8560","76.09","Etoposide oral 50 mg--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9032","44.36","Injection belinostat 10mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9041","44.79","Inj. velcade 0.1 mg--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9047","44.03","Injection carfilzomib 1 mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9173","78.20","Inj. durvalumab 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9179","132.80","Eribulin mesylate injection--0.1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9185","92.21","Fludarabine phosphate inj--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9208","26.62","Ifosfamide injection--1 GM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9214","32.74","Interferon alfa-2b inj--1 MIL UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9261","155.90","Nelarabine injection--50 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9266","23577.01","Pegaspargase injection--1 EA","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9268","2206.44","Pentostatin injection--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9299","29.69","Injection nivolumab--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9316","71.65","Pertuzu trastuzu 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9325","60.62","Inj talimogene laherparepvec--1 millionáPFU","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9330","35.35","Temsirolimus injection--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0138","1.09","Ferumoxytol non-esrd--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q2043","55114.75","Sipuleucel-t auto cd54+--Per infusion (minimum 50 million cells)","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4101","30.51","Apligraf--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5105","0.84","Inj retacrit esrd on dialysi--100 UNITS","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5112","76.89","Inj ontruzant 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5113","52.97","Inj herzuma 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5116","55.79","Inj. trazimera 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9963","0.23","Hocm 350-399mg-ml iodine1ml--1 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9991","1858.61","Buprenorph xr 100 mg or less--Less than or equal to 100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q9992","1858.61","Buprenorphine xr over 100 mg--Greater than 100 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0110","1500.00","Room and Board Private (one bed) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0113","1500.00","Room and Board Private (one bed) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0120","1500.00","Room and Board Semiprivate (two beds) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0122","1500.00","Room and Board Semiprivate (two beds) - OB","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0131","1500.00","Room and Board (3 and 4 beds) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0133","1500.00","Room and Board (3 and 4 beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0145","1500.00","Room and Board Deluxe Private - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0153","1500.00","Room and Board Ward - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0154","1500.00","Room and Board Ward - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0164","1500.00","Other Room and Board - Sterile","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0172","1500.00","Nursery - Newborn Level II","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0183","1500.00","Leave of Absence - Therapeutic Leave","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0193","1500.00","Subacute - Level III/Complex Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0204","1500.00","Intensive Care Unit - Psychiatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0212","1500.00","Coronary Care Unit - Pulmonary Care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0636","55.00",,"Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0830","470.00","Peritoneal Dialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0832","470.00","Peritoneal Dialysis-Outpatient or Home - Home Supplies","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9217","200.73","Leuprolide acetate suspnsion--7.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9218","15.00","Leuprolide acetate injeciton--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9250","0.26","Methotrexate sodium inj--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9262","3.65","Inj omacetaxine mep 0.01mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9281","285.36","Mitomycin instillation--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9298","180.64","Inj nivol relatlimab 3mg-1mg--3 mg-1 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9309","118.11","Inj polatuzumab vedotin 1mg--1 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9311","38.21","Inj rituximab hyaluronidase--10 mg","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9313","23.39","Inj. lumoxiti 0.01 mg--0.01 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9317","32.04","Sacituzumab govitecan-hziy--2.5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9349","12.97","Inj. tafasitamab-cxix--2 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","J9395","15.65","Injection fulvestrant--25 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","P9047","52.45","Albumin (human) 25% 50ml--50 ML","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q0164","0.44","Prochlorperazine maleate 5mg--5 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4102","12.03","Oasis wound matrix--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q4106","31.97","Dermagraft--1 SQ CM","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5115","57.35","Inj truxima 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5118","50.59","Inj. zirabev 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5119","56.37","Inj ruxience 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","CPTRM","","","","","Q5121","45.30","Inj. avsola 10 mg--10 MG","Per Unit Rate","94.3396",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0100","1500.00","All Inclusive Rate - Room & Board & Ancillary","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0101","1500.00","All Inclusive Rate - Room & Board","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0111","1500.00","Room and Board Private (one bed) - Medical/Surgical/GYN","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0118","1500.00","Room and Board Private (one bed) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0123","1500.00","Room and Board Semiprivate (two beds) - Pediatric","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0125","1500.00","Room and Board Semiprivate (two beds) - Hospice","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0128","1500.00","Room and Board Semiprivate (two beds) - Rehabilitation","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0130","1500.00","Room and Board (3 and 4 beds) - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0136","1500.00","Room and Board (3 and 4 beds) - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0139","1500.00","Room and Board (3 and 4 beds) - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0140","1500.00","Room and Board Deluxe Private - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0146","1500.00","Room and Board Deluxe Private - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0156","1500.00","Room and Board Ward - Detoxification","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0169","1500.00","Other Room and Board - Other","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0170","1500.00","Nursery - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0174","1500.00","Nursery - Newborn Level IV","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0202","1500.00","Intensive Care Unit - Medical ","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0207","1500.00","Intensive Care Unit - Burn care","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0210","1500.00","Coronary Care Unit - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","UB92RM","","","","","0213","1500.00","Coronary Care Unit - Heart Transplant","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0252","70.00","Pharmacy - Nongeneric Drugs","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0257","70.00","Pharmacy - Non-Prescription","Percent of Charges","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0820","470.00","Hemodialysis-Outpatient or Home - General","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0823","470.00","Hemodialysis-Outpatient or Home - Home Equipment","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Carve Out Term","UB92RM","","","","","0835","470.00","Peritoneal Dialysis-Outpatient or Home - Home Support Services","Per Unit Rate","100",,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","Combo-PercentOfChargeRM","","","","",,,,,,,,,,"","70.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","Outpatient","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","100.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","100.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","L","Standard Term","PercentOfChargeRM","","","","",,,,,,,,,,"","80.00",,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","TieredPerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","TieredPerDiemRM","","","","",,,,,,,,,,"",,,,"","","Per Diem","2323.53",,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","MedicareInpatientLTCRM","","","","",,,,,,,,"LTCH PPS","100.00","",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","MedicareInpatientLTCRM","","","","",,,,,,,,"LTCH PPS/Site Neutral","178.20","",,,,"","",,,,,,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Med Surg Per Diem","3810.67",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Dialysis Rate","450.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Intermediate ICU CCU Per Diem","3810.67",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Hospice Per Diem","2728.50",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"ICU CCU Per Diem","3810.67",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Nursery ICU Per Diem","1700.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Nursery Per Diem","1700.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Psychiatric Per Diem","1700.00",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Rehabilitation Per Diem","3810.67",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Detoxification Per Diem","2728.50",,,,"","","","","","",,,,,,,,,,,,,"","" "4851","Kindred Hospital Lima","Maximum Negotiated Charge","Maximum Negotiated Charge","I","Standard Term","LevelOfCarePerDiemRM","","","","",,,,,,,,,,"",,,,"","",,,"Subacute Per Diem","3810.67",,,,"","","","","","",,,,,,,,,,,,,"",""