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["28000425","ACETASOL HC (VOSOL HC) OTIC SOLN **NF**","ACETASOL/HC O","00000000","00000000","N","N",637,"AM",null,15.63,40.5,20020122,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000457","LIDOCAINE (XYLOCAINE) JELLY 2% TUBE","XYLOCAINE 2%","10306000","40240028","N","N",637,"AM",null,53.01,53.1,20191112,0,0,"30000028",0,0,20191112,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000474","COUMADIN (WARFARIN) 10MG TAB ****NF****","COUMADIN TAB","00000000","00000000","N",null,637,"AM",null,0,3.49,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000488","ALUPENT INHALER                     *NF","METAPROTERENO","00000000","00000000","N",null,637,"AM",null,0,47.4,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000498","AMMONIA AROMATIC INHALANT","AMMONIA AROMA","00000000","00000000","N","N",637,"AM",null,0,4.95,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000526","AUGMENTIN (AMOX/CLAV) TAB 250MG ***NF***","AUGMENTIN 250","00000000","00000000","N",null,637,"AM",null,5.93,8.34,20020122,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000538","PROBENECID TAB 500MG *****NF*******","PROBENECID 50","00000000","00000000","N","N",637,"AM",null,3.25,4,20020122,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000567","CAPTOPRIL (CAPOTEN) TAB 50MG ***NF***","CAPTOPRIL 50M","00000000","00000000","N",null,637,"AM",null,5,4.3600000000000003,20020122,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000660","FLUCONAZOLE (DIFLUCAN) TAB 100MG","DIFLUCAN 100M","00000000","00000000","N","N",250,"78",null,26.26,26.3,20190513,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000683","DOPamine/D5W SOL 400MG/250ML","DOPamine","00000000","00000000","N","Y",636,"7E","J1265",50.1,85.95,20091127,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000708","ENLON PLUS (EDROPH/ATROP) INJ 5Ml","ENLON PLUS IN","00000000","00000000","N","N",250,"78",null,68.760000000000005,82.5,20150217,0,0,"30000028",0,0,20150217,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000744","GENTAMICIN (GARAMYCIN) CREAM 0.1% 30GM","GARAMYCIN (GE","00000000","00000000","N","N",637,"AM",null,13.8,75,20120813,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000761","HALOPERIDOL (HALDOL) TAB 1 MG","HALOPERIDOL","00000000","00000000","N",null,637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000785","HYTRIN (TERAZOSIN) CAP : 5MG ****NF****","HYTRIN 5MG","00000000","00000000","N",null,637,"AM",null,0,5.5,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000786","IBERET-FOLIC 500 FILMTAB*****NF****","IBERET-FOLIC","00000000","00000000","N",null,637,"AM",null,0,3.68,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000832","CLONAZEPAM (KLONOPIN) TAB 1 MG ****NF***","KLONOPIN 1MG","00000000","00000000","N",null,637,"AM",null,0,4.01,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000863","INDAPAMIDE (LOZOL) 1.25MG TAB****NF****","LOZOL 1.25MG","00000000","00000000","N",null,637,"AM",null,5.25,4.75,20000228,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000875","TRIAMT/HCTZ (MAXZIDE-25) TAB 37.5/25MG","MAXZIDE 37.5","00000000","00000000","N",null,637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000893","METRONIDAZOLE (FLAGYL) TAB 500MG","FLAGYL (GEN)","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000906","MUMPS SKIN TEST 10 TESTS/VIAL *DC BY MFR","MUMPS SKIN TE","00000000","00000000","N",null,250,"78",null,40.450000000000003,49.9,20030310,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000913","SUCCINYLCHL (ANCECTINE) 20CC****NF****","ANECTINE 20MG","00000000","00000000","N",null,250,"78",null,0,15,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000927","METHYLENE BLUE 1% 10X1ML","METHYLENE BLU","00000000","00000000","N","N",250,"78",null,714.76,716.8,20180531,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000951","PREVACID (LANSAPRAZOLE)15MG CAP***NF****","PREVACID CAP","00000000","00000000","N","N",637,"AM",null,10.53,5.33,20020123,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28000961","BISMUTH SUB (PEPTO-BISMOL) LIQ PER ML","PEPTO-BISMOL","00000000","00000000","N","N",637,"AM",null,0.4,0.33,20020824,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28000985","PREDNISONE TAB  5MG","PREDNISONE 5M","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28001002","PROPOXYPH/APAP (DARVOCET N-100) TA**NF**","DARVOCET N-10","00000000","00000000","N","N",637,"AM",null,4.5,5.0999999999999996,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28001769","DOXAZOSIN (CARDURA) 2MG TAB****NF***","DOXAZOSIN 2MG","00000000","00000000","N",null,259,"79",null,0,5.5,20020101,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28001858","VITAMIN C (ASCORBIC ACID) TAB 500 MG","ASCORBIC ACID","00000000","00000000","N",null,637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["28001912","C-PHEN DM(RONDEC DM) INFANT DROP*NF**","RONDEC DM DRO","00000000","00000000","N","N",637,"AM",null,138.30000000000001,138.30000000000001,20090827,0,0,"30000028",0,0,0,0,0,"30100028",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
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["28030311","LOSARTAN/HCTZ (HYZAAR) TAB 100-25MG**NF*","HYZAAR 100-25","00000000","00000000","N","N",637,"AM",null,0,6.33,20030311,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030319","DIFLUCAN 400MG 200ML IV PREMIX  ***NF***","DIFLUCAN 400M","00000000","00000000","N","N",636,"7E","J1450",399.9,399.9,20081113,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030324","SALICYLIC ACID 17%(OCCLUSAL HP)****NF**","OCCLUSAL-HP (","00000000","00000000","N","N",637,"AM",null,0,63,20030708,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030332","TETRACYCLINE 250MG TAB **NF***","SUMYCIN 250 T","00000000","00000000","N","N",637,"AM",null,0,0,20000103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030340","NURSING COMMENT  * * * *","NURSING COMME","00000000","00000000","N",null,637,"AM",null,0,0,20000103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030345","CHANGE IV TUBING  ///////","CHANGE IVT","00000000","00000000",null,"N",250,"78",null,0,0,20010725,0,0,"00000000",0,0,20010725,0,0,"00000000",0,0,20010725,0,0,"00000000",0,0,20010725,0,0,"00000000",0,0,20010725,0,0,"00000000"]
["28030354","DURAMORPH INJ 10MG**NF* (USE ASTRAMORPH)","DURAMORPH INJ","00000000","00000000","N","N",636,"7E","J2274",33.549999999999997,39.49,20020204,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030359","TYLENOL TAB 500MG #700 *BRAND NAME*  *NF","TYLENOL TAB 5","00000000","00000000","N",null,259,"79",null,0,0,20000103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030367","AMOX/CLAV (AUGMENTIN) 400/57MG 50ML*NF*","AUGMENTIN 400","00000000","00000000","N","N",637,"AM",null,122.55,121.83,20040113,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030375","ACTOS (PLOGLITAZONE) TAB 30MG ****NF***","ACTOS 30MG TB","00000000","00000000","N","N",637,"AM",null,24.1,24.3,20091210,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030380","IN-LINE FILTER *REQUIRED*","FILTER 1.2MIC","00000000","00000000",null,null,250,"78",null,7,0,20020222,0,0,"00000000",0,0,20011116,0,0,"00000000",0,0,20011116,0,0,"00000000",0,0,20011116,0,0,"00000000",0,0,20011116,0,0,"00000000"]
["28030388","DIOVAN (VALSARTAN) TAB 160MG**NF**","DIOVAN 160MG","00000000","00000000","N","N",637,"AM",null,5.15,10.41,20111103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030396","PONARIS NASAL EMOLLIENT **NF***","PONARIS NASAL","00000000","00000000","N",null,637,"AM",null,0,24,20020104,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030401","ASPIRIN (ENTERIC COATED) TAB 81mg","ASPIRIN ENT81","00000000","00000000","N","N",637,"AM",null,0,4,20021023,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030409","MINOXIDIL TAB 10MG  *****NF*******","MINOXIDIL TAB","00000000","00000000","N",null,637,"AM",null,0,4,20020218,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030414","PERMETHRIN (ELIMITE) CREAM 5% ****NF****","PERMETHRIN (E","00000000","00000000","N","N",637,"AM",null,75,371.25,20140115,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030424","CORTANE-B AQUEOUS EAR DROP 10ML *NONFORM","CORTANE-B AQ","00000000","00000000","N",null,259,"79",null,0,0,20000103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030433","SUMATRIPTAN (IMITREX) TAB 50MG ***NF***","IMITREX TAB","00000000","00000000","N","N",637,"AM",null,41.22,75.42,20091116,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030438","BENZACLIN TOPICAL GEL *****NF*******","BENZACLIN TOP","00000000","00000000","N","N",637,"AM",null,0,0,20000103,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030446","ZOMIG-ZMT (ZOLMITRIPTAN) 2.5MG TAB **NF*","ZOMIG-ZMT (ZO","00000000","00000000","N","N",637,"AM",null,0,48,20020723,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030461","NIACIN TR CAPSULE 500MG","NIACIN TR CAP","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030462","FLUOXETINE (PROZAC) 40MG CAP ***NF****","FLUOXETINE (P","00000000","00000000","N","N",637,"AM",null,0,13.34,20020913,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030470","FLOVENT-HFA 110mcg INHALER 120-DOSE **NF","FLOVENTHFA110","00000000","00000000","N","N",637,"AM",null,386.1,386.1,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030484","PEPTO-BISMOL TAB 262MG CHEWABLE","PEPTO-BISMOL","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030485","LISINOPRIL (ZESTRIL) TAB 10MG","LISINOPRIL TA","00000000","00000000","N","N",250,"78",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030493","ATROVENT (IPRATROPIUM) NASAL SPRAY *NF*","ATROVENT (IPR","00000000","00000000","N","N",637,"AM",null,0,123,20021203,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030505","MYAMBUTOL (ETHAMBUTOL) TAB 400MG*NF*","ETHAMBUTOL HC","00000000","00000000","N","N",637,"AM",null,0,7.15,20030107,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030506","PAXIL (PAROXETINE) 40MG TAB******NF*****","PAXIL (PAROXE","00000000","00000000","N",null,637,"AM",null,0,8.99,20030109,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030518","ANZEMET (DOLASETRON) 12.5MG/0.625ML**NF*","ANZEMET 12.5","00000000","00000000","N","N",636,"7E","J1260",68.599999999999994,68.599999999999994,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030526","NAPROXEN-EC(NAPROSYN-EC) TAB 375MG**NF**","NAPROXEN EC(N","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030527","METOPROLOL SUCC (TOPROL XL) TAB 25 MG","TOPROL XL  25","00000000","00000000","N","N",637,"AM",null,4.7,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030542","POTASSIUM CHL 20MEQ PREMIX/ 100ML H20","POTASSIUM CHL","00000000","00000000","N","N",636,"7E","J3480",0,25.5,20030425,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030550","DROPERIDOL (INAPSINE) INJ 5MG/2ML AMP","DROPERIDOL (I","00000000","00000000","N","N",636,"7E","J1790",25,25,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030551","PEDIASURE SUPPLEMENT VAN -CASE-***NF***0","PEDIASURE SUP","00000000","00000000","N",null,637,"AM",null,2126.4499999999998,105.63,20030301,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030566","CORTICAINE CREAM 0.5% 1 OZ TUBE****NF***","CORTICAINE CR","00000000","00000000","N",null,637,"AM",null,0,24.4,20030626,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030575","ERYPED (ERYTHROM ETHYL) 200MG/5ML SUSP","ERYTHROMYCIN","00000000","00000000","N","N",637,"AM",null,0.6,38.89,20091230,0,0,"30000028",0,0,20091231,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030580","MOTRIN IB (IBUPROFEN) 200MG TAB EACH","MOTRIN IB (IB","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030588","CORTANE-B (PRAMOX/CHLOROXY/HC) LOT ***NF","CORTANE-B (PR","00000000","00000000","N","N",637,"AM",null,96.24,33.549999999999997,20110126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030596","REMINYL (GALANTAMINE) 8MG TAB***NF****","REMINYL (GALA","00000000","00000000","N",null,637,"AM",null,8.3000000000000007,8.3000000000000007,20081112,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030601","NEO/POLY/BACIT/HYDROCORT OPTH OIN **NF**","CORTISPORIN O","00000000","00000000","N",null,637,"AM",null,39.18,39.18,20031126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030609","ACYCLOVIR (ZOVIRAX) 200MG CAP","ACYCLOVIR (ZO","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030615","LEVEMIR (INSULIN GLARGINE) 10ML *NF*","LANTUS (INSUL","00000000","00000000","N","N",637,"AM",null,194.25,0,20101019,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030624","ZOVIRAX (ACYCLOVIR) CREAM 5% 5GM","ZOVIRAX CRM 2","00000000","00000000","N","N",637,"AM",null,197.5,1186.8900000000001,20130312,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030632","DIOVAN-HCT (VALSART/HCT) TAB 80/12.5*NF*","DIOVAN-HCT 80","00000000","00000000","N","N",637,"AM",null,39.18,0,20031126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030637","CEFUROXIME (CEFTIN) 500MG TAB ***NF****","CEFUROXIME500","00000000","00000000","N","N",637,"AM",null,39.18,0,20031126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030645","METFORMIN-ER (GLUCOPHAGE)TAB 500MG*NF","metformin-ER5","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20081112,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030653","TRETINOIN (RETIN-A) 0.05% CRM 20GM","TRETINOIN .05","00000000","00000000","N","N",637,"AM",null,0,0,20031126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030658","HAVRIX (HEPATITIS A VAC) 1440ELU/ML **NF","HAVRIX (HEPAT","00000000","00000000","N",null,250,"78",null,0,198.48,20040707,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030667","LOSARTAN (COZAAR) TAB 100 MG ****NF*****","COZAAR 100MG","00000000","00000000","N","N",637,"AM",null,0,6.93,20040805,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030672","FENOFIBRATE (TRICOR) TAB 160MG ****NF***","TRICOR 160MG","00000000","00000000","N","N",637,"AM",null,0,7.12,20110126,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030681","OSMOLITE (ISOCAL) LIQ 240ML","OSMOLITE LIQ","00000000","00000000","N",null,637,"AM",null,0,5.15,20040923,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030690","SPIRIVA (TIOTROPIUM)HANDIHALER 18MCG*NF*","SPIRIVA CAP18","00000000","00000000","N","N",637,"AM",null,0,23.8,20100414,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030695","DOVONEX (CALCIPOTRIENE) 0.005% OINT *NF*","DOVONEX O 60G","00000000","00000000","N",null,637,"AM",null,39.18,373.65,20031209,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030704","PENTAZOCINE/NALOXONE (TALWIN NX) TAB*NF*","PENTAZOCINE/N","00000000","00000000","N",null,637,"AM",null,4,4.5,20081112,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030709","TIMENTIN (TICARCILL/CLAV): 3.1GM/NS*NF*","TIMENTIN 3.1G","00000000","00000000","N","N",250,"78",null,0,0,20050301,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030717","LEVOTHROID (LEVOTHYROXINE) TAB 100mc**NF","LEVOTHROID100","00000000","00000000","N",null,637,"AM",null,4.5,4.5,20081113,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030725","OLUX (CLOBETASOL) FOAM 0.05% 50GM **NF**","OLUX FOAM 0.0","00000000","00000000","N","N",637,"AM",null,0,0,20041013,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030730","GABAPENTIN (NEURONTIN) 100mg CAP","GABAPENTIN100","00000000","00000000","N","N",637,"AM",null,4.5,4.5,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030738","FLUOROURACIL (EFUDEX) 2% TOP 10ML ***NF*","FLUOROURACIL","00000000","00000000","N",null,637,"AM",null,0,0,20041013,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030747","PROTONIX (PANTOPRAZOLE) 20MG TAB***NF***","PROTONIX 20MG","00000000","00000000","N","N",637,"AM",null,13.3,13.3,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030756","PREMARIN (ESTROGEN) VAG CREAM**NF**","PREMARIN VAGI","00000000","00000000","N","N",637,"AM",null,358.6,542.5,20121210,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
["28030764","MAGNESIUM SULF 4 GM/ H2O 100ML PREMIX","MAGNESIUM SUL","00000000","00000000","N","N",636,"7E","J3475",34.200000000000003,31.8,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
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["28030778","CLORAZEPATE 7.5MG (TRANXENE) TAB **NF***","CLORAZEPATE 7","00000000","00000000","N",null,637,"AM",null,7.8,7.8,20090827,0,0,"30000028",0,0,20000103,0,0,"30100028",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000",0,0,20000103,0,0,"00000000"]
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["45000700","MRI T-SPINE W/ CONTRAST","MRI T-SPINE W","00000000","00000000",null,"Y",610,"AF","72147",3352.03,3452.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45000800","MRI L-SPINE W/O CONTRAST","MRI L-SPINE W","00000000","00000000",null,"Y",610,"AF","72148",3017.08,3107.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45000900","MRI L-SPINE W/ CONTRAST","MRI L-SPINE W","00000000","00000000",null,"Y",610,"AF","72149",3308.77,3408,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45001000","MRI CONTRAST MATERIAL","MRI CONTRAST","00000000","00000000",null,"N",610,"AF","A4643",343.61,354,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45070336","MRI TMJ'S","MRI TMJ'S","00000000","00000000","N",null,610,"AF","70336",2766.17,2849.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000","   70336"]
["45070542","MRI ORBIT/FACE/NECK W/ CONTRAST","MRI ORBIT/FAC","00000000","00000000","N","N",610,"AF","70542",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070543","MRI ORBIT/FACE/NECK W/ & W/O CONTRAST","MRI ORBIT/FAC","00000000","00000000","N","N",610,"AF","70543",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070544","MRA HEAD W/O CONTRAST","MRA HEAD W/OU","00000000","00000000","N","N",610,"AF","70544",2787.18,2870.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070545","MRA HEAD W/ CONTRAST","MRA HEAD WITH","00000000","00000000","N","N",610,"AF","70545",2787.18,2870.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070546","MRA HEAD W/ & W/O CONTRAST","MRA HEAD W/WO","00000000","00000000","N","N",610,"AF","70546",4076.33,4198.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070547","MRA CAROTIDS W/O CONTRAST","MRA CAROTIDS","00000000","00000000","N","N",610,"AF","70547",3395.29,3497.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070548","MRA CAROTIDS W/ CONTRAST","MRA CAROTIDS","00000000","00000000","N","N",610,"AF","70548",3395.29,3497.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070549","MRA CAROTIDS W/ & W/O CONTRAST","MRA CAROTIDS","00000000","00000000","N","N",610,"AF","70549",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45070552","MRI BRAIN W/CONTRAST","MRI BRAIN W/C","00000000","00000000",null,"N",610,"AF","70552",3308.77,3408,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45070553","MRI BRAIN W/&W/O CONTRAST","MRI BRAIN W/&","00000000","00000000",null,"N",610,"AF","70553",3513.95,3619.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45071550","MRI CHEST W/O CONTRAST","MRI CHEST W/O","00000000","00000000","Y","Y",610,"AF","71550",2350.87,2421.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45071551","MRI CHEST W/ CONTRAST","MRI CHEST W/","00000000","00000000","Y","Y",610,"AF","71551",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45071552","MRI CHEST W/ & W/O CONTRAST","MRI CHEST W/","00000000","00000000","Y","Y",610,"AF","71552",4101.05,4224,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45072156","MRI C-SPINE W/ & W/O CONTRAST","MRI C-SPINE W","00000000","00000000",null,"Y",610,"AF","72156",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45072157","MRI T-SPINE W/ & W/O CONTRAST","MRI T SPINE","00000000","00000000","Y","Y",610,"AF","72157",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45072158","MRI L-SPINE W/ & W/O CONTRAST","MRI L-SPINE W","00000000","00000000","N","Y",610,"AF","72158",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45072195","MRI PELVIS W/O CONTRAST","MRI PELVIS W/","00000000","00000000","N",null,610,"AF","72195",2350.87,2421.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45072196","MRI PELVIS W/ CONTRAST","MRI PELVIS","00000000","00000000","N",null,610,"AF","72196",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45072197","MRI PELVIS W/ & W/O CONTRAST","MRI PELVIS W/","00000000","00000000","N",null,610,"AF","72197",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073218","MRI HUMERUS, FOREARM,HAND W/O CONT LT","MRI HUMERUS,F","00000000","00000000","N","Y",610,"AF","73218LT",2758.75,2841.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45073219","MRI HUMERUS/FOREARM/HAND W/O CONTRAST","MRI HUMERUS,","00000000","00000000","N","Y",610,"AF","73218",2350.87,2421.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45073220","MRI HUMERUS, FOREARM,HAND W&W/O CONT BIL","MRI HUMERUS,","00000000","00000000","N","Y",610,"AF","7322050",5516.27,5681.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45073221","MRI SHOULDER, ELBOW, WRIST W/O CONT LT","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","73221LT",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073222","MRI SHOULDER, ELBOW, WRIST W/ CONTBIL","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","7322250",5500.2,5665.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20020924,0,0,"00000000",0,0,20020924,0,0,"00000000"]
["45073223","MRI SHOULDER/ELBOW/WRIST W/WO CONT","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","73223",1891.08,1947.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073718","MRI FEMUR/TIB/FIB/FOOT W/O CONTRAST","MRI FEMUR/TIB","00000000","00000000","N",null,610,"AF","73718",2350.87,2421.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073721","MRI HIP/KNEE/ANKLE W/O CONTRAST RT","MRI OF HIP/KN","00000000","00000000","N","N",610,"AF","73721RT",1891.08,1947.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073722","MRI HIP/KNEE/ANKLEY W/CONTRAST LT","MRI HIP/KNEE/","00000000","00000000","N","N",610,"AF","73722LT",3093.71,3186.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45073723","MRI HIP/KNEE/ANKLE W/ & W/O CONTRAST","MRI  HIP/KNEE","00000000","00000000","N","N",610,"AF","73723",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45074181","MRI ABDOMEN W/O CONTRAST","MRI ABDOMEN W","00000000","00000000","N",null,610,"AF","74181",2887.3,2974,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45074183","MRA RENAL/ABDOMEN W OR W/OUT CONTRAST","MRA RENAL/ABD","00000000","00000000","N","N",618,"AJ","74185",3609.12,3717.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45074185","MRI ABDOMEN W/ & W/O CONTRAST","MRI ABD W/&W/","00000000","00000000","N","N",610,"AF","74183",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45170540","MRI ORBIT/FACE/NECK W/O CONTRAST","MRI ORBIT/FAC","00000000","00000000","N",null,610,"AF","70540",3008.42,3098.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173218","MRI HUMERUS, FOREARM,HAND W/O CONT RT","MRI HUMERUS","00000000","00000000","N","Y",610,"AF","73218RT",2758.75,2841.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45173219","MRI HUMERUS/FOREARM/HAND W/ CONTRAST","MRI HUMERUS,","00000000","00000000","N","Y",610,"AF","73219",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45173220","MRI HUMERUS, FOREARM,HAND W&W/O CONT RT","MRI HUMERUS,","00000000","00000000","N","Y",610,"AF","73220RT",2758.75,2841.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45173221","MRI SHOULDER, ELBOW, WRIST W/O CONT BIL","MRI UPPER EXT","00000000","00000000","N","N",610,"AF","7322150",4639.9399999999996,4779.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173222","MRI SHOULDER, ELBOW, WRIST W/ CONT RT","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","73222RT",1891.08,1947.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20020924,0,0,"00000000",0,0,20020924,0,0,"00000000"]
["45173223","MRI SHOULDER/ELBOW/WRIST W/WO CONT BIL","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","7322350",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173719","MRI FEMUR/TIB/FIB/FOOT W/CONTRAST RIGHT","MRI FEMUR/TI","00000000","00000000","N","N",610,"AF","73719RT",1891.08,1947.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173720","MRI FEMUR/TIB/FIB/FOOT W/ & W/O CONTRAST","MRI FEMUR/TIB","00000000","00000000","N","N",610,"AF","73720",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173721","MRI LOWER EXT JNT W/O CONT LT","MRI OF LOWER","00000000","00000000","N","N",610,"AF","73721LT",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173722","MRI HIP/KNEE/ANKLE W/ CONTRAST","MRI HIP/KNEE/","00000000","00000000","N","N",610,"AF","73722",3093.71,3186.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45173723","MRI HIP/KNEE/ANKLE W/ & W/O CONTRAST BIL","MRI HIP/KNEE/","00000000","00000000","N",null,610,"AF","7372350",5500.2,5665.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45270540","MRI ORBITS, FACE W/OUT CONTRAST","MRI OF ORBITS","00000000","00000000","N","N",610,"AF","70540",2766.17,2849.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273218","MRI HUMERUS,FOREAREM,HAND W/O CONT BIL","MRI HUMERUS","00000000","00000000","N","Y",610,"AF","7321850",5516.27,5681.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45273220","MRI HUMERUS/FOREARM/HAND W/ & W/O CONTRA","MRI HUMERUS,","00000000","00000000","N","Y",610,"AF","73220",3709.24,3820.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20000418,0,0,"00000000",0,0,20000418,0,0,"00000000"]
["45273221","MRI SHOULDER/ELBOW/WRIST W/O CONTRAST","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","73221",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273222","MRI SHOULDER/ELBOW/WRIST W/ CONTRAST","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","73222",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,20020924,0,0,"00000000",0,0,20020924,0,0,"00000000"]
["45273223","MRI SHOULDER, ELBOW, WRIST W/WO CONT BIL","MRI SHOULDER,","00000000","00000000","N","N",610,"AF","7322350",3780.92,3894.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273718","MRI FEMUR/TIB/FIB/FOOT W/O CONTRAST BIL","MRI FEMUR/TIB","00000000","00000000","N","N",610,"AF","7371850",3780.92,3894.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273720","MRI FEMUR/TIB/FIB/FOOT W/ CONTRAST","MRI FEMUR/TIB","00000000","00000000","N","N",610,"AF","73719",3028.2,3119,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273721","MRI HIP/KNEE/ANKLE W/O CONTRAST LT","MRI KNEE W/O","00000000","00000000","N","N",610,"AF","73721LT",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45273722","MRI HIP/KNEE/ANKLE W/ CONTRAST BIL","MRI LOWER EXT","00000000","00000000","N","N",610,"AF","7372250",6187.42,6373,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45373721","MRI FOOT","MRI FOOT","00000000","00000000","N","N",610,"AF","73721",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45473720","MRI FEMUR/TIB/FIB/FOOT W/ & W/O CONT BIL","MRI LOWER EXT","00000000","00000000","N","N",610,"AF","7372050",3780.92,3894.25,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45473721","MRI ANKLE RT","MRI ANKLE","00000000","00000000","N","N",610,"AF","73721RT",2732.8,2814.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45573721","MRI ABDOMEN W/ CONTRAST","MRI ABD W/CON","00000000","00000000","N","N",610,"AF","74182",3093.71,3186.5,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["45737210","MRI FEMUR/TIB/FIB/FOOT W/O CONTRAST RT","MRI LOWER LEG","00000000","00000000","N","N",610,"AF","73718RT",1891.08,1947.75,20190115,0,0,"30000045",0,0,20190115,0,0,"30100045",0,0,20190115,0,0,"00000000",0,0,0,0,0,"00000000",0,0,0,0,0,"00000000"]
["46004641","NM PROVISIONAL (LV CONTRAST)","NM PROVISIONA","00000000","00000000",null,"Y",343,"74","A4641",150,155,20131003,0,0,"30000046",0,0,20131003,0,0,"30100046",0,0,20000303,0,0,"00000000",0,0,20000303,0,0,"00000000",0,0,20000303,0,0,"00000000"]
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