0.9% NACL-20 MEQ KCL (NS 20KCL) IV SOLN 3900001 EA $ 109.75 0.9% NACL-40 MEQ KCL (NS 40KCL) IV SOLN 3900002 EA $ 109.75 1" IODOFORM 8408640 EA $ 12.60 1/2" IODOFORM 8408642 EA $ 10.50 1200CC CANISTER 8402097 EA $ 7.00 14FR FOLEY CAT TRAY 8408400 EA $ 7.11 17 HYDROXYPROGESTRONE 2700559 EA $ 112.05 24 HOUR CATECHOLAMINES 2700592 EA $ 138.84 24 HOUR CORTISOL 2700479 EA $ 91.88 24 HOUR CREATININE CLEARANCE 2700255 EA $ 51.96 24 HOUR METANEPHRINES 2700485 EA $ 93.16 24 HOUR SODIUM (NA+) 2700132 EA $ 26.76 24 HOUR URIC ACID 2700126 EA $ 26.12 24 HR URINE BUN 2700063 EA $ 13.28 24 HR URINE CALCIUM 2700174 EA $ 33.16 24 HR URINE PROTEN ELECTROPHORESIS 2700497 EA $ 98.08 24 URINE ARSENIC 2700522 EA $ 103.56 24 URINE COPPER 2700363 EA $ 68.24 24 URINE CREATINE 2700246 EA $ 50.96 24 URINE LEAD 2700347 EA $ 66.07 24 URINE MERCURY 2700469 EA $ 88.72 3LUMEN CVC CATH KIT 8402293 EA $ 139.86 4X4 XTHIN DRESSING 8401780 EA $ 37.38 5 % DEXTROSE- 0.9 % NACL (D5NS) IV SOLN 3900003 EA $ 79.00 5 % DEXTROSE-0.45 % NACL (D5 1/2NS) SOLN 3900004 EA $ 79.00 5 HYDROXYINDOLEACETATE 2700372 EA $ 70.20 5 NUCLEOTIDASE 2700282 EA $ 60.84 60ML STERILE SYRINGE 8401690 EA $ 7.00 ABD 5"X9" PAD STERILE 8403102 EA $ 7.00 ABG KITS 90000001 EA $ 5.00 ABO 2700068 EA $ 16.40 ACE 2" 8408493 EA $ 7.00 ACE 3" 8408494 EA $ 16.66 ACE 4" 8418494 EA $ 29.58 ACE 6" 8408496 EA $ 26.99 ACETAMINOPHEN 2700553 EA $ 111.28 ACETAMINOPHEN (TYLENOL) 120 MG SUPP 3900005 EA $ 9.35 ACETAMINOPHEN (TYLENOL XS) 500 MG TAB 3900006 EA $ 5.00 ACETAMINOPHEN (TYLENOL) 160 MG/5 ML LIQD 3900007 EA $ 4.15 ACETAMINOPHEN (TYLENOL) 325 MG SUPP 3900008 EA $ 9.35 ACETAMINOPHEN (TYLENOL) 325 MG TAB 3900009 EA $ 4.15 ACETAMINOPHEN (TYLENOL) 650 MG SUPP 3900010 EA $ 9.35 ACETONE (SERUM) 2700081 EA $ 18.08 ACETYLCHOLINE RECEPTOR BINDING ANTIBODY 2700410 EA $ 74.28 ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY 2700409 EA $ 74.28

�1

ACETYLCHOLINE RECEPTOR MODULATING ANTIBO 2700408 EA $ 74.28 ACETYLCYSTEINE (MUCOMYST) 100 MG/ML SOLN 3900011 EA $ 48.00 ACTH 2700611 EA $ 218.84 ACTIVATED CHARCOAL-SORB 25 GM/120 ML SUS 3900012 EA $ 54.20 ACYLCARNITINE 2700483 EA $ 92.72 ADD'L 5CM OR LESS COMPLEX EY,NOSE, EAR, 1800164 EA $ 271.03 ADDTL SEQ INFUS OF NEW DRUG TO 1 HOUR 1000011 EA $ 97.13 ADDTL SEQ INFUS OF NEW DRUG TO 1 HR 1800126 EA $ 97.13 ADENOSINE (ADENOCARD) 6MG/2ML INJ 3900013 EA $ 87.00 ADLT TRAY SNL 3.5IN 20GA 8401980 EA $ 56.39 ADULT AMBU BAG 8401652 EA $ 116.66 AEROSOL MASK ADULT 80000033 EA $ 5.00 AFB STAIN 2700160 EA $ 29.56 ALBUMIN 2700135 EA $ 27.20 ALBUTEROL (ACCUNEB) 0.63 MG/3 ML NEB 3900014 EA $ 15.50 ALBUTEROL SULFATE 2.5 MG /3 ML NEB 3900015 EA $ 15.50 ALDOLASE 2700259 EA $ 53.36 ALDOSTERONE 2700558 EA $ 112.04 ALKALINE PHOSPHATASE (ALP) 2700145 EA $ 28.44 ALLERGEN SPECIFIC iGg QUANTITATIVE /SEMI 2700651 EA $ 28.64 ALLOPURINOL (ZYLOPRIM) 100 MG TAB 3900016 EA $ 9.35 ALPHA FET0PROTEIN 2700480 EA $ 92.24 ALPHA LACTALBUMIN IGE 2700152 EA $ 28.48 ALPHA-1 ANTITRYPSIN PHENOTYPE 2700428 EA $ 78.92 ALPHA-1- ANTITRYPSIN- QUANT 2700400 EA $ 73.32 ALPHA-1-ANTITRYPSIN -MUTATION 2700576 EA $ 119.10 ALPHA-1-ANTITRYPSIN TOTAL 2700597 EA $ 147.76 ALPHA-2 MUCNOGLUBIN 2700406 EA $ 74.16 ALT (SGPT) 2700156 EA $ 29.08 ALTEPLASE (ACTIVASE) 100 MG 3900018 EA $ 43,560.00 ALTERNARIA Ige 2700054 EA $ 10.28 AMBU PEDI BAG 8401651 EA $ 87.15 AMINOPHYLLINE 250 MG/10 ML INJ 3900019 EA $ 38.00 AMINOPHYLLINE 500 MG/20 ML INJ 3900020 EA $ 45.00 AMIODARONE (CORDARONE) 200 MG TAB 3900021 EA $ 9.35 AMIODARONE (CORDARONE) 50 MG/ML INJ 3900022 EA $ 85.00 AMITRIPTYLINE 2700500 EA $ 98.44 AMITRIPTYLINE (ELAVIL) 10 MG TAB 3900023 EA $ 7.00 AMLODIPINE (NORVASC) 10 MG TAB 3900024 EA $ 10.00 AMLODIPINE (NORVASC) 5 MG TAB 3900025 EA $ 8.00 AMMONIA 2700434 EA $ 80.12 AMMONIA INHALANT 15 % SOLN 3900026 EA $ 9.50 AMOX-CLAV (AUGMENTIN ES) 600MG/5ML SUSP 3900027 EA $ 8.00 AMOX-CLAV (AUGMENTIN) 500-125 MG TAB 3900028 EA $ 20.00 AMOX-CLAV (AUGMENTIN) 875-125 MG TAB 3900029 EA $ 22.00

�2

AMOXICILLIN 125 MG/5 ML SUSP 3900030 EA $ 7.00 AMOXICILLIN 250 MG CAP 3900031 EA $ 9.35 AMOXICILLIN 875 MG TAB 3900032 EA $ 12.10 AMYLASE 2700188 EA $ 35.64 ANA 2700356 EA $ 66.48 ANA sCREEN IFA W/REFLEX TO TITER/PATTERN 2700308 EA $ 65.96 ANA TITER 2700283 EA $ 61.40 ANCA SCREEN W REFLUX 2700652 EA $ 142.85 ANCA VASCULITIDES 2700091 EA $ 20.49 ANGIOTENSIN 1 (ACE) 2700436 EA $ 80.28 ANTI SMOOTH MUSCLE 2700552 EA $ 109.32 ANTIBODY CYTOMEGALOVIRUS i 2700177 EA $ 33.60 ANTIBODY IDENTIFICATION 2700619 EA $ 300.00 ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBO 2700496 EA $ 98.01 ANTIBODY SCREEN 2700369 EA $ 70.00 ANTIGEN SCREEN 2700256 EA $ 52.28 ANTIPHOSPHOLIPID Ab IgG 2700269 EA $ 58.32 ANTITHROMBIN ACTIVITY 2700281 EA $ 60.00 ANTITHROMBIN III ANTIGEN 2700278 EA $ 59.44 APAP-CODEINE (TYL+COD) 120-12MG/5ML LIQ 3900033 EA $ 8.00 APOLIPOPROTEIN A1 2700451 EA $ 84.56 APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 2100014 EA $ 107.00 APPL MODALITY 1/> AREAS ELEC STIMJ UNAT 2100030 EA $ 114.40 APPL MODALITY 1/> AREAS ELEC STIMJ UNATT 2100010 EA $ 114.40 APPL MODALITY 1/> AREAS IONTOPHORESIS EA 2100015 EA $ 129.55 APPL MODALITY 1/> AREAS PARAFFIN BATH 2100011 EA $ 28.17 APPL MODALITY 1/> AREAS TRACTION MECHANI 2100009 EA $ 44.82 APPL MODALITY 1/> AREAS ULTRASOUND EA 15 2100016 EA $ 35.22 APPLICATION CAST SHOULDER HAND LONG ARM 2100005 EA $ 152.65 APPLICATION FINGER SPLINT STATIC 1800087 EA $ 138.36 APPLICATION LONG ARM SPLINT SHOULDER HAN 1800085 EA $ 202.90 APPLICATION MODALITY 1/= AREA WHIRLPOOL 2100012 EA $ 61.41 APPLICATION MODALITY 1/> AREAS DIATHERMY 2100013 EA $ 18.70 APPLICATION MODALITY 1/> AREAS HOT/COLD 2100008 EA $ 36.30 APPLICATION SHORT ARM SPLINT FOREARM-HAN 1800086 EA $ 133.88 APPLICATION SHORT LEG CAST BELOW KNEE-TO 1800088 EA $ 203.11 APPLICATION SHORT LEG SPLINT CALF FOOT 1800089 EA $ 170.63 ARGININE VASOPRESSIN 2700606 EA $ 186.64 ARMBOARD LARGE 8408616 EA $ 12.00 ARSENIC 2700299 EA $ 64.24 ARTERIAL BLOOD GAS 2400003 EA $ 200.00 ARTERIAL PUNCTURE 2400001 EA $ 118.25 ARTHROCENTESIS ASPIR&/INJECTION INTERM J 1800061 EA $ 249.96 ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT 1800062 EA $ 201.85 ARTHROCENTESIS ASPIR&/INJECTION SMALL JT 1800060 EA $ 123.48

�3

ASCA (IgA) 2700358 EA $ 67.40 ASCA (IgG) 2700359 EA $ 67.40 ASO 2700166 EA $ 31.72 ASO TITER 2700201 EA $ 38.44 ASPERGILLUS Ag 2700310 EA $ 65.96 ASPERGILLUS FUMIGATUS ALLERGEN 2700036 EA $ 10.28 ASPERGILLUS FUMIGATUS ANTIBODY 2700093 EA $ 20.54 ASPIRIN (BABY ASA) 81 MG CHEW 3900034 EA $ 4.15 ASPIRIN (BABY ASA) 81 MG TBEC 3900035 EA $ 4.15 ASPIRIN 300 MG SUPP 3900036 EA $ 6.00 ASPIRIN 325 MG TAB PLAIN 3900037 EA $ 5.00 ASPIRIN EC (ECOTRIN) 325 MG TAB 3900038 EA $ 5.00 AST (SGOT) 2700147 EA $ 28.44 ATENOLOL (TENORMIN) 25 MG TAB 3900039 EA $ 8.00 ATORVASTATIN (LIPITOR) 10 MG TAB 3900040 EA $ 14.50 ATORVASTATIN (LIPITOR) 40 MG TAB 3900041 EA $ 16.00 ATROPINE 0.4MG/ML INJ 3901531 EA $ 100.00 ATROPINE 1 MG/10 ML (0.1MG/ML) SYRG 3900042 EA $ 198.85 ATROPINE OPTHALMIC 1 % DROP 3900043 EA $ 40.00 AVULSION NAIL PLATE PARTIAL/COMPLETE SIM 1800020 EA $ 178.68 AZITHROMYCIN (ZITHROMAX) 200 MG/5 ML SUS 3900044 EA $ 22.00 AZITHROMYCIN (ZITHROMAX) 250 MG TAB 3900045 EA $ 40.00 AZITHROMYCIN (ZITHROMAX) 500 MG INJ 3900046 EA $ 97.00 B2 GLYCOPROTEIN IgG 2700590 EA $ 138.48 B2 GLYCOPROTEIN IgM 2700589 EA $ 138.48 BAHIA GRASS Ige 2700053 EA $ 10.28 BARTONELLA SPECIES ANTIBODY 2700633 EA $ 627.00 BB RED BLOOD CELLS LEUKOREDUCED 2700623 EA $ 364.00 BENAZEPRIL (LOTENSIN) 10 MG TAB 3900047 EA $ 9.35 BENAZEPRIL (LOTENSIN) 20 MG TAB 3900048 EA $ 9.35 BENTYL 10MG/5ML (DICYCLOMINE) LIQ 3900381 EA $ 6.00 BENZOCAINE (HURRICAINE) 20 % SPRAY 3900049 EA $ 95.00 BENZOIN TINCTURE 3900050 EA $ 35.00 BENZONATATE (TESSALON PERLES) 100 MG CAP 3900051 EA $ 7.00 BERMUDA GRASS 2700037 EA $ 10.28 BETA 2 MICROGILOULIN 2700464 EA $ 88.28 BETA LACTAGLOBULIN IGE 2700153 EA $ 28.48 BETA LACTOMASE 2700129 EA $ 26.12 BILIRUBIN DIRECT/INDIRECT 2700138 EA $ 27.60 BILIRUBIN TOTAL 2700137 EA $ 27.60 BIPAP 2400052 EA $ 188.95 BIRCH 2700038 EA $ 10.28 BISACODYL (DULCOLAX) 10 MG SUPP 3900052 EA $ 9.35 BISACODYL (DULCOLAX) 5 MG TBEC 3900053 EA $ 5.00 BISOPROLOL-HCTZ (ZIAC) 5-6.25 MG TAB 3900054 EA $ 12.00

�4

BK VIRUS DNA QUANT 2700573 EA $ 117.76 BLADDER SCAN 1800105 EA $ 59.75 BLEEDING TIME 2700114 EA $ 24.76 BLOOD ADMINISTATION LEVEL 4 5600004 EA $ 992.70 BLOOD ADMINISTRATION LEVEL 1 1000005 EA $ 392.70 BLOOD ADMINISTRATION LEVEL 2 1000001 EA $ 592.70 BLOOD ADMINISTRATION LEVEL 3 1000002 EA $ 792.70 BLOOD ADMINISTRATION LEVEL 4 1000003 EA $ 992.70 BLOOD ADMINISTRATION LEVEL 5 1000004 EA $ 1,192.70 BLOOD COUNT DIFFERENTIAL 2700082 EA $ 18.92 BNP 2700605 EA $ 186.64 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILA 2400076 EA $ 168.00 BROM-SUD-DEX(BROMFED DM)2-30-10MG/5ML LQ 3900055 EA $ 8.00 BUDESONIDE (PULMICORT) 0.5 MG/2 ML NEB 3900056 EA $ 30.00 BUMETANIDE (BUMEX) 1 MG TAB 3900057 EA $ 9.35 BUN 2700102 EA $ 21.72 BUPRENORPHINE (SUBUTEX) 8 MG SUBL 3900062 EA $ 25.00 BURETROL CHAMBER 8407565 EA $ 13.79 BUSPIRONE (BUSPAR) 5 MG TAB 3900063 EA $ 9.50 C DIFFICILE TOXIN 2700311 EA $ 65.96 C REACTIVE PROTEIN 2700148 EA $ 28.44 C3 2700319 EA $ 66.00 C4 2700318 EA $ 66.00 CA 125 2700565 EA $ 114.44 CA 15-3 2700563 EA $ 114.44 CA 27-29 2700562 EA $ 114.44 CA19-9 2700564 EA $ 114.44 CALCITRIOL (ROCALTROL) 0.25 MCG CAP 3900064 EA $ 8.00 CALCIUM 2700143 EA $ 28.36 CALCIUM RANDOM URINE 2700142 EA $ 28.36 CALCIUM CARBONATE (TUMS) 750 MG CHEW 3900065 EA $ 5.00 CALCIUM CARB-VIT D3 600 MG-400 IU TAB 3900066 EA $ 5.00 CALCIUM CHLORIDE 10%-1,000 MG/10ML SYRG 3900067 EA $ 45.00 CALCIUM GLUCONATE 100 MG/ML - 10% INJ 3900068 EA $ 35.00 CALCIUM IONIZED 2700415 EA $ 75.16 CALPROTECTIN, STOOL 2700662 EA $ 249.72 CAMPYLOBACTER ANTIGEN 2700302 EA $ 65.44 CANNULA CRVD N-FLAIR 8401401 EA $ 7.00 CANOPY TENT 8401704 EA $ 101.50 CARBAMIDE PEROXIDE (EAR WAX) DROP 3900069 EA $ 10.00 CARBIDOPA-LEVO (SINEMET) 25-100 MG TAB 3900070 EA $ 8.50 CARDIAC STRESS TEST W/ SUPERVISION 2400031 EA $ 1,200.00 CARDIO IQ LIPOPROTEIN SUBFRACTIONATION 2700459 EA $ 86.72 CARDIOLIPIN Ab (IgG) 2700526 EA $ 104.91 CARDIOLIPIN AB (igM) 2700591 EA $ 138.48

�5

CARDIOPULMONARY RESUSCITATION 2400005 EA $ 1,014.50 CARDIOVERSION INC CONSCIOUS SEDATION 1800120 EA $ 417.66 CARDIZEM CD 120 MG (DILTIAZEM ER) CAP E 3901496 EA $ 9.00 CARNITINE 2700424 EA $ 77.68 CARRAKLENZ 8408394 EA $ 30.63 CARVEDILOL (COREG) 12.5 MG TAB 3900071 EA $ 9.35 CARVEDILOL (COREG) 3.125 MG TAB 3900072 EA $ 9.35 CASEIN IGE 2700154 EA $ 28.48 CAT Ige 2700056 EA $ 10.28 CATALASE ENZYME TEST 2700127 EA $ 26.12 CATECHOLAMINES FRACTIONATED (PLASMA) 2700523 EA $ 104.13 CATH 16FR FOLEY 8408666 EA $ 17.26 CATH BAG 8408421 EA $ 7.00 CATH FOLEY 12FR 8408404 EA $ 12.00 CATH FOLEY 16FR 8408411 EA $ 12.00 CATH IV IAG STRL PNK 8401597 EA $ 11.57 CATH PLUG STERILE 8401376 EA $ 7.00 CATH STRAIGHT TIP 10FR 8401699 EA $ 7.00 CATH STRAP 8408424 EA $ 15.89 CATH SUCTION CONTROL STRL 14FR 8403289 EA $ 7.00 CATH SUCTION PEFI 8FR 8402794 EA $ 7.00 CATH URTH 16FR 2W 8408405 EA $ 12.00 CATHETER FOLEY 24 FR 30CC LATEX STERILE 8401707 EA $ 21.46 CATHETER FOLEY SILI ELAST LTX 18FR 8408669 EA $ 12.00 CATHETER STRAP 8401459 EA $ 19.22 CBC (NO AUTO DIFF) 2700186 EA $ 35.56 CBC/AUTO DIFF 2700212 EA $ 42.76 CEA 2700525 EA $ 104.32 CEFAZOLIN (ANCEF) 1 GM INJ 3900073 EA $ 55.00 CEFTRIAXONE (ROCEPHIN) 1 GRAM INJ 3900074 EA $ 95.00 CEFTRIAXONE (ROCEPHIN) 2 GRAM INJ 3900075 EA $ 150.00 CEFTRIAXONE (ROCEPHIN) 500 MG INJ 3900076 EA $ 85.00 CELIAC DISEASE PANEL 2700571 EA $ 117.52 Central Line5yr & up 1800155 EA $ 982.97 CENTROMERE 2700273 EA $ 58.76 CEPHALEXIN (KEFLEX) 500 MG CAP 3900077 EA $ 12.00 CERULOPLASMIN 2700274 EA $ 59.04 CETIRIZINE (ZYRTEC) 5 MG/5ML LIQD 3900078 EA $ 8.00 CH50 2700555 EA $ 111.72 CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O 1800102 EA $ 976.00 CHEST PERCUSSION INITIAL 2400047 EA $ 78.65 CHEST PERCUSSION SUBSEQUENT 2400048 EA $ 78.65 CHLORDIAZEPOXIDE HCL (LIBRIUM) 25 MG CAP 3900079 EA $ 7.00 CHLORIDE 2700121 EA $ 25.28 CHOLESTEROL 2700111 EA $ 23.92

�6

CHROMATIN 2700506 EA $ 98.60 CHROMIUM 2700554 EA $ 111.52 CHROMOGRANIN A 2700566 EA $ 114.44 CHROMOSOME ANALYSIS 15-20 2700621 EA $ 342.66 CIADOSPORIUM HERBARUM 2700039 EA $ 10.28 CIPROFLOXACIN 500 MG TAB 3900080 EA $ 15.00 CIPROFLOXACIN IN D5W 400 MG/200 ML PGBK 3900081 EA $ 155.00 CIRCUIT BIPAP DISP VISION STERILE 8403168 EA $ 29.88 CITALOPRAM (CELEXA) 20 MG TAB 3900082 EA $ 8.00 CITRIC ACID 24 URINE 2700567 EA $ 114.66 CLAM 2700028 EA $ 10.28 CLEARLINK HEPLOCK 8401902 EA $ 11.57 CLINDAMYCIN (CLEOCIN) 300 MG PGBK 3900083 EA $ 125.00 CLINDAMYCIN HCL (CLEOCIN) 150 MG CAP 3900084 EA $ 15.00 CLONAZEPAM (KLONOPIN) 0.5 MG TAB 3900085 EA $ 10.00 CLONIDINE (CATAPRES) 0.1 MG TAB 3900086 EA $ 9.35 CLONIDINE (CATAPRES-TTS) 0.1 MG/24 HR PT 3900087 EA $ 95.00 CLOPIDOGREL (PLAVIX) 75 MG TAB 3900088 EA $ 21.00 CLOSED TX ANKLE DISLOCATION W/O ANESTHES 1800081 EA $ 1,251.25 CLOSED TX PATELLAR DISLOCATION W/ANESTHE 1800080 EA $ 1,624.60 CLOSED TX PATELLAR DISLOCATION W/O ANEST 1800079 EA $ 1,123.12 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1800063 EA $ 111.65 CLOSTRIDIUM DIFFICILE TOXIN B QUAL PCR 2700537 EA $ 107.08 CLOTRIMAZOLE (LOTRIMIN AF) 1 % CREAM 3900089 EA $ 35.00 CLOTRIM-BETA (LOTRISONE) 1-0.05 % CREAM 3900090 EA $ 70.00 CLSD TX SHOULDER DISLC W/MANIPULATION RE 1800065 EA $ 1,338.02 CLSD TX SHOULDER DISLC W/MANIPULATION W/ 1800064 EA $ 1,045.73 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL 1800082 EA $ 1,671.32 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ E 1800073 EA $ 612.99 CLTX HIP DISLOCATION TRAUMATIC REQ ANEST 1800077 EA $ 2,586.61 CLTX HIP DISLOCATION TRAUMATIC W/O ANEST 1800076 EA $ 642.64 CLTX IPHAL JT DISLC W/MANJ W/O ANES 1800074 EA $ 642.00 CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W 1800070 EA $ 855.32 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELB 1800069 EA $ 319.52 CMP 2700267 EA $ 58.12 CO2 2700133 EA $ 26.88 CO2 DETECTOR EASY CAP II 8402599 EA $ 84.91 CO2 DETECTOR PEDIATRIC 80000066 EA $ 71.96 COAGULASE ENZYME TEST 2700128 EA $ 26.12 COBALT 2700580 EA $ 120.76 COBAN 1" 8408629 EA $ 7.00 COBAN 2" 8401582 EA $ 7.00 COBAN 3" 8408498 EA $ 8.12 COBAN 4" 8408499 EA $ 9.45 COBAN 6" 8408500 EA $ 16.28

�7

COCKROACH 2700040 EA $ 10.28 CODFISH 2700029 EA $ 10.28 COLCHICINE (COLCRYS) 0.6 MG TAB 3900091 EA $ 29.00 COLONOSCOPY RE W/SNARE 1000036 EA $ 3,434.71 COLONOSCOPY W/ REMOVAL B FORCEPS 1000035 EA $ 3,434.71 COLONOSCOPY WITH BIOP 1000034 EA $ 3,434.71 COMPLEX SPECIAL STAIN TRICHROME 2700507 EA $ 98.84 CONCURRENT INFUSION 1000012 EA $ 66.43 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 1800090 EA $ 197.96 COOMBS DIRECT 2700159 EA $ 29.56 COOMBS INDIRECT 2700164 EA $ 31.48 COPPER 2700364 EA $ 68.24 CORN Ige 2700050 EA $ 10.28 CORONARY THROMBOLYSIS BY IV INFUSION 1800121 EA $ 399.07 CORTISOL BINDING GLOBULIN 2700508 EA $ 98.96 CORTISOL FREE 2700365 EA $ 68.24 CORTISOL LEVEL 2700471 EA $ 89.64 CORTISONE 2700588 EA $ 132.30 CPAP VENTILATION INITIATION & MANAGE 2400054 EA $ 188.95 CPAP/BIPAP MASK 2400039 EA $ 100.00 C-PEPTIDE 2700460 EA $ 87.40 CPK 2700189 EA $ 35.80 CPR 1800118 EA $ 647.57 CREATININE 2700141 EA $ 28.16 CROSSMATCH 2700284 EA $ 61.50 CROTALIDAE POLY IMMUNE FAB (CROFAB) INJ 3900092 EA $ 7,000.00 CRYOGLOBULIN 2700184 EA $ 35.56 CRYPTOCOCCAL Ag CSF 2700264 EA $ 56.04 CSF CELL COUNT WITH DIFF 2700020 EA $ 9.72 CSF GLUCOSE 2700098 EA $ 21.56 CSF TOTAL PROTEIN 2700089 EA $ 20.16 CT 3 PHASE LIVER 3500001 EA $ 1,832.75 CT 3D RENDERING W/INTERP CT/MRI/US/OTHER 3500002 EA $ 273.95 CT ABDOMEN W/CONTRAST 3500006 EA $ 1,443.75 CT ABDOMEN W/O CONTRAST 3500008 EA $ 1,064.90 CT ABDOMEN WWO CONTRAST 3500007 EA $ 1,832.75 CT ABDOMEN/PELVIS W/ CONTRAST 3500003 EA $ 1,638.40 CT ABDOMEN/PELVIS W/O CONTRAST 3500004 EA $ 1,074.15 CT ABDOMEN/PELVIS WWO CONTRAST 3500005 EA $ 2,075.80 CT CERVICAL SPINE W/CONTRAST 3500009 EA $ 1,216.20 CT CERVICAL SPINE W/O CONTRAST 3500011 EA $ 996.55 CT CERVICAL SPINE WWO CONTRAST 3500010 EA $ 1,452.30 CT CHEST HIGH RESOLUTION 3500012 EA $ 1,224.64 CT HEAD/BRAIN W CONTRAST 3500016 EA $ 1,005.25 CT HEAD/BRAIN W/O CONTRAST 3500018 EA $ 766.60

�8

CT HEAD/BRAIN WWO CONTRAST 3500017 EA $ 1,018.45 CT HEART CONTRAST EVAL CARDIAC STRUCTURE 3500019 EA $ 1,439.15 CT HEART NO CONTRAST QUANT EVAL CORONRY 3500020 EA $ 355.40 CT HRT CONTRST CARDIAC STRUCT&MORPH CONG 3500021 EA $ 1,786.20 CT LOWER EXTREMITY W/ CONTRAST LEFT 3500063 EA $ 1,311.95 CT LOWER EXTREMITY W/ CONTRAST RIGHT 3500022 EA $ 1,311.95 CT LOWER EXTREMITY W/O CONTRAST LEFT 3500059 EA $ 1,061.60 CT LOWER EXTREMITY W/O CONTRAST RIGHT 3500024 EA $ 1,061.60 CT LOWER EXTREMITY WWO CONTRAST LEFT 3500060 EA $ 1,661.45 CT LOWER EXTREMITY WWO CONTRAST RIGHT 3500023 EA $ 1,661.45 CT LUMBAR SPINE W/CONTRAST 3500025 EA $ 1,217.70 CT LUMBAR SPINE W/O CONTRAST 3500027 EA $ 972.45 CT LUMBAR SPINE WWO CONTRAST 3500026 EA $ 1,452.30 CT MAXILLOFACIAL W/CONTRAST 3500028 EA $ 1,274.10 CT MAXILLOFACIAL W/O CONTRAST 3500030 EA $ 1,058.90 CT MAXILLOFACIAL WWO CONTRAST 3500029 EA $ 1,531.35 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST 3500031 EA $ 1,487.90 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRA 3500032 EA $ 1,285.95 CT ORBIT SELLA/POST FOSSA/EAR WWO CONT 3500033 EA $ 1,646.45 CT PELVIS W/CONTRAST 3500034 EA $ 1,268.60 CT PELVIS W/O CONTRAST 3500036 EA $ 810.55 CT PELVIS WWO CONTRAST 3500035 EA $ 1,420.90 CT SOFT TISSUE NECK W/CONTRAST 3500037 EA $ 1,244.95 CT SOFT TISSUE NECK W/O CONTRAST 3500039 EA $ 1,035.45 CT SOFT TISSUE NECK WWO CONTRAST 3500038 EA $ 1,483.00 CT THORACIC SPINE W/CONTRAST 3500040 EA $ 1,220.75 CT THORACIC SPINE W/O CONTRAST 3500042 EA $ 975.50 CT THORACIC SPINE WWO CONTRAST 3500041 EA $ 1,459.95 CT THORAX W/CONTRAST 3500043 EA $ 1,218.05 CT THORAX W/O CONTRAST 3600309 EA $ 974.30 CT THORAX WWO CONTRAST 3500044 EA $ 1,474.10 CT UPPER EXTREMITY W/O CONTRAST LT 3500047 EA $ 969.50 CT UPPER EXTREMITY W/O CONTRAST RT 3500064 EA $ 969.50 CT UPPER EXTREMITY WITH CONTRAST LT 3500065 EA $ 1,189.20 CT UPPER EXTREMITY WITH CONTRAST RT 3500048 EA $ 1,189.20 CT UPPER EXTREMITY WWO CONTRAST LT 3500066 EA $ 1,509.50 CT UPPER EXTREMITY WWO CONTRAST RT 3500046 EA $ 1,509.50 CTA ABD AORTA/BILAT ILIOFEM W/CONT POS 3500051 EA $ 2,087.90 CTA ABD/PELVIS CONTRAST WWO 3500049 EA $ 2,086.32 CTA ABDOMEN W/CONTRAST/NONCON 3500050 EA $ 1,883.60 CTA CHEST W/CONTRAST 3500052 EA $ 1,873.20 CTA HEAD W/CONTRAST/NONCONTRA 3500053 EA $ 2,313.20 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3500054 EA $ 1,754.60 CTA LOWER EXTREMITY LEFT 3500061 EA $ 1,880.50 CTA LOWER EXTREMITY RIGHT 3500055 EA $ 1,880.50

�9

CTA NECK W/CONTRAST/NONCONTRA 3500056 EA $ 2,391.10 CTA PELVIS W/CONTRAST/NONCONT 3500057 EA $ 1,859.10 CTA UPPER EXTREMITY LEFT 3500062 EA $ 1,700.05 CTA UPPER EXTREMITY RIGHT 3500058 EA $ 1,700.05 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1800091 EA $ 353.57 CULTURE AFB 2700217 EA $ 44.50 CULTURE ANAEROBIC 2700254 EA $ 51.88 CULTURE BLOOD 2700265 EA $ 56.76 CULTURE BLOOD #2 2700646 EA $ 56.76 CULTURE BODY FLUID 2700237 EA $ 47.36 CULTURE BONE 2700239 EA $ 47.76 CULTURE CATH 2700226 EA $ 47.36 CULTURE CSF 2700227 EA $ 47.36 CULTURE EAR 2700228 EA $ 47.36 CULTURE EYE 2700229 EA $ 47.36 CULTURE FUNGUS 2700223 EA $ 46.20 CULTURE FUNGUS W/SMEAR HAIR SKIN & NAIL 2700210 EA $ 42.40 CULTURE GROUP B STREP 2700192 EA $ 36.46 CULTURE MISC 2700230 EA $ 47.36 CULTURE NASAL 2700231 EA $ 47.36 CULTURE SPUTUM 2700232 EA $ 47.36 CULTURE STOOL 2700253 EA $ 51.88 CULTURE STREP A 2700193 EA $ 36.48 CULTURE THROAT 2700233 EA $ 47.36 CULTURE URINE 2700218 EA $ 44.52 CULTURE VAGINAL (CERVIX) 2700234 EA $ 47.36 CULTURE VIRAL BODY FLUIDS 2700579 EA $ 120.00 CULTURE WOUND 2700235 EA $ 47.36 CYCLIC CITRULLINE PEPTIDE (CCP) 2700385 EA $ 71.20 CYCLOBENZAPRINE (FLEXERIL) 10 MG TAB 3900093 EA $ 9.35 CYCLOSPORIN 2700178 EA $ 33.72 CYSTIC FIBROSIS SCREEN 2700301 EA $ 65.00 CYTO EVAL OF FNA 2700366 EA $ 68.52 CYTO FORENSIC (SPERM) 2700064 EA $ 13.44 CYTOLOGY HYBRID FISH URINARY COMPUTER 2700631 EA $ 520.36 CYTOLOGY IN SITU HYBRID FISH URINARY TRA 2700632 EA $ 605.98 CYTOMEGAIOVIRUS Ab IgG 2700294 EA $ 64.00 CYTOMEGALOVIRUS QUANT 2700595 EA $ 144.00 CYTOPATHOLOGY 2700179 EA $ 34.00 CYTOPATHOLOGY CERVICAL/VAGINAL/ 2700556 EA $ 111.72 CYTOPATHOLOGY EVAL OF FNA 2700021 EA $ 9.80 CYTOPATHOLOGY EVAL OF FNA EVALUATION 2700405 EA $ 74.00 CYTOPATHOLOGY EVAL OF FNA FOR ADEQU 2700136 EA $ 27.40 CYTOPATHOLOGY SLIDES CERVICAL /VAGINAL 2700279 EA $ 59.88 CYTOPATHOLOGY SMEAR 2700221 EA $ 45.50

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CYTOPATHOLOGY SMEAR PREPARATION 2700241 EA $ 47.94 CYTOPATHOLOGY SMEAR OVER 5 SLIDES 2700367 EA $ 68.98 CYTOPATHOLOGY SMEARS W/INTER 2700379 EA $ 70.92 CYTOPATHOLOGY W/FILTER W/INTERPRETATION 2700180 EA $ 34.00 D5-1/2NS-20 MEQ KCL IV SOLN 3900094 EA $ 109.75 DANTROLENE (DANTRIUM) 20 MG INJ 3900095 EA $ 150.70 DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS 1800011 EA $ 948.47 D-DIMER 2700263 EA $ 55.96 DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ C 1800014 EA $ 809.73 DEBRIDEMENT NAIL ANY METHOD 1-5 1800019 EA $ 121.88 DEBRIDEMENT OPEN WOUND 20 SQ CM/< 2100028 EA $ 208.11 DEBRIDEMENT SKIN SC AND MUSCLE 1800013 EA $ 542.33 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM 1800012 EA $ 211.44 DEHISCENCE WOUND WITH PACKING 1800036 EA $ 477.68 Dental Nerve Block 1800158 EA $ 734.10 DEPAKENE (DEPAKOTE) (VALPORIC) 2700412 EA $ 74.52 DERMATOPHAGOIDES PTERONYSSINUS IgE 2700151 EA $ 28.48 DERMATOPHOGOIDES FARINAE 2700041 EA $ 10.28 DERMATP[JAGPRDES FARINA Ige 2700094 EA $ 20.56 DEVELOPMENT OF COGNITIVE SKILLS EACH 15 2100027 EA $ 73.38 DEXAMETHASONE 2700350 EA $ 66.24 DEXAMETHASONE (DECADRON) 4 MG/ML INJ 3900096 EA $ 35.00 DEXTRO-GUAIF (ROBITUSS DM)10-100 MG/5ML 3900097 EA $ 9.00 DEXTROSE 25% IN WATER (D25W) SYRG 10ML 3900098 EA $ 75.00 DEXTROSE 5% IN WATER (D5W) 1000ML IV SOL 3900099 EA $ 79.00 DEXTROSE 50% IN WATER (D50W) 25 GM SYRG 3900100 EA $ 100.00 DHEA 2700524 EA $ 104.22 DHFA SULFATE 2700477 EA $ 90.99 DIAG COLON IN CONJ WITH OTHER 1000038 EA $ 1,754.90 DIAGNOSTIC COLONOSCOPY 1000033 EA $ 3,208.18 DIAZEPAM (VALIUM) 10 MG/2 ML INJ 3900101 EA $ 90.00 DIAZEPAM (VALIUM) 5 MG TAB 3900102 EA $ 13.00 DICYCLOMINE (BENTYL) 10 MG CAP 3900103 EA $ 9.35 DIGOXIN (LANOXIN) 2700399 EA $ 73.00 DIGOXIN (LANOXIN) 125 MCG TAB 3900104 EA $ 9.35 DIGOXIN (LANOXIN) 500 MCG/ 2 ML INJ 3900105 EA $ 44.00 DILATIN (PHENYTION) 2700398 EA $ 72.88 DILTIAZEM HCL (CARDIZEM CD) 180MG CAP 3900106 EA $ 12.10 DILTIAZEM HCL (CARDIZEM) 25 MG/5ML INJ 3900107 EA $ 75.00 DILTIAZEM HCL (CARDIZEM) 30 MG TAB 3900108 EA $ 9.35 DILTIAZEM HCL (CARDIZEM) 50 MG/10 ML INJ 3900109 EA $ 98.00 DIMETH-ZINC OX (MOISTURE BARRIER) CREAM 3900110 EA $ 28.00 DIPHENHYDRAMINE (BENADRYL) 2-0.1 % CREAM 3900111 EA $ 21.00 DIPHENHYDRAMINE (BENADRYL) 25 MG CAP 3900112 EA $ 5.00 DIPHENHYDRAMINE (BENADRYL) 50 MG/ML INJ 3900113 EA $ 26.50

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DIPHENHYDRAMINE(BENADRYL) 12.5MG/5ML LIQ 3900114 EA $ 8.00 DIPHENOX-ATROP (LOMOTIL) 2.5-0.025MG TAB 3900115 EA $ 9.35 DIPRIVAN (PROPOFOL) 200MG/20ML 3901368 EA $ 100.00 DISP STETH YELLOW 8408543 EA $ 8.51 DIVALPROEX (DEPAKOTE) 250 MG TBEC 3900116 EA $ 10.00 DNA DS ANTIBODY 2700419 EA $ 75.52 DOBUTAMINE IN D5W 250 MG/250 ML IV SOLN 3900117 EA $ 115.00 DOCUSATE SODIUM (COLACE) 100 MG CAP 3900118 EA $ 5.00 DOG Ige 2700027 EA $ 10.28 DONEPEZIL (ARICEPT) 10 MG TAB 3900119 EA $ 10.00 DOPAMINE IN D5W 400 MG/250 ML SOLN 3900120 EA $ 115.00 DOT DRUG SCREEN 2700645 EA $ 50.00 DOT DRUG SCREEN COLLECTION 2700219 EA $ 45.00 DOXAZOSIN (CARDURA) 2 MG TAB 3900121 EA $ 9.35 DOXYCYCLINE MONOHYDRATE 100 MG CAP 3900122 EA $ 15.00 DRAINAGE EXTERNAL EAR, ABSCESS SIMPLE 1800165 EA $ 499.07 DRAINAGE FINGER ABSCESS SIMPLE 1800072 EA $ 462.53 DRESSING 3X3 IN ADAPTIC NON-ASHESION 8402735 EA $ 12.00 DRESSING CHANGE TRAY 8408467 EA $ 11.17 DRG ABSC CST HMTMA FROM DENTOALVEOLAR ST 1800101 EA $ 586.57 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ ME 1800054 EA $ 384.44 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SM 1800053 EA $ 183.93 DRUG CLASSES 8-14 2500005 EA $ 790.44 DRUG SCREEN 7 PANEL (M) 2700220 EA $ 15.00 EA ADDLT PUSH OF NEW DRUG 1000017 EA $ 71.16 EBV NUCLEAR Ag Ab 2700447 EA $ 83.48 EBV VCA ANTIBODY IgG 2700510 EA $ 99.00 EBV VCA ANTIBODY IgM 2700509 EA $ 99.00 EGG Ige 2700051 EA $ 10.28 EH ADDLT PUSH OF NEW DRUG 1800133 EA $ 71.16 ELECTROCARDIOGRAM 3300001 EA $ 172.45 ELECTROLYTE PANEL 2700202 EA $ 38.56 ELM 2700042 EA $ 10.28 ENCEPHALTIS CALIFORNIA Ab CSF 2700392 EA $ 72.52 ENCEPHALTIS EAST Ab CSF 2700393 EA $ 72.52 ENCEPHALTIS ST LOUIS Ab CSF 2700394 EA $ 72.52 ENCIPHALTIS WEST Ab CSF 2700395 EA $ 72.52 ENDOTRACHEAL INTUBATION 2400036 EA $ 583.55 ENDOTRACHEAL INTUBATION EMERGENCY 2400010 EA $ 583.55 ENEMIA SET SOAP SUDS 1800150 EA $ 173.00 ENOXAPARIN (LOVENOX) 30 MG/0.3 ML SYRG 3900123 EA $ 114.00 ENOXAPARIN (LOVENOX) 40 MG/0.4 ML SYRG 3900124 EA $ 180.00 ENOXAPARIN (LOVENOX) 60 MG/0.6 ML SYRG 3900125 EA $ 225.00 ENVIRONMENTAL CULTURE 2700236 EA $ 47.36 EOSINOPHIL COUNT URINE 2700103 EA $ 23.48

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EPHEDRINE 50MG/ML INJ 3901534 EA $ 200.00 EPINEPHRINE 0.1 MG/ML-1:10,000 SYRG 3900126 EA $ 125.00 EPINEPHRINE 1 MG/ML-1:1,000 INJ 3900127 EA $ 26.00 EPSTEIN BARR VIRUS AB 2700449 EA $ 84.12 EPSTEIN-BAR VIRUS EARLY ANTIGEN 2700407 EA $ 74.25 ER CRITICAL CARE EACH ADD'L 30 MINUTES 1800144 EA $ 465.80 ER CRITICAL CARE LEVEL 1ST HOUR 1800143 EA $ 1,041.52 ER LEVEL 1 1800138 EA $ 150.00 ER LEVEL 2 1800139 EA $ 243.21 ER LEVEL 3 1800140 EA $ 351.51 ER LEVEL 4 1800141 EA $ 522.72 ER LEVEL 5 1800142 EA $ 902.66 ERYTHROMYCIN OPTHALMIC OINT 3900128 EA $ 36.00 ERYTHROPOIETIN 2700521 EA $ 103.36 ESCITALOPRAM (LEXAPRO) 10 MG TAB 3900129 EA $ 14.00 ESTRADIOL 2700599 EA $ 153.64 ESTRIOL 2700608 EA $ 199.50 ESTROGEN 2700577 EA $ 119.28 ET TUBE HOLDER 2400042 EA $ 20.00 ET TUBES ALL SIZES 2400041 EA $ 8.52 ETHANOL 2700277 EA $ 44.84 ETHOSUXIMIDE 2700473 EA $ 89.88 ETOMIDATE 20MG/10ML INJ 3900852 EA $ 25.00 EVACUATION SUBUNGUAL HEMATOMA 1800021 EA $ 109.59 EVAL & MGT 3 KEY COMPONENTS 1000039 EA $ 127.13 EVAL/CONSULTATI AND MANAGEMENT OF NEW PT 1000037 EA $ 324.57 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1. 1800018 EA $ 488.53 EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 1800016 EA $ 302.84 EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 1800017 EA $ 542.57 EXCISION NAIL MATRIX PERMANENT REMOVAL 1800022 EA $ 588.91 EXPL UNDESCENDED TSTIS INGUN/SCROTAL ARE 1800107 EA $ 1,068.90 EXPLORATION PENETRATING WOUND SPX EXTREM 1800055 EA $ 1,194.55 EXT SET CONTROL-A-FLO 8400965 EA $ 22.16 EXTERNAL PACING 1800119 EA $ 37.87 EZ I O INTRAOSSEUS VENOUS ACCESS DEVICE 1800099 EA $ 492.80 EZ-IO 15MM PINK 8409018 EA $ 11.57 EZ-IO 25MM BLUE 8409001 EA $ 11.57 EZ-IO 45MM YELLOW 8409079 EA $ 11.57 F/C 18FR 5CC 8408406 EA $ 12.00 FACTOR V 2700495 EA $ 97.04 FACTOR VIII ACTIVITY 2700499 EA $ 98.40 FAMOTIDINE (PEPCID) 20 MG TAB 3900130 EA $ 9.35 FAMOTIDINE (PEPCID) 20 MG/2 ML INJ 3900131 EA $ 45.00 FECAL FAT QUAL 2700140 EA $ 27.98 FECAL FAT QUAN 2700543 EA $ 107.72

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FECAL LACTOFERRIN 2700536 EA $ 106.84 Fecal Potassium 2700657 EA $ 79.86 FECAL SODIUM 2700658 EA $ 83.24 FECAL WBC 2700060 EA $ 12.88 FENTANYL CITRATE 50 MCG/ML INJ 3900132 EA $ 65.00 FERRITIN 2700414 EA $ 74.92 FERROUS SULFATE 325 MG TBEC 3900133 EA $ 9.35 FIBINOGEN 2700225 EA $ 46.72 FINASTERIDE (PROSCAR) 5 MG TAB 3900134 EA $ 10.00 FINGERSTICK 2700017 EA $ 43.00 FLU ADMINISTRATION 1000020 EA $ 17.00 FLU VAC 2018-2019 6MOS &UP 60 MCG SUSP 3900135 EA $ 35.00 FLUCONAZOLE (DIFLUCAN) 100 MG TAB 3900136 EA $ 40.00 FLUMAZENIL (ROMAZICON) 0.1 MG/ML INJ 3900137 EA $ 205.00 FLUORESCEIN-BENOX (FLURESS)0.25-0.4% OPT 3900138 EA $ 40.00 FLUORO GUIDANCE/BIOPSY/ASPIRATION/INJ 3600061 EA $ 368.55 FLUOXETINE (PROZAC) 20 MG CAP 3900139 EA $ 15.00 FOLATE 2700437 EA $ 80.84 FOLATE RBC 2700491 EA $ 95.24 FOLEY CATH 16FR 8420837 EA $ 20.02 FOLEY CATH 18FR 8421774 EA $ 25.52 FOLIC ACID (FOLATE) 1 MG TAB 3900140 EA $ 9.35 FOLLICE STIMULATING HORMONE (FSH) 2700519 EA $ 102.16 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCH 1800106 EA $ 261.60 FREE KAPPA 2700421 EA $ 75.56 FREE LAMBDA 2700420 EA $ 75.56 FTA-ABS 2700655 EA $ 100.11 FUROSEMIDE (LASIX) 20 MG TAB 3900141 EA $ 9.35 FUROSEMIDE (LASIX) 20 MG/ 2 ML INJ 3900142 EA $ 35.00 FUROSEMIDE (LASIX) 40 MG TAB 3900143 EA $ 9.35 FUROSEMIDE (LASIX) 40 MG/ 4 ML INJ 3900144 EA $ 42.00 GABAPENTIN (NEURONTIN) 100 MG CAP 3900145 EA $ 9.35 GABAPENTIN (NEURONTIN) 300 MG CAP 3900146 EA $ 12.00 GAD-65 2700570 EA $ 117.22 Gait Training 470013 EA $ 109.08 GANGLIOSIIDE ASIOLO AB 2700382 EA $ 71.20 GARDNERCLLA VAGINALIS 2700467 EA $ 88.44 GASTRIC OCCULT 2700079 EA $ 17.92 GASTRIN 2700494 EA $ 96.96 GAUZE PETROLATUM 4X4 8402201 EA $ 7.00 GEL US AQSN 100 AQ DISP 250ML 90000019 EA $ 12.00 GENTAMYCIN 2700474 EA $ 90.12 GEODON ( ZIPRASIDONE) INJ 20MG/ML 3900373 EA $ 120.00 GGT 2700205 EA $ 39.60 GI COCKTAIL SUSP 30ML 3900147 EA $ 20.00

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GIARDIA ANTIBODY 2700438 EA $ 80.96 GIARDIA ANTIGEN 2700312 EA $ 65.96 GLIMEPIRIDE (AMARYL) 2 MG TAB 3900148 EA $ 7.00 GLIPIZIDE (GLUCOTROL) 5 MG TAB 3900149 EA $ 9.35 GLOMERULAR BASEMENT MEMBRANCE 2700280 EA $ 60.00 GLUCAGON EMERGENCY 1 MG KIT 3900150 EA $ 305.00 GLUCOSE 2700099 EA $ 21.56 GLUCOSE POSTPRANDIAL 1 HOUR 2700124 EA $ 26.12 GLUCOSE TOLERANCE TEST- 2HR 2700375 EA $ 70.76 GLUCOSE TOLERANCE TEST- 3HR 2700100 EA $ 21.56 GLUCOSE-6 PHOSPATE DEHYDROGENASE QUANT 2700456 EA $ 85.76 GLUTOSE 15 (ORAL GLUCOSE) GEL 3900151 EA $ 10.00 GLYCERIN (CHILD) SUPP 3900152 EA $ 9.00 GLYCOHEMOGLOBIN (A1C) 2700260 EA $ 53.36 GLYCOMARK 2700288 EA $ 63.36 GLYCOPYRROLATE 0.2MG/ML (ROBINUL) INJ 3901532 EA $ 70.00 GRAM STAIN 2700059 EA $ 12.88 GRIPPER NEEDLE 3/4" 21-2733-24 CARD HLTH 1800149 EA $ 12.00 GROWTH HORMONE 2700478 EA $ 91.72 GUAIFENESIN (MUCINEX) 600 MG TBER 3900153 EA $ 7.00 GUAIFENESIN (ROBITUSSIN) 100 MG/5 ML LIQ 3900154 EA $ 6.00 H PYLORI ANTIBODIES 2700454 EA $ 85.20 H PYLORI ANTIBODIES (STOOL) 2700429 EA $ 79.08 H PYLORI BREATH TEST 2700624 EA $ 370.36 H PYLORI UREASE 2700411 EA $ 74.36 HALOPERIDOL LACTATE (HALDOL) 5 MG/ML INJ 3900155 EA $ 55.00 HAND HELD NEBULIZER INITIAL 2400007 EA $ 133.16 HAND HELD NEBULIZER SUBSEQUENT 2400008 EA $ 69.72 HAPTOGLOBIN 2700090 EA $ 20.48 HCG BETA QUANTATIVE 2700182 EA $ 35.28 HCT 2700061 EA $ 13.04 HEMOGLOBIN 2700062 EA $ 13.04 HEMOGLOBINOPATHY EVALUATION 2700168 EA $ 33.00 HEP A ANTIBODY 2700362 EA $ 68.12 HEP B ANTIBODY 2700290 EA $ 63.60 HEP B ANTIGEN 2700475 EA $ 90.24 HEP B CORE IGM ANTIBODY 2700300 EA $ 64.72 HEP B CORE TOTAL 2700355 EA $ 66.28 HEP B SURGACE ANTIGEN 2700266 EA $ 56.80 HEP C VIRAL RNA GENOTYPE 2700614 EA $ 239.76 HEPARIN (SQ HEPARIN) 5,000 UNIT/ML INJ 3900156 EA $ 36.00 HEPARIN, PORCINE FLUSH 10 UNIT/ML SYRG 3900157 EA $ 15.00 HEPARIN-0.45% NACL 25,000 UNT/250 ML SOL 3900158 EA $ 95.00 HEPATITIS B DNA QUANT (PCR) 2700574 EA $ 117.81 HEPATITIS B SURF ANTIBODY HBSAB 2700276 EA $ 59.04

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HEPATITIS B SURFACE AB QUANT 2700338 EA $ 66.00 HEPATITIS C ANTIBODY 2700427 EA $ 78.48 HEPATITIS C qUANT 2700572 EA $ 117.76 HEPATITIS C VIRAL RNA QUALITATIVE 2700534 EA $ 106.80 HEPATITIS PANEL 2700617 EA $ 269.88 HERPES ANITBODY 2 2700530 EA $ 106.40 HERPES ANTIBODY 1 2700397 EA $ 72.52 HERPES SIMPLEX VIRUS CULTURE 2700446 EA $ 83.18 HERPES TYPE 1 CSF 2700396 EA $ 72.52 HERPES TYPE 2 CSF 2700529 EA $ 106.40 HFE HEREDITARY HEMOCHROMATOSIS GENE ANA 2700622 EA $ 358.64 HISTOCHEMICAL STAIN 2700609 EA $ 206.40 HISTONE Ab 2700270 EA $ 58.32 HISTORICAL TYPING PER AG 2700096 EA $ 20.88 HIV 2700417 EA $ 75.40 HIV 1/2 AG & AB 4TH GEN W REFLEX 2700501 EA $ 98.58 HIV Ab WESTERN BLOT 2700528 EA $ 106.40 HIV-1 RNA QN REAL TIME PCR 2700587 EA $ 130.00 HLA B27 DETERMINATION 2700511 EA $ 99.25 HOLTER MONITOR 24 HOUR 2400035 EA $ 414.00 HOLTER RECORDING 2400037 EA $ 220.55 HOLTER RECORDING SCANNING 2400038 EA $ 555.25 HOMOCYSTEINE LEVEL 2700484 EA $ 92.76 HPV High Risk 2700541 EA $ 107.68 HPV Low Risk 2700540 EA $ 107.68 HPV TYPES 16 & 18 (ONLY) 2700542 EA $ 107.68 HS-CRP 2700368 EA $ 70.00 HSP-70 Ab 2700487 EA $ 93.64 HSV 1 & 2 DNA REAL TIME PCR QUAL 2700596 EA $ 144.00 HU AB CSF 2700305 EA $ 65.76 HUMIDIFIER WATER STERILE 340ML 8402684 EA $ 7.00 HYDRALAZINE (APRESOLINE) 20 MG/ML INJ 3900159 EA $ 75.00 HYDRALAZINE (APRESOLINE) 25 MG TAB 3900160 EA $ 9.35 HYDROCHLOROTHIAZIDE (HCTZ) 25 MG TAB 3900161 EA $ 6.00 HYDROCOD-HOMA (HYDROMET) 5-1.5MG/5ML LIQ 3900162 EA $ 18.00 HYDROCODONE-APAP (NORCO) 5-325 MG TAB 3900163 EA $ 12.00 HYDROCODONE-APAP (NORCO) 7.5-325 MG TAB 3900164 EA $ 14.00 HYDROCORTISONE (SOLU-CORTEF) 100MG INJ 3900165 EA $ 26.50 HYDROCORTISONE 1 % CREAM 3900166 EA $ 22.00 HYDROMORPHONE (DILAUDID) 1 MG/ML INJ 3901020 EA $ 35.00 HYDROMORPHONE (DILAUDID) 2 MG/ML INJ 3900167 EA $ 38.50 HYDROMORPHONE (DILAUDID) 4 MG/ML INJ 3900168 EA $ 45.00 HYDROXYZINE HCL (ATARAX) 10 MG/5 ML SYRP 3900169 EA $ 12.00 HYDROXYZINE HCL (ATARAX) 25 MG TAB 3900170 EA $ 8.00 HYDROXYZINE PAMOATE (VISTARIL) 25 MG CAP 3900171 EA $ 9.00

�16

HYPERSENSITIVITY PNEUMONITIS SCREEN 2700659 EA $ 255.34 I&D HEMATOMA SEROMA/FLUID COLLECTION 1800009 EA $ 322.74 I&D OF BARTHOLINS GLAND ABSCESS 1800109 EA $ 470.72 I&D PERIANAL ABSCESS SUPERFICIAL 1800103 EA $ 331.80 I&D VULVA/PERINEAL ABSCESS 1800108 EA $ 372.19 IA-2 2700551 EA $ 108.80 IBUPROFEN (MOTRIN) 100 MG/5 ML SUSP 3900172 EA $ 5.00 IBUPROFEN (MOTRIN) 400 MG TAB 3900173 EA $ 8.00 IBUPROFEN (MOTRIN) 600 MG TAB 3900174 EA $ 10.00 ICE PACKS 8408518 EA $ 7.00 IGA 2700252 EA $ 51.12 IGA CSF 2700250 EA $ 51.12 IGD 2700249 EA $ 51.12 IGE 2700476 EA $ 90.56 IGF BINDING PROTEIN 2700403 EA $ 73.72 IGG 2700247 EA $ 51.12 IgG SUBCLASS 1 2700173 EA $ 33.09 IgG SUBCLASS 2 2700170 EA $ 33.09 IgG SUBCLASS 3 2700171 EA $ 33.09 IgG SUBCLASS 4 2700172 EA $ 33.09 IGM 2700248 EA $ 51.12 IGM CSF 2700251 EA $ 51.12 IM/SUBQ INJECTION 5600013 EA $ 81.06 IMMUNOFIXATION (SERUM) 2700582 EA $ 122.84 IMMUNOFIXATION URINE 2700489 EA $ 93.68 IN DIRECT IMMUNOFLUORESCENT STUDY 2700602 EA $ 179.04 INCENTIVE SPIROMETER 2400012 EA $ 39.60 INCENTIVE SPIROMETRY Q1H WHILE AWAKE 2400011 EA $ 97.32 INCISION & DRAINAGE ABSCESS SIMPLE/SINGL 1800004 EA $ 322.28 INCISION & DRAINAGE PILONIDAL CYST SIMPL 1800006 EA $ 346.12 INCISION THROMBOSED HEMORRHOID EXTERNAL 1800104 EA $ 361.52 INCISION&DRAINAGE ABSCESS COMPLICATED/MU 1800005 EA $ 603.12 INCISION&REMOVAL FOREIGN BODY SIMPLE 1800007 EA $ 346.05 INCISION&REMOVAL FOREIGN BODY COMPLEX 1800008 EA $ 631.79 INDOLE ENZYME TEST 2700130 EA $ 26.12 INDOMETHACIN (INDOCIN) 25 MG CAP 3900175 EA $ 12.00 INFECTIOUS AGENT ANTIGEN DETECT;CRYPTOS 2700650 EA $ 65.96 INFLAMMATORY BOWEL DISEASE AB 2700660 EA $ 714.25 INFLUENZA SCREEN 2700618 EA $ 282.48 INITIAL TX 1ST DEGREE BURN LOCAL TX 1800052 EA $ 160.30 INJECTION 1 TENDON SHEATH/LIGAMENT APONE 1800057 EA $ 143.82 INJECTION ANESTHETIC AGENT FACIAL NERVE 1800111 EA $ 257.39 INJECTION INTRA-ARTERIAL 1800131 EA $ 74.52 INJECTION INTRAVEN PUSH SNG OR INITIAL 1000016 EA $ 179.31 INJECTION SINGLE/MLT TRIGGER POINT 1/2 M 1800058 EA $ 131.36

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INJECTION SINGLE/MLT TRIGGER POINT 3/> M 1800059 EA $ 148.30 INJECTION SUBCUT OR INTRAMUSCULAR 1000015 EA $ 81.06 INSERTION PICC LINE 1000006 EA $ 500.00 INSJ NON-TUNNELED CENTRAL VENOUS CATH <5 1800097 EA $ 990.12 INSJ NON-TUNNELED CENTRAL VENOUS CATH AG >5 1800098 EA $ 427.95 INSULIN 2700286 EA $ 62.84 INSULIN 70/30 NPH -REG HUMAN 100 UNIT/ML 3900179 EA $ 4.00 INSULIN AUTOANTIBODY 2700550 EA $ 108.80 INSULIN GLARGINE (LANTUS) 100 UNIT/ML 3900176 EA $ 6.00 INSULIN GROWTH IGF 2700463 EA $ 87.66 INSULIN LISPRO (HUMALOG) 100 UNIT/ML 3900177 EA $ 4.00 INSULIN LISPRO PROT & LISP 100 UNIT/ML 3900178 EA $ 4.00 INSULIN REGULAR (HUMULIN R) 100 UNIT/ML 3900180 EA $ 4.00 INTERACTIVE LAB CORP COLLECTION FEE 2700664 EA $ 15.00 INTRAVENOUS HYDRATION INIT 31 MIN-1 HOUR 1000007 EA $ 181.44 INTRAVENOUS HYDRATION INIT 31MIN-1 HOUR 1800122 EA $ 181.44 INTRINSIC FACTOR BLOCKING AB 2700445 EA $ 82.88 INTRO CATH SAFETY 18GA 8401979 BX $ 291.73 INTRO CATH SAFETY 22G 8401974 EA $ 7.00 INTRO CATH SAFETY 24GA 8401973 EA $ 7.00 INTRO CATH SAFTEY 20G 8401975 EA $ 7.00 INTUBATION ENDOTRACHEAL-ER 1800093 EA $ 460.96 IODOFORM 1/2" 8408645 EA $ 9.98 IODOFORM 1/4" 8408644 EA $ 9.98 IPRATRO-ALBUT (DUONEB) 0.5MG-3MG/3ML NEB 3900181 EA $ 37.00 IPRATROPIUM (ATROVENT) 0.5 MG/2.5 ML NEB 3900182 EA $ 15.50 IRON 2700187 EA $ 35.60 ISLET CELL AB SCREEN 2700546 EA $ 107.96 ISOSORBIDE DINITRATE (ISORDIL) 10 MG TAB 3900183 EA $ 9.35 ISOSORBIDE MONONITRATE ER (IMDUR)30 MG 3900184 EA $ 9.00 IV HYDRATION EA ADD'L HOUR 5600008 EA $ 48.51 IV HYDRATION INITIAL 31 MIN TO 1 HOUR 5600007 EA $ 181.44 IV INFUS HYDRATION EACH ADDITL HOUR 1000008 EA $ 48.51 IV INFUS HYDRATION EACH ADDTL HOUR 1800123 EA $ 48.51 IV INFUSION ADD'L SEQ'L NEW DRUG UP 1 HR 5600011 EA $ 66.43 IV INFUSION CONCURRENT 5600012 EA $ 66.43 IV INFUSION EA ADD'L HOUR 5600010 EA $ 60.90 IV INFUSION FOR THERAPY INTL TO 1 HR 1000009 EA $ 274.36 IV INFUSION FOR THERAPY INTL TO 1HR 1800124 EA $ 274.36 IV INFUSION THERAPY EA ADDTL HR 1000010 EA $ 60.90 IV INFUSION THERAPY EACH ADDTL HR 1800125 EA $ 60.90 IV INFUSION UP TO ONE HOUR 5600009 EA $ 274.36 IV PUSH ADD'L SEQ NEW DRUG 5600015 EA $ 71.16 IV PUSH ADD'L SEQ SAME DRUG 5600016 EA $ 71.16 IV PUSH EACH ADD'TNAL SEQ 1000018 EA $ 71.16

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IV PUSH EACH ADD'TNAL SEQUENTIAL 1800134 EA $ 71.16 IV PUSH INITIAL 5600014 EA $ 179.31 IV START KIT 8408457 EA $ 7.00 JENKINS COLLECTION FEE 2700072 EA $ 17.00 JO-1Ab 2700505 EA $ 98.60 KCL (K RIDER) 10 MEQ/100 ML PGBK 3900185 EA $ 40.00 KETOROLAC (TORADOL) 30 MG/ML INJECTION 3900186 EA $ 40.00 KETOROLAC (TORADOL) 60 MG/2 ML INJECTION 3900187 EA $ 60.00 KETOTIFEN FUMARATE (ZADITOR) OPTH DROPS 3900188 EA $ 42.00 KLING 2" 8408630 EA $ 7.00 KLING 3" 8408633 EA $ 7.00 KLING 4" 8408631 EA $ 7.00 KLING 6" 8408632 EA $ 7.00 KOH 2700108 EA $ 23.48 LAB CORP COLLECTION 2700025 EA $ 10.00 LABETALOL (NORMADYNE) 100 MG/20 ML INJ 3900189 EA $ 55.00 LABETALOL (NORMADYNE) 200 MG TAB 3900190 EA $ 9.35 LACERATION TRAY 8408465 EA $ 14.32 LACOSAMIDE 2700351 EA $ 66.24 LACTATED RINGERS (LR) 1000ML IV SOLN 3900191 EA $ 79.00 LACTATED RINGERS (LR) 500ML IV SOLN 3900192 EA $ 45.00 LACTIC ACID 2700206 EA $ 40.08 LACTULOSE 10 GM/15 ML SOLN 3900193 EA $ 15.00 LAMICTAL (LAMOTRIGINE) 2700390 EA $ 72.36 LARYNGOSCOPE 2400044 EA $ 32.00 LAYER CLOSURE WOUNDS NECK HANDS 7.6-12.5 1800044 EA $ 733.53 LDH 2700175 EA $ 33.20 LDL CHOLESTEROL 2700257 EA $ 52.44 LEAD (BLOOD) 2700357 EA $ 66.56 LEGAL BLOOD DRAW 2700643 EA $ 25.00 LEVALBUTEROL (XOPENEX) 0.63 MG/3 ML NEB 3900194 EA $ 22.00 LEVALBUTEROL (XOPENEX)1.25 MG/0.5 ML NEB 3900195 EA $ 22.00 LEVETIRACETAM 2700416 EA $ 75.32 LEVETIRACETAM (KEPPRA) 500 MG TAB 3900196 EA $ 16.50 LEVOFLOXACIN (LEVAQUIN) 250MG PREMIX 3900197 EA $ 149.00 LEVOFLOXACIN (LEVAQUIN) 500 MG PREMIX 3900198 EA $ 245.00 LEVOFLOXACIN (LEVAQUIN) 500 MG TAB 3900199 EA $ 42.00 LEVOFLOXACIN (LEVAQUIN) 750 MG PREMIX 3900200 EA $ 305.00 LEVOTHYROXINE (SYNTHROID) 100 MCG TAB 3900201 EA $ 9.35 LEVOTHYROXINE (SYNTHROID) 25 MCG TAB 3900202 EA $ 9.35 LEVOTHYROXINE (SYNTHROID) 75 MCG TAB 3900203 EA $ 9.35 LIDOCAINE 1% INJ 3901695 EA $ 25.00 LIDOCAINE 1%-50 MG/5ML SYRG 3900204 EA $ 10.00 LIDOCAINE 2%-100 MG/5 ML SYRG 3900205 EA $ 30.00 LIDOCAINE HCL VISCOUS 2 % SOLN 3900208 EA $ 12.00

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LIDOCAINE IN D5W 4 MG/ML 500 ML IV SOLN 3900209 EA $ 155.00 LIPASE 2700200 EA $ 37.88 LIPID PROFILE 2700402 EA $ 73.68 LIPOPROTEIN A 2700384 EA $ 71.20 LISINOPRIL (ZESTRIL) 20 MG TAB 3900212 EA $ 9.00 LISINOPRIL (ZESTRIL) 5 MG TAB 3900213 EA $ 6.00 LITHIUM 2700191 EA $ 36.36 LIVE OAK Ige 2700026 EA $ 10.28 LIVER PROFILE (LFT) 2700224 EA $ 46.28 LKM-1 ANTIBODY 2700431 EA $ 79.96 LOPERAMIDE (IMMODIUM) 1 MG/5 ML LIQ 3900214 EA $ 6.50 LOPERAMIDE (IMMODIUM) 2 MG TAB 3900215 EA $ 7.00 LORATADINE (CLARITIN) 10 MG TAB 3900216 EA $ 12.00 LORAZEPAM (ATIVAN) 0.5 MG TAB 3900217 EA $ 9.35 LORAZEPAM (ATIVAN) 2 MG/ML INJ 3900218 EA $ 39.00 LOSARTAN (COZAAR) 50 MG TAB 3900219 EA $ 12.00 LUMBAR PUNCTURE TRAY PED 21GX2.5 8420502 EA $ 31.29 LUPUS ANTICOAGULANT EVALUATION 2700258 EA $ 52.64 LUTEINIZING HORMONE 2700518 EA $ 101.84 LYME DISEASE Ab IgG 2700453 EA $ 85.20 LYME DISEASE Ab WITH REFLEX TO BLOT EIA 2700488 EA $ 93.64 LYMPH CHORIOMENINGITIS CSF 2700377 EA $ 70.76 LYMPHOCYTE SUBSET PANEL 4 2700586 EA $ 129.18 LYMPHOCYTE SUBSET PANEL 5 2700539 EA $ 107.67 MAALOX (ALUM MAG SIMETH) 200-200-20/ 5ML 3900397 EA $ 5.00 MACROBID 100MG E 3900933 EA $ 10.00 MAG SULFATE 4 MEQ/ML (5GM/10ML) INJ 3900220 EA $ 35.00 MAGNESIUM (MG) 2700197 EA $ 36.84 MAGNESIUM CITRATE LIQ 3900221 EA $ 10.00 MAGNESIUM HYDROXIDE (MOM) 400MG/5ML SUSP 3900222 EA $ 10.00 MAGNESIUM OXIDE (MAG OX) 400 MG TAB 3900223 EA $ 8.00 MANUAL THERAPY TQS 1/> REGIONS EACH 15 M 2100021 EA $ 81.54 MAPLE 2700043 EA $ 10.28 MASK O2 VNYL ADLT VNTR TBG AIR 8401394 EA $ 14.22 MECLIZINE (ANTIVERT) 25 MG TAB 3900224 EA $ 9.00 MEGESTROL (MEGACE) 400 MG/10 ML SUSP 3900225 EA $ 12.00 MELOXICAM (MOBIC) 7.5 MG TAB 3900226 EA $ 12.00 MEMANTINE (NAMENDA) 10 MG TAB 3900227 EA $ 15.00 MEPERIDINE (DEMEROL) 25 MG/ML INJ SYG 3900228 EA $ 45.00 MEPERIDINE (DEMEROL) 25 MG/ML INJ VL 3900229 EA $ 45.00 MEPERIDINE (DEMEROL) 50 MG/ML INJ SYG 3900230 EA $ 55.00 MEPERIDINE (DEMEROL) 50 MG/ML INJ VL 3900231 EA $ 55.00 MERCURY 2700261 EA $ 54.40 METFORMIN (GLUCOPHAGE) 500 MG TAB 3900232 EA $ 9.35 METHYLMALONIC ACID 2700472 EA $ 89.80

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METHYLPREDNISOLONE ACETATE 80 MG/ML INJ 3900233 EA $ 45.00 METHYLPREDNISOLONE SOD SUC 125 MG INJ 3900234 EA $ 70.00 METHYLPREDNISOLONE SOD SUC 40 MG INJ 3900235 EA $ 45.00 METOCLOPRAMIDE (REGLAN) 10 MG TAB 3900236 EA $ 9.35 METOCLOPRAMIDE (REGLAN) 10 MG/2 ML INJ 3900237 EA $ 27.00 METOPROLOL (LOPRESSOR) 5 MG/5 ML INJ 3900238 EA $ 126.80 METOPROLOL SUCC (TOPROL XL) 25 MG TB24 3900239 EA $ 15.00 METOPROLOL TART (LOPRESSOR) 25 MG TAB 3900240 EA $ 7.00 METOPROLOL TART (LOPRESSOR) 50 MG TAB 3900241 EA $ 9.35 METRONIDAZOLE (FLAGYL) 500 MG TAB 3900242 EA $ 13.00 METRONIDAZOLE (FLAGYL) 500 MG/100ML PGBK 3900243 EA $ 145.00 MI-2 AUTO Ab 2700513 EA $ 99.80 MIDAZOLAM (VERSED) 10 MG/2 ML INJ 3900244 EA $ 38.00 MIDAZOLAM (VERSED) 2 MG/2 ML INJ 3900245 EA $ 25.00 MIDAZOLAM (VERSED) 50 MG/10 ML INJ 3901737 EA $ 60.00 MILK Ige 2700052 EA $ 10.28 MILOCHONDRIAL Ab 2700352 EA $ 66.28 MIRTAZAPINE (REMERON) 15 MG TAB 3900246 EA $ 14.00 MONO TEST 2700149 EA $ 28.44 MORPHINE (MS CONTIN) 15 MG TBER 3900247 EA $ 15.00 MORPHINE 2 MG/ML INJ 3900248 EA $ 31.00 MORPHINE 4 MG/ML INJ 3900249 EA $ 38.00 MORPHINE CONC (ROXANOL) 100 MG/5 ML SOLN 3900250 EA $ 13.00 MOUNTAIN CEDAR 2700045 EA $ 10.28 MRSA - SELECT (NASAL) 2700194 EA $ 36.48 MUCOUS TRAP 2400055 EA $ 7.00 MULTIVITAMIN (MVI) TAB 3900251 EA $ 4.00 MUMPS AB CSF 2700387 EA $ 71.76 MUPIROCIN (BACTROBAN) 2 % OINT 3900252 EA $ 50.00 MVI, ADULT (INFUVITE) INJECTION 3900253 EA $ 105.00 MYCCPLASM PNEUMONIAE IgG 2700389 EA $ 72.28 MYCCPLASMA PNEUMONIAE IgM 2700388 EA $ 72.28 MYELIN BASIC PROTEIN CSF 2700490 EA $ 94.60 MYELIN-ASSOCIATED GLYCOPROTEN 2700383 EA $ 71.20 MYELOPEROXIDASE Ab (Anca-c) 2700118 EA $ 25.00 MYOGLOBIN URINE 2700380 EA $ 71.00 NALOXONE (NARCAN) 2 MG/2 ML SYRG 3900254 EA $ 125.00 NAPROXEN (NAPROSYN) 500 MG TAB 3900255 EA $ 9.00 NASAL CANNULA 25FT 90000030 EA $ 12.00 NASAL CANNULA 7FT 8401427 EA $ 7.00 NASAL CANNULA 7FT PEDIATRIC 8401757 EA $ 9.24 NASAL CANNULA CURVED TIP 8401411 EA $ 7.00 NEBULIZER KIT 90000208 EA $ 152.36 NEEDLE GRIPPER 20G 3/4IN. 90000438 EA $ 16.14 NEEDLE GRIPPER 22G 3/4IN. 8402733 EA $ 16.14

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NEEDLE GRIPPER 22G PORT 1.25IN 8401787 EA $ 16.14 NEO-BACI-POLY (NEOSPORIN) OINT TUBE 3900256 EA $ 23.00 NEO-BACI-POLY (TRIPLE ANTIBIOTIC) PACKET 3900257 EA $ 8.00 NEO-POLY-DEX (MAXITROL) OPTH SUSP 3900258 EA $ 16.00 NEO-POLY-HC (CORTISPORIN) OTIC SOLN 3900259 EA $ 95.00 NETTLE 2700046 EA $ 10.28 NG Tube Insertion 1800153 EA $ 330.01 NICKEL RANDOM URINE 2700514 EA $ 100.29 NICOTINE 21 MG/24 HR PATCH 3900260 EA $ 15.00 NICOTINE AND EXPANDED METABOLITES 2700653 EA $ 119.24 NITRO SET W/DUOVENT 8407551 EA $ 17.61 NITROGLYCERIN (NITRO BID) 2 % OINT 3900261 EA $ 11.00 NITROGLYCERIN (NITROSTAT) 0.4 MG SUBL 3900262 EA $ 10.00 NITROGLYCERIN 0.2 MG/24HR PATCH 3900263 EA $ 13.00 NITROGLYCERIN IN D5W 50 MG/250 ML SOLN 3900264 EA $ 97.00 NONINVASIVE EAR/PULSE OXIMETRY 2400075 EA $ 291.50 NOREPINEPHRINE (LEVOPHED) 4MG/4ML INJ 3900265 EA $ 79.00 NT/ET SUCTIONING 2400014 EA $ 23.95 N-TELOPEPTICLE URINE 2700520 EA $ 102.76 NYSTATIN 100,000 UNIT/G CREAM 3900266 EA $ 42.00 NYSTATIN 100,000 UNIT/G POWDER 3901433 EA $ 22.00 NYSTATIN 100,000 UNIT/ML ORAL SUSP 3900267 EA $ 12.00 O/P TREATMENT ROOM 1800151 EA $ 152.00 O2 MASK ADULT 80000084 EA $ 19.74 OBS DIRECT ADMIT 1000023 EA $ 248.00 OCCULT BLOOD - IMMUNOASSAY 2700461 EA $ 87.44 OFFICE OUTPATIENT NEW 10 MINUTES 1800136 EA $ 164.48 OFFICE OUTPATIENT VISIT 5 MINUTES 1800137 EA $ 152.62 OLANZAPINE (ZYPREXA) 5 MG TAB 3900268 EA $ 25.00 OMEPRAZOLE (PRILOSEC) 20 MG CAP 3900269 EA $ 12.00 ONDANSETRON (ZOFRAN ODT) 4 MG TBDL 3900270 EA $ 35.00 ONDANSETRON (ZOFRAN) 4 MG/2 ML INJ 3900271 EA $ 70.00 ORAPRED (PREDNISOLONE) 15MG/5ML LIQ 3900399 EA $ 12.00 ORPHENADRINE (NORFLEX) 60 MG/2 ML INJ 3900272 EA $ 90.00 OSMOLALITY URINE 2700198 EA $ 37.48 OT EVAL LOW COMPLEXITY 4700002 EA $ 256.00 OT ADL SELF CARE 15M 470008 EA $ 105.00 OT COG SKILLS DEV 15M 470010 EA $ 75.25 OT EVAL HIGH 470004 EA $ 256.00 OT EVAL LOW 470002 EA $ 256.00 OT EVAL MED 470003 EA $ 256.00 OT MANUAL THER 15M 470009 EA $ 90.50 OT NEUROMUSC REED 15M 470011 EA $ 100.75 OT ORTHOTIC MGT& TRNING 470012 EA $ 100.00 OT THER ACT 15M 470006 EA $ 106.00

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OT THER EX 15M 470007 EA $ 96.75 OUTPATIENT TREATMENT ROOM 5600001 EA $ 152.00 OUTPATIENT VISIT EP LEVEL III 1800167 EA $ 130.20 OUTPATIENT VISIT EP LEVEL IV 1800168 EA $ 195.03 OUTPATIENT VISIT NP LEVEL II 1800166 EA $ 125.55 OUTPATIENT OBS VISIT LEVEL II 1800169 EA $ 336.85 OVA & PARASITES IDENTIFICATION (STOOL) 2700243 EA $ 48.92 OXALIC ACID 24 URINE 2700376 EA $ 70.76 OXYBUTYNIN (DITROPAN) 5 MG TAB 3900273 EA $ 9.35 OXYCODONE-ACET (PERCOCET) 5-325 MG TAB 3900274 EA $ 14.00 OXYGEN X1 HR PER HR 2400059 EA $ 21.20 OXYMETAZOLINE (AFRIN) NSL DECON SPRAY 3900275 EA $ 16.50 PANCREATIC ELASTASE 2700268 EA $ 58.32 PANTOPRAZOLE (PROTONIX) 40 MG INJ 3900276 EA $ 75.00 PANTOPRAZOLE (PROTONIX) 40 MG TAB 3900277 EA $ 14.00 PAP-THIN PREP W/IMAGING 2700262 EA $ 54.57 PARATHYROID HORMONE 2700561 EA $ 113.48 PARAVIRUS B19 Ab (IgG) 2700443 EA $ 82.68 PARAVIRUS B19 Ab (IgM) 2700442 EA $ 82.68 PARIETAL CELL AB 2700354 EA $ 66.28 PARING/CUTTING BENIGN HYPERKERATOTIC LES 1800015 EA $ 62.76 PAROXETINE (PAXIL) 20 MG TAB 3900278 EA $ 13.00 PATHOLOGY CONSULTATION EA ADD'L 2700176 EA $ 33.28 PATHOLOGY CONSULTATION CYTOLOGIC EA ADD'L 2700360 EA $ 67.52 PATHOLOGY CONSULTATION FIRST BLOCK 2700493 EA $ 96.88 PATHOLOGY CONSULTATION CYTOLOGIC INITIAL 2700533 EA $ 106.64 PATHOLOGY SMEAR REVIEW 2700157 EA $ 29.15 PATIENT RBC TYPING PER AG 2700208 EA $ 41.20 PATIENT RH PHENO TYPE 2700209 EA $ 42.28 PEANUT 2700030 EA $ 10.28 PECAN TREE IGE 2700155 EA $ 28.68 PENICILLIUM NOTATUM 2700047 EA $ 10.28 PEP TREATMENT INITIAL 2400019 EA $ 234.05 PEP TREATMENT SUBSEQUENT 2400021 EA $ 47.60 PEPTO-BISMOL 262 MG/15 ML SUSP 3900279 EA $ 8.00 PERIPH NERVE BLOCK 1800162 EA $ 165.00 PHENOBARBITAL 2700287 EA $ 62.96 PHENOBARBITAL 16.2 MG TAB 3900280 EA $ 18.00 PHENYLEPHRINE 10MG/ML INJ 3901533 EA $ 100.00 PHENYLEPHRINE(NEO SYNEPHRINE) NASAL SPRY 3900281 EA $ 15.00 PHENYTOIN (DILANTIN) 100 MG/ 2 ML INJ 3900282 EA $ 47.00 PHENYTOIN (DILANTIN) 125 MG/5 ML SUSP 3900283 EA $ 13.00 PHENYTOIN (DILANTIN) 250 MG/ 5 ML INJ 3900284 EA $ 53.00 PHENYTOIN EXTENDED (DILANTIN) 100 MG CAP 3900285 EA $ 11.00 PHLEBOTOMY THERAPEUTIC 1800135 EA $ 184.64

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PHOSPHATE 24 URINE 2700146 EA $ 28.44 PHOSPHORUS (PO4) 2700123 EA $ 26.08 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT E 2100029 EA $ 91.89 PHYSICAL THERAPY EVALUATION 2100006 EA $ 214.29 PHYSICAL THERAPY RE-EVALUATION 2100007 EA $ 116.37 PHYTONADIONE (VIT K) 10 MG/ML INJ 3900286 EA $ 135.00 PIOGLITAZONE (ACTOS) 15 MG TAB 3900287 EA $ 21.00 PIPERACILLIN-TAZO (ZOSYN) 2.25 GM INJ 3900288 EA $ 75.00 PIPERACILLIN-TAZO (ZOSYN) 3.375 GM INJ 3900289 EA $ 100.00 PIPERACILL-TAZO/NS IVPB : 2.25GM/100ML 3905013 EA $ 150.00 PIPERACILL-TAZO/NS IVPB : 3.375GM/100ML 3905014 EA $ 150.00 PLANTERS DRUG SCREEN COLLECTION 2700663 EA $ 17.00 PLATELET COUNT 2700113 EA $ 24.60 PNEUMOCENTESIS PUNCTURE LUNG ASPIRATION 1800094 EA $ 444.95 PNEUMONIIA ADMINISTRATION 1000021 EA $ 17.00 POLYETHYLENE GLYCOL (MIRALAX) 17 GM/DOSE 3900290 EA $ 10.00 POLYSOMNOGRAPHY >6 SLEEP STAGING 4 MORE 2300001 EA $ 3,271.00 POLYSOMNOGRAPHY 4 OR MORE ATTENDED 2300002 EA $ 3,271.00 POLYVINYL ALC (ARTIFICIAL TEARS) OPTH 3900291 EA $ 23.00 PORPHOBILINOGEN 2700222 EA $ 46.04 PORPHYRINS PLASMA 2700371 EA $ 70.20 PORPHYRINS URINE 2700547 EA $ 108.28 POST ARTHROPLASTY HIP DISLOCATION 1800078 EA $ 1,350.97 POTASSIUM (K+) 2700122 EA $ 25.28 POTASSIUM CHL (KLOR CON) 10 MEQ TBER 3900292 EA $ 9.35 POTASSIUM CHLORIDE (K DUR) 20 MEQ TAB 3900293 EA $ 9.35 POTASSIUM CHLORIDE 20 MEQ/15 ML LIQD 3900294 EA $ 39.00 POUCH 14IN DRAINAGE 8401522 EA $ 13.23 PRAVASTATIN (PRAVACHOL) 20 MG TAB 3900295 EA $ 12.00 PREALBUMIN 2700435 EA $ 80.20 PREDNISOLONE ACET (PRED FORTE) 1 % OPTH 3900296 EA $ 77.00 PREDNISOLONE SOD PHOS 5 MG/5ML LIQ 3900297 EA $ 8.00 PREDNISONE 10 MG TAB 3900298 EA $ 10.00 PREGABULIN 2700560 EA $ 112.32 PREGNENOLONE 2700455 EA $ 85.26 PRIMARY IV TUBING 8420834 EA $ 17.61 PRIMIDONE (MYSOLINE) 50 MG TAB 3900299 EA $ 9.00 PROGESTERONE 2700557 EA $ 112.00 PROLACTIN 2700532 EA $ 106.56 PROMETHAZINE (PHENERGAN) 12.5 MG SUPP 3900300 EA $ 40.00 PROMETHAZINE (PHENERGAN) 25 MG TAB 3900301 EA $ 9.35 PROMETHAZINE (PHENERGAN) 25 MG/ML INJ 3900302 EA $ 36.00 PROMETHAZINE (PHENERGAN) 6.25MG/5ML LIQ 3900303 EA $ 9.00 PROMETHAZINE-DM 6.25-15 MG/5 ML SYRP 3900304 EA $ 11.00 PROTEIN C ACTIVITY 2700422 EA $ 76.04

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PROTEIN C ANTIGEN 2700348 EA $ 66.08 PROTEIN ELECTROPHORESIS SERUM 2700275 EA $ 59.04 PROTEIN S ACTIVITY 2700450 EA $ 84.24 PROTEIN S ANTIGEN 2700293 EA $ 63.80 PROTEINASE -3 Ab (Anca-p) 2700119 EA $ 25.00 PROTHROMBIN GENE ANALYSIS 2700433 EA $ 80.00 PROTHROMBIN MUTATION 2700578 EA $ 120.00 PROTHROMBIN TIME 2700071 EA $ 16.70 PSA (TOTAL) DIAGNOSTIC 2700515 EA $ 101.16 PSA (TOTAL) SCREENING 2700517 EA $ 101.16 PSA FREE 2700516 EA $ 101.16 PSEUDOEPHEDRINE (SUDAFED) 30 MG TAB 3900305 EA $ 9.35 PT EVAL HIGH COMPLEXITY 2100024 EA $ 215.13 PT EVAL LOW COMPLEXITY 2100022 EA $ 215.13 PT EVAL MODERATE COMPLEXITY 2100023 EA $ 215.13 PT RE-EVAL CODE 2017 2100025 EA $ 145.61 PTH RELATED PROTEIN 2700401 EA $ 73.56 PTT (APTT) 2700169 EA $ 33.00 PULSE OXIMETRY AT ROOM AIR 2400022 EA $ 236.50 PULSE OXIMETRY CONTINUOUS 2400024 EA $ 236.50 PULSE OXIMETRY SINGLE 2400023 EA $ 236.50 PUNCTURE ASPIRATION ABSCESS HEMATOMA BUL 1800010 EA $ 322.74 PYRIDIUM 100MG (PHENAZOPYRIDINE) 3900776 EA $ 8.00 QUANTIFERON TB GOLD 2700601 EA $ 170.40 QUETIAPINE (SEROQUEL) 50 MG TAB 3900306 EA $ 13.00 RA LATEX 2700162 EA $ 31.20 RA LATEX (TITER) 2700163 EA $ 31.20 RACEPINEPHRINE (RACEMIC EPI) 2.25 % NEB 3900307 EA $ 15.50 RAGWEED Ige 2700055 EA $ 10.28 RAMIPRIL (ALTACE) 5 MG CAP 3900308 EA $ 12.00 RANITIDINE HCL (ZANTAC) 15 MG/ML LIQ 3900309 EA $ 12.00 RAST 2700095 EA $ 20.56 RBC 2700112 EA $ 24.00 RBC MAGNESIUM 2700196 EA $ 36.84 READYBATH 8408584 PK $ 7.00 REGLAN (METOCLOPRAMIDE) 5MG/5ML LIQ 3900398 EA $ 5.00 REM FB from Nose 1800152 EA $ 105.00 REMOVAL EMBEDDED FOREIGN BODY EYELID 1800114 EA $ 398.90 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL 1800112 EA $ 218.04 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 1800084 EA $ 458.68 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEAT 1800056 EA $ 495.85 REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEE 1800066 EA $ 932.00 REMOVAL IMPACTED CERUMEN UNILATERAL 1800116 EA $ 28.98 Remove FB from deep penile tissue 1800156 EA $ 493.25 RENAL FUNCTION PANEL 2700244 EA $ 49.20

�25

RENIN ACTIVITY PLASMA 2700581 EA $ 120.96 REPAIR COMPLEX EYES, NOSE EARS AND LIPS 1800163 EA $ 897.11 REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 1800050 EA $ 909.65 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 C 1800051 EA $ 296.07 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 C 1800046 EA $ 579.15 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5 1800047 EA $ 687.58 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7 1800048 EA $ 740.01 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-1 1800049 EA $ 781.55 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12. 1800045 EA $ 916.72 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5 1800042 EA $ 527.73 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6 1800043 EA $ 675.26 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM 1800040 EA $ 824.53 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< 1800037 EA $ 515.17 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM 1800038 EA $ 653.72 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM 1800041 EA $ 959.21 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM 1800039 EA $ 701.40 REPAIR NAIL BED 1800023 EA $ 449.51 RESPIRATORY CONSULT 2400026 EA $ 146.96 RESPIRATORY SYNCYTIAL VIRUS RSU Ag 2700309 EA $ 65.96 RETIC 2700110 EA $ 23.64 RH 2700069 EA $ 16.40 RI AB CSF 2700307 EA $ 65.76 RICKETTSIA 2700531 EA $ 106.41 RISPERIDONE (RISPERDAL) 0.5 MG TAB 3900310 EA $ 16.50 RISTOCETIN CLOTING FACTOR 2700584 EA $ 126.16 RMVL FB XTRNL AUDITORY CANAL W/O ANES 1800115 EA $ 198.21 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 1800113 EA $ 147.88 RMVL IMPACTED CERUMEN SPX 1/BOTH EARS 1800117 EA $ 114.94 ROCURONIUM 100 MG/10ML INJ 3900311 EA $ 62.00 ROCURONIUM 50 MG/5 ML INJ 3900312 EA $ 62.00 ROOM RATE PRIVATE AND SEMI PRIVATE EA $ 3,000.00 ROOM RATE SWING BED EA $ 2,105.00 ROOM RATE RESPITE EA AVGROPINIROLE (REQUIP) 0.5 MG TAB 3900313 EA $ 9.00 ROSUVASTATIN (CRESTOR) 10 MG TAB 3900314 EA $ 10.00 ROTOVIRUS 2700313 EA $ 65.96 ROUGH PIGWEED IgE 2700150 EA $ 28.48 RPR 2700106 EA $ 23.48 RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX 1800100 EA $ 731.29 RPR WITH REFLEX 2700104 EA $ 23.48 RSV IMMUNOASSAY 2700316 EA $ 65.96 RUBELLA 2700296 EA $ 64.00 RUBELLA IMMUNE STATUS 2700295 EA $ 64.00 S R 12.6 TO 20.0CM EXT, NK,TR,SCALP 1800027 EA $ 524.69 S R 2.6-7.5 CM EXT, NK,TR,SCALP 1800025 EA $ 257.67

�26

S R 20.01-30.00CM EXT, NK,TR,SCALP 1800028 EA $ 638.52 S R 7.6 TO 12.5CM EXT NK,TR,SCALP 1800026 EA $ 418.68 S R OVER 30CM EXT,NK,TR,SCALP 1800029 EA $ 771.80 SALEM SLUMP 12FR 8402228 EA $ 7.00 SALEM SLUMP 14FR 8402229 EA $ 7.00 SALICYLATE 2700203 EA $ 39.00 SALIVA ALCOHOL 2700120 EA $ 25.00 SCALLOP 2700031 EA $ 10.28 SCALPELS-15 1800146 EA $ 58.14 SCOPOLAMINE (SCOP PATCH) 1 MG PATCH 72HR 3900315 EA $ 42.00 SECONDARY TUBING 8419912 EA $ 7.00 SED RATE (ESR) 2700084 EA $ 19.52 SENNOSIDES (SENNA) 8.6 MG TAB 3900316 EA $ 7.00 SERTRALINE (ZOLOFT) 50 MG TAB 3900317 EA $ 11.00 SERUM PREGNANCY 2700183 EA $ 35.28 SESAME SEED 2700032 EA $ 10.28 SET XTN 6.3ML 43IN 8400971 EA $ 11.73 SEX BINDING GLOBULIN 2700470 EA $ 89.61 SHEEP SORREL 2700048 EA $ 10.28 Shepeard Sample Transport 2700656 EA $ 125.00 SHRIMP 2700034 EA $ 10.28 SICKLE CELL 2700161 EA $ 30.36 SILVER NITRATE STICK 3900318 EA $ 11.00 SILVER SULFADIAZINE (SILVADENE) 1% CREAM 3900319 EA $ 95.00 SIMETHICONE (MYLICON) 40 MG/0.6 ML DRPS 3900320 EA $ 8.00 SIMPLE REPAIR F/E/E/N/L/M >30.0CM 1800034 EA $ 376.48 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< 1800030 EA $ 195.41 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM 1800031 EA $ 218.75 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM 1800032 EA $ 278.53 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5CM 1800033 EA $ 346.99 SIMVASTATIN (ZOCOR) 20 MG TAB 3900321 EA $ 15.40 SIMVASTATIN (ZOCOR) 40 MG TAB 3900322 EA $ 19.00 SINGULAIR (MONTELUKAST) 10MG 3901281 EA $ 10.00 SIX MINUTE WALK PULMONARY STRESS TEST 2400027 EA $ 288.20 SJOGREN'S ANTIBODY A SS-A 2700503 EA $ 98.60 SJOGREN'S ANTIBODY B SS-B 2700504 EA $ 98.60 SKIN STAPLE REMOVER 8408468 EA $ 7.00 SLEEP STUDY UNATTENDED SIMULTANEOUS 2300003 EA $ 1,090.56 SMALL ARMBOARD 8408615 EA $ 12.00 SMOKING CESSATION <10 MINUTES 2400028 EA $ 47.72 SMOKING CESSATION INITIATION 2400029 EA $ 146.96 SMOOTH MUSCLE Ab 2700304 EA $ 65.76 SMOOTH MUSCLE RNP ANTIBODY 2700502 EA $ 98.60 SOD CHLORIDE 23.4% (HYPERTONIC SAL) INJ 3900323 EA $ 38.00 SOD CL-POT CHL (SALT SUPPLEMENT) TAB 3900324 EA $ 9.35

�27

SOD PHOS,DI AND MONO-K PHOS 250 MG TAB 3900325 EA $ 9.35 SODIUM (NA+) 2700131 EA $ 26.48 SODIUM BICARB 8.4% (50MEQ/50ML) SYRG 3900326 EA $ 66.00 SODIUM BICARBONATE 325 MG TAB 3900327 EA $ 9.35 SODIUM BICARBONATE 8.4 % (1MEQ/1ML) INJ 3900328 EA $ 58.00 SODIUM CHLORIDE (AYR) 0.65 % NASAL SPRAY 3900329 EA $ 21.00 SODIUM CHLORIDE 0.45 % (1/2 NS) IV SOLN 3900330 EA $ 79.00 SODIUM CHLORIDE 0.9 % (NS) 100 ML IV SOL 3900331 EA $ 50.00 SODIUM CHLORIDE 0.9 % (NS) 1000ML IV SOL 3900332 EA $ 79.00 SODIUM CHLORIDE 0.9 % (NS) 250ML IV SOLN 3900333 EA $ 48.00 SODIUM CHLORIDE 0.9 % (NS) 500 ML SOLN 3900334 EA $ 60.00 SODIUM CHLORIDE 0.9 % (NS) PLUG 100 ML 3900335 EA $ 65.00 SODIUM CHLORIDE 0.9% (NS) IRRIGATION 1L 3900336 EA $ 26.00 SODIUM HYPOCHLORITE (DAKINS) 0.125 % SOL 3900337 EA $ 43.00 SODIUM POLYSTYRENE SULF 15 G/60 ML SUSP 3900338 EA $ 30.00 SOYBEAN Ige 2700044 EA $ 10.28 SP SERO 12 (12F) 2700321 EA $ 66.00 SP SERO 17 (17F) 2700323 EA $ 66.00 SP SERO 19 (19F) 2700324 EA $ 66.00 SP SERO 20 2700325 EA $ 66.00 SP SERO 22 (22F) 2700326 EA $ 66.00 SP SERO1 2700330 EA $ 66.00 SP SERO14 2700322 EA $ 66.00 SP SERO2 2700339 EA $ 66.00 SP SERO23 (23F) 2700327 EA $ 66.00 SP SERO26 (6B) 2700328 EA $ 66.00 SP SERO3 2700340 EA $ 66.00 SP SERO34 (10A) 2700329 EA $ 66.00 SP SERO4 2700341 EA $ 66.00 SP SERO43 (11A) 2700331 EA $ 66.00 SP SERO5 2700342 EA $ 66.00 SP SERO51 (7F) 2700332 EA $ 66.00 SP SERO54(15B) 2700333 EA $ 66.00 SP SERO56 (18C) 2700334 EA $ 66.00 SP SERO57 (19A) 2700335 EA $ 66.00 SP SERO6 (6A) 2700343 EA $ 66.00 SP SERO68 (9V) 2700336 EA $ 66.00 SP SERO70 (33F) 2700337 EA $ 66.00 SP SERO8 2700344 EA $ 66.00 SP SERO9 (9N) 2700320 EA $ 66.00 SP SERO9 (9V) 2700345 EA $ 66.00 SPECIAL STAIN 2700615 EA $ 243.36 SPECIFIC GRAVITY 2700018 EA $ 9.18 SPINAL PUNCTURE LUMBAR DIAGNOSTIC 1800110 EA $ 273.70 SPIROMETRY PRE-POST 2400062 EA $ 78.65

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SPIRONOLACTONE (ALDACTONE) 25 MG TAB 3900339 EA $ 9.35 SPUTUM COLLECTION 2400033 EA $ 97.90 SR 2.5 CM OR < EXT,NK,TR,SCA 1800024 EA $ 156.31 SS DNA AB 2700349 EA $ 66.08 STAPLE SKIN STAPLE REMOVAL KIT DYNJ0405 1800147 EA $ 7.00 STERILE 2X2 GAUZE 8408609 BX $ 7.00 STERILE 4X4 GAUZE PK 8408610 PK $ 7.00 STERILE WATER FOR IRRIGATION 2400064 EA $ 10.00 STERILE WATER FOR IRRIGATION 1000ML 3900340 EA $ 60.00 STOCKING THIGH L 8402801 PR $ 19.67 STOCKING-THIGH-M 8402798 PR $ 19.67 STOCKING-THIGH-S 8402791 PR $ 19.67 STOCKING-THIGH-XL REG TED LF 8402796 PR $ 19.67 STONE ANALYSIS 2700291 EA $ 63.64 STREP PNEUMO IgG AB(7) 2700346 EA $ 66.00 STREP SCREEN 2700535 EA $ 106.80 STRIATED MUSCLE AB 2700353 EA $ 66.28 STRONGILOIDES ANTIBODY 2700381 EA $ 71.00 STYLET 2400063 EA $ 10.95 SUBCUT INFUS FOR THERAPY INTL TO 1 HR 1800128 EA $ 615.90 SUBCUT INFUSION EACH ADDTL HR 1800129 EA $ 50.79 SUCCINYLCHOLINE (ANECTINE)200MG/10ML INJ 3900341 EA $ 45.00 SUCRALFATE (CARAFATE) 1 GM TAB 3900342 EA $ 10.00 SULFAMETH-TRIM (BACTRIM DS)800-160MG TAB 3900343 EA $ 10.00 SULFATE URINE 2700492 EA $ 96.30 SUMATRIPTAN (IMITREX) 50 MG TAB 3900344 EA $ 75.00 SUMATRIPTAN (IMITREX) 6 MG/0.5 ML INJ 3900345 EA $ 110.00 SUTURE REMOVAL KIT 1800148 EA $ 99.28 SYNOVIAL CELL COUNT WITH DIFF 2700019 EA $ 9.72 SYNOVIAL FLUID CRYSTALS 2700204 EA $ 39.32 SYNOVIAL FLUID GLUCOSE 2700097 EA $ 21.56 SYNOVIAL FLUID PH 2700085 EA $ 19.68 SYNOVIAL FLUID PROTEIN 2700088 EA $ 20.16 T 3 REVERSE 2700457 EA $ 86.68 T-3 FREE 2700486 EA $ 93.16 T-3 TOTAL 2700370 EA $ 70.12 T-3 UPTAKE 2700185 EA $ 35.56 T-4 FREE 2700245 EA $ 49.60 T-4 TOTAL 2700199 EA $ 37.76 TACROLIMUS (PROGRAF) 2700418 EA $ 75.48 TAMSULOSIN (FLOMAX) 0.4 MG CAP 3900346 EA $ 14.00 TAPE DURA 1IN 90000401 RL $ 12.00 TAPE DURA 2IN 8402933 RL $ 12.00 TAPE MEDIPORE 2" 8402962 EA $ 13.90 TEGRETOL (CARBAMAZEPINE) 2700441 EA $ 82.48

�29

TELFA 4X4 8402839 EA $ 7.00 TELFA 4X8 8407666 EA $ 7.00 TELFA ISLAND 4X10 8401458 EA $ 15.12 TEMAZEPAM (RESTORIL) 15 MG CAP 3900347 EA $ 12.00 TENECTEPLASE (TNK) 50 MG KIT 3900348 EA $ 29,016.00 TESTOSTERONE 2700594 EA $ 141.96 TESTOSTERONE FREE & TOTAL 2700593 EA $ 140.00 TETANUS ANTITOXOID 2700439 EA $ 81.36 TETANUS-DIPHTHERIA TOXOIDS INJ 3900349 EA $ 100.00 TETRACAINE 0.5% OPTHALMIC SOL 3900350 EA $ 18.00 THEOPHYLLINE 2700425 EA $ 77.80 THEOPHYLLINE ER (THEO-DUR) 300 MG TAB 3900351 EA $ 9.35 THER ACTV DIR PT CONTACT BY PROVIDER EAC 2100026 EA $ 95.40 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ 2100019 EA $ 77.55 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC 2100018 EA $ 90.90 THER PX 1/> AREAS EACH 15 MINUTES MASSAG 2100020 EA $ 71.52 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXE 2100017 EA $ 174.48 THIAMINE HCL (VIT B1) 100 MG TAB 3900352 EA $ 6.00 THIAMINE HCL (VIT B1) 200 MG/ 2 ML INJ 3900353 EA $ 65.00 THORACENTESIS TRAY LONG SAFETY 8408216 EA $ 230.65 THYAMIN VITAMIN B1 2700569 EA $ 116.76 THYROGLOBULIN ANTIBODY 2700465 EA $ 88.32 THYROGLUBLIN Ab 2700462 EA $ 87.44 THYROID PEROXIDOSE ANTIBODY 2700432 EA $ 79.96 THYROID STIM IMMUNE GLOBULINS TSI 2700458 EA $ 86.70 TIMOTHY GRASS 2700049 EA $ 10.28 TOBRAMYCIN 2700661 EA $ 145.11 TOBRAMYCIN SULF (TOBREX) 0.3 % OPTH DROP 3900354 EA $ 55.00 TOBRAMYCIN SULFATE 80 MG/ 2 ML INJ 3900355 EA $ 57.00 TOTAL PROTEIN 2700086 EA $ 20.16 TOXOPLASMA Ab IgG 2700297 EA $ 64.00 TOXOPLASMA aB igM 2700430 EA $ 79.20 TRAMADOL (ULTRAM) 50 MG TAB 3900356 EA $ 12.65 TRANEXAMIC ACID 1000MG/10ML (TXA) 3901492 EA $ 100.00 TRANSFERRIN 2700373 EA $ 70.20 TRANSGLUTAMINOSE AB (IGA) 2700272 EA $ 58.72 TRAY SUTURE REMOVAL METAL 8408537 EA $ 7.00 TRAY TRACH W/ GLOVE 8402812 EA $ 15.39 TRAZODONE (DESYREL) 50 MG TAB 3900357 EA $ 11.00 TREATMENT CLOSED ELBOW DISLOCATION REQ A 1800068 EA $ 1,918.24 TREATMENT CLOSED ELBOW DISLOCATION W/O A 1800067 EA $ 1,408.08 TRIAMCINOLONE ACET (KENALOG) 0.1 % CREAM 3900358 EA $ 38.00 TRICHOMONAS VAGINALIS 2700468 EA $ 88.44 TRIGLYCERIDES 2700165 EA $ 31.60 TRILEPTAL (10-HYDROXYCARBAZEPINE) 2700512 EA $ 99.28

�30

TRONSGLUTAMINASE ANTIBODIES AB(IGA) 2700271 EA $ 58.72 TRYPSIN 2700404 EA $ 73.72 TRYPTASE 2700374 EA $ 70.64 TSH 2700481 EA $ 92.40 TUBE ET 7.0MM NSL/ORL 8401614 EA $ 9.45 TUBE ET 7.5MM NSL/ORL 8401615 EA $ 9.45 TUBE THORACOSTOMY INCLUDES WATER SEAL 1800096 EA $ 621.43 TUBERCULIN PPD 5 TUB.UNIT/0.1 ML SOLN 3900359 EA $ 38.00 TUBING BLUE CORRUGATED 100FT 8401407 EA $ 101.07 TX FX distal radius/ulna 1800159 EA $ 4,049.82 Tx FX Radius/Ulna No manipulation 1800160 EA $ 644.70 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE C 1800035 EA $ 1,073.92 ULTRASOUND CLEANING SOLUTION 90000355 EA $ 12.00 UMA 24 URINE 2700452 EA $ 84.56 UNLISTED PROCEDURE LEG/ANKLE 1800083 EA $ 265.40 UNLISTED PROCEDURE NOSE 1800092 EA $ 109.00 UREA CLEARANCE 2700190 EA $ 36.04 URIC ACID 2700116 EA $ 24.84 URIC ACID SYNOVIAL FLUID 2700125 EA $ 26.12 URINALYSIS W MICROSOPIC 2700073 EA $ 17.40 URINALYSIS W/O MICROSCOPIC 2700058 EA $ 12.36 URINE ACETONE 2700115 EA $ 24.84 URINE CHLORIDE 2700139 EA $ 27.64 URINE CREATINE 2700067 EA $ 15.00 URINE CREATININE 2700144 EA $ 28.44 URINE MICROALBUMIN 2700167 EA $ 31.80 URINE POTASSIUM (K+) 2700109 EA $ 23.64 URINE PREGNANCY 2700181 EA $ 34.80 URINE PROTEIN ELECTROPHORESES SERUM 2700498 EA $ 98.08 URINE SODIUM 2700083 EA $ 19.00 URINE TOTAL PROTEIN 2700087 EA $ 20.16 URINE TOTAL VOLUME MEASURE 2700070 EA $ 16.48 URINE/PROTEIN CREATINE RATIO 2700647 EA $ 75.60 US ABDOMINAL COMPLETE 3700064 EA $ 657.45 US ABDOMINAL LIMITED 3700086 EA $ 505.40 US CAROTID 3700065 EA $ 1,106.15 US CHEST REAL TIME W/IMAGE DOCUMENTATION 3700066 EA $ 413.05 US DOPPLER ABD PELVIS SCROTUM 37001005 EA $ 932.00 US ECHO 3700067 EA $ 873.70 US EXT NON-VASC REAL-TIME IMG COMP LT 3700099 EA $ 570.30 US EXT NON-VASC REAL-TIME IMG COMP RT 3700068 EA $ 570.30 US EXT NON-VASC REAL-TIME IMG LMTD LT 3700101 EA $ 167.65 US EXT NON-VASC REAL-TIME IMG LMTD RT 3700069 EA $ 167.65 US GUIDANCE NEEDLE PLACEMENT RS&I 3700070 EA $ 948.30 US LOWER EXT ART BILAT 3700073 EA $ 1,167.70

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US LOWER EXT ART LEFT 3700095 EA $ 672.05 US LOWER EXT ART RIGHT 3700074 EA $ 672.05 US LOWER EXT VENOUS BILAT 3700075 EA $ 881.80 US LOWER EXT VENOUS LEFT 3700096 EA $ 533.55 US LOWER EXT VENOUS RIGHT 3700076 EA $ 533.55 US OB COMPLETE 3700077 EA $ 694.10 US OB FIRST TRIMESTER TRANSABD 3700078 EA $ 596.35 US OB LIMITED 3700079 EA $ 396.45 US OB TRANSVAG 3700080 EA $ 480.65 US PELVIC NONOB 3700081 EA $ 582.00 US PELVIC NONOB LIMITED 3700082 EA $ 443.70 US RETROPERITONEAL RENAL 3700083 EA $ 619.55 US SCROTUM/CONTENTS 3700087 EA $ 581.15 US SOFT TISSUE HEAD/NECK REAL TIME IMG 3700084 EA $ 570.55 US STUDY FOLLOW UP 3700085 EA $ 468.55 US TRANSRECTAL 3700088 EA $ 342.20 US TRANSVAGINAL 3700089 EA $ 354.35 US UPPER EXT ART BILAT 3700090 EA $ 1,109.65 US UPPER EXT ART LEFT 3700097 EA $ 743.45 US UPPER EXT ART RIGHT 3700091 EA $ 743.45 US UPPER EXT VENOUS BILAT 3700092 EA $ 881.70 US UPPER EXT VENOUS LEFT 3700098 EA $ 533.55 US UPPER EXT VENOUS RIGHT 3700093 EA $ 533.55 US URINARY BLADDER 3700094 EA $ 359.71 UTOX DRUG PANEL 2500004 EA $ 394.60 UTOX PANEL TEST 2500003 EA $ 19.86 Vaginal Del. No Pre or Postpartum Care 1800157 EA $ 6,818.31 VALACYCLOVIR (VALTREX) 500 MG TAB 3900360 EA $ 44.00 VALSARTAN (DIOVAN) 80 MG TAB 3900361 EA $ 15.00 VANCOMYCIN 2700413 EA $ 74.52 VANCOMYCIN 1 GRAM INJ 3900362 EA $ 155.00 VANCOMYCIN 500 MG INJ 3900363 EA $ 98.00 VAP CHOLESTEROL TEST 2700448 EA $ 84.04 VARICELLA ZOSTER Ab(IgG) 2700378 EA $ 70.84 VDRL CSF 2700105 EA $ 23.48 VENIPUNCTURE 2700057 EA $ 12.00 VENTI MASK 2400040 EA $ 7.00 VENTILATION ASSIST 1ST VENT INITIAL 2400070 EA $ 594.00 VENTILATION ASSIST SUBSEQUENT 2400073 EA $ 594.00 VENTILATOR CIRCUIT 2400015 EA $ 100.00 VIAL MATE ADAPTOR 3900364 EA $ 8.00 VITAMIN A 2700292 EA $ 63.80 VITAMIN B-12 2700444 EA $ 82.88 VITAMIN B12 BINDING CAPACITY 2700426 EA $ 78.16 VITAMIN B6 (pyridoxine) 2700568 EA $ 115.86

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VITAMIN D 1 25 DIHYDROXY 2700610 EA $ 211.68 VITAMIN D-25 HYDROXY 2700600 EA $ 162.80 VITAMIN E (TOCOPHEROL) 2700423 EA $ 77.36 VON WILLEBRAND AG MULTIMERIC ANALYSIS 2700585 EA $ 126.16 VON WILLEBRAND ANTIGEN 2700583 EA $ 126.15 VON WILLEBRAND DISEASE 2700386 EA $ 71.50 WALNUT 2700035 EA $ 10.28 WARFARIN (COUMADIN) 1 MG TAB 3900365 EA $ 9.35 WARFARIN (COUMADIN) 2.5 MG TAB 3900366 EA $ 12.00 WARFARIN (COUMADIN) 5 MG TAB 3900367 EA $ 14.00 WATER FOR INJECTION, STERILE SOLN 3900368 EA $ 12.00 WBC 2700066 EA $ 13.96 WEST NILE Ab CSF 2700298 EA $ 64.00 WEST NILE VIRUS Ab (IGM) CSF 2700482 EA $ 92.60 WET MOUNT 2700107 EA $ 23.48 WHEAT Ige 2700033 EA $ 10.28 WHITE PETROLATUM (VASELINE) GEL 3900369 EA $ 15.00 WHITE PETRO-ZINC OX (FLANDERS BUTT) OINT 3900370 EA $ 22.00 XR ABD AP/ADDITIONAL OBLQ/CONE 2 V 3600095 EA $ 182.85 XR ABD COMPLETE FLAT/UPRIGHT 2 VIEWS 3600096 EA $ 191.15 XR ABD COMPLETE WITH CHEST 1 VIEW 3600097 EA $ 230.20 XR ABDOMEN AP KUB 1 VIEW 3600098 EA $ 116.30 XR A-C JOINTS BILAT W/WO WEIGHTS 3600099 EA $ 191.55 XR ANKLE 2 V LT 3600100 EA $ 137.30 XR ANKLE 2 V RT 3600266 EA $ 137.30 XR ANKLE COMPLETE MINIMUM 3 V LT 3600102 EA $ 158.85 XR ANKLE COMPLETE MINIMUM 3 V RT 3600268 EA $ 158.85 XR BONE AGE STUDIES 3600104 EA $ 110.35 XR BONE LENGTH STUDIES 3600105 EA $ 182.15 XR CALCANEUS MINIMUM 2 V LT 3600106 EA $ 135.80 XR CALCANEUS MINIMUM 2 V RT 3600269 EA $ 135.80 XR CERV SPINE COMPLETE W/ OBLQ/FLEX/EXT 3600108 EA $ 293.65 XR CERVICAL SPINE 2/3 V 3600107 EA $ 169.00 XR CERVICAL SPINE MINIMUM 4 V 3600109 EA $ 228.60 XR CHEST 2 VIEWS FRONTAL&LAT 3600112 EA $ 142.95 XR CHEST 2 VIEWS W/ APICAL LORDOTIC 3600111 EA $ 177.40 XR CHEST COMPLETE MINIMUM 4 V 3600114 EA $ 457.84 XR CHEST HEALTH DEPARTMENT 3600060 EA $ 35.00 XR CHEST SINGLE VIEW (PORTABLE) 3600115 EA $ 110.15 XR CLAVICLE COMPLETE LT 3600123 EA $ 137.30 XR CLAVICLE COMPLETE RT 3600270 EA $ 137.30 XR ELBOW 2 V LT 3600129 EA $ 135.60 XR ELBOW 2 V RT 3600271 EA $ 135.60 XR ELBOW COMPLETE MINIMUM 3 V LT 3600131 EA $ 158.85 XR ELBOW COMPLETE MINIMUM 3 V RT 3600273 EA $ 158.85

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XR EMPLOYEE CHEST 3600132 EA $ 20.00 XR ESOPHAGUS 3600135 EA $ 429.80 XR EYE DETECTION OF FOREIGN BODY 3600136 EA $ 137.50 XR FACIAL BONES < 3 V 3600137 EA $ 142.40 XR FACIAL BONES COMPLETE MINIMUM 3 V 3600138 EA $ 201.70 XR FEMUR 1V LT 3600139 EA $ 248.48 XR FEMUR 1V RT 3600274 EA $ 248.48 XR FEMUR 2 V AP / LAT LT 3600140 EA $ 136.05 XR FEMUR 2 V AP / LAT RT 3600275 EA $ 136.05 XR FINGER MINIMUM 2 V LT 3600141 EA $ 159.70 XR FINGER MINIMUM 2 V RT 3600276 EA $ 159.70 XR FLUOROSCOPY SPX <1 HOUR PHYSICIAN TIM 3600142 EA $ 929.34 XR FLUOROSCOPY SPX > 1 HOUR PHYSICIAN TI 3600143 EA $ 1,161.55 XR FOOT 2 V LT 3600144 EA $ 131.20 XR FOOT 2 V RT 3600277 EA $ 131.20 XR FOOT COMPLETE MINIMUM 3 V LT 3600145 EA $ 149.70 XR FOOT COMPLETE MINIMUM 3 V RT 3600278 EA $ 149.70 XR FOREARM 2 V LT 3600146 EA $ 132.75 XR FOREARM 2 V RT 3600279 EA $ 132.75 XR HAND 2 V LT 3600151 EA $ 131.20 XR HAND 2 V RT 3600280 EA $ 131.20 XR HAND MINIMUM 3 V LT 3600152 EA $ 154.30 XR HAND MINIMUM 3 V RT 3600281 EA $ 154.30 XR HIP 2 VIEWS LEFT 3600304 EA $ 187.15 XR HIP 2 VIEWS RIGHT 3600305 EA $ 187.15 XR HIP UNILAT W/PELVIS MIN 2-3 V RT 3600285 EA $ 187.15 XR HIP UNILATERAL 2 V LT 3600154 EA $ 136.85 XR HIP UNILATERAL 2 V RT 3600283 EA $ 136.85 XR HIP UNILATERAL COMPLETE MINIMUM 3600308 EA $ 190.70 XR HIP UNILATERAL W/ PELVIS MIN 2-3 V LT 3600156 EA $ 187.15 XR HIPS BILATERAL 2 V AP /LAT 3600157 EA $ 255.71 XR HIPS BILATERAL 3-4V WITH PELVIS 3600158 EA $ 225.75 XR HIPS BILATERAL WITH PELVIS MIN 5V 3600159 EA $ 261.55 XR HUMERUS MINIMUM 2 V LT 3600160 EA $ 137.50 XR HUMERUS MINIMUM 2 V RT 3600286 EA $ 137.50 XR JCHD HEALTH DEPT TB CHEST SCREENING 3600063 EA $ 35.00 XR JOINT SURVEY SINGLE VIEW 2 OR MORE JO 3600167 EA $ 192.00 XR KNEE 1/2 V LT 3600168 EA $ 148.30 XR KNEE 1/2 V RT 3600287 EA $ 148.30 XR KNEE 3 V LT 3600169 EA $ 179.00 XR KNEE 3 V RT 3600288 EA $ 179.00 XR KNEE COMPLETE 4/MORE V LT 3600171 EA $ 208.70 XR KNEE COMPLETE 4/MORE V RT 3600290 EA $ 208.70 XR KNEES BILAT STANDING 3600172 EA $ 171.20 XR LOWER EXT INFANT MIN 2 V LEFT 3600307 EA $ 132.75

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XR LOWER EXT INFANT MIN 2 V RIGHT 3600173 EA $ 132.75 XR LUMBOSACRAL SPINE 2/3 V 3600174 EA $ 170.55 XR LUMBOSACRAL SPINE COMPLETE W/BENDING 3600175 EA $ 302.15 XR LUMBOSACRAL SPINE MINIMUM 4 V 3600176 EA $ 231.65 XR LUMBOSACRAL SPINE ONLY BENDING 2/3 V 3600177 EA $ 221.80 XR MANDIBLE COMPLETE MIN 4 V 3600178 EA $ 187.75 XR MANDIBLE LESS THAN 4 V 3600179 EA $ 163.65 XR MASTOID COMPLETE MIN 3 V PER SIDE 3600181 EA $ 169.75 XR MASTOIDS COMPL MINIMUM 3 V PR 3600182 EA $ 277.90 XR NASAL BONES COMPLETE MINIMUM 3 V 3600187 EA $ 158.85 XR NECK SOFT TISSUE 2V 3600188 EA $ 131.35 XR NOSE RECTUM FOREIGN BODY 1 V BABYGRAM 3600189 EA $ 126.95 XR ORBITS COMPLETE MINIMUM 4 V 3600191 EA $ 206.60 XR OSSEOUS SURVEY COMPLETE 3600192 EA $ 444.95 XR OSSEOUS SURVEY INCOMPLETE 3600193 EA $ 481.40 XR OSSEOUS SURVEY LI 3600194 EA $ 361.15

XR PELVIS 1/2 VIEWS LT 3600196 EA $ 137.60 XR PELVIS 1/2 VIEWS RT 3600291 EA $ 137.60 XR PELVIS COMPLETE MINIMUM 3 V LT 3600197 EA $ 205.50 XR PELVIS COMPLETE MINIMUM 3 V RT 3600292 EA $ 205.50 XR PHARYNX&/CERVICAL ESOPHAGUS 3600200 EA $ 366.85 XR RIBS BI W/POSTERIOR /ANT W CHEST MINI 3600204 EA $ 277.05 XR RIBS BILATERAL 3 V 3600205 EA $ 192.70 XR RIBS UNI W/ PA CHEST MINIMUM 3 LT 3600206 EA $ 186.80 XR RIBS UNI W/ PA CHEST MINIMUM 3 RT 3600293 EA $ 186.80 XR RIBS UNILATERAL 2 V LT 3600207 EA $ 153.65

XR RIBS UNILATERAL 2 V RT 3600294 EA $ 153.65 XR SACROILIAC JOINTS <3V 3600208 EA $ 140.55 XR SACROILIAC JOINTS >3V 3600209 EA $ 163.80 XR SACRUM & COCCYX MINIMUM 2 VIEWS 3600210 EA $ 137.50 XR SCAPULA COMPLETE LT 3600211 EA $ 152.85 XR SCAPULA COMPLETE RT 3600295 EA $ 152.85 XR SCOLIOSIS SPINE MIN 6 V 3600212 EA $ 372.75 XR SCOLIOSIS SPINE STUDY 4-5 V 3600213 EA $ 312.15 XR SCOLIOSIS SPINE STUDY W/SUPINE&EREC 2 3600214 EA $ 287.30 XR SHOULDER 1 V LT 3600216 EA $ 112.70 XR SHOULDER 1 V RT 3600296 EA $ 112.70 XR SHOULDER COMPLETE MINIMUM 2 V LT 3600218 EA $ 146.90 XR SHOULDER COMPLETE MINIMUM 2 V RT 3600298 EA $ 146.90 XR SINUSES PARANASAL < 3 V 3600219 EA $ 105.45 XR SINUSES PARANASAL COMPL MINIMUM 3 V 3600220 EA $ 184.70 XR SKULL < 4 V 3600221 EA $ 173.90 XR SKULL COMPLETE MINIMUM 4 3600222 EA $ 222.95 XR SMALL INTESTINE W/MULTIPLE SERIAL 3600223 EA $ 478.50 XR STERNOCLAVICULAR JT/JTS MINIMUM 3 3600224 EA $ 176.55

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XR STERNUM MINIMUM 2 V 3600225 EA $ 148.70 XR TEMPOROMANDBLE JOINT OPEN&CLOSED BILA 3600230 EA $ 228.85 XR TEMPOROMANDBLE JOINT OPEN&CLOSED UNIL 3600231 EA $ 151.40 XR THORACIC SPINE 2 V 3600233 EA $ 159.75 XR THORACIC SPINE 3 V 3600234 EA $ 175.00 XR THORACIC SPINE MINIMUM 4 V 3600235 EA $ 208.60 XR THORACOLUMBAR SPINE STANDING SCOLIOSI 3600236 EA $ 180.15 XR TIBIA & FIBULA 2 V LT 3600237 EA $ 131.35 XR TIBIA & FIBULA 2 V RT 3600299 EA $ 131.35 XR TOE MINIMUM 2 V LT 3600238 EA $ 144.45 XR TOE MINIMUM 2 V RT 3600300 EA $ 144.45 XR UPPER EXT INFANT MIN 2V LEFT 3600306 EA $ 154.10 XR UPPER EXT INFANT MIN 2V RIGHT 3600240 EA $ 154.10 XR WRIST 2 VIEWS LT 3600262 EA $ 152.70 XR WRIST 2 VIEWS RT 3600301 EA $ 152.70 XR WRIST COMPLETE MINIMUM 3V LT 3600264 EA $ 178.75 XR WRIST COMPLETE MINIMUM 3V RT 3600303 EA $ 178.75 YO AB CSF 2700306 EA $ 65.76 Y-TYPE BLOOD SOULTION SET 8400972 EA $ 40.45 ZINC 2700285 EA $ 62.60 ZINC OXIDE 20 % OINT 3900371 EA $ 21.00 ZOLPIDEM (AMBIEN) 5 MG TAB 3900372 EA $ 12.50 ZONISAMIDE 2700391 EA $ 72.36

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