CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201...

90
CHARGE CODE CHARGE DESC CHARGE AMOUNT 21110 SENSITIVITY PER ORGANISM( $103.37 21160 FUNGAL SMEAR $38.50 21234 AEROBIC DEFINITIVE BACT I $95.87 21235 ANAEROBIC DEFINITIVE BACT $63.35 21236 BACTERIAL ID DEFINITIVE-U $63.35 21237 BACTERIAL ID PRESUMPTIVE- $61.60 21923 FUNGUS IDENTIFICATION CHA $141.40 22116 PLATELETS, PHERESIS, LEUK $1,850.00 24136 CYTOPATHOLOGY, NON-GYN,PR $88.00 26300 LEVEL 1 GROSS EXAM ONLY T $41.65 26302 LEVEL 2 GROSS & MICRO EX $86.49 26304 LEVEL 3 GROSS & MICRO EXA $89.46 26305 LEVEL 4 GROSS 7 MICRO EXA $122.36 26307 LEVEL 5 GROSS & MICRO EXA $272.97 26309 LEVEL 6 GROSS & MICRO EXA $379.58 26311 DECALCIFICATION PROCEDURE $12.36 26312 SPECIAL STAINS, GROUP 1, $118.76 26313 SPECIAL STAINS, GROUP 11 $94.85 26331 FROZEN SECTION, TC, FORST $58.98 26342 IMMUNOPEROXIDASE HISTOCHE $113.37 30074 Aldosterone/Renin Activit $328.50 35428 ANCA Associated Vasculiti $28.22 38415 PHLEBOTOMY FEE, VENIPUNCT $17.40 38416 PHLEBOTOMY FEE, ARTERIAL $88.70 44783 Renin, Direct Plasma $145.10 44916 SUSCEPTIBILITY-ANAEROBE $298.20 44970 BETA-LACTAMASE ENZYME DET $102.90 1009960 PAIN LEVEL 1 $700.00 1009961 PAIN LEVEL 1ADTL MINUTES $140.00 1009962 PAIN LEVEL 2 $1,500.00 1009963 PAIN LEVEL 2 ADTL MINUTES $300.00 1009964 PAIN LEVEL 3 $3,000.00 1009965 PAIN LEVEL 3 ADTL MINUTES $600.00 1009966 PAIN LEVEL 4 $6,151.00 1009967 PAIN LEVEL 4 ADTL MINUTES $1,230.00 1009968 PAIN LEVEL 5 $9,868.00 1009969 PAIN LEVEL 5 ADTL MINUTES $2,266.00 1009972 PAIN LEVEL 7 $900.00 1100008 ADMIN INFLUENZA VIRUS VAC $86.84 1100009 ADMIN PNEUMOCOCCAL VACC $86.84 1100378 OBSERVATION EACH ADDITION $44.00 1100379 OBSERVATION FIRST HOUR $200.00 1100471 IMMUNO ADMIN ID SQ IM 1 V $121.84 1100935 CPM (CONTINOUS PASSIVE MO $150.00 1101798 MEASURE POST-VOID RESIDUA $159.74 1102270 SPINAL PUNCTURE LUMBAR DX $954.59

Transcript of CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201...

Page 1: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

CHARGE CODE CHARGE DESC CHARGE AMOUNT

21110 SENSITIVITY PER ORGANISM( $103.37

21160 FUNGAL SMEAR $38.50

21234 AEROBIC DEFINITIVE BACT I $95.87

21235 ANAEROBIC DEFINITIVE BACT $63.35

21236 BACTERIAL ID DEFINITIVE-U $63.35

21237 BACTERIAL ID PRESUMPTIVE- $61.60

21923 FUNGUS IDENTIFICATION CHA $141.40

22116 PLATELETS, PHERESIS, LEUK $1,850.00

24136 CYTOPATHOLOGY, NON-GYN,PR $88.00

26300 LEVEL 1 GROSS EXAM ONLY T $41.65

26302 LEVEL 2 GROSS & MICRO EX $86.49

26304 LEVEL 3 GROSS & MICRO EXA $89.46

26305 LEVEL 4 GROSS 7 MICRO EXA $122.36

26307 LEVEL 5 GROSS & MICRO EXA $272.97

26309 LEVEL 6 GROSS & MICRO EXA $379.58

26311 DECALCIFICATION PROCEDURE $12.36

26312 SPECIAL STAINS, GROUP 1, $118.76

26313 SPECIAL STAINS, GROUP 11 $94.85

26331 FROZEN SECTION, TC, FORST $58.98

26342 IMMUNOPEROXIDASE HISTOCHE $113.37

30074 Aldosterone/Renin Activit $328.50

35428 ANCA Associated Vasculiti $28.22

38415 PHLEBOTOMY FEE, VENIPUNCT $17.40

38416 PHLEBOTOMY FEE, ARTERIAL $88.70

44783 Renin, Direct Plasma $145.10

44916 SUSCEPTIBILITY-ANAEROBE $298.20

44970 BETA-LACTAMASE ENZYME DET $102.90

1009960 PAIN LEVEL 1 $700.00

1009961 PAIN LEVEL 1ADTL MINUTES $140.00

1009962 PAIN LEVEL 2 $1,500.00

1009963 PAIN LEVEL 2 ADTL MINUTES $300.00

1009964 PAIN LEVEL 3 $3,000.00

1009965 PAIN LEVEL 3 ADTL MINUTES $600.00

1009966 PAIN LEVEL 4 $6,151.00

1009967 PAIN LEVEL 4 ADTL MINUTES $1,230.00

1009968 PAIN LEVEL 5 $9,868.00

1009969 PAIN LEVEL 5 ADTL MINUTES $2,266.00

1009972 PAIN LEVEL 7 $900.00

1100008 ADMIN INFLUENZA VIRUS VAC $86.84

1100009 ADMIN PNEUMOCOCCAL VACC $86.84

1100378 OBSERVATION EACH ADDITION $44.00

1100379 OBSERVATION FIRST HOUR $200.00

1100471 IMMUNO ADMIN ID SQ IM 1 V $121.84

1100935 CPM (CONTINOUS PASSIVE MO $150.00

1101798 MEASURE POST-VOID RESIDUA $159.74

1102270 SPINAL PUNCTURE LUMBAR DX $954.59

Page 2: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1102945 ACCU-CHECK (GLUCOSE) $67.50

1106430 TRANSFUSION BLOOD/BLOOD P $1,300.00

1106556 INSERTION CENTRAL CATH AG $2,714.81

1109003 SEMI-PRIVATE ROOM UMSH $1,258.00

1109300 EKG 12-LEAD $93.63

1109901 OR LEVEL 1 BASE $517.00

1109902 OR LEVEL 1 ADDITIONAL $103.00

1109903 OR LEVEL 2 BASE $1,550.00

1109904 OR LEVEL 2 ADDITIONAL $310.00

1109905 OR LEVEL 3 BASE $3,616.00

1109906 OR LEVEL 3 ADDITIONAL $723.00

1109907 OR LEVEL 4 BASE $4,649.00

1109908 OR LEVEL 4 ADDITIONAL $930.00

1109909 OR LEVEL 5 BASE $6,405.00

1109910 OR LEVEL 5 ADDITIONAL $1,281.00

1109911 OR LEVEL 6 BASE $8,161.00

1109912 OR LEVEL 6 ADDITIONAL $1,632.00

1109913 OR LEVEL 7 BASE $10,194.00

1109914 OR LEVEL 7 ADDITIONAL $2,341.00

1109915 OR LEVEL 8 BASE $11,880.00

1109916 OR LEVEL 8 ADDITIONAL $2,376.00

1109917 OR LEVEL 9 BASE $16,108.00

1109918 OR LEVEL 9 ADDITIONAL $3,275.00

1109919 OR LEVEL 10 BASE $20,227.00

1109920 OR LEVEL 10 ADDITIONAL $4,100.00

1109921 GI LAB $1,131.00

1109922 GI LAB ADDITIONAL MINUTES $566.00

1109998 ANES FACILITY FEE $489.00

1109999 ANES FACILITY FEE ADDITIO $232.00

1401005 TOTAL HIP PACK $478.05

1401017 LAP CHLOE PACK $227.75

1401020 PACK,D AND C,GYNECOLOGY $130.40

1401051 FLEXIBLE IRIS RETRACTORS $550.00

1401055 2.3MM CONTRAST 25G/4MM/24 $185.00

1401056 SURGICAL 2 X 14 $372.30

1401059 CRE 15-18MM 8CM F/G $995.00

1401072 UMBILICAL HERNIAS VPATCH $1,434.63

1401079 CLIP APPL, ENDOPATH MULT $534.80

1401098 WRAP, KNEE POST-OP COLD U $182.45

1401100 WRAP, SHOULDER POST-OP 2P $134.75

1401147 BSS PLUS 500ML KIT GLASS< $262.40

1401149 CLEAR TRAC CANNULA $131.75

1401157 PKG., AGG. PLUS SHAVER $210.00

1401169 70X12.5X1MM RECIP BLD DBL $185.00

1401173 PKG; TUBESET FOR ARTHROSC $235.00

1401196 .015 THK SHT TAPRD RECP 2 $354.75

1401201 PROVISC 0.55ML 27G $219.30

Page 3: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1401203 DUOVISC (0.55PRO/0.50VIS) $443.60

1401204 VISCOAT 0.50ML 27G<USA $306.20

1401231 PERCUFLEX PLUS 6X26 $484.50

1401233 PERCUFLEX PLUS 6X28 $545.00

1401239 POLARIS ULTRA 5/26 $725.00

1401241 UNO-MAX BALOON DILATOR $1,685.00

1401244 TALON XTRA STR 3/120 $1,100.00

1401245 STONE RETRVL BASKETS2.4FR $945.00

1401247 STONE RETRVL BASKETS 3.0 $895.00

1401249 STONE RETRVL BAS 1.9FR 'O $1,158.35

1401251 STONE RETRVL BAS 1.3FR $1,127.50

1401256 MICRO SM CROSS CUT $255.00

1401257 ALLIANCE INFLATION SYRING $165.00

1401260 ROEW CARBIDE BURR $165.00

1401263 5X5X10MM $165.00

1401264 JACKSON SPIRAL PATIENT CA $224.65

1401269 OPTIFLEX STONE BAS 3CMX15 $188.60

1401282 SIDEKICK RIGID NEEDLE 14. $144.50

1401283 MULTIFIRE SCORPING NEEDLE $850.00

1401290 SUTURE LASSO 25 DEGREE LE $700.00

1401291 SUTURE LASSO 25 DEGREE RI $700.00

1401295 PASSPORT CANNULA 8X3 $160.00

1401297 PASSPORT CANNULA 8X5 $160.00

1401298 #2 FIBERWIRE $92.50

1401305 #2 FIBERLOOP $225.00

1401306 #2 FIBERLINK $250.00

1401307 #2 FIBERTAPE $204.00

1401308 #2 TIGERTAPE $255.00

1401310 ARROW-KARLAN INTRO LAP CH $392.70

1401313 400 MICRON LASER FIBER $1,498.35

1401367 SUTURE C-3 7-0 BLACK BRAI $97.50

1401382 X-LONG WD BL(39.0mm X 13. $191.05

1401383 AVER MED BL(25.0mm X 9.0m $191.05

1401384 LONG MEDIUM BL(31.0mm X9. $191.05

1401385 AGG MED BLD (25.0X9.0MM) $191.05

1401386 LONG NARROW(25.0MMX5.5MM) $288.65

1401387 LONG MED BL(25.0mm X 9.0m $173.30

1401388 MICR BLD S,C/O 9 X 35 X.6 $168.25

1401389 DUAL CUT SAG BLD(11x1.19x $289.65

1401390 DUAL CUT SAG BLADE(18X90X $289.65

1401391 DUAL CUT SAG BLADE(18X90X $289.65

1401392 DUAL CUT SAG BLADE (25X90 $289.65

1401398 SAGITTAL BLADE13.0X1.27X7 $278.85

1401399 SAGITTAL BLADE 13.0X1.27X $287.35

1401400 SAGITTAL BLADE 13.0X1.37X $278.85

1401401 SAGITTAL BLADE 18.0X1.27X $318.00

1401402 SAGITTAL BLADE 25.0X1.27X $293.55

Page 4: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1401412 HD SAG BLD 35 X 64 X .80 $192.00

1401476 SUTURE, PDS CLR MONO 2-0 $18.20

1401481 SUTURE, ETHLON BLK MONO 1 $133.55

1401494 SUTURE, ETHBND X GRN BR 0 $79.65

1401557 LONE STAR ELASTIC STAY $277.45

1401564 MESH VENTRALIGHT 4.5 $4,053.65

1401569 MULTI LIMEN CVC KIT $545.00

1401599 RELOAD ENDO CUTTER 45MM 1 $616.30

1401603 RETRIEVER, SUTURE DISP MD $239.00

1401606 RING RETRACTOR $274.15

1401609 SCISSOR DIRECT DRIVE DISP $326.10

1401614 SINGLE SENSOR CATHETER $150.20

1401619 SORAFIX FIXATION DEVICE $2,698.75

1401630 SUTURE PASSER $577.50

1401694 SUTURE VICRYL UD BR CT 0 $11.65

1401722 TUTOPLAST PATCH GRAFT $1,211.25

1401724 UNIVERSAL PACK W/GOWN $136.90

1401725 URINE METER TRAY, W/SIL F $144.70

1401726 VERSA KATH KIT $450.00

1401735 6.5 HEALIX ANCHOR $1,775.00

1401739 5.5 HEALIX ANCHOR $1,775.00

1401750 ABDOMINAL CATHETER $127.30

1401811 DISTRACTION SCREW 12MM $200.00

1401812 DISTRACTION SCREW 14MM $200.00

1401828 ENDO SPECI BAG $390.95

1401830 ENDOCUTTER FLEX LINEAR CU $1,258.20

1401839 FLOSEAL $799.39

1401841 FULGERATING ELECTRODE $708.35

1401848 STERI BUMP $198.00

1401850 6.0 BIPOLAR SEALER $2,475.00

1401859 RELOAD ENOSTITCH WHITE $661.00

1401860 ENDO LINEAR CUTTER 60MM $1,782.00

1401861 SHOULDER STABILIZATION KI $305.00

1401865 PALACOS RG CEMENT $1,352.57

1401866 VACUUM MIXING BOWL $499.70

1401870 BACK TABLE COVER $204.00

1401883 BRAVO CAPSULES $1,044.31

1401890 ENDOCLIP APPLIER 5MM $901.25

1401895 HEMOVAC 400ML DRAINE W/TR $130.85

1401921 BLADE COLD KNIFE (1/2 MOO $1,200.05

1401924 BUR LONG HIP BARREL 5.5 8 $259.10

1401927 BUR BARREL 5MM 6FL $210.00

1401937 10CC MOZIAK PUTTY $5,316.75

1401943 PRECISION CARTG BLADE $926.85

1401944 PROVISC .85 $346.80

1403077 CHIA $653.00

1403082 CORKSCREW SUTURE ANCHOR W $828.75

Page 5: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1403083 CORKSCREW ANCHOR $977.50

1403213 BLADE LONG HIP AGG PLUS 5 $210.00

1403215 ORTHOCORD 1-2 26MM $135.40

1403232 FLYTE HOOD W/PEEL AWAY MA $202.00

1403249 CURVE CANNULA 150X10 (NEE $150.00

1403252 SMALL TEAR CROSS CUT RASP $654.75

1403262 CORNEAL PROTECTORS $35.25

1403267 OMNI LOOP $630.00

1403288 8MM PILOT REAMER $1,465.00

1403402 MIXING KIT W/BREAKAWAY NO $500.00

1403428 VERSA KATH NEEDLE 24" $315.00

1403451 AMVISC PLUS .8ML $250.00

1403455 B & L EYE KIT $400.00

1403457 SCISSOR METZ TIP CURVED $371.05

1403459 ACCESS SYSTEM $114.25

1403468 MALYUGIN RING 6.25MM $625.00

1403469 MALYUGIN RING 7.00MM $625.00

1403478 ENDOSTITCH 48 SRDAC DLU $407.35

1403635 25G END GRIPPING FORCEP $600.00

1403638 RETINA PACK BASIC $175.00

1403652 RECIPROCATING BLADE $505.00

1408018 ALEUTIAN CAGE $35,266.50

1408123 HAEMONETICS CELLSAVER 170 $193.38

1408140 SURGICAL LEAD (PRECISION) $12,750.00

1408141 LEAD EXTENSION (PRECISION $3,264.00

1408165 AUTOPLEX $4,037.50

1408182 ACL TIGHTROPE $1,670.25

1408194 COMPACT VACUUM CEMENT MIX $1,140.00

1408200 SUTURE ANCHOR SWIVELOCK T $2,490.50

1408231 CANNULA 7X75MM $152.00

1408232 LUPINE ANCHOR W/ORTHOCORD $2,133.50

1408251 EXTENSION STEM 11MM X 65M $6,162.50

1408261 TIBIAL BEARING $9,426.50

1408286 ACETABULAR SHELL 54MM $6,800.00

1408294 TIBIAL TRAY FIXED SZ 4 RT $6,162.50

1408315 DOUBLE MOBILITY HCPE LINE $4,887.50

1408317 FEMUR BONE MODEL RT $687.50

1408319 FEMORAL COMPONENT SZ 5 LT $9,619.75

1408320 TIBIAL TRAY FIXED SZ 4 LT $6,162.50

1408334 TIBIAL TRAY FIXED SZ 5 LT $6,162.50

1408335 TIBIAL INSERT FIXED SX 5 $3,390.82

1408337 LOCKING SCREW 3.5X16 $1,173.00

1408340 TEMP FIXATION PIN 1.4MM $530.00

1408462 FIBERSNARE #2 $715.00

1408473 CINCH ANCHOR $348.50

1408475 TOGGLELOC/WASHERLOC DISP $3,825.00

1408482 LUPINE BR ANCHOR $2,074.00

Page 6: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1408483 EXPRESSEW III NEEDLE $851.00

1408492 INBONE TALAR STEM $5,741.75

1408493 INBONE STEM TIBIAL BASE $3,004.75

1408499 K-WIRE 1.4X28 $130.00

1408500 STEINMAN PIN 2.4MM $130.00

1408501 DRILL 6MM $1,460.00

1408502 DRILL ANTIROTATIONAL NOTC $770.00

2001002 5-HYDROXYINDOLEACETIC ACI $19.60

2001005 ABO BLOOD GROUP $57.96

2001012 ACID-FAST SMEAR ONLY $19.70

2001013 ACTIVATED PROTEIN C RESIS $23.80

2001014 ADRENOCORTICOTROPIC HORMO $68.10

2001016 ALBUMIN, BODY FLUID $10.90

2001017 ALBUMIN, CEREBROSPINAL FL $25.90

2001018 ALBUMIN, SERUM OR PLASMA $8.60

2001019 ALCOHOL, ETHYL, BLOOD $36.90

2001022 ALDOSTERONE, SERUM OR PLA $26.50

2001026 ALKALINE PHOSPHATASE, TOT $11.50

2001218 ALPHA-1-ANTITRYPSIN, SERU $37.60

2001222 ALUMINUM, SERUM $57.50

2001227 AMMONIA, PLASMA $45.30

2001230 AMPHETAMINES SCREEN, BY E $5.30

2001232 AMYLASE, PANCREATIC, SERU $17.00

2001239 ANGIOTENSIN CONVERTING EN $28.90

2001241 ANTIBODY IDENTIFICATION $325.34

2001244 ANTIBODY SCREEN $10.70

2001288 ANTITHROMBIN III, FUNCTIO $78.30

2001291 ARSENIC, URINE, 24-HOUR $47.70

2001330 BETA-C-TERMINAL TELOPEPTI $90.30

2001333 BILIRUBIN, DIRECT $10.70

2001340 BLOOD TYPING, ABO $5.80

2001343 BLOOD TYPING, RH $62.34

2001345 B-TYPE NATRIURETIC PEPTID $224.72

2001353 CA 19-9, BY CHEMILUMINESC $59.20

2001357 CADMIUM, URINE, RANDOM $33.00

2001360 CALCIUM, IONIZED $110.36

2001361 CALCIUM, SERUM OR PLASMA $8.10

2001362 CALCIUM, URINE, 24-HOUR $15.60

2001363 CALCIUM, URINE, RANDOM $15.60

2001367 CARBAMAZEPINE, TOTAL $47.10

2001371 CARCINOEMBRYONIC ANTIGEN, $66.20

2001372 CARDIOLIPIN IGA ANTIBODY $23.90

2001373 CARDIOLIPIN IGG ANTIBODY $11.40

2001374 CARDIOLIPIN IGM ANTIBODY $11.40

2001378 CBC WITH AUTOMATED DIFFER $102.26

2001380 CBC WITHOUT DIFFERENTIAL $85.70

2001385 CELL COUNT, BODY FLUID $8.60

Page 7: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2001386 CELL COUNT, CEREBROSPINAL $8.40

2001424 COAGULATION FACTOR II ASS $44.40

2001425 COAGULATION FACTOR V ASSA $59.80

2001426 COAGULATION FACTOR VII AS $59.80

2001427 COAGULATION FACTOR VIII A $59.80

2001430 COAGULATION FACTOR IX ASS $59.80

2001431 COAGULATION FACTOR X ASSA $59.80

2001444 COMPLEMENT COMPONENT 3 $28.60

2001445 COMPLEMENT COMPONENT 4 $28.60

2001453 CORTISOL, FREE, URINE, RA $49.50

2001454 CORTISOL, SERUM OR PLASMA $52.80

2001460 C-PEPTIDE, SERUM OR PLASM $11.40

2001462 C-REACTIVE PROTEIN, QUANT $13.70

2001463 CREATINE KINASE, TOTAL $17.00

2001465 CREATINE KINASE-MB, BY EC $39.90

2001466 CREATINE KINASE-MB, BY EC $39.90

2001468 CREATININE, BODY FLUID $10.20

2001469 CREATININE, SERUM OR PLAS $54.76

2001471 CREATININE, URINE, RANDOM $10.20

2001488 CRYPTOSPORIDIUM ANTIGEN, $21.20

2001489 CRYSTALS, BODY FLUID $8.60

2001491 CULTURE, ACID-FAST BACILL $20.60

2001494 CULTURE, BLOOD, ROUTINE $52.30

2001499 CULTURE, DIALYSIS FLUID $15.90

2001503 CULTURE, FUNGUS, BLOOD $42.90

2001509 CULTURE, METHICILLIN RESI $8.80

2001513 CULTURE, RESPIRATORY, UPP $15.90

2001520 CULTURE, VANCOMYCIN RESIS $8.80

2001523 CYCLIC CITRULLINATED PEPT $28.80

2001531 D-DIMER, QUANTITATIVE, PL $48.30

2001536 DIFFERENTIAL, BODY FLUID $8.60

2001538 DIGOXIN, SERUM OR PLASMA $37.60

2001539 DILUTE RUSSELL VIPER VENO $15.50

2001540 DIRECT ANTIGLOBULIN TEST $16.10

2001615 ELECTROLYTE PANEL $7.50

2001630 EOSINOPHIL SMEAR, URINE $8.40

2001639 ESTRADIOL, SERUM OR PLASM $72.70

2001649 FAT, QUANTITATIVE, FECES $104.00

2001654 FERRITIN $28.30

2001659 FIBRIN DEGRADATION PRODUC $32.70

2001660 FIBRINOGEN $16.50

2001663 FOLATE, SERUM $170.77

2001664 FOLLICLE STIMULATING HORM $275.52

2001677 GENERAL HEALTH PANEL $29.20

2001678 GENTAMICIN, PEAK LEVEL $52.80

2001680 GENTAMICIN, TROUGH LEVEL $52.80

2001682 GIARDIA ANTIGEN, BY EIA, $21.20

Page 8: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2001690 GLUCOSE, BODY FLUID $9.50

2001691 GLUCOSE, CEREBROSPINAL FL $8.10

2001698 GRAM STAIN $71.01

2001710 HCG, QUALITATIVE/PREGNANC $17.10

2001711 HCG, QUANTITATIVE, SERUM $43.30

2001714 HDL CHOLESTEROL $21.10

2001715 HDN RBC ANTIBODY SCREEN $10.70

2001725 HEMATOCRIT, BLOOD $44.24

2001726 HEMATOCRIT, BODY FLUID $4.20

2001727 HEMATOPATHOLOGY CONSULTAT $29.80

2001729 HEMOGLOBIN $38.16

2001730 HEMOGLOBIN A1C $16.60

2001733 HEMOGLOBIN, FETAL $17.00

2001736 HEPARIN, LOW MOLECULAR WE $59.20

2001737 HEPARIN-ASSOCIATED ANTIBO $146.00

2001742 HEPATIC FUNCTION PANEL $228.77

2001743 HEPATITIS A VIRUS IGM ANT $46.60

2001750 HEPATITIS B VIRUS SURFACE $31.60

2001753 HEPATITIS C VIRUS ANTIBOD $36.00

2001761 HEPATITIS PANEL, ACUTE $119.50

2001776 HIV-1/O/2 ANTIBODY SCREEN $36.90

2001779 HIV-1/2 ANTIBODY SCREEN, $79.70

2001781 HIV-1 ANTIBODY, BY WESTER $44.80

2001785 HIV-2 ANTIBODY, BY WESTER $22.25

2001786 HLA-B27 $56.90

2001789 HOMOCYSTEINE, TOTAL, SERU $52.60

2001794 IGA, QUANTITATIVE, SERUM $23.70

2001802 IGG, QUANTITATIVE, CEREBR $23.30

2001803 IGG, QUANTITATIVE, SERUM $23.70

2001808 IMMUNOFIXATION, URINE $33.90

2001812 INFLUENZA VIRUS A AND B, $175.90

2001817 INSULIN, TOTAL $28.90

2001833 LACTATE DEHYDROGENASE, TO $10.30

2001834 LACTATE DEHYDROGENASE, TO $8.60

2001839 LACTOFERRIN, FECES $62.00

2001842 LAMOTRIGINE, SERUM OR PLA $55.50

2001847 LEAD, WHOLE BLOOD $24.60

2001848 LEGIONELLA PNEUMOPHILA AN $24.90

2001856 LEVETIRACETAM (KEPPRA½), $85.20

2001859 LIPASE, SERUM $22.00

2001860 LIPID PANEL $233.10

2001862 LITHIUM, SERUM OR PLASMA $117.33

2001874 MAGNESIUM, SERUM $81.45

2001883 PROTHROMBIN TIME $8.10

2001886 METABOLIC PANEL, BASIC $167.05

2001887 METABOLIC PANEL, COMPREHE $259.70

2001894 MICROALBUMIN SCREEN, SEMI $40.09

Page 9: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2001905 MYELOPEROXIDASE (MPO) IGG $34.00

2001907 MYOGLOBIN, URINE, RANDOM $18.70

2001929 OSMOLALITY, SERUM $15.20

2001930 OSMOLALITY, URINE $14.20

2001934 OXCARBAZEPINE METABOLITE $26.70

2001938 OXYGEN SATURATION, ARTERI $30.40

2001970 PARATHYROID HORMONE, INTA $302.22

2001973 PARTIAL THROMBOPLASTIN TI $71.31

2001975 APTT MIXING STUDIES (IF I $14.00

2001987 PHENYTOIN, TOTAL $37.60

2001991 PHOSPHORUS, SERUM $11.50

2001998 PLATELET COUNT $9.10

2001999 PLATELET FUNCTION ANALYSI $75.50

2002003 POTASSIUM, SERUM OR PLASM $8.60

2002005 POTASSIUM, URINE, RANDOM $8.60

2002006 PREALBUMIN $149.65

2002010 PROGESTERONE $33.00

2002011 PROLACTIN $49.60

2002017 PROTEIN C, FUNCTIONAL $88.70

2002018 PROTEIN S, FUNCTIONAL $96.10

2002020 PROTEIN, TOTAL, BODY FLUI $10.90

2002021 PROTEIN, TOTAL, CEREBROSP $9.50

2002022 PROTEIN, TOTAL, SERUM $8.60

2002023 PROTEIN, TOTAL, URINE, 24 $11.20

2002028 PT MIXING STUDIES (IF IND $8.10

2002030 RENAL FUNCTION PANEL $9.70

2002031 RENIN ACTIVITY $23.90

2002037 RETICULOCYTE COUNT $6.20

2002038 RETICULOCYTE HEMOGLOBIN E $12.40

2002040 RHEUMATOID FACTOR, SERUM $10.20

2002049 SCLERODERMA (SCL-70) IGG $17.00

2002053 SEDIMENTATION RATE $66.45

2002066 SMOOTH MUSCLE ANTIBODY $37.40

2002068 SODIUM, SERUM OR PLASMA $8.60

2002070 SODIUM, URINE, RANDOM $8.60

2002076 STONE (CALCULI) ANALYSIS $183.65

2002077 STREPTOCOCCUS, GROUP A, A $11.30

2002083 T3, FREE $62.20

2002084 T3, TOTAL $42.40

2002085 T4, FREE $33.80

2002086 T4, TOTAL $13.90

2002087 TACROLIMUS, WHOLE BLOOD $71.70

2002093 TESTOSTERONE, FREE, ADULT $117.90

2002094 TESTOSTERONE, TOTAL $62.20

2002096 THEOPHYLLINE, SERUM OR PL $32.50

2002097 THROMBIN CLOTTING TIME $22.50

2002103 THYROID STIMULATING HORMO $191.29

Page 10: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2002112 TOPIRAMATE, SERUM OR PLAS $46.20

2002134 TROPONIN I, QUANTITATIVE $167.73

2002146 UCG, QUALITATIVE/PREGNANC $87.19

2002148 UREA NITROGEN, SERUM OR P $7.10

2002150 UREA NITROGEN, URINE, RAN $8.10

2002151 URIC ACID, BODY FLUID $8.60

2002152 URIC ACID, SERUM OR PLASM $8.60

2002153 URIC ACID, URINE, 24-HOUR $12.40

2002154 URIC ACID, URINE, RANDOM $12.40

2002155 URINALYSIS, MACROSCOPIC $4.40

2002156 URINALYSIS, MICROSCOPIC $6.20

2002157 URINALYSIS, ROUTINE $65.79

2002158 URINALYSIS, WITH CULTURE $7.40

2002163 VAGINOSIS, BACTERIAL, GRA $10.00

2002164 VALPROIC ACID, FREE $44.90

2002165 VALPROIC ACID, TOTAL $39.10

2002166 VANCOMYCIN, PEAK LEVEL $52.80

2002167 VANCOMYCIN, RANDOM OR NON $52.80

2002168 VANCOMYCIN, TROUGH LEVEL $52.80

2002171 VARICELLA-ZOSTER VIRUS IG $23.30

2002174 VITAMIN B1 (THIAMINE) $109.80

2002175 VITAMIN B12 $183.74

2002178 VITAMIN D, 1, 25-DIHYDROX $299.97

2002183 VON WILLEBRAND FACTOR ANT $86.10

2002211 RED BLOOD CELLS, LEUKOCYT $700.00

2002224 CULTURE BACTERIAL ANY SOU $186.37

2002226 CONCENTRATION FOR INFECTI $33.11

2002227 PROTEIN ELECTROPHORETIC F $53.24

2002228 THROMBOPLASTIN INHIBITION $47.74

2002231 IRON BINDING CAPACITY $43.33

2002233 MOLECULAR DIAG MOLECULAR $19.88

2002234 MOLECULAR DIAG NUCLEIC AC $19.88

2002235 MOLECULAR DIAG AMPLIFICAT $83.09

2002236 MOLECULAR DIAG INTERP & R $19.88

2002240 MERCURY, URINE, 24-HOUR $64.30

2002242 Crossmatch and Type $143.85

2002249 CHLAMYDIA/GC BY NAAT - SW $154.70

2002250 CULTURE WITH SENSITIVITY, $87.85

2002251 C DIFFICILE TOXIN B BY PC $408.45

2002256 SCREEN-SPUTUM $35.00

2002274 I-STAT CREATININE $52.15

2002275 I-STAT POTASSIUM $52.15

2002276 ARTERIAL BLOOD GASES/POC $180.43

2002279 I-STAT CHEM8+ - VENOUS $169.50

2002283 IVY BLEEDING TIME $104.30

2002284 COMPLETE BLOOD COUNT/MAN $52.15

2002285 MANUAL DIFFERENTIAL ONLY $23.10

Page 11: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2002288 FECAL OCCULT BLD, DIAGNOS $87.85

2002305 ANA, ANTINUCLEAR ANTIBODY $66.85

2002324 PSA TOTAL, DIAGNOSTIC $86.80

2002326 5'NUCLEOTIDASE $63.00

2002328 MYELIN BASIC PROTEIN, CSF $78.75

2002449 TRIAGE METER DRUG SCREEN $88.20

2004145 Procalcitonin, Serum or P $210.45

2100150 FACIAL BONES MIN 3 VW $304.18

2100160 NASAL BONES MIN 3 VW $224.58

2100200 ORBITS MIN 4 VW $292.85

2100220 SINUSES MIN 3 VW $270.39

2100260 SKULL MIN 4 VW $352.80

2100360 SOFT TISSUE NECK $210.24

2101100 RIBS 2 VW UNI RT $231.72

2101101 RIBS/CHEST 3+ VW UNILAT R $316.90

2101102 RIBS/CHEST 3+ VW UNILAT L $316.90

2101110 RIBS BILAT 3 VW $344.87

2101120 STERNUM MIN 2 VW $247.21

2102020 SPINE 1 VW ANY LEVEL $211.19

2102040 SPINE CERV 2-3 VW $257.64

2102050 SPINE CERV MIN 4 VW $392.00

2102070 SPINE THOR 2 VW $198.00

2102080 SPINE THORACOLUMBAR 2 VW $192.75

2102100 SPINE LUMB 2-3 VW $247.36

2102110 SPINE LUMB MIN 4 VW $414.21

2102170 PELVIS 1-2 VW $195.00

2102190 PELVIS MIN 3 VW $294.00

2102202 SI JNTS 3 OR MORE VW $259.71

2102220 SACRUM & COCCYX MIN 2 VW $251.67

2103000 CLAVICLE LT $181.83

2103010 SCAPULA RT $216.36

2103011 SCAPULA LT $216.36

2103020 SHOULDER 1 VW RT $190.74

2103021 SHOULDER 1 VW LT $190.74

2103030 SHOULDER MIN 2 VW LT $234.97

2103031 SHOULDER MIN 2 VW RT $234.97

2103040 ARTHROGRAM SHOULDER LT $982.03

2103060 HUMERUS MIN 2 VW RT $205.42

2103061 HUMERUS MIN 2 VW LT $205.42

2103070 ELBOW 2 VW LT $185.86

2103071 ELBOW 2 VW RT $185.86

2103080 ELBOW MIN 3 VW LT $235.37

2103081 ELBOW MIN 3 VW RT $235.37

2103090 FOREARM 2 VW RT $217.39

2103091 FOREARM 2 VW LT $217.39

2103100 WRIST 2 VW RT $172.31

2103101 WRIST 2 VW LT $172.31

Page 12: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2103110 WRIST MIN 3 VW LT $238.38

2103111 WRIST MIN 3 VW RT $238.38

2103115 ARTHROGRAM WRIST LT $982.03

2103120 HAND 2 VW RT $213.00

2103121 HAND 2 VW LT $213.00

2103130 HAND MIN 3 VW LT $231.88

2103131 HAND MIN 3 VW RT $231.88

2103140 FINGER(S) MIN 2 VW RT $174.72

2103141 FINGER(S) MIN 2 VW LT $174.72

2103521 X-RAY EXAM HIPS BI 2 VIEW $156.80

2103522 X-RAY EXAM HIPS BI 3-4 VI $156.80

2103523 X-RAY EXAM HIPS BI 5/> VI $156.80

2103525 ARTHROGRAM HIP LT $982.03

2103560 KNEE 1-2 VW LT $228.86

2103561 KNEE 1-2 VW RT $228.86

2103562 KNEE 3 VW RT $273.00

2103563 KNEE 3 VW LT $273.00

2103565 KNEES STANDING AP $254.80

2103580 ARTHROGRAM KNEE LT $982.03

2103590 TIB/FIB 2 VW RT $242.14

2103600 ANKLE 2 VW LT $164.81

2103601 ANKLE 2 VW RT $164.81

2103610 ANKLE MIN 3 VW RT $224.84

2103611 ANKLE MIN 3 VW LT $224.84

2103620 FOOT 2 VW LT $176.31

2103621 FOOT 2 VW RT $176.31

2103630 FOOT MIN 3 VW RT $227.28

2103631 FOOT MIN 3 VW LT $227.28

2103650 CALCANEUS MIN 2 VW LT $202.81

2103651 CALCANEUS MIN 2 VW RT $202.81

2103660 TOE(S) MIN 2 VW LT $174.22

2103661 TOE(S) MIN 2 VW RT $174.22

2104022 ACUTE ABDO SERIES W/1 VW $414.09

2104220 ESOPHAGUS $363.60

2104230 SWALLOW FUNCTION W/RECORD $330.96

2104246 UGI W/AIR W/O KUB $584.37

2104249 UGI W/AIR W/KUB W/SM $857.67

2104250 SMALL BOWEL $422.02

2104320 C-ARM CHOLANGIOGRAM $5,031.39

2104400 IVP W OR W/O KUB $1,145.00

2104420 RETROGRADE PYELOGRAM $814.67

2104430 CYSTOGRAM $183.79

2104455 URETHROCYSTOGRAM VOIDING $320.85

2105021 SURGICAL RENAL BX RT $2,368.45

2107002 NEEDLE LOCALIZATION BY XR $526.16

2107010 MANDIBLE <4 VW $213.00

2107110 RIBS 2 VW UNI LT $231.72

Page 13: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2107300 CLAVICLE RT $181.83

2107304 ARTHROGRAM SHOULDER RT $982.30

2107311 ARTHROGRAM WRIST RT $982.03

2107352 ARTHROGRAM HIP RT $982.03

2107358 ARTHROGRAM KNEE RT $982.03

2107359 TIB/FIB 2 VW LT $242.14

2110450 CT HEAD/BRAIN W/O CONT $671.62

2110460 CT HEAD/BRAIN W/CONT $1,051.72

2110470 CT HEAD/BRIAN W & W/O CON $1,169.32

2110480 CT ORBIT/SELLA/ETC W/O CO $671.62

2110481 CT ORBIT/SELLA/ETC W/CONT $1,051.72

2110482 CT ORBIT/SELLA/ETC W & W/ $1,169.32

2110486 CT FACIAL W/O CONT $671.62

2110487 CT FACIAL W/CONT $1,051.72

2110488 CT FACIAL W & W/O CONT $1,169.32

2110489 CT SINUSES W/CONT $1,051.72

2110490 CT NECK W/O CONT $671.62

2110491 CT NECK W/CONT $1,051.72

2110492 CT NECK W & W/O CONT $1,169.32

2110496 CT ANGIOGRAPH HEAD $1,184.65

2110497 CT SINUSES W & W/O CONT $1,169.32

2110498 CT ANGIOGRAPH NECK $1,184.65

2111250 CT CHEST W/O CONT $671.62

2111260 CT CHEST W/CONT $1,051.72

2111270 CT CHEST W & W/O CONT $1,169.32

2111275 CT ANGIOGRAPH CHEST $1,184.65

2112125 CT C SPINE W/O CONT $671.62

2112126 CT C SPINE W/CONT $1,051.72

2112127 CT C SPINE W & W/O CONT $1,169.32

2112128 CT T SPINE W/O CONT $671.62

2112129 CT T SPINE W/CONT $1,051.72

2112130 CT T SPINE W & W/O CONT $1,169.32

2112131 CT L SPINE W/O CONT $671.62

2112132 CT L SPINE W/CONT $1,051.72

2112133 CT L SPINE W & W/O CONT $1,169.32

2112191 CT ANGIOGRAPH PELVIS $1,184.65

2112192 CT PELVIS W/O CONT $671.62

2112193 CT PELVIS W/CONT $1,051.72

2112194 CT PELVIS W & W/O CONT $1,169.32

2113200 CT UP EXTREM W/O CONT LT $671.62

2113201 CT UP EXTREM W/CONT LT $1,051.72

2113202 CT UP EXTREM W & W/O CONT $1,169.32

2113203 CT UP EXTREM W/CONT RT $1,051.72

2113204 CT UP EXTREM W & W/O CONT $1,169.32

2113206 CT ANGIOGRAPH UP EXTREM L $1,184.65

2113207 CT ANGIOGRAPH UP EXTREM R $1,184.65

2113700 CT LOW EXTREM W/O CONT LT $671.62

Page 14: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2113701 CT LOW EXTREM W/CONT LT $1,051.72

2113702 CT LOW EXTREM W & W/O CON $1,169.32

2113703 CT LOW EXTREM W/O CONT RT $671.62

2113704 CT LOW EXTREM W/CONT RT $1,051.72

2113705 CT LOW EXTREM W & W/O CON $1,169.32

2113706 CT ANGIOGRAPH LOW EXTREM $1,184.65

2113707 CT ANGIOGRAPH LOW EXTREM $1,184.65

2114150 CT ABDO W/O CONT $671.62

2114160 CT ABDO W/CONT $1,051.72

2114170 CT ABDO W & W/O CONT $1,169.32

2114174 CT ANGIOGRAPH ABDO/PEL $2,031.89

2114175 CT ANGIOGRAPH ABDO $1,184.65

2114176 CT ABDO/PELVIS W/O CONT $1,418.10

2114177 CT ABDO/PELVIS W/CONT $2,031.89

2114178 CT ABDO/PELVIS W & W/O CO $2,031.89

2115635 CT AORTA $1,092.98

2117048 CT SINUSES W/O CONT $671.62

2117320 CT UP EXTREM W/O CONT RT $671.62

2120336 MRI TMJ(S) $1,184.44

2120540 MRI ORBIT/FACE/NECK W/O C $1,184.65

2120542 MRI ORBIT/FACE/NECK W/CON $1,525.44

2120543 MRI ORBIT/FACE/NECT W & W $1,869.11

2120544 MRA HEAD W/O CONT $1,184.44

2120546 MRA HEAD W & W/O CONT $1,869.11

2120547 MRA NECK W/O CONT $1,184.44

2120548 MRA NECK W/CONT $1,525.44

2120549 MRA NECK W & W/O CONT $1,869.11

2120551 MRI BRAIN W/O CONT $1,184.44

2120552 MRI BRAIN W/CONT $1,525.44

2120553 MRI BRAIN W & W/O CONT $1,869.11

2121552 MRI CHEST W & W/O CONT $1,869.11

2122141 MRI C SPINE W/O CONT $1,184.44

2122142 MRI C SPINE W/CONT $1,525.44

2122146 MRI T SPINE W/O CONT $1,184.44

2122147 MRI T SPINE W/CONT $1,525.44

2122148 MRI L SPINE W/O CONT $1,184.44

2122149 MRI L SPINE W/CONT $1,525.44

2122156 MRI C SPINE W & W/O CONT $1,869.11

2122157 MRI T SPINE W & W/O CONT $1,869.11

2122158 MRI L SPINE W & W/O CONT $1,869.11

2122195 MRI PELVIS W/O CONT $1,184.44

2122196 MRI PELVIS W/CONT $1,525.44

2122197 MRI PELVIS W & W/O CONT $1,869.11

2123218 MRI UP EXTREM NO JNT W/O $1,184.44

2123219 MRI UP EXTREM NO JNT W/CO $1,525.44

2123220 MRI UP EXTREM NO JNT W & $1,869.11

2123221 MRI UP EXTREM W/JNT W/O C $1,184.44

Page 15: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2123222 MRI UP EXTREM W/JNT W/CON $1,525.44

2123223 MRI UP EXTREM W/JNT W & W $1,869.11

2123224 MRI UP EXTREM NO JNT W/CO $1,525.44

2123225 MRI UP EXTREM NO JNT W & $1,869.11

2123226 MRI UP EXTREM W/JNT W/O C $1,184.44

2123227 MRI UP EXTREM W/JNT W/CON $1,525.44

2123228 MRI UP EXTREM W/JNT W & W $1,869.11

2123718 MRI LOW EXTREM NO/JNT W/O $1,184.44

2123719 MRI LOW EXTREM NO/JNT W/C $1,525.44

2123720 MRI LOW EXTREM NO/JNT W & $1,869.11

2123721 MRI LOW EXTREM W/JNT W/O $1,184.44

2123722 MRI LOW EXTREM W/JNT W/CO $1,525.44

2123723 MRI LOW EXTREM W/JNT W & $1,869.11

2123725 MRI LOW EXTREM NO/JNT W/C $1,525.44

2123726 MRI LOW EXTREM NO/JNT W & $1,869.11

2123727 MRI LOW EXTREM W/JNT W/O $1,184.44

2123728 MRI LOW EXTREM W/JNT W/CO $1,525.44

2123729 MRI LOW EXTREM W/JNT W & $1,869.11

2124181 MRI ABDO W/O CONT $1,184.44

2124182 MRI ABDO W/CONT $1,525.44

2124183 MRI ABDO W & W/O CONT $1,869.11

2127321 MRI UP EXTREM NO JNT W/O $1,184.44

2128900 MRA ABDO W/CONT $1,525.44

2128901 MRA ABDO W/O CONT $1,184.44

2128902 MRA ABDO W & W/O CONT $1,869.11

2128912 MRA LOW EXTREM W/CONT LT $1,525.44

2128913 MRA LOW EXTREM W/O CONT L $1,184.44

2128918 MRA PELVIS W/CONT $1,525.44

2128919 MRA PELVIS W/O CONT $1,184.44

2128920 MRA PELVIS W & W/O CONT $1,869.11

2128933 MRA SPINE W & W/O CONT $1,869.11

2128940 MRA LOW EXTREM W/CONT RT $1,525.44

2128941 MRA LOW EXTREM W/O CONT R $1,184.44

2132421 US THORACENTESIS ASPIRATI $1,348.55

2133306 ECHO W/2D SPEC DOP W/COLO $1,374.73

2133307 ECHO W/2D SPEC DOP W/O CO $1,374.73

2133880 EXTRACRANIAL ART DUPLEX B $532.46

2133970 EXTREM VEINS DUPLEX BILAT $532.46

2133971 EXTREM VEINS DUPLEX UNI/L $337.09

2133978 DUPLEX AORTA IVC ILIAC VA $532.46

2136536 US SOFT TISS NECK (THYROI $337.09

2136700 US ABDO COMPLETE $337.09

2136705 US ABDO LTD $337.09

2136770 US RETROPERI COMPLETE $337.09

2136775 US RETROPERI LTD $337.09

2136805 US OB PREG POST/FST/SINGL $337.09

2136816 US OB PREG F/U PER FETUS $220.22

Page 16: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2136818 US FETAL BIO PROFILE W/O $337.09

2136830 US TRANSVAG $337.09

2136858 US PELVIC CMPLT $337.09

2136870 US SCROTUM $337.09

2136882 US EXTREM NON-VASC LTD LT $220.22

2136883 US EXTREM NON-VASC LTD RT $220.22

2136885 US HIPS INFANT DYNAMIC $220.22

2136886 US HIPS INFANT STATIC/LTD $220.22

2136942 US GUIDANCE NEEDLE PLCMT $601.77

2136946 US AMNIOCENTESIS $401.18

2501502 TRACH TUBE CHANGE $118.48

2501720 CATHETER ASPIRATION NASOT $103.99

2502803 ABG $193.20

2504002 VENT ASSIST/MGMT INITIATI $751.91

2504003 VENT ASSIST/MGMT IP EA SU $751.91

2504010 SPIROMETRY $181.16

2504060 BRONCHODILATION PRE/POST $345.80

2504150 VITAL CAPACITY TOTAL $181.16

2504467 ACAPELLA THERAPY $67.00

2504640 INHALATION TX FOR ACUTE A $103.99

2504642 AEROSOL INHAL PENTAMIDINE $345.80

2504644 CONTINUOUS INHAL TX W/AER $159.74

2504645 CONTINUOUS INHAL TX W/AER $159.74

2504660 CPAP INITIAT/MGMT $345.80

2504664 MDI OR IPPB DEVICE $103.99

2504667 CHEST WALL MANIP INITIAL $103.99

2504668 CHEST WALL MANIP SUBQ $103.99

2504761 PULSE OX MULTI DETERMIN $53.90

2504762 PULSE OX CONTINUOUS OVERN $228.87

2506601 ARTERIAL PUNCTURE FOR DIA $65.87

2607012 TRACTION MECHANICAL $38.27

2607014 E-STIM UNATTEND $37.67

2607032 E-STIM MANUAL EA 15 MIN $41.73

2607035 ULTRASOUND EA 15 MIN $41.01

2607110 TX EXERCISE 1 OR MORE ARE $68.43

2607112 NEUROMUSCULAR RE-ED EA 15 $66.98

2607113 AQUATIC TX EA 15 MIN $75.71

2607116 GAIT TRAINING/STAIR CLIMB $60.42

2607124 MASSAGE EA 15 MIN $45.14

2607140 MANUAL TX 1 OR MORE AREAS $52.42

2607150 THERAPEUTIC PROCEDURES GR $37.86

2607530 THERAPEUTIC ACTIVITIES 1- $60.37

2607535 SELF-CARE/HOME MGMT EA 15 $63.11

2607542 WHEELCHAIR MGMT EA 15 MIN $38.42

2607760 ORTHOTIC(S) MGMT/TRAIN EA $100.66

2607761 PROSTHETIC TRAIN UP/LOW E $92.27

2707014 E-STIM UNATTEND $37.67

Page 17: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2707016 VASOPNEUMATIC DEVICES $46.64

2707018 PARAFFIN BATH $38.27

2707032 E-STIM MANUAL EA 15 MIN $41.73

2707033 IONTOPHORESIS EA 15 MIN $60.44

2707035 ULTRASOUND EA 15 MIN $41.01

2707140 MANUAL TX 1 OR MORE AREAS $52.42

2707150 THERAPEUTIC PROCEDURES GR $37.86

2707530 THERAPEUTIC ACTIVITIES 1- $60.37

2707533 SENSORY INTEGRATIVE TECHN $53.51

2707535 SELF-CARE/HOME MGMT EA 15 $63.11

2707542 WHEELCHAIR MGMT EA 15 MIN $38.42

2707760 ORTHOTIC(S) MGMT/TRAIN EA $100.66

2707761 PROSTHETIC TRAIN UP/LOW E $92.27

2802507 SPEECH TX INDIVIDUAL $125.63

2802508 SPEECH TX GROUP $87.39

2802516 FACIAL NERVE FUNCTION STU $242.20

2802520 LARYNGEAL FUNCTION STYUDI $456.23

2802526 TX SWALLOWING DYSFUNCTION $163.86

2900008 ADMIN INFLUENZA VIRUS VAC $86.84

2900009 ADMIN PNEUMOCOCCAL VACC $86.84

2900010 ADMIN HEP B VACC $121.84

2900471 IMMUNO ADMIN ID SQ IM 1 V $121.84

2900472 IMMUNO ADMIN ID SQ IM EA $86.84

6000011 BUPIVACAINE VL 0.0025 $10.00

6000033 DESFLURANE LIQ 1 $907.00

6000056 LIDOCAINE ANESTHESIA SDV $18.00

6000061 LIDOCAINE ANESTHESIA AMP $40.00

6000292 METRONIDAZOLE/NACL IVP 5M $12.00

6000364 KETAMINE ML 50MG/ML $26.50

6000966 HYDROMORPHONE PCA 12MG / $39.00

6001046 CARVEDILOL TAB 3.125MG $10.00

6001061 CEFAZOLIN 2 GM SYRINGE $26.50

6001117 DICYCLOMINE CAP 10MG $3.50

6001135 DILTIAZEM CD CAP 120MG $6.00

6001151 LIPOCAINE/EPI/BSS OPHTH I $100.00

6001158 GABAPENTIN CAP 400MG $10.00

6001163 HYDROCORTISONE CRM 0.01 $13.50

6001171 HYDROCORTISONE TAB 10MG $3.50

6001172 VANCOMYCIN 25 MG/ML ORAL $375.00

6001190 DEXTROSE/WATER IV 0.05 $31.50

6001287 CALCIUM CARB TAB 500MG $3.50

6001325 LEVALBUTEROL SOL 1.25MG/3 $33.50

6001376 CALCIUM GLUCONATE INJ 1GM $32.50

6001385 DEXTROSE/WATER SYG 0.25 $50.50

6001395 EPINEPHRINE VL 1MG/ML $3.50

6001415 LIDOCAINE AMP 0.02 $15.50

6001439 DEXTROSE 5%-1/2NS IV 5/0. $12.00

Page 18: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6001998 BUPIVACAINE/EPI E VL $79.50

6002001 POLYMYXIN B SULFATE VL 50 $67.50

6002013 LATANOPROST DRP 0.00005 $97.50

6002026 CAFFEINE/SOD BENZOATE VL $109.50

6002048 DOXAZOSIN MESYLATE TAB 2M $19.00

6002370 PHENYLEPHRINE HCL DROP 5M $3.50

6003324 POTASSIUM CHL INJ 40MEQ $25.00

6004317 LACTULOSE SOL 20GM $4.50

6005526 MAG/ALUM HYDROX/SIMET SUS $14.00

6006441 ZINC SULFATE CAP 220MG $3.50

6007379 GENTAMICIN INJ 80 MG/2ML $7.00

6007381 GENTAMICIN 160MG/NS 100ML $100.00

6009546 LORAZEPAM 1ML INJ 2MG/ML $6.00

6009556 PROPARACAINE DROP 0.5% 15 $3.50

6009560 OFLOXACIN DROP 0.3% 5ML $105.00

6009855 FLUCONAZOLE TAB 150MG $70.00

6009947 OMEPRAZOLE CAP 20MG $15.00

6011201 VANCO 1GM/NS 250ML PGBK $118.50

6011220 SCOPOLAMINE PAT 1.5MG/72 $128.00

6015608 AMP/SULB3GM/NS100 PGBK $103.00

6015707 AMP/SULB 1.5GM/NS100 PGBK $32.50

6016209 DIPHENHYDRAM 50MG/ML INJ $6.50

6016559 MELOXICAM TAB 7.5MG $16.00

6016560 MELOXICAM TAB 15MG $24.00

6018668 HYDROXYZINE PAM 25MG CAP $3.50

6018980 VENLAFAXINE TAB 75MG $11.00

6019206 SERTRALINE TAB 50MG $14.00

6019227 SERTRALINE TAB 100MG $14.00

6020698 LEVOTHYROXINE TAB 112MCG $3.50

6021928 PRAMIPEXOLE DI-HCL TAB 0. $15.00

6021937 NICOTINE TRANSDERMAL PAT $10.00

6023543 HYDROXYZINE HCL INJ 25MG $121.00

6024285 NYSTATIN PWD 100KU/GM $187.50

6024652 FINASTERIDE TAB 5MG $16.00

6024682 HYDROMORPHONE TAB 2MG $4.00

6024894 AMMONIA INHALANTS AMP $3.50

6025288 BISACODYL SUPP SUP 10MG $3.50

6025461 AMPICILLIN/SULBACTAM VL 3 $54.00

6025518 CARBAMAZEPINE TAB 200MG $3.50

6028466 FLUOXETINE CAP 10MG $13.00

6028958 METOPROLOL SUCCINATE TAB $6.00

6030101 SULFAMETHOXAZOLE/TRI TAB $3.50

6030180 TRAMADOL TAB 50MG $4.50

6030850 ONDANSETRON INJ 4 MG/2 ML $6.00

6032055 ONDANSETRON ODT 4MG TAB $116.00

6032512 HYPROMELLOSE E DRP $16.50

6032566 FLUCONAZOLE TAB 100MG $44.00

Page 19: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6032828 DOPAMINE IN D5% BAG 1.6MG $73.50

6033719 GLIPIZIDE TAB 5MG $3.50

6033745 ALBUTEROL INHALER 8GM $18.00

6034195 AMIODARONE TAB 200MG $40.00

6034853 ACETAZOLAMIDE TAB 250MG $14.50

6035051 PHENYLEPHRINE INJ 10MG/ML $23.50

6035063 REMIFENTANIL VL 1MG $337.50

6035091 DIPHENHYDRAMINE/ZINC CRM $20.00

6037012 SIMVASTATIN TAB 20MG $31.00

6037660 EPHEDRINE SULFATE VL 50MG $65.50

6038371 CITALOPRAM TAB 20MG $13.50

6038396 ROPIVACAINE 0.5% 150MG/30 $130.50

6039847 AMLODIPINE TAB 5MG $9.00

6039858 AMLODIPINE TAB 2.5MG $9.00

6040425 OXYCODONE ER TAB 10MG $23.00

6041418 ACETAMINOPHEN TAB 325MG $3.50

6041702 SIMETHICONE CHEW CHW 80MG $3.50

6041975 BETHANECHOL CHLORIDE TAB $13.50

6042183 ZOLPIDEM TAB 5MG $3.50

6042194 ZOLPIDEM TAB 10MG $3.50

6043125 CHLORTHALIDONE TAB 25MG $11.50

6045184 METFORMIN TAB 500MG $4.00

6049723 HYDROMORPHONE TAB 2MG $4.00

6051016 ALBUT-IPRATR 0.5-3MG/3ML $11.00

6053092 TRIAMCINOLONE INJ 40 MG/M $56.50

6054784 VANCO 750MG/NS100ML PGBK $75.00

6054793 VANCO 500MG/NS100ML PGBK $65.00

6058198 CARVEDILOL TAB 12.5MG $10.00

6058400 FAMOTIDINE TAB 20MG $9.00

6058491 HYDRALAZINE TAB 25MG $3.50

6058675 EPINEPHRINE SYR 1 MG/10ML $24.00

6058690 VERAPAMIL VL 2.5MG $174.00

6064723 DEXTROSE 5% IVP 0.05 $31.50

6065199 ENALAPRILAT DIHYDRAT SDV $18.50

6065897 AMOX TR/POT CLAVULAN TAB $25.50

6066605 ALBUTER 0.083% 2.5MG/3ML $7.00

6068727 OXYMETAZOLINE SPY 0.0005 $10.50

6069303 CEPHALEXIN CAP 500MG $7.00

6069690 CEFTAZIDIME INJ 1GM $32.50

6071205 PIP/TAZO 4.5GM/NS 100 PGB $125.00

6072548 SODIUM BICARBONATE SDV 1M $58.50

6072638 VANCOMYCIN INJ 500MG $48.50

6072973 PANTOPRAZOLE TAB 40MG $20.50

6073322 POVIDONE-IODINE ONT 0.1 $16.00

6073659 BUPIVACAINE SDV 0.005 $31.50

6079003 LANSOPRAZOLE EC CAP 30MG $28.50

6084094 AMIODARONE INJ 150MG/3ML $12.50

Page 20: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6084133 NITROGLYCERIN VL 5MG/ML $81.50

6084214 FLUMAZENIL MDV 0.1MG $41.00

6085742 VIT B12 TAB 1000MCG $3.50

6087419 RINGERS SOL,LAC 1000ML $31.50

6087454 PANTOPRAZOLE BOLUS PER VI $175.00

6088255 ATROPINE OINT 1% $105.50

6089434 POTASSIUM CHLORIDE S TAB $3.50

6090335 TIMOLOL MALEATE DRP 0.005 $244.00

6090638 ATROPINE SULFATE VL 0.4MG $44.00

6090960 DEXMEDETOMIDINE VL 100MCG $770.50

6094513 PANTOPRAZOLE DRIP PER VIA $175.00

6095854 NITROFURANTOIN MCR CAP 10 $26.00

6096906 PIPERACILL/TAZOBACT VL 3. $62.00

6098253 NA/KET/DURA/EPI/NS BAG $600.00

6098748 PROMETHAZINE SUP 25MG $22.50

6101174 ENDO STITCH $1,994.70

6101198 CATH, FOLEY W/URINE METER $138.55

6101214 IRRIGATOR, HYDRO+LAP W/TI $637.00

6101227 PREP GEL, PREVAIL PREOP(5 $28.60

6101260 HEMOVAC,100ML STRL W/TROC $158.50

6101271 ADHESIVE, SKIN DERMABOND $139.80

6101290 SHEATH SET, URETERAL ACCE $484.00

6101294 MANIPUJECTOR, KRONNER (12 $224.75

6101299 SHOULDER IMMOBILIZER, ELA $141.65

6101300 SHOULDER IMMOBILIZER, ELA $141.65

6101301 SHOULDER IMMOBILIZER, ELA $141.65

6101302 SHOULDER IMMOBILIZER, ELA $141.65

6101304 SLEEVE, SCD KNEE LNTH LG $200.20

6101305 STOCKING, SCD EXPRESS FOO $144.60

6101306 COMPRESSION SYSTEM, SCD E $144.60

6101580 BUSPIRONE TAB 5MG $4.00

6102032 VANCO1.25GM/NS 250ML PGBK $100.00

6102306 VANCO 1.5G/NS 250ML PGBK $100.00

6102311 VANCO 1.75G/NS 250ML PGBK $100.00

6102346 VANCO 2GM/ NS 250ML PGBK $125.00

6103186 KNEE POSITIONER IMP $178.25

6103202 POTASSIUM CHLORIDE 1 LIQ $93.50

6103229 T5 HOOD W/PEEL AWAY MASK $176.65

6103408 CELECOXIB CAP 100MG $31.00

6103419 PHENAZOPYRIDINE TAB 100MG $6.50

6104023 FOLIC ACID TAB 1MG $3.50

6104280 METHYLPRED 40MG/ML INJ $36.50

6104500 NALOXONE INJ 1MG/ML $102.00

6104567 PIP/TAZO 2.25GM/NS 50ML P $85.00

6104573 BENZONATATE CAP 100MG $4.00

6105001 NICOTINE TRANSDERMAL PAT $11.00

6105149 THROMBIN KIT 5000U $516.00

Page 21: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6105201 DEXTROSE MINI BAG + BAG 0 $30.00

6105278 PAROXETINE TAB 10MG $13.50

6105280 CEFAZOLIN 2GM/NS 100 PGBK $55.50

6105299 ROPINIROLE TAB 0.5MG $34.00

6105391 KCL10MEQ/100ML WATER BAG $17.50

6105416 CEFTRIAXONE1G/NS 100 PGBK $117.50

6105427 CLINDA600MG/D5 50ML BAG 6 $105.00

6105430 CLINDA900MG/D5 50ML BAG 9 $128.00

6105454 PIP/TAZO 3.375GM/NS 50ML $113.00

6105472 CEFTAZIDIME1G/NS100 BAG 1 $62.50

6105482 AMITRIPTYLINE TAB 10MG $3.50

6105491 VENLAFAXINE TAB 100MG $24.00

6105608 IMIPENEM/CIL/NS100ML BAG $160.00

6105717 NYSTATIN U.D CUPS SUS 10 $8.50

6105740 SULFASALAZINE TAB 500MG $3.50

6106498 ERYTHROMYCIN BASE OP ONT $95.00

6108012 HEPARIN (for subq) VL 500 $10.50

6108021 METHYLPRED ACET 80MG/ML $110.50

6108308 FENTANYL 100MCG/2ML INJ $8.00

6108321 FENTANYL PCA 1500 MCG/30M $72.00

6108514 EPINEPHRINE 1MG/1ML INJ $13.00

6108745 CEFTRIAXONE2G/NS 100 PGBK $150.00

6108884 DIAZEPAM UP TO 5 MG VL 5M $219.00

6110051 LIDOCAINE/EPI/BSS (SHUGAR $135.00

6111127 BELLADONNA/OPIUM SUP 60/1 $167.50

6111151 INSULIN LISPRO INJ 3ML $494.50

6111176 INSULIN GLARGINE INJ 10ML $1,617.50

6111189 BUPIVACAINE/EPI MPF SDV 0 $38.50

6111217 MAGNESIUM SUL 1GM/2ML INJ $9.50

6111228 HYDROCORTISONE INJ 100MG $60.00

6111233 CEFTRIAXONE INJ 1GM $9.00

6111249 BUPIVACAINE/EPI VL 0.005 $15.00

6111288 PREDNISOLONE AC OPHT SUS $264.00

6111471 MIDAZOLAM 10MG/5 ML UD CU $24.50

6112871 D5 %-0.9 % SODIUM CHLORID $13.50

6116491 CYCLOPENTOLATE 2% OPHTH $3.50

6120151 BUPROPION SR 100MG $8.50

6122841 SUMATRIPTAN SUCCINATE 25 $135.50

6123740 ALPRAZOLAM TAB 0.5MG $4.00

6124211 METOCLOPRAMIDE TAB 10MG $3.50

6126981 TORSEMIDE 10MG TABLET $4.00

6127211 FLUORESCEIN 1MG OPTHALMIC $0.70

6129071 IPRATROPIUM-ABUTEROL 20-1 $2,235.50

6129911 PHENOL 89% SWAB $27.29

6130421 HEPARIN LOCK FLUSH SYRG 5 $19.00

6133331 CHLORPROMAZINE ORAL 25 MG $48.00

6135682 SODIUM CHLORIDE BAG 0.009 $12.00

Page 22: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6135850 DEX 5%-1/2NS-20KCL IV 20M $30.50

6138341 KETAMINE 50 MG/ML 1ML $3.50

6138401 PRAVASTATIN 20 MG TAB $16.50

6139021 TRANEXAMIC ACID 100 MG/ML $187.50

6139026 TRANEXAMIC ACID 1 GM / NS $292.50

6139036 TRANEXAMIC 2GM / NS 100ML $574.00

6140420 METHYLNALTREX 12MG /0.6ML $654.00

6141010 DIAZEPAM TAB 10MG $3.50

6141761 VECURONIUM BROMIDE 10 MG $38.00

6142612 DILTIAZEM TAB 30MG $3.50

6142653 DILTIAZEM TAB 60MG $4.00

6142791 TRIMETHOBEN 200MG/2ML INJ $231.50

6142801 ALLOPURINOL TAB 100MG $3.50

6142891 ONABOTULINU INJ 100 UNITS $3,246.00

6143610 SPIRONOLACTONE TAB 25MG $3.50

6145551 INSULIN REGULAR (VIAL) $268.00

6146696 ENOXAPARIN SYR 100MG $447.00

6148621 FEXOFENADINE 180 MG TAB $3.50

6148874 BUMETANIDE TAB 1MG $3.50

6151025 SEVOFLURANE LIQ $816.00

6155722 ISOSORBIDE MONONIT S TAB $8.50

6156611 TRIAMCINOLONE/ MOXIFLOXAC $125.00

6157477 RISPERIDONE TAB 1MG $23.00

6157740 LIDOCAINE (PF) 1% 5ML VIA $20.50

6157914 MAGNESIUM CITRATE LIQ $7.00

6157995 levETIRAcetam TAB 500MG $4.00

6159367 IBUPROFEN TAB 400MG $3.50

6161677 MULTIVITAMIN W/MIN TAB $3.50

6161741 LURASIDONE 40 MG TABLET $245.00

6163061 METHOCARBAMOL 500 MG TABL $3.50

6163191 METHOCARBAMOL 750 MG TABL $3.50

6163989 SOD POLYSTYRENE SUL SUS 1 $56.50

6170621 BUPIVACAINE (PF) 0.75% 10 $12.00

6171501 CARBACHOL 0.01% 1.5ML $202.50

6175936 MORPHINE PCA 30 MG/ 30 ML $80.00

6178931 TAPENTADOL TAB 50MG $32.00

6183741 CETIRIZINE 10 MG TAB $12.50

6183801 GABAPENTIN 250 MG/5 ML 10 $16.00

6184911 CALCIUM POLYCARBOPHIL 625 $3.50

6187201 LIOCAINE (PF) 3.5% GEL DR $133.00

6189131 INSULIN LIRAGLUTIDE 6MG/M $1,741.00

6189401 MORPHINE (PF) 1MG/1ML $41.00

6191991 ETHYL CHLORIDE MIST SPRAY $3.50

6194254 PROPOFOL 200MG/20ML $34.00

6195361 GLIMEPIRIDE 1 MG $5.50

6199291 ROSUVASTATIN 10 MG TAB $52.50

6200701 CAFFEINE CITRATE 240MG/D5 $488.45

Page 23: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6200971 PIPERACILLIN-TAZOBACTAM 4 $88.50

6201701 CYCLOBENZAPRINE 5 MG TABL $8.50

6202741 OXYCODONE IR 10 MG TAB $4.50

6203671 MORPHINE 5MG/ML PFS $16.00

6204361 HYDROcodone -APAP 7.5/325 $24.50

6206851 AtORvastatin 10MG TAB $3.50

6208074 PHENYLEPHRINE (EYE) DROP $3.50

6211454 CALCIUM CHLORIDE SYG 100M $24.00

6213666 OXYCODONE 30MG TB12 $34.64

6213676 OXYCODONE 60MG TB12 $63.20

6218449 VANCO 2.25 GM/ NS 250ML $135.00

6224431 RANITIDINE 150MG TAB $3.50

6228046 CAL CLORIDE RIDER 1 GM / $28.50

6229256 ALBUMIN, HUMAN 5% (250 ML $290.00

6235140 DONATAL/MYLA/LIDOCAI $52.50

6235416 METOPROLOL TARTRATE SDV 1 $24.00

6245321 METHYLENE BLUE (ANTIDOTE) $84.00

6254101 VITD (CHOLECALCIFERO) CAP $3.50

6256901 TRANEXAMIC ACID 650 MG TA $26.50

6257413 VANCO 2.5 GM/ NS 250ML $175.00

6258747 DRONABINOL ORAL 2.5 MG CA $27.00

6270976 BACITRACIN ZN/POLYMY ONT $128.50

6271761 DILTIAZEM 100 MG ADD-VANT $73.00

6273711 VANCOMYCIN 1GM 1ADD-VANTA $124.00

6274526 SOD CHL 0.9% FLUSH SYR $3.50

6277051 MEROPENEM 1GM/NS 100ML $65.00

6278621 AMIODARONE 150MG/D5W 100M $44.00

6279621 MORPHINE 2MG/1ML SYR $10.00

6302540 LEVOTHYROXINE TAB 25MCG $3.50

6321021 ATROPINE 1MG/ML 1ML VIAL $69.00

6322158 DEXAMETHASONE INJ 10MG/ML $8.00

6324021 MEROPENEM 1GM VIAL $120.00

6325108 SODIUM CHLORIDE NASA SPY $11.00

6325231 MIDAZOLAM/KETAMINE/ONDANS $83.50

6325405 LEVOFLOXACIN TAB 750MG $99.00

6325501 ENOXAPARIN SYR 150MG $745.50

6325872 DIFF STAT JAR 7.5B/1B $13.00

6325895 ESMOLOL IV 100MG $44.00

6326076 OMEPRAZOLE 40 MG DR CAPSU $33.50

6332517 DEXTROSE 5% 0.25NACL INJ $32.00

6335414 SODIUM CHLORIDE IV 0.009 $12.50

6340531 ATORVASTATIN 40MG TABLET $28.00

6341231 METHOCARBAMOL 100 MG/ML 1 $356.50

6346581 CEFOXITIN 2 GM/ NS 50ML P $102.00

6346582 CEFOXITIN 2 GM $72.00

6347122 HYDROCORTISONE TAB 5MG $17.00

6349021 ARIPIPRAZOLE 10 MG TAB $161.00

Page 24: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6349214 OXYBUTYNIN CHLORIDE TAB 5 $3.50

6350851 SUGAMMADEX 100 MG/ML 2 ML $570.00

6352991 MELATONIN 5 MG ODT $3.50

6359271 OXYBUTYNIN CHLORIDE ER 5 $38.50

6374121 LEVOTHYROXINE TAB 100MCG $7.50

6374805 HYDROXYCHLOROQUINE SU TAB $22.00

6378936 TETRACAINE HCL (PF) 0.5% $61.50

6391571 BUPIVACAINE LIPOSOME (PF) $1,710.00

6391572 BUP/MOR/KET/NS $500.00

6391581 EPI/MOR/KET/EXPAREL/NS $1,870.10

6410028 LAMOTRIGINE TAB 25MG $25.50

6410039 LAMOTRIGINE TAB 100MG $3.50

6411443 IPRATROPIUM 2.5ML NEB $10.00

6417877 DIAZEPAM 50MG/10ML INJ $219.00

6441440 CLOTRIMAZOLE CRM 0.01 $55.00

6454548 FLUOCINONIDE N CRM $228.00

6457022 ROCURONIUM INJ 10 MG/ML 5 $98.50

6458218 TRAZODONE TAB 50MG $3.50

6458719 CLONAZEPAM TAB 1MG $5.00

6471238 DULOXETINE CPDR 20 MG CAP $43.00

6476842 FOSPHENY INJ 100 MG/2ML $9.00

6505068 CEFEPIME INJ 2 GRAM $202.00

6512123 GUAIFEN/D-METHORPHAN SYR $9.00

6512891 LIDOCAINE 1 % 10 ML VIAL $13.00

6514515 BETAMETH DIPRO/PROP G CRM $264.50

6517453 SODIUM CHLORIDE MIN 0.009 $30.00

6518452 ACETYLCHOLINE INJ 0.01 $565.50

6518776 ACETAMINOPHEN IV 1,000MG $241.00

6532147 MUPIROCIN OINT OIN 0.02 $56.50

6532403 PREGABALIN CAP 75MG $49.50

6532810 PROMETHAZINE 25MG/100ML $25.00

6541206 AZITHROMYCIN 500 MG INJ $36.00

6541222 ACETAMINOPHEN U.DCUP SUS $8.50

6541234 SIMVASTATIN TAB 10MG $14.00

6542102 VITD(ERGOCALCIFEROL) CAP $8.50

6542153 LITHIUM CARBONATE TAB 300 $7.00

6542181 ADENOSINE INJ 6MG/2ML $36.00

6542349 DILTIAZEM ADV 100MG $117.00

6542424 BUTALBITAL/APAP/CAFFE TAB $8.50

6543154 CISATRACURIUM BESYLA INJ $94.50

6544217 PNEUMOCOCCAL A SDV $601.50

6544220 LUBIPROSTONE CAP 24MCG $37.50

6544326 ORPHENADRINE ER TAB 100MG $11.00

6545129 DOXYCYCLINE VL 100MG $73.00

6545185 AMPHETAMINE SALTS TAB 10M $10.50

6545446 SIMETHICONE DRP 40MG/0.6 $17.50

6545463 CEFEPIME 2GM/NS100ML PGBK $75.00

Page 25: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6545487 CEFEPIME VL 1GM $36.00

6545613 LIDOCAINE 2% VL 20MG/ML $13.00

6545657 LIDOCAINE 2GM/D5W 500ML $26.00

6545975 WATER FOR INJECT STER SDV $7.50

6547219 FAMOTIDINE VL 10MG $5.50

6548413 DILTIAZEM VL 5MG/ML $54.00

6548456 BETHANECHOL CHLORIDE TAB $10.50

6548741 PHENOL/SODIUM PHENOLA SPY $21.00

6548754 LIDOCAINE 2% VL 20MG/ML $16.50

6554229 INFLUENZA VIRUS MDV MDV 4 $127.00

6565448 MEROPENEM INJ 500MG $176.00

6565690 BUPIVACAINE SDV 0.005 $11.50

6565711 DILTIAZEM VL 5MG/ML $13.50

6565771 FISH OIL T CAP $3.50

6565799 DAPTOMYCIN INJ 500MG $2,673.00

6565806 EUCERIN LOT $39.50

6565815 ENEMA MINERAL OIL ENM $10.50

6565942 DEXTROSE 5% IVP 0.05 $13.00

6565956 ALTEPLASE PWD 2MG $918.50

6574129 METOPROLOL SUCCINATE TAB $6.00

6574510 MIDAZOLAM 5MG/5ML INJ $9.00

6584582 RIVAROXABAN TAB 10MG $84.00

6587421 MOXIFLOXACIN OPHTH DRP 0. $6.00

6589109 FAT EMULSIONS 250ML EML 0 $95.50

6593541 EPI/NAR/KET/MOR/NS $600.00

6598879 NEOMYCIN/POLY/BACIT/ ONT $18.00

6651502 DEXTROSE 10% IV 0.1 $31.50

6654159 NITROGLYCERIN ONT 0.02 $14.00

6654442 LIDOCAINE 1% VL 10MG/ML $9.00

6658455 OLOPATADINE SPY 665MCG $1,737.50

6683187 LEVOFLOXACIN 500MG TAB $95.00

6687416 BUPROPION XL TAB 150MG $26.50

6688036 TRYPAN BLUE 0.06 % $310.00

6692456 GEMFIBROZIL $6.00

6712636 SPOT ENDOSCOPIC MARKER $17.00

6732269 ENOXAPARIN SYR 40MG $178.50

6736376 BRILLIANT BLUE G $225.00

6754127 CALCIUM CARBONATE CHE CHW $3.50

6754392 FERROUS SULFATE TAB 325MG $3.50

6756558 TAMSULOSIN CAP 0.4MG $21.50

6756983 IMIPENEM/CILASTATIN VL 50 $196.00

6758208 SENNOSIDES TAB 8.6MG $3.50

6758746 MORPHINE SULFATE IR TAB 1 $5.00

6780701 INDOCYANINE GREEN 25MG IN $530.00

6785412 BENZOCAINE/MENTHOL M LOZ $7.50

6790054 HEPARIN 25,000UNITS/D5W 2 $51.00

6790064 SODIUM CHLORIDE BAG 0.009 $9.00

Page 26: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6790155 METRONIDAZOLE TAB 500MG $4.50

6790234 PANTOPRAZOLE PER VIAL VL $30.00

6790285 SODIUM CHLORIDE BAG 0.009 $31.50

6790309 DEXTROSE 5% WATER 500 ML $12.50

6790338 DEXTROSE/NACL IV 5/0.9% $31.50

6790571 GUAIFENESIN SA TAB 600MG $3.50

6790755 LEVOFLOXACIN 750/150ML $79.00

6790909 NOREPINEPHRINE BITAR SDV $121.50

6791006 SODIUM CHLORIDE ADV 0.009 $14.50

6791026 HETASTARCH/NACL BAG 6/0.9 $131.00

6791246 CIPROFLOX 400MG/200ML D5W $141.00

6791297 BACITRACIN LYOPHILIZE VL $67.00

6791330 CEFEPIME1GM/NS100 PGBK $102.00

6791367 BUPIVACAINE MDV 0.005 $30.50

6791377 FUROSEMIDE 20MG/2ML INJ $9.50

6791856 LIDOCAINE URO-JET SYG 0.0 $38.50

6791861 ETOMIDATE VL 2MG/ML $33.50

6791876 OXYCODONE TAB 30MG $18.00

6792027 BUDESONIDE/FORMOTERO INH $1,334.50

6792120 NORTRIPTYLINE CAP 10MG $4.00

6792340 LIDOCAINE/EPI 1% VL 1:100 $30.50

6792346 LIDO-EPI 1%-1:100K 20ML I $22.50

6792366 INSULIN DETEMIR INJ 100UN $1,762.50

6792422 METHYLENE BLUE SDV 0.01 $1,007.00

6792432 METAXALONE TAB 800MG $24.50

6792516 DESVENLAFAXINE TAB 50MG $70.00

6792549 GLYCERIN ADULT SUP $47.00

6792572 HYDROCORTISONE ONT 0.025 $55.00

6792708 BUDESONIDE/FORMOTERO INH $1,160.00

6794776 CIPROFLOXACIN TAB 500MG $25.50

6796720 ZINC OXIDE OINT 20% 56.7G $3.50

6796733 HEPARIN INJ 30,000 UNITS $40.00

6797130 FLUCONAZOLE400MG/NS BAG 2 $84.00

6797776 DEXAMETHASONE INJ 4MG/ML $13.50

6798304 RACEPINEPHRINE SOL 0.0225 $9.00

6798717 SODIUM CHLORIDE ADV 0.009 $19.00

6798772 LEVOTHYROXINE TAB 88MCG $3.50

6799884 LIDOCAINE HCL ANESTH AMP $49.00

6824711 FLUTICASONE PROP SPY 50MC $426.50

6845790 MORPHINE 10MG/1ML INJ $6.50

6852311 CALCIUM GLUCONATE 2GM/NS $74.50

6852317 CALCIUMGLUCONATE1GM BAG 1 $62.50

6852324 SOD BIPHOS/POT PHOSPH PKT $3.50

6854849 AMIODARONE/D5WPREMIX PGBK $227.00

6865710 PHENYTOIN SODIUM EXT CAP $3.50

6868184 DIPHENOXYLATE-ATROPI TAB $3.50

6868712 FUROSEMIDE TAB 20MG $3.50

Page 27: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6868733 FUROSEMIDE TAB 40MG $3.50

6869029 PIOGLITAZONE TAB 15MG $35.50

6870990 LIDOCAINE HCL TOPICA PAT $95.00

6872048 FUROSEMIDE 40MG/4ML INJ $11.00

6874549 LIDOCAINE LTA KIT KIT 40M $32.50

6875328 LEVOFLOXACIN 500MG/100ML $83.00

6879039 LINEZOLID TAB 600MG $1,020.50

6879621 LABETALOL TAB 100MG $3.50

6879714 HYDRALAZINE INJ 20MG/ML $90.00

6880561 ALPRAZOLAM TAB 1MG $5.50

6880570 CLONAZEPAM TAB 0.5MG $4.50

6885166 LORAZEPAM TAB 0.5MG $3.50

6885850 DOCUSATE SODIUM CAP 100MG $3.50

6886328 HYDROCHLOROTHIAZIDE TAB 2 $3.50

6887457 NITROGLYCERIN TAB 0.4MG $187.00

6888674 AMITRIPTYLINE TAB 25MG $3.50

6889604 CARBIDOPA/LEVODOPA TAB 25 $4.00

6889854 LINEZOLID SOL 600MG/300MG $375.00

6890018 SODIUM CHLORIDE MIN 0.009 $30.00

6890038 IBUPROFEN TAB 200MG $3.50

6890230 BUPIVACAINE (PF) 0.25% (1 $10.00

6895406 LABETALOL VL 5MG/ML $30.00

6895421 DEXTROSE/LACT RINGERS 100 $28.50

6895555 ZIPRASIDONE CAP 20MG $45.00

6896894 KETOROLAC INJ 30 MG/1ML $34.50

6897808 DEXTROSE/WATER SYG 0.5 $49.50

6900002 GUAIFEN/D-METH SA 12H TAB $3.50

6900012 TOBRAMYCIN SULFATE SDV 1. $1,050.00

6900027 SODIUM CHLORIDE BAG 0.009 $12.00

6900043 INSULIN NPH HUMAN REC INJ $827.40

6900145 LIDOCAINE TOPICAL L JEL $39.50

6900166 PROPRANOLOL TAB 10MG $3.50

6900196 ESOMEPRAZOLE 2 CAP $47.50

6900222 TEMAZEPAM CAP 15MG $4.50

6900269 BUPIVACAINE/EPI E SDV $30.00

6900273 TOBRAMYCIN 80MG/2ML INJ $20.50

6900283 SODIUM CHLORIDE BAG 0.004 $31.50

6900293 SILVER SULFADIAZINE CRM 0 $45.00

6900323 RIFAMPIN CAP 150MG $8.00

6900384 OFLOXACIN OTIC DRP 0.003 $771.50

6900401 VIT C(ASCORBIC ACID) TAB $3.50

6900432 ASPIRIN/SOD BICARB/CA TAB $3.50

6900457 DEXAMETHASONE TAB 0.5MG $3.50

6900480 ACETAMINOPHEN TAB 500MG $3.50

6900511 METHYLPRED DSPK 4MG $150.50

6900568 POLYETH GLYC U.D PKT $6.00

6900629 METHADONE TAB 10MG $3.50

Page 28: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6900706 FENTANYL 250MCG/5ML INJ $11.50

6900785 ROCURONIUM BROMIDE VL 10M $46.50

6900985 PIPERACILLIN/TAZOBAC VL 2 $57.50

6901006 GLYCOPYRROLATE VL 0.2MG $10.00

6901028 LIDOCAINE HCL VISCOU SOL $71.00

6901043 TIZANIDINE TAB 2MG $11.00

6901065 MINERAL OIL $3.50

6901087 TOPIRAMATE TAB 25MG $10.50

6901147 NALOXONE SDV 0.4MG $95.00

6901178 FENTANYL TRANSDERMAL PAT $106.50

6901181 FENTANYL TRANSDERMAL PAT $297.00

6901192 FENTANYL TRANSDERMAL PAT $394.00

6901273 NEOSTIGMINE INJ 10 MG/10M $168.00

6901345 TOBRAMYCIN SULFATE OP DRP $73.00

6901359 LOSARTAN POTASSIUM TAB 10 $16.00

6901528 LIDOCAINE/D5W PREMIX BAG $30.50

6901556 BENZOCAINE 20% T/S 0.2 $151.00

6901809 VIT B1(THIAMINE) TAB 100M $3.50

6901867 MIRTAZAPINE TAB 15MG $17.00

6902005 SODIUM BICARBONATE SYR 0. $63.50

6902016 FENTANYL TRANSDERMAL PAT $102.00

6902021 FENTANYL TRANSDERMAL PAT $194.50

6902190 VIT B6(PYRIDOXINE) TAB 10 $3.50

6902401 PROMETHAZINE TAB 25 MG $3.50

6902540 ACYCLOVIR TAB 400MG $19.00

6902709 SODIUM CHLORIDE SDV SDV 0 $5.50

6903022 SUCCINYLCH INJ 200MG/10ML $115.50

6903175 LIDOCAINE 2% SYRINGE SYG $18.50

6903395 INSULIN REG HUM/NPH H INJ $268.00

6903538 OXYCODONE HCL SR 12H TAB $72.50

6904485 DESMOPRESSIN TAB 0.2MG $38.50

6904494 INSULIN REG (PER UNIT) $3.50

6904532 METOCLOPRAMIDE SOL 5MG/5M $3.50

6904544 GUAIFENESIN SOL 100MG/5M $300.00

6905249 HYDROCHLOROTHIAZIDE CAP 1 $4.50

6905260 CALCIUM CARB/ VIT D TAB 6 $3.40

6905884 NEOMYCIN/POLYMYX/DEX ONT $220.00

6905915 OXYCODONE IR TAB 5MG $3.50

6905921 OXYCODONE/ACETAMINOP TAB $7.00

6906505 AMMONIUM LACTATE LOT 0.12 $91.50

6906523 DIPHENHYDRAM UD CUPS LIQ $13.00

6906610 PROMETH-CODEINE 6.25-10MG $48.50

6907222 BACITRACIN ONT 500U/GM $3.50

6907264 CYCLOSPORINE OPHTH DRP 0. $3.50

6907966 DOXYCYCLINE TAB 100MG $7.00

6908170 METHADONE TAB 5MG $3.50

6908742 MIDAZOLAM SDV 5MG/ML $4.50

Page 29: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6909065 VENLAFAXINE XR CAP 37.5MG $17.50

6909270 VANCOMYCIN 1GM 1.0 VL $37.50

6910818 DIGOXIN TAB 0.125MG $11.50

6911191 PROTAMINE SULF 50MG/5ML $74.00

6911403 PROPOFOL 1000MG/100ML $171.00

6911429 ESCITALOPRAM TAB 10MG $22.50

6911812 VIT B COMPLEX TAB $3.50

6914395 WARFARIN TAB 1MG $3.50

6914417 WARFARIN TAB 2.5MG $3.50

6914438 WARFARIN TAB 5MG $3.50

6915217 GLUCAGON INJ 1MG/ML $1,030.00

6916078 ASPIRIN TAB 325MG $3.50

6923688 LORATADINE TAB 10MG $4.00

6924569 TRIAMTERENE/HCTZ CAP 37.5 $3.50

6925499 SENNA/DOCUSATE SODIU TAB $3.50

6925873 VITD(CHOLECALCIFERO) TAB $3.50

6926154 PREDNISONE TAB 5MG $3.50

6926341 CLOPIDOGREL BISULFAT TAB $3.50

6927628 METHYLPREDNISOLONE ORAL P $7.50

6927905 LOPERAMIDE CAP 2MG $4.50

6928169 POTASSIUM CHLORIDE S TAB $3.50

6928861 GLYBURIDE TAB 5MG $3.50

6930023 MULTIVITAMIN TAB 1 TAB $3.50

6930266 CLONIDINE TAB 0.1MG $3.50

6930887 BISACODYL EC TAB 5MG $3.50

6931300 ATENOLOL TAB 50MG $6.00

6931311 ATENOLOL TAB 25MG $4.50

6932818 LISINOPRIL TAB 10MG $6.50

6933840 LISINOPRIL TAB 20MG $7.00

6933856 AMANTADINE CAP 100MG $10.50

6934011 MOXIFLOXACIN SOL 0.005 $986.00

6935066 CYCLOPENTOLATE DRP 0.01 $3.50

6936444 MORPHINE SULFATE SA TAB 1 $9.50

6936650 MECLIZINE TAB 25MG $4.50

6938245 CEFAZOLIN INJ 1GM $7.00

6939311 HEPARIN LOCK FLUSH SYRG 5 $18.00

6939430 DIGOXIN 500MCG/2ML INJ $33.00

6942075 MORPHINE SULFATE SA TAB 3 $17.00

6942455 CELECOXIB CAP 200MG $72.50

6943362 CARISOPRODOL TAB 350MG $4.00

6944628 AZTREONAM VL 1GM $198.00

6946152 OXYCODONE/ACETAMINOP TAB $18.00

6947103 ARIPIPRAZOLE TAB 5MG $178.50

6948357 METOPROLOL TARTRATE TAB 2 $3.50

6948531 HYDROMORPHONE INJ 2 MG/ML $9.50

6950158 BUPROPION SR TAB 150MG $47.00

6951260 ENOXAPARIN SYR 30MG $122.00

Page 30: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6951453 MAGNESIUM OXIDE TAB 400MG $3.50

6952311 METHYLPRED 125MG/2ML INJ $35.50

6953395 HYDROCODONE-APAP TAB 10/3 $5.50

6953403 HYDROCODONE/ACETAMIN TAB $3.50

6953411 LOSARTAN POTASSIUM TAB 25 $8.50

6953701 CLINDAMYCIN CAP 150MG $3.50

6953971 DIAZEPAM TAB 5MG $3.50

6954111 SUCRALFATE TAB 1GM $4.00

6954375 PRIMIDONE TAB 50MG $3.50

6954525 AZITHROMYCIN 500MG/NS 250 $50.00

6954633 BUPIVACAINE/DEXT / AMP $27.00

6956579 ACETAMINOPHEN SOL 160MG/5 $3.50

6956889 DULOXETINE CAP 30MG $44.00

6960144 TIZANIDINE TAB 4MG $7.50

6960911 BACLOFEN TAB 10MG $3.50

6960949 METOPROLOL TARTRATE TAB 5 $3.50

6961351 GLUCOSE CHEWABLE CHW 4GM $12.00

6962949 GABAPENTIN TAB 600MG $16.00

6964042 GLIPIZIDE ER TAB 10MG $4.50

6965013 TIOTROPIUM BR INH CAP 18M $473.00

6965481 LUBIPORSTONE CAP 8MCG $37.50

6965999 CARBAMIDE PEROXIDE OT DRP $23.50

6966957 CYCLOBENZAPRINE TAB 10MG $3.50

6968054 HYDROCODONE/ACETAMIN TAB $3.50

6968550 HALOPERIDOL INJ 5MG/ML $7.50

6968793 OXYCODONE/ACETAMINOP TAB $14.00

6969090 GABAPENTIN CAP 300MG $8.50

6969694 LIDOCAINE PF AMP 0.04 $26.00

6969862 ALPRAZOLAM TAB 0.25MG $3.50

6970411 GABAPENTIN CAP 100MG $3.50

6972824 BACITRACIN ZINC ONT 500U/ $9.50

6972941 LIDOCAINE/EPI 2% VL 1:100 $18.00

6973379 DEXAMETHASONE TAB 4MG $6.50

6974210 CEFTAZIDIME 2G/NS100 $175.00

6976794 METOCLOPRAMIDE 10MG/2ML $7.00

6976894 MAGNESIUM HYDROXIDE SUS $12.00

6977384 DIPHENHYDRAMINE CAP 25MG $3.50

6977724 OXYCODONE CR TAB 20MG $21.50

6977734 OXYCODONE IR TAB 15MG $6.50

6977744 OXYCODONE TB12 15MG $33.50

6978450 PROMETHAZINE INJ 25MG/1ML $11.50

6979729 TROPICAMIDE SOL 0.01 $3.50

6981133 MONTELUKAST SODIUM TAB 10 $35.50

6981191 ASPIRIN CHEW CHW 81MG $3.50

6981494 PREGABALIN CAP 50MG $45.00

6982026 NEBIVOLOL TAB 2.5MG $27.00

6983344 VANCOMYCIN INJ 5 GM $534.00

Page 31: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6984317 AMPICILLIN/SULBACTAM PER $23.50

6984512 CITRIC ACID/SOD CITRA SOL $11.00

6985250 SUCRALFATE SUS 1GM/10ML $52.50

6985408 PROPYLENE GLYCOL/PEG DRP $26.50

6985410 SUMATRIPTAN INJ 6MG/0.5ML $454.50

6985421 MAG/ALUM HYDROX/SIMET SUS $14.00

6987411 MAGNESIUM2GM/NS 50ML BAG $3.50

6987470 ACETAMINOPHEN SUP 325MG $3.50

6987540 LORATIDINE/P-EPHED SR TAB $3.50

6988033 AZITHROMYCIN TAB 250MG $21.50

6988988 LIDOCAINE HCL/EPI AN VL 0 $21.00

6989939 MEPERIDINE INJ 50MG/ML $7.00

6990718 FLUOXETINE CAP 20MG $12.50

6991565 LEVOTHYROXINE TAB 75MCG $3.50

6992606 LEVOTHYROXINE TAB 50MCG $3.50

6992644 ENALAPRIL MALEATE TAB 5MG $8.00

6993281 FENTANYL CITRATE AMP 0.05 $10.00

6993291 MIDAZOLAM 2MG/2ML INJ $6.00

6995437 ATROPINE SYR 1MG/10ML $55.50

6997888 DIAZEPAM 10MG/2ML SYG $164.50

6998013 DOPAMINE INJ 400 MG/10 ML $11.50

6998444 QUETIAPINE TAB 50MG $38.50

6999712 MEROPENEM 500MG/NS100 PGB $50.00

6999725 LIDOCAINE TOPICAL L JEL $124.00

6999762 CISATRACURIUM BESYLA INJ $165.50

6999841 INSULIN ASPART (PER UNIT) $1.55

6999842 INSULIN LISPRO (PER UNIT) $3.50

6999848 GLUCOSE GEL GEL 0.4 $20.00

6999933 ACETYLCYST 20% INJ 6GM $61.50

6999940 INSULIN ASPART VL 1 UNIT $1,653.50

6999955 SILVER NITRATE APPLIC APP $36.50

7260095 MRI MRCP $1,184.44

7847123 SUMATRIPTAN TAB 100MG $126.00

10031222 3.5 MM SHAVER BLADE $353.95

10031223 SHAVER BLADE SMALL JOINT $387.85

10031366 IOHEXOL 240 MG/ML PER ML $89.45

10031367 IOHEXOL 180 MG/ML PER ML $84.40

10031368 Gadodiamide Inj 287MG/20M $242.55

10031370 IOHEXOL 350 MG/ML PER ML $57.40

10031371 GADODIAMIDE INJ 5MMOL/10M $125.95

10031372 IOHEXOL 350 MG/ML PER ML $82.00

10031373 GADODIAMIDE INJ 7.5MMOL/1 $181.90

10031374 IOHEXOL 240 MG/ML VL 240M $189.60

10031375 IOHEXOL 300 MG/ML PER ML $84.70

10031996 LIGATURE CURVED 18CM $2,675.00

10032076 3.5 VAPOR HOOK ELECTRODE $1,225.00

10032122 ROUND BUR 6 FLUTE $173.85

Page 32: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10032124 BARREL BUR $210.00

10032137 HOOK 3.5 MM $675.00

10032244 SUTURE $50.05

10032282 RT ANGLE KNIFE ELECTRODE $618.65

10032283 CUTTING LOOP $332.90

10032401 CLIP APPLIER $346.45

10032682 DRILL BIT 1.5MM $222.24

10032684 DRILL BIT 2.5MM $221.81

10032685 DRILL BIT 2.7MM $223.26

10032689 DRILL BIT 4.5MM $224.11

10032723 BACK BRACE $10,207.55

10032733 CANNULATED SCREW 6.5X85MM $1,708.50

10032734 PIN GUIDE $200.43

10032735 HEWSON SUTURE RETRIEVER $500.00

10032737 RELOAD ENOSTITCH GREEN $661.00

10032738 ENDOSTITCH SURGIDAC 2-0 $319.85

10032746 INTRAOCULAR BIPOLAR ERASE $495.85

10032752 AMIS HIP PACK $640.55

10032753 SHOULDER PACK $428.35

10032754 TOTAL KNEE PACK $507.15

10032755 LAMINECTOMY PACK $330.70

10032756 EXTREMITY PACK $250.75

10032757 Anterior Cervical Pack $272.15

10032758 KNEE SCOPE PACK $293.25

10032759 HAND PACK $221.45

10032760 MINOR SINGLE BASIN PACK $163.90

10032762 MORSELIZED CANCELLOUS ALL $9,170.00

10032772 CAPSULAR TENSION RING $743.75

10032793 aquacell dressing 3.5 x 1 $213.65

10032797 VITRECTOMY CUTTER 20G ANT $432.00

10032801 DISCOGRAPHY PROBE $875.00

10032812 COVAC WAND $900.00

10032813 MEGAVAC WAND $850.00

10032816 SUTURE 9-0 $135.40

10032817 NEEDLE VENOM 100 MM $200.00

10032818 NEEDLE VENOM 150 MM $250.00

10032819 TROCAR EXCEL 5 X 100 MM $714.90

10032820 TROCAR EXCEL 12 X 150 $946.05

10032824 BIO A MESH $2,547.88

10032837 HEYMAN FOLLOWER SET 10-24 $385.20

10032848 BREVI CATH 14 FR $364.05

10032851 PRECISON ROUND BUR 4.0MM $750.00

10032852 ROUNDED FLUTED BUR 4.0MM $400.00

10032854 RASP HELIOCOIDAL $661.85

10032857 PERFLUORON KIT 7 ML $2,716.90

10032858 SILIKON 8.5 ML VIAL $2,561.65

10032860 VISCOUS FLUID SYSTEM $334.70

Page 33: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10032867 GRAFT JACKET 4 X 7 EXTREM $11,980.75

10032868 POST TIBIALIS TENDON $7,650.00

10032882 TISSEEL 2ML $444.51

10032902 DRILL BIT 2.0 $329.76

10032903 DRILL BIT 2.7 $325.76

10033010 CLIP RESOLUTION 236 CM L $807.50

10033015 SUTURE PDS 3-0 27" $11.99

10033016 SUTURE SILK 2-0 18" $36.30

10033028 TROCAR BLADLESS ENDOPATH $663.35

10033038 TROCAR EXCEL BLDLESS $523.86

10033039 SLEEVE EXCEL 5MM $305.92

10033052 KIT CATHERIZATION MIDLINE $672.35

10033068 SCREW CORTICAL 2.7 X 22MM $85.81

10033150 POUCH RETRIEVER $299.92

10033157 TROCAR ENDOPATH XCEL 11MM $672.72

10033177 PULSE LAVAGE $148.75

10033181 VITRECTOMY PK 25G POST $2,018.75

10033183 KIT TROCAR VALVE ESA 25GA $425.00

10033201 Canuula oil removal $195.50

10033206 SCREW 55 MM $1,708.50

10033310 Pack phaco premiun 1.8mm $283.31

10033314 Probe laser endo 25G flex $361.25

10033315 Forceps retina ILM dispos $403.75

10033346 Mask CPAP large adult del $204.00

10033347 Mask CPAP small adult del $204.00

10033369 HookEffect VAPR w/hand co $1,168.75

10033484 KIT CATHETER LUMBAR DRAIN $977.50

10033485 SYSTEM DRAINAGE EDS CSF E $897.75

10033520 BLADE DUAL CUT SAG SURGIC $282.65

10033527 BUR PRECISON ROUND 3.0MM $750.00

10033533 BLADE SHAVER 4.0 SCALLOPE $210.00

10033534 BUR BARREL 5.5MM 6 FLUTE $210.00

10033535 CANNULA DISP. 8.5X85MM FU $254.15

10033541 SHEAR HARMONIC FOCUS LONG $3,660.00

10033555 BUR ROUND CARBIDE 2.4MM $281.20

10033557 NEEDLE RIGID 25G 6 FRENCH $247.50

10033569 GRAFT TENDINOSOUS SEMI PA $9,137.50

10033594 SOL 0.9% SODIUM CHLORIDE $10.14

10033604 BLADE XL WIDE 34.5 X 13.0 $186.25

10033669 CUFF TOURN 44X4 1 BLA 1 P $128.55

10033672 SOL IRRIGANTION 0.9% SODI $11.15

10033696 INTRA ABDOMINAL PRESSURE $700.00

10033707 POWER GELFOAM HEMOSTATIC $312.55

10033743 PORT POWER MRI 8GR SHORT $3,153.50

10033749 PICC XCELA W/PASV 5FDL-55 $743.75

10033754 CASSETTE IRRIGATION CORE $225.00

10033761 GRAFT POSTERIOR TIBIAL $11,050.00

Page 34: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10033764 RETRACTORS CAPSULE MST $550.00

10033765 SCALPEL HARMONIC (45) $3,742.65

10033799 DRESSING AGUACEL 3.5X6 SI $156.00

10033848 GRAFT TENDON ACHILLES W B $6,375.00

10033850 FIBER LASER 200 MICRON FI $710.00

10033862 NICROSCISSORS CURVED DISP $1,165.00

10033865 GRAFT MESH 4X4.5 EPIX DEH $5,926.63

10033902 DRESSING MED VAC SIMPLACE $251.35

10033903 CANISTER W GEL 500ML INFO $201.80

10033925 CLIP IPRISM VIEW STABILIZ $250.00

10033949 APPLICATOR ENDOSCOPIC 41C $313.55

10033950 GEL PORT DEVICE HAND ACCE $2,875.00

10033956 TUBESET IRRIGATION BONESC $237.50

10033957 BONESCAPEL 20MM BLUNT $2,113.75

10033958 BONESHAVER MICROHOOK $2,113.75

10033987 PILLOW ABDUCTION MED CS/6 $178.15

10033989 CONTRAST ISOVUE-M 200 41% $160.25

10033990 CONTRAST MULTIHANCE 529MG $367.40

10033991 CONTRAST MULTIHANCE 529MG $294.40

10033992 CUFF TOURN 18X5.5 2 BLA 1 $150.00

10034028 ORTHOSIS FOOT ANKLE PREFA $1,440.00

10034049 SCREW CANCELLOUS 4 X 22MM $94.56

10034060 BLADE MILL MEDIUM DISPOSA $1,375.00

10034108 SCREW CANCELLOUS 4 X 20MM $94.56

10034109 SCREW CANCELLOUS 4 X 10MM $94.56

10034110 BUR 3.0MM CARBIDE MATCH H $925.00

10034115 PRESS BONE HENSLER STRL C $2,250.00

10034128 ADHESIVE SKIN PRINEO DERM $513.00

10034131 DRAPE ZEISS PENTERO BX/5 $143.20

10034138 FLOSEAL 10ML CS/6 $1,287.75

10034158 SET DRAINAGE LUMBAR INTEG $1,920.00

10034189 BUR 4.0MM CARBIDE ROUND E $925.00

10034211 ENDOPATH XCEL 5X150MM BLD $250.00

10034213 TROCAR XCEL 15X150MM BLDL $584.30

10034214 ENDOPATH LINEAR CUTTR 60X $912.50

10034215 ENDOPATH LINEAR CUTTR 60X $912.50

10034216 ENDOPATH LINEAR CUTTR 60X $912.50

10034217 ENDOPATH FLEX 60X440MM BX $2,167.55

10034240 SEAMGUARD BIOABSORB EC60M $807.05

10034266 SCREWS 6.0 X 50MM EXPEDIU $4,250.00

10034273 PROBE 90-S $750.00

10034274 TUBING CASSETTE INTEGRATE $416.65

10034291 FORCEP BIOPSY PIRANHA 3F $1,619.50

10034303 SEALER TISSUE ARTCLTN 5MM $2,615.70

10034321 SYSTEM CALIBRATION GASTRE $924.50

10034324 SCREW CANNULATED 6.5X55MM $1,536.80

10034325 REAMER 4.8MM CANNULATED $2,612.00

Page 35: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10034326 K WIRE 2.4X23MM BX/6 $212.00

10034327 WASHER PK/6 $288.15

10034330 SOL IV LR DEX 5 1000ML CS $1.82

10034347 ROUTER 1.5MM TAPERED $130.31

10034348 BUR 2.5MM MATCH HD MIS 13 $925.00

10034354 BRACE BACK TLSO TRIPLANAR $2,332.45

10034360 PUNCH SET DONOR 7.75MM TR $526.32

10034376 BLADE DUAL KAHOOK $1,950.00

10034377 ENDOSERTER CONREAL DELIV $956.25

10034379 SOL IV 0.9% SOD CHL 1000M $10.54

10034398 TROCAR ENDO XCEL 12X100MM $294.00

10034408 SOL IV SOD CHL 0.9% 500ML $19.05

10034420 SOL IV LAC. RINGER 1000ML $24.25

10034421 BONE MATRIX CELLULAR SMAL $2,252.50

10034422 BONE MATRIX CELLULAR MED $9,690.00

10034431 AIRWAY LMA SZ3 FLEX $161.25

10034475 BUR 3.0MM NEURO MATCH HEA $800.00

10034478 STEM FEMORAL SZ 9 125MM T $11,475.00

10034544 SCREW CANNULATED 6.5X75MM $1,644.37

10034546 RELOAD LINEAR CUTTER PROX $225.35

10034550 DRESSING SURGIFOAM HYDROG $131.05

10034557 GRAFT AMNIO 2.5 X 2.0CM E $3,353.25

10034582 VALVE AHMED $2,528.75

10034639 HEMOSTAT ABSOR 3X4" SURGI $325.05

10038397 LENS SV25T3 20.0 $883.01

10064505 INJ ANES SPHENOPALATINE G $900.00

10080012 CERV. PLATE LEVEL 1 14MM $6,766.00

10080153 FIXATION PIN 150MM $459.00

10080154 PRE-BENT ROD 5.5X 90MM $2,766.75

10080255 ACETABULAR SHELL SZ 50MM $6,800.00

10080256 FEMORAL HEAD SZ S (COCR) $1,912.50

10080260 PATELLA (A) 25X8MM $2,902.75

10080268 FEMORAL HEAD SZ M 28MM $1,912.50

10080276 NEXGEN TIBIAL COMPNENT SZ $4,114.47

10080284 CONICAL SUBTALAR IMPLANT $7,314.25

10080297 TIBIAL CUTTING BLOCK SZ 4 $687.50

10080299 ACETABULAR SHELL SZ 60MM $6,800.00

10080316 FEMORAL COMPONENT SZ 5 RT $9,619.75

10080318 FEMUR CUTTING BLOCK SZ 5 $687.50

10080322 FEMUR CUTTING BLOCK SZ 5 $687.50

10080324 TIBIAL CUTTING BLOCK SZ 5 $687.50

10080351 NEXGEN POLY PATELLA SZ 38 $2,125.00

10080368 IMP Pre Bent Rod 120mm $2,766.75

10080369 IMP Pre Bent Rod 130mm $2,766.75

10080370 FIXATION PIN 130MM $459.00

10080372 IMP Pre Bent Rod 80mm $2,766.75

10080379 IMP Patella Resurfacing S $2,125.00

Page 36: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10080380 FEMUR CUTTING BLOCK SZ 3 $687.50

10080381 TIBIAL CUTTING BLOCK SZ 3 $687.50

10080382 TIBIAL PLATE FIXED 67MM $5,159.50

10080383 VANGUARD TIBIAL INLAY 10X $4,475.25

10080385 SUP Drill Bit 1/8 $560.00

10080386 IMP Patella 28x8mm $2,902.75

10080387 IMP Vanguard Tibial Beari $9,426.50

10080388 VANGUARD FEMORAL 67.5MM R $11,130.75

10080389 TIBIAL PLATE FIXED 71MM $5,159.50

10080393 TIBIAL TRAY FIXED SZ 6 $6,162.50

10080395 FEMUR CUTTING BLOCK SZ 7 $687.50

10080396 TIBIAL CUTTING BLOCK SZ 6 $687.50

10080399 TIBIAL CUTTING BLOCK SZ 4 $687.50

10080401 TIBIAL TRAY FIXED SZ 3 LT $4,887.50

10080402 TIBIAL INSERT FIXED SZ 3 $4,037.50

10080412 HEADED SCREW 48MM $301.80

10080445 ACETABULAR SHELL SZ 0 52M $6,800.00

10080446 DBLE MOBILITY LINER $4,887.50

10080455 NEXGEN TIBIAL COMPNENT SZ $4,114.47

10080475 PATELLA (A) 31X8MM $2,902.75

10080479 FIXATION PIN 160MM $459.00

10080481 PRE-BENT ROD 5.5 X 140MM $2,766.75

10080483 IDEAL SUTURE SHUTTLE 25 L $1,075.00

10080484 PRE-BENT ROD 5.5X100MM $2,766.75

10080490 TIBIAL TRAY FIXED SZ 6 LT $6,197.01

10080493 TIBIAL CUTTING BLOCK SZ 6 $687.50

10080494 FIXATION PIN 110MM $459.00

10080497 CERV. PLATE LV 2 38MM $10,387.00

10080498 CERV. PLATE LEVEL 1 16MM $6,766.00

10080503 BIOFOAM EVANS WEDGE 20X20 $10,093.75

10080512 ACETABULAR SHELL 56MM $6,800.00

10080523 BUMPY ANCHOR $1,168.75

10080524 ACCESSORY KIT $1,000.00

10080529 FIXATION PIN 140MM $459.00

10080531 ALEUTIAN CAGE 10X18X50MM $35,266.50

10080539 FEMORAL HEAD SZ L (COCR) $1,912.50

10080550 MILLING BURR - ZIMMER $1,050.00

10080552 NEXGEN POLY PATELLA SZ 29 $1,996.02

10080563 CERCLAGE CABLE W/ CRIMP $1,646.11

10080573 VITOSS IMPLANT $17,612.60

10080581 BIOFOAM EVANS WEDGE 18X18 $11,045.75

10080582 CORNEA TRANSPLANT (DSAEK/ $15,725.00

10080605 FEMORAL STEM SZ 7 $13,736.64

10080606 ACETABULAR SHELL SZ 0 62M $6,800.00

10080609 CERV. PLATE LV 2- 32MM $8,309.60

10080616 INBONE TIBIAL STEM SZ 12M $2,758.25

10080618 INBONE STEM TIBIAL MID 12 $2,758.25

Page 37: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10080620 INBONE TALAR DOME SZ 2 $16,456.00

10080623 POROUS STEM- ECHO COLLARL $14,275.75

10080646 LOCKING SCREW 3.5X24MM $884.00

10080649 DRILL BIT 2.8MM $595.00

10080671 DRILL BIT $850.00

10080674 PRE BENT ROD 5.5X130MM $2,766.75

10080682 STRAIGHT ROD 5.5x300MM $2,766.75

10080684 NEXGEN TIBIAL COMPONENT S $4,114.47

10080728 BONE FILLER $350.00

10080729 DRILL $500.00

10080735 LOCKING SCREW 5X45MM $832.54

10080761 VANGURAD FEMORAL 65MM $11,130.75

10080762 PATELLA (A) 37X10MM $2,902.75

10080763 FEMUR CUTTING BLOCK SZ 6 $687.50

10080764 FEMORAL COMPONENT SZ 6N L $10,200.00

10080765 TIBIAL INSERT FIXED SZ 5 $3,390.82

10080766 FEMORAL STEM SZ 3 $12,750.00

10080775 TIBIAL TRAY FIXED SZ 2 LT $6,162.50

10080779 ACETABULAR SHELL SZ 0 48M $6,800.00

10080786 VANGUARD TIBIAL BEARING 1 $4,475.25

10080788 RESURFACING PATELLAR COMP $2,550.00

10080792 VANGURAD FEMORAL 65MM RT $11,130.75

10080804 EXPLANT TRUNICATED BLADE $5,250.00

10080805 EXPLANT FULL BLADE 52MM $5,250.00

10080806 INBONE STEM TIBIAL BASE 1 $3,004.75

10080807 INBONE STEM TIBIAL MID 16 $2,758.25

10080808 INBONE TIBIAL TRAY SZ 4 R $6,468.50

10080813 FIXATION PIN 120MM $459.00

10080832 CELL SAVER SERVICE LIMITE $3,605.00

10080845 VANGURAD FEMORAL 62.5MM R $11,130.75

10080847 FORCE FIBER #2 $150.00

10080848 KNOTILUS LOOP $1,237.50

10080849 SOFT TISSUE PACK $2,137.50

10080855 FEMORAL STEM SZ 2 $12,750.00

10080856 HEX WRENCH $260.00

10080857 TUNNELER $1,080.00

10080864 BIOLOX TAPER ADAPTER $1,130.50

10080871 FIXATION PIN 180MM $459.00

10080885 ACETABULAR SHELL 58MM $6,800.00

10080890 PEEK ZIP ANCHOR $1,007.25

10080902 ALEUTIAN CAGE 12X18X55MM $35,266.50

10080908 FLAT HEAD SCREW 6.5X35MM $488.75

10080909 FLAT HEAD SCREW 6.5X30MM $488.75

10080916 TRANSPORT CANNULA $450.00

10080919 VANGURAD FEMORAL 62.5MM L $11,130.75

10080920 FEMORAL STEM SZ 6 $12,750.00

10080938 FEMUR CUTTING BLOCK SZ 6 $687.50

Page 38: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10080939 RINGLOC DRILL BIT $585.00

10080941 BIOLOX TAPER ADAPTER +3 N $1,130.50

10080942 VALOR NAIL DRILL LONG $1,330.00

10080943 VALOR NAIL K WIRE $1,195.00

10080944 VALOR NAIL GUIDE WIRE $1,195.00

10080949 VALOR NAIL END CAP $1,130.50

10080952 TIBIAL TRAY FIXED SZ 5 RT $6,197.01

10080976 MODULAR TIBIAL LOCKING BA $690.20

10080994 OLIVE WIRE 1.1 MM $530.00

10081001 TIBIAL BEARING 12 X 67MM $9,426.50

10081043 DRILL BIT 3.0 $640.00

10081054 SIGMA FEMORAL POSTERIOR S $9,562.50

10081057 DOUBLE MOBILTY LINER SZ 0 $5,494.66

10081064 TIBIAL INSERT FIXED SZ 4 $4,037.50

10081067 VARIABLE SCREW 12 MM $2,635.00

10081069 ALEUTIAN CAGE 12 X 18 X60 $35,266.50

10081071 DISTAL FIBULA PLATE 7 HOL $3,165.83

10081076 DRILL BIT 1.9 $656.40

10081077 DRILL BIT 2.0 $570.75

10081078 DISTAL RADIUS-PLATE SHORT $3,978.00

10081079 NON LOCKING SCREW 2.7 X 1 $430.95

10081080 K WIRE 1.1 X 150 $133.20

10081082 LOCKING SCREW 2.3 X 20 $543.66

10081083 LOCKING SCREW 2.3 X 22 $543.66

10081084 NON LOCKING SCREW 2.7 X 1 $430.95

10081085 LOCKING SCREW 2.3 X 16 $543.66

10081089 OXFORD TWIN PEGGED FEMORA $15,835.50

10081090 OXFORD TIBIAL TRAY LEFT S $10,548.50

10081091 OXFORD MENISCAL BEARING L $6,447.25

10081094 NEXAGEN ARTICULAR SURFACE $2,337.50

10081118 BI-WING ANCHOR $765.00

10081119 ACCESSORY KIT $275.00

10081121 RESTORE SENSORE W/ MRI $87,690.25

10081122 PATIENT PROGRAMMER $4,475.00

10081123 CHARGING SYSTEM $6,000.00

10081125 .9 K WIRE $170.00

10081126 DRILL BIT 2.0 (DARTFIRE) $1,245.00

10081140 TIBIAL TRAY FIXED SZ 5 12 $4,037.50

10081141 INBONE TIBAL TRAY SZ 3 3L $6,468.50

10081143 TALAR DRILL $750.00

10081151 TWISTER FIBER $4,305.00

10081152 PRECISION EPIMEND INSERTI $260.00

10081154 SELF TAPPING BONE SCREW 6 $352.75

10081157 MODULAR HEAD 36 MM $2,507.50

10081162 TIBIAL INSERT FIX SZ 5 14 $4,037.50

10081165 TIBIAL CUTTING BLOCK SZ 2 $687.50

10081166 DRILL BIT 12MM $841.50

Page 39: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081171 LOCKING SCREW 2.7 MM X 14 $1,130.50

10081174 BIOLOX TAPER ADAPTER $1,130.50

10081180 PERSONA TIBIA SZ D RT $5,100.00

10081187 SCREW VAR.CERV. 4.25 X 12 $1,441.60

10081188 CELL SAVER SERVICE (STAND $1,595.00

10081224 TIBIAL CUTTING BLOCK FIXE $584.38

10081225 TIBIAL TRAY FIXED SZ 3 RT $6,162.50

10081228 FEMUR CUTTING BLOCK SZ 3 $584.38

10081233 ORCA CAGE 9 X 45MM $36,299.25

10081240 DRILL BIT 12MM $911.20

10081248 ALEUTIAN CAGE 8 X 18 X 50 $35,266.50

10081275 VANGUARD TIBIAL BEARING 1 $9,426.50

10081279 SCREW LOCKING 2.7X14 $543.66

10081280 SCREW LOCKING 2.7 X 12 $543.66

10081304 CERIVAL PLATE LEVEL 3 49M $12,507.75

10081316 FEMUR CEMENTED POSTERIOR $12,692.63

10081318 NATURAL TIBIA CEMENTED 5 $5,100.00

10081320 FIXATION PIN 100MM $459.00

10081333 FEMUR SUTTING BLOCK 4 LEF $583.38

10081346 DRILL QUICK RELEASE ANTI $624.75

10081347 STEINMANN PIN ACCESS 3.2M $586.50

10081348 GLENOID POST PT HYBRID PO $2,125.00

10081350 SHOULDER SYSTEM VERSA DIA $850.00

10081352 SHOULDER SYSTEM PRIMARY M $14,875.00

10081356 IN-BONE SCREW REMOVER $671.50

10081357 PLATE CERVICAL LEVEL 2 30 $8,309.60

10081359 ACETABULAR LINER RINGLOC $4,105.50

10081360 MODULAR HEAD 36MM TYPE 1 $2,507.50

10081365 REGENERATIVE MATRIX 4.0 X $8,612.63

10081366 BEARING TIBIAL ANTER STAB $9,426.50

10081372 SYSTEM KNEE FEMUR POSTER $12,692.63

10081376 TISSUE PART PLACENTAL WND $7,720.13

10081388 SYS KNEE FEMUR POSTER STA $12,692.63

10081389 SYS KNEE TIBIA 5 DEG CEME $5,100.00

10081390 ANCHOR SUTURE SWIVELOCK 6 $2,490.50

10081392 CANNULA PASSPORT 10 X 5MM $195.50

10081414 ANCHOR REELX STT 4.5MM $2,180.25

10081415 ANCHOR SUTURE W/NEEDLE W $1,851.30

10081418 KWIRE ASNIS $190.83

10081426 SCREW NON LOCK 24 X 3.5 $381.23

10081428 BIT DRILL 2.6 $727.73

10081429 SCREW LOCK 14 X 3.5 $745.88

10081444 WIRE SMOOTH OLIVE 1.4 MM $446.25

10081450 SHELL ACETABULAR SZ 50MM $6,438.75

10081455 SYSTEM KNEE TIBIA NATURAL $5,100.00

10081465 SYSTEM KNEE FEMUR CEMUR P $12,692.63

10081476 ANCHOR HEALIX TI W/ORTHCO $1,717.00

Page 40: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081495 CAGE ALEUTIAN 12 X 18 X 4 $35,266.50

10081505 COMPONENT FEMORAL LFT STD $10,200.00

10081506 LENS AMD 10.0 AR40MM $807.50

10081515 LENS 22.5D ACRYSOF $680.00

10081517 KIT LEAD $12,023.25

10081522 INST ENDOSCOPIC CENTERLIN $1,215.50

10081526 BIT DRILL CANNULATED 2.2M $1,058.25

10081544 HEAD FEMORAL SZ. MO 36MM $2,358.11

10081546 BIT DRILL 2.5MM $773.50

10081548 K-WIRE 1.4 X 1500MM $144.50

10081560 PLATE CERVICAL 70MM LEVEL $15,053.50

10081604 KIT IMPLANT FUSEFORCE 25X $5,312.50

10081607 BLOCK CUTTING TIBAL SZ 2 $584.38

10081613 BEARING TIBIAL ANTERIOR S $4,475.25

10081614 LENS AR40MN 3.0 $807.50

10081615 LENS AR40MN 3.5 $807.50

10081620 PATELLA POLY CEMENTED 32M $4,862.17

10081626 TRAY TIBIAL FIXED SZ 3 FI $13,615.94

10081628 AUGMENTATION TIBIAL SZ 3 $5,610.00

10081636 SCREW LOCKING 5MM X 60MM $832.54

10081639 System knee articular sur $6,402.97

10081652 BLUE RIGDE 24MM $7,388.20

10081661 Screw locking 3.5 x 18mm $1,173.00

10081663 Screw non locking ortholo $595.00

10081673 Wedge bone lapidus 8mm $7,858.46

10081698 Screw 3.5 x 38mm hex head $382.50

10081699 Femur narrow right sz 6 c $12,692.63

10081748 BIT DRILL 2.0 X 30MM $752.25

10081750 Screw talon 4.5 x 35mm $8,015.50

10081751 Screw talon 4.5 x 40MM $8,015.50

10081759 CANNULA FLOWPORT II W/ OB $1,678.75

10081760 Injector II needle cartri $1,253.75

10081761 KIT PORTAL ENTRY $1,398.25

10081762 NANOPASS REACH CRESENT $1,228.25

10081763 SLINGSHOT 70 UP $1,483.25

10081767 System knee B right media $10,548.50

10081768 Bearing maniscal anatomic $4,934.25

10081776 BIOFOAM WEDGE 22X22X12MM $11,045.75

10081783 BLOCK CUTTING TIBIAL SZ 5 $687.50

10081785 BIT DRILL CINCHLOCK SS $945.00

10081786 ANCHOR CINCHLOCK KNOTLESS $2,065.50

10081790 CANNULA DRI-LOK 8.0 X 75M $171.80

10081793 SCREW SET $212.50

10081805 SCREW BONE 3.5 X 14MM T10 $381.22

10081806 SCREW BONE 3.5 X 12MM T10 $381.22

10081807 SCREW BONE 3.5 X 10MM T10 $381.22

10081808 SCREW BONE 3.5 X 18MM T10 $381.22

Page 41: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081810 FEMUR NARROW RIGHT SZ 8 K $12,692.63

10081811 EXTENSION STEM 14MM DIAM $5,100.00

10081828 SCREW TALON 5 X 35MM $8,015.50

10081831 VANGUARD CR FEMORAL 70MM $11,130.75

10081858 SUTURE W/NEEDLE FIBER FOR $165.75

10081870 COMPONENT TIBIAL SZ 3 STE $5,100.00

10081872 AUGENT TIBIAL FULL BLOCK $6,087.87

10081898 BLADE ACE MODIFIED W/GUAR $57.40

10081899 INST. LIGASURE TISSUE FUS $3,493.15

10081904 TUNNELING LONG 35CM $1,080.00

10081905 KIT TOTAL HIP OPTIVAC $755.44

10081906 KIT CLOTALYST W GPS III S $3,255.00

10081907 KIT BLOOD DRAW $300.00

10081908 KIT COAXIAL SPRAY $1,300.00

10081909 KNEE FEMORAL PRT CEMENTED $15,835.50

10081912 BIT DRILL PERIPHERAL SCRE $935.00

10081913 BIT DRILL CENTRAL SCREW 3 $965.00

10081914 KIT SERARTION PLATELET CO $3,505.00

10081916 STEM SHOULDER STD. 10 X 1 $14,875.00

10081920 SCREW CENTRAL 25MM $425.00

10081929 GRAFT ACHILLES TENDON WIT $11,900.00

10081932 BIT DRILL 3.2 X 15MM QUIC $490.00

10081935 SCREW ACETABULAR G7 6.5MM $718.25

10081936 LINER ACETABULAR 40MM G7 $9,167.25

10081938 KIT SCREW DISP. GENTLE TH $3,170.00

10081939 SCREW INTERF 9X25MM FULL $1,419.50

10081940 SCREW INTERF. 10X25MM FUL $1,419.50

10081941 SYSTEM KNEE STRYKER OSC 9 $610.00

10081942 PATELLA STND A SER 34 X 8 $2,902.75

10081944 STEM FINNED 80MM W SCREW $1,521.50

10081945 BOX FEMORAL PS OPEN 65MM $9,915.25

10081946 BEARING TIBIAL DCN PS 10 $4,080.00

10081947 ANCHOR SUTURE 3 X 14.5 BI $2,065.50

10081951 BIT DRILL 3.2 X 20MM QUIC $490.00

10081953 SCREW ACETABULAR 6.5 35MM $718.25

10081954 HEAD FEMORAL MALLORY PF 1 $14,275.75

10081959 NEEDLE SPEEDSTITCH $462.50

10081960 CARTRIDGE SUTURE MAGNUM W $1,025.00

10081961 IMPLANT FIXATION 3.4MM KN $2,550.00

10081970 DRILL 11G $333.35

10081971 VERTEPORT BONE FILLER $255.00

10081977 HEAD MODULAR 40X18X46MM S $8,359.75

10081979 STEM SHOULDER MINI PRIMAR $20,604.00

10081987 BIT DRILL CANNULATED 2.6 $768.75

10081998 GRAFT FLEXIT 50 X 25MM MA $10,699.38

10082015 GUIDE ALIGNMENT INBONE PR $5,000.00

10082018 BIT DRILL SIZE 2 ANTI-ROT $770.00

Page 42: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082026 PATELLA STANDARD 31 X 8MM $2,902.75

10082027 PLATE TIBIAL PRIMARY W LO $4,551.75

10082029 KNEE DISTAL FEMORAL PEG V $1,453.50

10082032 TRAY TIBIAL INBONE SZ 2 R $6,468.50

10082034 DOME TALAR INBONE SZ 1 LE $16,456.00

10082035 HEAD DELTA OPTION BIOLOX $6,481.25

10082043 VANGUARD PS OPEN BX FEMOR $9,915.25

10082046 CAGE ALEUTIAN 8 X 18 X 45 $35,266.50

10082049 COMP MODULAR HEAD 32MM DI $2,507.50

10082050 SCREW SPEED 5.5MM PEEK KN $2,550.00

10082057 SMARTSTITCH WITH MW WHITE $1,419.50

10082058 SMARTSTITCH M-CONNECTOR P $905.00

10082059 PARAGON T2 ICW $1,000.00

10082065 BEARING TIBIAL DCM PLUS P $4,377.50

10082077 INSERT INBONE POLY SIZXE $6,965.75

10082078 BIT DRILL SIZE 4 ANTI ROT $770.00

10082081 DOME TALAR SIZE 4 LEFT/RI $16,456.00

10082082 PIN STEINMANN SHOULDER RE $297.50

10082089 LINER ACE 36MM HIGH WALL $9,167.25

10082091 BLADE PACK STAIN STEEL $2,740.00

10082092 TRAY TIBIAL SZ A RHT MEDI $10,548.50

10082093 BEARING MENISCAL KNEE EX $4,934.25

10082094 CEMENT BONE WITH MIXER HV $658.75

10082097 KIT IVAS 15MM GUAGE $5,666.65

10082099 COMPONENT FEMORAL SZ 3 RG $12,665.00

10082101 COMPONENT FEMORAL SZ2+ LE $16,575.00

10082102 INSERT TIBIAL SZ 2 LFT 10 $8,287.50

10082103 STEM FEMORAL MALLIRY/HEAD $14,275.75

10082126 TUBING SMOKE EVACUATOR $260.00

10082127 FEMORAL MALLORY/HEAD PF 1 $14,275.75

10082128 HEAD FEMORAL TYPE 1 40MM $6,481.25

10082130 ADAPTOR TIBIAL TRAY OFFSE $3,952.50

10082136 PATELLA STD 40 X 10MM SER $2,902.75

10082142 SCREW CENTRAL 6.5 30MM $705.50

10082144 PLATE TIBIAL PRIM W LOCK $4,551.75

10082146 BEARING TIBIAL 10X63/67MM $9,426.50

10082147 SCREW NON LOCKING 4.75 X $714.00

10082156 PIN DRILL HEADLESS TROCAR $1,759.90

10082159 SCREW CORTEX 3.5 X 12MM $5,469.75

10082161 CAP CERTEX $879.75

10082166 SHELL ACETABULAR 3 HOLE 5 $11,875.50

10082167 LINER ACETABULAR HI-WALL $8,172.75

10082169 HEAD MODULAR 36MM TYPE 1 $2,507.50

10082170 CANNULA PASSPORT BUTTON 1 $230.00

10082173 INSERT LINER E HEAD 36MM $5,843.75

10082174 SHELL ACETABULAR SIZE 54M $6,438.75

10082176 BEARING TIBIAL DCM ANTER $4,475.25

Page 43: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082183 LINER ACE HIGH WALL 32MM $9,167.25

10082184 SCREW ACETABULAR 6.5MM X $718.25

10082185 SCREW ACETABULAR 6.5MM X $718.25

10082204 INSERT INBONE POLY SIZE 2 $7,186.75

10082206 FILLER BONE VOID 5ML $6,353.75

10082207 SCREW BONE SELF-TAP LOW P $352.75

10082212 GRAFT PLUS DBM STAGRAFT $5,695.00

10082220 STYLET ENHANCED 70CM $660.00

10082221 SCREW BONE 6.5X40MM LOW P $352.75

10082223 COMPONENT HIP MODULAR HEA $2,507.50

10082224 LINER ACETABULAR +3 HI-WA $4,105.50

10082226 SCREW 5.0 X 30MM LOW PROF $1,377.00

10082229 SCREW 5.0 X 45MM LOW PROF $1,377.00

10082231 ROD GUIDE BALL TIP 3.0 X8 $1,535.00

10082233 BIT DRILL 4.0 SHORT AO PI $1,225.00

10082234 BIT DRILL 4.0 LONG AO PIL $1,685.00

10082244 SCREW 4.3 X 34MM SHORT TH $1,041.25

10082245 JUGGERKNOT 1.0MM MINI 3-0 $1,857.25

10082267 TIBIA NATURAL 5 DEG RIGHT $5,100.00

10082268 SCREW CANNULATED 4.5 X 40 $872.10

10082269 WASHER FOR 4.5MM CANNULAT $176.51

10082270 PIN GUIDE TROCAR TIP 2.4M $393.98

10082271 BIT DRILL 3.2MM $2,772.00

10082273 HEAD FEMORAL TAPER 12/14 $1,912.50

10082275 COMP FEM SZ 4 RIGHT SPHER $16,575.00

10082276 INSERT TIBIAL SZ 4 RGHT 1 $8,287.50

10082277 TRAY TIBIAL FIXED SZ T3-I $6,162.50

10082278 STEM MALLORY/HEAD FEM PF $14,275.75

10082279 COMPONENT HIP SYSTEM MOD $2,507.50

10082312 SHOULDER REVERSE GLENOSPH $5,737.50

10082313 BEARING REVERSE SHOULDER $5,525.00

10082321 STEM SHOULDER PRIMARY MIN $20,604.00

10082325 BIT DRILL 2.0 $915.80

10082327 SCREW CORTICAL 2.7 X 14 $484.50

10082329 SCREW LOCKING 2.4 X 24 $623.39

10082330 SCREW LOCKING 2.4 X 26 $623.39

10082332 SCREW NON LOCK CORTICAL 2 $484.50

10082333 SCREW NON LOCK 2.7 X 16 $484.50

10082338 PEG TWIN PARTIAL KNEE SZ $15,835.50

10082339 TRAY TIBIAL MEDIAL LEFT S $10,548.50

10082342 MALLORY/HEAD FEMORAL 9.0X $14,275.75

10082347 LENS MA60MA -1.0 $174.00

10082348 LENS MA60MA 1.0 $174.00

10082350 LENS AO60 -0.0 $200.00

10082357 TIBIA NATURAL 5 DEGREE ST $5,100.00

10082366 HEAD MOD 40MM HEAD DIAM P $6,481.25

10082374 ANCHOR SUTURE 1.4MM W FLE $1,865.75

Page 44: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082375 BIT DRILL 1.4MM FLEX SHAF $1,040.00

10082384 LOOP PROCINCH ADJ STD TEN $2,295.00

10082388 TIBIA NATURAL 5 DEG LEFT $5,100.00

10082389 BEARING TIBIAL 10MM 71/75 $9,426.50

10082391 INSERT TIBIAL FIXED SZ 4 $8,287.50

10082392 BEARING TIBIAL ANTERIOR S $4,475.25

10082398 SCREW BONE NON LOCKING 3. $497.42

10082399 BIT DRILL 2.6MM X 135MM S $915.80

10082401 KIT INTERSERTION 3MM SUTU $1,395.00

10082403 PLUG BONE LG INTERAMEDULL $1,045.50

10082407 WIRE GUIDE BALL NOSE 3.0M $1,060.00

10082422 BEARING TIBIAL 10 X 63/67 $4,080.00

10082426 MALLORY/HEAD FEMORAL PF 1 $14,275.75

10082427 HEAD MODULAR 40MM DIAM ST $6,481.25

10082428 TAPER FEMORAL SZ 4 LAT HA $12,750.00

10082429 SCREW 30MM SAMBA SYSTEM $21,783.38

10082430 SCREW 40MM SAMBA SYSTEM $21,781.25

10082431 PIN GUIDE 3.2MM 9" $722.50

10082432 LENS S122UV 15.0 $200.00

10082434 HEAD FEMORAL TYPE 1 TAPER $6,481.25

10082435 SCREW LOCKING 4.75 X 35 $318.75

10082436 PLATE TIBIAL PRIM W LOCK $9,426.50

10082437 OPEN BOX FEM PS 72.5MM LE $14,938.75

10082438 BEARING TIBIAL PS VANGUAR $14,335.25

10082439 PLATE TIBIAL PRIM W LOCK $4,551.75

10082442 BLUE RIDGE PLATE 42MM $9,392.50

10082448 STEM FEMORAL SZ 11 TYPE 1 $14,275.75

10082449 COMPONENT FEMORAL SZ 5N R $10,200.00

10082454 SCREW LOCKING 2.7 X 18MM $543.66

10082494 INBONE TALAR DOME $16,456.00

10082495 INBONE STEM TIBIAL MID $2,758.25

10082496 INBONE STEM TIBIAL TOP $2,758.25

10082498 INBONE TIBIAL TRAY LEFT $7,892.25

10082511 JUGGERKNOT MINI SIFT ONE $1,768.00

10082520 STEM KNEE SPLINED W SCREW $7,067.75

10082521 TRAY TIBIAL OFFSET 71MM W $11,908.50

10082523 AUGMENT FEMORAL DISTAL 15 $5,635.50

10082524 AUGMENT POSTERIOR FEMORAL $5,805.50

10082525 AUGMENT DISTAL FEMORAL 15 $5,635.50

10082527 BEARING TIBAL DCM 16 X 71 $10,990.50

10082547 TRAY TIBIAL INBONE SZ 2 L $6,468.50

10082562 BLOCK TIBIAL AUGEMENTATIO $5,291.25

10082565 PLUG BONE XL INTRAMEDUALL $871.25

10082566 CENTRALIZER DISTAL 15MM I $892.50

10082569 FEMUR NARROW RGHT SZ 9 CE $12,692.63

10082589 FEMORAL OPEN BOX PS 67.5M $9,915.25

10082593 ORCA CAGE 11 X 18 X 60MM $36,299.25

Page 45: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082607 HEAD FEMORAL 40MM DIAM 12 $3,633.75

10082614 NUWAVE MONITORING CANCELL $250.00

10082615 LENS SN6CWS 25.5D $225.00

10082617 SURFACE ARTICULAR FIXED B $6,402.97

10082619 GUIDE WIRE $255.00

10082632 LENS ZCT525 16.0 $520.01

10082633 LENS ZCT400 17.5 $520.01

10082634 LENS ZCT150 23.0 $520.01

10082637 CAGE ALEUTIAN 8 X 16 X 40 $35,266.50

10082638 CAGE ALEUTIAN 10 X 16 X 4 $35,266.50

10082642 COMPONENT FEMORAL SZ 2+ R $16,575.00

10082643 INSERT TIBIAL SZ 2 RGHT 1 $8,287.50

10082646 GLENOSPHERE SHOULDER 36MM $5,737.50

10082664 IMPLANT PHALINX CANNULATE $4,989.50

10082668 LENS ZCT150 24.5 $520.01

10082669 LENS ZCT225 18.0 $520.01

10082670 SCREW BONE LOW PROFILE SE $352.75

10082673 LENS ZCT150 26.5 $520.01

10082676 CAGE ALEUTION 9MM $7,483.40

10082677 CAGE ALEUTION 8MM $7,483.40

10082681 GRAFT DBM PLUS STAGRAFT $8,797.50

10082694 INSERT TIBIAL FIXED SZ 2 $8,287.50

10082696 LENS ZCT450 15.5 $520.01

10082697 BLOCK CUTTING FEMUR SZ 3+ $687.50

10082698 COMP FEMORAL CEMENTED 3+ $9,775.00

10082699 COMP FEMORAL SZ 4 LEFT SP $16,575.00

10082700 INSERT TIBIAL SZ 4 LEFT 1 $8,287.50

10082705 LENS ZCT450 16.0 $520.01

10082707 TRAY TIBIAL FIXED LFT CEM $6,162.50

10082714 BIT DRILL 6.0/5.0MM STEP $1,887.00

10082716 BIT DRILL 5.0MM $1,411.00

10082731 SCREW CENTRAL 6.5 X 40MM $425.00

10082736 LINER RINGLOC 36MM 10 DEG $12,418.50

10082741 LENS ZCT150 15.5 $520.01

10082742 LENS ZCT300 22.5 $520.01

10082743 SHELL MALLORY/HEAD 4 FIN $4,258.50

10082744 CONNECTOR ROD TO ROD OPEN $4,902.80

10082746 LENS ZCT525 10.5 $520.01

10082747 LENS ZLB00 24.5 $940.01

10082749 LINER ACETABULAR SZ D 36M $9,167.25

10082750 SCREW 45MM SAMBA SYSTEM $21,781.25

10082751 SCREW 35MM SAMBA SYSTEM $21,783.38

10082753 LENS ZCT150 15.0 $520.01

10082754 LENS ZLB00 16.0 $940.01

10082758 TRAY TIBIAL STEMMED W LOC $13,502.25

10082760 LENS SN6CWS 19.0 $225.00

10082761 LENS ZLB00 24.0 $940.01

Page 46: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082762 STEM SHOULDER PRIMARY STN $14,875.00

10082763 STEM MODULAR FINNED 80MM $1,521.50

10082764 FEMORAL BOX PS OPEN 67.5M $9,915.25

10082767 SCREW NON LOCK HEX 3.5 X $433.50

10082771 SCREW LOCK HEX 3.5 X 10MM $726.75

10082772 SCREW LOCK HEX 3.5 X 10MM $726.75

10082773 LENS ZLB00 15.5 $940.01

10082774 LENS ZCT600 25.0 $520.01

10082778 INSERT TIBIAL FIXED SZ 3 $4,250.00

10082780 LENS SN60WF 9.0 $220.00

10082790 SCREW SNAP OFF 2.0 X 14MM $1,630.98

10082792 LENS ZCT600 23.5 $520.01

10082793 LENS ZCT150 24.0 $520.01

10082798 COMPONENT FEMORAL SZ 3+ R $16,575.00

10082799 FEMUR CUTTING BLOCK SZ 3+ $687.50

10082839 SCREW LOCKING 3.5 X 14MM $726.75

10082842 PLATE DORSAL LOCKING 4 DE $3,642.25

10082844 TRAY TIBIAL INBONE SZ 4 L $7,892.25

10082845 SHELL ACETABULAR 3 HOLE S $15,130.00

10082848 LENS SN6CWS 14.5 $225.00

10082849 LENS ZCT300 21.0 $520.01

10082851 LENS 250 19.0 HOYA $200.00

10082852 LENS 250 21.0 HOYA $200.00

10082853 LENS 250 20.5 HOYA $200.00

10082854 LENS 250 17.0 HOYA $200.00

10082862 LENS SN6CWS 14.0 $225.00

10082865 PATELLA POLY 38MM X 9.5 M $4,862.17

10082868 BEARING TIBAL 12 X 71/75M $4,080.00

10082872 ANCHOR SUTURE 4.75 X 22MM $2,533.00

10082874 KIT PATIENT TRIAL $440.00

10082877 LENS 250 19.5 HOYA $200.00

10082878 LENS 250 18.5 HOYA $200.00

10082881 SHELL ACETABULAR 56MM RAD $4,258.50

10082894 KIT BONE CEMENT FEMORAL P $1,202.75

10082895 CENTRALIZER DISTAL 13MM I $892.50

10082899 MALLORY/HEAD FEMORAL PF 1 $14,275.75

10082900 SHELL 4 HOLE ACETABULAR S $15,130.00

10082902 BEARING SHOULDER RVRSE HM $3,400.00

10082903 FILLER BONE VOID 10ML $12,707.50

10082922 LENS ZCT150 16.5 $520.01

10082923 LENS ZCT225 24.5 $520.01

10082924 ANCHOR SUTURE 3X12.7MM KN $2,584.00

10082925 LENS SN6CWS 19.5 $225.00

10082928 TRAY HUMERAL 44MM +5MM W $5,950.00

10082931 LENS ZCT225 24.0 $520.01

10082932 LENS ZCT300 24.0 $520.01

10082933 SCREW REVERSE COMP 6.5X35 $425.00

Page 47: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082937 LINER ACETABULAR HIGH WAL $8,172.75

10082939 ADAPTER TAPER OPTION MINU $1,130.50

10082941 CONNECTOR CROSS 32 -42 MM $9,488.13

10082942 FEMORAL BOX PS OPEN 70MM $9,915.25

10082943 SHELL ACETABULAR 54MM RAD $5,950.00

10082944 LINER ACETABULAR +3 HI WA $4,105.50

10082947 GLENOSPHERE SHOULDER 41MM $5,737.50

10082948 BEARING SHOULDER RVRSE HM $3,400.00

10082949 SHELL ACETABULAR 54MM SZ $15,130.00

10082952 LENS ZCT300 17.0 $520.01

10082958 BEARING MENISCAL SMALL RG $4,934.25

10082967 BEARING TIBIAL 14 X 63/67 $11,322.00

10082968 FEMORAL BOX PS OPEN 75MM $9,915.25

10082969 PLATE TIBIAL FXD I-BEAM W $5,159.50

10082979 INSERT TIBIAL FIXED SZ 6 $8,287.50

10082996 LENS ZCT450 12.0 $520.01

10082997 LENS ZCT150 16.0 $520.01

10082998 BEARING MENISCAL MEDIUM L $4,934.25

10082999 PROBE ENERGY 50-S XL $2,296.70

10083000 ANCHOR CINCHLOCK KNOTLESS $2,656.25

10083002 BIT DRILL FLEX CINCHLOCK $1,250.00

10083004 LINER ACETABULAR SIZE 40M $9,167.25

10083006 TRAY TIBIAL MEDIAL RIGHT $10,548.50

10083007 BEARING MENISCAL MEDIUM R $4,934.25

10083008 KIT TOTAL OPTIVAC 80 GRAM $465.00

10083009 NEEDLE BONE BIOPSY SZ 2 T $700.00

10083010 PLATE TIBIAL PRIMAR W LOC $4,551.75

10083019 LENS ZCB00 31.5 TECHNIS $195.00

10083020 LENS ZCT450 13.0 $520.01

10083021 LENS ZCT450 12.5 $520.01

10083022 LENS ZLB00 20.5 $940.01

10083023 LENS ZMA00 19.5 $940.01

10083024 PLATE TIBIAL FXD I-BEAM W $5,159.50

10083033 SHELL ACETABULAR 52MM SZ $15,130.00

10083037 LENS ZCB00 29.0 TECHNIS $195.00

10083038 Lens ZCT300 16.5 $520.01

10083040 SCREW CENTRAL REVERS 6.5 $425.00

10083041 STEM MALLORY/HEAD FEMORAL $14,275.75

10083042 LENS SN6CWS 28.5 $225.00

10083043 SYSTEM CABLE GRIP DISTAL $1,197.69

10083044 TROCANTERIC REATTACH EXTN $14,971.05

10083045 SCREW BONE CORTICAL 38MM $238.00

10083046 SCREW CORTICAL 5.5 X 25MM $918.00

10083047 SCREW BONE CORTICAL 40MM $238.00

10083048 BLADE SAW OXFRD KNEE STBL $2,740.00

10083049 BEARING MENISCAL MEDIUM L $5,805.00

10083050 TRAY TIBIAL MEDIAL LEFT S $10,548.50

Page 48: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083051 BLOCK FEMUR CUTTING SZ 6+ $687.50

10083052 COMPONENT FEMORAL SZ 6+ L $16,575.00

10083054 STEM TAPER FEMORAL SZ 5 S $12,750.00

10083055 SHELL ACETABULAR 58MM SZ $15,512.50

10083056 BIT DRILL 2.5MM AO STERIL $500.00

10083057 TAP CORTICAL 3.5MM AO STE $500.00

10083058 GAUGE LENGTH ACROMIOCLAVI $1,000.00

10083059 INTRODUCER ANGLED RH $3,475.00

10083060 TENSIONER LOOP DISPOSABLE $975.00

10083061 LOCKDOWN ACROMIACLAVICULA $11,581.25

10083062 WASHER 9X1MM STAINLESS ST $212.50

10083063 SCREW CORTICAL 18MM & WAS $297.50

10083064 SCREW CANNULATED 4.0MM TH $1,389.75

10083065 WASHER 7.0MM $171.06

10083066 WIRE GUIDE NON-THREAD 1.2 $227.50

10083067 SCREW CANULATED 4.5 X 36M $872.10

10083068 SCREW CANULATED 4.5 X 30M $872.10

10083069 SCREW CANULATED 5.5 X 45M $902.70

10083070 HEAD FEMORAL TYPE 1 TAPER $6,481.25

10083071 LENS SN60WF 18.5 $225.00

10083072 TISSUE PARTICUL PLACENTAL $2,662.63

10083073 PLATE TIBIAL FXD I-BEAM W $5,159.50

10083082 STEM KNEE 12 180MM W/SCRE $7,280.25

10083083 BEARING TIBIAL ANTER STAB $9,426.50

10083084 STEM SHOULDER PRIMARY 15 $14,875.00

10083085 FEMORAL BOX PS OPEN 72.5M $9,915.25

10083086 BEARING TIBIAL PS VANGUAR $9,426.50

10083087 REAMER LOW PROFILE 10MM $2,550.00

10083088 SCREW GENTLE THREAD 8X20M $1,572.50

10083089 SCREW GENTLE THREAD 10 X $1,572.50

10083090 LENS ZXT225 12.5 $1,035.01

10083091 LENS ZXT225 13.0 $1,035.01

10083092 LENS ZXT225 13.5 $1,035.01

10083093 LENS ZXT225 16.0 $1,035.01

10083094 LENS ZCT150 25.5 $520.01

10083095 BIT DRILL PHOENIX 0.9MM $975.00

10083096 XBRAID 1.2MM TT 100% BLUE $637.50

10083097 BUR ROUND XL 4.0MM DIAMON $1,400.00

10083098 LENS SN6AT5 17.0 $490.01

10083099 CONNECTOR SMARTSTITCH PER $905.00

10083100 CARTRIDGE SUTURE BLUE CO- $1,206.58

10083101 SHELL ACETABULAR 58MM RAD $4,258.50

10083102 STEM MALLORY/HEAD FEMORAL $14,275.75

10083103 SHELL ACETABULAR 56MM SZ $18,270.75

10083104 SCREW BONE SELF TAP 6.5 X $504.69

10083105 SCREW BONE SELF TAP 6.5 X $504.69

10083106 SCREW BONE SELF TAP 6.5 X $504.69

Page 49: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083107 BLOCK FEMUR CUTTING SZ 5+ $687.50

10083108 INSERT TIBIAL FIXED SZ 4 $8,287.50

10083109 COMPONENT FEMORAL SZ 5+ R $16,575.00

10083110 TAPER FEMORAL SZ 1 LAT HA $12,750.00

10083111 SHELL ACETABULAR 50MM RAD $5,950.00

10083112 HIP GEMORAL FX 11 X 140MM $8,317.25

10083113 HEAD MODULAR CONSTRAINED $7,603.25

10083114 LENS ZXT150 16.5 $1,035.01

10083115 PATELLA OVAL DOME 3 PEG 4 $2,337.50

10083116 TRAY TIBIAL ROTATING PLAT $7,862.50

10083117 INSERT TIBIAL ROTATING PL $6,587.50

10083118 SHELL ACETABULAR 48MM SZ $15,130.00

10083119 LINER ACETABULAR SIZE 32M $9,167.25

10083120 COMPONENT MODULAR HEAD 32 $2,507.50

10083121 LENS SN60WF 20.5 $220.00

10083122 LINER 32X56MM 20 DEG ELE $4,845.00

10083123 NECK MODULAR 12/14 TAPER $3,300.38

10083124 HEAD FEMORAL 12/14 TAPER $2,949.76

10083125 SCREW CENTRAL 6.5X25MM RE $425.00

10083126 STEM SHOULDER MINI HUMERA $14,875.00

10083128 SHELL ACETABULAR 54MM SZ $18,270.75

10083129 SCREW BONE SELF TAP 6.5 X $504.69

10083130 SCREW BONE SELF TAP 6.5 X $504.69

10083131 SCREW BONE SELF TAP 6.5 X $504.69

10083132 GLENOSPHERE SHOULDER 36MM $5,737.50

10083133 ADAPTOR SHOULDER MINI TAP $850.00

10083134 LENS ZCT300 20.5 $520.01

10083135 LENS ZCT400 15.5 $520.01

10083136 TRAY TIBIAL INBONE SZ 2 L $6,468.50

10083138 INSERT INBONE POLY SZ 1+ $7,186.75

10083139 SCREW BONE 22.0MM STND AC $2,550.00

10083140 SCREW NON LOCKING 3.5 X 1 $433.50

10083141 PIN 2.0 X 20MM BIOTAK $1,296.25

10083142 PLATE DORSAL LOCKING 4 DE $3,642.25

10083143 BIT DRILL LONG ACUTRAK 2 $1,805.00

10083144 BIT DRILL 2.8MM QUICK REL $775.00

10083145 SCREW BONE 12.0MM MICRO A $2,550.00

10083148 BIT DRILL MICRO PIN 2.0 $2,435.00

10083149 COPPERHEAD CEVICAL IBFD, $4,675.00

10083150 COPPERHEAD CEVICAL IBFD, $4,675.00

10083151 PLATE 59MM $4,462.50

10083152 SCREW VARIABLE 4X14MM $850.00

10083153 BIT DRILL 12MM $375.00

10083154 FEMORAL BOX PS OPEN 70MM $9,915.25

10083155 CAGE 10MM 6DEG LUMBAR $14,450.00

10083156 CAGE 12MM 12DEG LUMBAR $14,450.00

10083157 SCREW REDUCTION 6.5X40MM $3,825.00

Page 50: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083158 SCREW REDUCTION 7.5X35MM $3,825.00

10083159 SCREW SET CAP $276.25

10083160 ROD PREBENT 5.5X70MM $850.00

10083161 LENS ZXR00 14.5 $940.01

10083162 LENS ZCT450 13.5 $520.01

10083163 CAGE 14MM 12DEG LUMBAR $14,450.00

10083164 ROD 5.5 X 60MM $850.00

10083165 SCREW REDUCTION 6.5X50MM $3,825.00

10083166 SCREW REDUCTION 7.5X40MM $3,825.00

10083167 WIRE LEAD CLIP ON DISPOSA $300.00

10083168 LENS ZCB00 8.5 $195.00

10083169 LENS ZCB00 9.0 $195.00

10083170 LENS ZCB00 9.5 $195.00

10083171 SCREW REDUCTION 4.5X35MM $3,825.00

10083172 ROD PREBENT 5.5X400MM $2,210.00

10083173 INSERT TIBIAL FIXED SZ 4 $8,287.50

10083175 KIT LEAD MRI 8 CONTACT 56 $13,170.75

10083176 LENS ZXR00 14.0 $940.01

10083177 LENS ZXR00 15.0 $940.01

10083178 LENS ZCB00 10.0 $195.00

10083179 LENS ZCB00 10.5 $195.00

10083180 SCREW 6X55 UNASS MATRIX $3,108.03

10083181 SCREW 6X45 UNASS MATRIX $3,108.03

10083182 RODS TI 5.5X60 MATRIX $1,243.21

10083183 CAPS LOCKING $984.94

10083184 SPACER 11X28X10 OPAL REVO $18,166.63

10083185 SPACER 13X28X10 OPAL REVO $18,166.63

10083186 HEADS POLYAXIAL $1,328.98

10083187 CAGE 12MM 6DEG LUMBAR $14,450.00

10083188 STEM FEMORAL SZ 9 130MM T $8,317.28

10083189 SCREW REDUCTION 5.5X40MM $3,825.00

10083190 ROD PREBENT 5.5X100MM $850.00

10083198 DIAMDBCK RED PED SCR TRIP $3,825.00

10083199 SPACER ACIS 7MM LORDOTIC/ $7,004.00

10083200 SPACER ACIS 6MM LORDOTIC/ $7,004.00

10083201 SCREW 4.0 X 16MM VA SD $1,422.69

10083202 PLATE ACDF 3 LEVEL 48MM S $7,004.00

10083203 GLENOSPHERE SHOULDER 41MM $5,737.50

10083204 REDUCTION PEDICLE SCR DBL $6,443.00

10083205 REDUCTION PEDICLE SCR DBL $6,443.00

10083206 REDUCTION PEDICLE SCR DBL $6,443.00

10083207 PEDICLE SCREW SET CAP $2,278.00

10083208 PRE-BENT ROD 5.5MM X 110M $2,278.00

10083209 BEARING TIBIAL DCM PS PLU $4,377.50

10083210 ALIF IBFD, 34MMx24MM, MED $26,775.00

10083211 REDUCTION PEDICLE SCR DBL $6,443.00

10083212 REDUCTION PEDICLE SCR DBL $6,443.00

Page 51: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083213 PRE-BENT ROD 5.5MM X 80MM $2,278.00

10083214 SURFACE ARTICULAR LEFT 10 $6,402.97

10083215 FEMUR STANDARD LEFT SZ 12 $12,692.63

10083216 RODS 5.5 X 45MM $1,243.21

10083217 CRISSKUBJ/TRANSCONNECTOR $6,808.50

10083218 LENS ZXT150 20.0 $1,035.01

10083219 LENS ZXT150 20.5 $1,035.01

10083220 LENS ZXT150 21.0 $1,035.01

10083221 LENS ZXR00 20.0 $940.01

10083222 LENS ZXR00 20.5 $940.01

10083223 LENS ZXR00 21.0 $940.01

10083224 MEMBRANE WOUND MATRIX 2.0 $2,065.50

10083225 CANNULA DISPOSABLE 8.5X75 $350.00

10083226 PLATE I LEVEL 14MM SKYLIN $6,128.50

10083227 SCREW 4.0 X 14MM VA SD $1,422.69

10083229 REDUCTION PEDICLE SCR DBL $6,443.00

10083230 PRE-BENT ROD 5.5MM X 90MM $2,278.00

10083231 SYSTEM ANKLE ZIPTIGHT FIX $5,397.50

10083232 TRAY TIBIAL MEDIAL RIGHT $10,548.50

10083233 BEARING MENISCAL MEDIUM R $4,934.25

10083234 STEM MALLORY/HEAD FEMORAL $14,275.75

10083235 KING COBRA CERVICAL PLATE $4,037.50

10083236 ANCHOR CLIK X STERILE KIT $1,678.75

10083237 LOCKDOWN ACROMIACLAVICULA $11,581.25

10083238 SCREW CORTICAL 26MM & WAS $297.50

10083239 LENS ZCT150 13.0 $520.01

10083240 LENS ZCT300 23.0 $520.01

10083241 SHELL ACETABULAR 52MM RAD $5,950.00

10083242 COTNMOUT ALIF IBFD 34X24M $14,450.00

10083243 DIAMDBCK RED PED SCR TRIP $3,825.00

10083244 DIAMDBCK PED PRE-BENT ROD $850.00

10083245 STEM MALLORY/HEAD FEMORAL $14,275.75

10083246 SCREW 6X40 UNASS MATRIX $3,108.03

10083247 SCREW 6X30 UNASS MATRIX $3,108.03

10083248 HEADS REDUCTION POLYAXIAL $3,730.14

10083249 RODS 5.5 X 75MM TI $1,243.21

10083251 SPACER 10 X 24 X 11 OPAL $18,166.63

10083252 BLOCK TIBIAL SZ 4 AUGMENT $4,592.68

10083253 EXTENSION STEM OFFSET 13 $6,723.67

10083254 KNEE POSTERIOR STAB SIZE $6,402.97

10083255 KIT LEAD INFINION CX 16 C $15,150.00

10083256 NEEDLE ENTRADA 11CM $1,975.00

10083257 KIT REMOTE CONTROL FREELI $5,140.00

10083258 LEAD BLANK $260.00

10083259 SCREW 6X50 MATRIX $3,108.03

10083260 ROD TI 5.5 X 65MM $1,243.13

10083261 ALIF IBFD, 34MMx24MM, MED $26,775.00

Page 52: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083262 PRE-BENT ROD 5.5MM X 100M $2,278.00

10083263 Lens ZCT150 13.5 $520.01

10083264 LENS ZXT150 17.0 $1,035.01

10083265 LENS ZXT150 17.5 $1,035.01

10083266 LLIF IBFD 18MMX50MM, NEUT $29,036.00

10083267 SCREW 7X50 MATRIX $3,108.03

10083268 SPACER 9X28X10 OPAL REVOL $18,166.63

10083269 LENS ZCT225 23.0 $520.01

10083270 FIBER LASER EVOLVE TWISTE $4,735.00

10083271 EXPRESSBRAID SINGLE PK BL $467.50

10083272 PLATE ACDF 3 LEVEL 45MM S $7,004.00

10083273 SPACER ACIS 6MM LORDOTIC/ $4,505.00

10083274 SPACER ACIS 7MM LORDOTIC/ $4,505.00

10083275 BEARING TIBIAL PS VANGUAR $9,426.50

10083276 COTNMOUT ALIF IBFD 34X24M $14,450.00

10083277 DIAMDBCK RED PED SCR TRIP $3,825.00

10083278 STEM SHOULDER MINI HUMERA $14,875.00

10083279 SPACER 10X28X12 OPAL REVO $12,951.88

10083280 LENS ZXR00 17.0 $940.01

10083281 LENS ZXR00 17.5 $940.01

10083282 LENS ZXR00 16.5 $940.01

10083283 CARTRIDGE SUTURE WHITE PE $1,206.58

10083284 LLIF IBFD 18MMX50MM, NEUT $29,036.00

10083285 REDUCTION PEDICLE SCR DBL $6,443.00

10083286 DIAMDBCK RED PED SCR TRIP $3,825.00

10083287 DIAMDBCK RED PED SCR TRIP $3,825.00

10083288 DIAMDBCK PED PRE-BENT ROD $850.00

10083289 PATELLA STNDARD 28X8MM SE $2,902.75

10083290 CAGE EXPANDABLE 9 X 23MM $29,750.00

10083291 ROD TI 5.5 X40MM $1,243.21

10083292 PRE-BENT ROD 5.5MM X 70MM $2,278.00

10083293 LLIF IBFD 18MMX55MM, NEUT $29,036.00

10083294 KIT ACCESSORY WRENCH $275.00

10083295 KIT ACCESSORY PLUG KIT $637.50

10083296 KIT ACCESSORY TUNNELING R $450.00

10083298 PLATE I LEVEL 12MM SKYLIN $6,128.50

10083302 SCREW LOCKING EXPEDIUM $850.00

10083303 ROD TI 5.5 X 125MM MATRIX $1,243.21

10083304 SCREWS 6.0 X 55MM EXPEDIU $4,250.00

10083306 SCREWS 6.0 X 45MM EXPEDIU $4,250.00

10083307 SCREWS 6.0 X 40MM EXPEDIU $4,250.00

10083308 SCREWS 5.0 X 50MM EXPEDIU $4,250.00

10083309 LENS ZCT450 16.5 $520.01

10083310 ANCHOR QUICK SUPER PLUS D $2,307.75

10083312 LINER CANISTER DISPOSABLE $178.85

10083313 TUBING SET W/ EXT DISPOSA $1,625.00

10083314 SPETZLER CLAW TIP UNIVERS $4,150.00

Page 53: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083315 SLINGSOT 70 UP CHAMPION $1,745.00

10083316 ANCHOR SUTUR SWVLCK 3.5X1 $2,431.00

10083317 TAPE 1.5MM LABRAL $425.00

10083318 TAPE 2MM FIBERTAPE COLLAG $459.00

10083319 TRAY TIBIAL MEDIAL LEFT S $10,548.50

10083320 BLADE SAW 25X90X1.27MM OS $265.50

10083321 COMPONENT FEMORAL SZ G LE $7,225.00

10083322 COMPONENT TIBIAL SZ 8 STE $5,100.00

10083323 SURFACE ARTICULAR SZ G H $2,975.00

10083324 DIAMDBCK RED PED SCR TRIP $3,825.00

10083325 BEARING REVERSE SHLDR E1 $5,525.00

10083326 LENS ZCB00 33.0 $195.00

10083327 LENS ZCB00 33.5 $195.00

10083328 LENS ZCB00 34.0 $195.00

10083329 DIAMDBCK PED PRE-BENT ROD $850.00

10083330 LENS SN60WF 23.5 $225.00

10083331 SYSTEM KNEE LFT 10MM ARTI $6,402.97

10083332 COMPONENT FEMORAL SZ 7 RG $16,575.00

10083333 BLADE SAW 13X90X1.27G OSC $150.00

10083334 COMPONENT FEMORAL SZ D LE $7,225.00

10083335 SURFACE ARTICULAR SZ CD 1 $2,975.00

10083336 BEARING TIBIAL PS VANGUAR $9,426.50

10083337 KIT MIXING VERTECEM II PM $1,751.00

10083338 KIT SYRINGE VERTECEM V + $1,030.00

10083339 KIT ACCESS 10G DIAMOND TI $1,100.00

10083340 SCREW 7X40 MATRIX $3,108.03

10083341 RODS TI 5.5X70 MATRIX $1,243.21

10083342 PLATE 2 LEVEL 30MM SKYLIN $6,566.25

10083343 PIN FIXATION TEMPORARY TH $625.75

10083344 COMPONENT FEMORAL SZ G RG $7,225.00

10083345 COMPONENT TIBIAL SZ7 STEM $5,100.00

10083346 NAIL TIBIAL 10MM X 34CM M $9,333.00

10083347 SCREW LOW PROFILE 5.0 X 5 $1,190.00

10083348 SCREW LOW PROFILE 5.0 X 2 $1,190.00

10083349 PIN GUIDE 3.2 X343MM $948.00

10083350 TROCAR T-HANDLE 3.2MM $3,930.00

10083351 LENS ZCT225 29.5 $520.01

10083352 LENS ZCT150 31.0 $520.01

10083353 LENS ZXR00 22.5 $940.01

10083354 KIT NEEDLE VERTEBROPL 8 G $1,823.10

10083355 SCREW 6X45 CANN MATRIX $7,988.94

10083356 ROD MIS 5.5 X 40MM MATRIX $1,965.29

10083357 K WIRE FLEX $378.65

10083358 TOOL DRIVER ULTRA 120MM T $4,400.00

10083359 GOUGE LONG 7MM POROUS $4,400.00

10083360 DRILL DISK 9.5MM ULTRA DR $4,400.00

10083361 STEM SHOULDER MINI 6X83MM $14,875.00

Page 54: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083362 TRAY HUMERAL 44MM +10MM W $5,950.00

10083363 INSERT INBONE POLY SIZE 3 $7,186.75

10083364 ROD 3.5 X 30MM $1,090.12

10083365 SHEATH ENTRADA 4.5" 2.0 S $475.00

10083366 TIGHTROPE ACL RT DELIVERY $2,732.75

10083367 FLIPCUTTER II 10MM $2,325.00

10083368 CUP ACETABULAR 28 X 52MM $6,804.25

10083369 LENS ZCT400 30.0 $520.01

10083370 LENS ZCT400 30.5 $520.01

10083371 LENS ZCT400 31.0 $520.01

10083372 LENS ZCB00 32.5 $195.00

10083374 ROD TI 5.5 X 85MM MATRIX $1,243.13

10083376 BEARING MENISCAL SMALL LE $4,934.25

10083377 BEARING MENISCAL SMALL LE $4,934.25

10083378 PLATE 2 LEVEL 28MM SKYLIN $6,566.25

10083379 SCREW LOCK 3.5 X 18 $952.00

10083380 BIT DRILL 2.5MM $1,005.00

10083381 SCREW LOCK 3.5 X 16 $952.00

10083382 PLATE FIBULA RIGHT 80MM $6,260.25

10083383 SCREW NON LOCK 3.5 X 18 $684.25

10083384 SCREW LOCK 3.5 X 14 $952.00

10083385 LENS ZXR00 22.0 $940.01

10083387 BIT DRILL CANNULATED 5 MM $750.00

10083388 SCREW HEADLESS 7.0 X 70 X $3,706.00

10083389 SCREW HEADLESS 7.0 X 80 X $3,706.00

10083390 BIT DRILL 8MM BONE GRAFT $2,990.00

10083391 REAMER STRAIGHT $2,475.00

10083392 ISOPLASTIC CEMEX 40G $765.00

10083393 INTERSPACE KNEE LG HIGH R $18,168.75

10083394 AUGUMENT DISTAL FEMORAL 1 $5,916.00

10083395 AUGUMENT POSTERIOR FEMORA $5,805.50

10083396 AUGUMENT POSTERIOR FEMORA $5,805.50

10083397 BEARING TIBIAL DCM 18X79/ $11,322.00

10083398 AUGUMENT DISTAL FEMORAL 1 $5,916.00

10083399 STEM SPLINED KNEE W SCREW $9,061.00

10083401 LENS ZXT150 10.0 $1,035.01

10083402 LENS ZXT150 10.5 $1,035.01

10083403 LENS ZXT150 9.5 $1,035.01

10083404 STEM SPLINED BOWED KNEE W $9,061.00

10083406 AUGMENT DISTAL FEMORAL 10 $5,916.00

10083407 AUGMENT DISTAL FEMORAL 10 $5,916.00

10083408 BEARING TIBIAL 18 X 71/75 $11,322.00

10083409 LENS ZCT450 17.0 $520.01

10083410 LENS SN6AT4 21.0 $490.01

10083411 ANCHOR CLIK X MRI $1,678.75

10083412 CAPS LOCKING $854.25

10083413 ROD 4.0 X 50MM $1,015.58

Page 55: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083414 SCREW 3.5 X 12MM SYNAPSE $7,332.31

10083415 BIT DRILL 2.4MM $1,150.00

10083416 PLATE 4 LEVEL 68MM SKYLIN $7,441.75

10083417 ROD 4.0 X 30MM TI $1,015.58

10083418 KIT REVISION INTRATHECAL $1,275.00

10083419 DIAMDBCK RED PED SCR TRIP $3,825.00

10083420 BLOCK FEMUR CUTTING SZ 2+ $687.50

10083421 INSERT TIBIAL FIXED SZ 2 $8,287.50

10083423 LENS ZXR00 18.5 $940.01

10083425 LENS ZXT225 11.0 $1,035.01

10083426 LENS ZXT225 10.5 $1,035.01

10083427 LENS ZXT225 11.5 $1,035.01

10083428 LENS ZXT150 19.5 $1,035.01

10083429 LENS ZXT150 19.0 $1,035.01

10083430 BLOCK FEMUR CUTTING 4+ LE $584.38

10083431 COMPONENT FEMORAL SZ 4+ L $16,575.00

10083432 INSERT TIBIAL FIXED SZ 4 $8,287.50

10083433 LENS SN60AT 20.5 $199.00

10083434 RODS TI 5.5 X 95MM MATRIX $1,243.21

10083437 SPACER ACIS 8MM LORDOTIC/ $7,004.00

10083438 PLATE 2 LEVEL 30MM SKYLIN $6,566.25

10083439 SCREW 4.0 X 14MM VA SD $1,422.69

10083440 CAGE ALEUTIAN 12 X 16 X 4 $35,266.50

10083441 BIT DRILL 4.5MM CANNULATE $2,405.50

10083442 LLIF IBFD 18MMX55MM, NEUT $29,036.00

10083443 LENS ZCT225 22.0 $520.01

10083444 COUNTERSINK CANNULATED 4. $750.00

10083445 BIT DRILL 2.7MM SHORT W/Q $612.00

10083446 SCREW CRTX 3.5 X 12MM PER $126.14

10083447 SCREW CRTX 3.5 X 14MM PER $126.14

10083448 SCREW OSTEOPENIA 5X12MM P $357.00

10083449 SCREW OSTEOPENIA 5X14MM P $357.00

10083450 PLATE 5 HOLE 3.5 X 83MM P $3,825.00

10083452 TRAY TIBIAL 67MM W LOCK B $13,502.25

10083453 STEM KNEE SPLINED 14 X 80 $8,542.50

10083454 ADAPTOR KNEE OFFSET 2.5MM $4,152.25

10083455 AUGMENT TIBIAL 67 X10MM W $5,397.50

10083456 WING TIBIAL CRUCIATE LARG $3,803.75

10083457 TAPER FEMORAL SZ 00 HA CO $12,750.00

10083458 SPACER 11 X 27 X 12 BULLE $20,136.50

10083459 SPACER 11 X 27 X 13 BULLE $20,136.50

10083460 ANCHOR SUTURE 5.5MM 2 #2 $2,252.50

10083461 LENS ZXR00 13.5 $940.01

10083462 SPACER ACIS 8MM LORDOTIC/ $7,004.00

10083463 SCREW CENTRAL 6.5 X 28MM $1,130.50

10083464 BASEPLATE GLENOID 28MM $12,401.50

10083465 WIRE PILOT $290.00

Page 56: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083466 BIT DRILL 3.1MM $775.00

10083467 SCREW PERIPHERAL 4.5 X 40 $1,130.50

10083468 SCREW PERIPHERAL 4.5 X 32 $1,130.50

10083469 SCREW PERIPHERAL 4.5 X 16 $1,130.50

10083470 SCREW PERIPHERAL 4.5 X 36 $1,130.50

10083473 INSERT HUMERAL X3 STANDAR $9,018.50

10083474 CUP HUMERAL 40 X 4 MM $11,271.00

10083475 SPACER ZERO-P 8MM VA LORD $15,759.00

10083476 PLATE 2 LEVEL 24MM SKYLIN $6,566.25

10083477 SCREW 3.7X16 VA SD ZPVA $1,532.13

10083478 SCREW LOCK FIXED 3.5 X 4. $318.75

10083479 BEARING SHOULDER RVRSE HM $3,400.00

10083480 PLATE CERVICAL 18MM LEVEL $6,791.50

10083481 SCREW CERVICAL 4X12MM VAR $1,440.75

10083482 SCREW CERVICAL 4.25X12MM $1,440.75

10083483 PEEK CERVICAL 8MM $8,810.25

10083484 STEM FEMORAL SZ 12 x 140M $14,275.75

10083485 HEAD CERAMIC MODULAR 36 S $17,850.00

10083486 SPACER 12 X 15 6MM 6 DEGR $11,050.00

10083487 PLATE CERVICAL 6MM $12,223.00

10083488 SCREW VARIABLE 12MM SELF $1,445.00

10083489 SCREW VARIABLE 14MM SELF $1,445.00

10083491 EXTENSION STEM STRAIGHT 1 $5,154.27

10083492 COMPONENT TIBIAL SZ 3 A/P $10,169.44

10083493 EXTENSION STEM OFFSET 11 $6,723.67

10083494 SURFACE ARTICULAR 14MM CO $9,699.69

10083495 SCREW 6X35 UNASS MATRIX $3,108.03

10083496 INSERT TIBIAL SZ 3 RGHT 1 $8,287.50

10083497 SCREW LOCKING 2.3 X 18MM $543.66

10083498 SCREW LOCKING 2.3 X 12MM $543.66

10083499 PLATE DISTAL NARROW RGHT $3,978.00

10083500 ROD TI 5.5 X 55MM CURVED $1,243.21

10083501 LENS ZCT400 5.5 $520.01

10083502 LENS ZCT400 5.0 $520.01

10083503 LENS ZXR00 23.5 $940.01

10083504 SCREW 8x45 TI MATRIX $3,108.03

10083505 STEM SHOULDER STND 17X122 $14,875.00

10083506 PLATE 40MM CAYMAN $15,035.23

10083507 SCREW 6X24MM CAYMAN $1,438.20

10083508 SCREW EVEREST 8.5X80MM $3,718.75

10083509 DIAMDBCK PED PRE-BENT ROD $850.00

10083510 SYSTEM KNEE LFT 13MM ARTI $6,402.97

10083512 COMPONENT FEMORAL SZ 5 LF $16,575.00

10083513 INSERT TIBIAL SZ 5 LEFT 1 $8,287.50

10083514 LENS ZXR00 24.0 $940.01

10083515 LENS ZCT225 5.0 $520.01

10083516 BEARING REVERSE SHLDR E1 $5,525.00

Page 57: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083517 ROD MIN 5.5 X45MM INVASIV $1,554.23

10083518 SCREW 5X50 TI MATRIX $3,108.03

10083519 OSTEOTOME VEE $4,725.00

10083520 OSTEOTOME ROUND NARROW FL $4,725.00

10083521 IMPACTOR $4,725.00

10083522 SPACER KNEE MED HI REL $18,678.75

10083523 ROD PREBENT 5.5 X50MM $2,278.00

10083524 PLATE CERVICAL LEVEL4 75M $12,044.50

10083525 PEEK CERVICAL 9MM $8,810.25

10083527 SCREW 25MM FINE TIP SYNFI $3,468.85

10083528 SLEEVE PROTECTIVE EVO SYN $695.25

10083529 LOCK SLEEVE THREADED SYNF $1,576.95

10083530 SCREW 6X40 CANN MATRIX TI $7,988.94

10083531 COMPONENT FEMORAL SZ H LE $7,225.00

10083532 BLOCK FEMUR CUTTING SZ 2+ $687.50

10083533 COMPONENT FEMORAL SZ 2 LF $16,575.00

10083534 LENS ZCT150 31.5 $520.01

10083535 LENS ZCT225 8.0 $520.01

10083536 COPPERHEAD CEVICAL IBFD, $4,675.00

10083537 PLATE BLUE RIDGE 65MM LEV $4,221.10

10083538 SCREW VAR.CERV. 4X14MM SE $765.85

10083539 FEMORAL STEM SZ 9 STD HA $12,750.00

10083540 DIAMDBCK PED PRE-BENT ROD $850.00

10083541 LENS ZCB00 30.5 $195.00

10083542 LENS ZCB00 31.0 $195.00

10083543 PLATE CERVICAL 33MM LEVEL $8,381.00

10083544 COPPERHEAD CEVICAL IBFD, $4,675.00

10083545 SCREW VAR.CERV. 4X12MM SE $765.85

10083546 SCREW VAR.CERV. 4.3 X 12M $765.85

10083547 PLATE BLUE RIDGE 22MM LEV $3,591.25

10083548 CAGE EXPANDABLE METAL SZ $27,625.00

10083549 REDUCTION PEDICLE SCR DBL $6,443.00

10083550 PRE-BENT ROD 5.5MM X 60MM $2,278.00

10083551 PLATE BLUE RIDGE 56MM LEV $4,221.10

10083552 PLATE BLUE RIDGE 59MM LEV $4,221.10

10083553 LENS ZCT300 25.5 $520.01

10083554 LENS ZCT450 21.0 $520.01

10083555 ANCHOR QUICK PLU MINI $2,473.50

10083556 SCREW LOCKING 2.4 X18MM $623.39

10083557 SCREW LOCKING 2.4 X20MM $623.39

10083558 SCREW LOCKING 2.4 X22MM $623.39

10083559 SCREW LOCKING 2.7 X16MM $623.39

10083560 PLATE DR INTERMEDT LFT 10 $4,441.25

10083561 BIT DRILL 2.0MM X 135MM S $1,520.00

10083562 LENS ZXT375 13.0 $1,035.01

10083564 SCREW LOCK FIXED 3.5 X 4. $318.75

10083565 CENTRALIZER HIP DISTAL 13 $504.69

Page 58: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083566 SHELL ACETABULAR SIZE 58M $6,162.50

10083567 INSERT LINER F HEAD 36MM $4,675.00

10083568 SCREW FLAT HEAD 6.5X45MM $403.75

10083569 HEAD FEMORAL SIZE 0 36MM $1,806.25

10083570 KIT WRIST 15X200MM STRL M $7,455.69

10083572 LEAD TRIAL VECRTIS 1X8 60 $5,554.75

10083579 DIAMDBCK RED PED SCR TRIP $3,825.00

10083581 ROD TI 5.5 X 35MM CURVED $1,067.69

10083582 PLATE CERVICAL LEVEL4 80M $12,044.50

10083584 WEDGE FEMORAL POSTERIOR S $5,362.23

10083585 WEDGE FEMORAL DISTAL SZ 3 $5,362.23

10083586 CONNECTOR OFFSET 5MM $10,836.65

10083587 STEM EXTENSION FLUTED 13M $7,942.83

10083588 STEM EXTENSION FLUTED 18M $7,942.83

10083589 TIBIAL INSERT FIXED SZ 3 $9,546.35

10083590 TRAPEZIUM TIE-IN SZ 3 SIL $8,993.00

10083591 INSERT TIBIAL FIXED SZ 3 $4,250.00

10083592 SHELL HEMISPERICAL 56MM D $14,938.75

10083593 SCREW PLATE 6.5X35MM REST $503.63

10083594 LINER CEMENTLESS 38MM D $7,384.38

10083595 LENS SV25T6 17.5 $883.01

10083596 LENS SV25T6 18.0 $883.01

10083597 LENS SV25T6 18.5 $883.01

10083598 LENS SV25T3 13.5 $883.01

10083599 LENS SV25T3 14.0 $883.01

10083600 LENS SV25T3 14.5 $883.01

10083601 LENS SV25T0 13.5 $883.01

10083602 LENS SV25T0 14.0 $883.01

10083603 LENS SV25T0 14.5 $883.01

10083604 DIAMDBCK PED PRE-BENT ROD $850.00

10083605 COPPERHEAD CEVICAL IBFD, $4,675.00

10083606 SURFACE ARTICULAR LEFT 14 $6,402.97

10083607 SCREW HEADLESS MUC 4.3 X $1,046.15

10083608 COUNTERSINK 4.3MM CANNULA $1,005.00

10083609 SCREW BONE 34.0MM STND AC $2,550.00

10083610 SCREW LOCKING 3.5 X 16MM $726.75

10083611 SCREW NON LOCKING 3.5 X 1 $433.50

10083612 SURFACE ARTCLR 10MM NEXGE $3,825.00

10083613 LENS SV25T5 17.5 $883.01

10083614 LENS SV25T5 18.0 $883.01

10083615 LENS SV25T5 18.5 $883.01

10083616 PLATE CERVICAL 41MM, LEVE $8,381.00

10083617 SCREW CERVICAL 4X14MM VAR $1,440.75

10083618 ROD PREBENT 5.5 X120MM $2,278.00

10083620 PLATE DR NARROW LFT 8 HOL $4,398.75

10083621 SCREW BONE 2.7 X 12MM FUL $484.50

10083622 SCREW LOCK 2.7 X 20MM FUL $623.39

Page 59: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083623 SCREW LOCK 2.7 X 14MM FUL $623.39

10083624 SCREW LOCK 2.7 X 18MM FUL $623.39

10083625 SCREW LOCK 2.7 X 22MM FUL $623.39

10083626 SCREW REDUCTION 5X45MM $6,443.00

10083627 SHELL ASSEMBLY TALL 27MM $17,000.00

10083628 SHIM 9 TO 12 X27MM 0 DEG $17,000.00

10083629 GUIDE PIN 27MM $1,000.00

10083630 SHELL ASSEMBLY SHORT 27MM $17,000.00

10083631 SHIM 11 TO 14 X27MM 0 DEG $17,000.00

10083633 BIT DRILL 1.9MM CANNULATE $1,207.50

10083634 SCREW HEADLESS COMPRESSIO $2,365.13

10083636 PLATE CERVICAL 49MM, LEVE $10,081.00

10083637 FEMORAL HEAD SZ M 36MM $3,825.00

10083638 INSERT TIBIAL FIXED SZ 3 $4,250.00

10083639 INSERT INBONE POLY SIZE 3 $6,965.75

10083640 SPACER 10X24X12 OPAL REVO $12,951.88

10083641 SCREW 4.0 X 16MM VA ST $1,013.63

10083642 BIT DRILL 16MM FLAT CHUCK $1,371.40

10083643 SPACER 10X28X9MM OPAL $12,951.88

10083644 PLATE CERVICAL 80MM LEVEL $4,887.50

10083645 BIT DRILL 12MM $900.00

10083646 BLOCK FEMUR CUTTING SZ 4+ $575.00

10083647 COMPONENT FEMORAL SZ 4+ R $9,775.00

10083648 COMPONENT FEMORAL SZ 5 RG $16,575.00

10083649 INSERT TIBIAL SZ 5 RIGHT $8,287.50

10083650 PLATE CERVICAL 35MM, LEVE $8,381.00

10083651 LENS SND1T4 13.5 $883.01

10083652 LENS SND1T4 14.0 $883.01

10083653 LENS SND1T4 14.5 $883.01

10083654 LENS SV25T4 20.5 $883.01

10083655 LENS SV25T4 21.0 $883.01

10083656 LENS SV25T4 21.5 $883.01

10083657 SCREW REDUCTION 4.5X40MM $3,825.00

10083658 SCREW REDUCTION 4.5X45MM $3,825.00

10083659 ROD PREBENT 5.5X110MM $850.00

10083660 LENS SN6AT4 15.0 $490.01

10083661 LENS SN6AT4 25.0 $490.01

10083663 LENS SN6AT3 21.5 $490.01

10083664 LENS ZXT375 21.5 $1,035.01

10083665 BIT DRILL NONCANNULATED 2 $1,025.00

10083666 FIBER LASER 1000 MICRON E $2,100.00

10083667 ROD STRAIGHT 5.5 X 500 MM $2,210.00

10083668 INSERT INBONE POLY SIZE 3 $6,965.75

10083671 ROD PREBENT 5.5 X40MM $2,278.00

10083672 PADDLE LEAD MRI SURE SCAN $33,575.00

10083673 LENS SN6AT4 17.5 $490.01

10083674 BEARING MENISCAL MEDIUM R $4,934.25

Page 60: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083675 TPILF IBFD 25X9X9MM $8,500.00

10083676 TPILF IBFD 25X9X11MM $8,500.00

10083677 LENS SV25T4 18.5 $883.01

10083678 LENS SV25T4 19.0 $883.01

10083679 LENS SV25T4 19.5 $883.01

10083680 LENS SV25T3 18.5 $883.01

10083681 LENS SV25T3 19.0 $883.01

10083682 LENS SV25T3 19.5 $883.01

10083683 CAGE ALEUTIAN 14X18X50MM $35,266.50

10083685 PLATE CERVICAL 2 LEVEL 37 $4,037.50

10083686 BEARING MENISCAL MEDIUM L $4,934.25

10083687 LENS ZCT225 16.0 $520.01

10083688 LENS SN6AT3 23.0 $490.01

10083689 ROD TI 5.5 X 80MM MATRIX $1,067.69

10083690 SURFACE ARTICULAR FXD BRN $6,402.97

10083691 FEMUR STANDARD RGHT SZ 10 $10,625.00

10083692 LENS SN6AT7 21.0 $490.01

10083693 LENS ZXT150 23.0 $1,035.01

10083694 LENS ZXR00 15.5 $940.01

10083695 STEM SHOULDER PRIMARY 16X $13,175.00

10083696 PLUG BONE 13-17MM CEMENTE $530.40

10083697 SPACER CEMENT UNIVERSAL D $561.00

10083698 PIECE EXTENSION 70MM $13,091.70

10083700 STEM CEMENTED CURVED 13MM $16,689.75

10083701 STEM EXTENDER CEMENTED 80 $4,006.05

10083702 BASEPLATE TIBIAL KNEE MRH $14,328.45

10083703 BUMPER KNEE INSERT MRH 3 $2,664.75

10083704 INSERT TIBIAL KNEE MRH 16 $4,954.65

10083705 BUMPER SLEEVE BUSHINGS NE $7,004.85

10083706 AXLE KNEE HINGE ROTATING $4,439.55

10083707 COMPONENT TIBIAL ROTATING $12,821.40

10083708 SURFACE ARTICULAR FXD BRN $6,402.97

10083709 BIT DRILL 12MM FLATT CHUC $1,371.40

10083711 OVERDRILL 3.5 X 122MM AO $915.80

10083712 COUNTERSINK FR SCREW 02.7 $650.65

10083713 SCREW LOCKING 3.5 X 12MM $946.39

10083714 SCREW LOCKING 3.5 X 18MM $946.39

10083715 SCREW LOCKING 3.5 X 20MM $946.39

10083716 SCREW BONE NON LOCK 3.5 X $497.42

10083717 SCREW BONE NON LOCK 3.5 X $497.42

10083718 SCREW BONE NON LOCK 3.5 X $497.42

10083719 SCREW BONE NON LOCK 3.5 X $497.42

10083720 LENS ZXT225 24.5 $1,035.01

10083721 LENS ZXR00 11.5 $940.01

10083722 Lens ZCT150 7.0 $520.01

10083723 Lens ZCT150 7.5 $520.01

10083724 Lens ZCT150 6.0 $520.01

Page 61: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083726 PEEK ZERO-P 8MM VA LORDOT $13,965.50

10083727 MENISCAL REPAIR SYSTEM 12 $2,575.50

10083728 TIBIA NATURAL 5 DEG LEFT $3,825.00

10083729 ROD TI 5.5 X 50MM CURVED $1,067.69

10083730 PLATE CERVICAL 14MM $3,825.00

10083731 SCREW VARIABLE 14MM SELF $1,445.00

10083732 SCREW 4.0 X 18MM VA SD $1,013.63

10083733 PLATE 3 LEVEL 42MM SKYLIN $5,180.75

10083734 LENS ZXR00 26.5 $940.01

10083735 LENS ZXT150 23.5 $1,035.01

10083736 LENS ZXT150 21.5 $1,035.01

10083737 LENS SN6AT4 22.5 $490.01

10083738 LENS ZXR00 16.0 $940.01

10083739 COMPONENT FEMORALSZ F RGH $5,100.00

10083740 SURFACE ARTICULAR SZ E F $2,550.00

10083741 BLADE SAW 90X17X1.27MM OS $265.50

10083742 ROD PREBENT 5.5X130MM $850.00

10083743 MENISCAL REPAIR SYSTEM 24 $2,575.50

10083744 SCREW CENTRAL 6.5 X 45MM $212.50

10083745 PLATE 3 LEVEL 57MM $4,462.50

10083746 STEM SHOULDER PRIMARY MIN $13,175.00

10083747 LENS ZCB00 18.5 $195.00

10083748 LENS SN6AT6 19.5 $490.01

10083749 LENS SN6AT3 17.5 $490.01

10083750 LENS SN6AT8 28.0 $490.01

10083751 LENS ZCB00 22.5 $195.00

10083752 CAGE EXPANDABLE SZ10 24X1 $27,625.00

10083753 PEEK ZERO-P 7MM VA LORDOT $13,965.50

10083754 SCREW 3.7X14 VA SD ZPVA $1,532.13

10083755 LENS ZXR00 18.0 $940.01

10083756 LENS ZXR00 25.5 $940.01

10083757 LENS SN6AT5 24.0 $490.01

10083758 AUGMENT POSTERIOR FEMORAL $5,805.50

10083759 AUGMENT DISTAL FEMORAL 5X $5,805.50

10083760 AUGMENT DISTAL FEMORAL 5X $5,805.50

10083761 LENS SN6AT4 20.0 $490.01

10083762 PLATE 2 LEVEL 26MM SKYLIN $6,566.25

10083763 FEMORAL BOX OPEN 57.5MM R $9,775.00

10083764 LENS SN6AT7 29.5 $490.01

10083765 CANNULA TRANSPORT 8MM LEN $450.00

10083766 CANNULA FLOWPORT II W OBT $1,975.00

10083767 BUR ROUND XL 5.5MM DIAMON $1,442.00

10083768 LENS SN6AT4 23.0 $490.01

10083769 LENS ZCB00 21.5 $195.00

10083770 LENS ZCB00 22.0 $195.00

10083771 LENS SN6AT4 20.5 $490.01

10083772 LENS ZCT300 26.0 $520.01

Page 62: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083773 LENS ZXR00 19.5 $940.01

10083774 LENS ZXR00 13.0 $940.01

10083782 PRE-BENT ROD 5.5MM X 140M $2,278.00

10083783 LENS SN6AT3 22.0 $490.01

10083784 LENS SN6CWS 24.5 $225.00

10083785 CAGE EXPANDABLE METAL SZ $27,625.00

10083786 LENS SN6AT4 19.5 $490.01

10083787 LENS ZXT300 17.0 $1,035.01

10083788 KIT ACCESSORY PASSING ELE $1,250.00

10083789 K-WIRE GUIDE FLEX WITH CO $853.30

10083790 PLATE HUMERUS LATERAL 4HO $10,361.93

10083791 SCREW LOCKING 4.0 X 24MM $788.12

10083792 SCREW LOCKING 4.0 X 26MM $788.12

10083793 SCREW LOCKING 4.0 X 30MM $788.12

10083794 SCREW LOCKING 4.0 X 32MM $788.12

10083795 SCREW LOCKING 4.0 X 38MM $788.12

10083796 SCREW LOCKING 4.0 X 40MM $788.12

10083797 SCREW CORTEX IT 3.5 X 24M $125.97

10083798 BIT DRILL LOCKING 3.1 X 2 $927.20

10083799 BIT DRILL 2.5 X 216MM NON $1,550.40

10083800 DRIL TIP K-WIRE 2.0 X234M $311.60

10083801 PLATE CERVICAL 72MM LEVEL $4,887.50

10083802 SCREW LOCKING 4.0 X 36MM $788.12

10083803 SCREW YUKON 3.5 X 10MM $3,421.25

10083804 SCREW YUKON 3.5 X 12MM $3,421.25

10083805 SCREW SET YUKON $255.00

10083806 ROD CONTOURED 4.0 X 65MM $1,238.88

10083807 LENS ZCB00 7.5 $195.00

10083808 LENS ZXR00 21.5 $940.01

10083809 LENS ZCT150 25.0 $520.01

10083810 SPACER ACIS 9MM LORDOTIC/ $4,505.00

10083811 SHELL ACETABULAR 48MM SZ $18,270.75

10083812 COMPONENT PATELLO FEMRL S $18,168.75

10083813 PLATE CERVICAL 2 LEVEL 30 $4,037.50

10083815 PLATE CERVICAL 2 LEVEL 34 $4,037.50

10083816 SURGACE ARTICULAR FXD BRN $6,402.97

10083817 LENS ZCB00 20.0 $195.00

10083818 LENS ZXT225 15.5 $1,035.01

10083819 PLATE CERVICAL 16MM LEVEL $6,791.50

10083821 LLIF IBFD 18MMX45MM, NEUT $29,036.00

10083822 CAGE 5/1 40X10MM EPIPHANY $29,750.00

10083823 CAGE 5/1 40X12MM EPIPHANY $29,750.00

10083824 LENS SN6AT5 22.0 $490.01

10083825 LENS ZXT225 10.5 $1,035.01

10083826 LINER ACETABULAR SIZE 40M $9,167.25

10083827 LENS ZXR00 8.5 $940.01

10083828 LENS ZXR00 9.0 $940.01

Page 63: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083829 LENS ZXR00 9.5 $940.01

10083830 CEMENT BONE REFOBACIN 1X4 $743.75

10083831 INSERT TIBIAL FIXED SZ 4 $8,287.50

10083832 LENS ZXT150 13.5 $1,035.01

10083833 LINER ACETABULAR DML SZ 6 $6,375.00

10083835 LENS ZCB00 8.0 $195.00

10083836 LENS SN6AT4 16.5 $490.01

10083837 LENS ZXT225 25.0 $1,035.01

10083838 LENS ZCB00 21.0 $195.00

10083839 HEAD MODULAR 40MM DIAM -6 $6,481.25

10083840 INSERT TIBIAL FIXED SZ 4 $8,287.50

10083841 CAGE 5/1 45X12MM EPIPHANY $29,750.00

10083842 LLIF IBFD 18MMX50MM, NEUT $29,036.00

10083843 SCREW VARIABLE 12MM SELF $1,445.00

10083844 LENS ZXT150 24.0 $1,035.01

10083845 LENS ZXT150 24.5 $1,035.01

10083846 GUIDE ALIGNMENT INFINITY $5,000.00

10083847 BIT DRILL 4.8MM TIBIAL CO $1,395.00

10083848 REAMER TALAR SZ 1-3 $1,895.00

10083849 TRAY TIBIAL SZ 2 PLASMA S $26,520.00

10083850 DOME TALAR SZ 2 SULCUS PL $28,139.25

10083851 INSERT POLY ANKLE SZ 2 H: $9,286.25

10083852 GLENOID BASE HYBRID 4MM M $7,688.25

10083853 KIT IMPLANT 8X8MM FUSEFOR $4,802.50

10083854 HEAD MODULR SHLDR W/VRBL $8,359.75

10083855 STEM SHOULDER PRIMARY 19X $13,175.00

10083856 CAGE 5/1 45 X10MM EPIPHAN $29,750.00

10083857 INSERT TIBIAL SZ 5 LEFT 1 $8,287.50

10083858 SCREW 5.0 X 44MM TITANIUM $867.38

10083859 SCREW 5.0 X 55MM TITANIUM $867.38

10083860 BIT DRILL 3.5MM CANNULATE $1,636.15

10083861 GUIDE WIRE 2.0 X 150MM TH $220.70

10083862 LENS ZCB00 18.0 $195.00

10083863 LENS ZXT150 25.5 $1,035.01

10083864 SCREW REDUCTION 5X50MM $6,443.00

10083865 DEVICE FUSION INTERBDY 9X $18,487.50

10083866 BEARING TIBIAL DCM PS PLU $4,377.50

10083867 LINER ACETABULAR +5MM SZ $9,490.25

10083868 LENS SN6AT5 28.5 $490.01

10083869 LENS ZXT150 18.0 $1,035.01

10083870 LENS ZCT450 25.5 $520.01

10083871 LENS SN6AT5 12.5 $490.01

10083872 LENS ZXT225 7.0 $1,035.01

10083873 LENS ZXT225 7.5 $1,035.01

10083874 LENS ZXT225 8.0 $1,035.01

10083875 LENS ZXT225 8.5 $1,035.01

10083876 LENS ZXT225 9.0 $1,035.01

Page 64: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083877 LENS ZXT225 9.5 $1,035.01

10083878 LENS ZXT300 7.0 $1,035.01

10083879 LENS ZXT300 7.5 $1,035.01

10083880 LENS ZXT300 8.0 $1,035.01

10083881 LENS ZXT300 8.5 $1,035.01

10083882 LENS ZXT300 9.0 $1,035.01

10083883 LENS ZXT300 9.5 $1,035.01

10083884 INSERT TIBIAL SZ 5 LEFT 1 $8,287.50

10083885 COMPONENT FEMORAL SZ 6 LF $16,575.00

10083886 CAGE 11X21MM EXPANDABLE L $17,000.00

10083887 NEEDLE CURVED TROFLEX $2,652.00

10083889 LENS SN6AT6 20.0 $490.01

10083890 LENS SN6AT6 12.5 $490.01

10083891 LENS ZCB00 19.0 $195.00

10083892 TRAY TIBIAL SZ AA RIGHT M $7,650.00

10083893 BEARING MENISCAL SMALL RI $4,934.25

10083894 DEVICE FUSION INTERBDY 11 $18,487.50

10083895 LENS SN60WF 21.0 $220.00

10083896 LENS ZXT225 31.5 $1,035.01

10083897 LENS ZCT150 14.5 $520.01

10083898 LENS ZXT225 18.0 $1,035.01

10083899 LENS SN6AT4 26.5 $490.01

10083900 LENS SN6AT4 13.0 $490.01

10083901 LENS SN6AT4 12.5 $490.01

10083902 CAGE 5/1 50X10MM EPIPHANY $29,750.00

10083903 DEVICE FUSION INTERBDY 11 $18,487.50

10083904 CAGE 9X21MM EXPANDABLE LI $29,750.00

10083905 CAGE 11X23MM EXPANDABLE L $17,000.00

10083906 SCREW 7X45 TI MATRIX $3,108.03

10083907 HEAD COMPONET MODULAR 32 $4,046.00

10083908 LENS ZCB00 12.5 $195.00

10083909 LENS ZCB00 13.0 $195.00

10083910 LENS ZCB00 13.5 $195.00

10083911 LENS ZXT150 7.5 $1,035.01

10083912 LENS ZXT150 8.0 $1,035.01

10083913 LENS ZXT150 8.5 $1,035.01

10083914 INSERT SZ 5-6 9MM HIGH FL $4,250.00

10083915 ANCHOR SUTURE SWIVLK BICO $2,584.00

10083916 ANCHOR SUTURE SWIVLK BICO $2,584.00

10083917 PUNCH CORKSCREW FT SWIVEL $540.00

10083918 PLATE MINI 2.0 X 44MM SIN $2,851.67

10083919 LOCKING SCREW 2.0X6MM $211.74

10083920 LENS ZXT150 29.0 $1,035.01

10083921 LENS SN6AT6 20.5 $490.01

10083922 Lens SN6AT3 16.5 $490.01

10083923 LENS ZXR00 5.0 $940.01

10083924 LENS ZXR00 5.5 $940.01

Page 65: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083925 LENS ZXR00 6.0 $940.01

10083926 PEEK CERVICAL 10MM $8,810.25

10083927 PLATE SUPERIOR 7 HOLE LEF $4,760.80

10083928 SCREW LOCKING T10 3.5 X 1 $768.27

10083929 SCREW LOCKING T10 3.5 X 1 $768.27

10083930 SCREW LOCKING T10 3.5 X 1 $768.27

10083931 TRAY TIBIAL INBONE SZ 5 R $6,468.50

10083932 INSERT INBONE POLY SIZE 4 $6,965.75

10083933 BIT DRILL SIZE 5MM INBONE $770.00

10083934 LINER ACETABULAR RINGLOC $14,101.50

10083935 STEM MALLORY/HEAD FEMORAL $14,275.75

10083936 KIT INSTRUMENT ACL DISPOS $2,200.00

10083937 SCREW GENTLE THREAD 8 X 2 $1,657.00

10083938 PLATE CERVICAL 14MM LEVEL $6,791.50

10083939 INSERT TIBIAL SZ 5 LEFT 1 $4,250.00

10083940 LENS SV25T4 15 $883.01

10083941 LENS SN6AT4 18.0 $490.01

10083942 LENS SN6AT3 18.5 $490.01

10083943 LENS SND1T3 22.0 $883.01

10083944 PLATE CERVICAL 52MM, LEVE $10,081.00

10083945 BLOCK DISTAL FEMORAL AUGM $4,239.38

10083946 BLOCK POSTERIOR FEMORAL A $4,239.38

10083947 PATELLA POLY 29 X 8.0MM C $2,975.00

10083948 COMPONENT TIBIAL SZ 2 STE $3,825.00

10083949 COMPONENT FEMORAL SZ C RG $25,741.49

10083950 SURFACE ARTICULAR 17MM CO $8,953.56

10083951 PEEK ZERO-P 9MM VA LORDOT $13,965.50

10083952 SCREW 3.7X18MM VA SD ZPVA $1,126.25

10083953 LENS SV25T3 21.5 $883.01

10083954 LENS SV25T0 22.0 $883.01

10083955 INSERT INBONE POLY SIZE 2 $6,965.75

10083956 IMPLANT FIXATION 6.5MM KN $2,550.00

10083957 PLATE CERIVCAL APC 58MM L $7,012.50

10083958 CATHETER PASSER .38CM DIS $490.00

10083959 LENS SN6AD1 15.0 $883.01

10083960 LENS SN6AT5 18.0 $490.01

10083961 LENS SV25T0 25.5 $883.01

10083962 LENS ZXT150 22.5 $1,035.01

10083963 LENS SV25T0 15.5 $883.01

10083964 LENS SV25T4 22.0 $883.01

10083965 KIT BIOLOGICS SPRAY BIOME $350.00

10083966 TIP APPLICATOR GPS DUAL S $250.00

10083967 ROD PREBENT 5.5 X130MM $1,381.25

10083968 WIRE LEAD CLIP ON DISPOSA $1,365.00

10083969 PROBE STIMU NERVE BALL TI $1,365.00

10083970 STEM FEMORAL SZ 10 130MM $11,475.00

10083971 PROBE LARYNGEAL SURF ELEC $1,250.00

Page 66: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10083972 PROBE MONOPLAR PEDICLE 16 $1,250.00

10083973 LENS SN6AT4 11.5 $490.01

10083974 LENS SV25T0 19.0 $883.01

10083975 LENS SN6AD1 20.5 $883.01

10083976 LENS SN6AT4 13.5 $490.01

10083977 WEDGE BIOFOAM EVANS 20 X $8,457.50

10083978 SCREW DARCO HEAD 4.5 X 50 $973.25

10083979 SYSTEM STRYKER OSC 90X19 $610.00

10083980 BLOCK CUTTING FEMUR SZ 5+ $575.00

10083981 COMPONENT FEMORAL SZ 5+ L $9,775.00

10083982 INSERT TIBIAL SZ 5 RGHT 1 $4,250.00

10083983 STEM SHOULDER MINI HUMERA $13,175.00

10083986 SCREW 8X44 TI MATRIX $2,662.46

10083987 LENS SN6AD1 25.5 $883.01

10083988 LENS SN6AT3 18.0 $490.01

10083989 LENS SN6AD1 16.0 $883.01

10083990 SCREW HEADLESS 3.0 X 28MM $981.75

10083991 PLATE MEDIUM LFT MTP FUSI $6,332.50

10083992 SCREW LOCKING 2.7 X 10MM $769.25

10083993 COUNTERSINK CANNULATED 2. $750.00

10083994 SCREW NON LOCK 3.5 X 16M $425.00

10083995 KIT IMPLANT 12X12MM FUSEF $4,228.75

10083996 PROBE MONOPLAR PEDICLE 20 $1,250.00

10083997 SCREW CANNULATED TITAN 4. $815.28

10083998 SCREW CANNULATED TITAN 4. $815.28

10083999 BLOCK TIBIAL AUGMENTATION $5,291.25

10084000 TRAY TIBIAL STEMMED W LOC $13,502.25

10084001 BEARING TIBIAL PS VANGUAR $6,800.00

10084002 AUGMENTATION TIBIAL SZ 2 $6,241.25

10084003 STEM EXTENSION FLUTED 10M $7,942.83

10084004 TRAY TIBIAL FIXED SZ 2 LE $13,615.94

10084005 PLATE CERVICAL 32MM LEVEL $6,162.50

10084006 PLATE CERVICAL 38MM LEVEL $6,162.50

10084007 LENS SV25T3 16.5 $883.01

10084008 LENS SND1T4 12.5 $883.01

10084009 LENS SN6AT4 15.5 $490.01

10084010 PATELLA STNDARD 34X8.5MM $2,125.00

10084011 BEARING TIBIAL PS VANGUAR $6,800.00

10084012 LENS SN6AT9 22.5 $490.01

10084013 LENS ZCT525 17.5 $520.01

10084014 LENS SN60WF 22.5 $225.00

10084015 BEARING TIBIAL 14X 63/67M $2,975.00

10084016 INSERT TIBIAL FIXED SZ 3 $4,250.00

10084017 LENS SND1T4 12.0 $883.01

10084018 LENS SV25T0 11.5 $883.01

10084019 LENS ZXT225 25.5 $1,035.01

10084020 LENS ZXT225 22.0 $1,035.01

Page 67: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084022 LENS SV25T0 8.5 $883.01

10084024 CENTRALIZER STEM DISTAL 1 $892.50

10084025 SURFACE ARTICULAR FXD BRN $6,402.97

10084026 KIT INSERTION FOR 3.0MM K $2,540.00

10084027 PLATE MINI 2.0MM SINGLE B $2,851.67

10084028 LENS SV25T4 26.0 $883.01

10084029 SCREW 6.5X45MM MODULAR CR $1,326.00

10084030 HEAD THREADED TULIP POLYA $2,660.50

10084031 CAPS LOCKING THREADED CRE $561.00

10084032 ROD CURVED 5.5X65MM TITAN $1,066.75

10084033 SPACER 8X22MM 8-14MM 10 D $17,000.00

10084034 ROD CURVED 5.5X45MM TITAN $1,066.75

10084035 SPACER 8X22MM 8-26MM 10 D $17,000.00

10084036 SPACER 8X22MM 8-22MM 10 D $17,000.00

10084037 LENS ZXR00 24.5 $940.01

10084038 LENS ZXT150 22.0 $1,035.01

10084039 LENS SN60WF 16.5 $225.00

10084040 LENS SN6AD1 12.5 $883.01

10084041 STEM SHOULDER MINI 8X83MM $13,175.00

10084042 SCREW 6.5X50MM MODULAR CR $1,326.00

10084043 SCREW 7.5X50MM MODULAR CR $1,326.00

10084044 ROD CURVED 5.5X100MM TITA $1,066.75

10084045 ROD CURVED 5.5X80MM TITAN $1,066.75

10084046 SPACER 10X26MM 10-17MM RI $17,000.00

10084047 LENS SN6AD1 9.0 $883.01

10084048 LENS SN6AD1 9.5 $883.01

10084049 ROD PREBENT 5.5 X 40MM $850.00

10084050 LASSO SUTURE CRESCENT SD $1,000.00

10084051 SCREW 5.5X50MM MODULAR CR $1,326.00

10084052 SURFACE ARTICULAR FXD BRN $5,100.00

10084053 LENS SND1T3 25.0 $883.01

10084054 LENS SND1T3 19.0 $883.01

10084055 PLATE ANTERIOR 7 HOLE MED $5,289.38

10084056 SCREW BONE 3.5 X 16MM T10 $392.65

10084057 SCREW BONE 3.5 X 22MM T10 $392.65

10084058 PACK FOAM 2.5CC BBTRAUMA $5,183.13

10084059 SCREW REDUCTION 7 X 50MM $5,312.50

10084060 HEAD COMPONENT MODULAR 32 $2,125.00

10084061 LENS SN6AT4 16.0 $490.01

10084062 LENS SND1T4 13.0 $883.01

10084063 PLATE CERVICAL 16MM $3,825.00

10084064 ELECTRODE LARYNGEAL SURF $1,250.00

10084065 PEEK CERVICAL 11MM $6,268.75

10084066 PLATE CERVICAL 30MM LEVEL $6,162.50

10084067 SCREW 6.5X55MM MODULAR CR $1,326.00

10084068 SPACER 10X30MM 10-17MM RI $17,000.00

10084069 ROD CURVED 5.5X40MM TITAN $1,066.75

Page 68: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084070 SCREW 3.5 X 12MM QUARTEX $4,551.75

10084071 ROD CURVED 4.0X30MM $1,066.75

10084072 CAP LOCKING QUARTEX $561.00

10084073 WAND COBLATION 50 FLOW WE $1,250.00

10084074 LENS SN6AD1 18.5 $883.01

10084075 SPACER 10X22MM SMALL OBLI $11,276.00

10084076 PLATE TIBIAL FXD I-BEAM W $3,825.00

10084077 BEARING TIBAL DCM PS PLUS $2,975.00

10084078 AUGMENT POSTERIOR FEMORAL $5,805.50

10084079 STEM KNEE SPLINED W/SCREW $7,420.50

10084080 BEARING REVERSE SHLDR E1 $5,100.00

10084081 SPACER 10X22MM 9-15MM RIS $17,000.00

10084082 SPACER 10X26MM 7-14MM RIS $17,000.00

10084083 PLATE CERVICAL 10MM XTEND $4,279.75

10084084 SCREW VARIABLE 14MM SELF $1,007.25

10084085 SPACER CERVICAL 12 X 14MM $11,776.75

10084086 LENS SN6AT6 15.0 $490.01

10084087 HEAD COMPONENT MODULAR 28 $2,125.00

10084088 BEARING HIP 28X46MM G DUA $11,475.00

10084089 SCREW 7.5X55MM MODULAR CR $1,326.00

10084090 ROD CURVED 5.5X50MM TITAN $1,066.75

10084091 SPACER STATIC G PEEK SUST $12,716.00

10084092 SURFACE ARTICULAR FXD BRN $6,402.97

10084093 PROBE MONOPLAR PEDICLE 90 $1,250.00

10084094 PACK PINS THREADED LONG 3 $1,500.00

10084095 LENS ZCB00 32.0 $195.00

10084096 LENS ZCT300 24.5 $520.01

10084097 LENS ZCT300 10.5 $520.01

10084098 DEVICE FUSION INTERBDY 9X $25,287.50

10084099 SCREW REDUCTION 4.5X30MM $3,825.00

10084100 ROD CREO 5.5X55MM TITANIU $1,066.75

10084101 SPACER 10X22MM 15 DEGREE $17,000.00

10084102 LENS SN6AT5 20.0 $490.01

10084103 LENS SND1T3 12.5 $883.01

10084104 ROD CURVED 5.5X55MM TITAN $1,066.75

10084105 MENISCAL REPAIR SYSTEM 0 $2,575.50

10084106 SPACER 10X30MM 10-22MM 9- $17,000.00

10084107 SYSTEM CEMENT MIXING/DELV $450.00

10084108 SURFACE ARTICULAR LEFT 12 $6,402.97

10084109 LENS SV25T0 20.0 $883.01

10084110 LENS SND1T3 18.5 $883.01

10084111 LENS SN6AT4 18.5 $490.01

10084112 CAGE 5/1 50X12MM EPIPHANY $29,750.00

10084113 SPACER 10X22MM 7-13MM RII $17,000.00

10084114 SPACER ACDF 14 X 16MM 6MM $11,776.75

10084115 ROD CURVED 5.5X60MM TITAN $1,066.75

10084116 SPACER STATIC G 10X22MM 1 $12,716.00

Page 69: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084117 SCREW 7.5X40MM MODULAR CR $1,326.00

10084118 SPACER CERVICAL 15X18MM 8 $11,776.75

10084119 SPACER CERVICAL 15X18MM 7 $11,776.75

10084120 SCREW VARIABLE 4.2X16MM S $1,007.25

10084121 PLATE CERVICAL 28MM XTEND $4,723.25

10084122 LENS SV25T0 13.0 $883.01

10084123 LENS SN6AD1 24.0 $883.01

10084124 LENS SN6AD1 20.5 $883.01

10084125 LENS ZXT150 15.0 $1,035.01

10084126 LENS SND1T3 22.5 $883.01

10084127 SCREW 3.5 X 14MM QUARTEX $4,551.75

10084128 SCREW 5.5 X 30MM QUARTEX $4,551.75

10084129 SCREW 3.5 X 16MM QUARTEX $4,551.75

10084130 ROD CURVED 4.0X105MM $862.75

10084131 ROD CURVED 4.0X120MM $862.75

10084132 ROD CREO 5.5X35MM TITANIU $1,066.75

10084133 SPACER 10X22MM 11-17MM RI $17,000.00

10084136 LENS S122UV 11.5 $350.00

10084137 LENS SV25T0 21.5 $883.01

10084138 LENS SV25T3 12.5 $883.01

10084139 BEARING TIBIAL 12X79/83MM $2,975.00

10084140 BEARING TIBIAL DCM PS PLU $2,975.00

10084141 INSERT TIBIAL FIXED SZ 5 $4,250.00

10084142 LENS SV25T0 21.0 $883.01

10084143 LENS SV25T0 23.5 $883.01

10084144 BEARING TIBIAL PS VANGUAR $6,800.00

10084145 FEMUR NARROW RGHT SZ 5 CE $10,625.00

10084146 SURFACE ARTICULAR FXD BRN $5,100.00

10084147 BEARING MENISCAL MEDIUM R $4,675.00

10084148 LENS SND1T3 20.5 $883.01

10084149 LENS SN6AD1 21.0 $883.01

10084150 LENS SND1T5 13.0 $883.01

10084151 PROBE MONOPLAR PEDICLE 16 $1,250.00

10084152 ROD STRAIGHT 5.5 X 300MM $2,278.00

10084153 PLATE HUMERUS LATERAL 3HO $10,672.77

10084154 SCREW LOCKING 4.0 X 44MM $811.75

10084155 SCREW LOCKING 4.0 X 50MM $811.75

10084156 SCREW CANCELLOUS 4X46MM F $182.96

10084157 SCREW LOCKING 4.0 X 28MM $811.75

10084158 SCREW CORTEX TI 3.5 X 28M $129.75

10084159 ROD PREBENT 5.5 X 150MM $1,381.25

10084160 SPACER ACDF 12X14MM 6MM 7 $11,776.75

10084161 SPACER ACDF 12X14MM 7MM 7 $11,776.75

10084162 HEAD THD 5.5 TULIP POLYAX $2,660.50

10084163 SCREW INTERF GENTLE THREA $1,657.50

10084164 SCREW INTERF 12X25MM FULL $1,657.50

10084165 WASHERLOC TISSUE FIXATION $3,442.50

Page 70: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084166 WASHERLOC CANCELLOUS SCRE $1,232.50

10084167 DEVICE FUSION INTERBDY 9X $18,487.50

10084168 PEEK CERVICAL 9MM 6 DEGRE $5,610.00

10084169 PEEK CERVICAL 8MM 6 DEGRE $5,610.00

10084170 PLATE OZARK 66MM 3 LEVEL $4,221.00

10084171 SCREW VAR.4X14MM SELF STA $765.85

10084172 KIT AVAFLEX CN W/O NEEDLE $3,635.00

10084173 KIT IVAS ELITE FRACTURE 1 $10,426.75

10084174 ROD CURVED 5.5X90MM TITAN $1,066.75

10084175 CANNULA 8 X 45MM THREADED $156.50

10084176 LENS SN6AT7 20.5 $490.01

10084177 LENS SV25T0 26.5 $883.01

10084178 LENS SN60AT 23.0 $199.00

10084179 LENS SN6AT7 12.5 $490.01

10084180 BLADE SAW STRYKER NARROW $875.00

10084181 BLADE SAW 25X90X1.37MM ST $265.50

10084182 LINER ACETABULAR DMM SZ 6 $6,375.00

10084183 LENS SN6AD1 22.5 $883.01

10084184 LENS SN6AT4 21.5 $490.01

10084185 LENS SN6AD1 16.5 $883.01

10084187 VALOR NAIL SMALL LT. 10 X $12,180.50

10084188 VALOR SCREW 5 MM X 30 MM $1,151.75

10084189 VALOR SCREW 5 MM X 50 MM $1,151.75

10084190 VALOR SCREW 5 MM X 85 MM $1,151.75

10084191 VALOR NAIL DRILL SHORT $1,250.00

10084194 ANCHOR 6.5MM DOUBLE LOAD $2,380.00

10084195 ANCHOR SUTURE 6.8MM #2 MA $2,380.00

10084196 COMPONENT FEMORAL SZ 6 RG $9,775.00

10084197 SCREW 5.5X45MM MODULAR CR $1,326.00

10084198 CONNECTOR CROSS 38 -50 MM $5,321.00

10084199 SCREW REDUCTION 6 X 55MM $5,312.50

10084200 INSERT TIBIAL FIXED SZ 2 $4,250.00

10084201 SPACER CERVICAL 12X14 5MM $4,080.00

10084202 ALLOGRAFT SPACER CERVICAL $4,080.00

10084203 PLATE ACDF 24MM XTEND 2 L $4,730.25

10084204 ROD 4.0X40MM QUARTEX $1,066.75

10084205 OVERDRILL 2.7MMX122MM AO $943.25

10084206 SCREW BONE NON LOCK 2.7X1 $512.34

10084207 SCREW BONE NON LOCK 2.7X2 $512.34

10084208 SCREW BONE NON LOCK 3.5X1 $512.34

10084209 SCREW LOCKING 3.5X16MM FU $974.78

10084210 SCREW LOCKING 3.5X14MM FU $974.78

10084211 SCREW CORTEX SELF TPNG ST $318.75

10084212 BEARING TIBAL DCM PS PLUS $2,975.00

10084213 CONNECTOR CROSS 45X60MM P $5,321.50

10084214 COUNTER SINK 7.0MM $970.00

10084215 SCREW HEADLESS MUC 7.0X65 $3,706.00

Page 71: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084216 SCREW HEADLESS MUC 4.3X60 $1,041.25

10084217 WEDGE BIOFOAM COTTON 20X7 $8,466.00

10084218 CONNECTOR CROSS 58 -70MM $5,321.00

10084219 PLATE VOLAR LEFT STANDARD $4,574.49

10084220 SCREW BONE 2.4 X 24 $499.04

10084221 SCREW BONE 2.4 X 28 $499.04

10084222 LENS SN6AT3 13.0 $490.01

10084223 LENS SV25T0 25.0 $883.01

10084225 BEARING MANISCAL ANATOMIC $4,675.00

10084226 STEM FEMORAL REV LAT SIZE $32,575.40

10084227 STEM FEMORAL SZ 5 LEFT TA $11,050.00

10084228 ROD CURVED 5.5X70MM TITAN $1,066.75

10084229 SURFACE ARTICULAR LEFT 11 $5,100.00

10084230 FEMUR STANDARD LEFT SZ 5 $10,625.00

10084231 STEM FEMORAL SZ 4 LEFT TA $11,050.00

10084232 HEAD REDUCTION POLY-AXID $2,660.50

10084233 SPACER ALIF MIS INDEPENDE $28,657.25

10084234 ANCHOR 25MM $1,041.25

10084235 KIT FOOT & ANKLE KNEE CRE $10,731.25

10084236 LENS SA6AT3 13.0 $490.01

10084237 LENS SND1T3 18.0 $883.01

10084238 LENS SV25T3 10.5 $883.01

10084239 LENS SND1T3 16.5 $883.01

10084240 LENS SV25T3 13.0 $883.01

10084241 LENS SA6AT6 19.5 $883.01

10084242 ROD CURVED 5.5X40MM TITAN $1,066.75

10084243 LINER ACETABULAR +5MM SZ $9,490.25

10084244 PATELLA POLY 41 X 10MM CE $2,975.00

10084245 SURFACE ARTICULAR LEFT 14 $6,402.97

10084246 BEAM SALVATION 6.5 X 115M $7,016.75

10084247 BEAM SALVATION 6.5 X 80MM $7,016.75

10084248 ROD CURVED 5.5X95MM TITAN $1,066.75

10084249 SCREW BONE 3.6MM VARIABLE $1,126.25

10084250 SCREW BONE 4.2MM VARIABLE $1,126.25

10084251 PLATE 16X8MM RP COALITION $10,820.50

10084252 SPACER 10X16X8MM 7 DEGREE $4,505.00

10084253 LENS SV25T0 19.5 $883.01

10084254 LENS SV25T3 23.0 $883.01

10084255 LENS SA6AT3 22.5 $490.01

10084256 LENS SA6AT4 26.5 $490.01

10084257 LENS SA6AT4 18.0 $490.01

10084258 LENS SA6AT4 13.5 $490.01

10084259 LENS SV25T0 24.0 $883.01

10084260 LENS SND1T4 19.0 $883.01

10084261 LENS SA6AT3 24.0 $490.01

10084262 LENS SA6AT6 24.0 $490.01

10084263 COUNTERSINK CANNULATED 2. $750.00

Page 72: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10084264 SCREW DART FIRE 2.5 X 12M $981.75

10084265 SPACER 8X14X5MM 7 DEGREE $4,505.00

10084266 SPACER 8X14X7MM 7 DEGREE $4,505.00

10084267 PLATE 12X14MM 5 DEGREE RP $10,820.50

10084268 PLATE 12X14MM 7 DEGREE RP $10,820.50

10084269 FEMORAL CR VANGUARD 75MM $11,050.00

10084270 SCREW CANNULATED 4.5 X 38 $872.10

10084271 BIT DRILL 2.4MM $958.75

10084272 SCREW CANNULATED 4.0X46MM $1,004.06

10084273 PLATE LAPIDUS RIGHT NO AR $6,768.13

10084274 SCREW LOCKING PLATE 3.5 X $856.38

10084275 SCREW NON LOCK PLATE 3.5 $663.00

10084276 SYSTEM STAPLE 10X10X10MM $6,063.69

10084277 SCREW BREAK OFF 2.0X16MM $1,322.81

10084278 SCREW BREAK OFF 2.0X14MM $1,322.81

10084279 INSTRUMENT SET KNEE SPHER $2,500.00

10084280 INSTRUMENT SET FEMORAL KN $1,500.00

10084281 FEMORAL STEM SZ 4 RGHT TA $11,050.00

10084282 SCREW REDUCTION 6 X 35MM $5,312.50

10084283 ANCHOR SUTURE 5.5X14.7MM $2,159.00

10084284 SPACER CERVICAL 14X16X7MM $11,776.75

10084285 SPACER CERVICAL 14X16X8MM $11,776.75

10084286 PLATE 2 LEVEL 32MM SKYLIN $4,730.25

10084287 SPACER 7MM CERVICAL ALLOG $4,472.06

10084288 SPACER 8MM CERVICAL ALLOG $4,471.00

10084289 JOINT FINGER W GROMMENTS $4,981.00

10084290 LENS SA6AT3 22.0 $490.01

10084291 LENS SA6AT5 15.0 $490.01

10084292 LENS SA6AT3 24.5 $490.01

10084293 LENS SV25T0 22.5 $883.01

10084294 LENS SND1T3 11.0 $883.01

10084295 LENS SV25T4 17.0 $883.01

10084296 LENS SN6AD1 12.0 $883.01

10084298 KIT SIZER ALLOGRAFT OSTEO $4,750.00

10084299 BIT DRILL 15MM CANNULATED $1,050.00

10084300 KIT INSTRUMENT ALLOGRAFT $6,500.00

10084301 ALLOGRAFT 15MM OSTEOCHOND $18,190.00

10084302 SCREW SHORT THREAD 4.0 X $1,092.25

10084303 SCREW LOCKING 2.7 X 20MM $858.50

10084305 SCREW NON LOCK PLATE 3.5 $663.00

10084306 STEM SHOULDER PRIMARY 14X $13,175.00

10084307 BLOCK CUTTING FEMUR SZ 4+ $575.00

10084308 BLOCK CUTTING TIBIAL SZ 3 $575.00

10084309 INSERT TIBIAL FIXED SZ 4 $4,250.00

10084310 PLATE CERIVCAL APC 64MM L $7,012.50

11062252 CSF SHUNT REPROGRAM $617.00

11093000 EKG 12-LEAD $158.00

Page 73: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

14095861 MUSCLE TEST 2 LIMBS $400.00

14095885 MUSC TST DONE W/NERV TST $435.00

14095907 NVR CNDJ TST 1-2 STUDIES $610.00

14095927 SLS-EPS PERIPH NRV, TRUNK $950.00

14095937 NEUROMUSCULAR JUNCTION TE $550.00

14095938 SOMATOSENSORY TESTING $2,000.00

14095939 C MOTOR EVOKED UPR & LWR $2,400.00

14095955 EEG DURING NONCRANIAL SUR $3,200.00

20027006 Ova and Parasites, Feces, $25.50

20044335 DIBUCAINE INHIBITION NUMB $12.09

20045790 CARBAMAZEPINE, FREE AND T $47.10

20087252 VIRUS INOCULATE TISSUE CU $104.00

21062305 MYELOGRAPHY LUMBAR INJECT $3,600.00

21071045 CHEST 1 VW $156.80

21071046 CHEST 2 VW $156.80

21071048 CHEST 4+ VIEWS $156.80

21072081 X-RAY EXAM ENTIRE SPI 1 V $156.80

21072082 X-RAY EXAM ENTIRE SPI 2/3 $156.80

21072083 X-RAY EXAM ENTIRE SPI 4/5 $156.80

21072084 X-RAY EXAM ENTIRE SPI 6/> $156.80

21074018 ABDOMEN 1 VW $205.00

21074019 ABDOMEN 2 VW $156.80

21074300 CHOLANGIOGRAM INTRAOP $730.00

21076000 FLUORO <1 HR $1,121.08

21077001 FLUORO GUIDED FOR VEIN DE $545.90

21077012 CT GUIDED NDL PLCMT BX/AS $1,913.39

26097161 PT EVAL LOW COMPLEX 20 MI $325.00

26097162 PT EVAL MOD COMPLEX 30 MI $350.00

26097163 PT EVAL HIGH COMPLEX 40 M $375.00

27097127 THER IVNTJ W/FOCUS COG FU $50.76

27097165 OT EVAL LOW COMPLEX 30 MI $325.00

27097166 OT EVAL MOD COMPLEX 45 MI $350.00

27097167 OT EVAL HIGH COMPLEX 60 M $375.00

28595782 PEDIATRIC SLEEP STUDY $4,730.00

28595783 PEDIATRIC SLEEP STUDY WIT $4,128.00

28595803 ACTIGRAPHY TESTING $396.75

28595806 HOME SLEEP TEST $512.00

28595807 PAP NAP $2,064.00

28595808 ATTENDED SLEEP STUDY 1-3> $2,408.00

28595810 ATTENDED SLEEP STUDY 4/> $3,360.00

28595811 ATTENDED SLEEP STUDY WITH $4,080.00

100033368 Electrode VAPR w/hand con $1,275.00

100333182 RELOAD ETS 45 ENDO LINER $648.51

10031161A GASTROVIEW 30 ML $20.40

10031365B OMNIPAQUE 180 MG / 20 ML $90.80

10032485A LENS AO60 4.0 $200.00

10032488A LENS AO60 6.0 $200.00

Page 74: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10032492A LENS AO60 8.0 $200.00

10032494A LENS AO60 9.0 $200.00

10032496C LENS AO60 10.0 $200.00

10032497A LENS AO60 10.5 $200.00

10032498A LENS AO60 11.0 $200.00

10032499A LENS AO60 11.5 $200.00

10032500A LENS AO60 12.0 $200.00

10032501A LENS AO60 12.5 $200.00

10032502A LENS AO60 13.0 $200.00

10032503A LENS AO60 13.5 $200.00

10032504A LENS AO60 14.0 $200.00

10032505A LENS AO60 14.5 $200.00

10032506A LENS AO60 15.0 $200.00

10032507A LENS AO60 15.5 $200.00

10032508A LENS AO60 16.0 $200.00

10032509A LENS AO60 16.5 $200.00

10032510A LENS AO60 17.0 $200.00

10032511A LENS AO60 17.5 $200.00

10032512A LENS AO60 18.0 $200.00

10032513A LENS AO60 18.5 $200.00

10032514A LENS AO60 19.0 $200.00

10032515A LENS AO60 19.5 $200.00

10032516A LENS AO60 20.0 $200.00

10032517A LENS AO60 20.5 $200.00

10032518A LENS AO60 21.0 $200.00

10032519A LENS AO60 21.5 $200.00

10032520A LENS AO60 22.0 $200.00

10032521A LENS AO60 22.5 $200.00

10032522A LENS AO60 23.0 $200.00

10032523A LENS AO60 23.5 $200.00

10032524B LENS AO60 24.0 $200.00

10032525A LENS AO60 24.5 $200.00

10032526A LENS AO60 25.0 $200.00

10032527A LENS AO60 25.5 $200.00

10032528B LENS AO60 26.0 $200.00

10032529A LENS AO60 26.5 $200.00

10032530A LENS AO60 27.0 $200.00

10032531A LENS AO60 27.5 $200.00

10032533A LENS AO60 28.5 $200.00

10032534A LENS AO60 29.0 $200.00

10032536A LENS AO60 30.0 $200.00

10032539A LENS LI61AO 3.0 SOFPORT $200.00

10032554A LENS LI61AO 11.5 SOFPORT $200.00

10032556A LENS LI61AO 12.5 SOFPORT $200.00

10032569A LENS LI61AO 19.0 SOFPORT $200.00

10032570A LENS LI61AO 19.5 SOFPORT $200.00

10032575A LENS LI61AO 22.0 SOFPORT $200.00

Page 75: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10032576A LENS LI61AO 22.5 SOFPORT $200.00

10032609C MESH RIGHT LARGE 3DMAX $988.30

10032625A LENS ZMB00 24.0 $940.01

10032674A LENS SN6AT6 22.0 $490.01

10032761A MORSELIZED CANCELLOUS ALL $2,030.00

10032761B MORSELIZED CANCELLOUS ALL $2,030.00

10032761C MORSELIZED CANCELLOUS ALL $1,972.00

10032764B MORSELIZED CANCELLOUS ALL $16,800.00

10032764C MORSELIZED CANCELLOUS ALL $16,800.00

10032791I BOLING EYE PACK MINI $492.20

10032869A LENS MN60MA 2.0 $199.00

10033366A Lens L122UV 5.5 ant chamb $350.00

10033566A STENT LEFT ISTENT PRE-LOA $7,026.49

10033865A GRAFT MESH EPIX DEHYD AMN $1,481.66

10033991A CONTRAST MULTIHANCE 529MG $294.40

10033991B CONTRAST MULTIHANCE 529MG $294.40

10034128B ADHESIVE SKIN PRINEO DERM $513.00

10080024B LENS SN60WS 15.0 $220.00

10080036A LENS SN6AD1 20.5 $883.01

10080095B LENS SN60WF 21.5 $220.00

10080096B LENS SN60WS 17.0 $220.00

10080102A LENS SN60WS 23.5 $220.00

10080105A LENS SN6AD1 20.0 $883.01

10080111A LENS SN6CWS 20.0 $225.00

10080263A LENS SN6AT5 13.5 $490.01

10080266A FEMORAL STEM SZ 5 $11,050.00

10080295C TIBIAL INSERT FIXED SZ 4 $4,037.50

10080328A LENS ZMA00 18.5 $940.01

10080342A POLY SCREW 7 X 35MM $8,015.50

10080344A CERV. PLATE LV 2- 35MM $8,309.60

10080360B LENS MN60AC 19.5 $199.00

10080361C LENS SN6AT4 14.0 $490.01

10080367B POLY SCREW 5 X 45MM $8,015.50

10080374B POLY SCREW 6 X 50MM $8,015.50

10080434I VARIAX FIB PLATE $2,913.89

10080444I FEMORAL STEM SZ 3 (CERAMI $14,102.95

10080470A LENS ZMB00 22.5 $940.01

10080471A LENS ZMA00 21.5 $940.01

10080472A LENS SN6AT3 21.0 $490.01

10080473A LENS SN6AT4 24.0 $490.01

10080474A LENS SN6AT3 15.0 $490.01

10080476I TIBIAL PLATE FIXED $5,159.50

10080477I VANGUARD FEMORAL 70MM $11,130.75

10080478I VANGUARD TIBIAL BEARING 1 $9,426.50

10080504A BIOFOAM WEDGE 20X6.5 $7,586.25

10080507A LENS SN6AT3 20.5 $490.01

10080508A LENS SN6AT3 22.5 $490.01

Page 76: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10080509A LENS SN60WS 15.5 $220.00

10080510A LENS SN6AT3 17.0 $490.01

10080511A LENS SN6CWS 18.0 $225.00

10080513A FEMORAL HEAD SZ S 28MM $10,412.50

10080515A FEMORAL STEM SZ 4 $12,750.00

10080526A FLEXIBLE HINGE TOE IMPLAN $4,496.50

10080527A PRE-BENT ROD 5.5 X 70MM $2,213.40

10080533B LENS ZMB00 20.0 $940.01

10080534A LENS ZMA00 19.0 $940.01

10080536C LENS SN60WF 14.0 $220.00

10080537A LENS SN6AT5 6.0 $490.01

10080538C LENS SN60WF 15.5 $220.00

10080540A LENS SN6AT3 19.0 $490.01

10080551I SCREW HEADED 33MM - ZIMME $600.00

10080583A LENS SN6AD1 22.0 $883.01

10080584A LENS SN60WS 16.0 $220.00

10080585A LENS SN6AT4 19.0 $490.01

10080586A LENS SN6CWS 18.5 $225.00

10080587A LENS SN60WS 14.5 $220.00

10080588A LENS SN60WS 12.0 $220.00

10080589A LENS SN6AT9 21.0 $490.01

10080591A FEMORAL HEAD SZ M 28MM $10,412.50

10080608A FEMORAL HEAD SZ L 28MM $10,412.50

10080613B LENS SN60WS 26.5 $220.00

10080614B LENS SN6AD1 19.5 $883.01

10080625A HEAD COMPONENT MODULAR 28 $2,507.50

10080638I 2 HOLE PLATE $5,941.50

10080652C STINGRAY PEEK 7MM $8,785.60

10080656A LENS SN6AT3 20.0 $490.01

10080688A ALEUTIAN CAGE 10X18X45MM $35,266.50

10080699I INFINION TRIAL LEAD $5,100.00

10080746B LENS SN60WF 7.0 $220.00

10080747A LENS SN60WS 13.5 $220.00

10080770B LENS SN60WF 13.5 $220.00

10080771A LENS SN60WS 17.5 $220.00

10080802A LENS SN6AD1 23.5 $883.01

10080803A LENS SN6CWS 13.0 $225.00

10080815B POLY SCREW 5 X 50MM $8,015.50

10080823A LENS SN6AT5 20.5 $490.01

10080827A CONTACT LEAD (LINEAR) $6,800.00

10080831C CERVICAL PLATE LEVEL 3 52 $10,006.20

10080861B BONE SCREW 6.5 X 30MM $352.75

10080865A BIOLOX CERAMIC HEAD 36MM $11,194.50

10081023I BONE CEMENT $752.25

10081038I FEMUR CUTTING BLOCK SZ 4 $687.50

10081058C FEMORAL HEAD SZ S 22.2MM $2,358.12

10081124A FLEXIBLE HINGED TOE IMPLA $4,496.50

Page 77: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081172A POLY SCREW 8 X 40MM $8,015.50

10081173B ALEUTIAN CAGE 10X18X60 CM $35,266.50

10081176A FEMUR CUTTING BLOCK SZ 2 $687.50

10081185C ACETABULAR LINER SZ 23 X $4,105.50

10081186C HEAD COMPONET MODULAR 32 $2,507.50

10081206A LENS SN60WS 27.5 $220.00

10081227A FEMORAL COMPONENT SZ 3 RT $10,200.00

10081249B LENS SN60WF 8.0 $220.00

10081250B LENS SN60WF 19.0 $220.00

10081274C LENS SN60WF 10.0 $220.00

10081349C GLENOID BASE HYBRID4MM SM $6,375.00

10081362B LENS SN60WS 12.5 $220.00

10081382A LENS SN6AT5 18.5 D $490.01

10081383A LENS ZMB00 28.0 D $940.01

10081384A LENS SN6AT3 12.0 D $490.01

10081385C CANCELLATION FEE $1,595.00

10081391I REAMER PILOT HEADED 6.5 $1,245.25

10081416C LENS SN6CWS 21.5D $225.00

10081452A STEM FEMORAL SZ 1 STD $12,750.00

10081458C IMP.INJECT PRODENSE 4CC C $6,829.75

10081520A COMPONENT FEMORAL SZ 4N R $10,200.00

10081521A INSERT TIBIAL FIXED SZ 3 $4,037.50

10081563A LENS SN6AT5 23.5 $490.01

10081564A LENS SN6AT3 26.5 $490.01

10081565B LENS ZMB00 20.5 $940.01

10081566B LENS ZMB00 23.5 $940.01

10081571A LENS ZMB00 17.5 $940.01

10081572A LENS L122 UV 10.5 INTERIO $350.00

10081576A COMPONET FEMORAL CEMENTED $16,575.00

10081582A LENS SN6AT9 12.5 $490.01

10081597D LENS ZCT225 21.5 $520.01

10081603B LENS ZCT225 21.0 $520.01

10081611A LENS ZMB00 24.5 $940.01

10081612A LENS ZCT150 20.5 $520.01

10081622A LENS ZMB00 15.0 $940.01

10081640A Lens SN6AT7 11.0 $490.01

10081641A Lens SN6AT7 10.5 $490.01

10081642A Lens SN6AT7 11.5 $490.01

10081643A LENS SN6AT5 11.0 $490.01

10081644B LENS ZMB00 22.0 $940.01

10081645B LENS ZMB00 21.0 $940.01

10081646A LENS ZMB00 14.5 $940.01

10081656C Patella-all poly 35mm dia $4,862.17

10081660A Plate lapidus size 0 orth $8,032.50

10081664A Lens ZCT150 11.0 toric te $520.01

10081665A Lens ZCT400 13.5 toric te $520.01

10081666A Lens ZCT150 10.5 toric te $520.01

Page 78: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081667A Lens ZCT150 11.5 $520.01

10081668A Lens ZCT400 13.0 $520.01

10081669A Lens ZCT400 14.0 $520.01

10081674A Lens ZCT225 26.0 $520.01

10081675B Lens ZCT225 26.5 $520.01

10081676A Lens ZCT225 27.0 $520.01

10081677C LENS ZCT225 22.5 $520.01

10081678A Lens SN6AT3 23.5 $490.01

10081679A Lens SN6AT3 25.5 $490.01

10081682A Lens ZCT300 27.5 $520.01

10081683A Lens ZCT300 28.0 $520.01

10081684A Lens ZCT300 28.5 $520.01

10081692A Taper femoral sz 3 std ha $12,750.00

10081693A TAPER FEMORAL SIZE 1 STD $12,750.00

10081696A Component femoral sz 3N r $10,200.00

10081708A Lens SN6AT4 25.5 $490.01

10081710A Lens SN6AT8 8.5 $490.01

10081711A Lens SN6AT8 9.0 $490.01

10081712A Lens SN6AT8 9.5 $490.01

10081713A Lens SN6AT8 10.0 $490.01

10081714A Lens SN6AT9 8.5 $490.01

10081715A Lens SN6AT9 9.0 $490.01

10081716A Lens SN6AT9 9.5 $490.01

10081717A Lens SN6AT9 10.0 $490.01

10081718A Lens SN6AT6 8.0 $490.01

10081719A Lens SN6AT6 8.5 $490.01

10081720A Lens SN6AT6 9.0 $490.01

10081721A Lens SN6AT6 9.5 $490.01

10081722A Lens SN6AT6 10.0 $490.01

10081723A Lens SN6AT7 8.0 $490.01

10081724A Lens SN6AT7 8.5 $490.01

10081725A Lens SN6AT7 9.0 $490.01

10081726A Lens SN6AT7 9.5 $490.01

10081727A Lens SN6AT7 10.0 $490.01

10081745A Lens ZCT300 19.5 $520.01

10081746C Kit prostate cyroablation $18,200.00

10081747A LENS ZMB00 19.0 $940.01

10081777A LENS ZMB00 5.5 $940.01

10081778A LENS ZMB00 6.0 $940.01

10081779A LENS ZMB00 6.5 $940.01

10081780A LENS ZMA00 5.5 $940.01

10081781A LENS ZMA00 6.0 $940.01

10081782A LENS ZMA00 6.5 $940.01

10081796A LENS SN6AT4 34.0 $490.01

10081813A Lens ZCT300 5.5 $520.01

10081814A Lens ZCT300 6.0 $520.01

10081815A Lens ZCT300 6.5 $520.01

Page 79: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081816A Lens ZCT300 14.0 $520.01

10081817A Lens ZCT300 14.5 $520.01

10081818A Lens ZCT300 15.0 $520.01

10081819A LENS ZCT225 14.0 $520.01

10081820A LENS ZCT225 14.5 $520.01

10081821A LENS ZCT225 15.0 $520.01

10081829B LENS ZCT150 19.0 $520.01

10081834A LENS SN6AT5 26.0 ACRSOF T $490.01

10081836A LENS ZMB00 7.0 $940.01

10081837A LENS ZMB00 7.5 $940.01

10081838A LENS ZMB00 8.0 $940.01

10081839A LENS ZMA00 7.0 $940.01

10081840A LENS ZMA00 7.5 $940.01

10081841A LENS ZMA00 8.0 $940.01

10081842A LENS ZCT225 12.0 $520.01

10081843A LENS ZCT225 12.5 $520.01

10081844A LENS ZCT225 13.0 $520.01

10081845A LENS ZCT225 13.5 $520.01

10081846A LENS ZCT225 5.5 $520.01

10081847A LENS ZCT225 6.0 $520.01

10081848A LENS ZCT225 6.5 $520.01

10081850A LENS ZCT225 7.5 $520.01

10081851A Lens ZCT150 10.0 $520.01

10081852A LENS ZCT150 12.0 $520.01

10081853A Lens ZCT150 27.5 $520.01

10081854A LENS ZCT150 28.0 $520.01

10081855A LENS ZCT150 28.5 $520.01

10081856B LENS ZCT150 29.0 $520.01

10081859C LENS ZCT150 27.0 $520.01

10081867A CONNECTOR CROSS 42 - 58 M $9,488.13

10081867B CONNECTOR CROSS 42 - 58 M $9,488.13

10081893A LENS ZCT300 11.0 $520.01

10081894A LENS ZCT300 11.5 $520.01

10081895A LENS ZCT300 12.0 $520.01

10081896A LENS ZCT300 12.5 $520.01

10081897A LENS ZCT300 13.0 $520.01

10081915C BASEPLATE SHOULDER GLENOS $5,737.50

10081917C GLENOSPHERE SHOULDER REV. $5,737.50

10081918B TRAY HUMERAL STAND 44MM W $5,950.00

10081919C BEARING HUMERAL RETENTIVE $3,400.00

10081921A SCREW LOCKING 4.75 X 25MM $318.75

10081922A SCREW NON LOCKING 20MM $318.75

10081927A Lens ZCT400 22.5 $520.01

10081928C LENS ZCT150 19.5 $520.01

10081933A HEAD MODULAR 40MM SELEX M $6,481.25

10081937A HEAD FOMORAL MALLORY PF 1 $14,275.75

10081943A PLATE TIBIAL PRIM. W LOCK $4,551.75

Page 80: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10081952A SHELL ACETABULAR G7 3 HOL $11,857.50

10081955A MAGNUM SELEX MODULAR HEAD $6,481.25

10081956A LENS SN6AT9 18.5 $490.01

10081957A LENS SN6AT9 18.0 $490.01

10081958A LENS SN6AT9 19.0 $490.01

10081967A Lens ZCT150 18.5 $520.01

10081994C LENS ZCT150 17.0 $520.01

10081995C LENS ZCT150 23.5 $520.01

10081996A LENS SN6AT4 17.0 $490.01

10081997A LENS ZCT400 12.5 $520.01

10082020A LENS ZCT300 21.5 $520.01

10082021A LENS ZMB00 13.0 $940.01

10082022B LENS ZCT150 22.5 $520.01

10082033C INSERT INBONE POLY SZ 1 + $9,375.50

10082047A LENS ZMB00 12.5 $940.01

10082048A SHELL MALLOR/HEAD 52MM 3 $5,950.00

10082056A LENS ZCT150 12.5 $520.01

10082064C BOX OPEN FEMORIAL PS 62.5 $9,915.25

10082069B Lens ZCT300 17.5 $520.01

10082070A Lens ZCT225 17.5 $520.01

10082071C Lens ZCT150 20.0 $520.01

10082083A SCREW LOCKING 4.75 X 30MM $318.75

10082084A SCREW NON-LOCKING 4.75X30 $318.75

10082086B LENS ZMB00 10.5 $940.01

10082088A SHELL ACE 3 HOLE 52MM CEM $11,857.50

10082090C HEAD MODULAR 36MM TYPE 1 $2,507.50

10082100A INSERT TIBIAL SZ 3 RGHT 1 $8,287.50

10082104A HEAD MODULAR COMPONENT HI $2,507.50

10082111A LENS MA60MA (-) 5.0 $174.00

10082112B LENS ZMB00 12.0 $940.01

10082140C BASEPLATE GLENOSPHERE MIN $5,737.50

10082141B BEARING HUMERAL 44MM SHOU $4,105.50

10082145A INTERLOK RIGHT FEMORAL BO $9,915.25

10082148C BEARING HUMERAL SHOULDER $5,525.00

10082168A SHELL MALLORY/HEAD 4 FIN $5,950.00

10082171A BOX FEMORAL PS OPEN 65MM $9,915.25

10082172D LENS ZCT225 19.0 $520.01

10082187A COMPONENT MODULAR HEAD 32 $2,507.50

10082197A TAPER FEMORAL STD SIZE HA $12,750.00

10082202B LENS ZMB00 14.0 $940.01

10082203A LENS MA60MA 00.0 $174.00

10082205A SHELL MALLORY/HEAD 54MM 3 $4,258.50

10082241B LENS ZLB00 20.0 $940.01

10082242B LENS ZMB00 13.5 $940.01

10082246A LENS ZCT150 29.5 $520.01

10082247A LENS ZCT150 30.0 $520.01

10082248B LENS SN6AT9 25.5 $490.01

Page 81: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082249A LENS SN6AT9 26.0 $490.01

10082250A LENS SN6AT9 26.5 $490.01

10082258B LENS ZCT300 20.0 $520.01

10082259B LENS ZMB00 23.0 $940.01

10082260B LENS MA60AC 17.5 $174.00

10082261A LENS MA60AC 17.0 $174.00

10082262A LENS MA60AC 18.0 $174.00

10082263A LENS ZKB00 22.0 $940.01

10082265B LENS ZKB00 23.0 $940.01

10082284B LENS ZCT300 22.0 $520.01

10082285A LENS ZCT525 14.0 $520.01

10082286B LENS ZCT525 14.5 $520.01

10082287A LENS ZCT525 15.0 $520.01

10082288A LENS SN6AT7 14.5 $490.01

10082289A LENS SN6AT7 15.0 $490.01

10082290A LENS SN6AT7 15.5 $490.01

10082291A LENS SN6AT8 14.5 $490.01

10082292A LENS SN6AT8 15.0 $490.01

10082293A LENS SN6AT8 15.5 $490.01

10082294A LENS SN6AT9 14.5 $490.01

10082295A LENS SN6AT9 15.0 $490.01

10082296A LENS SN6AT9 15.5 $490.01

10082309 A SCREW LOCK REVERSE 3.5 X $318.75

10082310A SCREW NON LOCK REVERSE 3. $318.75

10082311C STEM SHOULDER PRIMARY 12 $14,875.00

10082314A LENS ZCT450 5.5 $520.01

10082315A LENS ZCT450 5.0 $520.01

10082316A LENS ZCT450 6.0 $520.01

10082317A STEM SHOULDER PRIMARY STD $14,875.00

10082318A SCREW REVERSE COMP CENTRA $425.00

10082319A SCREW LOCKING 20MM $318.75

10082320A SCREW NON LOCK 35MM $318.75

10082322A LENS ZCT150 17.5 $520.01

10082323C LENS ZCT150 21.0 $520.01

10082324C LENS ZCT225 20.5 $520.01

10082341C LINER ACETABULAR HIGH WAL $8,172.75

10082344A LENS ZCT525 12.5 $520.01

10082345A LENS ZCT525 13.0 $520.01

10082346A LENS ZCT525 13.5 $520.01

10082349A LENS ZCT225 17.0 $520.01

10082351A LENS SN6AT9 24.0 $490.01

10082352A LENS SN6AT9 23.5 $490.01

10082353A LENS SN6AT9 24.5 $490.01

10082372A LENS SN60WS 16.5 $220.00

10082385A LENS ZCT525 11.5 $520.01

10082402C STEM SHOULDER PRIMARY 11X $14,875.00

10082421B FEMORAL BOX PS OPEN 60MM $9,915.25

Page 82: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

10082445A LENS ZCT150 18.0 $520.01

10082446C LENS ZCT300 18.0 $520.01

10082459A LENS ZCT525 16.5 $520.01

10082526A INTERLOK FEMORAL 65MM RIG $34,616.25

10082529C LENS ZCT225 19.5 $520.01

10082531C LENS ZCT150 22.0 $520.01

10082554A LENS ZCT300 18.5 $520.01

10082570A LENS SN6CWS 22.5 $225.00

10082571C LENS ZCT300 19.0 $520.01

10082572A LENS ZLB00 11.0 $940.01

10082594A LENS ZCT300 25.0 $520.01

10082612C TRAY KYPHOPAK FIRST FRACT $15,307.50

10082626C LENS ZCT150 26.0 $520.01

10082627C LENS ZCT400 24.5 $520.01

10082628C LENS ZCT225 20.0 $520.01

10082629C LENS ZCT150 21.5 $520.01

10082663A ENVELOPE NEURO ABSORB ANT $8,478.75

10082744A CONNECTOR ROD TO ROD OPEN $6,128.50

10082830A STINGRAY PEEK 9MM $8,785.60

10082847A CONNECTOR CROSS 58 - 74 M $7,588.80

10082847B CONNECTOR CROSS 58 - 74 M $9,488.13

10082950A PLATE BUTTRESS 21MM $9,979.00

10082950B PLATE BUTTRESS 21MM $12,473.75

10082951A SCREW BUTTRESS PLATE 20MM $2,325.60

10082951B SCREW BUTTRESS PLATE 20MM $2,907.00

10082995B PAK SUPPLY NEUROMONITORIN $225.00

10083036A KIT REMOTE CONTROL FREELI $4,369.00

10083074A NAIL RIGHT LONG 10X360MM $11,101.94

10083075A SET U BLADE LAG SCREW 10. $3,805.62

10083076A SCREW LOCKING FULL THREAD $832.53

10083077A SCREW LOCKING FULL THREAD $832.53

10083078A NAIL TIBIAL STANDARD 10X3 $6,726.43

10083079A CAP END +5MM T2 $841.97

10083080A SCREW LOCKING FULL THREAD $832.53

10083195B PACK PINS SMOOTH & BIT DR $425.00

10083197B PACK SCREWS $170.00

10083571A PLATE 4 LEVEL 64MM SKYLIN $5,631.25

1008362A Lens SN6AT3 15.5 $490.01

10084304A BIT DRILL 2.0MM $960.00

10088264A LENS ZKB00 22.5 $940.01

1100610I ARTHROCEN MAJOR JNT/BURSA $913.05

1106569A Insertion of Peripheral V $2,714.81

1107370A INJ, KNEE ARTHOGRAPHY LT $550.00

1107371A INJ, KNEE ARTHOGRAPHY RT $550.00

1109004A TELEMETRY $106.00

1109300A EKG 12-LEAD $94.63

1109995A PACU BASE $819.00

Page 83: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1109996A PACU ADDITIONAL MINUTES $192.00

1109997A PHASE 2 $442.00

110G0008 ADMIN FLU VIRUS VACCINE $86.84

110Q2038 FLUZONE VACC 3 YRS & > IM $61.00

1127500A COMPLEX UROFLOWMETRY $400.00

1401057A SURGICAL 4X4 $1,079.57

1401145C INFUSE BONE GRAFT KIT - L $24,335.04

1401229C PERCUFLEX PLUS 6X24 $484.50

1401275A ORTHOSORB PIN $333.46

1401276A ORTHOSORB PIN KIT $1,487.50

1401277B OBTRYX HALO SINGLE SYSTEM $3,428.82

1401280B COAPTITE BULKING AGENT 1 $1,346.40

1401288A 5.5MM BIOCOMPOSITE SWIVEL $1,700.00

1401547I HOOK TIP SCISSORS $478.05

1401555I LG. ACTIGUARD HIP DRAPE $162.15

1401852A DURAGEN PLUS 1X3 $2,534.96

1401903I ACAPELLA GREEN $178.00

1401936B TISSEEL 10ML $2,329.73

1401936C TISSEEL 10ML $1,570.80

1401938A 15CC MOZIAK PUTTY $5,103.40

1401938B 15CC MOZIAK PUTTY $6,379.25

1401940A HEMASORB $850.00

1403064I GLOVE XRAY LTX LEAD STR S $168.50

1403265I SF6 GAS $128.00

1403607A PROLITE MESH 3X6 IMPLANT $114.54

1403616A MESH - VENTRALIGHT 4X6 $3,094.00

1403617B MESH - VENTRALIGHT 6X8 $4,773.18

1403620I MESH - VENTRALIGHT 8X10 $8,419.25

1403627B AMNIOTIC MEMBRANE AMBIO 5 $2,443.75

1403662B LENS ZMB00 21.5 $940.01

1408001A POLY SCREW 7X40MM $8,015.50

1408003A FLAT LOCK SCREW (GREEN) $2,213.40

1408006B POLY SCREW 6X40MM $6,412.40

1408007B POLY SCREW 7X30MM $6,412.40

1408010B BUTT PLATE 23MM (BLACK WI $11,024.50

1408011A SCREW 20MM (BLACK WIDOW) $5,295.00

1408013A SCREWW VAR CERVICAL 4X12M $1,441.60

1408016I GUIDEWIRE INTRADISCAL $544.00

1408020I CHARGING KIT (PRECISION) $12,920.00

1408023I CLIK ANCHOR $1,678.75

1408025A LENS SN60WS 19.5 $220.00

1408026A LENS SN6AD1 13.0 $883.01

1408027A LENS SN60WS 20.0 $220.00

1408028A LENS SN6AT3 18.0 $490.01

1408029A LENS SN60AT 22.0 $199.00

1408030A LENS SN6CWS 21.0 $225.00

1408031A LENS SN60WS 21.5 $220.00

Page 84: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1408032A LENS SN60WS 19.0 $220.00

1408033A LENS SN60WS 14.0 $220.00

1408034A LENS SN60WS 20.5 $220.00

1408037A LENS SN6CWS 20.5 $225.00

1408038A LENS SN60WS 24.5 $220.00

1408039B LENS SN60WS 25.0 $220.00

1408041A LENS SN6AD1 21 $883.01

1408042A LENS SN60WS 24 $220.00

1408043A LENS SN6CWS 23.5 $225.00

1408044C LENS SN60WF 21.0 $220.00

1408045A LENS SN60WS 22.5 $220.00

1408054I DRILL BIT 2.7X160MM (CANN $2,649.60

1408061B POLY SCREW 7X45MM $8,015.50

1408070A NU WAVE MONITORING/1ST 5 $4,500.00

1408071A NUWAVE MONITORING ADITION $12.50

1408074I CELL SAVER SERVICE $4,055.00

1408086I TIBIAL TRAY FIXED $6,162.50

1408088A RESURFACING PATELLA $2,975.00

1408089I FEMUR BONE MODEL $687.50

1408091I TIBIAL CUTTING BLOCK $687.50

1408093I 90 MM PIN $218.90

1408094I SAMURAI BLADE $1,225.00

1408097A LENS SN60WS 18.0 $220.00

1408098A LENS SN60WS 18.5 $220.00

1408099B LENS SN60WS 22.0 $220.00

1408101B LENS SN60WS 23.0 $220.00

1408103A LENS SN60WS 25.5 $220.00

1408104A LENS SN6AD1 17.0 $883.01

1408106A LENS SN6AD1 21.5 $883.01

1408107A LENS SN6AD1 23.0 $883.01

1408108A LENS SN6AT7 16.5 $490.01

1408109A LENS SN6AT3 19.5 $490.01

1408110A LENS SN6AT5 23.0 $490.01

1408144C LEAD ARRAY (PRECISION) $3,400.00

1408145A TRIAL LEAD KIT 60MM $3,825.00

1408174A LENS SN60WS 10.5D $220.00

1408175B OSTEOSET RESORBABLE BEAD $2,367.25

1408176A LENS SN6CWS 10.5D $225.00

1408177B LENS SN60WF 20.0D $220.00

1408178B LENS SN60WF 25.5D $220.00

1408195A LENS SN60WS 8.5 $220.00

1408206C SNAP OFF SCREW $994.50

1408251A EXTENSION STEM 11MM X 65M $6,162.50

1408257B LENS SN6AD1 19.0 $883.01

1408258B LENS SN60AT 20.0 $199.00

1408264A LENS SN6CWS 22.0 $225.00

1408267C DOUBLE MOBILITY LINER $4,887.50

Page 85: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

1408287C MOBILE UHMWPE LINER 28 MM $4,887.50

1408292A FEMORAL COMPONENT SZ 4 RT $10,200.00

1408293C RESURFACING PATELS SZ 3 $2,975.00

1408321A FEMUR BONE MODEL LT $687.50

1408323A TIBIAL BONE MODEL LT $687.50

1408326B LENS ZMB00 19.5 $940.01

1408327B LENS ZMB00 18.5 $940.01

1408329A LENS ZMA00 17.5 $940.01

1408331I PASSING ELEVATOR $260.00

1408333A RESURFACING PATELLA SZ 4 $2,975.00

1408341B POLY SCREW 6x45MM $6,412.40

1408342A POLY SCREW 5x40MM $8,015.50

1408345A SCREW VAR.CERV. 4x14MM $1,441.60

1408345B SCREW VAR.CERV. 4x14MM $1,802.00

1408347C STRINGRAY PEEK 8MM $8,785.60

1408348B LENS SN60WS 21.0 $220.00

1408481C HEALIX TI SUTURE ANCHOR W $1,899.75

14095861A MUSCLE TEST 2 LIMBS $400.00

14095939A C MOTOR EVOKED UPR & LWR $2,400.00

140G0453 CONT INTRAOP NEURO MONITO $75.00

2001230A AMPHETAMINES SCREEN, BY E $5.30

2001230B AMPHETAMINES SCREEN, BY E $5.30

2001244A ANTIBODY SCREEN $10.70

2001245A ANTIBODY SCREEN, PREWARME $11.80

2001715A HDN RBC ANTIBODY SCREEN $10.70

2002232A DRUG SCREEN QUANT $36.27

2002232B DRUG SCREEN QUANT $36.27

2102240B MYELOGRAM CERVICAL $2,466.00

2102255B MYELOGRAM THORACIC $2,600.00

2102265B MYELOGRAPHY LUMBOSACRAL $2,046.23

2102335A INJ SHOULDER ARTHRO OR CT $525.00

2102709A INJ HIP ARTHRO RT $725.00

2103350A INJ SHOULDER ARTHRO OR CT $525.00

2104450A CYSTOGRAM RETRO $723.63

2106000A FLUORO >1 HR $1,121.08

2106001A FLUOROGUIDE FOR SPINE INJ $521.53

2107093A INJ HIP ARTHRO LT $725.00

21073501LT X-RAY EXAM HIP UNI 1 VIEW $156.80

21073501RT X-RAY EXAM HIP UNI 1 VIEW $156.80

21073502LT X-RAY EXAM HIP UNI 2-3 VI $156.80

21073502RT X-RAY EXAM HIP UNI 2-3 VI $156.80

21073503LT X-RAY EXAM HIP UNI 4/> VI $156.80

21073551LT X-RAY EXAM OF FEMUR 1 LT $156.80

21073551RT X-RAY EXAM OF FEMUR 1 RT $156.80

21073552LT X-RAY EXAM OF FEMUR 2/> L $156.80

21073552RT X-RAY EXAM OF FEMUR 2/> R $156.80

210G0389 US AAA Screen $498.50

Page 86: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2123724A MRI LOW EXTREM NO/JNT W/O $1,184.44

21376641LT US BREAST COMPLETE LT $220.22

21376641RT US BREAST COMPLETE RT $220.22

21376642LT US BREAST LIMITED LT $220.22

21376642RT US BREAST LIMITED RT $220.22

2607201GP MOBILITY CURRENT STATUS 0 $1.01

2607202GP MOBILITY CURRENT STATUS 1 $1.01

2607203GP MOBILITY CURRENT STATUS 2 $1.01

2607204GP MOBILITY CURRENT STATUS 4 $1.01

2607205GP MOBILITY CURRENT STATUS 6 $1.01

2607206GP MOBILITY CURRENT STATUS 8 $1.01

2607207GP MOBILITY CURRENT STATUS 1 $1.01

2607208GP MOBILITY GOAL STATUS 0% $1.01

2607209GP MOBILITY GOAL STATUS 1-19 $1.01

2607210GP MOBILITY GOAL STATUS 20-3 $1.01

2607211GP MOBILITY GOAL STATUS 40-5 $1.01

2607212GP MOBILITY GOAL STATUS 60-7 $1.01

2607213GP MOBILITY GOAL STATUS 80-9 $1.01

2607214GP MOBILITY GOAL STATUS 100% $1.01

2607215GP MOBILITY D/C STATUS 0% $1.01

2607216GP MOBILITY D/C STATUS 1-19% $1.01

2607217GP MOBILITY D/C STATUS 20-39 $1.01

2607218GP MOBILITY D/C STATUS 40-59 $1.01

2607219GP MOBILITY D/C STATUS 60-79 $1.01

2607220GP MOBILITY D/C STATUS 80-99 $1.01

2607221GP MOBILITY D/C STATUS 100% $1.01

2607269GP SELF CARE CURRENT STATUS $1.01

2607277GP SELF CARE GOAL STATUS 100 $1.01

2607284GP SELF CARE D/C STATUS 100% $1.01

2707204GO MOBILITY CURRENT STATUS 4 $1.01

2707209GO MOBILITY GOAL STATUS 1-19 $1.01

2707210GO MOBILITY GOAL STATUS 20-3 $1.01

2707216GO MOBILITY D/C STATUS 1-19% $1.01

2707217GO MOBILITY D/C STATUS 20-39 $1.01

2707264GO SELF CARE CURRENT STATUS $1.01

2707265GO SELF CARE CURRENT STATUS $1.01

2707266GO SELF CARE CURRENT STATUS $1.01

2707267GO SELF CARE CURRENT STATUS $1.01

2707268GO SELF CARE CURRENT STATUS $1.01

2707269GO SELF CARE CURRENT STATUS $1.01

2707270GO SELF CARE CURRENT STATUS $1.01

2707271GO SELF CARE GOAL STATUS 0% $1.01

2707272GO SELF CARE GOAL STATUS 1-1 $1.01

2707273GO SELF CARE GOAL STATUS 20- $1.01

2707274GO SELF CARE GOAL STATUS 40- $1.01

2707275GO SELF CARE GOAL STATUS 60- $1.01

2707276GO SELF CARE GOAL STATUS 80- $1.01

Page 87: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

2707277GO SELF CARE GOAL STATUS 100 $1.01

2707278GO SELF CARE D/C STATUS 0% $1.01

2707279GO SELF CARE D/C STATUS 1-19 $1.01

2707280GO SELF CARE D/C STATUS 20-3 $1.01

2707281GO SELF CARE D/C STATUS 40-5 $1.01

2707282GO SELF CARE D/C STATUS 60-7 $1.01

2707283GO SELF CARE D/C STATUS 80-9 $1.01

2707284GO SELF CARE D/C STATUS 100% $1.01

28595805A MULTIPLE SLEEP LATENCY TE $2,408.00

28595805TC MULTIPLE SLEEP LATENCY TE $2,408.00

28595806B HOME SLEEP TEST $825.00

28595808B ATTENDED SLEEP STUDY 1-3> $2,408.00

28595810G ATTENDED SLEEP STUDY 4/> $4,360.00

28595810TC ATTENDED SLEEP STUDY 4/> $3,360.00

28595811G ATTENDED SLEEP STUDY WITH $5,180.00

28595811TC ATTENDED SLEEP STUDY WITH $4,080.00

285G0398 HOME SLEEP TEST/TYPE 2 PO $875.00

285G0399 HOME SLEEP TEST/TYPE 3 PO $825.00

285G0399A HOME SLEEP TEST/TYPE 3 PO $825.00

285G0399G HOME SLEEP TEST/TYPE 3 PO $1,325.00

285G0399TC HOME SLEEP TEST/TYPE 3 PO $825.00

285G0400 HOME SLEEP TEST/TYPE 4 PO $775.00

6001151K LIPOCAINE/EPI/BSS OPHTH I $100.00

6001376M CALCIUM GLUC INJ 1GM $32.50

6002370K PHENYLEPHRINE HCL DROP $45.00

6003324M POTASSIUM CHL INJ 2MEQ $1.25

6007379M GENTAMICIN INJ 80 MG/2ML $7.00

6009546M LORAZEPAM 1ML INJ 2 MG/ML $6.00

6009556K PROPARACAINE DROP 0.5% $45.00

6009560K OFLOXACIN DROP 0.3% $45.00

6011201M VANCOMYCIN/NS PGBK 500MG $118.50

6015608M AMP/SULB/NS 1.5GM $51.50

6015707M AMP/SULB/NS 1.5GM $32.50

6016209M DIPHENHYDRAM 50MG/ML INJ $6.50

6018668M HYDROXYZINE PAM 25MG CAP $3.50

6023543M HYDROXYZINE HCL INJ 25MG $121.00

6030850M ONDANSETRON INJ 1MG $1.50

6032055M ONDANSETRON ODT TAB 1MG $29.00

6033745M ALBUTEROL INH 0.5M $1.13

6035051M PHENYLEPHRINE INJ 10MG/ML $23.50

6038396M ROPIVACAINE INJ 1MG $0.87

6051016M ALBUT-IPRATROP 0.5-3MG/3M $11.00

6053092C TRIAMCINOLONE INJ 1MG $1.41

6053092M TRIAMCINOLONE INJ 1MG $113.00

6058675M EPINEPHRINE SYR 0.1MG $2.40

6066605M ALBUTER 0.083% NEB 0.5MG $1.40

6069690M CEFTAZIDINE INJ 500MG $16.25

Page 88: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6071205M PIP/TAZO/NS PGBK 1.125MG $31.25

6072638M VANCOMYCIN INJ 500MG $48.50

6084094M AMIODARONE INJ 30MG $2.50

6087419M RINGERS SOL,LAC 1000ML $31.50

6102032M VANCOMYCIN/NS PGBK 500MG $40.00

6102306M VANCOMYCIN/NS PGBK 500MG $33.33

6102311M VANCOMYCIN/NS PGBK 500MG $28.57

6102346M VANCOMYCIN/ NS PGBK 500MG $31.25

6104280M METHYLPRED 40MG/ML INJ $36.50

6104500M NALOXONE INJ 1 MG/ML $102.00

6104567M PIP/TAZO/NS PGBK 1.125MG $42.50

6105280M CEFAZOLIN/NS PGBK 500MG $13.88

6105316K TETRACAINE DRP 0.005 $45.00

6105416M CEFTRIAXONE/NS PGBK 250MG $29.38

6105454M PIP/TAZO/NS PGBK 1.125MG $37.67

6108021M METHYLPRED ACET 80MG/ML $110.50

6108308M FENTANYL INJ 100MCG $8.00

6108514M EPINEPHRINE INJ 0.1MG $1.30

6108745M CEFTRIAXONE/NS PGBK 250MG $18.75

6111151M INSULIN LISPRO 50 UNITS $82.42

6111176M INSULIN GLARGINE 5 UNITS $8.09

6111217M MAGNESIUM SULF INJ 0.5GM $4.75

6111228M HYDROCORTISONE INJ 100 MG $60.00

6111233M CEFTRIAXONE INJ 250MG $2.25

6111288K PREDNISOLONE AC OPHT SUS $22.50

6116491K CYCLOPENTOLATE 2% OPHTH $45.00

6133331M CHLORPROMAZINE ORAL 5MG $9.60

6140420M METHYLNALTREX INJ 0.1MG $357.30

6142791M TRIMETHOBEN 200MG/2ML INJ $175.70

6142891M ONABOTULINUMTOX INJ 1UNIT $3,246.00

6146696M ENOXAPARIN SYR 10MG $406.40

6194254M PROPOFOL INJ 10MG $1.70

6218449M VANCOMYCIN/NS PGBK 500MG $30.00

6257413M VANCOMYCIN/NS PGBK 500MG $35.00

6258747M DRONABINOL ORAL 2.5MG $27.00

6274526K SOD CHL 0.9% FLUSH SYR $3.50

6279621M MORPHINE 2MG/1ML SYR $10.00

6321021C ATROPINE 1MG/ML 1ML VIAL $12.50

6322158M DEXAMETHASONE INJ 1MG $0.80

6325405M LEVOFLOXACIN ORAL 250MG $33.00

6325501M ENOXAPARIN SYR 10MG $49.70

6346581M CEFOXITIN INJ 500MG $51.00

6411443M IPRATROPIUM 2.5ML NEB $10.00

6417877M DIAZEPAM INJ 5MG $21.90

6476842M FOSPHENYTOIN INJ 50MG $4.50

6518776M ACETAMINOPHEN IV 10MG $74.58

6532810M PROMETHAZINE 25MG/100ML $25.00

Page 89: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6542181M ADENOSINE INJ 1MG $6.00

6545463M CEFEPIME/NS PGBK 500MG $18.75

6545657M LIDOCAINE/D5W PGBK 10MG $0.13

6565799M DAPTOMYCIN INJ 1MG $5.35

6565956M ALTEPLACE PWD 1MG $459.25

6574510M MIDAZOLAM INJ 1MG $1.80

6683187M LEVOFLOXACIN ORAL 250MG $47.50

6732269M ENOXAPARIN SYR 10MG $44.63

6790309M DEXTROSE 5% WATER 500 ML $12.50

6790755M LEVOFLOXACIN/D5W 250MG $26.33

6791246M CIPROFLOX/D5W PGBK 200MG $70.50

6791330M CEFEPIME/NS PGBK 500MG $51.00

6791377M FUROSEMIDE INJ 20MG $9.50

6796733M HEPARIN INJ 1,000 UNITS $1.33

6797776M DEXAMETHASONE INJ 1MG $3.38

6845790M MORPHINE 10MG/1ML INJ $6.50

6854849M AMIODARONE/D5W PGBK 30MG $23.08

6872048M FUROSEMIDE INJ 20MG $5.50

6875328M LEVOFLOXACIN/D5W 250MG $41.50

6879714M HYDRALAZINE INJ 20 MG/ML $90.00

6889854M LINEZOLID/NS PGBK 200MG $125.00

6895421M DEXTROSE/LACT RINGERS 100 $28.50

6896894M KETOROLAC INJ 15MG $17.25

6900273M TOBRAMYCIN 80MG/2ML INJ $20.50

6900457M DEXAMETHASONE ORAL 0.25MG $1.75

6900511M METHYLPRED ORAL 4MG $7.17

6900706M FENTANYL INJ 100MCG $4.60

6901273M NEOSTIGMINE INJ 0.5MG $8.40

6902540M ACYCLOVIR ORAL 5MG $0.24

6903022M SUCCINYLCHOLINE INJ 20MG $11.55

6904494M INSULIN REGULAR 1 UNIT $3.50

6911191M PROTAMINE INJ 10MG $14.80

6911403M PROPOFOL INJ 10MG $1.71

6915217M GLUCAGON INJ 1 MG/ML $1,030.00

6935066K CYCLOPENTOLATE DRP 0.01 $45.00

6938245M CEFAZOLIN INJ 500MG $3.50

6939430M DIGOXIN INJ 0.25MG $16.50

6948531M HYDROMORPHONE INJ 2 MG/ML $9.50

6951260M ENOXAPARIN SYR 10MG $40.67

6952311M METHYLPRED 125MG/2ML INJ $35.50

6954525M AZITHROMYCIN/NS PGBK 500M $50.00

6968550M HALOPERIDOL INJ 5MG/ML $7.50

6973379M DEXAMETHASONE ORAL 0.25MG $0.41

6976794M METOCLOPRAMIDE 10MG/2ML $7.00

6977384M DIPHENHYDRAMINE 25MG CAP $3.50

6978450M PROMETHAZINE INJ 25MG/1ML $11.50

6979729K TROPICAMIDE SOL 0.01 $22.50

Page 90: CHARGE CODE CHARGE DESC CHARGE AMOUNT ......1401196 .015 THK SHT TAPRD RECP 2 $354.75 1401201 PROVISC 0.55ML 27G $219.30 1401203 DUOVISC (0.55PRO/0.50VIS) $443.60 1401204 VISCOAT 0.50ML

6983344M VANCOMYCIN INJ 500MG $53.40

6985410M SUMATRIPTAN INJ 6MG/0.5 $454.50

6989939M MEPERIDINE INJ 50MG/ML $7.00

6993291M MIDAZOLAM INJ 1MG $3.00

6995437M ATROPINE SYR 0.1MG $0.06

6997888M DIAZEPAM SYR 5MG $82.25

6998013M DOPAMINE INJ 40MG $1.15

6999712M MEROPENEM/NS 100MG $10.00

6999933M ACETYLCYST 20% INJ 100MG $1.03

7260095A MRI MRCP $1,184.44