+IMMUNOHIST/CYTO CHEM ADD 88341 177.160206-015-000: CEMENT MIXING BOWL 59.740210-114-100: INTERPULSE HANDPIECE 42.230408-800-100: FLYTE HOOD W/PEEL AWAY 48.411000406-00: ATRIUM MESH 4x6 C1781 42.2311-1422: ICEMAN COOLER W/UNIV LOOP 118.4512 CC SYRINGES BOX O.P. 13.0014.3.3 ETA PROTEIN 83520 148.321607-2-35: 4.0MM EGG BURR SAW BLADE 65.921885-500-24: 24" KNEE IMMOBILIZER 42.232296-3-125: LONG MED BLADE 39.1422G 1" NEEDLES BOX O.P. 19.00279-351-250: 50-S SERFAS ENERGY 180.252794N: COBAN2 LITE COMPRESSION 46.352N07A: GORTEX CV-2 SUTURE 26.782ND ANTIBIOTIC INF- OP 96367 100.942ND ANTIBIOTIC INF-ER 96367 100.943045: VENAFLOW THIGH CUFF 30.903D RENDER W/INTRP POSTPROCESS 76377 452.005921-034-136: PURPLE 34" TOURNIQUET CUFF 23.695921-044-136: 44" TOURNIQUET CUFF 26.785DCS: SCISSOR ENDOPATH CURVED 5MM 80.346000-006-000: INSTRUMENT BATTERY 27.816191-1-010: SIMPLEX CEMENT 107.126197-9-010: TOBRAMYCIN CEMENT 433.636625-127-105: PRECISION SAW BLADE 337.8472202468: FAST FIX 360 CURVED NEEDLE 477.9272202674: KNOT PUSHER SUTURE 130.819001: NEEDLE EZ-IO 25MM BLUE 145.23925.ZDK: ZERO PILLOW 32.96A&D OINMENT [1LB] 62.50abatacept 4 x 250 mg Vials (1000 mg ) J0129 14,115.30ABD PARACENTESIS W IMAGING SURGERY 49083 1,500.00ABD SINGLE VIEW 74018 234.84ABDOMEN 3+VIEWS 74021 421.27ABDOMEN COMP XRY 74022 421.27ABDOMEN KUB/UPRIGHT 2 VIEW 74019 309.00ABDUCTION PILLOW 314.15ABREVA CREAM 10% [2GM] 50.24ACEBUTOLOL CAP 400 MG 3.85ACETAMIN. [500MG - DIPHEN 15.14ACETAMINOPHEN 80299 182.31

1

ACETAMINOPHEN 12 HR G0480 182.31ACETAMINOPHEN 4HR/RDM 80329 182.31ACETAMINOPHEN CAP 650 MG 19.92ACETAMINOPHEN DROPS 80 MG 12.49ACETAMINOPHEN ELIXIR [160 14.87ACETAMINOPHEN ELIXIR [160 20.22ACETAMINOPHEN ELIXIR [160 1.40ACETAMINOPHEN IV J0131 213.13ACETAMINOPHEN SUPP [325MG 2.30ACETAMINOPHEN SUPP [650MG 2.30ACETAMINOPHEN SUPP 120 MG 2.30ACETAMINOPHEN TAB 325 MG 0.79ACETAMINOPHEN TAB 500 MG 0.79ACETAMINOPHEN/COD [120/12 17.06ACETAMINOPHEN/COD [120/12 9.93ACETAMINOPHEN/COD [120/12 73.29ACETAMINOPHEN/CODEINE TAB 2.66ACETAZOLAMIDE ER CAP [500 10.09acetAZOLAMIDE sodium Inj (500 mg mix wit 150.27ACETAZOLAMIDE TAB [250MG] 6.97ACETIC ACID 2% OTIC [15ML] 152.50ACETIC ACID SOL IRR [ .2 35.56ACETOMINOPHEN 12HR 80329 182.31ACETYLCYSTEINE [30ML VIA 52.70acetylcysteine IV in D5W J0132 640.18ACROMIOCLAVICULAR 73050 270.89ACRRONIOCLAVICLR SP 312.09ACTH Stimulation , 2 specimens Cortisol 82533 300.76ACTIDOSE/SORBITOL BTL [ 47.02ACTIDOSE/SORBITOL BTL [2 62.24ACTIDOSE-AQUA BTL [120ML 47.02ACTIDOSE-AQUA BTL [240ML 62.24ACTIVASE INJ [100MG W/DIL J2997 26,409.58ACTIVASE INJ [CATHFLO 2MG J2997 522.78activated charcoal Caps (260 mg) 16.40ACTONEL TAB [5MG] 25.16ACTONEL TAB [150MG ] 975.04ACTOS TAB [15MG] 27.00ACTOS TAB [30MG] 40.00ACTOS TAB [45MG] 43.00ACULAR OPHTH SOLN [0.5%] 889.86aCYclovir *IVPB* (500MG/100ML NS) 27.94

2

ACYCLOVIR SODIUM INJ [500 J0133 51.94ACYCLOVIR SUSP [200MG/5ML 255.48ACYCLOVIR TAB [400MG] 3.50ADD SURGERY DESCRIPTION 49999 4,000.00ADDN'L HR ANTIBIOTICS TX 96366 100.94ADDUCTOR CANEL BLOCK INJ 64447 484.10ADENOCARD INJ [6MG/2ML] J0153 77.62adenosine Inj (12 mg/4 ml) 36.47Adenovirus- Film Array Resp panel 87633 45.32ADM OF ANESTHETIC/ #UNITS 143.17ADVAIR DISKUS 100/50MCG [ 902.58ADVAIR DISKUS 100/50MCG [ 518.32ADVAIR DISKUS 250/50MCG [ 518.32ADVAIR DISKUS 250/50MCG [ 1,119.40ADVAIR DISKUS 500/50MCG [ 839.43ADVAIR DISKUS 500/50MCG [ 1,562.80AERDS 2 (btl 120) 64.28AGGRASTAT PREMIX [12.5MG J3246 1,561.92AGGRENOX CAP [200-25MG] 15.24AIR ANKLE SPLINT/RIGHT 334.75AK-DILATE OPHTH SOLN [10% 181.30ALAWAY EYE DROPS [10ML] 31.81ALBENZA TAB [200MG] 6.52ALBUMIN SERUM 82040 31.93Albumin- CSF Fluid 82042 30.90ALBUMIN HUMAN 25% 50ML #1 P9047 326.51ALBUMIN HUMAN 25% 50ML #3 P9047 326.51ALBUMIN HUMAN 25% 50ML #4 P9047 326.51Albumin pleural fluid 82042 56.65ALBUMINAR (ALBURX 25) IN 397.30ALBUMINHUMAN 25% 50ML #2 P9047 326.51ALBUTEROL HFA INHALER [8.5] 297.44ALBUTEROL SVN [ 0.083% 2. 11.38ALBUTEROL SVN [0.083% 2.5 37.30ALBUTEROL SYRUP [2MG/5ML 5.31ALBUTEROL SYRUP [2MG/5ML 31.28ALCAINE OPHTH [ .5%--15ML 160.13Alcohol Methyl Blood 80320 80.00ALDARA CREAM [ 5%] 173.20ALENDRONATE SODIUM TAB [7 34.14ALKALINE PHOSPHATASE 84075 33.99ALLERGEN CEDAR MOUNTAIN 86003 40.17

3

ALLERGEN RAGWEED COMMON 86003 40.17ALLERGY PANEL 14 - PEDS 86003 86.52ALLOPURINOL TAB [100MG] 2.96ALLOPURINOL TAB [300MG] 3.93Alpha-1 Antitrypsin Mutation (Genetics) 81332 135.96Alpha-1-Antitrypsin Phenotype 82104 67.98ALPRAZOLAM TAB [0.25MG] 3.58ALPRAZOLAM TAB [0.5MG] 3.65ALPRAZOLAM TAB [1MG] 4.11ALREX 0.2% OPHTH SUSP [5M 812.02ALS 1 -LTC TO HOSPITAL A0427 1,616.07ALS 1- RES TO HOSPTIAL A0427 1,616.07ALS 1-ACCIDENT TO HOSP A0427 1,616.07ALS 1-HOSITAL TO AIRPORT A0427 1,616.07ALS 1-HOSPITAL TO HOSPITAL A0427 1,616.07ALS 1-OTHER AMBULANCE TRANSFER A0427 1,616.07ALS 2 - ACC SCENE TO HOSP A0433 2,266.00ALS 2 - HOSP TO AIRPORT A0433 2,266.00ALS 2 - HOSP TO HOSP A0433 2,266.00ALS 2 - LTC TO HOSP A0433 2,266.00ALS 2 - OTHER AMBULANCE TRANSER A0433 2,266.00ALS 2 - RES TO HOSP A0433 2,266.00ALS-HOSPITAL TO RES A0427 1,616.07ALT (SGPT) 84460 40.17ALTERNAGEL SUSP [12 OZ] 12.00AMANTADINE CAP [100MG] 5.63AMB ACC SCENE/HOSP BASE A0428 1,251.45AMB ACC SCENE/HOSP P MILE A0425 24.72AMB HOSP TO RES PER MILE A0425 24.72AMB HOSP TO RESIDENCE BAS A0428 1,251.45AMB HOSP TO SNF A0425 24.72AMB HOSP TO SNF A0428 1,251.45AMB HOSP/ HOSP BASE A0428 1,251.45AMB HOSP/AIRP PER MILE A0425 24.72AMB HOSP/AIRPORT BASE A0428 1,251.45AMB HOSP/DIALY FAC BASE A0428 1,251.45AMB HOSP/HOSP PER MILE A0425 24.72AMB RES/HOSP BASE A0428 1,251.45AMB RES/HOSP PER MILE A0425 24.72AMB RES/SNF BASE A0428 1,251.45AMB RES/SNF PER MILE A0425 24.72AMB SNF TO DIALY PER MILE A0425 24.72

4

AMB SNF TO HOSP BASE A0428 1,251.45AMB SNF TO HOSP PER MILE A0425 24.72AMB SNF TO OTHER SNF A0428 1,251.45AMB SNF TO OTHER SNF/P MI A0425 24.72AMB SNF/DIALY FAC BASE A0428 1,251.45AMB SNF/DIALY FAC P MILE A0425 24.72AMB.TREATMENT & RELEASE A0999 414.06AMB/ OTHER TO HOSP BASE A0428 1,251.45AMB/OTHER TO HOSP PER MI A0425 24.72AMERIGEL OINT DRESSING [T 52.49AMILORIDE TAB [5MG] 2.91AMILORIDE/HCTZ TAB 5/50 4.30amino acid electrolyte/ dext 50 (10 %/50 189.00AMINOCAPROIC ACID 250MG/M 39.48AMINOPHYLLINE [25MG/ML 20 11.57AMIODARONE *VIAL* [150MG/3ML INJ] 19.30AMIODARONE 360MG/200ML D5W 207.82AMIODARONE INJ [150MG/3ML J0282 14.59AMIODARONE TAB [200MG] 14.81AMITIZA CAP [24MCG] 16.33AMITRIPTYLIN 80330 83.43AMITRIPTYLINE TAB [10MG] 2.99AMITRIPTYLINE TAB [25MG] 3.49AMITRIPTYLINE TAB [50MG] 4.14AMLODIPINE TAB [ 5MG] 5.05AMLODIPINE TAB [10MG] 2.68AMLODIPINE-BENAZEPRIL CAP 6.70AMMONIA AROMATIC AMP [.33 10.43AMMONIA LEVEL 82140 60.77AMMONIUM LACTATE CR. 12% 39.89AMOXICILLIN 200MG/5ML SUS 25.02AMOXICILLIN 200MG/5ML SUS 41.40AMOXICILLIN 400MG/5ML SUS 26.14AMOXICILLIN 400MG/5ML SUS 43.82AMOXICILLIN CAP [250MG] 2.91AMOXICILLIN CAP [500MG] 3.18AMOXICILLIN/CLAVUL SUSP [ 183.62AMOXICILLIN/CLAVUL SUSP [ 147.69AMOXICILLIN/CLAVUL SUSP [ 115.96AMOXICILLIN/CLAVUL TAB [5 8.37AMOXICILLIN/CLAVUL TAB [8 10.33AMOXICILLIN/CLAVULANATE E 14.39

5

Amphetamine-Dextroamphet ER CAP [30MG] 321.87amPHOTERicin B LIPOSOME SUSP [50MG] 904.42AMPICILLIN *IVPB* [1000MG/50ML NS] 39.59AMPICILLIN *IVPB* [2000MG /100ML NS] 52.00AMPICILLIN *IVPB* [2000MG /100ML NS] 92.81AMPICILLIN ADDV [1GM] J0290 76.00AMPICILLIN ADDV [2GM] J0290 116.00AMPICILLIN INJ [500MG] J0290 40.00AMPICILLIN INJ (2GM] J0290 73.00AMPICILLIN INJ [1GM] J0290 63.59AMPICILLIN INJ [250MG] J0290 66.00AMPICILLIN/SULBACTAM [1.5 J0295 47.62AMPICILLIN/SULBACTAM [3GM J0295 59.93AMPICILLIN/SULBACTAM ADDV J0295 41.00AMPICILLIN/SULBACTAM ADDV J0295 46.00AMPICILLIN-SULBACTAM *IVPB* [1.5GM/100ml 47.62AMPICILLIN-SULBACTAM *IVPB* [3GM/100ml N J0290 59.93AMPUTATION OF FINGER 26951 696.28AMPUTATION OF LOWER LEG 27880 8,000.00AMPUTATION OF TOE 28820 8,500.00AMPUTATION THIGH THRU FEMUR OPEN 27592 7,200.00AMPUTATION TOE AND METATARSAL 28810 4,500.00AMYLASE BLOOD 82150 85.49AMYLASE -BODY FLUID 82150 85.49AMYLASE URINE 82150 85.49ANAEROBE ID - FIRST ORG. 87076 77.25ANAEROBE ID- ADD'L ORG. 87076 77.25ANALGASICS NON-OPIOIDS G0480 182.31Anavip 1 vial 3,668.50ANBESOL GEL [7.1GM] 12.33Andexxa C9041 16,508.50ANTABUSE TAB [250MG] 18.81ANTACID ALUM/MAG/SIMETH SUSP DOUBLE STR. 3.00ANTACID SUSPENSION [30ML 1.40ANTACID SUSPENSION [355ML 14.35ANTACID SUSPENSION DS [35 13.29ANTERPOSTERIOR COPORRHAPHY COMBINED 57260 6,500.00ANTIBIOTIC ADDTN'L HR 96366 100.94ANTIBODY SCREEN 86850 92.70ANTIDREPRESSIANT TRICYCLIC 80335 83.43ANTIPYRINE/BENZOCAINE OTI 51.52ANTIZOL 1.5GM INJ 2,097.00

6

APAP/DICH/ISOMETH CAP 4.43APIDRA (RAPID ACTING) IN 519.61APIXABAN TAB [5 MG] 20.72Apolipoprotein A1 82172 64.89APPENDECTOMY ADD ON 44955 2,200.00APPLICATION OF FIGURE 8 29049 154.50APPLICATION OF FOREARM CAST 29075 900.00APPLICATION RIGID TOTAL LEG CAST 29445 772.50APPLIER 601.52APPLY STATIC FINGER SPLIN 29130 47.38APPLY STATIC SHORTARM SPL 29125 105.06AQUA GLYCOLIC HAND-BODY L 58.56AQUAPHOR OINT [50GM TUBE] 15.80Aquaporin-4 (AQP4) Ab NMO-IgG Elisa 83516 618.00AR-1008: ACL LIGAMENT STAPLE 83.43AR-1204AS-80: 8.0MM FLIP CUTTER 345.05AR-1204AS-85: 8.5MM FLIP CUTTER 345.05AR-13991N: SUREFIRE SCORPION NEEDLE 148.32AR-13995N: SCORPION NEEDLE 180.25AR-1588RT-J: ACL TIGHTROPE W/DEPL SUTURE 392.43AR-1589RT: TIGHTROPE BUTTON EXTENDER 238.96AR-1595T: DRILL PIN TIGHTROPE 132.87AR-1606: STAR SLEEVE 74.16AR-1923BC: BIO-COMP-SITE PLCK 2.9X15.5MM C1713 424.36AR-1927BF: BIO CORKSCREW 5.5 C1713 302.82AR-2323BCC: BIO-COMP SWVLCK CLD 5.5X19.1 424.36AR-2324BCM: 4.75 SWIVEL LOCK C1713 445.99AR-6068-45L: 45 DEG CURVED L LASSO 169.95AR-6068-45R: 45 DEG CURV RT SUT LASSO 169.95AR-6410: ARTHRO PUMP TUBING 64.89AR-6430: DUAL WAVE OUTFLOW TUBE 42.23AR-6564: CANNULA PARTIALLY THRD 5.75 26.78AR-6570: 7MM TWIST IN CANNULA 26.78AR-6572: CANNULA SYSTEM 8.25MMIDX9CM 33.99AR-7200: SUTURE FIBERWIRE 23.69AR-7209: #2 FIBERSTICK 53.56AR-7209T: TIGERSTICK #2 TIGERWIRE 53.56AR-7220: SUTURE FIBERWIRE 23.69AR-7237: FIBERTAPE 111.24AR-7237-7: FIBERTAPE 53.56AR-7250: 0 FIBERWIRE 23.69AR-8150PP-45: POWERPICK 45 DEG 107.12

7

AR-8400TD: TORPEDO 4.0MM X 13CM C1713 107.12AR-8500BC: BONE CUTTER 5.0MMX13CM 70.04AR-8500COT: BUR OVAL CLEARCUT 5.0MMX13C 70.04Aranesp 60mcg 1,401.70ARANESP SOL [100MCG/ML] J0881 2,330.50ARANESP SOL [150MCG/ML] J0881 3,491.50ARANESP SOL [200MCG/ML] J0881 4,652.50ARANESP SOL [300MCG/0.6ML J0881 6,974.50ARANESP SOL [40MCG/0.4ML J0881 937.30ARC AB ID PANEL 86870 138.02ARICEPT TAB [ 5MG] 36.00ARIPiprazole Oral Tab [10 MG] 124.09ARIPiprazole Tab (5 mg) 70.02ARIPiprazole Tab [15 MG] 123.97ARIXTRA [2.5MG 0.5ML PRE J1652 248.75ARM IMMOBOL SMALL 291.49ARM/SHOULDER IMMOB/UNIVER 306.94ARROW INTRO KIT 331.66ARTERIAL CATHETERIZATION 36620 221.45ARTERIAL PUNCTURE - ABG 36600 78.28ARTERIAL PUNCTURE LAB 36600 77.25ARTHROCENTESIS ASP JOINT W US 20611 650.00ARTHROCENTESIS ASPIRATION JOINT 20600 1,800.00ARTHROGRAM TRAY 51.50ARTHROPLASTY WRIST JOINTS 25447 5,500.00ARTHROSCOPY KNEE JOINT 29882 4,500.00ARTHROSCOPY SHOULDER DEBRIDEMENT 29822 3,500.00ARTHROSCOPY SHOULDER SLAP LESION 29807 6,500.00ARTHROTEC TAB 50/0.2MG 21.67Asacol HD 800mg 24.82ASACOL/DELZICOL CAP [400M 8.58ASCRIPTIN TAB [325MG] 1.95ASMANEX AER [220MCG 30] 533.05ASP/ INJ INTERMEDIATE JNT 20605 423.33ASP/ABCESS HEMATOMA/CYST 10160 430.54ASP/INJ MAJOR JOINT 20610 421.27ASPERCREME CRM [85GM] 15.03ASPERCREME CRM [142GM] 17.61Aspergillus antigen, EIA serum 87305 134.00ASPERGILLUS DNA QUAL PCR 87798 250.29ASPIRATION FLUID ABSCESS 10160 231.75ASPIRATION OR INJ OF LARGE JOINT 20610 550.00

8

ASPIRATION PLEURA W/O IMG 32554 573.71ASPIRATION/ INJ OF JOINT 20605 500.00ASPIRATION/INJ SM JOINT 20600 464.53ASPIRATOR 357.41ASPIRIN CHEWABLE TAB [81M 0.79ASPIRIN EC TAB [81MG] 0.79ASPIRIN EC-ORANGE TAB [32 0.79ASPIRIN SUPP [300MG] 3.20aspirin tab (81mg x 4 tabs) 9.36ASPIRIN TAB 325 MG 0.79AST (SGOT) 84450 40.17ASTRAMORPH (DURAMORPH) AM 122.33ATACAND TAB [ 4MG] 9.38ATACAND TAB [16MG] 7.42ATENOLOL TAB [ 25MG] 3.74ATENOLOL TAB [ 50MG] 3.88ATENOLOL TAB [100MG] 4.44ATHROSCOPY SHOULDER BICEP TENDON 29828 1,500.00ATORVASTATIN TAB [20MG] 3.31ATORVASTATIN TAB [40MG] 3.57ATRACURIUM INJ [10MG/ML 1 64.66ATROPINE INJ [0.4MG/ML 1M J0461 11.44atropine inj 1mg/ml J0461 58.00atropine ophth 1% drops (2 mL) 169.06ATROPINE SYR [0.05MG/ML 5 68.39ATROPINE SYR [1MG/10ML A 32.34ATROVENT INHALER HFA [12. 1,242.67AUGMENTIN XR TAB [1000MG] 23.00AVANDIA TAB [2MG] 7.39AVAPRO TAB [150MG] 10.00AVAPRO TAB [300MG] 12.00AVEENO BATH TREATMENT [1 15.71AVELOX TAB [400MG] 106.51AVLN/NAIL PLT SMPL EA ADD 11732 141.11AVODART CAP [0.5MG] 13.30AVP ARGININE VASOPRESSIN 84588 176.13AVULSION/NAIL PLT SIMPLE 11730 344.02AYR SALINE GEL NASAL [14. 12.60AZASITE SOL 1% OPHTH [BT 428.19AZELASTINE HCL NASAL SPRA 387.36AZELASTINE OPTH DROP [0.0 383.15AZITHROMYCIN *IVPB* [500 mg/NS 250 mL] 103.78

9

AZITHROMYCIN INJ [500MG] J0456 45.46AZITHROMYCIN SUSP [100MG/ 106.16AZITHROMYCIN SUSP [200MG/ 106.16AZITHROMYCIN TAB [250MG] 16.26AZOPT SUS 1% OPHTH [10ML] 984.52b complex vitamins Oral Cap 13.91B NEURO PEPTIDE 83880 190.55B.PERTUSSIS BY PCR 87798 237.93BACITRACIN OPH OINTMENT 434.88bacitracin zinc oint (1/32 oz pkg) 0.79BACITRACIN ZINC OINTMENT 15.02BACITRACIN ZINC OINTMENT 92.00BACITRACIN-POLYMYX.B OPTH 111.64BACK TABLE COVER 132.87BACLOFEN TAB [10MG] 6.24BACLOPHEN TAB [20MG] 3.83BACT ID - UA - FIRST 87088 67.98BACT ID- UA ADDL 87088 67.98BACT ID. GRAM NEGATIVE 87077 62.83BACT ID. GRAM POSITIVE 87077 62.83BACT. ID HNID 87077 64.89BACT.ID -IMMUNO-ADD'L ORG 87077 62.83BACT.ID. - ADD'L ORG. 87077 62.83BACTERIA SENS -ADD'L ORG. 87186 81.37BACTERIA SENSITIVITY POSITIVE ORGANISM 87186 81.37BACTERIA SENSITIVITY- GRAM NEGATIVE 87186 81.37BACTERIA SENSITIVITY- MICRO STREP 87186 81.37Bacterial detection by PCR 87801 323.42Bacterial pathogens panel by PCR 87505 309.00BACT-ID-IMMUNO-FIRST ORG. 87077 62.83BAG BALM OINT [10 OZ] 9.02BAKER TIBE PED 772.50BAKER TUBES 773.53BAL IN OIL AMP [100MG/ML 547.58BALSALAZIDE DISODIUM CAP 750 1,128.05BANANA BAG NS 1000ml 28.50BARIUM ENEMA 74270 611.82BARIUM ENEMA/AIR CN 74280 874.47BASIC LIFE SUPPORT MILEAG A0380 24.72BASIC METABOLIC PANEL 80048 82.40BAYGAM INJ 1,267.50BCR-ABL1 Gene Qnt PCR P190 81207 356.38

10

BCR-ABL1 Gene Qnt PCR P210 81206 471.74BECONASE-AQ NASAL IN 0.04 888.58BELLADONNA & PHENOBARBITA 52.99BELLADONNA & PHENOBARBITA 577.33BENAZEPRIL TAB [ 5MG] 4.13BENAZEPRIL TAB [10MG] 3.98BENAZEPRIL TAB [20MG] 4.13BENEFIBER POWDER SF [8.3O 32.48BENEFIBER ULTRA TAB [BTL 40.09BENGAY CREAM [57GM] 8.50BENICAR HCT TAB 40-25MG 28.25BENICAR TAB [20MG] 15.20BENICAR TAB [40MG] 28.25BENTYL INJ [10MG/ML] J0500 371.63BENZOIN COMPOUND TINCTURE 37.63BENZONATATE CAP [100MG] 3.35BENZTROPINE TAB [0.5MG] 3.10BETADINE 5% OPHTH [PREP S 10.50BETADINE 5% OPHTH PREP ST 68.64Betamethasone 0.1% oint 45gm 117.06BETAMETHASONE DIPROP 0.05 206.75BETAMETHASONE DIPROP 0.05 146.54BETAMETHASONE PHOSPH/BETA 53.00BETAMETHASONE VAL 0.1% LO 125.20BETASEPT 4% SURGICAL SRUB 35.92BETHANECHOL TAB [10MG] 4.99BETHANECHOL TAB [25MG] 6.64BETIMOL 0.5% OPHTH SOLN [ 69.70BETOPTIC-S 0.25% OPHTH SU 940.10BETOPTIC-S 0.25% OPHTH SU 142.65B-HCG - QUANTITATIVE 84702 141.11B-HCG -SERUM QUALITATIVE 84703 71.07B-HCG- URINE- QUALITATIVE 81025 71.07BICALUTAMIDE TAB [ 50MG] 30.79BICILLIN C-R INJ [1.2MU/2 J0558 493.60BICILLIN C-R INJ [900/300 493.61BICILLIN L-A INJ [ 60000 461.91BICILLIN L-A INJ [1200000 610.95BILIRUBIN DIRECT 82248 42.23BILIRUBIN INDIRECT 82248 42.23BILIRUBIN NEONATAL -TOTAL 82247 33.99BILIRUBIN TOTAL 82247 33.99

11

BILIRUBIN URINE 81005 46.35BIOPSY ABD/PELIVS SOFT TISSUE DEEP 49180 1,591.35BIOPSY ANORECTAL WALL 45100 2,364.88BIOPSY BONE SUPERFICIAL 20220 1,536.76BIOPSY FORCEP W/NEE 402.73BIOPSY LIVER 47000 1,536.76BIOPSY LUNG/MEDICASTINUM 32405 1,462.60BIOPSY LYMPH NODE 38505 1,390.50BIOPSY NEEDLE -RAD 209.09BIOPSY RENAL 50200 1,520.28BIOPSY SHOULDER SOFT TISSUE 23066 562.38BIOPSY SKIN LESION 11100 301.79BIOPSY SOFT TISSUE 20206 282.22BIOPSY/ REMOVAL LYMPH NODES 38500 3,500.00BIOTENE DRY MTH ORAL RINS 15.63BISACODYL EC TAB [5MG] 0.79BISACODYL SUPP [10MG] 1.80BISOPROLOL FUM TAB [5MG] 4.67BISOPROLOL/HCTZ TAB [2.5/ 7.72BISOPROLOL/HCTZ TAB [5/6. 7.72bisoprolol-HCTZ Tab (10-6.25 mg) 4.27BLADDER DRAIN W SUPRAPUBIC CATH 51102 1,655.21BLD ADMIN 1 UNIT 36430 463.50BLD ADMIN FEE 1 UNIT 36430 463.50BLD ADMIN FEE 3 UNITS 36430 849.75BLD OPT ADMIN FEE 2 UNIT 36430 618.00BLD OPT ADMIN FEE 4 UNITS 36430 1,018.67BLEEDING TIME - TEMPLATE 85002 84.46BLEPHAMIDE OPHTH OINT S.O 497.35BLEPHAMIDE OPHTH SUSP [10 925.10BLOOD GASES 82803 227.63BLOOD PUMP SET 238.96BLOOD SMEAR INTERPRETATIO 85060 133.90BLOOD SMEAR W/O WBC DIFF 85008 30.90BLOOD TYPE ABO 86900 47.38BLOOD TYPE RH 86901 46.35BONE AGE STUDIES 77072 280.16BONE NEEDLE 11G 153.02BONE NEEDLE 13G 153.02BONE SURVEY MET 77075 440.84BONIVA INJ [3MG/3ML KIT] J1740 368.50BONIVA TAB [150MG] 504.10

12

Boron Blood 83018 127.72BRAC1 81215 114.33BRAC2 81217 114.33Braf Gene 81210 466.00BREAST BIOPSY OPEN INCISIONAL 19101 1,700.00BREAST CORE BIOPSY TRAY 80.34BREAST CORE BX TRAY-CLIPS 175.10Brilinta 90 mg tab 16.95BRIMONIDINE 0.2% OPHTH [ 499.09BRINZOLAMIDE-BRIMONIDINE OPHTH SUSP. [1- 585.36BRUCELLA AB (IGG) 86622 85.49BRUCELLA AB (IGM) 86622 85.49BUDESONIDE RESPULES [ 0.5 28.60BUDESONIDE RESPULES [0.5M 28.60BUDESONIDE SR CAP [3MG/24 6.64bumetanide 5mg drip 34.28BUMETANIDE INJ [0.25MG/ML 21.39BUMETANIDE TAB [1MG] 5.81BUMETANIDE TAB [2MG] 7.05BUN - SERUM 84520 36.05BUPIVACAINE 0.25% [2.5MG 19.79BUPIVACAINE 0.5% [5MG/ML 18.95bupivacaine liposome 1MG injection (10ml 614.49bupivacaine liposome Inj 1 mg (20ml) 1,011.04bupivicaine-epi 0.5% 30mL vial 11.47BUPRENEX AMP [0.3MG/ML] 74.03buprenorphine Patch weekly * 10 mcg/hr b 243.27BUPROPION SR TAB [100MG] 5.12BUPROPION SR TAB [150MG] 5.51BUPROPION TAB [ 75MG] 4.90BUPROPION TAB [100MG] 5.54BUPROPION XL 24HR TAB [15 9.90BUPROPION XL 24HR TAB [30 9.89BURN SHEET 292.52BUSPIRONE TAB [5MG] 3.70BUSPIRONE TAB [10MG] 4.58BUSPIRONE TAB [15MG] 5.63BUTALBITAL/APAP/CAFFEINE 5.12BUTORPHANOL INJ 2MG/ML [ 16.28BUTRANS DIS [ 5MCG/HR] 227.47BUTRANS DIS [10MCG/HR] 243.27BX BILAT BREAST W STEREO 19081 4,500.00

13

BX BREAST W MRI ADD LESION 19086 1,236.00BX BREAST W MRI 1ST LESION 19085 3,193.00BX BREAST W STEROTACTIC ADD LESION 19082 1,236.00BX BREAST W ULTRASOUND 1ST LESION 19083 3,296.00BX BREAST W ULTRASOUND EACH ADD 19084 1,236.00BX L BREAST W STEREOTACTIC 1ST LESION 19081 3,193.00BX RT BREAST W STEREOTACTIC 1ST LESION 19081 3,193.00BYDUREON PEN 2,170.78BYETTA INJ [ 5MCG/DOSE] 1,289.78BYETTA INJ [10MCG/DOSE] 1,289.77BYSTOLIC TAB [ 5MG] 13.49BYSTOLIC TAB [10MG] 13.24C MYELOGRAM 72240 1,536.76C P M PAD 242.05C SPINE 4-5 VIEWS 72050 365.65C.DIFF TOX B GENE-PCR 87493 218.36C.diff toxins A/B -Stool 87324 90.64C.DIFFICLE ANTIGEN - STOOL 87449 125.66C1 Esterase Inhibitor Protein 86160 112.27CABERGOLINE TAB [0.5MG] 133.11Cadmium Blood 82300 94.76CALAMINE LOTION [4OZ] 11.81CALCITRIOL CAP [0.25MCG] 4.48CALCIUM SERUM 82310 33.99CALCIUM & MAGNESUIM TAB 0.29CALCIUM CARBONATE CHW TAB 0.79CALCIUM CARBONATE/D TAB 0.79CALCIUM CITRATE TAB [200M 0.79CALCIUM CITRATE TAB [250M 15.23CALCIUM CITRATE WITH D TA 15.22CALCIUM CL INJ [10% 10ML 91.98CALCIUM CL INJ [10% 13.6 37.81CALCIUM GLUCONATE INJ [10 J0610 48.03calcium gluconate*IVPB* (4.65 mEq 10%/1 J0610 74.94CALCIUM LIQUID SOFTGELS [ 16.39CALCIUM-MAGNESIUM-ZINC TA 13.47CALCUIM- URINE 82340 59.74CALMOSEPTINE OINTMENT [TU 18.00CAMPY DIRECT BY EIA 87899 70.04CANDIDIA ALBICANS SKIN TE 408.34CAPEX 0.01% SHAMPOO 753.54CAPILLARY COLLECTION 36416 25.75

14

CAPSAICIN CRM [60GM] 38.75CAPSAICIN-HP CREME [42.5G 39.96CAPTOPRIL TAB [12.5MG] 4.46CARBAMAZEPINE TAB [200MG] 4.98CARBAMIDE PEROXIDE EAR DR 10.81CARBIDOPA/LEVODOPA ER TAB 5.30CARBIDOPA/LEVODOPA ER TAB 3.79CARBIDOPA/LEVODOPA TAB 10 3.70CARBIDOPA/LEVODOPA TAB 25 3.78CARBIDOPA/LEVODOPA TAB 25 3.83Cardio IQ Lipoprotein fractionation 83704 138.02Cardioversion - EXTERNAL 92960 1,049.57CARHART DEODORANT POWDER 33.16CARISOPRODOL TAB [350MG] 3.76CARPAL TUNNEL WRIST ENDOSCOPY 29848 3,500.00CARVEDILOL TAB [ 3.125MG] 5.76CARVEDILOL TAB [ 6.25MG] 6.00CARVEDILOL TAB [12.5MG] 5.81CARVEDILOL TAB [25MG] 5.76CAST FINGER 29086 178.19CAST FOREARM 29075 266.77CAST LONG ARM 29065 330.63CAST LONG LEG 29345 375.95CAST- LONG LEG 387.28CAST SHORT LEG 29405 314.15CAST-LEG SHORT 324.45CAST-LONG ARM 339.90CASTOR OIL [59ML] 14.39CAST-SHORT ARM 126.69CATH ANTERIAL EMBOL 5FR 400.67CATH ARTERIAL EMBOL 3FR 360.50CATH ARTERIAL EMBOL 4FR 360.50CATH BILARY PROBE 5FR 418.18CATH CENTRAL VENOUS M/L 402.73CATH CYSTIC DUCT CH 460.41CATH FOGERTY IRR 360.50CATH FOGTY VEN EMB 386.25CATH FOGTY VEN THROM 386.25CATH FROGERTY IRRIG 6FR 360.50CAUTERY SUPPLIES 349.17CBC HEMOGRAM 85027 76.22CBC HEMOGRAM w/MAN DIFF 85025 93.73

15

CBC W/AUTO COMPLETE DIFF 85025 76.22CBC W/RX MAN DIFF 85025 93.73CBG (TRANSCORTIN) 84449 111.24CEDAX CAP [400MG] 84.48CEDAX SUSP [90MG/5ML 60M 308.20CEFADROXIL CAP [500MG] 8.27ceFAZOLin *IVPB* [1GM/NS 50ml] 41.90ceFAZOLin *IVPB* [2GM/NS 100ml] 41.59cefazolin 3gm/100mL J0690 50.22CEFAZOLIN ADDV [1GM] J0690 37.00CEFAZOLIN DDS [1GM IN DEX J0690 72.07CEFAZOLIN DDS [2GM IN DEX J0690 81.92CEFAZOLIN INJ [1GM SDV] J0690 41.90CEFDINIR CAP [300MG] 10.43CEFDINIR SUSP [125MG/5ML] 135.97cefepime 2gm/NS 50 mL J0692 177.80CEFEPIME INJ [2GM] J0692 177.78ceFOTAXime *IVPB* [2GM/NS 50ml] 59.63CEFOTAXIME SODIUM ADDV [2 J0698 59.63CEFPODOXIME PROXETIL TAB 12.96CEFPROZIL TAB [250MG] 9.63cefTARoline *IVPB* (600mg/100ml NS) 710.30ceftazidime 1gm 50.64CEFTAZIDIME ADDV [1GM] J0713 54.96CEFTAZIDIME ADDV [2GM] J0713 80.02CEFTIZOXIME INJ [1GM] 144.00CEFTRIAXONE INJ [250MG] J0696 35.74CEFTRIAXONE INJ [500MG] J0696 36.60CEFTRIAXONE INJ [1GM] J0696 38.98CEFTRIAXONE INJ [2GM] J0696 44.81cefTRIAXone *IVPB* [ 500 mg/NS 50 mL] 36.60cefTRIAXone *IVPB* [1 gm/NS 50 mL] 50.13cefTRIAXone *IVPB* [2 gm/NS 50 mL] 66.43CEFTRIAXONE ADDV [1GM] J0696 96.00CEFTRIAXONE ADDV [2GM] J0696 168.00CEFTRIAXONE IN DEXTROSE D J0696 73.43CEFUROXIME *IVPB* [1.5GM/NS 50ml] 55.94CEFUROXIME DDS [1.5GM/DEX J0697 92.98CEFUROXIME INJ [1.5GM SDV J0697 55.94CEFUROXIME TAB [250MG] 10.35CELEBREX CAP [100MG] 12.43celecoxib Cap (100 mg btl) 1,159.48

16

celecoxib Cap (200 mg) 14.25CELESTONE SOLUSPAN INJ [6 230.98CELL COUNT- BODY FLUID 89051 93.73CENESTIN TAB [0.625MG] 9.61CENTESIS 5FR CATHETER (OSC-5F-10T) 73.13CENTRAL LINE DRESSING KIT 50.00CENTRAL VENOUS CATH REMOV 36590 1,303.98CENTRAL VENOUS TUNNELED CV CATH 36561 4,233.00CEPACOL LOZ REG CHERRY SF 12.41CEPASTAT LOZENGES CHERRY 11.94CEPHALEXIN CAP [250MG] 3.85CEPHALEXIN CAP [500MG] 4.39CEPHALEXIN SUSP [125MG/5M 94.00CEPHALEXIN SUSP [250/5ML 136.62CERAVE CREAM [16OZ JAR] 37.21CERVICAL PLEXUS BLOCK INJ 64413 824.00CERVICAL X-RAY SPINE 1 VIEW 72020 188.49Cervical/Thoracic Facet Inj Lvl 1 Bilate 64490 2,093.99Cervical/Thoracic Facet Inj Lvl 2 Bilate 64491 525.30Cervical/Thoracic Facet Inj Lvl 3+ 64492 350.20Cervical/Thoracic Facet Inj Lvl 3+ Bilat 64492 525.30Cervical/Thoracic Facet Injection Lvl 1 64490 1,395.65Cervical/Thoracic Facet Injection Lvl 2 64491 350.20CETACAINE SPRAY [1 DOSE] 41.24cetirizine 5mg/5ml 21.73CETIRIZINE TAB [10MG] 11.73CEVIMELINE HCL CAP [30MG] 7.91Change desrcription to match 468.00Change PEG Tube w/out imaging 43760 471.74CHANTIX STARTER TAB PAK 417.54CHARCOCAPS CAPS [260MG] 11.00CHERRY SYRUP [60ML] 11.25CHEST 1 VIEW XRY 71045 225.57CHEST 3 VIEWS 71047 276.04CHEST 4 VIEW XRY 71048 350.20CHEST TUBE 152.44CHEST WALL MANIPULATION 94668 134.93CHEST XRY 2 VIEW 71046 231.75CHLAMYDIA BY PCR GX 87491 159.65Chlamydophila pneumo-Film array Resp pan 87486 152.44CHLORAL HYDRATE [500MG/5M 13.26CHLORAMPHENICOL [1GM 15ML 176.63

17

CHLORASEPTIC LOZ CHERRY [ 11.81CHLORASEPTIC LOZ CHERRY [ 0.79CHLORASEPTIC SPRAY [177ML 13.67Chlordiazepoxide 5 mg Cap 2.65CHLORDIAZEPOXIDE CAP [10M 2.72CHLORDIAZEPOXIDE CAP [25M 3.89CHLORDIAZEPOXIDE/CLIDINIU 10.47chlorhexidine gluc oral rinse Sol 15 mL 18.75CHLORHEXIDINE GLUCONATE S 37.27CHLORIDE- BLOOD 82435 28.84CHLOROPROCAINE-MFP 3% SDV 19.52CHLORPROMAZINE INJ [25MG 73.55CHLORPROMAZINE TAB [ 10MG 9.01CHLORPROMAZINE TAB [ 25MG 14.34CHLORPROMAZINE TAB [ 50MG 4.71CHLORPROMAZINE TAB [200MG 822.80CHLORTHALIDONE TAB [25MG] 4.37CHLORZOXAZONE TAB [500MG] 4.18CHOLANGIOGRAM T TUBE INJ 47531 800.00CHOLECALCIFEROL TAB *DOSE 1000IU* 0.79CHOLECYSTECTOMY W CHOLANGIOGRAPHY 47605 4,200.00CHOLESTEROL- SERUM 82465 37.08CHOLESTYRAMINE PWD [378GM 375.66CHOLESTYRAMINE PWD PKT [4GMS-SINGLE DOSE 7.72Chronic urticaria IgE Ab (anti-IgE IgG) 83520 141.71Chronic Urticaria Panel 2 Comp. 402.22CICLOPIROX GEL [0.77% 30G 171.50CICLOPIROX OLAMINE CRM [0.77% 30GM] 19.56CILOSTAZOL TAB [100MG] 5.33CILOXAN 0.3% OPHTH OINT [ 728.74CILOXAN OPHTH SOLN 0.3% 414.78CIPRO HC OTIC [10ML] 956.10CIPRO SUSP [250MG/5ML 100 288.82CIPRODEX 0.3-0.1% OTIC SU 845.45CIPROFLOXACIN I.V. SOL D5 J0744 17.70CIPROFLOXACIN I.V. SOL D5 J0744 19.86CIPROFLOXACIN INJ [400MG J0744 47.55ciprofloxacin oral susp (500 mg/5 ml bt 419.76CIPROFLOXACIN TAB [250MG] 2.88CIPROFLOXACIN TAB [500MG] 10.40CIPROFLOXACN OPHTH SOLN 0 68.98CITALOPRAM TAB [10 MG] 6.26

18

CITALOPRAM TAB [20MG] 6.67CITRUCEL ORANGE [DOSE] 1.40CKMB QUANTITATIVE 82553 138.02CL TX FINGER FRACTURE EACH 26755 515.00CL/HT AEROSL ADDTNL HR 94645 202.91CLARITHROMYCIN ER TAB [50 10.26CLARITHROMYCIN TAB [500MG 11.82CLEOCIN ADDV [600MG] 59.00CLINDAMYCIN *IVPB* [600MG/NS 50ml] 45.20clindamycin 600mg/50ml premix 61.92CLINDAMYCIN CAP [150MG] 3.47CLINDAMYCIN CAP [300MG] 8.26CLINDAMYCIN INJ [600MG 4M 45.20CLINDAMYCIN PHOSPHATE *IVPB* [900MG/NS50 51.29Clindamycin Phosphate topical 1 % Gel (3 175.84Clindamycin premix 600mg/50ml NS 54.64CLOBETASOL CREAM [0.05% 3 228.02CLOBETASOL PROP SHAMPOO [118ML BTL] 636.46CLOBETASOL PROPIONATE SOL 142.04CLONAZEPAM TAB [0.5MG] 6.24CLONAZEPAM TAB [2MG] 5.56CLONIDINE FOR EPIDURAL IN J0735 206.50CLONIDINE TAB [0.1MG] 2.86CLONIDINE TTS-1 PATCH [0. 87.20CLONIDINE TTS-2 PATCH [0. 140.56CLONIDINE TTS-3 PATCH [0. 191.52Clopidogrel Plavix 81225 644.78CLOPIDOGREL TAB [75 MG] 9.26CLORAZEPATE DIPOT TAB [3. 13.82CLORAZEPATE DIPOT TAB [7. 11.29CLORPACTIN WCS-90 POWDER 22.32CLOSED REDUCT DISLOC KNEE 27552 515.00CLOSED REDUCT WRIST 25605 546.93CLOSED REDUCTION OR RIGHT DISTAL FX 25605 1,718.04CLOSED REDUCTION RADIUS/ULNA 25605 2,100.00CLOSED TRMT DIS FINGER 26770 206.00CLOSED TX ANKLE FX 27818 768.38CLOSED TX DISL SHOULDER 23655 1,277.20CLOSED TX DISLOC ELBOW 24605 515.00CLOSED TX FOREARM FX 25565 515.00CLOSED TX HIP DISLOCATION 27265 721.00CLOSED TX HIP DISLOCATION 27266 721.00

19

CLOSED TX HUMERUS FRACTURE 24576 489.25CLOSED TX NASAL FRACTURE W/O STABILIZATI 21315 2,185.66CLOSED TX OF MP JT W MANI 26742 721.00CLOSED TX OF TIBIA FRACTURE 27752 2,500.00CLOSED TX PROX HUMERAL FX 23605 721.00CLOSED TX RADIAL SHAFT FRACTURE W/O MANI 25500 874.47CLOSED TX RADIAL SHAFT FX 25505 721.00CLOSED TX TMJ DISLOCATION 21480 515.00CLOSED TX ULNAR SHAFT FRACTURE W/MANIPUL 25535 436.72CLOSED TX ULNAR SHAFT FRACTURE W/O MANIP 25530 436.72CLOTRIMAZOLE SOLUTION [1 129.57CLOTRIMAZOLE CRM [1% 45GM 135.22CLOTRIMAZOLE TROCHE [10MG 4.71CLOTRIMAZOLE/BETAMETHASON 124.27CLOTRIMAZOLE/BETAMETHASON 247.70CLSD REDU PROX TIBIAL FX 27532 515.00CLSD TX SHOULDER DISLC W MANI 23655 1,700.00CLTX CARPO/METACARPAL FX DISLC THUMB W/M 26645 678.77CMPLX RPR 2.6CM - 7.5CM 13132 4,233.00CMPLX RPR E/N/E/L 1.1-2.5CM 13151 515.00CMPLX RPR E/N/E/L 2.6-7.5CM 13152 765.29CMPLX RPR F/C/C/M/N/AX/G/H/F 1.1-2.5 CM 13131 383.16CMPLX RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM 13132 1,044.42CMPLX RPR F/C/C/M/N/AX/G/H/F ADDTNL 5CM 13133 578.86CMPLX RPR S/A/L 1.1-2.5 CM 13120 983.65CMPLX RPR S/A/L 2.6-7.5CM 13121 515.00CMPLX RPR TRUNK 1.1-2.5 CM 13100 983.65CMPLX RPR TRUNK 2.6-7.5 CM 13101 983.65CO2- TOTAL BLOOD 82374 27.81Cobalt blood 83018 133.90COcaine 10% SOLUTION [10ml] 220.45COcaine 20% SOLUTION [10ml] 434.01COCCIDIOIDES SEROLOGY PANEL 86635 71.07Coenzyme Q10 82542 164.80COLA SYRUP [BTL] 13.34COLCHICINE TAB [0.6MG] 14.82COLD AGGLUTININ- SCREEN 86157 75.19COLECTOMY PATRIAL W ANASTOMOSIS 44140 7,200.00COLESTID TAB [1GM] 5.56COLLECT BLD 36415 57.68COLLECT BLD FROM IMPLANTED PORT 36591 80.34COLON PREP (1 Bottle of Magnesium Citrat 52.47

20

COLONOSCOPY ANESTHESIA 00811 143.17COLONOSCOPY ANESTHESIA SCREENING 00812 143.17COLONOSCOPY- HI RSK PT G0105 1,200.00COLONOSCOPY- LO RSK G0121 1,500.00COLONOSCOPY SUBMUCOUS NJX 45381 1,200.00COLONOSCOPY W BAND LIGATION 45398 1,500.00COLONOSCOPY W BX SINGLE OR MULTIPLE 45380 1,700.00COLONOSCOPY W LESION REMOVAL BX HOT 45384 1,600.00COLONOSCOPY W LESION RML BY SNARE 45385 1,700.00COLONSCOPY FLEXIBLE W CONTROL BLEEDING 45382 2,200.00COMBIGAN OPHTH SOL 0.2/0. 1,119.42COMBIVENT RESPIMAT INHALE 1,287.85COMP MET PANEL 80053 107.12COMPATIBILITY- AHG 86922 122.57COMPATIBLE UNIT SCRN MMH 86904 75.19COMTAN TAB [200MG] 20.36CONCURRENT 2ND IV SITE 96368 100.94CONCURRENT 2ND IV SITE 96368 100.94CONFIDENTIAL PATIENT PAY 86703 114.33CONT DRUG ADMIN-HOSPITAL 01996 245.14CONTINUOUS INHALATION TREATMENT (1ST HR) 94644 139.05CONTINUOUS INHALATION TX (ADTL HR) 94645 202.91COOL/HEAT AEROSL HR 94644 154.50COOMBS- DIRECT 86880 59.74COOMBS- INDIRECT 86886 101.97COPAXONE SYRINGE [20MG BO J1595 21,350.50COREG CR CAP [10MG] 24.22CORICIDIN HBP COUGH AND C 15.60CORNSTARCH 13.42Coronavirus 2293-Film array Resp panel 87633 45.32Coronavirus HKV1-Film array Resp panel 87633 45.32Coronavirus NL63-Film array Resp panel 87633 45.32Coronavirus OC43-Film array Resp panel 87633 45.32CORONER SALICYLATE 80329 16.48CORONER -URINE DRUG SCREEN 80306 32.96CORRECTION OF BUNION 28297 5,305.00CORTISPORIN 1% OINT [15 315.17CORTROSYN INJ [0.25MG] J0834 366.61COUGH DROPS (SUGAR FREE) 13.90Coxsackie B (1-6) Antibodies serum 86658 432.60CPAP MASK SM-MED-LG 235.87CPAP/BiPAP VENT 94660 604.61

21

CPR 92950 639.63CPR 92950 639.63CPR-RESPIRATORY ARREST 92950 639.63CPT INITIAL FLUTTER/PERCUTION 94667 145.23CR LT ELBOW WITH & W/O 73202 1,844.73C-REACTIVE PROTEIN 86140 50.47CREATINE KINASE (CK) 82550 60.77CREATININE CLEARANCE 82575 104.03CREATININE SERUM 82565 46.35CREATININE URINE 82570 46.35CREATININE -URINE VMA 82570 46.35CREON CAP [24000] 14.81CRESTOR TAB [10MG] 16.35CRESTOR TAB [20MG] 19.68CRITIC-AID SKIN PASTE [18 39.43CRITICAL CARE ADD/30 MIN 99292 554.14CROFAB INJ IV 9,602.50CRYSTALS BODY FLUID 89060 53.56CT ABD/PELVIS W & W/O 74178 4,433.12CT ABD/PELVIS W/O 74176 2,999.36CT ABD/PELVIS WITH 74177 3,649.29CT ABDOMEN W 74160 1,942.58CT ABDOMEN W/WO 74170 2,345.31CT ABDOMEN WO 74150 1,607.83CT ANGIO ABD AORTA W RUNOFF 75635 1,802.50CT ANGIO ABD W/WO 74175 1,854.00CT ANGIO ABD/PEL W/WO 74174 2,472.00CT ANGIO CHEST 71275 1,751.00CT ANGIO HEAD 70496 1,545.00CT ANGIO LOWER EXT W OR WO DYE 73706 1,648.00CT ANGIO NECK 70498 1,751.00CT ANGIO UPPER EXT UNI/BILAT 73206 824.00CT C SPINE W 72126 2,105.32CT C SPINE W & W/O 72127 2,152.70CT C SPINE W/O 72125 1,820.01CT CHEST HIGH RESOLUTIONS 71250 1,591.35CT CHEST LOW DOSE W/O G0297 1,591.35CT CHEST W 71260 1,890.05CT CHEST W/O CONTRAST 71250 1,591.35CT CHEST W/WO 71270 2,254.67CT FACIAL W 70487 1,588.26CT FACIAL W/WO 70488 1,988.93

22

CT FACIAL WO 70486 1,368.87CT HEAD W 70460 1,653.15CT HEAD W/WO 70470 1,973.48CT HEAD WO 70450 1,487.32CT L SPINE W 72132 2,107.38CT L SPINE W/WO 72133 2,305.14CT L SPINE WO 72131 1,791.17CT LT ANKLE W/O 73700 1,527.49CT LT ANKLE WITH 73701 1,935.37CT LT ANKLE WITH & W/O 73702 2,005.41CT LT ELBOW W/O 73200 1,490.41CT LT ELBOW WITH 73201 1,727.31CT LT FEMUR W/O 73700 1,527.49CT LT FEMUR WITH 73701 1,935.37CT LT FEMUR WITH & W/O 73702 2,005.41CT LT FOOT W/O 73700 1,527.49CT LT FOOT WITH 73701 1,935.37CT LT FOOT WITH & W/ 73702 2,005.41CT LT FOREARM W/O 73200 1,490.41CT LT FOREARM WITH 73201 1,727.31CT LT FOREARM WITH & W/O 73202 1,844.73CT LT HAND W/O 73200 1,490.41CT LT HAND WITH 73201 1,727.31CT LT HAND WITH & W/O 73202 1,844.73CT LT HIP W&W/O 73702 2,005.41CT LT HIP W/O 73700 1,528.52CT LT HIP WITH 73701 1,935.37CT LT HUMERUS W/O 73200 1,490.41CT LT HUMERUS WITH 73201 1,727.31CT LT HUMERUS WITH & W/O 73202 1,844.73CT LT KNEE W/O 73700 1,527.49CT LT KNEE WITH 73701 1,935.37CT LT KNEE WITH & W/O 73702 2,005.41CT LT SHOULDER W/O 73200 1,490.41CT LT SHOULDER WITH 73201 1,728.34CT LT SHOULDER WITH&W/O 73202 1,844.73CT LT TIBAL/FIBULA WITH 73701 1,935.37CT LT TIBIA/FIBULA W/O 73700 1,527.49CT LT TIBIA/FIBULA WITH & W/O 73702 2,005.41CT LT WRIST W/O 73200 1,490.41CT LT WRIST WITH 73201 1,727.31CT LT WRIST WITH & W/O 73202 1,844.73

23

CT NECK W 70491 1,834.43CT NECK W/WO 70492 2,031.16CT NECK WO 70490 1,568.69CT NEEDLE PLACEMENT 77012 1,658.30CT NON-IONIC 240/ 1ML Q9966 3.09CT NON-IONIC 300 50 ML Q9967 370.80CT NON-IONIC 350 / 75ML Q9967 246.17CT NON-IONIC 350/ 100 ML Q9967 327.54CT NON-IONIC 350/ 50ML Q9967 164.80CT ORBIT/ EAR / FOSSA W/O 70480 1,587.23CT ORBIT/ EAR/ FOSSA W & WO 70482 2,010.56CT ORBIT/ EAR/ FOSSA/ W DYE 70481 1,707.74CT PELVIS W 72193 1,847.82CT PELVIS W/WO 72194 2,224.80CT PELVIS WO 72192 1,568.69CT PERFUSION W CONTRAST 0042T 206.00CT RT ANKLE W/O 73700 1,527.49CT RT ANKLE WITH 73701 1,935.37CT RT ANKLE WITH & W/O 73702 2,005.41CT RT ELBOW W/O 73200 1,490.41CT RT ELBOW WITH 73201 1,727.31CT RT ELBOW WITH & W/O 73202 1,844.73CT RT FEMUR W/O 73700 1,527.49CT RT FEMUR WITH 73701 1,935.37CT RT FEMUR WITH & W/O 73702 2,005.41CT RT FOOT W/O 73700 1,527.49CT RT FOOT WITH 73701 1,935.37CT RT FOOT WITH & W/O 73702 2,005.41CT RT FOREARM W/O 73200 1,490.41CT RT FOREARM WITH 73201 1,727.31CT RT FOREARM WITH & W/O 73202 1,844.73CT RT HAND WI/O 73200 1,490.41CT RT HAND WITH 73201 1,728.34CT RT HAND WITH & W/O 73202 1,844.73CT RT HIP W&W/O 73702 2,005.41CT RT HIP W/O 73700 1,528.52CT RT HIP WITH 73701 1,935.37CT RT HUMERUS W/O 73200 1,490.41CT RT HUMERUS WITH 73201 1,727.31CT RT HUMERUS WITH & W/O 73202 1,844.73CT RT KNEE W/O 73700 1,527.49CT RT KNEE WITH 73701 1,935.37

24

CT RT KNEE WITH & W/O 73702 2,005.41CT RT SHOULDER WITH 73201 1,728.34CT RT SHOULDER WITH&W/O 73202 1,844.73CT RT SHOULDER W/O 73200 1,490.41CT RT TIBIA/FIBULA W/O 73700 1,527.49CT RT TIBIA/FIBULA WITH 73701 1,935.37CT RT TIBIA/FIBULA WITH & W/O 73702 2,005.41CT RT WRIST W/O 73200 1,490.41CT RT WRIST WITH 73201 1,727.31CT RT WRIST WITH & W/O 73202 1,844.73CT SINUS W/O 70486 978.50CT T SPINE WO 72128 1,779.84CT T-SPINE WITH 72129 2,026.01CTRL NASAL HEMOR-ANT-CMPL 30903 440.84CTRL NASAL HEMOR-POSTERIO 30905 484.10CULTURE - ANAEROBIC 87075 141.11CULTURE BLOOD 87040 164.80CULTURE - GROUP B STREP 87081 75.19CULTURE - NASAL 87070 112.27CULTURE - SPUTUM 87070 112.27CULTURE - STOOL-VIBRIO 87046 40.17CULTURE - VAGINAL 87070 112.27CULTURE -ANAEROBIC-ADD'L 87075 141.11CULTURE- ANY OTHER SOURCE 87070 112.27CULTURE -ANY SAME -ADD'L 87070 112.27CULTURE -ASPIRATE -ADDL 87070 112.27CULTURE- BLOOD-ADD'L 87040 164.80CULTURE- STOOL-SAL/SHIG 87045 112.27CULTURE -STOOL-YERSINIA 87046 40.17CULTURE -SURGERY-FIRST 87070 112.27CULTURE- THROAT 87070 112.27CULTURE- UA -W/COL CT 87086 86.52CULTURE-ASPIRATE -FIRST 87070 112.27CULTURELLE CAP [BTL 30] 12.96CULTURE-STOOL-CAMPYLOBACT 87046 40.17CULTURE-STOOL-E.COLI 0157 87046 40.17CULTURE-SURGERY -ADDL 87070 112.27CURVED NEEDLE 11G 993.95CUTTER-ATW35 1,437.88CUTTER-TLC55 622.12CUTTER-TR35W 594.31CV STRESS TEST PHYSICIAN 93016 40.17

25

CYANIDE ANTI KIT PKG UNIT 1,157.70CYANOCOBALAMIN INJ [1000M 39.96CYANOCOBALAMIN TAB [1000M 16.21CYCLOBENZAPRINE TAB [10MG 2.65CYCLOMYDRIL 1% OPHTH SOL 128.74CYCLOSPORA ISOSPORA CONCE 87015 100.94CYCLOSPORA ISOSPORA SMEAR 87207 100.94CYCLOSPORINE CAP [100MG] 11.02CYMBALTA CAP [30MG] 19.19CYMBALTA CAP [60MG] 23.00CYPROHEPTADINE TAB [4MG] 4.15CYSTATIN C 82610 124.63Cystine 24 hour Urine 82131 131.84CYSTO CONRAY 250ML Q9958 138.02CYSTROGRAM XRAY 74450 529.42CYTOPATH C/V THIN LAYER 88142 115.36CYTOPATH CELL ENHANCE PRO 88112 132.87CYTOPATH CELL ENHANCE TC 88112 333.72CYTOPATH EVAL FNA 88173 327.54CYTOPATH EVAL FNA 88173 322.39CYTOTEC TAB [100MCG] 9.89D.H.E. 45 INJ [1MG/ML] J1110 449.84DAKIN'S SOLUTION [0.25% 1 48.44DANTRIUM IV INJ [20MG] 391.43DANTROLENE CAP [25MG] 4.16DANTROLENE CAP [50MG] 5.18DAP CBC 15.00DAP CMP 25.00DAP ESR 10.00DAP Fecal occult blood 10.00DAP Ferritin 15.00DAP Free T4 20.00DAP General Health Panel 60.00DAP Glycohemoglobin A1c 25.00DAP Iron/IBC 35.00DAP Lipid profile 20.00DAP Pregnancy test Qualitative 15.50DAP Protime/INR 25.00DAP PSA 15.00DAP TSH 20.00DAP Uric acid 10.00DAP Urinalysis 25.00

26

DAP Venipuncture 7.00DAP Vitamin D-25 Hydroxy 50.00DAPTOmycin * IVPB* (500 mg/NS 50mL) 1,368.95DAPTOmycin * IVPB* (range greater than 5 J0878 2,705.40DAPTOmycin *IV Push* (500 mg) J0878 1,368.95DARBEPOETIN INJ [ 60MCG/0.3ML] 1,261.00Darbepoetin Inj (10mcg/0.4ml) 342.87DAWSON MUELLER DRAINAGE CATH 12FR 318.27DAYPRO TAB [600MG] 20.70DDAVP TAB [0.2MG] 25.92D-DIMER TEST QUANT. 85379 129.78DEB SUBQ TISSUE 20 SQ CM 11042 2,300.00DEB SUBQ TISSUE ADD ON 11045 1,500.00DEBRIDE I <= 20 SQ CM 97597 130.81DEBRIDE II > 20 SQ CM 157.59DEBRIDE INFECTED SKIN 11000 273.98DEBRIDE MUSCLE OR FASCIA 20SQ OR LESS 11043 4,233.00DEBRIDE NAIL 11720 257.50DEBRIDE SKIN AT FX SITE 11010 2,300.00DEBRIDE WOUND <= 20 SQ CM 97597 324.45DEBRIDEMENT BONE MUSCLE 20SQ 11044 1,800.00DEBRIDEMENT MUSCLE & FASCIA EA ADDL 20CM 11046 1,500.00DEBRIDEMENT OPEN FX 11010 1,166.99DECALCIFY TISSUE PATH COM 88311 66.95DECALCIFY TISSUE TECH COM 88311 74.16DELESTROGEN INJ [20MG/ML J1380 637.04DELIVERY INST PACK 154.50DEMEROL INJ [ 25MG/ML INJ J2175 18.47DEMEROL INJ [ 50MG/ML INJ J2175 18.87DEMEROL INJ [100MG/ML INJ J2175 35.72DEMNSTRAT/EVAL PT USE OF INHALER 94664 139.05DENAVIR CR. [1% CR. 1.5GM 194.51DEPAKOTE SPR CAP [125MG] 4.74DEPO-ESTRADIOL INJ [5MG/M 395.54DEPO-MEDROL INJ [40MG/ML 54.15DEPO-MEDROL INJ [80MG/ML 87.74DEPO-PROVERA INJ [150MG/M 709.90DERMABOND 181.28DESFERAL INJ [500MG] 49.15DESITIN GENERIC DIAPER RA 16.32DESMOPRESSIN TAB [0.1MG] 10.69DESONIDE CREAM [0.05% 60G 148.24

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DESONIDE LOTION [0.05% 11 721.46DESOWEN LOT [0.05%] 493.76DESOXIMETASONE CRM [0.05% 607.90DESOXIMETASONE CRM [0.25% 151.90DESTRUCT B9 LESION 17110 1,200.00DETROL LA CAP [2MG] 32.12DETROL LA CAP [4MG] 17.30DETROL TAB [1MG] 15.94Dexamethasone 0.75 mg Tab 2.88dexaMETHASONE 0/S CONC. [INTNESOL 1MG/ML 27.50DEXAMETHASONE ELIXIR [ 0. 17.22DEXAMETHASONE ELIXIR [0.5 42.72DEXAMETHASONE INJ [ 4MG/M 19.88DEXAMETHASONE INJ [10MG/M 14.12DEXAMETHASONE SOD OPHTH [ 334.26DEXAMETHASONE TAB [4MG] 4.34DEXT 10% [1000ML] 57.68DEXT 50% [500ML/1000ML P 73.00DEXT 5% IN LR 1000 ML 59.74DEXT 5% .20% NACL [1000ML 57.68DEXT 5% .45% NACL [1000ML 56.65DEXT 5% .45% NACL--20MEQ 62.00DEXT 5% 0.9% NACL [1000ML 56.65DEXT 5% IN WATER [1000ML] 53.56DEXT 5% IN WATER [250ML] 82.40DEXT 5% IN WATER [500ML] 51.50DEXT 5% IN WATER [50ML AD 62.00DEXT 5% IN WATER PF [100/150ML] 68.00DEXT 5%/HEPARIN [25000U 141.00DEXTROSE SYRINGE [50% 50M 47.21DIABETIC COUNSELEING S9465 165.00DIAGNOSTIC COLONOSCOPY 45378 1,200.00DIAGNOSTIC SIGMOIDOSCOPY 45330 1,960.00DIAMOX SEQUELS CAP [500MG 19.70DIAZEPAM INJ [5MG/ML 2ML] J3360 114.84DIAZEPAM TAB [2MG] 2.69DIAZEPAM TAB [5MG] 3.00DICLOFENAC K+ TAB [50MG T 6.78dicloxacillin 500 mg 6.38DICYCLOMINE TAB [20MG] 3.43DIETARY SVCS DIABETIC G0108 82.00DIFFICULT DRAW MIDLINES 36410 39.14

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DIFFUSION CAPACITY (DLCO) 94729 327.54DIGIFAB INJ [40MG] J1162 11,471.50DIGOXIN INJ [0.25MG/ML 2M J1160 35.41DIGOXIN LEVEL 80162 116.39DIGOXIN TAB [0.125MG] 2.50DIGOXIN TAB [0.25MG] 2.50DILANTIN/PHENYTOIN LEVEL 80185 124.63DILAUDID INJ [2MG/ML] J1170 15.24DILAUDID PCA [0.2MG/ML OR 77.93DILTIAZEM CD CAP [120MG] 3.17DILTIAZEM CD CAP [180MG] 3.14DILTIAZEM CD CAP [240MG] 5.68DILTIAZEM CD CAP [300MG] 6.58DILTIAZEM HCL TAB [30MG] 2.78DILTIAZEM HCL TAB [60MG] 2.94DILTIAZEM INJ [ 5ML VIAL] 10.38DILTIAZEM INJ [25ML FOR I 47.38DILTIAZEM NS 100ml DRIP [125MG/125ml] 47.38DIOVAN TAB [ 40MG] 12.00DIOVAN TAB [ 80MG] 10.01DIOVAN TAB [160MG] 12.00DIPHENHYDRAMINE CAP [25MG 0.79DIPHENHYDRAMINE CAP [50MG 2.58DIPHENHYDRAMINE CREAM [2 15.11DIPHENHYDRAMINE INJ [50MG J1200 20.38DIPHENHYDRAMINE SOLU [12. 0.79DIPHENHYDRAMINE SOLU [12. 11.05DIPHENOXYLATE/ATROPINE SO 218.50DIPHENOXYLATE/ATROPINE TA 3.94DIPRIVAN INJ [10MG/ML 10 J2704 143.50DIPRIVAN INJ [10MG/ML] J2704 16.95DIPRIVAN INJ [10MG/ML 50M J2704 34.42DIPYRIDAMOLE TAB [25MG] 4.14DIPYRIDAMOLE TAB [50MG] 5.15DIPYRIDAMOLE TAB [75MG] 6.04DISLOC METACARPOPHALANGEA 26700 515.00DISLOCATION LITTLE TOE 28660 515.00DISLOCATION SHOULDER - TX 23650 721.00DISP TROCAR 542.81DISSECTOR-5DCD 509.85DITROPAN XL TAB [15MG] 17.21DIVALPROEX DR TAB [250 MG 5.23

29

DIVALPROEX ER TAB [500 MG 8.23DL-ALPHA TOCOPHERYL ACETATE CAP (1000 un 48.08DNX12: DERMABOND SKIN ADHESIVE 0.7ML 23.69DOBUTAMINE HCL INJ [250MG 32.23DOBUTAMINE/D5W PREMIX BAG J1250 43.92DOCUSATE CALCIUM CAP [24O 0.79DOCUSATE NA/ SENNOSIDES T 0.79DOCUSATE SOD. LIQUID [60 0.79DOCUSATE SODIUM CAP [100M 0.79DONEPEZIL TAB [ 5MG] 2.75DONEPEZIL TAB [10MG] 1.95DOPAMINE IN D5W PREMIX BA J1265 61.11DORIBAX INJ [500MG] J1267 212.82DORZOLAMIDE-TIMOLOL OPHTH 449.86DOUBLE ANTIBIOTIC OINTMEN 11.99DOVONEX 0.005% CRM [60G 1,495.84DOXAPRAM INJ [20MG/ML 20 246.10DOXAZOSIN TAB [2MG] 4.00DOXAZOSIN TAB [4MG] 8.61DOXEPIN 80335 98.88doxepin Cap (50 mg) 4.31DOXEPIN HCL CAP [ 10MG] 3.49DOXEPIN HCL CAP [ 25MG] 3.77DOXEPIN HCL CAP [150MG] 7.32DOXYCYCLINE *IVDRIP* [100MG/NS 250ML] 123.22DOXYCYCLINE CAP [100MG] 7.59DOXYCYCLINE INJ [100MG 10 123.22DOXYLAMINE TAB [25MG BTL] 11.77DRAIN EXTERNAL EAR LESION 69000 148.32DRAINAGE FINGER ABCESS 26010 206.00DRAINAGE OF SKIN ABSCESS 10060 2,300.00DRAINAGE PELVIS 26990 2,251.58DRESSING CHANGE SUPPLY 73.91DRONABINOL CAP [5MG] 33.01DROPERIDOL INJ [2.5MG/ML J1790 37.88DRSG/DEBRIDE - W/O ANES SM 16020 305.91DRSG/DEBRIDE W/O ANES - LG 16030 367.71DRSG/DEBRIDE W/O ANES - MED 16025 307.97DRUG SCREEN NON TLC/DEVICE 80305 75.19DT LESS THAN 7 YRS IM 90702 76.22DULAGLUTIDE PEN INJECTOR [1.5MG/0.5ML X 2,286.70DULAGLUTIDE SOLUTION PEN INJECTOR [0.75M 2,286.70

30

DULERA HFA INHALER 100-5 942.55duloxetine DR Cap (30 mg) 14.67duloxetine DR Cap (60 mg) 14.44DX LAP ABDOMEN, PERITONEUM W OR WO SPEC 49320 2,200.00DXA BONE DENSITY STUDY 77080 365.65DYNAMIC ACTIVITY - 15MIN 97530 128.75DYRENIUM CAP [50MG] 20.32E. COLI 0157 PCR 87798 189.52E.Coli 0157 Shigatoxin 87335 81.37ECONAZOLE CREAM [1%] 715.52ED BLD ADMIN FEE 2 UNITS 36430 618.00ED BLD ADMIN FEE 3 UNITS 36430 849.75ED BLD ADMIN FEE 4 UNITS 36430 1,018.67ED Change of Cystostomy tube simple 51705 471.74ED Contrl nasal hemorrhage-anterior-simp 30901 418.18ED EAR WAS W/ REMOVAL BY INSTRUMENT 69210 154.50ED FNA BX W/ US GUIDANCE 10005 597.40ED FNA W/O IMAGING 10021 424.36ED HUMEROUS OR ELBOW PROCEDURE 24999 463.50ED PARACENTESIS WITH IMAGING GUIDANCE 49083 1,419.00ED PHYS INSERTION PICC LINE 36573 824.00ED US ABD LTD FAST 76705 212.18ED US ABDOMINAL AORTA 76706 154.50ED US BLADDER 76775 283.25ED US CHEST 76604 309.00ED US Echocardiography Limited 93308 270.89ED US OPHTHALMIC FOREIGN BODY LOCALIZE 76529 257.50ED US SOFT TISSUE 76882 267.80ED US VASCULAR ACCESS 76937 154.50ED-ALBUTEROL INHALER HFA 297.44ED-ALBUTEROL SYR [2MG/5ML 36.19ED-AMOXICILLIN & K CLAV S 187.46ED-AMOXICILLIN & K CLAVUL TAB [875MG#6] 117.61ED-AMOXICILLIN CAP [500MG 17.93ED-AMOXICILLIN SUSP [200/ 25.02ED-AMOXICILLIN SUSP [400/ 26.14ED-ANTIPYRINE-BENZOCAINE 51.52ED-APAP/CODEINE SOLN [120 16.72ED-APAP/CODEINE TAB [300- 16.30ED-AZITHROMYCIN SUSP [100MG/5ML 15ML BTL 134.07ED-AZITHROMYCIN TAB [250M 176.63ED-CEFDINIR SUSP [125MG/5 192.06

31

ED-CEPHALEXIN CAP [500MG 37.23ED-CYCLOBENZAPRINE TAB [10MG #6] 33.50ED-DEXAMETHASONE ELIXIR [ 66.55ED-DICLOFENAC K+ TAB [50M 42.02ED-DIPHENHYDRAMINE CAP [5 9.60ED-DIPHENOXYLATE/ATROPINE 23.62ED-DOXYCYCLINE CAP [100MG 141.27EDECRIN TAB [25MG] 64.53ED-ERYTHROMYCIN OPHTHALMIC OINTMENT 5MG 39.80ED-ERYTHROMYCIN OPTH 75.64ED-ERYTHROMYCIN-SULFISOX 69.00ED-GENTAMICIN SULFATE OPH 86.62ED-HYDROCODONE/APAP [10/325 #6] 34.64ED-HYDROCODONE/APAP [5/325 #6] 25.68ED-HYDROCODONE/APAP TAB [ 4.00ED-HYOSCYAMINE DROPS [0.1 152.46ED-HYOSCYAMINE SL TAB [ 0 26.86ED-IBUPROFEN SUSP [100/5M 14.07ED-IBUPROFEN TAB [600MG # 20.33ED-KETOROLAC TAB [10MG] 55.09ED-LORAZEPAM TAB [1MG #6] 27.10ED-ONDANSETRON TAB/ODT [4MG #6] 23.70ED-ORPHENADRINE ER TAB [1 55.68ED-Penicillin VK 250mg #6 pack 26.86ED-PHENYLEPH TAN./CHLORPH 18.00ED-PROMETHAZINE TAB [25MG 19.44ED-promethazine/codeine syr (60 mL BTL) 23.43Edrophonium Chl 150mg/15ml 31.54ED-SILVER SULFADIAZINE CR 103.79ED-SILVER SULFADIAZINE CREAM *dose* 9.00ED-TMP-SMX DS TAB [800/16 38.79ED-TMP-SMX SUSP [200-40/5 106.86ED-TRAMADOL TAB [50MG #6] 26.59ED-ZOMIG NASAL SPRAY [5MG 552.43EFFIENT TAB [10MG] 40.39EFUDEX CREAM [5% 40 GRAM] 125.20EGD & COLONOSCOPY (SAME TIME) 00813 143.17EGD BALLOON DILATION ESOPHAGUS 43249 1,500.00EGD BX TRANSORAL SINGLE OR MULTIPLE 43239 1,900.00EGD CONTROL BLEEDING 43255 2,200.00EGD DIAGNOSITC BRUSH WASH 43235 1,200.00EGD ENDO MUCOSAL RESECTION 43254 2,300.00

32

EGD FLEXIBLE FOREIGN BODY REMOVAL 43247 2,300.00EKG - TRACING ONLY 93005 198.79EKG- INTERPRETATION ONLY 93010 50.47EKG TRACING- RHC 93005 22.00EL STIM ELECTRODES P SET 40.17ELBOW 2 VIEWS LT 73070 185.40ELBOW 2 VIEWS RT 73070 185.40ELBOW REPAIR PERC 24357 3,500.00ELEC STIMULATION -15 MIN 115.36ELECTRODE 1 STEP ZOL PAD 207.50ELECTROLYTES 4 80051 84.46ELIQUIS TAB 2.5 MG 20.72EMB CATH 498.52EMERGENCY ANESTHESIA 99140 279.13EMLA CREAM [2.5% 30GM W\O 158.00ENABLEX TAB [ 7.5MG] 33.53ENABLEX TAB [15MG] 33.53ENALAPRIL TAB [ 2.5MG] 4.76ENALAPRIL TAB [ 5MG] 5.37ENALAPRIL TAB [10MG] 5.51ENALAPRIL TAB [20MG] 6.79ENALAPRILAT INJ [1.25MG/M 25.78ENALAPRILAT INJ [2.5MG/2M 20.88ENDO CLIP 1,432.73ENDO CLIP 861.08ENDO CLIP 1,634.61ENDO SLEEVE-CB11LT 227.63ENOXAPARIN SODIUM SYR [ 3 J1650 21.50ENOXAPARIN SODIUM SYR [ 4 J1650 34.42ENOXAPARIN SODIUM SYR [ 6 J1650 34.51ENOXAPARIN SODIUM SYR [10 J1650 51.87ENOXAPARIN SODIUM SYR [12 J1650 111.53ENTAMOEBA Ag 87336 82.92ENTRO VIRUS RNA QUAL PCR 87498 255.44ENVISAN PAK 964.08ENVISAN PAK 963.05ENZYME HISTOCHEM 88319 221.45ENZYME HISTOCHEM 88319 107.12EPHEDRINE SULF AMP [50MG/ 212.79EPIDERAL BLOOD OR CLOT PATCH 62273 941.42EPIDURAL BLOOD PATCH 62273 941.42EPIDURAL INJ C-T SPINE 62321 1,202.01

33

EPIDURAL INJ L-S SPINE 62322 1,055.75EPIDURAL INJECT L-S SPINE 62323 976.44EPIDURAL INJECT SACROILIAC JOINT 27096 1,060.90EPINEPHRINE [1:10000 10 M J0171 46.30EPINEPHRINE AMP [1:1000 1 J0171 71.50EPINEPHRINE INJ [0.1MG/ML J0171 46.30EPINEPHRINE INJ [0.3MG A J0171 557.00EPIPEN SYRINGE [0.3MG] J0171 921.41EPOC ABG - POCT 82803 215.27EPOC GFR - POCT 82565 44.29EPOC Hematocrit POCT 85014 33.99EPOC panel - POCT (11 tests) 80051 250.00EPOGEN [2000 U/ML 1ML S J0885 239.45EPOGEN [3000 U/ML 1ML S J0885 223.38EPOGEN [4000 U/ML 1ML S J0885 295.00EPOGEN [10000 U/ML 1ML S J0885 906.46EPOGEN [20000 U/ML 1ML M J0885 1,003.30EPOGEN [40000 U/ML 1ML S J0885 295.00EPSOM SALT USP [16 OZ] 6.17ER CLASS I 99281 200.00ER CLASS II 99282 350.00ER CLASS III 99283 600.00ER CLASS IV 99284 900.00ER CLASS V 99285 1,200.00ER CRITICAL CARE 30-74 MI 99291 1,768.51ER DRESSING CHANGE 154.50ER PHY CMPLX RPR F/C/C/M/N/AX/G/H/F+ 5CM 13133 142.14ER PHY CRITICAL CARE 99291 662.29ER PHY FEE SHORT ARM SPLINT 29125 183.34ER PHY FEE/KNEE IMMOBILIZER 29530 360.50ER PHY LEVEL 1 EXAM 99281 120.51ER PHY LEVEL 2 EXAM 99282 192.61ER PHY LEVEL 3 EXAM 99283 241.02ER PHY LEVEL 4 EXAM 99284 362.56ER PHY LEVEL 5 EXAM 99285 479.98ER PHY REMOVE TUNNELED CV CATH W/O PORT 36589 515.00ER PHY RPR F/C/C/M/N/AX/G/H/F 1-2.5 CM 13131 577.83ER PHY STRAP SHLDR IMM 29240 223.51ER PHY TOE FRACTURE 28515 239.99ER PHY WALKING BOOT 29425 327.54ER PHY/SUTURE TENDON 26418 773.53ER PHYS 2.5 CM SIMPLE S/N/AX/GEN/TRNK 12001 313.12

34

ER PHYS 2.6-7.5CM SIMPLE F/E/E/N/L/M 12013 235.87ER PHYS 12.6-20.0 CM SIMPLE F/E/E/N/L/M 12016 693.19ER PHYS 2.6-7.5CM SIMPLE S/N/AX/GEN/TRNK 12002 349.17ER PHYS 20.1-30.0CM SIMPLE F/E/E/N/L/M 12017 839.45ER PHYS 20.1-30.0CM SMPL S/N/AX/GEN/TRNK 12006 656.11ER PHYS 5.1-7.5CM SIMPLE F/E/E/N/L/M 12014 417.15ER PHYS 7.6-12.5 CM SIMPEL F/E/E/N/L/M 12015 565.47ER PHYS 7.6-12.5CM SMPLE S/N/AX/GEN/TRNK 12004 413.03ER PHYS ABSCES PERITONSILLAR 42700 421.27ER PHYS AMPUTATION OF FINGER 26951 1,311.19ER PHYS ANKLE STRAPPING 29540 360.50ER PHYS APPLICATION CAST FIGURE OF 8 29049 309.00ER PHYS APPLICATION FINGER SPLINT 29130 360.50ER PHYS APPLICATION OF RIGID LEG CAST 29445 463.50ER PHYS APPLICATION SHORT LEG CAST 29405 360.50ER PHYS APPLICATION SHORT LEG SPLINT 29515 360.50ER PHYS ASP/ABCESS - HEMATOMA/ CYST 10160 463.50ER PHYS ASP/INJ MAJOR JOINT 20610 309.00ER PHYS ASPIRATE/INJ JT/BIRS WO US 20605 309.00ER PHYS ASPIRATION/INJ SM JOINT 20600 309.00ER PHYS AVLN/NAIL PLT - SMPL EA ADD 11732 360.50ER PHYS AVULSION/NAIL PLT0 - SIMPLE 11730 211.15ER PHYS CARDIOPULMONARY RESUSCITATION 92950 639.63ER PHYS CARDIOVERSION 92960 506.76ER PHYS CAST FINGER 29086 206.00ER PHYS CAST HAND & LOWER FOREARM 29085 360.50ER PHYS CATERY CERVIX 57510 515.00ER PHYS CHANGE CYSTOSTOMY TUBE- SIMPLE 51705 257.50ER PHYS CL TX FINGER FX EACH 26755 257.50ER PHYS CLOSD TX SHOULDER DISCLOC 23655 690.10ER PHYS CLOSED ELBOW DISLOCATION 24605 1,360.63ER PHYS CLOSED TRMT DIS FINGER 26770 291.49ER PHYS CLOSED TX DISLOC ANKLE 27840 682.89ER PHYS CLOSED TX HIP DISLOCATION 27266 1,191.71ER PHYS CLOSED TX NASAL FX WO STABILIZAT 21315 312.09ER PHYS CLOSED TX RADIAL SHAFT FX 25505 874.47ER PHYS CLOSED TX RADIAL SHAFT FX W0 25500 841.51ER PHYS CLOSED TX TOE 28495 309.00ER PHYS CLOSED TX ULNAR SHAFT FX W MANI 25535 917.73ER PHYS CLOSED TX ULNAR SHAFT FX WO MANI 25530 481.01ER PHYS CLSD-METATARSAL W/O MANIP 28470 331.66ER PHYS CMPLX RPR E/N/E/L 1.1-2.5CM 13151 567.53

35

ER PHYS CMPLX RPR E/N/E/L 2.6-7.5CM 13152 919.79ER PHYS CMPLX RPR S/A/L 1.1-2.5 CM 13120 451.14ER PHYS CMPLX RPR TRUNK 1.1-2.5 CM 13100 515.00ER PHYS CMPLX RPR TRUNK 2.6-7.5 CM 13101 669.50ER PHYS COMPLEX REPAIR 13122 309.00ER PHYS COMPLEX WOUND REPAIR 2.5-7.5 CM 13121 529.42ER PHYS CONTROL NASAL BLEED ANTERIOR SMP 30901 208.06ER PHYS CONTROL OF NOSEBLEED 30906 218.36ER PHYS CRITICAL CARE ADDL 30 MIN 99292 339.90ER PHYS CRTL NASAL HEMOR/POSTERIO 30905 364.62ER PHYS CTRL NASAL HEMO ANT - CMPLX 30903 360.50ER PHYS CUTDOWN VENI PUNCT 36410 257.50ER PHYS CUTDOWN VENI PUNCT 36420 306.94ER PHYS CUTDOWN VENI PUNCT 36425 219.39ER PHYS DEBRIDE INFECTED SKIN 11000 515.00ER PHYS DEBRIDE MED BURN 16025 669.50ER PHYS DEBRIDE WOUND <= 20 SQ CM 97597 257.50ER PHYS DEBRIDE WOUND EA ADDL 20 SQ CM 97598 257.50ER PHYS DISLOC METACARPOPHALANGEA 26700 470.71ER PHYS DISLOCATION LITTLE TOE 28660 295.61ER PHYS DISLOCATION SHOULD 23650 723.06ER PHYS DISTAL RADIAL FRACTURE 25605 239.99ER PHYS DRSG/DEBRIDE W/O ANES - LG 16030 425.39ER PHYS DRSG/DEBRIDE W/O ANES - SM 16020 180.25ER PHYS ED PICC LINE PLACEMENT 36569 591.22ER PHYS ED PINCH SKIN GRAFT < 2CM 15050 917.73ER PHYS EPIDERAL BLOOD OR CLOT PATCH 62273 941.42ER PHYS ESOPHAGOSCOPY W REMOVAL OF FB 43215 257.50ER PHYS EVACUATION SUBUNGUAL HEMATOMA 11740 360.50ER PHYS EXC- NAIL & MATRIX PERM 11750 469.68ER PHYS EXC THROMOSED HEMORRHOID 46320 550.00ER PHYS EXCISION - SKIN LESION 11400 250.00ER PHYS EXCISION B9 <0.5CM LESION 11420 280.16ER PHYS FNA BX W/US GUIDIANCE 10005 250.00ER PHYS FNA W/O IMAGING 10021 371.83ER PHYS FRAC/MET FIXATION 26607 1,322.52ER PHYS FRACTRUE MALLEOLUS 27760 780.74ER PHYS FRACTURE CALVICLE 23500 421.27ER PHYS FRACTURE FIBULA 27786 780.74ER PHYS FRACTURE HUMERUS 24505 988.80ER PHYS FRACTURE LOWER LEG 27825 498.52ER PHYS FRACTURE METACARPAL 26600 644.78

36

ER PHYS FRACTURE METACARPAL 26605 960.99ER PHYS FRACTURE PHALANGEAL 26720 361.53ER PHYS FX CLTX PROX FIBULA/SHFT 27780 723.06ER PHYS FX RADIUS/ULNA W MANIPULATION 25565 669.50ER PHYS FX WITH MANIP/PHA 26725 723.06ER PHYS GASTRIC INTUBATION 43753 204.97ER PHYS HUMERUS & ELBOW FRACTURE 24576 600.00ER PHYS I & D ABCESS SIMPLE 10060 214.24ER PHYS I& REMOVE FB SUBQ COMP 10121 590.19ER PHYS I&D ABCESS COMP/MULTI 10061 469.68ER PHYS I&D FINGER ABSCESS 26010 148.32ER PHYS I&D OF PILONIDAL CYST SIM 10080 293.55ER PHYS I&D PERIRECTAL ABCESS 46040 292.52ER PHYS I&D UP ARM/ELBOW 23931 340.93ER PHYS I&D VULVA/PERINEAL ABSCES 56405 178.19ER PHYS ID PERIANAL ABSCESS SUPERFICIAL 46050 199.82ER PHYS INCISION OF THROM HEMORRH 46083 293.55ER PHYS INCISION/DRAIN/HEMATOMA 10140 367.71ER PHYS INS NON INDWELLING BLADDER CATH 51701 55.62ER PHYS INS NON-TUNNELED CATH 36556 1,479.08ER PHYS INSERT COMPL CATH 256.47ER PHYS INSERT FOLEY CATH SIM 51702 71.07ER PHYS INTMD RPR FACE/MM >30.0 CM 12057 976.44ER PHYS INTMD RPR FACE/MM 2.5 CM/&lt 12051 325.48ER PHYS INTMD RPR FACE/MM 2.6-5.0 CM 12052 435.69ER PHYS INTMD RPR FACE/MM 20.1-30.0 12056 867.26ER PHYS INTMD RPR FACE/MM 5.1-7.5 CM 12053 541.78ER PHYS INTMD RPR FACE/MM 7.6-12.5CM 12054 650.96ER PHYS INTMD RPR N-HF/GENIT >30.0CM 12047 761.17ER PHYS INTMD RPR N-HF/GENIT12.6-20 12045 577.83ER PHYS INTMD RPR N-HF/GENIT2.6-7.5 12042 399.64ER PHYS INTMD RPR N-HF/GENIT20.1-30 12046 669.50ER PHYS INTMD RPR N-HF/GENIT7.6-12.5 12044 489.25ER PHYS INTMD RPR S/TR/EXT >30.0 CM 12037 705.55ER PHYS INTUBATION 31500 459.38ER PHYS IUD REMOVAL 58301 176.13ER PHYS JAW TX DISLOCATION 21480 515.00ER PHYS KNEE DISLOCATION TREATMENT 27550 664.35ER PHYS KNUCKLE DISLOC W ANESTHES 26705 433.63ER PHYS KNUCKLE DISLOCATION 26705 404.79ER PHYS LACER <2.5CM S/A/T/EXT 12031 254.41ER PHYS LACER 2.5CM SIMPLE F/E/E/N/L/M 12011 320.33

37

ER PHYS LACER SIMPLE- DERMABOND G0168 57.68ER PHYS LIGTN OF EXTEMITY ART 37618 500.58ER PHYS LONG ARM SPLINT 29105 215.27ER PHYS LONG LEG SPLINT 29505 183.34ER PHYS LOWER EXTREMITY LONG LEG CAST 29345 299.73ER PHYS LUMBAR PUNCTURE 62270 536.63ER PHYS METATASEAL FRACTURE 28475 239.99ER PHYS NG TUBE PLMT 43752 87.55ER PHYS NON-SELECTIVE DEBRIDE W/O ANESTH 97602 309.00ER PHYS NSERTION CHEST TUBE 32551 713.79ER PHYS NTMD RPR FACE/MM 12.6-20 CM 12055 761.17ER PHYS NTMD RPR N-HF/GENIT 2.5CM/&lt; 12041 307.97ER PHYS OVER 30CM SIMPLE F/E/E/N/L/M 12018 994.98ER PHYS OVER 30CM SIMPLE S/N/AX/GEN/TRNK 12007 753.96ER PHYS PARACENTESIS W IMAGING GUIDANCE 49083 566.50ER PHYS PERICARDOICENTESIS 33010 723.06ER PHYS PUSH TRANSFUSION 36440 362.56ER PHYS REDUCT/NURSEMAID ELBOW 24640 450.00ER PHYS REDUCTION/ANKLE FRAC/MAN 27810 638.60ER PHYS REMOVAL EAR CERUMEN 69210 250.00ER PHYS REMOVAL FB INTRANASAL 30300 367.71ER PHYS REMOVAL FB NOSE W ANESTH 30310 367.71ER PHYS REMOVAL FB SKIN SUBQ SIMPLE 10120 285.31ER PHYS REMOVAL FB XTRNL EYE 65220 250.00ER PHYS REMOVAL FOOT FOREIGN BODY 28190 518.09ER PHYS REMOVAL FULL ARM/FULL LEG CAST 29705 206.00ER PHYS REMOVAL GAUNLET/BOOT/CAST 29700 290.00ER PHYS REMOVAL IMPACTED CERUMEN LAVAGE 69209 257.50ER PHYS REMOVAL SKIN TAGS 11200 257.50ER PHYS REMOVE FB EYE 65205 250.00ER PHYS REMOVE FB EYELID 67938 250.00ER PHYS REMOVE FB PHARYNX 42809 226.60ER PHYS REMOVE FB XTRNL AUDITORY CANAL 69200 250.00ER PHYS REMOVE FB/MUSC/TEND/SHE 20520 469.68ER PHYS REPAIR COMPLEX TRUNK EA ADD 5 CM 13102 515.00ER PHYS REPAIR COMPLX EYE/NOSE/EAR/LIP 13153 550.00ER PHYS REPAIR OF NAIL BED 11760 339.90ER PHYS RML F/B INTRAOC ANT CHAMBER EYE 65235 787.95ER PHYS RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM 13132 940.39ER PHYS RPR INTERMED S/A/T/E 12.6-20.0CM 12035 524.27ER PHYS RPR INTERMED S/A/T/E 20.1-30.0CM 12036 614.91ER PHYS RPR INTERMEDIATE S/A/T/E 2.6-7. 12032 345.05

38

ER PHYS RPR INTERMEDIATE S/A/T/E 7.6-12 12034 435.69ER PHYS SEC CLOSURE SURG WOUND DEHSN 13160 631.39ER PHYS SHORT ARM CAST 29075 500.00ER PHYS SPINAL TAP W FLUID 62272 824.00ER PHYS STRAPPING UNNA BOOT 29580 206.00ER PHYS STRAPPING WRIST 29260 250.00ER PHYS SUTURE TENDON 27380 981.59ER PHYS TENDON REPAIR 26370 545.90ER PHYS TENDON REPR-FOREARM PRI 25260 622.12ER PHYS THORACENTESE W IMAGING 32555 850.00ER PHYS THORACENTESIS PLEURA WO IMAGING 32554 566.50ER PHYS THUMB DISLOCATION 26641 545.90ER PHYS TOE DISCLOCATION 28630 257.50ER PHYS TOE STRAPPING 29550 257.50ER PHYS TRACHEOSTOMEY EMERGENT 31605 880.65ER PHYS TREAT DISLOCATION/FX SHOULDER 23665 669.50ER PHYS TREATMENT OF THIGH FX 27502 1,069.14ER PHYS TRIG PNT 3 OR MORE MUSCLE 20553 206.00ER PHYS TRIG POINT INJ 1-2 MUSC S 20552 309.00ER PHYS TRIM SKIN LESION 11055 257.50ER PHYS TRMT FRACTURE RADIUS W/O 25600 613.88ER PHYS TRMT FX TOE W/O MANI 28490 361.53ER PHYS TRMT PATELLAR DISLOCATION 27560 400.00ER PHYS TX CLOSED ELBOW DISLOCATE 24600 409.94ER PHYS TX CLOSED HIP DISLOCATION 27252 1,529.55ER PHYS TX FINGER FX 26750 214.24ER PHYS TX FX RADIUS/ULNA W/O MANIP 25560 510.88ER PHYS TX INGROWN NAIL 11765 250.00ER PHYS TX SUPERFICIAL WOUND 12021 300.00ER PHYS TX SUPERFICIAL WOUND SIMPLE 12020 383.16ER PHYS TX WRIST BONE FRACTURE 25630 400.00ER PHYS US ABD LIMITED 76705 180.25ER PHYS US FB EYE 76529 250.00ER PHYS VAGINAL DELIVERY 59409 2,500.00ER PHYS12.6-20.0CM SMPLE S/N/AX/GEN/TRNK 12005 517.06ER SHORT LEG SPLINT 29515 412.00ER TX PHYS CLOSED HIP DISLOC W/O ANES 27250 700.00ERTAPENEM *IVPB* [1GM/NS 50ml] 452.50ERY-TAB EC TAB [333MG] 32.54ERYTHRO/SULFISOX SUSP [20 96.00ERYTHROMYCIN BASE FILMTAB 24.08ERYTHROMYCIN DR CAP [250M 12.90

39

ERYTHROMYCIN INJ [500MG] J1364 384.13ERYTHROMYCIN OPHTH OINT [ 27.68ERYTHROMYCIN OPHTH OINT [ 76.90ERYTHROMYCIN OPHTHALMIC OINTMENT 5 MG 14.76ESCITALOPRAM TAB [10MG] 9.21ESCITALOPRAM TAB [20MG] 9.50ESMOLOL INJ [10MG/ML 10ML 70.62esoMEPRAZOLE DR CAP 40MG 16.21ESOPHAGOSCOPY W REMOVAL OF FB 43215 566.50ESOPHAGUS XRY 74220 429.51ESR/SED RATE -AUTOMATED 85652 44.29ESTRACE VAGINAL CREAM 559.86ESTRADIOL TAB [0.5MG] 3.35ESTRADIOL TAB [1MG] 3.09ESTRADIOL TAB [2MG] 3.96ESTRING RING [2MG] 1,355.73ESTROGENS-CONJUGATED INJ J1410 943.42ET CO2 MONITORING 94770 354.32ETHANOL LEVEL BLOOD 80320 80.00ETHYL CHLORIDE SPRAY [3.5 93.43ETODOLAC ER TAB [400MG] 7.00ETOMIDATE INJ [2MG/ML 10M 36.10EUCERIN CREAM [4OZ] 12.00EUCERIN LOTION [8OZ] 29.69EVAC CONTAINER 1000 7.21EVAC-SUBUNG HEMATOMA 11740 232.78EVACUATION CONTAINER 250 10.45EVACUATION CONTAINER 1000 23.69EVACULATED BOTTLE 26.89EVAL SPEECH SOUND PRODUCTION 92522 277.07Evaluation of speech fluency 92521 224.54Evenity 2x105mg/1.17mL 5,483.50EVEROLIMUS 80169 192.61EVISTA TAB [60MG] 2.45EVIVA STANDARD NEEDLE 600.00EXC ABD SOFT TISSUE < 3CM 22902 4,233.00EXC ABD TUMOR SOFT TISSUE 22903 4,000.00EXC ANAL EXT TAG OR PIPILLA 46220 1,900.00EXC ARM ELBOW SOFT TISSUE 3 CM 24071 3,200.00EXC BENIGN LESION 1.1 TO 2.0 CM 11402 1,900.00EXC BREAST TISSUE OPEN 19120 3,000.00EXC BREAST TISSUE OPEN 1 LESION 19120 1,000.00

40

EXC FOOT LESION 28090 1,658.00EXC GANGLION WRIST 25112 4,501.00EXC HAND LES SC 1.5 CM 26111 2,500.00EXC MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM 11603 3,200.00EXC MALIGNANT LESION OVER 4 CM F/E/E/N/L 11646 1,500.00EXC NECK SOFT TIS 3 CM 21552 3,200.00EXC THIGH KNEE SOFT TISSUE 3 CM 27337 3,200.00EXC TUMOR SOFT TISS ARM/ ELBOW 24075 1,658.00EXC TUMOR SOFT TISSUE FACE/SCALP 2 CM 21012 2,100.00EXC TUMOR SOFT TISSUE LEG/ANKLE 27632 3,200.00EXC TUMORE SOFT TISS BACK/FLANK 5 CM 21933 1,500.00EXC. NAIL & MATRIX - PERM 11750 1,181.41EXCISION B9 <0.5CM LESION 11420 1,238.06EXCISION BREAST LESION 19125 2,200.00EXCISION TUMOR SOFT TISSUE BACK 21931 2,100.00EXELON PATCH [ 4.6MG/24HR 48.83EXELON PATCH [9.5MG/24HR 73.71EXERCISE I- 15 MIN 97110 86.52EXPLORE/TREAT FINGER JOINT 26075 2,500.00EYE STREAM IRRIGATION [ DOSE] 13.37EYE STREAM IRRIGATION [1 OZ BTL] 57.91EZ10G: ENDOLOOP O PSDII LIGATURE 18" 50.47FACIAL BONES LTD X 70140 253.38FACIAL BONES XRY 70150 367.71FACTOR VIII ACTIVITY -CLOTTING 85240 198.79FAMCICLOVIR TAB [500MG] 22.17FAMOTIDINE BAG [20MG INJ 29.24FAMOTIDINE INJ [20MG/2ML] 12.34FAMOTIDINE TAB [20MG] 3.75FAMOTIDINE TAB [40MG] 7.68Faslodex 250mg/5ml injection J9395 2,541.00FECAL LEUKO-FERRIN 83630 93.73FECAL OCCULT BLOOT TEST G0328 91.00FELBATOL TAB [400MG] 33.37FELBATOL TAB [600MG] 38.25FELODIPINE ER TAB [2.5MG] 4.84FELODIPINE ER TAB [5MG] 4.84FENOFIBRATE TAB [160MG] 6.18FENTANYL AMP [250MCG/5ML J3010 18.87FENTANYL AMP 2 ML J3010 16.85fentaNYL patch ( 37.5 mcg/hr) 163.09FENTANYL PATCH [ 12MCG/HR 56.86

41

FENTANYL PATCH [ 25MCG/HR 59.14FENTANYL PATCH [ 50MCG/HR 100.71FENTANYL PATCH [ 75MCG/HR 148.91FENTANYL PATCH [100MCG/HR 194.71FENTANYL PCA [10MCG/ML] J3010 104.54FERAHEME INJ [510MG/17ML] 1,386.00FERRITIN LEVEL 82728 47.38FERROUS GLUCONATE TAB [32 14.02FERROUS GLUCONATE TAB [32 0.79FERROUS SULFATE ELIXER [2 20.14FERROUS SULFATE ER TAB [1 21.67FERROUS SULFATE TAB [325 0.79FERUmoxytol [510MG/17ML] 3,222.75FEXOFENADINE TAB [180MG] 9.20FIBER CHOICE [BTL] 12.00FIBER LAXATIVE TAB (GENER 0.79FIBER LAXATIVE TAB [500MG 33.63FIBRINOGEN- ACTIVITY 85384 86.52Film Array Respiratory Panel- IHC 1,302.95FINASTERIDE TAB [5MG] 3.76FINGER 2 VIEWS 73140 198.79FINGER FRACTURE EACH 26742 2,500.00FINGER FX EACH WITH MANIPULATION 26727 1,600.00FINGER SPLINT 29130 206.00FISH OIL OMEGA-3 CAP [100 16.25FISTULAGRAM/SINUS X 76080 410.97FIT TESTING FOR COMPANYS 66.95FIXATION OF SHOULDER 23700 5,500.00FL FEEDING TUBE INS 74340 515.00FLECAINIDE TAB [50MG] 5.63FLECTOR TOPICAL PATCH [1. 990.61FLO CYTO 9-15 MARKERS PRO 88188 140.08FLORASTOR CAP [250MG BTL 48.00Flovent Diskus 100mcg (60 doses) 656.31FLOVENT HFA INHALER 220MC 1,211.22FLOW CYTO 1-MARKER TC 88184 186.43FLOW CYTO 2-8 MARKERS PRO 88187 115.36FLOW CYTO ADD-ON TECH FEE 88185 96.82FLU A & B BY PCR 87502 385.22FLU A- FLU B- H1N1- PCR 87502 175.10FLUCONACOLE 400mg IVPB J1450 68.98FLUCONAZOLE PREMIX [200 M J1450 29.56

42

FLUCONAZOLE SUSP [10MG/ML 87.54FLUCONAZOLE SUSP [40MG/ML 87.54FLUCONAZOLE TAB [100 MG] 16.07FLUCONAZOLE TAB [150MG] 24.10FLUDROCORTISONE TAB [0.1M 4.13FLULVESTRANT PFS [500MG - 2X250MG/5ML] J9395 5,825.65FLUMAZENIL INJ [0.1MG/ML 36.58FLUOCINONIDE CREAM [0.05 164.13FLUOCINONIDE TOPICAL SOLN 165.50fluorescein sodium Ophth. Strip (1) 9.18FLUORO GUIDE SPINE INJ 77003 122.57FLUORO GUIDED NDL PLACMNT 77002 122.57FLUOROMETHOLONE OPHTH SUS 315.44FLUOROSCOPY INDEPN UP TO 1HR 76000 450.11FLUOROURICIL INJ [500MG/1 21.46FLUOXETINE CAP [10MG] 6.25FLUOXETINE CAP [20MG] 6.35FLUOXETINE CAP [40MG] 10.77FLUOXETINE LIQ [20MG/5ML 961.34FLUPHENAZINE DECON. INJ [ J2680 142.39FLURBIPROFEN TAB [100MG] 5.44FLUTICASONE NASAL SPR [50 279.47FLUTTER DEVICE RESP 87.55FLUTTER EDUCATION 94664 139.05FLUVOXAMINE TAB [100MG] 6.59FOLIC ACID INJ [5MG/ML MD 203.40FOLIC ACID TAB [1MG] 3.06FOLTX (GENERIC) TAB 9.72FOMEPIZOLE SOD INJ [1.5GM J1451 2,062.10FORADIL CAP AEROLIZE INHA 824.84FOREARM SPLINT 29125 155.53FOREIGN BODY REMOVAL FROM EYE 65235 2,026.01FORTEO INJ [20MCG/DOSE 75 J3110 10,288.00FORTICAL SPRAY [200 IU/SP 378.90FOSINOPRIL TAB [10MG] 4.34FOSPHENYTOIN INJ [50MG/ML 23.40FREAMINE 8.5% TPN 5 276.04FREEING OF BOWEL ADHESION 44005 3,500.00FRUITY CHEWS TAB 2.00FSH PEDIATRICS 83001 150.38FUNCT SELF CARE TRT-15MIN 97535 72.10Fungal Stain, Calcofluor, Misc. 87206 75.19

43

FUNGI-NAIL SOLN [30ML] 32.94FUNGIZONE INJ [50MG VIAL] 77.00FUNGIZONE INJ [50MG] 179.50FUROSEMIDE *IVPB* [100mg/NS100ml] 33.34FUROSEMIDE INJ [ 20MG/2ML J1940 23.06FUROSEMIDE INJ [ 40MG/4ML J1940 20.98FUROSEMIDE INJ [100MG/10 J1940 25.74FUROSEMIDE TAB [20MG] 2.68FUROSEMIDE TAB [40MG] 3.41FUROSEMIDE TAB [80MG] 2.91FUSION OF ANKLE JOINT OPEN 27870 6,700.00FX HUMERUS 24505 1,430.67FX PHALANX WITH MANIPULATION 26725 2,300.00FX WITH MANIP PHALANX 26725 515.00G/C SCREEN 87081 75.19GABAPENTIN CAP [100MG] 2.72GABAPENTIN CAP [300MG] 2.80GABAPENTIN CAP [400MG] 4.39GABAPENTIN TAB [600MG] 6.19GABAPENTIN TAB [800MG] 7.23GABITRIL TAB [12MG] 17.31GADOLINIUM PER ML A9579 13.39GAIT TRAINING I - 15 MIN 97116 67.98GALANTAMINE ER CAP [16MG] 12.37GALANTAMINE ER CAP [24MG] 11.96GAMMA GTP- SERUM 82977 47.38Ganglioside GM-1 Ab (IgG, IgM) EIA 83520 146.26GAS DILUTATION OR WASHOUT 4 LUNG VOLUMES 94727 139.05GASTRIC INTUBATION 43753 420.24GASTRIC LAVAGE KIT 418.18Gastric Parietal Cell Ab, ELISA 83516 98.00GASTROGRAFIN ORAL SOL [12 193.58Gastrointestinal Pathogen Panel PCR fec. 1,250.00GASTROSCOPE/EGD PER MIN 58.00GAVISCON LIQUID [360ML] 14.00GELFOAM SPONGE SIZE 50 97.00GEMFIBROZIL TAB [600MG] 6.09GENERAL HEALTH PANEL 80050 288.40GENICULAR NERVE ABLATION 64640 721.00GENICULAR NERVE BLOCK 64450 715.85GENTAMICIN - PEAK 80170 151.41GENTAMICIN - TROUGH 80170 151.41

44

GENTAMICIN *IVPB/50ml* [LESS THAN 400MG/ 102.27GENTAMICIN INJ [40MG/ML 2 J1580 46.45GENTAMICIN OPHTH OINT [0. 136.08GENTAMICIN OPHTH SOLN [0. 86.62GENTAMICIN SUL [0.1% 15GM 136.53GENTEAL OPHTH GEL [1 TUBE 18.87GEODON CAP [20MG] 33.00GEODON CAP [60MG] 39.00GEODON INJ [20MG/ML VIAL] J3486 233.61GERITOL LIQUID [360ML BO 15.66GI COCKTAIL [20ML] 8.50GINKGO BILOBA CAP [60MG] 0.79GLIMEPIRIDE TAB [1MG] 2.90GLIMEPIRIDE TAB [2MG] 2.45GLIMEPIRIDE TAB [4MG] 2.90GLIPIZIDE ER TAB [2.5MG] 3.13GLIPIZIDE ER TAB [5MG] 3.13GLIPIZIDE TAB [5MG] 3.06GLOMERULAR BASEMENT MEMBRANE AbIgG GMB 83520 156.56GLUCAGON INJ [1MG W/DILUE J1610 887.65GLUCOSAMINE CAP [500MG] 16.75GLUCOSAMINE-CHONDROITIN C 19.18GLUCOSE 1 HR 82947 36.05GLUCOSE 1HR >DOSE 82950 47.38GLUCOSE 2 HR>DOSE 82950 47.38GLUCOSE 2HR >DOSE 82950 47.38GLUCOSE BODY FLUID 82945 59.74GLUCOSE CSF 82945 59.74GLUCOSE FAST/PP/RANDOM 82947 46.35GLUCOSE- REAGENT STRIP 82948 28.84GLUCOSE STRIP 82948 28.84GLUCOSE TOLERANCE - 3 HOUR 82951 114.33GLUCOSE-GTT 4HR 82952 38.11GLUCOSE-GTT 5HR 82952 38.11GLUCOSE-GTT-FAST 82947 36.05GLUCOVANCE TAB 5MG/500MG 3.85GLUTOSE 15 TUBE 13.75GLYBURIDE TAB [2.5MG] 2.97GLYBURIDE TAB [5MG] 2.87GLYCATED HEMOGLOBIN 83036 78.28GLYCERIN 99.5% USP [118ML 19.21GLYCERIN ADULT SUPP 1.80

45

GLYCERIN PEDIATRIC SUPP 1.80GLYCOPYRROLATE INJ [0.2M 32.69GLYCOPYRROLATE INJ [0.2MG 455.87GLYCOPYRROLATE TAB [1MG] 4.54GOLD BOND FOOT POWDER [11 12.88GOLD BOND POWDER [283GM] 17.13GOLD BOND POWDER 283GM 16.00GOLYTELY SOLN [4L] 60.82GRAM STAIN - SPUTUM 87205 51.50GRAM STAIN - SPUTUM 87205 51.50GRAM STAIN- DIRECT- FIRST 87205 51.50GRAM STAIN- OTHER #2 87205 51.50GRAM STAIN-DIRECT-ADD'L 87205 51.50GRAM STAIN-OTHER #1 87205 51.50GRANULEX SPRAY [113GM] 62.21GRISEOFULVIN ULTRAMICROSI 14.77GTT 90 Min Spec 82947 36.05GTT/INSULIN+DOSE 82951 114.33GUAIFEN/PSEUODEPHEDRINE T 1,471.00GUAIFENESIN AC (CODEINE) 4.97GUAIFENESIN AC (CODEINE) 43.42GUAIFENESIN DM SYRUP [118 13.81GUAIFENESIN DM SYRUP [DOS 1.40GUAIFENESIN ER TAB [ 600M 1.40GUAIFENESIN SYRUP [118ML] 11.07GUAIFENESIN SYRUP [473ML] 16.94GUAIFENESIN SYRUP [DOSE] 1.40GUANFACINE TAB [2MG] 4.32H PYLORI 86677 29.00H. Pylori urease breath test 83013 254.41H.PYLORI- IGG- SERUM 86677 125.66HALDOL INJ [5MG/ML 1ML AM J1630 78.00HALOPERIDOL INJ [5MG/ML J1630 35.02HALOPERIDOL ORAL SOLN [2M 254.28HALOPERIDOL TAB [0.5 MG] 2.96HALOPERIDOL TAB [1MG] 3.20HALOPERIDOL TAB [2MG] 3.43HALOPERIDOL TAB [5MG] 4.19HAND BILATERAL LIMITED 73120 404.00HCTZ CAP [12.5MG] 3.16HCTZ TAB [25MG] 2.63HDL-DIRECT MEASURE 83718 61.80

46

HEMABATE INJ [250 MCG/ML] 1,071.80HEMATOCRIT - AUTOMATED 85014 33.99HEMATOCRIT MICRO SPUN 85013 27.81HEMO VAC SET 260.59HEMOCULT 1-3 82270 36.00HEMOGLOBIN 85018 42.23Hemoglobin- Free - Plasma 83051 73.13Hemoglobinopathy Evaluation 83021 117.42HEP B SURFACE AB QUAVL 86706 104.03Hep B Virus DNA - Quant PCR w/reflex 87517 312.09Hep C Ab w/reflex to HCV - RNA Quant PCR 86803 135.96HEPARIN DRIP [25000U IN 50.12HEPARIN INJ [5000 USP U 16.41HEPARIN LINE FLUSH 13.50HEPATIC PANEL 80076 108.15Hepatitis D Virus RNA Qualitative PCR 87798 222.48Hepatits E Ab - IgG 132.87HERNIA IMPLANT MESH 49568 1,200.00HETASTARCH INJ [6%/NACL 5 73.34HIP ARTHROGRAM LT 73525 799.28HIP ATHRORGRAM RT 73525 799.28HIP PAC 373.89HIP PACK 373.89HIP/PELVIS INF/CH 73501 192.61HIPS BILATERAL 73521 360.50Histamine Release (Chronic Urticaria) 86343 136.70HISTOCHEMSTAIN ADD ON 88314 170.98HISTOCHEMSTAIN ADD ON 88314 107.12HIV 1 / HIV 2 G0432 114.33HIV 1/2 AG/AB G0432 116.39HIV-1 GENOTYPE 87901 589.16HLA-B5701 TYPING 81381 333.72HOME SLEEP TEST/TYPE 3 95806 384.19HPV ORARISK ORAL DNA 87623 170.98HPVDNA HI/LO RECTAL SWAB 87623 170.98HPYLORI AgG- IgG - IgA - IgM 86677 130.81HPYLORI AB IgA 86677 130.81HPYLORI AB IgG 86677 130.81HPYLORI AB IgM 86677 130.81HU AB SCREEN W/TITER 86255 121.54HUMALOG [10ML VIAL ECF O 502.96HUMALOG [UNITS] 6.65

47

HUMALOG 75/25 MIXTURE [10 520.96Human metapneumovirus-Film array Resp pa 87633 45.32Human Rhino/Enterovirus-Film array Resp 87633 45.32HUMERUS FX 23605 750.00HUMULIN 70/30 MIXTURE [1 329.69HUMULIN 70/30 MIXTURE [5 188.21HUMULIN 70/30 MIXTURE [UN 5.89HUMULIN NPH [ VIAL ECF O 329.69HUMULIN NPH [UNITS] 5.89HUMULIN R [10ML VIAL ECF 329.69HUMULIN R [UNITS] 5.89Humulin R U-500 1,042.06Huntington Disease Mutation Analysis 81401 544.87HYDRALAZINE INJ [20MG/ML 366.14HYDRALAZINE TAB [10MG] 2.69HYDRALAZINE TAB [25MG] 1.95HYDRALAZINE TAB [50MG] 3.37HYDRATION ADDN'L HR- ER 96361 114.33HYDRATION ADDN'L HR- TX 96361 114.33HYDRO INSUFF IRRIGATION 329.60HYDROCERIN CREAM [4OZ] 18.73HYDROCOD/APAP ELIX [7.5/3 72.33HYDROCOD/APAP ELIX [7.5/3 26.21HYDROCOD/APAP ELIX [7.5/3 116.83HYDROCOD/APAP ELIX [7.5/3 185.80hydrocodon/apap 7.5mg #6 surgery 22.02HYDROCODONE POLST-CHLORPH 120.93HYDROCODONE POLST-CHLORPH 200.90HYDROCODONE/APAP 5/325 T 4.11HYDROCODONE/APAP 7.5/325 3.79HYDROCODONE/APAP 10/325 T 5.61HYDROCORTISONE CREAM [1% 13.81HYDROCORTISONE CREAM [2.5 16.96HYDROCORTISONE CREME [0.5 12.81HYDROCORTISONE SUPP [25MG 33.18HYDROCORTISONE TAB [ 5 MG 3.03HYDROCORTISONE TAB [20 MG 4.18HYDROmorphone Inj (1 mg/mL) 24.05HYDROmorphone TAB [2MG] 3.97HYDROmorphone TAB [4MG] 3.97HYDROXYCHLOROQUINE 80299 87.55HYDROXYCHLOROQUINE TAB [2 8.99

48

HYDROXYZINE HCL SYR [10MG 6.27HYDROXYZINE HCL SYR [1OMG 32.65HYDROXYZINE HCL TAB [25MG 2.97HYDROXYZINE INJ [50MG/1ML J3410 104.62HYDROXYZINE PAM CAP [50MG 3.00HYLENEX INJ 150 UNITS/ML 249.56HYOSCYAMINE SL/PO TAB [0. 3.82HYOSCYAMINE SO4 DROPS [15 16.58HYOSCYAMINE SR TAB [0.375 4.98HYPERAL TUBING 70.04hyperKALEMIA SOLUTION 56.00HYPERTONIC SODIUM CHLORIDE 3% [ 250ml] 27.90HYPERTONIC SODIUM CHLORIDE 3% [ 500ml] 37.60HYPERTONIC SODIUM CHLORIDE 3% [1000ML] 66.69HYSTERO CATHETER 187.46HYSTERO TRAY 87.55HYSTROSALPINGOGRAM 74740 562.38I & D PERIRECTAL ABCESS 46040 309.00I & D SIMPLE ABCESS 10060 416.12I&D PILONIDA CYST - SIMPLE 10080 440.84I&D VULVA/ PERINEAL ABSCE 56405 515.00I&REMOVE FB - SUBQ SIMPLE 10120 1,013.52I&REMOVE FB - SUBQ COMP 10121 3,423.72IBUPROFEN SUSP [100MG/5ML 6.00IBUPROFEN SUSP [100MG/5ML 1.40IBUPROFEN SUSP [100MG/5ML 14.07IBUPROFEN TAB [200MG] 0.79IBUPROFEN TAB [400MG] 3.11IBUPROFEN TAB [600MG] 2.97IBUPROFEN TAB [800MG] 3.12ICAPS CAP [BOX 60] 59.66ICCU ROOM 2,600.00ICUT ALLERGY TES DRUG/ 95024 67.98ICY HOT CREAM [90GM] 17.67ID RESISTENT STAPH 87077 60.77ID VANCO RESISTENT 87077 62.83IDARUCIZUMAB IV SOLUTION [5GM/100ML] 12,028.90IGA SERUM 82784 60.77ILEOSTOMY/ JEJUNOSTOMY 44310 6,200.00IM INJ OF SUBSTANCE/DRUG 96372 107.12IMIPENEM/CILASTATIN *IVPB* (500mg/100ml 74.45IMIPENEM/CILASTATIN SODIU 74.45

49

IMIPRAMINE 80335 98.88IMIPRAMINE TAB [50MG] 4.39IMMINOHIST AB + SLIDE PRO 88344 138.02IMMINOHIST AB + SLIDE TC 88344 216.30IMMUN-ADM SQ-IM- 1 VACCIN 90471 42.23immune globulin ( 5 gm vial) J1459 1,712.52immune globulin (10 gm vial) J1459 3,425.04immune globulin (20 gm vial) J1459 6,850.08IMMUNHISTO AB SLIDE 88341 210.12IMMUNNOHISTO AB SLIDE 88341 134.93IMMUNOHISTO/CYTO CHEM 88342 306.94IMMUNOHISTOCHEM PATH 88342 143.17IMMUNOHISTOCHEM TECH 88342 225.57INC AND DRAINAGE OF HEMATOMA FLUID 10140 4,110.00INCENTIVE SPIROMETER/RESP 62.83INCISE FINGER TENDON SHEATH 26055 2,500.00INCISION & DRAIN HEMATOMA 10140 2,565.73INCISION & DRAINAGE 46050 515.00INCISION OF METATARSAL 28308 2,100.00INCISION OF TENDON SHEATH 25000 4,250.00INCISION THROMBOSED HEMORRHOID EXTERNAL 46083 545.90INDAPAMIDE TAB [2.5MG] 4.90indigo tindisulfonate Amp (0.8 % 40 mg/5 586.00INDOMETHACIN CAP [25MG] 3.12INDOMETHACIN ER CAP [75MG 7.20Infanrix DTaP 90700 116.54INFED [50MG/ML 2ML] J1750 121.00INFLOW TUBING 413.03Influenza A/2009-H1-Film array Resp pane 87633 45.32Influenza A/H3-Film array Resp panel 87633 45.32INFLUENZA ADM. FEE Q2038 41.00Influenza A-Film array Resp panel 87633 101.97Influenza B-Film array Resp panel 87633 101.97INFLUENZA DNA AMP PROBE 87502 192.00INFLUENZA INJ AGE 65 AND 90662 234.09INFLUENZA INJ AGES 18 TO 64 INTRADERMAL 90662 85.59INFLUENZA INJ AGES 36 MONTHS AND OLDER I 80.62INFUSION IV 1 HR 96413 286.34INFUSION IV ADDL HR 96415 154.50Infuvite Adult Vitamins Injection 95.89INGUINAL HERNIA RED 5 AND OLDER 49505 4,500.00INJ DRAINAGE ASP C-T SPINE OR CORD 62320 573.71

50

INJ FEMORAL NERVE, INF BY CATH 64448 2,131.07INJ FORAMEN EPIDURAL L/S 64483 1,420.37INJ FORAMEN EPIDURAL L/S BILAT ADDL LVLS 64484 525.30INJ FORAMEN EPIDURAL L/S BILATERAL 64483 2,130.04INJ FORAMENT EPIDURAL L/S ADDL LVLS 64484 350.20INJ HIP ARTHROGRAM 27093 414.06INJ IV PUSH MEDS ER 96374 128.75INJ IV PUSH MEDS TX 96374 128.75INJ KNEE ARTHROGRAM 27370 414.06INJ MAJOR JOINT 20610 311.06INJ NERVE BLOCK SCIATIC NERVE 64445 1,002.19INJ NERVE BLOCK -SOMATIC NERVES 64415 824.00INJ SHOULDER ARTHRO 23350 434.66INJ TRIG PNT 3/MORE MUSCL 20553 912.58INJ WRIST ARTHROGRAM 25246 365.65INSERT CEN VEN CATH 36556 1,277.20INSERT NON-TUNNEL CV CATH AGE 5 AND UP 36556 1,009.40INSERT OF NON-DWELL CATH 51701 126.69INSERTION OF CHEST TUBE 32551 723.06INSERTION PICC W IMAGING 36573 978.50INSITU HYBRID (FISH) PRO 88365 557.23INSITU HYBRID (FISH) TC 88365 374.92INSITU HYBRIDIZATION PATH 88368 125.66INSITU HYBRIDIZATION TECH 88368 345.05Insulin Drip Hum R 100 units 70.84INSULIN FREE 83527 84.46INSULIN RESPONSE TO GLUCOSE 83525 96.82INTEGRILIN INJ [0.75MG/ML J1327 1,640.65INTEGRILIN INJ [2MG/ML 10 J1327 592.61interferon Beta-1A Inj (30mcg/0.5 mL 4pk 17,471.50INTMD RPR FACE/MM >30.0 CM 12057 333.72INTMD RPR FACE/MM 12.6-20 CM 12055 412.00INTMD RPR FACE/MM 2.5 CM/&lt 12051 463.50INTMD RPR FACE/MM 2.6-5.0 CM 12052 515.00INTMD RPR FACE/MM 20.1-30.0 12056 639.63INTMD RPR FACE/MM 5.1-7.5 CM 12053 566.50INTMD RPR FACE/MM 7.6-12.5CM 12054 515.00INTMD RPR N-HF/GENIT >30.0CM 12047 3,060.13INTMD RPR N-HF/GENIT 2.5CM/&lt; 12041 412.00INTMD RPR N-HF/GENIT12.6-20 12045 492.34INTMD RPR N-HF/GENIT2.6-7.5 12042 412.00INTMD RPR N-HF/GENIT20.1-30 12046 639.63

51

INTMD RPR N-HF/GENIT7.6-12.5 12044 515.00INTRALIPID INJ 20% [250ML 79.66INTRAOP CYTO PATH CSLT TC 88333 220.42INTRAOP CYTO PATH CSLT-PR 88333 443.93INTUBATION 31500 458.35INTUBATION EMERG ET 31500 719.97INTUBATION ET EMER 31500 719.97INTUBATION ETT 31500 719.97INVANZ ADDV [1GM] J1335 259.00INVANZ INJ [1GM] J1335 452.50Iodine - serum/plasma 83789 150.38IONTOPHORESIS -15 MIN 115.36IPECAC SYP [30ML BOTTLE] 10.00IPRATROPIUM BR SVN [ 0.5M 14.84IPRATROPIUM BR SVN [0.5MG 160.56IPRATROPIUM NASAL SPRAY [ 191.02IPRATROPIUM-ALBUTEROL SVN 16.73IPRATROPIUM-ALBUTEROL SVN 246.96IRBESARTAN TAB [300MG] 8.22irbesartan-HCTZ 150-12.5 mg 8.26IRON BINDING CAPACITY 83550 70.04IRON LEVEL 83540 57.68Iron Sucrose *IVPB* [200MG/NS 100ml] 440.50Iron Sucrose [300MG/NS 250ml] 512.50Iron Sucrose [500MG/NS 250ml] 848.50IRRAD PLATELET PHERES P9037 2,048.67IRRAD.RBC -LEUKORED. P9040 1,102.10IRRIGA IMPLNTD VENOUS ACCESS DRUG DELI 96523 119.48Islet Cell Antibody Screen w/ reflex 86341 151.41ISOFLURANE INHALANT [1 DO 22.00ISOPTO CARPINE OPHTH SOLN 419.62ISOPTO HYOSCINE OPTH SOLN 147.60ISOPTO HYOSCINE OPTH SOLN 147.60ISOSORBIDE DINITRATE TAB 4.18ISOSORBIDE MONO ER TAB [3 5.10ISTALOL OPH SOLN 0.5% 119.00ISTALOL OPHTH SOLN [0.5% 1,105.00ITRACONAZOLE CAP [100MG] 20.47itralipid 20% 500 mL 103.88IV FILTER SET 72.10IV HYDRATION INITIAL- ER 96360 282.22IV HYDRATION INITIAL-TX 96360 282.22

52

IV NITROGLICERIN TUBING 93.73IV PUMP TUBING 160.68IV PUSH SEQ DRUG- TX 96376 100.94IV PYELOGRAM/XRY 74400 732.33IV TUBING O.P. 10.00JAK 2 GENE 81270 405.82JAK2 V617F Qualitative Exon 12 81403 552.08JAK2 V617F Qualitative Exon13 81403 552.08JAK2 V617F Qualitative Leumeta 81270 472.77JEVITY PLUS 13.00KAOPECTATE LIQ REGULAR [B 14.18KAOPECTATE LIQ REGULAR [D 9.22Kappa/ Lambda lc/f ratio re to imm 83883 350.20Kappa/Lambda LT chains ratio 24UR 83883 92.70KATZ EXTRACTOR 100.00Kcentra 1000 unit kit 7,508.50KCl 40 mEq/100 mL NS J3480 17.14KENALOG INJ [40MG/1ML 1ML J3301 48.93KETAMINE INJ [100MG/ML DO 31.40KETOCONAZOLE CRM [2% 30GM 143.30KETOCONAZOLE SHAMPOO [2% 89.09KETOCONAZOLE TAB [200MG] 12.20KETONES- SERUM- QUAL. 82009 51.50KETONES URINE 81005 46.35KETOPROFEN TAB [75MG] 6.83KETOROLAC INJ [15MG/ML J1885 11.91KETOROLAC INJ [30MG/ML J1885 12.26KETOROLAC INJ [60MG/2ML 2 J1885 12.95KETOROLAC TAB [10MG] 5.84KLOR-CON POWDER PACKET [2 19.15KNEE ARTHROSCOPY 29877 5,000.00KNEE ARTHROSCOPY 29881 6,350.00KNEE ARTHROSCOPY 29888 4,500.00KNEE ARTHROSCOPY ABRASION 29879 4,300.00KNEE ARTHROSCOPY LATERAL RELEASE 29873 6,350.00KNEE ARTHROSCOPY SYNOVECTOMY LIMITED 29875 3,200.00KNEE ARTHROSCOPY W MENISCECTOMY 29880 6,350.00KNEE BILAT 2 VIEW 73560 493.37KNEE BILAT 3 VIEW 73562 594.31KNEE BILAT 4 VIEW 73564 697.31KNEE DISLOCATION TREATMENT 27550 552.08KNEE FRACTURE OPEN 27536 6,300.00

53

KOH PREP 87220 51.50Kras Gene Additional variants Path 81276 475.00L PUNCTURE MYELOGRAM 62304 565.47L SPINE COMPLETE + ADD VIEWS 72114 562.38LAB FOLLOW UP WITH INSTRUCTIONS FOR MEDI 1.40LABETALOL INJ [5MG/ML DO 15.41LABETALOL INJ [5MG/ML 20M 30.10LABETALOL TAB [100MG] 6.04LACER <2.5CM S/A/T/EXT 12031 318.27LACER 12.6-20.0 CM SIMPLE F/E/E/N/L/M 12016 530.45LACER 12.6-20.0CM SIMPLE S/N/AX/GEN/TRNK 12005 500.58LACER 2.5 CM SIMPLE F/E/E/N/L/M 12011 433.63LACER 2.5 CM SIMPLE S/N/AX/GEN/TRNK 12001 225.00LACER 2.6- 7.5 CM SIMPLE F/E/E/N/L/M 12013 449.08LACER 2.6-7.5 CM SIMPLE S/N/AX/GEN/TRNK 12002 424.36LACER 20.1-30.0 CM SIMPLE F/E/E/N/L/M 12017 556.20LACER 20.1-30.0CM SIMPLE S/N/AX/GEN/TRNK 12006 497.49LACER 5.1-7.5 CM SIMPLE F/E/E/N/L/M 12014 466.59LACER 7.6-12.5 CM SIMPLE F/E/E/N/L/M 12015 494.40LACER 7.6-12.5 CM SIMPLE S/N/AX/GEN/TRNK 12004 466.59LACER INTMD RPR S/TR/EXT >30.0 CM 12037 5,464.15LACER OVER 30.0 CM SIMPLE F/E/E/N/L/M 12018 865.20LACER OVER 30CM SIMPLE S/N/AX/GEN/TRNK 12007 601.52LACER REPAIR INTERMEDIATE S/A/T/E 7.6-12 12034 566.50LACER REPAIR INTERMEIATE S/A/T/E 2.6-7 12032 318.27LACER RPAIR INTERMED S/A/T/E 20.1-30.0CM 12036 989.83LACER RPR INTERMED S/A/T/E 12.6-20.0CM 12035 618.00LACER SIMPLE- DERMABOND G0168 206.00LACRI-LUBE OPHTH OINT S.O 15.10LACTASE TAB 1.40LACTATED RINGER'S [1000ML 55.62LACTATED RINGER'S [500ML] J7120 29.36LACTINEX TAB [KEPT IN FRI 0.29LACTOBACILLUS TAB [KEPT I 1.40LACTULOSE SYRUP [10GM/15M 88.81LACTULOSE SYRUP [10GM/15M 2.48LAMISIL *AT* AF SPRAY [BT 16.00LAMISIL *AT* CREAM [1% 12 19.91LAMOTRIGINE TAB [100MG] 9.86LANSINOH BREAST CREAM [60 16.20LANSOPRAZOLE DISINTEGRATI 34.70LANSOPRAZOLE DR CAP [30M 4.92

54

LANTUS INSULIN [10ML VIA 518.90LANTUS INSULIN [UNITS] 11.70LAP CHOLECYSTECTOMY W CHOLANGIOGRAPHY 47563 6,350.00LAP CHOLEY PAK 307.97LAPAROSCOPIC APPENDECTOMY 44970 6,350.00LAPAROSCOPIC CHOLECYSTECTOMY 47562 6,200.00LAPAROSCOPY REMOVAL OVARIES AND TUBES 58661 4,500.00LATANOPROST OPHTH SOLN [2 78.48LDH - Pleural fluid 83615 72.10LDH BLOOD 83615 50.47LDH BODY FLUID 83615 50.47LEAD SCREEN 83655 75.19LEE-WHITE CLOTTING TIME 85345 175.10LEFLUNOMIDE TAB [20MG] 24.00LEG CRAMPS TAB (BTL) 44.93Leptospira DNA Qualitative PCR 87798 383.16LESCOL CAP [40MG] 13.46LEUCOVOR TAB [ 5MG] 5.19LEUCOVOR TAB [25MG] 30.11LEUCOVORIN INJ [100MG VIA 28.59Leukemia/ Lymphoma Evaluation 88184 217.33LEUKOREDUCED RBC PROC FEE P9016 757.05LEVALBUTEROL MDI [200 DOSES] 273.82LEVALBUTEROL SVN [1.25MG/ 80.50LEVALBUTEROL SVN [1.25MG/ 10.90LEVAQUIN TAB [250MG] 63.00LEVAQUIN TAB [750MG] 133.00LEVEMIR INSULIN [VIAL] 563.16LEVEMIR-DETEMIR *UNITS* 11.85LEVETIRACETAM INJ [500/5 J1953 53.86LEVETIRACETAM TAB [500MG] 3.61LEVOBUNOLOL OPHTH [0.5% 1 17.10LEVOFLOXACIN INJ [500MG P J1956 56.02LEVOFLOXACIN INJ [750MG P J1956 33.99LEVOFLOXACIN TAB [250MG] 25.33LEVONORGESTREL [1.5MG] 148.90LEVOPHED BIT INJ [1MG/ML 95.89levothyroxine Inj 100 mcg 427.49LEVOTHYROXINE TAB [ 25MCG 1.95LEVOTHYROXINE TAB [ 50MCG 1.95LEVOTHYROXINE TAB [ 75MCG 3.35LEVOTHYROXINE TAB [ 88MCG 2.45

55

LEVOTHYROXINE TAB [100MCG 2.45LEVOTHYROXINE TAB [112MCG 2.45LEVOTHYROXINE TAB [125MCG 2.45LEVOTHYROXINE TAB [150MCG 3.64LEVOTHYROXINE TAB [175MCG 3.75LEXAPRO TAB [10MG] 19.00LEXAPRO TAB [20MG] 19.00LH PEDIATRICS 83002 151.41lido 1% 20 mL 21.24lidocaine 2% 5 ml 21.46LIDOCAINE INJ [1% MDV 50M 20.55LIDOCAINE INJ [1% SINGLE 6.00LIDOCAINE INJ [10MG/ML 50 20.57LIDOCAINE INJ [2% 5ML SYR 32.00LIDOCAINE INJ [2% 5ML SYR 23.06LIDOCAINE INJ [2% MDV 20M 22.93LIDOCAINE INJ [2% SINGLE 10.31lidocaine Inj PF (0.5% SDV 50 mL) 25.22LIDOCAINE JELLY [2% 1 DOS 16.39LIDOCAINE JELLY [2% TUBE] 156.69LIDOCAINE MPF Inj (1 % amp 5 ml) 18.11LIDOCAINE OINT [5% 35.44 18.27LIDOCAINE OINT [5% 1 DOSE 56.06LIDOCAINE OINT [5% 1 DOSE 162.87LIDOCAINE TOPICAL PATCH 5 671.66LIDOCAINE TOPICAL PATCH 5 13.37LIDOCAINE TOPICAL SOLN [4 133.11LIDOCAINE VISCOUS [ 2% 20 8.50LIDOCAINE VISCOUS [2% 20M 43.02LIDOCAINE VISCOUS/DIPHENH 14.79LIDOCAINE W/EPI INJ [1% 1 23.90LIDOCAINE W/EPI INJ [1% 1 11.43LIDOCAINE/D5W INJ [4MG/ML 40.53LIDOCAINE/HYDROCORTISONE 149.73LIDOCAINE/PRILOCAINE CRM 145.83LIDOCAINE/PRILOCAINE CRM 28.94LIDODERM TOPICAL PATCH [5 31.04LIDODERM TOPICAL PATCH [5 715.00LINDANE LOTION [1% 2OZ] 228.98LINDANE SHAMPOO [1% 2OZ] 228.98LIOTHYRONINE TAB [25MCG] 4.13LIP REAPIR 40650 1,249.39

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LIPASE LEVEL 83690 93.73LIPID PANEL 80061 87.55LIPITOR TAB [10MG] 18.00LIPITOR TAB [20MG] 24.00LIRAGLUTIDE INJ [1.2mg] 2,912.08LISINOPRIL TAB [ 2.5MG] 3.52LISINOPRIL TAB [ 5MG] 2.62LISINOPRIL TAB [10MG] 2.60LISINOPRIL TAB [20MG] 4.15LISINOPRIL TAB [40MG] 4.90Listeria Antibody CF Serum 86609 63.00LITHIUM CARB ER TAB [450M 3.67LITHIUM CARBONATE CAP [150MG] 2.72LITHIUM CARBONATE CAP [30 2.77LITHIUM CITRATE SYR [8MEQ 383.36LITHIUM ER TAB [300MG] 3.22LITHIUM LEVEL 80178 73.13LITTLE NOSES NASAL DROPS 13.61Liver Cytosol (LC-1) Autoantibodies 86376 175.10LONG ARM SPLINT 29105 412.00LONG LEG SPLINT 29505 180.25LOPERAMIDE A-D LIQUID [12 15.32LOPERAMIDE CAP [2MG] 9.67loperamide susp 1mg/7.5ml 15.00LORATADINE TAB [10MG] 9.56LORAZEPAM INJ [2MG/ML] J2060 15.76LORAZEPAM ORAL CONC [2MG/ 115.64LORAZEPAM TAB [0.5MG] 2.64LORAZEPAM TAB [1MG] 4.23LORAZEPAM TAB [2MG] 4.34LOSARTAN K+ TAB [ 50MG] 6.01LOSARTAN K+ TAB [100MG] 3.69LOVASTATIN TAB [40MG] 9.12LOW BACK DISK SURGERY 63030 15,000.00LOXAPINE CAP [25MG] 5.48LR RBC IRRAD CMV NEG FEE P9058 1,186.56LR/REGLAN/DHE 1000ML 50.00LT ANKLE COMPLETE 73610 262.65LT ANKLE LIMITED 73600 204.97LT ANKLE STRESS 77071 164.80LT CLAVICAL 73000 239.99LT ELBOW 3 VIEWS 73080 271.92

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LT FEMUR 1 VIEW 73551 192.61LT FEMUR 2/ > VIEWS 73552 270.89LT FOOT 73630 260.59LT FOOT LIMITED 73620 210.12LT FOREARM 73090 243.08LT HAND 2 VIEWS 73120 201.88LT HAND COMPLETE 73130 260.59LT HEEL XRAY 73650 222.48LT HIP 1 VIEW 73501 192.61LT HIP 1 VIEW- WITH PELVIS 73501 192.61LT HIP 2/3 VIEWS WITH PELVIS 73502 276.04LT HIP OR 73501 192.61LT HUMERUS 73060 256.47LT KNEE 3 VIEWS 73562 287.37LT KNEE 4 + VIEWS 73564 336.81LT KNEE ARTHROGRAM 73580 706.58LT KNEE LIMITED 73560 232.78LT RIBS 71101 349.17LT SHOULD ARTHROGRAM 73040 658.17LT SHOULDER 73030 285.31LT SHOULDER 1 VIEW 73020 135.96LT TOES 73660 198.79LT US EXT VEINS 93971 666.41LT US LWR ARTERIES 93926 632.42LT WRIST 2 VIEWS 73100 204.97LT WRIST 3 VIEWS 73110 260.59LT WRIST ARTHRO 73115 552.08LUBRIFRESH PM OPTH OINT 13.41LUMBAR PUCTURE TRAY 45.32LUMBAR PUNCTURE 62270 535.60LUMBAR PUNCTURE 62270 565.47LUMBAR VETEBRAL AUGMENTATION 22514 12,360.00LUMBAR X-RAY SPINE 1 VIEW 72020 188.49Lumbar/Sacral Facet Inj Level 1 64493 1,395.65Lumbar/Sacral Facet Inj Level 1 Bilatera 64493 2,093.99Lumbar/Sacral Facet Inj Level 2 64494 350.20Lumbar/Sacral Facet Inj Level 3+ 64495 350.20Lumbar/Sacral Facet Inj Lvl 2 Bilateral 64494 525.30Lumbar/Sacral Facet Inj Lvl 3+ Bilateral 64495 525.30LUMIGAN OPHTH DROPS [0.01 1,248.90LUMIGAN OPHTH DROPS [0.01 703.40LUMIGAN OPHTH DROPS [0.03 427.47

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LUNESTA TAB [2MG] 46.97LUPRON DEPOT INJ [ 7.5MG J9217 5,001.30LUPRON DEPOT INJ [22.5MG J9217 14,986.88LUPRON DEPOT INJ [30MG KI J9217 19,979.68LURASIDONE HCL TAB [40MG] 112.94LURASIDONE HCL TAB [80MG] 112.94LUTEIN ORAL CAP [20MG] 33.84LYMPHAZURIN BLUE INJ [1% 1,895.58Lyrica 150 mg 5.49LYRICA CAP [25MG] 26.15LYRICA CAP [50MG ] 4.30LYRICA CAP [75MG] 4.33LYSOZYME LEVEL 85549 86.52M/S EXTEND RECOVER >6HRS 51.50M/S OVS 1 HR G0378 345.05M/S OVS ADDITIONAL HRS G0378 46.35M/S OVS HIGH ACUITY G0378 443.93M/S OVS HIGH ACUITY >24 HRS G0378 75.19M/S OVS HIGH ACUITY ADDT'L HRS G0378 59.74M/S RM HIGH AQUITY 1,815.89M/S ROOM CHG SEMI-PVT 1,423.46M00558370: ESOPHOGEAL BALLOON DILATOR 212.18MA BCC BILAT SCREENING MAMMOGRAM 77067 255.44MA BCC DIAGNOSTIC MAMMOGRAM 77066 313.12MA DIAGNOSITIC BILAT IMIPLANTS MAMMO 77066 313.12MA DIAGNOSTIC BILAT MAMMOGRAM SAME DAY 77066 313.12MA DIAGNOSTIC MAMMO BILAT 77066 313.12MA DIAGNOSTIC UNILAT LT IMPLANTS MAMMO 77065 214.24MA DIAGNOSTIC UNILAT RT IMPLANTS MAMMO 77065 214.24MA LOCALIZATION LEFT 1ST LESION 19281 119.48MA LOCALIZATION LEFT 2ND LESION 19282 119.48MA LOCALIZATION RIGHT 1ST LESION 19281 119.48MA LOCALIZATION RIGHT 2ND LESION 19282 119.48MA MAMMOGRAM DIAGNOSTIC BILATERAL 77066 313.12MA MAMMOGRAM SCREENING BILATERAL 77067 255.44MA POST CLIP PLACEMENT BILATERAL 19281 154.50MA POST CLIP PLACEMENT LT 19281 128.75MA POST CLIP PLACEMENT RT 19281 128.75MA SCREENING BILATERAL IMPLANTS 77067 255.44MA SCREENING MAMMO BILAT IMPLANTS 77067 255.44MA SCREENING MAMMO LT IMPLANTS 77067 196.73MA SCREENING MAMMO RT IMPLANTS 77067 196.73

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MA SURGERY SPECIMAN 76098 378.01MA TOMO UNILAT OR BILAT DIAGNOSTIC G0279 51.50MA UNI SCREENING LEFT 77067 196.73MA UNI SCREENING RIGHT 77067 196.73MA UNILATERAL LEFT DIAGNOSTIC SAME DAY 77065 239.99MA UNILATERAL LEFT MAMMOGRAM 77065 239.99MA UNILATERAL RIGHT DIAGNOSTIC SAME DAY 77065 239.99MA UNILATERAL RIGHT MAMMOGRAM 77065 239.99MAALOX QD TAB [ ASST BTL] 11.00MAALOX SUSP [ 30ML DOSE] 1.00MAALOX SUSP [148ML] 6.00MAGNESIUM CITRATE ORAL SO 11.29MAGNESIUM LEVEL 83735 70.04MAGNESIUM OXIDE TAB [400M 1.95MAGNESIUM OXIDE TAB [500M 14.41Magnesium RBC 83735 84.46MAGNESIUM SO4 INJ [5GM/10 27.51MAGNESIUM SULF *IVPB* (2gm/NS50ml) 18.00MAGNESIUM SULF 50% [10ML 18.00MANDIBLE XRY 70110 359.47MANNITOL [12.5GM/50ML 25 20.38MANNITOL [20% SOLN 500ML] 90.80MANUAL DIFF W/CBC 85007 40.17MARCAINE SPINAL INJ [2ML] 18.52MASSAGE - 15 MIN 97124 117.42MASTECTOMY PARTIAL REMOVAL 19301 6,200.00MASTECTOMY PARTIAL W LYMPH NODES 19302 6,700.00MASTECTOMY SIMPLE COMPLETE 19303 6,500.00MAXAIR AUTOHALER [14 GM 0 1,887.23MAXITROL OPHTH OINT [0.1% 663.34MD-GASTROVIEW SOLN [120ML 101.00MDI/DPI TX 94640 139.05MDMA/MDA CONFIRMATION 80307 146.26MEBENDAZOLE CHW TAB [100M 12.39meclizine Tab (12.5 mg) 2.64meclizine Tab (25 mg) 3.12Med Match confirmation Amphetamines ur G0480 207.03Med Match confirmation Opiates urine G0480 207.03MEDROXYPROGESTERONE TAB [ 2.98MEDROXYPROGESTERONE TAB [ 3.23MEGESTROL AC SUSP [40MG/ 321.51MEGESTROL AC SUSP [40MG/ 91.55

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MEGESTROL ACETATE TAB [40 4.41MELATONIN ES [5MG] 14.47MELATONIN ORAL TAB [3MG] 0.79MELOXICAM TAB [7.5MG] 7.41MEMANTINE TAB [ 5MG] 2.45MEMANTINE TAB [10MG] 3.98MENTHOLATUM REG [JAR 30GM 16.47MEPERIDINE PCA [10MG/ML] J2175 88.02MEPHYTON TAB [5MG] 155.13meropenem *IVPB* ( range 500 mg to 1000 58.61MEROPENEM [1000MG INJ] 84.34MEROPENEM [500MG INJ] J2185 57.56METACARPAL FRACTURE WITH HARDWARE 26608 2,250.00METAMUCIL PACKET [SF] 1.40METAMUCIL SF [DOSE] 43.92METAXALONE TAB [800MG] 10.08METFORMIN ER TAB [500MG] 3.82METFORMIN TAB [ 500MG] 2.57METFORMIN TAB [ 850MG] 4.35METFORMIN TAB [1000MG] 2.67METHADONE CONFIRMATION 80358 146.26METHADONE TAB [ 5MG] 2.70METHADONE TAB [10MG] 3.63Methamphetamine & Metabolite - quant- ur 80324 101.97METHAZOLAMIDE TAB [25MG] 3.24METHENAMINE HIPPURATE TAB [1GM] 5.74METHENAMINE MANDELATE TAB 6.17METHIMAZOLE TAB [ 5MG] 3.19METHIMAZOLE TAB [10MG] 3.69METHOCARBAMOL TAB [500MG] 0.95METHOCARBAMOL TAB [750MG] 3.41METHOTREXATE INJ [25MG/ML J9250 26.14METHOTREXATE TAB [2.5MG] 12.17METHYLDOPA TAB [250MG] 2.45methylene blue (1% 100 mg/10 mL) 572.30METHYLENE BLUE [1% 10ML S 572.30METHYLERGONOVINE MALEATE 93.86METHYLPHENIDATE TAB [ 5M 4.01METHYLPHENIDATE TAB [10MG 10.16MethylPREDNISolone *IVPB* (SUCC. 1000mg/ 189.47METHYLPREDNISOLONE DOSEPA 4.72METHYLPREDNISOLONE TAB [4 4.72

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METOCLOPRAMIDE HCL TAB [ 3.02METOCLOPRAMIDE HCL TAB [1 2.70METOCLOPRAMIDE INJ [10MG/ 13.30METOLAZONE TAB [2.5MG] 6.30METOPROLOL [SUCC] ER TAB 5.22METOPROLOL [SUCC] ER TAB 2.90METOPROLOL [SUCC] ER TAB 2.90METOPROLOL INJ [1MG/ML 5M 16.28METOPROLOL TAB [100MG] 3.78METOPROLOL TAB [25MG] 2.88METOPROLOL TAB [50MG] 3.48METRISET 176.13METRONIDAZOLE CREAM [0.75 301.46METRONIDAZOLE IV [500MG 1 16.36METRONIDAZOLE TAB [250MG] 3.36METRONIDAZOLE TAB [500MG] 3.61METRONIDAZOLE VAGINAL [0. 254.53MG-PLUS PROTEIN TAB [BTL] 13.00MIACALCIN [200 I.U./ML D J0630 2,989.55MIACALCIN [200 I.U./ML E 5,970.60MIACALCIN NASAL [200 IU/D 909.95MICARDIS HCT TAB [80/25MG 15.88MICARDIS TAB [40MG] 11.05MICARDIS TAB [80MG] 15.88MICONAZOLE NITRATE VAG CR 34.26MICROALB EXCRETION 24H 82043 61.80MICROALBUMIN - URINE 82043 61.80MICROALBUMIN RANDOM URINE 82043 61.80MICRODISSECTION MAN 88381 320.33MICRODISSECTION MAN 88381 320.33MICRONEFRIN [11.25MG/ML . 28.00MICROPROTEIN CSF/BODY FLD 83873 114.33Microsatellite Instability Path 81301 628.00MICROSCOPIC ONLY- URINE 81015 27.81MICROSPORDIA SPORE SMEAR 87207 81.37MICROSPORIA SPORE CONCENT 87015 75.19MIDAZOLAM INJ (5MG/ML 1ML) 12.95MIDAZOLAM INJ [1MG/ML 2ML J2250 10.86MIDAZOLAM INJ [5MG/ML VI J2250 38.31MIDAZOLAM SYRUP [2MG/ML 2 12.43MIDODRINE TAB [ 5MG] 3.45MIDODRINE TAB [10MG] 10.64

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MILK OF MAG [473ML ECF O 7.00MILK OF MAG [30ML DOSE] 1.40MILLER ABBOTT TUBE 350.20MINERAL ICE THERAPY [8OZ] 18.74MINERAL OIL [473ML] 13.81MINERAL OIL SDV [25ML] 27.59MINIMAL RM CHARGE LEVEL1 113.00MINIMAL RM CRG LEVEL 2 355.00MINNESOTA SOLUTION [BOTTL 154.00MINOXIDIL TAB [2.5MG] 3.41MIOCHOL-E INTRAOCULAR [1 457.13MIRALAX POW [3350 NF 255G 56.00MIRAPEX TAB [ 0.125MG] 16.00MIRAPEX TAB [1.5MG] 17.00MIRTAZAPINE TAB [15MG] 6.71MIRTAZAPINE TAB [30MG] 6.83MIRTAZAPINE TAB OD [30MG] 6.65MISOPROSTOL TAB [200MCG] 4.36MITY VAC PUMP 305.91MNT SUBS TX FOR CHANGE DX G0270 48.00MOBIC TAB [7.5MG] 19.00MOD SED OTH PHY/QHP >5- 15 MIN 99155 73.13MOD SED OTH PHY/QHP 5 / > 15 MIN 99156 73.13MOD SED OTH PHY/QHP ADDL 15 MIN 99157 73.13MOD SED SAME PHY/QHP <5 YRS 99151 73.13MOD SED SAME PHY/QHP 5/> YRS -1ST 15 MIN 99152 294.58MOD SED SAME PHY/QHP ADDL 15 MIN 99153 114.33MOD SEDATION <5 YEARS OLD 99155 134.93MOD SEDATION 5YRS OR OLDER 99156 134.93MOD SEDATION ADDL 15 MINS 99157 33.99MODAFINIL TAB [200MG] 77.89MOEXIPRIL TAB [15MG] 4.76MOLECULAR PATH INTERPRET G0452 118.45MOMETASONE FUROATE OINT 0 124.68MOMETASONE-FORMOTEROL INHALER 200-5MCG [ 716.65MONOSCREEN 86308 71.07MONTELUKAST SODIUM TAB [1 3.11MORPHINE SOLN [20MG/5ML O 60.00MORPHINE SOLN [20MG/5ML O 34.25MORPHINE SULF INJ [ 2MG/M J2270 17.38MORPHINE SULF INJ [ 4MG/M J2270 17.43MORPHINE SULF INJ [10MG/M J2270 17.61

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MORPHINE SULF PCA [1MG/ML 87.07MORPHINE SULF SUPPOSITORY 7.62MORPHINE SULFATE CONC. SO 79.06MORPHINE SULFATE ER/SR TA 9.22MORPHINE SULFATE ER/SR TA 16.57MORPHINE SULFATE ER/SR TA 12.43MORPHINE SULFATE ER/SR TA 24.82MORPHINE SULFATE PF VIAL J2274 87.00MOUTHWASH/RINSE- MAGIC WA 83.62moxifloxacin IVPB (400 mg/250 mL) J2280 206.79MRA ABD W OR WO 74185 2,285.00MRA BRAIN W 70545 2,206.00MRA BRAIN W/O 70544 2,081.00MRA CHEST W OR WO 71555 1,652.00MRA LWR EXT LT W OR W/O 73725 923.00MRA LWR EXT RT W OR W/O 73725 923.00MRA NECK W 70548 2,181.00MRA NECK W & W/O 70549 2,531.00MRA NECK W/O 70547 2,057.00MRCP S8037 2,410.00MRI ANKLE RT WITH 73722 2,215.00MRI ANKLE RT WITH & W/O 73723 2,460.00MRI HAND LT W/O 73218 1,349.00MRI ABD W/ CONTRAST 74182 2,641.00MRI ABD W/O 74181 2,471.00MRI ABD W/WO CONTRAST 74183 3,445.00MRI ANKLE LT W/O 73721 1,844.00MRI ANKLE LT WITH 73722 2,215.00MRI ANKLE LT WITH & W/O 73723 2,460.00MRI ANKLE RT W/O 73721 1,844.00MRI BRAIN W STEM W CONTRAST 70552 2,941.00MRI BRAIN W/WO 70553 3,513.00MRI BRAIN WO 70551 2,445.00MRI C SPINE W/O CONT 72141 2,485.00MRI C SPINE W/WO 72156 3,631.00MRI C SPINE WITH 72142 2,081.00MRI CHEST W/O 71550 2,278.00MRI CHEST WITH AND WITHOUT 71552 3,264.00MRI ELBOW LT W/O 73221 1,350.00MRI ELBOW LT WITH 73222 1,477.00MRI ELBOW LT WITH & W/O 73223 2,955.00MRI ELBOW RT W & W/O 73223 2,955.00

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MRI ELBOW RT W/O 73221 1,350.00MRI ELBOW RT WITH 73222 1,477.00MRI FACE ORBIT & NECK WO & W DYE 70543 3,389.00MRI FEMUR LT WITH 73719 2,213.00MRI FEMUR RT WITH 73219 1,476.00MRI FOOT LT W & W/O 73720 2,460.00MRI FOOT LT W/O - NON JT 73718 1,844.00MRI FOOT LT WITH 73719 2,213.00MRI FOOT RT W & W/O 73720 2,460.00MRI FOOT RT W/O - NON JT 73718 1,844.00MRI FOOT RT WITH 73719 2,213.00MRI FOREARM LT W & W/O 73220 2,955.00MRI FOREARM LT W/O 73218 1,349.00MRI FOREARM LT WITH 73219 1,476.00MRI FOREARM RT W & W/O 73220 2,955.00MRI FOREARM RT W/O 73218 1,349.00MRI FOREARM RT WITH 73219 1,476.00MRI HAND LT W & W/O 73220 2,955.00MRI HAND LT WITH 73219 1,476.00MRI HAND RT W/O 73218 1,349.00MRI HAND RT WITH 73218 1,476.00MRI HAND RT WTH & W/O 73220 2,955.00MRI HIP LT W/O 73721 1,844.00MRI HIP LT WITH 73722 2,215.00MRI HIP LT WITH & W/O 73723 2,460.00MRI HIP RT W/O 73721 1,844.00MRI HIP RT WITH 73722 2,215.00MRI HIP RT WITH & W/O 73723 2,460.00MRI KNEE LT W/O 73721 1,844.00MRI KNEE LT WITH 73722 2,213.00MRI KNEE LT WITH & W/O 73723 2,460.00MRI KNEE RT W/O 73721 1,844.00MRI KNEE RT WITH 73722 2,213.00MRI KNEE RT WITH & W/O 73723 2,460.00MRI L SPINE W/O 72148 2,500.00MRI L SPINE LMT 72148 900.00MRI L SPINE W 72149 2,872.00MRI L SPINE W/WO 72158 3,493.00MRI LOWER LEG LT W 73719 2,213.00MRI LOWER LEG LT W/O - NON JT 73718 1,844.00MRI LOWER LEG LT WITH & W/O 73720 2,460.00MRI LOWER LEG RT W/O - NON JT 73718 1,844.00

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MRI LOWER LEG RT WITH 73719 2,213.00MRI LOWER LEG RT WITH & W/O 73720 2,460.00MRI NECK & FACE W CONTRAST 70542 2,679.00MRI NECK FACE ORBIT WO DYE 70540 2,461.00MRI NECK ORBITS FACE W & WO DYE 70543 3,389.00MRI PELVIS W 72196 2,500.00MRI PELVIS W/O 72195 2,041.00MRI PELVIS W/WO 72197 2,791.00MRI SHOULDER ARTHROGRAM LT 73222 1,477.00MRI SHOULDER ARTHROGRAM RT 73222 1,477.00MRI SHOULDER LT W/O 73221 1,350.00MRI SHOULDER LT WITH & W/O 73223 2,955.00MRI SHOULDER RT W/O 73221 1,350.00MRI SHOULDER RT WITH & W/O 73223 2,955.00MRI T SPINE W 72147 2,779.00MRI T SPINE W/WO 72157 3,560.00MRI THIGH LT W/O - NON JT 73718 1,844.00MRI THIGH LT WITH & W/O 73720 2,460.00MRI THIGH RT W/O - NON JT 73718 1,844.00MRI THIGH RT WITH & W/O 73720 2,460.00MRI THORACIC SPINE W/O CONTRAST 72146 2,502.00MRI TMJ 70336 2,322.00MRI T-SPINE LMT 72146 900.00MRI UPER ARM RT WITH 73219 1,476.00MRI UPPER ARM LT W & W/O 73220 2,955.00MRI UPPER ARM LT W/O 73218 1,349.00MRI UPPER ARM LT WITH 73219 1,476.00MRI UPPER ARM RT W & W/O 73220 2,955.00MRI UPPER ARM RT W/O 73218 1,349.00MRI WRIST LEFT ARTHROGRAM 73222 1,477.00MRI WRIST LT W & W/O 73223 2,955.00MRI WRIST LT W/O 73221 1,350.00MRI WRIST LT WITH 73222 1,477.00MRI WRIST RIGHT ARTHROGRAM 73222 1,477.00MRI WRIST RT W & W/O 73223 2,955.00MRI WRIST RT W/O 73221 1,350.00MRI WRIST RT WITH 73222 1,477.00MRSA Screen 87081 85.49MRSA-SA SCRN PCR 87641 75.19MTHFR METHYLENETRAHYDROFOLATE 81291 318.27MUCINEX DM ER TAB [600-30 9.35MULTIPLE VITAMINS W/ MINE 0.79

66

MULTIPLE VITAMINS W/ MINERALS CAP * SING 1.40MULTIPURPOSE DRAINIAGE CATH 8.5 FR 290.46MULTITRACE-4 CONC INJ [1M 61.42MULTIVITAMIN CHEWABLE TAB 14.87MULTI-VITAMIN LIQUID [237 15.22MUPIROCIN OINTMENT [2% 2 146.80MURO-128 OPTH SOLN [2% 1 49.50MUSK QUANT AB TITERS TEST 83519 833.27MVI-12 INJ [10ML INJ SDV] 52.20Mycobacteria PCR, culture and smear, res 542.81MYCOPHENOLATE TAB [500MG] 14.80MYCOPHENOLIC ACID 80180 182.31Mycoplasma pneumo-Film array Resp panel 87581 185.40Myelin-Associated Glypro (MAG) Ab (IgM) 83520 143.17MYELOGRAM L SPINE 72265 1,241.15MYELOGRAM MULTIPLE LEVELS 72270 2,251.58MYELOGRAM TRAY 147.29Myocardial Perfusion Spect Pro 78452 288.40MYOFLEX CREAM [10%] 14.06MYOGLOBIN - QUANT. 83874 141.11Myositis AssessR plus Jo-1 Ab panel 83516 1,183.47MYSOLINE TAB [50MG] 36.34N.GONORRHOEA BY PCR GX 87591 157.59NABUMETONE TAB [500MG] 4.51NADOLOL TAB [40MG] 8.72NAFCILLIN SOD INJ [1GM VI 85.06NAFCILLIN SOD INJ [2GM VI 134.46NALBUPHINE INJ [10MG/ML] J2300 24.01NALOXONE INJ [0.4MG/ML] J2310 75.85naloxone IVPB 2 mg/ 500 345.24NAPHCON-A EYE DROPS [15M 20.50NAPROXEN TAB [220MG] 0.79NAPROXEN TAB [500MG] 4.58NAROPIN 0.2% FEMORAL BLOC J2795 359.79NAROPIN 0.2% FEMORAL BLOC J2795 184.14NAROPIN 0.2% FEMORAL BLOC J2795 50.32NAROPIN 0.5% [5MG/ML INJ J2795 98.61NASACORT AQ NASAL SPRAY [ 46.41NASAL BONES XRY 70160 270.89NASAL HEMOSTAT KIT 301.79NASAL SMR FOR EOSINOPHILS 89190 57.68NASAL/TRACH SUCTION 31720 178.19

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NASAREL NASAL SPRAY [25MC 267.48NATEGLINIDE TAB [60MG] 5.08NECK/SOFT TISSU XRY 70360 232.78NEFAZODONE TAB [100MG] 9.94NEO/POLY B/ GRAM OPHTH SO 229.04NEO/POLY B/BAC OPHTH/OINT 197.64NEO/POLY B/DEXAMETH OPHT 166.90NEO/POLY B/DEXAMETHASONE 166.90NEO/POLY B/HYDROCORT OTIC 153.48NEO/POLY/BAC/HC OPHTH OIN 242.68NEO/POLY/DEX OPHTH SUSP [ 80.00NEOMYCIN TAB [500MG] 4.34NEOSPORIN GU IRR [MDV 5M 382.50NEOSTIGMINE [1:1000 DOSE 87.81NEO-SYNEPHRINE INJ [1% A 34.42NEO-SYNEPHRINE NOSE SPRAY 14.18NEPTUNE 2-4 PORT MANIFOLD 100.00NERVE BLOCK FASCIA ILIACA 64450 715.85NERVE BLOCK ILIO-ING NERVES 64425 1,002.19NERVE BLOCK INJ AXILLARY 64417 824.00NERVE BLOCK INJ FEM CONT INF 64448 824.00NERVE BLOCK INJ FEM SINGLE 64447 1,002.19NESACAINE-MPF [3% SDV 20M 39.27NEULASTA INJ [6MG/0.6ML] J2505 18,701.68NEUPOGEN INJ [300MCG 1ML J1442 953.00NEUPOGEN INJ [480MCG 0.8M J1442 1,602.78NEUROMUSCLR RE-ED -15 MIN 97112 78.28NEUROMUSCLR RE-ED -15 MIN 97112 92.70NEXIUM CAP [40MG BTL OF 3 662.49NEXIUM CAP [40MG] 22.08NEXIUM DR PACKET [40MG B 715.48NG TUBE PLMT BY DR 43752 450.11NIACIN ER TAB (500MG) J2360 2.60NIASPAN ER TAB [500MG] 13.64NICARdipine *IVPB* (25 mg/ 250 ml NS = 0 95.51NICOTINE PATCH [ 7MG] 11.35NICOTINE PATCH [14MG] 11.35NICOTINE PATCH [21MG] 13.99NICOTROL INHALER [168CART 1,320.68NIFEDEPINE/HC CREAM 2/2.5 [30GM] 30.32NIFEDIPINE CAP [10MG] 4.16NIFEDIPINE CR TAB [30MG] 4.29

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NIMBEX INJ [2MG/ML 5ML VI 76.23NITRO-BID OINT PACKET [2% 9.92NITRO-BID OINT TUBE [2% 3 119.69NITROFURANTOIN CAP [100MG 7.47NITROFURANTOIN CAP [50MG] 6.02NITROFURANTOIN SUSP [25MG 1,679.57NITROGLYCERIN ER CAP [2.5 3.57NITROGLYCERIN ER CAP [6.5 3.74NITROGLYCERIN IN D5W [100 84.38NITROGLYCERIN PATCH [0.1M 13.34NITROGLYCERIN PATCH [0.2M 12.77NITROGLYCERIN PATCH [0.4M 13.34NITROGLYCERIN SUBLINGUAL 4.09NITROPRESS [50MG/2ML IV F 445.30Nitroprusside [50mg/250ml D5W] 445.30NJX INTERLAMINAR LMBR/SAC 62322 1,002.19NM BONESCAN 3PHRASE 78315 2,442.13NM CARDIOLITE <40 MILLICU A9500 463.50NM DMSA 78700 1,430.67NM GASTRIC EMPTYING 78264 1,354.45NM GI BLEED 78278 1,115.49NM HEPATOBILIARY IMAGING 78226 2,192.87NM ISOTOPE BONE SCAN A9561 318.27NM ISOTOPE CHOLETEC >15mC A9537 303.85NM ISOTOPE I-123 100 mc A9516 152.44NM ISOTOPE MDP A9503 303.85NM ISOTOPE TC99M-DTPA A9567 77.25NM ISOTOPE TC99m-MAA A9540 67.98NM KINEVAC (SINCALIDE) ISOTOPE J2805 312.09NM LEXISCAN J2785 405.82NM LIMITED BONE 78300 2,006.44NM LIVER SPECT 78205 1,398.74NM LIVERSPLEEN FLOW 78216 1,102.10NM LUNG PERFUSION 78580 1,053.69NM MAG3 Tc-99m A9562 393.46NM MECKELS GI 78290 934.21NM MUGA SCAN 78472 1,688.17NM MYOCARDIAL PERF SPECT 78452 1,909.62NM PARATHYROID SCAN 78070 840.48NM REN/FLO/FUNCTION 78707 1,462.60NM RENAL FUNCTION STUDY 78725 710.70NM RENAL SCAN 78701 1,013.52

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NM SENTINEL NODE 38792 844.60NM SESTAMIBI A9500 152.44NM TC99M LABELED RBC A9560 202.91NM Tc-99m Sulfur Colloid A9541 136.99NM TESTICULAR SCAN 78761 1,774.69NM THYROID UPTAKE 78012 434.66NM THYROID UPTAKE & IMAGING 78014 1,118.58NM VENT & PERF LUNG SCAN 78582 2,030.13NM VENTILATION LUNG SCAN 78579 2,030.13NM WHOLE BODY BONE 78306 2,132.10NM-400U-0423: INJECTORFORCE MAX NEEDLE 30.90NON-COVERD MILES A0888 24.72NON-SELECTIVE DEBRIDE W/O ANESTH 97602 324.45NOREPINEPHRINE [4mg/250ml D5W] 86.33NOREPINEPHRINE [8mg/100ml NS] 164.16NOREPINEPHRINE INJ [1MG/M 46.30NORTRIPTYLINE CAP [10mg] 3.18NORTRIPTYLINE CAP [25MG] 3.87NORTRIPTYLINE CAP [50MG] 4.85NOVOLIN 70/30 MIXTURE [1 305.93Novolin R 305.93NOVOLOG [UNITS] 11.74NOVOLOG 70/30 MIXTURE [EC 548.71NOVOLOG INJ [100/ML 10ML 529.34NRAS Gene variants Exon 2&3 81311 585.00NS 1000ML BAG O.P. 8.00NUPERCAINAL OINT [1% 28.4 26.84NUTRITION ED- INT 15 MIN 97802 53.00NUTRITION ED- REASSMNT 97803 48.00NUTRITIONAL COUNSELING S9470 165.00NYSTATIN CREAM [100000 U 57.47NYSTATIN CREAM [100000 U 79.17NYSTATIN ORAL SUSP BOTTLE 120ML 100000 77.62NYSTATIN POWDER [100000 106.97NYSTATIN/TRIAM CR [30GM] 265.23O2 INP/OVS/SWG < 12 HRS 112.27OBSERV/ICU HOURLY G0378 101.97OBSTETRICAL CARE VAG DELIVERY 59409 2,482.30OCCULT BLD FECES 1-3 TEST 82272 36.00OCCULT BLOOD- STOOL 1-3 82274 49.44OCCULT BLOOD SINGLE 82274 49.44ocrelizumab 300 mg J2350 48,758.50

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ocrelizumab 600 mg J2350 97,508.50OCTREOTIDE ACETATE INJ [0 51.44OCUFLOX OPTH [0.3% 5 ML] 405.48OCUVITE TAB 0.79oFLAXACIN OTIC SOLUTION [0.3% 10ML] 872.47OFLOXACIN OPHTH SOLN [0.3 56.96OLANZAPINE 15MG TAB 108.48Olanzapine Inj J2358 157.90OLANZAPINE TAB [2.5MG] 19.86OLANZAPINE TAB [5MG] 22.98Olopatadine HCl Ophthalmic Solution 0.2 510.82omalizumab prefilled syringe (150 mg/ml) J2357 3,393.95OMEPRAZOLE DR/ER CAP [40MG] 13.77OMEPRAZOLE ER CAP [20MG] 6.48OMINICON 329.60Omnipaque 300 mg/50 mL Q9967 228.67ONDANSETRON INJ [ 2MG/ML J2405 11.09ONDANSETRON INJ [2MG/ML J2405 20.20ondansetron sol (4mg/5ml) 25.10ONDANSETRON TAB [8MG] 7.00ONDANSETRON TAB/ODT [4MG] 3.95ONGLYZA TAB [5MG] 38.11ON-Q C-BLOC PUMP A4306 613.00OP TX KNEE CAP FRACTURE 27524 3,200.00OPEN REDUCTION RADIAL FX 25609 7,000.00OPEN REPAIR OF ROTATOR CUFF 23410 7,000.00OPEN TREATMENT OF BROKEN ANKLE 27814 4,300.00OPEN TX ANKLE FRACTURE 27766 4,000.00OPEN TX CLAVICULAR FX INTERNAL FIXATION 23515 7,150.00OPEN TX DISTAL PHALANGEAL FRACTURE EACH 26765 2,700.00OPEN TX FRACTURE DISTAL TIBIA & FIBULA 27828 7,500.00OPEN TX FX RAD INTRA-ARTICUL 25608 3,500.00OPEN TX METACARPAL FRACTURE 26615 7,200.00OPEN TX OF BROKEN ANKLE 27792 4,500.00OPEN TX SHFT FX WITH 27506 7,200.00OPEN TX THIGH FRACTURE 27236 6,800.00OPEN TX ULNAR SHAFT FRACTURE 25545 6,500.00OR MAJOR 1 ADD'L 15 MIN 401.00OR MAJOR 2 1ST HOUR 8,465.00OR MAJOR 2 ADDL 15 MIN 531.00OR MINOR 2 1ST HOUR 4,233.00OR MINOR 2 ADD'L 15 MIN 268.00

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OR MINOR SUR1 ADD'L 15 MI 107.00OR MINOR SURGERY1 1ST/HR 1,658.00ORAJEL GEL 14.67ORAMORPH SR TAB [60MG] 15.26ORBITS 70200 344.02ORPHENADRINE CIRTRATE INJ J2360 89.50ORPHENADRINE TAB [100MG] 5.89ORTHOPEDIC PACK 376.98OT ELECRIC STIM- 15 MIN 97032 31.93OT EVAL HIGH COMPLEX 60 MIN 97167 273.98OT EVAL LOW COMPLEX 30 MIN 97165 223.51OT EVAL MOD COMPLES 45 MIN 97166 246.17OT RE-EVAL EST PLAN CARE 97168 223.51OTH RESP PROC INDIV G0238 107.12OUTPATIENT NEW E&M 20 MIN 99202 145.00OVS ADMIT LEVEL 3 99220 485.00OVS ADMIT/DISC L 1 99234 286.00OXCARBAZEPINE TAB [150MG] 4.73OXCARBAZEPINE TAB [300MG] 6.77OXIMETRY OVERNITE 94762 284.28OXYBUTYNIN XL TAB [5MG] 7.71oxybutynin ER (10 mg) 7.60OXYBUTYNIN TAB [5MG] 3.28oxyCODONE IR TAB [**15MG**] 10.27OXYCODONE TAB [5MG] 3.80OXYCODONE/APAP TAB 5-325M 6.40oxyCODONE-apap Tab (10-325 mg] 12.79OXYCONTIN CR TAB [10MG] 16.32OXYCONTIN CR TAB [20MG] 25.89OXYCONTIN CR TAB [40MG] 42.26OXYGEN 225.57OXYMETAZOLINE HCL NASAL S 11.05oxymetazoline nasal spray ER 31.72OXYTOCIN INJ [10 UNITS/ML 11.78PACU 30 MIN RECOVERY 446.00PACU ADDL 15 MIN RECOVERY 135.00Pain Management Antipsychotics w/conf. 80307 207.03PAIN RELIEVING RUB [85GMG 14.68PAMIDRONATE DISODIUM INJ J2430 163.37PANCRELIPASE CAP [10500 UNITS BTL] 909.40PANCRELIPASE CAP [5000 UN 319.47PANCURONIUM INJ [2MG/ML 2 30.90

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Pantoprazole Inj *BOLUS IVPB* [80mg/NS10 64.66Pantoprazole Inj *IVPB* [80mg/NS100ml] 64.66PANTOPRAZOLE TAB [40MG] 3.20PARACENTESIS WITH IMAGING 49083 1,419.00Parainfluenza 1-Film array Resp panel 87633 45.32Parainfluenza 2-Film array Resp panel 87633 45.32Parainfluenza 3-Film array Resp panel 87633 45.32Parainfluenza 4-Film array Resp panel 87633 45.32PARANASAL SINUS XRY 70220 350.20PAROXETINE ER TAB [12.5MG 11.14PAROXETINE ER TAB [25MG] 11.52PAROXETINE HCL TAB [10MG] 6.56PAROXETINE HCL TAB [20MG] 2.91PARTIAL EXC FINGER BONE 26236 2,500.00PARTIAL REMOVAL COLLAR BONE AT SHOULDER 29824 4,000.00PATANOL OPHTH SOLN [0.1% 726.70PATH CONSULT INTRAOP ADDL 88332 197.76PATH CONSULT INTRAOP ADDL 88332 160.68PATH INTRAOP 1-BLOC PATH 88331 209.09PATH INTRAOP 1-BLOC TECH 88331 220.42PATIENT CREDIT 21.00PEAK FLOW METER/RESP 112.27PED HEPATITIS B VACCINE A 20.00PELVIS COMP XRY 72190 292.52PELVIS XRY 72170 234.84PENICILLIN G PROCAINE IM 271.28PENICILLIN VK TAB [250MG] 3.78PENICILLIN VK TAB [500MG] 4.22PENLAC SOLN [8% 6.6ML] 2,184.02PENTASA CR CAP [500MG] 16.03PENTOTHAL KIT [500MG] 162.86PENTOXIFYLLINE TAB [400MG 4.82PEPCID LIQ [40MG/5ML 50ML 454.00PEPTO-BISMOL CHEWABLE TAB 0.79PEPTO-BISMOL ORIGINAL LIQ 12.44PEPTO-BISMOL ORIGINAL LIQ 17.60PERCOCET TAB 5/325MG 7.00PERCUT PINNING OF THUMB 26650 618.00PERITONEAL LAV KIT 363.59PERMETHRIN CRM 5% [60GM] 208.00PERMETHRIN LOT [1% 60ML] 32.33PERPHENAZINE-AMITRIPTYLIN 4.88

73

PETROLATUM WHITE [106GM] 11.92PFT SPIRO PRE AND POST 94060 474.83PFT SPIROMETRY PRE 94010 75.00PH BLOOD 82800 108.15PH BODY FLUID- NOT BLOOD 83986 44.29PHASE II PACU PER HR/ MAX 6HRS 167.00PHENAZOPYRIDINE HCL TAB [ 6.68PHENCLOR TANNATE PED SUSP 67.00PHENCLOR TANNATE PED SUSP 7.00PHENOBARBITAL ELIXIR [20M 50.42PHENOBARBITAL ELIXIR [20M 15.49PHENOBARBITAL INJ [65MG/1 J2515 102.75PHENOBARBITAL LEVEL 80184 124.63PHENOBARBITAL TAB [64.8MG 4.12PHENOL EZ SWABS 19.66PHENTOLAMINE INJ [5MG/2ML 1,345.95PHENYLEPH TAN./CHLORPHEN 4.00PHENYLEPHRINE INJ [1% 10 24.34PHENYTOIN [ 500MG/NS 100ml] 24.17PHENYTOIN [1000MG/NS 250ml] 39.83PHENYTOIN ER CAP [100MG] 3.64PHENYTOIN INJ [50MG/ML 2M 22.00PHENYTOIN INJ [50MG/ML 5M J1165 16.31PHENYTOIN SUSP [125MG/5ML 16.56PHLEBOTOMY- THERAPEUTIC 99195 211.15PHOSLO TAB [667MG] 4.09PHOSPHA 250 NEUTRAL TAB [ 191.27PHOSPHORUS INORGANIC 84100 42.23PHOSPHORUS- URINE 84105 51.50PHY DBRDMT SKN SUBQ NECRO INFCT GEN/ABDL 11006 1,600.00PHY ESOPHAGOSCOPY W BX SINGLE OR MULTIPL 43193 700.00PHY EXC MAL LES T/A/L 1.1-2.0CM 11602 700.00PHY EXC MALIGNANT LES S/N/H/F/G 1.1-2.0 11622 900.00PHY EXC TMR SFT TIS FACE/SCLP SUBQ <2CM 21011 900.00PHY EXC TMR SFT TIS NECK THRX SUBFS 5CM> 21554 2,000.00PHY EXC TUMOR SOFT TIS ABD WALL SUBQ 3CM 22903 1,300.00PHY EXCISION LESION TR EXT .6-1CM BENIGN 11401 700.00PHY LAPAROSCOPY W/RMVL ADNEXAL STRUCTURE58661 1,367.00PHY LAPSCOPIC COLECTOMY PTL W ANASTOMOSI44204 3,500.00PHY RECURRENT INGUNIAL HERNIA STRANGULAT 49521 1,800.00PHY REPAIR EPIGASTRIC HERNIA INCARCERAT 49572 1,800.00PHY SIMPLE CLOSE SUPERFICIAL WOUND DHIS 12020 700.00

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PHY SPLIT AGRFT F/S/H/F/G/M/D GT1ST 100C 15120 1,800.00PHYS ABD PARACENTESIS 49083 600.00PHYS ADD 20 SQ CM TISSUE 11045 550.00PHYS AMP F/TH 1/2 JT/PHALANX- NEURECT 26951 1,500.00PHYS AMPUTATION OF TOE JOINT 28820 1,500.00PHYS AMPUTATION THIGH THROUGH FEMUR 27590 2,000.00PHYS ANTERIOR COLPORRAPHY RPR 57240 1,700.00PHYS ANTERPOST COLPORRAHPHY W/ CYSTO 57260 2,300.00PHYS APPENDECTOMY DURING OTHER SURGERY 44955 900.00PHYS ARTHROCENTESIS ASP JOINT W US 20611 800.00PHYS BENIGN LESION 3.1-4.0 CM 11404 900.00PHYS BX LYMP OPEN DEEP CERVICAL NODE 38510 2,500.00PHYS BX OF BREAST OPEN INCISIONAL 19101 1,100.00PHYS BX SKIN SUBQ MUCOUS MEMBRANE 1 LES 11100 550.00PHYS BX/EXC LYMPH NODE OPEN SUPERFICIAL 38500 1,100.00PHYS BX/EXC LYMPHOPEN DEEP AXI NODE 38525 1,500.00PHYS CARDIOVERSION 92960 492.00PHYS CHOLECYSTECTOMY W CHOL 47605 2,175.00PHYS CIRCUMCISION AGE 28 DAYS/OLDER 54161 1,100.00PHYS COLONOSCOPY FLEX WITH ABL 91117 1,030.00PHYS COLONOSCOPY FLX DX 45378 732.00PHYS COLONOSCOPY HIGH RISK G0105 665.00PHYS COLONOSCOPY SCN-LO RSK PT G0121 800.00PHYS COLONOSCOPY SCR-HI RSK PT G0105 1,200.00PHYS COLONOSCOPY W ABLATION 45388 1,100.00PHYS COLONOSCOPY W BAND LIGATION 45398 1,100.00PHYS COLONOSCOPY W BIOPSY 45380 798.00PHYS COLONOSCOPY W TATTOO 45381 764.00PHYS COLONOSCOPY W/ BIOPSY 45380 1,100.00PHYS COLONOSCOPY W/ CTRL BLEED 45382 1,200.00PHYS COLONOSCOPY W/ DILATION 45386 900.00PHYS COLONOSCOPY W/ HOT BIOPSY 45384 900.00PHYS COLONOSCOPY W/ SNARE PLYP 45385 1,100.00PHYS COLONOSCOPY W/ SNARE PLYP 45385 1,100.00PHYS COLONOSCOPY W/ TATTOO 45381 900.00PHYS COLONOSCOPY W/FB REMOVAL 45379 900.00PHYS COLONOSCOPY WITH SNARE 44394 1,033.00PHYS COLONSOCOPY THRU STOMA 44388 900.00PHYS COLONSOCOPY W/ HOT BIOPSY 45384 798.00PHYS COMPLEX REPAIR 1.1-2.5 CM 13131 900.00PHYS COMPLEX WOUND REPAIR 2.5-7.5 CM 13121 1,000.00PHYS COMPLEX WOUND REPAIR ADD 5CM 13122 550.00

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PHYS CRITICAL CARE 30-74 MIN 99291 488.00PHYS CRITICAL CARE ADD 30 99292 245.00PHYS DEBRIDE MUSCLE/FASCIA EA ADD 20SQCM 11046 500.00PHYS DEBRIDEMENT INFECTED SKIN UP TO 10% 11000 600.00PHYS DEBRIDEMENT REPAIR/MUSCLE 11043 550.00PHYS DEBRIDEMENT SUBCT TISSUE 20 SQ CM 11042 900.00PHYS DEST INTERNAL HEMORRHOID(S) CAUTERY 46930 1,100.00PHYS DEST PREMALIG LSN 2-14 17003 150.00PHYS DESTR LESION ANUS SIMPL SURG EXC 46922 900.00PHYS DESTRUCT BENIGN LESION 1-14 17110 750.00PHYS DESTRUCTION PREMALIG LESION 1ST 17000 550.00PHYS DIAGNOSTIC ESOPHAGOSCOPY 43191 700.00PHYS DILATGION OF RECTAL STRICTURE 45910 800.00PHYS DILATION AND CURETTAGE 58120 727.00PHYS DILATION OF ESOPHAGUS 43450 550.00PHYS DX BRONCHOSCOPE/WASH 31622 600.00PHYS EDG TRANSORAL BIOPSY 43239 750.00PHYS EDG W CONTROL OF BLEEDING 43255 863.00PHYS EDG W/FOREIGN BODY REMOVE 43215 800.00PHYS EGD W GASTRIC/DUOD STRICTURE 43245 800.00PHYS EGD W/ BIOPSY SINGLE/MULTIPLE 43239 700.00PHYS EGD W/ CTRL OF BLEEDING 43255 863.00PHYS EGD W/ HOT BIOPSY 43250 800.00PHYS EGD W/ HOT BIOPSY 43250 800.00PHYS EGD W/ SNARE POLYECTOMY 43251 850.00PHYS ESOPH EDG DILATION BALLOON 43249 750.00PHYS ESOPHAGOSCOPY FLEXIBLE TRANSORAL DX43200 750.00PHYS ESOPHEGOSCOPY W BIOPSY 43202 750.00PHYS EX TRUNK EXT B9 0.5CM< 11400 550.00PHYS EXC B9 LES F/E/E/N/L/M 2.1-3.0 CM 11443 750.00PHYS EXC B9 S/N/H/F/G 1.1-2.0 cm 11422 500.00PHYS EXC BACK/FLANK LESS 3CM 21930 820.00PHYS EXC BENIGN 1.1-2.0 CM T/A/L 11402 700.00PHYS EXC BENIGN 2.1-3.0 CM S/N/H/F/G 11423 900.00PHYS EXC BENIGN LESION S/N/H/F/G .5CM< 11420 900.00PHYS EXC BENIGN LESION T/A/L 2.1-3.0 cm 11403 900.00PHYS EXC BENIGN LESION T/A/L over 4.0 cm 11406 950.00PHYS EXC BREAST LESION PLACMNT RAD MARK 19125 913.00PHYS EXC BRST LES PREOP PLMT RAD EA ADD 19126 650.00PHYS EXC H/F/NK/SP B9+MARG>4 CM 11426 700.00PHYS EXC MAL LES T/A/L 0.6-1.0 CM 11601 900.00PHYS EXC MAL LESION F/E/E/N/L 2.1-3.0CM 11643 800.00

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PHYS EXC MAL LESION F/E/E/N/L 3.1-4.0CM 11644 788.00PHYS EXC MALIG +MARGINS T/A/L 4.0CM+ 11606 857.00PHYS EXC MALIG F/E/E/N/L 0.5 CM< 11640 900.00PHYS EXC MALIG F/E/E/N/L 1.1 to 2.0 cm 11642 900.00PHYS EXC MALIG LESION F/E/E/N/L .6-1.0CM 11641 1,200.00PHYS EXC MALIGNANT LES F/E/E/N/L >4CM 11646 1,200.00PHYS EXC MALIGNANT TRUNK/EXT 2.1-3CM 11603 900.00PHYS EXC SFT TIS ABD WALL SUBFASC 5CM> 22901 1,400.00PHYS EXC SFT TIS FOREARM/WRIST SUBQ 3CM> 25071 950.00PHYS EXC SPERMATOCELE W/WO EPIDIDYMECTOM54840 675.00PHYS EXC TMR BACK/FLANK SUBFAS <5CM 21932 1,274.00PHYS EXC TMR BACK/FLANK SUBFAS 5CM> 21933 1,700.00PHYS EXC TMR NECK/ANT THORAX SUBQ 3> 21552 1,000.00PHYS EXC TMR THIGH/KNEE SUBQ 3CM > 27337 809.00PHYS EXC TUMOR ABD WALL SUBFASC <5CM 22900 1,400.00PHYS EXC TUMOR BACK/FLANK SUBQ 3CM> 21931 912.00PHYS EXC TUMOR FACE/SCALP SUBQ 2CM > 21012 796.00PHYS EXC TUMOR LEG/ANKLE LESS THAN 5CM 27619 1,061.00PHYS EXC TUMOR SFT TISSUE NECK SUBQ <3CM 21555 803.00PHYS EXC TUMOR SHOULDER 3CM> 23071 1,200.00PHYS EXC TUMOR SOFT LEG/ANKLE SUBQ <3CM 27618 950.00PHYS EXC TUMOR SOFT TISS UP ARM/ELB 3CM> 24071 1,200.00PHYS EXC TUMOR THIGH/KNEE SUBQ <3CM 27327 876.00PHYS EXC TUMOR TISSUE SUBQ ABD WALL <3CM 22902 839.00PHYS EXCISE ANUS TAG/PAPILLA 46220 1,967.00PHYS EXCISION BARTHOLIN'S GLAND LESION 56740 600.00PHYS EXCISION BENIGN F/E/E/N/L/M 0.5CM< 11440 600.00PHYS EXCISION BENIGN S/N/H/F/G .6-1CM 11421 700.00PHYS EXCISION HYDROCELE UNILATERAL 55040 1,300.00PHYS EXCISION PILONIDAL CYST SIMPLE 11770 700.00PHYS FLOW CYTO >16 MARKERS 88189 172.01PHYS FX DIAGNOSTIC COLONSCOPY 45378 900.00PHYS GASTROI W/ REMOVAL FB 43247 800.00PHYS GASTROI W REMOVAL FB 43247 597.00PHYS HEMORRHOID W FISSURECTO 46257 1,200.00PHYS HEMORRHOIDECTOMY- EXT 46250 863.00PHYS HEMORRHOIDECTOMY INT/EXT 46260 907.00PHYS HEMORRHOIDECTOMY RUBBER BAND LIG 46221 750.00PHYS HEMORRHOIDECTOMY- SIMPLE 46255 996.00PHYS HOME SLEEP TEST/TYPE 3 95806 260.59PHYS HOSPITAL DISCHRGE MNGT 30 MIN< 99238 146.00PHYS I & D ABSCESS SIMPLE 10060 550.00

77

PHYS I & D BARTHOLINS GLAND 56420 550.00PHYS I & D HEMATOMA SEROMA/ FLUID 10140 550.00PHYS I & D PERIANAL ABSCESS SUPERFICIAL 46050 600.00PHYS I & D PILONIDAL CYST SIMPLE 10080 650.00PHYS I &D ABSCESS COMPLICATED 10061 700.00PHYS I&D BURSA FOOT 28001 700.00PHYS I&D LEG/ANKLE ABSCESS/HEMATOMA 27603 1,014.00PHYS I&D PERIRECTAL ABSCESS 46040 1,018.00PHYS ID DEEP ABSC HEMATOMA THIGH/KNEE 27301 1,260.00PHYS IMPLANTATION OF MESH 49568 800.00PHYS INCISION BONE CORTEX FOOT 28005 1,167.00PHYS INCISION OF RECTAL ABSCES 46045 833.00PHYS INCISION REMOVE FB SUBQ TISS SIMPLE 10120 500.00PHYS INCISION THROM HEMORRHOID 46083 600.00PHYS INCISIONAL HERNIA INCARCERATED 49561 1,910.00PHYS ING HERNIA 5YRS/>INCARCERATED 49507 1,185.00PHYS INGUN HERNIA 5> REDUCIBLE 49505 1,600.00PHYS INITIAL HOSP CARE/DAY 30 MIN 99221 203.00PHYS INITIAL HOSPITAL CARE 99222 200.00PHYS INITIAL OBSERVATION PER DAY 30 MIN< 99218 201.00PHYS INSERT TUNNELED CV CATH W SUBQ PORT 36561 1,200.00PHYS INSERTION NON -TUNNELED CATH 36556 1,200.00PHYS INSERTION NON-TUNNEL CV CATH 36556 1,200.00PHYS INTMD RPR S/TR/EXT 7.6-12.5CM 12034 900.00PHYS LAP APPENDECTOMY 44970 1,600.00PHYS LAP CHOLECYSTECTOMY 47562 2,100.00PHYS LAP CHOLECYSTECTOMY W/CHOL 47563 2,310.00PHYS LAPAROSCOPY TUBAL CAUTERY 58670 1,500.00PHYS LAPRO FULG/EXC OVARY 58662 2,204.00PHYS LAPS ABD PRT OMN DX 49320 1,200.00PHYS LAVH BSO 58552 2,864.00PHYS LOW BACK DISK SURGERY 63030 7,500.00PHYS MASTECTOMY PARTIAL 19301 2,500.00PHYS MASTECTOMY SIMPLE COMPLETE 19303 1,943.00PHYS MASTOTOMY W EXPLORE OF ABSCESS DEEP19020 1,200.00PHYS METATARSECTOMY 28140 1,180.00PHYS MODF RADICAL MASTECTOMY 19307 2,516.00PHYS MUSCLE BIOPSY SUPERFICIAL 20200 600.00PHYS NEEDLE BX LIVER ADD-ON 47001 550.00PHYS OBSERVATION CARE 30 MIN 99218 286.00PHYS OBSERVATION CARE 50 MIN 99219 369.00PHYS OBSERVATION CARE DISCHARGE 99217 155.00

78

PHYS OBSERVATION/INPT HOSP CARE 40 MIN 99234 270.00PHYS OVS ADMIT/DISCH L 2 99235 397.00PHYS OVS ADMIT/DISCH L 3 99236 445.00PHYS OVS DISCHARGE 99217 200.00PHYS PARING BNGN HYPERKERATITIC LSN >4 11057 550.00PHYS PART MASTECTOMY WITH AXILLARY NODES 19302 1,729.00PHYS PICC LINE INSERTION >5YRS 36569 591.22PHYS PILONIDAL CYST EXTENSIVE 11771 1,500.00PHYS PUNCTURE ASPIRATION ABSCESS HEMATOM10160 550.00PHYS RAD RESCT TUMOR TISS BACK/FLANK 5CM 21936 3,000.00PHYS RECURRNET INGUINAL HERNIA REDUCIBLE 49520 1,700.00PHYS REMOVAL HEMORRHOID CLOT 46320 550.00PHYS REMOVAL OF ANAL FISSURE 46200 1,200.00PHYS REMOVAL OF ANAL TAGS 46230 550.00PHYS REMOVAL OF OVARY(S)/TUBE(S) 58720 2,300.00PHYS REMOVAL OF TESTIS 54520 1,300.00PHYS REMOVAL SKIN TAGS ANY AREA UP TO 15 11200 500.00PHYS REMOVAL TUNNELED CV ACCESS PORT 36590 900.00PHYS REMOVE FB UPPR ARM 24200 300.00PHYS REPAIR 1ST FEM HERNIA INCARCERATED 49553 1,500.00PHYS REPAIR INCISIONAL/ VENTRAL HERNIA 49560 1,800.00PHYS REPAIR INITIAL FEM HERNIA REDUCIBLE 49550 1,400.00PHYS REPAIR INTER F/E/E/N/L/MUC 2.5CM< 12051 750.00PHYS REPAIR INTERMED S/A/T/E 2.6-7.5 CM 12032 700.00PHYS REPLACMENT G TUBE 43762 900.00PHYS REREPAIR INCIS/ VENT HERN REDUBIBLE 49565 1,700.00PHYS RESECTION SM INSTESTINE 44120 2,700.00PHYS RPR 1ST INGUN HRNA 6MO-<5YRS REDUC 49500 1,300.00PHYS RPR LIP FULL THICKNESS 40650 700.00PHYS RPR UMBILICAL HRNA >5yrs REDUCIBLE 49585 1,600.00PHYS SBSQ OBSV CARE/DAY 15 MIN 99224 90.00PHYS SCREENING COLONOSCOPY G0121 732.00PHYS SHAVE BX DERMAL T/A/L .5CM OF LESS 11300 550.00PHYS SHAVE BX SKIN LESION 0.6-1.0 CM 11301 550.00PHYS SHAVE SKIN LESION .5cm OR LESS 11310 500.00PHYS SHAVING LESION S/N/H/F/G 1.1-2.0 CM 11307 600.00PHYS SHVG SKIN LN F/E/E/N/L/M 1.1-2.0CM 11312 600.00PHYS SIGMOIDOSCOPY DIAGNOSTIC 45330 700.00PHYS SIGMOIDOSCOPY FLX W BAND LIGATIONS 45350 750.00PHYS SIGMOIDOSCOPY WITH BX 45331 775.00PHYS SIGMOIDSCOPY 45330 700.00PHYS SIMPLE EPIGASTRIC REPAIR HERNIA 49570 1,200.00

79

PHYS SIMPLE REPAIR S/N/AX/G/TRUNK 2.5CM< 12001 500.00PHYS SLITTING OF PREPUCE EXCEPT NEWBORN 54001 700.00PHYS SPLT AUTOGRAFT T/A/L 1ST 100CM/1% 15100 1,800.00PHYS SUBSQ HOSPITAL CARE DAY 99231 85.00PHYS THORACENTESIS W IMAGING 32555 550.00PHYS THORACENTESIS WO IMAGING 32554 500.00PHYS THORACOSTOMY 32551 1,200.00PHYS TRANSORAL EGD DX 43235 800.00PHYS TRANSORAL EGD DX 43235 800.00PHYS TREAT RADIUS FRACTURE 24655 650.00PHYS TROCHANTERIC PRESSURE ULCER 15956 2,200.00PHYS UGI-ENDO DIR GASTRI TUBE 43246 732.00PHYS UMBILICAL HERNIA >5 yrs INCARCERAT 49587 1,700.00PHYS UPPER GI ENDOSCOPY 43197 700.00PHYS UPR GI ENDO W ESO DILITA 43249 750.00PHYS US Echocardiography Limited 93308 130.81PHYS US LIMITED ECHO PRO FEE 93308 130.81PHYS VAGINAL HYSTERECTOMY UTERUS 250 GM< 58260 1,800.00PHYS VASECTOMY BILATERAL 55250 900.00PHYSOSTIGMINE [1MG/1ML 2M 346.69PICC LINE INSERTION >5YRS 36569 396.55PICC LINE PLACEMENT 5 YRS OLDER 36573 824.00PIHYS NITIAL OBSERVATION CARE/DAY 50 MIN 99219 369.00PILOCARPINE HCL OPHTH [1% 363.32PIMECROLIMUS 1% CRM [30GM] 594.18PINCH SKIN GRAFT < 2CM 15050 874.47PIOGLITAZONE HCL TAB [15M 15.41PIOGLITAZONE HCL TAB [45M 20.50PIPERACILLIN/TAZOBACTAM *IVPB* (2.25gm/ 76.81PIPERACILLIN/TAZOBACTAM (3.375gm/100ml N 92.42PIPERACILLIN/TAZOBACTAM *IVPB* (4.5gm/10 J2543 116.69PIPERACILLIN/TAZOBACTAM A J2543 98.97PITOCIN INJ [10 U/ML 1ML] 21.00PLASMA PROCESSING FEE P9017 275.01PLATELET COUNT AUTOMATED 85049 53.56PLATELET FUNCTION TEST 85576 143.17PLAVIX TAB [ 75MG] 21.00PLAVIX TAB [300MG] 100.02PLETHYSMOGRAPHY VOLUME/RESISTANCE 94726 253.38PLEUR EVAC 399.64PLT/PHERESED/PROCESS FEE P9034 1,740.70PNEUMOCOCCAL 23 VACCINE 90732 361.95

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PNEUMOTHORAX SET 529.42POLAR PACK UNIT 664.35POLYETHYLENE GLYCOL [3350 56.52POLYETHYLENE GLYCOL [3350 67.82polyethylene glycol COLON PREP KIT 20.56POLY-IRON CAP [150 FORTE] 2.93POLYMYXIN B INJ [500000U 71.38POLYMYXIN B-TRIMETHOPRIM 56.88POLYTRIM O/SOLN 10 94.00PONARIS NASAL EMOLLIENT [ 52.58PORPHYRINS - FRACTIONATED- PLASMA 82542 156.56PORPHYRINS TOTAL PLASMA 82542 167.89PORPHYSIN FRAC QUAT URINE 84120 113.30POT PHOS MONO-SOD PHPS DI & MONOPHOSPHA 2.00POTASSIUM- URINE 84133 50.47POTASSIUM CHL INJ [20MEQ 22.54POTASSIUM CHL INJ [40MEQ 28.01POTASSIUM CHLORIDE CAP [ 3.52potassium chloride (60 mEq/NS 500 mL) J3480 25.78POTASSIUM CHLORIDE [20MEQ/NS 100ml] 22.54POTASSIUM CHLORIDE [40MEQ/NS 250ml] J3480 28.02POTASSIUM CHLORIDE CAP [1 3.51POTASSIUM CHLORIDE LIQ 10 127.04potassium chloride oral liq 10% *Dose* ( 30.93POTASSIUM CHLORIDE TAB [1 3.51POTASSIUM CHLORIDE TAB [2 3.55potassium phos mono-sod phos di & mono T 3.81POTASSIUM PHOSPHATE INJ [ 72.48POTASSIUM PHOSPHATES *IVDRIP* [20MMOLES/ 93.85POTASSIUM PHOSPHATES *IVDRIP* [20MMOLES/ 94.23POTASSIUM- SERUM 84132 37.08POWER PICC CATHETER C1725 221.06PRADAXA CAP [ 75MG] 20.18PRADAXA CAP [150MG] 17.62PRAMIPEXOLE TAB [0.5MG] 7.28PRAMIPEXOLE TAB [1.5mg] 7.28PRAVASTATIN TAB [40MG] 9.93PRAVASTATIN TAB [80MG] 9.93PRAZOSIN CAP [1MG] 3.89Precedex 371.38PREDNISOLONE OPHTH DROPS 406.44PREDNISOLONE SYR [15MG/5M 20.03

81

PREDNISOLONE SYR [15MG/5M 73.72PREDNISOLONE SYR [5MG/5ML 117.86PREDNISOLONE SYR [5MG/5ML 32.31PREDNISONE TAB [ 1MG] 2.89PREDNISONE TAB [ 5MG] 2.89PREDNISONE TAB [10MG] 2.86PREDNISONE TAB [20MG] 2.87PREGNANCY TEST - URINE 81025 26.00PREMARIN INJ [25MG/5ML] J1410 943.42PREMARIN TAB [0.3MG] 15.59PREMARIN TAB [0.625MG] 15.59PREMARIN TAB [1.25MG] 15.59PREMARIN VAGINAL CREAM 773.10PREMPRO TAB [0.45MG/1.5MG 535.39PRENATAL COMP 80055 144.20PREP H HC CREAM 30.76PREPARATION H OINT [28GM] 24.23PREPARATION-H SUPP [EACH] 9.25PRESERVISION AREDS CAP [1 67.07PREVACID SOLUTAB [30MG] 36.53PREVALON MATTS 3242 244.37PREVIDENT 5000 BOOSTER + 36.81PREVNAR13 VACCINE INJ [0. 90670 708.02PRIMAXIN ADDV [500MG] 131.00PRIMIDONE TAB [250MG] 4.04PRIMIDONE TAB [50MG] 3.22PRISTIQ SR TAB [50MG] 30.69PRO US Echocardiography 93306 267.80PROBENECID TAB [500MG] 4.02PROBIOTIC LACTO TAB [BTL] 15.00PROCAINAMIDE INJ [500MG/M 318.17PROCALAMINE 3% 1000 37.08PROCALAMINE IV [3% 1000ML 106.33PROCALCITONIN 84145 338.87PROCHLORPERAZINE INJ [5MG J0780 88.42PROCHLORPERAZINE SUPP [25 28.94PROCHLORPERAZINE TAB [10M 3.88Procollagen Type I Intact N term Prop 83519 180.00PROCRIT INJ [40000U/ML 1 J0885 3,215.50PROF ECHO TRANSTHO W/WO CONT 93308 360.50Progesterone Caps 100 mg 5.80PROGRAF CAP [0.5MG BTL] J7507 913.35

82

PROGRAF CAP [1MG BTL] J7507 1,818.22PROGRAF/TACROLIMUS CHEM 80197 133.90PROLIA PFS SOL INJ [60MG J0897 3,844.88PROMETHAZINE INJ [12.5MG J2550 22.00PROMETHAZINE INJ [25MG/M J2550 16.49PROMETHAZINE INJ [50MG/M J2550 16.49PROMETHAZINE PLAIN SYRUP 15.40PROMETHAZINE PLAIN SYRUP 20.86PROMETHAZINE SUP [12.5MG 40.72PROMETHAZINE SUP [25MG] 40.72PROMETHAZINE SUP [50MG] 82.26PROMETHAZINE TAB [25MG] 3.98PROMETHAZINE VC/COD SYR 27.65PROMETHAZINE VC/COD SYR 97.88PROMETHAZINE VC/COD SYR 150.89PROMETHAZINE /COD SYR [ 100.20PROMETHAZINE /COD SYR [1 38.41PROMETHAZINE /COD SYR [D 10.99PROMETHAZINE-DM SYRUP [6. 17.93PROPAFENONE TAB [150MG] 5.11PROPAFENONE TAB [225MG] 6.11PROPOFOL INJ [10MG/ML 20M J2704 18.87PROPOXYPHENE HCL CAP [65M 3.00PROPOXYPHENE-N/ APAP TAB 3.00PROPRANOLOL ER CAP [60MG] 4.56PROPRANOLOL INJ [1MG/ML] 43.06propranolol soln 40 mg/5ml 16.90PROPRANOLOL TAB [10MG] 3.04Propylene Glycol Lubricant ophth Drops ( 31.99PROTAMINE INJ [50MG/5ML S 121.32PROTEIN - BODY FLUID 84155 30.90PROTEIN DIPSTIX UA 81005 46.35Protein S Antigen - Free 85306 224.54PROTIME 85610 46.35PROTIME SUBSTITUTE PLASMA 85611 61.80PROTONIX INJ [40MG] 36.58PROTOPAM CHLORIDE INJ [1G J2730 383.04PROTOPIC OINTMENT [0.1%] 1,000.13PROVIGIL TAB [100MG] 69.38PRW35: SKIN STAPLER 35 WIDE 21.63PSA Post prostatectomy 84153 140.08PSA SCREEN ANNUAL 84153 87.55

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PSA - TOTAL W/FREE 84153 87.55PSA FREE 84154 106.09PSA- TOTAL DIAGNOSTIC 84153 87.55PSA W/REFLEX FREE PSA 84153 87.55PSEUDOEPHEDRINE HCL TAB [ 0.79PSYLLIUM CAP [0.52GM BOT 21.79PT EVAL HIGH COMP 45 MIN 97163 214.24PT EVAL LOW COMPLEX 20 MIN 97161 214.24PT EVAL MOD COMP 30 MIN 97162 214.24PT II GENE 20210TIER1 81240 256.47PT NON SELECTIVE DEBRIDEMENT 97602 324.45PT RE-EVAL EXT PLAN CARE 97164 97.85PTH W/O CALCIUM 83970 143.17PTH-related protein (PTH-rP) 83519 142.14PTT SUBSTITUTE PLASMA 85732 108.15PTT/APTT 85730 79.31PULM SCREEN/ OCC HEALTH 94375 75.00PULMONARY STRESS TEST 94618 109.18PYRIDOSTIGMINE TAB [60MG] 4.48PYRUVIC ACID (PYRUVATE) 84210 65.92QUADRICEPS HAMSTRING RUPTURE PRIMARY 27385 3,700.00QUETIAPINE TAB [ 25MG] 8.26QUETIAPINE TAB [ 50MG] 12.68QUETIAPINE TAB [100MG] 3.37QUINAPRIL TAB [10MG] 4.40QUINAPRIL TAB [20MG] 2.90QUINAPRIL TAB [5MG] 4.40QUINIDINE LEVEL 80194 111.24QUININE SULFATE CAP [324M 13.45QUIXIN OPTH SOLN [0.5% 5M 339.63QVAR HFA AERO INHAL [40MC 446.62QVAR HFA AERO INHAL [80MC 864.24RABAVERT INJ SDV [2.5 IU/ 864.49RABBIES VACCINATION IM 90675 108.15Rabies Immune Globulin 300 IU / 2 mL 96372 2,398.30RABIES VACCINE (IMOVAX) I 1,131.00RACEPINEPHRINE SVN [2.25% 12.10RADIOLOGY PACK 142.49RALOXIFENE HCL TAB [60MG] 3.50RAMIPRIL CAP [ 2.5MG] 3.97RAMIPRIL CAP [ 5MG] 4.17RAMIPRIL CAP [10MG] 4.63

84

RANEXA TAB [500MG] 17.26RANITIDINE HCL [25MG/ML M 41.84RANITIDINE HCL DUTIP SYRU 109.60RANITIDINE TAB [150MG] 10.52RAPID RHINO 4.5/ 5.5 129.78RAZADYNE ER TAB [8MG] 7.43RECOMBIVAX HB INJ [10MCG 277.06RECOVERY PHASE II PER HR/MAX 6HRS 172.01RED BLOOD CELL ANTIGEN TYPING 86905 259.56REDUCTION/NURSEMAID ELBOW 24640 412.00RE-EVALUATION 97.85REFRESH PLUS OPHTH [0.5% 55.66RELISTOR INJ [12/0.6ML] J2212 706.63Remicade ( Infliximab) Act and Neut. Ab 86352 362.56REMICADE SDV [100MG] J1745 28,036.10REMOVAL F/B EYE 65220 251.32REMOVAL F/B EYE CONJUNCTIVAL SUPERFICIAL 65205 327.54REMOVAL FOREIGN BODY EXTERNAL EAR 69200 566.50REMOVAL FOREIGN BODY FOOT 28190 618.00REMOVAL IMPACTED CERUMEN- LAVAGE 69209 309.00REMOVAL OF CYST AT WRIST 25111 4,200.00REMOVAL OF DEEP BONE IMPLANT 20680 1,800.00REMOVAL OF FOREIGN BODY- ARM 24200 463.50REMOVAL OF HEMRRHOID CLOT 46320 2,026.01REMOVAL OF METATARSAL 28110 4,500.00REMOVAL OF SMALL INTESTINE 44120 8,500.00REMOVAL PHARYNX FOREIGN BODY 42809 438.78REMOVAL SKIN TAGS <15 11200 218.36REMOVAL TUNNELED CV CATH 36590 1,658.00REMOVAL TUNNELED CV CATH W/O PORT/PMP 36589 569.59REMOVAL/BIVALVING FULL ARM/FULL LEG CAST 29705 486.16REMOVE EPIDYMIS LESION 54840 3,200.00REMOVE FB - INTRANASAL 30300 306.94REMOVE FB/MUSC/TEND SHE 20520 1,684.05RENAL PANEL 80069 121.54RENVELA PACKET [0.8GM BOX 3,104.11RENVELA TAB [800MG TAB BT 4,240.66REPAIR ACHILLES TENDON 27650 3,500.00REPAIR ACHILLES TENDON OPEN 27650 690.10REPAIR FINGER TENDON 26418 857.99REPAIR LEG TENDON EACH 27658 4,000.00REPAIR NAIL BED 11760 1,700.00

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REPAIR OF ANKLE LIGAMENT 27698 4,300.00REPAIR OF HAMMERTOE 28285 4,700.00REPAIR OF NAIL BED 11760 257.50REPAIR OF RUPTURED TENDON 24342 7,500.00REPAIR OF TIBIA 27720 3,200.00REPAIR TENDON/ MUSCLE UPPER ARM 24341 6,500.00REPAIR VENTRAL HERNIA REDUCIBLE 49560 8,000.00REPEAT CONTROL OF NOSEBLEED 30906 383.16REPLACEMENT G TUBE 43762 1,200.00RESPIRATORY MONITORING 412.00RESTASIS EMUL OPHTH DROP 886.88RESUS BAG /RESP 130.81RETAVASE [HALF KIT] J2993 6,523.32RETIC COUNT - FLOW CYTO. 85045 50.47RETICULIN IGG 86255 67.98Reticulin screen IgA 86255 103.00Reticulin titer IgA 86256 103.00RETICULIN TITER IGG 86256 67.98REVISE REPLACE KNEE JOINT 27487 11,500.00REVISE ULNAR NERVE AT ELBOW 64718 4,000.00RHC PROTHROMBIN TIME 85610 44.00Rheumatoid Factor IgA,IgG,IgM 83520 318.27RHEUMATOID FACTOR TITER 86431 67.98RhoGam J2790 99.32RIBS BILATERAL XRY 71111 417.15RIFAMPIN CAP [300MG] 5.45RIFAMPIN INJ [600MG] 313.30RIMANTADINE TAB [100MG] 5.34RISPERDAL CONSTA SYR [25M 1,534.00RISPERDAL TAB [0.5MG] 22.00RISPERDAL TAB [1 MG] 24.00Risperidone 80342 153.47RISPERIDONE TAB [0.25MG] 8.54RISPERIDONE TAB [0.5MG] 5.93RISPERIDONE TAB [1MG] 9.57RISTOCETIN CO FACTOR 85245 180.25RISTOCETIN COFACTOR 85245 180.25RITUXAN INJ [100MG] J9310 2,827.05RITUXAN INJ [500MG] J9310 14,101.30RIVASTIGMINE CAP [ 1.5MG] 9.04RIVASTIGMINE CAP [3MG] 9.08RIVASTIGMINE CAP [4.5MG] 9.73

86

RML TISSUE OR BONE AT ELBOW W TENDO RPR 24359 3,000.00RNA POLYMERASE 3 ANTIBODY 83520 146.26rocuronium bromide *DOSE 10 mg/mL* 24.27rocuronium bromide 10 MG 24.27ROPINIROLE TAB [0.5MG] 6.38ROPINIROLE TAB [1MG] 3.55ROPINIROLE TAB [2MG ] 6.38ROPINIROLE TAB [3MG] 6.48ROPIVACAINE [2MG/ML PAIN BALL 550ML] J2795 916.96ropivacaine 0.2% femoral/epidural block J2795 253.66ROTATOR CUFF REPAIR 29827 4,780.00ROXICET TAB 5/325MG 6.40ROZEREM TAB [8MG] 34.23RPR EPIGASTRIC HERNIA REDUCE 49570 4,500.00RPR ING HERNIA INIT REDUCE 49500 5,500.00RPR OF FIBROUS TISSUE OF FOOT 29893 4,233.00RPR- QUALITATIVE 86592 46.35RPR RECRT INGUINAL HERNIA ANY AGE 49520 4,800.00RPR TENDON FOOT EXTENSOR EACH 28208 3,500.00RPR UMBILICAL HERNIA REDUCIBLE > 5 YR 49585 5,500.00RPR VENTRAL HERN INCARCERATED 49561 5,500.00RSV ANTIGEN SCREEN 87420 146.26RSV-Film array Resp panel 87633 45.32RSV-RNA Qualitative Real time PCR 87798 210.12RT ANKLE COMPLETE 73610 262.65RT ANKLE LIMITED 73600 204.97RT ANKLE STRESS 77071 164.80RT CLAVICAL 73000 239.99RT ELBOW 3 VIEWS 73080 271.92RT FEMUR 1 VIEW 73551 192.61RT FEMUR 2/ > VIEWS 73552 270.89RT FOOT 73630 260.59RT FOOT LIMITED 73620 210.12RT FOREARM 73090 243.08RT HAND 2 VIEWS 73120 201.88RT HAND COMPLETE 73130 260.59RT HEEL 73650 222.48RT HIP 1 VIEW 73501 192.61RT HIP 1 VIEW- WITH PELVIS 73501 192.61RT HIP 2/3 VIEWS WITH PELVIS 73502 276.04RT HIP OR 73501 192.61RT HUMERUS 73060 256.47

87

RT KNEE 3 VIEWS 73562 287.37RT KNEE 4 + VIEWS 73564 336.81RT KNEE ARTHROGRAM 73580 706.58RT KNEE LIMITED 73560 232.78RT RIBS 71101 349.17RT SHOULD ARTHROGRAM 73040 658.17RT SHOULDER 73030 285.31RT SHOULDER 1 VIEW 73020 135.96RT TIBIA/FIBULA 73590 259.56RT TOES 73660 198.79RT US BREAST 76641 415.09RT US BREAST BCC 76641 415.09RT US BREAST BX 1ST LESION 19083 844.60RT US BREAST LOCAL 1ST 19285 119.48RT US BREAST LOCAL 2ND 19286 119.48RT US EXT VEINS 93971 666.41RT US LWR ARTERIES 93926 632.42RT WRIST 2 VIEWS 73100 204.97RT WRIST 3 VIEWS 73110 260.59RT WRIST ARTHRO 73115 552.08RUBELLA ANTIBODY IGG 86762 81.37S I JOINTS XRY 72202 278.10SACRUM AND COCCYX 72220 278.10SAFELINE INJECT SITE O.P. 2.00SALICYLATE LEVEL 80329 112.27SALINE FLUSH HEP 13.50SALINE NASAL SOLN [0.65% 11.68SALIVART SYN SALIVA 270.51SALONPAS PATCH [20] 0.79SANCTURA TAB [20MG] 9.33SANDOSTATIN KIT LAR INJ [ 9,363.80SANTYL OINTMENT [250 UNIT 413.22SARS-CoV-2 RNA RT-PCR 87635 95.00SAT CHECK MULT/ WALKING 94761 202.91SAT CHECK SINGLE 94760 114.33SAW PALMETTO CAP [500MG B 15.79SCAPULA LT XRAY 73010 258.53SCAPULA RT XRAY 73010 258.53SCISSORS-DCS12 516.03Sec'd clsr of surg wd or dehisce + 13160 3,060.13selegiline hcl Tab 5 mg 6.07SELSUN BLUE BALANCED SHAM 17.94

88

SELSUN LOTION [2.5%] 36.49SEMEN ANALYSIS- COMPLETE 89320 153.47SEMEN PRESENCE TESTING 89321 75.19SENNOSIDES TAB [8.6MG] 0.79SENSIPAR TAB [30MG TAB BO 2,129.69SENSIPAR TAB [90MG BTL] 6,389.06SENSORCAINE INJ 0.25% [M 19.79SENSORCAINE INJ 0.25% [S 10.45SENSORCAINE INJ 0.25% W/ 26.85SENSORCAINE INJ 0.25% W/ 11.86SENSORCAINE INJ 0.5% [MD 23.70SENSORCAINE INJ 0.5% [SI 6.11SENSORCAINE INJ 0.5% W/E 28.15SENSORCAINE INJ 0.5% W/E 18.01SENSORCAINE-MPF INJ 0.25% 14.84SENSORCAINE-MPF INJ 0.5% 6.38SEPTOPLASTY 30520 4,500.00SEQ IV PUSH - NEW DRUG 96375 100.94SEQ IV PUSH- NEW DRUG 96375 100.94SEQ IV PUSH SAME DRUG 96376 57.68SEQ SAME DRUG IV PUSH- TX 96376 13.39SEREVENT DISKUS [50MCG 60 1,205.98SEROQUEL TAB [ 25MG] 13.00SEROQUEL TAB [ 50MG] 21.00SEROQUEL TAB [100MG] 21.00SEROQUEL TAB [200MG] 38.00SEROQUEL XR TAB [300MG] 54.00SERTRALINE TAB [ 25MG] 0.90SERTRALINE TAB [ 50MG] 0.90SERTRALINE TAB [100MG] 1.65SHAVE SKIN LESION .5 CM 11300 1,200.00SHAVING SHOULDER BONE 29826 2,500.00SHEET ARTHROSCOPE 298.70Shiga Toxin by PCR 87798 189.52SHIGA-LIKE TOXIN 1 - EIA 87427 76.22SHIGA-LIKE TOXIN 2 - EIA 87427 76.22SHOULDER ARTHROPLASTY 23470 12,200.00SHOULDER ARTHROSCOPY 29806 4,500.00SIGMOIDOSCOPY AND BIOPSY 45331 1,400.00SIGN LANGUAGE/ORAL INTERPRETER 15 MINUTE T1013 12.36SILDENAFIL TAB 20MG 84.35SILVASORB HYDROGEL [TUBE] 89.86

89

SILVER NITRATE APPLICATOR 2.40SILVER SULFADIAZINE CREAM 171.78SILVER SULFADIAZINE CREAM 35.50SILVER SULFADIAZINE CREAM 79.72SIMETHICONE CAP [125MG] 14.47SIMETHICONE DROPS [30ML] 20.83SIMETHICONE TAB [80MG] 0.79SIMVASTATIN TAB [ 20MG] 0.90SIMVASTATIN TAB [ 40MG] 0.90SINGULAIR CHEWABLE TAB [4 17.00SINGULAIR TAB [10MG] 17.00SINUSES > 3 VIEWS 70210 148.32Sirolimus, LC/MS/MS 80195 141.00SITAGLIPTIN PHOSPHATE TAB [ 50MG] 41.66SITAGLIPTIN PHOSPHATE TAB [100MG] 41.66SKELAXIN TAB [800MG] 26.84SKIN AFRAFT TRNK / ARMS / LEG 15100 4,300.00SKULL LIMITED XRY 70250 247.20SKULL XRY 70260 383.16SMALL BOWEL XRY 74250 530.45SO (1-3) BETA-D-GLUCAN FU 84311 362.56SO 5HIAA/SEROTONIN -URINE 83497 101.97SO 5'NUCLEOTIDASE 83915 73.13SO A-1-ANTITRYP W/PHENOTP 82104 73.13SO ACETYL RECEP BLOC AB 83519 184.37SO ACETYL RECEP MOD AB 83519 184.37SO ACETYL RECEPT BIND AB 83519 184.37SO ACID PHOS- PROSTATE 84066 57.68SO ACTH 82024 79.31SO ACTIVAT PROTEIN C-RES 85307 132.87SO ADENOVIRUS BY PCR 87798 192.61SO AEROBAS PULLU PPT-AB 86331 47.38SO AFB AMP PROBE PCR 87556 282.22SO AFB CONC INF AGT 87015 54.59SO AFB CULTURE 87116 133.90SO AFB ORGANISM ID 87118 119.48SO AFB SENS ETHAMBUTOL 87190 22.66SO AFB SENS ISONIAZID 87190 22.66SO AFB SENS PZA 87190 22.66SO AFB SENS RIFAMPIN 87190 22.66SO AFB SENS STREPTOMYCIN 87190 22.66SO AFB SMEAR 87206 72.10

90

SO AFP AMNIOTIC FLD 82106 62.83SO AFP MATERNAL 82105 57.68SO AFP TUMOR & AFP-L3 82107 57.68SO ALBUMIN- URINE 82042 44.29SO ALDOLASE 82085 50.47SO ALDOSTERONE LEVEL 82088 130.81SO ALK PHOS BONE SPECIFIC 84075 80.34SO ALK PHOS FOR ISOS 84075 47.38SO ALK PHOS ISOENZYMES 84080 153.47SO ALLERGEN - ALFALFA 86003 55.62SO ALLERGEN - BIRCH 86003 37.08SO ALLERGEN - CANDIDA 86003 55.62SO ALLERGEN - CAT 86003 55.62SO ALLERGEN - DUST 86003 55.62SO ALLERGEN - GLUTEN IGE 86003 55.62SO ALLERGEN - IGE EA 86003 55.62SO ALLERGEN - JUNIPER 86003 55.62SO ALLERGEN - MULBERRY 86003 37.08SO ALLERGEN - OLIVE 86003 55.62SO ALLERGEN - RUSS OLIVE 86003 59.74SO ALLERGEN - WILLOW 86003 59.74SO ALLERGEN ALDER 86003 37.08SO ALLERGEN ASCARIS 86003 37.08SO ALLERGEN ASPER NIG IGG 86001 53.56SO ALLERGEN BANANA 86003 55.62SO ALLERGEN BARLEY 86003 55.62SO ALLERGEN BEAN NAVY/WHI 86003 55.62SO ALLERGEN CHOCOLATE 86003 55.62SO ALLERGEN CLADOSPOR.HER 86003 37.08SO ALLERGEN CLAM 86003 55.62SO ALLERGEN COCKROACH 86003 37.08SO ALLERGEN -CODFISH 86003 55.62SO ALLERGEN CRAB 86003 55.62SO ALLERGEN D.PTERONYSSIN 86003 37.08SO ALLERGEN EGG WHITE 86003 55.62SO ALLERGEN ELM 86003 37.08SO ALLERGEN HALIBUT 86003 55.62SO ALLERGEN HORMODENDRIUM 86003 55.62SO ALLERGEN LATEX 86003 55.62SO ALLERGEN LEMON 86003 55.62SO ALLERGEN LOBSTER 86003 55.62SO ALLERGEN MAPLE BOX E 86003 37.08

91

SO ALLERGEN MOUSE 86003 55.62SO ALLERGEN OAK 86003 37.08SO ALLERGEN OAT 86003 55.62SO ALLERGEN ORANGE 86003 55.62SO ALLERGEN PEA GREEN 86003 55.62SO ALLERGEN PEANUT 86003 55.62SO ALLERGEN PENICILLIN 86003 55.62SO ALLERGEN- PORK 86003 55.62SO ALLERGEN POTATO WHITE 86003 55.62SO ALLERGEN RED TOP GRASS 86003 37.08SO ALLERGEN RICE 86003 55.62SO ALLERGEN RYE 86003 55.62SO ALLERGEN SALMON 86003 55.62SO ALLERGEN SCALLOP 86003 37.08SO ALLERGEN SESAME 86003 37.08SO ALLERGEN SHRIMP 86003 55.62SO ALLERGEN SOY 86003 55.62SO ALLERGEN STACHBOT IGE 86003 37.08SO ALLERGEN STACHBOT IGG 86001 53.56SO ALLERGEN STRAWBERRY 86003 55.62SO ALLERGEN TUNA 86003 55.62SO ALLERGEN WALNUT 86003 37.08SO ALLERGEN YEAST BAKERS 86003 55.62SO ALLERGEN-ALTERNARIA 86003 55.62SO ALLERGEN-ASPERGLS FUMA 86003 55.62SO ALLERGEN-BERMUDA GRASS 86003 55.62SO ALLERGEN-COCKELBUR 86003 55.62SO ALLERGEN-CORN FOOD 86003 55.62SO ALLERGEN-COTTONWOOD 86003 55.62SO ALLERGEN-COW'S MILK 86003 55.62SO ALLERGEN-D.FARINAE 86003 55.62SO ALLERGEN-DOG HAIR 86003 55.62SO ALLERGEN-EGGS WHOLE 86003 55.62SO ALLERGEN-KOCHIA 86003 55.62SO ALLERGEN-MUCOR 86003 59.74SO ALLERGEN-PIGWEED/REDRT 86003 55.62SO ALLERGEN-RUSS.THISTLE 86003 55.62SO ALLERGEN-SAGEBRUSH 86003 55.62SO ALLERGEN-TIMOTHY GRASS 86003 55.62SO ALLERGEN-TOMATOES 86003 55.62SO ALLERGEN-WHEAT 86003 55.62SO ALLERGN ASPERGLS NIGR 86003 55.62

92

SO ALPHA 2 MACROGLOBULIN 83883 70.04SO ALPHA-1-ANTITRYPS -TOT. 82103 109.18SO ALPHA-GALACTOSIDAS -SER 84311 378.01SO ALUMINUM LEVEL 82108 75.19SO AMIKACIN LEVEL 80150 60.77SO AMINOLEV.ACID-DELTA-UA 82135 83.43SO AMITRYPTYLINE 80335 66.95SO AMMONIA URINE 82140 51.50SO AMYLASE ISO PANCREATIC 82150 76.22SO AMYLASE w/ISOENZYMES 82150 45.32SO ANA 86038 50.47SO ANA COMPLETE RX LUPUS 86038 50.47SO ANA for COMPLETE 86038 50.47SO ANA SCREEN - ARUP 86038 53.56SO ANA SCREEN W/PNL 86038 50.47SO ANA TITER 86039 49.44SO ANA TITER 86039 46.35SO ANA TITER W/PNL 86039 46.35SO ANCA SCRN RX TITER 86021 80.34SO ANDROSTENEDIONE 82157 155.53SO ANGIOTEN CONVERT ENZYM 82164 60.77SO ANNA IGG SCREEN 86255 126.69SO ANNA IMMUNO HU 83516 108.15SO ANNA IMMUNO RI 83516 108.15SO ANNA RX TITER 86256 113.30SO ANTI-ds DNA IGG 86225 59.74SO ANTI-dsDNA ANTIBDY -IgG 86225 59.74SO ANTI-GLOM BASE MEMB 83520 112.27SO ANTIMITROCHONDRIAL AB 86255 87.55SO ANTI-MULLERIAN HORMONE 83520 132.87SO ANTI-SMOOTH MUSCLE AB 86255 67.98SO ANTI-ss DNA IGG 86226 111.24SO ANTITHROMB III -ACTVITY 85300 66.95SO APOLIPOPROTEIN-B 82172 64.89SO AQUAPORIN-4 RECP AB 83516 487.19SO ARC AB-ID EA PNL-MEDIA 86870 203.94SO ARC ABO 86900 46.35SO ARC AGT CROSSMATCH 86922 138.02SO ARC ANTIBODY SCREEN 86850 117.42SO ARC ANTIGEN TYPE/UNIT 86902 114.33SO ARC DAT 86880 73.13SO ARC DIFF ADS EA 86978 129.78

93

SO ARC ELUTION 86860 129.78SO ARC INCUBAT W/ENZYMES 86971 42.23SO ARC PHENOTYP RBC AG EA 86905 71.07SO ARC PRETREAT RBC 86970 108.15SO ARC RARE AG PT SRM EAC 86904 30.90SO ARC RETIC SEPARATION 86972 146.26SO ARC RH 86901 46.35SO ARC RH PHENOTYP COMP 86906 117.42SO ARSENIC BLOOD 82175 82.40SO ARSENIC URINE 82175 70.04SO ASO TITER 86060 47.38SO ASPERG FLAVUS PPT-AB 86331 47.38SO ASPERG FUM #1 PPT-AB 86331 47.38SO ASPERG FUM #2 PPT-AB 86331 47.38SO ASPERG FUM #3 PPT-AB 86331 47.38SO ASPERG FUM #6 PPT-AB 86331 47.38SO ASPERGILLUS AB - CF 86606 70.04SO ASPERGILLUS AB - ID 86606 70.04SO B.PARAPERTUSSIS BY PCR 87798 237.93SO B.PERTUSS - IGA 86615 80.34SO B.PERTUSS - IGA - PT 86615 75.19SO B.PERTUSS - IGG 86615 80.34SO B.PERTUSS - IGG - PT 86615 75.19SO B.PERTUSS - IGM 86615 80.34SO B.PERTUSSIS CULTURE 87081 86.52SO B2 GLYCOPROTEIN IGA 86146 133.90SO B2 GLYCOPROTEIN IGG 86146 133.90SO B2 GLYCOPROTEIN IGM 86146 133.90SO B2 MICROGLOBULIN 82232 60.77SO BACT.AG- CSF- EACH 86403 62.83SO BACT.AG QUANT BY RIA 86403 111.24SO BARBITURATE CONFIRM UA 80307 128.75SO BART HENSE IGG TITER 86611 47.38SO BART HENSE IGM SCRN 86611 31.93SO BART HENSE IGM TITER 86611 47.38SO BART HENSEL IGG SCRN 86611 58.00SO BART QUINT IGG SCRN 86611 31.93SO BART QUINT IGG TITER 86611 47.38SO BART QUINT IGM SCRN 86611 31.93SO BART QUINT IGM TITER 86611 47.38SO B-CELLS - TOTAL 86355 141.11SO BENZODIAZEPINES SERUM 80346 98.88

94

SO BETA-2 MICROGLOB-ARUP 82232 60.77SO B-HCG- TRIPLE SCREEN 84702 62.83SO B-HYDROXYBUTYRIC ACID 82010 83.43SO BILE ACIDS TOTAL 82239 82.40SO BILIRUBIN -AMN FLD 82143 44.29SO BK VIRUS PCR PLASMA 87799 481.01SO BK VIRUS QT BLOOD 87799 481.01SO BK VIRUS QT- URINE 87799 481.01SO BLASTOMYCES AB 86612 151.41SO C ANCA TITER 86021 62.83SO C.DIFF CULTURE W/RX TX 87081 80.34SO C.DIFF CYTOTOXIN ASSAY 87230 126.69SO C1 INHIBITOR FUNCTIONA 83520 122.57SO C1q COMPLEMENT COMPONT 86160 109.18SO CA 15-3 86300 71.07SO CA 19-9 ANTIGEN 86301 66.95SO CA 27.29 ANTIGEN 86300 62.83SO CA-125 ANTIGEN 86304 62.83SO CALCITONIN LEVEL 82308 73.13SO CALCIUM IONIZ W/PTH 82330 64.89SO CALCIUM -IONIZED 82330 64.89SO CALCIUM W/PTH 82310 47.38SO CALPROTECTIN-FECAL 83993 261.62SO Campylobacter culture 87046 63.86SO CANDIDA ALBICANS AB 86628 241.02SO CARBOXYHEMOGLOBIN LVL 82375 103.00SO CARCINOEMBRYONIC AG 82378 62.83SO CARDIOLIPIN IGA 86147 128.75SO CARDIOLIPIN IGG 86147 128.75SO CARDIOLIPIN IGM 86147 128.75SO CARDIOLIPIN SCN/RX 86147 77.25SO CARNITINE LEVEL 82379 299.73SO CAROTENE LEVEL 82380 61.80SO CATECHOLAMINES PLASMA 82383 101.97SO CATECHOLAMINES- URINE 82384 124.63SO CD-16 CELL MARKER 88184 155.53SO CD-2 CELL MARKER 88184 155.53SO CD-3 CELL MARKER 88184 155.53SO CD4 CD8 T-CELLS 86360 202.91SO CD4 T-CELL COUNT 86361 80.34SO CD-5 CELL MARKER 88184 155.53SO CD-56 CELL MARKER 88184 155.53

95

SO CD-57 CELL MARKER 88184 155.53SO CD-7 CELL MARKER 88184 155.53SO CD-8 CELL MARKER 88184 155.53SO CENTROMERE ANTIBODY 86038 50.47SO CERULOPLASMIN 82390 53.56SO CHLAM PSITT IGA 86631 47.38SO CHLAM PSITT IGG 86631 47.38SO CHLAM PSITT IGM 86632 67.98SO CHLAMYDIA AB IGG 86631 77.25SO CHLAMYDIA CULTURE 87110 111.24SO CHLAMYDIA DNA PB ONLY 87490 53.56SO CHLAMYDIA DNA PROBE 87490 53.56SO CHLAMYDIA STAIN W/CULT 87140 37.08SO CHLAMYDIA-GC MO SCREEN 87800 151.41SO CHLORIDE - FECES 82438 64.89SO CHLORIDE-URINE 82436 55.62SO CHOLINESTERASE- RBC 82482 92.70SO CHROM ANALYS 15-20 88262 722.03SO CHROM ANALYS- AMNIOTIC 88269 894.04SO CHROM ANYLS-AMNIO ADDL 88280 203.94SO CHROMATIN(NUCLEOSOM)AB 86235 71.07SO CHROMIUM SERUM 82495 113.30SO CHROMOGRANIN A 86316 154.50SO CHROMOSOM ANYLS PERIPH 88230 473.80SO CITRATE-URINE 82507 70.04SO CK ISOEMZYMES 82552 92.70SO CK W/ISOENZYMES 82550 60.77SO CLOZAPINE 80159 76.22SO CMV IGG 86644 105.06SO CMV IGM 86645 60.77SO CMV QUANT BY PCR 87497 503.67SO CMV QUANT PCR BLOOD 87497 503.67SO COCCIDIOIDES AB 86635 79.31SO CODEINE LEVEL 80361 111.24SO COMPLEMENT - TOT CH50 86162 59.74SO COMPLEMENT C1 86160 55.62SO COMPLEMENT C2 86160 55.62SO COMPLEMENT C3 86160 98.88SO COMPLEMENT C4 86160 92.70SO COPPER- SERUM 82525 53.56SO COPPER-24HR URINE 82525 92.70SO CORTISOL FREE- URINE 82530 62.83

96

SO CORTISOL- SERUM 80400 59.74SO CORTISOL SERUM EACH AFTER 2 82533 59.74SO CORTISOL SERUM FIRST ADDL. 82533 59.74SO CORTISOL-FREE SERUM 82530 62.83SO CORTISOL-SALIVA 82533 143.17SO CORTISONE URINE 83789 185.40SO COTININE-NICOTININE 80323 130.81SO COUMADIN-WARFARIN LVL 80299 117.42SO C-PEPTIDE 84681 67.98SO C-REACT PROT - ULTRA SEN 86141 75.19SO CREAT W/TOBRA PEAK 82565 47.38SO CREAT W/TOBRA TROUGH 82565 47.38SO CREATINE 24HR URINE 82540 62.83SO CROHN ANTI-12 ELISA 83520 96.82SO CROHN DNA 3020insC 88346 107.12SO CROHN DNA C2104T R702W 88346 107.12SO CROHN DNA G2722C G908R 88346 107.12SO CRYOCRIT IMMUNODIFFUSN 86329 117.42SO CRYOCRIT IMMUNOFIXAT 86334 159.65SO CRYOGLOBULIN -QUAL 82595 45.32SO CRYPTOCOCCUS AG - CSF 87449 67.98SO CRYPTOSPORIDIUM AG 87328 77.25SO CRYSTALS IN FLUID 89060 100.94SO C-TELOPEPTIDE (CTX) 82523 169.95SO CULTURE - INFLU A 87254 51.50SO CULTURE- INFLU B 87254 51.50SO CYCLIC CITRU PEP AB 86200 152.44SO CYCLOSPORINE LEVEL 80158 80.34SO CYSTICERCOSIS IGG 86682 128.75SO D-DIMER - QUANT. 85379 144.20SO DEOYCORTICOSTERONE 82633 204.97SO DHEA UNCONJUGATED 82626 101.97SO DHEA-S LEVEL 82627 62.83SO DIHYDROTESTOSTERONE 80327 157.24SO DIL RUSS VIP VENOM SCN 85613 96.82SO DIPTHERIA ANTIBODY 86648 86.52SO DNA ANALYSIS 88182 456.29SO DRUG SCREEN/NIDA 80306 71.07SO DRVVT CONFIRM RX 85597 96.82SO DRVVT RX MIX 85613 96.82SO dsDNA ANTIBODIES 86225 61.80SO E.HISTOLYTICA AB 86753 79.31

97

SO ECHINOCOCCUS GRAN AB 86682 187.46SO ELASTASE-1 PANCREATIC 82656 303.85SO ELECTROPHOR URINE 84166 85.49SO ELECTROPHORESIS SERUM 84165 106.09SO ENA - RNP-IgG ANTIBODY 86235 73.13SO ENA- Jo1 ANTIBODY 86235 79.31SO ENA- SCL-70 ANTIBODY 86235 77.25SO ENA SCREEN 86235 81.37SO ENA- SMITH ANTIBODY 86235 73.13SO ENA- SSA(Ro) ANTIBODY 86235 55.62SO ENA- SSB(La) ANTIBODY 86235 55.62SO ENCEPH - CALIFORNIA AB 86651 115.36SO ENCEPH - E EQUINE AB 86652 115.36SO ENCEPH - ST LOUIS AB 86653 115.36SO ENCEPH - W EQUINE AB 86654 115.36SO ENDOMYCIAL SCREEN 86255 134.93SO ENDOMYCIAL SCREEN 86255 134.93SO ENDOMYCIAL TITER 86256 67.98SO ENTEROVIRUS-PCR-CSF 87798 233.81SO EPS BARR DNA QN PCR 87799 350.20SO EPS BARR EARLY AG 86663 60.77SO EPS BARR EBNA 86664 94.76SO EPS BARR VCA - IGM 86665 60.77SO EPS BARR VCA -IGG 86665 59.74SO ERYTHROPOIENTIN LEVEL 82668 113.30SO ESTRADIOL HI SENS 82670 124.63SO ESTRADIOL LEVEL 82670 152.44SO ESTRIOL LEVEL 82677 67.98SO ESTROGEN - TOTAL 82672 96.82SO ESTRONE LEVEL 82679 113.30SO ETHANOL -BREATH 82075 258.53SO ETHYLENE GLYCOL 82693 130.81SO F-ACTIN (SM) AB 83516 98.88SO FACTOR 11 85270 112.27SO FACTOR 12 85280 117.42SO FACTOR 13 - QUAL 85291 92.70SO FACTOR 9 85250 117.42SO FACTOR II ACTIVITY 85210 117.42SO FACTOR V ACTIVITY 85220 117.42SO FACTOR V LEIDEN TIER 1 81241 439.81SO FACTOR VII 85230 85.49SO FACTOR VIII - VWF - AG 85246 153.47

98

SO FACTOR VIII -VWF - RCoF 85245 153.47SO FACTOR VIII:C 85240 199.82SO FACTOR X ACTIVITY 85260 117.42SO FECAL FAT - QUAL 82705 67.98SO FECAL FAT- QUANT. 82710 106.09SO FELBAMATE 80299 114.33SO FENTANYL LEVEL 80361 181.28SO FETAL RBC SCREEN 85460 77.25SO FIBRIN MONOMER 85362 96.82SO FLECAINIDE LEVEL 80299 72.10SO FLOW CYTO CONSULT LTD 80500 100.94SO FLOW CYTO-EA ADDL MARK 88185 111.24SO FOLATE LEVEL 82746 50.47SO FREE KAPPA LIGHT CHNS 83883 164.80SO FREE LAMBDA LIGHT CHNS 83883 164.80SO FREE T3 84481 80.00SO FRUCTOSAMINE 82985 75.19SO FSH LEVEL 83001 60.77SO FTA ABS- CONFIRMATORY 86780 55.62SO FUNG SENS 5-FLUCYTOSIN 87186 42.23SO FUNG SENS AMPHOTER B 87186 42.23SO FUNG SENS ANIDULAFUNGI 87186 42.23SO FUNG SENS CASPOFUNGIN 87186 42.23SO FUNG SENS FLUCONAZOLE 87186 42.23SO FUNG SENS ITRACONAZOLE 87186 42.23SO FUNG SENS MICAFUNGIN 87186 42.23SO FUNG SENS POSACONAZOLE 87186 42.23SO FUNG SENS VORICONAZOLE 87186 42.23SO FUNGUS CULTURE - MISC 87102 82.40SO FUNGUS CULTURE - SKIN 87101 82.40SO FUNGUS CULTURE- BLOOD 87103 82.40SO FUNGUS CULTURE- OTHER 87102 82.40SO FUNGUS ID 87106 51.50SO GALACTOKINASE(B) 82759 280.16SO GALACTOSE-1-PHOS - RBC 84378 326.51SO GASTRIN LEVEL 82941 62.83SO GIARDIA AB - SERUM 86674 105.06SO GIARDIA ANTIGEN 87328 70.04SO GLIADIN AB IGA 83516 70.04SO GLIADIN AB IGG 83516 70.04SO GLIADIN IGA 83516 57.68SO GLIADIN IGG 83516 57.68

99

SO GLUCAGON LEVEL 82943 73.13SO GLUCOSE-6-PHOS DEHYD 82955 85.49SO GLUTM ACID DECARBXY-65 86341 151.41SO GLYCOMARK 84378 77.25SO GROWTH HORMONE HUMAN 83003 55.62SO H.PYLORI ANTIGEN 87338 101.97SO HANTAVIRUS AB-IGG 86790 113.30SO HANTAVIRUS AB-IGM 86790 113.30SO HAPTOGLOBIN 83010 112.27SO HBSAG CONFIRMATION 87341 67.98SO HCV GENOTYP PCR PROBE 87902 304.88SO HEMOCHROMATOSIS DNA 81256 421.27SO HEP A AB TOTAL 86708 59.74SO HEP B CORE AB- IGM 86705 53.56SO HEP B CORE AB- TOTAL 86704 57.68SO HEP B E ANTIBODY 86707 55.62SO HEP B E ANTIGEN 87350 61.80SO HEP B SURFACE ANTIBODY 86706 47.38SO HEP B SURFACE ANTIGEN 87340 47.38SO HEP C RNA-PCR-QUAL 87521 352.26SO HEP C RNA-PCR-QUANT 87522 543.33SO HEP PANEL ACUTE 80074 96.82SO HEPARIN LO MOLEC WT 85520 153.47SO HEPATITIS - delta ABDY 86692 67.98SO HEPATITIS A IGM 86709 47.38SO HEPATITIS C ANTIBODY 86803 61.80SO HEPATITIS E IGM 86790 124.63SO HEPTIMAX HCV RNA 87522 585.04SO HERPES CULT W/TYPE 87255 77.25SO HERPES CULTURE TYPING 87140 53.56SO HERPES SIMPLEX BY PCR 87529 277.07SO HERPES SIMPLEX II- IGG 86696 60.77SO HERPES SIMPLEX I-IGG 86695 60.77SO HERPES SIMPLX-1 IGM 86695 47.38SO HERPES SIMPLX-2 IGM 86696 59.74SO HEXAG PHASE CONFIRM 85598 92.70SO HGB ELECTROPHORESIS 83020 114.33SO HGB EVAL - HCT 85018 38.11SO HGB EVAL - HGB 85014 30.90SO HGB EVAL - RBC 85041 31.93SO HGB EVAL CHROMATOGRAPH 83021 84.46SO HISTAMINE - 24H URINE 83088 117.42

100

SO HISTAMINE - PLASMA 83088 156.56SO HISTO/CYTO ENZYMES 88319 182.31SO HISTONE AB 83516 86.52SO HISTOPLASMA AB 86698 77.25SO HIV GENO DRUG RESIST 87901 454.23SO HIV PHENO DRUG RESIST 87900 275.01SO HIV RNA QL PCR 87535 287.37SO HIV RNA QUANT 87536 188.49SO HIV-1 WEST.BLOT 86689 73.13SO HIV-2 ELISA 86702 153.47SO HLA B-27 86812 59.74SO HLA DR-A COMPLETE 86817 239.99SO HLA DR-B COMPLETE 86817 239.99SO HLA SINGLE ANTIGEN 86812 59.74SO HOMOCYSTINE - CARDIO 83090 84.46SO HPV PAPILLOMA 87623 96.82SO HTLV I/II AB 86790 144.20SO HUMAN HERPES 6 IGG 86790 101.97SO HUMAN HERPES 6 IGM 86790 101.97SO HVA HOMOVANILLIC ACID 83150 132.87SO HYALURONIC ACID 83520 122.57SO HYDROCODONE LEVEL 80361 83.43SO HYDROXYPROGESTERONE 17 83498 97.85SO HYDROXYPROLINE 24HR 83505 109.18SO IBD 4A-FLAX2 83520 96.82SO IBD ASCA IGA 83520 108.15SO IBD ASCA IGG 83520 103.00SO IBD CBIR1 83520 103.00SO IBD CRP 86140 64.89SO IBD DNA ATG16L1 81479 86.52SO IBD DNA ECM1 81479 86.52SO IBD DNA STAT3 81479 86.52SO IBD DNASE SENS 88346 144.20SO IBD FLAX 83520 96.82SO IBD ICAM 82397 98.88SO IBD IFA PERINUCLEAR 88346 144.20SO IBD NEUTROPHIL AUTOAB 83520 103.00SO IBD NKX2-3 81479 86.52SO IBD OMPC IGA 83520 103.00SO IBD SAA 82397 98.88SO IBD VCAM 82397 98.88SO IBD VEGF 83520 96.82

101

SO IBS BDNF 82397 37.08SO IBS GRO-a 82397 37.08SO IBS IL-1 BETA 82397 37.08SO IBS N-GAL 82397 37.08SO IBS TIMP-1 82397 37.08SO IBS TWEAK 82397 37.08SO IBUPROFEN LEVEL 80329 57.68SO IFE - URINE 86335 79.31SO IFE-SERUM-ARUP 86334 85.49SO IGA 82784 57.68SO IGA - CSF. 82784 59.74SO IGA LEVEL 82784 57.68SO IGA PLATELET ASSOCIATE 86023 108.15SO IGA PLATELET CIRCULATE 86022 81.37SO IGA TOTAL PROMETHEUS 82784 57.68SO IGE LEVEL 82785 57.68SO IGF BIND.PROTEIN 3 83519 125.66SO IGF-1 INSULIN-LIKE GRO 84305 73.13SO IGF2-INSULIN-LIKE GRO 83519 130.81SO IGG - ARUP 82784 57.68SO IGG - CSF 82784 59.74SO IGG LEVEL 82784 57.68SO IGG PLATELET ASSOCIATE 86023 108.15SO IGG PLATELET CIRCULATE 86022 81.37SO IGG SERUM 82784 57.68SO IGG SUBCLASS -1-2-3 OR 4 82787 80.34SO IGG W/SUBCLASSES 82784 86.52SO IGM - ARUP 82784 57.68SO IGM - CSF 82784 59.74SO IGM LEVEL 82784 57.68SO IGM LEVEL 82784 57.68SO IGM PLATELET ASSOCIATE 86023 108.15SO IGM PLATELET CIRCULATE 86022 81.37SO IMMUNOELECTRO SERUM 86334 85.49SO IMMUNOELECTRO URINE 86335 79.31SO INDICAN- URINE 81005 75.19SO INFLUENZAE A AB 86710 101.97SO INFLUENZAE B AB 86710 101.97SO INHIBIN A 86336 179.22SO INHIBIN B 83520 225.57SO INSULIN ANTIBODIES 86337 235.87SO INSULIN ISI FASTING 83525 77.25

102

SO INSULIN LEVEL 83525 77.25SO INSULIN LEVEL 120MIN 83525 77.25SO INSULIN LEVEL 30MIN 83525 77.25SO INSULIN LEVEL 60MIN 83525 77.25SO INSULIN LEVEL 90MIN 83525 77.25SO INTERLEUKIN 2 83520 114.33SO INTERLEUKIN 8 83520 114.33SO INTERLUKIN 6 82397 189.52SO INT'FERON B IGG W/RX 83520 190.55SO INTRINSIC FACT.BLK AB 86340 140.08SO IODINE URINE 82542 130.81SO JC VIRUS - PCR QUANT 87798 392.43SO JC VIRUS PER QUAL 87798 250.29SO JCV AB INHIBITION 86790 437.75SO JCV STRATIFY AB W/RX 86790 962.02SO KAPPA LIGHT CHAINS UA 83883 92.70SO KETOSTEROIDS-17 24 HR 83586 92.70SO KOH EXAM 87220 51.50SO KRAS MUTATION ANALYSIS 81275 627.27SO LACOSAMIDE-VIMPAT 80299 146.26SO LACTATE - LACTIC ACID 83605 103.00SO LAMBDA LIGHT CHAINS UA 83883 92.70SO LAMOTRIGINE-LAMICTAL 80299 72.10SO LDH ISOENZYMES 83625 62.83SO LDH W/ISOENZYMES 83615 50.47SO LDL -DIRECT MEASURE 83721 55.62SO LEAD BLOOD INDUSTRIAL 83655 71.07SO LEAD URINE 83655 64.89SO LEGIONELLA AB TITER 86713 83.43SO LEGIONELLA AG URINE 87449 67.98SO LEPTOSPIRA AB 86720 101.97SO LEUKOCYTE ALK PHOS 85540 83.43SO LEVETIRACETAM-KEPPRA 80177 75.19SO LIDOCAINE LEVEL 80176 64.89SO LIGHT CHAIN KAPPA - SER. 83883 75.19SO LIGHT CHAIN LAMBD - SER 83883 75.19SO LIPASE -URINE RANDOM 83690 83.43SO LIPOPROTEIN (a) 83695 87.55SO LIPOPROTEIN A 82172 75.19SO LIPOPROTEIN ELECTROPH 83700 126.69SO LIVER-KIDNE MICRO-1 86376 105.06SO LUTENIZING HORMONE -LH 83002 60.77

103

SO LYME DISEASE ANTIBODY 86618 55.62SO LYME WEST BLOT IGG 86617 73.13SO LYME WEST BLOT IGM 86617 73.13SO MAGNESIUM - FECES 83735 53.56SO MAGNESIUM URINE 83735 51.50SO MANGANESE LEVEL 83785 114.33SO MERCAPTOPURINE 80299 235.87SO MERCURY BLOOD 83825 72.10SO MERCURY URINE 83825 70.04SO METANEPHRINE RDM W/CRE 83835 92.70SO METANEPHRINES- PLASMA 83835 178.19SO METANEPHRINES URINE 83835 92.70SO METHYLMALONIC ACID 83921 184.37SO MICROPOLY FAENI PPT-AB 86331 47.38SO MICROSOMAL AB(TPO) 86376 71.07SO MITOCHONDRIAL AB TITER 86256 72.10SO MITOCHONDRIAL M2 AB 83516 87.55SO MONO CELL AG - GUANT 86356 117.42SO MOPATH LEVEL 2 - CROHN 81401 592.25SO MUMPS AB - IGG 86735 72.10SO MUMPS AB - IGM 86735 72.10SO MYCOPHENOLIC ACID G 80299 133.90SO MYCOPLASMA ANTIBODY 86738 61.80SO MYELIN BASIC PROTEIN 83873 83.43SO MYLEOPEROXIDASE AB 83876 67.98SO MYOGLOBIN URINE 83874 66.95SO N.GONORRHOEAE AB IGG 86609 80.34SO N.MENINGITIDIS A - AB 86741 114.33SO N.MENINGITIDIS C- AB 86741 114.33SO NATURAL KILL CELL -TOT. 86357 141.11SO NEISS GONO DNA PROBE 87590 53.56SO NEUROMYO OPT NMO AB 86255 621.09SO NEURONAL AB HU 83516 108.15SO NEURONAL AB RI 83516 108.15SO NEURONAL AB YO 83516 108.15SO NEURONTIN(GABAPEN) 80299 80.34SO NEUTROPHIL ANTIBODY 86021 160.68SO NICOTINE - URINE 80323 139.05SO NMDA RECEPTOR AB CSF 86255 341.96SO NMDA RECP AB CSF TITER 86256 225.57SO NOREPINEPHRINE-SERUM 82542 139.05SO NOROVIRUS - STOOL 87449 176.13

104

SO NORPACE LEVEL 80299 79.31SO NORTRIPTYLINE LEVEL 80345 83.43SO N-Telopeptide (NTx) 24HR Urine 82523 114.33SO N-TELOPEP-X-LINK SERUM 82523 330.63SO NTx URINE (OSTEOMARK) 82523 101.97SO O/P DIRECT SMEAR 87177 57.68SO O/P SPECIAL STAIN 87209 46.35SO OLIGLOCLONAL AB 83916 77.25SO OPIATE CONFIRM UA 80361 145.23SO OPIATES- SERUM LEVEL 80361 189.52SO OSMOLALITY- BLOOD 83930 55.62SO OSMOLALITY- URINE 83935 57.68SO OSMOLARITY FECES 84999 128.75SO OSMOTIC FRAGILITY 85557 189.52SO OSTEOCALCIN 83937 92.70SO OXALATE - URINE 83945 77.25SO OXYCODONE SERUM LEVEL 80361 114.33SO P-ANCA ATYPICAL TITER 86021 62.83SO P-ANCA TITER 86021 62.83SO PARAINFLU 1 BY PCR 87798 110.21SO PARAINFLU 2 BY PCR 87798 110.21SO PARAINFLU 3 BY PCR 87798 110.21SO PARATHYROID HORMONE 83970 143.17SO PARVOVIRUS - IGG 86747 59.74SO PARVOVIRUS - IGM 86747 59.74SO PARVOVIRUS-HUMAN- PCR 87798 221.45SO PEP TOT PROTEIN-ARUP 84155 62.83SO PEP TOTAL PROTEIN 84155 30.90SO pH - FECES 83986 73.13SO PH- OTHER FLUID 83986 73.13SO PHENOBARB W/PRIM-MYSOL 80184 84.46SO PHENOTHIAZINE"THORAZN" 80342 298.70SO PHOSPHORUS - FECES 84100 60.77SO PHOSTIDYLSERINE IGA 86148 53.56SO PHOSTIDYLSERINE IGG 86148 53.56SO PHOSTIDYLSERINE IGM 86148 53.56SO PIGEON SERUM PPT-AB 86331 47.38SO PLAC (Lp-PLA2) 83698 234.84SO PLATELET AB INDIRECT 86022 108.15SO PLAVIX P2Y12 PLT FUNCT 85576 154.50SO PLT W/CD4/CD8 85049 81.37SO POLIO VIRUS AB TYPE 1 86382 178.19

105

SO POLIO VIRUS AB TYPE 2 86382 178.19SO POLIO VIRUS AB TYPE 3 86382 178.19SO PORPHOBILINOGEN QUANT 84110 82.40SO PORPHRINS- URINE QUANT 84120 124.63SO POTASSIUM - FECES 84311 100.94SO POTASSIUM- OTHER FLUID 84132 47.38SO PREALBUMIN 84134 50.47SO PREGNENOLONE 84140 116.39SO PRIMIDONE/MYSOLINE 80188 101.97SO PROCAINAMINDE LEVEL 80192 60.77SO PROGESTERONE 84144 141.11SO PROINSULIN LEVEL 84206 254.41SO PROLACTIN LEVEL 84146 57.68SO PROMETHEUS 6MMP METAB 82542 153.47SO PROMETHEUS 6TGN METAB 82542 153.47SO PROPOXYPHENE LEVEL 80361 186.43SO PROSTAGLANDIN D2 URINE 84150 374.92SO PROT ELEC W/PNL 1 84165 85.49SO PROTEIN C FUNCTIONAL 85303 101.97SO PROTEIN C AG - TOTAL 85302 141.11SO PROTEIN S - TOTAL 85305 153.47SO PROTEIN S ACTIVITY 85306 152.44SO PROTEINASE 3 AB 86021 62.83SO PROTHROMB FRAG 1.2 83520 148.32SO PROTHROMBIN IGG 83520 66.95SO PROTHROMBIN IGM 83520 66.95SO PSEUDOCHOLINESTERASE 82480 60.77SO PTH W/IONIZED CALCIUM 83970 143.17SO PTT 85730 72.10SO PURKINJO CELL AB SCREE 86255 126.69SO PURKINJO CELL AB TITER 86256 113.30SO Q FEVER IGG P1 SCN 86638 36.05SO Q FEVER IGG P1 TITER 86638 92.70SO Q FEVER IGG P2 SCRN 86638 36.05SO Q FEVER IGG P2 TITER 86638 92.70SO Q FEVER IGM P1 SCRN 86638 36.05SO Q FEVER IGM P1 TITER 86638 106.09SO Q FEVER IGM P2 SCRN 86638 36.05SO Q FEVER IGM P2 TITER 86638 106.09SO RAPAMYCIN/SIROLIMUS 80195 156.56SO RBC FOLATE 82747 86.52SO RECEPTOR ASSY-ESTROGEN 84233 495.43

106

SO RECEPTOR ASSY-PROGEST 84234 495.43SO REDUCE SUBST -FECAL 82945 45.32SO RENIN PLASMA 84244 83.43SO RF W/CRYO PNL 86431 75.19SO RIBOSOMAL P AB 83516 165.83SO RNP ANTIBODIES 86235 77.25SO RNP-IgG ANTIBODY 86235 77.25SO ROCKY MTN SPOT IGG 86757 77.25SO ROCKY MTN SPOT IGM 86757 77.25SO ROTAVIRUS 87425 67.98SO RSV ANTIBODY 86756 112.27SO RSV BY PCR 87798 197.76SO RUBELLA ANTIBODY IGM 86762 62.83SO RUBEOLA ABDY - IGG 86765 84.46SO RUBEOLA IGM 86765 129.78SO RUSSELL VIPER VENOM TM 85612 114.33SO SACCH VIRIDIS PPT-AB 86331 47.38SO SALMONELLA H TYPE A 86768 37.08SO SALMONELLA H TYPE B 86768 37.08SO SALMONELLA H TYPE D 86768 37.08SO SALMONELLA O TYPE D 86768 37.08SO SALMONELLA O TYPE VI 86768 37.08SO SEROTONIN - SERUM 84260 113.30SO SEROTONIN -WHOLE BLOOD 84260 100.94SO SEX HORMONE BIND GLOB 84270 81.37SO SICKLE CELL SCREEN 85660 51.50SO SILVER-SERUM 83018 133.90SO SJOGREN-SSA(Ro) AB 86235 59.74SO SJOGREN-SSB(La) AB 86235 59.74SO SMITH ANTIBODIES 86235 77.25SO SODIUM - FECES 84302 51.50SO SODIUM - OTHER FLUID 84302 44.29SO SPECIAL STAIN GRP II 88313 103.00SO SPECIAL STAIN HIST/FRZ 88314 139.05SO SPEP ARUP 84165 106.09SO SS-A (Ro) ANTIBODIES 86235 59.74SO SS-B (La) ANTIBODIES 86235 59.74SO STONE ANAYSIS 82365 133.90SO STRONGYLOIDES IGG 86682 87.55SO SULFATE URINE 84392 51.50SO SULFONAMIDE LEVEL 80299 181.28SO T PROT W/ELECT RDM 84156 62.83

107

SO T3 - REVERSE 84482 57.68SO T3 - TOTAL 84480 154.50SO T3 UPTAKE (RT3U) 84479 60.77SO T4 - TOTAL 84436 44.29SO TACROLIMUS/PROGRAF LVL 80197 133.90SO TB QUANTIFERON GOLD 86480 214.24SO T-CELLS - TOTAL 86359 154.50SO TESTOSTERON WOMAN/CHIL 84403 124.63SO TESTOSTERONE - FREE 84402 62.83SO TESTOSTERONE TOT W/PNL 84403 111.24SO TET.HYD.ALDOSTERON-U 82542 222.48SO TETANUS ANTIBODY 86774 81.37SO THERMO CANDIDUS PPT-AB 86331 47.38SO THERMO SACCHARI PPT-AB 86331 47.38SO THERMO VULGARIS PPT-AB 86331 47.38SO THIOPUR MTHYLTR-TIER 1 81401 450.11SO THROMBIN-ANTITHROM CPX 83520 132.87SO THYROGLOB AB 86800 55.62SO THYROGLOBULIN 84432 83.43SO THYROGLOBULIN - RIA 84432 148.32SO THYROGLOBULIN AB 86800 55.62SO THYROID STIMULATE IGG 84445 145.23SO THYROTROP BD INHB IMM 83519 219.39SO THYROXINE -TOTAL(T4) 84436 44.29SO TISSUE CULT-AMNIOTIC 88235 71.07SO TISSUE TRANSGL IGG Q 83516 114.33SO TISSUE TRANSGLU IGA Q 83516 114.33SO TMPT ENZYME ACTIVITY 82657 228.66SO TOCAINIDE/LIDOCA LEVEL 80176 146.26SO TOPIRAMATE LEVEL 80201 115.00SO TOT PROTEIN - URINE 84156 62.83SO TOTAL PROTEIN W/PNL 1 84155 30.90SO TOXOCARA AB IGG 86682 98.13SO TOXOPLASMA IGG 86777 102.00SO TOXOPLASMA- IgM 86778 83.43SO TPMT 6-METHYL-THIOGUNI 82542 173.04SO TPO/MICROSOMAL AB 86376 71.07SO TRANSFERRIN 84466 55.62SO TRICHINELLA IBB 86784 85.49SO TRIMETHOPRIM LEVEL 82542 159.65SO TRYPSIN 83519 122.57SO TRYPSIN - FECAL - RANDOM 84488 77.25

108

SO TRYPTASE 83520 124.63SO T-TRANSGLUTAM - IGA P 83516 114.33SO T-TRANSGLUTAM IGG P 83516 114.33SO T-TRANSGLUTAMINASE IGA 83516 119.48SO TULAREMIA AB 86668 117.42SO TYPSIN-LIKE ACT -SERUM 83519 110.21SO UR CREAT W/ELECT RDM 82570 46.35SO UR PEP PROTEIN ARUP 84156 62.83SO UR PROT ELEC RDM 84166 85.49SO UR PROTEIN QUANT 84156 62.83SO URINE CREATININE 82570 47.38SO URINE VOLUME SENDOUT 81050 25.75SO URINE VOLUME-ARUP 81050 25.75SO VAP CHOLESTEROL 83701 118.45SO VAP TRIGLYCERIDE 84478 61.80SO VARICELLA ZOSTER IGG 86787 55.62SO VARICELLA ZOSTER IGM 86787 55.62SO VDRL-CSF 86592 64.89SO VIP/VASO.INTESTIN.PEP. 84586 100.94SO VIRAL CULTURE 87252 83.43SO VISCOSITY - SERUM 85810 76.22SO VITAMIN A RETINOL 84590 66.95SO VITAMIN B1 THIAMINE 84425 119.48SO VITAMIN B-6 PYRIDOXINE 84207 98.88SO VITAMIN C-ASCORBIC AC 82180 82.40SO VITAMIN D 1 25 DIHYDRO 82652 83.43SO VITAMIN E A-TOCOPHEROL 84446 66.95SO VITAMIN K LEVEL 84597 265.74SO VMA - URINE 84585 62.83SO W NILE VIRUS IGG 86789 92.70SO W NILE VIRUS IGM 86788 92.70SO WBC W/CD4/CD8 85048 44.29SO WEST NILE CSF IGG 86789 72.10SO WEST NILE CSF IGM 86788 75.19SO WEST NILE PCR CSF 87798 412.00SO ZINC PROTOPORPHYRIN QN 84202 71.07SO ZINC SERUM 84630 67.98SO ZONISAMIDE-ZONEGRAN 80299 146.26SODIUM - URINE 84300 47.38SODIUM- SERUM 84295 30.90SODIUM ACETATE [2MEQ/ML 2 23.12SODIUM BICARB 4.2% [10 ML 27.65

109

SODIUM BICARB 8.4% [10MEQ 69.20SODIUM BICARB 8.4% [50MEQ 66.82SODIUM BICARB Drip[(150mEq/1000ml D5W] 145.36SODIUM BICARBONATE TAB [1 0.79SODIUM CHLORIDE 0.45% [1000] 50.47SODIUM CHLORIDE 0.9% [20ML P-F] 14.54SODIUM CHLORIDE 0.9% [250ML] 80.34SODIUM CHLORIDE 0.9% [500ML] 50.47SODIUM CHLORIDE 0.9% [1000ML] J7050 53.56SODIUM CHLORIDE 0.9%/20ME 70.00SODIUM CHLORIDE HYPERTONIC SVN [7%/4ML] 8.86SODIUM CHLORIDE INJ .9% BACT 30ML] 13.30SODIUM CHLORIDE INJ [4MEQ 27.90SODIUM CHLORIDE INJ 0.9% [10ML P-F] 11.70SODIUM CHLORIDE INJ 0.9% [100/150] 68.04SODIUM CHLORIDE INJ 0.9% [50/100] 66.95SODIUM CHLORIDE SOL 0.9% IRR 1000 86.52SODIUM CHLORIDE SOL 0.9% IRR 2000 76.22SODIUM CHLORIDE SOL 0.9% IRR 3000 47.38SODIUM CHLORIDE SOL 0.9% IRR 500 57.68SODIUM CHLORIDE TAB [1GM 19.14SODIUM CHLORIDE TAB [1GM] 19.14SODIUM PHOSPHATE [45MMP 1 151.10sodium polystrene Powder *Bottle* (15 gm 498.50sodium polystrene Powder *Dose* (15 gm/ 11.46SODIUM POLYSTYRENE SUSP [ 196.60SODIUM POLYSTYRENE SUSP [ 15.68SOLCUTRANS 898.16Soluble Liver Antigen (SLA) Autoantibody 83520 148.32SOLU-CORTEF INJ [ 100MG A J1720 71.97SOLU-CORTEF INJ [ 250MG A J1720 125.86SOLU-MEDROL INJ [ 40MG A J2920 34.49SOLU-MEDROL INJ [ 125MG A J2930 50.37SOLU-MEDROL INJ [ 500MG A J2930 177.20SOLU-MEDROL INJ [1000MG) J2930 253.88SONOHYSTEROGRAM 76831 649.93SORBITOL SOLN [70% SOLN 6 12.76SORE THROAT SPR CHERRY [W 13.67SOTALOL HCL TAB [ 80MG] 6.14SOTALOL HCL TAB [120MG] 7.80SPACER FOR INHALER 81.22SPEC COLLECT -RESEARCH 99001 28.84

110

SPEC STAIN GP-1 PATH COMP 88312 180.25SPEC STAIN GP-1 TECH COMP 88312 140.08SPEC STAIN GP-2 PATH COMP 88313 78.28SPEC STAIN GP-2 TECH COMP 88313 136.99SPECIAL ANESTHESIA SERVIC 99100 140.08SPECIFIC GRAVITY 81005 46.35SPECIMEN SHIP/HANDLING 99001 38.11SPEECH SOUND LANG COMP 92523 277.07SPEECH TREATMENT (1) 92507 230.72SPERM COUNT- POST VAS. 89310 82.40SPERM PRESENCE 89300 82.40Spinal puncture lumbar diagnostic 62270 1,107.25SPINAL TAP W DRAINAGE OF FLUID 62272 618.00SPINE BENDING 2/3 VIEWS 72120 362.56SPINE CERVI/CMP XRY 72052 461.44SPINE CERVICAL < 3 VIEWS 72040 303.85SPINE ENTIRE AP & LAT 72082 291.49SPINE LUMBAR 2 VIEW 72100 329.60SPINE LUMBAR 4 VIEW 72110 461.44SPINE THORACIC COMP XRAY 72074 387.28SPINE THORACIC/SWIM 72072 345.05SPINE THRC LMBR JT 72080 290.46SPIRIVA CAP HANDIHALER [3 1,374.23SPIRIVA CAP HANDIHALER [5 397.98SPIRONOLACTONE TAB [25MG] 3.19SPIRONOLACTONE TAB [50MG] 2.45SPLINT LONG ARM 29105 250.29SPLINT SHORT LEG 29515 215.27SPLINT,LONG ARM 225.00SPLINT/LONG ARM 258.53SPLINT/SHORT ARM 125.66SPLINT/SHORT LEG 221.45SPLINT-BUCKS TRACT 201.88SQ/ IM MEDS TX 96372 108.15SQ/IM MEDS 96372 108.15SSKI sol. 1gm/1ml 30ml BT 59.88STALEVO TAB 50 20.19STALEVO TAB 150 20.19STAPLE RELOADER 461.44STAPLE RELOADER 426.42STAPLE TX60B 569.59STAPLER-CDH29 1,389.47

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STAPLER-TL90 324.45STAPLER-XR60B 611.82STAPLER-XR60G 568.56STARLIX TAB [120MG] 9.87STENT DOUBLE J 6.0X26CM 1,054.72STERILE TALC POWD 5GM 166.00STERN CLAVIC XRY 71130 256.47STERNUM XRY 71120 270.89STOMACH RELIEF CAPLET [B 16.33Stonerisk Diagnostic Panel 121.54STRAPPING SHOULDER 29240 309.00STREP SCREEN DIRECT 87430 45.00STREP SCRN-GROUP A-THROAT 87651 101.97STREP SCRN-GROUP B -VAGINA 87802 86.52Strep. pneumo IgG Ab 23 serotypes- MAID 86317 287.37Streptococcus pneumoniae Ag, Urine 87899 79.31STRESS TEST READ 93018 204.97STRESS TEST/MMH 93016 704.52STRESS TEST/OTHER DR'S 93016 704.52SUB OVS CARE - L 1 99224 64.00SUB OVS CARE- L 2 99225 107.00SUB OVS CARE- L 3 99226 158.00SUCCINYLCHOLINE INJ [20ML 94.81SUC-IRR TUBING 761.17SUCRALFATE TAB [1GM] 3.74SUCTION-IRR SIMPULS 386.25SUCT-IRR ELECTRODE 1,117.55SUFENTANIL INJ [50MCG/ML 27.88SUGAMMADEX 200mg/2ml inj 360.36SULAR CR TAB [20MG] 36.19SULFACETAMIDE OPHTH [10% 9.84SULFACETAMIDE/SULFLUR 10-5 211.94SULFAMETH/TRIMETH INJ [80 62.67SULFAMETH/TRIMETH PED SUS 70.29SULFASALAZINE TAB [500MG] 2.88SULINDAC TAB [150MG] 4.02SULINDAC TAB [200MG] 4.37SUMATRIPTAN SUCC. INJ [6M J3030 314.50SUPRANE INHALANT [1 DOSE 123.86SUPRAPUBIC CATH 387.28SUPRAX SUSP [100/5ML 50M 620.97SUPRAX TAB [400MG] 46.59

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SURGICAL PATH GROSS 88300 53.56SURGICAL PATH GROSS 88300 94.76SURGICAL TX OF ANAL FISTULA SUBCUTANEOUS 46270 1,800.00SURGI-LAV 398.61SVN SALINE TREATMENT 9.08SVN TX 94640 139.05SWALLOWING EVAL COMP (2) 92610 537.66SWALLOWING EVAL FLOU COM2 92611 537.66SWALLOWING TREAT (1) 92526 292.52SWING BED HIGH ACUITY 1,420.00SWING BED ROOM CHG 1,071.00SYMBICORT INH AER [ 80-4. 946.10SYMBICORT INH AER [160-4. 1,080.20SYMBYAX CAP [6-25MG] 35.40T M JOINTS 70330 338.87T4 (THYROXINE) FREE Direct Dialysis 84439 113.00tafluprost ophth soln 0.0015% (3 x 10 si 724.21TAMIFLU CAP [75MG] 26.44TAMIFLU O/SUSP [6MG/ML 60 37.99TAMOXIFEN TAB [10MG] 5.44TAMSULOSIN CAP [0.4 MG] 9.03TAP BLOCK BILATERAL INJ 64488 318.27TAP BLOCK UNILATERAL INJ 64486 276.04TAZICEF INJ ADDV [1GM] J0713 57.83TAZICEF INJ ADDV [2GM] J0713 83.97TAZORAC GEL [0.1% 30GM] 873.55TCC EZ CAST (TCC 23051) 253.69TDAP VACCINE .5 ML 90715 157.76TEARS NATURALE SOL II OPH 18.08TEFLARO INJ [600MG] J0712 710.30TEGRETOL XR TAB [400MG] 14.28TEGRETOL/CARBAMAZ. LEVEL 80156 136.99TEKTURNA TAB [150MG] 14.53TEKTURNA TAB [300MG] 18.33TEMAZEPAM CAP [15MG] 4.14TEMAZEPAM CAP [7.5MG] 17.54TENDON REPAIR INFRAPATELL 27380 515.00TENDON REPAIR-FOREARM 25260 515.00TERAZOL-7 VAG CREAM [0.4 198.54TERAZOSIN HCL CAP [1MG] 4.99TERAZOSIN HCL CAP [2MG] 4.74TERAZOSIN HCL CAP [5MG] 4.99

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TERBINAFINE HCL CREAM[1% 35.59TERBINAFINE TAB 250 MG 22.14TERBUTALINE SULF. INJ [1M 16.28TERBUTALINE TAB [2.5MG] 10.93TERBUTALINE TAB [5MG] 12.80TERCONAZOLE-7 VAGINAL CR 124.53TESTOSTERONE CYPIONATE IM 373.50TESTOSTERONE ENANTHATE IM 314.32TESTOSTERONE LEVEL 84403 111.24TET/DIP ADLT INJ [5-2LF A 90715 121.17TET/DIP PED INJ [5-2LF] 154.26Tetanus immune globulin 250 units J1670 1,677.70TETRACAINE HCL SPINAL [1% 336.57TETRACAINE OPHTH SOL [0.5 117.11TETRACAINE OPHTH SOL [0.5 52.69TETRACYCLINE CAP [250MG] 2.63TEVETEN HCT TAB 600-12.5 8.19TEVETEN TAB [600MG ] 11.67THEO-24 ER CAP [400MG] 9.69THEOPHYLLINE CR TAB [200M 3.59THEOPHYLLINE CR TAB [300M 3.57THEOPHYLLINE LEVEL 80198 122.57THER IVNTJ W/FOCUS COG FUNCTION 97127 47.38THER/PROPH/DIAG IV INF INIT 96365 183.34THER/PROPH/DIAG IV INF INIT TX 96365 183.34THERA STRG ENDUR G0237 90.64THERAPEUTIC BATH OIL 15.81THERAPEUTIC -MULTI-VIT WI 0.79THERAPY ACTIVITY -15MIN 97530 45.32THERAPY EXCERCISE- 15 MIN 97110 92.70THEREVAC SB ENEMA 5.00THERMOTABS TAB [BTL] 18.46thiamine *IVPB* (100 mg/ml 2ml ) J3411 51.48THIAMINE INJ [100MG/1ML] J3411 38.39THIAMINE TAB [100MG BTL] 12.72Thiamine tab 100mg 0.79THIGH FRACTURE 27240 6,500.00THIGH FRACTURE 27244 6,700.00THIGH FRACTURE SURGERY 27245 4,500.00THIORIDAZINE TAB [50MG] 3.98THORA/PACACENTESIS TRAY 125.66THORACENTESE PLEURA W IMAGING 32555 578.86

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THORACENTESIS W IMAGING 32555 578.86THORACIC MYELOGRAM 72255 1,350.33THORACIC VERTEBRAL AUGMENTATION 22513 12,360.00THORACIC X-RAY SPINE 1 VIEW 72020 188.49THORAVAC AN50 292.52THORENC TRAY NON-DP 129.78THROMBIN TOPICAL SPRAY KI 590.62THROMIN TIME - PLASMA 85670 86.52Thyrogen 1.1 mg vial J3240 3,658.36Thyroid Peroxidase Antibodies 86376 103.00THYROID TAB [ 15MG] 3.75THYROID TAB [ 30MG] 3.83THYROID TAB [ 60MG] 2.45THYROID TAB [ 90MG] 4.81THYROID TAB [120MG] 4.26THYROXINE- FREE(Free T4) 84439 93.73TIBIA LT 73590 259.56TIMENTIN ADDV [3.1GM] 68.00TIMENTIN INJ [3.1GM] 90.10TIMOLOL GEL SOL OPHTH [0. 616.86TIMOLOL MAL OPHTH [0.25% 62.50TIMOLOL MAL OPHTH [0.5% 5 30.21Tinactin Spray 16.43TISSUE EXAM PATHOLOGIST 2 88302 103.00TISSUE EXAM PATHOLOGIST-4 88304 143.17TISSUE EXAM PATHOLOGIST-5 88305 118.45TISSUE EXAM PATHOLOGIST-7 88307 293.55TISSUE EXAM PATHOLOGIST-9 88309 358.44TISSUE EXAM TECH COMP 2 88302 149.35TISSUE EXAM TECH COMP 4 88304 199.82TISSUE EXAM TECH COMP-5 88305 266.77TISSUE EXAM TECH COMP-7 88307 395.52TISSUE EXAM TECH COMP-9 88309 578.86TIZANIDINE TAB [2MG] 6.70TIZANIDINE TAB [4MG] 6.45TMP-SMX DS TAB 800/160MG 3.07TMP-SMX SUSP [60ML] 85.01TMP-SMX SUSP [DOSE] 13.00TMT OF DIST ELBOW WO ANET 24600 515.00TNKase INJ (50mg w/DIL) J2997 18,665.08TOBI NEB [300MG/5ML] 448.77TOBRADEX OPHTH OINT [O.3% 775.28

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TOBRADEX OPHTH OINT [O.3% 149.34TOBRADEX OPHTH SUSP [0.3% 350.57TOBRADEX OPHTH SUSP [0.3% 42.71TOBRAMYCIN INJ [1.2GM] 621.00TOBRAMYCIN INJ [40MG/ML 2 J3260 37.38tobramycin IVPB/50 mL (less than 400mg) J3260 81.72TOBRAMYCIN OPHTH SOL [0.3 90.10TOBRAMYCIN PEAK 80200 154.50TOBRAMYCIN SOAKER [40MG/M J3260 34.94TOBRAMYCIN TROUGH 80200 154.50TOBRAMYCIN-DEXAMETHASONE 269.72tocilizumab 400mg/20mL J3262 13,843.30TOLTERODINE TARTRATE ER CAP [4MG] 14.94TOLTERODINE TARTRATE TAB 7.76TOMO DIGITAL BREAST SCREEN BILAT 77063 77.25TOMO DIGITAL BREAST SCREEN IMPLANTS LT 77063 51.50TOMO DIGITAL BREAST SCREEN IMPLANTS RT 77063 51.50TOMO DIGITAL BREAST SCREEN LT UNILATERAL 77063 51.50TOMO DIGITAL BREAST SCREEN RT UNILATERAL 77063 51.50TOMO DIGITAL BREAST SCREENING IMPLANTS B 77063 77.25TONSILLECTOMY & ADENOIDECTOMY <12 42820 1,800.00TONSILLECTOMY & ADENOIDECTOMY AGE 12> 42821 2,100.00TONSILLECTOMY OVER 12 YRS OLD 42826 1,700.00TOPAMAX TAB [25MG] 16.30TOPIRAMATE TAB [ 25MG] 4.62TOPIRAMATE TAB [100MG] 13.27TOPROL-XL TAB [ 25MG] 5.00TOPROL-XL TAB [ 50MG] 5.00TOPROL-XL TAB [100MG] 7.00TORSEMIDE TAB [20MG] 3.78TOTAL HIP REPLACEMENT 27130 13,500.00TOTAL KNEE ARTHROPLASTY 27447 13,500.00TOTAL KNEE JOINT 10,303.09TOTAL PROTEIN SERUM 84155 30.90TOTAL SHOULDER JOINT 23472 10,500.00Toviaz TAB [4MG] 30.64TOVIAZ TAB [8MG] 30.64TPN AMINO ACID/DEXTROSE [2000ML] 199.32TR TREATMENT ROOM CLASS 1 99211 166.86TRAb ( TSH receptor binding antibody) 83519 184.37TRACAR-35LNS 322.39TRACH TUBE NON-CUFFED 196.73

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Tracheostomy emergency- cricothyroid me 31605 983.65TRACHEOSTOMY TUBE 440.84TRACTION BANDAGES 21.63TRADJENTA TAB [5MG] 40.69TRAMADOL TAB [50MG] 4.18TRAMADOL-APAP TAB 37.5-32 5.28TRANDOLAPRIL TAB [4MG] 4.36TRANEXAMIC ACID INJ [1000 101.65TRANSDERM-SCOP PATCH [1.5 63.17TRAUMA ACCIDENT TO HOSP A0429 1,251.45TRAUMA HOSP TO DIALYSIS A0429 1,251.45TRAUMA HOSP TO HOSP A0429 1,251.45TRAUMA HOSP TO LTC A0429 1,251.45TRAUMA HOSP TO RES A0429 1,251.45TRAUMA HOSPITAL TO AIRPRT A0429 1,251.45TRAUMA LONGTERM TO DIALYS A0429 1,251.45TRAUMA LONGTERM TO HOSP A0429 1,251.45TRAUMA LTC TO LTC A0429 1,251.45TRAUMA OTHER AMBULANCE TRANSFER A0429 1,251.45TRAUMA RES TO HOSPITAL A0429 1,251.45TRAUMA RES TO LONGTERM FA A0429 1,251.45TRAVATAN OPHTH SOLN [0.00 660.28TRAY BONE BIOPSY 337.84TRAY TRACOTOMY 333.72TRAY-BONE MARROW 301.79TRAY-DISC-ASP-BIOPSY 301.79TRAY-PARACENTESIS 318.27TRAY-THOR W/ NEEDLE 357.41TRAY-THOR W/CATH 374.92TRAZODONE TAB [ 50MG] 2.73TRAZODONE TAB [100MG] 3.72TREAMENT OF THUMB DISLOCATION 26641 436.72TREAT DISLOCATION/FX SHOULDER 23665 573.71TREAT FX OPEN ULNA/RADIUS 25575 8,500.00TREAT KNEE FRACTURE 27535 3,000.00TREAT KNUCKLE DISLOCATION 26705 900.22TREAT RADIUS FRACTURE 24655 591.22TREAT TOE DISLOCATION 28635 545.90TREAT TOE DISLOCATION 28635 545.90TREATMENT METATARSAL FX/DISLOCATION 28475 327.54TREATMENT OF NASAL FX 21320 515.00TREATMENT OF THIGH FX 27502 1,350.33

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TREATMENT OF TOE FX 28515 495.43TREATMENT WRIST DISLOCATION 25690 945.54Trelegy Ellipta 906.07Treponema Pallidum Antibody 86780 87.55TRIAMCINOLONE CRM [0.025% 41.72TRIAMCINOLONE CRM [0.1% 1 27.91TRIAMCINOLONE CRM [0.1% 8 37.58TRIAMCINOLONE DENTAL PAST 138.94TRIAMCINOLONE OINT[0.5% 1 39.12TRIAMTERENE/HCTZ 37.5/25MG 3.88TRIAZOLAM TAB [0.25MG] 11.07TRICOR TAB [145MG] 12.60TRICOR TAB [48MG] 2.45TRIFLUOPERAZINE TAB [2MG] 4.50TRIFLURIDINE OPH DROPS [1 632.73TRIG PNT 1-2 MUSCLE (S) 20552 678.77Triglycerides Pleural fluid 84478 57.68TRIGLYCERIDES- SERUM 84478 61.80TRIHEXYPHENIDYL TAB [2MG] 1.95TRIHEXYPHENIDYL TAB [5MG 139.43TRILEPTAL OXCARBAZEPIN 80299 96.82TRILYTE SOLN [4L SOD CHLO 74.54TRIM SKIN LESION 11055 246.17TRI-MARK BREAST MARKER 230.10TRIMETHOPRIM TAB [100MG] 3.56TRIPLE ANTIBIOTIC OINTMEN 16.68TRIPLE ANTIBIOTIC UNIT DO 1.40TRMT FRACTURED RADIUS W/O 25600 721.00TRMT PATELLAR DISLOCATION 27560 721.00TROCAR 11MM-B11LPH 330.63TROCAR 35NLT 403.76TROCAR 512ON 429.51TROCAR-355L 413.03TROCAR-512SD 442.90TROCAR-B12LPH 340.93TROPONIN I - QUANT. 84484 153.47TSH REFLEXIVE FT4 84443 105.06TSH -THYROID STIM.HORMONE 84443 105.06TSH w/ HAMA Treatment 84443 153.00TUBERSOL TEST [5 T.U.] 82.33TUMOR IMMUNOHISTO PATH 88360 215.27TUMOR IMMUNOHISTO TECH 88360 242.05

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TUSSI-12 S SUSPENSION [DO 13.00TUSSIONEX GENERIC ER [DOS 20.55TUSSIONEX SUSP [DOSE] 12.00TX CLOSED HIP DISLOCATION 27252 721.00TX CLOSED HIP DISLOCATION W/O ANESTHESIA 27250 436.72TX FINGER DISLOCATION OPEN 26785 2,300.00TX FINGER FX 26750 309.00TX FX RADIUS/ULNA W/O MANIPULATION 25560 436.72TX SUPERFICIAL WOUND WITH PACKING 12021 639.63TX SUPERFICIAL WOUND; SIMPLE CLOSURE 12020 601.52TX THIGH FX GROWTH PLATE 27517 824.00TYGACIL INJ [50MG] 558.35TYMPANOSTOMY 69436 3,200.00UA BIOCHEM ONLY 81003 38.11UA w/ MICROSCOPIC EXAM 81001 59.74UA W/ RX MICRO/C&S 81003 38.11ULORIC TAB [40MG] 29.04ULTANE INHALANT [1 DOSE 2 170.93ULTIVA INJ [1MG] 273.28ULTRASOUND -15 MIN 74.16umeclidinium bromide Inhal (62 5 mcg) 1,039.88UNA BOOT 111.24UNISOM/VITAMIN B-6 ANTI-N 24.00UNLISTED ABD PROCEDURE 49999 796.19UNLISTED ARTHROSCOPY PROCEDURE 29999 3,000.00UNNA BOOT 29580 164.80UPPER G I XRY 74247 669.50UPPER GI W SM BOWEL 74249 870.35UR CREAT W/MICROALB 82570 47.38UREA CLEARANCE 84545 226.60UREA CREAM 20% [3OZ TUBE] 43.83Urea Nitrogen Urine 84540 36.05URIC ACID - SERUM 84550 40.17URIC ACID - URINE 84560 40.17Urine - Eosinophil count 85999 77.25URINE DIPSTICK 81002 29.00URINE GLUCOSE FASTING 81005 46.35URINE GLUCOSE 1 HR 81005 46.35URINE GLUCOSE 2 HR 81005 46.35URINE GLUCOSE HALF HR 81005 46.35URINE URIC ACID 84560 53.56URINE VOLUME CREAT TIMED 81050 25.75

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URINE VOLUME TIMED MALB 81050 27.81URINE VOLUME/TIMED 81050 25.75URISPAS TAB [100MG] 4.75UROCIT-K CAPLET [10MEQ] 6.78Urorisk Diagnostic Profile 133.90UROXATRAL TAB [10MG] 91.27URSODIOL CAP [300MG] 13.89US ART/BILAT LOWER EXT 93925 886.83US ABDOMEN 76700 772.50US ABDOMEN LIMITED 76705 212.18US Abdominal Aorta 76706 212.18US ABI 93923 284.28US ADDITIONAL BREAST ASPIRATION SITE 19001 309.00US AMNIOCENTESIS 76946 421.27US BILAT DUPLEX UPPER EXT 93930 768.38US BIOPHYS PROFILE 76818 537.66US BLADDER 76775 283.25US BREAST BCC LT 76641 415.09US BREAST BILAT COMPLETE 76641 515.00US BREAST BILAT LIMITED 76642 206.00US BREAST BX 1ST LESION LT 19083 844.60US BREAST BX ADDL LESION LT 19084 181.28US BREAST LOCAL 1ST LT 19285 119.48US BREAST LOCAL 2ND LT 19286 119.48US BREAST LT 76641 415.09US BREAST LT CYST ASPIRATION 19000 327.54US BREAST RT CYST ASPIRATION 19000 327.54US CAROTIDS 93880 919.79US CHEST 76604 309.00US CRANIAL 76506 216.30US Definity Contrast - Bill 2 unit dose Q9957 107.12US DRAINAGE LT LEG 27603 545.90US DRAINAGE RT LEG 27603 545.90US ECHOCARDIOGRAPHY 93306 740.57US ECHOCARDIOGRAPHY LIMITED 93308 270.89US ECHOCARDIOGRAPHY W BUBBLE STUDY 93306 740.57US Echocardiography w/ Contrast C8929 1,058.84US EXTREM VEN/BILAT 93970 968.20US EXTREMITY NON VASCULAR LMT LT 76882 267.80US EXTREMITY NON VASCULAR LMT RT 76882 267.80US FNA ADD LESION 10006 500.00US FNA FIRST LESION 10005 779.71

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US GUIDANCE FOR PICC, MIDLINE PLACEMENT 76937 138.02US INFANT HIPS 76885 200.00US INJECTION MAJOR JOINT 20611 400.00US LT BREAST LIMITED 76642 129.78US LT COMPLETE JOINT OF ARM OR LEG 76881 309.00US LT COMPLETE JOINT OF ARM OR LEG 76881 309.00US LT LIMITED LOWER EXT LMT/SFT TISSUE 76882 267.80US OB 76805 609.76US OB LIMITED 76815 365.65US OB LIMITED MEASURE 76816 345.05US OB LIMITED/MEASURE/2 76816 563.41US OB MULTI GESTATION 76810 664.35US PARACENTESIS NO IMAGING 49082 1,085.00US PELVIC 76856 354.32US RENAL 76770 645.81US RT BREAST BIOPSY ADDTL LESION 19084 181.28US RT BREAST LIMITED 76642 129.78US RT LMTD UPR EXT NON VASCULAR 76882 267.80US RT LOWER EXT NON-VAS COMPLETE 76881 309.00US RT UPR EXT NON-VASCULAR COMPLETE 76881 309.00US SCROTAL 76870 567.53US SOFT TISSUE ABD WALL AND/OR LOWER BAC 76705 450.00US SOFT TISSUE CHEST AND/OR UPPER BACK 76604 450.00US THYROID CYST ASPIRATION 60300 591.22US THYROID/NECK 76536 534.57US TRANSVAGINAL OB 76817 331.66US TRANSVAGINAL PELVIC 76830 331.66US UPPER EXTREMITY ARTERIAL LT 93931 532.51US UPPER EXTREMITY ARTERIAL RT 93931 532.51US VACULAR ACCESS 76937 154.50US VASCULAR ABD + 93975 1,063.99vaccination administration charge G0008 41.00vaccination administration pneumococcal G0009 41.00vaccination administration Prevnar 13 ch G0009 41.00VACCINE ADMINISTRATION 27.00VACUUM BOTTLE 43.26VACUUM EXTRACTOR DEL 292.52VALACYCLOVIR HCL TAB [500 12.53VALPROATE INJ [500MG/5ML 83.18VALPROIC ACID LEVEL 80164 130.81VALPROIC ACID SYRUP [250/ 54.08VALPROIC ACID SYRUP [250/ 34.49

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VALSARTAN TAB [ 40MG] 8.79VALSARTAN TAB [160MG] 10.25VALTREX TAB [ 500MG] 22.00VALTREX TAB [1000MG] 36.00VANCOMYCIN - PEAK 80202 152.44VANCOMYCIN [RANGE 0.5-1.25 gm/NS 250 mL] 58.38VANCOMYCIN [RANGE ABOVE 1.25-2 mg/NS 500 58.38VANCOMYCIN [RANGE ABOVE 2-3 gm/NS 500 mL 110.13VANCOMYCIN ADDV [1GM] J3370 41.00VANCOMYCIN INJ [1GM] J3370 58.38VANCOMYCIN INJ [500MG] J3370 42.05VANCOMYCIN ORAL [1000MG/8 J3370 101.79VANCOMYCIN -TROUGH 80202 152.44Varicella Zoster Virus Quant. PCR 87799 371.83Vascular Endothelial Growth Factor- VEGF 83520 299.73VASECTOMY 55250 2,800.00VASELINE JELLY [1.75OZ] 13.81VASOLEX OINTMENT [TUBE] 149.85VASOPRESSIN DRIP [120units/240ML= 0.5u/m 3,244.72VASOPRESSIN INJ [20U/ML 1 612.60VCUG XRY 74455 520.15VECTICAL OINT [3MCG/GM 10 1,764.42VECURONIUM INJ [10MG] 31.18VEDOLIZUMAB INJ 1 MG 300 mg J3380 20,191.45VENIPUNCTURE 36415 28.84VENIPUNCTURE 3 & YOUNGER, REQUIRES SKILL 36400 103.00Venipuncture for Blood Culture 36415 32.96VENIPUNCTURE UNDER 3 36400 36.05VENLAFAXINE ER CAP [37.5M 3.45VENLAFAXINE ER CAP [75MG] 9.73VENOFER INJ [20MG/ML 5ML] J1756 224.50VENTILATOR INITIAL 94002 1,013.52VENTILATOR/DAY 94003 1,013.52VERAPAMIL ER (PM) CAP [10 5.54VERAPAMIL ER TAB [120MG] 4.16VERAPAMIL ER TAB [180MG] 4.73VERAPAMIL ER TAB [240MG] 6.43VERAPAMIL INJ [2.5MG/ML 2 86.39VERAPAMIL TAB [80MG] 3.38VERTEBROPLASTY ADDL LEVEL (C-T OR L) 22512 1,967.30VERTEBROPLASTY AUTOPLEX HV C1713 1,960.61VERTEBROPLASTY C-T SPINE 22510 5,172.66

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VERTEBROPLASTY KIT 173.56VERTEBROPLASTY L/S SPINE 22511 5,172.66VESICARE TAB [5MG] 33.92VETEBRAL AUGMENTATION ADDITIONAL LEVELS 22515 7,725.00VIACTIVE CHEWABLE [CARMEL 15.20VIAGRA TAB [50MG] 195.84VICKS VAPORUB CREAM [100G 16.38VIGAMOX OPHTH DROPS [0.5% 426.89VISINE SOL 0.05% OPTH [15 13.63vitamin a-beta carotene Cap (10,000 unit 13.42VITAMIN B-12 82607 107.12VITAMIN B-12 TAB [1000MCG 15.18VITAMIN B-12 TAB [100MCG 11.49Vitamin B2 (Riboflavin) 84252 150.38vitamin b6 100mg bottle 0.79VITAMIN B-6 INJ [100MG/ML 74.16VITAMIN C CHEWABLE TAB [5 11.00VITAMIN C CHEWABLE TAB [5 0.29VITAMIN C TAB [500MG] 0.79VITAMIN D 25 HYDROXY 82306 80.34VITAMIN D CAP [5000 IU B 16.47VITAMIN D CAP [50000 IU 480.50VITAMIN D CAP [50000 IU] 5.11VITAMIN D TAB [400 IU BTL 11.36VITAMIN D3 TAB [1000IU BO 12.34VITAMIN E CAP [400 IU ] 0.79VITAMIN E OIL 17.09VITAMIN K1 INJ [10MG/ML-- 216.90VITAMIN K1 INJ [1MG/0.5ML 26.86VLOCL0024: V-LOC 180 ABS SUTURE 47.38VMACID 24HR WITH CR #1 84585 70.04VOLTAREN GEL [1% GEL 100G 150.02VON WILLEBRAND AG MULTIMERIC 85247 191.58VON WILLEBRAND FACTOR AG 85246 176.13WARFARIN SODIUM TAB [ 1MG 6.33WARFARIN SODIUM TAB [ 2.5 6.62WARFARIN SODIUM TAB [ 2MG 6.50WARFARIN SODIUM TAB [ 3MG 6.65WARFARIN SODIUM TAB [ 4MG 6.65WARFARIN SODIUM TAB [ 5MG 6.79WARFARIN SODIUM TAB [ 7.5 8.24WARFARIN SODIUM TAB [10MG 8.45

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WATER FOR INJ [20ML SDV] 13.81WATER STERILE IRR 1000 86.52WATER STERILE IRR 1000 CASE 540.75WBC COUNT AUTOMATED 85048 36.05WEDGE EXC - INGROWN NAIL 11765 376.98WELCHOL TAB [625MG] 9.64WET PREP 87210 53.56WHEELCHAIR MGMT-15MIN 97542 33.99WITCH HAZEL-GLYCERIN CLEA 11.94WOUND VAC Supply 69.01WOUND VAC SERVICES < / = 50 CM 97605 338.87WOUND VAC SERVICES > 50CM 97606 644.78XARELTO ORAL TAB [15MG] 41.35XARELTO TAB [10MG] 41.35XARELTO TAB [20MG] 41.35XENADERM OINT [60GM] 186.38XGEVA INJ [120MG/1.7ML] 7,065.25XIFAXAN TAB [550MG] 112.45XM Archive Tissue Molecular Analysis 88363 67.00XOPENEX 1.25MG 3ML DOSE 9.00X-RAY DRAINAGE CATH RETROPERITONEAL 49406 2,758.34X-RAY DRAINAGE CATH VISCERA 49405 2,758.34X-RAY INJ INTERMEDIATE JOINT 20605 423.33X-RAY ORBITS SCREENING 70030 38.11X-RAY SNIFF TEST 76000 450.11XYLOCAINE INJ [0.5% SINGL 10.09XYLOCAINE MPF INJ [0.5% S 53.82XYLOCAINE MPF INJ [1.5% S 59.99XYLOCAINE MPF INJ [2% 1 A 34.55XYLOCAINE MPF INJ [4% 1 A 35.67XYLOCAINE MPF W/EPI INJ [ 65.09XYLOCAINE W/EPI INJ [0.5% 10.26XYLOCAINE W/EPI INJ [0.5% 30.50XYLOCAINE W/EPI INJ [2% M 34.02XYLOCAINE W/EPI INJ [2% S 11.78ZAFIRLUKAST TAB [20MG] 6.58ZALEPLON CAP [5MG] 8.22ZANTAC PREMIX BAG [50MG/5 31.90ZEMAIRA IV INJ [1000MG VI J0256 1,558.50ZETIA TAB [10MG] 6.55Zika Virus RNA Qualitative - PCR 87798 461.44ZINACEF ADDV [1.5GM] J0697 66.00

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ZINACEF INJ [1.5GM] J0697 66.00ZINC OXIDE OINT [60GM TUB 14.86Zinc RBC 84630 85.49ZINC SULFATE CAP [220MG] 0.79ZINC TAB [50MG] 0.79Zinc Transporter 8 (ZnT8) Antibody 86341 141.00ZIPRASIDONE CAP [20MG] 16.39ZIPRASIDONE CAP [40MG] 16.24ZOLADEX IMPLANT [10.8MG J9202 5,453.50ZOLEDRONIC ACID INJ [5MG/ J3489 908.50ZOLPIDEM TAB [ 5MG] 15.08ZOLPIDEM TAB [10MG] 15.08ZOMETA INJ [4MG] J3489 202.90ZOMIG NASAL SPRAY [5MG 1- 358.17ZONISAMIDE CAP [100MG] 5.71ZOSTAVAX INJ [0.65ML] 495.79zoster vac recomb adjuvanted (0.5 ml) 335.54ZOSYN INJ [3.375GM] J2543 88.00ZOVIRAX 5% CREAM [5GM TU 1,641.04ZOVIRAX 5% OINTMENT [30GM 2,828.96ZYMAR OPHTH DROPS [0.3% 5 322.06ZYMAXID OPHTH DROPS [0.5% 433.88ZYPREXA TAB [ 2.5MG] 32.00ZYPREXA TAB [ 7.5MG] 44.00ZYRTEC TAB [10MG] 3.00ZYRTEC-D ER TAB [5-120MG 33.00ZYVOX SOL [600MG/300ML] J2020 213.13ZYVOX TAB [600MG] 408.00

TDAP Vaccine .5 ML 90715 209.06Acetylcystein IV J0132 640.18

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