Ellenville Regional Hospital Chargemaster as of 3/25/15 ... file4000011-0THORACENTESIS W/TUBE $ 741 4000013-0COLONOSCOPY CONTROL $ 1,425 4000031-0ERCP W ... Ellenville Regional Hospital

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Ellenville Regional HospitalChargemaster as of 3/25/15

Code Description Charge0442137-0 MED GLOVE PF NITRILE 12$ 1000001-0 RM & BED-SEMI PRIVAT 861$ 1000002-0 RM & BED-TELEMETRY 861$ 1000003-0 RM & BED-ISOLATION 861$ 1000110-0 BORDER STATUS ROOM 400$ 1050001-0 RM & BED-SWING 861$ 4000001-0 BIOPSY BREAST ND COR 875$ 4000002-0 BRONCHOSCOPY NDL ASP 1,551$ 4000011-0 THORACENTESIS W/TUBE 741$ 4000013-0 COLONOSCOPY CONTROL 1,425$ 4000031-0 ERCP W LITHOTR CALC 2,400$ 4000103-0 OR 1/4 HR 405$ 4000104-0 OR 1/2 HOUR 805$ 4000105-0 OR 3/4 HOUR OPERATIO 1,407$ 4000106-0 OR 1 HOUR OPERATION 1,768$ 4000107-0 OR 1 1/4 HOUR OPERAT 2,014$ 4000108-0 OR 1 1/2 HOUR OPERAT 2,342$ 4000109-0 OR 1 3/4 HOUR OPERAT 2,682$ 4000110-0 OR 2 HOUR OPERATION 2,930$ 4000111-0 OR 2 1/4 HOUR OPERAT 3,106$ 4000112-0 OR 2 1/2 HOUR OPERAT 3,334$ 4000113-0 OR 2 3/4 HOUR OPERAT 3,875$ 4000115-0 OR 3 1/4 HOUR OPERAT 4,245$ 4000116-0 OR 3 1/2 HOUR OPERAT 4,413$ 4000117-0 OR 3 3/4 HOUR OPERAT 4,940$ 4000118-0 OR 4 HOURS OPERATION 5,241$ 4000119-0 OR 4 1/4 HOURS OPERA 5,247$ 4000120-0 OR 4 1/2HOURS OPERAT 5,557$ 4000121-0 OR 4 3/4 HOURS OPERA 5,845$ 4000122-0 OR 5 HOURS OPERATION 6,123$ 4000123-0 OR 5 1/4 HOURS OPERA 6,391$ 4000124-0 OR 5 1/2 HOURS OPERA 6,662$ 4000125-0 OR 5 3/4 HOURS OPERA 6,932$ 4000126-0 OR 6 HOURS OPERATION 7,160$ 4000213-0 RECOVRY RM LV1-0-3HR 699$ 4000214-0 RECOVRY RM LV2-4-9HR 1,398$ 4000216-0 RECOVRY RM LV3-10+HR 2,097$ 4000228-0 TREATMENT ROOM 201$ 4000339-0 ARTHROSC KN MED/LAT 6,050$ 4000340-0 ARTHROSC KN; W MENSC 6,050$

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Code Description Charge4000341-0 GROSS&MICRO PATHOLOG 337$ 4000343-0 SPECIMEN COLLECTION 19$ 4000344-0 US BLADDER SCAN OR 143$ 4000345-0 US GUIDED NEEDLE PLA 250$ 4000346-0 PUNCTURE ASP ABCESS 311$ 4000347-0 I&D ABSC; COMPL OR M 311$ 4000348-0 ARTHROSCOPY KNEE; AB 6,599$ 4000349-0 KNEE ARTHROSCOPY/SUR 6,599$ 4000350-0 ARTHROSCOPY KNEE; LI 6,599$ 4000351-0 EXC BEN LES T/A/L; > 3,506$ 4000352-0 EXC BEN LES T/A/L; 2 1,823$ 4000353-0 EXC BLES S/N/EX G; 1 1,823$ 4000354-0 INJECTION OF STEROID 1,768$ 4000355-0 INJ PARAVERT F JNT L 1,767$ 4000356-0 COLONOSCOPE SUBMUCOU 2,275$ 4000357-0 CL TX RADIAL SHFT FX 1,246$ 4000358-0 COLONOSCOPY FLEX W R 2,160$ 4000359-0 COLONOSCOPY FLEX W R 2,161$ 4000360-0 SCRN COLONOSCOPY PT 1,912$ 4000361-0 EXC BEN LES T/A/L; 3 3,790$ 4000362-0 LAPAROSCOPY; CHOLECY 10,897$ 4000363-0 OCCLUDE FALLOPIAN TU 4,545$ 4000364-0 REM FB MUSCLE; DEEP 5,191$ 4000365-0 TENDON SHEATH INCISI 3,705$ 4000371-0 US GUIDED NEEDLE PLA 109$ 4000373-0 JOIN MAX RENTAL 1,000$ 4000763-0 OR FLUOROSCOPY 300$ 4110001-0 TREAT RM UP 0-1 HR 250$ 4120002-0 ANESTHESIA 15 MINS 67$ 4120003-0 ANESTHESIA 30 MIN 87$ 4120004-0 ANESTHESIA 60 MIN 175$ 4120005-0 ANESTHESIA 90 MIN 263$ 4120006-0 ANESTHESIA 120 MIN 315$ 4120007-0 ANESTHESIA 150 MIN 368$ 4120008-0 ANESTHESIA 180 MIN 420$ 4120009-0 ANESTHESIA 210 MIN 473$ 4120100-0 SENTINEL NODE INJECT 1,250$ 4150001-0 ABDOMEN 1 VIEW 183$ 4150003-0 ABD-COMPL DECUB/EREC 284$ 4150004-0 ACROMI JOINT BILAT W 270$

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Code Description Charge4150005-0 XRAY LT TOE 2ND DGT 194$ 4150006-0 XRAY LT TOE 3RD DGT 194$ 4150007-0 XRAY LT TOE 4TH DGT 194$ 4150008-0 XRAY LT TOE 5TH DGT 194$ 4150009-0 XRAY RT GREAT TOE 194$ 4150010-0 XRAY RT TOE 2ND DGT 194$ 4150011-0 XRAY RT TOE 3RD DGT 194$ 4150012-0 XRAY RT TOE 4TH DGT 194$ 4150013-0 XR ANKLE 2 V RT 178$ 4150014-0 ANKLE 3 VIEWS RT 194$ 4150015-0 XRAY RT TOE 5TH DGT 194$ 4150016-0 XRAY FINGER LT 2ND 199$ 4150017-0 XRAY FINGER LT 3RD 199$ 4150018-0 XRAY FINGER LT 4TH 199$ 4150019-0 XRAY FINGER LT 5TH 199$ 4150020-0 XRAY FINGER RT THUMB 199$ 4150021-0 XR BARIUM SWALLOW 573$ 4150023-0 XR FINGER RT INDEX 199$ 4150024-0 XRAY FINGER RT 3RD 199$ 4150025-0 X-RAY BONE AGE-HANDS 194$ 4150026-0 BONE LENGTH STUDY 287$ 4150027-0 X-RAY FINGER RT 4TH 199$ 4150028-0 X-RAY FINGER RT 5TH 199$ 4150029-0 GUIDE NDL BREAST MAM 400$ 4150036-0 CERVICAL SPINE COMP 366$ 4150037-0 X-RAY CHEST 1 VIEW 183$ 4150039-0 X-RAY CHEST PA & LA 219$ 4150040-0 CHEST PA/LAT & API 246$ 4150050-0 XR ELBOW 1-2 V RT 201$ 4150051-0 ELBOW RT 3-4 VIEWS 271$ 4150057-0 EYE-DETECT FOREIGN 166$ 4150058-0 XR ANKLE 2 V LT 178$ 4150059-0 ANKLE LT 3 V 194$ 4150060-0 FEMUR RT 239$ 4150061-0 FLUID & ABCESS DRN 780$ 4150064-0 FLUORO PROCED < 1 HR 235$ 4150065-0 XR FOOT 2 VIEW RT 178$ 4150066-0 FOOT RT 3 V 199$ 4150067-0 FOREARM RT 199$ 4150068-0 CLAVICLE LT 239$

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Code Description Charge4150069-0 XR ELBOW 1-2 V LT 201$ 4150070-0 ELBOW LT 3-4V 271$ 4150071-0 XR HAND 2 VIEW RT 199$ 4150072-0 HAND RT 3 V 210$ 4150073-0 HEEL OS CALCIS RT 199$ 4150074-0 XR HIP 1 VIEW LEFT 239$ 4150075-0 XR HIP 1 VIEW RIGHT 239$ 4150076-0 HIP 2 VIEWS LT 239$ 4150077-0 HIP 2 VIEWS RT 239$ 4150078-0 FEMUR LT 239$ 4150082-0 HUMERUS RT 239$ 4150084-0 XR HAND 2 VIEW LT 199$ 4150086-0 XR HAND 3+ VIEW LT 210$ 4150087-0 HEEL OS CALCIS LT 199$ 4150088-0 HUMERUS LT 239$ 4150089-0 XR KNEE 1-2 VIEW LT 239$ 4150091-0 XR KNEE 1-2 VIEW RT 239$ 4150092-0 KNEE RT 3V RT 262$ 4150093-0 KNEE RT 4 V RT 284$ 4150094-0 KNEES A/P STAND BILA 199$ 4150098-0 LUMBAR SPNE 2 OR 3V 270$ 4150099-0 LS SPINE COMPL W BEN 435$ 4150102-0 MAMMO DIAGNOSTIC LT 217$ 4150104-0 MAMMO,SCRN BILAT 2V 217$ 4150106-0 MAMMO,DIAG BILAL 256$ 4150111-0 MANDIBLE < 4 VW 305$ 4150112-0 MASTOIDS 3+ VIEWS 452$ 4150113-0 MAXILLA/FACIAL BONE 345$ 4150114-0 KNEE LT 3 VIEWS 262$ 4150115-0 KNEE LT 4 VIEWS 284$ 4150116-0 SCAPULA LT 239$ 4150117-0 NASAL BONES 287$ 4150119-0 XR NECK SOFT TISSUE 194$ 4150120-0 SHOULDER LT 239$ 4150121-0 TIBIA FIBULA LT 194$ 4150122-0 ORBITS 4+ VIEWS 345$ 4150125-0 XR WRIST 2 VIEW LT 135$ 4150127-0 WRIST X-RAY 3 V LT 194$ 4150128-0 PELVIS 1-2 VIEWS 219$ 4150129-0 PELVIS W/OBL > 3 VW 355$

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Code Description Charge4150130-0 XR FOOT 2 VIEW LT 178$ 4150131-0 FOOT 3 VIEW LT 199$ 4150135-0 XR MANDIBLE 4+ VIEW 305$ 4150146-0 FEMUR BL 478$ 4150152-0 FOREARM LT 199$ 4150157-0 RIBS LEFT 239$ 4150158-0 RIBS RIGHT 239$ 4150159-0 RIBS BILATERAL 299$ 4150161-0 SACROILIAC JTS >3VW 317$ 4150162-0 SACRUM AND COCCYX 270$ 4150163-0 XR JOINT STRESS 246$ 4150164-0 SCAPULA RT 239$ 4150165-0 SCOLIOSIS SPINE STDY 539$ 4150169-0 XR SHOULDER 2+ V RT 239$ 4150172-0 XR SINUSES 3+ VIEWS 135$ 4150174-0 SKULL COMPLETE < 4 V 324$ 4150178-0 XR STERNUM 287$ 4150179-0 CLAVICLE RT COMPLETE 239$ 4150180-0 TEMPORMANDIBULAR BIL 539$ 4150181-0 TEMPORMANDIBULAR JNT 446$ 4150182-0 THORACENTESIS RAD 780$ 4150183-0 TIBIA FIBULA RT 194$ 4150190-0 ENTIRE SPINE AP & LA 805$ 4150191-0 XRAY FACIAL 3+V 445$ 4150192-0 XRAY RIBS/CHST 3+V 275$ 4150193-0 XRAY RIBS/CHST4+V 270$ 4150194-0 XRAY SKULL 4+V 425$ 4150196-0 CHST XRAY 2 V FR&LAT 250$ 4150197-0 HYSTEROSALPINGOGRAM 585$ 4150216-0 XR WRIST 2 VIEW RT 135$ 4150217-0 WRIST RT 3 V RT 194$ 4150218-0 XRAY BREAST SPECIME 135$ 4150219-0 XR FINGER LT THUMB 199$ 4150220-0 XRAY LT GREAT TOE 194$ 4150222-0 XRAY THOR SPINE 2 VW 258$ 4150224-0 SACROILIAC JT < 3 VW 266$ 4150225-0 SHOULDER BL >= 2 VW 478$ 4150226-0 HUMERUS BILAT >= 2VW 478$ 4150227-0 HIP BILAT >=2 VW EA 239$ 4150228-0 ANKLE BILAT >=3 VW 388$

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Code Description Charge4150229-0 FOREARM BL 2 VW 199$ 4150230-0 ANKLE BILAT 2 VW 356$ 4150231-0 MAMMARY DUCTO 217$ 4150235-0 X-RAY SHLD RT 1 V 165$ 4150236-0 X-RAY SHLD BILAT 1V 330$ 4150256-0 XRAY THOR SPINE 3 VW 485$ 4150258-0 XRAY THOR SPINE 4 VW 485$ 4150309-0 INJECTION OF STEROID 2,042$ 4150310-0 VIDEO SWALLOW SPEECH 761$ 4150311-0 DEXA-AXIAL SKELETON 333$ 4150312-0 DEXA-APPENDICULAR SK 333$ 4150313-0 DEXA-VERTEBRAL FRACT 333$ 4150318-0 X-RAY WRIST >=3 VW 388$ 4150319-0 WRIST BILAT 2 VW 270$ 4150320-0 LUMBAR SPINE >=4 VW 396$ 4150321-0 CERVICAL SPIN 2-3 VW 267$ 4150322-0 CERVICAL SPIN >=4 VW 366$ 4150324-0 BONE SURVEY METS 717$ 4150325-0 BONE SRVY METABOLIC 717$ 4150326-0 CLAVICLE RT 239$ 4150327-0 XR CHEST 2V W/FLOUR 362$ 4150328-0 XR CYSTOGRAM RETRO 440$ 4150329-0 XR FOREARM BILAT 398$ 4150330-0 XR SPIN LUMB BEND 225$ 4150331-0 XR SCOLIOSIS T-L STA 148$ 4150332-0 XR STERNOCLAV JNT 265$ 4150333-0 XR FLUORO >1 HR 565$ 4150334-0 XR FOOT 3+ V BILAT 4$ 4150335-0 XR OPTIC FORAMINA 158$ 4150336-0 XR PELVIMETRY 225$ 4150337-0 XR PYELEOGRAM RETRO 549$ 4150338-0 ANKLE 2 V BL 345$ 4150339-0 XR SPINE 1 VIEW 135$ 4150340-0 SCRN MAMMO DIR DIGIT 307$ 4150341-0 DX MAMMO DIR DIGITAL 307$ 4150342-0 DX MAMMO DIR DIGITAL 324$ 4150343-0 CAD SCREEN MAMMOGRA 82$ 4150344-0 CAD DIAGNOSTIC MAMMO 82$ 4150345-0 X-RAY EXAM OF FACIAL 161$ 4150346-0 INJECT FOR SPINE DIS 3,331$

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Code Description Charge4150347-0 X-RAY EXAM OF MASTOI 208$ 4150348-0 PED FOREIGN BODY IMA 208$ 4200001-0 US EXAM RENAL/RETROP 610$ 4200002-0 US GUIDE NEEDLE PL 109$ 4200005-0 US BLADDER 580$ 4200006-0 US BREAST UNI LIMITE 321$ 4200010-0 OB US >/= 14 WKS ADD 345$ 4200011-0 US ABDOMEN LIMITED 580$ 4200012-0 US OF ABDOMEN COMPLE 618$ 4200013-0 UNLISTED ULTRASOUND 235$ 4200014-0 US PROSTATE VOL BT 415$ 4200015-0 US EXAM PELVIC LIMIT 445$ 4200016-0 US PROSTATE & CONTEN 630$ 4200018-0 US XTR NON-VASC COMP 135$ 4200019-0 US KIDNEY TRNS W/DOP 610$ 4200021-0 US FOLLOW-UP STUDY 275$ 4200022-0 DUPLEX EXT VEINS; BI 755$ 4200023-0 OB US LMTD 1+FETUS 389$ 4200024-0 FETAL BIOPHYS PROFIL 503$ 4200025-0 US GALLBLADDER 580$ 4200026-0 HYSTEROSONOGRAPHY 470$ 4200027-0 DUPLEX A IVC IL/BPG; 381$ 4200029-0 US ART EXT UPP LT 464$ 4200030-0 US VEIN EXT UPPER 635$ 4200034-0 US PELVIC NON-OB COM 477$ 4200039-0 US EXAM OF HEAD AND 347$ 4200043-0 US ART EXT LOW BI 851$ 4200044-0 US ARTERY EXT LOWER 426$ 4200045-0 DUPLEX UE ART/BPG; C 851$ 4200047-0 EXT VEIN STUDY COMP 591$ 4200048-0 US VEIN EXT LOW BIL 851$ 4200049-0 US VEIN EXT LOWER 426$ 4200050-0 VASCULAR DUPLEX STUD 851$ 4200051-0 DUPLEX SCAN ARTERIAL 426$ 4200052-0 VAS DUPLEX STUDY AOR 851$ 4200054-0 DOPPLER CLR FLOW ADD 272$ 4200055-0 US RETROPERITNL LTD 489$ 4200066-0 CARDOTID DUPLEX DOPP 1,131$ 4200067-0 US PARACENTESIS 1,376$ 4200071-0 US EXTMITY NONVAS LM 316$

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Code Description Charge4200081-0 DR LN ABSES/LTD, EXT 850$ 4200082-0 DR LN ABSES/LTD, SMP 600$ 4200083-0 DR OVARIAN ABSES, AB 850$ 4200085-0 OB US<14 WKS ADD FTS 650$ 4200086-0 OB US<14 WKS SNG FTS 600$ 4200087-0 OB US DTL ADDL FTS 725$ 4200088-0 OB US DTL SNGL FTS 970$ 4200089-0 TRANSRECTAL US 450$ 4200090-0 US GUIDE INTRAOP 2,450$ 4200091-0 US MULTIFETAL PREG R 850$ 4200092-0 PERC BX OR EXC LN 625$ 4200093-0 BX PANCREAS PERC NDL 580$ 4200094-0 BX PLEURA PERCUT NDL 575$ 4200095-0 DR PELV ABSC TRANSVA 650$ 4200096-0 HYSTEROGR/SIS CONTR/ 650$ 4200098-0 RENAL BIOPSY PERQ 850$ 4200099-0 TRANSCERV FALLOPIAN 685$ 4200100-0 TRANSVAGINAL OB US 250$ 4200115-0 OB US F-UP PER FETUS 298$ 4200116-0 OB US >= 14.00 WKS 580$ 4200127-0 DUPLEX UE ART/BPG; U 464$ 4200198-0 ECHO EXAM OF ABDOMEN 565$ 4200199-0 FETAL BIOPHYSICAL W 435$ 4200201-0 US PV RESIDUAL URINE 135$ 4201023-0 DUPLEX EXT VEINS; UN 635$ 4201024-0 DUPLEX ARTERIAL FLOW 785$ 4201025-0 DUPLEX ARTERIAL FLOW 919$ 4201026-0 DUPLEX UE ART/BPG; U 464$ 4201028-0 US SUBCLAVIAN DUPL 158$ 4201029-0 US STRESS ECHO 1,502$ 4201030-0 US VEIN EXT LWR LFT 426$ 4201031-0 US VEIN EXT LWR RT 426$ 4201032-0 US VEIN EXT UPPR BIL 845$ 4201033-0 US VEIN EXT UPP LT 426$ 4201034-0 US VEIN EXT UPP RT 426$ 4201035-0 US ARTERY EXT LWR BI 851$ 4201036-0 US ARTERY LWR RT 426$ 4201037-0 US ARTERY EXT LWR LT 426$ 4201038-0 US ARTERY EXT UPP BI 851$ 4201039-0 US ARTERY EXT UPP RT 426$

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Code Description Charge4201040-0 US ABD DUPLEX 951$ 4201041-0 US ABD DUP LMTD 381$ 4201042-0 US TRANSESOPHEGEAL 1,579$ 4201043-0 US TRANSVGINL NON-OB 300$ 4201044-0 US GUIDE VASCULAR AC 96$ 4201045-0 US EXAM ABDOM COMPLE 348$ 4201046-0 US XTR NON-VASC LMTD 226$ 4201047-0 US EXAM CHEST 226$ 4201048-0 US EXAM BREAST COMPL 321$ 4201049-0 US SPINE 226$ 4210001-0 GI BLEEDING 1,112$ 4210002-0 ACUTE VENOUS THROMB 746$ 4210003-0 MULTI AREA STATIC BO 890$ 4210004-0 BONE AND/OR JINT IMG 700$ 4210005-0 BONE SCAN-WHOLE BODY 1,050$ 4210006-0 BONE SPECT 2,000$ 4210007-0 BRAIN SPECT 1,489$ 4210009-0 CARDIAC BLD POOL MUG 1,247$ 4210010-0 CISTERNOGRAPHY 1,112$ 4210011-0 WBC/GALLIUM WHOLE BO 1,611$ 4210013-0 GASTRIC EMPTYING STU 1,150$ 4210014-0 GASTROESOPHAG REFLUX 746$ 4210016-0 GB SCAN W/O DRUG 915$ 4210017-0 RENAL SCAN W/O DRUG 1,720$ 4210018-0 LIVER SPECT IMAGING 1,112$ 4210019-0 LIVER/SPLEEN IMAGE 692$ 4210021-0 MECKELS SCAN 1,350$ 4210027-0 CARDIAC SPECT MULTI 2,037$ 4210028-0 CARDIAC SPECT SINGLE 1,132$ 4210029-0 PARATHYROID IMAGING 1,200$ 4210030-0 PLANAR MYOCARDIAL IM 1,158$ 4210031-0 LUNG VENT AERO MULT 1,334$ 4210032-0 LUNG VENT/PERFUSION 802$ 4210033-0 RENAL SCAN W AND W/O 1,377$ 4210034-0 CAPTOPRIL RENAL 1,223$ 4210035-0 SHUNT EVALUATION 780$ 4210036-0 TESTICULAR SCAN W/FL 791$ 4210037-0 3 PHASE BONE SCAN 1,112$ 4210039-0 THYROID UPTAKE MULTI 352$ 4210040-0 NM RAI UPTAKE SING 352$

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Code Description Charge4210044-0 THYROID UPTAKE &SCAN 835$ 4210046-0 ABSC LOCALIZ; WB 1,377$ 4210054-0 TC99M MDP =< 30 MCI 385$ 4210055-0 TL201 THALLIUM PER 1 140$ 4210058-0 IODINE I-123 NA 100- 335$ 4210059-0 TC99M EXAMETAZIM <25 2,294$ 4210060-0 TC99M CHOLETEC =< 15 435$ 4210061-0 TC99M PENTETATE < 25 490$ 4210062-0 TC99M MAA =< 10 MCI 275$ 4210063-0 TC99M 20M SLFR COLL 350$ 4210066-0 TC99M LBLD RBC =<30 350$ 4210067-0 TC99M MAG 3 =< 15 MC 450$ 4210068-0 TECHNETIUM AER 75MC 92$ 4210070-0 INDIUM IN-111 AUTO P 2,758$ 4210075-0 DX I-123 IOFLUPNE 5 92$ 4210076-0 IODINE I-125 SERUM 5 55$ 4210077-0 I131 IODIDE CAP RX 1 25$ 4210078-0 INDIUM IN-111 PNET 6 650$ 4210079-0 INTRA-ARTERIAL PHARM 85$ 4210080-0 IOD I-123 IOBENGU 15 92$ 4210081-0 IODINE I-123 NA ID 1 30$ 4210082-0 MUGA SGL W RV EF BY 350$ 4210083-0 MUGA SPECT W WM & E 400$ 4210084-0 SM 153 LEXIDRO =<150 92$ 4210085-0 TECHNETIUM AUT WBC 325$ 4210086-0 TECHNETIUM TEBBORO 450$ 4210087-0 BRAIN IMAGE W/FLOW>4 1,350$ 4210088-0 NM BRAIN W/F <4 1,375$ 4210089-0 BRAIN VASCULAR FLOW 1,375$ 4210090-0 CARD PET PERFUS; MUL 1,520$ 4210091-0 CARD PET PERFUS; SIN 1,520$ 4210092-0 KIDNEY IMAGING (3D) 1,585$ 4210093-0 KIDNEY IMAGING MORPH 1,585$ 4210094-0 KIDNEY IMAGING W/FLO 1,600$ 4210095-0 LNG PERF VENT;W/WO 1,585$ 4210096-0 LUNG PERF W VENTIL; 1,600$ 4210097-0 LUNG VENT; GAS W RB 1,825$ 4210098-0 MUGA; MULTI W WM & E 2,430$ 4210099-0 NON-CARDIAC VASC FLO 1,350$ 4210101-0 THYROID METS UPTAKE 575$

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Code Description Charge4211214-0 TC99M HEPATOLITE 121$ 4211234-0 LUNG VENTILATION/PER 1,875$ 4211235-0 TUMOR LOCALIZED SPEC 1,091$ 4211236-0 NM THYROID 951$ 4211237-0 NM ABCESS LMTD 1,311$ 4211238-0 NM ABCESS WHL BDY 1,377$ 4211239-0 SCHILLING ABSOR W/IF 461$ 4211240-0 CARDIOLITE UNIT DOSE 196$ 4211242-0 TC99M PERTECHNETATE 121$ 4211243-0 GALLIUM 67 (PER MCI) 59$ 4211244-0 PYROPHOSPHATE 350$ 4211245-0 INDIUM 111 OXINE 1,484$ 4211246-0 LEXISCAN .1MG 168$ 4211247-0 GB SCAN W DRUG 915$ 4211248-0 TECHNETIUM TC99M AER 735$ 4211249-0 MUGA; SGL W WM & EF 1,340$ 4220001-0 3D RENDER W/O POSTPR 393$ 4220003-0 ABDOMEN W/WO CONTRAS 2,365$ 4220004-0 ABDOMEN W CONTRAST 1,454$ 4220005-0 BIOPSY GUIDANCE 1,463$ 4220008-0 CT CERV SPINE W & WO 2,525$ 4220009-0 CERVICAL SPINE WITH 1,454$ 4220010-0 CHEST W/O CONTRAST 1,200$ 4220011-0 CHEST W/WO CONTRAST 1,540$ 4220012-0 CHEST W CONTRAST 1,454$ 4220015-0 CT ANGIOGRAPH PELV W 3,200$ 4220016-0 SFT TISS BX - NCK/TH 3,100$ 4220020-0 CT CERV SPINE WO CON 1,455$ 4220022-0 HEAD NON CONTRAST 1,112$ 4220023-0 HEAD W/WO CONTRAST 1,286$ 4220024-0 HEAD WITH CONTRAST 1,197$ 4220025-0 LOWER EXTREMITY W/O 1,400$ 4220026-0 LOWER EXTREMITY W/WO 1,454$ 4220027-0 LOWER EXTREMITY WITH 1,365$ 4220028-0 LUMBAR SPINE W/O CON 1,365$ 4220029-0 LUMBAR SPINE W/WO CO 1,543$ 4220030-0 LUMBAR SPINE WITH CO 1,454$ 4220031-0 MAXILLOFACIAL W/O CO 1,112$ 4220032-0 MAXILLOFACIAL W/WO C 1,286$ 4220033-0 MAXILLOFACIAL WITH C 1,197$

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Code Description Charge4220034-0 NECK W/O CONTRAST 1,220$ 4220035-0 NECK W/WO CONTRAST 1,540$ 4220036-0 NECK WITH CONTRAST 1,454$ 4220037-0 ORBIT W CONT-OSPF OR 1,197$ 4220038-0 ORBIT W/O CONT-OSPF/ 1,112$ 4220039-0 ORBIT W/WO CONT OSPF 1,286$ 4220040-0 PELVIS NON CONTRAST 1,365$ 4220041-0 PELVIS W/WO CONTRAST 2,300$ 4220042-0 PELVIS WITH CONTRAST 1,454$ 4220045-0 THORACIC SPINE W/O C 1,300$ 4220046-0 THORACIC SPINE W/WO 1,543$ 4220047-0 UPPER EXTREMITY W/CO 1,365$ 4220048-0 UPPER EXTREMITY W/O 1,286$ 4220049-0 UPPER EXTREMITY W/WO 1,290$ 4220057-0 ABDOMEN & PELVIS W/O 1,365$ 4220058-0 ABDOMEN & PELVIS WIT 1,454$ 4220059-0 ABDOMEN & PELVIS W/W 1,540$ 4220070-0 DRAIN DEEP PERIURETH 1,290$ 4220071-0 CT COLONOGRAPHY W/DY 2,500$ 4220072-0 CTANGIO UPEXTRM W/WO 2,500$ 4220073-0 CT SCAN FOR LOCALIZA 2,500$ 4220074-0 CT ANGIOGRAPHY HEAD 2,500$ 4220075-0 CT ANGIO ABD W/WO DY 2,600$ 4220076-0 CT PERFUSION W/CONTR 2,500$ 4220077-0 CT ANGIO ABD ARTERI 3,060$ 4220078-0 CT COLONOGRAPHY DX 2,600$ 4220080-0 CT ABD WO CONTRAST 1,350$ 4220089-0 CT THORACIC SPINE W 1,850$ 4220300-0 TRANSCATHETER BX 685$ 4220302-0 EXCHANGE PREV DRNG C 650$ 4220303-0 DRAIN PERITONEAL ABS 685$ 4220304-0 DRN RETROPERITON AB 685$ 4220305-0 DRAIN SUBDIAPHRAGMAT 685$ 4220306-0 BIOPSY THYROID PERC 810$ 4220307-0 CHANGE OF URETER TUB 575$ 4220308-0 ST BX; HIP/PELVIS; S 500$ 4220891-0 CT ANGIOGRAPHY NECK 2,500$ 4220892-0 CT ANGIOGRAPHY CHEST 2,600$ 4224301-0 ABSC CYST CONSTR INJ 795$ 4224302-0 CT IAC W/CONTRAST 1,844$

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Code Description Charge4224303-0 CT IAC W/O CONTRAST 1,504$ 4224304-0 CT IAC W/WO CONTRAST 3,232$ 4224305-0 CT SPINE CERVICAL WO 1,365$ 4224306-0 CT SPINE THORASIC W 1,454$ 4224307-0 CT MASTOID W CONTRAS 939$ 4224308-0 CT MASTOIDS W/O CONT 600$ 4224309-0 CT MASTOIDS W & W/O 1,045$ 4230001-0 MRI ABDOMEN W/O CONT 2,600$ 4230002-0 MRI ABDOMEN W & W/O 3,956$ 4230003-0 MRI CHEST W/O CONTRA 2,600$ 4230004-0 MRI CHEST W & W/O CO 4,250$ 4230005-0 MRI PELVIS W/O CONTR 2,200$ 4230006-0 MRI PELVIS W CONTRAS 3,650$ 4230007-0 MRI PELVIS W & W/O C 3,750$ 4230008-0 MRI BRAIN W/O CONTRA 2,350$ 4230009-0 MRI BRAIN W & W/O CO 3,650$ 4230010-0 MRI CERVICAL SPINE W 2,500$ 4230011-0 MRI CERVI SPINE W/WO 3,650$ 4230012-0 MRI THORAC SPINE W/O 2,200$ 4230013-0 MRI THORA SPINE W/WO 3,850$ 4230014-0 MRI LUMBAR SPINE W/O 2,300$ 4230015-0 MRI LUMB SPINE W/WO 3,750$ 4230016-0 MRI LOEXT JNT KN W/O 2,200$ 4230017-0 MRI LO EXT JNT KN W 3,809$ 4230018-0 MRI LOEXT JNT W/WO 3,750$ 4230019-0 MRI LOEXT NOJNT FTWO 2,500$ 4230020-0 MRI LE JNT W CONTR 3,850$ 4230021-0 MRI UP EXTJNT SHL WO 2,164$ 4230022-0 MRI UPEXT JNT SHL W 3,450$ 4230023-0 MRI UPPER EXT JNT W 4,250$ 4230024-0 MRI UPP EXT NONJNT F 3,310$ 4230025-0 MRI UPEXT NONJNT W 3,100$ 4230026-0 MRI UPEXT NOJNT W/WO 4,250$ 4230027-0 MRI ABDOMEN W CON 2,000$ 4230028-0 MRI CHEST W CONTR 3,000$ 4230029-0 MRI BRAIN W CONTRAST 1,800$ 4230030-0 MRI CERVICAL SPINE W 3,650$ 4230031-0 MRI THORACIC SPINE W 4,200$ 4230032-0 MRI LUMBAR SPINE W C 2,850$ 4230033-0 MRI LEXT NO JNT W/WO 3,869$

Page 14 of 112


Code Description Charge4230034-0 MRA HEAD W/O CONTRAS 2,530$ 4230035-0 MRA HEAD W/ CONTRAST 2,150$ 4230036-0 MRA HEAD W & W/O CON 1,600$ 4230037-0 MRA NECK W/O CONTRAS 2,600$ 4230038-0 MRA NECK W/ CONTRAST 2,500$ 4230039-0 MRA NECK W & W/O CON 3,200$ 4230040-0 MRI TMJ 2,750$ 4230041-0 MRI FACE ORBIT NECK 2,500$ 4230042-0 MRI FACE ORBIT NECK 3,650$ 4230043-0 MRI FACE ORBIT NECK 3,770$ 4230044-0 MRA CHEST (EXCL. MYO 2,200$ 4230045-0 MRA SPINAL CANAL W W 3,750$ 4230046-0 MRA PELVIS W W/O CON 1,850$ 4230047-0 MRA UPPER EXTREMITY 2,200$ 4230048-0 MRA LOWER EXTREMITY 1,750$ 4230049-0 MRA ABDOMEN W W/O CO 2,200$ 4230063-0 MRA ABD W CONTRAST 2,250$ 4230064-0 MRA ABD W/WO CONTRAS 2,750$ 4230066-0 MAGNETIC RESONANCE S 2,200$ 4230068-0 MRA LEXTREM W/WO CON 3,850$ 4230069-0 MRI - LEXTREM W CONT 2,750$ 4230070-0 PELVIS MRA W CONTR 2,750$ 4230071-0 PELVIS MRA W & WO CO 2,750$ 4230072-0 MRA LEXTREM W CONT 2,750$ 4230073-0 MRA CHEST W/WO CONTR 1,650$ 4230074-0 MRA CHEST W CONTRAST 1,650$ 4230120-0 PELVIS MRA WO CONTR 1,850$ 4230200-0 ORAL MR CONTRAST 100 1,500$ 4230201-0 MRA W/O&W/DYE UPPER 2,100$ 4230202-0 MRA W/O&W/DYE SPINAL 2,000$ 4230203-0 MRA W/O DYE UPPER EX 1,750$ 4230205-0 MRA W/DYE UPPER EXTR 1,700$ 4230206-0 MRA W/DYE SPINAL CAN 1,700$ 4230207-0 MRA LEXTREM WO CONTR 1,400$ 4230208-0 MRA CHEST WO CONTR 1,850$ 4230209-0 MRA ABD WO CONTRAST 1,650$ 4230210-0 3D RENDERING W/POSTP 1,250$ 4230234-0 MRA W/O DYE SPINAL C 1,800$ 4231222-0 NON IONIC CONTRAST 175$ 4250323-0 MAMMO DIAGN RT 217$

Page 15 of 112


Code Description Charge4300002-0 17 HYDROXYCORTICOSTE 102$ 4300003-0 17 KETOSTEROIDS TOTA 72$ 4300004-0 HYDROXYPROGESTERONE 128$ 4300005-0 17-KETOGENIC STEROID 87$ 4300007-0 5-HIAA URINE QUANTIT 87$ 4300008-0 5-NUCLEOTIDAS 67$ 4300009-0 88-BLOOD 137$ 4300010-0 88-OCORD 137$ 4300012-0 ABO GROUP 40$ 4300013-0 BLOOD TYPING ABO-RH 68$ 4300014-0 ACETAMINOPHEN 97$ 4300015-0 ACETONE SEMI QUANT 54$ 4300017-0 ACETYLMORPHINE CONF 126$ 4300019-0 ACID FAST SMEAR 32$ 4300020-0 ACID PHOSPHATASE TOT 42$ 4300021-0 ACTH 248$ 4300022-0 ACUTE HEPATIT 223$ 4300023-0 ADENOVIRUS GROUP ANT 99$ 4300024-0 ADH 251$ 4300026-0 AFP-AMNIOTIC FLUID 91$ 4300028-0 ALBUMIN 5% 50ML 26$ 4300029-0 ALBUMIN SERUM 24$ 4300030-0 ALDOLASE 51$ 4300031-0 ALDOSTERONE & RENIN 221$ 4300032-0 ALDOSTERONE SERUM 224$ 4300033-0 ALDOSTERONE URINE 234$ 4300034-0 ALKALINE PHOSPHATASE 26$ 4300035-0 ALKALINE PHOSPHATISO 79$ 4300036-0 ALPHA 1 ANTITRYPSIN 88$ 4300037-0 ALPHA I ANTITRYP TOT 88$ 4300038-0 ALT (SGPT) 26$ 4300039-0 ALUMINUM SERUM/URINE 120$ 4300040-0 AMIKACIN 100$ 4300042-0 AMINO ACID SCREEN Q1 52$ 4300044-0 AMINO ACIDS SCN QUAL 87$ 4300046-0 AMMONIA PLASM 91$ 4300048-0 AMP CYLIC-URI 206$ 4300049-0 AMPH CONF (BLOOD) 203$ 4300050-0 AMPHETAMINES CONFIRM 97$ 4300051-0 ELECTROPHORESIS NES 260$

Page 16 of 112


Code Description Charge4300052-0 AMYLASE SERUM 34$ 4300053-0 AMYLASE URINE 35$ 4300054-0 AMYLASE BODY FLUID 73$ 4300055-0 ANDROSTENEDIONE-SERU 186$ 4300056-0 ANGIOTENSION CONV EN 89$ 4300057-0 ANTI DNP ABS 72$ 4300058-0 ANTI JO 1 114$ 4300059-0 ANTI SS-A 87$ 4300060-0 ANTI SS-B 87$ 4300062-0 ANTIBODY ID/ABSORTIO 62$ 4300063-0 ANTIBODY IDENTIFICAT 91$ 4300064-0 ANTIBODY SCREEN 102$ 4300065-0 ANTIBODY TITER 153$ 4300066-0 ANTIBODY PROTOZOA NE 168$ 4300067-0 ANTICARDIOLI AB IGMQ 131$ 4300068-0 ANTICARDIOLIAB IGG 99$ 4300069-0 ANTICARDIOLI AB IGMM 236$ 4300070-0 ANTICARDIOLI AB IGGQ 131$ 4300071-0 ANTICARDIOLI AB IGM 206$ 4300072-0 ANTI-DNA ANTIBODY DB 73$ 4300073-0 ANTI-ENA (ANTI RNP) 88$ 4300074-0 ANTI-ENA (SMITH) 87$ 4300075-0 ANTIGEN TYPING 36$ 4300076-0 ANTIGEN TYPING (AGI) 38$ 4300077-0 ANTIGLIADIN ABS AIGG 72$ 4300078-0 ANTI-GLOMERULAR BASE 221$ 4300079-0 ANTIHEMOPHILIC FAC B 183$ 4300080-0 ANTIHEMOPHILIC FAC C 191$ 4300081-0 ANTIHEMOPHILIC FACTO 197$ 4300082-0 ANTIMITOCHONDRIAL AB 80$ 4300083-0 TITER EACH ANTIBODY 172$ 4300084-0 ANTI-NUCLEAR ANTIBOD 58$ 4300085-0 ANTIPANCREATIC ISLET 132$ 4300086-0 ANTIPARIETAL CELL QU 84$ 4300087-0 ANTIPLATELET ANTIBOD 189$ 4300088-0 ANTISMOOTH MUSCLE AB 93$ 4300089-0 TITER EACH ANTIBODY 87$ 4300090-0 ANTISTREPTOLYSIN O T 42$ 4300092-0 ANTITHROMBIN III 191$ 4300094-0 ANTI-THROMBIN III AC 155$

Page 17 of 112


Code Description Charge4300095-0 ANTI-THYROGLUBULIN A 75$ 4300096-0 APOLIPOPROTEIN A-1 74$ 4300098-0 ARSENIC BLOOD 97$ 4300099-0 ARSENIC URINE 101$ 4300100-0 ARTERIAL PUNCTURE 47$ 4300101-0 ASPERGILLUS FLAVUS A 55$ 4300102-0 ASPERGILLUS NIGER AB 55$ 4300103-0 AST (SGOT) 26$ 4300104-0 ATYPICAL LEGIONELLA 58$ 4300105-0 B PERTUSSIS SMEAR 102$ 4300107-0 B PERTUSSIS IGG ABS 96$ 4300108-0 B PERTUSSIS IGM ABS 4$ 4300109-0 BACTERIAL CULTURE 59$ 4300110-0 FOLIC ACID; SERUM 203$ 4300111-0 BARB CONF (BLOOD) 239$ 4300112-0 BARBITAL SERUM 65$ 4300113-0 BARBITURATES CONFIRM 97$ 4300114-0 BARBITURATES QUAL-UR 67$ 4300115-0 BARBITURATES-SERUM 95$ 4300116-0 BARIUM 108$ 4300117-0 BASIC METABOLIC PANE 44$ 4300119-0 BB ANTIGEN II 206$ 4300120-0 BB ANTIGEN III 305$ 4300121-0 BENZ CONF (BLOOD) 244$ 4300122-0 BENZO CONFIRM GC/MS 97$ 4300123-0 BENZODIAZEPINES GC/M 65$ 4300124-0 BETA STREP CULTURE 39$ 4300125-0 BETA-2-MICROGLOBULIN 107$ 4300126-0 HCG; QUAN 72$ 4300127-0 BILIRUBIN DIRECT 24$ 4300129-0 BILIRUBIN TOTAL 30$ 4300130-0 BLEEDING TIME 42$ 4300131-0 BLOOD GAS ANALYSIS 92$ 4300132-0 GLUCOSE; BLOOD REAGE 32$ 4300133-0 BLOOD UNIT POOLING 91$ 4300134-0 BLOOD UNIT SPLITTING 197$ 4300137-0 C1 ESTERASE INHIBITO 58$ 4300138-0 C1Q IMMUNE COMPLEX D 115$ 4300139-0 C2 COMPLEMENT 96$ 4300140-0 CADMIUM 70$

Page 18 of 112


Code Description Charge4300141-0 CALCIUM SERUM 26$ 4300142-0 CALCIUM URINE 24HR 97$ 4300143-0 STONE ANALYSIS 99$ 4300144-0 STONE; X-RAY DIFFRAC 59$ 4300145-0 CALCULI URINE W/PHOT 59$ 4300146-0 CAMPYLOBACTER 33$ 4300147-0 CANDIDA SCREEN 41$ 4300148-0 CANN CONF (BLOOD) 218$ 4300149-0 CANNABINOIDS 67$ 4300150-0 CANNABINOIDS CONFIRM 97$ 4300151-0 CARBON DIOXIDE (CO2) 24$ 4300152-0 ASSAY CARBOXYHB QUAN 63$ 4300153-0 CARNMITINE TOT & FRE 141$ 4300154-0 CAROTENE SERUM 63$ 4300155-0 CAT SCRATCH DIS AB P 176$ 4300156-0 CATECHOL FRACT PLASM 225$ 4300157-0 CATECHOL TOTAL URINE 87$ 4300158-0 CATECHOLAMINES FRACT 152$ 4300159-0 CATECHOLAMINES UR FR 134$ 4300160-0 COMPL AUTOM CBC W PL 30$ 4300161-0 CBC WITH DIFF (AUTO) 39$ 4300162-0 C-DIFFICILE TOXIN 119$ 4300163-0 CEA 91$ 4300164-0 CELL BLOCK 235$ 4300166-0 CERULOPLASMIN 312$ 4300167-0 CH50 135$ 4300168-0 CHEM UNSPEC DNA-PCR 286$ 4300169-0 CHLAM & GONOCO DNA P 188$ 4300170-0 CHLAM TRACH ANTI PSI 96$ 4300171-0 CHLAM TRACH GROUP AB 112$ 4300172-0 CHLAMYDIA CULTURE 120$ 4300173-0 CHLAMYDIA IGM ANTIBO 112$ 4300175-0 CHLORIDE SERUM 23$ 4300176-0 CHLORIDE URINE 44$ 4300177-0 CHLORIDE URINE 27$ 4300178-0 CHOLESTEROL TOTAL 21$ 4300179-0 CHROMIUM 97$ 4300180-0 CHROMOSOME AMNIOTIC 522$ 4300181-0 CHROMOSOME AMNIOTIC 835$ 4300182-0 FACTOR INHIBITOR TES 243$

Page 19 of 112


Code Description Charge4300183-0 CIRCULATING EOS-NASA 42$ 4300184-0 CITRATE URINE 131$ 4300185-0 CLONAZEPAM (KLONOPIN 99$ 4300186-0 CLOTTING FACTOR II P 63$ 4300187-0 CLOZAPINE 144$ 4300188-0 C-MRSA 36$ 4300189-0 CMV ABS IGM QUAN 107$ 4300190-0 CMV ANTIBODIES IGG 97$ 4300191-0 CMV CULTURE 136$ 4300192-0 COC CONF (BLOOD) 203$ 4300193-0 COCAINE 67$ 4300194-0 COCAINE CONFIRM GC/M 97$ 4300195-0 COCAINE BLOOD 95$ 4300196-0 COCAINE URINE QUAL 67$ 4300197-0 COCCIDIOIDES 89$ 4300199-0 COLD AGGLUT TITER QU 42$ 4300200-0 COMPATIBILITY TEST E 110$ 4300201-0 COMPLEMENT C3 72$ 4300202-0 COMPLEMENT C4 76$ 4300203-0 COMPOUNDS (11-DEOXYC 197$ 4300204-0 COMPREHENSIVE METABO 50$ 4300206-0 CONFIRMATION GC/MS U 97$ 4300207-0 COOMBS DIRECT 54$ 4300208-0 COPPER SERUM 63$ 4300209-0 CORTISOL SERUM-PLASM 88$ 4300210-0 CORTISOL FREE URINE 101$ 4300211-0 COXSACKIE VIRUS GR A 183$ 4300212-0 COXSACKIE VIRUS GR B 243$ 4300213-0 C-PEPTIDE SERUM 113$ 4300214-0 CPK ISOENZYMES-INC C 66$ 4300215-0 CPK TOTAL 34$ 4300216-0 CPK-MB SCREEN 66$ 4300218-0 C-REACTIVE PROTEIN C 32$ 4300220-0 CREATINE SERUM 42$ 4300221-0 CREATININE CLEARANCE 50$ 4300222-0 CREATININE SERUM 26$ 4300223-0 CREATININE URINE RAN 27$ 4300224-0 CREATININE; NOT BLOO 27$ 4300225-0 CRYOGLOBULINS QUAL 33$ 4300226-0 CRYOPRECIPTATES (BLO 153$

Page 20 of 112


Code Description Charge4300227-0 CRYPTOCOCCUS ANTI 88$ 4300228-0 CRYPTOCOCCUS ANTI CS 44$ 4300230-0 CRYPTOSPORIDIUM 72$ 4300231-0 CRYPTOSPORIDIUM SMEA 126$ 4300233-0 CULTURE ANAEROBIC 82$ 4300234-0 CULTURE BETA STREPTO 33$ 4300235-0 CULTURE BLOOD 72$ 4300236-0 CULTURE CATHETER TIP 57$ 4300237-0 CULTURE CSF 46$ 4300238-0 CULTURE FLUID 121$ 4300239-0 CULTURE FUNGUS KOH S 67$ 4300240-0 CULTURE G C 52$ 4300241-0 CULTURE NODES & OTHE 57$ 4300242-0 CULTURE NOSE 46$ 4300243-0 CULTURE SPUTUM 49$ 4300244-0 CULTURE STOOL 75$ 4300245-0 CULTURE T B MYCOBACT 131$ 4300246-0 CULTURE THROAT (CULT 96$ 4300247-0 CULTURE URINE ROUTIN 50$ 4300248-0 CULTURE UROGENITAL 52$ 4300249-0 CULTURE WOUND 80$ 4300250-0 CULTURE VIRAL 256$ 4300251-0 CYANIDE BLOOD 92$ 4300252-0 CYCLOSPORIN WHOLE BL 116$ 4300254-0 CYSTINE URINE QUALIT 40$ 4300255-0 CYSTINE URINE QUANTI 113$ 4300256-0 CYTOLOGY EFFUSIONS 79$ 4300257-0 CYTOLOGY FLUIDS 285$ 4300258-0 CYTOLOGY RESPIRATORY 79$ 4300259-0 CYTOPATH FLUID WASH 79$ 4300260-0 D-DIMER 72$ 4300261-0 DEGLYCEROL RBC 1,003$ 4300262-0 DELTA AMINOLEV ACID 92$ 4300263-0 DEPAKENE VALPROIC AC 84$ 4300264-0 DESIPRAMINE NORPRAMI 100$ 4300265-0 DESOXYN URINE 66$ 4300266-0 DESYREL 354$ 4300267-0 DHEA SULFATE 151$ 4300268-0 DHEA SERUM 198$ 4300269-0 DIFFERENTIAL (MANUAL 20$

Page 21 of 112


Code Description Charge4300271-0 DIGOXIN SERUM 67$ 4300272-0 DILANTIN SERUM 76$ 4300273-0 DIRECT LDL 102$ 4300274-0 DISOPYRAMIDE NORPACE 89$ 4300275-0 DNA ANTIBODIES 96$ 4300276-0 DOXEPIN 104$ 4300277-0 DRUG 8 BLOOD 250$ 4300278-0 DRUG SCREEN 112$ 4300280-0 DRUG SCREEN QUAL 67$ 4300281-0 DRUG SCREEN BLOOD & 269$ 4300282-0 DRUG SCREENING URINE 95$ 4300283-0 DRUG SCREEN-URINE 99$ 4300284-0 DRUG UNKNOWN Q1 QN 260$ 4300285-0 E TEST SENSITIVITY 102$ 4300289-0 EAR CULTURE 46$ 4300290-0 EBV ABS VCA 96$ 4300291-0 EBV PROFILE 70$ 4300292-0 ECHOVIRUS AB CF 183$ 4300293-0 ELAVIL 100$ 4300294-0 ELECTROLYTE PANEL 27$ 4300295-0 ELUTION 186$ 4300296-0 ENDOMYSIAL AB IGA IF 113$ 4300297-0 ENDOMYSIAL ABS 90$ 4300298-0 ENTEROS THER-HOME VI 210$ 4300301-0 EOSINOPHIL 23$ 4300302-0 EPST-BARR NUCLEAR AG 76$ 4300303-0 EPSTEIN BAR VIRUS IG 91$ 4300304-0 EPSTEIN BAR VIRUS IG 91$ 4300305-0 EPSTEIN BARR VIRUS E 114$ 4300306-0 EPSTEIN-BARR EARLY A 79$ 4300307-0 ER DRUG SCREEN 95$ 4300308-0 ERA ESTROGEN REC ASS 293$ 4300309-0 ERYTHROPOIETIN-SERUM 124$ 4300310-0 ESR-SEDIMENTATION RA 19$ 4300311-0 ESTRADIOL SERUM 149$ 4300312-0 ESTRIOL SERUM 115$ 4300313-0 ESTROGENS TTL SERUM 141$ 4300314-0 ETHANOL QUANT BLOOD 65$ 4300315-0 ETHANOL-URINE 95$ 4300316-0 ETHOSUXIMIDE 77$

Page 22 of 112


Code Description Charge4300317-0 ETHOSUXIMIDE 77$ 4300318-0 ETHYLENE GLYCOL 82$ 4300319-0 EXTRACTABLE NUCLEAR 101$ 4300320-0 EYE CULTURE 46$ 4300333-0 FACTOR IX 184$ 4300334-0 FACTOR V 177$ 4300335-0 FACTOR V LEIDEN 201$ 4300336-0 FACTOR VII 177$ 4300337-0 FACTOR VIII ANTIGEN 184$ 4300338-0 FACTOR X 191$ 4300339-0 FACTOR XII 191$ 4300340-0 FACTOR XI 160$ 4300341-0 FACTOR XIII 123$ 4300342-0 CLOTTING INHIBITOR; 180$ 4300343-0 FAT FECAL 24 HR STOO 139$ 4300344-0 FATTY ACID STOOL QUA 34$ 4300345-0 FEBRILE AGGLUTININS 63$ 4300346-0 FELBAMATE 90$ 4300349-0 FERRITIN 76$ 4300350-0 FETAL HGB QUANTITATI 108$ 4300352-0 FFP BLOOD BAND 744$ 4300353-0 FIBRIN SPLIT PRODUCT 59$ 4300354-0 FIBRINOGEN 47$ 4300356-0 FOLATES RBS 125$ 4300357-0 FOLIC ACID (FOLATES) 76$ 4300358-0 FREE PHENYTOIN-DILAN 62$ 4300359-0 FREE THROXINE INDEX 44$ 4300360-0 FRUCTOSAMINE 72$ 4300361-0 FSH-SERUM 101$ 4300362-0 FUNGUS STAIN 35$ 4300365-0 GAMMA GLUT TRANS (GG 35$ 4300366-0 GASTRIN SERUM 89$ 4300367-0 GC DNA PROBE 31$ 4300368-0 GENERAL HEALTH PANEL 114$ 4300369-0 GENTAMICIN TROUGH 91$ 4300370-0 GENTAMICIN PEAK 91$ 4300371-0 GENTAMICIN RANDON 91$ 4300372-0 GIARDIA LAMBLIA ABS 149$ 4300373-0 GIARDIA LAMBLIA EIA 113$ 4300375-0 GLU TOL 3 HR (1ST 3 62$

Page 23 of 112


Code Description Charge4300376-0 GLU TOL 4 HR (1ST 3 62$ 4300377-0 GLUC-6 PD QUAN 72$ 4300378-0 GLUC-6-PD SCREEN 84$ 4300379-0 GLUCOSE RANDOM 21$ 4300380-0 GLUCOSE 1 HR PP 19$ 4300381-0 GLUCOSE 2 HR PP 19$ 4300382-0 GLUCOSE BODY FLUID 73$ 4300383-0 GLUCOSE CSF 23$ 4300384-0 GLUTOL EACH ADD SPEC 16$ 4300385-0 GLYCOSYLATED HEMOGLO 51$ 4300386-0 GONOCOCCUS DNA PROBE 96$ 4300387-0 GRAM S STAIN 73$ 4300388-0 GRANULOCYTE ANTIBODI 158$ 4300389-0 GROWTH HORMONE 98$ 4300390-0 HEMOGLOBIN 33$ 4300391-0 H PYLORI SCREEN 91$ 4300395-0 HANDLING FEE 34$ 4300396-0 HAPTOGLOBIN 79$ 4300397-0 ALBUMIN (HUMAN) 25% 226$ 4300398-0 HCV QUANT 291$ 4300399-0 HEAVY MTL SCRN UR/BL 137$ 4300400-0 HELICOBACTER PYLOR C 171$ 4300401-0 HELICOBACTER PYL IGG 125$ 4300402-0 HEMATOCRIT 17$ 4300404-0 HEMO CARDS 23$ 4300405-0 HEMOGLOBIN 18$ 4300406-0 HEMOGLOBIN A1C 55$ 4300407-0 HEMOGLOBIN A2 QUANT 88$ 4300408-0 HGB FRACT & QUAN; EP 79$ 4300410-0 HEMOGLOBIN F 51$ 4300411-0 HEMOGLOBIN FETAL QUA 44$ 4300412-0 HEMOGLOBIN SOLUBILIT 33$ 4300413-0 HEMOGLOBIN FREE PLAS 54$ 4300414-0 HEMOPHILUS INFLU BAG 58$ 4300415-0 HEMOSIDERINE URINE 38$ 4300416-0 HEP A AB IGM 73$ 4300417-0 HEP A AB TOTAL 69$ 4300418-0 HEP A TOTAL AB (IGG- 59$ 4300419-0 HEP B CORE AB IGM 81$ 4300420-0 HEP B CORE AB TOTAL 73$

Page 24 of 112


Code Description Charge4300421-0 HEP B PREVACCINATION 51$ 4300422-0 HEP B SURF ANTIBODY 72$ 4300423-0 HEP B SURFACE AG 55$ 4300424-0 HEP C VIRUS A 77$ 4300425-0 HEP D AGENT AB 84$ 4300426-0 HEPATIC FUNCTION PAN 36$ 4300427-0 HEPATITIS B CORE 72$ 4300428-0 HEPATITIS B VIRUS DN 212$ 4300429-0 HEPATITIS BE AB 158$ 4300430-0 HEPATITIS BE ANTIGEN 189$ 4300431-0 HEPATITIS C AB/RIBA 134$ 4300432-0 HEPATITIS C ANTIBODY 134$ 4300433-0 HEPATITIS PROFILE XI 72$ 4300434-0 HEP C RNA (PCR) 228$ 4300435-0 HERPES CULTURE 130$ 4300436-0 HERPES SIMPLEX VIRUS 65$ 4300437-0 HERPES VIRUS IGG 104$ 4300438-0 HERPES VIRUS IGM 146$ 4300439-0 HERPES VIRUS TYPE II 69$ 4300440-0 HETEROPHILE ABS QUAL 26$ 4300441-0 HETEROPHILE ABS QUAN 47$ 4300442-0 HIGH DENSITY LIPO PR 74$ 4300443-0 HISTAMINE BLOOD 317$ 4300444-0 HISTONE ANTIBODY 120$ 4300445-0 HLA TYPE TRANSFUSION 270$ 4300446-0 HLA TYPING 345$ 4300448-0 HLA TYPING DR/DQ 299$ 4300449-0 HLA-B27 122$ 4300450-0 HOMOGENTISIC ACID 26$ 4300451-0 HOMOVANILLIC ACID HV 168$ 4300452-0 HTLV-1 ANTIBODIES 58$ 4300454-0 HUMAN BABESIOSIS 171$ 4300455-0 HVS 1/2 PCR 531$ 4300456-0 HYDROXY PROLINE TOTA 206$ 4300461-0 IBUPROFEN 87$ 4300462-0 IGA QUANT CSF 51$ 4300463-0 IGA QUANT SERUM 47$ 4300464-0 IGG QUANT SERUM 47$ 4300465-0 IGG SUBCLASSES(1-2-3 319$ 4300466-0 IGG 1 2 3 OR 4 EACH 189$

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Code Description Charge4300467-0 ZINC 24HR URIN 126$ 4300468-0 COPPER 24 HOUR URIN 141$ 4300469-0 IGM QUANT SERUM 47$ 4300470-0 IMMEDIATE SPIN CROSS 91$ 4300471-0 IMMUNOELECTROPHO URI 135$ 4300472-0 IMMUNOELECTROPHO 135$ 4300473-0 IMMUNOELECTROPHO CSF 134$ 4300474-0 IMMUNOELECTROPHO QU 146$ 4300475-0 IMMUNOGLOB A CSF(IGA 60$ 4300476-0 IMMUNOGLOB M CSF(IGM 62$ 4300477-0 IMMUNOGLOB G CSF(IGG 66$ 4300478-0 IMMUNOGLOBULIN D IGD 91$ 4300479-0 IMMUNOGLOBULIN E(IGE 98$ 4300480-0 IMMUNOGLOBULIN IGA 47$ 4300481-0 ASSAY OF IGE 142$ 4300482-0 IMMUNOGLOBULINS IGG 47$ 4300483-0 IMMUNOGLOBU IGG A&M 47$ 4300484-0 IMMUNOGLOBULINS IGM 49$ 4300485-0 INDIA INK PRE 33$ 4300486-0 INFLUENZA A ANTIBODY 139$ 4300488-0 INFLUENZA B ANTIBODY 217$ 4300489-0 INFLUENZA VIRUS CULT 123$ 4300490-0 INSULIN TOLERANCE (3 176$ 4300491-0 INSULIN 67$ 4300492-0 INSULIN ABS-BOVINE 101$ 4300493-0 INSLUIN ABS-PORCINE\ 101$ 4300494-0 INTRINSIC FACTOR BLO 104$ 4300495-0 IONIZED CALCIUM 91$ 4300496-0 IRON 33$ 4300497-0 IRON BINDING CAP/TIB 42$ 4300498-0 KDC MRSA 46$ 4300499-0 KDC NASAL 46$ 4300500-0 KIDNEY STONE SCREEN 354$ 4300501-0 KIRBY BAUER SENSITIV 30$ 4300502-0 L LONGBEACHEA AB 73$ 4300503-0 L PNEUMOPHILA AB 73$ 4300504-0 L/S RATIO AMNIOTIC F 178$ 4300505-0 LAB TEST CHEM UNSPEC 96$ 4300507-0 LACTIC ACID 75$ 4300508-0 LACTOSE TOL EACH ADD 16$

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Code Description Charge4300509-0 LACTOSE TOL (3 SEPC) 62$ 4300510-0 LAMOTRIGINE 81$ 4300512-0 LASA LIPID ASS SIALI 76$ 4300514-0 LDH 31$ 4300515-0 LDH BODY FLUID 73$ 4300516-0 LDH-ISOENZYMES 91$ 4300519-0 LEGIONELLA CULTURE 132$ 4300520-0 LEGIONELLA URINE ANT 144$ 4300521-0 LEPTOSPIRAL ABS 91$ 4300522-0 LEUKO IRRAD PLT PHER 1,183$ 4300523-0 LR IRRAD WHOLE BLD E 443$ 4300524-0 LEUKOCYTE ALKALINE P 52$ 4300525-0 LEUKOCYTE(WBC) COUNT 18$ 4300526-0 LEUKOREDUCED RBC 420$ 4300527-0 LIBRIUM 91$ 4300528-0 LIDOCAINE LAB 76$ 4300529-0 LIPASE-URINE 35$ 4300530-0 LIPID PROFILE 73$ 4300531-0 LIPOPROTEIN ELECTROP 63$ 4300532-0 LITHIUM SERUM 38$ 4300533-0 LOW DENSITY LIPO PRO 46$ 4300534-0 LOXAPINE SERUM 90$ 4300535-0 LUI ELUTION 91$ 4300536-0 LUPUS ANTICOAGULANT 119$ 4300537-0 LUTEINIZING HORMONE- 108$ 4300539-0 LYME DIS ABS 118$ 4300540-0 LYME DIS TOT ABS REF 141$ 4300541-0 LYME DIS TOT ABS NO 141$ 4300542-0 LYME DISEASE DNA (TI 448$ 4300543-0 LYME DISEASE CSF 80$ 4300544-0 LYME WB SYNOVIAL 184$ 4300545-0 LYSOZYME SERUM MURAM 116$ 4300546-0 M I C 79$ 4300547-0 MAGNESIUM 34$ 4300548-0 MAGNESIUM URINE 47$ 4300549-0 MALARIA SMEAR 51$ 4300550-0 MANGANESE 116$ 4300551-0 MARIJUANA URINE QUAL 67$ 4300552-0 MELLARIL 79$ 4300553-0 MERCURY QUANTITIVE-S 96$

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Code Description Charge4300555-0 MET PATH DRAW FEE 14$ 4300556-0 METANEPHRINES 24 HR 184$ 4300557-0 METHADONE QN URINE 124$ 4300558-0 METHAMPHETAMINE QUAL 67$ 4300559-0 METHANOL BLOOD 72$ 4300560-0 METHEMOGLOBIN 75$ 4300561-0 METHYLMALONIC ACID 80$ 4300562-0 MEXILETINE 76$ 4300563-0 MICROALBUMIN URINE 46$ 4300564-0 MICROALBUMIN 24 HR U 54$ 4300565-0 MICROSPORIDIA STOOL 102$ 4300567-0 MISC CULTURE 46$ 4300568-0 MORPHINE SERUM 79$ 4300569-0 MUCIN QUALITATIVE SY 23$ 4300570-0 MUMPS SCREEN IGG 50$ 4300571-0 MURINE TYPHUS AB IGG 58$ 4300572-0 MYCOPLASMA PNEUM CUL 124$ 4300573-0 MYCOPLASMA PNEUM AB 80$ 4300574-0 MYELIN BASIC PROTEIN 134$ 4300575-0 MYOGLOBIN 93$ 4300576-0 MYOGLOBIN-URINE QUAL 90$ 4300577-0 MYSOLINE 82$ 4300578-0 N-ACETYL PROCAINAMID 79$ 4300579-0 NAVANE (THIOTHIXENE) 88$ 4300580-0 NEISSRIA MENINGIT AG 87$ 4300581-0 BARBITURATES NES 84$ 4300582-0 NEURONTIN (GABAPENTI 112$ 4300583-0 NICKEL 97$ 4300584-0 NICOTINE SCREEN URIN 67$ 4300585-0 NICOTINE URINE 108$ 4300586-0 NON GYN SMEAR 207$ 4300587-0 NORTRIPTLYINE (AVENT 108$ 4300588-0 OCCULT BLOOD-STOOL 17$ 4300589-0 OLIGOCLONAL PROTEINS 125$ 4300590-0 OPI CONF (BLOOD) 203$ 4300591-0 OPIATE CONFIRM GC/MS 97$ 4300592-0 OPIATE CONFIRMATION 65$ 4300593-0 OPIATES 95$ 4300594-0 ORGANISM ID MOLD 108$ 4300595-0 ORGANISM ID YEAST 54$

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Code Description Charge4300597-0 OSMOLALITY-SERUM 41$ 4300598-0 OSMOLARITY URINE 34$ 4300599-0 OVA AND PARASITES & 81$ 4300600-0 OXALATE 88$ 4300601-0 OXAZEPAM 89$ 4300602-0 PANCREATIC ONOFETAL 168$ 4300603-0 PAP SMEAR MD INT-SLI 44$ 4300604-0 PAP SMEAR/BETHESDA 1 44$ 4300605-0 PAP SMEAR/BETHESDA 2 54$ 4300606-0 PARAINFLUENZA CF 198$ 4300607-0 PARASITE IDENTIFICAT 47$ 4300608-0 PARATHYROID HORMONE 223$ 4300609-0 PARIETAL CELL ABS 58$ 4300611-0 PARVOVIRUS DNA PCR 171$ 4300612-0 PCP CONFIRM GC/MS 97$ 4300613-0 PEDIATRIC SEPSIS URI 80$ 4300615-0 PERPHENAZINE 74$ 4300616-0 PERTUSSIS SMEAR 36$ 4300619-0 PH URINE/GASTRIC/FLU 108$ 4300620-0 PHEN CONF (BL0OD) 203$ 4300621-0 PHENCYCLIDINE 67$ 4300622-0 PHENCYCLIDINE (PCP) 79$ 4300623-0 PHENCYCLIDINE PCP SE 93$ 4300625-0 PHENOBARBITAL 69$ 4300626-0 PHENYLALANINE PLASMA 92$ 4300627-0 PHOSPHORUS 24$ 4300628-0 URINE PHOSPHATE 30$ 4300629-0 PINWORM DETERMINATIO 44$ 4300630-0 PKU 107$ 4300631-0 PLATELETS EA UNIT 120$ 4300632-0 PLATELET COUNT 27$ 4300633-0 PLATELET IRRADIATED 125$ 4300634-0 PLATELET PHERESIS LE 1,463$ 4300635-0 PLATELET HLA-MATCH E 1,661$ 4300636-0 PNEMOCOCCAL 141$ 4300637-0 PNEUMOCYSTIS SMEAR 90$ 4300638-0 PORPHOBILINOGEN URQN 47$ 4300639-0 PORPHOBILINOGEN QN U 55$ 4300640-0 PORPHYRINS 102$ 4300641-0 POST GLUCOSE DOSE 23$

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Code Description Charge4300642-0 POTASSIUM 23$ 4300643-0 POTASSIUM URINE 24 H 23$ 4300644-0 URINE POTASSIUM 27$ 4300645-0 PPD 54$ 4300646-0 PRA(PROGESTERONE REC 304$ 4300647-0 PREALBUMIN 93$ 4300648-0 PREG TEST SERUM QUAL 36$ 4300649-0 PREG TEST/URINE QUAL 36$ 4300650-0 OBSTETRIC PANEL 95$ 4300651-0 PROCAINAMIDE W METAB 79$ 4300652-0 PROCAINAMIDE 89$ 4300653-0 PROGESTERONE SERUM 104$ 4300654-0 PROLACTIN 123$ 4300655-0 PROLIXIN 79$ 4300656-0 PROPERDIN FACTOR B 88$ 4300658-0 PROST ACID PHOS SER 58$ 4300659-0 PROSTATE-SPECIFIC AG 105$ 4300660-0 PROSTATIC ACID PHOSH 66$ 4300661-0 PROTEIN; EP FRACT & 51$ 4300664-0 PROTEIN S ANTIGEN 107$ 4300665-0 URINE TOTAL PROTEIN 35$ 4300666-0 PROTEIN TOTAL 20$ 4300669-0 PROTHROMBIN TIME 19$ 4300670-0 PROTOPROPHYRINS RBC 57$ 4300671-0 PROTRIPTYLINE QN 107$ 4300672-0 PROZAC 102$ 4300673-0 PSA TOTAL 149$ 4300674-0 PT MIXING STUDY 19$ 4300676-0 PTT 31$ 4300680-0 QUICK STREP 42$ 4300681-0 QUINIDINE SERUM 79$ 4300682-0 RABIES TITER 80$ 4300684-0 RAPID GRP A STREP SC 49$ 4300685-0 RBC AUTOLOGOUS & DIR 217$ 4300686-0 RBC MORPHOLOGY 18$ 4300687-0 RECTAL CS FOR VRE 75$ 4300688-0 RED BLOOD CELLS (AS- 385$ 4300692-0 RENAL FUNCTION PANEL 39$ 4300693-0 RENIN 131$ 4300694-0 REST-ADSORPTION 65$

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Code Description Charge4300695-0 RETICULIN ABS-IGA 100$ 4300696-0 RETICULIN ABS-IGG 100$ 4300697-0 RETICULOCYTE COUNT 23$ 4300698-0 REVERSE T3 201$ 4300699-0 RH TYPE 98$ 4300700-0 RHEUMATOID ARTH QUAN 44$ 4300701-0 RHEUMATOID FACTOR R 33$ 4300702-0 RHEUMATOID FACTOR TI 33$ 4300703-0 RHEUMATOID PROFILE 34$ 4300705-0 ROCKY MT SPOT FEVER 128$ 4300706-0 ROCKY MT SPOT FEVER 123$ 4300707-0 ROTAVIRUS EIA 120$ 4300708-0 ROUTINE DRUG SCRN GA 124$ 4300709-0 RSV CF 91$ 4300710-0 RUBELLA ABS IGM 123$ 4300711-0 RUBELLA ABS IGG 69$ 4300712-0 RUBELLA SCREEN 69$ 4300713-0 MEASLES (RUBEOLA SCR 62$ 4300714-0 RUBEOLA QUANT 100$ 4300715-0 RUSSELL VIPER VENOM 102$ 4300716-0 SALICYLATE 40$ 4300717-0 SALIVARY DUCT ANTIBO 98$ 4300719-0 SCL-70 (SCLERODERMA) 118$ 4300720-0 DETERGNT TX FROZ PLA 177$ 4300724-0 SELENIUM 121$ 4300725-0 SEMEN ANALYSIS 122$ 4300726-0 SERENTIL-MESORIDAZIN 77$ 4300727-0 SEROTONIN 81$ 4300729-0 SICKLE CELL SCREEN 27$ 4300730-0 SJOGREN AB 114$ 4300731-0 SKIN AUTO ANTIBODY 128$ 4300732-0 SMEAR MALARIA 50$ 4300733-0 SMEAR VINCENTS SMEAR 21$ 4300734-0 SODIUM SERUM 24$ 4300735-0 SODIUM URINE 24 HR 24$ 4300736-0 SODIUM URINE RANDOM 24$ 4300737-0 SOMATOMEDIN-C 262$ 4300739-0 SPECIFIC GRAVITY 14$ 4300740-0 SPECIMEN COLLECTION 19$ 4300741-0 SPERM VAS CHECK 79$

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Code Description Charge4300742-0 SPINAL FLUID ANTIGEN 89$ 4300743-0 CEA 91$ 4300744-0 STOOL FOR WBC 24$ 4300746-0 STRIATIONAL ANTIBODI 58$ 4300749-0 SYPHLIS (RPR-STS) SC 27$ 4300750-0 T HELPER CD4 65$ 4300753-0 T3 TRIIODOTHYRONINE 92$ 4300754-0 T3 UPTAKE 33$ 4300755-0 T3 FREE 212$ 4300756-0 T4 (THYROXINE) 34$ 4300757-0 T4 FREE 82$ 4300760-0 TACROLIMUS-BLOOD 171$ 4300761-0 TEGRETOL (CARBAMAZEP 82$ 4300762-0 TEICHOIC ACID ABS 82$ 4300763-0 TESTOSTERONE FREE SE 244$ 4300764-0 TESTOSTERONE; TOTAL 153$ 4300765-0 TETANUS AB SCREEN 135$ 4300766-0 THAW (BILL ONLY) 91$ 4300767-0 THEOPHYLLINE 72$ 4300768-0 THERAPEUTIC PHLEBOTO 165$ 4300769-0 THORAZINE 91$ 4300770-0 THROMBIN TIME 44$ 4300771-0 THYROID STIM HORM (T 82$ 4300772-0 THYROGLOBULINS 125$ 4300773-0 ANTI-THYROID 75$ 4300774-0 THYROID ANTIMICROSOM 69$ 4300777-0 THYROXIN BIND GOLD ( 120$ 4300779-0 TOBRAMYCIN 93$ 4300780-0 C CHROMATOGR QUAN AN 159$ 4300781-0 TOFRANIL SERUM 100$ 4300783-0 TOTAL PROTEIN URINE 50$ 4300784-0 TOTAL PROTEIN BODY F 76$ 4300785-0 TOTAL PROTEIN CSF 24$ 4300786-0 TOXOCARA AB S 134$ 4300787-0 TOXOPLASMA GONDI IGG 82$ 4300788-0 TOXOPLASMA GONDI IGM 128$ 4300789-0 TOXOPLASMOSIS PANEL 102$ 4300790-0 TRANSFERRIN 67$ 4300791-0 TRANSFUSION-BLOOD OV 700$ 4300794-0 TRICH PREP 44$

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Code Description Charge4300795-0 TRICHINELLA IGB AB 124$ 4300796-0 TRIGLYCERIDE 30$ 4300797-0 TRIGLYCERIDE AND CHO 30$ 4300798-0 TROPONIN QUAN 112$ 4300799-0 TRYPSIN 134$ 4300800-0 TSI 239$ 4300802-0 AUTOM URINE DIP W MI 17$ 4300803-0 UREA CLEARANCE 50$ 4300804-0 UREA NITROGEN 19$ 4300805-0 UREA NITROGEN (URINE 23$ 4300806-0 UREAPLASMA CULT 93$ 4300807-0 UREAPLASMA CULTURE 69$ 4300808-0 URIC ACID 24$ 4300809-0 URIC ACID 24 HR 26$ 4300810-0 N-AUTOM URINALYS WO 20$ 4300811-0 URINALYSIS 30$ 4300812-0 URINALYSIS (NO MICRO 18$ 4300813-0 URINE BILE ACID 68$ 4300814-0 URINE CHLORIDE 24HR 17$ 4300815-0 V ZOSTER IGM TITER 99$ 4300816-0 V ZOSTER IMMUNITY IG 88$ 4300817-0 VAG/RECTAL CS FOR GB 39$ 4300818-0 VAGINAL CULTURE 46$ 4300819-0 VALIUM 91$ 4300820-0 DEPAKOTE LEVEL/VALPO 76$ 4300821-0 VANCOMUCIN PEAK 66$ 4300822-0 VASOACTIVE INTEST PO 251$ 4300823-0 VDRL CSF 38$ 4300824-0 VENIPUNCT-HOMEBOUND 31$ 4300825-0 VIP (VASOACTIVE) 224$ 4300826-0 VISCOSITY SERUM 88$ 4300827-0 VITAMIN B-12 LEVEL 72$ 4300828-0 VIT B12 UNSATUR BIND 101$ 4300829-0 VIT D 1 25 DIHYDROXY 297$ 4300830-0 VIT D 25 DIHYDROXY 216$ 4300831-0 VITAMIN A 91$ 4300832-0 VITAMIN B1 100$ 4300833-0 VITAMIN B12 CYANOCOB 88$ 4300834-0 VITAMIN B2 160$ 4300835-0 VMA URINE 24HR 90$

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Code Description Charge4300837-0 WARM-ADSORPTION 65$ 4300838-0 WASHED RBC 458$ 4300839-0 WBC 17$ 4300840-0 XANAX (ALPRAZOLAM) 149$ 4300841-0 XYLOSE TOLERANCE 75$ 4300842-0 YERSINIA 27$ 4300843-0 ZINC 67$ 4300844-0 COC URINE TOXIC PANE 100$ 4300845-0 MONOSPOT 96$ 4300846-0 ELECTROLYTES (URINE) 27$ 4300891-0 DX PAP TL; MANUAL SC 325$ 4300892-0 DX PAP; MANUAL SCREE 325$ 4300893-0 DX PAP; MANUAL SCRN 325$ 4300894-0 TOTAL PROTEIN OTHER 45$ 4300895-0 NEISSERIA AMPLIF NA 1,875$ 4300998-0 RPR 21$ 4300999-0 VENIPUNCTURE 19$ 4301000-0 VARICELLA SCREEN (IG 46$ 4301001-0 URINE TOXICOLOGY 67$ 4301002-0 URINE ALCOHOL 74$ 4301003-0 ALUMINUM BLOOD 42$ 4301004-0 PACKED RED BLOOD CEL 512$ 4301005-0 PLATELETS (BLOOD BAN 145$ 4301006-0 BLOOD BAND IRRADIATE 54$ 4301007-0 VANCOMUCIN THROUGH 66$ 4301008-0 QUANTITATION OF DRUG 66$ 4301009-0 BLOOD CROSS MATCH (B 91$ 4301011-0 HCP W/ VIRAL LOAD 200$ 4301012-0 TOXICOLOGY 128$ 4301015-0 SERUME KETONE 97$ 4301016-0 5' NUCLEOTIDA 54$ 4301017-0 CARBOXY HGB 97$ 4301018-0 BLOOD GAS MIXED WO O 92$ 4301019-0 HIV SCREENING 118$ 4301020-0 VANCOMYCIN TROUGH 104$ 4301021-0 CA-27-29 201$ 4301022-0 IMMUNOFIXATION SERUM 105$ 4301023-0 CA 19-9 98$ 4301024-0 ANTITHYROID GLOBELIN 75$ 4301025-0 ERLICHIOSIS SEROLOGY 107$

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Code Description Charge4301026-0 IMMUNOFIXATION URINE 105$ 4301028-0 CA-125 98$ 4301030-0 ALPHA FETO PROTEIN 80$ 4301031-0 LH-SERUM 80$ 4301032-0 HOMOCYSTEINE 80$ 4301033-0 CARDIO CRP 79$ 4301034-0 INSULIN SERUM 55$ 4301035-0 PREGNENOLONE 142$ 4301036-0 LYME SCREEN 80$ 4301037-0 WEST NILE VIRUS 223$ 4301038-0 ANCA C/ANCA P 264$ 4301039-0 C-3 58$ 4301040-0 C-4 58$ 4301041-0 CH 50 197$ 4301042-0 SERUM ELECTROPHORESI 108$ 4301043-0 CLOTTING: FACTOR VII 233$ 4301044-0 PTT; SUBSTITUTION PL 98$ 4301045-0 LIPASE SERUM 87$ 4301046-0 FACTOR II FUNCTIONAL 215$ 4301047-0 THYROID PEROXIDASE A 132$ 4301048-0 LYMPH SUBSET CD4-CD8 401$ 4301049-0 AUTOLOG BLOOD PREDEP 816$ 4301050-0 ISLET CELL AB 270$ 4301052-0 CULTURE FLUID W/STAI 121$ 4301054-0 ALBUMIN URINE 142$ 4301055-0 LEUKEMIA/LYMPHOCYTE 1,118$ 4301056-0 HGE AB 107$ 4301057-0 A-1 ANTITRYPSON 102$ 4301058-0 HEPTIMAX 373$ 4301059-0 IRRADIATE BLD PRODUC 95$ 4301060-0 POOLING FEE 161$ 4301062-0 E. HISTOLYTICA AB 139$ 4301063-0 HEP C GENOTYPE 1,196$ 4301064-0 HGB ELECTRO 195$ 4301065-0 ALBUMIN FLUID 73$ 4301066-0 OSMOLALITY FLUID 177$ 4301067-0 HEP D 81$ 4301068-0 DNA DS (NATIVE) 66$ 4301069-0 ANTICARDIOLIPIN ANTI 69$ 4301072-0 ISOPROPANOL ALCOHOL 116$

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Code Description Charge4301073-0 IMMUNOASSAY QUANT NO 221$ 4301074-0 CC/MS; QUAN SS & MP 195$ 4301075-0 VENOUS BLOOD GAS (VB 92$ 4301076-0 AFP PLUS 325$ 4301079-0 OBSTETRIC PANEL 354$ 4301080-0 CADMIUM URINE 142$ 4301081-0 ERYTHROPOIETIN -EPOG 196$ 4301082-0 PROTEIN C (PRO C-ACT 77$ 4301084-0 CULTURE SALMONELLA/S 59$ 4301085-0 MYCOBACTERIA CULTURE 96$ 4301086-0 CULTURE AFB URINE 96$ 4301087-0 ANTIBIOTIC SENSITIVI 30$ 4301088-0 BACTERIAL ID 40$ 4301089-0 URINE CULTURE 40$ 4301090-0 H PYLORI AB (IGG) 44$ 4301091-0 H PYLORI AB (IGM) 44$ 4301092-0 H PYLORI AB (IGA) 41$ 4301093-0 CULTURE FLUID W/ STA 60$ 4301094-0 STREP SERO GROUP 32$ 4301095-0 HCV RNA GENOTYPE DUP 1,196$ 4301096-0 HCV RNA QN PCR EXPAN 268$ 4301097-0 COCAINE SERUM 364$ 4301098-0 EPSTEIN-BARR DNA ULT 402$ 4301099-0 CC/MS; QUAN SS & MP 256$ 4301100-0 AMPHETAMINE SERUM 150$ 4301101-0 BARBITURDTES SERUM 72$ 4301102-0 URINE CULTURE BIOCHE 40$ 4301103-0 BLASTOMYCES (YEAST I 116$ 4301104-0 ATYPICAL ANTIBODY ID 843$ 4301105-0 AFP TUMOR MARKER SER 80$ 4301106-0 CHROMOGRADIN A 183$ 4301107-0 MOLECULE NUCLEIC AMP 320$ 4301109-0 SCHISTOSOMA AB 188$ 4301110-0 AMINO ACIDS 6/> QUA 777$ 4301112-0 CHROMOSOMES,HEMATOLO 1,254$ 4301113-0 TISSUE PATHOLOGY 226$ 4301115-0 IMMUNOCYTOCHEM 351$ 4301117-0 DECALCIFICATION 104$ 4301119-0 FLUID CRYSTAL EXAM ( 153$ 4301120-0 ANTI ENA (SM/RNP) 191$

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Code Description Charge4301121-0 LUPUS ANTICOAGULANT 122$ 4301123-0 CULTURE FUNGAL FLUID 110$ 4301124-0 ASSAY OF PROTEIN SER 73$ 4301125-0 CHLORIDE FLUID 73$ 4301126-0 NATRIURETIC PEPTIDE 409$ 4301127-0 B-TYPE NATRIURETIC P 260$ 4301128-0 HEMOAGGLUTINATION IN 110$ 4301129-0 TISSUE TRANSGLUFAMIN 201$ 4301130-0 TEMAZEPAM 180$ 4301131-0 GLIADIN AB IGG,IGA 244$ 4301134-0 LUPUS COMPREHENSIVE 322$ 4301135-0 BIOCHEMICAL ID 30$ 4301136-0 ANTIBIOTIC SENSITIVI 41$ 4301137-0 URINE CULTURE ID 20$ 4301138-0 STREP SEVO GROUP 55$ 4301139-0 BACTERIAL ID 55$ 4301141-0 LEUCINE AMIOPEPTIDAS 107$ 4301143-0 H PYLORI FOR STOOL 194$ 4301144-0 GROSS & MICRO LAB ON 338$ 4301145-0 E.COLI 0157 108$ 4301146-0 NATRIURETIC PEPTIDE 191$ 4301147-0 VITAMIN E 139$ 4301152-0 CALCITONIN 245$ 4301153-0 URINE MUCOPOLYSACCHA 201$ 4301155-0 PATHOLOGY REVIEW 101$ 4301156-0 BUFFY COAT SMEAR 101$ 4301165-0 B PERTUSSIS IGA ABS 283$ 4301167-0 TOPAMAX (TOPIRAMATE) 156$ 4301169-0 FECAL LACTOFERRIN QU 122$ 4301170-0 PEP URINE OR CSF 122$ 4301171-0 RSV IA W DIR OBSERV 92$ 4301172-0 VIT C 110$ 4301175-0 INHIBIN SERUM 237$ 4301177-0 QUANT BORDITELLA PER 248$ 4301179-0 HIV1 RNA QUANT BY PC 118$ 4301180-0 ANTI-PEROXIDASE ANTI 75$ 4301184-0 HELICOBACTER PYLORI 125$ 4301186-0 HELICOBACTER PYLORI 125$ 4301187-0 KEPPRA (LEVETIRACETA 136$ 4301188-0 METHOTREXATE LEVEL ( 157$

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Code Description Charge4301189-0 METANEPHRINES PLASMA 361$ 4301190-0 CHRONIC MYELOGENOUS 711$ 4301191-0 PLASMINOGEN 180$ 4301196-0 WEST NILE VIRUS ANTI 351$ 4301197-0 WEST NILE VIRUS AB I 251$ 4301198-0 VITAMIN D 25 HYDROXY 294$ 4301199-0 VITAMIN B6 201$ 4301200-0 VIRUS ISOLATE; ADDTL 205$ 4301201-0 VARICELLA ZOSTER AG 195$ 4301202-0 URIC ACID; BLOOD 50$ 4301203-0 TROPONIN QUAL 50$ 4301204-0 TREPONEMA PALLIDUM 100$ 4301205-0 TOXIN ASSAY TISSUE C 95$ 4301206-0 TISSUE CULTURE; SKIN 95$ 4301207-0 TISSUE CULTURE; OTHE 95$ 4301208-0 THYROGLOBULIN 165$ 4301209-0 THROMBIN TIME; TITER 165$ 4301210-0 T CELLS; TOTAL COUNT 165$ 4301211-0 T CELLS; ABSOL CD4 C 170$ 4301212-0 STREPTOKINASE AB 70$ 4301213-0 STREP A AG EIA 44$ 4301214-0 STONE; QUAN CHEMICAL 125$ 4301215-0 STAPH A DNA AMP PROB 80$ 4301216-0 SHIGA-LIKE TOXIN AG 95$ 4301217-0 SERUM PRETX; INHIBIT 110$ 4301218-0 SCRN PAP TL; SCRN & 125$ 4301219-0 RUBEOLA AG BY IF 95$ 4301220-0 RSV AG BY IF 95$ 4301221-0 ROTAVIRUS AG EIA 95$ 4301222-0 RESP SYNCYTIAL AG EI 100$ 4301223-0 QUINNE 100$ 4301224-0 QUAN FECAL PORPHYRIN 125$ 4301225-0 QUAL URINE PORPHYRIN 80$ 4301226-0 QUAL FECAL PORPHYRIN 110$ 4301227-0 PYRUVATE 125$ 4301228-0 PSA; FREE 170$ 4301229-0 PSA SCREENING 150$ 4301230-0 PSA - COMPLEXED 180$ 4301231-0 PROTOPORPHYRIN RBC; 130$ 4301232-0 PROTEIN WESTERN BLOT 140$

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Code Description Charge4301233-0 PROINSULIN 100$ 4301234-0 PROCALCITONIN (PCT) 110$ 4301235-0 PORPHOBILINOGEN URIN 98$ 4301236-0 PINWORM EXAM 100$ 4301237-0 PATH CONSULT; COMPRE 125$ 4301238-0 PARAINFLUENZA AG BY 95$ 4301239-0 PAPILLOMAVIRUS NA QU 150$ 4301240-0 PAPILLOMAVIRUS DIR N 108$ 4301241-0 OCCULT BLOOD OTHER S 70$ 4301242-0 NEISSERIA NA QUAN 150$ 4301243-0 NEISSERIA DIR NA PRO 108$ 4301244-0 N. GONORRHOEAE ASSAY 150$ 4301245-0 MYCOPLASMA NA QUAN 120$ 4301246-0 MYCOPLASMA DIR NA PR 108$ 4301247-0 MYCOBACTERIA T NA QU 130$ 4301248-0 MYCOBACTERIA T DIR N 108$ 4301249-0 MYCOBACTERIA NA QUAN 151$ 4301250-0 MYCOBACTERIA DIR NA 108$ 4301251-0 MYCOBACTERIA A DIR N 108$ 4301252-0 MIGRATION INHIBITORY 130$ 4301253-0 MACROSCOPIC EXAM PAR 50$ 4301254-0 MACROSCOPIC EXAM ART 20$ 4301255-0 LYMES NA PROBE QUAN 100$ 4301256-0 LHR TEST 100$ 4301257-0 LEGIONELLA P AG BY D 113$ 4301258-0 LEGIONELLA NA QUAN 110$ 4301259-0 LEGIONELLA M AG BY I 110$ 4301260-0 LEGIONELLA DIR NA PR 110$ 4301261-0 INVESTIG TRANSFUS RE 120$ 4301262-0 INFLUENZA B AG BY IF 110$ 4301263-0 INFLUENZA A/B AG EIA 110$ 4301264-0 INFLUENZA A AG BY DF 110$ 4301265-0 IMMUNFIX E-PHORSIS/U 137$ 4301266-0 IA QUANT; CA 15-3 (2 150$ 4301267-0 HLA TYPE; DR/DQ SGL 120$ 4301268-0 HIV-2 AG EIA 150$ 4301269-0 HIV-1 DIR NA PROBE 110$ 4301270-0 HIV-1 AG EIA 150$ 4301271-0 HISTOPLASMA CAPSUL A 130$ 4301272-0 HGH AB 100$

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Code Description Charge4301273-0 HERPES SIMPLEX 2 AG 150$ 4301274-0 HERPES SIMPLEX 1 AG 110$ 4301275-0 HERPES S NA QUAN 120$ 4301276-0 HERPES S DIR NA PROB 110$ 4301278-0 HEPATITIS B SURFACE 350$ 4301279-0 HEP-B NA QUAN 330$ 4301280-0 H PYLORI AG EIA 200$ 4301281-0 GIARDIA AG BY IF 150$ 4301282-0 GENET VIRUS ISOLATE 150$ 4301283-0 FUNGUS CULTURE DEF I 30$ 4301284-0 FUNGUS CULTURE BLOOD 125$ 4301285-0 FACTOR 8 VWF MULTIMR 110$ 4301286-0 17-HYDROXYPREGNENOLO 100$ 4301287-0 6-PGD RBC 85$ 4301288-0 AB ID; PLATELET IG A 6$ 4301289-0 AB; BORRELIA 55$ 4301290-0 AB; ACTINOMYCES 53$ 4301291-0 AB; BARTONELLA 53$ 4301292-0 AB; BRUCELLA 55$ 4301293-0 AB; CAMPYLOBACTER 55$ 4301294-0 AB; CANDIDA 55$ 4301295-0 AB; COXIELLA BRUNETI 65$ 4301296-0 AB; CRYPTOCOCCUS 85$ 4301297-0 AB; DIPHTHERIA 85$ 4301298-0 AB; FRANCISELLA TULA 175$ 4301299-0 AB; FUNGUS NES 75$ 4301300-0 AB; HEMOPHILUS INFLU 75$ 4301301-0 AB; HISTOPLASMA 35$ 4301302-0 AB; HIV-1 & HIV-2 SG 97$ 4301303-0 AB; HIV-2 97$ 4301304-0 AB; HSV 1 158$ 4301305-0 AB; HTLV OR HIV WB 158$ 4301400-0 AB; HTLV-II 158$ 4301401-0 AB; MALARIA 160$ 4301402-0 AB; NEISSERIA MENING 158$ 4301403-0 AB; RICKETTSIA 158$ 4301404-0 AB; SALMONELLA 158$ 4301405-0 AB; SHIGELLA 158$ 4301406-0 AB; YERSINIA 158$ 4301407-0 ACTIVATED PROTEIN C 97$

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Code Description Charge4301408-0 ADENOVIRUS AG BY IF 97$ 4301409-0 ADENOVIRUS AG EIA 97$ 4301410-0 ADENOVIRUS ASSAY W/O 97$ 4301411-0 ALLERG SP IGG QUAN 60$ 4301412-0 ALPHA-1-ANTITRYPSIN; 65$ 4301413-0 ALPHA-FETOPROTEIN L3 70$ 4301414-0 AMINO ACIDS; 2-5 QUA 85$ 4301415-0 AMINO ACIDS; SINGLE 85$ 4301416-0 ANDROSTANEDIOL GLUCU 95$ 4301417-0 ANDROSTERONE 160$ 4301418-0 ANGIOTENSIN II 160$ 4301419-0 ANTI-PHOSPHATIDYLSER 167$ 4301420-0 ANTINUCLEAR AB (ANA) 95$ 4301421-0 ASO; SCREEN 115$ 4301422-0 ASSAY CARBOXYHB QUAL 150$ 4301423-0 AUTOM CBC WO PLTS 45$ 4301424-0 AUTOMATED PLATELET C 45$ 4301425-0 AUTOMATED RBC COUNT 70$ 4301426-0 B CELLS TOTAL COUNT 70$ 4301427-0 BACT CULT - QUAN ANA 94$ 4301428-0 BC - ANAEROBE - ADDT 75$ 4301429-0 BETA 2 GLYCOPROTEIN 175$ 4301430-0 BLD TYPE; AG SCRN W 125$ 4301431-0 BLD TYPE; RH PHENOTY 125$ 4301432-0 BONE MARROW ASPIRATE 100$ 4301433-0 BORDATELLA P AG BY D 95$ 4301434-0 CARB DEFICIENT TRANS 112$ 4301435-0 CARNITINE QUAN EA 143$ 4301436-0 CATECHOLAMINES; BLOO 125$ 4301437-0 CHYLMDP AMPLIF NA PR 112$ 4301438-0 CHYLMD P DIR NA PRO 95$ 4301439-0 CHYLMDT AG BY DFA 95$ 4301440-0 CHYLMD T DIR NA PRO 93$ 4301441-0 CHYLMDT NA QUAN 95$ 4301442-0 CHYLMD TRACH AG EIA 95$ 4301443-0 CHYLMD TRACH ASSAY W 95$ 4301444-0 CLOSTRIDIUM AG EIA 145$ 4301445-0 CLOTTING INHIBITOR P 242$ 4301446-0 CLOTTING; FACTOR VII 220$ 4301447-0 CLOTTING; FACTOR XII 210$

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Code Description Charge4301448-0 COLD AGGLUTININ; SCR 125$ 4301449-0 COMPATIBILITY TEST A 123$ 4301450-0 COMPATIBILITY TEST I 82$ 4301451-0 COOMBS TEST INDIRECT 50$ 4301452-0 COUNTER IEP EA AG 50$ 4301453-0 CPK: ISOENZYMES 87$ 4301454-0 CRYPTOCOCCUS NEOFORM 48$ 4301455-0 CRYPTOSPOR AG BY IFA 48$ 4301456-0 CULT FUNGUS W P ID; 65$ 4301457-0 CULT MYCOBACTERIA DE 174$ 4301458-0 CULTURE; GLC/HPLC 174$ 4301459-0 CYTOMEGALOVIRUS AG E 174$ 4301460-0 CYTOMEGALOVIRUS DFA 174$ 4301461-0 DEVIATE - STAND BB P 125$ 4301462-0 DFA SYPHILIS ANTIGEN 175$ 4301463-0 DIFFICULT CROSS MATC 165$ 4301464-0 DNA AB 165$ 4301465-0 DNA/RNA DIRECT PROBE 175$ 4301467-0 E COLI 0157 AG EIA 165$ 4301468-0 EIA HIV-1/HIV-2 SCRE 165$ 4301469-0 ELISA HIV-1/HIV-2 SC 165$ 4301470-0 ENTEROVIRUS AB BY DF 165$ 4302356-0 LEUKOREDUCED IRRAD P 315$ 4302357-0 LEUKO REDUCED PLATEL 612$ 4302358-0 PLATELETS PHERESIS E 315$ 4302359-0 PLATELETS PHERESIS I 300$ 4304859-0 FROZEN BLOOD FREEZE 150$ 4304860-0 RBC IRRADIATED EACH 250$ 4304861-0 QUAN SENSITIVY URINE 75$ 4304863-0 BLOOD DRAW FROM PORT 133$ 4304864-0 GLUCOSE BLD BY MONIT 31$ 4304865-0 URINE COLLECTION FEE 16$ 4304866-0 ANTIBIOTIC SENSITIVI 41$ 4304867-0 CHLAMYDIA T AMPLIF N 96$ 4304868-0 NEISSERIA AMPLIF NA 156$ 4304869-0 ARTERIAL PUNCT SWING 47$ 4304870-0 PROTEIN S FUNCTIONAL 77$ 4304871-0 BORDETELLA PERTUSSIS 90$ 4304872-0 CSF CELL COUNT 90$ 4304873-0 HGB CHROMATOGRAPHY 90$

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Code Description Charge4304874-0 STAT DRUG URINE 165$ 4304875-0 AEROBIC/ANAEROBIC CU 95$ 4304876-0 FRESH FROZEN PLASMA 605$ 4304877-0 VIRUS ISOL SHELL VIA 256$ 4304878-0 GENET VIRUS ISOLATE 256$ 4304879-0 QUANTIFERON TP GOLD 298$ 4304880-0 LYMES AMPLIFIED NA P 169$ 4304881-0 AB; PARVOVIRUS 71$ 4304882-0 ECUP TEST 50$ 4304883-0 GENET VIRUS ISOLATE 161$ 4304884-0 ENTEROVIRUS PROBE&RE 168$ 4305500-0 STAT AMYLASE, BODY F 8$ 4305501-0 STAT BASIC METABOLIC 10$ 4305502-0 STAT BILIRUBIN DIREC 8$ 4305504-0 STAT BILI TOT/DIR SE 12$ 4305505-0 STAT BILI TOT/DIR NE 12$ 4305506-0 STAT BUN 8$ 4305507-0 STAT CBC W DIFF/PLAT 10$ 4305508-0 STAT CHLORIDE SERUM 8$ 4305509-0 STAT CREATININE SERU 8$ 4305510-0 STAT DIGOXIN SERUM 16$ 4305511-0 STAT PHENYTOIN SERUM 16$ 4305512-0 STAT ELECTROLYTE PAN 35$ 4305513-0 STAT ESTRADIOL 35$ 4305514-0 STAT HCG QUAL URINE 9$ 4305515-0 STAT GLUCOSE SERUM 8$ 4305516-0 STAT HCG QUAL SERUM 12$ 4305517-0 STAT POTASSIUM SERUM 8$ 4305518-0 STAT PROGESTERONE 26$ 4305519-0 STAT PROTHROMBIN TIM 8$ 4305520-0 STAT PTT ACTIVATED 8$ 4305521-0 STAT SEDIMENTATION R 8$ 4305522-0 STAT SODIUM SERUM 8$ 4305523-0 STAT THEOPHYLLINE SE 18$ 4305524-0 STAT URINALYSIS ROUT 8$ 4305525-0 STAT BLOOD DRAW 10$ 4305526-0 STAT URINE COLLECTIO 3$ 4305527-0 CYTOMEGALOV AMPLIF N 174$ 4305528-0 CP CONCENTR TECH SME 102$ 4305529-0 HIV 1&2 AB QUAL 115$

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Code Description Charge4400001-0 ARIPIPRAZOLE 5MG TAB 93$ 4400002-0 ACETAMIN 325MG SUPP 6$ 4400003-0 ACETA/BUT 325-50 TAB 6$ 4400004-0 ACETYLCYS 200MG/ML 677$ 4400005-0 ACETAMIN 120MG SUPP 6$ 4400006-0 CODEINE/ACET ELIX 6$ 4400007-0 CODEINE/ACET TAB 6$ 4400008-0 ACETAZOLAMID 250MG T 9$ 4400009-0 ACETAZOLAMID 500MG C 13$ 4400010-0 ACETAZOL 500MG INJ 150$ 4400011-0 ACETYLCYS 200MG 30ML 75$ 4400012-0 ACETYLCYS 200MG 10ML 44$ 4400013-0 ACIDOPHILUS TAB 6$ 4400014-0 CHARCOAL/SOR 50GM LI 71$ 4400015-0 ACTIVATED CH 50GM LI 71$ 4400016-0 ACYCLOVIR 400MG TABS 11$ 4400017-0 ACYCLOVIR 500MG INJ 16$ 4400018-0 ADENOSINE 3MG/ML SDP 40$ 4400019-0 EPINEPHRINE 1MG/ML S 7$ 4400020-0 FLUTICASONE 100-50M 394$ 4400021-0 FLUTICASONE 250-50M 394$ 4400022-0 FLUTICASONE 500-50M 641$ 4400023-0 OXYMETAZOLIN SPRY 16$ 4400024-0 DIPYRIDAMOLE 200-25M 20$ 4400025-0 BACITRACIN/P 500-100 77$ 4400026-0 ALBUTEROL SU 0.83MG/ 6$ 4400027-0 ALBUTEROL SU 2MG/5ML 6$ 4400028-0 ALBUTEROL/IP 2.5-0.5 7$ 4400029-0 FEXOFENADINE 180MG T 6$ 4400030-0 CETIRIZINE H 10MG TA 7$ 4400031-0 ALLOPURINOL 100MG TA 6$ 4400032-0 ALPRAZOLAM 0.25MG TA 6$ 4400033-0 ALPRAZOLAM 0.5MG TAB 6$ 4400035-0 ETOMIDATE 2MG/ML SDV 35$ 4400036-0 AMIODARONE H 200MG T 6$ 4400037-0 AMIODARONE H 50MG/ML 8$ 4400038-0 AMITRIPTYLIN 10MG TA 6$ 4400039-0 AMITRIPTYLIN 25MG TA 6$ 4400040-0 AMLODIPINE B 10MG TA 7$ 4400041-0 AMLODIPINE B 2.5MG T 6$

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Code Description Charge4400042-0 AMLODIPINE B 5MG TAB 6$ 4400043-0 AMMONIUM LAC 0.12 CR 42$ 4400044-0 AMMONIUM LAC 224GM 55$ 4400045-0 AMOXICILLIN 250MG/5 6$ 4400046-0 AMOXICILLIN 400MG/5 6$ 4400047-0 AMOXICILLIN 500MG C 6$ 4400048-0 AMOXICILLIN 875MG T 6$ 4400049-0 AMOXICILLIN/ 400-57M 6$ 4400050-0 AMOXICILLIN/ 500-125 11$ 4400051-0 AMOXICILLIN/ 875-125 15$ 4400052-0 AMPHOTERICIN 50MG PW 137$ 4400053-0 AMPICILLIN S 1GM PWV 9$ 4400054-0 AMPICILLIN S 2GM PWV 12$ 4400055-0 AMPICILLIN S 500MG P 11$ 4400056-0 AMPICILLIN/S 1.5GM P 11$ 4400058-0 AMPICILLIN/S 3GM PWV 19$ 4400060-0 ANASTROZOLE 1MG TABS 6$ 4400061-0 LOPERAMIDE H 1MG/5ML 6$ 4400062-0 ANTIPYRINE/B 5.4-1.4 26$ 4400063-0 HYDROCORTISO 25MG SU 68$ 4400064-0 TUBERCULIN P 5TU 1ML 16$ 4400065-0 TUBERCULIN P 5TU 5ML 11$ 4400066-0 DARBEPOETIN 100MCG/ 24$ 4400067-0 DONEPEZIL HC 10MG TA 23$ 4400068-0 DONEPEZIL HC 5MG TAB 6$ 4400069-0 FONDAPARINUX 2.5MG/0 200$ 4400070-0 FONDAPARINUX 5MG/0.4 1,178$ 4400071-0 THYROID 60MG TABS 6$ 4400072-0 HERBAL/HOMEO GEL 6$ 4400073-0 ARTIFICIAL TEARS 6$ 4400074-0 MESALAMINE 400MG TAB 7$ 4400075-0 ASPIRIN 325MG TABS 6$ 4400076-0 ASPIRIN 325MG EC 6$ 4400077-0 ASPIRIN 81MG CHEW 6$ 4400078-0 ASPIRIN 81MG TABS 6$ 4400079-0 CANDESARTAN 16MG TA 10$ 4400080-0 CANDESARTAN 4MG TAB 11$ 4400081-0 CANDESARTAN 8MG TAB 10$ 4400082-0 ATROPINE SUL 0.01 DR 10$ 4400083-0 ATROPINE .1MG/M ANSY 6$

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Code Description Charge4400084-0 ATROPINE .1MG/M LSSY 6$ 4400085-0 IPRATROPIUM 17MCG A 851$ 4400086-0 DUTASTERIDE 0.5MG GC 17$ 4400087-0 AZITHROMYCIN 100MG/5 35$ 4400088-0 AZITHROMYCIN 250MG T 22$ 4400089-0 AZITHROMYCIN 500MG P 22$ 4400090-0 BRINZOLAMIDE 0.01 DR 576$ 4400091-0 VITAMIN B12/ 1000MCG 6$ 4400092-0 BACITRACIN 50MU PWVL 40$ 4400093-0 BACITRACIN Z 500U/GM 6$ 4400094-0 BACLOFEN 10MG TABS 6$ 4400095-0 BACLOFEN 20MG TABS 6$ 4400098-0 DICYCLOMINE 10MG/ML 83$ 4400099-0 BENZOIN SPRAY 6$ 4400100-0 BENZONATATE 100MG CA 6$ 4400101-0 BENZTROPINE 1MG/ML 198$ 4400102-0 POVIDONE-IOD 473ML 15$ 4400103-0 POVIDONE-IOD 946ML 15$ 4400104-0 BETAMETH ACE 6MG/ML 127$ 4400105-0 BISACODYL 10MG SUPP 6$ 4400106-0 BISACODYL 5MG TABS 6$ 4400109-0 DIPHTH PERTU SDPF 134$ 4400110-0 TDAP-BOOSTRIX OR ADA 134$ 4400112-0 ESMOLOL HCL 10MG/ML 26$ 4400114-0 BUMETANIDE 0.25MG/ML 8$ 4400115-0 BUMETANIDE 1MG TABS 6$ 4400116-0 BUPROPION HC 75MG TA 6$ 4400118-0 BUPROPION HC 150MG T 14$ 4400119-0 EXENATIDE 10MCG/0.04 26$ 4400120-0 CAFFEINE/SOD 250MG/M 38$ 4400121-0 CALAMINE 6$ 4400122-0 CALCIUM CARB 500MG C 6$ 4400123-0 CALCIUM CHLO 100MG/M 17$ 4400124-0 CALCIUM CIT/ 315MG-2 6$ 4400125-0 CALCIUM/VITA 1000MG- 6$ 4400126-0 CALAMINE/ZIN 13$ 4400127-0 EMOLLIENT/SK 14$ 4400128-0 CAPTOPRIL 12.5MG TAB 6$ 4400129-0 CAPTOPRIL 50MG TABS 6$ 4400130-0 CAPSAICIN 0.001 CRM 31$

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Code Description Charge4400131-0 CARBAMAZEPIN 200MG T 6$ 4400132-0 CARBIDOPA/LE 25-100M 6$ 4400133-0 CARISOPRODOL 350MG T 6$ 4400134-0 CARVEDILOL 12.5MG TA 7$ 4400135-0 CARVEDILOL 25MG TABS 6$ 4400136-0 CARVEDILOL 3.125MG T 6$ 4400137-0 CARVEDILOL 6.25MG TA 6$ 4400138-0 CLONIDINE 0.1MG PAT 100$ 4400140-0 CEFAZOLIN SO 1GM PWV 3$ 4400141-0 CEFEPIME HCL 1GM PWV 21$ 4400142-0 CEFACLOR 250MG CAPS 6$ 4400143-0 CEFOXITIN SO 1GM PWV 22$ 4400144-0 CEFPROZIL 125MG/5ML 6$ 4400145-0 CEFTAZIDIME 1GM PWV 17$ 4400146-0 CEFTRIAXONE 1GM PWV 3$ 4400147-0 CEFTRIAXONE 2GM PWV 3$ 4400148-0 CEFUROXIME A 500MG T 24$ 4400149-0 CEFUROXIME S 1.5GM P 20$ 4400150-0 CELECOXIB 100MG CAPS 16$ 4400151-0 MULTIVITAMIN TABS 6$ 4400152-0 BENZOCAINE/M 15-3.6M 6$ 4400153-0 CEPHALEXIN M 250MG C 6$ 4400154-0 CEPHALEXIN M 250MG/5 6$ 4400155-0 CEPHALEXIN M 500MG C 6$ 4400157-0 CHLORDIAZEPO 25MG CA 6$ 4400158-0 CHLORDIAZEPO 5MG CAP 6$ 4400159-0 CHOLESTYRAMI 4GM PCK 10$ 4400160-0 CIPROFLOXACI 500MG T 15$ 4400161-0 CIPROFLOXACI 250MG T 16$ 4400163-0 CIPROFLOXACI 10MG/ML 17$ 4400164-0 CITALOPRAM H 10MG TA 7$ 4400165-0 CITALOPRAM H 20MG TA 8$ 4400166-0 CITALOPRAM H 40MG TA 11$ 4400167-0 CITRIC ACID POWD 6$ 4400168-0 MAGNESIUM CI NOT AVA 6$ 4400169-0 CLINDAMYCIN 300MG C 12$ 4400170-0 CLINDAMYCIN 150MG C 6$ 4400171-0 CLINDAMYCIN 150MG/M 11$ 4400173-0 CLONAZEPAM 0.5MG TAB 6$ 4400174-0 CLONIDINE HC 0.1MG T 6$

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Code Description Charge4400175-0 CLONIDINE HC 100MCG/ 158$ 4400176-0 CLOTRIMAZOLE 35GM CR 24$ 4400177-0 CLOTRIMAZOLE 15GM CR 17$ 4400178-0 CLOTRIMAZOLE 30GM CR 33$ 4400179-0 CLOTRIMAZOLE 28GM CR 24$ 4400180-0 CLOTRIMAZOLE 10MG LO 6$ 4400181-0 CLOTRIMAZOLE 1-0.05% 103$ 4400182-0 COLCHICINE 0.6MG TAB 20$ 4400183-0 ALBUTEROL/IP 103-18M 779$ 4400184-0 BENZOIN COMP NOT AVA 15$ 4400185-0 CARVEDILOL P 40MG CA 21$ 4400186-0 CARVEDILOL P 80MG CA 21$ 4400187-0 CORTISONE AC 25MG TA 9$ 4400188-0 WARFARIN SOD 1MG TAB 6$ 4400189-0 WARFARIN SOD 2.5MG T 6$ 4400190-0 WARFARIN SOD 2MG TAB 6$ 4400191-0 WARFARIN SOD 3MG TAB 6$ 4400192-0 WARFARIN SOD 4MG TAB 6$ 4400193-0 WARFARIN SOD 5MG TAB 6$ 4400194-0 WARFARIN SOD 6MG TAB 8$ 4400195-0 WARFARIN SOD 7.5MG T 9$ 4400196-0 ROSUVASTATIN 10MG TA 23$ 4400197-0 ROSUVASTATIN 20MG TA 23$ 4400198-0 NORGESTREL/E 0.3-0.0 8$ 4400199-0 SOD THIOSULF NOT AVA 1,379$ 4400200-0 CYANOCOBALAM 1000MCG 14$ 4400202-0 CYCLOBENZAPR 10MG TA 6$ 4400203-0 CYCLOPENTOLA 0.005 D 219$ 4400204-0 DULOXETINE H 30MG CA 26$ 4400205-0 DANTROLENE S 25MG CA 6$ 4400206-0 TETANUS DIPH 5-2LFU 75$ 4400207-0 DEMECLOCYCLI 300MG T 51$ 4400208-0 METHYLPRED 400MG/10M 19$ 4400209-0 METHYLPRED 40MG/ML 30$ 4400210-0 METHYLPREDNI 80MG/ML 52$ 4400212-0 MICONAZOLE N 0.02 PO 17$ 4400213-0 ZINC OXIDE 0.4 OINT 6$ 4400214-0 DESMOPRESSIN 4MCG/ML 70$ 4400215-0 TOLTERODINE 4MG CAP 30$ 4400216-0 DEXAMETHASON 0.75MG 6$

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Code Description Charge4400217-0 DEXAMETHASON 10MG/ML 6$ 4400218-0 DEXAMETH 20MG/5ML 6$ 4400219-0 DEXAMETH 120MG/30ML 6$ 4400220-0 DEXAMETH 4MG/ML 6$ 4400221-0 DEXTROSE 25% 0.25 AN 25$ 4400222-0 DEXTROSE 50% 0.5 ANS 6$ 4400223-0 DEXTROSE 50% 0.5 LSS 34$ 4400224-0 DIAZEPAM 5MG/ML SYRN 9$ 4400225-0 DIAZEPAM 5MG/ML CARP 40$ 4400226-0 DIAZEPAM 5MG/ML MDV 7$ 4400227-0 DICLOXACILLI 500MG C 7$ 4400228-0 DICYCLOMINE 10MG CA 6$ 4400229-0 DIGOXIN IMMU 40MG PW 8,176$ 4400230-0 PHENYTOIN SO 100MG C 6$ 4400231-0 DILTIAZEM HC 30MG TA 6$ 4400232-0 DILTIAZEM 5MG/ML 5ML 7$ 4400233-0 DILTIAZEM 5MG/ML 25M 6$ 4400234-0 DILTIAZEM HC 90MG CA 6$ 4400235-0 DILTIAZEM 5MG/ML 10M 6$ 4400237-0 DILTIAZEM HC 120MG C 6$ 4400238-0 DILTIAZEM HC 180MG C 6$ 4400239-0 VALSARTAN 160MG TABS 17$ 4400240-0 DIPHENHYDRAM 12.5MG/ 6$ 4400241-0 DIPHENHYDRAM 25MG CA 6$ 4400242-0 DIPHENHYDRAM 50MG/ML 6$ 4400243-0 DIPHENOXYLAT 2.5-0.0 6$ 4400244-0 DIPYRIDAMOLE 50MG TA 6$ 4400245-0 DIPYRIDAMOLE 5MG/ML 3$ 4400246-0 DIVALPROEX S 250MG T 7$ 4400247-0 DIVALPROEX S 500MG T 10$ 4400248-0 DOBUTAMINE H 12.5MG/ 16$ 4400251-0 DOCUSATE SOD 100MG C 6$ 4400252-0 BELLADONNA A 16.2MG 28$ 4400253-0 BELLADONNA A 16.2MG/ 30$ 4400254-0 DOXAPRAM HCL 20MG/ML 8$ 4400255-0 DORZOLAMIDE/ 2-0.5% 203$ 4400256-0 DOXAZOSIN ME 2MG TAB 6$ 4400257-0 DOXAZOSIN ME 8MG TAB 6$ 4400258-0 DOXYCYCLINE 100MG P 55$ 4400259-0 DOXYCYCLINE 100MG T 6$

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Code Description Charge4400261-0 HYDROCOLLOID NOT AVA 22$ 4400263-0 DIFLUPREDNAT 0.0005 386$ 4400264-0 CARBAMIDE PE 0.065 D 8$ 4400265-0 PRASUGREL 10MG TABS 23$ 4400266-0 DARIFENACIN 15MG TAB 25$ 4400267-0 DARIFENACIN 7.5MG TA 25$ 4400268-0 ENALAPRIL MA 10MG TA 6$ 4400269-0 ENALAPRIL MA 5MG TAB 6$ 4400270-0 ENALAPRILAT 1.25MG/ 11$ 4400271-0 HEPATITIS B 20MCG/M 189$ 4400272-0 LACTOSE FREE NOT AVA 6$ 4400274-0 EPINEPHRINE 0.1MG/ML 22$ 4400275-0 ERYTHROMYCIN 250MG T 14$ 4400276-0 ERYTHROMYCIN 500MG P 156$ 4400277-0 ERYTHROMYCIN 5MG/GM 57$ 4400279-0 ETHYL CHLORI NOT AVA 10$ 4400282-0 RALOXIFENE H 60MG TA 24$ 4400283-0 SODIUM BORAT NOT AVA 10$ 4400284-0 FAMOTIDINE 10MG/ML S 6$ 4400285-0 FAMOTIDINE 20MG TABS 6$ 4400286-0 FENTANYL 100MCG/HR P 185$ 4400287-0 FENTANYL 25MCG/HR PT 50$ 4400288-0 FENTANYL 50MCG/HR PT 79$ 4400289-0 FENTANYL CIT 0.05MG/ 6$ 4400290-0 FERROUS SULF 325MG T 6$ 4400291-0 FERROUS SULF 220MG/5 6$ 4400292-0 FERROUS SULF 300MG/5 6$ 4400293-0 ACETAMINOPHE 120MG S 6$ 4400294-0 CALCIUM POLY 625MG T 6$ 4400295-0 FINASTERIDE 5MG TABS 10$ 4400296-0 HYDROCORTISO 0.1 GEL 288$ 4400297-0 DICLOFENAC E 0.013 P 27$ 4400298-0 SODIUM PHOS NOT AVA 6$ 4400300-0 FLUTICASONE 110MCG 655$ 4400301-0 FLUCONAZOLE 150MG TA 42$ 4400302-0 FLUDROCORTIS 0.1MG T 6$ 4400303-0 FLUMAZENIL 0.1MG/ML 6$ 4400304-0 FLUPHENAZINE 2.5MG T 6$ 4400305-0 FLURBIPROFEN 0.0003 26$ 4400306-0 FLUTICASONE 50MCG S 226$

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Code Description Charge4400307-0 FOLIC ACID 1MG TABS 6$ 4400308-0 FOLIC ACID 5MG/ML MD 6$ 4400309-0 FOMEPIZOLE 1GM/ML SD 4,095$ 4400311-0 FUROSEMIDE 10MG/ML S 13$ 4400312-0 FUROSEMIDE 20MG TABS 6$ 4400313-0 FUROSEMIDE 40MG TABS 6$ 4400315-0 GABAPENTIN 100MG CAP 6$ 4400316-0 GABAPENTIN 400MG CAP 6$ 4400317-0 GABAPENTIN 300MG CAP 6$ 4400318-0 GEMFIBROZIL 600MG TA 13$ 4400319-0 GENTAMICIN S 0.003 O 59$ 4400320-0 GENTAMICIN S 0.001 O 99$ 4400321-0 GENTAMICIN S 0.003 D 64$ 4400322-0 GENTAMICIN S 40MG/ML 12$ 4400323-0 ARTIFICIAL T 0.003 G 23$ 4400325-0 AMMONIUM LAC 8 OZ 23$ 4400326-0 GLIMEPIRIDE 4MG TABS 6$ 4400327-0 GLIPIZIDE 5MG TABS 6$ 4400330-0 GLUCAGON HUM 1MG KIT 706$ 4400333-0 GLIPIZIDE 2.5MG TABS 6$ 4400334-0 DEXTROSE 0.4 GEL 12$ 4400335-0 GLYBURIDE 5MG TABS 6$ 4400336-0 GUAIFENESIN 100MG/5M 6$ 4400337-0 GUAIFEN/DM 100-10MG/ 6$ 4400338-0 GUAIFEN/COD 100-10MG 6$ 4400339-0 HALOPERIDOL 0.5MG TA 6$ 4400340-0 HALOPERIDOL 1MG TABS 6$ 4400341-0 HALOPERIDOL 5MG/ML 108$ 4400342-0 HEPATITIS A 1440ELU 227$ 4400344-0 HEPARIN SOD 100UNIT 10$ 4400346-0 HEPARIN SOD 10UNITS 9$ 4400347-0 HEPARIN SOD 5000UNI 9$ 4400348-0 INSULIN LISP 100U/ML 6$ 4400350-0 HUMIDIFIER NOT AVAIL 161$ 4400353-0 INSULIN NPH 100U/ML 6$ 4400354-0 INSULIN REG 100U/ML 6$ 4400355-0 HYDRALAZINE 20MG/ML 45$ 4400356-0 HYDRALAZINE 25MG TA 6$ 4400357-0 EMOLLIENT/SK NOT AVA 13$ 4400358-0 HYDROCHLOROT 12.5MG 6$

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Code Description Charge4400359-0 HYDROCHLOROT 25MG TA 6$ 4400361-0 HYDROCOD/ACE 5-500MG 6$ 4400362-0 HYDROCORTISO 0.01 CR 14$ 4400363-0 HYDROCORTISO 0.025 C 31$ 4400364-0 HYDROCORTISO 10MG TA 6$ 4400365-0 HYDROCORTISO 0.01 PC 6$ 4400367-0 HYDROMORPHON 2MG TAB 6$ 4400368-0 HYDROMORPHON 2MG/ML 6$ 4400370-0 HYDROMORPHON 4MG TAB 6$ 4400371-0 HYDROXYZINE 10MG/5M 6$ 4400372-0 HYDROXYZINE 25MG/ML 11$ 4400373-0 HYDROXYZINE 25MG CA 6$ 4400375-0 HYOSCYAMINE 0.125MG 6$ 4400376-0 SODIUM CHLOR 0.07 AM 6$ 4400377-0 IBUPROFEN 100MG/5ML 6$ 4400378-0 IBUPROFEN 200MG TABS 6$ 4400379-0 IBUPROFEN 400MG TABS 6$ 4400380-0 IBUPROFEN 600MG TABS 6$ 4400383-0 IBUPROFEN 800MG TABS 6$ 4400384-0 IBUTILIDE FU 0.1MG/M 1,008$ 4400385-0 IMIPRAMINE H 10MG TA 6$ 4400386-0 INDAPAMIDE 2.5MG TAB 6$ 4400387-0 INDOMETHACIN 25MG CA 6$ 4400388-0 MULTIVITAMIN SDV 32$ 4400389-0 EPTIFIBATIDE 0.75MG/ 1,622$ 4400390-0 EPTIFIBAT 20MG/10ML 518$ 4400391-0 EPTIFIB 200MG/100ML 4,483$ 4400392-0 ERTAPENEM SO 1GM PWV 140$ 4400393-0 IPRATROPIUM 0.2MG/M 6$ 4400394-0 ISOSORBIDE M 30MG TA 6$ 4400395-0 ISOPROTERENO 0.2MG/M 175$ 4400396-0 SITAGLIPTIN 50MG TA 36$ 4400398-0 TRIAMCINOL 200MG/5ML 31$ 4400399-0 TRIAMCINOLON 40MG/ML 31$ 4400400-0 KETAMINE HCL 50MG/ML 22$ 4400401-0 KETOCONAZOLE CR 15 156$ 4400402-0 KETOCONAZOLE CR 30 237$ 4400403-0 KETOCONAZOLE CR 60 93$ 4400404-0 KETOROLAC TR 0.004 D 317$ 4400405-0 KETOROLAC 30MG/ML 7$

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Code Description Charge4400406-0 KETOROLAC 60MG/2ML 2$ 4400407-0 POTASSIUM CH 8MEQ TA 6$ 4400408-0 POTASSIUM CH 10MEQ T 6$ 4400409-0 LABETALOL HC 100MG T 6$ 4400410-0 LABETALOL HC 200MG T 6$ 4400411-0 LABETALOL 5MG/ML CAR 13$ 4400412-0 LABETALOL 5MG/ML MDV 6$ 4400413-0 LACTULOSE 10GM/15ML 6$ 4400414-0 DIGOXIN 0.125MG TABS 9$ 4400415-0 INSULIN GLAR 100U/ML 269$ 4400416-0 LEVOCARNITIN 500MG T 6$ 4400417-0 MAGNESIUM HY 200-200 6$ 4400418-0 MAGNESIUM HY 400-400 6$ 4400419-0 MENTHOL 7MG LOZG 6$ 4400420-0 ACETAMINOPHE 500MG G 6$ 4400422-0 LEFLUNOMIDE 10MG TAB 49$ 4400423-0 LETROZOLE 2.5MG TABS 54$ 4400424-0 LEVOFLOXACIN 250MG T 26$ 4400425-0 LEVOFLOXACIN 500MG T 57$ 4400426-0 LEVOFLOXACIN 750MG T 168$ 4400427-0 INSULIN DETE 100U/ML 240$ 4400428-0 LEVETIRACETA 100MG/M 6$ 4400429-0 LEVETIRACETA 250MG T 9$ 4400430-0 LEVETIRACETA 500MG T 11$ 4400431-0 LEVETIRACETA 500MG/5 18$ 4400433-0 NOREPINEPHRI 1MG/ML 13$ 4400435-0 ESCITALOPRAM 10MG TA 13$ 4400436-0 REGADENOSON 0.08MG/M 789$ 4400437-0 LIDOCAINE 0.05 OINT 900$ 4400438-0 LIDOCAINE HC 20 ML 6$ 4400439-0 LIDOCAINE HC 10 ML 6$ 4400440-0 LIDOCAINE HC 0.02 30 6$ 4400441-0 LIDOCAINE HC 0.02 10 23$ 4400442-0 LIDOCAINE HC 0.02 LS 9$ 4400443-0 LIDOCAINE HC 0.02 50 6$ 4400444-0 LIDOCAINE HC 0.02 SD 6$ 4400445-0 LIDOCAINE HC 0.02 25 6$ 4400446-0 LIDOCAINE HC 5-7.5% 25$ 4400447-0 LIDOCAINE HC 0.02 SO 43$ 4400448-0 LIDOCAINE/EP 1-0. 20 6$

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Code Description Charge4400449-0 LIDOCAINE/EP 2-0. 30 6$ 4400450-0 LIDOCAINE/PR 2.5-2.5 24$ 4400451-0 LIDOCAINE 0.05 PTCH 31$ 4400452-0 ATORVASTATIN 10MG TA 6$ 4400453-0 ATORVASTATIN 40MG TA 6$ 4400454-0 LISINOPRIL 10MG TABS 6$ 4400455-0 LISINOPRIL 20MG TABS 6$ 4400456-0 LISINOPRIL 40MG TABS 6$ 4400457-0 LISINOPRIL 5MG TABS 6$ 4400458-0 LISINOPRIL/H 20-25MG 6$ 4400459-0 LIDOCAINE 0.04 CRM15 80$ 4400460-0 LIDOCAINE 0.04 CRM30 147$ 4400461-0 LIDOCAINE 0.04 CRM 5 30$ 4400462-0 LOPERAMIDE H 2MG CAP 6$ 4400463-0 LORATADINE 10MG TABS 6$ 4400465-0 LORAZEPAM 0.5MG TABS 6$ 4400466-0 LORAZEPAM 2MG/ML SDV 6$ 4400467-0 LORAZEPAM 4MG/ML SDV 6$ 4400468-0 LORAZEPAM 2MG/ML CON 6$ 4400469-0 LOVASTATIN 20MG TABS 6$ 4400470-0 OMEGA-3-ACID 1GM GCA 6$ 4400471-0 ENOXAPARIN S 100MG/M 30$ 4400472-0 ENOXAPARIN S 30MG/0. 20$ 4400473-0 ENOXAPARIN S 40MG/0. 20$ 4400474-0 BIMATOPROST 0.0001 D 416$ 4400475-0 BIMATOPROST 0.0003 D 349$ 4400476-0 PREGABALIN 25MG CAPS 16$ 4400477-0 PREGABALIN 50MG CAPS 17$ 4400478-0 MAGNESIUM HY NOT AVA 16$ 4400479-0 MAGNESIUM OX 400MG T 6$ 4400481-0 MAGNESIUM 4MEQ/ML 10 6$ 4400482-0 MAGNESIUM 4MEQ/ML 2M 6$ 4400483-0 BUPIVACAINE 2.5MG/M 6$ 4400484-0 BUPIVACAINE 5MG/ML 6$ 4400485-0 BUPIVACAINE/ 7.5MG/M 14$ 4400486-0 MECLIZINE HC 12.5MG 6$ 4400487-0 MECLIZINE HC 25MG TA 6$ 4400488-0 MEGESTROL AC 625MG/5 91$ 4400489-0 MENINGOCOCCA NOT AVA 443$ 4400490-0 METHYL SALIC NOT AVA 6$

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Code Description Charge4400491-0 PSYLLIUM NOT AVAILAB 6$ 4400492-0 METFORMIN HC 500MG T 6$ 4400493-0 METFORMIN HC 1000MG 6$ 4400496-0 METFORMIN HC 750MG T 6$ 4400497-0 METHADONE HC 10MG TA 6$ 4400498-0 METHIMAZOLE 5MG TABS 6$ 4400499-0 METHOTREXATE 2.5MG T 19$ 4400500-0 METHYLENE BL 0.01 SD 155$ 4400501-0 METOCLOPRAMI 10MG TA 6$ 4400502-0 METOCLOPRAMI 5MG/ML 6$ 4400503-0 METOCLOPRAMI 5MG TAB 6$ 4400504-0 METOLAZONE 2.5MG TAB 6$ 4400505-0 METOLAZONE 5MG TABS 7$ 4400507-0 METOPROLOL T 100MG T 6$ 4400508-0 METOPROLOL T 1MG/ML 6$ 4400510-0 METOPROLOL T 25MG TA 6$ 4400511-0 METOPROLOL T 50MG TA 6$ 4400512-0 METRONIDAZOL 250MG T 6$ 4400513-0 METRONIDAZOL 500MG T 6$ 4400514-0 MICONAZOLE N 0.02 CR 26$ 4400515-0 MIDAZOLAM HC 1MG/ML 6$ 4400517-0 MIDAZOLAM HC 5MG/ML 6$ 4400518-0 MIDODRINE HC 2.5MG T 6$ 4400519-0 MAGNESIUM HY 400MG/5 6$ 4400521-0 MOMETASONE F 0.001 O 55$ 4400522-0 MORPHINE SUL 10MG/5M 6$ 4400523-0 MORPHINE SUL 10MG/ML 6$ 4400524-0 MORPHINE SUL 15MG TA 6$ 4400525-0 MORPHINE SUL 1MG/ML 27$ 4400526-0 MORPHINE SUL 20MG/ML 6$ 4400527-0 MORPHINE SUL 5MG/ML 6$ 4400528-0 IBUPROFEN 200MG CAPS 6$ 4400529-0 GUAIFENESIN 600MG TA 6$ 4400530-0 DRONEDARONE 400MG TA 26$ 4400531-0 MUPIROCIN 0.02 OINT 34$ 4400532-0 NABUMETONE 500MG TAB 6$ 4400533-0 NADOLOL 40MG TABS 12$ 4400534-0 NAFCILLIN SO 1GM PWV 40$ 4400535-0 NAFCILLIN SO 2GM PWV 104$ 4400536-0 NALBUPHINE H 10MG/ML 11$

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Code Description Charge4400537-0 NALOXONE HCL .4 10ML 9$ 4400538-0 NALOXONE HCL .4 1ML 56$ 4400539-0 NALOXONE HCL 1MG/ML 59$ 4400540-0 MEMANTINE HC 5MG TAB 19$ 4400541-0 NAPROXEN 250MG TABS 6$ 4400542-0 NAPROXEN 500MG TABS 6$ 4400543-0 NAPROXEN SOD 220MG T 6$ 4400544-0 ROPIVACAINE 10MG/ML 41$ 4400545-0 ROPIVACAI 20MG/10ML 18$ 4400546-0 ROPIVACAI 200MG/100M 15$ 4400547-0 ROPIVACAINE 5MG/ML 52$ 4400548-0 OXYMETAZOLIN 0.0005 9$ 4400549-0 NEOMYCIN/POL 0.001 D 132$ 4400550-0 NEOMYCIN/POL NOT AVA 186$ 4400551-0 NEOMYCIN/POL 0.01 DR 93$ 4400552-0 NEOSTIGMINE 0.73611 51$ 4400553-0 PHENYLEPHRIN 0.01 SP 13$ 4400554-0 FILGRASTIM 480MCG/1. 1,703$ 4400558-0 NIACIN (VITA 500MG T 15$ 4400559-0 NICOTINE 21MG/24HR P 7$ 4400560-0 NICOTINE 14MG/24HR P 8$ 4400563-0 NICOTINE 7MG/24HR PT 7$ 4400564-0 NIFEDIPINE 30MG TABS 6$ 4400565-0 NITROGLYCERI 0.02 OI 8$ 4400566-0 NITROFURANTO 100MG C 10$ 4400567-0 NITROGLYCERI 0.4MG/H 6$ 4400568-0 NITROGLYCERI 5MG/ML 26$ 4400569-0 NITROGLYCERI 6.5MG C 6$ 4400570-0 NITROGLYCERI 0.1MG/M 25$ 4400571-0 NITROGLYCERI 0.2MG/H 6$ 4400572-0 NITROPRUSSID 25MG/ML 774$ 4400573-0 NITROGLYCERI 0.4MG T 6$ 4400576-0 INSULIN NPH 70-30U/ 6$ 4400577-0 INSULIN ASPA 100U/ML 6$ 4400578-0 NYSTATIN 100MU/GM PO 112$ 4400579-0 NYSTATIN 100MU CR 15 53$ 4400580-0 NYSTATIN 100MU CR 30 79$ 4400581-0 NYSTATIN 100MU/ML SU 6$ 4400582-0 NYSTATIN/TRI 100MU-0 336$ 4400583-0 OCTREOTIDE A 0.1MG/M 36$

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Code Description Charge4400584-0 OFLOXACIN 0.003 DROP 68$ 4400585-0 FISH OIL 1000MG GCAP 6$ 4400586-0 OMEPRAZOLE 20MG CAPS 12$ 4400587-0 OMEPRAZOLE 40MG CAPS 22$ 4400588-0 ONDANSETRON 20ML 6$ 4400589-0 ONDANSETRON 4MG/ML 6$ 4400590-0 ONDANSETRON 4MG TDIS 67$ 4400591-0 FOAM BANDAGE NOT AVA 10$ 4400592-0 GADOVERS 330.9 SV 10 135$ 4400593-0 GADOVERS 330.9 SV 15 202$ 4400594-0 GADOVERS 330.9 SV 20 269$ 4400595-0 GADOVERS 330.9 SR 10 14$ 4400596-0 GADOVERS 330.9 SR 15 147$ 4400597-0 GADOVERS 330.9 SR 20 14$ 4400598-0 OXYBUTYNIN C 5MG TAB 6$ 4400600-0 OXYCODONE HC 5MG TAB 6$ 4400601-0 OXYCODONE/AC 5-325MG 6$ 4400602-0 OXYCODONE HC 10MG TA 9$ 4400603-0 OXYCODONE HC 20MG TA 16$ 4400604-0 OXYTOCIN 10U/ML SDV 6$ 4400605-0 AMYLASE/LIPA 5000U C 6$ 4400606-0 PANTOPRAZOLE 40MG TA 12$ 4400608-0 PAROXETINE H 10MG TA 8$ 4400609-0 PAROXETINE H 40MG TA 9$ 4400610-0 OLOPATADINE 0.001 D 684$ 4400611-0 PAROXETINE H 10MG/5M 6$ 4400615-0 PENICILLIN V 250MG/5 6$ 4400616-0 PENICILLIN V 500MG T 6$ 4400617-0 PHENAZOPYRID 100MG T 6$ 4400618-0 PHENYLEPHRIN 0.025 D 70$ 4400619-0 PHENYLEPHRIN 10MG/ML 43$ 4400620-0 PHENYTOIN SO 50MG/ML 6$ 4400621-0 SODIUM PHOS/ NOT AVA 6$ 4400624-0 PILOCARPINE 0.01 DR 279$ 4400625-0 CLOPIDOGREL 300MG T 93$ 4400626-0 CLOPIDOGREL 75MG TA 6$ 4400627-0 PNEUMOCOCCAL 25 MDV 261$ 4400628-0 PNEUMOCOCCAL 25 SDV 261$ 4400629-0 POLYETHYLENE 17GM PK 6$ 4400631-0 POLYMYXIN B 10MU-0. 40$

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Code Description Charge4400632-0 POTASSIUM CH 20MEQ T 6$ 4400633-0 POTASSIUM 20MEQ/15ML 6$ 4400634-0 POTASSIUM 20MEQ/10ML 9$ 4400635-0 POTASSIUM 40MEQ/20ML 12$ 4400637-0 POTASSIUM PH 3MMOL/M 10$ 4400638-0 DABIGATRAN E 75MG CA 13$ 4400639-0 PRAMIPEXOLE 0.25MG 9$ 4400640-0 PRAMIPEXOLE 1MG TAB 6$ 4400641-0 REPAGLINIDE 1MG TABS 19$ 4400642-0 PRAVASTATIN 80MG TA 14$ 4400643-0 PRAVASTATIN 20MG TA 10$ 4400644-0 PREDNISOLONE 15MG/5M 7$ 4400645-0 PREDNISOLONE 0.01 DR 166$ 4400646-0 PREDNISONE 10MG TABS 6$ 4400647-0 PREDNISONE 20MG TABS 6$ 4400648-0 PREDNISONE 5MG TABS 6$ 4400649-0 ADHESIVE BAN NOT AVA 6$ 4400650-0 IMIPENEM/CIL 250MG P 35$ 4400651-0 IMIPENEM/CIL 500MG P 19$ 4400652-0 PRIMIDONE 50MG TABS 6$ 4400653-0 PROCHLORPERA 5MG/ML 67$ 4400654-0 EPOETIN ALFA 3000U/M 77$ 4400655-0 PROMETHAZINE 6.25MG/ 6$ 4400656-0 PROMETHAZINE 25MG/ML 6$ 4400657-0 PROMETHAZINE 25MG TA 6$ 4400658-0 PROMETHAZINE 12.5MG 53$ 4400659-0 PROMETHAZINE 25MG SU 53$ 4400660-0 PROPOFOL 10MG/ML 10 22$ 4400661-0 PROPOFOL 10MG/ML 100 113$ 4400662-0 PROPRANOLOL 10MG TA 6$ 4400663-0 PROPRANOLOL 1MG/ML 30$ 4400664-0 PROPYLTHIOUR 50MG TA 6$ 4400667-0 PANTOPRAZOLE 40MG PW 18$ 4400668-0 BUDESONIDE 0.5MG/2ML 37$ 4400669-0 RESPIRATORY NOT AVA 99$ 4400670-0 TETRACYC HCL 125-140 16$ 4400671-0 PYRIDOXINE H 100MG/M 34$ 4400672-0 ACETAMIN 160MG/5 ELI 6$ 4400673-0 ACETAMIN 160MG/5 SUS 6$ 4400674-0 QUININE SULF 324MG C 24$

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Code Description Charge4400675-0 SUCCINYLCHOL 20MG/ML 1$ 4400676-0 RANOLAZINE 500MG TAB 16$ 4400677-0 INFLIXIMAB 100MG PWV 334$ 4400678-0 SEVELAMER HC 400MG T 10$ 4400680-0 CYCLOSPORINE 0.0005 20$ 4400681-0 PHARMACY SUP NOT AVA 6$ 4400682-0 RIBAVIRIN 200MG CAPS 30$ 4400683-0 RISPERIDONE 0.25MG T 11$ 4400684-0 ROCURONIUM B 10MG/ML 25$ 4400685-0 ROPINIROLE H 0.25MG 6$ 4400686-0 RACEPINEPHRI 0.0225 6$ 4400687-0 SODIUM CHLOR 0.0065 7$ 4400688-0 COLLAGENASE 250U/GM 669$ 4400689-0 MILNACIPRAN 25MG TA 12$ 4400690-0 SENNOSIDES 8.6MG TAB 6$ 4400691-0 CINACALCET H 30MG TA 66$ 4400693-0 QUETIAPINE F 100MG T 21$ 4400694-0 QUETIAPINE F 25MG TA 14$ 4400695-0 SERTRALINE H 100MG T 8$ 4400696-0 SERTRALINE H 50MG TA 6$ 4400697-0 SEVOFLURANE NOT AVAI 6$ 4400698-0 SILVER DRESS NOT AVA 92$ 4400699-0 SILVER NITRA NOT AVA 6$ 4400700-0 SIMETHICONE 80MG CHE 6$ 4400701-0 SIMVASTATIN 10MG TAB 8$ 4400702-0 SIMVASTATIN 40MG TAB 15$ 4400704-0 MONTELUKAST 10MG TA 17$ 4400705-0 SODIUM BICAR 0.5MEQ/ 6$ 4400706-0 SODIUM BICAR 1MEQ/ML 22$ 4400707-0 SODIUM BICAR 325MG T 6$ 4400708-0 SODIUM CHLOR 0.009 A 6$ 4400709-0 SODIUM CHLOR 0.009 M 6$ 4400710-0 SODIUM CHLOR 0.009 S 6$ 4400711-0 GEL DRESSING NOT AVA 6$ 4400712-0 HYDROCORTISO 100MG P 25$ 4400713-0 METHYLPREDNI 125MG P 19$ 4400714-0 METHYLPREDNI 40MG PW 12$ 4400715-0 SOTALOL HCL 80MG TAB 6$ 4400716-0 TIOTROPIUM B 18MCG A 57$ 4400717-0 SPIRONOLACTO 25MG TA 6$

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Code Description Charge4400718-0 BENZOIN NOT AVAILABL 27$ 4400719-0 SODIUM POLYS 15GM/60 34$ 4400720-0 SILVER SULFA CR 50GM 45$ 4400721-0 SILVER SULFA CR 400G 234$ 4400722-0 POTASSIUM IO 1GM/ML 68$ 4400723-0 MISC MEDICAL NOT AVA 6$ 4400724-0 SUCRALFATE 1GM TABS 6$ 4400725-0 PSEUDOEPHEDR 30MG TA 6$ 4400726-0 SUFENTANIL C 50MCG/M 27$ 4400727-0 SULFACETAMID 0.1 DRO 183$ 4400728-0 SULFAMETHOXA 800-160 6$ 4400729-0 SUMATRIPTAN 6MG/0.5 94$ 4400735-0 BUDESONIDE/F 160-4.5 622$ 4400736-0 LEVOTHYROXIN 100MCG 6$ 4400737-0 LEVOTHYROXIN 150MCG 6$ 4400738-0 LEVOTHYROXIN 200MCG 6$ 4400739-0 LEVOTHYROXIN 25MCG T 6$ 4400740-0 LEVOTHYROXIN 50MCG T 6$ 4400741-0 LEVOTHYROXIN 75MCG T 6$ 4400742-0 LEVOTHYROXIN 88MCG T 6$ 4400743-0 HYALURONATE 8MG/ML 167$ 4400744-0 OSELTAMIVIR 75MG CA 44$ 4400745-0 TAMOXIFEN CI 10MG TA 6$ 4400746-0 TAMSULOSIN H 0.4MG C 6$ 4400747-0 TEMAZEPAM 15MG CAPS 6$ 4400748-0 TERBUTALINE 1MG/ML 65$ 4400749-0 TETRACAINE H 0.005 D 30$ 4400750-0 TETRACYCLINE 250MG C 6$ 4400751-0 THEOPHYLLINE 200MG T 6$ 4400752-0 THEOPHYLLINE 300MG T 6$ 4400753-0 MULTIVIT/CA/ NOT AVA 6$ 4400754-0 MULTIVIT/MIN NOT AVA 6$ 4400755-0 MULTIVITAMIN LIQD 6$ 4400756-0 THIAMINE HCL 100MG/M 37$ 4400757-0 STARCH NOT AVAILABLE 6$ 4400758-0 THROMBIN 5MU PWVL 258$ 4400759-0 TRIMETHOBENZ 100MG/M 39$ 4400760-0 TICARCILLIN/ 3.1GM P 48$ 4400761-0 TIMOLOL MALE 0.005 D 54$ 4400762-0 TENECTEPLASE 50MG KI 14,950$

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Code Description Charge4400763-0 TOBRAMYCIN/D 0.3-0.1 79$ 4400764-0 TOPIRAMATE 25MG TABS 6$ 4400765-0 TOPIRAMATE 50MG TABS 15$ 4400766-0 METOPROLOL S 25MG TA 6$ 4400767-0 METOPROLOL S 50MG TA 6$ 4400768-0 TRAMADOL HCL 50MG TA 6$ 4400769-0 SCOPOLAMINE 1.5MG/72 65$ 4400770-0 TRAZODONE HC 50MG TA 6$ 4400771-0 METHOTREXATE 7.5MG T 20$ 4400772-0 TRIAMCINOLON 0.005 O 30$ 4400773-0 TRIAMTERENE/ 37.5-25 6$ 4400774-0 TRIHEXYPHENI 2MG TAB 6$ 4400775-0 FENOFIBRIC A 135MG C 23$ 4400776-0 TROPICAMIDE 0.01 DRO 30$ 4400777-0 PRAMOXINE/MO 1-46.6- 6$ 4400778-0 WITCH HAZEL 12 EA 6$ 4400779-0 WITCH HAZEL 40 EA 6$ 4400782-0 TIGECYCLINE 50MG PWV 365$ 4400783-0 ACETAMINOPHE 325MG T 6$ 4400784-0 FEBUXOSTAT 40MG TABS 28$ 4400785-0 VALACYCLOVIR 500MG T 22$ 4400786-0 VALPROATE SO 100MG/M 13$ 4400787-0 VALACYCLOVIR 1GM TAB 45$ 4400788-0 VANCOMYCIN H 250MG C 173$ 4400789-0 VANCOMYCIN H 1GM PWV 11$ 4400790-0 VANCOMYCIN H 500MG P 14$ 4400791-0 VASOPRESSIN 10U/.5ML 9$ 4400792-0 VASOPRESSIN 20U/ML M 90$ 4400793-0 VENLAFAXINE 37.5MG 6$ 4400794-0 ALBUTEROL SU NOT AVA 61$ 4400795-0 ALBUTEROL SU 90MCG A 41$ 4400796-0 VERAPAMIL HC 120MG T 6$ 4400797-0 VERAPAMIL HC 2.5MG/M 95$ 4400798-0 VERAPAMIL HC 40MG TA 6$ 4400800-0 SOLIFENACIN 5MG TAB 27$ 4400801-0 VINCRISTINE 1MG/ML 18$ 4400802-0 VITA B COMPL NOT AVA 6$ 4400803-0 CYANOCOBALAM 500MCG 6$ 4400804-0 ASCORBIC ACI 500MG T 6$ 4400805-0 VITAMIN D 1000U TABS 6$

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Code Description Charge4400806-0 VITAMIN D 400U GCAP 6$ 4400807-0 VITAMIN D 400U TABS 6$ 4400808-0 VITAMIN E 400U CAPS 6$ 4400809-0 VITAMIN K (P 10MG/ML 113$ 4400810-0 WATER STERIL 10ML 6$ 4400811-0 WATER STERIL 50ML 7$ 4400812-0 LATANOPROST 0.00005 285$ 4400813-0 RIFAXIMIN 200MG TABS 53$ 4400814-0 LEVALBUTEROL 0.31MG/ 20$ 4400815-0 LEVALBUTEROL 0.63MG/ 20$ 4400816-0 LEVALBUTEROL 1.25MG/ 20$ 4400817-0 LEVALBUTEROL 45MCG A 185$ 4400818-0 LIDOCAINE/EP 1-0. 10 6$ 4400819-0 LIDOCAINE/EP 2-0. 20 6$ 4400820-0 EZETIMIBE 10MG TABS 24$ 4400821-0 ZINC GLUCONA 50MG TA 6$ 4400822-0 ZINC SULFATE 220MG C 6$ 4400824-0 ZOLPIDEM TAR 5MG TAB 14$ 4400825-0 ZOSTER VACCI NOT AVA 427$ 4400826-0 PIPERACILLIN 3.375GM 37$ 4400827-0 ACYCLOVIR 0.05 OINT 602$ 4400828-0 OLANZAPINE 2.5MG TAB 37$ 4400829-0 OLANZAPINE 5MG TABS 40$ 4401235-0 CEPACOL 3 MG 6$ 4401236-0 CMPND BENZ SWAB 100 6$ 4401237-0 ATORVASTATIN 10MG 6$ 4401238-0 CLINDAMYCIN 300M INJ 9$ 4401240-0 LOVENOX 100 MG 20$ 4401242-0 LOVENOX 120 MG 20$ 4401243-0 LOVENOX 150 MG 20$ 4401244-0 BUDESONIDE NEB SOL 0 28$ 4401245-0 BUDESONIDE NEB SOL 0 33$ 4401246-0 ONDANSETRON 4 MG TAB 74$ 4401247-0 NAMENDA 10 MG TABLET 19$ 4401248-0 CEFTRIAXONE 1 GM 10$ 4401249-0 CEFAZOLIN 1 GM 8$ 4401250-0 JANUVIA 25 MG 36$ 4401251-0 CYMBALTA 20 MG 23$ 4401253-0 BENZTROPINE 1 MG 6$ 4401254-0 DEXAMETHASONE 1 MG 6$

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Code Description Charge4401255-0 ZOSYN 2.25 G 25$ 4401256-0 DEXAMETHASONE 4 MG 6$ 4401257-0 CRESTOR 10 MG 6$ 4401258-0 SERTALINE 25 MG 6$ 4401259-0 ACETYLCYSTEINE 4 ML 46$ 4401260-0 ASPIRIN 325 MG 6$ 4401261-0 PROPRANOLOL 10 MG 6$ 4401262-0 DOCUSATE 100 MG CAP 6$ 4401263-0 MINERAL OIL 6$ 4401264-0 CYCLOBENZAPRINE 5 MG 6$ 4401265-0 VENLAFAXINE XR 37.5 11$ 4401266-0 GLIPIZIDE ER 5 MG 6$ 4401267-0 CUBICIN INJ 500MG 3$ 4401268-0 LISINOPRIL 5 MG TAB 6$ 4401269-0 ATORVASTATIN 10 MG 6$ 4401270-0 PREVACID SOLUTAB 15 37$ 4401271-0 ROPINEROLE 1 MG TAB 6$ 4401272-0 TRIPLE ANTIBIOT OINT 6$ 4401273-0 PROCHLOR SUPPOS 25 M 40$ 4401274-0 DOCUSATE LIQ 50 MG 6$ 4401275-0 MEGESTEROL SUSP 40MG 6$ 4401276-0 COENZYME Q 10 CAP 6$ 4401277-0 AMINOPHYLLINE 250INJ 13$ 4401278-0 TYLENOL XTRA ST 500M 6$ 4401279-0 ORTHOVISC 2ML 1,169$ 4401624-0 GRAPSEED OIL 100MG 6$ 4403355-0 PEGFILGRASTIM 6 MG I 4,823$ 4404329-0 TENEX (GUANFACINE) 6$ 4408025-0 MELATONIN 5MG TABLET 6$ 4408026-0 VIBRYD 10MG 36$ 4408027-0 SAPHRIS 5MG 87$ 4408935-0 VITD 50K 6$ 4408936-0 FLUARIX (FLU VACCINE 39$ 4408937-0 HYDRALAZINE 10MG TAB 6$ 4408938-0 SMZ-TMP DS TAB 6$ 4408939-0 OXCARBAZEPINE 150 MG 6$ 4408940-0 SIMVASTATIN 20 MG 15$ 4408941-0 LOVASTATIN 20 MG 6$ 4408942-0 ALPRAZOLAM 1 MG 6$ 4408943-0 M-M-R II 214$

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Code Description Charge4408944-0 AMYL NITRATE 6$ 4408945-0 GLYCERIN SUPPOS (PED 6$ 4408946-0 ASPIRIN SUPPOS 300MG 6$ 4408947-0 ASPIRIN SUPPOS 600MG 6$ 4408948-0 ACEPHEN SUPPOS 650 M 6$ 4408949-0 DIAZEPAM TAB 2 MG 6$ 4408950-0 DIAZEPAM 5 MG TAB 6$ 4408951-0 ZOLPIDEM 10 MG TAB 16$ 4408952-0 PHENOBARB INJ 65 MG 58$ 4408953-0 PHENOBARB SOLN 20 MG 6$ 4408954-0 ORTHOVISC INJ 490$ 4408955-0 FENTANYL PATCH 75 MC 140$ 4408956-0 HYDROMORPHONE 50 MG 34$ 4408957-0 CALCIUM GLUCONATE IN 15$ 4408958-0 ZYVOX 600 MG TAB 488$ 4408959-0 ENOXAPARIN 30 MG INJ 6$ 4408960-0 ENOXAPARIN 40 MG INJ 6$ 4408961-0 CEFTRIAXONE 500 MG 6$ 4408962-0 DIGOXIN INJ 20$ 4408963-0 METRONIDAZOLE 500 MG 6$ 4408964-0 HEPARIN 25000 UNITS/ 30$ 4408965-0 LIDOCAINE LV 2G INJ 19$ 4408966-0 CHOLESTYRAMINE LITE 10$ 4408967-0 NITROGLYCERIN 0.1 MG 8$ 4408968-0 PERMETHRIN CREAM 371$ 4408969-0 TERBINAFINE CR 1% 24$ 4408970-0 TRIAMCINOLONE CR 0.1 35$ 4408971-0 TRIAMCINOLONE DENTAL 242$ 4408972-0 LDR STOMACH RELIEF 6$ 4408973-0 CHLORHEXIDINE .12 % 6$ 4408974-0 VALPOIC ACID SYP 250 6$ 4408975-0 PHENYTOIN SUSP 6$ 4408976-0 SUCRALFATE SUSP 22$ 4408977-0 PEDIATRIC ELECTROLYT 13$ 4408978-0 SMZ-TMP SUSP 7$ 4408979-0 ORACIT 7$ 4408980-0 PEDIA LAX 4 OZ LIQ 6$ 4408981-0 FLUCONAZPLE ORAL SUS 15$ 4408982-0 FUROSEMIDE ORAL SOLN 6$ 4408983-0 EPHEDRINE SULFATE 35$

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Code Description Charge4408984-0 EPINEPHRINE 1:1000 I 8$ 4408985-0 ETOMIDATE INJ 34$ 4408986-0 GLYCOPYROLLATE INJ 96$ 4408987-0 XYLOCAINE MPF 19$ 4408988-0 MANNITOL INJ 25% 6$ 4408989-0 SOLU-MEDROL 1 GRAM 85$ 4408990-0 PROTAMINE INJ 250 MG 33$ 4408991-0 SOLU-CORTEF 250 MG 6$ 4408992-0 VECURONIUM BR INJ 10 32$ 4408993-0 ZYPREXA INJ 141$ 4408994-0 GLYCERIN USP LIQ 6$ 4408995-0 DUODERM GEL 25$ 4408996-0 CETACAINE SPRAY 237$ 4408997-0 TUCKS PADS 6$ 4408998-0 TOBRADEX OO 639$ 4408999-0 TOBREX OO 357$ 4409000-0 TOBRAMYCIN OS 44$ 4409001-0 TIMOLOL 0.5% GFS 410$ 4409002-0 EYE DROPS (GENERIC V 6$ 4409003-0 TRAVATAN Z OS 417$ 4409004-0 ALPHAGANP 0.15 OS 318$ 4409005-0 OFLOXACIN OS 223$ 4409006-0 APRACLONIDINE OS 0.5 272$ 4409007-0 DICLOFENAC OS 0.1% 134$ 4409008-0 FML OO 337$ 4409009-0 FLUOROMETHALONE OS 206$ 4409010-0 DETROL LA 2 MG 30$ 4409011-0 MEPHYTON 5 MG 133$ 4409012-0 ACTOS 15 MG 34$ 4409013-0 ACTOS 45 MG 57$ 4409014-0 AMOXICILLIN 250 MG C 6$ 4409015-0 AMPICILLIN 250 MG CA 6$ 4409016-0 GENTIAN VIOLET 6$ 4409017-0 CLOVE LEAF OIL 6$ 4409018-0 HYDRALAZINE 50 MG TA 6$ 4409019-0 METFORMIN 500 MG TAB 6$ 4409020-0 METAXALONE 800 MG 18$ 4409021-0 RIFAMPIN 300 MG PO 6$ 4409022-0 RISPERIDONE 1 MG TAB 7$ 4409023-0 VITAMIN B 1 (THIAMIN 6$

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Code Description Charge4409024-0 VITAMIN B 6 (PYRIDOX 6$ 4409025-0 PLAN B 122$ 4409026-0 HYDROXYCHLOROQUINE 1 13$ 4409027-0 NITROFURANTOIN 50 MG 7$ 4409028-0 MELATONIN 5 MG 6$ 4409029-0 MEGESTROL 40 MG TAB 6$ 4409030-0 PROPRANOLOL ER 60 MG 7$ 4409031-0 PREVACID SOLUTAB 30 37$ 4409032-0 CO-Q-10 100MG 6$ 4409033-0 SODIUM CHLORIDE 1 G 6$ 4409034-0 VITAMIN D3 50,000 UN 6$ 4409035-0 ATENOLOL 25 MG 6$ 4409036-0 ATENOLOL 50 MG 6$ 4409037-0 BETHANECHOL 10 MG TA 6$ 4409038-0 CHARCOCAPS 6$ 4409039-0 TRICOR 48 MG 8$ 4409040-0 TRICOR 145 MG 16$ 4409041-0 FLUOXETINE 10 MG 7$ 4409042-0 ISONIAZID 100 MG 6$ 4409043-0 KETOROLAC TAB 10 MG 6$ 4409044-0 COMBIVIR TAB 54$ 4409045-0 METHYLPREDNISOLONE 4 6$ 4409046-0 MIRTAZAPINE 15 MG TA 10$ 4409047-0 NEOMYCIN SULFATE 500 6$ 4409048-0 CALAMINE LOTION 120 6$ 4409049-0 TERAZOSIN 1 MG CAP 6$ 4409050-0 CIPROFLOXACIN OS 75$ 4409051-0 CYCLOPENTOLATE 1 % O 56$ 4409053-0 KINEVAC (CCK) 186$ 4409054-0 TORSEMIDE 20 MG PO 6$ 4409055-0 BISOPROLOL 10 MG 6$ 4409056-0 WELCHOL 625 MG 9$ 4409057-0 URSODIOL 300 MG 23$ 4409058-0 SEREVENT 798$ 4409059-0 XARELTO 10MG 38$ 4409060-0 BUPROPION SR 150MG 6$ 4409061-0 PRADAXA 150 MG 6$ 4409062-0 LAMOTRIGINE 25 MG 13$ 4409063-0 HYPERTET 6$ 4409064-0 MEPERIDINE 100 MG 6$

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Code Description Charge4409065-0 PHENOBARBITAL 30 MG 6$ 4409066-0 METHENAMINE 1G 6$ 4409067-0 VERAPAMIL 120 MG 6$ 4409068-0 VIAGRA 25 MG 114$ 4409070-0 PHARM GI COCKTAIL 30$ 4409071-0 HYDROCODONE APAP 5 6$ 4409072-0 HYDROCODONE APAP 10 6$ 4409073-0 OFIRMEV 10 MG / ML 128$ 4409074-0 RECLAST INJECTION 2,982$ 4409075-0 ALLOPURINOL 300 MG 6$ 4409076-0 PHOS-LO (CA ACETATE) 6$ 4409077-0 BUSPIRONE 15 MG 6$ 4409078-0 LIDOCAINE TOP SOL 4% 28$ 4409079-0 ITRACONAZOLE 100 MG 28$ 4409080-0 METHYLDOPA 250 MG TA 6$ 4409081-0 MERCAPTOPURINE 50 MG 6$ 4409082-0 PRAMIPEXOLE 0.125 MG 9$ 4409083-0 ALFUZOSIN 10 MG TAB 13$ 4409084-0 ABILIFY 2 MG TAB 93$ 4409085-0 DOXEPIN 50 MG CAPSUL 6$ 4409086-0 GXELON PATCH 45$ 4409087-0 AZACTAM 1 GRAM INJEC 105$ 4409088-0 FLUCONAZOLE 100 MG 26$ 4409089-0 HALOPERIDOL ORAL CON 6$ 4409090-0 NORTRIPTYLINE 25 MG 6$ 4409091-0 LIOTHYRONINE 5 MCG T 6$ 4409092-0 SULINDAC 200 MG TABL 6$ 4409093-0 VENOFER INJECTION 10 2$ 4409094-0 BUPROPION SR 100 MG 6$ 4409095-0 TERAZOSIN 5 MG CAPSU 6$ 4409096-0 BYSTOLIC 5 MG TAB 11$ 4409097-0 PROCHLORPERAZINE 5 M 6$ 4409098-0 MARINOL CAPSULES 2.5 36$ 4409099-0 BUPROPION 100 MG 6$ 4409100-0 NEULASTA 6MG INJ 16,079$ 4409101-0 BRIMONIDINE 0.2 % EY 55$ 4409103-0 CLARITHROMYCIN 500 M 19$ 4409104-0 LAMOTRIGINE 100 MG T 14$ 4409105-0 TEFLARO 600 MG INJEC 455$ 4409106-0 NATEGLINIDE 120 MG T 6$

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Code Description Charge4409107-0 ARANESP 200MCG 24$ 4409108-0 METOCLOPRAMIDE ORAL 6$ 4409109-0 PREDNISONE 1 MG TABL 6$ 4409110-0 DIPYRIDAMOLE 25 MG T 6$ 4409112-0 VANCOMYCIN 125 MG CA 94$ 4409113-0 BIOGLO FLUORESCEIN O 6$ 4409114-0 70 MG TABLET (ALENDR 62$ 4409115-0 SYNTHROID 6$ 4409116-0 SUPRANE 6$ 4409117-0 HYDROCODONE/APAP 5/3 6$ 4409118-0 TERRELL SOLUTION 6$ 4409119-0 HYDROCODONE/APAP 10/ 6$ 4409120-0 ZOMETA 4 MG INJECTIO 806$ 4409121-0 RAMIPRIL 1.25 MG 6$ 4409122-0 RAMIPRIL 2.5 MG 6$ 4409123-0 RAMIPRIL 5 MG 6$ 4409124-0 CHANTIX 0.5 MG TABLE 15$ 4409125-0 DOXYCYCLINE 100 MG 17$ 4409126-0 HYDROMORPHONE 2MG IN 6$ 4409127-0 XARELTO 15 MG TAB 38$ 4409128-0 XARELTO 20 MG TABLET 38$ 4409129-0 EXFORGE 10/160 TAB 21$ 4409130-0 PYRIDOSTIGMINE 60 MG 6$ 4409131-0 SYNTHROID 112 MCG TA 6$ 4409132-0 CHLORASEPTIC PUMP SP 6$ 4409133-0 DELZICOL 400 MG CAPS 9$ 4409134-0 COMBIVENT RESPIMAT I 1,004$ 4409135-0 BROVANA 2 ML 15 MCG 36$ 4409136-0 COMBIGAN EYE DROPS 5 372$ 4409137-0 RENVELA 800 MG TABLE 15$ 4409138-0 CALCITRIOL CAPSULE 0 6$ 4409139-0 FORADIL AEROLIZER 17$ 4409140-0 HUMALOG INSULIN KWIK 282$ 4409141-0 NATEGLINIDE 60 MG TA 6$ 4409142-0 ZEMPLAR 1 MCG CAPSUL 43$ 4409143-0 PERPHENAZINE/AMITRIP 6$ 4409144-0 MAGIC MOUTHWASH 18$ 4409145-0 METFORMIN TABLET 850 6$ 4409146-0 MELOXICAM TAB 7.5 MG 10$ 4409147-0 BISOPROLOL/HCTZ 10/6 6$

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Code Description Charge4409148-0 NYSTATIN POWDER 30 G 220$ 4409149-0 NYSTATIN OINTMENT 30 76$ 4409150-0 CULTURELLE CAPSULES 6$ 4409151-0 MYAMBUTOL 400 MG TA 6$ 4409152-0 PYRIZINAMIDE 500 MG 9$ 4409153-0 MISC PHARMACY 6$ 4409154-0 FLUARIX QUADRAVALENT 45$ 4409155-0 DEPAKOTE SPRINKLE CA 6$ 4409156-0 BYSTOLIC 2.5 MG TABL 11$ 4409157-0 HUMALOG 75/25 MIX IN 282$ 4409158-0 GLIMEPERIDE 1 MG TAB 6$ 4409159-0 FLUARIX QUADRAVALENT 57$ 4409160-0 REVATIO 20 MG TABLET 92$ 4409161-0 DALIRESP 500 MCG TAB 28$ 4409162-0 FENOFIBRIC ACID 45 M 6$ 4409163-0 CARDENE IV SOLUTION 342$ 4409164-0 MORPHINE SULFATE ORA 6$ 4409165-0 VENLAFAXINE ER 150 M 18$ 4409166-0 CLOBETASOL CREAM 0.0 385$ 4409167-0 METHOCARBAMOL 750 MG 6$ 4409168-0 QC NATURAL VEGETABLE 6$ 4409169-0 NITROFURANTOIN MONOH 7$ 4409170-0 TENIVAC 5-2 LFU INJ 86$ 4409171-0 ATROPINE SULFATE INJ 6$ 4409172-0 KETAMINE INJECTION 1 53$ 4409173-0 ALBUTEROL PEDIATRIC 6$ 4409174-0 CHILDREN'S APAP SUSP 6$ 4409175-0 MAG AL PLUS XS 30 6$ 4409176-0 NYSATIN ORAL SUP 5ML 6$ 4409178-0 PRAVASTATIN 10 MG TA 10$ 4409179-0 CLOPIDOGREL 300 MG T 84$ 4409180-0 ACYCLOVIR INJECTION 68$ 4409181-0 NIFEDIPINE 10 MGIR C 6$ 4409182-0 CALCIUM ACETATE 667 6$ 4409184-0 LIDOCAINE PF .04 IN 13$ 4409185-0 HALOPERIDOL 5MG TAB 6$ 4409187-0 AMIODARONE 450MG INJ 27$ 4409188-0 MEROPENEM 1 GRAM 211$ 4409189-0 IBUPROFEN SUSP 100MG 6$ 4409190-0 ADRENALIN 1MG INJ 1M 10$

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Code Description Charge4409191-0 SENSORCAINE MPF .002 6$ 4409193-0 XYLOCAINE MPF .01 IN 12$ 4409194-0 MISC PHARMACY 6$ 4409195-0 MISC PHARMACY 9$ 4409196-0 HEPARIN FLUSH 100 UN 9$ 4409198-0 MISC PHARMACY 9$ 4409199-0 LIDOCAINE ORAL SOLUT 6$ 4409200-0 MISC PHARMACY 323$ 4409201-0 MISC PHARMACY 3,063$ 4409204-0 LEFLUNOMIDE 20 MG (G 49$ 4409205-0 XYLOCAINE 2% 10ML IN 11$ 4409206-0 KETAMINE 100 MG/ML I 6$ 4409207-0 BYSTOLICE 10 MG TABL 11$ 4409208-0 HYDROXYIREA 500 MG C 6$ 4409209-0 ELIQUIS 2.5 MG TABLE 19$ 4409210-0 CEFEPIME 2 GRAM INJE 35$ 4409211-0 OXYBUTYNIN 5 MG 10$ 4409212-0 TRANEXAMIC ACID 100 111$ 4409213-0 RANITIDINE SOLUTION 36$ 4409214-0 LYRICA CAPSULES 100 17$ 4409215-0 SULFASALAZINE 500 MG 6$ 4409216-0 KCENTRA INJECTION, 1 7$ 4409218-0 FLUARIX QUADRIVALENT 45$ 4409219-0 AZACTAM (AZTREONAM) 209$ 4409221-0 CARBIDOPE/LEVODOPA E 6$ 4409222-0 MISC PHARM 12$ 4409223-0 MEGESTEROL UNIT DOSE 6$ 4409224-0 BISOPROLOL 5 MG TABL 6$ 4409225-0 MISC PHARM 6$ 4409226-0 LOSARTAN 25 MG TAB N 6$ 4409227-0 MIDODRINE 5 MG TAB, 12$ 4409228-0 LOSARTAN 50 MG TABLE 7$ 4419101-0 5CC SYRINGE 6$ 4447217-0 ER NASAL PACKING 24$ 4450001-0 MOXIFLOXACIN 400MG/2 6$ 4450002-0 CIPROFLOXACI 400MG/2 10$ 4450003-0 DOBUTAMINE H 1MG/ML 59$ 4450004-0 DOPAMINE HCL 0.8MG/M 32$ 4450005-0 FLUCONAZOLE/ 100MG/5 4$ 4450006-0 FLUCONAZOLE/ 200MG/1 2$

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Code Description Charge4450007-0 HEPARIN SOD 50UNITS 21$ 4450008-0 LEVOFLOXACIN 250MG I 26$ 4450009-0 LEVOFLOXACIN 500MG I 25$ 4450010-0 LEVOFLOXACIN 750MG I 16$ 4450011-0 MAGNESIUM SU 1GM IPS 6$ 4450012-0 POTASSIUM CH 10MEQ/5 10$ 4450013-0 POTASSIUM 20MEQ/100M 10$ 4450014-0 SODIUM CHLOR 0.009 I 18$ 4450015-0 SODIUM CHLOR 0.03 IV 10$ 4450016-0 LINEZOLID 200MG/100M 251$ 4450017-0 LINEZOLID 600MG/300M 502$ 4450018-0 20 MEQ KCL D5 1000ML 9$ 4450019-0 0.45% NS 1000ML 19$ 4450020-0 0.9% NS 500ML 3$ 4450021-0 0.9% NS 1000ML 19$ 4450022-0 0.9% NS 250ML 19$ 4450023-0 0.9% NS 100ML 6$ 4450024-0 0.9% NS 50ML 6$ 4450025-0 10 MEQ KCL D5 1/2 1L 9$ 4450026-0 20 MEQ KCL NS 1000ML 10$ 4450027-0 20 MEQ KCL D5 NS 1L 10$ 4450028-0 20 MEQ KCL D5 1/2 1L 8$ 4450029-0 40 MEQ KCL NS 1000ML 10$ 4450030-0 40 MEQ KCL D5 1/2 1L 9$ 4450031-0 40 MEQ KCL D5 NS 1L 5$ 4450032-0 5% DEXTROSE 250ML 7$ 4450033-0 5% DEXTROSE 1000ML 19$ 4450034-0 5% DEXTROSE 100ML 6$ 4450035-0 5% DEXTROSE 500ML 19$ 4450036-0 5% DEX 0.45% NS 1L 3$ 4450037-0 5% DEX 0.45% NS 500 19$ 4450038-0 5% DEX 0.9% NS 1000M 19$ 4450039-0 LACTATED RINGERS 1L 19$ 4450040-0 LACTATED RING D5 1L 19$ 4450041-0 STERILE H20 1000ML 19$ 4450101-0 IM OR SUBCUTANEOUS 32$ 4450102-0 INTRA-ARTERIAL 110$ 4450103-0 HYDRATION IV INFUSIO 155$ 4450104-0 HYDRATION EACH ADDIT 110$ 4450105-0 THER/PROPH/DIAG IV I 310$

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Code Description Charge4450106-0 IV THERAPY EACH HOUR 79$ 4450107-0 IVP SINGLE DRUG OR S 133$ 4450108-0 TX/PRO/DX INJ NEW DR 150$ 4450109-0 ADDITIONAL IVP SAME 165$ 4450110-0 TRANSFUSION BLOOD 2 765$ 4450111-0 TRANSFUSION BLOOD 4 845$ 4450112-0 TRANSFUSION BLOOD 6 965$ 4450113-0 TRANSFUSION BLOOD 8 965$ 4450114-0 REMOVE TNL CV CATH 215$ 4450115-0 REPLACE NON-TUNNELED 1,988$ 4450116-0 IRRIG IMPLANT VENOUS 134$ 4450117-0 10% DEX 500ML IN 1K 18$ 4450118-0 0.4% LIDO HCI 5% DEX 18$ 4450119-0 .45 SOD CHLOR 500ML 4$ 4450120-0 5%DEX .33 SOD CHLOR 16$ 4450121-0 5% DXTR &RING INJ 50 4$ 4451234-0 IV PUSH SEQ INJ SAME 165$ 4451236-0 IV PUMP USAGE 18$ 4451237-0 IV START 35$ 4451238-0 0.9% NS FLUSH 10CC 5$ 4451239-0 ENOXAPARIN 60 MG INJ 20$ 4451240-0 LOVENOX 80 MG 20$ 4451242-0 IV THERAPY INITIAL 310$ 4451243-0 THER/DIAG CONCURRENT 135$ 4451244-0 IVP SUBSEQUENT 165$ 4451245-0 IV INFUSION KIT 90$ 4451246-0 IV PORT FLUSH KIT 55$ 4451247-0 IV BLOOD TRANS KIT 70$ 4451248-0 IV PORT FLUSH (OMP) 40$ 4451250-0 TX/PROPH/DG ADDL 123$ 4451251-0 REMOVE TNL CV CATH 123$ 4451252-0 COLLECT BLOOD FROM P 154$ 4451253-0 INS TEMP BLADDER CAT 174$ 4451254-0 CHEMO IV INFUSION 1 805$ 4451255-0 CHEMO IV INFUSION AD 137$ 4451256-0 INSERT PICC CATH <5 2,751$ 4451257-0 PHLEBOTOMY THERAPEUT 284$ 4470911-0 SONNET SHORT THROW S 85$ 4470912-0 BOXER SPLINT SMALL R 44$ 4470913-0 BOXER SPLINT SMALL L 44$

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Code Description Charge4470914-0 BOXER SPLINT MED RT 44$ 4470915-0 BOXER SPLINT MED LT 44$ 4470916-0 BOXER SPLINT LRG RT 44$ 4471000-0 DISP SCLEROTHERP NDL 92$ 4471002-0 BIPOLAR HEMOST PROBE 263$ 4471003-0 RAPID FIRE LIGATOR 227$ 4471005-0 ELIM PYLORIC/COLONIC 331$ 4471006-0 VENTRLX HERN PTCH SM 1,548$ 4471007-0 VENTRLX HERN PTCH MD 2,184$ 4471008-0 VENTRLX HERN PTCH LG 2,577$ 4471009-0 MASK OXYG W/TUBING 2$ 4471012-0 ADULT NRB W/ VENT 6$ 4471017-0 SPRMTR VOL INC4000ML 10$ 4471018-0 FLOWMTR PEAK ASTHMA 34$ 4471019-0 HAND HELD NEBULIZERS 2$ 4471022-0 ROTH NET 2.5MM DISP 294$ 4471025-0 FLUOROGUID STEERCATH 106$ 4471027-0 PERFIX PLG MD 1.3"X1 1,222$ 4471028-0 PERFIX PLUG LG, 1.6" 1,233$ 4471033-0 CATH 16FR 2WAY COUDE 55$ 4471034-0 METER PEAK FLOW 62$ 4471035-0 6" STCK DBLE PLY STR 13$ 4471040-0 AIR-STIRRUP ANKLE BR 52$ 4471045-0 2.5MM SM-JNT FUL RAD 156$ 4471048-0 GASTROGRAFFIN 120ML 44$ 4471056-0 SUPRAPUBIC CATH SET 318$ 4471072-0 4.5CM SM ANAT/PEDI 100$ 4471073-0 5.5CM FOR ADLT EPIST 83$ 4471080-0 8CMX5M COMPRILAN 18$ 4471081-0 10CMX5M COMPRILAN 38$ 4471105-0 TRAECH SET 3.5MM 489$ 4471106-0 TRAECH SET 4.0MM 489$ 4471115-0 BENTSON PLUS WRE GDE 75$ 4471117-0 BLADE SURGICAL SZ 10 28$ 4471125-0 DRES DUODERM 4INX4IN 48$ 4471126-0 NITINOL WIRE GUIDE 75$ 4471127-0 VENTI VENTURI MASKS 6$ 4471128-0 ISOVUE 300 50 ML 25$ 4471129-0 ISOVUE 300 100ML 94$ 4471130-0 10 SCLPL CURTY DISP 2$

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Code Description Charge4471131-0 11 SCLPL CURTY DISP 2$ 4471133-0 PLEUR EVAC 116$ 4471137-0 BNDG COMPRS 2INX210 2$ 4471138-0 HOT DISP BIOP FORCEP 70$ 4471142-0 SM FROG SPLINTS 3$ 4471143-0 BNDG COMPRS 3INX210 2$ 4471149-0 MED FROG SPLINTS 3$ 4471150-0 ISOVUE 200M 10ML 25$ 4471151-0 ISOVUE 200M 20ML 15$ 4471153-0 4" ACE BANDAGE 3$ 4471161-0 LG FROG SPLINTS 3$ 4471162-0 BNDG COMPRS 6INX210 4$ 4471165-0 STOCKIN,IMPERV LG 10$ 4471166-0 BNDG ELAS 2IN ELITE 16$ 4471167-0 4" BANDG ELAS STER 21$ 4471168-0 UNIV ANKLE BRACE 35$ 4471169-0 6" HCOMB VELCRO BNDG 5$ 4471170-0 SUT ETHILON 6/0 18IN 30$ 4471171-0 4-0 ETHILON 18" PS-4 30$ 4471172-0 3-0 ETHILON 18" PS-2 16$ 4471176-0 DEV 5MM ENDO PEANUT 243$ 4471179-0 DRES ADH 2X3IN PATC 5$ 4471180-0 SM STKG ANTI-EMB TGH 34$ 4471182-0 MD STKG ANTI-EMB TGH 34$ 4471183-0 SUT SURG 1 5X18IN BL 16$ 4471184-0 3.5"X22" CERVCL COL 10$ 4471186-0 LG STKG ANTI-EMB TGH 17$ 4471188-0 SHLDR IMMOB W/FOAM 27$ 4471190-0 XL STKG ANTI-EMB TGH 17$ 4471191-0 STER 3IN STOCKINET 12$ 4471192-0 STER 10IN STOCKINET 12$ 4471193-0 STER 8IN STOCKINET 24$ 4471194-0 PORT-A-CATH II IMPAB 836$ 4471195-0 4X4.1 YD CON STRETCH 2$ 4471196-0 HEELBO SM YELLOW 31$ 4471197-0 15X7MM OSC BLADE 28$ 4471209-0 DOBUTAMIN5%DXTR250MG 7$ 4471216-0 NASOPH AIRWY 6.0 10$ 4471217-0 NASOPH AIRWY 7.0 11$ 4471219-0 NASOPH AIRWY 8.0 11$

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Code Description Charge4471221-0 FOLY INSRT TRY 10CC 15$ 4471222-0 LMBR PUNC TRY ADLT 2 46$ 4471223-0 LMBR PUNCT TRY PEDI 39$ 4471224-0 THORAC TRY 16GAX3 55$ 4471230-0 ESMARK BANDG 6"X4YD 10$ 4471231-0 CATH SUCT DRY RIGID 2$ 4471232-0 1.4 K-WIRE 91$ 4471233-0 STRYKEFLOW II W/ TIP 266$ 4471234-0 BIOPSY FORCEPS 2,025$ 4471236-0 CHLORAPREP 10.5ML 13$ 4471237-0 26ML CHLORAPREP 23$ 4471240-0 CUTS/BURRS ULTIM SER 145$ 4471241-0 4.0 MM TCAT ARTHROS 145$ 4471242-0 5.5 MM RND BUR ARTHR 171$ 4471243-0 SERFAS PRBE NON-SUCT 91$ 4471244-0 SERFAS PRB90 ASD SCT 368$ 4471250-0 HEEL FLOAT SM 92$ 4471251-0 8.0 TRIFL LAT ST GLV 5$ 4471252-0 7.5 GLOVE PROTEGRITY 3$ 4471253-0 8.0 GLOVE PROTEGRITY 3$ 4471254-0 GLV PROTEGRITY 8.5 3$ 4471255-0 6.0 NEOPREN SURG GLV 5$ 4471256-0 6.5 NEOPREN SURG GLV 5$ 4471257-0 7.5 NEOPREN SURG GLV 5$ 4471258-0 8.0 NEOPREN SURG GLV 5$ 4471259-0 7.0 NEOPREN SURG GLV 3$ 4471260-0 7.5 NEOPREN SURG GLV 5$ 4471261-0 8.5 NEOPREN SURG GLV 5$ 4471262-0 HEEL FLOAT LG 118$ 4471264-0 2"X10YDS HYPAFIX 18$ 4471265-0 4"X10YDS HYPAFIX 5$ 4471267-0 AMBU SPUR II AD,CLSD 26$ 4471272-0 LACR TRY SS INSTRU 18$ 4471274-0 CAUT LOWTEMP FINETIP 28$ 4471276-0 OCTRODE PERM LEAD 8,850$ 4471277-0 LEAD KIT 7,529$ 4471281-0 SHLDR IMMOB W/FOAM 27$ 4471284-0 CAUT HGH TMP FINETIP 40$ 4471289-0 HEELBO MED BLUE 20$ 4471290-0 HEELBO LG WHITE 20$

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Code Description Charge4471291-0 XL HEELBO 21$ 4471294-0 CRT AL PSH BTN ADLT 27$ 4471297-0 ARTHROS PUMP TUBING 150$ 4471299-0 MEDTRONC IMP ACC KIT 210$ 4471300-0 MEDTRONC IMP ACC KIT 473$ 4471301-0 MEDTRONC IMP ACC KIT 950$ 4471302-0 MEDTRONC IMP ACC KIT 473$ 4471305-0 MEDTRONC IMP ACC KIT 441$ 4471306-0 MEDTRONC IMP ANTENNA 280$ 4471308-0 EON MINI CHARG SYS 4,725$ 4471310-0 4.0MM RESECTOR CUT 150$ 4471311-0 4.0MM AGRESSIVE PLUS 150$ 4471312-0 4.0MM TOMCAT CUTTER 150$ 4471313-0 4.0MM END CUTTER 150$ 4471314-0 4.0MM 12 FLUT RND BU 150$ 4471315-0 4.0MM 12 FLUTBARL BU 150$ 4471316-0 MEDTRONC PAIN IMP 56,250$ 4471317-0 MEDTR PATIENT PRGMMR 4,165$ 4471318-0 MEDTRONC CHARG SYS 8,365$ 4471319-0 LEAD KITS 7,844$ 4471320-0 MEDTRONIC LEAD KIT 7,844$ 4471321-0 MEDTR IMP LEAD KIT 100,000$ 4471322-0 EON MINI IPG 53,985$ 4471324-0 EON PROGRAMMER 3,719$ 4471325-0 MEDTRONIC TRIAL LEAD 1,050$ 4471331-0 FOLY SILICN 5CC 16FR 21$ 4471333-0 SALEM SUMP 10FR 1,347$ 4471334-0 EPISTAT NASL CATH II 141$ 4471335-0 SALEM SUMP 12FR 1,347$ 4471338-0 SALEM SUMP 14FR 1,347$ 4471339-0 SALEM SUMP 16FR 5$ 4471340-0 SALEM SUMP 18FR 5$ 4471341-0 VLVE F/SALEM SUMP AN 20$ 4471342-0 SUCT CONN TUBE 1/4X1 5$ 4471343-0 CATH TROCAR 20FR 16L 1,162$ 4471344-0 SHLDR IMB W/FM ST XL 27$ 4471345-0 CATH TROCAR 24FR 16L 1,162$ 4471346-0 CATH TROCAR 28FR 16L 1,162$ 4471347-0 6" 17G PERCUT DISCEC 5,639$ 4471348-0 6" 15G PERCUT DISCEC 5,639$

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Code Description Charge4471349-0 VENTRICULAR LEAD 1,890$ 4471350-0 CAPSUREFIX NOVUS III 2,079$ 4471351-0 CAPSUREFIX NOVUS II 2,079$ 4471352-0 CAPSUREFIX NOVUS 2,079$ 4471353-0 STRYK BATT PK 9.6V 1,299$ 4471354-0 CATH FOLY 16FR BARDE 47$ 4471365-0 3/4X3IN BND STAT STR 12$ 4471367-0 4.3X48MM COMPR SCRW 332$ 4471368-0 4.3X50MM COMPR SCRW 332$ 4471369-0 DRL FOR 4.3MM SCRW 145$ 4471371-0 HD DRL4.3MM CMP SCRW 240$ 4471374-0 NDL SPIN 25GAX3-1/2 5$ 4471375-0 22G 3-1/2 IN SPIN ND 5$ 4471376-0 NDL SPIN S/SU 20G 3- 7$ 4471378-0 18G 3-1/2 IN SPIN ND 7$ 4471379-0 WET SKIN PREP TRAY 12$ 4471388-0 LPT REG GREAT TOE 5,382$ 4471391-0 DBM BONE GRAFT 4,435$ 4471393-0 SPIN TRY 25GA WHITAC 49$ 4471399-0 ALLIANCE II INFL SYS 1,410$ 4471403-0 NDL SPIN 20GX6 YELLW 18$ 4471405-0 NDL STER 25G 4-11/16 5$ 4471406-0 4"X0.045" K-WIRES 19$ 4471408-0 6"X0.045" K-WIRES 19$ 4471414-0 NDL INTRADISCAL 18GA 5$ 4471421-0 ECON COTT STOCKIN 4" 1$ 4471422-0 ECON COTT STOCKIN 5" 12$ 4471423-0 2" COBAN STERILE LF 12$ 4471424-0 4" COBAN STERILE LF 11$ 4471425-0 6" COBAN STERILE LF 7$ 4471426-0 SYRNGS FOR INJECTION 6$ 4471427-0 14FR COUDE CATH 53$ 4471428-0 16FR COUDE CATH 7$ 4471429-0 18FR COUDE CATH 122$ 4471439-0 CATH URETH VNYL 6FR 5$ 4471444-0 GENTLE COMPR GLVS 5$ 4471445-0 CATH URETH VNYL 8FR 5$ 4471447-0 DISP HIGH FLOW INSUL 46$ 4471448-0 CATH FOLY LAT 5CC14F 4$ 4471449-0 CATH FOLY LAT 5CC16F 3$

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Code Description Charge4471451-0 LEUKOTAPE 1╜"X15 YDS 34$ 4471455-0 ARTIFL NONWV BND,10C 8$ 4471459-0 DRSAL PF NIGHT SP MD 115$ 4471460-0 DRSAL PF NIGHT SP LG 115$ 4471463-0 FOLYTRY CL 16FR 5CC 5$ 4471467-0 FRAZ TIP SUCT TIPS 1 7$ 4471468-0 SHAVE PREP TRY 2 COM 10$ 4471469-0 10CC SALINE FLUSH 6$ 4471471-0 4.0 ET TUBE 9$ 4471472-0 4.5 ET TUBE 9$ 4471473-0 7.0 ET TUBE 9$ 4471474-0 7.5 ET TUBE 11$ 4471475-0 8.0 ET TUBE 9$ 4471477-0 NEBULIZER SET 7FT 5$ 4471478-0 UNNA BT W CALAMINE 4 17$ 4471486-0 MEDTR POCKET ADAPTOR 1,485$ 4471503-0 HYDROCOLLOID 6X6IN 19$ 4471517-0 10 CC CATH INSRT TRY 5$ 4471527-0 4.5INX4.1YD BULKY KE 2$ 4471530-0 CATH FOLY 14FR DOVER 47$ 4471531-0 GLV SURG PF 6 DERMAP 5$ 4471532-0 GLV SURG PF 7 DERMAP 5$ 4471533-0 GLV SURG PF 8 DERMAP 5$ 4471539-0 OR IV TUBING 3 CLAVE 12$ 4471540-0 BLOOD 2NDRY SET 26" 8$ 4471542-0 AMINOSYN 3.5% 161$ 4471544-0 XL UNIV KN WRP W/CLO 28$ 4471545-0 XXL UNIV KN WRP CLOS 44$ 4471546-0 CATH FOLY 16FR DOVER 47$ 4471555-0 XS SPEC ARM SLNG 13$ 4471556-0 SM SPEC ARM SLNG 13$ 4471557-0 MDSPEC ARM SLNG 13$ 4471558-0 LG SPEC ARM SLNG 13$ 4471559-0 XLG SPEC ARM SLNG 13$ 4471564-0 XS RT CMTFORM WRST 35$ 4471565-0 SM RT CMTFORM WRST 23$ 4471566-0 MD RT CMTFORM WRST 23$ 4471567-0 LG RT CMTFORM WRST 23$ 4471568-0 XLG RT CMTFORM WRST 23$ 4471569-0 XS LT CMTFORM WRST 35$

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Code Description Charge4471570-0 SM LT CMTFORM WRST 23$ 4471571-0 MDLT CMTFORM WRST 23$ 4471572-0 LG LT CMTFORM WRST 23$ 4471573-0 XLG LT CMTFORM WRST 23$ 4471574-0 RXS WRST W/ABD THMB 50$ 4471575-0 R SM WRST W/ABD THMB 49$ 4471576-0 R MDWRST W/ABD THMB 49$ 4471577-0 R LG WRST W/ABD THMB 49$ 4471578-0 RXL WRST W/ABD THMB 49$ 4471579-0 LXS WRST W/ABD THMB 50$ 4471580-0 L SM WRST W/ABD THMB 49$ 4471581-0 L MDWRST W/ABD THMB 49$ 4471582-0 L LG WRST W/ABD THMB 49$ 4471583-0 LXL WRST W/ABD THMB 49$ 4471587-0 POST-OP SHOE MALE SM 18$ 4471588-0 POST-OP SHOE MALE MD 18$ 4471589-0 POST-OP SHOE MALE LG 18$ 4471590-0 POST-OP SHOE MALEXLG 38$ 4471591-0 POST-OP SHOE FML SM 18$ 4471592-0 POST-OP SHOE FML MD 38$ 4471593-0 POST-OP SHOE FML LG 18$ 4471596-0 .9% SODCH 3000ML IRR 15$ 4471598-0 16" QCK BSC KN SPLIN 37$ 4471599-0 18" QCK BSC KN SPLIN 43$ 4471600-0 22" QCK BSC KN SPLIN 48$ 4471601-0 26" QCK BSC KN SPLIN 59$ 4471602-0 2X3.75IN BANDAID 4$ 4471603-0 ORTHOWEDGE SM 44$ 4471604-0 ORTHOWEDGE MED 43$ 4471605-0 ORTHOWEDGE LG 43$ 4471606-0 ORTHOWEDGE XL 44$ 4471607-0 PROSTEP CAM WLKR SM 65$ 4471608-0 PROSTEP CAM WLKR MD 65$ 4471609-0 PROSTEP CAM WLKR LG 65$ 4471610-0 DUAL SPRY FOR GPSIII 134$ 4471611-0 4" CANN FOR GPS III 145$ 4471612-0 GPS III APP KIT 110$ 4471613-0 GPS III SYSTEM 1,803$ 4471614-0 4" KERLIX 6$ 4471620-0 PLASTER BNDG 2"X3 YD 5$

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Code Description Charge4471621-0 PLASTER BNDG 3"X3 YD 6$ 4471622-0 PLASTER BAND 4"X5 YD 7$ 4471623-0 8.0 ET TUBE 18$ 4471625-0 UNIV STRYK SAW BLADE 124$ 4471626-0 OIL EMULSION 3INX3IN 5$ 4471628-0 TRY,IRR W/60 CC BULB 4$ 4471630-0 PISTON STER SYRINGE 6$ 4471631-0 SPNG GZE 4X4IN 12-P 2$ 4471636-0 PROXIMAL REV KIT 983$ 4471637-0 5CC ALLOMATRIX PUTTY 2,841$ 4471638-0 STAND GRFT JACKET 7,305$ 4471639-0 SYNCHROMED II PUMP 42,864$ 4471640-0 SUT LOOP GUIDE RODS 600$ 4471641-0 REGEN TISS SKIN GRFT 4,500$ 4471642-0 SUTURELESS CATH 2,085$ 4471644-0 LNLRATHECAL CATH 3,438$ 4471648-0 DRES AMD ISLAND 3X4 5$ 4471649-0 STRP IODOFRM PAC 1/4 11$ 4471650-0 STRP IODOFRM PAC 1/2 11$ 4471651-0 STRP IODOFRM PAC 1X5 13$ 4471652-0 STRP IODOFRM PAC 2X5 17$ 4471653-0 GZE XEROF 5INX9IN PE 2$ 4471654-0 TUBING FLOWTRON 38$ 4471655-0 BAG LEG URINARY MED 6$ 4471656-0 PERSONAL THERP MGR 2,385$ 4471659-0 CATH FOLY LAT 5CC18F 4$ 4471660-0 CATH FOLY LAT 5CC20F 4$ 4471661-0 CATH FOLY LAT 5CC22F 4$ 4471683-0 RAD. REDUCING GLVS S 129$ 4471686-0 #10 SCALPEL BLADE 1$ 4471689-0 #11 SCALPEL BLADE 5$ 4471690-0 #12 SCALPEL BLADE 3$ 4471691-0 #15 SCALPEL BLADE 1$ 4471696-0 NERVER BLCK TRY W/O 59$ 4471698-0 TENSGRP STCK 3 1/2E 132$ 4471699-0 TENSGRP STCK 3 1/2F 208$ 4471700-0 TENSGRP STCKN 4.5" G 182$ 4471701-0 TENSGRP STOCKIN 3" D 91$ 4471709-0 ADAPTA DR 17,251$ 4471715-0 2 FIBERWIRE SUTURE 58$

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Code Description Charge4471725-0 APP SEPP CHLORAPREP 1$ 4471734-0 BIPOLAR PROBE 10FR. 450$ 4471735-0 BIPOLAR PROBE 7FR. 500$ 4471746-0 CATH URETHRAL TRAY 10$ 4471748-0 NEB STER WTR 760ML A 9$ 4471760-0 BONE CEMENT PLUS MIX 1,047$ 4471761-0 TROCAR ENDO BLUNT 12 662$ 4471764-0 OPTICAL ACC KII THRE 88$ 4471766-0 3" SMTH CAST PADD 3$ 4471767-0 2" STRETCH BANDAGE 1$ 4471768-0 3" STRETCH BANDAGE 2$ 4471769-0 4" STRETCH BANDAGE 5$ 4471770-0 4"X36" NYLATEX WRAPS 39$ 4471771-0 4"X48" NYLATEX WRAPS 38$ 4471777-0 BONE CEM W/MIX KYPHX 662$ 4471779-0 DISP CRV SPIN ND 22G 5$ 4471780-0 25GA 1 1/2" ND PORTX 1$ 4471785-0 COTTON STOCKINET 3"" 12$ 4471786-0 COTTON STOCKINET 4"" 12$ 4471790-0 6" STRETCH BANDAGE 13$ 4471791-0 BNDG STRETCH CO 2INX 18$ 4471792-0 2" SMTH CAST PD STER 23$ 4471793-0 4" SMTH CAST PD STER 42$ 4471794-0 6" SMTH CAST PADD 12$ 4471797-0 4" SMTH CAST PADD 4$ 4471798-0 6" SMTH CAST PADD 6$ 4471802-0 RETR SYS 10MM ENDSCP 172$ 4471812-0 SNGL LUMEN CTR VEN C 119$ 4471818-0 COTTON STOCKINET 6"" 12$ 4471820-0 TRAECH SET 6MM 489$ 4471821-0 ACCESS SYS KII OPTCL 56$ 4471822-0 TRIPLE LUMEN TRAY 324$ 4471823-0 2-0 ETHIBND CT-2 SUT 17$ 4471827-0 3" ESMARK 8$ 4471828-0 4" ESMARK 8$ 4471829-0 6" ESMARK 16$ 4471831-0 4" SCTCH PLUS CST TP 19$ 4471832-0 5" SCTCH PLUS CST TP 23$ 4471833-0 DISP BIOP FORCP SPKD 30$ 4471834-0 SHEET FLAT BARD MSH 329$

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Code Description Charge4471835-0 2.7X14MM LOCK SCREW 612$ 4471836-0 2.7X16MM LOCK SCREW 612$ 4471837-0 2.7X22MM LOCK SCREW 612$ 4471838-0 4MM ROW II LCK PLATE 5,133$ 4471841-0 2.0MM DRILL 537$ 4471843-0 DILATION SYRNG 60CC 109$ 4471853-0 LMBR PUNCT TRY 20GX3 49$ 4471860-0 SUT VICRYL 0 18IN VI 30$ 4471867-0 MASTISL LIQADH 2/3CC 7$ 4471868-0 SIZE 3 BIOPSY 19$ 4471869-0 SZ2 BONE BIOP DEV 457$ 4471870-0 BIOP FORCEP 3.7MM CH 1,086$ 4471872-0 HOT BIOPSY FORCEPS 1,086$ 4471873-0 4" ECON COTT STOCKIN 12$ 4471874-0 6" ECON COTT STOCKIN 1$ 4471876-0 MICROPUNCT INTRO SET 118$ 4471877-0 PICC LINE TURBO-JET 484$ 4471878-0 JUGULR VENA CAVA FIL 4,785$ 4471879-0 FEMORL VENA CAVA FIL 4,785$ 4471881-0 2.5CMX3CM GAMMA GRFT 993$ 4471883-0 6" ELASTIC BANDAGES 21$ 4471886-0 3"X22" CERVCL COL 10$ 4471887-0 4"X23" CERVCL COL 10$ 4471888-0 4.5"X24" CERVCL COL 10$ 4471890-0 HERC 3-STG DILTR 8CM 609$ 4471891-0 HERC 3-STG DILTR 8CM 609$ 4471892-0 HERC 3-STG DILTR 8CM 508$ 4471893-0 3 STG BALLN DILA 18- 61$ 4471894-0 HERC 3-STG DILTR 8CM 508$ 4471895-0 PRIMARY IV TUBING 13$ 4471896-0 HOT BIOP FORCEP COOK 19$ 4471900-0 IV BAG ACCESS 7$ 4471902-0 1.2 MICRN FIL EXT SE 31$ 4471903-0 OR IV TUBING 10$ 4471906-0 2NDRY PIGGYBCK IV TB 5$ 4471907-0 3-0 VICRYL MHV-26 SU 12$ 4471908-0 3-0 VICRYL 27 CT-2 T 11$ 4471909-0 5-0 VICRYL 18" FS-2 19$ 4471910-0 4-0 VICRYL 18" FS-2 19$ 4471911-0 6-0 VICRYL UN 18PC-3 28$

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Code Description Charge4471912-0 6-0 VICRYL UND 18PC- 4,899$ 4471913-0 BIOCLUSIVE DRESS 2X3 33$ 4471915-0 3X3YD SPEC EXTFST PL 28$ 4471916-0 BNDG 4X5YD SPECIALST 21$ 4471917-0 6X5YD SPEC EXTFST PL 78$ 4471919-0 SECONDARY IV TUBING 3$ 4471922-0 PCA TUBING 14$ 4471941-0 LACTAT RING INJ 1000 9$ 4471951-0 DVT BT FOR FLTRN 17" 46$ 4471952-0 DVT BT FOR FLTRN 23" 74$ 4471955-0 OUCHLS NON ADHER PA 5$ 4471956-0 3" CAST PADDING 21$ 4471961-0 SIZE 15/2 BALLOONS 1,616$ 4471965-0 16 FR SILICONE FOLY 47$ 4471967-0 10/2 FIRST FRACT KIT 12,364$ 4471969-0 SUT PSORB 0 6X18IN V 20$ 4471970-0 20FR STRT THOR CATH 5$ 4471972-0 24FR STRT THOR CATH 5$ 4471973-0 COLD BIOPSY FORCEPS 14$ 4471975-0 RESOLUT CLIP 235CM 744$ 4471976-0 18FR PEG F-TUBE W/BA 78$ 4471978-0 EN SFTY PEG PSH METH 570$ 4471979-0 28FR STRT THOR CATH 5$ 4471980-0 32FR STRT THOR CATH 5$ 4471981-0 EZ-IO AD 15G INTROAS 359$ 4471982-0 EZ-IO AD 15G INTROA 359$ 4471985-0 3M COBAN 2"X5YD 5$ 4471986-0 3M COBAN 3"X5YD 16$ 4471987-0 3M COBAN 4"X5YD 8$ 4471988-0 3M COBAN 6"X5YD 16$ 4471989-0 FOLYKIT TWR BAG,16FR 24$ 4471994-0 SOLUT SURG DURAPREP 19$ 4471995-0 SOLUT SURG DURAPR 6M 10$ 4472001-0 STAPLER SKIN PRECISE 13$ 4472003-0 MEROCEL NASL PKING 4 118$ 4472006-0 MEROCEL NASL PKING 8 118$ 4472008-0 EZY SPLINT ROLL 5" 32$ 4472009-0 25GA 6" SPIN NDL 10$ 4472010-0 EZY SPLINT ROLL 2" 18$ 4472011-0 EZY SPLINT ROLL 3" 12$

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Code Description Charge4472012-0 EZY SPLINT ROLL 4" 30$ 4472014-0 18GA 1" NDL PORTEX 1$ 4472015-0 INSULN SYRNG LO-DOSE 19$ 4472018-0 INSULN SYRNG HI-DOSE 5$ 4472019-0 18GA 1 1/2" ND PORTX 1$ 4472020-0 20GA 1" NDL PORTEX 1$ 4472021-0 22GA 1" NDL PORTEX 1$ 4472024-0 22GA 1 1/2" ND PORTX 1$ 4472025-0 25GA 1" NDL PORTEX 1$ 4472029-0 TUBERCU SYR 25GA 1ML 1$ 4472030-0 ABG SYRINGE 2$ 4472031-0 THORACENTESIS SET 9$ 4472033-0 5X5CM SKIN GRFT MATR 2,250$ 4472038-0 3" ECON COTT STOCKIN 12$ 4472048-0 SKIN STICH 6$ 4472053-0 PREC IMPABLE PULS GE 96,110$ 4472054-0 PREC IMPABLE PULS GE 59,790$ 4472055-0 LINEAR ST LEAD 50CM 9,033$ 4472056-0 LINEAR ST LEAD 50CM 9,033$ 4472057-0 LINEAR ST LEAD 70CM 9,033$ 4472058-0 O.R. CABLE 750$ 4472059-0 6.5 INSERTION NEEDLE 6$ 4472061-0 STYLET KIT W/STRNG C 9$ 4472063-0 PATIENT PRGMMR KIT 3,570$ 4472064-0 PATIENT PRGMMR KIT 3,855$ 4472065-0 PATIENT PRGMMR KIT 4,170$ 4472066-0 PRECIS CHG KIT 2.0 6,090$ 4472067-0 PRECIS CHG SYS KIT 10,170$ 4472068-0 PRECIS CHG SYS KIT 12,460$ 4472072-0 SENSIA DR PACEMAKER 14,280$ 4472081-0 MONOSOF 6/0 18IN BLA 30$ 4472083-0 SPRO 4/0 18IN BL FS2 28$ 4472085-0 3-0 SPRO 18 C-14 CUT 14$ 4472087-0 29GA LODOSE INSULIN 1$ 4472088-0 HUBER NDL 22GAX1.5" 6$ 4472089-0 20GA 3/4" GRIP HUBER 11$ 4472090-0 20GA 1" GRIP HUBR ND 11$ 4472091-0 20GA 1 1/4GRP HUB ND 11$ 4472096-0 SPIROMETER COACH-2 28$ 4472097-0 25GA 5/8" NDL PORTEX 1$

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Code Description Charge4472098-0 25GA 3CC SYRNG & NDL 19$ 4472099-0 22GA 2.5 LAN SPIN ND 5$ 4472101-0 22GA 6" SPIN NDL 9$ 4472103-0 22GA 8" SPIN NDL 10$ 4472104-0 22GA 6 CURV QUI SPIN 5$ 4472106-0 FLUORGUD STR CATH KT 391$ 4472107-0 TARGET CATH ACC KIT 78$ 4472114-0 ONE STEP INTRODUCER 177$ 4472115-0 ND EPIDUR18GX6IN DET 13$ 4472122-0 VARI INJ. NDL 23GA. 6$ 4472123-0 VARI INJ. NDL 25GA. 6$ 4472135-0 17GX3.5" WV PNT INTR 31$ 4472136-0 SMALL GLOVE PF NITRI 12$ 4472138-0 LARGE GLOVE PF NITRI 12$ 4472139-0 TUBING OXYGEN 7FT CR 12$ 4472140-0 CONNECTOR OXYGEN TUB 12$ 4472141-0 MASK OXYGEN ADT HI-C 12$ 4472142-0 ADULT AEROSOL MASK 12$ 4472143-0 AIR MATTRESS 161$ 4472144-0 IV SALINE LOC 24$ 4472145-0 20G ANGIOCATH 5$ 4472148-0 STERI STRIPS ╝ INC 4$ 4472152-0 3" SCTCH PLUS CST TP 11$ 4472153-0 2" SCTCH PLUS CST TP 14$ 4472154-0 ER GLOVES ANY SIZE 6$ 4472155-0 ER SCALPL BLDE #10-1 5$ 4472156-0 KERLIX STRETCH GAUZE 6$ 4472157-0 STRETCH BANDAGE 2-6" 5$ 4472158-0 IODOFORM PAC </= 1/2 12$ 4472159-0 IODOFORM PAC >/= 1X5 17$ 4472160-0 ER ET TUBE 3.0-10.0 5$ 4472161-0 ER ARM SLING CHILD 14$ 4472162-0 ER ARM SLING ADULT 14$ 4472163-0 ER ACE BANDAGE 2-6" 7$ 4472164-0 ER SMTH CAST PADNG 2 5$ 4472165-0 ER SMTH PADNG 4-6+" 15$ 4472166-0 ER LEG SPLINT 45$ 4472167-0 ER SOFT CAST JONES 18$ 4472168-0 COLLES SPLINT 18$ 4472169-0 CLAVICLE STRAP 37$

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Code Description Charge4472170-0 ER CERVICAL COLLAR 22$ 4472172-0 CATH FOLEY 5CC ANY S 5$ 4472173-0 CATH TROCAR ANY SIZE 43$ 4472174-0 CATH FOLEY(DOVER) AN 51$ 4472175-0 CATH FOLEY(BARD) ANY 27$ 4472176-0 WRIST IMMOB/SPLINT 30$ 4472177-0 RAPID RHINO/EPITAXIS 79$ 4472178-0 CATH URETH ANY SIZE 6$ 4472179-0 SALEM SUMP/DBL LUMEN 6$ 4472180-0 STERILE SYRINGE 6$ 4472181-0 MONOJET SYRINGE 5$ 4472182-0 STERI STRIPS 24$ 4472183-0 PELVIC EXAM SUPPLIES 24$ 4472184-0 IV SUPPLIES/SOLUTION 40$ 4472185-0 NON-REBREATHER MASK 6$ 4472186-0 SUTURES POLYSORB 17$ 4472187-0 SUTURES VICRYL ANY 7$ 4472188-0 SUTURES SILK ANY 8$ 4472189-0 STERILE GAUZE 5$ 4472190-0 TEFLA PAD ANY SIZE 5$ 4472191-0 VASELINE GAUZE 21$ 4472192-0 PLAIN PACKING STRIP 10$ 4472193-0 IODOFORM PAC STRIP 16$ 4472194-0 PORTEX NEEDLE ANY S 5$ 4472195-0 HUBER NEEDLE ANY 5$ 4472196-0 SPINAL NEEDLE ANY SI 16$ 4472197-0 CRUTCHES ANY SIZE 44$ 4472198-0 STERILE DRESSING 5$ 4472199-0 IV SOLUTION PER CC 6$ 4472200-0 RINGERS LACTATE 6$ 4472201-0 D5/NS % ANY PER DOSE 6$ 4472202-0 D5/NS/KCL % ANY PER 6$ 4472203-0 ABSORBABLE HEMOSTATE 92$ 4472204-0 NON REBREATHABLE MAS 6$ 4472205-0 GLUCOMETER 16$ 4472206-0 NASAL/MASK CANNULA 6$ 4472207-0 ANGIOCATH 5$ 4472208-0 GLUCOMETER X2 32$ 4472209-0 GLUCOMETER X3 32$ 4472210-0 GLUCOMETER X4 40$

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Code Description Charge4472211-0 BUDDY TAPE ER 5$ 4472212-0 AUTOSUTURE ROYAL 35W 61$ 4472213-0 ETHIBOND GREEN 30" C 12$ 4472214-0 TICRON BLUE 5 X 18" 31$ 4472215-0 FINGER SPLINT 3$ 4472216-0 CATHETHER SECUREMENT 16$ 4472217-0 AEROSOL MASK ADULT 6$ 4472218-0 AEROSOL MASK PEDIATR 6$ 4478141-0 PATRIOT COLLAR 22$ 4478142-0 6" PLASTER BANDAGE 9$ 4478143-0 O2 MASK ADULT 5$ 4478145-0 1 POLYSORB GS-24 15$ 4478146-0 0 POLYSORB 3.5 12X18 68$ 4478147-0 STERI STRIP 1/2" 5$ 4478148-0 ABSORBABLE HEMOSTAT 6$ 4478149-0 0 3.5 METRIC POLYSOR 6$ 4478150-0 4-0 MONOSOF P-12 25$ 4478151-0 0 3.5 METRIC POLYSOR 36$ 4478152-0 4-0 MONOSOF P-13 26$ 4478153-0 3-0 ETHILON PS-2 6$ 4478154-0 VICRYL P-3 28$ 4478155-0 3-0 MONOSOF P-12 27$ 4478156-0 3-0 2.0 METRIC SILK 27$ 4478157-0 0 TR CRON GS-22 66$ 4478158-0 3-0PROLENE FS-1 19$ 4478159-0 ETHILON CT-1 GRN B 16$ 4478160-0 3-0 POLYSORB GL-126 12$ 4478161-0 3-0 SURGIPRO II P-14 14$ 4478162-0 5-0 ETHILON FS-2 10$ 4478163-0 5-0 ETHILON PS-2 42$ 4478164-0 5-0 MONOSOF P-13 25$ 4478165-0 6-0 MONOSOF P-13 34$ 4478166-0 2-0 ETHILON PS-2 12$ 4478186-0 SUTURES NYLON ANY 1$ 4478187-0 FLEETS ENEMA 6$ 4478188-0 DRESSING ADHESIVE IS 10$ 4478189-0 DRESSING 4X4 COPA FO 5$ 4478190-0 VENTILATOR CIRCUIT 11$ 4478191-0 ORAL SUCTION CATH KI 8$ 4478192-0 100FT CORRUGATED TUB 36$

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Code Description Charge4478193-0 HYGROSCOPIC CONDENSE 5$ 4478194-0 FACE TENT MASK 7$ 4478195-0 ANEST. BREATHING CIR 8$ 4478196-0 ADULT BREATHING CIRC 12$ 4478197-0 IODINE PREP PADS 2$ 4478198-0 IODINE SWABS 2$ 4478199-0 ORAL AIRWAY 50MM 5$ 4478200-0 ORAL AIRWAY 60MM 5$ 4478201-0 ORAL AIRWAY 70MM 5$ 4478202-0 ORAL AIRWAY 80MM 5$ 4478203-0 ORAL AIRWAY 90MM 5$ 4478204-0 ORAL AIRWAY 100MM 5$ 4478205-0 12FR 5CC FOLEY CATHE 7$ 4478206-0 10FR 3CC FOLEY 16$ 4478207-0 8FR 3CC FOLEY 21$ 4478208-0 14FR 23CM LOOP SUPRA 163$ 4478209-0 26FR 5CC FOLEY 13$ 4478210-0 24FR 5CC FOLEY 13$ 4478211-0 IRRIGATION/ TUR SET 15$ 4478212-0 TRACH CARE KIT 5$ 4478213-0 SUCTION CATH MINI TR 5$ 4478214-0 NASOGASTRIC TUBE HOL 2$ 4478215-0 10FRX45" ENTERAL FEE 48$ 4478216-0 10FR SUCTION KIT 5$ 4478217-0 INFANT 5/6FR SUCTION 5$ 4478218-0 14FR SUCTION WITH GL 2$ 4478219-0 10FR SUCTION WITH GL 2$ 4478220-0 18FR SUCTION CATH 5$ 4478221-0 3.0 ET TUBE 9$ 4478222-0 6.5 ET TUBE 9$ 4478223-0 6.0 ET TUBE 9$ 4478224-0 5.5 ET TUBE 20$ 4478225-0 5.0 ET TUBE 9$ 4478226-0 8.5 ET TUBE 89$ 4478227-0 10.0 ET TUBE 9$ 4478228-0 9.5 ET TUBE 9$ 4478229-0 9.0 ET TUBE 9$ 4478230-0 CONNECT TUBE W/SURE 5$ 4478231-0 PERCUTANEOUS DECOMPR 7,031$ 4478232-0 SLING QUICK RELEA M. 12$

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Code Description Charge4478233-0 SLING QUICK RELEAS L 11$ 4478234-0 29MM MALE CATHETER E 5$ 4478235-0 25MM MALE CATHETER E 5$ 4478236-0 36MM MALE CATHETER E 5$ 4478237-0 41MM MALE CATHETER E 5$ 4478238-0 TEMP THERAPY PAD 15$ 4478239-0 BLANKET 24$ 4478244-0 UPMIST ADULT AEROSOL 5$ 4479013-0 POLYPECTOMY SNARE 165$ 4479017-0 BOXER SPLINT LRG LT 44$ 4479076-0 CANE 24$ 4479078-0 SPOT INDIAN INK 65$ 4479079-0 COLLAR PHILADELPHIA 47$ 4479080-0 COLLAR PHILADELPHIA 47$ 4479081-0 COLLAR PHILADELPHIA 47$ 4479082-0 EPIDURAL CATHETER HM 312$ 4479083-0 THERACATH« EPIDURAL 81$ 4479084-0 DISP DUAL-INCI 797$ 4479085-0 DISP DUAL-INCI FALOP 563$ 4479086-0 FALOPE RING« BANDS,3 47$ 4479087-0 NEUTRON NEEDLEFREE C 11$ 4479088-0 MEDTRONIC SCS IMPLAN 65,469$ 4479089-0 MEDTRONIC ACESSOR KI 8,785$ 4479090-0 IPG GENERATOR SC1110 65,391$ 4479091-0 CHARGING KIT 64123BS 7,469$ 4479092-0 PROGRAMER KIT SC5500 4,344$ 4479093-0 NON STERILE COBAN 1 6$ 4479094-0 NON STERILE COBAN 2 6$ 4479095-0 NON STERILE COBAN 3 6$ 4479096-0 NON STERILE COBAN 4 6$ 4479097-0 NON STERILE 4X4 6$ 4479098-0 1/4" PENROSE DRAIN 5$ 4479099-0 SHORT THROW SNARE 18$ 4479100-0 2 X 2 NON STERILE GA 6$ 4479102-0 10CC SYRINGE 6$ 4479103-0 UNDER CAST PADDING 6$ 4479104-0 2 X 4 BANDAID 6$ 4479105-0 4 X 4 STERILE GAUZE 6$ 4479106-0 3 X 3 NON ADHER DRES 6$ 4479107-0 STERILE TONGUE BLADE 6$

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Code Description Charge4479108-0 RADIO-OPAQUE EPIDURA 155$ 4479109-0 WAYNE PNEUMOTHORAX 506$ 4479110-0 INNER CANNULA DISPOS 23$ 4479111-0 CHLORAPREP SWAB 5$ 4479112-0 URETHRAL CATHETER 5$ 4479113-0 SENSOR BATTERY IMPLA 65,469$ 4479114-0 TELFA 3X8 6$ 4479115-0 ADULT PACER PADS 55$ 4479116-0 PEDIACTRI PACER PAD 55$ 4479117-0 ADULT TRACH MASK 5$ 4479118-0 PACER PADS 8$ 4479119-0 ENT(WOODS LAMP)TRAY 45$ 4479120-0 EYE TRAY 45$ 4479121-0 PROGRAMMER 8835 PERS 2,485$ 4479122-0 PUMP 8637-20 BATTER 35,000$ 4479123-0 REPAIR KIT 8590-9 297$ 4479124-0 CATH 8709SC 1PC SUTH 2,171$ 4479125-0 COLD PACK SUPPLY 38$ 4479126-0 2-0 VICRYL SUTURE CO 6$ 4479127-0 EXTREMITY DRAPE 32$ 4479128-0 BARRIER SKIN 11/4 FL 19$ 4479129-0 BARRIER SKIN 1 1/2 F 19$ 4479130-0 BARRIER SKIN 2 1/4 F 23$ 4479131-0 BARRIER SKIN 2 3/4 F 23$ 4479132-0 POUCH SURE FIT 8$ 4479133-0 POUCH SURE FIT 1 1/2 8$ 4479134-0 POUCH NATURAL 2 1/4 8$ 4479135-0 POUCH NATURAL 2 3/4 8$ 4479137-0 PASTE STOMAHESSIVE 2 6$ 4479138-0 POWDER STOMAHESIVE 6$ 4479139-0 ADULT TRACH MASK CAT 6$ 4479140-0 INFANT O2 MASK NON R 15$ 4479141-0 5-10 MM STYLET SATIN 21$ 4479142-0 SIZE 4 SHILEY 292$ 4479143-0 SIZE 6 SHILEY 292$ 4479144-0 9.0 ET TUBE CUFFED 6$ 4479145-0 5.0 ET TUBE CUFFED 6$ 4479146-0 5.5 ET TUBE CUFFED 6$ 4479147-0 6.0 ET TUBE CUFFED 6$ 4479148-0 6.5 ET TUBE CUFFED 20$

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Code Description Charge4479149-0 7.0 ET TUBE CUFFED 14$ 4479150-0 7.5 ET TUBE CUFFED 14$ 4479151-0 8.0 ET TUBE CUFFED 6$ 4479152-0 8.5 ET TUBE CUFFED 6$ 4479153-0 EPIDURAL CATHETER SE 197$ 4479154-0 CANNULA 2$ 4479155-0 O2 TUBING 2$ 4479156-0 ANESTHESIA FACE MASK 6$ 4479157-0 BITE BLOCKS 42$ 4479158-0 GUHL ANKLE DISTRAKTE 832$ 4479159-0 ENDOSCOPIC CYTOLOGY 47$ 4479160-0 STRYKER CUTTING BLAD 94$ 4479161-0 PEDIATRIC DRAPE 21$ 4479162-0 O2 SENSOR ADULT 27$ 4479163-0 EX SCRUB 3$ 4479164-0 NEEDLE COUNTERS 6$ 4479165-0 1500ML SUCTION CANIS 5$ 4479166-0 2500ML SUCTION CANIS 5$ 4479167-0 EASY CAP CO2 DETECTO 31$ 4479168-0 12" PANEL BINDER 30- 28$ 4479169-0 12" PANEL BINDER 45- 28$ 4479170-0 12" PERSONAL BINDER 27$ 4479171-0 XRAY SPONGES 6$ 4479172-0 3/4 SHEETS 4$ 4479173-0 BASIC PACKS 33$ 4479175-0 3CC SYRINGE 2$ 4479176-0 RADIATION REDUCTION 145$ 4479177-0 14FR FOLEY CATHETER 15$ 4479178-0 16FR FOLEY CATHETER 15$ 4479179-0 18FR FOLEY CATHETER 15$ 4479180-0 LAP CHOLE PACK 778$ 4479181-0 LAPAROSCOPY PACK 137$ 4479182-0 CLIP APPLIER 10MM 533$ 4479183-0 UPPER EXTREMITY PACK 97$ 4479184-0 TROCAR BALLOON KIT 299$ 4479185-0 XXL GOWN 14$ 4479186-0 CAUTERY PENCIL 18$ 4479187-0 HOT BIOPSY 144$ 4479188-0 CAUTERY PAD 11$ 4479189-0 IMPL SGL CHAMBR RR P 15,050$

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Code Description Charge4479190-0 CERVICOOL KIT CEK-17 2,625$ 4479191-0 LUMBAR KIT (CERVICOO 2,625$ 4479192-0 SINERGY KIT(CERVICOO 1,837$ 4479193-0 COOLED LUMBAR PROBE 1,838$ 4479194-0 SILVER ALGINATE DRES 53$ 4479195-0 SKIN BARRIER (COLOST 29$ 4479196-0 SEAL COHESIVE WAFFER 15$ 4479197-0 DRAIN POUCH (COLOSTO 8$ 4479198-0 DISPOSABLE STETHESCO 9$ 4479199-0 PEDIATRIC PULSE OX 61$ 4479200-0 PEDIATRIC CAPNOLINE 35$ 4479201-0 SILVER ALGINATE DRES 54$ 4479203-0 DISPOSABLE GAIT BELT 14$ 4479204-0 CVC/PICC DRESSING KI 58$ 4479205-0 OSTOMY BAG 12$ 4479206-0 OSTOMY WAFERS 6$ 4479207-0 THORACIC RF KIT:THK- 2,625$ 4479208-0 KNEE KIT:CRK-17-100- 2,625$ 4479209-0 DISPERSIVE ELECTRODE 300$ 4479210-0 ECHOBRIGHT 22GX50MM 51$ 4479211-0 ECHOBRIGHT 20GX100MM 51$ 4479212-0 ECHOBRIGHT 20GX1501M 51$ 4479213-0 ECHOLONG 18GX50MM NE 118$ 4479214-0 ECHOLONG 18GX100MM N 118$ 4479215-0 ECHOLONG 18GX150MM N 137$ 4479216-0 CANNULA 20GX100MMX10 682$ 4479217-0 GROUNDING PADS 35$ 4479218-0 AUTOCLAVE CASES 875$ 4479219-0 SINERGY PROB TIP 17X 1,837$ 4479220-0 COOLED INTRODUCER 174$ 4479223-0 PROBE KIT GENICULAR 2,625$ 4479224-0 THERACOOL KIT-845177 2,625$ 4479225-0 STERILE DRAPE-61050 20$ 4479226-0 STIRRUPS-52710 14$ 4479227-0 STERILE SLEEVE-59900 5$ 4479228-0 RISAMINE OINTMENT 6$ 4479229-0 TRIPLE ANTIBIOTIC OI 6$ 4479230-0 HYDROCORTISONE CREAM 6$ 4479231-0 BACITRACIN OINTMENT 6$ 4479232-0 HYDROCERIN CREAM (GE 6$

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Code Description Charge4479233-0 DUODERM CGF BORDER 28$ 4479234-0 DUDERM 4X4 CGF DRESS 23$ 4479235-0 4X5 AQUACEL AG DRESS 58$ 4479236-0 4X4 AQUACEL DRESSING 27$ 4479237-0 4.5MM ANGLED AGGRESS 175$ 4479238-0 CROSSFLOW INTEGRATED 455$ 4479239-0 TEGADERM DRESSING 168$ 4479241-0 .9% SODCH 1000ML IRR 4$ 4479242-0 LUMBAR RF KIT 150 2,625$ 4479243-0 LUMBAR COOL INTRODUC 350$ 4479244-0 THERA COOL INTRODUCE 175$ 4479245-0 KYPHON EXPRESS CURRE 300$ 4479246-0 SINERGY SYSTEM 17GX1 2,625$ 4479247-0 SINERGY INTRODUCER 1 349$ 4479248-0 SINERGY PROBE KIT17X 2,625$ 4479249-0 SINERGY INTRODUCER17 175$ 4479250-0 SINERGY EPSILON RULE 61$ 4479251-0 TRANSDISCAL PROBEKIT 4,375$ 4479252-0 TRANSDISCAL PROBETIP 1,838$ 4479253-0 TRANSDISCAL CABLE 1,487$ 4479254-0 TRANSDISCAL INTRODUC 349$ 4479255-0 TRANSDISCAL TUBING+B 420$ 4479256-0 CERVICOLL KIT CEK-17 2,625$ 4479257-0 GEN COOLED RF KIT 2,625$ 4479258-0 GEN COOLED RF PROBET 1,838$ 4479259-0 GEN COOLED PROBE NOT 350$ 4479260-0 GEN COOLED RF KIT 75 2,625$ 4479261-0 GEN COOLED RF GUAGE 1,838$ 4479262-0 GEN COOLED RF PROBE 350$ 4479263-0 LUMBAR PROBLU9-17-15 1,838$ 4479264-0 3.5MM CORTICAL SCREW 90$ 4479265-0 4.0MM CANCELLOUS SCR 90$ 4479266-0 4.0MM 1/3 THREAD SCR 225$ 4479267-0 ONE-THIRD TUBULAR PL 55$ 4479268-0 SUPER QUCK ANCHOR PL 1,501$ 4479269-0 BETADINE-SUPPLY 6$ 4479270-0 K-WIRE 49$ 4479271-0 TENSION BAND WIRE 25$ 4479273-0 CANNULA CURVED SHARP 68$ 4479274-0 PNEUMOTHORAX TRAY 611$

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Code Description Charge4479275-0 COUDE BLUNT NERVE BL 56$ 4479276-0 STIRRUP WITH SLIP RI 14$ 4479277-0 SHOULDER ARTHROSCOPY 310$ 4479278-0 5.0FR TURBOJECT PIC 577$ 4479279-0 OVOSAPIAN FBROPTC AI 20$ 4479280-0 3.5MM SURFAS SUCTááá 145$ 4479281-0 26ML CHLORAPREP WITH 27$ 4479282-0 17G TUOHY NDL WINGED 10$ 4479283-0 17G TUOHY NEEDLEáá 21$ 4479284-0 5.0 BARRELL BURRááá 175$ 4479285-0 MEDIHONEY 144$ 4479286-0 2.5 ET TUBE #86222 8$ 4479287-0 8FR CATHETER KIT 108 12$ 4479288-0 5FR CATH KIT 10815 12$ 4479289-0 JMAX TRIGGER FLEX 1,120$ 4479290-0 JMAX VERTICAL ISOLAT 140$ 4479291-0 JMAX TUBING SET JIFP 140$ 4479292-0 JMAX DISP ACCESS KIT 3,850$ 4479293-0 JMAX NEEDLE GUIDE WI 193$ 4479294-0 AVAMAX BONE CEMENT 2,350$ 4479295-0 AVAFLEX VERT BALL TR 8,050$ 4479296-0 PREC SPEC IMP PUL GE 47,460$ 4479297-0 PREC SPEC REMOTE CON 6,090$ 4479298-0 AQUACEL DRESSING 21$ 4479299-0 ANGLED TOMCAT 4.5MM 175$ 4479300-0 ZINC OXIDE OINTMENT 6$ 4479301-0 SOFSILK 4-0 14$ 4479302-0 CHROMIC GUT 4-0 18$ 4479303-0 BIOSYN 5-0 12$ 4479304-0 CHROMIC GUT 5-0 28$ 4479305-0 BIOSYN 6-0 14$ 4479306-0 TROCAR 2END KWIRE6.3 15$ 4479307-0 TROCAR 1END KWIRE6.3 17$ 4479308-0 TROCAR 2END KWIRE6.4 16$ 4479309-0 TROCAR 1END KWIRE6.4 17$ 4479310-0 TROCAR 2END KWIRE6.6 16$ 4479311-0 TROCAR 1END KWIRE6.6 17$ 4479312-0 18GAUGE ORTHO WIRE 26$ 4479314-0 HERCULES 3 STAGE 295$ 4479315-0 PRISM DRESSING 41$

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Code Description Charge4479316-0 PLEURX VACUUM BOTTLE 165$ 4480003-0 CARDIOVERSION ELECTI 1,231$ 4480008-0 TTE W/DOPPLER COMPLE 860$ 4480010-0 ECHO-STRESS RE TIME/ 1,992$ 4480013-0 EKG 12-LEAD 196$ 4480014-0 HEMODIALYSIS ACCESS 725$ 4480024-0 RHYTHM ECG TRACING O 206$ 4480026-0 STRESS TEST TRACING 773$ 4480028-0 ECG RECORD/REVIEW & 197$ 4480038-0 EVENT MONITOR HOOKU 244$ 4480039-0 ABPM HOOKUP 244$ 4480040-0 REMOTE 30 DAY ECG TE 1,031$ 4480041-0 ERGONOVINE PROVOCATI 178$ 4480042-0 ECG/MONITOR AND ANAL 110$ 4480080-0 COMPL FETAL DOPPER E 835$ 4480081-0 DUPLEX EXT VEINS; UN 475$ 4480082-0 DUPLEX ARTERIAL FLOW 785$ 4480083-0 DUPLEX ARTERIAL FLOW 575$ 4480084-0 LIMIT FETAL DOPPLER 825$ 4480085-0 CARDIO TRED STRESS T 725$ 4480086-0 EKG TRACING 196$ 4480087-0 ECHO 2D/M DOPPLER 1,178$ 4480088-0 PULSE OXIMETRY 62$ 4480089-0 ABP MONITORING 24+ H 195$ 4480090-0 CPR MED SURG 563$ 4480091-0 CARDIOVERSION ELECTR 1,398$ 4530001-0 AEROSOL TREATMENT 187$ 4530002-0 AIRWAY RESISTANCE 284$ 4530006-0 VENTILATION INITIAL 780$ 4530007-0 CARBOGEN PER RX UNLS 102$ 4530009-0 CHEST PHYSICAL THERA 70$ 4530010-0 CO DIFFUSING CAPACIT 186$ 4530011-0 EVAL PT USE OF IPPB 422$ 4530012-0 CPAP 362$ 4530025-0 CATHETER ASPIRATION 202$ 4530026-0 PULMONARY COMPLIANCE 102$ 4530031-0 PULMONARY STRESS TES 1,223$ 4530034-0 PULSE OXIMETRY CONT 62$ 4530035-0 RESP FLOW VOLUME LOO 161$ 4530037-0 RIBAVIRIN THERA (*3 422$

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Code Description Charge4530038-0 NEBULIZER TREATMENT 187$ 4530039-0 NEBULIZER TX 2 374$ 4530040-0 NEBULIZER TX 3 450$ 4530041-0 NEBULIZER TX 4 561$ 4530042-0 PULSE OX SNGL RESP 62$ 4530043-0 PULSE OX MULT RESPRI 75$ 4530044-0 SPIROMETRY 162$ 4530045-0 VENT MGMT INPAT INIT 772$ 4530046-0 VENT MGMT INPAT SUBQ 672$ 4530047-0 INTUBATION MED SURG 503$ 4600001-0 ADDING WALKER TO CAS 224$ 4600002-0 ADMINIST-HEPATITIS B 39$ 4600004-0 ADMINIST-PNEUMOCOCCA 57$ 4600005-0 ANOSCOPY DIAGNOSTIC 115$ 4600006-0 APP BOD CAS SHO/HI 2 224$ 4600007-0 APP-BOD CAS SHO/HI 1 224$ 4600010-0 APPBODYCAST SHL/HIP 224$ 4600014-0 APP-SHRT ARM SPL DYN 224$ 4600016-0 APP LONG LEG SPLNT 182$ 4600018-0 APP SHORT LEG SPLNT 182$ 4600020-0 APP HAND&LW FOREAREM 224$ 4600028-0 APPLICATION-LONG ARM 224$ 4600030-0 APPLICATION-PTB CAST 224$ 4600033-0 APP -TURNBUCK JCKT 224$ 4600045-0 BURN INITL TREAT 1ST 228$ 4600046-0 CR-SCA AMS/LGS 2.6-7 321$ 4600047-0 CR SCA AMS/LGS ADD 5 321$ 4600048-0 CR -SCA ARS/LG 1.1-2 321$ 4600049-0 ER CARDIOVERS ELECTI 937$ 4600050-0 INS TMP BLAD CAT STR 140$ 4600052-0 CNTRL LINE PERCUT>5 1,988$ 4600054-0 CHEST TUBE INSERTION 585$ 4600055-0 CLSED TX RAD HED W/M 435$ 4600056-0 CLOSED TX ANKLE DISL 435$ 4600057-0 CLSED TX CLAVICLE FX 435$ 4600058-0 CLOSED TX ELBOW DISL 435$ 4600059-0 CLSD TX PROX HUMERFX 435$ 4600060-0 CLSD TX SHLDER DISL 435$ 4600061-0 CLSD TX TEMPMAND DI 333$ 4600062-0 CLOSED TX THUMB DISL 435$

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Code Description Charge4600063-0 CLOSED TX INTERPHAL 435$ 4600064-0 CLOSED TX PATELLAR D 435$ 4600065-0 CLOSED TX RAD/ULN SH 435$ 4600066-0 COM REP TRUNK 2.6CM 1,018$ 4600067-0 COM REPAIR TRUNK EAC 321$ 4600068-0 COMP REP TRUNK 1.1CM 1,018$ 4600069-0 COMPLEX REPAIR-1.1 T 321$ 4600070-0 COMPLEX REPAIR-2.6 T 321$ 4600071-0 COMPLEX REPAIR-EACH 321$ 4600072-0 CPR 666$ 4600075-0 DRESS/DEBRIDE INIT W 196$ 4600076-0 DRESS/DEBRIDE INIT W 228$ 4600082-0 EMERGE DEPT VISIT 1 246$ 4600083-0 EMERGE DEPT VISIT 2 324$ 4600084-0 EMERGE DEPT VISIT 3 440$ 4600085-0 EMERGE DEPT VISIT 4 753$ 4600086-0 EMERGE DEPT VISIT 5 753$ 4600087-0 EVACUAT SUBUNGUAL HE 112$ 4600088-0 EXC BENIGN LES <5 654$ 4600089-0 EXC CHALAZION SING 516$ 4600090-0 FB REM EXT EYE CONJU 377$ 4600092-0 FB REM EXT EYE CORNE 377$ 4600093-0 FB REMOVE EMBEDDED E 362$ 4600094-0 FB RMVE EXT EYE CORN 377$ 4600096-0 NASAL FOREIGN BODY 217$ 4600097-0 FOREIGN BODY REMOVE 217$ 4600098-0 I & D ABCS COMP/MUL 312$ 4600099-0 I & D ABSCESS FINGER 1,736$ 4600100-0 I & D ABSCESS FINGER 312$ 4600101-0 I & D ABSCESS ISCHIO 1,764$ 4600102-0 I & D CYST PILONIDAL 312$ 4600103-0 I & D HEMATOMA SEROM 1,736$ 4600104-0 I & D POST OP WOUND 1,736$ 4600105-0 I & D ABSCESS VULVA 474$ 4600106-0 I & D ABSCESS SIMPLE 391$ 4600107-0 I & D ABSCESS BARTHO 474$ 4600108-0 I & D ABSCESS PERIAN 595$ 4600109-0 I&D BURSA UPPER ARM 789$ 4600110-0 INC/REM FOR BODY SUB 312$ 4600111-0 INC/REM FOR BODY SUB 312$

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Code Description Charge4600112-0 INCISION EXT THROMB 595$ 4600113-0 INJ ANESTH AGENT FAC 428$ 4600114-0 INJ ANESTH AGENT PER 428$ 4600119-0 LAYER CLOSURE-12.6 T 321$ 4600120-0 LAYER CLOSURE-2.5 CM 321$ 4600121-0 LAYER CLOSURE-2.6 TO 321$ 4600122-0 LAYER CLOSURE-2.6 TO 321$ 4600124-0 LAYER CLOSURE-20.1 T 321$ 4600126-0 LAYER CLOSURE-20.1 T 321$ 4600127-0 LAYER CLOSURE-5.1 TO 321$ 4600128-0 LAYER CLOSURE-7.6 TO 321$ 4600131-0 LAYER CLOSURE-2.5CM 321$ 4600133-0 TX GASTRO INTUB W/AS 285$ 4600135-0 NASAL HEMORRAGE ANTE 286$ 4600136-0 NASAL HEMORRAGE POST 286$ 4600137-0 PERICARDIOCENTESIS I 585$ 4600138-0 PUNCTURE ASP ABCESS 311$ 4600139-0 R MO FL&ANT2/3TON 2. 333$ 4600140-0 REPAIR EXT TENDON HA 2,456$ 4600142-0 REPLACEMENT GASTROST 363$ 4600143-0 SIMPLE FOR BODY REMO 654$ 4600144-0 SMPLE REPAIR 12.6-20 321$ 4600146-0 SIMPLE REPAIR 2.5 < 321$ 4600148-0 SIMPLE REPAIR 2.6-5. 321$ 4600149-0 SIMPLE REPAIR 2.6-7. 321$ 4600150-0 SMPLE REP 20.1-30 321$ 4600152-0 SIMPLE REPAIR-5.1 TO 321$ 4600154-0 SIMPLE REPAIR-7.6-12 321$ 4600155-0 SPINAL PUNCTURE LUMB 830$ 4600156-0 STRAPPING ANKLE 182$ 4600167-0 TETANUS/DIPTHERIA TO 266$ 4600168-0 TETANUS/DIPTHERIA TO 27$ 4600170-0 THER PROPH DX INJ IN 198$ 4600172-0 TRANSCUTANEOUS PACIN 666$ 4600173-0 UNLISTED CASTING PRO 182$ 4600205-0 EXC BLES S/N/EX G; 2 972$ 4600270-0 PLATELET RICH PLASMA 315$ 4600989-0 DEBRIDE NAIL 6 OR MO 73$ 4600990-0 PARE BENIGN LES; SIN 125$ 4600991-0 DEB SUBQ TISSUE ADD- 175$

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Code Description Charge4601088-0 EXC FACE-MM B9+MARG 759$ 4601186-0 CRUTCHES-S 28$ 4601187-0 EXC BENGN LES TRNK 1 613$ 4601481-0 OSTEOPATHIC MANI THE 101$ 4601567-0 CLOSED TX OF ULNAR S 328$ 4601723-0 CARDI RHY MONIT 1-3 150$ 4601749-0 ER PULSE OXIMETRY 62$ 4601988-0 INTUBATION ET EMERGE 666$ 4602028-0 BLOOD TRANSFUSION 700$ 4602120-0 BL PUSH TRANSFUSE 2 195$ 4602121-0 FLU IMMUN ADMIN/PREV 150$ 4602122-0 FLU IMMUN NOT ADMIN/ 45$ 4602123-0 IMMUNIZATION ADM; EA 36$ 4602124-0 REM IMP EAR WAX 45$ 4602125-0 REMOVE IMPACTED EAR 45$ 4602143-0 CBI CONT BLADDER IRR 197$ 4602145-0 CL LACERTON MOUTH 2. 835$ 4602146-0 COMPLC REM FB FROM F 775$ 4602147-0 CPLX REP E/N/E/L; 1. 805$ 4602148-0 DECLOT VASCULAR DEVI 1,650$ 4602149-0 DEEP I&D THIGH/KNEE 1,075$ 4602150-0 EXC PILONID CYST; SM 895$ 4602151-0 I&D DEEP ABSC SFT TI 1,100$ 4602152-0 I&D LEG/ANKLE DEEP A 1,120$ 4602153-0 INS NON-TUN CVCATH < 725$ 4602185-0 VENIPUNCTURE AGE 3 Y 295$ 4602186-0 VEIN ACCESS CUTDOWN 295$ 4602187-0 TX SPONTAN HIP DISLO 195$ 4602188-0 SIMPLE CNTRL NOSE BL 155$ 4602189-0 REPAIR NAIL BED 125$ 4602190-0 REMOVAL OF NAIL BED 175$ 4602191-0 REMOVAL OF HEMORRHOI 5,339$ 4602192-0 REM FB MUSCLE; DEEP 2,825$ 4602193-0 INC ST ABSC; DEEP 1,975$ 4602194-0 I&D PILONID CYST; CP 1,575$ 4602195-0 EXTENSOR TENDON REPA 1,200$ 4602196-0 ESCHAROTOMY; INIT IN 1,650$ 4602197-0 ESCHAROTOMY; ADDL IN 1,350$ 4602198-0 BL DRAW < 3 YRS OTHE 295$ 4602199-0 CAPILLARY BLOOD DRAW 350$

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Code Description Charge4602200-0 GLUCOSE; BLD BY MONI 31$ 4602201-0 ER CARDIOVER SEL INT 895$ 4602202-0 CL TX CMC FX DISL TH 475$ 4602203-0 CL TX NSAL SEPTAL FX 3,693$ 4602204-0 CL TX RADIAL SHFT FX 2,250$ 4602205-0 CL TX SHDR DISLOC W 2,250$ 4602206-0 CL TX SHLDR DISL W M 2,350$ 4602207-0 CL TX SHLDR DISL &FX 2,350$ 4602208-0 CL TX ULNAR SHFT FX 2,350$ 4602209-0 COLCT BLOOD FRM PICC 115$ 4602210-0 CTRL POST EPISTAX SQ 395$ 4602211-0 DEEP FB REM - FOREAR 695$ 4602212-0 DEEP I&D - UA/ELBOW 695$ 4602213-0 DEEP I&D ABSC - FARM 695$ 4602214-0 DEEP INCISION OF HAN 695$ 4602215-0 DELIVERY OF PLACENTA 2,250$ 4602216-0 DR ABSC CYST HEMAT-M 695$ 4602217-0 DR EXT EAR ABSC/HEM 550$ 4602218-0 DRAW BLOOD OFF VENOU 270$ 4602219-0 DRESSNG CHG NOT BUR 115$ 4602606-0 CANE 32$ 4602747-0 CONTROL NASAL HEMORR 103$ 4604032-0 ER VENIPUNCTURE FEE 19$ 4604611-0 IMMUNIZATION ADMIN 1 83$ 4604612-0 PULSE OX MULTIPLE 35$ 4604613-0 EPISIOTOMY OR VAGINA 4,333$ 4604614-0 ANOSCOPY; W REM FB 1,305$ 4604615-0 NONSELECTIVE CATH PL 35$ 4608865-0 CL TX MC FX SGL; W M 335$ 4609020-0 ER SIMPLE <2.5 CM LA 321$ 4609025-0 FACIAL INT <2.5CM 321$ 4609026-0 FACIAL INT 0-2.5CM 709$ 4609568-0 I&D ABSC; SMPL OR SG 895$ 4609569-0 DEBRIDEMENT OF NAIL 71$ 4609570-0 SGL NAIL AVULSION 61$ 4609571-0 NAIL AVULSION EA ADD 185$ 4609572-0 WEDGE EXC NAIL FOLD 185$ 4609573-0 SMP REP WND DEHISC 470$ 4609574-0 SM JNT INJ/ASPIRATIO 310$ 4609575-0 MEDIUM JOINT/BURSA I 280$

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Code Description Charge4609576-0 LARGE JOINT/BURSA I 870$ 4609577-0 TNGE LACERATION 2.6 1,563$ 4609578-0 CL TX CLAVICULAR FX; 4,021$ 4609579-0 CL TX DSTL RADIOULNA 315$ 4609580-0 CL TX TRAUMA HIP DIC 315$ 4609581-0 TX SP HIP DISL ABD S 315$ 4609583-0 CL TX KNEE DISL; WO 315$ 4609584-0 CLTX BIMALLEOLAR ANK 315$ 4609585-0 CL TX MTP JNT DISLOC 315$ 4609586-0 STRAPPING; ELBOW OR 234$ 4609587-0 STRAPPING; THORAX 234$ 4609588-0 SHORT ARM SPLINTS CL 85$ 4609589-0 STRAPPING; SHOULDER 234$ 4609590-0 STRAPPING; KNEE 234$ 4609591-0 STRAPPING OF TOES 234$ 4609592-0 STRAPPING UNNA BOOT 550$ 4609593-0 RMVE CAST FUL ARM OR 35$ 4609594-0 SMPL REPAIR >30CM 234$ 4609595-0 SMPL REPAIR 7.6-12.5 321$ 4609596-0 ER SMPLE REP-12.6-2 321$ 4609597-0 ER SMP REPAIR-20.1-3 321$ 4609598-0 ER SIMP REP;>30 681$ 4609599-0 TRACH TUBE CHG BEFOR 29,400$ 4609600-0 LARYNGOSCOPY IND; DI 225$ 4609601-0 TRACH EMERG; TRANSTR 1,563$ 4609602-0 TRACHE EMERG;CRICO 1,563$ 4609603-0 INS NON-TUN CVCATH > 2,124$ 4609604-0 PLCE NDL INTRAOSS IN 336$ 4609605-0 I&D ABSCESS; PERITON 654$ 4609606-0 FB REMOVE PHARYNS 217$ 4609607-0 GASTRIC LAVAGE INTUB 199$ 4609608-0 I&D ABSCESS ISCHIO/P 1,764$ 4609609-0 ABD PARACENTESIS 1,202$ 4609610-0 ABD PARACENTESIS W/I 1,202$ 4609611-0 INS TEMP BLAD CAT ST 140$ 4609612-0 INS BLAD CATH COMPLX 190$ 4609613-0 VAGINAL DELIVERY ONL 45,125$ 4609615-0 FB REM CONJUNCTI SMP 222$ 4609616-0 FB REM EXT EYE; CORN 222$ 4609617-0 FB REM EXT AUDITORY 135$

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Code Description Charge4609618-0 NG TUBE PLC W FLUORO 275$ 4609619-0 ER SIMPLE 2.6 TO 7.5 321$ 4609620-0 LAYER INT 12.6 TO 20 321$ 4609621-0 LAYER INT 20.1 TO 30 321$ 4609622-0 LAYER INT >30 CM 321$ 4609623-0 LAYER INT 2.6-7.5 CM 321$ 4609624-0 LAYER INT 7.6-12.5CM 321$ 4609625-0 LAYER INT >30CM 321$ 4609626-0 FACIAL INT 7.6-12.5C 321$ 4609627-0 FACIAL INT 12.6-20CM 321$ 4609628-0 FACIAL INT >30CM 321$ 4609629-0 CPLX REP 1.1-2.5CM 1,563$ 4609630-0 CPLX REP 2.6CM 1,087$ 4609631-0 CREP E/N/E/L; EA ADD 681$ 4609632-0 REPAIR LIP FT; UP TO 1,563$ 4609633-0 REPAIR LIP FT; > 1/2 1,563$ 4609634-0 TNGE LACERATION < 2. 333$ 4609635-0 ER EYE TRAY 26$ 4609636-0 REM FB FOOT; SQ 1,800$ 4609637-0 PORT FLUSH ER 131$ 4609638-0 SUTURE TRAY ER 32$ 4609639-0 ANTISEPTIC SCRUB ER 12$ 4609640-0 BETADINE ER ONLY 6$ 4609641-0 I&D TRAY ER 30$ 4609642-0 TX SUPRFCL WND DEHI 711$ 4609643-0 REM FB UP ARM OR ELB 967$ 4609644-0 FLUORESCEIN STRIP ER 12$ 4609645-0 COLD PACK ER 15$ 4609646-0 HOT PACK ER 15$ 4609647-0 US BLADDER SCAN ER 143$ 4609648-0 CLTX BIMALLEOLAR ANK 329$ 4609649-0 EXC BEN LES T/A/L; 2 1,810$ 4609650-0 DEB MUSC/FASCIA 20 S 603$ 4609651-0 US GUIDED NEEDLE PLA 250$ 4609652-0 I&D ABSC; COMPL OR M 311$ 4609653-0 US GUIDE VASCULAR AC 96$ 4609654-0 INJ SGL TENDON SHTH 571$ 4609655-0 CL TX ARTFX MCP/IP J 428$ 4609656-0 FINGER SPLINT APPLIC 50$ 4609657-0 REP INIT INCI/ VENTR 8,502$

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Code Description Charge4609658-0 INJ ANESTH ; TRIGEMI 549$ 4609659-0 CL TX MTP JNT DISLOC 4,382$ 4609660-0 REM EMB FB FROM DENT 6,506$ 4609661-0 CL TX TIB SHFT FX W 4,382$ 4609662-0 GANGLION CYST INJECT 571$ 4609663-0 CL TX RADIAL HD/NECK 328$ 4609664-0 FNA W/IMAGE 1,439$ 4609665-0 CL TX OF NASAL BONE 1,907$ 4609666-0 DRESS/DEBRID P-THICK 514$ 4609667-0 REMOVE VAGINAL FOREI 1,847$ 4609668-0 REM GAUNTLET BOOT OR 447$ 4650004-0 COLD PACKS PT ONLY 30$ 4650005-0 CONTRAST BATH APPLIC 51$ 4650010-0 ELECTRIC STIM/UNATTE 92$ 4650011-0 GAIT TRAINING 15 MIN 114$ 4650012-0 GROUP TREATMENT THER 54$ 4650013-0 HOT PACKS 34$ 4650015-0 PT IONTOPHORESIS 141$ 4650019-0 MASSAGE 15 MINUTES T 70$ 4650021-0 MECHANICAL TRACTION 70$ 4650022-0 MMT EXT/TRUNK EXCLUD 54$ 4650023-0 MMT HAND MUSCLE TEST 51$ 4650024-0 MANUAL THERAPY EA 15 125$ 4650025-0 NEUROMUSC REED 15MIN 125$ 4650026-0 NON-SELECTIVE DEBRID 74$ 4650027-0 ORTHO MGMT TRAIN 15M 92$ 4650028-0 PT EVALUATION -INITI 225$ 4650029-0 PT RE-EVAL 105$ 4650030-0 PARAFFIN BATH 70$ 4650034-0 ROM HAND MEASUREMENT 26$ 4650035-0 SLCTV WND DEBRIDEM 2 186$ 4650036-0 SELF CARE TRAIN 15M 70$ 4650038-0 THER DIR ACTIV 15MIN 120$ 4650039-0 THERAPY EXER 15MIN 70$ 4650041-0 PT ULTRASOUND 15MIN 70$ 4650042-0 WHEELCHAIR MGMT 15M 68$ 4650043-0 WHIRLPOOL THERAPY 77$ 4650044-0 WORK HARDENING INIT 54$ 4650045-0 WORK TASK ANALYSIS 98$ 4650046-0 OT INITIAL EVAL 225$

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Code Description Charge4650047-0 TENS APPLICATION 75$ 4650048-0 OT RE-EVAL 105$ 4650049-0 OT INPATIENT HOSP/DA 168$ 4650050-0 OT THER EX JOINT RX 120$ 4650051-0 PHYSICAL PERFORM TES 92$ 4650052-0 OT AQUTIC THERA/EXER 48$ 4650053-0 OT PARAFFIN BATH THE 70$ 4650054-0 OT MANUAL THERAPY 15 125$ 4650057-0 P T EVALUATION-IP 168$ 4650058-0 THER DIR ACTIV 30MIN 140$ 4650059-0 THER DIR ACTIV 60MIN 200$ 4650061-0 PULSE OXIMETRY SINGL 62$ 4650062-0 APPL SPLINT- LNG ARM 98$ 4650063-0 APP STATICSPLNT SARM 69$ 4650064-0 APPLY FINGER SPLINT; 53$ 4650065-0 APP SPLINT-SHRT LEG 89$ 4650066-0 TEAM CONF W/PAT BY H 80$ 4650067-0 WORK HARDENING EA AD 62$ 4650069-0 POSITION SEAT SPEC O 30$ 4650070-0 WOUND ULTRASOUND 70$ 4650071-0 LOW-LEVEL LASER 15M 65$ 4650073-0 SELF-MGMT EDUC & TRA 82$ 4650074-0 MUSCLE TEST; TOT BOD 82$ 4650075-0 MUSCLE TEST; TOT BOD 82$ 4650076-0 CANALITH REPOSITIONI 62$ 4650077-0 ELECTRIC STIMULATION 92$ 4650078-0 VASOPNEUMATIC DEVICE 110$ 4650079-0 SLCTV WND DEBRIDEM 150$ 4650080-0 ELECTRIC STIM 15MIN 87$ 4650081-0 GAIT TRAINING 30 MIN 114$ 4650082-0 GAIT TRAINING 45 MIN 114$ 4650083-0 GAIT TRAINING 60 MIN 114$ 4650084-0 NEUROMUSC REED 30MIN 163$ 4650085-0 NEUROMUSC REED 45MIN 200$ 4650086-0 NEUROMUSC REED 60MIN 238$ 4650087-0 THER DIR ACTIV 45MIN 180$ 4650088-0 THERAPY EXER 30MIN 140$ 4650089-0 THERAPY EXER 45MIN 210$ 4650090-0 THERAPY EXER 60MIN 280$ 4650091-0 PT ULTRASOUND 30MIN 70$

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Code Description Charge4650092-0 PT ULTRASOUND 45MIN 70$ 4650093-0 PT ULTRASOUND 60MIN 70$ 4650094-0 ELECTRIC STIM 30MIN 87$ 4650095-0 ELECTRIC STIM 45MIN 87$ 4650096-0 ELECTRIC STIM 60MIN 87$ 4650101-0 ORTHO MGHT TRAIN 30M 92$ 4650111-0 NON-SELECT DEBRIDE 84$ 4650112-0 SELECTIVE WND DEBRI 186$ 4650113-0 THERAPY PUTTY 35$ 4650115-0 MANUAL THERAPY 30MIN 250$ 4650116-0 MANUAL THERAPY 45 MI 375$ 4650117-0 OT COGNITIV SKLS DEV 75$ 4650118-0 OT ADL/SELF CARE 15 85$ 4650119-0 OT WHEELCHAIR MNGMEN 75$ 4650120-0 OT MASSAGE THER 15 85$ 4650122-0 OT THERAPETIC ACT 15 85$ 4650123-0 OT HOT OR COLD PACKS 35$ 4650124-0 OT THERAPEUTIC EX 15 35$ 4650125-0 OT NEUROMUSCUL RE 15 125$ 4650126-0 OT ORTHOTIC MGMT 15 92$ 4650127-0 OT ADL/SELF CARE 30 95$ 4650128-0 OT ADL/SELF CARE 45 110$ 4650129-0 OT MASSAGE THER 30 95$ 4650130-0 OT MASSAGE THER 45 110$ 4650131-0 OT MANUAL THERAPY 30 250$ 4650132-0 OT MANUAL THERAPY 45 250$ 4650133-0 OT THERAPETIC ACT 30 95$ 4650134-0 OT THERAPEUTIC EX 30 95$ 4650135-0 OT THERAPETIC ACT 45 110$ 4650136-0 OT THERAPEUTIC EX 45 110$ 4650137-0 OT NEUROMUSCUL RE 30 250$ 4650138-0 OT NEUROMUSCUL RE 45 250$ 4650139-0 OT ORTHOTIC MGMT 30 102$ 4650140-0 OT ORTHOTIC MGMT 45 122$ 4660001-0 CARDIAC REHAB W/MONI 410$ 4660002-0 CARDIAC REHAB W/O MO 362$ 4660003-0 INTENS CARD REHAB W/ 462$ 4660004-0 INTENS CARD-REHB W/O 401$ 4670001-0 ACOUSTIC REFLEX DECA 79$ 4670002-0 ACOUSTICS REFLEX 79$

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Code Description Charge4670003-0 ADJUST ASS LISTENING 136$ 4670004-0 AIRBONE TESTING 213$ 4670005-0 APHASIA ASSESSMENT P 659$ 4670006-0 AUDIOLOGICAL EVAL CO 284$ 4670007-0 AUDIOLOGY 260$ 4670008-0 AUDIOLOGY SCREENING 96$ 4670009-0 AURAL REHABILITATION 95$ 4670010-0 BIN HEARING AID-2 CH 3,473$ 4670011-0 BINAURAL DIG/PROG HE 6,862$ 4670012-0 BRAINSTEM EVOKED RES 810$ 4670013-0 CALORIC VESTIBULAR T 277$ 4670014-0 CENTRAL AUDITORY FUN 92$ 4670015-0 CONDITIONED PLAY 213$ 4670016-0 CONSULTATION-A 95$ 4670017-0 DEV COG SKILLS EACH 58$ 4670018-0 DIRECT SWALLOW ASSES 360$ 4670019-0 DYSPHAGIA TREATMENT 136$ 4670020-0 ELECTROACOUSTIC CHEC 144$ 4670021-0 ELECTROACOUSTIC CHEC 84$ 4670022-0 EVAL-PRESCRIPT SPEEC 351$ 4670023-0 EVAL-PRESCRIPT VOICE 351$ 4670024-0 EVAL-SPEECH LANGUAGE 360$ 4670025-0 EVOKED OTOACOU EMMIS 277$ 4670026-0 EVOKED OTOACOUSTIC E 191$ 4670027-0 FILTERED SPEECH TEST 92$ 4670028-0 HEAR AID CHECK BINAU 95$ 4670029-0 HEAR AID CHECK-MONAU 47$ 4670031-0 HEARING AID EVALUATI 159$ 4670032-0 HEARING AID REPAIR 182$ 4670033-0 HEARING AID BTE BINA 1,557$ 4670034-0 HEARING AID BTE MONA 780$ 4670035-0 HEARING AID ITC BINA 2,342$ 4670036-0 HEARING AID ITC MONA 1,173$ 4670037-0 HEARING AID ITE BINA 1,917$ 4670038-0 HEARING AID ITE MONA 960$ 4670039-0 HEARING AID CIC BINU 3,165$ 4670040-0 HEARING AID CIC MONU 1,583$ 4670041-0 INDIRECT SWALLOW ASS 283$ 4670042-0 INDUSTRIAL HEARING S 63$ 4670043-0 INITIAL FIT BINUARAL 1,002$

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Code Description Charge4670044-0 INITIAL FIT MONUARAL 1,002$ 4670045-0 INITIAL FITTING BINU 846$ 4670046-0 INITIAL FITTING MONU 846$ 4670047-0 LANG DEVELOP EXAM EX 659$ 4670048-0 MODIFY/TRAIN USE OF 260$ 4670049-0 MON HEARING AID-2 CH 1,737$ 4670050-0 HEARING SERVICE 4,641$ 4670051-0 OPTOKINETIC NYSTAGMU 191$ 4670052-0 OSCILLATING TRACKING 191$ 4670053-0 POS NYSTAGMUS TEST 4 256$ 4670054-0 PROGRAM HEAR AID BTE 2,586$ 4670055-0 PROGRAM HEAR AID BTE 1,755$ 4670056-0 PROGRAM HEAR AID CIC 3,975$ 4670057-0 PROGRAM HEAR AID CIC 2,443$ 4670058-0 PROGRAM HEAR AID ITC 3,150$ 4670059-0 PROGRAM HEAR AID ITC 2,033$ 4670060-0 PROGRAM HEAR AID ITE 2,723$ 4670061-0 PROGRAM HEAR AID ITE 1,822$ 4670062-0 PROSTETIC/AUG/ALT DE 389$ 4670063-0 PURETONE AUDIOMETRY 123$ 4670064-0 RE-EVAL USING SPEECH 263$ 4670065-0 REPAIR MODIFICATION 270$ 4670066-0 SAT WITH SPEECH RECO 79$ 4670067-0 SCREENING AUDIOMETRY 79$ 4670068-0 SELECT PICTURE AUDIO 134$ 4670069-0 SPEECH DEVELOP EX 60 659$ 4670070-0 SPEECH LANGUE GRP 60 147$ 4670071-0 SPONT NYSTAGMUS TEST 191$ 4670072-0 STAGGARD SPONDAIC WO 206$ 4670073-0 STENGER TEST 213$ 4670074-0 THERAPEUTIC ACTIVITY 114$ 4670075-0 THERAPUETIC PROCEDUR 125$ 4670076-0 TONE DECAY TEST 79$ 4670077-0 TRAINING-SPEECH DEVI 260$ 4670078-0 TREATMENT SPEECH DIS 144$ 4670079-0 TYMPANOMETRY 79$ 4670080-0 TYMPANOMETRY 79$ 4670081-0 USE OF VERTICAL ELEC 191$ 4670082-0 VISUAL REINFORCE AUD 213$ 4670083-0 SPEECH EVALUATION 409$

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Code Description Charge4670084-0 SPEECH THERAPY (PER 52$ 4760001-0 OBSERVATN HR-OPER RM 122$ 4760002-0 OBSERVATN HR-EMER RM 122$ 4760003-0 OBSERVATN HR-MEDSURG 122$ 4780001-0 DIET-FOLLOW UP 147$ 4780004-0 NUTRITION THERAPY F/ 151$ 4780005-0 NUTRITION THERAPY FO 110$ 4780006-0 NUTRITION THERAPY FO 197$ 4780201-0 DIABETES IN PREGNANC 974$ 4780202-0 DIABETES NUTRITION M 431$ 4780203-0 DIABETES NUTRITION M 431$ 4780204-0 DIABETES NUTRITION M 431$ 4780205-0 NUTRITION/DIABETIC I 161$ 4780206-0 ESTAB. CONSULT 30 MI 108$ 4780207-0 ESTAB. CONSULT 45 MI 135$ 4780208-0 LIVING W/DIABETES MO 311$ 4780209-0 MEDICATION MANAGEMEN 338$ 4780210-0 DIETICIAN CONSULT 20$ 4850000-0 OFFICE/OUTPATIENT VI 168$ 4850001-0 OFFICE/OUTPATIENT VI 225$ 4850002-0 OFFICE/OUTPATIENT VI 297$ 4850003-0 OFFICE/OUTPATIENT VI 407$ 4850004-0 OFFICE/OUTPATIENT VI 552$ 4850005-0 OFFICE/OUTPATIENT VI 225$ 4850006-0 OFFICE/OUTPATIENT VI 225$ 4850007-0 OFFICE/OUTPATIENT VI 297$ 4850008-0 OFFICE/OUTPATIENT VI 407$ 4850009-0 ORTHO CLINIC CONSULT 168$ 4850015-0 LONG ARM CAST APPLIC 550$ 4850016-0 SHORT LEG CAST APPLI 561$ 4850017-0 SHORT LEG WALKING CA 561$ 4850018-0 LONG LEG CAST APPL 561$ 4850019-0 APPLY CLUBFOOT CAST 246$ 4850020-0 LONG ARM SPLINTS APP 246$ 4850021-0 SHRT ARM SPLINTS APP 246$ 4850022-0 FINGER SPLINT APPLIC 183$ 4850023-0 LONG LEG SPLINT APPL 246$ 4850024-0 SHORT LEG SPLINT 246$ 4850025-0 CARPAL TUNNEL INJECT 571$ 4850026-0 TENDON SHETH/LIGAMEN 571$

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Code Description Charge4850027-0 TENDON ORIGIN INJECT 571$ 4850028-0 TRIGGER POINTS INJE 571$ 4850029-0 SMALL JOINT/BURSA IN 707$ 4850030-0 MEDIUM JOINT/BURSA I 568$ 4850031-0 DRAIN/INJ MAJOR JNT/ 571$ 4850032-0 GANGLION CYST INJ OR 571$ 4850119-0 US GUIDED NEEDLE PLA 116$ 4850125-0 EXC BEN LES T/A/L; 1 967$ 4850126-0 APPLY FINGER CAST 246$ 4850127-0 CL TX RADIAL HD/NEC 328$ 4850128-0 CL TX ART FX MCP/IP 350$ 4850129-0 CL TX CMC DISL W M E 350$ 4850130-0 CL TX D PHAL FX FGR/ 328$ 4850131-0 CL TX D PHAL FX FGRR 328$ 4850132-0 CL TX FX GT PHALANX( 328$ 4850133-0 CL TX FX GT PHALANX( 328$ 4850134-0 CL TX FX PHALANX/PHA 350$ 4850135-0 CL TX FX PHALNX/PHAL 328$ 4850136-0 CL TX IP JT D W MANI 375$ 4850137-0 CL TX MC FX SGL; WO 328$ 4850138-0 CL TX MCP DISLOC SGL 328$ 4850139-0 CL TX METATARSAL FX; 328$ 4850140-0 CL TX METATARSAL FX; 328$ 4850141-0 CL TX OF RAD SHAF WO 328$ 4850142-0 CL TX PHAL SHAFT FX; 328$ 4850143-0 CL TX PHAL SHFT FX W 328$ 4850144-0 CL TX PROX TIBIAL FX 4,192$ 4850145-0 CL TX RADIAL & ULNAR 328$ 4850146-0 CL TX SESAMOID FRACT 328$ 4850147-0 CL TX TALUS FX; WO M 328$ 4850148-0 CL TX ULNAR SHAFT FX 328$ 4850149-0 CLOSED TX OF ULNAR S 328$ 4850150-0 CLTX CARPL BONE FX W 328$ 4850151-0 CLTX DSTL RADIAL FX/ 328$ 4850152-0 CLTX DSTL RDL FX/EPI 1,114$ 4850153-0 INC FTS WRIST 4,830$ 4850154-0 INJ EPIDURAL BLOOD O 1,635$ 4850155-0 KNEE ARTHROSCOPY W L 6,488$ 4850156-0 MANIP ELBOW W ANESTH 3,382$ 4850157-0 MANIP FING JNT W AN 1,114$

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Code Description Charge4850158-0 MANIPULATE WRIST W A 4,192$ 4850159-0 PERC SK FIX METATARS 5,725$ 4850160-0 PIN ULNAR STYLOID FX 5,725$ 4850161-0 RMVE FULL ARM/ LG CA 246$ 4850162-0 TX TARSL BNE FX ; WO 328$ 4850163-0 TX TARSL BONE FX; W 328$ 4850164-0 WEDGING OF CAST NOT 246$ 4850165-0 WINDOWING OF CAST 246$ 4850172-0 ARTHROPL KNEE C&P ML 29,069$ 4850173-0 INJ TRIGGER PNT >/=3 1,300$ 4850174-0 KNEE ARTHRO DIFF COM 690$ 4850175-0 KNEE ARTHROGRAPHY IN 250$ 4850176-0 SHLDER ARTHROGRAM IN 235$ 4850177-0 SIJ ANESTH/STEROID I 1,635$ 4850178-0 SIJ INJ - ARTHROGR/A 12$ 4850179-0 TENOTOMY SQ TOE; SIN 4,836$ 4850180-0 WRST ARTHROGRPHY INJ 561$ 4850185-0 INJ PARAVERT F JNT L 549$ 4850186-0 INJ TRIGGER PNT 1/2 184$ 4850187-0 INJ A/S TRANSF EPID; 853$ 4850188-0 INJ PARAVERT F JNT L 1,768$ 4850189-0 ORTHOVISC INJ PER 15 520$ 4850190-0 INJ PARAVT F JNT C 1 523$ 4850191-0 INJ PARAVERT F JNT C 571$ 4850192-0 INJ PARAVERT F JNT C 571$ 4850193-0 INJ ANESTH ; TRIGEMI 549$ 4850197-0 INJ FORAMEN EPI ADD 911$ 4850198-0 INJ FORAMEN EPIDURAL 1,635$ 4850199-0 INJ PARAVERT F JNT L 570$ 4850200-0 INJ PARAVERT F JNT L 570$ 4850201-0 INJ PARAVERT F JNT L 549$ 4850205-0 INJECT SACROILIAC JO 625$ 4850250-0 HOT/COLD H2OBOT/CAP 50$ 4850259-0 DEB MUSC FAC <20CM 603$ 4850663-0 N BLOCK INJ PLANTAR 639$ 4851253-0 INS TEMP BLADDER CAT 174$ 4851915-0 COLONOSCOPY FLEX W 2,161$ 4851916-0 COLONOSCOPY FLEX ; D 2,159$ 4851925-0 UGI W BX. SGL/MULTIP 1,949$ 4851926-0 APPLY MULTLAY COMPRS 246$

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Code Description Charge4851985-0 INJ(S) FORAMEN EPIDU 1,547$ 4855439-0 CL TX MC FX SGL; W 328$ 4855440-0 UNNA BOOT STRAPPING 243$ 4855441-0 CL TX PHALANG SHFT F 418$ 4855442-0 DEBRIDE NAIL 6 OR MO 224$ 4855443-0 DEBRIDE NAIL 1-5 224$ 4855444-0 PARE BENIGN LES; SGL 224$ 4856409-0 PARTIAL EXC PHALANX 1,032$ 4856547-0 DEB MUSC/FA >=20CM 603$ 4856548-0 DEB SUBQ TISSUE 20 S 655$ 4856549-0 DEB SUBQ TISSUE ADD- 734$ 4856550-0 DEBRIDEMENT TRAY 45$ 4856551-0 DEBRIDEMENT TRAY 75$ 4856552-0 TRIM SKIN LESIONS OV 334$ 4856653-0 INJ SGL TENDON SHTH 571$ 4856654-0 SHAVE LES S/N/H/F/G; 224$ 4856655-0 I&D ABSC; SMPL OR SG 392$ 4856656-0 TRIM ND NAILS 89$ 4856657-0 REMOVAL OF NAIL BED 448$ 4856658-0 REMOVAL OF NAIL BED 448$ 4856659-0 SIMPLE BUNION CORREC 7,673$ 4856660-0 STRAPPING UNA BOOT 550$ 4856661-0 CL TX MC FX SGL; W M 418$ 4856662-0 STRAPPING: ELBOW 234$ 4856663-0 APPL LONG ARM SPLINT 224$ 4856664-0 APPLY SHORT LEG SPLI 330$ 4856665-0 ASPIRATE/INJ GANGLIO 640$ 4856666-0 APPLY SHORT ARM SPLI 330$ 4856667-0 TRIM SKIN LESIONS 2 259$ 4856668-0 DRAIN/INJ INTERM JNT 637$ 4856669-0 INJECT TRIGGER POINT 637$ 4856670-0 STRAPPING; SHOULDER 189$ 4856671-0 SPL AVULSE NP; SGL 250$ 4856672-0 SPL AVULSE NP; EA AD 125$ 4856673-0 PUNCT ASP - ABSC HEM 439$ 4856674-0 EXC BLES S/N/EX G; 0 290$ 4856675-0 STRAP ANKLE OR FOOT 196$ 4856676-0 CL TX DISTL FIB FX W 607$ 4856677-0 APPLY SH LEG CAST 484$ 4856678-0 INJECT SPINE L/S (CD 2,344$

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Code Description Charge4856679-0 APPLY SHORT ARM CAST 484$ 4856680-0 CLTX CARPL BONE FX W 605$ 4856681-0 INJECT SPINE C/T 1,295$ 4856682-0 INC & REM FB SQ; SMP 361$ 4856683-0 INC & REM FB SQ; COM 4,012$ 4856684-0 I&D HEMATOMA/FLUID 351$ 4856685-0 DEB MUSC/FASCIA 20 S 528$ 4856686-0 DEB BONE 20 SQ CM/< 1,239$ 4856687-0 BX-SKIN SQ/MM; SGL 244$ 4856689-0 REM SKIN TAGS; <=15 308$ 4856691-0 SHAVE LES T/A/L; 0.5 290$ 4856692-0 SHAVE LES T/A/L; 0.6 290$ 4856693-0 SHAVE LES T/A/L; 1.1 290$ 4856694-0 SHAVE LES T/A/L; > 2 514$ 4856695-0 SHAVE LES S/N/H/F/G; 290$ 4856696-0 EXC BLES S/N/EX G; 0 339$ 4856697-0 EXC BLES S/N/EX G; 1 371$ 4856698-0 EXC BLES S/N/EX G; 2 410$ 4856699-0 EXC BLES S/N/EX G; 3 2,215$ 4856700-0 EXC BLES S/N/EX G; > 3,356$ 4856701-0 EVAC SU HEMATOMA 115$ 4856702-0 REMOVE NAIL BED/FING 635$ 4856703-0 BX NAIL UNIT 290$ 4856704-0 REPAIR NAIL BED 381$ 4856705-0 WEDGE EXC NAIL FOLD 290$ 4856706-0 I&D ABSC; COMPL OR M 308$ 4856707-0 INC ST ABSC; DEEP 1,239$ 4856708-0 INC MULTI SQ TOE TEN 3,255$ 4856710-0 REMOVE SGLE TOE PHAL 3,255$ 4856711-0 RESECT HD OF TOE PHA 3,255$ 4856712-0 INTERPHALANG TOE JNT 3,255$ 4856713-0 REM FB FOOT; SQ 640$ 4856714-0 REM DEEP FB OF FOOT 2,215$ 4856715-0 COMPLIC REM FB FROM 1,239$ 4856716-0 HAMMERTOE OP ONE TOE 3,255$ 4856717-0 COCK-UP 5TH TOE W PL 3,255$ 4856718-0 PRTL REM FOOT BONE M 3,255$ 4856719-0 REPAIR HALLUX RIGIDU 3,255$ 4856720-0 SIMPLE BUNION CORREC 5,054$ 4856721-0 KELLER/MCBRIDE/MAYO 5,054$

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Code Description Charge4856722-0 CL TX METATARSAL FX; 335$ 4856723-0 CL TX CALCANEAL FX; 864$ 4856724-0 SLCTV WND DEBRIDEM 2 516$ 4856725-0 UNLISTED PROCEDURE C 200$ 4856726-0 THER/PROPH/DIAG INJ 200$ 4856727-0 DESTRUCT B9 LESION 1 344$

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Ellenville Regional Hospital Chargemaster as of 3/25/15 ... file4000011-0THORACENTESIS W/TUBE $ 741 4000013-0COLONOSCOPY CONTROL $ 1,425 4000031-0ERCP W ... Ellenville Regional Hospital