Service Code Service Description CDM Price 31300005 ROOM CHARGE SEMI-PRIVATE SO 1,680.40 31300010 ROOM CHARGE PRIVATE SO 1,680.40 31300021 OBSERVATION INITIAL - 1ST HOUR 749.90 31300022 OBSERVATION EACH ADDN'L HOUR 40.80 31300029 OBSERVATION DIRECT ADMIT SO 1,079.80 31300035 ROOM CHARGE PRIVATE SO ISO 2,354.90 31300050 PHS II RECOV 0-1 HRS TOTAL 233.60 31300055 PHS II RECOV 1-2 HRS TOTAL 450.10 31300060 PHS II RECOV 2-3 HRS TOTAL 645.20 31300065 PHS II RECOV 3-4 HRS TOTAL 823.40 31300070 PHS II RECOV 4-5 HRS TOTAL 980.20 31300075 PHS II RECOV 5-6 HRS TOTAL 1,141.70 31306430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 31396360 IV HYDRATION INITIAL 31-60 MIN 491.70 31396361 IV HYDRATION EA ADTNL HR 298.50 31396365 IV DRUG INFUSION 1ST HR 604.90 31396366 IV DRUG INFUS EA ADTNL HR 263.70 31396367 IV INFUSION SEQUENTIAL 1ST HR 327.30 31396368 IV INFUSION CONCURRENT 307.50 31396372 DRUG INJ SUB/IM - SO 194.60 31396374 IV PUSH 225.40 31396375 IV PUSH DIFFERENT DRUG 257.70 31396376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 31400005 ROOM CHARGE SEMI-PRIVATE MO 1,680.40 31400010 ROOM CHARGE PRIVATE MO 1,680.40 31400021 OBSERVATION INITIAL - 1ST HOUR 749.90 31400022 OBSERVATION EACH ADDN'L HOUR 40.80 31400029 OBSERVATION DIRECT ADMIT MO 1,079.80 31400030 ROOM CHARGE PRIVATE MO ISO 2,354.90 31406430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 31416430 BLOOD ADMINISTRATION >4 UNITS 1,709.90 31436415 VENIPUNCTURE ROUTINE 72.20 31436591 SPECIMEN ACQUISITION VAD 156.00 31436593 DECLOT THROMB AGNT IMP VAD/CAT 881.80 31496360 IV HYDRATION INITIAL 31-60 MIN 491.70 31496361 IV HYDRATION EA ADTNL HR 298.50 31496365 IV DRUG INFUSION 1ST HR 604.90 31496366 IV DRUG INFUS EA ADTNL HR 263.70 31496367 IV INFUSION SEQUENTIAL 1ST HR 327.30 31496368 IV INFUSION CONCURRENT 307.50 31496372 DRUG INJ SUB/IM - MO 194.60 31496374 IV PUSH 225.40 31496375 IV PUSH DIFFERENT DRUG 257.70 31496376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 31496401 CHEMO ANTI-NEOPL SQ/IM 576.60 31496413 CHEMO IV INFUS 1ST HR 1,005.50 31496415 CHEMO IV INFUS ADTNL HR 389.80 31496416 CHEMO IV INFUSE PUMP 827.60

31496523 VAD FLUSH/NO INFUSION OR INJ 203.60 31500005 ROOM CHARGE SEMI-PRIVATE AMS 1,680.40 31500010 ROOM CHARGE PRIVATE AMS 1,680.40 31500021 OBSERVATION INITIAL - 1ST HOUR 749.90 31500022 OBSERVATION EACH ADDN'L HOUR 40.80 31500029 OBSERVATION DIRECT ADMIT AMS 1,079.80 31500030 ROOM CHARGE PRIVATE AMS ISO 2,354.90 31500060 PHS II RECOV 2-3 HRS TOTAL 645.20 31500065 PHS II RECOV 3-4 HRS TOTAL 823.40 31500070 PHS II RECOV 4-5 HRS TOTAL 980.20 31500075 PHS II RECOV 5-6 HRS TOTAL 1,141.70 31506430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 31516430 BLOOD ADMINISTRATION >4 UNITS 1,709.90 31593236 TELEMETRY 621.20 31596360 IV HYDRATION INITIAL 31-60 MIN 491.70 31596361 IV HYDRATION EA ADTNL HR 298.50 31596365 IV DRUG INFUSION 1ST HR 604.90 31596366 IV DRUG INFUS EA ADTNL HR 263.70 31596367 IV INFUSION SEQUENTIAL 1ST HR 327.30 31596368 IV INFUSION CONCURRENT 307.50 31596372 DRUG INJ SUB/IM - AMS 194.60 31596374 IV PUSH 225.40 31596375 IV PUSH DIFFERENT DRUG 257.70 31596376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 33000005 ROOM CHARGE SEMI-PRIVATE PEDS 1,715.00 33000010 ROOM CHARGE PRIVATE PEDS 1,715.00 33000015 ROOM CHARGE-OVERFLOW ADULT PED 1,680.40 33000018 ROOM CHARGE-OVERFLOW NSY PEDS 1,184.80 33000021 OBSERVATION INITIAL - 1ST HOUR 749.90 33000022 OBSERVATION EACH ADDN'L HOUR 40.80 33000024 OBSERVATION EA ADDN'L HR ISO 57.10 33000029 OBSERVATION DIRECT ADMIT PEDS 1,079.80 33000030 ROOM CHARGE PRIVATE PEDS ISO 2,395.20 33000035 ROOM CHARGE OVFL ADULT PED ISO 2,354.90 33006430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 33036591 SPECIMEN ACQUISITION VAD 149.40 33096360 IV HYDRATION INITIAL 31-60 MIN 491.70 33096361 IV HYDRATION EA ADTNL HR 298.50 33096365 IV DRUG INFUSION 1ST HR 604.90 33096366 IV DRUG INFUS EA ADTNL HR 263.70 33096367 IV INFUSION SEQUENTIAL 1ST HR 327.30 33096372 DRUG INJ SUB/IM - PEDS 194.60 33096374 IV PUSH 225.40 33096375 IV PUSH DIFFERENT DRUG 257.70 33096376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 33096523 VAD FLUSH/NO INFUSION OR INJ 203.60 33500005 ROOM CHARGE SEMI-PRIVATE REHAB 2,101.70 33500010 ROOM CHARGE PRIVATE REHAB 2,101.70 33500030 ROOM CHARGE REHAB ISO 2,702.50

33500115 NEUROMUSCULAR RE-EDUC 15 MIN 204.30 33500120 GAIT TRAINING 162.40 33500122 THERAPEUTIC ACTIVITIES 15 MIN 243.40 33500161 STANDING TABLE 132.40 33500221 GROUP EXERCISE 129.80 33500226 PHYS PERF W/REPORT 15 MIN 254.80 33500231 COMM/WORK REINTEGRAT EA 15 M 132.40 33500235 WHEELCHAIR MANAGEMEN 15MINS PT 137.90 33500250 THERAPEUTIC EXERCISE 15 MIN 224.50 33500260 PT / FAMILY EDUCATION 15 MIN 209.20 33500290 INDIVIDUAL TREATMENT 15 MIN 209.20 33500306 NEUROMUSCULAR RE-EDUC 15 MIN 204.30 33500310 GROUP EXERCISE 129.80 33500320 TREATMENT ADL'S 15 MIN 197.20 33500321 ACTIVITIES EXT 243.40 33500340 ORTH MGMT TRAIN 15 MIN OT INIT 218.50 33500365 OT / FAMILY EDUCATION 15 MIN 209.20 33500385 THERAPEUTIC EXERCISE 15 MIN 224.50 33500390 INDIVIDUAL TREATMENT 15 MIN 209.20 33500409 EVAL SPEECH SOUND/LANG PRODUC 684.70 33500411 SWALLOW EVAL-BEDSIDE 360.00 33500415 DYSPHAGIA/FEEDING TREATMENT OT 396.60 33500416 MODIFIED BARIUM SWALLOW EVAL 627.60 33500420 INDIVIDUAL TREATMENT 475.80 33500421 INDIVID TREAT EXT SPEECH 475.80 33500430 GROUP TREATMENT 2-4 132.40 33500440 PT / FAMILY EDUCATION 15 MIN 209.20 33506430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 33520015 2 IN 1 DRESSING STICK 46.50 33520020 LONG HANDLE BATH SPONGE 38.10 33520025 SHOE HORN 89.50 33520030 ADJUSTABLE CANE 59.90 33520035 ANKLE / FOOT ORTHTOSIS 260.00 33520050 WALKER BASKET 297.70 33520060 BUTTON HOOK 446.50 33520070 COMPRESSION GLOVE 70.70 33520075 SOCK AIDE 119.50 33520100 CARE COVER FOR WALKER 157.10 33520115 ELASTIC SHOELACES 15.20 33520130 GAIT BELT 111.30 33520135 HAND EXERCISER 87.00 33520145 LEG LIFTER 110.10 33520343 ROLYAN-D-RING WRIST BRACE LM 112.00 33520344 ROLYAN-D-RING WRIST BRACE LS 112.00 33520346 ROLYAN-D-RING WRIST BRACE RS 112.00 33520356 SPLINT PAM MITT RSTG WHT RT SM 208.60 33520359 SPLINT PAN MT RSTG WHT LFT MED 208.60 33520360 SPLINT PAN MT RSTG WHT RT LG 208.60 33520377 TRANSFER BOARD HI-D SHORT PLAS 286.50

33520837 SLING GIVMOHR MED 198.15 33597161 PT EVAL LOW 20 MIN 402.30 33597162 PT EVAL MOD 30 MIN 827.60 33597163 PT EVAL HIGH 45 MIN 1,103.50 33597165 OT EVAL LOW 30 MIN 402.30 33597166 OT EVAL MOD 45 MIN 827.60 33597167 OT EVAL HIGH 60 MIN 1,103.50 34000015 ROOM CHARGE OVERFLOW INTO ICU 1,680.40 34000021 OBSERVATION INITIAL - 1ST HOUR 749.90 34000022 OBSERVATION EACH ADDN'L HOUR 40.80 34000025 ROOM CHARGE ICU 4,890.40 34000029 OBSERVATION DIRECT ADMIT ICU 1,079.80 34000030 ROOM CHARGE ICU ISO 5,566.00 34000035 ROOM CHARGE OVERFLOW ICU ISO 2,354.90 34000100 PHS II RECOV 0-1 HRS TOTAL 233.60 34000105 PHS II RECOV 1-2 HRS TOTAL 450.10 34000115 PHS II RECOV 3-4 HRS TOTAL 823.40 34000120 PHS II RECOV 4-5 HRS TOTAL 980.20 34000125 PHS II RECOV 5-6 HRS TOTAL 1,141.70 34006430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 34092960 CARDIOVERSION ELECTIVE EXTERNL 2,126.90 34096360 IV HYDRATION INITIAL 31-60 MIN 491.70 34096361 IV HYDRATION EA ADTNL HR 298.50 34096365 IV DRUG INFUSION 1ST HR 604.90 34096366 IV DRUG INFUS EA ADTNL HR 263.70 34096367 IV INFUSION SEQUENTIAL 1ST HR 327.30 34096372 DRUG INJ SUB/IM - ICU 194.60 34096374 IV PUSH 225.40 34096375 IV PUSH DIFFERENT DRUG 257.70 34096376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 34300005 ROOM CHARGE SEMI-PRIVATE CPS 2,315.70 34300010 ROOM CHARGE PRIVATE CPS 2,315.70 34300021 OBSERVATION INITIAL - 1ST HOUR 749.90 34300022 OBSERVATION EACH ADDN'L HOUR 40.80 34300030 ROOM CHARGE PRIVATE CPS ISO 2,996.00 34399281 SAFE KIT 672.10 34600005 ROOM CHARGE SEMI-PRIVATE OB 1,796.70 34600010 ROOM CHARGE PRIVATE OB 1,796.70 34600016 OB TRIAGE CHARGE 896.40 34600021 OBSERVATION INITIAL - 1ST HOUR 858.40 34600022 OBSERVATION EACH ADDN'L HOUR 41.10 34600029 OBSERVATION DIRECT ADMIT OB 1,079.80 34600054 BAKRI BALLOON JSOS100500 845.40 34600055 SYMPHONY BREASTFEED SUPPLY KIT 144.10 34600056 ARISTA 3 GRAMS HEMOSTASE 619.20 34600057 PICO DRESSING 4X12 466.80 34600300 PHS I LEVEL II 0-30 MIN 1,188.10 34600305 PHS I LEVEL II 31-59 MIN 1,357.90 34600310 PHS I LEVEL II 60-89 MIN 1,629.60

34600315 PHS I LEVEL II 90-119 MIN 1,765.30 34696360 IV HYDRATION INITIAL 31-60 MIN 491.70 34696365 IV DRUG INFUSION 1ST HR 604.90 34696366 IV DRUG INFUS EA ADTNL HR 263.70 34696367 IV INFUSION SEQUENTIAL 1ST HR 327.30 34696372 DRUG INJ SUB/IM - OB 194.60 34696374 IV PUSH 225.40 34696375 IV PUSH DIFFERENT DRUG 257.70 34696376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 35000010 CIRCUMCISION 3,764.00 35000030 ROOM CHARGE NSY LEVEL I ISO 1,924.40 35000050 ROOM CHARGE NSY LEVEL I 1,248.80 35000065 ROOM CHARGE NSY LEVEL II 2,261.70 35041010 FRENOTOMY 2,170.50 35100060 *BILICHEK DISP CALIB TIP 56.10 35100071 SNOW HEMO SURGICEL 2300002081 260.30 35900005 ROOM CHARGE SEMI-PRIVATE TCF 903.50 35900010 ROOM CHARGE PRIVATE TCF 903.50 35906430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 36000130 MAJOR 1 MIN OVER 30 113.00 36000131 MAJOR 1 PLANNED 0-30 MIN 7,395.20 36000132 MAJOR 1 URGENT 0-30 MIN 8,071.70 36000133 MAJOR 1 EMERGENCY 0-30 MIN 8,071.70 36000140 MAJOR 2 MIN OVER 30 126.60 36000141 MAJOR 2 PLANNED 0-30 MIN 8,297.10 36000142 MAJOR 2 URGENT 0-30 MIN 8,973.40 36000143 MAJOR 2 EMERGENCY 0-30 MIN 8,973.40 36000150 MAJOR 3 MIN OVER 30 140.10 36000151 MAJOR 3 PLANNED 0-30 MIN 9,154.00 36000152 MAJOR 3 URGENT 0-30 MIN 9,875.30 36000153 MAJOR 3 EMERGENCY 0-30 MIN 9,875.30 36000160 MINOR 1 MIN OVER 30 33.00 36000161 MINOR 1 PLANNED 0-30 MIN 2,660.80 36000162 MINOR 1 URGENT 0-30 MIN 3,201.80 36000163 MINOR 1 EMERGENCY 0-30 MIN 3,201.80 36000170 MINOR 2 MIN OVER 30 62.00 36000171 MINOR 2 PLANNED 0-30 MIN 4,464.50 36000172 MINOR 2 URGENT 0-30 MIN 5,186.00 36000173 MINOR 2 EMERGENCY 0-30 MIN 5,186.00 36000180 MINOR 3 MIN OVER 30 76.10 36000181 MINOR 3 PLANNED 0-30 MIN 5,186.00 36000182 MINOR 3 URGENT 0-30 MIN 5,727.10 36000183 MINOR 3 EMERGENCY 0-30 MIN 5,727.10 36200001 DRAPE/MAYO STAND COVER 23.90 36200003 DRAPE/LAPAROTOMY SHEET 84.40 36200004 DRAPE/SPLIT SHEET 97.80 36200006 DRAPE/EXTREMITY OR LAP CHOLE 101.00 36200007 DRAPE/CHEST BREAST SHEET 128.20 36200008 DRAPE/GOWN XLG REG #9541 57.70

36200012 CATHETER/EMBOLECTOMY 3FR 507.70 36200013 CATHETER/EMBOLECTOMY 4FR 507.70 36200014 DRAPE/PFANN LAP SHEET 84.40 36200016 DRAPE/TOWELS ASSORTED 27.20 36200019 DRAPE/HALF SHEET 23.90 36200020 ASEPTO / BULB SYRINGE 17.20 36200021 PACK/ARTHROSCOPY 400.40 36200025 CBI NACL 3000ML 87.80 36200042 DISP BASIN 49.20 36200050 BAG-A-JET 33.80 36200057 LAP/FLOSEAL ENDOSCOPIC APP 395.30 36200058 FLOSEAL MATRIX HEMO SEALANT 882.20 36200060 ARCH BARS 117.90 36200085 LAP/GELPORT 1,936.50 36200095 DERMATONE BLADE 285.80 36200104 FISH RETRACTOR/DISP 249.00 36200105 LONE STAR RETRACTOR 423.60 36200106 LONE STAR RETRACTOR HOOKS 400.40 36200110 EMBOLECTOMY BOOTS 453.80 36200112 FEMORAL BRUSH 181.80 36200114 DRAPE/CASSETTE OR BACK TABLE 44.10 36200116 DRAPE/CAMERA OR REMOTE BAG 87.80 36200135 CATHETER/URETERAL ASSORTED 131.50 36200139 CATH/XK LONG TERM DIAL 5883270 1,407.20 36200140 CATH CONNECT TITAN CC-2300 432.00 36200141 Y TEC STD PROC PK VP-210 555.20 36200153 HEMACLEAR 90 PRH090BW01A 542.40 36200154 DISP TOURNIQUET CUFF 289.30 36200161 DRESS/ACE - LATEX FREE 70.80 36200162 DRESS/COVERLET SMALL 23.90 36200167 SPONGE/COTTONOID OR PLEDGET 87.80 36200170 TUR CUTTING LOOP 490.70 36200173 CRVD METZ SCISSOR TIPS 171.80 36200177 CLIP APPLIER LIGAMAX 5MM EL5ML 607.60 36200185 DRAIN/ASSORTED STYLE & SIZES 181.80 36200194 SET/VACURETTE DISP COLLECTION 43.50 36200195 DRAPE/C-ARM 88.50 36200196 CAUTERY/PAD 57.70 36200198 CAUTERY/DISPOSABLE TIP 23.90 36200201 DRAPE/IOBAN MEDIUM 91.20 36200202 DRAPE/IOBAN LARGE 97.80 36200216 DRAPE/MICROSCOPE OR MINI C-ARM 215.60 36200217 ALEXIS WOUND RET XSMALL 233.00 36200220 DRAPE/IOBAN #6617 HIP PIN 346.60 36200223 DRAPE/U-DRAPE 91.20 36200232 LAP/ENDO-BAG OR HIGH PRE SYR 366.50 36200237 DRESS/PLASTER ROLL ASSORTED 47.50 36200245 DRESS/GYPSONA PLASTER 3 9.80 36200248 DRESS/COTTON CURITY 3583002287 26.10

36200251 ASPIRA PLEURAL 5 KIT 4992509 1,642.80 36200268 SHEATH/ENDO SCRUB 4MM 1912000 170.70 36200271 BLADE/XOMED TRI 4MM 1884004HR 599.60 36200326 PACK/LAP CHOLE 517.90 36200330 LEEP ELECTRODE 208.60 36200333 LUKI DISP/ASP TUBE 77.60 36200334 BLADE/STRYKER DISP MENIS BLADE 450.70 36200335 GENTLE TOUCH COLOSTOMY SET 175.20 36200359 CANNULA THREAD 6.5MM 72200427 144.00 36200360 CANNULA THRD FLEX 8.0 7220042 177.60 36200400 NEEDLE HUBER 19 GA 1 IN 56.20 36200401 SCORPION NEEDLE MULTIFIRE 548.90 36200405 TRU-CUT BIOPSY NEEDLE 222.20 36200415 PACK/C-SECTION 430.40 36200416 PACK/LAPAROSCOPY OR UNIVERSAL 121.20 36200420 PACK/CYSTO 87.80 36200421 TOOMEY SYRINGE DISPOSABLE 23.90 36200425 PACK/BASIC 287.80 36200440 PACK/PATIENT PREP 61.00 36200442 SPONGE/PEANUTS 30.70 36200447 PACK/LITHOTOMY 171.50 36200449 ARTICULAR LINEAR HANDLE ATS45 735.40 36200450 LAP/CON-MED UNIVERSAL HANDLE 406.80 36200451 LAP/CON-MED ELECT HOOKNEEDLE 279.20 36200452 FORCE FIBER SUTURE W/NEEDLE 306.80 36200453 NEEDLE EYE TROCAR POINT 18264D 41.00 36200454 NEED 1/2 CIRC 18266D 41.00 36200486 IMPREV/ STOCKINETTE NON22540T 36.80 36200517 ABLATION DEVICE 014807 5,062.10 36200570 INCISOR PLUS 4.5MM 7210976 202.20 36200580 DYONICS WHIRLWIND 90 72202139 505.80 36200581 DYONICS STONECUT BURR 72200729 219.10 36200596 SIGMOIDSCOPE DISP SPECULU 27.20 36200600 BAL SALT W/FILTER 30 CC 111.40 36200610 SIMPLSE IRRG SYSTEM/SETUP 501.10 36200614 STRYKEFLOW II SUC/IRRIGATOR 321.60 36200620 SPONGE/LAP 44.10 36200624 SPONGE/RAYTEX 20.50 36200625 SPONGE/VAG LAP 57.70 36200639 STERILE PEN ADAPT 137.40 36200640 SKIN STAPLER 111.40 36200641 STERILE SKIN MARKER 23.90 36200647 STOCKINETT REG 97.80 36200655 SUCTION/YANKEUR TIP 17.20 36200660 SUCTION/TIP & TUBE SETUP 70.80 36200665 SUCTION/POOLE TIP 33.80 36200666 SUCTION/EXTRA TUBING 14.00 36200670 LAP/TROCAR KIT 5MM OR TROCAR 333.10 36200672 LAP/UNIV REDUCER OR PEANUT 238.80

36200673 LAP/REDUCER OR SEPARATOR 148.40 36200679 SEPRAFILM 695.80 36200681 SURGICEL LG 312.80 36200683 ELECTRO LUBRICANT 291.00 36200687 SUTURE MERSILENE/GORE TEX 191.80 36200688 SUTURE/ASSORTED SIZES 165.00 36200689 SUTURE/ASSORTED SIZES 235.40 36200691 SUTURE/ASSORTED SIZES 94.40 36200692 SUTURE/ASSORTED SIZES 111.40 36200693 SUTURE/ASSORTED SIZES 442.60 36200695 SUTURE/ASSORTED SIZES 20.50 36200696 SUTURE/ASSORTED SIZES 37.50 36200698 SUTURE/ASSORTED SIZES 74.30 36200703 SPONGE/TONSIL 5/PKG 64.30 36200711 PACK/TOTAL KNEE 1,448.50 36200714 PACK/TOTAL HIP OR SHOULDER 1,613.00 36200718 TISSEEL VHSD 4 ML FROZEN 744.40 36200725 APPLICATOR FLEXITIP XL AM0005 117.60 36200747 VS/CATHETER GUIDING ASSORTED 423.40 36200761 VACUUM CURETTAGE/SETUP 309.60 36200775 EAR SUCTION TUBE/ASSORT SIZES 37.50 36200777 VESSEL LOOPS 20.50 36200788 SUTURE PASSER DISP 224038 355.70 36200789 SUTURE PASSER STANDARD 224039 327.30 36200809 BLADE/BEAVER MIS 67 23.90 36200848 TROC TIP 0.9 71101521 168.70 36200849 TROC TIP WIRE 2.0 71101507 168.70 36200858 WIRE/TROC TIP 1.25 X 150 MM 168.70 36200881 CATHETER/CHOLANGIOGRAM ASS'T 302.90 36200898 LAP/ENDOLOOP VICRYL EJL 215.60 36200910 NON BALLOON HASSON COR85 151.80 36200968 LAP/OPTICAL ACCESS THREAD/ASSO 221.40 36200980 ACCU-PASS STR SHUTTLE 721042 303.20 36200981 ACCU PASS STR 45 CURVE 7210424 303.20 36201031 NERVE ELECTRODE XOMED 453.80 36201047 BLADE/STRYKER OSCILLATING SAW 569.60 36201052 HS SHEARS 14CM/COBLATOR WAND 816.90 36201054 SUC HANDLE CONTROL 20.00 36201055 MEDKAMP DISP SUCTION TIP 24.40 36201060 SUTURE DEVICE ENDOSTITC 173016 549.70 36201061 SUT POLYSORB ES9 NEEDLE 170052 211.30 36201062 RUMI KOH-EFFICIENT KC-RUMI 303.20 36201063 RUMI TIP YELLOW 5.1MM UMY514 222.00 36201065 RUMI TIP LAVENDER 5.1MM UML516 222.00 36201080 TUBING INSUFFLATION 7205861 147.10 36201091 GLUE GUN 418100 419.60 36201092 RIM SPEED PIN 45 MM 74013471 385.60 36201094 PIN NON-RIM SPEED 65MM 7401348 132.00 36201102 DISTAL RADIUS DRILL BIT 425.50

36201119 DRILL BIT/QUICK COUP 7117000 220.50 36201124 DRILL BIT/QUICK COUP 71170007 220.50 36201133 DRILL/TWIST FLEX 2.3 72203160 379.80 36201138 DRILL GUIDE/PLOC 2.7 71173582 470.30 36201139 DRILL BIT/PLOC 2.0 W/QC 711735 326.70 36201143 DRILL BIT 2.2MM 231200200 232.30 36201179 NEOPROBE COVER 67.70 36201398 BONE CLEANING TIP 183.80 36201403 BLADE/ASSORTED STYLE & SIZES 355.10 36201414 ESMARK/STERILE 4 IN 148.40 36201415 DRESS/COBAN STERILE ASSORTED 84.60 36201417 ESMARK/STERILE 6 IN 148.40 36201595 ENT/OTO THORACIC CAUTERY BLADE 104.60 36201597 ENT/LANCE FLAT BLADE 930021 72.80 36201598 SPLINT/DOYLE NASAL 74.70 36201605 HEALICOIL DISP DILATOR 7220395 665.30 36201650 FAST FIX 360 CRBD KPSC 7220267 369.10 36201652 FAST FIX 360 CRVD NDL 72202468 1,364.30 36201699 DRILL BIT/2.0 71173801 310.40 36201705 DRILL BIT/ASSORTED STYLE 403.40 36201713 DRILL BIT/P-LOC 2.7 71173503 349.30 36201715 DRILL BIT/5.2 MM 71119106 943.70 36201718 DRILL BIT/2.7 71173803 243.20 36201724 SURESHOT DRILL SHORT 71692810 531.30 36201725 SURESHOT DRILL LONG 71692811 581.80 36201726 SURESHOT DRILL PROBE 71692814 811.50 36201999 COMP RVS 3.2 MM DRILL 405883 211.50 36202000 REVERSE 2.7MM DRILL 405889 459.30 36202001 TRACTION SHOULDER 369.90 36202003 REVERSE STEINMAN PIN 9 405800 338.40 36202060 CYBERWAND PROBE CWRBP 1,973.20 36202181 MANIFOLD STAND NEPTUNE 7000200 91.90 36202182 SPECIMAN TRAP 700050000 87.30 36202186 DARTFIRE CANN DRILL 2.2 DSDS00 314.50 36202188 KWIRE DARTFIRE DSDS10 120.80 36202189 DRILL/DARTFIRE CANN 2.0 DSDS00 308.20 36202234 DRILL NEWCLIP ANC0 254.20 36202235 DRILL BIT/ASSORTED SIZES 268.50 36202246 DRILL BIT/ASSORTED SIZES 537.80 36202268 TWIST DRILL BIT - ASSORTED 289.30 36202310 KWIRE/DVR 1.6 KWD062SS 146.10 36202313 INTERSPACE SHOULDER KIT SPS002 8,980.80 36202314 FIBERLOOP #2 AR7264 272.70 36202315 TENSON CUTTING BLADE 10MM AR23 381.80 36202319 SUTURE TAPE 1.3 AR7500 162.60 36202320 ENDOSTITCH RELOAD V-LOC VLOCA 223.70 36202321 ABC PROBE 5MM 160655 214.90 36202328 BARRELL BURR 2.9 72201520 217.10 36202331 ABC FLEX PROBE 133023 529.10

36202335 CHISEL BLADE 12X60X1 75100520 498.60 36202336 UTERINE MANIPULATOR 305.50 36202340 ADVINCULA 4.0CM DILINEATOR 216.00 36202342 ADVINCULA 3.0CM MANIPULATOR 216.00 36202349 CANNULA 5MM X 55MM 123.30 36202353 CAPIO SLIM SUTURE DEVICE 1,133.00 36202357 SUTURE O MONDEK 177.80 36202359 NOVEPASS SUTURE PASSER STR 327.30 36202360 AMBIENT SUP MULTIVAC 50 IFS 472.40 36202361 VACURETTE 7MM CRVD 31.60 36202362 VERSALIGHT STANDARD 294.60 36202363 CONTOUR STAPLER 996.10 36202365 LASER FIBER 100 MICRON 709.10 36202371 ARGON BEAM HAND PIECE 171.30 36202372 ARGON BEAM ELECTRODE TIP 196.40 36202373 ENT CO2 LASER FIBER 2,945.60 36202378 WIRE CAP/1.6MM 65.50 36202380 DRILL/VLP MM LONG 1.5 290.20 36202381 PUMP TUBE SET 199.70 36202383 CHISEL BLADE 10 X 27 X 1MM 605.50 36202386 PLASMA BUTTON 1,048.40 36202388 FLIPCUTTER II SHORT 9.5MM 709.10 36202389 BMT/STN PIN THRD TIP 1/8 X 2.5 220.30 36202390 DRILL/VLP MM 1.8M 279.00 36202394 DISP TOURN 18 X 3 126.90 36202395 DISP TOURN 34 X 4 121.70 36202396 DISP TOURN 44 X 4 144.80 36202397 DISP TOURN 30 X 4 121.70 36202398 DISP TOURN 12 3.5 111.20 36202399 DISP TOURN 24 X 4 110.20 36202400 SM SPACER SHOULDER KIT SPS0121 11,268.80 36202403 PASSPORT BUTTON CANNULA 188.80 36202406 FLOW TUBING 160.50 36202409 LAP LIGASURE MARYLAND JAW 1,010.20 36202410 CRVD LARGE JAW OPEN SEALER 1,255.70 36202411 LIGASURE MARYLAND JAW OPEN 1,010.20 36202422 OVAL BUTTON 24FR 12-30DEG 1,175.90 36202423 LIGASURE LAP BLUNT TIP 917.90 36202427 SONICISION DISSECTOR 6CM 870.70 36202428 DISSECTOR CORDLESS 13CM 740.60 36202429 LIGASURE CRDV SM JAW SEAL/DIV 817.20 36202432 WIRE/PROVIS FIX SHORT 1.5MM 273.80 36202433 K-WIRE/VLP MM 0.8MM X 70MM 23.10 36202436 LIGASURE RETRACT L-HOOK 37MM 1,295.50 36202437 DRILL BIT/EVOLVE TRIAD 1.3MM 428.00 36202439 WEREWOLF COBLATION WAND 618.90 36202440 ARTHREX DISP KIT T3 AMZ 1,046.90 36202442 TSA/PERFORM REV PERIPHERAL 209.80 36202443 TSA/AEQ PERFORM GUIDE PIN 2 288.50

36202445 FIBERLOOP AR-7266 262.30 36202448 PAIN/20 TUNNELING TOOL 178.30 36202449 10FR DUAL LUMEN CATH 123.80 36202450 PAIN/2 PORT HEADER 734.30 36202451 PAIN/MULTILEAD TRIAL CABLE 419.60 36202454 LAP/RELIATACK ART RELOAD FIX 1,113.40 36202455 URO ACCESS SHEATH 12/14 X 38CM 331.50 36202458 DISP KIT FOR FIBERTAK STRAIGHT 367.20 36202459 AMBIENT SUPER TURBOVAC 90 IFS 454.20 36202460 TOE/INSTRUMENT PKG 3.2 686.10 36202462 8.5MM-13MM CANNULA SEAL 178.30 36202463 8MM BLADELESS OBTURATOR 144.80 36202465 8MM CANNULA GREEN SEAL 87.10 36202466 PAIN/CHARGER KIT 2,981.30 36202467 PAIN/NEEDLE CURVE TIP 236.00 36202468 PAIN/N300 LEAD KIT 356.70 36202469 PAIN/PATIENT REMOTE KIT 2,146.30 36202470 BIPOLAR ELECTRODE 1,066.80 36202476 GELPOINT ADV ACCESS PLATFORM 944.10 36202477 PAIN/CONNECTOR CABLE 839.20 36202478 PAIN/OR CABLE KIT 239.20 36202479 AIRSEAL TRI-LUMEN TUBE SET 275.90 36202480 12MM ACC PORT 120MM 275.90 36202481 5MM ACC PORT 120MM 262.30 36202482 8MM ACC PORT LOW PROFILE 120MM 265.40 36202484 200 SERIES HOLMUIM LASER FIBER 890.60 36202485 ENDOWRIST ONE VESSEL SEALER 1,248.30 36202486 PINK PAD XL TRENDELENBURG KT 242.30 36202487 ONE-STEP FACE PROTECTOR 143.70 36202488 ACUMED FUSION DRILL 24MM 274.80 36202489 ACUMED DRILL GUIDE .062 115.40 36202490 LAP/TROCAR BLADE 5X100 CFB03 87.10 36202491 DISP STERILE DRAINAGE BAG 96.50 36202492 DISP KIT FOR FIBERTAK 577.00 36202494 L HOOK ULTRA COAT 5MM X 44CM 118.00 36202495 BENTSON STR .035 X 180CM 89.00 36202496 MICROPUNCTURE KIT 4FR 153.00 36202497 CON SHEATH 6FR 52.00 36202498 SUPER SHEATH 4FR 52.00 36202499 BALLOON/STERLING 4 X 80 X 135 917.00 36202500 REDIFLOW FILTER SYSTEM SUCTION 276.20 36202521 CEMENT/VORTEX MIXING SYSTEM 700.80 36202534 TRIGEN BALL TIP GUIDE ROD 511.00 36202535 TRIGEN DISP EXTRACTOR 71431320 542.80 36202537 CON ENCORE ADVANTAGE KIT 20ML 157.00 36202538 8MM BLADELESS OBTURATOR LONG 138.00 36202539 PROLENE 7-0 BV-1 SUTURE 55.00 36202540 STRATAFIX 0 SUTURE 107.00 36202542 PROLENE 6-0 BV-1 SUTURE 51.00

36202543 STRATAFIX 3-0 SUTURE 115.00 36202544 PAIN/PT CONTROLLER 2,500.00 36202546 ARTHREX/DRILL 3.9MM 210.00 36202547 OMNIGUIDE LASER FIBER 2,190.00 36202548 BASKET X-CATCH NT 1.8FRX115CM 330.00 36202549 CATH COUDE 5CC 14FR 86.00 36202550 TWIST DRILL 1.7MM ANCHOR 72203 641.20 36202551 CATH COUDE 5CC 16FR 86.00 36202552 CATH SILASTIC 20FR 44.00 36202553 URETER DILATION SHEATH 8/10 204.00 36202554 SURLOCK FLAT WIRE SEGURA 253.00 36202555 FOLEY CATH TIP PUNCH 205.00 36202556 CATH 2-WAY BARDEX IC 22FR 50.00 36202558 CONE TIP URETER CATH 5FR 53.00 36202559 CATH COUDE 5CC 20FR 86.00 36202560 ELECTRODE ROLLER BALL LARGE 369.00 36202562 CATH 2-WAY BARDEX 30CC 22FR 43.00 36202563 SURESEAL II ENDO VALVE 61.00 36202564 CATH SILASTIC 22FR 44.00 36202565 CATH COUNCIL TIP 18FR 94.00 36202567 GUIDEWIRE SUREGLIDE .035X150 A 125.00 36202569 CATH 2-WAY BARDEX IC 20FR 50.00 36202570 BASKET ULTRACATCH NT 1.8 X 115 330.00 36202571 GUIDEWIRE SUREGLIDE .035X150 S 125.00 36202572 BUGBEE CORD 61.00 36202574 STONE CONE COIL 3F 115CM 7MM 752.00 36202575 AMPLATZ DILATION SET 431.00 36202577 CATH SILASTIC 18FR 44.00 36202578 STONE GRASPER 2.6 X 120CM 426.00 36202579 URO/BUGBEE FULG SHORT TIP 105 259.00 36202580 RAT TOOTH FORCEP 3.3FR 115CM 581.00 36202582 CATH COUNCIL TIP 16FR 123.00 36202583 CATH 3-WAY 30CC 22FR 129.00 36202584 OPEN END URETER CATH 5FR 86.00 36202585 CATH COUNCIL TIP 20FR 94.00 36202587 FLEX TIP LASER FIBER 200 849.00 36202588 CATH 2-WAY BARDEX IC 16FR 50.00 36202589 CATH COUDE 5CC 18FR 111.00 36202590 CATH 3-WAY 30CC 24FR 67.00 36202591 CATH 2-WAY BARDEX IC 18FR 50.00 36202593 URO BALLOON 18FR X 4CM 386.00 36202595 ELECTRODE LOOP 24FR 279.00 36202596 ELECTRODE LOOP 26FR 279.00 36202597 DISP BLADDER EVACUATOR 114.00 36202599 CUP BIOPSY FORCEP 3.3FR 115CM 675.00 36202603 URO ACCESS SHEATH 12/14 24CM 227.00 36202604 LASER FIBER 1000 MICRON 1,850.00 36202605 INFLATION DEVICE 183.00 36202607 URO BALLOON 24FR X 8CM 847.00

36202608 ELECTRODE LOOP 28FR 271.00 36202609 URO ACCESS SHEATH 12/14 46CM 227.00 36202610 CATH SILASTIC 16FR 59.00 36202611 UROSEAL ADJ ENDO VALVE 180.00 36202612 WIRE AMPLATZ .035 X 150 ST 113.00 36202613 URO BIOPSY PORT SEAL 120.00 36202614 DRILL MINI ACUTRAK 2 690.00 36202615 ALEXIS RETRACTOR XX-SM/SHORT 136.00 36202616 PAIN/NEEDLE CURVED 4 165.00 36202617 PAIN/INTELLIS RECHARGER 97755 3,130.00 36202618 PAIN/INTELLIS CONTROLLER 97745 1,700.00 36202620 1.7MM DRILL FIBERTAK 210.00 36202621 TUNNEL TOOL 800.00 36202623 PAIN/NEVRO TORQUE WRENCH KIT 228.00 36202624 UROVAC BLADDER EVACUATOR 128.00 36202625 GOLDVAC SLIM SMOKE/CAUT PENCIL 111.00 36202627 TERUMO GLIDECATH 4FR X 65CM 215.00 36202629 TERUMO GLIDECATH 5FR X 65CM 215.00 36202630 BALLOON STERLING 6 X 20 X 40 917.00 36202631 BALLOON STERLING 8 X 40 X 40 917.00 36202632 BALLOON STERLING 6 X 40 X 40 917.00 36202633 SHEATH 5FR 1.9 X 45CM STR 196.00 36202634 SHEATH 6FR 2.2 X 45CM STR 204.00 36202636 PAIN/WIRELESS EXT NEURO 97725 400.00 36202637 TROCAR/HASSON 12 X 150 CFF71 138.00 36202638 ZIPWIRE STR TIP .035 X 260 166.00 36202639 ZIPWIRE ANGLED TIP .035 X 180 153.00 36202669 KIT/MEDTRONIC ACCESSORY 35502 439.90 36202670 THA/KIT IM PREP 627.00 36202672 LAP/CANNULA VALVE 5 MM 107.80 36202679 ARTHREX/FIBERLINK AR7235 323.50 36202680 ARTHREX/FIBERTAPE 2MM AR7237 290.20 36202683 ARTHREX/CANNULA 5.75 AR6564 215.70 36202684 ARTHREX/FIBERSTICK AR7209 298.10 36202686 ARTHREX/SUTURE LASSO AR406845L 453.00 36202688 ARTHREX/SUTURE LASSO AR406845R 453.00 36202689 TIGER TAPE AR72377T 290.20 36202700 ARTHREX/FIBERWIRE 2 AR7202 139.50 36202704 FLIP CUTTER II AR1204AF 1,022.50 36202705 ARTHREX/FIBERLOOP AR72 246.50 36202708 ARTHREX/DISP INST KIT AR1322DS 549.60 36202719 ZIPWIRE STR TIP .035 X 180 179.00 36202720 BENTSON STR .035 X 260 108.00 36202721 NEEDLE BX MAXCORE DISP 18GA 134.00 36202722 NEEDLE POINT 22G X 7 BLACK 33.00 36202723 SUTUREFIX 1.7 DRILL 389.00 36202724 SUTURE/2-0 VLOC 6 112.00 36202725 NEEDLE GUIDE 84.00 36202726 TENDON STABILIZING GUIDE 270.00

36202728 PAIN/NEEDLE CURVE TIP 225.00 36202729 STRATAFIX 3-O MONO PLUS 70CM 120.00 36202730 LAP SMOKE EVACUATION TUBING 68.00 36202731 ULTRAVERSE 5MM 40MM 75CM 255.00 36202732 CONQUEST CATH 6FR 7 X 75 4CM 370.00 36202733 DRILL BIT 3.5MM X 130MM 304.00 36202734 GUIDEWIRE SHEATH .035 9FR 11CM 52.00 36202737 GUIDEWIRE SHEATH .035 7FR 11CM 52.00 36202738 GUIDEWIRE SHEATH .035 5FR 11CM 52.00 36202739 FOGARTY EMB CATH 5.5FR 80CM 270.00 36202740 GUIDEWIRE SHEATH .035 8FR 11CM 52.00 36202741 GUIDEWIRE SHEATH .035 6FR 11CM 52.00 36202743 GUIDEWIRE SHEATH .035 4FR 11CM 52.00 36202744 FOGARTY EMB CATH 5.5FR 40CM 270.00 36202745 MICROPUNCTURE SET 4FR 121.00 36202747 NAVIGATOR HD 13FR/15FR 45CM 240.00 36202748 STONE BASKET NIT 1.9FR 120CM 288.00 36202756 CONQUEST CATH 6FR 75CM 4CM 8MM 350.00 36202760 CONQUEST CATH 6FR 75CM 4CM 6MM 350.00 36202762 LUTONIX BALLOON 6MM 150MM 130 3,100.00 36202763 VISIONS CATH .014 5FR 1,500.00 36202764 VISIONS CATH .035 8.5FR 90CM 1,900.00 36202765 ULTRAVERSE BALLOON 6MM 40MM 75 255.00 36202769 GLIDEWIRE STIFF STR .035 180CM 208.00 36202770 GLIDEWIRE STIFF STR .035 260CM 222.00 36202774 CONQUEST CATH 6FR 5MM 4CM 75CM 370.00 36202776 CONQUEST CATH 6FR 8MM 8CM 75CM 370.00 36202777 SUTURE TAPE TIGERLINK 1.3 255.00 36202778 SUTURE TAPE FIBERLOOP 210.00 36202779 ULTRAVERSE BALLOON 12MM X 40MM 255.00 36202780 TENDON MARKERS 225.00 36202781 BASKET/DAKOTA 1.9F 120CM 11MM 684.00 36202782 INTRODUCER SUPRAPUBIC CATH 215.00 36202783 WIRE CAP 1.25MM 69.00 36202784 LASER FIBER MOSES 550 1,090.00 36202786 LASER FIBER MOSES 200 1,100.00 36202787 LASER FIBER XPEEDA 2,230.00 36202788 ARTHREX LOW PROFILE REAMER 390.00 36202793 2.0MM DRILL 191MM 259.00 36202794 MUSTANG BALLOON 5.0 X 60 75CM 649.00 36202796 MUSTANG BALLOON 5.0 X 40 135CM 649.00 36202799 HANDPIECE IVRIG SET/BONECLEAN 653.20 36202809 KIT/HYSTEROSCOPY PROCEDURE 894.90 36202815 INSERT KIT FOR 3.0MM STAK AR19 425.50 36202857 ELECTRODE BLADE INSULATED 1381 10.90 36202876 ELECTRODE/LLETZ BALL 5 MM 101.70 36202906 SUTURE/FORCE FIBER SUTURE #2 232.80 36202908 SUTURE/ULTRABRAID #2 W/NEEDLE 281.30 36202909 SUTURE/COBRAID #2 281.30

36202914 MONARCH RETRIEVAL SYSTEM 298.10 36202937 BURR/ASSORTED STYLES 259.10 36203049 HOLMIUM LASER FIBER 242.00 36203054 LASER FIBER PROSTATE 2,261.20 36203062 TUBE/BARD GASTROSTOMY 294.60 36203079 LASER FIBER OMNI GUIDE ENT-L 4,183.70 36203086 PAIN/CHARGING SYSTEM 97754 4,940.10 36203088 PAIN/SNAP LID CABLE 355531 646.90 36203089 PAIN/NEEDLE CURVED TIP 342.60 36203090 PAIN/REFILL KIT 336.20 36203098 PAIN/MEDTRONIC PLUG 617.30 36203179 CATHETER/LAP CHOLAINGIOCATH 383.70 36203221 PAIN/PATIENT PROGRAMMER 97740 2,460.40 36203319 ALUMINUM HAND POSITIONER 255.50 36203320 SKW RETRACTOR SYSTEM 581.80 36203321 KIT/ AMS ACCESSORY 2,398.80 36203339 ARTHREX/REAMER 10MM AR18975 631.20 36203341 CANNULATED REAMER 2.7 117066 1,050.10 36203395 ARTHREX/LOW PRO REAMER AR140 612.50 36203419 LABRALTAPE WH/BL 1.55 AR7276T 324.20 36203421 NEEDLE TAPERS CRVD 26MM AR7281 127.10 36203450 SHORT SHOT BANDER G34063 247.40 36203506 DRILL 5.5 MM CANN AR121855 471.80 36203507 DRILL 8 MM CANN AR121880 471.80 36203510 TWIST DRILL 1.9 STR ANC 722038 641.20 36203551 CLEARVISION II TUBING SET 0312 142.80 36203600 AQUAMANTYS 6.0 231121 980.80 36203685 DISP BIPOLAR FORCEPS 371.80 36203718 MAIN PUMP TUBING 237.30 36203722 TUBING W/WND SPNG GUARD 80.60 36203831 LONG DRILL 801522 711.30 36203920 FACEMASK DISP STERILE 7210559 144.00 36203950 SUTURE MONOCRYL 3.0 23000Y4976 34.30 36204001 SONICBEAT 10 CM SB0510IC 885.00 36204103 CHISEL BLADE LAT 75100525 576.00 36204162 DRAIN/JACKSON PRATT RESERVIOR 61.00 36204310 DRILL/VLP MINI 1.8MM 74462402 249.50 36204311 DRILL/VLP MINI MOD 1.5MM 71177 249.50 36204312 OVERDRILL/VLP MINI MOD 2.0 711 249.50 36204315 WIRE/VLP FIX SHORT 1.8 7446240 316.30 36204402 INTRODUCER/ASSORTED SIZES 121.20 36204507 MUSTANG BALLOON 9.0 X 80 X 75 649.00 36204508 MUSTANG BALLOON 4.0 X 20 X 75 649.00 36204512 MUSTANG BALLOON 7.0 X 60 X 135 649.00 36204513 MUSTANG BALLOON 10.0 X 40 X 75 649.00 36204516 OMNI FLUSH 4FR .035 65CM 83.00 36204524 MUSTANG BALLOON 6.0 X 80 X 75 649.00 36204530 MUSTANG BALLOON 4.0 X 80 X 75 649.00 36204535 GLOW N TELL TAPE 30CM 180.00

36204539 MUSTANG BALLOON 10.0 X 60 X 75 649.00 36204547 MUSTANG BALLOON 7.0 X 80 X 75 649.00 36204556 MUSTANG BALLOON 4.0 X 40 X 135 649.00 36204557 MUSTANG BALLOON 7.0 X 40 X 75 649.00 36204560 MUSTANG BALLOON 12.0 X 80 X 75 649.00 36204563 INTRODUCER 7FR X 4CM 121.00 36204564 LUTONIX DCB 6 X 60MM .035 75CM 2,500.00 36204565 MUSTANG BALLOON 6.0 X 40 X 75 649.00 36204568 LUTONIX DCB 5 X 60MM .035 75CM 3,100.00 36204569 MUSTANG BALLOON 3.0 X 40 X 135 649.00 36204573 WIRE V-18 STR .018 X 300CM 233.00 36204574 MUSTANG BALLOON 8.0 X 40 X 75 649.00 36204581 MUSTANG BALLOON 7.0 X 60 X 75 649.00 36204584 MUSTANG BALLOON 9.0 X 60 X 75 649.00 36204585 INTRODUCER 6FR X 4CM 121.00 36204587 KYPHON BALLOON 3 15MM 6,886.00 36204588 DRILL BIT 4.5 W/ QC 374.00 36204589 VISTA BRITE TIP CATH 8FR 90CM 166.00 36204592 DRILL GUIDE PIN 2.7MM X 25MM 521.00 36204593 ACUMED WIREGUIDE .035 X 6 121.00 36204595 PAIN/NEEDLE 6 ACCK1015 228.00 36204597 PENILE/AMS DILATOR 9-12MM 458.00 36204598 EPIX UNIVERSAL CLIP APPLIER 255.00 36204599 VENA CAVE FILTER RETRIEVAL SET 450.00 36204922 PAIN/TORQUE WRENCH 355.80 36205000 TORQUE WRENCH COMPONENT 977A26 199.70 36205100 GUIDEWIRE .045 WS1106ST 100.50 36205110 ELECTROBLADE RESECTOR 7205962 1,087.50 36205111 ELECTROBLADE RESECTOR 4.5 7209 535.90 36205112 ULTRATAPE 2MM BLUE 72203896 189.70 36205150 COVIDIEN/PROTACK TACKER 174006 1,011.30 36205180 GLASSCOCK EAR DRESS ADULT S100 87.10 36205181 GLASSCOCK EAR DRESS PEDS S1003 87.10 36205190 THERMASPLINT 15290 142.80 36205205 CORDIS GUIDEWIRE 97.80 36205208 ARTH/ANLKE DISTRACTOR FT STRAP 312.80 36205210 DISP KIT Q-FIX 2.0MM 252810 807.30 36205211 DISP KIT FOR 1.8MM Q-FIX 25181 807.30 36205249 KNIFE COLD STRAIGHT 504.00 36205270 BLADE 3.5 BONE CUTTER 7210488 221.50 36205273 SAGITTAL SAW BLADE DUAL CUT 243.40 36205308 KIT/STAND OFF OR ACCESS PORT 262.50 36205360 BARD SPC INTRODUCER KIT 346.60 36205400 WHITE RELOAD 60 ECHELON 2299EC 314.50 36205401 BLUE RELOAD 60 ECHELON 2299ECR 314.50 36205656 SUT PLAIN 6.0 FASTABSORB 1916G 36.30 36205668 ROLLER BALL KNIFE 435.50 36205750 GUIDEWIRE 0.038 STRAIGHT M0066 214.90 36205752 DURASEAL EXT TIP APPL 205108 278.20

36205800 THUNDERBEAT 5X10 INLINE GRIP 763.70 36205804 TRUECLEAR INCISOR 72202536 1,307.00 36205805 TRUECLEAR INSICOR PLUS 7209509 1,178.20 36205806 TRUECLEAR ULTRA PLUS 72203012 1,743.40 36206000 ENT/TRACKER PATIENT 9733534 445.20 36206001 ENT/TRACKER INSTRUMENT 9733533 313.30 36206002 ENT/NIM PRASS PROBE 8225825 373.80 36206003 ENT/NIM SUBDURAL ELEC 8227410 304.70 36206005 ENT/NIM EMG TUBE 822950 757.80 36206400 ASSEMBLY DISP BULB/BLADDER D30 133.10 36206442 BLADE/FULL RADIUS 3.5 7210751 202.20 36206447 FULL RADIUS BONECUTTER 7220253 355.40 36206448 BONECUTTER ELECTROBLADE 722022 574.60 36206455 DRILL BIT/PLOC 3.5 W/QC 711735 318.60 36206456 DRILL BIT/PLOC 3.5MM 71173504 312.50 36206457 DRILL BIT/PLOC 2.7MM 71173502 228.20 36206458 DRILL BIT/ASSORTED SIZES 645.40 36206468 PLOC DRILL BIT 4.5MM 71173508 1,141.50 36206660 LAP/DIRECT DRIVE GRASPER C4130 262.70 36206661 MINI LAP ALLIGATOR GRASPER 025 362.90 36206702 BLADE FULL RAD 2.9 MAGMINI 722 275.90 36206703 THIGH SUPPORT FERREL PAD 72201 239.50 36206704 SPIDER ANKLE STAB KIT 72202931 186.30 36206710 DURASEAL SEALANT 5 ML 206520 1,962.60 36206719 HEMOSTASE 3 GRAMS 619.20 36206749 GUIDE PIN 3.2 MM 71631436 319.70 36206750 GUIDE PIN - ASSORTED SIZES 144.90 36206751 GUIDE PIN THREADED W/SCREW TRA 228.90 36206756 LAP/BABCOCK DISPOSABLE 5MM 420.30 36206758 GUIDE PIN/THREADED 3.2 7167429 397.70 36206760 GUIDE WIRE 600MM BALL 71665026 370.60 36206764 SHOULDER STABILIZ KIT 7210573 212.80 36206813 LAP/SUTURE SYSTEM OR TROCAR 287.30 36206839 DRESS/DJ ULTRA SLING ASSORTED 323.80 36206871 TSA/AEQ GLENOID RVS PIN DWD063 362.30 36206873 TSA/AEQ PIN GUIDE 9722908 306.20 36206875 TSA/SCREW DRIVER BIT 35 DWD016 333.80 36207054 VS/CATHETER SOFT VU ASSORTED 244.20 36207056 VS/GUIDEWIRE ASSORT SZ 323.40 36207081 VS/SHEATH GUIDEWIRE INTRODUCE 515.50 36207089 KRONMER UTERINE MANIPUJECTOR 279.20 36207117 TRIGEN PILOT DRILL - ASSORTED 480.90 36207138 LUGOL'S SOLUTION 81.30 36207760 NAIL EXTRACTOR 71687111 754.80 36207926 BLADE/MICRO SAW 9.5 X 41 MM 336.20 36208116 LEGGINGS 44.10 36208300 MONSEL SOLUTION 67.50 36208575 CHOLANGIOGRAM CATH LATEX FREE 235.80 36208848 STRYKER NEURO DRILL 5820107 341.50

36208849 STRYKER NEURO BURR 8450107 426.60 36208910 BLADE ASSEMBLY DISP 8101006 505.20 36208911 HEWSON SUTURE PASSER 185.40 36208978 BLADE/OSTEOTOME - ASSORTED 255.70 36208982 BLADE STRAIGHT QUADCUT 1884380 688.30 36208983 BLADE CURVED ROTATE ROHS 18840 675.10 36209029 LAP/TROCAR BALLOON 722.70 36209031 KII SHIELDED BLADED ACCESS CTB 193.40 36209032 LAP/TROCAR BLUNT C0718 152.70 36209033 LAP/OPTICAL THREAD 04160C0101 145.90 36209034 KIT SHIELDED BLADED ACC CFB73 127.60 36209045 PIN 3.5 MM PR 40 MM 71173325 354.10 36209049 PIN DRILL SET ACCURIS 480.90 36209085 TRIGEN THREADED TIP GUIDEWIRE 484.10 36209087 TROCAR TIP WIRE 1.6 71101508 168.70 36209129 BURR/ASSORTED STYLES 386.80 36209170 ARTH/DIS KIT OR SURGISAFE PAD 114.70 36209438 TKA/GENESIS TROCAR PIN - ASS'T 579.70 36209681 GUIDEWIRE/ASSORTED SZ 272.50 36209712 DERMATOME CARRIER 205.20 36250002 DRESS/STERI-STRIP 1/2 21.40 36250004 SYRINGE 35CC LEUR TIP 9.50 36250006 SYRINGE 60CC CATH TIP 9.50 36250007 DRAIN/PENROSE 1/2 12.40 36250008 DRAIN/HEMOVAC MEDIUM 189.20 36250010 DRESS/VASELINE GAUZE 1 X 8 9.50 36250014 DRESS/ELASTOPLAST 3 39.30 36250018 DRAIN/JP 10FR ROUND SMALL 117.30 36250020 DRAIN/JP 19FR ROUND LARGE 117.30 36250022 DRAIN/PENROSE 1 12.40 36250127 CATHETER LEG BAG 33.30 36250191 DRAIN/JP 7MM FLAT SMALL 117.30 36250200 CATHETER/ROBNEL ASST' SIZES 12.40 36250824 IV/ANGIOCATH ASSORTED SIZES 27.40 36250830 CATHETER/TRAY W/METER 171.30 36250833 URIMETER BAG W/O TRAY 105.20 36250835 CYSTO IRRIG SET 33.30 36250836 Y TYPE IRRIG SET 54.40 36250837 Y TYPE TUR SET 54.40 36250841 DENTURE CUP 6.30 36250844 DRAIN/PENROSE 1/4 12.40 36250845 DRAIN/HEMOVAC LG (SOFT) 189.20 36250846 DRESS/KLING 1 9.50 36250849 DRESS/KLING 2 9.50 36250850 DRESS/KLING 3 12.40 36250851 DRESS/KLING 4 12.40 36250852 DRESS/ACE 4 27.40 36250853 DRESS/ACE 6 36.30 36250854 DRESS/ACE 3 21.40

36250855 DRESS/STERI STRIP 1/4 21.40 36250856 DRESS/TELFA SMALL 6.30 36250857 DRESS/TELFA - LARGE 6.30 36250858 DRESS/ADAPTIC 3X3 9.50 36250860 DRESS/XEROFORM 21.40 36250862 DRESS/KERLEX FLUFFS 15.40 36250863 DRESS/KERLEX ROLL 26.60 36250864 DRESS/PERI PAD SINGLE 12.40 36250865 DRESS/HEAVY DRAINAGE PACK 33.30 36250866 DRESS/ABD 6.30 36250870 DRESS/TOPPER 6.30 36250871 DRESS/PLAIN STERILE 4 X 4 15.40 36250875 CONNECTOR - 5 IN 1 21.40 36250876 DRESS/SPLIT TOPPER 6.30 36250877 TRACH TUBE SHILEY FEN 390.20 36250878 TRACH TUBE SHILEY DCT 420.30 36250879 DRESS/HIP ABDUCTION PILLOW 300.10 36250880 DRESS/VAGINAL PACKING 12.40 36250882 DRESS/IODOFORM PACKING 1/2 57.30 36250883 DRESS/IODOFORM PACKING 1 78.30 36250884 DRESS/IODOFORM PACKING 2 45.20 36250889 SYRINGE 35 CC 9.50 36250890 SYRINGE 60 CC 9.50 36250898 DRESS/SPLINT 75.30 36250900 SPECIMEN JAR 6.30 36250903 DRESS/OP SITE SMALL 18.20 36250911 IV/EXT T SET 27.40 36251001 DISTRACTION PIN 12MM DISP 200.40 36305067 PAIN/CATHETER PASSER 662.20 36350005 ELECTRIC SOUND LITHOTRIPSY 21,304.50 36350010 ELEC SOUND LITHOTRIPSY-INTRA 21,304.50 36350050 PVP LASER 11,966.00 36450009 PAIN/ANS OCTRODE PERC SCS LEAD 13,102.60 36450012 PAIN/ANS SINGLE LEAD EXT 3,975.40 36450019 THA/REFLECTION INTERFIT SHELL 7,598.00 36450026 THA/OXINIUM FEMORAL HEAD/ASSRT 8,402.00 36450037 VENA CAVA FILTER G-2 RF400F 4,944.60 36450063 PAIN/GENERATOR NEURO 97714 53,104.30 36450112 PENILE IMPL/PUMP 15CM 72404251 17,174.30 36450150 BONE CEMENT 534.60 36450157 ALLOMATRIX INJ PUTTY 1 CC 666.40 36450168 ALLOFUSE GEL 1 CC 90138001 357.40 36450169 ALLOFUSE GEL 5CC 90138005 1,575.10 36450171 CANCELLOUS CHIPS 15CC 27615015 543.50 36450239 RADIESSE INJ SYRINGE 1CC 1,257.60 36450245 TOTAL HIP 37,885.30 36450281 KIT/MINI JET X DISTAL RADIUS 5,436.80 36450298 TKA/COMPETITOR TROCHLEAR COMP 15,972.90 36450308 BONE FILLER/ASSORTED MANUF 2,907.50

36450317 PRO STIM INJ 10CC 86SR0410 6,653.90 36450327 DISTAL CENT POST ASSORTED 523.60 36450331 MESH/ATRIUM PROLOOP LG 30902 452.30 36450332 MESH/ATRIUM PROLOOP XL 30903 452.30 36450333 MESH/ATRIUM PROLOOP MED 30901 452.30 36450334 MESH/ATRIUM C-QUR VPATCH 31200 1,403.00 36450335 MESH/ATRIUM C-QUR 6X8 31533 2,085.70 36450336 MESH/ATRIUM C-QUR 4X6 31528 1,154.90 36450337 MESH/ATRIUM MESH 2 X 4 417.00 36450342 MESH/MARLEX PLUG (MED) C1781 779.90 36450343 MESH/MARLEX PLUG (LG) C1781 779.90 36450356 MESH/MARLEX PLUG X-LG 981.40 36450364 MESH/ATRIUM C-QUR VPATCH 31201 1,275.10 36450365 MESH/ATRIUM C-QUR VPATCH 31202 1,575.10 36450368 MESH/ATRIUM C-QUR 8X12 31537 2,933.30 36450369 MESH/C-QUR RND 15CM 31507 1,195.80 36450370 MESH/TAC SHIELD 4X6 31628 1,200.30 36450371 MESH/TAC SHIELD 6X8 31633 1,942.90 36450374 MESH/PROLITE 2.5 101030606 253.10 36450381 JOURNEY/UNI OX FEM 714223 14,588.60 36450418 THA/SYN STEM POR HO 71306117 22,581.60 36450419 THA/SYN STEM TITAN PRESS 12 12,675.50 36450420 THA/SYNERGY TITAN FEM 71306814 12,675.50 36450421 THA/SN FEM COMP SZ 11 71306611 9,005.10 36450426 THA/SYN TITAN STEM 713068 12,675.50 36450428 THA/LINER R3 560 ID 71332756 5,695.00 36450429 THA/FEM COMP SZ 14 71306614 17,908.10 36450431 THA/SYN POR FEM STEM 71306613 17,908.10 36450434 THA/FEM COMP SZ 15 71306615 17,908.10 36450435 THA/SYN POR STEM 71306112 9,005.10 36450440 THA/R3 3 HOLE SHELL 71335560 2,562.00 36450441 THA/R3 LINER 36MM 71335760 1,981.70 36450444 THA/SYN FEM COMP 15 71306115 7,470.90 36450466 TRIG FUSION NAIL 11.5 7170116 9,256.50 36450467 SCREW/INTERTAN LAG 105 716771 2,132.70 36450471 SCREW/90 LAG 85 COMP 71677090 1,481.40 36450486 K-WIRE/PLOC 1.6 71161016 161.40 36450487 KWIRE/PLOC 1.25MM 71161012 172.30 36450489 PLATE/VLP FIB 3.5 72821004 2,326.60 36450490 PLATE/VLP PLOC FIB 72822004 2,318.40 36450491 PLATE/VLP FIB LOC 3.5 72821007 2,140.40 36450498 PLATE/ASSORTED STYLE & SIZES 578.20 36450507 PLATE/ASSORTED SIZES & TYPES 480.90 36450526 UNIPOLAR HIP IMPLANT 6,430.60 36450545 SCREW/ASSORTED STYLE AND SIZES 719.40 36450570 SCREW/LAG AND ASSORTED SPECIAL 843.60 36450571 SCREW/ASSORTED STYLES & SIZES 551.60 36450574 SCREW/P-LOC 4.5 LP S-T CORTEX 249.00 36450579 THA/REF SPH SCREW 6.5 71332520 337.80

36450580 SCREW/ASSORTED C1713 158.20 36450581 PLATE/RICHARDS COMP W/SCREW 1,931.90 36450586 SCREW/SELF TAP LOC 2.7 MM 255.00 36450590 PAIN/SYNC II PUMP W/FIL 863740 50,056.60 36450596 SCREW/SELF TAP 2.7 7182301 130.20 36450603 SCREW/CANNULATED-ASSRT C1713 605.20 36450631 SCREW/MINI FRAGMENT 369.90 36450632 PLATE/ASSORTED STYLE & SIZES 833.50 36450650 SCREW/P-LOC 3.5 LCK 408.60 36450651 SCREW/P-LOC 3.5 CRT 149.60 36450655 SCREW/CORTEX 3.5 718212 339.20 36450656 SCREW/2.7 728231 339.20 36450667 SCREW/INTERTAN LAG 71677095 1,481.40 36450670 SCREW/INTERTAN LOC LAG 7167710 1,481.40 36450683 SCREW/2.7 LOC 72823124 361.00 36450691 SCREW/LOC 2.5 718212 361.00 36450692 SCREW/SELF TAP CORT 3.5 130.20 36450706 THA/3 HOLE ACE SHELL 71335554 6,656.10 36450707 THA/R3 XLPE 200 LINER 71335754 5,324.90 36450708 THA/NECK 36 M + 0 71343600 7,397.90 36450720 THA/ACE SHELL 50MM 71335550 6,655.00 36450721 THA/LINER 50OD32ID 50 71337650 5,324.90 36450736 THA/SYN FEM SZ 14 71306114 9,005.10 36450737 THA/R3 HEMISPHERE ACE 71335556 7,206.10 36450738 THA/R3 XLPE 20DEG 71335756 2,219.70 36450739 THA/STEM 12MM 73106612 9,005.10 36450740 THA/R3 XLPE 36MM ACE 71332754 2,219.70 36450747 THA/GEN II FEM LUGS 71420999 421.70 36450748 THA/SYN FEM SZ 13 71306113 9,005.10 36450751 TKA/LEG CON FEM CMP R 7142117 21,809.90 36450785 WIRE-K PLAIN/GUIDE-WIRE 121.20 36450881 SPHINCTER/AMS 800 IZ ACC KIT 1,883.30 36450883 SPHINCTER/AMS 800 CONTROL PUMP 13,272.60 36450909 MESH/VICRYL KNITTED 12 X 12 3,136.80 36450946 GRAFT/TENDON 7,558.90 36450955 GRAFT/ORTHO JACKET HAND 2X4 CM 3,955.60 36451015 POSISEP X ENT SPLINT 9210584 328.10 36451016 ENT/ARMSTRONG R BVD GRO 510281 87.90 36451060 BONE FILLER/ASSORTED MANUF 4,522.70 36451312 SCREW/HEADED DARTFIRE D1N300 1,108.50 36451322 SCREW/DARTFIRE 3.5 HEAD D1N350 701.40 36451323 SCREW/DARTFIRE HEAD D1N200 655.50 36451324 SCREW/DARTFIRE HEAD 3.0 D1N300 678.50 36451325 SCREW/DARTFIRE HEAD 2.5 D1N25 655.50 36451326 SCREW/DARTFIRE HEAD 4.0 D1N400 862.40 36451327 SCREW/DARTFIRE HEADLESS D2N 908.40 36451361 NAIL/INTERTAN 11.5 716765 7,586.40 36451362 PLATE/OLECRANON LOC 6H 7182390 4,223.90 36451410 MICRO SUTURE LASSO AR8703 958.60

36451422 ARTHREX/ACL TIGHTROPE RT PIN 1,445.30 36451432 BTB TIGHTROPE AR1588BTB 1,465.40 36451435 ARTHREX/TIGHTROPE AR1588TN 760.10 36451441 CATH EXT FLEX NECK CF-5560 1,394.60 36451478 SCREW/VLP P-L 3.5 LOCK 718212 453.90 36451484 PLATE/VLP FIB 5H 3.5 72822005 2,455.00 36451485 PLATE/VLP FIB 3.5 RT 72822007 2,589.00 36451503 BIORAPTOR ANC KNOTLES 72202403 1,153.70 36451504 OSTEORAPTOR CRVD COBRD 7220329 1,137.30 36451507 COMP RVRS MINI BSPLT 010000589 7,242.00 36451508 SHO/COMP RVRS GLEN STD 1153 5,401.30 36451511 ACROM XL 44 STD HMRL 11536 3,599.40 36451512 REVERSE TRAY COMP 44MM 11537 6,241.80 36451522 COMP PRIM STEM MINI 1136 16,567.10 36451534 ACHILLES TENDON 10017000 4,926.70 36451541 PRIMARY STEM 8MM STD 113648 13,744.20 36451593 ENT/TUBE POPE 2.6 530001 141.50 36451594 ENT/U TUBE 381650 190.30 36451600 T TUBE 1.27MM MOD GOODE 24771 171.60 36451702 ARTHREX/MINI TIGHTROPE AR8914D 1,788.30 36451706 ARTHREX/SWIVELOC BIO ANC AR232 1,371.90 36451707 ARTHREX/SPEEDBRIDGE AR2600SNS4 5,992.20 36451710 ANC SWIVELOCK CLOSED AR2323BCC 1,371.90 36451723 TSA/AEQ REV INSERT 36 DWF361B 4,784.30 36451724 TSA/AEQ RVS FLEX DWF520 7,518.10 36451725 TSA/FLEX STD PTC STEM DWF60 16,403.10 36451728 TSA/AEQ FLEX ECC HEAD DWF0 12,302.30 36451730 TSA/AEQ FLEX STD HUM STM DWF60 16,403.10 36451737 TSA/AEQ FLEX RVS TRAY DWF50 5,625.00 36451738 TSA/AEQ STD PTC STEM DWF60 14,951.50 36451742 TSA/AEQ RVS INSERT 42 DWF42 4,379.00 36451749 TSA/AEQ PEG GLENOID L50 DAW422 7,704.10 36451750 TSA/CORTILOC GLENOID M40 DWE41 7,309.40 36451751 TSA/CORILOC GLENOID S40 DWE403 7,309.40 36451752 TSA/GLEN PEG CORTILOC S30 DWE4 7,309.40 36451754 TSA/GLEN CORTILOC PEG DWE412 8,444.00 36451770 TSA/SCREW FIX LOCK 3.5 18055 580.70 36451771 TSA/SCREW CENTRAL 6.5 115395 573.40 36451773 TSA/ACROM HUM BRG STD XL11536 3,750.00 36451779 TSA/CEMENT RESTRICTOR 24MM EBO 689.90 36451791 TSA/AEQ SCREW LOCK 65MM 640106 2,247.40 36451792 TSA/AEQ SECURITIZATION SET 640 1,254.60 36451793 TSA/AEQ SPACER STEM 11MM 65011 7,636.70 36451794 TSA/AEQ METAPHYSIS STEM 660361 12,382.40 36451796 TSA/AEQ PED GLENOID L40 DWE421 7,676.00 36451911 PLATE/VLP PLOC 3.5 6H 72823006 846.80 36451912 PLATE/VLP P-LOC 3.5 7H 728208 2,126.60 36452261 WASHER/VLP 7.0MM OD 71143107 186.90 36452298 ARTHREX/FLIP CUTTER PIN 1,330.50

36452299 ARTHREX/ACL TIGHTROPE RT 1,124.00 36452304 ARTHREX/DIS BICEPS DEL AR2600 3,069.60 36452307 SWIVELOCK TENDOESIS AR1662BCC8 1,582.90 36452311 SUTURE ANCHOR PEEK TAK AR1938P 1,200.10 36452356 THA/SLEEVE TAPER 71344248 688.10 36452358 THA/SLEEVE TAPER 71344247 688.10 36452359 THA/FEM HEAD MOD 71342340 6,889.70 36452364 THA/FEM HEAD 2200X 71302200 1,561.60 36452383 THA/SYNERGY STEM 18 71306818 15,979.30 36452393 THA/ANTH FEM SO POR HA 71357 19,886.90 36452394 THA/ANTH HO POR HA 7135710 19,886.90 36452395 THA/ACE LINER 32MM 0D 71339548 6,629.00 36452417 ACL TIGHTROPE MPFL BIO AR1360 5,258.40 36452551 ANCHOR/PUSHLOCK SHORT AR2923BC 1,383.90 36452900 BICORTICAL POST 4.5 AR1365 345.90 36453092 PAIN/INTRATHECAL CATH 8780 3,007.20 36453246 TKA/GEN II TIB INS 71420526 4,449.90 36453248 TKA/JOURN PFJ OX TROC 71461014 13,582.40 36453261 TKA/GEN II INSERT CONS 7142052 5,608.00 36453263 TKA/LEG FEM WEDGE 71421667 3,474.40 36453264 TKA/REV TIBIAL BASE 71424015 8,107.50 36453317 TKA/LEG PRESSFIT STEM 71424049 4,020.20 36453333 TKA/LEGION INSERT PS 714532 8,734.70 36453334 TKA/GEN II CON ART INS 714205 9,677.80 36453385 TKA/UNI GII OXI FEMORAL COMP 13,383.90 36453401 TKA/JOUR OX TROCH COM 71461012 15,121.30 36453426 TKA/GEN II PATELLA OVAL 714210 4,237.50 36453429 TKA/JRNY TIB BASE 740222 8,504.00 36453432 TKA/JRNY PAT RESRF RD 740248 3,689.50 36453433 TKA/JRNY II BCS FEM OX 740221 19,202.90 36453435 TKA/JRNY II FEM OX RT 740221 19,202.90 36453436 TKA/JRNY II ART INSERT 740272 12,273.30 36453623 TKA/JRNY ART INSRT RT 7-8 9MM 12,273.30 36454473 TKA/LEG REV INSERT 71420523 5,608.00 36454746 PAIN/PISCES QUAD LEAD 3487A-56 5,126.60 36454753 PAIN/MEDTRON PAIN CON REV 8578 637.90 36454764 PAIN/LEAD KIT 977A2 7,282.20 36454850 MESH/MOSAIC 31128 988.90 36455317 MIC TRANSGASTRIC FEEDING TUBE 1,435.10 36455360 INTERNAL BRACE LIGAMENT AR1688 3,716.10 36455600 ALLOGRAFT GRAFTLINK 10MM FGL 5,946.20 36455605 ALLOGRAFT GRACILIS FGRACILIS 3,155.10 36456006 GRAFT/COMP VENT HERNIA CSLH8H 13,692.10 36456064 SCREW/CORTEX LOC 2.7 718223 399.20 36456065 SCREW/DTS LOCKING SDT28L 269.60 36456066 SCREW/PLOC CRTX 3.5 718213 172.30 36456068 SCREW/PLOC 3.5 718212 318.60 36456069 SCREW/PLOC 2.7 CRTX 738230 187.30 36456070 SCREW/PLOC 2.7 T15 LK 738223 437.90

36456071 SCREW/PLOC 2.5 T20 CRTX 738240 125.60 36456072 SCREW/PLOC CRT 2.7 718230 133.30 36456073 SCREW/PLOC OSTEO 5.0 718220 344.50 36456074 SCREW/PLOC 3.5 CRTX 73824018 187.30 36456077 SCREW/TRIGEN LP 5.0 716450 779.20 36456081 SCREW/PLOC VLP CRTX 3.5 718213 163.30 36456088 LAG/COM SCREW KIT 115/110 7167 2,361.30 36456246 PAIN/OCTRODE LEAD KIT 90CM 6,430.00 36456344 PLATE/VLP FIB 3.5 131MM 728210 2,749.20 36456349 SCREW/ CORTEX 2.4 X 9 74402409 241.10 36456414 SCREW/VLP CORTEX 2.4 744024 261.10 36456415 SCREW/VLP MINI LOCK 2.4 744124 365.70 36456416 SCREW/VLP CRTX 2.0 744020 261.10 36456427 PLATE/CERVICAL 15 MM 9,493.50 36456429 SCREW/LP NONLCK 2.7 131227218 245.50 36456430 PLATE/DVR LCK NARROW MINI 1318 1,377.90 36456431 TKA/JRNY INSERT RT 11MM 740272 12,273.30 36456432 SCREW/VLP LOC 3.5 X 20 718212 453.80 36456436 TKA/ART INSRT 7-8 10MM 7402727 12,273.30 36456440 SCREW/ LOCKING 2.4 X 9 744124 338.20 36456441 TIGHTROPE BUTTON 12MM AR1588TB 698.20 36456443 TSA/HUM STEM 9 X 130 DWD902 18,485.20 36456444 HEALICOIL 4.75MM 72203705 1,636.40 36456445 BONE CEMENT RALLY HV 71271560 327.30 36456446 BONE CEMENT RALLY MV 71271580 327.30 36456447 PLATE/LEFT NARROW 131821050 2,755.80 36456448 INTERTAN NAIL 11.5 71675202 5,825.70 36456453 TSA PEG GLEN S35 DWE402 8,444.00 36456463 SCREW/LOCK GREEN 26MM SDT28L 218.20 36456464 PLATE/DVR CROSSLOCK STD LEFT 2,755.80 36456466 TKA ART INSERT LEFT 15MM 5-6 12,273.30 36456469 NAIL/INTERTAN 125* 10 X 18 716 5,825.70 36456470 TKA/JRNY ART INSRT LT 11 7-8 12,273.30 36456503 SCREW/LCK 3.5 X 6 71821206 453.80 36456504 TKA/ART INS 5-6 13MM 74027255 12,273.30 36456505 TKA/ART INSERT 7-8 15MM 740272 12,273.30 36456507 SCREW/VLP MM LOCK 2.0 X 12MM 338.20 36456510 PLATE/VLP MM T-PLATE 2 X 6HOLE 1,603.70 36456512 SCREW/VLP MM LOCK 2.0 X 10MM 338.20 36456517 BONE CEMENT/RALLY HV AB 40GRAM 1,232.80 36456531 THA/ANTH FEM SO POR PL HA SZ 6 19,211.80 36456532 THA/ANTH FEM HO PRO PL HA SZ3 19,211.80 36456533 SCREW/VLP MM CRTX 2.0 X 8MM 241.10 36456535 SCREW/VLP MM LOCK 2.0 X 8MM 338.20 36456536 SCREW/VLP MM CRTX 2.0 X 9MM 241.10 36456537 ALLOFUSE PLUS DBM PASTE 1CC 305.50 36456563 THA/R3 3HOLE SHELL 46MM 8,247.70 36456564 THA/R3 XLPE LINER 28 X 46 0* 6,403.90 36456565 THA/OX FEM HEAD 28MM +12 12/14 8,575.00

36456567 SCREW/HEXALOBE LOCK 3.5 X 18 497.50 36456581 TKA/JRNY ART INRT RT 5-6 15MM 12,273.30 36456587 TKA/JRNY ART INST LT 5-6 13MM 12,273.30 36456589 TKA/JRNY ART INST LEFT 18 7-8 12,273.30 36456597 PERI-LOC CABLE SADDLE SHORT 665.50 36456598 STENT/LUBRI-FLEX 4.5 X 26 425.50 36456615 TKA/JRNY ART INSERT LT 7-8 9MM 12,273.30 36456616 HEALICOIL 4.75MM 1,636.40 36456621 SCREW/VLP MM CRTX 2.0 X 14 247.70 36456626 GRAFT/LIFENET ROTATOR CUFF 8,485.50 36456635 ALLOMED 4X8 3,360.20 36456643 STENT/OPEN TIP 4.5FR X 28CM 425.50 36456645 DISTAL BICEPS REPAIR ANCHOR 3,430.00 36456647 TIGHTROPE BUTTON RND CON 14MM 698.20 36456651 TKA/JRNY ART INSRT LT 3-4 15MM 12,273.30 36456652 HEALICOIL 5.5 1,017.50 36456653 SCREW/PLOC LOCK 3.5 X 32 413.30 36456657 TKA/JRNY UNI TIB LM/RL 9MM SZ4 8,402.50 36456659 PLATE/PLOC VLP LOCK 3.5 7H 86 998.70 36456662 SCREW/PLOC CORTEX 3.5 X 30 194.10 36456664 PLATE/VLP MM 2.0MM 6HOLE STR 1,401.50 36456665 SCREW/VLP MM CRTX 2.0 X 7MM 245.50 36456672 TSA/LAT HUM INSERT 36MM +9MM 5,731.70 36456673 TSA/LAT HUM INSERT 36MM +6MM 5,731.70 36456675 NICELOOP GREEN 276.90 36456676 NICELOOP WHITE/GREEN 276.90 36456682 FIBERTAK WITH SUT TAPE 1,065.80 36456684 TKA/JRNY ART INSERT RT 7-8 15 12,986.60 36456685 GUIDEWIRE/EZ GLIDER 131.10 36456688 TKA/JRNY ART INSRT LT 7-8 10MM 12,986.60 36456692 SCREW/PLOC LOCK 3.5 X 38 475.20 36456699 SCREW/VLP MINI LOCK 2.4 X 11MM 323.10 36456711 SPACER/TPS LARGE LORDOTIC 8MM 6,707.30 36456718 ARTHREX/ALLOGRAFT CONV PACK 2,817.60 36456726 SCREW/DVR LOCKING 2.7 X 14MM 295.80 36456734 SCREW/VLP MINI LOCK 2.4 X 13MM 323.10 36456735 SCREW/VLP MM LOCK 2.0 X 7MM 344.10 36456737 SCREW/VLP MM LOCK 2.0 X 6MM 325.20 36456738 SCREW/PLOC LOCK 2.7 X 46MM 467.90 36456739 PLATE/OLECRANON LOCK RT 8H 107 5,559.70 36456743 SCREW/VLP MM LOCK 2.0 X 11MM 344.10 36456744 SCREW/PLOC LOCK 3.5 X 36MM 474.20 36456750 TSA/AEQ REV LAT HUM SNSERT 12 5,731.70 36456754 SCREW/EVOLVE TRIAD 2.0 X 18MM 283.20 36456755 SCREW/ORTHOLOC MINI 2.0 X 18MM 648.30 36456760 SCREW/PLOC LOCK 3.5 X 34MM 474.20 36456763 PLATE/PLOC HUM LK RT 11H 191MM 6,084.20 36456772 STAPLER/ECHELON 60 MM ENDOCUTT 1,064.50 36456776 STAPLER/ASSORTED STYLE & SIZES 386.80

36456779 STAPLER/ASSORTED STYLE & SIZES 575.00 36456780 STAPLER/RELOAD ART/TR45W/TR45B 615.20 36456783 STAPLER/LINEAR CUT TLC75 TCT75 833.50 36456784 STAPLER/ARTICULATING ASST SIZE 1,112.30 36456787 STAPLER/CIRCULAR & INTRALUMINA 1,451.60 36456791 STAPLER/CONTOUR CURVED CUTTER 1,812.20 36456792 STAPLER/CONTOUR RELOAD 937.00 36456793 STAPLER/RELOAD 3.5 XR608 340.40 36456794 STAPLER/BLUE LINEAR 3.5 TX60B 454.50 36456796 STAPLER/TR 90 RELOAD 470.00 36456797 STAPLER/TL 90 LINEAR 474.40 36456801 STAPLER/GREEN RELOAD ECRGOG 394.20 36456809 SCREW/VLP MM LOCK 2.0 X 9MM 338.20 36456838 VAD/HICKMAN CATHETER 961.10 36456904 STAPLER/ENDO LINEAR CUTTER 605.20 36457005 MESH/PRO-GRIP 15 X 10 1,166.50 36457006 MESH/PROLOOP PREFORMED PLUG XL 604.20 36457007 PLATE/DVR CROSSLOCK STD RIGHT 2,649.80 36457008 ARTHREX BIOCOMP MPFL SYSTEM 4,458.30 36457009 ARTHREX/BI-CORT POST 4.5 X 50 300.00 36457014 TSA/PER REV STD BASEPLATE 25 6,409.40 36457015 TSA/SCREW REV PERI 5.0 X 34MM 635.70 36457016 TSA/SCREW REV PERI 5.0 X 38MM 635.70 36457017 TSA/PER REV STD GLENOSPHERE 42 12,044.60 36457018 TSA/SIMP NUCLEUS SZ 2 16,828.10 36457019 TSA/SCREW REV CEN 6.5 X 40MM 2,135.80 36457021 TSA/SIMP HUMERAL HEAD 52 X 18 12,976.10 36457022 PLATE/VLP MM 2.0MM STR 8HOLE 1,586.10 36457023 SUT ANCH MINI PUSHLOCK 2.5 X 8 1,080.50 36457024 SCREW/VLP MM CORTX 2.0 X 11MM 238.10 36457025 BONE CEMENT/RALLY MV ALL IN 1 2,160.90 36457033 TSA/SCREW REV PERI 5.0 X 26MM 635.70 36457035 TSA/SCREW REV CEN 9.5 X 30MM 2,135.80 36457036 TIGHTROPE BUTTON CC ROUND 11MM 1,124.50 36457037 TSA/SCREW REV PERI 5.0 X 22MM 635.70 36457038 AUTOGRAFT GRAFTLINK PACK ANC 2,039.30 36457039 IMPL SYS INT KNEE LIGAMENT ANC 3,583.40 36457045 GUIDEWIRE/ULTRATRA 0.035 X 150 744.80 36457046 URO ACCESS SHEATH 12/14 X 38CM 331.50 36457050 PAIN/PROCLAIM ELITE PULSE GEN 68,363.30 36457054 SCREW/PLOC 2.7 X 50MM LOCK 467.90 36457058 SCREW/PLOC 2.7 X 60MM LOCK 444.80 36457065 K-WIRE/VLP MM 1.0 X 150MM 138.50 36457076 KIT INVISIKNOT ANKLE FRACTURE 2,727.40 36457078 SCREW/PLOC LOCK 2.7 X 40MM 467.90 36457089 TSA/SIMP HUMERAL HD 56MM/21MM 12,976.10 36457090 TSA/SIMPLICITI NUCLEUS SZ 3 16,828.10 36457091 TOE/IMPLANT PKG 3.2 3,772.20 36457102 THA/CENTRAL HOLE COVER 420.30

36457109 THA/R3 3 HOLE SHELL 71335548 6,655.00 36457110 THA/R3 ACE LINER XLPE 71337648 5,301.90 36457117 THA/R3 SHELL SZ 52 71335552 2,869.20 36457124 PRODENSE BONE GRF 4CC 87SR4040 5,393.90 36457128 PRO DENSE BONE GRAFT 5,890.70 36457151 TSA/SIMP HUM HD 56MMX18MM 12,976.10 36457153 PAIN/BLUE PERC LEAD KIT 5,245.00 36457155 PLATE/PLOC LCK 4.5MM 8H 157MM 2,077.00 36457157 SCREW/PLOC CORTEX 4.5 X 40MM 194.10 36457159 PAIN/IPG KIT 62,940.00 36457160 SCREW/PLOC LOCK 4.5 X 40MM 558.10 36457161 SCREW/PLOC CORTEX 4.5 X 34MM 194.10 36457164 TSA/REV CENT SCREW 6.5 X 35MM 2,135.80 36457165 TSA/REV PERI SCREW 5.0 X 30MM 635.70 36457166 TSA/REV PERI SCREW 5.0 X 42MM 635.70 36457167 TSA/AEQ REV STD GLENOSPHERE 36 12,044.60 36457171 NAIL/TRIGEN 1250 10MM X 20CM 5,884.90 36457174 TSA/SIMP HUM HEAD 48MM 15MM 12,976.10 36457180 SCREW/DVR LP NONLOCK 2.7 X 10 358.80 36457181 TSA/SCREW REV PERI 5.0 X 46MM 635.70 36457183 ACUSEAL VASCULAR GRAFT 6X40CM 2,710.60 36457187 TSA/AEQ REV STD GLENOSPHERE 29 12,044.60 36457188 ACUSEAL VASCULAR GRAFT 6X20CM 1,605.00 36457189 TSA/FLEX REV INSERT 39MM +6 B 4,107.90 36457191 TKA/PRESSFIT STEM 10MM X 100MM 5,979.30 36457193 ACHILLES SPEEDBRIDGE WITH JUMP 5,979.30 36457194 PAIN/LEAD SLIM TIP 50CM 8,287.10 36457196 PAIN/TUNNELING TOOL KIT 35CM 239.20 36457197 PLATE/VLP MM 2.0 STOUT 6HOLE 1,634.30 36457198 PAIN/BLUE LEAD ADAP KIT 25CM 1,678.40 36457202 TSA/SCREW REV CENTRAL 9.5 X 25 2,135.80 36457203 TSA/SCREW REV PERI 5.0 X 18MM 635.70 36457204 NAIL/KNEE FUSION RT 13MX70CM 12,902.70 36457205 TSA/AEQ CORT GLEN MED RT 15* 12,059.30 36457206 MESH SYMBOTEX 20CM 2,960.30 36457207 STENT/LITHO 7FR X 30CM 461.60 36457208 MESH SYMBOTEX 25CM X 15CM 3,578.10 36457209 TSA/SIMP STB HUM HEAD 48 X 18 13,366.40 36457210 MESH/PARITEX PLUG/PATCH 6X3 LG 580.10 36457211 PAIN/NEUROSTIMULATOR 97713 39,337.50 36457212 TSA/SIMP HUM HEAD 52MM X 21MM 13,366.40 36457213 BI-CORTICAL POSR 4.5 X 47.5MM 300.00 36457214 ACUTRAK FUSION 30MM 6MM 1,067.90 36457215 LAP/RELIATACK DEEP TACKS 467.90 36457216 TKA/DISH ART INSERT 18MM 3-4 6,650.70 36457217 THA/REDAPT FEM COMP 13 240MM 30,295.10 36457218 TSA/AEQ CORT GLEN MED LEFT 25* 12,541.80 36457219 FIBERTAK SUTURE ANCHOR #1 1,275.60 36457220 ACL/PCL REP FIX WITH SWIVELOCK 1,800.10

36457224 THA/ANTH HO FEM COMP SZ 10 19,584.80 36457235 ANCHOR BUMPY 97791 533.20 36457401 HEALICOIL RG SUT ANC 722037 1,028.20 36457402 HEALICOIL RG SUT ANC 72203707 1,076.70 36457403 SUTUREFIX ULTRA ANC W/1 722038 1,018.50 36457404 SUTUREFIX ULTRA ANC W/2 722038 1,161.30 36457407 SUTURE ANCHOR 1.8 Q-FIX 251800 1,337.50 36457408 HEALCOIL RSB SUT ANC 5.5 72203 1,058.20 36457410 PROCHONDRIX CRYO 15MM X 1.0MM 8,234.70 36457411 TKA/JRNY INSERT 1-2 RIGHT 10MM 12,986.60 36457412 PLATE/VLP MM 2.0 STOUT 8 HOLE 2,100.00 36457414 PROPATEN VASCULAR GRAFT 8X40CM 2,092.00 36457415 NAIL./INTERTAN 10MMX36 125D RT 6,900.00 36457416 MESH SYMBOTEX 9CM 1,069.00 36457417 MESH MEDIUM PLUG 235.00 36457418 TSA/SIMP HUM HEAD 44MM 15MM 13,252.00 36457419 TSA/SIMP NUCLEUS SIZE 1 17,684.00 36457420 NAIL/INTERTAN 13MMX18CM 125* 5,920.00 36457421 TSA/AEQ REV LA BASEPLATE 29 +3 9,536.00 36457422 PLATE/VLP MM 2.4MM STOUT 8HOLE 2,100.00 36457423 NAIL/META RETRO FEM 13MMX40CM 6,440.00 36457424 TSA/SCREW REV CEN 6.5 X 30MM 2,036.00 36457425 ARTHREX/SUT ANC 3.9 X 10.2MM 1,100.00 36457426 PAIN/PULSE GENERATOR 87,630.00 36457427 TKA.JRNY ART INST RT 7-8 18MM 13,250.00 36457428 SCREW/PLOC CORTEX 2.7 X 24MM 198.00 36457429 STENT LUBRI-FLEX 7FR X 26CM 229.00 36457430 STENT LUBRI-FLEX 7FR X 28CM 229.00 36457431 STENT LUBRI-FLEX 6FR X 28CM 229.00 36457432 STENT LUBRI-FLEX 7FR X 24CM 229.00 36457433 STENT LITHO 7FR X 26CM 202.00 36457434 STENT LUBRI-FLEX 6FR X 24CM 229.00 36457435 STENT LUBRI-FLEX 6FR X 26CM 229.00 36457436 STENT LUBRI-FLEX 4.5FR X 30CM 202.00 36457437 STENT LITHO 7FR X 24CM 202.00 36457438 STENT LITHO 7FR X 28CM 202.00 36457440 STENT LUBRI-FLEX 6FR X 30CM 229.00 36457441 SCREW/18.0 MINI ACUTRAK 2 BONE 1,632.00 36457442 PLATE/DVR CROSSLOCK LONG FEET 3,420.00 36457443 SCREW/22.0 MINI ACUTRAK 2 BONE 1,632.00 36457444 SCREW/20.0 MINI ACUTRAK 2 BONE 1,632.00 36457445 TSA/AEQ REV HUM STEM 11 X 130 18,150.00 36457446 TSA/AEQ REV STD BASEPLATE 29MM 6,110.00 36457447 PAIN/SWIFT-LOCK ANCHOR 350.00 36457448 PAIN/ANS OCTRODE LEAD 3186 3,570.00 36457450 PAIN/INTELLIS ADAPT STIM 97715 45,900.00 36457451 SCREW 34MM PERI-LOC T15 LK 476.00 36457452 PL VLP 3.5MM TIB LK PL 3H 74MM 3,750.00 36457453 REDAPT MONO STEM 240MM SZ 16 30,610.00

36457454 PATIENT CONTROLLER 063372 3,250.00 36457455 PROCLAIM ELITE GENERATOR 65,170.00 36457456 PERI-LOC 3.5MM X 32MM LK SCREW 466.00 36457457 REDAOT SLVLS STEM 240MM 20 SO 30,610.00 36457458 4.5MM LCK COMP PL 8H 157MM 2,110.00 36457459 4.5MM NARROW PL 9HL 178MM 632.00 36457460 CQUR MOSAIC MESH 9X9 CM 690.00 36457461 ATTUNE TIBIAL INSERT SZ8 18MM 6,524.00 36457462 MED DIST HUM LK PL 7H R 103MM 4,840.00 36457463 P-L-D HUM LK PL 15H R 207MM 5,760.00 36457464 INTERTAN 1.5 11.5MMX36CM 125D 7,900.00 36457465 PERFORM REV AUG BASEPL 35DX25M 10,038.00 36457466 3.5MM LK RECON PL 10H 118MM 1,554.40 36457467 MESH PRO GRIP 15X10 CM RIGHT 1,250.00 36457468 MESH SYMBOTEX ROUND 15CM 1,918.00 36457470 SIM STB HUMERAL HEAD DI 13,252.00 36457471 PERF REV PERI SCREW 606.00 36457472 PERF REV CENRAL SCREW 2,036.00 36457473 REV INSERT 42X6X7.5 5,386.00 36457474 PAIN/NEURO ABSORB ENVELOPE LG 3,990.00 36457475 PERF REV CENTRAL SCREW 20,366.00 36457476 JRNY XLPE INSERT SZ 3-4RT 18MM 13,250.00 36457477 AEQ REV PTC HUMERAL STEM 12,520.00 36457478 LOCKING SCREW 75MM 2,504.00 36457479 LOCKING SCREW 90MM 2,504.00 36457480 STEM 15MM X 15MM SPAC 8,510.00 36457481 STEM 15MMX25MM SPAC 8,510.00 36457482 STEM 15MMX50MM SPAC 8,510.00 36457483 STEM 15MM METAPHYSIS 13,794.00 36457485 NAIL/INTERTAN 11.5 38CM RT 125 7,900.00 36457486 LG BIONINDUCTIVE IMPLANT 5,600.00 36457487 TENDOR ANCHOR KIT W/ 8 ANCHORS 3,800.00 36457488 BONE ANCHORS W/ DELIVERY SYS 3,800.00 36457489 TKA/JRNY INSERT 7-8 RIGHT 13 13,250.00 36457490 TKA/JRNY FEM COMP RIGHT 9 24,490.00 36457491 TKA/JRNY TIBIAL BASE RIGHT 8 9,830.00 36457492 NAIL/INTERTAN 10 X 32 RT 125* 7,900.00 36457493 PLATE/VLP 3.5 1/3 TUB 7H 86MM 1,014.00 36457494 THA/REDAPT FEM STD 18 300MM 32,280.00 36457497 PLATE/EVOLE TRIAD 2.0 X 22MM 300.00 36457498 SUTUREFIX ANCHOR 1.7 72204688 1,050.00 36457500 PLATE/EVOLE TRIAD RHP 20MM 4,568.00 36457513 PIN/RUSH 352.50 36457576 CLIP/ASSORTED STYLE & SIZES 432.10 36457578 CLIP/LIGATING ASST SZ 291.00 36457589 PLATE/ASSORTED STYLE & SIZES 554.70 36457604 NAIL/META TIBIAL 71655 6,060.50 36457605 NAIL/META RETRO FEM 71653 6,220.80 36457606 PLATE/NARROW LOCKING LTDVPN1 3,290.30

36457608 SCREW/PART THRD LAG 16MM QT28L 269.60 36457609 SCREW/SELF TAP CT35L 283.30 36457610 SCREW/LOCKING CORTICAL VT35L 424.20 36457611 KWIRE NEWCLIP 1.4MM 96.60 36457614 PLATE/OLECRANON LK 8H LT 71822 4,551.90 36457615 PLATE/OLECRANON 6H 81MM 718229 2,164.90 36457630 CAP/META NAIL SET SCREW 716560 607.10 36457644 SCREW/ASSORTED STYLES & SIZES 319.40 36457652 SCREW/PERI-LOC 3.5 738240 187.30 36457653 SCREW/PERI-LOC 3.5 738250 456.60 36457656 SCREW/NON LOCK 3.5 738240 187.30 36457670 PLATE/VLP FIB LOC 11H 72822011 2,552.40 36457672 PLATE/VLP 3.5 FIB 3H 72822003 1,964.00 36457698 PLATE/DVR MINI 131822040 2,622.70 36457699 PLATE/DVR LOCK NARROW MIMI 131 2,759.70 36457700 PLATE/DVR LOCK NARROW 13181105 2,764.30 36457702 SCREW/DVR NON LOCK 2.7 1312272 244.90 36457703 SCREW/DVR LOCK 2.7 1312271 324.20 36457710 PLATE/ORTHOLOC MINI 2.0 X 16MM 684.00 36457711 TSA/SIMP HUM HEAD 48MM 21MM 13,252.00 36457712 PLATE/EVOLE TRIAD 2.0 X 10MM 300.00 36457713 TSA/AEQ HUM HEAD 1B 66MM 14,596.00 36457714 SUTUREFIX ANCHOR 1.7 72204687 1,100.00 36457716 LEAD ANCHOR KIT 600.00 36457717 JRNY BCS FEMORAL OXIN LT SZ 9 24,490.00 36457718 TKA/JRNY PFJTROCH XS LEFT 19,090.00 36457721 PLATE/PLOC PRX HUM 3.5 11H 191 7,120.00 36457722 TSA/AEQ REV SPACER 9MM 4,370.00 36457723 LUTONIX BALLOON 7.0 X 60MM 4,796.00 36457724 LUTONIX BALLOON 7.0 X 40MM 4,796.00 36457725 PAIN/BLUE PERC LEAD KIT 5,000.00 36457726 MYNX CLOSURE 390.00 36457727 PLATE/PLOC TIB LEFT 5HOLE 72MM 3,132.00 36457728 SCREW/VLP P-LOC LOCK 3.5 X 26 416.00 36457731 TKA/JRNY ART INSRT LT 3-4 12MM 15,290.00 36457735 GRAFT FLUENCY 8MM 40MM 80CM 7,934.00 36457740 GRAFT FLUENCY 8MM 60MM 80CM 7,934.00 36457742 PLATE/PLOC VLP LK 3.5 5H 62MM 934.00 36457743 PLATE/LONG POLY DIS RADIUS RT 3,560.00 36457744 TSA/SCREW REV CEN 9.5 X 35MM 2,036.00 36457745 STENT/LIFESTREAM 10MM X 38MM 4,600.00 36457746 TKA/JRNY ART INSERT RT 5-6 15 15,290.00 36457747 MEDIUM BIOINDUCTIVE IMPLANT 8,000.00 36457748 BONE CEMENT/RALLY HV AB 70GM 2,670.00 36457749 ARTHREX BRACE LISFRANC REP KIT 4,272.00 36457750 TORNADO PLATINUM EMBOLI COIL 318.00 36457751 PLATE/PRX HUM LK 3.5 7H RT 140 6,670.00 36457752 SCREW/CANNULATED 2.5 X 34 800.00 36457753 SCREW/CANNULATED 2.5 X 40 800.00

36457754 SCREW/PLOC VLP CORTEX 2.7 X 36 127.00 36457756 SCREW/VLP MM CORTEX 2.0 X 16MM 258.00 36457757 PLATE/PLOC COMP 3.5 10H 145MM 802.00 36457758 2.5MM CANN SCREW 36MM 800.00 36457759 SCREW/PLOC CRT 3.7X10MM 139.00 36457760 2.5MM CANN SCREW 30MM 800.00 36457761 JRNY BCS ISRT SZ 5-6 RT 18MM 13,910.00 36457762 XEMPLIFI DBM PLUS 1CC 456.00 36457763 NAIL/INTERTAN 10MMX32CM 125 LT 6,540.00 36457765 TSA/AEQ REV FRAC 45 +9MM 6,024.00 36457766 THA/REDAPT REV FEM STEM 21 240 32,450.00 36457767 AMS 800 CUFF WITH IZ 12,236.00 36457768 KYPHON BONE CEMENT 375.00 36457769 AMS 800 PRESS BALLLOON 51-60 5,594.00 36457770 SCREW/PLOC CORTEX NL 4.5 X 54 160.00 36457771 SCREW/PLOC CANN LOCK 5.7 X 75 1,150.00 36457772 SCREW/PLOC CANN LOCK 5.7 X 45 1,150.00 36457773 SCREW/PLOC CANN LOCK 5.7 X 70 1,150.00 36457774 SCREW/PLOC CANN LOCK 5.7 X 35 1,150.00 36457775 SCREW/PLOC CORTEX NL 4.5 X 64 160.00 36457776 SCREW/PLOC CORTEX LCK 4.5 X 32 654.00 36457777 SCREW/PLOC CORTEX NL 4.5 X 30 160.00 36457778 SCREW/PLOC CORTEX LCK 4.5 X 34 654.00 36457779 WASHER/PLOC 10MM 936.00 36457780 SCREW/CANN LOCK 5.7 X 65MM 700.00 36457782 SCREW/CANN LOCK 5.7 X 80MM 700.00 36457783 SCREW/TRIGEN LAG 125 COMP 120 2,700.00 36457784 GORE VIABAHN 8MM 5CM 7FR 6,874.00 36457785 GORE VIABAHN 7MM 10CM 7FR 7,520.00 36457786 NAIL/INT 10S 10MM 38CM 125 RT 8,450.00 36457787 TKA/JRNY ART INS LT 7-8 13MM 15,290.00 36457788 NAIL/TRI META TIBIA 13MM 33CM 6,630.00 36457789 PLATE/VLP MM 2.4 T 8 X 8 HOLE 2,210.00 36457790 SCREW/VLP MM LOCK 2.4 X 16MM 364.00 36457791 SCREW/FEMORAL NAIL - ASSORTED 544.70 36457793 TSA/REV INSERT 36MM 6M 7.5* 5,386.00 36457794 TSA/AEQ REV BASEPLATE 25MM 15* 10,038.00 36457795 THA/ANTH POR FEM COMP SIZE 9 20,980.00 36457796 SCREW/ACUTRAK MICRO 26MM 1,632.00 36457797 SCREW/ACUTRAK MICRO 18MM 1,632.00 36457798 SCREW/PLOC LOCKING 2.7 X 36MM 548.00 36457799 SCREW/PLOC CORTEX 2.7 X 36MM 160.00 36457802 TSA/AEQ PEG GLENOID XL40 8,290.00 36457803 TSA/FLEX HUM HEAD 54MM 18MM 11,342.00 36457804 SCREW/DVR LOCK 2.7 X 26MM 380.00 36457805 PENILE/AMS RESERVIOR CONCEAL 4,902.00 36457807 THA/ANTH POR PL FEM STD SZ 4 20,980.00 36457808 ACUSEAL VASC GRAFT 4-7MM 45CM 3,226.00 36457809 PLATE/4.5MM PRX HUM LK LT 9H 7,880.00

36457810 INSERT/PLOC 4.5MM LCK HEX SST 436.00 36457811 ARTHREX/TIGHTROPE DBL PASS SUT 1,058.00 36457812 THA/REV FEM STEM 300MM SZ 17 34,220.00 36457913 CLIP/APPLIER MULTI MED 405.60 36457914 CLIP/CARTRIDGE 396.80 36457915 CLIP/APPLIER MULTI LG 522.40 36458160 PLATE/PLOC FIB 3.5 72821005 2,466.00 36458191 PLATE/ASSORTED STYLE AND SIZES 5,078.10 36458192 PLATE/ASSORTED STYLE AND SIZES 4,147.90 36458202 PLATE/PLOC 3.5 6 98 71820706 3,583.60 36458204 PLATE/PLOC 3.5 10 148 71820710 3,658.40 36458205 PLATE/PLOC 3.5 13 186 71820713 3,699.80 36458215 PLATE/PROX LOCK 3.5 71821403 3,513.90 36458222 PIN/WRIGHT PLACEMENT DC4212 405.90 36458227 PLATE/MTP LT 7282401 1,503.60 36458240 PLATE/3.5 LT 72821003 1,280.10 36458246 PLATE/STD PLYXL LOC PT VPS2 2,748.10 36458247 SCREW/FULL THREAD LAG QDT2.8L 269.60 36458265 PLATE/PROX HUM LOC 3.5 5H 7182 5,213.70 36458406 VAD/BARD DUAL LUM PORT 0607655 1,825.70 36458410 VAD/PORT VACCESS CT 7480000 858.70 36458997 MESH/COOK HERNIA GRAFT G31141 721.70 36458998 MESH/SURGIS BIO 13X15 CSAH8H 8,215.50 36459028 MESH/ATRIUM 6 X 6 306.10 36459051 TKA/PATELLAR COMPONENT - ASS'T 2,597.40 36459152 TKA/PRESS FIT STEM 714213 6,383.50 36459158 TKA/REV PRESSFIT STEM 71421312 5,419.30 36459186 SCREW/ASSORTED STYLES & SIZES 575.00 36459399 CABLE/ACCORD W/CLAMP 71340008 1,900.00 36459407 CABLE/ZIM PIN IMPLANT SET 45 1,539.90 36459425 PAIN/EXTENSION KIT 5,224.50 36459429 TKA/TIBIAL COMP OR FLEX INSER 14,479.80 36459441 TKA/LEG COUPLER 6MM 71424227 5,991.00 36459442 TKA/LEGION PFIT STEM 71424048 5,915.00 36459445 TKA/LEGION PRESS STEM 7142405 5,782.10 36459451 TKA/LEGION TIBIAL COMPONENT 12,714.80 36459458 TKA/LEGION PRES FIT 71424029 4,409.30 36459461 TKA/LEG TIB BASE 4RT 71424014 12,061.00 36459465 TKA/LEGION OS COUPLER 71424223 2,203.30 36459467 TKA/LEG FEM COMP 71421164 21,809.90 36459468 TKA/LEGION FEM STEM 71424046 4,018.20 36459472 TKA/LEG FEM CMP SZ 6 71421176 21,809.90 36459475 TKA/LEG INSERT 71453221 3,550.80 36459482 TKA/LGN DISHED INSERT 714532 9,217.60 36459628 TRIGEN NAIL CAP 706.00 36459640 TKA/OXINIUM FEMORAL COMPONENT 17,940.00 36459660 LAP/PERMAFIX TACKER 0113120 632.30 36459699 SUTURE ANCHOR Q-FIX 2.8MM 2528 1,337.50 36459705 SECURE STRAP TACKER 1,514.50

36459815 THA/DISTAL CENTRALIZER 575.20 36459820 SYNERGY HIP STEM ASST 11,193.30 36459824 THA/R3 XLPE 20 DEG 71335752 2,220.80 36459825 THA/OX TRP FEM HD 71343608 3,582.90 36459827 THA/OX FEM HEAD 36MM 71343603 8,575.00 36459829 THA/R3 SHELL 58MM 71335558 2,869.20 36459831 THA/R3 XLPE 20 DEG 71335758 3,151.60 36459833 THA/SYN FEM STEM 71306616 9,005.10 36459841 THA/R3 LINER 32 ID X 50 OD 1,842.20 36459842 THA/R3 LINER 20 DEG 7133868 8,680.00 36459843 THA/MOD HEAD SLEEVE 71344245 640.20 36459846 THA/SYN POR FEM COMP 71306610 22,581.60 36459847 THA/BIOLOX FEM HEAD 7653916 9,254.10 36459848 THA/MOD HEAD SLEEVE 71344249 837.10 36459849 THA/R3 0 DEG ACE LINER 713386 8,080.60 36459855 THA/3 HOLE SHELL 71335564 8,348.00 36459856 THA/DISTAL CENT POST 11MM 556.40 36459969 SCREW/STD 4.6 X 16MM 1,483.30 36500001 PHS I LEVEL I 0-30 MIN 679.10 36500002 PHS I LEVEL I EA MIN > 30 7.20 36500003 PHS I LEVEL II 0-30 MIN 1,188.10 36500004 PHS 1 LEVEL II EA MIN > 30 10.70 36500005 PHS I LEVEL III 0-30 MIN 1,765.30 36500006 PHS I LEVEL III EA MIN > 30 14.00 36500619 DISP OXISENSOR 168.50 37000001 CHARGE LABOR BEFORE C-SECT 1,016.10 37000002 CESAREAN SECTION 9,198.70 37000003 BIRTHING SERVICE 3,544.60 37000010 DELIVERY ROOM 3,434.50 37000050 SCALP ELECTRODE 57.70 37000051 MITYVAC 282.60 37000055 VACUUM PROCUP FETAL ASSIST 207.90 37000057 KIWI OMNICUP 207.90 37000059 RETRACTOR TRAXI PANNICULUS 245.50 37000065 NST - FETAL MONITOR 1,088.40 37000090 OB ULTRASOUND - CONSULT 1,071.40 37000200 IUPC 302.90 37059412 EXTERNAL VERSION 3,238.60 37099465 DEL/BRTH RM NEWBORN RESUSCITAT 745.50 37500010 ADAPTER VENTED SPIKE 18.30 37500030 AMNIHOOK 33.90 37500040 ASPIRATOR MECONIUM 55.40 37500050 BAG CLOSED U A 67.50 37500060 BAG LEG U A 55.40 37500082 KIT PARACENTESIS DISP 228.30 37500098 CATH CLOSED SUCTION 186.80 37500100 BAG MALE UA 31.00 37500101 ULTRASET DRAIN BAG 5C4366P 75.10 37500180 BELT LUMBO SACREL SMALL 241.90

37500181 BELT LUMBO SACREL MED 241.90 37500182 BELT LUMBO SACRL LG 241.90 37500183 BELT LUMBO SACRL - XLG 241.90 37500187 BELT RIB UNIVERSAL 95.20 37500190 BELT COLOSTOMY 73.70 37500199 BINDER ABDOMINAL MED 226.60 37500201 BINDER ABDOMINAL SMALL 226.60 37500202 BINDER ABDOMINAL LG 226.60 37500220 BNDG KLING 1 INCH 9.50 37500225 BNDG KLING 2 INCH 9.50 37500230 BNDG KLING 3 INCH 9.50 37500235 BNDG KLING 4 INCH 9.50 37500265 BNDG ACE WRAP 2IN 33.90 37500270 BNDG ACE WRAP 3 IN 33.90 37500275 BNDG ACE WRAP 4IN 33.90 37500280 BNDG ACE WRAP 6IN 33.90 37500287 BRIEF PRO MEDIUM 70.70 37500288 BRIEF PRO LG 80.00 37500289 BOOT WAFFLE 406.90 37500292 BOTTLE THORA KLEX 535.10 37500294 BOTTLE EVACUATED 82.90 37500295 BOTTLE VACUUM W/DRAIN LINE 296.50 37500298 CANN INNER XLT DISP 6.0MM/BOX 177.90 37500299 CANNULA INNER 4 61.40 37500301 CANNULA LEVER LOK 9.50 37500302 CANNULA MICROSTREAM CAPNOLINE 99.00 37500310 CANISTERS W/GEL 755.20 37500318 DRESSING/MEPILEX 4X8 38.20 37500319 DRESSING/XTRASORB 4X5 19110895 22.30 37500321 DRESSING/XTRASORB 6X9 89569 35.40 37500322 SHOE POST OP MEN SM 76.20 37500323 SHOE POST OP MEN MED 76.20 37500324 SHOE POST OP MEN LG 76.20 37500325 SHOE POST OP WOMEN SM 76.20 37500326 SHOE POST OP WOMEN MED 76.20 37500327 SHOE POST OP WOMEN LG 76.20 37500333 SHOE POST OP MENS XLG 76.20 37500379 CATH COUDE 18 FR 5CC 2W 135.00 37500385 CATH DE LEE 49.40 37500387 CATH EXTERNAL LG 27.80 37500388 CATH EXTERNAL SM 27.80 37500391 CATH EXTERNAL MEDIUM 40.20 37500395 FAST CATH 6 FR 300.10 37500396 CATH VIP AMC THROMBOSHIELD 446.20 37500397 CATH DIAL 3 LUMEN CRV 5615150 634.00 37500398 CATH DIAL 3 LUMEN CRV 5615240 634.00 37500399 CATH DIALYS 3 LUMEN ST 5605150 1,141.70 37500400 CATH DIALYS 3 LUMEN ST 5605240 1,082.50 37500417 CATH IV PLACEMENT 24 GA 28.10

37500418 CATH IV PLACEMENT 16 GA 28.10 37500419 CATH IV PLACEMENT 14 GA 28.10 37500420 CATH IV PLACEMENT 18 GA 28.10 37500421 CATH IV PLACEMENT 20 28.10 37500422 CATH IV PLACEMENT 22 28.10 37500423 CATH ROBNEL 12 FR 9.50 37500427 CATH PLUG 27.80 37500429 CATH RADIAL ARTERY 98.30 37500430 CATH ROBNEL #14 9.50 37500440 CATH SIMPLASTIC FOLEY 39.80 37500449 CATH TROCAR 28 FR 238.90 37500450 CATH TROCAR 32 FR 238.90 37500454 CATH TROCAR 20 FR 238.90 37500456 CATH TROCAR 16 FR 238.90 37500483 CATH THORACIC ST 40FR 76.70 37500484 CATH THORACIC ST 36FR 76.70 37500486 CATH/PACING FLOW 485.30 37500504 BNDG CLOS STERI STRIP 1/8 15.60 37500505 CASSETTE ULTA VERALINK 548.10 37500506 KIT DRESSING ULTA VERAFLO 1,315.50 37500512 DISP CERVICLE COLLAR SMALL 168.50 37500513 DISP CERVICLE COLLAR MED 168.50 37500514 DISP CERVICLE COLLAR LG 168.50 37500516 ARMBOARD ADULT BENDABLE 104.60 37500517 COLLECTION BLOOD ASSEMBLY 12.70 37500535 CONNECTOR Y - LG 14.20 37500540 CONNECTOR 5 IN 1 21.80 37500555 CONTROLLER DIALA FLO 86.00 37500570 COVER BILI EYE - NB 76.70 37500571 MASK BILI SM 20.20 37500582 CUFF ADULT SZ DISP BULB/METER 201.30 37500583 CUFF CHILD SZ DISP BULB/METER 172.80 37500585 CULTURETTE 9.50 37500608 DISP PILLOW ABDUCTN 367.10 37500615 DISP PANTY MATERNITY 61.40 37500617 ALOE SKIN BARRIER WIPES 86.00 37500619 DISP OXISENSOR 168.50 37500621 BLANKET WARMING FULL BODY 57.00 37500641 DRSNG ADAPTIC 3 X 3 9.50 37500643 DRESSING ADAPTIC 3X8 6.20 37500646 DRSNG DUODERM THIN/EA 64.50 37500650 DRSNG KALTOSTAT 80.00 37500655 DRSNG OP-SITE LG 27.80 37500660 DRSNG OP-SITE SMALL 26.70 37500661 DRSNG AQUACEL 4X4 129.40 37500663 DRESSING MEPILEX W/BORDER 72.80 37500664 DRESSING MEPILEX SACRUM 56.50 37500680 DRSNG PETROL 3 X 9 12.70 37500685 DRSNG PETROL 1/2X72 24.80

37500695 DRSNG VENI GARD 12.70 37500698 DRSNG POLYMEN 4X4 67.60 37500700 DRSNG XERO 5 X 9 24.80 37500705 DRSNG WOUND MED 732.30 37500709 ELECTRODE PEDIATRIC MULTI FUN 397.80 37500710 ELECTRODE PACING - ZOL 385.80 37500711 SET EMULSION FAT ADM 31.00 37500712 TUBE TRACH NONFEN #4 419.00 37500714 TUBE ENDO FEN #4 397.80 37500715 TUBE ENDO FEN #6 397.80 37500720 KIT ENEMA 18.80 37500743 EXT SET T-PORT 24.80 37500745 EXTRACTOR-SKIN STAPL 21.80 37500790 FILTER URINE 24.80 37500795 GAUZE FINE MESH 3X8 31.00 37500799 GEL SILVA SORB 244.90 37500800 ARROW SPRING WIRE GUIDE 253.30 37500801 HOSE THIGH XLG REG 91.50 37500802 HOSE THIGH XLG LONG 91.50 37500803 HOSE THIGH XXLG REG 91.50 37500804 HOSE THIGH XXL LONG 91.50 37500819 HEP LOK INF SITE 21.80 37500820 HOSE KNEE SMALL-REGULAR 61.40 37500821 HOSE KNEE LG LONG 61.40 37500822 HOSE KNEE LG REG 61.40 37500823 HOSE KNEE MED REG 61.40 37500824 HOSE THIGH LG REG 86.00 37500825 HOSE THIGH SMALL-SHORT 86.00 37500826 HOSE THIGH LG LONG 86.00 37500827 HOSE THIGH LG SHORT 86.00 37500828 HOSE THIGH MED LONG 86.00 37500829 HOSE THIGH MED REG 86.00 37500830 IMMOB KNEE LARGE 241.90 37500831 IMMOB KNEE MED 241.90 37500832 IMMOB KNEE SM 241.90 37500833 IMMOB KNEE XLG 241.90 37500834 IMMOB KNEE XXLG 241.90 37500835 IMMOB SHOULDER 125.70 37500836 HOSE THIGH MED SHORT 86.00 37500838 HOSE THIGH SM REG 86.00 37500840 HOSE KNEE XLG REG 61.40 37500841 IMMOB SHOULDER XLG 119.70 37500842 IMMOB SHOULDER LG 119.70 37500843 IMMOB SHOULDER MED 119.70 37500845 IMMOB SHOULDER XXLG 95.60 37500850 IRRIG 250 H2O 15.60 37500852 IRRIG 500 H2O 15.60 37500855 IRRIG WATER BTL 1000 15.60 37500870 IRRIG VAG UNIT 18.80

37500876 IRRIG VISI FLOW 257.00 37500877 IRRIG 250CC SAL 15.60 37500878 IRRIG 500CC SAL 15.60 37500879 IRRIG 1000CC SAL 15.60 37500885 DRSNG KERLIX FLUFF-6 PKG 12.70 37500890 DRSNG KERLIX ST ROLL 27.20 37500895 BRACE KNEE TELESCOPING COOL 636.30 37500896 BRACE KNEE POP LONG COOL 636.30 37500901 INTERDRY SWEEN TEXTILE W/SIL 217.80 37500905 KIT IV CATH CARE 24.80 37500906 KIT FEMALE CATH 33.90 37500910 KIT MATERNITY 131.80 37500911 KIT PERICARDIO 6FR STRGHT 633.20 37500913 KIT MIDSTREAM URINE 21.80 37500914 KIT MINI-CATH PEDS 31.00 37500920 KIT SUCTION CATH 12.80 37500921 TRAY POWER PICC SINGLE 4 FR 611.40 37500922 TRAY POWER PICC DOUBLE 5 FR 636.60 37500923 TRAY POWER PICC TRIPLE HF 5FR 732.70 37500924 NEEDLE GUIDE FOR PICC LINE 136.20 37500925 KIT SUTURE REMOVAL 31.00 37500926 KIT PNEUMOTHORAX 498.10 37500927 KIT CENTRL VEN CATH PERC 8.5FR 365.60 37500929 KIT CVC 7FR 3 LUMEN 400.70 37500931 KIT CATH ART LINE 18GA 04018 175.30 37500932 KIT EZ MICROINTRODUCER 5 FR 227.50 37500939 LINER SUCTION 31.00 37500947 BNDG HIGH COMPRESSION 127.50 37500957 MASK INF FACE LG 61.40 37500959 MASK INF FACE DISP 61.40 37500967 NEEDLE SPINAL 20 X 3 1/2 27.80 37500968 NEEDLE SPINAL 22 X 1 1/2 27.80 37500969 NEEDLE SPINAL 18 X 3 1/2 27.80 37500972 CONDITIONER /SKIN ALO VESTA 18.20 37500980 NEEDLE SPINAL 22 GA 3 1/2 27.80 37500985 OINTMENT ANTIFUNGAL 78.20 37500995 PACK HEAVY DRNG 40.90 37501005 PACK O.B. GYN 110.40 37501025 PAD CUSHION/AIR 235.90 37501032 PADS INCONTINENCE 49.40 37501035 PAD O.B.-PACKAGE 46.30 37501036 PADS HEEL EPIFLEX SM 113.50 37501037 PADS HEEL EPIFLEX - MED 113.50 37501038 PADS HEEL EPIFLEX - LG 113.50 37501039 PADS HEEL EPIFLEX - X LG 113.50 37501042 PADS MONITOR BED 303.00 37501074 PAD TEMP-LARGE 229.50 37501075 PAD TEMP -SM 89.10 37501076 HOVER MAT SINGLE USE DISP 300.10

37501101 POWDER STOMAHESIVE 95.20 37501110 OXISENS0R ADULT RD MASIMO 40.90 37501111 OXISENSOR NEONATAL RD MASIMO 52.50 37501136 PUMP SUPPLY KIT 297.00 37501137 STATLOCK IV MACRO SMARTSITE 59.40 37501160 RESTRAINT WRIST & ARM 49.40 37501165 SENSOR QUATRO 210.50 37501167 SET CO II 177.60 37501170 RING INVALID RUBBER 31.00 37501172 SET BASIC TUBING 2C6401 21.80 37501173 SET KANGAROO 46.30 37501176 SET MINI-VOL EXT 60 58.60 37501183 SET INLINE SUCTION 174.80 37501187 SET 3 LEAD EXT 24.80 37501188 CATH SET ARTERIAL/VEN 16ga 6 152.70 37501189 CATH SET ART/VEN 18ga 4 1/2 139.00 37501192 SHELLS BREAST 76.70 37501193 INTO SHEATH PERCUTANEOUS 5FR 324.60 37501200 SHIELD EYE METAL 12.70 37501202 SLING DISP LIFT X-LG 430.30 37501218 SLING ENVELOPE ARM SMALL 37.00 37501237 SOLUTION D5&2%NS 52.60 37501240 SPONGE 10ST X-RAY 4X4 12.70 37501249 DRESS/SURGICAL TAPE 4 92.70 37501265 SPLINT LG ADULT CLAV 193.10 37501270 SPLINT MED ADUL CLAV 193.10 37501285 SPLINT YOUTH CLAV 193.10 37501287 SPLINT FOOT DROP 255.20 37501305 SPONGE 4X4 STERILE PKG 17.90 37501323 DISP STETHOSCOPE 67.60 37501324 PICC PLUS TRICOT 40.70 37501365 3-WAY STOPCOCK 12.70 37501366 STOPCOCK 3 WAY LARGE BORE 20.80 37501367 STOPCOCK 4WAY LARGE W/LUER 12.40 37501368 SET EXT STD BORE 8 3584470124 11.40 37501370 STRAP CATH 52.60 37501380 STRP PK BTL PL 1/4IN 49.40 37501381 STRP PK BTL PL 1/2IN 49.40 37501385 STRP PK BTL IODO 1/4 49.40 37501386 STRP PK BTL IODO 1/2 49.40 37501387 STRP PK BTL IODO 1IN 49.40 37501388 STRP PK BTL IODO 2IN 49.40 37501402 STYLE SATIN SLIP 64.50 37501410 FLO TRAC DEVICE MHD8 958.10 37501414 CATH FOLEY 20FR 2W 5CC SILAS 36.00 37501417 SUPPORT HAND/WRIST 76.70 37501450 SUSPENSORY LG 110.40 37501451 SUSPENSORY XLG 110.40 37501475 SYRINGE EAR 2 OZ 70.70

37501540 TOWEL STERILE 31.00 37501543 HOLDER TUBE FEEDING 51.80 37501545 HOLDER TRACHES TUBE DALE 42.80 37501546 HOLDER TUBE END TRACHEAL 117.70 37501547 TRACTION BOOT 195.90 37501561 TRANSDUCER MONITOR 235.90 37501600 TRAY CATH 15FR 31.00 37501609 TRAY CHEST TUBE DISP 480.40 37501630 TRAY IRRIGATION 21.80 37501633 TRAY LACERATION DIPS 140.80 37501635 TRAY LUMBAR PUNCTURE 128.70 37501652 TRAY PUDENDAL BLOCK 159.30 37501668 TRAY THORA DISPOS 218.70 37501670 KIT TRACHEOTOMY TRAY 46.30 37501690 TRAY URIMETER W/CATH 171.60 37501695 TRAY MINOR 177.30 37501710 TUBE ASPIRATING 86.00 37501711 TUBE BLKMOR 20F NASAL GASTR 1,131.60 37501713 TUBE CORPAK FEEDING 190.10 37501745 TUBE INF FEED 8FR 42 18.80 37501750 TUBE LEVINE 12 FR 18.80 37501760 TUBE RECTAL 21.80 37501795 TUBE YANKUER 15.60 37501805 TUBE CONNECTING 12.70 37501807 TUBE CATH UA EXT 37.00 37501825 TUBE IV EXTENSION 21.80 37501829 TUBE LECTRO SPIRAL 60 80.00 37501831 TUBE LECTRO SPIRAL 70 80.00 37501832 TUBE NITRO SET 82.90 37501834 TUBE PCA 67.60 37501835 TUBE PENROSE 9.50 37501836 TUBING HYPERAL BRAUN 51.00 37501838 TUBING NITRO/FAT EMULSION BRAU 74.00 37501839 TUBING BLOOD/Y TYPE BRAUN 74.30 37501840 TUBING CONT FLO/BASIC 43.40 37501841 TUBING ADD A LINE BRAUN 19.00 37501843 TUBING FLASHBALL B BRAUN 19.50 37501846 TUBING BURETROL 375122 76.00 37501847 TUBING BLOOD GRAVITY NF5145 43.40 37501848 TUBING MINIDRIP GRAVITY NF1290 30.20 37501849 TUBING SOL ADM SET GRAVITY NF1 30.20 37501850 FILTER MICRON 0.2 473036 29.70 37501860 URIMETER DOVER 80.00 37501869 VALVE LOPEZ 33.30 37501872 VALVE ANTI REFLUX 67.60 37501874 CAP VALVE PLEURX DRAINAGE 50.40 37501875 VALVE PASSY MUIR PURPLE 703200 300.00 37501977 DRSNG /SORBA VIEW ULTIMATE 45.20 37501978 DISP ANCHOR DEVICE 73.00

37502001 BAG SUCT DRN TRU/CLOSE 001590 265.90 37502005 AIRWAY ORAL 100MM 12.70 37502006 AIRWAY ORAL 90 MM 12.70 37502007 AIRWAY ORAL BERMAN 80 MM 17.80 37502080 SLEEVE THIGH LG 012080 335.50 37502098 2-WAY FOLEY 22 FR 5 CC 82.90 37502099 2-WAY FOLEY 12 FR 5 CC 86.00 37502100 2-WAY FOLEY 14 FR 5 CC 86.00 37502101 2-WAY FOLEY 16 FR 5 CC 86.00 37502102 2-WAY FOLEY 18 FR 5 CC 86.00 37502103 2-WAY FOLEY 20 FR 5 CC 86.00 37502106 2-WAY FOLEY 18 FR 30 CC 86.00 37502107 2-WAY FOLEY 20 FR 30 CC 86.00 37502108 2-WAY FOLEY 22 FR 30 CC 86.00 37502109 2-WAY FOLEY 24 FR 30 CC 86.00 37502110 2-WAY FOLEY 26 FR 30 CC 73.10 37502111 2-WAY FOLEY 28 FR 30 CC 82.90 37502112 3-WAY FOLEY 24 FR 30 CC 82.90 37502113 3-WAY FOLEY 26 FR 30 CC 137.80 37502114 2-WAY FOLEY 16FR 30CC 82.90 37502115 3-WAY FOLEY 20 FR 30 CC 86.00 37502116 DRSNG 3 COBAN 49.40 37502117 CATH FLOLEY 16FR 3-WAY 30CC 81.30 37502122 CATH ROBNEL 8 FR 9.50 37502124 CATH ROBNEL 16 FR 9.50 37502128 CATH SUCTION 10 FR 9.50 37502130 CATH SUCTION #18 12.70 37502133 CATH UMB ART 5.0 FR 116.60 37502201 ROM WALKER SM 151.10 37502202 ROM WALKER LG 153.20 37502203 ROM WALKER MED 151.10 37502264 TUBE TRACH XLT #8 SINGLE 492.70 37502265 TUBE TRACH XLT #6 SINGLE 492.70 37502319 NEEDLE INFUSION 23 GA 12.70 37502379 PLUG DECONULAZATION DISP DCP 60.10 37502423 BNDG 1/2 INCH STERISTRIP 21.80 37502424 BNDG 1/4 INCH STERISTRIP 21.80 37502444 SYRGE 60 CC CATH TIP 9.50 37502445 STRGE 60 CC LUER LOK 9.50 37502476 TRAY BLADDER 16 FR 82.90 37502477 TRAY BLADDER 18 FR 82.90 37502485 TRAY INF LUMBAR PUNC 135.00 37502494 TUBE ENDO UNCUFFED 4.0 37.00 37502504 TUBE INF FEED 5 X 36 18.80 37502505 TUBE INF FEED 8 X 16 18.80 37502506 TUBE INF FEED 10 X 15 18.80 37502510 TUBE SALEM SUMP 16 FR 74.30 37502511 TUBE SALEM SUMP 18 FR 74.30 37502975 TUBE TRACH NONFN UNCFD #6 324.60

37503000 ADAPTER UNIVERSAL TUBING 139.80 37503005 KIT DRESSING ASPIRA 131.90 37503630 CATH SUPERPUBIC SUPRAFLEX 1707 267.40 37503906 DRSNG ISLAND 24.80 37504000 ELECTRODE ZOLL 1 STEP ADULT 249.80 37504001 ELECTRODE ZOLL 1 STEP PEDS 238.90 37504005 BARRIER FLEX SENSURA 144.00 37504006 POUCH FLEX DRAIN SENSURA 181.00 37504007 POUCH UROSTOMY 2314 SOFT TOUCH 178.00 37504087 TUBE TRACH NONFEN UNCUF 4.0 DC 309.80 37504101 SLEEVE KNEE LNGTH SCD 512.30 37504142 SLING ARM PEDIATRIC 40.80 37504143 SLING ARM CHILD 40.80 37504144 SLING ARM EXTRA LARGE 111.30 37504215 PROBE PULSE OX PED 10-50 KG 117.30 37504216 PROBE PULSE OX INF 3-20 KG 152.70 37504217 PULSE OX HEAD PROBE OXIMAX 300.10 37504218 FOLEY CATH PROBE TEMP 16FR 116.50 37504219 VEST SM/MED HYPO DISP DVH530 282.90 37504220 VEST LG HYPO DISP DHV535 192.90 37504221 WRAP LEG HYPO DISP DHX540 188.70 37504222 TEMP PROB ESOPH/RECTAL DISP 40.90 37504593 DRSNG MOLDABLE FLANGE 1 3/4 58.40 37504595 POUCH SENSURA 1 PC POST OP 283.20 37504596 POUCH CUT TO FIT SENSURA 42.00 37504597 RING SEAL PROTECTIVE BRAVA 37.00 37504598 POUCH DRAIN 1 PC CUT TO FIT 4.65 37505000 POUCH CUT TO FIT COLOPLAST 29.00 37505001 POUCH DRAIN 23/4 HOLLISTER 37.50 37505011 DRSNG DURELAST 10CM X 5CM 119.80 37505306 CBI BAG 3000 CC NACL 80.00 37505353 TRAY UROLOGIST DISP 813.90 37505354 TRAY THORACIC VENT PROC 13FR 842.00 37505358 TRAY CATH DIALYSIS TEMP-ST 447.40 37505380 SET CYSTRO IRRIG 33.90 37505400 HOSE TED KNEE XXL REG 7470LF 34.30 37505401 HOSE KNEE TED XXXL LONG 7473LF 34.30 37505402 SLEEVE KNEE XL SCD 9790 194.90 37505403 RING EAKIN 4 216.00 37505404 STRIPS BARRIER COLOPLASTPLAST 115.00 37505405 POUCH CUT TO FIT DBL LAYER 178.00 37505406 BARRIER FILM NO STING CAVILON 255.00 37505851 SET Y-TYPE IRRIG 55.40 37505852 Y-TYPE T.U.R. 55.40 37506440 BMS MANAGEMENT SYSTEM 1,871.10 37506501 DRSNG EAKIN SEAL 2 /BOX 343.00 37506502 RING EAKIN 2 44.00 37507891 CANNULA INNER # 8 XLT 367.80 37508005 ADAPTER ACCUSEAL 27.80

37508055 BARRIER SKIN 4X4 58.60 37508057 BARRIER MOISTURE OINT CRIT-AID 57.90 37508100 CLOSURE TAIL 31.00 37508106 COLLECT BAG MGMT SYS/DIGNICARE 43.60 37508110 BAG DRAINAGE ASPRIA 4982301 199.70 37508201 FLANGE FLEXIBLE 1314IN 43.10 37508202 FLANGE ACCORDIAN 2314 43.10 37508203 FLANGE SURFIT 4 80.00 37508400 PASTE STOMAHESIVE 95.20 37508409 POUCH CLOSED END 6504-22 41.10 37508415 POUCH UROSTOMY 2314 55.40 37508416 POUCH UROSTOMY 1314 55.40 37508417 POUCH CUSTOM CUT 58.60 37508420 POUCH DRAINABLE 4 43.10 37508423 POUCH DRAIN W/FILTER 2 3/4 17.20 37508424 POUCH DRAIN W/FILTER 1 3/4 17.20 37508602 SLEEVE IRRIG 1 3/4 47.10 37514000 TUBE ENDO 2.5 W/CUF 37.00 37514017 2-WAY FOLEY 10 FR 3CC 101.10 37514022 CATH ROBNEL 10 FR 9.50 37514026 CATH TROCAR 24 FR 238.90 37514050 NEEDLE INFUSION 25 GA X 3-1/2 8.80 37514062 CANNULA INNER #8 61.40 37514063 CANNULA INNER #6 61.40 37514074 SLING ARM LARGE 111.30 37514078 SLING ARM MEDIUM 111.30 37514090 TUBE ENDO W/CUFF 3.0 31.00 37514091 TUBE INF FEED 5 X 16 18.80 37514125 TUBE ENDO NONFEN #6 419.00 37514178 CATH SUCTION 6 FR 15.60 37514183 NEEDLE HUBER 22 GA 3/4 101.10 37514218 NEEDLE HUBER 19 GA 1 IN 101.10 37514219 NEEDLE HUBER 20 GA 1 101.10 37514220 NEEDLE HUBER 22 GA 1 101.10 37514221 NEEDLE HUBER 19 GA 3/4 101.10 37514224 NEEDLE HUBER 19 GA 1 1/2 101.10 37514243 CATH SUCTION 8 FR 18.80 37514265 2-WAY FOLEY 30FR 30CC 86.00 37514267 2-WAY FOLEY 8 FR 3 CC 86.00 37514335 FIXATIVE FOR O & P 37.00 37515000 CATH TWIN 104.40 37515020 SOL PERI DIALYSIS 2.5 2000ML 216.80 37515030 SOL PERI DIALYSIS 4.25 2000ML 219.70 37515040 SOL PER DIALYSIS 1.5 2000ML 194.20 37515050 SOL MINI CAP PROVIDNE 62.30 37515053 CATH COUDE 14FR 5CC 2W 135.00 37515055 CATH COUDE 16FR 5CC 2W 135.00 37515061 ULTRACLAMP 5C4957 DIALYSIS 52.00 37515070 SET MINI CAP TRAN W/CLAMP 398.80

37515080 TUBING AUTO PD CASS RSC4479C 187.20 37515081 BAG DRAIN 15 LITER SC4145P 76.00 37515082 EXT STERILE DRAIN 12FT SC4464P 42.90 37515083 FLEXICAPS FOR DIALYSIS SC4456 28.10 37515084 SOL LOW CAL DIALYSIS 1.5 B9770 257.50 37515085 SOL LOW CAL DIALYSIS 2.5 B9771 263.10 37515086 SOL LOW CAL DIALYSIS 4.2 B9772 270.30 37516000 KIT CATH CENT VEN 7FR 462.00 37517350 NEEDLE SPINAL 22X1 1/2 DR.C. 27.80 37800002 BANDAGE PLASTER 2 SPECIAL 13.00 37800003 BANDAGE PLASTER 3 SPECIAL 14.60 37800004 BANDAGE PLASTER 4 SPECIAL 17.90 37800005 BANDAGE PLASTER 5 SPECIAL 24.80 37800007 ORTHOGLASS 3 IN 71.70 37800008 ORTHOGLASS 4 IN 87.80 37800009 ORTHOGLASS 5 IN 100.20 37800011 ORTHOGLASS 2 IN 182.20 37800016 IO NEEDLE PEDS/ADULT 562.50 37800055 LENS MORGAN 279.10 37800425 DISP OXISENSOR ADULT 150.50 37800441 DISP C COLLAR STIFFNECK ADULT 123.50 37800442 DISP C-COLLAR STIFFNECK PED 95.40 37800490 MULTI LUMEN IV CATH 700.40 37800500 ANKLE / WRIST SPLINT 198.10 37800730 SPLINT CRUSHED FINGER 36.10 37800740 SPLINT ALUMINUM 49.20 37800760 STOCKINETTE / BATTING / GUAZE 19.90 37800780 SHOE POST OP 87.80 37800855 OXYCEL NASAL PLEDGET 80.60 37800861 RAPID RHINO PACK 356.70 37800910 POPE EARWICK 36.10 37801001 ER PROCEDURE I 423.60 37801002 ER PROCEDURE II 849.90 37801003 ER PROCEDURE III 1,702.80 37801004 ER PROCEDURE IV 2,555.70 37801005 IMMUNIZATION ADMINISTRATION 134.40 37801006 IMMUNIZATION ADMIN EA ADD'L 134.40 37801007 FLU ADMINISTRATION INJ IM 80.70 37801026 THROMBOLYSIS 637.00 37801027 CARDIOVERSION ER 2,108.70 37801028 CARDIOPULMONARY RESUSCITATION 1,346.30 37801030 ER LEVEL 1 269.50 37801031 ER LEVEL 2 607.50 37801032 ER LEVEL 3 944.10 37801033 ER LEVEL 4 1,472.80 37801034 ER LEVEL 5 2,233.80 37801035 ER LEVEL 6 30-74 MIN 3,025.30 37801135 ER LEVEL 6 EA ADD'L 30 MIN 1,512.40 37801235 TRAUMA ACTIVATION LEVEL 1 2,245.40

37802000 LEAD TELE 6 KENDALL DISPOSABLE 131.20 37804021 PULSE OX SINGLE 137.60 37804022 PULSE OX MULTIPLE 332.10 37805025 FECAL OCCULT BLOOD TEST 71.90 37806430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 37816430 BLOOD ADMINISTRATION >4 UNITS 1,709.90 37851798 US BLADDER SCAN POST VOID 378.20 37896360 IV HYDRATION INITIAL 31-60 MIN 484.50 37896361 IV HYDRATION EA ADTNL HR 297.50 37896365 IV DRUG INFUSION 1ST HR 604.90 37896366 IV DRUG INFUS EA ADTNL HR 239.70 37896367 IV INFUSION SEQUENTIAL 1ST HR 327.30 37896368 IV INFUSION CONCURRENT 307.50 37896371 SUB Q HYDRATION ADDTNL SITE 154.60 37896372 DRUG INJ SUB/IM - ER 229.00 37896374 IV PUSH 233.20 37896375 IV PUSH DIFFERENT DRUG 257.80 37896376 IVP-IV PUSH SEQ SAME DRUG >31M 165.50 37899152 CON/MOD SED > 5 YR 1ST 15 MIN 939.50 37981001 PRO ED PROCEDURE I 434.50 37981002 PRO ED PROCEDURE II 868.80 37981003 PRO ED PROCEDURE III 1,737.30 37981004 PRO ED PROCEDURE IV 2,605.70 37990500 EXAM CLASS I / MINIMAL 229.50 37990505 EXAM CLASS II / BRIEF 440.00 37990510 EXAM CLASS III 664.60 37990515 EXAM CLASS IV 965.90 37990517 EXAM CLASS V 1,223.20 37991005 CARDIOPULMONARY RESUSCITATION 1,358.00 37999291 CRITICAL CARE 1ST HOUR 1,432.70 37999292 CRITICAL CARE ADDN'L 30 MIN 554.00 38000016 EMESIS BAG 19.70 38000041 TRAY MINOR DRESSING 79.30 38000280 ACE WRAP 6 43.70 38000320 BLS AMB NON EMERGENCY 1,001.70 38000322 BLS AMB EMERGENCY 1,164.50 38000326 AMB ALS NON EMERGENCY 1,379.40 38000330 AMB ALS1 EMERGENCY 1,625.40 38000331 AMB ALS2 EMERGENCY 2,364.50 38000380 AMB BLS LOADED MILE 25.60 38000390 AMB ALS LOADED MILE 25.60 38000420 18 GAUGE IV ANGIOCATH 33.00 38000427 ALS1 SPLIT TRIP EMERG 1,625.40 38000429 BLS SPLIT TRIP EMERG 1,082.80 38000473 NEEDLE HUBER 98.40 38000474 EZ-IO NEEDLE ADULT/PEDS 547.60 38000878 NS IRRIGATION SOLUTION 500CC 24.70 38000881 MAXIMIST 155.10 38000890 KERLEX 26.40

38000905 IV START KIT 30.10 38000910 SET EXT STANDART BORE 8 35844 11.30 38000935 QUICKCOMBO PATCHES A/P 335.10 38000995 PACK HEAVY DRAINAGE 39.80 38001015 ABD PAD 10.70 38001115 ORAL/NASALPHARYNGEAL AIRWAY 6.30 38001120 DISP CERVICAL COLLAR 164.00 38001160 RESTRAINTS SOFT 48.10 38001305 SPONGE 4X4 STERILE PKG 17.40 38001310 BLADE MAC #4 DISP 350013000 86.20 38001415 SUCTION 141.50 38001760 ENDOTRACHEAL TUBE HOLDERS 58.40 38002499 ENDO TUBE 7.0 FR 36.00 38005115 IV LINE MACRO 46.50 38005240 IV LINE BLOOD 80.70 38005600 IV LINE MINIDRIP 46.50 38014078 SLING ARM MEDIUM 108.30 38014079 SAM SPLINT 111.40 38014080 AUTOPULSE LIFEBANDS 348.00 38014081 KING AIRWAY 196.00 38014082 BURETROL TUBING 45.80 38014085 DISP FIBEROPT LARYNG BLADE 44.00 38014086 STABILIZER EZ-IO 37.20 38014088 STAT LOCKS 38.90 38014094 CIRCUIT SINGLE LIMB ADULT/PED 58.20 38014096 HARNESS MARK UNIVERSAL 72.10 38014098 MASK CPAP #5 REGULAR ADULT 47.40 38014099 MASK CPAP #6 LARGE ADULT 47.40 38014100 FILTER EFFICIENT FILTA GUARD 28.00 38014101 HOVER MAT SNGL USE DISP 300.10 38300001 EGD 2,528.90 38300009 COLONSCOPY INCOMPLETE 1,994.50 38300010 COLONOSCOPY 3,079.30 38300011 ENDOSCOPY SECONDARY PROCEDURE 720.50 38300012 BRAVO PH G-ESOPH REFLX TEST 3,502.80 38300015 ENDOSCOPY CAPSULE 3,477.50 38300020 BRONCHOSCOPY 2,610.60 38300034 HALO ABLATION 6,883.40 38300039 PROBE/ERBE ASSORTED SIZES 991.40 38300050 ERCP DIAGNOSTIC 3,673.70 38300056 SNARE ENDOCHOICE 30MM DSO010 65.90 38300090 PROCEDURE TIME UP TO 60 MIN 2,522.50 38300094 PROCEDURE TIME 90 MIN 3,760.30 38300101 CANNULA/R.E. BALL TIP 436.90 38300104 R.E. CYTOLOGY BRUSH 549.70 38300111 CANNULA/R.E. XL 517.90 38300156 NEEDLE/CARR LOCKE INJ 484.80 38300157 ASP NEEDLE/WANG 19 GA MW319 225.50 38300180 PEG TRAY/BARB PONSKEY GAUDERER 712.50

38300215 SNARE/DISPOSABLE 282.60 38300270 FORCEPS/DISPOSABLE BIOPSY 352.80 38300345 COLONIC DECOMPRESSIOIN SET 529.40 38300360 SIGMOIDOSCOPY 2,118.20 38300470 GOLDPROBE HEMOSTASIS CATH 1,075.50 38300580 SPEED BAND KIT 1,247.50 38300650 AIRWAY/WILLIAMS ORAL 46.40 38300740 RESCUE FORCEP RAT TOOTH DGC383 300.10 38300741 RESCUE RAT TOOTH GRASP DGR2775 214.40 38300760 ERCP CONNECTING TUBING 101.00 38300770 BRUSH/CYTOLOGY & WHISTLE CLEAN 148.40 38300775 KIT PEG 20FR PULL 605.20 38300780 KIT GASTROSOTMY 20FR PUSH 537.80 38300832 PARACENTESIS 985.20 38300885 ROTH NET/ FOOD BOLUS 640.00 38300905 OVERTUBE ENDO 25CM 666.70 38301250 TRACER METRO .035 59726254 355.40 38301800 SHORT SHOT BANDER G34063 247.40 38305003 SPOT TUMOR MARKER 255.70 38305300 MIC-KEY G-TUBE KIT 14FR 2 3642 320.20 38305635 STENT/FLEXIMA 11.5 X 5 CM 534.60 38305636 STENT/ASSORTED TYPES AND SIZES 534.60 38306833 REINFLATION DEVICE 484.10 38307340 BALLOON/REPL G TUBE/20 FR 279.20 38307348 BALLOON/REPL G TUBE/18 FR 279.20 38307895 BALLOON/REPL G TUBE/16 FR 336.20 38307896 BALLOON/REPL G TUBE/24 FR 336.20 38310259 PROBE/BEAMER 2.3 ABEAM4 616.00 38310281 BALLOON HERCULES WG HBDW1212 572.50 38310294 BOTTLES EVACUATED 91.20 38310298 JEJUNAL FEEDING TUBE 8.5FR TIP 631.20 38310299 40 CC ARGYLE SPECIMEN TRAP 12.20 38310370 ANOSCOPE DISP W/LIGHT C060100 28.40 38310371 BALLOON EXP RGA 360 64082 5,182.10 38310372 DEVICE COOK SPHERE INFLATION 162.60 38310374 BARRX CHANNEL RFA ENDO CATH 3,472.20 38310375 SPHINCTER DOMETIP 5.5 X .021 535.00 38310379 MIC-KEY G TUBE KIT 20F 2.7CM 284.30 38310380 MIC-KEY G TUBE KIT 20F 3.0CM 284.30 38310381 STENT/EVOL ESOPH COV 18X23X8 4,510.70 38310388 ELEVIEW 243.00 38310389 HEMOSPRAY 10FR 2,930.00 38310390 HEMOSPRAY 7FR 2,930.00 38310420 CATH IV PLACEMENT 18 28.10 38310421 CATH IV PLACEMENT 20 28.10 38310422 CATH IV PLACEMENT 22 28.10 38310541 AUXILIARY WATER PORT CONNECTOR 47.00 38310543 CONNECTOR W/PORT 610U5257 12.20 38310619 DISP OXISENSOR PEDS 141.50

38310743 EXTENSION T-PORT SET 20.90 38310819 HEP LOK INF SITE 17.40 38310885 ROTH NET POLYP USE ONLY 426.20 38310905 KIT IV CATH CARE 20.30 38310980 NEEDLE SPINAL 22 GA 3 1/2 30.70 38311100 MASK 02 SIMPLE ADULT 071000120 4.70 38311111 NEBULIZER AEROECLIPSE II 58645 38.30 38311130 DEVICE/RESOLUTION CLIP 728.50 38311540 TOWEL STERILE 19.20 38311710 TUBE ASPIRATING 86.00 38311795 TUBE YANKUER 15.60 38311805 TUBING CONNECT 10.50 38311807 ENDOGATER PUMP IRRIGATION 121.60 38312445 60 CC LUER LOK SYRGE 9.40 38312500 OMNITOME PRELOADED 260 G34693 984.30 38313011 HALO CAP SMALL 901.70 38313012 HALO GUIDEWIRE 404.00 38315856 FORCEP/RADIAL JAW 4 LG 157.90 38315859 FORCEP MINI BIO WO SPIK G53006 175.00 38318070 SNARE/I 532.10 38318071 TALON GRASPING DEVICE 420.60 38318073 FUSION OMNI TOME G31903 638.40 38318074 FUSION STENT INTRO G31527 317.50 38318076 FUSION 8.5 INTRODUCER G31526 317.50 38318079 FUSION QUATTRO EXTRACT BALLOON 451.00 38318082 FUSION TITAN BILIARY DIL BALLO 685.30 38318083 STENT/BILIARY COTTON-LEUNG 199.50 38318093 BALLOON 3 STAGE 429.40 38318094 BALLOON 3 STAGE WG 572.50 38318095 SYRINGE INFLATION DS 60CCS 148.90 38318096 CATH CENTESIS 5FR 10CM 138.10 38318097 FLUID ADMIN SET NON VENTED 24.70 39600002 EMP RESPIRATOR FIT TEST 65.00 40002004 Chem Profile 8 w/ionized Ca 465.90 40002006 Troponin POC 371.90 40100300 VAC SNAP CARTRIDGE 125MM HG 293.10 40100301 DRESSING SNAP FOAM 15 X 15 199.10 40100302 BETADINE SWAB 9.40 40100303 CALMOSEPTINE OINT PACKET 10.00 40100304 EMLA CREAM 5GM TUBE 58.30 40100305 DOME PASTE 4 X 360 90.10 40100306 GRANULEX/TBC SPRAY 4 OZ 120.00 40100307 IODOFLEX PAD 118.60 40100308 SILVER NITRATE APPL 10.00 40100310 XYLOCAINE 1% 20ML VIAL 26.90 40100311 XYLOCAINNE 1% 10 ML 18.70 40100312 KIT CUTIMED OFF LOAD TCC SELCT 278.60 40100313 DRESSING/HYDROFERA BLUE 4X4 40.00 40100314 DRESS/ ADV WND MIRRAGEN 4X4 209.80

40100315 DRESSING POLYMEM SILVER 29.00 40100317 DRESSING/ULTRASILVER FOAM 4X5 54.25 40108002 APLIGRAF 44 SQ CM 4,703.30 40108003 PICO NEG PRESSURE DRESSING 616.80 40108012 PURAPLY AM 2 X 4 1,932.00 40108013 PURAPLY AM 5 X 5 6,039.00 40108014 NUSHIELD 2x4 1,900.00 40109211 EST PATIENT W/PROC 1-19 MIN 311.60 40109212 EST PATIENT W/PROC 20-34 MIN 371.90 40109213 EST PATIENT W/PROC 35-49 MIN 498.70 40109214 EST PATIENT W/PROC 50-64 MIN 515.70 40109215 EST PATIENT W/PR0C 65-75 MIN 645.70 40110060 I&D ABSCESS SIMPLE 428.70 40111042 DEBRIDE SKIN SUB Q TISSUE 1,060.90 40111043 DEBRIDE SKIN SUB Q TISS/MUSCLE 1,480.50 40111044 DEBRIDE BONE/TISSUE 1ST 20 CM 2,595.20 40111045 DEBRIDE SUB Q TISS EA ADD 2OCM 1,060.90 40111046 DEB SUB Q TISS/MUS EA ADD 20CM 1,480.50 40111055 PARING BENIGN LESION/SINGLE 274.00 40115002 WND PREP CH/INF TRK/ARM/LG 2,511.30 40115271 SSG T/A/L 1ST 25 UP TO 100SQCM 2,995.90 40115272 SSG T/A/L EA ADD'L 25^100 SQCM 253.60 40116020 DRESS/DEBRIDE BURN(S) < 5% 353.80 40117250 CHEMICAL CAUTERIZATION 466.50 40129445 APPL RIGID TOTAL LEG CAST 463.10 40129580 MULTI LAYER COMP DRSG UNNA 356.50 40197597 SEL DEBRIDE W/O ANES 0-20 CM 510.30 40197598 SEL DEBRIDE W/O ANES > 20 CM 655.80 40197602 NON SEL DEBRIDE/SESSION 437.30 40197605 NEG PRESS W/DME TX 0-50 SQ CM 1,060.90 40197606 *NEG PRESS W/DME TX > 50 SQ CM 1,480.50 40197607 NEG PRESS W/DISP 0-50 SQ CM 1,060.90 40199211 EST PATIENT 1-19 MIN 311.60 40199212 EST PATIENT 20-34 MIN 371.90 40199213 EST PATIENT 35-49 MIN 498.70 40199214 EST PATIENT 50-64 MIN 515.70 40199215 EST PATIENT 65-75 MIN 645.70 40200002 ABO Group 145.80 40200010 Acetone (Ketones) 197.70 40200011 Acetone Urine 102.80 40200050 Albumin 129.80 40200051 Albumin Body Fluid 216.20 40200075 Alkaline Phosphatase 184.10 40200095 Ammonia 401.00 40200105 Amylase 247.70 40200110 Antenatal Screen 362.40 40200140 Antibody ID Blood bank 844.80 40200145 Antigen Screen Bld Bank 195.40 40200175 Streptozyme (ASO) Quant 214.30

40200176 Streptozyme (ASO) Qual 97.50 40200220 Bilirubin Direct 140.00 40200230 Bilirubin Total Only 179.30 40200239 Blood Gas Capillary 432.50 40200240 ABG (Arterial Blood Gas) 431.20 40200241 Blood Gas Venous 431.20 40200247 BNP (B Natriuretic Peptide) 413.30 40200248 Blood Gas Cord Blood 431.20 40200270 B12 VITAMIN 256.50 40200285 Calcium Serum 143.30 40200316 Carbon Monoxide (%COHB) venous 306.60 40200334 Cell Count Body Fluid with dif 228.10 40200335 Cell Count Body Fluid (no diff 169.10 40200344 Chemistry Profile 8 (Basic) 290.80 40200346 Metabolic Panel Complete 316.70 40200361 Chloride 24hr Urine 139.00 40200370 Cholesterol Total 158.10 40200371 Cholesterol Pleural Fluid 113.30 40200379 Clo Test 236.40 40200384 Clostridium Diff Toxin 394.00 40200390 Absorption Auto/Allo Bld Bk 608.70 40200395 Cold Agglutinins 137.60 40200400 CBC With Automated Diff 189.30 40200420 Direct Coombs 212.30 40200421 Direct Coombs Cord Blood 212.30 40200425 Antibody Screen 246.70 40200445 CK (Creatine Kinase) 216.30 40200451 CK-MB 363.80 40200453 Creatinine Random Urine 145.40 40200455 Creatinine 149.80 40200456 Creatinine 24 hr Urine 150.70 40200460 Creatinine Clearance 357.40 40200462 CROSSMATCH IMMED SPIN 425.50 40200466 Crossmatch Each Unit 479.80 40200468 CRP (C Reactive Protein) 212.00 40200476 Culture Bronchial 309.30 40200477 Culture Ear 309.30 40200478 Culture Eye 309.30 40200479 Culture Body Fluid 309.30 40200480 Culture Anaerobe 330.20 40200482 Cult Surg Non-Tissue 309.30 40200483 Culture Sputum 309.30 40200484 Culture Genital 309.30 40200486 Culture Wound 309.30 40200494 Culture Pertussis 309.30 40200505 Culture Stool 263.50 40200509 Culture Grp B Vag/Rect 175.00 40200515 Culture Blood 411.20 40200520 Culture Fungal Other 323.80

40200521 Culture Fungal Skin 236.40 40200527 Culture Nasopharyngeal 309.30 40200530 Culture Throat Full 267.20 40200560 Digoxin (Lanoxin) 272.60 40200565 Dilantin (Phenytoin) 329.70 40200576 Draw Fee Arterial 277.00 40200577 DRAW FEE VENIPUNCTURE 57.70 40200595 Electrolytes 208.30 40200600 Elution (Blood cell Ab) 608.70 40200601 Enzyme Treatment panel 730.30 40200603 Eosinophil Smear Sputum 87.50 40200604 Eosinophil Smear Urine 111.50 40200655 Ferritin 327.70 40200660 Fetal Cell Stain 293.50 40200661 Fetal/Maternal Bid Screen 149.10 40200662 Fetal Fibronectin 1,028.10 40200670 FDP (Fibrin Deg Prod) 243.50 40200675 Fibrinogen 318.00 40200680 Folate (Folic Acid) 250.90 40200702 Gentamicin Random 335.20 40200705 Gentamicin Trough 335.20 40200706 Gentamicin Peak 335.20 40200710 GGTP (Gamma GT) 165.60 40200717 Glucose Reck WBC 117.60 40200719 Glucose CSF 221.80 40200726 Glucose Challenge Test 154.40 40200741 GTT 1st 3 specimens 227.70 40200742 GTT serum spec #4 72.50 40200743 GTT urine dipstick #1 90.40 40200750 Gram Stain 126.30 40200775 Hematocrit 74.90 40200780 HDL (Hi Density L-Protein) 159.60 40200797 Hemoglobin 73.80 40200800 Hemoglobin A1C 185.80 40200846 ID Anaerobe 152.30 40200847 ID Fungus 127.80 40200861 ID Org Con Urine 154.40 40200862 ID Organism kit Nonurine 73.30 40200864 IEP & Consult Urine 730.30 40200865 IEP & Consult Serum 637.20 40200884 Influenzae A by EIA 290.10 40200887 Influenzae B by EIA 290.10 40200890 Iron Binding Capacity 177.80 40200895 Iron (Fe) 152.30 40200930 Lactic Acid (Lactate) 325.00 40200945 LDH (LA Dehydrogenase) 149.40 40200985 Lipase 239.90 40200987 Lipid Profile 296.00 40200995 Lithium (Eskalith) 247.40

40200999 Liver Function Panel 358.80 40201015 Magnesium Serum 180.80 40201020 Malaria Smear 216.30 40201040 MIC 227.30 40201043 Myoglobin Urine Screen 173.30 40201045 Mono Test 146.30 40201075 Occult Blood Stool 69.20 40201076 Occult Blood Gastric 77.70 40201085 Osmolality Serum 205.10 40201090 Ova & Parasites 300.50 40201091 O&P Direct Exam 114.60 40201093 Trichrome Stain (O&P) 133.10 40201140 Therapeutic Phlebotomy 317.50 40201150 Phosphorus 158.30 40201175 Platelet Count 140.70 40201185 Potassium 100.80 40201186 Potassium Urine Random 149.10 40201187 Potassium 24Hr Urine 173.50 40201193 Prealbumin 353.90 40201200 Pregnancy Test Urine 236.10 40201220 UPE with Consult 413.70 40201225 SPE with Consult 377.60 40201230 Protein Total 129.10 40201240 PT (Prothrombin Time) 119.40 40201250 PTT 184.70 40201278 Renal Function Panel 392.70 40201289 RH 145.40 40201290 ANTIBODY TITER SCORE BB 329.60 40201295 RA Factor 143.30 40201310 RPR 123.70 40201322 RSV 335.20 40201330 S-Profile 149.10 40201354 Sed Rate (ESR) Westergren 115.00 40201360 Semen (Sperm) Check 161.90 40201365 Semen (Sperm Count & Stdy) 359.60 40201366 Sensitivity KB 12 or less 256.10 40201375 SGOT (AST) 143.50 40201385 SGPT (ALT) 129.10 40201404 Sodium 24Hr Urine 134.10 40201405 Sodium 90.50 40201406 Sodium Urine Random 134.10 40201440 S Pneumo AG Serum 485.50 40201443 Rapid Strep Screen 143.90 40201450 Glucose Fasting 117.60 40201452 Glucose 2 HR PP 99.30 40201470 Tegretol (Carbamazepine) 355.20 40201480 Theophylline 315.90 40201515 Triglycerides 187.40 40201520 TSH 303.30

40201551 T4 Free 243.30 40201559 Troponin I Quantitative 371.90 40201562 Urea Nitrogen Blood 114.70 40201565 Uric Acid 168.50 40201570 Urinalysis AUTO W/MICRO 159.40 40201571 Urinalysis; Micro only 75.00 40201575 UA Dipstick 102.80 40201585 Valproic Acid 335.70 40201589 Vancomycin Trough 441.10 40201590 Vancomycin Peak 441.10 40201601 WBC Count Only 85.70 40201602 Retic Automated 138.50 40201606 PSA (Prostate Spec Ag) DX 317.30 40201609 D-Dimer Quantitative 333.90 40201610 Differential Manual 79.50 40202000 Specimen Acquis Venipuncture 57.70 40202004 TRAVEL ALLOW/MILE >20 1.40 40202006 TRAVEL ALLOW CHG 1-1 26.30 40202007 TRAVEL ALLOW CHG 1-2 13.20 40202008 TRAVEL ALLOW CHG 1-3 8.80 40202009 TRAVEL ALLOW CHG 1-4 6.70 40202010 TRAVEL ALLOW CHG 1-5 5.40 40202011 TRAVEL ALLOW CHG 1-6 4.50 40202012 TRAVEL ALLOW CHG 1-7 3.90 40202013 TRAVEL ALLOW CHG 1-8 3.30 40202015 TRAVEL ALLOW CHG 1-10 2.70 40202021 TRAVEL ALLOW CHG 2-2 19.80 40202022 TRAVEL ALLOW CHG 2-3 13.20 40202023 TRAVEL ALLOW CHG 2-4 10.00 40202024 TRAVEL ALLOW CHG 2-5 8.00 40202025 TRAVEL ALLOW CHG 2-6 6.70 40202026 TRAVEL ALLOW CHG 2-7 5.80 40202027 TRAVEL ALLOW CHG 2-8 5.00 40202028 TRAVEL ALLOW CHG 2-9 4.50 40202029 TRAVEL ALLOW CHG 2-10 4.10 40202032 TRAVEL ALLOW CHG 2-13 3.20 40202034 TRAVEL ALLOW CHG 2-15 2.70 40202035 TRAVEL ALLOW CHG 3-3 16.30 40202036 TRAVEL ALLOW CHG 3-4 12.30 40202037 TRAVEL ALLOW CHG 3-5 9.80 40202038 TRAVEL ALLOW CHG 3-6 8.20 40202039 TRAVEL ALLOW CHG 3-7 7.00 40202040 TRAVEL ALLOW CHG 3-8 5.50 40202041 TRAVEL ALLOW CHG 3-9 5.50 40202042 TRAVEL ALLOW CHG 3-10 4.90 40202043 TRAVEL ALLOW CHG 3-11 4.50 40202044 TRAVEL ALLOW CHG 3-12 4.10 40202045 TRAVEL ALLOW CHG 3-13 3.80 40202046 TRAVEL ALLOW CHG 3-14 3.50

40202055 ID Org Con Non-Urine 145.30 40202059 Lactic Acid Arterial 325.00 40202071 N Meningitidis Grp B CSF 374.00 40202073 N Meningitidis W 135 CSF 374.00 40202076 Osmolality Random Urine 246.50 40202077 PH Venous 243.50 40202078 PH Body Fluid 122.40 40202079 PH Stool 122.40 40202084 Rotavirus 286.60 40202093 KOH Prep (Yeast) 114.60 40202097 Leukocytes Stool 113.60 40202098 Hanging Drop (Wet Prep) 126.30 40202103 S Pneumo AG Urine 485.50 40202118 Vancomycin Random 441.10 40202128 GTT serum spec #5 72.50 40202132 GTT urine dipstick #2 90.40 40202133 GTT urine dipstick #3 90.40 40202134 GTT urine dipstick #4 90.40 40202135 GTT urine dipstick #5 90.40 40202143 Culture Catheter Tip 309.30 40202144 Culture CSF 309.30 40202147 Scabies Exam 102.30 40202150 Antigen ID patient 162.70 40202151 Semen analysis Sprm Ct only 161.90 40202152 Activated Coagulation Time-LR 137.90 40202157 PSA (Prostate Spec Ag) Screen 257.70 40202158 DRAW FEE BLOOD PATCH 69.00 40202162 SPECIFIC GRAVITY AUTO W/O M 51.90 40202177 Draw Fee Capillary 36.00 40202194 PLT Aggregation ADP 223.20 40202195 PLT Aggregation EPI 223.20 40202196 Tobramycin Peak 293.50 40202197 Tobramycin Random 293.50 40202198 Tobramycin Trough 293.50 40202199 Protein Total CSF 208.10 40202201 Protein Total Urine Random 215.20 40202203 HIV Rapid Screen HIV 1 & 2 412.40 40202204 Culture Urine 175.00 40202205 Specific Gravity Bdy Fluid 66.10 40202207 T3 Free 464.10 40202208 Sub plasma fract (PTT mix stud 502.40 40202209 Sub plasma fract (PT mix stdy) 270.30 40202210 Glucose Body Fluid 221.80 40202212 Crystal Exam 275.00 40202214 Parathyroid Hormone Intact 541.40 40202215 General Health Panel 307.20 40202216 Total B-hCG Quantitative 270.60 40202229 Shiga-like Toxin 55.20 40202231 Vitamin D 25-OH Total 341.60

40202232 Drugs of Abuse Urine 367.10 40202242 Salicylate 206.70 40202243 Acetaminophen 398.90 40202244 Ethanol 352.80 40202245 Prenatal Profile w/HIV 420.40 40202251 MRSA by PCR Screen 143.90 40202252 RA Factor Quantitative 286.60 40205003 Decalcification 166.90 40205005 Frozen Section 427.50 40205006 Frozen Section Addtional Blk 259.50 40205007 Micro Tissue Level II 316.10 40205008 Micro Tissue Level III 439.30 40205009 Tissue Level IV/Cell Block 562.30 40205010 Micro Tissue Level V 823.60 40205011 Micro Tissue Level VI 1,286.20 40205012 Non-GYN Cytology Fluid 274.40 40205013 Non-GYN Cytology Smear 300.50 40205020 Special Stain Group 1 215.80 40205021 Special Stain Group 2 295.40 40205028 Micro Tissue Lev I (Gross) 170.10 40205035 PAP Thin Layer 190.70 40205041 Immunohistochemistry Stain 589.90 40205057 ICH each add'l 589.90 40205153 Cytologic exam initial site 970.40 40205154 Cytologic exam each additional 217.50 40205506 IHC Stains Computer Assisted 806.30 40205539 *Path Consult w/Slide Prp 1,114.80 40206000 Collection/Handling Fee 57.70 40206001 Collection Fee II 130.80 40206009 Drug Screen COC 272.30 40206012 Occult Blood Immunoassay 69.20 40206014 LabCorp Blood Collection 21.00 40206015 LabCorp Urine Collection 5.00 40206017 LabCorp NonBlood/Urine Collect 5.30 40207029 NEWBORN SCREENING PANEL 255.70 40208088 Culture Viral 120.50 40208201 Parathyroid Horm Intact 297.70 40208251 T Pallidium test 104.00 40209116 Anti Platelet Ab1 878.10 40210000 17-Hydroxyprogesterone 650.10 40210001 5-HIAA URINE 313.30 40210005 ACTH 989.20 40210008 AFP (Tumor Marker) 416.70 40210010 Aldolase Serum 449.80 40210011 Aldosterone Serum 1,004.60 40210012 Aldosterone Urine 909.30 40210013 Alkaline Phosphotase isoenzyme 356.20 40210014 Alkaline Phosphatase 145.60 40210018 Allergen Beef 95.30

40210021 Allergen D. Farinae 238.00 40210022 Allergen D. Pteronyssinus 238.00 40210025 Allergen Gluten 95.30 40210027 Allergen Grass Bermuda 238.00 40210028 Allergen Honeybee Venom 95.30 40210030 Allergen Horse Hair Dander 95.30 40210032 Allergen Milk (Cow) 95.30 40210033 Allergen Oat 95.30 40210034 Allergen Peanut 95.30 40210038 Allergen Weed English Planta 95.30 40210042 Alpha-1-Antitrypsin 174.90 40210043 Alpha-1-Antitrypsin 454.20 40210044 Alpha-1-Antitrypsin Phenotype 574.20 40210050 Blood: Chromosome Analysis Cou 1,020.50 40210051 Blood: Tissue Culture 1,020.50 40210052 Blood: Interpretation and Repo 1,020.50 40210058 Amino Acids Quantitative Plas 914.40 40210111 Amylase Isoenzymes 111.10 40210116 Phagocytophilum IgG Titer 692.60 40210117 Phagocytophilum IgM Titer 692.60 40210121 Angiotensin Convert Enz CSF 261.00 40210122 Angiotensin Converting Enzyme 522.00 40210132 Anti-Nuclear Ab IgG by ELISA 357.40 40210133 Antithrombin Enzymatic 219.00 40210134 APC Resistance Profile 598.20 40210139 Arsenic Blood 752.90 40210140 Aspergillus Ab by ID 174.80 40210141 B. Burgdorferi by PCR (LYME) P 791.80 40210144 B.Burgdorferi Ab IgG WB (CSF) 564.10 40210145 B.Burgdorferi Ab IgM WB (CSF) 564.10 40210148 B2Glycoprotein I IgG Ab 465.60 40210149 B2Glycoprotein I IgM Ab 465.60 40210151 B2Glycoprotein I IgA Ab 301.40 40210156 Bartonella Henselae Ab IgG 359.10 40210157 Bartonella Henselae Ab IgM 359.10 40210162 Bartonella Quintana Ab IgG 179.70 40210163 Bartonella QuintanaAb IgM 179.70 40210166 Beta-2-Microglobulin Serum 880.60 40210167 Beta-2-Microglobulin Urine 415.60 40210172 Beta-HCG Serum Quant Tumor Ma 503.90 40210175 BK Virus DNA Quantitation 1,696.50 40210184 C. Difficile Cytotoxin Assay 389.50 40210185 C. Trachomatis Amplified 154.60 40210187 C-1-Esterase Inhib. Functional 180.30 40210188 Calcium Ionized Serum 183.10 40210194 Cancer Antigen 125 250.10 40210195 Cancer Antigen 27.29 266.20 40210196 Cancer Antigen-Breast (CA15-3) 249.50 40210197 Cancer Antigen-GI (CA 19-9) 249.30

40210200 CarcinoEmbryonic Ag 213.80 40210201 Anti-Cardiolipin IgG Antibody 297.70 40210202 Anti-Cardiolipin IgM Antibody 297.70 40210203 Cardiolipin Ab IgA 297.30 40210211 Carnitine Free and Total 158.60 40210222 Catecholamins Frac Plasma 383.60 40210229 Cateccholamins Urine (Free) 388.80 40210237 Immunoglobulin A Serum 161.40 40210240 Ceruloplasmin 147.10 40210241 C. Pneumoniae IgM Titer 59.50 40210242 C. Trachomatis IgM Titer 59.50 40210243 C. Psittaci IgM Titer 59.50 40210244 C. Pneumoniae IgG Titer 59.50 40210245 C. Trachomatis IgG Titer 59.50 40210246 C. Psittaci IgG Titer 59.50 40210253 Chromogranin A 302.90 40210268 CK Isoenzymes 118.90 40210279 CMV Ab IgG 183.10 40210280 CMV Ab IgM 191.70 40210282 CMV DNA Quantitation by PCR 1,286.50 40210283 Coccidioides Ab (ID) 69.50 40210284 Complement Activity Total EIA 249.50 40210285 *Complement Component 237.60 40210286 Complement component 3 141.50 40210287 Complement Component 4 141.50 40210288 Copper Serum 89.10 40210293 Copper Urine 222.80 40210297 Cortisol Serum or Plasma 191.70 40210300 Cortisol Urine Free by LCMSMS 271.10 40210304 C-Peptide Serum or Plasma 264.00 40210306 Creatine Urine 510.40 40210311 Cryofibrinogen 53.70 40210319 Cryptococcus Antigen CSF EIA 336.80 40210320 Cryptococcus Antigen Serum EI 134.80 40210322 CT/GC bY Amplified Detection 399.10 40210325 Cyclic Citrul Peptide Ab IgG 360.70 40210327 Cyclosporine LC/MS/MS WB 683.30 40210339 Cytomegalovirus Culture 431.60 40210340 DHEA Sulfate Serum 270.20 40210341 DHEA Serum 316.30 40210417 EBV Ab To Viral Capsid Ag IgG 218.00 40210418 EBV Ab To Viral Capsid Ag IgM 218.10 40210419 EBV Ab To Nuclear Ag IgG 140.00 40210420 EBV Ab to Early (D) Ag IgG 167.90 40210426 Ehrlichia Chaffeensis IgG Ab 663.40 40210427 Ehrlichia chaffeensis IgM Ab 663.40 40210432 Enterovirus detection by RTPCR 940.10 40210435 Erythropoietin 337.00 40210437 Estrogens Serum Fract 376.40

40210438 Estradiol Serum 319.80 40210444 Ethylene Glycol 182.30 40210451 F-Actin Antibody IgG 233.20 40210452 Factor IX Activity 475.10 40210454 Factor V Activity 316.90 40210458 Fat Fecal Qual 207.10 40210460 Factor X Activity 188.40 40210461 Factor XI Activity 326.60 40210477 Follicle Stimulating Hormone 126.70 40210478 Allergen Egg White 74.60 40210479 Allergen Milk (Cow) 74.60 40210480 Allergen Wheat 74.60 40210481 Allergen Corn 74.60 40210482 Allergen Peanut 74.60 40210483 Allergen Soybean 74.60 40210484 Allergen Shrimp 74.60 40210485 Allergen Walnut 74.60 40210486 Allergen Clam 74.60 40210487 Allergen Codfish/Whitefish 74.60 40210488 Allergen Scallop 74.60 40210489 Immunoglobulin E 74.60 40210490 Immunocap Score 74.70 40210499 Fungal (Mould) Identification 663.40 40210500 Gabapentin 321.80 40210504 Gastrin 222.80 40210506 Giardia Antigen by EIA 279.10 40210507 Gliadin Peptide Ab IgA 233.20 40210508 Gliadin Peptide Ab IgG 233.20 40210510 Glucose-6-Phosphate Dehydrog 99.30 40210524 Growth Hormone 99.30 40210525 Haloperidol 303.80 40210526 HBV DNA Ultra QNT PCR 828.90 40210528 HCV Genotyping by Sequencing 750.00 40210529 Arsenic Urine - ug/L 181.50 40210532 Lead Urine - ug/L 181.50 40210535 Mercury Urine - ug/L 207.90 40210548 Helicobacter Pylori Antigen 408.20 40210554 Hemoglobin A1C 71.40 40210565 Heparin Anti-Xa LMWH 695.90 40210567 Hepatitis A Ab IgM 69.50 40210568 Hepatitis A Abs (TOTAL) 57.50 40210569 Hepatitis A Abs (Total) 187.40 40210570 Hepatitis A Ab IgM 187.40 40210577 Hepatitis B Core Ab (Total) 332.60 40210578 Hepatitis B Core Ab IgM 187.40 40210581 Hepatitis B Surface Ab 146.10 40210584 Hepatitis B Surface Ag Confirm 148.60 40210586 Hepatitis Be Ab 91.20 40210587 Hepatitis Be Ag 81.40

40210588 Hepatitis C Ab 359.90 40210598 HEP C RNA Quant Real-Time PCR 754.10 40210599 Hepatitis C Genotyping Reflex 603.30 40210601 Hepatitis B Surface Ag 333.00 40210611 Histoplasma AG Urine 680.40 40210615 HIV-1 RNA QUANT by PCR 791.70 40210619 Homocysteine Total 321.80 40210627 HSV 1 Glycoprotein G Ab IgG 134.80 40210628 *HSV 1 Glycoprotein G Ab IgG 210.60 40210629 HSV 2 Glycoprotein G Ab IgG 325.30 40210631 HSV 2 Glycoprotein G Ab IgG 134.80 40210632 HSV by PCR 495.00 40210634 HSV Culture (Reflx-HSV Typing) 363.60 40210645 Immunoglobulin G Serum 156.90 40210649 IGF-1 (Insulin-Like Growth) 297.00 40210657 Immunoglobulin D Serum 157.40 40210658 Immunoglobulin E 218.30 40210659 Immunoglobulin G Subclass 1 95.20 40210660 Immunoglobulin G Subclass 2 95.20 40210661 Immunoglobulin G Subclass 3 95.20 40210662 Immunoglobulin G Subclass 4 95.20 40210664 Immunoglobulin G Serum 166.40 40210665 Immunoglobulin G CSF 166.40 40210666 Albumin Serum (NEPH)) 104.00 40210667 Albumin CSF 104.00 40210674 Immunoglobulin M Serum 160.50 40210675 Immunoglobulin G Serum 161.90 40210676 Immunoglobulin A Serum 161.90 40210677 Immunoglobulin M Serum 161.90 40210684 Insulin Antibody 257.50 40210686 Insulin Fasting 149.40 40210687 Free Insulin 173.50 40210688 Total Insulin 173.50 40210690 Insulin Random 173.50 40210691 Intact-Parathyroid Hormone 193.10 40210693 Intrinsic Factor Blocking Ab 272.50 40210700 JC Virus DNA PCR 1,398.60 40210703 JO-1 Ab IgG 89.10 40210704 Kappa QNT Free Light Chains 429.40 40210705 Lamda QNT Free Light Chains 429.40 40210709 Lamotrigine 343.70 40210717 Lead Whole Blood Capillary 153.10 40210718 Lead Whole Blood Venous 155.90 40210720 Legionella Pneumophila 1-6 Ig 183.50 40210721 Legionella Pneumphila Antigen 247.70 40210724 Lipoprotein(a) 128.90 40210726 Liver-KID Microsome-1 Ab IgG 95.20 40210728 Prothrombin Time 160.50 40210729 Partial Thromboplastin 160.50

40210731 Platelet Neutralization 224.60 40210732 Dilute Russell viper Venom PA 160.50 40210737 Luteinizing Hormone 208.30 40210738 B. Burgdorferi IgG WB 138.90 40210739 B.Burgdorferi Ab IgM by WB 138.90 40210802 Measles (Rubeola) Ab IgG 130.80 40210806 Mercury Blood 185.60 40210817 Metanephrines Plasma (Free) 618.70 40210823 Metanephrines Urine Fract 347.20 40210827 Methanol 166.40 40210831 Methylmalonic Acid Serum 316.90 40210832 Mitochondrial M2 Ab IgG 162.70 40210839 Total Protein-electrophoresis 96.50 40210840 Albumin 96.50 40210861 Myeloperox Abs IgG 95.20 40210862 Serine Protease3 IgG 95.20 40210868 Mumps Virus Ab IgG 163.70 40210869 Mumps Virus Ab IgM 166.40 40210871 Mycoplasma Pneumoniae Ab IgG 183.10 40210872 Mycoplasma Pneumoniae Ab IgM 183.10 40210873 Myelin Basic Protein 321.80 40210878 Myoglobin Serum 207.30 40210879 Myoglobin Urine 213.10 40210916 Organic Acids Urine 989.50 40210932 Parietal Cell Antibody IgG 297.00 40210939 Parvovirus B19 Antidbody IgG 272.50 40210940 Parvovirus B19 Antibody IgM 272.50 40210951 Phosphorus Urine 104.20 40210976 Porphyrins Urine Fract 148.60 40210980 Primidone (Mysoline) 49.80 40210981 Phenobarbital 49.80 40210983 Progesterone 266.20 40210984 Prolactin 230.80 40210985 PSA Free 222.90 40210986 Prostate Specific Antigen 219.60 40210990 Protein C Functional 316.90 40210991 Protein C Total Ag 128.90 40210992 Protein C Functional 139.30 40210993 Protein S Functional 347.80 40210995 Protein S Ag Free 209.10 40210998 Protein S Total Ag 446.90 40211013 Allergen Alternaria Tenuis 68.20 40211014 Allergen Oak Tree 68.20 40211015 Allergen Elm Tree 68.20 40211016 Allergen Common/Short Ragweed 68.20 40211017 Immunoglobulin E 68.20 40211018 Allergen June Grass/Kentucky 68.20 40211019 Allergen Box Elder/Maple Tree 68.20 40211020 Allergen Birch Tree 68.20

40211021 Allergen German Cockroach 68.20 40211022 Allergen Orchard Grass/Cocksf 68.20 40211023 Allergen Marsh Elder 68.20 40211024 Allergen Cat EPI and Dander 68.20 40211025 Allergen Dog Dander 68.20 40211026 Allergen D. Farinae 68.20 40211027 Allergen D. Pteronyssinus 68.20 40211028 Allergen A. Fumigatus 68.20 40211029 Allergen Hormodendrum 68.20 40211032 Renin Activity 274.70 40211039 Rocky Mt Spotted Fever IgG 253.60 40211040 Rocky Mt Spotted Fever IgM 242.80 40211041 Rubella Ab IgG 86.80 40211046 Serotonin Serum 383.40 40211049 Sirolimus (Rapamune Rapamycin 396.10 40211059 T.Pallidum Ab IgG (FTA-ABS) 69.50 40211060 Tacrolimus 544.60 40211065 Testosterone Total 327.60 40211066 Testosterone SHBG 340.20 40211070 Testosterone Free Adult Male 126.70 40211073 Thyroglobulin 218.00 40211074 Thyroglobulin Ab 64.90 40211078 Thyroid Peroxidase (TPO) Ab 148.60 40211079 Thyroglobulin Ab 207.90 40211081 T3 Uptake 42.70 40211085 Thyroxine 103.90 40211089 Tissue Transglutaminase Ab IgA 148.60 40211090 Tissue Transglutaminase Ab IgG 396.20 40211091 Topiramate 558.20 40211092 Toxoplasma Ab IgM 176.10 40211093 Rubella Ab IgM 176.10 40211094 *CMV Ab IgM 176.10 40211095 *HSV Type 1/2 Combined Ab IgM 199.90 40211097 Transferrin Serum 153.70 40211099 Triiodothyronine Total 165.90 40211100 Tryptase 785.90 40211106 Ureaplasma-Mycoplasma Culture 257.50 40211107 Urine Supersaturation: Calcium 177.60 40211108 Urine Supersaturation:Chloride 177.60 40211109 Urine Supersaturation: Citrate 177.60 40211111 Urine Supersaturation:Uric 177.60 40211112 Urine Supersaturation:Magnesiu 177.60 40211113 Urine Supersaturation:Oxalate 177.60 40211117 Urine Supersaturation:Phosphat 177.60 40211118 Viral Culture 540.20 40211119 Viscosity Serum 134.60 40211120 Vitamin B1 Plasma 356.20 40211121 Vitamin B2 (Riboflavin) 519.60 40211122 Urine Supersaturation:Potassiu 177.60

40211123 Vitamin B6 Plasma 282.20 40211124 Vitamin D 1 25-Dihydroxy 378.70 40211128 Urine Supersaturation:Sodium 177.60 40211129 Urine Supersaturation:Sulfate 177.60 40211130 Urine Supersaturation:pH 177.60 40211132 VMA Urine 256.80 40211140 Factor VIII:C Activity 343.30 40211141 Von Willebrand Factor Ag 343.30 40211142 Von Willebrand Factor (RCF) 343.30 40211144 VZV Ab IgG 165.20 40211145 VZV Ab IgM 183.10 40211146 VZV by PCR 495.00 40211152 Zinc Serum 70.10 40211203 Oligoclonal Bands CSF Serum 485.20 40211210 Testosterone LC-MC/MS Free 283.20 40211212 Vitamin E Plasma or Serum 247.70 40211215 Tissue Trans Ab IGA W/Reflex 137.50 40211217 Oxcarbazepine Metabolite 316.90 40211219 Vitamin K1 Serum 286.30 40211220 Vitamin A Serum or Plasma 74.40 40211221 MuSK Antibody 2,937.60 40211222 Hemoglobinopathy Profile 247.70 40211223 ANCA (Anti neutrophil cyto Ab) 354.60 40211240 Toxoplasma Ab IgG 69.50 40211249 Estrone Serum 130.80 40211251 HSV 1 & 2 IgG 79.40 40211252 HSV 1 & 2 IgM 79.40 40211253 Triiodothyronine (T3) Reverse 142.60 40211258 Cryoglobulin Qualitative 49.80 40211274 Anti-glomerular AB IGG 495.00 40211275 Aspergillus Galactomannan Ag 554.40 40211277 Hepatitis E Ab IgM 345.90 40211278 Hepatitis E Ab IgG 325.60 40211280 Allergen Timothy Grass 31.30 40211282 Allergen Penicillium Notatum 31.30 40211286 Allergen Lambs Quarters 31.30 40211289 Porphobilinogen Urine 204.00 40211302 HTLV I/II w/Reflex Confirmatio 79.40 40211303 HMS Panel 4 Blood Arsenic 183.90 40211304 HMS Panel 4 Blood Cadmium 183.90 40211305 HMS Panel 4 Blood Lead 183.90 40211306 HMS Panel 4 Blood Mercury 183.90 40211307 LDL Cholesterol Direct 65.10 40211308 Pancreatic Elastase Fecal 927.80 40211309 Calprotectin Fecal 1,107.10 40211310 Lactoferrin Fecal 176.50 40211317 Maternal Serum Screen AFP onl 83.70 40211318 Allergen Food Panel 1 Barley 31.30 40211319 Allergen Food Panel 1 Beef 31.30

40211320 Allergen Food Panel 1 Bell Pep 31.30 40211321 Allergen Food Panel 1 Cabbage 31.30 40211322 Allergen Food Panel 1 Carrot 31.30 40211323 Allergen Food Panel 1 Chicken 31.30 40211324 Allergen Food Panel 1 Codfish/ 31.30 40211325 Allergen Food Panel 1 Corn 31.30 40211326 Allergen Food Panel 1 Crab 77.80 40211327 Allergen Food Panel 1 EggWhite 31.30 40211328 Allergen Food Panel 1 Grapes 31.30 40211329 Allergen Food Panel 1 Lettuce 31.30 40211330 Allergen Food Panel Cows Milk 31.30 40211331 Allergen Food Panel 1 NavyBean 31.30 40211332 Allergen Food Panel 1 Oat 31.30 40211333 Allergen Food Panel 1 Orange 31.30 40211334 Allergen Food Panel 1 Peanut 31.30 40211335 Allergen Food Panel 1 Pork 31.30 40211336 Allergen Food Panel 1 Potato 31.30 40211337 Allergen Food Panel 1 Rice 31.30 40211338 Allergen Food Panel 1 Rye 31.30 40211339 Allergen Food Panel 1 Shrimp 31.30 40211340 Allergen Food Panel 1 Soybean 31.30 40211341 Allergen Food Panel 1 Tomato 31.30 40211342 Allergen Food Panel 1 Tuna 31.30 40211343 Allergen Food Panel 1 Wheat 31.30 40211344 Allergen Chocolate 31.30 40211388 Factor VIII activity reflx-qu 120.80 40211395 Allergen Tuna 31.30 40211398 Insulin 2 hours 139.30 40211402 Bile Acids Fract & Total 943.20 40211406 Plasminogen Activator Inhibito 334.10 40211408 Zone 10 Immunocap Score 30.20 40211409 Zone 10 American Cockroach 31.30 40211410 Zone 10 Stemp botryosum 31.30 40211411 Zone 10 Alternaria tenius 31.30 40211412 Zone 10 Cat Epi & Dander 31.30 40211413 Zone 10 Dog Epithelium 31.30 40211414 Zone 10 June/Ky Grass 31.30 40211415 Zone 10 Pigweed 31.30 40211416 Zone 10 Russian Thistle 31.30 40211417 Zone 10 Hormo Cladosporium 31.30 40211418 Zone 10 Elm Tree 31.30 40211419 Zone 10 Oak Tree 31.30 40211420 Zone 10 English Plantain 31.30 40211421 Zone 10 Asp fumigatus 31.30 40211422 Zone 10 D pteronyssinus 31.30 40211423 Zone 10 D farinae 31.30 40211424 Zone 10 Bermuda Grass 31.30 40211425 Zone 10 Pen notatum 31.30 40211426 Zone 10 Common/Short Ragweed 31.30

40211427 Zone 10 Sycamore Tree 31.30 40211428 Zone 10 Pecan Tree 31.30 40211429 Zone 10 Cedar/Red Tree 31.30 40211430 Zone 10 Mucor racemosus 31.30 40211431 Zone 10 Red Maple 215.90 40211432 Zone 10 White Mulberry 31.30 40211433 Zone 10 Nettle 31.30 40211434 Zone 10 Sheep Sorrel 31.30 40211462 Estradiol Free 560.60 40211488 ACTH Stimulation 0 minutes 68.40 40211489 ACTH Stimulation 30 minutes 68.40 40211490 ACTH Stimulation 60 minutes 68.40 40211491 Acylcarn 472.30 40211492 Carnitine 472.30 40211493 Calculi Urinary 386.60 40211498 Pregnenolone 167.50 40211548 Midwest 1 Alternia alternata 69.20 40211549 Midwest 1 Cat epi & dander 69.20 40211550 Midwest 1 Juniper 69.20 40211551 Midwest 1 Common/Short ragweed 69.20 40211552 Midwest 1 Cottonwood 69.20 40211553 Midwest 1 Mites 69.20 40211554 Midwest 1 Dandelion 69.20 40211555 Midwest 1 Dog epi 69.20 40211556 Midwest 1 Elm 69.20 40211557 Midwest 1 Giant Ragweed 69.20 40211558 Midwest 1 Hormodendrum 69.20 40211559 Midwest 1 House Dust Greer 69.20 40211560 Midwest 1 June/Kentuky Grass 69.20 40211561 Midwest 1 Meado2w Fescue 69.20 40211562 Midwest 1 Maple/Box Elder 69.20 40211563 Midwest 1 Olive Tree 69.20 40211564 Midwest 1 Orchard Gras/Cocksft 69.20 40211565 Midwest 1 Perennial Rye Grass 69.20 40211566 Midwest 1 Russioan Thistle 69.20 40211567 Midwest 1 Sabegrush/Woodworm 69.20 40211568 Midwest 1 Timothy Grass 69.20 40211572 Cystine Quant Urine 476.40 40211573 DNase-B Antibody 58.30 40211576 Borrelia burgdoferi (Lyme) 176.80 40211592 EBV Quantitative by PCR 1,021.50 40211599 Zinc Whole Blood 448.90 40211602 Allergen Food Lobster 27.80 40211620 Hepatitis Panel Acute 237.60 40211623 Scleroderma (Scl-70) Ab IgG 89.10 40211624 Chrom Analy POC 15-20 1,140.00 40211625 Chrom Analy POC Tis Culture 1,140.00 40211626 Chrom Analy POC Interp & Rpt 1,140.00 40211629 Quanti-Feron TB Gold in Tube 786.80

40211630 Celiac Disease Dual Ag Screen 326.60 40211631 *Celiac Rflx to TTA IgG 166.40 40211632 Celiac Rflx to Gliad Pep IgA 59.50 40211633 Celiac Rflx to Gliad Pep IgG 59.50 40211634 Celiac Rflx to TTA IgA 53.70 40211678 Double Stranded DNA IgG 44.70 40211679 Double Stranded DNA IgG IFA 44.70 40211680 RNP Antibody IgG 51.70 40211681 Smith Antibody IgG 51.70 40211682 SSA Antibody IgG 51.70 40211683 SSB Antibody IgG 51.70 40211698 Mycophenolic Acid 110.60 40211699 Allergen Peds March Alt alter 19.80 40211700 Allergen Peds March Cat Dander 19.80 40211701 Allergen Peds Mar Cockroach Ge 19.80 40211702 Allergen Peds March D farinae 19.80 40211703 Allergen Peds March D pteronly 19.80 40211704 Allergen Peds March Dog Dander 19.80 40211705 Allergen Peds March Egg White 19.80 40211706 Allergen Peds Mar Codfish/Whit 19.80 40211707 Allergen Peds March Cows Milk 19.80 40211708 Allergen Peds March Peanut 19.80 40211709 Allergen Peds March Soybean 19.80 40211710 Allergen Peds March Wheat 19.80 40211711 Allergen Peds March IgE 19.80 40211740 von Willebrand Multimeric 99.10 40211741 von Willebrand Multimeric F8 99.10 40211742 von Willebrand Multi VWF/AG 99.10 40211743 von Willebrand Multimeric RCF 99.10 40211761 KSRP II Urine Calcium 45.60 40211762 KSRP II Urine Chloride 45.60 40211763 KSRP II Urine Citric Acid 79.30 40211764 KSRP II Urine Cystine 49.70 40211765 KSRP II Urine Magnesium 45.60 40211766 KSRP II Urine Oxalate 45.60 40211767 KSRP II Urine Phosphorus 45.60 40211768 KSRP II Urine Potassium 45.60 40211769 KSRP II Urine Sodium 45.60 40211770 KSRP II Urine Uric Acid 45.60 40211787 Sodium Stool 45.60 40211788 Potassium Stool 45.60 40211789 Anti-Mullerian Hormone 361.30 40211804 Aspergillus Fumigatus #1 34.80 40211805 Aspergillus Fumigatus #6 34.80 40211806 Aureobasidium pullulans 34.80 40211807 Pigeon Serum 34.80 40211808 Micropolyspora faeni 34.80 40211809 Micropolyspora faeni 34.80 40211810 Thermoactinomyces vulgaris #1 34.80

40211811 Aspergillus flavus 34.80 40211812 Aspergillus fumigatus #2 34.80 40211813 Aspergillus fumigatus #3 34.80 40211814 Saccharomonospora viridis 34.80 40211815 Thermoactinomyces candidus 34.80 40211816 Thermoactinomyces sacchari 34.80 40211817 Allergen Fungi Molds Phomabeta 15.90 40211818 Allergen Food Beef 15.90 40211819 Allergen Food Pork 15.90 40211820 Allerg Epi Animal Pro Feather 15.90 40211826 Pyruvic Acid 83.30 40211827 Creatine Serum/Plasma 243.50 40211851 Tissue Culture 435.50 40211852 Chromosome Analysis Ct 45 cell 435.50 40211855 Interp and report 435.50 40211861 T-cell total count 108.90 40211862 Absolute CD4 & CD8 count/ratio 134.70 40211863 HIV 1 2 49.70 40211866 Bone Specific Alkaline Phospha 247.50 40211868 Allergen Candida Albicans 19.80 40211869 Allergen Cow Hair/Dander 19.80 40211871 Allergen Johnson Grass 19.80 40211873 Allergen Latex 19.80 40211874 Arginine Vasopression Hormone 99.10 40211875 Allergen Mesquite 19.80 40211876 Androstenedione 128.80 40211881 Centromere AB IgG 59.50 40211883 Dexamethasone 362.30 40211884 Prolnsulin 89.10 40211886 *Coagulation Factor II 154.40 40211889 Neisseria Gonorrhoeae Amp 154.60 40211896 Haptoglobin 49.70 40211897 Osmolality Fecal 89.10 40211898 Lactic Acid CSF 39.70 40211899 Leukocyte Alkaline Phosphatase 221.80 40211903 ADAMTS13 Activity 593.80 40211904 17-Hydroxycorticosteroids 168.30 40211905 CRP High Sensitivity 89.10 40211907 Varicella-Zoster Virus DFA 198.00 40211908 Herpes Simplex Virus DFA Type1 99.10 40211931 Allergen Mountain Cedar Junipe 35.80 40211932 Allergen Mugwort 35.80 40211933 Bile Acids Total 83.30 40211943 Folate RBC 55.60 40211950 Cortisol Free Serum 277.10 40211956 Herpes Simplex Virus DFA Type2 99.10 40211957 Thyroid Stimulating (TRAb) 126.80 40211958 Treponema Pallidum Screen 29.70 40211959 Treponema Pallidum Titer 79.30

40211961 Chloride Urine 31.80 40211980 Blood Culture Fungal 164.30 40212008 AFB Culture-includes AFB stain 184.20 40212021 IGF Binding Protein-3 79.30 40212022 Thyroxine Binding Globulin 61.60 40212035 Thrombin Time 54.50 40212036 C1-Esterase Inhibitor 52.50 40212037 Thiopurine Methyltransferase 959.90 40212038 LDH Total Body Fluid 27.90 40212041 Thryoid Stimulating Immunoglob 253.50 40212046 Allergen Food Strawberry 19.80 40212047 Vitamin B12 49.70 40212076 *Trichinella AB by ELISA 162.50 40212077 Brucella AB Total by Agg 31.60 40212081 Amylase Body Fluid 31.80 40212086 Allergen Food Mushroom 19.80 40212091 Iron Total 19.80 40212092 Iron Binding Capacity 25.90 40212095 Testosterone Free 202.00 40212096 Testosterone Total 202.00 40212131 Thyroxine Free by ED/HPLC-TDM 111.00 40212133 Legionella Species Culture 146.60 40212151 Total Protein Body Fluid 29.70 40212153 Absolute CD4 297.00 40212166 25-Hydroxyvitamin D2 & D3 Tota 341.60 40212168 Islet Cell Antibody IgG 79.00 40212187 Aldosterone 105.20 40212188 Renin Activity 61.50 40212212 Hexagonal Phospholipid Neutral 236.60 40212213 Reptilase Time 87.60 40212214 dRVVT 1:1 35.10 40212215 dRVVT Confirmation 75.50 40212216 PTT 1:1 Mix 35.10 40212217 Thromboplastin Time 61.50 40212218 Heparin Neutralization 61.50 40212230 ANA by IFA IgG 49.10 40212236 Francisella Tularensis Ab IgG 94.70 40212237 Francisella Tularensis Ab IgM 94.70 40212241 Sickle Solubility (HPROF) 89.40 40212242 Valproic Acid 43.80 40212268 Allergen Food Cranberry 149.00 40212272 Carbamazepine Total 68.40 40212273 Carbamazepine Epoxide 68.40 40212279 Allergen Food Sesame Seed 17.60 40212280 Allergen Food Pistachio 17.60 40212281 Calcitonin 77.10 40212282 Cortisol Saliva 136.80 40212291 Glucose Body Fluid 26.30 40212300 Selenium Serum 79.00

40212357 Helicobacter Pylori Breath Tes 175.10 40212359 HLA-B27 175.10 40212360 immunoglobulin IgG a95614 107.00 40212361 Immunoglobulin IgM a95615 107.00 40212363 Platelet Antibodies Indirect 516.70 40212373 *CD14 a2005006 199.70 40212374 *CD15 a2005006 199.70 40212375 *CD24 a2005006 199.70 40212376 *CD33 a2005006 199.70 40212377 *FLAER a2005006 199.70 40212378 *CD59 a2005006 199.70 40212379 *Glycophorin a2005006 199.70 40212385 Creatinine Urine a50203 26.30 40212386 Microalbumin Urine a50203 26.30 40212390 Niacin (Vitamin B3) 254.10 40212420 Urticaria-Inducing Activity 394.10 40212422 Allergen Food Crab a51835 14.00 40212423 Allergen Food Shrimp a51835 14.00 40212424 Allergen Food Blue Mussel a518 14.00 40212425 Allergen Food Lobster a51835 14.00 40212426 Allergen Food Clam a51835 14.00 40212427 Allergen Food Scallop a51835 14.00 40212428 Allergen Food Oyster a51835 14.00 40212435 S. Cerevisiae Ab IgG a50564 71.20 40212436 S. Cerevisiae Ab IgA a50564 71.20 40212439 Cholesterol Body Fluid 18.60 40212440 (1 3)-Beta-D-glucan (Fungitell 463.70 40212481 Sol Liver Antigen Antibody IgG 46.50 40212482 Vasoactive Intestinal Peptide 92.70 40212495 Potassium Fecal a60185 34.00 40212496 Sodium Fecal a60185 34.00 40212497 Chloride Fecal a60185 34.00 40212502 A Fumigatus Ab IgG by ELISA 197.90 40212516 Hepatitic C Virus RNA PCR Quan 1,375.70 40212517 Chlamydia Trachomatis a60734 231.90 40212518 Neisseria Gonorrhoeae a60734 231.90 40212538 B-Cells Total Count a95899 92.70 40212539 NK Cells Total Count a95899 92.70 40212540 T-Cells Total Count a95899 92.70 40212541 Absolute CD4/C8 Count w/ratio 116.00 40212542 CD4 46.50 40212543 CD45RA a95899 46.50 40212544 CD45RO a95899 46.50 40212545 CD2 a95899 46.50 40212546 HLA-DR a95899 46.50 40212562 Reducing Substances Fecal 100.60 40212564 Allergen Honeybee Venom a55105 14.00 40212565 Allergen Paper Wasp a55105 14.00 40212566 Allergen White-Faced Hornet 14.00

40212567 Allergen Yellow-Faced Hornet 14.00 40212568 Allergen Yellow Jacket Venom 14.00 40212572 Allergen Food Banana 23.30 40212576 Tissue Culture a60285 72.70 40212577 Shell Vial a60285 72.70 40212579 Tissue Culture a65005 61.90 40212580 IP Stain a65005 61.90 40212591 Neutrophil Oxidative Burst Asy 575.10 40212593 Allergen Food Peanut a51831 23.30 40212594 Aller Walnut/Bl Walnut a51831 23.30 40212595 Allergen Food Chestnut a51831 23.30 40212596 Allergen Food Hazelnut a51831 23.30 40212597 Allergen Food Pecan a51831 23.30 40212598 Allergen Food Cashew a51831 23.30 40212599 Allergen Food BrazilNut a51831 23.30 40212600 Allergen Food Almond a51831 23.30 40212602 Allergen Food Almond a55345 23.30 40212603 Allergen Food Coconut a55345 23.30 40212605 Allergen Food Pecan a55345 23.30 40212606 Allerg Food Sesame Seed a55345 23.30 40212626 Allergen Food Peanut a55345 23.30 40212627 Cell Function assay a2005415 309.20 40212628 Thyroglobulin Antibod a2005415 46.50 40212629 Thyroid Stim Hormone a2005415 46.50 40212630 Thyroid Peroxidose Ab a2005415 46.50 40212631 Allergen Food Blueberry 23.30 40212632 Allergen Food Cherry 23.30 40212638 Allergen Food Pistachio 23.30 40212639 Hantavirus Ab IgG a2001540 136.10 40212640 Hantavirus Ab IgM a2001540 136.10 40212644 Thyroglobulin by LG-MS S/P 177.80 40212650 Allerg Food Egg White a2002124 23.30 40212651 Allerg Food Cows Milk a2002124 23.30 40212652 Allergen Food Peanut a2002124 23.30 40212653 Allergen Food Soybean a2002124 23.30 40212654 Allergen Food Wheat a2002124 23.30 40212655 Allergen Food Corn a2002124 23.30 40212656 Allerg Food Egg Yolk a2002124 23.30 40212657 Allergen Food Gluten a2002124 23.30 40212658 Allergen Food Bananan a2002124 23.30 40212659 Allerg Food Strawberry a200212 23.30 40212662 Galactose-Alpha 1.3 Galactose 131.40 40212669 Serotonin Release Assay Unfrac 927.40 40212707 Allergen Food Almond 23.30 40212715 A1A total a51256 309.20 40212716 A1A Gene Analysis a51256 309.20 40212717 Ankylosing Sprondy HLA-B27 Gen 347.80 40212718 APC Resist Prof rflx F5 Leiden 61.90 40212719 Cystic Fibrosis 32 Mutations 316.90

40212723 Factor 5 R506Q Mutation 193.20 40212725 Hemochromatosis (HFE) 3 Mutati 649.20 40212728 MTHFR 2 Mutations 241.20 40212729 Prothrombin (F2) G20210A Mutat 201.00 40212730 Amiodarone & Metatbolite 52.50 40212734 Aquaporin-4 Receptor Ab 1,082.10 40212736 Thyroid Stimulating Hormone 116.00 40212739 Endomysial Ab IgA 103.50 40212746 HLA Class 1 Typing 786.70 40212747 HLA Antibody 876.40 40212750 Molecular RBC Antigen Typing 248.50 40212753 Unlisted Path Procedure 772.90 40212771 Beta-Hydroxybutyric Acid 65.00 40212772 Allergen Baker/Brewer Yeast 27.70 40212779 Unlisted Path Procedure 478.90 40212793 GBM IgG by MBA a2008403 138.00 40212794 GBM IgG by IFA a2008403 138.00 40212804 H Pylori Culture a2006686 62.10 40212805 Tissue Homogenization a2006686 62.10 40212806 Procalcitonin 462.40 40212807 Allergen Specific IgE a55245 207.10 40212808 IgE a55245 41.40 40212818 Coxsackie B Ab 248.50 40212819 E Histolytica Ab IgG 69.10 40212821 Respiratory Virus Panel PCR 1,380.10 40212838 Maternal Scrn Integrated Spec1 122.20 40212840 IGHV Mutation Analysis by Seq 1,419.20 40212842 Antithrombin Enzymatic a30370 67.20 40212843 Antithromibin Antigen a30370 67.20 40212844 Striated Muscle Ab IgG Screen 42.70 40212845 Striated Muscle Ab IgG Titer 85.50 40212846 Iodine Serum 378.70 40212850 Maternal Screen Integra Spec 2 305.30 40212869 Allergen specific IgE each 91.60 40212882 *Infliximab Act & Neutral Ab 977.00 40212898 NK cell total count a95862 134.40 40212899 T cells total count a95862 134.40 40212900 Abs CD4 & CD8 count a95862 134.40 40212902 Pyruvate a2007935 42.70 40212903 Lactic acid a2007935 42.70 40212905 Cdiff toxin B by PCR 222.30 40212935 MEN2 RET Gene Mutations by Seq 1,362.90 40212936 Everolimus 196.60 40212938 Flow cyto first marker a92099 119.60 40212939 Flow cyto each addl a92099 119.60 40212976 DOA Confirm THC Urine 244.70 40212982 PTH Related Peptide 1,277.00 40212983 HIV Combo Ag/Ab 58.10 40212984 ACTH Binding Ab a2005639 77.80

40212985 Titin Ab a2005639 77.80 40212986 ACTH Blocking Ab a2005639 77.80 40212987 Striated Muscle Ab a2005639 77.80 40213001 CFTR sequence a2010876 1,741.40 40213002 Molecular Path L5 a2010876 3,482.80 40213003 Unlist molecular path a2010876 1,741.40 40213004 Desmoglein 1 & 3 Ab IgG 665.20 40213005 Liver Fibrosis Chronic Hep 452.80 40213010 Group 2 Stain 232.20 40213011 Level IV 232.20 40213012 immunoflourescence each Ab 348.30 40213013 Electron Microscopy 580.50 40213017 Tick-Borne Disease Panel/PCR 847.50 40213037 Adalimumab Act & Neut Ab 998.40 40213038 Cytogenomic SNP Microarray 2,542.50 40213043 Enterovirus by PCR 214.80 40213044 HSV by PCR 214.80 40213045 Parechovirus Detection by PCR 214.80 40213049 Immunofixation Electrophoresis 232.40 40213060 Clonazepam 225.40 40213064 Seroquel (Quetiapine) 718.90 40213067 Risperidone 561.20 40213068 Veniafaxine 711.70 40213075 Lacosamide (Vimpat) 307.80 40213078 Nicotine/Metab Conf Urine 377.90 40213079 Nicotine/Metab Confirm 337.30 40213081 Fentanyl/Metab Urine 270.15 40213082 DOA 9 Panel Screen Urine 154.20 40213084 Hypoglycemia Panel 638.00 40213087 DOA Conf Barbiturates Urine 217.70 40213089 Benzodiazepines confirm Urine 232.20 40213093 Buprenorphine & Met Conf Urine 132.20 40213094 Ethanol Urine 110.20 40213095 Amphetamines D;L Ratio Urine 495.70 40213098 Trazodone 122.30 40213099 Duloxetine (Cymbalta) 513.30 40213100 Pain Mgmt Panel w/interp 231.80 40213104 Opiates Confirm Urine 232.20 40213105 Amphetamines Conf Urine 232.20 40213107 DOA Panel Meconium 1,693.60 40213108 Opiates Confrim Mec 323.90 40213109 Methadone Confirm Mec 126.40 40213110 Amphetamine Confirm Mec 34.60 40213114 THC Confirm Med 308.10 40213116 Amitriptyline & Nortiptyline 57.90 40213119 Bupropion 346.40 40213120 Chla trach by TMA a2006258 110.20 40213121 GC by TMA a2006258 110.20 40213122 Trich by TMA a2006258 110.20

40213123 HIV-1 Antibody a2012669 110.20 40213124 HIV-2 Antibody a2012669 110.20 40213127 IHC per spec initial single 275.40 40213128 Aquaporin-4 Receptor Ab CSF 771.00 40213132 Lurasidone Qnt (Latada) 376.70 40213135 Clobazam Qnt 387.70 40213138 KRAS Gene Variants Exon 2 440.60 40213139 KRAS Gene Addl Variants 440.60 40213140 NRAS Gene Variants Exon 2&3 881.20 40213141 BRAF by NGS 881.20 40213146 BC-Aerobic Addl ID 110.20 40213147 Microbe Susceptible 110.20 40213148 PD-L1 IHC Genpath 991.30 40213150 EGFR by NGS 1,860.50 40213151 IGH by PCR 403.80 40213152 JAK2 V617F Mutation Analysis 596.90 40213153 JAK2 V617F Mutation Analysis 629.70 40213154 Microsatellite Instabil by PCR 1,290.10 40213155 Lymphoma T-Cell TCR Gamma PCR 513.50 40213159 HPV PLUS 175.60 40213161 Bone Marrow Slide Consult 329.10 40213163 ISH single antibody 158.80 40213166 BCR/ABL 1,428.40 40213169 HER2 by Fish 696.60 40213171 IFA Add'l Stain 55.10 40213176 Zika PCR 22.00 40213177 IHC Ab Slide initial gp5137 461.30 40213178 IHC Ab Slide add'l gp5137 55.10 40213179 Flow cyto 1st mark gp5515 881.20 40213180 Flow cyto add'l mark gp5515 1,777.10 40213181 Tissue Culture BM gp5250 713.10 40213182 Chrom Anal 15-20 cell gp5250 713.10 40213185 IHC Ab Slide initial gpA943 461.30 40213186 IHC Ab Slide add'l gpA943 110.20 40213187 Insitu Hybrid Initial gp5280 969.30 40213188 Insitu Hybrid add'l gp5280 330.40 40213189 IHC Ab Slide initial gp5139-1 461.30 40213190 IHC Ab Slide add'l gp5139-1 165.20 40213191 Flow cyto 1st marker gp5535 461.30 40213192 Flow cyto add'l marker gp5535 936.20 40213193 Flow cyto 1st marker gp5409 461.30 40213194 Flow cyto add'l mark gp5409 220.30 40213195 Insitu Hybrid Initial gp5282 306.50 40213196 Insitu Hybrid multi gp5282 306.50 40213197 Insitu Hybrid multi gp5282 1,225.90 40213198 IHC Ab Slide initial gp5579 461.30 40213199 IHC Ab Slide add'l gp5579 550.70 40213200 Insitu Hybrid Initial gp5281 306.50 40213201 Insitu Hybrid add'l gp5281 306.50

40213202 Insitu Hybrid multi gp5281 613.10 40213207 Flow cyto 1st marker gp5564 461.30 40213208 Flow cyto add'l marker gp5564 220.30 40213209 Flow cyto 1st marker gp573 103.50 40213210 Flow cyto add'l marker gp5573 1,138.60 40213211 Chlamydia gp3851 82.60 40213212 N.Gonorhoeae gp3851 82.60 40213215 Targeted Genomic Seq Anal 1,971.60 40213218 Drug Definitive 8-14 Ameritox 270.70 40213219 Drug Definitive 15-21 Ameritox 365.50 40213222 Aripiprazole and Metab 92.50 40213224 Keppra (Levetiracetam) 435.70 40213239 Urea Nitrogen Urine 55.10 40213240 B cells total count 359.10 40213241 NK cells total count 359.10 40213242 T cells total count 359.10 40213243 T cells; Absol CD4&CD8 359.10 40213246 Drug Test Pres Cord a2006621 521.00 40213247 Drug Test 15-21 Cord a2006621 521.00 40213249 Uric Acid Urine 208.10 40213250 Calcium Urine 177.60 40213252 HCV Phenotype Inf Agent Drug 702.10 40213253 HCV Genotype 702.10 40213254 ALK by FISH 704.90 40213257 CRP (C Reactive Protein) 55.10 40213259 IHC Initial Ab Stain Mayo 461.50 40213260 IHC 1 Add'l Ab Stain Mayo 350.30 40213267 Array CGH Molecular Karotyping 1,090.40 40213272 Drug Test Prsmv Chem Analyzer 330.40 40213273 Mumps Virus PCR 722.60 40213274 Total Protein Urine 110.20 40213275 Cryptosporidium Ag IA 44.10 40213285 Fluor Ab Scr Each a2013955 178.30 40213286 Immunoassay NonAb a2013955 89.20 40213287 Drug Presump Ameritox 174.40 40213288 Magnesium Urine 42.00 40213293 HER2 NEU by IHC 386.00 40213298 Factor XIII Activity 388.10 40213300 HCV NS5A Drug Resist by Seq 1,093.10 40213302 Maternal Scr AFP/HCG/Est/Inh 419.60 40213303 Mayo Path Consult 1,049.00 40213308 ACHR Binding Ab 42.00 40213309 ACHR Blocking Ab 52.50 40213310 ACHR Modulating Ab 83.90 40213312 HLA 2 Typing 1 High Res 204.60 40213313 HLA 2 Typing 1 Low Res 409.10 40213316 Onkosight Colrectal Cancer Pan 1,542.00 40213318 OnkoSight Lung Cancer Panel 1,542.00 40213319 OnkoSight Melanoma Panel 1,542.00

40213320 OnkoSight Myeloid Disorder Pan 1,542.00 40213325 *Thiopurine Metabolites 272.70 40213333 Allergen specific IgG each 91.60 40213335 DNA Ploidy 128.00 40213337 FMR1 Gene Detection 314.70 40213338 Dihydrotestosterone 73.40 40213341 MPL Codon 515 828.70 40213342 CALR Exon 9 608.40 40213343 JAK2 V617F 314.70 40213344 BCR/ABL1 Gene Major a2005010 314.70 40213345 BCR/ABL1 Gene Minor a2005010 314.70 40213346 BCR/ABL1 Gene Major 608.40 40213348 AST (liver fibrosis) 76.10 40213349 ALT (liver fibrosis) 76.10 40213350 Ferritin (liver fibrosis) 76.10 40213351 Glucose (liver fibrosis) 76.10 40213356 Felbamate 246.50 40213357 Flow Cyto 1st marker a2008003 629.40 40213358 Flow Cyto 20 addl a2008003 52.50 40213359 Flow Cyto 19 addl a2008003 52.50 40213360 Flow Cyto 18 addl a2008003 52.50 40213361 Flow Cyto 17 addl a2008003 52.50 40213362 Flow Cyto 16 addl a2008003 52.50 40213364 Flow Cyto 21 addl a2008003 52.50 40213365 Flow Cyto 22 addl a2008003 52.50 40213366 Flow Cyto 23 addl a2008003 52.50 40213370 JAK2 EXON 12 MUTATION PCR 629.40 40213376 Galactose-1-Phoph Uridyltransf 182.50 40213377 MolCyto probe each a2002295 637.80 40213378 MolCyto 100-300 cells a2002295 637.80 40213379 Norovirus Group 1&2 PCR 230.80 40213380 *BRACA 1/2 Seq/Del/Dup 4,290.40 40213381 Malaria Det & Spec PCR 692.30 40213382 Thiopurine Metabolites 272.70 40213383 Beta-2 Transferrin 140.00 40213384 Pyridinoline & Deoxypyrid 242.00 40213386 Tumor Necrosis Factor Alpha 190.00 40213387 Ab ID; Platelet AB a2007237 220.00 40213388 Ab ID; Plt Ig Assay a2007237 220.00 40213389 Toxocara Ab IgG 44.80 40213390 RhD Ag Genotyping 440.00 40213391 All spec crude IgE a2007211 42.00 40213392 All spec recomb IgE a2007211 210.00 40213393 HLA I Typing 1 Locus 650.00 40213394 PSA 4Kscore 1,540.00 40213395 Coenzyme Q10 Total 150.00 40213396 Transform Growth Factor beta 320.00 40213397 Glutathione 176.00 40213398 Leukocyte Adhesion Def Panel 248.80

40213399 Vascular Endoth Growth Factor 400.00 40213400 Melanocyte Stim Hormone Alpha 360.00 40213401 Complement Comp Level 4a 203.16 40213402 Complement Comp Level 3a 120.00 40213403 MMP-9 203.66 40213404 JCV Antibody 2,800.00 40213405 S Pneumo Ag Urine 80.00 40213406 DPYD Gene Com Var a2007228 560.00 40213407 TYMS Gene Com Var a2007228 560.00 40213409 Mononuclear Cell Ag a2008901 243.60 40213410 Lyso & Peri SD Screen Mayo 306.78 40213411 Psychosine Mayo 515.20 40213412 T-Cell Clonality PCR 497.52 40213413 Mononuclear Cell Ag a2013805 280.00 40213414 NK Cells Tot Cnt a2013805 55.00 40213415 B Cell Total Count a95892 55.00 40213416 NK Cells Tot Cnt a95892 55.00 40213417 T Cell Total Count a95892 55.00 40213418 T Cell Abs CD4 & CD8 a95892 65.00 40213419 Allergen Spec IgE Recomb EA 30.00 40213420 Candida a65153 40.00 40213421 Gardnerella a65153 40.00 40213422 Trich Vaginalis a65153 40.00 40213423 Allergen Food Profile 13 125.00 40213424 Prealbumin 50.00 40213425 Antimicrobial Suscept-CRE 170.80 40213426 Gaucher Enzyme Act Leukocyte 320.00 40213427 Cytokine Panel TH1 450.00 40213428 Parvovirus B19 by PCR 221.20 40213431 Histone Ab IgG 28.48 40213432 Immunoassay Qnt 250.00 40213433 Qnt Therapeutic Drug 250.00 40213435 Rapid Plasma Reagin 15.00 40213436 CMV Ab a50772 35.00 40213437 HSV NonSpecific Ab a50772 35.00 40213438 Rubella Ab a50772 35.00 40213439 Toxoplasma Ab a50772 35.00 40213441 Barbiturates Qnt 105.60 40213442 Comp Metabolic Panel 26.08 40213443 Lipid Panel 33.06 40213444 Allergen Spec IgE Qnt a50157 38.64 40213445 Allergen Spec IgE Qual a50157 19.68 40213446 Immundiffusion a50157 207.06 40213447 Aspergillus Ab a50157 185.90 40213448 Ethyl Glucuronide 228.00 40213449 Filaria Ab IgG4 165.00 40213450 CKMB CREAT/KINASE MB FRACTION 363.80 40213452 Chemiluminescent Assay 34.00 40213453 PTH Antibody 374.00

40213454 Familial TTR Sequencing 1,100.00 40213455 Complement Component 5 67.20 40213456 Complement Component 1Q 134.00 40213457 Pregabalin 228.00 40213458 Influenza A a60281 30.00 40213459 Influenza B a60281 30.00 40213460 ParaInfluenza a60281 30.00 40213461 Adenovirus a60281 30.00 40213462 Infectious Ag nonspec a60281 30.00 40213463 PBG Deaminase Erythrocyte 99.68 40213464 *BRCA1 & BRCA2 Sequencing 4,791.68 40217440 AFP Total & L3 % 314.70 40217441 Des-gamma-carboxy Prothrombin 285.30 40217442 Streptolysin O Antibody (ASO) 52.50 40217443 HIT PF4 IgG 78.70 40300004 DIAG CATH LAB SECONDARY PROC 8,908.80 40300005 CATH LAB TIME FIRST 30 MIN 8,908.80 40300006 CATH LAB TIME EACH ADD'L MIN 148.60 40300011 IC CATH TIME FIRST 30 MIN 17,814.90 40300012 IC CATH TIME EA ADD'L MIN 296.90 40300252 INTRODUCER REMINGTON 7009 338.30 40300360 OBTURATOR 10 CM 5 FR XX501 59.70 40300380 WIRE/CORDIS .025 X 260 CM 285.40 40300382 FILTER WIRE 20100-300 5,432.10 40300383 PRESS PROTECT STATION 64000936 124.70 40300400 MEDTRONIC STERILE SLEEVE 6177 101.20 40300419 DRAPE RADIAL/FEMORAL STERILE 125.00 40300450 FL DEL SYS 91300004 27.40 40300501 KIT/GENERAL SUPPLY OR ESSENT 305.90 40300502 INTRODUCER/SHEATH 229.50 40300504 DISP OXISENSOR 168.50 40300610 PACK/PACEMAKER 1,599.20 40300615 KIT/SWAN GANZ OR CENTRAL VEN 544.00 40300617 TORQUE DEV MILTI 92.00 40300633 CABLE/DISP PACE LOC 194.30 40300634 CABLE/ALLIGATOR CLIP 156.10 40300638 PACK/ CARDIAC CATH 335.50 40300690 LEAD/ST JUDE TENDRIL 58 2088TC 5,108.30 40300695 LEAD ENDOTAK RELAINCE 4 029 26,523.90 40300850 PRIME WIRE PRESTIGE PLUS 9185 1,913.80 40300851 EAGLE EYE PLATINUM 85900P 2,050.40 40300900 CON 6F IM 3896926 437.40 40300901 CON 6F IM 08641201 67.00 40300903 TERUMO 5FR ANG/TAP GLIDE CG508 283.00 40300904 TERUMO RUNTHRU 180CM 251011 389.60 40300950 REVEAL LINQ MONITOR LNQ11 15,229.70 40301003 CATHETER BS 7 FR CLS 3.5 265.90 40301035 CATH/ ST JUDE ASSORT 123.60 40301038 CATH/ IMPULSE ASSORT 114.90

40301041 CATH/ASSORTED 282.50 40301044 CATH/RENAL GUIDE 605.70 40301049 CATH/BOSTON SCI WILLIAMS 08526 100.90 40301055 CATH/TERUMO TIGER 4.0 405011 211.70 40301057 CATH/TERUMO JACKY 4.0 405024 210.00 40301058 TERUMO TR BAND XX RF06L 229.10 40301065 CATH/GLIDECATH 508.70 40301076 FIBER OPTIC INTRA AORTIC 40CC 3,105.00 40301077 TERUMO JACKY 4.0 5FR 405023 210.00 40301200 GUIDEWIRE/CON CHOICE ES 12135 366.30 40301213 GUIDEWIRE/ 367.80 40301214 GUIDEWIRE/WHOLLY 532.10 40301217 WIRE/BMW 190 ELITE 1011882 751.90 40301220 CATH/CON GUIDEWIR LUGE 1213001 1,831.70 40301304 LEAD ACUITY SPIRAL 4677 20,488.20 40301305 ICD/INOGEN X4 CRT-D G148 99,931.90 40301306 LEAD/ACUITY X4 SPIRAL 4674 20,488.20 40301307 LEAD/ACUITY X4 SPIRAL L 94CM 20,488.20 40301312 ICD/EMBLEM ELEC 45 SUB-Q 3401 24,001.10 40301313 PACE/LEAD INGEVITY 7741 3,545.60 40301314 PACE/ESSENTIO SR MRI L110 28,681.30 40301316 PACE/LEAD INGEVITY 7740 3,545.60 40301318 PACE/ESSENTIO DR MRI L111 32,827.00 40301321 PACE/LEAD INGEVITY 7742 3,545.60 40301323 ADAPTER Y LUMEN 0.125 66.60 40301325 SYNERGY MR 3.00 X 20 8,633.30 40301326 ICD/DYNAGEN CRTD G151 99,864.80 40301327 PACE/VALITUDE X4 CRT-P 31,459.50 40301329 ICD/AMPLIA MRI CRT-D 108,382.70 40301330 CELLULAR USB ADAPTER LATITUDE 417.50 40301333 ICD/MRI EMBELEM SUB-Q 92,836.50 40301335 ANGIOSCULPT BALLOON 2.0 X 10MM 1,745.50 40301337 GLIDESHEATH SLENDER A KIT 220.30 40301338 ANGIOSCULPT BALLOON 3.0 X 10MM 1,745.50 40301339 GLIDESHEATH/SLENDER 5FR 45CM 220.30 40301340 SYNERGY MR 2.25 X 8 8,633.30 40301341 SYNERGY MR 4.00 X 12 8,633.30 40301342 SYNERGY MR 2.75 X 28 8,633.30 40301343 SYNERGY MR 3.50 X 28 8,633.30 40301344 SYNERGY MR LONG 2.75 X 38 8,633.30 40301345 SYNERGY MR LONG 2.75 X 32 8,633.30 40301347 SYNERGY MR 3.00 X 8 8,633.30 40301349 SYNERGY MR 4.00 X 16 8,633.30 40301350 SYNERGY MR LONG 2.50 X 32 8,633.30 40301352 SYNERGY MR 4.00 X 28 8,633.30 40301353 SYNERGY MR LONG 2.50 X 38 8,633.30 40301354 GUIDEZILLA II 6FR 828.70 40301356 IMPELLA CP PUMP SET 56,646.00 40301357 SYNERGY MR 4.00 X 20 8,633.30

40301358 SYNERGY MR LONG 3.50 X 38 8,633.30 40301359 SYNERGY MR LONG 4.00 X 38 8,633.30 40301360 SYNERGY MR 3.00 X 28 8,633.30 40301361 SYNERGY MR 2.5 X 38 8,633.30 40301362 SYNERGY MR LONG 3.50 X 32 8,633.30 40301363 SYNERGY MR LONG 3.00 X 38 8,633.30 40301365 SYNERGY MR 2.50 X 28 8,633.30 40301367 SYNERGY MR 2.75 X 8 8,633.30 40301368 SYNERGY MR 2.50 X 8 8,633.30 40301369 ICD/EVERA MRI XT DR DDMB1D1 80,773.00 40301372 TR BAND REGULAR 165.00 40301373 ICD/VISIA MRI DVFB1D1 75,000.00 40301374 ICD/DYNAGEN CRT-D DF4 G150 95,200.00 40301375 SYNERGY MR LONG 3.00 X32 8,230.00 40301377 PHOTON BLADE 550.00 40301378 REVEAL BIOMONITOR 2-AF 40,000.00 40301379 FLEX-STR 0.025 X SS KIT 6FR 210.00 40301381 COVER LF IVAS TRANSDUCER 52.00 40301382 GUARDIAN II NC HEMO VALVE 210.00 40301383 ICD/DYNAGEN EL ICD DR D152 26,576.00 40301384 ICD/EMBELM S-ICD 3501 22,000.00 40301385 PROGLIDE VASC CLOSURE SYS 6F 370.00 40301386 CATH/CON CONVEY 6F LBU 3.5 153.00 40301391 PACE/EDORA 8 DR-T 407145 38,028.00 40301401 KIT/SWAN GANZ 7 FR 720.50 40301450 SMART NEEDLE 556.00 40301451 COOK NEEDLE 18X9 G00273 26.70 40301500 CATH FEMORAL CURVE 6FR 08641 67.00 40301501 CATHETER ANG 145 PIGTL 0864124 67.00 40301505 STRAIGHT ZIP WIRE 260CM 46317B 191.10 40301550 ABBOTT/HI TORQUE .014 222 389.60 40303025 ICD/UNIFY ASSURA BI-V CD335740 187,244.10 40303030 ICD/ELLIPSE VR CD141136C 122,691.30 40303035 ICD/DYNAGEN MINI VR D020 86,700.30 40303045 ICD/DYNAGEN EL VR DF4 D150 90,150.00 40303101 PACE/ESSENTIO DR L101 26,435.60 40303431 BALLOON/STERLING 1,519.70 40303991 STENT/REBEL 12 MM H74939275 4,944.50 40304002 EMERGE CATHETER H749391891 2,146.00 40304003 CON 6F FL4 3896907 437.40 40304004 EMERGE PUSH WIRE H74939190150 2,146.00 40304005 CON 5F SHEATH H7491603505B1 478.50 40304007 NC QUANTUM MR 12 H7493912412 2,146.00 40304008 CATH EXPORTAP EX MED EXPORTAP 1,900.00 40304009 ANGIOSEAL VIP 6 FR 610130 874.90 40304013 ANGLED ZIP WIRE 260CM 46316B 191.10 40304020 MYNXACE CLOSURE MX6740 448.50 40304050 T AIRWAY ADAPT LEUR LOC 766527 120.30 40305000 PACE ASSURITY PM2240 37,898.90

40305754 PLASMA BLADE 3.OS PS210030 680.80 40306379 KIT/AMPLATZ SNARE 1,278.20 40309100 SYRINGE 12ML H965700870071 63.00 40309109 ACIST DISP HAND CONTROL 305.90 40309110 ACIST DISP MANIFOLD 267.70 40309111 ACIST DISP SYRINGE 338.30 40309208 ADHESIVE/DERMABOND 213.30 40309220 CLOSURE DEVICE/FEMSTOP 3,612.50 40309221 FEMOSTOP GOLD 482.20 40309320 SHEATH/CORDIS STERILE FR 0-9 100.30 40309338 PACE/REPOSITIONING SLEEVE 82.00 40309341 STENT/NON COAT/COV'D W/DEL SYS 6,281.20 40392978 IVUS HEART INIT VESSEL ADD-ON 5,171.60 40392979 IVUS HEART EA ADD'L VESSEL ADD 5,372.70 40393571 HEART FFR INIT VESSEL ADD ON 3,527.10 40393572 HEART FFR EA ADD'L VESS ADD-ON 3,912.20 40400010 PHASE II CARDIAC REHAB 350.90 40400020 PHASE III CARDIAC REHAB 9.30 40400030 PHASE II PULM REHAB W/O COPD 888.40 40400040 PHASE III PULMONARY REHAB 9.30 40400424 PHASE II PULM REHAB W/ COPD 954.20 41000042 Proc CMV testing Supplier 258.70 41000046 Cryo Proc Fee 504.70 41000049 FFP Proc Fee 396.00 41000051 FFP Thaw 431.00 41000070 PTL Pher L/R proc fee 3,413.70 41000078 PLT Pher Proc Fee L/R Irrad 3,670.90 41000082 Pooling Blood Product 134.60 41000086 RBC L/R proc fee 1,355.70 41000093 Red Cell Proc Fee L/R Irrad 1,622.80 41000100 Rh Immune Globulin 545.80 41000133 CRYO proc fee #2 504.70 41000134 CRYO proc fee #3 504.70 41000135 CRYP proc fee #4 504.70 41000136 CRYO proc fee #5 504.70 41000417 Plasma Frozen 24 Proc Fee 396.00 41100001 ECHO CONG TRANSTH COMP W/O CON 1,768.80 41100002 ECHO CONG TRNSTHO LMTD W/O CON 1,305.40 41100004 2-D ECHO LIMITED W/O CONT 1,036.00 41100005 TRANSESOPHAG ECHO-TEE W/O CONT 3,297.20 41100007 CARDIAC DOPPLER COMP 959.10 41100008 CARDIAC DOPLER LIMIT 487.00 41100009 COLOR FLOW MAP 953.10 41100010 STRESS ECHO 2,681.00 41100011 D S EXT-CRAIN ART COMPL 2,009.90 41100012 D S EXT-CRAIN ART LIM 1,393.10 41100013 ART EXT STDY SNGL LEV LMTD 632.30 41100015 D S LOWER EXT COMP 1,689.50 41100016 D S LOWER EXT UNILAT 1,255.10

41100017 D S UPPER EXT BILAT 1,290.20 41100018 D S UPPER EXT UNILAT 1,255.10 41100019 D S EXT COMPLETE 1,850.60 41100020 VENOUS EXT LIMITED 1,272.30 41100021 ART EXT COMP W/O TRDMILL -CALF 930.10 41100028 D S ABD/PEL/SCRO/RETRO LIMITED 1,268.80 41100029 2-D ECHO/M-MODE COMP W/O CONT 4,067.90 41100032 DS HEMO ACCESS 1,147.60 41100104 2-D ECHO LIMITED INTRP 459.60 41100105 ECHO/TRANSEOPHAGEAL INTR 1,342.30 41100107 CARDIAC DOPPLER COMP INTR 278.80 41100108 CARDIAC DOPLER LIMIT INTR 118.20 41100109 COLOR FLOW MAP INTER 58.50 41100110 STRESS ECHO INTERP 689.50 41100111 D S EXT-CRAIN ART C INTER 368.30 41100112 D S EXT-CRAIN ART L INTER 258.30 41100113 ART EXT STDY SNGL LEV LMTD INT 184.30 41100115 D S LOWER EXT COMP INTRP 368.30 41100116 D S LOWER EXT UNILAT INTR 241.00 41100117 D S UPPER EXT BILAT INTRP 315.00 41100118 D S UPPER EXT UNILAT INTERP 204.80 41100119 D S EXT COMPLETE INTRP 425.20 41100120 VENOUS EXT LIMITED INTRP 278.80 41100121 ART EXT COMP W/O TRDMILL INTER 350.90 41100128 DS ABD/PEL/SCRO/RETRO LIM INT 286.90 41100129 2-D ECHO/M-MODE COMP INTERP 949.40 41100132 DS HEMO ACCESS INTERP 332.60 41100404 2-D ECHO LIMITED W/CONT 1,685.40 41100405 TRANSOPHAGEAL ECHO TEE W/CONT 4,050.10 41100410 STRESS ECHO W/CONTRAST 2,995.70 41100429 2-D ECHO/M-MODE COMP W/CONT 4,370.80 41200001 EVENT MONITOR 1,040.80 41200012 EKG W/O INTERP 380.10 41200020 HOLTER MONITOR HOOKUP TO 48HRS 1,728.60 41200021 HOLTER MONITOR SCAN TO 48HRS 1,911.20 41200101 EVENT MONITOR INTERP 414.20 41200112 EKG INTERP 91.40 41200120 INTERP HOLTER MONITOR TO 48HRS 828.30 41200297 HOLTER MONITOR SCAN > 48HRS 3,322.70 41206001 STRESS TESTING 1,433.40 41293018 STRESS TEST INTERP 414.20 41400110 MVV 318.10 41400115 SPIROMETRY PRE/POST B.D. 661.80 41400130 *PULMONARY EXERCISE STUDY 595.00 41400135 SCREENING SPIROMETRY 530.30 41400140 BEDSIDE SPIROMETRY 173.80 41400210 INTERP MVV 98.30 41400215 INTERP SPIROMETRY PRE/POST B D 230.20 41400235 INTERP SCREENING SPIROMETRY 128.80

41404726 INTERP PULM FUNCT PLETHYSMOGRA 95.90 41404729 INTERP CO/MEMBRANE DIFFUSE CA 168.50 41494618 PULMONARY STRESS TEST/SIMPLE 595.00 41494669 MECHANICAL CHEST WALL OSCILL 338.00 41494726 PULM FUNCT TEST PLETHYSMOGRAPH 554.50 41494727 PULM FUNCTION TEST BY GAS 444.30 41494729 CO/MEMBRANE DIFFUSE CAPACITY 365.30 41494761 EXERCISE PULSE OX STUDY 332.10 41500003 AEROSOL PENTAMIDINE TX 303.30 41500004 NEBULIZER TX SUB 201.20 41500008 AIRWAY CLEARANCE INITIAL 216.40 41500009 AIRWAY CLEARANCE SUB 125.60 41500010 SPUTUM INDUCTION INITIAL 322.20 41500013 VENT MGMT 1ST DAY 2,787.80 41500014 VENT MGMT SUBSEQUENT DAY 2,787.80 41500015 NEBULIZER TX INITIAL 201.20 41500017 BI-PAP/CPAP 1,028.70 41500150 EXERCISE PULSE OX STUDY 332.10 41500300 PULSE OX CHECK 137.60 41500400 MDI INITIAL 201.20 41500401 MDI SUBSEQUENT 373.00 41500500 ARTERIAL INSERT/DRAW 277.00 41500501 BI-PAP/CPAP LEVEL 2 821.00 41531500 INTUBATION EMERGENCY PROC 1,269.70 41531502 TRACH TUBE CHANGE 981.30 41531720 NASOTRACHEAL CATH ASPIRATION 145.90 41594644 CONT INH TX W/RX 1ST HR 419.60 41594645 CONT INH W/RX EA ADD'L 419.60 41594664 DEMO/EVAL 419.60 41594762 PULSE OX OVERNIGHT 715.90 41600001 SPACER 260.10 41600004 INCENTIVE SPIROMETRY 128.70 41600005 OXYGEN PER HOUR 33.90 41600006 PEAK FLOW SETUP 135.00 41600007 COOL/HEATED AEROSOL SETUP 63.30 41600008 O2 SETUP 54.60 41600009 OXIHOOD INITIAL SETUP 366.80 41600010 AIRWAY CLEARANCE SUPPLY 404.10 41600014 COOL/HEATED AEROSOL/HOUR 33.90 41710006 PEAK FLOW SETUP 135.00 41710012 EKG W/O INTERP 380.10 41710020 HOLTER MONITOR HOOKUP TO 48HRS 1,728.60 41710021 HOLTER MONITOR SCAN TO 48HRS 1,911.20 41710115 SPIROMETRY PRE/POST B.D. 661.80 41710135 SCREENING SPIROMETRY 530.30 41788738 HGB QUANT TRANSCUTANEOUS 30.50 41794070 SPIROMETRY MULTIPLE EVALUATION 1,281.30 41794726 PULM FUNCT TST PLETHYSMOGRAPH 554.50 41794727 PULM FUNCTION TEST BY GAS 444.30

41794729 CO/MEMBRANE DIFFUSE CAPACITY 365.30 41794761 EXERCISE PULSE OX STUDY 332.10 41795070 INHALATION CHALLANGE TEST 935.00 41900399 UNATTEN HOME SLEEP TYPE III 1,490.60 41904001 ADULT EEG AWAKE AND ASLEEP 1,486.70 41904050 CEREBR SEIZURE 16/> CH 24 HR 3,500.00 41905805 INTERP MSLT/MWT - COX 934.60 41905810 INTERP/ATTEN SLEEP STUDY - COX 1,456.10 41905811 INTERP/ATTEN SLEEP W/CPA - COX 1,671.70 41905813 INTERP EEG EXT MONITOR > 1 HR 828.10 41910399 INTRP UNATT HOME SLEEP TYPEIII 772.90 41914001 INTERP EEG AWAKE AND ASLEEP 303.70 41995805 MSLT/MWT - COX 3,945.50 41995810 ATTEN SLEEP STUDY - COX 6,880.90 41995811 ATTEN SLEEP STUDY W/CPAP - COX 7,898.40 41995813 EEG EXT MONITORING > 1 HR 1,852.60 41995951 INTER CEREB SEIZR 16/> CH 24HR 889.00 42070110 MANDIBLE COMPLETE 4+ VIEWS 983.00 42070160 NASAL BONES 3+ VIEWS 856.60 42070260 SKULL COMPLETE MINIMUM 4 VIEWS 761.70 42070360 NECK SOFT TISSUE 692.20 42071020 *CHEST 2 VIEWS PA & LAT 559.80 42071046 X-RAY EXAM CHEST 2 VIEWS 560.10 42071100 RIBS UNILATERAL 2 VIEWS 761.70 42071101 RIBS UNILAT W/PA CHEST 3+ VWS 998.70 42071110 RIBS BILATERAL 3 VIEWS 1,147.20 42072040 C-SPINE 2 OR 3 VIEWS 766.10 42072050 C-SPINE 4 OR 5 VIEWS 951.40 42072072 T-SPINE 3 VIEWS 916.60 42072100 L-SPINE 2 OR 3 VIEWS 737.70 42072110 L-SPINE 4+ VIEWS 1,046.50 42072114 L-SPINE COMP W/BEND MIN 6 VWS 1,261.10 42072170 PELVIS 1 OR 2 VIEWS 495.50 42072202 SACROILIAC JOINT 3+ VIEWS 951.40 42072220 SACRUM & COCCYX 951.40 42073000 CLAVICLE COMPLETE 588.10 42073010 SCAPULA COMPLETE 588.10 42073030 SHOULDER 2+ VIEWS 610.60 42073060 HUMERUS 2+ VIEWS 558.00 42073080 ELBOW COMPLETE 3+ VIEWS 575.20 42073090 FOREARM 2 VIEWS 550.10 42073110 WRIST 3+ VIEWS 588.10 42073130 HAND 3+ VIEWS 769.80 42073140 DIGITS FINGER(S) 2+ VIEWS 518.40 42073502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 42073521 X-RAY EXAM HIPS BI 2 VIEWS 717.90 42073522 X-RAY EXAM HIPS BI 3-4 VIEWS 745.10 42073523 X-RAY EXAM HIPS BI 5/> VIEWS 842.90 42073552 X-RAY EXAM OF FEMUR 2/> 574.50

42073562 KNEE 3 VIEWS 653.10 42073564 KNEE COMPLETE 4 VIEWS 809.10 42073565 KNEE BILATERAL AP/STANDING 847.70 42073590 TIBIA & FIBULA 2 VIEWS 572.20 42073610 ANKLE COMPLETE 3+ VIEWS 721.20 42073630 FOOT COMPLETE 3+ VIEWS 654.50 42073650 HEEL CALCANEUS 2+ VIEWS 572.20 42073660 TOE(S) 2+ VIEWS 572.20 42074018 X-RAY EXAM ABDOMEN 1 VIEW 504.70 42074019 X-RAY EXAM ABDOMEN 2 VIEWS 738.80 42074020 *ABD COMP INC DECUB/ERECT VIEW 738.50 42077072 BONE AGE STUDIES 429.90 42103100 WRISTS 2 VIEWS RA SURVEY 1,074.50 42103130 HANDS 3+ VIEWS RA SURVEY 1,175.90 42120501 IP SINUS TRACT DX 445.70 42123350 IP SHOULDER ARTHROGRAM 681.00 42125246 IP WRIST ARTHROGRAM 445.70 42127093 IP HIP ARTHRO W/O ANESTHESIA 445.70 42127370 * IP KNEE ARTHROGRAM 465.20 42136005 IP CONTRAST VENOGRAPHY 1,668.30 42136598 CONTRAST EVAL VAD 1,036.90 42147531 INJ FOR CHOLANGIOGRAM 4,733.00 42150690 IP VISUAL ILEAL COND/URETPYELO 891.10 42151600 IP CYSTO/VOIDING URETHROCYSTO 1,305.70 42158340 CATH INTRO NA/CONTRAST HYSTERO 1,781.90 42162270 SPINAL PUNCTURE LUMBAR DIAG 1,441.30 42162272 SPINAL PUNCTURE - THERAPEUTIC 1,781.90 42162302 MYELOGRAPHY C-SPINE 8,998.70 42162303 MYELOGRAPHY T-SPINE 8,998.70 42162304 MYLEOGRAPHY L-SPINE 8,998.70 42170100 PANELIPSE-MANDIBLE <4 VIEWS 826.50 42170110 MANDIBLE - COMPLETE 4+ VIEWS 983.00 42170140 FACIAL BONES < 3 VIEWS 761.70 42170150 FACIAL BONES COMPLETE 3+ VIEWS 856.60 42170160 NASAL BONES 3+ VIEWS 856.60 42170200 ORBITS - 4+ VIEWS 951.40 42170220 SINUSES/PARANASAL-COMPLETE 3+ 951.40 42170250 SKULL <4 VIEWS W-W/O STEREO 743.10 42170260 SKULL COMPLETE MINIMUM 4-VWS 761.70 42170330 TMJ BILATERAL OPEN & CLOSED 951.40 42170360 NECK - SOFT TISSUE 692.20 42171010 *CHEST - 1 VIEW FRONTAL 477.50 42171020 *CHEST 2 VIEWS PA & LAT 559.80 42171023 *CHEST - 2 VIEWS W/FLUOROSCOPY 881.40 42171045 X-RAY EXAM CHEST 1 VIEW 477.60 42171046 X-RAY EXAM CHEST 2 VIEWS 560.10 42171100 RIBS UNILATERAL 2 VIEWS 761.70 42171101 RIBS UNILAT W/PA CHEST 3+ VIEW 998.70 42171110 RIBS BILATERAL 3 VIEWS 1,147.20

42171111 RIBS BILAT W/PA CHEST 4+ VIEWS 1,261.10 42171120 STERNUM 2 VIEWS 644.90 42172020 SPINE 1 VIEW SPECIFY LEVEL 441.80 42172040 C-SPINE 2 OR 3 VIEWS 766.10 42172050 C-SPINE 4 OR 5 VIEWS 951.40 42172052 C-SPINE COMP W/OBLIQUE & FLEX 1,283.20 42172070 T-SPINE 2 VIEWS 697.10 42172072 T-SPINE 3 VIEWS 916.60 42172074 T-SPINE 4+ VIEWS 1,093.60 42172080 THORACOLUMBAR JUCTION 2 VIEWS 718.40 42172081 X-RAY EXAM ENTIRE SPI 1 VW 882.50 42172082 X-RAY EXAM ENTIRE SPI 2/3 VW 926.00 42172083 X-RAY EXAM ENTIRE SPI 4/5 VW 1,023.80 42172100 L-SPINE 2 OR 3 VIEWS 737.70 42172110 L-SPINE MIN 4 VIEWS 1,046.50 42172114 L-SPINE COMP W/BEND MIN 6 VWS 1,261.10 42172120 L-SPINE BENDING ONLY 2-3 VIEWs 875.60 42172170 PELVIS 1 OR 2 VIEWS 495.50 42172190 PELVIS COMPLETE 3+ VIEWS 951.40 42172200 SACROILIAC JOINT <3 VIEWS 591.20 42172202 SACROILIAC JOINTS 3+ VIEWS 951.40 42172220 SACRUM & COCCYX 2+ VIEWS 951.40 42172285 DISKOGRAPHY CERVICAL/THORACIC 4,834.20 42172295 DISKOGRAPHY LUMBAR 6,901.60 42173000 CLAVICLE - COMPLETE 588.10 42173010 SCAPULA COMPLETE 588.10 42173020 SHOULDER 1 VIEW 518.40 42173030 SHOULDER 2+ VIEWS 610.60 42173040 SHOULDER ARTHROGRAPHY 1,698.30 42173050 ACROMIOCLAVICULAR JOINTS BIL 567.30 42173060 HUMERUS 2+ VIEWS 558.00 42173070 ELBOW 2 VIEWS 537.50 42173080 ELBOW COMPLETE 3+ VIEWS 575.20 42173090 FOREARM 2 VIEWS 550.10 42173100 WRIST 2 VIEWS 554.30 42173110 WRIST 3+ VIEWS 588.10 42173115 WRIST ARTHROGRAPHY 1,125.30 42173120 HAND 2 VIEWS 681.10 42173130 HAND 3+ VIEWS 769.80 42173140 DIGITS-FINGER(S) 2+ VIEWS 518.40 42173501 X-RAY EXAM HIP UNI 1 VIEW 424.60 42173502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 42173503 HIP UNI 4+ VIEWS W/PELVIS 543.80 42173521 X-RAY EXAM HIPS BI 2 VIEWS 717.90 42173522 X-RAY EXAM HIPS BI 3-4 VIEWS 745.10 42173523 X-RAY EXAM HIPS BI 5/> VIEWS 842.90 42173525 HIP ARTHROGRAPHY 1,294.70 42173551 X-RAY EXAM OF FEMUR 1 547.30 42173552 X-RAY EXAM OF FEMUR 2/> 574.50

42173560 KNEE 1 OR 2 VIEWS 572.20 42173562 KNEE 3 VIEWS 653.10 42173564 KNEE COMPLETE 4+ VIEWS 809.10 42173565 KNEE BILATERAL AP/STANDING 847.70 42173580 KNEE ARTHROGRAPHY 1,320.80 42173590 TIBIA & FIBULA 2 VIEWS 572.20 42173592 EXTREMITY-LOWER INFANT 2+ VIEW 458.50 42173600 ANKLE 2 VIEWS 692.90 42173610 ANKLE COMPLETE 3+ VIEWS 721.20 42173620 FOOT 2 VIEWS 603.10 42173630 FOOT COMPLETE 3+ VIEWS 654.50 42173650 HEEL CALCANEUS 2+ VIEWS 572.20 42173660 TOE(S) 2+ VIEWS 572.20 42174000 *ABDOMEN A/P 1 VIEW 504.40 42174018 X-RAY EXAM ABDOMEN 1 VIEW 483.00 42174019 X-RAY EXAM ABDOMEN 2 VIEWS 738.80 42174020 *ABD COMP INC DECUB/ERECT VIEW 738.50 42174022 ACUTE ABD SUP/ERECT W/1V CHEST 880.50 42174220 RADIOLOGIC EXAM ESOPHAGUS 874.60 42174230 SWAL FUNCT W/CINERAD/VIDEO/RAD 950.30 42174240 UGI W-W/O DELAYED FILM W/O KUB 1,404.30 42174241 UGI W-W/O DELAYED FILM W/KUB 1,192.30 42174245 UGI W/SMALL INTESTINE SERIES 1,811.60 42174246 UGI AIR CONTRAST W/O KUB 1,343.30 42174247 UGI AIR CONTRAST W/KUB 1,582.50 42174249 UGI AIR CONTRAST W/SBFT 1,920.40 42174250 SMALL INTESTINE SERIES 1,171.00 42174270 LGI-COLON BA ENEMA W-W/O KUB 1,320.50 42174280 LGI AIR CONTRAST W/BARIUM 1,969.80 42174290 CHOLECYSTOGRAM ORAL CONTRAST 942.30 42174300 CHOLANGIO/PANCRETOGRAM INTRAOP 1,291.90 42174330 ERCP BILIARY/PANCREATIC DUCTS 2,061.20 42174425 URO-ANTEGRADE LOOPO/PYELO/NEPH 1,219.70 42174455 URETHROCYSTOGRAM VOIDING 1,210.10 42174740 HYSTEROSALPINGOGRAM 809.90 42175820 VENOGRAM EXTREMITY UNILATERAL 3,197.70 42175822 VENOGRAM EXTREMITY BILATERAL 2,081.70 42176000 FLUOROSCOPY - UP TO 1 HOUR 1,051.20 42176010 FB NOSE TO RECTUM CHILD 1 VIEW 530.80 42176080 FISTULA-ABSCESS-SINUS TRACT 813.00 42177001 CVAD FLUORO 1,289.80 42177002 FLUORO NEEDLE PLACE BX/ASP/INJ 862.30 42177072 BONE AGE STUDIES 429.90 42177073 BONE LENGTH - SCANOGRAM 667.10 42177074 BONE SURVEY LIMITED-METASTASES 1,415.00 42177075 BONE SURVEY COMP AXIAL/APPEND 1,481.90 42177076 BONE SURVEY - INFANT 742.90 42206816 US PREG UTERUS F/U PER FETUS 1,288.30 42206819 FETAL BIOPHY PROF W/O NON-STRS 1,308.60

42210035 PERQ DEV SOFT TISS 1ST IMAG 1,146.00 42210160 PUNCTURE/DRAIN ABSCESS 461.90 42219000 PUNCT ASP CYST BREAST 986.30 42219083 BX BREAST 1ST LESION US IMAG 5,242.20 42219084 BX BREAST ADD LESION US IMAG 3,931.80 42219285 PERQ DEV BRST 1ST US IMAG LO/C 4,446.00 42232555 THORACENTESIS PLEU ASP W/GUID 3,064.50 42242400 BIOPSY SALIVARY GLAND; NEEDLE 1,800.00 42247001 BX LIVER PERCUT W/PROCEDURE 881.40 42249083 ABD PARACENT W/IMAGE GUIDE 1,739.60 42258340 CATH INTRO NA/CONTRAST HYSTERO 1,781.90 42260100 BX THYROID PERCUT CORE NEEDLE 977.30 42260300 ASP/INJ THYROID CYST 1,846.90 42276506 ECHO EXAM OF HEAD 1,008.20 42276536 SOFT TISSUE HEAD / NECK 1,223.40 42276604 CHEST 1,504.60 42276641 US BREAST COMPLETE UNILATERAL 919.80 42276642 US BREAST LIMITED UNILATERAL 919.80 42276700 ABDOMEN COMPLETE 2,170.80 42276705 ABDOMEN LIMITED 1,296.30 42276770 RETROPERITONEAL COMPLETE 1,623.10 42276775 RETROPERITONEAL LIMITED 1,320.10 42276800 US SPINAL CANAL & CONTENTS 1,757.30 42276801 US OB 1ST TRI SGL GESTATION 1,874.20 42276802 US OB EA ADD'L GEST 1ST TRI 1,071.40 42276805 US PREGNANT UTERUS COMPL >14WK 1,877.30 42276810 US OB EA ADD'L GEST AFTER 14WK 1,071.40 42276811 US OB DETAILED SNGL FETUS 1,534.30 42276815 OB - LIMITED 1,071.40 42276816 US PREG UTERUS F/U PER FETUS 1,288.30 42276817 US OB TRANSVAGINAL 1,213.70 42276819 FETAL BIOPHY PROF W/O NON-STRS 1,308.60 42276820 FETAL UMBILICAL ARTERY DOPPLER 889.90 42276830 US NON OB TRANSVAGINAL 1,308.60 42276831 US SALINE INFUS SONOHYSTEROGRP 958.50 42276856 PELVIC COMPLETE 1,345.80 42276857 PELVIC LIMITED / FOLLOW-UP 1,071.40 42276870 TESTICULAR / SCROTUM 1,373.90 42276881 US EXT NON-VASC W/IMAGE COMP 1,174.40 42276882 US EXT NON-VASC W IMAGE LMTD 759.10 42276886 HIPS INFANT LIMITED W/O MANIP 951.40 42276937 US GUIDED VASC ACCESS 759.10 42276942 GUIDED NEEDLE BX/ASP/INJ/LOCAL 1,864.60 42300117 TECHNE TC99M MERTIATIDE/MCI 1,239.40 42300207 I-123 SODIUM CAPSULE / 100 UCI 586.30 42309500 TC99M SESTAMIBI DIAG/STDY DOSE 1,298.40 42309502 TECHNE TC99M TETRO DIAG < 40 1,388.20 42309505 TL201 THALLIUM DIAG/MCI 665.70 42309528 I 131 CAPSULES DIAG/MCI 885.20

42309537 TC99M MEBROFENIN DIAG < 15 MCI 480.70 42309538 TC99M PYP DIAG < 25 MCI 480.70 42309540 TC99M MAA DIAG < 10 MCI 494.20 42309541 TC99M SULF COLLOID DIAG<20 MCI 484.80 42309561 TC99M OXIDRONATE DIAG < 30 MCI 480.70 42309969 NON-HEU TC-99M ADD-ON PER DOSE 10.00 42378014 THYROID IMAGING INC SIM/SUP/DC 1,879.40 42378018 THYROID METASTASES WHOLE BODY 2,327.40 42378070 PARATHYROID SCAN 2,113.70 42378195 LYMPHATIC & LYMPH NODES SCAN 2,516.30 42378226 HEPATOBILIARY (HIDA) SCAN 2,429.50 42378227 HEPATOBILIARY (HIDA) W/DRUG 2,608.40 42378264 GASTRIC EMPTYING SCAN 2,462.80 42378300 BONE-JOINT SCAN LIMITED 1,984.60 42378306 BONE-JOINT SCAN WHOLE BODY 2,367.60 42378315 BONE-JOINT SCAN 3 PHASE 3,160.90 42378451 MYCARDIAL SCAN SPECT SINGLE 4,518.80 42378452 MYCARDIAL SCAN SPECT MULTIPLE 6,077.80 42378466 MYOCARDIAL INFARCT SCAN 1,823.50 42378580 LUNG PERFUSION SCAN 1,619.80 42378582 LUNG VENT & PERFUSION IMAGING 2,369.80 42378708 RENAL VASCULAR FLOW ONLY SCAN 2,724.20 42378803 RADIOPHARM LOCAL TUMOR SPECT 2,748.90 42410022 *FINE NEEDLE ASP W/IMAGING 1,484.60 42410030 GUIDE CATHET FLUID DRAINAGE 1,146.00 42420220 BX BONE SUPERFICIAL-NDL/TROCAR 1,783.90 42420225 BX BONE DEEP-NEEDLE/TROCAR 2,352.00 42432405 BX LUNG/MEDIASTINUM PERC NDL 3,284.60 42447000 BX LIVER PERCUTANEOUS NEEDLE 3,284.60 42447001 BX LIVER PERCUT W/PROCEDURE 881.40 42449180 BX ABD/RETROPERITONEAL MASS 1,846.90 42450200 BX RENAL PERCUT TROCAR/NEEDLE 1,846.90 42450390 ASP/INJ RENAL CYST/PELVIS 1,846.90 42470450 CT HEAD/BRAIN W/O CONTRAST 2,664.50 42470460 HEAD OR BRAIN W/CONTRAST 2,574.50 42470470 HEAD OR BRAIN W/0 & W/CONTRAST 3,679.40 42470480 CT ORBIT SELLA IAC W/O CONTRST 2,718.50 42470481 ORBIT SELLA IAC W/CONTRAST 2,656.90 42470482 ORBIT SELLA IAC W/O & W/CNTRST 3,789.20 42470486 CT MAXILLOFACIAL W/O CONTRAST 2,590.70 42470487 MAXILLOFACIAL W/CONTRAST 3,175.40 42470488 MAXILLOFACIAL W/O & W/CONTRAST 3,715.20 42470490 CT SOFT TIS NECK W/O CONTRAST 2,969.40 42470491 SOFT TISSUE NECK W/CONTRAST 3,252.70 42470496 ANGIOGRAM HEAD W/O & W/CNTRAST 4,399.00 42470498 ANGIOGRAM NECK W/O & W/CNTRAST 4,238.50 42471250 CT CHEST W/O CONTRAST 2,852.70 42471260 CHEST W/CONTRAST 3,861.00 42471270 CHEST W/O & W/CONTRAST 4,034.40

42471275 ANGIOGRAM CHEST W/O & W/CNTRST 4,850.50 42472125 CT C-SPINE W/O CONTRAST 3,219.30 42472126 C-SPINE W/CONTRAST 3,601.00 42472127 C-SPINE W/O & W/CONTRAST 3,700.30 42472128 CT T-SPINE W/O CONTRAST 3,377.40 42472129 T-SPINE W/CONTRAST 4,050.30 42472131 CT L-SPINE W/O CONTRAST 3,552.30 42472132 L-SPINE W/CONTRAST 4,106.00 42472192 CT PELVIS W/O CONTRAST 3,020.30 42472193 PELVIS W/CONTRAST 3,909.30 42472194 PELVIS W/O & W/CONTRAST 4,409.90 42473200 CT UPPER EXTREMTY W/O CONTRAST 2,682.60 42473201 UPPER EXTREMITY W/CONTRAST 2,893.10 42473202 UPPER EXTRMTY W/O & W/CONTRAST 3,540.50 42473206 ANGIOGRAM UPPER EXT W/O & WITH 3,200.40 42473700 CT LOWER EXTREMTY W/O CONTRAST 2,858.00 42473701 LOWER EXTREMITY W/CONTRAST 2,923.50 42473706 ANGIOGRAM LOWER EXT W/O & WITH 4,984.70 42474150 CT ABDOMEN W/O CONTRAST 2,870.00 42474160 ABDOMEN W/CONTRAST 3,783.00 42474170 ABDOMEN W/O & W/CONTRAST 4,490.30 42474174 CT ANGIOGRAPHY ABD/PEL W/WO 7,692.20 42474175 ANGIOGRAM ABDOMEN W/O & W/CNTR 5,003.60 42474176 CT ABDOMEN/PELVIS W/O CONTRAST 5,890.10 42474177 CT ABDOMEN/PELVIS W/CONTRAST 7,692.20 42474178 CT ABDOMEN/PELVIS W & W/O CONT 8,900.20 42475574 CT ANGIO HRT W/3D IMAGE 5,066.10 42475635 ANGIOGRAM ABD AORTA W/O & WITH 5,692.50 42475989 PERC DRNG W/PLC CATH ABS/SPCOL 1,845.90 42476376 CT 3-D IMG W/O INDEP WRK STA 1,351.80 42476377 CT 3-D IMG WITH INDEP WRK STA 2,353.00 42476497 CT LEG LENGTH STUDY 840.70 42477011 CT SCAN FOR LOCALIZATION 1,510.00 42477012 CT GUIDE NDL BX/ASP/INJ/LOCAL 2,879.80 42500001 PICC W/O PORT/PUMP > 5 YRS 3,053.10 42500011 IR PROC TIME 1ST 30 MIN 17,746.90 42500012 IR PROC TIME EA ADD'L MIN 295.80 42520610 INJ PROC ARTH MAJ JNT W/O US 800.90 42536005 VENOGRAM EXTREMITY UNILATERAL 1,668.30 42536584 REPLACE PICC CATH 1,429.60 42544500 LONG GI TUBE INSERT 1,160.10 42547531 INJ FOR CHOLANGIOGRAM 4,733.00 42549465 CONTRAST INJ EVAL GI TUBE 582.10 42550690 VISUAL ILEAL COND/URETPYELO 891.10 42562305 MYLEOGRAPHY 2 OR MORE REG S&I 15,747.70 42574340 LONG TUBE FLUORO 832.70 42574425 URO ANTEGR LOOP/PYELO/NEPH S&I 1,219.70 42575820 VENOGRAPHY UNILATERAL S&I 3,197.70 42577002 FLUORO NEEDLE PLACE BX/ASP/INJ 862.30

42580001 SHEATH 6 FR CON 54.60 42580002 INFL DEVICE KIT ENCORE 26 169.90 42580003 PACK CARDIAC CATH LAB 199.30 42608900 ANGIO ABDOMEN W/CONT 5,432.40 42608901 ANGIOGRAM ABDOMEN W/O CONT 2,299.00 42619085 BX BREAST 1ST LESION MR IMAG 5,242.20 42670336 TEMPOROMANDIBULAR JOINT 4,509.60 42670540 ORBIT-FACE &/OR NECK W/O CONT 4,488.00 42670543 ORBIT-FACE-NECK W/O & W/CNTRST 5,972.40 42670544 ANGIOGRAPHY HEAD W/O CONTRAST 4,164.10 42670547 ANGIOGRAPHY NECK W/O CONTRAST 3,757.30 42670548 ANGIOGRAPHY NECK W/CONTRAST 4,036.50 42670551 BRAIN & STEM W/O CONTRAST 4,981.10 42670552 BRAIN & STEM W/CONTRAST 5,157.80 42670553 BRAIN & STEM W/O & W/CONTRAST 6,843.90 42671550 CHEST W/O CONTRAST 4,509.60 42672141 C-SPINE W/O CONTRAST 4,942.90 42672146 T-SPINE W/O CONTRAST 4,590.00 42672148 L-SPINE W/O CONTRAST 5,154.60 42672149 L-SPINE W/CONTRAST 5,220.40 42672156 C-SPINE W/O & W/CONTRAST 6,515.90 42672157 T-SPINE W/O & W/CONTRAST 7,076.70 42672158 L-SPINE W/O & W/CONTRAST 6,685.70 42672195 PELVIS W/O CONTRAST 4,937.40 42672197 PELVIS W/O & W/CONTRAST 6,861.10 42672198 ANGIOGRAPHY PELVIS W/CONT 3,792.10 42673218 UPPER EXT-NO JOINT W/O CONTRST 4,509.60 42673220 UPPER EXT-NO JOINT W/O & W/CNT 6,357.90 42673221 UPPER EXT-ANY JOINT W/O CNTRST 4,945.80 42673222 UPPER EXT-ANY JOINT W/CONTRAST 5,220.40 42673223 UPPER EXT-ANY JNT W/O & W/CNTR 5,479.70 42673718 LOWER EXT-NO JOINT W/O CONTRST 4,398.90 42673720 LOWER EXT-NO JOINT W/O & W/CNT 6,228.50 42673721 LOWER EXT-ANY JOINT W/O CNTRST 5,066.20 42673722 LOWER EXT-ANY JOINT W/CONTRAST 5,931.50 42673723 LOWER EXT-ANY JNT W/O & W/CNTR 6,228.50 42674181 ABDOMEN W/O CONTRAST 4,411.80 42674183 ABDOMEN W/O & W/CONTRAST 6,623.80 42677058 *MRI BREAST W/O OR W/CONT UNI 4,177.60 42677059 *MRI BREAST W/O OR W/CONT BIL 8,351.80 42703100 WRISTS 2 VIEW RA SURVEY 1,074.50 42703130 HANDS 3+ VIEWS RA SURVEY 1,175.90 42770140 FACIAL BONES < 3 VIEWS 761.70 42770150 FACIAL BONES COMPLETE 3+ VIEWS 856.60 42770160 NASAL BONES 3+ VIEWS 856.60 42770210 SINUSES/PARANASAL < 3 VIEWS 761.70 42770260 SKULL COMPLETE MINIMUM 4 VIEWS 761.70 42770360 NECK SOFT TISSUE 692.20 42771010 *CHEST 1 VIEW FRONTAL 477.50

42771020 *CHEST 2 VIEWS PA & LAT 559.80 42771045 X-RAY EXAM CHEST 1 VIEW 477.60 42771046 X-RAY EXAM CHEST 2 VIEWS 560.10 42771100 RIBS UNILATERAL 2 VIEWS 761.70 42771101 RIBS UNILAT W/PA CHEST 3+ VWS 998.70 42771111 RIBS BILAT W/PA CHEST 4+ VIEWS 1,261.10 42772020 SPINE 1 VIEW SPECIFY LEVEL 441.80 42772040 C-SPINE 2 OR 3 VIEWS 766.10 42772050 C-SPINE 4 OR 5 VIEWS 951.40 42772070 T-SPINE 2 VIEWS 697.10 42772072 T-SPINE 3 VIEWS 916.60 42772074 T-SPINE 4+ VIEWS 1,093.60 42772080 T-L SPINE 2 VIEWS 718.40 42772100 L-SPINE 2 OR 3 VIEWS 737.70 42772110 L-SPINE MIN 4 VIEWS 1,046.50 42772190 PELVIS COMPLETE 3+ VIEWS 951.40 42772220 SACRUM & COCCYX 951.40 42773000 CLAVICLE COMPLETE 588.10 42773010 SCAPULA COMPLETE 588.10 42773030 SHOULDER 2+ VIEWS 610.60 42773060 HUMERUS 2+ VIEWS 558.00 42773070 ELBOW 2 VIEWS 537.50 42773090 FOREARM 2 VIEWS 550.10 42773100 WRIST 2 VIEWS 554.30 42773110 WRIST 3+ VIEWS 588.10 42773120 HAND 2 VIEWS 681.10 42773130 HAND 3+ VIEWS 769.80 42773140 DIGITS FINGER(S) 2+ VIEWS 518.40 42773502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 42773521 X-RAY EXAM HIPS BI 2 VIEWS 717.90 42773522 X-RAY EXAM HIPS BI 3-4 VIEWS 745.10 42773552 X-RAY EXAM OF FEMUR 2/> 574.50 42773560 KNEE 1 OR 2 VIEWS 572.20 42773562 KNEE 3 VIEWS 653.10 42773564 KNEE COMPLETE 4 VIEWS 809.10 42773590 TIBIA & FIBULA 2 VIEWS 572.20 42773600 ANKLE 2 VIEWS 692.90 42773610 ANKLE COMPLETE 3+ VIEWS 721.20 42773620 FOOT 2 VIEWS 603.10 42773630 FOOT COMPLETE 3+ VIEWS 654.50 42773650 HEEL CALCANEUS 2+ VIEWS 572.20 42773660 TOE(S) 2+ VIEWS 572.20 42774000 *ABDOMEN A/P 1 VIEW 504.40 42774018 X-RAY EXAM ABDOMEN 1 VIEW 504.70 42774019 X-RAY EXAM ABDOMEN 2 VIEWS 738.80 42774022 ACUTE ABD SUP/ERECT W/1V CHEST 880.50 42871046 X-RAY EXAM CHEST 2 VIEWS 560.10 42871100 RIBS UNILATERAL 2 VIEWS 761.70 42872040 C-SPINE 2 OR 3 VIEWS 766.10

42872070 T-SPINE 2 VIEWS 697.10 42872081 X-RAY EXAM ENTIRE SPI 1 VW 882.50 42872082 X-RAY EXAM ENTIRE SPI 2/3 VW 926.00 42872100 L-SPINE 2 OR 3 VIEWS 737.70 42872110 L-SPINE MIN 4 VIEWS 1,046.50 42872120 L-SPINE BENDING ONLY 2-3 VIEWS 875.60 42872170 PELVIS 1 OR 2 VIEWS 495.50 42872190 PELVIS COMPLETE 3+ VIEWS 951.40 42872220 SACRUM & COCCYX 951.40 42873000 CLAVICLE COMPLETE 588.10 42873010 SCAPULA COMPLETE 588.10 42873020 SHOULDER 1 VIEW 518.40 42873030 SHOULDER 2+ VIEWS 610.60 42873060 HUMERUS 2+ VIEWS 558.00 42873070 ELBOW 2 VIEWS 537.50 42873080 ELBOW COMPLETE 3+ VIEWS 575.20 42873090 FOREARM 2 VIEWS 550.10 42873100 WRIST 2 VIEWS 554.30 42873110 WRIST 3+ VIEWS 588.10 42873120 HAND 2 VIEWS 681.10 42873130 HAND 3+ VIEWS 769.80 42873140 DIGITS FINGER(S) 2+ VIEWS 518.40 42873501 X-RAY EXAM HIP UNI 1 VIEW 424.60 42873502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 42873521 X-RAY EXAM HIPS BI 2 VIEWS 717.90 42873551 X-RAY EXAM OF FEMUR 1 547.30 42873552 X-RAY EXAM OF FEMUR 2/> 574.50 42873560 KNEE 1 OR 2 VIEWS 572.20 42873562 KNEE 3 VIEWS 653.10 42873564 KNEE COMPLETE 4 VIEWS 809.10 42873590 TIBIA & FIBULA 2 VIEWS 572.20 42873600 ANKLE 2 VIEWS 692.90 42873610 ANKLE COMPLETE 3+ VIEWS 721.20 42873620 FOOT 2 VIEWS 603.10 42873630 FOOT COMPLETE 3+ VIEWS 654.50 42873650 HEEL CALCANEUS 2+ VIEWS 572.20 43000000 DISPENSE FEE 1 EA MISC 111.10 43000001 EPINEPHRINE 1MG/ML 30ML 66.90 43000005 A & D OINTMENT 33.20 43000006 ALOXI 0.25 MG/5 ML 2,093.50 43000020 ASPIRIN SUPP 600MG 18.60 43000025 ASPIRIN SUPP 300MG 18.10 43000031 OFIRMEV 1000 MG/100 ML SDV 93.30 43000055 TYLENOL 650MG SUPP 12.10 43000067 ATROPINE SULFATE 1 MG VIAL 18.00 43000081 TNKASE 50 MG KIT 12,026.00 43000083 CATHFLO ACTIVASE 2 MG 567.00 43000084 ACTIGALL 300MG CAP 26.00 43000085 ACTIVASE 100 MG INJ 21,946.80

43000087 ABILIFY 10 MG TAB 117.70 43000088 ABILIFY 15MG TAB 117.70 43000089 ACTOS 30 MG TAB 68.80 43000090 ADENOCARD 6MG/2MLB SDV 90.00 43000092 ABILIFY 2 MG TAB 117.70 43000095 ADRENALIN 1/1000 (1MG) 77.40 43000097 ADVAIR DISKUS 100/50 MCG INH 513.60 43000098 ADVAIR DISKUS 500/50 MCG INH 832.30 43000099 ADVAIR DISKUS 250/50 MCG 14 BP 513.60 43000110 *ADDAMEL N 10 ML 126.40 43000115 AFRIN NASAL SPRAY 22.40 43000117 AGGRENOX CAP 36.70 43000124 VENTOLIN HFA 8 GM INHALER 82.10 43000127 VENTOLIN HFA 6.7 GM INH 250.80 43000128 CEFOXITIN 1000MG:2000MG/50MLIV 131.20 43000131 AK-DILATE 2.5% 2 ML OPHTH SOLN 141.20 43000140 ALDACTONE 25MG TAB 11.00 43000155 ALDOMET 500MG TABLET 12.70 43000164 ALTACE 10 MG CAP 31.20 43000167 ALFENTA 1000 MCG/2ML 73.60 43000169 ALPHAGAN OPTH SOLN 0.2% 5ML 424.10 43000171 ANTABUSE 250 MG TAB 39.70 43000190 AMBIEN 5MG TABLET 42.10 43000208 AMIDATE 40 MG/20 ML SDV 67.30 43000209 AMIDATE 20 MG/ML 107.60 43000215 AMINOPHYLLINE IV 250MG 44.00 43000220 AMINOPHYLLINE IV 500MG 47.50 43000221 *AMIODARONE HCL 150MG/3ML INJ 75.30 43000222 AMIDATE 40MG/2ML ABBOJECT SYR 156.50 43000223 AMIODARON 150MG/100ML PREMIX 225.50 43000224 AMIODARONE 360MG/200 ML PREMIX 225.50 43000250 ELAVIL 10MG TABLET 9.10 43000260 ELAVIL 25MG TABLET 11.50 43000261 ELAVIL 50 MG TAB 12.40 43000275 AMMONIA PEARL 0.33ML 10.10 43000277 AMOX-CLAV ES 600MG/5 ML SUSP 217.90 43000291 AMOXIL 250MG/5ML 150ML 58.10 43000300 AMOXICILLIN 250MG CAPSULE 9.70 43000302 COMTAN 200 MG TAB 34.70 43000305 AMOXICILLIN 500MG CAPSULE 11.50 43000315 CELLCEPT 250 MG CAP 44.80 43000318 CHANTIX 0.5 MG TAB 30.40 43000319 CHANTIX 1 MG TAB 30.40 43000325 AMPICILLIN 1GM INJ 64.00 43000327 AMPICILLIN 2GM INJ SDV 102.50 43000335 AMPICILLIN 250MG INJ SDV 58.10 43000345 AMPICILLIN 500 MG INJ SDV 70.10 43000359 QUELICIN 20MG/1ML 10ML 22.60 43000375 ANTIVERT 25MG TABLET 9.80

43000380 ANGIOMAX 250 MG/5ML SDV 3,349.90 43000390 ANUSOL-HC SUPP 34.10 43000395 ANUSOL SUPPOSTORY 9.70 43000400 APRESOLINE 20MG/1ML INJ 97.90 43000405 APRESOLINE 25MG TABLET 10.40 43000410 APRESOLINE 50MG TABLET 11.00 43000414 PRISTIQ 50 MG TAB SR 41.80 43000415 APRESOLINE 10MG TAB 9.50 43000420 AQUAMEPHYTON 10MG INJ 102.70 43000426 AQUA-MEPHYTON 1 MG/0.5 ML SYR 41.60 43000427 AQUAPHOR OINT 480GM 72.00 43000428 AREDIA 30MG INJECTION 713.80 43000445 ARTANE 2MG TABLET 9.10 43000452 ARTIFICAL TEARS 44.80 43000455 SINGULAIR 4 MG CHEW TAB 46.00 43000456 SINGULAIR 5MG CHEW TAB 46.00 43000457 SINGULAIR 10MG TAB 46.00 43000464 ASACOL HD 800 MG TABDR 36.80 43000495 ASCORBIC ACID 500MG 8.20 43000502 ASTRAMORPH PF 10MG/10ML 119.60 43000503 MORPHINE SULFATE 100 MG TABCR 55.40 43000515 ATARAX 10MG TAB 12.20 43000519 ATIVAN 0.5MG TAB 12.80 43000520 ATIVAN 1MG TABLET 14.20 43000524 ATIVAN 2 MG/1ML TUBEX 14.20 43000525 ATIVAN 20 MG/10 ML VIAL MDV 93.10 43000546 ATROPINE SYR 1MG SDV 71.00 43000547 ATROPINE 8 MG/20 ML MDV 162.10 43000549 ATROPINE SULFATE 0.04 MG/ML 27.50 43000551 *ATROPINE SUL 0.8 MG/2 ML SYRG 68.80 43000554 IPRATROPIUM BROMIDE 12.9GM INH 922.10 43000555 ATROPINE 1.0% OPHTH 5ML 106.50 43000558 AUGMENTIN 500MG TAB 48.40 43000561 AUGMENTIN SUSP 400MG/5ML 258.50 43000562 AUGMENTIN 200 MG/5ML SUSP 208.70 43000581 *COLLOIDAL OATMEAL 71 GM LOTN 18.30 43000582 PAMELOR 10MG CAP 10.70 43000583 PAMELOR 25MG CAPSULE 13.50 43000605 AZULFIDINE 500MG TAB 12.70 43000610 B&O SUPPR 16A 128.90 43000625 B-12 INJ 1000MCG 16.40 43000640 BACTRIM D.S. TAB 15.90 43000650 BACTRIM PED SUSP 800/160ML 12.20 43000662 BSS 500 ML IRRIG SOLN 135.40 43000663 VIGAMOX 0.5 % OPHTH 463.60 43000701 BENADRYL 25 MG/10M LELIXIR 14.20 43000710 BENADRYL 50MG/ML INJ 14.80 43000722 BENGAY CREAM 20.80 43000735 BENTYL 20MG TABLET 10.40

43000762 *DERMOPLAST HOSP SPRAY 42.70 43000778 BETADINE 118 ML BTL 12.60 43000820 BICILLIN L.A.1.2MIL UNITS 296.60 43000830 BICILLIN LA 600000 UNITS SDV 174.70 43000855 BRETHINE INJ 1MG/1ML 41.60 43000874 BREVIBLOC 100MG/10ML INJ 128.50 43000875 BREVIBLOC 2500MG SOLN 762.90 43000880 BROMDAY 0.09% OPHTH SOLN 863.50 43000881 VISIONBLUE 0.06 OPHTH SOLN 0.5 272.10 43000883 BUMEX 1MG/4ML VIAL 17.10 43000885 BUMEX INJ 0.5MG/2ML 10ML 21.40 43000886 BUMEX 1MG TAB 10.70 43000887 BUSPAR 5MG 16.20 43000888 BUSPAR 15 MG TAB 22.00 43000889 BYSTOLIC 5MG TAB 22.60 43000890 BYSTOLIC 10 MG TAB 22.60 43000901 CA CHLORIDE SYR 10% 70.30 43000905 CA GLUC 10% .465MEQ/ML SDV 25.30 43000906 CA GLUC 10% 23 MEQ/50 ML SDV 66.40 43000935 CAFFE SOD BENZ 500 MG/2 ML SDV 87.30 43000947 OSCAL 500MG/5ML LIQUID 42.80 43000956 STAY AWAKE 200 MG TAB 8.90 43000961 CAPOTEN 12.5MG TAB 13.00 43000968 CARAFATE 1GM TAB 13.40 43000970 CARBOCAINE-POLOCAINE 1% 62.10 43000972 CARBOCAINE POLOCAINE 2% VIAL 68.10 43000973 CARDIZEM 60MG TABLET 12.80 43000976 CARAFATE 1GM/10ML SUSP 74.50 43000980 CARDENE 25 MG/10 ML INJ 119.00 43000983 CARDIZEM CD 300MG CAP 26.50 43000984 CATAPRES TTS-1 197.80 43000986 CATAPRES TTS-3 451.40 43000988 CARDIZEM CD 180MG CAP 18.60 43000989 CARDIZEM CD 240MG CAP 22.40 43000990 CATAPRES 0.2MG TABLET 10.10 43000991 CATAPRES 0.2 MG/24 HR PATCH 269.40 43000993 CARDIZEM CD 120MG CAP 16.50 43000994 CARDIZEM CD 90 MG CAP 14.70 43000995 CARDIZEM 50MG/10ML VIAL 72.90 43000996 CATAPRES 0.1 MG TAB 9.60 43000997 CARDIZEM 125 MG/125 ML PRMX 114.50 43001001 OCUCOAT 265.50 43001004 CEFAZOLIN SOD/DEX 2000 MG PRMX 68.50 43001008 CEFAZOLIN 1 GM PREMIX 41.40 43001009 CEFTRIAXONE 1 GM PREMIX 94.80 43001013 MAG SUL 2 GM/50 ML PRMX 60.20 43001014 MAGNESIUM SULFATE 50% 1 GM/2ML 53.40 43001015 ANCEF 1GM INJ 82.00 43001026 CELESTONE 12 MG/2 ML INJ 107.20

43001029 CELEBREX 100MG CAPSULE 28.60 43001031 CELEBREX 200 MG CAP 41.80 43001032 CELEXA 20MG TABLET 25.90 43001034 CEFZIL 250MG/5ML SUSP 100ML 270.20 43001035 CEFZIL 250 MG TAB 15.60 43001036 CEFOXITIN SOD/DEXT 1000MG/50ML 84.70 43001041 CEREBYX 50MG/ML 10ML 443.60 43001042 CERVIDIL VAG SUPP 1,207.80 43001090 CHLORASEPTIC LOZENGE 9.00 43001095 *CHLORASEPTIC SPRAY 180ML 25.50 43001112 HYGROTON 25MG TABLET 11.50 43001113 *PARAFON 500 MG TABLET 11.50 43001114 CILOXAN 0.3% OPHTH SOLN 125.20 43001116 CIPRO 400MG IVPB 49.70 43001117 CIPRO 500 MG TAB 27.05 43001118 CIPRODEX OTIC SUSP 735 ML 780.00 43001125 CITRATE OF MAGNESIUM 300ML 28.90 43001130 CLAFORAN 1000 MG (1GM) VIAL 69.90 43001132 CLARITIN 10MG/10ML SYR 42.10 43001134 CLARITIN 10 MG TAB 13.90 43001135 CLEOCIN 150MG CAPSULE 16.40 43001136 CEFEPIME HYDROCHLO 1000MG VIAL 157.70 43001138 CEFEPIME HCL/D5W 1000 MG PRMX 92.50 43001139 CEFEPIME HCL/D5W 2000 MG PRMX 122.00 43001144 CLEOCIN 600 MG/4 ML SDV 91.90 43001145 CLEOCIN 75MG/5ML SUSP 100ML 365.70 43001149 CLEOCIN 900 MG IVPB PREMIX 121.10 43001150 CLEOCIN 600MG IVPB PREMIX 100.60 43001151 CLEOCIN 900MG INJ 72.70 43001152 CLIMARA 0.05 MG PATCH 118.70 43001153 CLIMARA PATCH 0.1MG 118.70 43001165 GYNE-LOTRIMIN VAG CR 45GM 82.90 43001175 LOTRIMIN 1% CR 15GM 39.50 43001181 CLOBETASOL PROP OINT .05% 113.30 43001191 CLOZARIL 25MG TABLETS 30.10 43001203 COGENTIN 1MG/ML INJ 664.70 43001204 COGENTIN 1MG TABLET 7.80 43001220 COLACE LIQ 50MG/5ML 11.40 43001229 COLCRYS 0.6 MG TAB 46.50 43001232 COLESTID 5GM PACKET 29.40 43001239 COMBIVENT RESPIMAT INHAL SPRAY 1,213.40 43001249 METHADONE 10 MG TAB 11.00 43001280 COMPAZINE 10MG TAB 14.40 43001285 SLO-BID 200MG TABLET 10.50 43001288 CORDARONE 200MG TABLET 31.10 43001289 CORDARONE 150MG INJ 19.30 43001290 COREG 3.125MG TABLET 26.50 43001291 COREG 12.5MG TAB 26.50 43001292 COREG 6.25 MG TAB 26.50

43001293 COREG 25 MG TAB 26.50 43001301 OMNICEF 300 MG CAP 49.10 43001302 OMNICEF 125 MG/5 ML 60 ML SUSP 328.20 43001325 CORTISPOR OPTH OINT 3.5GM 312.60 43001340 CORTISPORIN/PEDIOTIC OTIC 152.20 43001342 CORTROSYN 0.25 MG INJ 607.00 43001350 COUMADIN 10MG TABLET 22.40 43001351 COUMADIN 3 MG TAB 18.00 43001352 COUMADIN 6 MG TAB 21.30 43001354 COUMADIN 1MG TABLET 17.10 43001355 COUMADIN 2MG TABLET 17.60 43001356 COUMADIN 4 MG TAB 18.00 43001360 COUMADIN 2.5MG TABLET 17.90 43001365 COUMADIN 5MG TABLET 18.30 43001370 COUMADIN 7.5MG TABLET 21.80 43001375 CREON DR 6 000 UNITS 15.10 43001400 CYCLOGYL 1% 2ML 120.10 43001401 CYCLOSPORINE 0.05% OPHTH SOLN 685.20 43001405 CYKLOKAPRON 1000 MG/10 ML SDV 262.20 43001410 CARDENE-NACL 20 MG/200 ML PRMX 483.80 43001418 CYTOTEC 25 MCG TAB 13.70 43001419 CYTOTEC 100MCG TABLET 13.70 43001426 CYTOMEL 25 MCG TAB 17.00 43001427 CYTOMEL 5 MCG TAB 14.90 43001431 EYE WASH 30 ML SOLN 102.70 43001441 DALIRESP 500 MCG TABLET 53.80 43001453 DAPSONE 100MG TABLET 9.40 43001497 DEBROX 15ML DROP 15ML 25.40 43001518 DEMADEX 10MG TABLET 13.30 43001529 DEMEROL 25MG/1ML INJ SDV 37.80 43001530 DEMEROL 50MG/1ML INJ 38.90 43001545 DEPAKENE 250MG/5ML SYRUP 54.40 43001546 DEPAKOTE 500MG TAB 8.10 43001547 DEPAKOTE ER 250 MG TAB 22.90 43001548 DEPAKOTE 250MG TABLET 7.30 43001550 DEPAKOTE ER 500 MG TAB 25.00 43001555 DEPO-MEDROL 40MG/1ML 68.00 43001556 LUPRON DEPOT 22.5 MG INJ 9,151.40 43001557 LEUPROLIDE ACE 11.25 MG KIT 6,457.00 43001558 LUPRON DEPOT 30 MG INJ KIT 10,254.60 43001559 LEUPROLIDE ACE 3.75 MG INJ 2,695.00 43001560 DEPO-MEDROL 80MG/1ML 99.70 43001568 DEPO-TESTOSTERONE INJ MDV 142.00 43001591 *NOREPINEPH BITRART 4000MCG/D5 166.00 43001609 DESYREL 50MG TABLET 13.80 43001610 DESYREL 100MG TABLET 12.10 43001611 DESYREL 150 MG TAB 18.30 43001617 DECADRON 0.5 MG/5 ML UDS 9.60 43001620 DEXAMETH 10MG/1ML INJ 18.90

43001625 DEXAMETH 4MG/1ML VIAL 15.30 43001641 DEXAMETH 0.5MG TAB 9.60 43001650 DEXAM SOD PHOS 1MG/0.1 ML MDV 0.90 43001655 DEXAMETHASONE 4MG TAB 12.20 43001659 DEXTROSE 50% IN WATER 50ML SDV 22.40 43001660 DEXTROSE 50% 50GM/50ML SDV 83.90 43001662 DHE-45 INJ 1 MG 3,148.60 43001675 DIAMOX 500MG INJECTION 250.30 43001684 DIASTAT 10 MG/2 ML GEL SUPP 662.30 43001685 DIAMOX 250MG TABLET 12.50 43001693 DIFLUCAN 100 MG TAB 16.60 43001694 DIFLUCAN 400 MG PREMIX IV 148.30 43001696 DIFLUCAN 40 MG/ML 35 ML SUSP 651.80 43001697 VOLUVEN 500 ML PRMX 273.80 43001701 DIFICID 200 MG TAB 794.90 43001705 DILANTIN 100MG CAP 12.40 43001720 DILANTIN 125MG/5ML SUSP 11.90 43001725 DILANTIN 50MG INFATAB 13.40 43001730 DILAUDID 2 MG INJECTION 20.00 43001733 *DILAUDID PCA 10 MG/50 MG SYRG 410.90 43001740 DILAUDID 4MG TAB 12.70 43001774 DIPHTH TET TOX PEDIATRIC 175.50 43001777 DIPROSONE CR 0.05% 15GM 174.90 43001785 DITROPAN 5MG TABLET 11.10 43001786 DITROPAN XL 5MG TABLET 11.20 43001807 PREVACID SOLUTAB 15 MG TAB 61.30 43001844 PROLIA 60 MG/1 ML SYRINGE 3,872.90 43001852 XIFAXAN 550 MG TAB 136.40 43001862 *ZOCOR 40 MG TAB 42.30 43001904 DURAGESIC 12 MCG/HR PATCH 129.60 43001905 DULCOLAX 10MG SUPP 9.50 43001912 DURAGESIC 100MCG/HR PATCH 458.40 43001913 DURAGESIC 75MCG/HR PATCH 347.20 43001914 DURAGESIC 50MCG/HR PATCH 230.40 43001915 DURAGESIC 25MCG/HR PATCH 129.60 43001925 DYAZIDE CAPSULE 16.90 43001926 *EMEND 150 MG INJ 1,478.30 43001931 EFFEXOR XR 37.5MG 42.30 43001932 VENLAFAXINE HCL 50MG TAB 22.40 43001933 EFFEXOR XR 75MG 46.50 43001934 EFFEXOR 75 MG TAB 23.30 43001970 ELIMITE 5% CREAM 382.60 43001985 EMLA CREAM 5GM TUBE 58.90 43001995 EPHEDRINE INJ 50 MG/1ML 63.80 43001997 ENTEREG 12 MG CAP 413.90 43002000 EPINEPHRINE SYR 1.5 INCH 44.70 43002002 ARANESP 300 MCG INJ 6,517.90 43002003 ARANESP 200 MCG INJ 4,347.80 43002004 PROCRIT 40 000 UNITS/ML 3,043.60

43002008 PROCRIT 4 000 UNITS/ML 372.10 43002009 PROCRIT 10 000 UNITS/ML 918.60 43002010 ARANESP 100 MCG INJ 2,720.40 43002014 ARANESP 60 MCG 0.3ML 1,960.90 43002015 ARANESP 500 MCG 10,857.90 43002017 PROCRIT 20 000 UNITS/ML 1,829.30 43002021 PLASBUMIN-25 100 ML VIAL 493.20 43002030 ELIQUIS 5 MG TAB 38.40 43002031 ELIQUIS 2.5 MG TAB 37.10 43002035 ENGERIX-B ADULT 132.10 43002057 ILOTYCIN OPHTH OINT 0.5% 85.50 43002058 ESTRACE 1MG TAB 10.10 43002080 EXELON 4.6 MG PATCH 70.00 43002082 EVISTA 60MG 41.80 43002083 EXELON 1.5 MG CAP 41.00 43002088 SUBLIMAZE 250MCG/5ML INJ 14.70 43002089 SUBLIMAZE 100MCG/2ML INJ 10.70 43002092 SUBLIMAZE Pf 2500MCG/50ML VIAL 53.00 43002095 FERROUS SO4 ELIXIR 30 ML 39.60 43002096 ASTRINGYN 8 GM SOLN 96.30 43002119 FIORICET TABLET 12.20 43002127 FISH OIL 8.20 43002128 *FISH OIL 1000 MG CAP 6.10 43002130 FLAGYL 250MG TABLET 11.40 43002135 FLAGYL 500MG PREMIX 70.40 43002136 FLAGYL 500 MG TAB 12.80 43002140 FLEET PHOSPHATE ENEMA 17.30 43002145 FLEET OIL RETENTION ENEMA 21.40 43002149 FLOVENT 44MCG INHALER 584.60 43002150 FLEXERIL 10MG TABLET 7.80 43002152 TACROLIMUS 1 MG CAP 41.40 43002153 FLOMAX 0.4 MG CAP 42.20 43002155 FLORINEF 0.1MG TABLET 13.30 43002166 *FLUOR-I-STRIP 8.90 43002184 FOLTX 2.5/25 MG TAB 14.20 43002185 FOLIC ACID 5MG/1ML 159.20 43002205 LASIX 10MG/ML ORAL 60ML 72.90 43002210 LASIX 20MG TABLET 9.10 43002215 LASIX 40MG TABLET 7.16 43002220 LASIX 100MG/10ML INJ 26.80 43002223 *HEPARIN FLUSH 10 U/ML SYR 20.70 43002225 LASIX 20MG INJ 20.60 43002230 LASIX 40MG INJ 22.60 43002250 GELATIN SPONGE ABSORBABLE 1 GM 325.60 43002265 GAMUNEX-C 10 GM/100 ML SDV 2,422.00 43002270 GENTAMICIN OINTMENT 15GM 153.15 43002271 GARAMYCIN 0.1% CREAM 15 GM 128.00 43002275 GENTAMICIM OPT OINT 3.5GM 123.20 43002285 GARAMYCIN PED INJ 20/2ML 41.60

43002317 GELFOAM 12-7 MM 70.80 43002318 GELFOAM 50 SPONGE 164.60 43002330 GEODON 20 MG CAP 48.00 43002331 GEODON 60 MG CAP 77.20 43002335 GEODON 20 MG INJ SDV 116.60 43002345 GLUCOPHAGE 500MG TABLET 15.80 43002347 GLUTOSE ORAL GEL 25.40 43002353 GLUCAGON RDNA 1MG KIT AMB 1,087.00 43002354 GLUCOTROL XL 5MG TABLET 13.50 43002356 GLUCOTROL 5MG TABLET 10.50 43002357 MICRONASE 5MG TABLET 11.60 43002358 GLUCOTROL XL 2.5 MG TAB 10.70 43002360 GLYCERIN SUPP ADULT 9.10 43002365 GLYCERIN SUPP INF 8.80 43002371 GOLYTELY/NULYTELY LAVAGE 195.20 43002379 GRASSHOPPER SUSPENSION 106.20 43002381 GUAIFENESIN/CODEINE PHOS 200MG 11.90 43002395 HALDOL INJ 5MG/ML 1ML 91.60 43002396 HALDOL DECA 50MG/LML INJ SDV 272.70 43002397 *HALDOL 2 MG/ML SOL 120 ML BTL 362.70 43002400 HALDOL 1MG TABLET 11.10 43002415 HALDOL 5MG TABLET 14.80 43002416 HALDOL DECANOATE 100 MG/ML 230.60 43002431 HEALON SYRINGE 0.6 ML 482.10 43002434 HEPARIN 1000U/ML 1ML MDV 40.60 43002436 HEPARIN SOD PORCINE 10000 U/10 16.40 43002437 HEPARIN 100 UNITS/ML 5 ML INJ 31.80 43002446 HEPARIN 1000U/500 ML PREMIX 50.70 43002449 HEPATITIS B VAC PED PF 132.10 43002451 HEP B IMMUNE GLOB 1 ML SDV 594.20 43002453 HEALON GV 14 MG/ML SYR 693.30 43002460 HIBICLENS 240ML 50.70 43002478 MUCINEX DM ER TAB 11.60 43002479 MUCINEX ER 600 MG TAB 11.00 43002507 HYDROCORTISONE 20MG TAB 9.40 43002510 HYDROCORT CR 1% 30 GM. 27.70 43002512 HYDROCORT CR 2.5% 30GM 76.60 43002515 HYDRODIURIL 25MG TABLET 8.50 43002523 VIIBRYD 10 MG TAB 41.20 43002524 VIIBRYD 20 MG TAB 39.80 43002543 HYPER-SAL 3% NEBU-STERILE 15.60 43002560 ADVIL 200MG TABLET 5.70 43002565 IMDUR 60MG TABLET 17.50 43002566 IMDUR 30 MG TAB 17.30 43002578 INJECTAFER 750 MG/15 ML SDV 2,431.40 43002580 IMITREX 6MG/0.5ML INJ SDV 508.40 43002581 IMITREX 50 ML TAB 154.80 43002588 IMMODIUM AD 1MG/5ML LIQ 9.60 43002591 IMURAN 50MG TAB 18.00

43002592 AZELASTINE HYDROCHLO 30ML NASF 607.80 43002600 *INDERAL 1MG/ML INJ 55.60 43002610 INDERAL 20MG TABLET 10.50 43002614 INDERAL LA 60 MG CAPSULE 17.30 43002615 INDERAL 40MG TABLET 10.70 43002616 INDERAL LA 80MG CAP 48.30 43002618 INVEGA 1.5 MG TABXR 122.60 43002619 INVEGA 3 MG TABXR 122.30 43002621 INVEGA 6 MG TABXR 122.30 43002623 INVEGA SUSTENNA 117 MG/0.75ML 3,801.90 43002625 INDOCIN 25MG CAPSULE 10.70 43002626 INVEGA SUSTENNA 156MG/1 ML INJ 4,055.00 43002627 INVEGA SUSTENNA 234 MG/1.5 ML 6,078.80 43002629 *HUMULIN REGULAR 100U/ML 51.10 43002631 INDOCIN 50 MG SUPP 311.00 43002649 NUTRILIPID 20% PREMIX 84.90 43002652 IODOFLEX PAD 119.90 43002657 LUGOLS STRONG IDODINE SOLN 8ML 57.80 43002670 ISONIAZID 300MG TABLET 9.00 43002715 ISORDIL 10MG TABLET 9.60 43002721 ISORDIL 20MG ORAL TAB 9.40 43002746 K-DUR 20MEQ TABLET 12.40 43002796 *KAYEXALATE 15GM/60ML SUSP 63.70 43002800 KCL 10 MEQ/5ML INJ 51.60 43002805 KCL 20 MEQ/10 ML INJ SDV 44.70 43002810 KCL 40 MEQ/20 ML INJ 13.80 43002811 KCL 10 MEQ/100 ML PREMIX SOLN 29.80 43002816 KTAB 100 MEQ TAB 12.90 43002820 KEFLEX 250MG CAPSULE 13.80 43002830 KEFLEX 250MG/5ML SUSP 100ML 149.90 43002835 KEFLEX 500MG CAPSULE 20.00 43002845 KEPPRA 500 MG TAB 44.20 43002846 KEPPRA 500 MG/5 ML VIAL 256.50 43002847 KEPPRA 500 MG/5 ML UD SOLN 74.10 43002848 KEPPRA 250 MG TAB 12.10 43002855 KETALAR 500 MG/5 ML MDV 83.40 43002858 KINEVAC 5 MCG INJ SDV 413.10 43002860 KLONOPIN 1MG TABLET 14.20 43002861 KLONOPIN 0.5MG TABLET 13.50 43002874 KYTRIL 1 MG/ML INJ 108.50 43002878 KYTRIL 100 MCG/0.1 ML INJ MDV 3.50 43002882 NORMODYNE 200MG TABLET 12.70 43002883 LABETALOL HCL 20MG/4ML SYRINGE 34.20 43002885 LACRI-LUBE OPTHALMIC OINT 35.20 43002899 LAMICTAL 100MG TABLET 50.90 43002903 LANSINOH TOPICAL 22.30 43002904 CHRONULAC SYRUP 20GM/30ML 28.90 43002905 LANOXIN INJ 0.50MG/2ML 24.50 43002914 LANOXIN 0.25 MG TABLET 16.40

43002920 LANOXIN 0.125MG TABLET 10.10 43002928 FEMARA 2.5 MG TAB 118.10 43002934 PLAN B ONE-STEP 1.5 MG TAB 190.60 43002936 LEVAQUIN 750 MG/150 ML PREMIX 128.80 43002939 LEVAQUIN 250 MG PREMIX 61.90 43002940 LEVOPHED 4MG/4ML INJ 75.80 43002941 LEVAQUIN 500MG IV PREMIX 113.80 43002942 LEVAQUIN 250MG TABLET 105.10 43002944 LEXAPRO 10 MG TAB 6.60 43002955 LIBRIUM 25MG CAPSULE 10.70 43002960 LIBRIUM 5MG CAPSULE 10.10 43002977 ARAVA 20 MG TAB 130.80 43002980 LIDOCAINE 2% 5ML 10MG/0.5ML 66.90 43002981 *LIDODERM 5% PATCH 71.50 43003001 ZESTRIL/PRINIVIL 5MG TAB 14.60 43003002 ZESTRIL/PRINIVIL 10MG TAB 14.90 43003003 LIORISAL 10MG TABLET 12.20 43003005 LITHIUM CARB 300MG CAP 9.70 43003008 ZESTRIL/LISINOPRIL 20MG TAB 14.90 43003009 LIPITOR 20MG TABLET 48.50 43003010 ZESTRIL 40 MG TAB 18.30 43003013 LIPITOR 40 MG TAB 13.80 43003016 LITHIUM CARBONATE 450 MG TABCR 11.60 43003017 LATUDA 40 MG TAB 116.10 43003018 LITHIUM CARBONATE 150 MG CAP 6.90 43003026 LOPRESSOR 5MG/5ML AMP 17.40 43003030 LOPRESSOR 100MG TABLET 13.70 43003035 LOPRESSOR 50MG TABLET 12.00 43003036 LOPRESSOR 25 MG TAB 9.60 43003037 LOZOL 2.5MG 13.90 43003048 LOVENOX 30MG INJ 134.70 43003049 LOVENOX 40 MG INJ 176.80 43003051 LOVENOX 80MG INJ 346.30 43003052 LOVENOX 100MG INJ 431.00 43003053 LOVENOX 60MG/0.6ML 261.80 43003054 LOVENOX 120MG INJ 515.80 43003056 LYRICA 25 MG CAP 29.70 43003057 LYRICA 75 MG CAP 29.70 43003058 LYRICA 100 MG CAP 29.70 43003075 MAG SULFATE 50% .5 GM/ML 45.40 43003076 MAG-DELAY 64 MG TAB 5.80 43003077 MAG OXIDE 400MG TABLET 9.50 43003078 MAGNESIUM SULFATE 1 EA BOX 8.00 43003079 MAG SUL 4 GM/WATER 50 ML IVPB 57.30 43003080 MAG SUL 6 MG/NS 100 ML PRMX 102.70 43003081 MAGNESIUM SULFATE 10GM/20ML VI 47.50 43003087 MAGIC MOUTHWASH 1 60 ML 81.30 43003088 MAGIC MOUTHWASH 120 ML 139.80 43003089 MAGIC MOUTHWASH 3 60 ML 68.00

43003092 MAGIC MOUTH WASH # 6 150.60 43003093 LARYNG (LIDO HCL) 160 MG/4 ML 64.30 43003095 CHLORHEXIDINE GLUCONATE 0.12% 11.50 43003110 MANNITOL INJ 12.5GM/50 ML SDV 63.20 43003120 MARCAINE 0.5% & EPI 50MG/10ML 31.10 43003126 SENSORCAINE MPF 2ML AMP SDV 23.00 43003127 SENSORCA.25% 75MG/30ML EPI 28.20 43003128 SENSORCA MPF .25% 75MG/30ML 29.30 43003129 SENSORCA MPF .25% 25MG/10ML 26.20 43003135 SENSORCA MPF 0.5% 150MG/30ML 20.00 43003136 SENSORCAINE MPF 0.5% 5MG/ML 21.90 43003137 SENSORCAINE MPF .75% 10ML 20.60 43003138 SENSORCAINE MPF .25%/EPI 21.40 43003140 SENSIPAR 30 MG TAB 103.30 43003141 MAXZIDE TABLET 75/50 14.20 43003145 MAXITROL OPTH OINT 3.5GM 214.00 43003150 MAXITROL OPHTH SOLN 5ML DROP 214.00 43003153 ROMAZICON 0.1MG/ML 5ML 649.70 43003168 MEDROL 4 MG TAB 36.20 43003180 MEFOXIN 1 GM INJ 90.00 43003181 MEFOXIN 2 GM VIAL 162.50 43003185 MELATONIN 3 MG TAB 8.50 43003191 MOBIC 7.5 MG TAB 30.30 43003215 MEROPENEM 1000 MG/50 ML PRMX 103.40 43003216 MEROPENEM 500 MG/50 ML PRMX 90.00 43003217 MERREM 1000 MG PDS VIAL 110.20 43003218 MERREM 500 MG VIAL 74.70 43003220 METAMUCIL PACKET 10.00 43003225 METHERGINE 0.2MG/1 ML INJ 64.90 43003230 METHERGINE 0.2MG TABLET 213.70 43003241 METHOTREXATE 2.5MG TABLET 35.50 43003247 METRO-GEL 0.75% 165.80 43003253 TPN ELECTROLYTES 59.40 43003258 MIACALCIN NASAL SPRAY 698.00 43003261 MILK OF MAGNESIA 2400 MG/30 ML 10.90 43003270 MINERAL OIL 30ML 12.20 43003271 MINERAL OIL STERILE 25 ML 25.50 43003275 MINIPRES 1MG CAPSULE 9.40 43003285 MINIPRES 5 MG CAPSULE 14.70 43003290 MIOCHOL-E OPHTH 2ML SOLN 283.10 43003291 MIRAPEX 1 MG TAB 35.80 43003292 MIRALAX 17 GM PKG 11.40 43003295 FIBERCON TABLET 8.80 43003298 MMR VACCINE 0.5 ML 277.20 43003300 MIDAZOLAM HCL INT-NASAL 10 MG 13.10 43003303 MOD DAKINS SOL 1/8 ST 42.00 43003304 MOD DAKINS SOL 1/4 ST 72.10 43003306 MOD DAKINS SOL 1/2 ST 72.10 43003312 MS CONTIN 30MG TABLET 30.50

43003317 MSIR 15 MG TABLET 10.10 43003318 MS CONTIN 15 MG TAB 14.20 43003320 MORPHINE SULFATE 10MG INJ 19.80 43003322 MORPHINE 4 MG/ML INJ 20.60 43003323 *MORPHINE PCA 50 MG 162.50 43003327 MORPHINE SUL 20 MG/ML UDS 2.45 43003332 MOTRIN PED SUSP 100MG/5ML 12.20 43003333 MOTRIN INFANTS DROPS 41.60 43003334 MOTRIN 400 MG TAB 9.50 43003335 MOTRIN 600MG TABLET 9.50 43003337 MOTRIN 800MG TABLET 10.00 43003340 MUCOMYST 20% 30ML 82.90 43003345 THERAVITE LIQUID 120ML 9.60 43003348 MURO 128 5% OPHTH SOLN 114.30 43003350 MVI-12 INJECTION 10ML 93.60 43003359 MYCAMINE 50 MG VIAL 533.50 43003370 MYCOLOG CREAM 15GM 475.20 43003380 MYCOSTATIN CREAM 30GM 87.30 43003385 MYCOSTATIN OINT 30GM 22.80 43003386 MYCOSTATIN 15GM POWDER 136.50 43003391 MYDRIACYL 1% OPHTH 3 ML 65.30 43003392 MYDRIACYL 1% OPHTH 15 ML 230.90 43003405 MYLICON 30ML DROP 32.50 43003409 MAALOX PLUS 30 ML UDC 13.30 43003410 MYLANTA GAS 80MG TABLET 9.00 43003419 MYSOLINE 50MG TABLET 11.50 43003420 MYSOLINE 250 MG TABLET 14.90 43003425 MYRBETRIQ 50 MG TAB 57.00 43003427 MYRBETRIQ 25 MG TAB.ER.24H 54.00 43003435 NAMENDA 5 MG TAB 9.60 43003436 NAPROSYN 375MG TABLET 15.60 43003437 NAPROSYN 500MG TABLET 17.40 43003439 FENT CIT/NS/PF 2500 MCG/250ML 138.80 43003441 FENTANYL/ROPIVACAINE/NS/PF 1,237.70 43003444 NARCAN 2MG/2ML AMPULE 132.50 43003445 NARCAN 0.4MG/ML AMP 41.50 43003446 NAROPIN 5MG/ML 30ML INJ 110.40 43003449 NAROPIN/NS 800MG/400ML PREMIX 1,343.00 43003452 NAROPIN 2 MG/ML INFUSION BTL 443.20 43003457 TYSABRI 300 MG/15 MLS 12,991.30 43003477 NEBUPENT 300MG INHAL SOLN 483.20 43003478 TOBRAMYCIN SUL 80 MG/2 ML MDV 44.60 43003479 TOBRAMYCIN SUL 80 mg/2 ml 7.70 43003480 TOBRAMYCIN SUL 80 mg/2 ml 8.10 43003500 FLORAJEN3 460 MG CAP 9.10 43003505 PREVNAR 13 SYRINGE 606.10 43003540 NEO-SYNEP INJ 10MG/1ML SDV 28.90 43003550 NEOMYCIN 500MG TABLET 21.90 43003565 NEOSPORIN OPHTH SOLN 10ML 148.60

43003570 NEORAL 25MG CAPSULE 18.90 43003575 NESACAINE 2% MPF 30ML 127.80 43003577 NESACAINE 3% MPF 20ML SDV 133.80 43003589 NEURONTIN 300MG CAPSULE 26.00 43003590 NEUTRA-PHOS POWDER 11.60 43003591 NEULASTA 6 MG INJ 13,181.60 43003592 NEURONTIN 400MG CAP 28.90 43003601 NICODERM 7MG/DAY PATCH 49.50 43003603 NICODERM 21MG/DAY PATCH 25.60 43003604 NICODERM 14MG/DAY PATCH 22.90 43003606 NIACIN SR 250MG CAPSULE 8.60 43003611 NIFEREX-150 9.60 43003612 NIX CREME RINSE 46.25 43003619 NIMBEX 200 MG/20 ML INJ 1,429.10 43003620 NIMBEX 20 MG/10 ML VIAL 139.60 43003630 NITRO 0.4MG TABLET 58.20 43003636 NITRO OINT 2% UD 1 GM PKT 11.40 43003651 NIZORAL 2% SHAMPOO 120ML 137.90 43003652 NIZORAL 2% CREAM 30GM 104.40 43003654 NORCURON 1MG/ML 20ML VIAL 129.10 43003655 NORCURON 10 MG/10ML VIAL 105.60 43003656 NITRODUR 0.2MG/HR 21.30 43003657 NITRODUR 0.4MG/HR PA 23.30 43003672 NORFLEX INJ 30MG/ML 142.00 43003682 NORVASC 5MG TABLET 26.50 43003683 NORVASC 10 MG TAB 33.20 43003695 NUBAIN 10MG/ML 1ML AMP 17.60 43003698 NUVIGIL 50 MG TAB 37.40 43003716 NYSTATIN 500 000 U/5 ML UDC SU 19.70 43003721 OCEAN NASAL SOLUTION 45ML 23.00 43003723 OCUFEN 0.03% 2.5ML DROP 65.90 43003733 OXYFAST 20 MG/ML UDS 47.20 43003739 *ORAJEL BABY 15GM 58.50 43003741 OMNIPAQUE 2400 MG/10 ML SDV 252.70 43003758 CALCIUM-VIT D 500 MG TAB 8.60 43003775 OXYCONTIN 80 MG TAB 93.60 43003780 LR 500 MLS/OXYTOCIN 30 UNITS 74.60 43003796 OXY IR 5MG CAPSULES 10.60 43003830 *PARLODEL 2.5MG TABLET 48.20 43003836 PAXIL 20MG TABLET 27.00 43003842 PEDIAPRED 5MG/5ML LIQUID 56.00 43003845 PENICILLIN G 5 MIL U 285.80 43003847 PEN G 5 ML UNIT/NS 100 MG IVPB 267.90 43003851 PENTASA 250MG CAPSULE 18.60 43003857 PEPTO BISMOL 240ML SUSP 26.40 43003860 PERCOCET 5/325MG TABLET 18.30 43003882 CYMBALTA 60 MG CAP 42.30 43003883 CYMBALTA 20 MG CAP 44.00 43003884 CYMBALTA 30 MG CAP 11.00

43003885 CYPROHEPTADINE HCL 4 MG TAB 11.40 43003890 PERFOROMIST 20 MCG 57.00 43003915 PHENYLEP-NS 1000 MCG/10 Ml SYR 40.60 43003920 PHENERGAN 25MG TABLET 8.10 43003921 PHENERGAN 12.5MG SUPPOSITORY 38.40 43003924 PHENERGAN PLAIN SYRUP 41.30 43003930 PHENERGAN 25MG INJ 15.10 43003950 PHENERGAN 25MG SUPP 39.20 43003965 PHENOBARB 130MG/ML INJ 199.35 43003970 PENICILLIN V 250MG TABLET 11.10 43003982 PEN VK 250MG/5ML 100/ML 69.40 43003983 PROPOFOL 10 MG/ML 10 ML SYR 73.80 43003984 PROPOFOL 200MG/20 ML SYR SDV 104.40 43003997 FLEET ENEMA PEDIATRIC 17.60 43004001 PHOSLO CAPSULES 667MG 13.80 43004030 PILOCARPINE 4% SOLN 15ML 131.20 43004032 FOSAMAX 35 MG TAB 120.00 43004035 PITOCIN 10 UNITS/1ML INJ 39.50 43004036 PLAVIX 75MG TABLET 56.30 43004043 PLAQUENIL 200MG TAB 16.60 43004044 PNEUMOVAX 0.5ML 324.50 43004050 PITOCIN 100 UNIT/10 ML VIAL 71.60 43004080 POTASSIUM ACETATE 40 MEQ/20ML 55.20 43004085 POT PHOSPHATE 4.4MEQ/1ML 15 ML 143.40 43004096 PRADAXA 75 MG CAP 39.05 43004097 PRADAXA 150 MG CAP 38.60 43004114 PRED-MILD (ECONOPRED) 139.40 43004115 PRED FORTE 1% OPHTH SOLN 175.40 43004120 DELTASONE 20MG TAB 9.10 43004124 PREDNISONE 1 MG TABLET 9.50 43004125 DELTASONE 5MG TAB 8.80 43004126 DELTASONE 10 MG TAB 8.60 43004127 DELTASONE 50 MG TAB 10.10 43004138 PREMARIN 0.45 MG TAB 24.70 43004139 PREMARIN 0.3MG TABLET 24.70 43004140 PREMARIN 0.625MG TABLET 24.70 43004150 PREMARIN VAG CREAM 30 GM 1,335.90 43004155 PREMARIN 25MG IV INJ SDV 630.40 43004168 PRAXBIND 2.5 GM/50 ML SDV 4,679.30 43004170 PRAVASTATIN SOD 20 MG TAB 30.80 43004171 PRAVASTATIN SOD 40 MG TAB 26.00 43004185 ACULAR 0.5% 5 ML 652.40 43004188 ADALAT CC 30MG TAB 19.80 43004189 ADALAT CC 60MG TAB 29.20 43004192 ADALAT/PROCARDIA 10MG CAP 14.20 43004193 PROCTOSOL-HC 2.5% CREAM 372.30 43004194 PROCTOCREAM HC 30GM 570.00 43004195 PROCTOFOAM-HC 10GM 367.50 43004196 PROCTOFORM PLAIN 15GM 210.90

43004197 PROGRAF 0.5 MG CAP 24.60 43004202 PROLIXIN 5MG/ML ORAL CONC 81.80 43004203 PROLIXIN 5MG TABLET 14.80 43004206 PROLIXIN DEC. 25MG/ML 397.50 43004214 PROBENECID 500 MG TAB (BENEMID 14.80 43004230 ALCAINE HCL 0.05% 15ML 110.10 43004233 *PROAIR HFA 200 PUFF/8.5 GM IN 217.00 43004238 DIPRIVAN 200 MG/20ML INJ 73.20 43004239 DIPRIVAN 1000MG/100ML BTL 252.40 43004240 PROPYLTHIOURACIL 50MG TAB 9.40 43004241 DIPRIVAN 5 MG INJ 57.50 43004242 PROSCAR 5MG TABLET 29.90 43004245 PROVOCHOLINE 252.60 43004260 PAIN PUMP REFILL SYRINGE 592.60 43004271 NEOSTIGMINE 1MG/ML 1ML 93.80 43004276 HEMABATE 250MCG/1ML INJ SDV 627.80 43004280 PROTAMINE SULF 50MG/5ML 96.50 43004289 CYCRIN/PROVERA 5 MG TAB 11.10 43004290 CYCRIN/PROVERA 10MG TAB 11.20 43004293 PROZAC 10MG CAPSULE 12.30 43004294 PROZAC 20MG CAPSULE 26.70 43004300 PYRIDIUM 100MG TAB 11.10 43004310 PYRIDOXINE 50MG TABLET 8.10 43004320 QUESTRAN 4 GM POWDER 31.50 43004360 RABIES IMM GLOB 1500UN/10MLSDV 8,083.60 43004365 *RABIES IMM GLOB 2ML 2,019.80 43004369 RANEXA 500 MG ER TAB 37.60 43004386 REGLAN 10MG/2ML INJECTION 12.20 43004387 REGLAN 10MG TAB 10.00 43004388 REGLAN 5 MG TAB 10.70 43004389 REGLAN SYRUP 5MG/5ML 12.20 43004397 REGITINE 5 MG PDS SDV 1,424.40 43004405 REMICADE 100MG INJ 3,272.10 43004408 REMINYL 4 MG TAB 34.70 43004409 RELISTOR 12 MG/0.6 ML SDV 266.50 43004410 REVIA 50MG TABLET 37.90 43004426 RESTORIL 7.5MG CAPSULE 84.50 43004428 RESTORIL 15MG CAPSULE 12.80 43004434 RETROVIR 100 MG CAPS 28.80 43004435 RIFAMPIN 300MG CAPSULE 29.30 43004436 REQUIP 0.25MG TABLET 10.60 43004437 REQUIP 1 MG TAB 10.60 43004439 ACAMPROSATE CALCIUM 333MG TAB 15.00 43004440 REQUIP 2 MG TAB 10.60 43004446 RISPERDAL 1 GM/ML SOL 2ML 86.90 43004447 RISPERDAL 1MG TABLET 50.60 43004448 RisperDAL 2 MG TAB 75.20 43004450 RISPERDAL 0.5 MG TAB 48.20 43004451 RISPERDAL 0.25 MG TAB 44.60

43004455 RITALIN 5MG TABLET 10.20 43004457 RISPERDAL CONSTA 37.5 MG/2 ML 2,284.40 43004458 RISPERDAL CONSTA 50 MG/2 ML 2,534.90 43004460 ROBAXIN 500MG TABLET 10.50 43004470 ROBAXIN 750MG TAB 11.50 43004486 ROBINUL 1 MG/5 ML VIAL 15.00 43004491 ROBITUSSIN DM 10ML U/D 12.10 43004492 ROBITUSSIN LIQ 15ML U/D 12.10 43004501 ROCALTROL 0.25MCG CAPS 19.90 43004505 ROCEPHIN 500MG INJECTION 165.10 43004506 ROCEPHIN 1GM INJECTION 254.60 43004507 ROCEPHIN 2GM INJECTION SDV 467.40 43004509 ROWASA ENEMA 4GM/60ML 105.30 43004510 RYTHMOL 150MG TABLET 20.00 43004511 SANDOSTATIN 20 MG IM INJ 9,342.10 43004512 SANDOSTATIN 100 MCG SQ/IV SDV 134.30 43004517 SALAGEN 5 MG TAB 22.00 43004520 SANDOSTATIN LAR 30 MG KIT 13,111.20 43004521 SANTYL 30 GM OINT 490.40 43004525 BIOTENE MOISTURIZING MOUTH SPR 41.60 43004532 SARNA ANTI-ITCH LOTION 52.20 43004553 SENNOSIDES 5 MG 1.76MG/ML SYRP 41.80 43004566 SEROQUEL 100MG TABLET 58.40 43004567 SEROQUEL 25 MG TAB 35.10 43004568 SEROQUEL 200 MG TAB 97.60 43004572 BICITRA-SHOL'S SOL 15ML 12.50 43004575 SILVADENE CR 400GM 217.00 43004577 RENVELA 800 MG TAB 27.20 43004580 SILVADENE CREAM 50 GM 65.30 43004586 SILVER NITRATE APPL. 10.10 43004590 SINEMET 10/100 TABLET 12.90 43004591 SINEMET 25/100 TABLET 13.50 43004595 SINEMET 25/250 TABLET 14.80 43004597 SINEMET 50/200 CR TABLET 20.10 43004605 DOXEPIN 10MG CAPSULE 10.10 43004606 DOXEPIN HCL 25 MG CAP 11.00 43004625 SOD ACETATE INJ 2MEQ/1ML 55.20 43004628 SOD BICARB 8.4% SYR 76.20 43004629 SOD BICARB 4.2% 10ML SYR 52.00 43004630 SOD BICARB 8.4% SYR 52.80 43004631 SOD BICARB 84MG/ML 50 ML VI 14.70 43004635 SOD BICARB 648MG TABLET 8.00 43004639 SOD CHLORIDE 1GM TABLET 8.60 43004643 SODIUM CHLORIDE 0.9% 150 ML 51.80 43004644 SOD CHL 4MEQ/1ML 30ML 54.40 43004645 SOD PHOSPHATE INJ 52.60 43004647 SODIUM THIOSULFATE 12.5 GM 403.60 43004648 SOD PHOSPATES 15 MM/5 ML SDV 81.80 43004660 SOLU MEDROL 1000MG INJ 163.30

43004661 SOLU MEDROL 500 MG INJ 122.10 43004665 SOLU-CORTEF 100MG INJ. 42.10 43004672 SPIRIVA INH 5 CAP 100.70 43004675 SOLU-MEDROL 125 MG SDV 70.40 43004680 SOLU-MEDROL 40MG INJ 33.40 43004690 SOMA 350MG TABLET 12.10 43004700 SEROQUEL XR 50 MG TAB 52.50 43004701 SEROQUEL XR 150 MG TAB 83.90 43004702 SEROQUEL XR 200 MG TAB 86.40 43004703 SEROQUEL XR 300 MG TAB 111.10 43004704 SEROQUEL XR 400 MG TAB 121.10 43004740 STELAZINE 2MG TABLET 14.10 43004745 STELAZINE 5MG TABLET 15.70 43004753 STRATTERA 60 MG CAP 53.80 43004754 STRATTERA 25 MG CAP 50.20 43004755 STRATTERA 40 MG CAP 53.80 43004771 SUCCINYL CHL/NS/PF 100MG/5ML 130.90 43004785 SUDAFED 30MG TABLET 8.20 43004787 SUFENTA 50MCG/1ML 52.90 43004789 BLEPH-10 OPHTH 15ML SOLN 104.80 43004792 SUPER DOOPER DIAPER 32.30 43004830 SYMMETREL 100 MG CAPSULE 17.10 43004844 SYNTHROID 100 MCG/5ML PDS VIAL 265.50 43004845 SYNTHROID .025 MG TABLET 8.90 43004847 SYNTHROID 0.088MG 9.00 43004850 SYNTHROID 0.1 MG TABLET 9.10 43004851 SYNTHROID 0.125MG 9.40 43004852 SYNTHROID 0.112 MG TABLET 11.00 43004855 SYNTHROID 0.15MG TABLET 9.40 43004860 SYNTHROID 0.2MG TABLET 9.70 43004863 SYNTHROID 175 MCG TAB 9.50 43004864 SYNTHROID 50 MCG TAB 9.00 43004865 SYNTHROID 75 MCG TAB 9.00 43004867 CARNITOR 330 MG TAB 13.90 43004890 TRANDATE 100 MG TAB 11.40 43004900 TAMBOCOR 100MG TAB 36.70 43004903 TAMIFLU 75 MG CAP 77.70 43004906 TAMIFLU 6 MG/ML SUSP (60 ML) 562.80 43004907 TAMIFLU 45 MG CAP 68.10 43004908 TAMIFLU 30 MG CAP 68.10 43004914 TEGRETOL 100MG CHEW TAB 12.80 43004915 TEGRETOL 200MG TABLET 10.50 43004917 TEGRETOL XR 400 MG 24.80 43004918 TEMOVATE CREAM 0.05% 30GM 113.30 43004919 TEGRETOL XR 100MG 12.10 43004921 TENEX 1MG TAB 11.90 43004923 TENORMIN 50MG TABLET 14.20 43004924 TENORMIN 25 MG TAB 13.50 43004950 TESSALON PERLES 100MG CAP 14.70

43004965 TETANUS IMMUNE GLOB 250 U 1,678.70 43005045 THIAMINE 100MG/1ML INJ 82.50 43005050 LOVENOX 150 MG/ML INJ 642.80 43005051 THIAMINE 100MG TABLET 5.15 43005070 THORAZINE 10MG TABLET 10.40 43005075 THORAZINE 25MG TABLET 10.00 43005085 THORAZINE 100 MG TABLET 82.85 43005090 THORAZINE 50MG/2ML INJ 67.00 43005093 THROMBIN (BOVINE) 5000 UNT SDV 308.90 43005100 THYROID 60MG TABLET 9.90 43005145 TIMOPTIC 0.25% 5ML. 101.60 43005150 TIMOPTIC 0.5% OPHTH SOLN 107.40 43005164 TOBRADEX OPHTH 2.5ML SUSP 294.30 43005165 TOBREX OPHT SOLN 5ML 372.45 43005167 TOBRADEX EYE OINT 3.5 GM TUBE 746.70 43005206 TOPAMAX TABLET 25MG 31.90 43005207 TOPAMAX 100MG TAB 32.80 43005210 TOPICORT 0.25% CR 15GM 277.90 43005213 TRANSDERM SCOP PATCH 94.10 43005216 TORADOL 30 MG / 1ML INJ 41.60 43005217 TORADOL 60 MG / 2ML 47.70 43005218 TORADOL 10MG TABLET 14.50 43005220 TOPROL XL 100 MG TAB 21.80 43005221 NITRODUR 0.1MG PATCH 34.70 43005226 TRENTAL 400MG TABLET 12.60 43005230 TAC CREAM 0.1% 15GM 45.00 43005235 TAC CREAM 0.5% 15GM 77.20 43005239 TAC CREAM 0.1% 80 GM 94.90 43005241 TAC CREAM 0.025% 80GM 77.60 43005245 KENALOG ORABASE 5GM 330.80 43005247 NORMODYNE 5MG/ML 20ML INJ 64.20 43005248 LACTAID/LACTASE 1 EACH CPLT 8.90 43005250 KENALOG-40 MG/ML SDV 73.10 43005251 TRILIPIX 45 MG CAPDR 20.50 43005252 TRILIPIX 135 MG CAPDR 43.40 43005262 TRILEPTAL 300 MG TAB 38.40 43005267 TRIMETHOPRIM 100MG TABLET 12.70 43005280 TUBERCULIN PPD 0.1ML 36.20 43005295 TUCKS MED PADS 8.20 43005320 TUSSIONEX SUSP 5ML 68.30 43005341 TYLENOL 325 MG/10.15 ML UDC 13.10 43005353 ZOVIRAX 200MG/5ML SUSP 49.40 43005365 TYLENOL W/COD #3 TABLET 10.10 43005370 ULTRAM 50MG TABLET 13.50 43005373 UNASYN 1.5GM INJECTION 99.70 43005374 UNASYN 3.0GM INJECTION SDV 139.90 43005375 ULTIVA 2 MG/5 ML INJ 275.90 43005380 UROCIT K 10 MEQ TAB 15.70 43005385 VALISONE CREAM 0.1% 15GM 96.90

43005390 VALIUM 2 MG TABLET 9.60 43005395 VALIUM 10MG/2ML VIAL SDV 31.80 43005400 VALIUM 5MG TABLET 10.10 43005403 *VANCOCIN HCL 125MG CAP 128.30 43005405 VANCOMYCIN 10 GM PDS VIAL 868.70 43005407 VANCOMYCIN 1GM INJECTION 99.30 43005417 VASOSTRICT 20UNIT/ML MDV 180.10 43005427 VASOTEC 2.5 MG/2 ML SDV 44.00 43005432 CALAN 120 MG ER TAB 15.50 43005436 CALAN ER 5MG/2ML INJ 24.50 43005437 CALAN 80MG TABLET 12.00 43005441 VERSED 5MG/ML 5ML VIAL 55.60 43005442 VERSED 5MG/5ML 5ML VIAL 19.70 43005443 CALAN SR 240MG TABLET 16.50 43005444 VERSED 2MG/ML ORAL SUSP 75.00 43005446 VERSED 100 MG/100 ML NS PREMIX 144.60 43005447 VERSED 2MG/2ML INJ 13.10 43005448 VENOFER 100 MG/5ML 308.90 43005455 DOXYCYCLINE 100MG IV SDV 127.50 43005474 VIMPAT 200 MG INJ SDV 235.90 43005475 VIMPAT 50 MG TAB 45.40 43005483 VICOPROFEN 7.5/200 MG TAB 16.00 43005486 VIROPTIC 1% 7.5 ML EYE DROPS 793.80 43005490 VISINE EYE DROPS 23.00 43005495 VISTARIL 25MG CAPSULE 10.00 43005506 VISTARIL 50 MG/ML INJ 35.70 43005509 VIT D 50000U CAP 14.80 43005511 D-VI-SOL 50 ML DROPS 59.20 43005513 VITAMIN D3 1000 UNITS TAB 5.70 43005528 VFEND 200 MG TAB 252.40 43005529 VFEND I.V. 200 MG VIAL SDV 758.50 43005536 WELLBUTRIN 75 MG 13.00 43005537 WELLBUTRIN 100 MG 14.80 43005541 WELLBUTRIN SR 150MG TAB 37.10 43005542 WELLBUTRIN SR 100MG TAB 35.20 43005551 XANAX 0.25MG 12.40 43005552 XANAX 0.5 MG 13.40 43005553 XANAX 1MG TABLET 14.90 43005557 ZOVIRAX 5 GM OINT 525.90 43005558 ZOVIRAX OINTMENT 30 GM 2,138.90 43005565 XYLOCA 1% C EPI 10MG/ML - 30ML 85.00 43005566 XYLO/EPI 1% 10MG/ML 10ML 66.80 43005572 XYLOCAINE 1% BUFF W/SOD BICARD 37.70 43005575 XYLOCAINE 0.5% MPF 50ML VIAL 37.10 43005579 XYLOCAINE 1% 10MG/10 ML MDV 18.90 43005580 XYLOCAINE (1% 30 ML) 10MG/ML 27.20 43005584 XYLOCAINE MPF 1% 2ML VIAL SDV 22.30 43005589 XYLOCAINE MPF 2% 200 MG/10ML 55.80 43005591 XYLOCAINE MPF 2% 10MG/5ML 27.80

43005592 XYLOCAINE 2%/EPI MPF 20ML 71.00 43005593 XYLOCAINE HCL 2% 50ML VIAL 27.80 43005600 XYLOCAINE 2% JELLY 5ML 63.70 43005605 XYLOCAINE 4% TOPICAL 50ML 68.70 43005608 LIDOCAINE HCL 2% JELLY 5ML URO 55.60 43005609 LIDOCAINE 4% 5 GM CREAM 73.60 43005625 ZANTAC 15MG/ML SYRUP 39.55 43005635 ZAROXOLYN 2.5MG TABLET 26.50 43005638 ZETIA 10MG TAB 40.10 43005639 ZEMURON 50 MG/5 ML VIAL 67.60 43005640 ZAROXOLYN 5MG TABLET 19.80 43005641 ZEMURON 100 MG/ML 236.50 43005644 ZINC-220 CAPSULE 8.40 43005645 ZINC OXIDE OINT 30GM 31.10 43005646 ZOSYN 4.5 GM INJ 175.00 43005647 ZITHROMAX 250MG CAP 82.50 43005648 ZOLOFT 50MG TABLET 18.40 43005649 ZOLOFT 100MG TABLET 40.60 43005650 ZOSYN 2.25GM INJECTION 128.50 43005651 ZOSYN 3.375GM INJECTION 164.40 43005653 ZITHROMAX 500MG INJECTION 200.30 43005654 ZOSTRIX CREAM 28.95 43005655 ZOVIRAX 400 MG TAB 21.30 43005656 ZOVIRAX 200MG CAPSULE 14.90 43005660 ZYLOPRIM 100MG TABLET 9.50 43005661 ZITHROMAX 200MG/5ML SUSP 23ML 276.20 43005663 ZOFRAN 4MG/2ML 16.70 43005670 ZYLOPRIM 300MG TABLET 12.20 43005671 ZYPREXA 15 MG 150.00 43005672 ZYPREXA 10 MG TAB 85.30 43005673 ZYPREXA 10 MG IM INJ 208.40 43005676 TOPROL XL 50 MG 17.00 43005677 TOPROL XL 25 MG TAB 17.00 43005678 ZYPREXA 2.5 MG TAB 78.80 43005679 RECLAST 5 MG/100 ML SOLN 4,029.70 43005681 ZOFRAN 4 MG TAB 137.10 43005682 ZOFRAN ODT 4 MG TAB 129.50 43005683 ZOFRAN 1 MG/0.5 ML INJ 5.80 43005700 ZEMPLAR 5 MCG/ML SDV 223.15 43005752 VERAPAMIL HCL 180 MG CAP 24H P 15.60 43005780 *LETS SOLN 5 ML SYR SINGLE 42.70 43005800 LORTAB 7.5MG/325 MG SOLN 15 ML 26.20 43005801 LORTAB 10MG/325 MG TAB 10.60 43005810 VICODIN 5 MG/325 MG TAB 9.50 43005950 VD 1.2% OVD 193.70 43006000 XYLOCAINE HCL 2% PF AMP 18.30 43006004 XYLOCAINE 4% NEBU 43.00 43006008 XYLO 2%-EPI MPF 20MG/ML - 10ML 61.30 43006010 CONRAY-43 250 ML SDV 111.80

43006011 TRIAMTERENE-HCTZ 37.5-25 MG 9.60 43006013 ADDERALL 5 MG TAB 13.60 43006015 COMPAZINE 10 MG /2 ML 88.50 43006019 VERSED 5MG/5ML 5ML MDV 13.40 43006022 CALCIMAR 400 INT.UNIT/2ML 5,869.40 43006023 DESENEX 43 GEM POWDER 24.50 43006024 HEPARIN 5 000 UNIT/ML SDV 24.30 43006026 *FLUZONE HIGH-DOSE 2017-18 SYR 171.00 43006027 *FLULAVAL QUAD 2017-2018 SYR 80.40 43006028 DEPO PROVERA 150MG/1ML 319.50 43006029 LOTEMAX 5 GM DROPS.GEL 645.30 43006030 HYDROCERIN CREAM 113 GM 28.60 43006031 ORAPRED SYRUP 15 MG/5 ML 35.20 43006032 PRIVIGEN 20 GM/200 ML SDV 6,806.30 43006034 PRIVIGEN 5 GM/50 ML SDV 2,209.60 43006035 PRIVIGEN 10 GM/100 ML SDV 3,519.20 43006036 INJ IVIG PRIVIGEN 40 GM 13,996.70 43006039 ONFI 10 MG TAB 85.60 43006040 ENTRESTO 97 MG-103 MG TABLET 44.70 43006042 OMNIPAQUE (350MG/ML) 100ML INJ 404.30 43006043 NORMOSOL-R PH 7.4 34.00 43006047 SALONPAS 4% PATCH 14.30 43006048 CUBICIN RF 500 MG SDV 1,515.10 43006050 FLUORESCEIN 0.6 MG STRIP 5.90 43006051 KETALAR 25 mg/Syr from MDV 2.90 43006053 KAYEXALATE 15GM/60ML SUSP BTL 53.50 43006054 INS GLARGINE(LANTUS) 1 UN INJ 1.00 43006055 LETS GEL 3 ML SYR SINGLE DOSE 25.90 43006063 CYCLOGYL 1% 15 ML 117.50 43006066 MORPHINE SUL 20 MG/ML UDS 2.45 43006067 SANDOSTATIN 20 MG IM INJ 9,342.10 43006072 MVI-12 (INFUVITE) 10 ML MDV 357.10 43006075 MIACALCIN NASAL SPRAY 360.60 43006076 DEBROX 15ML DROP 15ML 12.50 43006077 NICODERM 14MG/DAY PATCH 14.60 43006078 NICODERM 21MG/DAY PATCH 13.64 43006079 NICODERM 7MG/DAY PATCH 14.55 43006080 ACETADOTE 6000 MG/30 ML INJ 1,055.00 43006081 NONCOVERED ITEM/SERV 2.15 43006082 PHENERGAN PLAIN SYRUP 1.05 43006083 THERAVITE LIQUID 120ML 1.25 43006084 DDAVP 0.2 MG TAB 18.20 43006085 COGENTIN 1MG TABLET 6.85 43006086 PERIACTIN 4 MG TAB 9.80 43006087 BETAPACE 80 MG TABLETS 16.50 43006088 CARDIZEM CD 180MG CAP 7.30 43006089 PROCRIT 2000 UNITS/ML 192.20 43006090 PROCRIT 3 000 UNITS/ML 287.90 43006092 MYFORTIC 180 MG TABDR 27.50

43006093 BRIDION 200 MG/2 ML SDV 347.00 43006094 DERMOPLAST SPRAY 26.50 43006096 CIPRO 200MG IVPB 17.90 43006097 NIPRIDE RTU 50 MG/100 ML VIAL 545.00 43006098 MORPHINE SULF 10 MG/ML SDV 15.35 43006099 *MORPHINE SUL 2 MG/2 ML INJ 17.45 43006100 VANCOMYCIN HCL 500 MG INJ MDV 41.10 43006103 *DIAZEPAM 1 MG/0.2 ML INJ MDV 2.00 43006105 DEFINITY (1.1 MG/ML) SDV 379.70 43006110 DEFINITY 1.5 ML 379.70 43006150 BACITRACIN 50 000 UNIT PDS SDV 91.80 43006155 BRILINTA 90 MG TAB 40.30 43006206 CA GLUC 10% 1 GM/10 ML SDV 48.90 43006207 CARDIZEM 25MG/5 ML VIAL 36.80 43006208 MORPHINE SUL PCA PUMP 62.40 43006210 ACTEMRA 200 MG/10 ML SDV 2,525.80 43006211 ABATACEPT 250 MG VIAL 2,536.00 43006213 ACTEMRA 400 MG/20 ML SDV 5,026.60 43006214 GAMUNEX-C 2.5 GM/25 ML SDV 1,011.60 43006215 NAROPIN 400 MG/200 ML 303.10 43006217 FIRVANQ 125MG/2.5ML UD 6.05 43006218 DILAUDID 0.5 MG/0.5 ML SYRINGE 22.80 43006219 B&O SUPP 16.2-30 MG 87.55 43006224 BOTOX 100 UNITS SDV 1,863.90 43006225 MORPHINE SULF 5 MG/10 ML SDV 36.20 43006226 *MORPHINE 8 MG/8 ML SYRINGE 26.00 43006227 DILAUDID 6 MG/30 ML PCA SYRG 246.60 43006230 KETALAR 25 MG/0.5 ML SYR MDV 2.90 43006231 MYCOPHENOLATE SODIUM 360MG TAB 56.40 43006232 NOREPINEPH BITRART 4000MCG/NS 166.00 43006233 HYDROXYZINE HCL 50 MG/ML SDV 85.10 43006236 MORPHINE SUL 8 MG/ML SDV 16.50 43006238 VANCOMYCIN HCI 1500 MG SDV 72.95 43006241 MAGNESIUM SUL 2 GM/3.2 ML SDV 50.35 43006242 MEGACE 40 MG TABLET 11.90 43006247 NOLVADEX 10MG TABLET 8.10 43006248 MUTAMYCIN 5 MG SDV - EYES 392.90 43006252 *BENZOCAINE ORAL GEL 28.35 43006253 MUTAMYCIN 20MG INJ 1,062.30 43006259 EMEND 150 MG PDS SDV LR 1,207.10 43006261 NEULASTA 6MG/O.6ML OBI KIT SD 14,959.50 43006262 FAMOTIDINE SUSP 555.85 43006264 AYGESTIN 5 MG TAB 16.95 43006265 CLEOCIN 300 MG CAPSULE 21.75 43006269 ROPIVACAINE /PF 1090 MG/545 ML 1,097.00 43006270 DRAMAMINE 50 MG MDV 53.15 43006273 RABIES IMM GLOB 1ML 300 IU SDV 2,135.35 43006274 RABIES IMM GLOB 1500UN/5MLSDV 7,803.85 43006275 CHLOROTHIAZIDE SOD INJ 500 MG 132.70

43006277 FILGRASTIM-SNDZ 1,321.95 43006278 FILGRASTIM-SNDZ 997.35 43006279 COZAAR 25 MG TABLETS 12.25 43006280 ANBESOL 9 GM 28.40 43006281 ROCEPHIN 250MG INJECTION 32.60 43006282 ROCEPHIN 500MG INJECTION 34.70 43006283 ROCEPHIN 2000 MG INJECTION SDV 299.25 43006284 ROCEPHIN 1GM INJECTION 33.10 43006290 ZEMPLAR 1 MCG/0.2ML INJ MDV 58.75 43006291 A & D OINTMENT 13.64 43006294 FLUZONE HIGH-DOSE 2018-19 SYR 173.55 43006295 FLULAVAL QUAD 2018-2019 SYR 75.10 43006300 GENTAMICIN 0.3% OPHTH 5 ML 85.60 43006302 BRIDIAN 500 MG/5 ML SDV 702.60 43006303 FILGRASTIM-SNDZ 1,471.10 43006304 FILGRASTIM-SNDZ 1,109.90 43006308 Zofran SOLN 52.70 43006309 BACTROBAN OINT 2% 22 GM 154.60 43006310 DITROPAN XL 10MG TAB 22.00 43006312 CILOXAN 0.3% OPHTH SOLN 146.95 43006313 POT CHL 10% SOLN 15ML 58.90 43006314 FLUOCINONIDE CR 0.05% 166.40 43006316 BUDESONIDE 0.5MG/2ML NEBU 55.30 43006320 XYLOCAINE VISCOUS 2% ORAL TOP 11.00 43006321 BSS 15 ML IRRIG SOLN 50.20 43006322 CEFEPIME HCL 2000MG PDS SDV 80.10 43006324 DOXYCYCLINE 100 MG CAP 8.10 43006325 ACTIDOSE/AQUA 75.30 43006326 ACTIDOSE/SORBITOL 75.30 43006327 THYROGEN 1.1 MG INJ 4,166.40 43006328 DIPHTH TET TOX ADULT 136.50 43006329 DDAVP INJ 4MCG/1ML 308.30 43006330 ZOVIRAX 500MG/10 ML SDV 90.40 43006332 OMNIPAQUE 4800 mg/20 ML SDV 189.90 43006334 PRECEDEX 400 MCG/100 INJ 356.10 43006338 TIMOPTOC 0.25% OPHTH 98.20 43006339 DEMADEX 100 MG TAB 20.80 43006340 METHOTREXATE PF 50 MG/2 ML SDV 78.50 43006341 GAMUNEX-C 5 GM/50 ML SDV 2,063.60 43006344 MULTITRACE-5 CONC 1 ML SDV 75.10 43006345 ROCEPHIN 250MG INJECTION 32.60 43006348 ISENTRESS 400 MG TAB 91.20 43006349 TRUVADA TAB 201.60 43006350 AMOXIL 400 MG/5ML 100ML ORAL 74.20 43006351 DILAUDID 1 MG/ML SYRINGE 20.90 43006355 FAMOTIDINE/PF 20 MG/2 ML SDV 11.50 43006358 TETRAVISC 0.5% OPHTH 102.10 43006360 MIDAZOLAM PER 1 MG MDV 1.30 43006361 PROVAYBLUE 10 ML 50MG/10 ML 723.50

43006362 PEN G K 600 000 UNITS MDV 6.70 43006364 PROLASTIN C INJ/1000 MG SDV 1,577.50 43006365 *MORPHINE SULF 4 MG/ML SDV 11.10 43006366 IPRAT-ALBUT 0.5-3(2.5) MG/3 Ml 11.80 43006367 GAMMAGARD 0.5 GM/5 ML INJ LIQ 6,914.20 43006368 VITAMIN K 5 MG/5 ML ORAL LIQ 101.50 43006369 *MENTHOL COUGH DROPS 13.00 43006370 DOTAREM 20 ML SDV 392.90 43006371 DOTAREM 15 ML SDV 296.00 43006373 SLO-BID 300MG TAB 20.20 43006374 BACITRACIN OINT 15.30 43006375 DELZICOL 400 MG CAPDR 24.00 43006376 IMOVAX RABIES VACCINE 1,266.10 43006378 AYR SALINE NASAL GEL SPRAY 29.20 43006379 UNNA-FLEX BANDAGE 533.40 43006380 HEPARIN FLUSH 10 UNITS/ML SYRI 17.60 43006381 *D50 FOR SYRINGE 9.00 43006383 PRAVASTATIN SOD 10 MG TAB 19.30 43006384 FAMOTIDINE 10 MG TAB 7.00 43006385 FAMOTIDINE 20 MG TAB 12.70 43006388 ARIMIDEX 1 MG TABLET 15.30 43006389 ZOMETA 4 MG/5 ML INJ 720.10 43006395 CRESTOR 20 MG TAB 50.00 43006396 CRESTOR 10 MG TAB 50.00 43006397 EPTIFIBATIDE INJ 20 MG 390.60 43006398 INTEGRILIN 75 MG INJ 1,161.00 43006399 KCENTRA 1 IU 5.70 43006803 BUSPAR 10 MG tab 11.10 43006805 TOBRADEX OPHTH 2.5ML SUSP 187.05 43006806 AMPICILLIN 500 MG INJ SDV 48.83 43006807 ZOCOR 40 MG TAB 27.15 43006809 ENTRESTO 49 MG-51 MG TABLET 44.70 43006810 ENTRESTO 24 MG-26 MG TABLET 44.70 43006812 CEFTRIAXONE 2 GM PREMIX 81.60 43006813 DIFLUCAN 400 MG PREMIX IV 33.05 43006814 CYTOTEC 25 MCG TAB 6.15 43006815 CYTOTEC 100MCG TABLET 9.40 43006821 *AVONEX 30 MCG INJ SDV 4,079.00 43006822 DIAMOX 125 MG TAB 14.80 43006823 SORE THROAT SPRAY 16.25 43006825 LINZESS 145 MCG CAP 63.05 43006827 ABILITY MAINTENA 400 MG SYR 5,204.40 43006830 LAC-HYDRIN 12% LOTION 73.40 43006831 MORPHINE 2 MG/ML INJ 15.15 43006835 BENADRYL 50MG/ML INJ 19.85 43006900 ZYPREXA DISINTIGRATING 5 MG 99.20 43006901 ZYPREXA DISINTEGRATING 20MG TB 202.80 43007006 COLESTIPOL HCL 1 GM TAB 12.60 43007007 FLONASE 0.05% NASAL SPRAY 434.00

43007009 B COMPLEX CAPSULE (RUGBY) 8.20 43007010 TRUSOPT 2% OPTHALMIC 10 ML 364.90 43007013 ZYPREXA 5 MG TABLET 91.70 43007017 FLOVENT 220MCG INHALER 1,206.90 43007018 VITAMIN B 12 TAB 100MCG 8.00 43007019 VITAMIN A CAP 8.10 43007022 LUVOX 100MG TABLET 26.50 43007024 VIT B COMP/VITAMI4 SGL RENAL 9.50 43007025 COZAAR 50MG TABLETS 28.30 43007026 COZAAR 100 MG TAB 34.60 43007027 AMARYL 2MG TABLET 12.50 43007028 LEVSIN/SL 0.125MG TABLET 10.00 43007031 NEURONTIN 100MG CAPSULE 14.20 43007032 NEURONTIN 600 MG TAB 25.70 43007034 NEURONTIN 100 MG/2 ML ORAL SOL 13.30 43007037 LEVBID 0.375MG ER TABLET 11.70 43007040 LEVETIRACETAM IN NACL 500MG PR 102.80 43007043 MACROBID 100MG CAPSULE 30.50 43007044 ALTACE 2.5MG CAPSULE 24.50 43007048 OXYCONTIN 20MG TABLET 37.50 43007051 OXYCONTIN 10MG CR TABLET 23.40 43007052 PROZAC LIQUID 20 MG/5 ML 105.90 43007056 DEPAKOTE 125MG SPRINKLE 16.50 43007062 AZACTAM 1000MG (1GM) 202.20 43007066 SANDIMMUNE 25MG CAPSULE 26.70 43007071 CASODEX 50MG TABLET 79.80 43007081 AUGMENTIN 875MG TABLET 62.10 43007082 MINOCYCLINE 100MG CAPSULE 31.80 43007083 TAPAZOLE 10 MG TAB 13.40 43007085 VITAMIN BL2 1000 MCG TAB 8.20 43007090 VITAMIN D 400 INT.UNIT TAB 8.00 43007096 LEVAQUIN 750 MG TAB 149.50 43007097 LEVAQUIN 500MG TABLET 15.20 43007098 XALATAN 0.005% OPTHAL SOL 509.40 43007099 ARICEPT 5 MG TABLET 73.30 43007103 *LAC-HYDRIN 12% LOTION 83.10 43007110 LAMICTAL 25 MG TABLETS 45.50 43007115 FLOVENT 110MCG INHALER 780.00 43007150 LUPRON DEPOT 7.5 MG KIT SINGLE 3,033.50 43007155 LUPRON DEPOT 45MG KIT SINGLE 19,718.70 43007205 NAROPIN 0.2% 200MG/100 ML PRMX 192.50 43007710 GLUCOPHAGE 850MG TABS 21.30 43007715 MESTINON 60MG TABLET 24.20 43007720 ZANAFLEX 4 MG TABLETS 25.50 43007723 LIPITOR 10MG TABLET 10.50 43007724 BETAPACE 80 MG TABLETS 25.90 43007725 ZADITOR O.25% OPHTH SOLM 5 ML 84.00 43007732 PRECEDEX 200 MCG/2 ML INJ 400.80 43007736 REMERON 15 MG TABLET 27.00

43007737 ZYRTEC 10 MG TABLET 9.90 43007739 ZYRTEC 5 MG/5 ML 49.90 43007740 ZYVOX 600 MG TAB 510.60 43007752 JANUVIA 100 MG TAB 61.90 43007753 JANUVIA 25 MG TAB 61.90 43007790 SKELAXIN 800 MG TAB 41.30 43007793 PLETAL 100 MG TAB 20.70 43007794 PROAMATINE HCL 2.5 MG TAB 16.40 43007795 MIRAPEX 0.25 MG TAB 35.80 43007799 OXACILLIN SODIUM 1000 MG SDV 130.30 43007801 PROSTAPHLIN 2000 MG VIAL 171.80 43007807 CIPRO 250 MG TAB 39.10 43007808 *LANTUS INSULIN PER/1 ML 82.40 43007809 PROTONIX 40 MG INJ 129.10 43007813 PROTONIX 40 MG TAB 50.40 43007814 PROTONIX 20 MG CAP 50.40 43007817 ZYVOX 600 MG/300 ML PREMIX 578.80 43007859 XARELTO 10 MG TAB 61.70 43007861 XARELTO 15 MG TAB 69.30 43007862 XARELTO 20 MG TAB 69.30 43007870 PHENOBARBUTAL 32.4 MG TAB 9.00 43007880 XGEVA 120 MG/1.7 ML VIAL 6,191.70 43008000 INSULIN REG 1 UNIT/0.01 ML INJ 0.70 43008001 INS LISPRO-PROTAM 75/25 1 UNIT 1.00 43008003 INSUL REG-ISOPHANE 1 UN/0.1ML 0.70 43008005 INS LISPRO (HUMALOG) 1 UN INJ 1.00 43008006 INS ISOPHANE HUMAN 1 UNIT INK 0.70 43008007 BACTRIM 80/16 MG 16MG/1 ML INJ 8.60 43008100 CONRAY-43 50 ML SDV 79.80 43008101 CONRAY-60 50 ML SDV 74.80 43008106 OMNIPAQUE (180MG/ML) 20 ML SDV 194.90 43008107 OMNIPAQUE (240MG/ML) 50 ML SDV 171.30 43008108 OMNIPAQUE (300MG/ML) 10 ML SDV 175.60 43008109 OMNIPAQUE (350MG/ML) 50 ML SDV 205.10 43008110 OMNIPAQUE (350MG/ML) 100ML SDV 404.30 43008111 OMNIPAQUE (350MG/ML) 200ML SDV 683.50 43008112 VISIPAQUE (320MG/ML) 100ML SDV 467.40 43008996 SYMBICORT 80-4.5 MCG INHALER 735.60 43008997 SYMBICORT 160-4.5 MCG INHALER 841.10 43009001 ALBUTEROL SULFATE 0.5%MG/ML NB 14.20 43009002 IPRATROPIUM BROMIDE 0.5MG NEBU 9.40 43009003 BUDESONIDE 0.25MG/2ML NEBU 63.00 43009005 RACEPINEPHRINE HCL 5.625MG NEB 16.70 43009008 XOPENEX 0.63MG/3ML NEBU 57.60 43009010 XOPENEX 1.25 MG/0.5 ML 57.60 43009012 ALBUTEROL SULFATE 1.25MG/3ML 14.60 43009244 LEXISCAN 0.4 MG/5 ML SYR 1,215.20 43009602 *ULTRAM 50 MG - 4 PK 3.80 43009603 *AMOXICILLIN 500 MG - 4 PK 4.00

43009605 *AUGMENTIN 875 MG - 2 PK 5.70 43009606 ZITHROMAX 250 MG - 2 PK 6.60 43009609 *CIPRO 500 MG - 2 PK 4.10 43009610 *SEPRA DS 800/160 MG - 2 PK 4.00 43009615 *VALIUM 5 MG - 2 PK 3.90 43009616 ATIVAN 1 MG - 2 PK 3.90 43009617 PERCOCET 5MG/325MG - 4 PK 4.00 43009618 *CLINDAMYCIN HCL 900 MG/PKT 4.20 43009619 ZOFRAN ODT 4MG START PK 2 TABS 4.50 43009620 VICODIN 5 MG/325 MG 6 PK TABS 4.90 43009624 STARTPK024 4.20 43009625 *STARTPK025 4.30 43009626 STARTPK026 5.20 43009627 *STARTPK027 6.00 43009628 DOXYCYCLINE START PACK 2 CAPS 4.10 43009630 CLINDAMYCIN HCL 300 MG/PKT 4.05 43009631 AMOXICILLIN 500 MG - 2 PK 4.00 43009632 CIPRO 500 MG - 1 PK 3.90 43009633 Ceprozil 250 Tab 1 PK 4.40 43009634 Promethazine 25 mg Tab 2 PK 3.80 43009635 SEPRA DS 800/160 MG - 1 PK 3.90 43009636 ULTRAM 50 MG - 2 PK 3.85 43009711 DEPACON INJ 500MG/5ML SDV 155.80 43009850 VALTREX 500 MG CAPLETS 10.70 43009940 *HUMALOG INSULIN U-100 94.70 43009949 *DIOVAN 80 MG CAPSULES 30.60 43009950 *DIOVAN 160 MG TAB 32.40 43009951 *DIOVAN 40 MG TAB 26.80 43009988 ANTI-ITCH TOPICAL CREAM 37.90 43009995 CARDIZEM 360 M GCAP 71.20 43090715 BOOSTRIX VACCINE SYRINGE 206.20 43100011 ADRIAMYCIN 50 MG/25 ML VIAL 381.70 43100012 ADRIAMYCIN 20 MG/10 ML VIAL 201.80 43100015 ABRAXANE 100 MG/20 ML 3,574.90 43100016 AVASTIN 100 MG/4 ML 2,752.30 43100017 AVASTIN 400 MG/16 ML 8,635.40 43100024 BLENOXANE 30 UNITS VIAL 489.90 43100035 LEUCOVORIN CAL 100 MG VIAL 109.90 43100037 LEUCOVORIN CALCIUM 200 MG VIA 168.10 43100038 LEUCOVORIN CALCIUM 500MG/50ML 281.50 43100048 DOXIL 50 MG/25 ML 9,651.30 43100049 DTIC 200MG INJECTION 199.50 43100057 CYTOXAN 1000 MG/50 ML VIAL 2,887.20 43100066 FLUOROURACIL 1000 MG/20ML VIAL 126.00 43100075 5-FU 500MG INJ 102.10 43100077 HYDREA 500MG CAPSULE 16.40 43100083 GEMZAR 200MG VIAL 10ML 911.30 43100084 GEMZAR 1000 MG VIAL 3,549.40 43100085 HYCANTIN 4MG VIAL 4,290.00

43100091 MEGACE 40 MG TABLET 11.90 43100093 MEGACE 200 MG/5 ML SUSP 10.60 43100096 METHOTREXATE 50MG INJ 109.40 43100105 NAVELBINE 50 MG/5 ML INJ 724.70 43100106 MUTAMYCIN 20MG INJ 1,062.30 43100107 NAVELBINE 10MG/1ML 275.00 43100109 MUTAMYCIN 5 MG VIAL - EYES 392.90 43100111 CYTOXAN 500 MG INJ 1,761.70 43100115 NOLVADEX 10MG TABLET 8.10 43100120 VINCRISTINE 1MG INJECTION 120.10 43100131 TREANDA 100MG/20 ML SDV 7,182.30 43100133 RITUXAN 100MG INJ 2,809.70 43100134 RITUXAN 500 MG/50 ML VIAL SDV 11,003.90 43100140 TAXOTERE 20 MG/1 ML VIAL 2,393.60 43100141 TAXOTERE 80 MG/4 ML VIAL 6,252.50 43100170 ALIMTA 500 MG INJ 9,705.40 43100171 ALIMTA 100 MG INJ 2,485.00 43100225 VELCADE CONC 2.5 MG/ML (3.5MG) 5,179.00 43100301 BENDAMUSTINE HCL 62.70 43100302 ELOXATIN 100 MG/20 ML 456.30 43100303 ELOXATIN 50 MG/10 ML PDS VIAL 255.90 43100305 HERCEPTIN 150 MG SDV 3,715.90 43100306 EMEND 150 MG PDS SDV LR 1,207.10 43100307 IMFINZI 500 MG/10 ML SDV 8,987.10 43100308 IMFINZI 120 MG/2.4 ML SDV 2,197.60 43100309 TAXOL 1MG/0.1666 ML INJ MDV 4.00 43100310 VECTIBIX 100 MG/5 ML VIAL SDV 3,259.10 43100311 VECTIBIX 400 MG/20 ML VIAL SDV 10,681.30 43100313 KYPROLIS 60 MG INJ SDV 6,292.00 43100314 CYRAMZA 100 MG/10 ML SDV 2,779.80 43100315 CYRAMZA 500 MG/50 ML SDV 13,676.30 43100318 PERJETA 420 MG/14 ML SDV 13,708.10 43100319 KEYTRUDA 100 MG/4 ML SDV 11,582.50 43100320 KADCYLA 100 MG/5 ML PDS SDV 7,866.10 43100321 TECENTRIQ 1200 MG/20 ML SDV 23,077.30 43100322 NEULASTA 6MG/O.6ML OBI KIT SD 14,959.50 43100323 LUPRON DEPOT 22.5 MG INJ 9,151.40 43100324 LUPRON DEPOT 30 MG INJ KIT 10,254.60 43100325 PROLIA 60 MG/1 ML SYRINGE 3,872.90 43100326 LUPRON DEPOT 45 MG KIT SNGL 19,718.70 43100327 XGEVA 120 MG/1.7 ML VIAL 6,191.70 43100330 KADCYLA 160 MG/8 ML PDS SDV 12,548.90 43100334 ALOXI 0.25 MG/5 ML 1,085.00 43100335 OPDIVO 240 MG/24 ML SDV 14,929.98 43100336 LEUPROLIDE ACE 3.75 MG INJ 2,695.00 43100337 LEUPROLIDE ACE 11.25 MG KIT 6,457.00 43100338 LUPRON DEPOT 7.5 MG KIT SINGLE 3,033.50 43100340 PERCOCET 10/325 MG TAB 21.05 43100348 DACOGEN 50 MG INJ 5,996.90

43100349 SANDOSTATIN LAR 30 MG KIT 13,111.20 43100350 *FILGRASTIM-SNDZ 1,471.10 43100359 *FILGRASTIM-SNDZ 1,109.90 43100360 NEULASTA 6 MG INJ 13,181.60 43100361 THYROGEN 1.1 MG INJ 4,166.40 43100362 SANDOSTATIN 20 MG IM INJ 9,342.10 43100367 PROVOCHOLINE 100 MG NEB 252.60 43100370 TORISEL 25 MG/ML KIT 4,572.70 43100375 IFOSFAMIDE 1 GM / 20 ML SDV 182.25 43100376 FILGRASTIM-SNDZ 1,321.95 43100377 FILGRASTIM-SNDZ 997.35 43100378 KYPROLIS 30 MG INJ 2,756.85 43100379 KYPROLIS 10 MG INJ 1,402.40 43100381 VENOFER 200 MG/10 ML 385.00 43100384 BENADRYL 50MG/ML INJ 6.25 43100392 YERVOY 50 MG/10 ML SDV 17,266.90 43100394 YERVOY 200 MG/ 40 ML SDV 68,917.60 43100502 PARAPLATIN 450 MG INJ MDV 49.30 43100503 PARAPLATIN 150 MG/15 ML MDV 65.60 43100504 PARAPLATIN 600 MG/60 ML MDV 176.20 43100511 CAMPTOSAR 100 MG/5 ML VIAL SDV 115.70 43100523 VEPESID 100 MG/5 ML 14.90 43100530 CISPLATIN 50 MG 37.90 43100535 VINBLASTINE 10 MG INJ 24.40 43100546 CISPLATIN 100 MG 25.30 43100549 ZOLADEX 3.6 MG IMPLANT 2,121.70 43100555 MESNEX 1000 MG INJ 73.00 43100571 TAXOL 100MG MDV 2.50 43100572 TAXOL 150 MG MDV 2.20 43100650 IRINOTECAN HCL 40 MG/2 ML VIAL 286.20 43100700 5-FU 500 MG/10 ML MDV 17.10 43102500 VIDAZA 100 MG VIAL 2,432.00 43102503 FASLODEX 250 MG/5 ML SYR 3,216.80 43200005 SOD CHLORIDE 0.45% 1OOOML 74.20 43200010 SOD CHLORIDE 0.9% 250ML 81.90 43200015 SOD CHLORIDE 0.9% 1000ML 74.20 43200020 SOD CHLORIDE 0.9% 5OOML. 50.60 43200060 DEX 5%/NS 0.45% 1000ML 74.20 43200075 LACTATED RINGERS 1000ML 74.20 43200080 DEX 5%/LR 1000ML 74.20 43200086 D10% 1/4NS 250 ML 53.10 43200105 NITRO 25 MG/D5W 250 ML 75.80 43200124 STER WATER FOR INJ 1000ML 74.20 43200130 STER WATER CBI 3000ML BAG 54.00 43200150 SOD CHLORIDE 0.9% 100ML 87.40 43200155 SOD CHLORIDE 0.9% 50ML 92.70 43200169 DEXTROSE 10% 500ML 57.80 43200170 DEXTROSE 10% 1000ML 74.20 43200178 DEXTROSE 70% INJECTION 85.60

43200195 D5W 100 ML 87.40 43200200 D5W 50 ML 87.40 43200208 SOD CHLORIDE 3% 500ML 53.90 43200214 DEXT W/KCL & NACL 1EA/1000ML 82.20 43200215 D5-1/2NS KCL 20MEQ 1000ML 82.20 43200216 D5-1/2NS KCL 40MEQ 1000ML 82.20 43200219 D5W 5%/NS 0.2% 1000ML 74.20 43200220 DEX 5%NS 0.45% 500ML 54.00 43200225 DEX 5%/NS 0.9% 1000ML 74.20 43200235 DEXTROSE 5% 1000ML 74.20 43200237 DEX 5%/NS KCL 20 MEQ 1000 ML 31.10 43200240 DEXTROSE 5% 250ML 83.40 43200241 D10250 25.50 43200244 HEPARIN PREMIX 50UNITS/ML 59.60 43200245 DEXTROSE 5% 500ML 52.20 43200247 DOBUTREX 500MG/D5W250ML 346.60 43200248 DOPAMINE 400 MG/D5W 250ML 137.20 43200274 TRAVASOL 10% 1000ML 564.10 43200310 IRRIG WATER 1000ML 54.00 43200315 IRRIG NS 1000ML 54.00 43200320 OSMITROL 500ML 205.30 43200330 CBI SORBITOL 3000ML 91.90 43200350 FENTANYL PCA 1000MCG/50ML 137.00 43200360 FREAMINE III 10% 564.10 43200400 SOD CHLORIDE 0.9% 1ML 0.10 43207811 KCL 40 MEQ NS 82.20 43207812 KCl 20 Meq in NACL 1000 ML 82.20 43300059 ALBUTEROL SULFA 2.5MG/3ML NEBU 9.20 43300160 ABATACEPT 250 MG VIAL 2,549.70 43300191 ACTEMRA 200 MG/10 ML SDV 3,442.70 43300192 ACTEMRA 400 MG/20 ML SDV 5,461.40 43300233 AMILORIDE HCL 5 MG TAB 16.90 43300245 BONIVA 3 MG/3 ML KIT 2,065.30 43300251 BOTOX 1,863.90 43300252 VECTIBIX 100 MG/5 ML VIAL SDV 3,259.10 43300253 VECTIBIX 400 MG/20 ML VIAL SDV 10,681.30 43300420 DACOGEN 50 MG INJ 5,996.90 43300551 EFFIENT 5 MG TAB 56.30 43300631 FIRMAGON 240 MG SQ INJ 3,663.05 43300808 INVANZ 1000 MG PDS VIAL 395.30 43300900 KYPROLIS 60 MG INJ 6,292.00 43300952 CYRAMZA 100 MG/10 ML SDV 2,779.80 43300953 CYRAMZA 500 MG/50 ML SDV 13,676.30 43301192 CLOZARIL 100 MG TAB 21.80 43301201 LOXAPINE 10 MG CAP 16.90 43301260 MEXITIL 150 MG CAP 15.70 43301265 MIOSTAT 0.01% 1.5ML OPHTH 155.90 43301303 OPIUM 6 MG/0.6 ML 27.30 43301310 OPDIVO 100 MG/10 ML SDV 6,808.90

43301311 OPDIVO 40 MG/4 ML SDV 2,758.70 43301360 MULTIVITAMIN W/O IRON 50ML LIQ 59.20 43301709 PERJETA 420 MG/14 ML SDV 13,708.10 43301797 HURRICAINE 20% ORAL UN DOS SPR 85.80 43301804 LANSOPRAZOLE 15 MG CAP 47.70 43301808 LITHIUM CARBONATE EXTENDED 11.20 43301811 MYCOPHENOLATE SODIUM 360MG TAB 56.40 43301825 PAIN EASE SPRAY 162.50 43301837 PROMETRIUM 100 MG CAP 16.20 43301858 SAVELLA 50 MG TAB 23.80 43301945 SILDENAFIL 20 MG TAB 29.50 43302295 GARAMYCIN 80 MG INJ 56.50 43302490 ULORIC 40 MG TAB 45.20 43302525 TRINTELLIX 10 MG TAB 64.70 43302901 LAMISIL 250MG TABLET 29.70 43303005 DOXYCYCLINE MONO 300MG/60ML SU 129.20 43303051 NEVANAC MUCOMYST 10% 4ML NEB 60.20 43303205 XOLAIR 150 MG /1.2 ML PDS SDV 2,997.60 43303245 KEYTRUDA 100 MG/4 ML SDV 11,582.50 43303250 KADCYLA 100 MG/5 ML PDS SDV 7,866.10 43303251 KADCYLA 160 MG/8 ML PDS SDV 12,548.90 43303634 NITRO 0.4 MG 4.9 GM SPRAY 884.20 43304037 PLAVIX 300 MG TAB 144.70 43304200 RIFAMPIN 150 MG CAP 15.60 43304404 SIMPONI ARIA 50 MG/4 ML SDV 3,956.90 43304412 CREON DR 36 000 UNITS 50.20 43304417 TECENTRIQ 1200 MG/20 ML SDV 23,077.30 43304420 EMPLICITI 300 MG PDS SDV 4,798.80 43304428 TRAVATAN 0.004% OPHTH 606.10 43304433 BYETTA 600MCG/2.4ML PEN 2,033.70 43304439 ENTYVIO 300 MG PDS SDV 13,411.80 43304440 NUCALA 100 MG PDS SDV 6,903.90 43304445 ASCORBIC ACID 500 MG/ML INJ 7.50 43304451 BENLYSTA 400 MG PDS SDV 4,316.40 43304452 PRESERVISION AREDS 2 SOFTGEL 6.70 43304453 SAPHRIS 5 MG SL TAB 87.40 43304456 TAZICEF 2000 MG SDV 83.30 43304457 ENTRESTO 49 MG-51 MG TABLET 44.70 43304458 ENTRESTO 24 MG-26 MG TABLET 44.70 43304461 OCREVUS 300 MG/10 ML SDV 41,783.50 43304465 ETHACRYNIC ACID 25 MG TAB 95.10 43304466 ETHACRYNATE SOD 50 MG PDS SDV 9,785.20 43304467 EXTAVIA 0.3 MG PDS SD KIT 1,532.60 43304468 TUDORZA PRESSAIR INH 30 PUFF 625.90 43304469 COPPER CHL 0.4 MG/ML 10 ML SDV 107.08 43304475 OPDIVO 240 MG/24 ML SDV 14,929.98 43304477 STELARA 130 MG/26 ML SDV 3,865.00 43304478 AVYCAZ 2.5 GRAM 1,204.65 43304480 CRESEMBA 186 MG CAP 319.35

43304481 REBIF 22 MCG/0.5 ML SYRINGE 1,825.00 43304482 ZANTAC 15MG/ML SYRUP 2.25 43304484 PALIPERIDONE PALMITATE 18,017.15 43304487 CHLOROTHIAZIDE SOD INJ 500 MG 132.70 43304491 DUREZOL OPHTH EMUL 626.80 43304492 RADICAVA 30 MG/100 ML PRMX 1,666.60 43304496 AVONEX 30 MCG INJ SDV 4,079.00 43304498 FETZIMA 120 MG CAP.SA 62.40 43305653 ZONEGRAN 25 MG CAP 8.80 43306071 AZILECT 1 MG TAB 92.45 43400011 LEVEL I PAIN MANAGEMENT 643.70 43400012 LEVEL II PAIN MANAGEMENT 1,787.10 43400013 LEVEL III PAIN MANAGEMENT 3,430.90 43400014 INJ EA ADD'L LEVEL OR JOINT 1,358.30 43400017 PROC/SPINALCORD NEUROSTM TRIAL 13,437.20 43400021 CATHETER INTRASPINAL 286.90 43400022 OCTRODE LEAD 8,189.00 43400027 NEEDLE CURVED TIP 342.60 43400028 OXYGEN PER HOUR 33.90 43400030 KYPHOPLASTY ANY LEVEL 17,153.90 43400031 KYPHOPLASTY EA ADD'L LEVEL 11,435.90 43403093 PAIN/CABLE SNAP LID CON 335031 1,453.90 43403094 KIT/MEDTRONIC EXT 3708240 5,433.50 43403095 INTRODUCER TOOL OSTEO T24C 1,521.70 43403097 CURETTE A13A 824.00 43403098 NEEDLE/CONT EPIDURAL AN02017 43.40 43403099 SYRINGE/7ML EPILOR 405292 19.20 43403100 CATH/EPIDURAL THERACATH EC0500 158.00 43403101 EXT SET 6 MINI BORE 18933 33.70 43403103 INJEX BI WING ANCHOR 471.80 43403104 BONE CEMENT DELIVERY GUN CD53A 604.40 43403105 BONE CEMENT CARTRIDGE CC02A 183.30 43403110 NEEDLE CURVE TIP-NEVRO CORP 225.00 43403111 TLEAD1058-50B NEVRO CORP 1,600.00 43499144 *MOD SED 5 YRS > 1ST 30 MIN 911.50 43499152 CON/MOD SED > 5 YR 1ST 15 MIN 876.40 43499153 MOD SED SAME PHYS EA ADD 15 876.40 43500010 GEN ANESTHESIA 695.00 43500015 MAC- MONITERED ANESTHESIA CARE 515.70 43500020 REGIONAL ANESTHESIA 515.70 43500025 DISPOSABLE SPINAL TRAY 333.00 43500027 DISPOSABLE EPIDURAL TRAY 387.80 43500037 RAPID INFUSOR 3 SPIKE DISP 349.40 43500120 ELECTRODES/BSI 257.60 43500204 CATH/RADIAL ART 94.00 43500205 CATH/RAPID INFUSION 7.0FR 175.10 43500206 CATH/RAPID INFUSION 8.5FR 175.10 43500207 STIMUCATH CON NERVE AB20608-S 399.70 43500300 PUMP ACTION CONT TAP BLOCK 419 493.10

43500301 T-FLOW SPLITTER FOR TAP BLOCK 151.60 43500302 CONT TAP BLOCK NEEDLE 358433 76.40 43500303 LMA 5 PROTECTOR AIRWAY 159.50 43500304 NEEDLE STEM QUICK-STIMULTE 73.40 43500305 CONT PERIP BLK KIT (SUB CLAV) 188.80 43500306 FORE-SIGHT SENSOR 272.20 43500308 POM MASK 39.90 43500309 LMA 4 PROTECTOR AIRWAY 159.50 43500310 STIMUCATH CONT NER BLK KIT 284.80 43500311 NEEDLE STEM QUICK-NON STIM 57.70 43500313 FIBEROPTIC AIRWAY OVASSAPIAN 33.00 43500314 SENSOR NASAL ALAR SP02 115.40 43500316 PROBE ESOPHAGEAL DOPPLER 522.40 43500317 SEDLINE MASIMO SENSOR 80.80 43500322 LARGE HYPER MASK-SUPERNOVA 170.00 43500323 ON-Q STIM KIT 4 W/DRUGS 226.00 43500324 ON-Q TRAY PREP TBLOC W/O DRUGS 171.00 43500325 ON-Q DUAL PUMP PERIP NERVE BLK 990.00 43500326 CATH CRICOTHYROTOMY 957.00 43500327 ON-Q ECHOBRIGHT NEEDLE 73.00 43500328 ON-Q QUICKBLOC OVER NEEDLE 136.00 43500329 MEDIUM HYPER MASK-SUPER NOVA 170.00 43500330 ON-Q STIM KIT 4 W/O DRUGS 211.00 43500332 RAINBOW-ADULT PULSE OX 200.00 43500400 CATH/ E L S FLO-TRAC 801.20 43500600 KIT/PRESSURE MONITORING 126.30 43500601 KIT/QUAD LUMEN CATH 530.00 43500602 KIT/TRIPLE LUMEN CATH 7FR 387.90 43500603 KIT/CATH 8.5FR 623.00 43500802 PUMP ON-Q C-BLOC CB001 556.90 43500804 PUMP PAIN CONT NERVE BLOCK 659.90 43500920 TUBE/ENDOTRAC LASER 5.5 654.50 43500921 TUBE/ENDOTRAC LASER 6.0 654.50 43500922 TUBE/ENDOTRACC LASER 7.0 654.50 43500927 SALEM SUMP TUBE 16 FR 52.80 43500928 SENSOR BILATERAL 219.70 43500929 NEEDLE GUIDE KIT 18G 9001C0212 166.70 43500930 DISP BP CUFF ADULT 23-33 45.20 43500931 DISP BP CUFF CHILD 12-19 37.50 43500932 DISP BP CUFF ADULT 17-25 41.40 43500933 DISP BP CUFF ADULT 31-40 51.20 43500934 DISP RANGER FLUID WARMING SET 21.70 43500935 DISP OXISENSOR ADULT 77.70 43500937 GVL STAT DISP SLEEVES 109.30 43500938 EYE GUARD STERILE 40.50 43500939 DISP OXYALERT NIRSENSOR ADULT 392.40 43500940 CHEETAH NICOM SENSOR 408.90 43500941 SAFERSONIC SNGL SHOT W/GEL 39.90 43500942 VIDEOSCOPE 5MM DIAM 1.2MM CHN 928.00

43609202 LEVEL 2 NEW PAT LOW/MODERATE 368.70 43609203 LEVEL 3 NEW PAT MODERATE 511.30 43609204 LEVEL 4 NEW PAT MODERATE/HIGH 640.10 43609212 LEVEL 2 EST PAT LOW/MODERATE 368.70 43609213 LEVEL 3 EST PAT MODERATE 494.50 43609214 LEVEL 4 EST PAT MODERATE/HIGH 511.30 43609215 LEVEL 5 EST PAT COMPREHENSIVE 380.00 43609244 LEVEL 4 CONS 60 MIN 325.90 43620225 PRO BONE BIOPSY TROCAR/NEEDLE 772.90 43620552 PRO TRIGGER POINT 255.40 43620553 PRO TRIGGER POINT 3+ MUSCLE GR 248.50 43620610 PRO MAJOR JNT OR BURSEA NO US 218.10 43620982 PRO ABLATE BONE TUMOR(S) PERQ 771.00 43622513 PRO KYPHO THORACIC 2,246.00 43622514 PRO KYPHO LUMBAR 2,151.50 43622515 PRO KYPHON 2ND LEVEL 1,030.30 43627096 PRO SI 879.20 43662290 PRO DISCOGRAM 942.60 43662291 PRO INJ PROC FOR DISCOGRAPHY E 942.60 43662321 PRO THOR/CERV EPI SINGL W/IMAG 650.60 43662323 PRO INJ INTER LMBR/SAC W/IMAG 553.40 43662327 PRO NFSN INTER LMBR/SAC W/IMAG 591.40 43662350 PRO IMPLANT EPI 1,885.20 43663650 PRO NEUROSTIMULATOR 2,263.60 43663663 PRO REVISION/REPLACEMENT 2,277.10 43664405 PRO OCCIPITAL NERVE 471.60 43664420 PRO INTERCOSTAL NERVE SINGLE 341.00 43664421 PRO INTERCOSTAL NERVE MULTIPLE 469.20 43664425 PRO ILLIOING ILIOHYPOGASTRIC N 365.80 43664450 PRO COCCYX LATERAL FEM CUTANEO 843.30 43664479 PRO CERVICAL/THORACIC EPI 726.00 43664480 PRO TRANS EPI 2+ LEVELS 436.20 43664483 PRO LES 634.90 43664484 PRO LUMBAR EPI ADD'L 362.90 43664490 PRO CERVICAL/THORACIC FACET 304.90 43664491 PRO CERVICAL/THORACIC 2ND LEVE 178.20 43664493 PRO LUMBAR FACET 257.40 43664494 PRO LUMBAR FACET 2ND LEVEL 150.60 43664633 PRO RF CERVICAL THORACIC 828.10 43664634 PRO RF CERVICAL/THORACIC ADDIT 406.30 43664635 PRO RF LUMBAR 828.10 43664636 PRO RF LUMBAR ADD'L LEVEL 456.80 43664640 PRO RFTC SACROILIAC NERVE 652.80 43672285 PRO DISCOGRAPHY CERVICAL OR TH 345.00 43672295 PRO XRAY OF LOWER SPINE DISC 483.10 43676942 PRO US GUIDANCE FOR NEEDLE PLA 124.80 43695970 PRO ELECT ANALYSIS OF IMPL PUL 251.30 43695971 PRO ELECT ANALYSIS OF IMPL PUL 294.00 43695972 PRO ANALYZE NEUROSTIM 1ST HR 294.00

43695991 PRO SPI/BRAIN PUMP REFIL/MAIN 232.20 43699001 PRO COLLECTION FEE 42.70 43699144 *PRO SEDATION 218.10 43699152 PRO CON SED > 5 YR 1ST 15 MIN 207.70 43699153 PRO CON SED SAME PHYS EA ADD15 327.20 43699202 INT EXP PROB FOCUSED NEW PT 248.50 43699203 INT PROB DETAILED NEW PT 289.80 43699204 INT COMPREHENSIVE NEW PT 441.60 43699212 EST PT PROB FOCUSED 105.00 43699213 EST PT EXP PROB FOCUSED 147.20 43699214 EST PT DETAILED 262.30 43699215 DETAILED OFFICE VISIT 296.70 43699231 IP VISIT SUP PROB FOCUSED 109.10 43699232 IP VISIT SUB EXPAND PROB 149.90 43699233 PRO SUB HOSP CARE 207.10 43699244 COMP OFFICE CONSULT NEW/ES 60M 407.10 43700015 ANKLE FOOT ORTHOSIS 217.40 43710001 AQUATIC THER W/THERAPUTIC EXER 180.60 43710005 THERAPEUTIC ACTIVITIES 15 MINS 177.90 43710025 ORTH MGMT TRAIN 15 MINS INIT 218.50 43710085 ELECTRIC STIMULATION UNATTEN 146.00 43710086 ELECTRIC STIMULATE ATTEND 15M 204.30 43710106 THERAPEUTIC EXERCISE 15 MINS 224.50 43710130 GAIT TRAINING 15 MINS 162.40 43710131 GAIT TRAIN EXTENSIVE 15 MINS 240.70 43710160 IONTOPHORESIS 15 MINS 258.30 43710164 SELF CARE/HOME MANAGEMENT 15M 209.20 43710215 MASSAGE 15 MINS 162.40 43710217 MEDX EXERCISE 15 MINS 177.90 43710220 MEDX TEST 15 MINS 344.30 43710221 MEDX PHASE III 26.70 43710229 MANUAL LYMPHATIC DRNG 15 MINS 209.20 43710230 MANUAL THERAPY TECHNIQUES 15M 209.20 43710236 PROSTHETIC TRAIN 15 MN INIT 162.40 43710272 TRACTION MECHANICAL 198.80 43710273 TRACTION MANUAL 15 MINS 209.20 43710275 ULTRASOUND 15 MINS 181.50 43710283 WHEELCHAIR MANAGEMENT 15MIN PT 137.90 43710297 WORK RE-ENTRY INITIAL 2 HOURS 305.10 43710298 WORK RE-ENTRY EACH ADDN'L HOUR 156.80 43711065 CPM MONITORED 15 MINS 221.20 43713525 NEUROMUSCULAR RE-EDUCATION 15M 204.30 43715013 BTE POET 125.00 43715017 BTE FCE/RTW CANCEL FEE 100.00 43718978 MOBILITY CURRENT STATUS 0.01 43718979 MOBILITY GOAL STATUS 0.01 43718980 MOBILITY D/C STATUS 0.01 43718981 BODY POS CURRENT STATUS 0.01 43718982 BODY POS GOAL STATUS 0.01

43718983 BODY POS D/C STATUS 0.01 43718984 CARRY CURRENT STATUS 0.01 43718985 CARRY GOAL STATUS 0.01 43718986 CARRY D/C STATUS 0.01 43718987 SELF CARE CURRENT STATUS 0.01 43718988 SELF CARE GOAL STATUS 0.01 43718989 SELF CARE D/C STATUS 0.01 43718990 OTHER PT/OT CURRENT STATUS 0.01 43718991 OTHER PT/OT GOAL STATUS 0.01 43718992 OTHER PT/OT D/C STATUS 0.01 43718993 SUB PT/OT CURRENT STATUS 0.01 43718994 SUB PT/OT GOAL STATUS 0.01 43797161 PT EVAL LOW 20 MIN 402.30 43797162 PT EVAL MOD 30 MIN 827.60 43797163 PT EVAL HIGH 45 MIN 1,103.50 43797164 PT RE-EVAL EST PLAN CARE 689.70 43800350 DRESSING STICK 24.00 43800355 KOMPREX SIZE 8CM 68.60 43801010 AIR PUTTY - 90CC 74.70 43801200 LONG HANDLE SPONGE 18.10 43801220 LONG SHOEHORN 44.80 43801720 REACHER - LONG HANDLE 80.60 43801860 SOCK AID 56.80 43810025 ORTH MGMT TRAIN 15 MIN INIT 218.50 43810031 THERAPEUTIC ACTIVI EXTN 15 MIN 243.40 43810067 BTE EXERCISE 15 MIN 177.90 43810500 THERAPEUTIC EXERCISE 15 MINS 224.50 43811550 SELF CARE/HOME MANAGEMENT 15M 209.20 43811960 TREATMENT ADL'S 15 MINS 197.20 43812031 MANUAL LYMPHATIC DRNG 15 MINS 209.20 43812032 MANUAL THERAPY TECHNIQUES 15M 209.20 43813515 ULTRASOUND 15 MINS 181.50 43813525 NEUROMUSCULAR RE-EDUCATION 15M 204.30 43813540 ELECTRIC STIMULATION UNATTEN 146.00 43813541 ELECTRIC STIMULATE ATTEND 15M 204.30 43813545 IONTOPHORESIS 15 MINS 258.30 43813569 LYMPHADEMA PUMP 472.80 43814999 WWS WORKFIT SCREEN 110.00 43818978 MOBILITY CURRENT STATUS 0.01 43818979 MOBILITY GOAL STATUS 0.01 43818980 MOBILITY D/C STATUS 0.01 43818981 BODY POS CURRENT STATUS 0.01 43818982 BODY POS GOAL STATUS 0.01 43818984 CARRY CURRENT STATUS 0.01 43818985 CARRY GOAL STATUS 0.01 43818986 CARRY D/C STATUS 0.01 43818987 SELF CARE CURRENT STATUS 0.01 43818988 SELF CARE GOAL STATUS 0.01 43818989 SELF CARE D/C STATUS 0.01

43829131 APPL FINGER SPLINT DYNAMIC 346.90 43897127 THER IVNTJ W/FOCUS COG FUNCJ 163.00 43897165 OT EVAL LOW 30 MIN 402.30 43897166 OT EVAL MOD 45 MIN 827.60 43897167 OT EVAL HIGH 60 MIN 1,103.50 43897168 OT RE-EVAL EST PLAN CARE 689.70 43900020 SPEECH INDIVIDUAL THERAPY 475.80 43900021 SPEECH INDIVIDUAL THERAPY EXTN 475.80 43900113 MOD BARIUM SWALLOW EVALUATION 627.60 43900120 DYSPHAGIA/FEEDING TREATMENT 396.60 43902112 SWALLOW EVAL EXT 696.90 43908996 SWALLOW CURRENT STATUS 0.01 43908997 SWALLOW GOAL STATUS 0.01 43908998 SWALLOW D/C STATUS 0.01 43908999 MOTOR SPEECH CURRENT STATUS 0.01 43909158 MOTOR SPEECH D/C STATUS 0.01 43909162 LANG EXPRESS CURRENT STATUS 0.01 43909163 LANG EXPRESS GOAL STATUS 0.01 43909164 LANG EXPRESS D/C STATUS 0.01 43909168 MEMORY CURRENT STATUS 0.01 43909169 MEMORY GOAL STATUS 0.01 43909170 MEMORY D/C STATUS 0.01 43909171 VOICE CURRENT STATUS 0.01 43909172 VOICE GOAL STATUS 0.01 43909173 VOICE D/C STATUS 0.01 43909186 MOTOR SPEECH GOAL STATUS 0.01 43992521 EVAL OF SPEECH FLUENCY 557.80 43992522 EVAL SPEECH SOUND PRODUCTION 608.50 43992523 EVAL SPEECH SOUND/LANG PRODUC 684.70 43992524 BEHAVIORAL QUAL ANALYSIS VOICE 710.00 43996125 COGNITIVE PERF TEST/HR 710.00 44000065 MAMM POST PROC DIAG-UNI-CR NC 472.30 44000067 MAMMO BILAT SCR W/CAD 396.10 44000202 *MAMMO SCREEN-BILAT-CR W/CAD 396.10 44000204 *MAMMO DIAG-BILAT-CR W/CAD 650.90 44000206 *MAMMO DIAG-UNILAT-CR W/CAD 472.30 44001067 MAMMO SCR DIGITAL UNI RT W/CAD 396.10 44002202 *MAMMO SCR DIGITAL UNI LT W/CA 396.10 44007065 MAMMO UNILATERAL CONE COMP N/C 472.30 44007066 MAMMO BILAT UPGRADE W/CAD 650.90 44007067 MAMMO SCR DIGITAL UNI LT W/CAD 396.10 44019081 BX BREAST 1ST LESION STRTCTC 3,931.80 44019281 PERQ DEVICE BREAST 1ST IMAG 4,446.00 44019282 PERQ DEVICE BREAST EA ADD IMAG 3,334.40 44076098 MAMMO SPECIMEN EXAM 1,273.20 44077061 BREAST TOMOSYNTHESIS UNI 60.00 44077062 BREAST TOMOSYNTHESIS BI 60.00 44077063 BREAST TOMOSYNTHESIS BI SCREEN 60.00 44077065 MAMMO UNI W/CAD 472.30

44077066 MAMMO BILAT - DX W/CAD 650.90 44077067 MAMMO SCREEN BILAT W/CAD 396.10 44077080 DEXA BONE DENSITY AXIAL 871.60 44077085 DEXA AXIAL VERTEBRAL FX ASSESS 899.90 44101717 HDR SOURCE USAGE FEE 2,923.00 44104648 TISSUE MARKER IMPLANTABLE 670.90 44109517 I131 IODINE PER MILLICURIE 136.50 44109606 RADIUM RA223 DICHLORIDE THER 270.40 44149411 PLACE INTERSTITIAL SNGL/MULT 2,716.50 44155876 PLACE INTERSTITIAL PROSTATE 2,476.50 44157155 INSERT UTERI TANDEM/OVOIDS 4,373.50 44157156 INSERT VAG RAD APPARAT BRACHY 967.20 44176872 TRANSRECTAL ULTRASOUND 1,498.20 44176942 GUIDED NEEDLE BX/ASP/INJ/LOCAL 1,864.60 44177014 CT GUIDED RADIATION THERAPY PL 1,424.10 44177280 SIMULATION-SIMPLE 1,498.80 44177290 SIMULATION-COMPLEX 2,981.90 44177293 RESPIRATORY MOTION MANAGE SIMU 3,834.90 44177295 3-D TREATMENT PLANNING 7,644.60 44177300 DOSIMETRY-BASIC RAD 726.50 44177301 IMRT TX PLAN 7,542.50 44177307 TELETHERAPY ISODOSE PL COMPLEX 2,470.00 44177332 TREAT DEVICE-SIMPLE 991.50 44177334 TREAT DEVICE-COMPLEX 1,792.20 44177336 CONTINUING-RAD PHYSICS 984.90 44177338 MULTI-LEAF COLLIMATOR FOR IMRT 5,565.20 44177370 SP MED RAD PHY CONSULT 1,521.90 44177373 STEROTACTIC X/FRAC >1 LESION 13,677.30 44177385 IMRT W/GUID/TRACKING SIMPLE 2,140.20 44177386 IMRT W/GUID/TRACKING COMPLEX 2,963.40 44177387 NON IMRT GUID LOC TARGET VOL 464.80 44177412 1 MEV COMP 3 OR MORE TX AREAS 1,315.80 44177417 PORT FILM 410.20 44177470 SPECIAL TREATMENT/CONE 3,965.30 44177770 HDR RDNCL NTRSTL/ICAV BRCHTX 5,827.00 44177771 HDR RDNCL NTRSTL/ICAV BRCHTX 7,282.90 44179005 I-131 TX THYROID CA ABLATION 1,794.60 44179101 RADIOPHAR THERAPY INTERVENOUS 1,714.10 44196372 DRUG INJ SUB/IM - RADONC 196.30 44196402 CHEMO HORMONE SQ/IM 581.60 44200001 HEMODIALYSIS UP TO 4 HRS 2,984.80 44200002 HEMODIALYSIS EA ADD'L HR 1,820.20 44200003 HEMODIALYSIS EMERGENT TO 4 HRS 2,984.80 44200004 HEMO DIALYSIS EMER EA ADD'L HR 2,166.20 44200100 AUTO PERITONEAL DIALYSIS CYCLE 7,509.70 44200101 PERITONEAL DIALYSIS 2,984.80 44200102 PERITONEAL DIALYSIS EA ADD'L 502.80 44200103 PERITONEAL DIALYSIS EMERGENT 2,984.80 44200105 PERITONEAL DIALYSIS W/CYCLER 2,984.80

44206430 BLOOD ADMINISTRATION 1-4 UNITS 1,157.00 44309552 F-18 FDG UP TO 45 MCI 1,532.70 44378815 PET IMAGE W/CT SKULL-THIGH 6,488.20 44378816 PET IMAGE W/CT FULL BODY 6,718.10 44400200 MICROJET PCA CASSETTE 233.50 44400201 SET MICRO EXT T CONNECTOR 24.80 44400202 DRESSING OPSITE SM 4X4 3/4 26.70 44400203 TRAY LF CATH 14 FR 31.00 44400204 CATH PROTECT IV 22 GA X 1 28.10 44400205 CATH PROTECT IV 20 GA X 1/4 28.10 44400207 TRAY MINOR DRESSING 177.30 44400208 CANNULA LEV LOK NEEDLES 9.50 44400209 SMARTSITE VALVE 21.80 44400211 TUBING CONT ADM NF3140 43.40 44400212 NEEDLE HUBER 19X3/4 POWERLOC 101.10 44400213 NEEDLE HUBER 20 X 1 POWERLOC 101.10 44400214 TUBING ADD-A-LINE 19.00 44400216 DRESSING SORBAVIEW 4X4 14.00 44401007 FLU ADMINISTRATION INJ IM 80.70 44401008 PNEUMOCOCCAL ADMINISTRATION 80.70 44436415 VENIPUNCTURE ROUTINE 72.20 44436591 SPECIMEN ACQUISITION VAD 156.00 44436593 DECLOT THROMB AGNT IMP VAD/CAT 881.80 44490471 IMMUN/VACCINE ADMIN IM -BC- 134.40 44490472 IMMUN/VACCINE ADMIN IM EA ADDL 134.40 44496360 IV HYDRATION INITIAL 31-60 MIN 491.70 44496361 IV HYDRATION EA ADTNL HR 298.50 44496365 IV DRUG INFUSION 1ST HR 604.90 44496366 IV DRUG INFUS EA ADTNL HR 263.70 44496367 IV INFUSION SEQUENTIAL 1ST HR 327.30 44496368 IV INFUSION CONCURRENT 307.50 44496372 DRUG INJ SUB/IM - BC 194.60 44496374 IV PUSH 225.40 44496375 IV PUSH DIFFERENT DRUG 257.70 44496376 IVP-IV PUSH SEQ SAME DRUG >31M 168.10 44496377 APPL ON BODY INJECTOR DDCI 196.30 44496401 CHEMO ANTI-NEOPL SQ/IM 576.60 44496402 CHEMO HORMONE SQ/IM 576.60 44496409 CHEMO IV PUSH 1ST RX 523.90 44496411 CHEMO IV PUSH NEW RX 406.00 44496413 CHEMO IV INFUS 1ST HR 1,005.50 44496415 CHEMO IV INFUS ADTNL HR 389.80 44496417 CHEMO IV INFUSE SEQUENCE 491.70 44496523 VAD FLUSH/NO INFUSION OR INJ 203.60 44496549 CHEMO IV INFUSE PUMP 811.60 44499195 THERAPEUTIC PHLEBOTOMY 317.50 45000130 MAJOR 1 MIN OVER 30 113.00 45000131 MAJOR 1 PLANNED 0-30 MIN 7,395.20 45000140 MAJOR 2 MIN OVER 30 126.60

45000141 MAJOR 2 PLANNED 0-30 MIN 8,297.10 45000160 MINOR 1 MIN OVER 30 33.00 45000161 MINOR 1 PLANNED 0-30 MIN 2,660.80 45000170 MINOR 2 MIN OVER 30 62.00 45000171 MINOR 2 PLANNED 0-30 MIN 4,464.50 45000180 MINOR 3 MIN OVER 30 76.10 45000181 MINOR 3 PLANNED 0-30 MIN 5,186.00 45000500 FINE NEEDLE ASPIRATION THYROID 1,126.50 45020001 DRAPE/MAYO STAND COVER 23.90 45020002 POUCH DRAPE 30.20 45020003 DRAPE/LAPAROTOMY SHEET 84.40 45020004 DRAPE/SPLIT SHEET 97.80 45020006 DRAPE/EXTREMITY OR LAP CHOLE 101.00 45020007 DRAPE/CHEST BREAST SHEET 128.20 45020008 DRAPE/GOWN XLG REG #9541 57.70 45020016 DRAPE/TOWELS ASSORTED 27.20 45020019 DRAPE/HALF SHEET 23.90 45020020 ASEPTO / BULB SYRINGE 17.20 45020025 CBI NACL 3000ML 87.80 45020041 DISP IRIS FORCEPS X FINE 3.5 51.20 45020042 DISP BASIN 49.20 45020043 FORCEP RADIAL JAW HOT 000854 141.50 45020044 ENDO SMARTCAP CO2 TUBE 100551 57.30 45020053 DRAPE/BILATERAL LIMB DYNJP8006 77.00 45020105 LONE STAR RETRACTOR 423.60 45020106 LONE STAR RETRACTOR HOOKS 400.40 45020135 CATHETER/URETERAL ASSORTED 131.50 45020158 KNIFE/SLIT 2.75 MM 8065992761 174.60 45020159 BLADE EYE SZ 66 ALCOM 114.60 45020167 SPONGE/COTTONOID OR PLEDGET 87.80 45020170 TUR CUTTING LOOP 490.70 45020195 DRAPE/C-ARM 88.50 45020199 CAUTERY/HI TEMP LOOP TIP 53.90 45020211 BIPOLAR PENCIL STRAIGHT 151.60 45020216 DRAPE/MICROSCOPE OR MINI C-ARM 215.60 45020223 DRAPE/U-DRAPE 91.20 45020268 SHEATH/ENDO SCRUB 4MM 1912000 170.70 45020271 BLADE/XOMED TRI 4MM 1884004HR 599.60 45020279 BLADE/XOMED RAD 40 CR 1884006H 161.60 45020280 BLADE/XOMED STRAIGHT QUAD 1884 687.10 45020281 BLADE/CURVED ROTATE ROHS 18840 675.10 45020326 PACK/LAP CHOLE 517.90 45020334 BLADE/STRYKER DISP MENIS BLADE 450.70 45020336 GUIDEWIRE/LUBRIGLIDE 309.60 45020416 PACK/LAPAROSCOPY OR UNIVERSAL 121.20 45020420 PACK/CYSTO 87.80 45020421 TOOMEY SYRINGE DISPOSABLE 23.90 45020422 CATH IV PLACEMENT 28.10 45020426 PACK/CUSTOM BASIC DYNJ3139 235.20

45020430 PACK/PERI-GYN 97.80 45020440 PACK/PATIENT PREP 61.00 45020442 SPONGE/PEANUTS 30.70 45020444 PACK/PHACOEMULSIFIER 585.00 45020450 LAP/CON-MED UNIVERSAL HANDLE 406.80 45020451 LAP/CON-MED ELECT HOOKNEEDLE 279.20 45020515 PROBE/BEAMER 2.3 ABEAM4 616.00 45020517 ABLATION DEVICE 014807 5,062.10 45020518 ASAP BIOPSY GUN - ASSORTED 443.80 45020610 SIMPLSE IRRG SYSTEM/SETUP 501.10 45020620 SPONGE/LAP 44.10 45020624 SPONGE/RAYTEX 20.50 45020640 SKIN STAPLER 111.40 45020641 STERILE SKIN MARKER 23.90 45020647 STOCKINETT REG 97.80 45020655 SUCTION/YANKEUR TIP 17.20 45020656 PHARCO TIPO 30 LAMINAR FLOW 179.10 45020657 VITREOUS CUTTER 552.80 45020660 SUCTION/TIP & TUBESETUP 70.80 45020666 SUCTION/EXTRA TUBING 14.00 45020673 LAP/REDUCER OR SEPARATOR 148.40 45020685 NEEDLE/SPINAL ASSORTED SIZES 27.20 45020686 RIGID INJECTION NEEDLE 9010M1 248.20 45020689 SUTURE/ASSORTED SIZES 235.40 45020691 SUTURE/ASSORTED SIZES 94.40 45020692 SUTURE/ASSORTED SIZES 111.40 45020696 SUTURE/ASSORTED SIZES 37.50 45020698 SUTURE/ASSORTED SIZES 74.30 45020703 SPONGE/TONSIL 5/PKG 64.30 45020742 VISITEC 235.40 45020762 PUNCH BARRON VACUUM K202108 263.80 45020775 EAR SUCTION TUBE/ASSORT SIZES 37.50 45020809 BLADE/BEAVER MIS 67 23.90 45020855 MICRO/GUIDEWIRE 600-103 309.60 45020856 FORCEP LG 1332 M00513322 89.20 45021000 LAP/CVRD METZ SISSOR TIPS 9171 146.10 45021007 MICRO/GLIDEWIRE 630-110 511.00 45021052 HS SHEARS 14CM/COBLATOR WAND 816.90 45021054 MEDKAMP SUCTION HANDLE CONTROL 20.00 45021055 MEDKAMP DISP SUCTION TIP 16G 24.40 45021056 COAG SUCTION HANDSWITCH 10 FR 93.30 45021099 CAUTERY PENCIL W/BLADE DISP 24.40 45021113 DRILL BIT/2.7 X 130 71173803 243.20 45021131 DRILL BIT 2.5 58850025 258.90 45021217 CATH COUNCIL TIP 18FR 102.60 45021218 CATH 3WAY 30CC 22FR 73.10 45021232 STONE BASKET NIT 120CM 2.4FR 412.40 45021234 STONE CONE COIL 3F 115CM 7MM 528.00 45021235 CATH 2WAY BARDEX IC 16FR 44.70

45021236 CATH 2WAY BARDEX IC 18FR 44.70 45021237 CATH 2WAY BARDEX IC 20FR 44.70 45021240 CATH COUNCIL TIP 20FR 102.60 45021243 CATH SILASTIC 18FR 48.00 45021247 CATH COUDE 5CC 16FR 93.80 45021248 CATH COUDE 5CC 18FR 93.80 45021251 GLYCINE 1.5% 3000ML BAG 34.90 45021256 RESURE SEALANT 245.50 45021259 LASER FIBER HOLMIUM 709.10 45021261 LASER FIBER 100 MICRON 709.10 45021262 BI POLAR ELECTRODE 1,086.60 45021263 GUIDEWIRE/ULTRATRA 0.035 X 150 184.40 45021270 ARTHROSURFACE PIN KIT 442.90 45021271 LASER FIBER 1000 MICRON 1,940.70 45021272 DISP TOURN 34 X 4 121.70 45021273 DISP TOURN 30 X 4 IN 121.70 45021274 DISP TOURN 12 X 3.5 111.20 45021275 DISP TOURN 24 X 4 110.20 45021276 DISP TOURN 44 X 4 144.80 45021280 K-WIRE 1.6 X 100MM TROCAR TIP 162.60 45021286 ELECTRODE LOOP 24FR 284.30 45021287 ELECTRODE LOOP 26FR 284.30 45021291 FLOW TUBING 160.50 45021293 WIRE AMPLATZ .035 X 150 ST 118.50 45021295 SURLOCK FLATWIRE SEGURA 265.40 45021297 GUIDEWIRE SUREGLIDE .035X150 S 131.10 45021298 URO BIOPSY PORT SEAL 125.90 45021403 BLADE/ASSORTED STYLE & SIZES 355.10 45021415 DRESS/COBAN STERILE ASSORTED 84.60 45021416 DRESS/COBAN 2 8.10 45021418 DRESS/ESMARK STERILE LF 4 X 9 20.00 45021434 DRILL BIT/CROSSCHECK 2.0 430.10 45021437 TOE/GUIDE PIN 2MM 302.10 45021440 LIGAMAX 5MM ENDO CLIP APPLIER 296.90 45021441 LAP/TROCAR 8MM X 100 87.10 45021442 TOE/INSTRUMENT PKG FOR 3.2 686.10 45021444 ROTH NET - POLYP 293.70 45021445 INK INDIA STERILE 163.60 45021446 ANOSCOPE DISP WITH LIGHT 27.30 45021447 DEVICE COOK SPHERE INFLATION 156.30 45021448 SNARE JUMBO 2.5 X 5.5CM 49.30 45021450 DISP TOURNIQUET STER 18X4 100.70 45021451 BASKET ULTRACATH NT 1.8 X 115 346.20 45021452 10FR DUAL LUMEN CATHETER 123.80 45021453 URO ACCESS SHEATH 12/14 X 38CM 238.10 45021454 SURESEAL II ENDO VALVE 64.00 45021456 TREACE SAW BLADE 223.40 45021463 FLEX TIP LASER FIBER 200 859.10 45021468 BASKET X--CATCH NT STONE 346.20

45021471 UROSEAL ENDO VALVE 170.00 45021475 GOLDVAC SLIM SMOKE/CAUT PENCIL 111.00 45021478 PROCISE MAX WAND 564.00 45021479 BLADE CAUTERY 4 28.00 45021480 K-WIRE 1.25 X 150 99.00 45021499 FIX PIN/CROSSCHECK 1.1MM 251.80 45021593 ENT/TRACKER INSTRUMENT 9733533 348.50 45021594 ENT/TRACKER PATIENT 9733534 445.20 45021595 ENT/OTO THORACIC CAUTERY BLADE 104.60 45021597 MEDKAMP LANCE FLAT BLADE 72.80 45021598 SUTURE SILK 4-0 709H 41.80 45021599 SUTURE PROLENE 10-0 1713G 83.40 45021600 SUTURE PROLENE 6-0 8714H 36.60 45021601 SUTURE ETHILON 10-0 7707G 149.20 45021602 SUTURE SILK 6-0 786G 36.60 45021603 SUTURE PROLENE 6-0 8617G 40.00 45021605 SUTURE VICRYL 6-0 J578G 69.50 45021608 SUTURE VICRYL 9-0 119.80 45021609 SUTURE CHROMIC 7-0 2300017456 119.80 45021610 SUTURE GUT CHROMIC 5-0 5312511 88.30 45021704 DRILL BIT/2.0 71173801 310.40 45021705 DRILL BIT/ASSORTED STYLE 403.40 45021709 DRILL TIP WIRE 1.1 71101413 209.90 45021717 WIRE DRILL TIP 1.6 71101502 211.70 45021799 BURR/ASSORTED STYLES 126.30 45022181 MANIFOLD STAND NEPTUNE 7000200 91.90 45022182 SPECIMAN TRAP 700050000 87.30 45022641 DRESS/ORTHROGLASS SPLINT ARM 436.90 45022642 DRESS/ORTHO GLASS SPLINT 393.50 45022672 LAP/CANNULA VALVE 5 MM 107.80 45022799 HANDPIECE IVRIG SET/BONECLEAN 653.20 45022850 ELECTRODE BLADE INSULAT 138104 10.90 45022937 BURR/ASSORTED STYLES 259.10 45023005 BLADE 15 DEG FULL HANDLE 80654 39.90 45023054 LASER FIBER PROSTATE 2,261.20 45023109 CDS/EYE JONES 1,216.40 45023125 EYE PACK DYNJS0120 139.10 45023332 SPLINT/DOYLE INTRANASAL 326.50 45023387 DISP ROUND RASP METAL CUTTER 675.40 45023685 DISP BIPOLAR FORCEPS 371.80 45023950 SUTURE MONOCRYL 3.0 23000Y4976 34.30 45024000 BLADE CRESCENT DISP 1.25 03645 166.90 45024001 PHACO PACK (JONES) BLV32200000 300.00 45024002 HOOK IRIS FLEXIBLE 61175 239.50 45024004 CAPSULAR TENSION RING STBL 604.80 45024005 KARATOME 2.65 E7551A 88.30 45024006 PHACO SLEEVE DP5531 124.70 45024007 VITRECTOMY ANTERIOR PK DP44006 261.30 45025249 KNIFE COLD STRAIGHT 504.00

45025250 ENDOSCOPIC KN WRIGHT AMO43005 1,789.30 45025553 CAUTERY/OPTHALMIC DISP 121.20 45025656 SUT PLAIN 6.0 FAST ABSORB 1916 36.30 45025668 ROLLER BALL KNIFE 435.50 45025750 GUIDEWIRE 0.038 STRAIGHT MOO66 214.90 45026719 ARISTA 3 GRAMS HEMOSTASE 619.20 45026813 LAP/SUTURE SYSTEM OR TROCAR 287.30 45026904 THERMASPLINT SMALL 1529000 139.10 45026905 THERMASPLINT MEDIUM 1529010 142.80 45026906 THERMASPLINT LARGE 1529020 139.10 45027200 DRAPE OPTHALMIC 8065104020 63.00 45027201 ANTERIOR CHAMBER CANN BENT 100 19.40 45027202 CYSTOTOME IRRIG FRMD 25GA E711 27.80 45027203 CYSTOTOME IRRIG FRMD 25GA 5003 19.40 45027900 OPTH/15 DEGREE KNIFE 91.20 45027926 BLADE/MICRO SAW 9.5 X 41 MM 336.20 45028116 LEGGINGS 44.10 45028537 DRAPE/STERI EYE 302.90 45028628 OPTH/ANGLED CRESCENT KNIFE 316.30 45028981 BLADE TURB ROTATABLE 612.40 45029129 BURR/ASSORTED STYLES 386.80 45029170 ARTH/DIS KIT OR SURGISAFE PAD 114.70 45030002 DRESS/STERI-STRIP 1/2 23.90 45030004 SYRINGE 35CC LEUR TIP 10.50 45030006 SYRINGE 60CC CATH TIP 10.50 45030014 DRESS/ELASTOPLAST 3 44.10 45030025 CATHETER/2-WAY 5CC 16FR FOLEY 91.20 45030026 CATHETER/2-WAY 5CC 18FR FOLEY 91.20 45030127 CATHETER LEG BAG 37.50 45030200 CATHETER/ROBNEL ASST' SIZES 14.00 45030830 CATHETER/TRAY W/METER 191.80 45030837 Y TYPE TUR SET 61.00 45030839 SALEM SUMP 77.60 45030844 DRAIN/PENROSE 1/4 14.00 45030846 DRESS/KLING 1 10.50 45030849 DRESS/KLING 2 10.50 45030850 DRESS/KLING 3 14.00 45030852 DRESS/ACE 4 30.70 45030853 DRESS/ACE 6 40.70 45030855 DRESS/STERI STRIP 1/4 23.90 45030856 DRESS/TELFA SMALL 7.10 45030857 DRESS/TELFA - LARGE 7.10 45030858 DRESS/ADAPTIC 3X3 10.50 45030860 DRESS/XEROFORM 23.90 45030862 DRESS/KERLEX FLUFFS 17.20 45030863 DRESS/KERLEX ROLL 29.90 45030866 DRESS/ABD 7.10 45030870 DRESS/TOPPER 7.10 45030871 DRESS/PLAIN STERILE 4 X 4 17.20

45030876 DRESS/SPLIT TOPPER 7.10 45030890 SYRINGE 60 CC 10.50 45030900 SPECIMEN JAR 7.10 45030903 DRESS/OP SITE SMALL 20.50 45030911 IV/EXT T SET 30.70 45040001 LENS INTRAOCULAR ASSORTED 1,409.70 45040009 TECNIS LENS 5.5 Z9002 362.60 45040015 LENS DIOP VARIOUS ZA9003 1,522.40 45040016 LENS VARIOUS DIOP TECNIS ZMB00 795.00 45041069 LENS/DIOP ISERT HOYA 16.5 272.70 45041085 LENS/DIOP ISERT HOYA 9.5 262.30 45041097 LENS/DIOP ISERT HOYA 25.0 262.30 45041100 LENS/TORIC 23.0 ZCT150 375.00 45041120 LENS/SYMFONY 17.5 ZCT300 375.00 45041121 LENS/DIOP ISERT HOYA 11.5 262.30 45041126 LENS/TORIC 16.0 ZCT150 375.00 45041127 LENS/TORIC 15.0 ZCT225 375.00 45041128 LENS/TORIC 5.0 ZCBOO 210.00 45041129 LENS/DIOP TORIC 26.5 SA6AT3 395.00 45041130 LENS/DIOP 15.0 375.00 45041131 LENS/ENVISTA DIOP 22.5 250.00 45041132 LENS/ENVISTA DIOP 17.5 250.00 45041133 LENS/ENVISTA DIOP 21.0 250.00 45041134 LENS/ENVISTA DIOP 24.5 250.00 45041135 LENS/ENVISTA DIOP 13.5 250.00 45041136 LENS/ENVISTA DIOP 19.5 250.00 45041137 LENS/ENVISTA DIOP 16.0 250.00 45041138 LENS/ENVISTA DIOP 13.0 250.00 45041139 LENS/ENVISTA DIOP 22.0 250.00 45041140 LENS/ENVISTA DIOP 27.0 250.00 45041141 LENS/ENVISTA DIOP 21.5 250.00 45041143 LION DIOP 28.0 250.00 45041144 LION DIOP 18.0 250.00 45041145 LION DIOP 10.0 250.00 45041146 LION DIOP 15.0 250.00 45041147 LION DIOP 14.5 250.00 45041148 LION DIOP 12.5 250.00 45041149 LION DIOP 20.5 250.00 45041150 LION DIOP 18.5 250.00 45041151 LION DIOP 25.5 250.00 45041152 LION DIOP 24.0 250.00 45041155 LION DIOP 10.5 250.00 45041156 LION DIOP 11.0 250.00 45041157 LION DIOP 11.5 250.00 45041158 LION DIOP 26.0 250.00 45041159 LION DIOP 14.0 250.00 45041160 LION DIOP 16.5 250.00 45041161 LION DIOP 15.5 250.00 45041162 LION DIOP 20.0 250.00

45041163 LION DIOP 19.0 250.00 45041164 LION DIOP 17.0 250.00 45041165 LION DIOP 25.0 250.00 45041166 LION DIOP 23.5 250.00 45041167 LION DIOP 30.0 250.00 45041169 LION DIOP 29.5 250.00 45041170 LION DIOP 26.5 250.00 45041171 LION DIOP 23.0 250.00 45041172 LENS ZCT 225 DIOP 20.5 375.00 45041173 LENS MAG0MA ICL MINUS 4.0 300.00 45041174 LENS ZCT 150 DIOP 19.0 375.00 45041175 LENS SAGAT5 DI0P 19.5 395.00 45041176 LENS SYMFONY TORIC 21.5 862.50 45041177 LENS SAGAT5 DIOP 19.0 395.00 45041178 LENS ZXT225 DIOP 21.5 862.50 45041180 LENS DIOP 33.0 250.00 45041182 LENS/TORIC 19.0 395.00 45041183 LENS/TORIC 25.0 395.00 45041184 LENS/TORIC 23.0 395.00 45041185 LENS/DIOP 31.0 MX60E 250.00 45041186 LENS/TORIC 6.0 ZCBOO 210.00 45041189 LENS/TORIC 25.5 SA6AT4 395.00 45041190 LENS/TORIC 21.0 SA6AT5 395.00 45041191 LENS/TORIC 19.5 395.00 45041192 LENS/TORIC 18.5 395.00 45041194 LENS/DIOP 15.5 395.00 45041196 LENS/TORIC 16.5 SA6AT5 395.00 45041197 LENS/TORIC 17.0 SA6AT3 395.00 45041198 LENS/DIOP 17.0 SA6AT6 395.00 45041199 LENS/DIOP 13.5 ZLBOO 775.00 45041200 LENS/TORIC 14.5 ZLBOO 775.00 45041202 LENS/TORIC 18.0 SA6AT5 395.00 45041203 LENS/DIOP 17.0 SA6AT7 395.00 45041205 LENS/TORIC DIOP 17.5 SA6AT3 395.00 45041206 LENS/TORIC DIOP 20.0 SA6AT9 395.00 45041208 LENS/DIOP 24.5 SA25T5 795.00 45041209 LENS/TORIC 24.0 795.00 45041211 LENS/TORIC 21.0 795.00 45041212 LENS/DIOP 21.5 SV25TO 795.00 45041345 LENS/TORIC 19.0 SN6AT4 395.00 45046263 LENS/TORIC 22.5 395.00 45050239 ENT/RADIESSE INJ SYRINGE 1CC 1,257.60 45050400 POSISEP X ENT SPLINT 9210584 328.10 45050580 SCREW/ASSORTED C1713 158.20 45050622 MITECK SUPER ANCHOR 1,095.80 45050635 SWANSON TOE G4260 2,956.40 45050655 SCREW/SELF TAP LOC 2.7 728231 339.20 45050785 WIRE-K PLAIN/GUIDE-WIRE 121.20 45050870 STENT/MICROVASIVE #125-132 712.50

45050871 STENT/MICROVASIVE #125-133 709.10 45050957 CORNEA PRE-CUT LAMELLAR 9,731.00 45050961 SHUNT/P200 LARGE 47203 3,089.20 45051016 ARMSTRONG R BVD GRO 510281 87.90 45051222 URETER CATH 5FR CONE TIP 57.80 45051225 UROMAX BALLOON KIT 24FR X 8CM 567.30 45051227 URETER CATH 5FR OPEN END 57.80 45051231 AMPLATZ DILATION SET 497.50 45051232 STENT/OPEN TIP 4.5 X 28 425.50 45051234 SCREW/LOCKING 3.0 X 12 584.80 45051237 SCREW/LOCKING 3.0 X 10 584.80 45051238 SCREW/LOCKING 3.0 X 18 584.80 45051239 SCREW/LOCKING 3.0 X 8 584.80 45051240 TOE/TAPER POST 9.5 X 18 1,125.90 45051241 TOE/PHALANGEAL FIX COMP 2,251.70 45051243 TOE/ART COMP 15MM 1.5 X 4.5 6,558.90 45051258 SCREW/LOCKING 3.0 X 14 584.80 45051260 HAT TRICK MTP UNI JOINT REPAIR 2,307.80 45051274 PLATE/MTP FUSION LOCK RT SMALL 3,877.10 45051281 SCREW/CROSSCHECK LOCK 2.7 X 16 746.90 45051282 SCREW/CROSSCHECK LAG 3.5 X 36 877.00 45051283 SCREW/CROSSCHECK LOCK 2.7 X 18 579.10 45051285 SCREW/CROSSCHECK NONLOC 2.7X22 579.10 45051286 PLATE/CROSSCHECK LAPIDUS 6,524.80 45051289 TOE/15MM ART COMP 2.5 X 4.5 6,306.60 45051290 TOE/IMPLANT PKG 3.8MM 3,772.20 45051291 TOE/INSTRUMENT PKG FOR 3.8MM 686.10 45051293 TOE/IMPLANT PKG 3.2 3,772.20 45051299 STENT/LUBRI-FLEX 6FR X 24CM 240.20 45051301 STENT/LUBRI-FLEX 6FR X 26CM 240.20 45051302 URO ACCESS SHEATH 12/14 X 24CM 238.10 45051303 URO ACCESS SHEATH 12/14 X 46CM 238.10 45051304 HAT TRICK MTP BI JOINT REPAIR 2,073.40 45051310 POD/ANATOMIC BIPLANAR FIXATION 14,046.10 45051312 STENT URET 6FX30CM 320.00 45051318 STENT/LUBRIFLEX 7FR X 26CM 240.20 45051321 TAPER POST 7.0MM X 13MM 1,082.60 45051322 PLATE/PLANTAR PYTHON LEFT 5,863.90 45051324 STENT/LITHO 7FR X 28CM 461.60 45051325 STENT/LITHO 7FR X 26CM 461.60 45051326 SCREW/QFX 2.0 X 14MM 721.70 45051327 SCREW/QFX 2.0 X 16MM 721.70 45051331 TOE/ART COMP 15MM 1.5 X 3.5MM 6,306.60 45051332 GRAVITY SUT ANCHOR 5.5 #2 950.00 45051333 GRAVITY SUT ANCHOR 3.5MM #0 950.00 45051337 TOE/HYPROCURE SINUS TARSI SZ 7 5,700.00 45051338 ART COMP 12MM X 1.0MM X 1.5MM 5,228.00 45051339 PLATE/2.7 TUB COMP 5HOLE 40MM 2,160.00 45051340 PLANTAR PLATE IMPLANT SET 3,300.00

45051341 SCREW/PLOC CORTEX 3.5 X 26 203.00 45051342 SCREW/PLOC LOCK 3.5 X 14 536.00 45051343 SCREW/PLOC LOCK 3.5 X 20 536.00 45051344 PLATE/VLP RIGHT STER 2.7MM 3,800.00 45051345 PLATE/MTP PHALANGEAL LEFT 3,696.00 45051346 STAPLE NITINOL 10 X 10 4,044.00 45051347 SCREW/CROSSCHECK NONLOC 2.7X28 758.00 45051351 ISTENT G2-M-IS 8,000.00 45051404 MINI TIGHTROPE FT AR-8917DS 1,940.50 45051590 ENT/TUBE POPE 2.6 530001 141.50 45051594 ENT/U TUBE 381650 190.30 45051598 ENT/T TUBE 1.27MM MOD 24771 171.60 45055500 I-STENT GTS100L 4,772.00 45055708 STENT/URETERAL 6 X 22 635.50 45059318 GUIDE WIRE/WRIGHT 1.6 X 150 MM 203.10 45062270 SPINAL FLUID TAP DIAGNOSTIC 1,441.30 45200001 EGD 2,528.90 45200005 MINOR PROCEDURE 1,104.90 45200010 COLONOSCOPY 3,079.30 45200011 ENDOSCOPY SECONDARY PROCEDURE 720.50 45200090 PROCEDURE TIME UP TO 60 MIN 2,522.50 45200156 NEEDLE/CARR LOCKE INJ 484.80 45200215 SNARE/DISPOSABLE 282.60 45200347 BALLOON 3 STAGE HBD 12-20 416.40 45200348 BALLOON 3 STAGE WG 10-20 543.50 45200349 INFLATION SYRINGE D560CCS 131.80 45200360 SIGMOIDOSCOPY 2,118.20 45200670 RESTRAINING MOUTHPIECE 37.50 45200680 CAUTERY GROUND PADS 49.60 45200939 LINER SUCTION 31.00 45201130 DEVICE/RESOLUTION CLIP 728.50 45201800 SHORT SHOT BANDER G34063 247.40 45201801 FORCEP RADIAL JAW JUMBO G56721 120.30 45201845 UNDERPADS/PKG 31.00 45202000 ENDOGATER ENDO IRR TUBING 99.00 45208503 SOL H20 ST IRRG 250 CC 14.10 45300010 GEN ANESTHESIA 695.00 45300015 MAC- MONITORED ANESTHESIA CARE 515.70 45471020 *CHEST 2 VIEWS PA & LAT 538.30 45471046 X-RAY EXAM CHEST 2 VIEWS 560.10 45472040 C-SPINE 2 OR 3 VIEWS 766.10 45472070 T-SPINE 2 VIEWS 697.10 45472072 T-SPINE 3 VIEWS 916.60 45472100 L-SPINE 2 OR 3 VIEWS 737.70 45472170 PELVIS 1 OR 2 VIEWS 495.50 45473030 SHOULDER 2+ VIEWS 610.60 45473120 HAND 2 VIEWS 681.10 45473130 HAND 3+ VIEWS 769.80 45473501 X-RAY EXAM HIP UNI 1 VIEW 424.60

45473502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 45473522 X-RAY EXAM HIPS BI 3-4 VIEWS 745.10 45473552 X-RAY EXAM OF FEMUR 2/> 574.50 45473560 KNEE 1 OR 2 VIEWS 572.20 45473590 TIBIA & FIBULA 2 VIEWS 572.20 45473630 FOOT COMPLETE 3+ VIEWS 654.50 45474018 X-RAY EXAM ABDOMEN 1 VIEW 504.70 45474019 X-RAY EXAM ABDOMEN 2 VIEWS 738.80 45508999 MOTOR SPEECH CURRENT STATUS 0.01 45509158 MOTOR SPEECH D/C STATUS 0.01 45509162 LANG EXPRESS CURRENT STATUS 0.01 45509163 LANG EXPRESS GOAL STATUS 0.01 45509168 MEMORY CURRENT STATUS 0.01 45509169 MEMORY GOAL STATUS 0.01 45509170 MEMORY D/C STATUS 0.01 45509186 MOTOR SPEECH GOAL STATUS 0.01 45592507 SPEECH INDIVIDUAL THERAPY 475.80 45592523 EVAL SPEECH SOUND/LANG PRODUC 684.70 45592526 DYSPHAGIA/FEEDING TREATMENT 396.60 45600108 OP DSMT INDIV/30 MIN 156.60 45700001 OP DIETARY CONSULT 75.00 45700108 OP DSMT INDIV/ 30 MIN 156.60 45797802 MNT INIT ASSESSMENT IND/15 MIN 64.50 45797803 MNT INIT REASSESMT IND/15 MIN 57.10 45800040 MYOFASCIAL RELEASE 15 MINS 209.20 45800140 MANUAL THERAPY TECHNIQUES 15M 209.20 45807110 TREATMENT HAND 15 MINS 224.50 45807112 NEUROMUSCULAR RE-EDUCATION 15M 204.30 45807140 MANUAL LYMPHATIC DRNG 15 MINS 209.20 45807535 TREATMENT ADL'S 15 MINS 197.20 45808978 MOBILITY CURRENT STATUS 0.01 45808984 CARRY CURRENT STATUS 0.01 45808985 CARRY GOAL STATUS 0.01 45808987 SELF CARE CURRENT STATUS 0.01 45808988 SELF CARE GOAL STATUS 0.01 45897033 IONTOPHORESIS 15 MINS 258.40 45897035 ULTRASOUND 15 MINS 181.50 45897110 THERAPEUTIC EXERCISE 15 MINS 224.50 45897165 OT EVAL LOW 30 MIN 402.30 45897166 OT EVAL MOD 45 MIN 827.60 45897167 OT EVAL HIGH 60 MIN 1,103.50 45897530 THERAPEUTIC ACTIVI EXTN 15 MIN 243.40 45897535 SELF CARE/HOME MANAGEMENT 15M 209.20 45900283 NON WND ELECT STIM 146.00 45907116 GAIT TRAINING THERAPY EA 15 MI 240.70 45907535 SELF CARE MNGMENT TRAINING 209.20 45908978 MOBILITY CURRENT STATUS 0.01 45908979 MOBILITY GOAL STATUS 0.01 45908980 MOBILITY D/C STATUS 0.01

45908981 BODY POS CURRENT STATUS 0.01 45908982 BODY POS GOAL STATUS 0.01 45908984 CARRY CURRENT STATUS 0.01 45908985 CARRY GOAL STATUS 0.01 45908987 SELF CARE CURRENT STATUS 0.01 45908988 SELF CARE GOAL STATUS 0.01 45910230 MANUAL THERAPY EA 15 MINS 209.20 45997012 MECHANICAL TRACTION THERAPY 1+ 198.80 45997032 ELECTRICAL STIMULATION EA 15 M 204.30 45997033 ELECTRIC CURRENT THERAPY EA 15 258.40 45997035 ULTRASOUND THERAPY EA 15 MINS 181.50 45997110 THERAPEUTIC EXERCISES EA 15 MI 224.50 45997112 NEUROMUSCULAR REEDUCATION EA 1 204.30 45997116 GAIT TRAINING THERAPY EA 15 MI 162.40 45997161 PT EVAL LOW 20 MIN 402.30 45997162 PT EVAL MOD 30 MIN 827.60 45997163 PT EVAL HIGH 45 MIN 1,103.50 45997164 PT RE-EVAL EST PLAN CARE 689.70 45997530 THERAPEUTIC ACTIVITIES 177.90 45997535 SELF CARE MNGMENT TRAINING 209.20 46003306 2-D ECHO/M-MODE COMP INTERP 949.40 46003880 D S EXT-CRAIN ART C INTER 368.30 46003922 ART EXT STDY SNGL LEV LMTD INT 184.30 46003925 D S LOWER EXT COMP INTRP 368.30 46003970 D S EXT COMPLETE INTRP 425.20 46003971 VENOUS EXT LIMITED INTRP 278.80 46003990 DS HEMO ACCESS INTERP 332.60 46008929 2-D ECHO/M-MODE COMP W/CONT 4,370.80 46093306 2-D ECHO/M-MODE COMP W/O CONT 4,067.90 46093308 2-D ECHO LIMITED W/O CONT 1,036.00 46093880 DS EX-CRAIN ART COMPL 2,009.90 46093922 ART EXT STDY SNGL LEV LMTD 632.30 46093925 DS LOWER EXT COMP 1,689.50 46093926 DS LOWER EXT UNILAT 1,255.10 46093970 D S EXT COMPLETE 1,850.60 46093971 VENOUS EXT LIMITED 1,272.30 46093990 DS HEMO ACCESS 1,147.60 46100001 EVENT MONITOR 1,040.80 46100012 EKG W/O INTERP 380.10 46100020 HOLTER MONITOR HOOKUP TO 48HRS 1,728.60 46100021 HOLTER MONITOR SCAN TO 48HRS 1,911.20 46100101 EVENT MONITOR INTERP 414.20 46100112 EKG INTERP 91.40 46100120 INTERP HOLTER MONITOR TO 48HRS 828.30 46100297 HOLTER MONITOR SCAN > 48HRS 3,322.70 46200010 INTERP/ATTEN SLEEP STUDY - COX 1,456.10 46200099 INTRP UNATT HOME SLEEP TYPEIII 772.90 46200399 UNATTEN HOME SLEEP TYPE III 1,490.60 46200810 ATTEN SLEEP STUDY - COX 6,880.90

46200811 INTERP/ATTEN SLEEP W/CPA - COX 1,671.70 46205811 ATTEN SLEEP STUDY W/CPCP - COX 7,898.40 46303130 HANDS 3+ VIEWS RA SURVEY 1,175.90 46370110 MANDIBLE - COMPLETE 4+ VIEWS 983.00 46370140 FACIAL BONES < 3 VIEWS 761.70 46370160 NASAL BONES 3+ VIEWS 856.60 46370200 ORBITS - 4+ VIEWS 951.40 46370220 SINUSES/PARANASAL-COMPLETE 3+ 951.40 46370250 SKULL <4 VIEWS W-W/O STEREO 743.10 46370328 TMJ UNILATERAL OPEN & CLOSED 761.70 46371020 *CHEST 2 VIEWS PA & LAT 559.80 46371045 X-RAY EXAM CHEST 1 VIEW 477.60 46371046 X-RAY EXAM CHEST 2 VIEWS 560.10 46371100 RIBS UNILATERAL 2 VIEWS 761.70 46371101 RIBS UNILAT W/PA CHEST 3+ VIEW 998.70 46371110 RIBS BILATERAL 3 VIEWS 1,147.20 46371111 RIBS BILAT W/PA CHEST 4+ VIEWS 1,261.10 46371120 STERNUM 2 VIEWS 644.90 46372040 C-SPINE 2 OR 3 VIEWS 766.10 46372050 C-SPINE 4 OR 5 VIEWS 951.40 46372052 C-SPINE COMP W/OBLIQUE & FLEX 1,283.20 46372070 T-SPINE 2 VIEWS 697.10 46372072 T-SPINE 3 VIEWS 916.60 46372081 X-RAY EXAM ENTIRE SPI 1 VW 882.50 46372082 X-RAY EXAM ENTIRE SPI 2/3 VW 926.00 46372100 L-SPINE 2 OR 3 VIEWS 736.70 46372110 L-SPINE MIN 4 VIEWS 1,046.50 46372170 PELVIS 1 OR 2 VIEWS 495.50 46372200 SACROILIAC JOINT <3 VIEWS 591.20 46372202 SACROILIAC JOINTS 3+ VIEWS 951.40 46372220 SACRUM & COCCYX 2+ VIEWS 951.40 46373000 CLAVICLE - COMPLETE 588.10 46373010 SCAPULA COMPLETE 588.10 46373030 SHOULDER 2+ VIEWS 610.60 46373060 HUMERUS 2+ VIEWS 558.00 46373070 ELBOW 2 VIEWS 537.50 46373080 ELBOW COMPLETE 3+ VIEWS 575.20 46373090 FOREARM 2 VIEWS 550.10 46373100 WRISTS 2 VIEWS 554.30 46373110 WRIST 3+ VIEWS 588.10 46373120 HAND 2 VIEWS 681.10 46373130 HANDS 3+ VIEWS 769.80 46373140 DIGITS-FINGER(S) 2+ VIEWS 518.40 46373502 X-RAY EXAM HIP UNI 2-3 VIEWS 516.70 46373521 X-RAY EXAM HIPS BI 2 VIEWS 717.90 46373522 X-RAY EXAM HIPS BI 3-4 VIEWS 745.10 46373552 X-RAY EXAM OF FEMUR 2/> 574.50 46373560 KNEE 1 OR 2 VIEWS 572.20 46373562 KNEE 3 VIEWS 653.10

46373564 KNEE COMPLETE 4+ VIEWS 809.10 46373565 KNEE BILATERAL AP/STANDING 847.70 46373590 TIBIA & FIBULA 2 VIEWS 572.20 46373600 ANKLE 2 VIEWS 692.90 46373610 ANKLE COMPLETE 3+ VIEWS 721.20 46373620 FOOT 2 VIEWS 603.10 46373630 FOOT COMPLETE 3+ VIEWS 654.50 46373650 HEEL CALCANEUS 2+ VIEWS 572.20 46373660 TOE(S) 2+ VIEWS 572.20 46374000 *ABDOMEN A/P 1 VIEW 504.40 46374018 X-RAY EXAM ABDOMEN 1 VIEW 504.70 46374019 X-RAY EXAM ABDOMEN 2 VIEWS 738.80 46374022 ACUTE ABD SUP/ERECT W/1V CHEST 880.50 46377072 BONE AGE STUDIES 429.90 46377074 BONE SURVEY LIMITED-METASTASES 1,415.00 46377077 JOINT SUR 1VW 2 OR MORE JOINTS 600.40 46406816 US PREG UTERUS F/U PER FETUS 1,288.30 46406819 FETAL BIOPHY PROF W/O NON-STRS 1,308.60 46476506 ECHO EXAM OF HEAD 1,008.20 46476536 SOFT TISSUE HEAD / NECK 1,223.40 46476604 CHEST 1,504.60 46476700 ABDOMEN COMPLETE 2,170.80 46476705 ABDOMEN LIMITED 1,296.30 46476770 RETROPERITONEAL COMPLETE 1,623.10 46476775 RETROPERITONEAL LIMITED 1,320.10 46476801 US OB 1ST TRI SGL GESTATION 1,874.20 46476805 US PREGNANT UTERUS COMPL >14WK 1,877.30 46476815 OB - LIMITED 1,071.40 46476816 US PREG UTERUS F/U PER FETUS 1,288.30 46476817 US OB TRANSVAGINAL 1,213.70 46476819 FETAL BIOPHY PROF W/O NON-STRS 1,308.60 46476820 FETAL UMBILICAL ARTERY DOPPLER 889.90 46476830 US NON OB TRANSVAGINAL 1,308.60 46476856 PELVIC COMPLETE 1,345.80 46476857 PELVIC LIMITED / FOLLOW-UP 1,071.40 46476870 TESTICULAR / SCROTUM 1,373.90 46476882 US EXT NON-VASC W IMAGE LMTD 759.10 46570450 CT HEAD/BRAIN W/O CONTRAST 2,664.50 46570470 HEAD OR BRAIN W/0 & W/CONTRAST 3,679.40 46570480 CT ORBIT SELLA IAC W/O CONTRST 2,718.50 46570486 CT MAXILLOFACIAL W/O CONTRAST 2,590.70 46570487 MAXILLOFACIAL W/CONTRAST 3,175.40 46570491 SOFT TISSUE NECK W/CONTRAST 3,252.70 46570492 SOFT TISSUE NECK W/O & W/CNTRS 4,023.20 46570496 ANGIOGRAM HEAD W/O & W/CNTRAST 4,399.00 46570498 ANGIOGRAM NECK W/O & W/CNTRAST 4,238.50 46571250 CT CHEST W/O CONTRAST 2,852.70 46571260 CHEST W/CONTRAST 3,861.00 46571270 CHEST W/O & W/CONTRAST 4,034.40

46571275 ANGIOGRAM CHEST W/O & W/CNTRST 4,850.50 46572125 CT C-SPINE W/O CONTRAST 3,219.30 46572128 CT T-SPINE W/O CONTRAST 3,377.40 46572131 CT L-SPINE W/O CONTRAST 3,552.40 46572133 L-SPINE W/O & W/CONTRAST 3,700.30 46572192 CT PELVIS W/O CONTRAST 3,020.30 46573200 CT UPPER EXTREMTY W/O CONTRAST 2,682.60 46573700 CT LOWER EXTREMTY W/O CONTRAST 2,858.00 46574150 CT ABDOMEN W/O CONTRAST 2,870.00 46574160 ABDOMEN W/CONTRAST 3,783.00 46574170 ABDOMEN W/O & W/CONTRAST 4,490.30 46574174 CT ANGIOGRAPHY ABD/PEL W/WO 7,692.30 46574176 CT ABDOMEN/PELVIS W/O CONTRAST 5,890.10 46574177 CT ABDOMEN/PELVIS W/CONTRAST 7,692.30 46574178 CT ABDOMEN/PELVIS W & W/O CONT 8,900.20 46575635 ANGIOGRAM ABD AORTA W/O & WITH 5,692.60 46670540 ORBIT-FACE &/OR NECK W/O CONT 4,488.00 46670544 ANGIOGRAPHY HEAD W/O CONTRAST 4,164.10 46670547 ANGIOGRAPHY NECK W/O CONTRAST 3,757.30 46670548 ANGIOGRAPHY NECK W/CONTRAST 4,036.50 46670551 BRAIN & STEM W/O CONTRAST 4,981.10 46670553 BRAIN & STEM W/O & W/CONTRAST 6,843.90 46672141 C-SPINE W/O CONTRAST 4,942.90 46672146 T-SPINE W/O CONTRAST 4,590.00 46672148 L-SPINE W/O CONTRAST 5,154.60 46672156 C-SPINE W/O & W/CONTRAST 6,515.90 46672157 T-SPINE W/O & W/CONTRAST 7,076.70 46672158 L-SPINE W/O & W/CONTRAST 6,685.70 46672195 PELVIS W/O CONTRAST 4,937.40 46672197 PELVIS W/O & W/CONTRAST 6,861.20 46673218 UPPER EXT-NO JOINT W/O CONTRST 4,509.60 46673220 UPPER EXT-NO JOINT W/O & W/CNT 6,357.90 46673221 UPPER EXT-ANY JOINT W/O CNTRST 4,945.80 46673223 UPPER EXT-ANY JNT W/O & W/CNTR 5,479.70 46673718 LOWER EXT-NO JOINT W/O CONTRST 4,398.90 46673720 LOWER EXT-NO JOINT W/O & W/CNT 6,228.60 46673721 LOWER EXT-ANY JOINT W/O CNTRST 5,066.20 46674181 ABDOMEN W/O CONTRAST 4,411.80 46674183 ABDOMEN W/O & W/CONTRAST 6,623.80 46700202 *MAMMO SCREEN-BILAT-CR W/CA 396.10 46700767 MAMMO SCR DIGITAL UNI LT W/CAD 396.10 46701067 MAMMO SCREEN-BILAT-CR W/CAD 396.10 46777063 BREAST TOMOSYNTHESIS BI SCREEN 60.00 46777080 DEXA BONE DENSITY AXIAL 871.60 46777085 DEXA AXIAL VERTEBRAL FX ASSESS 899.90 49520001 COLLECTION FEE DRUG SCREEN 35.00 49520003 HEALTH RISK ASSESS (HEALICS) 90.00 49520005 TUBERCULIN PPD 25.00 49520010 RESP QUESTIONNAIRES EMPL 30.00

49520103 PSA (Prostate Spec Ag) Screen 25.00 49586706 HEP B TITRE 43.00 49586787 VARICELLA TITRE 25.00 49590471 IMMUN/VACC 25.00 49590658 FLU VACC 25.00 49590707 MMR VACC 85.00 49590715 TdAP (ADACELL) 70.00 49590716 VARICILLA VACC 145.00 49590746 HEP B SERIES 40.00

435500005 BASE UNITS 251.30 435500010 ASA MODIFIER 251.30 435500100 SKIN HEAD SAL GLANDS MAC 17.30 435500120 EXT/MID/INNER EAR INCLUDE BX 17.30 435500126 TYMPANOTOMY 17.30 435500142 LENS SURGERY 17.30 435500160 NOSE/ACCESSORY SINUS MAC 17.30 435500164 BX SOFT TISSUE NOSE MAC 17.30 435500170 INTRAORAL PROCED INCLUDE BX 17.30 435500190 PROCEDURE FACIAL BONES/SKULL 17.30 435500300 ANES SKIN-NERVE NECK/HEAD/TRNK 17.30 435500320 ESOPHAGUS/THY/LARYNX/NECK 1+YR 17.30 435500350 MAJOR NECK VESSEL PROCEDURES 17.30 435500352 SIMPLE LIGATION 17.30 435500400 ANT INTEG CHEST SUBQ MAC 17.30 435500404 MOD/RAD BREAST PROCEDURES 17.30 435500410 ELE CONV ARRHYTHMIAS MAC 17.30 435500450 PROCED ON CLAVICLE & SCAPULA 17.30 435500520 CLOSD CHEST PROC BRONCH/THORAC 17.30 435500532 ACCESS CENTRAL VENOUS CIRCULTN 17.30 435500534 INTRAPACING CARDIOVERTER-DEFIB 17.30 435500600 CERVICAL SPINE & CORD; NOS 17.30 435500630 PROCEDURE ON LUMBAR SPINE 17.30 435500700 PROCED UPPER ANTERIOR ABD WALL 17.30 435500730 PROC UPPER POSTERIOR ABD WALL 17.30 435500731 ANES UPR GI NDSC PX NOS 17.30 435500732 ANES UPR GI NDSC PX ERCP 17.30 435500740 *UPPER GI ENDOSCOPY MAC 17.30 435500750 HERNIA REPAIR UPPER ABDDOMEN 17.30 435500752 LUMBAR/VENTRAL/INCISION HERNIA 17.30 435500790 INTRAPERITONEAL UPPER ABD NOS 17.30 435500800 LOWER ANTERIOR ABDOMINAL WALL 17.30 435500810 *LOWER INTESTINAL ENDO PROC 17.30 435500811 ANES LWR INTST NDSC NOS 17.30 435500812 ANES LWR INTST SCR COLSC 17.30 435500813 ANES UPR LWR GI NDSC PX 17.30 435500820 LOWER POSTERIOR ABDOMINAL WALL 17.30 435500830 HERNIA REP LOWER ABDOMEN NOS 17.30 435500832 VENTRAL/INCISIONAL HERNIA REP 17.30 435500840 INTRAPERITONEAL LOW ABD 17.30

435500844 ABDOMINOPERINEAL RESECT 17.30 435500851 TUBAL LIGATION/TRANSECTION 17.30 435500860 EXTRAPERITONEAL LOWER ABD 17.30 435500862 RENAL INC UP 1/3 URETER 17.30 435500873 LITHOTRIPSY W/O WATER BTH 17.30 435500902 ANORECTAL W/ENDOSCOPY/BX 17.30 435500910 TRANSURETHRAL CYSTOSCOPY 17.30 435500912 TURP BLADDER TUMOR/TURBT 17.30 435500914 TURP 17.30 435500918 TUR W/REMOV RETERAL CALC 17.30 435500920 MALE EXT GENITAL PRO MAC 17.30 435500921 VASECTOMY UNILAT/BILAT 17.30 435500926 RADICAL ORCHIECTOMY ING 17.30 435500938 INSERT PENILE PROSTHESIS 17.30 435500940 VAGINAL BX LABIA/CERV/ENDO 17.30 435500942 COLPOTOMY VAGINECTOMY COLP 17.30 435500944 VAGINAL HYSTERECTOMY 17.30 435500952 HYSTEROSCOPY 17.30 435501112 BONE MARROW BIOPSY ANT/POST 17.30 435501200 CLOSED PROC HIP JOINT 17.30 435501210 OPEN PROCEDURES HIP JOINT 17.30 435501214 TOTAL HIP ARTHROPLASTY 17.30 435501215 TOTAL HIP ARTHROPLASTY REVISIN 17.30 435501220 CLOSED PROC UPPER 2/3 FEMUR 17.30 435501230 OPEN PROC UPPER 2/3 FEMUR 17.30 435501232 AMPUTATION UPPER LEG 17.30 435501250 NERVE MUSCLE TENDON UPPER LEG 17.30 435501270 UPPER LEG/BYPASS GRAFT 17.30 435501320 NERVE MUSCLE TENDON OF KNEE 17.30 435501360 OPEN LOWER 1/3 FEMUR 17.30 435501382 DX ARTHROSCOPIC KNEE JOINT 17.30 435501390 CLOSED UPPER TIBIA FIB PATELLA 17.30 435501392 OPEN UPPER TIBIA/FIBULA/PATELA 17.30 435501400 SRG ARTHROSCOPIC PROC KNEE JNT 17.30 435501402 TOTAL KNEE ARTHROPLASTY 17.30 435501404 DISARTICULATION AT KNEE 17.30 435501432 ARTERIOVENOUS FISTULA 17.30 435501462 CLOSED LOWER LEG ANKLE FOOT 17.30 435501470 NERVE/MUSCLE/TENDON LOW LEG/FT 17.30 435501472 REPAIR RUPTURE ACHILLES TENDON 17.30 435501480 OPEN BONE LOWER LEG/ANKLE/FOOT 17.30 435501482 RADICAL RESECTION INCLUDE BKA 17.30 435501500 LOW LEG ARTERIES BYPASS GRAFT 17.30 435501620 CLSD HUMERUS HD/NECK/SHOULD JT 17.30 435501622 DX ARTHROSCOPIC SHOULDER JOINT 17.30 435501630 SRG ARTHROS HEAD/NECK/SHOULDER 17.30 435501638 TOTAL SHOULDER REPLACEMENT 17.30 435501710 NERVE MUSCLE TENDON UPPER ARM 17.30 435501716 TENODESIS RUPT-LONG TEND BICEP 17.30

435501730 CLOSED HUMERUS ELBOW MAC 17.30 435501740 SRG ARTHROSCOPIC PROC ELBOW 17.30 435501770 UPPER ARM/ELBOW ARTERY PROC 17.30 435501810 NERVE MUSCLE TEND FOREARM/HAND 17.30 435501820 CLOSED RADIUS ULNA HAND 17.30 435501830 SRG ARTHRO RAD/ULNA/WRIST JNT 17.30 435501844 FARM WRIST HAND VASC/SHUNT/REV 17.30 435501850 FOREARM/WRIST/HAND VEINS NOS 17.30 435501920 CARDIAC CATHERIZATION 17.30 435501922 NON-INVASE IMAGING/RAD THERAPY 17.30 435501924 THER RAD PROC/ARTERIAL NOS 17.30 435501930 THER RAD PROC VENOUS/LYMP NOS 17.30 435501935 PERC IMAGE PROC SPINE/CORD DIA 17.30 435501961 ANES CESAREAN DELIVERY ONLY 17.30 435501967 NEURAXIAL PLANNED VAGINAL DEL 17.30 435501968 ANES C-SEC DEL AFT NEUR LABOR 17.30 435501991 NERVE BLOCK/INJ OTH THAN PRONE 17.30 435501996 DAILY HOSP MANAGEMENT EPIDURAL 251.30 435531500 ENDOTRACHEAL INTUBATION EMERG 1,338.40 435536400 VENIPUNCTURE <3YR FEM/JUG/SA 103.10 435536410 VENIPUNCTURE >3YRS NON-ROUTINE 49.30 435536556 INS NON-TUNNELED CV CATH >5 YR 4,043.00 435536620 ARTERIAL SAMPLING/MONITOR 299.90 435562270 SPINAL PUNCTURE LUMBAR DIAG 1,445.90 435562273 BLOOD PATCH LUMB EPIDURAL INJ 608.60 435562318 *EPIDURAL CERVICAL-THORACIC 572.50 435562324 NFSN INTERLAMINAR CRV/THRC 545.30 435564415 BRACHIAL PLEXUS NERVE BLOCK 413.90 435564416 BRACHIAL PLEXUS CONT INFU/CATH 944.40 435564417 AXILLARY NERVE SNGL INJ 377.40 435564445 SCIATIC NERVE SNGL INJ 422.70 435564446 CONT SCIATIC NERVE CATH 907.70 435564447 FEMORAL NERVE SNGL INJ 413.30 435564448 CONT FEMORAL NERVE CATH 817.70 435564450 CONT PERIPHERIAL NERVE CATH 843.30 435564486 TAP BLOCK UNILAT INJ 1,183.00 435564488 TAP BLOCK BILAT INJ 1,455.80 435564489 TAP BLOCK BILAT CONT INFUS 2,000.20 435576937 GUIDED NEEDLE FOR VASC ACCESS 57.60 435576942 GUIDED NEEDLE BX/ASP/INJ/LOCAL 124.80 435599100 PATIENT EXTREME AGE <1 OR >70 251.30 435599140 EMERGENT PROC/THREAT TO LIFE 251.30 435600005 BASE UNITS 251.30 435600126 TYMPANOTOMY 17.30 435600160 NOSE/ACCESSORY SINUS MAC 17.30 435600170 INTRAORAL PROCED INCLUDE BX 17.30 435600320 ESOPHAGUS/THY/LARYNX/NECK 1+YR 17.30 435636400 VENIPUNCTURE <3YR FEM/JUG/SA 103.10 435636410 VENIPUNCTURE >3YRS NON-ROUTINE 49.30

435636556 INS NON-TUNNELED CV CATH >5 YR 4,043.00 453100005 BASE UNITS 251.30 453100010 ASA MODIFIER 251.30 453100103 RECONSTRUCTIVE PROC EYELID 17.30 453100120 EXT/MID/INNER EAR INCLUDE BX 17.30 453100126 TYMPANOTOMY 17.30 453100140 PROCEDURES ON EYE 17.30 453100142 LENS SURGERY 17.30 453100160 NOSE/ACCESSORY SINUS MAC 17.30 453100170 INTRAORAL PROCED INCLUDE BX 17.30 453100190 PROCEDURE FACIAL BONES/SKULL 17.30 453100300 ANES SKIN-NERVE NECK/HEAD/TRNK 17.30 453100320 ESOPHAGUS/THY/LARYNX/NECK 1+YR 17.30 453100352 SIMPLE LIGATION 17.30 453100400 ANT INTEG CHEST SUBQ MAC 17.30 453100620 PROC ON THOR SPINE & CORD 17.30 453100731 ANES UPR GI NDSC PX NOS 17.30 453100740 *UPPER GI ENDOSCOPY MAC 17.30 453100750 HERNIA REPAIR UPPER ABDDOMEN 17.30 453100790 INTRAPERITONEAL UPPER ABD NOS 17.30 453100810 *LOWER INTESTINAL ENDO PROC 17.30 453100811 ANES LWR INTST NDSC NOS 17.30 453100812 ANES LWR INTST SCR COLSC 17.30 453100813 ANES UPR LWR GI NDSC PX 17.30 453100840 INTRAPERITONEAL LOW ABD 17.30 453100851 TUBAL LIGATION/TRANSECTION 17.30 453100860 EXTRAPERITONEAL LOWER ABD 17.30 453100873 LITHOTRIPSY W/O WATER BTH 17.30 453100902 ANORECTAL W/ENDOSCOPY/BX 17.30 453100910 TRANSURETHRAL CYSTOSCOPY 17.30 453100912 TURP BLADDER TUMOR/TURBT 17.30 453100918 TUR W/REMOV RETERAL CALC 17.30 453100920 MALE EXT GENITAL PRO MAC 17.30 453100940 VAGINAL BX LABIA/CERV/ENDO 17.30 453100952 HYSTEROSCOPY 17.30 453101112 BONE MARROW BIOPSY ANT/POST 17.30 453101214 TOTAL HIP ARTHROPLASTY 17.30 453101470 NERVE/MUSCLE/TENDON LOW LEG/FT 17.30 453101472 REPAIR RUPTURE ACHILLES TENDON 17.30 453101480 OPEN BONE LOWER LEG/ANKLE/FOOT 17.30 453101810 NERVE MUSCLE TEND FOREARM/HAND 17.30 453101935 PERC IMAGE PROC SPINE/CORD DIA 17.30 453164446 CONT SCIATIC NERVE CATH 907.70 453176942 GUIDED NEEDLE BX/ASP/INJ/LOCAL 124.80 453199100 PATIENT EXTREME AGE <1 OR >70 251.30 453200005 BASE UNITS 251.30 453200010 ASA MODIFIER 251.30 453200126 TYMPANOTOMY 17.30 453200140 PROCEDURES ON EYE 17.30

453200142 LENS SURGERY 17.30 453200160 NOSE/ACCESSORY SINUS MAC 17.30 453200170 INTRAORAL PROCED INCLUDE BX 17.30 453200400 ANT INTEG CHEST SUBQ MAC 17.30 453200731 ANES UPR GI NDSC PX NOS 17.30 453200810 *LOWER INTESTINAL ENDO PROC 17.30 453200811 ANES LWR INTST NDSC NOS 17.30 453200812 ANES LWR INTST SCR COLSC 17.30 453200813 ANES UPR LWR GI NDSC PX 17.30 453201470 NERVE/MUSCLE/TENDON LOW LEG/FT 17.30 453201480 OPEN BONE LOWER LEG/ANKLE/FOOT 17.30 453299100 PATIENT EXTREME AGE <1 OR >70 251.30