California Pacific Medical Center - CA OSHPD€¦ · XLS file · Web view · 2010-06-29CDM CPMC 2010_06_01 CPMC Common 25 CDM_Publish_OSHPD_2005_07_01 CDM_Publish_OSHPD_CPMC_061305

AB 1045 - List of 25 CommonOutpatient Procedures for 2010

AB 1045 (May 2010)

Hospital Name: California Pacific Medical CenterOSHPD Facility No: 106380933/106380929Effective Date of Charges: June 1, 2010Evaluation & Management Services (CPT Codes 99201-99499)

Emergency Room Visit, Level 2 99282 646.00Emergency Room Visit, Level 3 99283 1,076.00Emergency Room Visit, Level 4 99284 1,647.00Laboratory & Pathology Services (CPT Codes 80048-89356)

Basic Metabolic Panel 80048 100.00Comprehensive Metabolic Panel 80053 113.00Lipid Panel 80061 138.00Creatine Kinase (CK), (CPK), Total 82550 69.00Blood Gas Analysis, including 02 saturation 82805Thyroid Stimulating Hormone 84443 179.00Troponin, Quantitative 84484 105.00Complete Blood Count, with differential WBC, automated 85025 83.00Complete Blood Count, automated 85027 69.00Prothrombin Time 85610 41.00Partial Thromboplastin Time 85730 64.00Radiology Services (CPT Codes 70010-79999)

CT Scan, Head or Brain, without contrast 70450 2,470.00X-Ray, Chest, two views 71020 519.00X-Ray, Lumbo Sacral, four views 72110 930.00CT Scan, Pelvis, with contrast 72193 3,731.00CT Scan, Abdomen, with contrast 74160 4,213.00Ultrasound, Abdomen, Complete 76700 970.00Ultrasound, OB, 14 weeks or more, single fetus, transabdominal 76805 1,012.00Mammography, Screening, Bilateral 77057 257.00Medicine Services (CPT Codes 90281-99607)

Electrocardiogram 12 Lead Tracing Only 93005 283.00Echocardiography, complete 93307Inhalation Treatment, pressurized or nonpressurized 94640 291.00Surgery Services (CPT Codes 10021-69990)

Arthroscopy, Knee, with meniscectomy (medial or lateral) 29881 13,917.02Arthroscopy, Shoulder, with partial acromioplasty 29826 20,627.12Carpal Tunnel Surgery 64721 9,956.89Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984 11,953.19Colonoscopy, diagnostic 45378 5,397.93Colonoscopy, with biopsy 45380 6,243.68Colonoscopy, with lesion removal, by snare technique 45385 7,228.43Discission, secondary membranous cataract, laser surgery 66821 2,353.60Endoscopy, Upper GI, with biopsy 43239 6,575.01Endoscopy, Upper GI, diagnostic 43235 5,513.02Excision, Breast Lesion 19120 9,374.26Hernia Repair, Inguinal, 5 years and older 49505 16,999.22Injection, Diagnostic or Therapeutic substance, epidural, sacral 62311 3,475.13Injection, Anesthetic or Steroid, transforaminal epidural, sacral 64483 5,345.33Laparoscopic Cholecystectomy 47562 26,124.32Tympanostomy (insert ventilating tube, general anesthesia) 69436 6,649.05Tonsillectomy with Adenoidectomy, less than 12 years old 42820 12,218.52Count of Reported Procedures (minimum 25 required) 40

2010 CPT Code

Outpatient Charge Amount

2010 CPT Code

2010 CPT Code

2010 CPT Code

2010 CPT Code

Average Charge Amount

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BILLING DESCRIPTION DEPARTMENT DESCRIPTION

52000002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 5200 1 EAST-SRC DHS52000102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 5200 1 EAST-SRC DHS52000001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS52000101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS53300001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS53300101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS52000045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS52000145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 5200 1 EAST-SRC DHS52200018 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5220 2 WEST DHS52200118 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5220 2 WEST DHS52200014 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5220 2 WEST DHS52200114 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5220 2 WEST DHS52200039 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5220 2 WEST DHS52200044 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5220 2 WEST DHS52200139 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5220 2 WEST DHS52200144 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5220 2 WEST DHS83002030 OBSERVATION PER HOUR $ 236.00 $ 236.00 8300 4N OTHER NURSING CHGS51500018 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5150 4W MATRNTY DHS51500118 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5150 4W MATRNTY DHS51500014 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5150 4W MATRNTY DHS51500114 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5150 4W MATRNTY DHS51600019 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5160 4W NURSERY DHS51600119 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5160 4W NURSERY DHS51600015 NEWBORN LEVEL I $ 1,706.00 $ 1,706.00 5160 4W NURSERY DHS51600115 NEWBORN LEVEL I $ 1,706.00 $ 1,706.00 5160 4W NURSERY DHS50100024 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5010 5E DHS50100124 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5010 5E DHS51400024 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5140 6 EAST DHS CHARGES (E)51400124 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5140 6 EAST DHS CHARGES (E)36410011 INDIV PTHER OP 45-50 W EM $ 120.00 $ 120.00 3641 ADLT PSYCH36410095 INJECTION IM/SQ EA $ 55.00 $ 55.00 3641 ADLT PSYCH36410070 MEDICATION MANAGEMENT $ 87.00 $ 87.00 3641 ADLT PSYCH36410056 PSYC DX INTERVIEW 1 HR $ 168.00 $ 168.00 3641 ADLT PSYCH

CHARGE CODE

CURRENT INPATIENT PRICE

CURRENT OUTPATIENT PRICE

DEPARTMENT CODE

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[Microsoft JET Created Table]00710100707071010

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BILLING DESCRIPTION DEPARTMENT DESCRIPTIONCHARGE CODE



DEPARTMENT CODE

36410057 PSYC DX INTERVIEW 1.5 HR $ 168.00 $ 168.00 3641 ADLT PSYCH36410065 PSYC DX INTERVIEW INTERAC $ 168.00 $ 168.00 3641 ADLT PSYCH36410015 PSYC TX 20-30M OP $ 60.00 $ 60.00 3641 ADLT PSYCH36410010 PSYC TX 45-50M OP $ 110.00 $ 110.00 3641 ADLT PSYCH36410012 PSYC TX FAMILY WO PATIENT $ 124.00 $ 124.00 3641 ADLT PSYCH36410080 PSYC TX GROUP $ 60.00 $ 60.00 3641 ADLT PSYCH36410091 PSYCH TESTS BY TECH/HR $ 100.00 $ 100.00 3641 ADLT PSYCH36410092 PSYCH TST PSYCHLGST/MD/HR $ 120.00 $ 120.00 3641 ADLT PSYCH36410026 PSYO TX FAM W PATIENT $ 120.00 $ 120.00 3641 ADLT PSYCH53800012 ROOM NO CHARGE $ - $ - 5380 AMADM DHS NO MAP PER LU53800112 ROOM NO CHARGE $ - $ - 5380 AMADM DHS NO MAP PER LU53900112 ROOM NO CHARGE $ - $ - 5380 AMADM DHS NO MAP PER LU24262007 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 2426 AMBUL CARE24256054 ADMIN INFLUENZA VACC $ 63.00 $ 63.00 2425 AMBUL CARE24256055 ADMIN PNEUMOCOCCAL VACC $ 20.00 $ 20.00 2425 AMBUL CARE24256010 BLOOD TRANSFUSN 2-4 HR $ 2,218.00 $ 2,218.00 2425 AMBUL CARE24256011 BLOOD TRANSFUSN 4-6 HR $ 3,488.00 $ 3,488.00 2425 AMBUL CARE24256012 BLOOD TRANSFUSN GT 6HR $ 4,289.00 $ 4,289.00 2425 AMBUL CARE24256000 BLOOD TRANSFUSN LT 2 HR $ 1,269.00 $ 1,269.00 2425 AMBUL CARE24256051 CHEM ADDL SEQ INF 0-60MN $ 1,503.00 $ 1,503.00 2425 AMBUL CARE24256050 CHEM IVP EA ADDL DRG $ 1,298.00 $ 1,298.00 2425 AMBUL CARE24256049 CHEM IVP SNGL/INIT DRG $ 755.00 $ 755.00 2425 AMBUL CARE24256029 CHEM NO-HORM ANTNEO SQ/IM $ 609.00 $ 609.00 2425 AMBUL CARE24256030 CHEMO PERITNL W/PERITONEO $ 1,216.00 $ 1,216.00 2425 AMBUL CARE24256053 COLL BLD IMP VEN ACCS DEV $ 463.00 $ 463.00 2425 AMBUL CARE24256026 COLL BLD PICC/CNTRL LN $ 163.00 $ 163.00 2425 AMBUL CARE24262006 D51/2NS 1000ML $ 122.01 $ 122.01 2426 AMBUL CARE24262008 D51/4NS 500ML $ 117.41 $ 117.41 2426 AMBUL CARE24256045 HYDRATN INFSN EA ADD HR $ 509.00 $ 509.00 2425 AMBUL CARE24256044 HYDRATN INFSN INIT 31-60M $ 730.00 $ 730.00 2425 AMBUL CARE24256046 INFSN W/MED ADD SEQ 16-60 $ 500.00 $ 500.00 2425 AMBUL CARE24256039 INFSN W/MED CONCURRENT $ 730.00 $ 730.00 2425 AMBUL CARE24256033 INFSN W/MED EA ADD HR $ 509.00 $ 509.00 2425 AMBUL CARE

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DEPARTMENT CODE

24256032 INFUSION W/MED 16-60MN $ 730.00 $ 730.00 2425 AMBUL CARE24256027 INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2425 AMBUL CARE24256028 INFUSN CHEMO EA ADD HR $ 639.00 $ 639.00 2425 AMBUL CARE24256038 INJ BLOOD PATCH $ 1,013.00 $ 1,013.00 2425 AMBUL CARE24256036 INJ EPID CERV THOR $ 2,594.00 $ 2,594.00 2425 AMBUL CARE24256037 INJ EPIDL L/S $ 2,779.00 $ 2,779.00 2425 AMBUL CARE24256048 INJ IVP ADDL SEQ NEW DRG $ 221.00 $ 221.00 2425 AMBUL CARE24256052 INJ IVP SAME DRG EA >30M $ 90.00 $ 90.00 2425 AMBUL CARE24256047 IRRIG IMPLNTD VNS ACC DVC $ 1,200.00 $ 1,200.00 2425 AMBUL CARE24262002 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 2426 AMBUL CARE24256007 LUMBAR PUNCTURE DX $ 1,521.00 $ 1,521.00 2425 AMBUL CARE24262005 NA CL 0.9% 1000CC $ 120.97 $ 120.97 2426 AMBUL CARE24262004 NA CL 0.9% 250CC $ 3.16 $ 3.16 2426 AMBUL CARE24262501 S NSTRL GOWN BR PWS STND $ 117.00 $ 117.00 2426 AMBUL CARE24262500 S NSTRL GOWN BR PWS XL $ 144.00 $ 144.00 2426 AMBUL CARE24257003 S STRL G-PROBE $ 788.00 $ 788.00 2425 AMBUL CARE24259999 S STRL MISCELLANEOUS $ - $ - 2425 AMBUL CARE24256004 S STRL OXI SENSOR ADLT/PD $ 187.00 $ 187.00 2425 AMBUL CARE24256005 S STRL OXI SENSOR NEONATE $ 275.00 $ 275.00 2425 AMBUL CARE24256035 SURG LVL 1 ADD 15M $ 1,060.00 $ 1,060.00 2425 AMBUL CARE24256034 SURG LVL 1 FIRST 30M $ 2,485.00 $ 2,485.00 2425 AMBUL CARE24256008 THORACENTESIS $ 2,500.00 $ 2,500.00 2425 AMBUL CARE40350715 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 4035 ANESTHESIA40340033 BLD GAS ART $ 667.00 $ 667.00 4034 ANESTHESIA40350703 CPLX GENRL ANES ADD 15M $ 737.00 $ 737.00 4035 ANESTHESIA40350702 CPLX GENRL ANES FIRST 30M $ 1,377.00 $ 1,377.00 4035 ANESTHESIA40350710 D10W 1000ML $ 123.19 $ 123.19 4035 ANESTHESIA40350711 D51/2NS 1000ML $ 128.23 $ 128.23 4035 ANESTHESIA40350712 D51/2NS 500ML $ 123.63 $ 123.63 4035 ANESTHESIA40350713 D51/4NS 500ML $ 123.63 $ 123.63 4035 ANESTHESIA40350714 D5LR 1000ML $ 135.87 $ 135.87 4035 ANESTHESIA40350719 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 4035 ANESTHESIA40350705 MAC/REG ADD 15M $ 561.00 $ 561.00 4035 ANESTHESIA

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DEPARTMENT CODE

40350622 MAC/REG ADD 15M NONOR $ 561.00 $ 561.00 4035 ANESTHESIA40350704 MAC/REG FIRST 30M $ 1,160.00 $ 1,160.00 4035 ANESTHESIA40350621 MAC/REG FIRST 30M NONOR $ 1,160.00 $ 1,160.00 4035 ANESTHESIA40350720 NA CL 0.45% 1000ML $ 127.19 $ 127.19 4035 ANESTHESIA40350721 NA CL 0.9% 1000CC $ 127.19 $ 127.19 4035 ANESTHESIA40350722 NA CL 0.9% 100ML $ 4.62 $ 4.62 4035 ANESTHESIA40350723 NA CL 0.9% 250CC $ 3.16 $ 3.16 4035 ANESTHESIA40350724 NA CL 0.9% 500ML $ 121.95 $ 121.95 4035 ANESTHESIA40350725 NORMOSOL R/D5W 1000ML $ 130.18 $ 130.18 4035 ANESTHESIA40340026 S CATH INFSN NO HD $ 304.00 $ 304.00 4034 ANESTHESIA40361062 S CATH INFSN NO HD $ 1,444.00 $ 1,444.00 4036 ANESTHESIA40361063 S CATH INFSN NO HD $ 650.00 $ 650.00 4036 ANESTHESIA40340120 S NSTRL AMBU BAG ADULT $ 360.00 $ 360.00 4034 ANESTHESIA40361014 S NSTRL AMBU BAG PEDI $ 154.00 $ 154.00 4036 ANESTHESIA40340106 S NSTRL BLNKT BR RG/LITH $ 123.00 $ 123.00 4034 ANESTHESIA40340105 S NSTRL BLNKT BR UNDRBDY $ 211.00 $ 211.00 4034 ANESTHESIA40340081 S NSTRL ET TBE LASER WRAP $ 396.00 $ 396.00 4034 ANESTHESIA40340007 S NSTRL LMA $ 553.00 $ 553.00 4034 ANESTHESIA40340052 S NSTRL OXI SENSOR AD/PED $ 210.00 $ 210.00 4034 ANESTHESIA40340053 S NSTRL OXI SENSOR-NEONAT $ 268.00 $ 268.00 4034 ANESTHESIA40340018 S NSTRL SKIN/REC TEMP PRB $ 71.00 $ 71.00 4034 ANESTHESIA40340041 S STRL 2-L CVP KIT/PEDI $ 469.00 $ 469.00 4034 ANESTHESIA40340042 S STRL 3-L CVP KIT/PEDI $ 396.00 $ 396.00 4034 ANESTHESIA40340049 S STRL 6.0-8.5 INTRODUCER $ 434.00 $ 434.00 4034 ANESTHESIA40340003 S STRL AIRWAY EXC CATH $ 482.00 $ 482.00 4034 ANESTHESIA40340140 S STRL ANESTHESIA SUPP $ - $ - 4034 ANESTHESIA40340047 S STRL ART LINE ADLT/PEDI $ 247.00 $ 247.00 4034 ANESTHESIA40340005 S STRL BELMONT DUA PT LNE $ 116.00 $ 116.00 4034 ANESTHESIA40340004 S STRL BELMONT ST FMS2516 $ 1,009.00 $ 1,009.00 4034 ANESTHESIA40340104 S STRL BLNKT BR HG CV $ 453.00 $ 453.00 4034 ANESTHESIA40361017 S STRL BLOOD FILTER $ 162.00 $ 162.00 4036 ANESTHESIA40361024 S STRL BLOOD TUBING $ 89.00 $ 89.00 4036 ANESTHESIA40340080 S STRL BRONCHOCATH DISP $ 1,019.00 $ 1,019.00 4034 ANESTHESIA

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DEPARTMENT CODE

40340035 S STRL CARTRIDGE ISTAT $ 124.00 $ 124.00 4034 ANESTHESIA40340067 S STRL CATHETR ONQ 2.5CM $ 420.00 $ 420.00 4034 ANESTHESIA40340068 S STRL CATHETR ONQ 5.0CM $ 547.00 $ 547.00 4034 ANESTHESIA40340002 S STRL CRICOTHYROTOMY SET $ 948.00 $ 948.00 4034 ANESTHESIA40340056 S STRL CV KIT 3L7FR16/20C $ 434.00 $ 434.00 4034 ANESTHESIA40340050 S STRL CVP 14/16 GA $ 386.00 $ 386.00 4034 ANESTHESIA40340055 S STRL CVP ANTECUB $ 531.00 $ 531.00 4034 ANESTHESIA40361023 S STRL DESERET SUBCLAVIAN $ 85.00 $ 85.00 4036 ANESTHESIA40340110 S STRL DIAL-A-FLOW $ 71.00 $ 71.00 4034 ANESTHESIA40340132 S STRL DISP SUCTION CATH $ 24.00 $ 24.00 4034 ANESTHESIA40340135 S STRL DSP BLD WMR SUP $ 1,035.00 $ 1,035.00 4034 ANESTHESIA40340134 S STRL DSP HTLIN BLD COIL $ 263.00 $ 263.00 4034 ANESTHESIA40340137 S STRL DSP JACK REESE CIR $ 75.00 $ 75.00 4034 ANESTHESIA40340131 S STRL DSP SPOTE SPNL NDL $ 437.00 $ 437.00 4034 ANESTHESIA40340040 S STRL ENDOTRACHEAL TUBE $ 116.00 $ 116.00 4034 ANESTHESIA40361046 S STRL ENDOTRACHEAL TUBE $ 65.00 $ 65.00 4036 ANESTHESIA40361106 S STRL EPIDURAL CATH PEDI $ 426.00 $ 426.00 4036 ANESTHESIA40361045 S STRL EPIDURAL CATHETER $ 35.00 $ 35.00 4036 ANESTHESIA40340028 S STRL EPIDURAL TRAY $ 368.00 $ 368.00 4034 ANESTHESIA40361016 S STRL ESOPH STETHESCOP $ 96.00 $ 96.00 4036 ANESTHESIA40340107 S STRL EXTN ONQ 5 $ 420.00 $ 420.00 4034 ANESTHESIA40340114 S STRL FENWALL BLD WARMER $ 117.00 $ 117.00 4034 ANESTHESIA40340112 S STRL GLUCOMETER $ 92.00 $ 92.00 4034 ANESTHESIA40340079 S STRL GUARDED TRACH TUBE $ 207.00 $ 207.00 4034 ANESTHESIA40361004 S STRL HEMOCUE $ 119.00 $ 119.00 4036 ANESTHESIA40340119 S STRL HOT LINE BLD WARMR $ 117.00 $ 117.00 4034 ANESTHESIA40361058 S STRL HUNSAKER MONOJE TB $ 259.00 $ 259.00 4036 ANESTHESIA40340063 S STRL INTRDCR DL 9FR ARW $ 631.00 $ 631.00 4034 ANESTHESIA40340044 S STRL INTRSHEATH 4.5 6.5 $ 255.00 $ 255.00 4034 ANESTHESIA40340070 S STRL IV TBG W/BLOD PMP $ 34.00 $ 34.00 4034 ANESTHESIA40340077 S STRL LASER ENDOTRACH TB $ 1,134.00 $ 1,134.00 4034 ANESTHESIA40361025 S STRL LASER ENDOTRACHEAL $ 647.00 $ 647.00 4036 ANESTHESIA40361019 S STRL LTA KIT $ 65.00 $ 65.00 4036 ANESTHESIA

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DEPARTMENT CODE

40340074 S STRL MUCOSAL ATOMIZATIO $ 46.00 $ 46.00 4034 ANESTHESIA40340031 S STRL NDL NRV BLK XTR BR $ 192.00 $ 192.00 4034 ANESTHESIA40340078 S STRL ORAL/NASAL RAE TB $ 125.00 $ 125.00 4034 ANESTHESIA40340017 S STRL PALL FILTER $ 88.00 $ 88.00 4034 ANESTHESIA40361104 S STRL PED CVP CAT DL $ 1,031.00 $ 1,031.00 4036 ANESTHESIA40361103 S STRL PED CVP CAT SNGL L $ 745.00 $ 745.00 4036 ANESTHESIA40340048 S STRL PEDI CVP 4FR-DL $ 568.00 $ 568.00 4034 ANESTHESIA40340076 S STRL PEDI ENDOTRACH TB $ 75.00 $ 75.00 4034 ANESTHESIA40340027 S STRL PEDI EPIDURAL KIT $ 551.00 $ 551.00 4034 ANESTHESIA40361048 S STRL PERIFIX CONT EPIDU $ 65.00 $ 65.00 4036 ANESTHESIA40340065 S STRL PUMP PN ONQ 100ML $ 741.00 $ 741.00 4034 ANESTHESIA40340066 S STRL PUMP PN ONQ 270ML $ 1,008.00 $ 1,008.00 4034 ANESTHESIA40361028 S STRL RADIAL ARTERY CATH $ 119.00 $ 119.00 4036 ANESTHESIA40340062 S STRL REGIONAL BLOCK NDL $ 51.00 $ 51.00 4034 ANESTHESIA40340117 S STRL RESERVOIR CARDIO $ 867.00 $ 867.00 4034 ANESTHESIA40340057 S STRL RETRO INTUBATIO ET $ 445.00 $ 445.00 4034 ANESTHESIA40361020 S STRL SALEM SUMP TUBE $ 77.00 $ 77.00 4036 ANESTHESIA40340051 S STRL SLIC CATH 2-L $ 83.00 $ 83.00 4034 ANESTHESIA40340109 S STRL SNSR CRBRL/SMTC AD $ 476.00 $ 476.00 4034 ANESTHESIA40340108 S STRL SNSR CRBRL/SMTC IN $ 743.00 $ 743.00 4034 ANESTHESIA40340008 S STRL SOLU BURETROL/DRIP $ 17.00 $ 17.00 4034 ANESTHESIA40361044 S STRL SPINAL TRAY $ 199.00 $ 199.00 4036 ANESTHESIA40340136 S STRL STIMUP NDL SHRT 2" $ 153.00 $ 153.00 4034 ANESTHESIA40340139 S STRL STIMUPL NDL MED 4" $ 226.00 $ 226.00 4034 ANESTHESIA40340141 S STRL STIMUPLEX NDL LG 6 $ 246.00 $ 246.00 4034 ANESTHESIA40340111 S STRL STOPCOCK GANG $ 112.00 $ 112.00 4034 ANESTHESIA40340054 S STRL SWAN-GAN W/THE OXI $ 1,717.00 $ 1,717.00 4034 ANESTHESIA40361054 S STRL TEMP PRBE/CARTRIDG $ 73.00 $ 73.00 4036 ANESTHESIA40340022 S STRL THERMOVENT $ 46.00 $ 46.00 4034 ANESTHESIA40340069 S STRL TNNLR ONQ 11X8/12 $ 549.00 $ 549.00 4034 ANESTHESIA40340143 S STRL TOUHY NDL 4"/6" $ 325.00 $ 325.00 4034 ANESTHESIA40340034 S STRL TRASDUCE ST/UP SPL $ 1,137.00 $ 1,137.00 4034 ANESTHESIA40361101 S STRL TRIPLE LUMEN CATH $ 1,118.00 $ 1,118.00 4036 ANESTHESIA

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DEPARTMENT CODE

40340064 S STRL TUB BLD WARM RANGR $ 144.00 $ 144.00 4034 ANESTHESIA40340061 S STRL UNIVENT TUBE $ 1,258.00 $ 1,258.00 4034 ANESTHESIA40340045 S WIRE GUIDE $ 181.00 $ 181.00 4034 ANESTHESIA40340046 S WIRE GUIDE $ 263.00 $ 263.00 4034 ANESTHESIA40361049 S WIRE GUIDE $ 85.00 $ 85.00 4036 ANESTHESIA40350624 STND ANES ADD 15M NONOR $ 594.00 $ 594.00 4035 ANESTHESIA40350623 STND ANES FIRST 30M NONOR $ 1,199.00 $ 1,199.00 4035 ANESTHESIA40350320 STND GENRL ANES ADD 15M $ 594.00 $ 594.00 4035 ANESTHESIA40350300 STND GENRL ANES FIRST 30M $ 1,199.00 $ 1,199.00 4035 ANESTHESIA40340006 TRANSESOPHAGEAL ECHO $ 683.00 $ 683.00 4034 ANESTHESIA40350726 WATER IJ 1000ML $ 104.76 $ 104.76 4035 ANESTHESIA24510007 MAC/REG ADD 15M NONOR $ 561.00 $ 561.00 2451 ANESTHESIA/NURSING MRI24510006 MAC/REG FIRST 30M NONOR $ 1,160.00 $ 1,160.00 2451 ANESTHESIA/NURSING MRI24560027 NA CL 0.9% 250CC $ 3.16 $ 3.16 2456 ANESTHESIA/NURSING MRI24560017 S NSTRL OXI $ 208.00 $ 208.00 2456 ANESTHESIA/NURSING MRI24560010 S STRL AMBU BAG $ 359.00 $ 359.00 2456 ANESTHESIA/NURSING MRI24560012 S STRL DISP MASK $ 48.00 $ 48.00 2456 ANESTHESIA/NURSING MRI24560013 S STRL DSP JACK REESE CIR $ 71.00 $ 71.00 2456 ANESTHESIA/NURSING MRI24560006 S STRL DSP SUC CATHETER $ 22.00 $ 22.00 2456 ANESTHESIA/NURSING MRI24560014 S STRL ENDOTRACH TBE ADLT $ 112.00 $ 112.00 2456 ANESTHESIA/NURSING MRI24560015 S STRL ENDOTRACH TUBE PED $ 72.00 $ 72.00 2456 ANESTHESIA/NURSING MRI24530005 S STRL HEMOCUE $ 89.00 $ 89.00 2453 ANESTHESIA/NURSING MRI24560016 S STRL ORAL/NASAL RAE TB $ 123.00 $ 123.00 2456 ANESTHESIA/NURSING MRI24560018 S STRL OXI SENSOR NEONATA $ 267.00 $ 267.00 2456 ANESTHESIA/NURSING MRI24560019 S STRL OXI WRAP INVIVO $ 8.00 $ 8.00 2456 ANESTHESIA/NURSING MRI24560002 S STRL PALL FILTER $ 85.00 $ 85.00 2456 ANESTHESIA/NURSING MRI24510017 STND ANES ADD 15M NONOR $ 594.00 $ 594.00 2451 ANESTHESIA/NURSING MRI24510016 STND ANES FIRST 30M NONOR $ 1,199.00 $ 1,199.00 2451 ANESTHESIA/NURSING MRI24510013 STND PACU LVL 1 ADD 15M $ 283.00 $ 283.00 2451 ANESTHESIA/NURSING MRI24510012 STND PACU LVL 1 FIRST 30M $ 576.00 $ 576.00 2451 ANESTHESIA/NURSING MRI24510015 STND PACU LVL 2 ADD 15M $ 323.00 $ 323.00 2451 ANESTHESIA/NURSING MRI24510014 STND PACU LVL 2 FIRST 30M $ 856.00 $ 856.00 2451 ANESTHESIA/NURSING MRI41031884 ACCESS AV DIAL GRFT EVAL $ 2,109.00 $ 2,109.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031886 ACCESS AV DIAL GRFT PROC $ 2,109.00 $ 2,109.00 4103 ANGIOGRAPH41031784 ACTIVATED CLOTTING TIME $ 142.00 $ 142.00 4103 ANGIOGRAPH41041612 AD EVAL ABR $ 270.00 $ 270.00 4104 ANGIOGRAPH41041621 ANS FCN; SUDOMOTOR $ 200.00 $ 200.00 4104 ANGIOGRAPH41031786 BLOOD GASES O2 SAT ONLY $ 303.00 $ 303.00 4103 ANGIOGRAPH41041609 C MOTOR EVOKED UPPR LIMBS $ 200.00 $ 200.00 4104 ANGIOGRAPH41041611 C MOTOR EVOKED, LWR LIMBS $ 200.00 $ 200.00 4104 ANGIOGRAPH41040063 CA CV CATH MECH CLEAR $ 2,674.00 $ 2,674.00 4104 ANGIOGRAPH41040029 CA ENDOVAS REPR IL ART $ 450.00 $ 450.00 4104 ANGIOGRAPH41040064 CA RMVL CVA DEV OBSTRCTN $ 2,208.00 $ 2,208.00 4104 ANGIOGRAPH41031464 CAC GRFT RPLC IL ART $ 2,573.00 $ 2,573.00 4103 ANGIOGRAPH41031432 CAC MECH REMOVE INTRACATH $ 996.00 $ 996.00 4103 ANGIOGRAPH41031434 CAC MECH REMOVE PERICATH $ 5,525.00 $ 5,525.00 4103 ANGIOGRAPH41031283 CAC NG TUBE PLC W FLUORO $ 985.00 $ 985.00 4103 ANGIOGRAPH41031782 CALCIUM IONIZED $ 472.00 $ 472.00 4103 ANGIOGRAPH41029116 CON GASTROGRAF 120ML $ 22.40 $ 22.40 4102 ANGIOGRAPH41029014 CON HOCM <=149MG/ML 1ML $ 2.00 $ 2.00 4102 ANGIOGRAPH41029016 CON HOCM <=149MG/ML 1ML $ 2.00 $ 2.00 4102 ANGIOGRAPH41029109 CON HOCM 300-349MG/ML 1ML $ 1.30 $ 1.30 4102 ANGIOGRAPH41029035 CON LOCM 300-349S I 1ML $ 4.80 $ 4.80 4102 ANGIOGRAPH41029053 CON LOCM 350-399S I 1ML $ 5.90 $ 5.90 4102 ANGIOGRAPH41031776 CREATININE $ 178.00 $ 178.00 4103 ANGIOGRAPH41060012 CT RECON FOR SURG PLAN $ 2,594.00 $ 2,594.00 4106 ANGIOGRAPH41041618 EEG GT 1 HR $ 270.00 $ 270.00 4104 ANGIOGRAPH41041619 ELCTRDE STIM BRAIN 1ST HR $ 270.00 $ 270.00 4104 ANGIOGRAPH41041617 EMG ANAL/URETHRAL SPHNCTR $ 200.00 $ 200.00 4104 ANGIOGRAPH41041616 EMG FOUR LIMBS $ 200.00 $ 200.00 4104 ANGIOGRAPH41041613 EMG HEAD OR NECK UNI $ 200.00 $ 200.00 4104 ANGIOGRAPH41041614 EMG TWO LIMBS $ 200.00 $ 200.00 4104 ANGIOGRAPH41054470 EP ICAR FX CV GD IN SHTH $ 429.00 $ 429.00 4105 ANGIOGRAPH41063710 EP ICAR FX CV GD IN SHTH $ 491.00 $ 491.00 4106 ANGIOGRAPH41029017 ETHIODIZED OIL 10ML $ 154.00 $ 154.00 4102 ANGIOGRAPH41031778 GLUCOSE $ 134.00 $ 134.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031777 HEMATOCRIT $ 80.00 $ 80.00 4103 ANGIOGRAPH41031779 HEMOGLOBIN $ 80.00 $ 80.00 4103 ANGIOGRAPH41000632 IR ABSCSS FIST SIN TRACT $ 610.00 $ 610.00 4100 ANGIOGRAPH41021500 IR ANGIO ADD VESSEL EA $ 2,691.00 $ 2,691.00 4102 ANGIOGRAPH41020074 IR ANGIO ADRENAL BIL $ 9,735.00 $ 9,735.00 4102 ANGIOGRAPH41020073 IR ANGIO ADRENAL UNI $ 3,391.00 $ 3,391.00 4102 ANGIOGRAPH41020032 IR ANGIO BRACH $ 3,209.00 $ 3,209.00 4102 ANGIOGRAPH41020042 IR ANGIO CAROTD CERE BIL $ 3,793.00 $ 3,793.00 4102 ANGIOGRAPH41020040 IR ANGIO CAROTD CERE UNI $ 3,391.00 $ 3,391.00 4102 ANGIOGRAPH41020058 IR ANGIO CAROTD CERV BIL $ 3,595.00 $ 3,595.00 4102 ANGIOGRAPH41020059 IR ANGIO CAROTD CERV UNI $ 3,290.00 $ 3,290.00 4102 ANGIOGRAPH41020037 IR ANGIO CAROTD XTL BIL $ 3,734.00 $ 3,734.00 4102 ANGIOGRAPH41020035 IR ANGIO CAROTD XTL UNI $ 3,290.00 $ 3,290.00 4102 ANGIOGRAPH41020027 IR ANGIO CERVICOCEREBRAL $ 3,161.00 $ 3,161.00 4102 ANGIOGRAPH41020067 IR ANGIO EXT BIL $ 3,680.00 $ 3,680.00 4102 ANGIOGRAPH41020065 IR ANGIO EXT UNI $ 3,290.00 $ 3,290.00 4102 ANGIOGRAPH41040015 IR ANGIO FU EXISTING CATH $ 941.00 $ 941.00 4104 ANGIOGRAPH41020080 IR ANGIO PELV SELECT $ 3,284.00 $ 3,284.00 4102 ANGIOGRAPH41020087 IR ANGIO PULM BIL SELECT $ 3,215.00 $ 3,215.00 4102 ANGIOGRAPH41020089 IR ANGIO PULM NONSELECT $ 3,161.00 $ 3,161.00 4102 ANGIOGRAPH41020085 IR ANGIO PULM UNI SELECT $ 3,028.00 $ 3,028.00 4102 ANGIOGRAPH41020072 IR ANGIO RENL BIL $ 3,739.00 $ 3,739.00 4102 ANGIOGRAPH41020070 IR ANGIO RENL UNI $ 3,247.00 $ 3,247.00 4102 ANGIOGRAPH41020050 IR ANGIO SPINAL SELECT $ 3,456.00 $ 3,456.00 4102 ANGIOGRAPH41020056 IR ANGIO VERTEBRAL $ 3,300.00 $ 3,300.00 4102 ANGIOGRAPH41020075 IR ANGIO VISCERAL $ 3,252.00 $ 3,252.00 4102 ANGIOGRAPH41020030 IR AORTOGRAM ABD BIL EXT $ 3,316.00 $ 3,316.00 4102 ANGIOGRAPH41020025 IR AORTOGRAM ABD W SER $ 3,065.00 $ 3,065.00 4102 ANGIOGRAPH41020022 IR AORTOGRAM THOR W SER $ 3,124.00 $ 3,124.00 4102 ANGIOGRAPH41000496 IR ARTHRO HIP $ 1,048.00 $ 1,048.00 4100 ANGIOGRAPH41000375 IR ARTHRO SI JNT $ 770.00 $ 770.00 4100 ANGIOGRAPH41040044 IR ATHERECTOMY PERIPH ADD $ 6,419.00 $ 6,419.00 4104 ANGIOGRAPH41040037 IR ATHERECTOMY PERIPH INI $ 9,751.00 $ 9,751.00 4104 ANGIOGRAPH

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DEPARTMENT CODE

41040041 IR ATHERECTOMY RENL $ 8,152.00 $ 8,152.00 4104 ANGIOGRAPH41040043 IR ATHERECTOMY VISC ADD $ 1,467.00 $ 1,467.00 4104 ANGIOGRAPH41040042 IR ATHERECTOMY VISC INI $ 4,634.00 $ 4,634.00 4104 ANGIOGRAPH41020124 IR AV DIALYSIS SHUNT IMAG $ 1,514.00 $ 1,514.00 4102 ANGIOGRAPH41000715 IR BILE STONE EXTRACTION $ 1,466.00 $ 1,466.00 4100 ANGIOGRAPH41000717 IR BILI DRN INT XTL $ 3,782.00 $ 3,782.00 4100 ANGIOGRAPH41000716 IR BILI DRN PRC $ 3,258.00 $ 3,258.00 4100 ANGIOGRAPH41040077 IR BILI DUCT DILATE PRC $ 1,369.00 $ 1,369.00 4104 ANGIOGRAPH41001005 IR BX TRANSCATHETER $ 6,285.00 $ 6,285.00 4100 ANGIOGRAPH41000820 IR CATH RENL PELV PRC $ 1,423.00 $ 1,423.00 4100 ANGIOGRAPH41031783 IR CHEMO IA PUSH $ 1,466.00 $ 1,466.00 4103 ANGIOGRAPH41000705 IR CHOL EXISTING CATH $ 524.00 $ 524.00 4100 ANGIOGRAPH41000710 IR CHOL TRANSHEPAT PRC $ 1,305.00 $ 1,305.00 4100 ANGIOGRAPH41000342 IR CISTERNOGRAM $ 410.00 $ 410.00 4100 ANGIOGRAPH41001095 IR CONSULT FOREIGN FLM $ 285.00 $ 285.00 4100 ANGIOGRAPH41000792 IR CORPORA CAVERNOSOGRAM $ 877.00 $ 877.00 4100 ANGIOGRAPH41031789 IR CS SAME MD ADD 15M $ 204.00 $ 204.00 4103 ANGIOGRAPH41031787 IR CS SAME MD GT5YR 0-30M $ 511.00 $ 511.00 4103 ANGIOGRAPH41031788 IR CS SAME MD LT5YR 0-30M $ 606.00 $ 606.00 4103 ANGIOGRAPH41000153 IR DACRYOCYSTOGRAPHY $ 636.00 $ 636.00 4100 ANGIOGRAPH41000825 IR DILATE NEPHROSTOMY $ 1,359.00 $ 1,359.00 4100 ANGIOGRAPH41000365 IR DISKOGRAM CERV THOR $ 1,765.00 $ 1,765.00 4100 ANGIOGRAPH41000370 IR DISKOGRAM LUMB $ 1,674.00 $ 1,674.00 4100 ANGIOGRAPH41000185 IR DRN W CATH PLACE PRC $ 1,385.00 $ 1,385.00 4100 ANGIOGRAPH41040013 IR DTA ENDO REPR W/SC $ 1,204.00 $ 1,204.00 4104 ANGIOGRAPH41040014 IR DTA PLC DST EXT PRS DL $ 588.00 $ 588.00 4104 ANGIOGRAPH41040012 IR DTA PLC PROX EXT PROS $ 658.00 $ 658.00 4104 ANGIOGRAPH41040005 IR EMBOL TX $ 12,956.00 $ 12,956.00 4104 ANGIOGRAPH41000720 IR ENDO BILI DUCT $ 2,164.00 $ 2,164.00 4100 ANGIOGRAPH41040018 IR ENDOVAS REPR ABD AO $ 760.00 $ 760.00 4104 ANGIOGRAPH41000636 IR ENTEROCLYSIS TUBE PRC $ 1,637.00 $ 1,637.00 4100 ANGIOGRAPH41000152 IR EPIDUROGRAM $ 1,006.00 $ 1,006.00 4100 ANGIOGRAPH41000730 IR ERCP BILI PANC DUCT $ 1,942.00 $ 1,942.00 4100 ANGIOGRAPH

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DEPARTMENT CODE

41000725 IR ERCP PANC DUCT $ 1,091.00 $ 1,091.00 4100 ANGIOGRAPH41040028 IR EXCHNGE INTRAVAS CATH $ 2,113.00 $ 2,113.00 4104 ANGIOGRAPH41000870 IR FALLOPN TUBE TRANSCERV $ 809.00 $ 809.00 4100 ANGIOGRAPH41000620 IR FB RMVL ESOPH $ 781.00 $ 781.00 4100 ANGIOGRAPH41006003 IR FLUOR CVAD PLC/RMV/RPR $ 1,278.00 $ 1,278.00 4100 ANGIOGRAPH41006000 IR FLUORO 1HR OR LES $ 1,278.00 $ 1,278.00 4100 ANGIOGRAPH41006002 IR FLUORO GUIDE SPINE INJ $ 817.00 $ 817.00 4100 ANGIOGRAPH41001003 IR FLUORO NDL PLACE $ 711.00 $ 711.00 4100 ANGIOGRAPH41001037 IR GALACTOGRAM 1 DUCT $ 1,894.00 $ 1,894.00 4100 ANGIOGRAPH41000735 IR GI TUBE INSERT LONG $ 1,562.00 $ 1,562.00 4100 ANGIOGRAPH41000865 IR HYSTEROSALPINGOGRAM $ 893.00 $ 893.00 4100 ANGIOGRAPH41000626 IR INTRALUMINAL DILATE $ 1,952.00 $ 1,952.00 4100 ANGIOGRAPH41040020 IR IVC FILTER PLACE $ 7,537.00 $ 7,537.00 4104 ANGIOGRAPH41021144 IR IVUS NONCO ADD $ 707.00 $ 707.00 4102 ANGIOGRAPH41021143 IR IVUS NONCO INI $ 1,448.00 $ 1,448.00 4102 ANGIOGRAPH41010125 IR NDL PLACE $ 2,300.00 $ 2,300.00 4100 ANGIOGRAPH41001034 IR PERC TUBE/CATH CHNG $ 1,230.00 $ 1,230.00 4100 ANGIOGRAPH41000157 IR PLACE OCC DEV VEIN ART $ 1,489.00 $ 1,489.00 4100 ANGIOGRAPH41040019 IR PLACE PROS REPR AAA $ 230.00 $ 230.00 4104 ANGIOGRAPH41021139 IR PORTOGRAM W HEM EVAL $ 3,054.00 $ 3,054.00 4102 ANGIOGRAPH41021135 IR PORTOGRAM W/O HEM EVAL $ 3,086.00 $ 3,086.00 4102 ANGIOGRAPH41040035 IR PTA PERIPH ART $ 3,498.00 $ 3,498.00 4104 ANGIOGRAPH41040040 IR PTA PERIPH ART ADD $ 2,059.00 $ 2,059.00 4104 ANGIOGRAPH41040050 IR PTA RENL VISC $ 3,787.00 $ 3,787.00 4104 ANGIOGRAPH41040062 IR PTA VEN $ 3,434.00 $ 3,434.00 4104 ANGIOGRAPH41040055 IR PTA VISC ADD $ 2,070.00 $ 2,070.00 4104 ANGIOGRAPH41000807 IR RENL CYST STDY $ 808.00 $ 808.00 4100 ANGIOGRAPH41040030 IR RETRIEVAL VASCULAR FB $ 3,514.00 $ 3,514.00 4104 ANGIOGRAPH41040016 IR SI DTA ENDO REPR WO SC $ 1,027.00 $ 1,027.00 4104 ANGIOGRAPH41000150 IR SIALOGRAM $ 776.00 $ 776.00 4100 ANGIOGRAPH41021105 IR SPLENOPORTOGRAM $ 6,986.00 $ 6,986.00 4102 ANGIOGRAPH41041603 IR STNT NOCOR/CAR/VERT EA $ 3,097.00 $ 3,097.00 4104 ANGIOGRAPH41040010 IR TRANSCATHETER TX IV $ 11,265.00 $ 11,265.00 4104 ANGIOGRAPH

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DEPARTMENT CODE

41000830 IR URETERAL STENT PRC $ 1,428.00 $ 1,428.00 4100 ANGIOGRAPH41000805 IR URETHROCYSTOGRAM VOID $ 1,097.00 $ 1,097.00 4100 ANGIOGRAPH41000783 IR UROGRAM RETRO $ 1,573.00 $ 1,573.00 4100 ANGIOGRAPH41010126 IR US VASC ACCESS ADD ON $ 316.00 $ 316.00 4100 ANGIOGRAPH41021145 IR VEN SAMPLING $ 2,851.00 $ 2,851.00 4102 ANGIOGRAPH41021134 IR VENOGRAM ADRENAL BIL $ 3,751.00 $ 3,751.00 4102 ANGIOGRAPH41021132 IR VENOGRAM ADRENAL UNI $ 2,968.00 $ 2,968.00 4102 ANGIOGRAPH41021137 IR VENOGRAM EPID $ 2,968.00 $ 2,968.00 4102 ANGIOGRAPH41021115 IR VENOGRAM EXT BIL $ 1,514.00 $ 1,514.00 4102 ANGIOGRAPH41021110 IR VENOGRAM EXT UNI $ 1,332.00 $ 1,332.00 4102 ANGIOGRAPH41021140 IR VENOGRAM HEP W EVAL $ 2,985.00 $ 2,985.00 4102 ANGIOGRAPH41021142 IR VENOGRAM HEP W/O EVAL $ 2,985.00 $ 2,985.00 4102 ANGIOGRAPH41021120 IR VENOGRAM IVC $ 2,921.00 $ 2,921.00 4102 ANGIOGRAPH41031535 IR VENOGRAM ORBITAL $ 3,849.00 $ 3,849.00 4103 ANGIOGRAPH41021129 IR VENOGRAM RENL BIL $ 3,215.00 $ 3,215.00 4102 ANGIOGRAPH41021127 IR VENOGRAM RENL UNI $ 2,969.00 $ 2,969.00 4102 ANGIOGRAPH41021136 IR VENOGRAM SAG SINUS $ 3,054.00 $ 3,054.00 4102 ANGIOGRAPH41021130 IR VENOGRAM SIN JUGULAR $ 3,054.00 $ 3,054.00 4102 ANGIOGRAPH41021125 IR VENOGRAM SVC $ 2,921.00 $ 2,921.00 4102 ANGIOGRAPH41006007 IR VRTPLSTY EA BDY FLUORO $ 3,541.00 $ 3,541.00 4100 ANGIOGRAPH41031560 IRC ABSCSS CYST LIVER PRC $ 3,868.00 $ 3,868.00 4103 ANGIOGRAPH41031612 IRC ABSCSS DRN PELV PRC $ 7,405.00 $ 7,405.00 4103 ANGIOGRAPH41031571 IRC ABSCSS DRN PERITNL $ 7,300.00 $ 7,300.00 4103 ANGIOGRAPH41031585 IRC ABSCSS DRN RENL $ 7,300.00 $ 7,300.00 4103 ANGIOGRAPH41031575 IRC ABSCSS DRN RETROPE $ 6,816.00 $ 6,816.00 4103 ANGIOGRAPH41031580 IRC ABSCSS DRN SUBDIAP $ 6,667.00 $ 6,667.00 4103 ANGIOGRAPH41031458 IRC AO UNIILIAC/FEM PROS $ 4,915.00 $ 4,915.00 4103 ANGIOGRAPH41031405 IRC ASP BLADDER SP CATH $ 1,914.00 $ 1,914.00 4103 ANGIOGRAPH41031370 IRC ASP RENL CYST $ 254.00 $ 254.00 4103 ANGIOGRAPH41031315 IRC BILI CATH CHNG $ 5,241.00 $ 5,241.00 4103 ANGIOGRAPH41031302 IRC BILI ENDO W STENT $ 967.00 $ 967.00 4103 ANGIOGRAPH41031295 IRC BILI ENDO W/O STENT $ 855.00 $ 855.00 4103 ANGIOGRAPH41031310 IRC BILI STENT PLACE $ 2,526.00 $ 2,526.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031290 IRC BILI STONE EXTRACT $ 1,694.00 $ 1,694.00 4103 ANGIOGRAPH41031300 IRC BILI STONE RMVL $ 1,145.00 $ 1,145.00 4103 ANGIOGRAPH41031675 IRC BX ABD RETROPE $ 1,663.00 $ 1,663.00 4103 ANGIOGRAPH41031680 IRC BX BONE DEEP $ 2,702.00 $ 2,702.00 4103 ANGIOGRAPH41031685 IRC BX BONE SUPER $ 1,075.00 $ 1,075.00 4103 ANGIOGRAPH41031697 IRC BX BREAST W IMAG $ 2,453.00 $ 2,453.00 4103 ANGIOGRAPH41031705 IRC BX EXCSN LYMPH NODE $ 2,212.00 $ 2,212.00 4103 ANGIOGRAPH41031690 IRC BX LIVER $ 2,191.00 $ 2,191.00 4103 ANGIOGRAPH41031750 IRC BX LIVER W MAJOR $ 531.00 $ 531.00 4103 ANGIOGRAPH41031695 IRC BX LUNG MEDIASTNM $ 795.00 $ 795.00 4103 ANGIOGRAPH41031700 IRC BX MUSCLE $ 1,866.00 $ 1,866.00 4103 ANGIOGRAPH41031710 IRC BX PANCREAS $ 2,716.00 $ 2,716.00 4103 ANGIOGRAPH41031725 IRC BX PLEURA $ 734.00 $ 734.00 4103 ANGIOGRAPH41031730 IRC BX PROSTATE $ 2,179.00 $ 2,179.00 4103 ANGIOGRAPH41031735 IRC BX RENL $ 1,717.00 $ 1,717.00 4103 ANGIOGRAPH41031745 IRC BX THYROID $ 596.00 $ 596.00 4103 ANGIOGRAPH41031692 IRC BX TRANSCATHETER $ 2,399.00 $ 2,399.00 4103 ANGIOGRAPH41031820 IRC CATH ABD LOW 1ST $ 1,363.00 $ 1,363.00 4103 ANGIOGRAPH41031825 IRC CATH ABD LOW 2ND $ 1,221.00 $ 1,221.00 4103 ANGIOGRAPH41031830 IRC CATH ABD LOW 3RD $ 1,080.00 $ 1,080.00 4103 ANGIOGRAPH41031835 IRC CATH ABD LOW ADD $ 929.00 $ 929.00 4103 ANGIOGRAPH41031906 IRC CATH PORTAL VEIN PRC $ 1,992.00 $ 1,992.00 4103 ANGIOGRAPH41031800 IRC CATH THOR 1ST ART $ 1,158.00 $ 1,158.00 4103 ANGIOGRAPH41031805 IRC CATH THOR 2ND ART $ 1,140.00 $ 1,140.00 4103 ANGIOGRAPH41031810 IRC CATH THOR 3RD ART $ 1,138.00 $ 1,138.00 4103 ANGIOGRAPH41031815 IRC CATH THOR ADD ART $ 1,129.00 $ 1,129.00 4103 ANGIOGRAPH41031384 IRC CHANGE URET STNT EXT $ 564.00 $ 564.00 4103 ANGIOGRAPH41031322 IRC CHG G-TUBE TO G-J PRC $ 1,162.00 $ 1,162.00 4103 ANGIOGRAPH41031320 IRC CHNG G TUBE WO IMG/GD $ 845.00 $ 845.00 4103 ANGIOGRAPH41031271 IRC CLOSURE ESOPH FISTULA $ 1,428.00 $ 1,428.00 4103 ANGIOGRAPH41031321 IRC CON IJ G/COLON TUBE $ 1,259.00 $ 1,259.00 4103 ANGIOGRAPH41031403 IRC CYSTOSCOPY URETR CATH $ 4,200.00 $ 4,200.00 4103 ANGIOGRAPH41031433 IRC DECLOT VASC DEVICE $ 741.00 $ 741.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031435 IRC DECLOT XTL CAN W BLN $ 479.00 $ 479.00 4103 ANGIOGRAPH41031227 IRC DEST NRV C/T 1 LVL $ 2,507.00 $ 2,507.00 4103 ANGIOGRAPH41031228 IRC DEST NRV C/T ADDL LVL $ 1,459.00 $ 1,459.00 4103 ANGIOGRAPH41031242 IRC DESTRUCT NRV L/S $ 2,500.00 $ 2,500.00 4103 ANGIOGRAPH41031226 IRC DESTRUCT NRV L/S ADD $ 955.00 $ 955.00 4103 ANGIOGRAPH41031264 IRC DESTRUCT NRV PERIPH $ 1,346.00 $ 1,346.00 4103 ANGIOGRAPH41031222 IRC DL IC VASOSPSM INIT $ 4,500.00 $ 4,500.00 4103 ANGIOGRAPH41031224 IRC DL IC VSPSM ADD-ON DF $ 2,214.00 $ 2,214.00 4103 ANGIOGRAPH41031223 IRC DL IC VSPSM ADD-ON SM $ 2,214.00 $ 2,214.00 4103 ANGIOGRAPH41031567 IRC DRN APPNCL ABSCSS PRC $ 2,719.00 $ 2,719.00 4103 ANGIOGRAPH41031342 IRC DRN PANC PSEUDOCYST $ 2,719.00 $ 2,719.00 4103 ANGIOGRAPH41031450 IRC EMBOL OCC NONHEAD NEC $ 2,760.00 $ 2,760.00 4103 ANGIOGRAPH41031444 IRC EMBOL UTERINE FIBROID $ 2,266.00 $ 2,266.00 4103 ANGIOGRAPH41031395 IRC ENDO RENL W URET CATH $ 6,503.00 $ 6,503.00 4103 ANGIOGRAPH41031260 IRC ENDO UPP GI RMVL FB $ 1,357.00 $ 1,357.00 4103 ANGIOGRAPH41031265 IRC ESOPH DILATE BLN >30M $ 2,276.00 $ 2,276.00 4103 ANGIOGRAPH41031627 IRC EXCHANGE DRN CATH $ 4,887.00 $ 4,887.00 4103 ANGIOGRAPH41031553 IRC EXCHNGE INTRAVAS CATH $ 3,476.00 $ 3,476.00 4103 ANGIOGRAPH41031457 IRC EXTCRAN CV STENT ADD $ 5,284.00 $ 5,284.00 4103 ANGIOGRAPH41031449 IRC EXTCRAN CV STENT INIT $ 17,744.00 $ 17,744.00 4103 ANGIOGRAPH41031215 IRC IJ FACET L/S 2 LVL $ 725.00 $ 725.00 4103 ANGIOGRAPH41031211 IRC IJ PV FACET C/T 1 LVL $ 2,470.00 $ 2,470.00 4103 ANGIOGRAPH41031212 IRC IJ PV FACET C/T 2 LVL $ 797.00 $ 797.00 4103 ANGIOGRAPH41031213 IRC IJ PV FACET C/T 3 LVL $ 797.00 $ 797.00 4103 ANGIOGRAPH41031251 IRC IJ TRANS EPI C/T 1LV $ 2,558.00 $ 2,558.00 4103 ANGIOGRAPH41031925 IRC IJ W/FLUOR EVAL CVAD $ 866.00 $ 866.00 4103 ANGIOGRAPH41031274 IRC IMP RVSN SPINAL CATH $ 2,743.00 $ 2,743.00 4103 ANGIOGRAPH41031335 IRC INC GALLBLADDER $ 1,932.00 $ 1,932.00 4103 ANGIOGRAPH41031195 IRC INJ ARTHRO ANKLE $ 219.00 $ 219.00 4103 ANGIOGRAPH41031200 IRC INJ ARTHRO ELBOW $ 2,612.00 $ 2,612.00 4103 ANGIOGRAPH41031205 IRC INJ ARTHRO HIP $ 1,173.00 $ 1,173.00 4103 ANGIOGRAPH41031210 IRC INJ ARTHRO KNEE $ 1,062.00 $ 1,062.00 4103 ANGIOGRAPH41031220 IRC INJ ARTHRO SHOULDER $ 2,612.00 $ 2,612.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031225 IRC INJ ARTHRO TMJ $ 263.00 $ 263.00 4103 ANGIOGRAPH41031230 IRC INJ ARTHRO WRIST $ 2,597.00 $ 2,597.00 4103 ANGIOGRAPH41031246 IRC INJ BLOOD PATCH $ 951.00 $ 951.00 4103 ANGIOGRAPH41031245 IRC INJ C1 C2 MYELOGRAM $ 611.00 $ 611.00 4103 ANGIOGRAPH41031249 IRC INJ CELIAC PLEX BLK $ 1,433.00 $ 1,433.00 4103 ANGIOGRAPH41031252 IRC INJ CELIAC PLEX LYTIC $ 2,163.00 $ 2,163.00 4103 ANGIOGRAPH41031285 IRC INJ CHOL TRANSHEPAT $ 222.00 $ 222.00 4103 ANGIOGRAPH41031325 IRC INJ CHOL VIA CATH $ 229.00 $ 229.00 4103 ANGIOGRAPH41031626 IRC INJ CON ABSCSS $ 1,289.00 $ 1,289.00 4103 ANGIOGRAPH41031360 IRC INJ CYSTO RETRO $ 793.00 $ 793.00 4103 ANGIOGRAPH41031775 IRC INJ DACROCYSTOGRAM $ 208.00 $ 208.00 4103 ANGIOGRAPH41031273 IRC INJ DEST HYPOGASTRIC $ 2,995.00 $ 2,995.00 4103 ANGIOGRAPH41031272 IRC INJ DILATE ESOPH $ 2,106.00 $ 2,106.00 4103 ANGIOGRAPH41031250 IRC INJ DISKOGRAM CERV $ 2,027.00 $ 2,027.00 4103 ANGIOGRAPH41031255 IRC INJ DISKOGRAM LUMB $ 2,476.00 $ 2,476.00 4103 ANGIOGRAPH41031243 IRC INJ EPID CERV THOR $ 1,514.00 $ 1,514.00 4103 ANGIOGRAPH41031244 IRC INJ EPID L/S $ 1,456.00 $ 1,456.00 4103 ANGIOGRAPH41031895 IRC INJ EXT VENOGRAM $ 2,725.00 $ 2,725.00 4103 ANGIOGRAPH41031216 IRC INJ FACET L/S 1 LVL $ 2,390.00 $ 2,390.00 4103 ANGIOGRAPH41031217 IRC INJ FACET L/S 3 LVL $ 725.00 $ 725.00 4103 ANGIOGRAPH41031350 IRC INJ ILEAL CONDUIT $ 634.00 $ 634.00 4103 ANGIOGRAPH41031770 IRC INJ LYMPHANGIO $ 583.00 $ 583.00 4103 ANGIOGRAPH41031791 IRC INJ MAJOR JNT BURSA $ 352.00 $ 352.00 4103 ANGIOGRAPH41031235 IRC INJ MYELOGRAM $ 1,721.00 $ 1,721.00 4103 ANGIOGRAPH41031345 IRC INJ NEPHROGRAM $ 932.00 $ 932.00 4103 ANGIOGRAPH41031269 IRC INJ NRV BLK C SPINE $ 1,105.00 $ 1,105.00 4103 ANGIOGRAPH41031253 IRC INJ NRV BLK C/T ADD $ 843.00 $ 843.00 4103 ANGIOGRAPH41031232 IRC INJ NRV BLK CERV THOR $ 597.00 $ 597.00 4103 ANGIOGRAPH41031233 IRC INJ NRV BLK L/S 1 LVL $ 2,740.00 $ 2,740.00 4103 ANGIOGRAPH41031234 IRC INJ NRV BLK L/S ADD $ 1,140.00 $ 1,140.00 4103 ANGIOGRAPH41031231 IRC INJ NRV BLK LUMB $ 1,449.00 $ 1,449.00 4103 ANGIOGRAPH41031254 IRC INJ NRV BLK LUMB THOR $ 1,755.00 $ 1,755.00 4103 ANGIOGRAPH41031357 IRC INJ PENILE CAVERNOUS $ 369.00 $ 369.00 4103 ANGIOGRAPH

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41031760 IRC INJ SIALOGRAM $ 4,378.00 $ 4,378.00 4103 ANGIOGRAPH41031625 IRC INJ SINOGRAM $ 1,011.00 $ 1,011.00 4103 ANGIOGRAPH41031259 IRC INJ SPINE W CATH L/S $ 1,700.00 $ 1,700.00 4103 ANGIOGRAPH41031905 IRC INJ SPLENOPORTOGRAM $ 331.00 $ 331.00 4103 ANGIOGRAPH41031410 IRC INJ URETERO PYELOGRAM $ 1,697.00 $ 1,697.00 4103 ANGIOGRAPH41031793 IRC INJ/ASP INT JNT/BURSA $ 250.00 $ 250.00 4103 ANGIOGRAPH41031790 IRC INJ/ASP JNT/BURSA $ 223.00 $ 223.00 4103 ANGIOGRAPH41031437 IRC INS NON-TUN CV CATH5+ $ 1,966.00 $ 1,966.00 4103 ANGIOGRAPH41031551 IRC INS PICC W/O PORT 5+ $ 2,405.00 $ 2,405.00 4103 ANGIOGRAPH41031438 IRC INS PICC W/O PORT LT5 $ 2,467.00 $ 2,467.00 4103 ANGIOGRAPH41031436 IRC INS TUNN CV DEV 2CATH $ 8,094.00 $ 8,094.00 4103 ANGIOGRAPH41031927 IRC INS TUNN CV DEV 5+ $ 4,705.00 $ 4,705.00 4103 ANGIOGRAPH41031907 IRC INS TUNN CV NO PORT5+ $ 4,783.00 $ 4,783.00 4103 ANGIOGRAPH41031362 IRC INSERT CATH TMP SMPL $ 724.00 $ 724.00 4103 ANGIOGRAPH41031893 IRC INSERT DIAL VEIN/VEIN $ 582.00 $ 582.00 4103 ANGIOGRAPH41031558 IRC INSRT PLEURAL CATH $ 6,434.00 $ 6,434.00 4103 ANGIOGRAPH41031926 IRC INSRT PLEURAL CATH $ 6,434.00 $ 6,434.00 4103 ANGIOGRAPH41031236 IRC INTRACRAN ANGIOPLSTY $ 5,164.00 $ 5,164.00 4103 ANGIOGRAPH41031221 IRC INTRACRN ANGIO W/STNT $ 5,900.00 $ 5,900.00 4103 ANGIOGRAPH41031885 IRC INTRO AORTA $ 298.00 $ 298.00 4103 ANGIOGRAPH41031875 IRC INTRO BRACH ART $ 313.00 $ 313.00 4103 ANGIOGRAPH41031892 IRC INTRO CAROTD VERT ART $ 385.00 $ 385.00 4103 ANGIOGRAPH41031870 IRC INTRO CATH AORTA $ 1,682.00 $ 1,682.00 4103 ANGIOGRAPH41031305 IRC INTRO CATH BILI DRN $ 2,526.00 $ 2,526.00 4103 ANGIOGRAPH41031417 IRC INTRO CATH FALLOPN $ 1,141.00 $ 1,141.00 4103 ANGIOGRAPH41031900 IRC INTRO CATH IVC/SVC $ 2,224.00 $ 2,224.00 4103 ANGIOGRAPH41031840 IRC INTRO CATH PULM $ 1,200.00 $ 1,200.00 4103 ANGIOGRAPH41031375 IRC INTRO CATH RENL PELV $ 3,539.00 $ 3,539.00 4103 ANGIOGRAPH41031880 IRC INTRO EXT ART $ 1,112.00 $ 1,112.00 4103 ANGIOGRAPH41031277 IRC INTRO G TUBE LONG $ 298.00 $ 298.00 4103 ANGIOGRAPH41031505 IRC INTRO IVC FILTER $ 9,159.00 $ 9,159.00 4103 ANGIOGRAPH41031390 IRC INTRO NEPHROSTOMY $ 2,196.00 $ 2,196.00 4103 ANGIOGRAPH41031380 IRC INTRO STENT CATH URET $ 7,580.00 $ 7,580.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031465 IRC IVCH RETRIEVE FB $ 2,810.00 $ 2,810.00 4103 ANGIOGRAPH41031914 IRC IVUS NONCO ADD $ 188.00 $ 188.00 4103 ANGIOGRAPH41031912 IRC IVUS NONCO INI $ 811.00 $ 811.00 4103 ANGIOGRAPH41031240 IRC LUMBAR PUNCTURE DX $ 2,393.00 $ 2,393.00 4103 ANGIOGRAPH41031385 IRC NEPHROSTOMY TUBE CHNG $ 5,667.00 $ 5,667.00 4103 ANGIOGRAPH41031445 IRC NONTHROMBOLYSIS IV $ 1,053.00 $ 1,053.00 4103 ANGIOGRAPH41031229 IRC NRV BLK HYPOGAS PLXS $ 931.00 $ 931.00 4103 ANGIOGRAPH41031903 IRC OPN INTRVAS STENT ADD $ 478.00 $ 478.00 4103 ANGIOGRAPH41031901 IRC OPN INTRVS STENT INIT $ 1,098.00 $ 1,098.00 4103 ANGIOGRAPH41031521 IRC OPN TRANS ANGIO ILIAC $ 803.00 $ 803.00 4103 ANGIOGRAPH41031526 IRC OPN TRANS ANGIO RENAL $ 3,079.00 $ 3,079.00 4103 ANGIOGRAPH41031522 IRC OPN TRANS ANGIO TIBIO $ 1,101.00 $ 1,101.00 4103 ANGIOGRAPH41031590 IRC PARACENT ABD INI $ 1,665.00 $ 1,665.00 4103 ANGIOGRAPH41031595 IRC PARACENT ABD SUBSQ $ 1,332.00 $ 1,332.00 4103 ANGIOGRAPH41031278 IRC PERC VERT AUG ADD VRT $ 1,587.00 $ 1,587.00 4103 ANGIOGRAPH41031455 IRC PERM EMBOL OCC CNS $ 2,393.00 $ 2,393.00 4103 ANGIOGRAPH41031281 IRC PLACE G-TUBE PERC $ 2,316.00 $ 2,316.00 4103 ANGIOGRAPH41031469 IRC PLACE IL OCC DEVICE $ 4,927.00 $ 4,927.00 4103 ANGIOGRAPH41031379 IRC PLC DST PROS DLYD END $ 2,858.00 $ 2,858.00 4103 ANGIOGRAPH41031326 IRC PLC DUD/JEJ TUBE PERC $ 1,162.00 $ 1,162.00 4103 ANGIOGRAPH41031279 IRC PRC VRT AUG LUMB 1VRT $ 1,680.00 $ 1,680.00 4103 ANGIOGRAPH41031276 IRC PRC VRT AUG THOR 1VRT $ 1,738.00 $ 1,738.00 4103 ANGIOGRAPH41031422 IRC PRM ART MTHROM ADD-ON $ 7,499.00 $ 7,499.00 4103 ANGIOGRAPH41031421 IRC PRM ART MTHROM/GUIDE $ 23,493.00 $ 23,493.00 4103 ANGIOGRAPH41031460 IRC PRM EMBL OCC HEAD NEC $ 1,915.00 $ 1,915.00 4103 ANGIOGRAPH41031427 IRC PSEUDOANEURYSM INJ $ 994.00 $ 994.00 4103 ANGIOGRAPH41031480 IRC PTA AORTIC $ 1,133.00 $ 1,133.00 4103 ANGIOGRAPH41031495 IRC PTA BRACHIOCEPH EA $ 1,444.00 $ 1,444.00 4103 ANGIOGRAPH41031490 IRC PTA FEMPOP $ 3,973.00 $ 3,973.00 4103 ANGIOGRAPH41031515 IRC PTA FEMPOP OPN $ 959.00 $ 959.00 4103 ANGIOGRAPH41031485 IRC PTA IL $ 3,414.00 $ 3,414.00 4103 ANGIOGRAPH41031475 IRC PTA RENL VISC $ 5,691.00 $ 5,691.00 4103 ANGIOGRAPH41031470 IRC PTA TIBEOPERONEAL EA $ 4,503.00 $ 4,503.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031500 IRC PTA VEN $ 1,027.00 $ 1,027.00 4103 ANGIOGRAPH41031542 IRC PTATHER BRACH $ 3,319.00 $ 3,319.00 4103 ANGIOGRAPH41031541 IRC PTATHER FEM $ 1,356.00 $ 1,356.00 4103 ANGIOGRAPH41031540 IRC PTATHER IL $ 2,532.00 $ 2,532.00 4103 ANGIOGRAPH41031544 IRC PTATHER RENL $ 4,168.00 $ 4,168.00 4103 ANGIOGRAPH41031543 IRC PTATHER TIBIA $ 1,525.00 $ 1,525.00 4103 ANGIOGRAPH41031845 IRC PULM ART L/R $ 1,500.00 $ 1,500.00 4103 ANGIOGRAPH41031850 IRC PULM ART SEG SUB $ 1,200.00 $ 1,200.00 4103 ANGIOGRAPH41031330 IRC REINSERT BILE TUBE $ 11,734.00 $ 11,734.00 4103 ANGIOGRAPH41031916 IRC REM TUNN CVA DEV W PT $ 2,151.00 $ 2,151.00 4103 ANGIOGRAPH41031382 IRC REMV RNL TUBE W/FLUOR $ 746.00 $ 746.00 4103 ANGIOGRAPH41031908 IRC REMV TUNN CV CATH W/O $ 779.00 $ 779.00 4103 ANGIOGRAPH41031323 IRC REPLACE G/C TUBE PERC $ 826.00 $ 826.00 4103 ANGIOGRAPH41031287 IRC REPO NASO/ORO G TUBE $ 831.00 $ 831.00 4103 ANGIOGRAPH41031456 IRC REPR AAA W MBD PROS $ 10,673.00 $ 10,673.00 4103 ANGIOGRAPH41031461 IRC REPR AAA W MODULAR $ 5,792.00 $ 5,792.00 4103 ANGIOGRAPH41031463 IRC REPR AAA W PROS ADD $ 2,134.00 $ 2,134.00 4103 ANGIOGRAPH41031472 IRC REPR AAA W UNIBODY $ 5,807.00 $ 5,807.00 4103 ANGIOGRAPH41031462 IRC REPR AAA/IL PROS INI $ 2,134.00 $ 2,134.00 4103 ANGIOGRAPH41031550 IRC REPS PREV PLC CV CATH $ 996.00 $ 996.00 4103 ANGIOGRAPH41031327 IRC RM G/COLON TUBE W/DVC $ 746.00 $ 746.00 4103 ANGIOGRAPH41031263 IRC RMVL INTHCL/EPID CATH $ 1,080.00 $ 1,080.00 4103 ANGIOGRAPH41031400 IRC RMVL KDY STN PRC/LES2 $ 5,089.00 $ 5,089.00 4103 ANGIOGRAPH41031262 IRC RMVL SQ PUMP/RESERVOR $ 1,223.00 $ 1,223.00 4103 ANGIOGRAPH41031921 IRC RPC CMP TUN PICC W/PT $ 8,967.00 $ 8,967.00 4103 ANGIOGRAPH41031439 IRC RPLC CMP TUN PICC W/O $ 2,421.00 $ 2,421.00 4103 ANGIOGRAPH41031431 IRC RPLC COMP NON-TUNN CV $ 2,410.00 $ 2,410.00 4103 ANGIOGRAPH41031917 IRC RPLC COMP TUN CV CATH $ 4,719.00 $ 4,719.00 4103 ANGIOGRAPH41031919 IRC RPLC COMP TUN CV W/PM $ 8,392.00 $ 8,392.00 4103 ANGIOGRAPH41031918 IRC RPLC COMP TUN CV W/PT $ 8,385.00 $ 8,385.00 4103 ANGIOGRAPH41031324 IRC RPLC DUD/JEJ TUBE PRC $ 1,162.00 $ 1,162.00 4103 ANGIOGRAPH41031423 IRC SEC ART MTHROM ADD-ON $ 15,918.00 $ 15,918.00 4103 ANGIOGRAPH41031855 IRC SELECT CATH 1ST VEN $ 1,700.00 $ 1,700.00 4103 ANGIOGRAPH

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DEPARTMENT CODE

41031860 IRC SELECT CATH 2ND VEN $ 1,300.00 $ 1,300.00 4103 ANGIOGRAPH41031452 IRC STENT NOCORO/CAR/VERT $ 15,164.00 $ 15,164.00 4103 ANGIOGRAPH41031453 IRC STENT PLACE NONCO ADD $ 5,107.00 $ 5,107.00 4103 ANGIOGRAPH41031378 IRC TAA ENDO PROS ADD-ON $ 894.00 $ 894.00 4103 ANGIOGRAPH41031376 IRC TAA ENDO REPR W/SC $ 4,679.00 $ 4,679.00 4103 ANGIOGRAPH41031473 IRC TAA ENDO REPR WO SC $ 4,153.00 $ 4,153.00 4103 ANGIOGRAPH41031474 IRC TAA PLACE ENDO PROS $ 3,190.00 $ 3,190.00 4103 ANGIOGRAPH41031454 IRC TEMP BAL ARTERIAL OCC $ 1,416.00 $ 1,416.00 4103 ANGIOGRAPH41031340 IRC THORACENTESIS $ 1,161.00 $ 1,161.00 4103 ANGIOGRAPH41031341 IRC THORACENTESIS W TUBE $ 1,640.00 $ 1,640.00 4103 ANGIOGRAPH41031430 IRC THROMBECTOMY AVS FIST $ 17,377.00 $ 17,377.00 4103 ANGIOGRAPH41031446 IRC THROMBOLYSIS CEREB IV $ 2,666.00 $ 2,666.00 4103 ANGIOGRAPH41031440 IRC THROMBOLYSIS IV NONCO $ 883.00 $ 883.00 4103 ANGIOGRAPH41031913 IRC TIPS INSERTION $ 11,726.00 $ 11,726.00 4103 ANGIOGRAPH41031911 IRC TIPS REVISION $ 11,726.00 $ 11,726.00 4103 ANGIOGRAPH41031447 IRC TRNCTH STNT CCA W/PRO $ 13,328.00 $ 13,328.00 4103 ANGIOGRAPH41031448 IRC TRNCTH STNT CCA WO/PR $ 13,328.00 $ 13,328.00 4103 ANGIOGRAPH41031280 IRC TUBE PLACE JEJUNUM $ 300.00 $ 300.00 4103 ANGIOGRAPH41031565 IRC TUBE THORACOSTOMY $ 3,216.00 $ 3,216.00 4103 ANGIOGRAPH41031275 IRC UP GI ENDO W/TUBE PLC $ 831.00 $ 831.00 4103 ANGIOGRAPH41031910 IRC VEN ANAST PORT OPN $ 3,378.00 $ 3,378.00 4103 ANGIOGRAPH41031865 IRC VEN CATH BLOOD SAMPLE $ 466.00 $ 466.00 4103 ANGIOGRAPH41031425 IRC VENOUS M-THROM ADD-ON $ 19,974.00 $ 19,974.00 4103 ANGIOGRAPH41031426 IRC VENOUS M-THROMBECTOMY $ 22,997.00 $ 22,997.00 4103 ANGIOGRAPH41041622 NRV MOTOR CONDUCT STDY EA $ 200.00 $ 200.00 4104 ANGIOGRAPH41041606 NRV TEST IOP EA HOUR $ 200.00 $ 200.00 4104 ANGIOGRAPH41050080 S CATH DRAINAGE $ - $ - 4105 ANGIOGRAPH41053000 S CATH DRAINAGE $ 272.00 $ 272.00 4105 ANGIOGRAPH41053005 S CATH DRAINAGE $ 272.00 $ 272.00 4105 ANGIOGRAPH41053008 S CATH DRAINAGE $ 172.00 $ 172.00 4105 ANGIOGRAPH41053010 S CATH DRAINAGE $ 272.00 $ 272.00 4105 ANGIOGRAPH41053015 S CATH DRAINAGE $ 578.00 $ 578.00 4105 ANGIOGRAPH41053020 S CATH DRAINAGE $ 272.00 $ 272.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41053025 S CATH DRAINAGE $ 286.00 $ 286.00 4105 ANGIOGRAPH41053030 S CATH DRAINAGE $ 286.00 $ 286.00 4105 ANGIOGRAPH41053035 S CATH DRAINAGE $ 286.00 $ 286.00 4105 ANGIOGRAPH41053050 S CATH DRAINAGE $ 476.00 $ 476.00 4105 ANGIOGRAPH41053055 S CATH DRAINAGE $ 476.00 $ 476.00 4105 ANGIOGRAPH41053060 S CATH DRAINAGE $ 578.00 $ 578.00 4105 ANGIOGRAPH41053065 S CATH DRAINAGE $ 578.00 $ 578.00 4105 ANGIOGRAPH41053070 S CATH DRAINAGE $ 586.00 $ 586.00 4105 ANGIOGRAPH41053080 S CATH DRAINAGE $ 744.00 $ 744.00 4105 ANGIOGRAPH41053085 S CATH DRAINAGE $ 744.00 $ 744.00 4105 ANGIOGRAPH41053095 S CATH DRAINAGE $ 744.00 $ 744.00 4105 ANGIOGRAPH41053100 S CATH DRAINAGE $ 744.00 $ 744.00 4105 ANGIOGRAPH41053105 S CATH DRAINAGE $ 835.00 $ 835.00 4105 ANGIOGRAPH41053110 S CATH DRAINAGE $ 835.00 $ 835.00 4105 ANGIOGRAPH41053120 S CATH DRAINAGE $ 882.00 $ 882.00 4105 ANGIOGRAPH41053125 S CATH DRAINAGE $ 1,197.00 $ 1,197.00 4105 ANGIOGRAPH41053130 S CATH DRAINAGE $ 1,197.00 $ 1,197.00 4105 ANGIOGRAPH41053135 S CATH DRAINAGE $ 1,197.00 $ 1,197.00 4105 ANGIOGRAPH41054590 S CATH DRAINAGE $ 744.00 $ 744.00 4105 ANGIOGRAPH41054605 S CATH DRAINAGE $ 1,417.00 $ 1,417.00 4105 ANGIOGRAPH41063956 S CATH DRAINAGE $ 297.00 $ 297.00 4106 ANGIOGRAPH41063957 S CATH DRAINAGE $ 504.00 $ 504.00 4106 ANGIOGRAPH41063958 S CATH DRAINAGE $ 304.00 $ 304.00 4106 ANGIOGRAPH41063960 S CATH DRAINAGE $ 321.00 $ 321.00 4106 ANGIOGRAPH41063961 S CATH DRAINAGE $ 299.00 $ 299.00 4106 ANGIOGRAPH41063962 S CATH DRAINAGE $ 335.00 $ 335.00 4106 ANGIOGRAPH41063963 S CATH DRAINAGE $ 328.00 $ 328.00 4106 ANGIOGRAPH41063964 S CATH DRAINAGE $ 52.00 $ 52.00 4106 ANGIOGRAPH41063966 S CATH DRAINAGE $ 1,143.00 $ 1,143.00 4106 ANGIOGRAPH41063967 S CATH DRAINAGE $ 368.00 $ 368.00 4106 ANGIOGRAPH41054372 S CATH GUIDING $ 957.00 $ 957.00 4105 ANGIOGRAPH41063024 S CATH GUIDING $ 708.00 $ 708.00 4106 ANGIOGRAPH41063823 S CATH GUIDING $ 566.00 $ 566.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063925 S CATH GUIDING $ 571.00 $ 571.00 4106 ANGIOGRAPH41063926 S CATH GUIDING $ 610.00 $ 610.00 4106 ANGIOGRAPH41063927 S CATH GUIDING $ 571.00 $ 571.00 4106 ANGIOGRAPH41053420 S CATH HD SHORT TERM $ 962.00 $ 962.00 4105 ANGIOGRAPH41053425 S CATH HD SHORT TERM $ 962.00 $ 962.00 4105 ANGIOGRAPH41053430 S CATH HD SHORT TERM $ 6,862.00 $ 6,862.00 4105 ANGIOGRAPH41063690 S CATH HD SHORT TERM $ 1,180.00 $ 1,180.00 4106 ANGIOGRAPH41063695 S CATH HD SHORT TERM $ 1,180.00 $ 1,180.00 4106 ANGIOGRAPH41063890 S CATH HD/PERTNL LNG TRM $ 2,159.00 $ 2,159.00 4106 ANGIOGRAPH41053403 S CATH INFSN NO HD $ 1,531.00 $ 1,531.00 4105 ANGIOGRAPH41053404 S CATH INFSN NO HD $ 1,551.00 $ 1,551.00 4105 ANGIOGRAPH41053415 S CATH INFSN NO HD $ 605.00 $ 605.00 4105 ANGIOGRAPH41063705 S CATH INFSN NO HD $ 1,132.00 $ 1,132.00 4106 ANGIOGRAPH41063770 S CATH INFSN NO HD $ 1,960.00 $ 1,960.00 4106 ANGIOGRAPH41063771 S CATH INFSN NO HD $ 2,191.00 $ 2,191.00 4106 ANGIOGRAPH41063772 S CATH INFSN NO HD $ 2,347.00 $ 2,347.00 4106 ANGIOGRAPH41063773 S CATH INFSN NO HD $ 2,527.00 $ 2,527.00 4106 ANGIOGRAPH41063777 S CATH INFSN NO HD $ 1,837.00 $ 1,837.00 4106 ANGIOGRAPH41063844 S CATH INFSN NO HD $ 1,132.00 $ 1,132.00 4106 ANGIOGRAPH41063481 S CATH INTRAVASCULAR US $ 9,784.00 $ 9,784.00 4106 ANGIOGRAPH41063482 S CATH INTRAVASCULAR US $ 9,784.00 $ 9,784.00 4106 ANGIOGRAPH41063071 S CATH OCCLUSION $ 3,231.00 $ 3,231.00 4106 ANGIOGRAPH41063450 S CATH OCCLUSION $ 1,465.00 $ 1,465.00 4106 ANGIOGRAPH41063455 S CATH OCCLUSION $ 1,465.00 $ 1,465.00 4106 ANGIOGRAPH41063483 S CATH OCCLUSION $ 1,286.00 $ 1,286.00 4106 ANGIOGRAPH41054374 S CATH THROMB/EMBOLCTMY $ 407.00 $ 407.00 4105 ANGIOGRAPH41063715 S CATH THROMB/EMBOLCTMY $ 2,273.00 $ 2,273.00 4106 ANGIOGRAPH41063717 S CATH THROMB/EMBOLCTMY $ 2,577.00 $ 2,577.00 4106 ANGIOGRAPH41063720 S CATH THROMB/EMBOLCTMY $ 4,559.00 $ 4,559.00 4106 ANGIOGRAPH41063725 S CATH THROMB/EMBOLCTMY $ 7,577.00 $ 7,577.00 4106 ANGIOGRAPH41063891 S CATH THROMB/EMBOLCTMY $ 4,384.00 $ 4,384.00 4106 ANGIOGRAPH41063918 S CATH THROMB/EMBOLCTMY $ 777.00 $ 777.00 4106 ANGIOGRAPH41063872 S CATH TRNSLML ATHR DIR $ 7,540.00 $ 7,540.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063931 S CATH TRNSLML ATHR DIR $ 11,269.00 $ 11,269.00 4106 ANGIOGRAPH41054370 S CATH TRNSLML ATHR ROT $ 6,009.00 $ 6,009.00 4105 ANGIOGRAPH41054375 S CATH TRNSLML ATHR ROT $ 6,081.00 $ 6,081.00 4105 ANGIOGRAPH41053955 S CATH TRNSML ANG NOLSR $ 1,426.00 $ 1,426.00 4105 ANGIOGRAPH41054025 S CATH TRNSML ANG NOLSR $ 1,525.00 $ 1,525.00 4105 ANGIOGRAPH41054030 S CATH TRNSML ANG NOLSR $ 1,536.00 $ 1,536.00 4105 ANGIOGRAPH41054035 S CATH TRNSML ANG NOLSR $ 1,536.00 $ 1,536.00 4105 ANGIOGRAPH41054040 S CATH TRNSML ANG NOLSR $ 1,536.00 $ 1,536.00 4105 ANGIOGRAPH41054065 S CATH TRNSML ANG NOLSR $ 1,645.00 $ 1,645.00 4105 ANGIOGRAPH41054095 S CATH TRNSML ANG NOLSR $ 1,755.00 $ 1,755.00 4105 ANGIOGRAPH41054100 S CATH TRNSML ANG NOLSR $ 1,755.00 $ 1,755.00 4105 ANGIOGRAPH41054110 S CATH TRNSML ANG NOLSR $ 1,813.00 $ 1,813.00 4105 ANGIOGRAPH41054115 S CATH TRNSML ANG NOLSR $ 1,813.00 $ 1,813.00 4105 ANGIOGRAPH41054120 S CATH TRNSML ANG NOLSR $ 1,923.00 $ 1,923.00 4105 ANGIOGRAPH41054125 S CATH TRNSML ANG NOLSR $ 1,923.00 $ 1,923.00 4105 ANGIOGRAPH41054130 S CATH TRNSML ANG NOLSR $ 1,923.00 $ 1,923.00 4105 ANGIOGRAPH41054135 S CATH TRNSML ANG NOLSR $ 1,923.00 $ 1,923.00 4105 ANGIOGRAPH41054140 S CATH TRNSML ANG NOLSR $ 1,923.00 $ 1,923.00 4105 ANGIOGRAPH41054145 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054150 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054155 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054160 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054165 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054170 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054171 S CATH TRNSML ANG NOLSR $ 2,194.00 $ 2,194.00 4105 ANGIOGRAPH41054172 S CATH TRNSML ANG NOLSR $ 2,194.00 $ 2,194.00 4105 ANGIOGRAPH41054185 S CATH TRNSML ANG NOLSR $ 2,504.00 $ 2,504.00 4105 ANGIOGRAPH41054190 S CATH TRNSML ANG NOLSR $ 2,504.00 $ 2,504.00 4105 ANGIOGRAPH41054195 S CATH TRNSML ANG NOLSR $ 2,504.00 $ 2,504.00 4105 ANGIOGRAPH41054200 S CATH TRNSML ANG NOLSR $ 2,504.00 $ 2,504.00 4105 ANGIOGRAPH41054205 S CATH TRNSML ANG NOLSR $ 2,656.00 $ 2,656.00 4105 ANGIOGRAPH41054210 S CATH TRNSML ANG NOLSR $ 2,656.00 $ 2,656.00 4105 ANGIOGRAPH41063035 S CATH TRNSML ANG NOLSR $ 1,995.00 $ 1,995.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063039 S CATH TRNSML ANG NOLSR $ 1,274.00 $ 1,274.00 4106 ANGIOGRAPH41063445 S CATH TRNSML ANG NOLSR $ 2,030.00 $ 2,030.00 4106 ANGIOGRAPH41063452 S CATH TRNSML ANG NOLSR $ 1,179.00 $ 1,179.00 4106 ANGIOGRAPH41063453 S CATH TRNSML ANG NOLSR $ 1,179.00 $ 1,179.00 4106 ANGIOGRAPH41063460 S CATH TRNSML ANG NOLSR $ 1,005.00 $ 1,005.00 4106 ANGIOGRAPH41063462 S CATH TRNSML ANG NOLSR $ 1,871.00 $ 1,871.00 4106 ANGIOGRAPH41063465 S CATH TRNSML ANG NOLSR $ 1,182.00 $ 1,182.00 4106 ANGIOGRAPH41063470 S CATH TRNSML ANG NOLSR $ 1,873.00 $ 1,873.00 4106 ANGIOGRAPH41063475 S CATH TRNSML ANG NOLSR $ 2,082.00 $ 2,082.00 4106 ANGIOGRAPH41063480 S CATH TRNSML ANG NOLSR $ 1,995.00 $ 1,995.00 4106 ANGIOGRAPH41063766 S CATH TRNSML ANG NOLSR $ 3,756.00 $ 3,756.00 4106 ANGIOGRAPH41063768 S CATH TRNSML ANG NOLSR $ 3,756.00 $ 3,756.00 4106 ANGIOGRAPH41063819 S CATH TRNSML ANG NOLSR $ 1,993.00 $ 1,993.00 4106 ANGIOGRAPH41063820 S CATH TRNSML ANG NOLSR $ 2,022.00 $ 2,022.00 4106 ANGIOGRAPH41063934 S CATH TRNSML ANG NOLSR $ 1,143.00 $ 1,143.00 4106 ANGIOGRAPH41063936 S CATH TRNSML ANG NOLSR $ 1,974.00 $ 1,974.00 4106 ANGIOGRAPH41063940 S CATH TRNSML ANG NOLSR $ 1,772.00 $ 1,772.00 4106 ANGIOGRAPH41063942 S CATH TRNSML ANG NOLSR $ 3,696.00 $ 3,696.00 4106 ANGIOGRAPH41063943 S CATH TRNSML ANG NOLSR $ 4,382.00 $ 4,382.00 4106 ANGIOGRAPH41063944 S CATH TRNSML ANG NOLSR $ 4,573.00 $ 4,573.00 4106 ANGIOGRAPH41063036 S DEVICE CLOSURE VASC $ 1,274.00 $ 1,274.00 4106 ANGIOGRAPH41063038 S DEVICE CLOSURE VASC $ 1,274.00 $ 1,274.00 4106 ANGIOGRAPH41063559 S DEVICE CLOSURE VASC $ 960.00 $ 960.00 4106 ANGIOGRAPH41053047 S DEVICE RETRIEVAL $ 1,974.00 $ 1,974.00 4105 ANGIOGRAPH41054618 S DEVICE RETRIEVAL $ 1,200.00 $ 1,200.00 4105 ANGIOGRAPH41054619 S DEVICE RETRIEVAL $ 1,138.00 $ 1,138.00 4105 ANGIOGRAPH41062000 S DEVICE RETRIEVAL $ 218.00 $ 218.00 4106 ANGIOGRAPH41062001 S DEVICE RETRIEVAL $ 218.00 $ 218.00 4106 ANGIOGRAPH41062004 S DEVICE RETRIEVAL $ 218.00 $ 218.00 4106 ANGIOGRAPH41063665 S DEVICE RETRIEVAL $ 1,485.00 $ 1,485.00 4106 ANGIOGRAPH41063670 S DEVICE RETRIEVAL $ 3,182.00 $ 3,182.00 4106 ANGIOGRAPH41063769 S DEVICE RETRIEVAL $ 3,424.00 $ 3,424.00 4106 ANGIOGRAPH41063782 S DEVICE RETRIEVAL $ 3,424.00 $ 3,424.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063783 S DEVICE RETRIEVAL $ 10,572.00 $ 10,572.00 4106 ANGIOGRAPH41063784 S DEVICE RETRIEVAL $ 10,572.00 $ 10,572.00 4106 ANGIOGRAPH41063971 S DEVICE RETRIEVAL $ 1,312.00 $ 1,312.00 4106 ANGIOGRAPH41063972 S DEVICE RETRIEVAL $ 2,267.00 $ 2,267.00 4106 ANGIOGRAPH41053435 S FILTER VENA CAVA $ 110.00 $ 110.00 4105 ANGIOGRAPH41063660 S FILTER VENA CAVA $ 4,951.00 $ 4,951.00 4106 ANGIOGRAPH41063663 S FILTER VENA CAVA $ 6,770.00 $ 6,770.00 4106 ANGIOGRAPH41063675 S FILTER VENA CAVA $ 5,957.00 $ 5,957.00 4106 ANGIOGRAPH41063676 S FILTER VENA CAVA $ 5,755.00 $ 5,755.00 4106 ANGIOGRAPH41063680 S FILTER VENA CAVA $ 5,957.00 $ 5,957.00 4106 ANGIOGRAPH41063970 S FILTER VENA CAVA $ 4,934.00 $ 4,934.00 4106 ANGIOGRAPH41063973 S FILTER VENA CAVA $ 5,487.00 $ 5,487.00 4106 ANGIOGRAPH41063978 S IMP 10 HELICAL-HS 2D/1L $ 3,696.00 $ 3,696.00 4106 ANGIOGRAPH41063866 S IMP 18 CMPLX DIA 14-20D $ 3,937.00 $ 3,937.00 4106 ANGIOGRAPH41063043 S IMP ANCURE ENDOGRAPH $ 49,355.00 $ 49,355.00 4106 ANGIOGRAPH41063889 S IMP AO ILIAC EXTENDER $ 9,818.00 $ 9,818.00 4106 ANGIOGRAPH41063070 S IMP AORT EXT CUFF 3.75C $ 10,522.00 $ 10,522.00 4106 ANGIOGRAPH41063950 S IMP AORTIC EXTENDER $ 8,419.00 $ 8,419.00 4106 ANGIOGRAPH41063847 S IMP ARTERIAL GRAFT COMP $ 3,029.00 $ 3,029.00 4106 ANGIOGRAPH41063045 S IMP BIFUR STNT GRAFT 13 $ 37,667.00 $ 37,667.00 4106 ANGIOGRAPH41063050 S IMP BIFUR STNT GRAFT 16 $ 39,226.00 $ 39,226.00 4106 ANGIOGRAPH41063954 S IMP BLUE SELF EXP STNT $ 4,258.00 $ 4,258.00 4106 ANGIOGRAPH41063056 S IMP CNTRA ILIAC LG ZNTH $ 12,599.00 $ 12,599.00 4106 ANGIOGRAPH41063951 S IMP CNTRLAT LG CMPNT $ 11,997.00 $ 11,997.00 4106 ANGIOGRAPH41063058 S IMP CONVERTER ZENITH $ 12,599.00 $ 12,599.00 4106 ANGIOGRAPH41063552 S IMP COOK 38 MCWE COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063551 S IMP COOK 38 MWCE COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063536 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063537 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063538 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063539 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063541 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063543 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063544 S IMP COOK MWCE 35 COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063548 S IMP COOK MWCE 38 COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063549 S IMP COOK MWCE 38 COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063553 S IMP COOK MWCE 38 COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063534 S IMP COOK MWCE 38 COILS $ 842.00 $ 842.00 4106 ANGIOGRAPH41063547 S IMP COOK MWCE 38 COILS $ 842.00 $ 842.00 4106 ANGIOGRAPH41063542 S IMP COOK MWCE COILS $ 790.00 $ 790.00 4106 ANGIOGRAPH41063520 S IMP COR 5M FL SPIR COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063525 S IMP CORDI 3M CMPLX COL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063530 S IMP CORDI 5M CMPLX COL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063540 S IMP CORDIS 3MM COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063546 S IMP CORDIS 5MM C COIL $ 1,278.00 $ 1,278.00 4106 ANGIOGRAPH41063535 S IMP CORDIS 5MM ST COIL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063515 S IMP CORDIS 7M CMPLX COL $ 842.00 $ 842.00 4106 ANGIOGRAPH41063852 S IMP COSMOS 10-SR 3-5D $ 4,828.00 $ 4,828.00 4106 ANGIOGRAPH41063976 S IMP COSMOS 10-SR 4D-5D $ 5,792.00 $ 5,792.00 4106 ANGIOGRAPH41063853 S IMP COSMOS 10-SR 6-8D $ 4,944.00 $ 4,944.00 4106 ANGIOGRAPH41063977 S IMP COSMOS 10-SR 6D-8D $ 6,172.00 $ 6,172.00 4106 ANGIOGRAPH41063862 S IMP COSMOS 18 10MMX36CM $ 5,128.00 $ 5,128.00 4106 ANGIOGRAPH41063863 S IMP COSMOS 18 11MMX39CM $ 5,128.00 $ 5,128.00 4106 ANGIOGRAPH41063864 S IMP COSMOS 18 12MMX43CM $ 5,445.00 $ 5,445.00 4106 ANGIOGRAPH41063865 S IMP COSMOS 18 13MMX47CM $ 5,445.00 $ 5,445.00 4106 ANGIOGRAPH41063861 S IMP COSMOS 18 9MMX31CM $ 5,128.00 $ 5,128.00 4106 ANGIOGRAPH41063888 S IMP EXCLUDER CL LEG $ 14,008.00 $ 14,008.00 4106 ANGIOGRAPH41063887 S IMP EXCLUDER MAIN BODY $ 26,122.00 $ 26,122.00 4106 ANGIOGRAPH41063764 S IMP GCD 10 SOFT 4MM $ 2,527.00 $ 2,527.00 4106 ANGIOGRAPH41063765 S IMP GDC 10 2D 3MMX8CM $ 2,504.00 $ 2,504.00 4106 ANGIOGRAPH41063747 S IMP GDC 10 3D 10MM $ 4,983.00 $ 4,983.00 4106 ANGIOGRAPH41063757 S IMP GDC 10 3D 3MM $ 4,544.00 $ 4,544.00 4106 ANGIOGRAPH41063750 S IMP GDC 10 3D 4MM $ 4,699.00 $ 4,699.00 4106 ANGIOGRAPH41063751 S IMP GDC 10 3D 5MM $ 4,793.00 $ 4,793.00 4106 ANGIOGRAPH41063752 S IMP GDC 10 3D 6MM $ 4,840.00 $ 4,840.00 4106 ANGIOGRAPH41063753 S IMP GDC 10 3D 7MM $ 4,840.00 $ 4,840.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063746 S IMP GDC 10 3D 8MM $ 4,840.00 $ 4,840.00 4106 ANGIOGRAPH41063763 S IMP GDC 10 SOFT 3MM $ 2,456.00 $ 2,456.00 4106 ANGIOGRAPH41063762 S IMP GDC 10 SOFT SR 2MM $ 3,554.00 $ 3,554.00 4106 ANGIOGRAPH41063748 S IMP GDC 10 USOFT 2.5MM $ 4,039.00 $ 4,039.00 4106 ANGIOGRAPH41063749 S IMP GDC 10 USOFT 3MM $ 4,109.00 $ 4,109.00 4106 ANGIOGRAPH41063745 S IMP GDC 10 USOFT 4 MM $ 4,156.00 $ 4,156.00 4106 ANGIOGRAPH41063739 S IMP GDC 18 2D 5MM $ 2,550.00 $ 2,550.00 4106 ANGIOGRAPH41063740 S IMP GDC 18 2D 6MM $ 2,787.00 $ 2,787.00 4106 ANGIOGRAPH41063786 S IMP GDC 18 2D 7MM $ 2,810.00 $ 2,810.00 4106 ANGIOGRAPH41063734 S IMP GDC 18 2D 8MM $ 2,810.00 $ 2,810.00 4106 ANGIOGRAPH41063735 S IMP GDC 18 2D 9MM $ 2,810.00 $ 2,810.00 4106 ANGIOGRAPH41063738 S IMP GDC 18 SOFT $ 2,527.00 $ 2,527.00 4106 ANGIOGRAPH41063756 S IMP GDC10 2D 10MMX30CM $ 2,787.00 $ 2,787.00 4106 ANGIOGRAPH41063758 S IMP GDC10 2D 4MMX10CM $ 2,621.00 $ 2,621.00 4106 ANGIOGRAPH41063759 S IMP GDC10 2D 5MMX15CM $ 2,645.00 $ 2,645.00 4106 ANGIOGRAPH41063760 S IMP GDC10 2D 6MMX20CM $ 2,763.00 $ 2,763.00 4106 ANGIOGRAPH41063761 S IMP GDC10 2D 7MMX25CM $ 2,763.00 $ 2,763.00 4106 ANGIOGRAPH41063754 S IMP GDC10 2D 8MMX30CM $ 2,787.00 $ 2,787.00 4106 ANGIOGRAPH41063755 S IMP GDC10 2D 9MMX30CM $ 2,787.00 $ 2,787.00 4106 ANGIOGRAPH41063767 S IMP GDC10 S2DSR 3MM $ 3,625.00 $ 3,625.00 4106 ANGIOGRAPH41063787 S IMP GDC10 S2DSR 4MM $ 3,743.00 $ 3,743.00 4106 ANGIOGRAPH41063788 S IMP GDC10 S2DSR 5MM $ 3,756.00 $ 3,756.00 4106 ANGIOGRAPH41063789 S IMP GDC10 S2DSR 6-7MM $ 3,920.00 $ 3,920.00 4106 ANGIOGRAPH41063736 S IMP GDC18 2D 10 TO 14MM $ 3,501.00 $ 3,501.00 4106 ANGIOGRAPH41063737 S IMP GDC18 2D 16 TO 20MM $ 3,141.00 $ 3,141.00 4106 ANGIOGRAPH41063732 S IMP GDC18 3D 10 TO 16MM $ 5,031.00 $ 5,031.00 4106 ANGIOGRAPH41063733 S IMP GDC18 3D 18 TO 20MM $ 5,101.00 $ 5,101.00 4106 ANGIOGRAPH41063731 S IMP GDC18 3D 6MM TO 8MM $ 4,889.00 $ 4,889.00 4106 ANGIOGRAPH41063744 S IMP GDC18 FI VRTX 2X3MM $ 2,952.00 $ 2,952.00 4106 ANGIOGRAPH41063743 S IMP GDC18 FI VRTX 2X4MM $ 3,022.00 $ 3,022.00 4106 ANGIOGRAPH41063742 S IMP GDC18 FI VRTX 2X5MM $ 3,093.00 $ 3,093.00 4106 ANGIOGRAPH41063741 S IMP GDC18 FI VRTX 2X6MM $ 3,164.00 $ 3,164.00 4106 ANGIOGRAPH41063952 S IMP GORE ILIAC EXTNDR $ 8,419.00 $ 8,419.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063979 S IMP HELICAL COIL 1-4CM $ 4,763.00 $ 4,763.00 4106 ANGIOGRAPH41063856 S IMP HELICAL COIL 2-4D $ 3,818.00 $ 3,818.00 4106 ANGIOGRAPH41063858 S IMP HELICAL COIL 2-5D $ 4,792.00 $ 4,792.00 4106 ANGIOGRAPH41063857 S IMP HELICAL COIL 2-6D $ 4,409.00 $ 4,409.00 4106 ANGIOGRAPH41063859 S IMP HELICAL COIL 3-6D $ 5,180.00 $ 5,180.00 4106 ANGIOGRAPH41063860 S IMP HELICAL COIL 5-6D $ 5,597.00 $ 5,597.00 4106 ANGIOGRAPH41063980 S IMP HELICAL COIL 5-8CM $ 5,448.00 $ 5,448.00 4106 ANGIOGRAPH41063981 S IMP HELICAL COIL 9-25CM $ 6,379.00 $ 6,379.00 4106 ANGIOGRAPH41063854 S IMP HF 10-SR 3-5D $ 6,701.00 $ 6,701.00 4106 ANGIOGRAPH41063855 S IMP HF 10-SR 6-8D $ 7,051.00 $ 7,051.00 4106 ANGIOGRAPH41063997 S IMP HYPRSFT COIL 2MM $ 3,472.00 $ 3,472.00 4106 ANGIOGRAPH41063998 S IMP HYPRSFT COIL 3MM $ 3,472.00 $ 3,472.00 4106 ANGIOGRAPH41063999 S IMP HYPRSFT COIL 4MM $ 3,616.00 $ 3,616.00 4106 ANGIOGRAPH41063842 S IMP HYPRSFT COIL 5MM $ 3,616.00 $ 3,616.00 4106 ANGIOGRAPH41063843 S IMP HYPRSFT COIL 6MM $ 3,616.00 $ 3,616.00 4106 ANGIOGRAPH41063065 S IMP ILIAC EXT CUFF 5.5C $ 10,522.00 $ 10,522.00 4106 ANGIOGRAPH41063060 S IMP ILIAC LEG 11.5 STNT $ 12,599.00 $ 12,599.00 4106 ANGIOGRAPH41063055 S IMP ILIAC LEG 8.5 STNT $ 11,559.00 $ 11,559.00 4106 ANGIOGRAPH41063059 S IMP ILIAC LG EXT ZNTH $ 10,522.00 $ 10,522.00 4106 ANGIOGRAPH41063982 S IMP INTRLCK VRTX 2/5MM $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063983 S IMP INTRLCK VRTX 2/6MM $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063984 S IMP INTRLCK VRTX 2D 3MM $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063985 S IMP INTRLCK VRTX 2D 4-5 $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063986 S IMP INTRLCK VRTX 2D 5MM $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063988 S IMP INTRLCK VRTX 2D 6-8 $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063987 S IMP INTRLCK VRTX 2D 6MM $ 1,513.00 $ 1,513.00 4106 ANGIOGRAPH41063953 S IMP IPSLTRL LG CMPNT $ 25,983.00 $ 25,983.00 4106 ANGIOGRAPH41063057 S IMP ISPLT ILIAC LG ZNTH $ 12,599.00 $ 12,599.00 4106 ANGIOGRAPH41063896 S IMP LC BEADS MICROSPHRE $ 5,561.00 $ 5,561.00 4106 ANGIOGRAPH41063069 S IMP MAIN BODY EXT ZNTH $ 6,515.00 $ 6,515.00 4106 ANGIOGRAPH41063049 S IMP MBD ENDOGRAPH ZNTH $ 39,226.00 $ 39,226.00 4106 ANGIOGRAPH41063868 S IMP MCRPLX 18 CMPLX $ 4,940.00 $ 4,940.00 4106 ANGIOGRAPH41053705 S IMP MICROCOILS $ 626.00 $ 626.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41063806 S IMP MTX EXTRA FIRM 2D $ 6,045.00 $ 6,045.00 4106 ANGIOGRAPH41063807 S IMP MTX EXTRA FIRM 3D $ 6,393.00 $ 6,393.00 4106 ANGIOGRAPH41063802 S IMP MTX FIRM 2D 5MM $ 4,912.00 $ 4,912.00 4106 ANGIOGRAPH41063803 S IMP MTX FIRM 2D 6MM $ 5,385.00 $ 5,385.00 4106 ANGIOGRAPH41063804 S IMP MTX FIRM 2D 7MM-9MM $ 4,919.00 $ 4,919.00 4106 ANGIOGRAPH41063835 S IMP MTX FIRM 3D 5MM $ 7,037.00 $ 7,037.00 4106 ANGIOGRAPH41063805 S IMP MTX FRM 2D 10-14MM $ 5,714.00 $ 5,714.00 4106 ANGIOGRAPH41063836 S IMP MTX FRM 3D 6MM-7MM $ 6,119.00 $ 6,119.00 4106 ANGIOGRAPH41063808 S IMP MTX FRM 3D 6MM-8MM $ 6,109.00 $ 6,109.00 4106 ANGIOGRAPH41063809 S IMP MTX FRM3D 10-14MM $ 6,292.00 $ 6,292.00 4106 ANGIOGRAPH41063790 S IMP MTX SFT HELICAL 2MM $ 4,782.00 $ 4,782.00 4106 ANGIOGRAPH41063791 S IMP MTX SOFT 2D 3MM $ 4,781.00 $ 4,781.00 4106 ANGIOGRAPH41063792 S IMP MTX SOFT 2D 4MM $ 4,840.00 $ 4,840.00 4106 ANGIOGRAPH41063793 S IMP MTX SOFT 2D 5MM $ 4,865.00 $ 4,865.00 4106 ANGIOGRAPH41063801 S IMP MTX STD 2D 10MM $ 5,668.00 $ 5,668.00 4106 ANGIOGRAPH41063794 S IMP MTX STD 2D 3MM X 8 $ 4,817.00 $ 4,817.00 4106 ANGIOGRAPH41063795 S IMP MTX STD 2D 4MM $ 4,936.00 $ 4,936.00 4106 ANGIOGRAPH41063796 S IMP MTX STD 2D 5MM $ 5,077.00 $ 5,077.00 4106 ANGIOGRAPH41063797 S IMP MTX STD 2D 6MM $ 5,337.00 $ 5,337.00 4106 ANGIOGRAPH41063798 S IMP MTX STD 2D 7MM $ 5,337.00 $ 5,337.00 4106 ANGIOGRAPH41063799 S IMP MTX STD 2D 8MM $ 5,385.00 $ 5,385.00 4106 ANGIOGRAPH41063800 S IMP MTX STD 2D 9MM $ 5,385.00 $ 5,385.00 4106 ANGIOGRAPH41063814 S IMP MTX STD 3D 10MM $ 6,272.00 $ 6,272.00 4106 ANGIOGRAPH41063810 S IMP MTX STD 3D 3MM $ 6,612.00 $ 6,612.00 4106 ANGIOGRAPH41063811 S IMP MTX STD 3D 4MM $ 6,849.00 $ 6,849.00 4106 ANGIOGRAPH41063812 S IMP MTX STD 3D 5-6MM $ 7,037.00 $ 7,037.00 4106 ANGIOGRAPH41063813 S IMP MTX STD 3D 7-8MM $ 6,099.00 $ 6,099.00 4106 ANGIOGRAPH41063837 S IMP MTX10 SFT SR2D 3MM $ 4,817.00 $ 4,817.00 4106 ANGIOGRAPH41063832 S IMP MTX10 USOFT SR2D2MM $ 4,746.00 $ 4,746.00 4106 ANGIOGRAPH41063833 S IMP MTX10 USOFT SR2D3MM $ 4,793.00 $ 4,793.00 4106 ANGIOGRAPH41063834 S IMP MTX10 USOFT SR2D4MM $ 4,840.00 $ 4,840.00 4106 ANGIOGRAPH41063831 S IMP MTX10SFT SD2D 6-7MM $ 5,832.00 $ 5,832.00 4106 ANGIOGRAPH41063839 S IMP MTX10SFT SR2D4-5MM $ 5,526.00 $ 5,526.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063995 S IMP NRFRM STNT 3.5-4.5 $ 15,747.00 $ 15,747.00 4106 ANGIOGRAPH41063994 S IMP NRFRM STNT 3.5MM X $ 15,747.00 $ 15,747.00 4106 ANGIOGRAPH41063993 S IMP NRFRM STNT 4-4.5MM $ 15,747.00 $ 15,747.00 4106 ANGIOGRAPH41063996 S IMP NRFRM STNT 4-4.5MM $ 15,747.00 $ 15,747.00 4106 ANGIOGRAPH41053690 S IMP OCCLUD SPRNG EMB 3M $ 372.00 $ 372.00 4105 ANGIOGRAPH41053695 S IMP OCCLUD SPRNG EMB 5M $ 372.00 $ 372.00 4105 ANGIOGRAPH41053700 S IMP OCCLUD SPRNG EMB 8M $ 372.00 $ 372.00 4105 ANGIOGRAPH41063838 S IMP PRECISE STENT $ 7,635.00 $ 7,635.00 4106 ANGIOGRAPH41063828 S IMP PVA PARTICLES $ 1,132.00 $ 1,132.00 4106 ANGIOGRAPH41063884 S IMP TAG ENDOPROSTHESIS $ 40,356.00 $ 40,356.00 4106 ANGIOGRAPH41063815 S IMP TRUFIL EMBOLIC $ 7,097.00 $ 7,097.00 4106 ANGIOGRAPH41063965 S IMP URETERAL STNT 8.5FR $ 495.00 $ 495.00 4106 ANGIOGRAPH41063846 S IMP VENOUS OUTFLOW COMP $ 5,561.00 $ 5,561.00 4106 ANGIOGRAPH41063989 S IMP VRTX CONICAL 2 4MM $ 432.00 $ 432.00 4106 ANGIOGRAPH41063990 S IMP VRTX CONICAL 3 5MM $ 432.00 $ 432.00 4106 ANGIOGRAPH41063991 S IMP VRTX CONICAL 3 6MM $ 432.00 $ 432.00 4106 ANGIOGRAPH41063922 S IMP VRTX CONICAL 3 7MM $ 432.00 $ 432.00 4106 ANGIOGRAPH41063851 S IMP WINGSPAN STENT $ 19,274.00 $ 19,274.00 4106 ANGIOGRAPH41053075 S INTR NOINTRACRD NOLSR $ 744.00 $ 744.00 4105 ANGIOGRAPH41054385 S INTR NOINTRACRD NOLSR $ 138.00 $ 138.00 4105 ANGIOGRAPH41054387 S INTR NOINTRACRD NOLSR $ 157.00 $ 157.00 4105 ANGIOGRAPH41054390 S INTR NOINTRACRD NOLSR $ 262.00 $ 262.00 4105 ANGIOGRAPH41054395 S INTR NOINTRACRD NOLSR $ 262.00 $ 262.00 4105 ANGIOGRAPH41054400 S INTR NOINTRACRD NOLSR $ 262.00 $ 262.00 4105 ANGIOGRAPH41054405 S INTR NOINTRACRD NOLSR $ 262.00 $ 262.00 4105 ANGIOGRAPH41054410 S INTR NOINTRACRD NOLSR $ 300.00 $ 300.00 4105 ANGIOGRAPH41054430 S INTR NOINTRACRD NOLSR $ 300.00 $ 300.00 4105 ANGIOGRAPH41054450 S INTR NOINTRACRD NOLSR $ 363.00 $ 363.00 4105 ANGIOGRAPH41054455 S INTR NOINTRACRD NOLSR $ 410.00 $ 410.00 4105 ANGIOGRAPH41054460 S INTR NOINTRACRD NOLSR $ 410.00 $ 410.00 4105 ANGIOGRAPH41054465 S INTR NOINTRACRD NOLSR $ 410.00 $ 410.00 4105 ANGIOGRAPH41054475 S INTR NOINTRACRD NOLSR $ 429.00 $ 429.00 4105 ANGIOGRAPH41054585 S INTR NOINTRACRD NOLSR $ 653.00 $ 653.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41063015 S INTR NOINTRACRD NOLSR $ 732.00 $ 732.00 4106 ANGIOGRAPH41063018 S INTR NOINTRACRD NOLSR $ 779.00 $ 779.00 4106 ANGIOGRAPH41063020 S INTR NOINTRACRD NOLSR $ 686.00 $ 686.00 4106 ANGIOGRAPH41063022 S INTR NOINTRACRD NOLSR $ 720.00 $ 720.00 4106 ANGIOGRAPH41063025 S INTR NOINTRACRD NOLSR $ 1,254.00 $ 1,254.00 4106 ANGIOGRAPH41063565 S INTR NOINTRACRD NOLSR $ 156.00 $ 156.00 4106 ANGIOGRAPH41063570 S INTR NOINTRACRD NOLSR $ 346.00 $ 346.00 4106 ANGIOGRAPH41063585 S INTR NOINTRACRD NOLSR $ 707.00 $ 707.00 4106 ANGIOGRAPH41063590 S INTR NOINTRACRD NOLSR $ 607.00 $ 607.00 4106 ANGIOGRAPH41063821 S INTR NOINTRACRD NOLSR $ 761.00 $ 761.00 4106 ANGIOGRAPH41063822 S INTR NOINTRACRD NOLSR $ 543.00 $ 543.00 4106 ANGIOGRAPH41063900 S INTR NOINTRACRD NOLSR $ 411.00 $ 411.00 4106 ANGIOGRAPH41063902 S INTR NOINTRACRD NOLSR $ 575.00 $ 575.00 4106 ANGIOGRAPH41063903 S INTR NOINTRACRD NOLSR $ 587.00 $ 587.00 4106 ANGIOGRAPH41063580 S INTRO GDE STRBLE NOPEEL $ 575.00 $ 575.00 4106 ANGIOGRAPH41063685 S INTRO GDE STRBLE NOPEEL $ 473.00 $ 473.00 4106 ANGIOGRAPH41050025 S NSTRL BILIARY DRAIN TR $ - $ - 4105 ANGIOGRAPH41050035 S NSTRL CYSTOSCOPY TRAY $ - $ - 4105 ANGIOGRAPH41050040 S NSTRL GASTROSTOMY TRAY $ - $ - 4105 ANGIOGRAPH41050055 S NSTRL NEPHROSTOMY TRAY $ - $ - 4105 ANGIOGRAPH41050060 S NSTRL PARACENTESIS TRAY $ - $ - 4105 ANGIOGRAPH41050070 S NSTRL STONE EXTRACT TR $ - $ - 4105 ANGIOGRAPH41063840 S PROBE CRYOABLATION $ 5,858.00 $ 5,858.00 4106 ANGIOGRAPH41063046 S STNT COATED WDEL SYS $ 8,111.00 $ 8,111.00 4106 ANGIOGRAPH41063047 S STNT COATED WDEL SYS $ 9,737.00 $ 9,737.00 4106 ANGIOGRAPH41063048 S STNT COATED WDEL SYS $ 11,364.00 $ 11,364.00 4106 ANGIOGRAPH41063083 S STNT COATED WDEL SYS $ 11,231.00 $ 11,231.00 4106 ANGIOGRAPH41063084 S STNT COATED WDEL SYS $ 8,112.00 $ 8,112.00 4106 ANGIOGRAPH41053091 S STNT NOCOAT WDEL SYS $ 6,797.00 $ 6,797.00 4105 ANGIOGRAPH41053092 S STNT NOCOAT WDEL SYS $ 6,797.00 $ 6,797.00 4105 ANGIOGRAPH41063075 S STNT NOCOAT WDEL SYS $ 9,456.00 $ 9,456.00 4106 ANGIOGRAPH41063080 S STNT NOCOAT WDEL SYS $ 9,456.00 $ 9,456.00 4106 ANGIOGRAPH41063082 S STNT NOCOAT WDEL SYS $ 7,334.00 $ 7,334.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063085 S STNT NOCOAT WDEL SYS $ 6,516.00 $ 6,516.00 4106 ANGIOGRAPH41063090 S STNT NOCOAT WDEL SYS $ 6,516.00 $ 6,516.00 4106 ANGIOGRAPH41063091 S STNT NOCOAT WDEL SYS $ 6,980.00 $ 6,980.00 4106 ANGIOGRAPH41063092 S STNT NOCOAT WDEL SYS $ 6,323.00 $ 6,323.00 4106 ANGIOGRAPH41063093 S STNT NOCOAT WDEL SYS $ 6,980.00 $ 6,980.00 4106 ANGIOGRAPH41063094 S STNT NOCOAT WDEL SYS $ 6,323.00 $ 6,323.00 4106 ANGIOGRAPH41063095 S STNT NOCOAT WDEL SYS $ 9,456.00 $ 9,456.00 4106 ANGIOGRAPH41063096 S STNT NOCOAT WDEL SYS $ 6,980.00 $ 6,980.00 4106 ANGIOGRAPH41063097 S STNT NOCOAT WDEL SYS $ 6,323.00 $ 6,323.00 4106 ANGIOGRAPH41063098 S STNT NOCOAT WDEL SYS $ 6,980.00 $ 6,980.00 4106 ANGIOGRAPH41063099 S STNT NOCOAT WDEL SYS $ 6,323.00 $ 6,323.00 4106 ANGIOGRAPH41063400 S STNT NOCOAT WDEL SYS $ 8,936.00 $ 8,936.00 4106 ANGIOGRAPH41063402 S STNT NOCOAT WDEL SYS $ 6,345.00 $ 6,345.00 4106 ANGIOGRAPH41063403 S STNT NOCOAT WDEL SYS $ 6,345.00 $ 6,345.00 4106 ANGIOGRAPH41063404 S STNT NOCOAT WDEL SYS $ 6,345.00 $ 6,345.00 4106 ANGIOGRAPH41063405 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063410 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063415 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063420 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063425 S STNT NOCOAT WDEL SYS $ 8,936.00 $ 8,936.00 4106 ANGIOGRAPH41063430 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063435 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063440 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063446 S STNT NOCOAT WDEL SYS $ 6,501.00 $ 6,501.00 4106 ANGIOGRAPH41063816 S STNT NOCOAT WDEL SYS $ 6,902.00 $ 6,902.00 4106 ANGIOGRAPH41063817 S STNT NOCOAT WDEL SYS $ 6,377.00 $ 6,377.00 4106 ANGIOGRAPH41063818 S STNT NOCOAT WDEL SYS $ 6,589.00 $ 6,589.00 4106 ANGIOGRAPH41063829 S STNT NOCOAT WDEL SYS $ 6,566.00 $ 6,566.00 4106 ANGIOGRAPH41063873 S STNT NOCOAT WDEL SYS $ 5,260.00 $ 5,260.00 4106 ANGIOGRAPH41063945 S STNT NOCOAT WDEL SYS $ 5,711.00 $ 5,711.00 4106 ANGIOGRAPH41063946 S STNT NOCOAT WDEL SYS $ 7,143.00 $ 7,143.00 4106 ANGIOGRAPH41063947 S STNT NOCOAT WDEL SYS $ 5,711.00 $ 5,711.00 4106 ANGIOGRAPH41063948 S STNT NOCOAT WDEL SYS $ 7,143.00 $ 7,143.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063949 S STNT NOCOAT WDEL SYS $ 5,711.00 $ 5,711.00 4106 ANGIOGRAPH41063431 S STNT NOCOAT WO DEL SYS $ 5,139.00 $ 5,139.00 4106 ANGIOGRAPH41063432 S STNT NOCOAT WO DEL SYS $ 5,139.00 $ 5,139.00 4106 ANGIOGRAPH41063433 S STNT NOCOAT WO DEL SYS $ 5,139.00 $ 5,139.00 4106 ANGIOGRAPH41063434 S STNT NOCOAT WO DEL SYS $ 5,411.00 $ 5,411.00 4106 ANGIOGRAPH41063436 S STNT NOCOAT WO DEL SYS $ 5,955.00 $ 5,955.00 4106 ANGIOGRAPH41063437 S STNT NOCOAT WO DEL SYS $ 5,955.00 $ 5,955.00 4106 ANGIOGRAPH41063438 S STNT NOCOAT WO DEL SYS $ 7,572.00 $ 7,572.00 4106 ANGIOGRAPH41063439 S STNT NOCOAT WO DEL SYS $ 7,586.00 $ 7,586.00 4106 ANGIOGRAPH41063442 S STNT NOCOAT WO DEL SYS $ 5,955.00 $ 5,955.00 4106 ANGIOGRAPH41054600 S STNT NOCOR WO DEL TMP $ 1,206.00 $ 1,206.00 4105 ANGIOGRAPH41054610 S STNT NOCOR WO DEL TMP $ 1,702.00 $ 1,702.00 4105 ANGIOGRAPH41054612 S STNT NOCOR WO DEL TMP $ 1,591.00 $ 1,591.00 4105 ANGIOGRAPH41054614 S STNT NOCOR WO DEL TMP $ 1,591.00 $ 1,591.00 4105 ANGIOGRAPH41054615 S STNT NOCOR WO DEL TMP $ 1,702.00 $ 1,702.00 4105 ANGIOGRAPH41054617 S STNT NOCOR WO DEL TMP $ 1,591.00 $ 1,591.00 4105 ANGIOGRAPH41053570 S STRL 1 WAY STOPCOCK $ - $ - 4105 ANGIOGRAPH41054990 S STRL 100-3516 16 GA 3.5 $ 126.00 $ 126.00 4105 ANGIOGRAPH41055095 S STRL 18G 3.5 SPIN NDL $ 27.00 $ 27.00 4105 ANGIOGRAPH41063614 S STRL 19-60 LV BX NDL $ 1,570.00 $ 1,570.00 4106 ANGIOGRAPH41054980 S STRL 20 GA 3.5 TOUHY $ 90.00 $ 90.00 4105 ANGIOGRAPH41054985 S STRL 20 GA 4.5 TOUHY $ 123.00 $ 123.00 4105 ANGIOGRAPH41055000 S STRL 23718 SMK C5 PROBE $ 357.00 $ 357.00 4105 ANGIOGRAPH41054995 S STRL 24 GA PEDI EPIDURA $ 493.00 $ 493.00 4105 ANGIOGRAPH41055110 S STRL 25G 3.5 SPINAL NDL $ 27.00 $ 27.00 4105 ANGIOGRAPH41063490 S STRL 32-133 GLD ST CATH $ 509.00 $ 509.00 4106 ANGIOGRAPH41063495 S STRL 32-157 GLD HI CATH $ 509.00 $ 509.00 4106 ANGIOGRAPH41063485 S STRL 32-192 GLD ANG CAT $ 509.00 $ 509.00 4106 ANGIOGRAPH41054975 S STRL 3407 EPID INJ TRAY $ 239.00 $ 239.00 4105 ANGIOGRAPH41053558 S STRL 3-M $ - $ - 4105 ANGIOGRAPH41055080 S STRL 4900 SMITH LOR SYR $ 39.00 $ 39.00 4105 ANGIOGRAPH41050005 S STRL ABSCESS DRAIN TRAY $ - $ - 4105 ANGIOGRAPH41063881 S STRL ADV OSTEO INTROD $ 1,660.00 $ 1,660.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41054485 S STRL ANGIOGRAPHY TRAY $ - $ - 4105 ANGIOGRAPH41055085 S STRL BALL 22G 2.5 CHIBA $ 50.00 $ 50.00 4105 ANGIOGRAPH41055090 S STRL BALLARD 25X2.5 SH $ 46.00 $ 46.00 4105 ANGIOGRAPH41053607 S STRL BAXTER $ 32.00 $ 32.00 4105 ANGIOGRAPH41063923 S STRL BIO VASC AC CATH $ 1,809.00 $ 1,809.00 4106 ANGIOGRAPH41054480 S STRL BIOPSY TRAY $ - $ - 4105 ANGIOGRAPH41063878 S STRL BONE ACCESS NEEDLE $ 174.00 $ 174.00 4106 ANGIOGRAPH41063880 S STRL BONE FILLER DEVICE $ 456.00 $ 456.00 4106 ANGIOGRAPH41053040 S STRL BROWN-MUELL T-FAST $ 420.00 $ 420.00 4105 ANGIOGRAPH41053210 S STRL CAT BERENSTEIN 5FR $ 243.00 $ 243.00 4105 ANGIOGRAPH41053300 S STRL CAT COBRA 1, 5.5FR $ 262.00 $ 262.00 4105 ANGIOGRAPH41053290 S STRL CAT COBRA 2, 5.5FR $ 262.00 $ 262.00 4105 ANGIOGRAPH41053295 S STRL CAT COBRA 3, 5.5FR $ 262.00 $ 262.00 4105 ANGIOGRAPH41053305 S STRL CAT DBL CURV 6.3FR $ 262.00 $ 262.00 4105 ANGIOGRAPH41053215 S STRL CAT PIGTAIL 30.154 $ 243.00 $ 243.00 4105 ANGIOGRAPH41053230 S STRL CAT PIGTAIL 30.155 $ 243.00 $ 243.00 4105 ANGIOGRAPH41053350 S STRL CAT SIM 1 5.5F 100 $ 281.00 $ 281.00 4105 ANGIOGRAPH41053355 S STRL CAT SIM 2 5.5F 100 $ 281.00 $ 281.00 4105 ANGIOGRAPH41053375 S STRL CAT SIMMONS 2, 5FR $ 292.00 $ 292.00 4105 ANGIOGRAPH41053370 S STRL CAT SIMMONS 3, 5FR $ 292.00 $ 292.00 4105 ANGIOGRAPH41053315 S STRL CAT TENN 5F,34.201 $ 272.00 $ 272.00 4105 ANGIOGRAPH41053185 S STRL CATH CEREBRAL 5FR $ 229.00 $ 229.00 4105 ANGIOGRAPH41053410 S STRL CATH INTERVENT 8FR $ 444.00 $ 444.00 4105 ANGIOGRAPH41053225 S STRL CATH PIGTAIL 5FR $ 243.00 $ 243.00 4105 ANGIOGRAPH41053240 S STRL CATH PIGTAIL 7.1FR $ 258.00 $ 258.00 4105 ANGIOGRAPH41053245 S STRL CATH PIGTAIL 8.2FR $ 258.00 $ 258.00 4105 ANGIOGRAPH41053195 S STRL CATH ROY FLUS 6 SH $ 239.00 $ 239.00 4105 ANGIOGRAPH41053200 S STRL CATH ROYAL FLUSH $ 239.00 $ 239.00 4105 ANGIOGRAPH41053220 S STRL CATH STRAIGHT 5FR $ 243.00 $ 243.00 4105 ANGIOGRAPH41053205 S STRL CATH STRAIGHT 6FR $ 243.00 $ 243.00 4105 ANGIOGRAPH41053390 S STRL CATH, COBRA 1, 5FR $ 292.00 $ 292.00 4105 ANGIOGRAPH41053380 S STRL CATH, COBRA 2, 5FR $ 292.00 $ 292.00 4105 ANGIOGRAPH41053385 S STRL CATH, COBRA 3, 5FR $ 292.00 $ 292.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41053285 S STRL CATH, H1H 5.5FR $ 262.00 $ 262.00 4105 ANGIOGRAPH41053165 S STRL CATH, HOCKEY STICK $ 219.00 $ 219.00 4105 ANGIOGRAPH41053190 S STRL CATH, MPA 5FR $ 229.00 $ 229.00 4105 ANGIOGRAPH41053160 S STRL CATH, STRAIGHT 5FR $ 210.00 $ 210.00 4105 ANGIOGRAPH41053226 S STRL CATHETER $ 427.00 $ 427.00 4105 ANGIOGRAPH41053265 S STRL CAT-PIGTA RYL FLSH $ 262.00 $ 262.00 4105 ANGIOGRAPH41063527 S STRL CIVCO TRANSDUC CVR $ 74.00 $ 74.00 4106 ANGIOGRAPH41063575 S STRL CON 9FR AYC-100 $ 339.00 $ 339.00 4106 ANGIOGRAPH41063895 S STRL CONCENTRIC 7FR GDE $ 3,516.00 $ 3,516.00 4106 ANGIOGRAPH41054535 S STRL CONNEC TUBE 14F-30 $ - $ - 4105 ANGIOGRAPH41054525 S STRL CONNECT TB 14FR-30 $ - $ - 4105 ANGIOGRAPH41054540 S STRL CONNECT TB 24FR-30 $ - $ - 4105 ANGIOGRAPH41053512 S STRL COPE SUT ANCHOR ST $ 501.00 $ 501.00 4105 ANGIOGRAPH41063550 S STRL CORDI EMBOLIZ CATH $ 2,000.00 $ 2,000.00 4106 ANGIOGRAPH41063555 S STRL CORDI EMBOLIZ CATH $ 1,969.00 $ 1,969.00 4106 ANGIOGRAPH41063929 S STRL CORDIS HYPER TRANS $ 1,619.00 $ 1,619.00 4106 ANGIOGRAPH41063849 S STRL CORE BIOPSY NDL $ 290.00 $ 290.00 4106 ANGIOGRAPH41053745 S STRL COURNAND, NEEDLE $ 105.00 $ 105.00 4105 ANGIOGRAPH41063939 S STRL CTTNG BLLN 4.2FR $ 3,049.00 $ 3,049.00 4106 ANGIOGRAPH41054530 S STRL CYSTO IRR SET $ 172.00 $ 172.00 4105 ANGIOGRAPH41055030 S STRL DBP-B GROUND PAD $ 141.00 $ 141.00 4105 ANGIOGRAPH41053630 S STRL DEFIBRILATOR PADS $ 248.00 $ 248.00 4105 ANGIOGRAPH41053500 S STRL DILATO/AMPLAT RENA $ 1,449.00 $ 1,449.00 4105 ANGIOGRAPH41053460 S STRL DILATOR 10FR $ 110.00 $ 110.00 4105 ANGIOGRAPH41053470 S STRL DILATOR 12FR $ 114.00 $ 114.00 4105 ANGIOGRAPH41053475 S STRL DILATOR 14FR $ 114.00 $ 114.00 4105 ANGIOGRAPH41053480 S STRL DILATOR 16FR $ 114.00 $ 114.00 4105 ANGIOGRAPH41053485 S STRL DILATOR 18FR $ 114.00 $ 114.00 4105 ANGIOGRAPH41053490 S STRL DILATOR 20FR $ 157.00 $ 157.00 4105 ANGIOGRAPH41053495 S STRL DILATOR 22FR $ 157.00 $ 157.00 4105 ANGIOGRAPH41043440 S STRL DILATOR 5FR $ 110.00 $ 110.00 4104 ANGIOGRAPH41053440 S STRL DILATOR 5FR $ 105.00 $ 105.00 4105 ANGIOGRAPH41053445 S STRL DILATOR 6FR $ 110.00 $ 110.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41053450 S STRL DILATOR 7FR $ 110.00 $ 110.00 4105 ANGIOGRAPH41053455 S STRL DILATOR 8FR $ 110.00 $ 110.00 4105 ANGIOGRAPH41053465 S STRL DILATOR 9FR $ 110.00 $ 110.00 4105 ANGIOGRAPH41063850 S STRL DISP SUBDURAL NDLS $ 43.00 $ 43.00 4106 ANGIOGRAPH41054545 S STRL DRAIN/BAG W METER $ 219.00 $ 219.00 4105 ANGIOGRAPH41053635 S STRL DRP, ANGIO-STERILE $ - $ - 4105 ANGIOGRAPH41063969 S STRL ENSNARE SYS 12-20 $ 1,314.00 $ 1,314.00 4106 ANGIOGRAPH41063968 S STRL ENSNARE SYS 9-15MM $ 1,314.00 $ 1,314.00 4106 ANGIOGRAPH41053540 S STRL ENTEROCLYSIS-GASTR $ 1,202.00 $ 1,202.00 4105 ANGIOGRAPH41053587 S STRL EPID CATH 155-1353 $ 319.00 $ 319.00 4105 ANGIOGRAPH41053588 S STRL EPID CATH 155-1838 $ 476.00 $ 476.00 4105 ANGIOGRAPH41053586 S STRL EPIDURAL NEEDLE $ 138.00 $ 138.00 4105 ANGIOGRAPH41055011 S STRL EPIMED TUN L CATH $ 557.00 $ 557.00 4105 ANGIOGRAPH41054960 S STRL EVAC CONTAINER $ 53.00 $ 53.00 4105 ANGIOGRAPH41053595 S STRL EYE SHEET, STERILE $ - $ - 4105 ANGIOGRAPH41063081 S STRL FEM STOP BARD $ 723.00 $ 723.00 4106 ANGIOGRAPH41053605 S STRL FLOW SWITCH $ 91.00 $ 91.00 4105 ANGIOGRAPH41053217 S STRL FLUSH CATHETER $ 223.00 $ 223.00 4105 ANGIOGRAPH41054555 S STRL FOLEY CATH 12FR $ 233.00 $ 233.00 4105 ANGIOGRAPH41054510 S STRL FOLEY CATH 14FR $ 53.00 $ 53.00 4105 ANGIOGRAPH41054560 S STRL FOLEY CATH 14FR $ 233.00 $ 233.00 4105 ANGIOGRAPH41054565 S STRL FOLEY CATH 18FR $ 233.00 $ 233.00 4105 ANGIOGRAPH41054575 S STRL FOLEY CATH 22FR $ 233.00 $ 233.00 4105 ANGIOGRAPH41054550 S STRL FOLEY KIT $ 219.00 $ 219.00 4105 ANGIOGRAPH41053505 S STRL FOLEY/GASTROSTOMY $ 119.00 $ 119.00 4105 ANGIOGRAPH41063924 S STRL GAST ENTERO TUBE $ 297.00 $ 297.00 4106 ANGIOGRAPH41053515 S STRL GASTRO TUBE 14FR $ 639.00 $ 639.00 4105 ANGIOGRAPH41053520 S STRL GASTRO TUBE 16FR $ 639.00 $ 639.00 4105 ANGIOGRAPH41053525 S STRL GASTRO TUBE 18FR $ 639.00 $ 639.00 4105 ANGIOGRAPH41053530 S STRL GASTRO TUBE 20FR $ 639.00 $ 639.00 4105 ANGIOGRAPH41053535 S STRL GASTROENT WIRE 16F $ 935.00 $ 935.00 4105 ANGIOGRAPH41053545 S STRL GASTROJEJUNOSTOMY $ 1,570.00 $ 1,570.00 4105 ANGIOGRAPH41063848 S STRL GATEWAY BALLOONS $ 3,715.00 $ 3,715.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41053650 S STRL GUIDE WIRE INTRO $ 81.00 $ 81.00 4105 ANGIOGRAPH41055040 S STRL HAVEL 2064 6IN SPI $ 162.00 $ 162.00 4105 ANGIOGRAPH41055020 S STRL HAVEL 22G 5.5 SPIN $ 169.00 $ 169.00 4105 ANGIOGRAPH41055027 S STRL HAVEL 25G 5.5 SPIN $ 169.00 $ 169.00 4105 ANGIOGRAPH41055055 S STRL HAVELS 22X8 SPINAL $ 162.00 $ 162.00 4105 ANGIOGRAPH41055050 S STRL HAVELS 25X6 SPINAL $ 162.00 $ 162.00 4105 ANGIOGRAPH41055060 S STRL HAVELS 25X8 SPINAL $ 162.00 $ 162.00 4105 ANGIOGRAPH41053685 S STRL HEMOSTATIC VALVE $ 311.00 $ 311.00 4105 ANGIOGRAPH41063928 S STRL HIFLO 3FR 10CM TIP $ 1,429.00 $ 1,429.00 4106 ANGIOGRAPH41053720 S STRL INDEFLATOR $ 916.00 $ 916.00 4105 ANGIOGRAPH41063882 S STRL INFLATION SYRINGE $ 473.00 $ 473.00 4106 ANGIOGRAPH41053617 S STRL INJECTOR SYR 100CC $ - $ - 4105 ANGIOGRAPH41053615 S STRL INJECTOR SYR 200CC $ - $ - 4105 ANGIOGRAPH41053618 S STRL INJECTOR TUBING $ - $ - 4105 ANGIOGRAPH41053645 S STRL INSERT INSTRU 8FR $ 382.00 $ 382.00 4105 ANGIOGRAPH41063521 S STRL IVALON EMB PARTIC $ 935.00 $ 935.00 4106 ANGIOGRAPH41063522 S STRL IVALON EMB PARTICL $ 781.00 $ 781.00 4106 ANGIOGRAPH41063955 S STRL JEJUNOSTMY TB 10FR $ 228.00 $ 228.00 4106 ANGIOGRAPH41063879 S STRL KYPHON MIXER $ 519.00 $ 519.00 4106 ANGIOGRAPH41063883 S STRL KYPHON MIXER $ 518.00 $ 518.00 4106 ANGIOGRAPH41055115 S STRL MEDTRO 34874 PROBE $ 8,902.00 $ 8,902.00 4105 ANGIOGRAPH41063894 S STRL MERCI BALLOON GDE $ 2,663.00 $ 2,663.00 4106 ANGIOGRAPH41063893 S STRL MERCI MICROCATH $ 1,812.00 $ 1,812.00 4106 ANGIOGRAPH41063892 S STRL MERCI RETRVR CATH $ 9,722.00 $ 9,722.00 4106 ANGIOGRAPH41061099 S STRL MISC. SUPP CHARGE $ - $ - 4106 ANGIOGRAPH41063030 S STRL N5.03570PLOSPIGCS $ 729.00 $ 729.00 4106 ANGIOGRAPH41053790 S STRL NDL 20G SPINAL 3IN $ 143.00 $ 143.00 4105 ANGIOGRAPH41053795 S STRL NDL 20G SPINAL 4IN $ 143.00 $ 143.00 4105 ANGIOGRAPH41053800 S STRL NDL 22G SPINAL 3IN $ 143.00 $ 143.00 4105 ANGIOGRAPH41053805 S STRL NDL 22G SPINAL 4IN $ 143.00 $ 143.00 4105 ANGIOGRAPH41053850 S STRL NDL CALIBRTD 22G $ 187.00 $ 187.00 4105 ANGIOGRAPH41053785 S STRL NDL COURNAND 18G $ 143.00 $ 143.00 4105 ANGIOGRAPH41053780 S STRL NDL MOD 18G 2 3/4R $ 129.00 $ 129.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41053820 S STRL NDL STRILE 14G 4IN $ 153.00 $ 153.00 4105 ANGIOGRAPH41053825 S STRL NDL STRILE 14G 6IN $ 162.00 $ 162.00 4105 ANGIOGRAPH41053815 S STRL NDL STRILE 18G 2.5 $ 143.00 $ 143.00 4105 ANGIOGRAPH41053830 S STRL NDL/CHIBA, 22G 15 $ 157.00 $ 157.00 4105 ANGIOGRAPH41053835 S STRL NDL/CHIBA, 22G 20 $ 157.00 $ 157.00 4105 ANGIOGRAPH41053870 S STRL NDL/DRAINAGE PTC $ 324.00 $ 324.00 4105 ANGIOGRAPH41053775 S STRL NEEDLE 18G 2.7 $ 124.00 $ 124.00 4105 ANGIOGRAPH41053740 S STRL NEEDLE, 22G 1.5 $ 42.00 $ 42.00 4105 ANGIOGRAPH41053875 S STRL NEEDLE/BIOPSY $ 343.00 $ 343.00 4105 ANGIOGRAPH41053860 S STRL NEEDLE/BIOPSY 17G $ 324.00 $ 324.00 4105 ANGIOGRAPH41053865 S STRL NEEDLE/BIOPSY 19G $ 324.00 $ 324.00 4105 ANGIOGRAPH41053885 S STRL NEEDLE/BIOPSY 21G $ 311.00 $ 311.00 4105 ANGIOGRAPH41053880 S STRL NEEDLE/BIOPSY 24G $ 286.00 $ 286.00 4105 ANGIOGRAPH41053755 S STRL NEEDLE/CHIBA 22G 6 $ 110.00 $ 110.00 4105 ANGIOGRAPH41053890 S STRL NEEDLE/DRAINAGE $ 353.00 $ 353.00 4105 ANGIOGRAPH41053855 S STRL NEEDLE/SIALOGRAPH $ 206.00 $ 206.00 4105 ANGIOGRAPH41054580 S STRL NEPH/YELLOW PIGTAI $ 286.00 $ 286.00 4105 ANGIOGRAPH41063841 S STRL NITROUS CARTRIDGE $ 372.00 $ 372.00 4106 ANGIOGRAPH41063011 S STRL PLUS 025 260 WIRE $ 856.00 $ 856.00 4106 ANGIOGRAPH41054490 S STRL PNEUMOTHORAX SET $ 754.00 $ 754.00 4105 ANGIOGRAPH41063700 S STRL POSSIS 3020P PUMP $ 1,364.00 $ 1,364.00 4106 ANGIOGRAPH41053750 S STRL POTTS NEEDLE 18G $ 110.00 $ 110.00 4105 ANGIOGRAPH41053580 S STRL PRESSURE CONNECTOR $ 67.00 $ 67.00 4105 ANGIOGRAPH41053670 S STRL PRESSURE MONIT SET $ 176.00 $ 176.00 4105 ANGIOGRAPH41054971 S STRL PULSE OXI PROBE $ 172.00 $ 172.00 4105 ANGIOGRAPH41063932 S STRL QCK X SUPPORT CATH $ 606.00 $ 606.00 4106 ANGIOGRAPH41063933 S STRL QCK X SUPPORT CATH $ 636.00 $ 636.00 4106 ANGIOGRAPH41053145 S STRL RENIN, CATH 6.3FR $ 191.00 $ 191.00 4105 ANGIOGRAPH41055015 S STRL RFK C15D-S-B-PROBE $ 396.00 $ 396.00 4105 ANGIOGRAPH41055010 S STRL RFK CIOD-S UB PROB $ 364.00 $ 364.00 4105 ANGIOGRAPH41053680 S STRL ROTAT HEMO VALVE $ 286.00 $ 286.00 4105 ANGIOGRAPH41063545 S STRL RTPS 100 TIPS SET $ 842.00 $ 842.00 4106 ANGIOGRAPH41063600 S STRL RUPS 100 TIPS SET $ 1,818.00 $ 1,818.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41053556 S STRL SC-45 PREF MEDICAL $ 24.00 $ 24.00 4105 ANGIOGRAPH41053557 S STRL SC-70 PREFER MED $ 34.00 $ 34.00 4105 ANGIOGRAPH41053288 S STRL SELECTIVE CATHETER $ 266.00 $ 266.00 4105 ANGIOGRAPH41055005 S STRL SMK CID PROBE $ 357.00 $ 357.00 4105 ANGIOGRAPH41053735 S STRL SPINAL NDL 18G 3.5 $ 42.00 $ 42.00 4105 ANGIOGRAPH41053760 S STRL SPINAL NDL 18G 6 $ 114.00 $ 114.00 4105 ANGIOGRAPH41053765 S STRL SPINAL NDL 20G 5.7 $ 114.00 $ 114.00 4105 ANGIOGRAPH41053730 S STRL SPINAL NDL 22G 3.5 $ 29.00 $ 29.00 4105 ANGIOGRAPH41053770 S STRL SPINAL NDL 22G 6 $ 114.00 $ 114.00 4105 ANGIOGRAPH41055125 S STRL STARBURST 15CM NDL $ 7,029.00 $ 7,029.00 4105 ANGIOGRAPH41055130 S STRL STARBURST 25CM NDL $ 7,029.00 $ 7,029.00 4105 ANGIOGRAPH41053575 S STRL STOMA WAFER $ 61.00 $ 61.00 4105 ANGIOGRAPH41053550 S STRL STRIL BAGS 28 X 12 $ - $ - 4105 ANGIOGRAPH41053555 S STRL STRIL BAGS 36 X 36 $ - $ - 4105 ANGIOGRAPH41053600 S STRL SUTURE $ - $ - 4105 ANGIOGRAPH41063778 S STRL SYNERG CNNCT CABLE $ 400.00 $ 400.00 4106 ANGIOGRAPH41053647 S STRL TEGADERM 10X12 $ - $ - 4105 ANGIOGRAPH41053648 S STRL TEGADERM 15X20 $ - $ - 4105 ANGIOGRAPH41053649 S STRL TEGADERM 20X30 $ - $ - 4105 ANGIOGRAPH41063930 S STRL TERUMO GLIDECATH $ 192.00 $ 192.00 4106 ANGIOGRAPH41063605 S STRL TJ LIVER BIOPSY ST $ 2,364.00 $ 2,364.00 4106 ANGIOGRAPH41053655 S STRL TOR DVCE .032-.038 $ 124.00 $ 124.00 4105 ANGIOGRAPH41063885 S STRL TRI LOBE BALLOON $ 2,122.00 $ 2,122.00 4106 ANGIOGRAPH41054495 S STRL TRNSJG/CHLE BX TRY $ 2,141.00 $ 2,141.00 4105 ANGIOGRAPH41063886 S STRL TS2030 SHEATH $ 1,278.00 $ 1,278.00 4106 ANGIOGRAPH41053675 S STRL TUOHY & INSERT TOL $ 281.00 $ 281.00 4105 ANGIOGRAPH41053665 S STRL TUOHY-BORST/SIDEPT $ 138.00 $ 138.00 4105 ANGIOGRAPH41063040 S STRL TYSHAK BALL CATH $ 2,468.00 $ 2,468.00 4106 ANGIOGRAPH41054515 S STRL URINARY DRAIN BAG $ 72.00 $ 72.00 4105 ANGIOGRAPH41054505 S STRL URINARY LEG BAG $ 42.00 $ 42.00 4105 ANGIOGRAPH41063845 S STRL VASC ACCESS KIT $ 1,505.00 $ 1,505.00 4106 ANGIOGRAPH41063875 S STRL XPAND 1ST FX SYST $ 12,457.00 $ 12,457.00 4106 ANGIOGRAPH41063876 S STRL XPAND ADD FX SYST $ 8,386.00 $ 8,386.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063877 S STRL XPAND INF BONE TMP $ 4,559.00 $ 4,559.00 4106 ANGIOGRAPH41063610 S STRL18-60 LIVER BX NDL $ 1,570.00 $ 1,570.00 4106 ANGIOGRAPH41054620 S WIRE GUIDE $ 162.00 $ 162.00 4105 ANGIOGRAPH41054625 S WIRE GUIDE $ 162.00 $ 162.00 4105 ANGIOGRAPH41054635 S WIRE GUIDE $ 172.00 $ 172.00 4105 ANGIOGRAPH41054640 S WIRE GUIDE $ 172.00 $ 172.00 4105 ANGIOGRAPH41054642 S WIRE GUIDE $ 172.00 $ 172.00 4105 ANGIOGRAPH41054645 S WIRE GUIDE $ 206.00 $ 206.00 4105 ANGIOGRAPH41054655 S WIRE GUIDE $ 167.00 $ 167.00 4105 ANGIOGRAPH41054665 S WIRE GUIDE $ 167.00 $ 167.00 4105 ANGIOGRAPH41054677 S WIRE GUIDE $ 167.00 $ 167.00 4105 ANGIOGRAPH41054680 S WIRE GUIDE $ 167.00 $ 167.00 4105 ANGIOGRAPH41054690 S WIRE GUIDE $ 172.00 $ 172.00 4105 ANGIOGRAPH41054695 S WIRE GUIDE $ 172.00 $ 172.00 4105 ANGIOGRAPH41054700 S WIRE GUIDE $ 176.00 $ 176.00 4105 ANGIOGRAPH41054705 S WIRE GUIDE $ 181.00 $ 181.00 4105 ANGIOGRAPH41054710 S WIRE GUIDE $ 281.00 $ 281.00 4105 ANGIOGRAPH41054725 S WIRE GUIDE $ 229.00 $ 229.00 4105 ANGIOGRAPH41054730 S WIRE GUIDE $ 243.00 $ 243.00 4105 ANGIOGRAPH41054750 S WIRE GUIDE $ 305.00 $ 305.00 4105 ANGIOGRAPH41054770 S WIRE GUIDE $ 353.00 $ 353.00 4105 ANGIOGRAPH41054775 S WIRE GUIDE $ 363.00 $ 363.00 4105 ANGIOGRAPH41054777 S WIRE GUIDE $ 262.00 $ 262.00 4105 ANGIOGRAPH41054780 S WIRE GUIDE $ 262.00 $ 262.00 4105 ANGIOGRAPH41054795 S WIRE GUIDE $ 300.00 $ 300.00 4105 ANGIOGRAPH41054800 S WIRE GUIDE $ 324.00 $ 324.00 4105 ANGIOGRAPH41054805 S WIRE GUIDE $ 353.00 $ 353.00 4105 ANGIOGRAPH41054820 S WIRE GUIDE $ 525.00 $ 525.00 4105 ANGIOGRAPH41054840 S WIRE GUIDE $ 744.00 $ 744.00 4105 ANGIOGRAPH41054855 S WIRE GUIDE $ 859.00 $ 859.00 4105 ANGIOGRAPH41054865 S WIRE GUIDE $ 1,030.00 $ 1,030.00 4105 ANGIOGRAPH41054870 S WIRE GUIDE $ 1,030.00 $ 1,030.00 4105 ANGIOGRAPH41054875 S WIRE GUIDE $ 1,311.00 $ 1,311.00 4105 ANGIOGRAPH

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DEPARTMENT CODE

41055045 S WIRE GUIDE $ 434.00 $ 434.00 4105 ANGIOGRAPH41063000 S WIRE GUIDE $ 484.00 $ 484.00 4106 ANGIOGRAPH41063002 S WIRE GUIDE $ 513.00 $ 513.00 4106 ANGIOGRAPH41063005 S WIRE GUIDE $ 572.00 $ 572.00 4106 ANGIOGRAPH41063010 S WIRE GUIDE $ 648.00 $ 648.00 4106 ANGIOGRAPH41063560 S WIRE GUIDE $ 818.00 $ 818.00 4106 ANGIOGRAPH41063620 S WIRE GUIDE $ 919.00 $ 919.00 4106 ANGIOGRAPH41063625 S WIRE GUIDE $ 919.00 $ 919.00 4106 ANGIOGRAPH41063630 S WIRE GUIDE $ 398.00 $ 398.00 4106 ANGIOGRAPH41063635 S WIRE GUIDE $ 1,082.00 $ 1,082.00 4106 ANGIOGRAPH41063640 S WIRE GUIDE $ 656.00 $ 656.00 4106 ANGIOGRAPH41063645 S WIRE GUIDE $ 655.00 $ 655.00 4106 ANGIOGRAPH41063650 S WIRE GUIDE $ 513.00 $ 513.00 4106 ANGIOGRAPH41063655 S WIRE GUIDE $ 513.00 $ 513.00 4106 ANGIOGRAPH41063730 S WIRE GUIDE $ 519.00 $ 519.00 4106 ANGIOGRAPH41063774 S WIRE GUIDE $ 1,015.00 $ 1,015.00 4106 ANGIOGRAPH41063775 S WIRE GUIDE $ 1,015.00 $ 1,015.00 4106 ANGIOGRAPH41063776 S WIRE GUIDE $ 1,015.00 $ 1,015.00 4106 ANGIOGRAPH41063779 S WIRE GUIDE $ 1,535.00 $ 1,535.00 4106 ANGIOGRAPH41063780 S WIRE GUIDE $ 1,535.00 $ 1,535.00 4106 ANGIOGRAPH41063781 S WIRE GUIDE $ 1,015.00 $ 1,015.00 4106 ANGIOGRAPH41063824 S WIRE GUIDE $ 640.00 $ 640.00 4106 ANGIOGRAPH41063825 S WIRE GUIDE $ 681.00 $ 681.00 4106 ANGIOGRAPH41063826 S WIRE GUIDE $ 720.00 $ 720.00 4106 ANGIOGRAPH41063827 S WIRE GUIDE $ 943.00 $ 943.00 4106 ANGIOGRAPH41063830 S WIRE GUIDE $ 6,116.00 $ 6,116.00 4106 ANGIOGRAPH41063904 S WIRE GUIDE $ 430.00 $ 430.00 4106 ANGIOGRAPH41063905 S WIRE GUIDE $ 495.00 $ 495.00 4106 ANGIOGRAPH41063906 S WIRE GUIDE $ 1,100.00 $ 1,100.00 4106 ANGIOGRAPH41063907 S WIRE GUIDE $ 1,524.00 $ 1,524.00 4106 ANGIOGRAPH41063908 S WIRE GUIDE $ 1,848.00 $ 1,848.00 4106 ANGIOGRAPH41063909 S WIRE GUIDE $ 495.00 $ 495.00 4106 ANGIOGRAPH41063910 S WIRE GUIDE $ 587.00 $ 587.00 4106 ANGIOGRAPH

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DEPARTMENT CODE

41063911 S WIRE GUIDE $ 620.00 $ 620.00 4106 ANGIOGRAPH41063912 S WIRE GUIDE $ 464.00 $ 464.00 4106 ANGIOGRAPH41063913 S WIRE GUIDE $ 400.00 $ 400.00 4106 ANGIOGRAPH41063914 S WIRE GUIDE $ 188.00 $ 188.00 4106 ANGIOGRAPH41063915 S WIRE GUIDE $ 336.00 $ 336.00 4106 ANGIOGRAPH41063916 S WIRE GUIDE $ 299.00 $ 299.00 4106 ANGIOGRAPH41063917 S WIRE GUIDE $ 336.00 $ 336.00 4106 ANGIOGRAPH41041607 SEP LOWER LIMBS BIL $ 150.00 $ 150.00 4104 ANGIOGRAPH41041608 SEP UPPER LIMBS BIL $ 150.00 $ 150.00 4104 ANGIOGRAPH41001028 US GDE PRNCHYML TISS ABLN $ 842.00 $ 842.00 4100 ANGIOGRAPH41001012 US NDL PLACE $ 1,485.00 $ 1,485.00 4100 ANGIOGRAPH41000867 US SAL INFN SONOHYSTERGHY $ 849.00 $ 849.00 4100 ANGIOGRAPH41031282 USC ABLTN LIVER RF OPN $ 3,727.00 $ 3,727.00 4103 ANGIOGRAPH41031284 USC ABLTN LIVER RF PRC $ 3,988.00 $ 3,988.00 4103 ANGIOGRAPH41000590 XR ABD 1V AP $ 414.00 $ 414.00 4100 ANGIOGRAPH41000785 XR CYSTOGRAM 3V OR MORE $ 1,480.00 $ 1,480.00 4100 ANGIOGRAPH41006001 XR FLUORO 1-2 HRS $ 2,546.00 $ 2,546.00 4100 ANGIOGRAPH41000800 XR URETHROCYSTOGRAM $ 1,404.00 $ 1,404.00 4100 ANGIOGRAPH41000782 XR UROGRAM ANTEGRADE $ 1,252.00 $ 1,252.00 4100 ANGIOGRAPH41000790 XR VASOGRAM VESICULOGRAM $ 1,565.00 $ 1,565.00 4100 ANGIOGRAPH41031660 XRC FNA W IMAG GUIDANCE $ 1,287.00 $ 1,287.00 4103 ANGIOGRAPH41031665 XRC FNA W/O IMAG GUIDANCE $ 697.00 $ 697.00 4103 ANGIOGRAPH41031206 XRC INJ SI JNT ANES/STRD $ 1,045.00 $ 1,045.00 4103 ANGIOGRAPH41121633 S STRL PROC TRAY CYS ASPI $ 195.00 $ 195.00 4112 BHC41121635 S STRL PROC TRAY FNA BX $ 370.00 $ 370.00 4112 BHC41121631 S STRL PROC TRAY NDL LOC $ 374.00 $ 374.00 4112 BHC41122000 S STRL PROC TRAY STEREOTA $ 518.00 $ 518.00 4112 BHC41121637 S STRL PROC TRY GALACTOGR $ 273.00 $ 273.00 4112 BHC41133055 US BREAST UNI OR BIL $ 560.00 $ 560.00 4113 BHC41131653 US NDL PLACE $ 1,485.00 $ 1,485.00 4113 BHC41111927 USC BX BREAST VAC ASSIST $ 1,406.00 $ 1,406.00 4111 BHC41144010 XR CONSULT FOREIGN FLM $ 450.00 $ 450.00 4114 BHC41111661 XR GALACTOGRAM 1 DUCT $ 1,362.00 $ 1,362.00 4111 BHC

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DEPARTMENT CODE

41111651 XR MAMMO DX BIL $ 461.00 $ 461.00 4111 BHC41111654 XR MAMMO DX CAD ADD-ON $ 54.00 $ 54.00 4111 BHC41111648 XR MAMMO DX UNI $ 354.00 $ 354.00 4111 BHC41111642 XR MAMMO GDE NDL EA LES $ 854.00 $ 854.00 4111 BHC41111647 XR MAMMO SCRN $ 257.00 $ 257.00 4111 BHC41111644 XR MAMMO SCRN CAD ADD-ON $ 54.00 $ 54.00 4111 BHC41111653 XR MAMMO SCRN DIG BILAT $ 257.00 $ 257.00 4111 BHC41111657 XR MAMMO SCRN DIG BILAT $ 257.00 $ 257.00 4111 BHC41156010 XR RN EVAL 30 MINUTES $ 146.00 $ 146.00 4115 BHC41156015 XR RN EVAL 60 MINUTES $ 401.00 $ 401.00 4115 BHC41156020 XR RN EVAL 90 MINUTES $ 401.00 $ 401.00 4115 BHC41111665 XR SPECIMEN SURGICAL $ 304.00 $ 304.00 4111 BHC41112001 XR STEREO LOC EA LESION $ 1,430.00 $ 1,430.00 4111 BHC41156005 XR VISIT BRIEF/INTER/COMP $ 74.00 $ 74.00 4115 BHC41111923 XRC ASP BREAST ADD $ 694.00 $ 694.00 4111 BHC41111921 XRC ASP BREAST CYST $ 1,334.00 $ 1,334.00 4111 BHC41111922 XRC BREAST NDL WIRE $ 1,919.00 $ 1,919.00 4111 BHC41111926 XRC BREAST NDL WIRE ADD $ 812.00 $ 812.00 4111 BHC41111920 XRC BX BREAST PRC W/O $ 1,335.00 $ 1,335.00 4111 BHC41112004 XRC BX BREAST W IMAG $ 2,453.00 $ 2,453.00 4111 BHC41111929 XRC FNA W IMAG GUIDANCE $ 1,287.00 $ 1,287.00 4111 BHC41111924 XRC FNA W/O IMAG GUIDANCE $ 697.00 $ 697.00 4111 BHC41111928 XRC IMAG LOC CLIP W BX $ 1,725.00 $ 1,725.00 4111 BHC41111925 XRC INJ DUCT GALACTOGRAM $ 1,926.00 $ 1,926.00 4111 BHC26640044 DIALYSATE $ 167.96 $ 167.96 2664 C.SVC-CPU26640032 S STRL PRISM DILUTION SET $ 1,241.00 $ 1,241.00 2664 C.SVC-CPU26640033 S STRL PRISMA 5L EFFLU BG $ 67.00 $ 67.00 2664 C.SVC-CPU26620044 S STRL CARDIAC OUTPUT SET $ 278.00 $ 278.00 2662 C.SVC-ICU26623678 S STRL FEMOSTOP $ 759.00 $ 759.00 2662 C.SVC-ICU26620041 S STRL OPTICATH PA CATH $ 1,431.00 $ 1,431.00 2662 C.SVC-ICU26620042 S STRL PAC 5 TRAY $ 352.00 $ 352.00 2662 C.SVC-ICU26620049 S STRL PIGTAIL CHEST TUBE $ 708.00 $ 708.00 2662 C.SVC-ICU26620073 S STRL RAPID INFUSE TUBE $ 810.00 $ 810.00 2662 C.SVC-ICU

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DEPARTMENT CODE

26620074 S STRL REPLACEMENT FILTER $ 106.00 $ 106.00 2662 C.SVC-ICU26620043 S STRL TRANSDUCER 3 $ 357.00 $ 357.00 2662 C.SVC-ICU26620080 S STRL VASCATH 3LUMEN CV $ 519.00 $ 519.00 2662 C.SVC-ICU26620085 S STRL VASCATH 3LUMEN ST $ 145.00 $ 145.00 2662 C.SVC-ICU26620076 S STRL VENOUS CATH 2LUMEN $ 175.00 $ 175.00 2662 C.SVC-ICU26660050 S STRL EXTERNAL PACIN PAD $ 353.00 $ 353.00 2666 C.SVC-PED47000020 GENETIC COUNSELING 30 MN $ 250.00 $ 250.00 4700 CANCER GENETIC PROGRAM47000011 LEVEL 1 EST PATIENT $ 111.00 $ 111.00 4700 CANCER GENETIC PROGRAM47000001 LEVEL 1 NEW PATIENT $ 111.00 $ 111.00 4700 CANCER GENETIC PROGRAM47000012 LEVEL 2 EST PATIENT $ 129.00 $ 129.00 4700 CANCER GENETIC PROGRAM47000002 LEVEL 2 NEW PATIENT $ 129.00 $ 129.00 4700 CANCER GENETIC PROGRAM47000013 LEVEL 3 EST PATIENT $ 147.00 $ 147.00 4700 CANCER GENETIC PROGRAM47000003 LEVEL 3 NEW PATIENT $ 147.00 $ 147.00 4700 CANCER GENETIC PROGRAM47000014 LEVEL 4 EST PATIENT $ 244.00 $ 244.00 4700 CANCER GENETIC PROGRAM47000004 LEVEL 4 NEW PATIENT $ 244.00 $ 244.00 4700 CANCER GENETIC PROGRAM47000015 LEVEL 5 EST PATIENT $ 262.00 $ 262.00 4700 CANCER GENETIC PROGRAM47000005 LEVEL 5 NEW PATIENT $ 262.00 $ 262.00 4700 CANCER GENETIC PROGRAM44006315 ACTIVATED CLOTTING TIME $ 142.00 $ 142.00 4400 CARD CATH44001074 BLD GAS ANALYSIS $ 667.00 $ 667.00 4400 CARD CATH44001075 BLOOD GASES O2 SAT ONLY $ 303.00 $ 303.00 4400 CARD CATH44001080 CA ANGIO EXT BIL $ 4,365.00 $ 4,365.00 4400 CARD CATH44001079 CA ANGIO EXT UNI $ 3,902.00 $ 3,902.00 4400 CARD CATH44001082 CA ANGIO RENL BIL $ 4,435.00 $ 4,435.00 4400 CARD CATH44001081 CA ANGIO RENL UNI $ 3,851.00 $ 3,851.00 4400 CARD CATH44007027 CA AORTOGRAM ABD BIL EXT $ 3,934.00 $ 3,934.00 4400 CARD CATH44001078 CA AORTOGRAM ABD W SER $ 3,635.00 $ 3,635.00 4400 CARD CATH44001077 CA AORTOGRAM THOR W SER $ 3,705.00 $ 3,705.00 4400 CARD CATH44007026 CA AORTOGRAM THOR W/O SER $ 4,942.00 $ 4,942.00 4400 CARD CATH44007044 CA ATHERECTOMY PERIPH ADD $ 7,613.00 $ 7,613.00 4400 CARD CATH44007043 CA ATHERECTOMY PERIPH INI $ 11,566.00 $ 11,566.00 4400 CARD CATH44006020 CA BIOPSY ENDOMYOCARDIAL $ 1,242.00 $ 1,242.00 4400 CARD CATH44001011 CA CARDIOASSIST INTERNAL $ 869.00 $ 869.00 4400 CARD CATH44006863 CA CARDIOVERSION INTERNAL $ 1,516.00 $ 1,516.00 4400 CARD CATH

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DEPARTMENT CODE

44006862 CA CARDIOVERT ELCTVE EXT $ 3,014.00 $ 3,014.00 4400 CARD CATH44006026 CA CORO/GRFT/IMA WO LHC $ 5,830.00 $ 5,830.00 4400 CARD CATH44006864 CA CPR $ 963.00 $ 963.00 4400 CARD CATH44006084 CA DPPLR W STRESS ADD VSL $ 887.00 $ 887.00 4400 CARD CATH44006083 CA DPPLR W STRESS INI $ 1,778.00 $ 1,778.00 4400 CARD CATH44006022 CA ECHO DPPLER CMPL $ 630.00 $ 630.00 4400 CARD CATH44006024 CA ECHO DPPLER COLOR FLOW $ 1,182.00 $ 1,182.00 4400 CARD CATH44006023 CA ECHO TEE CNGNITL ANOM $ 3,274.00 $ 3,274.00 4400 CARD CATH44006870 CA EP 3D MAPPING $ 2,208.00 $ 2,208.00 4400 CARD CATH44006865 CA EP ABLTN AV NDE/CNDCTN $ 3,470.00 $ 3,470.00 4400 CARD CATH44006866 CA EP ABLTN OF SVT $ 18,676.00 $ 18,676.00 4400 CARD CATH44006867 CA EP ABLTN OF VT $ 16,703.00 $ 16,703.00 4400 CARD CATH44006872 CA EP ESOPH RECORD W PACE $ 609.00 $ 609.00 4400 CARD CATH44006871 CA EP ESOPH RECORDING $ 539.00 $ 539.00 4400 CARD CATH44006009 CA EP EVAL COMP W INDUCT $ 7,340.00 $ 7,340.00 4400 CARD CATH44006010 CA EP EVAL COMP WO INDUCT $ 7,639.00 $ 7,639.00 4400 CARD CATH44001060 CA EP EVAL ICD LEADS $ 6,040.00 $ 6,040.00 4400 CARD CATH44001061 CA EP EVAL ICD LEADS/GEN $ 6,808.00 $ 6,808.00 4400 CARD CATH44001062 CA EP EVAL PACING ICD $ 4,860.00 $ 4,860.00 4400 CARD CATH44006853 CA EP EVAL W L ATR PACING $ 11,403.00 $ 11,403.00 4400 CARD CATH44006854 CA EP EVAL W L VENT PACNG $ 1,910.00 $ 1,910.00 4400 CARD CATH44006012 CA EP FOLLOW UP STUDY $ 2,855.00 $ 2,855.00 4400 CARD CATH44006856 CA EP HIS BUNDLE RECORD $ 1,986.00 $ 1,986.00 4400 CARD CATH44006875 CA EP IC ECHO W INTRVNTN $ 4,353.00 $ 4,353.00 4400 CARD CATH44001008 CA EP IND/TRM ARRHYTH PPM $ 1,761.00 $ 1,761.00 4400 CARD CATH44006873 CA EP INDUCT ARR BY PACNG $ 4,060.00 $ 4,060.00 4400 CARD CATH44006092 CA EP INTRA ATR PACING $ 1,846.00 $ 1,846.00 4400 CARD CATH44006087 CA EP INTRA ATR RECORD $ 1,415.00 $ 1,415.00 4400 CARD CATH44006097 CA EP INTRA VENT PACING $ 1,986.00 $ 1,986.00 4400 CARD CATH44006869 CA EP MAP VENT/ATR TACHY $ 3,388.00 $ 3,388.00 4400 CARD CATH44006008 CA EP PRG PCNG POST RX $ 1,795.00 $ 1,795.00 4400 CARD CATH44006089 CA EP R VENT RECORD $ 1,808.00 $ 1,808.00 4400 CARD CATH44006900 CA ERGONOVINE PROV TEST $ 1,326.00 $ 1,326.00 4400 CARD CATH

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DEPARTMENT CODE

44007030 CA EXCHNGE INTRAVAS CATH $ 2,506.00 $ 2,506.00 4400 CARD CATH44006025 CA HEART CATH LEFT $ 13,285.00 $ 13,285.00 4400 CARD CATH44006005 CA HEART CATH RIGHT $ 6,128.00 $ 6,128.00 4400 CARD CATH44001030 CA INJ AORTOGRAPHY $ 1,204.00 $ 1,204.00 4400 CARD CATH44001035 CA INJ CORO ANGIO $ 1,908.00 $ 1,908.00 4400 CARD CATH44001010 CA INJ GRAFT ANGIO $ 1,204.00 $ 1,204.00 4400 CARD CATH44001005 CA INJ IMA CONDUIT $ 1,204.00 $ 1,204.00 4400 CARD CATH44001019 CA INJ L VENT/ATR ANGIO $ 1,204.00 $ 1,204.00 4400 CARD CATH44001015 CA INJ PULM ANGIO $ 1,204.00 $ 1,204.00 4400 CARD CATH44001026 CA INJ R VENT/ATR ANGIO $ 1,204.00 $ 1,204.00 4400 CARD CATH44007031 CA IVC FILTER PLACE $ 8,939.00 $ 8,939.00 4400 CARD CATH44006801 CA IVUS CORO ADD VSL $ 2,043.00 $ 2,043.00 4400 CARD CATH44006800 CA IVUS CORO INI VSL $ 3,661.00 $ 3,661.00 4400 CARD CATH44007033 CA IVUS NONCO ADD $ 2,912.00 $ 2,912.00 4400 CARD CATH44007032 CA IVUS NONCO INI $ 2,969.00 $ 2,969.00 4400 CARD CATH44007045 CA LEVEL 1 EST PATIENT $ 216.00 $ 216.00 4400 CARD CATH44006718 CA PLACE DRG EL STNT ADDL $ 18,922.00 $ 18,922.00 4400 CARD CATH44006717 CA PLACE DRG EL STNT SNGL $ 18,236.00 $ 18,236.00 4400 CARD CATH44001073 CA PLACE OCC DEV VEIN ART $ 1,766.00 $ 1,766.00 4400 CARD CATH44006850 CA PLACE RAD DEL DEVICE $ 964.00 $ 964.00 4400 CARD CATH44001057 CA PM INSERT $ 1,313.00 $ 1,313.00 4400 CARD CATH44007035 CA PTA PERIPH ART $ 4,149.00 $ 4,149.00 4400 CARD CATH44007036 CA PTA PERIPH ART ADD $ 2,443.00 $ 2,443.00 4400 CARD CATH44007037 CA PTA RENL VISC $ 4,492.00 $ 4,492.00 4400 CARD CATH44007039 CA PTA VEN $ 4,073.00 $ 4,073.00 4400 CARD CATH44007038 CA PTA VISC ADD $ 2,455.00 $ 2,455.00 4400 CARD CATH44006767 CA PTC ATHERCTMY ADD VSL $ 1,040.00 $ 1,040.00 4400 CARD CATH44006769 CA PTC ATHERCTMY SNGL VSL $ 3,997.00 $ 3,997.00 4400 CARD CATH44006760 CA PTCA ADD VSL $ 945.00 $ 945.00 4400 CARD CATH44006759 CA PTCA SNGL VSL $ 3,623.00 $ 3,623.00 4400 CARD CATH44006105 CA RETRIEVAL VASCULAR FB $ 4,168.00 $ 4,168.00 4400 CARD CATH44001009 CA RHC CNGNITL ANMLES $ 9,000.00 $ 9,000.00 4400 CARD CATH44001021 CA RHC/LHC CNGNITL ANMLES $ 17,611.00 $ 17,611.00 4400 CARD CATH

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DEPARTMENT CODE

44006045 CA RHC/LHC RETRO $ 17,350.00 $ 17,350.00 4400 CARD CATH44006050 CA RHC/TS LHC INTCT SEP $ 22,000.00 $ 22,000.00 4400 CARD CATH44001037 CA S/I ANGIO PULM/AO/CORO $ 3,467.00 $ 3,467.00 4400 CARD CATH44001027 CA S/I ANGIO VENTRCLR/ATR $ 2,238.00 $ 2,238.00 4400 CARD CATH44006715 CA SEPTOSTMY ATR TV METHD $ 10,976.00 $ 10,976.00 4400 CARD CATH44006748 CA STENT IC SNGL VSL PRC $ 17,204.00 $ 17,204.00 4400 CARD CATH44006746 CA STNT IC ADD VSL PRC $ 1,326.00 $ 1,326.00 4400 CARD CATH44007034 CA STNT NOCOR/CAR/VERT EA $ 3,673.00 $ 3,673.00 4400 CARD CATH44006950 CA THROMBECTOMY CORO PRC $ 1,047.00 $ 1,047.00 4400 CARD CATH44001007 CA THROMBOLYSIS CORO IV $ 6,110.00 $ 6,110.00 4400 CARD CATH44001044 CA TMP TRNSCUTANEOUS PACE $ 1,518.00 $ 1,518.00 4400 CARD CATH44001028 CA TRANSCATH CLOSURE ASD $ 2,505.00 $ 2,505.00 4400 CARD CATH44006021 CA TRANSCATH CLOSURE VSD $ 2,816.00 $ 2,816.00 4400 CARD CATH44007029 CA TRANSCATHETER TX IV $ 13,361.00 $ 13,361.00 4400 CARD CATH44007040 CA US VASC ACCESS ADD ON $ 374.00 $ 374.00 4400 CARD CATH44006754 CA VALVULOPLSTY AORTC PRC $ 9,111.00 $ 9,111.00 4400 CARD CATH44006755 CA VALVULOPLSTY PULM PRC $ 7,233.00 $ 7,233.00 4400 CARD CATH44001043 CA VENOGRAM EXT BIL $ 1,795.00 $ 1,795.00 4400 CARD CATH44001042 CA VENOGRAM EXT UNI $ 1,580.00 $ 1,580.00 4400 CARD CATH44001083 CA VENOGRAM IVC $ 3,464.00 $ 3,464.00 4400 CARD CATH44001085 CA VENOGRAM RENL BIL $ 3,813.00 $ 3,813.00 4400 CARD CATH44007028 CA VENOGRAM RENL UNI $ 3,521.00 $ 3,521.00 4400 CARD CATH44001086 CA VENOGRAM SIN JUGULAR $ 3,623.00 $ 3,623.00 4400 CARD CATH44001084 CA VENOGRAM SVC $ 3,464.00 $ 3,464.00 4400 CARD CATH44001006 CAC ART CATH MNTRNG PERC $ 868.00 $ 868.00 4400 CARD CATH44007014 CAC CATH ABD LOW 1ST $ 1,332.00 $ 1,332.00 4400 CARD CATH44007015 CAC CATH ABD LOW 2ND $ 3,855.00 $ 3,855.00 4400 CARD CATH44007016 CAC CATH ABD LOW 3RD $ 5,176.00 $ 5,176.00 4400 CARD CATH44007017 CAC CATH ABD LOW ADD $ 907.00 $ 907.00 4400 CARD CATH44007010 CAC CATH THOR 1ST ART $ 1,131.00 $ 1,131.00 4400 CARD CATH44007011 CAC CATH THOR 2ND ART $ 1,114.00 $ 1,114.00 4400 CARD CATH44007012 CAC CATH THOR 3RD ART $ 1,112.00 $ 1,112.00 4400 CARD CATH44007013 CAC CATH THOR ADD ART $ 1,103.00 $ 1,103.00 4400 CARD CATH

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DEPARTMENT CODE

44001088 CAC EMBOL OCC NONHEAD NEC $ 2,004.00 $ 2,004.00 4400 CARD CATH44001024 CAC EP INSRT TMP LDS DUAL $ 443.00 $ 443.00 4400 CARD CATH44001050 CAC EP REPAIR SNGL LEAD $ 1,460.00 $ 1,460.00 4400 CARD CATH44007023 CAC EXCHNGE INTRAVAS CATH $ 3,397.00 $ 3,397.00 4400 CARD CATH44001040 CAC I/D HEMATOMA SHLDR $ 2,509.00 $ 2,509.00 4400 CARD CATH44001012 CAC IMP VENTRICULAR DEV $ 20,000.00 $ 20,000.00 4400 CARD CATH44001045 CAC IMPLANT CARD EVNT RCD $ 4,650.00 $ 4,650.00 4400 CARD CATH44001041 CAC INJ EXT VENOGRAM $ 2,597.00 $ 2,597.00 4400 CARD CATH44006098 CAC INS NON-TUN CV CATH5+ $ 1,909.00 $ 1,909.00 4400 CARD CATH44001059 CAC INS/REP LEADS INS PG $ 13,709.00 $ 13,709.00 4400 CARD CATH44006878 CAC INS/REP LEADS INS PG $ 29,277.00 $ 29,277.00 4400 CARD CATH44001049 CAC INSERT ELECT DUAL $ 5,196.00 $ 5,196.00 4400 CARD CATH44001048 CAC INSERT ELECT SNGL $ 9,103.00 $ 9,103.00 4400 CARD CATH44006052 CAC INSERT IABP PRC $ 3,804.00 $ 3,804.00 4400 CARD CATH44001036 CAC INSERT LD PRIOR PACER $ 1,358.00 $ 1,358.00 4400 CARD CATH44001023 CAC INSERT PACER DUAL LDS $ 13,815.00 $ 13,815.00 4400 CARD CATH44001031 CAC INSERT PACER GEN DUAL $ 9,274.00 $ 9,274.00 4400 CARD CATH44001029 CAC INSERT PACER GEN SNGL $ 7,855.00 $ 7,855.00 4400 CARD CATH44006710 CAC INSERT PACER TMP SNGL $ 3,779.00 $ 3,779.00 4400 CARD CATH44001038 CAC INSERT PACER W 3RD LD $ 1,103.00 $ 1,103.00 4400 CARD CATH44001022 CAC INSERT PACER/ELEC VNT $ 11,896.00 $ 11,896.00 4400 CARD CATH44001018 CAC INSERT PACER/ELECATR $ 13,977.00 $ 13,977.00 4400 CARD CATH44007009 CAC INTRO CATH AORTA $ 2,056.00 $ 2,056.00 4400 CARD CATH44006051 CAC INTRO CATH IVC /SVC $ 3,803.00 $ 3,803.00 4400 CARD CATH44007005 CAC INTRO CATH IVC /SVC $ 3,803.00 $ 3,803.00 4400 CARD CATH44007008 CAC INTRO EXT ART $ 223.00 $ 223.00 4400 CARD CATH44007025 CAC INTRO IVC FILTER $ 9,489.00 $ 9,489.00 4400 CARD CATH44007020 CAC IVCH RETRIEVE FB $ 4,171.00 $ 4,171.00 4400 CARD CATH44007024 CAC IVUS NONCO INI $ 811.00 $ 811.00 4400 CARD CATH44007019 CAC NONTHROMBOLYSIS IV $ 1,029.00 $ 1,029.00 4400 CARD CATH44006705 CAC PERICARDIOCENT INI $ 9,539.00 $ 9,539.00 4400 CARD CATH44001087 CAC PTA AORTIC $ 3,816.00 $ 3,816.00 4400 CARD CATH44007003 CAC PTA FEMPOP $ 1,001.00 $ 1,001.00 4400 CARD CATH

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DEPARTMENT CODE

44007002 CAC PTA IL $ 3,337.00 $ 3,337.00 4400 CARD CATH44007001 CAC PTA RENL VISC $ 1,547.00 $ 1,547.00 4400 CARD CATH44007000 CAC PTA TIBEOPERONEAL EA $ 3,204.00 $ 3,204.00 4400 CARD CATH44007004 CAC PTA VEN $ 1,004.00 $ 1,004.00 4400 CARD CATH44007041 CAC PTATHER FEM $ 1,290.00 $ 1,290.00 4400 CARD CATH44007042 CAC PTATHER TIBIA $ 1,489.00 $ 1,489.00 4400 CARD CATH44001053 CAC REPO LD/PRIOR PACER $ 1,080.00 $ 1,080.00 4400 CARD CATH44001039 CAC REPO PRIOR LV LEAD $ 1,296.00 $ 1,296.00 4400 CARD CATH44001051 CAC REPR ELECT DUAL $ 1,449.00 $ 1,449.00 4400 CARD CATH44001058 CAC RMV ICD ELEC TV EXTRC $ 3,020.00 $ 3,020.00 4400 CARD CATH44001034 CAC RMV ICD PACING GEN SQ $ 6,973.00 $ 6,973.00 4400 CARD CATH44001046 CAC RMVL CARD EVNT RCDR $ 1,199.00 $ 1,199.00 4400 CARD CATH44001054 CAC RMVL PERM PACER GEN $ 7,930.00 $ 7,930.00 4400 CARD CATH44001056 CAC RMVL TV PACR ELC DUAL $ 2,312.00 $ 2,312.00 4400 CARD CATH44001055 CAC RMVL TV PACR ELC SNGL $ 1,665.00 $ 1,665.00 4400 CARD CATH44001032 CAC RVSN PCKT PACING ICD $ 5,263.00 $ 5,263.00 4400 CARD CATH44001052 CAC RVSN/REL POCKET/PACER $ 4,118.00 $ 4,118.00 4400 CARD CATH44001033 CAC SC/DC ICD GENRATR CHG $ 14,908.00 $ 14,908.00 4400 CARD CATH44006877 CAC SC/DC ICD GENRATR CHG $ 14,908.00 $ 14,908.00 4400 CARD CATH44007006 CAC SELECT CATH 1ST VEN $ 1,150.00 $ 1,150.00 4400 CARD CATH44007007 CAC SELECT CATH 2ND VEN $ 941.00 $ 941.00 4400 CARD CATH44007021 CAC STENT NOCORO/CAR/VERT $ 14,823.00 $ 14,823.00 4400 CARD CATH44007022 CAC STENT PLCE NONCOR ADD $ 4,992.00 $ 4,992.00 4400 CARD CATH44007018 CAC THROMBOLYSIS IV NONCO $ 863.00 $ 863.00 4400 CARD CATH44001047 CAC UPGRD PACE SNGL DUAL $ 12,706.00 $ 12,706.00 4400 CARD CATH44006756 CAC VALPLASTY TRI WO RING $ 14,061.00 $ 14,061.00 4400 CARD CATH44029052 CON LOCM 300-349S I 1ML $ 10.60 $ 10.60 4402 CARD CATH44051031 EP ICAR FX CV GD IN SHTH $ 367.00 $ 367.00 4405 CARD CATH44001076 O2 SAT ART $ 303.00 $ 298.00 4400 CARD CATH44007046 OXYGEN UPTAKE REST $ 54.00 $ 54.00 4400 CARD CATH44051010 S CATH EP ABLT 3D VC MP $ 9,349.00 $ 9,349.00 4405 CARD CATH44051023 S CATH EP ABLT 3D VC MP $ 13,373.00 $ 13,373.00 4405 CARD CATH44051028 S CATH EP ABLT 3D VC MP $ 9,349.00 $ 9,349.00 4405 CARD CATH

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DEPARTMENT CODE

44051004 S CATH EP ABLTN NOCOOL $ 5,557.00 $ 5,557.00 4405 CARD CATH44051015 S CATH EP ABLTN NOCOOL $ 3,990.00 $ 3,990.00 4405 CARD CATH44051016 S CATH EP ABLTN NOCOOL $ 5,557.00 $ 5,557.00 4405 CARD CATH44051020 S CATH EP ABLTN NOCOOL $ 2,121.00 $ 2,121.00 4405 CARD CATH44051026 S CATH EP ABLTN NOCOOL $ 5,177.00 $ 5,177.00 4405 CARD CATH44051027 S CATH EP ABLTN NOCOOL $ 3,865.00 $ 3,865.00 4405 CARD CATH44051005 S CATH EP DX NO3D LT20 $ 1,540.00 $ 1,540.00 4405 CARD CATH44051006 S CATH EP DX NO3D LT20 $ 1,540.00 $ 1,540.00 4405 CARD CATH44051014 S CATH EP DX NO3D LT20 $ 5,507.00 $ 5,507.00 4405 CARD CATH44051019 S CATH EP DX NO3D LT20 $ 5,455.00 $ 5,455.00 4405 CARD CATH44051043 S CATH EP DX NO3D LT20 $ 4,042.00 $ 4,042.00 4405 CARD CATH44051044 S CATH EP DX NO3D LT20 $ 6,314.00 $ 6,314.00 4405 CARD CATH44051065 S CATH EP DXABLTN COOL TP $ 3,082.00 $ 3,082.00 4405 CARD CATH44051086 S CATH GUIDING $ 436.00 $ 436.00 4405 CARD CATH44051088 S CATH GUIDING $ 120.00 $ 120.00 4405 CARD CATH44051089 S CATH GUIDING $ 165.00 $ 165.00 4405 CARD CATH44051090 S CATH GUIDING $ 626.00 $ 626.00 4405 CARD CATH44051091 S CATH GUIDING $ 85.00 $ 85.00 4405 CARD CATH44051092 S CATH GUIDING $ 411.00 $ 411.00 4405 CARD CATH44051093 S CATH GUIDING $ 411.00 $ 411.00 4405 CARD CATH44051094 S CATH GUIDING $ 411.00 $ 411.00 4405 CARD CATH44051096 S CATH GUIDING $ 411.00 $ 411.00 4405 CARD CATH44051097 S CATH GUIDING $ 222.00 $ 222.00 4405 CARD CATH44051098 S CATH GUIDING $ 411.00 $ 411.00 4405 CARD CATH44051099 S CATH GUIDING $ 85.00 $ 85.00 4405 CARD CATH44051100 S CATH GUIDING $ 192.00 $ 192.00 4405 CARD CATH44051101 S CATH GUIDING $ 192.00 $ 192.00 4405 CARD CATH44051102 S CATH GUIDING $ 413.00 $ 413.00 4405 CARD CATH44051103 S CATH GUIDING $ 540.00 $ 540.00 4405 CARD CATH44051104 S CATH GUIDING $ 540.00 $ 540.00 4405 CARD CATH44051105 S CATH GUIDING $ 540.00 $ 540.00 4405 CARD CATH44051469 S CATH GUIDING $ 1,906.00 $ 1,906.00 4405 CARD CATH44051470 S CATH GUIDING $ 1,078.00 $ 1,078.00 4405 CARD CATH

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DEPARTMENT CODE

44051418 S CATH INFSN NO HD $ 420.00 $ 420.00 4405 CARD CATH44051618 S CATH INFSN NO HD $ 552.00 $ 552.00 4405 CARD CATH44051531 S CATH INTRACARDIAC ECHO $ 9,607.00 $ 9,607.00 4405 CARD CATH44051030 S CATH INTRAVASCULAR US $ 9,784.00 $ 9,784.00 4405 CARD CATH44051022 S CATH OCCLUSION $ 1,262.00 $ 1,262.00 4405 CARD CATH44051119 S CATH THROMB/EMBOLCTMY $ 7,191.00 $ 7,191.00 4405 CARD CATH44051155 S CATH THROMB/EMBOLCTMY $ 2,403.00 $ 2,403.00 4405 CARD CATH44051156 S CATH THROMB/EMBOLCTMY $ 3,375.00 $ 3,375.00 4405 CARD CATH44051595 S CATH TRNSLML ATHR ROT $ 6,802.00 $ 6,802.00 4405 CARD CATH44051157 S CATH TRNSLMNL ANG LSR $ 8,362.00 $ 8,362.00 4405 CARD CATH44051163 S CATH TRNSLMNL ANG LSR $ 9,438.00 $ 9,438.00 4405 CARD CATH44051164 S CATH TRNSLMNL ANG LSR $ 2,428.00 $ 2,428.00 4405 CARD CATH44051087 S CATH TRNSML ANG NOLSR $ 772.00 $ 772.00 4405 CARD CATH44051109 S CATH TRNSML ANG NOLSR $ 765.00 $ 765.00 4405 CARD CATH44051110 S CATH TRNSML ANG NOLSR $ 1,609.00 $ 1,609.00 4405 CARD CATH44051111 S CATH TRNSML ANG NOLSR $ 1,611.00 $ 1,611.00 4405 CARD CATH44051113 S CATH TRNSML ANG NOLSR $ 765.00 $ 765.00 4405 CARD CATH44051114 S CATH TRNSML ANG NOLSR $ 1,700.00 $ 1,700.00 4405 CARD CATH44051116 S CATH TRNSML ANG NOLSR $ 1,977.00 $ 1,977.00 4405 CARD CATH44051131 S CATH TRNSML ANG NOLSR $ 1,020.00 $ 1,020.00 4405 CARD CATH44051161 S CATH TRNSML ANG NOLSR $ 3,861.00 $ 3,861.00 4405 CARD CATH44051162 S CATH TRNSML ANG NOLSR $ 993.00 $ 993.00 4405 CARD CATH44051167 S CATH TRNSML ANG NOLSR $ 2,428.00 $ 2,428.00 4405 CARD CATH44051436 S CATH TRNSML ANG NOLSR $ 269.00 $ 269.00 4405 CARD CATH44051133 S DEVICE CLOSURE VASC $ 420.00 $ 420.00 4405 CARD CATH44051165 S DEVICE CLOSURE VASC $ 849.00 $ 849.00 4405 CARD CATH44051050 S EVENT RECORDER CARDIAC $ - $ - 4405 CARD CATH44051054 S FILTER VENA CAVA $ 3,556.00 $ 3,556.00 4405 CARD CATH44051107 S FILTER VENA CAVA $ 7,086.00 $ 7,086.00 4405 CARD CATH44051108 S FILTER VENA CAVA $ 5,622.00 $ 5,622.00 4405 CARD CATH44051048 S ICD DUAL CHAMBER $ - $ - 4405 CARD CATH44051056 S ICD OTHR THAN SNGL/DL $ - $ - 4405 CARD CATH44051049 S ICD SNGL CHAMBER $ - $ - 4405 CARD CATH

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DEPARTMENT CODE

44051154 S IMP VAD IMPELLA IMPLANT $ 91,982.00 $ 91,982.00 4405 CARD CATH44051038 S INTR NOINTRACRD NOLSR $ 118.00 $ 118.00 4405 CARD CATH44051081 S INTR NOINTRACRD NOLSR $ 273.00 $ 273.00 4405 CARD CATH44051082 S INTR NOINTRACRD NOLSR $ 257.00 $ 257.00 4405 CARD CATH44051083 S INTR NOINTRACRD NOLSR $ 742.00 $ 742.00 4405 CARD CATH44051084 S INTR NOINTRACRD NOLSR $ 636.00 $ 636.00 4405 CARD CATH44051085 S INTR NOINTRACRD NOLSR $ 745.00 $ 745.00 4405 CARD CATH44051002 S INTRO GDE STRBLE NOPEEL $ 859.00 $ 859.00 4405 CARD CATH44051007 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 4405 CARD CATH44051012 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 4405 CARD CATH44051013 S INTRO GDE STRBLE NOPEEL $ 219.00 $ 219.00 4405 CARD CATH44051033 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 4405 CARD CATH44051034 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 4405 CARD CATH44051041 S INTRO GDE STRBLE NOPEEL $ 959.00 $ 959.00 4405 CARD CATH44051046 S INTRO GDE STRBLE NOPEEL $ 605.00 $ 605.00 4405 CARD CATH44051051 S LD ICD ENDOCRD 1 COIL $ - $ - 4405 CARD CATH44051057 S LD ICD ENDOCRD 2 COIL $ - $ - 4405 CARD CATH44051058 S LD ICD NOEND 1OR2 CL $ - $ - 4405 CARD CATH44051059 S LD PCR NO TV SNGL PAS $ - $ - 4405 CARD CATH44051052 S LD PCR TV VDD 1 PASS $ - $ - 4405 CARD CATH44051060 S LD PCR/ICD COMBO $ - $ - 4405 CARD CATH44051061 S LD VENT CORO VEN SYS LT $ - $ - 4405 CARD CATH44051063 S PCR 1 CHMBR NRR $ - $ - 4405 CARD CATH44051053 S PCR 1 CHMBR RR $ - $ - 4405 CARD CATH44051062 S PCR 2 CHMBR NRR $ - $ - 4405 CARD CATH44051047 S PCR 2 CHMBR RR $ - $ - 4405 CARD CATH44051064 S PCR NOT 1 OR 2 CHMBR $ - $ - 4405 CARD CATH44051152 S STNT COATED WDEL SYS $ 9,615.00 $ 9,615.00 4405 CARD CATH44051153 S STNT COATED WDEL SYS $ 9,615.00 $ 9,615.00 4405 CARD CATH44051339 S STNT COATED WDEL SYS $ 11,608.00 $ 11,608.00 4405 CARD CATH44051401 S STNT COATED WDEL SYS $ 12,767.00 $ 12,767.00 4405 CARD CATH44051145 S STNT NOCOAT WDEL SYS $ 5,748.00 $ 5,748.00 4405 CARD CATH44051146 S STNT NOCOAT WDEL SYS $ 6,090.00 $ 6,090.00 4405 CARD CATH

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DEPARTMENT CODE

44051147 S STNT NOCOAT WDEL SYS $ 6,389.00 $ 6,389.00 4405 CARD CATH44051149 S STNT NOCOAT WDEL SYS $ 6,304.00 $ 6,304.00 4405 CARD CATH44051150 S STNT NOCOAT WDEL SYS $ 6,710.00 $ 6,710.00 4405 CARD CATH44051151 S STNT NOCOAT WDEL SYS $ 7,288.00 $ 7,288.00 4405 CARD CATH44051551 S STNT NOCOAT WDEL SYS $ 8,232.00 $ 8,232.00 4405 CARD CATH44051144 S STNT NOCOAT WO DEL SYS $ 6,898.00 $ 6,898.00 4405 CARD CATH44051142 S STRL AMPLATE SUP STIFF $ 419.00 $ 419.00 4405 CARD CATH44051025 S STRL ANGIO WEST 18 NDL $ 20.00 $ 20.00 4405 CARD CATH44051138 S STRL ARTERIAL TAMPER $ 409.00 $ 409.00 4405 CARD CATH44051530 S STRL BAL BIPOLAR ELECT $ 1,036.00 $ 1,036.00 4405 CARD CATH44051118 S STRL BALLOON CUTTING $ 3,968.00 $ 3,968.00 4405 CARD CATH44051425 S STRL BERMAN ANGIO $ 439.00 $ 439.00 4405 CARD CATH44051121 S STRL BERMAN CATH $ 395.00 $ 395.00 4405 CARD CATH44051622 S STRL BIOMEDI CNNLA 17FR $ 967.00 $ 967.00 4405 CARD CATH44051510 S STRL BI-POLAR CATH $ 591.00 $ 591.00 4405 CARD CATH44051499 S STRL BRACHY CATH $ 11,741.00 $ 11,741.00 4405 CARD CATH44051032 S STRL BRK 71CM NDL $ 1,136.00 $ 1,136.00 4405 CARD CATH44051039 S STRL BRK 89CM NDL $ 1,136.00 $ 1,136.00 4405 CARD CATH44051040 S STRL BRK-1 71CM NDL $ 1,136.00 $ 1,136.00 4405 CARD CATH44051593 S STRL CORONARY SNARE $ 2,422.00 $ 2,422.00 4405 CARD CATH44051506 S STRL CVS ULTRASOUND CAT $ 5,101.00 $ 5,101.00 4405 CARD CATH44051024 S STRL DFIB ADLT T2 PAD $ 259.00 $ 259.00 4405 CARD CATH44051585 S STRL DOCAB WR .014-.018 $ 907.00 $ 907.00 4405 CARD CATH44051417 S STRL DOUBLE LUMEN CVP $ 255.00 $ 255.00 4405 CARD CATH44051474 S STRL EXCHANGE SYS AMPLT $ 1,735.00 $ 1,735.00 4405 CARD CATH44051036 S STRL FEMOSTOP $ 357.00 $ 357.00 4405 CARD CATH44051055 S STRL FOGARTY CATH $ 416.00 $ 416.00 4405 CARD CATH44051066 S STRL GLOW N TELL 30CM $ 259.00 $ 259.00 4405 CARD CATH44051583 S STRL HEMOSTATIC VALVE $ 300.00 $ 300.00 4405 CARD CATH44051505 S STRL INFLATION DEVICE $ 510.00 $ 510.00 4405 CARD CATH44051501 S STRL INFUSION CATHETER $ 1,233.00 $ 1,233.00 4405 CARD CATH44051621 S STRL INNRCL CIRC SET $ 1,715.00 $ 1,715.00 4405 CARD CATH44051620 S STRL INNRCL CTH 10.7FR $ 6,546.00 $ 6,546.00 4405 CARD CATH

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DEPARTMENT CODE

44051021 S STRL INTRO/BIV PACE KIT $ 4,547.00 $ 4,547.00 4405 CARD CATH44051035 S STRL INTRODUCER $ 269.00 $ 269.00 4405 CARD CATH44051592 S STRL J PACING LEAD $ 1,144.00 $ 1,144.00 4405 CARD CATH44051141 S STRL MAGNET EXCH DEVICE $ 368.00 $ 368.00 4405 CARD CATH44061099 S STRL MISC. SUPP CHARGE $ - $ - 4406 CARD CATH44051525 S STRL MYLAR CATH $ 1,739.00 $ 1,739.00 4405 CARD CATH44051095 S STRL MYOCARDI BIPSY FOR $ 2,495.00 $ 2,495.00 4405 CARD CATH44051405 S STRL NIH $ 623.00 $ 623.00 4405 CARD CATH44051421 S STRL OPTICATH $ 657.00 $ 657.00 4405 CARD CATH44051423 S STRL OXIMETRIX SWAN $ 2,120.00 $ 2,120.00 4405 CARD CATH44051533 S STRL PACEWEDGE CATH $ 1,418.00 $ 1,418.00 4405 CARD CATH44051552 S STRL PCI BALLOON $ 5,811.00 $ 5,811.00 4405 CARD CATH44051139 S STRL PERCL KNOT PUSHER $ 409.00 $ 409.00 4405 CARD CATH44051492 S STRL PERFUSION BALLOON $ 6,257.00 $ 6,257.00 4405 CARD CATH44051000 S STRL POTTS COURNAND $ 123.00 $ 123.00 4405 CARD CATH44051037 S STRL PTCA INTRODUCER $ 497.00 $ 497.00 4405 CARD CATH44051134 S STRL PULLBACK SLED $ 295.00 $ 295.00 4405 CARD CATH44051520 S STRL QUADRIPOLAR ELECT $ 2,244.00 $ 2,244.00 4405 CARD CATH44051406 S STRL RADI WIRE $ 2,766.00 $ 2,766.00 4405 CARD CATH44051003 S STRL RADL ART CATH TRAY $ 137.00 $ 137.00 4405 CARD CATH44051009 S STRL RAMP INTRODUCER $ 911.00 $ 911.00 4405 CARD CATH44051029 S STRL REFSTAR QUIKPATCH $ 1,516.00 $ 1,516.00 4405 CARD CATH44051516 S STRL RF ABLATION CATH $ 3,636.00 $ 3,636.00 4405 CARD CATH44051143 S STRL ROTO ADVANCER $ 817.00 $ 817.00 4405 CARD CATH44051441 S STRL ROTO GLIDE $ 585.00 $ 585.00 4405 CARD CATH44051581 S STRL ROTOBLADER WIRE $ 1,144.00 $ 1,144.00 4405 CARD CATH44051008 S STRL RSPNCE CSL 120CM $ 2,122.00 $ 2,122.00 4405 CARD CATH44051498 S STRL SCHWARTEN LP $ 4,836.00 $ 4,836.00 4405 CARD CATH44051509 S STRL SIZE PLATE AMPLT $ 49.00 $ 49.00 4405 CARD CATH44051507 S STRL SIZING BALLOON AMP $ 968.00 $ 968.00 4405 CARD CATH44051465 S STRL SONES CATH $ 623.00 $ 623.00 4405 CARD CATH44051623 S STRL TANDEMHEART KIT $ 82,018.00 $ 82,018.00 4405 CARD CATH44051570 S STRL TERUMO WIRE $ 283.00 $ 283.00 4405 CARD CATH

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DEPARTMENT CODE

44051136 S STRL THE CLOSER $ 919.00 $ 919.00 4405 CARD CATH44051420 S STRL THERMAL SWAN $ 534.00 $ 534.00 4405 CARD CATH44051410 S STRL TRANSEPTAL $ 623.00 $ 623.00 4405 CARD CATH44051515 S STRL TRI-POLAR CATH $ 2,438.00 $ 2,438.00 4405 CARD CATH44051430 S STRL USCI LEHMAN $ 473.00 $ 473.00 4405 CARD CATH44051117 S STRL VALVULOPL CATH 5.5 $ 4,816.00 $ 4,816.00 4405 CARD CATH44051115 S STRL VALVULOPLASTY CATH $ 3,475.00 $ 3,475.00 4405 CARD CATH44051125 S STRL WEDGE CATH $ 321.00 $ 321.00 4405 CARD CATH44051554 S STRL ZOLL PRD PADS $ 437.00 $ 437.00 4405 CARD CATH44051106 S SYS EMBLZTN PROTCTIVE $ 6,289.00 $ 6,289.00 4405 CARD CATH44051159 S SYS EMBLZTN PROTCTIVE $ 7,261.00 $ 7,261.00 4405 CARD CATH44051158 S SYS SEPTAL DEFECT IC $ 22,605.00 $ 22,605.00 4405 CARD CATH44051160 S SYS SEPTAL DEFECT IC $ 16,224.00 $ 16,224.00 4405 CARD CATH44051471 S SYS SEPTAL DEFECT IC $ 3,968.00 $ 3,968.00 4405 CARD CATH44051473 S SYS SEPTAL DEFECT IC $ 14,090.00 $ 14,090.00 4405 CARD CATH44051517 S SYS SEPTAL DEFECT IC $ 11,954.00 $ 11,954.00 4405 CARD CATH44051619 S SYS SEPTAL DEFECT IC $ 21,325.00 $ 21,325.00 4405 CARD CATH44051011 S WIRE GUIDE $ 834.00 $ 834.00 4405 CARD CATH44051017 S WIRE GUIDE $ 728.00 $ 728.00 4405 CARD CATH44051018 S WIRE GUIDE $ 261.00 $ 261.00 4405 CARD CATH44051042 S WIRE GUIDE $ 90.00 $ 90.00 4405 CARD CATH44051067 S WIRE GUIDE $ 679.00 $ 679.00 4405 CARD CATH44051068 S WIRE GUIDE $ 753.00 $ 753.00 4405 CARD CATH44051069 S WIRE GUIDE $ 658.00 $ 658.00 4405 CARD CATH44051070 S WIRE GUIDE $ 749.00 $ 749.00 4405 CARD CATH44051071 S WIRE GUIDE $ 485.00 $ 485.00 4405 CARD CATH44051072 S WIRE GUIDE $ 409.00 $ 409.00 4405 CARD CATH44051073 S WIRE GUIDE $ 736.00 $ 736.00 4405 CARD CATH44051074 S WIRE GUIDE $ 381.00 $ 381.00 4405 CARD CATH44051075 S WIRE GUIDE $ 428.00 $ 428.00 4405 CARD CATH44051076 S WIRE GUIDE $ 411.00 $ 411.00 4405 CARD CATH44051077 S WIRE GUIDE $ 541.00 $ 541.00 4405 CARD CATH44051078 S WIRE GUIDE $ 742.00 $ 742.00 4405 CARD CATH

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DEPARTMENT CODE

44051079 S WIRE GUIDE $ 651.00 $ 651.00 4405 CARD CATH44051080 S WIRE GUIDE $ 834.00 $ 834.00 4405 CARD CATH44051166 S WIRE GUIDE $ 114.00 $ 114.00 4405 CARD CATH44051508 S WIRE GUIDE $ 377.00 $ 377.00 4405 CARD CATH44051540 S WIRE GUIDE $ 204.00 $ 204.00 4405 CARD CATH44051545 S WIRE GUIDE $ 165.00 $ 165.00 4405 CARD CATH44051560 S WIRE GUIDE $ 364.00 $ 364.00 4405 CARD CATH44051565 S WIRE GUIDE $ 288.00 $ 288.00 4405 CARD CATH44051575 S WIRE GUIDE $ 1,144.00 $ 1,144.00 4405 CARD CATH26710925 CARDIAC REHAB W EKG $ 332.00 $ 332.00 2671 CARD REHAB26710924 CARDIAC REHAB WO EKG $ 211.00 $ 211.00 2671 CARD REHAB26710950 PHASE III SELF PAY REHAB $ 18.50 $ 18.50 2671 CARD REHAB26610020 BRONCHOSCOPY $ 2,574.00 $ 2,574.00 2661 CARD-NSG PICU26610050 S NSTRL BENDY BUMPER 30"R $ 279.00 $ 279.00 2661 CARD-NSG PICU26610040 S NSTRL BENDY BUMPER 48"R $ 364.00 $ 364.00 2661 CARD-NSG PICU26610100 S STRL CHEST TUBE TRAY $ 831.00 $ 831.00 2661 CARD-NSG PICU26612000 S STRL DSP OXY PROBE $ 134.00 $ 134.00 2661 CARD-NSG PICU26610031 S STRL TRIPLE LUMEN CATH $ 363.00 $ 363.00 2661 CARD-NSG PICU40262114 D51/2NS 1000ML $ 128.23 $ 128.23 4026 CASE CART40262116 D51/2NS 500ML $ 123.63 $ 123.63 4026 CASE CART40262099 D5W 100ML $ 4.66 $ 4.66 4026 CASE CART40262111 GLYCINE IRRG $ 136.92 $ 136.92 4026 CASE CART40262102 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 4026 CASE CART40262107 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 4026 CASE CART40262118 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 4026 CASE CART40262119 LACTATED RINGER IRRIG $ 129.80 $ 129.80 4026 CASE CART40262129 LACTATED RINGER IRRIG $ 123.58 $ 123.58 4026 CASE CART40262101 NA CL 0.9% 1000CC $ 127.19 $ 127.19 4026 CASE CART40262098 NA CL 0.9% 100ML $ 4.62 $ 4.62 4026 CASE CART40262115 NA CL 0.9% 250CC $ 3.16 $ 3.16 4026 CASE CART40262117 NA CL 0.9% 500ML $ 121.95 $ 121.95 4026 CASE CART40262136 NA CL IRRIG 500ML $ 53.62 $ 53.62 4026 CASE CART40262137 NA CL IRRIG 500ML $ 20.88 $ 20.88 4026 CASE CART

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DEPARTMENT CODE

40263115 S CATH DRAINAGE $ 16.00 $ 16.00 4026 CASE CART40263143 S CATH DRAINAGE $ 335.00 $ 335.00 4026 CASE CART40263156 S CATH DRAINAGE $ 129.00 $ 129.00 4026 CASE CART40263100 S CATH SP/CYSTOSCOPIC $ 65.00 $ 65.00 4026 CASE CART40263104 S CATH SP/CYSTOSCOPIC $ 233.00 $ 233.00 4026 CASE CART40263105 S CATH SP/CYSTOSCOPIC $ 228.00 $ 228.00 4026 CASE CART40263142 S CATH SP/CYSTOSCOPIC $ 357.00 $ 357.00 4026 CASE CART40267634 S NSTRL IMMOBILIZER KNEE $ 120.00 $ 120.00 4026 CASE CART40267352 S NSTRL IMOBLIZR SHOULDR $ 126.00 $ 126.00 4026 CASE CART40261127 S NSTRL PAD BOVIE AD/PRE $ 64.00 $ 64.00 4026 CASE CART40265227 S STRL 3M CASETE PMP TB $ 727.00 $ 727.00 4026 CASE CART40265213 S STRL ACUFEX UNI CANNULA $ 236.00 $ 236.00 4026 CASE CART40268104 S STRL ADAPTIC/XROFRM $ 35.00 $ 35.00 4026 CASE CART40267435 S STRL ARCH BAR $ 65.00 $ 65.00 4026 CASE CART40265169 S STRL ARTHROPLASTY BLADE $ 712.00 $ 712.00 4026 CASE CART40265168 S STRL ARTHROPLASTY BURR $ 778.00 $ 778.00 4026 CASE CART40265226 S STRL ARTHROSCOPY TUBING $ 236.00 $ 236.00 4026 CASE CART40265224 S STRL ARTHROWAND $ 2,260.00 $ 2,260.00 4026 CASE CART40263150 S STRL BILE BAG $ 120.00 $ 120.00 4026 CASE CART40266146 S STRL BLADE BEAVER 64 $ 91.00 $ 91.00 4026 CASE CART40261154 S STRL BLOOD TUBING $ 89.00 $ 89.00 4026 CASE CART40261126 S STRL BOVIE EXT TIP $ 69.00 $ 69.00 4026 CASE CART40261169 S STRL BOVIE HD/FT PENCIL $ 71.00 $ 71.00 4026 CASE CART40261150 S STRL BSS TUBING $ 39.00 $ 39.00 4026 CASE CART40261155 S STRL BURETROL $ 60.00 $ 60.00 4026 CASE CART40265111 S STRL CEMENT MIXER FEMOR $ 673.00 $ 673.00 4026 CASE CART40265110 S STRL CEMENT MIXER REGUL $ 401.00 $ 401.00 4026 CASE CART40263127 S STRL CFT/UNCFT TRACH TB $ 226.00 $ 226.00 4026 CASE CART40263130 S STRL CHEST TUBE $ 183.00 $ 183.00 4026 CASE CART40267134 S STRL CHOLANGIOCATH SPD $ 236.00 $ 236.00 4026 CASE CART40263146 S STRL CYSTO TUBING $ 67.00 $ 67.00 4026 CASE CART40265153 S STRL DISP ESMARK $ 126.00 $ 126.00 4026 CASE CART40267306 S STRL DISP.BIPOLAR CORD $ 52.00 $ 52.00 4026 CASE CART

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DEPARTMENT CODE

40261124 S STRL DSP FIBE.BOVIE PD $ 201.00 $ 201.00 4026 CASE CART40267305 S STRL DSP IR BIPLAR CORD $ 478.00 $ 478.00 4026 CASE CART40263102 S STRL FEEDING TUBE $ 19.00 $ 19.00 4026 CASE CART40263107 S STRL FLEY KT W/DRAIN BG $ 213.00 $ 213.00 4026 CASE CART40263106 S STRL FOLEY KIT W/METER $ 218.00 $ 218.00 4026 CASE CART40263155 S STRL HEMOVAC $ 437.00 $ 437.00 4026 CASE CART40268136 S STRL IDOFORM PACKING $ 65.00 $ 65.00 4026 CASE CART40268176 S STRL ILIZAROV KIT $ 283.00 $ 283.00 4026 CASE CART40265115 S STRL INTRAMEDULLA BRUSH $ 154.00 $ 154.00 4026 CASE CART40261139 S STRL IOBAN DRAPE $ 222.00 $ 222.00 4026 CASE CART40261122 S STRL IOBAN POUCH $ 129.00 $ 129.00 4026 CASE CART40265161 S STRL IRRG CASSET CORE $ 236.00 $ 236.00 4026 CASE CART40265109 S STRL JAMSH NDL 1LG 4 IN $ 83.00 $ 83.00 4026 CASE CART40265228 S STRL JORGENSON TRAP BOT $ 355.00 $ 355.00 4026 CASE CART40261133 S STRL LIMB ISOLATION BAG $ 138.00 $ 138.00 4026 CASE CART40267415 S STRL MEROCEL SINUS PACK $ 147.00 $ 147.00 4026 CASE CART40267307 S STRL NEURO PATTIES $ 74.00 $ 74.00 4026 CASE CART40268147 S STRL N-TERFACE DRESS LG $ 51.00 $ 51.00 4026 CASE CART40268146 S STRL N-TERFACE DRESS SM $ 34.00 $ 34.00 4026 CASE CART40268135 S STRL PACKING ADAPTIC $ 74.00 $ 74.00 4026 CASE CART40268123 S STRL PACKNG MEROGEL $ 14.00 $ 14.00 4026 CASE CART40263161 S STRL PLEUR-EVAC-ATS $ 1,150.00 $ 1,150.00 4026 CASE CART40263159 S STRL RESERVOIR JP 100 $ 82.00 $ 82.00 4026 CASE CART40263158 S STRL RESERVOIR JP 400 $ 152.00 $ 152.00 4026 CASE CART40263145 S STRL SALEM SUMP TUBE $ 78.00 $ 78.00 4026 CASE CART40268140 S STRL SCARLET RED $ 45.00 $ 45.00 4026 CASE CART40266111 S STRL SHARP-POINT BLADE $ 102.00 $ 102.00 4026 CASE CART40267185 S STRL STAPLER LS3091 $ 871.00 $ 871.00 4026 CASE CART40267184 S STRL STAPLER LS3111 $ 924.00 $ 924.00 4026 CASE CART40267176 S STRL SUCT/IRRIG PROBE $ 724.00 $ 724.00 4026 CASE CART40261118 S STRL TAB MACHINE TUBING $ 83.00 $ 83.00 4026 CASE CART40261148 S STRL TBG ARTHRO ARTHRX $ 513.00 $ 513.00 4026 CASE CART40267045 S STRL TBING INSUFFLATION $ 573.00 $ 573.00 4026 CASE CART

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DEPARTMENT CODE

40267044 S STRL TROCA INERDYNE 12M $ 1,045.00 $ 1,045.00 4026 CASE CART40263131 S STRL TROCAR CHEST TUBES $ 192.00 $ 192.00 4026 CASE CART40267170 S STRL TRUCUT BIOPSY NDL $ 147.00 $ 147.00 4026 CASE CART40263113 S STRL TUBE T BILIARY $ 847.00 $ 847.00 4026 CASE CART40265223 S STRL TUBING ARTHROSCOPY $ 392.00 $ 392.00 4026 CASE CART40263319 S STRL TUBING TUR $ 157.00 $ 157.00 4026 CASE CART40265229 S STRL TUBNG PULSE LAVGE $ 394.00 $ 394.00 4026 CASE CART40263165 S STRL URINE DRAIN BAG $ 71.00 $ 71.00 4026 CASE CART40263170 S STRL URINE METER $ 126.00 $ 126.00 4026 CASE CART40266190 S STRL WECK SPONGE $ 34.00 $ 34.00 4026 CASE CART40262131 WATER IRRIG 500ML $ 121.95 $ 121.95 4026 CASE CART40262138 WATER IRRIG 500ML $ 60.31 $ 60.31 4026 CASE CART40262139 WATER IRRIG 500ML $ 40.28 $ 40.28 4026 CASE CART40262140 WATER IRRIG 500ML $ 20.88 $ 20.88 4026 CASE CART83012040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 8301 CCU OTHER NURSING CHGS83012030 OBSERVATION PER HOUR $ 236.00 $ 236.00 8301 CCU OTHER NURSING CHGS83010015 S NSTRL CARDIA INSTR BK $ 55.00 $ 55.00 8301 CCU OTHER NURSING CHGS83010019 S STRL CARDIAC OUTPUT TB $ 224.00 $ 224.00 8301 CCU OTHER NURSING CHGS83010005 S STRL CATH M-LUMEN CVP $ 676.00 $ 676.00 8301 CCU OTHER NURSING CHGS83010008 S STRL CATH PROTECT SLV $ 106.00 $ 106.00 8301 CCU OTHER NURSING CHGS83010006 S STRL CATH RADIAL ARTERY $ 312.00 $ 312.00 8301 CCU OTHER NURSING CHGS83010007 S STRL CATHETER PACEMAKER $ 1,622.00 $ 1,622.00 8301 CCU OTHER NURSING CHGS83010011 S STRL DISP TRANSDUCER $ 532.00 $ 532.00 8301 CCU OTHER NURSING CHGS83010017 S STRL DSP TRANSDUCER DBL $ 342.00 $ 342.00 8301 CCU OTHER NURSING CHGS83010016 S STRL DSP TRANSDUCER SGL $ 285.00 $ 285.00 8301 CCU OTHER NURSING CHGS83010004 S STRL FEMORAL ARTERY KIT $ 297.00 $ 297.00 8301 CCU OTHER NURSING CHGS83010010 S STRL PERICARDI WIRE GDE $ 116.00 $ 116.00 8301 CCU OTHER NURSING CHGS83010009 S STRL PERICARDIOCEN CATH $ 204.00 $ 204.00 8301 CCU OTHER NURSING CHGS83010018 S STRL PERICARDIOCENT NDL $ 285.00 $ 285.00 8301 CCU OTHER NURSING CHGS83010003 S STRL SWAN-GAN INTRO KIT $ 520.00 $ 520.00 8301 CCU OTHER NURSING CHGS83010014 S STRL TRACHE SUC SYSTEM $ 275.00 $ 275.00 8301 CCU OTHER NURSING CHGS83010012 S STRL WIRE GUIDE 65CM $ 139.00 $ 139.00 8301 CCU OTHER NURSING CHGS83010013 S STRL WIRE GUIDE 70+145 $ 201.00 $ 201.00 8301 CCU OTHER NURSING CHGS

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DEPARTMENT CODE

62412380 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 6241 CENT DIST62412390 D10W 1000ML $ 123.19 $ 123.19 6241 CENT DIST62412395 D10W 1000ML $ 123.19 $ 123.19 6241 CENT DIST62412400 D10W 500ML 2247 $ 121.29 $ 121.29 6241 CENT DIST62412475 D51/2NS 1000ML $ 128.23 $ 128.23 6241 CENT DIST62412480 D51/2NS 1000ML $ 128.23 $ 128.23 6241 CENT DIST62412470 D51/2NS 500ML $ 123.63 $ 123.63 6241 CENT DIST62412465 D51/4NS 500ML $ 123.63 $ 123.63 6241 CENT DIST62412455 D5LR 1000ML $ 135.87 $ 135.87 6241 CENT DIST62412460 D5LR 1000ML $ 135.87 $ 135.87 6241 CENT DIST62412490 D5NS 1000ML $ 128.23 $ 128.23 6241 CENT DIST62412500 D5NS 1000ML $ 128.23 $ 128.23 6241 CENT DIST62412495 D5NS 500ML $ 129.23 $ 129.23 6241 CENT DIST62412385 D-5-W 1000 CC $ 127.19 $ 127.19 6241 CENT DIST62412370 D5W 100ML $ 4.66 $ 4.66 6241 CENT DIST62412375 D5W 250ML $ 2.98 $ 2.98 6241 CENT DIST62412371 D5W 50ML $ 4.66 $ 4.66 6241 CENT DIST62412410 GLYCINE IRRG $ 136.92 $ 136.92 6241 CENT DIST62412415 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 6241 CENT DIST62412420 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 6241 CENT DIST62412536 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 6241 CENT DIST62412537 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 6241 CENT DIST62412435 NA CL 0.45% 1000ML $ 127.19 $ 127.19 6241 CENT DIST62412430 NA CL 0.45% 500ML $ 121.95 $ 121.95 6241 CENT DIST62412520 NA CL 0.9% 1000CC $ 127.19 $ 127.19 6241 CENT DIST62412509 NA CL 0.9% 100ML $ 4.62 $ 4.62 6241 CENT DIST62412510 NA CL 0.9% 250CC $ 3.16 $ 3.16 6241 CENT DIST62412515 NA CL 0.9% 500ML $ 121.95 $ 121.95 6241 CENT DIST62412505 NA CL 0.9% 50ML $ 4.70 $ 4.70 6241 CENT DIST62440832 NA CL IRRIG 500ML $ 54.89 $ 54.89 6244 CENT DIST62440833 NA CL IRRIG 500ML $ 54.89 $ 54.89 6244 CENT DIST62440834 NA CL IRRIG 500ML $ 54.89 $ 54.89 6244 CENT DIST62440835 NA CL IRRIG 500ML $ 54.89 $ 54.89 6244 CENT DIST

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DEPARTMENT CODE

62440837 NA CL IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST62440838 NA CL IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST62440839 NA CL IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST62412530 RINGERS SOL IV 500ML $ 101.21 $ 101.21 6241 CENT DIST62411285 S CATH BLN DILATE NOVSC $ 110.00 $ 110.00 6241 CENT DIST62410535 S LD PCR TEMP PACING LEAD $ 304.00 $ 304.00 6241 CENT DIST62411467 S NSTRL ADAPT PASTE $ 6.00 $ 6.00 6241 CENT DIST62400023 S NSTRL AIR-PUTTY,MEDIUM $ 107.00 $ 107.00 6240 CENT DIST62400022 S NSTRL AIR-PUTTY,SOFT $ 107.00 $ 107.00 6240 CENT DIST62411771 S NSTRL AIRWAY GUEDEL 90M $ 11.00 $ 11.00 6241 CENT DIST62430206 S NSTRL BAL SUSPENSION $ 106.00 $ 106.00 6243 CENT DIST62430165 S NSTRL BAR GRAB $ 357.00 $ 357.00 6243 CENT DIST62430170 S NSTRL BAR GRAB TUB $ 357.00 $ 357.00 6243 CENT DIST62400185 S NSTRL BATH SPONGE $ 40.00 $ 40.00 6240 CENT DIST62440002 S NSTRL BED CHECK ALA PAD $ - $ - 6244 CENT DIST62400137 S NSTRL BEDFOR DBL STL 3" $ 114.00 $ 114.00 6240 CENT DIST62400136 S NSTRL BEDFORD DBL STAL $ 108.00 $ 108.00 6240 CENT DIST62430160 S NSTRL BENCH BATHTUB $ 396.00 $ 396.00 6243 CENT DIST62400105 S NSTRL BIG GRIP 30LB $ 102.00 $ 102.00 6240 CENT DIST62400106 S NSTRL BIG GRIP 60LB $ 102.00 $ 102.00 6240 CENT DIST62411217 S NSTRL BOLU FEED TB 12FR $ 149.00 $ 149.00 6241 CENT DIST62440830 S NSTRL BR PWS GWN REG $ 126.00 $ 126.00 6244 CENT DIST62440831 S NSTRL BR PWS GWN X LRG $ 156.00 $ 156.00 6244 CENT DIST62400006 S NSTRL BUTTON HOOK $ 67.00 $ 67.00 6240 CENT DIST62412335 S NSTRL CAST PAD SYN 4" $ 39.00 $ 39.00 6241 CENT DIST62412340 S NSTRL CAST PAD SYN 6" $ 58.00 $ 58.00 6241 CENT DIST62412345 S NSTRL CAST PAD WEBR 3" $ 18.00 $ 18.00 6241 CENT DIST62412350 S NSTRL CAST PAD WEBR 4" $ 19.00 $ 19.00 6241 CENT DIST62412325 S NSTRL CAST PADD SPEC 4" $ 19.00 $ 19.00 6241 CENT DIST62412330 S NSTRL CAST PADD SPEC 6" $ 30.00 $ 30.00 6241 CENT DIST62412351 S NSTRL CASTING TAPE 2" $ 137.00 $ 137.00 6241 CENT DIST62412355 S NSTRL CASTING TAPE 3" $ 137.00 $ 137.00 6241 CENT DIST62412360 S NSTRL CASTING TAPE 4" $ 177.00 $ 177.00 6241 CENT DIST

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DEPARTMENT CODE

62412365 S NSTRL CASTING TAPE 5 $ 177.00 $ 177.00 6241 CENT DIST62411703 S NSTRL CATH NASAL OLIVE $ 33.00 $ 33.00 6241 CENT DIST62411715 S NSTRL CATHETER PLUG $ - $ - 6241 CENT DIST62430330 S NSTRL CERVOR PILLOW CVR $ 68.00 $ 68.00 6243 CENT DIST62430325 S NSTRL CERVOREST PILLOW $ 127.00 $ 127.00 6243 CENT DIST62400010 S NSTRL CON. FOAM HAND EX $ 120.00 $ 120.00 6240 CENT DIST62400014 S NSTRL COWRP COHE BD 2X5 $ 21.00 $ 21.00 6240 CENT DIST62409999 S NSTRL CPD MISC CHARGE $ - $ - 6240 CENT DIST62400028 S NSTRL CYLIND FOAM BEIGE $ 35.00 $ 35.00 6240 CENT DIST62400026 S NSTRL CYLIND FOAM BLUE $ 37.00 $ 37.00 6240 CENT DIST62400029 S NSTRL CYLIND FOAM LT BL $ 33.00 $ 33.00 6240 CENT DIST62400027 S NSTRL CYLIND FOAM RED $ 36.00 $ 36.00 6240 CENT DIST62400114 S NSTRL DEL FINGER GLOVE $ 282.00 $ 282.00 6240 CENT DIST62400055 S NSTRL DENTURE BRUSH $ 67.00 $ 67.00 6240 CENT DIST62400321 S NSTRL DRAIN POUCH #227 $ 320.00 $ 320.00 6240 CENT DIST62400322 S NSTRL DRAIN POUCH #227 $ 320.00 $ 320.00 6240 CENT DIST62400324 S NSTRL DRAIN POUCH #227 $ 320.00 $ 320.00 6240 CENT DIST62400331 S NSTRL DRAIN POUCH #227 $ 320.00 $ 320.00 6240 CENT DIST62400082 S NSTRL DRESSING STICK $ 54.00 $ 54.00 6240 CENT DIST62400035 S NSTRL EASY PULL SOCKAID $ 163.00 $ 163.00 6240 CENT DIST62461867 S NSTRL EHOB CUSHION ADLT $ 164.00 $ 164.00 6246 CENT DIST62461868 S NSTRL EHOB CUSHION BARI $ 346.00 $ 346.00 6246 CENT DIST62400160 S NSTRL ELASTIC SHOELACES $ 50.00 $ 50.00 6240 CENT DIST62400161 S NSTRL ELASTIC SHOELACES $ 50.00 $ 50.00 6240 CENT DIST62400162 S NSTRL ELASTIC SHOELACES $ 50.00 $ 50.00 6240 CENT DIST62400018 S NSTRL ELASTOMER PUTTY $ 57.00 $ 57.00 6240 CENT DIST62400032 S NSTRL EXERSTIK $ 300.00 $ 300.00 6240 CENT DIST62430335 S NSTRL FM WDG BDY ALIGN $ 155.00 $ 155.00 6243 CENT DIST62400083 S NSTRL FOOD GUARD $ 110.00 $ 110.00 6240 CENT DIST62400257 S NSTRL GEL SHELL PAD RPL $ 164.00 $ 164.00 6240 CENT DIST62400031 S NSTRL GLOVE EDEMA L/LG $ 76.00 $ 76.00 6240 CENT DIST62400020 S NSTRL GLOVE ISO MED $ 205.00 $ 205.00 6240 CENT DIST62400019 S NSTRL GLOVE ISOTONER LG $ 205.00 $ 205.00 6240 CENT DIST

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DEPARTMENT CODE

62400021 S NSTRL GLOVE ISOTONER SM $ 205.00 $ 205.00 6240 CENT DIST62400186 S NSTRL GLOVE VISCO SMALL $ 250.00 $ 250.00 6240 CENT DIST62400108 S NSTRL HAND GRIP HEAVY $ 73.00 $ 73.00 6240 CENT DIST62400340 S NSTRL HOLL DRN PCH 7/8" $ 313.00 $ 313.00 6240 CENT DIST62400334 S NSTRL HOLL POUCH #3612 $ 280.00 $ 280.00 6240 CENT DIST62400336 S NSTRL HOLL POUCH #3613 $ 280.00 $ 280.00 6240 CENT DIST62400337 S NSTRL HOLL POUCH #3614 $ 280.00 $ 280.00 6240 CENT DIST62400338 S NSTRL HOLL POUCH #3615 $ 280.00 $ 280.00 6240 CENT DIST62400339 S NSTRL HOLL POUCH #3616 $ 280.00 $ 280.00 6240 CENT DIST62400356 S NSTRL HOLL POUCH 1 1/2" $ 382.00 $ 382.00 6240 CENT DIST62400348 S NSTRL HOLL POUCH 1 1/4" $ 280.00 $ 280.00 6240 CENT DIST62400347 S NSTRL HOLL POUCH 1 1/8" $ 280.00 $ 280.00 6240 CENT DIST62400355 S NSTRL HOLL POUCH 1 3/8" $ 382.00 $ 382.00 6240 CENT DIST62400345 S NSTRL HOLL POUCH 7/8" $ 382.00 $ 382.00 6240 CENT DIST62400353 S NSTRL HOLL TWO PIECE ST $ 155.00 $ 155.00 6240 CENT DIST62400349 S NSTRL HOLL URO POUCH $ 454.00 $ 454.00 6240 CENT DIST62400323 S NSTRL HOLL.CUT TO FITX $ 352.00 $ 352.00 6240 CENT DIST62400346 S NSTRL HOLL.URO.POUCH 1" $ 280.00 $ 280.00 6240 CENT DIST62400061 S NSTRL KNIFE WOOD HANDLE $ 59.00 $ 59.00 6240 CENT DIST62400042 S NSTRL LEG LIFTER $ 128.00 $ 128.00 6240 CENT DIST62400329 S NSTRL LITTLE 1'S FLANGE $ 48.00 $ 48.00 6240 CENT DIST62400326 S NSTRL LITTLE ONES #209 $ 27.00 $ 27.00 6240 CENT DIST62400327 S NSTRL LITTLE ONES #209 $ 30.00 $ 30.00 6240 CENT DIST62400328 S NSTRL LITTLE ONES #209 $ 23.00 $ 23.00 6240 CENT DIST62400341 S NSTRL LITTLEONES #209 $ 411.00 $ 411.00 6240 CENT DIST62400342 S NSTRL LITTLEONES #209 $ 239.00 $ 239.00 6240 CENT DIST62400343 S NSTRL LITTLEONES #209 $ 239.00 $ 239.00 6240 CENT DIST62400344 S NSTRL LITTLEONES #209 $ 444.00 $ 444.00 6240 CENT DIST62400350 S NSTRL LITTLEONES #209 $ 444.00 $ 444.00 6240 CENT DIST62401640 S NSTRL LONG ARM CAST $ 406.00 $ 406.00 6240 CENT DIST62401480 S NSTRL LONG HANDLE SPONG $ - $ - 6240 CENT DIST62400033 S NSTRL MINI MASSAGER $ 258.00 $ 258.00 6240 CENT DIST62400017 S NSTRL MIRROR HANDLE FLE $ 189.00 $ 189.00 6240 CENT DIST

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DEPARTMENT CODE

62400158 S NSTRL MOLESKIN ROLL $ 24.00 $ 24.00 6240 CENT DIST62400116 S NSTRL OPEN-END SLING $ 35.00 $ 35.00 6240 CENT DIST62401635 S NSTRL ORT SHT LG CT/HEL $ 490.00 $ 490.00 6240 CENT DIST62430260 S NSTRL ORTHO LEG EXER ST $ 195.00 $ 195.00 6243 CENT DIST62401395 S NSTRL PAD RESTON 7/16 $ 33.00 $ 33.00 6240 CENT DIST62401400 S NSTRL PAD SHEEP 30 X 60 $ 136.00 $ 136.00 6240 CENT DIST62431346 S NSTRL PADDING 1 SHEET $ 56.00 $ 56.00 6243 CENT DIST62401105 S NSTRL PEAK FLOWMETER $ 83.00 $ 83.00 6240 CENT DIST62430065 S NSTRL PELVIC BELT LARGE $ 229.00 $ 229.00 6243 CENT DIST62430060 S NSTRL PELVIC BELT SMALL $ 229.00 $ 229.00 6243 CENT DIST62401175 S NSTRL PLA SPLT GY 5X30 $ 17.00 $ 17.00 6240 CENT DIST62401170 S NSTRL PLA SPLT GYP 4X15 $ 17.00 $ 17.00 6240 CENT DIST62401165 S NSTRL PLAS SPLT GY 3X15 $ 17.00 $ 17.00 6240 CENT DIST62431336 S NSTRL PLAST CYL CST ARM $ 90.00 $ 90.00 6243 CENT DIST62401166 S NSTRL PLASTER SPLT 3X2 $ 16.00 $ 16.00 6240 CENT DIST62401155 S NSTRL PLASTER SPLT 4X15 $ 17.00 $ 17.00 6240 CENT DIST62401160 S NSTRL PLASTER SPLT 5X30 $ 18.00 $ 18.00 6240 CENT DIST62401140 S NSTRL PLASTER X-FAST 3" $ 20.00 $ 20.00 6240 CENT DIST62401145 S NSTRL PLASTER X-FAST 4" $ 31.00 $ 31.00 6240 CENT DIST62401150 S NSTRL PLASTER X-FAST 6" $ 38.00 $ 38.00 6240 CENT DIST62431335 S NSTRL PLSTE CYL CST HND $ 41.00 $ 41.00 6243 CENT DIST62461365 S NSTRL POLYFORM SPLINT $ 67.00 $ 67.00 6246 CENT DIST62430175 S NSTRL POST CAST SHOE $ 246.00 $ 246.00 6243 CENT DIST62430180 S NSTRL POST OP SHOE $ 129.00 $ 129.00 6243 CENT DIST62430075 S NSTRL POST-OP BOOT LGE $ 133.00 $ 133.00 6243 CENT DIST62430080 S NSTRL POST-OP BOOT MED $ 133.00 $ 133.00 6243 CENT DIST62430071 S NSTRL POST-OP BOOT SM $ 123.00 $ 123.00 6243 CENT DIST62430081 S NSTRL POSTOP BOT XLARGE $ 123.00 $ 123.00 6243 CENT DIST62400351 S NSTRL POUCH ALL SZ. EA. $ 61.00 $ 61.00 6240 CENT DIST62400080 S NSTRL QUAD WASH MITT $ 105.00 $ 105.00 6240 CENT DIST62400111 S NSTRL RD FOAM HAND EXER $ 83.00 $ 83.00 6240 CENT DIST62430030 S NSTRL REACHER $ - $ - 6243 CENT DIST62400015 S NSTRL REACHER 20 W/CUPS $ 243.00 $ 243.00 6240 CENT DIST

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DEPARTMENT CODE

62400016 S NSTRL REACHER 30 W/CUPS $ 247.00 $ 247.00 6240 CENT DIST62400132 S NSTRL REACHER LONG $ 179.00 $ 179.00 6240 CENT DIST62400131 S NSTRL REACHER REGULAR $ 179.00 $ 179.00 6240 CENT DIST62430035 S NSTRL REACHER-EX LONG $ - $ - 6243 CENT DIST62430045 S NSTRL REACHER-REGULAR $ - $ - 6243 CENT DIST62400030 S NSTRL ROLY ADJ OUTRIG $ 694.00 $ 694.00 6240 CENT DIST62400126 S NSTRL ROLYAN HEMISLING $ 227.00 $ 227.00 6240 CENT DIST62430001 S NSTRL SEAT BELT ALARM $ - $ - 6243 CENT DIST62440029 S NSTRL SENSOR MAT PAD $ 316.00 $ 316.00 6244 CENT DIST62400145 S NSTRL SHOE HORN 12" $ 104.00 $ 104.00 6240 CENT DIST62400140 S NSTRL SHOE HORN 18" $ 106.00 $ 106.00 6240 CENT DIST62400150 S NSTRL SHOE HORN 24" $ 107.00 $ 107.00 6240 CENT DIST62400151 S NSTRL SHOE HORN 30" $ 117.00 $ 117.00 6240 CENT DIST62401645 S NSTRL SHORT ARM CAST $ 182.00 $ 182.00 6240 CENT DIST62400221 S NSTRL SHORT EXT SPLT LG $ 237.00 $ 237.00 6240 CENT DIST62401630 S NSTRL SHORT LEG CAST $ 296.00 $ 296.00 6240 CENT DIST62430130 S NSTRL SLING ARM ADJ LG $ 177.00 $ 177.00 6243 CENT DIST62430125 S NSTRL SLING ARM ADJ MED $ 177.00 $ 177.00 6243 CENT DIST62430120 S NSTRL SLING ARM DISP LG $ 177.00 $ 177.00 6243 CENT DIST62430115 S NSTRL SLING ARM DSP MED $ 177.00 $ 177.00 6243 CENT DIST62400008 S NSTRL SLING CVA 99976 $ 180.00 $ 180.00 6240 CENT DIST62400146 S NSTRL SLO-FM X-SFT YELL $ 73.00 $ 73.00 6240 CENT DIST62461485 S NSTRL SPLINT BLANKS $ 64.00 $ 64.00 6246 CENT DIST62400048 S NSTRL SPLINT EXTRA SM $ 171.00 $ 171.00 6240 CENT DIST62461515 S NSTRL SPLINT FINGER 2" $ 82.00 $ 82.00 6246 CENT DIST62400057 S NSTRL SPLINT LARGE $ 550.00 $ 550.00 6240 CENT DIST62461490 S NSTRL SPLINT LEG LARGE $ 174.00 $ 174.00 6246 CENT DIST62461495 S NSTRL SPLINT LEG MED $ 174.00 $ 174.00 6246 CENT DIST62461500 S NSTRL SPLINT LEG SMALL $ 174.00 $ 174.00 6246 CENT DIST62400053 S NSTRL SPLINT MEDIUM $ 441.00 $ 441.00 6240 CENT DIST62461580 S NSTRL SPLINT PEDI-HIP $ 147.00 $ 147.00 6246 CENT DIST62400052 S NSTRL SPLINT SMALL $ 318.00 $ 318.00 6240 CENT DIST62461530 S NSTRL SPLINT STAX #3 $ 55.00 $ 55.00 6246 CENT DIST

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DEPARTMENT CODE

62461535 S NSTRL SPLINT STAX #4 $ 55.00 $ 55.00 6246 CENT DIST62461540 S NSTRL SPLINT STAX #5 $ 55.00 $ 55.00 6246 CENT DIST62461545 S NSTRL SPLINT STAX #5.5 $ 55.00 $ 55.00 6246 CENT DIST62461550 S NSTRL SPLINT STAX #6 $ 55.00 $ 55.00 6246 CENT DIST62461555 S NSTRL SPLINT STAX #7 $ 55.00 $ 55.00 6246 CENT DIST62400058 S NSTRL SPLINT X-LARGE $ 710.00 $ 710.00 6240 CENT DIST62461520 S NSTRL SPLT MET FINGER 6 $ 82.00 $ 82.00 6246 CENT DIST62461465 S NSTRL SPLT REST LFT/MED $ 133.00 $ 133.00 6246 CENT DIST62461460 S NSTRL SPLT REST LT/LGE $ 133.00 $ 133.00 6246 CENT DIST62461470 S NSTRL SPLT REST LT/SM $ 133.00 $ 133.00 6246 CENT DIST62461480 S NSTRL SPLT REST RHT/MED $ 133.00 $ 133.00 6246 CENT DIST62461475 S NSTRL SPLT REST RT/LG $ 133.00 $ 133.00 6246 CENT DIST62461585 S NSTRL SPLT REST RT/SM $ 133.00 $ 133.00 6246 CENT DIST62461575 S NSTRL SPLT ULNAR LT/MD $ 133.00 $ 133.00 6246 CENT DIST62461560 S NSTRL SPLT ULNAR LT/SM $ 133.00 $ 133.00 6246 CENT DIST62461570 S NSTRL SPLT ULNAR RT/SM $ 133.00 $ 133.00 6246 CENT DIST62400180 S NSTRL SPONGE-LONG $ 15.00 $ 15.00 6240 CENT DIST62431338 S NSTRL SPRING SPLINT $ 30.00 $ 30.00 6243 CENT DIST62400191 S NSTRL STAIN GLASS $ 8.00 $ 8.00 6240 CENT DIST62410875 S NSTRL STOPCOCK W/TUBING $ - $ - 6241 CENT DIST62400098 S NSTRL STRAP 1X1YD $ 33.00 $ 33.00 6240 CENT DIST62400099 S NSTRL STRAPPING 2"X1YD $ 40.00 $ 40.00 6240 CENT DIST62440157 S NSTRL SZEWS BARI W/FM $ - $ - 6244 CENT DIST62440160 S NSTRL SZEWS BIG TURN $ - $ - 6244 CENT DIST62440158 S NSTRL SZEWS MIGHT AIR $ - $ - 6244 CENT DIST62440161 S NSTRL SZEWS PULS W/SC $ - $ - 6244 CENT DIST62440159 S NSTRL SZEWS ST ROTATE $ - $ - 6244 CENT DIST62400044 S NSTRL T-HANDLE MUG $ 61.00 $ 61.00 6240 CENT DIST62400225 S NSTRL THERABAND 1 YR $ 23.00 $ 23.00 6240 CENT DIST62400202 S NSTRL THERABAND BLUE $ 32.00 $ 32.00 6240 CENT DIST62400201 S NSTRL THERABAND GREEN $ 25.00 $ 25.00 6240 CENT DIST62400199 S NSTRL THERABAND RED 3FT $ 24.00 $ 24.00 6240 CENT DIST62400198 S NSTRL THERABAND YELLOW $ 23.00 $ 23.00 6240 CENT DIST

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DEPARTMENT CODE

62401590 S NSTRL THOMAS SLING $ 204.00 $ 204.00 6240 CENT DIST62430265 S NSTRL THOMAS SPLINT $ 909.00 $ 909.00 6243 CENT DIST62400230 S NSTRL TOILET AID $ 182.00 $ 182.00 6240 CENT DIST62400231 S NSTRL TOILET AID PLASTI $ 197.00 $ 197.00 6240 CENT DIST62401450 S NSTRL TOILET SEAT RAISE $ 611.00 $ 611.00 6240 CENT DIST62430270 S NSTRL TRIANG PILLOW $ 324.00 $ 324.00 6243 CENT DIST62400239 S NSTRL TRIM EXT SPLNT MD $ 254.00 $ 254.00 6240 CENT DIST62400241 S NSTRL TRIML EXR SPLN XL $ 254.00 $ 254.00 6240 CENT DIST62400240 S NSTRL TRIML EXT SPLT LG $ 254.00 $ 254.00 6240 CENT DIST62400237 S NSTRL TRIML EXT SPLT SM $ 254.00 $ 254.00 6240 CENT DIST62400236 S NSTRL TRIML EXT SPLT XS $ 254.00 $ 254.00 6240 CENT DIST62400133 S NSTRL TUBI PD 2-1/2"X 1 $ 54.00 $ 54.00 6240 CENT DIST62400134 S NSTRL TUBIPAD 3"X 1FT $ 56.00 $ 56.00 6240 CENT DIST62400895 S NSTRL URO.CONNECTOR TBE $ - $ - 6240 CENT DIST62400238 S NSTRL WALKER BAG $ 270.00 $ 270.00 6240 CENT DIST62400001 S NSTRL WALKER BASKET $ 387.00 $ 387.00 6240 CENT DIST62430002 S NSTRL WEDGE CUSHION $ - $ - 6243 CENT DIST62401243 S NSTRL WHEELCHIR CUSHION $ 53.00 $ 53.00 6240 CENT DIST62440202 S ORTHO ANN ARBOR FRAME $ 205.00 $ 205.00 6244 CENT DIST62430282 S ORTHO ARM IMMOBILIZER $ 126.00 $ 126.00 6243 CENT DIST62400277 S ORTHO ARM SUPPORT ELEV $ 287.00 $ 287.00 6240 CENT DIST62460260 S ORTHO BCKS TRAXN UNILAT $ 119.00 $ 119.00 6246 CENT DIST62430340 S ORTHO BELT PELVIC 30-45 $ 156.00 $ 156.00 6243 CENT DIST62430350 S ORTHO BELT RIB FEMALE $ 90.00 $ 90.00 6243 CENT DIST62430355 S ORTHO BELT RIB MALE $ 90.00 $ 90.00 6243 CENT DIST62400283 S ORTHO BEN THUMB SPLT MD $ 193.00 $ 193.00 6240 CENT DIST62400287 S ORTHO BENI THMB SPLT LG $ 193.00 $ 193.00 6240 CENT DIST62400282 S ORTHO BENI THMB SPLT SM $ 193.00 $ 193.00 6240 CENT DIST62400281 S ORTHO BENIK WRST SPLINT $ 179.00 $ 179.00 6240 CENT DIST62430322 S ORTHO BKS TRACT SPLN LG $ 337.00 $ 337.00 6243 CENT DIST62430321 S ORTHO BKS TRACT SPLN MD $ 337.00 $ 337.00 6243 CENT DIST62430320 S ORTHO BKS TRACT SPLN SM $ 364.00 $ 364.00 6243 CENT DIST62460255 S ORTHO BKS TRAXN BILATER $ 214.00 $ 214.00 6246 CENT DIST

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DEPARTMENT CODE

62460635 S ORTHO BRACE - AFO $ 525.00 $ 525.00 6246 CENT DIST62430385 S ORTHO BRACE CLAVICAL $ 80.00 $ 80.00 6243 CENT DIST62460625 S ORTHO BRCE ANKL TRAN LT $ 260.00 $ 260.00 6246 CENT DIST62460630 S ORTHO BRCE ANKL TRAN RT $ 260.00 $ 260.00 6246 CENT DIST62460615 S ORTHO BRCE ANKLE AIR LT $ 260.00 $ 260.00 6246 CENT DIST62460620 S ORTHO BRCE ANKLE AIR RT $ 260.00 $ 260.00 6246 CENT DIST62430217 S ORTHO BUCKS SPLINT LGE $ 233.00 $ 233.00 6243 CENT DIST62430216 S ORTHO BUCKS SPLINT MED $ 233.00 $ 233.00 6243 CENT DIST62430215 S ORTHO BUCKS SPLINT SM $ 253.00 $ 253.00 6243 CENT DIST62400050 S ORTHO BUDDY STRAPS SOFT $ 157.00 $ 157.00 6240 CENT DIST62401725 S ORTHO BUNNY BOOT COMP $ 396.00 $ 396.00 6240 CENT DIST62401730 S ORTHO BUNNY SPLINTS $ 145.00 $ 145.00 6240 CENT DIST62400004 S ORTHO BUNNYLINE SLING $ 51.00 $ 51.00 6240 CENT DIST62460270 S ORTHO CAST SHOE $ 167.00 $ 167.00 6246 CENT DIST62440095 S ORTHO CAST TRIM LARGE $ 45.00 $ 45.00 6244 CENT DIST62440080 S ORTHO CAST TRIM SMALL $ 27.00 $ 27.00 6244 CENT DIST62400100 S ORTHO CENTE FRM 8" WRST $ 164.00 $ 164.00 6240 CENT DIST62400085 S ORTHO CENTE FRM TH/SPIC $ 338.00 $ 338.00 6240 CENT DIST62460275 S ORTHO CERVICAL COLLAR $ 260.00 $ 260.00 6246 CENT DIST62430240 S ORTHO CERVICAL HALTER $ 110.00 $ 110.00 6243 CENT DIST62400216 S ORTHO COIL EXT SPLT LG $ 338.00 $ 338.00 6240 CENT DIST62400215 S ORTHO COIL EXT SPLT MED $ 338.00 $ 338.00 6240 CENT DIST62400217 S ORTHO COIL EXT SPLT XLG $ 338.00 $ 338.00 6240 CENT DIST62400214 S ORTHO COL EXT SPLNT SM $ 338.00 $ 338.00 6240 CENT DIST62430087 S ORTHO COLAR CERVICAL LG $ 61.00 $ 61.00 6243 CENT DIST62430086 S ORTHO COLAR CERVICAL SM $ 61.00 $ 61.00 6243 CENT DIST62430085 S ORTHO COLLAR CERVIC MED $ 68.00 $ 68.00 6243 CENT DIST62431334 S ORTHO CUST NEOPRE SPLT $ 251.00 $ 251.00 6243 CENT DIST62401650 S ORTHO CYLANDER CAST $ 318.00 $ 318.00 6240 CENT DIST62400142 S ORTHO DIGIFINGER LARGE $ 33.00 $ 33.00 6240 CENT DIST62400141 S ORTHO DIGIFINGER MEDIUM $ 33.00 $ 33.00 6240 CENT DIST62400139 S ORTHO DIGIFINGER SMALL $ 33.00 $ 33.00 6240 CENT DIST62413100 S ORTHO DONJOY ROM SPLINT $ 843.00 $ 843.00 6241 CENT DIST

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DEPARTMENT CODE

62400064 S ORTHO DRG WRST BRCE LLG $ 233.00 $ 233.00 6240 CENT DIST62400043 S ORTHO DRG WRST BRCE RLG $ 233.00 $ 233.00 6240 CENT DIST62400066 S ORTHO DRG WRST BRCE RSM $ 233.00 $ 233.00 6240 CENT DIST62400067 S ORTHO DRNG WRT BRCE LME $ 233.00 $ 233.00 6240 CENT DIST62400063 S ORTHO DRNG WRT BRCE RME $ 233.00 $ 233.00 6240 CENT DIST62400121 S ORTHO ELAS SUPRT W/STRP $ 237.00 $ 237.00 6240 CENT DIST62400266 S ORTHO ELBO SPLT PROTECT $ 201.00 $ 201.00 6240 CENT DIST62400203 S ORTHO EXT FINGE SPLT LG $ 223.00 $ 223.00 6240 CENT DIST62400200 S ORTHO EXT FNGER SPLT MD $ 223.00 $ 223.00 6240 CENT DIST62400194 S ORTHO EXT FNGER SPLT SM $ 223.00 $ 223.00 6240 CENT DIST62431344 S ORTHO EXT/OUTRIG ST/5 $ 697.00 $ 697.00 6243 CENT DIST62400206 S ORTHO FLX FNGER SPRG SM $ 223.00 $ 223.00 6240 CENT DIST62430276 S ORTHO FOOT DROP STOP $ 297.00 $ 297.00 6243 CENT DIST62430317 S ORTHO FOOT SPLINT MED $ 846.00 $ 846.00 6243 CENT DIST62430316 S ORTHO FOOT SPLINT SMALL $ 846.00 $ 846.00 6243 CENT DIST62401667 S ORTHO FULL ARM CAST COV $ 141.00 $ 141.00 6240 CENT DIST62400256 S ORTHO GEL SPICA SPLINT $ 345.00 $ 345.00 6240 CENT DIST62430050 S ORTHO HND SPLT PREFAB $ 167.00 $ 167.00 6243 CENT DIST62430090 S ORTHO IMMOB KNEE SHORT $ 282.00 $ 282.00 6243 CENT DIST62430105 S ORTHO IMMOB SHOULDER LG $ 112.00 $ 112.00 6243 CENT DIST62430100 S ORTHO IMMOB SHULDER MED $ 112.00 $ 112.00 6243 CENT DIST62430095 S ORTHO IMMOBIL KNEE LONG $ 299.00 $ 299.00 6243 CENT DIST62430380 S ORTHO IMMOBIL SHOULDER $ 125.00 $ 125.00 6243 CENT DIST62430245 S ORTHO KNEE ASPIRATION $ 136.00 $ 136.00 6243 CENT DIST62461225 S ORTHO KNEE BRCE W/HINGE $ 1,010.00 $ 1,010.00 6246 CENT DIST62430365 S ORTHO KNEE IMMOB LARGE $ 462.00 $ 462.00 6243 CENT DIST62430367 S ORTHO KNEE IMMOB SMALL $ 428.00 $ 428.00 6243 CENT DIST62430366 S ORTHO KNEE IMMOB X-LG. $ 428.00 $ 428.00 6243 CENT DIST62430360 S ORTHO KNEE IMMOBILI MED $ 462.00 $ 462.00 6243 CENT DIST62430300 S ORTHO KNEE IMMOB-LTE-SU $ 326.00 $ 326.00 6243 CENT DIST62430290 S ORTHO KNEE SPLINT $ 345.00 $ 345.00 6243 CENT DIST62460340 S ORTHO KNEE SPLINT $ 519.00 $ 519.00 6246 CENT DIST62400153 S ORTHO KNUCK BENDER MED $ 227.00 $ 227.00 6240 CENT DIST

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DEPARTMENT CODE

62400156 S ORTHO KNUCK REVER SM $ 227.00 $ 227.00 6240 CENT DIST62400154 S ORTHO KNUCK REVER XSM $ 227.00 $ 227.00 6240 CENT DIST62400149 S ORTHO KNUCKLE BEND X-SM $ 227.00 $ 227.00 6240 CENT DIST62400152 S ORTHO KNUCKLE BENDER SM $ 227.00 $ 227.00 6240 CENT DIST62400157 S ORTHO KNUCKLE REVER MED $ 227.00 $ 227.00 6240 CENT DIST62400190 S ORTHO KUSHION 1/8 X 1/4 $ 46.00 $ 46.00 6240 CENT DIST62400197 S ORTHO KUSHONFLX 1/8X1/2 $ 86.00 $ 86.00 6240 CENT DIST62400196 S ORTHO KUSHONFLX 1/8X1/3 $ 59.00 $ 59.00 6240 CENT DIST62460310 S ORTHO LEG SPLINT $ 237.00 $ 237.00 6246 CENT DIST62430010 S ORTHO LEG SPLT KNE LGHT $ 189.00 $ 189.00 6243 CENT DIST62431330 S ORTHO LG SPLINT W/STRAP $ 393.00 $ 393.00 6243 CENT DIST62431331 S ORTHO LG SPLT W/STRP PD $ 624.00 $ 624.00 6243 CENT DIST62400211 S ORTHO LG STRTCH COL MD $ 338.00 $ 338.00 6240 CENT DIST62400077 S ORTHO LMB FINGER SPRING $ 46.00 $ 46.00 6240 CENT DIST62431367 S ORTHO LMB SPRG W/O COIL $ 201.00 $ 201.00 6243 CENT DIST62431366 S ORTHO LMB SPRING W/COIL $ 338.00 $ 338.00 6243 CENT DIST62401620 S ORTHO LONG LEG CAST $ 547.00 $ 547.00 6240 CENT DIST62431329 S ORTHO MD SPLT W/STRP-PD $ 396.00 $ 396.00 6243 CENT DIST62431328 S ORTHO MED SPLT W/STRAP $ 251.00 $ 251.00 6243 CENT DIST62400170 S ORTHO MINIM PIN SPL XLG $ 223.00 $ 223.00 6240 CENT DIST62400124 S ORTHO NEO UNI WRST WRAP $ 164.00 $ 164.00 6240 CENT DIST62400267 S ORTHO NEPRNE ELBO SLEEV $ 179.00 $ 179.00 6240 CENT DIST62400110 S ORTHO NT FOOT SPLT ALL $ 267.00 $ 267.00 6240 CENT DIST62430210 S ORTHO ORT ARM SPLT $ 255.00 $ 255.00 6243 CENT DIST62430225 S ORTHO ORT BALAN CERV $ 340.00 $ 340.00 6243 CENT DIST62440085 S ORTHO ORT CAST REMO LG $ 98.00 $ 98.00 6244 CENT DIST62440222 S ORTHO ORT CAST REMOV SM $ 27.00 $ 27.00 6244 CENT DIST62440227 S ORTHO ORT CAST REPAR SM $ 27.00 $ 27.00 6244 CENT DIST62430285 S ORTHO ORT CCKUP WRS SPT $ 166.00 $ 166.00 6243 CENT DIST62440090 S ORTHO ORT CST RPAR LG $ 100.00 $ 100.00 6244 CENT DIST62440217 S ORTHO ORT HIP SPCA UNIL $ 1,045.00 $ 1,045.00 6244 CENT DIST62430280 S ORTHO ORT KNEE SLG KODE $ 126.00 $ 126.00 6243 CENT DIST62401625 S ORTHO ORT L-LEG CST/HEE $ 387.00 $ 387.00 6240 CENT DIST

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DEPARTMENT CODE

62430235 S ORTHO ORT POSTERIO SPLT $ 95.00 $ 95.00 6243 CENT DIST62440065 S ORTHO ORT SKELA TRACTIO $ 443.00 $ 443.00 6244 CENT DIST62440100 S ORTHO ORT STENM PIN CUT $ 127.00 $ 127.00 6244 CENT DIST62430255 S ORTHO ORT THOMAS SLG ST $ 443.00 $ 443.00 6243 CENT DIST62440207 S ORTHO ORT UNILAT BUCK'S $ 249.00 $ 249.00 6244 CENT DIST62430220 S ORTHO ORTH STRGH CERVI $ 296.00 $ 296.00 6243 CENT DIST62401615 S ORTHO ORTHO FOOT BOARD $ 69.00 $ 69.00 6240 CENT DIST62430275 S ORTHO ORTHO FOOT CRADLE $ 45.00 $ 45.00 6243 CENT DIST62401660 S ORTHO ORTHO LARGE DRES $ 82.00 $ 82.00 6240 CENT DIST62460315 S ORTHO ORTHO MISC $ - $ - 6246 CENT DIST62401655 S ORTHO ORTHO SMALL DRES $ 38.00 $ 38.00 6240 CENT DIST62461350 S ORTHO PACKET RT ANGLE $ 88.00 $ 88.00 6246 CENT DIST62430370 S ORTHO PAD FINGE SPLT MD $ 92.00 $ 92.00 6243 CENT DIST62460320 S ORTHO PATLLAR KNE SUPPT $ 519.00 $ 519.00 6246 CENT DIST62430088 S ORTHO PHILADELPH COLLAR $ 326.00 $ 326.00 6243 CENT DIST62431373 S ORTHO PIP LIGAM RPAR SP $ 323.00 $ 323.00 6243 CENT DIST62400228 S ORTHO POLCUSHON 1/4X1/2 $ 121.00 $ 121.00 6240 CENT DIST62400229 S ORTHO POLCUSHON 1/4X1/3 $ 87.00 $ 87.00 6240 CENT DIST62400274 S ORTHO POLCUSHON 1/4X1/4 $ 67.00 $ 67.00 6240 CENT DIST62400273 S ORTHO POLCUSHON 1/8X1/2 $ 95.00 $ 95.00 6240 CENT DIST62400272 S ORTHO POLCUSHON 1/8X1/3 $ 67.00 $ 67.00 6240 CENT DIST62400226 S ORTHO POLCUSHON 1/8X1/4 $ 52.00 $ 52.00 6240 CENT DIST62461360 S ORTHO POLY PED CLEOFORM $ 46.00 $ 46.00 6246 CENT DIST62400075 S ORTHO POS SPLNT-LT-LG $ 273.00 $ 273.00 6240 CENT DIST62400072 S ORTHO POS SPLNT-LT-MED $ 273.00 $ 273.00 6240 CENT DIST62400076 S ORTHO POS SPLNT-RT-LG $ 273.00 $ 273.00 6240 CENT DIST62400071 S ORTHO POS SPLNT-RT-SM $ 273.00 $ 273.00 6240 CENT DIST62460350 S ORTHO POSEY TIBIA SPLT $ 213.00 $ 213.00 6246 CENT DIST62400069 S ORTHO POSI SPLN-LEFT-SM $ 273.00 $ 273.00 6240 CENT DIST62400084 S ORTHO POSIT SPLT-R-MED $ 273.00 $ 273.00 6240 CENT DIST62431368 S ORTHO PREFA NEOPR SPLT $ 242.00 $ 242.00 6243 CENT DIST62431355 S ORTHO PREFA SPRG WRE 18 $ 12.00 $ 12.00 6243 CENT DIST62431353 S ORTHO PREFAB 1 DRING X5 $ 65.00 $ 65.00 6243 CENT DIST

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DEPARTMENT CODE

62431352 S ORTHO PREFAB 2 DRING X2 $ 20.00 $ 20.00 6243 CENT DIST62431348 S ORTHO PREFAB FNGER LOPS $ 12.00 $ 12.00 6243 CENT DIST62431349 S ORTHO PREFAB FNGER SLGS $ 15.00 $ 15.00 6243 CENT DIST62431354 S ORTHO PREFAB NYLON SCRW $ 72.00 $ 72.00 6243 CENT DIST62431351 S ORTHO PREFAB UNI SPRING $ 15.00 $ 15.00 6243 CENT DIST62431356 S ORTHO PRFAB OUTR ROD 18 $ 8.00 $ 8.00 6243 CENT DIST62431350 S ORTHO PRFB BRAID ELA 1Y $ 16.00 $ 16.00 6243 CENT DIST62431347 S ORTHO PRFB RUBE BND PST $ 8.00 $ 8.00 6243 CENT DIST62400242 S ORTHO PRG FLE SPLT XXSM $ 458.00 $ 458.00 6240 CENT DIST62400253 S ORTHO PRO EXT SPLT X-LG $ 374.00 $ 374.00 6240 CENT DIST62400249 S ORTHO PRO EXT SPLT X-SM $ 374.00 $ 374.00 6240 CENT DIST62400248 S ORTHO PRO EXT SPLT XXSM $ 374.00 $ 374.00 6240 CENT DIST62400245 S ORTHO PRO FLEX SPLT MED $ 458.00 $ 458.00 6240 CENT DIST62400247 S ORTHO PRO FLX SPLNT XLG $ 458.00 $ 458.00 6240 CENT DIST62400243 S ORTHO PRO FLX SPLNT XSM $ 458.00 $ 458.00 6240 CENT DIST62400252 S ORTHO PROG EXT SPLT LG $ 374.00 $ 374.00 6240 CENT DIST62400251 S ORTHO PROG EXT SPLT MED $ 374.00 $ 374.00 6240 CENT DIST62400250 S ORTHO PROG EXT SPLT SM $ 374.00 $ 374.00 6240 CENT DIST62400246 S ORTHO PROG FLEX SPLT LG $ 458.00 $ 458.00 6240 CENT DIST62400244 S ORTHO PROG FLEX SPLT SM $ 458.00 $ 458.00 6240 CENT DIST62400123 S ORTHO REST HAND SPLINT $ 102.00 $ 102.00 6240 CENT DIST62400125 S ORTHO ROL ARM SUPPORT $ 88.00 $ 88.00 6240 CENT DIST62400094 S ORTHO ROL BEGE-LEFT MD $ 296.00 $ 296.00 6240 CENT DIST62400097 S ORTHO ROL BEGE-RT LARGE $ 296.00 $ 296.00 6240 CENT DIST62400093 S ORTHO ROL BEG-RT SMALL $ 296.00 $ 296.00 6240 CENT DIST62400092 S ORTHO ROL BEIGE-LEFT SM $ 296.00 $ 296.00 6240 CENT DIST62400095 S ORTHO ROL BEIGE-RT MED $ 296.00 $ 296.00 6240 CENT DIST62400096 S ORTHO ROL BGE-LT LG $ 296.00 $ 296.00 6240 CENT DIST62400255 S ORTHO ROL DORSAL D-RING $ 282.00 $ 282.00 6240 CENT DIST62400254 S ORTHO ROL DRN BRCE W/MC $ 458.00 $ 458.00 6240 CENT DIST62400129 S ORTHO ROL DRNG BRC SHRT $ 263.00 $ 263.00 6240 CENT DIST62400128 S ORTHO ROL DRNG BRCE LG $ 287.00 $ 287.00 6240 CENT DIST62400078 S ORTHO ROL ERG HAND EXER $ 154.00 $ 154.00 6240 CENT DIST

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DEPARTMENT CODE

62431369 S ORTHO ROL FT DROP SPLT $ 778.00 $ 778.00 6243 CENT DIST62400258 S ORTHO ROL HND INLNE SPL $ 193.00 $ 193.00 6240 CENT DIST62400259 S ORTHO ROL INLINE SPLINT $ 427.00 $ 427.00 6240 CENT DIST62400261 S ORTHO ROL NEOZIP SUPPOR $ 164.00 $ 164.00 6240 CENT DIST62400262 S ORTHO ROL SFT ULNAR DEV $ 179.00 $ 179.00 6240 CENT DIST62400268 S ORTHO ROL THE RX EL WRP $ 266.00 $ 266.00 6240 CENT DIST62400264 S ORTHO ROL THE RX WST/TH $ 422.00 $ 422.00 6240 CENT DIST62400263 S ORTHO ROL THER RX DRING $ 190.00 $ 190.00 6240 CENT DIST62400260 S ORTHO ROL THUMB NEO WRP $ 300.00 $ 300.00 6240 CENT DIST62400127 S ORTHO ROL ULNAR DEVIATI $ 254.00 $ 254.00 6240 CENT DIST62400086 S ORTHO ROL WHITE-LEFT SM $ 296.00 $ 296.00 6240 CENT DIST62400091 S ORTHO ROL WHT-RT LARGE $ 296.00 $ 296.00 6240 CENT DIST62400089 S ORTHO ROL WHT-RT MED $ 296.00 $ 296.00 6240 CENT DIST62400090 S ORTHO ROL WTE-LT LG $ 296.00 $ 296.00 6240 CENT DIST62400087 S ORTHO ROLYAN WHTE-RIGHT $ 296.00 $ 296.00 6240 CENT DIST62400088 S ORTHO ROLYAN WHT-LT MD $ 296.00 $ 296.00 6240 CENT DIST62400168 S ORTHO SCKAID MOLD W/CRD $ 163.00 $ 163.00 6240 CENT DIST62430310 S ORTHO SHLDE ABDUC SUPPT $ 613.00 $ 613.00 6243 CENT DIST62430395 S ORTHO SHOULD EXERCISOR $ 136.00 $ 136.00 6243 CENT DIST62440218 S ORTHO SHOULD SPICA CAST $ 867.00 $ 867.00 6244 CENT DIST62400219 S ORTHO SHRT EXT SPLNT SM $ 237.00 $ 237.00 6240 CENT DIST62400220 S ORTHO SHRT EXT SPLT MED $ 237.00 $ 237.00 6240 CENT DIST62400222 S ORTHO SHRT EXT SPLT XLG $ 237.00 $ 237.00 6240 CENT DIST62400218 S ORTHO SHRT EXT SPLT XSM $ 237.00 $ 237.00 6240 CENT DIST62430205 S ORTHO SHULDER IMMOB VEL $ 156.00 $ 156.00 6243 CENT DIST62431326 S ORTHO SM SPLINT W/STRP $ 138.00 $ 138.00 6243 CENT DIST62431327 S ORTHO SM SPLT W/STRP-PD $ 167.00 $ 167.00 6243 CENT DIST62430142 S ORTHO SPACE BOOTS PR $ 339.00 $ 339.00 6243 CENT DIST62461505 S ORTHO SPL METAL FNGE LG $ 27.00 $ 27.00 6246 CENT DIST62461510 S ORTHO SPL METAL FNGE MD $ 27.00 $ 27.00 6246 CENT DIST62461525 S ORTHO SPL METAL FNGE SM $ 27.00 $ 27.00 6246 CENT DIST62461565 S ORTHO SPL ULNAR RT/MED $ 133.00 $ 133.00 6246 CENT DIST62461590 S ORTHO SPORK - MEDIUM $ 17.00 $ 17.00 6246 CENT DIST

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DEPARTMENT CODE

62400081 S ORTHO STRCH EXT SPL SM $ 208.00 $ 208.00 6240 CENT DIST62400235 S ORTHO STRE EXT SPLT XLG $ 208.00 $ 208.00 6240 CENT DIST62400223 S ORTHO STRE EXT SPLT XSM $ 208.00 $ 208.00 6240 CENT DIST62400234 S ORTHO STRET EXT SPLT LG $ 208.00 $ 208.00 6240 CENT DIST62400232 S ORTHO STRET EXT SPLT MD $ 208.00 $ 208.00 6240 CENT DIST62400278 S ORTHO THERABOOT UNIV $ 894.00 $ 894.00 6240 CENT DIST62431371 S ORTHO THUMB SPICA SPLT $ 364.00 $ 364.00 6243 CENT DIST62461670 S ORTHO TRACTION CERVICAL $ 278.00 $ 278.00 6246 CENT DIST62460375 S ORTHO TRACTION OVERHEAD $ 172.00 $ 172.00 6246 CENT DIST62431357 S ORTHO VELC/VELF STRP 1F $ 19.00 $ 19.00 6243 CENT DIST62461860 S ORTHO WALK ANKLE FT/SM $ 1,076.00 $ 1,076.00 6246 CENT DIST62461850 S ORTHO WALKER ANK FT/LGE $ 1,076.00 $ 1,076.00 6246 CENT DIST62461865 S ORTHO WALKETTE W/WHEELS $ 770.00 $ 770.00 6246 CENT DIST62400120 S ORTHO WAN WRITER LG-RT $ 314.00 $ 314.00 6240 CENT DIST62400118 S ORTHO WANC WRTER SM-RT $ 314.00 $ 314.00 6240 CENT DIST62400119 S ORTHO WANCH WRTER LG-LT $ 314.00 $ 314.00 6240 CENT DIST62400117 S ORTHO WANCH WRTER SM-LT $ 314.00 $ 314.00 6240 CENT DIST62400269 S ORTHO WEN ELBO EXT BRCE $ 1,087.00 $ 1,087.00 6240 CENT DIST62400270 S ORTHO WEN ELBO EXT SPLT $ 525.00 $ 525.00 6240 CENT DIST62400054 S ORTHO WEN EXT/CLOCKSPRG $ 247.00 $ 247.00 6240 CENT DIST62400174 S ORTHO WEN MINI PIN SPLT $ 296.00 $ 296.00 6240 CENT DIST62400275 S ORTHO WEN MODI PIN SPL $ 251.00 $ 251.00 6240 CENT DIST62400070 S ORTHO WEN REVE OPPENHEI $ 358.00 $ 358.00 6240 CENT DIST62400192 S ORTHO WEN SPRNG WRE SPL $ 247.00 $ 247.00 6240 CENT DIST62400073 S ORTHO WEN THOMAS SUSPEN $ 367.00 $ 367.00 6240 CENT DIST62400163 S ORTHO WENGER KNUCK BEND $ 345.00 $ 345.00 6240 CENT DIST62400165 S ORTHO WHFO I $ 455.00 $ 455.00 6240 CENT DIST62430315 S ORTHO WRIST FOREARM SPL $ 200.00 $ 200.00 6243 CENT DIST62400039 S ORTHO WRST BRCE FUT RLG $ 228.00 $ 228.00 6240 CENT DIST62431372 S ORTHO WRST SUPPRT SPLNT $ 266.00 $ 266.00 6243 CENT DIST62400265 S ORTHO WRST SUPRT W/THMB $ 124.00 $ 124.00 6240 CENT DIST62400041 S ORTHO WRT BRCE FUT L MD $ 228.00 $ 228.00 6240 CENT DIST62400038 S ORTHO WRT BRCE FUT R MD $ 228.00 $ 228.00 6240 CENT DIST

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DEPARTMENT CODE

62431332 S ORTHO X-LG SPLT W/STRAP $ 749.00 $ 749.00 6243 CENT DIST62431333 S ORTHO XLG SPLT W/STR-PD $ 687.00 $ 687.00 6243 CENT DIST62411355 S STRL ABD PAD 5X9/EACH $ - $ - 6241 CENT DIST62411360 S STRL ABD PAD 8X10/EACH $ - $ - 6241 CENT DIST62411365 S STRL ADAPTIC 3X3 $ - $ - 6241 CENT DIST62411370 S STRL ADAPTIC 3X8 $ - $ - 6241 CENT DIST62413327 S STRL AIRWY NASO 6.5-26F $ - $ - 6241 CENT DIST62413328 S STRL AIRWY NASO 7.0-28F $ - $ - 6241 CENT DIST62413329 S STRL AIRWY NASO 7.5-30F $ - $ - 6241 CENT DIST62413358 S STRL AIRWY NASO 8.0-32F $ - $ - 6241 CENT DIST62413359 S STRL AIRWY NASO 8.5-34F $ - $ - 6241 CENT DIST62411464 S STRL ALGISITE M 4X4 $ 3.00 $ 3.00 6241 CENT DIST62413361 S STRL AMBU BAG ADULT $ 210.00 $ 210.00 6241 CENT DIST62413362 S STRL AMBU BAG PEDIATRIC $ 249.00 $ 249.00 6241 CENT DIST62413367 S STRL AMBU BAG-INFANT $ 61.00 $ 61.00 6241 CENT DIST62412025 S STRL AMNIOCENTESIS TRAY $ 253.00 $ 253.00 6241 CENT DIST62413070 S STRL AMNIOHOOKS $ 31.00 $ 31.00 6241 CENT DIST62412401 S STRL AQUA PACK HUMID $ 14.00 $ 14.00 6241 CENT DIST62411428 S STRL AQUACEL AG 6X6 $ 27.00 $ 27.00 6241 CENT DIST62411429 S STRL AQUACEL AG RIBBON $ 15.00 $ 15.00 6241 CENT DIST62461866 S STRL AQUAPHORESIS FILT $ 3,787.00 $ 3,787.00 6246 CENT DIST62411134 S STRL ART LINE KIT 20GA $ 161.00 $ 161.00 6241 CENT DIST62412030 S STRL ART.LINE TRAY 18GA $ 260.00 $ 260.00 6241 CENT DIST62440181 S STRL AVI FOOT PAD $ 884.00 $ 884.00 6244 CENT DIST62440816 S STRL BAG AMBU W/MSK INF $ 190.00 $ 190.00 6244 CENT DIST62440808 S STRL BAG DRNG BILE 19OZ $ 45.00 $ 45.00 6244 CENT DIST62410779 S STRL BALL TRACH SUC 12 $ 205.00 $ 205.00 6241 CENT DIST62410780 S STRL BALL TRACH SUC 14 $ 133.00 $ 133.00 6241 CENT DIST62440718 S STRL BAND FETAL MONITOR $ 382.00 $ 382.00 6244 CENT DIST62413160 S STRL BASIC TRAY W NDL $ 296.00 $ 296.00 6241 CENT DIST62412780 S STRL BILE BAG $ 102.00 $ 102.00 6241 CENT DIST62412252 S STRL BIOPSY NEEDLE PED $ 490.00 $ 490.00 6241 CENT DIST62412251 S STRL BIOPSY NEEDLE PEDI $ 626.00 $ 626.00 6241 CENT DIST

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DEPARTMENT CODE

62412253 S STRL BIOPSY NEEDLE PEDI $ 490.00 $ 490.00 6241 CENT DIST62412250 S STRL BIOPSY,NEEDLE 4.5 $ 626.00 $ 626.00 6241 CENT DIST62410530 S STRL BI-POL INT CAT 5FR $ 642.00 $ 642.00 6241 CENT DIST62401060 S STRL BLAKEMORE TUBE $ 617.00 $ 617.00 6240 CENT DIST62401706 S STRL BLANKE BAIR HUGGER $ 299.00 $ 299.00 6240 CENT DIST62412616 S STRL BLOOD TB Y VENTED $ 27.00 $ 27.00 6241 CENT DIST62413584 S STRL BLOOD WARM LEVEL I $ 493.00 $ 493.00 6241 CENT DIST62413585 S STRL BLOOD WARMING COIL $ 157.00 $ 157.00 6241 CENT DIST62410583 S STRL BOLUS FEED TB 12FR $ 128.00 $ 128.00 6241 CENT DIST62410582 S STRL BOLUS FEED TB 8FR $ 128.00 $ 128.00 6241 CENT DIST62411216 S STRL BOLUS FEED TB 8FR $ 149.00 $ 149.00 6241 CENT DIST62411221 S STRL BONE MARR.NDL/PEDS $ 420.00 $ 420.00 6241 CENT DIST62412050 S STRL BONE MARROW TRAY $ 420.00 $ 420.00 6241 CENT DIST62411709 S STRL BOWEL MGMT COL BAG $ 172.00 $ 172.00 6241 CENT DIST62411708 S STRL BOWEL MGMT SYS 6MM $ 1,691.00 $ 1,691.00 6241 CENT DIST62440792 S STRL BRACE BACK FORM LG $ 204.00 $ 204.00 6244 CENT DIST62440822 S STRL BRACE BACK FRM SM $ 204.00 $ 204.00 6244 CENT DIST62440809 S STRL BRACE BACK MED $ 204.00 $ 204.00 6244 CENT DIST62400051 S STRL BRASURG SUP 3XL $ 294.00 $ 294.00 6240 CENT DIST62400013 S STRL BRASURG SUP XLG $ 288.00 $ 288.00 6240 CENT DIST62413080 S STRL BREAST PUMP KIT $ 497.00 $ 497.00 6241 CENT DIST62440756 S STRL BREAST THERASHELL $ 64.00 $ 64.00 6244 CENT DIST62413151 S STRL BROVIAC REPAIR KIT $ 853.00 $ 853.00 6241 CENT DIST62412585 S STRL BURETTE VENTED TB $ 41.00 $ 41.00 6241 CENT DIST62411231 S STRL CAT PAC 4F BIPOLAR $ 596.00 $ 596.00 6241 CENT DIST62411232 S STRL CAT PAC 5F BIPOLAR $ 596.00 $ 596.00 6241 CENT DIST62410580 S STRL CAT SHEAT INTR 5FR $ 228.00 $ 228.00 6241 CENT DIST62410789 S STRL CATH & SLEEVE 10FR $ 35.00 $ 35.00 6241 CENT DIST62411116 S STRL CATH 2.5FR X 2.5CM $ 244.00 $ 244.00 6241 CENT DIST62411115 S STRL CATH 2.5FR X 5CM $ 244.00 $ 244.00 6241 CENT DIST62411120 S STRL CATH 3FR X 8CM $ 244.00 $ 244.00 6241 CENT DIST62411175 S STRL CATH 3-LUMEN 5.5FR $ 372.00 $ 372.00 6241 CENT DIST62411176 S STRL CATH 3-LUMEN 5.5FR $ 372.00 $ 372.00 6241 CENT DIST

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DEPARTMENT CODE

62411180 S STRL CATH 3-LUMEN 5.5FR $ 372.00 $ 372.00 6241 CENT DIST62411235 S STRL CATH 3-LUMEN 5FR X $ 372.00 $ 372.00 6241 CENT DIST62411240 S STRL CATH 3-LUMEN 5FR X $ 372.00 $ 372.00 6241 CENT DIST62411245 S STRL CATH 3-LUMEN 5FR X $ 372.00 $ 372.00 6241 CENT DIST62411250 S STRL CATH 3-LUMEN 5FR X $ 372.00 $ 372.00 6241 CENT DIST62411189 S STRL CATH 3-LUMEN 7FR $ 149.00 $ 149.00 6241 CENT DIST62411177 S STRL CATH 3-LUMEN 7FR X $ 372.00 $ 372.00 6241 CENT DIST62411110 S STRL CATH 5FR X 12CM $ 244.00 $ 244.00 6241 CENT DIST62411105 S STRL CATH 5FR X 8CM $ 244.00 $ 244.00 6241 CENT DIST62411181 S STRL CATH 7.0FR X 16CM $ 244.00 $ 244.00 6241 CENT DIST62440720 S STRL CATH ACCUTRACE $ 195.00 $ 195.00 6244 CENT DIST62440805 S STRL CATH ADPTR Y PED $ 113.00 $ 113.00 6244 CENT DIST62411263 S STRL CATH CENTESIS $ 617.00 $ 617.00 6241 CENT DIST62440769 S STRL CATH CNCL 22FR 5CC $ 107.00 $ 107.00 6244 CENT DIST62440798 S STRL CATH CNCL FLY 2WAY $ 91.00 $ 91.00 6244 CENT DIST62440818 S STRL CATH CNCL FLY 2WAY $ 91.00 $ 91.00 6244 CENT DIST62411620 S STRL CATH CODE 5CC 20FR $ 125.00 $ 125.00 6241 CENT DIST62411215 S STRL CATH COOK NDL 20GA $ 495.00 $ 495.00 6241 CENT DIST62411220 S STRL CATH COOK NDL 24GA $ 495.00 $ 495.00 6241 CENT DIST62440738 S STRL CATH COUDE FOLEY $ 82.00 $ 82.00 6244 CENT DIST62440785 S STRL CATH CRICOTHY SET $ 623.00 $ 623.00 6244 CENT DIST62440812 S STRL CATH CV 2.5FR 5CM $ 219.00 $ 219.00 6244 CENT DIST62411254 S STRL CATH ELECT BIPOLAR $ 994.00 $ 994.00 6241 CENT DIST62410361 S STRL CATH FEMALE SELF $ 18.00 $ 18.00 6241 CENT DIST62411614 S STRL CATH FILI SPIR 4FR $ 111.00 $ 111.00 6241 CENT DIST62411616 S STRL CATH FILI SPIR 5FR $ 111.00 $ 111.00 6241 CENT DIST62411609 S STRL CATH FILIFORM 4FR $ 499.00 $ 499.00 6241 CENT DIST62411612 S STRL CATH FILIFORM 4FR $ 499.00 $ 499.00 6241 CENT DIST62411611 S STRL CATH FILIFORM 5FR $ 499.00 $ 499.00 6241 CENT DIST62411613 S STRL CATH FILIFORM 5FR $ 499.00 $ 499.00 6241 CENT DIST62440826 S STRL CATH FILIFORM 5FR $ 219.00 $ 219.00 6244 CENT DIST62440793 S STRL CATH FILIFORM COUD $ 214.00 $ 214.00 6244 CENT DIST62440814 S STRL CATH FLY 24FR 5CC $ 58.00 $ 58.00 6244 CENT DIST

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DEPARTMENT CODE

62440819 S STRL CATH FOLEY 20FR $ 61.00 $ 61.00 6244 CENT DIST62440783 S STRL CATH FOLEY 3WAY $ 66.00 $ 66.00 6244 CENT DIST62440810 S STRL CATH HEMA 2WAY 24F $ 147.00 $ 147.00 6244 CENT DIST62440797 S STRL CATH HEMA 3WAY 22F $ 146.00 $ 146.00 6244 CENT DIST62440782 S STRL CATH HEMA 3WAY 2FR $ 129.00 $ 129.00 6244 CENT DIST62413580 S STRL CATH HEMATU 2-WAY $ 147.00 $ 147.00 6241 CENT DIST62413581 S STRL CATH HEMATU 3-WAY $ 154.00 $ 154.00 6241 CENT DIST62413586 S STRL CATH INTRAUTERINE $ 280.00 $ 280.00 6241 CENT DIST62411272 S STRL CATH INTRO 5FR 12C $ 139.00 $ 139.00 6241 CENT DIST62411271 S STRL CATH INTRO 6FR 12C $ 139.00 $ 139.00 6241 CENT DIST62440729 S STRL CATH OXIM VENOUS $ 929.00 $ 929.00 6244 CENT DIST62411233 S STRL CATH PACING 6FR $ 648.00 $ 648.00 6241 CENT DIST62411270 S STRL CATH PER-Q-CATH 2. $ 1,128.00 $ 1,128.00 6241 CENT DIST62411275 S STRL CATH PER-Q-CATH 3. $ 1,128.00 $ 1,128.00 6241 CENT DIST62411602 S STRL CATH PHILLIPS 12FR $ 760.00 $ 760.00 6241 CENT DIST62411603 S STRL CATH PHILLIPS 14FR $ 760.00 $ 760.00 6241 CENT DIST62411604 S STRL CATH PHILLIPS 16FR $ 760.00 $ 760.00 6241 CENT DIST62411606 S STRL CATH PHILLIPS 18FR $ 760.00 $ 760.00 6241 CENT DIST62411607 S STRL CATH PHILLIPS 20FR $ 760.00 $ 760.00 6241 CENT DIST62411608 S STRL CATH PHILLIPS 22FR $ 760.00 $ 760.00 6241 CENT DIST62411601 S STRL CATH PHILLIPS 8FR $ 760.00 $ 760.00 6241 CENT DIST62440807 S STRL CATH PHILLIPS 8FR $ 349.00 $ 349.00 6244 CENT DIST62400354 S STRL CATH PRE 27G W/KIT $ 500.00 $ 500.00 6240 CENT DIST62440804 S STRL CATH REP BROV 6.6 $ 475.00 $ 475.00 6244 CENT DIST62440777 S STRL CATH SET CRICOTHYR $ 623.00 $ 623.00 6244 CENT DIST62411618 S STRL CATH STAMEY SUPRA $ 360.00 $ 360.00 6241 CENT DIST62440791 S STRL CATH STMY SUPRPUB $ 244.00 $ 244.00 6244 CENT DIST62412135 S STRL CATH STRAIT TR 15F $ 244.00 $ 244.00 6241 CENT DIST62440772 S STRL CATH STYLET CRVD $ 214.00 $ 214.00 6244 CENT DIST62411617 S STRL CATH STYLETTE 6 FR $ 402.00 $ 402.00 6241 CENT DIST62411780 S STRL CATH SUC REPO 10FR $ 65.00 $ 65.00 6241 CENT DIST62411795 S STRL CATH THORACIC 24FR $ 126.00 $ 126.00 6241 CENT DIST62440775 S STRL CATH THR TRCR 16FR $ 284.00 $ 284.00 6244 CENT DIST

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DEPARTMENT CODE

62411255 S STRL CATH TWIN IV $ 1,776.00 $ 1,776.00 6241 CENT DIST62411820 S STRL CATH UMB.VESS 5FR $ 164.00 $ 164.00 6241 CENT DIST62411815 S STRL CATH UMB.VESS 3.5F $ 164.00 $ 164.00 6241 CENT DIST62440758 S STRL CATH UMBIL 3.5 D $ 219.00 $ 219.00 6244 CENT DIST62410400 S STRL CATH URETHRAL 26FR $ 244.00 $ 244.00 6241 CENT DIST62410850 S STRL CATH,FOLEY 2-W 10F $ 137.00 $ 137.00 6241 CENT DIST62410855 S STRL CATH,FOLEY 2-W 12F $ 51.00 $ 51.00 6241 CENT DIST62411635 S STRL CATH,FOLEY 2-W 14F $ 76.00 $ 76.00 6241 CENT DIST62411640 S STRL CATH,FOLEY 2-W 16F $ 76.00 $ 76.00 6241 CENT DIST62411645 S STRL CATH,FOLEY 2-W 18F $ 76.00 $ 76.00 6241 CENT DIST62411650 S STRL CATH,FOLEY 2-W 20F $ 75.00 $ 75.00 6241 CENT DIST62411665 S STRL CATH,FOLEY 2-W 20F $ 87.00 $ 87.00 6241 CENT DIST62411030 S STRL CATH,FOLEY 2-W 22F $ 87.00 $ 87.00 6241 CENT DIST62411655 S STRL CATH,FOLEY 2-W 22F $ 76.00 $ 76.00 6241 CENT DIST62411660 S STRL CATH,FOLEY 2-W 24F $ 87.00 $ 87.00 6241 CENT DIST62411670 S STRL CATH,FOLEY 2-W 24F $ 87.00 $ 87.00 6241 CENT DIST62411675 S STRL CATH,FOLEY 2-W 26F $ 231.00 $ 231.00 6241 CENT DIST62411680 S STRL CATH,FOLEY 2-W 28F $ 87.00 $ 87.00 6241 CENT DIST62411630 S STRL CATH,FOLEY 2-W 8FR $ 137.00 $ 137.00 6241 CENT DIST62411685 S STRL CATH,FOLEY 3-W 18F $ 157.00 $ 157.00 6241 CENT DIST62411690 S STRL CATH,FOLEY 3-W 22F $ 163.00 $ 163.00 6241 CENT DIST62411695 S STRL CATH,FOLEY 3-W 22F $ 167.00 $ 167.00 6241 CENT DIST62411700 S STRL CATH,FOLEY 3-W 24F $ 81.00 $ 81.00 6241 CENT DIST62412940 S STRL CHEST DRAIN,ADULT $ 582.00 $ 582.00 6241 CENT DIST62412935 S STRL CHEST DRAIN,INFANT $ 619.00 $ 619.00 6241 CENT DIST62411126 S STRL CHEST TUBE 12FR W/ $ 294.00 $ 294.00 6241 CENT DIST62411785 S STRL CHEST TUBE TRAY 10 $ 769.00 $ 769.00 6241 CENT DIST62411786 S STRL CHEST TUBE TRAY 16 $ 769.00 $ 769.00 6241 CENT DIST62411787 S STRL CHEST TUBE TRAY 24 $ 769.00 $ 769.00 6241 CENT DIST62411788 S STRL CHEST TUBE TRAY 32 $ 731.00 $ 731.00 6241 CENT DIST62411789 S STRL CHEST TUBE TRAY 36 $ 731.00 $ 731.00 6241 CENT DIST62413610 S STRL CIRC CLAMP SZ 1.1 $ 260.00 $ 260.00 6241 CENT DIST62413611 S STRL CIRC CLAMP SZ 1.3 $ 260.00 $ 260.00 6241 CENT DIST

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DEPARTMENT CODE

62413612 S STRL CIRC CLAMP SZ 1.45 $ 260.00 $ 260.00 6241 CENT DIST62413270 S STRL CIRCUMCISION TRAY $ 41.00 $ 41.00 6241 CENT DIST62440803 S STRL CLMP PENILE ZIPSER $ 240.00 $ 240.00 6244 CENT DIST62440829 S STRL CLSTY/ILSTY 70MM $ 53.00 $ 53.00 6244 CENT DIST62440722 S STRL CNSTR INFO VAC W/ $ 264.00 $ 264.00 6244 CENT DIST62411227 S STRL COBE CRRT SPIKE $ 37.00 $ 37.00 6241 CENT DIST62411229 S STRL COBE DRAIN BAG $ 60.00 $ 60.00 6241 CENT DIST62411228 S STRL COBE PRE-DILUTION $ 1,152.00 $ 1,152.00 6241 CENT DIST62401050 S STRL CONDOM CATH LG $ 49.00 $ 49.00 6240 CENT DIST62401045 S STRL CONDOM CATH MED $ 49.00 $ 49.00 6240 CENT DIST62401040 S STRL CONDOM CATH SM $ 49.00 $ 49.00 6240 CENT DIST62411259 S STRL CONNEC TUBE 14F3OC $ 171.00 $ 171.00 6241 CENT DIST62411825 S STRL CONNECTING TUBE $ - $ - 6241 CENT DIST62411830 S STRL CONNECTING TUBE 3/ $ - $ - 6241 CENT DIST62411826 S STRL CONNECTING TUBE 5M $ - $ - 6241 CENT DIST62412857 S STRL CONT FLEX 1000 ML $ 94.00 $ 94.00 6241 CENT DIST62412856 S STRL CONT FLEX.500.ML $ 82.00 $ 82.00 6241 CENT DIST62411260 S STRL COOK CATH PIGTAIL $ 741.00 $ 741.00 6241 CENT DIST62411051 S STRL COOK EXTENSION TUB $ - $ - 6241 CENT DIST62411155 S STRL COOK GUIDE WIRE .0 $ 187.00 $ 187.00 6241 CENT DIST62413075 S STRL CORD CLAMP $ 22.00 $ 22.00 6241 CENT DIST62411610 S STRL COUDE CATH 14 FR $ 197.00 $ 197.00 6241 CENT DIST62411615 S STRL COUDE CATH 16 FR $ 197.00 $ 197.00 6241 CENT DIST62411619 S STRL COUDE CATH 18FR $ 142.00 $ 142.00 6241 CENT DIST62411166 S STRL CSF DRAIN SYSTE KT $ 1,080.00 $ 1,080.00 6241 CENT DIST62411168 S STRL CSF GUIDE KIT-GHAJ $ 1,898.00 $ 1,898.00 6241 CENT DIST62411167 S STRL CSF REPLACEMENT BA $ 494.00 $ 494.00 6241 CENT DIST62440734 S STRL CUF NIBP SZ3 DISP $ 48.00 $ 48.00 6244 CENT DIST62440746 S STRL CUFF BLD LG BX/5 $ 138.00 $ 138.00 6244 CENT DIST62440730 S STRL CUFF BLD PRES SM $ 40.00 $ 40.00 6244 CENT DIST62440786 S STRL CUFF BP ADLT DINA $ 109.00 $ 109.00 6244 CENT DIST62440707 S STRL CUFF BP DISP ADLT $ 43.00 $ 43.00 6244 CENT DIST62440728 S STRL CUFF BP DISP ADLT $ 43.00 $ 43.00 6244 CENT DIST

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DEPARTMENT CODE

62440779 S STRL CUFF BP INF $ 80.00 $ 80.00 6244 CENT DIST62440770 S STRL CUFF BP PEDI $ 41.00 $ 41.00 6244 CENT DIST62413522 S STRL CVP CATH 3L 5.5FR $ 499.00 $ 499.00 6241 CENT DIST62411170 S STRL CVP CATH KIT,DBL L $ 527.00 $ 527.00 6241 CENT DIST62411182 S STRL CVP CATH KIT,DBL L $ 372.00 $ 372.00 6241 CENT DIST62411187 S STRL CVP CATH KIT,DBL L $ 343.00 $ 343.00 6241 CENT DIST62411188 S STRL CVP CATH KIT,DBL L $ 372.00 $ 372.00 6241 CENT DIST62411580 S STRL CVP CATH KIT,DBL L $ 343.00 $ 343.00 6241 CENT DIST62411585 S STRL CVP CATH KIT,DBL L $ 343.00 $ 343.00 6241 CENT DIST62411590 S STRL CVP CATH KIT,DBL L $ 343.00 $ 343.00 6241 CENT DIST62411595 S STRL CVP CATH KIT,DBL L $ 372.00 $ 372.00 6241 CENT DIST62412590 S STRL CYSTO DRAIN TUBING $ 35.00 $ 35.00 6241 CENT DIST62410700 S STRL DEFIB PADS 3M $ 59.00 $ 59.00 6241 CENT DIST62412633 S STRL DERMABOND ADHESIVE $ 217.00 $ 217.00 6241 CENT DIST62440731 S STRL DETECTOR CO2 EASY $ 73.00 $ 73.00 6244 CENT DIST62412060 S STRL DOUCHE ADMIN.TRAY $ 1,550.00 $ 1,550.00 6241 CENT DIST62413480 S STRL DRAI EXT RPLMNT BG $ 287.00 $ 287.00 6241 CENT DIST62413475 S STRL DRAI EXT W/BAG&TUB $ 822.00 $ 822.00 6241 CENT DIST62400301 S STRL DRAIN IRRIGATION $ 12.00 $ 12.00 6240 CENT DIST62412734 S STRL DRAIN SET FUHRMAN $ 648.00 $ 648.00 6241 CENT DIST62411485 S STRL DRAIN SPONG 4X4/BX $ - $ - 6241 CENT DIST62440827 S STRL DRN WND COLL 4X8 $ 122.00 $ 122.00 6244 CENT DIST62440715 S STRL DRSG ANTIMIC BLU $ 50.00 $ 50.00 6244 CENT DIST62440741 S STRL DRSG GRANUFOAM VAC $ 469.00 $ 469.00 6244 CENT DIST62440800 S STRL DRSG NASAL 5.5CM $ 279.00 $ 279.00 6244 CENT DIST62411436 S STRL DRSG PROFORE LITE $ 240.00 $ 240.00 6241 CENT DIST62440763 S STRL DRSG VERSAFOAM SM $ 82.00 $ 82.00 6244 CENT DIST62413311 S STRL DSP INNE CANN SZ 4 $ 416.00 $ 416.00 6241 CENT DIST62413312 S STRL DSP INNE CANN SZ 6 $ 430.00 $ 430.00 6241 CENT DIST62413301 S STRL DSP INNE CANN SZ 7 $ 5.00 $ 5.00 6241 CENT DIST62413313 S STRL DSP INNE CANN SZ 8 $ 430.00 $ 430.00 6241 CENT DIST62413302 S STRL DSP INNE CANN SZ 9 $ 5.00 $ 5.00 6241 CENT DIST62413309 S STRL DSP INNER CANN EA $ 41.00 $ 41.00 6241 CENT DIST

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DEPARTMENT CODE

62413314 S STRL DSP. INNER CAN #10 $ 416.00 $ 416.00 6241 CENT DIST62413010 S STRL DUAL TEMP PAD DSP $ 272.00 $ 272.00 6241 CENT DIST62440714 S STRL ELECT ADLT 4.25X6 $ 191.00 $ 191.00 6244 CENT DIST62440717 S STRL ELECT DEFIB MULTI $ 116.00 $ 116.00 6244 CENT DIST62440765 S STRL ELECT DFIB RDLCNT $ 102.00 $ 102.00 6244 CENT DIST62411605 S STRL ELECTRODE CATH,BI- $ 22.00 $ 22.00 6241 CENT DIST62410576 S STRL EPISTAT SILI CATH $ 426.00 $ 426.00 6241 CENT DIST62412865 S STRL EVAC CONTAIN 1000 $ 32.00 $ 32.00 6241 CENT DIST62411845 S STRL EXTENSION SET 60 $ - $ - 6241 CENT DIST62411840 S STRL EXTENSION SET MINI $ - $ - 6241 CENT DIST62412555 S STRL EXTENSION T SET/CO $ - $ - 6241 CENT DIST62410830 S STRL EXTENSION TUBE $ - $ - 6241 CENT DIST62400294 S STRL FECAL COLLECTOR $ 120.00 $ 120.00 6240 CENT DIST62410575 S STRL FEED TBE 3.5 F $ 29.00 $ 29.00 6241 CENT DIST62411859 S STRL FEED TBE COPK 5FR $ 177.00 $ 177.00 6241 CENT DIST62411858 S STRL FEED TBE COPK 6FR $ 177.00 $ 177.00 6241 CENT DIST62411857 S STRL FEED TBE COPK 8FR $ 177.00 $ 177.00 6241 CENT DIST62410584 S STRL FEED TBE CRPA 10FR $ 152.00 $ 152.00 6241 CENT DIST62410574 S STRL FEED TBE MICKE 1.0 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410573 S STRL FEED TBE MICKE 1.2 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410571 S STRL FEED TBE MICKE 1.5 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410572 S STRL FEED TBE MICKE 1.7 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410577 S STRL FEED TBE MICKE 2.0 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410578 S STRL FEED TBE MICKE 2.3 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410579 S STRL FEED TBE MICKE 2.5 $ 1,022.00 $ 1,022.00 6241 CENT DIST62410581 S STRL FEED TBE MICKE 3.0 $ 1,022.00 $ 1,022.00 6241 CENT DIST62401081 S STRL FEEDER HABERMAN $ 130.00 $ 130.00 6240 CENT DIST62411860 S STRL FEEDING TUBE 5FR $ 76.00 $ 76.00 6241 CENT DIST62410570 S STRL FEEDING TUBE 5FR-P $ 27.00 $ 27.00 6241 CENT DIST62411875 S STRL FEEDING TUBE 8FR $ 19.00 $ 19.00 6241 CENT DIST62411880 S STRL FEEDING TUBE 8FR $ 21.00 $ 21.00 6241 CENT DIST62411865 S STRL FEEDING TUBE 8FR X $ 76.00 $ 76.00 6241 CENT DIST62413065 S STRL FEMALE CAT KIT 8F $ 24.00 $ 24.00 6241 CENT DIST

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DEPARTMENT CODE

62411282 S STRL FEMOSTOP ARCHES $ 764.00 $ 764.00 6241 CENT DIST62440824 S STRL FILIFORM COUDE 4FR $ 214.00 $ 214.00 6244 CENT DIST62440821 S STRL FILIFORM TIP 4FR $ 214.00 $ 214.00 6244 CENT DIST62440747 S STRL FLLWR 14FR OPEN $ 418.00 $ 418.00 6244 CENT DIST62440754 S STRL FLLWR 18FR OPEN $ 396.00 $ 396.00 6244 CENT DIST62440768 S STRL FLLWR PHILIP 16FR $ 593.00 $ 593.00 6244 CENT DIST62440774 S STRL FLLWR PHILLIP 22FR $ 396.00 $ 396.00 6244 CENT DIST62440794 S STRL FLLWR PHLLPS 20FR $ 396.00 $ 396.00 6244 CENT DIST62440802 S STRL FLLWR PHLP OP 12FR $ 359.00 $ 359.00 6244 CENT DIST62411463 S STRL FM DRS ADH OV4X4.5 $ 5.00 $ 5.00 6241 CENT DIST62411461 S STRL FM DRS ADHESV 4X4 $ 5.00 $ 5.00 6241 CENT DIST62411462 S STRL FM DRS NO ADHSV4X4 $ 4.00 $ 4.00 6241 CENT DIST62410320 S STRL FOLEY CATH COUNCIL $ 25.00 $ 25.00 6241 CENT DIST62411701 S STRL FOLEY CATH HOLDER $ - $ - 6241 CENT DIST62412055 S STRL FOLEY CATH TRAY $ 248.00 $ 248.00 6241 CENT DIST62412040 S STRL FOLEY CATH TRAY 16 $ 183.00 $ 183.00 6241 CENT DIST62412045 S STRL FOLEY CATH TRAY 18 $ 152.00 $ 152.00 6241 CENT DIST62411121 S STRL FUHRMAN PLEURAL/PN $ 706.00 $ 706.00 6241 CENT DIST62412950 S STRL FULLER SHIELD $ 106.00 $ 106.00 6241 CENT DIST62410873 S STRL GDE WIRE .018X50CM $ 177.00 $ 177.00 6241 CENT DIST62410871 S STRL GDE WIRE ST 116358 $ 100.00 $ 100.00 6241 CENT DIST62440724 S STRL GDWR CODE MANDRIL $ 223.00 $ 223.00 6244 CENT DIST62440735 S STRL GEL CURASOL 3OZ $ 70.00 $ 70.00 6244 CENT DIST62410310 S STRL GESCO PER-Q-CATH $ 626.00 $ 626.00 6241 CENT DIST62413074 S STRL GOMCO CLAMP #1.1 $ 316.00 $ 316.00 6241 CENT DIST62413081 S STRL GOMCO CLAMP #1.3 $ 1,409.00 $ 1,409.00 6241 CENT DIST62413082 S STRL GOMCO CLAMP #1.45 $ 316.00 $ 316.00 6241 CENT DIST62410996 S STRL GROSH MICRO INT 5F $ 427.00 $ 427.00 6241 CENT DIST62410986 S STRL GROSH MIDLINE 3FR $ 681.00 $ 681.00 6241 CENT DIST62410987 S STRL GROSH MIDLINE 4FR $ 681.00 $ 681.00 6241 CENT DIST62410988 S STRL GROSH PIC LINE 4FR $ 1,156.00 $ 1,156.00 6241 CENT DIST62410989 S STRL GROSH PIC LINE 5FR $ 1,443.00 $ 1,443.00 6241 CENT DIST62411006 S STRL GROSHO CATH-REP 4F $ 164.00 $ 164.00 6241 CENT DIST

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DEPARTMENT CODE

62411007 S STRL GROSHO CATH-REP 5F $ 164.00 $ 164.00 6241 CENT DIST62411005 S STRL GROSHO CATH-REP 7F $ 119.00 $ 119.00 6241 CENT DIST62411000 S STRL GROSHO CATH-REP 8F $ 119.00 $ 119.00 6241 CENT DIST62411015 S STRL GROSHO REP KIT $ 436.00 $ 436.00 6241 CENT DIST62410990 S STRL GROSHONG CATH-REP $ 119.00 $ 119.00 6241 CENT DIST62410995 S STRL GROSHONG CATH-REP $ 119.00 $ 119.00 6241 CENT DIST62411010 S STRL GROSHONG INJ. CAP $ 119.00 $ 119.00 6241 CENT DIST62410991 S STRL GROSHONG PICC KIT $ - $ - 6241 CENT DIST62411020 S STRL GROSHONG REPAI KIT $ 568.00 $ 568.00 6241 CENT DIST62411008 S STRL GROSHONG SFR INTRO $ 220.00 $ 220.00 6241 CENT DIST62411021 S STRL GROSHONG TRAY 3FR $ 785.00 $ 785.00 6241 CENT DIST62412925 S STRL GROUNDING PAD $ 61.00 $ 61.00 6241 CENT DIST62411160 S STRL GUIDE WIRE .015 X $ 147.00 $ 147.00 6241 CENT DIST62411150 S STRL GUIDE WIRE .018 X $ 279.00 $ 279.00 6241 CENT DIST62410860 S STRL GUIDE WIRE .025 X $ 179.00 $ 179.00 6241 CENT DIST62410865 S STRL GUIDE WIRE .025 X $ 190.00 $ 190.00 6241 CENT DIST62411195 S STRL GUIDE WIRE .025 X $ 190.00 $ 190.00 6241 CENT DIST62410872 S STRL GUIDE WIRE .025X80 $ 135.00 $ 135.00 6241 CENT DIST62410845 S STRL GUIDE WIRE .035 X $ 187.00 $ 187.00 6241 CENT DIST62411165 S STRL GUIDE WIRE .035 X $ 190.00 $ 190.00 6241 CENT DIST62412745 S STRL GUIDE WIRE .038 CU $ 187.00 $ 187.00 6241 CENT DIST62410870 S STRL GUIDE WIRE .35X145 $ 156.00 $ 156.00 6241 CENT DIST62412747 S STRL GUIDE WIRE 21 X 14 $ 259.00 $ 259.00 6241 CENT DIST62412740 S STRL GUIDE WIRE 60 CURV $ 187.00 $ 187.00 6241 CENT DIST62412735 S STRL GUIDE WIRE 70 STRA $ 187.00 $ 187.00 6241 CENT DIST62412231 S STRL GUIDE WIRE INTRO 1 $ 187.00 $ 187.00 6241 CENT DIST62440781 S STRL HD COMFORT CONVERT $ 123.00 $ 123.00 6244 CENT DIST62413325 S STRL HEIM CHEST VALVE $ 160.00 $ 160.00 6241 CENT DIST62413150 S STRL HICKMAN REP.KIT $ 235.00 $ 235.00 6241 CENT DIST62400310 S STRL HOL OSTOMY BELT LG $ 46.00 $ 46.00 6240 CENT DIST62400320 S STRL HOL OSTOMY BELT SM $ 46.00 $ 46.00 6240 CENT DIST62400352 S STRL HOLL DRAIN TUBE $ 89.00 $ 89.00 6240 CENT DIST62400309 S STRL HOLL DRN TB ADAPT $ 71.00 $ 71.00 6240 CENT DIST

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DEPARTMENT CODE

62400357 S STRL HOLL EXT TUBE $ 51.00 $ 51.00 6240 CENT DIST62400358 S STRL HOLL LEG BG STRAP $ 57.00 $ 57.00 6240 CENT DIST62400305 S STRL HOLL PENIS POUCH $ 63.00 $ 63.00 6240 CENT DIST62410340 S STRL HOLLISTER BLANKET $ 249.00 $ 249.00 6241 CENT DIST62413380 S STRL HUBER NDL ALL SIZE $ 76.00 $ 76.00 6241 CENT DIST62440040 S STRL HYPERTHERMIA UNIT $ - $ - 6244 CENT DIST62412960 S STRL INCENTIVE SPIROMET $ 105.00 $ 105.00 6241 CENT DIST62440900 S STRL INNRCL CATH 10.7FR $ 7,030.00 $ 7,030.00 6244 CENT DIST62440901 S STRL INNRCL CATH 14FR $ 7,072.00 $ 7,072.00 6244 CENT DIST62440902 S STRL INNRCL INTR 10.7FR $ 438.00 $ 438.00 6244 CENT DIST62440903 S STRL INNRCL INTRO 14FR $ 419.00 $ 419.00 6244 CENT DIST62440815 S STRL INTRD W/GUIDE 5FR $ 170.00 $ 170.00 6244 CENT DIST62440820 S STRL INTRD W/GUIDE 6FR $ 73.00 $ 73.00 6244 CENT DIST62411267 S STRL INTRO SHEATH 9FR $ 411.00 $ 411.00 6241 CENT DIST62411264 S STRL INTRODUCER SHIC $ 244.00 $ 244.00 6241 CENT DIST62411266 S STRL INTRODUCER SHIELD $ 111.00 $ 111.00 6241 CENT DIST62411295 S STRL INTRODUCER/ADAPTER $ - $ - 6241 CENT DIST62410777 S STRL INTUBATION KIT 7FR $ 569.00 $ 569.00 6241 CENT DIST62400316 S STRL IRRIGATION ONLY $ 241.00 $ 241.00 6240 CENT DIST62400296 S STRL IRRIGATION SLEEVES $ 282.00 $ 282.00 6240 CENT DIST62411941 S STRL JACKSON PIATT BULB $ 70.00 $ 70.00 6241 CENT DIST62412034 S STRL JAMISH BIOPS W/NDL $ 358.00 $ 358.00 6241 CENT DIST62413370 S STRL JAMSHIDI 11GA X 4- $ 408.00 $ 408.00 6241 CENT DIST62413375 S STRL JAMSHIDI 13GA X3.5 $ 408.00 $ 408.00 6241 CENT DIST62413290 S STRL KEOFEED TUBE 6FR $ 131.00 $ 131.00 6241 CENT DIST62440709 S STRL KIT CATH OXIMETRY $ 972.00 $ 972.00 6244 CENT DIST62440708 S STRL KIT CNTRL VENOUS $ 529.00 $ 529.00 6244 CENT DIST62440706 S STRL KIT IV CNTRL LINE $ 384.00 $ 384.00 6244 CENT DIST62440813 S STRL KIT REP HICK $ 432.00 $ 432.00 6244 CENT DIST62440705 S STRL KIT SYMPH BRST DBL $ 206.00 $ 206.00 6244 CENT DIST62440811 S STRL KIT TB CHST PLEURA $ 463.00 $ 463.00 6244 CENT DIST62440751 S STRL KIT ULTRA PERC SZ8 $ 1,048.00 $ 1,048.00 6244 CENT DIST62440766 S STRL KIT ULTRA PERC SZ9 $ 1,048.00 $ 1,048.00 6244 CENT DIST

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DEPARTMENT CODE

62440229 S STRL K-PAD 15 X 22 3324 $ 86.00 $ 86.00 6244 CENT DIST62411561 S STRL LACERATION TRAY $ 161.00 $ 161.00 6241 CENT DIST62440789 S STRL LAV GSTRC CODE BLU $ 407.00 $ 407.00 6244 CENT DIST62411940 S STRL LAVACUATOR TUBE $ 158.00 $ 158.00 6241 CENT DIST62413230 S STRL LAVAGE TRAY $ 582.00 $ 582.00 6241 CENT DIST62412775 S STRL LEG BAG LARGE $ 87.00 $ 87.00 6241 CENT DIST62412770 S STRL LEG BAG MEDIUM $ 86.00 $ 86.00 6241 CENT DIST62440788 S STRL LENS IRR EY DISP $ 113.00 $ 113.00 6244 CENT DIST62412035 S STRL LIVER BIOPSY TRAY $ 582.00 $ 582.00 6241 CENT DIST62412075 S STRL LUMBAR PUNCT PEDS $ 180.00 $ 180.00 6241 CENT DIST62412080 S STRL LUMBAR PUNCT TRAY $ 189.00 $ 189.00 6241 CENT DIST62412090 S STRL MANOMETER TRAY $ 104.00 $ 104.00 6241 CENT DIST62440740 S STRL MATTRSS WARM DISP $ 577.00 $ 577.00 6244 CENT DIST62411200 S STRL MIC-KEY EXT SET $ 131.00 $ 131.00 6241 CENT DIST62413350 S STRL MINNESOTA TUBE $ 1,107.00 $ 1,107.00 6241 CENT DIST62411575 S STRL M-LUMEN SET 7FX16C $ 427.00 $ 427.00 6241 CENT DIST62413470 S STRL MONIT INTRACRA KIT $ 2,592.00 $ 2,592.00 6241 CENT DIST62411399 S STRL NASAL EPIST II KIT $ 638.00 $ 638.00 6241 CENT DIST62460010 S STRL NASAL SLINGS/PKG $ 121.00 $ 121.00 6246 CENT DIST62411397 S STRL NASAL TAMPON-DOYLE $ 192.00 $ 192.00 6241 CENT DIST62440801 S STRL NDL BIOP 14GAX4.5I $ 87.00 $ 87.00 6244 CENT DIST62440115 S STRL NDL BONE MALOW 15G $ 169.00 $ 169.00 6244 CENT DIST62440787 S STRL NDL BONE MARROW $ 129.00 $ 129.00 6244 CENT DIST62440795 S STRL NDL ILIAC ASP 15GA $ 105.00 $ 105.00 6244 CENT DIST62440764 S STRL NDL INFS 18GAX4.0 $ 289.00 $ 289.00 6244 CENT DIST62440828 S STRL NDL JAMISHIDI BIOP $ 148.00 $ 148.00 6244 CENT DIST62440126 S STRL NDL JAMSHIDI 11GA $ 216.00 $ 216.00 6244 CENT DIST62440116 S STRL NDL JAMSHIDI 13GA $ 231.00 $ 231.00 6244 CENT DIST62440125 S STRL NDL JAMSHIDI 17GA $ 166.00 $ 166.00 6244 CENT DIST62440127 S STRL NDL JAMSHIDI 8GA $ 195.00 $ 195.00 6244 CENT DIST62440123 S STRL NDL PREC INT 1.9FR $ 184.00 $ 184.00 6244 CENT DIST62413379 S STRL NDL QUCK CORE 15 $ 299.00 $ 299.00 6241 CENT DIST62413378 S STRL NDL QUCK CORE 16 $ 299.00 $ 299.00 6241 CENT DIST

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DEPARTMENT CODE

62413377 S STRL NDL QUCK CORE 18 $ 299.00 $ 299.00 6241 CENT DIST62413374 S STRL NDL QUCK CORE 19 $ 299.00 $ 299.00 6241 CENT DIST62440737 S STRL NEB HRT BAND B120A $ 122.00 $ 122.00 6244 CENT DIST62401106 S STRL NEBULIZER 3254 $ 7.00 $ 7.00 6240 CENT DIST62410440 S STRL NEBULIZER KIT $ 61.00 $ 61.00 6241 CENT DIST62412237 S STRL NEEDLE CENTESIS 5F $ 152.00 $ 152.00 6241 CENT DIST62440120 S STRL NEEDLE SPECIAL $ 136.00 $ 136.00 6244 CENT DIST62401465 S STRL NEEDLE VYGON 20GX1 $ 174.00 $ 174.00 6240 CENT DIST62411437 S STRL NO STING BARRIER $ 49.00 $ 49.00 6241 CENT DIST62413040 S STRL N-TERFACE 4 X 12* $ 244.00 $ 244.00 6241 CENT DIST62410977 S STRL O2 SENSOR FETAL $ 753.00 $ 753.00 6241 CENT DIST62411136 S STRL OPTICATH OXIMETRIX $ 1,568.00 $ 1,568.00 6241 CENT DIST62400317 S STRL OSTOMY BELT MED $ 46.00 $ 46.00 6240 CENT DIST62400318 S STRL OSTOMY CLAMP #7765 $ 24.00 $ 24.00 6240 CENT DIST62400319 S STRL OSTOMY CLAMP #7770 $ 24.00 $ 24.00 6240 CENT DIST62401085 S STRL OXI ADULT 0-25 $ 146.00 $ 146.00 6240 CENT DIST62401100 S STRL OXI INFANT I-20R $ 88.00 $ 88.00 6240 CENT DIST62401095 S STRL OXI NEONATE N25-R $ 88.00 $ 88.00 6240 CENT DIST62401090 S STRL OXI PEDI 0-20 $ 146.00 $ 146.00 6240 CENT DIST62413485 S STRL PAC TEM ART CAT 5F $ 756.00 $ 756.00 6241 CENT DIST62411258 S STRL PAC WIRE TEMP 5FR $ 994.00 $ 994.00 6241 CENT DIST62411775 S STRL PACEPORT CATHETER $ - $ - 6241 CENT DIST62411256 S STRL PACING BALECT 5FR $ 1,019.00 $ 1,019.00 6241 CENT DIST62440076 S STRL PAD DUAL TEMP $ 400.00 $ 400.00 6244 CENT DIST62401710 S STRL PAD HYPERTHERMIA $ 318.00 $ 318.00 6240 CENT DIST62413240 S STRL PARACENTESIS TRAY $ 759.00 $ 759.00 6241 CENT DIST62440817 S STRL PASTE SKN PROTEC $ 92.00 $ 92.00 6244 CENT DIST62440759 S STRL PCH UROSTY CONVEX $ 161.00 $ 161.00 6244 CENT DIST62440780 S STRL PCH WND 6.9X4.3 RE $ 84.00 $ 84.00 6244 CENT DIST62440744 S STRL PCH WND 9.7X6.3 $ 131.00 $ 131.00 6244 CENT DIST62440796 S STRL PD PRO MINI PED $ 196.00 $ 196.00 6244 CENT DIST62413045 S STRL PELVIC EXAM TRAY $ 182.00 $ 182.00 6241 CENT DIST62411298 S STRL PERC.ENTRY NDL.21G $ 46.00 $ 46.00 6241 CENT DIST

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DEPARTMENT CODE

62410510 S STRL PERICARDIDCEN TRAY $ 843.00 $ 843.00 6241 CENT DIST62413110 S STRL PERICARDIOCEN TRAY $ 1,905.00 $ 1,905.00 6241 CENT DIST62411225 S STRL PERI-PLEURA SET 5F $ - $ - 6241 CENT DIST62411230 S STRL PERI-PLEURA SET 7F $ - $ - 6241 CENT DIST62411273 S STRL PER-Q-CATH 2FRX22G $ 436.00 $ 436.00 6241 CENT DIST62411276 S STRL PER-Q-CATH D-L 4.0 $ 1,042.00 $ 1,042.00 6241 CENT DIST62411277 S STRL PER-Q-CATH D-L 5.0 $ 1,042.00 $ 1,042.00 6241 CENT DIST62411279 S STRL PER-Q-CATH REPAIR $ 35.00 $ 35.00 6241 CENT DIST62411280 S STRL PER-Q-CATH REPAIR $ 35.00 $ 35.00 6241 CENT DIST62411278 S STRL PER-Q-CATH S-L 4.0 $ 180.00 $ 180.00 6241 CENT DIST62401565 S STRL PHOTOTHERAPY MASK, $ 40.00 $ 40.00 6240 CENT DIST62401570 S STRL PHOTOTHERAPY MASK, $ 40.00 $ 40.00 6240 CENT DIST62401575 S STRL PHOTOTHERAPY MASK, $ 40.00 $ 40.00 6240 CENT DIST62411274 S STRL PICC LINE 1.9FR $ 493.00 $ 493.00 6241 CENT DIST62440752 S STRL PILLOW ABDUCT MED $ 151.00 $ 151.00 6244 CENT DIST62413071 S STRL PLASTIBILL CLAMP $ 49.00 $ 49.00 6241 CENT DIST62413072 S STRL PLASTIBILL CLAMP $ 49.00 $ 49.00 6241 CENT DIST62413073 S STRL PLASTIBILL CLAMP $ 49.00 $ 49.00 6241 CENT DIST62411223 S STRL PLEUR-EVAC PLUS $ 506.00 $ 506.00 6241 CENT DIST62411222 S STRL PLEUREVAC RPLC BAG $ 497.00 $ 497.00 6241 CENT DIST62413326 S STRL PNEUMOTHOROX $ 600.00 $ 600.00 6241 CENT DIST62413390 S STRL PORT-A-CATH TRAY $ 1,776.00 $ 1,776.00 6241 CENT DIST62460410 S STRL POUCH CLAMP $ 30.00 $ 30.00 6246 CENT DIST62412369 S STRL PRE-DILUTION SET $ 1,152.00 $ 1,152.00 6241 CENT DIST62410771 S STRL PRESS INF BAG 500C $ 152.00 $ 152.00 6241 CENT DIST62410620 S STRL PRESSURE TUBING IN $ - $ - 6241 CENT DIST62411905 S STRL RECTAL TUBE 28FR $ 111.00 $ 111.00 6241 CENT DIST62401010 S STRL RED ROB CATH 8FR $ 69.00 $ 69.00 6240 CENT DIST62401015 S STRL RED ROBI CATH 10FR $ 69.00 $ 69.00 6240 CENT DIST62401020 S STRL RED ROBI CATH 12FR $ 72.00 $ 72.00 6240 CENT DIST62401025 S STRL RED ROBI CATH 16FR $ 70.00 $ 70.00 6240 CENT DIST62401030 S STRL RED ROBI CATH 18FR $ 70.00 $ 70.00 6240 CENT DIST62401033 S STRL RED ROBI CATH 20FR $ 69.00 $ 69.00 6240 CENT DIST

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DEPARTMENT CODE

62401035 S STRL RED ROBINSON CATH $ 20.00 $ 20.00 6240 CENT DIST62401038 S STRL RED ROBINSON CATH $ 75.00 $ 75.00 6240 CENT DIST62401039 S STRL RED ROBINSON CATH $ 30.00 $ 30.00 6240 CENT DIST62440733 S STRL REST HAND FINGER $ 148.00 $ 148.00 6244 CENT DIST62440757 S STRL RESTRAINT VEST XL $ 116.00 $ 116.00 6244 CENT DIST62411363 S STRL RHINO ROCKET LARGE $ 102.00 $ 102.00 6241 CENT DIST62411362 S STRL RHINO ROCKET MED $ 90.00 $ 90.00 6241 CENT DIST62411361 S STRL RHINO ROCKET SMALL $ 76.00 $ 76.00 6241 CENT DIST62411364 S STRL RHINO ROCKET X-LG $ 124.00 $ 124.00 6241 CENT DIST62413595 S STRL SAFELINE ATTACHMEN $ 31.00 $ 31.00 6241 CENT DIST62410565 S STRL SALEM SUMP TBE 6FR $ 51.00 $ 51.00 6241 CENT DIST62410566 S STRL SALEM SUMP TBE 8FR $ 51.00 $ 51.00 6241 CENT DIST62410555 S STRL SALEM SUMP TUBE 10 $ 43.00 $ 43.00 6241 CENT DIST62410560 S STRL SALEM SUMP TUBE 12 $ 43.00 $ 43.00 6241 CENT DIST62411910 S STRL SALEM SUMP TUBE 14 $ 89.00 $ 89.00 6241 CENT DIST62411915 S STRL SALEM SUMP TUBE 16 $ 89.00 $ 89.00 6241 CENT DIST62411920 S STRL SALEM SUMP TUBE 18 $ 89.00 $ 89.00 6241 CENT DIST62440037 S STRL SCD SLEEVE KL $ 516.00 $ 516.00 6244 CENT DIST62440034 S STRL SCD SLEEVE TL $ 624.00 $ 624.00 6244 CENT DIST62440036 S STRL SCD SLEEVE TL $ 736.00 $ 736.00 6244 CENT DIST62440039 S STRL SCD SLEEVE TL $ 566.00 $ 566.00 6244 CENT DIST62440038 S STRL SCD SLEEVE TL MED $ 650.00 $ 650.00 6244 CENT DIST62410360 S STRL SELF CATH,FEM.14FR $ 18.00 $ 18.00 6241 CENT DIST62440749 S STRL SENSOR OXIMAX PED $ 92.00 $ 92.00 6244 CENT DIST62440799 S STRL SET SECURE LOK EXT $ 72.00 $ 72.00 6244 CENT DIST62411434 S STRL SETOPRES BANDAGE 4 $ 216.00 $ 216.00 6241 CENT DIST62412632 S STRL SILK SUTURE 2.0 $ 35.00 $ 35.00 6241 CENT DIST62412631 S STRL SILK SUTURE 2.0 BL $ 33.00 $ 33.00 6241 CENT DIST62413335 S STRL SILK SUTURE 3.0 $ 38.00 $ 38.00 6241 CENT DIST62412635 S STRL SILK SUTURE 4.0 BL $ 95.00 $ 95.00 6241 CENT DIST62413575 S STRL SILO BG 5CM 31446 $ 944.00 $ 944.00 6241 CENT DIST62401356 S STRL SKIN SCRUB TRAY $ 29.00 $ 29.00 6240 CENT DIST62412620 S STRL SKIN STAPLER 35 LG $ 133.00 $ 133.00 6241 CENT DIST

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DEPARTMENT CODE

62412630 S STRL SLIK SUTURE 4.0 BL $ 63.00 $ 63.00 6241 CENT DIST62440753 S STRL SLNG SWATHE UNIV $ 78.00 $ 78.00 6244 CENT DIST62440784 S STRL SLV KNEE BARIATRIC $ 227.00 $ 227.00 6244 CENT DIST62440700 S STRL SLV KNEE REG $ 136.00 $ 136.00 6244 CENT DIST62440710 S STRL SLV THIGH LG $ 249.00 $ 249.00 6244 CENT DIST62440703 S STRL SLV THIGH REG $ 123.00 $ 123.00 6244 CENT DIST62440701 S STRL SNSR LNCS ADT ADLT $ 50.00 $ 50.00 6244 CENT DIST62440736 S STRL SNSR LNCS INF-L $ 52.00 $ 52.00 6244 CENT DIST62440704 S STRL SNSR LNCS NEONTL $ 114.00 $ 114.00 6244 CENT DIST62440719 S STRL SNSR OXI MTR PEDI $ 69.00 $ 69.00 6244 CENT DIST62412232 S STRL SPIN NDL 18G X 3.5 $ 38.00 $ 38.00 6241 CENT DIST62412233 S STRL SPINAL NDL 20GX3.5 $ 37.00 $ 37.00 6241 CENT DIST62412234 S STRL SPINAL NDL 22GX3.5 $ 24.00 $ 24.00 6241 CENT DIST62412245 S STRL SPINAL NDL 22X1.5 $ 39.00 $ 39.00 6241 CENT DIST62412236 S STRL SPINAL NDL 25GX3 $ 37.00 $ 37.00 6241 CENT DIST62440739 S STRL SPT ANKL LFT HONEY $ 202.00 $ 202.00 6244 CENT DIST62440742 S STRL SPT ANKL RT HONEY $ 177.00 $ 177.00 6244 CENT DIST62440771 S STRL SPT STERNUM HRT SM $ 560.00 $ 560.00 6244 CENT DIST62440773 S STRL SPT STERNUM LG $ 517.00 $ 517.00 6244 CENT DIST62440762 S STRL SPT STERNUM REG $ 560.00 $ 560.00 6244 CENT DIST62440745 S STRL SPT STRNM HGGR XL $ 560.00 $ 560.00 6244 CENT DIST62440767 S STRL STCKNTTE NUBAND SM $ 259.00 $ 259.00 6244 CENT DIST62411468 S STRL STOMAHESIVE POWDER $ 4.00 $ 4.00 6241 CENT DIST62440760 S STRL STPLR SKIN 35 WIDE $ 56.00 $ 56.00 6244 CENT DIST62411770 S STRL SUC CATH KIT 14-16 $ 29.00 $ 29.00 6241 CENT DIST62411750 S STRL SUC CATH KIT 8F $ 13.00 $ 13.00 6241 CENT DIST62411737 S STRL SUC CATH REPGLE 8F $ 78.00 $ 78.00 6241 CENT DIST62411736 S STRL SUC CTH/SLEVE 10FR $ 18.00 $ 18.00 6241 CENT DIST62410778 S STRL SUCTION BALLARD 10 $ 14.00 $ 14.00 6241 CENT DIST62410782 S STRL SUCTION BALLARD 10 $ 14.00 $ 14.00 6241 CENT DIST62410781 S STRL SUCTION BALLARD 12 $ 14.00 $ 14.00 6241 CENT DIST62410788 S STRL SUCTION BALLARD 16 $ 14.00 $ 14.00 6241 CENT DIST62410786 S STRL SUCTION BALLARD 6 $ 14.00 $ 14.00 6241 CENT DIST

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DEPARTMENT CODE

62410783 S STRL SUCTION BALLARD 8 $ 14.00 $ 14.00 6241 CENT DIST62411760 S STRL SUCTION CAT KIT 12 $ 20.00 $ 20.00 6241 CENT DIST62411765 S STRL SUCTION CAT KIT 14 $ 25.00 $ 25.00 6241 CENT DIST62411755 S STRL SUCTION CAT KIT 1O $ 24.00 $ 24.00 6241 CENT DIST62411745 S STRL SUCTION CAT KIT 6F $ 24.00 $ 24.00 6241 CENT DIST62411725 S STRL SUCTION CAT KIT 8F $ 19.00 $ 19.00 6241 CENT DIST62410790 S STRL SUCTION CATH 12FR $ 24.00 $ 24.00 6241 CENT DIST62410795 S STRL SUCTION CATH 5F $ 18.00 $ 18.00 6241 CENT DIST62411730 S STRL SUCTION CATH KIT $ 12.00 $ 12.00 6241 CENT DIST62410755 S STRL SUCTION CATH KIT 1 $ 24.00 $ 24.00 6241 CENT DIST62411720 S STRL SUCTION CATHETER $ 13.00 $ 13.00 6241 CENT DIST62411740 S STRL SUCTION CATHETER 5 $ 50.00 $ 50.00 6241 CENT DIST62413590 S STRL SUCTION SWAB KIT $ 67.00 $ 67.00 6241 CENT DIST62440823 S STRL SUTR SOF 3.0 SC-2 $ 82.00 $ 82.00 6244 CENT DIST62410720 S STRL SWAN GANZ THERMO C $ 1,063.00 $ 1,063.00 6241 CENT DIST62440778 S STRL SYS COL SAFETOUCH $ 123.00 $ 123.00 6244 CENT DIST62440726 S STRL SYS SUCTIONPRO72 $ 51.00 $ 51.00 6244 CENT DIST62440750 S STRL SYS SUCTIONPRO72 $ 120.00 $ 120.00 6244 CENT DIST62440761 S STRL SYS SUCTIONPRO72 $ 47.00 $ 47.00 6244 CENT DIST62440806 S STRL SYS SUCTIONPRO72 $ 53.00 $ 53.00 6244 CENT DIST62413363 S STRL TB TRACH #6 W/TALK $ 936.00 $ 936.00 6241 CENT DIST62413364 S STRL TB TRACH #8 W/TALK $ 936.00 $ 936.00 6241 CENT DIST62411070 S STRL TED SLEEVES #5345 $ 808.00 $ 808.00 6241 CENT DIST62411065 S STRL TED SLEEVES KNEE $ 774.00 $ 774.00 6241 CENT DIST62411055 S STRL TED SLEEVES THIGH $ 887.00 $ 887.00 6241 CENT DIST62411060 S STRL TED SLEEVES THIGH $ 937.00 $ 937.00 6241 CENT DIST62400905 S STRL TED STOCKING K-L $ 76.00 $ 76.00 6240 CENT DIST62400910 S STRL TED STOCKING K-L $ 76.00 $ 76.00 6240 CENT DIST62400915 S STRL TED STOCKING K-L $ 76.00 $ 76.00 6240 CENT DIST62400939 S STRL TED STOCKING K-L $ 85.00 $ 85.00 6240 CENT DIST62401515 S STRL TED STOCKING K-L $ 76.00 $ 76.00 6240 CENT DIST62401520 S STRL TED STOCKING K-L $ 124.00 $ 124.00 6240 CENT DIST62400938 S STRL TED STOCKING K-L # $ 76.00 $ 76.00 6240 CENT DIST

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DEPARTMENT CODE

62401510 S STRL TED STOCKING K-L # $ 76.00 $ 76.00 6240 CENT DIST62400903 S STRL TED STOCKING T-L $ 211.00 $ 211.00 6240 CENT DIST62400904 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62400920 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62400925 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62400930 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62400935 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62400937 S STRL TED STOCKING T-L $ 211.00 $ 211.00 6240 CENT DIST62401525 S STRL TED STOCKING T-L $ 107.00 $ 107.00 6240 CENT DIST62401526 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62401530 S STRL TED STOCKING T-L $ 124.00 $ 124.00 6240 CENT DIST62401540 S STRL TED STOCKING T-L $ 52.00 $ 52.00 6240 CENT DIST62401545 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401546 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401547 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401548 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401549 S STRL TED STOCKING/BELT $ 158.00 $ 158.00 6240 CENT DIST62401550 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401551 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401552 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401553 S STRL TED STOCKING/BELT $ 124.00 $ 124.00 6240 CENT DIST62401554 S STRL TED STOCKING/BELT $ 158.00 $ 158.00 6240 CENT DIST62413196 S STRL THERMOSET TUBING $ 310.00 $ 310.00 6241 CENT DIST62412110 S STRL THORACENTESIS TRAY $ 330.00 $ 330.00 6241 CENT DIST62412115 S STRL THORACENTESIS TRAY $ 250.00 $ 250.00 6241 CENT DIST62411801 S STRL THORACIC CATH 10FR $ 208.00 $ 208.00 6241 CENT DIST62411799 S STRL THORACIC CATH 12FR $ 92.00 $ 92.00 6241 CENT DIST62411798 S STRL THORACIC CATH 16FR $ 95.00 $ 95.00 6241 CENT DIST62411797 S STRL THORACIC CATH 20FR $ 95.00 $ 95.00 6241 CENT DIST62411800 S STRL THORACIC CATH 28FR $ 220.00 $ 220.00 6241 CENT DIST62411796 S STRL THORACIC CATH 32F $ 133.00 $ 133.00 6241 CENT DIST62411805 S STRL THORACIC CATH 32FR $ 112.00 $ 112.00 6241 CENT DIST62411810 S STRL THORACIC CATH 36FR $ 148.00 $ 148.00 6241 CENT DIST

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DEPARTMENT CODE

62412065 S STRL TRACH CLEAN TRAY $ - $ - 6241 CENT DIST62412066 S STRL TRACH KIT BL/RH 6F $ 1,130.00 $ 1,130.00 6241 CENT DIST62412067 S STRL TRACH KIT BL/RH 8F $ 1,130.00 $ 1,130.00 6241 CENT DIST62410775 S STRL TRACH SUC NEO 6FR $ 187.00 $ 187.00 6241 CENT DIST62410784 S STRL TRACH SUC NEO 8FR $ 187.00 $ 187.00 6241 CENT DIST62413120 S STRL TRACH TRAY $ - $ - 6241 CENT DIST62413339 S STRL TRACH TUBE 2.5 NEO $ 599.00 $ 599.00 6241 CENT DIST62413341 S STRL TRACH TUBE 2.5 PED $ 599.00 $ 599.00 6241 CENT DIST62413342 S STRL TRACH TUBE 3.0 NEO $ 599.00 $ 599.00 6241 CENT DIST62413343 S STRL TRACH TUBE 3.0 PED $ 599.00 $ 599.00 6241 CENT DIST62413353 S STRL TRACH TUBE 3.0 TIG $ 1,499.00 $ 1,499.00 6241 CENT DIST62413344 S STRL TRACH TUBE 3.5 NEO $ 599.00 $ 599.00 6241 CENT DIST62413346 S STRL TRACH TUBE 3.5 PED $ 599.00 $ 599.00 6241 CENT DIST62413354 S STRL TRACH TUBE 3.5 TIG $ 1,499.00 $ 1,499.00 6241 CENT DIST62413347 S STRL TRACH TUBE 4.0 NEO $ 626.00 $ 626.00 6241 CENT DIST62413348 S STRL TRACH TUBE 4.0 PED $ 626.00 $ 626.00 6241 CENT DIST62413355 S STRL TRACH TUBE 4.0 TIG $ 1,499.00 $ 1,499.00 6241 CENT DIST62413349 S STRL TRACH TUBE 4.5 PED $ 1,499.00 $ 1,499.00 6241 CENT DIST62413356 S STRL TRACH TUBE 4.5 TIG $ 615.00 $ 615.00 6241 CENT DIST62413351 S STRL TRACH TUBE 5.0 PED $ 599.00 $ 599.00 6241 CENT DIST62413357 S STRL TRACH TUBE 5.0 TIG $ 1,499.00 $ 1,499.00 6241 CENT DIST62413352 S STRL TRACH TUBE 5.5 PED $ 599.00 $ 599.00 6241 CENT DIST62413316 S STRL TRACH TUBE FENEST $ 582.00 $ 582.00 6241 CENT DIST62413317 S STRL TRACH TUBE FENEST $ 631.00 $ 631.00 6241 CENT DIST62413318 S STRL TRACH TUBE FENEST $ 631.00 $ 631.00 6241 CENT DIST62413319 S STRL TRACH TUBE-LOW PRE $ 631.00 $ 631.00 6241 CENT DIST62413321 S STRL TRACH TUBE-LOW PRE $ 631.00 $ 631.00 6241 CENT DIST62413322 S STRL TRACH TUBE-LOW PRE $ 631.00 $ 631.00 6241 CENT DIST62413323 S STRL TRACH TUBE-NEONATA $ 501.00 $ 501.00 6241 CENT DIST62413324 S STRL TRACH TUBE-NEONATA $ 501.00 $ 501.00 6241 CENT DIST62413331 S STRL TRACH TUBE-NEONATA $ 501.00 $ 501.00 6241 CENT DIST62413332 S STRL TRACH TUBE-PEDI #0 $ 518.00 $ 518.00 6241 CENT DIST62413333 S STRL TRACH TUBE-PEDI #0 $ 518.00 $ 518.00 6241 CENT DIST

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62413334 S STRL TRACH TUBE-PEDI #1 $ 518.00 $ 518.00 6241 CENT DIST62413336 S STRL TRACH TUBE-PEDI #2 $ 501.00 $ 501.00 6241 CENT DIST62413338 S STRL TRACH TUBE-PEDI #3 $ 518.00 $ 518.00 6241 CENT DIST62413337 S STRL TRACH TUBE-PEDI #4 $ 518.00 $ 518.00 6241 CENT DIST62413193 S STRL TRANSDUCER 2 $ 414.00 $ 414.00 6241 CENT DIST62412130 S STRL TRANSDUCER KIT-NEO $ 197.00 $ 197.00 6241 CENT DIST62413194 S STRL TRANSDUCER TRANS 3 $ 420.00 $ 420.00 6241 CENT DIST62410925 S STRL TRANSDUCER,DSP PED $ 197.00 $ 197.00 6241 CENT DIST62411466 S STRL TRAUMA PAD 104389 $ 63.00 $ 63.00 6241 CENT DIST62440702 S STRL TRAY FOLEY 16FR $ 109.00 $ 109.00 6244 CENT DIST62440711 S STRL TRAY FOLEY URINE $ 135.00 $ 135.00 6244 CENT DIST62440712 S STRL TRAY GROSHONG 5FR $ 735.00 $ 735.00 6244 CENT DIST62440748 S STRL TRAY LP PED INF $ 101.00 $ 101.00 6244 CENT DIST62440743 S STRL TRAY UROLOGIST $ 905.00 $ 905.00 6244 CENT DIST62430110 S STRL TRIANGULAR PILLOW $ 369.00 $ 369.00 6243 CENT DIST62440723 S STRL TRNDCR IV SNGL LN $ 59.00 $ 59.00 6244 CENT DIST62413500 S STRL TRNSFSN EXCHG TRAY $ 409.00 $ 409.00 6241 CENT DIST62411210 S STRL TROCAR CATH 10FR $ 188.00 $ 188.00 6241 CENT DIST62411205 S STRL TROCAR CATH 8FR $ 281.00 $ 281.00 6241 CENT DIST62411702 S STRL TRY HEYMAN STRICT $ 1,223.00 $ 1,223.00 6241 CENT DIST62440716 S STRL TUBE FDING 10FR $ 252.00 $ 252.00 6244 CENT DIST62440790 S STRL TUBG D/E W/HANDLE $ 52.00 $ 52.00 6244 CENT DIST62412615 S STRL TUR SERIES SET $ 58.00 $ 58.00 6241 CENT DIST62413495 S STRL UMB VESS INSERT TR $ 358.00 $ 358.00 6241 CENT DIST62410835 S STRL URETHRAL CONNECTOR $ - $ - 6241 CENT DIST62411621 S STRL URIN DRN CATH 3.5F $ 267.00 $ 267.00 6241 CENT DIST62412750 S STRL URINE BAG,2000 CC $ 91.00 $ 91.00 6241 CENT DIST62412765 S STRL URINEMETER/BAG $ 248.00 $ 248.00 6241 CENT DIST62413600 S STRL VACUUM OB 14418 $ 173.00 $ 173.00 6241 CENT DIST62413605 S STRL VACUUM W/TRA 30775 $ 270.00 $ 270.00 6241 CENT DIST62411435 S STRL VAGINAL PACKING $ - $ - 6241 CENT DIST62411191 S STRL VAS CATH PEDI 6.5 $ 93.00 $ 93.00 6241 CENT DIST62411192 S STRL VAS CATH PEDI 6.5 $ 93.00 $ 93.00 6241 CENT DIST

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DEPARTMENT CODE

62411193 S STRL VAS CATH PEDI 6.5 $ 93.00 $ 93.00 6241 CENT DIST62411207 S STRL VAS CATH PEDI 8.0 $ 93.00 $ 93.00 6241 CENT DIST62411194 S STRL VAS CATH PEDI 9.0 $ 93.00 $ 93.00 6241 CENT DIST62411440 S STRL VASELINE DRESSING $ 39.00 $ 39.00 6241 CENT DIST62411445 S STRL VASELINE DRESSING $ 39.00 $ 39.00 6241 CENT DIST62411450 S STRL VASELINE DRESSING $ 39.00 $ 39.00 6241 CENT DIST62410610 S STRL VCAT 3L CV 12FX20C $ 604.00 $ 604.00 6241 CENT DIST62410601 S STRL VCAT 3L ST 12FX16C $ 604.00 $ 604.00 6241 CENT DIST62410605 S STRL VCATH 3L 12FX16CM $ 536.00 $ 536.00 6241 CENT DIST62410604 S STRL VCATH 3L CV 12FX20 $ 536.00 $ 536.00 6241 CENT DIST62440721 S STRL VEST POSEY MED $ 127.00 $ 127.00 6244 CENT DIST62440732 S STRL VEST POSEY SM $ 127.00 $ 127.00 6244 CENT DIST62440776 S STRL VEST POSEY XXL $ 194.00 $ 194.00 6244 CENT DIST62440727 S STRL VEST REST QUICK $ 127.00 $ 127.00 6244 CENT DIST62411459 S STRL VIGILON DRESS 6X8 $ 128.00 $ 128.00 6241 CENT DIST62440825 S STRL WIRE GUIDE 18G $ 148.00 $ 148.00 6244 CENT DIST62413330 S STRL WIRE SCISSOR $ - $ - 6241 CENT DIST62440165 S STRL WND VAC BLK FOAM L $ 305.00 $ 305.00 6244 CENT DIST62440166 S STRL WND VAC BLK FOAM M $ 305.00 $ 305.00 6244 CENT DIST62440167 S STRL WND VAC BLK FOAM S $ 305.00 $ 305.00 6244 CENT DIST62440168 S STRL WND VAC WHITE FOAM $ 323.00 $ 323.00 6244 CENT DIST62400308 S STRL WND VAC Y CONN $ 2.00 $ 2.00 6240 CENT DIST62400284 S STRL WOUND DRN COLL $ 181.00 $ 181.00 6240 CENT DIST62400285 S STRL WOUND DRN COLL $ 118.00 $ 118.00 6240 CENT DIST62440175 S STRL WOUND VAC REP CAN $ 489.00 $ 489.00 6244 CENT DIST62440713 S STRL WRAP FOOT REG $ 170.00 $ 170.00 6244 CENT DIST62440725 S STRL WRAP FT LG $ 169.00 $ 169.00 6244 CENT DIST62440755 S STRL WRAP LG PEDI IV $ 124.00 $ 124.00 6244 CENT DIST62411460 S STRL XEROFORM 5X9 3126 $ 49.00 $ 49.00 6241 CENT DIST62410800 S STRL ZOLL PACER ELECT $ 462.00 $ 462.00 6241 CENT DIST62413491 S STRL ZOLL PACER PADS $ 259.00 $ 259.00 6241 CENT DIST62412535 WATER IRRIG 500ML $ 111.51 $ 111.51 6241 CENT DIST62412540 WATER IRRIG 500ML $ 111.51 $ 111.51 6241 CENT DIST

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DEPARTMENT CODE

62440840 WATER IRRIG 500ML $ 61.58 $ 61.58 6244 CENT DIST62440841 WATER IRRIG 500ML $ 61.58 $ 61.58 6244 CENT DIST62440842 WATER IRRIG 500ML $ 61.58 $ 61.58 6244 CENT DIST62440843 WATER IRRIG 500ML $ 40.28 $ 40.28 6244 CENT DIST62440844 WATER IRRIG 500ML $ 40.28 $ 40.28 6244 CENT DIST62440847 WATER IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST62440848 WATER IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST62440849 WATER IRRIG 500ML $ 19.40 $ 19.40 6244 CENT DIST45034500 HLTH/BHV INT FAM/NO PT 15 $ 50.00 $ 50.00 4503 CHILD DEV CTR45034503 MED NUTR TX EA 15 $ 90.00 $ 90.00 4503 CHILD DEV CTR45034502 MED NUTR TX REASMNT EA 15 $ 90.00 $ 90.00 4503 CHILD DEV CTR45040601 OT EVAL 15 $ 43.50 $ 43.50 4504 CHILD DEV CTR45040605 OT EVAL 150 $ 434.93 $ 434.93 4504 CHILD DEV CTR45040606 OT EVAL 180 $ 521.91 $ 521.91 4504 CHILD DEV CTR45040602 OT EVAL 30 $ 86.98 $ 86.98 4504 CHILD DEV CTR45040607 OT EVAL 375 $ 1,087.32 $ 1,087.32 4504 CHILD DEV CTR45040603 OT EVAL 45 $ 130.49 $ 130.49 4504 CHILD DEV CTR45040604 OT EVAL 60 $ 173.98 $ 173.98 4504 CHILD DEV CTR45040618 OT EVAL ADD 15 $ 43.50 $ 43.50 4504 CHILD DEV CTR45040617 OT EVAL INIT 30 $ 87.00 $ 87.00 4504 CHILD DEV CTR45040620 OT EXER GP ADD 15 $ 32.50 $ 32.50 4504 CHILD DEV CTR45040619 OT EXER GP INIT 30 $ 65.00 $ 65.00 4504 CHILD DEV CTR45040500 OT FINE MOTOR GRP $ 515.00 $ 515.00 4504 CHILD DEV CTR45041604 OT ORTHO CHECK PER 15 MIN $ 66.18 $ 66.18 4504 CHILD DEV CTR45040651 OT PHYS PERFRM TEST EA 15 $ 85.00 $ 85.00 4504 CHILD DEV CTR45040612 OT PROC THER GP 15 $ 25.00 $ 25.00 4504 CHILD DEV CTR45040613 OT PROC THER GP 30 $ 50.00 $ 50.00 4504 CHILD DEV CTR45040614 OT PROC THER GP 45 $ 75.00 $ 75.00 4504 CHILD DEV CTR45040615 OT PROC THER GP 60 $ 100.00 $ 100.00 4504 CHILD DEV CTR45040608 OT RE-EVAL 15 $ 43.50 $ 43.50 4504 CHILD DEV CTR45040609 OT RE-EVAL 30 $ 86.98 $ 86.98 4504 CHILD DEV CTR45040610 OT RE-EVAL 45 $ 130.49 $ 130.49 4504 CHILD DEV CTR45040611 OT RE-EVAL 60 $ 173.98 $ 173.98 4504 CHILD DEV CTR

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45040616 OT THER ACT EA 15 $ 32.50 $ 32.50 4504 CHILD DEV CTR45060004 PARENT INFANT PROGRAM CV $ 108.89 $ 108.89 4506 CHILD DEV CTR45060003 PARENT INFANT PROGRAM HV $ 145.88 $ 145.88 4506 CHILD DEV CTR45060005 PIP CV EXT 90MIN $ 121.64 $ 121.64 4506 CHILD DEV CTR45012364 PSYC DX INTERVIEW $ 175.62 $ 175.62 4501 CHILD DEV CTR45012362 PSYC EVAL RCRD/RPRT/TESTS $ 175.62 $ 175.62 4501 CHILD DEV CTR45049455 PT EVAL 15 $ 60.36 $ 60.36 4504 CHILD DEV CTR45049459 PT EVAL 150 $ 845.04 $ 845.04 4504 CHILD DEV CTR45049454 PT EVAL 30 $ 120.72 $ 120.72 4504 CHILD DEV CTR45049457 PT EVAL 45 $ 181.08 $ 181.08 4504 CHILD DEV CTR45049458 PT EVAL 60 $ 241.44 $ 241.44 4504 CHILD DEV CTR45049447 PT EVAL ADD 15 $ 60.36 $ 60.36 4504 CHILD DEV CTR45049446 PT EVAL INIT 30 $ 120.72 $ 120.72 4504 CHILD DEV CTR45049468 PT ORTHO CHECK PER 15 MIN $ 66.18 $ 66.18 4504 CHILD DEV CTR45049469 PT ORTHOTIC TRAIN EA 15 $ 40.00 $ 40.00 4504 CHILD DEV CTR45049460 PT RE-EVAL 15 $ 79.00 $ 79.00 4504 CHILD DEV CTR45049461 PT RE-EVAL 30 $ 176.00 $ 176.00 4504 CHILD DEV CTR45049462 PT RE-EVAL 45 $ 192.00 $ 192.00 4504 CHILD DEV CTR45049463 PT RE-EVAL 60 $ 268.00 $ 268.00 4504 CHILD DEV CTR45049449 PT SINGLE PROC ADD 15 $ 33.45 $ 33.45 4504 CHILD DEV CTR45049448 PT SINGLE PROC INIT 30 $ 66.90 $ 66.90 4504 CHILD DEV CTR45049443 PT THER ACT EA 15 $ 33.45 $ 33.45 4504 CHILD DEV CTR45034504 RD NUTRITIONAL EVAL 30MIN $ 98.26 $ 98.26 4503 CHILD DEV CTR45034505 RD NUTRITIONAL REEVAL 30M $ 98.26 $ 98.26 4503 CHILD DEV CTR45034029 SP EVAL FNX SWALL 15 $ 70.00 $ 70.00 4503 CHILD DEV CTR45034030 SP EVAL FNX SWALL 150 $ 700.00 $ 700.00 4503 CHILD DEV CTR45034031 SP EVAL FNX SWALL 225 $ 1,120.00 $ 1,120.00 4503 CHILD DEV CTR45034018 SP EVAL LANG 15 $ 55.20 $ 55.20 4503 CHILD DEV CTR45034032 SP EVAL MTN FLUOR SWAL 30 $ 200.00 $ 200.00 4503 CHILD DEV CTR45034033 SP EVAL MTN FLUOR SWAL 60 $ 403.00 $ 403.00 4503 CHILD DEV CTR45034034 SP EVAL MTN FLUOR SWAL 90 $ 590.00 $ 590.00 4503 CHILD DEV CTR45034000 SP EVAL SP/LNG/COM/AUD 15 $ 55.20 $ 55.20 4503 CHILD DEV CTR45034010 SP EVAL SP/LNG/COM/AUD 15 $ 55.20 $ 55.20 4503 CHILD DEV CTR

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45034001 SP EVAL SP/LNG/COM/AUD 30 $ 110.41 $ 110.41 4503 CHILD DEV CTR45034011 SP EVAL SP/LNG/COM/AUD 30 $ 110.41 $ 110.41 4503 CHILD DEV CTR45034002 SP EVAL SP/LNG/COM/AUD 45 $ 110.38 $ 110.38 4503 CHILD DEV CTR45034012 SP EVAL SP/LNG/COM/AUD 45 $ 165.60 $ 165.60 4503 CHILD DEV CTR45034003 SP EVAL SP/LNG/COM/AUD 60 $ 147.17 $ 147.17 4503 CHILD DEV CTR45034013 SP EVAL SP/LNG/COM/AUD 60 $ 220.82 $ 220.82 4503 CHILD DEV CTR45034004 SP EVAL SP/LNG/COM/AUD 75 $ 183.97 $ 183.97 4503 CHILD DEV CTR45034005 SP EVAL SP/LNG/COM/AUD 90 $ 220.77 $ 220.77 4503 CHILD DEV CTR45034014 SP EVAL SP/LNG/COM/AUD 90 $ 331.23 $ 331.23 4503 CHILD DEV CTR45034015 SP EVL SP/LNG/COM/AUD 270 $ 993.67 $ 993.67 4503 CHILD DEV CTR45034016 SP EVL SP/LNG/COM/AUD 300 $ 1,104.07 $ 1,104.07 4503 CHILD DEV CTR45034017 SP EVL SP/LNG/COM/AUD 375 $ 1,380.09 $ 1,380.09 4503 CHILD DEV CTR45034026 SP SP/LANG THER EA 30 $ 65.00 $ 65.00 4503 CHILD DEV CTR45034027 SP THER SP/LANG EA 60 $ 130.00 $ 130.00 4503 CHILD DEV CTR45034025 SP THER SP/LANG GRP 60 $ 100.00 $ 100.00 4503 CHILD DEV CTR45034021 SP TX SP/LANG/COM GP 15 $ 25.00 $ 25.00 4503 CHILD DEV CTR45034022 SP TX SP/LANG/COM GP 30 $ 50.00 $ 50.00 4503 CHILD DEV CTR45034023 SP TX SP/LANG/COM GP 45 $ 75.00 $ 75.00 4503 CHILD DEV CTR45034024 SP TX SP/LANG/COM GP 60 $ 100.00 $ 100.00 4503 CHILD DEV CTR45034006 SP TX SP/LANG/COM IND 15 $ 32.50 $ 32.50 4503 CHILD DEV CTR45034007 SP TX SP/LANG/COM IND 30 $ 65.00 $ 65.00 4503 CHILD DEV CTR45034008 SP TX SP/LANG/COM IND 45 $ 97.50 $ 97.50 4503 CHILD DEV CTR45034009 SP TX SP/LANG/COM IND 60 $ 130.00 $ 130.00 4503 CHILD DEV CTR45034019 SP TX SP/LANG/COM IND 75 $ 162.50 $ 162.50 4503 CHILD DEV CTR45034020 SP TX SP/LANG/COM IND 90 $ 195.00 $ 195.00 4503 CHILD DEV CTR45034052 SP TX SWALL/ORAL FNX 15 $ 33.45 $ 33.45 4503 CHILD DEV CTR45034053 SP TX SWALL/ORAL FNX 30 $ 66.92 $ 66.92 4503 CHILD DEV CTR45034054 SP TX SWALL/ORAL FNX 45 $ 100.36 $ 100.36 4503 CHILD DEV CTR45034055 SP TX SWALL/ORAL FNX 60 $ 133.84 $ 133.84 4503 CHILD DEV CTR45034056 SP TX SWALL/ORAL FNX 60 $ 100.00 $ 100.00 4503 CHILD DEV CTR45012330 TEAM CONF W/PAT BY HC PRO $ 91.00 $ 91.00 4501 CHILD DEV CTR45023008 TEAM CONF W/PAT BY HC PRO $ 91.00 $ 91.00 4502 CHILD DEV CTR45012329 TM CONF W/O PT BY HC PRO $ 85.00 $ 85.00 4501 CHILD DEV CTR

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45012331 TM CONF W/O PT BY HC PRO $ 85.00 $ 85.00 4501 CHILD DEV CTR45023007 TM CONF W/O PT BY HC PRO $ 91.00 $ 91.00 4502 CHILD DEV CTR45059467 UNCANCELLED VISIT $ 65.00 $ 65.00 4505 CHILD DEV CTR45512390 NEURPSY TST PSYCHLG/MD/HR $ 139.38 $ 139.38 4551 CHILD DEV CTR AT ST LUKES45540601 OT EVAL 15 $ 43.50 $ 43.50 4554 CHILD DEV CTR AT ST LUKES45540605 OT EVAL 150 $ 434.93 $ 434.93 4554 CHILD DEV CTR AT ST LUKES45540606 OT EVAL 180 $ 521.91 $ 521.91 4554 CHILD DEV CTR AT ST LUKES45540602 OT EVAL 30 $ 86.98 $ 86.98 4554 CHILD DEV CTR AT ST LUKES45540607 OT EVAL 375 $ 1,087.32 $ 1,087.32 4554 CHILD DEV CTR AT ST LUKES45540603 OT EVAL 45 $ 130.49 $ 130.49 4554 CHILD DEV CTR AT ST LUKES45540604 OT EVAL 60 $ 173.98 $ 173.98 4554 CHILD DEV CTR AT ST LUKES45540618 OT EVAL ADD 15 $ 43.50 $ 43.50 4554 CHILD DEV CTR AT ST LUKES45540617 OT EVAL INIT 30 $ 87.00 $ 87.00 4554 CHILD DEV CTR AT ST LUKES45540620 OT EXER GP ADD 15 $ 32.50 $ 32.50 4554 CHILD DEV CTR AT ST LUKES45540619 OT EXER GP INIT 30 $ 65.00 $ 65.00 4554 CHILD DEV CTR AT ST LUKES45540612 OT PROC THER GP 15 $ 25.00 $ 25.00 4554 CHILD DEV CTR AT ST LUKES45540613 OT PROC THER GP 30 $ 50.00 $ 50.00 4554 CHILD DEV CTR AT ST LUKES45540614 OT PROC THER GP 45 $ 75.00 $ 75.00 4554 CHILD DEV CTR AT ST LUKES45540615 OT PROC THER GP 60 $ 100.00 $ 100.00 4554 CHILD DEV CTR AT ST LUKES45540608 OT RE-EVAL 15 $ 43.50 $ 43.50 4554 CHILD DEV CTR AT ST LUKES45540609 OT RE-EVAL 30 $ 86.98 $ 86.98 4554 CHILD DEV CTR AT ST LUKES45540610 OT RE-EVAL 45 $ 130.49 $ 130.49 4554 CHILD DEV CTR AT ST LUKES45540611 OT RE-EVAL 60 $ 173.98 $ 173.98 4554 CHILD DEV CTR AT ST LUKES45540616 OT THER ACT EA 15 $ 32.50 $ 32.50 4554 CHILD DEV CTR AT ST LUKES45550425 PSYC ASST INTRN CHG 20-30 $ 50.00 $ 50.00 4555 CHILD DEV CTR AT ST LUKES45550420 PSYC ASST INTRN CHG 45-50 $ 100.00 $ 100.00 4555 CHILD DEV CTR AT ST LUKES45512364 PSYC DX INTERVIEW $ 175.62 $ 175.62 4551 CHILD DEV CTR AT ST LUKES45512362 PSYC EVAL RCRD/RPRT/TESTS $ 175.62 $ 175.62 4551 CHILD DEV CTR AT ST LUKES45512363 PSYC GRP INTERACTIVE $ 177.00 $ 177.00 4551 CHILD DEV CTR AT ST LUKES45512339 PSYC TX 20-30M OP $ 60.00 $ 60.00 4551 CHILD DEV CTR AT ST LUKES45512360 PSYC TX 20-30M OP $ 87.80 $ 87.80 4551 CHILD DEV CTR AT ST LUKES45512338 PSYC TX 45-50M OP $ 120.00 $ 120.00 4551 CHILD DEV CTR AT ST LUKES45512361 PSYC TX 45-50M OP $ 175.62 $ 175.62 4551 CHILD DEV CTR AT ST LUKES

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DEPARTMENT CODE

45523005 PSYC TX GRP 60 $ 100.00 $ 100.00 4552 CHILD DEV CTR AT ST LUKES45512370 PSYCH TST PSYCHLGST/MD/HR $ 139.38 $ 139.38 4551 CHILD DEV CTR AT ST LUKES45534018 SP EVAL LANG 15 $ 55.20 $ 55.20 4553 CHILD DEV CTR AT ST LUKES45534010 SP EVAL SP/LNG/COM/AUD 15 $ 55.20 $ 55.20 4553 CHILD DEV CTR AT ST LUKES45534011 SP EVAL SP/LNG/COM/AUD 30 $ 110.41 $ 110.41 4553 CHILD DEV CTR AT ST LUKES45534012 SP EVAL SP/LNG/COM/AUD 45 $ 165.60 $ 165.60 4553 CHILD DEV CTR AT ST LUKES45534013 SP EVAL SP/LNG/COM/AUD 60 $ 220.82 $ 220.82 4553 CHILD DEV CTR AT ST LUKES45534014 SP EVAL SP/LNG/COM/AUD 90 $ 331.23 $ 331.23 4553 CHILD DEV CTR AT ST LUKES45534015 SP EVL SP/LNG/COM/AUD 270 $ 993.67 $ 993.67 4553 CHILD DEV CTR AT ST LUKES45534016 SP EVL SP/LNG/COM/AUD 300 $ 1,104.07 $ 1,104.07 4553 CHILD DEV CTR AT ST LUKES45534017 SP EVL SP/LNG/COM/AUD 375 $ 1,380.09 $ 1,380.09 4553 CHILD DEV CTR AT ST LUKES45534026 SP SP/LANG THER EA 30 $ 65.00 $ 65.00 4553 CHILD DEV CTR AT ST LUKES45534027 SP THER SP/LANG EA 60 $ 130.00 $ 130.00 4553 CHILD DEV CTR AT ST LUKES45534006 SP TX SP/LANG/COM IND 15 $ 32.50 $ 32.50 4553 CHILD DEV CTR AT ST LUKES45534007 SP TX SP/LANG/COM IND 30 $ 65.00 $ 65.00 4553 CHILD DEV CTR AT ST LUKES45534008 SP TX SP/LANG/COM IND 45 $ 97.50 $ 97.50 4553 CHILD DEV CTR AT ST LUKES45534009 SP TX SP/LANG/COM IND 60 $ 130.00 $ 130.00 4553 CHILD DEV CTR AT ST LUKES45512330 TEAM CONF W/PAT BY HC PRO $ 91.00 $ 91.00 4551 CHILD DEV CTR AT ST LUKES45512329 TM CONF W/O PT BY HC PRO $ 85.00 $ 85.00 4551 CHILD DEV CTR AT ST LUKES45512331 TM CONF W/O PT BY HC PRO $ 85.00 $ 85.00 4551 CHILD DEV CTR AT ST LUKES45559467 UNCANCELLED VISIT $ 65.00 $ 65.00 4555 CHILD DEV CTR AT ST LUKES45023010 EDUC REMEDIATION 20-30 $ 50.00 $ 50.00 4507 CHILD DEV PRO FEE45023111 EDUC REMEDIATION 45-50 $ 100.00 $ 100.00 4507 CHILD DEV PRO FEE45012332 FAMILY TX W PT 30 MIN $ 83.62 $ 83.62 4507 CHILD DEV PRO FEE45012336 FAMILY TX W PT 60 MIN $ 175.62 $ 175.62 4507 CHILD DEV PRO FEE45012337 FAMILY TX W PT 90 MIN $ 250.87 $ 250.87 4507 CHILD DEV PRO FEE45012333 FAMILY TX WO PT 30 MIN $ 83.62 $ 83.62 4507 CHILD DEV PRO FEE45012334 FAMILY TX WO PT 60 MIN $ 175.62 $ 175.62 4507 CHILD DEV PRO FEE45012335 FAMILY TX WO PT 90 MIN $ 250.87 $ 250.87 4507 CHILD DEV PRO FEE45023012 NEUROBEHAVIOR EXAM/HR $ 85.00 $ 85.00 4507 CHILD DEV PRO FEE45012390 NEURPSY TST PSYCHLG/MD/HR $ 139.38 $ 139.38 4507 CHILD DEV PRO FEE45050420 PSYC ASST INTRN CHG 20-30 $ 50.00 $ 50.00 4507 CHILD DEV PRO FEE45050425 PSYC ASST INTRN CHG 45-50 $ 100.00 $ 100.00 4507 CHILD DEV PRO FEE

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45012363 PSYC GRP INTERACTIVE $ 167.26 $ 167.26 4507 CHILD DEV PRO FEE45012339 PSYC TX 20-30M OP $ 60.00 $ 60.00 4507 CHILD DEV PRO FEE45012360 PSYC TX 20-30M OP $ 87.80 $ 87.80 4507 CHILD DEV PRO FEE45012338 PSYC TX 45-50M OP $ 120.00 $ 120.00 4507 CHILD DEV PRO FEE45012361 PSYC TX 45-50M OP $ 175.62 $ 175.62 4507 CHILD DEV PRO FEE45023013 PSYC TX GRP 120 $ 50.00 $ 50.00 4507 CHILD DEV PRO FEE45023014 PSYC TX GRP 15 $ 25.00 $ 25.00 4507 CHILD DEV PRO FEE45023015 PSYC TX GRP 30 $ 50.00 $ 50.00 4507 CHILD DEV PRO FEE45023016 PSYC TX GRP 45 $ 75.00 $ 75.00 4507 CHILD DEV PRO FEE45023005 PSYC TX GRP 60 $ 100.00 $ 100.00 4507 CHILD DEV PRO FEE45023017 PSYC TX GRP 60 $ 100.00 $ 100.00 4507 CHILD DEV PRO FEE45012370 PSYCH TST PSYCHLGST/MD/HR $ 139.38 $ 139.38 4507 CHILD DEV PRO FEE45023000 TEST DEV LTD $ 375.00 $ 375.00 4507 CHILD DEV PRO FEE45023002 TEST DEV LTD $ 375.00 $ 375.00 4507 CHILD DEV PRO FEE45023019 TEST DEV LTD $ 375.00 $ 375.00 4507 CHILD DEV PRO FEE45023020 TEST DEV LTD $ 375.00 $ 375.00 4507 CHILD DEV PRO FEE45023021 TEST DEV LTD $ 375.00 $ 375.00 4507 CHILD DEV PRO FEE45023009 TEST DEVELOPMNTL EXTENDED $ 249.00 $ 249.00 4507 CHILD DEV PRO FEE26115347 ACTIVATED CLOTTING TIME $ 142.00 $ 42.00 2611 CIRC SUPPT26115364 BLD GAS ANALYSIS $ 667.00 $ 667.00 2611 CIRC SUPPT26100900 CELL SAVER SERVICE $ 3,763.00 $ 3,763.00 2610 CIRC SUPPT26111600 CX CASE OR $ 2,300.00 $ 2,300.00 2611 CIRC SUPPT26100301 GLUCOSE $ 134.00 $ 132.00 2610 CIRC SUPPT26115361 HEPARIN ASSAY $ 266.00 $ 266.00 2611 CIRC SUPPT26115362 HEPARIN DOSE RESPONSE $ 115.00 $ 115.00 2611 CIRC SUPPT26116001 PERFUSION SERVICE $ 2,303.00 $ 2,303.00 2611 CIRC SUPPT26116002 PERFUSION SERVICE $ 13,815.00 $ 13,815.00 2611 CIRC SUPPT26116003 PERFUSION SERVICE $ 6,785.00 $ 6,785.00 2611 CIRC SUPPT26116006 PERFUSION SERVICE $ 6,794.00 $ 6,794.00 2611 CIRC SUPPT26101000 POOLING BLD PROD $ 2,303.00 $ 117.00 2610 CIRC SUPPT26114001 S IMP VAD CENTRIMAG $ 39,368.00 $ 39,368.00 2611 CIRC SUPPT26115360 S IMP VAD HEARTMATE $ 220,033.00 $ 220,033.00 2611 CIRC SUPPT26115366 S IMP VENTR ASSIST DEV $ 148,115.00 $ 148,115.00 2611 CIRC SUPPT

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26115304 S STRL BLD POOLING SPPLYS $ 3,494.00 $ 3,494.00 2611 CIRC SUPPT26115307 S STRL CLL SAVR BWL/FLTR $ 1,022.00 $ 1,022.00 2611 CIRC SUPPT26115305 S STRL CRCIT SEQOIA HD $ 1,105.00 $ 1,105.00 2611 CIRC SUPPT26100330 S STRL EXTRACORPORE CIRCU $ 3,816.00 $ 3,816.00 2610 CIRC SUPPT26115302 S STRL HEARTMATE SUP KIT $ 38,464.00 $ 38,464.00 2611 CIRC SUPPT26115319 S STRL HRTMT II IMPL KIT $ 287,061.00 $ 287,061.00 2611 CIRC SUPPT26115320 S STRL HRTMT SYS CNTRL EX $ 14,763.00 $ 14,763.00 2611 CIRC SUPPT26100501 S STRL INTRAORTIC PER CAT $ 9,002.00 $ 9,002.00 2610 CIRC SUPPT26115301 S STRL MISC SUPPLY $ - $ - 2611 CIRC SUPPT26100700 S STRL PERFUSN SUPP $ 9,811.00 $ 9,811.00 2610 CIRC SUPPT26115306 S STRL PMP SPPL CNTRMG $ 2,590.00 $ 2,590.00 2611 CIRC SUPPT26115321 S STRL TBNG 2ND CARDIPLG $ 385.00 $ 385.00 2611 CIRC SUPPT26115313 VAD BATERY CLIPS RPLCMNT $ 1,845.00 $ 1,845.00 2611 CIRC SUPPT26115328 VAD BATERY CLIPS RPLCMNT $ 3,955.00 $ 3,955.00 2611 CIRC SUPPT26115312 VAD BATTERY REPLACEMENT $ 4,611.00 $ 4,611.00 2611 CIRC SUPPT26115327 VAD BATTERY REPLACEMENT $ 2,246.00 $ 2,246.00 2611 CIRC SUPPT26115315 VAD BELT/VEST REPLACMNT $ 1,152.00 $ 1,152.00 2611 CIRC SUPPT26115325 VAD DISP MOD/CABLE REPLC $ 1,079.00 $ 1,079.00 2611 CIRC SUPPT26115310 VAD FILTER REPLACEMENT EA $ 279.00 $ 279.00 2611 CIRC SUPPT26115353 VAD GT 24 HRS EA 24 HR $ 10,263.00 $ 10,263.00 2611 CIRC SUPPT26115314 VAD HOLSTER REPLACEMENT $ 2,024.00 $ 2,024.00 2611 CIRC SUPPT26115330 VAD HOLSTER REPLACEMENT $ 1,420.00 $ 1,420.00 2611 CIRC SUPPT26115324 VAD MICRPRSR CU ELEC REP $ 13,928.00 $ 13,928.00 2611 CIRC SUPPT26115331 VAD MONITOR ELEC/PNEU RPL $ 8,666.00 $ 8,666.00 2611 CIRC SUPPT26115311 VAD POWER PK BASE RPLCMNT $ 4,283.00 $ 4,283.00 2611 CIRC SUPPT26115323 VAD PWR MOD CABLE REPLMNT $ 3,415.00 $ 3,415.00 2611 CIRC SUPPT26115318 VAD PWR MODULE REPLCMNT $ 24,141.00 $ 24,141.00 2611 CIRC SUPPT26115316 VAD SHOWER COVER RPLCMNT $ 2,177.00 $ 2,177.00 2611 CIRC SUPPT26115329 VAD SHOWER COVER RPLCMNT $ 809.00 $ 809.00 2611 CIRC SUPPT26115326 VAD SYS MON/PWR CAB REPLC $ 1,438.00 $ 1,438.00 2611 CIRC SUPPT26115322 VAD UNIV BATT CHRGE REPLC $ 22,284.00 $ 22,284.00 2611 CIRC SUPPT35450510 AC PARACENTESIS EYE DX $ 895.00 $ 895.00 3545 CLIN-EYE35450564 AC PARACENTESIS EYE DX $ 895.00 $ 895.00 3545 CLIN-EYE

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DEPARTMENT CODE

35450512 AC PARACENTESIS EYE THER $ 773.00 $ 773.00 3545 CLIN-EYE35450552 BIOPSY CONJUNCTIVA $ 471.00 $ 471.00 3545 CLIN-EYE35450554 BIOPSY CORNEA $ 682.00 $ 682.00 3545 CLIN-EYE35450550 BIOPSY EYELID $ 508.00 $ 508.00 3545 CLIN-EYE35450556 BIOPSY OF LACRIMAL SAC $ 1,888.00 $ 1,888.00 3545 CLIN-EYE35450540 CHEMO DENERV EXTROC MUSC $ 333.00 $ 333.00 3545 CLIN-EYE35450538 CHEMO DENERV FACE MUSC $ 340.00 $ 340.00 3545 CLIN-EYE35432002 CONTACT LENS EXAM $ 162.00 $ 162.00 3543 CLIN-EYE35450508 CORNEAL SCRAPING DX $ 485.00 $ 485.00 3545 CLIN-EYE35450080 CYCLOPHOTCOAG TRANSSCLERL $ 1,425.00 $ 1,425.00 3545 CLIN-EYE35450526 DIL TEAR DUCT OPENING $ 475.00 $ 475.00 3545 CLIN-EYE35450528 DIL TEAR DUCT OPENING $ 475.00 $ 475.00 3545 CLIN-EYE35450060 DISCISSN 2ND MEM CAT LASR $ 780.00 $ 780.00 3545 CLIN-EYE35450030 DSTRCT RETNL LSN CRYO/DIA $ 1,425.00 $ 1,425.00 3545 CLIN-EYE35450095 DSTRCT RTNPTHY CRYO/DIATH $ 1,521.00 $ 1,521.00 3545 CLIN-EYE35450560 EX LES FACE 0.6 TO 1.0 CM $ 988.00 $ 988.00 3545 CLIN-EYE35450547 EXCISION CHALAZION SNGL $ 496.00 $ 496.00 3545 CLIN-EYE35450548 EXCISION PTERYGIUM $ 2,445.00 $ 2,445.00 3545 CLIN-EYE35420622 FIT CNTC LENS TX W LENS $ 231.00 $ 231.00 3542 CLIN-EYE35432001 FIT CNTC LENS TX W LENS $ 231.00 $ 231.00 3543 CLIN-EYE35450541 INCIS/DRN LACRIMAL GLAND $ 730.00 $ 730.00 3545 CLIN-EYE35405053 INCISION CONJUNCTIVA $ 452.00 $ 452.00 3545 CLIN-EYE35400004 INTRAVITREAL IJ DRUG $ 1,014.00 $ 1,014.00 3540 CLIN-EYE35450070 IRIDOTOMY/IRIDECTOMY LSR $ 1,511.00 $ 1,511.00 3545 CLIN-EYE35420621 LACR PUNCT CLOSUR EA PLUG $ 496.00 $ 496.00 3542 CLIN-EYE35450518 LACR PUNCT CLOSUR EA PLUG $ 496.00 $ 496.00 3545 CLIN-EYE35450520 LACR PUNCT CLOSUR EA PLUG $ 496.00 $ 496.00 3545 CLIN-EYE35450050 LASER EYE SEVER ADHESIONS $ 1,493.00 $ 1,493.00 3545 CLIN-EYE35400027 LEVEL 2 EST PATIENT $ 183.00 $ 183.00 3540 CLIN-EYE35420040 LEVEL 2 EST PATIENT $ 183.00 $ 183.00 3542 CLIN-EYE35410040 LEVEL 3 EST PATIENT $ 209.00 $ 209.00 3541 CLIN-EYE35420060 LEVEL 3 EST PATIENT $ 209.00 $ 209.00 3542 CLIN-EYE35422014 OPHTHALM EXAM COMP EST PT $ 161.00 $ 161.00 3542 CLIN-EYE

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DEPARTMENT CODE

35422004 OPHTHALM EXAM COMP NEW PT $ 230.00 $ 230.00 3542 CLIN-EYE35422012 OPHTHALM EXAM INT EST PT $ 135.00 $ 135.00 3542 CLIN-EYE35422002 OPHTHALM EXAM INT NEW PT $ 134.00 $ 134.00 3542 CLIN-EYE35420620 PF INIT IP CONSULT 80 MIN $ 302.00 $ 302.00 3542 CLIN-EYE35450522 PROBE NASOLACRIMAL DUCT $ 1,148.00 $ 1,148.00 3545 CLIN-EYE35450524 PROBE NASOLACRIMAL DUCT $ 1,148.00 $ 1,148.00 3545 CLIN-EYE35450010 PROPH RET DETACH CRYO/DIA $ 1,437.00 $ 1,437.00 3545 CLIN-EYE35450020 PROPH RET DETCH PHOTOCOAG $ 1,425.00 $ 1,425.00 3545 CLIN-EYE35450502 REMOVE FB EYE CONJ EMBED $ 508.00 $ 508.00 3545 CLIN-EYE35450500 REMOVE FB EYE CONJ SUPERF $ 223.00 $ 223.00 3545 CLIN-EYE35450504 REMV FB CORNEAL W/O LAMP $ 236.00 $ 236.00 3545 CLIN-EYE35450530 REP/REVISE ANTERIOR SEGMT $ 3,257.00 $ 3,257.00 3545 CLIN-EYE35450570 REPR RETINL DETACH AIR IJ $ 2,770.00 $ 2,770.00 3545 CLIN-EYE35450558 RET LES PHOTOCOAGULATION $ 1,314.00 $ 1,314.00 3545 CLIN-EYE35450536 RETROBULBAR INJECTION $ 329.00 $ 329.00 3545 CLIN-EYE35450506 RMV FB EYE CORN W LAMP $ 299.00 $ 299.00 3545 CLIN-EYE35442343 S NSTRL 1 GASPER APHA RPL $ 201.00 $ 201.00 3544 CLIN-EYE35442363 S NSTRL 1 GASPER BIFO RPL $ 306.00 $ 306.00 3544 CLIN-EYE35442323 S NSTRL 1 GASPERM STD,RPL $ 175.00 $ 175.00 3544 CLIN-EYE35442345 S NSTRL 1 GP APHAK W/RLI $ 157.00 $ 157.00 3544 CLIN-EYE35442335 S NSTRL 1 GP KERATO RPL $ 228.00 $ 228.00 3544 CLIN-EYE35442331 S NSTRL 1 GP KERATOC INIT $ 1,047.00 $ 1,047.00 3544 CLIN-EYE35442333 S NSTRL 1 GP KERATOCO RPL $ 272.00 $ 272.00 3544 CLIN-EYE35442325 S NSTRL 1 GSP STD RP W/RL $ 131.00 $ 131.00 3544 CLIN-EYE35442321 S NSTRL 1 GSP STD, INIT $ 537.00 $ 537.00 3544 CLIN-EYE35442353 S NSTRL 1 GSP TORIC RPL $ 257.00 $ 257.00 3544 CLIN-EYE35442351 S NSTRL 1 GSP TORIC,INIT $ 730.00 $ 730.00 3544 CLIN-EYE35433331 S NSTRL 1 GSPE APHAK,INIT $ 563.00 $ 563.00 3544 CLIN-EYE35451005 S NSTRL 1 MISC LENS, INIT $ - $ - 3545 CLIN-EYE35451015 S NSTRL 1 MISC LENS, RPL $ - $ - 3545 CLIN-EYE35432371 S NSTRL 1 PK DW DISP, QT $ 441.00 $ 441.00 3543 CLIN-EYE35432372 S NSTRL 1 PK DW DSP QT RP $ 136.00 $ 136.00 3543 CLIN-EYE35432374 S NSTRL 1 PK TOR DISP,QTR $ 249.00 $ 249.00 3543 CLIN-EYE

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DEPARTMENT CODE

35432373 S NSTRL 1 PK TORIC DIS,QT $ 557.00 $ 557.00 3543 CLIN-EYE35432385 S NSTRL 1 SFT BIFO W/RLI $ 296.00 $ 296.00 3543 CLIN-EYE35432381 S NSTRL 1 SFT BIFOCA, INI $ 701.00 $ 701.00 3543 CLIN-EYE35432383 S NSTRL 1 SFT BIFOCA, RPL $ 339.00 $ 339.00 3543 CLIN-EYE35432391 S NSTRL 1 SFT COL LEN INI $ 565.00 $ 565.00 3543 CLIN-EYE35432395 S NSTRL 1 SFT COL LENS $ 160.00 $ 160.00 3543 CLIN-EYE35432393 S NSTRL 1 SFT COLOR LENS $ 204.00 $ 204.00 3543 CLIN-EYE35432353 S NSTRL 1 SOFT APHAK, RPL $ 283.00 $ 283.00 3543 CLIN-EYE35432343 S NSTRL 1 SOFT TORIC, RPL $ 249.00 $ 249.00 3543 CLIN-EYE35432341 S NSTRL 1 SOFT TORIC,INI $ 837.00 $ 837.00 3543 CLIN-EYE35432335 S NSTRL 1 SOFT XWR STD $ 125.00 $ 125.00 3543 CLIN-EYE35442344 S NSTRL 2 GASPER APHA RPL $ 296.00 $ 296.00 3544 CLIN-EYE35442362 S NSTRL 2 GASPER BIFO INI $ 1,140.00 $ 1,140.00 3544 CLIN-EYE35442322 S NSTRL 2 GASPERM STD,INI $ 651.00 $ 651.00 3544 CLIN-EYE35442324 S NSTRL 2 GASPERM STD,RPL $ 251.00 $ 251.00 3544 CLIN-EYE35442346 S NSTRL 2 GP APHAK W/RLI $ 208.00 $ 208.00 3544 CLIN-EYE35442366 S NSTRL 2 GP BIFOCA W/RLI $ 383.00 $ 383.00 3544 CLIN-EYE35442336 S NSTRL 2 GP KERATO RPL $ 261.00 $ 261.00 3544 CLIN-EYE35442332 S NSTRL 2 GP KERATOC INIT $ 1,162.00 $ 1,162.00 3544 CLIN-EYE35442334 S NSTRL 2 GP KERATOCO RPL $ 349.00 $ 349.00 3544 CLIN-EYE35442326 S NSTRL 2 GSP STD RP W/RL $ 164.00 $ 164.00 3544 CLIN-EYE35442352 S NSTRL 2 GSP TORIC,INIT $ 928.00 $ 928.00 3544 CLIN-EYE35442342 S NSTRL 2 GSPE APHAK,INIT $ 704.00 $ 704.00 3544 CLIN-EYE35451010 S NSTRL 2 MISC LENS, INIT $ - $ - 3545 CLIN-EYE35451020 S NSTRL 2 MISC LENS, RPL $ - $ - 3545 CLIN-EYE35432361 S NSTRL 2 PK DAIL WR DISP $ 464.00 $ 464.00 3543 CLIN-EYE35432362 S NSTRL 2 PK DLY WR DSP $ 157.00 $ 157.00 3543 CLIN-EYE35432386 S NSTRL 2 SFT BIFO W/RLI $ 438.00 $ 438.00 3543 CLIN-EYE35432382 S NSTRL 2 SFT BIFOCA, INI $ 979.00 $ 979.00 3543 CLIN-EYE35432384 S NSTRL 2 SFT BIFOCA, RPL $ 526.00 $ 526.00 3543 CLIN-EYE35432396 S NSTRL 2 SFT COL LENS $ 212.00 $ 212.00 3543 CLIN-EYE35432392 S NSTRL 2 SFT COLOR LENS $ 710.00 $ 710.00 3543 CLIN-EYE35432394 S NSTRL 2 SFT COLOR LENS $ 300.00 $ 300.00 3543 CLIN-EYE

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DEPARTMENT CODE

35432334 S NSTRL 2 SFT EX WR ST $ 242.00 $ 242.00 3543 CLIN-EYE35432352 S NSTRL 2 SOFT APHAK, INI $ 867.00 $ 867.00 3543 CLIN-EYE35432354 S NSTRL 2 SOFT APHAK, RPL $ 431.00 $ 431.00 3543 CLIN-EYE35432324 S NSTRL 2 SOFT STD, RPL $ 242.00 $ 242.00 3543 CLIN-EYE35432344 S NSTRL 2 SOFT TORIC RPL $ 376.00 $ 376.00 3543 CLIN-EYE35432342 S NSTRL 2 SOFT TORIC, INI $ 1,028.00 $ 1,028.00 3543 CLIN-EYE35432363 S NSTRL 4 PK DAIL WR DISP $ 563.00 $ 563.00 3543 CLIN-EYE35432364 S NSTRL 4 PK DLY WR DISP $ 257.00 $ 257.00 3543 CLIN-EYE35432355 S NSTRL SFT APHAKI, W/RLI $ 240.00 $ 240.00 3543 CLIN-EYE35432356 S NSTRL SFT APHAKI, W/RLI $ 343.00 $ 343.00 3543 CLIN-EYE35432345 S NSTRL SFT TORIC, W/RPLI $ 206.00 $ 206.00 3543 CLIN-EYE35432346 S NSTRL SFT TORIC, W/RPLI $ 288.00 $ 288.00 3543 CLIN-EYE35450532 SUBCONJUNCTIVAL INJECTION $ 192.00 $ 192.00 3545 CLIN-EYE35450534 TENON'S CAPSULE INJECTION $ 572.00 $ 572.00 3545 CLIN-EYE35450040 TRABECULOPLASTY LASER $ 585.00 $ 585.00 3545 CLIN-EYE35450514 TRICH EPILATION FORCEPS $ 289.00 $ 289.00 3545 CLIN-EYE35450516 TRICH EPILATION OTHER $ 634.00 $ 634.00 3545 CLIN-EYE35450100 TX RTNPTHY PHOTOCOAGULATN $ 1,425.00 $ 1,425.00 3545 CLIN-EYE40831780 BLOOD GASES O2 SAT ONLY $ 303.00 $ 303.00 4083 CT SCAN40860012 CA RECON FOR SURG PLAN $ 2,644.00 $ 2,644.00 4086 CT SCAN40831775 CALCIUM IONIZED $ 472.00 $ 472.00 4083 CT SCAN40829117 CON GASTROGRAF 120ML $ 22.40 $ 22.40 4082 CT SCAN40829035 CON LOCM 300-349S I 1ML $ 4.80 $ 4.80 4082 CT SCAN40829053 CON LOCM 350-399S I 1ML $ 5.90 $ 5.90 4082 CT SCAN40831755 CREATININE $ 178.00 $ 178.00 4083 CT SCAN40860007 CT 3D RENDER W/O POSTPROS $ 964.00 $ 964.00 4086 CT SCAN40860009 CT 3D RENDER W/POSTPROCES $ 994.00 $ 994.00 4086 CT SCAN40805260 CT ABD W/CON $ 4,213.00 $ 4,213.00 4080 CT SCAN40805250 CT ABD W/O CON $ 3,033.00 $ 3,033.00 4080 CT SCAN40805270 CT ABD W-W/O CON $ 5,674.00 $ 5,674.00 4080 CT SCAN40805118 CT ANGIO HRT W/3D IMAGE $ 2,755.00 $ 2,755.00 4080 CT SCAN40805287 CT BONE DENSTY STDY AXIAL $ 2,159.00 $ 2,159.00 4080 CT SCAN40805025 CT BRAIN W CON $ 3,188.00 $ 3,188.00 4080 CT SCAN

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DEPARTMENT CODE

40805005 CT BRAIN W/O CON $ 2,470.00 $ 2,470.00 4080 CT SCAN40805030 CT BRAIN W-W/O CON $ 3,906.00 $ 3,906.00 4080 CT SCAN40805188 CT COLONOSCOPY SCRN $ 1,199.00 $ 1,199.00 4080 CT SCAN40801095 CT CONSULT FOREIGN FLM $ 267.00 $ 267.00 4080 CT SCAN40805299 CT DRN W CATH PLACE PRC $ 1,300.00 $ 1,300.00 4080 CT SCAN40805235 CT EXT LOW W CON $ 3,776.00 $ 3,776.00 4080 CT SCAN40805246 CT EXT LOW W CON $ 3,776.00 $ 3,776.00 4080 CT SCAN40805230 CT EXT LOW W/O CON $ 3,063.00 $ 3,063.00 4080 CT SCAN40805245 CT EXT LOW W/O CON $ 3,063.00 $ 3,063.00 4080 CT SCAN40805240 CT EXT LOW W-W/O CON $ 4,951.00 $ 4,951.00 4080 CT SCAN40805247 CT EXT LOW W-W/O CON $ 4,951.00 $ 4,951.00 4080 CT SCAN40805215 CT EXT UPP W CON $ 3,746.00 $ 3,746.00 4080 CT SCAN40805225 CT EXT UPP W CON $ 3,746.00 $ 3,746.00 4080 CT SCAN40805210 CT EXT UPP W/O CON $ 3,058.00 $ 3,058.00 4080 CT SCAN40805227 CT EXT UPP W/O CON $ 3,058.00 $ 3,058.00 4080 CT SCAN40805220 CT EXT UPP W-W/O CON $ 4,936.00 $ 4,936.00 4080 CT SCAN40805226 CT EXT UPP W-W/O CON $ 4,936.00 $ 4,936.00 4080 CT SCAN40805293 CT GUIDANCE TISSUE ABLTN $ 5,589.00 $ 5,589.00 4080 CT SCAN40805295 CT GUIDE NDL PLACEMENT $ 1,973.00 $ 1,973.00 4080 CT SCAN40805117 CT HRT W/3D IMAGE $ 4,186.00 $ 4,186.00 4080 CT SCAN40805119 CT HRT W/O DYE W/CA TEST $ 416.67 $ 416.67 4080 CT SCAN40805053 CT LTD OR FU STDY $ 467.00 $ 467.00 4080 CT SCAN40805262 CT LTD OR FU STDY $ 467.00 $ 467.00 4080 CT SCAN40805104 CT LUNG SCREENING $ 467.00 $ 467.00 4080 CT SCAN40805055 CT MAXILLOFACIAL W CON $ 3,891.00 $ 3,891.00 4080 CT SCAN40805052 CT MAXILLOFACIAL W/O CON $ 3,183.00 $ 3,183.00 4080 CT SCAN40805060 CT MAXILLOFACIAL W-W/O $ 4,820.00 $ 4,820.00 4080 CT SCAN40805075 CT NEC W CON $ 3,771.00 $ 3,771.00 4080 CT SCAN40805070 CT NEC W/O CON $ 3,073.00 $ 3,073.00 4080 CT SCAN40805080 CT NEC W-W/O CON $ 4,695.00 $ 4,695.00 4080 CT SCAN40805045 CT ORBIT SELLA FOSA W-W/O $ 5,207.00 $ 5,207.00 4080 CT SCAN40805040 CT ORBIT SELLA FOSSA W $ 4,494.00 $ 4,494.00 4080 CT SCAN40805037 CT ORBIT/SELLA/FOSSA W/O $ 3,816.00 $ 3,816.00 4080 CT SCAN

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DEPARTMENT CODE

40805195 CT PELV W CON $ 3,731.00 $ 3,731.00 4080 CT SCAN40805190 CT PELV W/O CON $ 3,048.00 $ 3,048.00 4080 CT SCAN40805200 CT PELV W-W/O CON $ 4,906.00 $ 4,906.00 4080 CT SCAN40805027 CT PERFUSION W/CON CBF $ 10,200.00 $ 10,200.00 4080 CT SCAN40805132 CT SPINE CERV W CON $ 3,927.00 $ 3,927.00 4080 CT SCAN40805125 CT SPINE CERV W/O CON $ 3,214.00 $ 3,214.00 4080 CT SCAN40805135 CT SPINE CERV W-W/O CON $ 4,891.00 $ 4,891.00 4080 CT SCAN40805160 CT SPINE LUMB W CON $ 3,927.00 $ 3,927.00 4080 CT SCAN40805155 CT SPINE LUMB W/O CON $ 3,198.00 $ 3,198.00 4080 CT SCAN40805165 CT SPINE LUMB W-W/O CON $ 4,901.00 $ 4,901.00 4080 CT SCAN40805143 CT SPINE THOR W CON $ 3,932.00 $ 3,932.00 4080 CT SCAN40805140 CT SPINE THOR W/O CON $ 3,203.00 $ 3,203.00 4080 CT SCAN40805147 CT SPINE THOR W-W/O $ 4,906.00 $ 4,906.00 4080 CT SCAN40805000 CT STEREOTACTIC LOC $ 8,551.00 $ 8,551.00 4080 CT SCAN40805105 CT THORAX W CON $ 3,927.00 $ 3,927.00 4080 CT SCAN40805100 CT THORAX W/O CON $ 3,203.00 $ 3,203.00 4080 CT SCAN40805110 CT THORAX W-W/O $ 4,926.00 $ 4,926.00 4080 CT SCAN40805272 CTA ABD W RUNOFF W-W/O $ 8,451.00 $ 8,451.00 4080 CT SCAN40805271 CTA ABD W-W/O CON $ 6,176.00 $ 6,176.00 4080 CT SCAN40805111 CTA CHST NOCORO W-W/O CON $ 6,020.00 $ 6,020.00 4080 CT SCAN40805241 CTA EXT LOW W-W/O CON $ 6,055.00 $ 6,055.00 4080 CT SCAN40805221 CTA EXT UPP W-W/O CON $ 5,528.00 $ 5,528.00 4080 CT SCAN40805031 CTA HEAD W-W/O CON $ 7,778.00 $ 7,778.00 4080 CT SCAN40805081 CTA NEC W-W/O CON $ 7,818.00 $ 7,818.00 4080 CT SCAN40805201 CTA PELV W-W/O CON $ 5,819.00 $ 5,819.00 4080 CT SCAN40831284 CTC ABLTN LIVER RF PRC $ 2,910.00 $ 2,910.00 4083 CT SCAN40831687 CTC ABLTN PEL/HIP RF PRC $ 6,082.00 $ 6,082.00 4083 CT SCAN40831560 CTC ABSCSS CYST LIVER PRC $ 6,072.00 $ 6,072.00 4083 CT SCAN40831612 CTC ABSCSS DRN PELV PRC $ 10,787.00 $ 10,787.00 4083 CT SCAN40831571 CTC ABSCSS DRN PERITNL $ 7,300.00 $ 7,300.00 4083 CT SCAN40831585 CTC ABSCSS DRN RENL $ 7,300.00 $ 7,300.00 4083 CT SCAN40831575 CTC ABSCSS DRN RETROPE $ 10,525.00 $ 10,525.00 4083 CT SCAN40831580 CTC ABSCSS DRN SUBDIAP $ 10,465.00 $ 10,465.00 4083 CT SCAN

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40831610 CTC ASP RENL CYST $ 254.00 $ 254.00 4083 CT SCAN40831675 CTC BX ABD RETROPE $ 1,663.00 $ 1,663.00 4083 CT SCAN40831680 CTC BX BONE DEEP $ 2,702.00 $ 2,702.00 4083 CT SCAN40831685 CTC BX BONE SUPER $ 1,075.00 $ 1,075.00 4083 CT SCAN40831747 CTC BX BRAIN W BURR HOLE $ 4,104.00 $ 4,104.00 4083 CT SCAN40831690 CTC BX LIVER $ 2,191.00 $ 2,191.00 4083 CT SCAN40831750 CTC BX LIVER W MAJOR $ 548.00 $ 548.00 4083 CT SCAN40831695 CTC BX LUNG MEDIASTNM $ 1,228.00 $ 1,228.00 4083 CT SCAN40831705 CTC BX LYMPH NODE SUPER $ 1,101.00 $ 1,101.00 4083 CT SCAN40831700 CTC BX MUSCLE $ 1,866.00 $ 1,866.00 4083 CT SCAN40831710 CTC BX PANCREAS $ 4,262.00 $ 4,262.00 4083 CT SCAN40831725 CTC BX PLEURA $ 734.00 $ 734.00 4083 CT SCAN40831730 CTC BX PROSTATE $ 2,179.00 $ 2,179.00 4083 CT SCAN40831735 CTC BX RENL $ 1,717.00 $ 1,717.00 4083 CT SCAN40831745 CTC BX THYROID $ 596.00 $ 596.00 4083 CT SCAN40831567 CTC DRN APPNCL ABSCSS PRC $ 14,111.00 $ 14,111.00 4083 CT SCAN40831342 CTC DRN PANC PSEUDOCYST $ 11,150.00 $ 11,150.00 4083 CT SCAN40831627 CTC EXCHANGE DRN CATH $ 4,887.00 $ 4,887.00 4083 CT SCAN40831660 CTC FNA W IMAG GUIDANCE $ 1,287.00 $ 1,287.00 4083 CT SCAN40831251 CTC INJ CELIAC PLEX BLK $ 1,433.00 $ 1,433.00 4083 CT SCAN40831253 CTC INJ CELIAC PLEX LYTIC $ 2,163.00 $ 2,163.00 4083 CT SCAN40831626 CTC INJ CON ABSCSS $ 1,289.00 $ 1,289.00 4083 CT SCAN40831615 CTC INJ SINOGRAM $ 1,011.00 $ 1,011.00 4083 CT SCAN40831693 CTC INS ID ABD/PEL RT PER $ 2,191.00 $ 2,191.00 4083 CT SCAN40831694 CTC INS ID ABD/PEL RT PER $ 2,191.00 $ 2,191.00 4083 CT SCAN40831698 CTC INS ID RT THOR PERC $ 1,228.00 $ 1,228.00 4083 CT SCAN40831699 CTC INS ID RT THOR PERC $ 1,228.00 $ 1,228.00 4083 CT SCAN40831590 CTC PARACENT ABD INI $ 1,665.00 $ 1,665.00 4083 CT SCAN40831595 CTC PARACENT ABD SUBSQ $ 1,332.00 $ 1,332.00 4083 CT SCAN40831614 CTC PR RF ABLT RNL TUMR U $ 3,785.00 $ 3,785.00 4083 CT SCAN40831416 CTC SAL INFN SONOHYSTER $ 211.00 $ 211.00 4083 CT SCAN40831340 CTC THORACENTESIS $ 1,161.00 $ 1,161.00 4083 CT SCAN40831341 CTC THORACENTESIS W TUBE $ 1,640.00 $ 1,640.00 4083 CT SCAN

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40831565 CTC TUBE THORACOSTOMY $ 3,216.00 $ 3,216.00 4083 CT SCAN40831765 GLUCOSE $ 134.00 $ 134.00 4083 CT SCAN40831760 HEMATOCRIT $ 80.00 $ 80.00 4083 CT SCAN40831770 HEMOGLOBIN $ 80.00 $ 80.00 4083 CT SCAN40853120 S CATH DRAINAGE $ 913.00 $ 913.00 4085 CT SCAN40860010 S NSTRL 3D MDL ADD COMPON $ 2,951.00 $ 2,951.00 4086 CT SCAN40860015 S NSTRL 3D MODEL HEMICRAN $ 5,915.00 $ 5,915.00 4086 CT SCAN40860005 S NSTRL 3D MODEL SGL PART $ 4,099.00 $ 4,099.00 4086 CT SCAN40850005 S STRL ABSCESS TRAY $ - $ - 4085 CT SCAN40854480 S STRL BIOPSY TRAY $ 301.00 $ 301.00 4085 CT SCAN40853850 S STRL CALIBRATED CHIBA $ 192.00 $ 192.00 4085 CT SCAN40853800 S STRL CHIBA NEEDLE $ 148.00 $ 148.00 4085 CT SCAN40853460 S STRL DILATOR 10FR $ 113.00 $ 113.00 4085 CT SCAN40853470 S STRL DILATOR 12FR - 18F $ 118.00 $ 118.00 4085 CT SCAN40853490 S STRL DILATOR 20FR-22FR $ 177.00 $ 177.00 4085 CT SCAN40853450 S STRL DILATOR 5FR - 8FR $ 113.00 $ 113.00 4085 CT SCAN40853875 S STRL GREEN BIOPSY NDL $ 355.00 $ 355.00 4085 CT SCAN40853615 S STRL INJECTOR SYR 200CC $ 125.00 $ 125.00 4085 CT SCAN40853618 S STRL INJECTOR TUBING $ 51.00 $ 51.00 4085 CT SCAN40853870 S STRL LINDERQUIST PTC $ 336.00 $ 336.00 4085 CT SCAN40853890 S STRL LPN 40-25 DRN/NDL $ 366.00 $ 366.00 4085 CT SCAN40861099 S STRL MISC. SUPP CHARGE $ - $ - 4086 CT SCAN40854488 S STRL PROCE TRAY 3 - CT $ 724.00 $ 724.00 4085 CT SCAN40854971 S STRL PULSE OXI PROBE $ 158.00 $ 158.00 4085 CT SCAN40853880 S STRL SCREW BIOPSY NDL $ 297.00 $ 297.00 4085 CT SCAN40853860 S STRL SURECUT NDL 17/19G $ 336.00 $ 336.00 4085 CT SCAN40853825 S STRL TRUECUT BIOPSY NDL $ 158.00 $ 158.00 4085 CT SCAN40854515 S STRL URINARY DRAIN BAG $ 74.00 $ 74.00 4085 CT SCAN40805285 XR BONE LENGTH STDY $ 601.00 $ 601.00 4080 CT SCAN84022030 OBSERVATION PER HOUR $ 236.00 $ 236.00 8402 D2N OBSERVATION CHGS81900002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8190 D3N NURSE STATION81900102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8190 D3N NURSE STATION81900001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8190 D3N NURSE STATION

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81900101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8190 D3N NURSE STATION81900045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8190 D3N NURSE STATION81900145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8190 D3N NURSE STATION84010005 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 8401 D3N OBSERVATION84010010 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 8401 D3N OBSERVATION84010001 OBSERVATION PER HOUR $ 236.00 $ 236.00 8401 D3N OBSERVATION55550010 S NSTRL WANDERGAURD $ 333.00 $ 333.00 5555 D-3S OTHER CHG83022040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 8302 DAVIES PCU OBSERV CHG83022030 OBSERVATION PER HOUR $ 236.00 $ 236.00 8302 DAVIES PCU OBSERV CHG31209999 MISC ORAL SOLID $ - $ - 3120 DC PHARM54130016 AMNIOCENTESIS DX $ 361.00 $ 361.00 5413 DEL & LABOR OTHER CHG54130103 CPLX PACU ADD 15M $ 593.00 $ 593.00 5413 DEL & LABOR OTHER CHG54130102 CPLX PACU FIRST 30M $ 1,097.00 $ 1,097.00 5413 DEL & LABOR OTHER CHG54130088 DELIVERY VAGINAL LEVEL 1 $ 5,074.00 $ 5,074.00 5413 DEL & LABOR OTHER CHG54130087 DELIVERY VAGINAL LEVEL 2 $ 5,799.00 $ 5,799.00 5413 DEL & LABOR OTHER CHG54130006 GLUCOSE FINGERSTICK $ 25.00 $ 25.00 5413 DEL & LABOR OTHER CHG54130130 HYDRATN INFSN EA ADD HR $ 325.00 $ 325.00 5413 DEL & LABOR OTHER CHG54130125 HYDRATN INFSN INIT 31-60M $ 465.00 $ 465.00 5413 DEL & LABOR OTHER CHG54130089 INFSN W/MED EA ADD HR $ 325.00 $ 325.00 5413 DEL & LABOR OTHER CHG54130002 INFUSION W/MED 16-60MN $ 465.00 $ 465.00 5413 DEL & LABOR OTHER CHG54130004 INJ BLOOD PATCH $ 646.00 $ 646.00 5413 DEL & LABOR OTHER CHG54130008 INJ IVP SNGL/INIT DRG $ 163.00 $ 163.00 5413 DEL & LABOR OTHER CHG54130009 INJECTION IM/SQ EA $ 205.00 $ 205.00 5413 DEL & LABOR OTHER CHG54130086 LABOR LEVEL 1 / HR-IP $ 673.00 $ 673.00 5413 DEL & LABOR OTHER CHG54130085 LABOR LEVEL 2 / HR-IP $ 842.00 $ 842.00 5413 DEL & LABOR OTHER CHG54130076 LEVEL 1 EST PATIENT $ 555.00 $ 555.00 5413 DEL & LABOR OTHER CHG54130071 LEVEL 1 NEW PATIENT $ 555.00 $ 555.00 5413 DEL & LABOR OTHER CHG54130077 LEVEL 2 EST PATIENT $ 709.00 $ 709.00 5413 DEL & LABOR OTHER CHG54130072 LEVEL 2 NEW PATIENT $ 709.00 $ 709.00 5413 DEL & LABOR OTHER CHG54130078 LEVEL 3 EST PATIENT $ 745.00 $ 745.00 5413 DEL & LABOR OTHER CHG54130073 LEVEL 3 NEW PATIENT $ 745.00 $ 745.00 5413 DEL & LABOR OTHER CHG54130079 LEVEL 4 EST PATIENT $ 987.00 $ 987.00 5413 DEL & LABOR OTHER CHG54130074 LEVEL 4 NEW PATIENT $ 987.00 $ 987.00 5413 DEL & LABOR OTHER CHG

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54130080 LEVEL 5 EST PATIENT $ 1,290.00 $ 1,290.00 5413 DEL & LABOR OTHER CHG54130075 LEVEL 5 NEW PATIENT $ 1,290.00 $ 1,290.00 5413 DEL & LABOR OTHER CHG54130010 OBSERVATION PER HOUR $ 236.00 $ 236.00 5413 DEL & LABOR OTHER CHG54130007 PHENYLALANINE BLOOD $ 59.00 $ 59.00 5413 DEL & LABOR OTHER CHG54130001 RHO D MINI 50MCG IJ $ 517.00 $ 517.00 5413 DEL & LABOR OTHER CHG54130044 S STRL 1L NORMAL SALINE $ 126.00 $ 126.00 5413 DEL & LABOR OTHER CHG54130104 S STRL ABD RETRACTOR $ 53.00 $ 53.00 5413 DEL & LABOR OTHER CHG54130056 S STRL COOK BALLOON $ 227.00 $ 227.00 5413 DEL & LABOR OTHER CHG54130048 S STRL DERMABOND $ 269.00 $ 269.00 5413 DEL & LABOR OTHER CHG54130081 S STRL FLOSEAL $ 750.00 $ 750.00 5413 DEL & LABOR OTHER CHG54130043 S STRL FOLEY CATHETER KIT $ 170.00 $ 170.00 5413 DEL & LABOR OTHER CHG54130068 S STRL GYN SUTURE $ 236.00 $ 236.00 5413 DEL & LABOR OTHER CHG54130032 S STRL POP OFF SUTURES $ 288.00 $ 288.00 5413 DEL & LABOR OTHER CHG54130046 S STRL PUMP PN ONQ 270ML $ 1,008.00 $ 1,008.00 5413 DEL & LABOR OTHER CHG54130033 S STRL SKIN STAPLER $ 94.00 $ 94.00 5413 DEL & LABOR OTHER CHG54130105 S STRL VICRYL SUTURE $ 2.00 $ 2.00 5413 DEL & LABOR OTHER CHG54130050 STND PACU LVL 1 ADD 15M $ 546.00 $ 546.00 5413 DEL & LABOR OTHER CHG54130049 STND PACU LVL 1 FIRST 30M $ 772.00 $ 772.00 5413 DEL & LABOR OTHER CHG54130083 STND PACU LVL 2 ADD 15M $ 558.00 $ 558.00 5413 DEL & LABOR OTHER CHG54130082 STND PACU LVL 2 FIRST 30M $ 1,215.00 $ 1,215.00 5413 DEL & LABOR OTHER CHG54130093 SURG LVL 1 ADD 15M $ 602.00 $ 602.00 5413 DEL & LABOR OTHER CHG54130090 SURG LVL 1 FIRST 30M $ 2,339.00 $ 2,339.00 5413 DEL & LABOR OTHER CHG54130094 SURG LVL 2 ADD 15M $ 756.00 $ 756.00 5413 DEL & LABOR OTHER CHG54130091 SURG LVL 2 FIRST 30M $ 2,589.00 $ 2,589.00 5413 DEL & LABOR OTHER CHG54130095 SURG LVL 3 ADD 15M $ 876.00 $ 876.00 5413 DEL & LABOR OTHER CHG54130092 SURG LVL 3 FIRST 30M $ 4,036.00 $ 4,036.00 5413 DEL & LABOR OTHER CHG54130064 SURG LVL 4 ADD 15M $ 1,510.00 $ 1,510.00 5413 DEL & LABOR OTHER CHG54130061 SURG LVL 4 FIRST 30M $ 4,449.00 $ 4,449.00 5413 DEL & LABOR OTHER CHG54130005 US FETAL TRANSFUSION IUT $ 383.00 $ 383.00 5413 DEL & LABOR OTHER CHG54130054 VENIPUNCTURE $ 23.00 $ 23.00 5413 DEL & LABOR OTHER CHG54130045 WATER 1 LITER H2O BOTTLE $ 128.00 $ 128.00 5413 DEL & LABOR OTHER CHG54130047 WATER 500ML H2O BOTTLE $ 123.00 $ 123.00 5413 DEL & LABOR OTHER CHG53400019 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5340 DHS - NICU EAST (WNICE)

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53400119 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5340 DHS - NICU EAST (WNICE)53400047 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5340 DHS - NICU EAST (WNICE)53400147 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5340 DHS - NICU EAST (WNICE)53400040 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5340 DHS - NICU EAST (WNICE)53400140 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5340 DHS - NICU EAST (WNICE)53400016 NEWBORN LEVEL IV $ 10,136.00 $ 10,136.00 5340 DHS - NICU EAST (WNICE)53400116 NEWBORN LEVEL IV $ 10,136.00 $ 10,136.00 5340 DHS - NICU EAST (WNICE)22200017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2220 DHS - P6S3 AS TICU222200117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2220 DHS - P6S3 AS TICU223700017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2370 DHS - TICU3 (P6N4)23700117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2370 DHS - TICU3 (P6N4)23700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2370 DHS - TICU3 (P6N4)23700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2370 DHS - TICU3 (P6N4)23700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2370 DHS - TICU3 (P6N4)23700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2370 DHS - TICU3 (P6N4)23700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2370 DHS - TICU3 (P6N4)23700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2370 DHS - TICU3 (P6N4)80300024 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 8030 DHS 1S SNF80300124 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 8030 DHS 1S SNF80700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8070 DHS 2N ACUTE80700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8070 DHS 2N ACUTE80700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8070 DHS 2N ACUTE80700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8070 DHS 2N ACUTE80700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8070 DHS 2N ACUTE80700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8070 DHS 2N ACUTE80900007 ROOM BEHAVIORAL HEALTH $ 4,932.00 $ 4,932.00 8090 DHS 2S GER PSYCH80900107 ROOM BEHAVIORAL HEALTH $ 4,932.00 $ 4,932.00 8090 DHS 2S GER PSYCH81100023 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8110 DHS 3S ACT REHAB81100123 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8110 DHS 3S ACT REHAB81100022 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8110 DHS 3S ACT REHAB81100122 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8110 DHS 3S ACT REHAB81300002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8130 DHS 4N ACUTE81300102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8130 DHS 4N ACUTE

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81300001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8130 DHS 4N ACUTE81300101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8130 DHS 4N ACUTE81300045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8130 DHS 4N ACUTE81300145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8130 DHS 4N ACUTE81500004 ROOM ICU $ 10,785.00 $ 10,785.00 8150 DHS 4N CCU81500104 ROOM ICU $ 10,785.00 $ 10,785.00 8150 DHS 4N CCU20400002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2040 DHS 4-N-420400102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2040 DHS 4-N-420400001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2040 DHS 4-N-420400101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2040 DHS 4-N-420400045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2040 DHS 4-N-420400145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2040 DHS 4-N-420400052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2040 DHS 4-N-420400152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2040 DHS 4-N-420500002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2050 DHS 4-N-520500102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2050 DHS 4-N-520500001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2050 DHS 4-N-520500101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2050 DHS 4-N-520500045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2050 DHS 4-N-520500145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2050 DHS 4-N-520600002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2060 DHS 4-N-620600102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2060 DHS 4-N-620600001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2060 DHS 4-N-620600101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2060 DHS 4-N-620600045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2060 DHS 4-N-620600145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2060 DHS 4-N-620300003 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 2030 DHS 4-S-3 PEDS INACTIVE20300103 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 2030 DHS 4-S-3 PEDS INACTIVE21000001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2100 DHS 5-N-421000101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2100 DHS 5-N-421000045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2100 DHS 5-N-421000145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2100 DHS 5-N-420700017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2070 DHS 5S CARD (5S1)

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20700117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2070 DHS 5S CARD (5S1)20700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2070 DHS 5S CARD (5S1)20700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2070 DHS 5S CARD (5S1)20700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2070 DHS 5S CARD (5S1)20700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2070 DHS 5S CARD (5S1)20700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2070 DHS 5S CARD (5S1)20700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2070 DHS 5S CARD (5S1)20700052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2070 DHS 5S CARD (5S1)20700152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2070 DHS 5S CARD (5S1)20800017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2080 DHS 5S CARD (5S2)20800117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2080 DHS 5S CARD (5S2)20800002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2080 DHS 5S CARD (5S2)20800102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2080 DHS 5S CARD (5S2)20800001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2080 DHS 5S CARD (5S2)20800101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2080 DHS 5S CARD (5S2)20800045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2080 DHS 5S CARD (5S2)20800145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2080 DHS 5S CARD (5S2)20800052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2080 DHS 5S CARD (5S2)20800152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2080 DHS 5S CARD (5S2)21600002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2160 DHS 6FL MED SPEC 6N421600102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2160 DHS 6FL MED SPEC 6N421600001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2160 DHS 6FL MED SPEC 6N421600101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2160 DHS 6FL MED SPEC 6N421600045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2160 DHS 6FL MED SPEC 6N421600145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2160 DHS 6FL MED SPEC 6N421700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2170 DHS 6FL MED SPEC 6N521700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2170 DHS 6FL MED SPEC 6N521700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2170 DHS 6FL MED SPEC 6N521700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2170 DHS 6FL MED SPEC 6N521700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2170 DHS 6FL MED SPEC 6N521700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2170 DHS 6FL MED SPEC 6N521800005 ADMIN PNEUMOCOCCAL VACC $ 20.00 $ 20.00 2180 DHS 6FL MED SPEC 6N621800002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2180 DHS 6FL MED SPEC 6N6

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21800102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2180 DHS 6FL MED SPEC 6N621800001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2180 DHS 6FL MED SPEC 6N621800101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2180 DHS 6FL MED SPEC 6N621800045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2180 DHS 6FL MED SPEC 6N621800145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2180 DHS 6FL MED SPEC 6N621300002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2130 DHS 6FL MED SPEC 6S121300102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2130 DHS 6FL MED SPEC 6S121300001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2130 DHS 6FL MED SPEC 6S121300101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2130 DHS 6FL MED SPEC 6S121300045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2130 DHS 6FL MED SPEC 6S121300145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2130 DHS 6FL MED SPEC 6S121400002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2140 DHS 6FL MED SPEC 6S221400102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2140 DHS 6FL MED SPEC 6S221400001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2140 DHS 6FL MED SPEC 6S221400101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2140 DHS 6FL MED SPEC 6S221400045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2140 DHS 6FL MED SPEC 6S221400145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2140 DHS 6FL MED SPEC 6S222600004 ROOM ICU $ 10,785.00 $ 10,785.00 2260 DHS CCU22600104 ROOM ICU $ 10,785.00 $ 10,785.00 2260 DHS CCU82100023 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8210 DHS D1NORTH ACUTE RHB82100123 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8210 DHS D1NORTH ACUTE RHB82100022 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8210 DHS D1NORTH ACUTE RHB82100122 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8210 DHS D1NORTH ACUTE RHB82200023 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8220 DHS D2NORTH ACUTE RHB82200123 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8220 DHS D2NORTH ACUTE RHB82200022 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8220 DHS D2NORTH ACUTE RHB82200122 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8220 DHS D2NORTH ACUTE RHB81000023 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8100 DHS D3SB REHAB81000123 ROOM REHAB ACUTE $ 4,703.00 $ 4,703.00 8100 DHS D3SB REHAB81000022 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8100 DHS D3SB REHAB81000122 ROOM REHAB ACUTE PVT $ 5,436.00 $ 5,436.00 8100 DHS D3SB REHAB81400002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8140 DHS D4N 200181400202 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8140 DHS D4N 2001

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DEPARTMENT CODE

81400001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8140 DHS D4N 200181400201 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8140 DHS D4N 200181400045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8140 DHS D4N 200181400245 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8140 DHS D4N 200183300030 ROOM COMING HOME HOSPICE $ 150.00 $ 150.00 8330 DHS D-COMING HOME HOSPICE83300130 ROOM COMING HOME HOSPICE $ 150.00 $ 150.00 8330 DHS D-COMING HOME HOSPICE22700017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2270 DHS INTERM ICU22700117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2270 DHS INTERM ICU22000004 ROOM ICU $ 10,785.00 $ 10,785.00 2200 DHS MEDICL SPC ICU22000104 ROOM ICU $ 10,785.00 $ 10,785.00 2200 DHS MEDICL SPC ICU23300019 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 2330 DHS NUR-M23300119 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 2330 DHS NUR-M23200018 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 2320 DHS OB23200118 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 2320 DHS OB23200014 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 2320 DHS OB23200114 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 2320 DHS OB23200039 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 2320 DHS OB23200044 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 2320 DHS OB23200139 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 2320 DHS OB23200144 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 2320 DHS OB22400017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2240 DHS P4S3 ADULT CARDIOLOGY22400117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2240 DHS P4S3 ADULT CARDIOLOGY22400002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2240 DHS P4S3 ADULT CARDIOLOGY22400102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2240 DHS P4S3 ADULT CARDIOLOGY22400001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2240 DHS P4S3 ADULT CARDIOLOGY22400101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2240 DHS P4S3 ADULT CARDIOLOGY22400045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2240 DHS P4S3 ADULT CARDIOLOGY22400145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2240 DHS P4S3 ADULT CARDIOLOGY22400052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2240 DHS P4S3 ADULT CARDIOLOGY22400152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2240 DHS P4S3 ADULT CARDIOLOGY81700017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 8170 DHS PCU-CCU81700117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 8170 DHS PCU-CCU81700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8170 DHS PCU-CCU

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DEPARTMENT CODE

81700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 8170 DHS PCU-CCU81700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8170 DHS PCU-CCU81700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 8170 DHS PCU-CCU81700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8170 DHS PCU-CCU81700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 8170 DHS PCU-CCU81700052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 8170 DHS PCU-CCU81700152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 8170 DHS PCU-CCU22100042 ROOM ICU PEDIATRICS $ 10,091.00 $ 10,091.00 2210 DHS PICU22100142 ROOM ICU PEDIATRICS $ 10,091.00 $ 10,091.00 2210 DHS PICU23100012 ROOM NO CHARGE $ - $ - 2310 DHS PSEUDO NO MAP PER LU23100112 ROOM NO CHARGE $ - $ - 2310 DHS PSEUDO NO MAP PER LU23000007 ROOM BEHAVIORAL HEALTH $ 4,932.00 $ 4,932.00 2300 DHS PSYCH23000107 ROOM BEHAVIORAL HEALTH $ 4,932.00 $ 4,932.00 2300 DHS PSYCH23000037 ROOM BEHAVIORL HEALTH PVT $ 5,582.00 $ 5,582.00 2300 DHS PSYCH23000137 ROOM BEHAVIORL HEALTH PVT $ 5,582.00 $ 5,582.00 2300 DHS PSYCH50800024 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5080 DHS SNF-E50800124 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5080 DHS SNF-E22800017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2280 DHS TCCU22800117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2280 DHS TCCU22500017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2250 DHS-CVIU22500117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2250 DHS-CVIU32610069 CA 2D TTE W-W/O F W/CON C $ - $ - 3261 ECHOCHARDIOGRAPHY32610057 CA 2D TTE W-W/O F W/CON F $ - $ - 3261 ECHOCHARDIOGRAPHY32610050 CA ECHO 2D LTD $ 1,535.00 $ 1,535.00 3261 ECHOCHARDIOGRAPHY32610091 CA ECHO 2D W STRES $ 2,684.00 $ 2,684.00 3261 ECHOCHARDIOGRAPHY32610072 CA ECHO DPPLER CMPL $ 630.00 $ 630.00 3261 ECHOCHARDIOGRAPHY32610074 CA ECHO DPPLER COLOR FLOW $ 1,182.00 $ 1,182.00 3261 ECHOCHARDIOGRAPHY32610080 CA ECHO TRANSESOPHAGEAL $ 4,098.00 $ 4,098.00 3261 ECHOCHARDIOGRAPHY32610075 CA TTE DPLR CMPLT WO CON $ 3,648.00 $ 3,648.00 3261 ECHOCHARDIOGRAPHY32610121 CON PERFLUTREN LIP MIC ML $ 315.90 $ 315.90 3261 ECHOCHARDIOGRAPHY32610087 CS SAME MD ADD 15M $ 99.00 $ 99.00 3261 ECHOCHARDIOGRAPHY32610086 CS SAME MD GT5YR 0-30M $ 147.00 $ 147.00 3261 ECHOCHARDIOGRAPHY32610118 INJ IVP SNGL/INIT DRG $ 234.00 $ 234.00 3261 ECHOCHARDIOGRAPHY

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DEPARTMENT CODE

32610028 NI ECHO CNGNITL ANOM CMPL $ 3,680.00 $ 3,680.00 3261 ECHOCHARDIOGRAPHY32610030 NI ECHO CNGNITL ANOM CMPL $ - $ - 3261 ECHOCHARDIOGRAPHY32610031 NI ECHO CNGNITL ANOM LTD $ 2,208.00 $ 2,208.00 3261 ECHOCHARDIOGRAPHY32610170 S NSTRL ECHO TAPE DUPLICA $ 143.00 $ 143.00 3261 ECHOCHARDIOGRAPHY32600017 CA PCR 1L PG EV/AD WO RPG $ 533.00 $ 533.00 3260 EKG32600016 CA PCR 2L PG EV/AD WO RPG $ 641.00 $ 641.00 3260 EKG32600021 CA PM R-STRIP DEV EVAL $ 768.00 $ 768.00 3260 EKG32600027 CA TILT TABLE TEST $ 1,764.00 $ 1,764.00 3260 EKG32600023 CARDIAC STRESS TEST $ 924.00 $ 924.00 3260 EKG32600065 CARDIOVERT ELECTIVE EXT $ 2,022.00 $ 2,022.00 3260 EKG32600005 EKG 12 LEAD TRACING $ 283.00 $ 283.00 3260 EKG32600030 EKG 1-3 LEAD TRACING ONLY $ 139.00 $ 139.00 3260 EKG32600109 EKG EVENT HOOKUP/RCRD $ 704.00 $ 704.00 3260 EKG32600108 EKG EVENT RCRD TRSMISSION $ 421.00 $ 421.00 3260 EKG32600107 EKG EVENT RCRD/MON/ANLYS $ - $ - 3260 EKG32600100 EKG W SCAN 24HR ANLYS/RPT $ 827.00 $ 827.00 3260 EKG32600105 EKG W SCAN 24HR RCRD $ 648.00 $ 648.00 3260 EKG32600130 S NSTRL PACEMAKER TRANSMI $ - $ - 3260 EKG32600068 S STRL DEFIBRILATOR PADS $ 40.00 $ 40.00 3260 EKG37506315 ACTIVATED CLOTTING TIME $ 142.00 $ 142.00 3750 ELECTROPHYSIOLOGY37506863 CA CARDIOVERSION INTERNAL $ 1,516.00 $ 1,516.00 3750 ELECTROPHYSIOLOGY37506864 CA CPR $ 963.00 $ 963.00 3750 ELECTROPHYSIOLOGY37506870 CA EP 3D MAPPING $ 2,208.00 $ 2,208.00 3750 ELECTROPHYSIOLOGY37506865 CA EP ABLTN AV NDE/CNDCTN $ 3,470.00 $ 3,470.00 3750 ELECTROPHYSIOLOGY37506866 CA EP ABLTN OF SVT $ 18,676.00 $ 18,676.00 3750 ELECTROPHYSIOLOGY37506867 CA EP ABLTN OF VT $ 16,703.00 $ 16,703.00 3750 ELECTROPHYSIOLOGY37506872 CA EP ESOPH RECORD W PACE $ 609.00 $ 609.00 3750 ELECTROPHYSIOLOGY37506871 CA EP ESOPH RECORDING $ 539.00 $ 539.00 3750 ELECTROPHYSIOLOGY37506009 CA EP EVAL COMP W INDUCT $ 7,340.00 $ 7,340.00 3750 ELECTROPHYSIOLOGY37506010 CA EP EVAL COMP WO INDUCT $ 7,639.00 $ 7,639.00 3750 ELECTROPHYSIOLOGY37501060 CA EP EVAL ICD LEADS $ 6,040.00 $ 6,040.00 3750 ELECTROPHYSIOLOGY37501061 CA EP EVAL ICD LEADS/GEN $ 6,808.00 $ 6,808.00 3750 ELECTROPHYSIOLOGY37501062 CA EP EVAL PACING ICD $ 4,860.00 $ 4,860.00 3750 ELECTROPHYSIOLOGY

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DEPARTMENT CODE

37506853 CA EP EVAL W L ATR PACING $ 11,403.00 $ 11,403.00 3750 ELECTROPHYSIOLOGY37506854 CA EP EVAL W L VENT PACNG $ 1,910.00 $ 1,910.00 3750 ELECTROPHYSIOLOGY37506012 CA EP FOLLOW UP STUDY $ 2,855.00 $ 2,855.00 3750 ELECTROPHYSIOLOGY37506856 CA EP HIS BUNDLE RECORD $ 1,986.00 $ 1,986.00 3750 ELECTROPHYSIOLOGY37506875 CA EP IC ECHO W INTRVNTN $ 4,353.00 $ 4,353.00 3750 ELECTROPHYSIOLOGY37501008 CA EP IND/TRM ARRHYTH PPM $ 2,544.00 $ 2,544.00 3750 ELECTROPHYSIOLOGY37506873 CA EP INDUCT ARR BY PACNG $ 4,060.00 $ 4,060.00 3750 ELECTROPHYSIOLOGY37506092 CA EP INTRA ATR PACING $ 1,846.00 $ 1,846.00 3750 ELECTROPHYSIOLOGY37506087 CA EP INTRA ATR RECORD $ 1,415.00 $ 1,415.00 3750 ELECTROPHYSIOLOGY37506869 CA EP MAP VENT/ATR TACHY $ 3,388.00 $ 3,388.00 3750 ELECTROPHYSIOLOGY37506008 CA EP PRG PCNG POST RX $ 1,795.00 $ 1,795.00 3750 ELECTROPHYSIOLOGY37506089 CA EP R VENT RECORD $ 1,808.00 $ 1,808.00 3750 ELECTROPHYSIOLOGY37506718 CA PLACE DRG EL STNT ADDL $ 18,922.00 $ 18,922.00 3750 ELECTROPHYSIOLOGY37506717 CA PLACE DRG EL STNT SNGL $ 31,949.00 $ 31,949.00 3750 ELECTROPHYSIOLOGY37501073 CA PLACE OCC DEV VEIN ART $ 1,766.00 $ 1,766.00 3750 ELECTROPHYSIOLOGY37501057 CA PM INSERT $ 1,313.00 $ 1,313.00 3750 ELECTROPHYSIOLOGY37506050 CA RHC/TS LHC INTCT SEP $ 17,083.00 $ 17,083.00 3750 ELECTROPHYSIOLOGY37501044 CA TMP TRNSCUTANEOUS PACE $ 1,518.00 $ 1,518.00 3750 ELECTROPHYSIOLOGY37501028 CA TRANSCATH CLOSURE ASD $ 2,505.00 $ 2,505.00 3750 ELECTROPHYSIOLOGY37506021 CA TRANSCATH CLOSURE VSD $ 3,190.00 $ 3,190.00 3750 ELECTROPHYSIOLOGY37501042 CA VENOGRAM EXT UNI $ 1,580.00 $ 1,580.00 3750 ELECTROPHYSIOLOGY37501006 CAC ART CATH MNTRNG PERC $ 868.00 $ 868.00 3750 ELECTROPHYSIOLOGY37501024 CAC EP INSRT TMP LDS DUAL $ 443.00 $ 443.00 3750 ELECTROPHYSIOLOGY37501050 CAC EP REPAIR SNGL LEAD $ 1,460.00 $ 1,460.00 3750 ELECTROPHYSIOLOGY37501040 CAC I/D HEMATOMA SHLDR $ 2,509.00 $ 2,509.00 3750 ELECTROPHYSIOLOGY37501045 CAC IMPLANT CARD EVNT RCD $ 4,650.00 $ 4,650.00 3750 ELECTROPHYSIOLOGY37501059 CAC INS/REP LEADS INS PG $ 23,161.00 $ 23,161.00 3750 ELECTROPHYSIOLOGY37506878 CAC INS/REP LEADS INS PG $ 23,161.00 $ 23,161.00 3750 ELECTROPHYSIOLOGY37501049 CAC INSERT ELECT DUAL $ 5,196.00 $ 5,196.00 3750 ELECTROPHYSIOLOGY37501048 CAC INSERT ELECT SNGL $ 9,103.00 $ 9,103.00 3750 ELECTROPHYSIOLOGY37501036 CAC INSERT LD PRIOR PACER $ 1,358.00 $ 1,358.00 3750 ELECTROPHYSIOLOGY37501023 CAC INSERT PACER DUAL LDS $ 13,815.00 $ 13,815.00 3750 ELECTROPHYSIOLOGY37501031 CAC INSERT PACER GEN DUAL $ 9,274.00 $ 9,274.00 3750 ELECTROPHYSIOLOGY

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DEPARTMENT CODE

37501029 CAC INSERT PACER GEN SNGL $ 7,855.00 $ 7,855.00 3750 ELECTROPHYSIOLOGY37506710 CAC INSERT PACER TMP SNGL $ 3,779.00 $ 3,779.00 3750 ELECTROPHYSIOLOGY37501038 CAC INSERT PACER W 3RD LD $ 1,103.00 $ 1,103.00 3750 ELECTROPHYSIOLOGY37501022 CAC INSERT PACER/ELEC VNT $ 11,896.00 $ 11,896.00 3750 ELECTROPHYSIOLOGY37501018 CAC INSERT PACER/ELECATR $ 13,977.00 $ 13,977.00 3750 ELECTROPHYSIOLOGY37501053 CAC REPO LD/PRIOR PACER $ 1,080.00 $ 1,080.00 3750 ELECTROPHYSIOLOGY37501039 CAC REPO PRIOR LV LEAD $ 1,296.00 $ 1,296.00 3750 ELECTROPHYSIOLOGY37501051 CAC REPR ELECT DUAL $ 1,449.00 $ 1,449.00 3750 ELECTROPHYSIOLOGY37501058 CAC RMV ICD ELEC TV EXTRC $ 3,020.00 $ 3,020.00 3750 ELECTROPHYSIOLOGY37501034 CAC RMV ICD PACING GEN SQ $ 6,973.00 $ 6,973.00 3750 ELECTROPHYSIOLOGY37501046 CAC RMVL CARD EVNT RCDR $ 1,199.00 $ 1,199.00 3750 ELECTROPHYSIOLOGY37501054 CAC RMVL PERM PACER GEN $ 7,930.00 $ 7,930.00 3750 ELECTROPHYSIOLOGY37501056 CAC RMVL TV PACR ELC DUAL $ 2,312.00 $ 2,312.00 3750 ELECTROPHYSIOLOGY37501055 CAC RMVL TV PACR ELC SNGL $ 1,665.00 $ 1,665.00 3750 ELECTROPHYSIOLOGY37501032 CAC RVSN PCKT PACING ICD $ 5,263.00 $ 5,263.00 3750 ELECTROPHYSIOLOGY37501052 CAC RVSN/REL POCKET/PACER $ 4,118.00 $ 4,118.00 3750 ELECTROPHYSIOLOGY37501033 CAC SC/DC ICD GENRATR CHG $ 14,908.00 $ 14,908.00 3750 ELECTROPHYSIOLOGY37506877 CAC SC/DC ICD GENRATR CHG $ 14,908.00 $ 14,908.00 3750 ELECTROPHYSIOLOGY37501047 CAC UPGRD PACE SNGL DUAL $ 12,706.00 $ 12,706.00 3750 ELECTROPHYSIOLOGY37529052 CON LOCM 300-349S I 1ML $ 10.60 $ 10.60 3752 ELECTROPHYSIOLOGY37550370 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550375 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550380 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550385 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550390 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550395 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550400 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37550405 EP ICAR FX CV GD IN SHTH $ 427.00 $ 427.00 3755 ELECTROPHYSIOLOGY37551031 EP ICAR FX CV GD IN SHTH $ 367.00 $ 367.00 3755 ELECTROPHYSIOLOGY37550215 S CATH EP ABLT 3D VC MP $ 10,847.00 $ 10,847.00 3755 ELECTROPHYSIOLOGY37550220 S CATH EP ABLT 3D VC MP $ 10,847.00 $ 10,847.00 3755 ELECTROPHYSIOLOGY37551010 S CATH EP ABLT 3D VC MP $ 9,349.00 $ 9,349.00 3755 ELECTROPHYSIOLOGY37551028 S CATH EP ABLT 3D VC MP $ 9,349.00 $ 9,349.00 3755 ELECTROPHYSIOLOGY

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DEPARTMENT CODE

37551065 S CATH EP ABLT 3D VC MP $ 11,498.00 $ 11,498.00 3755 ELECTROPHYSIOLOGY37550340 S CATH EP ABLTN NOCOOL $ 10,452.00 $ 10,452.00 3755 ELECTROPHYSIOLOGY37550345 S CATH EP ABLTN NOCOOL $ 10,452.00 $ 10,452.00 3755 ELECTROPHYSIOLOGY37550350 S CATH EP ABLTN NOCOOL $ 10,452.00 $ 10,452.00 3755 ELECTROPHYSIOLOGY37551004 S CATH EP ABLTN NOCOOL $ 5,557.00 $ 5,557.00 3755 ELECTROPHYSIOLOGY37551015 S CATH EP ABLTN NOCOOL $ 3,990.00 $ 3,990.00 3755 ELECTROPHYSIOLOGY37551016 S CATH EP ABLTN NOCOOL $ 5,557.00 $ 5,557.00 3755 ELECTROPHYSIOLOGY37551020 S CATH EP ABLTN NOCOOL $ 2,121.00 $ 2,121.00 3755 ELECTROPHYSIOLOGY37551027 S CATH EP ABLTN NOCOOL $ 3,865.00 $ 3,865.00 3755 ELECTROPHYSIOLOGY37550200 S CATH EP DX NO3D LT20 $ 2,520.00 $ 2,520.00 3755 ELECTROPHYSIOLOGY37550205 S CATH EP DX NO3D LT20 $ 2,034.00 $ 2,034.00 3755 ELECTROPHYSIOLOGY37550315 S CATH EP DX NO3D LT20 $ 4,948.00 $ 4,948.00 3755 ELECTROPHYSIOLOGY37550320 S CATH EP DX NO3D LT20 $ 4,948.00 $ 4,948.00 3755 ELECTROPHYSIOLOGY37550325 S CATH EP DX NO3D LT20 $ 4,224.00 $ 4,224.00 3755 ELECTROPHYSIOLOGY37550330 S CATH EP DX NO3D LT20 $ 619.00 $ 619.00 3755 ELECTROPHYSIOLOGY37550410 S CATH EP DX NO3D LT20 $ 1,833.00 $ 1,833.00 3755 ELECTROPHYSIOLOGY37551005 S CATH EP DX NO3D LT20 $ 1,540.00 $ 1,540.00 3755 ELECTROPHYSIOLOGY37551006 S CATH EP DX NO3D LT20 $ 1,540.00 $ 1,540.00 3755 ELECTROPHYSIOLOGY37551014 S CATH EP DX NO3D LT20 $ 5,507.00 $ 5,507.00 3755 ELECTROPHYSIOLOGY37551019 S CATH EP DX NO3D LT20 $ 5,455.00 $ 5,455.00 3755 ELECTROPHYSIOLOGY37551043 S CATH EP DX NO3D LT20 $ 4,042.00 $ 4,042.00 3755 ELECTROPHYSIOLOGY37551044 S CATH EP DX NO3D LT20 $ 6,314.00 $ 6,314.00 3755 ELECTROPHYSIOLOGY37550360 S CATH EP DXABLTN COOL TP $ 6,311.00 $ 6,311.00 3755 ELECTROPHYSIOLOGY37550365 S CATH EP DXABLTN COOL TP $ 6,311.00 $ 6,311.00 3755 ELECTROPHYSIOLOGY37551531 S CATH INTRACARDIAC ECHO $ 9,607.00 $ 9,607.00 3755 ELECTROPHYSIOLOGY37551022 S CATH OCCLUSION $ 1,262.00 $ 1,262.00 3755 ELECTROPHYSIOLOGY37550250 S DEVICE RETRIEVAL $ 1,985.00 $ 1,985.00 3755 ELECTROPHYSIOLOGY37550255 S DEVICE RETRIEVAL $ 1,985.00 $ 1,985.00 3755 ELECTROPHYSIOLOGY37550260 S DEVICE RETRIEVAL $ 1,985.00 $ 1,985.00 3755 ELECTROPHYSIOLOGY37550265 S DEVICE RETRIEVAL $ 1,985.00 $ 1,985.00 3755 ELECTROPHYSIOLOGY37550270 S DEVICE RETRIEVAL $ 1,985.00 $ 1,985.00 3755 ELECTROPHYSIOLOGY37551050 S EVENT RECORDER CARDIAC $ - $ - 3755 ELECTROPHYSIOLOGY37551048 S ICD DUAL CHAMBER $ - $ - 3755 ELECTROPHYSIOLOGY

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DEPARTMENT CODE

37551056 S ICD OTHR THAN SNGL/DL $ - $ - 3755 ELECTROPHYSIOLOGY37551049 S ICD SNGL CHAMBER $ - $ - 3755 ELECTROPHYSIOLOGY37551038 S INTR NOINTRACRD NOLSR $ 118.00 $ 118.00 3755 ELECTROPHYSIOLOGY37550235 S INTRO GD FXD CRV NOPL $ 1,031.00 $ 1,031.00 3755 ELECTROPHYSIOLOGY37550240 S INTRO GD FXD CRV NOPL $ 756.00 $ 756.00 3755 ELECTROPHYSIOLOGY37550245 S INTRO GD FXD CRV NOPL $ 756.00 $ 756.00 3755 ELECTROPHYSIOLOGY37551002 S INTRO GDE STRBLE NOPEEL $ 859.00 $ 859.00 3755 ELECTROPHYSIOLOGY37551007 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY37551012 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY37551013 S INTRO GDE STRBLE NOPEEL $ 219.00 $ 219.00 3755 ELECTROPHYSIOLOGY37551033 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY37551034 S INTRO GDE STRBLE NOPEEL $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY37551041 S INTRO GDE STRBLE NOPEEL $ 959.00 $ 959.00 3755 ELECTROPHYSIOLOGY37551046 S INTRO GDE STRBLE NOPEEL $ 605.00 $ 605.00 3755 ELECTROPHYSIOLOGY37550275 S INTRO NOGDE CARD EP LSR $ 8,480.00 $ 8,480.00 3755 ELECTROPHYSIOLOGY37550280 S INTRO NOGDE CARD EP LSR $ 8,480.00 $ 8,480.00 3755 ELECTROPHYSIOLOGY37550285 S INTRO NOGDE CARD EP LSR $ 8,480.00 $ 8,480.00 3755 ELECTROPHYSIOLOGY37551051 S LD ICD ENDOCRD 1 COIL $ - $ - 3755 ELECTROPHYSIOLOGY37551057 S LD ICD ENDOCRD 2 COIL $ - $ - 3755 ELECTROPHYSIOLOGY37551058 S LD ICD NOEND 1OR2 CL $ - $ - 3755 ELECTROPHYSIOLOGY37551059 S LD PCR NO TV SNGL PAS $ - $ - 3755 ELECTROPHYSIOLOGY37551052 S LD PCR TV VDD 1 PASS $ - $ - 3755 ELECTROPHYSIOLOGY37551060 S LD PCR/ICD COMBO $ - $ - 3755 ELECTROPHYSIOLOGY37551061 S LD VENT CORO VEN SYS LT $ - $ - 3755 ELECTROPHYSIOLOGY37551063 S PCR 1 CHMBR NRR $ - $ - 3755 ELECTROPHYSIOLOGY37551053 S PCR 1 CHMBR RR $ - $ - 3755 ELECTROPHYSIOLOGY37551062 S PCR 2 CHMBR NRR $ - $ - 3755 ELECTROPHYSIOLOGY37551047 S PCR 2 CHMBR RR $ - $ - 3755 ELECTROPHYSIOLOGY37551064 S PCR NOT 1 OR 2 CHMBR $ - $ - 3755 ELECTROPHYSIOLOGY37551025 S STRL ANGIO WEST 18 NDL $ 20.00 $ 20.00 3755 ELECTROPHYSIOLOGY37551032 S STRL BRK 71CM NDL $ 1,136.00 $ 1,136.00 3755 ELECTROPHYSIOLOGY37551039 S STRL BRK 89CM NDL $ 1,136.00 $ 1,136.00 3755 ELECTROPHYSIOLOGY37551040 S STRL BRK-1 71CM NDL $ 1,136.00 $ 1,136.00 3755 ELECTROPHYSIOLOGY

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DEPARTMENT CODE

37550355 S STRL CARDIO STEREOTAXIS $ 2,149.00 $ 2,149.00 3755 ELECTROPHYSIOLOGY37550210 S STRL COOL FLOW TUBING $ 466.00 $ 466.00 3755 ELECTROPHYSIOLOGY37551024 S STRL DFIB ADLT T2 PAD $ 259.00 $ 259.00 3755 ELECTROPHYSIOLOGY37550335 S STRL FLOW SEAL 10CC $ 1,443.00 $ 1,443.00 3755 ELECTROPHYSIOLOGY37551021 S STRL INTRO/BIV PACE KIT $ 4,547.00 $ 4,547.00 3755 ELECTROPHYSIOLOGY37550290 S STRL LEAD CUTTER $ 583.00 $ 583.00 3755 ELECTROPHYSIOLOGY37550295 S STRL LLD ACCESSORY KIT $ 458.00 $ 458.00 3755 ELECTROPHYSIOLOGY37550310 S STRL MICROPUNCTURE KIT $ 238.00 $ 238.00 3755 ELECTROPHYSIOLOGY37561099 S STRL MISC SUPP CHARGE $ - $ - 3756 ELECTROPHYSIOLOGY37551405 S STRL NIH $ 623.00 $ 623.00 3755 ELECTROPHYSIOLOGY37550305 S STRL PERICARDIO KIT $ 342.00 $ 342.00 3755 ELECTROPHYSIOLOGY37551575 S STRL PTCA WIRE .014-018 $ 1,144.00 $ 1,144.00 3755 ELECTROPHYSIOLOGY37551003 S STRL RADL ART CATH TRAY $ 137.00 $ 137.00 3755 ELECTROPHYSIOLOGY37551009 S STRL RAMP INTRODUCER $ 911.00 $ 911.00 3755 ELECTROPHYSIOLOGY37551029 S STRL REFSTAR QUIKPATCH $ 1,516.00 $ 1,516.00 3755 ELECTROPHYSIOLOGY37551008 S STRL RSPNCE CSL 120CM $ 2,122.00 $ 2,122.00 3755 ELECTROPHYSIOLOGY37550225 S STRL SNARE 15MM $ 1,237.00 $ 1,237.00 3755 ELECTROPHYSIOLOGY37550230 S STRL SNARE 25MM $ 1,237.00 $ 1,237.00 3755 ELECTROPHYSIOLOGY37550300 S STRL THORACENTESIS TRAY $ 905.00 $ 905.00 3755 ELECTROPHYSIOLOGY37551540 S STRL TSF .018-.021 $ 204.00 $ 204.00 3755 ELECTROPHYSIOLOGY37551011 S WIRE GUIDE $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY37551017 S WIRE GUIDE $ 728.00 $ 728.00 3755 ELECTROPHYSIOLOGY37551018 S WIRE GUIDE $ 261.00 $ 261.00 3755 ELECTROPHYSIOLOGY37551042 S WIRE GUIDE $ 90.00 $ 90.00 3755 ELECTROPHYSIOLOGY37551080 S WIRE GUIDE $ 834.00 $ 834.00 3755 ELECTROPHYSIOLOGY33415130 EMG FOUR LIMBS $ 1,216.00 $ 1,216.00 3341 EMG33415100 EMG ONE LIMB $ 205.00 $ 205.00 3341 EMG33415230 EMG THORACIC/PARASPINAL $ 56.00 $ 56.00 3341 EMG33415120 EMG THREE LIMBS $ 755.00 $ 755.00 3341 EMG33415110 EMG TWO LIMBS $ 1,100.00 $ 1,100.00 3341 EMG33415235 H REFLX TEST GSTR/SOL UNI $ - $ - 3341 EMG33415141 MTR NRV CNDCT STDY W/F EA $ 100.00 $ 100.00 3341 EMG33415140 NRV MOTOR CONDUCT STDY EA $ 99.00 $ 99.00 3341 EMG

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DEPARTMENT CODE

33415150 NRV SNSRY CONDUCT STDY EA $ 78.00 $ 78.00 3341 EMG33415155 S STRL DISPOSABLE NEEDLE $ 43.00 $ 43.00 3341 EMG29000235 ADMIN IMMUN SGL VACC $ 86.00 $ 86.00 2900 ER29000236 ADMIN INFLUENZA VACC $ 88.00 $ 88.00 2900 ER29000057 AEROSOL TX DEMO/EVAL $ 286.00 $ 286.00 2900 ER29006214 AEROSOL TX SUBSQ $ 133.00 $ 133.00 2900 ER29006235 AEROSOL TX SUBSQ $ 133.00 $ 133.00 2900 ER29000140 ART CATH MNTRNG PERC $ 36.00 $ 36.00 2900 ER29000079 ARTERIAL PUNCTURE $ 125.00 $ 125.00 2900 ER29006240 BLOOD TRANSFUSN 2-4 HR $ 1,537.00 $ 1,537.00 2900 ER29006241 BLOOD TRANSFUSN 4-6 HR $ 2,417.00 $ 2,417.00 2900 ER29006242 BLOOD TRANSFUSN GT 6HR $ 2,972.00 $ 2,972.00 2900 ER29006218 BLOOD TRANSFUSN LT 2 HR $ 880.00 $ 880.00 2900 ER29000065 CARDIOVERT ELECTIVE EXT $ 1,018.00 $ 1,018.00 2900 ER29000240 CATH SPECIMEN COLL SGL PT $ 92.00 $ 92.00 2900 ER29000225 CBT 1ST HOUR $ 315.00 $ 315.00 2900 ER29000230 CBT EACH ADDL HOUR $ 171.00 $ 171.00 2900 ER29005021 CO2 MONITORING/ETCO2 $ 438.00 $ 438.00 2900 ER29000130 COLL BLD IMP VEN ACCS DEV $ 321.00 $ 321.00 2900 ER29000310 COLL BLD PICC/CNTRL LN $ 113.00 $ 113.00 2900 ER29006215 CPR $ 325.00 $ 325.00 2900 ER29000042 ED CC 1ST 30-74 MN $ 2,378.00 $ 2,378.00 2900 ER29000045 ED CC EA ADD 30 MN $ 789.00 $ 789.00 2900 ER29000010 ED LEVEL 1 $ 419.00 $ 419.00 2900 ER29000020 ED LEVEL 2 $ 646.00 $ 646.00 2900 ER29000030 ED LEVEL 3 $ 1,076.00 $ 1,076.00 2900 ER29000040 ED LEVEL 4 $ 1,647.00 $ 1,647.00 2900 ER29000050 ED LEVEL 5 $ 1,974.00 $ 1,974.00 2900 ER29006232 ED PROC MAJOR $ 930.00 $ 930.00 2900 ER29006231 ED PROC MINOR $ 387.00 $ 387.00 2900 ER29000058 GASTRIC LAVAGE $ 566.00 $ 566.00 2900 ER29000215 GLUCOSE FINGERSTICK $ 28.00 $ 28.00 2900 ER29000078 HYDRATN INFSN EA ADD HR $ 353.00 $ 353.00 2900 ER

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DEPARTMENT CODE

29000334 HYDRATN INFSN EA ADD HR $ 353.00 $ 353.00 2900 ER29000077 HYDRATN INFSN INIT 31-60M $ 505.00 $ 505.00 2900 ER29000332 HYDRATN INFSN INIT 31-60M $ 505.00 $ 505.00 2900 ER29000074 INFSN W/MED ADD SEQ 16-60 $ 346.00 $ 346.00 2900 ER29000340 INFSN W/MED ADD SEQ 16-60 $ 346.00 $ 346.00 2900 ER29000076 INFSN W/MED CONCURRENT $ 505.00 $ 505.00 2900 ER29000342 INFSN W/MED CONCURRENT $ 505.00 $ 505.00 2900 ER29000071 INFSN W/MED EA ADD HR $ 353.00 $ 353.00 2900 ER29000338 INFSN W/MED EA ADD HR $ 353.00 $ 353.00 2900 ER29000070 INFUSION W/MED 16-60MN $ 505.00 $ 505.00 2900 ER29000336 INFUSION W/MED 16-60MN $ 505.00 $ 505.00 2900 ER29006234 INJ IVP ADDL SEQ NEW DRG $ 153.00 $ 153.00 2900 ER29006254 INJ IVP ADDL SEQ NEW DRG $ 153.00 $ 153.00 2900 ER29000315 INJ IVP SAME DRG EA >30M $ 63.00 $ 63.00 2900 ER29006256 INJ IVP SAME DRG EA >30M $ 63.00 $ 63.00 2900 ER29006233 INJ IVP SNGL/INIT DRG $ 177.00 $ 177.00 2900 ER29006252 INJ IVP SNGL/INIT DRG $ 177.00 $ 177.00 2900 ER29006217 INJECTION IM/SQ EA $ 223.00 $ 223.00 2900 ER29006250 INJECTION IM/SQ EA $ 223.00 $ 223.00 2900 ER29000120 INTRO NDL INTRACA VEN $ 103.00 $ 103.00 2900 ER29000170 NT CATHETER SX/ASPIRATION $ 117.00 $ 117.00 2900 ER29000069 OCCLT BLD STL QL MULT SPC $ 40.00 $ 40.00 2900 ER29000213 PULSE OXIMETRY - MULTIPLE $ 203.00 $ 203.00 2900 ER29000218 PULSE OXIMETRY - SINGLE $ 78.00 $ 78.00 2900 ER29006056 S NSTRL ARM SLING $ 179.00 $ 179.00 2900 ER29000212 S O2 OXYGEN $ 68.00 $ 68.00 2900 ER29006025 S ORTHO CANE $ - $ - 2900 ER29006065 S ORTHO CAST SHOE $ 127.00 $ 127.00 2900 ER29006030 S ORTHO CRUTCHES $ - $ - 2900 ER29006046 S ORTHO PHILADELPH COLLAR $ 273.00 $ 273.00 2900 ER29006045 S ORTHO SFT CERVICA COLLA $ 141.00 $ 141.00 2900 ER29006203 S STRL ABD PADS $ - $ - 2900 ER29006122 S STRL BIRTH DELIVERY TRY $ 948.00 $ 948.00 2900 ER

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DEPARTMENT CODE

29006111 S STRL CENTRAL LINE TR $ 771.00 $ 771.00 2900 ER29006121 S STRL CHESTTUBE TRAY $ 836.00 $ 836.00 2900 ER29006113 S STRL CONDOM CATH $ 49.00 $ 49.00 2900 ER29006100 S STRL CRYCOTHYROTOMY KIT $ 1,343.00 $ 1,343.00 2900 ER29000390 S STRL D & C SUPPLIES $ 410.00 $ 410.00 2900 ER29006006 S STRL DERMA SKN ADHSIVE $ 351.00 $ 351.00 2900 ER29006125 S STRL EYE EXAM TRAY $ 90.00 $ 90.00 2900 ER29005999 S STRL I & D TRAY $ 360.00 $ 360.00 2900 ER29006119 S STRL INTEROSSEOUS NDL $ 244.00 $ 244.00 2900 ER29006204 S STRL IODOFORM GAUZE $ 73.00 $ 73.00 2900 ER29000086 S STRL IV START KIT $ 93.00 $ 93.00 2900 ER29006124 S STRL LACERATION TRAY $ 319.00 $ 319.00 2900 ER29005011 S STRL LAVACUATOR TUBE $ 158.00 $ 158.00 2900 ER29005005 S STRL MRGNLEN/OPT IRRIGA $ 228.00 $ 228.00 2900 ER29006105 S STRL NASOPHARYNGEAL AIR $ - $ - 2900 ER29006116 S STRL OB TRAY $ 107.00 $ 107.00 2900 ER29006106 S STRL ORAL AIRWAY $ - $ - 2900 ER29000291 S STRL PARACENTESIS TRAY $ 668.00 $ 668.00 2900 ER29006118 S STRL PERICARDIAL TAP TR $ 107.00 $ 107.00 2900 ER29005006 S STRL PRESSPATCH EYE PAD $ - $ - 2900 ER29005009 S STRL RESCUSITATION BAG $ 36.00 $ 36.00 2900 ER29006002 S STRL SKIN STAPLER $ 276.00 $ 276.00 2900 ER29005028 S STRL SPACER $ 111.00 $ 111.00 2900 ER29006107 S STRL SUCTION CATHETER $ 49.00 $ 49.00 2900 ER29006109 S STRL SUCTION SET-UP $ 120.00 $ 120.00 2900 ER29006000 S STRL SUTURES $ 61.00 $ 61.00 2900 ER29006207 S STRL TRAUMA DRSG PAD $ - $ - 2900 ER29006117 S STRL UMBILICAL ART TRAY $ 193.00 $ 193.00 2900 ER29006208 S STRL VASELINE GAUZE $ 39.00 $ 39.00 2900 ER29006209 S STRL XEROFORM GAUZE $ 49.00 $ 49.00 2900 ER29000320 SC THER INFSN 16-60 MN $ 502.00 $ 502.00 2900 ER29000344 SC THER INFSN 16-60 MN $ 502.00 $ 502.00 2900 ER29000325 SC THER INFSN ADDL HR $ 222.00 $ 222.00 2900 ER

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DEPARTMENT CODE

29000346 SC THER INFSN ADDL HR $ 222.00 $ 222.00 2900 ER29000330 SC THER INFSN ADDL PMP SU $ 176.00 $ 176.00 2900 ER29000348 SC THER INFSN ADDL PMP SU $ 176.00 $ 176.00 2900 ER29000160 SCRN VISUAL ACTY QN BIL $ 31.00 $ 31.00 2900 ER29006216 TEMP TRANSCUTANEOUS PACE $ 513.00 $ 513.00 2900 ER29000150 TUBERCULN SKIN TEST INTRA $ 117.00 $ 117.00 2900 ER29005555 URNALYSIS MAN W/O MICRO $ 31.00 $ 31.00 2900 ER29000087 VENIPUNCTURE $ 25.00 $ 25.00 2900 ER29000095 VENIPUNCTURE AGE 3 YRS/> $ 66.00 $ 66.00 2900 ER29006225 VENT MNGMNT INITIAL DAY $ 1,825.00 $ 1,825.00 2900 ER43210080 ANT SEG PHOT W MIC/CNT $ 243.00 $ 243.00 4321 EYE PROF43210010 FLUORSCEIN ANGIOGRAM $ 425.00 $ 425.00 4321 EYE PROF43210015 FLUORSCEIN ANGIOGRAM $ 849.00 $ 849.00 4321 EYE PROF43210020 FUNDUS PHOTOGRAPHY $ 229.00 $ 229.00 4321 EYE PROF43210028 SLIT LAMP PROCEDURE $ 38.00 $ 38.00 4321 EYE PROF43210060 SLIT LAMP PROCEDURE $ 76.00 $ 76.00 4321 EYE PROF30526032 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 3052 GI LAB30510175 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 3051 GI LAB30510148 ANORECTAL MANOMETRY $ 1,798.00 $ 1,798.00 3051 GI LAB30510086 ANOSCOPY INTERVENTN $ 2,558.00 $ 2,558.00 3051 GI LAB30510102 ANOSCOPY INTERVENTN $ 2,558.00 $ 2,558.00 3051 GI LAB30510210 BIOFEEDBACK TRNG EMG $ 402.00 $ 402.00 3051 GI LAB30500074 BLOOD TRANSFUSN 2-4 HR $ 760.00 $ 760.00 3050 GI LAB30510149 BREATH HYDROGEN TEST $ 578.00 $ 578.00 3051 GI LAB30510063 BX LIVER $ 2,191.00 $ 2,191.00 3051 GI LAB30510162 COLONOSCOPY $ 2,691.00 $ 2,691.00 3051 GI LAB30510163 COLONOSCOPY INTERVENTN $ 3,193.00 $ 3,193.00 3051 GI LAB30510118 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3051 GI LAB30510208 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3051 GI LAB30510153 EGD $ 2,601.00 $ 2,601.00 3051 GI LAB30510154 EGD INTERVENTN $ 2,793.00 $ 2,793.00 3051 GI LAB30510101 ELECTROGASTROGRAPHY DIAG $ 1,224.00 $ 1,224.00 3051 GI LAB30510200 ENDO BILI DUCT $ 1,235.00 $ 1,235.00 3051 GI LAB

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DEPARTMENT CODE

30510110 ENTEROSCOPY $ 3,181.00 $ 3,181.00 3051 GI LAB30510070 ENTEROSCOPY INTERVENTN $ 3,871.00 $ 3,871.00 3051 GI LAB30520171 EP ICAR FX CV GD IN SHTH $ 181.00 $ 181.00 3052 GI LAB30510173 ERCP $ 2,270.00 $ 2,270.00 3051 GI LAB30510202 ERCP BILI PANC DUCT $ 1,108.00 $ 1,108.00 3051 GI LAB30510174 ERCP INTERVENTN $ 5,702.00 $ 5,702.00 3051 GI LAB30510201 ERCP PANC DUCT $ 623.00 $ 623.00 3051 GI LAB30510074 ESOPH ACID PERFUSION TEST $ 530.00 $ 530.00 3051 GI LAB30510061 ESOPH IMPED FUNCT >1HR $ 425.00 $ 425.00 3051 GI LAB30510103 ESOPH IMPED FUNCTION $ 495.00 $ 495.00 3051 GI LAB30510071 ESOPHAGEAL MOTILITY $ 3,103.00 $ 3,103.00 3051 GI LAB30510113 GASTRIC ANALYSIS TEST $ 1,351.00 $ 1,351.00 3051 GI LAB30510147 GASTRIC MOTILITY $ 1,702.00 $ 1,702.00 3051 GI LAB30511111 ILEOSCOPY $ 1,320.00 $ 1,320.00 3051 GI LAB30511112 ILEOSCOPY INTERVENTN $ 3,079.00 $ 3,079.00 3051 GI LAB30510105 INS PH CAPSULE GERD MUCOS $ 2,105.00 $ 2,105.00 3051 GI LAB30527044 NA CL 0.9% 500ML $ 121.95 $ 121.95 3052 GI LAB30510130 NRV MOTOR CONDUCT STDY EA $ 341.00 $ 341.00 3051 GI LAB30510117 PARACENT ABD INI $ 1,665.00 $ 1,665.00 3051 GI LAB30510161 PH ESOPH NASAL CATH ELECT $ 1,944.00 $ 1,944.00 3051 GI LAB30510155 PROCTOSCOPY $ 1,278.00 $ 1,278.00 3051 GI LAB30510156 PROCTOSCOPY INTERVENTN $ 2,493.00 $ 2,493.00 3051 GI LAB30520130 S BARRIER ADHESION $ 219.00 $ 219.00 3052 GI LAB30520066 S CATH ABLTN NOCARD ENDVS $ 1,802.00 $ 1,802.00 3052 GI LAB30520174 S CATH ABLTN NOCARD ENDVS $ 432.00 $ 432.00 3052 GI LAB30520175 S CATH ABLTN NOCARD ENDVS $ 541.00 $ 541.00 3052 GI LAB30520059 S CATH BLN DILATE NOVSC $ 1,425.00 $ 1,425.00 3052 GI LAB30520158 S CATH BLN DILATE NOVSC $ 723.00 $ 723.00 3052 GI LAB30520167 S CATH BLN DILATE NOVSC $ 489.00 $ 489.00 3052 GI LAB30520061 S CATH DRAINAGE $ 228.00 $ 228.00 3052 GI LAB30520062 S CATH DRAINAGE $ 233.00 $ 233.00 3052 GI LAB30520139 S CATH DRAINAGE $ 997.00 $ 997.00 3052 GI LAB30520150 S CATH DRAINAGE $ 1,241.00 $ 1,241.00 3052 GI LAB

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DEPARTMENT CODE

30520151 S CATH DRAINAGE $ 1,553.00 $ 1,553.00 3052 GI LAB30520152 S CATH DRAINAGE $ 887.00 $ 887.00 3052 GI LAB30520153 S CATH DRAINAGE $ 1,109.00 $ 1,109.00 3052 GI LAB30520154 S CATH EP ABLTN NOCOOL $ 971.00 $ 971.00 3052 GI LAB30520045 S CATH EP DXABLTN COOL TP $ 1,733.00 $ 1,733.00 3052 GI LAB30520135 S CATH GUIDING $ 497.00 $ 497.00 3052 GI LAB30520176 S CATH GUIDING $ 162.00 $ 162.00 3052 GI LAB30520040 S CATH THROMB/EMBOLCTMY $ 431.00 $ 431.00 3052 GI LAB30520041 S CATH THROMB/EMBOLCTMY $ 1,337.00 $ 1,337.00 3052 GI LAB30520057 S CATH THROMB/EMBOLCTMY $ 320.00 $ 320.00 3052 GI LAB30520069 S CATH THROMB/EMBOLCTMY $ 1,735.00 $ 1,735.00 3052 GI LAB30521069 S CATH TRNSML ANG NOLSR $ 278.00 $ 278.00 3052 GI LAB30520060 S DEVICE RETRIEVAL $ 1,817.00 $ 1,817.00 3052 GI LAB30520134 S DEVICE RETRIEVAL $ 1,295.00 $ 1,295.00 3052 GI LAB30520141 S DEVICE RETRIEVAL $ 887.00 $ 887.00 3052 GI LAB30520142 S DEVICE RETRIEVAL $ 1,330.00 $ 1,330.00 3052 GI LAB30520156 S DEVICE RETRIEVAL $ 841.00 $ 841.00 3052 GI LAB30520161 S DEVICE RETRIEVAL $ 275.00 $ 275.00 3052 GI LAB30520162 S DEVICE RETRIEVAL $ 426.00 $ 426.00 3052 GI LAB30520173 S DEVICE RETRIEVAL $ 250.00 $ 250.00 3052 GI LAB30510096 S EVENT RECORDER CARDIAC $ 1,018.00 $ 1,018.00 3051 GI LAB30510225 S IMP COLONIC STENT $ 10,672.00 $ 10,672.00 3051 GI LAB30520168 S NEEDLE BRACHYTHERAPY $ 94.00 $ 94.00 3052 GI LAB30520177 S NEEDLE BRACHYTHERAPY $ 557.00 $ 557.00 3052 GI LAB30520179 S NEEDLE BRACHYTHERAPY $ 510.00 $ 510.00 3052 GI LAB30520180 S NEEDLE BRACHYTHERAPY $ 129.00 $ 129.00 3052 GI LAB30540157 S NEEDLE BRACHYTHERAPY $ 70.00 $ 70.00 3054 GI LAB30520046 S O2 OXYGEN $ 287.00 $ 287.00 3052 GI LAB30520064 S STNT COATED WDEL SYS $ 7,767.00 $ 7,767.00 3052 GI LAB30520147 S STNT COATED WDEL SYS $ 10,006.00 $ 10,006.00 3052 GI LAB30520048 S STNT NOCOR WDEL SYS TMP $ 1,078.00 $ 1,078.00 3052 GI LAB30520172 S STNT NOCOR WDEL SYS TMP $ 5,231.00 $ 5,231.00 3052 GI LAB30520178 S STNT NOCOR WDEL SYS TMP $ 5,231.00 $ 5,231.00 3052 GI LAB

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DEPARTMENT CODE

30510236 S STRL ALLIANCE SYRINGE $ 334.00 $ 334.00 3051 GI LAB30510095 S STRL ARGON COAG PROBE $ 902.00 $ 902.00 3051 GI LAB30510217 S STRL BIL MANOMTRY CATH $ 812.00 $ 812.00 3051 GI LAB30510238 S STRL COTTON SLEEVE $ 731.00 $ 731.00 3051 GI LAB30510223 S STRL CRE FXD DIL BLLN $ 1,319.00 $ 1,319.00 3051 GI LAB30510207 S STRL ENDOCINCH KIT $ 7,844.00 $ 7,844.00 3051 GI LAB30510239 S STRL EXPULSION BALLOON $ 150.00 $ 150.00 3051 GI LAB30520164 S STRL FORCEP PEDI RECTAL $ 710.00 $ 710.00 3052 GI LAB30510232 S STRL GSTRC LAVAGE TRAY $ 580.00 $ 580.00 3051 GI LAB30510224 S STRL IMPEDENCE CATHETER $ 557.00 $ 557.00 3051 GI LAB30510151 S STRL LACTOSE SUGAR $ 34.00 $ 34.00 3051 GI LAB30510150 S STRL LACTULOSE SYRUP $ 31.00 $ 31.00 3051 GI LAB30510227 S STRL LEVINE DILATORS $ 258.00 $ 258.00 3051 GI LAB30510213 S STRL LITHOTRIPTOR CABLE $ 781.00 $ 781.00 3051 GI LAB30510211 S STRL LITHOTRPTR OLYMPUS $ 2,291.00 $ 2,291.00 3051 GI LAB30510221 S STRL MINI PRB SHEATH $ 3,680.00 $ 3,680.00 3051 GI LAB30539999 S STRL MISC CHARGE CODE $ - $ - 3053 GI LAB30510240 S STRL PNEOMATIC DILATOR $ 3,007.00 $ 3,007.00 3051 GI LAB30520131 S STRL PULSE OXI SENSOR $ 120.00 $ 120.00 3052 GI LAB30510234 S STRL SEW RITE KIT $ 9,632.00 $ 9,632.00 3051 GI LAB30520138 S STRL SIDE ARM ADAPTOR $ 75.00 $ 75.00 3052 GI LAB30520133 S STRL SNARE $ 1,408.00 $ 1,408.00 3052 GI LAB30510229 S STRL STNT GUIDEWIRE CLN $ 2,988.00 $ 2,988.00 3051 GI LAB30510230 S STRL ULTRASOUND BALLOON $ 188.00 $ 188.00 3051 GI LAB30510215 S STRL WIRE BASKET $ 781.00 $ 781.00 3051 GI LAB30510204 S STRL YUETH NEEDLE $ 170.00 $ 170.00 3051 GI LAB30520035 S TISSUE MARKER $ 58.00 $ 58.00 3052 GI LAB30520148 S WIRE GUIDE $ 2,808.00 $ 2,808.00 3052 GI LAB30520170 S WIRE GUIDE $ 348.00 $ 348.00 3052 GI LAB30540195 SCLEROTHERAPY INTERVENTN $ 1,074.00 $ 1,074.00 3054 GI LAB30510165 SIGMOIDOSCOPY $ 1,383.00 $ 1,383.00 3051 GI LAB30510166 SIGMOIDOSCOPY INTERVENTN $ 2,739.00 $ 2,739.00 3051 GI LAB30520096 SMART PILL GI MONITORING $ 2,818.00 $ 2,818.00 3052 GI LAB

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DEPARTMENT CODE

30510134 STND PACU LVL 1 ADD 15M $ 283.00 $ 283.00 3051 GI LAB30510132 STND PACU LVL 1 FIRST 30M $ 576.00 $ 576.00 3051 GI LAB30510138 STND PACU LVL 2 ADD 15M $ 323.00 $ 323.00 3051 GI LAB30510136 STND PACU LVL 2 FIRST 30M $ 856.00 $ 856.00 3051 GI LAB30639999 S STRL MISC SUPPLY CHARGE $ - $ - 3063 GI LAB - OBSERVATION30926032 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 3092 GI MOTILITY30910175 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 3091 GI MOTILITY30910148 ANORECTAL MANOMETRY $ 1,798.00 $ 1,798.00 3091 GI MOTILITY30910086 ANOSCOPY INTERVENTN $ 2,558.00 $ 2,558.00 3091 GI MOTILITY30910087 BIOFEEDBACK $ 216.00 $ 216.00 3091 GI MOTILITY30900074 BLOOD TRANSFUSN 2-4 HR $ 760.00 $ 760.00 3090 GI MOTILITY30910149 BREATH HYDROGEN TEST $ 578.00 $ 578.00 3091 GI MOTILITY30910098 CAPSULE ENDOSCOPY $ 2,235.00 $ 2,235.00 3091 GI MOTILITY30910100 COLONIC MOTILITY $ 3,103.00 $ 3,103.00 3091 GI MOTILITY30910162 COLONOSCOPY $ 2,691.00 $ 2,691.00 3091 GI MOTILITY30910163 COLONOSCOPY INTERVENTN $ 3,193.00 $ 3,193.00 3091 GI MOTILITY30910118 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3091 GI MOTILITY30910208 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3091 GI MOTILITY30910153 EGD $ 2,601.00 $ 2,601.00 3091 GI MOTILITY30910154 EGD INTERVENTN $ 2,793.00 $ 2,793.00 3091 GI MOTILITY30910101 ELECTROGASTROGRAPHY DIAG $ 1,224.00 $ 1,224.00 3091 GI MOTILITY30910200 ENDO BILI DUCT $ 1,235.00 $ 1,235.00 3091 GI MOTILITY30910110 ENTEROSCOPY $ 3,181.00 $ 3,181.00 3091 GI MOTILITY30910070 ENTEROSCOPY INTERVENTN $ 3,871.00 $ 3,871.00 3091 GI MOTILITY30920171 EP ICAR FX CV GD IN SHTH $ 181.00 $ 181.00 3092 GI MOTILITY30910173 ERCP $ 2,270.00 $ 2,270.00 3091 GI MOTILITY30910202 ERCP BILI PANC DUCT $ 1,108.00 $ 1,108.00 3091 GI MOTILITY30910174 ERCP INTERVENTN $ 5,702.00 $ 5,702.00 3091 GI MOTILITY30910201 ERCP PANC DUCT $ 623.00 $ 623.00 3091 GI MOTILITY30910074 ESOPH ACID PERFUSION TEST $ 530.00 $ 530.00 3091 GI MOTILITY30910061 ESOPH IMPED FUNCT >1HR $ 425.00 $ 425.00 3091 GI MOTILITY30910103 ESOPH IMPED FUNCTION $ 495.00 $ 495.00 3091 GI MOTILITY30910071 ESOPHAGEAL MOTILITY $ 3,103.00 $ 3,103.00 3091 GI MOTILITY

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DEPARTMENT CODE

30910113 GASTRIC ANALYSIS TEST $ 1,351.00 $ 1,351.00 3091 GI MOTILITY30910147 GASTRIC MOTILITY $ 1,702.00 $ 1,702.00 3091 GI MOTILITY30911111 ILEOSCOPY $ 1,320.00 $ 1,320.00 3091 GI MOTILITY30911112 ILEOSCOPY INTERVENTN $ 3,079.00 $ 3,079.00 3091 GI MOTILITY30910105 INS PH CAPSULE GERD MUCOS $ 2,105.00 $ 2,105.00 3091 GI MOTILITY30910063 IRC BX LIVER $ 2,191.00 $ 2,191.00 3091 GI MOTILITY30910117 IRC PARACENT ABD INI $ 1,665.00 $ 1,665.00 3091 GI MOTILITY30927044 NA CL 0.9% 500ML $ 121.95 $ 121.95 3092 GI MOTILITY30910130 NRV MOTOR CONDUCT STDY EA $ 341.00 $ 341.00 3091 GI MOTILITY30910161 PH ESOPH NASAL CATH ELECT $ 1,944.00 $ 1,944.00 3091 GI MOTILITY30910155 PROCTOSCOPY $ 1,278.00 $ 1,278.00 3091 GI MOTILITY30910156 PROCTOSCOPY INTERVENTN $ 2,493.00 $ 2,493.00 3091 GI MOTILITY30920130 S BARRIER ADHESION $ 219.00 $ 219.00 3092 GI MOTILITY30920066 S CATH ABLTN NOCARD ENDVS $ 1,802.00 $ 1,802.00 3092 GI MOTILITY30920174 S CATH ABLTN NOCARD ENDVS $ 432.00 $ 432.00 3092 GI MOTILITY30920175 S CATH ABLTN NOCARD ENDVS $ 541.00 $ 541.00 3092 GI MOTILITY30920059 S CATH BLN DILATE NOVSC $ 1,425.00 $ 1,425.00 3092 GI MOTILITY30920158 S CATH BLN DILATE NOVSC $ 723.00 $ 723.00 3092 GI MOTILITY30920167 S CATH BLN DILATE NOVSC $ 489.00 $ 489.00 3092 GI MOTILITY30920062 S CATH DRAINAGE $ 233.00 $ 233.00 3092 GI MOTILITY30920150 S CATH DRAINAGE $ 1,241.00 $ 1,241.00 3092 GI MOTILITY30920151 S CATH DRAINAGE $ 1,553.00 $ 1,553.00 3092 GI MOTILITY30920152 S CATH DRAINAGE $ 887.00 $ 887.00 3092 GI MOTILITY30920153 S CATH DRAINAGE $ 1,109.00 $ 1,109.00 3092 GI MOTILITY30920135 S CATH GUIDING $ 497.00 $ 497.00 3092 GI MOTILITY30920176 S CATH GUIDING $ 162.00 $ 162.00 3092 GI MOTILITY30920040 S CATH THROMB/EMBOLCTMY $ 431.00 $ 431.00 3092 GI MOTILITY30920041 S CATH THROMB/EMBOLCTMY $ 1,337.00 $ 1,337.00 3092 GI MOTILITY30920057 S CATH THROMB/EMBOLCTMY $ 320.00 $ 320.00 3092 GI MOTILITY30920069 S CATH THROMB/EMBOLCTMY $ 1,735.00 $ 1,735.00 3092 GI MOTILITY30920045 S CATH TRNSML ANG NOLSR $ 1,733.00 $ 1,733.00 3092 GI MOTILITY30921069 S CATH TRNSML ANG NOLSR $ 278.00 $ 278.00 3092 GI MOTILITY30920060 S DEVICE RETRIEVAL $ 1,817.00 $ 1,817.00 3092 GI MOTILITY

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DEPARTMENT CODE

30920134 S DEVICE RETRIEVAL $ 1,295.00 $ 1,295.00 3092 GI MOTILITY30920141 S DEVICE RETRIEVAL $ 887.00 $ 887.00 3092 GI MOTILITY30920142 S DEVICE RETRIEVAL $ 1,330.00 $ 1,330.00 3092 GI MOTILITY30920154 S DEVICE RETRIEVAL $ 971.00 $ 971.00 3092 GI MOTILITY30920156 S DEVICE RETRIEVAL $ 841.00 $ 841.00 3092 GI MOTILITY30920164 S DEVICE RETRIEVAL $ 710.00 $ 710.00 3092 GI MOTILITY30920173 S DEVICE RETRIEVAL $ 250.00 $ 250.00 3092 GI MOTILITY30910096 S EVENT RECORDER CARDIAC $ 1,018.00 $ 1,018.00 3091 GI MOTILITY30910225 S IMP COLONIC STENT $ 10,672.00 $ 10,672.00 3091 GI MOTILITY30920177 S NEEDLE BRACHYTHERAPY $ 557.00 $ 557.00 3092 GI MOTILITY30920179 S NEEDLE BRACHYTHERAPY $ 510.00 $ 510.00 3092 GI MOTILITY30920180 S NEEDLE BRACHYTHERAPY $ 129.00 $ 129.00 3092 GI MOTILITY30940157 S NEEDLE BRACHYTHERAPY $ 70.00 $ 70.00 3094 GI MOTILITY30920046 S O2 OXYGEN $ 287.00 $ 287.00 3092 GI MOTILITY30910247 S STNT COATED WDEL SYS $ 6,545.00 $ 6,545.00 3091 GI MOTILITY30920064 S STNT COATED WDEL SYS $ 7,767.00 $ 7,767.00 3092 GI MOTILITY30910246 S STNT NOCOAT WDEL SYS $ 6,545.00 $ 6,545.00 3091 GI MOTILITY30920048 S STNT NOCOR WDEL SYS TMP $ 1,078.00 $ 1,078.00 3092 GI MOTILITY30920147 S STNT NOCOR WDEL SYS TMP $ 10,006.00 $ 10,006.00 3092 GI MOTILITY30920172 S STNT NOCOR WDEL SYS TMP $ 5,231.00 $ 5,231.00 3092 GI MOTILITY30920178 S STNT NOCOR WDEL SYS TMP $ 5,231.00 $ 5,231.00 3092 GI MOTILITY30910236 S STRL ALLIANCE SYRINGE $ 334.00 $ 334.00 3091 GI MOTILITY30910095 S STRL ARGON COAG PROBE $ 902.00 $ 902.00 3091 GI MOTILITY30910217 S STRL BIL MANOMTRY CATH $ 812.00 $ 812.00 3091 GI MOTILITY30910099 S STRL CAPSULE CAMERA $ 2,244.00 $ 2,244.00 3091 GI MOTILITY30910238 S STRL COTTON SLEEVE $ 731.00 $ 731.00 3091 GI MOTILITY30910223 S STRL CRE FXD DIL BLLN $ 1,319.00 $ 1,319.00 3091 GI MOTILITY30910242 S STRL DBL BLLN OVRTBE $ 838.00 $ 838.00 3091 GI MOTILITY30910207 S STRL ENDOCINCH KIT $ 7,844.00 $ 7,844.00 3091 GI MOTILITY30910239 S STRL EXPULSION BALLOON $ 150.00 $ 150.00 3091 GI MOTILITY30920161 S STRL FORCEP RADIAL UAW $ 275.00 $ 275.00 3092 GI MOTILITY30910232 S STRL GSTRC LAVAGE TRAY $ 580.00 $ 580.00 3091 GI MOTILITY30910224 S STRL IMPEDENCE CATHETER $ 557.00 $ 557.00 3091 GI MOTILITY

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DEPARTMENT CODE

30910227 S STRL LEVINE DILATORS $ 258.00 $ 258.00 3091 GI MOTILITY30910213 S STRL LITHOTRIPTOR CABLE $ 781.00 $ 781.00 3091 GI MOTILITY30910211 S STRL LITHOTRPTR OLYMPUS $ 2,291.00 $ 2,291.00 3091 GI MOTILITY30910221 S STRL MINI PRB SHEATH $ 3,680.00 $ 3,680.00 3091 GI MOTILITY30939999 S STRL MISC SUPPLY CHARGE $ - $ - 3094 GI MOTILITY30910240 S STRL PNEOMATIC DILATOR $ 3,007.00 $ 3,007.00 3091 GI MOTILITY30920162 S STRL POSITRAP RETRIL $ 426.00 $ 426.00 3092 GI MOTILITY30920131 S STRL PULSE OXI SENSOR $ 111.00 $ 111.00 3092 GI MOTILITY30910234 S STRL SEW RITE KIT $ 9,632.00 $ 9,632.00 3091 GI MOTILITY30920138 S STRL SIDE ARM ADAPTOR $ 75.00 $ 75.00 3092 GI MOTILITY30920133 S STRL SNARE $ 1,408.00 $ 1,408.00 3092 GI MOTILITY30910241 S STRL SNGL BLLN OVRTBE $ 884.00 $ 884.00 3091 GI MOTILITY30910243 S STRL SPYBITE $ 1,334.00 $ 1,334.00 3091 GI MOTILITY30910245 S STRL SPYPROBE $ 9,022.00 $ 9,022.00 3091 GI MOTILITY30910244 S STRL SPYSCOPE $ 2,447.00 $ 2,447.00 3091 GI MOTILITY30910229 S STRL STNT GUIDEWIRE CLN $ 2,988.00 $ 2,988.00 3091 GI MOTILITY30910230 S STRL ULTRASOUND BALLOON $ 188.00 $ 188.00 3091 GI MOTILITY30910215 S STRL WIRE BASKET $ 781.00 $ 781.00 3091 GI MOTILITY30920035 S TISSUE MARKER $ 58.00 $ 58.00 3092 GI MOTILITY30920148 S WIRE GUIDE $ 491.00 $ 491.00 3092 GI MOTILITY30920170 S WIRE GUIDE $ 348.00 $ 348.00 3092 GI MOTILITY30940195 SCLEROTHERAPY INTERVENTN $ 1,074.00 $ 1,074.00 3094 GI MOTILITY30910165 SIGMOIDOSCOPY $ 1,383.00 $ 1,383.00 3091 GI MOTILITY30910166 SIGMOIDOSCOPY INTERVENTN $ 2,739.00 $ 2,739.00 3091 GI MOTILITY30920096 SMART PILL GI MONITORING $ 2,818.00 $ 2,818.00 3092 GI MOTILITY30910134 STND PACU LVL 1 ADD 15M $ 283.00 $ 283.00 3091 GI MOTILITY30910132 STND PACU LVL 1 FIRST 30M $ 576.00 $ 576.00 3091 GI MOTILITY30910138 STND PACU LVL 2 ADD 15M $ 323.00 $ 323.00 3091 GI MOTILITY30910136 STND PACU LVL 2 FIRST 30M $ 856.00 $ 856.00 3091 GI MOTILITY42340891 PT EVAL ADD 15 $ 199.00 $ 147.00 4234 HAND THERAPY PT/DAVIES42340892 PT EVAL INIT 30 $ 398.00 $ 294.00 4234 HAND THERAPY PT/DAVIES42340701 PT SINGLE MODAL ADD 15 $ 202.00 $ 149.00 4234 HAND THERAPY PT/DAVIES42340700 PT SINGLE MODAL INIT 30 $ 392.00 $ 291.00 4234 HAND THERAPY PT/DAVIES

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DEPARTMENT CODE

42340811 PT SINGLE PROC ADD 15 $ 236.00 $ 175.00 4234 HAND THERAPY PT/DAVIES42340810 PT SINGLE PROC INIT 30 $ 480.00 $ 356.00 4234 HAND THERAPY PT/DAVIES42340801 PT TREAT COMBO ADD 15 $ 212.00 $ 157.00 4234 HAND THERAPY PT/DAVIES42340800 PT TREAT COMBO INIT 30 $ 416.00 $ 308.00 4234 HAND THERAPY PT/DAVIES42341012 S ORTHO WHF 2ND MP ABDC $ 55.00 $ 55.00 4234 HAND THERAPY PT/DAVIES42341016 S ORTHO WHF ADJ MP FLX/IP $ 153.00 $ 153.00 4234 HAND THERAPY PT/DAVIES42341013 S ORTHO WHF IP EX W/MP SP $ 109.00 $ 109.00 4234 HAND THERAPY PT/DAVIES42341014 S ORTHO WHF MP EXTN AST $ 90.00 $ 90.00 4234 HAND THERAPY PT/DAVIES42341015 S ORTHO WHF TB IP EX W/MP $ 92.00 $ 92.00 4234 HAND THERAPY PT/DAVIES42341011 S ORTHO WHF THMB ABDC BAR $ 71.00 $ 71.00 4234 HAND THERAPY PT/DAVIES42341010 S ORTHO WHFO RGD W/O JNTS $ 237.00 $ 237.00 4234 HAND THERAPY PT/DAVIES42341026 S OT AFO PLASTIC PREFAB $ 286.00 $ 286.00 4234 HAND THERAPY PT/DAVIES42341002 S OT EO WO JOINTS CF $ 242.00 $ 242.00 4234 HAND THERAPY PT/DAVIES42341005 S OT EWHFO RGD WO JNTS CF $ 1,074.00 $ 1,074.00 4234 HAND THERAPY PT/DAVIES42341006 S OT EWHFO W/JOINT(S) CF $ 1,138.00 $ 1,138.00 4234 HAND THERAPY PT/DAVIES42341003 S OT EWHO RIG WO JNTS CF $ 1,074.00 $ 1,074.00 4234 HAND THERAPY PT/DAVIES42341004 S OT EWHO W/JNT(S) CF $ 1,138.00 $ 1,138.00 4234 HAND THERAPY PT/DAVIES42341022 S OT FO NONTORSION JNT CF $ 186.00 $ 186.00 4234 HAND THERAPY PT/DAVIES42341021 S OT FO W/O JOINTS CF $ 179.00 $ 179.00 4234 HAND THERAPY PT/DAVIES42341020 S OT HFO W/JOINT(S) CF $ 269.00 $ 269.00 4234 HAND THERAPY PT/DAVIES42341018 S OT HFO WO JOINTS CF $ 227.00 $ 227.00 4234 HAND THERAPY PT/DAVIES42341019 S OT HO WO JOINTS CF $ 227.00 $ 227.00 4234 HAND THERAPY PT/DAVIES42341024 S OT SEWHO AIR W/JNT(S CF $ 1,663.00 $ 1,663.00 4234 HAND THERAPY PT/DAVIES42341023 S OT SEWHO AIR WO JNTS CF $ 1,663.00 $ 1,663.00 4234 HAND THERAPY PT/DAVIES42341025 S OT SEWHO AIR WO JNTS CF $ 1,408.00 $ 1,408.00 4234 HAND THERAPY PT/DAVIES42341001 S OT SO AIR W/JNT CF $ 1,024.00 $ 1,024.00 4234 HAND THERAPY PT/DAVIES42341000 S OT SO AIR W/O JNTS CF $ 939.00 $ 939.00 4234 HAND THERAPY PT/DAVIES42341007 S OT WHFO RIGID W/O JNTS $ 230.00 $ 230.00 4234 HAND THERAPY PT/DAVIES42341008 S OT WHFO RIGID W/O JNTS $ 359.00 $ 359.00 4234 HAND THERAPY PT/DAVIES42341009 S OT WHFO W/JNT(S) CF $ 381.00 $ 381.00 4234 HAND THERAPY PT/DAVIES42341017 S OT WHO NONTRSN JNT(S CF $ 831.00 $ 831.00 4234 HAND THERAPY PT/DAVIES42340005 S OT WHO WO JNT CUST $ 650.00 $ 650.00 4234 HAND THERAPY PT/DAVIES41710001 HEART ACQUISITION $ 130,062.00 $ 130,062.00 4171 HEART ACQ

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DEPARTMENT CODE

41922113 ADMIN HEPATITIS B VACC $ 44.00 $ 44.00 4192 HEMODIAL41952119 ADMIN HEPATITIS B VACC $ 44.00 $ 44.00 4195 HEMODIAL41922115 ADMIN INFLUENZA VACC $ 60.00 $ 60.00 4192 HEMODIAL41952122 ADMIN INFLUENZA VACC $ 60.00 $ 60.00 4195 HEMODIAL41922114 ADMIN PNEUMOCOCCAL VACC $ 27.00 $ 27.00 4192 HEMODIAL41952121 ADMIN PNEUMOCOCCAL VACC $ 27.00 $ 27.00 4195 HEMODIAL41952150 DIALYS CAPD HM $ 234.00 $ 234.00 4195 HEMODIAL41952125 DIALYS HEMO HM $ 630.00 $ 630.00 4195 HEMODIAL41910100 DIALYS HEMO IP $ 2,932.00 $ 2,932.00 4191 HEMODIAL41910400 DIALYS HEMO IP $ 123.00 $ 123.00 4191 HEMODIAL41910600 DIALYS HEMO IP $ 2,932.00 $ 2,932.00 4191 HEMODIAL41922102 DIALYS HEMO IP $ 2,932.00 $ 2,932.00 4192 HEMODIAL41922105 DIALYS HEMO IP $ 2,932.00 $ 2,932.00 4192 HEMODIAL41922108 DIALYS HEMO OP WITH LAB $ 996.00 $ 996.00 4192 HEMODIAL41952103 DIALYS PRITNEAL NOCAPD IP $ 774.00 $ 774.00 4195 HEMODIAL41952126 DIALYS TRAIN EA SESS CCPD $ 1,365.00 $ 1,365.00 4195 HEMODIAL41922111 ESRD IV ADMIN $ 2.00 $ 2.00 4192 HEMODIAL41952117 ESRD IV ADMIN $ 2.00 $ 2.00 4195 HEMODIAL41922112 ESRD SYRINGE $ 1.00 $ 1.00 4192 HEMODIAL41952118 ESRD SYRINGE $ 1.00 $ 1.00 4195 HEMODIAL41952109 S NSTRL PERITONEAL CYCLER $ 538.00 $ 538.00 4195 HEMODIAL41922116 S STRL BLD ADMIN SUPPLIES $ 24.00 $ 24.00 4192 HEMODIAL41952113 S STRL INPT CAP $ 37.00 $ 37.00 4195 HEMODIAL41952111 S STRL INPT DIANEAL $ 182.00 $ 182.00 4195 HEMODIAL41952112 S STRL INPT TUBING $ 77.00 $ 77.00 4195 HEMODIAL41952114 S STRL LOCKING CAP $ 37.00 $ 37.00 4195 HEMODIAL41952110 S STRL TITANIUM ADAPTOR $ 1,112.00 $ 1,112.00 4195 HEMODIAL41952107 S STRL TRANSFER SET CHG $ 306.00 $ 306.00 4195 HEMODIAL41952116 S STRL UNIVERSAL ADAPTOR $ 52.00 $ 52.00 4195 HEMODIAL30820013 CYTOTOXIC PRA SCRN QUICK $ 273.45 $ 273.45 3082 HISTOCOMP30820011 HLA SINGLE AG I $ 371.00 $ 371.00 3082 HISTOCOMP30820022 HLA SINGLE AG II $ 371.00 $ 371.00 3082 HISTOCOMP30810001 HLA TYP A B C MULTI AG $ 578.76 $ 546.00 3081 HISTOCOMP

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DEPARTMENT CODE

30810010 HLA TYP A B C MULTI AG $ 578.76 $ 578.76 3081 HISTOCOMP30810002 HLA TYPE DR/DQ MULTI AG $ 578.76 $ 546.00 3081 HISTOCOMP30810009 HLA TYPE DR/DQ MULTI AG $ 578.76 $ 578.76 3081 HISTOCOMP30830019 HLA XM FINAL AHG W TITRAT $ 273.45 $ 273.45 3083 HISTOCOMP30830018 HLA XM FINAL FLOW WO TITR $ 484.90 $ 484.90 3083 HISTOCOMP30810012 PRA FLOW CLASS I $ 336.31 $ 336.31 3081 HISTOCOMP30810013 PRA FLOW CLASS II $ 336.31 $ 336.31 3081 HISTOCOMP30820003 PRA SCREEN (AHG) $ 212.83 $ 212.83 3082 HISTOCOMP30820002 PRA SCREEN (DTT) $ 237.21 $ 237.21 3082 HISTOCOMP30820001 PRA SCREEN (STD) $ 113.30 $ 113.30 3082 HISTOCOMP30830001 XMATCH AUTO $ 758.35 $ 758.35 3083 HISTOCOMP30830010 XMATCH B-CELL $ 257.97 $ 257.97 3083 HISTOCOMP30840001 XMATCH CADAVER (PHASE I) $ 1,350.00 $ 1,350.00 3084 HISTOCOMP30830003 XMATCH EVAL (DTT) $ 345.06 $ 345.06 3083 HISTOCOMP30830002 XMATCH EVALUATION $ 273.45 $ 273.45 3083 HISTOCOMP30830004 XMATCH FINAL $ 273.45 $ 273.45 3083 HISTOCOMP30830005 XMATCH FINAL (DTT) $ 345.06 $ 345.06 3083 HISTOCOMP30830011 XMATCH FLOW CYTOMETRY $ 484.90 $ 484.90 3083 HISTOCOMP30830008 XMATCH T-CELL $ 273.45 $ 273.45 3083 HISTOCOMP30830009 XMATCH T-CELL (DTT) $ 345.06 $ 345.06 3083 HISTOCOMP30626032 5% DEXTROSE/WATER 500 ML $ 123.29 $ 123.29 3062 INTERVENTIONAL ENDOSCOPY30610175 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 3061 INTERVENTIONAL ENDOSCOPY30610148 ANORECTAL MANOMETRY $ 1,798.00 $ 1,798.00 3061 INTERVENTIONAL ENDOSCOPY30610086 ANOSCOPY INTERVENTN $ 2,558.00 $ 2,558.00 3061 INTERVENTIONAL ENDOSCOPY30610087 BIOFEEDBACK $ 216.00 $ 216.00 3061 INTERVENTIONAL ENDOSCOPY30600080 BLD GAS ANALYSIS $ 667.00 $ 667.00 3060 INTERVENTIONAL ENDOSCOPY30600074 BLOOD TRANSFUSN 2-4 HR $ 760.00 $ 760.00 3060 INTERVENTIONAL ENDOSCOPY30610077 CA ECHO TRANSESOPHAGEAL $ 1,972.00 $ 1,972.00 3061 INTERVENTIONAL ENDOSCOPY30610098 CAPSULE ENDOSCOPY $ 2,235.00 $ 2,235.00 3061 INTERVENTIONAL ENDOSCOPY30610162 COLONOSCOPY $ 2,691.00 $ 2,691.00 3061 INTERVENTIONAL ENDOSCOPY30610163 COLONOSCOPY INTERVENTN $ 3,193.00 $ 3,193.00 3061 INTERVENTIONAL ENDOSCOPY30610118 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3061 INTERVENTIONAL ENDOSCOPY30610208 CON HOCM <=149MG/ML 1ML $ 1.10 $ 1.10 3061 INTERVENTIONAL ENDOSCOPY

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DEPARTMENT CODE

30600077 CTC PLC DEV/MARKR NON PRO $ 1,420.00 $ 1,420.00 3060 INTERVENTIONAL ENDOSCOPY30610153 EGD $ 2,601.00 $ 2,601.00 3061 INTERVENTIONAL ENDOSCOPY30610154 EGD INTERVENTN $ 2,793.00 $ 2,793.00 3061 INTERVENTIONAL ENDOSCOPY30600083 ELECTROLYTE PNL $ 251.00 $ 251.00 3060 INTERVENTIONAL ENDOSCOPY30610200 ENDO BILI DUCT $ 1,235.00 $ 1,235.00 3061 INTERVENTIONAL ENDOSCOPY30610110 ENTEROSCOPY $ 3,181.00 $ 3,181.00 3061 INTERVENTIONAL ENDOSCOPY30610070 ENTEROSCOPY INTERVENTN $ 3,871.00 $ 3,871.00 3061 INTERVENTIONAL ENDOSCOPY30620171 EP ICAR FX CV GD IN SHTH $ 181.00 $ 181.00 3062 INTERVENTIONAL ENDOSCOPY30610173 ERCP $ 2,270.00 $ 2,270.00 3061 INTERVENTIONAL ENDOSCOPY30610202 ERCP BILI PANC DUCT $ 1,108.00 $ 1,108.00 3061 INTERVENTIONAL ENDOSCOPY30610174 ERCP INTERVENTN $ 5,702.00 $ 5,702.00 3061 INTERVENTIONAL ENDOSCOPY30610201 ERCP PANC DUCT $ 623.00 $ 623.00 3061 INTERVENTIONAL ENDOSCOPY30610074 ESOPH ACID PERFUSION TEST $ 530.00 $ 530.00 3061 INTERVENTIONAL ENDOSCOPY30610080 ESOPHAGOSCOPY $ 2,003.00 $ 2,003.00 3061 INTERVENTIONAL ENDOSCOPY30610081 ESOPHAGOSCOPY INTERVENTN $ 5,842.00 $ 5,842.00 3061 INTERVENTIONAL ENDOSCOPY30610113 GASTRIC ANALYSIS TEST $ 1,351.00 $ 1,351.00 3061 INTERVENTIONAL ENDOSCOPY30610147 GASTRIC MOTILITY $ 1,702.00 $ 1,702.00 3061 INTERVENTIONAL ENDOSCOPY30600081 GLUCOSE $ 134.00 $ 134.00 3060 INTERVENTIONAL ENDOSCOPY30600082 HEMATOCRIT $ 80.00 $ 80.00 3060 INTERVENTIONAL ENDOSCOPY30611111 ILEOSCOPY $ 1,320.00 $ 1,320.00 3061 INTERVENTIONAL ENDOSCOPY30611112 ILEOSCOPY INTERVENTN $ 3,079.00 $ 3,079.00 3061 INTERVENTIONAL ENDOSCOPY30610105 INS PH CAPSULE GERD MUCOS $ 2,105.00 $ 2,105.00 3061 INTERVENTIONAL ENDOSCOPY30610063 IRC BX LIVER $ 2,191.00 $ 2,191.00 3061 INTERVENTIONAL ENDOSCOPY30610117 IRC PARACENT ABD INI $ 1,665.00 $ 1,665.00 3061 INTERVENTIONAL ENDOSCOPY30627043 NA CL 0.9% 250CC $ 3.16 $ 3.16 3062 INTERVENTIONAL ENDOSCOPY30627044 NA CL 0.9% 500ML $ 121.95 $ 121.95 3062 INTERVENTIONAL ENDOSCOPY30610161 PH ESOPH NASAL CATH ELECT $ 1,944.00 $ 1,944.00 3061 INTERVENTIONAL ENDOSCOPY30610155 PROCTOSCOPY $ 1,278.00 $ 1,278.00 3061 INTERVENTIONAL ENDOSCOPY30610156 PROCTOSCOPY INTERVENTN $ 2,493.00 $ 2,493.00 3061 INTERVENTIONAL ENDOSCOPY30600084 PROTHROMBIN TIME $ 140.00 $ 140.00 3060 INTERVENTIONAL ENDOSCOPY30620130 S BARRIER ADHESION $ 219.00 $ 219.00 3062 INTERVENTIONAL ENDOSCOPY30620066 S CATH ABLTN NOCARD ENDVS $ 1,802.00 $ 1,802.00 3062 INTERVENTIONAL ENDOSCOPY30620174 S CATH ABLTN NOCARD ENDVS $ 432.00 $ 432.00 3062 INTERVENTIONAL ENDOSCOPY

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DEPARTMENT CODE

30620175 S CATH ABLTN NOCARD ENDVS $ 541.00 $ 541.00 3062 INTERVENTIONAL ENDOSCOPY30620037 S CATH BLN DILATE NOVSC $ 1,389.00 $ 1,389.00 3062 INTERVENTIONAL ENDOSCOPY30620059 S CATH BLN DILATE NOVSC $ 1,425.00 $ 1,425.00 3062 INTERVENTIONAL ENDOSCOPY30620158 S CATH BLN DILATE NOVSC $ 723.00 $ 723.00 3062 INTERVENTIONAL ENDOSCOPY30620159 S CATH BLN DILATE NOVSC $ 126.00 $ 126.00 3062 INTERVENTIONAL ENDOSCOPY30620167 S CATH BLN DILATE NOVSC $ 489.00 $ 489.00 3062 INTERVENTIONAL ENDOSCOPY30620062 S CATH DRAINAGE $ 233.00 $ 233.00 3062 INTERVENTIONAL ENDOSCOPY30620139 S CATH DRAINAGE $ 997.00 $ 997.00 3062 INTERVENTIONAL ENDOSCOPY30620150 S CATH DRAINAGE $ 1,241.00 $ 1,241.00 3062 INTERVENTIONAL ENDOSCOPY30620151 S CATH DRAINAGE $ 1,553.00 $ 1,553.00 3062 INTERVENTIONAL ENDOSCOPY30620152 S CATH DRAINAGE $ 887.00 $ 887.00 3062 INTERVENTIONAL ENDOSCOPY30620153 S CATH DRAINAGE $ 1,109.00 $ 1,109.00 3062 INTERVENTIONAL ENDOSCOPY30620135 S CATH GUIDING $ 497.00 $ 497.00 3062 INTERVENTIONAL ENDOSCOPY30620136 S CATH GUIDING $ - $ - 3062 INTERVENTIONAL ENDOSCOPY30620143 S CATH GUIDING $ 887.00 $ 887.00 3062 INTERVENTIONAL ENDOSCOPY30620176 S CATH GUIDING $ 162.00 $ 162.00 3062 INTERVENTIONAL ENDOSCOPY30620056 S CATH INTRAVASCULAR US $ 320.00 $ 320.00 3062 INTERVENTIONAL ENDOSCOPY30620040 S CATH THROMB/EMBOLCTMY $ 431.00 $ 431.00 3062 INTERVENTIONAL ENDOSCOPY30620041 S CATH THROMB/EMBOLCTMY $ 1,337.00 $ 1,337.00 3062 INTERVENTIONAL ENDOSCOPY30620057 S CATH THROMB/EMBOLCTMY $ 320.00 $ 320.00 3062 INTERVENTIONAL ENDOSCOPY30620069 S CATH THROMB/EMBOLCTMY $ 1,735.00 $ 1,735.00 3062 INTERVENTIONAL ENDOSCOPY30620045 S CATH TRNSML ANG NOLSR $ 1,733.00 $ 1,733.00 3062 INTERVENTIONAL ENDOSCOPY30621069 S CATH TRNSML ANG NOLSR $ 278.00 $ 278.00 3062 INTERVENTIONAL ENDOSCOPY30620052 S DEVICE RETRIEVAL $ 1,437.00 $ 1,437.00 3062 INTERVENTIONAL ENDOSCOPY30620060 S DEVICE RETRIEVAL $ 1,817.00 $ 1,817.00 3062 INTERVENTIONAL ENDOSCOPY30620134 S DEVICE RETRIEVAL $ 1,295.00 $ 1,295.00 3062 INTERVENTIONAL ENDOSCOPY30620141 S DEVICE RETRIEVAL $ 887.00 $ 887.00 3062 INTERVENTIONAL ENDOSCOPY30620142 S DEVICE RETRIEVAL $ 1,330.00 $ 1,330.00 3062 INTERVENTIONAL ENDOSCOPY30620144 S DEVICE RETRIEVAL $ 1,307.00 $ 1,307.00 3062 INTERVENTIONAL ENDOSCOPY30620154 S DEVICE RETRIEVAL $ 971.00 $ 971.00 3062 INTERVENTIONAL ENDOSCOPY30620156 S DEVICE RETRIEVAL $ 841.00 $ 841.00 3062 INTERVENTIONAL ENDOSCOPY30620164 S DEVICE RETRIEVAL $ 710.00 $ 710.00 3062 INTERVENTIONAL ENDOSCOPY30620173 S DEVICE RETRIEVAL $ 250.00 $ 250.00 3062 INTERVENTIONAL ENDOSCOPY

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DEPARTMENT CODE

30610096 S EVENT RECORDER CARDIAC $ 1,018.00 $ 1,018.00 3061 INTERVENTIONAL ENDOSCOPY30610225 S IMP COLONIC STENT $ 10,672.00 $ 10,672.00 3061 INTERVENTIONAL ENDOSCOPY30620145 S INTR NOINTRACRD NOLSR $ 1,198.00 $ 1,198.00 3062 INTERVENTIONAL ENDOSCOPY30620146 S INTR NOINTRACRD NOLSR $ 1,020.00 $ 1,020.00 3062 INTERVENTIONAL ENDOSCOPY30620177 S NEEDLE BRACHYTHERAPY $ 557.00 $ 557.00 3062 INTERVENTIONAL ENDOSCOPY30620179 S NEEDLE BRACHYTHERAPY $ 510.00 $ 510.00 3062 INTERVENTIONAL ENDOSCOPY30620180 S NEEDLE BRACHYTHERAPY $ 129.00 $ 129.00 3062 INTERVENTIONAL ENDOSCOPY30640157 S NEEDLE BRACHYTHERAPY $ 70.00 $ 70.00 3064 INTERVENTIONAL ENDOSCOPY30610094 S NSTRL ARGON PLASMA COAG $ 971.00 $ 971.00 3061 INTERVENTIONAL ENDOSCOPY30640059 S NSTRL IV MEDICATION $ 86.00 $ 86.00 3064 INTERVENTIONAL ENDOSCOPY30620046 S O2 OXYGEN $ 287.00 $ 287.00 3062 INTERVENTIONAL ENDOSCOPY30620064 S STNT COATED WDEL SYS $ 7,767.00 $ 7,767.00 3062 INTERVENTIONAL ENDOSCOPY30620048 S STNT NOCOR WDEL SYS TMP $ 1,078.00 $ 1,078.00 3062 INTERVENTIONAL ENDOSCOPY30620147 S STNT NOCOR WDEL SYS TMP $ 10,006.00 $ 10,006.00 3062 INTERVENTIONAL ENDOSCOPY30620172 S STNT NOCOR WDEL SYS TMP $ 92.00 $ 92.00 3062 INTERVENTIONAL ENDOSCOPY30620178 S STNT NOCOR WDEL SYS TMP $ 5,231.00 $ 5,231.00 3062 INTERVENTIONAL ENDOSCOPY30610236 S STRL ALLIANCE SYRINGE $ 334.00 $ 334.00 3061 INTERVENTIONAL ENDOSCOPY30610095 S STRL ARGON COAG PROBE $ 902.00 $ 902.00 3061 INTERVENTIONAL ENDOSCOPY30610217 S STRL BIL MANOMTRY CATH $ 812.00 $ 812.00 3061 INTERVENTIONAL ENDOSCOPY30610099 S STRL CAPSULE CAMERA $ 2,244.00 $ 2,244.00 3061 INTERVENTIONAL ENDOSCOPY30610238 S STRL COTTON SLEEVE $ 731.00 $ 731.00 3061 INTERVENTIONAL ENDOSCOPY30610223 S STRL CRE FXD DIL BLLN $ 1,319.00 $ 1,319.00 3061 INTERVENTIONAL ENDOSCOPY30620034 S STRL CYTOLOGY BRUSH $ 216.00 $ 216.00 3062 INTERVENTIONAL ENDOSCOPY30610207 S STRL ENDOCINCH KIT $ 7,844.00 $ 7,844.00 3061 INTERVENTIONAL ENDOSCOPY30620161 S STRL FORCEP RADIAL UAW $ 275.00 $ 275.00 3062 INTERVENTIONAL ENDOSCOPY30610232 S STRL GSTRC LAVAGE TRAY $ 580.00 $ 580.00 3061 INTERVENTIONAL ENDOSCOPY30620160 S STRL IV SOLUTION TUBING $ 303.00 $ 303.00 3062 INTERVENTIONAL ENDOSCOPY30610227 S STRL LEVINE DILATORS $ 258.00 $ 258.00 3061 INTERVENTIONAL ENDOSCOPY30610213 S STRL LITHOTRIPTOR CABLE $ 781.00 $ 781.00 3061 INTERVENTIONAL ENDOSCOPY30610211 S STRL LITHOTRPTR OLYMPUS $ 2,291.00 $ 2,291.00 3061 INTERVENTIONAL ENDOSCOPY30610221 S STRL MINI PRB SHEATH $ 3,680.00 $ 3,680.00 3061 INTERVENTIONAL ENDOSCOPY30620162 S STRL POSITRAP FB RETRIL $ 426.00 $ 426.00 3062 INTERVENTIONAL ENDOSCOPY30620131 S STRL PULSE OXI SENSOR $ 111.00 $ 111.00 3062 INTERVENTIONAL ENDOSCOPY

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DEPARTMENT CODE

30610219 S STRL ROTH NET $ 520.00 $ 520.00 3061 INTERVENTIONAL ENDOSCOPY30610234 S STRL SEW RITE KIT $ 9,632.00 $ 9,632.00 3061 INTERVENTIONAL ENDOSCOPY30620138 S STRL SIDE ARM ADAPTOR $ 75.00 $ 75.00 3062 INTERVENTIONAL ENDOSCOPY30620133 S STRL SNARE $ 1,408.00 $ 1,408.00 3062 INTERVENTIONAL ENDOSCOPY30610209 S STRL SPECIMEN TRAP $ 13.00 $ 13.00 3061 INTERVENTIONAL ENDOSCOPY30610229 S STRL STNT GUIDEWIRE CLN $ 2,988.00 $ 2,988.00 3061 INTERVENTIONAL ENDOSCOPY30610230 S STRL ULTRASOUND BALLOON $ 188.00 $ 188.00 3061 INTERVENTIONAL ENDOSCOPY30610215 S STRL WIRE BASKET $ 781.00 $ 781.00 3061 INTERVENTIONAL ENDOSCOPY30620035 S TISSUE MARKER $ 58.00 $ 58.00 3062 INTERVENTIONAL ENDOSCOPY30620049 S WIRE GUIDE $ 1,468.00 $ 1,468.00 3062 INTERVENTIONAL ENDOSCOPY30620148 S WIRE GUIDE $ 2,808.00 $ 2,808.00 3062 INTERVENTIONAL ENDOSCOPY30620170 S WIRE GUIDE $ 348.00 $ 348.00 3062 INTERVENTIONAL ENDOSCOPY30640195 SCLEROTHERAPY INTERVENTN $ 1,074.00 $ 1,074.00 3064 INTERVENTIONAL ENDOSCOPY30610165 SIGMOIDOSCOPY $ 1,383.00 $ 1,383.00 3061 INTERVENTIONAL ENDOSCOPY30610166 SIGMOIDOSCOPY INTERVENTN $ 2,739.00 $ 2,739.00 3061 INTERVENTIONAL ENDOSCOPY30610134 STND PACU LVL 1 ADD 15M $ 283.00 $ 283.00 3061 INTERVENTIONAL ENDOSCOPY30610132 STND PACU LVL 1 FIRST 30M $ 576.00 $ 576.00 3061 INTERVENTIONAL ENDOSCOPY30610138 STND PACU LVL 2 ADD 15M $ 323.00 $ 323.00 3061 INTERVENTIONAL ENDOSCOPY30610136 STND PACU LVL 2 FIRST 30M $ 856.00 $ 856.00 3061 INTERVENTIONAL ENDOSCOPY30600078 US NDL PLACE $ 1,485.00 $ 1,485.00 3060 INTERVENTIONAL ENDOSCOPY31112004 ABATACEPT 10MG IJ $ 101.03 $ 101.03 3111 IP PHARMACY INJECT31112039 ABCIXIMAB 10MG IJ $ 2,659.00 $ 2,659.00 3111 IP PHARMACY INJECT31114016 ABCIXIMAB 10MG IJ $ 1,395.60 $ 1,395.60 3111 IP PHARMACY INJECT31112001 ACETAZOLAMIDE 500MG INJ $ 205.38 $ 205.38 3111 IP PHARMACY INJECT31112002 ACETAZOLAMIDE 500MG INJ $ 205.38 $ 205.38 3111 IP PHARMACY INJECT31117502 ACETIC ACID .25% 1000ML $ 76.90 $ 76.90 3111 IP PHARMACY INJECT31117539 ACYCLOVIR CR 2GM $ 149.96 $ 149.96 3111 IP PHARMACY INJECT31117501 ACYCLOVIR OINT 5% (15GM) $ 312.54 $ 312.54 3111 IP PHARMACY INJECT31117506 AL SO4 PACKETS $ 17.74 $ 17.74 3111 IP PHARMACY INJECT31162007 ALBUMIN 5%/250ML $ 575.78 $ 575.78 3116 IP PHARMACY INJECT31111095 ALDESLEUKIN 5MU $ 607.07 $ 607.07 3111 IP PHARMACY INJECT31115001 ALDESLEUKIN/SGL DOSE IJ $ 2,649.53 $ 2,649.53 3111 IP PHARMACY INJECT31119008 ALUM IRRIG 1000ML $ 121.15 $ 121.15 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112016 AMIFOSTINE 500MG IJ $ 1,215.52 $ 1,215.52 3111 IP PHARMACY INJECT31114006 AMINOCAPROIC AC 5GM IJ $ 163.10 $ 163.10 3111 IP PHARMACY INJECT31114007 AMINOCAPROIC AC 5GM IJ $ 133.80 $ 133.80 3111 IP PHARMACY INJECT31114008 AMINOCAPROIC AC 5GM IJ $ 163.10 $ 163.10 3111 IP PHARMACY INJECT31112043 AMPHO B LIPOSOME 10MG IJ $ 101.19 $ 101.19 3111 IP PHARMACY INJECT31112044 AMPHO B LIPOSOME 10MG IJ $ 101.19 $ 101.19 3111 IP PHARMACY INJECT31112017 AMPHOTRCN B 1MG IJ IP PED $ 147.40 $ 147.40 3111 IP PHARMACY INJECT31112018 AMPHOTRCN B 1MG IJ IP PED $ 134.20 $ 134.20 3111 IP PHARMACY INJECT31112020 AMPICILLIN 500MG IJ $ 109.93 $ 109.93 3111 IP PHARMACY INJECT31112024 AMPICILLIN/SULB 1.5GM IJ $ 117.35 $ 117.35 3111 IP PHARMACY INJECT31112026 AMPICILLIN/SULB 1.5GM IJ $ 116.49 $ 116.49 3111 IP PHARMACY INJECT31117715 ANALGESIC BALM OINTMENT $ 37.28 $ 37.28 3111 IP PHARMACY INJECT31112221 ANTITHYMOCYT GLOBULN 25MG $ 1,644.75 $ 1,644.75 3111 IP PHARMACY INJECT31116005 ANUSOL $ 19.86 $ 19.86 3111 IP PHARMACY INJECT31117789 ANUSOL RECTAL OINT 30GM $ 39.92 $ 39.92 3111 IP PHARMACY INJECT31116060 ANUSOL SUPP 25MG $ 21.84 $ 21.84 3111 IP PHARMACY INJECT31116001 APAP SUPP 120MG $ 2.77 $ 2.77 3111 IP PHARMACY INJECT31116002 APAP SUPP 325MG $ 2.77 $ 2.77 3111 IP PHARMACY INJECT31116003 APAP SUPP 650MG $ 2.95 $ 2.95 3111 IP PHARMACY INJECT31116008 ASA SUPP 300MG $ 2.15 $ 2.15 3111 IP PHARMACY INJECT31116009 ASA SUPP 600MG $ 2.15 $ 2.15 3111 IP PHARMACY INJECT31112027 ASCORBIC ACID IVPB $ 144.96 $ 144.96 3111 IP PHARMACY INJECT31111001 ASPARAGINASE 10000U IJ $ 710.67 $ 710.67 3111 IP PHARMACY INJECT31111002 ASPARAGINASE 10000U IJ $ 710.67 $ 710.67 3111 IP PHARMACY INJECT31111006 AZATHIOPRINE 100MG IJ $ 789.57 $ 789.57 3111 IP PHARMACY INJECT31112031 AZATHIOPRINE 100MG IJ $ 342.94 $ 342.94 3111 IP PHARMACY INJECT31115006 AZATHIOPRINE 100MG IJ $ 342.94 $ 342.94 3111 IP PHARMACY INJECT31115007 AZATHIOPRINE 100MG IJ $ 342.94 $ 342.94 3111 IP PHARMACY INJECT31112041 AZITHROMYCIN 500MG IJ $ 159.08 $ 159.08 3111 IP PHARMACY INJECT31112042 AZITHROMYCIN 500MG IJ $ 193.56 $ 193.56 3111 IP PHARMACY INJECT31112034 AZTREONAM 500MG IJ $ 172.12 $ 172.12 3111 IP PHARMACY INJECT31116020 B&O SUPPOS. $ 21.04 $ 21.04 3111 IP PHARMACY INJECT31117781 BACI/POLYMIX OINT 30GM $ 41.52 $ 41.52 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31117518 BACITRACIN OINT 15GM $ 39.62 $ 39.62 3111 IP PHARMACY INJECT31117508 BACITRACIN OINT 30GM $ 36.38 $ 36.38 3111 IP PHARMACY INJECT31117505 BACITRACIN OINT PCKT $ 16.64 $ 16.64 3111 IP PHARMACY INJECT31119003 BERWICK'S DYE 30ML $ 76.15 $ 76.15 3111 IP PHARMACY INJECT31119002 BERWICK'S DYE 5ML $ 73.15 $ 73.15 3111 IP PHARMACY INJECT31115008 BEVACIZUMAB 100MG INJ $ - $ - 3111 IP PHARMACY INJECT31115009 BEVACIZUMAB PER 10MG IJ $ 177.38 $ 177.38 3111 IP PHARMACY INJECT31116015 BISACODYL SUPP 10MG $ 17.04 $ 17.04 3111 IP PHARMACY INJECT31111009 BLEOMYCIN 15U IJ $ 666.33 $ 666.33 3111 IP PHARMACY INJECT31111010 BLEOMYCIN 15U IJ $ 666.33 $ 666.33 3111 IP PHARMACY INJECT31111011 BLEOMYCIN 15U IJ $ 666.33 $ 666.33 3111 IP PHARMACY INJECT31111012 BLEOMYCIN 15U IJ $ 666.33 $ 666.33 3111 IP PHARMACY INJECT31115010 BLEOMYCIN 15U IJ $ 666.33 $ 666.33 3111 IP PHARMACY INJECT31115014 BORTEZOMIB PER 0.1MG IJ $ 148.04 $ 148.04 3111 IP PHARMACY INJECT31119004 BUNNELL'S SOLN 1000ML $ 82.15 $ 82.15 3111 IP PHARMACY INJECT31112049 CA CL 10% IVPB $ 134.20 $ 134.20 3111 IP PHARMACY INJECT31114043 CA CL CONT DC $ 135.60 $ 135.60 3111 IP PHARMACY INJECT31114042 CA CL CONT ST $ 133.90 $ 133.90 3111 IP PHARMACY INJECT31112050 CA GLUCONATE 10ML IJ $ 39.08 $ 39.08 3111 IP PHARMACY INJECT31112047 CA GLUCONATE 1GM IVPB $ 144.20 $ 144.20 3111 IP PHARMACY INJECT31112048 CA GLUCONATE 2GM IVPB $ 144.20 $ 144.20 3111 IP PHARMACY INJECT31117668 CADEXOMR IODINE 40GM $ 141.76 $ 141.76 3111 IP PHARMACY INJECT31117673 CADEXOMR IODINE PATCH 6 $ 119.36 $ 119.36 3111 IP PHARMACY INJECT31116045 CAFERGOT SUPP $ 26.26 $ 26.26 3111 IP PHARMACY INJECT31117533 CALAMINE 120ML $ 35.58 $ 35.58 3111 IP PHARMACY INJECT31111014 CARBOPLATIN 50MG IJ $ 515.36 $ 515.36 3111 IP PHARMACY INJECT31115015 CARBOPLATIN 50MG IJ $ 515.36 $ 515.36 3111 IP PHARMACY INJECT31111013 CARMUSTINE 100MG IJ $ 769.97 $ 769.97 3111 IP PHARMACY INJECT31115018 CARMUSTINE 100MG IJ $ 769.97 $ 769.97 3111 IP PHARMACY INJECT31112051 CASPOFUNGIN/5MG IJ $ 106.14 $ 106.14 3111 IP PHARMACY INJECT31112052 CASPOFUNGIN/5MG IJ $ 955.88 $ 955.88 3111 IP PHARMACY INJECT31119503 CEFAZOLIN FORT. OP SOL $ 91.38 $ 91.38 3111 IP PHARMACY INJECT31112060 CEFAZOLIN IVPB 500MG $ 106.43 $ 106.43 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112067 CEFOTAXIME 1GM IJ $ 126.91 $ 126.91 3111 IP PHARMACY INJECT31112069 CEFOTAXIME 1GM IJ $ 154.59 $ 154.59 3111 IP PHARMACY INJECT31112085 CEFTRIAXONE 250MG IJ $ 128.89 $ 128.89 3111 IP PHARMACY INJECT31112093 CEFUROXIME NA 750MG IJ $ 120.83 $ 120.83 3111 IP PHARMACY INJECT31115019 CETUXIMAB PER 10MG IJ $ 154.80 $ 154.80 3111 IP PHARMACY INJECT31112100 CHLORAMPHENICOL 1GM IJ $ 140.50 $ 140.50 3111 IP PHARMACY INJECT31117558 CHLORHEX GLUC 480ML $ 58.68 $ 58.68 3111 IP PHARMACY INJECT31115037 CIDOFOVIR 375 MG IJ $ 1,894.62 $ 1,894.62 3111 IP PHARMACY INJECT31112110 CIPROFLOXACIN 200MG IJ $ 119.31 $ 119.31 3111 IP PHARMACY INJECT31112112 CIPROFLOXACIN 200MG IJ $ 119.31 $ 119.31 3111 IP PHARMACY INJECT31111017 CISPLATIN 10MG IJ $ 139.47 $ 139.47 3111 IP PHARMACY INJECT31115022 CISPLATIN 10MG IJ $ 140.03 $ 140.03 3111 IP PHARMACY INJECT31115020 CLADRIBINE/1MG IJ $ 682.03 $ 682.03 3111 IP PHARMACY INJECT31117562 CLINDAMYCIN 1% 60ML $ 77.88 $ 77.88 3111 IP PHARMACY INJECT31112113 CLINDAMYCIN 300MG IJ $ 114.03 $ 114.03 3111 IP PHARMACY INJECT31117568 CLINDAMYCIN VAG CREAM $ 68.86 $ 68.86 3111 IP PHARMACY INJECT31117563 CLOBETASOL 0.05% CR 15GM $ 73.18 $ 73.18 3111 IP PHARMACY INJECT31117564 CLOBETASOL 0.05% OT 15 OT $ 77.88 $ 77.88 3111 IP PHARMACY INJECT31117565 CLONIDINE $ 54.32 $ 54.32 3111 IP PHARMACY INJECT31117566 CLONIDINE $ 98.20 $ 98.20 3111 IP PHARMACY INJECT31117567 CLONIDINE $ 129.90 $ 129.90 3111 IP PHARMACY INJECT31117520 CLOTRI/BETAMETH CREAM 15M $ 80.16 $ 80.16 3111 IP PHARMACY INJECT31117519 CLOTRI/BETAMETH CREAM 45M $ 134.50 $ 134.50 3111 IP PHARMACY INJECT31117570 CLOTRIMAZOLE CR 1% 15GM $ 45.06 $ 45.06 3111 IP PHARMACY INJECT31117571 CLOTRIMAZOLE CR 1% 30GM $ 67.72 $ 67.72 3111 IP PHARMACY INJECT31117572 CLOTRIMAZOLE LOT 1% 30ML $ 73.02 $ 73.02 3111 IP PHARMACY INJECT31116033 CLOTRIMAZOLE SUPP 100MG $ 51.08 $ 51.08 3111 IP PHARMACY INJECT31116034 CLOTRIMAZOLE VAG CR 45GM $ 49.08 $ 49.08 3111 IP PHARMACY INJECT31117569 COCAINE 10% 10ML $ 246.58 $ 246.58 3111 IP PHARMACY INJECT31117578 COCAINE 10% 4ML $ 119.10 $ 119.10 3111 IP PHARMACY INJECT31117573 COCAINE 4% 10ML $ 157.74 $ 157.74 3111 IP PHARMACY INJECT31117579 COCAINE SOL 4% 4ML $ 119.10 $ 119.10 3111 IP PHARMACY INJECT31117798 COLLAGENASE OINT 15GM $ 144.44 $ 144.44 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112120 CORTROSYN 0.25MG IJ $ 332.61 $ 332.61 3111 IP PHARMACY INJECT31119036 CUSHINGS OINTMENT $ 70.40 $ 70.40 3111 IP PHARMACY INJECT31111023 CYCLOPHOSPHAMID 100MG IJ $ 70.89 $ 70.89 3111 IP PHARMACY INJECT31111030 CYCLOPHOSPHAMID 100MG IJ $ 54.63 $ 54.63 3111 IP PHARMACY INJECT31115030 CYCLOPHOSPHAMID 100MG IJ $ 54.63 $ 54.63 3111 IP PHARMACY INJECT31112124 CYCLOSPORINE 250MG IJ $ 190.50 $ 190.50 3111 IP PHARMACY INJECT31111032 CYTARABINE 100MG IJ $ 81.99 $ 81.99 3111 IP PHARMACY INJECT31111033 CYTARABINE 100MG IJ $ 299.26 $ 299.26 3111 IP PHARMACY INJECT31111034 CYTARABINE 100MG IJ $ 299.26 $ 299.26 3111 IP PHARMACY INJECT31111035 CYTARABINE 100MG IJ $ 81.99 $ 81.99 3111 IP PHARMACY INJECT31111036 CYTARABINE 100MG IJ $ 299.26 $ 299.26 3111 IP PHARMACY INJECT31115035 CYTARABINE 100MG IJ $ 81.99 $ 81.99 3111 IP PHARMACY INJECT31115033 CYTARABINE LIPO 10MG IJ $ 1,510.00 $ 1,510.00 3111 IP PHARMACY INJECT31111039 DACARBAZINE 100MG IJ $ 311.13 $ 311.13 3111 IP PHARMACY INJECT31111040 DACARBAZINE 100MG IJ $ 158.26 $ 158.26 3111 IP PHARMACY INJECT31115041 DACARBAZINE 100MG IJ $ 311.13 $ 311.13 3111 IP PHARMACY INJECT31112126 DACLIZUMAB 25MG IJ $ 1,260.20 $ 1,260.20 3111 IP PHARMACY INJECT31111045 DACTINOMYCIN 0.5MG IJ $ 604.59 $ 604.59 3111 IP PHARMACY INJECT31111046 DACTINOMYCIN 0.5MG IJ $ 91.91 $ 91.91 3111 IP PHARMACY INJECT31111047 DACTINOMYCIN 0.5MG IJ $ 604.59 $ 604.59 3111 IP PHARMACY INJECT31115045 DACTINOMYCIN 0.5MG IJ $ 604.59 $ 604.59 3111 IP PHARMACY INJECT31117580 DAKINS SOL 0.25% 500ML $ 49.32 $ 49.32 3111 IP PHARMACY INJECT31111052 DAUNORUBICIN 10MG IJ $ 397.10 $ 397.10 3111 IP PHARMACY INJECT31111053 DAUNORUBICIN 10MG IJ $ 361.00 $ 361.00 3111 IP PHARMACY INJECT31115052 DAUNORUBICIN 10MG IJ $ 397.10 $ 397.10 3111 IP PHARMACY INJECT31115043 DECITABINE 1MG IJ $ 81.89 $ 81.89 3111 IP PHARMACY INJECT31112128 DEFEROXAMINE 500MG IJ $ 176.04 $ 176.04 3111 IP PHARMACY INJECT31117845 DESITIN TRIPLE PASTE 60GM $ 43.12 $ 43.12 3111 IP PHARMACY INJECT31112131 DESMOPRESSIN IVPB $ 185.52 $ 185.52 3111 IP PHARMACY INJECT31112135 DEXRAZOXANE/250MG IJ $ 1,086.83 $ 1,086.83 3111 IP PHARMACY INJECT31112140 DIGOXIN IMM FAB VIAL IJ $ 1,332.20 $ 1,332.20 3111 IP PHARMACY INJECT31114052 DILTIAZEM 100MG/100ML $ 89.15 $ 89.15 3111 IP PHARMACY INJECT31114053 DILTIAZEM 125MG/125ML $ 179.70 $ 179.70 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112054 DILTIAZEM IVPB $ 184.08 $ 184.08 3111 IP PHARMACY INJECT31116040 DINOPROSTONE 10MG SUPP $ 529.62 $ 529.62 3111 IP PHARMACY INJECT31116130 DINOPROSTONE 2 VAG SUPPOS $ 222.94 $ 222.94 3111 IP PHARMACY INJECT31116039 DINOPROSTONE SUPP 20MG $ 222.94 $ 222.94 3111 IP PHARMACY INJECT31114057 DOBUTAMINE 250/D5W250 $ - $ - 3111 IP PHARMACY INJECT31114056 DOBUTAMINE 500/D5W250 $ - $ - 3111 IP PHARMACY INJECT31114058 DOBUTAMINE 500/D5W250 $ - $ - 3111 IP PHARMACY INJECT31111060 DOCETAXEL 1MG IJ $ 54.15 $ 54.15 3111 IP PHARMACY INJECT31115050 DOCETAXEL 1MG IJ $ 1,198.46 $ 1,198.46 3111 IP PHARMACY INJECT31109573 DOLASETRON MESYLT 10MG IJ $ 300.18 $ 300.18 3111 IP PHARMACY INJECT31114062 DOPAMINE 400MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31114064 DOPAMINE 400MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31114065 DOPAMINE 400MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31114066 DOPAMINE 400MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31114063 DOPAMINE 800MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31114067 DOPAMINE 800MG/D5W 250ML $ - $ - 3111 IP PHARMACY INJECT31111056 DOXORUBICIN 10MG IJ $ 206.54 $ 206.54 3111 IP PHARMACY INJECT31111057 DOXORUBICIN 10MG IJ $ 206.54 $ 206.54 3111 IP PHARMACY INJECT31115056 DOXORUBICIN 10MG IJ $ 206.54 $ 206.54 3111 IP PHARMACY INJECT31115048 DOXORUBICIN LIPID 10MG IJ $ 1,604.38 $ 1,604.38 3111 IP PHARMACY INJECT31112138 DOXYCYCLINE IVPB $ 174.34 $ 174.34 3111 IP PHARMACY INJECT31112136 DOXYCYCLINE IVPB 100MG $ 174.34 $ 174.34 3111 IP PHARMACY INJECT31112137 DOXYCYCLINE IVPB 200MG $ 215.18 $ 215.18 3111 IP PHARMACY INJECT31114060 DROTRECOGIN 10MG IVPB $ 2,158.20 $ 2,158.20 3111 IP PHARMACY INJECT31114061 DROTRECOGIN 20MG IVPB $ 4,804.80 $ 4,804.80 3111 IP PHARMACY INJECT31112143 EDETATE CALCIUM D.1000MG $ 179.90 $ 179.90 3111 IP PHARMACY INJECT31117589 EMLA CREAM 5GM $ 52.88 $ 52.88 3111 IP PHARMACY INJECT31112145 ENALAPRILAT IVPB $ 189.46 $ 189.46 3111 IP PHARMACY INJECT31117620 EPINEPHRINE TOP. 30ML $ 52.70 $ 52.70 3111 IP PHARMACY INJECT31115058 EPIRUBICIN 2MG IJ $ 80.52 $ 80.52 3111 IP PHARMACY INJECT31112141 EPOPROSTENOL 0.5MG IJ $ 176.70 $ 176.70 3111 IP PHARMACY INJECT31112150 ERYTHROMYCIN LAC 500MG IJ $ 110.49 $ 110.49 3111 IP PHARMACY INJECT31112151 ERYTHROMYCIN LAC 500MG IJ $ 130.19 $ 130.19 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112153 ERYTHROMYCIN LAC 500MG IJ $ 127.71 $ 127.71 3111 IP PHARMACY INJECT31117552 ESTRADIOL 0.05MG PATCH $ 29.78 $ 29.78 3111 IP PHARMACY INJECT31117560 ESTRADIOL 0.05MG PATCH $ 27.26 $ 27.26 3111 IP PHARMACY INJECT31117553 ESTRADIOL 0.075MG PATCH $ 29.78 $ 29.78 3111 IP PHARMACY INJECT31117554 ESTRADIOL 0.1MG PATCH $ 29.78 $ 29.78 3111 IP PHARMACY INJECT31117596 ESTRADIOL PATCH 0.05MG $ 21.94 $ 21.94 3111 IP PHARMACY INJECT31117593 ESTRADIOL PATCH 0.05MG. $ 21.94 $ 21.94 3111 IP PHARMACY INJECT31117561 ESTRADIOL PATCH 0.1MG $ 28.54 $ 28.54 3111 IP PHARMACY INJECT31117597 ESTRADIOL PATCH 0.1MG $ 22.40 $ 22.40 3111 IP PHARMACY INJECT31117594 ESTRADIOL PATCH 0.1MG. $ 22.40 $ 22.40 3111 IP PHARMACY INJECT31116048 ESTROGENS VAG CR45GM $ 271.78 $ 271.78 3111 IP PHARMACY INJECT31112159 ETHACRYNIC ACID IVPB $ 369.70 $ 369.70 3111 IP PHARMACY INJECT31112158 ETHACRYNIC ACID IVPB 50MG $ 369.70 $ 369.70 3111 IP PHARMACY INJECT31112007 ETOH ABSOLUTE INJ $ 153.32 $ 153.32 3111 IP PHARMACY INJECT31115062 ETOPOSIDE 10MG IJ $ 58.82 $ 58.82 3111 IP PHARMACY INJECT31112165 FAMOTIDINE 20MG IJ $ 115.23 $ 115.23 3111 IP PHARMACY INJECT31112167 FAMOTIDINE 20MG IJ $ 114.85 $ 114.85 3111 IP PHARMACY INJECT31114090 FENOLDOPAM 10MG DRIP $ 632.38 $ 632.38 3111 IP PHARMACY INJECT31114087 FENT 2MCG/BUPIV 0.1%100ML $ 192.88 $ 192.88 3111 IP PHARMACY INJECT31114088 FENT 5MCG/BUPIV 0.1%250ML $ 211.38 $ 211.38 3111 IP PHARMACY INJECT31114081 FENTANYL 0.1MG IJ $ 227.12 $ 227.12 3111 IP PHARMACY INJECT31117610 FENTANYL 25MCG PATCH $ 91.62 $ 91.62 3111 IP PHARMACY INJECT31117611 FENTANYL 50MCG PATCH $ 122.28 $ 122.28 3111 IP PHARMACY INJECT31117612 FENTANYL 75MCG PATCH $ 122.52 $ 122.52 3111 IP PHARMACY INJECT31114086 FENTANYL BUPIV 250 ML $ 194.38 $ 194.38 3111 IP PHARMACY INJECT31117613 FENTANYL PATCH 100MCG $ 151.76 $ 151.76 3111 IP PHARMACY INJECT31117619 FENTANYL PATCH 12MCG $ 44.14 $ 44.14 3111 IP PHARMACY INJECT31112156 FERRIC GLUC 125MG INJ $ 218.20 $ 218.20 3111 IP PHARMACY INJECT31112164 FILGRASTIM 300MCG IJ $ 666.68 $ 666.68 3111 IP PHARMACY INJECT31116052 FLEET ENEMA 4.5OZ. $ 18.34 $ 18.34 3111 IP PHARMACY INJECT31116051 FLEET ENEMA PEDIATRIC $ 34.74 $ 34.74 3111 IP PHARMACY INJECT31111067 FLOXURIDINE 500MG IJ $ 851.59 $ 851.59 3111 IP PHARMACY INJECT31115070 FLOXURIDINE 500MG IJ $ 815.15 $ 815.15 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112169 FLUCONAZOL 400MG/200ML NS $ - $ - 3111 IP PHARMACY INJECT31112163 FLUCONAZOLE 200MG IJ $ 112.13 $ 112.13 3111 IP PHARMACY INJECT31112168 FLUCONAZOLE 200MG IJ $ 150.89 $ 150.89 3111 IP PHARMACY INJECT31112170 FLUCONAZOLE 200MG IJ $ 150.89 $ 150.89 3111 IP PHARMACY INJECT31112172 FLUCONAZOLE 200MG IJ $ 124.89 $ 124.89 3111 IP PHARMACY INJECT31115072 FLUDARABINE 50MG IJ $ 1,267.01 $ 1,267.01 3111 IP PHARMACY INJECT31117632 FLUOCINOLONE ACET IMPLANT $ 44,899.90 $ 44,899.90 3111 IP PHARMACY INJECT31117603 FLUOCINOLONE CR .01% 15G $ 46.34 $ 46.34 3111 IP PHARMACY INJECT31117604 FLUOCINOLONE CR .01% 45G $ 61.78 $ 61.78 3111 IP PHARMACY INJECT31117609 FLUOCINOLONE SOL .01% 60 $ 107.16 $ 107.16 3111 IP PHARMACY INJECT31117616 FLUOCINONIDE CR .05% 15G $ 65.36 $ 65.36 3111 IP PHARMACY INJECT31117615 FLUOCINONIDE CR .05%60GM $ 109.52 $ 109.52 3111 IP PHARMACY INJECT31117607 FLUOCINONIDE OINT. 0.025% $ 65.52 $ 65.52 3111 IP PHARMACY INJECT31117618 FLUOCINONIDE SOL .05% 20 $ 70.50 $ 70.50 3111 IP PHARMACY INJECT31117614 FLUOCINONIDE UNG .05% 30 $ 88.68 $ 88.68 3111 IP PHARMACY INJECT31111073 FLUOROURACIL 500MG IJ $ 582.53 $ 582.53 3111 IP PHARMACY INJECT31111074 FLUOROURACIL 500MG IJ $ 582.53 $ 582.53 3111 IP PHARMACY INJECT31111075 FLUOROURACIL 500MG IJ $ 583.83 $ 583.83 3111 IP PHARMACY INJECT31115075 FLUOROURACIL 500MG IJ $ 590.43 $ 590.43 3111 IP PHARMACY INJECT31114094 FUROSEMIDE 20MG IJ $ 144.60 $ 144.60 3111 IP PHARMACY INJECT31117622 GANCICLOVIR 4.5MG IMPLNT $ 9,666.15 $ 9,666.15 3111 IP PHARMACY INJECT31111076 GANCICLOVIR SOD 500 MG IJ $ 178.84 $ 178.84 3111 IP PHARMACY INJECT31111077 GANCICLOVIR SOD 500 MG IJ $ 178.88 $ 178.88 3111 IP PHARMACY INJECT31111078 GANCICLOVIR SOD 500 MG IJ $ 225.48 $ 225.48 3111 IP PHARMACY INJECT31111079 GANCICLOVIR SOD 500 MG IJ $ 518.07 $ 518.07 3111 IP PHARMACY INJECT31112176 GANCICLOVIR SOD 500 MG IJ $ 225.48 $ 225.48 3111 IP PHARMACY INJECT31115076 GANCICLOVIR SOD 500 MG IJ $ 225.48 $ 225.48 3111 IP PHARMACY INJECT31115077 GANCICLOVIR SOD 500 MG IJ $ 225.48 $ 225.48 3111 IP PHARMACY INJECT31117628 GEL OPTH FILM $ 76.40 $ 76.40 3111 IP PHARMACY INJECT31117627 GELATIN SPONGE 100MM $ 125.00 $ 125.00 3111 IP PHARMACY INJECT31117626 GELATIN SPONGE 12-7MM $ 52.00 $ 52.00 3111 IP PHARMACY INJECT31117625 GELATIN SPONGE 1GM PWD $ 199.74 $ 199.74 3111 IP PHARMACY INJECT31115078 GEMCITABINE 200MG IJ $ 511.77 $ 511.77 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112188 GENTAMICIN 100MG/100ML NS $ - $ - 3111 IP PHARMACY INJECT31112184 GENTAMICIN 60MG/50ML NS $ - $ - 3111 IP PHARMACY INJECT31112185 GENTAMICIN 70MG/100ML NS $ - $ - 3111 IP PHARMACY INJECT31112189 GENTAMICIN 80MG/100ML NS $ - $ - 3111 IP PHARMACY INJECT31112187 GENTAMICIN 90MG/100ML NS $ - $ - 3111 IP PHARMACY INJECT31119514 GENTAMICIN FORT. OP SOL $ 85.28 $ 85.28 3111 IP PHARMACY INJECT31116055 GLYCERIN ADULT SUPP $ 16.84 $ 16.84 3111 IP PHARMACY INJECT31116056 GLYCERIN CHILD SUPP $ 16.84 $ 16.84 3111 IP PHARMACY INJECT31117644 HEP LOCK FLUSH 10U IJ $ 69.51 $ 69.51 3111 IP PHARMACY INJECT31162062 HEPAGAM B 0.5ML IV IJ $ 2,014.98 $ 2,014.98 3116 IP PHARMACY INJECT31114102 HEPARIN 1000U IJ $ 109.23 $ 109.23 3111 IP PHARMACY INJECT31114100 HEPARIN 25KU/1/2NS250 $ - $ - 3111 IP PHARMACY INJECT31117652 HYDROCORT 2.5% CRM $ 50.76 $ 50.76 3111 IP PHARMACY INJECT31117650 HYDROCORT 2.5% LOT. $ 58.08 $ 58.08 3111 IP PHARMACY INJECT31117651 HYDROCORT 2.5% OINT $ 50.76 $ 50.76 3111 IP PHARMACY INJECT31116061 HYDROCORT 60ML $ 59.84 $ 59.84 3111 IP PHARMACY INJECT31117648 HYDROCORT CR 0.5% 30GM $ 37.08 $ 37.08 3111 IP PHARMACY INJECT31117790 HYDROCORT CREAM 30GM $ 57.08 $ 57.08 3111 IP PHARMACY INJECT31117647 HYDROCORT CRM 1%30GM $ 42.48 $ 42.48 3111 IP PHARMACY INJECT31116006 HYDROCORT HC SUPP $ 22.46 $ 22.46 3111 IP PHARMACY INJECT31117649 HYDROCORT LT 1%120ML $ 60.58 $ 60.58 3111 IP PHARMACY INJECT31111080 HYDROCORT NA SUC 100MG IJ $ 138.90 $ 138.90 3111 IP PHARMACY INJECT31112200 HYDROCORT NA SUC 100MG IJ $ 138.90 $ 138.90 3111 IP PHARMACY INJECT31117645 HYDROCORT OINT 0.5% 30GM $ 36.28 $ 36.28 3111 IP PHARMACY INJECT31117646 HYDROCORT OINT 1% 30GM $ 37.88 $ 37.88 3111 IP PHARMACY INJECT31116067 HYDROMORPHONE SUPP 3MG $ 37.78 $ 37.78 3111 IP PHARMACY INJECT31111091 IFOSFAMIDE/1GM IJ $ 497.97 $ 497.97 3111 IP PHARMACY INJECT31115080 IFOSFAMIDE/1GM IJ $ 497.97 $ 497.97 3111 IP PHARMACY INJECT31112033 IG LYMPHOCYTE 250MG $ 1,051.56 $ 1,051.56 3111 IP PHARMACY INJECT31112207 IMIPENEM/CILAST 250MG IJ $ 180.85 $ 180.85 3111 IP PHARMACY INJECT31112209 IMIPENEM/CILAST 250MG IJ $ 184.03 $ 184.03 3111 IP PHARMACY INJECT31117671 IODINE TC 7% SOL STRONG L $ 39.48 $ 39.48 3111 IP PHARMACY INJECT31115082 IRINOTECAN 20MG IJ $ 506.25 $ 506.25 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31114127 ISOPROTERENOL CNT IV PEDI $ 167.90 $ 167.90 3111 IP PHARMACY INJECT31114126 ISOPROTERENOL CONT IV $ 137.85 $ 137.85 3111 IP PHARMACY INJECT31114124 ISOPROTERENOL CONT IV 10L $ 169.88 $ 169.88 3111 IP PHARMACY INJECT31114125 ISOPROTERENOL CONT IV 20L $ 203.84 $ 203.84 3111 IP PHARMACY INJECT31115084 IXABEPILONE 1MG IJ $ 153.66 $ 153.66 3111 IP PHARMACY INJECT31112320 K ACET IVPB $ 139.00 $ 139.00 3111 IP PHARMACY INJECT31112323 K CL 10MEQ/WATER 100ML $ - $ - 3111 IP PHARMACY INJECT31112324 K CL 20MEQ/WATER 100ML $ - $ - 3111 IP PHARMACY INJECT31112327 K CL 30MEQ PB $ - $ - 3111 IP PHARMACY INJECT31112325 K CL 50MEQ PB $ - $ - 3111 IP PHARMACY INJECT31112326 K PHOS IVPB $ 35.08 $ 35.08 3111 IP PHARMACY INJECT31117674 KETOCONAZOLE CRM 15GM. $ 119.36 $ 119.36 3111 IP PHARMACY INJECT31114134 LABETALOL 500MG $ 158.96 $ 158.96 3111 IP PHARMACY INJECT31114150 LABETALOL CON IV 1MG/ML $ 138.26 $ 138.26 3111 IP PHARMACY INJECT31114151 LABETALOL CON IV 2MG/ML $ 144.32 $ 144.32 3111 IP PHARMACY INJECT31114153 LABETALOL CON IV PEDI $ 138.26 $ 138.26 3111 IP PHARMACY INJECT31114152 LABETALOL CONT IV $ 138.26 $ 138.26 3111 IP PHARMACY INJECT31112223 LABETALOL IVPB $ 138.26 $ 138.26 3111 IP PHARMACY INJECT31112222 LABETALOL IVPB 200MG $ 144.32 $ 144.32 3111 IP PHARMACY INJECT31117690 LACHYDRIN HYDRIN5%LOT $ - $ - 3111 IP PHARMACY INJECT31116080 LACTULOSE RECTAL SOLN $ 68.98 $ 68.98 3111 IP PHARMACY INJECT31111103 LEUCOVORIN 50MG TAB $ 139.70 $ 139.70 3111 IP PHARMACY INJECT31111102 LEUCOVORIN/50MG IJ $ 139.70 $ 139.70 3111 IP PHARMACY INJECT31115088 LEUCOVORIN/50MG IJ $ 139.70 $ 139.70 3111 IP PHARMACY INJECT31111108 LEUPROLIDE 7.5MG IJ $ 2,054.83 $ 2,054.83 3111 IP PHARMACY INJECT31111107 LEUPROLIDE/3.75MG IJ $ 1,807.01 $ 1,807.01 3111 IP PHARMACY INJECT31119518 LIDO/EPI/TETRACAINE 5ML $ 46.08 $ 46.08 3111 IP PHARMACY INJECT31114141 LIDOCAINE 2GM IJ $ 147.89 $ 147.89 3111 IP PHARMACY INJECT31114140 LIDOCAINE 2GM/D5W250 $ 155.55 $ 155.55 3111 IP PHARMACY INJECT31117694 LIDOCAINE 4% CR 5GM $ 37.24 $ 37.24 3111 IP PHARMACY INJECT31117680 LIDOCAINE JELLY 2% 30GM $ 74.34 $ 74.34 3111 IP PHARMACY INJECT31117679 LIDOCAINE JELLY 5ML $ 50.06 $ 50.06 3111 IP PHARMACY INJECT31117684 LIDOCAINE OINT 5% 35GM $ 60.70 $ 60.70 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31117682 LIDOCAINE SOLN 4% 50ML $ 51.40 $ 51.40 3111 IP PHARMACY INJECT31117681 LIDOCAINE UROJET 2% 5ML $ 52.36 $ 52.36 3111 IP PHARMACY INJECT31112224 LINEZOLID/200MG IJ $ 213.99 $ 213.99 3111 IP PHARMACY INJECT31112231 MAG SO4 1GM $ 114.63 $ 114.63 3111 IP PHARMACY INJECT31112232 MAG SO4 2GM $ 114.23 $ 114.23 3111 IP PHARMACY INJECT31112236 MAG SO4 3GM PB $ 101.23 $ 101.23 3111 IP PHARMACY INJECT31112233 MAG SO4 4GM $ 113.39 $ 113.39 3111 IP PHARMACY INJECT31114162 MAG SO4 50GM $ 131.57 $ 131.57 3111 IP PHARMACY INJECT31114163 MAG SO4 50GM/500ML D5W $ 258.03 $ 258.03 3111 IP PHARMACY INJECT31112226 MANNITOL 20% 10GM. $ 177.47 $ 177.47 3111 IP PHARMACY INJECT31112227 MANNITOL 20% 15GM $ 243.89 $ 243.89 3111 IP PHARMACY INJECT31112228 MANNITOL 20% 20GM $ 248.23 $ 248.23 3111 IP PHARMACY INJECT31112229 MANNITOL 20% 25GM $ 177.47 $ 177.47 3111 IP PHARMACY INJECT31112230 MANNITOL 20% 30GM $ 177.47 $ 177.47 3111 IP PHARMACY INJECT31111109 MECHLORETHAMINE 10MG IJ $ 142.30 $ 142.30 3111 IP PHARMACY INJECT31111110 MECHLORETHAMINE 10MG IJ $ 152.42 $ 152.42 3111 IP PHARMACY INJECT31111111 MELPHALAN 50MG IJ $ 4,268.83 $ 4,268.83 3111 IP PHARMACY INJECT31116082 MESALAMINE RECTAL SUSP $ 56.98 $ 56.98 3111 IP PHARMACY INJECT31116084 MESALAMINE SUPPOSITORY $ 37.26 $ 37.26 3111 IP PHARMACY INJECT31111116 MESNA 200MG IJ $ 94.29 $ 94.29 3111 IP PHARMACY INJECT31111117 MESNA 200MG IJ $ 94.29 $ 94.29 3111 IP PHARMACY INJECT31111120 MESNA 200MG IJ $ 94.29 $ 94.29 3111 IP PHARMACY INJECT31115100 MESNA 200MG IJ $ 94.29 $ 94.29 3111 IP PHARMACY INJECT31111125 METHOTREXATE 5MG IJ $ 29.01 $ 29.01 3111 IP PHARMACY INJECT31111126 METHOTREXATE 5MG IJ $ 12.08 $ 12.08 3111 IP PHARMACY INJECT31112235 METHYLDOPATE 250MG IJ $ 155.68 $ 155.68 3111 IP PHARMACY INJECT31112239 METOCLOPRAMIDE 10MG IJ $ 203.16 $ 203.16 3111 IP PHARMACY INJECT31112247 METRONIDAZOLE 500MG IJ $ 115.55 $ 115.55 3111 IP PHARMACY INJECT31112248 METRONIDAZOLE 500MG IJ $ 115.55 $ 115.55 3111 IP PHARMACY INJECT31114076 METRONIDAZOLE 500MG IJ $ 388.87 $ 388.87 3111 IP PHARMACY INJECT31114077 METRONIDAZOLE 500MG IJ $ 388.87 $ 388.87 3111 IP PHARMACY INJECT31114078 METRONIDAZOLE 500MG IJ $ 388.87 $ 388.87 3111 IP PHARMACY INJECT31117706 METRONIDAZOLE GEL 30GM $ 94.04 $ 94.04 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31117719 MICONAZOLE CREAM 30GM $ 40.08 $ 40.08 3111 IP PHARMACY INJECT31117717 MICONAZOLE POWDER 90GMS $ 42.98 $ 42.98 3111 IP PHARMACY INJECT31117720 MICONAZOLE SPRAY 2% (90G $ 42.54 $ 42.54 3111 IP PHARMACY INJECT31116086 MICONAZOLE VAG CR 47GM $ 70.08 $ 70.08 3111 IP PHARMACY INJECT31116085 MICONAZOLE VAG SUPP $ 45.08 $ 45.08 3111 IP PHARMACY INJECT31117718 MICONAZOLE VAG SUPP $ 37.64 $ 37.64 3111 IP PHARMACY INJECT31112267 MILRINONE 20MG/100ML $ - $ - 3111 IP PHARMACY INJECT31114170 MILRINONE 20MG/100ML $ - $ - 3111 IP PHARMACY INJECT31114172 MILRINONE 40MG/200ML $ - $ - 3111 IP PHARMACY INJECT31117725 MINERAL OIL 10ML STERILE $ 34.08 $ 34.08 3111 IP PHARMACY INJECT31117726 MINERAL OIL 2ML TOP $ 37.58 $ 37.58 3111 IP PHARMACY INJECT31116053 MINERAL OIL ENEMA $ 18.94 $ 18.94 3111 IP PHARMACY INJECT31117723 MINERAL OIL TOPICAL $ 38.88 $ 38.88 3111 IP PHARMACY INJECT31111113 MITOMYCIN 5MG IJ $ 57.38 $ 57.38 3111 IP PHARMACY INJECT31111127 MITOMYCIN 5MG IJ $ 578.09 $ 578.09 3111 IP PHARMACY INJECT31111129 MITOMYCIN 5MG IJ $ 578.09 $ 578.09 3111 IP PHARMACY INJECT31115054 MITOMYCIN 5MG IJ $ 578.09 $ 578.09 3111 IP PHARMACY INJECT31115110 MITOMYCIN 5MG IJ $ 923.59 $ 923.59 3111 IP PHARMACY INJECT31111130 MITOXANTRONE/5MG IJ $ 1,005.19 $ 1,005.19 3111 IP PHARMACY INJECT31115115 MITOXANTRONE/5MG IJ $ 1,005.19 $ 1,005.19 3111 IP PHARMACY INJECT31114161 MORPHINE PF 10MG IJ $ 181.38 $ 181.38 3111 IP PHARMACY INJECT31119090 MOUTHWASH,SALT/SODA 480M $ 42.58 $ 42.58 3111 IP PHARMACY INJECT31112268 MOXIFLOXACIN 400MG PB $ - $ - 3111 IP PHARMACY INJECT31112269 MOXIFLOXACIN 400MG PB $ - $ - 3111 IP PHARMACY INJECT31117732 MUPIROCIN 1GM NASAL OINT $ 34.02 $ 34.02 3111 IP PHARMACY INJECT31117731 MUPIROCIN 2% OINT $ 87.48 $ 87.48 3111 IP PHARMACY INJECT31112271 MYCOPHENOLATE 1.5GM IVPB $ 411.20 $ 411.20 3111 IP PHARMACY INJECT31112270 MYCOPHENOLATE 1GM IVPB $ 318.20 $ 318.20 3111 IP PHARMACY INJECT31119526 NA CL 3% 15ML $ 18.54 $ 18.54 3111 IP PHARMACY INJECT31119527 NA CL 5% 3ML $ 18.54 $ 18.54 3111 IP PHARMACY INJECT31119528 NA CL 7% 3ML $ 18.54 $ 18.54 3111 IP PHARMACY INJECT31117581 NA HYPOCHLORITE SOL .5% L $ 49.32 $ 49.32 3111 IP PHARMACY INJECT31112345 NA PHOS IVPB $ 37.28 $ 37.28 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31111139 NA THIOSULFATE 12.5GM $ 181.20 $ 181.20 3111 IP PHARMACY INJECT31115150 NA THIOSULFATE PB $ 181.20 $ 181.20 3111 IP PHARMACY INJECT31111140 NA THIOSULFATE SYRG $ 181.20 $ 181.20 3111 IP PHARMACY INJECT31112283 NAFCILLIN 2GM IJ $ 143.03 $ 143.03 3111 IP PHARMACY INJECT31112284 NAFCILLIN 2GM IJ $ 143.23 $ 143.23 3111 IP PHARMACY INJECT31112282 NAFCILLIN IVPB 1.5GM $ 166.18 $ 166.18 3111 IP PHARMACY INJECT31112281 NAFCILLIN IVPB 1GM $ 126.45 $ 126.45 3111 IP PHARMACY INJECT31112280 NAFCILLIN IVPB 500MG $ 108.03 $ 108.03 3111 IP PHARMACY INJECT31162110 NALOXONE 1MG IJ $ 167.65 $ 167.65 3116 IP PHARMACY INJECT31114117 NEONATE INSULIN DRIP $ 174.70 $ 174.70 3111 IP PHARMACY INJECT31117735 NEOSPORIN GU IRRIG AMP $ 165.60 $ 165.60 3111 IP PHARMACY INJECT31117739 NEOSPORIN OINT 30GM $ 37.08 $ 37.08 3111 IP PHARMACY INJECT31117734 NEOSPORIN OINT PCKTS $ 16.74 $ 16.74 3111 IP PHARMACY INJECT31114176 NICARDIPINE 20MG/200ML $ 414.20 $ 414.20 3111 IP PHARMACY INJECT31114174 NICARDIPINE 25MG IV $ 387.86 $ 387.86 3111 IP PHARMACY INJECT31114173 NICARDIPINE IVAD $ 693.26 $ 693.26 3111 IP PHARMACY INJECT31117759 NICOTINE 14MG PATCH $ - $ - 3111 IP PHARMACY INJECT31117758 NICOTINE 7MG PATCH $ - $ - 3111 IP PHARMACY INJECT31117760 NICOTINE PATCH 21MG $ - $ - 3111 IP PHARMACY INJECT31114206 NITROPRUSSIDE CONT DC $ 209.52 $ 209.52 3111 IP PHARMACY INJECT31114207 NITROPRUSSIDE CONT PEDI $ 171.06 $ 171.06 3111 IP PHARMACY INJECT31114205 NITROPRUSSIDE CONT ST $ 171.06 $ 171.06 3111 IP PHARMACY INJECT31114224 NOREPINEPHRINE 20MG $ 179.00 $ 179.00 3111 IP PHARMACY INJECT31114221 NOREPINEPHRINE CONT DC $ 112.95 $ 112.95 3111 IP PHARMACY INJECT31114222 NOREPINEPHRINE CONT IV $ 89.55 $ 89.55 3111 IP PHARMACY INJECT31114223 NOREPINEPHRINE CONT PEDI $ 89.55 $ 89.55 3111 IP PHARMACY INJECT31114220 NOREPINEPHRINE CONT ST $ 89.55 $ 89.55 3111 IP PHARMACY INJECT31114190 NTG 100MG IJ $ 139.71 $ 139.71 3111 IP PHARMACY INJECT31114192 NTG 100MG IJ $ 156.20 $ 156.20 3111 IP PHARMACY INJECT31117751 NTG 10MG $ 20.44 $ 20.44 3111 IP PHARMACY INJECT31117752 NTG 15MG $ 21.58 $ 21.58 3111 IP PHARMACY INJECT31117748 NTG 2.5MG $ 19.88 $ 19.88 3111 IP PHARMACY INJECT31117741 NTG 3GM OINT $ 19.24 $ 19.24 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31114191 NTG 50MG IJ $ 139.75 $ 139.75 3111 IP PHARMACY INJECT31117749 NTG 5MG $ 19.96 $ 19.96 3111 IP PHARMACY INJECT31117750 NTG 7.5MG $ 21.18 $ 21.18 3111 IP PHARMACY INJECT31117746 NTG OINT 30GM $ 52.76 $ 52.76 3111 IP PHARMACY INJECT31117747 NTG SPRAY $ 105.22 $ 105.22 3111 IP PHARMACY INJECT31117756 NYSTATIN CREAM 15GM $ 39.08 $ 39.08 3111 IP PHARMACY INJECT31117755 NYSTATIN OINT 15GM $ 39.08 $ 39.08 3111 IP PHARMACY INJECT31117757 NYSTATIN TOP POWDER 15GM $ 88.00 $ 88.00 3111 IP PHARMACY INJECT31116097 NYSTATIN VAG SUPP $ 18.44 $ 18.44 3111 IP PHARMACY INJECT31117776 OATMEAL COLL OILATED PCKT $ 17.94 $ 17.94 3111 IP PHARMACY INJECT31117775 OATMEAL COLL PACKETS $ 18.04 $ 18.04 3111 IP PHARMACY INJECT31112290 ONDANSETRON/1MG IJ $ 5.57 $ 5.57 3111 IP PHARMACY INJECT31117530 ORBASE B 5GM $ 41.54 $ 41.54 3111 IP PHARMACY INJECT31115119 OXALIPLATIN 0.5MG IJ $ 297.35 $ 297.35 3111 IP PHARMACY INJECT31115120 OXALIPLATIN 0.5MG IJ $ 59.93 $ 59.93 3111 IP PHARMACY INJECT31114233 OXYTOCIN 10U IJ $ 150.92 $ 150.92 3111 IP PHARMACY INJECT31114323 OXYTOCIN 10U IJ $ 186.38 $ 186.38 3111 IP PHARMACY INJECT31111144 PACLITAXEL 30MG IJ $ 108.36 $ 108.36 3111 IP PHARMACY INJECT31115123 PACLTXL PROTN PART 1MG IJ $ 29.99 $ 29.99 3111 IP PHARMACY INJECT31112291 PAMIDRONATE/30MG IJ $ 188.48 $ 188.48 3111 IP PHARMACY INJECT31114240 PANCURONIUM CONT IV PEDI $ 159.20 $ 159.20 3111 IP PHARMACY INJECT31112297 PANTOPRAZOLE/VIAL IJ $ 192.20 $ 192.20 3111 IP PHARMACY INJECT31112298 PANTOPRAZOLE/VIAL IJ $ 67.35 $ 67.35 3111 IP PHARMACY INJECT31117537 PAPAIN/UREA OINTMENT 53GS $ 142.18 $ 142.18 3111 IP PHARMACY INJECT31112296 PCN G K IVPB $ 140.20 $ 140.20 3111 IP PHARMACY INJECT31111138 PEGASPARGASE SNGL DOSE VL $ 4,578.83 $ 4,578.83 3111 IP PHARMACY INJECT31115096 PEMETREXED PER 10MG IJ $ 151.55 $ 151.55 3111 IP PHARMACY INJECT31112292 PENICILLN G 1MU IJ IP PED $ 134.90 $ 134.90 3111 IP PHARMACY INJECT31112308 PENTAMIDINE 300MG IJ $ 329.70 $ 329.70 3111 IP PHARMACY INJECT31114175 PENTOBARBITAL 250MG IV $ 712.88 $ 712.88 3111 IP PHARMACY INJECT31115097 PENTOSTATIN/10MG IJ $ 5,890.83 $ 5,890.83 3111 IP PHARMACY INJECT31117784 PERMETHRIN CREAM 5% 60GM $ 86.38 $ 86.38 3111 IP PHARMACY INJECT31117783 PERMETHRIN LIQ 1% 60ML $ 46.94 $ 46.94 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112028 PHYTONADIONE 1MG IJ $ 144.20 $ 144.20 3111 IP PHARMACY INJECT31112312 PHYTONADIONE 1MG IJ $ 140.10 $ 140.10 3111 IP PHARMACY INJECT31119077 POLY-BACI IRRIG 30ML $ 202.25 $ 202.25 3111 IP PHARMACY INJECT31116138 POLYSTYRENE ENEMA $ 67.80 $ 67.80 3111 IP PHARMACY INJECT31112328 PRALIDOXIME 1GM IJ $ 280.70 $ 280.70 3111 IP PHARMACY INJECT31112332 PROCAINAMIDE 1GM IJ $ 198.62 $ 198.62 3111 IP PHARMACY INJECT31114265 PROCAINAMIDE 1GM IJ $ 198.62 $ 198.62 3111 IP PHARMACY INJECT31114266 PROCAINAMIDE 1GM IJ $ 165.40 $ 165.40 3111 IP PHARMACY INJECT31116119 PROCHLORPERAZIN SUPP 25MG $ 23.20 $ 23.20 3111 IP PHARMACY INJECT31116118 PROCHLORPERAZIN SUPP 5MG $ 20.32 $ 20.32 3111 IP PHARMACY INJECT31116123 PROMETHAZINE SUPP 12.5MG $ 24.34 $ 24.34 3111 IP PHARMACY INJECT31116124 PROMETHAZINE SUPP 25MG $ 25.20 $ 25.20 3111 IP PHARMACY INJECT31116125 PROMETHAZINE SUPP 50MG $ 32.54 $ 32.54 3111 IP PHARMACY INJECT31112340 QUINIDINE GLUC IVPB $ 162.06 $ 162.06 3111 IP PHARMACY INJECT31112333 RASBURICASE 0.5MG IJ $ 903.48 $ 903.48 3111 IP PHARMACY INJECT31115117 RASBURICASE 0.5MG IJ $ 1,786.15 $ 1,786.15 3111 IP PHARMACY INJECT31112344 RIFAMPIN IVPB $ 225.20 $ 225.20 3111 IP PHARMACY INJECT31112342 RIFAMPIN IVPB 300MG $ 225.20 $ 225.20 3111 IP PHARMACY INJECT31112343 RIFAMPIN IVPB 600MG $ 318.18 $ 318.18 3111 IP PHARMACY INJECT31115122 RITUXIMAB 100MG IJ $ 1,853.45 $ 1,853.45 3111 IP PHARMACY INJECT31117588 S NSTRL DERMABOND $ 78.46 $ 78.46 3111 IP PHARMACY INJECT31117685 S NSTRL INDERMIL $ 75.20 $ 75.20 3111 IP PHARMACY INJECT31117678 S NSTRL MEDICINAL LEECHES $ 23.54 $ 23.54 3111 IP PHARMACY INJECT31117507 S STRL AVITENE 1GM PWD $ 288.80 $ 288.80 3111 IP PHARMACY INJECT31117666 S STRL INSTANT SPONGE $ 106.68 $ 106.68 3111 IP PHARMACY INJECT31117575 S STRL INSTAT 3X4IN SPONG $ 129.66 $ 129.66 3111 IP PHARMACY INJECT31117669 S STRL INTERCEDE SPONGE $ 432.08 $ 432.08 3111 IP PHARMACY INJECT31117771 S STRL NUKNIT 6X9 $ 231.44 $ 231.44 3111 IP PHARMACY INJECT31117778 S STRL SURGICEL 2X14 $ 275.08 $ 275.08 3111 IP PHARMACY INJECT31117801 S STRL SURGICEL 2X3 $ 91.16 $ 91.16 3111 IP PHARMACY INJECT31117774 S STRL SURGICEL 2X3 INCH $ 91.16 $ 91.16 3111 IP PHARMACY INJECT31117802 S STRL SURGICEL 4X8 $ 118.42 $ 118.42 3111 IP PHARMACY INJECT31117799 S STRL SURGICEL FIBR 2X4 $ 365.38 $ 365.38 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31117800 SCOPOLAMINE PATCH $ 23.74 $ 23.74 3111 IP PHARMACY INJECT31117804 SELENIUM SULFID 120ML $ 38.78 $ 38.78 3111 IP PHARMACY INJECT31117803 SELENIUM SULFID 120ML. $ 36.78 $ 36.78 3111 IP PHARMACY INJECT31117813 SILV SULFADIAZN 400G $ 103.22 $ 103.22 3111 IP PHARMACY INJECT31117812 SILV SULFADIAZN CREAM 50M $ 49.60 $ 49.60 3111 IP PHARMACY INJECT31117810 SILVER NIT STICKS $ 18.54 $ 18.54 3111 IP PHARMACY INJECT31114004 STATISTICAL TRACKING $ - $ - 3111 IP PHARMACY INJECT31162144 SUFENTANIL INJ (50MCG/ML $ 299.23 $ 299.23 3116 IP PHARMACY INJECT31112375 SYNERCID 500 MG IJ $ 387.88 $ 387.88 3111 IP PHARMACY INJECT31117805 TALC AEROSOL POWDER $ 305.15 $ 305.15 3111 IP PHARMACY INJECT31117808 TESTOSTERONE 5MG PATCH $ 25.54 $ 25.54 3111 IP PHARMACY INJECT31112358 THIAMINE IVPB $ 156.04 $ 156.04 3111 IP PHARMACY INJECT31117821 THROMBIN 5000 UNITS $ 245.57 $ 245.57 3111 IP PHARMACY INJECT31112352 TICAR/CLAV 3.1GM IJ $ 132.55 $ 132.55 3111 IP PHARMACY INJECT31112353 TICAR/CLAV 3.1GM IJ $ 132.55 $ 132.55 3111 IP PHARMACY INJECT31112357 TOBRAMYCIN 20MG VL IP PED $ 147.20 $ 147.20 3111 IP PHARMACY INJECT31112355 TOBRAMYCIN 80MG IJ $ 159.78 $ 159.78 3111 IP PHARMACY INJECT31119525 TOBRAMYCIN FORT. OP SOL $ 83.18 $ 83.18 3111 IP PHARMACY INJECT31115121 TOPOTECAN 4MG IJ $ 2,908.41 $ 2,908.41 3111 IP PHARMACY INJECT31117828 TRIAMCINOLONE 5GM $ 55.56 $ 55.56 3111 IP PHARMACY INJECT31117835 TRIAMCINOLONE CR .1% 15GM $ 49.88 $ 49.88 3111 IP PHARMACY INJECT31117830 TRIAMCINOLONE CR.025%15GM $ 44.78 $ 44.78 3111 IP PHARMACY INJECT31117836 TRIAMCINOLONE CRM .1%80GM $ 71.98 $ 71.98 3111 IP PHARMACY INJECT31117843 TRIAMCINOLONE CRM .5%15GM $ 39.58 $ 39.58 3111 IP PHARMACY INJECT31117837 TRIAMCINOLONE LOT .1%60ML $ 85.78 $ 85.78 3111 IP PHARMACY INJECT31117832 TRIAMCINOLONE LT.025%60ML $ 78.18 $ 78.18 3111 IP PHARMACY INJECT31117833 TRIAMCINOLONE OI.025%15GM $ 44.68 $ 44.68 3111 IP PHARMACY INJECT31117839 TRIAMCINOLONE OIN .1%15GM $ 49.68 $ 49.68 3111 IP PHARMACY INJECT31117840 TRIAMCINOLONE OIN .1%80GM $ 71.58 $ 71.58 3111 IP PHARMACY INJECT31117829 TRIAMCINOLONE OIN .5%15GM $ 39.08 $ 39.08 3111 IP PHARMACY INJECT31117834 TRIAMCINOLONE OINT .025%M $ 63.88 $ 63.88 3111 IP PHARMACY INJECT31117874 TUCKS $ - $ - 3111 IP PHARMACY INJECT31114360 UROKINASE 250K IU IJ $ 1,211.76 $ 1,211.76 3111 IP PHARMACY INJECT

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DEPARTMENT CODE

31112365 VALPROATE 500MG INJ $ 148.96 $ 148.96 3111 IP PHARMACY INJECT31119530 VANCOMYCIN FORT. OP SOL $ 118.68 $ 118.68 3111 IP PHARMACY INJECT31114382 VASOPRESSIN CONT IV $ 180.56 $ 180.56 3111 IP PHARMACY INJECT31114381 VASOPRESSIN CONT IV DC $ 212.80 $ 212.80 3111 IP PHARMACY INJECT31114383 VASOPRESSIN CONT IV PEDI $ 148.40 $ 148.40 3111 IP PHARMACY INJECT31114380 VASOPRESSIN CONT IV ST $ 148.40 $ 148.40 3111 IP PHARMACY INJECT31114390 VECURONIUM CONT IV PEDI $ 139.40 $ 139.40 3111 IP PHARMACY INJECT31111160 VINBLASTINE 1MG IJ $ 48.25 $ 48.25 3111 IP PHARMACY INJECT31115185 VINBLASTINE 1MG IJ $ 48.25 $ 48.25 3111 IP PHARMACY INJECT31111170 VINCRISTINE 1MG IJ $ 650.03 $ 650.03 3111 IP PHARMACY INJECT31111171 VINCRISTINE 1MG IJ $ 650.03 $ 650.03 3111 IP PHARMACY INJECT31115190 VINCRISTINE 1MG IJ $ 649.83 $ 649.83 3111 IP PHARMACY INJECT31111162 VINORELBINE 10MG IJ $ 362.34 $ 362.34 3111 IP PHARMACY INJECT31111165 VINORELBINE 10MG IJ $ 362.34 $ 362.34 3111 IP PHARMACY INJECT31115205 VINORELBINE 10MG IJ $ 362.34 $ 362.34 3111 IP PHARMACY INJECT31112374 VORICONAZOLE 200MG INJ $ 405.54 $ 405.54 3111 IP PHARMACY INJECT31112379 VORICONAZOLE 200MG INJ $ 405.54 $ 405.54 3111 IP PHARMACY INJECT31117870 VYTONE CREAM 30GM $ 137.00 $ 137.00 3111 IP PHARMACY INJECT31117854 XENADERM 30GM OINT $ 157.02 $ 157.02 3111 IP PHARMACY INJECT31117878 ZINC OX OINT 30GM $ 35.08 $ 35.08 3111 IP PHARMACY INJECT31112380 ZOLEDRONIC ZOMETA 1MG IJ $ 662.70 $ 662.70 3111 IP PHARMACY INJECT31126032 5% DEXTROSE/WATER 500 ML $ 121.95 $ 121.95 3112 IP PHARMACY OPHTH/NASAL31120001 ACETYLCHOLINE OP 1%(2ML) $ 128.94 $ 128.94 3112 IP PHARMACY OPHTH/NASAL31120024 ACETYLCYSTEINE $ 28.50 $ 28.50 3112 IP PHARMACY OPHTH/NASAL31120018 ACETYLCYSTEINE 10% 10ML $ 57.88 $ 57.88 3112 IP PHARMACY OPHTH/NASAL31120021 ACETYLCYSTEINE 10% 30ML $ 128.74 $ 128.74 3112 IP PHARMACY OPHTH/NASAL31120019 ACETYLCYSTEINE 20% 10ML $ 65.96 $ 65.96 3112 IP PHARMACY OPHTH/NASAL31120020 ACETYLCYSTEINE 20% 30ML $ 152.02 $ 152.02 3112 IP PHARMACY OPHTH/NASAL31120044 ACETYLCYSTEINE 20% 4ML $ 28.92 $ 28.92 3112 IP PHARMACY OPHTH/NASAL31127506 ADULT TPN 1000ML $ 827.10 $ 827.10 3112 IP PHARMACY OPHTH/NASAL31127509 ADULT TPN 1500ML $ 1,102.79 $ 1,102.79 3112 IP PHARMACY OPHTH/NASAL31127512 ADULT TPN 2000ML $ 1,102.79 $ 1,102.79 3112 IP PHARMACY OPHTH/NASAL31127515 ADULT TPN 2500ML $ 1,102.79 $ 1,102.79 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31127518 ADULT TPN 3000ML $ 1,378.49 $ 1,378.49 3112 IP PHARMACY OPHTH/NASAL31120035 ADVAIR DISKUS 100-50 $ 268.94 $ 268.94 3112 IP PHARMACY OPHTH/NASAL31120028 ADVAIR DISKUS 250-50 $ 318.66 $ 318.66 3112 IP PHARMACY OPHTH/NASAL31120031 ADVAIR DISKUS 500-50 $ 432.86 $ 432.86 3112 IP PHARMACY OPHTH/NASAL31125003 ALBUMIN 25%/20ML $ 416.36 $ 416.36 3112 IP PHARMACY OPHTH/NASAL31125002 ALBUMIN 25%/50ML $ 575.78 $ 575.78 3112 IP PHARMACY OPHTH/NASAL31125004 ALBUMIN 5%/250ML $ 575.78 $ 575.78 3112 IP PHARMACY OPHTH/NASAL31125001 ALBUMIN 5%/50ML IV $ 432.76 $ 432.76 3112 IP PHARMACY OPHTH/NASAL31125006 ALBUMIN 5%/50ML IV $ 432.76 $ 432.76 3112 IP PHARMACY OPHTH/NASAL31120007 ALBUTEROL 0.5% 0.5ML $ 17.24 $ 17.24 3112 IP PHARMACY OPHTH/NASAL31120002 ALBUTEROL 20ML INH SL $ 74.12 $ 74.12 3112 IP PHARMACY OPHTH/NASAL31120003 ALBUTEROL 3ML RT SOL $ 19.96 $ 19.96 3112 IP PHARMACY OPHTH/NASAL31120016 ALBUTEROL 6 GM HFA INH $ 69.10 $ 69.10 3112 IP PHARMACY OPHTH/NASAL31120004 ALBUTEROL 6.8GM INHALER $ 91.08 $ 91.08 3112 IP PHARMACY OPHTH/NASAL31121503 ALBUTEROL INHALER 17GM $ 92.66 $ 92.66 3112 IP PHARMACY OPHTH/NASAL31120005 AMMONIA ARROMATIC VAPORO $ 18.94 $ 18.94 3112 IP PHARMACY OPHTH/NASAL31121533 AMOXICILLIN 250/5.100ML $ 42.12 $ 42.12 3112 IP PHARMACY OPHTH/NASAL31121501 AMOXICILLIN125MG/5ML150ML $ 48.88 $ 48.88 3112 IP PHARMACY OPHTH/NASAL31121502 AMOXICILLIN250MG/5ML150ML $ 48.88 $ 48.88 3112 IP PHARMACY OPHTH/NASAL31120006 AMYL NITRITE INHAL $ 17.34 $ 17.34 3112 IP PHARMACY OPHTH/NASAL31125008 ANTITHROMBIN 3/IU IJ $ 6.60 $ 6.60 3112 IP PHARMACY OPHTH/NASAL31120022 APRACLONIDINE 1% OPHTH. $ 57.24 $ 57.24 3112 IP PHARMACY OPHTH/NASAL31120017 ATROPINE OIN 1% 3.5GM $ 47.42 $ 47.42 3112 IP PHARMACY OPHTH/NASAL31120012 ATROPINE OP SL 1% 2ML $ 41.40 $ 41.40 3112 IP PHARMACY OPHTH/NASAL31120013 ATROPINE OP SL 1% 5ML $ 58.58 $ 58.58 3112 IP PHARMACY OPHTH/NASAL31121534 AUGMENTIN 400/5 100ML $ 74.08 $ 74.08 3112 IP PHARMACY OPHTH/NASAL31120023 AURALGAN OTIC 15ML $ 59.78 $ 59.78 3112 IP PHARMACY OPHTH/NASAL31121532 AZITHROMYCIN 30ML $ 98.94 $ 98.94 3112 IP PHARMACY OPHTH/NASAL31120227 BACI/POLYMIX OP OIN 3.5GM $ 62.84 $ 62.84 3112 IP PHARMACY OPHTH/NASAL31120025 BACITRACIN 3.5GM OP UNG $ 41.64 $ 41.64 3112 IP PHARMACY OPHTH/NASAL31121523 BACTRIM DS #10 RX $ 40.08 $ 40.08 3112 IP PHARMACY OPHTH/NASAL31120034 BECLOMETHASONE 6.8GM INH $ 128.92 $ 128.92 3112 IP PHARMACY OPHTH/NASAL31120037 BETAXOLOL 0.5% 5ML OPHTH $ 95.48 $ 95.48 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120036 BETAXOLOL 2.5ML OPHTH $ 56.66 $ 56.66 3112 IP PHARMACY OPHTH/NASAL31120164 BRIMONIDINE 5ML OPHTH $ 97.64 $ 97.64 3112 IP PHARMACY OPHTH/NASAL31120041 BRIMONIDINE OPHTH 5ML $ 114.18 $ 114.18 3112 IP PHARMACY OPHTH/NASAL31120043 BSS 15 ML $ 44.78 $ 44.78 3112 IP PHARMACY OPHTH/NASAL31126002 BSS 500ML $ 93.08 $ 93.08 3112 IP PHARMACY OPHTH/NASAL31120029 BSS OPHTH SOLN (15ML) $ 44.78 $ 44.78 3112 IP PHARMACY OPHTH/NASAL31126001 BSS SOL. 500ML $ 63.08 $ 63.08 3112 IP PHARMACY OPHTH/NASAL31120045 BUDESONIDE 0.25/2ML SOL $ 31.40 $ 31.40 3112 IP PHARMACY OPHTH/NASAL31120046 BUDESONIDE 0.5MG/2ML SOL $ 29.14 $ 29.14 3112 IP PHARMACY OPHTH/NASAL31127801 CA CL ADD (CALCIUM) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120060 CALCITONIN NASAL SPRAY $ 229.06 $ 229.06 3112 IP PHARMACY OPHTH/NASAL31120504 CANDIDA SKN TST $ 134.20 $ 134.20 3112 IP PHARMACY OPHTH/NASAL31120048 CARBACHOL TOPICAL 0.01% $ 91.20 $ 91.20 3112 IP PHARMACY OPHTH/NASAL31120049 CARBACHOL TOPICAL 0.01% $ 91.20 $ 91.20 3112 IP PHARMACY OPHTH/NASAL31120050 CARBACHOL TOPICAL 0.75% $ 75.58 $ 75.58 3112 IP PHARMACY OPHTH/NASAL31120051 CARBACHOL TOPICAL 1.5% $ 88.08 $ 88.08 3112 IP PHARMACY OPHTH/NASAL31120052 CARBACHOL TOPICAL 3% 15ML $ 82.70 $ 82.70 3112 IP PHARMACY OPHTH/NASAL31120058 CARBAMIDE PEROX 15ML $ 37.76 $ 37.76 3112 IP PHARMACY OPHTH/NASAL31127540 CARDIOPLEGIC SOL 1000ML $ 551.40 $ 551.40 3112 IP PHARMACY OPHTH/NASAL31126272 CARDIOPLGIC SOL 1000ML $ 720.43 $ 720.43 3112 IP PHARMACY OPHTH/NASAL31121506 CEPHALEXIN 500MG #10 $ 39.08 $ 39.08 3112 IP PHARMACY OPHTH/NASAL31121520 CEPHALEXIN 500MG #4 ER RX $ 36.28 $ 36.28 3112 IP PHARMACY OPHTH/NASAL31120251 CETAPRED OP UNG 3.5GM $ 72.58 $ 72.58 3112 IP PHARMACY OPHTH/NASAL31127807 CHROMIUM CL ADD (MTE-5) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120087 CIPRO OPHTM OINT $ 161.34 $ 161.34 3112 IP PHARMACY OPHTH/NASAL31120064 CIPRO OPTH SOL $ 83.14 $ 83.14 3112 IP PHARMACY OPHTH/NASAL31120068 COLISTIMETHATE 150MG IJ $ 246.20 $ 246.20 3112 IP PHARMACY OPHTH/NASAL31120047 COMBIVENT INH $ 313.36 $ 313.36 3112 IP PHARMACY OPHTH/NASAL31121516 COMBIVIR #6 $ 135.08 $ 135.08 3112 IP PHARMACY OPHTH/NASAL31120140 CORTISPORIN OTIC 10ML $ 68.86 $ 68.86 3112 IP PHARMACY OPHTH/NASAL31120071 CROMOLYN INH SOL $ 18.14 $ 18.14 3112 IP PHARMACY OPHTH/NASAL31120069 CROMOLYN ORAL INHALER $ 127.30 $ 127.30 3112 IP PHARMACY OPHTH/NASAL31127529 CRRT 3000ML REPLACE SOL $ 1,378.49 $ 1,378.49 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31127530 CRRT DIALYSATE 5000ML $ 1,378.49 $ 1,378.49 3112 IP PHARMACY OPHTH/NASAL31127803 CUPRIC SULFATE ADD (COPP) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120079 CYCLOMYDRIL 2ML OPHTH. $ 60.58 $ 60.58 3112 IP PHARMACY OPHTH/NASAL31120074 CYCLOPENTOLATE 1% 5ML $ 81.08 $ 81.08 3112 IP PHARMACY OPHTH/NASAL31120075 CYCLOPENTOLATE 2% 2ML $ 66.08 $ 66.08 3112 IP PHARMACY OPHTH/NASAL31120076 CYCLOPENTOLATE 2% 5ML $ 71.58 $ 71.58 3112 IP PHARMACY OPHTH/NASAL31120072 CYCLOPENTOLATE OP .5% 5ML $ 50.58 $ 50.58 3112 IP PHARMACY OPHTH/NASAL31120073 CYCLOPENTOLATE OP 1% 2ML $ 50.58 $ 50.58 3112 IP PHARMACY OPHTH/NASAL31126062 D10 1/2NS 1000ML $ 159.23 $ 159.23 3112 IP PHARMACY OPHTH/NASAL31126065 D10 1/2NS 500ML $ 129.23 $ 129.23 3112 IP PHARMACY OPHTH/NASAL31126063 D10 1/4NS 1000ML $ 159.23 $ 159.23 3112 IP PHARMACY OPHTH/NASAL31126064 D10 1/4NS 500ML $ 123.23 $ 123.23 3112 IP PHARMACY OPHTH/NASAL31126060 D10NS 1000ML $ 129.23 $ 129.23 3112 IP PHARMACY OPHTH/NASAL31126061 D10NS 1000ML $ 159.23 $ 159.23 3112 IP PHARMACY OPHTH/NASAL31126054 D10W 1000ML $ 123.19 $ 123.19 3112 IP PHARMACY OPHTH/NASAL31126053 D10W 500ML $ 121.29 $ 121.29 3112 IP PHARMACY OPHTH/NASAL31126040 D51/2NS 1000ML $ 128.23 $ 128.23 3112 IP PHARMACY OPHTH/NASAL31126039 D51/2NS 500ML $ 123.63 $ 123.63 3112 IP PHARMACY OPHTH/NASAL31126044 D51/4NS 1000ML $ 128.23 $ 128.23 3112 IP PHARMACY OPHTH/NASAL31126043 D51/4NS 500ML $ 123.63 $ 123.63 3112 IP PHARMACY OPHTH/NASAL31126012 D5LR 1000 +20KCL $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126048 D5LR 1000ML $ 135.87 $ 135.87 3112 IP PHARMACY OPHTH/NASAL31126037 D5NS 1000ML $ 128.23 $ 128.23 3112 IP PHARMACY OPHTH/NASAL31126036 D5NS 500ML $ 123.63 $ 123.63 3112 IP PHARMACY OPHTH/NASAL31127012 D5W 100ML $ 4.66 $ 4.66 3112 IP PHARMACY OPHTH/NASAL31126033 D-5-W 100O CC $ 127.19 $ 127.19 3112 IP PHARMACY OPHTH/NASAL31127013 D5W 250ML $ 2.98 $ 2.98 3112 IP PHARMACY OPHTH/NASAL31127010 D5W 25ML $ 4.70 $ 4.70 3112 IP PHARMACY OPHTH/NASAL31127009 D5W 50ML $ 22.36 $ 22.36 3112 IP PHARMACY OPHTH/NASAL31127011 D5W 50ML $ 4.66 $ 4.66 3112 IP PHARMACY OPHTH/NASAL31120081 DESMOPRESSIN NASAL (RHIN $ 256.74 $ 256.74 3112 IP PHARMACY OPHTH/NASAL31120080 DESMOPRESSIN NSL SL 2.5ML $ 158.88 $ 158.88 3112 IP PHARMACY OPHTH/NASAL31120082 DEXAMETHASONE OP OIN3.5GM $ 65.58 $ 65.58 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120083 DEXAMETHASONE SL 0.1% 5ML $ 65.58 $ 65.58 3112 IP PHARMACY OPHTH/NASAL31126020 DEXTRAN 40/D5W 500ML $ 152.23 $ 152.23 3112 IP PHARMACY OPHTH/NASAL31126021 DEXTRAN 40/NS 500ML $ 152.03 $ 152.03 3112 IP PHARMACY OPHTH/NASAL31126073 DIALYSATE BGK2/0 5L $ 149.23 $ 149.23 3112 IP PHARMACY OPHTH/NASAL31126072 DIALYSATE BGO/3.5 5L $ 149.23 $ 149.23 3112 IP PHARMACY OPHTH/NASAL31121519 DICLOXACILLIN 250MG#20 $ 45.08 $ 45.08 3112 IP PHARMACY OPHTH/NASAL31120086 DIPIVEFRIN SOLN 0.1% 5ML $ 62.08 $ 62.08 3112 IP PHARMACY OPHTH/NASAL31121518 DONNATAL 120ML ER RX $ 38.08 $ 38.08 3112 IP PHARMACY OPHTH/NASAL31120084 DORNASE ALFA NONCOMP 1MG $ 151.34 $ 151.34 3112 IP PHARMACY OPHTH/NASAL31120101 EPINEPHRINE 1:100 10MLIN $ 56.40 $ 56.40 3112 IP PHARMACY OPHTH/NASAL31121521 ERYTHROMYCIN 250MG #15 $ 37.58 $ 37.58 3112 IP PHARMACY OPHTH/NASAL31121507 ERYTHROMYCIN 3.5GM EYE O $ 71.08 $ 71.08 3112 IP PHARMACY OPHTH/NASAL31120103 ERYTHROMYCIN OP UNG 1GM $ 34.94 $ 34.94 3112 IP PHARMACY OPHTH/NASAL31120104 ERYTHROMYCIN OP UNG 3.5G $ 71.08 $ 71.08 3112 IP PHARMACY OPHTH/NASAL31120040 EYE IRRIG 120ML $ 49.08 $ 49.08 3112 IP PHARMACY OPHTH/NASAL31120106 EYE IRRIG 30ML $ 38.58 $ 38.58 3112 IP PHARMACY OPHTH/NASAL31120009 EYE LUBE (15ML) $ 49.96 $ 49.96 3112 IP PHARMACY OPHTH/NASAL31120207 EYE LUBE 7 GM. OINT $ 51.10 $ 51.10 3112 IP PHARMACY OPHTH/NASAL31125011 FACTOR 7A RECOM 1MCG IJ $ 5.26 $ 5.26 3112 IP PHARMACY OPHTH/NASAL31125030 FACTOR 8 RECM/IU IJ $ 521.16 $ 521.16 3112 IP PHARMACY OPHTH/NASAL31125042 FACTOR 8 RECM/IU IJ $ 5.21 $ 5.21 3112 IP PHARMACY OPHTH/NASAL31125043 FACTOR 9 CMPLX/IU IJ $ 2.71 $ 2.71 3112 IP PHARMACY OPHTH/NASAL31125048 FACTOR 9 CMPLX/IU IJ $ 1.94 $ 1.94 3112 IP PHARMACY OPHTH/NASAL31125031 FACTOR 9 RECM/IU IJ $ 27.09 $ 27.09 3112 IP PHARMACY OPHTH/NASAL31125032 FACTR COMP HUMATE-P EA IU $ 438.60 $ 438.60 3112 IP PHARMACY OPHTH/NASAL31125044 FACTR COMP HUMATE-P EA IU $ 5.26 $ 5.26 3112 IP PHARMACY OPHTH/NASAL31120108 FLUNISOLIDE 7GM INHALER $ 149.90 $ 149.90 3112 IP PHARMACY OPHTH/NASAL31120112 FLUORESCEIN 10% 5ML $ 61.58 $ 61.58 3112 IP PHARMACY OPHTH/NASAL31120114 FLUORESCEIN OP 5ML $ 55.96 $ 55.96 3112 IP PHARMACY OPHTH/NASAL31120110 FLUORESCEIN OP STRIPS $ 16.84 $ 16.84 3112 IP PHARMACY OPHTH/NASAL31120120 FLURBIPROFEN .03% 2.5ML $ 63.76 $ 63.76 3112 IP PHARMACY OPHTH/NASAL31120117 FLUROMETHOLONE 10ML $ 95.40 $ 95.40 3112 IP PHARMACY OPHTH/NASAL31120121 FLUTICASONE 0.05% SOL $ 200.34 $ 200.34 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120124 FLUTICASONE 110MCG/ACT $ 296.76 $ 296.76 3112 IP PHARMACY OPHTH/NASAL31120125 FLUTICASONE 220MCG/ACT $ 442.64 $ 442.64 3112 IP PHARMACY OPHTH/NASAL31120123 FLUTICASONE 44MCG INHALE $ 230.00 $ 230.00 3112 IP PHARMACY OPHTH/NASAL31127804 FOLIC ACID ADD (FOLATE) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31125019 GAMMA GLOBULIN IM IJ 1 CC $ 1,290.00 $ 1,290.00 3112 IP PHARMACY OPHTH/NASAL31125026 GAMMA GLOBULIN IM IJ 2 CC $ 80.15 $ 80.15 3112 IP PHARMACY OPHTH/NASAL31120126 GENTAMICIN OP SOL 5ML $ 59.94 $ 59.94 3112 IP PHARMACY OPHTH/NASAL31120127 GENTAMICIN OP UNG 3.5GM $ 72.42 $ 72.42 3112 IP PHARMACY OPHTH/NASAL31120131 GONIOSOL OP SOL 15ML $ 56.88 $ 56.88 3112 IP PHARMACY OPHTH/NASAL31125037 HEMIN/1MG IJ $ 20.59 $ 20.59 3112 IP PHARMACY OPHTH/NASAL31125010 HEPAGAM B 0.5ML IM IJ $ 460.22 $ 460.22 3112 IP PHARMACY OPHTH/NASAL31125038 HEPAGAM B 0.5ML IV IJ $ 203.82 $ 203.82 3112 IP PHARMACY OPHTH/NASAL31127805 HEPARIN 1000U IJ $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126070 HETASTARCH 500ML $ 156.73 $ 156.73 3112 IP PHARMACY OPHTH/NASAL31121515 HIV PEP KIT $ 283.08 $ 283.08 3112 IP PHARMACY OPHTH/NASAL31120136 HOMATROPINE 2% 5ML $ 59.34 $ 59.34 3112 IP PHARMACY OPHTH/NASAL31120138 HOMATROPINE OP 2% 5ML $ 58.08 $ 58.08 3112 IP PHARMACY OPHTH/NASAL31120137 HOMATROPINE OP 5% 5ML $ 63.08 $ 63.08 3112 IP PHARMACY OPHTH/NASAL31121513 HYDROCOD/APAP 10 #4 ER RX $ 46.08 $ 46.08 3112 IP PHARMACY OPHTH/NASAL31121512 HYDROCOD/APAP 5 TAB#6 $ 33.78 $ 33.78 3112 IP PHARMACY OPHTH/NASAL31120145 HYDROCORT 2.5% LT 120ML $ 66.08 $ 66.08 3112 IP PHARMACY OPHTH/NASAL31121522 IBUPROFEN 600MG #4 RX $ 35.28 $ 35.28 3112 IP PHARMACY OPHTH/NASAL31125046 IG RABIES IM/SUBCU $ 1,812.17 $ 1,812.17 3112 IP PHARMACY OPHTH/NASAL31125050 IG TETANUS 250 IU IJ $ 113.03 $ 113.03 3112 IP PHARMACY OPHTH/NASAL31120027 IPRATROPIUM 2.5ML RT $ 19.58 $ 19.58 3112 IP PHARMACY OPHTH/NASAL31120151 IPRATROPIUM INH 14GM $ 238.08 $ 238.08 3112 IP PHARMACY OPHTH/NASAL31125029 IVIG FLEBOGAMMA 500MG IJ $ 258.00 $ 258.00 3112 IP PHARMACY OPHTH/NASAL31125034 IVIG GAMUNEX 500MG IJ $ 129.00 $ 129.00 3112 IP PHARMACY OPHTH/NASAL31125035 IVIG GAMUNEX 500MG IJ $ 132.56 $ 132.56 3112 IP PHARMACY OPHTH/NASAL31125036 IVIG GAMUNEX 500MG IJ $ 132.56 $ 132.56 3112 IP PHARMACY OPHTH/NASAL31125013 IVIG LYOPHILIZD 500MG NOS $ 258.00 $ 258.00 3112 IP PHARMACY OPHTH/NASAL31125023 IVIG LYOPHILIZD 500MG NOS $ 258.00 $ 258.00 3112 IP PHARMACY OPHTH/NASAL31125025 IVIG LYOPHILIZD 500MG NOS $ 258.00 $ 258.00 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31125028 IVIG LYOPHILIZD 500MG NOS $ 243.00 $ 243.00 3112 IP PHARMACY OPHTH/NASAL31125033 IVIG LYOPHILIZD 500MG NOS $ 129.00 $ 129.00 3112 IP PHARMACY OPHTH/NASAL31125045 IVIG PRIVIGEN 500 MG IJ $ 139.32 $ 139.32 3112 IP PHARMACY OPHTH/NASAL31127007 IVPB DILUENTS $ 4.04 $ 4.04 3112 IP PHARMACY OPHTH/NASAL31120157 KETOROLAC 0.5% 0.4ML $ 26.76 $ 26.76 3112 IP PHARMACY OPHTH/NASAL31126201 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 3112 IP PHARMACY OPHTH/NASAL31121627 LAMIVUDINE 150MG RX #12 $ 137.08 $ 137.08 3112 IP PHARMACY OPHTH/NASAL31126014 LARGE VOLUME IV DRIPS $ 128.23 $ 128.23 3112 IP PHARMACY OPHTH/NASAL31120165 LATANOPROST 2.5ML $ 198.40 $ 198.40 3112 IP PHARMACY OPHTH/NASAL31120169 LEVALBUTEROL 0.31/3ML $ 25.04 $ 25.04 3112 IP PHARMACY OPHTH/NASAL31120170 LEVALBUTEROL 1.25/3ML $ 25.04 $ 25.04 3112 IP PHARMACY OPHTH/NASAL31120162 LEVALBUTEROL 3ML $ 25.04 $ 25.04 3112 IP PHARMACY OPHTH/NASAL31120163 LEVOFLOXACIN 5ML OPMTH $ 107.38 $ 107.38 3112 IP PHARMACY OPHTH/NASAL31120171 LIDOCAINE PATCH $ 29.94 $ 29.94 3112 IP PHARMACY OPHTH/NASAL31127906 LIPID EMULSION 20% 200ML $ 133.23 $ 133.23 3112 IP PHARMACY OPHTH/NASAL31127908 LIPID EMULSION 20% 500ML $ 159.73 $ 159.73 3112 IP PHARMACY OPHTH/NASAL31121508 LORAZEPAM 1MG TAB #3 $ 33.12 $ 33.12 3112 IP PHARMACY OPHTH/NASAL31127806 MAG SO4 ADD (MAGNESIUM) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126252 MANNITOL 20% 250ML $ 177.47 $ 177.47 3112 IP PHARMACY OPHTH/NASAL31126250 MANNITOL 20% 500ML $ 271.87 $ 271.87 3112 IP PHARMACY OPHTH/NASAL31120167 MAXITROL 3.5GM OINT $ 49.08 $ 49.08 3112 IP PHARMACY OPHTH/NASAL31120168 MAXITROL SOL. 5ML $ 49.08 $ 49.08 3112 IP PHARMACY OPHTH/NASAL31120174 METAPROTERENOL INH 2.5ML $ 20.66 $ 20.66 3112 IP PHARMACY OPHTH/NASAL31120175 METAPROTERENOL INHALER $ 83.74 $ 83.74 3112 IP PHARMACY OPHTH/NASAL31126850 MISC CONTROLLED INJECTION $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126900 MISC CONTROLLED ORAL $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126950 MISC ENT DRUG $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126750 MISC INJECTION $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126600 MISC ORAL LIQUID $ - $ - 3112 IP PHARMACY OPHTH/NASAL31127000 MISC OTHER DRUG $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126700 MISC TOPICAL/RECTAL $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120181 MOXIFLOXACIN 3ML 0.5% $ 171.96 $ 171.96 3112 IP PHARMACY OPHTH/NASAL31120528 MUMPS/PPD/CAN SKIN TESTS $ 216.30 $ 216.30 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31128852 MUROMONAB/5MG IJ $ 2,131.50 $ 2,131.50 3112 IP PHARMACY OPHTH/NASAL31128853 MUROMONAB/5MG IJ $ 2,131.50 $ 2,131.50 3112 IP PHARMACY OPHTH/NASAL31127809 MVI PEDI ADD (MVI-PEDI) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31127808 MVI-12 ADD (MVI-12) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126254 NA BICARB 5% 500ML IV $ 188.23 $ 188.23 3112 IP PHARMACY OPHTH/NASAL31128020 NA BICARB TPN ADD $ - $ - 3112 IP PHARMACY OPHTH/NASAL31126122 NA CL 0.45% 1000ML $ 127.19 $ 127.19 3112 IP PHARMACY OPHTH/NASAL31126120 NA CL 0.45% 500ML $ 121.95 $ 121.95 3112 IP PHARMACY OPHTH/NASAL31126106 NA CL 0.9% 1000ML $ 127.19 $ 127.19 3112 IP PHARMACY OPHTH/NASAL31127042 NA CL 0.9% 100ML $ 4.62 $ 4.62 3112 IP PHARMACY OPHTH/NASAL31120239 NA CL 0.9% 15ML INHAL $ 18.14 $ 18.14 3112 IP PHARMACY OPHTH/NASAL31127043 NA CL 0.9% 250CC $ 3.16 $ 3.16 3112 IP PHARMACY OPHTH/NASAL31127040 NA CL 0.9% 25ML $ 4.86 $ 4.86 3112 IP PHARMACY OPHTH/NASAL31126080 NA CL 0.9% 500ML $ 121.57 $ 121.57 3112 IP PHARMACY OPHTH/NASAL31126105 NA CL 0.9% 500ML $ 121.95 $ 121.95 3112 IP PHARMACY OPHTH/NASAL31127041 NA CL 0.9% 50ML $ 4.70 $ 4.70 3112 IP PHARMACY OPHTH/NASAL31120245 NA CL NASAL SPRAY 45ML $ 37.18 $ 37.18 3112 IP PHARMACY OPHTH/NASAL31120134 NA HYALURONATE OPHTHALMIC $ 253.65 $ 253.65 3112 IP PHARMACY OPHTH/NASAL31120139 NA HYALURONATE OPHTHALMIC $ 303.65 $ 303.65 3112 IP PHARMACY OPHTH/NASAL31120143 NA HYALURONATE OPHTHALMIC $ 409.95 $ 409.95 3112 IP PHARMACY OPHTH/NASAL31120144 NA HYALURONATE OPHTHALMIC $ 313.65 $ 313.65 3112 IP PHARMACY OPHTH/NASAL31120192 NA HYALURONATE OPHTHALMIC $ 156.15 $ 156.15 3112 IP PHARMACY OPHTH/NASAL31120233 NEO/POLY/HC 7.5ML $ 121.84 $ 121.84 3112 IP PHARMACY OPHTH/NASAL31128200 NEONATAL TPN $ 827.10 $ 827.10 3112 IP PHARMACY OPHTH/NASAL31121530 NEVIRAPINE 200MG RX#3 $ 60.92 $ 60.92 3112 IP PHARMACY OPHTH/NASAL31120187 NITRIC OXIDE TX/HOUR $ 370.23 $ 370.23 3112 IP PHARMACY OPHTH/NASAL31120196 OFLOXACIN 0.5 ML OTIC $ 43.96 $ 43.96 3112 IP PHARMACY OPHTH/NASAL31120199 OFLOXACIN 5ML $ 121.82 $ 121.82 3112 IP PHARMACY OPHTH/NASAL31120202 OXYMETAZOLINE NSLSPY 15ML $ 38.78 $ 38.78 3112 IP PHARMACY OPHTH/NASAL31128006 PEDI TPN 1000ML $ 827.10 $ 827.10 3112 IP PHARMACY OPHTH/NASAL31128012 PEDI TPN 2000ML $ 1,102.79 $ 1,102.79 3112 IP PHARMACY OPHTH/NASAL31128002 PEDI TPN 500ML $ 827.10 $ 827.10 3112 IP PHARMACY OPHTH/NASAL31120203 PENTAMIDINE 300MG IJ $ 2.13 $ 2.13 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120204 PENTAMIDINE 300MG IJ $ 230.94 $ 230.94 3112 IP PHARMACY OPHTH/NASAL31120205 PENTAMIDINE 300MG IJ $ 263.65 $ 263.65 3112 IP PHARMACY OPHTH/NASAL31121510 PHENAZOPYRIDINE 200MG #6 $ 34.64 $ 34.64 3112 IP PHARMACY OPHTH/NASAL31120209 PHENYLEPHRINE 10% OP 5ML $ 71.34 $ 71.34 3112 IP PHARMACY OPHTH/NASAL31120217 PHENYLEPHRINE 2.5% 2MLOPT $ 41.58 $ 41.58 3112 IP PHARMACY OPHTH/NASAL31120208 PHENYLEPHRINE 2.5% OP5ML $ 58.18 $ 58.18 3112 IP PHARMACY OPHTH/NASAL31120220 PILOCARPINE 1% OP 15ML $ 62.58 $ 62.58 3112 IP PHARMACY OPHTH/NASAL31120219 PILOCARPINE 1% OP 2ML $ 40.18 $ 40.18 3112 IP PHARMACY OPHTH/NASAL31120222 PILOCARPINE 2% OP 15ML $ 63.34 $ 63.34 3112 IP PHARMACY OPHTH/NASAL31120221 PILOCARPINE 2% OP 2ML $ 38.98 $ 38.98 3112 IP PHARMACY OPHTH/NASAL31120224 PILOCARPINE 3% OP 15ML $ 66.68 $ 66.68 3112 IP PHARMACY OPHTH/NASAL31120223 PILOCARPINE 4% OP 15ML $ 65.34 $ 65.34 3112 IP PHARMACY OPHTH/NASAL31120218 PILOCARPINE 4% OP GEL $ 129.34 $ 129.34 3112 IP PHARMACY OPHTH/NASAL31120225 PILOCARPINE GEL 4% 3.5GM $ 129.34 $ 129.34 3112 IP PHARMACY OPHTH/NASAL31125040 PLASMAPROT FRAC 5% 250ML $ 555.76 $ 555.76 3112 IP PHARMACY OPHTH/NASAL31120226 POLYMYX/TRIMETH 10ML $ 102.22 $ 102.22 3112 IP PHARMACY OPHTH/NASAL31120039 POVIDONE IODINE 5%OPT30ML $ 56.20 $ 56.20 3112 IP PHARMACY OPHTH/NASAL31121517 PREDNISOLONE 5ML RX DISC $ 35.08 $ 35.08 3112 IP PHARMACY OPHTH/NASAL31120230 PREDNISOLONE FRT 1% OP5ML $ 70.20 $ 70.20 3112 IP PHARMACY OPHTH/NASAL31120231 PREDNISOLONE FRT 1%OP10ML $ 76.84 $ 76.84 3112 IP PHARMACY OPHTH/NASAL31121509 PROCHLORPERAZIN SUPPOS 23 $ 35.28 $ 35.28 3112 IP PHARMACY OPHTH/NASAL31120234 PROPARACINE OP .5% 15ML $ 82.46 $ 82.46 3112 IP PHARMACY OPHTH/NASAL31120102 RACEPINEPHRINE 0.5 $ 19.20 $ 19.20 3112 IP PHARMACY OPHTH/NASAL31120246 RIBAVIRIN 6GM $ 1,195.65 $ 1,195.65 3112 IP PHARMACY OPHTH/NASAL31120008 S NSTRL AEROCHAMBER $ 88.76 $ 88.76 3112 IP PHARMACY OPHTH/NASAL31120026 S STRL AVITEN SHEET 70X35 $ 267.32 $ 267.32 3112 IP PHARMACY OPHTH/NASAL31128503 S STRL BLOOD TUBING $ 99.61 $ 99.61 3112 IP PHARMACY OPHTH/NASAL31128532 S STRL ENTERAL PUMP SET $ 98.97 $ 98.97 3112 IP PHARMACY OPHTH/NASAL31128501 S STRL ENTERAL SET $ 98.97 $ 98.97 3112 IP PHARMACY OPHTH/NASAL31128531 S STRL PUMP BLOOD TUBING $ 99.95 $ 99.95 3112 IP PHARMACY OPHTH/NASAL31120242 SALMETEROL INHALER $ 183.12 $ 183.12 3112 IP PHARMACY OPHTH/NASAL31120253 SALMETEROL PWD INHALER $ 224.70 $ 224.70 3112 IP PHARMACY OPHTH/NASAL31120241 SCOPOLAMINE OP .25% 15ML $ 75.58 $ 75.58 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120240 SCOPOLAMINE OP 0.25% 5ML $ 61.08 $ 61.08 3112 IP PHARMACY OPHTH/NASAL31127812 SELENIOUS ACID ADD SELENI $ - $ - 3112 IP PHARMACY OPHTH/NASAL31121529 STAVUDINE 40MG RX #6 $ 89.88 $ 89.88 3112 IP PHARMACY OPHTH/NASAL31121524 SULFACETAMIDE 10% 15ML RX $ 67.08 $ 67.08 3112 IP PHARMACY OPHTH/NASAL31120263 SULFACETAMIDE 10% 2ML OP $ 37.48 $ 37.48 3112 IP PHARMACY OPHTH/NASAL31120249 SULFACETAMIDE 10% 3.5G $ 63.08 $ 63.08 3112 IP PHARMACY OPHTH/NASAL31120247 SULFACETAMIDE 10% OP 5ML $ 59.00 $ 59.00 3112 IP PHARMACY OPHTH/NASAL31120285 SYMBICORT 160/4.5 INHALER $ 332.36 $ 332.36 3112 IP PHARMACY OPHTH/NASAL31120284 SYMBICORT 80/4.5 INHALER $ 293.26 $ 293.26 3112 IP PHARMACY OPHTH/NASAL31120264 TETRACAINE .5% 2ML $ 40.58 $ 40.58 3112 IP PHARMACY OPHTH/NASAL31120262 TETRACAINE/ADREN./COCAIN $ 41.08 $ 41.08 3112 IP PHARMACY OPHTH/NASAL31120267 TETRAHYDROZOLIN DRPS 15ML $ 62.28 $ 62.28 3112 IP PHARMACY OPHTH/NASAL31127814 THIAMINE HCL 100 MG IJ $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120270 TIMOLOL 0.25% 5ML $ 61.80 $ 61.80 3112 IP PHARMACY OPHTH/NASAL31120271 TIMOLOL 0.5% 5ML $ 62.40 $ 62.40 3112 IP PHARMACY OPHTH/NASAL31120273 TOBRA/DEXAMETH 2.5ML SOL. $ 115.08 $ 115.08 3112 IP PHARMACY OPHTH/NASAL31120272 TOBRA/DEXAMETH OP OIN3.5M $ 218.08 $ 218.08 3112 IP PHARMACY OPHTH/NASAL31121511 TOBRAMYCIN 5ML OPHTH SOL $ 41.16 $ 41.16 3112 IP PHARMACY OPHTH/NASAL31120280 TOBRAMYCIN INH 150MG $ 188.40 $ 188.40 3112 IP PHARMACY OPHTH/NASAL31120281 TOBRAMYCIN INH 80MG $ 146.80 $ 146.80 3112 IP PHARMACY OPHTH/NASAL31120279 TOBRAMYCIN INH SYR 60MG $ 143.20 $ 143.20 3112 IP PHARMACY OPHTH/NASAL31120275 TOBRAMYCIN OP OINT 3.5GM $ 152.28 $ 152.28 3112 IP PHARMACY OPHTH/NASAL31120274 TOBRAMYCIN OP SOL 5ML $ 81.14 $ 81.14 3112 IP PHARMACY OPHTH/NASAL31127815 TRACE ELEM (TRACE PEDI) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31120277 TRIAMCINOLONE INHALER $ 355.68 $ 355.68 3112 IP PHARMACY OPHTH/NASAL31120278 TRIETHANOLAMINE OTIC DROS $ 66.18 $ 66.18 3112 IP PHARMACY OPHTH/NASAL31120282 TRIFLURIDINE 0.1% 7.5ML $ 233.92 $ 233.92 3112 IP PHARMACY OPHTH/NASAL31120290 TROPICAMIDE 1% 3ML OPHTH $ 58.08 $ 58.08 3112 IP PHARMACY OPHTH/NASAL31120288 TROPICAMIDE OP 0.5% 15ML $ 84.58 $ 84.58 3112 IP PHARMACY OPHTH/NASAL31120289 TROPICAMIDE OP 1% 15ML $ 84.54 $ 84.54 3112 IP PHARMACY OPHTH/NASAL31120546 TUBERCULN SKIN TEST INTRA $ 135.10 $ 135.10 3112 IP PHARMACY OPHTH/NASAL31120252 VASOCIDIN 5ML OPHTH SOL $ 70.90 $ 70.90 3112 IP PHARMACY OPHTH/NASAL31120294 VASOCIDIN OPHTH OINT $ 56.20 $ 56.20 3112 IP PHARMACY OPHTH/NASAL

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DEPARTMENT CODE

31120341 VIDARABINE 3.5GM OP. UNG $ 68.08 $ 68.08 3112 IP PHARMACY OPHTH/NASAL31120345 VISCOAT OCULAR 0.5ML $ 330.13 $ 330.13 3112 IP PHARMACY OPHTH/NASAL31127046 WATER 100ML INJ $ 4.04 $ 4.04 3112 IP PHARMACY OPHTH/NASAL31120297 ZANAMIVIR DISKHALER 20'S $ 122.00 $ 122.00 3112 IP PHARMACY OPHTH/NASAL31121526 ZIDOVUDINE 100MG RX #8 $ 60.12 $ 60.12 3112 IP PHARMACY OPHTH/NASAL31127816 ZINC ADD (ZINC) $ - $ - 3112 IP PHARMACY OPHTH/NASAL31100006 ABACAVIR 300MG $ 35.40 $ 35.40 3110 IP PHARMACY ORAL31104042 ABACAVIR 300MG/15ML $ 28.58 $ 28.58 3110 IP PHARMACY ORAL31104065 ABACAVIR 300MG/15ML $ 28.58 $ 28.58 3110 IP PHARMACY ORAL31100013 ACARBOSE 50MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31106001 ACETAZOLAMIDE 500MG INJ $ 205.38 $ 205.38 3110 IP PHARMACY ORAL31106002 ACETAZOLAMIDE 500MG INJ $ 139.33 $ 139.33 3110 IP PHARMACY ORAL31109502 ACETAZOLAMIDE 500MG INJ $ 168.80 $ 168.80 3110 IP PHARMACY ORAL31100018 ACETAZOLAMIDE CAP 500MG $ 22.90 $ 22.90 3110 IP PHARMACY ORAL31100016 ACETAZOLAMIDE TAB 125MG $ 17.28 $ 17.28 3110 IP PHARMACY ORAL31100017 ACETAZOLAMIDE TAB 250MG $ 17.50 $ 17.50 3110 IP PHARMACY ORAL31104056 ACETYLCYSTEINE 10% $ 57.88 $ 57.88 3110 IP PHARMACY ORAL31107118 ACETYLCYSTEINE 100MG INJ $ 10.35 $ 10.35 3110 IP PHARMACY ORAL31104057 ACETYLCYSTEINE 20% $ 65.96 $ 65.96 3110 IP PHARMACY ORAL31100027 ACYCLOVIR 400MG TAB $ 20.42 $ 20.42 3110 IP PHARMACY ORAL31106967 ACYCLOVIR 5 MG IJ $ 16.25 $ 16.25 3110 IP PHARMACY ORAL31100026 ACYCLOVIR 800MG TAB $ 23.64 $ 23.64 3110 IP PHARMACY ORAL31100025 ACYCLOVIR CAP 200MG $ 18.52 $ 18.52 3110 IP PHARMACY ORAL31104018 ACYCLOVIR LIQ $ 18.68 $ 18.68 3110 IP PHARMACY ORAL31106982 ADALIMUMAB 20MG IJ $ 1,941.93 $ 1,941.93 3110 IP PHARMACY ORAL31100029 ADEFOVIR DIPIV $ 54.48 $ 54.48 3110 IP PHARMACY ORAL31106003 ADENOSINE 6 MG RX IJ $ 148.01 $ 148.01 3110 IP PHARMACY ORAL31106004 ADENOSINE 6 MG RX IJ $ 148.01 $ 148.01 3110 IP PHARMACY ORAL31106753 ADENOSINE DX 30 MG IJ $ 137.65 $ 137.65 3110 IP PHARMACY ORAL31107288 ADENOSINE DX 30 MG IJ $ 480.16 $ 480.16 3110 IP PHARMACY ORAL31100038 ALBENDAZOLE 200MG $ 19.34 $ 19.34 3110 IP PHARMACY ORAL31104020 ALBUTEROL (2MG/5ML)2MG $ 17.38 $ 17.38 3110 IP PHARMACY ORAL31104021 ALBUTEROL (2MG/5ML)4MG $ 18.22 $ 18.22 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100030 ALBUTEROL TAB 2MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100031 ALBUTEROL TAB 4MG $ 17.58 $ 17.58 3110 IP PHARMACY ORAL31100042 ALENDRONATE 70MG TAB $ 62.04 $ 62.04 3110 IP PHARMACY ORAL31100011 ALISKIREN 150MG $ 21.40 $ 21.40 3110 IP PHARMACY ORAL31100012 ALISKIREN 300MG $ 22.68 $ 22.68 3110 IP PHARMACY ORAL31106829 ALLOPURINOL 500MG INJ $ 1,356.80 $ 1,356.80 3110 IP PHARMACY ORAL31100036 ALLOPURINOL TAB 100MG $ 17.06 $ 17.06 3110 IP PHARMACY ORAL31100037 ALLOPURINOL TAB 300MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31100035 ALLOPURINOL TAB 50MG $ 16.90 $ 16.90 3110 IP PHARMACY ORAL31104028 ALOH GEL SUSP $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31104025 ALOH GEL SUSP 15ML $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31104026 ALOH GEL SUSP 30ML $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31104027 ALOH GEL SUSP 60ML $ 19.02 $ 19.02 3110 IP PHARMACY ORAL31100050 ALOH II TAB $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31103521 ALPRAZOLAM TAB 0.25MG $ 34.38 $ 34.38 3110 IP PHARMACY ORAL31103522 ALPRAZOLAM TAB 0.5MG $ 34.82 $ 34.82 3110 IP PHARMACY ORAL31107120 ALPROSTADIL 1.25MCG IJ $ 22.58 $ 22.58 3110 IP PHARMACY ORAL31107121 ALPROSTADIL 1.25MCG IJ $ 12.31 $ 12.31 3110 IP PHARMACY ORAL31107122 ALPROSTADIL 1.25MCG IJ $ 6.17 $ 6.17 3110 IP PHARMACY ORAL31106822 ALTEPLASE 1MG IJ $ 126.53 $ 126.53 3110 IP PHARMACY ORAL31107005 ALTEPLASE 1MG IJ $ 137.04 $ 137.04 3110 IP PHARMACY ORAL31107116 ALTEPLASE 1MG IJ $ 92.80 $ 92.80 3110 IP PHARMACY ORAL31100021 ALVIMOPAN 12MG $ 175.54 $ 175.54 3110 IP PHARMACY ORAL31104043 AMANTADINE 100MG LIQ $ 21.48 $ 21.48 3110 IP PHARMACY ORAL31100053 AMANTADINE HCL CAP 100MG $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31104045 AMANTADINE SYRUP $ 19.54 $ 19.54 3110 IP PHARMACY ORAL31107123 AMIKACIN 100MG IJ $ 15.07 $ 15.07 3110 IP PHARMACY ORAL31107124 AMIKACIN 100MG IJ $ 27.86 $ 27.86 3110 IP PHARMACY ORAL31107265 AMIKACIN 100MG IJ $ 27.86 $ 27.86 3110 IP PHARMACY ORAL31107269 AMIKACIN 100MG IJ $ 19.53 $ 19.53 3110 IP PHARMACY ORAL31109505 AMIKACIN 100MG IJ $ 148.46 $ 148.46 3110 IP PHARMACY ORAL31100054 AMILORIDE HCL 5MG. $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31106010 AMINOCAPROIC AC 5 GM $ 129.15 $ 129.15 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104050 AMINOCAPROIC AC LQ 1GM $ 23.04 $ 23.04 3110 IP PHARMACY ORAL31104051 AMINOCAPROIC AC LQ 2GM $ 29.56 $ 29.56 3110 IP PHARMACY ORAL31104052 AMINOCAPROIC AC LQ 4GM $ 42.58 $ 42.58 3110 IP PHARMACY ORAL31104053 AMINOCAPROIC AC LQ 5GM $ 49.54 $ 49.54 3110 IP PHARMACY ORAL31104054 AMINOCAPROIC AC LQ1GM/4ML $ 23.24 $ 23.24 3110 IP PHARMACY ORAL31100057 AMINOCAPROIC AC TAB 500MG $ 20.00 $ 20.00 3110 IP PHARMACY ORAL31104047 AMINOPHYLLINE 105/5ML LIQ $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31106087 AMINOPHYLLINE 250MG IJ $ 139.92 $ 139.92 3110 IP PHARMACY ORAL31109509 AMINOPHYLLINE 250MG IJ $ 134.20 $ 134.20 3110 IP PHARMACY ORAL31100074 AMIODARONE 400MG TAB $ 30.66 $ 30.66 3110 IP PHARMACY ORAL31109700 AMIODARONE 75MG SYR $ 137.20 $ 137.20 3110 IP PHARMACY ORAL31107125 AMIODARONE HCL 30 MG IJ $ 22.03 $ 22.03 3110 IP PHARMACY ORAL31107126 AMIODARONE HCL 30 MG IJ $ 10.78 $ 10.78 3110 IP PHARMACY ORAL31107127 AMIODARONE HCL 30 MG IJ $ 62.44 $ 62.44 3110 IP PHARMACY ORAL31107275 AMIODARONE HCL 30 MG IJ $ 33.98 $ 33.98 3110 IP PHARMACY ORAL31100061 AMIODARONE TAB 200MG $ 23.34 $ 23.34 3110 IP PHARMACY ORAL31100068 AMITRIPTYLINE TAB 100MG $ 18.58 $ 18.58 3110 IP PHARMACY ORAL31100064 AMITRIPTYLINE TAB 10MG $ 16.90 $ 16.90 3110 IP PHARMACY ORAL31100069 AMITRIPTYLINE TAB 150MG $ 19.68 $ 19.68 3110 IP PHARMACY ORAL31100065 AMITRIPTYLINE TAB 25MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31100066 AMITRIPTYLINE TAB 50MG $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31100067 AMITRIPTYLINE TAB 75MG $ 18.28 $ 18.28 3110 IP PHARMACY ORAL31100071 AMLODIPINE 10MG $ 21.82 $ 21.82 3110 IP PHARMACY ORAL31100070 AMLODIPINE 5MG $ 19.84 $ 19.84 3110 IP PHARMACY ORAL31107128 AMOBARBITAL 125MG IJ $ 30.78 $ 30.78 3110 IP PHARMACY ORAL31107129 AMOBARBITAL 125MG IJ $ 30.81 $ 30.81 3110 IP PHARMACY ORAL31100075 AMOXAPINE 50MG CAP $ 20.60 $ 20.60 3110 IP PHARMACY ORAL31104059 AMOXICILLIN 125/5ML 125M $ 48.88 $ 48.88 3110 IP PHARMACY ORAL31104060 AMOXICILLIN 125/5ML 250M $ 48.88 $ 48.88 3110 IP PHARMACY ORAL31104061 AMOXICILLIN 125MG/5ML $ 48.88 $ 48.88 3110 IP PHARMACY ORAL31104064 AMOXICILLIN 250MG/5ML $ 51.68 $ 51.68 3110 IP PHARMACY ORAL31104062 AMOXICILLIN 250MG/5ML 25 $ 51.68 $ 51.68 3110 IP PHARMACY ORAL31104063 AMOXICILLIN 250MG/5ML 50 $ 51.68 $ 51.68 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100080 AMOXICILLIN CAP 250MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100081 AMOXICILLIN CAP 500MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31106025 AMPHOTERICIN B 50 MG IJ $ 171.20 $ 171.20 3110 IP PHARMACY ORAL31109512 AMPHOTERICIN B 50 MG IJ $ 151.20 $ 151.20 3110 IP PHARMACY ORAL31104070 AMPICILLIN 125MG/5ML $ 40.58 $ 40.58 3110 IP PHARMACY ORAL31104068 AMPICILLIN 125MG/5ML 125 $ 40.58 $ 40.58 3110 IP PHARMACY ORAL31104069 AMPICILLIN 125MG/5ML 250 $ 40.58 $ 40.58 3110 IP PHARMACY ORAL31104073 AMPICILLIN 250MG/5ML $ 44.58 $ 44.58 3110 IP PHARMACY ORAL31104071 AMPICILLIN 250MG/5ML 250 $ 44.58 $ 44.58 3110 IP PHARMACY ORAL31104072 AMPICILLIN 250MG/5ML 500 $ 44.58 $ 44.58 3110 IP PHARMACY ORAL31106017 AMPICILLIN 500MG IJ $ 108.03 $ 108.03 3110 IP PHARMACY ORAL31107130 AMPICILLIN 500MG IJ $ 63.03 $ 63.03 3110 IP PHARMACY ORAL31107131 AMPICILLIN 500MG IJ $ 38.08 $ 38.08 3110 IP PHARMACY ORAL31107132 AMPICILLIN 500MG IJ $ 66.15 $ 66.15 3110 IP PHARMACY ORAL31100085 AMPICILLIN CAP 250MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31100086 AMPICILLIN CAP 500MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31106014 AMPICILLIN INJ 125MG $ 71.09 $ 71.09 3110 IP PHARMACY ORAL31106015 AMPICILLIN INJ 250MG $ 74.51 $ 74.51 3110 IP PHARMACY ORAL31109517 AMPICILLIN/SULB 1.5GM IJ $ 149.46 $ 149.46 3110 IP PHARMACY ORAL31106009 AMRINONE INJ $ 293.32 $ 293.32 3110 IP PHARMACY ORAL31100088 ANASTROZOLE 1MG PO $ 55.96 $ 55.96 3110 IP PHARMACY ORAL31107277 ANIDULAFUNGIN 1MG IJ $ 7.71 $ 7.71 3110 IP PHARMACY ORAL31106863 ANIDULAFUNGIN 50MG IJ $ 357.20 $ 357.20 3110 IP PHARMACY ORAL31106006 ANTI CITRATE DEXTROSE A $ 116.77 $ 116.77 3110 IP PHARMACY ORAL31106019 ANTITHYMOCYT GLOBULN 25MG $ 1,051.56 $ 1,051.56 3110 IP PHARMACY ORAL31104004 APAP (80MG/2.5ML) $ 2.35 $ 2.35 3110 IP PHARMACY ORAL31104003 APAP (80MG/2.5ML)120M $ 3.05 $ 3.05 3110 IP PHARMACY ORAL31104002 APAP (80MG/2.5ML)80MG $ 2.35 $ 2.35 3110 IP PHARMACY ORAL31100004 APAP 120MG CHEW $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31104001 APAP 80MG/.8ML $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104007 APAP LIQ $ 2.35 $ 2.35 3110 IP PHARMACY ORAL31104005 APAP LIQ 325MG $ 2.57 $ 2.57 3110 IP PHARMACY ORAL31104006 APAP LIQ 650MG $ 3.21 $ 3.21 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104008 APAP PEDI SUSP $ 26.34 $ 26.34 3110 IP PHARMACY ORAL31100001 APAP TAB 325MG $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31100002 APAP TAB 500MG $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31100003 APAP TAB 650 MG $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31103501 APAP/COD #2 TAB $ 33.64 $ 33.64 3110 IP PHARMACY ORAL31103502 APAP/COD #3 TAB $ 33.72 $ 33.72 3110 IP PHARMACY ORAL31103503 APAP/COD #4 TAB $ 34.26 $ 34.26 3110 IP PHARMACY ORAL31104012 APAP/COD LIQ $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31104010 APAP/COD LIQ 10ML $ 33.88 $ 33.88 3110 IP PHARMACY ORAL31104011 APAP/COD LIQ 15ML $ 34.28 $ 34.28 3110 IP PHARMACY ORAL31104009 APAP/COD LIQ 5ML $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31103507 APAP/OXYCOD TAB $ 39.66 $ 39.66 3110 IP PHARMACY ORAL31103510 APAP/PROPOX NAP TAB $ 34.14 $ 34.14 3110 IP PHARMACY ORAL31100055 APREPITANT ORAL 5MG $ 19.34 $ 19.34 3110 IP PHARMACY ORAL31100058 APREPITANT ORAL 5MG $ 13.99 $ 13.99 3110 IP PHARMACY ORAL31106843 ARGATROBAN 5MG IJ $ 68.47 $ 68.47 3110 IP PHARMACY ORAL31109523 ARGININE 10% SYRINGE $ 139.28 $ 139.28 3110 IP PHARMACY ORAL31100083 ARIPIPRAZOLE 10MG $ 39.56 $ 39.56 3110 IP PHARMACY ORAL31100084 ARIPIPRAZOLE 15MG $ 39.56 $ 39.56 3110 IP PHARMACY ORAL31100059 ARIPIPRAZOLE 30MG $ 49.10 $ 49.10 3110 IP PHARMACY ORAL31100062 ARIPIPRAZOLE 5MG $ 39.56 $ 39.56 3110 IP PHARMACY ORAL31106871 ARSENIC TRIOXIDE 1MG IJ $ 85.14 $ 85.14 3110 IP PHARMACY ORAL31100096 ASA TAB 325MG $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31100097 ASA TAB 325MG EC $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31100095 ASA TAB 81MG $ 1.75 $ 1.75 3110 IP PHARMACY ORAL31100039 ASA/DIPYR $ 22.50 $ 22.50 3110 IP PHARMACY ORAL31103518 ASA/OXYCOD TAB $ 34.94 $ 34.94 3110 IP PHARMACY ORAL31104081 ASCORBIC ACID (100MG/ML) $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31106021 ASCORBIC ACID INJ $ 134.96 $ 134.96 3110 IP PHARMACY ORAL31106020 ASCORBIC ACID INJ 500MG $ 68.91 $ 68.91 3110 IP PHARMACY ORAL31104079 ASCORBIC ACID LIQ 100MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104080 ASCORBIC ACID LIQ 200MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100089 ASCORBIC ACID TAB 250MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100090 ASCORBIC ACID TAB 500MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31100092 ASTEMIZOLE 10MG TAB $ 19.74 $ 19.74 3110 IP PHARMACY ORAL31100123 ATAZANAVIR 150 MG CAP $ 46.26 $ 46.26 3110 IP PHARMACY ORAL31100122 ATAZANAVIR 200MG CAP $ 46.26 $ 46.26 3110 IP PHARMACY ORAL31100127 ATAZANAVIRV 300MG $ 85.06 $ 85.06 3110 IP PHARMACY ORAL31100101 ATENOLOL 25MG TABLET $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31100103 ATENOLOL TAB 100MG $ 21.00 $ 21.00 3110 IP PHARMACY ORAL31100102 ATENOLOL TAB 50MG $ 18.78 $ 18.78 3110 IP PHARMACY ORAL31100104 ATORVASTATIN 10MG TAB $ 23.28 $ 23.28 3110 IP PHARMACY ORAL31100105 ATORVASTATIN 20MG TAB $ 26.14 $ 26.14 3110 IP PHARMACY ORAL31100107 ATORVASTATIN 40MG TAB $ 26.14 $ 26.14 3110 IP PHARMACY ORAL31100121 ATORVASTATIN 80MG $ 26.12 $ 26.12 3110 IP PHARMACY ORAL31104075 ATOVAQUONE LIQ 750MG/5ML $ 44.30 $ 44.30 3110 IP PHARMACY ORAL31100124 ATRIPLA $ 112.40 $ 112.40 3110 IP PHARMACY ORAL31106047 ATROPINE 0.4MG INJ $ 70.35 $ 70.35 3110 IP PHARMACY ORAL31106872 ATROPINE SO4 0.01MG IJ $ 13.38 $ 13.38 3110 IP PHARMACY ORAL31107133 ATROPINE SO4 0.01MG IJ $ 28.79 $ 28.79 3110 IP PHARMACY ORAL31107284 ATROPINE SO4 0.01MG IJ $ 1.70 $ 1.70 3110 IP PHARMACY ORAL31107285 ATROPINE SO4 0.01MG IJ $ 0.75 $ 0.75 3110 IP PHARMACY ORAL31100079 AUGMENTIN 400MG CHEW TB $ 25.24 $ 25.24 3110 IP PHARMACY ORAL31104077 AUGMENTIN 400MG/5ML SUS $ 207.38 $ 207.38 3110 IP PHARMACY ORAL31104083 AUGMENTIN 400MG/5ML SUS $ 207.38 $ 207.38 3110 IP PHARMACY ORAL31100082 AUGMENTIN 875MG $ 27.60 $ 27.60 3110 IP PHARMACY ORAL31104058 AUGMENTIN ES SUSP $ 109.40 $ 109.40 3110 IP PHARMACY ORAL31104066 AUGMENTIN LIQ 125MG/5ML $ 97.36 $ 97.36 3110 IP PHARMACY ORAL31104067 AUGMENTIN LIQ 250MG/5ML $ 156.78 $ 156.78 3110 IP PHARMACY ORAL31100076 AUGMENTIN TAB 250MG $ 23.20 $ 23.20 3110 IP PHARMACY ORAL31100077 AUGMENTIN TAB 500MG $ 24.14 $ 24.14 3110 IP PHARMACY ORAL31100110 AZATHIOPRINE ORAL 50MG $ 19.42 $ 19.42 3110 IP PHARMACY ORAL31100113 AZATHIOPRINE ORAL 50MG $ 19.02 $ 19.02 3110 IP PHARMACY ORAL31104082 AZATHIOPRINE ORAL 50MG $ 32.94 $ 32.94 3110 IP PHARMACY ORAL31100117 AZITHROMYCIN 250MG $ 33.82 $ 33.82 3110 IP PHARMACY ORAL31100118 AZITHROMYCIN 600MG TAB $ 56.06 $ 56.06 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104096 AZITHROMYCIN SUSP 200/5 $ 106.34 $ 106.34 3110 IP PHARMACY ORAL31107134 AZTREONAM 500MG IJ $ 106.43 $ 106.43 3110 IP PHARMACY ORAL31107135 AZTREONAM 500MG IJ $ 53.23 $ 53.23 3110 IP PHARMACY ORAL31106033 BACITRACIN 50MU INJ. $ 105.75 $ 105.75 3110 IP PHARMACY ORAL31106710 BACLOFEN 10 MG IJ $ 853.17 $ 853.17 3110 IP PHARMACY ORAL31106711 BACLOFEN 10 MG IJ $ 440.55 $ 440.55 3110 IP PHARMACY ORAL31100125 BACLOFEN TAB 10MG $ 17.42 $ 17.42 3110 IP PHARMACY ORAL31100126 BACLOFEN TAB 20MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31104708 BACTRIM LIQ $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31104706 BACTRIM LIQ 10ML $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31104707 BACTRIM LIQ 20ML $ 19.74 $ 19.74 3110 IP PHARMACY ORAL31101348 BACTRIM TAB $ 17.86 $ 17.86 3110 IP PHARMACY ORAL31106761 BASILIXIMAB 20MG IJ $ 4,353.43 $ 4,353.43 3110 IP PHARMACY ORAL31100133 BENAZEPRIL 10MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31100134 BENAZEPRIL 20MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31101110 BENZOCAINE LOZ 3'S $ - $ - 3110 IP PHARMACY ORAL31100128 BENZONATATE PERLE $ 17.80 $ 17.80 3110 IP PHARMACY ORAL31106039 BENZTROPINE MESYL 1MG IJ $ 80.75 $ 80.75 3110 IP PHARMACY ORAL31107137 BENZTROPINE MESYL 1MG IJ $ 40.20 $ 40.20 3110 IP PHARMACY ORAL31100130 BENZTROPINE TAB 0.5MG $ 16.92 $ 16.92 3110 IP PHARMACY ORAL31100131 BENZTROPINE TAB 1MG $ 17.30 $ 17.30 3110 IP PHARMACY ORAL31100132 BENZTROPINE TAB 2MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31106111 BERACTANT $ 979.70 $ 979.70 3110 IP PHARMACY ORAL31106790 BERACTANT 4ML INJ $ 979.64 $ 979.64 3110 IP PHARMACY ORAL31100141 BETHANECHOL 50MG $ 22.24 $ 22.24 3110 IP PHARMACY ORAL31100139 BETHANECHOL TAB 10MG $ 19.74 $ 19.74 3110 IP PHARMACY ORAL31100140 BETHANECHOL TAB 25MG $ 20.10 $ 20.10 3110 IP PHARMACY ORAL31100138 BETHANECHOL TAB 5MG $ 17.96 $ 17.96 3110 IP PHARMACY ORAL31107138 BETMTH AC/NA PHOS 3MG EA $ 64.86 $ 64.86 3110 IP PHARMACY ORAL31100144 BISACODYL TAB 5MG EC $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31106841 BIVALIRUDIN 1MG IJ $ 7.56 $ 7.56 3110 IP PHARMACY ORAL31106652 BOTULINUM TOX A/U IJ $ 1,186.15 $ 1,186.15 3110 IP PHARMACY ORAL31100148 BROMOCRIPTINE TAB 2.5MG $ 21.20 $ 21.20 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100149 BROMOCRIPTINE TAB 5MG $ 26.86 $ 26.86 3110 IP PHARMACY ORAL31100151 BUDESONIDE 3MG $ 27.02 $ 27.02 3110 IP PHARMACY ORAL31106052 BUMETANIDE 0.5MG IJ $ 69.39 $ 69.39 3110 IP PHARMACY ORAL31106054 BUMETANIDE 0.5MG IJ $ 69.39 $ 69.39 3110 IP PHARMACY ORAL31106873 BUMETANIDE 0.5MG IJ $ 21.00 $ 21.00 3110 IP PHARMACY ORAL31107139 BUMETANIDE 0.5MG IJ $ 26.57 $ 26.57 3110 IP PHARMACY ORAL31109527 BUMETANIDE SYRINGE $ 148.54 $ 148.54 3110 IP PHARMACY ORAL31100153 BUMETANIDE TAB 0.5MG $ 17.18 $ 17.18 3110 IP PHARMACY ORAL31100154 BUMETANIDE TAB 1MG $ 17.42 $ 17.42 3110 IP PHARMACY ORAL31100155 BUMETANIDE TAB 2MG $ 17.98 $ 17.98 3110 IP PHARMACY ORAL31106068 BUPIV/DEXT AMP $ 75.97 $ 75.97 3110 IP PHARMACY ORAL31106784 BUPIV/EPI .25%/EPI 50ML $ 86.57 $ 86.57 3110 IP PHARMACY ORAL31106069 BUPIV/EPI .5% 50ML $ 81.19 $ 81.19 3110 IP PHARMACY ORAL31106061 BUPIV/EPI 0.25%/EPI $ 81.35 $ 81.35 3110 IP PHARMACY ORAL31106060 BUPIV/EPI 0.5%/EPI $ 82.45 $ 82.45 3110 IP PHARMACY ORAL31106783 BUPIV/EPI 0.5%/EPI50ML $ 88.15 $ 88.15 3110 IP PHARMACY ORAL31106055 BUPIVACAINE 0.25% 50ML $ 82.91 $ 82.91 3110 IP PHARMACY ORAL31106065 BUPIVACAINE 0.5% 50ML $ 84.81 $ 84.81 3110 IP PHARMACY ORAL31106067 BUPIVACAINE 0.75% 10ML $ 73.33 $ 73.33 3110 IP PHARMACY ORAL31106062 BUPIVACAINE 30ML IJ $ 77.95 $ 77.95 3110 IP PHARMACY ORAL31106064 BUPIVACAINE 30ML IJ $ 76.35 $ 76.35 3110 IP PHARMACY ORAL31106066 BUPIVACAINE 30ML IJ $ 83.03 $ 83.03 3110 IP PHARMACY ORAL31107140 BUPIVACAINE 30ML IJ $ 37.82 $ 37.82 3110 IP PHARMACY ORAL31107141 BUPIVACAINE 30ML IJ $ 18.27 $ 18.27 3110 IP PHARMACY ORAL31106058 BUPIVACAINE INJ (0.25%) $ 75.81 $ 75.81 3110 IP PHARMACY ORAL31106057 BUPIVACAINE INJ (0.5%) $ 80.65 $ 80.65 3110 IP PHARMACY ORAL31106056 BUPIVACAINE INJ (0.75%). $ 72.75 $ 72.75 3110 IP PHARMACY ORAL31100158 BUPROPION 150MG TAB $ - $ - 3110 IP PHARMACY ORAL31100157 BUPROPION TAB 100MG $ 18.64 $ 18.64 3110 IP PHARMACY ORAL31100156 BUPROPION TAB 75MG $ 18.12 $ 18.12 3110 IP PHARMACY ORAL31100161 BUSPIRONE HCL TAB 10MG $ 19.54 $ 19.54 3110 IP PHARMACY ORAL31100160 BUSPIRONE HCL TAB 5MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31100165 BUSULFAN 2MG PO $ 19.26 $ 19.26 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100174 CA ACET 667MG $ 19.68 $ 19.68 3110 IP PHARMACY ORAL31100175 CA CARB 500 TAB $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31104109 CA CARB LIQ $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104105 CA CARB LIQ 10ML $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104231 CA CARB LIQUID $ 43.58 $ 43.58 3110 IP PHARMACY ORAL31104110 CA CARB SUSPENSION $ 38.48 $ 38.48 3110 IP PHARMACY ORAL31100178 CA CARB TAB 420MG $ 16.66 $ 16.66 3110 IP PHARMACY ORAL31100183 CA CARB/VIT D 250 TAB $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31100185 CA CIT 950MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31109702 CA CL 1GM SYR $ 133.90 $ 133.90 3110 IP PHARMACY ORAL31109703 CA CL 2GM SYR $ 135.60 $ 135.60 3110 IP PHARMACY ORAL31106071 CA CL CHLORIDE $ 34.78 $ 34.78 3110 IP PHARMACY ORAL31106075 CA CL SYR $ 91.71 $ 91.71 3110 IP PHARMACY ORAL31106072 CA CL SYRG 10ML $ 89.95 $ 89.95 3110 IP PHARMACY ORAL31109531 CA CL SYRINGE $ 36.08 $ 36.08 3110 IP PHARMACY ORAL31107142 CA GLUCONATE 10ML IJ $ 18.89 $ 18.89 3110 IP PHARMACY ORAL31109704 CA GLUCONATE 10ML IJ $ 135.40 $ 135.40 3110 IP PHARMACY ORAL31106081 CA GLUCONATE 10ML VIAL $ 69.35 $ 69.35 3110 IP PHARMACY ORAL31106079 CA GLUCONATE INJ(10%) $ 36.28 $ 36.28 3110 IP PHARMACY ORAL31106082 CA GLUCONATE IV ADD $ 39.08 $ 39.08 3110 IP PHARMACY ORAL31109532 CA GLUCONATE SYRING $ 135.14 $ 135.14 3110 IP PHARMACY ORAL31100187 CA GLUCONATE TAB 500MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100535 CA POLYCARBOPH CAP $ 16.86 $ 16.86 3110 IP PHARMACY ORAL31100484 CAFERGOT TAB $ 18.62 $ 18.62 3110 IP PHARMACY ORAL31106099 CAFF CIT 20MG $ 103.43 $ 103.43 3110 IP PHARMACY ORAL31109528 CAFF CIT 5MG $ 141.52 $ 141.52 3110 IP PHARMACY ORAL31109529 CAFF CIT 5ML $ 141.52 $ 141.52 3110 IP PHARMACY ORAL31105004 CAFF CIT CITRATE LIQ. $ 25.86 $ 25.86 3110 IP PHARMACY ORAL31105005 CAFF CIT LIQ(10MG/ML) $ 32.14 $ 32.14 3110 IP PHARMACY ORAL31106084 CAFF NA BENZ INJ $ 81.65 $ 81.65 3110 IP PHARMACY ORAL31100189 CALCIFEDIOL 20 MCG. $ 17.86 $ 17.86 3110 IP PHARMACY ORAL31106073 CALCITONIN 400U IJ $ 144.51 $ 144.51 3110 IP PHARMACY ORAL31107002 CALCITRIOL 0.1MCG IJ $ 5.88 $ 5.88 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31107024 CALCITRIOL 0.1MCG IJ $ 5.88 $ 5.88 3110 IP PHARMACY ORAL31100172 CALCITRIOL 0.25MG PO $ 19.22 $ 19.22 3110 IP PHARMACY ORAL31107143 CALCITRIOL 0.25MG PO $ 26.73 $ 26.73 3110 IP PHARMACY ORAL31107144 CALCITRIOL 0.25MG PO $ 10.37 $ 10.37 3110 IP PHARMACY ORAL31106070 CALCITRIOL INJ 1MCG/ML $ 92.31 $ 92.31 3110 IP PHARMACY ORAL31105002 CAPTOPRIL 1MG/ML 50ML $ 38.08 $ 38.08 3110 IP PHARMACY ORAL31100201 CAPTOPRIL TAB 100MG $ 21.20 $ 21.20 3110 IP PHARMACY ORAL31100197 CAPTOPRIL TAB 12.5MG $ 18.44 $ 18.44 3110 IP PHARMACY ORAL31100199 CAPTOPRIL TAB 25MG $ 18.60 $ 18.60 3110 IP PHARMACY ORAL31100200 CAPTOPRIL TAB 50MG $ 20.04 $ 20.04 3110 IP PHARMACY ORAL31100196 CAPTOPRIL TAB 6.25MG $ 18.44 $ 18.44 3110 IP PHARMACY ORAL31104111 CARBAMAZEPINE LIQUID $ 17.10 $ 17.10 3110 IP PHARMACY ORAL31100207 CARBAMAZEPINE TAB 100MG $ 17.02 $ 17.02 3110 IP PHARMACY ORAL31100208 CARBAMAZEPINE TAB 200MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31106089 CARBOPROST INJ $ 259.67 $ 259.67 3110 IP PHARMACY ORAL31106088 CARBOPROST INJ 250MCG $ 259.67 $ 259.67 3110 IP PHARMACY ORAL31100204 CARVEDILOL 12.5MG TAB $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31100205 CARVEDILOL 25MG TAB $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31100202 CARVEDILOL 3.125MG TAB $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31100203 CARVEDILOL 6.25MG TAB $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31104127 CEFACLOR $ 67.18 $ 67.18 3110 IP PHARMACY ORAL31104125 CEFACLOR (125MG/5ML)125MG $ 67.18 $ 67.18 3110 IP PHARMACY ORAL31104126 CEFACLOR (125MG/5ML)250MG $ 67.18 $ 67.18 3110 IP PHARMACY ORAL31104130 CEFACLOR (250MG/5ML) $ 88.64 $ 88.64 3110 IP PHARMACY ORAL31104128 CEFACLOR (250MG/5ML)250MG $ 88.64 $ 88.64 3110 IP PHARMACY ORAL31104129 CEFACLOR (250MG/5ML)500MG $ 88.64 $ 88.64 3110 IP PHARMACY ORAL31100219 CEFACLOR CAP 250MG $ 21.10 $ 21.10 3110 IP PHARMACY ORAL31100220 CEFACLOR CAP 500MG $ 25.34 $ 25.34 3110 IP PHARMACY ORAL31106098 CEFAZOLIN $ 138.40 $ 138.40 3110 IP PHARMACY ORAL31106094 CEFAZOLIN 500MG IJ $ 138.00 $ 138.00 3110 IP PHARMACY ORAL31107006 CEFAZOLIN 500MG IJ $ 106.43 $ 106.43 3110 IP PHARMACY ORAL31107145 CEFAZOLIN 500MG IJ $ 56.27 $ 56.27 3110 IP PHARMACY ORAL31107146 CEFAZOLIN 500MG IJ $ 31.27 $ 31.27 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106097 CEFAZOLIN INJ $ 114.33 $ 114.33 3110 IP PHARMACY ORAL31106095 CEFAZOLIN INJ 1GM $ 114.33 $ 114.33 3110 IP PHARMACY ORAL31106096 CEFAZOLIN INJ 2GM $ 125.53 $ 125.53 3110 IP PHARMACY ORAL31109530 CEFAZOLIN SYR 500MG $ 138.40 $ 138.40 3110 IP PHARMACY ORAL31107147 CEFEPIME HCL 500MG IJ $ 72.27 $ 72.27 3110 IP PHARMACY ORAL31107148 CEFEPIME HCL 500MG IJ $ 29.00 $ 29.00 3110 IP PHARMACY ORAL31106101 CEFOTAXIME 1GM IJ $ 126.91 $ 126.91 3110 IP PHARMACY ORAL31106102 CEFOTAXIME 1GM IJ $ 126.91 $ 126.91 3110 IP PHARMACY ORAL31107149 CEFOTXIME 100MG IJ IP PED $ 48.01 $ 48.01 3110 IP PHARMACY ORAL31107150 CEFOTXIME 100MG IJ IP PED $ 45.15 $ 45.15 3110 IP PHARMACY ORAL31107151 CEFOTXIME 100MG IJ IP PED $ 6.32 $ 6.32 3110 IP PHARMACY ORAL31100242 CEFPODOXIME 200MG $ 30.26 $ 30.26 3110 IP PHARMACY ORAL31107008 CEFTAZIDIME 500MG IJ $ 113.99 $ 113.99 3110 IP PHARMACY ORAL31107152 CEFTAZIDIME 500MG IJ $ 64.19 $ 64.19 3110 IP PHARMACY ORAL31107153 CEFTAZIDIME 500MG IJ $ 40.27 $ 40.27 3110 IP PHARMACY ORAL31106112 CEFTRIAXONE 250MG IJ $ 102.33 $ 102.33 3110 IP PHARMACY ORAL31107009 CEFTRIAXONE 250MG IJ $ 109.89 $ 109.89 3110 IP PHARMACY ORAL31107100 CEFTRIAXONE 250MG IJ $ 14.87 $ 14.87 3110 IP PHARMACY ORAL31107101 CEFTRIAXONE 250MG IJ $ 28.15 $ 28.15 3110 IP PHARMACY ORAL31107102 CEFTRIAXONE 250MG IJ $ 28.15 $ 28.15 3110 IP PHARMACY ORAL31104132 CEFUROXIME 125MG/5ML $ 157.08 $ 157.08 3110 IP PHARMACY ORAL31106120 CEFUROXIME NA 750MG IJ $ 120.83 $ 120.83 3110 IP PHARMACY ORAL31107154 CEFUROXIME NA 750MG IJ $ 71.23 $ 71.23 3110 IP PHARMACY ORAL31104133 CEFUROXIME SUSP 125MG/5M $ 138.54 $ 138.54 3110 IP PHARMACY ORAL31109553 CEFUROXIME SYRINGE $ 153.80 $ 153.80 3110 IP PHARMACY ORAL31100225 CEFUROXIME TAB 125MG $ 20.20 $ 20.20 3110 IP PHARMACY ORAL31100226 CEFUROXIME TAB 250MG $ 23.30 $ 23.30 3110 IP PHARMACY ORAL31100227 CEFUROXIME TAB 500MG $ 29.70 $ 29.70 3110 IP PHARMACY ORAL31100232 CELECOXIB 100MG $ 21.30 $ 21.30 3110 IP PHARMACY ORAL31100234 CELECOXIB 200MG $ 24.36 $ 24.36 3110 IP PHARMACY ORAL31104138 CEPHALEXIN 125MG/5ML $ 57.78 $ 57.78 3110 IP PHARMACY ORAL31104136 CEPHALEXIN 125MG/5ML125MG $ 57.78 $ 57.78 3110 IP PHARMACY ORAL31104137 CEPHALEXIN 125MG/5ML250MG $ 57.78 $ 57.78 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104141 CEPHALEXIN 250MG/5ML $ 79.68 $ 79.68 3110 IP PHARMACY ORAL31104139 CEPHALEXIN 250MG/5ML250MG $ 79.68 $ 79.68 3110 IP PHARMACY ORAL31104140 CEPHALEXIN 250MG/5ML500MG $ 79.68 $ 79.68 3110 IP PHARMACY ORAL31100230 CEPHALEXIN CAP 250MG $ 19.06 $ 19.06 3110 IP PHARMACY ORAL31100231 CEPHALEXIN CAP 500MG $ 21.42 $ 21.42 3110 IP PHARMACY ORAL31104146 CHARCOAL (AQU $ 45.98 $ 45.98 3110 IP PHARMACY ORAL31104147 CHARCOAL/SORB (25GM $ 45.98 $ 45.98 3110 IP PHARMACY ORAL31104152 CHLORAL HYDRATE LIQ $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104151 CHLORAL HYDRATE LIQ 1GM $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104150 CHLORAL HYDRATE LIQ 500MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100237 CHLORAMBUCIL 2MG PO $ 19.26 $ 19.26 3110 IP PHARMACY ORAL31106124 CHLORAMPHENICOL 1GM IJ $ 176.20 $ 176.20 3110 IP PHARMACY ORAL31109557 CHLORAMPHENICOL 1GM IJ $ 144.70 $ 144.70 3110 IP PHARMACY ORAL31104585 CHLORASEPTIC SPRAY $ 38.94 $ 38.94 3110 IP PHARMACY ORAL31104155 CHLORHEX GLUC 15ML ORAL $ 19.46 $ 19.46 3110 IP PHARMACY ORAL31106126 CHLOROPROCAINE 30ML IJ $ 97.65 $ 97.65 3110 IP PHARMACY ORAL31106127 CHLOROPROCAINE 30ML IJ $ 95.41 $ 95.41 3110 IP PHARMACY ORAL31100238 CHLOROQUINE TAB 250MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31106128 CHLOROTHIAZIDE 500MG IJ $ 780.63 $ 780.63 3110 IP PHARMACY ORAL31109537 CHLOROTHIAZIDE 500MG IJ $ 846.68 $ 846.68 3110 IP PHARMACY ORAL31104157 CHLOROTHIAZIDE LIQ $ 20.00 $ 20.00 3110 IP PHARMACY ORAL31104156 CHLOROTHIAZIDE LIQ 250MG $ 18.00 $ 18.00 3110 IP PHARMACY ORAL31100244 CHLORPHENIRAMIN TAB 4MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31106129 CHLORPROMAZINE 50MG IJ $ 86.55 $ 86.55 3110 IP PHARMACY ORAL31106132 CHLORPROMAZINE 50MG IJ $ 86.65 $ 86.65 3110 IP PHARMACY ORAL31100251 CHLORPROMAZINE HCL TAB $ 17.50 $ 17.50 3110 IP PHARMACY ORAL31106130 CHLORPROMAZINE INJ 25MG $ 80.65 $ 80.65 3110 IP PHARMACY ORAL31100253 CHLORPROMAZINE TAB 100MG $ 18.00 $ 18.00 3110 IP PHARMACY ORAL31100250 CHLORPROMAZINE TAB 10MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31100254 CHLORPROMAZINE TAB 200MG $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31100252 CHLORPROMAZINE TAB 50MG $ 17.68 $ 17.68 3110 IP PHARMACY ORAL31101545 CHOLECALCIFEROL 400IU $ 16.56 $ 16.56 3110 IP PHARMACY ORAL31104166 CHOLESTYRAMINE 4GM $ 20.26 $ 20.26 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100294 CINACALCET 30MG $ 36.74 $ 36.74 3110 IP PHARMACY ORAL31100295 CINACALCET 60MG $ 57.00 $ 57.00 3110 IP PHARMACY ORAL31100296 CINACALCET 90MG $ 77.26 $ 77.26 3110 IP PHARMACY ORAL31104135 CIPRO 10% SUSP 100ML $ 305.58 $ 305.58 3110 IP PHARMACY ORAL31104134 CIPRO 5% 100ML SUSP $ 257.70 $ 257.70 3110 IP PHARMACY ORAL31100266 CIPRO TAB 250MG $ 25.34 $ 25.34 3110 IP PHARMACY ORAL31100267 CIPRO TAB 500MG $ 27.28 $ 27.28 3110 IP PHARMACY ORAL31100268 CIPRO TAB 750MG $ 27.34 $ 27.34 3110 IP PHARMACY ORAL31107155 CIPROFLOXACIN 200MG IJ $ 69.61 $ 69.61 3110 IP PHARMACY ORAL31109567 CIPROFLOXACIN 200MG IJ $ 152.28 $ 152.28 3110 IP PHARMACY ORAL31100275 CITALOPRAM 20MG TABLET $ 20.64 $ 20.64 3110 IP PHARMACY ORAL31104176 CITALOPRAM LIQ 20MG $ 26.86 $ 26.86 3110 IP PHARMACY ORAL31105039 CITRIC ACID LIQ $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31105038 CITRIC ACID LIQ 60ML $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31107156 CLADRIBINE/1MG IJ $ 67.29 $ 67.29 3110 IP PHARMACY ORAL31104143 CLARITHROMYCIN 125MG $ 116.70 $ 116.70 3110 IP PHARMACY ORAL31104145 CLARITHROMYCIN 250MG $ 116.70 $ 116.70 3110 IP PHARMACY ORAL31100270 CLARITHROMYCIN 250MG. $ 27.14 $ 27.14 3110 IP PHARMACY ORAL31104144 CLARITHROMYCIN 250MG/5ML $ 116.70 $ 116.70 3110 IP PHARMACY ORAL31100271 CLARITHROMYCIN 500MG. $ 27.14 $ 27.14 3110 IP PHARMACY ORAL31100279 CLARITHROMYCIN XL 500MG $ 27.46 $ 27.46 3110 IP PHARMACY ORAL31104142 CLARITHROMYCIN125MG/5MLSU $ 98.56 $ 98.56 3110 IP PHARMACY ORAL31107157 CLINDAMYCIN 300MG IJ $ 63.75 $ 63.75 3110 IP PHARMACY ORAL31107158 CLINDAMYCIN 300MG IJ $ 38.39 $ 38.39 3110 IP PHARMACY ORAL31107159 CLINDAMYCIN 300MG IJ $ 44.35 $ 44.35 3110 IP PHARMACY ORAL31109569 CLINDAMYCIN 300MG IJ $ 146.44 $ 146.44 3110 IP PHARMACY ORAL31104180 CLINDAMYCIN 75/5100ML $ 94.30 $ 94.30 3110 IP PHARMACY ORAL31100273 CLINDAMYCIN CAP 150MG $ 22.18 $ 22.18 3110 IP PHARMACY ORAL31100274 CLINDAMYCIN CAP 300MG $ 28.42 $ 28.42 3110 IP PHARMACY ORAL31104179 CLINDAMYCIN LIQ $ 19.62 $ 19.62 3110 IP PHARMACY ORAL31104178 CLINDAMYCIN LIQ 150MG $ 22.70 $ 22.70 3110 IP PHARMACY ORAL31104177 CLINDAMYCIN LIQ 75MG $ 19.62 $ 19.62 3110 IP PHARMACY ORAL31100278 CLOFAZIMINE CAP 100MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100277 CLOFAZIMINE CAP 50MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100281 CLOFIBRATE CAP 500MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31100283 CLOMIPHENE TAB 50MG $ 19.18 $ 19.18 3110 IP PHARMACY ORAL31100282 CLOMIPRAMINE TAB 25MG $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31100284 CLOMIPRAMINE TAB 75MG $ 20.04 $ 20.04 3110 IP PHARMACY ORAL31103536 CLONAZEPAM TAB (PEDI) $ 35.44 $ 35.44 3110 IP PHARMACY ORAL31103530 CLONAZEPAM TAB 0.5MG $ 34.64 $ 34.64 3110 IP PHARMACY ORAL31103531 CLONAZEPAM TAB 1MG $ 34.86 $ 34.86 3110 IP PHARMACY ORAL31103532 CLONAZEPAM TAB 2MG $ 35.48 $ 35.48 3110 IP PHARMACY ORAL31105007 CLONIDINE 0.1/ML 60ML SU $ 118.08 $ 118.08 3110 IP PHARMACY ORAL31100285 CLONIDINE HCL TAB 0.1MG $ 17.70 $ 17.70 3110 IP PHARMACY ORAL31100286 CLONIDINE HCL TAB 0.2MG $ 18.28 $ 18.28 3110 IP PHARMACY ORAL31100287 CLONIDINE HCL TAB 0.3MG $ 18.62 $ 18.62 3110 IP PHARMACY ORAL31100288 CLONIDINE TAB $ 17.70 $ 17.70 3110 IP PHARMACY ORAL31100293 CLOPIDOGREL 300MG $ 56.36 $ 56.36 3110 IP PHARMACY ORAL31100292 CLOPIDOGREL 75MG TABLET $ 26.26 $ 26.26 3110 IP PHARMACY ORAL31100297 CLOTRIMAZOLE ORAL TROCHE $ 20.56 $ 20.56 3110 IP PHARMACY ORAL31100290 CLOZAPINE 25MG PO $ 21.74 $ 21.74 3110 IP PHARMACY ORAL31107160 CLOZAPINE 25MG PO $ 6.42 $ 6.42 3110 IP PHARMACY ORAL31107161 CODEINE 30MG IJ $ 49.90 $ 49.90 3110 IP PHARMACY ORAL31109008 CODEINE 30MG IJ $ 46.60 $ 46.60 3110 IP PHARMACY ORAL31103534 CODEINE SO4 TAB 30MG $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31103535 CODEINE SO4 TAB 65MG $ 33.78 $ 33.78 3110 IP PHARMACY ORAL31100301 COLCHICINE TAB 0.6MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31104610 COLYTE $ 62.72 $ 62.72 3110 IP PHARMACY ORAL31100304 COMBIVIR300MG/EPIVIR150MG $ 40.50 $ 40.50 3110 IP PHARMACY ORAL31107162 CORTICOTROPIN 40U IJ $ 252.66 $ 252.66 3110 IP PHARMACY ORAL31106153 CORTROSYN 0.25MG IJ $ 332.61 $ 332.61 3110 IP PHARMACY ORAL31106154 CORTROSYN 0.25MG IJ $ 332.61 $ 332.61 3110 IP PHARMACY ORAL31100248 CREON 12 $ 19.80 $ 19.80 3110 IP PHARMACY ORAL31100249 CREON 24 $ 22.54 $ 22.54 3110 IP PHARMACY ORAL31100247 CREON 6 $ 18.30 $ 18.30 3110 IP PHARMACY ORAL31106158 CYANOCOBALAMIN 1000MCG IJ $ 69.55 $ 69.55 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106161 CYANOCOBALAMIN 1000MCG IJ $ 68.65 $ 68.65 3110 IP PHARMACY ORAL31107010 CYANOCOBALAMIN 1000MCG IJ $ 69.55 $ 69.55 3110 IP PHARMACY ORAL31100314 CYCLOBENZAPRINE TAB 10MG $ 18.48 $ 18.48 3110 IP PHARMACY ORAL31100316 CYCLOPHOSPHAMIDE 25MG PO $ 20.10 $ 20.10 3110 IP PHARMACY ORAL31107163 CYCLOPHOSPHAMIDE 25MG PO $ 11.53 $ 11.53 3110 IP PHARMACY ORAL31105903 CYCLOSPORINE 100MG PO $ 28.40 $ 28.40 3110 IP PHARMACY ORAL31105906 CYCLOSPORINE 100MG PO $ 28.40 $ 28.40 3110 IP PHARMACY ORAL31107276 CYCLOSPORINE 100MG PO $ 14.22 $ 14.22 3110 IP PHARMACY ORAL31106155 CYCLOSPORINE 250MG IJ $ 190.50 $ 190.50 3110 IP PHARMACY ORAL31105902 CYCLOSPORINE 25MG PO $ 19.84 $ 19.84 3110 IP PHARMACY ORAL31105908 CYCLOSPORINE 25MG PO $ 19.84 $ 19.84 3110 IP PHARMACY ORAL31105907 CYCLOSPORINE 50ML EMULSIO $ 693.16 $ 693.16 3110 IP PHARMACY ORAL31105901 CYCLOSPORINE LIQ $ 693.16 $ 693.16 3110 IP PHARMACY ORAL31100320 CYPROHEPTADINE TAB 4MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31106156 CYSTEINE $ 89.15 $ 89.15 3110 IP PHARMACY ORAL31107164 CYTARABINE 100MG IJ $ 52.01 $ 52.01 3110 IP PHARMACY ORAL31100322 DANAZOL 50MG. $ 19.02 $ 19.02 3110 IP PHARMACY ORAL31100323 DANAZOL CAP 100MG $ 20.26 $ 20.26 3110 IP PHARMACY ORAL31100324 DANAZOL CAP 200MG $ 22.74 $ 22.74 3110 IP PHARMACY ORAL31106165 DANTROLENE 20MG $ 289.80 $ 289.80 3110 IP PHARMACY ORAL31100327 DANTROLENE CAP 25MG $ 18.18 $ 18.18 3110 IP PHARMACY ORAL31106160 DANTROLENE INJ $ 289.80 $ 289.80 3110 IP PHARMACY ORAL31106159 DANTROLENE INJ 20MG $ 289.80 $ 289.80 3110 IP PHARMACY ORAL31100331 DAPSONE TAB 100MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31100330 DAPSONE TAB 25MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31106842 DAPTOMYCIN 1MG IJ $ 1.47 $ 1.47 3110 IP PHARMACY ORAL31100325 DARUNAVIR 300MG $ 32.14 $ 32.14 3110 IP PHARMACY ORAL31100299 DARUNAVIR 400MG $ 50.76 $ 50.76 3110 IP PHARMACY ORAL31100326 DARUNAVIR 600MG $ 50.76 $ 50.76 3110 IP PHARMACY ORAL31100328 DEFERASIROX 125MG $ 52.26 $ 52.26 3110 IP PHARMACY ORAL31100329 DEFERASIROX 250MG $ 87.94 $ 87.94 3110 IP PHARMACY ORAL31106163 DEFEROXAMINE 500MG IJ $ 109.99 $ 109.99 3110 IP PHARMACY ORAL31100333 DELAVIRDINE 100MG $ 18.30 $ 18.30 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100332 DELAVIRDINE 200MG $ 20.06 $ 20.06 3110 IP PHARMACY ORAL31100334 DEMECLOCYCLINE TAB 150MG $ 37.80 $ 37.80 3110 IP PHARMACY ORAL31100335 DEMECLOCYCLINE TAB 300MG $ 59.10 $ 59.10 3110 IP PHARMACY ORAL31100341 DESIPRAMINE 100MG TAB $ 20.36 $ 20.36 3110 IP PHARMACY ORAL31100338 DESIPRAMINE HCL TAB 10MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100339 DESIPRAMINE HCL TAB 25MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31100340 DESIPRAMINE HCL TAB 50MG $ 19.00 $ 19.00 3110 IP PHARMACY ORAL31106874 DESMOPRESSIN ACET 1MCG IJ $ 29.32 $ 29.32 3110 IP PHARMACY ORAL31107165 DESMOPRESSIN ACET 1MCG IJ $ 15.51 $ 15.51 3110 IP PHARMACY ORAL31107280 DESMOPRESSIN ACET 1MCG IJ $ 46.39 $ 46.39 3110 IP PHARMACY ORAL31104196 DEXAMETHASONE 1MG/ML LIQ $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31104187 DEXAMETHASONE INTNSL 30ML $ 71.18 $ 71.18 3110 IP PHARMACY ORAL31104193 DEXAMETHASONE LIQ $ 2.91 $ 2.91 3110 IP PHARMACY ORAL31104188 DEXAMETHASONE LIQ 0.5MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104189 DEXAMETHASONE LIQ 1.0MG $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31104191 DEXAMETHASONE LIQ 2.5MG $ 23.24 $ 23.24 3110 IP PHARMACY ORAL31104190 DEXAMETHASONE LIQ 2MG $ 21.84 $ 21.84 3110 IP PHARMACY ORAL31104192 DEXAMETHASONE LIQ 4.0MG $ 27.14 $ 27.14 3110 IP PHARMACY ORAL31104194 DEXAMETHASONE LIQ DOSE $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31106875 DEXAMETHASONE PHOS 1MG IJ $ 17.10 $ 17.10 3110 IP PHARMACY ORAL31106876 DEXAMETHASONE PHOS 1MG IJ $ 3.79 $ 3.79 3110 IP PHARMACY ORAL31107109 DEXAMETHASONE PHOS 1MG IJ $ 8.90 $ 8.90 3110 IP PHARMACY ORAL31107110 DEXAMETHASONE PHOS 1MG IJ $ 1.12 $ 1.12 3110 IP PHARMACY ORAL31100350 DEXAMETHASONE TAB $ 3.23 $ 3.23 3110 IP PHARMACY ORAL31100343 DEXAMETHASONE TAB 0.25MG $ 8.01 $ 8.01 3110 IP PHARMACY ORAL31100344 DEXAMETHASONE TAB 0.5MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100345 DEXAMETHASONE TAB 0.75MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31100347 DEXAMETHASONE TAB 1.5MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31100346 DEXAMETHASONE TAB 1MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100348 DEXAMETHASONE TAB 2MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31100349 DEXAMETHASONE TAB 4MG $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31103538 DEXEDRINE TAB 5MG $ 33.50 $ 33.50 3110 IP PHARMACY ORAL31101362 DEXTROSE 11ML $ 18.06 $ 18.06 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106176 DEXTROSE 25% 1OML $ 98.55 $ 98.55 3110 IP PHARMACY ORAL31106167 DEXTROSE 50% 50ML VL $ 69.51 $ 69.51 3110 IP PHARMACY ORAL31106168 DEXTROSE 50% 50ML VL $ 69.68 $ 69.68 3110 IP PHARMACY ORAL31100589 DEXTROSE 5GM TAB $ 16.88 $ 16.88 3110 IP PHARMACY ORAL31109021 DIAZEPAM 2.5ML GEL $ 347.18 $ 347.18 3110 IP PHARMACY ORAL31107011 DIAZEPAM 5MG IJ $ 101.77 $ 101.77 3110 IP PHARMACY ORAL31107166 DIAZEPAM 5MG IJ $ 51.65 $ 51.65 3110 IP PHARMACY ORAL31109014 DIAZEPAM 5MG IJ $ 102.87 $ 102.87 3110 IP PHARMACY ORAL31109015 DIAZEPAM 5MG IJ $ 106.53 $ 106.53 3110 IP PHARMACY ORAL31109017 DIAZEPAM 5MG IJ $ 113.67 $ 113.67 3110 IP PHARMACY ORAL31104199 DIAZEPAM LIQ $ 99.73 $ 99.73 3110 IP PHARMACY ORAL31109018 DIAZEPAM RANGE $ 106.53 $ 106.53 3110 IP PHARMACY ORAL31103542 DIAZEPAM TAB 10MG $ 35.00 $ 35.00 3110 IP PHARMACY ORAL31103540 DIAZEPAM TAB 2MG $ 33.82 $ 33.82 3110 IP PHARMACY ORAL31103541 DIAZEPAM TAB 5MG $ 34.24 $ 34.24 3110 IP PHARMACY ORAL31103543 DIAZEPAM TAB RANGE $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104376 DIAZOXIDE LIQ $ 367.24 $ 367.24 3110 IP PHARMACY ORAL31100354 DICLOFENAC TAB 25MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100355 DICLOFENAC TAB 50MG $ 18.70 $ 18.70 3110 IP PHARMACY ORAL31100356 DICLOFENAC TAB 75MG $ 19.14 $ 19.14 3110 IP PHARMACY ORAL31100358 DICLOXACILLIN CAP 250MG $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31100359 DICLOXACILLIN CAP 500MG $ 20.14 $ 20.14 3110 IP PHARMACY ORAL31106178 DICYCLOMINE 20MG IJ $ 107.87 $ 107.87 3110 IP PHARMACY ORAL31106179 DICYCLOMINE 20MG IJ $ 107.87 $ 107.87 3110 IP PHARMACY ORAL31100362 DICYCLOMINE HCL CAP 10MG $ 17.00 $ 17.00 3110 IP PHARMACY ORAL31100363 DICYCLOMINE HCL TAB 20MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31107167 DIDANOSINE 25MG PO $ 4.70 $ 4.70 3110 IP PHARMACY ORAL31107168 DIDANOSINE 25MG PO $ 3.48 $ 3.48 3110 IP PHARMACY ORAL31107169 DIDANOSINE 25MG PO $ 2.45 $ 2.45 3110 IP PHARMACY ORAL31107170 DIDANOSINE 25MG PO $ 3.13 $ 3.13 3110 IP PHARMACY ORAL31104209 DIGOXIN 0.125MG ELIX. $ 21.42 $ 21.42 3110 IP PHARMACY ORAL31104207 DIGOXIN 0.25MG ELIXIR $ 21.42 $ 21.42 3110 IP PHARMACY ORAL31106180 DIGOXIN 0.5MG IJ $ 70.99 $ 70.99 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106183 DIGOXIN 0.5MG IJ $ 70.99 $ 70.99 3110 IP PHARMACY ORAL31106184 DIGOXIN IMM FAB VIAL IJ $ 1,332.20 $ 1,332.20 3110 IP PHARMACY ORAL31104208 DIGOXIN LIQ (50MCG/ML) $ 91.72 $ 91.72 3110 IP PHARMACY ORAL31106181 DIGOXIN PED 0.1MG IJ $ 77.79 $ 77.79 3110 IP PHARMACY ORAL31106182 DIGOXIN PED 0.1MG IJ $ 77.79 $ 77.79 3110 IP PHARMACY ORAL31100373 DIGOXIN TAB 0.125MG $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31100374 DIGOXIN TAB 0.25MG $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31106186 DIHYDROERGOTAMINE 1MG IJ $ 92.51 $ 92.51 3110 IP PHARMACY ORAL31106187 DIHYDROERGOTAMINE 1MG IJ $ 92.51 $ 92.51 3110 IP PHARMACY ORAL31106090 DILTIAZEM 25MG INJ. $ 92.09 $ 92.09 3110 IP PHARMACY ORAL31100396 DILTIAZEM CD 120MG $ 18.92 $ 18.92 3110 IP PHARMACY ORAL31100380 DILTIAZEM CD 180MG $ 20.62 $ 20.62 3110 IP PHARMACY ORAL31100391 DILTIAZEM CD 240MG $ 20.62 $ 20.62 3110 IP PHARMACY ORAL31100392 DILTIAZEM CD 300MG $ 21.80 $ 21.80 3110 IP PHARMACY ORAL31100386 DILTIAZEM HCL TAB 120MG $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31100383 DILTIAZEM HCL TAB 30MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100384 DILTIAZEM HCL TAB 60MG $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31106091 DILTIAZEM INJ. $ 184.08 $ 184.08 3110 IP PHARMACY ORAL31100382 DILTIAZEM TAB (PEDI) $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100385 DILTIAZEM TAB 90MG $ 18.64 $ 18.64 3110 IP PHARMACY ORAL31104211 DIPHENHYDRAMINE 12.5MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104214 DIPHENHYDRAMINE 12.5MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104215 DIPHENHYDRAMINE 12.5MG $ 35.88 $ 35.88 3110 IP PHARMACY ORAL31100393 DIPHENHYDRAMINE 25MG $ 17.12 $ 17.12 3110 IP PHARMACY ORAL31104212 DIPHENHYDRAMINE 25MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100394 DIPHENHYDRAMINE 50MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104213 DIPHENHYDRAMINE 50MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31106197 DIPHENHYDRAMINE 50MG IJ $ 69.75 $ 69.75 3110 IP PHARMACY ORAL31106198 DIPHENHYDRAMINE 50MG IJ $ 69.75 $ 69.75 3110 IP PHARMACY ORAL31106199 DIPHENHYDRAMINE 50MG IJ $ 69.75 $ 69.75 3110 IP PHARMACY ORAL31105016 DIPYRIDAMOLE 10/ML SUSP $ 76.84 $ 76.84 3110 IP PHARMACY ORAL31100400 DIPYRIDAMOLE TAB (PEDI) $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31100401 DIPYRIDAMOLE TAB 12.5MG $ 17.22 $ 17.22 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100402 DIPYRIDAMOLE TAB 25MG $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31100403 DIPYRIDAMOLE TAB 50MG $ 17.62 $ 17.62 3110 IP PHARMACY ORAL31100404 DIPYRIDAMOLE TAB 75MG $ 17.98 $ 17.98 3110 IP PHARMACY ORAL31106200 DIPYRIDAMOLE/10MG IJ $ 118.75 $ 118.75 3110 IP PHARMACY ORAL31100410 DISOPYRAMIDE 150MG CR $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31100408 DISOPYRAMIDE CAP 100MG $ 17.60 $ 17.60 3110 IP PHARMACY ORAL31100409 DISOPYRAMIDE CAP 150MG $ 17.80 $ 17.80 3110 IP PHARMACY ORAL31100411 DISOPYRAMIDE CR 100MG. $ 17.68 $ 17.68 3110 IP PHARMACY ORAL31100414 DISULFIRAM TAB 250MG $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31100418 DIVALPROEX TAB 125MG $ 18.18 $ 18.18 3110 IP PHARMACY ORAL31100419 DIVALPROEX TAB 250MG EC $ 19.72 $ 19.72 3110 IP PHARMACY ORAL31100420 DIVALPROEX TAB 500MG EC $ 23.48 $ 23.48 3110 IP PHARMACY ORAL31106204 DOBUTAMINE 250MG IJ $ 136.31 $ 136.31 3110 IP PHARMACY ORAL31106205 DOBUTAMINE 250MG IJ $ 117.75 $ 117.75 3110 IP PHARMACY ORAL31106989 DOBUTAMINE 250MG IJ $ 59.71 $ 59.71 3110 IP PHARMACY ORAL31106990 DOBUTAMINE 250MG IJ $ 34.79 $ 34.79 3110 IP PHARMACY ORAL31109578 DOBUTAMINE 250MG IJ $ 150.72 $ 150.72 3110 IP PHARMACY ORAL31109580 DOBUTAMINE 250MG IJ $ 136.82 $ 136.82 3110 IP PHARMACY ORAL31109581 DOBUTAMINE 250MG IJ $ 141.44 $ 141.44 3110 IP PHARMACY ORAL31100425 DOCUSATE NA CAP 100M $ 17.08 $ 17.08 3110 IP PHARMACY ORAL31100426 DOCUSATE NA CAP 250M $ 17.08 $ 17.08 3110 IP PHARMACY ORAL31104223 DOCUSATE NA LIQ $ 17.96 $ 17.96 3110 IP PHARMACY ORAL31104221 DOCUSATE NA LIQ 100M $ 17.96 $ 17.96 3110 IP PHARMACY ORAL31104222 DOCUSATE NA LIQ 250M $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100413 DOFETILIDE 125MCG #1CAP $ - $ - 3110 IP PHARMACY ORAL31100421 DOFETILIDE 125MCG CAP $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100416 DOFETILIDE 250MCG #1 CAP $ - $ - 3110 IP PHARMACY ORAL31100422 DOFETILIDE 250MCG CAP $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100417 DOFETILIDE 500MCG #14CAP $ - $ - 3110 IP PHARMACY ORAL31100423 DOFETILIDE 500MCG CAP $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100429 DOLASETRON 100MG PO $ 169.02 $ 169.02 3110 IP PHARMACY ORAL31100430 DOLASETRON 100MG PO $ 127.16 $ 127.16 3110 IP PHARMACY ORAL31100432 DOLASETRON 50MG PO $ 127.16 $ 127.16 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106826 DOLASETRON MESYLT 10MG IJ $ 52.25 $ 52.25 3110 IP PHARMACY ORAL31106877 DOLASETRON MESYLT 10MG IJ $ 49.71 $ 49.71 3110 IP PHARMACY ORAL31100441 DONEPEZIL 10MG TAB $ 31.46 $ 31.46 3110 IP PHARMACY ORAL31100440 DONEPEZIL 5MG TAB $ 31.46 $ 31.46 3110 IP PHARMACY ORAL31104091 DONNATAL LIQ $ 18.88 $ 18.88 3110 IP PHARMACY ORAL31104090 DONNATAL LIQ 10ML $ 21.54 $ 21.54 3110 IP PHARMACY ORAL31104089 DONNATAL LIQ 5ML $ 19.04 $ 19.04 3110 IP PHARMACY ORAL31100106 DONNATAL TAB $ 17.60 $ 17.60 3110 IP PHARMACY ORAL31107172 DOPAMINE 80MG IP PED $ 33.72 $ 33.72 3110 IP PHARMACY ORAL31107173 DOPAMINE 80MG IP PED $ 14.32 $ 14.32 3110 IP PHARMACY ORAL31109594 DOPAMINE 80MG IP PED $ 136.20 $ 136.20 3110 IP PHARMACY ORAL31106987 DOPAMINE HCL 40 MG IJ $ 10.32 $ 10.32 3110 IP PHARMACY ORAL31106988 DOPAMINE HCL 40 MG IJ $ 5.57 $ 5.57 3110 IP PHARMACY ORAL31109593 DOPAMINE HCL 40 MG IJ $ 134.20 $ 134.20 3110 IP PHARMACY ORAL31100431 DOXAZOSIN 2MG $ 18.52 $ 18.52 3110 IP PHARMACY ORAL31100437 DOXEPIN HCL CAP 100MG $ 18.66 $ 18.66 3110 IP PHARMACY ORAL31100433 DOXEPIN HCL CAP 10MG $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31100438 DOXEPIN HCL CAP 150MG $ 20.06 $ 20.06 3110 IP PHARMACY ORAL31100434 DOXEPIN HCL CAP 25MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100435 DOXEPIN HCL CAP 50MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31100436 DOXEPIN HCL CAP 75MG $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31106212 DOXYCYCLINE 100MG INJ. $ 108.29 $ 108.29 3110 IP PHARMACY ORAL31100444 DOXYCYCLINE CAP 100MG $ 20.34 $ 20.34 3110 IP PHARMACY ORAL31100443 DOXYCYCLINE CAP 50MG $ 18.44 $ 18.44 3110 IP PHARMACY ORAL31103545 DRONABINOL 2.5MG PO $ 45.10 $ 45.10 3110 IP PHARMACY ORAL31107174 DRONABINOL 2.5MG PO $ 29.18 $ 29.18 3110 IP PHARMACY ORAL31100439 DRONEDARONE 400MG $ 25.18 $ 25.18 3110 IP PHARMACY ORAL31106208 DROPERIDOL 5MG IJ $ 76.75 $ 76.75 3110 IP PHARMACY ORAL31106209 DROPERIDOL 5MG IJ $ 76.75 $ 76.75 3110 IP PHARMACY ORAL31106210 DROPERIDOL 5MG IJ $ 76.75 $ 76.75 3110 IP PHARMACY ORAL31106211 DROPERIDOL 5MG IJ $ 76.75 $ 76.75 3110 IP PHARMACY ORAL31106825 DROTRECOGIN 1MG INJ $ 215.82 $ 215.82 3110 IP PHARMACY ORAL31109560 DROTRECOGIN 2MG SYRINGE $ 456.82 $ 456.82 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31109561 DROTRECOGIN 3MG SYRINGE $ 571.03 $ 571.03 3110 IP PHARMACY ORAL31109562 DROTRECOGIN 4MG SYRINGE $ 713.92 $ 713.92 3110 IP PHARMACY ORAL31106800 DROTRECOGIN 5MG $ 1,201.20 $ 1,201.20 3110 IP PHARMACY ORAL31109563 DROTRECOGIN 5MG SYRINGE $ 1,079.10 $ 1,079.10 3110 IP PHARMACY ORAL31100442 DULOXETINE 20MG $ 25.76 $ 25.76 3110 IP PHARMACY ORAL31100406 DULOXETINE 30MG $ 26.88 $ 26.88 3110 IP PHARMACY ORAL31100412 DULOXETINE 60MG $ 26.88 $ 26.88 3110 IP PHARMACY ORAL31100788 DYAZIDE $ 18.16 $ 18.16 3110 IP PHARMACY ORAL31101485 DYAZIDE CAP $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31106978 ECULIZUMAB 10MG IJ $ 686.40 $ 686.40 3110 IP PHARMACY ORAL31106085 EDETATE CALCIUM D.1000MG $ 125.15 $ 125.15 3110 IP PHARMACY ORAL31106214 EDETATE CALCIUM D.1000MG $ 115.85 $ 115.85 3110 IP PHARMACY ORAL31106215 EDROPHONIUM 10MG AMP $ 74.31 $ 74.31 3110 IP PHARMACY ORAL31106237 EDROPHONIUM 10ML INJ $ 103.07 $ 103.07 3110 IP PHARMACY ORAL31106216 EDROPHONIUM INJ $ 74.31 $ 74.31 3110 IP PHARMACY ORAL31100446 EFAVIRENZ 100MG CAPSULE $ 22.08 $ 22.08 3110 IP PHARMACY ORAL31100447 EFAVIRENZ 200MG CAP $ 27.62 $ 27.62 3110 IP PHARMACY ORAL31100445 EFAVIRENZ 600MG $ 49.82 $ 49.82 3110 IP PHARMACY ORAL31100448 EMTRICITABINE 20MG $ 45.66 $ 45.66 3110 IP PHARMACY ORAL31106220 ENALAPRILAT 2.5MG INJ $ 123.41 $ 123.41 3110 IP PHARMACY ORAL31106243 ENALAPRILAT INJ $ 123.41 $ 123.41 3110 IP PHARMACY ORAL31106242 ENALAPRILAT INJ 1.25MG $ 94.75 $ 94.75 3110 IP PHARMACY ORAL31106960 ENFUVIRTIDE 1MG IJ $ 1.78 $ 1.78 3110 IP PHARMACY ORAL31106878 ENOXAPARIN 10MG IJ $ 31.79 $ 31.79 3110 IP PHARMACY ORAL31106879 ENOXAPARIN 10MG IJ $ 25.59 $ 25.59 3110 IP PHARMACY ORAL31106880 ENOXAPARIN 10MG IJ $ 28.11 $ 28.11 3110 IP PHARMACY ORAL31106881 ENOXAPARIN 10MG IJ $ 28.52 $ 28.52 3110 IP PHARMACY ORAL31106882 ENOXAPARIN 10MG IJ $ 38.43 $ 38.43 3110 IP PHARMACY ORAL31100451 ENTECAVIR 0.5MG $ 65.86 $ 65.86 3110 IP PHARMACY ORAL31100452 ENTECAVIR 1MG $ 65.86 $ 65.86 3110 IP PHARMACY ORAL31106217 EPHEDRINE 25MG INJ $ 68.15 $ 68.15 3110 IP PHARMACY ORAL31106219 EPHEDRINE INJ $ 68.35 $ 68.35 3110 IP PHARMACY ORAL31106218 EPHEDRINE INJ 50MG $ 68.35 $ 68.35 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106213 EPINEPHRINE 1ML IJ $ 67.05 $ 67.05 3110 IP PHARMACY ORAL31106221 EPINEPHRINE 1ML IJ $ 83.15 $ 83.15 3110 IP PHARMACY ORAL31106222 EPINEPHRINE 1ML IJ $ 81.15 $ 81.15 3110 IP PHARMACY ORAL31106223 EPINEPHRINE 1ML IJ $ 69.75 $ 69.75 3110 IP PHARMACY ORAL31107175 EPINEPHRINE 1ML IJ $ 73.61 $ 73.61 3110 IP PHARMACY ORAL31107176 EPINEPHRINE 1ML IJ $ 2.84 $ 2.84 3110 IP PHARMACY ORAL31107177 EPINEPHRINE 1ML IJ $ 47.70 $ 47.70 3110 IP PHARMACY ORAL31107270 EPINEPHRINE 1ML IJ $ 14.91 $ 14.91 3110 IP PHARMACY ORAL31109570 EPINEPHRINE 1ML IJ $ 133.10 $ 133.10 3110 IP PHARMACY ORAL31109574 EPINEPHRINE 1ML IJ $ 132.70 $ 132.70 3110 IP PHARMACY ORAL31100467 EPLERENONE 25MG TAB $ 25.72 $ 25.72 3110 IP PHARMACY ORAL31100466 EPLERENONE 50MG TAB $ 25.66 $ 25.66 3110 IP PHARMACY ORAL31107026 EPO ALFA 100U ESRD <10000 $ 44.32 $ 44.32 3110 IP PHARMACY ORAL31107074 EPO ALFA 100U ESRD <10000 $ 4.52 $ 4.52 3110 IP PHARMACY ORAL31107075 EPO ALFA 100U ESRD <10000 $ 9.88 $ 9.88 3110 IP PHARMACY ORAL31107076 EPO ALFA 100U ESRD <10000 $ 7.04 $ 7.04 3110 IP PHARMACY ORAL31107077 EPO ALFA 100U ESRD <10000 $ 5.62 $ 5.62 3110 IP PHARMACY ORAL31107078 EPO ALFA 100U ESRD <10000 $ 5.10 $ 5.10 3110 IP PHARMACY ORAL31107079 EPO ALFA 100U ESRD <10000 $ 4.72 $ 4.72 3110 IP PHARMACY ORAL31107080 EPO ALFA 100U ESRD <10000 $ 4.59 $ 4.59 3110 IP PHARMACY ORAL31107081 EPO ALFA 100U ESRD >10000 $ 4.39 $ 4.39 3110 IP PHARMACY ORAL31106233 EPOETIN NON-ESRD/1000U IJ $ 100.83 $ 100.83 3110 IP PHARMACY ORAL31106823 EPOETIN NON-ESRD/1000U IJ $ 97.97 $ 97.97 3110 IP PHARMACY ORAL31106778 EPOPROSTENOL 0.5MG IJ $ 239.68 $ 239.68 3110 IP PHARMACY ORAL31106883 EPOPROSTENOL 0.5MG IJ $ 78.64 $ 78.64 3110 IP PHARMACY ORAL31106828 EPTIFIBATIDE 5MG IJ $ 63.03 $ 63.03 3110 IP PHARMACY ORAL31100476 EPZICOM $ 68.34 $ 68.34 3110 IP PHARMACY ORAL31100470 ERGOCALCIFEROL $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31104230 ERGOCALCIFEROL LIQ DROPS $ 122.28 $ 122.28 3110 IP PHARMACY ORAL31100485 ERLOTINIB 150MG $ 297.80 $ 297.80 3110 IP PHARMACY ORAL31106884 ERTAPENEM 500MG IJ $ 161.64 $ 161.64 3110 IP PHARMACY ORAL31104234 ERYTHROMYCIN $ 56.98 $ 56.98 3110 IP PHARMACY ORAL31104232 ERYTHROMYCIN 100MG $ 56.90 $ 56.90 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104237 ERYTHROMYCIN 100ML $ 56.90 $ 56.90 3110 IP PHARMACY ORAL31104233 ERYTHROMYCIN 200MG $ 56.90 $ 56.90 3110 IP PHARMACY ORAL31104236 ERYTHROMYCIN 400 (100ML) $ 49.26 $ 49.26 3110 IP PHARMACY ORAL31100490 ERYTHROMYCIN BASE 250MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31100492 ERYTHROMYCIN BASE 500MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31106236 ERYTHROMYCIN LAC 500MG IJ $ 130.19 $ 130.19 3110 IP PHARMACY ORAL31107178 ERYTHROMYCIN LAC 500MG IJ $ 91.90 $ 91.90 3110 IP PHARMACY ORAL31109575 ERYTHROMYCIN SYR 500MG $ 163.16 $ 163.16 3110 IP PHARMACY ORAL31100491 ERYTHROMYCIN TAB 250MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31100493 ERYTHROMYCIN TAB 500MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31100487 ESCITALOPRAM 10MG $ 23.02 $ 23.02 3110 IP PHARMACY ORAL31100488 ESCITALOPRAM 20MG $ 23.30 $ 23.30 3110 IP PHARMACY ORAL31104238 ESCITALOPRAM 5MG/5ML $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31106244 ESMOLOL 100MG/ML 10ML $ 70.39 $ 70.39 3110 IP PHARMACY ORAL31109706 ESMOLOL 10MG/ML $ 258.70 $ 258.70 3110 IP PHARMACY ORAL31109707 ESMOLOL 20MG/ML SYR $ 385.20 $ 385.20 3110 IP PHARMACY ORAL31106238 ESMOLOL INJ $ 357.50 $ 357.50 3110 IP PHARMACY ORAL31106857 ESOMEPRAZOLE MAG INJ 40MG $ 121.15 $ 121.15 3110 IP PHARMACY ORAL31106188 ESTRADIOL VAL 20MG IJ $ 95.73 $ 95.73 3110 IP PHARMACY ORAL31106234 ESTRADIOL VAL 20MG IJ $ 157.67 $ 157.67 3110 IP PHARMACY ORAL31106235 ESTRADIOL VAL 20MG IJ $ 281.57 $ 281.57 3110 IP PHARMACY ORAL31106240 ESTROGEN CONJ 25 MG IJ $ 248.07 $ 248.07 3110 IP PHARMACY ORAL31106241 ESTROGEN CONJ 25 MG IJ $ 248.07 $ 248.07 3110 IP PHARMACY ORAL31100503 ESTROGENS CONJ 0.9MG TAB $ 17.38 $ 17.38 3110 IP PHARMACY ORAL31100499 ESTROGENS CONJ TAB .625MG $ 17.52 $ 17.52 3110 IP PHARMACY ORAL31100500 ESTROGENS CONJ TAB 0.3MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100501 ESTROGENS CONJ TAB 1.25MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31100502 ESTROGENS CONJ TAB 2.5MG $ 18.88 $ 18.88 3110 IP PHARMACY ORAL31106245 ETHACRYNIC ACID 50MG INJ $ 80.15 $ 80.15 3110 IP PHARMACY ORAL31106246 ETHACRYNIC ACID INJ $ 303.65 $ 303.65 3110 IP PHARMACY ORAL31100510 ETHACRYNIC ACID TAB 25MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31100506 ETHAMBUTOL TAB 100MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100507 ETHAMBUTOL TAB 400MG $ 20.32 $ 20.32 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106247 ETHANOLOMINE 100MG IJ $ 266.55 $ 266.55 3110 IP PHARMACY ORAL31106007 ETOH ABSOLUTE 1ML INJ $ 80.15 $ 80.15 3110 IP PHARMACY ORAL31106109 ETOH ABSOLUTE INJ $ 114.15 $ 114.15 3110 IP PHARMACY ORAL31106838 ETOMIDATE 20MG INJ $ 94.91 $ 94.91 3110 IP PHARMACY ORAL31106260 ETOMIDATE SYRG $ 80.91 $ 80.91 3110 IP PHARMACY ORAL31106261 ETOPOSIDE 10MG IJ $ 57.38 $ 57.38 3110 IP PHARMACY ORAL31100518 ETOPOSIDE 50MG PO $ 140.24 $ 140.24 3110 IP PHARMACY ORAL31100508 ETRAVIRINE 100MG $ 30.32 $ 30.32 3110 IP PHARMACY ORAL31106821 FACTOR 7A RECOM 1MCG IJ $ 5,228.46 $ 5,228.46 3110 IP PHARMACY ORAL31100521 FAMCICLOVIR 125MG $ 25.52 $ 25.52 3110 IP PHARMACY ORAL31100519 FAMCICLOVIR 250MG $ 26.26 $ 26.26 3110 IP PHARMACY ORAL31100520 FAMCICLOVIR 500MG $ 38.22 $ 38.22 3110 IP PHARMACY ORAL31106250 FAMOTIDINE $ 84.55 $ 84.55 3110 IP PHARMACY ORAL31106736 FAMOTIDINE 20MG IJ $ 107.19 $ 107.19 3110 IP PHARMACY ORAL31106885 FAMOTIDINE 20MG IJ $ 112.95 $ 112.95 3110 IP PHARMACY ORAL31109576 FAMOTIDINE 20MG IJ $ 140.16 $ 140.16 3110 IP PHARMACY ORAL31109577 FAMOTIDINE 20MG IJ $ 140.16 $ 140.16 3110 IP PHARMACY ORAL31104241 FAMOTIDINE LIQ $ 196.92 $ 196.92 3110 IP PHARMACY ORAL31104239 FAMOTIDINE LIQ 20MG $ 196.92 $ 196.92 3110 IP PHARMACY ORAL31104240 FAMOTIDINE LIQ 40MG $ 196.92 $ 196.92 3110 IP PHARMACY ORAL31100522 FAMOTIDINE TAB 20MG $ 20.40 $ 20.40 3110 IP PHARMACY ORAL31100523 FAMOTIDINE TAB 40MG $ 23.12 $ 23.12 3110 IP PHARMACY ORAL31107001 FE GLUCONATE 12.5MG IJ $ 25.97 $ 25.97 3110 IP PHARMACY ORAL31100526 FE GLUCONATE TAB 325MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31104243 FE SO4 0.3ML SOL $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31104250 FE SO4 DROPS $ 52.46 $ 52.46 3110 IP PHARMACY ORAL31104249 FE SO4 LIQ $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104248 FE SO4 LIQ 300M $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100529 FE SO4 TAB 325M $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31104242 FELBAMATE LIQUID $ 19.48 $ 19.48 3110 IP PHARMACY ORAL31100538 FELODIPINE 5MG $ 18.62 $ 18.62 3110 IP PHARMACY ORAL31107179 FENTANYL 0.1MG IJ $ 22.52 $ 22.52 3110 IP PHARMACY ORAL31107180 FENTANYL 0.1MG IJ $ 14.42 $ 14.42 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31107181 FENTANYL 0.1MG IJ $ 3.64 $ 3.64 3110 IP PHARMACY ORAL31107182 FENTANYL 0.1MG IJ $ 12.28 $ 12.28 3110 IP PHARMACY ORAL31107183 FENTANYL 0.1MG IJ $ 15.82 $ 15.82 3110 IP PHARMACY ORAL31109026 FENTANYL 0.1MG IJ $ 108.53 $ 108.53 3110 IP PHARMACY ORAL31109027 FENTANYL 0.1MG IJ $ 110.47 $ 110.47 3110 IP PHARMACY ORAL31106794 FERRIC GLUC 62.5MG INJ $ 129.86 $ 129.86 3110 IP PHARMACY ORAL31106249 FILGRASTIM 300MCG IJ $ 600.63 $ 600.63 3110 IP PHARMACY ORAL31106251 FILGRASTIM 300MCG IJ $ 600.63 $ 600.63 3110 IP PHARMACY ORAL31106252 FILGRASTIM 480MCG IJ $ 917.31 $ 917.31 3110 IP PHARMACY ORAL31100536 FINASTERIDE 5MG PO $ 23.48 $ 23.48 3110 IP PHARMACY ORAL31100547 FIORICET $ 19.82 $ 19.82 3110 IP PHARMACY ORAL31100537 FLECAINIDE TAB 100MG $ 18.66 $ 18.66 3110 IP PHARMACY ORAL31104688 FLEET PHOSPHA SODA LIQ $ 23.04 $ 23.04 3110 IP PHARMACY ORAL31104266 FLUCONAZOLE 10MG/ML LIQ. $ 105.28 $ 105.28 3110 IP PHARMACY ORAL31106993 FLUCONAZOLE 200MG IJ $ 87.31 $ 87.31 3110 IP PHARMACY ORAL31109579 FLUCONAZOLE 200MG IJ $ 183.86 $ 183.86 3110 IP PHARMACY ORAL31104260 FLUCONAZOLE 40MG/ML SUSP. $ 294.60 $ 294.60 3110 IP PHARMACY ORAL31100543 FLUCONAZOLE TAB 100MG $ 31.94 $ 31.94 3110 IP PHARMACY ORAL31100542 FLUCONAZOLE TAB 200MG $ 41.76 $ 41.76 3110 IP PHARMACY ORAL31100544 FLUCONAZOLE TAB 50MG $ 25.74 $ 25.74 3110 IP PHARMACY ORAL31100540 FLUCYTOSINE CAP 250MG $ 26.32 $ 26.32 3110 IP PHARMACY ORAL31100541 FLUCYTOSINE CAP 500MG $ 80.94 $ 80.94 3110 IP PHARMACY ORAL31100545 FLUDROCORTISONE TAB .1MG $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31106271 FLUMAZENIL $ 142.65 $ 142.65 3110 IP PHARMACY ORAL31106573 FLUMAZENIL 5ML INJ $ 142.65 $ 142.65 3110 IP PHARMACY ORAL31109589 FLUORESCEIN 10% 1ML SYRG $ 136.40 $ 136.40 3110 IP PHARMACY ORAL31101325 FLUORIDE NA TAB 2.2MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31106269 FLUOROURACIL 500MG IJ $ 580.83 $ 580.83 3110 IP PHARMACY ORAL31100548 FLUOXETINE 10MG TAB $ 21.60 $ 21.60 3110 IP PHARMACY ORAL31100549 FLUOXETINE CAP 20MG $ 22.46 $ 22.46 3110 IP PHARMACY ORAL31104251 FLUOXETINE LIQ. 20MG(5ML $ 25.78 $ 25.78 3110 IP PHARMACY ORAL31104247 FLUOXETINE LIQUID 20MG/5 $ 25.78 $ 25.78 3110 IP PHARMACY ORAL31106254 FLUPHENAZINE DECA 25MG IJ $ 273.65 $ 273.65 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104259 FLUPHENAZINE LIQ. $ 150.24 $ 150.24 3110 IP PHARMACY ORAL31104246 FLUPHENAZINE LIQUID $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100559 FLUPHENAZINE TAB 10MG $ 20.74 $ 20.74 3110 IP PHARMACY ORAL31100556 FLUPHENAZINE TAB 1MG $ 18.30 $ 18.30 3110 IP PHARMACY ORAL31100557 FLUPHENAZINE TAB 2.5MG $ 19.04 $ 19.04 3110 IP PHARMACY ORAL31100558 FLUPHENAZINE TAB 5MG $ 19.74 $ 19.74 3110 IP PHARMACY ORAL31103548 FLURAZEPAM CAP 15MG $ 34.14 $ 34.14 3110 IP PHARMACY ORAL31100563 FLUTAMIDE 125MG PO $ 21.08 $ 21.08 3110 IP PHARMACY ORAL31100565 FLUVOXAMINE 25MG $ 20.94 $ 20.94 3110 IP PHARMACY ORAL31106258 FOLIC ACID $ 70.15 $ 70.15 3110 IP PHARMACY ORAL31106257 FOLIC ACID 1MG $ 70.15 $ 70.15 3110 IP PHARMACY ORAL31106259 FOLIC ACID INJ (5MG/ML) $ 35.80 $ 35.80 3110 IP PHARMACY ORAL31100567 FOLIC ACID TAB 1MG $ 17.00 $ 17.00 3110 IP PHARMACY ORAL31106858 FOMEPIZOLE 15MG IJ $ 3,140.20 $ 3,140.20 3110 IP PHARMACY ORAL31106887 FONDAPARINUX 0.5MG IJ $ 49.97 $ 49.97 3110 IP PHARMACY ORAL31100569 FOSAMPRENAVIR 700MG $ 39.70 $ 39.70 3110 IP PHARMACY ORAL31106888 FOSCARNET SOD 1000 MG IJ $ 93.43 $ 93.43 3110 IP PHARMACY ORAL31107184 FOSCARNET SOD 1000 MG IJ $ 47.06 $ 47.06 3110 IP PHARMACY ORAL31107185 FOSCARNET SOD 1000 MG IJ $ 47.06 $ 47.06 3110 IP PHARMACY ORAL31106889 FOSPHENYTOIN 50MG IJ $ 8.12 $ 8.12 3110 IP PHARMACY ORAL31106972 FOSPHENYTOIN 50MG IJ $ 221.51 $ 221.51 3110 IP PHARMACY ORAL31106890 FULVESTRANT 25MG IJ $ 323.73 $ 323.73 3110 IP PHARMACY ORAL31106262 FUROSEMIDE 20MG IJ $ 70.55 $ 70.55 3110 IP PHARMACY ORAL31106263 FUROSEMIDE 20MG IJ $ 70.55 $ 70.55 3110 IP PHARMACY ORAL31106268 FUROSEMIDE 20MG IJ $ 70.55 $ 70.55 3110 IP PHARMACY ORAL31106891 FUROSEMIDE 20MG IJ $ 31.65 $ 31.65 3110 IP PHARMACY ORAL31106892 FUROSEMIDE 20MG IJ $ 18.25 $ 18.25 3110 IP PHARMACY ORAL31106893 FUROSEMIDE 20MG IJ $ 9.96 $ 9.96 3110 IP PHARMACY ORAL31106894 FUROSEMIDE 20MG IJ $ 7.30 $ 7.30 3110 IP PHARMACY ORAL31106895 FUROSEMIDE 20MG IJ $ 38.95 $ 38.95 3110 IP PHARMACY ORAL31107266 FUROSEMIDE 20MG IJ $ 38.13 $ 38.13 3110 IP PHARMACY ORAL31104261 FUROSEMIDE 40MG LIQUID $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31104255 FUROSEMIDE LIQ 10MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104252 FUROSEMIDE LIQ 2MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104253 FUROSEMIDE LIQ 3MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104254 FUROSEMIDE LIQ 5MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104256 FUROSEMIDE LIQUID 40MG/5 $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31100571 FUROSEMIDE TAB 20MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100572 FUROSEMIDE TAB 40MG $ 16.96 $ 16.96 3110 IP PHARMACY ORAL31100573 FUROSEMIDE TAB 80MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31100574 GABAPENTIN 100MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31104299 GABAPENTIN 100MG SOL $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100575 GABAPENTIN 300MG $ 19.48 $ 19.48 3110 IP PHARMACY ORAL31104284 GABAPENTIN 300MG SOL $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31100576 GABAPENTIN 400MG $ 20.08 $ 20.08 3110 IP PHARMACY ORAL31104298 GABAPENTIN 400MG SOL $ 20.14 $ 20.14 3110 IP PHARMACY ORAL31100583 GABAPENTIN 600MG $ 21.40 $ 21.40 3110 IP PHARMACY ORAL31100584 GABAPENTIN 800MG $ 22.36 $ 22.36 3110 IP PHARMACY ORAL31104276 GABAPENTIN SOL 300MG $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31106278 GAMMA GLOBULIN IM IJ 1 CC $ 375.36 $ 375.36 3110 IP PHARMACY ORAL31104321 GELCLAIR 15ML $ 35.60 $ 35.60 3110 IP PHARMACY ORAL31100580 GEMFIBROZIL TAB 600MG $ 18.24 $ 18.24 3110 IP PHARMACY ORAL31106802 GEMTUZUMAB/5MG IJ $ 6,209.33 $ 6,209.33 3110 IP PHARMACY ORAL31106671 GEN ANES DRUG 30MIN $ 131.23 $ 131.23 3110 IP PHARMACY ORAL31106996 GENTAMICIN 10MG IJ IP PED $ 16.56 $ 16.56 3110 IP PHARMACY ORAL31106191 GENTAMICIN 20MG VL IP PED $ 136.40 $ 136.40 3110 IP PHARMACY ORAL31106274 GENTAMICIN 20MG VL IP PED $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31106997 GENTAMICIN 20MG VL IP PED $ 42.42 $ 42.42 3110 IP PHARMACY ORAL31107186 GENTAMICIN 20MG VL IP PED $ 49.46 $ 49.46 3110 IP PHARMACY ORAL31109585 GENTAMICIN 20MG VL IP PED $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31109586 GENTAMICIN 20MG VL IP PED $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31109587 GENTAMICIN 20MG VL IP PED $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31106273 GENTAMICIN 80MG IJ $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31106276 GENTAMICIN 80MG IJ $ 67.15 $ 67.15 3110 IP PHARMACY ORAL31107013 GENTAMICIN 80MG IJ $ 133.20 $ 133.20 3110 IP PHARMACY ORAL31100586 GLIPIZIDE TAB 10MG $ 17.82 $ 17.82 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100585 GLIPIZIDE TAB 5MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31106282 GLUCAGON HCL 1MG IJ $ 264.75 $ 264.75 3110 IP PHARMACY ORAL31106284 GLUCAGON HCL 1MG IJ $ 264.75 $ 264.75 3110 IP PHARMACY ORAL31107187 GLUCAGON HCL 1MG IJ $ 227.61 $ 227.61 3110 IP PHARMACY ORAL31100590 GLYBURIDE TAB 1.25MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100591 GLYBURIDE TAB 2.5MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100592 GLYBURIDE TAB 5MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31104264 GLYCERIN ORAL LIQ (50%) $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31106280 GLYCOPYRROLATE INJ $ 67.35 $ 67.35 3110 IP PHARMACY ORAL31106279 GLYCOPYRROLATE INJ 0.2MG $ 67.35 $ 67.35 3110 IP PHARMACY ORAL31100598 GLYCOPYRROLATE TAB 1MG $ 16.98 $ 16.98 3110 IP PHARMACY ORAL31104274 GUAIF/COD $ 33.88 $ 33.88 3110 IP PHARMACY ORAL31104273 GUAIF/COD 10ML $ 33.88 $ 33.88 3110 IP PHARMACY ORAL31104272 GUAIF/COD 5ML $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31104279 GUAIF/DM $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104278 GUAIF/DM 10ML $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104277 GUAIF/DM 5ML $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104590 GUAIF/PHENYL LIQ $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31104267 GUAIFENESIN 120ML $ 37.68 $ 37.68 3110 IP PHARMACY ORAL31104271 GUAIFENESIN SYRUP $ 17.28 $ 17.28 3110 IP PHARMACY ORAL31104269 GUAIFENESIN SYRUP 10ML $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31104270 GUAIFENESIN SYRUP 15ML $ 17.96 $ 17.96 3110 IP PHARMACY ORAL31104268 GUAIFENESIN SYRUP 5ML $ 17.28 $ 17.28 3110 IP PHARMACY ORAL31100606 GUANFACINE TAB 1MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31106277 HALOPERIDOL 5MG IJ $ 81.55 $ 81.55 3110 IP PHARMACY ORAL31106295 HALOPERIDOL 5MG IJ $ 81.55 $ 81.55 3110 IP PHARMACY ORAL31106296 HALOPERIDOL 5MG IJ $ 81.55 $ 81.55 3110 IP PHARMACY ORAL31104285 HALOPERIDOL CONC. 15ML $ 85.78 $ 85.78 3110 IP PHARMACY ORAL31106297 HALOPERIDOL DECA 50MG IJ $ 126.35 $ 126.35 3110 IP PHARMACY ORAL31106298 HALOPERIDOL DECA 50MG IJ $ 126.35 $ 126.35 3110 IP PHARMACY ORAL31104289 HALOPERIDOL LIQ $ 20.94 $ 20.94 3110 IP PHARMACY ORAL31104287 HALOPERIDOL LIQ 2MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104288 HALOPERIDOL LIQ 5MG $ 20.14 $ 20.14 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100609 HALOPERIDOL TAB 0.5MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31100613 HALOPERIDOL TAB 10MG $ 19.76 $ 19.76 3110 IP PHARMACY ORAL31100610 HALOPERIDOL TAB 1MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31100614 HALOPERIDOL TAB 20MG $ 22.70 $ 22.70 3110 IP PHARMACY ORAL31100611 HALOPERIDOL TAB 2MG $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31100612 HALOPERIDOL TAB 5MG $ 19.14 $ 19.14 3110 IP PHARMACY ORAL31100633 HCTZ 25MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100634 HCTZ 50MG $ 16.88 $ 16.88 3110 IP PHARMACY ORAL31109591 HEMIN/1MG IJ $ 36.73 $ 36.73 3110 IP PHARMACY ORAL31106304 HEP LOCK FLUSH 10U IJ $ 35.28 $ 35.28 3110 IP PHARMACY ORAL31107188 HEP LOCK FLUSH 10U IJ $ 15.12 $ 15.12 3110 IP PHARMACY ORAL31107189 HEP LOCK FLUSH 10U IJ $ 11.15 $ 11.15 3110 IP PHARMACY ORAL31107190 HEP LOCK FLUSH 10U IJ $ - $ - 3110 IP PHARMACY ORAL31107191 HEP LOCK FLUSH 10U IJ $ 11.67 $ 11.67 3110 IP PHARMACY ORAL31107192 HEP LOCK FLUSH 10U IJ $ 3.51 $ 3.51 3110 IP PHARMACY ORAL31107272 HEP LOCK FLUSH 10U IJ $ 1.14 $ 1.14 3110 IP PHARMACY ORAL31106313 HEPARIN 1000U IJ $ 75.43 $ 75.43 3110 IP PHARMACY ORAL31106991 HEPARIN 1000U IJ $ 5.42 $ 5.42 3110 IP PHARMACY ORAL31106992 HEPARIN 1000U IJ $ 4.98 $ 4.98 3110 IP PHARMACY ORAL31107263 HEPARIN 1000U IJ $ 53.38 $ 53.38 3110 IP PHARMACY ORAL31107281 HEPARIN 1000U IJ $ 53.61 $ 53.61 3110 IP PHARMACY ORAL31109590 HEPARIN 1000U IJ $ 135.56 $ 135.56 3110 IP PHARMACY ORAL31106765 HEPARIN 20KU/D5W500 $ - $ - 3110 IP PHARMACY ORAL31106317 HEPARIN LOCK 10U/ML 10ML $ 34.08 $ 34.08 3110 IP PHARMACY ORAL31104296 HOMATROPINE LIQ $ 34.28 $ 34.28 3110 IP PHARMACY ORAL31104295 HOMATROPINE LIQ 10ML $ 35.48 $ 35.48 3110 IP PHARMACY ORAL31104294 HOMATROPINE LIQ 5ML $ 34.28 $ 34.28 3110 IP PHARMACY ORAL31106315 HYALURONIDASE 150U IJ $ 130.55 $ 130.55 3110 IP PHARMACY ORAL31106318 HYDRALAZINE 20MG IJ $ 94.95 $ 94.95 3110 IP PHARMACY ORAL31106319 HYDRALAZINE 20MG IJ $ 94.95 $ 94.95 3110 IP PHARMACY ORAL31106320 HYDRALAZINE 20MG IJ $ 94.95 $ 94.95 3110 IP PHARMACY ORAL31100624 HYDRALAZINE HCL TAB 10MG $ 16.92 $ 16.92 3110 IP PHARMACY ORAL31100625 HYDRALAZINE HCL TAB 25MG $ 17.08 $ 17.08 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100626 HYDRALAZINE HCL TAB 50MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31105020 HYDRALAZINE LIQ 1MG/ML $ 78.58 $ 78.58 3110 IP PHARMACY ORAL31105021 HYDRALAZINE LIQ. SYRG $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100627 HYDRALAZINE TAB 100MG $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31103628 HYDROCOD/APAP 10-325MG $ 35.28 $ 35.28 3110 IP PHARMACY ORAL31103504 HYDROCOD/APAP 10MG/50 $ 34.16 $ 34.16 3110 IP PHARMACY ORAL31104369 HYDROCOD/APAP 15ML LIQUID $ 39.72 $ 39.72 3110 IP PHARMACY ORAL31103626 HYDROCOD/APAP 5-325MG $ 34.16 $ 34.16 3110 IP PHARMACY ORAL31103506 HYDROCOD/APAP 5MG $ 34.16 $ 34.16 3110 IP PHARMACY ORAL31103505 HYDROCOD/APAP 7.5 $ 34.32 $ 34.32 3110 IP PHARMACY ORAL31103627 HYDROCOD/APAP 7.5-325MG $ 34.30 $ 34.30 3110 IP PHARMACY ORAL31104367 HYDROCOD/APAP LIQ 10ML $ 38.48 $ 38.48 3110 IP PHARMACY ORAL31104366 HYDROCOD/APAP LIQUID 5ML $ 37.68 $ 37.68 3110 IP PHARMACY ORAL31106325 HYDROCORT NA SUC 100MG IJ $ 72.85 $ 72.85 3110 IP PHARMACY ORAL31106329 HYDROCORT NA SUC 100MG IJ $ 72.85 $ 72.85 3110 IP PHARMACY ORAL31106330 HYDROCORT NA SUC 100MG IJ $ 1.29 $ 1.29 3110 IP PHARMACY ORAL31107193 HYDROCORT NA SUC 100MG IJ $ 12.54 $ 12.54 3110 IP PHARMACY ORAL31107194 HYDROCORT NA SUC 100MG IJ $ 19.14 $ 19.14 3110 IP PHARMACY ORAL31107195 HYDROCORT NA SUC 100MG IJ $ 26.99 $ 26.99 3110 IP PHARMACY ORAL31109592 HYDROCORT NA SUC 100MG IJ $ 138.88 $ 138.88 3110 IP PHARMACY ORAL31100641 HYDROCORT TAB $ 1.29 $ 1.29 3110 IP PHARMACY ORAL31100639 HYDROCORT TAB 10MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100640 HYDROCORT TAB 20MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31109050 HYDROMORPHONE 1MG INJ $ 101.77 $ 101.77 3110 IP PHARMACY ORAL31107016 HYDROMORPHONE 4MG IJ $ 101.69 $ 101.69 3110 IP PHARMACY ORAL31107196 HYDROMORPHONE 4MG IJ $ 23.27 $ 23.27 3110 IP PHARMACY ORAL31107197 HYDROMORPHONE 4MG IJ $ - $ - 3110 IP PHARMACY ORAL31109044 HYDROMORPHONE 4MG IJ $ 101.97 $ 101.97 3110 IP PHARMACY ORAL31109046 HYDROMORPHONE 4MG IJ $ 104.03 $ 104.03 3110 IP PHARMACY ORAL31103571 HYDROMORPHONE 8MG TAB $ 19.30 $ 19.30 3110 IP PHARMACY ORAL31109045 HYDROMORPHONE INJ $ 101.39 $ 101.39 3110 IP PHARMACY ORAL31109043 HYDROMORPHONE INJ 2MG $ 102.07 $ 102.07 3110 IP PHARMACY ORAL31103563 HYDROMORPHONE TAB 1MG $ 33.54 $ 33.54 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31103564 HYDROMORPHONE TAB 2MG $ 34.06 $ 34.06 3110 IP PHARMACY ORAL31103565 HYDROMORPHONE TAB 4MG $ 34.56 $ 34.56 3110 IP PHARMACY ORAL31100649 HYDROXYUREA 500MG PO $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31106334 HYDROXYZINE HCL 25MG IJ $ 67.25 $ 67.25 3110 IP PHARMACY ORAL31107198 HYDROXYZINE HCL 25MG IJ $ 33.36 $ 33.36 3110 IP PHARMACY ORAL31107199 HYDROXYZINE HCL 25MG IJ $ 17.03 $ 17.03 3110 IP PHARMACY ORAL31104302 HYDROXYZINE HCL LIQ $ 17.56 $ 17.56 3110 IP PHARMACY ORAL31104300 HYDROXYZINE HCL LIQ 10MG $ 17.56 $ 17.56 3110 IP PHARMACY ORAL31104301 HYDROXYZINE HCL LIQ 25MG $ 19.08 $ 19.08 3110 IP PHARMACY ORAL31100651 HYDROXYZINE HCL TAB 10MG $ 17.72 $ 17.72 3110 IP PHARMACY ORAL31100652 HYDROXYZINE HCL TAB 25MG $ 18.28 $ 18.28 3110 IP PHARMACY ORAL31100653 HYDROXYZINE HCL TAB 50MG $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31100658 HYOSCYAMNE 0.125MG $ 17.62 $ 17.62 3110 IP PHARMACY ORAL31106338 HYSKON 70 100ML INJ $ 174.25 $ 174.25 3110 IP PHARMACY ORAL31100659 IBUPROFEN 200MG TAB $ 16.70 $ 16.70 3110 IP PHARMACY ORAL31104307 IBUPROFEN 200MG/5ML SUSP $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104309 IBUPROFEN 40MG/ML $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31104306 IBUPROFEN CONC. 40MG/ML $ 43.00 $ 43.00 3110 IP PHARMACY ORAL31100661 IBUPROFEN TAB 400MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31100662 IBUPROFEN TAB 600MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100663 IBUPROFEN TAB 800MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31106086 IC GREEN 50MG $ 766.15 $ 766.15 3110 IP PHARMACY ORAL31106785 IDARUBICIN/5MG IJ $ 1,140.46 $ 1,140.46 3110 IP PHARMACY ORAL31106718 IG VARICELLA-ZOSTER IM $ 570.76 $ 570.76 3110 IP PHARMACY ORAL31106897 IMIPENEM/CILAST 250MG IJ $ 90.01 $ 90.01 3110 IP PHARMACY ORAL31109596 IMIPENEM/CILAST 250MG IJ $ 213.82 $ 213.82 3110 IP PHARMACY ORAL31100667 IMIPRAMINE HCL TAB 10MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31100668 IMIPRAMINE HCL TAB 25MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31100671 IMIPRAMINE TAB 100MG $ 19.08 $ 19.08 3110 IP PHARMACY ORAL31100669 IMIPRAMINE TAB 50MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31100670 IMIPRAMINE TAB 75MG $ 18.44 $ 18.44 3110 IP PHARMACY ORAL31106340 INDIGO CARMINE 5ML INJ $ 83.15 $ 83.15 3110 IP PHARMACY ORAL31100677 INDINAVIR 200MG CAP $ 27.68 $ 27.68 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100682 INDINAVIR 400MG $ 22.88 $ 22.88 3110 IP PHARMACY ORAL31100674 INDOMETHACIN CAP 25MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100675 INDOMETHACIN CAP 50MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31100676 INDOMETHACIN CAP 75MG SR $ 19.10 $ 19.10 3110 IP PHARMACY ORAL31106423 INDOMETHACIN INJ $ 1,340.15 $ 1,340.15 3110 IP PHARMACY ORAL31106767 INFLIXIMAB 10MG IJ $ 194.66 $ 194.66 3110 IP PHARMACY ORAL31106827 INTERFERON A-2B 1000KU IJ $ 88.24 $ 88.24 3110 IP PHARMACY ORAL31107200 INTERFERON A-2B 1000KU IJ $ 71.67 $ 71.67 3110 IP PHARMACY ORAL31106807 INTERFERON B-1A 11MCG IM $ 257.47 $ 257.47 3110 IP PHARMACY ORAL31104311 IPECAC SYRUP $ 20.30 $ 20.30 3110 IP PHARMACY ORAL31104310 IPECAC SYRUP 30ML $ 20.30 $ 20.30 3110 IP PHARMACY ORAL31106147 IRON DEXTRAN 50 MG IJ $ 207.20 $ 207.20 3110 IP PHARMACY ORAL31106339 IRON DEXTRAN 50 MG IJ $ 87.45 $ 87.45 3110 IP PHARMACY ORAL31107003 IRON DEXTRAN 50 MG IJ $ 169.90 $ 169.90 3110 IP PHARMACY ORAL31107201 IRON DEXTRAN 50 MG IJ $ 51.86 $ 51.86 3110 IP PHARMACY ORAL31106816 IRON SUCROSE 100MG INJ $ 269.70 $ 269.70 3110 IP PHARMACY ORAL31106847 IRON SUCROSE 1MG IJ $ 2.24 $ 2.24 3110 IP PHARMACY ORAL31100925 ISOMETH/DICHOR 2.5MG $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100929 ISOMETH/DICHOR 5MG $ 21.38 $ 21.38 3110 IP PHARMACY ORAL31106370 ISONIAZID INJ 100MG/ML $ 97.85 $ 97.85 3110 IP PHARMACY ORAL31104314 ISONIAZID LIQ 100MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31104315 ISONIAZID LIQ 200MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104316 ISONIAZID LIQ 300MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100685 ISONIAZID TAB 100MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31100686 ISONIAZID TAB 300MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31106374 ISOPROTERENOL 5ML INJ $ 169.08 $ 169.08 3110 IP PHARMACY ORAL31100683 ISOSORBIDE MONO 30MG $ 19.98 $ 19.98 3110 IP PHARMACY ORAL31100696 ISOSORBIDE MONO 60MG $ 23.42 $ 23.42 3110 IP PHARMACY ORAL31100687 ISOSORBIDE SL 2.5MG $ 16.98 $ 16.98 3110 IP PHARMACY ORAL31100688 ISOSORBIDE SL 5MG $ 17.02 $ 17.02 3110 IP PHARMACY ORAL31100695 ISOSORBIDE SR 40MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100691 ISOSORBIDE TAB 10MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100692 ISOSORBIDE TAB 20MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100693 ISOSORBIDE TAB 30MG $ 17.52 $ 17.52 3110 IP PHARMACY ORAL31100694 ISOSORBIDE TAB 40MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100689 ISOSORBIDE TAB 5MG $ 17.02 $ 17.02 3110 IP PHARMACY ORAL31100703 ISRADIPINE 2.5MG $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31100702 ISRADIPINE 5MG $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31100704 ITRACONAZOLE 100MG CAP $ 32.10 $ 32.10 3110 IP PHARMACY ORAL31100705 IVERMECTIN 3MG $ 27.34 $ 27.34 3110 IP PHARMACY ORAL31106534 K ACET $ 70.15 $ 70.15 3110 IP PHARMACY ORAL31106570 K ACET (SLIDING SCALE) $ 37.08 $ 37.08 3110 IP PHARMACY ORAL31109630 K ACET SYRING $ 136.12 $ 136.12 3110 IP PHARMACY ORAL31101141 K BICARB/K CIT 25 MEQ $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31106517 K CL 10MEQ $ 67.15 $ 67.15 3110 IP PHARMACY ORAL31106538 K CL 20MEQ INJ $ 35.08 $ 35.08 3110 IP PHARMACY ORAL31106535 K CL 2OMEQ IJ $ 35.38 $ 35.38 3110 IP PHARMACY ORAL31106539 K CL 30MEQ INJ $ 34.18 $ 34.18 3110 IP PHARMACY ORAL31106540 K CL 40MEQ INJ $ 34.28 $ 34.28 3110 IP PHARMACY ORAL31104616 K CL LIQ $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31104614 K CL LIQ 10MEQ $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31104615 K CL LIQ 20MEQ $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31104617 K CL LIQ 40MEQ $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31106610 K CL ORAL SOLUTION 2MEQ/M $ 35.08 $ 35.08 3110 IP PHARMACY ORAL31109632 K CL SYRIN $ 136.12 $ 136.12 3110 IP PHARMACY ORAL31101142 K CL TAB 10MEQ $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31101143 K CL TAB 20MEQ $ 17.70 $ 17.70 3110 IP PHARMACY ORAL31106900 K CL/2MEQ INJ $ 19.58 $ 19.58 3110 IP PHARMACY ORAL31106901 K CL/2MEQ INJ $ 9.57 $ 9.57 3110 IP PHARMACY ORAL31106902 K CL/2MEQ INJ $ 3.09 $ 3.09 3110 IP PHARMACY ORAL31104623 K IODIDE LIQ $ 57.28 $ 57.28 3110 IP PHARMACY ORAL31106526 K PHOS $ 68.15 $ 68.15 3110 IP PHARMACY ORAL31106525 K PHOS INJ 5ML $ 33.86 $ 33.86 3110 IP PHARMACY ORAL31106568 K PHOS SLIDING SCALE $ 35.08 $ 35.08 3110 IP PHARMACY ORAL31109631 K PHOS SYRI $ 135.72 $ 135.72 3110 IP PHARMACY ORAL31100709 KALETRA 133/33.3MG $ 29.80 $ 29.80 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104305 KALETRA 80ML $ 471.98 $ 471.98 3110 IP PHARMACY ORAL31106380 KANAMYCIN 500MG IJ $ 87.85 $ 87.85 3110 IP PHARMACY ORAL31106909 KANAMYCIN 500MG IJ $ 55.65 $ 55.65 3110 IP PHARMACY ORAL31106141 KETAMINE 100/ML 5ML $ 143.77 $ 143.77 3110 IP PHARMACY ORAL31109715 KETAMINE 100MG SYR $ 194.68 $ 194.68 3110 IP PHARMACY ORAL31109716 KETAMINE 250MG $ 238.62 $ 238.62 3110 IP PHARMACY ORAL31106384 KETAMINE HCL INJ (10MG/M $ 128.53 $ 128.53 3110 IP PHARMACY ORAL31106385 KETAMINE INJ 50MG/ML $ 144.65 $ 144.65 3110 IP PHARMACY ORAL31100710 KETOCONAZOLE TAB 200MG $ 23.28 $ 23.28 3110 IP PHARMACY ORAL31106294 KETOROLAC 15MG IJ $ 70.05 $ 70.05 3110 IP PHARMACY ORAL31106910 KETOROLAC 15MG IJ $ 31.62 $ 31.62 3110 IP PHARMACY ORAL31106911 KETOROLAC 15MG IJ $ 15.81 $ 15.81 3110 IP PHARMACY ORAL31106860 LABETALOL 20MG $ 67.03 $ 67.03 3110 IP PHARMACY ORAL31106382 LABETALOL 20ML INJ $ 72.21 $ 72.21 3110 IP PHARMACY ORAL31106378 LABETALOL 40ML INJ $ 78.27 $ 78.27 3110 IP PHARMACY ORAL31106414 LABETALOL INJ $ 72.21 $ 72.21 3110 IP PHARMACY ORAL31100718 LABETALOL TAB 100MG $ 17.70 $ 17.70 3110 IP PHARMACY ORAL31100716 LABETALOL TAB 200MG $ 18.16 $ 18.16 3110 IP PHARMACY ORAL31100714 LABETALOL TAB 25MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100717 LABETALOL TAB 300MG $ 18.68 $ 18.68 3110 IP PHARMACY ORAL31103573 LACOSAMIDE 100MG $ 46.40 $ 46.40 3110 IP PHARMACY ORAL31109055 LACOSAMIDE 1MG IJ $ 1.25 $ 1.25 3110 IP PHARMACY ORAL31103574 LACOSAMIDE 200MG $ 48.54 $ 48.54 3110 IP PHARMACY ORAL31109066 LACOSAMIDE 200MG/20ML IJ $ 183.23 $ 183.23 3110 IP PHARMACY ORAL31103572 LACOSAMIDE 50MG $ 41.60 $ 41.60 3110 IP PHARMACY ORAL31104717 LACTOBACILLUS 3ML $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104335 LACTOBACILLUS PACK 1GM $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31100719 LACTOBACILLUS TAB 250MG $ 16.92 $ 16.92 3110 IP PHARMACY ORAL31104718 LACTOBACILLUS TSP $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104343 LACTULOSE SYRUP $ 22.50 $ 22.50 3110 IP PHARMACY ORAL31104340 LACTULOSE SYRUP 15ML $ 20.04 $ 20.04 3110 IP PHARMACY ORAL31104341 LACTULOSE SYRUP 30ML $ 22.50 $ 22.50 3110 IP PHARMACY ORAL31104342 LACTULOSE SYRUP 60ML $ 28.46 $ 28.46 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100720 LAMIVUDINE 100MG TAB $ 19.86 $ 19.86 3110 IP PHARMACY ORAL31104345 LAMIVUDINE 10MG/ML $ 22.06 $ 22.06 3110 IP PHARMACY ORAL31100721 LAMIVUDINE 150MG $ 35.54 $ 35.54 3110 IP PHARMACY ORAL31100713 LAMOTRIGINE 100MG $ 27.08 $ 27.08 3110 IP PHARMACY ORAL31100712 LAMOTRIGINE 25MG $ 25.78 $ 25.78 3110 IP PHARMACY ORAL31100711 LAMOTRIGINE 5MG $ 25.48 $ 25.48 3110 IP PHARMACY ORAL31100732 LANSOPRAZOLE 15MG CAP $ 28.46 $ 28.46 3110 IP PHARMACY ORAL31100708 LANSOPRAZOLE 30MG CAP $ 28.46 $ 28.46 3110 IP PHARMACY ORAL31106776 LEPIRUDIN 50MG IJ $ 493.20 $ 493.20 3110 IP PHARMACY ORAL31100725 LEUCOVORIN TAB 25MG $ 73.04 $ 73.04 3110 IP PHARMACY ORAL31100724 LEUCOVORIN TAB 5MG $ 27.94 $ 27.94 3110 IP PHARMACY ORAL31106390 LEUCOVORIN/50MG IJ $ 139.70 $ 139.70 3110 IP PHARMACY ORAL31106912 LEUCOVORIN/50MG IJ $ 65.13 $ 65.13 3110 IP PHARMACY ORAL31106913 LEUCOVORIN/50MG IJ $ 42.35 $ 42.35 3110 IP PHARMACY ORAL31109600 LEUCOVORIN/50MG IJ $ 139.70 $ 139.70 3110 IP PHARMACY ORAL31109660 LEUCOVORIN/50MG IJ $ 139.70 $ 139.70 3110 IP PHARMACY ORAL31106979 LEVETIRACETAM 10MG IJ $ 5.17 $ 5.17 3110 IP PHARMACY ORAL31100742 LEVETIRACETAM 250MG $ 22.62 $ 22.62 3110 IP PHARMACY ORAL31106867 LEVETIRACETAM 500MG INJ $ 225.00 $ 225.00 3110 IP PHARMACY ORAL31100744 LEVETIRACETAM 500MG TAB $ 23.96 $ 23.96 3110 IP PHARMACY ORAL31104337 LEVETIRACETAM 60ML $ 101.28 $ 101.28 3110 IP PHARMACY ORAL31104116 LEVOCARNITINE 120ML $ 73.72 $ 73.72 3110 IP PHARMACY ORAL31107018 LEVOCARNITINE 1GM IJ $ 141.15 $ 141.15 3110 IP PHARMACY ORAL31100723 LEVOCARNITINE 330MG $ 18.46 $ 18.46 3110 IP PHARMACY ORAL31106078 LEVOCARNITINE INJ $ 207.20 $ 207.20 3110 IP PHARMACY ORAL31104112 LEVOCARNITINE LIQ $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100734 LEVOTHYROXINE 0.075MG. $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31100733 LEVOTHYROXINE 0.175MG. $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31106397 LEVOTHYROXINE INJ $ 81.15 $ 81.15 3110 IP PHARMACY ORAL31100739 LEVOTHYROXINE TAB .025MG $ 17.12 $ 17.12 3110 IP PHARMACY ORAL31100740 LEVOTHYROXINE TAB .05MG $ 17.52 $ 17.52 3110 IP PHARMACY ORAL31100741 LEVOTHYROXINE TAB 0.125M $ 17.86 $ 17.86 3110 IP PHARMACY ORAL31100736 LEVOTHYROXINE TAB 0.15MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100735 LEVOTHYROXINE TAB 0.1MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31100737 LEVOTHYROXINE TAB 0.2MG $ 18.60 $ 18.60 3110 IP PHARMACY ORAL31100738 LEVOTHYROXINE TAB 0.3MG $ 18.60 $ 18.60 3110 IP PHARMACY ORAL31106381 LIDO/EPI 0.5% 50ML $ 75.15 $ 75.15 3110 IP PHARMACY ORAL31106388 LIDO/EPI 1% 30ML $ 66.15 $ 66.15 3110 IP PHARMACY ORAL31106371 LIDO/EPI 1% 50ML $ 77.35 $ 77.35 3110 IP PHARMACY ORAL31106387 LIDO/EPI 1.5% 30ML $ 85.09 $ 85.09 3110 IP PHARMACY ORAL31106389 LIDO/EPI 2% 30ML $ 71.07 $ 71.07 3110 IP PHARMACY ORAL31106372 LIDO/EPI 2%/EPI 50ML $ 73.33 $ 73.33 3110 IP PHARMACY ORAL31106775 LIDO/EPI 50ML 0.5% $ 78.15 $ 78.15 3110 IP PHARMACY ORAL31106402 LIDOCAINE 0.5% 50ML $ 74.75 $ 74.75 3110 IP PHARMACY ORAL31106386 LIDOCAINE 1% 2ML INJ $ 69.35 $ 69.35 3110 IP PHARMACY ORAL31106787 LIDOCAINE 1% 2ML INJ $ 69.39 $ 69.39 3110 IP PHARMACY ORAL31106392 LIDOCAINE 1% 30ML INJ $ 80.27 $ 80.27 3110 IP PHARMACY ORAL31106117 LIDOCAINE 1% 30ML SYRG. $ 99.55 $ 99.55 3110 IP PHARMACY ORAL31106403 LIDOCAINE 1% 50ML $ 72.45 $ 72.45 3110 IP PHARMACY ORAL31106396 LIDOCAINE 1% 5ML $ 70.65 $ 70.65 3110 IP PHARMACY ORAL31106383 LIDOCAINE 1% 5ML ABBOJEC $ 87.55 $ 87.55 3110 IP PHARMACY ORAL31106772 LIDOCAINE 1.% $ 70.65 $ 70.65 3110 IP PHARMACY ORAL31106376 LIDOCAINE 1.5% 30ML $ 86.05 $ 86.05 3110 IP PHARMACY ORAL31106495 LIDOCAINE 2 GM INJ $ 104.33 $ 104.33 3110 IP PHARMACY ORAL31106425 LIDOCAINE 2% 10ML $ 82.75 $ 82.75 3110 IP PHARMACY ORAL31106393 LIDOCAINE 2% 20ML $ 68.95 $ 68.95 3110 IP PHARMACY ORAL31106377 LIDOCAINE 2% 50ML INJ $ 74.05 $ 74.05 3110 IP PHARMACY ORAL31106395 LIDOCAINE 2% 5ML $ 67.85 $ 67.85 3110 IP PHARMACY ORAL31106442 LIDOCAINE 2% 5ML $ 69.45 $ 69.45 3110 IP PHARMACY ORAL31106498 LIDOCAINE 4% 5ML $ 71.45 $ 71.45 3110 IP PHARMACY ORAL31106192 LIDOCAINE 4% KIT $ 80.15 $ 80.15 3110 IP PHARMACY ORAL31106398 LIDOCAINE INJ 1% 10ML $ 68.35 $ 68.35 3110 IP PHARMACY ORAL31106369 LIDOCAINE INJ 1% 20ML $ 68.75 $ 68.75 3110 IP PHARMACY ORAL31106400 LIDOCAINE INJ 1% 20ML $ 71.51 $ 71.51 3110 IP PHARMACY ORAL31106401 LIDOCAINE INJ 2% 20ML $ 72.21 $ 72.21 3110 IP PHARMACY ORAL31106399 LIDOCAINE SYR 2% 5ML $ 80.15 $ 80.15 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104347 LIDOCAINE VISC SOL $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31104348 LIDOCAINE VISC SOL 20ML $ 19.24 $ 19.24 3110 IP PHARMACY ORAL31104349 LIDOCAINE VISCOUS 2% 100 $ 61.90 $ 61.90 3110 IP PHARMACY ORAL31100748 LINEZOLID 600MG TAB $ 191.54 $ 191.54 3110 IP PHARMACY ORAL31104344 LINEZOLID SUSP 75ML $ 471.06 $ 471.06 3110 IP PHARMACY ORAL31104346 LINEZOLID SUSP 75ML $ 909.04 $ 909.04 3110 IP PHARMACY ORAL31100756 LISINOPRIL TAB 10MG $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31100757 LISINOPRIL TAB 20MG $ 18.68 $ 18.68 3110 IP PHARMACY ORAL31100755 LISINOPRIL TAB 5MG $ 18.36 $ 18.36 3110 IP PHARMACY ORAL31100754 LISINOPRIL TAPER $ 5.49 $ 5.49 3110 IP PHARMACY ORAL31100758 LITHIUM CAP 300MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100760 LITHIUM CAP 600MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100759 LITHIUM CARB TAB 300MGSR $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31104357 LITHIUM CIT 120ML $ 38.52 $ 38.52 3110 IP PHARMACY ORAL31104356 LITHIUM CIT LIQ $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104354 LITHIUM CIT LIQ 300MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104355 LITHIUM CIT LIQ 600MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100765 LITHIUM TAB 300MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104219 LOMOTIL 60ML $ 123.29 $ 123.29 3110 IP PHARMACY ORAL31104217 LOMOTIL LIQ 10ML $ 35.88 $ 35.88 3110 IP PHARMACY ORAL31104216 LOMOTIL LIQ 5ML $ 34.48 $ 34.48 3110 IP PHARMACY ORAL31100397 LOMOTIL TAB $ 33.94 $ 33.94 3110 IP PHARMACY ORAL31100761 LOMUSTINE 10MG PO $ 25.72 $ 25.72 3110 IP PHARMACY ORAL31107203 LOMUSTINE 10MG PO $ 7.38 $ 7.38 3110 IP PHARMACY ORAL31107204 LOMUSTINE 10MG PO $ 6.45 $ 6.45 3110 IP PHARMACY ORAL31104360 LOPERAMIDE 60ML $ 45.24 $ 45.24 3110 IP PHARMACY ORAL31100764 LOPERAMIDE CAP 2MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104363 LOPERAMIDE HCL LIQ $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104361 LOPERAMIDE HCL LIQ 1MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104362 LOPERAMIDE HCL LIQ 2MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104350 LORATADINE 10MG 10ML $ 19.20 $ 19.20 3110 IP PHARMACY ORAL31100775 LORATADINE 10MG TAB $ 21.60 $ 21.60 3110 IP PHARMACY ORAL31106958 LORAZEPAM 2MG IJ $ 52.14 $ 52.14 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31107019 LORAZEPAM 2MG IJ $ 104.71 $ 104.71 3110 IP PHARMACY ORAL31107205 LORAZEPAM 2MG IJ $ 12.62 $ 12.62 3110 IP PHARMACY ORAL31107206 LORAZEPAM 2MG IJ $ 2.14 $ 2.14 3110 IP PHARMACY ORAL31107207 LORAZEPAM 2MG IJ $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31109058 LORAZEPAM 2MG IJ $ 100.79 $ 100.79 3110 IP PHARMACY ORAL31109059 LORAZEPAM 2MG IJ $ 102.01 $ 102.01 3110 IP PHARMACY ORAL31109060 LORAZEPAM 2MG IJ $ 104.71 $ 104.71 3110 IP PHARMACY ORAL31109062 LORAZEPAM 2MG IJ $ 108.31 $ 108.31 3110 IP PHARMACY ORAL31104365 LORAZEPAM LIQUID $ 339.83 $ 339.83 3110 IP PHARMACY ORAL31103575 LORAZEPAM TAB 0.5MG $ 34.56 $ 34.56 3110 IP PHARMACY ORAL31103576 LORAZEPAM TAB 1MG $ 35.02 $ 35.02 3110 IP PHARMACY ORAL31103577 LORAZEPAM TAB 2MG $ 35.90 $ 35.90 3110 IP PHARMACY ORAL31100767 LOSARTAN 25MG TAB $ 20.44 $ 20.44 3110 IP PHARMACY ORAL31100768 LOSARTAN 50MG $ 20.44 $ 20.44 3110 IP PHARMACY ORAL31100769 LOSARTAN TAB $ 20.20 $ 20.20 3110 IP PHARMACY ORAL31100778 LOVASTATIN 10MG $ 19.22 $ 19.22 3110 IP PHARMACY ORAL31100773 LOVASTATIN TAB 20MG $ 19.22 $ 19.22 3110 IP PHARMACY ORAL31100774 LOVASTATIN TAB 40MG $ 21.14 $ 21.14 3110 IP PHARMACY ORAL31100772 LOXAPINE 5MG $ 18.82 $ 18.82 3110 IP PHARMACY ORAL31100770 LOXAPINE CAP 10MG $ 18.80 $ 18.80 3110 IP PHARMACY ORAL31100771 LOXAPINE CAP 25MG $ 19.90 $ 19.90 3110 IP PHARMACY ORAL31100780 LUBIPROSTONE 24MCG $ 23.10 $ 23.10 3110 IP PHARMACY ORAL31104034 MAG ALOH HYD SUSP $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104031 MAG ALOH HYD SUSP 15ML $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104032 MAG ALOH HYD SUSP 30ML $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104033 MAG ALOH HYD SUSP 60ML $ 19.34 $ 19.34 3110 IP PHARMACY ORAL31104040 MAG ALOH SIMETH ES SUSP $ 18.30 $ 18.30 3110 IP PHARMACY ORAL31104037 MAG ALOH SIMETH SUSP 15ML $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31104038 MAG ALOH SIMETH SUSP 30ML $ 18.30 $ 18.30 3110 IP PHARMACY ORAL31104382 MAG CIT LIQ $ 36.90 $ 36.90 3110 IP PHARMACY ORAL31104380 MAG CIT LIQ 150ML $ 36.90 $ 36.90 3110 IP PHARMACY ORAL31104381 MAG CIT LIQ 300ML $ 36.90 $ 36.90 3110 IP PHARMACY ORAL31109604 MAG CL SYR 1000MG $ 37.28 $ 37.28 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104444 MAG HYDROXIDE SUSP 15ML $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31104445 MAG HYDROXIDE SUSP 30ML $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31104446 MAG HYDROXIDE SUSP 60ML $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31104447 MAG HYDROXIDE SUSP. $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31100782 MAG OXIDE TAB 250M $ 16.76 $ 16.76 3110 IP PHARMACY ORAL31106456 MAG SO4 10ML INJ $ 68.85 $ 68.85 3110 IP PHARMACY ORAL31106737 MAG SO4 50% 50ML VIAL $ 50.08 $ 50.08 3110 IP PHARMACY ORAL31106413 MAG SO4 8MEQ IJ $ 41.58 $ 41.58 3110 IP PHARMACY ORAL31106405 MAG SO4 INJ $ 37.28 $ 37.28 3110 IP PHARMACY ORAL31109605 MAG SO4 SYRINGE $ 38.28 $ 38.28 3110 IP PHARMACY ORAL31106448 MANNITOL 20% 500ML $ 177.47 $ 177.47 3110 IP PHARMACY ORAL31106441 MANNITOL 25% 50ML $ 76.79 $ 76.79 3110 IP PHARMACY ORAL31106412 MANNITOL INJ (20%) $ 119.63 $ 119.63 3110 IP PHARMACY ORAL31106411 MANNITOL IVP INJ (25%) $ 76.79 $ 76.79 3110 IP PHARMACY ORAL31100785 MAPROTILINE HCL TAB 25MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31100786 MAPROTILINE HCL TAB 50MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31100783 MARAVIROC 150MG $ 52.78 $ 52.78 3110 IP PHARMACY ORAL31104385 MCT OIL 30ML $ 45.08 $ 45.08 3110 IP PHARMACY ORAL31104384 MCT OIL 480ML $ 99.88 $ 99.88 3110 IP PHARMACY ORAL31100793 MECLIZINE TAB 12.5MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100794 MECLIZINE TAB 25MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100799 MEDROXYPROGEST TAB 10MG $ 18.36 $ 18.36 3110 IP PHARMACY ORAL31100798 MEDROXYPROGEST TAB 2.5MG $ 17.50 $ 17.50 3110 IP PHARMACY ORAL31107208 MEDROXYPROGESTER 50MG IJ $ 29.41 $ 29.41 3110 IP PHARMACY ORAL31100803 MEGESTROL ACETATE 20MG PO $ 18.34 $ 18.34 3110 IP PHARMACY ORAL31107209 MEGESTROL ACETATE 20MG PO $ 23.12 $ 23.12 3110 IP PHARMACY ORAL31107271 MEGESTROL ACETATE 20MG PO $ 8.72 $ 8.72 3110 IP PHARMACY ORAL31100808 MELPHALAN 2MG PO $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31100801 MEMANTINE 10MG $ 23.16 $ 23.16 3110 IP PHARMACY ORAL31100800 MEMANTINE 5MG $ 23.16 $ 23.16 3110 IP PHARMACY ORAL31103585 MEPERIDINE HCL TAB 50MG $ 34.64 $ 34.64 3110 IP PHARMACY ORAL31109075 MEPERIDINE INJ $ 102.71 $ 102.71 3110 IP PHARMACY ORAL31109074 MEPERIDINE INJ 100MG $ 102.71 $ 102.71 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31109071 MEPERIDINE INJ 25MG $ 102.61 $ 102.61 3110 IP PHARMACY ORAL31109072 MEPERIDINE INJ 50MG $ 102.67 $ 102.67 3110 IP PHARMACY ORAL31109073 MEPERIDINE INJ 75MG $ 102.71 $ 102.71 3110 IP PHARMACY ORAL31109078 MEPERIDINE INJ RANGE $ 106.31 $ 106.31 3110 IP PHARMACY ORAL31109069 MEPERIDINE PCA 10MG/ML $ 118.91 $ 118.91 3110 IP PHARMACY ORAL31109068 MEPERIDINE PCA SYRG. $ 129.35 $ 129.35 3110 IP PHARMACY ORAL31104389 MEPERIDINE SYRUP $ 36.98 $ 36.98 3110 IP PHARMACY ORAL31104388 MEPERIDINE SYRUP 100MG $ 40.78 $ 40.78 3110 IP PHARMACY ORAL31104387 MEPERIDINE SYRUP 50MG $ 36.98 $ 36.98 3110 IP PHARMACY ORAL31109076 MEPERIDINE W/PROMETH INJ $ 101.23 $ 101.23 3110 IP PHARMACY ORAL31109080 MEPERIDINE W/PROMETH INJ $ 101.23 $ 101.23 3110 IP PHARMACY ORAL31109077 MEPERIDINE W/VISTAR INJ $ 101.23 $ 101.23 3110 IP PHARMACY ORAL31109079 MEPERIDINE W/VISTAR INJ $ 101.23 $ 101.23 3110 IP PHARMACY ORAL31106125 MEPIVACAINE 10ML IJ $ 86.11 $ 86.11 3110 IP PHARMACY ORAL31106420 MEPIVACAINE 10ML IJ $ 88.53 $ 88.53 3110 IP PHARMACY ORAL31106571 MEPIVACAINE 10ML IJ $ 93.33 $ 93.33 3110 IP PHARMACY ORAL31100819 MERCAPTOPURINE 50MG PO $ 20.14 $ 20.14 3110 IP PHARMACY ORAL31106918 MEROPENEM 100 MG IJ $ 23.79 $ 23.79 3110 IP PHARMACY ORAL31106919 MEROPENEM 100 MG IJ $ 23.79 $ 23.79 3110 IP PHARMACY ORAL31100883 MESALAMINE 400MG. $ 20.22 $ 20.22 3110 IP PHARMACY ORAL31100863 MESNA 400MG TAB $ 191.54 $ 191.54 3110 IP PHARMACY ORAL31100828 METAPROTERENOL TAB 10MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31100829 METAPROTERENOL TAB 20MG $ 17.56 $ 17.56 3110 IP PHARMACY ORAL31100845 METFORMIN 500MG $ 18.10 $ 18.10 3110 IP PHARMACY ORAL31100846 METFORMIN 850MG TAB $ 19.20 $ 19.20 3110 IP PHARMACY ORAL31106439 METH BLU/ANY VSUAL ADJNCT $ 80.15 $ 80.15 3110 IP PHARMACY ORAL31106920 METH BLU/ANY VSUAL ADJNCT $ 9.62 $ 9.62 3110 IP PHARMACY ORAL31109081 METHADONE 10 MG IJ $ 122.31 $ 122.31 3110 IP PHARMACY ORAL31100407 METHADONE 5MG PO $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31103590 METHADONE 5MG PO $ 33.94 $ 33.94 3110 IP PHARMACY ORAL31104403 METHADONE 5MG PO $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31104406 METHADONE 5MG PO $ 33.18 $ 33.18 3110 IP PHARMACY ORAL31107211 METHADONE 5MG PO $ 16.74 $ 16.74 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31107212 METHADONE 5MG PO $ 4.18 $ 4.18 3110 IP PHARMACY ORAL31107213 METHADONE 5MG PO $ 11.30 $ 11.30 3110 IP PHARMACY ORAL31100834 METHAZOLAMIDE TAB 50MG $ 18.08 $ 18.08 3110 IP PHARMACY ORAL31100843 METHIMAZOLE TAB 10MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100842 METHIMAZOLE TAB 5MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31100848 METHOCARBAMOL TAB 500MG $ 17.42 $ 17.42 3110 IP PHARMACY ORAL31100849 METHOCARBAMOL TAB 750MG $ 17.76 $ 17.76 3110 IP PHARMACY ORAL31100851 METHOTREXATE 2.5MG PO $ 24.62 $ 24.62 3110 IP PHARMACY ORAL31100852 METHOTREXATE 2.5MG PO $ 24.62 $ 24.62 3110 IP PHARMACY ORAL31106824 METHOTREXATE 5MG IJ $ 3.10 $ 3.10 3110 IP PHARMACY ORAL31100856 METHYLDOPA TAB 250MG $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31100857 METHYLDOPA TAB 500MG $ 17.78 $ 17.78 3110 IP PHARMACY ORAL31106426 METHYLDOPATE 250MG IJ $ 89.63 $ 89.63 3110 IP PHARMACY ORAL31100865 METHYLERGONOVIN TAB 0.2MG $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31106428 METHYLERGONOVINE 0.2MG IJ $ 73.15 $ 73.15 3110 IP PHARMACY ORAL31106450 METHYLERGONOVINE 0.2MG IJ $ 73.45 $ 73.45 3110 IP PHARMACY ORAL31103596 METHYLPHENIDATE TAB 10MG $ 34.10 $ 34.10 3110 IP PHARMACY ORAL31103597 METHYLPHENIDATE TAB 20MG $ 34.54 $ 34.54 3110 IP PHARMACY ORAL31103595 METHYLPHENIDATE TAB 5MG $ 33.80 $ 33.80 3110 IP PHARMACY ORAL31106185 METHYLPRED ACET 40MG IJ $ 147.05 $ 147.05 3110 IP PHARMACY ORAL31106430 METHYLPRED ACET 40MG IJ $ 82.33 $ 82.33 3110 IP PHARMACY ORAL31106432 METHYLPRED ACET 40MG IJ $ 82.33 $ 82.33 3110 IP PHARMACY ORAL31106431 METHYLPRED ACET 80MG IJ $ 92.79 $ 92.79 3110 IP PHARMACY ORAL31106434 METHYLPRED SUCC 125MG IJ $ 84.35 $ 84.35 3110 IP PHARMACY ORAL31106921 METHYLPRED SUCC 125MG IJ $ 34.16 $ 34.16 3110 IP PHARMACY ORAL31106922 METHYLPRED SUCC 125MG IJ $ 23.91 $ 23.91 3110 IP PHARMACY ORAL31107107 METHYLPRED SUCC 125MG IJ $ 51.00 $ 51.00 3110 IP PHARMACY ORAL31106433 METHYLPRED SUCC 40MG IJ $ 73.03 $ 73.03 3110 IP PHARMACY ORAL31100868 METHYLPRED TAB 2MG $ 17.36 $ 17.36 3110 IP PHARMACY ORAL31100869 METHYLPREDNISOLONE 4MG PO $ 18.12 $ 18.12 3110 IP PHARMACY ORAL31100872 METHYLPREDNISOLONE 4MG PO $ 1.62 $ 1.62 3110 IP PHARMACY ORAL31107214 METHYLPREDNISOLONE 4MG PO $ 9.29 $ 9.29 3110 IP PHARMACY ORAL31107215 METHYLPREDNISOLONE 4MG PO $ 4.95 $ 4.95 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106443 METOCLOPRAMIDE 10MG IJ $ 70.85 $ 70.85 3110 IP PHARMACY ORAL31106444 METOCLOPRAMIDE 10MG IJ $ 70.85 $ 70.85 3110 IP PHARMACY ORAL31106446 METOCLOPRAMIDE 10MG IJ $ 70.85 $ 70.85 3110 IP PHARMACY ORAL31106923 METOCLOPRAMIDE 10MG IJ $ 34.91 $ 34.91 3110 IP PHARMACY ORAL31104425 METOCLOPRAMIDE LIQ $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31104423 METOCLOPRAMIDE LIQ 10MG $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31104424 METOCLOPRAMIDE LIQ 20MG $ 20.94 $ 20.94 3110 IP PHARMACY ORAL31100881 METOCLOPRAMIDE TAB 10MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31100880 METOCLOPRAMIDE TAB 5MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31100889 METOLAZONE TAB 10MG $ 21.48 $ 21.48 3110 IP PHARMACY ORAL31100887 METOLAZONE TAB 2.5MG $ 20.16 $ 20.16 3110 IP PHARMACY ORAL31100888 METOLAZONE TAB 5MG $ 20.66 $ 20.66 3110 IP PHARMACY ORAL31100890 METOLAZONE TAB 5MG(PEDI) $ 20.66 $ 20.66 3110 IP PHARMACY ORAL31100896 METOPROLOL 25MG TAB $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31106447 METOPROLOL INJ (1MG/ML) $ 70.97 $ 70.97 3110 IP PHARMACY ORAL31100894 METOPROLOL TAB 100MG $ 18.20 $ 18.20 3110 IP PHARMACY ORAL31100893 METOPROLOL TAB 50MG $ 17.68 $ 17.68 3110 IP PHARMACY ORAL31100878 METOPROLOL XL 25MG $ 18.28 $ 18.28 3110 IP PHARMACY ORAL31100879 METOPROLOL XL 50MG $ 18.36 $ 18.36 3110 IP PHARMACY ORAL31106994 METRONIDAZOLE 250MG $ - $ - 3110 IP PHARMACY ORAL31105032 METRONIDAZOLE 300ML SUSP $ 108.08 $ 108.08 3110 IP PHARMACY ORAL31107218 METRONIDAZOLE 500MG IJ $ 81.76 $ 81.76 3110 IP PHARMACY ORAL31109601 METRONIDAZOLE 500MG IJ $ 148.52 $ 148.52 3110 IP PHARMACY ORAL31109602 METRONIDAZOLE 500MG IJ $ 148.52 $ 148.52 3110 IP PHARMACY ORAL31100891 METRONIDAZOLE TAB 250MG $ 17.48 $ 17.48 3110 IP PHARMACY ORAL31100892 METRONIDAZOLE TAB 500MG $ 18.18 $ 18.18 3110 IP PHARMACY ORAL31100900 METYROSINE CAP 250MG $ 20.54 $ 20.54 3110 IP PHARMACY ORAL31100904 MEXILETINE CAP 150MG $ 18.48 $ 18.48 3110 IP PHARMACY ORAL31100905 MEXILETINE CAP 200MG $ 18.78 $ 18.78 3110 IP PHARMACY ORAL31100906 MEXILETINE CAP 250MG $ 18.72 $ 18.72 3110 IP PHARMACY ORAL31107219 MIDAZOLAM 1MG IJ $ 50.80 $ 50.80 3110 IP PHARMACY ORAL31107220 MIDAZOLAM 1MG IJ $ 10.17 $ 10.17 3110 IP PHARMACY ORAL31107221 MIDAZOLAM 1MG IJ $ 1.81 $ 1.81 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31107222 MIDAZOLAM 1MG IJ $ 11.27 $ 11.27 3110 IP PHARMACY ORAL31107278 MIDAZOLAM 1MG IJ $ 0.85 $ 0.85 3110 IP PHARMACY ORAL31109719 MIDAZOLAM 250MG INJ $ 521.38 $ 521.38 3110 IP PHARMACY ORAL31109085 MIDAZOLAM 25MG IJ $ 69.43 $ 69.43 3110 IP PHARMACY ORAL31104456 MIDAZOLAM 5MG SYRP $ 38.48 $ 38.48 3110 IP PHARMACY ORAL31100882 MIDODRINE 10MG TAB $ 28.04 $ 28.04 3110 IP PHARMACY ORAL31100895 MIDRIN TAB $ 17.50 $ 17.50 3110 IP PHARMACY ORAL31106925 MILRINONE/5MG IJ $ 42.58 $ 42.58 3110 IP PHARMACY ORAL31106926 MILRINONE/5MG IJ $ 28.39 $ 28.39 3110 IP PHARMACY ORAL31107223 MILRINONE/5MG IJ $ 37.77 $ 37.77 3110 IP PHARMACY ORAL31109615 MILRINONE/5MG IJ $ 136.50 $ 136.50 3110 IP PHARMACY ORAL31109616 MILRINONE/5MG IJ $ 139.20 $ 139.20 3110 IP PHARMACY ORAL31104461 MINERAL OIL LIQ $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31104459 MINERAL OIL LIQ 15ML $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31104460 MINERAL OIL LIQ 30ML $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100902 MINOCYCLINE 100MG $ 19.92 $ 19.92 3110 IP PHARMACY ORAL31100901 MINOCYCLINE 50MG $ 19.92 $ 19.92 3110 IP PHARMACY ORAL31100912 MINOXIDIL 10MG PO $ 18.22 $ 18.22 3110 IP PHARMACY ORAL31100911 MINOXIDIL TAB 2.5MG $ 17.30 $ 17.30 3110 IP PHARMACY ORAL31105027 MIRACLE MOUTHWASH $ 103.08 $ 103.08 3110 IP PHARMACY ORAL31104401 MIRALAX 119GM $ 43.88 $ 43.88 3110 IP PHARMACY ORAL31104400 MIRALAX 17GM PKT $ 19.86 $ 19.86 3110 IP PHARMACY ORAL31100922 MIRTAZAPINE 15MG $ 21.84 $ 21.84 3110 IP PHARMACY ORAL31100967 MIRTAZAPINE 15MG SOLTAB $ 22.32 $ 22.32 3110 IP PHARMACY ORAL31100884 MIRTAZAPINE 30MG TAB $ 23.02 $ 23.02 3110 IP PHARMACY ORAL31100972 MIRTAZAPINE SOL 30MG $ 22.48 $ 22.48 3110 IP PHARMACY ORAL31109116 MISC INJECTION $ 269.42 $ 269.42 3110 IP PHARMACY ORAL31102000 MISC O/P RX $ - $ - 3110 IP PHARMACY ORAL31109999 MISC ORAL SOLID $ - $ - 3110 IP PHARMACY ORAL31100907 MISOPROSTOL 100MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31100908 MISOPROSTOL TAB 200MCG $ 18.42 $ 18.42 3110 IP PHARMACY ORAL31100910 MOLINDONE 10MG $ 17.80 $ 17.80 3110 IP PHARMACY ORAL31100932 MOLINDONE 25MG $ 21.02 $ 21.02 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100909 MOLINDONE 5MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31100969 MONTELUKAST 10MG $ 24.18 $ 24.18 3110 IP PHARMACY ORAL31100953 MONTELUKAST 4MG CHEW $ 23.76 $ 23.76 3110 IP PHARMACY ORAL31100931 MONTELUKAST 5MG $ 24.16 $ 24.16 3110 IP PHARMACY ORAL31107020 MORPHINE 10MG IJ $ 102.63 $ 102.63 3110 IP PHARMACY ORAL31107224 MORPHINE 10MG IJ $ 39.68 $ 39.68 3110 IP PHARMACY ORAL31107225 MORPHINE 10MG IJ $ 8.13 $ 8.13 3110 IP PHARMACY ORAL31109095 MORPHINE 10MG IJ $ 102.07 $ 102.07 3110 IP PHARMACY ORAL31109097 MORPHINE 10MG IJ $ 102.07 $ 102.07 3110 IP PHARMACY ORAL31109104 MORPHINE 10MG IJ $ 105.39 $ 105.39 3110 IP PHARMACY ORAL31103602 MORPHINE CONT 15MG $ 35.00 $ 35.00 3110 IP PHARMACY ORAL31109110 MORPHINE CONT IV $ 202.86 $ 202.86 3110 IP PHARMACY ORAL31103605 MORPHINE CONT TAB 100MG $ 43.00 $ 43.00 3110 IP PHARMACY ORAL31103603 MORPHINE CONT TAB 30MG $ 37.00 $ 37.00 3110 IP PHARMACY ORAL31103604 MORPHINE CONT TAB 60MG $ 40.84 $ 40.84 3110 IP PHARMACY ORAL31109102 MORPHINE INJ .5MG/ML PSF $ 122.73 $ 122.73 3110 IP PHARMACY ORAL31109096 MORPHINE INJ 15MG $ 102.27 $ 102.27 3110 IP PHARMACY ORAL31109092 MORPHINE INJ 2MG $ 101.87 $ 101.87 3110 IP PHARMACY ORAL31109093 MORPHINE INJ 4MG $ 101.87 $ 101.87 3110 IP PHARMACY ORAL31109103 MORPHINE INJ 5MG PSF $ 118.03 $ 118.03 3110 IP PHARMACY ORAL31109094 MORPHINE INJ 8MG $ 101.97 $ 101.97 3110 IP PHARMACY ORAL31100468 MORPHINE LIQ 10MG $ 17.78 $ 17.78 3110 IP PHARMACY ORAL31100469 MORPHINE LIQ 10MG $ 19.02 $ 19.02 3110 IP PHARMACY ORAL31100471 MORPHINE LIQ 20MG $ 19.02 $ 19.02 3110 IP PHARMACY ORAL31104479 MORPHINE LIQ CONC $ 34.28 $ 34.28 3110 IP PHARMACY ORAL31104477 MORPHINE LIQ CONC 10MG $ 33.48 $ 33.48 3110 IP PHARMACY ORAL31104478 MORPHINE LIQ CONC 20MG $ 34.16 $ 34.16 3110 IP PHARMACY ORAL31104481 MORPHINE LIQ RANGE $ 34.58 $ 34.58 3110 IP PHARMACY ORAL31104468 MORPHINE ORAL 20MG/1ML $ 35.18 $ 35.18 3110 IP PHARMACY ORAL31107226 MORPHINE PF 10MG IJ $ 20.95 $ 20.95 3110 IP PHARMACY ORAL31107227 MORPHINE PF 10MG IJ $ 13.52 $ 13.52 3110 IP PHARMACY ORAL31109099 MORPHINE PF 10MG IJ $ 119.23 $ 119.23 3110 IP PHARMACY ORAL31109105 MORPHINE PF 10MG IJ $ 116.53 $ 116.53 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31109106 MORPHINE PF 10MG IJ $ 117.73 $ 117.73 3110 IP PHARMACY ORAL31109109 MORPHINE RANGE W/PROMETH $ 106.27 $ 106.27 3110 IP PHARMACY ORAL31109107 MORPHINE RANGE W/VISTAR $ 106.31 $ 106.31 3110 IP PHARMACY ORAL31109101 MORPHINE WITH HYDROXYZIN $ 101.73 $ 101.73 3110 IP PHARMACY ORAL31109108 MORPHINE WITH PROMETHAZI $ 101.73 $ 101.73 3110 IP PHARMACY ORAL31105030 MOUTHWASH 1:1:1 $ 36.54 $ 36.54 3110 IP PHARMACY ORAL31105029 MOUTHWASH 1:1:1 10ML $ 36.54 $ 36.54 3110 IP PHARMACY ORAL31105031 MOUTHWASH 1:1:1 300ML $ 53.08 $ 53.08 3110 IP PHARMACY ORAL31105028 MOUTHWASH 1:1:1 5ML $ 36.54 $ 36.54 3110 IP PHARMACY ORAL31106927 MOXIFLOXACIN 100 MG IJ $ 53.48 $ 53.48 3110 IP PHARMACY ORAL31101009 MOXIFLOXACIN 400MG $ 41.98 $ 41.98 3110 IP PHARMACY ORAL31104483 MVI 120ML $ 40.08 $ 40.08 3110 IP PHARMACY ORAL31100917 MVI CHEW TAB $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104485 MVI LIQ $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104488 MVI LIQ $ 17.32 $ 17.32 3110 IP PHARMACY ORAL31104487 MVI LIQ 10ML $ 18.10 $ 18.10 3110 IP PHARMACY ORAL31104486 MVI LIQ 5ML $ 17.32 $ 17.32 3110 IP PHARMACY ORAL31104462 MVI LIQ 60ML $ 47.64 $ 47.64 3110 IP PHARMACY ORAL31104504 MVI PEDI 1ML ORAL $ 16.58 $ 16.58 3110 IP PHARMACY ORAL31106454 MVI PEDI 5ML $ 46.62 $ 46.62 3110 IP PHARMACY ORAL31101536 MVI PRENATAL TAB PO $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100945 MVI RX $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100916 MVI TAB $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100918 MVI THERAPEUTIC TAB $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31104489 MVI/FE $ 52.76 $ 52.76 3110 IP PHARMACY ORAL31104490 MVI/FE $ 37.78 $ 37.78 3110 IP PHARMACY ORAL31104777 MVI/FE 0.5ML $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31100229 MVI/MIN JR. W/EXTRA CA $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100920 MVI/MIN TAB $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100028 MVI/ZNC $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31106452 MVI-12 10ML $ 52.42 $ 52.42 3110 IP PHARMACY ORAL31100867 MYCOPHEN ACID ORAL/180MG $ 28.92 $ 28.92 3110 IP PHARMACY ORAL31101011 MYCOPHEN ACID ORAL/180MG $ 22.64 $ 22.64 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104458 MYCOPHENOLATE 1.5GM-7.5ML $ 31.62 $ 31.62 3110 IP PHARMACY ORAL31104458 MYCOPHENOLATE 1.5GM-7.5ML $ 31.62 $ 31.62 3110 IP PHARMACY ORAL31100866 MYCOPHENOLATE 250MG PO $ 33.02 $ 33.02 3110 IP PHARMACY ORAL31100923 MYCOPHENOLATE 250MG PO $ 24.70 $ 24.70 3110 IP PHARMACY ORAL31106768 MYCOPHENOLATE INJECTION $ 225.20 $ 225.20 3110 IP PHARMACY ORAL31104463 MYCOPHENOLATE SOL 400MG $ 31.62 $ 31.62 3110 IP PHARMACY ORAL31106621 NA ACET 2/ML INJ $ 35.38 $ 35.38 3110 IP PHARMACY ORAL31109642 NA ACET SYRINGE $ 35.58 $ 35.58 3110 IP PHARMACY ORAL31101322 NA BENZOATE 5GM $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31106617 NA BICARB $ 48.58 $ 48.58 3110 IP PHARMACY ORAL31106622 NA BICARB 10MEQ SYRINGE $ 57.94 $ 57.94 3110 IP PHARMACY ORAL31106605 NA BICARB 4.2% 5ML SY $ 91.35 $ 91.35 3110 IP PHARMACY ORAL31106623 NA BICARB 50MEQ SYRINGE $ 71.90 $ 71.90 3110 IP PHARMACY ORAL31106613 NA BICARB 50ML INJ $ 34.78 $ 34.78 3110 IP PHARMACY ORAL31106614 NA BICARB INJ $ 35.18 $ 35.18 3110 IP PHARMACY ORAL31105034 NA BICARB PEDI SYRG $ 34.08 $ 34.08 3110 IP PHARMACY ORAL31101312 NA BICARB TAB 325MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101313 NA BICARB TAB 650MG $ 16.78 $ 16.78 3110 IP PHARMACY ORAL31105037 NA CIT DIHYDR LIQ 30ML $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31106611 NA CL $ 36.28 $ 36.28 3110 IP PHARMACY ORAL31106606 NA CL 10ML $ 34.84 $ 34.84 3110 IP PHARMACY ORAL31106638 NA CL 2ML INJ $ 34.38 $ 34.38 3110 IP PHARMACY ORAL31106624 NA CL 4MEQ/ML $ 68.05 $ 68.05 3110 IP PHARMACY ORAL31106612 NA CL INJ $ 34.08 $ 34.08 3110 IP PHARMACY ORAL31109641 NA CL SYRINGE $ 35.30 $ 35.30 3110 IP PHARMACY ORAL31101319 NA CL TAB 1GM $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31106618 NA PHOS $ 35.38 $ 35.38 3110 IP PHARMACY ORAL31109646 NA PHOS SYRINGE $ 38.34 $ 38.34 3110 IP PHARMACY ORAL31106602 NA THIOSULFATE 10% 10M $ 106.35 $ 106.35 3110 IP PHARMACY ORAL31100928 NADOLOL 120MG $ 19.04 $ 19.04 3110 IP PHARMACY ORAL31101023 NADOLOL 20MG $ 18.38 $ 18.38 3110 IP PHARMACY ORAL31100926 NADOLOL 40MG $ 18.70 $ 18.70 3110 IP PHARMACY ORAL31100927 NADOLOL 80MG $ 18.86 $ 18.86 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106712 NAFCILLIN 1GM INJ $ 116.53 $ 116.53 3110 IP PHARMACY ORAL31109619 NAFCILLIN 501-1000MG $ 148.74 $ 148.74 3110 IP PHARMACY ORAL31109618 NAFCILLIN SYR 500MG $ 139.10 $ 139.10 3110 IP PHARMACY ORAL31106514 NALBUPHINE 10MG IJ $ 71.37 $ 71.37 3110 IP PHARMACY ORAL31106646 NALBUPHINE 10MG IJ $ 68.15 $ 68.15 3110 IP PHARMACY ORAL31106651 NALBUPHINE 10MG IJ $ 71.57 $ 71.57 3110 IP PHARMACY ORAL31106929 NALBUPHINE 10MG IJ $ 31.78 $ 31.78 3110 IP PHARMACY ORAL31106466 NALOXONE 0.4MG INJ $ 78.87 $ 78.87 3110 IP PHARMACY ORAL31106457 NALOXONE 1MG IJ $ 88.67 $ 88.67 3110 IP PHARMACY ORAL31107229 NALOXONE 1MG IJ $ 43.71 $ 43.71 3110 IP PHARMACY ORAL31107230 NALOXONE 1MG IJ $ 54.00 $ 54.00 3110 IP PHARMACY ORAL31107231 NALOXONE 1MG IJ $ 28.66 $ 28.66 3110 IP PHARMACY ORAL31106465 NALOXONE INJ $ 78.87 $ 78.87 3110 IP PHARMACY ORAL31100933 NALTREXONE TAB 50MG $ 22.84 $ 22.84 3110 IP PHARMACY ORAL31104511 NAPROXEN LIQ $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104508 NAPROXEN LIQ 250MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31104509 NAPROXEN LIQ 375MG $ 18.84 $ 18.84 3110 IP PHARMACY ORAL31104510 NAPROXEN LIQ 500MG $ 19.54 $ 19.54 3110 IP PHARMACY ORAL31104507 NAPROXEN SUSP 120ML $ 51.22 $ 51.22 3110 IP PHARMACY ORAL31100937 NAPROXEN TAB 250MG $ 18.22 $ 18.22 3110 IP PHARMACY ORAL31100938 NAPROXEN TAB 375MG $ 18.66 $ 18.66 3110 IP PHARMACY ORAL31100939 NAPROXEN TAB 500MG $ 19.16 $ 19.16 3110 IP PHARMACY ORAL31106966 NATALIZUMAB 1MG INJ $ 30.92 $ 30.92 3110 IP PHARMACY ORAL31100940 NEFAZODONE 10OMG $ 18.84 $ 18.84 3110 IP PHARMACY ORAL31100943 NEFAZODONE 150MG $ 18.86 $ 18.86 3110 IP PHARMACY ORAL31100946 NEFAZODONE TAB $ 18.84 $ 18.84 3110 IP PHARMACY ORAL31100934 NELFINAVIR 250MG TAB $ 21.58 $ 21.58 3110 IP PHARMACY ORAL31100971 NELFINAVIR 625MG $ 26.34 $ 26.34 3110 IP PHARMACY ORAL31104514 NEOMYCIN 500MG LIQ $ 20.54 $ 20.54 3110 IP PHARMACY ORAL31100941 NEOMYCIN TAB 500MG $ 22.84 $ 22.84 3110 IP PHARMACY ORAL31100942 NEOMYCIN TAB PEDI $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31106468 NEOSTIGMINE 0.5 MG IJ $ 94.35 $ 94.35 3110 IP PHARMACY ORAL31106931 NEOSTIGMINE 0.5 MG IJ $ 44.99 $ 44.99 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31100944 NEOSTIGMINE TAB 15MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31106855 NESIRITIDE 0.1 MG IJ $ 91.13 $ 91.13 3110 IP PHARMACY ORAL31106930 NESIRITIDE 0.1 MG IJ $ 98.79 $ 98.79 3110 IP PHARMACY ORAL31104526 NEUTRA-PHOS PACKET $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31104527 NEUTRA-PHOS-K PACKET $ 17.30 $ 17.30 3110 IP PHARMACY ORAL31100935 NEVIRAPINE 200MG TAB $ 34.36 $ 34.36 3110 IP PHARMACY ORAL31100948 NIACIN TAB 100MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100949 NIACIN TAB 500MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31100947 NIACIN TAB 50MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31109712 NICARDIPINE 25MG SYR $ 387.86 $ 387.86 3110 IP PHARMACY ORAL31109711 NICARDIPINE 5MG SYR $ 183.32 $ 183.32 3110 IP PHARMACY ORAL31100952 NICOTINE 2MG (NF) $ - $ - 3110 IP PHARMACY ORAL31100964 NICOTINE LOZENGE $ - $ - 3110 IP PHARMACY ORAL31100956 NIFEDIPINE CAP (PEDI) $ 17.80 $ 17.80 3110 IP PHARMACY ORAL31100959 NIFEDIPINE CAP 10MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31100960 NIFEDIPINE CAP 20MG $ 18.86 $ 18.86 3110 IP PHARMACY ORAL31100961 NIFEDIPINE TAB 30MG ER $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31100955 NIFEDIPINE TAB 60MG ER $ 20.30 $ 20.30 3110 IP PHARMACY ORAL31100954 NIFEDIPINE TAB 90MG ER $ 21.12 $ 21.12 3110 IP PHARMACY ORAL31100962 NIMODIPINE CAP 30MG $ 37.10 $ 37.10 3110 IP PHARMACY ORAL31100963 NIMODIPINE CAP 60MG $ 57.66 $ 57.66 3110 IP PHARMACY ORAL31100966 NITROFURANTOIN CAP 100MG $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31100965 NITROFURANTOIN CAP 50MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31104518 NITROFURANTOIN LIQ 100MG $ 21.34 $ 21.34 3110 IP PHARMACY ORAL31104517 NITROFURANTOIN LIQ 50MG $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31104519 NITROFURANTOIN SUSP $ 18.94 $ 18.94 3110 IP PHARMACY ORAL31104520 NITROFURANTOIN SUSP 60ML $ 67.44 $ 67.44 3110 IP PHARMACY ORAL31109732 NITROPRUSSIDE 10MG $ 171.06 $ 171.06 3110 IP PHARMACY ORAL31106474 NITROPRUSSIDE 50MG INJ $ 171.06 $ 171.06 3110 IP PHARMACY ORAL31109728 NITROPRUSSIDE 5MG $ 136.20 $ 136.20 3110 IP PHARMACY ORAL31109731 NOREPINEPHRINE 2MG SYR $ 143.90 $ 143.90 3110 IP PHARMACY ORAL31109729 NOREPINEPHRINE 4MG SYR $ 155.20 $ 155.20 3110 IP PHARMACY ORAL31106476 NOREPINEPHRINE AMP $ 89.55 $ 89.55 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101014 NORTRIPTYLINE CAP 10MG $ 17.58 $ 17.58 3110 IP PHARMACY ORAL31101015 NORTRIPTYLINE CAP 25MG $ 18.52 $ 18.52 3110 IP PHARMACY ORAL31101016 NORTRIPTYLINE CAP 50MG $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31104525 NORTRIPTYLINE LIQ $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104523 NORTRIPTYLINE LIQ 10MG $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31104524 NORTRIPTYLINE LIQ 25MG $ 18.24 $ 18.24 3110 IP PHARMACY ORAL31106472 NTG 100MCG/ML $ 164.82 $ 164.82 3110 IP PHARMACY ORAL31106483 NTG 50MG IV $ 172.68 $ 172.68 3110 IP PHARMACY ORAL31101006 NTG SL 0.3MG $ 48.64 $ 48.64 3110 IP PHARMACY ORAL31101007 NTG SL 0.4MG $ 48.64 $ 48.64 3110 IP PHARMACY ORAL31101008 NTG SL 0.6MG $ 48.64 $ 48.64 3110 IP PHARMACY ORAL31104532 NYSTATIN LIQ $ 18.34 $ 18.34 3110 IP PHARMACY ORAL31104531 NYSTATIN LIQ 10ML $ 20.34 $ 20.34 3110 IP PHARMACY ORAL31104530 NYSTATIN LIQ 5ML $ 18.34 $ 18.34 3110 IP PHARMACY ORAL31106974 OCTREOTIDE NON DEPO 25MCG $ 18.00 $ 18.00 3110 IP PHARMACY ORAL31106975 OCTREOTIDE NON DEPO 25MCG $ 29.46 $ 29.46 3110 IP PHARMACY ORAL31106976 OCTREOTIDE NON DEPO 25MCG $ 45.78 $ 45.78 3110 IP PHARMACY ORAL31107232 OCTREOTIDE NON DEPO 25MCG $ 160.27 $ 160.27 3110 IP PHARMACY ORAL31101034 OLANZAPINE 10MG TAB $ 47.04 $ 47.04 3110 IP PHARMACY ORAL31101013 OLANZAPINE 2.5MG $ 33.68 $ 33.68 3110 IP PHARMACY ORAL31101027 OLANZAPINE 5MG TAB $ 36.78 $ 36.78 3110 IP PHARMACY ORAL31101032 OLANZAPINE 7.5MG TAB $ 41.16 $ 41.16 3110 IP PHARMACY ORAL31101018 OLANZAPINE ZYDIS 10MG $ 49.48 $ 49.48 3110 IP PHARMACY ORAL31101017 OLANZAPINE ZYDIS 5MG $ 39.20 $ 39.20 3110 IP PHARMACY ORAL31101037 OLSALAZINE 250MG $ 18.32 $ 18.32 3110 IP PHARMACY ORAL31101044 OMEGA-3 ACID ESTERS 1GM $ 19.26 $ 19.26 3110 IP PHARMACY ORAL31104505 OMEPRAZOLE 20MG SUSP $ 28.94 $ 28.94 3110 IP PHARMACY ORAL31101028 OMEPRAZOLE CAP 20MG $ 24.34 $ 24.34 3110 IP PHARMACY ORAL31101042 ONDANSETRON 4MG PO $ 69.04 $ 69.04 3110 IP PHARMACY ORAL31101047 ONDANSETRON 4MG PO $ 23.96 $ 23.96 3110 IP PHARMACY ORAL31106971 ONDANSETRON 8MG IV $ - $ - 3110 IP PHARMACY ORAL31101043 ONDANSETRON 8MG PO $ 104.00 $ 104.00 3110 IP PHARMACY ORAL31101048 ONDANSETRON 8MG PO $ 23.96 $ 23.96 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106952 ONDANSETRON/1MG IJ $ 16.77 $ 16.77 3110 IP PHARMACY ORAL31106953 ONDANSETRON/1MG IJ $ 16.51 $ 16.51 3110 IP PHARMACY ORAL31106970 ONDANSETRON/1MG IJ $ 8.39 $ 8.39 3110 IP PHARMACY ORAL31109620 ONDANSETRON/1MG IJ $ 49.81 $ 49.81 3110 IP PHARMACY ORAL31104512 OPIUM TINCTURE 0.4ML $ 34.08 $ 34.08 3110 IP PHARMACY ORAL31104535 OPIUM TINCTURE 0.6ML $ 33.68 $ 33.68 3110 IP PHARMACY ORAL31104536 OPIUM TINCTURE TINCTURE $ 33.68 $ 33.68 3110 IP PHARMACY ORAL31106786 OPRELVEKIN 5MG IJ $ 678.15 $ 678.15 3110 IP PHARMACY ORAL31104516 OSELTAMIVIR 5ML SUSP $ 27.38 $ 27.38 3110 IP PHARMACY ORAL31101038 OSELTAMIVIR 75MG $ 31.86 $ 31.86 3110 IP PHARMACY ORAL31101046 OXCARBAZEPINE 150MG $ 19.26 $ 19.26 3110 IP PHARMACY ORAL31101500 OXCARBAZEPINE 300MG $ 21.54 $ 21.54 3110 IP PHARMACY ORAL31104502 OXCARBAZEPINE 300MG/5ML $ 20.54 $ 20.54 3110 IP PHARMACY ORAL31101045 OXYBUTYNIN 5MG TAB $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31104537 OXYBUTYNIN LIQ.5MG/5ML $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31103615 OXYCODONE 10MG TAB $ 37.20 $ 37.20 3110 IP PHARMACY ORAL31103616 OXYCODONE 20MG TAB $ 40.96 $ 40.96 3110 IP PHARMACY ORAL31103617 OXYCODONE 40MG TAB $ 47.08 $ 47.08 3110 IP PHARMACY ORAL31104522 OXYCODONE 5ML $ 33.88 $ 33.88 3110 IP PHARMACY ORAL31103623 OXYCODONE 80MG ER $ 35.28 $ 35.28 3110 IP PHARMACY ORAL31104543 OXYCODONE LIQ. 1MG/ML $ 33.98 $ 33.98 3110 IP PHARMACY ORAL31103613 OXYCODONE TAB 5MG $ 33.28 $ 33.28 3110 IP PHARMACY ORAL31106485 OXYTOCIN 10U IJ $ 42.44 $ 42.44 3110 IP PHARMACY ORAL31106487 OXYTOCIN 10U IJ $ 38.78 $ 38.78 3110 IP PHARMACY ORAL31106491 OXYTOCIN 10U IJ $ 42.44 $ 42.44 3110 IP PHARMACY ORAL31106932 OXYTOCIN 10U IJ $ 44.22 $ 44.22 3110 IP PHARMACY ORAL31107233 OXYTOCIN 10U IJ $ 25.26 $ 25.26 3110 IP PHARMACY ORAL31107234 OXYTOCIN 10U IJ $ 4.59 $ 4.59 3110 IP PHARMACY ORAL31106585 PAMIDRONATE/30MG IJ $ 188.48 $ 188.48 3110 IP PHARMACY ORAL31100752 PANCREASE $ 17.48 $ 17.48 3110 IP PHARMACY ORAL31100753 PANCREASE $ 20.32 $ 20.32 3110 IP PHARMACY ORAL31101054 PANCREASE 12 $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31100749 PANCREASE CAP $ 17.46 $ 17.46 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101056 PANCREASE MT 10 $ 18.90 $ 18.90 3110 IP PHARMACY ORAL31101053 PANCREASE MT20 $ 21.48 $ 21.48 3110 IP PHARMACY ORAL31101060 PANCREASE TAB $ 17.48 $ 17.48 3110 IP PHARMACY ORAL31106490 PANCURONIUM INJ $ 93.15 $ 93.15 3110 IP PHARMACY ORAL31106489 PANCURONIUM INJ 100MG $ 94.15 $ 94.15 3110 IP PHARMACY ORAL31101055 PANTOPRAZOLE 40MG TAB $ 24.42 $ 24.42 3110 IP PHARMACY ORAL31106494 PAPAVERINE 60MG INJ $ 69.15 $ 69.15 3110 IP PHARMACY ORAL31106493 PAPAVERINE INJ (30MG/ML) $ 69.15 $ 69.15 3110 IP PHARMACY ORAL31104546 PAREGORIC LIQ $ 33.58 $ 33.58 3110 IP PHARMACY ORAL31104544 PAREGORIC LIQ 10ML $ 34.08 $ 34.08 3110 IP PHARMACY ORAL31104545 PAREGORIC LIQ 5ML $ 33.58 $ 33.58 3110 IP PHARMACY ORAL31107000 PARICALCITOL 1MCG IJ $ 37.73 $ 37.73 3110 IP PHARMACY ORAL31107025 PARICALCITOL 1MCG IJ $ 37.73 $ 37.73 3110 IP PHARMACY ORAL31106869 PARICALCITOL 2MCG $ 75.45 $ 75.45 3110 IP PHARMACY ORAL31101067 PAROMOMYCIN CAP 250MG $ 23.28 $ 23.28 3110 IP PHARMACY ORAL31101066 PAROXETINE 20MG $ 22.10 $ 22.10 3110 IP PHARMACY ORAL31104558 PAROXETINE 20MG/10ML $ 25.84 $ 25.84 3110 IP PHARMACY ORAL31106510 PCN G BENZ 1.2MU IJ $ 167.91 $ 167.91 3110 IP PHARMACY ORAL31106511 PCN G BENZ 2.4MU IJ $ 287.15 $ 287.15 3110 IP PHARMACY ORAL31106505 PCN G BENZ CR 1.2MU IJ $ 147.25 $ 147.25 3110 IP PHARMACY ORAL31106506 PCN G BENZ CR 2.4MU IJ $ 287.15 $ 287.15 3110 IP PHARMACY ORAL31107283 PCN G BENZ CR 2500U IJ $ 0.33 $ 0.33 3110 IP PHARMACY ORAL31107274 PCN G K 600,000U IJ $ 17.36 $ 17.36 3110 IP PHARMACY ORAL31109622 PCN G K SYR 5 MIL. UNITS $ 140.20 $ 140.20 3110 IP PHARMACY ORAL31104549 PCN V K 125/5ML $ 37.88 $ 37.88 3110 IP PHARMACY ORAL31104547 PCN V K 125/5ML 125MG $ 37.88 $ 37.88 3110 IP PHARMACY ORAL31104548 PCN V K 125/5ML 250MG $ 37.88 $ 37.88 3110 IP PHARMACY ORAL31104550 PCN V K 125/5ML, 100ML $ 37.88 $ 37.88 3110 IP PHARMACY ORAL31104553 PCN V K 250MG/5ML $ 41.48 $ 41.48 3110 IP PHARMACY ORAL31104554 PCN V K 250MG/5ML 100ML $ 41.48 $ 41.48 3110 IP PHARMACY ORAL31104551 PCN V K 250MG/5ML 250MG $ 41.48 $ 41.48 3110 IP PHARMACY ORAL31104552 PCN V K 250MG/5ML 500MG $ 41.48 $ 41.48 3110 IP PHARMACY ORAL31101080 PCN V K TAB 250MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101081 PCN V K TAB 500MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31106835 PEG INTER ALFA 2-A 180MCG $ 958.97 $ 958.97 3110 IP PHARMACY ORAL31106803 PEGASPARGASE SNGL DOSE VL $ 5,578.83 $ 5,578.83 3110 IP PHARMACY ORAL31101075 PENICILLAMINE CAP 125MG $ 17.84 $ 17.84 3110 IP PHARMACY ORAL31101076 PENICILLAMINE CAP 250MG $ 18.40 $ 18.40 3110 IP PHARMACY ORAL31109621 PENICILLN G 1MU IJ IP PED $ 134.86 $ 134.86 3110 IP PHARMACY ORAL31109624 PENICILLN G 1MU IJ IP PED $ 135.80 $ 135.80 3110 IP PHARMACY ORAL31107237 PENTAMIDINE 300MG IJ $ 268.29 $ 268.29 3110 IP PHARMACY ORAL31109629 PENTAMIDINE 300MG IJ $ 329.70 $ 329.70 3110 IP PHARMACY ORAL31107235 PENTOBARBITAL 50MG IJ $ 60.24 $ 60.24 3110 IP PHARMACY ORAL31107236 PENTOBARBITAL 50MG IJ $ 14.71 $ 14.71 3110 IP PHARMACY ORAL31109117 PENTOBARBITAL 50MG IJ $ 110.13 $ 110.13 3110 IP PHARMACY ORAL31109119 PENTOBARBITAL 50MG IJ $ 110.13 $ 110.13 3110 IP PHARMACY ORAL31109739 PENTOBARBITAL 50MG IJ $ 219.88 $ 219.88 3110 IP PHARMACY ORAL31109740 PENTOBARBITAL 50MG IJ $ 175.88 $ 175.88 3110 IP PHARMACY ORAL31101086 PENTOXIFYLLINE TAB 400MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31101092 PERPHENAZINE 4MG PO $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31107238 PERPHENAZINE 4MG PO $ 6.73 $ 6.73 3110 IP PHARMACY ORAL31107239 PERPHENAZINE 4MG PO $ 66.07 $ 66.07 3110 IP PHARMACY ORAL31101091 PERPHENAZINE TAB 2MG $ 17.60 $ 17.60 3110 IP PHARMACY ORAL31101100 PHENAZOPYRIDINE TAB100MG $ 17.66 $ 17.66 3110 IP PHARMACY ORAL31101101 PHENAZOPYRIDINE TAB200MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31101105 PHENELZINE TAB 15MG $ 17.08 $ 17.08 3110 IP PHARMACY ORAL31109126 PHENOBARBITAL 120MG IJ $ 102.43 $ 102.43 3110 IP PHARMACY ORAL31109627 PHENOBARBITAL 120MG IJ $ 108.23 $ 108.23 3110 IP PHARMACY ORAL31109124 PHENOBARBITAL INJ $ 103.23 $ 103.23 3110 IP PHARMACY ORAL31109125 PHENOBARBITAL INJ 65MG/M $ 101.63 $ 101.63 3110 IP PHARMACY ORAL31104577 PHENOBARBITAL LIQ $ 34.00 $ 34.00 3110 IP PHARMACY ORAL31104576 PHENOBARBITAL LIQ 20MG $ 34.00 $ 34.00 3110 IP PHARMACY ORAL31103632 PHENOBARBITAL TAB 100MG $ 33.38 $ 33.38 3110 IP PHARMACY ORAL31103629 PHENOBARBITAL TAB 15MG $ 33.28 $ 33.28 3110 IP PHARMACY ORAL31103630 PHENOBARBITAL TAB 30MG $ 33.28 $ 33.28 3110 IP PHARMACY ORAL31103631 PHENOBARBITAL TAB 60MG $ 33.28 $ 33.28 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101112 PHENOXYBENZAMIN CAP10MG $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31109735 PHENTOLAMINE 125MG $ 183.74 $ 183.74 3110 IP PHARMACY ORAL31106516 PHENTOLAMINE 5 MG IJ $ 117.69 $ 117.69 3110 IP PHARMACY ORAL31107279 PHENTOLAMINE 5 MG IJ $ 6.58 $ 6.58 3110 IP PHARMACY ORAL31109734 PHENTOLAMINE 50MG $ 647.74 $ 647.74 3110 IP PHARMACY ORAL31106519 PHENYLEPHRINE 1ML IJ $ 77.65 $ 77.65 3110 IP PHARMACY ORAL31106520 PHENYLEPHRINE 1ML IJ $ 71.15 $ 71.15 3110 IP PHARMACY ORAL31106934 PHENYLEPHRINE 1ML IJ $ 14.40 $ 14.40 3110 IP PHARMACY ORAL31106935 PHENYLEPHRINE 1ML IJ $ 26.29 $ 26.29 3110 IP PHARMACY ORAL31106984 PHENYTOIN 50MG IJ $ 14.81 $ 14.81 3110 IP PHARMACY ORAL31106985 PHENYTOIN 50MG IJ $ 34.26 $ 34.26 3110 IP PHARMACY ORAL31107267 PHENYTOIN 50MG IJ $ 28.38 $ 28.38 3110 IP PHARMACY ORAL31107268 PHENYTOIN 50MG IJ $ 13.65 $ 13.65 3110 IP PHARMACY ORAL31101122 PHENYTOIN CAP 100MG $ 17.06 $ 17.06 3110 IP PHARMACY ORAL31101121 PHENYTOIN CHEW TAB 50MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31104606 PHENYTOIN LIQ $ 17.88 $ 17.88 3110 IP PHARMACY ORAL31104604 PHENYTOIN LIQ 100MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31104605 PHENYTOIN LIQ 300MG $ 20.56 $ 20.56 3110 IP PHARMACY ORAL31100707 PHOSPHORUS 250MG NEUTRAL $ 17.00 $ 17.00 3110 IP PHARMACY ORAL31101116 PHOSPHORUS NEUT 250MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31106518 PHYSOSTIGMINE 2MG INJ $ 85.47 $ 85.47 3110 IP PHARMACY ORAL31106528 PHYSOSTIGMINE INJ $ 85.47 $ 85.47 3110 IP PHARMACY ORAL31104501 PHYTONADIONE 10MG ORAL $ 40.98 $ 40.98 3110 IP PHARMACY ORAL31106533 PHYTONADIONE 1MG IJ $ 76.77 $ 76.77 3110 IP PHARMACY ORAL31106537 PHYTONADIONE 1MG IJ $ 76.77 $ 76.77 3110 IP PHARMACY ORAL31106937 PHYTONADIONE 1MG IJ $ 7.35 $ 7.35 3110 IP PHARMACY ORAL31101132 PHYTONADIONE TAB (PEDI) $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31101131 PHYTONADIONE TAB 5MG $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31106746 PHYTONADIONE TPN ADD $ 46.98 $ 46.98 3110 IP PHARMACY ORAL31101120 PINDOLOL TAB 10MG $ 18.34 $ 18.34 3110 IP PHARMACY ORAL31101119 PINDOLOL TAB 5MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31104100 PINK BISMUTH $ 20.14 $ 20.14 3110 IP PHARMACY ORAL31104098 PINK BISMUTH 15ML $ 20.14 $ 20.14 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104097 PINK BISMUTH 240ML $ 38.12 $ 38.12 3110 IP PHARMACY ORAL31104099 PINK BISMUTH 30ML $ 20.14 $ 20.14 3110 IP PHARMACY ORAL31101138 PIOGLITAZONE 15MG $ 27.06 $ 27.06 3110 IP PHARMACY ORAL31101136 PIOGLITAZONE 30MG $ 32.72 $ 32.72 3110 IP PHARMACY ORAL31101130 PIOGLITAZONE 45MG $ 34.06 $ 34.06 3110 IP PHARMACY ORAL31107243 PIPERACILLIN 500MG IJ $ 39.55 $ 39.55 3110 IP PHARMACY ORAL31107244 PIPERACILLIN 500MG IJ $ 29.05 $ 29.05 3110 IP PHARMACY ORAL31107245 PIPERACILLIN 500MG IJ $ 23.61 $ 23.61 3110 IP PHARMACY ORAL31100645 PLAQUENIL TAB 200MG $ 20.32 $ 20.32 3110 IP PHARMACY ORAL31106527 POLYMYXIN B 50MG INJ $ 76.75 $ 76.75 3110 IP PHARMACY ORAL31104694 POLYSTYRENE $ 30.28 $ 30.28 3110 IP PHARMACY ORAL31104692 POLYSTYRENE 15GM $ 33.82 $ 33.82 3110 IP PHARMACY ORAL31104693 POLYSTYRENE 30GM $ 29.98 $ 29.98 3110 IP PHARMACY ORAL31104600 POSACONAZOLE 60ML $ 575.46 $ 575.46 3110 IP PHARMACY ORAL31106544 PRALIDOXIME 1GM IJ $ 214.65 $ 214.65 3110 IP PHARMACY ORAL31101144 PRAMIPEXOLE 0.25MG $ 18.56 $ 18.56 3110 IP PHARMACY ORAL31101146 PRAMIPEXOLE 0.25MG TAB $ 18.58 $ 18.58 3110 IP PHARMACY ORAL31101145 PRAMIPEXOLE 1MG $ 20.68 $ 20.68 3110 IP PHARMACY ORAL31100186 PRASUGREL 10MG $ 29.60 $ 29.60 3110 IP PHARMACY ORAL31101186 PRASUGREL 10MG $ 29.60 $ 29.60 3110 IP PHARMACY ORAL31101885 PRASUGREL 5MG $ 28.96 $ 28.96 3110 IP PHARMACY ORAL31101139 PRAVASTATIN 20MG TAB $ 23.06 $ 23.06 3110 IP PHARMACY ORAL31101140 PRAVASTATIN 40MG TAB $ 26.10 $ 26.10 3110 IP PHARMACY ORAL31101148 PRAZOSIN HCL CAP 1MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31101149 PRAZOSIN HCL CAP 2MG $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31101150 PRAZOSIN HCL CAP 5MG $ 18.62 $ 18.62 3110 IP PHARMACY ORAL31104665 PREDNISOLONE 15MG/5ML $ 19.78 $ 19.78 3110 IP PHARMACY ORAL31104660 PREDNISOLONE 20ML $ 41.50 $ 41.50 3110 IP PHARMACY ORAL31104602 PREDNISOLONE 5MG PO $ 2.26 $ 2.26 3110 IP PHARMACY ORAL31104626 PREDNISOLONE 5MG PO $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104627 PREDNISOLONE 5MG PO $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31101155 PREDNISONE 5MG PO $ 16.76 $ 16.76 3110 IP PHARMACY ORAL31104624 PREDNISONE 5MG PO $ 17.84 $ 17.84 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104625 PREDNISONE 5MG PO $ 0.32 $ 0.32 3110 IP PHARMACY ORAL31104632 PREDNISONE 60ML LIQ $ 44.92 $ 44.92 3110 IP PHARMACY ORAL31104631 PREDNISONE LQ 5MG/ML 30ML $ 56.14 $ 56.14 3110 IP PHARMACY ORAL31101159 PREDNISONE TAB $ 0.32 $ 0.32 3110 IP PHARMACY ORAL31101161 PREDNISONE TAB $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101156 PREDNISONE TAB 10MG $ 16.76 $ 16.76 3110 IP PHARMACY ORAL31101153 PREDNISONE TAB 1MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101154 PREDNISONE TAB 2.5MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31101157 PREDNISONE TAB 20MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101158 PREDNISONE TAB 50MG $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31101165 PREGABALIN 100MG $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31101166 PREGABALIN 25MG $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31104644 PREGABALIN 50MG $ 22.18 $ 22.18 3110 IP PHARMACY ORAL31103640 PREGABALIN 75MG $ 38.72 $ 38.72 3110 IP PHARMACY ORAL31101168 PRIMAQUINE TAB 26.3MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31104633 PRIMIDONE 60ML $ 50.68 $ 50.68 3110 IP PHARMACY ORAL31104630 PRIMIDONE LIQ $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31104629 PRIMIDONE LIQ 500MG $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31101163 PRIMIDONE TAB 250MG $ 17.60 $ 17.60 3110 IP PHARMACY ORAL31101162 PRIMIDONE TAB 50MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31100303 PROBENECID TAB $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31101172 PROBENECID TAB 500MG $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31106545 PROCAINAMIDE 1GM IJ $ 132.57 $ 132.57 3110 IP PHARMACY ORAL31106546 PROCAINAMIDE 1GM IJ $ 132.57 $ 132.57 3110 IP PHARMACY ORAL31106547 PROCAINAMIDE 1GM IJ $ 132.57 $ 132.57 3110 IP PHARMACY ORAL31106556 PROCAINE 1% 2ML $ 72.29 $ 72.29 3110 IP PHARMACY ORAL31101188 PROCARBAZINE 50MG PO $ 106.82 $ 106.82 3110 IP PHARMACY ORAL31101193 PROCHLORPERAZIN TAB 10MG $ 18.40 $ 18.40 3110 IP PHARMACY ORAL31101192 PROCHLORPERAZIN TAB 5MG $ 17.80 $ 17.80 3110 IP PHARMACY ORAL31106551 PROCHLORPERAZINE 10MG IJ $ 73.35 $ 73.35 3110 IP PHARMACY ORAL31106552 PROCHLORPERAZINE 10MG IJ $ 73.35 $ 73.35 3110 IP PHARMACY ORAL31106555 PROGESTERONE 50MG IJ $ 79.95 $ 79.95 3110 IP PHARMACY ORAL31106558 PROGESTERONE 50MG IJ $ 83.75 $ 83.75 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31104648 PROMETH/COD LIQ $ 33.98 $ 33.98 3110 IP PHARMACY ORAL31104647 PROMETH/COD LIQ 10ML $ 36.88 $ 36.88 3110 IP PHARMACY ORAL31104646 PROMETH/COD LIQ 5ML $ 34.98 $ 34.98 3110 IP PHARMACY ORAL31106560 PROMETHAZINE 50 MG IJ $ 71.15 $ 71.15 3110 IP PHARMACY ORAL31106561 PROMETHAZINE INJ $ 70.93 $ 70.93 3110 IP PHARMACY ORAL31106559 PROMETHAZINE INJ 25MG $ 70.93 $ 70.93 3110 IP PHARMACY ORAL31106562 PROMETHAZINE RANGE INJ $ 70.93 $ 70.93 3110 IP PHARMACY ORAL31101204 PROPAFENONE 150MG $ 20.02 $ 20.02 3110 IP PHARMACY ORAL31106780 PROPOFOL 100ML IV $ 251.15 $ 251.15 3110 IP PHARMACY ORAL31106564 PROPOFOL 200MG $ 136.97 $ 136.97 3110 IP PHARMACY ORAL31106565 PROPOFOL 50ML INJ. $ 175.13 $ 175.13 3110 IP PHARMACY ORAL31106566 PROPRANOLOL 1MG IJ $ 88.27 $ 88.27 3110 IP PHARMACY ORAL31106567 PROPRANOLOL 1MG IJ $ 88.27 $ 88.27 3110 IP PHARMACY ORAL31101212 PROPRANOLOL HCL TAB 10MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31101213 PROPRANOLOL HCL TAB 20MG $ 17.44 $ 17.44 3110 IP PHARMACY ORAL31101214 PROPRANOLOL HCL TAB 40MG $ 17.70 $ 17.70 3110 IP PHARMACY ORAL31101215 PROPRANOLOL HCL TAB 60MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31101216 PROPRANOLOL HCL TAB 80MG $ 18.20 $ 18.20 3110 IP PHARMACY ORAL31104651 PROPRANOLOL LIQUID $ 17.24 $ 17.24 3110 IP PHARMACY ORAL31101219 PROPYLTHIOURACL TAB 50MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31106572 PROTAMINE 10MG IJ $ 79.43 $ 79.43 3110 IP PHARMACY ORAL31106938 PROTAMINE 10MG IJ $ 14.81 $ 14.81 3110 IP PHARMACY ORAL31101229 PSEUD/TRIP TAB $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31104654 PSEUDOEPHEDRINE LIQ $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104652 PSEUDOEPHEDRINE LIQ 30MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104653 PSEUDOEPHEDRINE LIQ 60MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101226 PSEUDOEPHEDRINE TAB 30MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31101227 PSEUDOEPHEDRINE TAB 60MG $ 16.86 $ 16.86 3110 IP PHARMACY ORAL31104661 PSYLLIUM PACKETS $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31101233 PYRAZINAMIDE TAB 500MG $ 18.64 $ 18.64 3110 IP PHARMACY ORAL31106582 PYRIDOSTIGMINE 100MG $ 70.65 $ 70.65 3110 IP PHARMACY ORAL31104664 PYRIDOSTIGMINE 120ML $ 46.70 $ 46.70 3110 IP PHARMACY ORAL31104663 PYRIDOSTIGMINE 5ML LIQ. $ 16.94 $ 16.94 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106581 PYRIDOSTIGMINE INJ $ 76.23 $ 76.23 3110 IP PHARMACY ORAL31101238 PYRIDOSTIGMINE TAB 60MG $ 17.18 $ 17.18 3110 IP PHARMACY ORAL31101239 PYRIDOSTIGMINE TMSPN180MG $ 18.02 $ 18.02 3110 IP PHARMACY ORAL31106583 PYRIDOXINE HCL 100 MG IJ $ 69.05 $ 69.05 3110 IP PHARMACY ORAL31101243 PYRIDOXINE HCL TAB 100MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101241 PYRIDOXINE HCL TAB 25MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101242 PYRIDOXINE HCL TAB 50MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101345 PYRIMETHAMINE TAB $ 21.44 $ 21.44 3110 IP PHARMACY ORAL31101245 PYRIMETHAMINE TAB 25MG $ 17.32 $ 17.32 3110 IP PHARMACY ORAL31101256 QUETIAPINE 100MG TABLET $ 25.56 $ 25.56 3110 IP PHARMACY ORAL31101249 QUETIAPINE 200MG $ 33.56 $ 33.56 3110 IP PHARMACY ORAL31101255 QUETIAPINE 25MG TABLET $ 21.80 $ 21.80 3110 IP PHARMACY ORAL31106586 QUINIDINE GLUC 10ML $ 96.01 $ 96.01 3110 IP PHARMACY ORAL31106587 QUINIDINE GLUC INJ $ 96.01 $ 96.01 3110 IP PHARMACY ORAL31101265 QUINIDINE GLUC TAB 324MG $ 17.72 $ 17.72 3110 IP PHARMACY ORAL31101267 QUINIDINE SO4 TAB 200MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31101269 QUINIDINE SO4 TAB 300MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31101276 QUININE SO4 CAP 200MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31101277 QUININE SO4 CAP 300MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101284 RALOXIFENE 60MG TAB $ 20.76 $ 20.76 3110 IP PHARMACY ORAL31101240 RALTEGRAVIR 400MG $ 52.34 $ 52.34 3110 IP PHARMACY ORAL31101275 RAMIPRIL 2.5MG $ 20.40 $ 20.40 3110 IP PHARMACY ORAL31101254 RAMIPRIL 5MG $ 21.28 $ 21.28 3110 IP PHARMACY ORAL31107247 RANITIDINE 25MG IJ $ 29.85 $ 29.85 3110 IP PHARMACY ORAL31107248 RANITIDINE 25MG IJ $ 70.72 $ 70.72 3110 IP PHARMACY ORAL31104666 RANITIDINE LIQUID $ 39.86 $ 39.86 3110 IP PHARMACY ORAL31101248 RANOLAZINE 500MG $ 24.00 $ 24.00 3110 IP PHARMACY ORAL31109135 REMIFENTANIL 1MG INJ $ 125.61 $ 125.61 3110 IP PHARMACY ORAL31106599 RHO D H SD 100 IU IJ $ 82.76 $ 82.76 3110 IP PHARMACY ORAL31101290 RIBAVIRIN 200MG CAP $ 38.62 $ 38.62 3110 IP PHARMACY ORAL31101289 RIFABUTIN 150 MG. $ 30.80 $ 30.80 3110 IP PHARMACY ORAL31101291 RIFAMPIN CAP 150MG $ 19.46 $ 19.46 3110 IP PHARMACY ORAL31101292 RIFAMPIN CAP 300MG $ 20.76 $ 20.76 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101323 RIFAXIMIN 200MG $ 27.34 $ 27.34 3110 IP PHARMACY ORAL31101280 RILUZOLE 50MG $ 46.54 $ 46.54 3110 IP PHARMACY ORAL31101264 RISEDRONATE 30MG TAB $ 53.90 $ 53.90 3110 IP PHARMACY ORAL31101261 RISEDRONATE 5MG TAB $ 21.86 $ 21.86 3110 IP PHARMACY ORAL31101262 RISPERIDONE 0.25MG TAB $ 24.12 $ 24.12 3110 IP PHARMACY ORAL31101340 RISPERIDONE 0.5MG $ 25.26 $ 25.26 3110 IP PHARMACY ORAL31101263 RISPERIDONE 0.5MG TAB $ 21.60 $ 21.60 3110 IP PHARMACY ORAL31101293 RISPERIDONE 1MG $ 25.38 $ 25.38 3110 IP PHARMACY ORAL31101341 RISPERIDONE 1MG $ 26.70 $ 26.70 3110 IP PHARMACY ORAL31101294 RISPERIDONE 2MG $ 31.34 $ 31.34 3110 IP PHARMACY ORAL31101295 RISPERIDONE 3MG $ 33.92 $ 33.92 3110 IP PHARMACY ORAL31101298 RISPERIDONE 4MG $ 39.86 $ 39.86 3110 IP PHARMACY ORAL31107249 RISPERIDONE LA 0.5MG IJ $ 13.80 $ 13.80 3110 IP PHARMACY ORAL31104674 RISPERIDONE LIQUID $ 26.44 $ 26.44 3110 IP PHARMACY ORAL31101283 RISPERIDONE TAB $ 24.86 $ 24.86 3110 IP PHARMACY ORAL31101274 RITONAVIR 100MG $ 20.26 $ 20.26 3110 IP PHARMACY ORAL31104668 RITONAVIR 80MG/ML $ 29.50 $ 29.50 3110 IP PHARMACY ORAL31106598 ROCURONIUM INJ 5ML $ 171.65 $ 171.65 3110 IP PHARMACY ORAL31101278 ROPINIROLE 0.25MG $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31101250 ROPINIROLE 0.25MG TAB $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31101251 ROPINIROLE 0.5MG TAB $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31101279 ROPINIROLE 1 MG $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31101252 ROPINIROLE 1MG TAB $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31101253 ROPINIROLE 2MG TAB $ 21.66 $ 21.66 3110 IP PHARMACY ORAL31107114 ROPIVACAINE 1MG IJ $ 0.35 $ 0.35 3110 IP PHARMACY ORAL31101257 ROSIGLITAZONE 2MG TAB $ 21.36 $ 21.36 3110 IP PHARMACY ORAL31101258 ROSIGLITAZONE 4MG TAB $ 23.40 $ 23.40 3110 IP PHARMACY ORAL31101259 ROSIGLITAZONE 8MG TAB $ 29.26 $ 29.26 3110 IP PHARMACY ORAL31106764 RSV MONO AB REC IM 50MG $ 1,746.42 $ 1,746.42 3110 IP PHARMACY ORAL31104593 RYNATUSS PED LIQ $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31100528 SACCHAROMYCES BOUL 250MG $ 18.10 $ 18.10 3110 IP PHARMACY ORAL31104442 SALIVA SUBSTITE 60ML $ 43.08 $ 43.08 3110 IP PHARMACY ORAL31104670 SALIVA SUBSTITE 75GM $ 43.18 $ 43.18 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101305 SAQUINAVIR 200MG PO $ 20.02 $ 20.02 3110 IP PHARMACY ORAL31101306 SAQUINAVIR 200MG PO $ 20.88 $ 20.88 3110 IP PHARMACY ORAL31101318 SAQUINAVIR 500MG $ 29.00 $ 29.00 3110 IP PHARMACY ORAL31106607 SCOPOLAMINE 1MG INJ $ 66.35 $ 66.35 3110 IP PHARMACY ORAL31106608 SCOPOLAMINE INJ $ 67.25 $ 67.25 3110 IP PHARMACY ORAL31101299 SELEGILINE TAB 5MG (NF) $ 23.26 $ 23.26 3110 IP PHARMACY ORAL31106804 SELENIUM 1-400MCG INJ $ 38.68 $ 38.68 3110 IP PHARMACY ORAL31101300 SELENIUM TAB 50MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31104679 SENNA 60ML SYRUP $ 49.18 $ 49.18 3110 IP PHARMACY ORAL31101301 SENNA CONC TAB 187MG $ 16.92 $ 16.92 3110 IP PHARMACY ORAL31104678 SENNA LIQ $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104677 SENNA LIQ 10ML $ 17.74 $ 17.74 3110 IP PHARMACY ORAL31104676 SENNA LIQ 5ML $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31101303 SERTRALINE 100MG TAB $ 21.96 $ 21.96 3110 IP PHARMACY ORAL31101309 SERTRALINE 25MG TAB $ 21.96 $ 21.96 3110 IP PHARMACY ORAL31104681 SERTRALINE 30ML $ 21.86 $ 21.86 3110 IP PHARMACY ORAL31101302 SERTRALINE 50MG TAB $ 21.96 $ 21.96 3110 IP PHARMACY ORAL31101314 SEVELAMER 400MG TAB $ 18.66 $ 18.66 3110 IP PHARMACY ORAL31101310 SEVELAMER 403MG $ 20.80 $ 20.80 3110 IP PHARMACY ORAL31101344 SEVELAMER CARB 800MG $ 20.64 $ 20.64 3110 IP PHARMACY ORAL31101358 SILDENAFIL 20MG PO $ 51.22 $ 51.22 3110 IP PHARMACY ORAL31101315 SILDENAFIL 25MG PO $ 37.74 $ 37.74 3110 IP PHARMACY ORAL31104683 SIMETHICONE DROPS $ 53.88 $ 53.88 3110 IP PHARMACY ORAL31101308 SIMETHICONE TAB 80MG $ 16.90 $ 16.90 3110 IP PHARMACY ORAL31101351 SIMVASTATIN 10MG $ 22.10 $ 22.10 3110 IP PHARMACY ORAL31101354 SIMVASTATIN 20MG $ 25.34 $ 25.34 3110 IP PHARMACY ORAL31101357 SIMVASTATIN 40MG $ 26.38 $ 26.38 3110 IP PHARMACY ORAL31106654 SINCALIDE 5MCG IJ $ 121.01 $ 121.01 3110 IP PHARMACY ORAL31100213 SINEMET 10/100 TAB $ 17.82 $ 17.82 3110 IP PHARMACY ORAL31100214 SINEMET 25/100 TAB $ 17.92 $ 17.92 3110 IP PHARMACY ORAL31100215 SINEMET 25/250 TAB $ 18.32 $ 18.32 3110 IP PHARMACY ORAL31100218 SINEMET CR 50/200 $ 20.78 $ 20.78 3110 IP PHARMACY ORAL31101304 SINEMET CR 50/200 $ 20.78 $ 20.78 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101316 SIROLIMUS/1MG PO $ 35.66 $ 35.66 3110 IP PHARMACY ORAL31104696 SIROLIMUS/1MG PO $ 43.94 $ 43.94 3110 IP PHARMACY ORAL31107136 SMZ/TMP 10ML IJ $ 42.18 $ 42.18 3110 IP PHARMACY ORAL31109645 SMZ/TMP 10ML IJ $ 144.36 $ 144.36 3110 IP PHARMACY ORAL31101317 SOD BENZOATE 5GM $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101329 SORAFENIB 200MG $ 125.18 $ 125.18 3110 IP PHARMACY ORAL31104703 SORBITOL LIQ (70%) $ 18.24 $ 18.24 3110 IP PHARMACY ORAL31104699 SORBITOL LIQ (70%) 15ML $ 18.24 $ 18.24 3110 IP PHARMACY ORAL31104701 SORBITOL LIQ (70%) 30ML $ 18.24 $ 18.24 3110 IP PHARMACY ORAL31104702 SORBITOL LIQ (70%) 60ML $ 19.84 $ 19.84 3110 IP PHARMACY ORAL31101327 SOTALOL 160 MG. $ 23.60 $ 23.60 3110 IP PHARMACY ORAL31101328 SOTALOL 240 MG. $ 25.72 $ 25.72 3110 IP PHARMACY ORAL31101326 SOTALOL 80MG $ 23.10 $ 23.10 3110 IP PHARMACY ORAL31105043 SPIRONOLACTONE LIQ $ 53.08 $ 53.08 3110 IP PHARMACY ORAL31105044 SPIRONOLACTONE SUSP ORAL $ 24.90 $ 24.90 3110 IP PHARMACY ORAL31101332 SPIRONOLACTONE TAB 100MG $ 19.48 $ 19.48 3110 IP PHARMACY ORAL31101330 SPIRONOLACTONE TAB 25MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31101331 SPIRONOLACTONE TAB 50MG $ 19.98 $ 19.98 3110 IP PHARMACY ORAL31107112 STATISTICAL TRACKING $ - $ - 3110 IP PHARMACY ORAL31101333 STAVUDINE 15MG $ 27.96 $ 27.96 3110 IP PHARMACY ORAL31101334 STAVUDINE 20MG $ 28.46 $ 28.46 3110 IP PHARMACY ORAL31101335 STAVUDINE 30MG $ 29.14 $ 29.14 3110 IP PHARMACY ORAL31101339 STAVUDINE 40MG $ 29.40 $ 29.40 3110 IP PHARMACY ORAL31104705 STAVUDINE SUSP 1MG/ML 20 $ 156.96 $ 156.96 3110 IP PHARMACY ORAL31106626 STREPTOMYCIN 1GM IJ $ 71.25 $ 71.25 3110 IP PHARMACY ORAL31106631 SUCCINYLCHOLINE 20MG IJ $ 68.39 $ 68.39 3110 IP PHARMACY ORAL31105048 SUCRALFATE 1GM/10ML $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31104711 SUCRALFATE SUSP. $ 20.70 $ 20.70 3110 IP PHARMACY ORAL31101338 SUCRALFATE TAB 1GM $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31101336 SUCRALFATE TAB 250MG $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31109154 SUFENTANIL 2ML $ 149.23 $ 149.23 3110 IP PHARMACY ORAL31109152 SUFENTANIL INJ $ 147.35 $ 147.35 3110 IP PHARMACY ORAL31109151 SUFENTANIL INJ 1ML $ 127.41 $ 127.41 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31109153 SUFENTANIL INJ 5ML $ 199.23 $ 199.23 3110 IP PHARMACY ORAL31101342 SULFADIAZINE TAB 500MG $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31101349 SULFAMETHOXAZOL DS TAB $ 18.82 $ 18.82 3110 IP PHARMACY ORAL31101355 SULFASALAZINE TAB 500MG $ 17.18 $ 17.18 3110 IP PHARMACY ORAL31101356 SULFASALAZINE TAB 500MGE $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31101361 SUMATRIPTAN 50MG TAB $ 67.42 $ 67.42 3110 IP PHARMACY ORAL31106640 SUMATRIPTAN INJECTION $ 250.55 $ 250.55 3110 IP PHARMACY ORAL31101365 TACROLIMUS 0.5MG $ 21.30 $ 21.30 3110 IP PHARMACY ORAL31101374 TACROLIMUS 0.5MG $ 21.30 $ 21.30 3110 IP PHARMACY ORAL31101346 TACROLIMUS/1MG PO $ 33.02 $ 33.02 3110 IP PHARMACY ORAL31101372 TACROLIMUS/1MG PO $ 25.10 $ 25.10 3110 IP PHARMACY ORAL31106706 TACROLIMUS/5MG IJ $ 473.74 $ 473.74 3110 IP PHARMACY ORAL31109647 TACROLIMUS/5MG IJ $ 473.74 $ 473.74 3110 IP PHARMACY ORAL31101376 TAMOXIFEN 10MG PO $ 19.90 $ 19.90 3110 IP PHARMACY ORAL31107250 TAMOXIFEN 10MG PO $ 12.07 $ 12.07 3110 IP PHARMACY ORAL31101377 TAMSULOSIN 0.4MG TAB $ 25.14 $ 25.14 3110 IP PHARMACY ORAL31103646 TEMAZEPAM 7.5MG. CAP $ 52.96 $ 52.96 3110 IP PHARMACY ORAL31103648 TEMAZEPAM CAP 15MG $ 34.46 $ 34.46 3110 IP PHARMACY ORAL31101381 TEMOZOLOMIDE 100MG $ - $ - 3110 IP PHARMACY ORAL31101384 TEMOZOLOMIDE 5MG PO $ 36.82 $ 36.82 3110 IP PHARMACY ORAL31101385 TEMOZOLOMIDE 5MG PO $ 26.16 $ 26.16 3110 IP PHARMACY ORAL31101387 TEMOZOLOMIDE 5MG PO $ 26.16 $ 26.16 3110 IP PHARMACY ORAL31106998 TENECTEPLASE 1MG IJ $ 126.57 $ 126.57 3110 IP PHARMACY ORAL31101380 TENOFOVIR 300MG $ 62.56 $ 62.56 3110 IP PHARMACY ORAL31101388 TERAZOSIN 1MG. $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31101389 TERAZOSIN 2MG $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31101390 TERAZOSIN 5MG TAB $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31106644 TERBUTALINE 1MG IJ $ 128.51 $ 128.51 3110 IP PHARMACY ORAL31106645 TERBUTALINE 1MG IJ $ 128.51 $ 128.51 3110 IP PHARMACY ORAL31106939 TERBUTALINE 1MG IJ $ 83.46 $ 83.46 3110 IP PHARMACY ORAL31106940 TERBUTALINE 1MG IJ $ 70.72 $ 70.72 3110 IP PHARMACY ORAL31107251 TERBUTALINE 1MG IJ $ 79.85 $ 79.85 3110 IP PHARMACY ORAL31107252 TERBUTALINE 1MG IJ $ 46.75 $ 46.75 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101382 TERBUTALINE TAB 2.5MG $ 17.48 $ 17.48 3110 IP PHARMACY ORAL31101383 TERBUTALINE TAB 5MG $ 17.78 $ 17.78 3110 IP PHARMACY ORAL31106648 TESTOSTERONE CYP 100MG IJ $ 122.83 $ 122.83 3110 IP PHARMACY ORAL31106650 TESTOSTERONE CYP 100MG IJ $ 147.69 $ 147.69 3110 IP PHARMACY ORAL31107004 TESTOSTERONE CYP 100MG IJ $ 119.55 $ 119.55 3110 IP PHARMACY ORAL31106657 TETRACAINE 1% 2ML $ 73.25 $ 73.25 3110 IP PHARMACY ORAL31101391 TETRACYCLINE CAP 250MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31101392 TETRACYCLINE CAP 500MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101414 THALIDOMIDE 100MG $ 363.54 $ 363.54 3110 IP PHARMACY ORAL31101415 THALIDOMIDE 200MG $ 411.54 $ 411.54 3110 IP PHARMACY ORAL31101413 THALIDOMIDE 50MG $ 230.32 $ 230.32 3110 IP PHARMACY ORAL31106941 THEOPHYLLINE 40 MG IJ $ 16.10 $ 16.10 3110 IP PHARMACY ORAL31101398 THEOPHYLLINE CAP 100MG $ 17.38 $ 17.38 3110 IP PHARMACY ORAL31101395 THEOPHYLLINE ER 100MG CA $ 17.00 $ 17.00 3110 IP PHARMACY ORAL31101405 THEOPHYLLINE ER 200MG CAP $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31101406 THEOPHYLLINE ER 300MG CAP $ 17.26 $ 17.26 3110 IP PHARMACY ORAL31104729 THEOPHYLLINE LIQ $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31104728 THEOPHYLLINE LIQ 80MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101399 THEOPHYLLINE TAB 100MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31101401 THEOPHYLLINE TAB 200MG $ 17.36 $ 17.36 3110 IP PHARMACY ORAL31101403 THEOPHYLLINE TAB 300MG $ 17.50 $ 17.50 3110 IP PHARMACY ORAL31106662 THIAMINE 100MG $ 35.48 $ 35.48 3110 IP PHARMACY ORAL31106660 THIAMINE HCL 100 MG IJ $ 56.92 $ 56.92 3110 IP PHARMACY ORAL31106661 THIAMINE HCL 100 MG IJ $ 56.92 $ 56.92 3110 IP PHARMACY ORAL31101412 THIAMINE TAB 100MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101411 THIAMINE TAB 50MG $ 16.64 $ 16.64 3110 IP PHARMACY ORAL31101420 THIOGUANINE TAB 40MG $ 24.54 $ 24.54 3110 IP PHARMACY ORAL31109170 THIOPENTAL 250MG $ 104.23 $ 104.23 3110 IP PHARMACY ORAL31109171 THIOPENTAL 500MG $ 113.73 $ 113.73 3110 IP PHARMACY ORAL31101436 THIOTHIXENE HCL CAP 10MG $ 18.80 $ 18.80 3110 IP PHARMACY ORAL31101433 THIOTHIXENE HCL CAP 1MG $ 17.28 $ 17.28 3110 IP PHARMACY ORAL31101437 THIOTHIXENE HCL CAP 20MG $ 19.82 $ 19.82 3110 IP PHARMACY ORAL31101434 THIOTHIXENE HCL CAP 2MG $ 17.62 $ 17.62 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101435 THIOTHIXENE HCL CAP 5MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31101445 THYROID 120MG TAB $ 16.88 $ 16.88 3110 IP PHARMACY ORAL31101446 THYROID 180MG TAB $ 17.04 $ 17.04 3110 IP PHARMACY ORAL31101442 THYROID TAB 15MG $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31101443 THYROID TAB 32MG $ 16.82 $ 16.82 3110 IP PHARMACY ORAL31101444 THYROID TAB 65MG $ 16.82 $ 16.82 3110 IP PHARMACY ORAL31106673 THYROTROPIN 1.1MG VL IJ $ 2,458.15 $ 2,458.15 3110 IP PHARMACY ORAL31109651 TICAR/CLAV 3.1GM IJ $ 165.52 $ 165.52 3110 IP PHARMACY ORAL31101439 TICLOPIDINE 250MG $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31106961 TIGECYCLINE 1MG IJ $ 6.19 $ 6.19 3110 IP PHARMACY ORAL31101450 TIOTROPIUM 18MCG $ 145.18 $ 145.18 3110 IP PHARMACY ORAL31101364 TIPRANAVIR 250MG $ 35.14 $ 35.14 3110 IP PHARMACY ORAL31106796 TISSEEL VH SEALANTTOP $ 1,116.15 $ 1,116.15 3110 IP PHARMACY ORAL31101451 TIZANIDINE 2MG TAB $ 20.60 $ 20.60 3110 IP PHARMACY ORAL31101452 TIZANIDINE 4MG TAB $ 21.48 $ 21.48 3110 IP PHARMACY ORAL31106678 TOBRAMYCIN 10MG IJ IP PED $ 135.20 $ 135.20 3110 IP PHARMACY ORAL31106674 TOBRAMYCIN 20MG VL IP PED $ 139.00 $ 139.00 3110 IP PHARMACY ORAL31107254 TOBRAMYCIN 20MG VL IP PED $ 49.51 $ 49.51 3110 IP PHARMACY ORAL31107255 TOBRAMYCIN 20MG VL IP PED $ 29.70 $ 29.70 3110 IP PHARMACY ORAL31109654 TOBRAMYCIN 20MG VL IP PED $ 136.20 $ 136.20 3110 IP PHARMACY ORAL31106676 TOBRAMYCIN 80MG IJ $ 146.80 $ 146.80 3110 IP PHARMACY ORAL31106677 TOBRAMYCIN 80MG IJ $ 146.80 $ 146.80 3110 IP PHARMACY ORAL31107022 TOBRAMYCIN 80MG IJ $ 146.80 $ 146.80 3110 IP PHARMACY ORAL31107253 TOBRAMYCIN 80MG IJ $ 48.22 $ 48.22 3110 IP PHARMACY ORAL31109655 TOBRAMYCIN 80MG IJ $ 146.80 $ 146.80 3110 IP PHARMACY ORAL31101459 TOLAZAMIDE 500MG $ 19.70 $ 19.70 3110 IP PHARMACY ORAL31101457 TOLAZAMIDE TAB 100MG $ 17.34 $ 17.34 3110 IP PHARMACY ORAL31101458 TOLAZAMIDE TAB 250MG $ 18.18 $ 18.18 3110 IP PHARMACY ORAL31101461 TOLBUTAMIDE TAB 250MG $ 16.84 $ 16.84 3110 IP PHARMACY ORAL31101462 TOLBUTAMIDE TAB 5OOMG $ 17.28 $ 17.28 3110 IP PHARMACY ORAL31101460 TOLTERODINE 2MG $ 19.08 $ 19.08 3110 IP PHARMACY ORAL31101455 TOPIRAMATE 100MG TAB $ 29.70 $ 29.70 3110 IP PHARMACY ORAL31101456 TOPIRAMATE 200MG TAB $ 30.04 $ 30.04 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101463 TOPIRAMATE 25MG $ 21.38 $ 21.38 3110 IP PHARMACY ORAL31106771 TOPOTECAN 4MG IJ $ 2,907.01 $ 2,907.01 3110 IP PHARMACY ORAL31101467 TRAMADOL 50MG TAB $ 18.40 $ 18.40 3110 IP PHARMACY ORAL31106705 TRANEXAMIC ACID 10GM INJ $ 829.42 $ 829.42 3110 IP PHARMACY ORAL31106704 TRANEXAMIC ACID 1GM INJ $ 201.94 $ 201.94 3110 IP PHARMACY ORAL31106799 TRASTUZUMAB 10MG IJ $ 196.96 $ 196.96 3110 IP PHARMACY ORAL31101470 TRAZODONE HCL TAB 100MG $ 19.56 $ 19.56 3110 IP PHARMACY ORAL31101471 TRAZODONE HCL TAB 150MG $ 20.12 $ 20.12 3110 IP PHARMACY ORAL31101469 TRAZODONE HCL TAB 50MG $ 19.08 $ 19.08 3110 IP PHARMACY ORAL31104761 TRETINOIN 10MG TAB $ 55.94 $ 55.94 3110 IP PHARMACY ORAL31107290 TRIAMCNLNE A INJ PRS-FREE $ 363.75 $ 363.75 3110 IP PHARMACY ORAL31106943 TRIAMCNLNE AC NOS 10MG IJ $ 18.50 $ 18.50 3110 IP PHARMACY ORAL31106944 TRIAMCNLNE AC NOS 10MG IJ $ 15.48 $ 15.48 3110 IP PHARMACY ORAL31101482 TRIAMTERENE CAP 100MG $ 17.40 $ 17.40 3110 IP PHARMACY ORAL31101481 TRIAMTERENE CAP 50MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31101492 TRIFLUOPERAZINE TAB 10MG $ 19.62 $ 19.62 3110 IP PHARMACY ORAL31101489 TRIFLUOPERAZINE TAB 1MG $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31101490 TRIFLUOPERAZINE TAB 2MG $ 18.18 $ 18.18 3110 IP PHARMACY ORAL31101491 TRIFLUOPERAZINE TAB 5MG $ 18.58 $ 18.58 3110 IP PHARMACY ORAL31104760 TRIHEXYPHENIDYL LIQ $ 17.54 $ 17.54 3110 IP PHARMACY ORAL31104758 TRIHEXYPHENIDYL LIQ 2MG $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104759 TRIHEXYPHENIDYL LIQ 5MG $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31101496 TRIHEXYPHENIDYL TAB 2MG $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101497 TRIHEXYPHENIDYL TAB 5MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31101506 TRIMETHOPRIM TAB 100MG $ 17.94 $ 17.94 3110 IP PHARMACY ORAL31101508 TRIZIVIR $ 59.36 $ 59.36 3110 IP PHARMACY ORAL31106853 TROMETHAMINE 100ML $ 154.15 $ 154.15 3110 IP PHARMACY ORAL31103656 TRUVADA $ 91.06 $ 91.06 3110 IP PHARMACY ORAL31101512 TRUVADA TAB $ 70.90 $ 70.90 3110 IP PHARMACY ORAL31106851 TRYPAN BLUE 0.5ML $ 154.15 $ 154.15 3110 IP PHARMACY ORAL31101058 ULTRASE MT 20 $ 20.72 $ 20.72 3110 IP PHARMACY ORAL31101059 ULTRASE MT 20 CAP $ 20.72 $ 20.72 3110 IP PHARMACY ORAL31101061 ULTRASE MT12 $ 18.86 $ 18.86 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101063 ULTRASE MT18 $ 20.18 $ 20.18 3110 IP PHARMACY ORAL31101513 URSODIOL (PEDI) 300MG $ 21.94 $ 21.94 3110 IP PHARMACY ORAL31104763 URSODIOL 120ML $ 84.48 $ 84.48 3110 IP PHARMACY ORAL31101516 URSODIOL CAP 300MG $ 21.94 $ 21.94 3110 IP PHARMACY ORAL31101541 VALACYCLOVIR 500MG $ 24.78 $ 24.78 3110 IP PHARMACY ORAL31101528 VALGANCICLOVIR 450MG $ 102.20 $ 102.20 3110 IP PHARMACY ORAL31109685 VALPROATE NA 500 SYRINGE $ 148.96 $ 148.96 3110 IP PHARMACY ORAL31101520 VALPROIC ACID 250MG TAB $ 19.32 $ 19.32 3110 IP PHARMACY ORAL31104762 VALPROIC ACID LIQUID $ 18.74 $ 18.74 3110 IP PHARMACY ORAL31101537 VALSARTAN 160MG $ 22.12 $ 22.12 3110 IP PHARMACY ORAL31101527 VALSARTAN 40MG $ 20.88 $ 20.88 3110 IP PHARMACY ORAL31101535 VALSARTAN 80MG $ 21.74 $ 21.74 3110 IP PHARMACY ORAL31106715 VANCOMYCIN 500MG IJ $ 74.47 $ 74.47 3110 IP PHARMACY ORAL31106717 VANCOMYCIN 500MG IJ $ 107.55 $ 107.55 3110 IP PHARMACY ORAL31107023 VANCOMYCIN 500MG IJ $ 108.15 $ 108.15 3110 IP PHARMACY ORAL31107104 VANCOMYCIN 500MG IJ $ 58.28 $ 58.28 3110 IP PHARMACY ORAL31107105 VANCOMYCIN 500MG IJ $ 57.98 $ 57.98 3110 IP PHARMACY ORAL31107106 VANCOMYCIN 500MG IJ $ 55.02 $ 55.02 3110 IP PHARMACY ORAL31107256 VANCOMYCIN 500MG IJ $ 58.20 $ 58.20 3110 IP PHARMACY ORAL31109659 VANCOMYCIN 500MG IJ $ 140.52 $ 140.52 3110 IP PHARMACY ORAL31109676 VANCOMYCIN 500MG IJ $ 140.52 $ 140.52 3110 IP PHARMACY ORAL31101525 VANCOMYCIN CAP 125MG $ 51.84 $ 51.84 3110 IP PHARMACY ORAL31101526 VANCOMYCIN CAP 250MG $ 87.84 $ 87.84 3110 IP PHARMACY ORAL31104767 VANCOMYCIN LIQ $ 61.38 $ 61.38 3110 IP PHARMACY ORAL31106719 VASOPRESSIN 20 U INJ $ 81.15 $ 81.15 3110 IP PHARMACY ORAL31106721 VASOPRESSIN INJ $ 74.85 $ 74.85 3110 IP PHARMACY ORAL31106720 VASOPRESSIN INJ 10UNITS $ 74.85 $ 74.85 3110 IP PHARMACY ORAL31106742 VECURONIUM 20MG INJ $ 80.67 $ 80.67 3110 IP PHARMACY ORAL31106727 VECURONIUM INJ 10MG $ 73.35 $ 73.35 3110 IP PHARMACY ORAL31106728 VECURONIUM INJ 10MG $ 73.35 $ 73.35 3110 IP PHARMACY ORAL31101519 VENLAFAXINE 150MG EXTREL $ 23.96 $ 23.96 3110 IP PHARMACY ORAL31101521 VENLAFAXINE 25MG $ 18.72 $ 18.72 3110 IP PHARMACY ORAL31101522 VENLAFAXINE 37.5MG TAB $ 18.78 $ 18.78 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101517 VENLAFAXINE 37.5MGEXTREL $ 20.82 $ 20.82 3110 IP PHARMACY ORAL31101523 VENLAFAXINE 50MG TAB $ 18.98 $ 18.98 3110 IP PHARMACY ORAL31101518 VENLAFAXINE 75MG EXT REL $ 21.34 $ 21.34 3110 IP PHARMACY ORAL31101524 VENLAFAXINE 75MG TAB $ 19.06 $ 19.06 3110 IP PHARMACY ORAL31106732 VERAPAMIL 10MG INJ $ 71.55 $ 71.55 3110 IP PHARMACY ORAL31106731 VERAPAMIL INJ $ 91.75 $ 91.75 3110 IP PHARMACY ORAL31106730 VERAPAMIL INJ 5MG $ 91.75 $ 91.75 3110 IP PHARMACY ORAL31101529 VERAPAMIL SR 120MG $ 18.66 $ 18.66 3110 IP PHARMACY ORAL31101532 VERAPAMIL TAB 120MG $ 18.34 $ 18.34 3110 IP PHARMACY ORAL31101534 VERAPAMIL TAB 180MG SR $ 19.22 $ 19.22 3110 IP PHARMACY ORAL31101533 VERAPAMIL TAB 240MG S.R. $ 19.62 $ 19.62 3110 IP PHARMACY ORAL31101530 VERAPAMIL TAB 40MG $ 17.20 $ 17.20 3110 IP PHARMACY ORAL31109663 VERCURONIUM 100MG SYR $ 207.20 $ 207.20 3110 IP PHARMACY ORAL31109662 VERCURONIUM 50MG SYR $ 169.70 $ 169.70 3110 IP PHARMACY ORAL31107257 VINBLASTINE 1MG IJ $ 4.82 $ 4.82 3110 IP PHARMACY ORAL31107258 VINCRISTINE 1MG IJ $ 70.69 $ 70.69 3110 IP PHARMACY ORAL31107259 VINORELBINE 10MG IJ $ 364.55 $ 364.55 3110 IP PHARMACY ORAL31101052 VIOKASE 16 $ 18.54 $ 18.54 3110 IP PHARMACY ORAL31101051 VIOKASE 8 $ 17.64 $ 17.64 3110 IP PHARMACY ORAL31101065 VIOKASE PWD $ 18.04 $ 18.04 3110 IP PHARMACY ORAL31101538 VIT A CAP 10000UN $ 17.22 $ 17.22 3110 IP PHARMACY ORAL31106735 VIT A INJ $ 108.37 $ 108.37 3110 IP PHARMACY ORAL31101543 VIT B CMPLX&C TAB $ 16.94 $ 16.94 3110 IP PHARMACY ORAL31101547 VIT E CAP 100IU $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31101548 VIT E CAP 400IU $ 17.14 $ 17.14 3110 IP PHARMACY ORAL31104779 VIT E ORAL DROPS $ 94.80 $ 94.80 3110 IP PHARMACY ORAL31104778 VIT E SOL 0.3ML $ 16.74 $ 16.74 3110 IP PHARMACY ORAL31101544 VORICONAZOLE 200MG $ 109.40 $ 109.40 3110 IP PHARMACY ORAL31104782 VORICONAZOLE SUSP 40/ML $ 1,310.24 $ 1,310.24 3110 IP PHARMACY ORAL31106201 VX DT DIP/TETTOX LT 7YRS $ 109.35 $ 109.35 3110 IP PHARMACY ORAL31106837 VX DTAP HIB IPV IM $ 247.35 $ 247.35 3110 IP PHARMACY ORAL31106203 VX DTAP LT 7YRS IM $ 115.27 $ 115.27 3110 IP PHARMACY ORAL31106983 VX DTAP LT 7YRS IM $ 118.55 $ 118.55 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31106849 VX FLU SPLIT 6-35MOS IM $ 89.15 $ 89.15 3110 IP PHARMACY ORAL31106791 VX FLU SPLIT GT=3YRS IM $ 85.15 $ 85.15 3110 IP PHARMACY ORAL31107012 VX FLU SPLIT GT=3YRS IM $ 85.15 $ 85.15 3110 IP PHARMACY ORAL31106343 VX FLU SPLIT PF 3 & > IM $ 85.15 $ 85.15 3110 IP PHARMACY ORAL31106272 VX HEMOPH FLU B PRP-T $ 120.23 $ 120.23 3110 IP PHARMACY ORAL31106659 VX HEP A ADULT IM $ 216.11 $ 216.11 3110 IP PHARMACY ORAL31106308 VX HEP A PED ADOL 3 DOSE $ 130.01 $ 130.01 3110 IP PHARMACY ORAL31106311 VX HEP A PED ADOL 3 DOSE $ 140.19 $ 140.19 3110 IP PHARMACY ORAL31106745 VX HEP A PED ADOL 3 DOSE $ 140.19 $ 140.19 3110 IP PHARMACY ORAL31106309 VX HEP B ADULT IM $ 213.87 $ 213.87 3110 IP PHARMACY ORAL31106310 VX HEP B ADULT IM $ 213.87 $ 213.87 3110 IP PHARMACY ORAL31106749 VX HEP B DIALY 3 DOSE $ 480.87 $ 480.87 3110 IP PHARMACY ORAL31107014 VX HEP B DIALY 3 DOSE $ 480.87 $ 480.87 3110 IP PHARMACY ORAL31107015 VX HEP B DIALY 4 DOSE $ 480.87 $ 480.87 3110 IP PHARMACY ORAL31106846 VX HIB CONJUGATE HEP B $ 175.03 $ 175.03 3110 IP PHARMACY ORAL31106752 VX IPV POLIOVIRUS SC/IM $ 122.75 $ 122.75 3110 IP PHARMACY ORAL31106500 VX MEASLES AND RUBELLA $ 117.31 $ 117.31 3110 IP PHARMACY ORAL31106499 VX MEASLES SUBCU $ 102.03 $ 102.03 3110 IP PHARMACY ORAL31106852 VX MENINGOCOCCAL CONJUGAT $ 236.15 $ 236.15 3110 IP PHARMACY ORAL31106808 VX MENINGOCOCCAL POLYSACC $ 228.09 $ 228.09 3110 IP PHARMACY ORAL31106415 VX MMR $ 160.07 $ 160.07 3110 IP PHARMACY ORAL31106449 VX MUMPS $ 112.95 $ 112.95 3110 IP PHARMACY ORAL31106795 VX PNEMOCCAL CONJ 7VAL IM $ 146.65 $ 146.65 3110 IP PHARMACY ORAL31106801 VX PNEMOCCAL CONJ 7VAL IM $ 146.65 $ 146.65 3110 IP PHARMACY ORAL31106543 VX PNMOCOCCL PLYSAC GT 2Y $ 158.73 $ 158.73 3110 IP PHARMACY ORAL31106596 VX RABIES INTRAMUSCULAR $ 478.65 $ 478.65 3110 IP PHARMACY ORAL31106597 VX RABIES INTRAMUSCULAR $ 478.65 $ 478.65 3110 IP PHARMACY ORAL31106601 VX RUBELLA $ 107.23 $ 107.23 3110 IP PHARMACY ORAL31106202 VX TD PF GT 7Y IM $ 111.15 $ 111.15 3110 IP PHARMACY ORAL31106859 VX TDAP GT 7Y $ 160.31 $ 160.31 3110 IP PHARMACY ORAL31106655 VX TETANUS TOXOID $ 101.15 $ 101.15 3110 IP PHARMACY ORAL31106697 VX TYPHOID (VICP) $ 226.97 $ 226.97 3110 IP PHARMACY ORAL31106656 VX VARICELLA VIRUS LIVE $ 241.33 $ 241.33 3110 IP PHARMACY ORAL

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DEPARTMENT CODE

31101566 WARFARIN 3MG TAB $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31101558 WARFARIN 4MG TAB $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31106830 WARFARIN 5MG INJ $ 177.20 $ 177.20 3110 IP PHARMACY ORAL31101567 WARFARIN 6MG TABLET $ 18.84 $ 18.84 3110 IP PHARMACY ORAL31101565 WARFARIN TAB $ 0.78 $ 0.78 3110 IP PHARMACY ORAL31101564 WARFARIN TAB 10MG $ 19.00 $ 19.00 3110 IP PHARMACY ORAL31101559 WARFARIN TAB 1MG $ 18.14 $ 18.14 3110 IP PHARMACY ORAL31101561 WARFARIN TAB 2.5MG $ 18.26 $ 18.26 3110 IP PHARMACY ORAL31101560 WARFARIN TAB 2MG $ 17.90 $ 17.90 3110 IP PHARMACY ORAL31101562 WARFARIN TAB 5MG $ 18.32 $ 18.32 3110 IP PHARMACY ORAL31101563 WARFARIN TAB 7.5MG $ 18.92 $ 18.92 3110 IP PHARMACY ORAL31101551 ZAFIRLUKAST 10MG $ 18.60 $ 18.60 3110 IP PHARMACY ORAL31101552 ZAFIRLUKAST 20MG $ 18.60 $ 18.60 3110 IP PHARMACY ORAL31103672 ZALEPLON 10MG CAP $ 39.42 $ 39.42 3110 IP PHARMACY ORAL31103671 ZALEPLON 5MG CAP $ 38.24 $ 38.24 3110 IP PHARMACY ORAL31101572 ZIDOVUDINE 100MG PO $ 20.24 $ 20.24 3110 IP PHARMACY ORAL31104786 ZIDOVUDINE 100MG PO $ 19.74 $ 19.74 3110 IP PHARMACY ORAL31106946 ZIDOVUDINE 10MG IJ $ 22.03 $ 22.03 3110 IP PHARMACY ORAL31101580 ZINC SO4 CAP 220MG $ 16.86 $ 16.86 3110 IP PHARMACY ORAL31101582 ZIPRASIDONE 20MG $ 31.46 $ 31.46 3110 IP PHARMACY ORAL31101583 ZIPRASIDONE 40MG $ 31.46 $ 31.46 3110 IP PHARMACY ORAL31101584 ZIPRASIDONE 80MG CAP $ 34.64 $ 34.64 3110 IP PHARMACY ORAL31106832 ZIPRASIDONE MESYL 10MG IJ $ 113.47 $ 113.47 3110 IP PHARMACY ORAL31106980 ZOLEDRONIC RECLAST 1MG IJ $ 858.66 $ 858.66 3110 IP PHARMACY ORAL31103675 ZOLPIDEM 5MG $ 39.10 $ 39.10 3110 IP PHARMACY ORAL31107260 ZOSYN 1GM / 0.125GM IJ $ 81.27 $ 81.27 3110 IP PHARMACY ORAL31107261 ZOSYN 1GM / 0.125GM IJ $ 59.42 $ 59.42 3110 IP PHARMACY ORAL31107262 ZOSYN 1GM / 0.125GM IJ $ 47.01 $ 47.01 3110 IP PHARMACY ORAL31130415 ALBUTEROL 0.03/3ML $ 19.78 $ 19.78 3113 IP PHARMACY TEST31130416 ALBUTEROL 1.25MG/3ML $ 19.78 $ 19.78 3113 IP PHARMACY TEST31132111 BE PREP KIT #3 $ 80.19 $ 80.19 3113 IP PHARMACY TEST31131112 BERNSTEIN SOL 250ML $ 47.58 $ 47.58 3113 IP PHARMACY TEST31132112 BERNSTEIN SOLUTION 30ML $ 47.58 $ 47.58 3113 IP PHARMACY TEST

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DEPARTMENT CODE

31131434 BUDESONIDE 0.25/2ML INH $ 27.40 $ 27.40 3113 IP PHARMACY TEST31130435 BUDESONIDE 0.5/2ML $ 31.40 $ 31.40 3113 IP PHARMACY TEST31130426 DUONEB 3ML $ 20.86 $ 20.86 3113 IP PHARMACY TEST31130448 NITRIC OXIDE $ - $ - 3113 IP PHARMACY TEST31130485 TOBRAMYCIN 300MG INH $ 244.60 $ 244.60 3113 IP PHARMACY TEST42120960 PT AQUATC THER EA 15 $ 201.00 $ 149.00 4212 IP PT-PPH42120990 PT PROC THER GP 45 $ 302.00 $ 223.00 4212 IP PT-PPH41700101 KIDNEY ACQUISITION CADAV $ 126,882.00 $ 126,882.00 4170 KIDNEY ACQ INACTIVE41700106 KIDNEY ACQUISITION LIVE $ 126,882.00 $ 126,882.00 4170 KIDNEY ACQ INACTIVE54140032 S STRL POP OFF SUTURES $ 284.00 $ 284.00 5414 L&D FBP OTHER CHG54140033 S STRL SKIN STAPLER $ 93.00 $ 93.00 5414 L&D FBP OTHER CHG30104432 AB ELUTION $ 244.00 $ 244.00 3010 LAB BLOOD BNK PROD30104425 AB ID $ 162.00 $ 162.00 3010 LAB BLOOD BNK PROD30104512 AB ID $ 210.00 $ 210.00 3010 LAB BLOOD BNK PROD30104426 AB ID 2 $ 325.00 $ 325.00 3010 LAB BLOOD BNK PROD30104427 AB ID 2 $ 325.00 $ 325.00 3010 LAB BLOOD BNK PROD30104405 AB SCRN $ 102.00 $ 102.00 3010 LAB BLOOD BNK PROD30104400 ABO TYP $ 32.00 $ 32.00 3010 LAB BLOOD BNK PROD30100490 AG SCRN PER UNIT RGNT $ 320.00 $ 99.00 3010 LAB BLOOD BNK PROD30104420 AG SCRN PER UNIT RGNT $ 41.00 $ 41.00 3010 LAB BLOOD BNK PROD30104470 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104472 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104473 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104474 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104476 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104477 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104478 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104479 AG TYP PT RBC EA $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104475 AG TYP PT RBC EA .IR $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30100135 AT PS $ 1,638.00 $ 508.00 3010 LAB BLOOD BNK PROD30100050 CMV AB $ 498.00 $ 155.00 3010 LAB BLOOD BNK PROD30104502 COMPATABILITY TEST INC.IR $ 25.00 $ 25.00 3010 LAB BLOOD BNK PROD30104508 COMPATABILITY TEST INC.IR $ 25.00 $ 25.00 3010 LAB BLOOD BNK PROD

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DEPARTMENT CODE

30104500 COMPATIBILITY TEST AHG $ 51.00 $ 51.00 3010 LAB BLOOD BNK PROD30104506 COMPATIBILITY TEST AHG $ 51.00 $ 51.00 3010 LAB BLOOD BNK PROD30104504 COMPATIBILITY TEST IS $ 25.00 $ 25.00 3010 LAB BLOOD BNK PROD30104510 COMPATIBILITY TEST IS $ 25.00 $ 25.00 3010 LAB BLOOD BNK PROD30104412 COOMBS DIRECT IG $ 102.00 $ 102.00 3010 LAB BLOOD BNK PROD30104410 COOMBS DIRECT POLY .IR $ 51.00 $ 51.00 3010 LAB BLOOD BNK PROD30100055 CRYO PS $ 198.00 $ 198.00 3010 LAB BLOOD BNK PROD30100056 CRYO PS $ 270.00 $ 270.00 3010 LAB BLOOD BNK PROD30100057 CRYO PS $ 151.80 $ 151.80 3010 LAB BLOOD BNK PROD30100058 CRYO PS $ 151.80 $ 151.80 3010 LAB BLOOD BNK PROD30100059 CRYO PS $ 151.80 $ 151.80 3010 LAB BLOOD BNK PROD30100060 CRYO PS $ 151.80 $ 151.80 3010 LAB BLOOD BNK PROD30104245 CRYO PS $ 533.43 $ 533.43 3010 LAB BLOOD BNK PROD30100161 FF PLASMA 8-24 HRS COLLCT $ 144.00 $ 144.00 3010 LAB BLOOD BNK PROD30100160 FFP PS $ 140.00 $ 140.00 3010 LAB BLOOD BNK PROD30100162 FFP PS $ 112.13 $ 112.13 3010 LAB BLOOD BNK PROD30100164 FFP PS $ 270.00 $ 270.00 3010 LAB BLOOD BNK PROD30100166 FFP PS $ 112.13 $ 112.13 3010 LAB BLOOD BNK PROD30100168 FFP PS $ 89.70 $ 89.70 3010 LAB BLOOD BNK PROD30100315 FFP PS $ 140.00 $ 140.00 3010 LAB BLOOD BNK PROD30100320 FFP PS $ 212.52 $ 212.52 3010 LAB BLOOD BNK PROD30100325 FFP PS $ 212.52 $ 212.52 3010 LAB BLOOD BNK PROD30104265 FFP PS $ 502.56 $ 502.56 3010 LAB BLOOD BNK PROD30104520 FRZN BLD FREEZING W PREP $ 132.38 $ 132.38 3010 LAB BLOOD BNK PROD30100205 IRRADIATION BLD PROD EA $ 614.00 $ 190.00 3010 LAB BLOOD BNK PROD30100210 IRRADIATION BLD PROD EA $ 614.00 $ 190.00 3010 LAB BLOOD BNK PROD30104525 LYMPHOCYTOTOX W/O TTR $ 102.00 $ 102.00 3010 LAB BLOOD BNK PROD30100279 PHER L/D CMV NEG PS $ 1,380.00 $ 1,380.00 3010 LAB BLOOD BNK PROD30100277 PHER L/D HLA MATCHED PS $ 1,569.75 $ 1,569.75 3010 LAB BLOOD BNK PROD30100282 PHER L/D IRRADIATED PS $ 1,235.00 $ 1,235.00 3010 LAB BLOOD BNK PROD30100278 PHER L/D PS $ 1,166.10 $ 1,166.10 3010 LAB BLOOD BNK PROD30104275 PHER L/D PS $ 1,275.12 $ 1,275.12 3010 LAB BLOOD BNK PROD30100275 PHER PS $ 1,358.00 $ 1,358.00 3010 LAB BLOOD BNK PROD

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DEPARTMENT CODE

30100170 PLAS CRYO REDUCED PS $ 115.00 $ 115.00 3010 LAB BLOOD BNK PROD30100280 PLT AB INDIRECT $ 2,300.00 $ 713.00 3010 LAB BLOOD BNK PROD30104468 PLT AGGREGATION EA AGENT $ 881.00 $ 273.00 3010 LAB BLOOD BNK PROD30100266 PLTC IRRADIATED PS $ 138.00 $ 138.00 3010 LAB BLOOD BNK PROD30100264 PLTC L/D IRRADIATED PS $ 138.00 $ 138.00 3010 LAB BLOOD BNK PROD30100269 PLTC L/D PS $ 198.38 $ 198.38 3010 LAB BLOOD BNK PROD30100260 PLTC PS $ 70.00 $ 70.00 3010 LAB BLOOD BNK PROD30100262 PLTC PS $ 70.00 $ 70.00 3010 LAB BLOOD BNK PROD30100268 PLTRP PS $ 198.38 $ 198.38 3010 LAB BLOOD BNK PROD30104235 POOLING BLD PROD $ 392.00 $ 121.00 3010 LAB BLOOD BNK PROD30100070 RBC DG PS $ 566.21 $ 566.21 3010 LAB BLOOD BNK PROD30100108 RBC L/D CMV NEG PS $ 409.00 $ 409.00 3010 LAB BLOOD BNK PROD30100106 RBC L/D DG/WASHED PS $ 631.35 $ 631.35 3010 LAB BLOOD BNK PROD30100107 RBC L/D DG/WASHED PS $ 631.35 $ 631.35 3010 LAB BLOOD BNK PROD30100097 RBC L/D IRRADIATED PS $ 320.85 $ 320.85 3010 LAB BLOOD BNK PROD30100010 RBC L/D PS $ 484.00 $ 484.00 3010 LAB BLOOD BNK PROD30100090 RBC L/D PS $ 400.00 $ 400.00 3010 LAB BLOOD BNK PROD30100102 RBC L/D PS $ 484.00 $ 484.00 3010 LAB BLOOD BNK PROD30100104 RBC L/D PS $ 400.00 $ 400.00 3010 LAB BLOOD BNK PROD30100355 RBC L/D PS $ 91.39 $ 91.39 3010 LAB BLOOD BNK PROD30100095 RBC L/D PS .IR $ 243.23 $ 243.23 3010 LAB BLOOD BNK PROD30104461 RBC PRETRTMT CHEM/DRG $ 183.00 $ 183.00 3010 LAB BLOOD BNK PROD30104515 RBC PRETRTMT CHEM/DRG $ 162.00 $ 162.00 3010 LAB BLOOD BNK PROD30104445 RBC PRETRTMT DENSITY GRAD $ 406.00 $ 406.00 3010 LAB BLOOD BNK PROD30104430 RBC PRETRTMT ENZYME $ 183.00 $ 183.00 3010 LAB BLOOD BNK PROD30104480 RH PHENOTYP COMPLETE $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104481 RH PHENOTYP COMPLETE $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104482 RH PHENOTYP COMPLETE $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104483 RH PHENOTYP COMPLETE $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104484 RH PHENOTYP COMPLETE $ 18.00 $ 18.00 3010 LAB BLOOD BNK PROD30104402 RH TYP $ 32.00 $ 32.00 3010 LAB BLOOD BNK PROD30104290 RHO D MINI 50MCG IJ $ 545.00 $ 545.00 3010 LAB BLOOD BNK PROD30100515 S STRL LEUKO FILTER PLT $ 166.00 $ 166.00 3010 LAB BLOOD BNK PROD

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DEPARTMENT CODE

30100510 S STRL LEUKO FILTER RBCS $ 117.00 $ 117.00 3010 LAB BLOOD BNK PROD30104450 SER PRETRTMT ABSORB $ 406.00 $ 406.00 3010 LAB BLOOD BNK PROD30104455 SER PRETRTMT ABSORB $ 406.00 $ 406.00 3010 LAB BLOOD BNK PROD30104460 SER PRETRTMT ABSORB $ 263.00 $ 263.00 3010 LAB BLOOD BNK PROD30104435 SER PRETRTMT DILU $ 254.00 $ 254.00 3010 LAB BLOOD BNK PROD30104440 SER PRETRTMT INC/INHIB $ 162.00 $ 162.00 3010 LAB BLOOD BNK PROD30104465 SER PRETRTMT INCUB/ DRG $ 508.00 $ 508.00 3010 LAB BLOOD BNK PROD30100310 SICKLE CL SCRN $ 187.00 $ 58.00 3010 LAB BLOOD BNK PROD30104462 SPLIT BLD PROD EA UNIT $ 392.00 $ 121.00 3010 LAB BLOOD BNK PROD30100099 WASHED RBC PS $ 425.00 $ 425.00 3010 LAB BLOOD BNK PROD30100100 WASHED RBC PS $ 545.10 $ 545.10 3010 LAB BLOOD BNK PROD30100020 WB PS $ 484.00 $ 484.00 3010 LAB BLOOD BNK PROD30100025 WB PS $ 301.88 $ 301.88 3010 LAB BLOOD BNK PROD30100030 WB PS $ 300.15 $ 300.15 3010 LAB BLOOD BNK PROD30100035 WB PS $ 388.13 $ 388.13 3010 LAB BLOOD BNK PROD30100110 WB PS $ 431.42 $ 431.42 3010 LAB BLOOD BNK PROD30100365 WB PS $ 433.55 $ 433.55 3010 LAB BLOOD BNK PROD30100370 WB PS $ 148.76 $ 148.76 3010 LAB BLOOD BNK PROD30100375 WB PS $ 148.76 $ 148.76 3010 LAB BLOOD BNK PROD30100400 WB PS $ 433.55 $ 433.55 3010 LAB BLOOD BNK PROD30100620 WB PS $ 318.37 $ 318.37 3010 LAB BLOOD BNK PROD30128525 AB ELUTION $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128500 AB ID $ 721.00 $ 224.00 3012 LAB BLOOD BNK TEST30128510 AB ID 2 $ 721.00 $ 224.00 3012 LAB BLOOD BNK TEST30129010 AB ID 3 $ 161.00 $ 161.00 3012 LAB BLOOD BNK TEST30129130 AB ID 4 $ 127.00 $ 127.00 3012 LAB BLOOD BNK TEST30128585 AB SCRN $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128586 AB SCRN $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128587 AB SCRN 2 $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128588 AB SCRN 3 $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128589 AB SCRN 3 $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128591 AB SCRN 3 $ 409.00 $ 130.00 3012 LAB BLOOD BNK TEST30128515 ABO TYP $ 107.00 $ 33.00 3012 LAB BLOOD BNK TEST

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DEPARTMENT CODE

30128516 ABO TYP $ 107.00 $ 33.00 3012 LAB BLOOD BNK TEST30128547 AG SCRN PER UNIT PT SPEC $ 329.00 $ 102.00 3012 LAB BLOOD BNK TEST30128602 AG SCRN PER UNIT PT SPEC $ 329.00 $ 102.00 3012 LAB BLOOD BNK TEST30128601 AG SCRN PER UNIT RGNT $ 320.00 $ 99.00 3012 LAB BLOOD BNK TEST30128545 AG TYP PT RBC EA $ 134.00 $ 41.00 3012 LAB BLOOD BNK TEST30128815 AT PS $ 1,638.00 $ 508.00 3012 LAB BLOOD BNK TEST30128550 COMPATIBILITY TEST AHG $ 516.00 $ 160.00 3012 LAB BLOOD BNK TEST30125556 COMPATIBILITY TEST INCUB $ 516.00 $ 160.00 3012 LAB BLOOD BNK TEST30128551 COMPATIBILITY TEST INCUB $ 516.00 $ 160.00 3012 LAB BLOOD BNK TEST30128553 COMPATIBILITY TEST IS $ 614.00 $ 190.00 3012 LAB BLOOD BNK TEST30128555 COMPATIBILITY TEST IS $ 614.00 $ 190.00 3012 LAB BLOOD BNK TEST30128572 COOMBS DIRECT C3 $ 187.00 $ 58.00 3012 LAB BLOOD BNK TEST30128570 COOMBS DIRECT IG $ 187.00 $ 58.00 3012 LAB BLOOD BNK TEST30128571 COOMBS DIRECT POLY $ 187.00 $ 58.00 3012 LAB BLOOD BNK TEST30128540 COOMBS IND EACH AB TITER $ 178.00 $ 55.00 3012 LAB BLOOD BNK TEST30128541 COOMBS IND EACH AB TITER $ 178.00 $ 55.00 3012 LAB BLOOD BNK TEST30128580 FETAL SCRN ROSETTE $ 231.00 $ 72.00 3012 LAB BLOOD BNK TEST30128975 FFP PS $ 94.09 $ 94.09 3012 LAB BLOOD BNK TEST30128565 POOLING BLD PROD $ 392.00 $ 121.00 3012 LAB BLOOD BNK TEST30128820 RBC PRETRTMT CHEM/DRG $ 409.00 $ 127.00 3012 LAB BLOOD BNK TEST30129135 RBC PRETRTMT CHEM/DRG $ 409.00 $ 127.00 3012 LAB BLOOD BNK TEST30128505 RBC PRETRTMT ENZYME $ 365.00 $ 113.00 3012 LAB BLOOD BNK TEST30129200 RH PHENOTYP COMPLETE $ 267.00 $ 83.00 3012 LAB BLOOD BNK TEST30129201 RH PHENOTYP COMPLETE $ 267.00 $ 83.00 3012 LAB BLOOD BNK TEST30129202 RH PHENOTYP COMPLETE $ 267.00 $ 83.00 3012 LAB BLOOD BNK TEST30129203 RH PHENOTYP COMPLETE $ 267.00 $ 83.00 3012 LAB BLOOD BNK TEST30129204 RH PHENOTYP COMPLETE $ 267.00 $ 83.00 3012 LAB BLOOD BNK TEST30128830 RH TYP $ 205.00 $ 63.00 3012 LAB BLOOD BNK TEST30128831 RH TYP $ 205.00 $ 63.00 3012 LAB BLOOD BNK TEST30128595 S STRL PALL FILTER PROCES $ 106.00 $ 53.00 3012 LAB BLOOD BNK TEST30128600 S STRL PLATELE INFUS. KIT $ 54.00 $ 54.00 3012 LAB BLOOD BNK TEST30128890 SER PRETRTMT ABSORB $ 222.00 $ 222.00 3012 LAB BLOOD BNK TEST30128822 SER PRETRTMT INC/INHIB $ 516.00 $ 160.00 3012 LAB BLOOD BNK TEST

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DEPARTMENT CODE

30128610 SPLIT BLD PROD EA UNIT $ 392.00 $ 121.00 3012 LAB BLOOD BNK TEST30128566 THAWING PROD PER UNIT $ 223.00 $ 69.00 3012 LAB BLOOD BNK TEST30129140 TRNSFUS RXN INVESTIGATE $ 409.00 $ 127.00 3012 LAB BLOOD BNK TEST30128630 WASHED RBC PS $ 266.38 $ 130.00 3012 LAB BLOOD BNK TEST30010000 ACETAMINOPHEN $ 694.00 $ 215.00 3001 LAB CHEM30010005 ACETAMINOPHEN $ 694.00 $ 215.00 3001 LAB CHEM30011040 ALBUMIN FLD $ 178.00 $ 55.00 3001 LAB CHEM30010025 ALBUMIN SERUM/PLASMA/BLD $ 169.00 $ 52.00 3001 LAB CHEM30010030 ALCOHOL (ETHANOL) $ 374.00 $ 116.00 3001 LAB CHEM30010035 ALCOHOL (ETHANOL) $ 374.00 $ 116.00 3001 LAB CHEM30011045 ALCOHOL (ETHANOL) UR $ 374.00 $ 116.00 3001 LAB CHEM30011280 ALCOHOL (ETHANOL) UR $ 374.00 $ 116.00 3001 LAB CHEM30010040 ALK PHOSPHATASE $ 178.00 $ 55.00 3001 LAB CHEM30010045 ALT (SGPT) $ 178.00 $ 55.00 3001 LAB CHEM30010050 AMIKACIN PK $ 516.00 $ 160.00 3001 LAB CHEM30011110 AMIKACIN RAN $ 516.00 $ 160.00 3001 LAB CHEM30011050 AMIKACIN TR $ 516.00 $ 160.00 3001 LAB CHEM30010055 AMMONIA $ 498.00 $ 155.00 3001 LAB CHEM30010060 AMMONIA $ 498.00 $ 155.00 3001 LAB CHEM30010065 AMYLASE $ 626.00 $ 194.00 3001 LAB CHEM30010070 AMYLASE $ 626.00 $ 194.00 3001 LAB CHEM30010240 AMYLASE FLD $ 626.00 $ 194.00 3001 LAB CHEM30010245 AMYLASE FLD $ 626.00 $ 194.00 3001 LAB CHEM30010885 AMYLASE UR RAN $ 626.00 $ 194.00 3001 LAB CHEM30010890 AMYLASE UR TIM $ 626.00 $ 194.00 3001 LAB CHEM30010215 AST (SGOT) $ 178.00 $ 55.00 3001 LAB CHEM30011983 BETA2 MICROGLOBULIN $ 261.00 $ 158.00 3001 LAB CHEM30010495 BILIRUBIN DIRECT $ 169.00 $ 52.00 3001 LAB CHEM30010225 BILIRUBIN NEONATAL $ 169.00 $ 52.00 3001 LAB CHEM30010230 BILIRUBIN NEONATAL $ 169.00 $ 52.00 3001 LAB CHEM30010250 BILIRUBIN TOTAL $ 169.00 $ 52.00 3001 LAB CHEM30010860 BILIRUBIN TOTAL $ 169.00 $ 52.00 3001 LAB CHEM30011410 BILIRUBIN TOTAL $ 169.00 $ 52.00 3001 LAB CHEM

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DEPARTMENT CODE

30010135 BLD GAS ART $ 667.00 $ 207.00 3001 LAB CHEM30011020 BLD GAS VEN $ 667.00 $ 207.00 3001 LAB CHEM30010465 BODY FLUID PH NOS $ 125.00 $ 39.00 3001 LAB CHEM30010246 B-TYP NATRIURETIC PEPTIDE $ 1,166.00 $ 362.00 3001 LAB CHEM30010310 BUN $ 134.00 $ 41.00 3001 LAB CHEM30010315 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011185 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011190 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011205 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011235 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011245 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011300 BUN $ 134.00 $ 41.00 3001 LAB CHEM30011305 BUN $ 134.00 $ 41.00 3001 LAB CHEM30010438 C REACTIVE PROTEIN $ 178.00 $ 55.00 3001 LAB CHEM30010356 CAFFEINE $ 392.00 $ 121.00 3001 LAB CHEM30010345 CALCIUM $ 178.00 $ 55.00 3001 LAB CHEM30010350 CALCIUM $ 178.00 $ 55.00 3001 LAB CHEM30011200 CALCIUM FLD $ 178.00 $ 55.00 3001 LAB CHEM30010330 CALCIUM IONIZED $ 500.00 $ 20.00 3001 LAB CHEM30010335 CALCIUM IONIZED $ 500.00 $ 20.00 3001 LAB CHEM30012330 CALCIUM IONIZED $ 91.00 $ 91.00 3001 LAB CHEM30012335 CALCIUM IONIZED $ 91.00 $ 91.00 3001 LAB CHEM30010900 CALCIUM UR 24HR $ 205.00 $ 63.00 3001 LAB CHEM30010895 CALCIUM UR RAN $ 205.00 $ 63.00 3001 LAB CHEM30010355 CARBAMAZEPINE TOTAL $ 498.00 $ 155.00 3001 LAB CHEM30011375 CARBAMAZEPINE TOTAL $ 498.00 $ 155.00 3001 LAB CHEM30010370 CARBOXYHEMOGLOBIN QN $ 277.00 $ 86.00 3001 LAB CHEM30011415 CARBOXYHEMOGLOBIN QN $ 277.00 $ 86.00 3001 LAB CHEM30010375 CHLORIDE $ 160.00 $ 50.00 3001 LAB CHEM30010380 CHLORIDE $ 160.00 $ 50.00 3001 LAB CHEM30010264 CHLORIDE FLD $ 169.00 $ 52.00 3001 LAB CHEM30010833 CHLORIDE SWEAT $ 169.00 $ 52.00 3001 LAB CHEM30010905 CHLORIDE UR $ 169.00 $ 52.00 3001 LAB CHEM

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DEPARTMENT CODE

30010910 CHLORIDE UR TIM $ 169.00 $ 52.00 3001 LAB CHEM30010385 CHOLESTEROL $ 151.00 $ 21.00 3001 LAB CHEM30011100 CHOLESTEROL FLD $ 151.00 $ 21.00 3001 LAB CHEM30010415 CK MB FRACTION $ 400.00 $ 124.00 3001 LAB CHEM30010420 CK MB FRACTION $ 400.00 $ 124.00 3001 LAB CHEM30010405 CK TOTAL $ 223.00 $ 69.00 3001 LAB CHEM30010410 CK TOTAL $ 223.00 $ 69.00 3001 LAB CHEM30010360 CO2 (BICARBONATE) $ 169.00 $ 20.00 3001 LAB CHEM30010365 CO2 (BICARBONATE) $ 169.00 $ 20.00 3001 LAB CHEM30010400 CORTISOL TOTAL $ 561.00 $ 174.00 3001 LAB CHEM30010437 C-REACTIVE PROTEIN HS $ 445.00 $ 138.00 3001 LAB CHEM30010425 CREATININE $ 178.00 $ 20.00 3001 LAB CHEM30010430 CREATININE $ 178.00 $ 20.00 3001 LAB CHEM30010435 CREATININE CLEARANCE $ 320.00 $ 99.00 3001 LAB CHEM30010255 CREATININE FLD $ 178.00 $ 55.00 3001 LAB CHEM30010920 CREATININE UR RAN $ 178.00 $ 55.00 3001 LAB CHEM30010925 CREATININE UR TIM $ 178.00 $ 55.00 3001 LAB CHEM30010485 DIGOXIN $ 454.00 $ 141.00 3001 LAB CHEM30010490 DIGOXIN $ 454.00 $ 141.00 3001 LAB CHEM30010260 ELECTROLYTE PNL FLD $ 240.00 $ 75.00 3001 LAB CHEM30010440 FETAL FIBRONECTIN $ 2,216.00 $ 687.00 3001 LAB CHEM30012440 FETAL FIBRONECTIN $ 427.00 $ 427.00 3001 LAB CHEM30010443 FLM FLUOR POLAR $ 650.00 $ 201.00 3001 LAB CHEM30012443 FLM FLUOR POLAR $ 51.00 $ 51.00 3001 LAB CHEM30010535 GENTAMICIN $ 561.00 $ 174.00 3001 LAB CHEM30011115 GENTAMICIN $ 561.00 $ 174.00 3001 LAB CHEM30010530 GENTAMICIN PK $ 561.00 $ 174.00 3001 LAB CHEM30011055 GENTAMICIN TR $ 561.00 $ 174.00 3001 LAB CHEM30010540 GGT $ 249.00 $ 77.00 3001 LAB CHEM30010545 GLUCOSE $ 134.00 $ 41.00 3001 LAB CHEM30010550 GLUCOSE $ 134.00 $ 41.00 3001 LAB CHEM30012545 GLUCOSE $ 8.00 $ 8.00 3001 LAB CHEM30010555 GLUCOSE 2HR PP $ 160.00 $ 50.00 3001 LAB CHEM

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DEPARTMENT CODE

30010445 GLUCOSE CSF $ 134.00 $ 41.00 3001 LAB CHEM30010450 GLUCOSE CSF $ 134.00 $ 41.00 3001 LAB CHEM30010265 GLUCOSE FLD $ 134.00 $ 41.00 3001 LAB CHEM30010270 GLUCOSE FLD $ 134.00 $ 41.00 3001 LAB CHEM30010930 GLUCOSE UR QN $ 134.00 $ 41.00 3001 LAB CHEM30011170 GLUCOSE UR QN $ 134.00 $ 41.00 3001 LAB CHEM30010557 GTT 2HR 1ST 3 SPEC $ 445.00 $ 138.00 3001 LAB CHEM30010560 GTT 3HR 1ST 3 SPEC $ 445.00 $ 138.00 3001 LAB CHEM30010570 GTT 4HR 1ST 3 SPEC $ 445.00 $ 138.00 3001 LAB CHEM30010580 GTT ADDED SAMPLE $ 134.00 $ 41.00 3001 LAB CHEM30010390 HDL CHOLESTEROL $ 285.00 $ 88.00 3001 LAB CHEM30012390 HDL CHOLESTEROL $ 55.00 $ 55.00 3001 LAB CHEM30010610 IRON $ 223.00 $ 69.00 3001 LAB CHEM30010612 IRON BINDING CAPACITY $ 303.00 $ 94.00 3001 LAB CHEM30010010 KETONES QL $ 151.00 $ 47.00 3001 LAB CHEM30010015 KETONES QL $ 151.00 $ 47.00 3001 LAB CHEM30010620 LACTIC ACID $ 365.00 $ 113.00 3001 LAB CHEM30010455 LACTIC ACID CSF $ 365.00 $ 113.00 3001 LAB CHEM30010635 LDH $ 205.00 $ 64.00 3001 LAB CHEM30010460 LDH CSF $ 251.00 $ 77.00 3001 LAB CHEM30010275 LDH FLD $ 205.00 $ 64.00 3001 LAB CHEM30010392 LDL BY DIRECT MEASURE $ 329.00 $ 102.00 3001 LAB CHEM30010645 LIDOCAINE $ 507.00 $ 157.00 3001 LAB CHEM30010650 LIDOCAINE $ 507.00 $ 157.00 3001 LAB CHEM30010075 LIPASE $ 240.00 $ 75.00 3001 LAB CHEM30010660 LITHIUM $ 231.00 $ 72.00 3001 LAB CHEM30010665 LITHIUM $ 231.00 $ 72.00 3001 LAB CHEM30010670 MAGNESIUM $ 231.00 $ 72.00 3001 LAB CHEM30010675 MAGNESIUM $ 231.00 $ 72.00 3001 LAB CHEM30010935 MAGNESIUM UR $ 231.00 $ 72.00 3001 LAB CHEM30011165 MAGNESIUM UR $ 231.00 $ 72.00 3001 LAB CHEM30010680 METHEMOGLOBIN $ 166.00 $ 52.00 3001 LAB CHEM30010685 METHOTREXATE $ 1,419.00 $ 440.00 3001 LAB CHEM

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DEPARTMENT CODE

30010690 METHOTREXATE $ 1,419.00 $ 440.00 3001 LAB CHEM30010938 MICROALBUMIN UR 24HR $ 196.00 $ 61.00 3001 LAB CHEM30010700 NAPA ONLY $ 1,419.00 $ 440.00 3001 LAB CHEM30010705 NAPA ONLY $ 1,419.00 $ 440.00 3001 LAB CHEM30011060 NAPA ONLY $ 1,419.00 $ 440.00 3001 LAB CHEM30011120 NAPA ONLY $ 1,419.00 $ 440.00 3001 LAB CHEM30010150 O2 SAT ART $ 303.00 $ 94.00 3001 LAB CHEM30011030 O2 SAT VEN $ 303.00 $ 94.00 3001 LAB CHEM30010710 OSMOLALITY SER $ 231.00 $ 72.00 3001 LAB CHEM30010715 OSMOLALITY SER $ 231.00 $ 72.00 3001 LAB CHEM30010940 OSMOLALITY UR $ 231.00 $ 72.00 3001 LAB CHEM30010945 OSMOLALITY UR $ 231.00 $ 72.00 3001 LAB CHEM30010280 PH C02 02 FLD $ 667.00 $ 207.00 3001 LAB CHEM30010720 PHENOBARBITAL $ 392.00 $ 121.00 3001 LAB CHEM30010725 PHENOBARBITAL $ 392.00 $ 121.00 3001 LAB CHEM30010730 PHENYTOIN TOTAL $ 454.00 $ 141.00 3001 LAB CHEM30010735 PHENYTOIN TOTAL $ 454.00 $ 141.00 3001 LAB CHEM30010955 PHOSPHOROUS UR RAN $ 178.00 $ 55.00 3001 LAB CHEM30010740 PHOSPHORUS (PO4) $ 160.00 $ 50.00 3001 LAB CHEM30010745 PHOSPHORUS (PO4) $ 160.00 $ 50.00 3001 LAB CHEM30010950 PHOSPHORUS UR TIM $ 178.00 $ 55.00 3001 LAB CHEM30010750 POTASSIUM $ - $ - 3001 LAB CHEM30010755 POTASSIUM $ 160.00 $ 20.00 3001 LAB CHEM30010765 POTASSIUM $ 160.00 $ 20.00 3001 LAB CHEM30010263 POTASSIUM FLD $ 160.00 $ 50.00 3001 LAB CHEM30010960 POTASSIUM UR RAN $ 151.00 $ 47.00 3001 LAB CHEM30010965 POTASSIUM UR TIM $ 151.00 $ 47.00 3001 LAB CHEM30010770 PRIMIDONE $ 366.00 $ 162.00 3001 LAB CHEM30010775 PROCAINAMIDE $ 578.00 $ 179.00 3001 LAB CHEM30010780 PROCAINAMIDE $ 578.00 $ 179.00 3001 LAB CHEM30011065 PROCAINAMIDE $ 578.00 $ 179.00 3001 LAB CHEM30011125 PROCAINAMIDE $ 578.00 $ 179.00 3001 LAB CHEM30011988 PROTEIN ELECTRO SER $ 185.00 $ 185.00 3001 LAB CHEM

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DEPARTMENT CODE

30010865 PROTEIN TOTAL BLOOD $ 125.00 $ 39.00 3001 LAB CHEM30010475 PROTEIN TOTAL CSF $ 125.00 $ 39.00 3001 LAB CHEM30010480 PROTEIN TOTAL CSF $ 125.00 $ 39.00 3001 LAB CHEM30010290 PROTEIN TOTAL FLD $ 125.00 $ 39.00 3001 LAB CHEM30010295 PROTEIN TOTAL FLD $ 125.00 $ 39.00 3001 LAB CHEM30011470 PROTEIN UR QN RAN $ 125.00 $ 39.00 3001 LAB CHEM30010709 PROTEIN UR QN TIM $ 125.00 $ 39.00 3001 LAB CHEM30010795 QUINIDINE $ 498.00 $ 155.00 3001 LAB CHEM30010800 QUINIDINE $ 498.00 $ 155.00 3001 LAB CHEM30011135 QUINIDINE $ 498.00 $ 155.00 3001 LAB CHEM30011140 QUINIDINE $ 498.00 $ 155.00 3001 LAB CHEM30010805 SALICYLATE $ 240.00 $ 75.00 3001 LAB CHEM30010810 SALICYLATE $ 240.00 $ 75.00 3001 LAB CHEM30010815 SODIUM $ 169.00 $ 20.00 3001 LAB CHEM30010825 SODIUM $ 169.00 $ 20.00 3001 LAB CHEM30010262 SODIUM FLD $ 169.00 $ 52.00 3001 LAB CHEM30010970 SODIUM UR RAN $ 169.00 $ 52.00 3001 LAB CHEM30010975 SODIUM UR RAN $ 169.00 $ 52.00 3001 LAB CHEM30010834 SWEAT COLLECTION $ 98.00 $ 30.00 3001 LAB CHEM30010835 THEOPHYLLINE $ 489.00 $ 152.00 3001 LAB CHEM30010840 THEOPHYLLINE $ 489.00 $ 152.00 3001 LAB CHEM30011075 THEOPHYLLINE $ 489.00 $ 152.00 3001 LAB CHEM30011085 THEOPHYLLINE $ 489.00 $ 152.00 3001 LAB CHEM30010850 TOBRAMYCIN $ 552.00 $ 171.00 3001 LAB CHEM30010855 TOBRAMYCIN $ 552.00 $ 171.00 3001 LAB CHEM30011150 TOBRAMYCIN PK $ 552.00 $ 171.00 3001 LAB CHEM30011090 TOBRAMYCIN TR $ 552.00 $ 171.00 3001 LAB CHEM30011989 TRANSFERRIN $ 436.00 $ 135.00 3001 LAB CHEM30010870 TRIGLYCERIDE $ 196.00 $ 61.00 3001 LAB CHEM30011105 TRIGLYCERIDE $ 196.00 $ 61.00 3001 LAB CHEM30012870 TRIGLYCERIDE $ 38.00 $ 38.00 3001 LAB CHEM30010873 TROPONIN I QN $ 338.00 $ 105.00 3001 LAB CHEM30010300 UR NITROGEN FLD $ 160.00 $ 50.00 3001 LAB CHEM

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DEPARTMENT CODE

30010980 UR NITROGEN UR RAN $ 160.00 $ 50.00 3001 LAB CHEM30010985 UR NITROGEN UR TIMED $ 160.00 $ 50.00 3001 LAB CHEM30010875 UREA CLEARANCE $ 231.00 $ 72.00 3001 LAB CHEM30010880 URIC ACID $ 151.00 $ 47.00 3001 LAB CHEM30012880 URIC ACID $ 8.00 $ 8.00 3001 LAB CHEM30010305 URIC ACID FLD $ 160.00 $ 50.00 3001 LAB CHEM30010990 URIC ACID UR RAN $ 160.00 $ 50.00 3001 LAB CHEM30010995 URIC ACID UR TIM $ 160.00 $ 50.00 3001 LAB CHEM30011000 VALPROIC ACID $ 463.00 $ 144.00 3001 LAB CHEM30011005 VALPROIC ACID $ 463.00 $ 144.00 3001 LAB CHEM30011015 VANCOMYCIN $ 993.00 $ 308.00 3001 LAB CHEM30011155 VANCOMYCIN $ 993.00 $ 308.00 3001 LAB CHEM30011010 VANCOMYCIN PK $ 993.00 $ 308.00 3001 LAB CHEM30011095 VANCOMYCIN TR $ 993.00 $ 308.00 3001 LAB CHEM30147080 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3014 LAB CYTOL30147085 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3014 LAB CYTOL30147090 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3014 LAB CYTOL30147030 CYTOLOGY CONCENTRATION $ 506.00 $ 157.00 3014 LAB CYTOL30147065 CYTOLOGY EXTENDED STUDY $ 180.00 $ 180.00 3014 LAB CYTOL30147070 CYTOLOGY EXTENDED STUDY $ 180.00 $ 180.00 3014 LAB CYTOL30147010 CYTOLOGY FLD $ 756.00 $ 234.00 3014 LAB CYTOL30147060 CYTOLOGY OTHER SOURCE $ 426.00 $ 132.00 3014 LAB CYTOL30147035 CYTOLOGY SEL CELL ENHANCE $ 364.00 $ 120.00 3014 LAB CYTOL30147000 CYTOLOGY UNLISTED $ - $ - 3014 LAB CYTOL30147005 HPV AMP PRB .CL $ 30.00 $ 30.00 3014 LAB CYTOL30025412 HPV AMP PRB .LC $ - $ - 3014 LAB CYTOL30147040 PAP DX MAN $ 239.00 $ 74.00 3014 LAB CYTOL30147050 PAP DX MAN $ 239.00 $ 74.00 3014 LAB CYTOL30141945 PAP DX THN LR SCRN $ 246.00 $ 69.00 3014 LAB CYTOL30147055 PAP MD INTERP $ - $ - 3014 LAB CYTOL30147100 SPEC STAIN GRP I MICR I/R $ 180.00 $ 58.00 3014 LAB CYTOL30147120 SPEC STAIN GRP II INTRP/R $ 189.00 $ 65.00 3014 LAB CYTOL30030005 ACTIVATED CLOTTING TIME $ 142.00 $ 44.00 3003 LAB HEMATO

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DEPARTMENT CODE

30030855 AT3 ACTIVITY $ 409.00 $ 127.00 3003 LAB HEMATO30030505 BETA HCG QL $ 258.00 $ 80.00 3003 LAB HEMATO30030025 BLD SMR EXAM W MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030245 BLD SMR EXAM W MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030280 BLD SMR EXAM W MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030450 BLD SMR EXAM W MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030027 BLD SMR EXAM WO MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030260 BLD SMR EXAM WO MAN DIFF $ 116.00 $ 36.00 3003 LAB HEMATO30030030 BLEEDING TIME TEST $ 1,255.00 $ 389.00 3003 LAB HEMATO30030035 BLEEDING TIME TEST $ 1,255.00 $ 389.00 3003 LAB HEMATO30030703 BODY FLUID PH NOS $ 125.00 $ 39.00 3003 LAB HEMATO30030370 CBC AUTO $ 223.00 $ 69.00 3003 LAB HEMATO30030085 CBC AUTO W AUTO DIFF WBC $ 267.00 $ 83.00 3003 LAB HEMATO30039085 CBC AUTO W AUTO DIFF WBC $ 8.00 $ 8.00 3003 LAB HEMATO30030050 CELL CNT FLD W/ DIFF $ 187.00 $ 75.00 3003 LAB HEMATO30030210 CELL CNT FLD W/ DIFF $ 187.00 $ 75.00 3003 LAB HEMATO30030235 CRYOFIBRINOGEN $ 294.00 $ 91.00 3003 LAB HEMATO30030240 CRYOGLOB QL OR SEMI QL $ 223.00 $ 69.00 3003 LAB HEMATO30030040 CRYSTAL ID TISS/FLD NO UR $ 392.00 $ 121.00 3003 LAB HEMATO30030270 D DIMER QN $ 347.00 $ 108.00 3003 LAB HEMATO30030840 ENZYME HISTOCHEMISTRY $ 524.00 $ 163.00 3003 LAB HEMATO30030565 EOSINOPHILS SMR NASAL $ 160.00 $ 50.00 3003 LAB HEMATO30030295 EUGLOBULIN LYSIS $ 285.00 $ 88.00 3003 LAB HEMATO30030704 FAT STAIN QL $ 151.00 $ 47.00 3003 LAB HEMATO30030230 FCTR INHIBITOR TEST $ 445.00 $ 138.00 3003 LAB HEMATO30039230 FCTR INHIBITOR TEST $ 8.00 $ 8.00 3003 LAB HEMATO30030310 FCTR IX $ 659.00 $ 204.00 3003 LAB HEMATO30030300 FCTR V $ 605.00 $ 188.00 3003 LAB HEMATO30030305 FCTR VIII $ 614.00 $ 190.00 3003 LAB HEMATO30030315 FCTR X $ 614.00 $ 190.00 3003 LAB HEMATO30030322 FCTR XA AB CHROMGN $ 409.00 $ 127.00 3003 LAB HEMATO30030860 FCTR XI $ 614.00 $ 190.00 3003 LAB HEMATO30030320 FCTR XIII SCRN $ 303.00 $ 94.00 3003 LAB HEMATO

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DEPARTMENT CODE

30030000 FETAL RBC SMR (K B) $ 267.00 $ 83.00 3003 LAB HEMATO30030330 FIBRIN DEGRAD PROD $ 240.00 $ 75.00 3003 LAB HEMATO30030335 FIBRIN DEGRAD PROD $ 240.00 $ 75.00 3003 LAB HEMATO30030340 FIBRINOGEN $ 294.00 $ 91.00 3003 LAB HEMATO30030355 G6PD SCRN $ 205.00 $ 63.00 3003 LAB HEMATO30030680 GLUCOSE $ - $ - 3003 LAB HEMATO30030365 HEINZ BODIES DIRECT $ 146.00 $ 89.00 3003 LAB HEMATO30030045 HEMATOCRIT $ 80.00 $ 25.00 3003 LAB HEMATO30031195 HEMATOCRIT SPUN $ 80.00 $ 25.00 3003 LAB HEMATO30039612 HEMOGLOBIN $ 80.00 $ 25.00 3003 LAB HEMATO30030020 HEMOGLOBIN F (APT) $ 205.00 $ 63.00 3003 LAB HEMATO30030465 HEMOGLOBIN PLAS $ 249.00 $ 77.00 3003 LAB HEMATO30030685 HEMOGLOBIN UR $ 157.00 $ 49.00 3003 LAB HEMATO30030360 HEMOLYSIN ACID (HAM'S) $ 277.00 $ 136.00 3003 LAB HEMATO30030765 HEMOLYSINS AGGL AT INCUB $ 236.00 $ 129.00 3003 LAB HEMATO30030447 HEPARIN NEUTRALIZATION $ 409.00 $ 127.00 3003 LAB HEMATO30030080 INTERP BM SMR $ 1,709.00 $ 530.00 3003 LAB HEMATO30030820 IRON STAIN BLD $ 56.00 $ 56.00 3003 LAB HEMATO30030478 LAMELLAR BODY DENSITY $ 650.00 $ 201.00 3003 LAB HEMATO30039478 LAMELLAR BODY DENSITY $ 8.00 $ 8.00 3003 LAB HEMATO30030440 LEUK ALK PHOS $ 294.00 $ 91.00 3003 LAB HEMATO30030790 OCCULT BLD GASTRIC QL $ 116.00 $ 36.00 3003 LAB HEMATO30030470 PLT CNT AUTO $ 151.00 $ 47.00 3003 LAB HEMATO30030500 PREGNANCY TEST SER QL $ 258.00 $ 80.00 3003 LAB HEMATO30030710 PROTEIN UR QN TIM $ 125.00 $ 39.00 3003 LAB HEMATO30030520 PROTHROMBIN TIME $ 134.00 $ 41.00 3003 LAB HEMATO30030420 PTT PLAS OR WB $ 205.00 $ 64.00 3003 LAB HEMATO30030455 PTT PLAS OR WB $ 205.00 $ 64.00 3003 LAB HEMATO30030445 PTT SUBSTITUTION EA $ 223.00 $ 69.00 3003 LAB HEMATO30030755 RBC OSMOTIC FRAG INCUB $ 279.00 $ 279.00 3003 LAB HEMATO30030825 RBC OSMOTIC FRAG INCUB $ 279.00 $ 279.00 3003 LAB HEMATO30030530 RBC OSMOTIC FRAG UNINCUB $ 324.00 $ 104.00 3003 LAB HEMATO30030555 RETICULOCYTE AUTO $ 134.00 $ 41.00 3003 LAB HEMATO

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DEPARTMENT CODE

30030285 SEDIMENTATION RATE MAN $ 125.00 $ 39.00 3003 LAB HEMATO30030795 SEM MOT/CNT (NO HUHNER) $ 294.00 $ 91.00 3003 LAB HEMATO30030580 SEMN ANLYS VOL/CT/MOT/DIF $ 418.00 $ 130.00 3003 LAB HEMATO30030600 SEROTONIN BLD $ 160.00 $ 75.00 3003 LAB HEMATO30030560 SICKLE CL SCRN $ 187.00 $ 58.00 3003 LAB HEMATO30030575 SMR GIEMSA $ 142.00 $ 44.00 3003 LAB HEMATO30030570 SMR MALARIA $ 347.00 $ 108.00 3003 LAB HEMATO30030070 SPEC GRAVITY FLD $ 89.00 $ 28.00 3003 LAB HEMATO30030590 SUGARS QL EA SPEC $ 187.00 $ 58.00 3003 LAB HEMATO30030011 T LYMPH CD4/8 CNT&RATIO $ 300.00 $ 93.00 3003 LAB HEMATO30030805 T LYMPH CD4/8 CNT&RATIO $ 300.00 $ 93.00 3003 LAB HEMATO30030006 T LYMPH TOT CNT $ 39.00 $ 49.00 3003 LAB HEMATO30030012 T LYMPH TOT CNT $ 39.00 $ 49.00 3003 LAB HEMATO30030605 THROMBIN TIME $ 196.00 $ 61.00 3003 LAB HEMATO30030610 URNALYSIS AUTO W/ MICRO $ 107.00 $ 33.00 3003 LAB HEMATO30030630 URNALYSIS AUTO W/ MICRO $ 107.00 $ 33.00 3003 LAB HEMATO30039610 URNALYSIS AUTO W/ MICRO $ 8.00 $ 8.00 3003 LAB HEMATO30030611 URNALYSIS AUTO W/O MICRO $ 80.00 $ 25.00 3003 LAB HEMATO30039611 URNALYSIS AUTO W/O MICRO $ 8.00 $ 8.00 3003 LAB HEMATO30030705 URNALYSIS MAN W/O MICRO $ 89.00 $ 28.00 3003 LAB HEMATO30030715 URNALYSIS MAN W/O MICRO $ 89.00 $ 28.00 3003 LAB HEMATO30030720 URNALYSIS QL OR SEMI QL $ 71.00 $ 22.00 3003 LAB HEMATO30030725 URNALYSIS QL OR SEMI QL $ 71.00 $ 22.00 3003 LAB HEMATO30030736 VENIPUNCTURE $ 73.00 $ 23.00 3003 LAB HEMATO30030737 VENIPUNCTURE $ 73.00 $ 23.00 3003 LAB HEMATO30030075 VISCOSITY $ 400.00 $ 124.00 3003 LAB HEMATO30040655 AFP TUMOR MARKER $ 578.00 $ 179.00 3004 LAB IMMUNO SERO30040242 AG DETECT EIA MULT STEP $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040734 AG DETECT EIA MULT STEP $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040830 AG DETECT EIA MULT STEP $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040586 AMPHETAMINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040596 AMPHETAMINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040075 ANA (ANTI NUCLEAR AB) $ 647.00 $ 201.00 3004 LAB IMMUNO SERO

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DEPARTMENT CODE

30041010 ANA (ANTI NUCLEAR AB) $ 624.00 $ 202.00 3004 LAB IMMUNO SERO30040010 ANA (ANTI NUCLEAR AB).CL $ 647.00 $ 201.00 3004 LAB IMMUNO SERO30041015 ANA TTR $ 74.00 $ 74.00 3004 LAB IMMUNO SERO30040015 ANA TTR .CL $ 383.00 $ 119.00 3004 LAB IMMUNO SERO30040030 ASO SCRN $ 196.00 $ 61.00 3004 LAB IMMUNO SERO30040580 BARBITURATES CONF $ 236.00 $ 107.00 3004 LAB IMMUNO SERO30040587 BARBITURATES SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040597 BARBITURATES SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040588 BENZODIAZEPINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040598 BENZODIAZEPINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040045 BETA HCG QN $ 516.00 $ 160.00 3004 LAB IMMUNO SERO30040050 BETA HCG QN $ 516.00 $ 160.00 3004 LAB IMMUNO SERO30040040 BETA2 MICROGLOBULIN $ 261.00 $ 198.00 3004 LAB IMMUNO SERO30040582 CANNABINOID SCRN $ 17.10 $ 5.27 3004 LAB IMMUNO SERO30040080 CEA $ 650.00 $ 201.00 3004 LAB IMMUNO SERO30040125 CEA $ 650.00 $ 201.00 3004 LAB IMMUNO SERO30040135 CERULOPLASMIN $ 365.00 $ 113.00 3004 LAB IMMUNO SERO30040140 CHLAMYDIA TRACH AG EIA $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040085 CMV AB $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30040150 CMV AB IGG $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30041050 CMV AB IGG $ 8.00 $ 8.00 3004 LAB IMMUNO SERO30040155 CMV AB IGM $ 566.00 $ 176.00 3004 LAB IMMUNO SERO30041055 CMV AB IGM $ 8.00 $ 8.00 3004 LAB IMMUNO SERO30040589 COCAINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040599 COCAINE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040160 COLD AGGLUTININ TTR $ 276.00 $ 86.00 3004 LAB IMMUNO SERO30040090 COMPLEMENT C3 $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040165 COMPLEMENT C3 $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040170 COMPLEMENT C4 $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040175 CRYPTOCOCCAL AG AGGL $ 347.00 $ 108.00 3004 LAB IMMUNO SERO30040185 CRYPTOCOCCAL AG AGGL $ 347.00 $ 108.00 3004 LAB IMMUNO SERO30040700 CRYPTOCOCCAL AG AGGL $ 347.00 $ 108.00 3004 LAB IMMUNO SERO30040720 CRYPTOCOCCAL AG AGGL $ 347.00 $ 108.00 3004 LAB IMMUNO SERO

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DEPARTMENT CODE

30041175 CRYPTOCOCCAL AG AGGL $ 8.00 $ 8.00 3004 LAB IMMUNO SERO30041700 CRYPTOCOCCAL AG AGGL $ 8.00 $ 8.00 3004 LAB IMMUNO SERO30040215 CYCLOSPORINE $ 623.00 $ 193.00 3004 LAB IMMUNO SERO30040785 DELTA O D AMNIOTIC FLD $ 214.00 $ 214.00 3004 LAB IMMUNO SERO30040760 DHEA SULFATE $ 211.00 $ 211.00 3004 LAB IMMUNO SERO30040585 DRG SCRN UR SGL 1ST $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040595 DRG SCRN UR SGL 1ST $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040217 ESTRADIOL (E2) $ 961.00 $ 298.00 3004 LAB IMMUNO SERO30040765 ESTRIOL $ 59.00 $ 59.00 3004 LAB IMMUNO SERO30040220 FAT STL QN $ 179.00 $ 55.00 3004 LAB IMMUNO SERO30040230 FERRITIN $ 472.00 $ 146.00 3004 LAB IMMUNO SERO30040240 FOLATE $ 507.00 $ 157.00 3004 LAB IMMUNO SERO30040445 FOLATE RBC $ 596.00 $ 185.00 3004 LAB IMMUNO SERO30041445 FOLATE RBC $ 51.00 $ 51.00 3004 LAB IMMUNO SERO30040549 FREE T4 $ 311.00 $ 97.00 3004 LAB IMMUNO SERO30040708 FREE T4 $ 311.00 $ 97.00 3004 LAB IMMUNO SERO30040780 FREE T4 $ 311.00 $ 97.00 3004 LAB IMMUNO SERO30040245 FSH $ 641.00 $ 199.00 3004 LAB IMMUNO SERO30040270 FTA ABS (TPPA) .CL $ 454.00 $ 141.00 3004 LAB IMMUNO SERO30040260 H PYLORI AB IGG $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30041260 H PYLORI AB IGG $ 96.00 $ 96.00 3004 LAB IMMUNO SERO30040265 HAPTOGLOBIN QN $ 436.00 $ 135.00 3004 LAB IMMUNO SERO30040670 HAV AB IGM $ 383.00 $ 119.00 3004 LAB IMMUNO SERO30040285 HAV AB TOTAL $ 427.00 $ 132.00 3004 LAB IMMUNO SERO30040290 HB CORE AB TOTAL $ 418.00 $ 130.00 3004 LAB IMMUNO SERO30040300 HBS AB $ 365.00 $ 113.00 3004 LAB IMMUNO SERO30040302 HBS AB $ 365.00 $ 113.00 3004 LAB IMMUNO SERO30040295 HBs AG $ 321.00 $ 100.00 3004 LAB IMMUNO SERO30040297 HBS AG NEUTRALIZATION $ 356.00 $ 110.00 3004 LAB IMMUNO SERO30040745 HCV AB $ 489.00 $ 152.00 3004 LAB IMMUNO SERO30040255 HEMOGLOBIN GLYCOSYLTD A1C $ 329.00 $ 102.00 3004 LAB IMMUNO SERO30040750 HEP C VIRUS BDNA QN $ 1,469.00 $ 455.00 3004 LAB IMMUNO SERO30040275 HGB ELECTRO $ 421.00 $ 131.00 3004 LAB IMMUNO SERO

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DEPARTMENT CODE

30040840 HIV 1 AB $ 303.00 $ 94.00 3004 LAB IMMUNO SERO30040738 HIV 1 QN BDNA $ 873.00 $ 873.00 3004 LAB IMMUNO SERO30040730 HIV 1/HIV 2 AB $ 472.00 $ 146.00 3004 LAB IMMUNO SERO30040305 HSV TYP 2 DFA $ 409.00 $ 127.00 3004 LAB IMMUNO SERO30040370 IGA $ 320.00 $ 99.00 3004 LAB IMMUNO SERO30040375 IGG $ 320.00 $ 99.00 3004 LAB IMMUNO SERO30040380 IGM $ 320.00 $ 99.00 3004 LAB IMMUNO SERO30040350 IMMUNOFIX SER $ 899.00 $ 279.00 3004 LAB IMMUNO SERO30040360 IMMUNOFIX UR $ 1,130.00 $ 351.00 3004 LAB IMMUNO SERO30040395 LH $ 641.00 $ 199.00 3004 LAB IMMUNO SERO30040593 METHADONE SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040405 MONO TEST SCRN $ 178.00 $ 55.00 3004 LAB IMMUNO SERO30040590 OPIATES SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040600 OPIATES SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040591 PCP SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040601 PCP SCRN $ 121.00 $ 38.00 3004 LAB IMMUNO SERO30040415 PREALBUMIN $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30040055 PREGNANCY TEST SER QL $ 258.00 $ 80.00 3004 LAB IMMUNO SERO30040420 PROGESTERONE $ 721.00 $ 224.00 3004 LAB IMMUNO SERO30040425 PROLACTIN $ 667.00 $ 207.00 3004 LAB IMMUNO SERO30040430 PROTEIN ELECTRO SER $ 372.00 $ 111.00 3004 LAB IMMUNO SERO30040605 PROTEIN ELECTRO UR $ 434.00 $ 141.00 3004 LAB IMMUNO SERO30041680 PSA TOTAL $ 122.00 $ 122.00 3004 LAB IMMUNO SERO30040680 PSA TOTAL SCRN $ 632.00 $ 196.00 3004 LAB IMMUNO SERO30040690 PTH C TERMINAL $ 534.00 $ 272.00 3004 LAB IMMUNO SERO30041690 PTH C TERMINAL $ 102.00 $ 102.00 3004 LAB IMMUNO SERO30040660 QN DRG MISC $ 258.00 $ 122.00 3004 LAB IMMUNO SERO30040665 QN DRG MISC $ 258.00 $ 122.00 3004 LAB IMMUNO SERO30040100 RHEUMATOID FCTR QL $ 196.00 $ 61.00 3004 LAB IMMUNO SERO30040500 RHEUMATOID FCTR QL $ 196.00 $ 61.00 3004 LAB IMMUNO SERO30040501 RHEUMATOID FCTR QN $ 196.00 $ 61.00 3004 LAB IMMUNO SERO30040505 RHEUMATOID FCTR QN $ 196.00 $ 61.00 3004 LAB IMMUNO SERO30040210 RPR NON-TREPNML AB QL $ 142.00 $ 44.00 3004 LAB IMMUNO SERO

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DEPARTMENT CODE

30041210 RPR NON-TREPNML AB QL $ 137.00 $ 44.00 3004 LAB IMMUNO SERO30040510 RPR NON-TREPNML AB QL.CL $ 142.00 $ 44.00 3004 LAB IMMUNO SERO30040620 RPR TTR NON-TREPNML AB QN $ 151.00 $ 47.00 3004 LAB IMMUNO SERO30040520 RUBELLA AB $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30040525 RUBEOLA AB IGG .CL $ 86.00 $ 86.00 3004 LAB IMMUNO SERO30040548 T3 TOTAL $ 489.00 $ 152.00 3004 LAB IMMUNO SERO30040535 T3 UPTAKE $ 223.00 $ 69.00 3004 LAB IMMUNO SERO30040740 TACROLIMUS (FK506) $ 472.00 $ 146.00 3004 LAB IMMUNO SERO30040825 TACROLIMUS (FK506) $ 472.00 $ 146.00 3004 LAB IMMUNO SERO30041740 TACROLIMUS (FK506) $ 150.00 $ 150.00 3004 LAB IMMUNO SERO30040545 TESTOSTERONE TOTAL $ 890.00 $ 276.00 3004 LAB IMMUNO SERO30040540 THYROXINE (T4) $ 240.00 $ 75.00 3004 LAB IMMUNO SERO30040556 TOXOPLAS AB IGG $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30041556 TOXOPLAS AB IGG $ 96.00 $ 96.00 3004 LAB IMMUNO SERO30040557 TOXOPLAS AB IGM $ 498.00 $ 155.00 3004 LAB IMMUNO SERO30041557 TOXOPLAS AB IGM $ 96.00 $ 96.00 3004 LAB IMMUNO SERO30040550 TSH $ 578.00 $ 179.00 3004 LAB IMMUNO SERO30040625 VITAMIN A $ 184.00 $ 184.00 3004 LAB IMMUNO SERO30040630 VITAMIN B12 $ 516.00 $ 160.00 3004 LAB IMMUNO SERO30040515 VZV AB $ 445.00 $ 138.00 3004 LAB IMMUNO SERO30050000 AFB CULT $ 374.00 $ 225.00 3005 LAB MICRO30052000 AFB CULT $ 72.00 $ 72.00 3005 LAB MICRO30050906 AFB ISOLATE ID $ 374.00 $ 250.00 3005 LAB MICRO30050395 BACTERIAL AG EA AG $ 347.00 $ 108.00 3005 LAB MICRO30050753 C DIFF AMPLIFIED PROB.CL $ 307.50 $ 307.50 3005 LAB MICRO30050141 C DIFFICILE TOXIN EIA $ 409.00 $ 127.00 3005 LAB MICRO30050880 CHLAMYDIA CULT $ 676.00 $ 210.00 3005 LAB MICRO30050750 CHLAMYDIA TRACH AMP PRB $ 1,210.00 $ 55.00 3005 LAB MICRO30050751 CHLAMYDIA TRACH AMP PRB $ 1,210.00 $ 55.00 3005 LAB MICRO30052750 CHLAMYDIA TRACH AMP PRB $ 55.00 $ 55.00 3005 LAB MICRO30052751 CHLAMYDIA TRACH AMP PRB $ 55.00 $ 55.00 3005 LAB MICRO30050760 CRYPTOSPORIDIUM $ 409.00 $ 127.00 3005 LAB MICRO30052760 CRYPTOSPORIDIUM $ 79.00 $ 79.00 3005 LAB MICRO

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DEPARTMENT CODE

30050080 CULT BACT AEROBIC ID $ 276.00 $ 86.00 3005 LAB MICRO30050081 CULT BACT AEROBIC ID $ 276.00 $ 86.00 3005 LAB MICRO30050082 CULT BACT AEROBIC ID $ 276.00 $ 86.00 3005 LAB MICRO30050072 CULT BACT ANAEROBIC $ 329.00 $ 102.00 3005 LAB MICRO30050077 CULT BACT ANAEROBIC ID $ 276.00 $ 86.00 3005 LAB MICRO30050120 CULT BLD BACTERIA $ 356.00 $ 128.00 3005 LAB MICRO30050130 CULT BLD BACTERIA $ 356.00 $ 128.00 3005 LAB MICRO30050640 CULT BX $ 294.00 $ 91.00 3005 LAB MICRO30050690 CULT CATHETER TIP $ 294.00 $ 91.00 3005 LAB MICRO30050830 CULT CMV $ 899.00 $ 279.00 3005 LAB MICRO30052830 CULT CMV $ 173.00 $ 173.00 3005 LAB MICRO30050650 CULT FLUID $ 294.00 $ 91.00 3005 LAB MICRO30050177 CULT FUNG SKIN HAIR NAIL $ 267.00 $ 83.00 3005 LAB MICRO30050178 CULT FUNGUS BLD $ 311.00 $ 97.00 3005 LAB MICRO30050176 CULT FUNGUS MOLD ID $ 356.00 $ 110.00 3005 LAB MICRO30050175 CULT FUNGUS YEAST ID $ 356.00 $ 110.00 3005 LAB MICRO30050085 CULT GENITAL $ 294.00 $ 91.00 3005 LAB MICRO30050735 CULT HSV $ 1,166.00 $ 362.00 3005 LAB MICRO30050415 CULT LEGIONELLA $ 231.00 $ 72.00 3005 LAB MICRO30050065 CULT MISC $ 294.00 $ 91.00 3005 LAB MICRO30050190 CULT SCRN GM NEG $ 231.00 $ 72.00 3005 LAB MICRO30050115 CULT SCRN ONLY $ 231.00 $ 72.00 3005 LAB MICRO30050571 CULT STL OTHER EA PLATE $ 320.00 $ 99.00 3005 LAB MICRO30050570 CULT STL SALM & SHIG $ 320.00 $ 99.00 3005 LAB MICRO30050585 CULT THROAT $ 294.00 $ 91.00 3005 LAB MICRO30050078 CULT TYP AGGL $ 178.00 $ 55.00 3005 LAB MICRO30050730 CULT TYP FLUORESCENT $ 16.00 $ 16.00 3005 LAB MICRO30050731 CULT TYP FLUORESCENT $ 16.00 $ 16.00 3005 LAB MICRO30050590 CULT UR COLONY CT ONLY $ 276.00 $ 86.00 3005 LAB MICRO30050117 CULT UR ID EACH ISOLATE $ 276.00 $ 86.00 3005 LAB MICRO30050890 CULT V ZOSTER $ 899.00 $ 279.00 3005 LAB MICRO30050630 CULT WOUND $ 294.00 $ 91.00 3005 LAB MICRO30050745 CULTVIRAL $ 899.00 $ 279.00 3005 LAB MICRO

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DEPARTMENT CODE

30050895 CULTVIRAL $ 899.00 $ 279.00 3005 LAB MICRO30050560 FAT STL QL $ 178.00 $ 55.00 3005 LAB MICRO30050738 GC AMP PRB $ 205.00 $ 55.00 3005 LAB MICRO30050739 GC AMP PRB $ 205.00 $ 55.00 3005 LAB MICRO30052738 GC AMP PRB $ 55.00 $ 55.00 3005 LAB MICRO30052739 GC AMP PRB $ 55.00 $ 55.00 3005 LAB MICRO30050662 HPV AMP PRB $ 30.00 $ 30.00 3005 LAB MICRO30050668 HSV TYP 1 DFA $ 409.00 $ 127.00 3005 LAB MICRO30050667 HSV TYP 2 DFA $ 409.00 $ 127.00 3005 LAB MICRO30050405 INDIA INK PREP CSF $ 142.00 $ 44.00 3005 LAB MICRO30050610 INDIA INK PREP CSF $ 142.00 $ 44.00 3005 LAB MICRO30051000 INFLU A H1N1 RNA RT PCR $ 127.00 $ 127.00 3005 LAB MICRO30051002 INFLUENZA A RNA PCR $ 127.00 $ 127.00 3005 LAB MICRO30050665 INFLUENZA AG A OR B EACH $ 409.00 $ 127.00 3005 LAB MICRO30050666 INFLUENZA B DFA $ 409.00 $ 127.00 3005 LAB MICRO30050410 KOH PREP SKIN HAIR NAIL $ 142.00 $ 44.00 3005 LAB MICRO30050435 LEGIONELLA PNEUMO DFA $ 409.00 $ 127.00 3005 LAB MICRO30050908 M AVIUM AMP PRB $ 368.00 $ 250.00 3005 LAB MICRO30050907 M TB AMP PRB $ 368.00 $ 250.00 3005 LAB MICRO30050492 MACRO EXAM PARASITE $ 142.00 $ 44.00 3005 LAB MICRO30050485 OCCLT BLD STL QL MULT SPC $ 116.00 $ 36.00 3005 LAB MICRO30050490 OVA & PARASITES W CONC $ 303.00 $ 100.00 3005 LAB MICRO30050491 OVA & PARASITES W CONC $ 303.00 $ 100.00 3005 LAB MICRO30052490 OVA & PARASITES W CONC $ 58.00 $ 58.00 3005 LAB MICRO30052491 OVA & PARASITES W CONC $ 58.00 $ 58.00 3005 LAB MICRO30050565 PINWORM CELLOPHANE TAPE $ 142.00 $ 44.00 3005 LAB MICRO30050755 ROTAVIRUS AG EIA $ 409.00 $ 127.00 3005 LAB MICRO30050660 RSV AG EIA $ 409.00 $ 127.00 3005 LAB MICRO30050045 SER BACTERICIDAL TTR $ 516.00 $ 160.00 3005 LAB MICRO30050020 SMR AFB STAIN $ 187.00 $ 58.00 3005 LAB MICRO30052020 SMR AFB STAIN $ 36.00 $ 36.00 3005 LAB MICRO30050145 SMR CRYPTOSPORIDIUM $ 187.00 $ 58.00 3005 LAB MICRO30052145 SMR CRYPTOSPORIDIUM $ 334.00 $ 108.00 3005 LAB MICRO

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DEPARTMENT CODE

30050037 SMR FLUOR + OR ACID FAST $ 187.00 $ 58.00 3005 LAB MICRO30050380 SMR GRAM STAIN $ 142.00 $ 44.00 3005 LAB MICRO30050385 SMR GRAM STAIN $ 142.00 $ 44.00 3005 LAB MICRO30050406 SMR WET MOUNT $ - $ - 3005 LAB MICRO30050021 SPEC CONCENTRATION $ 231.00 $ 72.00 3005 LAB MICRO30052021 SPEC CONCENTRATION $ 16.00 $ 16.00 3005 LAB MICRO30050945 SPEC STAIN GRP II INTRP/R $ 189.00 $ 59.00 3005 LAB MICRO30050700 STREP GRP A AG EIA $ 409.00 $ 127.00 3005 LAB MICRO30050201 SUSCEPT BY E TEST $ 160.00 $ 50.00 3005 LAB MICRO30052001 SUSCEPT BY ENZYME DETECT $ 160.00 $ 50.00 3005 LAB MICRO30050200 SUSCEPT KB DISK <=12 $ 240.00 $ 75.00 3005 LAB MICRO30050320 SUSCEPT KB DISK <=12 $ 240.00 $ 75.00 3005 LAB MICRO30050025 SUSCEPT MIC PER PLATE $ 294.00 $ 91.00 3005 LAB MICRO30050240 SUSCEPT MIC PER PLATE $ 294.00 $ 91.00 3005 LAB MICRO30050300 SUSCEPT MIC PER PLATE $ 294.00 $ 91.00 3005 LAB MICRO30050520 SUSCEPT MIC PER PLATE $ 294.00 $ 91.00 3005 LAB MICRO30050002 T LYMPH CD4 (HELPER) CNT $ 803.00 $ 803.00 3005 LAB MICRO30052002 T LYMPH CD4 (HELPER) CNT $ 95.00 $ 95.00 3005 LAB MICRO30050642 TISSUE HOMOGENIZATION $ 205.00 $ 63.00 3005 LAB MICRO30057070 VZV AB IGG $ 86.00 $ 86.00 3005 LAB MICRO30050885 VZV AB IGG .CL $ 86.00 $ 86.00 3005 LAB MICRO30160415 CALC ANALYSIS XR DIFFRAC $ 50.00 $ 50.00 3016 LAB PATH30160205 CHEM HISTOCHEMISTRY $ 509.00 $ 158.00 3016 LAB PATH30160430 CRYSTAL ID TISS/FLD NO UR $ 392.00 $ 121.00 3016 LAB PATH30160040 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3016 LAB PATH30160220 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3016 LAB PATH30160420 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3016 LAB PATH30161100 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3016 LAB PATH30161800 CYTO CL BLK 5 CNT/1 KARY $ 771.00 $ 107.00 3016 LAB PATH30160295 CYTOLOGY PREP & INTERP $ 572.00 $ 177.00 3016 LAB PATH30160400 DECALCIFICATION $ 241.00 $ 75.00 3016 LAB PATH30160405 DECALCIFICATION $ 241.00 $ 75.00 3016 LAB PATH30160650 DNA CL CYCLE $ 290.00 $ 90.00 3016 LAB PATH

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DEPARTMENT CODE

30160670 DNA CL CYCLE $ 290.00 $ 90.00 3016 LAB PATH30160715 DNA CL CYCLE $ 290.00 $ 90.00 3016 LAB PATH30160245 ELECTRON MICROSCOPY $ 4,815.00 $ 1,493.00 3016 LAB PATH30160250 ELECTRON MICROSCOPY $ 4,815.00 $ 1,493.00 3016 LAB PATH30160275 ELECTRON MICROSCOPY $ 4,815.00 $ 1,493.00 3016 LAB PATH30160000 ENZYME HISTOCHEMISTRY $ 524.00 $ 163.00 3016 LAB PATH30160210 ENZYME HISTOCHEMISTRY $ 524.00 $ 163.00 3016 LAB PATH30160215 ENZYME HISTOCHEMISTRY $ 524.00 $ 163.00 3016 LAB PATH30160330 FNA INTERP & RPT $ 359.00 $ 111.00 3016 LAB PATH30160335 FNA INTERP & RPT $ 359.00 $ 111.00 3016 LAB PATH30160340 FNA INTERP & RPT $ 359.00 $ 111.00 3016 LAB PATH30160350 FNA INTERP & RPT $ 359.00 $ 111.00 3016 LAB PATH30160190 HISTO STAIN FRZN SECT I/R $ 466.00 $ 466.00 3016 LAB PATH30160080 IMMUNOFL STDY DRCT EA ANT $ 505.00 $ 156.00 3016 LAB PATH30160070 IMMUNOHISTOCHEMISTRY $ 600.00 $ 152.00 3016 LAB PATH30160075 IMMUNOHISTOCHEMISTRY $ 600.00 $ 152.00 3016 LAB PATH30160010 INTERP BLD SMR $ 160.00 $ 50.00 3016 LAB PATH30160020 INTERP BM SMR $ 1,709.00 $ 530.00 3016 LAB PATH30160030 INTERP BM SMR $ 1,709.00 $ 530.00 3016 LAB PATH30160294 INTRAOP CYTOPATH CON ADDL $ 534.00 $ 165.00 3016 LAB PATH30160292 INTRAOP CYTOPATH CON INIT $ 961.00 $ 298.00 3016 LAB PATH30160060 IRON STAIN BLD $ 56.00 $ 56.00 3016 LAB PATH30160100 OUTSD COMPR CONSULT $ 144.00 $ 144.00 3016 LAB PATH30160130 OUTSD SLIDE CONSULT $ 92.00 $ 29.00 3016 LAB PATH30160131 OUTSD SLIDE CONSULT $ 92.00 $ 29.00 3016 LAB PATH30160120 OUTSD SLIDE CONSULT PREP $ 452.00 $ 140.00 3016 LAB PATH30160132 OUTSD SLIDE CONSULT PREP $ 452.00 $ 140.00 3016 LAB PATH30160133 OUTSD SLIDE CONSULT PREP $ 452.00 $ 140.00 3016 LAB PATH30160280 PATH FRZN SECTION 1 BLK $ 497.00 $ 154.00 3016 LAB PATH30160290 PATH FRZN SECTION ADD $ 267.00 $ 83.00 3016 LAB PATH30160805 RECEPT ASSAY ESTROGEN $ 163.00 $ 163.00 3016 LAB PATH30160860 RECEPT ASSAY PROGEST $ 163.00 $ 163.00 3016 LAB PATH30160160 SPEC STAIN GRP I MICR I/R $ 180.00 $ 56.00 3016 LAB PATH

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DEPARTMENT CODE

30160170 SPEC STAIN GRP II INTRP/R $ 189.00 $ 59.00 3016 LAB PATH30160360 SURG PATH LVL I $ 401.00 $ 124.00 3016 LAB PATH30161000 SURG PATH LVL II $ 917.00 $ 284.00 3016 LAB PATH30161700 SURG PATH LVL II $ 917.00 $ 284.00 3016 LAB PATH30161050 SURG PATH LVL III $ 1,175.00 $ 150.00 3016 LAB PATH30161750 SURG PATH LVL III $ 1,175.00 $ 150.00 3016 LAB PATH30161250 SURG PATH LVL V $ 2,812.00 $ 500.00 3016 LAB PATH30161850 SURG PATH LVL V $ 2,812.00 $ 500.00 3016 LAB PATH30161450 SURG PATH LVL VI $ 3,916.00 $ 1,214.00 3016 LAB PATH30161900 SURG PATH LVL VI $ 3,916.00 $ 1,214.00 3016 LAB PATH30160530 SURG PATH UNLISTED $ - $ - 3016 LAB PATH30160032 TISS EX MOLE STUDY ADD-ON $ 336.00 $ 336.00 3016 LAB PATH30160031 TISS EXAM MOLECULAR STUDY $ 336.00 $ 336.00 3016 LAB PATH30160490 XR SPECIMEN SURGICAL $ 304.00 $ 304.00 3016 LAB PATH30008362 BASIC METBLC PNL TOTAL CA $ 294.00 $ 100.00 3000 LAB PROFLS30008365 BASIC METBLC PNL TOTAL CA $ 294.00 $ 100.00 3000 LAB PROFLS30008382 COMPR MET PNL $ 365.00 $ 113.00 3000 LAB PROFLS30008110 ELECTROLYTE PNL $ 240.00 $ 75.00 3000 LAB PROFLS30008115 ELECTROLYTE PNL $ 240.00 $ 75.00 3000 LAB PROFLS30008392 HEPATIC FUNCTION PNL $ 285.00 $ 88.00 3000 LAB PROFLS30008402 LIPID PNL $ 445.00 $ 138.00 3000 LAB PROFLS30008310 PRENATAL PNL $ 1,157.00 $ 359.00 3000 LAB PROFLS30008395 RENAL FUNCTION PNL $ 303.00 $ 94.00 3000 LAB PROFLS30023464 11 DEOXYCORTISOL .Q3 $ 55.96 $ 55.96 3002 LAB REFRD30021590 17 OH CORTICOSTERIODS.Q3 $ 39.71 $ 39.71 3002 LAB REFRD30023085 17 OH PROGESTRONE $ 14.50 $ 14.50 3002 LAB REFRD30025326 17 OH PROGESTRONE .LC $ 14.25 $ 14.25 3002 LAB REFRD30020945 17 OH PROGESTRONE .Q3 $ 28.46 $ 28.46 3002 LAB REFRD30021580 5 HIAA UR $ 34.36 $ 34.36 3002 LAB REFRD30025628 5 HIAA UR .LC $ 10.00 $ 10.00 3002 LAB REFRD30021581 5 HIAA UR .Q3 $ 17.94 $ 17.94 3002 LAB REFRD30020000 5 NUCLEOTIDASE $ 25.17 $ 25.17 3002 LAB REFRD30020150 ACE (ANGIOTN CONVR EN.Q3 $ 13.80 $ 13.80 3002 LAB REFRD

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DEPARTMENT CODE

30020151 ACE (ANGIOTN CONVR ENZ) $ 19.76 $ 19.76 3002 LAB REFRD30023746 ACE (ANGIOTN CONVR ENZ.LC $ 9.56 $ 9.56 3002 LAB REFRD30025720 ACETOMINOPHEN SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD30025352 ACETYLCHOLINE BLK AB .LC $ 30.50 $ 30.50 3002 LAB REFRD30020011 ACETYLCHOLINE BLK AB .Q3 $ 55.20 $ 55.20 3002 LAB REFRD30025368 ACETYLCHOLINE MODULE .LC $ 120.00 $ 120.00 3002 LAB REFRD30020012 ACETYLCHOLINE MODULE .Q3 $ 67.85 $ 67.85 3002 LAB REFRD30025286 ACETYLCHOLINE RECEPT .LC $ 22.25 $ 22.25 3002 LAB REFRD30020014 ACETYLCHOLINE RECEPT .Q3 $ 51.75 $ 51.75 3002 LAB REFRD30020010 ACETYLCHOLINE RECEPT AB $ 48.36 $ 48.36 3002 LAB REFRD30025570 ACID PHOS PROSTATIC .LC $ 17.50 $ 17.50 3002 LAB REFRD30022190 ACID PHOS PROSTATIC .Q3 $ 11.21 $ 11.21 3002 LAB REFRD30020020 ACTH $ 51.16 $ 51.16 3002 LAB REFRD30024034 ACTH .LC $ 22.00 $ 22.00 3002 LAB REFRD30020019 ACTH .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30023466 ACYLCARNITINES QN EA .Q3 $ 148.12 $ 148.12 3002 LAB REFRD30025612 ACYLCARNITINES QN EA .LC $ 130.00 $ 130.00 3002 LAB REFRD30025868 ACYLCARNITINES QN EA .LC $ 142.73 $ 142.73 3002 LAB REFRD30024144 ACYLCARNITINES QN EA .Q3 $ 86.00 $ 86.00 3002 LAB REFRD30023264 ADENOVIRUS AB .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30025290 ADENOVIRUS AB .LC $ 15.00 $ 15.00 3002 LAB REFRD30025934 ADENOVIRUS DFA .LC $ 22.00 $ 22.00 3002 LAB REFRD30025821 ADH (VASOPRESSIN) .LC $ 30.00 $ 30.00 3002 LAB REFRD30021800 ADH (VASOPRESSIN) .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30025278 ADRENAL AB SCRN .LC $ 18.00 $ 18.00 3002 LAB REFRD30023926 AFB ISOLATE ID .Q3 $ 34.65 $ 34.65 3002 LAB REFRD30025930 AG DETECT EIA MULT ST.LC $ 23.00 $ 23.00 3002 LAB REFRD30023060 AG DETECT EIA MULT ST.Q3 $ 27.60 $ 27.60 3002 LAB REFRD30021243 AG DETECT NOS DNA AMP $ 127.83 $ 127.83 3002 LAB REFRD30023262 AG DETECT NOS DNA AMP .Q3 $ 109.25 $ 109.25 3002 LAB REFRD30023380 AG DETECT NOS DNA AMP .Q3 $ 196.65 $ 196.65 3002 LAB REFRD30025304 AG DETECT NOS DNA AMP.LC $ 293.00 $ 293.00 3002 LAB REFRD30025872 AG DETECT NOS DNA AMP.LC $ 142.87 $ 142.87 3002 LAB REFRD

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DEPARTMENT CODE

30022475 AG DETECT NOS DNA AMP.Q3 $ 97.75 $ 97.75 3002 LAB REFRD30023536 ALBUMIN FLD .LC $ 30.80 $ 30.80 3002 LAB REFRD30023184 ALBUMIN FLD .Q3 $ 14.74 $ 14.74 3002 LAB REFRD30023472 ALBUMIN FLD .Q3 $ 8.22 $ 8.22 3002 LAB REFRD30023532 ALBUMIN SERUM/PLASMA/.LC $ 30.80 $ 30.80 3002 LAB REFRD30024080 ALBUMIN SERUM/PLASMA/.LC $ 19.35 $ 19.35 3002 LAB REFRD30023188 ALBUMIN SERUM/PLASMA/.Q3 $ 14.75 $ 14.75 3002 LAB REFRD30023476 ALBUMIN SERUM/PLASMA/.Q3 $ 8.22 $ 8.22 3002 LAB REFRD30023846 ALBUMIN SERUM/PLASMA/.Q3 $ 7.18 $ 7.18 3002 LAB REFRD30020030 ALDOLASE $ 11.97 $ 11.97 3002 LAB REFRD30025792 ALDOLASE .LC $ 3.25 $ 3.25 3002 LAB REFRD30020031 ALDOLASE .Q3 $ 9.78 $ 9.78 3002 LAB REFRD30020040 ALDOSTERONE $ 48.36 $ 48.36 3002 LAB REFRD30025798 ALDOSTERONE .LC $ 17.00 $ 17.00 3002 LAB REFRD30020041 ALDOSTERONE .Q3 $ 31.05 $ 31.05 3002 LAB REFRD30020043 ALDOSTERONE UR $ 70.99 $ 70.99 3002 LAB REFRD30021620 ALDOSTERONE UR $ 70.99 $ 70.99 3002 LAB REFRD30020047 ALDOSTERONE UR 24HR .Q3 $ 44.85 $ 44.85 3002 LAB REFRD30025380 ALK PHOS ISOENZYMES .LC $ 4.62 $ 4.62 3002 LAB REFRD30020051 ALK PHOS ISOENZYMES .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30025378 ALK PHOSPHATASE .LC $ 4.62 $ 4.62 3002 LAB REFRD30023100 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023276 ALLERGEN SPEC IGE QN .Q3 $ 24.67 $ 24.67 3002 LAB REFRD30023286 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023406 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023412 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023416 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023418 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023422 ALLERGEN SPEC IGE QN .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023282 ALLERGEN SPEC IGG QN .Q3 $ 34.44 $ 34.44 3002 LAB REFRD30023678 ALLERGEN SPECIFIC IGE .LC $ 5.09 $ 5.09 3002 LAB REFRD30023876 ALLERGEN SPECIFIC IGE .LC $ 5.09 $ 5.09 3002 LAB REFRD30023314 ALLERGEN SPECIFIC IGE .Q3 $ 55.66 $ 55.66 3002 LAB REFRD

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DEPARTMENT CODE

30023352 ALLERGEN SPECIFIC IGE .Q3 $ 24.21 $ 24.21 3002 LAB REFRD30020601 ALLERGEN SPECIFIC IGE QN $ 6.82 $ 6.82 3002 LAB REFRD30020602 ALLERGEN SPECIFIC IGE QN $ 6.82 $ 6.82 3002 LAB REFRD30025770 ALLERGEN SPECIFIC IGE QN $ 7.50 $ 7.50 3002 LAB REFRD30025356 ALLERGEN SPECIFIC IGE.LC $ 30.00 $ 30.00 3002 LAB REFRD30025482 ALLERGEN SPECIFIC IGE.LC $ 11.75 $ 11.75 3002 LAB REFRD30025610 ALLERGEN SPECIFIC IGE.LC $ 4.00 $ 4.00 3002 LAB REFRD30025766 ALLERGEN SPECIFIC IGE.LC $ 4.00 $ 4.00 3002 LAB REFRD30025768 ALLERGEN SPECIFIC IGE.LC $ 4.50 $ 4.50 3002 LAB REFRD30025776 ALLERGEN SPECIFIC IGE.LC $ 9.50 $ 9.50 3002 LAB REFRD30025838 ALLERGEN SPECIFIC IGE.LC $ 6.00 $ 6.00 3002 LAB REFRD30025840 ALLERGEN SPECIFIC IGE.LC $ 9.50 $ 9.50 3002 LAB REFRD30020603 ALLERGEN SPECIFIC IGE.Q3 $ 6.82 $ 6.82 3002 LAB REFRD30020604 ALLERGEN SPECIFIC IGE.Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023958 ALLERGEN SPECIFIC IGE.Q3 $ 5.14 $ 5.14 3002 LAB REFRD30023960 ALLERGEN SPECIFIC IGE.Q3 $ 8.45 $ 8.45 3002 LAB REFRD30023962 ALLERGEN SPECIFIC IGE.Q3 $ 8.03 $ 8.03 3002 LAB REFRD30023964 ALLERGEN SPECIFIC IGE.Q3 $ 4.16 $ 4.16 3002 LAB REFRD30023966 ALLERGEN SPECIFIC IGE.Q3 $ 4.17 $ 4.17 3002 LAB REFRD30021502 ALLERGEN SPECIFIC IGE.SP $ 49.07 $ 49.07 3002 LAB REFRD30021503 ALLERGEN SPECIFIC IGE.SP $ 49.07 $ 49.07 3002 LAB REFRD30021504 ALLERGEN SPECIFIC IGE.SP $ 30.34 $ 30.34 3002 LAB REFRD30023320 ALLERGEN SPECIFIC IGG .Q3 $ 24.21 $ 24.21 3002 LAB REFRD30023334 ALLERGEN SPECIFIC IGG .Q3 $ 24.21 $ 24.21 3002 LAB REFRD30023848 ALLERGEN SPECIFIC IGG .Q3 $ 9.88 $ 9.88 3002 LAB REFRD30025764 ALLERGEN SPECIFIC IGG.LC $ 4.00 $ 4.00 3002 LAB REFRD30023322 ALLERGEN TETANUS IGG .Q3 $ 27.73 $ 27.73 3002 LAB REFRD30025772 ALLGN MOLD IGE QL MLT.LC $ 6.00 $ 6.00 3002 LAB REFRD30023360 ALLGN MOLD IGE QL MLT.Q3 $ 13.65 $ 13.65 3002 LAB REFRD30023396 ALLGN MOLD IGE QL MLT.Q3 $ 13.65 $ 13.65 3002 LAB REFRD30025774 ALLGN SPEC IGE QL MLT.LC $ 4.00 $ 4.00 3002 LAB REFRD30025494 ALPHA 1 ANTITRYP PHEN.LC $ 7.00 $ 7.00 3002 LAB REFRD30020065 ALPHA 1 ANTITRYP PHEN.Q3 $ 25.30 $ 25.30 3002 LAB REFRD

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DEPARTMENT CODE

30020060 ALPHA 1 ANTITRYP PHENO $ 42.38 $ 42.38 3002 LAB REFRD30020050 ALPHA 1 ANTITRYPSIN $ 17.18 $ 17.18 3002 LAB REFRD30023682 ALPHA 1 ANTITRYPSIN .LC $ 10.20 $ 10.20 3002 LAB REFRD30025360 ALPHA 1 ANTITRYPSIN .LC $ 105.00 $ 105.00 3002 LAB REFRD30025492 ALPHA 1 ANTITRYPSIN .LC $ 7.00 $ 7.00 3002 LAB REFRD30020052 ALPHA 1 ANTITRYPSIN .Q3 $ 15.24 $ 15.24 3002 LAB REFRD30022360 ALPHA 2 ANTIPLASMIN $ 47.74 $ 47.74 3002 LAB REFRD30025298 ALPHA 2 ANTIPLASMIN .LC $ 55.00 $ 55.00 3002 LAB REFRD30025942 ALPRAZOLAM .LC $ 18.00 $ 18.00 3002 LAB REFRD30025670 ALT (SGPT) .LC $ 38.75 $ 38.75 3002 LAB REFRD30020080 ALUMINUM $ 23.47 $ 23.47 3002 LAB REFRD30023586 ALUMINUM .LC $ 17.12 $ 17.12 3002 LAB REFRD30020081 ALUMINUM .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30025802 AMEBIC AB .LC $ 41.40 $ 41.40 3002 LAB REFRD30020090 AMEBIC AB .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30023384 AMINO ACIDS CSF >5 QN .Q3 $ 195.79 $ 195.79 3002 LAB REFRD30020117 AMINO ACIDS MULT QL $ 27.67 $ 27.67 3002 LAB REFRD30023075 AMINO ACIDS MULT QL .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30023001 AMINO ACIDS PLAS >5 Q.Q3 $ 110.98 $ 110.98 3002 LAB REFRD30023912 AMINO ACIDS PLAS >5 QN.LC $ 183.60 $ 183.60 3002 LAB REFRD30020115 AMINO ACIDS PLAS>5 QN.Q3 $ 122.98 $ 122.98 3002 LAB REFRD30020110 AMINO ACIDS SGL QN $ 536.02 $ 536.02 3002 LAB REFRD30022270 AMINO ACIDS SGL QN $ 486.86 $ 486.86 3002 LAB REFRD30023468 AMINO ACIDS SGL QN .Q3 $ 74.75 $ 74.75 3002 LAB REFRD30025490 AMINO ACIDS UR >5 QN .LC $ 151.00 $ 151.00 3002 LAB REFRD30020116 AMINO ACIDS UR MULT Q.Q3 $ 22.43 $ 22.43 3002 LAB REFRD30023000 AMINO ACIDS UR MULT Q.Q3 $ 27.67 $ 27.67 3002 LAB REFRD30022275 AMINO ACIDS UR>5 QN .Q3 $ 150.65 $ 150.65 3002 LAB REFRD30020100 AMIODARONE $ 19.99 $ 19.99 3002 LAB REFRD30020101 AMIODARONE .Q3 $ 33.35 $ 33.35 3002 LAB REFRD30020120 AMITRIPTYLINE $ 28.99 $ 28.99 3002 LAB REFRD30020121 AMITRIPTYLINE .Q3 $ 26.45 $ 26.45 3002 LAB REFRD30024152 AMPHETAMINE QN .Q3 $ 35.55 $ 35.55 3002 LAB REFRD

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DEPARTMENT CODE

30025732 AMPHETAMINE QN .Q3 $ 92.00 $ 92.00 3002 LAB REFRD30023150 AMPHETAMINE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025344 AMPHETAMINE SCRN .LC $ 50.00 $ 50.00 3002 LAB REFRD30020125 AMPHETAMINE SCRN .Q3 $ 28.54 $ 28.54 3002 LAB REFRD30025548 AMPHETAMINE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30025854 AMPLIF NA PROBE NOS A.Q3 $ 110.00 $ 110.00 3002 LAB REFRD30025858 AMPLIF NA PROBE NOS A.Q3 $ 115.00 $ 115.00 3002 LAB REFRD30025496 AMYLASE .LC $ 10.00 $ 10.00 3002 LAB REFRD30023932 AMYLASE .Q3 $ 37.32 $ 37.32 3002 LAB REFRD30023732 ANA (ANTI NUCLEAR AB) .LC $ 19.68 $ 19.68 3002 LAB REFRD30023106 ANA (ANTI NUCLEAR AB) .Q3 $ 25.85 $ 25.85 3002 LAB REFRD30023242 ANA (ANTI NUCLEAR AB) .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023657 ANA (ANTI NUCLEAR AB).LC $ 10.35 $ 10.35 3002 LAB REFRD30025452 ANA (ANTI NUCLEAR AB).LC $ 63.75 $ 63.75 3002 LAB REFRD30025844 ANA (ANTI NUCLEAR AB).LC $ 33.23 $ 33.23 3002 LAB REFRD30025442 ANA (ANTI NUCLEAR AB).Q3 $ 7.27 $ 7.27 3002 LAB REFRD30020145 ANA (ANTI NUCLEAR AB).SP $ 10.20 $ 10.20 3002 LAB REFRD30025444 ANA TTR .Q3 $ 8.00 $ 8.00 3002 LAB REFRD30025544 ANA TTR .Q3 $ 8.00 $ 8.00 3002 LAB REFRD30025426 ANCA IBD SCREEN .Q3 $ 31.26 $ 31.26 3002 LAB REFRD30025428 ANCA IBD TITER .Q3 $ 125.00 $ 125.00 3002 LAB REFRD30020620 ANCA NEUT CYTO AB SCRN $ 35.25 $ 35.25 3002 LAB REFRD30025324 ANDROSTENEDIONE .LC $ 20.00 $ 20.00 3002 LAB REFRD30020140 ANDROSTENEDIONE .Q3 $ 24.15 $ 24.15 3002 LAB REFRD30020170 ANTI DNA DBL STRAND $ 17.49 $ 17.49 3002 LAB REFRD30023578 ANTI DNA DBL STRAND .LC $ 10.71 $ 10.71 3002 LAB REFRD30023718 ANTI DNA DBL STRAND .LC $ 19.61 $ 19.61 3002 LAB REFRD30023122 ANTI DNA DBL STRAND .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023669 ANTI DNA DBL STRAND .LC $ 10.35 $ 10.35 3002 LAB REFRD30025682 ANTI DNA DBL STRAND .LC $ 10.86 $ 10.86 3002 LAB REFRD30020171 ANTI DNA DBL STRAND .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30023730 ANTI MITOCHRONDRIAL AB.LC $ 19.61 $ 19.61 3002 LAB REFRD30023726 ANTI PARIETAL CELL AB .LC $ 19.61 $ 19.61 3002 LAB REFRD

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DEPARTMENT CODE

30023714 ANTI RNP AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023742 ANTI RNP AB .LC $ 10.83 $ 10.83 3002 LAB REFRD30023228 ANTI RNP AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023661 ANTI RNP AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30025684 ANTI RNP AB .LC $ 10.86 $ 10.86 3002 LAB REFRD30023716 ANTI SM AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023226 ANTI SM AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023728 ANTI SMOOTH MUSCLE AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30025366 ANTIFUNGAL FLUCONAZOL.LC $ 88.00 $ 88.00 3002 LAB REFRD30023192 ANTINEUTROPHILIC AB .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30021207 ANTINEUTROPHILIC AB .Q3 $ 38.99 $ 38.99 3002 LAB REFRD30023104 ANTIRETICULIN AB W/RFX.Q3 $ 15.18 $ 15.18 3002 LAB REFRD30023234 ANTIRETICULIN AB W/RFX.Q3 $ 15.61 $ 15.61 3002 LAB REFRD30021055 APOLIOPPROTEIN B .Q3 $ 16.10 $ 16.10 3002 LAB REFRD30024252 APOLIPOPROTEIN A1 .LC $ 4.00 $ 4.00 3002 LAB REFRD30025660 APOLIPOPROTEIN A1 .LC $ 38.70 $ 38.70 3002 LAB REFRD30021041 APOLIPOPROTEIN A1 .Q3 $ - $ - 3002 LAB REFRD30021058 APOLIPOPROTEIN A1 .Q3 $ 12.65 $ 12.65 3002 LAB REFRD30021059 APOLIPOPROTEIN A1 .Q3 $ 16.39 $ 16.39 3002 LAB REFRD30025928 APOLIPOPROTEIN B .LC $ 5.00 $ 5.00 3002 LAB REFRD30020280 ARSENIC BLD $ 20.08 $ 20.08 3002 LAB REFRD30020809 ARSENIC BLD .Q3 $ 27.09 $ 27.09 3002 LAB REFRD30021630 ARSENIC UR .Q3 $ 18.98 $ 18.98 3002 LAB REFRD30025632 ARSENIC UR 24HR .LC $ 10.40 $ 10.40 3002 LAB REFRD30021950 ASO TTR $ 13.47 $ 13.47 3002 LAB REFRD30025336 ASO TTR .LC $ 43.00 $ 43.00 3002 LAB REFRD30020225 ASO TTR .Q3 $ 11.21 $ 11.21 3002 LAB REFRD30025708 ASPERGILLUS AB .LC $ 11.33 $ 11.33 3002 LAB REFRD30025710 ASPERGILLUS AB .LC $ 11.34 $ 11.34 3002 LAB REFRD30020290 ASPERGILLUS AB .Q3 $ 78.07 $ 78.07 3002 LAB REFRD30020392 ASPERGILLUS AB .Q3 $ 7.10 $ 7.10 3002 LAB REFRD30023938 ASPERGILLUS AB .Q3 $ 7.11 $ 7.11 3002 LAB REFRD30024146 ASSAY OF OPIATES .Q3 $ 56.87 $ 56.87 3002 LAB REFRD

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DEPARTMENT CODE

30024150 ASSAY OF OPIATES .Q3 $ 204.85 $ 204.85 3002 LAB REFRD30023260 AT3 ACTIVITY .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30025509 AT3 ACTIVITY .LC $ 20.50 $ 20.50 3002 LAB REFRD30023254 AT3 AG IMMUNOLOGIC .Q3 $ 29.90 $ 29.90 3002 LAB REFRD30024246 AT3 AG IMMUNOLOGIC .LC $ 14.00 $ 14.00 3002 LAB REFRD30025510 AT3 AG IMMUNOLOGIC .LC $ 20.50 $ 20.50 3002 LAB REFRD30025588 AUTO DIFF WBC COUNT .LC $ 25.00 $ 25.00 3002 LAB REFRD30025754 B CELLS TOTAL CNT .LC $ 139.00 $ 139.00 3002 LAB REFRD30025836 B CELLS TOTAL CNT .LC $ 145.84 $ 145.84 3002 LAB REFRD30023035 B PERTUSSIS/PARAPERT .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30020345 B PERTUSSIS/PARAPERT DFA $ 120.44 $ 120.44 3002 LAB REFRD30023630 B QUINTANA IGG AB .LC $ 7.67 $ 7.67 3002 LAB REFRD30025520 B QUINTANA IGG AB .LC $ 5.88 $ 5.88 3002 LAB REFRD30023628 B QUINTANA IGM AB .LC $ 7.67 $ 7.67 3002 LAB REFRD30025518 B QUINTANA IGM AB .LC $ 5.88 $ 5.88 3002 LAB REFRD30025438 BACTERIAL AG EA AG .Q3 $ 14.18 $ 14.18 3002 LAB REFRD30024156 BARBITURATES QN .Q3 $ 29.90 $ 29.90 3002 LAB REFRD30023152 BARBITURATES SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025550 BARBITURATES SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30023632 BARTONELLA AB IGG .LC $ 7.67 $ 7.67 3002 LAB REFRD30023440 BARTONELLA AB IGG .Q3 $ 36.65 $ 36.65 3002 LAB REFRD30025516 BARTONELLA AB IGG .LC $ 5.88 $ 5.88 3002 LAB REFRD30023634 BARTONELLA AB IGM .LC $ 7.66 $ 7.66 3002 LAB REFRD30023441 BARTONELLA AB IGM .Q3 $ 36.65 $ 36.65 3002 LAB REFRD30025514 BARTONELLA AB IGM .LC $ 5.88 $ 5.88 3002 LAB REFRD30023154 BENZODIAZEPINE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30020155 BENZODIAZEPINE SCRN .Q3 $ 42.57 $ 42.57 3002 LAB REFRD30025552 BENZODIAZEPINE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30025722 BENZODIAZEPINE SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD30020510 BENZODIAZEPINES $ 22.76 $ 22.76 3002 LAB REFRD30020505 BENZODIAZEPINES .Q3 $ 18.98 $ 18.98 3002 LAB REFRD30024154 BENZODIAZEPINES .Q3 $ 42.90 $ 42.90 3002 LAB REFRD30023157 BENZOYLECGONINE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD

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DEPARTMENT CODE

30025556 BENZOYLECGONINE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30025316 BETA HCG QL .LC $ 7.00 $ 7.00 3002 LAB REFRD30020325 BETA2 MICROGLOBULIN $ 25.43 $ 25.43 3002 LAB REFRD30023488 BETA2 MICROGLOBULIN .Q3 $ 25.43 $ 25.43 3002 LAB REFRD30025812 BETA2 MICROGLOBULIN .LC $ 15.00 $ 15.00 3002 LAB REFRD30025590 B-HEXOSAMINIDASE EA A.LC $ 29.00 $ 29.00 3002 LAB REFRD30020891 B-HEXOSAMINIDASE EA AS.Q3 $ 142.23 $ 142.23 3002 LAB REFRD30020892 B-HEXOSAMINIDASE EA AS.Q3 $ 115.41 $ 115.41 3002 LAB REFRD30020340 BILE ACIDS CONJUGATED $ 191.18 $ 191.18 3002 LAB REFRD30020335 BILE ACIDS SER FRAC .Q3 $ 191.18 $ 191.18 3002 LAB REFRD30020330 BILE ACIDS TOTAL $ 30.89 $ 30.89 3002 LAB REFRD30025818 BILE ACIDS TOTAL .LC $ 11.34 $ 11.34 3002 LAB REFRD30023850 BILIRUBIN DIRECT .Q3 $ 7.18 $ 7.18 3002 LAB REFRD30025662 BILIRUBIN TOTAL .LC $ 38.70 $ 38.70 3002 LAB REFRD30023087 BIOTINIDASE ASSAY $ 14.50 $ 14.50 3002 LAB REFRD30025384 BLD CNT RBC AUTO .LC $ 5.00 $ 5.00 3002 LAB REFRD30025392 BLD CNT RBC AUTO .Q3 $ 5.04 $ 5.04 3002 LAB REFRD30025276 BLD FATTY ACIDS .LC $ 13.07 $ 13.07 3002 LAB REFRD30020750 BLD FATTY ACIDS .Q3 $ 26.47 $ 26.47 3002 LAB REFRD30023426 BORDETELLA AB .Q3 $ 14.87 $ 14.87 3002 LAB REFRD30023428 BORDETELLA AB .Q3 $ 14.92 $ 14.92 3002 LAB REFRD30025896 BORDETELLA AB .LC $ 19.00 $ 19.00 3002 LAB REFRD30021072 BORELLIA BURG AMP PRB.Q3 $ 143.75 $ 143.75 3002 LAB REFRD30022915 BORRELIA BURGD CONF .Q3 $ 54.54 $ 54.54 3002 LAB REFRD30022921 BORRELIA BURGD CONF .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30020350 BRUCELLA AB $ 64.24 $ 64.24 3002 LAB REFRD30020355 BRUCELLA AB .Q3 $ 203.92 $ 203.92 3002 LAB REFRD30020437 C DIF TOX BY TISSUE C.Q3 $ 15.16 $ 15.16 3002 LAB REFRD30020435 C DIFFICILE TOXIN EI.Q3 $ 20.70 $ 20.70 3002 LAB REFRD30020360 C PEPTIDE $ 23.25 $ 23.25 3002 LAB REFRD30025810 C PEPTIDE .LC $ 8.40 $ 8.40 3002 LAB REFRD30020361 C PEPTIDE .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30020370 C REACTIVE PROTEIN $ 26.13 $ 26.13 3002 LAB REFRD

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DEPARTMENT CODE

30020371 C REACTIVE PROTEIN .Q3 $ 12.68 $ 12.68 3002 LAB REFRD30020375 C REACTIVE PROTEIN .Q3 $ 11.20 $ 11.20 3002 LAB REFRD30025302 C1 ESTERASE INHIBITOR.LC $ 23.75 $ 23.75 3002 LAB REFRD30020358 C1 ESTERASE INHIBITOR.Q3 $ 28.28 $ 28.28 3002 LAB REFRD30020380 CA 125 $ 17.61 $ 17.61 3002 LAB REFRD30023798 CA 125 .LC $ 13.11 $ 13.11 3002 LAB REFRD30020381 CA 125 .Q3 $ 17.54 $ 17.54 3002 LAB REFRD30020395 CA 15 3 (27.29) $ 18.42 $ 18.42 3002 LAB REFRD30023558 CA 15 3 (27.29) .LC $ 14.98 $ 14.98 3002 LAB REFRD30023588 CA 15 3 (27.29) .LC $ 12.74 $ 12.74 3002 LAB REFRD30020390 CA 15 3 (27.29) .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30020391 CA 15 3 (27.29) .Q3 $ 16.10 $ 16.10 3002 LAB REFRD30020400 CA 19 9 $ 21.17 $ 21.17 3002 LAB REFRD30023800 CA 19 9 .LC $ 19.93 $ 19.93 3002 LAB REFRD30020401 CA 19 9 .Q3 $ 17.60 $ 17.60 3002 LAB REFRD30023404 CADMIUM .Q3 $ 29.33 $ 29.33 3002 LAB REFRD30025284 CADMIUM .LC $ 35.00 $ 35.00 3002 LAB REFRD30021640 CADMIUM .Q3 $ 38.24 $ 38.24 3002 LAB REFRD30025638 CADMIUM UR 24HR .LC $ 10.40 $ 10.40 3002 LAB REFRD30025640 CADMIUM UR 24HR .LC $ 15.00 $ 15.00 3002 LAB REFRD30022010 CAFFEINE $ 238.00 $ 70.00 3002 LAB REFRD30020418 CALC ANALYSIS CHEM QN $ 26.77 $ 26.77 3002 LAB REFRD30023786 CALC ANALYSIS CHEM QN .LC $ 19.11 $ 19.11 3002 LAB REFRD30024060 CALC ANALYSIS CHEM QN.LC $ 15.00 $ 15.00 3002 LAB REFRD30020419 CALC ANALYSIS INFRAR.Q3 $ 28.75 $ 28.75 3002 LAB REFRD30023020 CALC ANALYSIS INFRARED $ 44.61 $ 44.61 3002 LAB REFRD30020420 CALC ANALYSIS QL $ 43.31 $ 43.31 3002 LAB REFRD30020410 CALCITONIN $ 25.43 $ 25.43 3002 LAB REFRD30025334 CALCITONIN .LC $ 18.00 $ 18.00 3002 LAB REFRD30020415 CALCITONIN .Q3 $ 31.63 $ 31.63 3002 LAB REFRD30023852 CALCIUM .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30024078 CALCIUM .LC $ 8.00 $ 8.00 3002 LAB REFRD30023156 CANNABINOID SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD

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DEPARTMENT CODE

30025554 CANNABINOID SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30023390 CARBO DEF TRANSFERRIN .Q3 $ 147.69 $ 147.69 3002 LAB REFRD30025616 CARBO DEF TRANSFERRIN.LC $ 140.00 $ 140.00 3002 LAB REFRD30020421 CARBO DEF TRANSFERRIN.SP $ 55.37 $ 55.37 3002 LAB REFRD30020160 CARDIOLIPIN AB $ 38.90 $ 38.90 3002 LAB REFRD30020162 CARDIOLIPIN AB $ 31.87 $ 31.87 3002 LAB REFRD30020163 CARDIOLIPIN AB $ 38.24 $ 38.24 3002 LAB REFRD30020164 CARDIOLIPIN AB $ 31.87 $ 31.87 3002 LAB REFRD30020161 CARDIOLIPIN AB .Q3 $ 28.81 $ 28.81 3002 LAB REFRD30020411 CARDIOLIPIN AB .Q3 $ 30.05 $ 30.05 3002 LAB REFRD30023580 CARDIOLIPIN IGA AB .LC $ 13.92 $ 13.92 3002 LAB REFRD30024054 CARDIOLIPIN IGA AB .LC $ 10.92 $ 10.92 3002 LAB REFRD30020167 CARDIOLIPIN IGA AB .Q3 $ 20.13 $ 20.13 3002 LAB REFRD30023574 CARDIOLIPIN IGG AB .LC $ 13.92 $ 13.92 3002 LAB REFRD30024056 CARDIOLIPIN IGG AB .LC $ 10.92 $ 10.92 3002 LAB REFRD30020165 CARDIOLIPIN IGG AB .Q3 $ 20.13 $ 20.13 3002 LAB REFRD30023576 CARDIOLIPIN IGM AB .LC $ 13.92 $ 13.92 3002 LAB REFRD30024058 CARDIOLIPIN IGM AB .LC $ 10.92 $ 10.92 3002 LAB REFRD30020166 CARDIOLIPIN IGM AB .Q3 $ 20.13 $ 20.13 3002 LAB REFRD30023646 CARNITINE .LC $ 21.67 $ 21.67 3002 LAB REFRD30020425 CARNITINE FREE & TOTA.Q3 $ 35.65 $ 35.65 3002 LAB REFRD30022290 CARNITINE FREE & TOTAL $ 45.56 $ 45.56 3002 LAB REFRD30021960 CAROTENE $ 18.73 $ 18.73 3002 LAB REFRD30025784 CAROTENE .LC $ 8.00 $ 8.00 3002 LAB REFRD30020422 CAROTENE .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30020430 CATECHOL FRAC PLAS $ 37.61 $ 37.61 3002 LAB REFRD30025542 CATECHOL FRAC PLAS .LC $ 25.20 $ 25.20 3002 LAB REFRD30020431 CATECHOL FRAC PLAS .Q3 $ 31.63 $ 31.63 3002 LAB REFRD30025646 CATECHOL FRAC UR .LC $ 15.95 $ 15.95 3002 LAB REFRD30021650 CATECHOL FRAC UR .Q3 $ 31.63 $ 31.63 3002 LAB REFRD30023950 CATECHOL FRAC UR .Q3 $ 31.63 $ 31.63 3002 LAB REFRD30023312 CCP AB IGG .Q3 $ 35.00 $ 35.00 3002 LAB REFRD30025924 CENTROMERE AB .LC $ 60.00 $ 60.00 3002 LAB REFRD

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DEPARTMENT CODE

30023280 CENTROMERE SCREEN .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30021050 CHLAMYDIA AB .Q3 $ 23.64 $ 23.64 3002 LAB REFRD30023486 CHLAMYDIA AB IGA .Q3 $ 9.78 $ 9.78 3002 LAB REFRD30023366 CHLAMYDIA AB IGG .Q3 $ 52.35 $ 52.35 3002 LAB REFRD30023484 CHLAMYDIA AB IGG .Q3 $ 9.78 $ 9.78 3002 LAB REFRD30025294 CHLAMYDIA AB IGG .LC $ 15.00 $ 15.00 3002 LAB REFRD30023482 CHLAMYDIA AB IGM .Q3 $ 9.58 $ 9.58 3002 LAB REFRD30023566 CHLAMYDIA CULT .LC $ 9.63 $ 9.63 3002 LAB REFRD30021659 CHLAMYDIA CULT .Q3 $ 26.45 $ 26.45 3002 LAB REFRD30021656 CHLAMYDIA TRACH AMP P.Q3 $ 39.51 $ 39.51 3002 LAB REFRD30021658 CHLAMYDIA TRACH AMP P.Q3 $ 39.51 $ 39.51 3002 LAB REFRD30023114 CHLAMYDIA TRACH AMP PR.Q3 $ 34.50 $ 34.50 3002 LAB REFRD30023550 CHLAMYDIA TRACH DIR PR.LC $ 5.36 $ 5.36 3002 LAB REFRD30023858 CHLAMYDIA TRACH DIR PR.LC $ 16.57 $ 16.57 3002 LAB REFRD30022447 CHLAMYDIA TRACH DNA Q.Q3 $ 31.29 $ 31.29 3002 LAB REFRD30023294 CHOLESTEROL .Q3 $ 9.58 $ 9.58 3002 LAB REFRD30025890 CHOLINESTERASE PLASMA.LC $ 8.00 $ 8.00 3002 LAB REFRD30025956 CHOLINESTERASE PLASMA.LC $ 8.75 $ 8.75 3002 LAB REFRD30025804 CHOLINESTERASE RBC .LC $ 9.50 $ 9.50 3002 LAB REFRD30025958 CHOLINESTERASE RBC .LC $ 8.75 $ 8.75 3002 LAB REFRD30020460 CHOLINESTERASE RBC .Q3 $ 28.60 $ 28.60 3002 LAB REFRD30020450 CHOLINESTERASE SER .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30020470 CHRMOSOM CNT/KAR .Q3 $ 121.12 $ 121.12 3002 LAB REFRD30020480 CHRMOSOM CNT/KARY $ 375.98 $ 375.98 3002 LAB REFRD30023820 CHRMOSOM CNT/KARY .LC $ 64.32 $ 64.32 3002 LAB REFRD30023864 CHRMOSOM CNT/KARY .LC $ 274.25 $ 274.25 3002 LAB REFRD30023346 CHRMOSOM CNT/KARY .Q3 $ 161.00 $ 161.00 3002 LAB REFRD30023992 CHRMOSOM CNT/KARY .Q3 $ 111.44 $ 111.44 3002 LAB REFRD30025404 CHRMOSOM CNT/KARY .Q3 $ 187.50 $ 187.50 3002 LAB REFRD30025746 CHRMOSOM CNT/KARY .Q3 $ 107.64 $ 107.64 3002 LAB REFRD30023822 CHRMOSOM HI RESD BND .LC $ 64.37 $ 64.37 3002 LAB REFRD30023348 CHRMOSOM HI RESD BND .Q3 $ 161.00 $ 161.00 3002 LAB REFRD30020985 CHROMAT EA ANALYTE .Q3 $ 21.02 $ 21.02 3002 LAB REFRD

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DEPARTMENT CODE

30021230 CHROMAT QN EA ANALTE $ 121.43 $ 121.43 3002 LAB REFRD30025938 CHROMAT QN EA ANALTE .LC $ 29.49 $ 29.49 3002 LAB REFRD30021281 CHROMAT QN MULT ANALT.Q3 $ 105.80 $ 105.80 3002 LAB REFRD30020475 CHROMOGRANIN A $ 41.55 $ 41.55 3002 LAB REFRD30021660 CITRATE UR 24HR $ 37.09 $ 37.09 3002 LAB REFRD30023658 CITRATE UR 24HR .LC $ 21.67 $ 21.67 3002 LAB REFRD30020485 CITRATE UR 24HR .Q3 $ 20.70 $ 20.70 3002 LAB REFRD30023050 CITRATE UR RNDM $ 32.56 $ 32.56 3002 LAB REFRD30025476 CMV AB .LC $ 5.50 $ 5.50 3002 LAB REFRD30023400 CMV AB IGG .Q3 $ 35.79 $ 35.79 3002 LAB REFRD30023840 CMV AB IGG .Q3 $ 18.39 $ 18.39 3002 LAB REFRD30025850 CMV AB IGG .LC $ 39.92 $ 39.92 3002 LAB REFRD30025960 CMV AB IGG .LC $ 5.88 $ 5.88 3002 LAB REFRD30025849 CMV AB IGG .Q3 $ 11.00 $ 11.00 3002 LAB REFRD30023402 CMV AB IGM .Q3 $ 35.80 $ 35.80 3002 LAB REFRD30025962 CMV AB IGM .LC $ 5.88 $ 5.88 3002 LAB REFRD30025860 CMV AB IGM .Q3 $ 11.00 $ 11.00 3002 LAB REFRD30025822 CMV AMP PRB .LC $ 142.60 $ 142.60 3002 LAB REFRD30025602 CMV DIR PRB .LC $ 138.75 $ 138.75 3002 LAB REFRD30023266 CMV DNA QN .Q3 $ 125.35 $ 125.35 3002 LAB REFRD30020552 CMV DNA QN .Q3 $ 185.76 $ 185.76 3002 LAB REFRD30020553 CMV DNA QN .SP $ 191.18 $ 191.18 3002 LAB REFRD30024158 COCAINE QN .Q3 $ 35.00 $ 35.00 3002 LAB REFRD30020525 COCAINE SCRN .Q3 $ 21.67 $ 21.67 3002 LAB REFRD30021940 COCCIDIOIDES AB $ 38.70 $ 38.70 3002 LAB REFRD30025504 COCCIDIOIDES AB .LC $ 40.00 $ 40.00 3002 LAB REFRD30025918 COCCIDIOIDES AB .LC $ 20.00 $ 20.00 3002 LAB REFRD30020530 COCCIDIOIDES AB .Q3 $ 22.50 $ 22.50 3002 LAB REFRD30021091 COL CHROM/MASS SPEC Q.Q3 $ 40.25 $ 40.25 3002 LAB REFRD30025604 COLD AGGLUTININ TTR .LC $ 65.00 $ 65.00 3002 LAB REFRD30025606 COLD AGGLUTININ TTR .Q3 $ 25.00 $ 25.00 3002 LAB REFRD30020545 COMPLEMENT C1 .Q3 $ 7.76 $ 7.76 3002 LAB REFRD30024250 COMPLEMENT C1 Q .LC $ 11.75 $ 11.75 3002 LAB REFRD

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DEPARTMENT CODE

30025894 COMPLEMENT C2 .LC $ 5.88 $ 5.88 3002 LAB REFRD30023005 COMPLEMENT C2 .Q3 $ 31.89 $ 31.89 3002 LAB REFRD30023954 COMPLEMENT C2 .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30023118 COMPLEMENT C3 .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023214 COMPLEMENT C3 .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023952 COMPLEMENT C3 .LC $ 10.35 $ 10.35 3002 LAB REFRD30025672 COMPLEMENT C3 .LC $ 10.86 $ 10.86 3002 LAB REFRD30023710 COMPLEMENT C4 .LC $ 19.22 $ 19.22 3002 LAB REFRD30023120 COMPLEMENT C4 .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023216 COMPLEMENT C4 .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023655 COMPLEMENT C4 .LC $ 10.35 $ 10.35 3002 LAB REFRD30025674 COMPLEMENT C4 .LC $ 10.86 $ 10.86 3002 LAB REFRD30020550 COMPLEMENT TOT (CH50) $ 31.14 $ 31.14 3002 LAB REFRD30023676 COMPLEMENT TOT (CH50) .LC $ 14.34 $ 14.34 3002 LAB REFRD30020551 COMPLEMENT TOT (CH50).Q3 $ 12.65 $ 12.65 3002 LAB REFRD30020560 COPPER $ 8.35 $ 8.35 3002 LAB REFRD30025786 COPPER .LC $ 18.00 $ 18.00 3002 LAB REFRD30020561 COPPER .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30020562 COPPER .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30020564 COPPER .Q3 $ 20.70 $ 20.70 3002 LAB REFRD30020563 COPPER UR 24HR $ 32.52 $ 32.52 3002 LAB REFRD30025622 COPPER UR 24HR .LC $ 15.00 $ 15.00 3002 LAB REFRD30021670 COPPER UR 24HR .Q3 $ 32.52 $ 32.52 3002 LAB REFRD30020565 CORTISOL FREE UR .Q3 $ 27.09 $ 27.09 3002 LAB REFRD30020412 COXSACKIE AB TYP A .Q3 $ 10.15 $ 10.15 3002 LAB REFRD30023968 COXSACKIE AB TYP A .Q3 $ 10.18 $ 10.18 3002 LAB REFRD30023518 C-REACTIVE PROTEIN HS .LC $ 10.71 $ 10.71 3002 LAB REFRD30020372 C-REACTIVE PROTEIN HS.Q3 $ 13.93 $ 13.93 3002 LAB REFRD30020570 CREATINE UR 24HR $ 44.61 $ 44.61 3002 LAB REFRD30025600 CREATININE UR .LC $ 13.25 $ 13.25 3002 LAB REFRD30023998 CREATININE UR .Q3 $ 6.90 $ 6.90 3002 LAB REFRD30024142 CREATININE UR .Q3 $ 17.50 $ 17.50 3002 LAB REFRD30025624 CREATININE UR 24HR .LC $ 15.00 $ 15.00 3002 LAB REFRD

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DEPARTMENT CODE

30025630 CREATININE UR 24HR .LC $ 10.40 $ 10.40 3002 LAB REFRD30025642 CREATININE UR 24HR .LC $ 15.00 $ 15.00 3002 LAB REFRD30025648 CREATININE UR 24HR .LC $ 14.75 $ 14.75 3002 LAB REFRD30025388 CREATININE UR RAN .LC $ 10.00 $ 10.00 3002 LAB REFRD30025502 CREATININE UR RAN .LC $ 7.63 $ 7.63 3002 LAB REFRD30025596 CREATININE UR RAN .LC $ 7.50 $ 7.50 3002 LAB REFRD30024218 CREATININE UR RAN .Q3 $ 7.50 $ 7.50 3002 LAB REFRD30023905 CRYOGLOB QL OR SEMI Q.Q3 $ 5.75 $ 5.75 3002 LAB REFRD30020574 CRYPTO AG DFA .Q3 $ 42.55 $ 42.55 3002 LAB REFRD30020575 CRYPTOSPORIDIUM $ 19.11 $ 19.11 3002 LAB REFRD30020554 CULT CMV .Q3 $ 46.00 $ 46.00 3002 LAB REFRD30023624 CULT HERPES .LC $ 14.65 $ 14.65 3002 LAB REFRD30022881 CULT HSV .Q3 $ 24.15 $ 24.15 3002 LAB REFRD30023930 CULT TYP BY NA PRB DP.Q3 $ 34.65 $ 34.65 3002 LAB REFRD30023568 CULT TYP FLUORESCENT .LC $ 9.63 $ 9.63 3002 LAB REFRD30023928 CULT TYP GLC METHOD .Q3 $ 34.65 $ 34.65 3002 LAB REFRD30023664 CULTVIRAL .LC $ 26.77 $ 26.77 3002 LAB REFRD30021811 CULTVIRAL .Q3 $ 34.50 $ 34.50 3002 LAB REFRD30020600 CYSTICERCUS AB $ 27.21 $ 27.21 3002 LAB REFRD30020610 CYSTICERCUS AB $ 31.67 $ 31.67 3002 LAB REFRD30025626 CYSTINE UR QN .LC $ 7.00 $ 7.00 3002 LAB REFRD30020615 CYSTINE UR QN .Q3 $ 75.19 $ 75.19 3002 LAB REFRD30025932 CYTOMEGALOVIRUS DFA .LC $ 18.00 $ 18.00 3002 LAB REFRD30022030 D XYLOSE ABS PNL $ 54.43 $ 54.43 3002 LAB REFRD30022031 D XYLOSE ABS PNL .Q3 $ 27.39 $ 27.39 3002 LAB REFRD30022032 D XYLOSE ABS PNL .Q3 $ - $ - 3002 LAB REFRD30021680 DELTA ALA .Q3 $ 32.20 $ 32.20 3002 LAB REFRD30025598 DEOXYPYRIDINOLINE .LC $ 13.25 $ 13.25 3002 LAB REFRD30023055 DEOXYPYRIDINOLINE .Q3 $ 56.35 $ 56.35 3002 LAB REFRD30025808 DESIPRAMINE .LC $ 17.00 $ 17.00 3002 LAB REFRD30020959 DESIPRAMINE .Q3 $ 20.99 $ 20.99 3002 LAB REFRD30020640 DHEA $ 36.37 $ 36.37 3002 LAB REFRD30023802 DHEA .LC $ 26.77 $ 26.77 3002 LAB REFRD

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DEPARTMENT CODE

30020641 DHEA .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30020651 DHEA SULFATE $ 19.99 $ 19.99 3002 LAB REFRD30023674 DHEA SULFATE .LC $ 13.92 $ 13.92 3002 LAB REFRD30020650 DHEA SULFATE .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30025272 DIBUCAINE NUMBER .LC $ 5.00 $ 5.00 3002 LAB REFRD30021675 DIBUCAINE NUMBER .Q3 $ 16.85 $ 16.85 3002 LAB REFRD30020660 DIGITOXIN $ 30.59 $ 30.59 3002 LAB REFRD30023448 DIPTHERIA AB .Q3 $ 34.79 $ 34.79 3002 LAB REFRD30022496 DNA CL CYCLE $ 223.04 $ 223.04 3002 LAB REFRD30023240 DNA DBL STRAND AB SCRN.Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023872 DNA PRB CYTGNTC 10 30 .LC $ 26.19 $ 26.19 3002 LAB REFRD30023870 DNA PRB CYTGNTC EA .LC $ 26.19 $ 26.19 3002 LAB REFRD30025546 DRG SCRN BLD VOLATILE.Q3 $ 4.70 $ 4.70 3002 LAB REFRD30020540 DRG SCRN QL CHROM EA $ 43.91 $ 43.91 3002 LAB REFRD30025484 DRG SCRN QL CHROM EA .LC $ 8.82 $ 8.82 3002 LAB REFRD30022230 DRG SCRN QL CHROM EA .Q3 $ 127.45 $ 127.45 3002 LAB REFRD30025718 DRG SCRN QL CHROM EA .Q3 $ 3.50 $ 3.50 3002 LAB REFRD30025486 DRG SCRN UR VOLATILES.LC $ 8.82 $ 8.82 3002 LAB REFRD30025364 E HISTOLYTICA GRP EIA.LC $ 29.00 $ 29.00 3002 LAB REFRD30020092 E HISTOLYTICA GRP EIA.Q3 $ 51.18 $ 51.18 3002 LAB REFRD30023172 EBV AB EBNA .Q3 $ 11.14 $ 11.14 3002 LAB REFRD30020680 EBV AB VCA .Q3 $ 36.83 $ 36.83 3002 LAB REFRD30023394 EBV DNA QNT PCR .Q3 $ 148.35 $ 148.35 3002 LAB REFRD30023170 EBV VCA AB IGG .Q3 $ 11.14 $ 11.14 3002 LAB REFRD30024044 EBV VCA AB IGG .LC $ 12.60 $ 12.60 3002 LAB REFRD30020683 EBV VCA AB IGG .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30023174 EBV VCA AB IGM .Q3 $ 11.14 $ 11.14 3002 LAB REFRD30025296 EBV VCA AB IGM .LC $ 12.60 $ 12.60 3002 LAB REFRD30020684 EBV VCA AB IGM .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30025498 ELECTROPHORESIS NOT S.LC $ 10.00 $ 10.00 3002 LAB REFRD30023128 ENA AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30020670 ENA AB .Q3 $ 41.40 $ 41.40 3002 LAB REFRD30020681 ENDOMYSIAL AB TTR $ 26.85 $ 26.85 3002 LAB REFRD

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DEPARTMENT CODE

30020682 ENDOMYSIAL AB TTR .Q3 $ 42.07 $ 42.07 3002 LAB REFRD30023794 ENTEROVIRUS AB .LC $ 35.44 $ 35.44 3002 LAB REFRD30023796 ENTEROVIRUS AB .LC $ 35.45 $ 35.45 3002 LAB REFRD30020690 ERYTHROPOIETIN $ 33.59 $ 33.59 3002 LAB REFRD30023768 ERYTHROPOIETIN .LC $ 13.39 $ 13.39 3002 LAB REFRD30020691 ERYTHROPOIETIN .Q3 $ 23.49 $ 23.49 3002 LAB REFRD30022436 ESTRADIOL (E2) $ 134.15 $ 84.00 3002 LAB REFRD30025312 ESTRADIOL (E2) .LC $ 14.28 $ 14.28 3002 LAB REFRD30025320 ESTRIOL .LC $ 13.00 $ 13.00 3002 LAB REFRD30022121 ESTRIOL .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30020710 ESTROGEN TOTAL $ 34.26 $ 34.26 3002 LAB REFRD30020713 ESTROGEN TOTAL $ 38.20 $ 38.20 3002 LAB REFRD30025314 ESTROGEN TOTAL .LC $ 18.48 $ 18.48 3002 LAB REFRD30023108 ESTROGEN TOTAL .Q3 $ 29.90 $ 29.90 3002 LAB REFRD30025318 ESTRONE .LC $ 20.00 $ 20.00 3002 LAB REFRD30020715 ESTRONE .Q3 $ 17.83 $ 17.83 3002 LAB REFRD30025724 ETHCHLORVYNOL SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD30022035 ETHOSUXIMIDE .Q3 $ 26.13 $ 26.13 3002 LAB REFRD30022405 FAT STL QN .Q3 $ 51.52 $ 51.52 3002 LAB REFRD30025532 FATTY ACIDS MULT ANAL.LC $ 216.00 $ 216.00 3002 LAB REFRD30025652 FATTY ACIDS MULT ANAL.Q3 $ 226.12 $ 226.12 3002 LAB REFRD30023374 FATTY ACIDS MULT ANALY.Q3 $ 116.36 $ 116.36 3002 LAB REFRD30022370 FCTR II $ 49.97 $ 49.97 3002 LAB REFRD30023744 FCTR II .LC $ 95.59 $ 95.59 3002 LAB REFRD30020725 FCTR II .Q3 $ 89.70 $ 89.70 3002 LAB REFRD30024038 FCTR V .LC $ 75.00 $ 75.00 3002 LAB REFRD30021832 FCTR VIII $ 157.47 $ 157.47 3002 LAB REFRD30023788 FCTR VIII .LC $ 67.59 $ 67.59 3002 LAB REFRD30023250 FCTR VIII .Q3 $ 51.75 $ 51.75 3002 LAB REFRD30023792 FCTR VIII VW .LC $ 67.61 $ 67.61 3002 LAB REFRD30023899 FCTR VIII VW .LC $ 34.98 $ 34.98 3002 LAB REFRD30023590 FCTR VIII VW AG .LC $ 95.59 $ 95.59 3002 LAB REFRD30023790 FCTR VIII VW AG .LC $ 67.59 $ 67.59 3002 LAB REFRD

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DEPARTMENT CODE

30023901 FCTR VIII VW AG .LC $ 34.98 $ 34.98 3002 LAB REFRD30022055 FCTR VIII VW AG .Q3 $ 302.06 $ 302.06 3002 LAB REFRD30021833 FCTR VIII VW MULTIMER.Q3 $ 79.35 $ 79.35 3002 LAB REFRD30022040 FCTR X $ 49.97 $ 49.97 3002 LAB REFRD30022400 FCTR XII $ 49.97 $ 49.97 3002 LAB REFRD30022057 FCTR XIII SCRN .Q3 $ 68.20 $ 68.20 3002 LAB REFRD30021030 FEBRILE AGGLUTINS $ 23.64 $ 23.64 3002 LAB REFRD30022050 FEBRILE AGGLUTINS $ 104.19 $ 104.19 3002 LAB REFRD30020720 FLECAINIDE $ 21.02 $ 21.02 3002 LAB REFRD30020986 FLECAINIDE .Q3 $ 23.12 $ 23.12 3002 LAB REFRD30025680 FLUOR AB SCRN EA AB S.LC $ 10.86 $ 10.86 3002 LAB REFRD30025696 FLUOR AB SCRN EA AB S.LC $ 49.00 $ 49.00 3002 LAB REFRD30025898 FLUOR AB SCRN EA AB S.LC $ 41.40 $ 41.40 3002 LAB REFRD30020983 FLUOR AB SCRN EA AB S.Q3 $ 14.38 $ 14.38 3002 LAB REFRD30023666 FLUOR AB SCRN EA AB SC.LC $ 10.52 $ 10.52 3002 LAB REFRD30025681 FLUOR AB SCRN EA AB T.LC $ 10.86 $ 10.86 3002 LAB REFRD30023708 FLUOR AB SCRN EA AB TT.LC $ 19.61 $ 19.61 3002 LAB REFRD30020745 FLUOXETINE .Q3 $ 23.58 $ 23.58 3002 LAB REFRD30025970 FREE T4 .LC $ 44.60 $ 44.60 3002 LAB REFRD30025972 FREE T4 .Q3 $ 8.30 $ 8.30 3002 LAB REFRD30022500 FSH $ 154.66 $ 128.00 3002 LAB REFRD30023302 FSH .Q3 $ 36.83 $ 36.83 3002 LAB REFRD30025450 FTA ABS (TPPA) .LC $ 70.00 $ 70.00 3002 LAB REFRD30025462 FTA ABS (TPPA) .LC $ 47.00 $ 47.00 3002 LAB REFRD30025436 FTA ABS (TPPA) .Q3 $ 8.85 $ 8.85 3002 LAB REFRD30020359 FUNCTIONAL C1 INHIB .Q3 $ 28.28 $ 28.28 3002 LAB REFRD30023828 FUNGUS NOT SPECIFIED .LC $ 185.45 $ 185.45 3002 LAB REFRD30023913 FUNGUS NOT SPECIFIED .Q3 $ 69.00 $ 69.00 3002 LAB REFRD30025382 G6PD QN .LC $ 5.00 $ 5.00 3002 LAB REFRD30020776 G6PD QN .Q3 $ 16.10 $ 16.10 3002 LAB REFRD30023010 G6PD QN .Q3 $ 20.78 $ 20.78 3002 LAB REFRD30020751 GABAPENTIN .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30020780 GASTRIN $ 19.06 $ 19.06 3002 LAB REFRD

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DEPARTMENT CODE

30020781 GASTRIN $ 19.11 $ 19.11 3002 LAB REFRD30025800 GASTRIN $ 8.00 $ 8.00 3002 LAB REFRD30020782 GASTRIN .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30022220 GBM AB $ 45.11 $ 45.11 3002 LAB REFRD30025282 GBM AB .LC $ 34.00 $ 34.00 3002 LAB REFRD30020786 GBM AB .Q3 $ 48.30 $ 48.30 3002 LAB REFRD30023116 GC AMP PRB .Q3 $ 34.50 $ 34.50 3002 LAB REFRD30021657 GC AMP PRB .Q3 $ 39.51 $ 39.51 3002 LAB REFRD30023070 GC AMP PRB .Q3 $ 79.02 $ 79.02 3002 LAB REFRD30023552 GC DIR PRB .LC $ 5.36 $ 5.36 3002 LAB REFRD30023860 GC DIR PRB .LC $ 16.57 $ 16.57 3002 LAB REFRD30025664 GGT .LC $ 38.70 $ 38.70 3002 LAB REFRD30023274 GIARDIA AB .Q3 $ 41.42 $ 41.42 3002 LAB REFRD30023288 GIARDIA AB IGA .Q3 $ 23.70 $ 23.70 3002 LAB REFRD30025862 GIARDIA AB IGA .LC $ 33.00 $ 33.00 3002 LAB REFRD30023284 GIARDIA AB IGG .Q3 $ 23.70 $ 23.70 3002 LAB REFRD30025864 GIARDIA AB IGG .LC $ 33.00 $ 33.00 3002 LAB REFRD30023290 GIARDIA AB IGM .Q3 $ 23.71 $ 23.71 3002 LAB REFRD30025866 GIARDIA AB IGM .LC $ 33.00 $ 33.00 3002 LAB REFRD30023462 GIARDIA AG EIA .Q3 $ 24.44 $ 24.44 3002 LAB REFRD30020785 GLIADIN AB .Q3 $ 32.78 $ 32.78 3002 LAB REFRD30020180 GLIADIN AB SCRN $ 51.82 $ 51.82 3002 LAB REFRD30025322 GLUCAGON .LC $ 21.00 $ 21.00 3002 LAB REFRD30020775 GLUCAGON .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30025880 GLUT ACID DECARB AUTO.LC $ 45.00 $ 45.00 3002 LAB REFRD30023025 GLUTAM ACID DECARB AU.Q3 $ 79.35 $ 79.35 3002 LAB REFRD30023893 GOLD URINE .Q3 $ 66.47 $ 66.47 3002 LAB REFRD30020790 GROWTH HORMONE $ 21.06 $ 21.06 3002 LAB REFRD30024032 GROWTH HORMONE .LC $ 9.00 $ 9.00 3002 LAB REFRD30020791 GROWTH HORMONE .Q3 $ 14.38 $ 14.38 3002 LAB REFRD30023210 H PILORI STL EIA .Q3 $ 60.95 $ 60.95 3002 LAB REFRD30023338 H PYLORI AB IGA .Q3 $ 28.20 $ 28.20 3002 LAB REFRD30023368 H PYLORI AB IGA .Q3 $ 30.42 $ 30.42 3002 LAB REFRD

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DEPARTMENT CODE

30025524 H PYLORI AB IGA .LC $ 13.44 $ 13.44 3002 LAB REFRD30025902 H PYLORI AB IGA .LC $ 15.12 $ 15.12 3002 LAB REFRD30022865 H PYLORI AB IGA .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30023546 H PYLORI AB IGG .LC $ 17.12 $ 17.12 3002 LAB REFRD30023336 H PYLORI AB IGG .Q3 $ 28.19 $ 28.19 3002 LAB REFRD30023370 H PYLORI AB IGG .Q3 $ 30.42 $ 30.42 3002 LAB REFRD30023386 H PYLORI AB IGG .Q3 $ 11.50 $ 11.50 3002 LAB REFRD30025526 H PYLORI AB IGG .LC $ 13.44 $ 13.44 3002 LAB REFRD30022870 H PYLORI AB IGG .Q3 $ 45.89 $ 45.89 3002 LAB REFRD30023372 H PYLORI AB IGM .Q3 $ 30.42 $ 30.42 3002 LAB REFRD30023414 H PYLORI AB IGM .Q3 $ 24.15 $ 24.15 3002 LAB REFRD30025528 H PYLORI AB IGM .LC $ 13.44 $ 13.44 3002 LAB REFRD30025904 H PYLORI AB IGM .LC $ 21.00 $ 21.00 3002 LAB REFRD30025666 HAPTOGLOBIN QN .LC $ 38.70 $ 38.70 3002 LAB REFRD30020823 HB CORE AB IGM $ 14.34 $ 14.34 3002 LAB REFRD30025254 HB CORE AB IGM .LC $ 5.04 $ 5.04 3002 LAB REFRD30020821 HB CORE AB IGM .Q3 $ 12.94 $ 12.94 3002 LAB REFRD30020804 HBE AB $ 19.18 $ 19.18 3002 LAB REFRD30020820 HBE AB $ 16.96 $ 16.96 3002 LAB REFRD30020831 HBE AB $ 19.10 $ 19.10 3002 LAB REFRD30023554 HBE AB .LC $ 9.38 $ 9.38 3002 LAB REFRD30020822 HBE AB .Q3 $ 11.50 $ 11.50 3002 LAB REFRD30020830 HBE AG $ 16.96 $ 16.96 3002 LAB REFRD30023544 HBE AG .LC $ 8.21 $ 8.21 3002 LAB REFRD30020824 HBE AG .Q3 $ 11.50 $ 11.50 3002 LAB REFRD30020816 HBS AB $ 20.78 $ 20.78 3002 LAB REFRD30023564 HBS AB .LC $ 4.29 $ 4.29 3002 LAB REFRD30024028 HBS AB .LC $ 3.36 $ 3.36 3002 LAB REFRD30020829 HBS AB .Q3 $ 17.48 $ 17.48 3002 LAB REFRD30020296 HBS AG .Q3 $ 15.99 $ 15.99 3002 LAB REFRD30020810 HBs AG NEUTRALIZATION $ 17.99 $ 17.99 3002 LAB REFRD30022490 HCV AB CONF $ 73.60 $ 73.60 3002 LAB REFRD30025830 HCV AB CONF .LC $ 101.20 $ 101.20 3002 LAB REFRD

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DEPARTMENT CODE

30020833 HCV AB CONF .Q3 $ 75.90 $ 75.90 3002 LAB REFRD30020850 HDV (DELTA) AB $ 29.54 $ 29.54 3002 LAB REFRD30025370 HDV (DELTA) AB .LC $ 107.00 $ 107.00 3002 LAB REFRD30020851 HDV (DELTA) AB .Q3 $ 35.54 $ 35.54 3002 LAB REFRD30022136 HDV (DELTA) AB .Q3 $ 32.06 $ 32.06 3002 LAB REFRD30020800 HEAVY METAL SCRN UR $ 90.10 $ 90.10 3002 LAB REFRD30025268 HEAVY METALS BLD QN E.LC $ 60.00 $ 60.00 3002 LAB REFRD30020253 HEAVY METALS BLD QN E.Q3 $ 62.68 $ 62.68 3002 LAB REFRD30020801 HEAVY METALS BLD QN E.Q3 $ 83.74 $ 83.74 3002 LAB REFRD30020802 HEAVY METALS BLD QN EA $ 119.57 $ 119.57 3002 LAB REFRD30020795 HEAVY METALS UR QN EA.Q3 $ 99.26 $ 99.26 3002 LAB REFRD30020799 HEAVY METALS UR QN EA.Q3 $ 34.50 $ 34.50 3002 LAB REFRD30023278 HELMINTH AB .Q3 $ 53.76 $ 53.76 3002 LAB REFRD30025396 HEMATOCRIT .Q3 $ 5.04 $ 5.04 3002 LAB REFRD30025394 HEMOGLOBIN .Q3 $ 5.04 $ 5.04 3002 LAB REFRD30021194 HEMOGLOBIN .WC $ - $ - 3002 LAB REFRD30023084 HEMOGLOBIN FRACTION QN $ 14.50 $ 14.50 3002 LAB REFRD30023570 HEMOGLOBIN FRACTION QN.LC $ 18.00 $ 18.00 3002 LAB REFRD30025399 HEMOGLOBIN FRACTION QN.Q3 $ 5.07 $ 5.07 3002 LAB REFRD30025948 HEMOGLOBIN PLAS .LC $ 12.55 $ 12.55 3002 LAB REFRD30020811 HEMOGLOBIN PLAS .Q3 $ 16.85 $ 16.85 3002 LAB REFRD30023015 HEMOGLOBIN PLAS .Q3 $ 15.62 $ 15.62 3002 LAB REFRD30025265 HEMOSIDERIN QL .LC $ 6.72 $ 6.72 3002 LAB REFRD30020826 HEMOSIDERIN QL .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30022560 HEP B PCR QN $ 114.91 $ 114.91 3002 LAB REFRD30023506 HEP B PCR QN .LC $ 318.63 $ 318.63 3002 LAB REFRD30025846 HEP B PCR QN .LC $ 520.75 $ 520.75 3002 LAB REFRD30020847 HEP B PCR QN .Q3 $ 210.30 $ 210.30 3002 LAB REFRD30020848 HEP B PCR QN .Q3 $ 103.41 $ 103.41 3002 LAB REFRD30025944 HEP B VIRUS AMP PRB .LC $ 74.75 $ 74.75 3002 LAB REFRD30020852 HEP B VIRUS AMP PRB .Q3 $ 109.25 $ 109.25 3002 LAB REFRD30020845 HEP B VIRUS BDNA QN $ 103.41 $ 103.41 3002 LAB REFRD30020828 HEP B VIRUS BDNA QN .Q3 $ 99.00 $ 99.00 3002 LAB REFRD

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DEPARTMENT CODE

30025416 HEP C VIRAL RNA GENOT.Q3 $ 120.00 $ 120.00 3002 LAB REFRD30023636 HEP C VIRAL RNA GENOTY.LC $ 263.82 $ 263.82 3002 LAB REFRD30020835 HEP C VIRUS AMP PRB $ 197.55 $ 197.55 3002 LAB REFRD30020836 HEP C VIRUS AMP PRB $ 137.20 $ 137.20 3002 LAB REFRD30020843 HEP C VIRUS AMP PRB $ 202.48 $ 202.48 3002 LAB REFRD30023648 HEP C VIRUS AMP PRB .LC $ 117.25 $ 117.25 3002 LAB REFRD30023256 HEP C VIRUS AMP PRB .Q3 $ 113.28 $ 113.28 3002 LAB REFRD30024022 HEP C VIRUS AMP PRB .LC $ 304.00 $ 304.00 3002 LAB REFRD30020841 HEP C VIRUS AMP PRB .Q3 $ 230.00 $ 230.00 3002 LAB REFRD30020834 HEP C VIRUS BDNA QN $ 135.42 $ 135.42 3002 LAB REFRD30020837 HEP C VIRUS BDNA QN $ 176.64 $ 176.64 3002 LAB REFRD30025614 HEP C VIRUS BDNA QN .LC $ 100.00 $ 100.00 3002 LAB REFRD30020839 HEP C VIRUS BDNA QN .Q3 $ 85.00 $ 85.00 3002 LAB REFRD30020842 HEP C VIRUS PCR QN $ 141.47 $ 141.47 3002 LAB REFRD30025716 HEP C VIRUS PCR QN .LC $ 100.00 $ 100.00 3002 LAB REFRD30020827 HEP C VIRUS PCR QN .Q3 $ 230.00 $ 230.00 3002 LAB REFRD30020838 HEP C VIRUS PCR QN .Q3 $ 80.00 $ 80.00 3002 LAB REFRD30020860 HEPARIN ASSAY $ 59.96 $ 59.96 3002 LAB REFRD30020805 HGB ELECTRO $ 18.56 $ 18.56 3002 LAB REFRD30020807 HGB ELECTRO .Q3 $ 14.09 $ 14.09 3002 LAB REFRD30020808 HGB ELECTRO .Q3 $ - $ - 3002 LAB REFRD30020900 HISTAMINE $ 26.45 $ 26.45 3002 LAB REFRD30020182 HISTONE AB $ 41.99 $ 41.99 3002 LAB REFRD30020910 HISTOPLAS AB $ 53.08 $ 53.08 3002 LAB REFRD30020911 HIV 1 AMP PRB $ 126.18 $ 126.18 3002 LAB REFRD30023458 HIV 1 AMP PRB .Q3 $ 143.75 $ 143.75 3002 LAB REFRD30025512 HIV 1 AMP PRB .LC $ 64.40 $ 64.40 3002 LAB REFRD30020914 HIV 1 GENOTYPE $ 350.50 $ 350.50 3002 LAB REFRD30020916 HIV 1 GENOTYPE $ 350.50 $ 350.50 3002 LAB REFRD30023936 HIV 1 GENOTYPE $ - $ - 3002 LAB REFRD30025758 HIV 1 GENOTYPE .LC $ 474.00 $ 474.00 3002 LAB REFRD30020917 HIV 1 GENOTYPE .Q3 $ 560.79 $ 560.79 3002 LAB REFRD30025946 HIV 1 PHENO 1ST 10 DR.LC $ 995.00 $ 995.00 3002 LAB REFRD

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DEPARTMENT CODE

30023110 HIV 1 PHENO 1ST 10 DR.Q3 $ 19.08 $ 19.08 3002 LAB REFRD30022698 HIV 1 PHENO EA ADDL DR.Q3 $ 19.08 $ 19.08 3002 LAB REFRD30020907 HIV 1 QN BDNA $ 103.87 $ 103.87 3002 LAB REFRD30020912 HIV 1 QN BDNA $ 126.18 $ 126.18 3002 LAB REFRD30022845 HIV 1 QN BDNA $ 188.63 $ 188.63 3002 LAB REFRD30024026 HIV 1 QN BDNA .LC $ 336.25 $ 336.25 3002 LAB REFRD30024018 HIV 1 QN BDNA .Q3 $ 113.05 $ 113.05 3002 LAB REFRD30020913 HIV 1 QN PCR .Q3 $ 96.77 $ 96.77 3002 LAB REFRD30025782 HIV 1 QN PCR .Q3 $ 175.00 $ 175.00 3002 LAB REFRD30020903 HIV 2 AMP PRB .Q3 $ 237.13 $ 237.13 3002 LAB REFRD30024002 HIV AB CONF WESTERN B.LC $ 55.20 $ 55.20 3002 LAB REFRD30020902 HIV AB CONF WESTERN B.Q3 $ 26.45 $ 26.45 3002 LAB REFRD30025420 HIV AB CONF WESTERN B.Q3 $ 23.00 $ 23.00 3002 LAB REFRD30025422 HIV AB CONF WESTERN B.Q3 $ 55.00 $ 55.00 3002 LAB REFRD30020806 HIV AB CONF WESTERN BLOT $ 29.62 $ 29.62 3002 LAB REFRD30022555 HIV AB CONF WESTERN BLOT $ 99.42 $ 99.42 3002 LAB REFRD30021245 HIV P24 AG $ 29.96 $ 29.96 3002 LAB REFRD30022485 HIV P24 AG $ 37.80 $ 37.80 3002 LAB REFRD30020796 HIV P24 AG .Q3 $ 29.96 $ 29.96 3002 LAB REFRD30025424 HIV-2 AB .Q3 $ 17.68 $ 17.68 3002 LAB REFRD30020920 HLA B27 $ 20.69 $ 20.69 3002 LAB REFRD30023672 HLA B27 .LC $ 31.66 $ 31.66 3002 LAB REFRD30020921 HLA B27 .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30020803 HOMOCYSTINE $ 31.87 $ 31.87 3002 LAB REFRD30023542 HOMOCYSTINE .LC $ 41.04 $ 41.04 3002 LAB REFRD30020935 HOMOCYSTINE .Q3 $ 23.22 $ 23.22 3002 LAB REFRD30025390 HPV AMP PRB .LC $ 249.00 $ 249.00 3002 LAB REFRD30022860 HPV AMP PRB .Q3 $ 36.35 $ 36.35 3002 LAB REFRD30025414 HPV AMP PRB .Q3 $ 29.00 $ 29.00 3002 LAB REFRD30020874 HSV 1 AB .Q3 $ 68.69 $ 68.69 3002 LAB REFRD30023444 HSV 1 AB IGG .Q3 $ 27.35 $ 27.35 3002 LAB REFRD30023842 HSV 1 AB IGG .Q3 $ 18.39 $ 18.39 3002 LAB REFRD30025398 HSV 1 AB IGG .LC $ 71.37 $ 71.37 3002 LAB REFRD

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DEPARTMENT CODE

30020875 HSV 1 AB IGG .Q3 $ 7.50 $ 7.50 3002 LAB REFRD30022875 HSV 1 AB IGG .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30022876 HSV 1 AB IGM .Q3 $ 20.85 $ 20.85 3002 LAB REFRD30025310 HSV 1&2 DNA BY PCR .LC $ 115.00 $ 115.00 3002 LAB REFRD30023894 HSV 2 AB IGG .LC $ 100.68 $ 100.68 3002 LAB REFRD30023446 HSV 2 AB IGG .Q3 $ 27.37 $ 27.37 3002 LAB REFRD30023844 HSV 2 AB IGG .Q3 $ 18.39 $ 18.39 3002 LAB REFRD30025400 HSV 2 AB IGG .LC $ 71.38 $ 71.38 3002 LAB REFRD30025900 HSV 2 AB IGG .LC $ 17.85 $ 17.85 3002 LAB REFRD30022877 HSV 2 AB IGG .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023944 HSV 2 AB IGG .Q3 $ 7.50 $ 7.50 3002 LAB REFRD30022878 HSV 2 AB IGM .Q3 $ 20.85 $ 20.85 3002 LAB REFRD30023520 HSV AB .LC $ 77.75 $ 77.75 3002 LAB REFRD30025470 HSV AB .LC $ 5.50 $ 5.50 3002 LAB REFRD30025954 HSV AB .LC $ 31.50 $ 31.50 3002 LAB REFRD30023442 HSV AB IGM .Q3 $ 27.35 $ 27.35 3002 LAB REFRD30025922 HSV AB IGM .LC $ 13.28 $ 13.28 3002 LAB REFRD30022885 HSV AMP PRB .Q3 $ 125.64 $ 125.64 3002 LAB REFRD30020873 HSV WESTERN BLOT .Q3 $ 164.99 $ 164.99 3002 LAB REFRD30020940 HTLV 1 AB .Q3 $ 38.18 $ 38.18 3002 LAB REFRD30025330 HYDROXYPROLINE TOTAL .LC $ 18.25 $ 18.25 3002 LAB REFRD30021700 HYDROXYPROLINE TOTAL .Q3 $ 64.98 $ 64.98 3002 LAB REFRD30025908 IA INFECTIOUS AGT AB .LC $ 12.00 $ 12.00 3002 LAB REFRD30025910 IA INFECTIOUS AGT AB .LC $ 12.00 $ 12.00 3002 LAB REFRD30023598 IGA .LC $ 9.33 $ 9.33 3002 LAB REFRD30023896 IGA .Q3 $ 40.63 $ 40.63 3002 LAB REFRD30025346 IGA .LC $ 40.00 $ 40.00 3002 LAB REFRD30020970 IGE $ 15.84 $ 15.84 3002 LAB REFRD30023606 IGE .LC $ 8.57 $ 8.57 3002 LAB REFRD30023424 IGE .Q3 $ 23.20 $ 23.20 3002 LAB REFRD30025842 IGE .LC $ 4.50 $ 4.50 3002 LAB REFRD30020975 IGE .Q3 $ 7.19 $ 7.19 3002 LAB REFRD30023956 IGE .Q3 $ 5.22 $ 5.22 3002 LAB REFRD

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DEPARTMENT CODE

30021451 IGFBP 3 $ 33.48 $ 33.48 3002 LAB REFRD30020955 IGFBP 3 .Q3 $ 33.35 $ 33.35 3002 LAB REFRD30025876 IGF-I .LC $ 23.50 $ 23.50 3002 LAB REFRD30023534 IGG .LC $ 30.80 $ 30.80 3002 LAB REFRD30023600 IGG .LC $ 9.33 $ 9.33 3002 LAB REFRD30023186 IGG .Q3 $ 14.75 $ 14.75 3002 LAB REFRD30023474 IGG .Q3 $ 8.22 $ 8.22 3002 LAB REFRD30024072 IGG .LC $ 7.56 $ 7.56 3002 LAB REFRD30020969 IGG SUBCLASSES $ 71.30 $ 71.30 3002 LAB REFRD30024074 IGG SUBCLASSES .LC $ 7.56 $ 7.56 3002 LAB REFRD30020979 IGG SUBCLASSES .Q3 $ 50.31 $ 50.31 3002 LAB REFRD30023602 IGM .LC $ 9.33 $ 9.33 3002 LAB REFRD30020960 IMIPRAMINE $ 30.48 $ 30.48 3002 LAB REFRD30020961 IMIPRAMINE .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30023432 IMMUNE COMPLEX CD3 CIR.Q3 $ 63.83 $ 63.83 3002 LAB REFRD30025478 IMMUNE COMPLEX CIQ BI.LC $ 26.50 $ 26.50 3002 LAB REFRD30020950 IMMUNE COMPLEX CIQ BIND $ 26.85 $ 26.85 3002 LAB REFRD30021340 IMMUNE COMPLEX CIQ BIND $ 68.70 $ 68.70 3002 LAB REFRD30023434 IMMUNE COMPLEX DETECTI.Q3 $ 63.84 $ 63.84 3002 LAB REFRD30025292 IMMUNE COMPLEX RAJII .LC $ 16.00 $ 16.00 3002 LAB REFRD30025480 IMMUNE COMPLEX RAJII .LC $ 26.50 $ 26.50 3002 LAB REFRD30023212 IMMUNE COMPLEX RAJII C.Q3 $ 51.73 $ 51.73 3002 LAB REFRD30025280 IMMUNOASSAY ANALYTE Q.LC $ 226.00 $ 226.00 3002 LAB REFRD30021542 IMMUNOASSAY ANALYTE Q.Q3 $ 220.80 $ 220.80 3002 LAB REFRD30023088 IMMUNOASSAY NONINFECT $ 20.50 $ 20.50 3002 LAB REFRD30023620 IMMUNOASSAY NONINFECT .LC $ 38.24 $ 38.24 3002 LAB REFRD30023638 IMMUNOASSAY NONINFECT .LC $ 15.53 $ 15.53 3002 LAB REFRD30023668 IMMUNOASSAY NONINFECT .LC $ 10.52 $ 10.52 3002 LAB REFRD30024244 IMMUNOASSAY NONINFECT.LC $ 16.70 $ 16.70 3002 LAB REFRD30025522 IMMUNOASSAY NONINFECT.LC $ 8.12 $ 8.12 3002 LAB REFRD30020685 IMMUNOASSAY NONINFECT.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023102 IMMUNOASSAY NONINFECT.Q3 $ 148.48 $ 148.48 3002 LAB REFRD30023548 IMMUNOASSAY NOT SPEC .LC $ 13.39 $ 13.39 3002 LAB REFRD

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DEPARTMENT CODE

30023268 IMMUNOASSAY NOT SPEC .Q3 $ 6.82 $ 6.82 3002 LAB REFRD30023270 IMMUNOASSAY NOT SPEC .Q3 $ 42.55 $ 42.55 3002 LAB REFRD30025374 IMMUNOASSAY NOT SPEC .LC $ 120.00 $ 120.00 3002 LAB REFRD30025816 IMMUNOASSAY NOT SPEC .LC $ 17.00 $ 17.00 3002 LAB REFRD30025824 IMMUNOASSAY NOT SPEC .LC $ 26.45 $ 26.45 3002 LAB REFRD30025826 IMMUNOASSAY NOT SPEC .LC $ 57.96 $ 57.96 3002 LAB REFRD30025914 IMMUNOASSAY NOT SPEC .LC $ 15.00 $ 15.00 3002 LAB REFRD30020362 IMMUNOASSAY NOT SPEC .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30020396 IMMUNOASSAY TUM AG EA $ 19.25 $ 19.25 3002 LAB REFRD30023292 IMMUNOASSAY TUM AG EA .Q3 $ 33.35 $ 33.35 3002 LAB REFRD30025828 IMMUNOASSAY TUM AG EA.LC $ 110.00 $ 110.00 3002 LAB REFRD30023909 IMMUNODIFFUSION .Q3 $ 22.43 $ 22.43 3002 LAB REFRD30025852 IMMUNODIFFUSION GEL Q.LC $ 39.18 $ 39.18 3002 LAB REFRD30020965 IMMUNOFIX SER $ 21.87 $ 21.87 3002 LAB REFRD30022062 IMMUNOFIX SER $ 60.13 $ 60.13 3002 LAB REFRD30023604 IMMUNOFIX SER .LC $ 9.34 $ 9.34 3002 LAB REFRD30020964 IMMUNOFIX SER .Q3 $ 25.00 $ 25.00 3002 LAB REFRD30023907 IMMUNOFIX SER .Q3 $ 36.80 $ 36.80 3002 LAB REFRD30020962 IMMUNOFIX UR $ 40.78 $ 40.78 3002 LAB REFRD30023764 IMMUNOFIX UR .LC $ 28.68 $ 28.68 3002 LAB REFRD30020968 IMMUNOFIX UR .Q3 $ 34.79 $ 34.79 3002 LAB REFRD30023582 IMMUNOHISTOCHEMISTRY .LC $ 70.90 $ 70.90 3002 LAB REFRD30023584 IN SITU HYBRIDIZ EA PR.LC $ 70.91 $ 70.91 3002 LAB REFRD30020341 INFECT AGENT DETECT DFA $ 24.15 $ 24.15 3002 LAB REFRD30025874 INFLU A H1N1 RNA RT P.LC $ 142.88 $ 142.88 3002 LAB REFRD30025853 INFLU A H1N1 RNA RT P.Q3 $ 110.00 $ 110.00 3002 LAB REFRD30025856 INFLU A H1N1 RNA RT P.Q3 $ 115.00 $ 115.00 3002 LAB REFRD30020972 INFLUENZA A AB $ 23.70 $ 23.70 3002 LAB REFRD30020973 INFLUENZA A AB $ 27.15 $ 27.15 3002 LAB REFRD30024040 INFLUENZA A AB .LC $ 10.00 $ 10.00 3002 LAB REFRD30020971 INFLUENZA A AB .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30024042 INFLUENZA B AB .LC $ 10.00 $ 10.00 3002 LAB REFRD30020951 INFLUENZA B AB .Q3 $ 18.40 $ 18.40 3002 LAB REFRD

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DEPARTMENT CODE

30020980 INSULIN $ 18.64 $ 18.64 3002 LAB REFRD30023804 INSULIN .LC $ 5.36 $ 5.36 3002 LAB REFRD30020982 INSULIN .Q3 $ 12.08 $ 12.08 3002 LAB REFRD30021880 IRON TISSUE $ 124.78 $ 124.78 3002 LAB REFRD30025892 ISLET CL AB .LC $ 22.00 $ 22.00 3002 LAB REFRD30023948 ISLET CL AB .Q3 $ 14.38 $ 14.38 3002 LAB REFRD30025372 KETONES QN .LC $ 46.00 $ 46.00 3002 LAB REFRD30021600 KETOSTEROIDS 17 TOTAL.Q3 $ 23.59 $ 23.59 3002 LAB REFRD30021010 L/S RATIO $ 197.55 $ 197.55 3002 LAB REFRD30023662 LA (SS B) AB .LC $ 12.11 $ 12.11 3002 LAB REFRD30023722 LA (SS B) AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023132 LA (SS B) AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023675 LA (SS B) AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30023224 LA(SS B) AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023784 LAMOTRIGINE .LC $ 44.61 $ 44.61 3002 LAB REFRD30022890 LAMOTRIGINE .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30021015 LDH ISOENZYMES .Q3 $ 11.26 $ 11.26 3002 LAB REFRD30021687 LDL BY DIRECT MEASURE.Q3 $ 16.10 $ 16.10 3002 LAB REFRD30020990 LEAD BLD $ 9.13 $ 9.13 3002 LAB REFRD30023504 LEAD BLD .LC $ 5.36 $ 5.36 3002 LAB REFRD30020991 LEAD BLD .Q3 $ 9.29 $ 9.29 3002 LAB REFRD30023940 LEAD BLD .Q3 $ 27.09 $ 27.09 3002 LAB REFRD30022900 LEAD UR .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30025634 LEAD UR 24HR .LC $ 10.40 $ 10.40 3002 LAB REFRD30022905 LEAD UR 24HR .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30021020 LEGIONELLA AB $ 20.26 $ 20.26 3002 LAB REFRD30025920 LEGIONELLA AB .LC $ 18.48 $ 18.48 3002 LAB REFRD30021018 LEGIONELLA AB .Q3 $ 23.29 $ 23.29 3002 LAB REFRD30023173 LEGIONELLA AB IGG .Q3 $ 13.03 $ 13.03 3002 LAB REFRD30023175 LEGIONELLA AB IGM .Q3 $ 13.03 $ 13.03 3002 LAB REFRD30023176 LEGIONELLA AB IGM .Q3 $ 13.08 $ 13.08 3002 LAB REFRD30022495 LH $ 189.05 $ 128.00 3002 LAB REFRD30023300 LH .Q3 $ 18.98 $ 18.98 3002 LAB REFRD

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DEPARTMENT CODE

30021060 LIPASE $ 8.50 $ 8.50 3002 LAB REFRD30021065 LIPASE .Q3 $ 7.48 $ 7.48 3002 LAB REFRD30023296 LIPOPROTEIN BLD .Q3 $ 9.58 $ 9.58 3002 LAB REFRD30022895 LIPOPROTEIN BLD .Q3 $ 115.00 $ 115.00 3002 LAB REFRD30025656 LIPROPROT BLD HI FRAC.LC $ 86.50 $ 86.50 3002 LAB REFRD30025778 LIPROPROT BLD HI FRAC.Q3 $ 16.00 $ 16.00 3002 LAB REFRD30023316 LYME DISEASE AB .Q3 $ 52.27 $ 52.27 3002 LAB REFRD30024248 LYME DISEASE AB .LC $ 14.70 $ 14.70 3002 LAB REFRD30025712 LYME DISEASE AB .LC $ 6.00 $ 6.00 3002 LAB REFRD30021070 LYME DISEASE AB .Q3 $ 52.27 $ 52.27 3002 LAB REFRD30022920 LYME DISEASE AB .Q3 $ 51.73 $ 51.73 3002 LAB REFRD30022925 LYME DISEASE AB .Q3 $ 59.26 $ 59.26 3002 LAB REFRD30023826 LYME DISEASE AB IGM .LC $ 28.04 $ 28.04 3002 LAB REFRD30025714 LYME DISEASE AB WB .LC $ 25.00 $ 25.00 3002 LAB REFRD30023697 MAG AB .Q3 $ 30.57 $ 30.57 3002 LAB REFRD30025264 MAGNESIUM RBC .LC $ 10.00 $ 10.00 3002 LAB REFRD30021175 MAGNESIUM RBC .Q3 $ 37.92 $ 37.92 3002 LAB REFRD30025262 MANGANESE SERUM .LC $ 45.00 $ 45.00 3002 LAB REFRD30021178 MANGANESE SERUM .Q3 $ 43.92 $ 43.92 3002 LAB REFRD30025376 MANNAN BINDING LECTIN.LC $ 68.00 $ 68.00 3002 LAB REFRD30023392 MANNOSE BIND PROTEIN A.Q3 $ 349.21 $ 349.21 3002 LAB REFRD30020336 MASS SPECT/TANDEM QN .Q3 $ 112.00 $ 112.00 3002 LAB REFRD30023086 MASS SPECT/TANDEM QN NES $ 14.75 $ 14.75 3002 LAB REFRD30023652 MERCURY .LC $ 44.61 $ 44.61 3002 LAB REFRD30021098 MERCURY .Q3 $ 51.75 $ 51.75 3002 LAB REFRD30021100 MERCURY .Q3 $ 20.70 $ 20.70 3002 LAB REFRD30023942 MERCURY .Q3 $ 27.12 $ 27.12 3002 LAB REFRD30025636 MERCURY 24 HOUR URINE.LC $ 10.40 $ 10.40 3002 LAB REFRD30021721 METANEPHRINES UR $ 46.61 $ 46.61 3002 LAB REFRD30025386 METANEPHRINES UR .LC $ 10.00 $ 10.00 3002 LAB REFRD30021720 METANEPHRINES UR .Q3 $ 37.10 $ 37.10 3002 LAB REFRD30022935 METANEPHRINES UR .Q3 $ 35.68 $ 35.68 3002 LAB REFRD30023178 METANEPHRINES UR .Q3 $ 46.61 $ 46.61 3002 LAB REFRD

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DEPARTMENT CODE

30024140 METANEPHRINES UR .Q3 $ 17.50 $ 17.50 3002 LAB REFRD30025650 METANEPHRINES UR 24HR.LC $ 14.75 $ 14.75 3002 LAB REFRD30021125 METANEPHRINES UR 24HR.Q3 $ 32.20 $ 32.20 3002 LAB REFRD30024138 METANEPHRINES UR 24HR.Q3 $ 28.00 $ 28.00 3002 LAB REFRD30024148 METHADONE .Q3 $ 61.10 $ 61.10 3002 LAB REFRD30023160 METHADONE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025558 METHADONE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30025256 METHANOL BLD .LC $ 14.00 $ 14.00 3002 LAB REFRD30023162 METHAQUALONE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025560 METHAQUALONE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30021103 METHYLMALONIC ACID .Q3 $ 29.00 $ 29.00 3002 LAB REFRD30023680 METHYLMALONIC ACID QN .LC $ 57.35 $ 57.35 3002 LAB REFRD30021120 MEXILETINE .Q3 $ 36.37 $ 36.37 3002 LAB REFRD30021061 MICROSOMAL AB $ 25.48 $ 25.48 3002 LAB REFRD30021069 MICROSOMAL AB $ 36.33 $ 36.33 3002 LAB REFRD30023594 MICROSOMAL AB .LC $ 10.67 $ 10.67 3002 LAB REFRD30025678 MICROSOMAL AB .LC $ 10.86 $ 10.86 3002 LAB REFRD30025916 MICROSOMAL AB .LC $ 13.65 $ 13.65 3002 LAB REFRD30024000 MISC CHEM TEST .LC $ - $ - 3002 LAB REFRD30020130 MISC CHEM TEST .Q3 $ 16.68 $ 16.68 3002 LAB REFRD30021316 MISC CHEM TEST .Q3 $ 31.63 $ 31.63 3002 LAB REFRD30023766 MITOCHONDRIAL AB SCRN .LC $ 12.31 $ 12.31 3002 LAB REFRD30023236 MITOCHONDRIAL AB SCRN .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30021991 MITOCHONDRIAL AB SCRN.Q3 $ 12.65 $ 12.65 3002 LAB REFRD30021135 MITOCHONDRIAL AB TTR $ 16.89 $ 16.89 3002 LAB REFRD30021990 MITOCHONDRIAL AB TTR $ 14.15 $ 14.15 3002 LAB REFRD30023528 ML DX AMP TR NA EA SQ.LC $ 5.24 $ 5.24 3002 LAB REFRD30023694 ML DX AMP TR NA EA SQ.LC $ 11.26 $ 11.26 3002 LAB REFRD30023884 ML DX AMP TR NA EA SQ.LC $ 5.24 $ 5.24 3002 LAB REFRD30024212 ML DX AMP TR NA EA SQ.LC $ 38.50 $ 38.50 3002 LAB REFRD30023144 ML DX AMP TR NA EA SQ.Q3 $ 17.64 $ 17.64 3002 LAB REFRD30023500 ML DX AMP TR NA EA SQ.Q3 $ 13.65 $ 13.65 3002 LAB REFRD30023512 ML DX AMP TR NA EA SQ.Q3 $ 22.29 $ 22.29 3002 LAB REFRD

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DEPARTMENT CODE

30023689 ML DX AMP TR NA EA SQ.Q3 $ 5.23 $ 5.23 3002 LAB REFRD30023725 ML DX AMP TR NA EA SQ.Q3 $ 18.29 $ 18.29 3002 LAB REFRD30023922 ML DX AMP TR NA EA SQ.Q3 $ 25.30 $ 25.30 3002 LAB REFRD30023986 ML DX AMP TR NA EA SQ.Q3 $ 22.08 $ 22.08 3002 LAB REFRD30024166 ML DX AMP TR NA EA SQ.Q3 $ 30.85 $ 30.85 3002 LAB REFRD30024168 MOL DX AMP PT N ACD E.Q3 $ 30.85 $ 30.85 3002 LAB REFRD30024190 MOL DX AMP TR N ACD 2.LC $ 40.00 $ 40.00 3002 LAB REFRD30024200 MOL DX AMP TR N ACD 2.LC $ 27.50 $ 27.50 3002 LAB REFRD30024210 MOL DX AMP TR N ACD 2.LC $ 38.50 $ 38.50 3002 LAB REFRD30025536 MOL DX AMP TR N ACD 2.LC $ 36.57 $ 36.57 3002 LAB REFRD30024094 MOL DX AMP TR N ACD 2.Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024102 MOL DX AMP TR N ACD 2.Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024110 MOL DX AMP TR N ACD 2.Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024122 MOL DX AMP TR N ACD 2.Q3 $ 17.43 $ 17.43 3002 LAB REFRD30024130 MOL DX AMP TR N ACD 2.Q3 $ 5.35 $ 5.35 3002 LAB REFRD30024164 MOL DX AMP TR N ACD 2.Q3 $ 30.85 $ 30.85 3002 LAB REFRD30025547 MOL DX AMP TR N ACD 2.Q3 $ 29.95 $ 29.95 3002 LAB REFRD30025561 MOL DX AMP TR N ACD 2.Q3 $ 4.95 $ 4.95 3002 LAB REFRD30025736 MOL DX AMP TR N ACD 2.Q3 $ 66.37 $ 66.37 3002 LAB REFRD30025974 MOL DX AMP TR N ACD 2.Q3 $ 24.25 $ 24.25 3002 LAB REFRD30025986 MOL DX AMP TR N ACD 2.Q3 $ 17.83 $ 17.83 3002 LAB REFRD30023612 MOL DX AMP TR N ACD E.LC $ 17.60 $ 17.60 3002 LAB REFRD30023685 MOL DX AMP TR N ACD E.LC $ 15.87 $ 15.87 3002 LAB REFRD30023760 MOL DX AMP TR N ACD E.LC $ 21.42 $ 21.42 3002 LAB REFRD30023776 MOL DX AMP TR N ACD E.LC $ 16.32 $ 16.32 3002 LAB REFRD30023814 MOL DX AMP TR N ACD E.LC $ 64.32 $ 64.32 3002 LAB REFRD30024180 MOL DX AMP TR N ACD E.LC $ 40.00 $ 40.00 3002 LAB REFRD30023306 MOL DX AMP TR N ACD E.Q3 $ 24.25 $ 24.25 3002 LAB REFRD30023514 MOL DX DOT/SLOT BLOT .Q3 $ 22.29 $ 22.29 3002 LAB REFRD30023688 MOL DX DOT/SLOT BLOT .LC $ 11.26 $ 11.26 3002 LAB REFRD30023691 MOL DX DOT/SLOT BLOT .Q3 $ 5.23 $ 5.23 3002 LAB REFRD30020590 MOL DX DT/SLT BLT EA NA $ 200.73 $ 200.73 3002 LAB REFRD30025988 MOL DX ENZ DIG EA ENZ.Q3 $ 17.83 $ 17.83 3002 LAB REFRD

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DEPARTMENT CODE

30023686 MOL DX ENZ DIGESTION .LC $ 11.26 $ 11.26 3002 LAB REFRD30023756 MOL DX ENZ DIGESTION .LC $ 21.42 $ 21.42 3002 LAB REFRD30023772 MOL DX ENZ DIGESTION .LC $ 16.32 $ 16.32 3002 LAB REFRD30023494 MOL DX ENZ DIGESTION .Q3 $ 13.65 $ 13.65 3002 LAB REFRD30023681 MOL DX ENZ DIGESTION .LC $ 15.87 $ 15.87 3002 LAB REFRD30024178 MOL DX ENZ DIGESTION .LC $ 40.00 $ 40.00 3002 LAB REFRD30024188 MOL DX ENZ DIGESTION .LC $ 40.00 $ 40.00 3002 LAB REFRD30024198 MOL DX ENZ DIGESTION .LC $ 27.50 $ 27.50 3002 LAB REFRD30024208 MOL DX ENZ DIGESTION .LC $ 38.50 $ 38.50 3002 LAB REFRD30024008 MOL DX ENZ DIGESTION .MP $ 50.00 $ 50.00 3002 LAB REFRD30020783 MOL DX ENZ DIGESTION .Q3 $ 18.29 $ 18.29 3002 LAB REFRD30020825 MOL DX ENZ DIGESTION .Q3 $ 162.51 $ 162.51 3002 LAB REFRD30021271 MOL DX ENZ DIGESTION .Q3 $ 114.71 $ 114.71 3002 LAB REFRD30022058 MOL DX ENZ DIGESTION .Q3 $ 117.83 $ 117.83 3002 LAB REFRD30023978 MOL DX ENZ DIGESTION .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30024128 MOL DX ENZ DIGESTION .Q3 $ 5.35 $ 5.35 3002 LAB REFRD30024224 MOL DX ENZ DIGESTION .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024228 MOL DX ENZ DIGESTION .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024234 MOL DX ENZ DIGESTION .Q3 $ 14.05 $ 14.05 3002 LAB REFRD30024240 MOL DX ENZ DIGESTION .Q3 $ 17.45 $ 17.45 3002 LAB REFRD30025555 MOL DX ENZ DIGESTION .Q3 $ 4.98 $ 4.98 3002 LAB REFRD30025559 MOL DX ENZ DIGESTION .Q3 $ 4.95 $ 4.95 3002 LAB REFRD30025567 MOL DX ENZ DIGESTION .Q3 $ 3.60 $ 3.60 3002 LAB REFRD30023522 MOL DX EXTRACTION .LC $ 5.24 $ 5.24 3002 LAB REFRD30023608 MOL DX EXTRACTION .LC $ 17.60 $ 17.60 3002 LAB REFRD30023684 MOL DX EXTRACTION .LC $ 11.26 $ 11.26 3002 LAB REFRD30023754 MOL DX EXTRACTION .LC $ 21.42 $ 21.42 3002 LAB REFRD30023770 MOL DX EXTRACTION .LC $ 16.32 $ 16.32 3002 LAB REFRD30023878 MOL DX EXTRACTION .LC $ 5.24 $ 5.24 3002 LAB REFRD30024006 MOL DX EXTRACTION .MP $ 50.00 $ 50.00 3002 LAB REFRD30024176 MOL DX EXTRACTION HI .LC $ 40.00 $ 40.00 3002 LAB REFRD30024186 MOL DX EXTRACTION HI .LC $ 40.00 $ 40.00 3002 LAB REFRD30024196 MOL DX EXTRACTION HI .LC $ 27.50 $ 27.50 3002 LAB REFRD

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DEPARTMENT CODE

30024206 MOL DX EXTRACTION HI .LC $ 38.50 $ 38.50 3002 LAB REFRD30025535 MOL DX EXTRACTION HI .LC $ 36.57 $ 36.57 3002 LAB REFRD30020511 MOL DX EXTRACTION HI .Q3 $ 5.29 $ 5.29 3002 LAB REFRD30022940 MOL DX EXTRACTION HI .Q3 $ 126.50 $ 126.50 3002 LAB REFRD30023719 MOL DX EXTRACTION HI .Q3 $ 18.29 $ 18.29 3002 LAB REFRD30023919 MOL DX EXTRACTION HI .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30023976 MOL DX EXTRACTION HI .Q3 $ 14.72 $ 14.72 3002 LAB REFRD30024088 MOL DX EXTRACTION HI .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024098 MOL DX EXTRACTION HI .Q3 $ 25.62 $ 25.62 3002 LAB REFRD30024108 MOL DX EXTRACTION HI .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024118 MOL DX EXTRACTION HI .Q3 $ 17.43 $ 17.43 3002 LAB REFRD30024126 MOL DX EXTRACTION HI .Q3 $ 5.35 $ 5.35 3002 LAB REFRD30024162 MOL DX EXTRACTION HI .Q3 $ 30.85 $ 30.85 3002 LAB REFRD30024298 MOL DX EXTRACTION HI .Q3 $ 13.97 $ 13.97 3002 LAB REFRD30025545 MOL DX EXTRACTION HI .Q3 $ 29.95 $ 29.95 3002 LAB REFRD30025565 MOL DX EXTRACTION HI .Q3 $ 3.60 $ 3.60 3002 LAB REFRD30025734 MOL DX EXTRACTION HI .Q3 $ 7.37 $ 7.37 3002 LAB REFRD30023810 MOL DX EXTRACTION HI P.LC $ 64.32 $ 64.32 3002 LAB REFRD30023140 MOL DX EXTRACTION HI P.Q3 $ 17.64 $ 17.64 3002 LAB REFRD30023304 MOL DX EXTRACTION HI P.Q3 $ 24.25 $ 24.25 3002 LAB REFRD30023492 MOL DX EXTRACTION HI P.Q3 $ 13.65 $ 13.65 3002 LAB REFRD30023508 MOL DX EXTRACTION HI P.Q3 $ 22.29 $ 22.29 3002 LAB REFRD30023683 MOL DX GEL ELECTRO SE.LC $ 15.87 $ 15.87 3002 LAB REFRD30020416 MOL DX GEL ELECTRO SE.Q3 $ 163.88 $ 163.88 3002 LAB REFRD30020471 MOL DX GEL ELECTRO SE.Q3 $ 529.00 $ 529.00 3002 LAB REFRD30020844 MOL DX GEL ELECTRO SE.Q3 $ 202.48 $ 202.48 3002 LAB REFRD30023030 MOL DX GEL ELECTRO SE.Q3 $ 248.40 $ 248.40 3002 LAB REFRD30023721 MOL DX GEL ELECTRO SE.Q3 $ 18.29 $ 18.29 3002 LAB REFRD30023980 MOL DX GEL ELECTRO SE.Q3 $ 18.40 $ 18.40 3002 LAB REFRD30025740 MOL DX GEL ELECTRO SE.Q3 $ 7.37 $ 7.37 3002 LAB REFRD30023524 MOL DX GEL ELECTRO SEP.LC $ 5.24 $ 5.24 3002 LAB REFRD30023610 MOL DX GEL ELECTRO SEP.LC $ 17.60 $ 17.60 3002 LAB REFRD30023690 MOL DX GEL ELECTRO SEP.LC $ 11.26 $ 11.26 3002 LAB REFRD

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DEPARTMENT CODE

30023758 MOL DX GEL ELECTRO SEP.LC $ 21.42 $ 21.42 3002 LAB REFRD30023774 MOL DX GEL ELECTRO SEP.LC $ 16.32 $ 16.32 3002 LAB REFRD30023812 MOL DX GEL ELECTRO SEP.LC $ 64.32 $ 64.32 3002 LAB REFRD30023880 MOL DX GEL ELECTRO SEP.LC $ 5.24 $ 5.24 3002 LAB REFRD30023496 MOL DX GEL ELECTRO SEP.Q3 $ 13.65 $ 13.65 3002 LAB REFRD30025551 MOL DX GL ELCTR SEP EA NA $ 29.95 $ 29.95 3002 LAB REFRD30023530 MOL DX INTERP & RPT .LC $ 5.41 $ 5.41 3002 LAB REFRD30023614 MOL DX INTERP & RPT .LC $ 17.60 $ 17.60 3002 LAB REFRD30023696 MOL DX INTERP & RPT .LC $ 11.29 $ 11.29 3002 LAB REFRD30023762 MOL DX INTERP & RPT .LC $ 21.51 $ 21.51 3002 LAB REFRD30023778 MOL DX INTERP & RPT .LC $ 16.36 $ 16.36 3002 LAB REFRD30023816 MOL DX INTERP & RPT .LC $ 64.32 $ 64.32 3002 LAB REFRD30023886 MOL DX INTERP & RPT .LC $ 5.41 $ 5.41 3002 LAB REFRD30023146 MOL DX INTERP & RPT .Q3 $ 17.65 $ 17.65 3002 LAB REFRD30023310 MOL DX INTERP & RPT .Q3 $ 24.25 $ 24.25 3002 LAB REFRD30023502 MOL DX INTERP & RPT .Q3 $ 13.71 $ 13.71 3002 LAB REFRD30023516 MOL DX INTERP & RPT .Q3 $ 22.29 $ 22.29 3002 LAB REFRD30023687 MOL DX INTERP & RPT .LC $ 15.87 $ 15.87 3002 LAB REFRD30024182 MOL DX INTERP & RPT .LC $ 40.00 $ 40.00 3002 LAB REFRD30024192 MOL DX INTERP & RPT .LC $ 40.00 $ 40.00 3002 LAB REFRD30024202 MOL DX INTERP & RPT .LC $ 27.50 $ 27.50 3002 LAB REFRD30024214 MOL DX INTERP & RPT .LC $ 38.50 $ 38.50 3002 LAB REFRD30025540 MOL DX INTERP & RPT .LC $ 36.57 $ 36.57 3002 LAB REFRD30023693 MOL DX INTERP & RPT .Q3 $ 5.23 $ 5.23 3002 LAB REFRD30023727 MOL DX INTERP & RPT .Q3 $ 18.29 $ 18.29 3002 LAB REFRD30023924 MOL DX INTERP & RPT .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30023988 MOL DX INTERP & RPT .Q3 $ 36.80 $ 36.80 3002 LAB REFRD30024096 MOL DX INTERP & RPT .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024106 MOL DX INTERP & RPT .Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024116 MOL DX INTERP & RPT .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024124 MOL DX INTERP & RPT .Q3 $ 17.43 $ 17.43 3002 LAB REFRD30024136 MOL DX INTERP & RPT .Q3 $ 5.40 $ 5.40 3002 LAB REFRD30024174 MOL DX INTERP & RPT .Q3 $ 30.90 $ 30.90 3002 LAB REFRD

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DEPARTMENT CODE

30025553 MOL DX INTERP & RPT .Q3 $ 29.96 $ 29.96 3002 LAB REFRD30025742 MOL DX INTERP & RPT .Q3 $ 8.61 $ 8.61 3002 LAB REFRD30025978 MOL DX INTERP & RPT .Q3 $ 38.70 $ 38.70 3002 LAB REFRD30025992 MOL DX INTERP & RPT .Q3 $ 17.85 $ 17.85 3002 LAB REFRD30025984 MOL DX ISO/EXT PRFD E.Q3 $ 17.83 $ 17.83 3002 LAB REFRD30020718 MOL DX ISO/EXT PRFD EA NA $ 117.83 $ 117.83 3002 LAB REFRD30023679 MOL DX ISOLATE & EXTR.LC $ 15.87 $ 15.87 3002 LAB REFRD30025568 MOL DX ISOLATE & EXTR.LC $ 165.60 $ 165.60 3002 LAB REFRD30025592 MOL DX ISOLATE & EXTR.LC $ 145.00 $ 145.00 3002 LAB REFRD30025608 MOL DX ISOLATE & EXTR.LC $ 99.25 $ 99.25 3002 LAB REFRD30023526 MOL DX NUC ACID PRB .LC $ 5.24 $ 5.24 3002 LAB REFRD30023692 MOL DX NUC ACID PRB .LC $ 11.26 $ 11.26 3002 LAB REFRD30023882 MOL DX NUC ACID PRB .LC $ 5.24 $ 5.24 3002 LAB REFRD30023142 MOL DX NUC ACID PRB .Q3 $ 17.64 $ 17.64 3002 LAB REFRD30023498 MOL DX NUC ACID PRB .Q3 $ 13.65 $ 13.65 3002 LAB REFRD30023510 MOL DX NUC ACID PRB .Q3 $ 22.29 $ 22.29 3002 LAB REFRD30024010 MOL DX NUC ACID PRB .MP $ 25.00 $ 25.00 3002 LAB REFRD30023695 MOL DX NUC ACID PRB .Q3 $ 5.23 $ 5.23 3002 LAB REFRD30023723 MOL DX NUC ACID PRB .Q3 $ 18.29 $ 18.29 3002 LAB REFRD30023921 MOL DX NUC ACID PRB .Q3 $ 25.30 $ 25.30 3002 LAB REFRD30023984 MOL DX NUC ACID PRB .Q3 $ 18.40 $ 18.40 3002 LAB REFRD30024090 MOL DX NUC ACID PRB .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024100 MOL DX NUC ACID PRB .Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024120 MOL DX NUC ACID PRB .Q3 $ 17.43 $ 17.43 3002 LAB REFRD30024172 MOL DX NUC ACID PRB .Q3 $ 30.85 $ 30.85 3002 LAB REFRD30024226 MOL DX NUC ACID PRB .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024230 MOL DX NUC ACID PRB .Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024242 MOL DX NUC ACID PRB .Q3 $ 5.35 $ 5.35 3002 LAB REFRD30025571 MOL DX NUC ACID PRB .Q3 $ 3.60 $ 3.60 3002 LAB REFRD30023982 MOL DX NUC ACID TRANS.Q3 $ 18.40 $ 18.40 3002 LAB REFRD30025569 MOL DX NUC ACID TRANS.Q3 $ 3.60 $ 3.60 3002 LAB REFRD30024170 MOL DX REV TRANSCRIPT.Q3 $ 30.85 $ 30.85 3002 LAB REFRD30025990 MOL DX SEP/ID HI RS E.Q3 $ 17.83 $ 17.83 3002 LAB REFRD

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DEPARTMENT CODE

30025760 MONONUCLEAR CELL ANTI.LC $ 56.50 $ 56.50 3002 LAB REFRD30021145 MUMPS AB $ 24.47 $ 24.47 3002 LAB REFRD30023650 MUMPS AB IGG .LC $ 8.03 $ 8.03 3002 LAB REFRD30023190 MUMPS AB IGG .Q3 $ 9.00 $ 9.00 3002 LAB REFRD30023340 MUMPS AB IGG .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30025966 MUMPS AB IGG .LC $ 8.59 $ 8.59 3002 LAB REFRD30021141 MUMPS AB IGG .Q3 $ 24.47 $ 24.47 3002 LAB REFRD30021143 MUMPS AB IGM $ 30.68 $ 30.68 3002 LAB REFRD30023706 MUMPS AB IGM .LC $ 11.90 $ 11.90 3002 LAB REFRD30023342 MUMPS AB IGM .Q3 $ 19.56 $ 19.56 3002 LAB REFRD30025968 MUMPS AB IGM .LC $ 8.59 $ 8.59 3002 LAB REFRD30021142 MUMPS AB IGM .Q3 $ 19.84 $ 19.84 3002 LAB REFRD30025266 MURAMIDASE .LC $ 16.17 $ 16.17 3002 LAB REFRD30025274 MURAMIDASE .LC $ 13.00 $ 13.00 3002 LAB REFRD30021080 MURAMIDASE .Q3 $ 20.70 $ 20.70 3002 LAB REFRD30022930 MURAMIDASE .Q3 $ 54.17 $ 54.17 3002 LAB REFRD30023308 MUTATION ID BY SEQ EA .Q3 $ 24.25 $ 24.25 3002 LAB REFRD30025976 MUTATION ID BY SEQ EA.Q3 $ 38.65 $ 38.65 3002 LAB REFRD30024184 MUTATION ID OLA/SBCE/.LC $ 40.00 $ 40.00 3002 LAB REFRD30024194 MUTATION ID OLA/SBCE/.LC $ 40.00 $ 40.00 3002 LAB REFRD30024204 MUTATION ID OLA/SBCE/.LC $ 27.50 $ 27.50 3002 LAB REFRD30024092 MUTATION ID OLA/SBCE/.Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024114 MUTATION ID OLA/SBCE/.Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024134 MUTATION ID OLA/SBCE/.Q3 $ 5.35 $ 5.35 3002 LAB REFRD30024232 MUTATION ID OLA/SBCE/.Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024236 MUTATION ID OLA/SBCE/.Q3 $ 17.43 $ 17.43 3002 LAB REFRD30023382 MYCOPLAS AB .Q3 $ 115.99 $ 115.99 3002 LAB REFRD30021160 MYCOPLAS AB .Q3 $ 42.38 $ 42.38 3002 LAB REFRD30023806 MYCOPLAS AB IGG .LC $ 8.57 $ 8.57 3002 LAB REFRD30023452 MYCOPLAS AB IGG .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30025912 MYCOPLAS AB IGG .LC $ 6.72 $ 6.72 3002 LAB REFRD30023808 MYCOPLAS AB IGM .LC $ 8.57 $ 8.57 3002 LAB REFRD30023388 MYCOPLAS AB IGM .Q3 $ 17.25 $ 17.25 3002 LAB REFRD

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DEPARTMENT CODE

30025906 MYCOPLAS AB IGM .LC $ 6.72 $ 6.72 3002 LAB REFRD30021150 MYCOPLAS CULT $ 23.59 $ 23.59 3002 LAB REFRD30025288 MYCOPLAS CULT .LC $ 35.00 $ 35.00 3002 LAB REFRD30021155 MYCOPLAS CULT .Q3 $ 32.20 $ 32.20 3002 LAB REFRD30021156 MYCOPLAS CULT .Q3 $ 34.50 $ 34.50 3002 LAB REFRD30025260 MYELIN BASIC PROTEIN .LC $ 13.00 $ 13.00 3002 LAB REFRD30021170 MYELIN BASIC PROTEIN .Q3 $ 21.85 $ 21.85 3002 LAB REFRD30023538 MYELIN BASIC PROTEIN C.LC $ 30.80 $ 30.80 3002 LAB REFRD30023182 MYELIN BASIC PROTEIN C.Q3 $ 14.74 $ 14.74 3002 LAB REFRD30023194 MYELOPEROXIDASE AB .Q3 $ 14.25 $ 14.25 3002 LAB REFRD30022945 MYELOPEROXIDASE AB .Q3 $ 77.11 $ 77.11 3002 LAB REFRD30025430 MYELOPEROXIDASE AB .Q3 $ 16.62 $ 16.62 3002 LAB REFRD30023246 MYOCARDIAL AB SCRN .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30025820 MYOGLOBIN .LC $ 11.00 $ 11.00 3002 LAB REFRD30021180 MYOGLOBIN .Q3 $ 30.48 $ 30.48 3002 LAB REFRD30025762 NATURAL KILLER CELLS .LC $ 56.50 $ 56.50 3002 LAB REFRD30023082 NB GENETIC SCR GALACT $ 14.50 $ 14.50 3002 LAB REFRD30021192 NB GENETIC SCR GALACT.WC $ - $ - 3002 LAB REFRD30021193 NB GENETIC SCR HYPOTH.WC $ - $ - 3002 LAB REFRD30021206 NEFAZODONE .Q3 $ 70.15 $ 70.15 3002 LAB REFRD30021201 NEURONAL AB (HU AB) T.Q3 $ 113.85 $ 113.85 3002 LAB REFRD30021204 NICOTINE & METABOLITE.Q3 $ 55.18 $ 55.18 3002 LAB REFRD30024050 NICOTINE METAB URINE .LC $ 6.50 $ 6.50 3002 LAB REFRD30021200 NORTRIPTYLINE $ 26.02 $ 26.02 3002 LAB REFRD30025806 NORTRIPTYLINE .LC $ 13.44 $ 13.44 3002 LAB REFRD30021203 NORTRIPTYLINE .Q3 $ 18.86 $ 18.86 3002 LAB REFRD30020535 NTELOPEPTIDE UR $ 53.53 $ 53.53 3002 LAB REFRD30020635 NTELOPEPTIDE UR $ 70.13 $ 70.13 3002 LAB REFRD30021331 NTELOPEPTIDE UR $ 40.15 $ 40.15 3002 LAB REFRD30025594 NTELOPEPTIDE UR .LC $ 7.50 $ 7.50 3002 LAB REFRD30021185 NTELOPEPTIDE UR .Q3 $ 44.85 $ 44.85 3002 LAB REFRD30021332 NTELOPEPTIDE UR .Q3 $ 63.25 $ 63.25 3002 LAB REFRD30021205 NTRPHL CYTO AB ANCA TTR $ 38.99 $ 38.99 3002 LAB REFRD

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DEPARTMENT CODE

30025538 NUCLEIC ACID HI RESOL.LC $ 36.57 $ 36.57 3002 LAB REFRD30024104 NUCLEIC ACID HI RESOL.Q3 $ 13.97 $ 13.97 3002 LAB REFRD30024112 NUCLEIC ACID HI RESOL.Q3 $ 18.00 $ 18.00 3002 LAB REFRD30024132 NUCLEIC ACID HI RESOL.Q3 $ 5.35 $ 5.35 3002 LAB REFRD30024222 NUCLEIC ACID HI RESOL.Q3 $ 14.25 $ 14.25 3002 LAB REFRD30024238 NUCLEIC ACID HI RESOL.Q3 $ 17.43 $ 17.43 3002 LAB REFRD30025549 NUCLEIC ACID HI RESOL.Q3 $ 29.95 $ 29.95 3002 LAB REFRD30025557 NUCLEIC ACID HI RESOL.Q3 $ 4.95 $ 4.95 3002 LAB REFRD30025563 NUCLEIC ACID HI RESOL.Q3 $ 4.95 $ 4.95 3002 LAB REFRD30025738 NUCLEIC ACID HI RESOL.Q3 $ 33.18 $ 33.18 3002 LAB REFRD30021225 OLIGOCLONAL BANDS CSF $ 23.52 $ 23.52 3002 LAB REFRD30023540 OLIGOCLONAL BANDS CSF .LC $ 30.84 $ 30.84 3002 LAB REFRD30023180 OLIGOCLONAL BANDS CSF .Q3 $ 14.74 $ 14.74 3002 LAB REFRD30023470 OLIGOCLONAL BANDS CSF .Q3 $ 23.52 $ 23.52 3002 LAB REFRD30025468 OLIGOCLONAL BANDS CSF.LC $ 12.60 $ 12.60 3002 LAB REFRD30021220 OLIGOCLONAL BANDS CSF.Q3 $ 20.13 $ 20.13 3002 LAB REFRD30023164 OPIATES SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025562 OPIATES SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30021231 ORGANIC ACIDS QN TOTA.Q3 $ 143.75 $ 143.75 3002 LAB REFRD30021101 ORGANIC ACIDS QN TOTAL $ 60.15 $ 60.15 3002 LAB REFRD30021240 OSTEOCALCIN $ 38.04 $ 38.04 3002 LAB REFRD30021241 OSTEOCALCIN $ 46.31 $ 46.31 3002 LAB REFRD30025814 OSTEOCALCIN .LC $ 17.00 $ 17.00 3002 LAB REFRD30022200 OVA & PARASITES W CON.Q3 $ 17.48 $ 17.48 3002 LAB REFRD30021242 OXALATE UR $ 15.93 $ 15.93 3002 LAB REFRD30021730 OXALATE UR .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30021731 OXALATE UR .Q3 $ 15.93 $ 15.93 3002 LAB REFRD30024216 OXALATE UR .Q3 $ 7.50 $ 7.50 3002 LAB REFRD30023626 OXALATE UR 24HR .LC $ 12.86 $ 12.86 3002 LAB REFRD30023398 OXYCARBAZEPINE .Q3 $ 31.05 $ 31.05 3002 LAB REFRD30025342 OXYCARBAZEPINE .LC $ 10.00 $ 10.00 3002 LAB REFRD30025440 PA TITER EA AB .Q3 $ 59.40 $ 59.40 3002 LAB REFRD30023332 PANCREAS POLYPEPTIDE .Q3 $ 59.80 $ 59.80 3002 LAB REFRD

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DEPARTMENT CODE

30025884 PANCREAS POLYPEPTIDE .LC $ 108.00 $ 108.00 3002 LAB REFRD30023248 PARIETAL CELL AB SCRN .Q3 $ 15.70 $ 15.70 3002 LAB REFRD30025308 PARVOVIRUS B 19 DNA P.LC $ 214.00 $ 214.00 3002 LAB REFRD30022470 PARVOVIRUS B19 AB $ 27.47 $ 27.47 3002 LAB REFRD30022478 PARVOVIRUS B19 AB $ 35.48 $ 35.48 3002 LAB REFRD30020947 PARVOVIRUS B19 AB .Q3 $ 34.50 $ 34.50 3002 LAB REFRD30023752 PARVOVIRUS B19 AB IGG .LC $ 44.61 $ 44.61 3002 LAB REFRD30024062 PARVOVIRUS B19 AB IGG.LC $ 12.50 $ 12.50 3002 LAB REFRD30021296 PARVOVIRUS B19 AB IGG.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023832 PARVOVIRUS B19 AB IGM .LC $ 44.61 $ 44.61 3002 LAB REFRD30024064 PARVOVIRUS B19 AB IGM.LC $ 12.50 $ 12.50 3002 LAB REFRD30021298 PARVOVIRUS B19 AB IGM.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023166 PHENCYCLIDINE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025564 PHENCYCLIDINE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30025756 PHENOTYPE INFEC AGNT .LC $ 474.00 $ 474.00 3002 LAB REFRD30021191 PHENYLALANINE BLOOD .WC $ - $ - 3002 LAB REFRD30021282 PHENYTOIN FREE .Q3 $ 25.88 $ 25.88 3002 LAB REFRD30023830 PHOSPHOLIPID AB .LC $ 95.59 $ 95.59 3002 LAB REFRD30021260 PLSMG $ 52.64 $ 52.64 3002 LAB REFRD30025299 PLSMG .LC $ 21.63 $ 21.63 3002 LAB REFRD30021272 PLSMG ACTIVATOR INHIB.Q3 $ 63.25 $ 63.25 3002 LAB REFRD30025534 PLT AB DIR IGG .LC $ 52.00 $ 52.00 3002 LAB REFRD30020210 PLT AB DIR IGG .Q3 $ 56.35 $ 56.35 3002 LAB REFRD30020200 PLT AB DRG INDUCED $ 73.22 $ 73.22 3002 LAB REFRD30025886 PLT AB DRG INDUCED .LC $ 41.25 $ 41.25 3002 LAB REFRD30025408 PLT AB DRG INDUCED .NI $ 94.93 $ 94.93 3002 LAB REFRD30022855 PLT AB HEPARIN .Q3 $ 69.00 $ 69.00 3002 LAB REFRD30023974 PLT NEUTRALIZATION .Q3 $ 4.00 $ 4.00 3002 LAB REFRD30021453 PNEMOCOCCAL AB .SP $ 66.08 $ 66.08 3002 LAB REFRD30023892 PNEUMOCOCCAL AB .LC $ 35.68 $ 35.68 3002 LAB REFRD30025506 PNEUMOCOCCAL AB .LC $ 22.41 $ 22.41 3002 LAB REFRD30025508 PNEUMOCOCCAL AB .LC $ 22.42 $ 22.42 3002 LAB REFRD30021455 PNEUMOCOCCAL AB .Q3 $ 6.22 $ 6.22 3002 LAB REFRD

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DEPARTMENT CODE

30021321 POLIO AB .Q3 $ 115.02 $ 115.02 3002 LAB REFRD30025796 PORPHOBILINOGEN QN .LC $ 11.34 $ 11.34 3002 LAB REFRD30021746 PORPHOBILINOGEN QN .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30021747 PORPHOBILINOGEN QN .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30025620 PORPHYRIN SCRN UR QL .LC $ 12.39 $ 12.39 3002 LAB REFRD30021283 PORPHYRINS UR QN&FX .Q3 $ 24.73 $ 24.73 3002 LAB REFRD30021740 PORPHYRINS UR QN&FX .Q3 $ 24.73 $ 24.73 3002 LAB REFRD30021270 PRIMIDONE .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30022505 PROLACTIN $ 143.74 $ 104.00 3002 LAB REFRD30023158 PROPOXYPHENE SCRN .Q3 $ 5.75 $ 5.75 3002 LAB REFRD30025566 PROPOXYPHENE SCRN .Q3 $ 4.80 $ 4.80 3002 LAB REFRD30020021 PROTEIN C ACTIVATED $ 71.89 $ 71.89 3002 LAB REFRD30021303 PROTEIN C ACTIVITY $ 34.40 $ 34.40 3002 LAB REFRD30023702 PROTEIN C ACTIVITY .LC $ 57.35 $ 57.35 3002 LAB REFRD30021300 PROTEIN C ACTIVITY .Q3 $ 38.24 $ 38.24 3002 LAB REFRD30021302 PROTEIN C AG $ 34.93 $ 34.93 3002 LAB REFRD30023704 PROTEIN C AG .LC $ 57.35 $ 57.35 3002 LAB REFRD30021301 PROTEIN C AG .Q3 $ 34.93 $ 34.93 3002 LAB REFRD30021980 PROTEIN ELECTRO CSF $ 25.76 $ 25.76 3002 LAB REFRD30023456 PROTEIN ELECTRO CSF .Q3 $ 17.91 $ 17.91 3002 LAB REFRD30021295 PROTEIN ELECTRO SER $ 14.77 $ 14.77 3002 LAB REFRD30023700 PROTEIN ELECTRO SER .LC $ 87.94 $ 87.94 3002 LAB REFRD30021293 PROTEIN ELECTRO SER .Q3 $ 6.00 $ 6.00 3002 LAB REFRD30021297 PROTEIN ELECTRO UR $ 19.48 $ 19.48 3002 LAB REFRD30023890 PROTEIN ELECTRO UR .LC $ 49.07 $ 49.07 3002 LAB REFRD30023914 PROTEIN ELECTRO UR .LC $ 4.15 $ 4.15 3002 LAB REFRD30021292 PROTEIN ELECTRO UR .Q3 $ 23.17 $ 23.17 3002 LAB REFRD30021294 PROTEIN ELECTRO UR .Q3 $ 23.17 $ 23.17 3002 LAB REFRD30025668 PROTEIN NEPHELOMET .LC $ 38.70 $ 38.70 3002 LAB REFRD30020357 PROTEIN NEPHELOMET .Q3 $ 19.55 $ 19.55 3002 LAB REFRD30021310 PROTEIN S ACTIVITY $ 50.66 $ 50.66 3002 LAB REFRD30021313 PROTEIN S ACTIVITY .Q3 $ 60.56 $ 60.56 3002 LAB REFRD30021311 PROTEIN S AG TOTAL $ 37.59 $ 37.59 3002 LAB REFRD

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DEPARTMENT CODE

30023736 PROTEIN S AG TOTAL .LC $ 57.35 $ 57.35 3002 LAB REFRD30021304 PROTEIN S AG TOTAL .Q3 $ 42.25 $ 42.25 3002 LAB REFRD30023738 PROTEIN S FREE .LC $ 57.35 $ 57.35 3002 LAB REFRD30023734 PROTEIN S FUNCTIONAL .LC $ 57.35 $ 57.35 3002 LAB REFRD30023698 PROTEIN TOTAL BLOOD .LC $ 87.94 $ 87.94 3002 LAB REFRD30021299 PROTEIN TOTAL BLOOD .Q3 $ 6.00 $ 6.00 3002 LAB REFRD30023454 PROTEIN TOTAL CSF .Q3 $ 17.91 $ 17.91 3002 LAB REFRD30023888 PROTEIN TOTAL FLD .LC $ 49.07 $ 49.07 3002 LAB REFRD30023916 PROTEIN UR QN RAN .LC $ 4.15 $ 4.15 3002 LAB REFRD30023996 PROTEIN UR QN RAN .Q3 $ 4.89 $ 4.89 3002 LAB REFRD30025306 PROTEIN WESTERN BLOT .LC $ 156.00 $ 156.00 3002 LAB REFRD30021171 PROTEIN WESTERN BLOT .Q3 $ 30.57 $ 30.57 3002 LAB REFRD30025432 PROTEINASE 3 AB .Q3 $ 16.62 $ 16.62 3002 LAB REFRD30025654 PROTEINASE 3 AB .Q3 $ 16.62 $ 16.62 3002 LAB REFRD30025466 PROTOPORPHYRIN RBC .LC $ 8.00 $ 8.00 3002 LAB REFRD30021862 PROTOPORPHYRIN RBC .Q3 $ 40.15 $ 40.15 3002 LAB REFRD30024220 PROTOPORPHYRIN ZINC .Q3 $ 51.75 $ 51.75 3002 LAB REFRD30021312 PSA FREE $ 31.87 $ 31.87 3002 LAB REFRD30023782 PSA FREE .LC $ 48.75 $ 48.75 3002 LAB REFRD30023904 PSA FREE .LC $ 9.48 $ 9.48 3002 LAB REFRD30021285 PSA FREE .Q3 $ 23.22 $ 23.22 3002 LAB REFRD30023780 PSA TOTAL DIAG .LC $ 48.75 $ 48.75 3002 LAB REFRD30021314 PSA TOTAL DIAG .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30024046 PSA TOTAL SCREEN .LC $ 10.00 $ 10.00 3002 LAB REFRD30024036 PTH C TERMINAL .LC $ 12.00 $ 12.00 3002 LAB REFRD30024076 PTH C TERMINAL .LC $ 8.00 $ 8.00 3002 LAB REFRD30021251 PTH C TERMINAL .Q3 $ 44.85 $ 44.85 3002 LAB REFRD30021253 PTH N-TERMINAL .Q3 $ 101.33 $ 101.33 3002 LAB REFRD30023970 PTT PLAS OR WB .Q3 $ 4.00 $ 4.00 3002 LAB REFRD30023906 PTT SUBSTITUTION EA .LC $ 47.38 $ 47.38 3002 LAB REFRD30023908 PTT SUBSTITUTION EA .LC $ 100.68 $ 100.68 3002 LAB REFRD30023910 PTT SUBSTITUTION EA .LC $ 78.18 $ 78.18 3002 LAB REFRD30023918 PTT SUBSTITUTION EA .LC $ 22.51 $ 22.51 3002 LAB REFRD

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DEPARTMENT CODE

30025328 PYRUVATE BLD .LC $ 9.00 $ 9.00 3002 LAB REFRD30021320 PYRUVATE BLD .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30021315 PYRUVATE BLD .Q3 $ 35.05 $ 35.05 3002 LAB REFRD30025940 PYRUVATE KINASE .LC $ 74.00 $ 74.00 3002 LAB REFRD30021330 Q FEVER AB $ 30.34 $ 30.34 3002 LAB REFRD30020730 QN DRG MISC $ 25.04 $ 25.04 3002 LAB REFRD30025338 QN DRG MISC $ 135.00 $ 135.00 3002 LAB REFRD30023450 RECEPT ASSAY TBII .Q3 $ 50.60 $ 50.60 3002 LAB REFRD30021350 RENIN $ 29.98 $ 29.98 3002 LAB REFRD30025878 RENIN .LC $ 129.75 $ 129.75 3002 LAB REFRD30021349 RENIN .Q3 $ 18.98 $ 18.98 3002 LAB REFRD30025418 RENIN .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30023124 RHEUMATOID FCTR QN .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023220 RHEUMATOID FCTR QN .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023659 RHEUMATOID FCTR QN .LC $ 10.35 $ 10.35 3002 LAB REFRD30025676 RHEUMATOID FCTR QN .LC $ 10.86 $ 10.86 3002 LAB REFRD30023911 RHEUMATOID FCTR QN .Q3 $ 8.63 $ 8.63 3002 LAB REFRD30021351 RIBOSOMAL P AB $ 46.84 $ 46.84 3002 LAB REFRD30021352 RIBOSOMAL P AB $ 43.72 $ 43.72 3002 LAB REFRD30023125 RIBOSOMAL P AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023232 RIBOSOMAL P AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023490 RIBOSOMAL P AB .Q3 $ 37.95 $ 37.95 3002 LAB REFRD30023677 RIBOSOMAL P AB .LC $ 32.20 $ 32.20 3002 LAB REFRD30023898 RMSF AB SCRN IGG .LC $ 33.17 $ 33.17 3002 LAB REFRD30023324 RMSF AB SCRN IGG .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023897 RMSF AB SCRN IGM .LC $ 33.17 $ 33.17 3002 LAB REFRD30023326 RMSF AB SCRN IGM .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023660 RO(SS A) AB .LC $ 12.11 $ 12.11 3002 LAB REFRD30023720 RO(SS A) AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023130 RO(SS A) AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023222 RO(SS A) AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023673 RO(SS A) AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30025460 RPR NON-TREPNML AB QL.LC $ 24.00 $ 24.00 3002 LAB REFRD

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DEPARTMENT CODE

30025456 RPR NON-TREPNML AB QL.Q3 $ 5.00 $ 5.00 3002 LAB REFRD30025448 RPR TTR NON-TREPNML A.LC $ 24.00 $ 24.00 3002 LAB REFRD30025464 RPR TTR NON-TREPNML A.LC $ 46.75 $ 46.75 3002 LAB REFRD30025458 RPR TTR NON-TREPNML A.Q3 $ 18.76 $ 18.76 3002 LAB REFRD30022210 RSV DFA $ 18.73 $ 18.73 3002 LAB REFRD30025472 RUBELLA AB .LC $ 5.50 $ 5.50 3002 LAB REFRD30023838 RUBELLA AB IGG .Q3 $ 18.39 $ 18.39 3002 LAB REFRD30021365 RUBELLA AB IGG .Q3 $ 9.78 $ 9.78 3002 LAB REFRD30021373 RUBELLA AB IGM .Q3 $ 9.78 $ 9.78 3002 LAB REFRD30021370 RUBEOLA AB $ 15.35 $ 15.35 3002 LAB REFRD30021372 RUBEOLA AB .Q3 $ 8.08 $ 8.08 3002 LAB REFRD30023408 RUBEOLA AB IGG .Q3 $ 9.29 $ 9.29 3002 LAB REFRD30025446 RUBEOLA AB IGG .LC $ 91.25 $ 91.25 3002 LAB REFRD30023410 RUBEOLA AB IGM .Q3 $ 13.23 $ 13.23 3002 LAB REFRD30023420 RUBEOLA AB IGM .Q3 $ 13.23 $ 13.23 3002 LAB REFRD30020621 RUSSELL VIPER VENOM D.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023972 RUSSELL VIPER VENOM D.Q3 $ 4.00 $ 4.00 3002 LAB REFRD30023920 RUSSELL VIPER VENOM DI.LC $ 22.51 $ 22.51 3002 LAB REFRD30025530 SACCHAROMYC CEREVISIA.LC $ 70.00 $ 70.00 3002 LAB REFRD30025726 SALICYLATE SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD30023724 SCL 70 AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023136 SCL 70 AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023230 SCL 70 AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023671 SCL 70 AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30025258 SCL 70 AB .LC $ 18.00 $ 18.00 3002 LAB REFRD30025690 SCL 70 AB .LC $ 10.88 $ 10.88 3002 LAB REFRD30020220 SCLERODERMA AB .Q3 $ 20.70 $ 20.70 3002 LAB REFRD30021390 SELENIUM $ 37.92 $ 37.92 3002 LAB REFRD30021400 SELENIUM $ 37.92 $ 37.92 3002 LAB REFRD30021750 SELENIUM $ 43.59 $ 43.59 3002 LAB REFRD30025270 SELENIUM .LC $ 35.00 $ 35.00 3002 LAB REFRD30025340 SELENIUM .LC $ 35.00 $ 35.00 3002 LAB REFRD30021391 SELENIUM .Q3 $ 29.33 $ 29.33 3002 LAB REFRD

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DEPARTMENT CODE

30021401 SELENIUM .Q3 $ 52.13 $ 52.13 3002 LAB REFRD30023258 SEROTONIN BLD .Q3 $ 57.50 $ 57.50 3002 LAB REFRD30025300 SEROTONIN BLD .LC $ 17.75 $ 17.75 3002 LAB REFRD30021410 SEROTONIN BLD .Q3 $ 56.35 $ 56.35 3002 LAB REFRD30025410 SEROTONIN RELEASE ASS.NI $ 199.07 $ 199.07 3002 LAB REFRD30024086 SEX HORMONE BIND GLOB.LC $ 19.35 $ 19.35 3002 LAB REFRD30021755 SHIGA LIKE TOXIN EIA .Q3 $ 50.98 $ 50.98 3002 LAB REFRD30023572 SICKLE CL SCRN .LC $ 18.00 $ 18.00 3002 LAB REFRD30021355 SIROLIMUS $ 175.58 $ 175.58 3002 LAB REFRD30024052 SIROLIMUS .LC $ 46.00 $ 46.00 3002 LAB REFRD30021341 SIROLIMUS .Q3 $ 63.25 $ 63.25 3002 LAB REFRD30025688 SJOGRENS AB .LC $ 10.86 $ 10.86 3002 LAB REFRD30021428 SJOGRENS AB .Q3 $ 26.45 $ 26.45 3002 LAB REFRD30021475 SKELETAL MUSCLE AB TT.Q3 $ 19.55 $ 19.55 3002 LAB REFRD30023740 SMITH AB .LC $ 10.83 $ 10.83 3002 LAB REFRD30023126 SMITH AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023663 SMITH AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30025686 SMITH AB .LC $ 10.86 $ 10.86 3002 LAB REFRD30020230 SMOOTH MUSCLE AB SCRN $ 17.99 $ 17.99 3002 LAB REFRD30023640 SMOOTH MUSCLE AB SCRN .LC $ 191.18 $ 191.18 3002 LAB REFRD30023238 SMOOTH MUSCLE AB SCRN .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30020231 SMOOTH MUSCLE AB SCRN.Q3 $ 14.95 $ 14.95 3002 LAB REFRD30025870 SMOOTH MUSCLE AB TTR .Q3 $ 11.50 $ 11.50 3002 LAB REFRD30020939 SMR CMV INCLUSION $ 38.18 $ 38.18 3002 LAB REFRD30025698 SMR INCL BODIES PARAS.LC $ 14.00 $ 14.00 3002 LAB REFRD30020585 SMR INCL BODIES PARAS.Q3 $ 34.50 $ 34.50 3002 LAB REFRD30023065 SMR INCL BODIES PARAS.Q3 $ 39.68 $ 39.68 3002 LAB REFRD30025882 SOL TRANSFERRIN RECEP.LC $ 42.00 $ 42.00 3002 LAB REFRD30021582 SOL TRANSFERRIN RECEP.Q3 $ 63.25 $ 63.25 3002 LAB REFRD30020957 SOMATOMEDIN C .Q3 $ 28.75 $ 28.75 3002 LAB REFRD30025700 SPEC CONCENTRATION .LC $ 14.00 $ 14.00 3002 LAB REFRD30021132 SPEC STAIN GRP II INT.Q3 $ 40.78 $ 40.78 3002 LAB REFRD30025358 SPECTROPH ADENO DEAMI.LC $ 115.00 $ 115.00 3002 LAB REFRD

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DEPARTMENT CODE

30025618 SPECTROPHOTOMETRY .LC $ 38.00 $ 38.00 3002 LAB REFRD30021745 SPECTROPHOTOMETRY .Q3 $ 44.85 $ 44.85 3002 LAB REFRD30021460 SPERM AB TEST $ 42.38 $ 42.38 3002 LAB REFRD30023915 SPERM AB TEST .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30023917 SPERM AB TEST .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30024066 SPERM ANTIBODY IGA .LC $ 17.33 $ 17.33 3002 LAB REFRD30024068 SPERM ANTIBODY IGG .LC $ 17.33 $ 17.33 3002 LAB REFRD30024070 SPERM ANTIBODY IGM .LC $ 17.34 $ 17.34 3002 LAB REFRD30023376 STREP PNEUM AB 1 SEROT.Q3 $ 6.22 $ 6.22 3002 LAB REFRD30021452 STREP PNEUM AB 1 SEROTYPE $ 66.08 $ 66.08 3002 LAB REFRD30025888 STRIATED MUSCLE AB SC.LC $ 12.00 $ 12.00 3002 LAB REFRD30023244 STRIATED MUSCLE AB SCR.Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023436 STRIATED MUSCLE AB SCR.Q3 $ 31.91 $ 31.91 3002 LAB REFRD30025350 STRONGYLOIDES AB ELIS.LC $ 40.00 $ 40.00 3002 LAB REFRD30020226 SULFAMETHOXAZOLE .Q3 $ 33.78 $ 33.78 3002 LAB REFRD30023354 T LYMPH CD4 (HELPER) C.Q3 $ 11.83 $ 11.83 3002 LAB REFRD30025584 T LYMPH CD4/8 CNT&RAT.LC $ 25.00 $ 25.00 3002 LAB REFRD30025752 T LYMPH CD4/8 CNT&RAT.LC $ 139.00 $ 139.00 3002 LAB REFRD30025834 T LYMPH CD4/8 CNT&RAT.LC $ 145.83 $ 145.83 3002 LAB REFRD30023362 T LYMPH CD4/8 CNT&RATI.Q3 $ 24.50 $ 24.50 3002 LAB REFRD30025582 T LYMPH TOT CNT .LC $ 25.00 $ 25.00 3002 LAB REFRD30025750 T LYMPH TOT CNT .LC $ 139.00 $ 139.00 3002 LAB REFRD30025832 T LYMPH TOT CNT .LC $ 145.83 $ 145.83 3002 LAB REFRD30023556 T3 FREE .LC $ 10.71 $ 10.71 3002 LAB REFRD30021485 T3 FREE .Q3 $ 12.65 $ 12.65 3002 LAB REFRD30021491 T3 REVERSE $ 61.35 $ 61.35 3002 LAB REFRD30025794 T3 REVERSE .LC $ 25.00 $ 25.00 3002 LAB REFRD30021490 T3 REVERSE .Q3 $ 33.35 $ 33.35 3002 LAB REFRD30021480 T3 TOTAL $ 18.56 $ 18.56 3002 LAB REFRD30021500 TESTOSTERONE FREE $ 16.50 $ 16.50 3002 LAB REFRD30023562 TESTOSTERONE FREE .LC $ 22.28 $ 22.28 3002 LAB REFRD30023202 TESTOSTERONE FREE .Q3 $ 9.50 $ 9.50 3002 LAB REFRD30024082 TESTOSTERONE FREE .LC $ 19.35 $ 19.35 3002 LAB REFRD

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DEPARTMENT CODE

30021499 TESTOSTERONE FREE .Q3 $ 48.07 $ 48.07 3002 LAB REFRD30023560 TESTOSTERONE TOTAL .LC $ 22.28 $ 22.28 3002 LAB REFRD30023200 TESTOSTERONE TOTAL .Q3 $ 9.50 $ 9.50 3002 LAB REFRD30024084 TESTOSTERONE TOTAL .LC $ 19.35 $ 19.35 3002 LAB REFRD30021492 TETANUS AB .Q3 $ 23.00 $ 23.00 3002 LAB REFRD30020252 THALLIUM BLD .Q3 $ 69.46 $ 69.46 3002 LAB REFRD30025373 THIOCYANATE .LC $ 50.00 $ 50.00 3002 LAB REFRD30021520 THIOCYANATE .Q3 $ 33.06 $ 33.06 3002 LAB REFRD30024016 THIRD PARTY REFLAB BILL $ - $ - 3002 LAB REFRD30025788 THYR BINDING GLOB (TB.LC $ 12.25 $ 12.25 3002 LAB REFRD30022480 THYR BINDING GLOB (TB.Q3 $ 20.99 $ 20.99 3002 LAB REFRD30021522 THYR STIM IG $ 81.26 $ 81.26 3002 LAB REFRD30024048 THYR STIM IG .LC $ 52.00 $ 52.00 3002 LAB REFRD30023318 THYR STIM IG .Q3 $ 52.00 $ 52.00 3002 LAB REFRD30023642 THYROGLOBULIN .LC $ 8.28 $ 8.28 3002 LAB REFRD30021535 THYROGLOBULIN .Q3 $ 20.48 $ 20.48 3002 LAB REFRD30020250 THYROGLOBULIN AB $ 13.58 $ 13.58 3002 LAB REFRD30023596 THYROGLOBULIN AB .LC $ 10.68 $ 10.68 3002 LAB REFRD30023644 THYROGLOBULIN AB .LC $ 8.28 $ 8.28 3002 LAB REFRD30023478 THYROGLOBULIN AB .Q3 $ 10.20 $ 10.20 3002 LAB REFRD30023667 THYROGLOBULIN AB .LC $ 10.35 $ 10.35 3002 LAB REFRD30024030 THYROGLOBULIN AB .LC $ 8.40 $ 8.40 3002 LAB REFRD30020251 THYROGLOBULIN AB .Q3 $ 9.29 $ 9.29 3002 LAB REFRD30023622 THYROID PEROXIDASE AB .LC $ 9.56 $ 9.56 3002 LAB REFRD30023712 THYROID PEROXIDASE AB .LC $ 19.61 $ 19.61 3002 LAB REFRD30023134 THYROID PEROXIDASE AB .Q3 $ 25.78 $ 25.78 3002 LAB REFRD30023218 THYROID PEROXIDASE AB .Q3 $ 15.61 $ 15.61 3002 LAB REFRD30023480 THYROID PEROXIDASE AB .Q3 $ 10.20 $ 10.20 3002 LAB REFRD30023665 THYROID PEROXIDASE AB.LC $ 10.35 $ 10.35 3002 LAB REFRD30020190 THYROID PEROXIDASE AB.Q3 $ 19.84 $ 19.84 3002 LAB REFRD30020192 THYROID PEROXIDASE AB.Q3 $ 10.21 $ 10.21 3002 LAB REFRD30020473 TISSUE CULT BM/BLD .Q3 $ 365.99 $ 365.99 3002 LAB REFRD30023818 TISSUE CULT LYMPH .LC $ 64.32 $ 64.32 3002 LAB REFRD

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DEPARTMENT CODE

30023862 TISSUE CULT LYMPH .LC $ 274.25 $ 274.25 3002 LAB REFRD30023344 TISSUE CULT LYMPH .Q3 $ 161.00 $ 161.00 3002 LAB REFRD30023701 TISSUE CULT LYMPH .Q3 $ 121.13 $ 121.13 3002 LAB REFRD30023990 TISSUE CULT LYMPH .Q3 $ 128.16 $ 128.16 3002 LAB REFRD30025744 TISSUE CULT LYMPH .Q3 $ 123.79 $ 123.79 3002 LAB REFRD30025402 TISSUE CULT SKIN/SOLI.Q3 $ 187.50 $ 187.50 3002 LAB REFRD30025348 TOXOPLAS AB .LC $ 32.00 $ 32.00 3002 LAB REFRD30025474 TOXOPLAS AB .LC $ 5.50 $ 5.50 3002 LAB REFRD30023836 TOXOPLAS AB IGG .Q3 $ 18.39 $ 18.39 3002 LAB REFRD30025950 TOXOPLAS AB IGG .LC $ 12.18 $ 12.18 3002 LAB REFRD30025952 TOXOPLAS AB IGM .LC $ 12.18 $ 12.18 3002 LAB REFRD30021541 TOXOPLAS AB IGM .Q3 $ 20.13 $ 20.13 3002 LAB REFRD30025728 TRICYCLIC SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD30023298 TRIGLYCERIDE .Q3 $ 9.59 $ 9.59 3002 LAB REFRD30025658 TRIGLYCERIDE .LC $ 86.50 $ 86.50 3002 LAB REFRD30025780 TRIGLYCERIDE .Q3 $ 16.00 $ 16.00 3002 LAB REFRD30025354 TRYPTASE .LC $ 54.00 $ 54.00 3002 LAB REFRD30021526 TRYPTASE .Q3 $ 56.35 $ 56.35 3002 LAB REFRD30021521 TSH $ 16.45 $ 16.45 3002 LAB REFRD30023083 TSH $ 14.50 $ 14.50 3002 LAB REFRD30021523 TSH .Q3 $ 13.66 $ 13.66 3002 LAB REFRD30023902 TYPHUS FEVER AB SC IGG.LC $ 33.17 $ 33.17 3002 LAB REFRD30023328 TYPHUS FEVER AB SC IGG.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023900 TYPHUS FEVER AB SC IGM.LC $ 33.17 $ 33.17 3002 LAB REFRD30023330 TYPHUS FEVER AB SC IGM.Q3 $ 17.25 $ 17.25 3002 LAB REFRD30021571 UREAPLASMA CULTURE .Q3 $ 35.68 $ 35.68 3002 LAB REFRD30023868 UREAPLSMA CULTURE .LC $ 25.79 $ 25.79 3002 LAB REFRD30023856 VASOACT INTEST PEPT (V.LC $ 55.76 $ 55.76 3002 LAB REFRD30021790 VASOACT INTEST PEPT .Q3 $ 56.35 $ 56.35 3002 LAB REFRD30025454 VDRL CSF NON-TREPML A.LC $ 52.00 $ 52.00 3002 LAB REFRD30025434 VDRL CSF NON-TREPML A.Q3 $ 6.00 $ 6.00 3002 LAB REFRD30023592 VIRUS AB NOT SPEC .LC $ 34.48 $ 34.48 3002 LAB REFRD30020941 VIRUS AB NOT SPEC .Q3 $ 28.75 $ 28.75 3002 LAB REFRD

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DEPARTMENT CODE

30022135 VIRUS AB NOT SPEC .Q3 $ 35.54 $ 35.54 3002 LAB REFRD30023946 VIRUS AB NOT SPEC .Q3 $ 68.68 $ 68.68 3002 LAB REFRD30025936 VIRUS CULT SHELL VIAL.LC $ 32.00 $ 32.00 3002 LAB REFRD30021514 VIRUS CULT SHELL VIAL.Q3 $ 24.15 $ 24.15 3002 LAB REFRD30022880 VIRUS CULT SHELL VIAL.Q3 $ 27.28 $ 27.28 3002 LAB REFRD30025332 VISCOSITY .LC $ 12.13 $ 12.13 3002 LAB REFRD30021762 VISCOSITY .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30022080 VITAMIN A $ 36.97 $ 36.97 3002 LAB REFRD30023618 VITAMIN A .LC $ 14.97 $ 14.97 3002 LAB REFRD30022081 VITAMIN A .Q3 $ 18.14 $ 18.14 3002 LAB REFRD30021511 VITAMIN B1 (THIAMINE) $ 32.00 $ 32.00 3002 LAB REFRD30021513 VITAMIN B1 (THIAMINE) $ 71.76 $ 71.76 3002 LAB REFRD30023750 VITAMIN B1 (THIAMINE) .LC $ 20.71 $ 20.71 3002 LAB REFRD30021510 VITAMIN B1 (THIAMINE).Q3 $ 20.00 $ 20.00 3002 LAB REFRD30022320 VITAMIN B12 BINDING CAP $ 89.54 $ 89.54 3002 LAB REFRD30022075 VITAMIN B6 $ 65.01 $ 65.01 3002 LAB REFRD30023616 VITAMIN B6 .LC $ 31.87 $ 31.87 3002 LAB REFRD30021512 VITAMIN B6 .Q3 $ 18.00 $ 18.00 3002 LAB REFRD30021831 VITAMIN D (125 DI HYD.Q3 $ 40.25 $ 40.25 3002 LAB REFRD30025848 VITAMIN D (125 DI HYD.Q3 $ 35.00 $ 35.00 3002 LAB REFRD30023654 VITAMIN D (125 DI HYDR.LC $ 30.58 $ 30.58 3002 LAB REFRD30021830 VITAMIN D (125 DI HYDROX) $ 60.54 $ 60.54 3002 LAB REFRD30023670 VITAMIN D 25HYDROXY .LC $ 26.13 $ 26.13 3002 LAB REFRD30021840 VITAMIN D 25HYDROXY .Q3 $ 23.22 $ 23.22 3002 LAB REFRD30022070 VITAMIN E $ 32.22 $ 32.22 3002 LAB REFRD30025488 VITAMIN E .LC $ 9.75 $ 9.75 3002 LAB REFRD30022071 VITAMIN E .Q3 $ 18.11 $ 18.11 3002 LAB REFRD30021763 VMA UR $ 24.85 $ 24.85 3002 LAB REFRD30025500 VMA UR .LC $ 7.62 $ 7.62 3002 LAB REFRD30021760 VMA UR .Q3 $ 15.81 $ 15.81 3002 LAB REFRD30021761 VMA UR .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30025644 VMA UR 24HR .LC $ 15.80 $ 15.80 3002 LAB REFRD30025730 VOLATILES SCRN .Q3 $ 5.25 $ 5.25 3002 LAB REFRD

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DEPARTMENT CODE

30025362 VZV AB .LC $ 25.00 $ 25.00 3002 LAB REFRD30023748 VZV AB IGG .LC $ 90.25 $ 90.25 3002 LAB REFRD30023460 VZV AB IGG .Q3 $ 27.09 $ 27.09 3002 LAB REFRD30023834 VZV AB IGM .LC $ 10.71 $ 10.71 3002 LAB REFRD30023252 VZV AB IGM .Q3 $ 11.88 $ 11.88 3002 LAB REFRD30021842 VZV AB IGM .Q3 $ 14.38 $ 14.38 3002 LAB REFRD30023430 VZV DFA .Q3 $ 26.45 $ 26.45 3002 LAB REFRD30025586 WBC CNT AUTO .LC $ 25.00 $ 25.00 3002 LAB REFRD30023040 XYLOSE 1HR BLD .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30023045 XYLOSE 2HR BLD .Q3 $ 17.25 $ 17.25 3002 LAB REFRD30022033 XYLOSE 5HR UR .Q3 $ 32.20 $ 32.20 3002 LAB REFRD30025964 XYLOSE BLD FASTING .LC $ 8.56 $ 8.56 3002 LAB REFRD30021850 ZINC $ 13.37 $ 13.37 3002 LAB REFRD30021853 ZINC $ 13.82 $ 13.82 3002 LAB REFRD30021854 ZINC $ 27.49 $ 27.49 3002 LAB REFRD30023656 ZINC .LC $ 10.71 $ 10.71 3002 LAB REFRD30025694 ZINC .LC $ 26.00 $ 26.00 3002 LAB REFRD30021851 ZINC .Q3 $ 14.95 $ 14.95 3002 LAB REFRD30021855 ZINC .Q3 $ 13.80 $ 13.80 3002 LAB REFRD30025692 ZINC RBC .LC $ 26.00 $ 26.00 3002 LAB REFRD30021852 ZINC RBC .Q3 $ 32.27 $ 32.27 3002 LAB REFRD30021870 MISC CHEM TEST $ - $ - 3008 LAB REFRD 252900018 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5290 LABOR & DEL DHS52900118 ROOM OB/MATERNAL $ 4,315.00 $ 4,315.00 5290 LABOR & DEL DHS52900014 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5290 LABOR & DEL DHS52900114 ROOM OB/MATERNAL PVT $ 5,334.00 $ 5,334.00 5290 LABOR & DEL DHS52900039 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5290 LABOR & DEL DHS52900044 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5290 LABOR & DEL DHS52900139 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5290 LABOR & DEL DHS52900144 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5290 LABOR & DEL DHS41720000 LIVER ACQUISITION CADAV $ 138,966.00 $ 138,966.00 4172 LIVER ACQ41720010 LIVER ACQUISITION LIVE $ 138,966.00 $ 138,966.00 4172 LIVER ACQ51200024 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5120 LONG TERM DHS RESV

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DEPARTMENT CODE

51200124 ROOM SNF M/S DSNCT $ 3,582.00 $ 3,582.00 5120 LONG TERM DHS RESV30138130 GLUC PRENAT 50 GM SCRN $ 160.00 $ 50.00 3013 MOB LAB30138240 POTASSIUM $ 160.00 $ 20.00 3013 MOB LAB30138405 VENIPUNCTURE $ 73.00 $ 23.00 3013 MOB LAB30138410 VENIPUNCTURE $ 73.00 $ 23.00 3013 MOB LAB41329038 CON GAD-BASE MR 1ML IJ $ 5.80 $ 5.80 4132 MRI41329042 CON GADOXETATE DISDM 1 ML $ 27.60 $ 27.60 4132 MRI41329043 CON MULTIHANCE IJ EA ML $ 20.57 $ 20.57 4132 MRI41307163 MR ABD W CON $ 3,062.00 $ 3,062.00 4130 MRI41307160 MR ABD W/O CON $ 2,270.00 $ 2,270.00 4130 MRI41307164 MR ABD W-W/O CON $ 3,823.00 $ 3,823.00 4130 MRI41307068 MR BRAIN W STEM W CON $ 2,816.00 $ 2,816.00 4130 MRI41307015 MR BRAIN W STEM W/O CON $ 2,546.00 $ 2,546.00 4130 MRI41307016 MR BRAIN W STEM W-W/O CON $ 3,703.00 $ 3,703.00 4130 MRI41307065 MR BREAST BIL W-W/O CON $ 2,613.00 $ 2,613.00 4130 MRI41307060 MR BREAST UNI W-W/O CON $ 2,127.00 $ 2,127.00 4130 MRI41307175 MR CARD MRI MORPH WO CON $ 2,058.00 $ 2,058.00 4130 MRI41307178 MR CARD MRI MORPH W-W/O $ 3,035.00 $ 3,035.00 4130 MRI41307174 MR CARD MRI VEL FLW MAP $ 1,789.00 $ 1,789.00 4130 MRI41307074 MR CHEST W CON $ 3,126.00 $ 3,126.00 4130 MRI41307070 MR CHEST W/O CON $ 2,805.00 $ 2,805.00 4130 MRI41307073 MR CHEST W-W/O CON $ 4,315.00 $ 4,315.00 4130 MRI41301095 MR CONSULT FOREIGN FLM $ 67.00 $ 67.00 4130 MRI41307126 MR EXT LOW JNT W CON $ 2,658.00 $ 2,658.00 4130 MRI41307127 MR EXT LOW JNT W-W/O CON $ 3,627.00 $ 3,627.00 4130 MRI41307130 MR EXT LOW JT W/O CON $ 2,462.00 $ 2,462.00 4130 MRI41307119 MR EXT LOW NO JNT W CON $ 2,757.00 $ 2,757.00 4130 MRI41307118 MR EXT LOW W/O CON $ 2,520.00 $ 2,520.00 4130 MRI41307145 MR EXT LOW W-W/O CON $ 3,825.00 $ 3,825.00 4130 MRI41307112 MR EXT UPP JNT W CON $ 2,634.00 $ 2,634.00 4130 MRI41307125 MR EXT UPP JNT W/O CON $ 2,416.00 $ 2,416.00 4130 MRI41307113 MR EXT UPP JNT W-W/O CON $ 3,636.00 $ 3,636.00 4130 MRI41307129 MR EXT UPP NO JNT W/CON $ 2,790.00 $ 2,790.00 4130 MRI

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DEPARTMENT CODE

41307128 MR EXT UPP NO JNT W/O CON $ 2,570.00 $ 2,570.00 4130 MRI41307120 MR EXT UPP NO JNT W-W/O $ 3,826.00 $ 3,826.00 4130 MRI41301090 MR GUIDE NDL PLACE $ 1,916.00 $ 1,916.00 4130 MRI41307041 MR ORBIT FACE NEC W CON $ 2,755.00 $ 2,755.00 4130 MRI41307040 MR ORBIT FACE NEC W/O CON $ 2,505.00 $ 2,505.00 4130 MRI41307042 MR ORBIT FACE NEC W-W/O $ 3,787.00 $ 3,787.00 4130 MRI41307190 MR PELV W CON $ 2,790.00 $ 2,790.00 4130 MRI41307188 MR PELV W/O CON $ 2,540.00 $ 2,540.00 4130 MRI41307183 MR PELV W-W/O CON $ 3,819.00 $ 3,819.00 4130 MRI41307189 MR PELV W-W/O CON $ 3,819.00 $ 3,819.00 4130 MRI41307208 MR SPECTROSCOPY $ 2,002.00 $ 2,002.00 4130 MRI41307078 MR SPINE CERV W CON $ 2,820.00 $ 2,820.00 4130 MRI41307075 MR SPINE CERV W/O CON $ 2,274.00 $ 2,274.00 4130 MRI41307079 MR SPINE CERV W-W/O CON $ 3,664.00 $ 3,664.00 4130 MRI41307099 MR SPINE LUMB W CON $ 2,811.00 $ 2,811.00 4130 MRI41307098 MR SPINE LUMB W/O CON $ 2,324.00 $ 2,324.00 4130 MRI41307101 MR SPINE LUMB W-W/O $ 3,648.00 $ 3,648.00 4130 MRI41307088 MR SPINE THOR W CON $ 2,539.00 $ 2,539.00 4130 MRI41307085 MR SPINE THOR W/O CON $ 2,335.00 $ 2,335.00 4130 MRI41307091 MR SPINE THOR W-W/O $ 3,448.00 $ 3,448.00 4130 MRI41307162 MRA ABD W-W/O CON $ 1,855.00 $ 1,855.00 4130 MRI41307072 MRA CHEST W-W/O CON $ 1,842.00 $ 1,842.00 4130 MRI41307144 MRA EXT LOW W-W/O CON $ 2,293.00 $ 2,293.00 4130 MRI41307122 MRA EXT UPP W-W/O CON $ 2,818.00 $ 2,818.00 4130 MRI41307063 MRA HEAD W CON $ 2,717.00 $ 2,717.00 4130 MRI41307062 MRA HEAD W/O CON $ 2,731.00 $ 2,731.00 4130 MRI41307018 MRA HEAD W-W/O CON $ 4,393.00 $ 4,393.00 4130 MRI41307037 MRA NEC W CON $ 2,842.00 $ 2,842.00 4130 MRI41307036 MRA NEC W/O CON $ 2,723.00 $ 2,723.00 4130 MRI41307038 MRA NEC W-W/O CON $ 4,397.00 $ 4,397.00 4130 MRI41307193 MRA PELV W CON $ 3,514.00 $ 3,514.00 4130 MRI41307194 MRA PELV W/O CON $ 2,424.00 $ 2,424.00 4130 MRI41307192 MRA PELV W-W/O CON $ 2,495.00 $ 2,495.00 4130 MRI

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DEPARTMENT CODE

41307204 MRC BX BREAST VAC ASSIST $ 1,406.00 $ 1,406.00 4130 MRI41307200 MRC BX BREAST W IMAG $ 2,453.00 $ 2,453.00 4130 MRI41307206 MRC IMAG LOC CLIP W BX $ 795.00 $ 795.00 4130 MRI41307020 MRI OF TMJ(S) $ 2,237.00 $ 2,237.00 4130 MRI41354480 S STRL BIOPSY TRAY $ 43.00 $ 43.00 4135 MRI41354485 S STRL BREAST BX CLIP $ 41.00 $ 41.00 4135 MRI41354483 S STRL BREAST BX SET HAND $ 362.00 $ 362.00 4135 MRI41354482 S STRL ENDOREC PROST COIL $ 485.00 $ 485.00 4135 MRI41354484 S STRL LOCALIZ INTRO SET $ 207.00 $ 207.00 4135 MRI41329029 S STRL MRI BIOPSY NDL VAC $ 1,569.00 $ 1,569.00 4132 MRI41361099 S STRL MRI MISC SUP CHGE $ - $ - 4136 MRI41354971 S STRL PULSE OXI PROBE $ 95.00 $ 95.00 4135 MRI35221019 AEROSOL TX DEMO/EVAL $ 83.00 $ 83.00 3522 MUSC DYST CLINIC35261272 AEROSOL TX SUBSQ $ 39.00 $ 39.00 3526 MUSC DYST CLINIC35261262 ARTERIAL PUNCTURE $ 37.00 $ 37.00 3526 MUSC DYST CLINIC35261225 CHNG G TUBE WO IMAG/GD $ 480.00 $ 480.00 3526 MUSC DYST CLINIC35261255 EKG 12 LEAD TRACING $ 62.00 $ 62.00 3526 MUSC DYST CLINIC35215100 EMG 1 LIMB $ 97.00 $ 97.00 3521 MUSC DYST CLINIC35215110 EMG 2 LIMBS $ 524.00 $ 524.00 3521 MUSC DYST CLINIC35215120 EMG 3 LIMBS $ 359.00 $ 359.00 3521 MUSC DYST CLINIC35215130 EMG 4 LIMBS $ 579.00 $ 579.00 3521 MUSC DYST CLINIC35215159 EMG LIMITED $ 125.00 $ 125.00 3521 MUSC DYST CLINIC35215157 EVAL ABR COMP $ 545.00 $ 545.00 3521 MUSC DYST CLINIC35264375 FLOW VOLUME LOOP $ 89.00 $ 89.00 3526 MUSC DYST CLINIC35215162 H REFLX TEST GSTR/SOL UNI $ 56.00 $ 56.00 3521 MUSC DYST CLINIC35221050 HEALTH/BEHV INITIAL EA 15 $ 69.00 $ 69.00 3522 MUSC DYST CLINIC35221053 HLTH/BHV INT FAM/NO PT 15 $ 65.00 $ 65.00 3522 MUSC DYST CLINIC35221052 HLTH/BHV INT FAM/PT EA 15 $ 59.00 $ 59.00 3522 MUSC DYST CLINIC35221051 HLTH/BHV INTERV IND EA 15 $ 69.00 $ 69.00 3522 MUSC DYST CLINIC35261248 INJECTION IM/SQ EA $ - $ - 3526 MUSC DYST CLINIC35261270 IPPB DEMO/EVAL $ 83.00 $ 83.00 3526 MUSC DYST CLINIC35261246 LUMBAR PUNCTURE DX $ 158.00 $ 158.00 3526 MUSC DYST CLINIC35261276 MED NUTR TX COND CH EA15 $ 79.00 $ 79.00 3526 MUSC DYST CLINIC

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DEPARTMENT CODE

35261278 MED NUTR TX GP COND EA30 $ 79.00 $ 79.00 3526 MUSC DYST CLINIC35215166 NEURMSC JUNCTION TEST EA $ 157.00 $ 157.00 3521 MUSC DYST CLINIC35215140 NRV MOTOR CONDUCT STDY EA $ 47.00 $ 47.00 3521 MUSC DYST CLINIC35215150 NRV SNSRY CONDUCT STDY EA $ 37.00 $ 37.00 3521 MUSC DYST CLINIC35215161 NRV SNSRY CONDUCT STDY EA $ 37.00 $ 37.00 3521 MUSC DYST CLINIC35221005 OT EVAL 15 $ 56.00 $ 56.00 3522 MUSC DYST CLINIC35221022 OT RE-EVAL 15 $ 61.00 $ 61.00 3522 MUSC DYST CLINIC35231000 PSYC DX INTERVIEW $ 456.00 $ 456.00 3523 MUSC DYST CLINIC35231020 PSYC DX INTERVIEW $ 456.00 $ 456.00 3523 MUSC DYST CLINIC35231001 PSYC DX INTERVIEW INTERAC $ 327.00 $ 327.00 3523 MUSC DYST CLINIC35231010 PSYC EVAL RCRD/RPRT/TESTS $ 243.00 $ 243.00 3523 MUSC DYST CLINIC35231005 PSYC TX 20-30M OP $ 71.00 $ 71.00 3523 MUSC DYST CLINIC35231006 PSYC TX 45-50M OP $ 153.00 $ 153.00 3523 MUSC DYST CLINIC35231021 PSYC TX 45-50M OP $ 153.00 $ 153.00 3523 MUSC DYST CLINIC35231007 PSYC TX 75-80M OP $ 762.00 $ 762.00 3523 MUSC DYST CLINIC35221007 PT ADL TRAIN EA 15 $ 51.00 $ 51.00 3522 MUSC DYST CLINIC35221001 PT EVAL 15 $ 54.00 $ 54.00 3522 MUSC DYST CLINIC35221003 PT GAIT TRAIN EA 15 $ 54.00 $ 54.00 3522 MUSC DYST CLINIC35261274 PT ORT/PRO/ADL CK INIT 30 $ 122.00 $ 122.00 3526 MUSC DYST CLINIC35221002 PT THER EX EA 15 $ 58.00 $ 58.00 3522 MUSC DYST CLINIC35221021 PULSE OXIMETRY MULTIPLE $ 59.00 $ 59.00 3522 MUSC DYST CLINIC35221020 PULSE OXIMETRY SINGLE $ 23.00 $ 23.00 3522 MUSC DYST CLINIC35215155 S STRL DISPOSABLE NEEDLE $ - $ - 3521 MUSC DYST CLINIC35215165 SEP LOWER LIMBS BIL $ 838.00 $ 838.00 3521 MUSC DYST CLINIC35215164 SEP UPPER LIMBS BIL $ 833.00 $ 833.00 3521 MUSC DYST CLINIC35221030 SP EVAL FNX SWALL 15 $ 116.00 $ 116.00 3522 MUSC DYST CLINIC35221012 SP EVAL FNX SWALL 30 $ 138.00 $ 138.00 3522 MUSC DYST CLINIC35221031 SP EVAL FNX SWALL 45 $ 185.00 $ 185.00 3522 MUSC DYST CLINIC35221032 SP EVAL FNX SWALL 60 $ 224.00 $ 224.00 3522 MUSC DYST CLINIC35221008 SP EVAL SP/LNG/COM/AUD 15 $ 74.00 $ 74.00 3522 MUSC DYST CLINIC35221011 SP TX SP/LANG/COM GP 15 $ 35.00 $ 35.00 3522 MUSC DYST CLINIC35221009 SP TX SP/LANG/COM IND 15 $ 69.00 $ 69.00 3522 MUSC DYST CLINIC35221013 SP TX SWALL/ORAL FNX 15 $ 67.00 $ 67.00 3522 MUSC DYST CLINIC

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DEPARTMENT CODE

35261253 SPIROMETRY $ 145.00 $ 145.00 3526 MUSC DYST CLINIC35261280 SPIROMETRY PRE/POST BD $ 188.00 $ 188.00 3526 MUSC DYST CLINIC35261235 VENIPUNCTURE $ 7.00 $ 7.00 3526 MUSC DYST CLINIC35261263 VENIPUNCTURE $ 7.00 $ 7.00 3526 MUSC DYST CLINIC45100620 LEVEL 4 NEW PATIENT $ 306.00 $ 306.00 4510 NBIC FU CLINIC45101620 LEVEL 4 NEW PATIENT $ 306.00 $ 306.00 4510 NBIC FU CLINIC45101630 LEVEL 5 NEW PATIENT $ 328.00 $ 328.00 4510 NBIC FU CLINIC45109035 TM CONF W/O PT BY HC PRO $ 182.00 $ 182.00 4510 NBIC FU CLINIC53000019 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5300 NBICU DHS53000119 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5300 NBICU DHS53000047 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5300 NBICU DHS53000147 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5300 NBICU DHS53000040 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5300 NBICU DHS53000140 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5300 NBICU DHS53000016 NEWBORN LEVEL IV $ 10,136.00 $ 10,136.00 5300 NBICU DHS53000116 NEWBORN LEVEL IV $ 10,136.00 $ 10,136.00 5300 NBICU DHS45156000 CENTER COORDINATOR $ 151.99 $ 151.99 4515 NBICU FU CLINIC45112855 OT TEST DEV LTD $ 172.00 $ 172.00 4511 NBICU FU CLINIC45112851 OT TEST DEVELOP EXTENDED $ 249.00 $ 249.00 4511 NBICU FU CLINIC45159037 PROLONG SVC WO FF 1ST HR $ 87.00 $ 87.00 4515 NBICU FU CLINIC45112854 PT TEST DEV LTD $ 172.00 $ 172.00 4511 NBICU FU CLINIC45112850 PT TEST DEVELOP EXTENDED $ 249.00 $ 249.00 4511 NBICU FU CLINIC45154403 TEAM CONF W/PAT BY HC PRO $ 91.00 $ 91.00 4515 NBICU FU CLINIC45159036 TEAM CONF W/PAT BY HC PRO $ 91.00 $ 91.00 4515 NBICU FU CLINIC45112853 TEST DEV LTD $ 375.00 $ 375.00 4511 NBICU FU CLINIC45112849 TEST DEVELOPMNTL EXTENDED $ 249.00 $ 249.00 4511 NBICU FU CLINIC28210291 AD EVAL ABR $ 1,145.00 $ 1,145.00 2821 NEUROPHYSIOLOGY28210275 AD EVAL OAE $ 331.00 $ 331.00 2821 NEUROPHYSIOLOGY28210270 AD EVAL PEDS >3 VRA $ 1,480.00 $ 1,480.00 2821 NEUROPHYSIOLOGY28210290 AUD EVOKE POTENT LTD $ 1,487.00 $ 1,487.00 2821 NEUROPHYSIOLOGY28210210 EEG AWAKE AND ASLEEP $ 1,390.00 $ 1,390.00 2821 NEUROPHYSIOLOGY28210216 EEG AWAKE AND ASLEEP $ 1,390.00 $ 1,390.00 2821 NEUROPHYSIOLOGY28210225 EEG AWAKE AND ASLEEP $ 1,390.00 $ 1,390.00 2821 NEUROPHYSIOLOGY

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DEPARTMENT CODE

28210220 EEG AWAKE AND DROWSY $ 1,018.00 $ 1,018.00 2821 NEUROPHYSIOLOGY28210234 EEG CBL RCRD/INTERP/24HR $ 3,172.00 $ 3,172.00 2821 NEUROPHYSIOLOGY28210315 EEG CBL RCRD/INTERP/24HR $ 3,172.00 $ 3,172.00 2821 NEUROPHYSIOLOGY28210250 EEG CEREBRAL DEATH EVAL $ 1,251.00 $ 1,251.00 2821 NEUROPHYSIOLOGY28210200 EEG DURING SURGERY $ 1,587.00 $ 1,587.00 2821 NEUROPHYSIOLOGY28210305 EEG GT 1 HR $ 1,426.00 $ 1,426.00 2821 NEUROPHYSIOLOGY28210235 EEG INSERT SPHEN ELECTR $ 270.00 $ 270.00 2821 NEUROPHYSIOLOGY28210240 EEG INSERT SPHEN ELECTR $ 270.00 $ 270.00 2821 NEUROPHYSIOLOGY28210232 EEG RCRD/INTERP/24HR $ 3,511.00 $ 3,511.00 2821 NEUROPHYSIOLOGY28210215 EEG SLEEP $ 1,819.00 $ 1,819.00 2821 NEUROPHYSIOLOGY28210230 EEG SLEEP $ 1,819.00 $ 1,819.00 2821 NEUROPHYSIOLOGY28210310 EEG UP TO 1HR $ 385.00 $ 385.00 2821 NEUROPHYSIOLOGY28210300 EEG W/VIDEO RCRD/24HR $ 6,111.00 $ 6,111.00 2821 NEUROPHYSIOLOGY28210304 EEG W/VIDEO RCRD/24HR $ 6,111.00 $ 6,111.00 2821 NEUROPHYSIOLOGY28210265 ELCTRDE STIM BRAIN 1ST HR $ 1,596.00 $ 1,596.00 2821 NEUROPHYSIOLOGY28210266 ELCTRDE STIM BRAIN ADD HR $ 2,169.00 $ 2,169.00 2821 NEUROPHYSIOLOGY28210205 ELECTROCORTICOGRAM SURG $ 1,944.00 $ 1,944.00 2821 NEUROPHYSIOLOGY28210268 NRV TEST IOP EA HOUR $ 3,851.00 $ 3,851.00 2821 NEUROPHYSIOLOGY28210285 SEP LOWER LIMBS BIL $ 1,760.00 $ 1,760.00 2821 NEUROPHYSIOLOGY28210283 SEP TRUNK/HEAD $ 1,659.00 $ 1,659.00 2821 NEUROPHYSIOLOGY28210280 SEP UPPER LIMBS BIL $ 1,749.00 $ 1,749.00 2821 NEUROPHYSIOLOGY28210255 VISUAL EVOKED POTENT TEST $ 1,124.00 $ 1,124.00 2821 NEUROPHYSIOLOGY28340070 NI DIAL ACCES $ 1,357.00 $ 1,357.00 2834 NONINV VAS28340030 NI DUPLEX EXT LOW BIL $ 2,126.00 $ 2,126.00 2834 NONINV VAS28340045 NI DUPLEX EXT LOW UNI $ 1,346.00 $ 1,346.00 2834 NONINV VAS28340065 NI DUPLEX EXT UPP BIL $ 1,655.00 $ 1,655.00 2834 NONINV VAS28340050 NI DUPLEX EXT UPP UNI $ 1,108.00 $ 1,108.00 2834 NONINV VAS28340020 NI DUPLEX EXT VEINS BIL $ 1,655.00 $ 1,655.00 2834 NONINV VAS28340021 NI DUPLEX EXT VEINS UNI $ 1,097.00 $ 1,097.00 2834 NONINV VAS28340010 NI DUPLEX EXTRACRAN BIL $ 1,655.00 $ 1,655.00 2834 NONINV VAS28340011 NI DUPLEX EXTRACRAN UNI $ 1,088.00 $ 1,088.00 2834 NONINV VAS28340035 NI EXT ART 1 LVL BIL $ 825.00 $ 825.00 2834 NONINV VAS28340055 NI EXT ART MULTI BIL $ 1,248.00 $ 1,248.00 2834 NONINV VAS

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DEPARTMENT CODE

28340040 NI EXT LOW W STRES $ 1,557.00 $ 1,557.00 2834 NONINV VAS28340005 NI INTRACRAN CMPL $ 1,927.00 $ 1,927.00 2834 NONINV VAS28340006 NI INTRACRAN LTD $ 1,315.00 $ 1,315.00 2834 NONINV VAS28340060 NI PENILE VESSELS CMPL $ 970.00 $ 970.00 2834 NONINV VAS28340126 NI US VASC ACCESS ADD ON $ 154.00 $ 154.00 2834 NONINV VAS28340075 US GUIDE ART PSEUDOANEUR $ 2,161.00 $ 2,161.00 2834 NONINV VAS41630220 NM ABSCSS LOC LTD $ 1,783.00 $ 1,783.00 4163 NUCL MED41630215 NM ABSCSS LOC WB $ 3,470.00 $ 3,470.00 4163 NUCL MED41630175 NM BONE MARROW LTD $ 1,617.00 $ 1,617.00 4163 NUCL MED41630170 NM BONE MARROW WB $ 2,500.00 $ 2,500.00 4163 NUCL MED41630010 NM BONE SCAN MULTI AREAS $ 2,216.00 $ 2,216.00 4163 NUCL MED41630021 NM BONE SCAN W SPECT $ 2,447.00 $ 2,447.00 4163 NUCL MED41630005 NM BONE SCAN WB $ 2,478.00 $ 2,478.00 4163 NUCL MED41630011 NM BONE THREE PHASE $ 3,365.00 $ 3,365.00 4163 NUCL MED41630145 NM BOWEL (MECKELS) $ 3,129.00 $ 3,129.00 4163 NUCL MED41630135 NM BRAIN CISTERNOGRAM $ 3,391.00 $ 3,391.00 4163 NUCL MED41630130 NM BRAIN CSF SHUNT EVAL $ 3,173.00 $ 3,173.00 4163 NUCL MED41630030 NM BRAIN FLOW ONLY $ 1,897.00 $ 1,897.00 4163 NUCL MED41630025 NM BRAIN GT3 STAT V W/FLW $ 3,208.00 $ 3,208.00 4163 NUCL MED41630035 NM BRAIN GT3 STATIC VW $ 1,980.00 $ 1,980.00 4163 NUCL MED41630040 NM BRAIN W TOMO SPECT $ 3,610.00 $ 3,610.00 4163 NUCL MED41630045 NM CARDIAC SHUNT EVAL $ 1,923.00 $ 1,923.00 4163 NUCL MED41630136 NM CSF FLOW W SPECT $ 2,949.00 $ 2,949.00 4163 NUCL MED41630125 NM CSF LEAKAGE DETECT $ 3,339.00 $ 3,339.00 4163 NUCL MED41630295 NM CYSTOGRAM VOIDING $ 2,115.00 $ 2,115.00 4163 NUCL MED41630372 NM ESOPH MOTILITY $ 1,675.00 $ 1,675.00 4163 NUCL MED41630165 NM GASTRIC EMPTYING $ 2,814.00 $ 2,814.00 4163 NUCL MED41630160 NM GASTROESOPH REFLUX $ 2,434.00 $ 2,434.00 4163 NUCL MED41630155 NM GI BLEEDING SCAN $ 3,374.00 $ 3,374.00 4163 NUCL MED41630055 NM HEART 1ST PASS ADD ON $ 1,001.00 $ 1,001.00 4163 NUCL MED41630061 NM HEART BLOOD POOL SPECT $ 2,762.00 $ 2,762.00 4163 NUCL MED41630065 NM HEART GATED MULTIVIEW $ 3,457.00 $ 3,457.00 4163 NUCL MED41630070 NM HEART GATED SNGL $ 2,574.00 $ 2,574.00 4163 NUCL MED

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DEPARTMENT CODE

41630080 NM HEART MI PLANAR $ 1,639.00 $ 1,639.00 4163 NUCL MED41630081 NM HEART MI W SPECT $ 2,556.00 $ 2,556.00 4163 NUCL MED41630095 NM HEART MP MULTI PLANAR $ 1,883.00 $ 1,883.00 4163 NUCL MED41630110 NM HEART MP MULTI W SPECT $ 6,299.00 $ 6,299.00 4163 NUCL MED41630085 NM HEART MP SNGL PLANAR $ 1,805.00 $ 1,805.00 4163 NUCL MED41630122 NM HEART MP SNGL W SPEC $ 3,985.00 $ 3,985.00 4163 NUCL MED41630245 NM HEPATOBILIARY DUCTAL $ 3,199.00 $ 3,199.00 4163 NUCL MED41630221 NM INFLAM LOCAL W SPECT $ 3,583.00 $ 3,583.00 4163 NUCL MED41646060 NM INTRSTIT RADIAT CMPLX $ 4,676.00 $ 4,676.00 4164 NUCL MED41630277 NM K FLOW/FUNCT MULTIPLE $ 3,452.00 $ 3,452.00 4163 NUCL MED41630276 NM K FLOW/FUNCT W/DRUG $ 1,682.00 $ 1,682.00 4163 NUCL MED41630290 NM K FLOW/FUNCT W/O DRG $ 2,321.00 $ 2,321.00 4163 NUCL MED41630270 NM KIDNEY IMAGING MORPHOL $ 1,774.00 $ 1,774.00 4163 NUCL MED41630281 NM KIDNEY IMAGING SPECT $ 2,395.00 $ 2,395.00 4163 NUCL MED41630263 NM KIDNEY IMAGING W/FLOW $ 2,150.00 $ 2,150.00 4163 NUCL MED41630235 NM LIVER SPLEEN STATIC $ 1,910.00 $ 1,910.00 4163 NUCL MED41630232 NM LIVER SPLEEN W FLOW $ 1,333.00 $ 1,333.00 4163 NUCL MED41630240 NM LIVER W SPECT $ 2,395.00 $ 2,395.00 4163 NUCL MED41630241 NM LIVER W VASCULAR FLOW $ 2,076.00 $ 2,076.00 4163 NUCL MED41630255 NM LUNG PERF $ 2,071.00 $ 2,071.00 4163 NUCL MED41630251 NM LUNG QUAN DIFF FNCTN $ 3,675.00 $ 3,675.00 4163 NUCL MED41630262 NM LUNG VENT MULTI $ 2,098.00 $ 2,098.00 4163 NUCL MED41630250 NM LUNG VENT W GAS $ 1,967.00 $ 1,967.00 4163 NUCL MED41630355 NM LYMPHATIC PATHWAY $ 3,330.00 $ 3,330.00 4163 NUCL MED41643051 NM MONOCLONAL AB IV INFSN $ 1,564.00 $ 1,564.00 4164 NUCL MED41660500 NM NM MOBILE $ - $ - 4166 NUCL MED41630325 NM PARATHYROID $ 1,643.00 $ 1,643.00 4163 NUCL MED41630180 NM PLASMA VOLUME MULTI $ 1,225.00 $ 1,225.00 4163 NUCL MED41630205 NM PLATELET SURVIVAL STDY $ 2,243.00 $ 2,243.00 4163 NUCL MED41630195 NM RED CELL SURVIVAL $ 2,733.00 $ 2,733.00 4163 NUCL MED41630282 NM RENL FNCTN NONIMAG $ 970.00 $ 970.00 4163 NUCL MED41630370 NM SALIVARY GLND W SER $ 1,294.00 $ 1,294.00 4163 NUCL MED41630375 NM TESTICULR IMGNG W FLOW $ 2,045.00 $ 2,045.00 4163 NUCL MED

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DEPARTMENT CODE

41630335 NM THYROID IMAG ONLY $ 1,578.00 $ 1,578.00 4163 NUCL MED41630330 NM THYROID IMAG UPT MULTI $ 1,298.00 $ 1,298.00 4163 NUCL MED41630342 NM THYROID METS UPT $ 769.00 $ 769.00 4163 NUCL MED41630340 NM THYROID METS WB $ 3,225.00 $ 3,225.00 4163 NUCL MED41630320 NM THYROID UPTAKE MULTI $ 905.00 $ 905.00 4163 NUCL MED41630350 NM TUMOR LOC LTD W RP $ 1,805.00 $ 1,805.00 4163 NUCL MED41630351 NM TUMOR LOC SPECT W RP $ 3,575.00 $ 3,575.00 4163 NUCL MED41630346 NM TUMOR LOC WB SNGL DAY $ 3,308.00 $ 3,308.00 4163 NUCL MED41643040 NM TX INTRACAVITY $ 1,154.00 $ 1,154.00 4164 NUCL MED41643060 NM TX RADIOPHARM IV ADM $ 1,141.00 $ 1,141.00 4164 NUCL MED41643050 NM TX RADIOPHARM ORAL ADM $ 979.00 $ 979.00 4164 NUCL MED41630143 NM UREA TEST C14 ACQ $ 140.00 $ 140.00 4163 NUCL MED41630365 NM VASCULAR FLOW NCARDIO $ 1,687.00 $ 1,687.00 4163 NUCL MED41630315 NM VEN THROMBOSIS ACUTE $ 2,392.00 $ 2,392.00 4163 NUCL MED41630310 NM VENOGRAM BIL $ 2,230.00 $ 2,230.00 4163 NUCL MED41630260 NM VENT/PER REBRTH/WASHOU $ 3,474.00 $ 3,474.00 4163 NUCL MED41630147 NM VP SHUNT PATENCY $ 2,390.00 $ 2,390.00 4163 NUCL MED41630185 NM WB VOL DETERMINATION $ 1,276.00 $ 1,276.00 4163 NUCL MED41630349 NM WHOLE BODY 2+ DAYS $ 6,105.00 $ 6,105.00 4163 NUCL MED41630124 PS HEART METBLC EVAL $ 1,657.00 $ 1,657.00 4163 NUCL MED41630406 PS/CT SKULL-THGH INITL $ 7,083.00 $ 7,083.00 4163 NUCL MED41630407 PS/CT SKULL-THGH SUBSQ $ 7,083.00 $ 7,083.00 4163 NUCL MED41630411 PS/CT WHOLE BODY INITL $ 7,252.00 $ 7,252.00 4163 NUCL MED41630412 PS/CT WHOLE BODY SUBSQ $ 7,252.00 $ 7,252.00 4163 NUCL MED41656120 RP C14 UREA/TEST $ 1,039.00 $ 1,039.00 4165 NUCL MED41656121 RP CO-57/58 DX 1UCI $ 786.00 $ 786.00 4165 NUCL MED41656140 RP CR51 CHROMTE DX 250UCI $ 638.00 $ 638.00 4165 NUCL MED41656085 RP DX I-131 CAP PER MCI $ 12.00 $ 12.00 4165 NUCL MED41656115 RP F-18 FDG DX DS 45MCI $ 1,588.00 $ 1,588.00 4165 NUCL MED41656065 RP GALLIUM GA-67 DX 1 MCI $ 74.00 $ 74.00 4165 NUCL MED41656084 RP I123 DX 100UCI TO 999 $ 77.00 $ 77.00 4165 NUCL MED41656190 RP I123 MIBG $ 6,041.00 $ 6,041.00 4165 NUCL MED41656180 RP I125 IOTHLMAT DX 10UCI $ 189.00 $ 189.00 4165 NUCL MED

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DEPARTMENT CODE

41656130 RP I125/10UCI $ 985.00 $ 985.00 4165 NUCL MED41656076 RP I131 MIBG DX 0.5MCI $ 1,780.00 $ 1,780.00 4165 NUCL MED41656092 RP IN111 DTPA/0.5MCI $ 1,656.00 $ 1,656.00 4165 NUCL MED41656170 RP IN111 IBRITUM DX 5MCI $ 7,110.00 $ 7,110.00 4165 NUCL MED41656102 RP IN111 OCTREOSC DX 6MCI $ 526.00 $ 526.00 4165 NUCL MED41656100 RP IN111 OXYQIN DX 0.5MCI $ 1,350.00 $ 1,350.00 4165 NUCL MED41656103 RP IN111 PRSTSCN DX 10MCI $ 3,329.00 $ 3,329.00 4165 NUCL MED41656081 RP P32 SODIUM PHO RX 1MCI $ 116.00 $ 116.00 4165 NUCL MED41656031 RP SR89 TX PER MCI $ 1,445.00 $ 1,445.00 4165 NUCL MED41656075 RP SR89 TX PER MCI $ 1,445.00 $ 1,445.00 4165 NUCL MED41656145 RP TC99M ACUTECT DX 20MCI $ 2,433.00 $ 2,433.00 4165 NUCL MED41656080 RP TC99M CERETEC DX 25MCI $ 1,326.00 $ 1,326.00 4165 NUCL MED41656066 RP TC99M DEPREOT DX 35MCI $ 3,017.00 $ 3,017.00 4165 NUCL MED41656185 RP TC99M FANOLSO DX 25MCI $ 2,516.00 $ 2,516.00 4165 NUCL MED41656005 RP TC99M GLUCEPT DX 25MCI $ 153.00 $ 153.00 4165 NUCL MED41656025 RP TC99M MAA DX 10MCI $ 162.00 $ 162.00 4165 NUCL MED41656020 RP TC99M MDP 1-30MCI $ 162.00 $ 162.00 4165 NUCL MED41656015 RP TC99M MEBROFN DX 15MCI $ 152.00 $ 152.00 4165 NUCL MED41656001 RP TC99M MERTIAT DX 15MCI $ 427.00 $ 427.00 4165 NUCL MED41656038 RP TC99M MYOVIEW DX 40MCI $ 313.00 $ 313.00 4165 NUCL MED41656000 RP TC99M PENTETA DX 25MCI $ 162.00 $ 162.00 4165 NUCL MED41656004 RP TC99M PENTETA DX 25MCI $ 162.00 $ 162.00 4165 NUCL MED41656045 RP TC99M PERTEC DX EA MCI $ 16.40 $ 16.40 4165 NUCL MED41656035 RP TC99M PYROPHO DX 25MCI $ 153.00 $ 153.00 4165 NUCL MED41656030 RP TC99M RBC/TAG DX 30MCI $ 324.00 $ 324.00 4165 NUCL MED41656036 RP TC99M SESTMBI DX 40MCI $ 313.00 $ 313.00 4165 NUCL MED41656003 RP TC99M SUCCIMR DX 10MCI $ 482.00 $ 482.00 4165 NUCL MED41656002 RP TC99M SULFR/C DX 20MCI $ 162.00 $ 162.00 4165 NUCL MED41656060 RP TL-201 DX PER MCI $ 158.00 $ 158.00 4165 NUCL MED41656086 RP TX I131 SOD SOL/MCI $ 45.00 $ 45.00 4165 NUCL MED41656070 RP XE133 DX 10MCI $ 276.00 $ 276.00 4165 NUCL MED41656175 RP Y90 IBRITUM RX 40MCI $ 32,090.00 $ 32,090.00 4165 NUCL MED41656195 S BRACH SOURCE YTTRIUM 90 $ 31,800.00 $ 31,800.00 4165 NUCL MED

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DEPARTMENT CODE

41656151 SINCALIDE 5MCG IJ $ 118.00 $ 118.00 4165 NUCL MED23640010 CIRCUMCISION $ 358.00 $ 358.00 2364 NURSERY OTHER23640030 CPR $ 299.00 $ 299.00 2364 NURSERY OTHER23630030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2363 NURSERY OTHER23620060 S NSTRL WATER MATTRESS $ 381.00 $ 381.00 2362 NURSERY OTHER23640042 S STRL NICU CUTDOWN TRAY $ 269.00 $ 269.00 2364 NURSERY OTHER23640043 S STRL PIC LINE KIT $ 126.00 $ 126.00 2364 NURSERY OTHER23620070 S STRL THORAKLE CHEST TBE $ 513.00 $ 513.00 2362 NURSERY OTHER54120045 S STRL CIRCUMCISION $ 413.00 $ 413.00 5412 NURSERY OTHER CHG54120054 VENIPUNCTURE $ 23.00 $ 23.00 5412 NURSERY OTHER CHG90400040 LEVEL 1 EST PATIENT $ 111.00 $ 111.00 9040 NUTR SVCS90400030 LEVEL 1 NEW PATIENT $ 111.00 $ 111.00 9040 NUTR SVCS90400042 LEVEL 2 EST PATIENT $ 129.00 $ 129.00 9040 NUTR SVCS90400032 LEVEL 2 NEW PATIENT $ 129.00 $ 129.00 9040 NUTR SVCS90400044 LEVEL 3 EST PATIENT $ 147.00 $ 147.00 9040 NUTR SVCS90400034 LEVEL 3 NEW PATIENT $ 147.00 $ 147.00 9040 NUTR SVCS90400046 LEVEL 4 EST PATIENT $ 244.00 $ 244.00 9040 NUTR SVCS90400036 LEVEL 4 NEW PATIENT $ 244.00 $ 244.00 9040 NUTR SVCS90400038 LEVEL 5 NEW PATIENT $ 262.00 $ 262.00 9040 NUTR SVCS45235014 CA ECHO DPPLER CMPL $ 630.00 $ 630.00 4523 OB CLINIC45235015 CA ECHO DPPLER COLOR FLOW $ 1,182.00 $ 1,182.00 4523 OB CLINIC45234000 CST (CONTRAC STRESS TEST) $ 875.00 $ 875.00 4523 OB CLINIC45234006 EXTERNAL VERSION $ 1,625.00 $ 1,625.00 4523 OB CLINIC45234007 INJECTION IM/SQ EA $ 205.00 $ 205.00 4523 OB CLINIC45234050 INJECTION IM/SQ EA $ 205.00 $ 205.00 4523 OB CLINIC45234005 NI DUPLEX ABD PELV CMPL $ 2,092.00 $ 2,092.00 4523 OB CLINIC45234001 NST (NON-STRESS TEST) $ 492.00 $ 492.00 4523 OB CLINIC45234045 NST (NON-STRESS TEST) $ 492.00 $ 492.00 4523 OB CLINIC45234009 S STRL INSTRUMENT TRAY $ 198.00 $ 198.00 4523 OB CLINIC45235017 S STRL INSTRUMENT TRAY $ 198.00 $ 198.00 4523 OB CLINIC45234021 US AMNIOCENTESIS $ 687.00 $ 687.00 4523 OB CLINIC45234004 US BIO PROFILE W NONSTRES $ 739.00 $ 739.00 4523 OB CLINIC45234016 US DPPLER ECHO FETAL $ 442.00 $ 442.00 4523 OB CLINIC

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DEPARTMENT CODE

45234017 US DPPLER ECHO FETAL FU $ 280.00 $ 280.00 4523 OB CLINIC45235006 US ECHO FETAL $ 1,343.00 $ 1,343.00 4523 OB CLINIC45234015 US ECHO FETAL FU REPEAT $ 777.00 $ 777.00 4523 OB CLINIC45235011 US FETAL TRANSFUSION IUT $ 692.00 $ 692.00 4523 OB CLINIC45235008 US NDL PLACE $ 1,485.00 $ 1,485.00 4523 OB CLINIC45234010 US OB 1ST TRI 1 GEST $ 984.00 $ 984.00 4523 OB CLINIC45234011 US OB 1ST TRI EA GEST $ 369.00 $ 369.00 4523 OB CLINIC45235001 US OB AFTR 1ST TRI 1 GEST $ 1,012.00 $ 1,012.00 4523 OB CLINIC45235004 US OB AFTR 1ST TRI EA GES $ 545.00 $ 545.00 4523 OB CLINIC45234012 US OB DTLD FTL EXAM 1 GES $ 1,708.00 $ 1,708.00 4523 OB CLINIC45234013 US OB DTLD FTL EXM EA GES $ 1,160.00 $ 1,160.00 4523 OB CLINIC45235002 US OB FU/REEVAL EA FETUS $ 732.00 $ 732.00 4523 OB CLINIC45234003 US OB LTD 1/MORE FETUSES $ 935.00 $ 935.00 4523 OB CLINIC45234040 US OB MID CEREBRAL ARTERY $ 639.00 $ 639.00 4523 OB CLINIC45234025 US OB NUCHAL MEAS 1 GEST $ 749.00 $ 749.00 4523 OB CLINIC45234030 US OB NUCHAL MEAS ADD-ON $ 394.00 $ 394.00 4523 OB CLINIC45234014 US OB TRANSVAGINAL $ 673.00 $ 673.00 4523 OB CLINIC45234035 US OB UMBILLICAL ARTERY $ 300.00 $ 300.00 4523 OB CLINIC45235007 US TRANSVAGINAL $ 773.00 $ 773.00 4523 OB CLINIC45235012 US VILLUS SAMPLING $ 615.00 $ 615.00 4523 OB CLINIC45235010 USC MULTIFETAL OB REDUCT $ 748.00 $ 748.00 4523 OB CLINIC53900012 ROOM NO CHARGE $ - $ - 5390 OB REC-OBS45201023 CA ECHO DPPLER COLOR FLOW $ 1,182.00 $ 1,182.00 4520 OB ULTRA45201030 CT 3D RENDER W/O POSTPROS $ 964.00 $ 964.00 4520 OB ULTRA45201027 S STRL SONOHYSTEROGRAM TR $ 67.00 $ 67.00 4520 OB ULTRA45201019 US AMNIOCENTESIS $ 687.00 $ 687.00 4520 OB ULTRA45201032 US OB 1ST TRI 1 GEST $ 984.00 $ 984.00 4520 OB ULTRA45201034 US OB 1ST TRI EA GEST $ 369.00 $ 369.00 4520 OB ULTRA45201002 US OB AFTR 1ST TRI 1 GEST $ 1,012.00 $ 1,012.00 4520 OB ULTRA45201007 US OB AFTR 1ST TRI EA GES $ 545.00 $ 545.00 4520 OB ULTRA45201036 US OB DTLD FTL EXAM 1 GES $ 1,708.00 $ 1,708.00 4520 OB ULTRA45201038 US OB DTLD FTL EXM EA GES $ 1,160.00 $ 1,160.00 4520 OB ULTRA45201003 US OB FU/REEVAL EA FETUS $ 732.00 $ 732.00 4520 OB ULTRA

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DEPARTMENT CODE

45201009 US OB LTD 1/MORE FETUSES $ 935.00 $ 935.00 4520 OB ULTRA45201040 US OB TRANSVAGINAL $ 673.00 $ 673.00 4520 OB ULTRA45201012 US PELV CMPL NONOB $ 752.00 $ 752.00 4520 OB ULTRA45201013 US PELV LTD FU NONOB $ 798.00 $ 798.00 4520 OB ULTRA45201026 US SAL INFN SONOHYSTERGHY $ 849.00 $ 849.00 4520 OB ULTRA45201042 US TRANSRECTAL $ 1,070.00 $ 1,070.00 4520 OB ULTRA45201011 US TRANSVAGINAL $ 773.00 $ 773.00 4520 OB ULTRA45205012 US VILLUS SAMPLING $ 615.00 $ 615.00 4520 OB ULTRA26312026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2631 OBS.CARE26332026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2633 OBS.CARE26342026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2634 OBS.CARE26312025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2631 OBS.CARE26332025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2633 OBS.CARE26342025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2634 OBS.CARE26312035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2631 OBS.CARE26332036 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2633 OBS.CARE26342035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2634 OBS.CARE26312040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2631 OBS.CARE26332041 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2633 OBS.CARE26342040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2634 OBS.CARE26312065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2631 OBS.CARE26332065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2633 OBS.CARE26342065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2634 OBS.CARE26312056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2631 OBS.CARE26332056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2633 OBS.CARE26342056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2634 OBS.CARE26312057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2631 OBS.CARE26332057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2633 OBS.CARE26342057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2634 OBS.CARE26312058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2631 OBS.CARE26332058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2633 OBS.CARE26342058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2634 OBS.CARE26312055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2631 OBS.CARE

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DEPARTMENT CODE

26332055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2633 OBS.CARE26342055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2634 OBS.CARE26312075 OBS CPR $ 299.00 $ 299.00 2631 OBS.CARE26332075 OBS CPR $ 299.00 $ 299.00 2633 OBS.CARE26342075 OBS CPR $ 299.00 $ 299.00 2634 OBS.CARE26312060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2631 OBS.CARE26332060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2633 OBS.CARE26342060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2634 OBS.CARE26312002 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2631 OBS.CARE26312081 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2631 OBS.CARE26332002 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2633 OBS.CARE26332081 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2633 OBS.CARE26342002 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2634 OBS.CARE26342081 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2634 OBS.CARE26312001 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2631 OBS.CARE26312080 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2631 OBS.CARE26332001 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2633 OBS.CARE26332080 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2633 OBS.CARE26342001 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2634 OBS.CARE26342080 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2634 OBS.CARE26312046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2631 OBS.CARE26312088 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2631 OBS.CARE26332046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2633 OBS.CARE26332088 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2633 OBS.CARE26342046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2634 OBS.CARE26342088 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2634 OBS.CARE26312008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2631 OBS.CARE26312084 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2631 OBS.CARE26332008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2633 OBS.CARE26332084 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2633 OBS.CARE26342008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2634 OBS.CARE26342084 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2634 OBS.CARE26312006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2631 OBS.CARE

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DEPARTMENT CODE

26312083 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2631 OBS.CARE26332006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2633 OBS.CARE26332083 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2633 OBS.CARE26342006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2634 OBS.CARE26342083 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2634 OBS.CARE26312033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2631 OBS.CARE26332033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2633 OBS.CARE26342033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2634 OBS.CARE26312005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2631 OBS.CARE26312082 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2631 OBS.CARE26332005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2633 OBS.CARE26332082 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2633 OBS.CARE26342005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2634 OBS.CARE26342082 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2634 OBS.CARE26312009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2631 OBS.CARE26312085 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2631 OBS.CARE26332009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2633 OBS.CARE26332085 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2633 OBS.CARE26342009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2634 OBS.CARE26342085 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2634 OBS.CARE26312051 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2631 OBS.CARE26332051 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2633 OBS.CARE26342051 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2634 OBS.CARE26312050 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2631 OBS.CARE26332050 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2633 OBS.CARE26342050 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2634 OBS.CARE26312045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2631 OBS.CARE26312087 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2631 OBS.CARE26332045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2633 OBS.CARE26332087 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2633 OBS.CARE26342045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2634 OBS.CARE26342087 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2634 OBS.CARE26312012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2631 OBS.CARE

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DEPARTMENT CODE

26312086 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2631 OBS.CARE26332012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2633 OBS.CARE26332086 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2633 OBS.CARE26342012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2634 OBS.CARE26342086 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2634 OBS.CARE26312071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2631 OBS.CARE26332071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2633 OBS.CARE26342071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2634 OBS.CARE26312070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2631 OBS.CARE26332070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2633 OBS.CARE26342070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2634 OBS.CARE26312047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2631 OBS.CARE26312089 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2631 OBS.CARE26332047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2633 OBS.CARE26332089 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2633 OBS.CARE26342047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2634 OBS.CARE26342089 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2634 OBS.CARE26312030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2631 OBS.CARE26332035 OBSERVATION PER HOUR $ 236.00 $ 236.00 2633 OBS.CARE26342030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2634 OBS.CARE26352030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2635 OBS.CARE26362030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2636 OBS.CARE PICU26322026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2632 OBS.CARE-PREV 5S,NEW 4S26322025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2632 OBS.CARE-PREV 5S,NEW 4S26322035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2632 OBS.CARE-PREV 5S,NEW 4S26322040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2632 OBS.CARE-PREV 5S,NEW 4S26322065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2632 OBS.CARE-PREV 5S,NEW 4S26322056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2632 OBS.CARE-PREV 5S,NEW 4S26322057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2632 OBS.CARE-PREV 5S,NEW 4S26322058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2632 OBS.CARE-PREV 5S,NEW 4S26322055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2632 OBS.CARE-PREV 5S,NEW 4S26322075 OBS CPR $ 299.00 $ 299.00 2632 OBS.CARE-PREV 5S,NEW 4S26322060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2632 OBS.CARE-PREV 5S,NEW 4S

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26322003 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2632 OBS.CARE-PREV 5S,NEW 4S26322081 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2632 OBS.CARE-PREV 5S,NEW 4S26322002 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322080 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2632 OBS.CARE-PREV 5S,NEW 4S26322088 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2632 OBS.CARE-PREV 5S,NEW 4S26322008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2632 OBS.CARE-PREV 5S,NEW 4S26322084 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2632 OBS.CARE-PREV 5S,NEW 4S26322006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2632 OBS.CARE-PREV 5S,NEW 4S26322083 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2632 OBS.CARE-PREV 5S,NEW 4S26322033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2632 OBS.CARE-PREV 5S,NEW 4S26322005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322082 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322085 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2632 OBS.CARE-PREV 5S,NEW 4S26322052 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2632 OBS.CARE-PREV 5S,NEW 4S26322051 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2632 OBS.CARE-PREV 5S,NEW 4S26322045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2632 OBS.CARE-PREV 5S,NEW 4S26322087 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2632 OBS.CARE-PREV 5S,NEW 4S26322012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2632 OBS.CARE-PREV 5S,NEW 4S26322086 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2632 OBS.CARE-PREV 5S,NEW 4S26322071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2632 OBS.CARE-PREV 5S,NEW 4S26322070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2632 OBS.CARE-PREV 5S,NEW 4S26322047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2632 OBS.CARE-PREV 5S,NEW 4S26322089 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2632 OBS.CARE-PREV 5S,NEW 4S26322030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2632 OBS.CARE-PREV 5S,NEW 4S26322050 OBSERVATION PER HOUR $ 236.00 $ 236.00 2632 OBS.CARE-PREV 5S,NEW 4S26452026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2645 OBSERVATION (P6S)26452025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2645 OBSERVATION (P6S)26452035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2645 OBSERVATION (P6S)26452040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2645 OBSERVATION (P6S)26452065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2645 OBSERVATION (P6S)26452056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2645 OBSERVATION (P6S)

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DEPARTMENT CODE

26452057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2645 OBSERVATION (P6S)26452058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2645 OBSERVATION (P6S)26452055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2645 OBSERVATION (P6S)26452075 OBS CPR $ 299.00 $ 299.00 2645 OBSERVATION (P6S)26452060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2645 OBSERVATION (P6S)26452002 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2645 OBSERVATION (P6S)26452001 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2645 OBSERVATION (P6S)26452046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2645 OBSERVATION (P6S)26452008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2645 OBSERVATION (P6S)26452006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2645 OBSERVATION (P6S)26452033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2645 OBSERVATION (P6S)26452005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2645 OBSERVATION (P6S)26452009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2645 OBSERVATION (P6S)26452051 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2645 OBSERVATION (P6S)26452050 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2645 OBSERVATION (P6S)26452045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2645 OBSERVATION (P6S)26452012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2645 OBSERVATION (P6S)26452071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2645 OBSERVATION (P6S)26452070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2645 OBSERVATION (P6S)26452047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2645 OBSERVATION (P6S)26452030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2645 OBSERVATION (P6S)26302026 IMMUN ADMIN EA ADD VACCNE $ 86.00 $ 86.00 2630 OBSERVATION CARE P5SOUTH26302025 IMMUN ADMIN SGL VACCNE $ 86.00 $ 86.00 2630 OBSERVATION CARE P5SOUTH26302035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2630 OBSERVATION CARE P5SOUTH26302040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2630 OBSERVATION CARE P5SOUTH26302065 OBS BLADDER IRRIG SMPL $ 39.00 $ 39.00 2630 OBSERVATION CARE P5SOUTH26302056 OBS BLOOD TRANSFSN 2-4 HR $ 2,218.00 $ 2,218.00 2630 OBSERVATION CARE P5SOUTH26302057 OBS BLOOD TRANSFSN 4-6 HR $ 3,488.00 $ 3,488.00 2630 OBSERVATION CARE P5SOUTH26302058 OBS BLOOD TRANSFSN GT 6HR $ 4,289.00 $ 4,289.00 2630 OBSERVATION CARE P5SOUTH26302055 OBS BLOOD TRANSFSN LT 2HR $ 1,269.00 $ 1,269.00 2630 OBSERVATION CARE P5SOUTH26302075 OBS CPR $ 299.00 $ 299.00 2630 OBSERVATION CARE P5SOUTH26302060 OBS DECLOT VASC DEVICE $ 741.00 $ 741.00 2630 OBSERVATION CARE P5SOUTH26302002 OBS HYDRAT INF EA ADD HR $ 509.00 $ 509.00 2630 OBSERVATION CARE P5SOUTH

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26302001 OBS HYDRTN INF INIT 31-60 $ 730.00 $ 730.00 2630 OBSERVATION CARE P5SOUTH26302046 OBS IJ IVP ADL SQ NEW DRG $ 221.00 $ 221.00 2630 OBSERVATION CARE P5SOUTH26302008 OBS INF W/MED ADDSQ 16-60 $ 500.00 $ 500.00 2630 OBSERVATION CARE P5SOUTH26302006 OBS INF W/MED EA ADD HR $ 509.00 $ 509.00 2630 OBSERVATION CARE P5SOUTH26302033 OBS INFLU H1N1 VACC ADMIN $ 43.00 $ 43.00 2630 OBSERVATION CARE P5SOUTH26302005 OBS INFSN W/MED 16-60MN $ 730.00 $ 730.00 2630 OBSERVATION CARE P5SOUTH26302009 OBS INFSN W/MED CONCURRNT $ 730.00 $ 730.00 2630 OBSERVATION CARE P5SOUTH26302051 OBS INFUSN CHEM EA ADD HR $ 639.00 $ 639.00 2630 OBSERVATION CARE P5SOUTH26302050 OBS INFUSN CHEMO 0-60 MN $ 1,089.00 $ 1,089.00 2630 OBSERVATION CARE P5SOUTH26302045 OBS INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2630 OBSERVATION CARE P5SOUTH26302012 OBS INJECTION IM/SQ EA $ 321.00 $ 321.00 2630 OBSERVATION CARE P5SOUTH26302071 OBS INSERT CATH TMP SMPL $ 104.00 $ 104.00 2630 OBSERVATION CARE P5SOUTH26302070 OBS INSRT BLADDER CATH $ 208.00 $ 208.00 2630 OBSERVATION CARE P5SOUTH26302047 OBS IVP SME DRG EA >30M $ 90.00 $ 90.00 2630 OBSERVATION CARE P5SOUTH26302030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2630 OBSERVATION CARE P5SOUTH26432030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2643 OBSERVATION CARE PMSCIU26432050 S NSTRL COOLING PAD $ 3,113.00 $ 3,113.00 2643 OBSERVATION CARE PMSCIU42710131 OT ADL TRAIN ADD 15 $ 169.00 $ 134.00 4271 OCC TX42720130 OT ADL TRAIN EA 15 $ 186.00 $ 147.00 4272 OCC TX42710130 OT ADL TRAIN INIT 30 $ 338.00 $ 269.00 4271 OCC TX42720055 OT AQUATC THER EA 15 $ 387.00 $ 307.00 4272 OCC TX42710056 OT AQUATC THER EX ADD 15 $ 216.00 $ 171.00 4271 OCC TX42710055 OT AQUATC THER EX INIT 30 $ 381.00 $ 302.00 4271 OCC TX42730051 OT ASST TECH ASSES ADD 15 $ 243.00 $ 193.00 4273 OCC TX42730050 OT ASST TECH ASSES INI 30 $ 486.00 $ 385.00 4273 OCC TX42720050 OT ASST TECH ASSESS EA 15 $ 254.00 $ 202.00 4272 OCC TX42730921 OT CASE CONF, REP ADD 15 $ 158.00 $ 125.00 4273 OCC TX42720180 OT CASE CONF, REP INIT 30 $ 277.00 $ 220.00 4272 OCC TX42730920 OT CASE CONF, REP INIT 30 $ 277.00 $ 220.00 4273 OCC TX42730925 OT CASE CONSULT AND REP $ 265.00 $ 210.00 4273 OCC TX42720040 OT COGNTVE SKIL DEV EA 15 $ 145.00 $ 115.00 4272 OCC TX42720131 OT COMMUNITY REINT EA 15 $ 213.00 $ 169.00 4272 OCC TX42720246 OT COMMUNITY REINT EA 15 $ 213.00 $ 169.00 4272 OCC TX

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42710080 OT COMPU ASSIST TRAIN >30 $ 314.00 $ 249.00 4271 OCC TX42710215 OT CONTRAST BATH INIT 30 $ 361.00 $ 286.00 4271 OCC TX42720215 OT CONTRAST BATHS EA 15 $ 197.00 $ 156.00 4272 OCC TX42720135 OT DEBRIDE NON-SELECT 15 $ 206.00 $ 163.00 4272 OCC TX42720136 OT DEBRIDE NON-SELECT 30 $ 371.00 $ 294.00 4272 OCC TX42720137 OT DEBRIDE NON-SELECT 45 $ 689.00 $ 547.00 4272 OCC TX42720138 OT DEBRIDE NON-SELECT 60 $ 791.00 $ 627.00 4272 OCC TX42720217 OT E-STIM EA 15 $ 145.00 $ 115.00 4272 OCC TX42710217 OT E-STIM MANUAL INIT 30 $ 266.00 $ 211.00 4271 OCC TX42710214 OT E-STIM SUPERVISED 15 $ 134.00 $ 107.00 4271 OCC TX42720214 OT E-STIM SUPERVISED 15 $ 134.00 $ 107.00 4272 OCC TX42720022 OT EVAL 45 $ 553.00 $ 439.00 4272 OCC TX42730021 OT EVAL ADD 15 $ 199.00 $ 158.00 4273 OCC TX42710120 OT EVAL BRIEF $ 203.00 $ 161.00 4271 OCC TX42710124 OT EVAL COMPREHENSIVE $ 884.00 $ 701.00 4271 OCC TX42710123 OT EVAL EXTENDED $ 663.00 $ 526.00 4271 OCC TX42710239 OT EVAL FNX CAPACITY 120 $ 1,277.00 $ 1,013.00 4271 OCC TX42710240 OT EVAL FNX CAPACITY 240 $ 3,075.00 $ 2,440.00 4271 OCC TX42710241 OT EVAL FNX CAPACITY 360 $ 3,923.00 $ 3,113.00 4271 OCC TX42710242 OT EVAL FNX CAPACITY 480 $ 6,785.00 $ 5,383.00 4271 OCC TX42730020 OT EVAL INIT 30 $ 408.00 $ 323.00 4273 OCC TX42710122 OT EVAL INTERMEDIATE $ 470.00 $ 373.00 4271 OCC TX42710121 OT EVAL LTD $ 428.00 $ 340.00 4271 OCC TX42730022 OT EVAL PRELIM 30 $ 541.00 $ 429.00 4273 OCC TX42710148 OT EXER GP ADD 15 $ 97.00 $ 77.00 4271 OCC TX42710147 OT EXER GP INIT 30 $ 154.00 $ 122.00 4271 OCC TX42710150 OT GP ED PER SESSION $ 242.00 $ 192.00 4271 OCC TX42730930 OT HOME EVALUATION $ 1,622.00 $ 1,287.00 4273 OCC TX42710042 OT IND INSTRUCT INIT 30 $ 401.00 $ 318.00 4271 OCC TX42720219 OT IONTOPHORESIS EA 15 $ 236.00 $ 187.00 4272 OCC TX42710219 OT IONTOPHORESIS INIT 30 $ 405.00 $ 321.00 4271 OCC TX42710247 OT JOB SITE ASSESS 120 $ 989.00 $ 785.00 4271 OCC TX42710248 OT JOB SITE ASSESS 180 $ 1,476.00 $ 1,171.00 4271 OCC TX

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42710249 OT JOB SITE ASSESS 240 $ 1,724.00 $ 1,368.00 4271 OCC TX42710251 OT JOB SITE ASSESS 300 $ 3,619.00 $ 2,871.00 4271 OCC TX42710252 OT JOB SITE ASSESS 360 $ 4,342.00 $ 3,446.00 4271 OCC TX42710246 OT JOB SITE ASSESS 60 $ 491.00 $ 389.00 4271 OCC TX42710221 OT JOINT MOB EA VISIT $ 189.00 $ 150.00 4271 OCC TX42720223 OT MANUAL THER EA 15 $ 167.00 $ 133.00 4272 OCC TX42710223 OT MANUAL TRACT INIT 30 $ 375.00 $ 298.00 4271 OCC TX42730931 OT MILEAGE >10 MI 1 WAY $ 250.00 $ 198.00 4273 OCC TX42720320 OT MMT BODY W HAND 15 $ 269.00 $ 213.00 4272 OCC TX42720321 OT MMT BODY W HAND 30 $ 734.00 $ 582.00 4272 OCC TX42720325 OT MMT BODY WO HAND 15 $ 297.00 $ 236.00 4272 OCC TX42720326 OT MMT BODY WO HAND 30 $ 594.00 $ 472.00 4272 OCC TX42720300 OT MMT HAND 15 $ 143.00 $ 114.00 4272 OCC TX42720305 OT MMT LIMB 15 $ 179.00 $ 142.00 4272 OCC TX42720306 OT MMT LIMB 30 $ 331.00 $ 263.00 4272 OCC TX42710222 OT MYOFAC/SOFT MOB 30 $ 320.00 $ 254.00 4271 OCC TX42720132 OT NEUROMUSC REED EA 15 $ 191.00 $ 151.00 4272 OCC TX42710132 OT NEUROMUSC REED INIT 30 $ 305.00 $ 242.00 4271 OCC TX42710161 OT ORT/PRO/ADL CK ADD 15 $ 146.00 $ 116.00 4271 OCC TX42710160 OT ORT/PRO/ADL CK INIT 30 $ 339.00 $ 269.00 4271 OCC TX42710300 OT ORTHOTIC FAB INIT 30 $ 413.00 $ 327.00 4271 OCC TX42710116 OT ORTHOTIC TRAIN ADD 15 $ 155.00 $ 123.00 4271 OCC TX42720115 OT ORTHOTIC TRAIN EA 15 $ 180.00 $ 143.00 4272 OCC TX42710115 OT ORTHOTIC TRAIN INIT 30 $ 350.00 $ 278.00 4271 OCC TX42710205 OT PARAFFIN BATH 15 $ 125.00 $ 99.00 4271 OCC TX42720205 OT PARAFFIN BATH 15 $ 125.00 $ 99.00 4272 OCC TX42720242 OT PHYS PERFRM TEST EA 15 $ 245.00 $ 194.00 4272 OCC TX42720250 OT PHYS PERFRM TEST EA 15 $ 245.00 $ 194.00 4272 OCC TX42720150 OT PROC THER GP 15 $ 196.00 $ 155.00 4272 OCC TX42720149 OT PROC THER GP 30 $ 267.00 $ 212.00 4272 OCC TX42720148 OT PROC THER GP 45 $ 356.00 $ 282.00 4272 OCC TX42720147 OT PROC THER GP 60 $ 434.00 $ 345.00 4272 OCC TX42710111 OT PROSTH TRAIN ADD 15 $ 170.00 $ 135.00 4271 OCC TX

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DEPARTMENT CODE

42720110 OT PROSTH TRAIN EA 15 $ 213.00 $ 169.00 4272 OCC TX42710110 OT PROSTH TRAIN INIT 30 $ 379.00 $ 301.00 4271 OCC TX42720118 OT PROSTHETIC FU EA 15M $ 154.00 $ 122.00 4272 OCC TX42720027 OT RE-EVAL 45 $ 606.00 $ 481.00 4272 OCC TX42710028 OT RE-EVAL COMPREHENSIVE $ 270.00 $ 214.00 4271 OCC TX42710029 OT RE-EVAL EXTENDED $ 883.00 $ 701.00 4271 OCC TX42710026 OT RE-EVAL INTERMEDIATE $ 394.00 $ 313.00 4271 OCC TX42710025 OT RE-EVAL LTD $ 360.00 $ 286.00 4271 OCC TX42720310 OT ROM BODY WO HAND 15 $ 82.00 $ 65.00 4272 OCC TX42720311 OT ROM BODY WO HAND 30 $ 151.00 $ 120.00 4272 OCC TX42720315 OT ROM HAND 15 $ 176.00 $ 140.00 4272 OCC TX42720975 OT SENS INTEGRATION EA 15 $ 201.00 $ 160.00 4272 OCC TX42710190 OT SOFT TISSUE MOB INT30 $ 316.00 $ 250.00 4271 OCC TX42710191 OT TAPING EA VISIT $ 236.00 $ 187.00 4271 OCC TX42710969 OT THER ACT ADD 15 $ 193.00 $ 153.00 4271 OCC TX42710971 OT THER ACT ADD 15 $ 193.00 $ 153.00 4271 OCC TX42720046 OT THER ACT EA 15 $ 167.00 $ 133.00 4272 OCC TX42710968 OT THER ACT INIT 30 $ 294.00 $ 233.00 4271 OCC TX42710970 OT THER ACT INIT 30 $ 294.00 $ 233.00 4271 OCC TX42720045 OT THER EX EA 15 $ 166.00 $ 131.00 4272 OCC TX42710045 OT THER EX INIT 30 $ 334.00 $ 265.00 4271 OCC TX42720220 OT THER MASSAGE EA 15 $ 120.00 $ 95.00 4272 OCC TX42710220 OT THER MASSAGE INIT 30 $ 262.00 $ 208.00 4271 OCC TX42730176 OT TREAT ADD 15 $ 176.00 $ 139.00 4273 OCC TX42730175 OT TREAT INIT 30 $ 349.00 $ 277.00 4273 OCC TX42720140 OT TRN BIOFD ANY MODAL 15 $ 230.00 $ 183.00 4272 OCC TX42720141 OT TRN BIOFD ANY MODAL 30 $ 284.00 $ 225.00 4272 OCC TX42720142 OT TRN BIOFD ANY MODAL 45 $ 487.00 $ 386.00 4272 OCC TX42720143 OT TRN BIOFD ANY MODAL 60 $ 563.00 $ 447.00 4272 OCC TX42710301 OT TX PHYS MED EA 15 $ 207.00 $ 164.00 4271 OCC TX42720216 OT ULTRASOUND EA 15 $ 181.00 $ 144.00 4272 OCC TX42710216 OT ULTRASOUND INIT 30 $ 296.00 $ 235.00 4271 OCC TX42710225 OT WHIRLPOOL 15 $ 170.00 $ 135.00 4271 OCC TX

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42720225 OT WHIRLPOOL 15 $ 170.00 $ 135.00 4272 OCC TX42720052 OT WHLCHR MNG/TRAIN EA 15 $ 212.00 $ 168.00 4272 OCC TX42720244 OT WORK COND ADD 60 $ 374.00 $ 297.00 4272 OCC TX42720243 OT WORK COND INIT 120 $ 749.00 $ 594.00 4272 OCC TX42711012 S ORTHO WHF 2ND MP ABDC $ 55.00 $ 55.00 4271 OCC TX42711016 S ORTHO WHF ADJ MP FLX/IP $ 153.00 $ 153.00 4271 OCC TX42711013 S ORTHO WHF IP EX W/MP SP $ 109.00 $ 109.00 4271 OCC TX42711014 S ORTHO WHF MP EXTN AST $ 90.00 $ 90.00 4271 OCC TX42711015 S ORTHO WHF TB IP EX W/MP $ 92.00 $ 92.00 4271 OCC TX42711011 S ORTHO WHF THMB ABDC BAR $ 71.00 $ 71.00 4271 OCC TX42711002 S OT EO WO JOINTS CF $ 242.00 $ 242.00 4271 OCC TX42711005 S OT EWHFO RGD WO JNTS CF $ 1,074.00 $ 1,074.00 4271 OCC TX42711006 S OT EWHFO W/JOINT(S) CF $ 1,138.00 $ 1,138.00 4271 OCC TX42711003 S OT EWHO RIG WO JNTS CF $ 1,074.00 $ 1,074.00 4271 OCC TX42711004 S OT EWHO W/JNT(S) CF $ 1,138.00 $ 1,138.00 4271 OCC TX42711022 S OT FO NONTORSION JNT CF $ 186.00 $ 186.00 4271 OCC TX42711021 S OT FO W/O JOINTS CF $ 179.00 $ 179.00 4271 OCC TX42711020 S OT HFO W/JOINT(S) CF $ 269.00 $ 269.00 4271 OCC TX42711018 S OT HFO WO JOINTS CF $ 227.00 $ 227.00 4271 OCC TX42711019 S OT HO WO JOINTS CF $ 227.00 $ 227.00 4271 OCC TX42711025 S OT SEWHFO AIR WO JNTS F $ 1,408.00 $ 1,408.00 4271 OCC TX42711024 S OT SEWHO AIR W/JNT(S CF $ 1,663.00 $ 1,663.00 4271 OCC TX42711023 S OT SEWHO AIR WO JNTS CF $ 1,663.00 $ 1,663.00 4271 OCC TX42711001 S OT SO AIR W/JNT CF $ 1,024.00 $ 1,024.00 4271 OCC TX42711000 S OT SO AIR W/O JNTS CF $ 939.00 $ 939.00 4271 OCC TX42711010 S OT WHFO RGD W/O JNTS $ 237.00 $ 237.00 4271 OCC TX42711007 S OT WHFO RIGID W/O JNTS $ 230.00 $ 230.00 4271 OCC TX42711008 S OT WHFO RIGID W/O JNTS $ 359.00 $ 359.00 4271 OCC TX42711009 S OT WHFO W/JNT(S) CF $ 381.00 $ 381.00 4271 OCC TX42711017 S OT WHO NONTRSN JNT(S CF $ 831.00 $ 831.00 4271 OCC TX42710005 S OT WHO WO JNT CUST $ 455.00 $ 455.00 4271 OCC TX42740131 OT ADL TRAIN ADD 15 $ 169.00 $ 134.00 4274 OCC TX HAND42750130 OT ADL TRAIN EA 15 $ 186.00 $ 147.00 4275 OCC TX HAND

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42740130 OT ADL TRAIN INIT 30 $ 338.00 $ 269.00 4274 OCC TX HAND42740080 OT COMPU ASSIST TRAIN >30 $ 314.00 $ 249.00 4274 OCC TX HAND42740215 OT CONTRAST BATH INIT 30 $ 361.00 $ 286.00 4274 OCC TX HAND42750215 OT CONTRAST BATHS EA 15 $ 197.00 $ 156.00 4275 OCC TX HAND42750135 OT DEBRIDE NON-SELECT 15 $ 206.00 $ 163.00 4275 OCC TX HAND42750136 OT DEBRIDE NON-SELECT 30 $ 371.00 $ 294.00 4275 OCC TX HAND42750137 OT DEBRIDE NON-SELECT 45 $ 689.00 $ 547.00 4275 OCC TX HAND42750138 OT DEBRIDE NON-SELECT 60 $ 791.00 $ 627.00 4275 OCC TX HAND42750217 OT E-STIM EA 15 $ 145.00 $ 115.00 4275 OCC TX HAND42740217 OT E-STIM MANUAL INIT 30 $ 266.00 $ 211.00 4274 OCC TX HAND42750179 OT E-STIM SUPERVISED 15 $ 134.00 $ 107.00 4275 OCC TX HAND42740214 OT E-STIM SUPERVISED 30 $ 392.00 $ 311.00 4274 OCC TX HAND42750022 OT EVAL 45 $ 553.00 $ 439.00 4275 OCC TX HAND42760021 OT EVAL ADD 15 $ 199.00 $ 158.00 4276 OCC TX HAND42740120 OT EVAL BRIEF $ 203.00 $ 161.00 4274 OCC TX HAND42740124 OT EVAL COMPREHENSIVE $ 884.00 $ 701.00 4274 OCC TX HAND42740123 OT EVAL EXTENDED $ 663.00 $ 526.00 4274 OCC TX HAND42760020 OT EVAL INIT 30 $ 408.00 $ 323.00 4276 OCC TX HAND42740122 OT EVAL INTERMEDIATE $ 470.00 $ 373.00 4274 OCC TX HAND42740121 OT EVAL LTD $ 428.00 $ 340.00 4274 OCC TX HAND42740148 OT EXER GP ADD 15 $ 97.00 $ 77.00 4274 OCC TX HAND42740147 OT EXER GP INIT 30 $ 154.00 $ 122.00 4274 OCC TX HAND42740021 OT EXTREMITY TEST ADD 15 $ 111.00 $ 88.00 4274 OCC TX HAND42740020 OT EXTREMITY TEST INT 30 $ 250.00 $ 198.00 4274 OCC TX HAND42740900 OT FNX ACT INIT 30 $ 325.00 $ 258.00 4274 OCC TX HAND42740150 OT GP ED PER SESSION $ 242.00 $ 192.00 4274 OCC TX HAND42740042 OT IND INSTRUCT INIT 30 $ 401.00 $ 318.00 4274 OCC TX HAND42750219 OT IONTOPHORESIS EA 15 $ 236.00 $ 187.00 4275 OCC TX HAND42740219 OT IONTOPHORESIS INIT 30 $ 405.00 $ 321.00 4274 OCC TX HAND42740221 OT JOINT MOB EA VISIT $ 189.00 $ 150.00 4274 OCC TX HAND42750223 OT MANUAL THER EA 15 $ 167.00 $ 133.00 4275 OCC TX HAND42740223 OT MANUAL TRACT INIT 30 $ 375.00 $ 298.00 4274 OCC TX HAND42750320 OT MMT BODY W HAND 15 $ 269.00 $ 213.00 4275 OCC TX HAND

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42750321 OT MMT BODY W HAND 30 $ 734.00 $ 582.00 4275 OCC TX HAND42750325 OT MMT BODY WO HAND 15 $ 297.00 $ 236.00 4275 OCC TX HAND42750326 OT MMT BODY WO HAND 30 $ 594.00 $ 472.00 4275 OCC TX HAND42750300 OT MMT HAND 15 $ 143.00 $ 114.00 4275 OCC TX HAND42750305 OT MMT LIMB 15 $ 179.00 $ 142.00 4275 OCC TX HAND42750306 OT MMT LIMB 30 $ 331.00 $ 263.00 4275 OCC TX HAND42740222 OT MYOFAC/SOFT MOB 30 $ 320.00 $ 254.00 4274 OCC TX HAND42750132 OT NEUROMUSC REED EA 15 $ 191.00 $ 151.00 4275 OCC TX HAND42740132 OT NEUROMUSC REED INIT 30 $ 305.00 $ 242.00 4274 OCC TX HAND42740161 OT ORT/PRO/ADL CK ADD 15 $ 146.00 $ 116.00 4274 OCC TX HAND42740160 OT ORT/PRO/ADL CK INIT 30 $ 339.00 $ 269.00 4274 OCC TX HAND42740300 OT ORTHOTIC FAB INIT 30 $ 413.00 $ 327.00 4274 OCC TX HAND42740116 OT ORTHOTIC TRAIN ADD 15 $ 155.00 $ 123.00 4274 OCC TX HAND42750115 OT ORTHOTIC TRAIN EA 15 $ 180.00 $ 143.00 4275 OCC TX HAND42740115 OT ORTHOTIC TRAIN INIT 30 $ 350.00 $ 278.00 4274 OCC TX HAND42740205 OT PARAFFIN BATH 15 $ 125.00 $ 99.00 4274 OCC TX HAND42750205 OT PARAFFIN BATH 15 $ 125.00 $ 99.00 4275 OCC TX HAND42750149 OT PROC THER GP 30 $ 267.00 $ 212.00 4275 OCC TX HAND42750148 OT PROC THER GP 45 $ 356.00 $ 282.00 4275 OCC TX HAND42750147 OT PROC THER GP 60 $ 434.00 $ 345.00 4275 OCC TX HAND42740111 OT PROSTH TRAIN ADD 15 $ 170.00 $ 135.00 4274 OCC TX HAND42750110 OT PROSTH TRAIN EA 15 $ 213.00 $ 169.00 4275 OCC TX HAND42740110 OT PROSTH TRAIN INIT 30 $ 379.00 $ 301.00 4274 OCC TX HAND42750118 OT PROSTHETIC FU EA 15M $ 154.00 $ 122.00 4275 OCC TX HAND42750027 OT RE-EVAL 45 $ 606.00 $ 481.00 4275 OCC TX HAND42740028 OT RE-EVAL COMPREHENSIVE $ 270.00 $ 214.00 4274 OCC TX HAND42740027 OT RE-EVAL EXTENDED $ 883.00 $ 701.00 4274 OCC TX HAND42740026 OT RE-EVAL INTERMEDIATE $ 394.00 $ 313.00 4274 OCC TX HAND42740025 OT RE-EVAL LTD $ 360.00 $ 286.00 4274 OCC TX HAND42750310 OT ROM BODY WO HAND 15 $ 82.00 $ 65.00 4275 OCC TX HAND42750311 OT ROM BODY WO HAND 30 $ 151.00 $ 120.00 4275 OCC TX HAND42750315 OT ROM HAND 15 $ 176.00 $ 140.00 4275 OCC TX HAND42750316 OT ROM HAND 30 $ 190.00 $ 151.00 4275 OCC TX HAND

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DEPARTMENT CODE

42750975 OT SENS INTEGRATION EA 15 $ 201.00 $ 160.00 4275 OCC TX HAND42740190 OT SOFT TISSUE MOB INT30 $ 316.00 $ 250.00 4274 OCC TX HAND42740191 OT TAPING EA VISIT $ 236.00 $ 187.00 4274 OCC TX HAND42740971 OT THER ACT ADD 15 $ 193.00 $ 153.00 4274 OCC TX HAND42750046 OT THER ACT EA 15 $ 167.00 $ 133.00 4275 OCC TX HAND42740970 OT THER ACT INIT 30 $ 294.00 $ 233.00 4274 OCC TX HAND42740048 OT THER EX ADD 15 $ 183.00 $ 146.00 4274 OCC TX HAND42750045 OT THER EX EA 15 $ 166.00 $ 131.00 4275 OCC TX HAND42740045 OT THER EX INIT 30 $ 334.00 $ 265.00 4274 OCC TX HAND42750220 OT THER MASSAGE EA 15 $ 120.00 $ 95.00 4275 OCC TX HAND42740220 OT THER MASSAGE INIT 30 $ 262.00 $ 208.00 4274 OCC TX HAND42760176 OT TREAT ADD 15 $ 176.00 $ 139.00 4276 OCC TX HAND42760175 OT TREAT INIT 30 $ 349.00 $ 277.00 4276 OCC TX HAND42740301 OT TX PHYS MED EA 15 $ 207.00 $ 164.00 4274 OCC TX HAND42740972 OT ULTRASOUND ADD 15 $ 181.00 $ 144.00 4274 OCC TX HAND42750216 OT ULTRASOUND EA 15 $ 181.00 $ 144.00 4275 OCC TX HAND42740216 OT ULTRASOUND INIT 30 $ 296.00 $ 235.00 4274 OCC TX HAND42740225 OT WHIRLPOOL 15 $ 170.00 $ 135.00 4274 OCC TX HAND42749225 OT WHIRLPOOL 15 $ 170.00 $ 135.00 4274 OCC TX HAND42750225 OT WHIRLPOOL 15 $ 170.00 $ 135.00 4275 OCC TX HAND42741012 S ORTHO WHF 2ND MP ABDC $ 55.00 $ 55.00 4274 OCC TX HAND42741016 S ORTHO WHF ADJ MP FLX/IP $ 153.00 $ 153.00 4274 OCC TX HAND42741013 S ORTHO WHF IP EX W/MP SP $ 109.00 $ 109.00 4274 OCC TX HAND42741014 S ORTHO WHF MP EXTN AST $ 90.00 $ 90.00 4274 OCC TX HAND42741015 S ORTHO WHF TB IP EX W/MP $ 92.00 $ 92.00 4274 OCC TX HAND42741011 S ORTHO WHF THMB ABDC BAR $ 71.00 $ 71.00 4274 OCC TX HAND42741026 S OT AFO PLASTIC PREFAB $ 286.00 $ 286.00 4274 OCC TX HAND42741002 S OT EO WO JOINTS CF $ 242.00 $ 242.00 4274 OCC TX HAND42741005 S OT EWHFO RGD WO JNTS CF $ 1,074.00 $ 1,074.00 4274 OCC TX HAND42741006 S OT EWHFO W/JOINT(S) CF $ 1,138.00 $ 1,138.00 4274 OCC TX HAND42741003 S OT EWHO RIG WO JNTS CF $ 1,074.00 $ 1,074.00 4274 OCC TX HAND42741004 S OT EWHO W/JNT(S) CF $ 1,138.00 $ 1,138.00 4274 OCC TX HAND42741022 S OT FO NONTORSION JNT CF $ 186.00 $ 186.00 4274 OCC TX HAND

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DEPARTMENT CODE

42741021 S OT FO W/O JOINTS CF $ 179.00 $ 179.00 4274 OCC TX HAND42741020 S OT HFO W/JOINT(S) CF $ 269.00 $ 269.00 4274 OCC TX HAND42741018 S OT HFO WO JOINTS CF $ 227.00 $ 227.00 4274 OCC TX HAND42741019 S OT HO WO JOINTS CF $ 227.00 $ 227.00 4274 OCC TX HAND42741025 S OT SEWHFO AIR WO JNTS F $ 1,408.00 $ 1,408.00 4274 OCC TX HAND42741024 S OT SEWHO AIR W/JNT(S CF $ 1,663.00 $ 1,663.00 4274 OCC TX HAND42741023 S OT SEWHO AIR WO JNTS CF $ 1,663.00 $ 1,663.00 4274 OCC TX HAND42741001 S OT SO AIR W/JNT CF $ 1,024.00 $ 1,024.00 4274 OCC TX HAND42741000 S OT SO AIR W/O JNTS CF $ 939.00 $ 939.00 4274 OCC TX HAND42741010 S OT WHFO RGD W/O JNTS $ 237.00 $ 237.00 4274 OCC TX HAND42741007 S OT WHFO RIGID W/O JNTS $ 230.00 $ 230.00 4274 OCC TX HAND42741008 S OT WHFO RIGID W/O JNTS $ 359.00 $ 359.00 4274 OCC TX HAND42741009 S OT WHFO W/JNT(S) CF $ 381.00 $ 381.00 4274 OCC TX HAND42741017 S OT WHO NONTRSN JNT(S CF $ 831.00 $ 831.00 4274 OCC TX HAND42740005 S OT WHO WO JNT CUST $ 690.00 $ 690.00 4274 OCC TX HAND24240015 DISCISSN 2ND MEM CAT LASR $ 2,485.00 $ 2,485.00 2424 OIS INFUSION24240006 INJ IVP SNGL/INIT DRG $ 256.00 $ 256.00 2424 OIS INFUSION24240005 INJECTION IM/SQ EA $ 321.00 $ 321.00 2424 OIS INFUSION24246007 INS PICC W/O PORT 5+ YR $ 1,611.00 $ 1,611.00 2424 OIS INFUSION24240014 IRIDOTOMY/IRIDECTOMY LSR $ 2,485.00 $ 2,485.00 2424 OIS INFUSION24240013 PARACENT ABD INI $ 2,485.00 $ 2,485.00 2424 OIS INFUSION24246008 RPLC COMP TUNN PICC W/O $ 1,463.00 $ 1,463.00 2424 OIS INFUSION24240016 TRABECULOPLASTY LASER $ 2,485.00 $ 2,485.00 2424 OIS INFUSION53100047 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5310 ONBIC DHS53100147 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5310 ONBIC DHS53100040 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5310 ONBIC DHS53100140 NEWBORN LEVEL III $ 6,991.00 $ 6,991.00 5310 ONBIC DHS40221002 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 4022 OPER ROOM40231104 CON HOCM 250-299MG/ML 1ML $ 2.50 $ 2.50 4023 OPER ROOM40231102 CON LOCM 300-349S I 1ML $ 4.80 $ 4.80 4023 OPER ROOM40231103 CON LOCM 300-349S I 1ML $ 5.90 $ 5.90 4023 OPER ROOM40289980 CORNEAL TISS ACQUISITION $ - $ - 4028 OPER ROOM40200200 CS DIFF MD ADD 15M $ 870.00 $ 870.00 4020 OPER ROOM

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DEPARTMENT CODE

40200193 CS DIFF MD GT5YR 0-30M $ 2,754.00 $ 2,754.00 4020 OPER ROOM40200192 CS DIFF MD LT5YR 0-30M $ 2,754.00 $ 2,754.00 4020 OPER ROOM40200194 CS SAME MD ADD 15M $ 870.00 $ 870.00 4020 OPER ROOM40200191 CS SAME MD GT5YR 0-30M $ 2,754.00 $ 2,754.00 4020 OPER ROOM40200190 CS SAME MD LT5YR 0-30M $ 2,754.00 $ 2,754.00 4020 OPER ROOM40221003 CX CASE OR $ 5,688.00 $ 5,688.00 4022 OPER ROOM40200178 CYST/URETSCP/PYLSCP LITHO $ 5,902.00 $ 5,902.00 4020 OPER ROOM40200213 DESTRUCT NRV C/T 1 LVL $ 2,695.00 $ 2,695.00 4020 OPER ROOM40200223 DESTRUCT NRV C/T 1 LVL $ 3,550.00 $ 3,550.00 4020 OPER ROOM40200214 DESTRUCT NRV C/T ADDL LVL $ 1,568.00 $ 1,568.00 4020 OPER ROOM40200215 DESTRUCT NRV L/S $ 2,688.00 $ 2,688.00 4020 OPER ROOM40200224 DESTRUCT NRV L/S $ 3,714.00 $ 3,714.00 4020 OPER ROOM40200216 DESTRUCT NRV L/S ADDL LVL $ 1,027.00 $ 1,027.00 4020 OPER ROOM40200229 DESTRUCT TRIG NRV $ 2,258.00 $ 2,258.00 4020 OPER ROOM40200195 ECT W NECESSRY MONITORING $ 2,663.00 $ 2,663.00 4020 OPER ROOM40200196 ECT W NECESSRY MONITORING $ 2,663.00 $ 2,663.00 4020 OPER ROOM40283149 EP ICAR FX CV GD IN SHTH $ 126.00 $ 126.00 4028 OPER ROOM40284197 EP ICAR FX CV GD IN SHTH $ 602.00 $ 602.00 4028 OPER ROOM40251009 GEN NRSTIM RECHG BAT SY $ - $ - 4025 OPER ROOM40254015 GEN NRSTIM RECHG BAT SY $ 42,717.00 $ 42,717.00 4025 OPER ROOM40200207 IJ A/S TRANS EPI C/T 1LV $ 2,594.00 $ 2,594.00 4020 OPER ROOM40255166 IMP ELBOW COMPLETE SYS A $ - $ - 4025 OPER ROOM40255068 IMP ELBOW COMPLETE SYS B $ - $ - 4025 OPER ROOM40255069 IMP ELBOW COMPLETE SYS C $ - $ - 4025 OPER ROOM40255070 IMP ELBOW COMPLETE SYS D $ - $ - 4025 OPER ROOM40255071 IMP ELBOW COMPLETE SYS E $ - $ - 4025 OPER ROOM40255072 IMP ELBOW COMPLETE SYS F $ - $ - 4025 OPER ROOM40255073 IMP ELBOW COMPLETE SYS G $ - $ - 4025 OPER ROOM40255074 IMP ELBOW COMPLETE SYS H $ - $ - 4025 OPER ROOM40255075 IMP ELBOW COMPONENT A $ - $ - 4025 OPER ROOM40255076 IMP ELBOW COMPONENT B $ - $ - 4025 OPER ROOM40255077 IMP HIP COMPLETE SYSTEM A $ - $ - 4025 OPER ROOM40255202 IMP HIP COMPLETE SYSTEM B $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40255203 IMP HIP COMPLETE SYSTEM C $ - $ - 4025 OPER ROOM40255204 IMP HIP COMPLETE SYSTEM D $ - $ - 4025 OPER ROOM40255206 IMP HIP COMPLETE SYSTEM E $ - $ - 4025 OPER ROOM40255078 IMP HIP COMPLETE SYSTEM F $ - $ - 4025 OPER ROOM40255079 IMP HIP COMPLETE SYSTEM G $ - $ - 4025 OPER ROOM40255080 IMP HIP COMPLETE SYSTEM H $ - $ - 4025 OPER ROOM40255081 IMP HIP COMPLETE SYSTEM I $ - $ - 4025 OPER ROOM40255082 IMP HIP COMPLETE SYSTEM J $ - $ - 4025 OPER ROOM40255083 IMP HIP COMPLETE SYSTEM K $ - $ - 4025 OPER ROOM40255084 IMP HIP COMPLETE SYSTEM L $ - $ - 4025 OPER ROOM40255085 IMP HIP COMPONENT A $ - $ - 4025 OPER ROOM40255086 IMP HIP COMPONENT B $ - $ - 4025 OPER ROOM40255087 IMP HIP COMPONENT C $ - $ - 4025 OPER ROOM40255088 IMP HIP COMPONENT D $ - $ - 4025 OPER ROOM40255089 IMP HIP COMPONENT E $ - $ - 4025 OPER ROOM40255090 IMP HIP COMPONENT F $ - $ - 4025 OPER ROOM40255091 IMP HIP COMPONENT G $ - $ - 4025 OPER ROOM40255092 IMP HIP HEMI A $ - $ - 4025 OPER ROOM40255093 IMP HIP HEMI B $ - $ - 4025 OPER ROOM40255094 IMP HIP HEMI C $ - $ - 4025 OPER ROOM40255095 IMP HIP HEMI D $ - $ - 4025 OPER ROOM40255096 IMP HIP HEMI E $ - $ - 4025 OPER ROOM40255097 IMP HIP HEMI F $ - $ - 4025 OPER ROOM40255098 IMP HIP HEMI G $ - $ - 4025 OPER ROOM40255109 IMP HIP HEMI H $ - $ - 4025 OPER ROOM40255027 IMP KNEE COMPLETE SYS A $ - $ - 4025 OPER ROOM40255208 IMP KNEE COMPLETE SYS B $ - $ - 4025 OPER ROOM40255209 IMP KNEE COMPLETE SYS C $ - $ - 4025 OPER ROOM40255210 IMP KNEE COMPLETE SYS D $ - $ - 4025 OPER ROOM40255212 IMP KNEE COMPLETE SYS E $ - $ - 4025 OPER ROOM40255028 IMP KNEE COMPLETE SYS F $ - $ - 4025 OPER ROOM40255029 IMP KNEE COMPLETE SYS G $ - $ - 4025 OPER ROOM40255030 IMP KNEE COMPLETE SYS H $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40255031 IMP KNEE COMPLETE SYS I $ - $ - 4025 OPER ROOM40255032 IMP KNEE COMPLETE SYS J $ - $ - 4025 OPER ROOM40255033 IMP KNEE COMPLETE SYS K $ - $ - 4025 OPER ROOM40255034 IMP KNEE COMPLETE SYS L $ - $ - 4025 OPER ROOM40255035 IMP KNEE COMPONENT A $ - $ - 4025 OPER ROOM40255036 IMP KNEE COMPONENT B $ - $ - 4025 OPER ROOM40255037 IMP KNEE COMPONENT C $ - $ - 4025 OPER ROOM40255038 IMP KNEE COMPONENT D $ - $ - 4025 OPER ROOM40255039 IMP KNEE COMPONENT E $ - $ - 4025 OPER ROOM40255040 IMP KNEE COMPONENT F $ - $ - 4025 OPER ROOM40255041 IMP KNEE COMPONENT G $ - $ - 4025 OPER ROOM40255042 IMP KNEE HEMI A $ - $ - 4025 OPER ROOM40255043 IMP KNEE HEMI B $ - $ - 4025 OPER ROOM40255044 IMP KNEE HEMI C $ - $ - 4025 OPER ROOM40255045 IMP KNEE HEMI D $ - $ - 4025 OPER ROOM40255046 IMP KNEE HEMI E $ - $ - 4025 OPER ROOM40255047 IMP KNEE HEMI F $ - $ - 4025 OPER ROOM40255048 IMP KNEE HEMI G $ - $ - 4025 OPER ROOM40255049 IMP KNEE HEMI H $ - $ - 4025 OPER ROOM40255050 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255051 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255052 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255053 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255054 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255055 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255056 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255057 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255058 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255059 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255215 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255216 IMP SHOULDER COMPLETE SYS $ - $ - 4025 OPER ROOM40255066 IMP SHOULDER COMPONENT $ - $ - 4025 OPER ROOM40255060 IMP SHOULDER COMPONENT A $ - $ - 4025 OPER ROOM

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40255061 IMP SHOULDER COMPONENT B $ - $ - 4025 OPER ROOM40255062 IMP SHOULDER COMPONENT C $ - $ - 4025 OPER ROOM40255063 IMP SHOULDER COMPONENT D $ - $ - 4025 OPER ROOM40255064 IMP SHOULDER COMPONENT E $ - $ - 4025 OPER ROOM40255065 IMP SHOULDER COMPONENT F $ - $ - 4025 OPER ROOM40255067 IMP SHOULDER COMPONENT H $ - $ - 4025 OPER ROOM40257216 IMPLANT BREAST SILICON $ - $ - 4025 OPER ROOM40200201 INJ EPID CERV THOR $ 2,594.00 $ 2,594.00 4020 OPER ROOM40200202 INJ EPIDL L/S $ 2,779.00 $ 2,779.00 4020 OPER ROOM40200230 INJ FACET L/S 1 LVL $ 2,255.00 $ 2,255.00 4020 OPER ROOM40200231 INJ FACET L/S 2 LVL $ 684.00 $ 684.00 4020 OPER ROOM40200234 INJ FACET L/S 3 LVL $ 684.00 $ 684.00 4020 OPER ROOM40200225 INJ MAJOR JNT BURSA $ 806.00 $ 806.00 4020 OPER ROOM40200226 INJ MAJOR JNT BURSA $ 1,344.00 $ 1,344.00 4020 OPER ROOM40200218 INJ NEUR0 EPI LUMB/CAUDAL $ 2,779.00 $ 2,779.00 4020 OPER ROOM40200235 INJ NRV BLK C SPINE $ 1,105.00 $ 1,105.00 4020 OPER ROOM40200208 INJ NRV BLK C/T ADDL LVL $ 855.00 $ 855.00 4020 OPER ROOM40200205 INJ NRV BLK L/S 1 LVL $ 2,779.00 $ 2,779.00 4020 OPER ROOM40200206 INJ NRV BLK L/S ADDL LVL $ 1,156.00 $ 1,156.00 4020 OPER ROOM40200219 INJ NRV BLK LUMB THOR $ 1,780.00 $ 1,780.00 4020 OPER ROOM40200209 INJ NRV BLK SCTC SNGL $ 1,780.00 $ 1,780.00 4020 OPER ROOM40200228 INJ NRV TRIGEMINAL $ 1,290.00 $ 1,290.00 4020 OPER ROOM40200232 INJ PV FACET C/T 1 LVL $ 2,330.00 $ 2,330.00 4020 OPER ROOM40200233 INJ PV FACET C/T 2 LVL $ 752.00 $ 752.00 4020 OPER ROOM40200210 INJ SI JNT ANES/STRD $ 2,779.00 $ 2,779.00 4020 OPER ROOM40200211 INJ SI JNT ANES/STRD $ 735.00 $ 735.00 4020 OPER ROOM40200217 INJ SPINE W CATH L/S $ - $ - 4020 OPER ROOM40200227 INJ/ASP INT JNT/BURSA $ 699.00 $ 699.00 4020 OPER ROOM40247674 ISOSULFAN BLUE $ 1,975.00 $ 1,975.00 4024 OPER ROOM40200177 LITHO ESWL BILAT $ 25,492.00 $ 25,492.00 4020 OPER ROOM40200176 LITHO ESWL UNILAT $ 20,315.00 $ 20,315.00 4020 OPER ROOM40200222 LYSIS EPI ADHES 1 DAY $ 1,591.00 $ 1,591.00 4020 OPER ROOM40200212 PERC IMPL NS EL ARRAY EPI $ 2,886.00 $ 2,886.00 4020 OPER ROOM

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DEPARTMENT CODE

40254014 S ADAP/EXT PCE/NEURSTM LD $ - $ - 4025 OPER ROOM40254231 S ANCHR $ 689.00 $ 689.00 4025 OPER ROOM40254232 S ANCHR $ 795.00 $ 795.00 4025 OPER ROOM40254233 S ANCHR $ 901.00 $ 901.00 4025 OPER ROOM40254234 S ANCHR $ 1,007.00 $ 1,007.00 4025 OPER ROOM40254235 S ANCHR $ 1,113.00 $ 1,113.00 4025 OPER ROOM40254236 S ANCHR $ 1,219.00 $ 1,219.00 4025 OPER ROOM40254237 S ANCHR $ 1,325.00 $ 1,325.00 4025 OPER ROOM40254238 S ANCHR $ 1,431.00 $ 1,431.00 4025 OPER ROOM40254239 S ANCHR $ 1,537.00 $ 1,537.00 4025 OPER ROOM40254240 S ANCHR $ 1,643.00 $ 1,643.00 4025 OPER ROOM40254241 S ANCHR $ 1,749.00 $ 1,749.00 4025 OPER ROOM40254242 S ANCHR $ 1,855.00 $ 1,855.00 4025 OPER ROOM40254243 S ANCHR $ 1,961.00 $ 1,961.00 4025 OPER ROOM40255124 S ANCHR $ 932.00 $ 932.00 4025 OPER ROOM40255130 S ANCHR $ 846.00 $ 846.00 4025 OPER ROOM40255131 S ANCHR $ 1,438.00 $ 1,438.00 4025 OPER ROOM40255148 S ANCHR $ 1,767.00 $ 1,767.00 4025 OPER ROOM40255149 S ANCHR $ 3,053.00 $ 3,053.00 4025 OPER ROOM40255196 S ANCHR $ 930.00 $ 930.00 4025 OPER ROOM40255198 S ANCHR $ 1,260.00 $ 1,260.00 4025 OPER ROOM40255199 S ANCHR $ 1,577.00 $ 1,577.00 4025 OPER ROOM40255222 S ANCHR $ 1,877.00 $ 1,877.00 4025 OPER ROOM40255223 S ANCHR $ 1,102.00 $ 1,102.00 4025 OPER ROOM40255225 S ANCHR $ 1,092.00 $ 1,092.00 4025 OPER ROOM40255227 S ANCHR $ 2,166.00 $ 2,166.00 4025 OPER ROOM40255231 S ANCHR $ 1,340.00 $ 1,340.00 4025 OPER ROOM40255175 S ANCHR PIN KNOWLES $ 259.00 $ 259.00 4025 OPER ROOM40255178 S ANCHR PIN STADER $ 901.00 $ 901.00 4025 OPER ROOM40255176 S ANCHR ROD RUSH $ 597.00 $ 597.00 4025 OPER ROOM40255165 S ANCHR STAPLE BONE $ - $ - 4025 OPER ROOM40254123 S BARRIER ADHESION $ 962.00 $ 962.00 4025 OPER ROOM40254124 S BARRIER ADHESION $ 1,006.00 $ 1,006.00 4025 OPER ROOM

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DEPARTMENT CODE

40254125 S BARRIER ADHESION $ 1,341.00 $ 1,341.00 4025 OPER ROOM40247458 S CATH BLN DILATE NOVSC $ 3,770.00 $ 3,770.00 4024 OPER ROOM40247725 S CATH BLN DILATE NOVSC $ 664.00 $ 664.00 4024 OPER ROOM40283126 S CATH BLN DILATE NOVSC $ 1,538.00 $ 1,538.00 4028 OPER ROOM40286991 S CATH BLN DILATE NOVSC $ 1,084.00 $ 1,084.00 4028 OPER ROOM40287000 S CATH BLN DILATE NOVSC $ 2,098.00 $ 2,098.00 4028 OPER ROOM40247700 S CATH BLN TIS DSCT NOVSC $ 1,591.00 $ 1,591.00 4024 OPER ROOM40247701 S CATH BLN TIS DSCT NOVSC $ 1,717.00 $ 1,717.00 4024 OPER ROOM40247780 S CATH BLN TIS DSCT NOVSC $ 899.00 $ 899.00 4024 OPER ROOM40283104 S CATH BLN TIS DSCT NOVSC $ 471.00 $ 471.00 4028 OPER ROOM40285154 S CATH BLN TIS DSCT NOVSC $ 16,359.00 $ 16,359.00 4028 OPER ROOM40287296 S CATH BLN TIS DSCT NOVSC $ 16,824.00 $ 16,824.00 4028 OPER ROOM40287297 S CATH BLN TIS DSCT NOVSC $ 11,446.00 $ 11,446.00 4028 OPER ROOM40247804 S CATH DRAINAGE $ 84.00 $ 84.00 4024 OPER ROOM40247812 S CATH DRAINAGE $ 1,600.00 $ 1,600.00 4024 OPER ROOM40247814 S CATH DRAINAGE $ 497.00 $ 497.00 4024 OPER ROOM40283135 S CATH DRAINAGE $ 173.00 $ 173.00 4028 OPER ROOM40284238 S CATH DRAINAGE $ 306.00 $ 306.00 4028 OPER ROOM40284239 S CATH DRAINAGE $ 460.00 $ 460.00 4028 OPER ROOM40247466 S CATH GUIDING $ 1,702.00 $ 1,702.00 4024 OPER ROOM40247301 S CATH HD SHORT TERM $ 331.00 $ 331.00 4024 OPER ROOM40257136 S CATH HD SHORT TERM $ 649.00 $ 649.00 4025 OPER ROOM40283098 S CATH HD SHORT TERM $ - $ - 4028 OPER ROOM40257137 S CATH HD/PERTNL LNG TRM $ 944.00 $ 944.00 4025 OPER ROOM40257139 S CATH HD/PERTNL LNG TRM $ 1,109.00 $ 1,109.00 4025 OPER ROOM40283099 S CATH HD/PERTNL LNG TRM $ - $ - 4028 OPER ROOM40283136 S CATH HD/PERTNL LNG TRM $ 1,771.00 $ 1,771.00 4028 OPER ROOM40283152 S CATH HD/PERTNL LNG TRM $ 2,287.00 $ 2,287.00 4028 OPER ROOM40283182 S CATH HD/PERTNL LNG TRM $ 2,745.00 $ 2,745.00 4028 OPER ROOM40247274 S CATH INFSN NO HD $ 818.00 $ 818.00 4024 OPER ROOM40247275 S CATH INFSN NO HD $ 1,614.00 $ 1,614.00 4024 OPER ROOM40247281 S CATH INFSN NO HD $ 2,067.00 $ 2,067.00 4024 OPER ROOM40247295 S CATH INFSN NO HD $ 3,682.00 $ 3,682.00 4024 OPER ROOM

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DEPARTMENT CODE

40247296 S CATH INFSN NO HD $ - $ - 4024 OPER ROOM40257140 S CATH INFSN NO HD $ 4,487.00 $ 4,487.00 4025 OPER ROOM40283117 S CATH INFSN NO HD $ 3,051.00 $ 3,051.00 4028 OPER ROOM40283119 S CATH INFSN NO HD $ 3,306.00 $ 3,306.00 4028 OPER ROOM40283120 S CATH INFSN NO HD $ 1,138.00 $ 1,138.00 4028 OPER ROOM40283121 S CATH INFSN NO HD $ 1,310.00 $ 1,310.00 4028 OPER ROOM40283122 S CATH INFSN NO HD $ 1,508.00 $ 1,508.00 4028 OPER ROOM40283142 S CATH INFSN NO HD $ 1,428.00 $ 1,428.00 4028 OPER ROOM40254001 S CATH INTRASPINAL $ - $ - 4025 OPER ROOM40254007 S CATH INTRASPINAL $ 473.00 $ 473.00 4025 OPER ROOM40254008 S CATH INTRASPINAL $ 190.00 $ 190.00 4025 OPER ROOM40257376 S CATH INTRASPINAL $ 2,691.00 $ 2,691.00 4025 OPER ROOM40287206 S CATH INTRASPINAL $ 1,335.00 $ 1,335.00 4028 OPER ROOM40287013 S CATH OCCLUSION $ 1,000.00 $ 1,000.00 4028 OPER ROOM40247229 S CATH SP/CYSTOSCOPIC $ 80.00 $ 80.00 4024 OPER ROOM40247781 S CATH SP/CYSTOSCOPIC $ 144.00 $ 144.00 4024 OPER ROOM40283108 S CATH SP/CYSTOSCOPIC $ 232.00 $ 232.00 4028 OPER ROOM40287008 S CATH SP/CYSTOSCOPIC $ 366.00 $ 366.00 4028 OPER ROOM40283110 S CATH THROMB/EMBOLCTMY $ 622.00 $ 622.00 4028 OPER ROOM40283111 S CATH THROMB/EMBOLCTMY $ 228.00 $ 228.00 4028 OPER ROOM40283125 S CATH URETERAL $ 114.00 $ 114.00 4028 OPER ROOM40247798 S CATH URETERAL RYL FLSH $ 130.00 $ 130.00 4024 OPER ROOM40251010 S DVC RPR URN INC NOSLG $ - $ - 4025 OPER ROOM40257176 S DVC RPR URN INC NOSLG $ 4,221.00 $ 4,221.00 4025 OPER ROOM40251004 S DVC RPR URN INCN SLNG $ - $ - 4025 OPER ROOM40257123 S DVC RPR URN INCN SLNG $ 4,020.00 $ 4,020.00 4025 OPER ROOM40257124 S DVC RPR URN INCN SLNG $ 4,221.00 $ 4,221.00 4025 OPER ROOM40257128 S DVC RPR URN INCN SLNG $ 6,686.00 $ 6,686.00 4025 OPER ROOM40257174 S DVC RPR URN INCN SLNG $ 5,635.00 $ 5,635.00 4025 OPER ROOM40257175 S DVC RPR URN INCN SLNG $ 2,989.00 $ 2,989.00 4025 OPER ROOM40254153 S FILTER VENA CAVA $ 4,275.00 $ 4,275.00 4025 OPER ROOM40254154 S FILTER VENA CAVA $ 5,819.00 $ 5,819.00 4025 OPER ROOM40251002 S GEN NEUROSTIM NONRECHG $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40254004 S GEN NEUROSTIM NONRECHG $ 42,068.00 $ 42,068.00 4025 OPER ROOM40254016 S GEN NEUROSTIM NONRECHG $ - $ - 4025 OPER ROOM40254136 S GRAFT VASCULAR $ - $ - 4025 OPER ROOM40254137 S GRAFT VASCULAR $ 1,611.00 $ 1,611.00 4025 OPER ROOM40254141 S GRAFT VASCULAR $ 1,067.00 $ 1,067.00 4025 OPER ROOM40257111 S GRAFT VASCULAR $ 1,884.00 $ 1,884.00 4025 OPER ROOM40257112 S GRAFT VASCULAR $ 3,765.00 $ 3,765.00 4025 OPER ROOM40257117 S GRAFT VASCULAR $ - $ - 4025 OPER ROOM40255180 S IMP 18 GA $ 91.00 $ 91.00 4025 OPER ROOM40255126 S IMP ANCHR MENSCL T-FIX $ 1,027.00 $ 1,027.00 4025 OPER ROOM40255117 S IMP ANCHR TIS/BNE/BNE $ 792.00 $ 792.00 4025 OPER ROOM40257300 S IMP ANEURYSM CLIP-PERMA $ 1,843.00 $ 1,843.00 4025 OPER ROOM40254225 S IMP BAND GASTRIC ADJUST $ 14,538.00 $ 14,538.00 4025 OPER ROOM40254226 S IMP BAND GASTRIC RLSE $ 10,433.00 $ 10,433.00 4025 OPER ROOM40254159 S IMP BAND STERNSL $ 278.00 $ 278.00 4025 OPER ROOM40257373 S IMP BICOL COLLAGEN SPO $ 453.00 $ 453.00 4025 OPER ROOM40255155 S IMP BONE SCREWS $ - $ - 4025 OPER ROOM40257154 S IMP BUTTON ENDO ACUFEX $ 562.00 $ 562.00 4025 OPER ROOM40257157 S IMP BUTTON GASTROSTOMY $ 1,487.00 $ 1,487.00 4025 OPER ROOM40257182 S IMP BUTTON NASAL $ 741.00 $ 741.00 4025 OPER ROOM40257156 S IMP CATH/PRT GASTRSTMY $ 457.00 $ 457.00 4025 OPER ROOM40255237 S IMP CBL SPR KNMD ORTHO $ 1,486.00 $ 1,486.00 4025 OPER ROOM40255192 S IMP CEMENT RESTRICTOR $ 502.00 $ 502.00 4025 OPER ROOM40257212 S IMP CLIP BIEMER LG $ 674.00 $ 674.00 4025 OPER ROOM40257062 S IMP CLIP FILSHIE GYN $ 529.00 $ 529.00 4025 OPER ROOM40257159 S IMP CLIP HEMOLCK EX LG $ 333.00 $ 333.00 4025 OPER ROOM40257158 S IMP CLIP LAPRATY $ 538.00 $ 538.00 4025 OPER ROOM40254172 S IMP CNTRA ILIAC LNG ZNT $ 12,599.00 $ 12,599.00 4025 OPER ROOM40257302 S IMP CODMAN UNISHUNT $ 3,559.00 $ 3,559.00 4025 OPER ROOM40257161 S IMP COIL FLLPN ESURE 2 $ 6,781.00 $ 6,781.00 4025 OPER ROOM40257155 S IMP CONNCT SHNT ST/ANG $ 105.00 $ 105.00 4025 OPER ROOM40254171 S IMP CONVERTER ZENITH $ 12,578.00 $ 12,578.00 4025 OPER ROOM40257305 S IMP COVER BURR HOLE $ 414.00 $ 414.00 4025 OPER ROOM

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DEPARTMENT CODE

40257374 S IMP CRANIOPLAST MAT KIT $ 3,399.00 $ 3,399.00 4025 OPER ROOM40254217 S IMP CRYO PULM VALV COND $ - $ - 4025 OPER ROOM40254216 S IMP CRYOAORTIC VALV CON $ - $ - 4025 OPER ROOM40254220 S IMP CRYOPR SAPHEN VEIN $ - $ - 4025 OPER ROOM40254218 S IMP CRYOPRE THORA AORTA $ - $ - 4025 OPER ROOM40255153 S IMP DALL MILES CABLE $ 1,715.00 $ 1,715.00 4025 OPER ROOM40255152 S IMP DALL MILES GRIP $ 4,827.00 $ 4,827.00 4025 OPER ROOM40255151 S IMP DALL MILES PLATE $ 2,126.00 $ 2,126.00 4025 OPER ROOM40257301 S IMP DELTA UNISHUNT $ 6,052.00 $ 6,052.00 4025 OPER ROOM40257303 S IMP DELTA VALVE $ 4,791.00 $ 4,791.00 4025 OPER ROOM40257133 S IMP DENVER SHUNT $ 3,863.00 $ 3,863.00 4025 OPER ROOM40257134 S IMP DENVER SHUNT CONN $ 412.00 $ 412.00 4025 OPER ROOM40256117 S IMP DERMAGRAFT $ 3,446.00 $ 3,446.00 4025 OPER ROOM40256203 S IMP DEVICE REPOSE KIT $ 7,742.00 $ 7,742.00 4025 OPER ROOM40257315 S IMP DURAFILM $ 2,142.00 $ 2,142.00 4025 OPER ROOM40255318 S IMP DURASEAL $ 2,697.00 $ 2,697.00 4025 OPER ROOM40257402 S IMP EAR INCUS SHEEHY $ 296.00 $ 296.00 4025 OPER ROOM40257401 S IMP EAR RIBBON PLATINM $ 818.00 $ 818.00 4025 OPER ROOM40255179 S IMP ENDER NAIL $ 424.00 $ 424.00 4025 OPER ROOM40257210 S IMP ENDOCLIP $ 1,444.00 $ 1,444.00 4025 OPER ROOM40254168 S IMP ENDOGRFT MN BDY ZNT $ 39,226.00 $ 39,226.00 4025 OPER ROOM40257178 S IMP ENDOTINE $ 1,035.00 $ 1,035.00 4025 OPER ROOM40257186 S IMP ETHICLIPS $ 55.00 $ 55.00 4025 OPER ROOM40254167 S IMP EXT AORT CUFF 3.75C $ 10,522.00 $ 10,522.00 4025 OPER ROOM40254166 S IMP EXT ILIAC CUFF 5.5C $ 10,522.00 $ 10,522.00 4025 OPER ROOM40254169 S IMP EXT MAIN BODY ZNTH $ 6,515.00 $ 6,515.00 4025 OPER ROOM40257160 S IMP FALLOPE RINGS $ 424.00 $ 424.00 4025 OPER ROOM40257164 S IMP FASTNR EXTR PK STOM $ 606.00 $ 606.00 4025 OPER ROOM40257215 S IMP FINGER JOINT $ - $ - 4025 OPER ROOM40257121 S IMP FIX DVC LAP SOLUT 2 $ 1,348.00 $ 1,348.00 4025 OPER ROOM40257405 S IMP GOOD T GROMMET $ 177.00 $ 177.00 4025 OPER ROOM40257412 S IMP GROMMET SHEPPARD $ 170.00 $ 170.00 4025 OPER ROOM40257090 S IMP HEMOLOCK CLIPS $ 226.00 $ 226.00 4025 OPER ROOM

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DEPARTMENT CODE

40256153 S IMP HYDROXYAPP ORBITAL $ 4,449.00 $ 4,449.00 4025 OPER ROOM40255181 S IMP IM NAIL $ - $ - 4025 OPER ROOM40247630 S IMP INST MAK MENIS D $ 551.00 $ 551.00 4024 OPER ROOM40254170 S IMP IPSLT ILIAC LNG ZNT $ 12,599.00 $ 12,599.00 4025 OPER ROOM40255105 S IMP K-WIRE $ 82.00 $ 82.00 4025 OPER ROOM40257181 S IMP LACTOSORB BROW $ 782.00 $ 782.00 4025 OPER ROOM40257132 S IMP LAVEEN SHUNT $ 2,639.00 $ 2,639.00 4025 OPER ROOM40256164 S IMP MEMBRN AMBIO DY2X3 $ 3,394.00 $ 3,394.00 4025 OPER ROOM40251000 S IMP MISC IMPLANT $ - $ - 4025 OPER ROOM40257331 S IMP NEUROCARDIAC CATH $ 1,255.00 $ 1,255.00 4025 OPER ROOM40257333 S IMP NEUROPERITONE CATH $ 957.00 $ 957.00 4025 OPER ROOM40257328 S IMP NEURO-VALVE-RESERV $ - $ - 4025 OPER ROOM40257332 S IMP NEUROVENTRICU CATH $ 676.00 $ 676.00 4025 OPER ROOM40256157 S IMP OCULR DRNG ASST DVC $ 3,817.00 $ 3,817.00 4025 OPER ROOM40256158 S IMP OCULR DRNG ASST DVC $ 3,122.00 $ 3,122.00 4025 OPER ROOM40286184 S IMP OCULR DRNG ASST DVC $ 281.00 $ 281.00 4028 OPER ROOM40257329 S IMP OMMAYA RESERVOIR $ - $ - 4025 OPER ROOM40257191 S IMP OPTH SPHERE PLASTIC $ 139.00 $ 139.00 4025 OPER ROOM40255120 S IMP PIN STEINMAN $ 210.00 $ 210.00 4025 OPER ROOM40255110 S IMP PINS RUSH $ 349.00 $ 349.00 4025 OPER ROOM40255111 S IMP PLATE ASIF RECNSTR $ - $ - 4025 OPER ROOM40255190 S IMP PLATES $ - $ - 4025 OPER ROOM40250050 S IMP PROVIDED BY OTHER $ 1.00 $ 1.00 4025 OPER ROOM40256174 S IMP PTCH AMNIOTC MEMBR $ - $ - 4025 OPER ROOM40256161 S IMP RING CPSL TNSN 14C $ 1,115.00 $ 1,115.00 4025 OPER ROOM40256160 S IMP RING TENSN FIX $ 1,356.00 $ 1,356.00 4025 OPER ROOM40254213 S IMP RING TRICUSPID $ - $ - 4025 OPER ROOM40255101 S IMP ROD HUNTER TENDON $ 1,299.00 $ 1,299.00 4025 OPER ROOM40254146 S IMP SAUVAGE FABRIC 6X6 $ 1,277.00 $ 1,277.00 4025 OPER ROOM40254148 S IMP SAUVAGE FABRIC-1X1 $ 396.00 $ 396.00 4025 OPER ROOM40256165 S IMP SCLERAL SPONGE $ 491.00 $ 491.00 4025 OPER ROOM40257407 S IMP SHEA PLTNM CUPP PI $ 813.00 $ 813.00 4025 OPER ROOM40254121 S IMP SHEET MEDPOR FLAT $ 728.00 $ 728.00 4025 OPER ROOM

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DEPARTMENT CODE

40254122 S IMP SHEET MEDPOR ROUND $ 1,767.00 $ 1,767.00 4025 OPER ROOM40254118 S IMP SHEET SILASTIC $ 741.00 $ 741.00 4025 OPER ROOM40257183 S IMP SHEET SILICONE ENT $ 146.00 $ 146.00 4025 OPER ROOM40257304 S IMP SHNT LUMB-PRTNL SPZ $ 2,860.00 $ 2,860.00 4025 OPER ROOM40256159 S IMP SHT MEDPORE TITAN $ 1,753.00 $ 1,753.00 4025 OPER ROOM40256170 S IMP SILCONE BAND/BUCKLE $ 136.00 $ 136.00 4025 OPER ROOM40256105 S IMP SILICONE TIRE $ 188.00 $ 188.00 4025 OPER ROOM40255183 S IMP SPINE $ - $ - 4025 OPER ROOM40255184 S IMP SPINE $ - $ - 4025 OPER ROOM40255185 S IMP SPINE $ - $ - 4025 OPER ROOM40255186 S IMP SPINE $ - $ - 4025 OPER ROOM40255164 S IMP SPKD WASH SYNT $ 183.00 $ 183.00 4025 OPER ROOM40255113 S IMP STAPLE 3M $ 860.00 $ 860.00 4025 OPER ROOM40255128 S IMP STAPLE SPIKE RICHD $ 483.00 $ 483.00 4025 OPER ROOM40254161 S IMP STENT ENDO $ - $ - 4025 OPER ROOM40254163 S IMP STNT BIFUR GRAFT 16 $ 39,226.00 $ 39,226.00 4025 OPER ROOM40257211 S IMP STNT ENDPYLOT/T-TUB $ 1,468.00 $ 1,468.00 4025 OPER ROOM40254165 S IMP STNT ILIAC LEG 11.5 $ 12,599.00 $ 12,599.00 4025 OPER ROOM40254164 S IMP STNT ILIAC LEG 8.5 $ 11,559.00 $ 11,559.00 4025 OPER ROOM40257184 S IMP SUSPN FRONTALIS $ 377.00 $ 377.00 4025 OPER ROOM40254117 S IMP SUTLESS MYOCARD LD $ 4,098.00 $ 4,098.00 4025 OPER ROOM40255224 S IMP SUTURE TAK ARTHS $ 1,654.00 $ 1,654.00 4025 OPER ROOM40257406 S IMP TB RUTER BOBBN S&N $ 295.00 $ 295.00 4025 OPER ROOM40257193 S IMP TEFLN PLTNM PISTON $ 766.00 $ 766.00 4025 OPER ROOM40254139 S IMP TEFLON FELT 2 X2 $ 144.00 $ 144.00 4025 OPER ROOM40254140 S IMP TEFLON FELT 4 X4 $ 240.00 $ 240.00 4025 OPER ROOM40254145 S IMP TEFLON FELT 6 X6 $ 306.00 $ 306.00 4025 OPER ROOM40254158 S IMP TEFLON PLEDGET $ 189.00 $ 189.00 4025 OPER ROOM40257201 S IMP TESTICULAR IMPLANT $ - $ - 4025 OPER ROOM40255118 S IMP TISS CONNCT NOHUMN $ 1,144.00 $ 1,144.00 4025 OPER ROOM40251003 S IMP TRIAL IMPLANT $ 1.00 $ 1.00 4025 OPER ROOM40257195 S IMP TUBE LACRIMAL JACK $ 326.00 $ 326.00 4025 OPER ROOM40257413 S IMP TUBE REUTER BOBBIN $ 240.00 $ 240.00 4025 OPER ROOM

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DEPARTMENT CODE

40254215 S IMP VALVE HEART $ - $ - 4025 OPER ROOM40254162 S IMP VALVED CONDUIT $ - $ - 4025 OPER ROOM40255195 S IMP WASHER VITALIUM $ 585.00 $ 585.00 4025 OPER ROOM40256168 S IMP WATSKE SILICONE SLV $ 93.00 $ 93.00 4025 OPER ROOM40257185 S IMP WECK CLIPS $ 213.00 $ 213.00 4025 OPER ROOM40257189 S IMP WEIGHT GOLD $ 1,239.00 $ 1,239.00 4025 OPER ROOM40255122 S IMP WIRE BUNNEL PULOUT $ 61.00 $ 61.00 4025 OPER ROOM40255112 S IMP WIRE HOUSE $ 183.00 $ 183.00 4025 OPER ROOM40255123 S IMP WIRE STAINLS STEEL $ 109.00 $ 109.00 4025 OPER ROOM40254223 S IMP WIRE STERNAL $ 279.00 $ 279.00 4025 OPER ROOM40254222 S IMP WIRE STERNAL MYO $ 335.00 $ 335.00 4025 OPER ROOM40255127 S IMP WIRE VITAL $ 109.00 $ 109.00 4025 OPER ROOM40283146 S INTR NOINTRACRD NOLSR $ 107.00 $ 107.00 4028 OPER ROOM40283147 S INTR NOINTRACRD NOLSR $ 236.00 $ 236.00 4028 OPER ROOM40251008 S INV DVC MISC $ - $ - 4025 OPER ROOM40256142 S IOL ANTERIOR CHAMBER $ 3,785.00 $ 3,785.00 4025 OPER ROOM40256148 S IOL ANTERIOR CHAMBER $ 703.00 $ 703.00 4025 OPER ROOM40257192 S IOL ANTERIOR CHAMBER $ - $ - 4025 OPER ROOM40256146 S IOL ASTIGMATISM CORRECT $ 2,039.00 $ 2,039.00 4025 OPER ROOM40256147 S IOL ASTIGMATISM CORRECT $ - $ - 4025 OPER ROOM40256143 S IOL POSTERIOR CHAMBER $ - $ - 4025 OPER ROOM40256144 S IOL POSTERIOR CHAMBER $ 915.00 $ 915.00 4025 OPER ROOM40256145 S IOL POSTERIOR CHAMBER $ 4,423.00 $ 4,423.00 4025 OPER ROOM40257180 S IOL POSTERIOR CHAMBER $ 4,875.00 $ 4,875.00 4025 OPER ROOM40282109 S LD NEUROSTIM TEST KIT $ 1,096.48 $ 1,096.48 4028 OPER ROOM40254002 S LD NEUROSTIMULATOR $ - $ - 4025 OPER ROOM40254011 S LD NEUROSTIMULATOR $ 13,203.00 $ 13,203.00 4025 OPER ROOM40254013 S LD NEUROSTIMULATOR $ 2,697.00 $ 2,697.00 4025 OPER ROOM40254160 S LD PCR IMPLNT GROUND $ 310.00 $ 310.00 4025 OPER ROOM40284223 S LD PCR PACE TMP OSC $ 190.00 $ 190.00 4028 OPER ROOM40254182 S LD PCR PACEMAKER LEAD $ - $ - 4025 OPER ROOM40254181 S LD PCR SCREW IN 53CM $ 2,723.00 $ 2,723.00 4025 OPER ROOM40254156 S LD PCR TV VDD 1 PASS $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40251007 S MESH IMPLANT $ - $ - 4025 OPER ROOM40257122 S MESH IMPLANT $ 634.00 $ 634.00 4025 OPER ROOM40257125 S MESH IMPLANT $ 8,972.00 $ 8,972.00 4025 OPER ROOM40257126 S MESH IMPLANT $ 1,807.00 $ 1,807.00 4025 OPER ROOM40257127 S MESH IMPLANT $ 3,093.00 $ 3,093.00 4025 OPER ROOM40257129 S MESH IMPLANT $ 1,368.00 $ 1,368.00 4025 OPER ROOM40257149 S MESH IMPLANT KGEL PATCH $ 1,433.00 $ 1,433.00 4025 OPER ROOM40257162 S MESH IMPLANT KGL CMP OS $ 3,141.00 $ 3,141.00 4025 OPER ROOM40257151 S MESH IMPLANT KGL PATCH $ 1,747.00 $ 1,747.00 4025 OPER ROOM40257153 S MESH IMPLANT KGL PATCH $ 2,147.00 $ 2,147.00 4025 OPER ROOM40257143 S MESH IMPLANT KY 1.8 $ 508.00 $ 508.00 4025 OPER ROOM40257144 S MESH IMPLANT MARLEX MED $ 831.00 $ 831.00 4025 OPER ROOM40257148 S MESH IMPLANT MRLX PLG $ 1,416.00 $ 1,416.00 4025 OPER ROOM40257150 S MESH IMPLANT MRLX PLG X $ 1,767.00 $ 1,767.00 4025 OPER ROOM40257135 S MESH IMPLANT PLUG SM $ 741.00 $ 741.00 4025 OPER ROOM40257163 S MESH IMPLANT PLVSFT GYN $ 2,723.00 $ 2,723.00 4025 OPER ROOM40257146 S MESH IMPLANT PROLENE LG $ 1,313.00 $ 1,313.00 4025 OPER ROOM40257147 S MESH IMPLANT PROLENE M $ 479.00 $ 479.00 4025 OPER ROOM40257145 S MESH IMPLANT PROLENE SM $ 412.00 $ 412.00 4025 OPER ROOM40257130 S MESH IMPLANT VNTRLX LG $ 2,506.00 $ 2,506.00 4025 OPER ROOM40257131 S MESH IMPLANT VNTRLX SM $ 2,097.00 $ 2,097.00 4025 OPER ROOM40283101 S MORCELLATOR $ 3,041.00 $ 3,041.00 4028 OPER ROOM40283102 S MORCELLATOR GYNCARE $ 2,958.00 $ 2,958.00 4028 OPER ROOM40282104 S NEUROSTIM PATIENT PRGRM $ 5,419.00 $ 5,419.00 4028 OPER ROOM40287205 S NEUROSTIM PATIENT PRGRM $ - $ - 4028 OPER ROOM40254012 S NEUROSTIM RECVR/TRNSMTR $ 42,717.00 $ 42,717.00 4025 OPER ROOM40287204 S NEUROSTIM RECVR/TRNSMTR $ - $ - 4028 OPER ROOM40234228 S NSTRL ABC GRND PAD $ 408.00 $ 408.00 4023 OPER ROOM40247315 S NSTRL ARM ELEV SLING $ 126.00 $ 126.00 4024 OPER ROOM40288150 S NSTRL ARM SLING $ 42.00 $ 42.00 4028 OPER ROOM40231115 S NSTRL BAIR HUGER BLKT $ 123.00 $ 123.00 4023 OPER ROOM40231119 S NSTRL BAIR HUGER CV STE $ 453.00 $ 453.00 4023 OPER ROOM40231111 S NSTRL BLNK BR UNDRBDY $ 211.00 $ 211.00 4023 OPER ROOM

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40231123 S NSTRL CAST PLASTR LONG $ 110.00 $ 110.00 4023 OPER ROOM40231122 S NSTRL CAST PLSTR SHORT $ 70.00 $ 70.00 4023 OPER ROOM40231110 S NSTRL COMPRS SLEV KNEE $ 277.00 $ 277.00 4023 OPER ROOM40234235 S NSTRL DRSG EPIFOAM $ 91.00 $ 91.00 4023 OPER ROOM40288171 S NSTRL FIBRGLS CAST ROLL $ 117.00 $ 117.00 4028 OPER ROOM40234236 S NSTRL GOWN BR PAWS STND $ 117.00 $ 117.00 4023 OPER ROOM40234237 S NSTRL GOWN BR PAWS XL $ 144.00 $ 144.00 4023 OPER ROOM40234229 S NSTRL GRND PD THRMGURD $ 51.00 $ 51.00 4023 OPER ROOM40288121 S NSTRL HYGINET/BANDNET $ 58.00 $ 58.00 4028 OPER ROOM40234234 S NSTRL IPC FT WRP RG/LG $ 217.00 $ 217.00 4023 OPER ROOM40234231 S NSTRL IPC KNEE DVT 10 $ 158.00 $ 158.00 4023 OPER ROOM40234232 S NSTRL IPC KNEE DVT 20 $ 216.00 $ 216.00 4023 OPER ROOM40234233 S NSTRL IPC THGH DVT30/40 $ 273.00 $ 273.00 4023 OPER ROOM40285145 S NSTRL KNEE IMMOBILIZER $ 520.00 $ 520.00 4028 OPER ROOM40247634 S NSTRL KNEE IMMOBILIZR $ 120.00 $ 120.00 4024 OPER ROOM40231114 S NSTRL K-PAD LG $ 437.00 $ 437.00 4023 OPER ROOM40231113 S NSTRL K-PAD SM $ 136.00 $ 136.00 4023 OPER ROOM40247494 S NSTRL MASK IMG GUID ENT $ 1,159.00 $ 1,159.00 4024 OPER ROOM40239143 S NSTRL MCCONNELL WRAP $ 278.00 $ 278.00 4023 OPER ROOM40234238 S NSTRL MSTECTOMY SUPPRT $ 104.00 $ 104.00 4023 OPER ROOM40287181 S NSTRL PAD GRND PED/RADI $ 137.00 $ 137.00 4028 OPER ROOM40288148 S NSTRL PADS GROUND RITA $ 1,006.00 $ 1,006.00 4028 OPER ROOM40247379 S NSTRL POST-OP SHOE $ 91.00 $ 91.00 4024 OPER ROOM40231105 S NSTRL SKIN TRAC TAPE $ 45.00 $ 45.00 4023 OPER ROOM40288151 S NSTRL SLING JOSLIN $ 169.00 $ 169.00 4028 OPER ROOM40231124 S NSTRL SPICA PLASTER $ 125.00 $ 125.00 4023 OPER ROOM40231120 S NSTRL SPLNT PLASTR ARM $ 58.00 $ 58.00 4023 OPER ROOM40231121 S NSTRL SPLNT PLASTR LEG $ 98.00 $ 98.00 4023 OPER ROOM40254183 S PCR 1 CHMBR NRR $ - $ - 4025 OPER ROOM40254180 S PCR 1 CHMBR RR $ - $ - 4025 OPER ROOM40254184 S PCR 2 CHMBR NRR $ - $ - 4025 OPER ROOM40254177 S PCR 2 CHMBR RR $ - $ - 4025 OPER ROOM40254179 S PCR ICD DUAL CHAMBER $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40254185 S PCR NOT 1 OR 2 CHMBR $ - $ - 4025 OPER ROOM40250216 S PORT INDWELLING $ 1,733.00 $ 1,733.00 4025 OPER ROOM40250217 S PORT INDWELLING $ 2,390.68 $ 2,390.68 4025 OPER ROOM40250218 S PORT INDWELLING $ 1,864.40 $ 1,864.40 4025 OPER ROOM40250219 S PORT INDWELLING $ 3,106.57 $ 3,106.57 4025 OPER ROOM40283100 S PORT INDWELLING $ - $ - 4028 OPER ROOM40283116 S PORT INDWELLING $ 3,898.00 $ 3,898.00 4028 OPER ROOM40255317 S PR CLGN IMP URN 2.5 ML $ - $ - 4025 OPER ROOM40257408 S PROS EAR MIDLE ROBIN P $ 723.00 $ 723.00 4025 OPER ROOM40255125 S PROS FINGER SWANSON $ 1,471.00 $ 1,471.00 4025 OPER ROOM40255115 S PROS TOE SCARLTO-LAPRT $ 1,728.00 $ 1,728.00 4025 OPER ROOM40255108 S PROS WRIST $ - $ - 4025 OPER ROOM40257200 S PROSTH BREAST $ - $ - 4025 OPER ROOM40257202 S PROSTH PENILE INFLTBL $ - $ - 4025 OPER ROOM40257214 S PROSTH PENILE NOINFLTBL $ - $ - 4025 OPER ROOM40254010 S PUMP INFSN NOPRGRM PERM $ - $ - 4025 OPER ROOM40254003 S PUMP INFSN PROGRAMABLE $ - $ - 4025 OPER ROOM40255121 S SCRW $ 823.00 $ 823.00 4025 OPER ROOM40255129 S SCRW $ 1,135.00 $ 1,135.00 4025 OPER ROOM40255156 S SCRW $ 1,535.00 $ 1,535.00 4025 OPER ROOM40255221 S SCRW $ 952.00 $ 952.00 4025 OPER ROOM40255229 S SCRW $ 1,489.00 $ 1,489.00 4025 OPER ROOM40255234 S SCRW $ 691.00 $ 691.00 4025 OPER ROOM40255235 S SCRW $ 643.00 $ 643.00 4025 OPER ROOM40256204 S SCRW $ 1,498.00 $ 1,498.00 4025 OPER ROOM40255099 S SCRW BN CEMENT W ANTIBC $ 1,300.00 $ 1,300.00 4025 OPER ROOM40255194 S SCRW BONE BLOCK 2X3 $ 4,331.00 $ 4,331.00 4025 OPER ROOM40255193 S SCRW BONE CHIPS 15CC $ 2,480.00 $ 2,480.00 4025 OPER ROOM40255238 S SCRW BONE CHIPS 30CC $ 3,347.00 $ 3,347.00 4025 OPER ROOM40255100 S SCRW BONE CMNT FULL PK $ 484.00 $ 484.00 4025 OPER ROOM40255104 S SCRW BONE CMNT HALF PK $ 298.00 $ 298.00 4025 OPER ROOM40257372 S SCRW CEMENT KYPHON $ 741.00 $ 741.00 4025 OPER ROOM40255233 S SCRW DYNAGRAFT 5ML $ 3,265.00 $ 3,265.00 4025 OPER ROOM

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DEPARTMENT CODE

40255217 S SCRW DYNAGRAFT CC $ 6,497.00 $ 6,497.00 4025 OPER ROOM40288120 S SRG DRS BIOPATCH CHLHX $ 49.00 $ 49.00 4028 OPER ROOM40288118 S SRG DRS NASPORE 4CM $ 471.00 $ 471.00 4028 OPER ROOM40288119 S SRG DRS NASPORE 8CM $ 707.00 $ 707.00 4028 OPER ROOM40281134 S SRG DRS PROSHIELD 12HR $ 186.00 $ 186.00 4028 OPER ROOM40281135 S SRG DRS PROSHIELD 24HR $ 225.00 $ 225.00 4028 OPER ROOM40288117 S SRG DRS RPD RHNO STMMB $ 388.00 $ 388.00 4028 OPER ROOM40281133 S SRG DRS TEGASORB $ 64.00 $ 64.00 4028 OPER ROOM40257203 S STNT NOCOR WO DEL TMP $ 295.00 $ 295.00 4025 OPER ROOM40257204 S STNT NOCOR WO DEL TMP $ 209.00 $ 209.00 4025 OPER ROOM40257205 S STNT NOCOR WO DEL TMP $ 1,498.00 $ 1,498.00 4025 OPER ROOM40257206 S STNT NOCOR WO DEL TMP $ 1,048.00 $ 1,048.00 4025 OPER ROOM40257207 S STNT NOCOR WO DEL TMP $ 741.00 $ 741.00 4025 OPER ROOM40257208 S STNT NOCOR WO DEL TMP $ 1,514.00 $ 1,514.00 4025 OPER ROOM40257209 S STNT NOCOR WO DEL TMP $ 885.00 $ 885.00 4025 OPER ROOM40257213 S STNT NOCOR WO DEL TMP $ 990.00 $ 990.00 4025 OPER ROOM40247248 S STRL 10 MM/11MM DISP $ 577.00 $ 577.00 4024 OPER ROOM40286113 S STRL 20/23 GA EREASER $ 424.00 $ 424.00 4028 OPER ROOM40287171 S STRL ACMI DSP.ACTI CORD $ 148.00 $ 148.00 4028 OPER ROOM40287078 S STRL ACMI ROLLER BALL $ 1,053.00 $ 1,053.00 4028 OPER ROOM40288123 S STRL ACTICOAT 4X4 $ 99.00 $ 99.00 4028 OPER ROOM40288124 S STRL ACTICOAT 4X8 $ 152.00 $ 152.00 4028 OPER ROOM40287050 S STRL ADAPT TOUHY-BORST $ 197.00 $ 197.00 4028 OPER ROOM40285122 S STRL AGEE WRIST JACK $ 9,450.00 $ 9,450.00 4028 OPER ROOM40286103 S STRL ALCON OCUTOME PRBE $ 1,327.00 $ 1,327.00 4028 OPER ROOM40286110 S STRL ALCON PARTS KIT $ 370.00 $ 370.00 4028 OPER ROOM40287004 S STRL AMPLA DLATR W/SHEA $ 394.00 $ 394.00 4028 OPER ROOM40287003 S STRL AMPLATZ DILATOR ST $ 1,483.00 $ 1,483.00 4028 OPER ROOM40287303 S STRL ANEURYSM CLIP-TEMP $ 1,808.00 $ 1,808.00 4028 OPER ROOM40283150 S STRL ANGIO THIN WAL 19 $ 27.00 $ 27.00 4028 OPER ROOM40286178 S STRL ANT VITRECTOMY PK $ 1,224.00 $ 1,224.00 4028 OPER ROOM40286188 S STRL ANT.CHAMBER MAINT $ 260.00 $ 260.00 4028 OPER ROOM40284109 S STRL AORTIC CANNULA $ 305.00 $ 305.00 4028 OPER ROOM

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DEPARTMENT CODE

40284105 S STRL AORTIC PUNCH $ 452.00 $ 452.00 4028 OPER ROOM40284158 S STRL APLR CLP CARD RBT $ 1,143.00 $ 1,143.00 4028 OPER ROOM40287232 S STRL APLR LAP DUPLSPRAY $ 648.00 $ 648.00 4028 OPER ROOM40287514 S STRL APPLR ENDCLP3 5MM $ 632.00 $ 632.00 4028 OPER ROOM40247751 S STRL ARGO BEAM 10M PRBE $ 330.00 $ 330.00 4024 OPER ROOM40247754 S STRL ARGON BEAM 5MM PRB $ 707.00 $ 707.00 4024 OPER ROOM40287102 S STRL ARGON COAGULA ELEC $ 73.00 $ 73.00 4028 OPER ROOM40287101 S STRL ARGON COAGULATOR $ 1,292.00 $ 1,292.00 4028 OPER ROOM40285232 S STRL ARTHRES OATS MEASR $ 1,181.00 $ 1,181.00 4028 OPER ROOM40285231 S STRL ARTHREX DISP OATS $ 3,898.00 $ 3,898.00 4028 OPER ROOM40287428 S STRL ARTHRO ENT COBLTND $ 1,063.00 $ 1,063.00 4028 OPER ROOM40247760 S STRL ARTHRO WND TRUB/CO $ 1,014.00 $ 1,014.00 4024 OPER ROOM40287143 S STRL ARTHROKNIFE LINVAT $ 714.00 $ 714.00 4028 OPER ROOM40285168 S STRL ARTHROSCOPY BLADE $ 717.00 $ 717.00 4028 OPER ROOM40247355 S STRL ARTHROWAND $ 2,260.00 $ 2,260.00 4024 OPER ROOM40287130 S STRL ARTIC LINEAR CUTER $ 2,679.00 $ 2,679.00 4028 OPER ROOM40287131 S STRL ARTIC RELAD L-CUTT $ 1,269.00 $ 1,269.00 4028 OPER ROOM40283166 S STRL ATCH VAC SYNRGY II $ 4,025.00 $ 4,025.00 4028 OPER ROOM40287193 S STRL AUTO CLIP APPL $ 873.00 $ 873.00 4028 OPER ROOM40287191 S STRL AUTO CLIP APPLIER $ 1,398.00 $ 1,398.00 4028 OPER ROOM40287153 S STRL AUTOSONIX ULTRASHE $ 2,366.00 $ 2,366.00 4028 OPER ROOM40247809 S STRL BAG INTSTNL SILO $ 953.00 $ 953.00 4024 OPER ROOM40283128 S STRL BAKER TUBE $ 1,253.00 $ 1,253.00 4028 OPER ROOM40287001 S STRL BALLOON OLBERT $ 1,512.00 $ 1,512.00 4028 OPER ROOM40285117 S STRL BARIUM PDR 50C 6G $ 760.00 $ 760.00 4028 OPER ROOM40247757 S STRL BARRO VACUUM TREPH $ 284.00 $ 284.00 4024 OPER ROOM40286102 S STRL BEAVER BLADE #57 $ 228.00 $ 228.00 4028 OPER ROOM40282107 S STRL BELZER SOLUTION $ 1,715.00 $ 1,715.00 4028 OPER ROOM40288109 S STRL BIOBANE $ 554.00 $ 554.00 4028 OPER ROOM40254126 S STRL BIOGLUE 2ML $ 1,307.00 $ 1,307.00 4025 OPER ROOM40254120 S STRL BIOGLUE 5ML CRTRG $ 5,182.00 $ 5,182.00 4025 OPER ROOM40287083 S STRL BIOGLUE APPLICATOR $ 341.00 $ 341.00 4028 OPER ROOM40287084 S STRL BIOGLUE EXTEND TIP $ 572.00 $ 572.00 4028 OPER ROOM

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DEPARTMENT CODE

40247749 S STRL BIOPSY KT CARTICEL $ 3,317.00 $ 3,317.00 4024 OPER ROOM40247383 S STRL BIOPSY PUNCH GEN $ 20.93 $ 20.93 4024 OPER ROOM40284261 S STRL BIPOLAR FORCEP DSP $ 458.00 $ 458.00 4028 OPER ROOM40247624 S STRL BLADE BEAVR RETRO $ 321.00 $ 321.00 4024 OPER ROOM40281119 S STRL BLADE CLIPPER DISP $ 226.00 $ 226.00 4028 OPER ROOM40285153 S STRL BLADE CORE SGT OSC $ 269.00 $ 269.00 4028 OPER ROOM40247715 S STRL BLADE CRESCENTRIC $ 197.00 $ 197.00 4024 OPER ROOM40247748 S STRL BLADE LASER EDGE $ 126.00 $ 126.00 4024 OPER ROOM40287022 S STRL BLADE MORCELLATOR $ 1,392.00 $ 1,392.00 4028 OPER ROOM40231125 S STRL BLADE SPECL CLIPR $ 104.00 $ 104.00 4023 OPER ROOM40287362 S STRL BLCK CNNCTR NEURO $ 24.12 $ 24.12 4028 OPER ROOM40283097 S STRL BLD MRCL EXT 12/15 $ 2,211.00 $ 2,211.00 4028 OPER ROOM40283095 S STRL BLD MRCLTR 12 STRZ $ 2,078.00 $ 2,078.00 4028 OPER ROOM40283096 S STRL BLD MRCLTR 15 STRZ $ 1,765.00 $ 1,765.00 4028 OPER ROOM40287372 S STRL BLD SAW CORDLESS $ 473.00 $ 473.00 4028 OPER ROOM40283161 S STRL BLD SW RDO/10X35 $ 253.00 $ 253.00 4028 OPER ROOM40283163 S STRL BLD SW STERN EXT $ 463.00 $ 463.00 4028 OPER ROOM40287115 S STRL BLD WTSN/STRZ/HUMB $ 83.00 $ 83.00 4028 OPER ROOM40287300 S STRL BLDE CRANI ANSPCH $ 735.00 $ 735.00 4028 OPER ROOM40284218 S STRL BLK CHST DRN W/CON $ 288.00 $ 288.00 4028 OPER ROOM40287091 S STRL BLUNTPORT 5-12MM $ 807.00 $ 807.00 4028 OPER ROOM40284008 S STRL BLW/MISTR CLRVW M $ 336.00 $ 336.00 4028 OPER ROOM40247802 S STRL BNE MRRW ASP KT $ 953.00 $ 953.00 4024 OPER ROOM40285124 S STRL BONE MILL $ 879.00 $ 879.00 4028 OPER ROOM40254127 S STRL BONE WAX 2.5GM $ 57.00 $ 57.00 4025 OPER ROOM40287501 S STRL BOVIE-SUC HANDPIEC $ 100.00 $ 100.00 4028 OPER ROOM40281132 S STRL BRACHY STBL NDL $ 725.00 $ 725.00 4028 OPER ROOM40287416 S STRL BREAST SIZER $ 595.00 $ 595.00 4028 OPER ROOM40247491 S STRL BROWN DERMATO/SPPL $ 588.00 $ 588.00 4024 OPER ROOM40287069 S STRL BRUSH BIOPSY CATH $ 577.00 $ 577.00 4028 OPER ROOM40285171 S STRL BT/BLD/BUR/DRL/RT1 $ 53.00 $ 53.00 4028 OPER ROOM40285172 S STRL BT/BLD/BUR/DRL/RT2 $ 159.00 $ 159.00 4028 OPER ROOM40285173 S STRL BT/BLD/BUR/DRL/RT4 $ 371.00 $ 371.00 4028 OPER ROOM

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DEPARTMENT CODE

40285174 S STRL BT/BLD/BUR/DRL/RT5 $ 477.00 $ 477.00 4028 OPER ROOM40285175 S STRL BT/BLD/BUR/DRL/RT6 $ 583.00 $ 583.00 4028 OPER ROOM40285176 S STRL BT/BLD/BUR/DRL/RT7 $ 689.00 $ 689.00 4028 OPER ROOM40285177 S STRL BT/BLD/BUR/DRL/RT8 $ 795.00 $ 795.00 4028 OPER ROOM40247493 S STRL BTRY IMG GUID ENT $ 190.00 $ 190.00 4024 OPER ROOM40285152 S STRL BUR/DSC/PSS/RSP CR $ 614.00 $ 614.00 4028 OPER ROOM40285164 S STRL BURR COOK/HALL/ZIM $ 258.00 $ 258.00 4028 OPER ROOM40247561 S STRL BX POST SEAL $ 78.00 $ 78.00 4024 OPER ROOM40287419 S STRL BYRO LAM AUTOIN TB $ 86.00 $ 86.00 4028 OPER ROOM40287048 S STRL C02 PT FILTER LINE $ 197.00 $ 197.00 4028 OPER ROOM40287313 S STRL CABLE/WIRE NUVS $ 1,905.00 $ 1,905.00 4028 OPER ROOM40287215 S STRL CANN 22G 54MM $ 241.00 $ 241.00 4028 OPER ROOM40284120 S STRL CANN 2-ST VENOUS $ 329.00 $ 329.00 4028 OPER ROOM40286154 S STRL CANN ANT CH LEWKY $ 32.00 $ 32.00 4028 OPER ROOM40284102 S STRL CANN PRPH BIOMDICS $ 1,241.00 $ 1,241.00 4028 OPER ROOM40288113 S STRL CANN VACWGEL KNTC $ 367.00 $ 367.00 4028 OPER ROOM40287239 S STRL CANNL BMC RDO FRQU $ 139.00 $ 139.00 4028 OPER ROOM40247669 S STRL CANNULA HT ABLATN $ 3,779.00 $ 3,779.00 4024 OPER ROOM40247481 S STRL CANNULA OPHTH $ 51.00 $ 51.00 4024 OPER ROOM40285233 S STRL CANULA ARTH ARTHXC $ 280.00 $ 280.00 4028 OPER ROOM40284145 S STRL CAP INTUITIVE MCR $ 177.00 $ 177.00 4028 OPER ROOM40247539 S STRL CAPSL POLISHER TR $ 53.00 $ 53.00 4024 OPER ROOM40287228 S STRL CAR TUNE ARTHR BLD $ 1,514.00 $ 1,514.00 4028 OPER ROOM40284205 S STRL CARDIOWRAP ABSB.02 $ 1,520.00 $ 1,520.00 4028 OPER ROOM40284227 S STRL CAROT BYPASS SHUNT $ 884.00 $ 884.00 4028 OPER ROOM40284225 S STRL CAROT SHUNT PRUITT $ 789.00 $ 789.00 4028 OPER ROOM40284228 S STRL CAROTID SHNT SUNDT $ 510.00 $ 510.00 4028 OPER ROOM40286168 S STRL CASET ACURUS+2500 $ 2,211.00 $ 2,211.00 4028 OPER ROOM40286167 S STRL CASET MAXVAC LEGC $ 446.00 $ 446.00 4028 OPER ROOM40286108 S STRL CASSETTE MICROTIP $ 856.00 $ 856.00 4028 OPER ROOM40247211 S STRL CASST IRRG RNGR $ 260.00 $ 260.00 4024 OPER ROOM40287047 S STRL CAT CON W/URE SDAM $ 197.00 $ 197.00 4028 OPER ROOM40247782 S STRL CATH CHOLGM KUMAR $ 222.00 $ 222.00 4024 OPER ROOM

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DEPARTMENT CODE

40247595 S STRL CATH EXT SIDEKICK $ 355.00 $ 355.00 4024 OPER ROOM40283105 S STRL CATH FOG BILI BALL $ 641.00 $ 641.00 4028 OPER ROOM40247479 S STRL CATH LVG ACLRT ENT $ 741.00 $ 741.00 4024 OPER ROOM40247726 S STRL CATH OCCULSI BALL $ 497.00 $ 497.00 4024 OPER ROOM40286997 S STRL CATH TUN-L 19GA $ 465.00 $ 465.00 4028 OPER ROOM40283143 S STRL CATH VNUS 8 CLOSU $ 4,858.00 $ 4,858.00 4028 OPER ROOM40287174 S STRL CATH.ANGIOGRAPHIC $ 220.00 $ 220.00 4028 OPER ROOM40247724 S STRL CATHETER ANGLOGRAP $ 37.00 $ 37.00 4024 OPER ROOM40283123 S STRL CATHETER FOLLOWER $ 296.00 $ 296.00 4028 OPER ROOM40287207 S STRL CATHETER RACZ $ 348.00 $ 348.00 4028 OPER ROOM40284128 S STRL CATHETER TUNNELER $ 388.00 $ 388.00 4028 OPER ROOM40247665 S STRL CATHETER UMBILICAL $ 38.00 $ 38.00 4024 OPER ROOM40287233 S STRL CATHETR ONQ 2.5CM $ 420.00 $ 420.00 4028 OPER ROOM40287234 S STRL CATHETR ONQ 5.0CM $ 547.00 $ 547.00 4028 OPER ROOM40284149 S STRL CAUT BIPL 8MN RBT $ 1,681.00 $ 1,681.00 4028 OPER ROOM40284150 S STRL CAUT HK/SP 8M RBT $ 1,244.00 $ 1,244.00 4028 OPER ROOM40285102 S STRL CEM SUC TIP-KAMVAC $ 275.00 $ 275.00 4028 OPER ROOM40287044 S STRL CHOLNGI CTH LAP A $ 652.00 $ 652.00 4028 OPER ROOM40247808 S STRL CIRCM PLSTC BELL $ 32.00 $ 32.00 4024 OPER ROOM40283172 S STRL CN ART/VN W INTRO $ 1,190.00 $ 1,190.00 4028 OPER ROOM40247795 S STRL CN CHNDLR INFS 25G $ 832.00 $ 832.00 4024 OPER ROOM40283170 S STRL CNN AORTIC EOPA $ 368.00 $ 368.00 4028 OPER ROOM40284009 S STRL CNN ART/FEM FLX 12 $ 1,015.00 $ 1,015.00 4028 OPER ROOM40283164 S STRL CNN ART/VEB FEM 16 $ 1,128.00 $ 1,128.00 4028 OPER ROOM40283167 S STRL CNN ARTC OVERFLW $ 151.00 $ 151.00 4028 OPER ROOM40284127 S STRL CNN IMA/VNT SUMP $ 148.00 $ 148.00 4028 OPER ROOM40247794 S STRL CNN INFS CHNDL 20G $ 726.00 $ 726.00 4024 OPER ROOM40283165 S STRL CNN INSERTION KIT $ 467.00 $ 467.00 4028 OPER ROOM40283171 S STRL CNN RETRO CRD 15F $ 675.00 $ 675.00 4028 OPER ROOM40284101 S STRL CNN VEN FEM/BIOMD $ 2,070.00 $ 2,070.00 4028 OPER ROOM40283168 S STRL CNN VEN QUIK DRAW $ 2,266.00 $ 2,266.00 4028 OPER ROOM40286187 S STRL COL MICRODISSE NDL $ 597.00 $ 597.00 4028 OPER ROOM40283176 S STRL COLOSTOMY SET $ 173.00 $ 173.00 4028 OPER ROOM

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DEPARTMENT CODE

40256169 S STRL CONFORMER OPHTH $ 219.00 $ 219.00 4025 OPER ROOM40284231 S STRL CONNCTR Y H-L $ 88.00 $ 88.00 4028 OPER ROOM40247801 S STRL CONNT BLK STRT/Y $ 37.00 $ 37.00 4024 OPER ROOM40247601 S STRL CONTCT LENS PLNO B $ 121.00 $ 121.00 4024 OPER ROOM40247702 S STRL CONTIGEN SYR EACH $ 3,273.00 $ 3,273.00 4024 OPER ROOM40286139 S STRL CORNE CONTACT LENS $ 267.00 $ 267.00 4028 OPER ROOM40284122 S STRL CORONA PERF CAN-HA $ 789.00 $ 789.00 4028 OPER ROOM40284107 S STRL CORONARY SUC TIP $ 34.00 $ 34.00 4028 OPER ROOM40253192 S STRL COSEAL 8ML $ 3,894.00 $ 3,894.00 4025 OPER ROOM40285166 S STRL COTTONY DACRON SUT $ 424.00 $ 424.00 4028 OPER ROOM40287216 S STRL COVER SNAP $ 21.00 $ 21.00 4028 OPER ROOM40284162 S STRL COVR SHER TIP RBT $ 192.00 $ 192.00 4028 OPER ROOM40247439 S STRL CPTR DVC SUT BST S $ 1,338.00 $ 1,338.00 4024 OPER ROOM40281124 S STRL CR40 PROBE 46/48 $ 2,752.00 $ 2,752.00 4028 OPER ROOM40281125 S STRL CR40 PROBE INTRODU $ 681.00 $ 681.00 4028 OPER ROOM40281126 S STRL CR40 TEMP PROBE 55 $ 943.00 $ 943.00 4028 OPER ROOM40287338 S STRL CRANI WIR PAS/BLDE $ 438.00 $ 438.00 4028 OPER ROOM40287321 S STRL CRANIOBLADE $ 242.00 $ 242.00 4028 OPER ROOM40286192 S STRL CRAWFORD LACRIM ST $ 726.00 $ 726.00 4028 OPER ROOM40282102 S STRL CUPLR VESL ANASTM $ 1,066.00 $ 1,066.00 4028 OPER ROOM40247400 S STRL CURRETT COOPER $ 60.00 $ 60.00 4024 OPER ROOM40247399 S STRL CURRETT VABRA $ 114.00 $ 114.00 4024 OPER ROOM40287333 S STRL CUSA PACK MICRO TP $ 4,155.00 $ 4,155.00 4028 OPER ROOM40287332 S STRL CUSA PACK REG TIP $ 3,658.00 $ 3,658.00 4028 OPER ROOM40247485 S STRL DAVOL DSPOSABLE DE $ 78.00 $ 78.00 4024 OPER ROOM40247745 S STRL DCR ODONOUGHUE TB $ 157.00 $ 157.00 4024 OPER ROOM40247478 S STRL DENVER NASAL SPLNT $ 244.00 $ 244.00 4024 OPER ROOM40285199 S STRL DEPU LIGAMEN PASSE $ 522.00 $ 522.00 4028 OPER ROOM40283192 S STRL DERMABOND $ 269.00 $ 269.00 4028 OPER ROOM40284116 S STRL DEVICE ENCLOSE CV $ 2,803.00 $ 2,803.00 4028 OPER ROOM40255236 S STRL DIGIT WIGIT EXT FX $ 5,539.00 $ 5,539.00 4025 OPER ROOM40247806 S STRL DILTR ANAL PEDI $ 465.00 $ 465.00 4024 OPER ROOM40247381 S STRL DILTR KT ESTECH $ 3,505.00 $ 3,505.00 4024 OPER ROOM

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DEPARTMENT CODE

40283174 S STRL DILTR SET PED COOK $ 409.00 $ 409.00 4028 OPER ROOM40286135 S STRL DISP CAUTERY $ 76.00 $ 76.00 4028 OPER ROOM40285162 S STRL DISP SAW BLADE/BUR $ 98.00 $ 98.00 4028 OPER ROOM40287322 S STRL DISP SKULL PINS $ 99.00 $ 99.00 4028 OPER ROOM40247228 S STRL DISP VEIN STRIP $ 295.00 $ 295.00 4024 OPER ROOM40286112 S STRL DISP.BIPOLAR ERASE $ 100.00 $ 100.00 4028 OPER ROOM40287431 S STRL DISP.LARYNGEC TUBE $ 679.00 $ 679.00 4028 OPER ROOM40287430 S STRL DISP.MYRINGO KNIFE $ 100.00 $ 100.00 4028 OPER ROOM40287319 S STRL DISTRACTOR PIN $ 703.00 $ 703.00 4028 OPER ROOM40254224 S STRL DOPPLER IMPLNTABL $ 2,175.00 $ 2,175.00 4025 OPER ROOM40257375 S STRL DOPPLER MICRO NEUR $ 823.00 $ 823.00 4025 OPER ROOM40287408 S STRL DOY INTEL NSL SPLT $ 228.00 $ 228.00 4028 OPER ROOM40287412 S STRL DOYLE NASAL TAMPON $ 117.00 $ 117.00 4028 OPER ROOM40285220 S STRL DRIL CANLTD ACUTRK $ 835.00 $ 835.00 4028 OPER ROOM40247305 S STRL DRILL/ENT BIT/BURR $ 584.00 $ 584.00 4024 OPER ROOM40288114 S STRL DRP VAC 30.3X26CM $ 72.00 $ 72.00 4028 OPER ROOM40287325 S STRL DRV HELICL BIOMET $ 1,562.00 $ 1,562.00 4028 OPER ROOM40287432 S STRL DSP BRONCH SUC CAT $ 181.00 $ 181.00 4028 OPER ROOM40285158 S STRL DSP BUR ANSPACH $ 704.00 $ 704.00 4028 OPER ROOM40285161 S STRL DSP BUR DIAMOND $ 485.00 $ 485.00 4028 OPER ROOM40287371 S STRL DSP.CRANIAL PERFOR $ 1,183.00 $ 1,183.00 4028 OPER ROOM40287316 S STRL DURA HOOK $ 205.00 $ 205.00 4028 OPER ROOM40247807 S STRL DVC ENDO FEEDING $ 242.00 $ 242.00 4024 OPER ROOM40287515 S STRL DVC ENSEAL 3X25 $ 1,394.00 $ 1,394.00 4028 OPER ROOM40247490 S STRL DVC INFLTN ACLRT $ 626.00 $ 626.00 4024 OPER ROOM40247502 S STRL E T TUBE NIMS $ 1,286.00 $ 1,286.00 4024 OPER ROOM40287006 S STRL E.H. LITHOTR PROBE $ 1,505.00 $ 1,505.00 4028 OPER ROOM40247480 S STRL EAR FLUID ASPIRATO $ 70.00 $ 70.00 4024 OPER ROOM40247635 S STRL EAR PACK MEROCEL $ 38.00 $ 38.00 4024 OPER ROOM40247206 S STRL ELCT HYST RCPRC SN $ 2,206.00 $ 2,206.00 4024 OPER ROOM40284148 S STRL ELCT LIGSUR 1000 $ 1,332.00 $ 1,332.00 4028 OPER ROOM40284146 S STRL ELCT LIGSUR 1100 $ 2,014.00 $ 2,014.00 4028 OPER ROOM40284147 S STRL ELCT LIGSUR 1500 $ 2,459.00 $ 2,459.00 4028 OPER ROOM

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DEPARTMENT CODE

40287369 S STRL ELCT SBDRM PRD NDL $ 43.00 $ 43.00 4028 OPER ROOM40247247 S STRL ELCTD TRI W CRD $ 1,802.00 $ 1,802.00 4024 OPER ROOM40287240 S STRL ELCTR BPL GYN GYRS $ 1,498.00 $ 1,498.00 4028 OPER ROOM40247205 S STRL ELCTR HYST RTRY SN $ 1,716.00 $ 1,716.00 4024 OPER ROOM40247249 S STRL ELCTR LGSR OV 4200 $ 413.00 $ 413.00 4024 OPER ROOM40287367 S STRL ELCTR STMLT MDTRNC $ 431.00 $ 431.00 4028 OPER ROOM40247557 S STRL ELCTRD CT LOP MLE $ 536.00 $ 536.00 4024 OPER ROOM40287368 S STRL ELCTRD ENDO TRACH $ 719.00 $ 719.00 4028 OPER ROOM40287512 S STRL ELCTRD ETR10 335 $ 1,720.00 $ 1,720.00 4028 OPER ROOM40287511 S STRL ELCTRD ETR10 345 $ 1,803.00 $ 1,803.00 4028 OPER ROOM40287513 S STRL ELCTRD NSEAL 545RH $ 1,629.00 $ 1,629.00 4028 OPER ROOM40287510 S STRL ELCTRD NSEAL525 H $ 1,334.00 $ 1,334.00 4028 OPER ROOM40247564 S STRL ELCTRD PRKSH KNF24 $ 499.00 $ 499.00 4024 OPER ROOM40287361 S STRL ELCTRD SUBDRL NEUR $ 1,122.00 $ 1,122.00 4028 OPER ROOM40285135 S STRL ELECT LAP MGDYN32 $ 78.00 $ 78.00 4028 OPER ROOM40287506 S STRL ELECTRD LAP MGYDN $ 488.00 $ 488.00 4028 OPER ROOM40287366 S STRL ELECTRD NIM NEURO $ 1,553.00 $ 1,553.00 4028 OPER ROOM40286996 S STRL ELTRD BIPL GYN ACM $ 2,718.00 $ 2,718.00 4028 OPER ROOM40287235 S STRL ENCLS DVC LAP CTT $ 741.00 $ 741.00 4028 OPER ROOM40287026 S STRL ENDO BAG $ 394.00 $ 394.00 4028 OPER ROOM40287046 S STRL ENDO-BABCOCK $ 1,291.00 $ 1,291.00 4028 OPER ROOM40287136 S STRL ENDOCLOSE $ 359.00 $ 359.00 4028 OPER ROOM40287030 S STRL ENDODISSECT $ 1,291.00 $ 1,291.00 4028 OPER ROOM40287054 S STRL ENDOFOG $ 83.00 $ 83.00 4028 OPER ROOM40287041 S STRL ENDOGRASP $ 1,254.00 $ 1,254.00 4028 OPER ROOM40287080 S STRL ENDOLOOP SUTURE $ 326.00 $ 326.00 4028 OPER ROOM40287034 S STRL ENDOLUNG FORCEP $ 868.00 $ 868.00 4028 OPER ROOM40287149 S STRL ENDOPADDLE RETRACT $ 1,037.00 $ 1,037.00 4028 OPER ROOM40287133 S STRL ENDOPEANUT $ 227.00 $ 227.00 4028 OPER ROOM40287113 S STRL ENDORETRACTOR $ 622.00 $ 622.00 4028 OPER ROOM40287132 S STRL ENDORETRACTOR HOOK $ 1,041.00 $ 1,041.00 4028 OPER ROOM40287021 S STRL ENDOSCISSOR $ 898.00 $ 898.00 4028 OPER ROOM40287029 S STRL ENDOSHEARS $ 480.00 $ 480.00 4028 OPER ROOM

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DEPARTMENT CODE

40287042 S STRL ENDOSHEARS MINI $ 972.00 $ 972.00 4028 OPER ROOM40247790 S STRL ERASER OPTH 18GA $ 61.00 $ 61.00 4024 OPER ROOM40247791 S STRL ERASER OPTH 25GA $ 352.00 $ 352.00 4024 OPER ROOM40283127 S STRL ERCP CATHETER $ 536.00 $ 536.00 4028 OPER ROOM40287175 S STRL ESOPHAG DILATOR ST $ 877.00 $ 877.00 4028 OPER ROOM40247406 S STRL ESWL ELECTRODES $ 1,365.00 $ 1,365.00 4024 OPER ROOM40247464 S STRL ETHMOID SINUS PACK $ 78.00 $ 78.00 4024 OPER ROOM40255220 S STRL EX FIX EBI DISP $ 7,560.00 $ 7,560.00 4025 OPER ROOM40287336 S STRL EXT. DRAIN BAG $ 289.00 $ 289.00 4028 OPER ROOM40287199 S STRL EXT.NASAL SPLT KIT $ 260.00 $ 260.00 4028 OPER ROOM40284108 S STRL EXTERNAL DEFIB.PAD $ 259.00 $ 259.00 4028 OPER ROOM40255103 S STRL EXTERNAL FIXATOR $ - $ - 4025 OPER ROOM40255219 S STRL EXTERNAL FIXATOR $ 6,737.00 $ 6,737.00 4025 OPER ROOM40247430 S STRL FBR LSR OMN BPL150 $ 4,040.00 $ 4,040.00 4024 OPER ROOM40247431 S STRL FBR LSR OMN BPS130 $ 2,989.00 $ 2,989.00 4024 OPER ROOM40247530 S STRL FBR LSR OPTH CO2 $ 653.00 $ 653.00 4024 OPER ROOM40286200 S STRL FIBER LASER PVP $ 4,903.00 $ 4,903.00 4028 OPER ROOM40283148 S STRL FIBER LASER YAG $ 1,090.00 $ 1,090.00 4028 OPER ROOM40281153 S STRL FIBER LSR GRNLITE $ 4,903.00 $ 4,903.00 4028 OPER ROOM40281152 S STRL FIBER LSR HOLMIUM $ 1,498.00 $ 1,498.00 4028 OPER ROOM40284141 S STRL FIBERWIRE SUTURE $ 261.00 $ 261.00 4028 OPER ROOM40283132 S STRL FILIFORM CATHETER $ 536.00 $ 536.00 4028 OPER ROOM40287417 S STRL FLEXAN DRESS 4X4 $ 57.00 $ 57.00 4028 OPER ROOM40284235 S STRL FLEXI LUM LIGHT $ 211.00 $ 211.00 4028 OPER ROOM40254119 S STRL FLOWSEAL $ 750.00 $ 750.00 4025 OPER ROOM40286166 S STRL FLTR CRUISE CNTRL $ 198.00 $ 198.00 4028 OPER ROOM40247602 S STRL FLX IRIS RETRACTOR $ 603.00 $ 603.00 4024 OPER ROOM40284241 S STRL FOGA SF-JAW BULLD $ 180.00 $ 180.00 4028 OPER ROOM40284242 S STRL FOGAR INSRT 33/61M $ 351.00 $ 351.00 4028 OPER ROOM40247475 S STRL FORCP BRONCH DISP $ 295.00 $ 295.00 4024 OPER ROOM40286173 S STRL FRAGMA ACCESORY PK $ 803.00 $ 803.00 4028 OPER ROOM40286159 S STRL FRAGTM ACCS PK AL $ 605.00 $ 605.00 4028 OPER ROOM40284152 S STRL FRCP DBKY 8MM RBT $ 1,152.00 $ 1,152.00 4028 OPER ROOM

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DEPARTMENT CODE

40247789 S STRL FRCP GRASP DSP 25G $ 741.00 $ 741.00 4024 OPER ROOM40247599 S STRL FRCP GRSP OPTH 23G $ 558.00 $ 558.00 4024 OPER ROOM40284151 S STRL FRCP LNG TIP 8RBT $ 1,525.00 $ 1,525.00 4028 OPER ROOM40284159 S STRL FRCP MIC BIPLR RBT $ 1,471.00 $ 1,471.00 4028 OPER ROOM40287237 S STRL FRCP PK DISCT RBT $ 1,653.00 $ 1,653.00 4028 OPER ROOM40284167 S STRL FRCP PK DSSCT RBT $ 353.51 $ 353.51 4028 OPER ROOM40287508 S STRL FRCPS PKS CUT 5/10 $ 1,957.00 $ 1,957.00 4028 OPER ROOM40287509 S STRL FRCPS PKS LYONS $ 1,084.00 $ 1,084.00 4028 OPER ROOM40284217 S STRL GENZYME STABILIZER $ 5,158.00 $ 5,158.00 4028 OPER ROOM40287320 S STRL GIGLI SAW $ 133.00 $ 133.00 4028 OPER ROOM40287051 S STRL GLIDEWIRE $ 424.00 $ 424.00 4028 OPER ROOM40247682 S STRL GLIDEWIRE STR/ANGL $ 63.00 $ 63.00 4024 OPER ROOM40247471 S STRL GOODE T-TUBE $ 153.00 $ 153.00 4024 OPER ROOM40286128 S STRL GRIES LT.PIPE-FINE $ 379.00 $ 379.00 4028 OPER ROOM40286140 S STRL GRIESH LTPIPE 20G $ 351.00 $ 351.00 4028 OPER ROOM40286129 S STRL GRIESHA E-I LGTPIP $ 778.00 $ 778.00 4028 OPER ROOM40286125 S STRL GRIESHA TISSUE MAN $ 1,214.00 $ 1,214.00 4028 OPER ROOM40285209 S STRL GUDE RO STR/BAL TP $ 430.00 $ 430.00 4028 OPER ROOM40287104 S STRL GYN T-TUBE DRAIN $ 236.00 $ 236.00 4028 OPER ROOM40287331 S STRL HALO APPARATUS $ 4,029.00 $ 4,029.00 4028 OPER ROOM40285165 S STRL HANDLE SHARP SHOTR $ 795.00 $ 795.00 4028 OPER ROOM40283154 S STRL HANDPICE VERSAJET $ 2,152.00 $ 2,152.00 4028 OPER ROOM40287088 S STRL HANDPORT LARGE $ 3,121.00 $ 3,121.00 4028 OPER ROOM40284113 S STRL HANNA TB/CONNECT $ 563.00 $ 563.00 4028 OPER ROOM40287027 S STRL HARMON SCALP SHEA $ 3,921.00 $ 3,921.00 4028 OPER ROOM40284226 S STRL HEART MICRO SUTURE $ 1,224.00 $ 1,224.00 4028 OPER ROOM40284214 S STRL HEART VALVE SUTURE $ 1,379.00 $ 1,379.00 4028 OPER ROOM40287138 S STRL HEATE INSUFFLAT TB $ 400.00 $ 400.00 4028 OPER ROOM40287060 S STRL HEIMLICH VALVE $ 126.00 $ 126.00 4028 OPER ROOM40281123 S STRL HELIU HIGH PSI GAS $ 547.00 $ 547.00 4028 OPER ROOM40284204 S STRL HEMOSTASE 5G ABSRB $ 972.00 $ 972.00 4028 OPER ROOM40281122 S STRL HIGH PRESSURE GAS $ 1,118.00 $ 1,118.00 4028 OPER ROOM40287223 S STRL HNDPRT/PROTRC GEL $ 2,707.00 $ 2,707.00 4028 OPER ROOM

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DEPARTMENT CODE

40287038 S STRL HOOK BLD HARMONIC $ 1,392.00 $ 1,392.00 4028 OPER ROOM40247796 S STRL HOOK IRIS RUPPORT $ 241.00 $ 241.00 4024 OPER ROOM40247523 S STRL HOOK PERFCT PUPIL $ 131.00 $ 131.00 4024 OPER ROOM40287323 S STRL HOSE DRV BIOMET $ 897.00 $ 897.00 4028 OPER ROOM40284237 S STRL HUMBY BLADE $ 123.00 $ 123.00 4028 OPER ROOM40286202 S STRL HYDRODISSECTIO CAN $ 49.00 $ 49.00 4028 OPER ROOM40283175 S STRL ILEOSTOMY SET $ 197.00 $ 197.00 4028 OPER ROOM40285156 S STRL ILIZAROV SPONGES $ 199.00 $ 199.00 4028 OPER ROOM40247793 S STRL ILUM ENDO OPT WIDE $ 489.00 $ 489.00 4024 OPER ROOM40247792 S STRL ILUMN ENDO OPTH20 $ 209.00 $ 209.00 4024 OPER ROOM40285151 S STRL IMPERV.STOCKINETTE $ 165.00 $ 165.00 4028 OPER ROOM40283189 S STRL INDERMIL $ 230.00 $ 230.00 4028 OPER ROOM40247560 S STRL INFLATN DVC UROMX $ 218.00 $ 218.00 4024 OPER ROOM40247246 S STRL INFLW TB HYST S&N $ 777.00 $ 777.00 4024 OPER ROOM40286158 S STRL INJ FLUD ACCRS 10 $ 597.00 $ 597.00 4028 OPER ROOM40286172 S STRL INNOV TOTAL PLS PK $ 2,611.00 $ 2,611.00 4028 OPER ROOM40283159 S STRL INSRT CLMP #1/SDE $ 153.00 $ 153.00 4028 OPER ROOM40247200 S STRL INSRT HYSTRS S&N $ 282.00 $ 282.00 4024 OPER ROOM40284191 S STRL INSRT OCTOBAS HRT $ 741.00 $ 741.00 4028 OPER ROOM40286993 S STRL INST HOOK DERMAL $ 130.00 $ 130.00 4028 OPER ROOM40284154 S STRL INST PEDI 5MM RBT $ 1,661.00 $ 1,661.00 4028 OPER ROOM40287236 S STRL INST STOMAPHYX $ 8,282.00 $ 8,282.00 4028 OPER ROOM40247779 S STRL INSTR CURET ADNOID $ 297.00 $ 297.00 4024 OPER ROOM40287324 S STRL INSTR DRIL BIOMET $ 1,837.00 $ 1,837.00 4028 OPER ROOM40285121 S STRL INSTROTEK ENDOBLAE $ 859.00 $ 859.00 4028 OPER ROOM40247236 S STRL INSTRUMT LITE MAT $ 505.00 $ 505.00 4024 OPER ROOM40287144 S STRL INSUFLATIO/ACE NDL $ 367.00 $ 367.00 4028 OPER ROOM40287096 S STRL INSUFLOW INSUF TUF $ 1,164.00 $ 1,164.00 4028 OPER ROOM40247637 S STRL INTRO VOICE RSTR $ 975.00 $ 975.00 4024 OPER ROOM40282103 S STRL INTRODUCER INTSTM $ 1,524.00 $ 1,524.00 4028 OPER ROOM40286189 S STRL JACKSON LACRIMA ST $ 687.00 $ 687.00 4028 OPER ROOM40284224 S STRL JAVID SHUNT $ 603.00 $ 603.00 4028 OPER ROOM40283129 S STRL JEJUNOSTOMY NDL KT $ 557.00 $ 557.00 4028 OPER ROOM

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DEPARTMENT CODE

40287166 S STRL JEJUNOSTOMY TUBE $ 808.00 $ 808.00 4028 OPER ROOM40287305 S STRL KIT CAMINO ICP $ 2,917.00 $ 2,917.00 4028 OPER ROOM40284220 S STRL KIT CTS STABILIZER $ 8,220.00 $ 8,220.00 4028 OPER ROOM40247805 S STRL KNF ARTHRO CONMED $ 297.00 $ 297.00 4024 OPER ROOM40284194 S STRL KT VEIN HARVST VSO $ 6,536.00 $ 6,536.00 4028 OPER ROOM40255106 S STRL K-WIRE ABSORBABLE $ 570.00 $ 570.00 4025 OPER ROOM40287184 S STRL LAP.CHOLE CATH $ 1,221.00 $ 1,221.00 4028 OPER ROOM40287141 S STRL LAPSAC 8X10 $ 595.00 $ 595.00 4028 OPER ROOM40287140 S STRL LAPSAC 8X5 $ 532.00 $ 532.00 4028 OPER ROOM40286199 S STRL LASER PROBE-ARGON $ 1,424.00 $ 1,424.00 4028 OPER ROOM40287095 S STRL LAVACUATOR MALLINO $ 133.00 $ 133.00 4028 OPER ROOM40247658 S STRL LEEP LOOP $ 87.00 $ 87.00 4024 OPER ROOM40286151 S STRL LENS DSP SET BIOM $ 554.00 $ 554.00 4028 OPER ROOM40286119 S STRL LENS GLIDE $ 45.00 $ 45.00 4028 OPER ROOM40286120 S STRL LEVEEN SYRINGE $ 338.00 $ 338.00 4028 OPER ROOM40284143 S STRL LIGASRE LAPSCPE EL $ 2,638.00 $ 2,638.00 4028 OPER ROOM40284142 S STRL LIGASURE ELECTRODE $ 1,289.00 $ 1,289.00 4028 OPER ROOM40284156 S STRL LIGASURE LS1200 $ 1,063.00 $ 1,063.00 4028 OPER ROOM40285112 S STRL LINVAT SHLDER CANN $ 250.00 $ 250.00 4028 OPER ROOM40247499 S STRL LIPO TUBING/FILTER $ 331.00 $ 331.00 4024 OPER ROOM40247811 S STRL LMBAR PUNCTR ST $ 70.00 $ 70.00 4024 OPER ROOM40284163 S STRL LUB RBT $ 135.00 $ 135.00 4028 OPER ROOM40247552 S STRL LUHR DRILL BIT $ 597.00 $ 597.00 4024 OPER ROOM40287337 S STRL LUMBAR EXT DRN CAT $ 955.00 $ 955.00 4028 OPER ROOM40286156 S STRL MANIP TISS BIPOLR $ 985.00 $ 985.00 4028 OPER ROOM40284221 S STRL MANIPULATOR GNZYM $ 4,692.00 $ 4,692.00 4028 OPER ROOM40287179 S STRL MANIPULATR UTERIN $ 289.00 $ 289.00 4028 OPER ROOM40247140 S STRL MARK TEMP AESCP $ 135.00 $ 135.00 4024 OPER ROOM40247759 S STRL MENISC SCREW DRVER $ 240.00 $ 240.00 4024 OPER ROOM40285230 S STRL MENISCECTOMY KIT $ 1,073.00 $ 1,073.00 4028 OPER ROOM40285103 S STRL MENISECTOMY ELECT $ 598.00 $ 598.00 4028 OPER ROOM40287422 S STRL MEPITEL DRES 20X30 $ 580.00 $ 580.00 4028 OPER ROOM40287421 S STRL MEPITEL DRES10X18 $ 232.00 $ 232.00 4028 OPER ROOM

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DEPARTMENT CODE

40247483 S STRL MESHGRAFT/DERMACAR $ 236.00 $ 236.00 4024 OPER ROOM40287154 S STRL METAL TIP CHOLECAT $ 405.00 $ 405.00 4028 OPER ROOM40287309 S STRL MICR SRG MAT W/SUC $ 357.00 $ 357.00 4028 OPER ROOM40287423 S STRL MICROANASTOMO DVCE $ 1,380.00 $ 1,380.00 4028 OPER ROOM40287226 S STRL MICRO-GRID $ 100.00 $ 100.00 4028 OPER ROOM40283153 S STRL MICROPUNCTURE $ 369.00 $ 369.00 4028 OPER ROOM40286109 S STRL MICROTIP ROUND 30 $ 656.00 $ 656.00 4028 OPER ROOM40285160 S STRL MIDAS REX TOOL $ - $ - 4028 OPER ROOM40247773 S STRL MINI SITE 2MM PORT $ 303.00 $ 303.00 4024 OPER ROOM40287151 S STRL MINIPORT 2MM $ 576.00 $ 576.00 4028 OPER ROOM40287600 S STRL MISC SUPPL. $ - $ - 4028 OPER ROOM40283156 S STRL MISTER/BLOWER CV $ 505.00 $ 505.00 4028 OPER ROOM40285239 S STRL MITE SUTURE GRASPR $ 1,250.00 $ 1,250.00 4028 OPER ROOM40285234 S STRL MITEK SUT PASS TIP $ 1,201.00 $ 1,201.00 4028 OPER ROOM40287298 S STRL MIXER KYPH CEMENT $ 741.00 $ 741.00 4028 OPER ROOM40284160 S STRL MNPLT CV MINVS STF $ 6,509.00 $ 6,509.00 4028 OPER ROOM40247195 S STRL MNPLTR UTRN V CARE $ 673.00 $ 673.00 4024 OPER ROOM40287312 S STRL MODULE NUVSVE JJB $ 5,774.00 $ 5,774.00 4028 OPER ROOM40286149 S STRL MVR KNIFE $ 352.00 $ 352.00 4028 OPER ROOM40284153 S STRL NDL DRV/PRGSP 8RB $ 1,370.00 $ 1,370.00 4028 OPER ROOM40284166 S STRL NDL DRVR/CUT RBT $ 970.00 $ 970.00 4028 OPER ROOM40247783 S STRL NDL INSUF SH SRGI $ 137.00 $ 137.00 4024 OPER ROOM40247647 S STRL NDL PROSTAT BIPSY $ 181.00 $ 181.00 4024 OPER ROOM40287364 S STRL NDL PS WOBTRT NEUR $ 57.00 $ 57.00 4028 OPER ROOM40286152 S STRL NDL SOFT TIP 20GA $ 207.00 $ 207.00 4028 OPER ROOM40285170 S STRL NDL/SUT SHRP SHOT $ 395.00 $ 395.00 4028 OPER ROOM40283158 S STRL NDLE AIR ASPIRATN $ 67.00 $ 67.00 4028 OPER ROOM40282105 S STRL NDLE INTSTM 3.5+5 $ 336.00 $ 336.00 4028 OPER ROOM40287209 S STRL NDLE RFKC 10/15CM $ 260.00 $ 260.00 4028 OPER ROOM40287210 S STRL NDLE ROOT BLK KIT $ 113.00 $ 113.00 4028 OPER ROOM40287211 S STRL NDLE SPINAL LNG/EX $ 129.00 $ 129.00 4028 OPER ROOM40287214 S STRL NDLE TOUY SPINAL $ 190.00 $ 190.00 4028 OPER ROOM40247452 S STRL NDLE VERISYE OPTH $ 295.00 $ 295.00 4024 OPER ROOM

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DEPARTMENT CODE

40287056 S STRL NEEDLE CHIBA $ 148.00 $ 148.00 4028 OPER ROOM40247121 S STRL NEEDLE SCORPION $ 763.00 $ 763.00 4024 OPER ROOM40247119 S STRL NEEDLE TATTOO $ 420.00 $ 420.00 4024 OPER ROOM40284263 S STRL NEEDLE TEMNO $ 445.00 $ 445.00 4028 OPER ROOM40287052 S STRL NEEDLE/SHEATH PTC $ 329.00 $ 329.00 4028 OPER ROOM40287081 S STRL NEPHROST DRAIN VPI $ 859.00 $ 859.00 4028 OPER ROOM40287213 S STRL NERVE BLCK CUSTOM $ 77.00 $ 77.00 4028 OPER ROOM40287150 S STRL NERVE STIMULATOR $ 351.00 $ 351.00 4028 OPER ROOM40287335 S STRL NEUR BG TUBING KIT $ 1,005.00 $ 1,005.00 4028 OPER ROOM40287334 S STRL NEUR EXTER DRN KIT $ 1,326.00 $ 1,326.00 4028 OPER ROOM40247688 S STRL NIMS ELECT DSPOSAL $ 1,290.00 $ 1,290.00 4024 OPER ROOM40247687 S STRL NIMS STIMULATO DSP $ 1,275.00 $ 1,275.00 4024 OPER ROOM40284164 S STRL OBTRT BLDLS 8M RBT $ 199.00 $ 199.00 4028 OPER ROOM40256171 S STRL OIL SILICN WT1000 $ 3,082.00 $ 3,082.00 4025 OPER ROOM40256173 S STRL OIL SILICN WT5000 $ 2,273.00 $ 2,273.00 4025 OPER ROOM40285101 S STRL ORTHO/VAS YANK SUC $ 18.00 $ 18.00 4028 OPER ROOM40247245 S STRL OUTFLW TB HYST SN $ 1,062.00 $ 1,062.00 4024 OPER ROOM40287085 S STRL PACING CABLE DSP $ 323.00 $ 323.00 4028 OPER ROOM40284203 S STRL PARSONNET PROBE $ 1,010.00 $ 1,010.00 4028 OPER ROOM40287299 S STRL PATIE MICRO NEURO $ 92.00 $ 92.00 4028 OPER ROOM40284119 S STRL PEDI.TOURNIQUET KT $ 75.00 $ 75.00 4028 OPER ROOM40287155 S STRL PERCUTAN CHOLE CAT $ 509.00 $ 509.00 4028 OPER ROOM40286190 S STRL PERFLOROP GASC3F8 $ 101.00 $ 101.00 4028 OPER ROOM40286142 S STRL PERFLURON $ 2,333.00 $ 2,333.00 4028 OPER ROOM40286165 S STRL PERFLURON 7ML $ 2,911.00 $ 2,911.00 4028 OPER ROOM40247813 S STRL PERFRTR ACRCT PED $ 850.00 $ 850.00 4024 OPER ROOM40286118 S STRL PERIBULBAR NEEDLE $ 68.00 $ 68.00 4028 OPER ROOM40287176 S STRL PERISTRIP DRY $ 912.00 $ 912.00 4028 OPER ROOM40286177 S STRL PHACO TURBO 9MM PK $ 1,425.00 $ 1,425.00 4028 OPER ROOM40286169 S STRL PICK ILLUM MEMBRN $ 481.00 $ 481.00 4028 OPER ROOM40255158 S STRL PIN ABSORBABLE $ 1,286.00 $ 1,286.00 4025 OPER ROOM40285157 S STRL PIN GUARD $ 58.00 $ 58.00 4028 OPER ROOM40285111 S STRL PLANTAR FASCIA BLD $ 1,177.00 $ 1,177.00 4028 OPER ROOM

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DEPARTMENT CODE

40247255 S STRL PLEUREVAS $ 614.00 $ 614.00 4024 OPER ROOM40287049 S STRL PLUG MALE LUER LK $ 189.00 $ 189.00 4028 OPER ROOM40247816 S STRL PMP ONQ 400WCATH $ 1,116.00 $ 1,116.00 4024 OPER ROOM40247142 S STRL PNS/MARKR TMP ASC $ 177.00 $ 177.00 4024 OPER ROOM40254178 S STRL POUCH PARSONNET $ 1,277.00 $ 1,277.00 4025 OPER ROOM40247321 S STRL POWER PULSE IRRG $ 437.00 $ 437.00 4024 OPER ROOM40287198 S STRL POWERED LDS STAPLE $ 1,416.00 $ 1,416.00 4028 OPER ROOM40281155 S STRL PRB FLX URTRSCPY $ 953.00 $ 953.00 4028 OPER ROOM40286162 S STRL PRB LASR ANG IRDX $ 1,090.00 $ 1,090.00 4028 OPER ROOM40286179 S STRL PRB LITE MIC OPTH $ 404.00 $ 404.00 4028 OPER ROOM40281154 S STRL PRB PNEUM LTHCLST $ 840.00 $ 840.00 4025 OPER ROOM40281156 S STRL PRB URO ULTR SND $ 423.00 $ 423.00 4028 OPER ROOM40286161 S STRL PRBE LASER ST/20G $ 934.00 $ 934.00 4028 OPER ROOM40247717 S STRL PRBE/ELECT ORATEC $ 1,333.00 $ 1,333.00 4024 OPER ROOM40285238 S STRL PRESSUR FEMOR CEME $ 93.00 $ 93.00 4028 OPER ROOM40284232 S STRL PROB TRANSONIC $ 488.00 $ 488.00 4028 OPER ROOM40247460 S STRL PROBE LASER $ 1,273.00 $ 1,273.00 4024 OPER ROOM40247785 S STRL PROBE LSR PED 25G $ 871.00 $ 871.00 4024 OPER ROOM40287365 S STRL PROBE NIM NEURO $ 2,099.00 $ 2,099.00 4028 OPER ROOM40287505 S STRL PROBE NOVASURE $ 5,695.00 $ 5,695.00 4028 OPER ROOM40287225 S STRL PROBE Q FLOW $ 4,903.00 $ 4,903.00 4028 OPER ROOM40281121 S STRL PROSTATE SEED NDL $ 943.00 $ 943.00 4028 OPER ROOM40281129 S STRL PROTACK 5MM $ 1,569.00 $ 1,569.00 4028 OPER ROOM40287147 S STRL PROTRACTOR 5M $ 1,138.00 $ 1,138.00 4028 OPER ROOM40287224 S STRL PROTRACTOR LG/EXL $ 741.00 $ 741.00 4028 OPER ROOM40254135 S STRL PSTE TEFLON-MENTO $ 2,229.00 $ 2,229.00 4025 OPER ROOM40284192 S STRL PSTNR HRT MDT/MNPL $ 2,178.00 $ 2,178.00 4028 OPER ROOM40285134 S STRL PULSE LAVAGE SUP $ 394.00 $ 394.00 4028 OPER ROOM40287230 S STRL PUMP PN ONQ 100ML $ 741.00 $ 741.00 4028 OPER ROOM40287231 S STRL PUMP PN ONQ 270ML $ 1,008.00 $ 1,008.00 4028 OPER ROOM40286193 S STRL QUICKERT PROBE $ 197.00 $ 197.00 4028 OPER ROOM40287212 S STRL QUINCKE POINT 23/5 $ 36.00 $ 36.00 4028 OPER ROOM40287370 S STRL RANEY CLIP $ 125.00 $ 125.00 4028 OPER ROOM

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DEPARTMENT CODE

40284118 S STRL RCS/RETROP CANNULA $ 923.00 $ 923.00 4028 OPER ROOM40285141 S STRL RD CR/EZ/STPR TXB $ 954.00 $ 954.00 4028 OPER ROOM40287098 S STRL REDUCER ETHICN BLR $ 111.00 $ 111.00 4028 OPER ROOM40237111 S STRL REESE DERMATO/SPPL $ 577.00 $ 577.00 4023 OPER ROOM40285119 S STRL REFLECTIVE SPHERES $ 1,375.00 $ 1,375.00 4028 OPER ROOM40287218 S STRL RELOD STPL XR30B/G $ 593.00 $ 593.00 4028 OPER ROOM40287016 S STRL RESECTOSCOPE ELECT $ 805.00 $ 805.00 4028 OPER ROOM40247649 S STRL RET STAY LONESTAR $ 435.00 $ 435.00 4024 OPER ROOM40287410 S STRL REUT BIVA NSL SPLT $ 275.00 $ 275.00 4028 OPER ROOM40281130 S STRL RF PROBE 3-5CM $ 9,037.00 $ 9,037.00 4028 OPER ROOM40281131 S STRL RF PROBE 4-7 CM $ 12,864.00 $ 12,864.00 4028 OPER ROOM40247797 S STRL RING BILIARY NDL $ 140.00 $ 140.00 4024 OPER ROOM40285132 S STRL RLD STPL ECR45W AL $ 950.00 $ 950.00 4028 OPER ROOM40285137 S STRL RLD STPL ECR60 ALL $ 1,143.00 $ 1,143.00 4028 OPER ROOM40247433 S STRL RNG/IRIS EXPND MLY $ 219.00 $ 219.00 4024 OPER ROOM40285150 S STRL ROUTER CORE ALL $ 555.00 $ 555.00 4028 OPER ROOM40287134 S STRL RT ANG CLIP APPLIE $ 1,694.00 $ 1,694.00 4028 OPER ROOM40284202 S STRL RTRC ESTECH CV $ 985.00 $ 985.00 4028 OPER ROOM40287294 S STRL RTRCT LAP ALXS LRG $ 291.00 $ 291.00 4028 OPER ROOM40287293 S STRL RTRCT LAP ALXS S/M $ 158.00 $ 158.00 4028 OPER ROOM40287295 S STRL RTRCT LAP ALXS XLG $ 433.00 $ 433.00 4028 OPER ROOM40284124 S STRL SARN FLE CARDI SUC $ 165.00 $ 165.00 4028 OPER ROOM40284155 S STRL SCISS RND 8MM RBT $ 1,215.00 $ 1,215.00 4028 OPER ROOM40247436 S STRL SCRP MBR TAN 20/25 $ 457.00 $ 457.00 4024 OPER ROOM40286170 S STRL SCRPR MEMBRN SYNR $ 847.00 $ 847.00 4028 OPER ROOM40247787 S STRL SCRPR TENO PED 25G $ 741.00 $ 741.00 4024 OPER ROOM40247141 S STRL SCRW/MKR 35&45 ASC $ 522.00 $ 522.00 4024 OPER ROOM40247598 S STRL SCSR CRVD OPTH 23G $ 707.00 $ 707.00 4024 OPER ROOM40281120 S STRL SEED NDL SPACER $ 54.00 $ 54.00 4028 OPER ROOM40247496 S STRL SH LP CUFFED TRACH $ 330.00 $ 330.00 4024 OPER ROOM40284161 S STRL SHEAR HOT RBT $ 1,743.00 $ 1,743.00 4028 OPER ROOM40247648 S STRL SHEATH ACCESS URO $ 757.00 $ 757.00 4024 OPER ROOM40287053 S STRL SHEATH PTC $ 100.00 $ 100.00 4028 OPER ROOM

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DEPARTMENT CODE

40247404 S STRL SHETH URETRL ACESS $ 741.00 $ 741.00 4024 OPER ROOM40284222 S STRL SHNT ANSTFLW 1.5 $ 581.00 $ 581.00 4028 OPER ROOM40287222 S STRL SHR/DIS HARMNC ACE $ 2,287.00 $ 2,287.00 4028 OPER ROOM40284207 S STRL SHUNT INTRACARDIAC $ 581.00 $ 581.00 4028 OPER ROOM40287160 S STRL SIGMODOSCOPY SUP $ 141.00 $ 141.00 4028 OPER ROOM40287409 S STRL SIMPLESPLINT NASAL $ 58.00 $ 58.00 4028 OPER ROOM40247271 S STRL SLEEVE 5MM XCEL $ 437.00 $ 437.00 4024 OPER ROOM40283173 S STRL SLEEVE CANN ETHIC $ 567.00 $ 567.00 4028 OPER ROOM40247435 S STRL SLV INFSN LMFLW 19 $ 135.00 $ 135.00 4024 OPER ROOM40287178 S STRL SMK EVAC TUB/FLTR $ 692.00 $ 692.00 4028 OPER ROOM40285123 S STRL SMOOTHER $ 1,221.00 $ 1,221.00 4028 OPER ROOM40284165 S STRL SNCT/CRD RBT $ 111.00 $ 111.00 4028 OPER ROOM40282108 S STRL SOL PRFS CUSTODIAL $ 906.00 $ 906.00 4028 OPER ROOM40287435 S STRL SOMNUS HANDPC PALE $ 2,363.00 $ 2,363.00 4028 OPER ROOM40287436 S STRL SOMNUS HANDPC TNGE $ 1,749.00 $ 1,749.00 4028 OPER ROOM40287434 S STRL SOMNUS HANDPC TURN $ 985.00 $ 985.00 4028 OPER ROOM40247437 S STRL SPNG RND 2MM DRS $ 309.00 $ 309.00 4024 OPER ROOM40288112 S STRL SPNG VAC TRAC LRG $ 398.00 $ 398.00 4028 OPER ROOM40288111 S STRL SPNG VAC TRAC MD $ 330.00 $ 330.00 4028 OPER ROOM40288110 S STRL SPNG VAC TRAC SM $ 299.00 $ 299.00 4028 OPER ROOM40281117 S STRL SPONGE IODOPHO SOL $ 50.00 $ 50.00 4028 OPER ROOM40287125 S STRL STAPL RELAD GIA 60 $ 807.00 $ 807.00 4028 OPER ROOM40287127 S STRL STAPL RELOA GIA 80 $ 1,367.00 $ 1,367.00 4028 OPER ROOM40287165 S STRL STAPLE ENDO GIA2 $ 1,201.00 $ 1,201.00 4028 OPER ROOM40287128 S STRL STAPLE ENDO GIA 30 $ 1,909.00 $ 1,909.00 4028 OPER ROOM40287037 S STRL STAPLE ENDO HERNIA $ 1,513.00 $ 1,513.00 4028 OPER ROOM40287126 S STRL STAPLE MLTIFIRE $ 1,694.00 $ 1,694.00 4028 OPER ROOM40287188 S STRL STAPLE PURSESTRING $ 943.00 $ 943.00 4028 OPER ROOM40287119 S STRL STAPLE RELOA TA 30 $ 1,166.00 $ 1,166.00 4028 OPER ROOM40287122 S STRL STAPLE RELOA TA 55 $ 1,221.00 $ 1,221.00 4028 OPER ROOM40287129 S STRL STAPLE RELOA TA 90 $ 358.00 $ 358.00 4028 OPER ROOM40287033 S STRL STAPLE RELOAD ENDO $ 1,388.00 $ 1,388.00 4028 OPER ROOM40287087 S STRL STAPLE ROTIC RLEND $ 1,287.00 $ 1,287.00 4028 OPER ROOM

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DEPARTMENT CODE

40287194 S STRL STAPLE UNIT REFILL $ - $ - 4028 OPER ROOM40287086 S STRL STAPLE UNIV HANDLE $ 1,286.00 $ 1,286.00 4028 OPER ROOM40287197 S STRL STAPLER CEEA $ 2,525.00 $ 2,525.00 4028 OPER ROOM40285136 S STRL STAPLER ECR 60 $ 1,279.00 $ 1,279.00 4028 OPER ROOM40287162 S STRL STAPLER ENDO TA $ 2,097.00 $ 2,097.00 4028 OPER ROOM40287124 S STRL STAPLER GIA 60 $ 703.00 $ 703.00 4028 OPER ROOM40287219 S STRL STAPLER NAW45 $ 4,025.00 $ 4,025.00 4028 OPER ROOM40287092 S STRL STAPLER PI 30 $ 881.00 $ 881.00 4028 OPER ROOM40287093 S STRL STAPLER PI 55 $ 920.00 $ 920.00 4028 OPER ROOM40287035 S STRL STAPLER ROTICUL 55 $ 1,916.00 $ 1,916.00 4028 OPER ROOM40287118 S STRL STAPLER TA 30 $ 1,301.00 $ 1,301.00 4028 OPER ROOM40287120 S STRL STAPLER TA 30V $ 1,476.00 $ 1,476.00 4028 OPER ROOM40287121 S STRL STAPLER TA 55 $ 1,288.00 $ 1,288.00 4028 OPER ROOM40287123 S STRL STAPLER TA 90 $ 1,467.00 $ 1,467.00 4028 OPER ROOM40287142 S STRL STAPLER TA45X3.5 $ 986.00 $ 986.00 4028 OPER ROOM40287221 S STRL STAPLER TR45W $ 638.00 $ 638.00 4028 OPER ROOM40287220 S STRL STAPLER TSW35 $ 1,685.00 $ 1,685.00 4028 OPER ROOM40287217 S STRL STAPLER TX30G/30V $ 1,011.00 $ 1,011.00 4028 OPER ROOM40287192 S STRL STAPLER UNIT $ - $ - 4028 OPER ROOM40287195 S STRL STAPLES SKIN $ 139.00 $ 139.00 4028 OPER ROOM40284157 S STRL STBLZ CV MINVS OCT $ 7,599.00 $ 7,599.00 4028 OPER ROOM40284193 S STRL STBLZR OCTPUS CV $ 5,447.00 $ 5,447.00 4028 OPER ROOM40284139 S STRL STITCH VALVE SUTUR $ 590.00 $ 590.00 4028 OPER ROOM40287173 S STRL STONE BASKET $ 1,090.00 $ 1,090.00 4028 OPER ROOM40286131 S STRL STORT I/A PHACO PK $ 1,125.00 $ 1,125.00 4028 OPER ROOM40286133 S STRL STORTZ POST.VIT.PK $ 1,424.00 $ 1,424.00 4028 OPER ROOM40286132 S STRL STORTZ U/S NEEDLE $ 245.00 $ 245.00 4028 OPER ROOM40285138 S STRL STPL ARTC L60 CUT $ 3,434.00 $ 3,434.00 4028 OPER ROOM40287163 S STRL STPL RELAD ENDO $ 1,012.00 $ 1,012.00 4028 OPER ROOM40287094 S STRL STPL RELAD PI 55 $ 461.00 $ 461.00 4028 OPER ROOM40287202 S STRL STPL RELD TA45X35 $ 507.00 $ 507.00 4028 OPER ROOM40286992 S STRL STPL RLD PLCR ALL $ 1,007.00 $ 1,007.00 4028 OPER ROOM40287189 S STRL STPL ROTICULATO 30 $ 1,795.00 $ 1,795.00 4028 OPER ROOM

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DEPARTMENT CODE

40286995 S STRL STPLR AG RALC30/45 $ 1,591.00 $ 1,591.00 4028 OPER ROOM40285144 S STRL STPLR ATW 45 $ 2,817.00 $ 2,817.00 4028 OPER ROOM40286994 S STRL STPLR CRL CS ALL $ 1,975.00 $ 1,975.00 4028 OPER ROOM40247799 S STRL STPLR CRV CS40G $ 1,408.00 $ 1,408.00 4024 OPER ROOM40247800 S STRL STPLR CTG 3.8ECR60 $ 958.00 $ 958.00 4024 OPER ROOM40285140 S STRL STPLR EC 60 $ 1,279.00 $ 1,279.00 4028 OPER ROOM40285131 S STRL STPLR EC45 $ 1,787.00 $ 1,787.00 4028 OPER ROOM40285139 S STRL STPLR EZ45B/G/6TB4 $ 2,970.00 $ 2,970.00 4028 OPER ROOM40285142 S STRL STPLR NAG 45 $ 3,870.00 $ 3,870.00 4028 OPER ROOM40287503 S STRL STPLR SKIN ABSRB $ 308.00 $ 308.00 4028 OPER ROOM40285143 S STRL STPLR TSW 45 $ 2,367.00 $ 2,367.00 4028 OPER ROOM40247830 S STRL STPLR/RLD CAT 1 $ 150.00 $ 150.00 4024 OPER ROOM40247839 S STRL STPLR/RLD CAT 10 $ 1,050.00 $ 1,050.00 4024 OPER ROOM40247840 S STRL STPLR/RLD CAT 11 $ 1,150.00 $ 1,150.00 4024 OPER ROOM40247841 S STRL STPLR/RLD CAT 12 $ 1,250.00 $ 1,250.00 4024 OPER ROOM40247842 S STRL STPLR/RLD CAT 13 $ 1,350.00 $ 1,350.00 4024 OPER ROOM40247843 S STRL STPLR/RLD CAT 14 $ 1,450.00 $ 1,450.00 4024 OPER ROOM40247844 S STRL STPLR/RLD CAT 15 $ 1,550.00 $ 1,550.00 4024 OPER ROOM40247845 S STRL STPLR/RLD CAT 16 $ 1,650.00 $ 1,650.00 4024 OPER ROOM40247846 S STRL STPLR/RLD CAT 17 $ 1,750.00 $ 1,750.00 4024 OPER ROOM40247847 S STRL STPLR/RLD CAT 18 $ 1,850.00 $ 1,850.00 4024 OPER ROOM40247848 S STRL STPLR/RLD CAT 19 $ 1,950.00 $ 1,950.00 4024 OPER ROOM40247831 S STRL STPLR/RLD CAT 2 $ 250.00 $ 250.00 4024 OPER ROOM40247849 S STRL STPLR/RLD CAT 20 $ 2,050.00 $ 2,050.00 4024 OPER ROOM40247850 S STRL STPLR/RLD CAT 21 $ 2,150.00 $ 2,150.00 4024 OPER ROOM40247851 S STRL STPLR/RLD CAT 22 $ 2,250.00 $ 2,250.00 4024 OPER ROOM40247852 S STRL STPLR/RLD CAT 23 $ 2,350.00 $ 2,350.00 4024 OPER ROOM40247853 S STRL STPLR/RLD CAT 24 $ 2,450.00 $ 2,450.00 4024 OPER ROOM40247854 S STRL STPLR/RLD CAT 25 $ 2,550.00 $ 2,550.00 4024 OPER ROOM40247855 S STRL STPLR/RLD CAT 26 $ 2,650.00 $ 2,650.00 4024 OPER ROOM40247856 S STRL STPLR/RLD CAT 27 $ 2,750.00 $ 2,750.00 4024 OPER ROOM40247857 S STRL STPLR/RLD CAT 28 $ 2,850.00 $ 2,850.00 4024 OPER ROOM40247858 S STRL STPLR/RLD CAT 29 $ 2,950.00 $ 2,950.00 4024 OPER ROOM

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DEPARTMENT CODE

40247832 S STRL STPLR/RLD CAT 3 $ 350.00 $ 350.00 4024 OPER ROOM40247859 S STRL STPLR/RLD CAT 31 $ 3,150.00 $ 3,150.00 4024 OPER ROOM40247860 S STRL STPLR/RLD CAT 32 $ 3,250.00 $ 3,250.00 4024 OPER ROOM40247861 S STRL STPLR/RLD CAT 33 $ 3,350.00 $ 3,350.00 4024 OPER ROOM40247862 S STRL STPLR/RLD CAT 34 $ 3,450.00 $ 3,450.00 4024 OPER ROOM40247863 S STRL STPLR/RLD CAT 35 $ 3,550.00 $ 3,550.00 4024 OPER ROOM40247864 S STRL STPLR/RLD CAT 36 $ 3,650.00 $ 3,650.00 4024 OPER ROOM40247865 S STRL STPLR/RLD CAT 37 $ 3,750.00 $ 3,750.00 4024 OPER ROOM40247866 S STRL STPLR/RLD CAT 38 $ 3,850.00 $ 3,850.00 4024 OPER ROOM40247833 S STRL STPLR/RLD CAT 4 $ 450.00 $ 450.00 4024 OPER ROOM40247835 S STRL STPLR/RLD CAT 6 $ 650.00 $ 650.00 4024 OPER ROOM40247836 S STRL STPLR/RLD CAT 7 $ 750.00 $ 750.00 4024 OPER ROOM40247837 S STRL STPLR/RLD CAT 8 $ 850.00 $ 850.00 4024 OPER ROOM40247838 S STRL STPLR/RLD CAT 9 $ 950.00 $ 950.00 4024 OPER ROOM40247834 S STRL STPLR/RLDCAT 5 $ 550.00 $ 550.00 4024 OPER ROOM40288189 S STRL STRP SEAMGARD $ 1,072.00 $ 1,072.00 4028 OPER ROOM40288188 S STRL STRT SHOT ADD $ 1,154.00 $ 1,154.00 4028 OPER ROOM40288187 S STRL STRT SHOT TUBING/E $ 1,034.00 $ 1,034.00 4028 OPER ROOM40284264 S STRL SUCT/CART ERBE KT $ 2,168.00 $ 2,168.00 4028 OPER ROOM40247218 S STRL SURGICLIP $ 448.00 $ 448.00 4024 OPER ROOM40247268 S STRL SURGIGRIP 5MM $ 118.00 $ 118.00 4024 OPER ROOM40287019 S STRL SURGINEEDLE LONG $ 357.00 $ 357.00 4028 OPER ROOM40287043 S STRL SURGINEEDLE X-LONG $ 424.00 $ 424.00 4028 OPER ROOM40285240 S STRL SUT RETRIEV ACUFEX $ 465.00 $ 465.00 4028 OPER ROOM40247709 S STRL SUT RETRIEVER $ 209.00 $ 209.00 4024 OPER ROOM40247440 S STRL SUTR CAPTURE DVC $ 232.00 $ 232.00 4024 OPER ROOM40285201 S STRL SUTR FIBRLOOP 4-0 $ 266.00 $ 266.00 4028 OPER ROOM40284201 S STRL SUTURE BOOTS $ 67.00 $ 67.00 4028 OPER ROOM40284131 S STRL SUTURE CATEGORY $ 27.00 $ 27.00 4028 OPER ROOM40284100 S STRL SUTURE CATEGORY 10 $ 741.00 $ 741.00 4028 OPER ROOM40284132 S STRL SUTURE CATEGORY 2 $ 65.00 $ 65.00 4028 OPER ROOM40284133 S STRL SUTURE CATEGORY 3 $ 102.00 $ 102.00 4028 OPER ROOM40284134 S STRL SUTURE CATEGORY 4 $ 136.00 $ 136.00 4028 OPER ROOM

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DEPARTMENT CODE

40284135 S STRL SUTURE CATEGORY 5 $ 186.00 $ 186.00 4028 OPER ROOM40284136 S STRL SUTURE CATEGORY 6 $ 409.00 $ 409.00 4028 OPER ROOM40284137 S STRL SUTURE CATEGORY 7 $ 903.00 $ 903.00 4028 OPER ROOM40284138 S STRL SUTURE CATEGORY 8 $ 594.00 $ 594.00 4028 OPER ROOM40284099 S STRL SUTURE CATEGORY 9 $ 297.00 $ 297.00 4028 OPER ROOM40284215 S STRL SUTURE GUIDE DISP $ 508.00 $ 508.00 4028 OPER ROOM40285236 S STRL SUTURE PASSER $ 279.00 $ 279.00 4028 OPER ROOM40247734 S STRL SUTURE SHUTTLE $ 138.00 $ 138.00 4024 OPER ROOM40283151 S STRL SYRING LIMAS VNUS $ 120.00 $ 120.00 4028 OPER ROOM40287208 S STRL SYRINGE LOR $ 30.00 $ 30.00 4028 OPER ROOM40285113 S STRL SYRINGE MONARCH 25 $ 1,176.00 $ 1,176.00 4028 OPER ROOM40247594 S STRL SYST ILLMNT SINUS $ 1,444.00 $ 1,444.00 4024 OPER ROOM40247192 S STRL TAB TUBING $ 658.00 $ 658.00 4024 OPER ROOM40247772 S STRL TAB VACCURETTE $ 88.00 $ 88.00 4024 OPER ROOM40247698 S STRL TACKER 5MM $ 2,328.00 $ 2,328.00 4024 OPER ROOM40247722 S STRL TACKER DOUBLE $ 1,150.00 $ 1,150.00 4024 OPER ROOM40287045 S STRL TACKER TYCO LAP/OP $ 611.00 $ 611.00 4028 OPER ROOM40286999 S STRL TACKR SALUTE DAVOL $ 2,086.00 $ 2,086.00 4028 OPER ROOM40286111 S STRL TANO MEMBRAN SCRAP $ 1,092.00 $ 1,092.00 4028 OPER ROOM40284103 S STRL TAPE RETRACTOR $ 155.00 $ 155.00 4028 OPER ROOM40283157 S STRL TB BLWR/SCTN/SILIC $ 260.00 $ 260.00 4028 OPER ROOM40247810 S STRL TB ENTERAL FEEDING $ 143.00 $ 143.00 4024 OPER ROOM40247762 S STRL TB LINVATEC WRIST $ 279.00 $ 279.00 4024 OPER ROOM40247416 S STRL TBG VISAO IRRIG $ 173.00 $ 173.00 4024 OPER ROOM40247432 S STRL TBNG INSFF RGLR $ 41.00 $ 41.00 4024 OPER ROOM40231118 S STRL TED STOCKING $ 96.00 $ 96.00 4023 OPER ROOM40286183 S STRL TEFLON BLOCK $ 212.00 $ 212.00 4028 OPER ROOM40284115 S STRL TEM PACIN WIRE-FLE $ 130.00 $ 130.00 4028 OPER ROOM40284114 S STRL TEM PACIN WIRE-MED $ 394.00 $ 394.00 4028 OPER ROOM40247317 S STRL TENDON LEADER $ 144.00 $ 144.00 4024 OPER ROOM40284262 S STRL TESIO DUAL CATH $ 2,478.00 $ 2,478.00 4028 OPER ROOM40287139 S STRL T-FASTENER $ 624.00 $ 624.00 4028 OPER ROOM40287413 S STRL THERMOP NASAL SPLT $ 68.00 $ 68.00 4028 OPER ROOM

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DEPARTMENT CODE

40287114 S STRL THORACOPORT $ 112.00 $ 112.00 4028 OPER ROOM40287504 S STRL TIP BIPLR EVEREST $ 2,010.00 $ 2,010.00 4028 OPER ROOM40247686 S STRL TIP ENDOSCISSOR $ 420.00 $ 420.00 4024 OPER ROOM40283187 S STRL TIP EVICEL 35CM $ 247.00 $ 247.00 4028 OPER ROOM40287507 S STRL TIP HOOK LAP MGDN $ 192.00 $ 192.00 4028 OPER ROOM40247207 S STRL TIP MRCLTR RCPRCT $ 2,206.00 $ 2,206.00 4024 OPER ROOM40247208 S STRL TIP MRCLTR ROTARY $ 1,716.00 $ 1,716.00 4024 OPER ROOM40247434 S STRL TIP PHC LM FLW 19G $ 420.00 $ 420.00 4024 OPER ROOM40283103 S STRL TIP RUMI COOPER $ 360.00 $ 360.00 4028 OPER ROOM40247209 S STRL TIP SCS CRV MDFLX $ 225.00 $ 225.00 4024 OPER ROOM40247786 S STRL TIP SFT OPTH PED25 $ 201.00 $ 201.00 4024 OPER ROOM40287099 S STRL TISSEAL LAP APPLCT $ 266.00 $ 266.00 4028 OPER ROOM40281127 S STRL TISSOMAT SPRAY SET $ 472.00 $ 472.00 4028 OPER ROOM40247365 S STRL TLS DRAIN $ 135.00 $ 135.00 4024 OPER ROOM40287292 S STRL TNNLR ONQ 11X8/12 $ 549.00 $ 549.00 4028 OPER ROOM40247501 S STRL TRACH TB SHILEY PE $ 248.00 $ 248.00 4024 OPER ROOM40247716 S STRL TRACT TOWER FINGER $ 60.00 $ 60.00 4024 OPER ROOM40286203 S STRL TRAN CORNE RETRACT $ 847.00 $ 847.00 4028 OPER ROOM40282106 S STRL TRANSPLT NACL SOL $ 394.00 $ 394.00 4028 OPER ROOM40247676 S STRL TRCR BLDLES/XCEL12 $ 643.00 $ 643.00 4024 OPER ROOM40247817 S STRL TRCR/PRT CATGRY 1 $ 50.00 $ 50.00 4024 OPER ROOM40247826 S STRL TRCR/PRT CATGRY 10 $ 950.00 $ 950.00 4024 OPER ROOM40247827 S STRL TRCR/PRT CATGRY 11 $ 1,050.00 $ 1,050.00 4024 OPER ROOM40247828 S STRL TRCR/PRT CATGRY 12 $ 1,150.00 $ 1,150.00 4024 OPER ROOM40247829 S STRL TRCR/PRT CATGRY 13 $ 1,250.00 $ 1,250.00 4024 OPER ROOM40247870 S STRL TRCR/PRT CATGRY 14 $ 1,350.00 $ 1,350.00 4024 OPER ROOM40247818 S STRL TRCR/PRT CATGRY 2 $ 150.00 $ 150.00 4024 OPER ROOM40247819 S STRL TRCR/PRT CATGRY 3 $ 250.00 $ 250.00 4024 OPER ROOM40247820 S STRL TRCR/PRT CATGRY 4 $ 350.00 $ 350.00 4024 OPER ROOM40247821 S STRL TRCR/PRT CATGRY 5 $ 450.00 $ 450.00 4024 OPER ROOM40247822 S STRL TRCR/PRT CATGRY 6 $ 550.00 $ 550.00 4024 OPER ROOM40247823 S STRL TRCR/PRT CATGRY 7 $ 650.00 $ 650.00 4024 OPER ROOM40247824 S STRL TRCR/PRT CATGRY 8 $ 750.00 $ 750.00 4024 OPER ROOM

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DEPARTMENT CODE

40247825 S STRL TRCR/PRT CATGRY 9 $ 850.00 $ 850.00 4024 OPER ROOM40247220 S STRL TRIAL SUPPLY $ 1.00 $ 1.00 4024 OPER ROOM40247755 S STRL TRIPLE HANDPIECE $ 195.00 $ 195.00 4024 OPER ROOM40287100 S STRL TRIPLE LUMEN SUMP $ 90.00 $ 90.00 4028 OPER ROOM40287023 S STRL TROCAR 11 MM $ 1,087.00 $ 1,087.00 4028 OPER ROOM40287032 S STRL TROCAR 12 MM $ 1,008.00 $ 1,008.00 4028 OPER ROOM40287025 S STRL TROCAR 5MM $ 837.00 $ 837.00 4028 OPER ROOM40247659 S STRL TROCAR APPLE $ 245.00 $ 245.00 4024 OPER ROOM40287020 S STRL TROCAR APPLE $ 602.00 $ 602.00 4028 OPER ROOM40287063 S STRL TROCAR BALLOON 11M $ 1,398.00 $ 1,398.00 4028 OPER ROOM40247646 S STRL TROCAR ENDOSCRUB $ 392.00 $ 392.00 4024 OPER ROOM40287097 S STRL TROCAR ETHICON BLE $ 1,166.00 $ 1,166.00 4028 OPER ROOM40287145 S STRL TROCAR MINIS 2/5MM $ 922.00 $ 922.00 4028 OPER ROOM40287057 S STRL TROCAR X-LONG $ 1,085.00 $ 1,085.00 4028 OPER ROOM40247660 S STRL TUBE CHEST ARGYLE $ 118.00 $ 118.00 4024 OPER ROOM40247524 S STRL TUBESET SOVRGN $ 590.00 $ 590.00 4024 OPER ROOM40247645 S STRL TUBING ARTHRO GRAV $ 82.00 $ 82.00 4024 OPER ROOM40286998 S STRL TUBING PLUME AWAY $ 216.00 $ 216.00 4028 OPER ROOM40247597 S STRL TUBNG SINUS EXTNSN $ 98.00 $ 98.00 4024 OPER ROOM40247788 S STRL TUBNG TOTL+25G ACC $ 2,446.00 $ 2,446.00 4024 OPER ROOM40287502 S STRL TUMENSENT TBG WJ G $ 153.00 $ 153.00 4028 OPER ROOM40247451 S STRL TUR LOOPS/VAPORTRA $ 1,089.00 $ 1,089.00 4024 OPER ROOM40284140 S STRL UCLIP ANASTAM CLIP $ 826.00 $ 826.00 4028 OPER ROOM40285241 S STRL ULTRABLATR LINVTEC $ 979.00 $ 979.00 4028 OPER ROOM40283124 S STRL URETERAL CONNECTOR $ 100.00 $ 100.00 4028 OPER ROOM40287007 S STRL UROL.VESSE DILATOR $ 68.00 $ 68.00 4028 OPER ROOM40247407 S STRL URTRL ILLUM ST 5F $ 667.00 $ 667.00 4024 OPER ROOM40287015 S STRL U-STASIS BALLOON $ 1,183.00 $ 1,183.00 4028 OPER ROOM40288106 S STRL VAC DRS FOAM WHT L $ 103.00 $ 103.00 4028 OPER ROOM40288105 S STRL VAC DRS FOAM WHT S $ 81.00 $ 81.00 4028 OPER ROOM40288107 S STRL VAC DRS Y CONNECT $ 15.00 $ 15.00 4028 OPER ROOM40288108 S STRL VAC DRSG SILVER $ 458.00 $ 458.00 4028 OPER ROOM40284247 S STRL VALVLTOME LMAITRE $ 3,477.00 $ 3,477.00 4028 OPER ROOM

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DEPARTMENT CODE

40287067 S STRL VAPORIZATION ELECT $ 1,434.00 $ 1,434.00 4028 OPER ROOM40284111 S STRL VENOUS CANN/VENT $ 289.00 $ 289.00 4028 OPER ROOM40284112 S STRL VESSEL CANNULA $ 75.00 $ 75.00 4028 OPER ROOM40247291 S STRL VESSELOOPS $ 35.00 $ 35.00 4024 OPER ROOM40286175 S STRL VFI SILICO OIL TUB $ 817.00 $ 817.00 4028 OPER ROOM40286174 S STRL VGIF ST INFUS TBI $ 1,308.00 $ 1,308.00 4028 OPER ROOM40287161 S STRL VISCERAL RETAINER $ 313.00 $ 313.00 4028 OPER ROOM40247456 S STRL VISTEC 1610 CYSTOT $ 21.00 $ 21.00 4024 OPER ROOM40284234 S STRL VITAL LIGHTED SUC $ 502.00 $ 502.00 4028 OPER ROOM40247534 S STRL VITREC KIT SOVRGN $ 1,173.00 $ 1,173.00 4024 OPER ROOM40287437 S STRL WAND COBLT ENT 55 $ 1,117.00 $ 1,117.00 4028 OPER ROOM40247671 S STRL WAND TATTOO $ 361.00 $ 361.00 4024 OPER ROOM40247359 S STRL WATER PIC SIMPULSE $ 610.00 $ 610.00 4024 OPER ROOM40247546 S STRL WECK DISP.TREPHINE $ 261.00 $ 261.00 4024 OPER ROOM40287363 S STRL WIRE GROUND NEURO $ 166.00 $ 166.00 4028 OPER ROOM40247815 S STRL WRE CTTR DSPS ENT $ 32.00 $ 32.00 4024 OPER ROOM40247505 S STRL XOMED EXT SPLINT $ 139.00 $ 139.00 4024 OPER ROOM40283137 S SYS DIALYSIS ACCESS $ 331.00 $ 331.00 4028 OPER ROOM40251005 S TISSUE CONNCTV HUMAN $ - $ - 4025 OPER ROOM40251011 S TISSUE CONNCTV HUMAN $ 10,631.00 $ 10,631.00 4025 OPER ROOM40251012 S TISSUE CONNCTV HUMAN $ 7,285.00 $ 7,285.00 4025 OPER ROOM40253193 S TISSUE CONNCTV HUMAN $ 703.00 $ 703.00 4025 OPER ROOM40253194 S TISSUE CONNCTV HUMAN $ 966.00 $ 966.00 4025 OPER ROOM40253195 S TISSUE CONNCTV HUMAN $ 2,375.00 $ 2,375.00 4025 OPER ROOM40256115 S TISSUE CONNCTV HUMAN $ 1,434.00 $ 1,434.00 4025 OPER ROOM40256116 S TISSUE CONNCTV HUMAN $ 2,332.00 $ 2,332.00 4025 OPER ROOM40256118 S TISSUE CONNCTV HUMAN $ 6,085.00 $ 6,085.00 4025 OPER ROOM40256119 S TISSUE CONNCTV HUMAN $ 7,477.00 $ 7,477.00 4025 OPER ROOM40256149 S TISSUE CONNCTV HUMAN $ 1,389.00 $ 1,389.00 4025 OPER ROOM40256150 S TISSUE CONNCTV HUMAN $ 3,113.00 $ 3,113.00 4025 OPER ROOM40256162 S TISSUE CONNCTV HUMAN $ 1,370.00 $ 1,370.00 4025 OPER ROOM40256163 S TISSUE CONNCTV HUMAN $ 1,869.00 $ 1,869.00 4025 OPER ROOM40256172 S TISSUE CONNCTV HUMAN $ - $ - 4025 OPER ROOM

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DEPARTMENT CODE

40257497 S TISSUE CONNCTV HUMAN $ 2,344.00 $ 2,344.00 4025 OPER ROOM40257498 S TISSUE CONNCTV HUMAN $ 4,173.00 $ 4,173.00 4025 OPER ROOM40257500 S TISSUE CONNCTV HUMAN $ 22,329.00 $ 22,329.00 4025 OPER ROOM40257501 S TISSUE CONNCTV HUMAN $ 24,756.00 $ 24,756.00 4025 OPER ROOM40255188 S TISSUE CONNCTV HUMAN B $ - $ - 4025 OPER ROOM40255189 S TISSUE CONNCTV HUMAN C $ - $ - 4025 OPER ROOM40251006 S TISSUE CONNCTV NOHUMAN $ - $ - 4025 OPER ROOM40251013 S TISSUE CONNCTV NOHUMAN $ 2,451.00 $ 2,451.00 4025 OPER ROOM40251014 S TISSUE CONNCTV NOHUMAN $ 558.00 $ 558.00 4025 OPER ROOM40251015 S TISSUE CONNCTV NOHUMAN $ 4,935.00 $ 4,935.00 4025 OPER ROOM40254138 S TISSUE CONNCTV NOHUMAN $ 2,295.00 $ 2,295.00 4025 OPER ROOM40257177 S TISSUE CONNCTV NOHUMAN $ 1,144.00 $ 1,144.00 4025 OPER ROOM40257306 S TISSUE CONNCTV NOHUMAN $ 5,174.00 $ 5,174.00 4025 OPER ROOM40257502 S TISSUE CONNCTV NOHUMAN $ 6,536.00 $ 6,536.00 4025 OPER ROOM40257503 S TISSUE CONNCTV NOHUMAN $ 3,269.00 $ 3,269.00 4025 OPER ROOM40254221 S TISSUE MARKER $ 148.00 $ 148.00 4025 OPER ROOM40254230 S TISSUE MARKER $ 96.00 $ 96.00 4025 OPER ROOM40256202 S TISSUE MARKER $ 163.00 $ 163.00 4025 OPER ROOM40247120 S TISSUE MARKER PIGMENT $ 249.00 $ 249.00 4024 OPER ROOM40247454 S WIRE GUIDE $ 741.00 $ 741.00 4024 OPER ROOM40247596 S WIRE GUIDE $ 476.00 $ 476.00 4024 OPER ROOM40283145 S WIRE GUIDE $ 317.00 $ 317.00 4028 OPER ROOM40284104 S WIRE GUIDE $ 148.00 $ 148.00 4028 OPER ROOM40287017 S WIRE GUIDE $ 220.00 $ 220.00 4028 OPER ROOM40287018 S WIRE GUIDE $ 267.00 $ 267.00 4028 OPER ROOM40287055 S WIRE GUIDE $ 181.00 $ 181.00 4028 OPER ROOM40287058 S WIRE GUIDE $ 141.00 $ 141.00 4028 OPER ROOM40287059 S WIRE GUIDE $ 173.00 $ 173.00 4028 OPER ROOM40287066 S WIRE GUIDE $ 517.00 $ 517.00 4028 OPER ROOM40287170 SORBITOL IRRI GU 3000 ML $ 71.24 $ 71.24 4028 OPER ROOM40200181 SURG LVL 1 ADD 15M $ 1,060.00 $ 1,060.00 4020 OPER ROOM40200180 SURG LVL 1 FIRST 30M $ 2,485.00 $ 2,485.00 4020 OPER ROOM40200183 SURG LVL 2 ADD 15M $ 1,257.00 $ 1,257.00 4020 OPER ROOM

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DEPARTMENT CODE

40200182 SURG LVL 2 FIRST 30M $ 3,130.00 $ 3,130.00 4020 OPER ROOM40200185 SURG LVL 3 ADD 15M $ 1,423.00 $ 1,423.00 4020 OPER ROOM40200184 SURG LVL 3 FIRST 30M $ 3,794.00 $ 3,794.00 4020 OPER ROOM40200187 SURG LVL 4 ADD 15M $ 1,510.00 $ 1,510.00 4020 OPER ROOM40200186 SURG LVL 4 FIRST 30M $ 4,449.00 $ 4,449.00 4020 OPER ROOM40200189 SURG LVL 5 ADD 15M $ 1,891.00 $ 1,891.00 4020 OPER ROOM40200188 SURG LVL 5 FIRST 30M $ 4,649.00 $ 4,649.00 4020 OPER ROOM40200198 SURG LVL 6 ADD 15M $ 2,751.00 $ 2,751.00 4020 OPER ROOM40200197 SURG LVL 6 FIRST 30M $ 10,941.00 $ 10,941.00 4020 OPER ROOM40253189 TISSEEL VH SEALANTTOP $ 599.00 $ 599.00 4025 OPER ROOM40253190 TISSEEL VH SEALANTTOP $ 2,233.00 $ 2,233.00 4025 OPER ROOM40253191 TISSEEL VH SEALANTTOP $ 3,351.00 $ 3,351.00 4025 OPER ROOM40256206 TRACH ESPH VOICE PR BYPRO $ 741.00 $ 741.00 4025 OPER ROOM40272667 S STRL CANNULA ACTHRO 5.5 $ 117.00 $ 117.00 4027 OR SUPPLY40272538 S STRL ELECTRODE ARTHROSC $ 224.00 $ 224.00 4027 OR SUPPLY40272854 S STRL HELICA STNE EXTRAC $ 981.00 $ 981.00 4027 OR SUPPLY40272460 S STRL PROBE ATRIAL ABLT $ 13,138.00 $ 13,138.00 4027 OR SUPPLY40272614 S STRL RETRIEVER HEWSON $ 158.00 $ 158.00 4027 OR SUPPLY40272660 S STRL SHAVER BLADE/BURR $ 529.00 $ 529.00 4027 OR SUPPLY40272225 S STRL STAPLER PPH03 $ 1,450.00 $ 1,450.00 4027 OR SUPPLY40272852 S WIRE GUIDE $ 57.00 $ 57.00 4027 OR SUPPLY40272853 S WIRE GUIDE $ 741.00 $ 741.00 4027 OR SUPPLY62450102 S NSTRL CAST A/L SCOT ADD $ 206.00 $ 206.00 6245 ORTHO TECH62450110 S NSTRL CAST APPLICATION $ 175.00 $ 175.00 6245 ORTHO TECH62450127 S NSTRL CAST APPLICATION $ 176.00 $ 176.00 6245 ORTHO TECH62450103 S NSTRL CAST BODY SCOTCH $ 320.00 $ 320.00 6245 ORTHO TECH62450111 S NSTRL CAST LEG $ 547.00 $ 547.00 6245 ORTHO TECH62450101 S NSTRL CAST LG LEG CHILD $ 406.00 $ 406.00 6245 ORTHO TECH62450115 S NSTRL CAST SUPPLIES $ - $ - 6245 ORTHO TECH62450113 S NSTRL LONG ARM CAST $ 406.00 $ 406.00 6245 ORTHO TECH62450114 S NSTRL MISC $ - $ - 6245 ORTHO TECH62450112 S NSTRL OR SHRT LG CST/HE $ 490.00 $ 490.00 6245 ORTHO TECH62450116 S NSTRL REACHER/DRESS STK $ 296.00 $ 296.00 6245 ORTHO TECH

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DEPARTMENT CODE

62450119 S ORTHO CAST REMOVAL $ 98.00 $ 98.00 6245 ORTHO TECH62450126 S ORTHO CAST REPAIR-30MIN $ 100.00 $ 100.00 6245 ORTHO TECH62450125 S ORTHO ORTHO UNILAT BUCK $ 249.00 $ 249.00 6245 ORTHO TECH62450109 S ORTHO TECH 1/4 $ - $ - 6245 ORTHO TECH42610070 OT COMMUNITY REINT EA 15 $ 213.00 $ 169.00 4261 OT PSY PH42630110 OT COMMUNITY REINT EA 15 $ 213.00 $ 169.00 4263 OT PSY PH42610017 OT EVAL 45 $ 553.00 $ 439.00 4261 OT PSY PH42630100 OT PHYS PERFRM TEST EA 15 $ 245.00 $ 194.00 4263 OT PSY PH42610063 OT PROC THER GP 120 $ 1,005.00 $ 797.00 4261 OT PSY PH42610057 OT PROC THER GP 15 $ 196.00 $ 155.00 4261 OT PSY PH42610064 OT PROC THER GP 150M TOTL $ 1,278.90 $ 1,013.50 4261 OT PSY PH42610065 OT PROC THER GP 180M TOTL $ 1,624.20 $ 1,287.10 4261 OT PSY PH42610058 OT PROC THER GP 30 $ 267.00 $ 212.00 4261 OT PSY PH42610059 OT PROC THER GP 45 $ 356.00 $ 282.00 4261 OT PSY PH42610060 OT PROC THER GP 60 $ 434.00 $ 345.00 4261 OT PSY PH42630120 OT PROC THER GP 60 $ 434.00 $ 345.00 4263 OT PSY PH42610061 OT PROC THER GP 75 $ 552.00 $ 438.00 4261 OT PSY PH42610062 OT PROC THER GP 90 $ 708.00 $ 561.00 4261 OT PSY PH53200019 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5320 OVRFL NSY DHS53200119 NEWBORN BOARDER BABY $ 2,079.00 $ 2,079.00 5320 OVRFL NSY DHS53200015 NEWBORN LEVEL I $ 1,706.00 $ 1,706.00 5320 OVRFL NSY DHS53200115 NEWBORN LEVEL I $ 1,706.00 $ 1,706.00 5320 OVRFL NSY DHS53200047 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5320 OVRFL NSY DHS53200147 NEWBORN LEVEL II $ 5,357.00 $ 5,357.00 5320 OVRFL NSY DHS24700017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2470 P 4SOUTH 1 ADULT NEW DHS24700117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2470 P 4SOUTH 1 ADULT NEW DHS24700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2470 P 4SOUTH 1 ADULT NEW DHS24700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2470 P 4SOUTH 1 ADULT NEW DHS24700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2470 P 4SOUTH 1 ADULT NEW DHS24700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2470 P 4SOUTH 1 ADULT NEW DHS24700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2470 P 4SOUTH 1 ADULT NEW DHS24700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2470 P 4SOUTH 1 ADULT NEW DHS24700052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2470 P 4SOUTH 1 ADULT NEW DHS

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DEPARTMENT CODE

24700152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2470 P 4SOUTH 1 ADULT NEW DHS25900002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2590 P 5 SOUTH 2 NEW25900102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2590 P 5 SOUTH 2 NEW25900001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2590 P 5 SOUTH 2 NEW25900101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2590 P 5 SOUTH 2 NEW25900045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2590 P 5 SOUTH 2 NEW25900145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2590 P 5 SOUTH 2 NEW25900052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2590 P 5 SOUTH 2 NEW25900152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2590 P 5 SOUTH 2 NEW25700002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2570 P 5 SOUTH1 DHS NEW25700102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2570 P 5 SOUTH1 DHS NEW25700001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2570 P 5 SOUTH1 DHS NEW25700101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2570 P 5 SOUTH1 DHS NEW25700045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2570 P 5 SOUTH1 DHS NEW25700145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2570 P 5 SOUTH1 DHS NEW25700052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2570 P 5 SOUTH1 DHS NEW25700152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2570 P 5 SOUTH1 DHS NEW26000002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2600 P 5SOUTH3 NEW (6/19/07)26000102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2600 P 5SOUTH3 NEW (6/19/07)26000001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2600 P 5SOUTH3 NEW (6/19/07)26000101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2600 P 5SOUTH3 NEW (6/19/07)26000045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2600 P 5SOUTH3 NEW (6/19/07)26000145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2600 P 5SOUTH3 NEW (6/19/07)26000052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2600 P 5SOUTH3 NEW (6/19/07)26000152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2600 P 5SOUTH3 NEW (6/19/07)24900017 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2490 P SOUTH3 ADULT NEW DHS24900117 ROOM ICU INTERM $ 6,368.00 $ 6,368.00 2490 P SOUTH3 ADULT NEW DHS24900002 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2490 P SOUTH3 ADULT NEW DHS24900102 ROOM MED/SURG/GYN $ 4,619.00 $ 4,619.00 2490 P SOUTH3 ADULT NEW DHS24900001 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2490 P SOUTH3 ADULT NEW DHS24900101 ROOM MED/SURG/GYN PVT $ 4,796.00 $ 4,796.00 2490 P SOUTH3 ADULT NEW DHS24900045 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2490 P SOUTH3 ADULT NEW DHS24900145 ROOM MED/SURG/GYN PVT MJ $ 4,796.00 $ 4,796.00 2490 P SOUTH3 ADULT NEW DHS

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DEPARTMENT CODE

24900052 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2490 P SOUTH3 ADULT NEW DHS24900152 ROOM TELEMETRY/SPEC CARE $ 5,013.00 $ 5,013.00 2490 P SOUTH3 ADULT NEW DHS26402030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2640 PAC CCU OBSERVATION CHGS26422035 OBS ADMIN INFLUENZA VACC $ 43.00 $ 43.00 2642 PAC TICU2 OBSERVATION CHG26422040 OBS ADMIN PNEUMOCOCAL VAC $ 20.00 $ 20.00 2642 PAC TICU2 OBSERVATION CHG26422030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2642 PAC TICU2 OBSERVATION CHG26442030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2644 PACIFIC CVIU OBSERVATION41730000 PANCREAS ACQUISITION $ 125,610.00 $ 125,610.00 4173 PANCRS ACQ41730005 PANCREAS ACQUISITON COMBO $ 37,100.00 $ 37,100.00 4173 PANCRS ACQ32460675 AIRWAY RESISTANCE $ 312.00 $ 312.00 3246 PED PULM32460615 BLD GAS ART $ 667.00 $ 667.00 3246 PED PULM32460656 BRONCHIAL PROVOCATION $ 1,500.00 $ 1,500.00 3246 PED PULM32430350 BRONCHOSCOPY $ 3,500.00 $ 3,500.00 3243 PED PULM32460658 CO DIFFUSING CAPACITY $ 608.00 $ 608.00 3246 PED PULM32460649 CO2 RESPONSE CURVE $ 1,594.00 $ 1,594.00 3246 PED PULM32420230 CPT INITIAL $ 495.00 $ 495.00 3242 PED PULM32460235 CPT SUBSEQUENT $ 281.00 $ 281.00 3246 PED PULM32460635 EKG 12 LEAD TRACING $ 468.00 $ 468.00 3246 PED PULM32460685 EXPIRED GAS COLLECTION $ 1,451.00 $ 1,451.00 3246 PED PULM32460661 FUNCTIONAL RES CAP/VOL $ 502.00 $ 502.00 3246 PED PULM32460650 HYPOXIC RESPONSE CURVE $ 2,325.00 $ 2,325.00 3246 PED PULM32430370 LARYNGOSCOPY DIAG $ 2,796.00 $ 2,796.00 3243 PED PULM32460712 MAXIMAL VOLUNTARY VENT $ 359.00 $ 359.00 3246 PED PULM32400035 MDI/NEB DEMO/EVAL $ 625.00 $ 625.00 3240 PED PULM32420210 MDI/NEB DEMO/EVAL $ 625.00 $ 625.00 3242 PED PULM32460662 NITROGEN WASHOUT $ 2,741.00 $ 2,741.00 3246 PED PULM32460720 PULMONARY COMPLIANCE $ 1,565.00 $ 1,565.00 3246 PED PULM32460627 PULMONARY STRESS COMPLEX $ 1,886.00 $ 1,886.00 3246 PED PULM32460625 PULMONARY STRESS SIMPLE $ 1,575.00 $ 1,575.00 3246 PED PULM32430325 PULSE OXIMETRY MULTIPLE $ 443.00 $ 443.00 3243 PED PULM32430321 PULSE OXIMETRY SINGLE $ 171.00 $ 171.00 3243 PED PULM32460715 RESP FLOW VOLUME LOOP $ 667.00 $ 667.00 3246 PED PULM32400040 S O2 TRANSCUT MON INI $ 331.00 $ 331.00 3240 PED PULM

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DEPARTMENT CODE

32460690 SPIROMETRY $ 995.00 $ 500.00 3246 PED PULM32460695 SPIROMETRY PRE/POST BD $ 1,408.00 $ 1,408.00 3246 PED PULM32460674 THORACIC GAS VOLUME $ 1,233.00 $ 1,233.00 3246 PED PULM32430340 TRACH CHNG NO FIST TRACT $ 651.00 $ 651.00 3243 PED PULM20100003 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 2010 PEDIATRIC ACUTE20100103 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 2010 PEDIATRIC ACUTE24410002 AMB GLUC MON SQ MINM 72HR $ 525.00 $ 525.00 2441 PEDIATRIC DIABETES CLIN24410015 DIAB TRNG SVCS GRP EA 30 $ 114.00 $ 114.00 2441 PEDIATRIC DIABETES CLIN24410014 DIAB TRNG SVCS IND EA 30 $ 149.00 $ 149.00 2441 PEDIATRIC DIABETES CLIN24410003 GLUCOSE $ 13.00 $ 13.00 2441 PEDIATRIC DIABETES CLIN24410006 GLUCOSE BLD REAGENT STRIP $ 11.00 $ 11.00 2441 PEDIATRIC DIABETES CLIN24410001 INSULIN PUMP THER EDUC $ 23.00 $ 23.00 2441 PEDIATRIC DIABETES CLIN24410033 MED NUTR TX COND CH EA15 $ 79.00 $ 79.00 2441 PEDIATRIC DIABETES CLIN24410030 MED NUTR TX EA 15 $ 90.00 $ 90.00 2441 PEDIATRIC DIABETES CLIN24410034 MED NUTR TX GP COND EA30 $ 79.00 $ 79.00 2441 PEDIATRIC DIABETES CLIN24410032 MED NUTR TX GP EA 30 $ 40.00 $ 40.00 2441 PEDIATRIC DIABETES CLIN24410031 MED NUTR TX REASMNT EA 15 $ 90.00 $ 90.00 2441 PEDIATRIC DIABETES CLIN24410005 S STRL CGM SENSOR $ 452.00 $ 452.00 2441 PEDIATRIC DIABETES CLIN42110915 PT ADL TRAIN EA 15 $ 171.00 $ 127.00 4211 PHYS TX42110905 PT COMMUNITY REINT EA 15 $ 197.00 $ 146.00 4211 PHYS TX42110944 PT DEBRIDE NON-SELECT 15 $ 190.00 $ 141.00 4211 PHYS TX42110941 PT DEBRIDE NON-SELECT 30 $ 342.00 $ 254.00 4211 PHYS TX42110942 PT DEBRIDE NON-SELECT 45 $ 637.00 $ 472.00 4211 PHYS TX42110943 PT DEBRIDE NON-SELECT 60 $ 731.00 $ 541.00 4211 PHYS TX42110710 PT E-STIM EA 15 $ 127.00 $ 94.00 4211 PHYS TX42110754 PT E-STIM SUPERVISED 15 $ 124.00 $ 92.00 4211 PHYS TX42110755 PT E-STIM SUPERVISED 30 $ 362.00 $ 268.00 4211 PHYS TX42110892 PT EVAL 45 $ 574.00 $ 425.00 4211 PHYS TX42110970 PT GAIT TRAIN EA 15 $ 183.00 $ 135.00 4211 PHYS TX42110971 PT GAIT TRAIN EA 15 $ 183.00 $ 135.00 4211 PHYS TX42110500 PT MMT BODY W HAND 15 $ 325.00 $ 241.00 4211 PHYS TX42110501 PT MMT BODY W HAND 30 $ 650.00 $ 481.00 4211 PHYS TX42110502 PT MMT BODY W HAND 45 $ 975.00 $ 722.00 4211 PHYS TX

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42110503 PT MMT BODY W HAND 60 $ 1,300.00 $ 962.00 4211 PHYS TX42110505 PT MMT BODY WO HAND 15 $ 264.00 $ 195.00 4211 PHYS TX42110506 PT MMT BODY WO HAND 30 $ 641.00 $ 474.00 4211 PHYS TX42110507 PT MMT BODY WO HAND 45 $ 791.00 $ 586.00 4211 PHYS TX42110508 PT MMT BODY WO HAND 60 $ 1,055.00 $ 781.00 4211 PHYS TX42110510 PT MMT HAND 15 $ 149.00 $ 110.00 4211 PHYS TX42110511 PT MMT HAND 30 $ 298.00 $ 220.00 4211 PHYS TX42110512 PT MMT HAND 45 $ 440.00 $ 326.00 4211 PHYS TX42110513 PT MMT HAND 60 $ 587.00 $ 435.00 4211 PHYS TX42110515 PT MMT LIMB 15 $ 166.00 $ 123.00 4211 PHYS TX42110516 PT MMT LIMB 30 $ 318.00 $ 235.00 4211 PHYS TX42110517 PT MMT LIMB 45 $ 440.00 $ 326.00 4211 PHYS TX42110518 PT MMT LIMB 60 $ 587.00 $ 435.00 4211 PHYS TX42110990 PT NEUROMUSC REED EA 15 $ 194.00 $ 144.00 4211 PHYS TX42110961 PT ORTHOTIC TRAIN EA 15 $ 166.00 $ 123.00 4211 PHYS TX42110873 PT PROC THER GP 15 $ 100.00 $ 74.00 4211 PHYS TX42110874 PT PROC THER GP 30 $ 195.00 $ 144.00 4211 PHYS TX42110875 PT PROC THER GP 45 $ 302.00 $ 223.00 4211 PHYS TX42110876 PT PROC THER GP 60 $ 367.00 $ 272.00 4211 PHYS TX42110945 PT PROSTH TRAIN EA 15 $ 196.00 $ 145.00 4211 PHYS TX42110962 PT PROSTHETIC FU EA 15M $ 142.00 $ 105.00 4211 PHYS TX42110897 PT RE-EVAL 45 $ 518.00 $ 383.00 4211 PHYS TX42110520 PT ROM BODY WO HAND 15 $ 136.00 $ 101.00 4211 PHYS TX42110521 PT ROM BODY WO HAND 30 $ 182.00 $ 135.00 4211 PHYS TX42110522 PT ROM BODY WO HAND 45 $ 273.00 $ 202.00 4211 PHYS TX42110523 PT ROM BODY WO HAND 60 $ 364.00 $ 270.00 4211 PHYS TX42110525 PT ROM HAND 15 $ 105.00 $ 77.00 4211 PHYS TX42110526 PT ROM HAND 30 $ 243.00 $ 180.00 4211 PHYS TX42110527 PT ROM HAND 45 $ 183.00 $ 136.00 4211 PHYS TX42110528 PT ROM HAND 60 $ 245.00 $ 181.00 4211 PHYS TX42110995 PT SENS INTEGRATION EA 15 $ 226.00 $ 167.00 4211 PHYS TX42110900 PT THER ACT EA 15 $ 223.00 $ 165.00 4211 PHYS TX42110870 PT THER EX EA 15 $ 197.00 $ 146.00 4211 PHYS TX

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DEPARTMENT CODE

42110910 PT THER EX EA 15 $ 197.00 $ 146.00 4211 PHYS TX42110720 PT THER MASSAGE EA 15 $ 158.00 $ 117.00 4211 PHYS TX42110935 PT TRN BIOFD ANY MODAL 15 $ 345.00 $ 255.00 4211 PHYS TX42110535 PT TRN BIOFD ANY MODAL 30 $ 401.00 $ 297.00 4211 PHYS TX42110536 PT TRN BIOFD ANY MODAL 45 $ 494.00 $ 365.00 4211 PHYS TX42110537 PT TRN BIOFD ANY MODAL 60 $ 659.00 $ 488.00 4211 PHYS TX42110705 PT ULTRASOUND EA 15 $ 168.00 $ 124.00 4211 PHYS TX42110980 PT WHLCHR MNG/TRAIN EA 15 $ 196.00 $ 145.00 4211 PHYS TX42110610 S NSTRL THERABAND $ 48.00 $ 48.00 4211 PHYS TX42140931 PT AQUATC THER EX ADD 15 $ 217.00 $ 161.00 4214 PHYSICAL THERAPY42150761 PT AQUATC THER EX ADD 15 $ 217.00 $ 161.00 4215 PHYSICAL THERAPY42140930 PT AQUATC THER EX INIT 30 $ 450.00 $ 333.00 4214 PHYSICAL THERAPY42150760 PT AQUATC THER EX INIT 30 $ 450.00 $ 333.00 4215 PHYSICAL THERAPY42140935 PT BIOFD PERI/URO/RECT 15 $ 450.00 $ 333.00 4214 PHYSICAL THERAPY42140936 PT BIOFD PERI/URO/RECT 30 $ 758.00 $ 561.00 4214 PHYSICAL THERAPY42140937 PT BIOFD PERI/URO/RECT 45 $ 1,125.00 $ 833.00 4214 PHYSICAL THERAPY42140938 PT BIOFD PERI/URO/RECT 60 $ 1,943.00 $ 1,439.00 4214 PHYSICAL THERAPY42150921 PT CASE CONF REP ADD 15 $ 90.00 $ 66.00 4215 PHYSICAL THERAPY42150920 PT CASE CONF REP INIT 30 $ 501.00 $ 371.00 4215 PHYSICAL THERAPY42150925 PT CASE CONSULT AND REP $ 55.00 $ 41.00 4215 PHYSICAL THERAPY42150731 PT COMPRESS PUMP ADD 15 $ 93.00 $ 69.00 4215 PHYSICAL THERAPY42150730 PT COMPRESS PUMP INIT 30 $ 209.00 $ 155.00 4215 PHYSICAL THERAPY42140950 PT COMPU ASSIST TRAIN >30 $ 174.00 $ 129.00 4214 PHYSICAL THERAPY42140766 PT CONTRAST BATH ADD 15 $ 241.00 $ 179.00 4214 PHYSICAL THERAPY42140765 PT CONTRAST BATH INIT 30 $ 482.00 $ 357.00 4214 PHYSICAL THERAPY42150631 PT DEBRIDE/DRESS ADD 15 $ 254.00 $ 188.00 4215 PHYSICAL THERAPY42150630 PT DEBRIDE/DRESS INIT 30 $ 508.00 $ 376.00 4215 PHYSICAL THERAPY42150711 PT E-STIM ADD 15 $ 144.00 $ 107.00 4215 PHYSICAL THERAPY42140711 PT E-STIM MANUAL ADD 15 $ 223.00 $ 165.00 4214 PHYSICAL THERAPY42150756 PT E-STIM MANUAL ADD 15 $ 223.00 $ 165.00 4215 PHYSICAL THERAPY42140710 PT E-STIM MANUAL INIT 30 $ 327.00 $ 242.00 4214 PHYSICAL THERAPY42150755 PT E-STIM SUP INIT 30 $ 236.00 $ 175.00 4215 PHYSICAL THERAPY42150891 PT EVAL ADD 15 $ 199.00 $ 147.00 4215 PHYSICAL THERAPY

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DEPARTMENT CODE

42140890 PT EVAL BRIEF $ 195.00 $ 144.00 4214 PHYSICAL THERAPY42140894 PT EVAL COMPREHENSIVE $ 365.00 $ 270.00 4214 PHYSICAL THERAPY42140893 PT EVAL EXTENDED $ 741.00 $ 549.00 4214 PHYSICAL THERAPY42150892 PT EVAL INIT 30 $ 398.00 $ 294.00 4215 PHYSICAL THERAPY42140892 PT EVAL INTERMEDIATE $ 636.00 $ 471.00 4214 PHYSICAL THERAPY42140891 PT EVAL LTD $ 400.00 $ 296.00 4214 PHYSICAL THERAPY42150890 PT EVAL PRELIM 30 $ 346.00 $ 256.00 4215 PHYSICAL THERAPY42140873 PT EXER GP ADD 15 $ 197.00 $ 146.00 4214 PHYSICAL THERAPY42140874 PT EXER GP INIT 30 $ 393.00 $ 291.00 4214 PHYSICAL THERAPY42140901 PT FNX ACT ADD 15 $ 180.00 $ 133.00 4214 PHYSICAL THERAPY42150901 PT FNX ACT ADD 15 $ 180.00 $ 133.00 4215 PHYSICAL THERAPY42140900 PT FNX ACT INIT 30 $ 353.00 $ 261.00 4214 PHYSICAL THERAPY42140971 PT GAIT TRAIN ADD 15 $ 192.00 $ 142.00 4214 PHYSICAL THERAPY42140970 PT GAIT TRAIN INIT 30 $ 387.00 $ 286.00 4214 PHYSICAL THERAPY42140870 PT GP ED PER SESSION $ 199.00 $ 147.00 4214 PHYSICAL THERAPY42150930 PT HOME EVALUATION $ 1,503.00 $ 1,113.00 4215 PHYSICAL THERAPY42140905 PT IND INSTRUCT INIT 30 $ 327.00 $ 242.00 4214 PHYSICAL THERAPY42150931 PT MILEAGE >10 MI 1 WAY $ 277.00 $ 205.00 4215 PHYSICAL THERAPY42140991 PT NEUROMUSC REED ADD 15 $ 190.00 $ 141.00 4214 PHYSICAL THERAPY42140990 PT NEUROMUSC REED INIT 30 $ 351.00 $ 260.00 4214 PHYSICAL THERAPY42140941 PT ORT/PRO/ADL CK ADD 15 $ 197.00 $ 146.00 4214 PHYSICAL THERAPY42140940 PT ORT/PRO/ADL CK INIT 30 $ 553.00 $ 410.00 4214 PHYSICAL THERAPY42140955 PT ORTHOTIC FAB INIT 30 $ 315.00 $ 233.00 4214 PHYSICAL THERAPY42140962 PT ORTHOTIC TRAIN ADD 15 $ 242.00 $ 179.00 4214 PHYSICAL THERAPY42140961 PT ORTHOTIC TRAIN INIT 30 $ 293.00 $ 217.00 4214 PHYSICAL THERAPY42140946 PT PROSTH TRAIN ADD 15 $ 192.00 $ 142.00 4214 PHYSICAL THERAPY42140945 PT PROSTH TRAIN INIT 30 $ 379.00 $ 281.00 4214 PHYSICAL THERAPY42150895 PT RE-EVAL ADD 15 $ 167.00 $ 124.00 4215 PHYSICAL THERAPY42140898 PT RE-EVAL COMPREHENSIVE $ 283.00 $ 209.00 4214 PHYSICAL THERAPY42140897 PT RE-EVAL EXTENDED $ 629.00 $ 466.00 4214 PHYSICAL THERAPY42150896 PT RE-EVAL INIT 30 $ 342.00 $ 253.00 4215 PHYSICAL THERAPY42140896 PT RE-EVAL INTERMEDIATE $ 479.00 $ 355.00 4214 PHYSICAL THERAPY42140895 PT RE-EVAL LTD $ 325.00 $ 241.00 4214 PHYSICAL THERAPY

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DEPARTMENT CODE

42150701 PT SINGLE MODAL ADD 15 $ 202.00 $ 149.00 4215 PHYSICAL THERAPY42150700 PT SINGLE MODAL INIT 30 $ 392.00 $ 291.00 4215 PHYSICAL THERAPY42150811 PT SINGLE PROC ADD 15 $ 236.00 $ 175.00 4215 PHYSICAL THERAPY42150810 PT SINGLE PROC INIT 30 $ 480.00 $ 356.00 4215 PHYSICAL THERAPY42140780 PT SOFT TISSUE MOB INIT30 $ 303.00 $ 224.00 4214 PHYSICAL THERAPY42140745 PT TAPING EA VISIT $ 360.00 $ 266.00 4214 PHYSICAL THERAPY42150736 PT TENS ADD 15 $ 161.00 $ 119.00 4215 PHYSICAL THERAPY42150735 PT TENS INIT 30 $ 215.00 $ 160.00 4215 PHYSICAL THERAPY42140921 PT THER ACT ADD 15 $ 137.00 $ 102.00 4214 PHYSICAL THERAPY42140920 PT THER ACT INIT 30 $ 311.00 $ 230.00 4214 PHYSICAL THERAPY42140911 PT THER EX ADD 15 $ 194.00 $ 144.00 4214 PHYSICAL THERAPY42150911 PT THER EX ADD 15 $ 194.00 $ 144.00 4215 PHYSICAL THERAPY42140910 PT THER EX INIT 30 $ 311.00 $ 230.00 4214 PHYSICAL THERAPY42150910 PT THER EX INIT 30 $ 311.00 $ 230.00 4215 PHYSICAL THERAPY42140721 PT THER MASSAGE ADD 15 $ 205.00 $ 152.00 4214 PHYSICAL THERAPY42140720 PT THER MASSAGE INIT 30 $ 376.00 $ 279.00 4214 PHYSICAL THERAPY42150801 PT TREAT COMBO ADD 15 $ 212.00 $ 157.00 4215 PHYSICAL THERAPY42150800 PT TREAT COMBO INIT 30 $ 416.00 $ 308.00 4215 PHYSICAL THERAPY42140976 PT TX PHYS MED EA 15 $ 195.00 $ 144.00 4214 PHYSICAL THERAPY42140705 PT ULTRASOUND INIT 30 $ 340.00 $ 251.00 4214 PHYSICAL THERAPY42150726 PT WHIRLPOOL SUP ADD 15 $ 191.00 $ 142.00 4215 PHYSICAL THERAPY42150725 PT WHIRLPOOL SUP INIT 30 $ 384.00 $ 284.00 4215 PHYSICAL THERAPY30400404 ALBUMIN 5%/250ML $ 620.00 $ 620.00 3040 PLASMAPHERESIS30400240 APHERESIS ADSORP/REINFUSE $ 5,636.00 $ 5,636.00 3040 PLASMAPHERESIS30400230 APHERESIS PLASMA $ 8,737.00 $ 8,737.00 3040 PLASMAPHERESIS30400220 APHERESIS PLATELET $ 5,670.00 $ 5,670.00 3040 PLASMAPHERESIS30400210 APHERESIS RBC $ 5,507.00 $ 5,507.00 3040 PLASMAPHERESIS30400250 APHERESIS SELECTIVE $ 2,289.00 $ 2,289.00 3040 PLASMAPHERESIS30400200 APHERESIS WBC $ 5,374.00 $ 5,374.00 3040 PLASMAPHERESIS30400140 HYDRATN INFSN EA ADD HR $ 175.00 $ 175.00 3040 PLASMAPHERESIS30400130 HYDRATN INFSN INIT 31-60M $ 250.00 $ 250.00 3040 PLASMAPHERESIS30400120 INFSN W/MED EA ADD HR $ 175.00 $ 175.00 3040 PLASMAPHERESIS30400110 INFUSION W/MED 16-60MN $ 250.00 $ 250.00 3040 PLASMAPHERESIS

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DEPARTMENT CODE

30400401 IVIG LYOPHILIZD 500MG NOS $ 430.00 $ 430.00 3040 PLASMAPHERESIS30400410 PHLEBOTOMY THERAPEUTIC $ 480.00 $ 480.00 3040 PLASMAPHERESIS40500014 CPLX PACU ADD 15M $ 919.00 $ 919.00 4050 POST ANESTH40500013 CPLX PACU FIRST 30M $ 1,851.00 $ 1,851.00 4050 POST ANESTH40560045 S CATH SP/CYSTOSCOPIC $ 86.00 $ 86.00 4056 POST ANESTH40576017 S CATH SP/CYSTOSCOPIC $ 76.00 $ 76.00 4057 POST ANESTH40560022 S NSTRL AMBU BAG ADULT $ 142.00 $ 142.00 4056 POST ANESTH40575005 S NSTRL AMBU BAG ADULT $ 128.00 $ 128.00 4057 POST ANESTH40560059 S NSTRL DEFIB PAD $ 58.00 $ 58.00 4056 POST ANESTH40500010 S NSTRL OXIM FINGER PROBE $ 248.00 $ 248.00 4050 POST ANESTH40576023 S NSTRL WARMING BLANK $ 119.00 $ 119.00 4057 POST ANESTH40560050 S NSTRL WARMING BLANKET $ 133.00 $ 133.00 4056 POST ANESTH40576024 S STRL ART/CVP/SG/ICP $ 506.00 $ 506.00 4057 POST ANESTH40560048 S STRL BLOOD GAS TRAY $ 86.00 $ 86.00 4056 POST ANESTH40560037 S STRL BLOOD TUBING SET $ 138.00 $ 138.00 4056 POST ANESTH40576009 S STRL BLOOD TUBING SET $ 125.00 $ 125.00 4057 POST ANESTH40560044 S STRL OVRHD IRRIG SET $ 65.00 $ 65.00 4056 POST ANESTH40576016 S STRL OVRHD IRRIG SET $ 58.00 $ 58.00 4057 POST ANESTH40560046 S STRL U-DRAIN BAG $ 207.00 $ 207.00 4056 POST ANESTH40576018 S STRL U-DRAIN BAG $ 187.00 $ 187.00 4057 POST ANESTH40500016 STND PACU LVL 1 ADD 15M $ 283.00 $ 283.00 4050 POST ANESTH40500015 STND PACU LVL 1 FIRST 30M $ 576.00 $ 576.00 4050 POST ANESTH40500018 STND PACU LVL 2 ADD 15M $ 323.00 $ 323.00 4050 POST ANESTH40500017 STND PACU LVL 2 FIRST 30M $ 856.00 $ 856.00 4050 POST ANESTH40515601 CARDIOVERT ELECTIVE EXT $ 1,469.00 $ 1,469.00 4051 POST ANESTHESIA40516030 D51/2NS 1000ML $ 128.23 $ 128.23 4051 POST ANESTHESIA40516029 D51/4NS 500ML $ 123.63 $ 123.63 4051 POST ANESTHESIA40516028 LACTATE RINGERS TO 1000CC $ 121.29 $ 121.29 4051 POST ANESTHESIA40516031 NA CL IRRIG 500ML $ 106.72 $ 106.72 4051 POST ANESTHESIA40516037 NA CL IRRIG 500ML $ 54.89 $ 54.89 4051 POST ANESTHESIA40516039 NA CL IRRIG 500ML $ 20.88 $ 20.88 4051 POST ANESTHESIA40516033 WATER IJ 250ML $ 106.01 $ 106.01 4051 POST ANESTHESIA40516040 WATER IRRIG 500ML $ 60.31 $ 60.31 4051 POST ANESTHESIA

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DEPARTMENT CODE

40516041 WATER IRRIG 500ML $ 20.88 $ 20.88 4051 POST ANESTHESIA44130000 DISCISSN 2ND MEM CAT LASR $ 780.00 $ 780.00 4413 PRF EYE LASER SURG44130001 IRIDOTOMY/IRIDECTOMY LSR $ 1,511.00 $ 1,511.00 4413 PRF EYE LASER SURG44130002 LASER EYE SEVER ADHESIONS $ 1,493.00 $ 1,493.00 4413 PRF EYE LASER SURG43221055 COLOR VISION EXAM EXTEN $ 189.00 $ 189.00 4322 PRF EYE SVC43243010 CORNEAL TOPOGRAPHY $ 195.00 $ 195.00 4324 PRF EYE SVC43221020 ELECT-OCULOGRAPHY $ 371.00 $ 371.00 4322 PRF EYE SVC43221030 ELECTRORETINOGRAPHY $ 507.00 $ 507.00 4322 PRF EYE SVC43241000 INDOCY GREEN ANGIOG $ 517.00 $ 517.00 4324 PRF EYE SVC43241002 INDOCY GREEN ANGIOG $ 1,034.00 $ 1,034.00 4324 PRF EYE SVC43246000 OPHTH BIO US ECHO ASCAN $ 189.00 $ 189.00 4324 PRF EYE SVC43247000 OPHTH BIO US ECHO ASCAN $ 378.00 $ 378.00 4324 PRF EYE SVC43242002 OPHTH DX IMG POST SEG UNI $ 219.00 $ 219.00 4324 PRF EYE SVC43244000 OPHTH US DX IMRSN BSCAN $ 445.00 $ 445.00 4324 PRF EYE SVC43243000 OPHTH US ECHO DX BSCAN $ 507.00 $ 507.00 4324 PRF EYE SVC43243050 OPHTH US ECHO DX BSCAN $ 507.00 $ 507.00 4324 PRF EYE SVC43249002 PACHYMETRY UNIL OR BILATL $ 137.00 $ 137.00 4324 PRF EYE SVC43221040 S NSTRL ERG ELECTRODES $ 100.00 $ 100.00 4322 PRF EYE SVC43220030 VISL FLD EXAM W I&R EXT $ 323.00 $ 323.00 4322 PRF EYE SVC43220060 VISL FLD EXAM W I&R EXT $ 323.00 $ 323.00 4322 PRF EYE SVC43220020 VISL FLD EXAM W I&R INT $ 287.00 $ 287.00 4322 PRF EYE SVC43220050 VISL FLD EXAM W I&R INT $ 287.00 $ 287.00 4322 PRF EYE SVC43220018 VISL FLD EXAM W I&R LTD $ 281.00 $ 281.00 4322 PRF EYE SVC43220040 VISL FLD EXAM W I&R LTD $ 281.00 $ 281.00 4322 PRF EYE SVC43221041 VISUAL EVOKED POTENTIAL $ 760.00 $ 760.00 4322 PRF EYE SVC42350761 PT AQUATC THER EX ADD 15 $ 217.00 $ 161.00 4235 PT OUTPATIENT42350760 PT AQUATC THER EX INIT 30 $ 450.00 $ 333.00 4235 PT OUTPATIENT42350891 PT EVAL ADD 15 $ 199.00 $ 147.00 4235 PT OUTPATIENT42350892 PT EVAL INIT 30 $ 398.00 $ 294.00 4235 PT OUTPATIENT42350701 PT SINGLE MODAL ADD 15 $ 202.00 $ 149.00 4235 PT OUTPATIENT42350700 PT SINGLE MODAL INIT 30 $ 392.00 $ 291.00 4235 PT OUTPATIENT42350811 PT SINGLE PROC ADD 15 $ 236.00 $ 175.00 4235 PT OUTPATIENT42350810 PT SINGLE PROC INIT 30 $ 480.00 $ 356.00 4235 PT OUTPATIENT

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DEPARTMENT CODE

42350801 PT TREAT COMBO ADD 15 $ 212.00 $ 157.00 4235 PT OUTPATIENT42350800 PT TREAT COMBO INIT 30 $ 416.00 $ 308.00 4235 PT OUTPATIENT26412030 OBSERVATION PER HOUR $ 236.00 $ 236.00 2641 PTICU OBSERVATION CHG42311100 1:1 PILATES -- INDIVIDUAL $ 56.00 $ 56.00 4231 PT-OUT42311101 1:1 PILATES -- PACKAGE $ 80.00 $ 80.00 4231 PT-OUT42311112 BIKE FIT -- FOLLOW-UP $ 51.00 $ 51.00 4231 PT-OUT42311110 BIKE FIT -- OPTION 1 $ 100.00 $ 100.00 4231 PT-OUT42311111 BIKE FIT -- OPTION 2 $ 150.00 $ 150.00 4231 PT-OUT42311140 FIT FOR LIFE CLASS $ 10.00 $ 10.00 4231 PT-OUT42311161 FITNESS 1:1 (45 MIN) $ 75.00 $ 75.00 4231 PT-OUT42311162 FITNESS 1:1 (60 MIN) $ 100.00 $ 100.00 4231 PT-OUT42311160 FITNESS CLASS $ 15.00 $ 15.00 4231 PT-OUT42311122 FOLLOW-UP RUNNING SESSION $ 60.00 $ 60.00 4231 PT-OUT42311130 GOLF CLASS $ 18.00 $ 18.00 4231 PT-OUT42311132 GOLF FOLLOW UP $ 75.00 $ 75.00 4231 PT-OUT42311131 GOLF VIDEO ASSESSMENT $ 100.00 $ 100.00 4231 PT-OUT42311102 MAT CLASS -- INDIVIDUAL $ 15.00 $ 15.00 4231 PT-OUT42311103 MAT CLASS -- PACKAGE $ 12.00 $ 12.00 4231 PT-OUT42310913 PT ADL TRAIN EA 15 $ 171.00 $ 127.00 4231 PT-OUT42310960 PT AQUATC THER EA 15 $ 201.00 $ 149.00 4231 PT-OUT42300961 PT AQUATC THER EX ADD 15 $ 217.00 $ 161.00 4230 PT-OUT42300960 PT AQUATC THER EX INIT 30 $ 450.00 $ 333.00 4230 PT-OUT42300880 PT ASST TECH ASSESS EA 15 $ 212.00 $ 157.00 4230 PT-OUT42310880 PT ASST TECH ASSESS EA 15 $ 212.00 $ 157.00 4231 PT-OUT42310248 PT COMMUNITY REINT EA 15 $ 197.00 $ 146.00 4231 PT-OUT42310925 PT COMMUNITY REINT EA 15 $ 197.00 $ 146.00 4231 PT-OUT42320925 PT COMMUNITY REINT EA 15 $ 197.00 $ 146.00 4232 PT-OUT42310955 PT COMPU ASSIST TRAIN >30 $ 174.00 $ 129.00 4231 PT-OUT42320955 PT COMPU ASSIST TRAIN >30 $ 174.00 $ 129.00 4232 PT-OUT42320630 PT DEBRIDE NON-SELECT 15 $ 190.00 $ 141.00 4232 PT-OUT42320631 PT DEBRIDE NON-SELECT 30 $ 342.00 $ 254.00 4232 PT-OUT42320632 PT DEBRIDE NON-SELECT 45 $ 637.00 $ 472.00 4232 PT-OUT42320633 PT DEBRIDE NON-SELECT 60 $ 731.00 $ 541.00 4232 PT-OUT

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DEPARTMENT CODE

42310710 PT E-STIM EA 15 $ 127.00 $ 94.00 4231 PT-OUT42320710 PT E-STIM EA 15 $ 127.00 $ 94.00 4232 PT-OUT42300710 PT E-STIM MANUAL INIT 30 $ 327.00 $ 242.00 4230 PT-OUT42330710 PT E-STIM MANUAL INIT 30 $ 327.00 $ 242.00 4233 PT-OUT42300754 PT E-STIM SUPERVISED 15 $ 124.00 $ 92.00 4230 PT-OUT42310754 PT E-STIM SUPERVISED 15 $ 124.00 $ 92.00 4231 PT-OUT42320754 PT E-STIM SUPERVISED 15 $ 124.00 $ 92.00 4232 PT-OUT42330754 PT E-STIM SUPERVISED 15 $ 124.00 $ 92.00 4233 PT-OUT42310892 PT EVAL 45 $ 574.00 $ 425.00 4231 PT-OUT42320892 PT EVAL 45 $ 574.00 $ 425.00 4232 PT-OUT42300890 PT EVAL BRIEF $ 195.00 $ 144.00 4230 PT-OUT42330890 PT EVAL BRIEF $ 195.00 $ 144.00 4233 PT-OUT42300894 PT EVAL COMPREHENSIVE $ 365.00 $ 270.00 4230 PT-OUT42330894 PT EVAL COMPREHENSIVE $ 365.00 $ 270.00 4233 PT-OUT42300893 PT EVAL EXTENDED $ 741.00 $ 549.00 4230 PT-OUT42330893 PT EVAL EXTENDED $ 741.00 $ 549.00 4233 PT-OUT42300892 PT EVAL INTERMEDIATE $ 636.00 $ 471.00 4230 PT-OUT42330892 PT EVAL INTERMEDIATE $ 636.00 $ 471.00 4233 PT-OUT42300891 PT EVAL LTD $ 400.00 $ 296.00 4230 PT-OUT42330891 PT EVAL LTD $ 400.00 $ 296.00 4233 PT-OUT42300931 PT EXER GP ADD 15 $ 197.00 $ 146.00 4230 PT-OUT42300930 PT EXER GP INIT 30 $ 393.00 $ 291.00 4230 PT-OUT42300886 PT EXTREMITY TEST ADD 15 $ 242.00 $ 179.00 4230 PT-OUT42330881 PT EXTREMITY TEST ADD 15 $ 242.00 $ 179.00 4233 PT-OUT42300885 PT EXTREMITY TEST INIT 30 $ 483.00 $ 358.00 4230 PT-OUT42330880 PT EXTREMITY TEST INIT 30 $ 483.00 $ 358.00 4233 PT-OUT42300900 PT FNX ACT INIT 30 $ 353.00 $ 261.00 4230 PT-OUT42330900 PT FNX ACT INIT 30 $ 353.00 $ 261.00 4233 PT-OUT42310970 PT GAIT TRAIN EA 15 $ 183.00 $ 135.00 4231 PT-OUT42300970 PT GAIT TRAIN INIT 30 $ 387.00 $ 286.00 4230 PT-OUT42330970 PT GAIT TRAIN INIT 30 $ 387.00 $ 286.00 4233 PT-OUT42300933 PT GP ED PER SESSION $ 199.00 $ 147.00 4230 PT-OUT42300925 PT IND INSTRUCT INIT 30 $ 327.00 $ 242.00 4230 PT-OUT

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DEPARTMENT CODE

42330925 PT IND INSTRUCT INIT 30 $ 327.00 $ 242.00 4233 PT-OUT42310745 PT IONTOPHORESIS EA 15 $ 218.00 $ 161.00 4231 PT-OUT42320745 PT IONTOPHORESIS EA 15 $ 218.00 $ 161.00 4232 PT-OUT42300745 PT IONTOPHORESIS INIT 30 $ 362.00 $ 268.00 4230 PT-OUT42330745 PT IONTOPHORESIS INIT 30 $ 362.00 $ 268.00 4233 PT-OUT42300510 PT JOINT MOB EA VISIT $ 374.00 $ 277.00 4230 PT-OUT42330510 PT JOINT MOB EA VISIT $ 374.00 $ 277.00 4233 PT-OUT42310515 PT MANUAL THER EA 15 $ 180.00 $ 133.00 4231 PT-OUT42320515 PT MANUAL THER EA 15 $ 180.00 $ 133.00 4232 PT-OUT42300500 PT MANUAL TRACT INIT 30 $ 325.00 $ 241.00 4230 PT-OUT42330500 PT MANUAL TRACT INIT 30 $ 325.00 $ 241.00 4233 PT-OUT42300715 PT MECH TRACT 15 $ 169.00 $ 125.00 4230 PT-OUT42310715 PT MECH TRACT 15 $ 169.00 $ 125.00 4231 PT-OUT42310105 PT MMT BODY W HAND 15 $ 325.00 $ 241.00 4231 PT-OUT42320105 PT MMT BODY W HAND 15 $ 325.00 $ 241.00 4232 PT-OUT42310106 PT MMT BODY W HAND 30 $ 650.00 $ 481.00 4231 PT-OUT42320106 PT MMT BODY W HAND 30 $ 650.00 $ 481.00 4232 PT-OUT42310110 PT MMT BODY WO HAND 15 $ 264.00 $ 195.00 4231 PT-OUT42320110 PT MMT BODY WO HAND 15 $ 264.00 $ 195.00 4232 PT-OUT42310111 PT MMT BODY WO HAND 30 $ 641.00 $ 474.00 4231 PT-OUT42320111 PT MMT BODY WO HAND 30 $ 641.00 $ 474.00 4232 PT-OUT42310115 PT MMT HAND 15 $ 149.00 $ 110.00 4231 PT-OUT42320115 PT MMT HAND 15 $ 149.00 $ 110.00 4232 PT-OUT42320116 PT MMT HAND 30 $ 298.00 $ 220.00 4232 PT-OUT42310120 PT MMT LIMB 15 $ 166.00 $ 123.00 4231 PT-OUT42320120 PT MMT LIMB 15 $ 166.00 $ 123.00 4232 PT-OUT42320121 PT MMT LIMB 30 $ 318.00 $ 235.00 4232 PT-OUT42300506 PT MYOFAC/SOFT MOB 30 $ 335.00 $ 248.00 4230 PT-OUT42330506 PT MYOFAC/SOFT MOB 30 $ 335.00 $ 248.00 4233 PT-OUT42310915 PT NEUROMUSC REED EA 15 $ 194.00 $ 144.00 4231 PT-OUT42320915 PT NEUROMUSC REED EA 15 $ 194.00 $ 144.00 4232 PT-OUT42300915 PT NEUROMUSC REED INIT 30 $ 351.00 $ 260.00 4230 PT-OUT42330915 PT NEUROMUSC REED INIT 30 $ 351.00 $ 260.00 4233 PT-OUT

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DEPARTMENT CODE

42300946 PT ORT/PRO/ADL CK ADD 15 $ 197.00 $ 146.00 4230 PT-OUT42330946 PT ORT/PRO/ADL CK ADD 15 $ 197.00 $ 146.00 4233 PT-OUT42300945 PT ORT/PRO/ADL CK INIT 30 $ 553.00 $ 410.00 4230 PT-OUT42330945 PT ORT/PRO/ADL CK INIT 30 $ 553.00 $ 410.00 4233 PT-OUT42300955 PT ORTHOTIC FAB INIT 30 $ 315.00 $ 233.00 4230 PT-OUT42330955 PT ORTHOTIC FAB INIT 30 $ 315.00 $ 233.00 4233 PT-OUT42300937 PT ORTHOTIC TRAIN ADD 15 $ 242.00 $ 179.00 4230 PT-OUT42330937 PT ORTHOTIC TRAIN ADD 15 $ 242.00 $ 179.00 4233 PT-OUT42310936 PT ORTHOTIC TRAIN EA 15 $ 166.00 $ 123.00 4231 PT-OUT42320941 PT ORTHOTIC TRAIN EA 15 $ 166.00 $ 123.00 4232 PT-OUT42300936 PT ORTHOTIC TRAIN INIT 30 $ 293.00 $ 217.00 4230 PT-OUT42330936 PT ORTHOTIC TRAIN INIT 30 $ 293.00 $ 217.00 4233 PT-OUT42320750 PT PARAFFIN BATH 15 $ 115.00 $ 85.00 4232 PT-OUT42330715 PT PARAFFIN BATH 15 $ 115.00 $ 85.00 4233 PT-OUT42310885 PT PHYS PERFRM TEST EA 15 $ 245.00 $ 245.00 4231 PT-OUT42310961 PT PROC THER GP 45 $ 302.00 $ 223.00 4231 PT-OUT42310980 PT PROC THER GP 60 $ 367.00 $ 272.00 4231 PT-OUT42310990 PT PROC THER GP 90 $ 434.00 $ 321.00 4231 PT-OUT42300934 PT PROSTH TRAIN ADD 15 $ 192.00 $ 142.00 4230 PT-OUT42330934 PT PROSTH TRAIN ADD 15 $ 192.00 $ 142.00 4233 PT-OUT42310935 PT PROSTH TRAIN EA 15 $ 196.00 $ 145.00 4231 PT-OUT42300935 PT PROSTH TRAIN INIT 30 $ 379.00 $ 281.00 4230 PT-OUT42330935 PT PROSTH TRAIN INIT 30 $ 379.00 $ 281.00 4233 PT-OUT42310942 PT PROSTHETIC FU EA 15M $ 142.00 $ 105.00 4231 PT-OUT42320942 PT PROSTHETIC FU EA 15M $ 142.00 $ 105.00 4232 PT-OUT42310897 PT RE-EVAL 45 $ 518.00 $ 383.00 4231 PT-OUT42320897 PT RE-EVAL 45 $ 518.00 $ 383.00 4232 PT-OUT42300898 PT RE-EVAL COMPREHENSIVE $ 283.00 $ 209.00 4230 PT-OUT42330898 PT RE-EVAL COMPREHENSIVE $ 283.00 $ 209.00 4233 PT-OUT42300897 PT RE-EVAL EXTENDED $ 629.00 $ 466.00 4230 PT-OUT42330897 PT RE-EVAL EXTENDED $ 629.00 $ 466.00 4233 PT-OUT42300896 PT RE-EVAL INTERMEDIATE $ 479.00 $ 355.00 4230 PT-OUT42330896 PT RE-EVAL INTERMEDIATE $ 479.00 $ 355.00 4233 PT-OUT

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DEPARTMENT CODE

42300895 PT RE-EVAL LTD $ 325.00 $ 241.00 4230 PT-OUT42330895 PT RE-EVAL LTD $ 325.00 $ 241.00 4233 PT-OUT42310125 PT ROM BODY WO HAND 15 $ 136.00 $ 101.00 4231 PT-OUT42320125 PT ROM BODY WO HAND 15 $ 136.00 $ 101.00 4232 PT-OUT42310126 PT ROM BODY WO HAND 30 $ 182.00 $ 135.00 4231 PT-OUT42320126 PT ROM BODY WO HAND 30 $ 182.00 $ 135.00 4232 PT-OUT42310130 PT ROM HAND 15 $ 105.00 $ 77.00 4231 PT-OUT42320130 PT ROM HAND 15 $ 105.00 $ 77.00 4232 PT-OUT42320131 PT ROM HAND 30 $ 243.00 $ 180.00 4232 PT-OUT42310995 PT SENS INTEGRATION EA 15 $ 226.00 $ 167.00 4231 PT-OUT42320995 PT SENS INTEGRATION EA 15 $ 226.00 $ 167.00 4232 PT-OUT42300780 PT SOFT TISSUE MOB INIT30 $ 303.00 $ 224.00 4230 PT-OUT42330780 PT SOFT TISSUE MOB INIT30 $ 303.00 $ 224.00 4233 PT-OUT42300750 PT TAPING EA VISIT $ 360.00 $ 266.00 4230 PT-OUT42330750 PT TAPING EA VISIT $ 360.00 $ 266.00 4233 PT-OUT42300906 PT THER ACT ADD 15 $ 137.00 $ 102.00 4230 PT-OUT42310900 PT THER ACT EA 15 $ 223.00 $ 165.00 4231 PT-OUT42320900 PT THER ACT EA 15 $ 223.00 $ 165.00 4232 PT-OUT42300905 PT THER ACT INIT 30 $ 311.00 $ 230.00 4230 PT-OUT42330905 PT THER ACT INIT 30 $ 311.00 $ 230.00 4233 PT-OUT42310910 PT THER EX EA 15 $ 197.00 $ 146.00 4231 PT-OUT42320910 PT THER EX EA 15 $ 197.00 $ 146.00 4232 PT-OUT42300910 PT THER EX INIT 30 $ 311.00 $ 230.00 4230 PT-OUT42330910 PT THER EX INIT 30 $ 311.00 $ 230.00 4233 PT-OUT42310720 PT THER MASSAGE EA 15 $ 158.00 $ 117.00 4231 PT-OUT42320720 PT THER MASSAGE EA 15 $ 158.00 $ 117.00 4232 PT-OUT42300720 PT THER MASSAGE INIT 30 $ 376.00 $ 279.00 4230 PT-OUT42330720 PT THER MASSAGE INIT 30 $ 376.00 $ 279.00 4233 PT-OUT42310940 PT TRN BIOFD ANY MODAL 15 $ 345.00 $ 255.00 4231 PT-OUT42320940 PT TRN BIOFD ANY MODAL 15 $ 345.00 $ 255.00 4232 PT-OUT42310966 PT TRN BIOFD ANY MODAL 30 $ 401.00 $ 297.00 4231 PT-OUT42320966 PT TRN BIOFD ANY MODAL 30 $ 401.00 $ 297.00 4232 PT-OUT42310967 PT TRN BIOFD ANY MODAL 45 $ 494.00 $ 365.00 4231 PT-OUT

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DEPARTMENT CODE

42320967 PT TRN BIOFD ANY MODAL 45 $ 494.00 $ 365.00 4232 PT-OUT42310968 PT TRN BIOFD ANY MODAL 60 $ 659.00 $ 488.00 4231 PT-OUT42320968 PT TRN BIOFD ANY MODAL 60 $ 659.00 $ 488.00 4232 PT-OUT42300976 PT TX PHYS MED EA 15 $ 195.00 $ 144.00 4230 PT-OUT42330976 PT TX PHYS MED EA 15 $ 195.00 $ 144.00 4233 PT-OUT42310705 PT ULTRASOUND EA 15 $ 168.00 $ 124.00 4231 PT-OUT42320705 PT ULTRASOUND EA 15 $ 168.00 $ 124.00 4232 PT-OUT42300705 PT ULTRASOUND INIT 30 $ 340.00 $ 251.00 4230 PT-OUT42330705 PT ULTRASOUND INIT 30 $ 340.00 $ 251.00 4233 PT-OUT42320751 PT WHIRLPOOL 15 $ 157.00 $ 116.00 4232 PT-OUT42330725 PT WHIRLPOOL 15 $ 157.00 $ 116.00 4233 PT-OUT42310950 PT WHLCHR MNG/TRAIN EA 15 $ 196.00 $ 145.00 4231 PT-OUT42311120 RUNNING EVAL W/FP & VIDEO $ 150.00 $ 150.00 4231 PT-OUT42311121 RUNNING VIDEO ANALYSIS $ 100.00 $ 100.00 4231 PT-OUT42311150 SKI CLASS $ 18.00 $ 18.00 4231 PT-OUT32230318 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 3223 PULM FX LB ADULT32220222 AEROSOL TX SUBSQ $ 291.00 $ 291.00 3222 PULM FX LB ADULT32260667 AIRWAY CLOSING VOLUME $ 645.00 $ 645.00 3226 PULM FX LB ADULT32260670 AIRWAY RESISTANCE $ 312.00 $ 312.00 3226 PULM FX LB ADULT32230300 ARTERIAL PUNCTURE $ 274.00 $ 274.00 3223 PULM FX LB ADULT32260615 BLD GAS ART $ 667.00 $ 667.00 3226 PULM FX LB ADULT32260656 BRONCHIAL PROVOCATION $ 1,500.00 $ 1,500.00 3226 PULM FX LB ADULT32230305 BRONCHOSCOPY $ 3,500.00 $ 3,500.00 3223 PULM FX LB ADULT32230307 BRONCHOSCOPY CA NAVGATION $ 7,861.00 $ 7,861.00 3223 PULM FX LB ADULT32260658 CO DIFFUSING CAPACITY $ 608.00 $ 608.00 3226 PULM FX LB ADULT32260649 CO2 RESPONSE CURVE $ 1,594.00 $ 1,594.00 3226 PULM FX LB ADULT32230306 EBUS DURING BRONCH $ 7,861.00 $ 7,861.00 3223 PULM FX LB ADULT32260635 EKG 12 LEAD TRACING $ 283.00 $ 283.00 3226 PULM FX LB ADULT32260685 EXPIRED GAS COLLECTION $ 1,451.00 $ 1,451.00 3226 PULM FX LB ADULT32260661 FUNCTIONAL RES CAP/VOL $ 502.00 $ 502.00 3226 PULM FX LB ADULT32260650 HYPOXIC RESPONSE CURVE $ 2,325.00 $ 2,325.00 3226 PULM FX LB ADULT32260712 MAXIMAL VOLUNTARY VENT $ 359.00 $ 359.00 3226 PULM FX LB ADULT32220210 MDI/NEB DEMO/EVAL $ 625.00 $ 625.00 3222 PULM FX LB ADULT

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DEPARTMENT CODE

32260663 NITROGEN WASHOUT $ 2,741.00 $ 2,741.00 3226 PULM FX LB ADULT32260698 PULMONARY COMPLIANCE $ 1,565.00 $ 1,565.00 3226 PULM FX LB ADULT32260627 PULMONARY STRESS COMPLEX $ 1,886.00 $ 1,886.00 3226 PULM FX LB ADULT32230355 PULMONARY STRESS SIMPLE $ 1,575.00 $ 1,575.00 3223 PULM FX LB ADULT32230325 PULSE OXIMETRY MULTIPLE $ 443.00 $ 443.00 3223 PULM FX LB ADULT32230320 PULSE OXIMETRY SINGLE $ 171.00 $ 171.00 3223 PULM FX LB ADULT32260606 RESP FLOW VOLUME LOOP $ 667.00 $ 667.00 3226 PULM FX LB ADULT32260690 SPIROMETRY $ 995.00 $ 500.00 3226 PULM FX LB ADULT32260695 SPIROMETRY PRE/POST BD $ 1,408.00 $ 1,408.00 3226 PULM FX LB ADULT32260674 THORACIC GAS VOLUME $ 1,233.00 $ 1,233.00 3226 PULM FX LB ADULT41545464 NMC UNL MALE GENITAL SYS $ 583.00 $ 583.00 4154 RAD THER41545315 RO APLY INTRACV RAD CMPLX $ 3,184.00 $ 3,184.00 4154 RAD THER41545310 RO APLY INTRACV RAD INTRM $ 2,363.00 $ 2,363.00 4154 RAD THER41545305 RO APLY INTRACV RAD SMPL $ 1,866.00 $ 1,866.00 4154 RAD THER41545325 RO APLY INTRSTL RAD INTRM $ 1,953.00 $ 1,953.00 4154 RAD THER41545320 RO APLY INTRSTL RAD SMPL $ 1,182.00 $ 1,182.00 4154 RAD THER41545090 RO BRACHY DOSE PLAN CMPLX $ 1,762.00 $ 1,762.00 4154 RAD THER41545085 RO BRACHY DOSE PLAN INTRM $ 1,335.00 $ 1,335.00 4154 RAD THER41545080 RO BRACHY DOSE PLAN SMPL $ 951.00 $ 951.00 4154 RAD THER41545112 RO CONSULT CONT MED PHYSC $ 527.00 $ 527.00 4154 RAD THER41545095 RO DOSIMETRY SPECIAL $ 267.00 $ 267.00 4154 RAD THER41545103 RO DSIGN MLC DEV FOR IMRT $ 8,802.00 $ 8,802.00 4154 RAD THER41545107 RO DVCS CONSTRUCT CMPLX $ 978.00 $ 978.00 4154 RAD THER41545110 RO DVCS CONSTRUCT CMPLX $ 978.00 $ 978.00 4154 RAD THER41545105 RO DVCS CONSTRUCT INTRM $ 729.00 $ 729.00 4154 RAD THER41545100 RO DVCS CONSTRUCT SMPL $ 507.00 $ 507.00 4154 RAD THER41545451 RO ECHO PROSTATE VOL STDY $ 1,055.00 $ 1,055.00 4154 RAD THER41545028 RO GUIDE RAD TX FIELDS $ 1,362.00 $ 1,362.00 4154 RAD THER41545355 RO HDR BRACHYTX 1 CHAN $ 1,182.00 $ 1,182.00 4154 RAD THER41545360 RO HDR BRACHYTX 2-4 CHAN $ 3,925.00 $ 3,925.00 4154 RAD THER41545365 RO HDR BRACHYTX 5-8 CHAN $ 4,095.00 $ 4,095.00 4154 RAD THER41545370 RO HDR BRACHYTX 9-12 CHAN $ 4,170.00 $ 4,170.00 4154 RAD THER41545375 RO HDR BRACHYTX GT12 CHAN $ 5,811.00 $ 5,811.00 4154 RAD THER

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DEPARTMENT CODE

41545256 RO IMRT DLVR EA SESSION $ 4,739.00 $ 4,739.00 4154 RAD THER41545046 RO IMRT PLAN $ 16,665.00 $ 16,665.00 4154 RAD THER41545330 RO INTRSTIT RADIAT CMPLX $ 3,571.00 $ 3,571.00 4154 RAD THER41545070 RO ISODOSE PLAN CMPLX $ 784.00 $ 784.00 4154 RAD THER41545065 RO ISODOSE PLAN INTRM $ 537.00 $ 537.00 4154 RAD THER41545060 RO ISODOSE PLAN SMPL $ 401.00 $ 401.00 4154 RAD THER41563105 RO LEVEL 2 EST PATIENT $ 184.00 $ 184.00 4156 RAD THER41563005 RO LEVEL 2 NEW PATIENT $ 184.00 $ 184.00 4156 RAD THER41563110 RO LEVEL 3 EST PATIENT $ 250.00 $ 250.00 4156 RAD THER41563010 RO LEVEL 3 NEW PATIENT $ 250.00 $ 250.00 4156 RAD THER41563020 RO LEVEL 4 NEW PATIENT $ 364.00 $ 364.00 4156 RAD THER41563120 RO LEVEL 5 EST PATIENT $ 461.00 $ 461.00 4156 RAD THER41563015 RO LEVEL 5 NEW PATIENT $ 461.00 $ 461.00 4156 RAD THER41560415 RO LOADING RAD SOURCE $ 434.00 $ 434.00 4156 RAD THER41545120 RO PLACE BREAST CATH RAD $ 5,180.00 $ 5,180.00 4154 RAD THER41545125 RO PLACE NDL MUSC/TIS RT $ 2,575.00 $ 2,575.00 4154 RAD THER41545150 RO PLACE NDLS PELVIC RT $ 2,141.00 $ 2,141.00 4154 RAD THER41545130 RO PLACE NEEDLES H&N RT $ 2,263.00 $ 2,263.00 4154 RAD THER41545140 RO PLC ID RT DEV/MARK PRO $ 1,235.00 $ 1,235.00 4154 RAD THER41545258 RO RAD PORT FILM(S) $ 137.00 $ 137.00 4154 RAD THER41545235 RO RAD TX 2 AREA 11-19MEV $ 1,589.00 $ 1,589.00 4154 RAD THER41545230 RO RAD TX 2 AREA 6-10MEV $ 1,439.00 $ 1,439.00 4154 RAD THER41545240 RO RAD TX 2 AREA GT 19MEV $ 1,701.00 $ 1,701.00 4154 RAD THER41545252 RO RAD TX 3/MORE 11-19MEV $ 2,083.00 $ 2,083.00 4154 RAD THER41545250 RO RAD TX 3/MORE 6-10MEV $ 1,872.00 $ 1,872.00 4154 RAD THER41545254 RO RAD TX 3/MORE GT 19MEV $ 2,093.00 $ 2,093.00 4154 RAD THER41545215 RO RAD TX SNGL 11-19MEV $ 1,178.00 $ 1,178.00 4154 RAD THER41545210 RO RAD TX SNGL 6-10MEV $ 1,068.00 $ 1,068.00 4154 RAD THER41545265 RO RAD TX SUPERFICIAL $ 264.00 $ 264.00 4154 RAD THER41545050 RO RADIAT DOSIMETRY CALC $ 421.00 $ 421.00 4154 RAD THER41545455 RO RADIATION FIELD PLACE $ 427.00 $ 427.00 4154 RAD THER41545115 RO RADIATION PHYSICS CNSL $ 1,031.00 $ 1,031.00 4154 RAD THER41545268 RO RADIOSRGRY CMPLT TX $ 30,145.00 $ 30,145.00 4154 RAD THER

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DEPARTMENT CODE

41545269 RO RADIOSRGRY TX EA SESSN $ 6,009.00 $ 6,009.00 4154 RAD THER41545045 RO SIMULATION 3D $ 4,306.00 $ 4,306.00 4154 RAD THER41545035 RO SIMULATION CMPLX $ 3,885.00 $ 3,885.00 4154 RAD THER41545030 RO SIMULATION INTRM $ 2,470.00 $ 2,470.00 4154 RAD THER41545025 RO SIMULATION SMPL $ 1,398.00 $ 1,398.00 4154 RAD THER41545075 RO SPECIAL PORT PLAN BODY $ 738.00 $ 738.00 4154 RAD THER41545275 RO SPECIAL TX PROCEDURE $ 1,472.00 $ 1,472.00 4154 RAD THER41545259 RO STER XR GD LOC TRGT $ 878.00 $ 878.00 4154 RAD THER41545135 RO TRANSPERI NDL PLC PROS $ 3,281.00 $ 3,281.00 4154 RAD THER41545465 S BRACHYTX NONSTRAN I-125 $ 110.00 $ 110.00 4154 RAD THER41545466 S BRACHYTX NONSTRAN P-103 $ 208.00 $ 208.00 4154 RAD THER41545462 US INTRO INTERSTITIAL TX $ 835.00 $ 835.00 4154 RAD THER41460650 CON GASTROGRAF 120ML $ 22.40 $ 22.40 4146 RADIOLOGY41429109 CON HOCM 300-349MG/ML 1ML $ 1.30 $ 1.30 4142 RADIOLOGY41460627 CON LOCM 200-249S I 1ML $ 7.50 $ 7.50 4146 RADIOLOGY41460602 CON LOCM 300-349S I 1ML $ 4.80 $ 4.80 4146 RADIOLOGY41460612 CON LOCM 300-349S I 1ML $ 5.90 $ 5.90 4146 RADIOLOGY41460645 ETHIODIZED OIL 10ML $ 218.00 $ 218.00 4146 RADIOLOGY41400900 IR ANGIO EXT UNI $ 3,290.00 $ 3,290.00 4140 RADIOLOGY41431383 IRC CHNGE URETR TUBE/STNT $ 846.00 $ 846.00 4143 RADIOLOGY41431282 IRC NG TUBE PLC W FLUORO $ 1,008.00 $ 1,008.00 4143 RADIOLOGY41450005 S STRL ABSCESS TRAY $ - $ - 4145 RADIOLOGY41450010 S STRL AMNIOCENTESIS TRAY $ 368.00 $ 368.00 4145 RADIOLOGY41453810 S STRL AMPLATZ NEEDLE $ 157.00 $ 157.00 4145 RADIOLOGY41454485 S STRL ANGIO TRAY $ 647.00 $ 647.00 4145 RADIOLOGY41450020 S STRL ARTHROGRAM TRAY $ 258.00 $ 258.00 4145 RADIOLOGY41454480 S STRL BIOPSY TRAY $ 320.00 $ 320.00 4145 RADIOLOGY41453800 S STRL CHIBA NEEDLE $ 157.00 $ 157.00 4145 RADIOLOGY41454960 S STRL EVAC CONTAINER $ 58.00 $ 58.00 4145 RADIOLOGY41450045 S STRL HYSTEROSALPINGO TR $ 368.00 $ 368.00 4145 RADIOLOGY41460410 S STRL INJECT SETUP ONLY $ 487.00 $ 487.00 4146 RADIOLOGY41454965 S STRL LOCALIZATION NDL $ 157.00 $ 157.00 4145 RADIOLOGY41461099 S STRL MISC. SUPP CHARGE $ - $ - 4146 RADIOLOGY

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DEPARTMENT CODE

41450050 S STRL MYLEGRAM TRAY $ 399.00 $ 399.00 4145 RADIOLOGY41454955 S STRL NEEDLE GUIDE KIT $ 300.00 $ 300.00 4145 RADIOLOGY41450055 S STRL NEPHROSTOMY TRAY $ - $ - 4145 RADIOLOGY41454950 S STRL PROBE COVERS $ 137.00 $ 137.00 4145 RADIOLOGY41454486 S STRL PROCED TRAY 1-RAD $ 283.00 $ 283.00 4145 RADIOLOGY41454487 S STRL PROCED TRAY 2-RAD $ 562.00 $ 562.00 4145 RADIOLOGY41454488 S STRL PROCED TRAY 3-RAD $ 770.00 $ 770.00 4145 RADIOLOGY41454971 S STRL PULSE OXI PROBE $ 161.00 $ 161.00 4145 RADIOLOGY41400590 XR ABD 1V AP $ 414.00 $ 414.00 4140 RADIOLOGY41400598 XR ABD CMPL DECUB ERECT $ 660.00 $ 660.00 4140 RADIOLOGY41400605 XR ABD CMPL W 1V CHEST $ 804.00 $ 804.00 4140 RADIOLOGY41400595 XR ABD W OBLIQUES CONE $ 634.00 $ 634.00 4140 RADIOLOGY41400632 XR ABSCSS FIST SIN TRACT $ 964.00 $ 964.00 4140 RADIOLOGY41401033 XR ABSCSS FIST SIN TRACT $ 964.00 $ 964.00 4140 RADIOLOGY41400405 XR AC JNT $ 617.00 $ 617.00 4140 RADIOLOGY41400545 XR ANKLE 2V $ 457.00 $ 457.00 4140 RADIOLOGY41400550 XR ANKLE 3V OR MORE $ 541.00 $ 541.00 4140 RADIOLOGY41400425 XR ARTHRO ELBOW $ 1,666.00 $ 1,666.00 4140 RADIOLOGY41400496 XR ARTHRO HIP $ 1,658.00 $ 1,658.00 4140 RADIOLOGY41400400 XR ARTHRO SHOULDER $ 1,903.00 $ 1,903.00 4140 RADIOLOGY41400130 XR ARTHRO TMJ $ 1,111.00 $ 1,111.00 4140 RADIOLOGY41400682 XR BE THRP $ 2,918.00 $ 2,918.00 4140 RADIOLOGY41400680 XR BE W AIR CON $ 3,671.00 $ 3,671.00 4140 RADIOLOGY41401010 XR BONE AGE STDY $ 364.00 $ 364.00 4140 RADIOLOGY41401015 XR BONE LENGTH STDY $ 601.00 $ 601.00 4140 RADIOLOGY41401025 XR BONE SURVEY CMPL $ 1,785.00 $ 1,785.00 4140 RADIOLOGY41401031 XR BONE SURVEY INF $ 1,506.00 $ 1,506.00 4140 RADIOLOGY41401020 XR BONE SURVEY LTD $ 1,159.00 $ 1,159.00 4140 RADIOLOGY41400575 XR CALCANEOUS 2V OR MORE $ 448.00 $ 448.00 4140 RADIOLOGY41431794 XR CHEMO CNS W/SPINL PUNC $ 3,510.00 $ 3,510.00 4143 RADIOLOGY41400160 XR CHEST 1V $ 399.00 $ 399.00 4140 RADIOLOGY41400165 XR CHEST 2V $ 519.00 $ 519.00 4140 RADIOLOGY41400166 XR CHEST 2V W AP LORDOTIC $ 617.00 $ 617.00 4140 RADIOLOGY

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DEPARTMENT CODE

41400177 XR CHEST 2V W FLUORO $ 1,176.00 $ 1,176.00 4140 RADIOLOGY41400175 XR CHEST 2V W OBLIQUES $ 761.00 $ 761.00 4140 RADIOLOGY41400170 XR CHEST 4V CMPL $ 770.00 $ 770.00 4140 RADIOLOGY41400180 XR CHEST 4V MORE W FLUORO $ 1,658.00 $ 1,658.00 4140 RADIOLOGY41400179 XR CHEST SPECIAL V EA $ 617.00 $ 617.00 4140 RADIOLOGY41400705 XR CHOL EXISTING CATH $ 829.00 $ 829.00 4140 RADIOLOGY41400695 XR CHOL IN OR $ 871.00 $ 871.00 4140 RADIOLOGY41400700 XR CHOL IN OR ADD SET $ 516.00 $ 516.00 4140 RADIOLOGY41400375 XR CLAVICLE CMPL $ 474.00 $ 474.00 4140 RADIOLOGY41401095 XR CONSULT FOREIGN FLM $ 450.00 $ 450.00 4140 RADIOLOGY41400675 XR CONTRAST ENEMA $ 2,664.00 $ 2,664.00 4140 RADIOLOGY41400785 XR CYSTOGRAM 3V OR MORE $ 1,480.00 $ 1,480.00 4140 RADIOLOGY41400117 XR DENTAL FULL EXAM $ 394.00 $ 394.00 4140 RADIOLOGY41400115 XR DENTAL PARTIAL EXAM $ 617.00 $ 617.00 4140 RADIOLOGY41400112 XR DENTAL SNGL FILM $ 189.00 $ 189.00 4140 RADIOLOGY41403025 XR DEXA APPEN $ 474.00 $ 474.00 4140 RADIOLOGY41403010 XR DEXA AXIAL SKELETON $ 800.00 $ 800.00 4140 RADIOLOGY41403012 XR DEXA BODY COMPOSITION $ 584.00 $ 584.00 4140 RADIOLOGY41400365 XR DISKOGRAM CERV THOR $ 1,377.00 $ 1,377.00 4140 RADIOLOGY41400370 XR DISKOGRAM LUMB $ 2,647.00 $ 2,647.00 4140 RADIOLOGY41403023 XR DXA BONE DENS VRT FRAC $ 395.00 $ 395.00 4140 RADIOLOGY41400415 XR ELBOW 2V $ 465.00 $ 465.00 4140 RADIOLOGY41400420 XR ELBOW 3V OR MORE $ 609.00 $ 609.00 4140 RADIOLOGY41400720 XR ENDO BILI DUCT $ 3,422.00 $ 3,422.00 4140 RADIOLOGY41400740 XR ENTEROCLYSIS TUBE PRC $ 2,588.00 $ 2,588.00 4140 RADIOLOGY41400730 XR ERCP BILI PANC DUCT $ 3,070.00 $ 3,070.00 4140 RADIOLOGY41400725 XR ERCP PANC DUCT $ 1,725.00 $ 1,725.00 4140 RADIOLOGY41400610 XR ESOPH $ 1,556.00 $ 1,556.00 4140 RADIOLOGY41400540 XR EXT INF LOW LES 1YR $ 482.00 $ 482.00 4140 RADIOLOGY41400435 XR EXT INF UPP LES 1YR $ 482.00 $ 482.00 4140 RADIOLOGY41400045 XR FACIAL BONE 3V OR MORE $ 719.00 $ 719.00 4140 RADIOLOGY41400040 XR FACIAL BONE LES 3V $ 491.00 $ 491.00 4140 RADIOLOGY41400867 XR FALLOPN TUBE TRANSCERV $ 2,415.00 $ 2,415.00 4140 RADIOLOGY

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DEPARTMENT CODE

41400010 XR FB IN EYE $ 482.00 $ 482.00 4140 RADIOLOGY41401005 XR FB LOC CHLD $ 474.00 $ 474.00 4140 RADIOLOGY41400515 XR FEMUR 2V $ 474.00 $ 474.00 4140 RADIOLOGY41400470 XR FINGER(S) 2V OR MORE $ 524.00 $ 524.00 4140 RADIOLOGY41406003 XR FLUOR CVAD PLC/RMV/RPR $ 495.00 $ 495.00 4140 RADIOLOGY41401001 XR FLUORO 1-2 HRS $ 2,546.00 $ 2,546.00 4140 RADIOLOGY41406005 XR FLUORO 1HR OR LES $ 2,021.00 $ 2,021.00 4140 RADIOLOGY41401002 XR FLUORO 2-3 HRS $ 2,724.00 $ 2,724.00 4140 RADIOLOGY41401004 XR FLUORO 3-4 HRS $ 2,915.00 $ 2,915.00 4140 RADIOLOGY41401006 XR FLUORO 4-5 HRS $ 3,119.00 $ 3,119.00 4140 RADIOLOGY41401007 XR FLUORO 5-6 HRS $ 3,337.00 $ 3,337.00 4140 RADIOLOGY41406002 XR FLUORO GUIDE SPINE INJ $ 1,154.00 $ 1,154.00 4140 RADIOLOGY41401003 XR FLUORO NDL PLACE $ 1,125.00 $ 1,125.00 4140 RADIOLOGY41400557 XR FOOT 2V $ 440.00 $ 440.00 4140 RADIOLOGY41400560 XR FOOT 2V $ 440.00 $ 440.00 4140 RADIOLOGY41400561 XR FOOT 2V $ 440.00 $ 440.00 4140 RADIOLOGY41400563 XR FOOT 2V $ 440.00 $ 440.00 4140 RADIOLOGY41400565 XR FOOT 3V OR MORE $ 533.00 $ 533.00 4140 RADIOLOGY41400430 XR FOREARM 2V $ 465.00 $ 465.00 4140 RADIOLOGY41400735 XR GI TUBE INSERT LONG $ 2,470.00 $ 2,470.00 4140 RADIOLOGY41400455 XR HAND 2V $ 457.00 $ 457.00 4140 RADIOLOGY41400458 XR HAND 2V $ 457.00 $ 457.00 4140 RADIOLOGY41400460 XR HAND 3V OR MORE $ 541.00 $ 541.00 4140 RADIOLOGY41400500 XR HIP OR $ 524.00 $ 524.00 4140 RADIOLOGY41400475 XR HIP UNI 1V $ 414.00 $ 414.00 4140 RADIOLOGY41400490 XR HIP UNI 2V OR MORE $ 626.00 $ 626.00 4140 RADIOLOGY41400485 XR HIPS BIL 2V W PELV $ 651.00 $ 651.00 4140 RADIOLOGY41400410 XR HUMERUS 2V OR MORE $ 491.00 $ 491.00 4140 RADIOLOGY41400865 XR HYSTEROSALPINGOGRAM $ 1,412.00 $ 1,412.00 4140 RADIOLOGY41431626 XR INJ CON ABSCSS $ 1,289.00 $ 1,289.00 4143 RADIOLOGY41431793 XR INJ/ASP INT JNT/BURSA $ 250.00 $ 250.00 4143 RADIOLOGY41400760 XR IVP W DRIP + OR BOLUS $ 2,157.00 $ 2,157.00 4140 RADIOLOGY41400765 XR IVP W NEPHROTOMOGRAM $ 2,537.00 $ 2,537.00 4140 RADIOLOGY

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DEPARTMENT CODE

41400750 XR IVP W-W/O TOMOGRAM $ 2,021.00 $ 2,021.00 4140 RADIOLOGY41401030 XR JNT SURVEY 1V $ 668.00 $ 668.00 4140 RADIOLOGY41400520 XR KNEE 1 OR 2V $ 482.00 $ 482.00 4140 RADIOLOGY41400525 XR KNEE 3V $ 592.00 $ 592.00 4140 RADIOLOGY41400510 XR KNEE 4V OR MORE $ 685.00 $ 685.00 4140 RADIOLOGY41400512 XR KNEES STANDING AP $ 524.00 $ 524.00 4140 RADIOLOGY41400140 XR LARYNGOGRAM W CON $ 975.00 $ 975.00 4140 RADIOLOGY41400587 XR MAN APP STRS ANY JNT $ 142.00 $ 142.00 4140 RADIOLOGY41400025 XR MANDIBLE 4V OR MORE $ 660.00 $ 660.00 4140 RADIOLOGY41400020 XR MANDIBLE LES 4V $ 524.00 $ 524.00 4140 RADIOLOGY41400345 XR MYELOGRAM CERV $ 2,698.00 $ 2,698.00 4140 RADIOLOGY41400355 XR MYELOGRAM LUMB $ 2,529.00 $ 2,529.00 4140 RADIOLOGY41400350 XR MYELOGRAM THOR $ 2,402.00 $ 2,402.00 4140 RADIOLOGY41400050 XR NASAL BONES 3V OR MORE $ 567.00 $ 567.00 4140 RADIOLOGY41400135 XR NEC SOFT TISSUE $ 457.00 $ 457.00 4140 RADIOLOGY41400070 XR ORBITS 4V OR MORE $ 736.00 $ 736.00 4140 RADIOLOGY41400185 XR PACEMAKER INSERT $ 1,751.00 $ 1,751.00 4140 RADIOLOGY41400320 XR PELV 1 OR 2V $ 431.00 $ 431.00 4140 RADIOLOGY41400325 XR PELV 3V OR MORE $ 694.00 $ 694.00 4140 RADIOLOGY41400505 XR PELV HIP 2V INF CHLD $ 634.00 $ 634.00 4140 RADIOLOGY41400850 XR PELVIMETRY $ 668.00 $ 668.00 4140 RADIOLOGY41401034 XR PERC TUBE/CATH CHNG $ 1,945.00 $ 1,945.00 4140 RADIOLOGY41400137 XR PHARYNGEAL SPEECH EVAL $ 1,429.00 $ 1,429.00 4140 RADIOLOGY41400215 XR RIBS BIL 3V $ 668.00 $ 668.00 4140 RADIOLOGY41400220 XR RIBS BIL W PA CXR $ 880.00 $ 880.00 4140 RADIOLOGY41400210 XR RIBS UNI & PA CHEST $ 643.00 $ 643.00 4140 RADIOLOGY41400205 XR RIBS UNI 2V $ 533.00 $ 533.00 4140 RADIOLOGY41400340 XR SACRUM COCCYX 2 V MORE $ 499.00 $ 499.00 4140 RADIOLOGY41400145 XR SALIVARY GLAND CALC $ 668.00 $ 668.00 4140 RADIOLOGY41400380 XR SCAPULA CMPL $ 482.00 $ 482.00 4140 RADIOLOGY41400395 XR SHOULDER 1V $ 389.00 $ 389.00 4140 RADIOLOGY41400390 XR SHOULDER 2V OR MORE $ 499.00 $ 499.00 4140 RADIOLOGY41400330 XR SI JNT 1 OR 2V $ 499.00 $ 499.00 4140 RADIOLOGY

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DEPARTMENT CODE

41400335 XR SI JNT 3V OR MORE $ 609.00 $ 609.00 4140 RADIOLOGY41400150 XR SIALOGRAM $ 1,878.00 $ 1,878.00 4140 RADIOLOGY41400090 XR SIN PARA 3V OR MORE $ 643.00 $ 643.00 4140 RADIOLOGY41400080 XR SIN PARA LES 3V $ 507.00 $ 507.00 4140 RADIOLOGY41400110 XR SKULL 4V OR MORE $ 761.00 $ 761.00 4140 RADIOLOGY41400105 XR SKULL LES 4V $ 592.00 $ 592.00 4140 RADIOLOGY41400670 XR SM BOWEL SERIES $ 1,869.00 $ 1,869.00 4140 RADIOLOGY41401101 XR SPECIMEN SURGICAL $ 304.00 $ 304.00 4140 RADIOLOGY41400260 XR SPINE C 4V & FLEX/EXT $ 1,142.00 $ 1,142.00 4140 RADIOLOGY41400255 XR SPINE CERV 2-3V $ 626.00 $ 626.00 4140 RADIOLOGY41400250 XR SPINE CERV 4V OR MORE $ 888.00 $ 888.00 4140 RADIOLOGY41400295 XR SPINE LUMB 2-3V $ 668.00 $ 668.00 4140 RADIOLOGY41400300 XR SPINE LUMB 4V OR MORE $ 930.00 $ 930.00 4140 RADIOLOGY41400310 XR SPINE LUMB 4V W BEND $ 1,260.00 $ 1,260.00 4140 RADIOLOGY41400315 XR SPINE LUMB BEND ONLY $ 880.00 $ 880.00 4140 RADIOLOGY41400290 XR SPINE SCOLIOSIS SUP ER $ 795.00 $ 795.00 4140 RADIOLOGY41400240 XR SPINE SNGL V CERV $ 398.00 $ 398.00 4140 RADIOLOGY41400237 XR SPINE SNGL V LUMB $ 398.00 $ 398.00 4140 RADIOLOGY41400239 XR SPINE SNGL V THOR $ 398.00 $ 398.00 4140 RADIOLOGY41400235 XR SPINE SURVEY ENTIRE $ 1,150.00 $ 1,150.00 4140 RADIOLOGY41400265 XR SPINE THOR 2V $ 558.00 $ 558.00 4140 RADIOLOGY41400270 XR SPINE THOR 3V $ 660.00 $ 660.00 4140 RADIOLOGY41400277 XR SPINE THOR 4V OR MORE $ 804.00 $ 804.00 4140 RADIOLOGY41400280 XR SPINE THOR LUMB 2V $ 592.00 $ 592.00 4140 RADIOLOGY41400230 XR STERNOCLAVIC 3V MORE $ 643.00 $ 643.00 4140 RADIOLOGY41400225 XR STERNUM 2V OR MORE $ 550.00 $ 550.00 4140 RADIOLOGY41401105 XR SUBTRACTION SERIES $ 563.00 $ 563.00 4140 RADIOLOGY41400615 XR SWALLOWING FNCTN $ 1,548.00 $ 1,548.00 4140 RADIOLOGY41400535 XR TIBIA FIBULA 2V $ 457.00 $ 457.00 4140 RADIOLOGY41400125 XR TMJ BIL $ 837.00 $ 837.00 4140 RADIOLOGY41400120 XR TMJ UNI $ 507.00 $ 507.00 4140 RADIOLOGY41400585 XR TOE(S) 2V OR MORE $ 491.00 $ 491.00 4140 RADIOLOGY41400655 XR UGI W AIR CON $ 2,165.00 $ 2,165.00 4140 RADIOLOGY

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DEPARTMENT CODE

41400660 XR UGI W AIR CON KUB $ 2,436.00 $ 2,436.00 4140 RADIOLOGY41400665 XR UGI W AIR CON SM BOWEL $ 3,349.00 $ 3,349.00 4140 RADIOLOGY41400645 XR UGI W KUB $ 1,979.00 $ 1,979.00 4140 RADIOLOGY41400650 XR UGI W SM BOWEL $ 3,070.00 $ 3,070.00 4140 RADIOLOGY41400640 XR UGI W/O KUB $ 1,818.00 $ 1,818.00 4140 RADIOLOGY41400800 XR URETHROCYSTOGRAM $ 1,404.00 $ 1,404.00 4140 RADIOLOGY41400805 XR URETHROCYSTOGRAM VOID $ 1,734.00 $ 1,734.00 4140 RADIOLOGY41400782 XR UROGRAM ANTEGRADE $ 1,252.00 $ 1,252.00 4140 RADIOLOGY41400783 XR UROGRAM RETRO $ 2,487.00 $ 2,487.00 4140 RADIOLOGY41406007 XR VRTPLSTY EA BDY FLUORO $ 5,599.00 $ 5,599.00 4140 RADIOLOGY41400440 XR WRIST 2V $ 491.00 $ 491.00 4140 RADIOLOGY41400445 XR WRIST 3V OR MORE $ 609.00 $ 609.00 4140 RADIOLOGY41460500 XR X MOBILE $ - $ - 4146 RADIOLOGY41431403 XRC CYSTOSCOPY URETR CATH $ 4,200.00 $ 4,200.00 4143 RADIOLOGY41431195 XRC INJ ARTHRO ANKLE $ 1,011.00 $ 1,011.00 4143 RADIOLOGY41431200 XRC INJ ARTHRO ELBOW $ 2,612.00 $ 2,612.00 4143 RADIOLOGY41431205 XRC INJ ARTHRO HIP $ 3,365.00 $ 3,365.00 4143 RADIOLOGY41431210 XRC INJ ARTHRO KNEE $ 1,062.00 $ 1,062.00 4143 RADIOLOGY41431220 XRC INJ ARTHRO SHOULDER $ 2,612.00 $ 2,612.00 4143 RADIOLOGY41431225 XRC INJ ARTHRO TMJ $ 263.00 $ 263.00 4143 RADIOLOGY41431230 XRC INJ ARTHRO WRIST $ 2,597.00 $ 2,597.00 4143 RADIOLOGY41431245 XRC INJ C1 C2 MYELOGRAM $ 1,069.00 $ 1,069.00 4143 RADIOLOGY41431325 XRC INJ CHOL VIA CATH $ 229.00 $ 229.00 4143 RADIOLOGY41431365 XRC INJ CYSTO RETRO $ 1,827.00 $ 1,827.00 4143 RADIOLOGY41431355 XRC INJ CYSTO VCUG $ 4,038.00 $ 4,038.00 4143 RADIOLOGY41431350 XRC INJ ILEAL CONDUIT $ 1,460.00 $ 1,460.00 4143 RADIOLOGY41431235 XRC INJ MYELOGRAM $ 3,965.00 $ 3,965.00 4143 RADIOLOGY41431345 XRC INJ NEPHROGRAM $ 2,147.00 $ 2,147.00 4143 RADIOLOGY41431760 XRC INJ SIALOGRAM $ 4,378.00 $ 4,378.00 4143 RADIOLOGY41431625 XRC INJ SINOGRAM $ 1,011.00 $ 1,011.00 4143 RADIOLOGY41431790 XRC INJ/ASP JNT/BURSA $ 223.00 $ 223.00 4143 RADIOLOGY41431362 XRC INSERT CATH TMP SMPL $ 1,667.00 $ 1,667.00 4143 RADIOLOGY41431417 XRC INTRO CATH FALLOPN $ 1,837.00 $ 1,837.00 4143 RADIOLOGY

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DEPARTMENT CODE

41400674 XRC INTRO G TUBE LONG $ 298.00 $ 298.00 4140 RADIOLOGY41400357 XRC LUMBAR PUNCTURE DX $ 2,393.00 $ 2,393.00 4140 RADIOLOGY41431415 XRC SAL INFN SONOHYSTER $ 2,529.00 $ 2,529.00 4143 RADIOLOGY54202035 ADMIN INFLUENZA VACC $ 43.00 $ 43.00 5420 REC CARE OTHER CHG54202040 ADMIN PNEUMOCOCCAL VACC $ 20.00 $ 20.00 5420 REC CARE OTHER CHG54202030 OBSERVATION PER HOUR $ 236.00 $ 236.00 5420 REC CARE OTHER CHG54204000 S STRL GYN PACKAGE SUP $ 948.00 $ 948.00 5420 REC CARE OTHER CHG51100010 ROOM RESIDENTIAL CARE PVT $ 254.00 $ 254.00 5110 RES CARE DHS51100110 ROOM RESIDENTIAL CARE PVT $ 242.00 $ 242.00 5110 RES CARE DHS51100011 ROOM RESIDENTIAL CARE SP $ 183.00 $ 183.00 5110 RES CARE DHS51100111 ROOM RESIDENTIAL CARE SP $ 174.00 $ 174.00 5110 RES CARE DHS33530318 ADDTNL ABSTRACTED CPT $ 0.01 $ 0.01 3353 RESP TX ADULT33500035 AEROSOL TX DEMO/EVAL $ 625.00 $ 625.00 3350 RESP TX ADULT33520210 AEROSOL TX SUBSQ $ 291.00 $ 291.00 3352 RESP TX ADULT33530300 ARTERIAL PUNCTURE $ 274.00 $ 274.00 3353 RESP TX ADULT33560610 BLD GAS ART $ 667.00 $ 667.00 3356 RESP TX ADULT33530305 BRONCHOSCOPY $ 3,500.00 $ 3,500.00 3353 RESP TX ADULT33560643 CALCIUM IONIZED $ 472.00 $ 472.00 3356 RESP TX ADULT33500081 CBT 1ST HOUR $ 739.00 $ 739.00 3350 RESP TX ADULT33510171 CBT EACH ADDL HOUR $ 295.00 $ 295.00 3351 RESP TX ADULT33560642 CHLORIDE $ 160.00 $ 160.00 3356 RESP TX ADULT33500065 CPAP/BIPAP INITIAL DAY $ 2,447.00 $ 2,447.00 3350 RESP TX ADULT33500075 CPAP/BIPAP INITIAL DAY $ 2,447.00 $ 2,447.00 3350 RESP TX ADULT33510150 CPAP/BIPAP SUBSEQUENT DAY $ 2,447.00 $ 2,447.00 3351 RESP TX ADULT33510165 CPAP/BIPAP SUBSEQUENT DAY $ 2,447.00 $ 2,447.00 3351 RESP TX ADULT33530376 CPR $ 711.00 $ 711.00 3353 RESP TX ADULT33520250 CPT INITIAL $ 495.00 $ 495.00 3352 RESP TX ADULT33520255 CPT SUBSEQUENT $ 281.00 $ 281.00 3352 RESP TX ADULT33530397 EKG 12 LEAD TRACING $ 468.00 $ 468.00 3353 RESP TX ADULT33500045 ETCO2 INIT DAY $ 957.00 $ 957.00 3350 RESP TX ADULT33510140 ETCO2 SUBSQ DAY $ 957.00 $ 957.00 3351 RESP TX ADULT33560645 HEMATOCRIT $ 80.00 $ 80.00 3356 RESP TX ADULT33530390 INHALATION TX PENTAMIDINE $ 434.00 $ 434.00 3353 RESP TX ADULT

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DEPARTMENT CODE

33500030 IPPB DEMO/EVAL $ 625.00 $ 625.00 3350 RESP TX ADULT33520205 IPPB TX SUBSEQUENT $ 291.00 $ 291.00 3352 RESP TX ADULT33530310 LARYNGOSCOPY DIAG $ 2,796.00 $ 2,796.00 3353 RESP TX ADULT33520240 MDI/NEB DEMO/EVAL $ 625.00 $ 625.00 3352 RESP TX ADULT33520245 MDI/NEB SUBSQ $ 291.00 $ 291.00 3352 RESP TX ADULT33560644 METHEMOGLOBIN $ 166.00 $ 166.00 3356 RESP TX ADULT33560620 PH BLD $ 294.00 $ 294.00 3356 RESP TX ADULT33560641 POTASSIUM $ 160.00 $ 160.00 3356 RESP TX ADULT33530325 PULSE OXIMETRY MULTIPLE $ 443.00 $ 443.00 3353 RESP TX ADULT33530320 PULSE OXIMETRY SINGLE $ 171.00 $ 171.00 3353 RESP TX ADULT33510156 PULSE OX-OVERNIGHT CONT $ 612.00 $ 612.00 3351 RESP TX ADULT33500060 S HELIOX INIT DAY $ 3,861.00 $ 3,861.00 3350 RESP TX ADULT33510120 S HELIOX SUBSQ DAY $ 2,956.00 $ 2,956.00 3351 RESP TX ADULT33510128 S N OXIDE INIT DAY $ 3,495.00 $ 3,495.00 3351 RESP TX ADULT33510129 S N OXIDE SUBSQ DAY $ 2,773.00 $ 2,773.00 3351 RESP TX ADULT33540410 S NSTRL ET/TRACH TUBE $ 377.00 $ 377.00 3354 RESP TX ADULT33540415 S NSTRL MANUAL RESUSCITAT $ 189.00 $ 189.00 3354 RESP TX ADULT33540491 S NSTRL PEAK FLOWMETER $ 93.00 $ 93.00 3354 RESP TX ADULT33540405 S NSTRL TRACH BUTTON DVIC $ 631.00 $ 631.00 3354 RESP TX ADULT33540400 S NSTRL TRACH TALK DEVICE $ 231.00 $ 231.00 3354 RESP TX ADULT33540470 S NSTRL TRACH TIES $ 48.00 $ 48.00 3354 RESP TX ADULT33500010 S O2 HI FLOW OXYGEN INI $ 1,832.00 $ 1,832.00 3350 RESP TX ADULT33500015 S O2 HI FLOW OXYGEN SUB $ 1,221.00 $ 1,221.00 3350 RESP TX ADULT33500005 S O2 O2/MED-GAS THER INIT $ 1,200.00 $ 1,200.00 3350 RESP TX ADULT33503330 S O2 OXYG/MED GAS THR SUB $ 987.00 $ 987.00 3350 RESP TX ADULT33510100 S O2 OXYG/MED GAS THR SUB $ 987.00 $ 987.00 3351 RESP TX ADULT33540490 S STRL MDI CHAMBER $ 116.00 $ 116.00 3354 RESP TX ADULT33540465 S STRL MED NEB DEVICE $ 35.00 $ 35.00 3354 RESP TX ADULT33540481 S STRL MICROBIOLOGY BRUSH $ 127.00 $ 127.00 3354 RESP TX ADULT33540496 S STRL NASOTRACH AIRWAY $ 74.00 $ 74.00 3354 RESP TX ADULT33540498 S STRL ORAL AIRWAY $ 55.00 $ 55.00 3354 RESP TX ADULT33510161 S STRL PROBE $ 584.00 $ 584.00 3351 RESP TX ADULT33540480 S STRL WANG NEEDLE $ 381.00 $ 381.00 3354 RESP TX ADULT

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DEPARTMENT CODE

33510160 SLEEP STUDY ATTENDED $ 6,001.00 $ 6,001.00 3351 RESP TX ADULT33560640 SODIUM $ 169.00 $ 169.00 3356 RESP TX ADULT33530315 SPIROMETRY $ 995.00 $ 500.00 3353 RESP TX ADULT33530398 SPIROMETRY PRE/POST BD $ 1,408.00 $ 1,408.00 3353 RESP TX ADULT33510130 SPUTUM INDCTN VIA AEROSOL $ 878.00 $ 878.00 3351 RESP TX ADULT33530335 SUCTION NASOTRACHEAL $ 186.00 $ 186.00 3353 RESP TX ADULT33500040 TCM INITIAL DAY $ 1,918.00 $ 1,918.00 3350 RESP TX ADULT33510135 TCM SUBSEQUENT DAY $ 1,918.00 $ 1,918.00 3351 RESP TX ADULT33530341 TRACH CHNG NO FIST TRACT $ 651.00 $ 651.00 3353 RESP TX ADULT33560630 VENIPUNCTURE $ 55.00 $ 55.00 3356 RESP TX ADULT33500027 VENT MGMNT INIT NEO/PEDS $ 3,989.00 $ 3,989.00 3350 RESP TX ADULT33500029 VENT MGMNT INIT NEO/PEDS $ 3,989.00 $ 3,989.00 3350 RESP TX ADULT33500023 VENT MGMNT INITIAL $ 3,989.00 $ 3,989.00 3350 RESP TX ADULT33500024 VENT MGMNT INITIAL $ 3,989.00 $ 3,989.00 3350 RESP TX ADULT33500026 VENT MGMNT INITIAL HF $ 4,713.00 $ 4,713.00 3350 RESP TX ADULT33500028 VENT MGMNT INITIAL HF $ 4,713.00 $ 4,713.00 3350 RESP TX ADULT33510137 VENT MGMNT SUBSEQUENT $ 3,254.00 $ 3,254.00 3351 RESP TX ADULT33510124 VENT MGMNT SUBSEQUENT HF $ 3,254.00 $ 3,254.00 3351 RESP TX ADULT33510126 VENT MGMNT SUBSQ NEO/PEDS $ 3,254.00 $ 3,254.00 3351 RESP TX ADULT24400002 AMB GLUC MON SQ MINM 72HR $ 525.00 $ 525.00 2440 SDC-MEDICL DIAB CLNC24400015 DIAB TRNG SVCS GRP EA 30 $ 114.00 $ 114.00 2440 SDC-MEDICL DIAB CLNC24400014 DIAB TRNG SVCS IND EA 30 $ 149.00 $ 149.00 2440 SDC-MEDICL DIAB CLNC24400003 GLUCOSE $ 13.00 $ 13.00 2440 SDC-MEDICL DIAB CLNC24400006 GLUCOSE BLD REAGENT STRIP $ 11.00 $ 11.00 2440 SDC-MEDICL DIAB CLNC24400001 INSULIN PUMP THER EDUC $ 23.00 $ 23.00 2440 SDC-MEDICL DIAB CLNC24400033 MED NUTR TX COND CH EA15 $ 79.00 $ 79.00 2440 SDC-MEDICL DIAB CLNC24400030 MED NUTR TX EA 15 $ 90.00 $ 90.00 2440 SDC-MEDICL DIAB CLNC24400034 MED NUTR TX GP COND EA30 $ 79.00 $ 79.00 2440 SDC-MEDICL DIAB CLNC24400032 MED NUTR TX GP EA 30 $ 40.00 $ 40.00 2440 SDC-MEDICL DIAB CLNC24400031 MED NUTR TX REASMNT EA 15 $ 90.00 $ 90.00 2440 SDC-MEDICL DIAB CLNC24400005 S STRL CGM SENSOR $ 452.00 $ 452.00 2440 SDC-MEDICL DIAB CLNC34622100 AD AUDIOMETRY COMP $ 126.00 $ 126.00 3462 SPCH/HEAR34622101 AD AUDIOMETRY COMP (7-AD) $ 185.00 $ 185.00 3462 SPCH/HEAR

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DEPARTMENT CODE

34612125 SP COGNTVE SKIL DEV EA 15 $ 96.00 $ 96.00 3461 SPCH/HEAR34632145 SP E-STIM SUP 15 $ 149.00 $ 149.00 3463 SPCH/HEAR34612145 SP E-STIM SUP 30 $ 299.00 $ 299.00 3461 SPCH/HEAR34632146 SP E-STIM SUP 30 $ 299.00 $ 299.00 3463 SPCH/HEAR34612146 SP E-STIM SUP 45 $ 448.00 $ 448.00 3461 SPCH/HEAR34632147 SP E-STIM SUP 45 $ 448.00 $ 448.00 3463 SPCH/HEAR34612147 SP E-STIM SUP 60 $ 598.00 $ 598.00 3461 SPCH/HEAR34632148 SP E-STIM SUP 60 $ 598.00 $ 598.00 3463 SPCH/HEAR34611146 SP E-STIM SUP ADD 15 $ 149.00 $ 149.00 3461 SPCH/HEAR34611145 SP E-STIM SUP INIT 30 $ 299.00 $ 299.00 3461 SPCH/HEAR34611112 SP EVAL 45 $ 525.00 $ 525.00 3461 SPCH/HEAR34612142 SP EVAL APHASIA HR $ 523.00 $ 523.00 3461 SPCH/HEAR34632136 SP EVAL ENDO LARY SNS 45 $ 558.00 $ 558.00 3463 SPCH/HEAR34632141 SP EVAL ENDO LARY SWAL 45 $ 819.00 $ 819.00 3463 SPCH/HEAR34632131 SP EVAL ENDO SWALL FNX 45 $ 558.00 $ 558.00 3463 SPCH/HEAR34632102 SP EVAL FNX SWALL 45 $ 446.00 $ 446.00 3463 SPCH/HEAR34611102 SP EVAL LANG 45 $ 551.00 $ 551.00 3461 SPCH/HEAR34632117 SP EVAL MTN FLUOR SWAL 45 $ 480.00 $ 480.00 3463 SPCH/HEAR34612102 SP EVAL SP/LNG/COM/AUD 45 $ 500.00 $ 500.00 3461 SPCH/HEAR34631112 SP EVAL SWALL & ORAL 45 $ 710.00 $ 710.00 3463 SPCH/HEAR34613100 SP GP ED PER SESSION $ 175.00 $ 175.00 3461 SPCH/HEAR34632156 SP LARYN FLX/RIG STROB 45 $ 1,113.00 $ 1,113.00 3463 SPCH/HEAR34613130 SP SP/LANG THER EA 30 $ 311.00 $ 311.00 3461 SPCH/HEAR34613131 SP THER SP/LANG EA 60 $ 631.00 $ 631.00 3461 SPCH/HEAR34613121 SP THER SP/LANG GRP 30 $ 295.00 $ 295.00 3461 SPCH/HEAR34613122 SP THER SP/LANG GRP 45 $ 402.00 $ 402.00 3461 SPCH/HEAR34613123 SP THER SP/LANG GRP 60 $ 518.00 $ 518.00 3461 SPCH/HEAR34612120 SP TX SP/LANG/COM GP 15 $ 85.00 $ 85.00 3461 SPCH/HEAR34612121 SP TX SP/LANG/COM GP 30 $ 180.00 $ 180.00 3461 SPCH/HEAR34612122 SP TX SP/LANG/COM GP 45 $ 215.00 $ 215.00 3461 SPCH/HEAR34612123 SP TX SP/LANG/COM GP 60 $ 354.00 $ 354.00 3461 SPCH/HEAR34612110 SP TX SP/LANG/COM IND 15 $ 166.00 $ 166.00 3461 SPCH/HEAR34612111 SP TX SP/LANG/COM IND 30 $ 253.00 $ 253.00 3461 SPCH/HEAR

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34612112 SP TX SP/LANG/COM IND 45 $ 425.00 $ 425.00 3461 SPCH/HEAR34612113 SP TX SP/LANG/COM IND 60 $ 548.00 $ 548.00 3461 SPCH/HEAR34612114 SP TX SP/LANG/COM IND 75 $ 794.00 $ 794.00 3461 SPCH/HEAR34632110 SP TX SWALL/ORAL FNX 15 $ 152.00 $ 152.00 3463 SPCH/HEAR34632111 SP TX SWALL/ORAL FNX 30 $ 285.00 $ 285.00 3463 SPCH/HEAR34632112 SP TX SWALL/ORAL FNX 45 $ 436.00 $ 436.00 3463 SPCH/HEAR34632113 SP TX SWALL/ORAL FNX 60 $ 493.00 $ 493.00 3463 SPCH/HEAR40600001 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4060 TRANS CLINIC40610003 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4061 TRANS CLINIC40610004 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4061 TRANS CLINIC40610005 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4061 TRANS CLINIC40620005 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4062 TRANS CLINIC40620006 LEVEL 4 EST PATIENT $ 287.00 $ 287.00 4062 TRANS CLINIC40600002 LEVEL 5 NEW PATIENT $ - $ - 4060 TRANS CLINIC40610002 LEVEL 5 NEW PATIENT $ 310.00 $ 310.00 4061 TRANS CLINIC40620004 LEVEL 5 NEW PATIENT $ 310.00 $ 310.00 4062 TRANS CLINIC40630000 LEVEL 5 NEW PATIENT $ 310.00 $ 310.00 4063 TRANS CLINIC40910033 NI AORTA IVC IL CMPL $ 1,554.00 $ 1,554.00 4091 ULTRASOUND40910037 NI AORTA IVC IL LTD $ 1,083.00 $ 1,083.00 4091 ULTRASOUND40930026 NI DIAL ACCES $ 1,357.00 $ 1,357.00 4093 ULTRASOUND40910035 NI DUPLEX ABD PELV CMPL $ 2,092.00 $ 2,092.00 4091 ULTRASOUND40930000 NI DUPLEX EXT LOW BIL $ 2,126.00 $ 2,126.00 4093 ULTRASOUND40930021 NI DUPLEX EXT LOW UNI $ 1,346.00 $ 1,346.00 4093 ULTRASOUND40930020 NI DUPLEX EXT UPP BIL $ 1,655.00 $ 1,655.00 4093 ULTRASOUND40930022 NI DUPLEX EXT UPP UNI $ 1,108.00 $ 1,108.00 4093 ULTRASOUND40930023 NI DUPLEX EXT VEINS BIL $ 1,655.00 $ 1,655.00 4093 ULTRASOUND40930032 NI DUPLEX EXT VEINS UNI $ 1,097.00 $ 1,097.00 4093 ULTRASOUND40930010 NI DUPLEX EXTRACRAN BIL $ 1,655.00 $ 1,655.00 4093 ULTRASOUND40910170 NI DUPLEX EXTRACRAN UNI $ 1,088.00 $ 1,088.00 4091 ULTRASOUND40910165 NI EXT LOW W STRES $ 1,557.00 $ 1,557.00 4091 ULTRASOUND40910006 NI INTRACRAN CMPL $ 1,927.00 $ 1,927.00 4091 ULTRASOUND40930025 NI PENILE VESSELS CMPL $ 970.00 $ 970.00 4093 ULTRASOUND40950005 S NSTRL ABSCESS TRAY $ - $ - 4095 ULTRASOUND

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40950010 S NSTRL AMNIO TRAY $ 331.00 $ 331.00 4095 ULTRASOUND40954492 S NSTRL PARACENTESIS TRAY $ 313.00 $ 313.00 4095 ULTRASOUND40954487 S NSTRL PROCEDURE TRAY $ 506.00 $ 506.00 4095 ULTRASOUND40954493 S NSTRL THORACENTESIS TR $ 273.00 $ 273.00 4095 ULTRASOUND40953810 S STRL AMPLATZ NEEDLE $ 142.00 $ 142.00 4095 ULTRASOUND40953747 S STRL ANGIO CATH $ 52.00 $ 52.00 4095 ULTRASOUND40954480 S STRL BIOPSY TRAY $ 288.00 $ 288.00 4095 ULTRASOUND40953800 S STRL CHIBA NEEDLE $ 142.00 $ 142.00 4095 ULTRASOUND40955051 S STRL COOK YUEN NEEDLE $ 100.00 $ 100.00 4095 ULTRASOUND40953667 S STRL DBL MALE LUER LOCK $ - $ - 4095 ULTRASOUND40954960 S STRL EVAC CONTAINER $ 52.00 $ 52.00 4095 ULTRASOUND40954965 S STRL LOCALIZATION NDL $ 142.00 $ 142.00 4095 ULTRASOUND40955052 S STRL MEDITECH ASAP NDL $ 361.00 $ 361.00 4095 ULTRASOUND40961099 S STRL MISC. SUPP CHARGE $ - $ - 4096 ULTRASOUND40954955 S STRL NEEDLE GUIDE KIT $ 269.00 $ 269.00 4095 ULTRASOUND40954950 S STRL PROBE COVERS $ 124.00 $ 124.00 4095 ULTRASOUND40954486 S STRL PROCEDURE TRAY 1US $ 255.00 $ 255.00 4095 ULTRASOUND40953837 S STRL TEMNO NEEDLE 16/15 $ 259.00 $ 259.00 4095 ULTRASOUND40910030 US ABD CMPL $ 970.00 $ 970.00 4091 ULTRASOUND40910075 US BIO PROFILE W NONSTRES $ 739.00 $ 739.00 4091 ULTRASOUND40910025 US BREAST UNI OR BIL $ 560.00 $ 560.00 4091 ULTRASOUND40910015 US CHEST $ 601.00 $ 601.00 4091 ULTRASOUND40901095 US CONSULT FOREIGN FLM $ 127.00 $ 127.00 4090 ULTRASOUND40910130 US DRN W CATH PLACE PRC $ 894.00 $ 894.00 4091 ULTRASOUND40910040 US ECHO ABD LTD $ 746.00 $ 746.00 4091 ULTRASOUND40910085 US ECHO FETAL $ 1,343.00 $ 1,343.00 4091 ULTRASOUND40910050 US ECHO RETROPE LTD $ 825.00 $ 825.00 4091 ULTRASOUND40910005 US ENCEPHALOGRAM $ 839.00 $ 839.00 4091 ULTRASOUND40910110 US EXT NONVASCULAR $ 949.00 $ 949.00 4091 ULTRASOUND40910140 US FU STDY $ 625.00 $ 625.00 4091 ULTRASOUND40910128 US GDE PRNCHYML TISS ABLN $ 842.00 $ 842.00 4091 ULTRASOUND40910183 US GUIDANCE INTRAOP $ 135.00 $ 135.00 4091 ULTRASOUND40910010 US HEAD & NEC SFT TISSUE $ 822.00 $ 822.00 4091 ULTRASOUND

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40910108 US NDL PLACE $ 1,485.00 $ 1,485.00 4091 ULTRASOUND40910125 US NDL PLACE $ 1,485.00 $ 1,485.00 4091 ULTRASOUND40910055 US OB AFTR 1ST TRI 1 GEST $ 1,012.00 $ 1,012.00 4091 ULTRASOUND40910065 US OB FU/REEVAL EA FETUS $ 732.00 $ 732.00 4091 ULTRASOUND40910070 US OB LTD 1/MORE FETUSES $ 935.00 $ 935.00 4091 ULTRASOUND40910095 US PELV CMPL NONOB $ 752.00 $ 752.00 4091 ULTRASOUND40910100 US PELV LTD FU NONOB $ 798.00 $ 798.00 4091 ULTRASOUND40910045 US RETROPE CMPL $ 943.00 $ 943.00 4091 ULTRASOUND40900867 US SAL INFN SONOHYSTERGHY $ 849.00 $ 849.00 4090 ULTRASOUND40910053 US SPINAL CANAL $ 735.00 $ 735.00 4091 ULTRASOUND40910105 US TESTICULAR SCROTUM $ 873.00 $ 873.00 4091 ULTRASOUND40910052 US TRANSPLNT KDNY W/DPPLR $ 1,074.00 $ 1,074.00 4091 ULTRASOUND40910160 US TRANSRECTAL $ 1,070.00 $ 1,070.00 4091 ULTRASOUND40910150 US TRANSVAGINAL $ 773.00 $ 773.00 4091 ULTRASOUND40960500 US US MOBILE $ - $ - 4096 ULTRASOUND40931282 USC ABLTN LIVER RF OPN $ 3,727.00 $ 3,727.00 4093 ULTRASOUND40931284 USC ABLTN LIVER RF PRC $ 3,988.00 $ 3,988.00 4093 ULTRASOUND40931613 USC ABLTN RENAL RF PRC $ 3,467.00 $ 3,467.00 4093 ULTRASOUND40931560 USC ABSCSS CYST LIVER PRC $ 4,782.00 $ 4,782.00 4093 ULTRASOUND40931612 USC ABSCSS DRN PELV PRC $ 9,005.00 $ 9,005.00 4093 ULTRASOUND40931571 USC ABSCSS DRN PERITNL $ 2,039.00 $ 2,039.00 4093 ULTRASOUND40931585 USC ABSCSS DRN RENL $ 7,300.00 $ 7,300.00 4093 ULTRASOUND40931575 USC ABSCSS DRN RETROPE $ 1,216.00 $ 1,216.00 4093 ULTRASOUND40931580 USC ABSCSS DRN SUBDIAP $ 3,304.00 $ 3,304.00 4093 ULTRASOUND40931610 USC ASP RENL CYST $ 254.00 $ 254.00 4093 ULTRASOUND40931520 USC ASP THYROID CYST $ 601.00 $ 601.00 4093 ULTRASOUND40931675 USC BX ABD RETROPE $ 1,663.00 $ 1,663.00 4093 ULTRASOUND40931680 USC BX BONE DEEP $ 2,702.00 $ 2,702.00 4093 ULTRASOUND40931685 USC BX BONE SUPER $ 1,075.00 $ 1,075.00 4093 ULTRASOUND40931705 USC BX EXCSN LYMPH NODE $ 2,212.00 $ 2,212.00 4093 ULTRASOUND40931690 USC BX LIVER $ 2,191.00 $ 2,191.00 4093 ULTRASOUND40931750 USC BX LIVER W MAJOR $ 522.00 $ 522.00 4093 ULTRASOUND40931695 USC BX LUNG MEDIASTNM $ 795.00 $ 795.00 4093 ULTRASOUND

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40931703 USC BX LYMPH NODE SUPER $ 1,101.00 $ 1,101.00 4093 ULTRASOUND40931700 USC BX MUSCLE $ 1,866.00 $ 1,866.00 4093 ULTRASOUND40931710 USC BX PANCREAS $ 3,357.00 $ 3,357.00 4093 ULTRASOUND40931725 USC BX PLEURA $ 734.00 $ 734.00 4093 ULTRASOUND40931730 USC BX PROSTATE $ 2,179.00 $ 2,179.00 4093 ULTRASOUND40931735 USC BX RENL $ 1,717.00 $ 1,717.00 4093 ULTRASOUND40931500 USC BX SFT TIS HIP SPRFCL $ 1,775.00 $ 1,775.00 4093 ULTRASOUND40931707 USC BX SOFT TISS NEC THOR $ 1,380.00 $ 1,380.00 4093 ULTRASOUND40931745 USC BX THYROID $ 596.00 $ 596.00 4093 ULTRASOUND40931567 USC DRN APPNCL ABSCSS PRC $ 2,719.00 $ 2,719.00 4093 ULTRASOUND40931342 USC DRN PANC PSEUDOCYST $ 1,197.00 $ 1,197.00 4093 ULTRASOUND40931627 USC EXCHANGE DRN CATH $ 4,887.00 $ 4,887.00 4093 ULTRASOUND40931515 USC FNA W IMAG GUIDANCE $ 1,287.00 $ 1,287.00 4093 ULTRASOUND40931626 USC INJ CON ABSCSS $ 1,289.00 $ 1,289.00 4093 ULTRASOUND40931615 USC INJ SINOGRAM $ 1,011.00 $ 1,011.00 4093 ULTRASOUND40931590 USC PARACENT ABD INI $ 1,665.00 $ 1,665.00 4093 ULTRASOUND40931595 USC PARACENT ABD SUBSQ $ 1,332.00 $ 1,332.00 4093 ULTRASOUND40931510 USC PSEUDOANEURYSM INJ $ 822.00 $ 822.00 4093 ULTRASOUND40931505 USC PUNCTURE DRN LESION $ 595.00 $ 595.00 4093 ULTRASOUND40931416 USC SAL INFN SONOHYSTER $ 1,350.00 $ 1,350.00 4093 ULTRASOUND40931340 USC THORACENTESIS $ 1,161.00 $ 1,161.00 4093 ULTRASOUND40931341 USC THORACENTESIS W TUBE $ 1,640.00 $ 1,640.00 4093 ULTRASOUND40931565 USC TUBE THORACOSTOMY $ 3,216.00 $ 3,216.00 4093 ULTRASOUND44900019 BIOFD PERI/URO/RECTL 15 $ 201.00 $ 201.00 4490 UROGYNECOLOGICAL PROGRAM44900003 CYSTOMETROGRAM CMPLX $ 842.00 $ 842.00 4490 UROGYNECOLOGICAL PROGRAM44900071 EMG ANAL/URETHRAL NO NDL $ 418.00 $ 418.00 4490 UROGYNECOLOGICAL PROGRAM44900090 HEPARIN 1000U IJ $ 66.00 $ 66.00 4490 UROGYNECOLOGICAL PROGRAM44900079 INSERT CATH NONINDWLLNG $ 208.00 $ 208.00 4490 UROGYNECOLOGICAL PROGRAM44900082 INSERT CATH TMP INDWL CMP $ 150.00 $ 150.00 4490 UROGYNECOLOGICAL PROGRAM44900089 K CL 2MEQ $ 30.00 $ 30.00 4490 UROGYNECOLOGICAL PROGRAM44900054 PESSARY FITTING/INSERTION $ 216.00 $ 216.00 4490 UROGYNECOLOGICAL PROGRAM44900091 S IMP BULKING AGENT URIN $ 357.00 $ 357.00 4490 UROGYNECOLOGICAL PROGRAM44900086 S ORTHO PESSARY NONRUBBER $ 379.00 $ 379.00 4490 UROGYNECOLOGICAL PROGRAM

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44900084 S ORTHO PESSARY RUBBER $ 379.00 $ 379.00 4490 UROGYNECOLOGICAL PROGRAM44900088 S PR CATH STRGHT TIP URN $ 253.00 $ 253.00 4490 UROGYNECOLOGICAL PROGRAM44900067 UROFLOWMETRY COMPLEX $ 83.00 $ 83.00 4490 UROGYNECOLOGICAL PROGRAM44900055 VP STUDY INTRAABDOMINAL $ 411.00 $ 411.00 4490 UROGYNECOLOGICAL PROGRAM52000044 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM52000144 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM53300039 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM53300044 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM53300139 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM53300144 ROOM SPECIAL CARE $ 5,830.00 $ 5,830.00 5330 W 1E ANTEPARTUM51900054 ROOM ICU INTERM PEDIATRIC $ 8,320.00 $ 8,320.00 5190 W3E (STEPDOWN) DHS51900154 ROOM ICU INTERM PEDIATRIC $ 8,320.00 $ 8,320.00 5190 W3E (STEPDOWN) DHS51900003 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5190 W3E (STEPDOWN) DHS51900103 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5190 W3E (STEPDOWN) DHS54210030 OBSERVATION PER HOUR $ 236.00 $ 236.00 5421 W3E (STEPDOWN) OBSERV CHG51800042 ROOM ICU PEDIATRICS $ 10,091.00 $ 10,091.00 5180 W3N (PICU) DHS51800142 ROOM ICU PEDIATRICS $ 10,091.00 $ 10,091.00 5180 W3N (PICU) DHS51800003 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5180 W3N (PICU) DHS51800103 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5180 W3N (PICU) DHS54160010 OBSERVATION PER HOUR $ 236.00 $ 236.00 5416 W3N (PICU) OBSERV CHG54160030 OBSERVATION PER HOUR $ 236.00 $ 236.00 5416 W3N (PICU) OBSERV CHG54150030 OBSERVATION PER HOUR $ 236.00 $ 236.00 5415 W5NW (PEDS) OBSERV HRS51700003 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5170 W5NW PEDS DHS51700103 ROOM PEDIATRIC $ 6,165.00 $ 6,165.00 5170 W5NW PEDS DHS

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Hospital Name: CPMC - Cal, Pac, & Davies Campuses

Column A Column B Column C Column D Column E

$3,189,722,575 $3,261,856,022 -$103,654,973 $175,788,420 5.51%

Column A = 1/1/2009 to 5/31/2009 actual charges, annualized.Column B = 1/1/2010 to 5/31/2010 actual charges, annualized.Column C = Any changes due to volume variances including services provided in one year and not the other.Column D = Rate change only, based on analysis using 1/1/2010 - 5/31/2010 volumes.Column E = Rate Increase only for submission to OSHPD (Column D divided by Column A).

Estimated annual revenue based on June 1, 2008 rates

Estimated annual revenue based on June 1, 2009 rates

Adjustment for any change in volume or factor other than rate

increaseChange in revenue due to rate increase(=B-A-C)

Percentage Change in Gross Charges

due to rate increase (D/A)

Documents

California Pacific Medical Center - CA OSHPD€¦ · XLS file · Web view · 2010-06-29CDM CPMC 2010_06_01 CPMC Common 25 CDM_Publish_OSHPD_2005_07_01 CDM_Publish_OSHPD_CPMC_061305