148
MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name Description Charge Amount 0.9 % NACL 100ML ADD-VAN 8.47 0.9 % NACL 250ML ADD-VAN 9.28 0.9 % SOD CL 1000ML IV 10.08 0.9 % SOD CL 100ML IV 8.09 0.9 % SOD CL 10ML 1.99 0.9 % SOD CL 250ML IV 9.57 0.9 % SOD CL 500ML IV 9.84 0.9 % SOD CL 50ML IV 7.90 0.9 % SOD CL 50ML PB 16.96 0.9 NACL 100ML MBPLUS IV 16.96 02 SATURATED GAS OR BLOOD 78.00 1-123 PER 100UCI 244.00 11-DEOXYCORTISOL 260.00 17 HYDROXYCORT (17OH) 169.00 17 HYDROXYPROGESTERO 241.00 2 HOUR GLUCOSE TOLER 114.50 3% SODIUM CL 500ML IV 16.91 3D CT/MRI/US/OTH IND 218.50 3D Mapping 5,515.50 3D TX PLANNING 6,474.50 3-D TX PLANNING 6,474.50 5 HIAA 124.00 6 MIN WALK TEST 244.00 A & D OINT 120GM 11.11 A.TENUIS 46.50 AA5%/CA/LYT/DEX15% 2,000 99.09 AB ID SELECT REGNT CELL 367.00 ABACAVIR SULF 300MG TAB 20.56 ABCIXIMAB 10 MG DOSE 2,421.53 ABD PARACENTESIS W/IMAGE 2,204.50 ABL1 GENE ANALYS VAR KIN 945.00 ABO TYPE 298.50 ACAMPROSATE CA 333MG TAB 2.56 ACARBOSE 25 MG TAB 2.03 ACARBOSE 50 MG TAB 2.07 ACETAMIN 650MG/20.3ML LQ 4.33 ACETAMIN COD 12.5 ML LIQ 2.85 ACETAMINOPHEN 120MG SUPP 1.87 ACETAMINOPHEN 325 MG TAB 1.17 ACETAMINOPHEN 325MG SUPP 1.93 ACETAMINOPHEN 500 MG TAB 1.19 ACETAMINOPHEN 650MG SUPP 2.00 ACETAMINOPHEN COD #2 TAB 1.40 ACETAMINOPHEN COD #4 TAB 1.80 ACETAMINOPHEN COD#3 TAB 1.46 ACETAMINOPHEN QN 97.00 ACETAZOLAMIDE 250 MG TAB 5.29 ACETAZOLAMIDE 500 MG CAP 5.99

Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

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Page 1: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

Description Charge Amount

0.9 % NACL 100ML ADD-VAN 8.47

0.9 % NACL 250ML ADD-VAN 9.28

0.9 % SOD CL 1000ML IV 10.08

0.9 % SOD CL 100ML IV 8.09

0.9 % SOD CL 10ML 1.99

0.9 % SOD CL 250ML IV 9.57

0.9 % SOD CL 500ML IV 9.84

0.9 % SOD CL 50ML IV 7.90

0.9 % SOD CL 50ML PB 16.96

0.9 NACL 100ML MBPLUS IV 16.96

02 SATURATED GAS OR BLOOD 78.00

1-123 PER 100UCI 244.00

11-DEOXYCORTISOL 260.00

17 HYDROXYCORT (17OH) 169.00

17 HYDROXYPROGESTERO 241.00

2 HOUR GLUCOSE TOLER 114.50

3% SODIUM CL 500ML IV 16.91

3D CT/MRI/US/OTH IND 218.50

3D Mapping 5,515.50

3D TX PLANNING 6,474.50

3-D TX PLANNING 6,474.50

5 HIAA 124.00

6 MIN WALK TEST 244.00

A & D OINT 120GM 11.11

A.TENUIS 46.50

AA5%/CA/LYT/DEX15% 2,000 99.09

AB ID SELECT REGNT CELL 367.00

ABACAVIR SULF 300MG TAB 20.56

ABCIXIMAB 10 MG DOSE 2,421.53

ABD PARACENTESIS W/IMAGE 2,204.50

ABL1 GENE ANALYS VAR KIN 945.00

ABO TYPE 298.50

ACAMPROSATE CA 333MG TAB 2.56

ACARBOSE 25 MG TAB 2.03

ACARBOSE 50 MG TAB 2.07

ACETAMIN 650MG/20.3ML LQ 4.33

ACETAMIN COD 12.5 ML LIQ 2.85

ACETAMINOPHEN 120MG SUPP 1.87

ACETAMINOPHEN 325 MG TAB 1.17

ACETAMINOPHEN 325MG SUPP 1.93

ACETAMINOPHEN 500 MG TAB 1.19

ACETAMINOPHEN 650MG SUPP 2.00

ACETAMINOPHEN COD #2 TAB 1.40

ACETAMINOPHEN COD #4 TAB 1.80

ACETAMINOPHEN COD#3 TAB 1.46

ACETAMINOPHEN QN 97.00

ACETAZOLAMIDE 250 MG TAB 5.29

ACETAZOLAMIDE 500 MG CAP 5.99

Page 2: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ACETAZOLAMIDE 500MG INJ 70.72

ACETIC ACID 500 ML LIQ 36.21

ACETYLCHOLINE BINDIN 120.00

ACETYLCHOLINE BLOCKI 120.00

ACETYLCHOLINE CL 10MG/ML 160.50

ACETYLCHOLINE MODULA 120.00

ACETYLCYST 100MG/ML 4ML 15.46

ACETYLCYST 200 MG/ML 4ML 20.46

ACETYLCYSTEI 100 MG DOSE 320.35

ACID PHOSPHATASE TOT 71.00

ACLIDINIUM BROM AER.POWD 299.71

ACT CLOT TIME 38.00

ACTH QN 372.00

ACTH STIM PANEL ADR INS 314.50

ACTICOAT 371.00

ACTIGRAPHY TESTING 251.50

ACTINOMYCES ANTIBODY 62.21

ACTIVATED CLOTTING T 38.00

ACUTE HEPATITIS PANEL 438.50

ACYCLOVIR 200 MG CAPSULE 2.63

ACYCLOVIR 200MG/5ML SUSP 632.18

ACYCLOVIR 5 MG DOSE 32.04

ACYCLOVIR 5 MG DOSE NB 32.04

ACYCLOVIR 5% OINT 30GM 566.30

ACYCLOVIR 5% OINT 5GM 199.34

ACYCLOVIR 800 MG TABLET 5.65

ADACEL TDAP 76.00

ADACEL TDAP 76.00

ADALIMUMAB 20 MG DOSE 5,060.27

ADALIMUMAB AB 121.00

ADALIMUMAB LEVEL 362.50

ADAMTS-13 204.00

Adapt/ext, pac/neur lead 3,270.00

Adapt/ext,pac/neu lead C 1,546.00

Addtl SVT/VT Ablation 5,515.50

ADENOSINE 1 MG DOS 30ML 217.53

ADENOSINE 1 MG DOSE 2ML 24.70

ADENOSINE 1 MG DOSE 4ML 44.30

ADENOSINE 1 MG DOSE NB 24.70

ADENOSINE 1 MG DOSE NB 24.70

ADENOSINE 30MG 146.50

ADENOVIRUS AG IFT 115.50

ADH (VASOPRESSIN) 327.50

ADHESION BARRIER 4,410.00

ADMIN INFLUENZA VAC 105.50

ADMIN INFLUENZA VAC 31.50

ADMIN INFLUENZA VAC 31.50

ADMIN INFLUENZA VAC 105.50

ADMIN INFLUENZA VAC 105.50

ADMIN INFLUENZA VAC 105.50

Page 3: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ADMIN INFLUENZA VACCINE 162.00

ADMIN INFLUENZA VIRU 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 21.00

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 105.50

ADMIN PNEUMOCOCCAL VAC 162.00

ADMIN PNEUMOCOCCAL VAC 162.00

ADMINISTER EACH ADD 220.50

ADMINISTER EACH ADD 220.50

ADMINISTER EACH ADD 220.50

ADMINISTER EACH ADD 220.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 21.00

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 105.50

ADMINISTER FLU VACCI 162.00

ADMINISTER FLU VACCI 105.50

ADMINISTER HEP A VACCINE 22.50

ADMINISTER PRIMARY V 166.00

ADMINISTER VACCINATI 220.50

ADMINISTER VACCINATI 220.50

ADMINISTER VACCINATI 220.50

ADMINISTER VACCINATI 220.50

ADMINISTER VACCINATION 220.50

ADMINISTER VACCINATION 220.50

ADMINISTER VACCINATION 220.50

ADMINISTER VACCINATION 220.50

ADMINISTER VACCINE 220.50

ADMINISTER VACCINE 220.50

ADMINISTER VACCINE 220.50

ADMINSTER VACCINE 220.50

ADMINSTER VACCINE 210.00

ADMINSTER VACCINE 220.50

Ado-Trastuzumab 1MG DOSE 5,589.06

ADP-PLATELET AGGREGA 98.00

ADRENAL ANTIBODY 107.50

AERESOL PT.DEMO AND E 529.00

AERESOL PT.DEMO AND E 529.00

AERESOL TX. 529.00

Page 4: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

AERESOL TX-SAME DAY-A 529.00

AFB CONCENTRATION 63.00

AFFINITY PER SQ CM 240.50

A-fib Ablation 55,545.00

AFP ESTERIOL 215.00

AFP HCG 134.00

AFP TUMOR MARKER 149.50

AG SC DON BLD REA SER EA 611.50

Aicd, dual chamber Cat1 27,769.50

Aicd, dual chamber Cat2 49,295.00

AIRWAY INHALATION TR 529.00

AIRWAY INHALATION TR 529.00

AIRWAY INHALATION TREATMENT 529.00

AIRWAY RESISTANCE IMP OS 1,437.50

AIRWY INHALATION TRE 529.00

ALBUMIN 44.00

ALBUMIN 25%,50 ML 74.12

ALBUMIN 25%,50 ML 148.25

ALBUMIN SERUM 44.00

ALBUMIN UR OR OTHER QN 50.50

ALBUTEROL 2.5MG/0.5 ML 2.00

ALBUTEROL 2.5MG/3ML 1.90

ALBUTEROL 4MG TAB 12.14

ALBUTEROL SULFATE INH 8G 37.59

ALCOHOL 3,840 ML SOL 46.16

ALCOHOL 473 ML SOLUTION 5.83

ALCOHOL QN EXCEPT BREATH 134.50

ALDOLASE 94.00

ALDOSTERONE SERUM 362.00

ALDOSTERONE UR QN 393.00

ALENDRONATE 10MG TAB 4.02

ALENDRONATE 35MG TAB 29.10

ALENDRONATE 70MG TAB 29.10

ALFUZOSIN 10 MG TAB.ER 32.65

ALISKIREN 150 MG TAB 12.10

ALK PHOS (ALP) 50.50

ALK PHOS ISOENZYMES 142.50

ALLERGEN GLUTEN 46.50

ALLERGEN IGE EACH 46.50

ALLERGEN MUGWORT 46.50

ALLOGRAFT 6,300.00

ALLOPURINOL 100 MG TAB 1.48

ALLOPURINOL 300 MG TAB 1.86

ALPHA 1 ANTITRYPSIN 129.00

ALPHA ANTITRYPSIN 119.50

ALPHA FETOPROTEINMAT 149.50

ALPHA SUBUNIT 109.50

ALPHA-1-ANTITRYPSINF 119.50

ALPRAZOLAM 0.25 MG TAB 1.80

ALPRAZOLAM 0.5 MG TAB 1.86

Page 5: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ALPRAZOLAM 1 MG TAB 2.00

ALPROSTADIL 500 MCG/ML 184.63

ALT (SGPT) 51.00

ALTEPLASE 1MG DOSE 100 14,995.81

ALTEPLASE 1MG DOSE 2 260.81

ALTEPLASE 6.25 MCG/ML 222.94

ALUMINUM 245.50

ALVIMOPAN 12 MG CAP 268.15

AMANTADINE 100 MG CAP 3.25

AMIKACIN 100 MG DOS 4ML 63.69

AMIKACIN QUANT 145.50

AMILORIDE HCL 5 MG TAB 1.37

AMINO ACID 15% 2,000 ML 185.75

AMINO ACIDS 1000ML 49.00

AMINO ACIDSPLASMA 150.00

AMINOCAP 1,250MG/5ML SOL 87.32

AMINOCAP 250MG/ML IJ 20M 19.53

AMINOLEVULINIC ACID ALA 159.00

AMINOPHYLLINE 250 MG DOS 24.64

AMIODARONE 150MG/100ML 59.11

AMIODARONE 200MG TAB 1.69

AMIODARONE 360MG/200ML 78.63

AMIODARONE 400MG TAB 22.22

AMIODARONE HCL 100MG TAB 22.22

AMIODARONE HCL 50MG/ML 7.90

AMIODARONE LEVEL 134.00

AMITRIP/CHLORDIAZ 5-12.5 2.63

AMITRIPTYLINE 10 MG TAB 1.42

AMITRIPTYLINE 25 MG TAB 1.74

AMITRIPTYLINE 50 MG TAB 2.16

AMITRIPTYLINE/NORTRI 243.50

AMLODIP/BENAZ 5-10 CAP 2.26

AMLODIP/BENAZ 5-20 CAP 2.33

AMLODIP/BENAZE 2.5-10CAP 3.75

AMLODIP/BENAZEP 10-20CAP 17.60

AMLODIPINE 10MG TAB 3.36

AMLODIPINE 2.5MG TAB 2.69

AMLODIPINE 5MG TAB 4.58

AMMONIA 129.50

AMMONIA 1 PUFF AMPUL 1.80

AMMONIUM ALUM 340 GM POW 32.63

AMMONIUM LACTATE 12% LOT 16.62

AMNIOEXCEL CAT1 799.00

AMNIOEXCEL CAT2 1,676.00

AMNIOEXCEL CAT3 8,316.00

AMNIOEXCEL SUSPENS CAT1 1,984.50

AMNIOEXCEL SUSPENS CAT2 3,071.50

AMNIOTIC FLUID PROT QUAL 309.50

Amniotic Membrane 2,234.00

AMNIOTIC MEMBRANE 951.00

Page 6: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

AMNIOTIC MEMBRANE 1,116.50

AMOX 125MG/5ML SUSP 100M 4.66

AMOX 250MG/5ML 100ML 11.59

AMOX/CLAV 200MG/5ML 50ML 23.95

AMOX/CLAV 250-125 TAB 14.38

AMOX/CLAV 250MG/5ML 150M 206.13

AMOX/CLAV 400MG/5ML 50ML 49.91

AMOX/CLAV 500-125 TAB 4.88

AMOX/CLAV 600MG/5ML 75ML 73.60

AMOX/CLAV 875-125 TAB 10.55

AMOX/CLAV XR 1000MG TAB 12.48

AMOXICILLIN 250MG CAP 1.35

AMOXICILLIN 500 MG CAP 1.53

AMOXICILLIN 875 MG TAB 1.97

AMP SCREEN 186.50

AMP/SULB 1500MG DOS 1.5G 18.74

AMP/SULB 1500MG DOSE 3G 25.60

AMPHETAMINE CONFIRMA 180.00

AMPHOTER B 0.015MG/0.3ML 64.75

AMPHOTERICIN 50MG DOSE 64.75

AMPICILLIN 500 MG DOSE 8.45

AMPICILLIN 500 MG DOSE 12.58

AMPICILLIN 500 MG DOSE 26.92

AMPICILLIN 500MG CAP 1.69

AMYL NITRITE INHALANTS 34.49

AMYLASE 58.00

AMYLASE BODY FLUIDS 58.00

AMYLASE UR 62.50

AMYLASE2HR URINE 58.00

ANA QUAL SCREEN 117.00

ANA QUANT TITER 108.00

ANAEROBIC ORG ID 78.00

ANAGRELIDE HCL 0.5MG CAP 16.66

ANALYZE NEURO CMPLX 1HR 361.50

ANALYZE NEUROSTIM NO PRC 289.50

ANALYZE NEUROSTIM SIMPLE 320.00

ANASTROZOLE 1 MG TABLET 3.17

ANCA MYELOPEROXIDASE 102.50

ANCA SERINE PROTEASE 102.50

ANCHOR/SCREW BN/BN, TIS/B 676.50

ANCHOR/SCREW BN/BN, TIS/B 7,476.50

ANCHOR/SCREW BN/BN, TIS/B 201.00

ANCHOR/SCREW BN/BN, TIS/B 903.00

ANCHOR/SCREW BN/BN, TIS/B 260.00

ANCHOR/SCREW BN/BN, TIS/B 801.50

ANCHOR/SCREW BN/BN, TIS/B 1,597.00

ANCHOR/SCREW BN/BN, TIS/B 719.00

ANCHOR/SCREW BN/BN, TIS/B 719.00

ANCHOR/SCREW BN/BN, TIS/B 6,868.00

ANCHOR/SCREW BN/BN, TIS/B 255.00

Page 7: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ANCHOR/SCREW BN/BN, TIS/B 3,150.00

ANCHOR/SCREW BN/BN, TIS/B 234.24

ANCHOR/SCREW BN/BN, TIS/B 2,377.44

ANCHOR/SCREW BN/BN, TIS/B 646.00

ANCHOR/SCREW BN/BN, TIS/B 661.50

ANCHOR/SCREW BN/BN, TIS/B 658.00

ANCHOR/SCREW BN/BN, TIS/B 391.00

ANCHOR/SCREW BN/BN, TIS/B 228.00

ANCHOR/SCREW BN/BN, TIS/B 4,082.00

ANCHOR/SCREW BN/BN, TIS/B 394.00

ANCHOR/SCREW BN/BN, TIS/B 678.50

ANCHOR/SCREW BN/BN, TIS/B 678.50

ANCHOR/SCREW BN/BN, TIS/B 685.00

ANCHOR/SCREW BN/BN, TIS/B 490.00

ANCHOR/SCREW BN/BN, TIS/B 1,386.00

ANCHOR/SCREW BN/BN, TIS/B 164.45

ANCHOR/SCREW BN/BN, TIS/B 433.20

ANCHOR/SCREW BN/BN, TIS/B 194.48

ANCHOR/SCREW BN/BN, TIS/B 5,016.60

ANCHOR/SCREW BN/BN, TIS/B 1,061.00

ANCHOR/SCREW BN/BN, TIS/B 857.00

ANCHOR/SCREW BN/BN, TIS/B 542.00

ANCHOR/SCREW BN/BN, TIS/B 857.00

ANCHOR/SCREW BN/BN, TIS/B 664.00

ANCHOR/SCREW BN/BN, TIS/B 2,100.00

ANCHOR/SCREW BN/BN, TIS/B 697.00

ANCHOR/SCREW BN/BN, TIS/B 4,171.00

ANCHOR/SCREW BN/BN, TIS/B 1,079.50

ANCHOR/SCREW BN/BN, TIS/B 470.50

ANCHOR/SCREW BN/BN, TIS/B 4,709.50

ANCHOR/SCREW BN/BN, TIS/B 736.00

ANCHOR/SCREW BN/BN, TIS/B 3,559.50

ANCHOR/SCREW BN/BN, TIS/B 4,012.50

ANCHOR/SCREW BN/BN, TIS/B 173.00

ANCHOR/SCREW BN/BN, TIS/B 5,328.00

ANCHOR/SCREW BN/BN, TIS/B 917.50

ANCHOR/SCREW BN/BN, TIS/B 403.50

ANCHOR/SCREW BN/BN, TIS/B 3,582.00

ANCHOR/SCREW BN/BN, TIS/B 5,508.50

ANCHOR/SCREW BN/BN, TIS/B 3,024.00

ANCHOR/SCREW BN/BN, TIS/B 4,193.00

ANCHOR/SCREW BN/BN, TIS/B 736.00

ANCHOR/SCREW BN/BN, TIS/B 4,082.00

ANCHOR/SCREW BN/BN, TIS/B 228.00

ANCHOR/SCREW BN/BN, TIS/B 686.00

ANCHOR/SCREW BN/BN, TIS/B 1,092.00

ANCHOR/SCREW BN/BN, TIS/B 455.00

ANCHOR/SCREW BN/BN, TIS/B 684.32

ANCHOR/SCREW BN/BN, TIS/B 1,116.00

ANCHOR/SCREW BN/BN, TIS/B 651.60

Page 8: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

Anchor/screw bn/bn,tis/b 6,825.00

Anchor/screw bn/bn,tis/b 1,567.00

Anchor/screw bn/bn,tis/b 5,177.50

Anchor/screw bn/bn,tis/b 1,000.50

Anchor/screw bn/bn,tis/b 280.00

Anchor/screw bn/bn,tis/b 13,125.00

Anchor/screw bn/bn,tis/b 2,625.00

ANDROSTENEDIONE 282.00

ANDROSTENEDIONE GLUC 256.00

ANESTHETIC ADDTL 15 315.00

ANESTHETIC FIRST 30 399.00

ANGIO AV SHUNT 2,302.50

ANGIOPLASTY PERIPHER 10,997.00

ANGIOPLASTY PERPH AD 1,082.50

ANGIOTENSIN CONVERT 130.00

ANGIOTENSION CONVERT 130.00

ANTERIOR INTRAOC LENS 134.00

ANTI MULLERIAN HORMONE 55.00

ANTIBODY ELUTION EA 367.00

ANTIBODY ID EA 611.50

ANTIBODY SCREEN EA 127.00

ANTIBODY TITER EA INDIR 367.00

ANTI-CCP 124.50

ANTI-CMV NEG PER TES 107.00

ANTIGEN TYPING EA 611.50

ANTI-HERPARIN XA 61.00

ANTI-SMOOTH MUSCLE 107.50

ANTISTREPTOLYSIN O QN 70.50

ANTITHROMBIN 3 ACT 114.00

ANTITHROMBIN 3 AG 104.00

APAP 10 MG DOSE 63.93

APAP 160MG/5ML OS 5ML 2.42

APAP/DIPHENHYD 500-25TAB 1.17

APC RESISTANCE 148.00

APDYNE 89% KIT 24.89

APERGILLUS FUMIGATUS 46.50

APIXABAN 2.5 MG TABLET 14.38

APIXABAN 5 MG TABLET 14.38

APLIGRAF 1 SQ CM 127.50

APLIGRAF 1 SQ CM 128.50

APOLIPOPROTEIN A1 150.00

APOLIPOPROTEIN B 150.00

APP OF SHORT LEG SPLINT BILAT 854.00

APP OF SHORT LEG SPLINT LT 427.00

APP OF SHORT LEG SPLINT RT 427.00

APP SHORT ARM SPLINT BILAT 671.00

APP SHORT ARM SPLINT LT 335.50

APP SHORT ARM SPLINT RT 335.50

APPL CAST ELBOW TO FING 480.00

APRACLONIDINE 0.5% OP 5M 123.21

Page 9: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

APRACLONIDINE 1% DROPER 44.57

APREPITANT 5MG DOSE 125 452.11

APREPITANT 5MG DOSE 40 156.11

AQUAPHOR 10 GRAM TUBE 3.92

AQUAPHOR 3.5OZ (99 GM) 14.46

AQUAPHOR OINT 396 GM 23.31

AQUATIC THERAPY 15MIN PT 117.00

ARANESP 500MCG/ML SYR 6,594.48

ARFORMOTEROL 15 MCG/2 ML 29.24

ARGATROBAN 250MG/2.5ML 852.00

ARIPIPRAZOLE 10 MG TAB 42.66

ARIPIPRAZOLE 15 MG TAB 43.89

ARIPIPRAZOLE 2 MG TAB 50.67

ARIPIPRAZOLE 20 MG TAB 58.80

ARIPIPRAZOLE 30 MG TAB 58.80

ARIPIPRAZOLE 400 MG INJ 3,691.56

ARIPIPRAZOLE 5 MG TAB 45.51

ARMODAFINIL 150MG TAB 37.77

ARSENIC BLOOD 150.00

ARSENICURINE 150.00

ARSENICURINE 150.00

ART.PUNCTURE FOR DX 298.50

ART.PUNCTURE FOR DX 610.00

ART.PUNCTURE FOR DX 610.00

ART.PUNCTURE FOR DX 610.00

ARTERIAL PUNCTURE 610.00

ARTERIO ABD & BILATF 7,075.50

ARTERIO ABD + BILATF 7,075.50

ARTHR EX REM INTERPHAL 2,888.50

ARTHR EX REM INTERT/TARS 4,754.00

ARTHR EX REM METATARSOP 4,754.00

ARTHRO/ASP/INJ INT JOI/B 728.00

ARTHRO/ASP/INJ MAJ JOI/B 728.00

ARTHRO/ASP/INJ SM JOI/BU 444.50

ARTICAINE/EPI 1.7 ML INJ 2.35

ASA/DIPYRIDAMOLE CAP 15.08

ASCORB ACID 500MG/ML 50M 154.18

ASCORBIC ACID 1000MG TAB 1.22

ASCORBIC ACID 250 MG TAB 1.13

ASCORBIC ACID 500 MG TAB 1.17

ASENAPINE MALEATE 5MG SL 31.14

ASO QUAL SCREEN 56.00

ASPERGILLIS AB IMMUN 122.50

ASPERGILLUS AB 133.00

ASPERGILLUS ANTIBODY 122.50

ASPERGILLUS FLAVUS AB 133.00

ASPERGILLUS FUMIGATUS AB 133.00

ASPERGILLUS NIGER AB 133.00

ASPIR/INJ GANGLION CYST 771.00

ASPIR/INJ GANGLION CYST 444.50

Page 10: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ASPIRIN 300 MG SUPP.RECT 2.96

ASPIRIN 325 MG TABLET 1.18

ASPIRIN 325 MG TABLET.DR 1.17

ASPIRIN 81 MG TAB.CHEW 1.19

ASPIRIN 81 MG TABLET.DR 1.18

ASSAY OF PSA DIRECT 72.00

ASSAY OF PSA FREE 72.00

ASSAY OF PSA FREE 72.00

ASSAY OF PSA TOTAL 163.50

AST (SGOT) 50.50

ATEN/CHLORTH 100-25 TAB 3.75

ATEN/CHLORTHAL 50-25 TAB 2.98

ATENOLOL 25 MG TABLET 1.90

ATENOLOL 50 MG TABLET 1.99

ATEZOLIZUMAB 10MG DO1200 17,370.34

ATEZOLIZUMAB 10MG DOS840 12,159.25

ATOMOXETINE 60 MG CAP 22.68

ATOMOXETINE 40 MG CAP 22.68

ATORVASTATIN 10 MG TAB 1.60

ATORVASTATIN 20 MG TAB 1.62

ATORVASTATIN 40 MG TAB 1.96

ATROPINE 0.4 MG/ML 20ML 59.81

ATROPINE 0.4 MG/ML INJ 14.25

ATROPINE 1 MG/10 ML SYR 16.30

ATROPINE 1% 3.5GM OPHTH 25.40

ATROPINE 1% DROPS 5ML 43.67

ATTENDANCE AT DELIVER 604.50

AUTOLOG COLLECTION 682.50

AV GRAFT DECLOTTING 814.50

AV Node Ablation 16,567.00

AVEENO BATH PACKET 2.04

AVEENO ITCH LOT 118ML 13.66

AVULS NAIL PLATE ADDTL 110.50

AVULS NAIL PLATE P/C S/S 507.00

AZACITIDINE 1MG DOSE IV 877.02

AZACITIDINE 1MG DOSE SQ 877.02

AZATHIOPRINE 50 MG TAB 3.45

AZELASTINE SPRAY 30ML 149.38

AZITHROM 200MG/5ML 15ML 49.53

AZITHROMYCIN 1 GM PACK 41.36

AZITHROMYCIN 250 MG TAB 58.49

AZITHROMYCIN 500MG DOSEB 19.92

AZITHROMYCIN 500MG DOSEV 20.90

AZTREONAM 1000 MG VIAL 56.15

AZTREONAM 2000 MG VIAL 98.83

B COMPLEX W VIT C TAB 1.15

B12 145.50

BACITRACIN OP OINT 3.5G 168.18

BACITRACIN 50,000UNIT IJ 24.31

BACITRACIN OINT 0.9GM 1.33

Page 11: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

BACITRACIN OINT 30GM 2.87

BACLOFEN 1 GM POWD 10.58

BACLOFEN 10 MG TABLET 1.60

BACLOFEN 20 MG TABLET 10.63

BACTERIA ANTIB NOT SPEC 78.71

BACTERIOSTAT SOD CL 30ML 2.43

BALL ANGIOPLAST VEN 6,911.00

BALLOON ASSEMBLY RESHAPE 4,410.00

BALSALAZIDE 750MG CAP 3.74

BARB SCREEN 186.50

BARBITURATE CONFIRMA 180.00

BARIUM SULF 450 ML ORAL 10.99

BARIUM SULF 450ML ORAL 10.99

BARONELLA DNA 246.00

BARTONELLA H IGG 98.50

BARTONELLA H IGM 98.50

BASIC METABOLIC CALC ION 81.50

BB PHYS TX REACTION 382.00

BCG 50MG VIAL 267.64

BCG LIVE INTRAVESICA 193.50

BCL-2 PCR 488.50

BCR/ABL1 MAJOR BREAKPT 1,578.50

BCR/ABL1 MINOR BREAKPT 1,394.00

BCR/ABL1 OTHER BREAK 1,166.50

BECLOMETH DIPROP AER 8.7 305.77

BED SIDE PFT 863.00

BEDSIDE PROCEDURE 1,236.50

BEHAV QL ANALYSIS VOICE 270.00

BENAZEP/HCTZ 10-12.5 TAB 3.17

BENAZEP/HCTZ 20.12.5 TAB 3.17

BENAZEPRIL HCL 10 MG TAB 2.05

BENAZEPRIL HCL 20 MG TAB 2.05

BENAZEPRIL HCL 5 MG TAB 2.01

BENDAMUSTINE 1MG DOSE 4 4,838.75

BENZALKONIUM CL SOL 11.77

BENZO CONFIRMATION 251.00

BENZO SCREEN 186.50

BENZOCAINE 10% LIQ 12.19

BENZOCAINE 20% SPRAY 2OZ 84.46

BENZOIN SPRAY (TMH) 16.65

BENZOIN CMP SPRAY120ML 12.16

BENZONATATE 100 MG CAP 2.89

BENZONATATE 200 MG CAP 5.87

BENZTROPIN MESYLATE 1 MG 83.43

BENZTROPINE 0.5 MG TAB 1.69

BENZTROPINE 1 MG TAB 1.51

BERMUDA GRASS 46.50

BETA 2 GLYCOPROT1 AB IGA 229.50

BETA 2 GLYCOPROT1 AB IGG 229.50

BETA 2 MICROGLOBULIN 140.00

Page 12: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

BETA HCG SCREEN URIN 67.00

BETA HCGQUANT ONLY 134.00

BETA HYDROXYBUTYRATE 79.00

BETA STREP SCREEN 101.50

BETA STREP SCREEN 101.50

BETA STREP SCREEN 101.50

BETA2 GLYCO AB IGM 229.50

BETAM DIP 0.05% OINT 15 87.32

BETAM/PROPGLYC OINT 45GM 181.35

BETAMET VA 0.1% OINT 15G 28.88

BETAMETHASON INJ ACE 3MG 36.00

BETAMETHASON INJ ACE 3MG 36.00

BETAX 0.25% OP DRP 10ML 529.15

BETAX 0.5% OP DRP 5ML 94.10

BETHANECHOL 25MG TAB 3.77

BETHANECHOL 5MG TAB 1.96

Bevacizumab 10MG DOS 100 1,558.82

Bevacizumab 10MG DOS 400 6,235.26

BICALUTAMIDE 50 MG TAB 24.03

BILE ACIDS TOT 165.00

BILIRUBIN DIRECT 39.00

BILIRUBIN TOT BLD 39.00

BILL ADJUST 43X 0.50

BIMATOPROST 0.01% 2.5ML 335.63

BIOPSY BREAST NDLE CORE 4,246.50

BIOPSY OF NAIL UNIT 954.00

BIOPSY OF PROSTATE 4,813.00

BIOPSY OF THYROID 1,698.50

BIOPSY RETROPERIT CT 4,246.50

BIOPSY SKIN LESION 295.00

BIOPSY SKIN LESION 945.00

BIOPSY SKIN SQ/MEM ADDT 110.50

BIOPSY SKIN SQ/MEM SINGL 448.00

BIOTENE ORAL BAL GEL 12.99

BISACODYL 10 MG SUPP 1.21

BISACODYL 5 MG TABLET 1.14

BISMUTH 262MG/15ML 120ML 5.03

BISMUTH SUBGAL 500GM POW 3,919.20

BISMUTH SUBSAL 262MG TAB 1.22

BISOPR/HCTZ 10-6.25 TAB 2.23

BISOPR/HCTZ 2.5-6.25 TAB 2.23

BISOPR/HCTZ 5-6.25 TAB 2.23

BISOPROLOL 5 MG TAB 2.45

BIVALIRUDIN 1 MG DOSE 1,853.75

BLASTOMYCES AB QUAL 124.00

BLEOMYCIN 15 UNIT DOSE 111.88

BLISTEX TUBE 3.17

BLOOD GAS OTHER ANY TWO 186.50

BLOOD GASESARTERIAL 252.00

BLOOD PRESS ANALYSIS 469.00

Page 13: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

BLOOD TRANSFUSION 1,065.00

BLOOD TRANSFUSION 1,065.00

BLOOD TRANSFUSION 10,650.00

BLOOD TRANSFUSION 1,065.00

BLOOD TRANSFUSION 1,065.00

BMP TOTAL CALCIUM 81.50

BODY FLUID CELL COUN 49.00

BODY FLUID CRYSTALS 64.00

BODY FLUID PH 31.50

BONE GRAFT 2X2 5,058.00

BONE MARROW ASP W/BX 3,740.00

BONE MARROW ASPIRATION 3,740.00

BONE MARROW BX 3,740.00

BONE SUBSTITUTE 15,627.50

BONE SURVEY INFANT 476.50

BONE VOID FILLER 10CC 5,005.50

BONE VOID FILLER 18CC 5,847.50

BONE VOID FILLER 5CC 2,503.00

BORD PERTUSSIS AG IFT 115.50

BORDATELLA PERTUSSIS 117.50

BORDATELLA PERTUSSIS 76.50

BORDETELLA PETUSSIS 311.50

BORRELIA BURGDORFERI 138.00

BORTEZOMIB 0.1 MG DOS IV 3,135.47

BORTEZOMIB 0.1 MG DOS SQ 3,135.47

BOTOX INJ 5,515.50

BOTOX INJ 5,515.50

BOTOX INJ 5,515.50

BOTULINUM-T 1 UNIT DOSE 1,175.56

BOX ELDER MAPLE 46.50

BRACA1/2 ANALYS DUP/DEL 7,097.00

BRACHYTX ISODO CAL CMPLX 917.50

BRACHYTX ISODO CAL INTMD 917.50

BRACHYTX ISODOSE CAL SMP 917.50

BRAF V600E VARIANT 1,265.00

BREAST BIOPSY DISCON LT 585.00

BREAST BIOPSY DISCON RT 585.00

BREAST TISSUE EXPANDER 3,189.50

BREATH CAPACITY TEST 387.00

BREATH CAPACITY TEST 387.00

BRENTUXIMAB 10MG DOSE 50 14,986.87

BREXPIPRAZOLE 2 MG TAB 63.02

BRIMONIDIN 0.1% OP 5ML 272.57

BRIMONIDINE 0.15% DRP 5M 207.50

BRIMONIDINE 0.2% DRP 5ML 23.63

BRINZOLAMIDE 1% DROP 5ML 525.49

BROMOCRIPTINE 2.5 MG TAB 5.24

BROMPHEN/PHENYLEP 118ML 3.67

BRONCHOSPASM EVAL. 1,437.50

BSS 500 ML IRRIG 46.82

Page 14: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

BSS OP 15ML 14.94

BSS PLUS 500ML IRRIG 125.36

BUDES/FORMOT 160/4.5 INH 401.60

BUDES/FORMOT 80/4.5 INH 349.09

BUDESONIDE 0.25MG/2ML 14.91

BUDESONIDE 0.5MG/2ML 16.58

BUDESONIDE 3 MG CAPSULE 24.35

BUDESONIDE 9 MG TAB 101.83

BUDESONIDE INHALER (TMH) 391.07

BUMET 0.25MG/ML 4ML 3.83

BUMETANIDE 1 MG TABLET 3.80

BUN 41.50

Bundle of His Record 16,567.00

BUNDLE OF HIS RECORDING 16,558.50

BUPIV 0.5%/EPI 50ML 22.78

BUPIV 0.5%/MPF 30 ML 3.66

BUPIV LIPO/PF 1MG DOSE 298.37

BUPIV/EPI 0.25% 30ML 4.38

BUPIV/EPI 0.5% 1.8 ML IJ 1.81

BUPIV0.125%/EPI1:400,000 20.32

BUPIV0.75 %/DEX8.25% 2ML 11.37

BUPIVAC 0.25%/EPI 50ML 20.36

BUPIVAC 0.5% /EPI 30ML 15.45

BUPIVAC/0.25% 10 ML 11.78

BUPIVACAINE 0.75% 10 ML 5.26

BUPIVACAINE 0.25% 30ML 5.66

BUPIVACAINE 0.25% 50ML 23.07

BUPIVACAINE 0.5% 50 ML 4.00

BUPIVACAINE 0.75% 30ML 5.00

BUPIVACAINE 1 MG POWD 1.16

BUPIVACAINE/PF0.5% 10ML 10.57

BUPRENO/NALOX 2-0.5 FILM 10.96

BUPRENO/NALOX 4-1 FILM 15.77

BUPRENO/NALOX 8-2 FILM 15.77

BUPRENORPHINE 0.1 MG DOS 19.71

BUPRENORPHINE 2MG TAB.SL 5.25

BUPRENORPHINE 8MG TAB.SL 13.24

BUPROPION 100 MG TAB 3.06

BUPROPION 100MG TAB.ER 2.79

BUPROPION 150 MG TAB(XL) 10.72

BUPROPION 150MG TAB(SR) 1.80

BUPROPION 300MG TAB(XL) 5.87

BUPROPION 75 MG TAB 2.65

BUSPIRONE 5 MG TABLET 1.87

BUSPIRONE 10 MG TABLET 2.45

BUTALB/APAP/CAFF TAB 3.05

BUTORPHANOL 1 MG DOSE,1 5.89

BUTORPHANOL 1 MG DOSE,2 11.36

BUTORPHANOL NASAL SPRAY 136.77

BX BONE DEEP 3,739.26

Page 15: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

BX BONE SUPERFICIAL 3,740.00

BX BONE SUPERFICIAL 3,740.00

BX BREAST NDL CORE LT 3,740.00

BX BREAST NDL CORE RT 3,740.00

BX LIVER 3,740.00

BX LIVER 1,371.00

BX MUSCLE PERC 3,740.00

BX MUSCLE PERC 3,740.00

BX PANCREAS 388.00

BX PANCREAS 3,740.00

BX RETROPER SURG 3,740.00

BX SKIN- EA ADDL LESION 97.00

C DIFFICIL TOXIN A&B EIA 115.50

C DIFFICIL TOXIN A+B EIA 115.50

C SECT EACH ADD 15 MIN 918.50

C SECTION FIRST HOUR 6,610.50

C1 INHIBITOR 107.00

C-1ESTERASE INHIBITO 107.00

C-1ESTERASE INHIBITO 107.00

C2COMPLEMENT 107.00

C3COMPLEMENT 107.00

C4COMPLEMENT 107.00

CA 125 QN 200.50

CA 15-3 QN 200.50

CA 19-9 QN 200.50

CA 27-29 QN 200.50

CA CARB 200MG TAB.CHEW 1.19

CA-15-3 200.50

CABAZITAXEL 1mg 21,150.34

CABAZITAXEL 1MG DOSE 21,150.34

CACL 100MG/ML SYR 10ML 16.30

CAFF CITR 60MG/3ML IV 48.45

CAFF CITR 60MG/3ML PO 40.90

CAFFEINE LEVEL 134.00

CALAMINE LOTION 177ML 6.10

CALC CARB 1,000MG TAB 1.17

CALC POLYCARB 625MG TAB 1.19

CALCITONIN 258.00

CALCITONIN 200 UNIT/ML 4,606.03

CALCITONIN SPRAY 3.7ML 168.33

CALCITRIOL 0.25 MCG CAP 2.38

CALCIUM 46.00

CALCIUM ACET 667 MG CAP 2.55

CALCIUM CARB/VIT D3 TAB 1.15

CALCIUM ELEM 500MG TAB 1.15

CALCIUM GLUCONATE 10 MLB 19.42

CALCIUM GLUCONATE 10 MLV 21.98

CALCIUM IONIZED 131.50

CALCIUM UR TIMED QN 58.50

CALCIUMURINE 54.00

Page 16: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CALFACTANT 35 MG/ML IJ 1,143.57

CALPROTECTIN FECAL 199.00

CALR GN ANLYS COM VAR EX9 473.50

CAMPYLOBACTER AG OIA 115.50

CANAGLIFLOZIN 100 MG TAB 24.08

CANDESARTAN 16 MG TAB 4.98

CANDESARTAN 4 MG TAB 5.36

CANDIDA AB IGA 79.50

CANDIDA AB IGG 79.50

CANDIDA AB IGM 79.50

CANDIDA SPECIES DNA 178.00

CAPSAICIN 0.025% CR 60GM 16.56

CAPTOPRIL 12.5 MG TAB 2.82

CAPTOPRIL 25 MG TAB 2.96

CAR SEAT CHALL EA ADDL 30M 45.00

CAR SEAT CHALL INIT 60MINS 87.50

CARB/LEVO/ENTACAP-100TAB 4.85

CARB/LEVO/ENTACAP-150TAB 14.68

CARBACHOL 1.5ML MIOSTAT 57.40

CARBAMAZE 200 MG/10ML OS 5.65

CARBAMAZEPI 100MG TAB.ER 2.64

CARBAMAZEPINE 100MG TAB 1.76

CARBAMAZEPINE 200 MG TAB 16.69

CARBAMAZEPINE 200MG 12HR 3.65

CARBAMAZEPINE 300MG 12HR 3.23

CARBAMAZEPINE TOT QN 140.50

CARBAMIDE EAR DRP 15ML 12.30

CARBAMIDE PEROX 10% SOL 12.27

CARBIDOP/LEVO 10-100 TAB 2.25

CARBIDOP/LEVO 25-100 CR 1.94

CARBIDOP/LEVO 25-100 TAB 1.92

CARBIDOP/LEVO 25-250 TAB 2.71

CARBIDOP/LEVO 50-200 CR 2.84

CARBIDOPA 25 MG TAB 16.00

CARBOFLEX 16-48SQCM 72.00

CARBON DIOXIDE BLD 47.50

CARBOplatin 50MG DOS 150 41.08

CARBOplatin 50MG DOS 600 140.25

CARBOplatin 50MG DOSE 50 26.84

CARBOPROST 250 MCG/ML 603.95

CARBOXYHEMOGLOBIN QN 81.50

CARD STENT W/ANGIO 1VSL 12,219.50

CARDIAC OUTPUT INIT 2,944.50

CARDIAC OUTPUT SUB 2,944.50

CARDIAC REHAB/MONITOR 331.50

Cardio-defib BI-V ICD 49,637.50

CARDIOLIPIN AB IGA 212.00

CARDIOLIPIN AB IGG 212.00

CARDIOLIPIN AB IGM 212.00

CARDIOVASC STRESS TEST 1,122.50

Page 17: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CARDIOVERSION ELECTIVE 1,455.50

CARDIOVERSION ELECTRIC 1,455.50

CARDIOVERSION ELECTRIC 1,455.50

CARDIOVERSION EXTERNAL 1,561.00

CARDIOVERSION EXTERNAL 1,561.00

CARDIOVERSION EXTERNAL 1,561.00

Carfilzomib 60MG/30ML 4,541.16

CARISOPRODOL 350 MG TAB 1.70

CARNITINE FREE & TOT 150.00

CARNITINE FREE + TOT 150.00

CARTEOLOL 1% OP DRP 5ML 25.14

CARVEDILOL 10MG 24HR 16.51

CARVEDILOL 12.5 MG TAB 3.23

CARVEDILOL 20MG 24HR 16.51

CARVEDILOL 25 MG TAB 3.20

CARVEDILOL 3.125 MG TAB 3.20

CARVEDILOL 6.25 MG TAB 3.20

CASPOFUNGIN 5MG DOSE 50 660.56

CASPOFUNGIN 5MG DOSE 70 686.33

CAT DANDER 46.50

CATECHOL FRACTION UR 224.50

CATECHOLAMINES PLASM 224.50

CATH 1 OR M 2ND OD RNL 6,441.00

CATH 1 OR M 2ND OD RNLBI 6,441.00

CATH 1ST OD LOW ART BI 324.50

CATH 1ST OD LOW ART LT 162.50

CATH 1ST OD LOW ART RT 162.50

CATH 1ST OD RENAL 6,441.00

CATH 1ST OD RENAL BIL 6,441.00

CATH 2ND OD LOW ART BI 324.50

CATH 2ND OD LOW ART RT 180.00

CATH 3RD OD LOW ART BI 360.50

CATH 3RD OD LOW ART RT 360.50

CATH 3RD ORD UP ART 149.50

CATH AORTA 162.50

CATH EA ADDL LOW ART 162.50

CATH EA ADDL UP ART 162.50

CATH HRT LT/INJ L VENT 8,657.00

CATH HRT R&L/INJ L VENT 8,832.50

CATH HRT R+L/INJ L VENT 8,832.50

CATH HRT RT W SAT/CO 8,657.00

CATH INTRA CARDIAC 3,309.50

CATH PLC/INJ CORONRY ART 8,657.00

CATH TRANLUMINAL ARTHER 8,273.00

Cath, bal dil, non-vasc 3,293.00

Cath, bal dil, non-vasc 659.00

Cath, bal dil, novasc Ca 337.00

Cath, drainage Cat1 89.00

Cath, drainage Cat2 182.50

Cath, drainage Cat3 269.00

Page 18: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CATH, ELCTRO DX CAT1 3,861.00

CATH, ELCTRO DX CAT1 1,655.00

CATH, ELCTRO DX CAT1 4,412.50

CATH, ELCTRO DX CAT1 1,103.50

CATH, ELCTRO DX CAT2 5,515.50

CATH, ELCTRO DX CAT2 2,914.00

CATH, ELCTRO DX CAT3 7,721.50

Cath, hemodialysis,l-c C 1,757.50

Cath, hemodialysis,l-t C 881.50

Cath, hemodialysis,l-t C 12,373.00

Cath, hemodialysis,l-ter 881.50

Cath, hemodialysis,l-ter 12,373.00

Cath, hemodialysis,s-t C 623.00

Cath, hemodialysis,s-ter 623.00

Cath, inf, per/cent/mid 1,312.50

Cath, inf, per/cent/mid 33.50

Cath, inf, per/cent/mid 449.00

CATH, INTRASPINAL 1,102.50

Cath, intravas ultrasoun 2,688.00

Cath, intravas US Cat1 1,531.00

Cath, thrombectomy/embol 3,309.50

Cath, thrombectomy/embol 179.50

CATH, TRANS ATHEREC, ROT 8,273.00

CATH, TRANS ATHEREC,ROT 8,273.00

Cath, transl nolaser Cat 2,548.00

Cath, translumin n-laser 513.00

Cath, translumin non-las 76.50

Cath,hemodialysis,s-t C 1,412.50

Cath/electro dx cat1 1,103.50

Cath/electro dx cat2 5,515.50

Cath/electro dx cat3 11,031.00

Catheter, guiding Cat1 67.00

Catheter, guiding Cat2 524.50

Catheter, guiding Cat3 2,219.50

Catheter, ureteral Cat1 2.50

Catheter, ureteral Cat2 46.50

Catheter, ureteral Cat3 140.50

CBC W/AUTO DIFF 69.00

CBC W/AUTO DIFF 69.00

CBC W/AUTO DIFF 69.00

CBC W/AUTO DIFF 69.00

CBC W/O DIFF 62.50

CBC W/O DIFF 57.50

CC PROC LEVEL 1 11,025.00

CC PROC LEVEL 2 16,537.50

CC PROC LEVEL 3 22,050.00

CCHD 39.50

CCL-BALLON DRUG ELUTING 5,262.00

CCL-GUIDEWIRE FILTER 3,048.00

CCL-LV LEAD 6,109.50

Page 19: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CCL-MEDTRONIC CARD REC 13,137.00

CCL-PACEMKR DUAL CHAMBER 21,040.00

CCL-SINGLE CHAMBER DEFIB 47,266.50

CCL-SINGLE CHAMBER DEFIB 27,676.50

CD4 ABSOLUTE COUNT O 238.00

CEA BODY FLUID 169.00

CEA(CARCINOEMBRYONIC 169.00

CEBPA ANLYS FULL GEN SEQ 941.00

CEFAZOLIN 500MG DOSE P2 20.25

CEFAZOLIN 100 MG/ML INJ 14.25

CEFAZOLIN 500 MG DOSE P1 16.60

CEFAZOLIN 500MG DOSE VL 6.82

CEFAZOLIN 500MG IM 3.11

CEFDINIR 250/5 OS 60ML 141.26

CEFDINIR 300 MG CAPSULE 10.61

CEFEPIME 500 MG DOS 0.5G 23.00

CEFEPIME 500 MG DOSE 1G 17.19

CEFEPIME 500MG DOSE IM 11.69

CEFOXITIN 1000 MG DOS 1G 18.20

CEFOXITIN 1000 MG DOS 2G 44.38

CEFOXITIN 1GM DOSE 1G 24.39

CEFOXITIN 1GM DOSE 2G 34.18

CEFPROZIL 250 MG TAB 5.48

CEFTAROLINE 10 MG DOSE 327.38

CEFTAROLINE inj 10mg 327.38

CEFTAZ/AVIBACTAM 2.5GM 558.37

CEFTAZIDIM 6MG/0.3 ML 14.25

CEFTAZIDIME 500 MG DO 2G 24.20

CEFTAZIDIME 500MG DO 1G 10.90

CEFTIAXONE SODIUM IN 116.50

CEFTIAXONE SODIUM INJ 116.50

CEFTOLOZANE/TAZ 50/25 185.07

CEFTRIAXONE 1G/2.86ML IM 2.90

CEFTRIAXONE 250 MG DO 1B 28.54

CEFTRIAXONE 250 MG DO 1G 7.30

CEFTRIAXONE 250 MG DO 1G 7.30

CEFTRIAXONE 250 MG DO 2B 31.07

CEFTRIAXONE 250 MG DO 2G 44.38

CEFTRIAXONE 250MG INJ 6.41

CEFTRIAXONE 500 MG INJ 6.65

CEFUROXIME 250 MG TAB 5.50

CELECOXIB 100 MG CAPSULE 13.56

CELECOXIB 200 MG CAPSULE 20.69

CELESTONE 6MG/ML 5ML INJ 87.76

CELL CT & DIFF CSF 53.50

CELL CT + DIFF CSF 53.50

CELLUVISC DROPER 0.3ML 1.61

CEPACOL LOZENGE (6 PACK) 3.65

CEPHALEX 250MG/5ML 100ML 40.83

CEPHALEXIN 250 MG CAP 1.78

Page 20: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CEPHALEXIN 500 MG CAP 2.45

CEREFOLIN NAC TAB 4.90

CEREFOLIN TAB 14.05

CERULOPLASMIN 103.50

CERUMEN REM BIL 69209 337.00

CERUMEN REM LT 69209 168.25

CERUMEN REM RT 69209 168.15

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU BIL 69210 336.50

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU LT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REM W/INSTRU RT 69210 168.25

CERUMEN REMOVAL BIL 336.50

CERUMEN REMOVAL BIL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL BILATERAL 336.50

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

Page 21: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL LT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CERUMEN REMOVAL RT 168.25

CETACAINE SPRAY 102.81

CETAPHIL LOTION 240ML 20.77

CETUXIMAB 10MG DOSE 100 1,216.05

CETUXIMAB 10MG DOSE 200 2,432.09

CEVIMELINE HCL 30 MG CAP 13.96

CFTR COMMON VARIANTS 1,753.50

CHANGE KIDNEY TUBE 4,730.00

CHANGE NEP/PYEL TB 3,676.00

CHANGE NEPHROSTOMY TU 2,731.50

CHANGE SUPRA CATH SIMPL 759.50

CHAR/H2O 50 GM/240ML 42.73

CHARC/SORB 50 GM/240ML 42.73

CHEM CAUT GRAN TISSUE 234.00

CHEMICAL CAUTERY TIS 480.00

CHEMICAL CAUTERY TIS 480.00

CHEMICAL CAUTERY TIS 480.00

CHEMICAL CAUTERY TIS 223.50

CHEMICAL CAUTERY TIS 480.00

CHEMICAL CAUTERY TIS 480.00

CHEMO ADM SUB/INTRAM 189.00

CHEMO ADM/SUB HORMONAL 188.50

CHEMO ADM/SUB INTRA 189.00

CHEMO ADM/SUB INTRA 189.00

CHEMO ADM/SUB INTRA 165.50

CHEMO ADMIN/NON HORM 253.50

CHEMO ADMIN/NON HORM 253.50

CHEMO ADMIN/NON HORM 188.50

CHEMO HORMON ANTINEO 165.50

CHEMO HORMONE ANTINE 189.00

CHEMO INJ ADD DRUG 1 165.50

CHEMO INTO CNS 908.50

CHEMO INTO CNS 845.00

CHEMO INTO CNS 845.00

CHEMO IV EA AD SEQ 1 HR 183.00

CHEMO IV EA AD SEQ 1 HR 183.00

CHEMO IV EA ADD HOUR 701.50

CHEMO IV EA ADD HOUR 183.00

Page 22: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CHEMO IV PUSH ADDL DRUG 165.50

CHEMO IV PUSH ADDL DRUG 278.00

CHEMO IV PUSH ADDL DRUG 278.00

CHEMO IV PUSH SING/IN DR 542.50

CHEMO IV PUSH SING/IN DR 542.50

CHEMO IV PUSH SING/IN DR 542.50

CHEMO IV PUSH SING/IN DR 542.50

CHEMO IV PUSH SING/IN DR 542.50

CHEMO IV SING/IN DR 1 HR 845.00

CHEMO PROLONG INF W/PUMP 845.00

CHEMO PROLONG INF W/PUMP 845.00

CHEMO THER 1ST HR 1,753.00

CHEMO THER EA ADD HR 701.50

CHEMO THER EA ADD HR 165.50

CHEMO THERAPY 1ST HR 1,753.00

CHEMO THERAPY 1ST HR 1,403.50

CHEMO UNSPECIFIED 105.50

CHEST ULTRASOUND W/ME 587.50

CHEST WALL MANIP SUBS 298.50

CHEST WALL MANIPULATION 298.50

CHILDBIRTH CLASSES PR 83.50

CHKT ORTH/PR EST 15 M OT 142.00

CHLAMYDIA TRACHOMATI 311.50

CHLORDIAZEPOX/CLIDIN CAP 72.36

CHLORDIAZEPOXID 10MG CAP 1.72

CHLORDIAZEPOXID 25MG CAP 1.77

CHLORDIAZEPOXIDE 5MG CAP 1.91

CHLORHEXIDINE 118 ML TOP 11.01

CHLORHEXIDINE 946 ML LIQ 15.90

CHLORHEXIDINE OS 473ml 17.50

CHLORIDE BLD 45.00

CHLORIDES URINE 49.00

CHLOROPROCAINE 20 ML 36.31

CHLOROTHIA 250/5 OS 60ML 24.48

CHLOROTHIAZIDE 500MG DOS 507.28

CHLOROTHIAZIDE 500MG TAB 2.34

CHLORPHENIRAMINE 4MG TAB 1.16

CHLORPROMAZIN 50MG/2ML 48.28

CHLORPROMAZINE 10MG TAB 5.30

CHLORPROMAZINE 25MG DOSE 42.70

CHLORPROMAZINE 25MG TAB 15.06

CHLORPROMAZINE 50MG DOSE 48.28

CHLORPROMAZINE 50MG TAB 19.33

CHLORTHALIDONE 25MG TAB 3.40

CHLORZOXAZONE 500MG TAB 2.18

CHOLESTEROL BLD 42.00

CHOLESTYRAMINE/ASPAR 4GM 4.55

CHOLINESTERASE RBC 74.50

CHONDR /HYAL 1.05 ML 283.66

CHONDR SULF/HYAL 0.5ML 204.05

Page 23: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CHROM & KARY 15-20 2 KAR 1,200.00

CHROM & KARYOTYPE 5 BM 1,569.00

CHROM + KARY 15-20 2 KAR 1,200.00

CHROM + KARYOTYPE 5 BM 1,569.00

CHROM ADDTL KARYOTYPE 241.50

CHROM ANAL 20-25 CELLS 1,200.00

CHROM ANALY ADD CELL CTS 169.00

CHROMAGEN FORTE CAP 2.33

CHROMATIN AB IA QL 111.50

CHROMATOGRAPHY QUANT 161.00

CHROMIUM 195.50

CHROMOGRANIN A IA QN 200.50

CICLOPIROX 0.77% CR30GM 72.56

CILOSTAZOL 100 MG TABLET 3.35

CINACALCET HCL 30 MG TAB 45.82

CIPROFLOX 0.3% OP DR 5ML 206.04

CIPROFLOX 200MG DOSE 100 8.39

CIPROFLOX 200MG DOSE 200 9.04

CIPROFLOX/DEX DRP 7.5ML 372.51

CIPROFLOX/HYDROCOR 10ML 507.78

CIPROFLOXACIN 250MG TAB 10.96

CIPROFLOXACIN 500MG TAB 1.45

CISATRACURIUM 200MG/20ML 506.09

CISATRACURIUM 20MG/10ML 46.87

CISPLATIN 10 MG DOSE 39.41

CITALOPRAM 10 MG TABLET 3.53

CITALOPRAM 20 MG TABLET 3.79

CITALOPRAM 40 MG TABLET 4.59

CITRIC AC/SOD CITR 30 ML 3.27

CITRIC/SOD CIT 15 ML SOL 2.81

CK MB 88.00

CK-ISOENZYMES 119.00

CL BLD SPEC FROM POR 321.00

CLACKS ORAL SOL 240ML 113.60

CLADOSPORIUM HERBARU 46.50

CLAM 46.50

CLARITHROMYCIN 250MG TAB 11.52

CLARITHROMYCIN 500MG TAB 12.49

CLINDAMYC 300MG/50ML PB 19.50

CLINDAMYC 3MG/0.3ML INJ 19.75

CLINDAMYC 600MG/50ML PB 23.82

CLINDAMYC 6MG/ML NB DIL 19.17

CLINDAMYC 900MG/50ML PB 26.66

CLINDAMYCIN 100 MG VAGX3 83.37

CLINDAMYCIN 150 MG CAP 2.25

CLINDAMYCIN 300MG/2ML IJ 8.44

CLOBAZAM 20 MG TABLET 56.76

CLOBETASOL 0.05% CR 30GM 364.17

CLOBETASOL 0.05% CR 60G 387.01

CLOBETASOL 0.05% OIN 60G 737.69

Page 24: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CLOBETASOL 0.05% SOL 50M 292.96

CLOMIPRAMINE 25MG CAP 16.74

CLONAZEPAM 0.5 MG TABLET 1.90

CLONAZEPAM 1 MG TABLET 4.16

CLONAZEPAM 2 MG TABLET 2.34

CLONAZEPAM SCREEN URINE 26.50

CLONAZEPAM(KLONOPIN) 251.00

CLONIDIN 10MCG/ML NB DIL 1.33

CLONIDINE 0.1 MG PATCH 47.03

CLONIDINE 0.2 MG PATCH 79.28

CLONIDINE 0.3 MG PATCH 109.85

CLONIDINE 1 MG DOSE 42.60

CLONIDINE HCL 0.1 MG TAB 1.33

CLONIDINE HCL 0.2 MG TAB 1.42

CLONIDINE HCL 0.3 MG TAB 1.57

CLONIDINE HCL 1 MG 28.67

CLOPIDOGREL 300MG TAB 39.53

CLOPIDOGREL 75MG TAB 5.46

CLOS DIFFICILE PCR 311.50

Closure dev, vasc Cat1 485.00

Closure dev, vasc Cat2 1,142.00

CLOTRIMAZOLE VAG CR 45G 13.50

CLOTRIMAZOLE 1% CR 15GM 3.05

CLOTRIMAZOLE 1% SOL 30ML 106.12

CLOTRIMAZOLE 10MG TROCHE 2.53

CLOTRIMAZOLE/BETA CR 15G 79.80

CLOZAPINE 134.00

CLOZAPINE 100 MG TAB 4.53

CLOZAPINE 25 MG TAB 4.53

CMPLX CYSTO W VOID PR 1,605.50

CMV AB IGG 107.00

CMV BY PCR BLOOD BM 311.50

CMV IGM QUAL 162.50

COAL TAR SOLUTION 5ML 1.47

COBALT QN 212.00

COBALT URINE 178.00

Coban 72.00

COC SCREEN 186.50

COCAINE CONFIRMATION 180.00

COCAINE SOLUTION 4% 4ML 316.83

COCCIDIOID AB QUAL 114.50

COCKROACH 46.50

COD LIVER OIL CAP 1.14

CODEINE SULF 15 MG TAB 1.68

COLCHICINE 0.6 MG TABLET 13.63

COLD AGGLUTININ TITER 74.00

COLESEVELAM 3.75GM POWD 37.32

COLESEVELAM 625MG TAB 5.05

COLESTIPOL HCL 1GM TAB 2.36

COLL BLD FROM CVL OR PIC 298.50

Page 25: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

COLL BLOOD FROM CVL OR PIC 298.50

COLL BLOOD IMPLANTED VAD 321.00

COLL BLOOD IMPLANTED VAD 321.00

COLLAGENASE OINT 30GM 403.85

COLLODION, FLEX 100ML 114.47

COLYTE 4,000ML 32.66

COMM/WORK ONE/ONE 15M OT 100.50

COMM/WORK ONE/ONE 15M PT 117.00

COMM/WORK REINTEGRAT 100.50

COMMON PIGWEED 46.50

COMMON RAGWEED 46.50

COMMON SILVER BIRCH 46.50

COMP METABOLIC PANEL 102.00

COMPLEMENT TOT CH50 195.50

COMPLETE METABOLIC P 102.00

COMPLETE METABOLIC PAN 102.00

COMPLEX UROFLOWMETRY 387.00

Conn tiss, hum(inc fas)C 3,632.50

Conn tiss, hum(inc fas)C 9,400.00

Conn tiss, non-hum Cat2 4,595.50

Conn tiss, non-human C1 124.50

Conn tiss,hum(inc fasc)C 1,227.50

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

CONSCIOUS SED<5YR INIT 15 MINS 120.00

COOLIEF 1,024.00

COPPER24 HR URINE 110.50

COPPERSERUM 110.50

COPPERURINE 110.50

CORE NEEDLE BIOP-THYROI 1,698.50

CORN 46.50

CORNEA GRAFT 884.00

Cornea Imp 6,776.00

Cornea Imp 7,442.00

CORNEA IMPL 9,343.00

CORONARY ART/GRFT ANGIO 8,657.00

CORONARY STENT EA AD 13,003.50

CORONARY STENT INITA 12,219.50

CORRECTION HAMMERTOE 4,754.00

CORTISOL FREE 161.50

CORTISOL TOTAL 157.00

CORTISOLTOTAL 145.00

CORTISPORIN OP DRP 7.5ML 220.78

CORTISPORIN OP OINT 3.5G 92.37

Page 26: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CORTISPORIN OTIC SOL 10M 142.97

CORTISPORIN OTIC SUS 10M 81.79

CORTROSYN 0.25 MG DOSE 181.60

COTTONWOOD 46.50

CPAP PER DAY 529.00

CPAP PROTOCOL 3,558.50

CPAP PROTOCOL < 6 HR 2,563.00

CPAP VENT INT&MGMT 529.00

CPAP VENT INT+MGMT 529.00

C-PEPTIDE 200.50

CPR 1,508.00

CPR 1,433.00

CPR 1,508.00

CR W/O MONITOR 331.50

C-REACTIVE PROTEIN 50.50

C-REACTIVE PROTEIN HS 124.50

CREAT KINASE (CK) TOTAL 63.00

CREATININE BLD 50.00

CREATININE CLEARANCE 91.50

CREATININE URINE 46.00

CREATININERANDOM URI 46.50

CRIT CARE 1ST 30-74 MINS 2,328.50

CRIT CARE EACH ADD 30MIN 331.50

CROMOLYN SODIUM 4% SPRAY 16.62

CROSS MATCH -37C 682.50

CROSS MATCH IS 682.50

CROSS MATCH-37C 682.50

CROSS MATCH-IS 682.50

CROSSMATCH AHG 367.00

CROTALIDAE FAB 1 GM DOSE 4,709.00

CRRT 1,543.50

CRYOGLOBULINS QL SQN 41.50

CRYOPRECIPITATE EA UNIT 684.00

CRYOPRECIPITATE EA UNIT 125.00

CRYPTOCOCCAL ANTIGEN 90.50

CRYPTOSPORIDIUM AG EIA 115.50

CT ABD W/CONTRAST 2,702.50

CT ABD&PELVIS W&WO CONT 3,598.00

CT ABD&PELVIS W/CONT 3,598.00

CT ABD&PELVIS W/O CONT 2,209.00

CT ABD+PELVIS W/CONT 3,598.00

CT ABD+PELVIS W/CONT 3,598.00

CT ABD+PELVIS W/O CONT 2,209.00

CT ABD+PELVIS W/O CONT 2,209.00

CT ABD+PELVIS W+WO CONT 3,598.00

CT ABD+PELVIS WWO CONT 3,598.00

CT ABDOMEN W&WO CONT 2,702.50

CT ABDOMEN W/CONT 2,702.50

CT ABDOMEN W/O CONT 1,307.00

CT ABDOMEN W/O CONT 1,307.00

Page 27: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CT ABDOMEN W/WO CONT 2,702.50

CT ABDOMEN W+WO CONT 2,702.50

CT ACROMIOCLAVICULAR BIL 2,615.00

CT ANGIO ABD W/LERO 2,702.50

CT ANGIO ABD WW/O 2,702.50

CT ANGIO ABD+PELV WW/O 3,598.00

CT ANGIO CHEST WW/O 2,702.50

CT ANGIO HEAD WW/O 2,702.50

CT ANGIO LOW BIL 5,405.00

CT ANGIO LOW EXT BIL 5,405.00

CT ANGIO LOW EXT LT 2,702.50

CT ANGIO LOW EXT RT 2,702.50

CT ANGIO LWR EXT RT 2,702.50

CT ANGIO NECK WW\O 3,351.00

CT ANGIO PELVIS WW/O CON 3,351.00

CT ANGIO PELVIS WW/O CON 3,351.00

CT ANGIO PELVIS WWO CON 3,351.00

CT ANGIO UP EXT LT 2,703.50

CT ANGIO UP EXT RT 2,703.50

CT ANGIO UPP EXT RT 2,703.50

CT ANGIO WR EXT RT 2,702.50

CT ASP ABCESS/HEMAT SUR 531.50

CT ASP ABCESS\HEMAT SUR 531.50

CT ASP/INJ CYST REN/PEL 1,013.00

CT CHEST W&W/O CONT 3,598.00

CT CHEST W/CONTRAST 2,702.50

CT CHEST W/O CONTRAST 1,307.00

CT CHEST W+W/O CONT 3,598.00

CT CHEST WITH 2,702.50

CT CHEST WO CONTRAST 1,307.00

CT CHEST WW/O 3,598.00

CT C-SPINE W&W/O CONT 2,702.50

CT C-SPINE W/CONTRAST 3,598.00

CT C-SPINE W/O CONTRAST 1,307.00

CT C-SPINE W+W/O CONT 2,702.50

CT FACIAL BONES W/ 2,702.50

CT FACIAL BONES W/O 1,307.00

CT FACIAL BONES WW/O 2,702.50

CT GUIDANCE FOR PROC 1,855.00

CT GUIDE ASPIR 1ST LESION 1,575.00

CT GUIDE ASPIR EA ADDL LES 1,575.00

CT GUIDE LUNG PROC 3,740.00

CT GUIDE RENAL PROC 3,740.00

CT HD/BR W&W/O CONT 2,702.50

CT HD/BR W+W/O CONT 2,702.50

CT HD/BR W+W/O CONT 2,702.50

CT HEAD/BRAIN W/CONT 2,702.50

CT HEAD/BRAIN W/CONT 2,702.50

CT HEAD/BRAIN W/O CONT 1,307.00

CT HEAD/BRAIN W/O CONT 1,307.00

Page 28: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CT HEART WO CN W QUAN CA 2,701.00

CT LEG LENGTHS 354.50

CT LEG LENGTHS 354.50

CT LOW EXT W/CONT LT 2,702.50

CT LOW EXT W/CONT RT 2,702.50

CT LOW EXT W/O CONT LT 1,307.00

CT LOW EXT W/O CONT LT 1,307.00

CT LOW EXT W/O CONT RT 1,307.00

CT LOW EXT W/O CONT RT 1,307.00

CT LOW EXT W/WO LT 2,701.00

CT LOW EXT W/WO RT 2,701.00

CT LOWER EXTRM W/CON LT 2,702.50

CT LOWER EXTRM W/CON RT 2,702.50

CT L-SPINE W&W/O CONT 2,702.50

CT L-SPINE W/CONTRAST 3,598.00

CT L-SPINE W/O CONTRAST 1,307.00

CT L-SPINE W+W/O CONT 2,702.50

CT LUNGS HI RESOL W/O 1,307.00

CT LUNGS HIGH RESOLUTION 1,307.00

CT LW EXTRM W&W/O CON LT 2,702.50

CT LW EXTRM W&W/O CON RT 2,702.50

CT LW EXTRM W+W/O CON LT 2,702.50

CT LW EXTRM W+W/O CON RT 2,702.50

CT MAXIFAC W&W/O CONT 2,702.50

CT MAXIFAC W/CONTRAST 2,702.50

CT MAXIFAC W/O CNT 1,307.00

CT MAXIFAC W+W/O CONT 2,702.50

CT NECK SFT TISS W 2,702.50

CT NECK SFT TISS W 2,702.50

CT NECK SFT TISS W/O 1,307.00

CT NECK SFT TISS W/O 1,307.00

CT NECK SFT TISS WW 2,702.50

CT NECK SFT TISS WW 2,702.50

CT NEPHROSTOGRAM INJ 4,387.00

CT ORB MID/INREAR W 2,702.50

CT ORB MID/INREAR W 2,702.50

CT ORB MID/INREAR WO 1,307.00

CT ORB MID/INREAR WO 1,307.00

CT ORB MID/INREAR WW 2,702.50

CT ORB MID/INREAR WW 2,702.50

CT ORBIT/SELLA/IAC W 2,702.50

CT PELVIS W&W/O CONT 2,702.50

CT PELVIS W/CONTRAST 2,702.50

CT PELVIS W/CONTRAST 2,702.50

CT PELVIS W/O CONTRAST 1,307.00

CT PELVIS W/O CONTRAST 1,307.00

CT PELVIS W+W/O CONT 2,702.50

CT PELVIS W+W/O CONT 2,702.50

CT PLACE RAD THPY FLD 537.50

CT SINUSES W/CONTRAST 2,702.50

Page 29: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CT SINUSES W/O 1,307.00

CT SINUSES W\ 2,702.50

CT SINUSES W\CONTRAST 2,702.50

CT SINUSES W\O 1,307.00

CT SINUSES W\O 1,307.00

CT SINUSES WW/O 2,702.50

CT SINUSES WW\O 2,702.50

CT SINUSES WW\O CONTRAST 2,702.50

CT SPINE CERV W 3,598.00

CT SPINE CERV WO 1,307.00

CT SPINE CERV WW/O 2,702.50

CT SPINE DORSAL W 2,702.50

CT SPINE DORSAL W/WO 2,702.50

CT SPINE DORSAL WO 1,307.00

CT SPINE LUMBAR W 3,598.00

CT SPINE LUMBAR WO 1,307.00

CT SPINE LUMBAR WW/O 2,702.50

CT TEMP BONES IAC W AND WO 2,702.50

CT TEMP BONES IAC W AND WO 2,702.50

CT TEMP BONES IACS W 2,702.50

CT TEMP BONES IACS W 2,702.50

CT TEMP BONES IACS WO 1,307.00

CT TEMP BONES IACS WO 1,307.00

CT TEMP BONES W AND WO 2,702.50

CT TEMP BONES WITH 2,702.50

CT T-SPINE W&W/O CONT 2,702.50

CT T-SPINE W/CONTRAST 2,702.50

CT T-SPINE W/O CONTRAST 1,307.00

CT T-SPINE W+W/O CONT 2,702.50

CT UP EXT W/O CONT LT 1,307.00

CT UP EXT W/WO LT 2,702.50

CT UP EXT W+WO RT 2,702.50

CT UP EXT WO CONT RT 1,307.00

CT UP EXTREM W/CONT LT 3,598.00

CT UP EXTREM W/CONT LT 3,598.00

CT UP EXTREM W/CONT RT 3,598.00

CT UP EXTREM W/CONT RT 3,598.00

CT UP EXTREM W/O CONT LT 1,307.00

CT UP EXTREM W/O CONT RT 1,307.00

CT UP EXTRM W&W/O CON LT 2,702.50

CT UP EXTRM W&W/O CON RT 2,702.50

CT UP EXTRM W+W/O CON LT 2,702.50

CT UP EXTRM W+W/O CON RT 2,702.50

CTA ABD AORTA IF LWEX RO 2,702.50

CTA ABDOMEN W+WO CONT 2,702.50

CTA ANGIO ABD+PELV WW/O 3,598.00

CTA CHEST 2,702.50

CTA HEAD 2,702.50

CTA HEART W/CONT EVAL 3,593.50

CTA LOW EXTREMITY LT 2,702.50

Page 30: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CTA NECK 3,351.00

CTA UPPER EXTREMITY LT 2,703.50

CTH PLC/INJ CR ART W RHC 8,657.00

CTH PLC/INJ LHC & L VENT 8,657.00

CTH PLC/INJ LHC + L VENT 8,657.00

CTH PLC/INJ LHC W GRAFT 10,304.50

CULT AFB 104.00

CULT CHLAMYDIA 188.50

CULT COLONY COUNT UR 78.00

CULT COLONY COUNT UR 78.00

CULT COLONY COUNT UR 78.00

CULT FUNGUS BLOOD 87.50

CULT FUNGUS CSF 81.00

CULT MRSA SCR 64.50

CULT NOSE 83.00

CULT QN WOUND 91.00

CULT THROAT 83.00

CULT VIRUS CPE 231.00

CULTURE ANAEROBIC 91.50

CULTURE BLOOD 100.00

CULTURE BODY FLUID 83.00

CULTURE BODY FLUIDS 76.50

CULTURE CATHETER TIP 83.00

CULTURE CSF 83.00

CULTURE EAR 83.00

CULTURE EYE 83.00

CULTURE GENITAL 83.00

CULTURE GROUP B SCRE 59.00

CULTURE MISCELLANEOU 76.50

CULTURE SPUTUM 83.00

CULTURE STOOL 91.00

CULTURE WOUND 83.00

CULTUREBRONCH AEROBI 76.50

CULTUREGC 59.00

CULTURETHROAT 59.00

CUPRIC CL 0.4 MG/ML 10ML 44.39

CUT BENIGN HYPER LES 2-4 532.50

CVVH PER DAY 683.50

CYANOCOBAL 1,000 MCG/ML 14.24

CYCLOBENZAPRINE 10MG TAB 2.31

CYCLOPENT 0.5% OP 15ML 129.65

CYCLOPENT 1% OP DRP 2ML 20.27

CYCLOPHOSPHAMID 100MG DO 1,343.22

CYCLOPHOSPHAMID 25MG DOS 22.68

CYCLOPHSPHMDE 500MGV/100 671.61

CYCLOSPOR 250MG/5 ML INJ 97.21

CYCLOSPORIN MOD 100MG CP 14.79

CYCLOSPORINE 0.05% DROP 16.65

CYCLOSPORINE 100 MG CAP 21.44

CYCLOSPORINE 100 MG DOSE 97.21

Page 31: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

CYCLOSPORINE 25 MG CAP 5.33

CYCLOSPORINE MOD 25MG CP 3.56

CYCLOSPORINE QUANT 174.00

CYPROHEPT 2MG/5ML 60 ML 13.67

CYPROHEPTADINE 4MG TAB 2.17

CYSTATIN C 131.00

CYSTEINE HCL 50 MG/ML 26.06

CYSTO W/CALIB OR DIL 4,813.00

CYSTO W/REMOVAL FB 4,813.00

CYSTOGRAPHY INJECTION 217.00

CYSTOSCOPY 1,605.50

CYSTOSCOPY W/TREAT URETH 5,609.00

CYTARABINE 100MG DO 100 18.50

CYTARABINE 100MG DO 2000 35.96

CYTO AUTO SCRN MAN R 202.00

CYTO FWB SMEAR & INTERP 90.50

CYTO FWB SMEAR + INTERP 90.50

CYTO INSITU HYB 3-5 COMP 1,016.50

CYTO INSITU HYB 3-5 MAN 1,370.00

CYTO PATH REVIEW 82.50

CYTOGEN DNA PROBE EACH 206.50

CYTOGEN IP 100-300 387.00

CYTOLOGY CONC & INTERP 138.00

CYTOLOGY CONC + INTERP 138.00

CYTP DX EVAL FNA 1ST 631.50

D FARINAE 46.50

D.PTERONYSSINUS 46.50

D10/W 1000ML 5.00

D5.4N+10MEQ KCL 1000ML 20.02

D5.4N+30MEQ KCL 1000ML 8.69

D5.4N+40MEQ KCL 1000ML 21.05

D5/0.25NS 1000ML 3.50

D5/0.45NS 1000ML 5.00

D5/0.5NS 500ML 3.50

D5/0.5NS KCL 10MEQ1000ML 7.00

D5/0.5NS KCL 20MEQ1000ML 7.00

D5/0.5NS KCL 40MEQ1000ML 7.00

D5/LR 500ML 4.50

D5/LR KCL 20MEQ 1000ML 8.00

D5/NS 1000ML 5.00

D5/NS KCL 20MEQ 1000ML 8.00

D5/W 100ML 6.00

D5/W 250ML 9.50

D5/W 50ML 6.00

D5LRS 1000ML 5.00

D5NS 500 ML 3.50

D5W 1000ML 3.50

D5W 500 ML 3.00

D70/W 500ML 21.00

DABIGATRAN 150 MG CAP 14.15

Page 32: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DABIGATRAN 75MG CAP 14.15

DACARBAZINE 100MG DOSE 25.40

DACRIOSE OP IR.SOL 118ML 5.90

Dalbavancin 100 MG DOSE 3,001.87

DALTEPARIN 2500 UN DOSE 69.92

DANTROLENE 25MG CAP 2.17

DANTROLENE SOD 20MG VIAL 151.05

DAPSONE 100 MG TAB 4.46

DAPSONE 25 MG TAB 3.84

DAPTOMYCIN 1MG DOSE 871.38

DARATUMUMAB 400MG/20ML 3,610.58

DARBEP NESRD 60MCG/0.3ML 791.34

DARBEPOETIN 1MCG DOS 100 1,318.90

DARBEPOETIN 1MCG DOS 150 1,978.34

DARBEPOETIN 1MCG DOS 200 2,637.79

DARBEPOETIN 1MCG DOS 25 329.72

DARBEPOETIN 1MCG DOS 40 527.56

DARIFENACIN 7.5 MG TAB 16.56

DAUNORUBICIN 10MG DOSE 2,623.81

DBX BONE MATRIX 893.50

DCLT IVAD/CATH B TA 470.00

D-DIMER 90.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE 20 SQ CM/< 3,826.50

DEB BONE EA ADD 20 SQCM 402.00

DEB BONE EA ADD 20 SQCM 402.00

DEB BONE EA ADD 20 SQCM 402.00

DEB BONE EA ADD 20 SQCM 402.00

DEB BONE EA ADD 20 SQCM 402.00

DEB BONE EA ADD 20 SQCM 402.00

DEB MUSC/FAS ADD 20 SQCM 234.00

DEB MUSC/FAS ADD 20 SQCM 234.00

DEB MUSC/FAS ADD 20 SQCM 234.00

DEB MUSC/FAS ADD 20 SQCM 234.00

DEB MUSC/FAS ADD 20 SQCM 234.00

DEB MUSC/FASC 20 SQCM/< 1,891.50

DEB MUSC/FASC 20 SQCM/< 1,891.50

DEB MUSC/FASC 20 SQCM/< 1,891.50

DEB MUSC/FASC 20 SQCM/< 1,891.50

DEB MUSC/FASC 20 SQCM/< 1,891.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

DEB SUBQ TIS 20 SQCM/< 1,012.50

Page 33: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DEB SUBQ TISS 20SQCM/LES 1,012.50

DEB SUBQ TISS ADD 20SQCM 731.00

DEB SUBQ TISS ADD 20SQCM 731.00

DEB SUBQ TISS ADD 20SQCM 731.00

DEB SUBQ TISS ADD 20SQCM 731.00

DEB SUBQ TISS ADD 20SQCM 731.00

DEB SUBQ TISS ADD 20SQCM 731.00

DEBRIDE NAIL 1-5 181.50

DEBRIDE NAIL 6+ 234.00

DECADRON 1 MG DOSE 3.98

DECLOT LINE 785.00

DECLOT LINE 785.00

DEFEROXAMINE 500 MG DOSE 22.36

DEFINITIVE ID 72.00

DEGARELIX 1MG DOSE 240 2,597.21

DEGARELIX 1MG DOSE 80 832.32

DELIVERY RM COMPLEX 4,816.00

DELIVERY RM SIMPLE 4,045.50

DEMECLOCYCLINE 150MG TAB 16.13

DENGUE FEVER VIRUS A 114.50

DENGUE FEVER VIRUS A 114.50

DENOSUMAB 1MG DOSE 120 3,891.50

DENOSUMAB 1MG DOSE 60 2,077.28

DEPLIN 7.5 MG TABLET 4.39

DEPO MEDROL 40MG INJ 22.00

DEPO MEDTROL 40MG INJ 22.00

DEPO-MEDROL 40MG VIA 22.00

Dermacell per sq cm 83.50

DERMAGRAFT 1 SQCM 113.00

DERMAGRAFT 1 SQCM 113.00

DERMAL SUBSTITUTE CAT 1 3,178.50

DERMAL SUBSTITUTE CAT 2 10,867.50

DERMOPLAST AEROSOL 56GM 12.70

DES LES PENIS SIMP CHEM 989.50

DES MAL LES TAL 0.6-1.0 556.00

DESFLURANE 240 ML LIQUID 273.01

DESIPRAMINE 25MG TAB 2.92

DESITIN OINT 113GM 12.27

DESMOPRESS 0.5MG/5ML SPR 335.69

DESMOPRESSIN 0.1 MG TAB 4.10

DESMOPRESSIN 1 MCG DOSE 1,014.22

DESMOPRESSIN 1MCG DOES 100.18

DESONIDE 0.05% CR 15G 114.01

DESONIDE 0.05% OINT 60GM 341.37

DESOXIMET 0.25% CR 15G 82.76

DESTR BEN LES <14 234.00

DESTR BEN LES 15+ 234.00

DESTR PREMAL LES 15+ 448.00

DESTR PREMAL LES 1ST 234.00

DESTR PREMAL LES 2-14EA 110.50

Page 34: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DESTRCT B9 LESION 1-14 480.00

DESTRCT B9 LESION 1-14 310.50

DESTRCT B9 LESION 1-14 480.00

DESTRCT B9 LESION 1-14 480.00

DESTRCT B9 LESION 1-14 310.50

DESTRCT B9 LESION 1-14 480.00

DESTRCT PREMAL LES 2-14 75.00

DESTRCT PREMAL LES 2-14 75.00

DESTRCT PREMAL LES 2-14 16.50

DESTRCT PREMAL LES 2-14 16.50

DESTRCT PREMAL LESN 1ST 480.00

DESTRCT PREMAL LESN 1ST 480.00

DESTRCT PREMAL LESN 1ST 480.00

DESTRCT PREMAL LESN 1ST 191.00

DESTRCT PREMAL LESN 1ST 480.00

DESTRCT PREMAL LESN 1ST 75.00

DESTRCT PREMAL LESN 2-14 17.50

DESTRCT PREMAL LESN 2-14 75.00

DESTRCT PREMAL LESN 2-14 75.00

DESTRCT PREMAL LESN 2-14 75.00

DESTRCT PREMAL LESN 2-14 75.00

DESTRCT PREMAL LESN 2-14 17.50

DESTRCT PREMAL LESN 2-14 75.00

DESTRCT PREMAL LESN 2-14 17.50

DESTRCT PREMALG LES 2-14 16.50

DESTRUCT B9 LES LESS 15 456.69

DESTRUCT B9 LESION 1 480.00

DESVENLAFAX 100MG TAB.ER 18.25

DESVENLAFAXI 50MG TAB.ER 20.77

DEUTETRABENAZINE 6MG TAB 93.38

DEV COG SKILLS EA 15M OT 64.00

DEX MOXIKET 39.05

DEXAMETH 0.5MG/5ML OS 2.19

DEXAMETH 1.2MG/0.3ML INJ 14.25

DEXAMETH 1MG/M NB IV DIL 2.66

DEXAMETH 1MG/M NB PO DIL 2.66

DEXAMETH 4MG/ML 5ML 11.83

DEXAMETHASON 0.1% OP 5ML 128.50

DEXAMETHASONE 83.00

DEXAMETHASONE 1 MG DOSE 10.75

DEXAMETHASONE 1 MG DOSE 7.06

DEXAMETHASONE 10MG/51ML 94.12

DEXAMETHASONE 2 MG TAB 1.89

DEXAMETHASONE 4 MG TAB 2.30

DEXLANSOPRAZOLE 30MG CAP 15.26

DEXLANSOPRAZOLE 60MG CAP 16.80

DEXMEDETOMI 400MCG/100ML 136.32

DEXMEDETOMIDI 200MCG/2ML 32.53

DEXRAZOXANE 250MG 918.86

DEXT 5 % 1/4NS 1,000ML 7.84

Page 35: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DEXT 5 % W 100ML MBPLUS 16.96

DEXT 5 %-0.2 % NS 500ML 7.50

DEXTR 5 % 1/3NS 1,000ML 7.84

DEXTR 5% 1/2NS 1,000ML 7.84

DEXTRAN 70/HYPROMEL 15ML 5.48

DEXTROAMP/AMP 10MG TAB 2.81

DEXTROAMPH/AMPH 10MG CAP 11.63

DEXTROM/QUINID 20/10 CAP 31.18

DEXTROSE 10 % 500ML 17.04

DEXTROSE 10 % 500ML 17.04

DEXTROSE 10 % W 1,000ML 8.26

DEXTROSE 37.5 GM GEL 10.67

DEXTROSE 5 % 500ML 9.33

DEXTROSE 5 % 50ML 8.14

DEXTROSE 5 % NS 1,000ML 7.84

DEXTROSE 5 % 1/2NS 500ML 8.00

DEXTROSE 5 % 50ML MBPLUS 16.96

DEXTROSE 5 % IN W 250ML 9.57

DEXTROSE 5 % W 1,000ML 10.23

DEXTROSE 5 % W 100ML 8.14

DEXTROSE 5%-LR 1,000ML 16.09

DEXTROSE 50 % 50ML SYRIN 17.50

DEXTROSE 50 % 50ML VIAL 4.34

DEXTROSE 50 % 50ML VIAL 4.34

DEXTROSE 70 % 2,000ML 28.68

DHEA 244.00

DHEA-S 214.00

DIAB TUSSIN DM 5ML SF 1.29

DIALYSIS HEMO-IN HOU 1,545.00

DIALYSIS PERIT. IN H 950.00

DIATRIZOATE/DIATRIZ 30ML 56.80

DIAZEPAM 10 MG RECTAL 527.03

DIAZEPAM 10 MG TABLET 1.53

DIAZEPAM 2 MG TABLET 1.34

DIAZEPAM 2.5 MG RECTAL 444.29

DIAZEPAM 5 MG TABLET 1.42

DIAZEPAM 5MG DOSE 46.60

DIBUCAINE 1% OINT 30GM 11.50

DICLO/MISOPR 50-200 TAB 13.72

DICLO/MISOPR 75-200 TAB 15.35

DICLOFENAC 0.1% OP 2.5ML 103.70

DICLOFENAC 1% GEL 100GM 92.04

DICLOFENAC 100MG TAB.ER 3.91

DICLOFENAC 50MG TAB 2.57

DICLOFENAC 75 MG TAB 1.75

DICYCLOMIN 10MG/5ML 60ML 19.71

DICYCLOMINE 10 MG CAP 1.70

DICYCLOMINE 20 MG DOSE 124.70

DICYCLOMINE 20MG TAB 1.70

DIFFUSION CAPACITY 524.00

Page 36: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DIFLORASON 0.05% OIN 60G 1,190.97

DIGOXIN (LANOXIN) QN 128.50

DIGOXIN 100MCG/ML PED IJ 157.05

DIGOXIN 125 MCG TABLET 2.78

DIGOXIN 250 MCG TABLET 2.78

DIGOXIN 50 MCG/ML SOL 5.18

DIGOXIN 500 MCG DOSE 12.10

DIGOXIN IMM FAB 40MG DOS 6,200.86

DIHYDROERGOTAMINE 1MG DO 212.63

DIL MALE URET STRIC, INIT 651.50

DIL MALE URET STRIC, SUBS 298.50

DIL MALE URETH W/FILFRM 1,605.50

DILATE FEMALE URETH SUB 298.50

DILATE FEMALE URETH, INIT 387.00

DILATERIA EXTRA THICK 18.37

DILATERIA MEDIUM 18.37

DILATERIA THICK (TMH) 18.50

DILATERIA THIN (TMH) 18.37

DILTIAZEM 120 MG SR CAP 12.02

DILTIAZEM 60MG SR CAP 5.07

DILTIAZEM 120 MG CD CAP 1.53

DILTIAZEM 180 MG CD CAP 1.61

DILTIAZEM 240MG CD CAP 1.71

DILTIAZEM 300MG CD CAP 3.78

DILTIAZEM 30MG TAB 1.55

DILTIAZEM 360MG CD CAP 15.33

DILTIAZEM 60MG TAB 1.80

DILTIAZEM 90MG SR CAP 5.77

DILTIAZEM 90MG TAB 1.96

DILTIAZEM BOLUS 25MG/5ML 3.72

DILTIAZEM HCL 100 MG INJ 25.51

DIMERCAPROL 100MG/ML 3ML 273.39

DIMETHYL SULFOX 50ML SOL 968.82

DINOPROSTONE 10 MG SUPP 699.65

DINOPROSTONE 20MG VAG 3,154.27

DIPHENHYD 12.5 MG/5ML OS 3.93

DIPHENHYDRA 12.5MG/5ML 2.62

DIPHENHYDRAMINE 25MG CAP 1.15

DIPHENHYDRAMINE 50 MG 2.38

DIPHENHYDRAMINE 50 MG DO 2.38

DIPHENHYDRAMINE 50MG CAP 1.17

DIPHENHYDRAMINE CR 30GM 3.92

DIPHENOX/ATRO TAB 1.98

DIPTHERIA AB 133.50

DIPYRIDAMOLE 10 MG 8.50

DIPYRIDAMOLE 10 MG DO 10.85

DIPYRIDAMOLE 10 MG DOSE 10.85

DIRECT COOMBS AHG EA 90.50

DIRECT COOMBS COMP EA 90.50

DIRECT COOMBS IGG EA 90.50

Page 37: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 1,191.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 73.50

DIRECT REFERRAL TO OBS 1,191.50

DISOPYRAMIDE NORPACE QN 59.00

DISTORTION PRODUCTS 706.50

DISULFIRAM 250 MG TAB 14.19

DIVALPROEX 125 MG SPRINK 2.52

DIVALPROEX 125 MG TAB 2.05

DIVALPROEX 250 MG TAB 2.86

DIVALPROEX 250MG TAB.ER 3.04

DIVALPROEX 500 MG TAB 2.52

DIVALPROEX 500MG TAB.ER 4.93

DNA CELL CYCLE FC 159.50

DNASE B ANTIBODY 118.00

DOBUT 1600MCG/ML NB SYR 17.08

DOBUT 800MCG/ML NB SYR 11.58

DOBUTAMINE 250MG DOS 500 59.46

DOBUTAMINE 250MG DOSE VL 17.66

DOBUTAMINE INFUS 250MG 78.00

DOCETAXEL 1 MG DOSE 485.71

DOCOSANOL 10% CREAM 2GM 23.18

DOCUSATE CALC 240MG CAP 1.17

DOCUSATE SOD 50MG CAP 1.49

DOCUSATE SOD 100 MG CAP 1.16

DOCUSATE SOD 100MG/10ML 2.03

DOFETILIDE 125 MCG CAP 15.91

DOFETILIDE 250 MCG CAP 17.97

DOFETILIDE 500 MCG CAP 15.91

DOG DANDER 46.50

DONEPEZIL HCL 10 MG TAB 2.73

DONEPEZIL HCL 23 MG TAB 23.60

DONEPEZIL HCL 5 MG TAB 1.26

DOPAMI 1600MCG/ML NB SYR 17.08

DOPAMIN 800MCG/ML NB SYR 18.67

DOPAMINE 40MG DOSE PB 26.54

DOPAMINE 40MG DOSE VL 9.42

DORNASE ALFA 1MG/ML SOL 195.82

DORZ/TIM 2%-0.5% OP 10ML 174.09

DORZOLAMIDE 2% OP 10ML 94.79

DOSE CALCULATION 388.50

DOSE CALCULATION 388.50

DOXAZOSIN 1MG TAB 4.86

DOXAZOSIN 4MG TAB 5.04

DOXEPIN HCL 10 MG CAP 1.74

Page 38: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DOXEPIN HCL 100 MG CAP 3.10

DOXEPIN HCL 25 MG CAP 1.94

DOXEPIN HCL 50 MG CAP 2.27

DOXEPIN HCL 75 MG CAP 2.91

DOXERCALCIF 0.5MCG CAP 12.70

DOXERCALCIF 2.5MCG CAP 22.18

DOXORUBICIN 10MG DOSE 47.35

DOXORUBICIN-LP 10MG DOSE 2,442.96

DOXYCYCLINE 50 MG CAP 3.35

DOXYCYCLINE 100 MG VIAL 44.87

DOXYCYCLINE 100MG CAP 15.12

DOXYLAMINE 25MG TAB 1.35

DRAIN ABSC COMPLX OR MULT 882.50

DRAIN BURSA FOOT 1,870.00

DRAIN SCROTUM ABSCESS 4,333.00

DRAIN SKIN ABSC COMP 882.50

DRAIN SKIN ABSC COMP 882.50

DRAIN SKIN ABSC SIMP 882.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 340.50

DRAIN SKIN ABSC SIMP 340.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 611.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSC SIMP 340.50

DRAIN SKIN ABSC SIMP 882.50

DRAIN SKIN ABSC SIMP 574.50

DRAIN SKIN ABSCESS COMPL 882.50

DRAIN/INJ INTMD JNT/BRSA 771.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 190.50

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 181.50

DRAIN/INJ JOINT/BURSA 181.50

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ JOINT/BURSA 695.00

DRAIN/INJ SMALL JT 771.00

DRAIN/INJ SMALL JT 771.00

Page 39: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE HEMATOMA/FLD 3,826.50

DRAINAGE OF HYDROCEL 1,626.00

DRAINAGE OF HYDROCELE 367.00

DRG SCR MULT 8-14 493.50

DRN PERIANAL ABSC SUPERF 2,208.50

DRN PERIANAL ABSC SUPERF 2,208.50

DRONABINOL 2.5 MG CAP 10.80

DRONEDARONE 400 MG TAB 17.42

DRUG DEPEND SCR URINE 226.50

DRUG ELUTING STENT P 29,832.50

DRUG TEST DEF 1-7CLASSES 360.50

DRY NEEDLING CONSULT 109.50

DRY NEEDLING PROC 37.00

DS DNA AB 132.50

DSMT GROUP EA 30 MIN 88.50

DSMT INDIVIDUAL EA 30MIN 163.50

DULOXETINE HCL 20 MG CAP 11.43

DULOXETINE HCL 30 MG CAP 11.43

DULOXETINE HCL 60 MG CAP 13.20

DUP AB/PEL/SC COMP 1,069.50

DUP AB/PEL/SC LTD 852.00

DUP AO/IVC/IV/BPG COMP 753.00

DUP EXTRACRANIAL BIL 853.00

DUP LE ART UNI/LTD 510.50

DUP UE ART BIL 1,021.50

DUP UE ART UNI/LTD 529.00

DUP VEIN BIL 969.50

DUP VEIN UNI/LTD 516.00

DURVALUMAB 10MG/120MGV 1,670.03

DURVALUMAB 10MG/500MGV 6,958.44

DUTASTERIDE 0.5 MG CAP 13.43

DX DEXA AXIAL W FRAX 354.50

DX DEXA AXIAL W FRAX 354.50

DX DEXA PERIPHERAL 196.50

DX DEXA PERIPHERAL 196.50

DXA BONE DENSITY AXIAL 561.00

E HISTOLYTICA TOTAL AB 119.50

E STIM ATTEND ea 15 MINS 73.50

EBV EARLY AB QUAL 127.00

EBV NUCLEAR IGG AB QUAL 133.00

EBV QUANTITATIVE PCR 261.80

EBV VIRAL CAPSID AG/ 122.50

EBV VIRAL CAPSID AG/ 122.50

ECG REV/REPORT 30 DAY 1,032.50

ECHO CLR FLOW DOPLR 235.50

Page 40: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ECHO GUIDE FOR BIOPS 895.00

ECHO STRESS 1,381.50

ECHO TRANSESOPH TEE MONI 1,487.50

ECHO TRANSESOPHAGEAL 2,879.00

ECHO TRANSESOPHAGEAL 2,879.00

ECHO TRANSESOPHAGEAL 1,796.50

ECHO TRANSESOPHAGEAL 1,510.50

ECHO TRANSTHORACIC 1,381.50

ECHOCARDIOGRAM (COMPR 353.00

ECON C STIMULATOR 19,879.50

ECONAZOLE 1% CR 85GM 617.27

ECP/EECP 317.00

ECT SINGLE SEIZURE 1,261.50

ECT Treatment 1,261.50

ECT TREATMENT 1,261.50

ECULIZUMAB 10 MG DOSE 12,545.78

ED PROC CAT 1 323.50

ED PROC CAT 1 EA ADD L 323.50

ED PROC CAT 2 564.50

ED PROC CAT 2 EA ADD L 564.50

ED PROC CAT 3 724.50

ED PROC CAT 3 EA ADD L 724.50

ED PROC CAT 4 1,057.00

ED PROC CAT 5 1,613.00

ED PROC CAT 6 2,743.00

ED PROC CAT 7 5,016.00

EDOXABAN 15 MG TAB 18.96

EDOXABAN 30MG TAB 18.28

EDOXABAN 60MG TAB 18.08

EEG CEREB DEATH 1,261.50

EEG GREATER THAN 1 HR 1,169.50

EEG MONIT/COMP 24HR 1,470.00

EEG MONIT/VIDEO <12HRS 2,485.00

EEG MONIT/VIDEO 24HR 3,178.50

EEG MONIT/VIDEO<12HRS 2,485.00

EEG REC AW & ASLEEP 706.50

EEG REC AW + ASLEEP 706.50

EES 200MG/5ML 100ML 641.50

EFAV/EMTR/TENOF TAB 144.74

EFAVIRENZ 200 MG CAP 18.57

EGFR COMMON VARIANTS 2,147.00

EIA SHIGA-TOXIN 1 107.00

EIA SHIGA-TOXIN 2 107.00

EL STIM UNATT IND NOT WC 102.50

EL STIM UNATT IND NOT WC 61.00

ELBOW 2 VWS LT 289.50

ELBOW COMP STUDY RT 316.00

ELEC ANALY PUMP W REPROGRAM 762.50

ELEC ANALY PUMP W/O REPR 836.00

ELEC STIMULATION/15M OT 47.50

Page 41: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ELECTROCARDIOGRAM TRACIN 159.00

ELECTROCARDIOGRAM TRACIN 159.00

ELECTROCARDIOGRAM TRACIN 162.50

ELECTROCARDIOGRAM TRACIN 188.50

ELECTRODE ARTHROS 249.50

ELECTROLYTE PANEL 57.00

ELECTROMYOGRAPHY COMPLT 561.00

ELECTROMYOGRAPHY LIMITED 421.00

ELECTROPHYSIOLOGY EVAL 5,515.50

ELM 46.50

EM DIAGNOSTIC 2,876.50

EMER DEPT LEVEL 1 209.50

EMER DEPT LEVEL 2 388.00

EMER DEPT LEVEL 3 695.00

EMER DEPT LEVEL 4 1,156.50

EMER DEPT LEVEL 5 1,722.00

EMTRICITABINE 200 MG CAP 30.47

ENALAPRIL 2.5 MG TAB 2.56

ENALAPRIL 20 MG TAB 3.87

ENALAPRIL 5 MG TAB 2.95

ENALAPRIL 10 MG TAB 2.72

ENALAPRIL/HCTZ 10/25 TAB 2.32

ENALAPRILAT 1.25MG/ML IJ 4.79

ENCEPH LACROSSE AB QUAL 127.50

ENCEPH ST LOUIS AB QUAL 127.50

ENCEPH W EQUINE AB QUAL 127.50

ENCEPH WEST NILE AB IGG 139.00

ENCEPH WEST NILE AB IGM 162.50

ENDOFORM DERMAL 2 78.50

ENDOMYSIAL AB IGA SC 102.50

ENDOMYSIAL ABIGA TIT 107.50

ENEMA 3-6-9 540 ML 35.50

ENOXAPARIN 10MG DOSE 100 126.82

ENOXAPARIN 10MG DOSE 120 152.24

ENOXAPARIN 10MG DOSE 150 211.68

ENOXAPARIN 10MG DOSE 30 42.27

ENOXAPARIN 10MG DOSE 40 56.36

ENOXAPARIN 10MG DOSE 60 84.65

ENOXAPARIN 10MG DOSE 80 101.46

ENTACAPONE 200 MG TABLET 6.04

ENTAMOEBA HISTOLYCA 107.00

ENTEROTOXIN B 46.50

ENTEROVIRUS PCR 311.50

EOSINOPHIL COUNT BLD AUT 25.00

EOSINOPHILS URINE 33.00

EOVIST 1ML/10ML BOTTLE 447.00

EP PROC LEVEL 1 11,025.00

EP PROC LEVEL 2 16,537.50

EP PROC LEVEL 3 22,050.00

EP STUDY W/INDUC 11,602.50

Page 42: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

EP Study w/o ind 55,545.00

EP+ABLATE VENTRIC TACHY 55,545.00

EPHEDRINE 50 MG/ML 47.36

EPHEDRINE/NS 25MG/5ML IJ 64.84

EPI 1MG/ML SOL 30ML TOP 355.81

EPIFIX 2X4 PER SQCM 675.00

EPIFIX 3.5X3.5 PER SQCM 410.00

EPIFIX 4X4.5 PER SQCM 302.50

EPINEP 0.15MG/0.3ML AUTO 1,037.07

EPINEPH 300MCG/ML NB SYR 3.64

EPINEPHRINE 0.1 DOSE 1,037.07

EPINEPHRINE 0.1 DOSE 355.81

EPINEPHRINE 0.1 DOSE 23.00

EPINEPHRINE 0.1 DOSE 28.95

EPINEPHRINE 0.1 MG DOSE 23.00

EPINEPHRINE-PLATELET 98.00

EPIRUBICIN 2MG DOSE 78.38

EPLERENONE 25 MG TABLET 5.20

EPOETIN 1000 UN DOSE 10 438.30

EPOETIN 1000 UN DOSE 20 910.79

EPOETIN 1000 UN DOSE 3 125.34

EPOETIN 1000 UN DOSE 4 175.33

EPOETIN 1000 UN DOSE 40 1,821.58

EPSOM SALT PACKET 3.00

EPTIFIBATIDE 5MG DOSE 10 296.23

EPTIFIBATIDE 5MG DOSE 75 927.06

ER LABOR VISIT 1 279.00

ER LABOR VISIT 2 332.00

ER LABOR VISIT 3 332.00

ER LABOR VISIT 4 306.50

ER LABOR VISIT 5 552.50

ERIBULIN MESY 0.1MG DOSE 1,939.15

ERTAPENEM 500 MG DOSE IM 199.48

ERTAPENEM 500 MG DOSE PB 184.88

ERTAPENEM 500 MG DOSE VL 199.48

ERYTHROMY BASE 500MG TAB 24.60

ERYTHROMY LACT 500MG INJ 116.17

ERYTHROMYC 0.5% O/O 3.5G 24.50

ERYTHROMYCIN 250 MG CAP 11.53

ERYTHROMYCIN O/O 1GM 15.72

ERYTHROPOIETIN QN 181.00

ESCITALOPRAM 10 MG TAB 5.48

ESCITALOPRAM 20 MG TAB 5.61

ESCITALOPRAM 5MG TAB 5.24

ESMOLOL 100MG/10ML INJ 28.26

ESMOLOL 2.5 GM/250 ML IJ 564.55

ESOPH IMPED FUNCT TEST 784.00

ESOPHAGEAL MANOMETRY 1,261.50

ESSURE STERIL COIL 4,079.50

EST NEPHRSTMY TRCT 1,707.50

Page 43: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

EST PT LEVEL 1 33.00

EST PT LEVEL 1 33.00

Est Pt Level 1 31.50

EST PT LEVEL 1 33.00

EST PT LEVEL 1 33.00

EST PT LEVEL 1 33.00

EST PT LEVEL 2 187.00

Est Pt Level 2 178.00

EST PT LEVEL 2 187.00

EST PT LEVEL 2 187.00

EST PT LEVEL 2 187.00

EST PT LEVEL 2 187.00

EST PT LEVEL 3 224.00

EST PT LEVEL 3 224.00

EST PT LEVEL 3 224.00

EST PT LEVEL 3 224.00

Est Pt Level 3 213.50

EST PT LEVEL 3 224.00

EST PT LEVEL 4 334.00

EST PT LEVEL 4 334.00

Est Pt Level 4 318.50

EST PT LEVEL 4 334.00

EST PT LEVEL 4 334.00

EST PT LEVEL 4 334.00

Est Pt Level 5 432.50

EST PT LEVEL 5 454.00

EST PT LEVEL 5 454.00

EST PT LEVEL 5 454.00

EST PT LEVEL 5 454.00

EST PT LEVEL 5 454.00

ESTAZOLAM 1 MG TAB 1.99

E-STIM 102.50

ESTRADIOL 269.00

ESTRADIOL 0.01% VAG CR 587.51

ESTRADIOL 1 MG TABLET 1.78

ESTRADIOL 2 MG TABLET 2.06

ESTRADIOL PATCH 0.05MG 31.38

ESTRADIOL PATCH 0.075MG 31.38

ESTRADIOL PATCH 0.1MG 31.38

ESTRATEST 1.25-2.5 TAB 5.90

ESTRATEST HS 0.625-1.25 5.87

ESTRIOL 215.00

ESTROGEN CONJ 0.45MG TAB 11.74

ESTROGEN CONJ 0.625MG TA 12.25

ESTROGEN CONJ 1.25MG TAB 11.74

ESTROGEN CONJ VAG 42.5G 636.54

ESTROGEN, CON 25 MG DOSE 491.02

ESTROGENS CONJ 0.3MG TAB 11.74

ESTROGENS CONJ 0.9MG TAB 11.93

ESTROGENS SERUM FRAC 287.00

Page 44: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ESTRONE 287.00

ESZOPICLONE 1 MG TABLET 22.62

ESZOPICLONE 3 MG TABLET 22.62

ETANERCEPT 25 MG DOSE 946.15

ETHAMBUTOL 100 MG TAB 1.68

ETHANOLAMINE 100 MG DOSE 728.47

ETHOSUXIMIDE (ZARONTIN) 157.50

ETHYL ACETATE 120 ML LIQ 3.11

ETHYL ALCOHOL 5 ML VIAL 151.83

ETHYL CHLORIDE SPRAY 52.54

ETODOLAC 200 MG CAPSULE 2.54

ETODOLAC 300 MG CAPSULE 2.72

ETODOLAC 400MG TAB.ER 4.06

ETODOLAC 500 MG TAB 2.60

ETOMIDATE 2MG/ML IJ 10ML 13.56

ETOPOSIDE 10MG DOSE 22.24

ETRAVIRINE 200MG TAB 36.04

EUCERIN CREAM 113 GM 14.10

EUCERIN CREAM 454 GM JAR 17.64

EUFLEXXA 20MG/2ML SYR 579.36

EVAC SUBUNG HEMATOMA 331.00

EVAC SUBUNG HEMATOMA 331.00

EVAC SUBUNG HEMATOMA 111.00

EVAL OF SP SOUND PROD 281.00

EVAL OF VOICE PROSTHE 344.00

EVAL ORAL/PHARYNG SWL SP 224.50

EVAL SP FLUENCY 346.00

EVAL SP SOUND PROD 598.50

EVAL USE/FIT VOICE PR SP 222.50

EVALUATION OF WHEEZING 1,437.50

EVENT RECORD MONITORI 983.00

EX LES TEN/TEN SH/CAP FT 2,888.50

EX LES TEN/TEN SH/CAP TO 2,888.50

EXC ABD LES SC 3CM+ 7,323.50

EXC BEN HYP SKIN LES 4MR 483.00

EXC BEN HYP SKIN LES SNG 507.00

EXC BEN LES 0.6-1.0CM 1,870.00

EXC BEN LES 1.1-2.0CM 1,870.00

EXC BEN LES 2.1-3.0CM 1,870.00

EXC BEN LES SCHFG 3.1-4.0 4,090.50

EXC BEN LES SNHFG 0.5LES 4,333.00

EXC BEN LES SNHFG 2.1-3 3,740.00

EXC BEN LES TR 3.1-4.0CM 4,246.50

EXC BENIGN LES <0.5CM 1,870.00

EXC BONE CYST/TUM TAL/CA 4,754.00

EXC BONE CYST/TUM TAR/ME 2,888.50

EXC FACE-MM B9+MAR 0.6-1 1,626.00

EXC FACE-MM B9+MAR 0.6-1 1,626.00

EXC FACE-MM B9+MAR 0.6-1 1,626.00

EXC FACE-MM B9+MAR 0.6-1 1,626.00

Page 45: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

EXC FACE-MM B9+MAR 0.6-1 487.50

EXC FACE-MM B9+MAR 0.6-1 1,626.00

EXC HFNKSP B9+MARG 0.6-1 1,626.00

EXC HFNKSP B9+MARG 0.6-1 1,626.00

EXC HFNKSP B9+MARG 0.6-1 455.00

EXC HFNKSP B9+MARG 0.6-1 455.00

EXC HFNKSP B9+MARG 0.6-1 1,626.00

EXC HFNKSP B9+MARG 0.6-1 1,626.00

EXC HFNKSP B9+MARG 0.6-1 1,626.00

EXC NAIL/MATRIX PART/COM 453.50

EXC S/N/H/F/G BEN 1.1-2 3,740.00

EXC S/N/H/F/G MAL 0.6-1 1,626.00

EXC S/N/H/F/G MAL 0.6-1 1,626.00

EXC S/N/H/F/G MAL 0.6-1 1,626.00

EXC S/N/H/F/G MAL 0.6-1 665.00

EXC S/N/H/F/G MAL 0.6-1 1,626.00

EXC S/N/H/F/G MAL 0.6-1 1,626.00

EXC S/N/H/F/G MAL 2.1-3 3,826.50

EXC S/N/H/F/G MAL 2.1-3 880.00

EXC S/N/H/F/G MAL 2.1-3 3,826.50

EXC S/N/H/F/G MAL 2.1-3 3,826.50

EXC S/N/H/F/G MAL 2.1-3 3,826.50

EXC S/N/H/F/G MAL 2.1-3 3,826.50

EXC THROMBOSED HEMORRH 3,097.00

EXC TMR SFT TIS NCK/ANT 6,599.00

EXC TMR SFT TIS NCK/ANT 1,403.00

EXC TMR SFT TIS NCK/ANT 6,599.00

EXC TMR SFT TIS NCK/ANT 6,599.00

EXC TMR SFT TIS NCK/ANT 6,599.00

EXC TMR/VASC MAL,HND,FGR 3,826.50

EXC TMR/VASC MAL,HND,FGR 3,826.50

EXC TMR/VASC MAL,HND,FGR 3,826.50

EXC TMR/VASC MAL,HND,FGR 1,279.50

EXC TMR/VASC MAL,HND,FGR 3,826.50

EXC TMR/VASC MAL,HND,FGR 3,826.50

EXC TR B9 MARG 0.6-1.0CM 882.50

EXC TR B9 MARG 1.1-2.0CM 1,825.00

EXC TR B9 MARG 1.1-2.0CM 1,626.00

EXC TR B9 MARG 2.1-3.0CM 1,783.00

EXC TR B9 MARG 3.1-4.0CM 4,246.50

EXC TR B9 MARG 4.1CM MOR 4,246.50

EXC TR B9 MARG LESS .5CM 1,804.50

EXC TR-EXT B0+MARG 1.1-2 1,626.00

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

Page 46: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 0.6-1 882.50

EXC TR-EXT B9+MARG 1.1-2 1,626.00

EXC TR-EXT B9+MARG 1.1-2 1,626.00

EXC TR-EXT B9+MARG 1.1-2 1,626.00

EXC TR-EXT B9+MARG 1.1-2 1,626.00

EXC TR-EXT B9+MARG 1.1-2 478.50

EXC TR-EXT B9+MARG 1.1-2 478.50

EXC TR-EXT B9+MARG 2.1-3 1,783.00

EXC TR-EXT B9+MARG 2.1-3 1,783.00

EXC TR-EXT B9+MARG 2.1-3 1,783.00

EXC TR-EXT B9+MARG 2.1-3 1,783.00

EXC TR-EXT MAL 0.6-1.0CM 1,804.50

EXC TR-EXT MAL 1.1-2CM 968.50

EXC TR-EXT MAL 1.1-2CM 968.50

EXC TR-EXT MAL 1.1-2CM 968.50

EXC TR-EXT MAL 1.1-2CM 968.50

EXC TR-EXT MAL 3.1-4.0CM 1,804.50

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 2.1-3 825.00

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 2.1-3 1,626.00

EXC TR-EXT MAL+MAR 3.1-4 1,804.50

EXC TR-EXT MAL+MAR 4.0+ 4,246.50

EXC TR-EXT MAL+MAR 4.0+ 4,246.50

EXC TUM BACK/FLANK 3CM+ 4,246.50

EXC TUM BACK/FLK LES 3CM 4,246.50

EXC TUMOR SFT TIS NECK/ANT 6,599.00

EXCHANGE TRANSFUSION 1,241.00

EXENATIDE 10MCG/0.04ML 1,138.75

EXENATIDE 5 MCG/0.02ML 1,138.75

EXERC TEST FOR BRONCHOSP 331.00

EXTENDED MONITORING 1,170.00

EXTRACRANIAL BILAT STUDY 853.00

EXTRACRANIAL UNI/LTD STD 585.00

EXTRACRANIAL UNI/LTD STD 585.00

EXTREMITY ANGIO BILAT 7,138.00

EXTREMITY ANGIO BILAT 7,138.00

EYE SHUNT GLAUCOMA 1,263.50

EZETIMIBE 10 MG TABLET 18.71

F-18 up to 45 millicuries 2,550.50

F2 GENE 20210G>A VARIANT 474.00

F5 GENE LEIDEN VARIANT 588.00

FACTOR 13 ASSAY 92.50

Page 47: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

FACTOR 5 LABILE 69.00

FACTOR 8 AHG 70.00

FACTOR 8 RISTOCETIN 221.50

FACTOR 9 ASSAY 74.50

FACTOR VIII INHIBITO 114.50

FACTOR VIII VON WILL 204.00

FACTOR XI ACTIVITY 70.00

FAMCICLOVIR 125 MG TAB 11.89

FAMCICLOVIR 500 MG TAB 18.19

FAMILY W/ PT CRT 50 MINS 352.00

FAMILY W/O PT 352.00

FAMILY W/O PT 50 MINS 352.00

FAMILY W/O PT 50 MINS 352.00

FAMOTIDINE 20 MG TAB 2.84

FAMOTIDINE 20 MG/2ML INJ 6.58

FAMOTIDINE 20MG/50 ML PB 16.76

FAMOTIDINE 40 MG TAB 5.78

FASCIOT FOOT AND/OR TOE 2,888.50

FAT EMULSION 20% 250ML 40.50

FAT EMULSION 20% 500ML 21.00

FAT EMULSIONS 20% 100ML 45.85

FAT EMULSIONS 20% 250 ML 70.13

FC 1ST MARK 611.50

FC ADDL MARKER 40.00

FDP SEMIQUANT 67.00

FE PS CMPLX 150MG CAP 1.30

FE PS CMPLX/VB12/FA CAP 1.30

FEBUXOSTAT 40 MG TAB 18.70

FECAL FAT QUAL 20.00

FECAL WBC COUNT QL 34.00

FELBAMATE 400 MG TAB 19.14

FELODIPINE 10 MG TAB 3.82

FELODIPINE 2.5 MG TAB 2.61

FELODIPINE 5 MG TAB 2.61

FENOFIBRATE 145MG TAB 10.65

FENOFIBRATE 160MG TAB 12.63

FENOFIBRATE 48MG TAB 3.01

FENOFIBRATE 54 MG TAB 1.89

FENOFIBRIC 135MG CAP 11.50

FENTAN-NS 10 MCG/ML BAG 47.90

FENTAN-NS 10 MCG/ML BAG 47.90

FENTANYL 50MCG/ML 20ml 20.60

FENTANYL 50MCG/ML 20ml 20.60

FENTANYL 50MCG/ML 2ML 7.61

FENTANYL 5MCG/ML NB DIL 3.02

FENTANYL 5MCG/ML NB DIL 3.02

FENTANYL 0.001 GM POW 5.29

FENTANYL 100 MCG DOSE 7.61

FENTANYL 50MCG/ML 50ML 30.35

FENTANYL 50MCG/ML 5ML 9.10

Page 48: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

FENTANYL 50MCG/ML 5ML 9.10

FENTANYL PATCH 100MCG 75.77

FENTANYL PATCH 12MCG 28.83

FENTANYL PATCH 25MCG 30.20

FENTANYL PATCH 50MCG 55.21

FENTANYL PATCH 75MCG 57.10

FENTANYL/ROPIV/NS 100 ML 57.16

FEROCON CAPSULE 1.49

FERR GLU/SUC 12.5MG DOSE 54.19

FERR SULF 159MG TAB.ER 1.16

FERR SULF 220MG/5ML SOL 11.62

FERRIC SUBSULF 8 GM SOL 20.35

FERRIC SUBSULFATE 100 ML 640.78

FERRITIN 131.00

FERROUS SUL 15MG/ML DRPS 19.65

FERROUS SULF 325 MG TAB 2.06

FERUMOX NESRD 510MG/17ML 1,606.52

FESOTERODINE 4 MG TAB.ER 16.74

FESOTERODINE 8 MG TAB.ER 18.13

FETAL BIOPHYSICAL W/NON 704.50

FETAL BIOPHYSICAL WO/NON 704.50

FETAL CONTRACT STRESS TEST 451.00

FETAL FIBRONECTIN 572.00

FETAL NON-STRESS TES 456.50

FETAL NON-STRESS TES 456.50

FETAL SCREEN 54.00

FIBRINOGEN ACTIVITY 82.00

FIBROTEST 227.50

FIDAXOMICIN 200 MG TAB 313.68

FINASTERIDE 5 MG TABLET 4.23

FINE NEEDLE ASPIR W/IMAG 1,111.00

FINE NEEDLE ASPIR W/IMAG 1,111.00

FIRST TRI ADD FETU 335.00

FISHCOD 46.50

FIT/INSERT PESSARY DEV 506.50

FL retrograde urography 1,707.50

FLECAINIDE 100MG TAB 4.68

FLECAINIDE 150MG TAB 5.44

FLECAINIDE DRUG LEVE 134.00

FLEET 133 ML ENEMA 3.14

FLEX ALLOPATCH HD 1 SQCM 87.50

FLEX HD PLIABLE LG 12,456.50

FLEX HD PLIABLE MED 10,022.00

FLEX HD PLIABLE XL 16,675.00

FLEX/ALLO/MATR PATCH HD 32.50

FLT3 GENE ANALYSIS I 1,079.50

FLU VACC NOS 3YR> 25.00

FLU VACC NOS 3YR> 25.00

FLU VACC NOS 3YR> 25.00

FLU VACC NOS 3YR> 25.00

Page 49: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

FLU VACC NOS 3YR> 25.00

FLU VACC NOS 3YR> 25.00

FLU VACC NOS 3YR> 25.00

FLUCELVAX FLU VACCIN 25.00

FLUCON 100MG/50ML PB 22.05

FLUCON 10MG/ML OS 35 ML 50.98

FLUCON 200MG/100ML PB 16.40

FLUCON 25MG/12.5ML PB 16.85

FLUCON 400MG/200ML PB 27.80

FLUCON 40MG/ML SUSP 35ML 185.17

FLUCON 50MG/25ML PB 16.85

FLUCONAZOLE 100 MG TAB 34.08

FLUCONAZOLE 150 MG TAB 22.22

FLUCONAZOLE 200 MG DOSE 16.40

FLUCONAZOLE 200 MG TAB 21.85

FLUCONAZOLE 50 MG TAB 11.10

FLUDARABINE 50MG DOSE 425.43

FLUDROCORTISO 0.1 MG TAB 1.90

FLUMAZENIL 0.1 MG/ML 5ML 13.64

FLUOCINOLONE ACET 0.59MG 27,015.50

FLUOCINON 0.05% GEL 30G 169.14

FLUOCINON 0.05% OINT 15G 100.47

FLUOCINONID 0.05% CR 15G 64.68

FLUORESCEIN 500MG/5ml IJ 74.88

FLUORESCEIN SODIUM STRIP 1.24

FLUORO EVAL OF SWALW SP 267.00

FLUORO GUID CTRL ACC DEV 316.00

FLUOROMETH 0.1% OP 5ML 119.29

FLUOROURACIL 500MG DOSE 17.66

FLUoxetine 10 MG CAPSULE 3.52

FLUoxetine 20 MG CAPSULE 3.58

FLUOXETINE 20MG/5ML SOL 12.34

FLUoxetine 40 MG CAPSULE 4.73

FLUPHENAZINE 5MG TAB 12.81

FLUPHENAZINE HCL 5MG TAB 12.81

FLURAZEPAM HCL 15MG CAP 1.83

FLUSH PORT ONLY 159.00

FLUSH PORT ONLY 159.00

FLUTICASONE 0.05% NS 16G 21.80

FLUTICASONE AER 110MCG 414.57

FLUTICASONE AER 220MCG 663.25

FLUTICASONE AER 44MCG 309.67

FLUVIRIN VACC 3 YRS 66.50

FLUVOXAMINE 50MG TAB 3.67

FLUVOXAMINE 100 MG TAB 3.74

FNA INTERP & REPORT 175.50

FNA INTERP + REPORT 175.50

FNA SAMPLE ADEQUACY IMM 631.50

FNA W/IMAGE 1,698.50

FNA W/O 1ST LES 979.50

Page 50: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

FNA W/O IMAG EA ADDL LES 169.50

FNA W/O IMAGE 979.50

FNA W/O IMAGING EA ADDTL 169.50

FNA W/US 1ST LES 1,574.91

FNA W/US EA ADD 194.50

FNA W/US EA ADD 194.50

FNA W/US EA ADDL 194.50

FOLATE (FOLIC ACID) SER 141.50

FOLATE RBC 167.00

FOLIC ACID 0.4 MG TAB 1.47

FOLIC ACID 1 MG TABLET 1.46

FOLIC ACID 5 MG/ML 1ML 76.88

FOLTX TABLET 2.39

FOMEPIZOLE 15MG DOSE 1,831.80

FONDAPARINUX 0.5 MG DO 77.60

FONDAPARINUX 0.5 MG DOSE 77.60

FONDAPARINUX 0.5MG DOSE 223.01

FORK STRAP/CUSTOM 278.00

FOSAPREPITANT 150 MG INJ 570.22

FOSFOMYCIN 3GM PACKET 148.11

FOSINOPRIL 10MG TAB 3.12

FOSPHENYTOIN 100MG/2ML 56.53

FOSPHENYTOIN 500MG/10ML 169.58

FRAGILE X SYNDR BY PCR 228.16

FREE CATECHOLAMINES 224.50

FREE T4 80.00

FREE T4 DIALYSIS RIA 80.00

FRUCTOSAMINE 59.00

FSH 179.50

FTA-ABS 118.00

FTL CONTRACTION STRESS 451.00

FULVESTRANT 25MG DOSE 1,896.39

FUNGAL ANTIBOD NOT SPEC 109.00

FUNGAL CULT. (SKINHA 68.50

FUNGAL ID REF LAB 57.50

FUROSEM 10MG/ML SOL 60ML 18.54

FUROSEM 1MG/ML NB IV DIL 6.04

FUROSEMIDE 10 MG DO,100S 28.66

FUROSEMIDE 10 MG DO,100v 17.90

FUROSEMIDE 10 MG DOSE,20 6.04

FUROSEMIDE 10 MG DOSE,40 4.57

FUROSEMIDE 20 MG TABLET 1.25

FUROSEMIDE 40 MG TABLET 1.27

FUROSEMIDE 80 MG TABLET 1.55

FUSION CHARGE 577.00

G-6-PD QUANT 47.50

GABAPEN 250MG/5ML OS 5ML 4.84

GABAPENTIN 100 MG CAP 1.24

GABAPENTIN 300 MG CAP 1.30

GABAPENTIN 400 MG CAP 3.33

Page 51: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

GABAPENTIN 600 MG TABLET 3.52

GABAPENTIN 800 MG TABLET 1.81

GABAPENTIN NEURONTIN QN 168.00

GABAPENTIN SCREEN URINE 26.50

GABITRIL (TIAGABINE) 134.00

GADOBENATE MULTIHANC /ML 10.50

GADOBUTROL INJ 0.1M 2.00

GAIT TRAINING/15 MIN 122.00

GAL-1-PO4 UT(CONFIRM 187.00

GALANTAMINE 24 MG CAP 11.87

GALANTAMINE 4 MG TABLET 5.32

GALANTAMINE 8 MG CAP 18.31

GALLIUM GA 67 PER MCI 160.00

GAMDOLINIUM CONTRAST/ML 10.50

GAMMA GT 69.50

GAMMAGARD 2.5GM/25ML VL 638.80

GAMMAGARD 500MG DOSE 10 2,555.19

GAMMAGARD 5GM/50ML VIAL 1,277.56

GARDNERELLA VAG DNA 178.00

GASTRIC BAND 0.50

GASTRIN 170.00

GASTROESOPH RFLX ELECTRD 1,431.50

GASTROESOPHAG REFLX TEST 1,261.50

GASTROGRAFIN 220.50

GATIFLOXAC 0.5% OP 2.5ML 298.11

GELATIN SPONGE 12-7 175.75

GELFOAM SPONGE 100 70.99

GEMCITABINE 197.6MG DOSE 87.30

GEMFIBROZIL 600 MG TAB 3.42

GEN NEUROSTIM NONRECH 29,200.50

Gen,neuro,non-HF re bat 35,437.50

Gen,neuro,non-HF re bat 26,066.50

Gen,neuro,non-HF re bat 23,711.00

GENERAL HEALTH PANEL 331.00

GENT 1200 MCG/0.3ML INJ 19.75

GENTAMICIN 0.1% CR 30GM 70.12

GENTAMICIN 0.3% OP 5ML 60.85

GENTAMICIN 0.1% OINT 30G 140.23

GENTAMICIN 0.3% O/O 3.5G 50.32

GENTAMICIN 20 MG/2 ML IJ 10.23

GENTAMICIN 80MG DOSE PB 8.70

GENTAMICIN 80MG DOSE VL 9.37

GENTAMICIN PEAK 145.50

GENTAMICINRANDOM 145.50

GENTAMYCIN TROUGH 145.50

GENTIAN VIOLET SOL 13.52

GIARDIA AB IFA 131.00

GIARDIA AG EIA 115.50

GLIADIN ANTIBODY IGA 102.50

GLIADIN ANTIBODY IGG 102.50

Page 52: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

GLIMEPIRIDE 1 MG TABLET 1.50

GLIMEPIRIDE 2 MG TABLET 2.33

GLIMEPIRIDE 4 MG TABLET 2.33

GLIPIZIDE 10 MG TAB 1.86

GLIPIZIDE 10 MG XL TAB 1.80

GLIPIZIDE 2.5 MG XL TAB 1.97

GLIPIZIDE 5 MG TAB.ER.24 1.58

GLIPIZIDE 5 MG TABLET 1.47

GLOMERULAR BASEMENT 102.50

GLU-1PG50 42.00

GLUCAGON 137.50

GLUCAGON 1 MG/ML VIAL 292.41

GLUCOMETER 28.50

GLUCOS/CHONDR CAP 1.23

GLUCOSE 2HR PC 35.00

GLUCOSE BLOOD REAGEN 28.50

GLUCOSE BODY FLD QN 38.00

GLUCOSE CSF 35.00

GLUCOSE SCREEN 50 GM 42.00

GLUCOSE TOL 3 HOUR 114.50

GLUCOSE TOL 4 HOUR 114.50

GLUCOSE TOL 5 HOUR 114.50

GLUCOSEFASTING 35.00

GLUCOSERANDOM 35.00

GLUTAMIC ACID DECARB 120.00

GLYB/METFOR 2.5-500 TAB 2.16

GLYB/METFOR 5-500 TAB 2.16

GLYBURIDE 1.25 MG TAB 1.38

GLYBURIDE 2.5 MG TABLET 1.41

GLYBURIDE 5 MG TABLET 1.63

GLYBURIDE,MICR 1.5MG TAB 1.46

GLYBURIDE,MICR 3MG TAB 1.70

GLYCERIN OPHTH 1ML 20.50

GLYCERIN SOLUTION 60 ML 44.99

GLYCERIN SUPP ADULT 2.38

GLYCERIN SUPP PEDIATRIC 1.27

GLYCOPYRR 0.2 MG/ML INJ 15.85

GLYCOPYRR 0.2 MG/ML INJ 15.85

GLYCOPYRROLATE 1 MG TAB 2.41

GP PSYTHER (PER SESS 204.50

GRAFIX CORE 1 SQ CM 549.50

GRAFIX CORE 1 SQ CM 922.50

GRAFIX CORE 1 SQ CM 318.00

GRAFIX CORE PER SQ CENT 547.50

GRAFIX CORE PER SQ CENT 918.00

GRAFIX PRIME PER SQ CENT 317.50

GRAFT JACKET PER SQ CENT 971.50

GRAFT JACKET PER SQ CENT 26,527.00

Graft, vascular Cat1 1,485.50

Graft, vascular Cat2 3,001.00

Page 53: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

Graft, vascular Cat3 9,840.50

GRAFTJACKET 1 SQCM 99.00

GRAFTJACKET 1 SQCM 500.50

GRAM NEG SENSI-VITEK 77.00

GRAM POS SENSI-VITEK 77.00

GRAM POS SENSI-VITEK 77.00

GRAM STAIN PRIMARY SRCE 34.00

GRANISETRON 0.1MG DOSE 1 32.38

GRANISETRON 1MG DOSE TAB 83.79

GREEN SOAP TINCTURE 60ML 19.92

GROUP 2 SPECIAL STAI 318.50

GROUP THERAPY 357.00

GROUP1 SPECIAL STAIN 631.50

GROWTH HORMONE (HGH) 161.00

GTT EA ADDTL >3 SPEC 38.00

GUAFENESIN 200MG/10ML OS 1.74

GUAIF/DEXT 600-30 TAB.ER 1.85

GUAIF/PSEU 600-60 TAB.ER 1.76

GUAIFENESIN 100MG/5ML OS 1.82

GUAIFENESIN 200 MG TAB 1.22

GUAIFENESIN 600MG TAB.ER 2.52

GUAIFENESIN/COD 5ML OS 1.81

GUAIFENESIN/DEXTROM 5ML 3.48

GUAIFENESIN/DM SF 118ML 12.45

GUANFACINE HCL 1 MG TAB 2.12

GUIDE FOR TARGET 663.50

GUIDE FOR TARGET VOL 663.50

GUIDE WIRE 279.50

GUIDE WIRE 182.00

Guide wire Cat1 144.50

Guide wire Cat2 538.50

Guide wire Cat3 1,329.00

GUIDEWIRE 319.00

GYM ACCESS AND MONITO 69.00

H PYLORI AG EIA STOOL 139.00

H PYLORI IGG 129.00

H PYLORI UREASE (BIOPSY) 79.50

H.PYLORI BREATH TEST 598.00

H2O FOR INJ.,BACTER 30ML 2.51

H2O INJECTION 10 ML VIAL 5.29

H2O INJECTION 1000 ML IV 20.11

H2O INJECTION 20 ML VIAL 2.58

H2O INJECTION 2000 ML IV 20.11

H2O INJECTION 50 ML VIAL 3.79

H2O IRRIG 1000 ML BAG 11.80

H2O IRRIG 1000 ML BOTTLE 4.60

H2O IRRIG 3,000 ML BAG 42.60

HAEMOPH B-TET 10 MCG INJ 48.85

HALDOL 5 MG DOSE 2.54

HALOBETASOL 0.05% CR 15G 113.00

Page 54: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

HALOBETASOL 0.05% OI 15G 113.00

HALOPER 2 MG/ML OC 15ML 19.90

HALOPERIDOL 0.5 MG TAB 1.45

HALOPERIDOL 1 MG TABLET 1.59

HALOPERIDOL 2 MG TABLET 1.77

HALOPERIDOL 5 MG TABLET 2.19

HALOPERIDOL DEC 50 MG DO 47.85

HAND/FINGER ORTHOSIS 272.00

HAPTOGLOBIN QUANT 121.50

HAZELNUT 46.50

HB S AB QUAL 103.50

HBO FULL BODY 30 MIN INT 923.50

HCG BETA QUANTITATIVE 145.50

HCG QUALITATIVE SERUM 72.50

HCG SERUM QUANT (REF 134.00

HCTZ 12.5MG CAP 1.52

HCTZ 1 MG/ML PO NB DIL 1.52

HCTZ 25MG TAB 1.23

HCTZ 50MG TAB 1.28

HD MATRIX 4,567.50

HDL CHOLESTEROL DM 79.00

HEARING SCREEN 706.50

HEART FLOW RESERVE A 5,152.00

HEART FLOW RESERVE I 1,104.50

HEART FLOW RESERVE S 5,152.00

HEAT SHOCK PROTEIN HSP70 121.50

HEMATOCRIT 23.50

HEMODIALYSIS 1,697.50

HEMOGLOBIN 23.50

HEMOGLOBIN A1C 38.00

HEMOGLOBIN A1C 38.00

HEMOGLOBIN A1C 38.00

HEMOGLOBIN A1C 38.00

HEMOGLOBIN A1C 94.00

HEMOGLOBIN EVAL QUAN 114.50

HEMOGLOBIN, FREE 28.50

HEMOSIDERIN QUAL 85.50

HEMOSIDERIN, URINE 28.50

HEP A AB IGM QUAL 109.00

HEP A AB TOTAL 119.50

HEP A VAC 1,440 UNIT/ML 118.31

HEP B 10 MCG/0.5 ML INJ 40.20

HEP B 20MCG/ML 91.89

HEP B CORE AB IGM QL 113.50

HEP B CORE AB TOTAL 116.50

HEP B DNA QN 412.50

HEP B IG 1560 UNIT/5 ML 1,142.30

HEP B IG 312 UNIT/ML 260.84

HEP B IG VAC ADMIN 105.50

HEP B S AG EIA 90.00

Page 55: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

HEP BE AG EIA 111.50

HEP C GENOTYPE 2,477.50

HEP C RNA QN 412.50

HEPA IMAG INCL GB 1,712.50

HEPA IMAG INCL GB W PHA 1,712.50

HEPARIN 1,000UNIT/ML 30M 19.16

HEPARIN 1000UNIT DOSE 23.24

HEPARIN 1000UNIT DOSE 30.26

HEPARIN 1000UNIT DOSE 4.22

HEPARIN 10UNIT DOSE 4.81

HEPARIN 10UNIT DOSE 7.51

HEPATIC FUNCTION PANEL 79.00

HEPATITIS BE AB QL 111.50

HEPATITIS C AB QUAL 127.50

HEPATITIS C RNA/PCR 311.50

HEPATITIS DELTA AB 67.00

HERED BRCA RELAT DISORD 3,307.50

HERPES CULTURE 231.00

HERPES SIMPLEX 1 AB QL 127.50

HERPES SIMPLEX 2 AB QL 186.50

HERPES SIMPLEX AB QUAL 139.00

HERPES SIMPLEX VIRUS 311.50

HETASTARCH 6%/NS 500ML 37.00

HETASTARCH IN NS 500ML 29.11

HEXAGONAL PHASE CONF 160.00

HFE COMMON VARIANTS 629.50

HIP COMPLETE STUDY LT 476.50

HIP COMPLETE STUDY RT 476.50

HIP SINGLE VIEW LT 289.50

HIP SINGLE VIEW RT 289.50

HISTAMINE URINE 284.50

HISTONE ANTIBODY IGC 102.50

HISTOPLASMA AG EIA 115.50

HISTOPLASMA ID 111.00

HIV 1&2 AB QUAL 122.00

HIV 1+2 AB QUAL 122.00

HIV1 RNA QUANTITATIO 755.50

HIV2 AB WESTERN BLOT 172.00

HLA B27 350.50

HOLTER MONITOR 24HR W 482.50

HOLTER MONITOR ANALYS 482.50

HOLTER RECORD VISUAL 482.50

HOME SLEEP STUDY 421.00

HOME SLEEP TEST (HST 387.00

HOMOCYSTEINE QN 162.50

HOMOVANILLIC ACID 172.00

HP FAST 72.00

HPV HIGH RISK 311.50

HPV SUREPATH AMPLIFI 311.50

HRT FLOW RESRV MEASURE 1,619.50

Page 56: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

HRT FLW RESRV MSRE EC AD 965.00

HSV ANTIBODIES IGM 128.00

HUMAN PLASMA SEAL 2ML 607.00

HUMAN PLASMA SEAL 2ML 4,961.50

HUMATE-P 1 UNIT DOSE 2,854.20

HUNTINGTON DISEASE M 432.00

HYALURON RECOM 150UN/ML 95.08

HYALURONA 14MG/ML 0.55ML 59.92

HYALURONATE 10MG/ML 2ML 323.76

HYALURONATE 23MG/ML 267.14

HYALURONIDASE 1 UNIT 95.08

HYALURONIDASE 150 UNIT 79.24

HYALURONIDASE 150UNIT/ML 79.24

HYDOROMORPHONE 1 MG DOSE 5.42

HYDRALAZINE 10 MG TAB 1.22

HYDRALAZINE 20 MG DOSE 21.20

HYDRALAZINE 20 MG DOSE 21.20

HYDRALAZINE 25 MG TAB 1.25

HYDRALAZINE 50 MG TAB 1.26

HYDROCHLORIC ACID 500 ML 261.62

HYDROCOD/APA 7.5-325 TAB 1.73

HYDROCOD/APAP 10-325 TAB 2.19

HYDROCOD/APAP 15 ML SOL 10.82

HYDROCOD/APAP 5-325 TAB 1.90

HYDROCOD/CHLORPHE 5ML OS 250.86

HYDROCOD/IBU 7.5-200 T 2.25

HYDROCODONE/APAP 5 ML 2.58

HYDROCORT 1% CR 28G 11.86

HYDROCORT 2.5% OINT 28G 16.50

HYDROCORT 0.5% CR 28G 11.00

HYDROCORT 0.5% OINT 28G 4.40

HYDROCORT 1% OINT 28G 11.86

HYDROCORT 100MG/60ML EN 16.17

HYDROCORT 2.5% CR 28G 6.00

HYDROCORT 2.5% LOT 59ML 73.88

HYDROCORT 2.5% RECT 30G 124.01

HYDROCORT VAL 0.2% C 45G 256.31

HYDROCORT/PRAM 1% REC CR 206.72

HYDROCORTISON 25MG SUPP 23.57

HYDROCORTISONE 1% 118ML 15.00

HYDROCORTISONE 10 MG TAB 2.17

HYDROCORTISONE 100 MG DO 21.61

HYDROCORTISONE 100MG 21.61

HYDROCORTISONE 10GM POWD 303.53

HYDROCORTISONE 20MG TAB 2.19

HYDROCORTISONE 25 GM POW 758.82

Hydrofera Blue <16sq 20.00

Hydrofera Blue <16sqcm 20.00

Hydrofera Blue >16<48 44.50

Hydrofera Blue >48 72.00

Page 57: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

HYDROMORP PCA 0.2 MG/ML 18.75

HYDROMORPH 30MG/30ML PCA 46.58

HYDROMORPHON 10MG/ML 5ML 19.61

HYDROMORPHONE 1 MG DOSE 3.03

HYDROMORPHONE 1 MG POW 1.30

HYDROMORPHONE 1MG/ML SYR 5.42

HYDROMORPHONE 2 MG TAB 1.81

HYDROXYCHLOROQ 200MG TAB 5.49

HYDROXYUREA 500 MG CAP 2.20

HYDROXYZ 10MG/5ML 60ML 25.44

HYDROXYZINE 25 MG TAB 2.01

HYDROXYZINE 10 MG TAB 1.38

HYDROXYZINE PAM 25MG CAP 1.70

HYDROXYZINE PAM 50MG CAP 1.42

HYLAN G-F20 48MG/6ML 2,214.26

HYOSCYAMINE 0.125MG SL 2.20

HYOSCYAMINE 0.375 MG CAP 2.09

HYOSYAMINE 0.25 MG DOSE 97.26

HYPERTHYROIDISM I-131 1,231.50

HYPROMELLOSE 2.5% OP 15M 33.65

HYSTEROSALPINGOGRA IN 150.00

I-131 NAI DIAG PER MILCU 127.50

I-131 NAI THERA 63.00

I-131 NAI THERA PER MILC 63.00

I23 IOBENGUANE UPTO 15MC 6,992.00

IA PACING 15,084.00

IBANDRONATE 150 MG TAB 197.00

IBUPROFEN 100 MG/5ML OS 2.34

IBUPROFEN 200 MG TABLET 1.21

IBUPROFEN 400 MG TABLET 1.17

IBUPROFEN 600 MG TABLET 1.40

IBUPROFEN 800 MG TABLET 1.50

IBUPROFEN 800MG/8 ML INJ 28.16

IBUTILIDE 1 MG DOSE 770.66

IBUTILIDE 1 MG DOSE 770.66

ICPS TEST 66.50

ICPS TEST - NO SHOW 66.50

ICU-GENERAL 1,986.00

ICU-GENERAL 1,986.00

IDARUBICIN 5MG DOSE 10 320.78

IDARUBICIN 5MG DOSE 5 161.08

IDARUCIZUMAB 2.5 GM/50ML 2,982.00

IF EA ADD SINGLE ANTI 82.00

IFOSFAMIDE 1000MG DOSE 113.55

IGA EA 90.00

IGF BINDING PROTEIN- 120.00

IGG SUBCLASS 1 71.00

IGG SUBCLASS 2 71.00

IGG SUBCLASS 3 71.00

IGG SUBCLASS 4 71.00

Page 58: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

IGH REARRANGE AMPLIFIED 1,905.50

IGH@VARIABLE REGION 2,614.00

IGK REARRANGE ABN CLONAL 1,437.50

IGM PEROX AB 611.50

IHC EA ADD AB ST SPEC 303.00

IHC EA MULTI ANTIB STAIN 712.50

IHC HPMS-1 QN/SQN COMP 1,370.00

IHC SEMI-QUANT 1,370.00

IKBKAP GENE ANALYSIS 244.50

ILC/FEM ART ANG AT C 2,059.00

ILEX SKIN PROTECT PASTE 32.50

ILOPERIDONE 1 MG TAB 25.50

ILOPERIDONE 2 MG TAB 25.50

ILOPERIDONE 4 MG TAB 25.50

IMATINIB 100 MG TAB 454.74

IMED CYOTO STUDY/DET 32.50

IMIPRAMINE 234.00

IMIPRAMINE 25MG TAB 1.53

IMIPRAMINE HCL 10 MG TAB 1.53

IMIPRAMINE HCL 50 MG TAB 1.87

IMIPRAMINE PAM 75 MG CAP 43.08

IMMOB KNEE 16" 110.50

IMMOB KNEE MISC 150.00

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN EA ADDTL 220.50

IMMUNIZ ADMIN LESS 18YR 220.50

IMMUNIZ ADMIN SGL 220.50

IMMUNIZ ADMIN SGL 220.50

IMMUNOASSAY RIA QUAN 115.00

IMMUNOFIX ELECTRO SER 215.50

IMMUNOFIX ELECTRO UR 282.50

IMMUNOGLOBULIN A 82.50

IMMUNOGLOBULIN D 82.50

IMMUNOGLOBULIN E 146.00

IMMUNOGLOBULIN G 82.50

IMMUNOGLOBULIN M 82.50

IMMUNOHISTO EACH ADD 240.00

IMMUNOHISTO EACH ADD 240.00

IMMUNOHISTOCHEM EA AB 611.50

IMMUNOHISTOCHEMISTRY 1,369.50

IMP BRST PROSTH SIL/EQ 5,654.50

IMPL CORNEA VCORPROKERA 7,442.00

IMPLANT BIOARCH 2,611.50

Page 59: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

IMPLANT BRST SIL/EQ LEV3 2,758.00

IMPLNT BRST SIL/EQ LEV1 1,324.00

IMPLNT BRST SILI/EQ LEV2 1,986.00

IMRT GUID/TRACK CMPLX 1,482.50

IMRT GUID/TRACK CMPLX 1,482.50

IMRT GUID/TRACK SIMP 1,482.50

IMRT GUID/TRACK SIMP 1,482.50

IMRT PLANNING 3,368.50

IMRT PLANNING 3,368.50

IN 111 PENTREOTIDE PE 6 6,050.00

IN SITU HYBRID EA PROBE 631.50

IN111 PENTETATE DX .5MCI 6,585.50

IN-111 PENTETATE PER 0.5 6,585.50

INC AND DRAIN OF ABSCESS 574.50

INC BX OF SKIN EA ADDL 232.00

INC BX OF SKIN EA ADDL 232.00

INC BX OF SKIN EA ADDL 232.00

INC BX OF SKIN EA ADDL 232.00

INC BX OF SKIN EA ADDL 232.00

INC BX OF SKIN EA ADDL 232.00

INC REMOV FOR BODY COMPL 2,807.00 INC REMOV FOR BODY COMPLEX

FOO 2,807.00

INC REMOV FOR BODY SQ SI 448.00

INC/DRAIN ABSC COMP/MUL 453.50

INC/DRAIN ABSCESS SIM/SINGLE 574.50

INC/DRAIN HEMA, SER, FLU 3,826.50

INC/DRAIN HEMATOMA EXTR 7,323.50

INC/DRN SML JT/BRSA 771.00

INC/DRN SML JT/BRSA 771.00

INCISIONAL BX OF SKIN 484.00

INCISIONAL BX OF SKIN 484.00

INCISIONAL BX OF SKIN 484.00

INCISIONAL BX OF SKIN 484.00

INCISIONAL BX OF SKIN 484.00

INCISIONAL BX OF SKIN 484.00

IND THERAPY 20/30 MI 352.00

IND THERAPY 45 MIN 352.00

INDAPAMIDE 1.25 MG TAB 2.52

INDAPAMIDE 2.5 MG TAB 2.65

INDIA INK 36.50

INDIA INK 59.64

INDIGO 8 MG/ML AMP 14.14

INDIV THERAPY 30 MIN 352.00

INDIV THERAPY 45 MIN 352.00

INDIV THERAPY 60 MIN 357.00

INDOCYANINE GREEN 25 MG 140.52

INDOMETH 0.5 MG/M NB DIL 912.49

INDOMETHACIN 1 MG VIAL 901.32

INDOMETHACIN 25 MG CAP 1.50

INDOMETHACIN 50MG SUPP 47.36

Page 60: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

INDUCED SPUTUM SPEC A 367.00

INDUCED SPUTUM SPEC A 367.00

Induct Arrhy by Pacing 2,869.00

INFLIXIMAB 10MG DOSE 2,284.25

INFLUENZA A AG IFT 115.50

INFLUENZA A SCREEN 107.00

INFLUENZA B AG EIA 115.50

INFLUENZA B SCREEN 107.00

INFLUENZA VACCINE AD 105.50

INFS SQ TX/PRPH/DG 1H 542.50

Infusion pump prog 16,537.50

INH TX AC AWY OBST 529.00

INH TX AC AWY OBST 529.00

INH TX AC AWY OBST 49.50

INH TX AC AWY OBST 49.50

INHIBIN A 139.00

INHIBIN B 157.50

INJ AORTOGRAM 197.50

INJ ARTHRO ELBOW LT 251.50

INJ ARTHRO ELBOW RT 251.50

INJ ARTHRO HIP W/O AN BI 170.50

INJ ARTHRO HIP W/O AN LT 251.50

INJ ARTHRO HIP W/O AN RT 251.50

INJ ARTHRO KNEE LT 251.50

INJ ARTHRO KNEE RT 251.50

INJ ARTHRO SHOULDER LT 251.50

INJ ARTHRO SHOULDER RT 251.50

INJ ARTHRO WRIST L 251.50

INJ ARTHRO WRIST LT 251.50

INJ ARTHRO WRIST RT 251.50

INJ N BLOCK OCCIPITAL 771.00

INJ PEYRONIE 723.50

INJ PULMONARY ANGIOGRM 2,944.50

INJ SACROILIAC JNT 764.00

INJ SACROILIAC JNT LT 764.00

INJ SACROILIAC JNT LT 764.00

INJ SACROILIAC JNT LT 742.44

INJ SACROILIAC JNT RT 764.00

INJ SACROILIAC JNT RT 742.44

INJ SACROILIAC JOINT 525.00

INJ SELECT LT VENT/ATRIA 2,944.50

INJ SELECT RT VENT/ATRIA 2,944.50

INJ SING/MLT TRIG PTS 3/>MUS 810.00

INJ SING/MULT TRIG PTS 810.00

INJ SING/MULT TRIG PTS 810.00

INJ SING/MULT TRIG PTS 810.00

INJ SUPRAVALV AORTOGRM 6,182.50

INJ TENDON SHEALTH/LIGMT 695.00

INJ TENDON SHEATH/LIGMT 695.00

INJ TENDON SHEATH/LIGMT 695.00

Page 61: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

INJ TENDON SHEATH/LIGMT 771.00

INJ TENDON SHEATH/LIGMT 177.00

INJ TENDON SHEATH/LIGMT 695.00

INJ TENDON SHEATH/LIGMT 177.00

INJ TENDON SHEATH/LIGMT 695.00

INJ THER CARPAL TUNNEL 771.00

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 70.50

INJ THER/PRPH/DIAG IM/SQ 70.50

INJ THER/PRPH/DIAG IM/SQ 166.00

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 165.50

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ THER/PRPH/DIAG IM/SQ 166.00

INJ THER/PRPH/DIAG IM/SQ 166.00

INJ THER/PRPH/DIAG IM/SQ 172.00

INJ;SACR O JT-PROV. O 1,542.50

INJECTION (SC)(IM)W/I 165.50

INJECTION INTRA-ARTERIAL 542.50

INS GLAR 100UNIT/ML 10ML 48.32

INS GLUL 100UNIT/ML 10ML 483.85

INSERT BLADDER CATH COMP 429.50

INSERT STRT BLADDER CATH 310.00

INSERT STRT BLADDER CATH 335.50

INSERT TEMP BLADDER 310.00

INSERT TEMP BLADDER 310.00

INSERT/PLACE HEART CATH 3,719.00

INSITU HYBRID COMP EA AD 471.00

INSITU HYBRIDIZ MAN SEMI 333.00

INSITU HYBRIDIZAT AUTO 1,370.00

INSTILL BLDR ANTICA AGNT 651.50

INSU LISP 100UNIT/ML 3ML 140.42

INSU N HUM 100UNIT/ML 3M 90.44

INSU N/R 70-30UNI/ML 3ML 90.17

Page 62: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

INSU R HUM 100UNIT/ML 3M 90.44

INSULIN AB 206.50

INSULIN LISP 75-25 10ML 450.03

INSULIN TOTAL 110.00

INTEN CARDIAC REHAB W 382.00

INTERFER B-1A 30MCG DOSE 11,801.48

INTERFERON ALFA-2B/1MIL 2,618.20

INTERFERON ALFA-2B;1MIL 2,618.20

INTERM URINARY CATH w/wo 22.50

INTEROGATION EVAL PM 107.50

INTERSPINOUS PROC DISTR 11,576.50

INTL TREAT 1ST DEG BURN 234.00

INTMD RPR N/H/F/G 2.5< 882.50

INTMD RPR N/H/F/G 2.5< 696.00

INTMD RPR N/H/F/G 2.5< 696.00

INTMD RPR N-HF/GENIT 2.5 882.50

INTMD RPR S/A/T/E 2.5< 1,028.00

Intra-Artrial Recording 16,567.00

INTRACARD EP 3D MAPPING 220.50

INTRACARDIAC ECHO 2,206.50

INTRAOP MON EA ADD 15MIN 68.00

INTRASPINAL CATH W/PUMP 79.00

INTRAVASC US ADDL VESSEL 3,863.50

INTRAVASC US INIT VESSEL 3,863.50

INTRINSIC FACT AB 145.50

INTRO/SHEATH GUID/NO PEEL 1,591.00

Intro/sheath, non-laser 62.50

Intro/sheath,non-lasCat2 224.00

Intro/sheath,non-lasCat3 550.50

Intro/sheath,strble,n-pC 572.50

Intro/sheath,strble,n-pC 330.00

Intro/sheath,strble,n-pM 1,103.50

INTRODUCER SHEATH 306.00

INTUBATE EMER PROC 360.50

INTUBATION 360.50

IOL ANTERIOR CHAMBER 134.00

IOL ASTIGMATISM CORRECT 3,990.00

IOL ASTIGMATISM CORRECT 2,079.00

IOL PRESBYOPIA CORRECT 3,759.00

IOL PRESBYOPIA CORRECT 3,990.00

IOL PRESBYOPIA CORRECT 4,137.00

IONTOPHORESIS/15 MIN. 72.50

IOP GP PSYTHER PER S 204.50

IOP GP PSYTHER PER SE 374.00

IOP IND PSYTHERP 45 352.00

IOP PER DIEM 374.00

IOP PER DIEM (BCBS) 392.50

IOP PER DIEM-MEDICAI 196.50

IOP PER SESSION (MED 196.50

IOP PSYTHER 30MIN 352.00

Page 63: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

IOP/PER-DIEM 374.00

IOPAMIDOL 30 ML VIAL 76.79

IPILIMUMAB 1MG DOSE 200 54,480.44

IPILIMUMAB 1MG DOSE 50 14,242.29

IPRATROP 0.03% 12.9GM IH 661.32

IPRATROP 0.03% 30ML NS 158.57

IPRATROP 0.06% 15ML NS 64.79

IPRATROP/ALBUT 3 ML NEB 3.31

IPRATROP/ALBUT INH 685.53

IPRATROPIUM 0.5MG/2.5 ML 56.23

IPV PT.DEMO AND EVAL 529.00

IPV TX 529.00

IPV TX-SAME DAY-ADD. 529.00

IRBESAR/HCTZ 150-12.5 TA 4.82

IRBESAR/HCTZ 300-12.5 TA 5.15

IRBESARTAN 150 MG TABLET 12.70

IRBESARTAN 300 MG TAB 14.15

IRINOTECAN 20MG DOSE 100 122.25

IRINOTECAN 20MG DOSE 40 48.90

IRON 62.50

IRON BINDING (TIBC) 84.00

IRON DEXTRAN 50 MG DOSE 45.20

IRON SUCR 1MG DOSE 100 97.80

IRON SUCR 1MG DOSE 200 170.40

IRON SUCROSE 100MG/5ML 85.20

IRRIGATION OF BLADDE 651.50

IRRIGATION OF IMPLAN 159.00

IRRIGATION OF VAD 159.00

IRRIGATION OF VAD 159.00

ISH SPEC EA ADL PROBSTAN 261.00

ISLET CELL AB 171.50

ISODOSE PLAN/1-2 POR 917.50

ISODOSE PLAN/1-2 POR 917.50

ISODOSE PLAN/COMPLEX 917.50

ISODOSE PLAN/COMPLEX 917.50

ISODOSE PLAN;COMPLEX 917.50

ISODOSE PLAN;COMPLEX 917.50

ISONIAZID 300 MG TABLET 2.26

ISOPROTERENOL 1MG/ML IJ 2,509.05

ISOPTO TEARS OPH 15ML 44.05

ISOSORB MONO 30MG TAB.ER 2.74

ISOSORB MONO 60MG TAB.ER 3.09

ISOSORBIDE DIN 10MG TAB 2.35

ISOSORBIDE DIN 20MG TAB 2.29

ISOSORBIDE DIN 5MG TAB 2.09

ISOSORBIDE MONO 20MG TAB 1.99

ISOSULFAN BLUE 5 ML VIAL 1,507.06

ISOVUE 200-299 PER ML 6.00

ISOVUE 300MG 134.00

ISOVUE M200 PER ML 6.00

Page 64: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

IV CHEMO INFUSION 1HR 845.00

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 118.50

IV HYDRAT EA ADD HR 114.00

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV HYDRAT INIT UP TO 1HR 542.50

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF THER/DIAG CONCURR 162.00

IV INF TX/PROPH/DG ADD 1 118.50

IV INF TX/PROPH/DG ADD 1 118.50

IV INF TX/PROPH/DG ADD 1 114.00

IV INF TX/PROPH/DG ADD 1 118.50

IV INF TX/PROPH/DG ADD 1 114.00

IV INF TX/PROPH/DG ADD 1 114.00

IV INF TX/PROPH/DG ADD 1 118.50

IV INF TX/PROPH/DG ADD 1 114.00

IV INF TX/PROPH/DG ADD 1 118.50

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 166.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INF TX/PRPH/DG AD SEQ 172.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

Page 65: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 600.00

IV INFUS TX/PROPH/DG 1H 579.00

IV INFUS TX/PROPH/DG 1H 579.00

IV INFUS TX/PROPH/DG 1H 542.50

IV INFUSION 1ST HOUR 600.00

IV PUSH SAME DRUG > 3 69.50

IV PUSH SAME DRUG >30 69.50

IV/IA MAP ID ORIGIN 2,206.50

IVIG (FLEBOGAMMA) 500MG 1,843.04

I-VITE TAB 1.18

IVP EA ADD SEQ SAME DRUG 162.00

IVP EA ADD SEQ SAME DRUG 162.00

IVP EA ADD SEQ SAME DRUG 89.50

IVP EA ADD SEQ SAME DRUG 162.00

IVP HYPERTENSIVE 767.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP THER/PROPH/DX SINGLE 542.50

IVP TX/PRO/DX ADD/NEW DR 118.50

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/NEW DR 118.50

IVP TX/PRO/DX ADD/NEW DR 118.50

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/NEW DR 118.50

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/NEW DR 118.50

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/NEW DR 114.00

IVP TX/PRO/DX ADD/SAME 115.00

IVP TX/PRO/DX SAME DR AD 162.00

IVP TX/PRO/DX SAME DR AD 69.50

IVP TX/PRO/DX SAME DR AD 87.00

IVP TX/PRO/DX SAME DR AD 69.50

IVP TX/PRO/DX SAME DR AD 162.00

IVP TX/PRO/DX SAME DR AD 162.00

IVP TX/PRO/DX SAME DR AD 162.00

IVUS EA ADDL VESSEL 3,574.50

IVUS INITIAL VESSEL 3,665.50

JAK2 V617F VARIANT 883.00

JO-1 ANTIBODY IGC 159.50

JOINT DEVICE (IMPLANT) 5,250.00

JOINT DEVICE (IMPLANT) 10,881.00

Page 66: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

JOINT DEVICE (IMPLANT) 4,438.50

JOINT DEVICE (IMPLANT) 4,174.00

JOINT DEVICE (IMPLANT) 7,056.00

JOINT DEVICE (IMPLANT) 8,968.50

JOINT DEVICE (IMPLANT) 10,776.50

JOINT DEVICE (IMPLANT) 8,968.50

JOINT DEVICE (IMPLANT) 4,602.50

JOINT DEVICE (IMPLANT) 6,870.50

JOINT DEVICE (IMPLANT) 1,140.00

JOINT DEVICE (IMPLANT) 9,975.00

JOINT DEVICE (IMPLANT) 1,781.00

JOINT DEVICE (IMPLANT) 9,655.00

JOINT DEVICE (IMPLANT) 3,399.00

JOINT DEVICE (IMPLANT) 1,798.00

JOINT DEVICE (IMPLANT) 4,438.50

JOINT DEVICE (IMPLANT) 6,158.50

JOINT DEVICE (IMPLANT) 5,229.00

JOINT DEVICE (IMPLANT) 5,297.50

JOINT DEVICE (IMPLANT) 21,807.50

JOINT DEVICE (IMPLANT) 5,229.00

JOINT DEVICE (IMPLANT) 3,391.00

JOINT DEVICE (IMPLANT) 10,362.60

Joint device (implant) 641.50

JOINT DEVICE (IMPLANT) 7,522.50

JOINT DEVICE (IMPLANT) 7,006.00

JOINT DEVICE (IMPLANT) 5,497.00

JOINT DEVICE (IMPLANT) 1,701.00

JOINT DEVICE (IMPLANT) 7,056.00

JOINT DEVICE (IMPLANT) 8,662.50

JOINT DEVICE (IMPLANT) 5,008.50

JOINT DEVICE (IMPLANT) 1,104.00

JOINT DEVICE (IMPLANT) 1,712.00

Joint device (implant) 8,098.00

JOINT DEVICE (IMPLANT) 3,591.00

JOINT DEVICE (IMPLANT) 6,271.50

JOINT DEVICE (IMPLANT) 1,197.00

JOINT DEVICE (IMPLANT) 1,798.00

JOINT DEVICE (IMPLANT) 13,054.00

JOINT DEVICE (IMPLANT) 5,859.00

JOINT DEVICE (IMPLANT) 13,498.00

JOINT DEVICE (IMPLANT) 3,449.50

JOINT DEVICE (IMPLANT) 4,205.50

Joint device (implant)Ca 3,448.00

Joint device (implant)MI 2,205.00

Joint device(implant)Cat 17,654.00

K+ BICARB/CIT 25MEQ TAB 2.35

KCENTRA 1 UNIT/1000 UNIT 4,515.10

KCENTRA 1 UNIT/500 UNIT 2,257.55

KCL/D51/2NS 20MEQ/1000ML 16.50

KCL/D51/4NS 20MEQ/1000ML 19.67

Page 67: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

KCL/D5LR 20MEQ/1000ML 21.42

KCL/D5LR 20MEQ/1000ML 21.42

KCL/D5NS 20MEQ/1000ML 21.04

KCL/D5W 20MEQ/1000ML 20.58

KCL/K BICARB/CIT 25MEQ 2.53

KCL/NS 20MEQ/1000ML 21.04

KCL/NS 20MEQ/1000ML 21.04

KCL/NS 40MEQ/1000ML 21.22

KCL/NS 40MEQ/1000ML 21.22

KCL-1/2NS 20MEQ/1000ML 25.88

KCL-1/2NS 20MEQ/1000ML 25.88

KELLER/MCBRIDE/MAYO PROC 4,754.00

KETALAR 50MG/5ML VIAL 30.67

Ketamine 50 MG/5 ML VIAL 17.02

Ketamine 500 MG/5 ML 12.70

KETOCON 2% SHAMP 120ML 38.50

KETOCONAZOLE 2% CR 30GM 186.49

KETOR/PF DROP 0.4ML 16.58

KETOROLAC 10 MG TABLET 3.26

KETOROLAC 0.5% DROPS 5ML 151.76

KETOROLAC 15 MG DOSE,15 5.60

KETOROLAC 15 MG DOSE,30 11.50

KETOROLAC 60MG/2ML 2.35

KIT GENE ANLYS D816 VAR 393.50

KIT GENE ANLYS TARG SEQ 1,038.00

KLEIHAUER BETKE 69.00

Ko adj jt pos r sup pre 1,299.50

KO DBL UPRT FLEX/EXT CUS 3,007.50

KOGENATE 250 UNIT VIAL 621.25

KPHOS NEUTRAL 250 MG TAB 1.61

KRAS ADDTL VARIANTS 609.00

KRAS VAR IN CODONS 12&13 1,285.00

KRAS VAR IN CODONS 12/13 1,285.00

L HRT ART/GRFT ANGIO 10,304.50

L HRT ART/GRFT ANGIO 8,657.00

L. ACIDOP/L.BULG GRAN 3.68

L. ACIDOP/L.BULG TAB 1.61

LABELED RBC DX TO 30 MCI 509.00

LABETALOL 5MG/ML 20ML 19.40

LABETALOL 5MG/ML 40ML 13.66

LABETALOL HCL 100 MG TAB 3.38

LABETALOL HCL 200 MG TAB 1.90

LABETALOL HCL 20MG/4ML 12.65

LABETALOL HCL 300 MG TAB 2.15

LABOR RM LEVEL 1 886.50

LABOR RM LEVEL 2 1,329.50

LABOR RM LEVEL 3 1,772.00

LACOSAMIDE 100 MG TAB 24.52

LACOSAMIDE 150 MG TAB 28.60

LACOSAMIDE 200MG/20ML IJ 112.56

Page 68: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LACOSAMIDE 50 MG TAB 16.87

LACRILUBE OPH OINT 3.5GM 4.98

LACRIMAL DUCT IMP TEMP 183.50

LACROSSE(CALIFORNIA) 117.50

LACTASE 3,000 UNIT TAB 1.21

LACTATED RINGERS 1000 ML 3.50

LACTATED RINGERS 1000 ML 5.00

LACTATION CONSULT 128.00

LACTIC ACID 103.00

LACTULOSE 10GM/15ML 273M 29.04

LACTULOSE 20 GM PACKET 14.25

LACTULOSE 20GM/30ML SOL 2.05

LAMIVU/ZIDOV 150-300 TAB 21.03

LAMIVUDINE 150 MG TAB 13.67

LAMOTRIGINE 100 MG TAB 1.33

LAMOTRIGINE 200 MG TAB 11.64

LAMOTRIGINE 25 MG TABLET 5.26

LAMOTRIGINE LAMICTAL QN 168.00

LANOLIN OINTMENT (TMH) 3.53

LANSOPRAZOLE 30 MG TAB 22.10

LANTHANUM CARB 500MG TAB 19.37

LATANOPR 0.005% OP 2.5ML 134.90

LATEX 46.50

LATUDA 60 MG TAB 57.54

LATUDA 60MG TAB 57.54

LDCT FOR LUNG CA SCREEN 196.50

LDCT FOR LUNG CA SCREEN 196.50

LDH 54.00

LDH 54.00

LDH ISOENZYMES 123.50

LDHFLUID 54.00

LDL CHOLESTEROL DM 92.00

LEAD (HEAVY METALS) 108.00

LEAD BLOOD 117.00

LEAD NEUROSTIM TST KIT 3,307.50

LEAD NEUROSTIM TST KIT 1,087.00

LEAD, CARDIO-DEFIB OTHER 8,269.00

LEAD, CARDIO-DEFIB SINGL 4,961.50

Lead, neurostim Cat2 4,561.00

Lead, neurostim MISC 16,537.50

Lead, neurostimulator 8,879.00

Lead, neurostimulator 37,406.50

Lead, neurostimulator 2,267.50

Lead, pmkr, other transC 2,234.00

Lead, pmkr/aicd combin 14,489.50

Lead, pmkr/aicd combinat 65.00

Lead,pmkr,oth th trs C 3,673.50

LEADURINE 108.00

LEFLUNOMIDE 10 MG TABLET 66.63

LEFLUNOMIDE 20 MG TAB 11.50

Page 69: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LEG PNEUMOPHILIA AG IFT 115.50

LEGIONAIRES 59.00

LEGIONELLA AB QUAL 148.00

LEGIONELLA AG SCREEN 85.50

LENS C1780 0.50

LENS C1840 0.50

LENS V2630 0.50

LENS V2632 0.50

LENS V2787 0.50

LENS V2788 0.50

Lens, intraocular(New)C 1,291.00

Lens, intraocular(newT)C 610.50

LETROZOLE 2.5 MG TAB 39.87

LETS KIT TPCL SLN 100ML 196.88

LEUCOVORIN 5MG TAB 4.35

LEUCOVORIN 100 MG VIAL 34.08

LEUCOVORIN 350 MG VIAL 32.29

LEUCOVORIN 50 MG DOSE 68.16

LEUKOCYTE HISTAMINE 111.00

LEUPROLIDE 1MG DOS 11.25 7,630.65

LEUPROLIDE 1MG DOSE 30 12,124.04

LEUPROLIDE 1MG DOSE 45 18,186.30

LEUPROLIDE 3.75MG DOSE 2,395.02

LEUPROLIDE 7.5MG 2,854.06

LEUPROLIDE 7.5MG 9,093.02

LEUPROLIDE ACETATE 7.5MG 619.50

LEVALBUTEROL 0.31MG/3ML 3.10

LEVALBUTEROL 0.63MG/3ML 25.50

LEVALBUTEROL 1.25MG/0.5M 12.20

LEVALBUTEROL 1.25MG/3ML 3.10

LEVALBUTEROL INH 15GM 116.28

Level 1 5,515.50

LEVEL 1 2,758.00

LEVEL 1 44,122.50

LEVEL 1 BILATERAL 5,516.00

LEVEL 1 BILATERAL ECH AD 2,206.50

LEVEL 1 BILATERAL ECH ADD 2,206.50

LEVEL 1 EACH ADD 1,103.50

Level 1 Proc Code 7,721.50

Level 1 Procedure 7,717.50

LEVEL 1-EACH ADD'L 15 MI 1,980.50

LEVEL 1-EACH ADD'L 15 MI 1,324.00

LEVEL 1-EACH ADD'L 15 MI 1,324.00

LEVEL 1-FIRST 30 MINUTES 4,538.50

LEVEL 1-FIRST 30 MINUTES 3,011.00

LEVEL 1-FIRST 30 MINUTES 3,011.00

Level 2 11,031.00

LEVEL 2 5,515.50

LEVEL 2 55,125.00

LEVEL 2 BILATERAL 11,030.50

Page 70: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LEVEL 2 BILATERAL ECH AD 4,410.00

LEVEL 2 BILATERAL ECH ADD 4,410.00

LEVEL 2 EACH ADD 2,205.00

LEVEL 2-EACH ADD'L 15 MI 1,470.00

LEVEL 2-EACH ADD'L 15 MI 2,227.50

LEVEL 2-EACH ADD'L 15 MI 1,470.00

LEVEL 2-FIRST 30 MINUTES 5,105.50

LEVEL 2-FIRST 30 MINUTES 3,345.50

LEVEL 2-FIRST 30 MINUTES 3,345.50

LEVEL 3 77,214.00

Level 3 16,546.00

LEVEL 3-EACH ADD'L 15 MI 1,634.00

LEVEL 3-EACH ADD'L 15 MI 2,475.50

LEVEL 3-EACH ADD'L 15 MI 1,634.00

LEVEL 3-FIRST 30 MINUTES 5,672.00

LEVEL 3-FIRST 30 MINUTES 3,717.00

LEVEL 3-FIRST 30 MINUTES 3,717.00

LEVEL 4-EACH ADD'L 15 MI 2,722.50

LEVEL 4-EACH ADD'L 15 MI 1,797.50

LEVEL 4-EACH ADD'L 15 MI 1,797.50

LEVEL 4-FIRST 30 MINUTES 4,089.00

LEVEL 4-FIRST 30 MINUTES 6,239.00

LEVEL 4-FIRST 30 MINUTES 4,089.00

LEVEL 5-EACH ADD'L 15 MI 3,267.50

LEVEL 5-EACH ADD'L 15 MI 1,977.00

LEVEL 5-EACH ADD'L 15 MI 1,977.00

LEVEL 5-FIRST 30 MINUTES 4,498.00

LEVEL 5-FIRST 30 MINUTES 7,488.00

LEVEL 5-FIRST 30 MINUTES 4,498.00

LEVETIRACE 500MG/5ML SOL 12.46

LEVETIRACET 500MG TAB.ER 5.55

LEVETIRACETAM 10 MG DO 29.90

LEVETIRACETAM 10 MG DO 84.53

LEVETIRACETAM 10 MG DOSE 26.00

LEVETIRACETAM 10 MG DOSE 29.90

LEVETIRACETAM 10 MG DOSE 84.53

LEVETIRACETAM 250 MG TAB 1.34

LEVETIRACETAM 500 MG TAB 4.26

LEVETIRACETAM KEPPRA QN 126.00

LEVOBUNOLOL 0.5% OP 5ML 34.34

LEVOCARN 100MG/ML 118 ML 53.68

LEVOCARNITINE 1GM DOSE 56.43

LEVOCARNITINE 330 MG TAB 2.32

LEVOFLOXACIN 250 MG DOSE 19.40

LEVOFLOXACIN 250 MG DOSE 18.34

LEVOFLOXACIN 250 MG DOSE 18.49

LEVOFLOXACIN 250 MG TAB 21.99

LEVOFLOXACIN 250MG/50ML 19.40

LEVOFLOXACIN 500 MG TAB 22.32

LEVOFLOXACIN 500MG/100ML 18.34

Page 71: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LEVOFLOXACIN 750 MG TAB 34.95

LEVOFLOXACIN 750MG/150ML 18.49

LEVOTHYROXINE 100 MCG IJ 179.91

LEVOTHYROXINE 100MCG TAB 1.66

LEVOTHYROXINE 112MCG TAB 2.59

LEVOTHYROXINE 125MCG TAB 1.76

LEVOTHYROXINE 137MCG TAB 2.52

LEVOTHYROXINE 150MCG TAB 2.59

LEVOTHYROXINE 175MCG TAB 2.51

LEVOTHYROXINE 200MCG TAB 2.59

LEVOTHYROXINE 25MCG TAB 2.59

LEVOTHYROXINE 50MCG TAB 2.59

LEVOTHYROXINE 75MCG TAB 1.65

LEVOTHYROXINE 88MCG TAB 2.45

LH 178.50

LHC TRANS SEPTAL/APICAL 1,103.50

LHC TRANS SEPTAL/APICAL 8,657.00

LIDOCA/PRILOCA 30GM CR 75.44

LIDOCA/PRILOCA CR 5GM 13.54

LIDOCAINE (XYLOCAINE) QN 141.50

LIDOCAINE 0.5%/EPI 50ML 5.25

LIDOCAINE 1% 20 ML 5.54

LIDOCAINE 1% MDV 50ML 4.45

LIDOCAINE 1%/EPI 20ML 5.60

LIDOCAINE 1%/EPI 30ML 4.85

LIDOCAINE 1.5%/EPI 30ML 21.82

LIDOCAINE 100 MG/5ML SYR 4.98

LIDOCAINE 2 GM/250 ML 19.01

LIDOCAINE 2% 10 ML 16.22

LIDOCAINE 2% 10ML 16.22

LIDOCAINE 2% 20 ML 5.11

LIDOCAINE 2% JELLY 30ML 130.19

LIDOCAINE 2% JELLY 5ML 13.30

LIDOCAINE 2% UROJET 10ML 13.19

LIDOCAINE 2% VISC 100ML 18.70

LIDOCAINE 2% VISCOUS 5ML 18.70

LIDOCAINE 2%/EPI 20ML 5.66

LIDOCAINE 4% TOPIC 50ML 68.16

LIDOCAINE 5% OINT 30GM 449.66

LIDOCAINE HCL/PF 1% 5 ML 5.14

LIDOCAINE MPF 4% AMP 5ML 10.70

LIDOCAINE PF 0.5% 50 ML 20.61

Lidocaine/Epi 1.8ML DENT 1.95

LIDOCAINE-MPF 1% 1ML 3.55

LIDOCAINE-MPF 2% POLYAMP 12.74

LIDODERM 5% PATCH 24.46

LIMITED ABDOMEN 880.00

LINDANE 1% SHAMPOO 60ML 194.34

LINEZOLID 200MG DOSE 80.71

LINEZOLID 600 MG TABLET 259.86

Page 72: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LIOTHYRONINE 25MCG TAB 3.62

LIOTHYRONINE 5 MCG TAB 3.02

LIP/PROT/AM 12K UNIT CAP 4.83

LIP/PROT/AM 24K UNIT CAP 12.90

LIP/PROT/AMY 6K UNIT CAP 2.74

LIPASE 67.00

LIPID PANEL 129.50

LIPID PANEL 129.50

LIPID PANEL 129.50

LIPOPROTEIN (A) 124.50

LIPOPROTEIN NMR LIPOPROF 304.00

LIRAGLUTIDE 18MG/3ML PEN 523.57

LISINOPR/HCTZ 10-12.5TAB 2.21

LISINOPR/HCTZ 20-12.5TAB 2.31

LISINOPR/HCTZ 20-25TAB 2.33

LISINOPRIL 10 MG TABLET 2.34

LISINOPRIL 2.5 MG TABLET 1.75

LISINOPRIL 20 MG TABLET 1.18

LISINOPRIL 40 MG TABLET 2.58

LISINOPRIL 5 MG TABLET 1.97

LITHIUM (ESKALITH) QN 64.00

LITHIUM CAR 300MG TAB.ER 1.57

LITHIUM CAR 450MG TAB.ER 1.86

LITHIUM CARB 150MG CAP 1.29

LITHIUM CARB 300MG TAB 1.36

LITHIUM CIT 8MEQ/5ML SOL 2.12

LITHROTRIPSY 8,000.00

LIVER-KIDNEY MICRO AB 140.50

LOOPOGRAM INJ PROC 1,708.00

LOPERAM 1MG/7.5ML 120ML 12.50

LOPERAMIDE HCL 2 MG CAP 1.97

LORATADINE 10 MG TABLET 1.56

LORATADINE 5MG/5ML 118ML 13.93

LORATADINE/PSE TAB ER.24 1.83

LORAZEPAM 0.5 MG TAB 1.74

LORAZEPAM 0.5 MG TABLET 1.74

LORAZEPAM 1 MG TABLET 1.98

LORAZEPAM 1 MG/0.5 ML OC 1.90

LORAZEPAM 2 MG TAB 1.25

LORAZEPAM 2MG DOSE 2 6.67

LORAZEPAM 2MG DOSE 4 30.32

LOSART/HCTZ 100-12.5 TAB 12.22

LOSARTAN 25MG TAB 2.78

LOSARTAN 50MG TAB 3.35

LOSARTAN 100MG TAB 2.00

LOSARTAN/HCTZ 100-25TAB 4.52

LOSARTAN/HCTZ 50-12.5TAB 3.60

LOW EXT INFANT BI 596.00

LOW EXT INFANT BI 596.00

LOW EXT INFANT BI 596.00

Page 73: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

LOW OSM CON 200-299MG/ML 6.00

LOW OSM CON 300-399MG/ML 2.00

LOW OSM CON 300-399MG/ML 2.00

LOW OSM CON 300-399MG/ML 2.00

LOW OSM CON 300-399MG/ML 662.50

LOW OSM CON 300-399MG/ML 2.00

LOW OSM CON 300-399MG/ML 2.00

LOW OSM CON 300-399MG/ML 2.00

LOWER ART EXTR STUDY 923.00

LOWER EXT INFANT LT 298.00

LOWER EXT INFANT RT 298.00

LOWER EXTREMITY STUDY 923.00

LOXAPINE SUCC 25MG CAP 3.02

LOXAPINE SUCC 5MG CAP 2.09

LT ANY JT LOW EXT W/ 4,524.00

LT ANY JT UP EXT W/C 3,104.00

LUBIPROSTONE 24 MCG CAP 12.92

LUBIPROSTONE 8 MCG CAP 12.50

LUBRIDERM LOTION 480ML 4.01

LUMBAR BCK BRACE/ 828.50

LUMBAR PUNCTURE 376.50

LUMBER CORSET 641.50

LUNG VOLUMES 863.00

LUPUS ANTICOAGULANT 35.50

LUPUS ANTICOAGULANT 53.50

LUPUS ANTICOAGULANT 57.50

LURASIDONE HCL 40 MG TAB 63.23

LYME ANTIBODIES CSF 151.50

LYME DISEASE SEROLOG 151.50

LYMPHATIC DRAIN/15 MINS 80.31

MA COMP SPEC EA MUTI PRB 631.50

MA MAN SPEC EA MUTI PBST 840.00

MAAL/BEN/LID MAGIC 240ML 6.10

MAALOX/BENADRYL/LID 10ML 1.60

MACROAGG ALBMN DX 10 MCI 398.00

MAG HYD/AL HYD/SIM 30ML 5.67

MAGNES SULF 1GM/100ML 19.88

MAGNES SULF 40GM/1,000ML 18.40

MAGNES SULF 4MEQ/ML 10ML 7.58

MAGNES SULF 4MEQ/ML 10ML 7.58

MAGNES SULF 4MEQ/ML 2ML 7.40

MAGNES SULF 4MEQ/ML 50ML 31.52

MAGNES SULF 4MEQ/ML 50ML 31.52

MAGNESIUM 59.50

MAGNESIUM 27 MG TAB 1.16

MAGNESIUM 500 MG 19.88

MAGNESIUM 500 MG 7.40

MAGNESIUM 500 MG 19.84

MAGNESIUM CITR 300ML SOL 3.88

MAGNESIUM CL 64MG TAB 1.22

Page 74: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MAGNESIUM GLUC 500MG TAB 1.27

MAGNESIUM HYDROXIDE 30ML 4.20

MAGNESIUM OX 400MG TAB 1.28

MAGNESIUM SULF 2GM/50ML 30.25

MAGNESIUM SULF 4GM/50ML 19.84

MAGNESIUM URINE 65.00

MAINT OF WAKEFULNESS 2,563.00

MALE PELVIS/FEMALE BL 587.50

MAMMO NEEDLE LT 1,111.00

MAMMO NEEDLE RT 1,111.00

MANGANESE WHOLE BLOO 218.50

MANNITOL 20% 250ML IV 84.59

MANNITOL 20% 500ML BAG 84.59

MANNITOL 20% 500ML BAG 84.59

MANNITOL 50 ML DOSE 5.54

MANUAL THERAPY/15MIN 84.50

MAPLE LEAF SYCAMORE 46.50

Mapping of Tachycardia 5,515.50

MASS SPECTROMETRY QU 436.50

MASSAGE 15 MIN PT 117.00

MASTISOL DROPERETTE 3.45

MATRIX HD 8CM X 5 208.50

MAXITROL OPHTH DROPS 5ML 25.36

MAXITROL OPHTH OINT 3.5G 62.48

MCT 7.7 KCAL/ML 30ML 4.03

MD BEDSIDE PROCEDURE 1,236.50

MD BEDSIDE PROCEDURE 1,288.50

MDI PT.DEMO AND EVAL 529.00

MDI TX. 529.00

MDI TX-SAME DAY-ADD-T 529.00

MEASURE BLOOD OXYG LEVEL 233.00

ME-BR 5 ML SYRUP 13.83

MEBROFENIN DX TO 15 MCI 237.50

MECLIZINE HCL 12.5MG TAB 1.94

MECLIZINE HCL 25MG TAB 1.94

MEDIHONEY 39.00

MEDRONATE DX UP TO 30MCI 102.50

MEDROXYPROGEST 2.5MG TAB 1.41

MEDROXYPROGEST 5MG TAB 1.57

MEDROXYPROGESTERONE 400 839.04

MEGESTROL 400MG/10ML OS 5.63

MEGESTROL ACET 40MG TAB 2.15

MELATONIN 3 MG TAB 1.48

MELOXICAM 15 MG TABLET 5.89

MELOXICAM 7.5 MG TABLET 2.83

MEMANTINE 14 MG CAP.SPR 24.09

MEMANTINE 7MG CAP.SPR 22.48

MEMANTINE HCL 10 MG TAB 14.39

MEMANTINE HCL 5 MG TAB 2.05

MEMANTINE/DONEP CAP.SPR 22.40

Page 75: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MEMDERM/DERMSPN PR SQ CM 3,682.50

MENING VAC (MENACTRA) 197.96

MENTH/ZNC OX 113GM (TMH) 12.45

MENTHOL 57 GM GEL 4.39

MEPERIDINE 25MG/ML INJ 12.64

MEPERIDINE 50MG/ML INJ 12.88

MEPERIDINE 75MG/ML INJ 14.38

MEPERIDINE HCL 1 MG POWD 1.21

MEPERIDINE HCL 50 MG TAB 4.12

MEPILEX 55.50

MEPILEX 55.50

MEPILEX TRANSF 55.50

MEPILEX TRANSF 39.00

MEPIV 10 MG/ML INJ 50ML 13.08

MEPIVAC 20 MG/ML 20ML 10.97

MEPIVAC 20MG/ML 50ML 14.98

MEPROBAMATE 400MG TAB 13.75

MERCURY (HEAVY METAL 144.50

MERCURYURINE 144.50

MEROPENEM 1,000 MG VIAL 49.67

MEROPENEM 100MG DOSE 30.54

MERTIATIDE DX TO 15 MCI 732.50

MESALAMINE 1,000 MG SUPP 65.99

MESALAMINE 1.2 GM TAB 16.73

MESALAMINE 250 MG CAP.ER 4.74

MESALAMINE 400 MG CAP 4.66

MESALAMINE 4GM/60ML ENEM 34.49

MESALAMINE 800 MG TAB 14.77

MESH (IMPLANTABLE) 4,074.00

MESH (IMPLANTABLE) 10,956.50

MESH (IMPLANTABLE) 6,574.00

MESH (IMPLANTABLE) 6,300.00

Mesh (implantable) 2,756.50

MESH (IMPLANTABLE) 6,300.00

MESH (IMPLANTABLE) 1,638.00

MESH (IMPLANTABLE) 2,247.00

Mesh (implantable) Cat1 251.00

Mesh (implantable) Cat2 615.00

Mesh (implantable) Cat3 1,944.50

Mesh (implantable) MISC 2,756.50

MESNA 1000MG DOSE 51.12

MESNA 400MG TABLET 133.92

METANEPHRINES FRACT 163.50

METANX = FOLTANX CAPSULE 5.37

METAXALONE 800 MG TABLET 11.39

METFORMIN 1,000MG TAB 2.17

METFORMIN 500MG TAB.ER 2.44

METFORMIN HCL 500 MG TAB 1.18

METFORMIN HCL 850 MG TAB 2.30

METHA+METAB MECONIUM 186.50

Page 76: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

METHACHOLIN CL 100MG NEB 114.17

METHADONE 10MG/ML ORAL 1.95

METHADONE 5MG/0.5ML ORAL 1.95

METHADONE HCL 10 MG TAB 1.86

METHADONE HCL 5 MG TAB 1.77

METHADONEREF 83.50

METHEMOGLOBIN QUANT 70.50

METHIMAZOLE 5 MG TABLET 1.54

METHOCARBAMOL 10ML DO 112.61

METHOCARBAMOL 500 MG TAB 1.61

METHOCARBAMOL 750 MG TAB 1.69

METHOHEXITAL 500MG INJ 112.92

METHOTREX PF 5MG DOS 250 16.34

METHOTREX PF 5MG DOSE 25 9.53

METHOTREXATE 2.5 MG TAB 11.74

METHYL SALICYLATE 60 ML 16.62

METHYLCELLULOS 500MG TAB 1.25

METHYLDOPA 250 MG TABLET 1.47

METHYLENE BLUE 10 ML INJ 285.93

METHYLERGONOVINE 0.2 MG 33.67

METHYLMALONIC ACID QN UR 159.00

METHYLMALONIC ACID S 146.00

METHYLPHENIDATE 10MG TAB 1.88

METHYLPHENIDATE 20MG TAB 2.61

METHYLPHENIDATE 5MG TAB 1.84

METHYLPRED ACET 80MG DOS 31.25

METHYLPREDNIS 500MG IV 43.11

METHYLPREDNISO 4MG DS.PK 42.61

METHYLPREDNISO 4MG DS.PK 42.61

METHYLPREDNISOLO 4MG TAB 49.19

METHYLPREDNISOLON 125MG 43.11

METHYLPREDNISOLON IN80MG 43.50

METHYLPREDNISOLONE 125MG 96.79

METHYLPREDNISOLONE 125MG 22.63

METHYLPREDNISOLONE 40 MG 18.19

METHYLPREDNISOLONE 40MG 12.72

METOCLOP 0.1MG/ML NB DIL 2.43

METOCLOPRA 10MG/10ML SOL 1.75

METOCLOPRAMIDE 10MG DOSE 2.43

METOCLOPRAMIDE 10MG TAB 2.08

METOCLOPRAMIDE 5 MG TAB 1.43

METOLAZONE 2.5 MG TABLET 4.39

METOLAZONE 5 MG TABLET 4.83

METOPROLOL SUCC 100MG XL 2.96

METOPROLOL SUCC 25MG XL 2.33

METOPROLOL SUCC 50MG XL 2.34

METOPROLOL TAR 100MG TAB 2.01

METOPROLOL TART 25MG TAB 1.38

METOPROLOL TART 50MG TAB 1.74

METOPROLOL TART 5MG/5ML 2.36

Page 77: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

METRONIDAZOL 500MG/100ML 6.05

METRONIDAZOLE 0.75% VAG 231.52

METRONIDAZOLE 250 MG TAB 1.65

METRONIDAZOLE 250MG/50ML 8.00

METRONIDAZOLE 500 MG TAB 1.93

METRONIDAZOLE TOP GEL 641.47

MEXILETINE HCL 150MG CAP 3.64

MG DVC PLC BRST ADD LT 1,213.00

MGMT PROMOTOR METHYL 526.50

MICAFUNGIN 1MG DOSE 365.77

MICONAZOLE 2% CR 28GM 4.88

MICONAZOLE 100MG SUPPVAG 2.95

MICONAZOLE VAG CR 45GM 18.30

MICONAZOLE/SKIN CLEANSER 13.06

MICROALBUMIN URINE 51.50

MICRODISSECTION MANUAL 442.00

MICROFIB COLLAGEN 1GM 323.76

MICROSATELLITE INSTABILI 2,787.00

MIDAZOLA 0.5MG/ML NB DIL 1.27

MIDAZOLAM 1MG DOSE 10ML 19.28

MIDAZOLAM 1MG DOSE 2ML 2.20

MIDAZOLAM 1MG DOSE 5ML 2.77

MIDAZOLAM 2MG/ML SYR 5ML 16.28

MIDAZOLAM 5MG/ML 1ML 3.96

MIDDLE EAR HEAR PROSTH 525.00

MIDODRINE HCL 2.5 MG TAB 2.79

MIDODRINE HCL 5 MG TAB 5.59

MIDRIN CAPSULE 11.36

MIGLITOL 25 MG TAB 3.85

MILD IMPLANT KIT 8,977.50

MILK 46.50

MILNACIPRAN HCL 50MG TAB 12.48

MILRINONE 20/100 ML BAG 29.24

MINERAL OIL 10ML STERILE 22.20

MINERAL OIL 133 ML ENEMA 3.18

MINERAL OIL 30 ML OIL UD 2.08

MINERAL OIL 473 ML 14.08

MINOCYCLINE 100MG CAP 2.42

MINOR PROCEDURE 1,520.50

MINOXIDIL 10 MG TABLET 3.22

MINOXIDIL 2.5 MG TABLET 2.80

MIRABEGRON 25MG TAB.ER 20.87

MIRTAZAPINE 15MG TAB 3.45

MIRTAZAPINE 30 MG TAB 3.53

MIRTAZAPINE 45 MG TAB 3.69

MISC OPTICAL PROSTH 827.00

MISOPROSTOL 100 MCG TAB 5.08

MISOPROSTOL 200 MCG TAB 3.02

MISOPROSTOL 25 MCG TAB 5.08

MITOCHONDRIAL M2 AB 102.50

Page 78: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MITOMYCIN 0.2MG OPTH 386.89

MITOMYCIN 5MG DOSE 20 1,005.10

MITOMYCIN 5MG DOSE 5 386.89

MMR VACC/PF 0.5 ML VIAL 120.20

M-NALTREX BR 12MG/0.6 ML 185.74

MNT 2ND REF GRP EA 30 MIN 46.00

MNT 2ND REF INDIV EA 15 MIN 90.00

MNT GROUP EA 30 MIN 59.00

MNT GROUP EA 30 MIN 59.00

MNT INTL ASSES INDV/15MN 100.00

MNT INTL ASSES INDV/15MN 100.00

MNT REASSESS EA 15 MIN 85.00

MNT REASSESS EA 15 MIN 85.00

MNTL HLTH ASSMNT NON PHY 315.00

MOD SED SUPP MD INIT 15MIN <5Y 120.00

MODAFINIL 100 MG TABLET 37.46

MODAFINIL 200 MG TAB 55.01

MOISTUREL LOTION 240 ML 15.79

MOLEC PATH LEV 6 6-10EX 949.50

MOLEC PATH LEV 7 11-25EX 891.50

MOLPATH TIER 2 LEVEL 2 724.00

MOLPATH TIER 2 LEVEL 4 583.50

MOLPATH TIER 2 LEVEL 5 866.00

MOMETASONE 0.1% CR 15G 75.20

MOMETASONE 0.1% OINT 15G 36.81

MOMETASONE 0.1% SOL 30ML 101.22

MOMETASONE FUROATE INH 383.03

MONO SCR (HETEROPHILE) 50.50

MONTELUKAST 10 MG TAB 11.01

MORPH 0.2MG/ML IV NB DIL 3.36

MORPH 0.4MG/ML PO NB DIL 3.36

MORPH 400MCG/10ML NB DRP 7.76

MORPHINE 0.5MG/ML VIAL 44.90

MORPHINE 100 MG TAB.ER 14.12

MORPHINE 10MG/5ML SOL 2.73

MORPHINE 10MG/ML INJ 3.40

MORPHINE 15MG IR TAB 1.62

MORPHINE 15MG TAB.ER 2.97

MORPHINE 15MG/ML 20ML 20.60

MORPHINE 20 MG/1ML ORAL 31.85

MORPHINE 20MG/5ML PO 5ML 1.98

MORPHINE 2MG/ML INJ 4.54

MORPHINE 30MG TAB.ER 4.43

MORPHINE 30MG/30ML PCA 22.52

MORPHINE 4MG/ML INJ 4.54

MORPHINE 50MG/50ML PCA 17.19

MORPHINE 5MG/0.25ML SOL 1.28

MORPHINE 60MG TAB.ER 10.82

Morphine Epidural 10 mg 374.88

Morphine Epidural 10 mg 221.52

Page 79: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MORPHINE PF 10MG/10ML 19.11

MORPHINE SULF 100 MG POW 12.88

MORPHINE SULF 1MG POWD 1.16

MOUNTAIN JUNIPER 46.50

MOXIFLOX 100MG DOSE PB 86.99

MOXIFLOXACIN 0.5% OP 3ML 296.69

MOXIFLOXACIN OPH 5MG/ML 20.50

MRA ABDOMEN W OR WO 2,496.00

MRA HD W&WO CONTRAST 4,110.00

MRA HD W/CONTRAST 4,108.00

MRA HD W/O CONT 2,496.00

MRA HD W+WO CONTRAST 4,110.00

MRA LWR EXT BI W OR WO 7,541.50

MRA NECK W&WO CONT 4,108.00

MRA NECK W/CONTRAST 4,110.00

MRA NECK W/O CONT 2,496.00

MRA NECK W+WO CONT 4,108.00

MRA UPPER EXT W/WO LT 1,730.00

MRA UPPER EXT W/WO RT 1,730.00

MRA W/CONT PELVIS 2,496.00

MRA W/O CONT CHEST 2,448.00

MRA W/O CONT PELVIS 2,496.00

MRA W/WO CONT CHEST 2,448.00

MRA W/WO LWR EXT LT 3,770.75

MRA WO FOL W CONT PELVIS 2,496.00

MRA WO W CONT LWR EXT RT 3,770.75

MRCP 2,496.00

MRI ABDOMEN W/CONT 4,110.00

MRI ABDOMEN W/O CONT 2,496.00

MRI ABDOMEN W/WO CONT 4,108.00

MRI ANY JT LOW EXT W/ LT 4,524.00

MRI ANY JT LOW EXT W/RT 4,524.00

MRI BRAIN W&WO CONT 4,108.00

MRI BRAIN W/CONTRAST 4,108.00

MRI BRAIN W/O CONTRAST 2,496.00

MRI BRAIN W+WO CONT 4,108.00

MRI CHEST W AND WO CONT 4,105.50

MRI CHEST W WO CONT 4,105.50

MRI CHEST W/CONTRAST 4,110.00

MRI CHEST W/O CONT 2,496.00

MRI C-SPINE W&W/O CONT 4,108.00

MRI C-SPINE W/CONTRAST 4,110.00

MRI C-SPINE W/O CONT 2,496.00

MRI C-SPINE W+W/O CONT 4,108.00

MRI LOW EXT W&WO CONT LT 4,108.00

MRI LOW EXT W&WO CONT RT 4,108.00

MRI LOW EXT W/CONT LT 4,108.00

MRI LOW EXT W/CONT RT 4,108.00

MRI LOW EXT W/O CONT LT 2,496.00

MRI LOW EXT W/O CONT RT 2,496.00

Page 80: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MRI LOW EXT W+WO CONT LT 4,108.00

MRI LOW EXT W+WO CONT RT 4,108.00

MRI L-SPINE W&W/O CONT 4,108.00

MRI L-SPINE W/CONT 4,110.00

MRI L-SPINE W/O CONT 2,496.00

MRI L-SPINE W+W/O CONT 4,108.00

MRI LW JNT W&WO CONT BI 4,108.00

MRI LW JNT W&WO CONT LT 2,054.00

MRI LW JNT W&WO CONT RT 2,054.00

MRI LW JNT W/CONTRAST BI 9,048.00

MRI LW JNT W/O CONT BI 4,992.00

MRI LW JNT W/O CONT LT 2,496.00

MRI LW JNT W/O CONT RT 2,496.00

MRI LW JNT W+WO CONT BI 4,108.00

MRI LW JNT W+WO CONT LT 2,054.00

MRI LW JNT W+WO CONT RT 2,054.00

MRI OR/FCE/NCK W&WO 4,108.00

MRI OR/FCE/NCK W/CONT 4,110.00

MRI OR/FCE/NCK W/O CONT 2,496.00

MRI OR/FCE/NCK W+WO 4,108.00

MRI PELVIS W&WO CONT 4,108.00

MRI PELVIS W/CONTRAST 4,110.00

MRI PELVIS W/O CONT 2,496.00

MRI PELVIS W+WO CONT 4,108.00

MRI TMJ 2,497.50

MRI T-SPINE W&W/O CONT 4,108.00

MRI T-SPINE W/CONTRAST 4,110.00

MRI T-SPINE W/O CONT 2,496.00

MRI T-SPINE W+W/O CONT 4,108.00

MRI UP EXT W/WO LT 4,108.00

MRI UP EXT W/WO RT 4,108.00

MRI UP JNT W&WO CONT LT 4,110.00

MRI UP JNT W&WO CONT RT 4,110.00

MRI UP JNT W/CONT LT 3,104.00

MRI UP JNT W/CONT RT 3,104.00

MRI UP JNT W/O CONT LT 2,496.00

MRI UP JNT W/O CONT RT 2,496.00

MRI UP JNT W+WO CONT LT 4,110.00

MRI UP JNT W+WO CONT RT 4,110.00

MRI UPPER EX W/CONT LT 4,110.00

MRI UPPER EX W/CONT RT 4,110.00

MRI UPPER EX W/O CONT LT 2,496.00

MRI UPPER EX W/O CONT RT 2,496.00

MRSA BY NAA 136.50

MTHFR COMMON VARIANTS 420.00

MUCINEX DM 1200-60 12HR 1.88

MULBERRY 46.50

MULTIPLE SLEEP LATEN 2,563.00

MULTIPLE SLEEP LATEN 2,563.00

MULTIVIT,THERAP 5ML 1.79

Page 81: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

MULTIVITAMIN TAB CHEW 1.23

MUMPS VIRUS ABIGG 116.50

MUMPS VIRUS AGIGM 116.50

MUPIROCIN 2% CR 30GM 590.10

MUPIROCIN 2% OINT 22GM 35.50

MURAMIDASE LYSOZYME 181.00

MUSCLE SPEC (MuSK) ANTIB 120.00

MVI, ADULT 10 ML VIAL 172.36

MVI, PEDI VIT K 5 ML 26.12

MYCOPHENOLATE 250MG CAP 5.06

MYCOPHENOLATE 500MG TAB 13.43

MYCOPLASMA DOUBLE 118.00

MYCOPLASMA PNEUMONIA 118.00

MYELIN BASIC PROT CSF 166.00

MYELO W S+I CERVICAL 2,735.00

MYELO W S+I LUMBOSAC 2,735.00

MYELO W S+I THORACIC 2,735.00

MYL/DONN/LIDOC 45M 29.07

MYOGLOBIN BLD 124.50

MYOGLOBINBLOOD 114.50

MYOGLOBINURINE 114.50

NA HYPOCHLORITE 480ML 23.86

NABUMETONE 500 MG TABLET 1.92

NADOLOL 20 MG TABLET 11.69

NADOLOL 40 MG TABLET 12.73

NALBUPHINE 10 MG DOSE 14.50

NALOXONE 0.4 MG/ML 10ML 202.34

NALOXONE 0.4 MG/ML VIAL 24.50

NALOXONE 1 MG DOSE 56.23

NALTREXONE HCL 50 MG TAB 3.62

NALTREXOONE MIC 1MG DOSE 2,230.54

NAPHAZ/PHENIR OP 15ML 14.31

NAPROXEN 250 MG TABLET 1.88

NAPROXEN 375 MG TAB.DR 2.70

NAPROXEN 375 MG TABLET 2.09

NAPROXEN 500 MG TAB.DR 2.40

NAPROXEN 500 MG TABLET 1.36

NAPROXEN SOD 220MG TAB 1.28

NAPROXEN SOD 550MG TAB 4.67

NARCAN 4MG NASAL SPRAY 106.50

NATEGLINIDE 120 MG TAB 3.17

NATEGLINIDE 60 MG TABLET 3.05

NATRIURETIC PEPTIDE 327.50

NAVICUALR VW ONLY LT 272.50

NAVICUALR VW ONLY LT 272.50

NAVICUALR VW ONLY LT 272.50

NAVICULAR VW ONLY RT 272.50

NAVICULAR VW ONLY RT 272.50

NAVICULAR VW ONLY RT 272.50

NDL BX/EXC LYMPH NODE 3,740.00

Page 82: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

NDL BX/EXC LYMPH NODE 881.50

NDL BX/EXC LYMPH NODE 881.50

NDL BX/EXC LYMPH NODE 881.50

NEBIVOLOL HCL 5 MG TAB 11.34

NEBULIZER TREATMENT 529.00

NEFAZODONE 100 MG TAB 5.90

NEG PRESS </=50 SQ C 855.00

NEG PRESS >50 SQ CM 882.50

NEG PRESSURE > 50 CM 882.50

NEG PRESSURE 50CM OR < 514.50

NEG PRESSURE DISP < 50 CM 855.00

NEG PRESSURE DISP > 50 CM 855.00

NEISSERIA GONORRHEAE 311.50

NEOMYCIN SULF 500MG TAB 2.46

NEONATAL STD PPN 240ML 355.00

NEOSPORIN GU 1 ML AMPUL 24.11

NEOSPORIN OINTMENT 15GM 10.92

NEOSPORIN OPHTH 10ML 87.95

NEOSPORIN OPHTH OIN 3.5G 74.61

NEOSPORIN PLUS CR 15GM 12.18

NEOSTIGMINE 1MG/ML 1OML 78.38

NEOSTIGMINE 0.5MG/ML INJ 129.96

NEPAFENAC 0.1% OP 3ML 462.86

NEPHELOMETRY EACH A 121.00

NEPHROCAP CAP 2.54

NEPHROSTOGRAM 1,708.00

NERVE COND 11-12 STDS 1,261.50

NERVE COND 1-2 STDS 387.00

NERVE COND 13+ STDS 1,261.50

NERVE COND 3-4 STDS 706.50

NERVE COND 5-6 STDS 706.50

NERVE COND 7-8 STDS 706.50

NERVE COND 9-10 STDS 1,261.50

NEURO MS RE-ED 15/MIN 122.00

NEUROMUSC REEDUCT 15M OT 105.50

NEUROMYELITIS OPTICA 102.50

NEURONAL NUCLEAR ABS 102.50

NEUTRA-PHOS PCAKET 1.96

NEUTROPHIL AB 145.50

NEWBORN RESUSCITATION 1,455.50

NEWBORN RESUSCITATION 1,455.50

NEXPLANON 68MG IMPLANT 1,517.07

NIACIN 100 MG TABLET 1.12

NIACIN 250 MG TABLET.ER 1.41

NIACIN 500 MG TAB.ER.24H 11.24

NIACIN 750 MG TAB.ER 11.54

NICARDIPIN 20MG/200ML IJ 173.21

NICARDIPINE 25MG/10ML 7.92

NICKEL, BLOOD 95.50

NICOTINE 10 MG/1 CARTRID 3.58

Page 83: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

NICOTINE 10 MG/6 CARTRID 277.44

NICOTINE 14 MG PATCH 3.83

NICOTINE 21 MG PATCH 3.83

NICOTINE 7 MG PATCH 3.13

NICOTINE POLACR 2MG GUM 1.61

NIFEDIPINE 10 MG CAPSULE 2.32

NIFEDIPINE 20 MG CAP 3.40

NIFEDIPINE 30 MG TAB.ER 2.42

NIFEDIPINE 60 MG TAB.ER 3.47

NIFEDIPINE 90 MG TAB.ER 3.71

NIMODIPINE 30 MG CAP 24.73

NITROFURAN MAC 100MG CAP 10.60

NITROFURAN MAC 50 MG CAP 5.52

NITROGLYCERI PATCH 0.1MG 2.96

NITROGLYCERI PATCH 0.2MG 2.72

NITROGLYCERI PATCH 0.4MG 3.27

NITROGLYCERIN 0.3 MG TAB 1.79

NITROGLYCERIN 0.4 MG TAB 53.09

NITROGLYCERIN 2% OIN 30G 55.03

NITROGLYCERIN 50 MG/10ML 23.50

NITROGLYCERIN OINT 1GM 3.61

NITROPRUSSIDE 50MG/2ML 511.20

NIVOLUMAB 1 MG DOS 10ML 5,205.71

NIVOLUMAB 1 MG DOSE 4 ML 2,082.28

NIVOLUMAB 1MG, 240 12,493.72

NM ABSCESS LCL SPECT 3,019.50

NM ABSCESS LCL W BODY 3,414.00

NM ACUTE GI BLOOD LOSS 1,488.50

NM BONE 3 PHASE 1,489.00

NM BONE LIMITED 1,489.00

NM BONE MULTIPLE 1,489.00

NM BONE SPECT 1,489.00

NM BONE WHOLE BODY 1,489.00

NM BRAIN < 4 STATIC 992.00

NM BRAIN VASC FLOW 2,450.50

NM CISTERNOGRAPHY 3,414.00

NM GASTRESOPHAG RFLX 1,488.50

NM GASTRIC EMPTYING 1,488.50

NM INTESTINE IMAGING 1,488.50

NM KDNEY FLW&FNC W/RX 1,917.00

NM KDNEY FLW+FNC W/RX 1,917.00

NM KDNEY SCAN FLW&FNC WO 1,916.00

NM KIDNEY FLW&FNC MUL 1,917.00

NM KIDNEY FLW+FNC MUL 1,917.00

NM KIDNEY SCAN W/FLOW 1,917.00

NM LIVER 3,414.00

NM LIVER & SPLEEN 1,712.50

NM LIVER +SPLEEN 1,712.50

NM LOCAL INFL PRCS LTD 3,414.00

NM MUGA R/S SINGLE 1,761.00

Page 84: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

NM MYOCARDIAL PERFREST 3,414.00

NM MYOCRD PERF R/S MULT 5,302.00

NM MYOCRD SPECT R/S MULT 5,302.00

NM PULM PERF PARTIC 1,406.50

NM TESTICULAR W/FLOW 1,917.00

NM THYROID METS W BDY 1,759.50

NM THYROID SCAN W/FL 992.00

NM THYROID SCN UP/STIM V 1,319.00

NM THYROID UPTAKE W STIM 992.00

NM TUM LC WB 2/MORE DAYS 5,320.00

NM TUMOR LC WHBD SGL DAY 3,414.00

NM TUMOR LCL SPECT 3,019.50

NM TUMOR LOCAL LTD 1,759.50

NM TUMOR LOCAL MULT 1,759.50

NON EXTREMITY 351.00

NON SELECT DEBRD< 480.00

NOREPINEPHRIN 1MG/ML 4ML 34.48

NOREPINEPHRINE 4MG/250ML 43.24

NOROVIRUS 1 BY PCR 311.50

NORTRIPTYLINE 119.00

NORTRIPTYLINE 10MG CAP 1.66

NORTRIPTYLINE 25MG CAP 1.70

Novolog 70-30UNIT/ML 10M 511.40

NPLATE 10MCG DOSE 3,235.22

NPMI GENE ANLYS 12 VARIANTS 1,608.00

NRAS VAR IN EXON 2/3 932.00

NS 1000 ML 3.50

NS 250 ML 3.00

NS 500 ML 3.00

N-TELOPEPTIDECROSS L 166.00

NTG 25 MG/250 ML BOTTLE 19.43

NTG 50 MG/250 ML BOTTLE 20.28

NUCLEOTIDASE 5 108.00

NURSERY BED 1,103.50

NURSERY LEVEL 1 1,103.50

NURSERY LEVEL 2 1,434.50

NURSERY LEVEL 3 1,655.00

NURSERY LEVEL 4 1,765.50

NUSHIELD PER SQ CM 222.00

NYSTAT/TRIAMCIN OINT 15G 158.95

NYSTATIN 100KUNIT/ML 5ML 2.28

NYSTATIN 100KUNIT/ML 60M 22.44

NYSTATIN CREAM 15GM 23.05

NYSTATIN OINT 15GM 22.30

NYSTATIN POWDER 53.19

NYSTATIN/TRIAMCIN CR 15G 158.95

O&P EXAM FECAL 79.50

O+P EXAM FECAL 79.50

OAK 46.50

OASIS PER 1 SQ CM 10.50

Page 85: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OASIS TRI MATRIX 1SQCM 40.50

OASIS WOUND MAT P SQ CEN 4.50

OASIS WOUND MAT P SQ CEN 80.50

OASIS WOUND MAT P SQ CEN 4.50

OASIS WOUND MAT P SQ CEN 13.50

OASIS WOUND MAT P SQ CEN 8.50

OBINUTUZUMAB 10 MG DOSE 126.24

OBINUTUZUMAB 10MG 126.24

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OBS PER HOUR 73.50

OCC BLD PEROX OTH SOURCE 31.50

OCCLUSIVE DEVICE VEN/ART 313.50

OCCULT BLD FECES 1-3 27.50

OCCULT BLD FECES 1-3 29.00

OCCULT BLD FECES 1-3 29.00

OCCULT BLD FECES 1-3 TESTS 29.00

OCCULT BLD SCN 3 SPEC 57.50

OCCULT BLD SCN 3 SPEC 31.50

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 17.00

OCCULT BLOOD FECES 1 29.00

OCCULT BLOOD FECES 1 29.00

OCCULT BLOOD FECES 1 29.00

OCCULT BLOOD FECES 1 29.00

OCCULT BLOODSTOOL 29.00

OCTAFLUOROPROPANE MCS ML 6.50

OCTAGAM 500MG DOSE 10 2,900.16

OCTAGAM 500MG DOSE 5 1,394.33

OCTREOTIDE 25MCG DO 1000 846.69

OCTREOTIDE 25MCG DOS 100 9.58

OCTREOTIDE 25MCG DOS 500 84.67

OCTREOTIDE 25MCG DOSE 50 16.40

OCTREOTIDE 25MCG/0.05ML 2.66

OCTREOTIDE DEPO 1MG DOSE 10,881.99

Ocular dev,intraop,d-r C 2,116.00

Ocular dev,intraop,d-r C 172.50

Ocular imp,aq drain de C 2,667.00

Page 86: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OCULAR IMPLANT 276.00

OCULAR IMPLANT 1,654.00

OCUVITE PRESERVISION TAB 1.27

OCUVITE TABLET 1.25

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 99.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 59.50

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 59.50

OFFICE/OUTPT EST PT 1 57.00

OFFICE/OUTPT EST PT 1 57.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 57.00

OFFICE/OUTPT EST PT 1 31.50

OFFICE/OUTPT EST PT 1 153.50

OFFICE/OUTPT EST PT 1 214.00

OFFICE/OUTPT EST PT 1 212.00

OFFICE/OUTPT EST PT 1 33.00

OFFICE/OUTPT EST PT 1 152.00

OFFICE/OUTPT EST PT 1 214.00

OFFICE/OUTPT EST PT 1 97.50

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 178.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 178.00

OFFICE/OUTPT EST PT 2 178.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 234.00

Page 87: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OFFICE/OUTPT EST PT 2 254.00

OFFICE/OUTPT EST PT 2 155.00

OFFICE/OUTPT EST PT 2 254.00

OFFICE/OUTPT EST PT 2 187.00

OFFICE/OUTPT EST PT 2 238.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 213.50

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 213.50

OFFICE/OUTPT EST PT 3 213.50

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 224.00

OFFICE/OUTPT EST PT 3 261.50

OFFICE/OUTPT EST PT 3 264.00

OFFICE/OUTPT EST PT 3 254.00

OFFICE/OUTPT EST PT 3 171.50

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 318.50

OFFICE/OUTPT EST PT 4 318.50

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 4 318.50

OFFICE/OUTPT EST PT 4 318.50

OFFICE/OUTPT EST PT 4 348.50

OFFICE/OUTPT EST PT 4 337.50

Page 88: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OFFICE/OUTPT EST PT 4 351.50

OFFICE/OUTPT EST PT 4 334.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 432.50

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 432.50

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 454.00

OFFICE/OUTPT EST PT 5 432.50

OFFICE/OUTPT EST PT 5 432.50

OFFICE/OUTPT EST PT 5 454.50

OFFICE/OUTPT EST PT 5 454.50

OFFICE/OUTPT EST PT 5 401.00

OFFICE/OUTPT EST PT 5 565.50

OFFICE/OUTPT EST PT 5 454.50

OFFICE/OUTPT NEW PT 1 114.50

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 114.50

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 99.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 109.50

OFFICE/OUTPT NEW PT 1 127.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 133.00

OFFICE/OUTPT NEW PT 1 114.50

OFFICE/OUTPT NEW PT 1 127.00

OFFICE/OUTPT NEW PT 1 214.00

OFFICE/OUTPT NEW PT 1 97.50

OFFICE/OUTPT NEW PT 1 133.50

OFFICE/OUTPT NEW PT 1 214.00

OFFICE/OUTPT NEW PT 1 133.00

Page 89: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 218.50

OFFICE/OUTPT NEW PT 2 218.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 218.50

OFFICE/OUTPT NEW PT 2 218.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 236.00

OFFICE/OUTPT NEW PT 2 155.00

OFFICE/OUTPT NEW PT 2 238.00

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 2 229.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 321.00

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 321.00

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 321.00

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 321.00

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 264.00

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 3 171.50

OFFICE/OUTPT NEW PT 3 337.50

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

Page 90: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 547.50

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 493.00

OFFICE/OUTPT NEW PT 4 493.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 4 493.00

OFFICE/OUTPT NEW PT 4 493.00

OFFICE/OUTPT NEW PT 4 548.00

OFFICE/OUTPT NEW PT 4 351.50

OFFICE/OUTPT NEW PT 4 548.00

OFFICE/OUTPT NEW PT 4 518.00

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 622.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 564.00

OFFICE/OUTPT NEW PT 5 537.50

OFFICE/OUTPT NEW PT 5 564.00

OFFICE/OUTPT NEW PT 5 564.00

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 653.50

OFFICE/OUTPT NEW PT 5 622.50

OFFICE/OUTPT NEW PT 5 654.00

OFFICE/OUTPT NEW PT 5 654.00

OFFICE/OUTPT NEW PT 5 401.00

OFFICE/OUTPT NEW PT 5 654.00

OFLOXACIN 0.3% OP 5ML 201.33

OLANZAPINE 10 MG VIAL 73.16

OLANZAPINE 10MG TAB.RAPD 37.59

OLANZAPINE 15 MG TAB 42.42

OLANZAPINE 2.5 MG TABLET 16.70

OLANZAPINE 20 MG TAB 56.56

OLANZAPINE 5MG TAB.RAPDI 23.46

Page 91: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OLANZAPINE 7.5 MG TAB 21.58

OLIGOCLONAL BANDS CS 178.50

OLMESAR/HCTZ 20-12.5 TAB 11.78

OLMESAR/HCTZ 40-25 TAB 16.17

OLMESARTAN 20 MG TAB 13.88

OLMESARTAN 40 MG TAB 16.17

OLMESARTAN 5 MG TAB 11.78

OLOPATADINE HCL EYE 5ML 467.17

OMEGA-3 1GM CAP 4.75

OMEP/SOD BICARB 40MG PAK 172.32

ONC-PUMP CATH SUPP 58.50

ONDANSETRON 1MG DOSE 4 6.64

ONDANSETRON 1 MG DOSE 40 20.42

ONDANSETRON 4MG TAB.RAPD 32.82

ONDANSETRON 8MG TAB.RAPD 52.72

OP VISIT LEVEL 2 EST 178.00

OP VISIT LEVEL 2 EST 187.00

OP VISIT LEVEL 2 EST 155.00

OP VISIT LEVEL 2 EST 238.00

OP VISIT LEVEL 2 EST 254.00

OP VISIT LEVEL 2 EST 254.00

OP VISIT LEVEL 3 EST 213.50

OP VISIT LEVEL 3 EST 261.50

OP VISIT LEVEL 3 EST 254.00

OP VISIT LEVEL 3 EST 171.50

OP VISIT LEVEL 3 EST 264.00

OPEN TRT ART FRAC W/FIX 7,681.00

OPI SCREEN 186.50

OPIATE CONFIRMATION 180.00

OPIUM/BELLADONNA SUPP 47.50

OPS-CATH EXTRAVAS AB 9,453.50

OPS-VISICOIL MARKER 417.00

ORA PLUS ORAL.SUSP 37.70

ORA SWEET LIQUID 37.70

ORA VERIFEYE 105.00

ORA VERIFEYE 105.00

Orajel 12.12

OR-BONE GRAFT GEL 1CC 549.00

OR-BONE GRANULES INTER 1,843.00

OR-CATHETERBALLN DILAT 741.00

OR-EYE SHUNT GLAUC EXP 2,408.00

ORGANIC ACIDS URINE 146.00

OR-GRAFT/CORMATRIX CMsq 125.50

ORITAVANCIN 10 MG DOSE 1,947.52

OR-LENS INTRAOCC MA30 707.50

OR-LENS INTRAOCC MISC 1,324.00

OR-MACROPLASTIQUE IMP 1,908.50

OR-ON-Q PAIN MGMT 1,815.50

ORPHENADRIN 100MG TAB.ER 3.28

ORPHENADRINE 60 MG DOSE 31.52

Page 92: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OR-RADIESSE VOICE GEL IM 1,835.00

OR-SEPRA FILM 3,309.50

OR-SEPRA FILM BIORESOR 482.50

ORTH MGT TRAIN EA 15M OT 138.50

ORTH/PROSTH CHECKOUT/15 MINS 142.00

ORTH/PROSTH CHECKOUT/15MIN 142.00

ORTHOTIC TRAINING/15 138.50

OSCAL 500 W/ VIT D TAB 1.23

OSELTAMIVIR 30MG CAP 19.68

OSELTAMIVIR 6MG/ML SUSP 232.67

OSELTAMIVIR 75MG CAP 23.73

OSMOLALITY BLD 64.00

OSMOLALITY UR 66.00

OSPTH MNP TRT OMT 1-2 BD 97.50

OSPTH MNP TRT OMT 1-2 BD 97.50

OSPTH MNP TRT OMT 1-2 BD 92.50

OSPTH MNP TRT OMT 1-2 BD 92.50

OSSICULA IMPLANT 4.2MM 551.50

OSSICULA IMPLANT 8MM 661.50

OSTEO OTHER PHAL/ANY TOE 4,754.00

OSTEO OTHER THAN 1ST MET 4,754.00

OSTEO SHORT/ANG/ROT COR 4,754.00

OSTEO TAR, NOT CALC/TAL 9,862.00

OSTEO W/WO LEN/SH/ANG 4,754.00

OSTEOPATH MANJ 1-2 REGIN 97.50

OSTEOTOMY TALUS 4,754.00

OT ATTEN CURRENT STAT 0 0.50

OT ATTEN CURRENT STAT 1 0.50

OT ATTEN CURRENT STAT 20 0.50

OT ATTEN CURRENT STAT 40 0.50

OT ATTEN CURRENT STAT 60 0.50

OT ATTEN CURRENT STAT 80 0.50

OT ATTEN CURRNT STAT 100 0.50

OT ATTEN DC STAT 0 0.50

OT ATTEN DC STAT 1 0.50

OT ATTEN DC STAT 100 0.50

OT ATTEN DC STAT 20 0.50

OT ATTEN DC STAT 40 0.50

OT ATTEN DC STAT 60 0.50

OT ATTEN DC STAT 80 0.50

OT ATTEN GOAL STAT 0 0.50

OT ATTEN GOAL STAT 1 0.50

OT ATTEN GOAL STAT 100 0.50

OT ATTEN GOAL STAT 20 0.50

OT ATTEN GOAL STAT 40 0.50

OT ATTEN GOAL STAT 60 0.50

OT ATTEN GOAL STAT 80 0.50

OT BODY POS CUR STAT 100 0.50

OT BODY POS CURR STAT 0 0.50

OT BODY POS CURR STAT 1 0.50

Page 93: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OT BODY POS CURR STAT 20 0.50

OT BODY POS CURR STAT 40 0.50

OT BODY POS CURR STAT 60 0.50

OT BODY POS CURR STAT 80 0.50

OT BODY POS DC STAT 0 0.50

OT BODY POS DC STAT 1 0.50

OT BODY POS DC STAT 100 0.50

OT BODY POS DC STAT 20 0.50

OT BODY POS DC STAT 40 0.50

OT BODY POS DC STAT 60 0.50

OT BODY POS DC STAT 80 0.50

OT BODY POS GL STAT 100 0.50

OT BODY POS GOAL STAT 0 0.50

OT BODY POS GOAL STAT 1 0.50

OT BODY POS GOAL STAT 20 0.50

OT BODY POS GOAL STAT 40 0.50

OT BODY POS GOAL STAT 60 0.50

OT BODY POS GOAL STAT 80 0.50

OT CARRY CURR STAT 100 0.50

OT CARRY CURRENT STAT 0 0.50

OT CARRY CURRENT STAT 1 0.50

OT CARRY CURRENT STAT 20 0.50

OT CARRY CURRENT STAT 40 0.50

OT CARRY CURRENT STAT 60 0.50

OT CARRY CURRENT STAT 80 0.50

OT CARRY DC STAT 0 0.50

OT CARRY DC STAT 1 0.50

OT CARRY DC STAT 100 0.50

OT CARRY DC STAT 20 0.50

OT CARRY DC STAT 40 0.50

OT CARRY DC STAT 60 0.50

OT CARRY DC STAT 80 0.50

OT CARRY GOAL STAT 0 1.50

OT CARRY GOAL STAT 1 0.50

OT CARRY GOAL STAT 100 0.50

OT CARRY GOAL STAT 20 0.50

OT CARRY GOAL STAT 40 0.50

OT CARRY GOAL STAT 60 0.50

OT CARRY GOAL STAT 80 0.50

OT MEMORY CURR STAT 100 0.50

OT MEMORY CURR STAT 20 0.50

OT MEMORY CURR STAT 40 0.50

OT MEMORY CURR STAT 60 0.50

OT MEMORY CURR STAT 80 0.50

OT MEMORY CURRENT STAT 0 0.50

OT MEMORY CURRENT STAT 1 0.50

OT MEMORY DC STAT 0 0.50

OT MEMORY DC STAT 1 0.50

OT MEMORY DC STAT 100 0.50

OT MEMORY DC STAT 20 0.50

Page 94: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OT MEMORY DC STAT 40 0.50

OT MEMORY DC STAT 60 0.50

OT MEMORY DC STAT 80 0.50

OT MEMORY GOAL STAT 0 0.50

OT MEMORY GOAL STAT 1 0.50

OT MEMORY GOAL STAT 100 0.50

OT MEMORY GOAL STAT 20 0.50

OT MEMORY GOAL STAT 40 0.50

OT MEMORY GOAL STAT 60 0.50

OT MEMORY GOAL STAT 80 0.50

OT MOBILITY CUR STAT 100 0.50

OT MOBILITY CURR STAT 0 0.50

OT MOBILITY CURR STAT 1 0.50

OT MOBILITY CURR STAT 20 0.50

OT MOBILITY CURR STAT 40 0.50

OT MOBILITY CURR STAT 60 0.50

OT MOBILITY CURR STAT 80 0.50

OT MOBILITY DC STAT 0 0.50

OT MOBILITY DC STAT 1 0.50

OT MOBILITY DC STAT 100 0.50

OT MOBILITY DC STAT 20 0.50

OT MOBILITY DC STAT 40 0.50

OT MOBILITY DC STAT 60 0.50

OT MOBILITY DC STAT 80 0.50

OT MOBILITY GL STAT 100 0.50

OT MOBILITY GOAL STAT 0 0.50

OT MOBILITY GOAL STAT 1 0.50

OT MOBILITY GOAL STAT 20 0.50

OT MOBILITY GOAL STAT 40 0.50

OT MOBILITY GOAL STAT 60 0.50

OT MOBILITY GOAL STAT 80 0.50

OT OTH PT/OT CUR STA 100 0.50

OT OTH PT/OT CUR STAT 20 0.50

OT OTH PT/OT CUR STAT 40 0.50

OT OTH PT/OT CUR STAT 60 0.50

OT OTH PT/OT CUR STAT 80 0.50

OT OTH PT/OT CURR STAT 0 0.50

OT OTH PT/OT CURR STAT 1 0.50

OT OTH PT/OT DC STAT 0 0.50

OT OTH PT/OT DC STAT 1 0.50

OT OTH PT/OT DC STAT 100 0.50

OT OTH PT/OT DC STAT 20 0.50

OT OTH PT/OT DC STAT 40 0.50

OT OTH PT/OT DC STAT 60 0.50

OT OTH PT/OT DC STAT 80 0.50

OT OTH PT/OT GL STAT 100 0.50

OT OTH PT/OT GL STAT 20 0.50

OT OTH PT/OT GL STAT 40 0.50

OT OTH PT/OT GL STAT 60 0.50

OT OTH PT/OT GL STAT 80 0.50

Page 95: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OT OTH PT/OT GOAL STAT 0 0.50

OT OTH PT/OT GOAL STAT 1 0.50

OT SELF CARE CUR STAT 20 0.50

OT SELF CARE CUR STAT 40 0.50

OT SELF CARE CUR STAT 60 0.50

OT SELF CARE CUR STAT 80 0.50

OT SELF CARE CURR STAT 0 0.50

OT SELF CARE CURR STAT 1 0.50

OT SELF CARE DC STAT 0 0.50

OT SELF CARE DC STAT 1 0.50

OT SELF CARE DC STAT 100 0.50

OT SELF CARE DC STAT 20 0.50

OT SELF CARE DC STAT 40 0.50

OT SELF CARE DC STAT 60 0.50

OT SELF CARE DC STAT 80 0.50

OT SELF CARE GL STAT 100 0.50

OT SELF CARE GOAL STAT 0 0.50

OT SELF CARE GOAL STAT 1 0.50

OT SLF CARE CUR STAT 100 0.50

OT SLF CARE GOAL STAT 20 0.50

OT SLF CARE GOAL STAT 40 0.50

OT SLF CARE GOAL STAT 60 0.50

OT SLF CARE GOAL STAT 80 0.50

OT SUB PT/OT CUR STA 100 0.50

OT SUB PT/OT CUR STAT 20 0.50

OT SUB PT/OT CUR STAT 40 0.50

OT SUB PT/OT CUR STAT 60 0.50

OT SUB PT/OT CUR STAT 80 0.50

OT SUB PT/OT CURR STAT 0 0.50

OT SUB PT/OT CURR STAT 1 0.50

OT SUB PT/OT DC STAT 0 0.50

OT SUB PT/OT DC STAT 1 0.50

OT SUB PT/OT DC STAT 100 0.50

OT SUB PT/OT DC STAT 20 0.50

OT SUB PT/OT DC STAT 40 0.50

OT SUB PT/OT DC STAT 60 0.50

OT SUB PT/OT DC STAT 80 0.50

OT SUB PT/OT GL STAT 100 0.50

OT SUB PT/OT GL STAT 20 0.50

OT SUB PT/OT GL STAT 40 0.50

OT SUB PT/OT GL STAT 60 0.50

OT SUB PT/OT GL STAT 80 0.50

OT SUB PT/OT GOAL STAT 0 0.50

OT SUB PT/OT GOAL STAT 1 0.50

OT TX EVAL COMP 717.50

OT TX EVAL LOW 274.50

OT TX EVAL MOD 497.00

OUCHTERLONY GEL DIFFUS 73.21

OUTPT NURSE PROCEDUR 1,288.50

OVERNIGHT DX PULSE OX 368.49

Page 96: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

OXALATE 124.00

OXALIPLATIN 0.5MG DO 100 195.60

OXALIPLATIN 0.5MG DOS 50 97.80

OXAZEPAM 10 MG CAP 2.34

OXAZEPAM 15 MG CAP 2.55

OXCARBAZEPINE 150 MG TAB 2.63

OXCARBAZEPINE 300 MG TAB 3.85

OXCARBAZEPINE 600 MG TAB 10.62

OXCARBAZEPINE QN 118.00

OXIDRONATE DX TO 30 MCI 75.00

OXYBUTYNIN 5 MG TAB 1.72

OXYBUTYNIN 5 MG TAB.ER 3.85

OXYBUTYNIN PATCH 3.9 MG 144.81

OXYCODONE 10 MG TAB.ER 6.06

OXYCODONE 20 MG TAB.ER 13.20

OXYCODONE 20MG/ML PO 1ML 525.12

OXYCODONE 40 MG TAB.ER 21.37

OXYCODONE 5MG/5ML PO 5ML 12.58

OXYCODONE IR 15 MG TAB 2.91

OXYCODONE IR 5 MG TABLET 1.72

OXYCODONE/APAP 10-325 T 4.65

OXYCODONE/APAP 5-325 TAB 2.47

OXYCODONE/APAP 7.5-325 T 3.82

OXYCODONE/ASA 5-325 TAB 2.72

OXYGEN SAT ONLY DM 78.00

OXYMETAZOL 0.05% SPR 15M 12.48

OXYMORPHONE 10MG TAB.ER 5.89

OXYMORPHONE 30MG TAB.ER 23.99

OXYMORPHONE 5MG TAB.ER 4.24

OXYTO/D5LR 20UNIT/1000ML 22.87

OXYTOCI/LR 40UNIT/1000ML 33.11

OXYTOCI/NS 20UNIT/1000ML 25.02

OXYTOCIN 10 UNIT DOSE 7.52

P.NOTATUM 46.50

PACLITAXEL 1MG DOSE 84.48

PACLITAXEL PB 1MG DOSE 2,695.38

PAIN MGT POSTOP P 1,434.50

PALIPERIDONE 1MG DOSE156 2,842.00

PALIPERIDONE 1MG DOSE234 4,262.88

PALIPERIDONE 3 MG TAB 57.78

PALIVIZUMAB 50 MG/0.5 ML 2,553.10

PAMIDRONATE 30MG DOSE 30 46.01

PAMIDRONATE 30MG DOSE 90 61.09

PANITUMUMAB 10MGD/100MGV 2,392.30

PANITUMUMAB 10MGD/400MGV 9,569.22

PANTOPRAZOLE 40 MG VIAL 22.70

PANTOPRAZOLE 20MG TAB.DR 5.09

PANTOPRAZOLE 40MG TAB.DR 1.55

PAP SMEAR 50.00

PAPAVERINE 60 MG DOSE 60.96

Page 97: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PAPDX TCSC NORSC TH 191.00

PAPDX TCSC NRSC BETH 102.00

PARACENTESIS W IMAGE 2,070.00

PARACENTESIS W IMAGE 2,070.00

PARAFFIN BATH OT 26.00

PARAFFIN BATH PT 69.50

PARAINFLUENZA I 107.00

PARAINFLUENZA II 114.50

PARAINFLUENZA III 114.50

PARATHYROID IMAGING W 1,035.50

PARENTERAL AA 10% 500 ML 80.56

PARICALCITOL 1 MCG CAP 13.50

PARICALCITOL 5 MCG DOSE 23.68

PARIETAL CELL AB 107.50

PAROXETINE 10MG TAB 3.77

PAROXETINE 12.5MG TAB.ER 11.08

PAROXETINE 20MG TAB 3.89

PAROXETINE 25MG TAB.ER 11.32

PAROXETINE 30MG TAB 3.83

PARVOVIRUS B19 IGG 133.50

PARVOVIRUS B19 IGM 133.50

PATH CONS EXTENDED REF 621.00

PATH CONS PREP SLIDES 648.50

PATH CONSULT FS 1 SPEC 631.50

PATH CONSULT FS EA ADDTL 450.50

PATH CONSULT INTRAOP 114.50

PATH CONSULT REF SLIDES 648.50

PATH DECALCIFICATION 104.50

Patient progr, neurostim 2,947.00

PCA3 803.50

PCP CONFIRMATION 130.50

PCU ROOM 1,986.00

PEANUT 46.50

PECAN HICKORY 46.50

PED MV COMB DROP 50ML 16.84

PED MV/IRON DROP 50ML 16.84

PEGFILGRAS 6MG DOSE 11,097.07

PEGFILGRAS 6MG DOSE KIT 12,187.95

PEMBROLIZUMAB 100MG/4ML 9,231.15

PEMETREXED DISOD 500MG 6,748.69

PEN G 1,000,000 26.19

PEN G 2.5MIL UNIT/100ML 86.28

PEN G 20,000,000 UNIT 86.28

PEN G 5MIL UNIT/100ML 86.28

PEN G BENZ 1.2M UNIT/2ML 268.15

PEN NEEDLE, DIS.NEEDLE 1.58

PEN VK 250 MG/5 ML SOL 15.74

PEN VK 250MG TAB 1.79

PENCICLOVIR CREAM 5GM 1,383.63

PENICILLIN G Ben 600000U 268.15

Page 98: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PENICILLIN VK 500MG TAB 2.27

PENILE INJECTION 715.00

PENTAMIDINE 300MG NEB 284.38

PENTAZO/NALOX 50-0.5 TAB 4.40

PENTETATE DX TO 25 MCI 163.50

PENTOSAN 100 MG CAP 15.45

PENTOXIFYLL 400MG TAB.ER 2.60

PERC D-E COR REVASC 13,505.00

PERC D-E COR STENT A 13,505.00

PERC DRUG EL COR STNT AD 32,221.00

PERC DRUG EL COR STNT SL 32,221.00

PERC DRUG-EL COR STE 13,505.00

PERC NEPHROSTOMY PROC 4,730.00

PERC TRANS CORON THROM 9,647.00

PERC TRANSCATH INTRC 12,219.50

PERC TRANSCATH STENT 12,219.50

PERFORMANCE/MEASURE/1 112.50

PERITONEAL-VENOUS SHU 1,140.50

PERMETHRIN CREAM 60GM 168.70

PERMETHRIN SPRAY 118 ML 11.76

PEROXIDE 3% 473ML 2.10

PERPHENAZINE 2 MG TAB 2.85

PERPHENAZINE 4 MG TAB 2.89

PERTECHNETATE DX PER MCI 2.00

PERTUZUMAB 1MG DOSE 8,541.40

PET BRAIN IMAGING 4,512.50

PET LTD AREA+FDG 4,512.50

PET SKULL TO MID THIG 4,512.50

PET WHOLE BODY 4,512.50

PETROLATUM 30GM OINT 4.38

PETROLATUM OINT 454GM 45.16

PHENAZOPYRIDINE 100MG TA 3.80

PHENOBARB 10MG/ML NB DIL 35.44

PHENOBARB 20MG/5ML ELIX 2.16

PHENOBARBITAL 78.00

PHENOBARBITAL 120MG DOSE 96.50

PHENOBARBITAL 16.2MG TAB 1.79

PHENOBARBITAL 32.4MG TAB 1.95

PHENOBARBITAL 64.8MG TAB 1.94

PHENOBARBITAL 65MG DO 35.44

PHENOBARBITAL 65MG DOSE 35.44

PHENOBARBITAL 97.2MG TAB 2.29

PHENOBARTBITOL 78.00

PHENOL SPRAY 177ML 4.72

PHENOL 100 ML LIQUID 142.99

PHENYLEPHRIN 10MG/ML 5ML 37.60

PHENYLEPHRIN 10MG/ML 5ML 37.60

PHENYLEPHRIN 2.5% OP 2ML 153.36

PHENYLEPHRINE 0.25% 15ML 10.54

PHENYLEPHRINE 0.5% 15ML 10.54

Page 99: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PHENYLEPHRINE 1% 15ML 11.16

PHENYLEPHRINE 10 MG/ML 25.40

PHENYLEPHRINE 10% OP 5ML 68.16

PHENYLEPHRINE 500MCG/ML 11.14

PHENYLEPHRINE SUPP 1.35

PHENYTOIN 100 MG/4 ML PO 6.09

PHENYTOIN 100MG CAP 2.82

PHENYTOIN 50 MG DOSE 7.02

PHENYTOIN 50 MG TAB.CHEW 2.75

PHENYTOIN DILANT TOT QN 128.00

PHENYTOIN DILANTIN FR QN 133.00

PHFECAL 31.50

PHONOPHORESIS/15 MIN. 61.00

PHOSPHOLIPID ANTIBOD IGA 62.50

PHOSPHOLIPID ANTIBOD IGG 62.50

PHOSPHOLIPID ANTIBOD IGM 62.50

PHOSPHORUS BLD 46.00

PHOSPHORUS UR 50.50

PHP FAMILY W/PT 50 MINS 352.00

PHY TX EVAL HIGH COMPLEX 717.50

PHY TX EVAL LOW 274.50

PHY TX EVAL LOW COMPLEX 274.50

PHY TX EVAL MOD 497.00

PHYSICS CONSULT 518.50

PHYSICS CONSULT 518.50

PHYSICS CONTIN QA 388.50

PHYSOSTIGMINE 1MG/ML 2ML 63.22

PHYTONADIONE 1MG/0.5ML 38.34

PILOCARPINE 1% OP 15ML 139.96

PILOCARPINE 2% OP 15ML 143.15

PILOCARPINE 4% OP 15ML 150.08

PILOCARPINE HCL 5 MG TAB 2.78

PIMECROLIMUS 1% CR 30GM 480.73

PINWORM EXAM 40.00

PIOGLITAZONE 15 MG TAB 12.51

PIOGLITAZONE 30MG TAB 14.18

PIOGLITAZONE 45MG TAB 14.92

PIROXICAM 20 MG CAP 5.59

PKU SCREEN 49.00

PLACE RT DEVICE/MARK 3,368.50

PLASMA 1 DNR FRZ W/I 8HR 333.00

PLASMA 1 DNR FRZ W/I 8HR 206.00

PLASMA FRZ WITHIN 24 HRS 211.00

PLASMINOGEN 63.00

PLATELET AB DIRECT/I 111.00

PLATELET AGGREGATION 98.00

PLATELET ANTIBODIES 177.00

PLATELET AUTOMATED 43.50

PLATELET NEUTRALIZAT 160.00

PLATELET PHERESIS LR 2,283.50

Page 100: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PLTS PHER IRR EA UNIT 1,574.00

PLTS PHER LEUK RED EA UN 2,284.50

PLTS PHER LEUK RED EA UN 1,354.00

PMKR NOT SINGLE/DUAL 21,499.00

PMKR SING CHAMB NON RESP 7,516.50

Pmkr, single, rate-resp 9,823.00

Pmkr, single, rate-resp 19,013.00

Pmkr, single,rate-re C3 28,171.50

PML/RARALPHA TRANSLO 1,840.00

PNEUMOCOCCAL VACCINATION 105.50

PNEUMOCOCCAL VACCINE 105.50

PNEUMOCOCCAL VACCINE 424.50

PNEUMOCOCCAL VACCINE 105.50

PNEUMOCOCCAL VACCINE 404.50 PNEUMOCOCCAL VACCINE

PREVNAR 424.50

PNEUMOCOCCAL-13 VAC 306.59

PNEUMOCOCCAL-23 VAC 170.71

PNEUMOCYSTIS CARINII 107.00

PNEUMOGRAM 12-24HRS 1,261.50

PNEUMOVAX VACCINE 424.50

PNEUMOVAX VACCINE 424.50

PNEUMOVAX VACCINE AD 105.50

POLARIUS ULTRA STENT W/O 711.50

POLIO AB 51.00

POLYETH GLYCO 3350 238GM 17.05

POLYETH GLYCOL 3350 17GM 3.58

POLYMYXIN B 500,000UNIT 24.20

POLYSPORIN OP OINT 3.5gm 40.68

POLYTRIM OPHTH DROP 10ML 18.57

PORACTANT A 120MG/1.5 ML 728.28

PORACTANT A 240MG/3ML 1,436.05

PORPHOBILINOGEN UR QUAN 81.50

PORPHYRINS UR QN + FRACT 141.50

PORT FILM 371.00

PORT FILM 371.00

Port, indwelling,imp C1 2,438.00

Port, indwelling,imp C2 3,277.00

Port, indwelling,impla 3,277.00

POST INTRAOC LENS 626.00

POST INTRAOC LENS 376.50

POST INTRAOC LENS-ALCON 581.50

POST INTRAOC LENS-ALCON 1,654.00

POST INTRAOC LENS-ALCON 992.50

POST-OP KNEE BRAC 2,242.50

POT ACETATE 2MEQ/ML 20ML 5.18

POT CITRATE 10MEQ TAB.ER 3.86

POT CL 10MEQ/5ML VIAL 10.14

POT CL 10MEQ/5ML VIAL 10.14

POT CL 20MEQ PACKET 16.24

POT CL 20MEQ TAB.ER 2.03

Page 101: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

POT CL 20MEQ/10ML VIAL 9.06

POT CL 20MEQ/10ML VIAL 9.06

POT CL 20MEQ/15 ML LIQ 24.10

POT CL 40MEQ/20ML VIAL 10.46

POT CL 40MEQ/20ML VIAL 10.46

POT IODIDE/IODINE 473ML 47.80

POT PHOS 3 MMOL/ML 15ml 28.77

POTASSIUM BLD 45.00

POTASSIUM CL 10MEQ TAB 1.72

POTASSIUM CL 10MEQ/100ML 8.97

POTASSIUM CL 10MEQ/100ML 8.97

POTASSIUM CL 20MEQ/100ML 8.69

POTASSIUM CL 20MEQ/100ML 8.69

POTASSIUM CL 40MEQ/100ML 9.37

POTASSIUM CL 40MEQ/100ML 9.37

POTASSIUM CL 8MEQ TABLET 1.76

POTASSIUM MMOL/L URI 38.00

POTASSIUM PHOS 500MG TAB 1.62

POVID-IOD 10% SOL 237ML 4.34

POVID-IOD 5% OP DRP 30ML 20.32

POVID-IOD 7.5% SCR 473ML 14.00

POV-IODINE 10% OINT 30GM 3.49

PPI REPOS CARD VEN LEAD 11,025.00

PRALIDOXIME 1 GM DOSE 147.74

PRAMIPEXOLE 0.125 MG TAB 2.90

PRAMIPEXOLE 0.5MG TAB 13.23

PRAMIPEXOLE 1MG TAB 13.23

PRAMOXINE LOT 118ML 23.36

PRASTERONE DHEA 25MG TAB 1.26

PRASUGREL HCL 10 MG TAB 22.20

PRAVASTATIN 10 MG TAB 1.73

PRAVASTATIN 20 MG TAB 4.35

PRAVASTATIN 40MG TAB 5.39

PRAVASTATIN 80MG TAB 5.89

PRAZOSIN HCL 1 MG CAP 2.91

PRAZOSIN HCL 5 MG CAP 3.28

PRC D-E COR REVSC AMI SL 45,471.50

PRC D-E COR REVSC CHRN A 32,221.00

PRC D-E COR REVSC CHRN S 45,471.50

PRC D-EL COR RVSC CABG A 32,221.00

PRC D-EL COR RVSC CABG S 32,221.00

PRC D-EL COR STNT ATH AD 32,221.00

PRC D-EL COR STNT ATH SL 45,471.50

PREALBUMIN 140.50

PREDNISO 5MG/5ML PO 5ML 5.19

PREDNISOL ACET 1% OP 5ML 247.92

PREDNISOLONE 15MG/5ML PO 3.50

PREDNISONE 1 MG TABLET 1.38

PREDNISONE 10 MG TABLET 1.37

PREDNISONE 2.5 MG TAB 1.28

Page 102: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PREDNISONE 20 MG TABLET 1.38

PREDNISONE 5 MG TABLET 1.35

PREDNISONE 5 MG/5 ML SOL 2.45

PREDNISONE 50 MG TABLET 1.52

PREGABALIN 100MG CAPSULE 15.80

PREGABALIN 25 MG CAPSULE 14.41

PREGABALIN 50 MG CAPSULE 15.80

PREGABALIN 75 MG CAPSULE 15.80

PRENATAL VITAMIN TABLET 1.14

PREPARATION H 60 GM 20.85

PREPUTIAL STRETCHING 723.50

PRESUMPTIVE IDURINE 103.50

PRETREAT RBC S CHEM EA 90.50

PRETREAT RBC S ENZ EA 611.50

PRETREAT SERUM ABSORP EA 136.00

PRETREAT SERUM INHIB EA 367.00

PREVNAR PNEUMOCO VACC 424.50

PREVNAR PNEUMOCO VACC 424.50

PREVNAR PNEUMOCOCCAL 424.50

PREVPAC COMB (TMH) 15.85

Prgrm Stim/IV Infus 5,515.50

PRIMIDONE (MYSOLINE) QN 160.50

PRIMIDONE 250 MG TABLET 2.05

PRIMIDONE 50 MG TABLET 1.89

PRISMA SKIN SUBSTIT 34.00

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,324.00

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,324.00

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,191.50

PRIVATE ROOM 1,986.00

PRIVATE ROOM 1,191.50

Private Room 1,984.50

PRIVATE ROOM PSYCH 1,765.50

PROBENECID 500 MG TAB 2.25

PROCAIN WITH NAPA QN 161.50

PROCAINAMIDE 1000MG DOSE 93.21

PROCALCITONIN PCT 258.00

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 214.50

Page 103: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PROCEDURE CATEGORY 1 214.50

PROCEDURE CATEGORY 1 472.50

PROCEDURE CATEGORY 1 196.50

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 430.00

PROCEDURE CATEGORY 2 392.50

PROCEDURE CATEGORY 2 945.00

PROCEDURE CATEGORY 3 1,986.00

PROCEDURE CATEGORY 3 829.50

PROCEDURE LEVEL 1 11,025.00

PROCEDURE LEVEL 1 11,025.00

PROCEDURE LEVEL 2 16,537.50

PROCEDURE LEVEL 2 16,537.50

PROCEDURE LEVEL 3 22,050.00

PROCEDURE LEVEL 3 22,050.00

PROCHLORPERAZIN 10MG TAB 2.07

PROCHLORPERAZINE 5 MG DO 31.55

PROCHLORPERAZINE 5MG TAB 1.71

PROCTO FOAM 1% 10GM 242.76

PRODUCT SPLITTING 610.00

PROGEST GEL VAG 1.125G 44.33

PROGESTERONE 201.00

PROGESTERONE 100 MG CAP 5.13

PROGESTERONE FREE 120.00

PROINSULIN 172.00

PROLACTIN 186.50

PROMETH 6.25MG/5ML 5ML 1.42

PROMETH/DEXTROM SYR 5ML 1.33

PROMETHAZINE 12.5MG SUPP 23.21

PROMETHAZINE 12.5MG TAB 1.66

PROMETHAZINE 25 MG DOSE 3.32

PROMETHAZINE 25MG SUPP 23.21

PROMETHAZINE 25MG TAB 1.64

PROMETHAZINE/COD SYR 5ML 1.45

PROMOT METHYLATION ANLYS 606.00

PROPAFENONE (RYTHMOL 134.00

PROPAFENONE 150MG TAB 2.78

PROPAFENONE 225 MG TAB 3.43

PROPAFENONE 225MG CAP.ER 15.21

PROPAFENONE 325MG CAP.ER 11.50

PROPAFENONE 425MG CAP.ER 11.50

PROPANTHELIN BR 15MG TAB 4.10

PROPARACAIN 0.5% OP 15ML 62.31

Page 104: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PROPOFOL 10MG DOSE 100 53.25

PROPOFOL 10MG DOSE 20 18.20

PROPOFOL 10MG DOSE 50 29.75

PROPOXYPHENE MECON 186.50

PROPRAN 0.1 MG/ML NB DIL 21.00

PROPRANOLOL 10 MG TAB 1.45

PROPRANOLOL 120MG CAP.SA 4.08

PROPRANOLOL 160MG CAP.SA 5.72

PROPRANOLOL 1MG/ML INJ 15.50

PROPRANOLOL 20 MG TAB 1.61

PROPRANOLOL 20MG/5ML SOL 1.76

PROPRANOLOL 40MG TAB 2.40

PROPRANOLOL 60 MG CAP.SA 3.28

PROPRANOLOL 80MG CAP.SA 3.55

PROPYLTHIOURACIL 50MG TA 2.00

PROS SPEC AG (PSA) SCR 72.00

PROS SPEC AG (PSA) SCR 31.50

PROS SPEC AG (PSA) SCR 31.50

PROS SPEC AG (PSA) SCR 72.00

PROS SPEC AG (PSA) SCR 177.50

PROS SPEC AG (PSA) TOTAL 177.50

PROS SPEC AG FREE 177.50

PROSTATIC ACID PHO 93.00

PROSTH IMPL MISC 6,067.00

PROSTHESIS BREAST IMP 3,696.00

PROSTHESIS BREAST IMP 3,444.00

PROSTHESIS BREAST IMP 3,960.00

Prosthesis, breast, imp 2,904.50

Prosthesis, breast, imp 5,923.00

PROSTHETIC EYE OTHER 298.50

PROSTHETIC IMPLANT 1,704.50

PROSTHETIC TRAINING/15 MINS 121.00

PROTAMINE 10 MG DOSE 19.54

PROTEIN C ACTIVITY 133.50

PROTEIN C AG 116.50

PROTEIN CSF 33.00

PROTEIN ELECTRO SER 103.50

PROTEIN ELECTRO URINE 172.00

PROTEIN S ANTIGEN TOTAL 112.00

PROTEIN S FREE 148.00

PROTHROMBIN TIME 35.00

PROTHROMBIN TIME 35.00

PROTHROMBIN TIME 35.00

PROTHROMBIN TIME 35.50

PROTHROMBINE TIME 35.00

PROTIME 38.00

PRQ CARD STENT W/ANG 13,003.50

PRQ CARD STENT W/ANG 15,718.00

PSA (MEDICARE) 163.50

PSA (MEDICARE) 72.00

Page 105: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PSA (MEDICARE) 72.00

PSA (MEDICARE) 72.00

PSA (MEDICARE) 72.00

PSA SCREENING 72.00

PSEUDOEPHED 120MG TAB.ER 1.72

PSEUDOEPHEDRINE 30MG TAB 1.20

PSYLLIUM HUSK 0.52GM CAP 1.21

PSYLLIUM/ASPART 3.4GM 1.70

PT BODY POS CUR STAT 100 0.50

PT BODY POS CURR STAT 0 0.50

PT BODY POS CURR STAT 1 0.50

PT BODY POS CURR STAT 20 0.50

PT BODY POS CURR STAT 40 0.50

PT BODY POS CURR STAT 60 0.50

PT BODY POS CURR STAT 80 0.50

PT BODY POS DC STAT 0 0.50

PT BODY POS DC STAT 1 0.50

PT BODY POS DC STAT 100 0.50

PT BODY POS DC STAT 20 0.50

PT BODY POS DC STAT 40 0.50

PT BODY POS DC STAT 60 0.50

PT BODY POS DC STAT 80 0.50

PT BODY POS GL STAT 100 0.50

PT BODY POS GOAL STAT 0 0.50

PT BODY POS GOAL STAT 1 0.50

PT BODY POS GOAL STAT 20 0.50

PT BODY POS GOAL STAT 40 0.50

PT BODY POS GOAL STAT 60 0.50

PT BODY POS GOAL STAT 80 0.50

PT CARRY CURR STAT 100 0.50

PT CARRY CURRENT STAT 0 0.50

PT CARRY CURRENT STAT 1 0.50

PT CARRY CURRENT STAT 40 0.50

PT CARRY CURRENT STAT 60 0.50

PT CARRY CURRENT STAT 80 0.50

PT CARRY DC STAT 0 0.50

PT CARRY DC STAT 100 0.50

PT CARRY DC STAT 20 0.50

PT CARRY DC STAT 40 0.50

PT CARRY DC STAT 60 0.50

PT CARRY DC STAT 80 0.50

PT CARRY GOAL STAT 0 0.50

PT CARRY GOAL STAT 1 0.50

PT CARRY GOAL STAT 100 0.50

PT CARRY GOAL STAT 20 0.50

PT CARRY GOAL STAT 40 0.50

PT CARRY GOAL STAT 60 0.50

PT CARRY GOAL STAT 80 0.50

PT MOBILITY CUR STAT 100 0.50

PT MOBILITY CURR STAT 0 0.50

Page 106: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PT MOBILITY CURR STAT 1 0.50

PT MOBILITY CURR STAT 20 0.50

PT MOBILITY CURR STAT 40 0.50

PT MOBILITY CURR STAT 60 0.50

PT MOBILITY CURR STAT 80 0.50

PT MOBILITY DC STAT 0 0.50

PT MOBILITY DC STAT 1 0.50

PT MOBILITY DC STAT 100 0.50

PT MOBILITY DC STAT 20 0.50

PT MOBILITY DC STAT 40 0.50

PT MOBILITY DC STAT 60 0.50

PT MOBILITY DC STAT 80 0.50

PT MOBILITY GL STAT 100 0.50

PT MOBILITY GOAL STAT 0 0.50

PT MOBILITY GOAL STAT 1 0.50

PT MOBILITY GOAL STAT 20 0.50

PT MOBILITY GOAL STAT 40 0.50

PT MOBILITY GOAL STAT 60 0.50

PT MOBILITY GOAL STAT 80 0.50

PT OTH PT/OT CUR STA 100 0.50

PT OTH PT/OT CUR STAT 20 0.50

PT OTH PT/OT CUR STAT 40 0.50

PT OTH PT/OT CUR STAT 60 0.50

PT OTH PT/OT CUR STAT 80 0.50

PT OTH PT/OT CURR STAT 0 0.50

PT OTH PT/OT CURR STAT 1 0.50

PT OTH PT/OT DC STAT 0 0.50

PT OTH PT/OT DC STAT 1 0.50

PT OTH PT/OT DC STAT 100 0.50

PT OTH PT/OT DC STAT 20 0.50

PT OTH PT/OT DC STAT 40 0.50

PT OTH PT/OT DC STAT 60 0.50

PT OTH PT/OT DC STAT 80 0.50

PT OTH PT/OT GL STAT 100 0.50

PT OTH PT/OT GL STAT 20 0.50

PT OTH PT/OT GL STAT 40 0.50

PT OTH PT/OT GL STAT 60 0.50

PT OTH PT/OT GL STAT 80 0.50

PT OTH PT/OT GOAL STAT 0 0.50

PT OTH PT/OT GOAL STAT 1 0.50

Pt progr, neurostim Cat2 4,638.50

PT PROGRAMMER EXTERNAL 5,515.50

PT SELF CARE CUR STAT 20 0.50

PT SELF CARE CUR STAT 40 0.50

PT SELF CARE CUR STAT 60 0.50

PT SELF CARE CUR STAT 80 0.50

PT SELF CARE CURR STAT 0 0.50

PT SELF CARE CURR STAT 1 0.50

PT SELF CARE DC STAT 0 0.50

PT SELF CARE DC STAT 1 0.50

Page 107: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PT SELF CARE DC STAT 100 0.50

PT SELF CARE DC STAT 20 0.50

PT SELF CARE DC STAT 40 0.50

PT SELF CARE DC STAT 60 0.50

PT SELF CARE DC STAT 80 0.50

PT SELF CARE GL STAT 100 0.50

PT SELF CARE GOAL STAT 0 0.50

PT SELF CARE GOAL STAT 1 0.50

PT SLF CARE CUR STAT 100 0.50

PT SLF CARE GOAL STAT 20 0.50

PT SLF CARE GOAL STAT 40 0.50

PT SLF CARE GOAL STAT 60 0.50

PT SLF CARE GOAL STAT 80 0.50

PT SUB PT/OT CUR STA 100 0.50

PT SUB PT/OT CUR STAT 20 0.50

PT SUB PT/OT CUR STAT 40 0.50

PT SUB PT/OT CUR STAT 60 0.50

PT SUB PT/OT CUR STAT 80 0.50

PT SUB PT/OT CURR STAT 0 0.50

PT SUB PT/OT CURR STAT 1 0.50

PT SUB PT/OT DC STAT 0 0.50

PT SUB PT/OT DC STAT 1 0.50

PT SUB PT/OT DC STAT 100 0.50

PT SUB PT/OT DC STAT 20 0.50

PT SUB PT/OT DC STAT 40 0.50

PT SUB PT/OT DC STAT 60 0.50

PT SUB PT/OT DC STAT 80 0.50

PT SUB PT/OT GL STAT 100 0.50

PT SUB PT/OT GL STAT 20 0.50

PT SUB PT/OT GL STAT 40 0.50

PT SUB PT/OT GL STAT 60 0.50

PT SUB PT/OT GL STAT 80 0.50

PT SUB PT/OT GOAL STAT 0 0.50

PT SUB PT/OT GOAL STAT 1 0.50

PT SUBSTITUTION MIXING 38.50

PTA AORTA 2,005.50

PTA BRACHIOCEPHALIC LT 2,005.50

PTA RENAL/VISC BI 2,005.50

PTA RENAL/VISC LT 2,005.50

PTA RENAL/VISC RT 2,005.50

PTCA COR EA ADD BCH LC 31,412.50

PTCA COR SGL ARTY LC 31,412.50

PTCA EA ADDL BRANCH 16,698.50

PTCA RVSC GRFT STNT ADDL 25,362.00

PTCA RVSC GRFT STNT SGL 29,832.50

PTCA SINGLE VESSEL 16,698.50

PTCA STENT W ANGIO ADDL 25,362.00

PTCA STENT W ATH ADDL 25,362.00

PTCA STENT W ATH SGL 25,362.00

PTEN MUTATION ANALYS 3,908.00

Page 108: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

PTH HORMONE-RELATED 120.00

PTH INTACT 397.50

PTH-CALCIUM 46.00

PTT 53.50

PTT COMPLETE 53.50

PTT SUBSTITUTION MIXING 62.50

PT-WHFO-CUSTOM 546.00

PUL ART BALLOON REPR PER 12,219.50

PULM COMPLIANCE STUDY 387.00

PULM VENT & PERF IMAG 1,981.00

PULM VENT + PERF IMAG 1,981.00

PULM VENT IMAGING 1,406.50

PULSE OXIMETRY SINGLE 39.50

PULSE OXIMETRY SINGLE 39.50

PUMP CATH SUPP/WK 58.50

PUN ASP ABSC,HEMA,BU,CY 453.50

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN 400.00

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PUNCH BX OF SKIN EA ADDL 196.50

PYRAZINAMIDE 500 MG TAB 4.02

PYRIDOSTIGMINE 60MG TAB 2.32

PYRIDOXAL 5 PHOS VIT B6 270.50

PYRIDOXINE 100 MG DOSE 23.74

PYRIDOXINE 100 MG/ML 1ML 23.74

PYRIDOXINE HCL 50 MG TAB 1.14

PYRUVIC ACID(PYRUVAT 96.50

QPUMP BUPIV 0.5%/NS400ML 440.20

QUANT DIF PULM PERF 1,406.50

QUANT DIF PULM PRF & VNT 1,981.00

QUANT DIF PULM PRF + VNT 1,981.00

QUANTITATION OF DRUG 134.00

QUANTITATIVE FECAL F 149.50

QUETIAPINE 100MG TAB 1.66

QUETIAPINE 150MG TAB.ER 23.20

QUETIAPINE 200MG TAB 2.25

QUETIAPINE 200MG TAB.ER 23.03

QUETIAPINE 25MG TAB 1.45

QUETIAPINE 300MG TAB 1.65

QUETIAPINE 300MG TAB.ER 32.63

Page 109: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

QUETIAPINE 400MG TAB.ER 38.35

QUETIAPINE 50MG TAB 1.66

QUETIAPINE 50MG TAB.ER 14.37

QUINAPR/HCTZ 10-12.5 TAB 2.32

QUINAPR/HCTZ 20-12.5 TAB 2.32

QUINAPRIL HCL 10 MG TAB 11.34

QUINAPRIL HCL 20 MG TAB 11.31

QUINAPRIL HCL 5 MG TAB 11.31

QUINIDINE GLUCONATE10 ML 30.62

QUINIDINE QUANT 141.00

R AND L HRT ART VENT ANGIO 9,568.50

R HRT ART/GRFT ANGIO 8,657.00

R HRT ART/GRFT ANGIO 8,657.00

R+L HRT ART/VENT ANGIO 10,354.00

RA QN 55.00

RABIES IG 150 UNIT DOSE 5,522.98

RABIES IG 150 UNIT DOSE 1,210.04

RABIES VACCINE 574.25

RABIES VACCINE 2.5 UNIT 574.25

RACEPINEPHRI 2.25% 0.5ML 3.55

RADIOPHARM THPY IV ADMIN 2,344.00

RADIOPHM THPY ORAL ADMIN 1,231.50

RALOXIFENE HCL 60 MG TAB 12.83

RALTEGRAVIR 400 MG TAB 39.46

RAMELTEON 8 MG TAB 21.06

RAMIPRIL 1.25 MG CAP 3.04

RAMIPRIL 10 MG CAP 1.68

RAMIPRIL 2.5 MG CAP 2.91

RAMIPRIL 5 MG CAP 2.99

RAMUCIRUMAB 5 MG 2,117.30

RAMUCIRUMAB 5MG 2,117.30

RANITIDINE 15MG/ML 10ML 13.63

RANITIDINE 25MG DOSE 2 9.49

RANOLAZINE 500MG TAB.ER 12.99

RAPAMUNE(SIROLIMUS) 122.00

RASAGILINE 1MG TAB 35.47

RASBURICASE 0.5MG DOSE 1,619.18

RBC LEUK RED/IRR EA UNIT 739.00

RBC LEUKOCYTES REDUCED 522.00

REC RM EA ADD 15 414.00

REC RM EA ADD 15M PHS1 442.00

REC RM EA ADD 15M PHS1 442.00

REC RM EA ADD 15M PHS1 414.00

REC RM EA ADD 15M PHS2 220.50

REC RM EA ADD 15M PHS2 220.50

REC RM FIRST 30 MIN PHS1 827.50

REC RM FIRST 30MIN PHS1 827.50

REC RM FIRST 30MIN PHS2 414.00

REC RM FIRST 30MIN PHS2 414.00

REC ROOM FIRST 30 827.50

Page 110: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

REC ROOM FIRST 30 MIN 827.50

RECOVERY RM 1,063.50

REDUC OF BLOOD 414.00

RE-EVALUATION 170.50

RE-EVALUATION OT 73.50

REFRESH OPHTH DROPS 18.04

REGADENOSON 0.4 MG/5 ML 414.00

RELETEX 3 DAY BAND 213.00

REM FB EYE/CORENA BILAT 2,080.00

REM FB EYE/CORNEA BILAT 2,080.00

REM FB SUB TISS COMPLX 882.50

REM FB SUB TISS SIMPLE 882.50

REM FB SUB TISSUE SIMPLE 882.50

REM FOR BODY EAR CANAL BIL 662.00

REM FOR BODY EAR CANAL BIL 662.00

REM FOR BODY EAR CANAL BILAT 662.00

REM FOR BODY EAR CANAL BILAT 662.00

REM FOR BODY EAR CANAL LT 331.00

REM FOR BODY EAR CANAL LT 331.00

REM FOR BODY EAR CANAL LT 331.00

REM FOR BODY EAR CANAL LT 331.00

REM FOR BODY EAR CANAL RT 331.00

REM FOR BODY EAR CANAL RT 331.00

REM FOR BODY EAR CANAL RT 331.00

REM FOR BODY EAR CANAL RT 331.00

REM FOR BODY EAR CANL BIL 662.00

REM FOR BODY FOOT SUBQ 1,804.50

REM PILONIDAL CYST SIMP 7,323.50

REM SKIN TAG EA ADD 10 210.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAG LESS 15 507.00

REM SKIN TAGS LESS/15 507.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REM SUT UNDER ANESTH-DIF 4,452.00

REMIFENTANIL HCL 1 MG 104.44

REMIFENTANIL HCL 2 MG 208.88

REMOV FB EYE/CORENA RT 1,040.00

REMOV FB EYE/CORNEA BILAT 2,080.00

REMOV FB EYE/CORNEA LT 1,040.00

Page 111: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

REMOV FB EYE/CORNEA LT 1,040.00

REMOV FB EYE/CORNEA RT 1,040.00

REMOV FB EYE/CORNEA RT 1,040.00

REMOV IMPACT EAR WAX BIL 172.00

REMOVAL FOREIGN BODY 882.50

REMOVAL FOREIGN BODY 882.50

REMOVAL OF FOREIGN B 882.50

REMOVAL OF NAIL BED 855.00

REMOVAL OF NAIL PLATE 559.00

REMOVAL OF NAIL PLATE 559.00

REMOVAL OF NAIL PLATE 559.00

REMOVAL OF NAIL PLATE 559.00

REMOVE FOREIGN BODY 882.50

REMOVE FOREIGN BODY 437.00

REMOVE SUT DIFF SURGEON 4,879.50

REMOVE SUT SAME SURGEON 1,521.50

RENAL FUNCTION PANEL 83.50

Renal Unilat or Bilat 2,648.00

RENIN 186.50

Rep dev, urinary, w/sli 2,115.50

Rep dev, urinary, w/slng 3,815.00

REPAGLINIDE 0.5 MG TAB 4.84

REPAGLINIDE 2 MG TAB 4.84

Ret dev, insertable Cat1 327.50

Ret dev, insertable Cat2 617.50

RETIC COUNT MANUAL 41.50

RETICULIN ANTIBODY L 107.50

RETICULOCYTE COUNT AUTO 36.00

RETICULOCYTE SEPARAT 682.50

REVASC FEM/POP STNT/ATH 35,798.50

REVASC FEM/POP W ANGIO 12,170.50

REVASC FEM/POP W ATHERCT 25,838.00

REVASC FEM/POP W STNTPLC 25,838.00

REVASC ILIAC W ANGIO ADD 12,170.50

REVASC ILIAC W ANGIO INI 12,170.50

REVASC ILIAC W STNT ADD 12,170.50

REVASC ILIAC W STNT INIT 12,170.50

REVASC TIB ANGIO EA ADD 12,170.50

REVASC TIB ATH EA ADD 25,838.00

REVASC TIB STNT/ATH ADD 12,170.50

REVASC TIB STNT/ATH INIT 35,798.50

REVASC TIB STNTPLC ADD 12,170.50

REVASC TIB W ANGIO INIT 12,170.50

REVASC TIB W ATH INIT 25,838.00

REVASC TIB W STNTPLC INI 25,838.00

RH PHENOTYPE 113.00

RH TYPE 90.50

RHO D IMMUNE G 100 UNIT 1,166.54

RHOPHYLAC 100 IU 172.00

RHYTHM ECG TRACING 159.00

Page 112: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

RID / A200 SHAMPOO 120ML 14.50

RIFAMPIN 300 MG CAPSULE 4.14

RIFAMPIN 600 MG VIAL 273.53

RIFAXIMIN 200 MG TABLET 31.60

RIFAXIMIN 550 MG TABLET 67.27

RIGHT HEART CATH 3,601.50

RIMABOTULINUM 100UN DOSE 990.02

RIMANTADINE 100MG TAB 4.35

RINGERS 500ML IV 4.50

RINGERS LACTATE 1000ML 16.31

RINGERS,LACT 3000ML IRR 22.19

RINGERS,LACTATED 500ML 10.50

RINGERS,LACTATED I1000ML 16.31

RISEDRONATE 150 MG TAB 331.43

RISEDRONATE 150MG TAB 331.43

RISEDRONATE SOD 35MG TAB 149.99

RISEDRONATE SOD 5MG TAB 19.44

RISPERIDONE 0.25 MG TAB 4.99

RISPERIDONE 0.5 MG TAB 5.03

RISPERIDONE 0.5MG D 12.5 386.38

RISPERIDONE 0.5MG DO 25 709.63

RISPERIDONE 0.5MG DO 50 1,419.36

RISPERIDONE 0.5MG TB.RAP 6.02

RISPERIDONE 1 MG TABLET 5.66

RISPERIDONE 1MG TAB.RAPD 11.25

RISPERIDONE 2 MG TAB.RAP 14.84

RISPERIDONE 2 MG TABLET 14.84

RISPERIDONE 3 MG TAB 13.80

RITUXIMAB 10MG 1,837.69

RITUXIMAB 10MG 9,188.51

RIVAROXABAN 10 MG TABLET 19.88

RIVAROXABAN 15 MG TABLET 22.26

RIVAROXABAN 20 MG TABLET 23.42

RIVASTIGMIN PATCH 13.3MG 33.73

RIVASTIGMINE 1.5 MG CAP 5.13

RIVASTIGMINE 3MG CAP 5.13

RIVASTIGMINE 4.5MG CAP 5.34

RIVASTIGMINE PATCH 4.6MG 36.76

RIVASTIGMINE PATCH 9.5MG 36.76

RIZATRIPTAN 10MG TAB.RAP 62.31

RMV ICD W RPLC SGL LD 43,542.00

RMV NEPH TBE W/FLUORO 1,787.00

RMV PPM W RPLC MULT LD 22,063.00

RNP (RIBONUCLEIC PRO 159.50

ROCEPHIN 250 MG DOSE 75.00

ROCEPHIN 250MG DOSE 75.00

ROCKY MTN SPOTTED FE 172.00

ROCKY MTN.SPOTTED FE 172.00

ROCURONIUM 10MG/ML 5ML 13.90

ROFLUMILAST 500 MCG TAB 19.95

Page 113: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ROM EA EXT/TRNK EX HN OT 56.50

ROM HAND W/WO COMP OT 19.00

ROM MEASUREMENTS AND 56.50

ROMA OVARIAN MONITOR 354.50

ROPINIROLE 0.25MG TAB 3.60

ROPINIROLE 1 MG TAB 3.60

ROPINIROLE 2 MG TAB 3.60

ROPINIROLE 0.5 MG TAB 3.60

ROPINIROLE 3MG TAB 12.16

ROPINIROLE 4MG TAB.ER 10.97

ROPIVAC 0.2% 2MG/ML 20ML 16.81

ROPIVAC 0.5% 5MG/ML 20ML 48.11

ROPIVACAINE 1 MG DOSE 16.81

ROPIVACAINE 1 MG DOSE 48.11

ROTAVIRUSSTOOL 107.00

ROUTINE EEG 706.50

RPR 38.00

RPR TITER 39.50

RSV AG IFT 115.50

RSV DNA/RNA AMP PROBE 287.00

RT FEMUR 2 VWS 289.50

Rt Ventric Recording 2,869.00

RT-CPAP MISC 529.00

RT-CPAP SET-UP 529.00

RUBELLA IGG 133.50

RUBELLA IGM 139.00

RUBEOLA AB QUAL 124.00

RVSC AMI STN THRMB SGL 25,362.00

RVSC CHR STN THRM SGL 25,362.00

RVSC CHR STNT THRMB ADDL 25,362.00

S CEREVISIAE AB IGA 109.00

S PNEUMONIAE AB/IGG( 133.50

S PNEUMONIAE AGS UR 107.00

S. CEREVISIAE AB IGG 109.00

SACCH BOULARDI 250MG CAP 2.00

SACUBITRI/VALS97-103 TAB 13.59

SACUBITRIL/VALS24-26 TAB 15.68

SACUBITRIL/VALS48-51 TAB 15.68

SALICYLATE 226.50

SALICYLIC ACID 1 GM POWD 23.53

SALINE 250 ML 6.00

SALINE 500ML 6.00

SALMETEROL XINAFOATE DIS 378.49

SALSALATE 500 MG TABLET 2.81

SALSALATE 750 MG TABLET 3.85

SALTWORT RUSSIAN TH. 46.50

SARNA LOTION 222ML 16.26

SCALLOP 46.50

SCLERODERMA SCL-70 A 159.50

SCN1A DNA SEQUENCING 2,666.00

Page 114: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SCOPOLAMINE PATCH 36.30

Sealant, pulm, liq Cat 674.50

Sealant, pulmonary, liq 192.50

Sealant, pulmonary, liq 1,157.50

SECRETIN ACET 16MCG INJ 1,118.25

SED RATE AUTO 26.00

SEL DEBR EA ADD 20 CM 189.50

SEL DEBR EA ADD 20 CM 472.50

SEL DEBR EA ADDL 20 CM 472.50

SELECTIVE DEBRIDE <20 532.50

SELECTIVE DEBRIDE <20 480.00

SELEGILINE 5MG CAP 3.40

SELENIUM 227.00

SELENIUM 40MCG/ML 10ML 6.10

SELF/HOME ONE/ONE 15M OT 104.00

SELFCR-HOME MGN/15 MI 104.00

SEMI PRIVAE PSY ROOM 1,412.50

SEMI PRIVATE ROOM 232.00

SEMI PRIVATE ROOM 1,984.50

Semi Private Room 1,765.50

SENNA 176MG/5ML SYR 15ML 13.26

SENNOSIDES 8.6 MG TABLET 1.16

SENNOSIDES/DOCUS SOD TAB 1.22

SENSORY INTEGRATN 15M OT 103.50

SENT NODE RAD TR INJ 965.00

SENTINEL NODE IDENTIF 1,240.00

SEROTONIN 298.50

SERTRALINE 100 MG TAB 17.15

SERTRALINE 25 MG TAB 1.50

SERTRALINE 50 MG TAB 1.50

SESAME SEED 46.50

SESAMOIDECTOMY 1ST TOE 2,888.50

SET RADIATION THERAP 917.50

SET RADIATION THERAP 917.50

SEVELAMER CARB 2.4G PACK 28.85

SEVELAMER CARB 800MG TAB 15.41

SEVELAMER HCL 400 MG TAB 5.33

SEVELAMER HCL 800 MG TAB 13.97

SEVOFLURANE 250 ML 202.78

SEX HORMONE BG 203.50

SH LES F/E/N/L 0.5CMLESS 532.50

SH SKN LES >2.0CM 979.50

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0 T/A/L 480.00

SH SKN LES 0.6-1.0cm T/A/L 480.00

SH SKN LESN 0.5CM/< SNHF 480.00

Page 115: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SH SKN LESN 0.5CM/< SNHF 480.00

SH SKN LESN 0.5CM/< SNHF 280.00

SH SKN LESN 0.5CM/< SNHF 480.00

SH SKN LESN 0.5CM/< SNHF 280.00

SH SKN LESN 0.5CM/<SNHF 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM< T/A/L 480.00

SH SKN LESN 0.5CM<T/A/L 480.00

SH SKN LESN 1.1-2.0CM 532.50

SHEEP SORREL 46.50

SHINGRIX 0.5ML VACC 238.56

SHOULDER PAD II M 248.50

SHRIMP 46.50

SHUGARCAINE 2ML VIAL 39.05

SICKLE CELL SCREEN 53.50

SILDENAFIL CITR 20MG TAB 21.98

SILODOSIN 8 MG CAP 14.47

SILV SULFADIAZ CR 20GM 15.48

SILV SULFADIAZ CR 400GM 92.23

SILVER NITRATE APPLIC 1.77

SIM REPAI SUP12.6-20.0CM 234.00

SIM REPAIR SUP 2.6-7.5CM 234.00

SIM REPAIR SUP7.5-12.5CM 234.00

SIM REPAIR SUPERF<2.5CM 234.00

SIMETHIC 40MG/0.6ML 30ML 4.06

SIMETHICONE 180 MG CAP 1.20

SIMETHICONE 80 MG TAB 1.23

SIMULATION COMPLE 1,295.00

SIMULATION COMPLEX 1,295.00

SIMULATION SIMPLE 777.00

SINCALIDE 5 MCG INJ 342.50

SINCALIDE 5MCG DOSE 172.39

SIROLIMUS 1 MG TAB 47.73

SITAGLIPTIN 25 MG TAB 23.55

SITAGLIPTIN 100 MG TAB 23.55

SKIN SUBSTITUTE NOS 15,473.00

SKIN SUBSTITUTE NOS 13,092.50

SKIN TB-PPD 50.00

SKIN TB-PPD 21.50

SKIN TB-PPD 50.00

SKIN TB-PPD 21.50

SLEEP STUDY 2,936.00

SLEEP STUDY < 6 HRS 2,563.00

SLEEP STUDY <6YR C 3,944.50

SLEEP STUDY <6YR & C 3,944.50

SLEEP STUDY <6YR W/4 3,322.00

Page 116: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SLIDES/MANUAL SCREEN 133.00

SLING & SWATHE BI 173.50

SLING +SWATHE BI 173.50

SMEAR AFB 52.00

SMEAR MALARIA STAIN 34.00

SMEARS AUTO.SCN PHYS 159.50

SMEARS AUTO.SCNMAN.R 94.00

SMITH (ENA) ANTIBODY 159.50

SMOKING CESSATION >3M 86.50

SMPL REP SNAGTHP <2.5CM 532.50

SMPL RPR F/E/N 2.6-5.0CM 532.50

SMPL RPR F/E/N 2.6-5.0CM 507.00

SMPL RPR N/H/F/G 2.6-7.5 507.00

SMPL RPR N/H/F/G 2.6-7.5 507.00

SMPL RPR N/H/F/G 2.6-7.5 507.00

SMPL RPR NHFG 2.6-7.5 507.00

SOCKET FITTING/KN 2,017.00

SOD ACETATE 2MEQ/ML 20ML 9.30

SOD BICAR 0.48MEQ/ML 5ml 20.16

SOD BICAR 0.5MEQ/ML 10ML 18.47

SOD BICARB 1 MEQ/ML VIAL 22.63

SOD BICARB 1MEQ/M SYRING 18.17

SOD CL 0.45 % 1000ML 16.91

SOD CL 0.45 % 500ML IV 7.84

SOD CL 1MEQ/ML PO NB DIL 10.89

SOD CL 2.5 MEQ/ML 20ML 2.58

SOD CL 4MEQ/ML 30ML 16.40

SOD CL INH 0.9% 15ML NEB 2.05

SOD CL INH 3% 15ML NEB 2.00

SOD CL IRRIG BAG 1000ML 2.98

SOD CL IRRIG BAG 3000ML 21.47

SOD CL IRRIG BOT 1000ML 4.85

SOD LACT 5MEQ/ML 10ML 8.56

SOD NITR/SOD THIOSU 60ML 269.80

SOD PHOS 3MMOL/ML 15ML 28.77

SOD POLY SULF 15GM/60 ML 12.70

SOD THIOSULF 12.5GM/50ML 151.94

SODIUM BICARB 325 MG TAB 1.15

SODIUM BICARB 650MG TAB 1.21

SODIUM BLD 46.50

SODIUM CHL 0.45% 1000ML 4.50

SODIUM CHL 0.45% 250ML 27.50

SODIUM CHL 0.45%K20MEQ1L 10.00

SODIUM CHL 0.9% 30ML 17.00

SODIUM CHL 0.9% 50ML 6.00

SODIUM CHL 0.9% K20MEQ1L 8.00

SODIUM CHL 0.9% K40MEQ1L 8.00

SODIUM CHL 3% 500ML 3.00

SODIUM CHLORIDE 1 GM TAB 1.23

SODIUM CL SPRAY 44 ML 2.33

Page 117: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SODIUM CL 5% OP 15ML 36.08

SODIUM CL 5% OP OI 3.5GM 17.97

SODIUM CL INH 3ML NEB 1.26

SODIUM MMOL/L URINE 43.50

SODIUM TETRADECYL 2 ML 133.13

SOLIFENACIN SUCC 5MG TAB 20.92

SOLUBLE LIVER AG 45.00

SOMATOMEDIN C IGF-1 205.00

SORBITOL 3000 ML IRRIG 34.93

SORBITOL SOLUTION 15 ML 1.39

SOTALOL 120MG TAB 4.56

SOTALOL HCL 80 MG TABLET 3.71

SOTALOL HCL AF 80 MG TAB 3.71

SOYBEAN 46.50

SP ANGIO EXT UNI LT 12,425.00

SP ATTEN CURRENT STAT 0 0.50

SP ATTEN CURRENT STAT 1 0.50

SP ATTEN CURRENT STAT 20 1.50

SP ATTEN CURRENT STAT 40 0.50

SP ATTEN CURRENT STAT 60 0.50

SP ATTEN CURRENT STAT 80 0.50

SP ATTEN CURRNT STAT 100 0.50

SP ATTEN DC STAT 0 0.50

SP ATTEN DC STAT 1 0.50

SP ATTEN DC STAT 100 0.50

SP ATTEN DC STAT 20 0.50

SP ATTEN DC STAT 40 0.50

SP ATTEN DC STAT 60 0.50

SP ATTEN DC STAT 80 0.50

SP ATTEN GOAL STAT 0 0.50

SP ATTEN GOAL STAT 1 0.50

SP ATTEN GOAL STAT 100 0.50

SP ATTEN GOAL STAT 20 0.50

SP ATTEN GOAL STAT 40 0.50

SP ATTEN GOAL STAT 60 0.50

SP ATTEN GOAL STAT 80 0.50

SP LANG COMP CUR STA 100 0.50

SP LANG COMP CUR STAT 20 0.50

SP LANG COMP CUR STAT 40 0.50

SP LANG COMP CUR STAT 60 0.50

SP LANG COMP CUR STAT 80 0.50

SP LANG COMP CURR STAT 0 0.50

SP LANG COMP CURR STAT 1 0.50

SP LANG COMP DC STAT 1 0.50

SP LANG COMP DC STAT 100 0.50

SP LANG COMP DC STAT 20 0.50

SP LANG COMP DC STAT 40 0.50

SP LANG COMP DC STAT 60 0.50

SP LANG COMP DC STAT 80 0.50

SP LANG COMP GL STAT 100 0.50

Page 118: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SP LANG COMP GL STAT 20 0.50

SP LANG COMP GL STAT 40 0.50

SP LANG COMP GL STAT 60 0.50

SP LANG COMP GL STAT 80 0.50

SP LANG COMP GOAL STAT 0 0.50

SP LANG COMP GOAL STAT 1 0.50

SP LANG EXP CUR STAT 100 0.50

SP LANG EXP CURR STAT 0 0.50

SP LANG EXP CURR STAT 1 0.50

SP LANG EXP CURR STAT 20 0.50

SP LANG EXP CURR STAT 40 0.50

SP LANG EXP CURR STAT 60 0.50

SP LANG EXP CURR STAT 80 0.50

SP LANG EXP DC STAT 0 0.50

SP LANG EXP DC STAT 1 0.50

SP LANG EXP DC STAT 100 0.50

SP LANG EXP DC STAT 20 0.50

SP LANG EXP DC STAT 40 0.50

SP LANG EXP DC STAT 60 0.50

SP LANG EXP DC STAT 80 0.50

SP LANG EXP GOAL STA 100 0.50

SP LANG EXP GOAL STAT 0 1.50

SP LANG EXP GOAL STAT 1 0.50

SP LANG EXP GOAL STAT 20 0.50

SP LANG EXP GOAL STAT 40 0.50

SP LANG EXP GOAL STAT 60 0.50

SP LANG EXP GOAL STAT 80 0.50

SP MEMORY CURR STAT 100 0.50

SP MEMORY CURR STAT 20 0.50

SP MEMORY CURR STAT 40 0.50

SP MEMORY CURR STAT 60 0.50

SP MEMORY CURR STAT 80 0.50

SP MEMORY CURRENT STAT 0 0.50

SP MEMORY CURRENT STAT 1 0.50

SP MEMORY DC STAT 0 0.50

SP MEMORY DC STAT 1 0.50

SP MEMORY DC STAT 100 0.50

SP MEMORY DC STAT 20 0.50

SP MEMORY DC STAT 40 0.50

SP MEMORY DC STAT 60 0.50

SP MEMORY DC STAT 80 0.50

SP MEMORY GOAL STAT 0 0.50

SP MEMORY GOAL STAT 1 0.50

SP MEMORY GOAL STAT 100 0.50

SP MEMORY GOAL STAT 20 0.50

SP MEMORY GOAL STAT 40 0.50

SP MEMORY GOAL STAT 60 0.50

SP MEMORY GOAL STAT 80 0.50

SP MOTOR SP CURR STA 100 0.50

SP MOTOR SP CURR STAT 0 0.50

Page 119: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SP MOTOR SP CURR STAT 1 0.50

SP MOTOR SP CURR STAT 20 0.50

SP MOTOR SP CURR STAT 40 0.50

SP MOTOR SP CURR STAT 60 0.50

SP MOTOR SP CURR STAT 80 0.50

SP MOTOR SP DC STA 100 0.50

SP MOTOR SP DC STAT 0 0.50

SP MOTOR SP DC STAT 1 0.50

SP MOTOR SP DC STAT 20 0.50

SP MOTOR SP DC STAT 40 0.50

SP MOTOR SP DC STAT 60 0.50

SP MOTOR SP DC STAT 80 0.50

SP MOTOR SP GOAL STA 100 0.50

SP MOTOR SP GOAL STAT 0 0.50

SP MOTOR SP GOAL STAT 1 0.50

SP MOTOR SP GOAL STAT 20 0.50

SP MOTOR SP GOAL STAT 40 0.50

SP MOTOR SP GOAL STAT 60 0.50

SP MOTOR SP GOAL STAT 80 0.50

SP OTH LANG CUR STAT 100 0.50

SP OTH LANG CURR STAT 0 0.50

SP OTH LANG CURR STAT 1 0.50

SP OTH LANG CURR STAT 20 0.50

SP OTH LANG CURR STAT 40 0.50

SP OTH LANG CURR STAT 60 0.50

SP OTH LANG CURR STAT 80 0.50

SP OTH LANG DC STAT 100 0.50

SP OTH LANG GL STAT 100 0.50

SP OTH LANG GOAL STAT 0 0.50

SP OTH LANG GOAL STAT 1 0.50

SP OTH LANG GOAL STAT 20 0.50

SP OTH LANG GOAL STAT 40 0.50

SP OTH LANG GOAL STAT 60 0.50

SP OTH LANG GOAL STAT 80 0.50

SP OTHER LANG DC STAT 0 0.50

SP OTHER LANG DC STAT 1 0.50

SP OTHER LANG DC STAT 20 0.50

SP OTHER LANG DC STAT 40 0.50

SP OTHER LANG DC STAT 60 0.50

SP OTHER LANG DC STAT 80 0.50

SP SWALLOW CURR STAT 0 0.50

SP SWALLOW CURR STAT 1 0.50

SP SWALLOW CURR STAT 100 0.50

SP SWALLOW CURR STAT 20 0.50

SP SWALLOW CURR STAT 40 0.50

SP SWALLOW CURR STAT 60 0.50

SP SWALLOW CURR STAT 80 0.50

SP SWALLOW DC STAT 0 0.50

SP SWALLOW DC STAT 1 0.50

SP SWALLOW DC STAT 100 0.50

Page 120: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SP SWALLOW DC STAT 20 0.50

SP SWALLOW DC STAT 40 0.50

SP SWALLOW DC STAT 60 0.50

SP SWALLOW DC STAT 80 0.50

SP SWALLOW GOAL STAT 0 0.50

SP SWALLOW GOAL STAT 1 0.50

SP SWALLOW GOAL STAT 100 0.50

SP SWALLOW GOAL STAT 20 0.50

SP SWALLOW GOAL STAT 40 0.50

SP SWALLOW GOAL STAT 60 0.50

SP SWALLOW GOAL STAT 80 0.50

SP VENOGRAM EXT UNI LT 3,136.50

SP VOICE CURR STAT 100 0.50

SP VOICE CURRENT STAT 0 0.50

SP VOICE CURRENT STAT 1 0.50

SP VOICE CURRENT STAT 20 0.50

SP VOICE CURRENT STAT 40 0.50

SP VOICE CURRENT STAT 60 0.50

SP VOICE CURRENT STAT 80 0.50

SP VOICE DC STAT 0 0.50

SP VOICE DC STAT 1 0.50

SP VOICE DC STAT 100 0.50

SP VOICE DC STAT 20 1.50

SP VOICE DC STAT 40 0.50

SP VOICE DC STAT 60 0.50

SP VOICE DC STAT 80 0.50

SP VOICE GOAL STAT 0 0.50

SP VOICE GOAL STAT 1 0.50

SP VOICE GOAL STAT 100 0.50

SP VOICE GOAL STAT 20 0.50

SP VOICE GOAL STAT 40 0.50

SP VOICE GOAL STAT 60 0.50

SP VOICE GOAL STAT 80 0.50

SPEC DOSIMETRY 454.00

SPEC DOSIMETRY (PDM) 454.00

SPEC PLAN (E-CALC) 917.50

SPEC PLAN (E-CALC) 917.50

SPECIAL TX PROC 1,482.50

SPERM ANALYSIS POST 107.50

SPIN/BRN PUMP REFL/MAINT 845.00

SPINAL MUSC ATRPH ANALY 548.00

SPINAL PUNCTURE 1,188.00

SPIROMETRY 387.00

SPIROMETRY 387.00

SPIROMETRY 100.50

SPIROMETRY 100.50

SPIROMETRY 387.00

SPIROMETRY 863.00

SPIRONOLAC/HCTZ 25-25 TA 3.26

SPIRONOLACTONE 100MG TAB 2.58

Page 121: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SPIRONOLACTONE 25 MG TAB 1.53

SPIRONOLACTONE 50 MG TAB 1.98

SPLINT WRST MD RT 74.50

SPRAY AND STRETCH CAN 51.12

SPS 30GM/120ML ENEMA 80.51

SS A/RO ANTIBODY 159.50

SS B/LA ANTIBODY 159.50

ST BRST BX ADD LESION LT 2,978.50

ST BRST BX ADD LESION RT 2,978.50

ST BRST BX ADD LESION RT 2,978.50

STAPLE KIT 10X10 1,298.50

STAPLE KIT 12X12 1,298.50

STAPLE KIT 15X15 1,789.50

STENT NONCO/NONCOV W/DEL 7,276.00

STENT NONCOR TEMP W/DEL 6,261.00

STENT NONCOR TEMP W/DEL 3,339.00

Stent panc/bil 386.00

Stent panc/bil plast 386.00

Stent, coat/cov w/del sy 1,103.50

STENT, COAT/COV W/DEL SYS 7,836.00

Stent,coat/cov w/del sys 462.00

Stent,coat/cov w/del sys 6,405.00

Stent,coat/cov w/del sys 4,164.00

Stent,non-coa/cov w/del 7,474.50

Stent,non-coa/cov w/delC 3,830.00

Stent,non-coa/cov w/delC 3,214.50

STENT,NON-COR,TEM W/O D 286.00

Stent,non-cor,tem w/o D 500.00

STIM & PACE AFTER IV INF 2,206.50

STIM + PACE AFTER IV INF 2,206.50

STONE CHEMICAL ANALY 114.50

STOOL CULTURE YERSIN 84.00

STRATTICE 20X30CM 31,560.00

STREP TEST 53.00

STREPTOZYME SCREEN 90.50

STRIATED MUSCLE AB I 107.50

STRIBILD TABLET 164.18

STRONTIUM SR89 CL TX MCI 6,349.00

ST-Voice Prosth w/wo val 348.50

ST-VOICE PROTH 20FR/10MM 340.50

SUCCINYLCHOLI 20MG DOSE 32.69

SUCRALFATE 1 GM TABLET 1.48

SUCRALFATE 1GM/10ML 10ML 16.80

SUFENTANIL 50MCG/ML 2ML 20.09

SUGAMMADEX 200 MG VIAL 169.96

SUGARS MONO,DI,OLIGO 49.00

SUGARS MONO,DI,OLIGO 49.00

SULFACET/PRED O/O 3.5GM 215.83

SULFACET/PRED OP DRP 5ML 247.92

SULFACETAMIDE 10% OP15ML 86.62

Page 122: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

SULFADIAZINE 500MG TAB 5.69

SULFAME/TRIME 160MG/10ML 26.05

SULFAMETH/TRIMET 20ML OS 5.88

SULFAMETH/TRIMETH TAB DS 2.93

SULFAMETH/TRIMETH TAB SS 1.76

SULFASALAZINE 500 MG TAB 1.66

SULFONYLUREA HYPOGLY 161.00

SULFUR COLLOID DX 20 MCI 48.00

SULFUR COLLOID DX 20 MCI 595.50

SULINDAC 150 MG TABLET 2.08

SULINDAC 200 MG TABLET 2.63

SUMATRIPTAN 6MG/0.5ML 40.90

SUMATRIPTAN 20 MG SPR 134.87

SUMATRIPTAN SUC 25MG TAB 38.41

SURESWAB CANDIDA DNA 311.50

SURESWAB CHLAMYDIA D 311.50

SURESWAB DETECT AGEN 380.50

SURESWAB GARDNER DNA 371.00

SURESWAB GONORRHEA D 311.50

SURESWAB TRICHOMONAS 311.50

SURFACTANT ADMIN 520.86

SURG COMPONENT 847.50

SURG PATH LEVEL 1 203.00

SURG PATH LEVEL 2 203.00

SURG PATH LEVEL 3 318.50

SURG PATH LEVEL 4 318.50

SURG PATH LEVEL 5 1,370.00

SURG PATH LEVEL 6 2,876.50

SURGICAL PROCEDURE AD 918.50

SURGICAL PROCEDURE FI 6,610.50

SUTURE TENSIONER 289.00

SVT Ablation 55,545.00

SWEET EASE UD CUP 15 ML 1.10

SYNDACTYLISM 2,888.50

T CELLS CD4 8 RATIO 453.00

T3 FREE 163.50

T3 REVERSE 152.00

T3 TOTAL 136.50

T3 UPTAKE 62.50

T4 TOTAL 66.50

TACROLIMUS 0.5 MG CAP 3.33

TACROLIMUS 5 MG CAP 31.67

TACROLIMUS QUANT 132.50

TALC 300 GM POWDER 23.07

TALC 4 GM AERO.POWD 228.68

TALC 5 GM VIAL POWDER 175.51

TALC 56.25 ML SYRINGE 175.51

TAMOXIFEN 10MG TAB 1.67

TAMSULOSIN 0.4 MG CAP.ER 5.31

TAN BX OF SKIN EA ADDL 171.50

Page 123: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

TAN BX OF SKIN EA ADDL 171.50

TAN BX OF SKIN EA ADDL 171.50

TAN BX OF SKIN EA ADDL 171.50

TAN BX OF SKIN EA ADDL 171.50

TAN BX OF SKIN EA ADDL 171.50

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TANGENTIAL BX OF SKIN 318.00

TARG GENO SEQ TUMOR >51 9,197.00

TARGT GENO SEQ HEME NEOP 2,393.00

TARGT GENO SEQ SOL TUMR 1,883.50

TB GAMMA INTERFERON RESP 550.50

TB INTRADERMAL TEST 50.00

TBO-FILGRAST 1MCG DOSE 3 425.76

TBO-FILGRAST 1MCG DOSE 4 681.40

TC-99M DTPA AEROSOL 75MC 378.00

TC-99M EXAMETAZIME WB 7,493.50

TC99M PERTECHNETATE mlc 2.00

TC99M SESTAMIBI DOSE 461.50

T-CELL RECEPT BETA GENE 812.50

TD VACCINE 54.57

TDAP BOOSTER 76.00

TDAP BOOSTERIX 76.00

TDAP BOOSTERIX 76.00

TDAP VACCINE 76.89

TEARS NATURALE OP DROPER 1.76

TELMISAR/HCTZ 40-12.5TAB 13.04

TELMISAR/HCTZ 80-12.5TAB 13.04

TELMISARTAN 40 MG TAB 13.04

TEMAZEPAM 15 MG CAP 1.81

TEMAZEPAM 30 MG CAP 1.93

TEMAZEPAM 7.5 MG CAP 15.44

TEMP EXTERNAL PACING 761.00

TEMSIROLIMUS 1MG DOSE 2,856.16

TENDON SHEATH INC (TRIG 4,252.50

TENOFOVIR 300MG TAB 64.77

TENOTOMY SQ TOE MULT 4,754.00

TENOTOMY SQ TOE, SING 2,888.50

TERAZOSIN HCL 1 MG CAP 2.71

TERAZOSIN HCL 2 MG CAP 2.71

TERAZOSIN HCL 5 MG CAP 2.71

TERBINAFINE 1% CR 15GM 15.75

TERBINAFINE 250MG TAB 18.52

TERBUTALINE 1 MG DOSE 30.67

TERBUTALINE 1 MG/ML VIAL 30.67

TERBUTALINE 2.5MG TAB 10.94

Page 124: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

TERBUTALINE 5MG TAB 12.15

TERCONAZOLE VAG CR 45GM 63.25

TESTOSTERONE 2.5 GM TOP 20.05

TESTOSTERONE 200MG 25.50

TESTOSTERONE 5 GM GEL 33.63

TESTOSTERONE FREE 245.50

TESTOSTERONE TOTAL 196.50

TESTOSTONE CY 1MG DOSE 125.23

TET DIP TOX 0.5 ML SYRIN 54.57

TET,DIP TOX PED 0.5 ML 92.60

TETANUS IMM GLOB 250 UN 648.81

TETANUS TOXOID 131.50

TETRACAINE 0.5% OP 2ML 17.77

TETRACAINE 0.5% 5ML OPTH 42.84

TETRACAINE 0.5% ML OPHTH 42.84

TETRACAINE 0.5% OP 15ML 16.30

TETRACAINE 1% 2 ML AMP 64.18

TETRACYCLINE 500MG CAP 21.25

TETRAHYDROZ 0.05% OP 15M 2.82

THC CONFIRMATION 180.00

THEOPHY 80MG/15ML ELIX 18.00

THEOPHYLLIN 100MG CAP.ER 3.09

THEOPHYLLIN 200MG CAP.ER 4.66

THEOPHYLLIN 300MG CAP.ER 4.73

THEOPHYLLIN 400MG CAP.ER 11.66

THEOPHYLLINE QUANT 136.00

THER ACTIV DIR 15 MIN OT 120.00

THER ACTIV DIR 15 MIN PT 120.00

THER EXERCISES 15 MIN OT 93.00

THER PROCD - GROUP 72.50

THER PROCD 15 MIN 93.00

THER PROCEDURES GROUP OT 56.00

THER/PROPH/DIAG INJ IA 542.50

THER/PROPH/DIAG INJ IA 542.50

THERAGRAN M TABLET 1.17

THERAGRAN PLAIN TABLET 1.16

THERAPEUTIC PHLEBOTOMY 348.00

THERAPUTIC PHLEBOTO 298.50

THERAPUTIC PHLEB 298.50

THERASKIN 1 SQ CM 78.50

THERASKIN PER SQ CENT-LG 78.50

THERASKIN PER SQ CENT-SM 228.00

THERGRAN LIQUID 15 ML 1.60

THIAMINE 100 MG DOSE 16.16

THIAMINE HCL 100 MG TAB 1.16

THIN LAYER AUTO SCRE 180.50

THINPREP/MANUAL SCRE 175.50

THIORIDAZINE 50MG TAB 2.05

THIOTEPA 15MG 2,282.00

THIOTHIXENE 2 MG CAP 3.49

Page 125: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

THIOTHIXENE 5 MG CAP 4.72

THORACENTESIS W/ IMAG 1,686.00

THORACENTESIS W/IM RT 1,987.00

THORACENTESIS W/IMAGE 2,155.50

THORACIC LUMBER B 3,938.50

THRMBTMY ART SEC PROCED 7,101.50

THROMBIN 20,000 UNIT SPR 506.43

THROMBIN 5,000 UNIT SPR 130.98

THROMBIN TIME 33.00

THROMBO INTRACOR INF ANG 5,405.00

THYROGLOB AB QL 153.50

THYROGLOBULIN 155.00

THYROID MICROSOMAL AB 140.50

THYROID STIM IMMUNO TSI 489.50

THYROID,PORK 30 MG TAB 1.71

THYROID,PORK 60 MG TAB 1.94

THYROTROPIN 120.00

THYROXINE BG (TBG) 142.50

TIAGABINE HCL 4 MG TAB 14.88

TICAGRELOR 90 MG TABLET 12.98

TIGECYCLINE 1MG DOSE 266.68

TILT TABLE W/WO RX 2,206.50

TILT TABLE W/WO RX 1,261.50

TIMOLOL 0.25% OP 5ML 20.50

TIMOLOL 0.25% OP XE 5ML 281.52

TIMOLOL 0.5% OP 5ML 22.50

TIMOLOL 0.5% OP XE 5ML 308.52

TIMOTHY GRASS 46.50

TIOTROPIUM INHALER 144.94

TISS CULT CHROM AM FL NM 1,307.00

TISS CULT CHROM BX NM 1,249.00

TISS CULT NEOPLAS BM BLD 1,216.00

TISS CULT NEOPLAS TUMOR 1,309.50

TISS IMMUNOFLUOR DIR AB 1,370.00

TISS TRANSGLUTAMINAS 102.50

TISS TRANSGLUTAMINAS 102.50

TISSUE CULTURE LYMPHOCYT 1,034.00

TISSUE GRINDING 52.50

TISSUE MARKER 284.00

TIZANIDINE HCL 2 MG TAB 2.32

TIZANIDINE HCL 4 MG TAB 3.65

TL-201 PER MCI 84.00

TOBRAMYCIN 0.3% O/O 3.5G 365.27

TOBRAMYCIN 0.3% OP 5ML 19.36

TOBRAMYCIN 80MG DOSE 7.88

TOBRAMYCIN SULFATE 1.2G 284.00

TOBRAMYCIN SULFATE 1.2G 284.00

TOBRAMYCIN TROUGH 143.00

TOBRAMYCIN/DEX O/O 3.5GM 366.86

TOBRAMYCIN/DEX OP 2.5ML 86.17

Page 126: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

TOBRAMYCINPEAK 143.00

TOBRAMYCINRANDOM 143.00

TOLNAFTATE 1% CREAM 30GM 13.80

TOLTERODINE 1MG TAB 13.35

TOLTERODINE 2MG CAP 18.98

TOLTERODINE 2MG TAB 11.70

TOLTERODINE 4MG CAP 18.97

TOLVAPTAN 15 MG TAB 768.16

TOLVAPTAN 30 MG TAB 651.47

TOPIRAMATE 100 MG TABLET 11.70

TOPIRAMATE 200 MG TABLET 2.22

TOPIRAMATE 25 MG TABLET 3.20

TOPIRAMATE QUANT 115.00

TOPOTECAN 0.1MG DOSE 293.40

TORSEMIDE 10 MG TABLET 1.80

TORSEMIDE 100 MG TABLET 3.99

TORSEMIDE 20 MG TABLET 1.94

TOTAL IGE 146.00

TOTAL PROTEIN BLD 35.50

TOTAL PROTEIN FLUID 33.00

TOTAL PROTEIN URINE QN 35.50

TOXOCARA C AB 125.00

TOXOPLASMA IGG 133.50

TOXOPLASMA IGM QUAL 139.00

TPMT GENOTYPE 611.00

TPMT RBC 161.00

TPN - COMPOUNDED 355.00

TPN 4.25%/DEX/ELE 1000ML 57.00

TR MED PHYSICS CONT 388.50

TR SIMULATION SIMPLE 777.00

TR TREAT DEVICE CPLEX 971.50

TRACE MINERALS 10ML VIAL 60.83

TRACH TUBE CUFFED 256.50

TRACTION MECHANICAL PT 69.50

TRAMADOL HCL 50 MG TAB 1.97

TRAMADOL/APAP 37.5-325 T 2.06

TRANDOLAPRIL 1 MG TAB 2.34

TRANEXAMIC ACID 1GM/10ML 123.24

TRANSCATH RTRV FB S&I 9,382.50

TRANSCATH RTRV FB S+I 9,382.50

TRANSCUT BILI CHECK 36.00

TRANSFERRIN 117.00

TRASTUZUMA 10MG DOSE 3,048.26

TRAUMA ACTIV PART P2 2,718.00

TRAUMA TEAM 3 1,115.50

TRAUMA TEAM ACTIVATION 2,718.00

TRAVOPROS 0.004% OP 2.5M 313.31

TRAZODONE HCL 100 MG TAB 1.88

TRAZODONE HCL 150 MG TAB 2.57

TRAZODONE HCL 50 MG TAB 1.26

Page 127: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

TREAT SUPER WOUND SIMP 850.50

TREATMENT/DEL MOR 1MEV C 624.00

TREATMENT/DEL MOR 1MEV C 624.00

TREATMENT/DEL MOR 1MEV I 418.50

TREATMENT/DEL MOR 1MEV I 418.50

TREATMENT/DEL MOR 1MEV S 354.50

TREATMENT/DEL MOR 1MEV S 354.50

TREPONEMA PALLIDUM A 118.00

TRETINOIN 10 MG CAP 43.05

TRG@REARRANGE ABNCLONAL 1,939.50

TRIAGE ONLY 0.50

TRIAMCINOLO 0.1% Orabase 114.44

TRIAMCINOLO-MOXIFLOX 1ML 31.24

TRIAMCINOLON 0.025% 15G 5.56

TRIAMCINOLON 0.1% CR 80G 14.98

TRIAMCINOLON 0.1% OI 80G 19.44

TRIAMCINOLON 0.5% CR 15G 15.61

TRIAMCINOLONE 10 MG DOSE 15.70

TRIAMCINOLONE 10 MG DOSE 19.54

TRIAMCINOLONE 10MG/ML IJ 19.54

TRIAMCINOLONE 200MG/5ML 73.87

TRIAMCINOLONE 200MG/5ML 73.87

TRIAMCINOLONE 40MG/ML IJ 15.70

TRIAMT/HCTZ 37.5-25 TAB 1.49

TRIAMTERENE 50 MG CAP 17.00

TRIAZOLAM 0.25 MG TAB 12.21

TRICHOMONAS VAG DNA 178.00

TRIESENCE 256.30

TRIESENCE 40MG/ML VIAL 256.30

TRIFLURIDINE 1% OP 7.5ML 316.57

TRIGLYCERIDES 56.00

TRIGLYCERIDES OTHER 56.00

TRIHEXYPHENIDYL 2MG TAB 1.65

TRIHEXYPHENIDYL 5MG TAB 1.46

TRIM DYSTROPHIC NAILS 176.50

TRIM NONDYSTROPHIC NAILS 176.50

TRIM SKIN LESION/SINGLE 507.00

TRIMCINOLONE ACE INJ10MG 66.50

TRIMETHOBE 200MG/2ML INJ 52.68

TRIMETHOBENZAMIDE 200MG 52.68

TRIMETHOPRIM 100MG TAB 1.78

Triple Anti 0.9gm 1.25

TRIPLE DYE SWAB (TMH) 5.78

TRNSCTH PL CC/EV/IC EAAD 5,463.50

TRNSCTH PL CC/EV/IC INT 6,768.00

TRNSCTH PL PERC/OPN INT 5,463.50

TRNSCTH PL PRC/OPN EAAD 5,463.50

TRNSCTH TX ART INI DAY 2,330.00

TROJAN CONDOM 1.65

TROLAMIN SALIC/ALOE 90G 12.01

Page 128: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

TROPICAMIDE 0.5% OP 15ML 35.50

TROPICAMIDE 1% OPH 15ML 16.15

TROPICAMIDE 1% OPH 2ML 19.50

TROPONIN QUANT 95.50

TROSPIUM CL 60MG CAP.ER 12.24

TROSPIUM CL 20 MG TAB 3.94

TRUVADA 200-300MG TAB 95.18

TSH RECEPTOR ANITBOD 120.00

TSH(THYROID STIMULAT 149.50

TTE F-UP OR LMTD 823.50

TTE W/DOPPLER COMPLETE 1,717.00

TTE W/O DOPPLER COMPLETE 1,610.00

TUBER PPD 5UNIT/0.1 ML 16.16

TWINRIX 96.50

TWINRIX 96.50

TX DEV COMPLEX 971.50

TX DEV COMPLEX W/IMR 3,832.00

TX DEV INTERMEDIATE 647.50

TX DEV INTERMEDIATE 647.50

TX DEV SIMPLE 412.00

TX DEV SIMPLE 412.00

TX SPEECH INDIVIDUAL SP 239.50

TX SWAL/ORAL FUNCTION SP 260.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 31.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA AUTO W/O MICRO 33.50

UA DIPSTICK 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

Page 129: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/MICRO 33.50

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 20.50

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 33.50

UA NON AUTO W/O MICRO 17.00

UA NON AUTO W/O MICRO 17.00

UBIDECARENONE 100MG CAP 1.61

UBIDECARENONE 200MG CAP 1.86

UBIDECARENONE 30MG CAP 1.38

UDENYCA 5MG DOSE 12 8,166.30

ULTRASOUND/15 MIN OT 41.00

ULTRASOUND/15 MIN. 61.00

UNLISTED MOLPATH PROC 869.00

UNLISTED THERAPEUTIC 105.50

UNNA BOOT BILATERAL 1,017.00

UNNA BOOT LT 508.50

UNNA BOOT RT 508.50

UNNA BOOT STRAPPING 427.00

UNNA BOUT APPL-SINGLE 424.50

UNNA BT APPL BIL 424.50

Unspecified Drug Topical 202.50

UPPER EXT INFANT LT 477.00

UPR/L XTREMITY ART 2 LEV 416.00

UPR/L XTREMITY ART 2 LEV 416.00

UPR/LXTR ART STDY 3+ LVLS 731.00

UPR/LXTR ART STDY 3+LV 731.00

UPR/LXTR ART STDY 3+LV 731.00

URIC ACID BLD 44.00

URIC ACID UR 46.00

URIC ACID URINE RAND 42.00

URINALYSIS AUTO W/ 33.50

URINALYSIS AUTO W/ 33.50

URINALYSIS AUTO W/O 33.50

URINALYSIS NON AUTO 17.00

URINE BUPRENOPHINE 226.50

URINE CATH COLL SINGLE 67.00

URINE CATH COLL SINGLE 52.00

URINE CULTURE AND SE 103.50

URINE CULTURE AND SE 103.50

URINE CULTURE AND SE 103.50

URINE CULTURE AND SE 103.50

Page 130: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

URINE FENTANYL 50.00

URINE METHADONE 226.50

URINE PHENAPHTHAZINE-PH 74.85

URINE UREA NITROGEN 46.00

URSODIOL 300 MG CAP 13.14

URSODIOL 500 MG TAB 5.85

US ABD AORTA SCREEN AAA 354.50

US ABD AORTA SCREEN AAA 354.50

US ABDOMEN COMPLETE 880.00

US ABDOMEN LTD 880.00

US AORTA 470.00

US AORTA 470.00

US ASCITES 880.00

US AXILLA LT 543.00

US AXILLA LT 543.00

US AXILLA RT 543.00

US AXILLA RT 543.00

US BREAST BIOPSY 838.50

US Breast Cyst Asp ea addl LT 1,574.91

US Breast Cyst Asp ea addl RT 1,574.91

US Breast Cyst Asp LT 1st Les 1,574.91

US Breast Cyst Asp RT 1st Les 1,574.91

US BREAST LT 587.50

US BREAST RT 587.50

US BRST BX 1ST LESION LT 2,978.50

US BRST BX 1ST LESION LT 2,978.50

US BRST BX 1ST LESION RT 2,978.50

US BRST BX 1ST LESION RT 2,978.50

US BRST CYST ADDSURG RT 611.00

US BRST UNI LT W AX COMP 587.50

US BRST UNI LT W AX COMP 587.50

US BRST UNI RT W AX COMP 587.50

US BRST UNI RT W AX COMP 587.50

US CHST W/MEDIASTINUM 587.50

US COMPLETE ABD SURVE 880.00

US EXTREM NON VASC COMP 880.00

US EXTREMITY-NON VAS LT 543.00

US EXTREMITY-NON VAS RT 543.00

US FETAL OVER 14 WK 880.50

US FETAL VIABILITY 587.50

US FIRST TRI ADD FETU 335.00

US FIRST TRI FETAL 704.50

US FIRST TRI-FETAL MAT 704.50

US FNA PROCEDURE 895.00

US FNA SURGICAL 407.00

US GALLBLADDER 880.00

US GB LIVER PANC 880.00

US GUIDE ASPIRATION 895.00

US GUIDE CATH PLACEMENT 895.00

US GUIDE CATH PLACEMENT 895.00

Page 131: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

US GUIDE NEEDLE LOC 895.00

US GUIDE VASC ACCESS 568.00

US GUIDED MAMMOTOME 895.00

US GUIDED MAMMOTOME 895.00

US HEAD AND NECK 587.50

US INFANT HIPS 470.00

US INFANT HIPS 470.00

US LIMITED ABD 880.00

US LIVER 880.00

US MALE PELVI/FEMALE 587.50

US NECK 587.50

US NEONATAL HEAD 895.00

US NEONATAL HEAD 895.00

US NON OB TRANSVAGINA 880.00

US OB FETAL OVER 14 WKS 570.50

US OB FETAL OVER 14 WKS 570.50

US OB TRANSVAGINAL 587.50

US PANCREAS 880.00

US PELVIC COMPLETE 880.00

US PELVIC SURVEY 880.00

US PELVIS LTD (NON OB 587.50

US PELVISLIMITED(NON OBS 587.50

US PREG AFTER 1ST TRI 880.50

US PREG UT TRANSVAGINAL 587.50

US PREGNANCY LTD 587.50

US PREGNANCY LTD 587.50

US RENAL BIL 704.50

US RENAL BILATERAL 704.50

US RENAL LIMITED 470.00

US RENAL UNIL LT 470.00

US RENAL UNIL RT 470.00

US SCROTUM AND CNTS 587.50

US SPINE FOR SAC DIMP 648.50

US SPINE FOR SAC DIMP 648.50

US SPINE SOFT TISSUE 470.00

US SPINE SOFT TISSUE 470.00

US SPLEEN 880.00

US TESTICLES 587.50

US THYROID 587.50

US THYROID 587.50

US THYROID BX PROC 880.50

US TRANSRECTAL 325.00

US TRANSVAGINAL 880.00

US URINE CAPACITY ME 159.00

US-ASCITES SURVEY 880.00

USG NDL PLACEMENT 895.00

USG NDL PLACEMENT 895.00

VALACYCLOVIR 500MG TAB 20.57

VALGANCICLOVIR 450MG TAB 142.11

VALPROIC A 250MG/5ML LIQ 1.85

Page 132: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

VALPROIC A 500MG/5ML INJ 19.04

VALPROIC ACID (DEPAKENE) 84.00

VALSAR/HCTZ 160-12.5 TAB 4.95

VALSART/HCTZ 160-25 TAB 5.47

VALSART/HCTZ 80-12.5 TAB 5.03

VALSARTAN 160 MG TABLET 6.10

VALSARTAN 320 MG TABLET 16.60

VALSARTAN 40 MG TABLET 12.32

VALSARTAN 80 MG TABLET 5.75

VANCOMYCI 125MG/2.5ML OS 5.50

VANCOMYCIN 1 MG/0.1 ML 14.25

VANCOMYCIN 250MG/5ML OS 5.50

VANCOMYCIN 500MG DOS 1GP 51.12

VANCOMYCIN 500MG DOS 1GV 30.25

VANCOMYCIN 500MG DOS 5GM 151.54

VANCOMYCIN 500MG DOS 750 25.50

VANCOMYCIN 500MG DOSE PB 19.00

VANCOMYCIN 500MG DOSE V 15.15

VANCOMYCIN 500MG/10ML OS 5.50

VANCOMYCIN 5MG/ML NB DIL 20.65

VANCOMYCINRANDOM 78.00

VANCOMYCINTROUGH 78.00

VARENICLINE 0.5 MG TAB 12.88

VARENICLINE 1MG TAB 14.10

VARIC ZOSTER IGG 124.00

VARIC ZOSTER IGM 131.00

VARICELLA 1350UNIT/0.5ML 183.27

VAS ABD VISC COMP 1,069.50

VAS ABD VISC LMTD 1,069.00

VAS ABD VISC LMTD 1,069.00

VAS AORTA DUPLEX 753.00

VAS ART BIL UPPER DUP 1,021.50

VAS ART UNI LOWER DUP 510.50

VAS ART UNIL UPPER DU 529.00

VAS RENAL ART DUP 1,069.50

VAS VEN BIL LOW/UP 969.50

VAS VEN UNIL LOW/UP 516.00

VASECTOMY 4,813.00

VASO INTEST PEPTIDE 340.50

VASOPNEUMATIC DEVICE 61.00

VASOPRESSIN 20UNIT/ML IJ 259.32

VASOPRESSIN 50UT/50MLBAG 497.00

VDRL SERUM 38.00

VDRL CSF 38.00

VECURONIUM BROMIDE 10 MG 15.70

VECURONIUM BROMIDE 20 MG 28.97

VELTASSA 8.4GM PACKET 46.62

VENA CAVE FILTER/ 3,928.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

Page 133: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 13.00

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 13.00

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.00

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE 19.50

VENIPUNCTURE FEE 19.50

VENIPUNCTURE FEE 19.50

VENLAFAXIN 37.5MG CAP.ER 4.85

VENLAFAXINE 150MG CAP.ER 5.67

VENLAFAXINE 25MG TAB 3.16

VENLAFAXINE 37.5MG TAB 3.10

VENLAFAXINE 50MG TAB 3.21

VENLAFAXINE 75 MG XR CAP 1.73

VENLAFAXINE 75MG TAB 3.28

VENOGRAM EXT UNIL LT 3,136.50

VENOGRAM EXT UNIL RT 3,136.50

VENOGRAM EXTREMITY U 3,165.50

VENOGRAM EXTREMITY U 1,842.00

VENT MGMT INITIAL IP/OBS 3,466.00

VENT MGMT IP/OBS SUB DAY 2,772.00

VENTRICULOGRAM 1,351.00

VERAPAMIL 100MG CAP24H 3.06

VERAPAMIL 120MG TAB.ER 2.17

VERAPAMIL 120MG TABLET 1.85

VERAPAMIL 180MG TAB.ER 3.59

VERAPAMIL 240MG TAB.ER 3.63

VERAPAMIL 40MG TAB 1.38

VERAPAMIL 5MG/2ML VIAL 49.32

VERAPAMIL 80MG TAB 1.67

VIBRIO CULTURE 84.00

VIDEOSTROBOSCOPY 892.00

VILAZODONE 20MG TAB 16.39

VINBLASTINE 1MG DOSE 84.24

VINCRISTINE 1MG DOSE 18.32

VINORELBINE 10MG DOSE 176.04

VIRAL CULTURE 231.00

VISCOSITY 112.50

Page 134: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

VISUAL EVOKED POTENT TST 668.00

VIT B12 1000MCG TAB 1.43

VIT B12 100MCG TAB 1.40

VIT B12 250MCG TAB 1.41

VIT C ASCORBIC ACID 96.00

VIT D2 50,000 UNIT CAP 3.13

VIT D3 1000 UNIT TAB 1.16

VIT D3 400 UNIT TAB 1.14

VIT D3 5,000 UNIT TAB 1.16

VITAL CAPACITY 387.00

VITAMIN A 112.00

VITAMIN A 10000 UNIT CAP 1.14

VITAMIN B1 188.50

VITAMIN B1(THIAMINE) 188.50

VITAMIN B12 145.50

VITAMIN B12 1000 MCG 14.24

VITAMIN B12 BIND CAP 138.50

VITAMIN B12 INJ 1000 MCG 33.50

VITAMIN B12 INJ 1000MCG 33.50

VITAMIN B5 262.50

VITAMIN D 1-25 W/WO FRAC 371.00

VITAMIN D3 25-OH 285.50

VITAMIN E 136.50

VITAMIN E 1,000 UNIT CAP 1.28

VITAMIN E 200 UNIT CAP 1.15

VITAMIN E 400 UNIT CAP 1.18

VITAMIN K 1 MG DOSE 75.12

VMA URINE 150.00

VOID PRESS STUDY, INTRA 332.00

VORICONAZOLE 0.3MG/0.3ML 106.50

VORICONAZOLE 0.3MG/0.3ML 106.50

VORICONAZOLE 10MG DOSE 254.22

VORICONAZOLE 200 MG TAB 74.10

VORTIOXETINE 20 MG TAB 20.62

VORTIOXETINE 5MG TAB 19.37

VYXEOS 44MG/100MG VIAL 13,040.00

VZV DNA by PCR 280.50

WAIST BELT/CUSTOM 324.50

WALNUT 46.50

WALNUT TREE 46.50

WARFARIN 10 MG TAB 4.82

WARFARIN 1 MG TAB 3.50

WARFARIN 2 MG TAB 3.60

WARFARIN 2.5 MG TAB 3.76

WARFARIN 3 MG TAB 3.77

WARFARIN 4 MG TAB 3.78

WARFARIN 5 MG TAB 3.88

WARFARIN 6 MG TAB 4.68

WARFARIN 7.5 MG TAB 4.80

WARFRIN 6 MG TAB 4.68

Page 135: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

WATER; DISTILLED 4,000ML 4.62

WC MNGT/15 MIN 127.50

WELLNESS CENTER CHARG 28.00

WET MNT INF AGT 36.50

WET MNT INF AGT 36.50

WET MNT INF AGT 36.50

WET MOUNT INCLUDE PR 83.00

WET PREP 36.50

WHEAT 46.50

WHEELCHAIR MGT 15M OT 101.50

WHFO DYNAMIC CABLE CUST 4,497.00

WHFO STATIC CUSTOM 1,016.00

WHIRLPOOL PT 56.00

WHITE ASH 46.50

WHO DYNAMIC CUST OUTRIG 2,693.50

WHOLE BLOOD GLUCOSE 35.00

WIRELESS CAPSULE END 2,593.00

WIRELESS CAPSULE ENDO 2,593.00

WIRELESS CAPSULE ENDO 2,593.00

WIRELESS CAPSULE ENT 2,593.00

WITCH HAZEL PAD 5.41

WK CONDIT/EA ADDL HR 134.00

WK CONDIT/INITIAL 2HRS 309.50

WORKSTEPS CHESAPEAKE 159.50

WORKSTEPS FIT FOR DUT 179.50

WORKSTEPS-FIT FOR DUT 159.50

WORKSTEPS-NO SHOW 179.50

WORKSTEPS-NO SHOW FEE 159.50

WORKSTEPS-PARTIAL TES 179.50

WORKSTEPS-POST OFFER 159.50

WORKSTEPS-POST OFFER 179.50

Wound Vac App 323.00

WOUND VAC APPL 323.00

WOUND VAC<=50SQ CM 220.00

WRIST/HAND ORTHOSIS 195.50

WS KEANE PO 154.50

WS-GARNEY NO SHOW 105.00

WS-GARNEY PO COMP EVAL 157.50

WS-GARNEY POST FIT DUTY 157.50

WS-RJ CORMAN PO 145.50

XMATCHIMMEDIATE SPIN 682.50

XOFIGO RADIUM PER MIC 430.50

XR ABD DECUB ONLY 1V 544.50

XR ABD FLAT/UPRIGHT 2v 544.50

XR ABD FLAT/UPRIGHT 2v 544.50

XR ABD FLAT/UPRIGHT 2v 544.50

XR ABD UPRIG + FLAT 3MOR 544.50

XR ABD UPRIG + FLAT 3MOR 544.50

XR ABD UPRIG + FLAT 3MOR 544.50

XR ABDOMEN KUB FLAT 1V 544.50

Page 136: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR Abdomen 1V KUB 544.50

XR Abdomen 1V KUB 544.50

XR Abdomen 1V KUB 544.50

XR ABDOMEN DECUB ON 1V 544.50

XR ABDOMEN DECUB ON 1V 544.50

XR ABDOMEN DECUB ONLY 1V 544.50

XR ABSCESS/FIST/SIN 1,708.00

XR AC JT BIL 298.00

XR AC JT BIL 298.00

XR AC JT BIL 298.00

XR Acute Abd Series/sgl V ches 361.00

XR Acute Abd Series/sgl V ches 361.00

XR Acute Abd Series/sgl V ches 361.00

XR ANKLE 2 VIEW BI 544.50

XR ANKLE 2 VIEWS BI 544.50

XR ANKLE 2 VIEWS BI 544.50

XR ANKLE 2 VIEWS LT 272.50

XR ANKLE 2 VIEWS RT 272.50

XR ANKLE 2 VIEWS RT 272.50

XR ANKLE 2 VWS LT 272.50

XR ANKLE 2VIEW BI 544.50

XR ANKLE 3 + V BI 596.00

XR ANKLE 3 + V BI 596.00

XR ANKLE 3 + V LT 298.00

XR ANKLE 3 + V RT 298.00

XR ANKLE 3 VIEWS LT 298.00

XR ANKLE 3 VIEWS RT 298.00

XR ANKLE 3+ V BI 596.00

XR ANKLE 3+ V BI 596.00

XR ARTHRO HIP IMAG LT 1,706.50

XR ARTHRO HIP IMAG RT 1,706.50

XR ARTHRO HIP INJ 251.50

XR ARTHRO KNEE INJ 251.50

XR ARTHRO KNEE LT 1,295.50

XR ARTHRO KNEE RT 1,295.50

XR ARTHRO SHOULDER IN 251.50

XR ARTHRO SHOULDER LT 1,706.50

XR ARTHRO SHOULDER RT 1,706.50

XR ARTHRO WRIST INJ 251.50

XR ARTHROGRAM ELBOW LT 1,707.50

XR ARTHROGRAM ELBOW RT 1,707.50

XR ARTHROGRAM HIP LT 1,706.50

XR ARTHROGRAM HIP RT 1,706.50

XR ARTHROGRAM KNEE LT 1,295.50

XR ARTHROGRAM KNEE RT 1,295.50

XR ARTHROGRAM SHLDR LT 1,706.50

XR ARTHROGRAM SHLDR RT 1,706.50

XR ARTHROGRAM WRIST LT 938.50

XR ARTHROGRAM WRIST LT 938.50

XR ARTHROGRAM WRIST R 938.50

Page 137: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR ARTHROGRAM WRIST RT 938.50

XR BILATERAL SI JOINTS 746.00

XR BONE AGE STUDIES 477.00

XR BONE AGE STUDIES 477.00

XR BONE AGE STUDIES 477.00

XR BONE DENS (DEXA) A 561.00

XR BONE SURVEY INFANT 476.50

XR BONE SURVEY COMP 824.50

XR BONE SURVEY COMP 824.50

XR BONE SURVEY COMP 824.50

XR BONE SURVEY INFANT 476.50

XR CALCANEOUS BI 596.00

XR CALCANEUS 2 + V BI 596.00

XR CALCANEUS 2 + V BI 596.00

XR CALCANEUS 2 + V LT 298.00

XR CALCANEUS 2 + V RT 298.00

XR CHANGE NEPHROSTOMY 3,162.50

XR CHEST DECUB INS 4V 544.50

XR CHEST 1 V 544.50

XR CHEST 1 V 544.50

XR CHEST 1 V 544.50

XR CHEST 2 V 544.50

XR CHEST 2 V 544.50

XR CHEST 3 V W/AP LOR 544.50

XR CHEST 3 V W/AP LOR 544.50

XR CHEST 3 V W/AP LOR 544.50

XR CHEST 3 V W/OBLIQUES 544.50

XR CHEST 4 V W/OBLIQUES 544.50

XR CHEST B-2 VIEWS 289.50

XR CHEST DECUB INS 3V 544.50

XR CHEST DECUB IN/EX 2V 544.50

XR CHEST DECUB IN/EX 3V 544.50

XR CHEST DECUB IN/EX 3V 544.50

XR CHEST DECUB IN/EX 4 544.50

XR CHEST DECUB IN/EX 4V 544.50

XR CHEST DECUB INS 2V 544.50

XR CHEST DECUB INS 4V 544.50

XR CHEST DECUB INSP/E 2V 544.50

XR CHEST DECUB INSP/E 4V 544.50

XR CHEST NON DIGITAL 117.50

XR CHEST OBLIQUE ON 2V 544.50

XR CHEST OBLIQUE ON 3V 544.50

XR CHEST OBLIQUE ON 4V 544.50

XR CHEST OBLIQUE ONLY 2V 544.50

XR CHEST OBLIQUE ONLY 3V 544.50

XR CHEST OBLIQUE ONLY 4V 544.50

XR CHEST OBLQ ONLY 2V 544.50

XR CHEST OBLQ ONLY 3V 544.50

XR CHEST OBLQ ONLY 4V 544.50

XR CHEST PA & LATERA 2V 544.50

Page 138: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR CHEST PA LAT & OBL 3V 544.50

XR CHEST PA LAT & OBL 4V 544.50

XR CHEST PA LAT + OBL 3V 544.50

XR CHEST PA LAT + OBL 4V 544.50

XR CHOLANG EXISTING CATH 9,468.50

XR CHOLANG INTRAOP 786.50

XR CHOLANG INTRAOP ADL 409.50

XR CHOLANGIOT-TUBE IN 9,468.50

XR CLAVICLE COMP BI 596.00

XR CLAVICLE COMP BI 596.00

XR CLAVICLE COMP BI 596.00

XR CLAVICLE COMP LT 298.00

XR CLAVICLE COMP RT 298.00

XR CLAVICLE LT 298.00

XR CLAVICLE RT 298.00

XR COLON AIR CONTRAST 939.00

XR COLON AIR CONTRAST 939.00

XR COLON BARIUM ENEMA 717.50

XR CONT ENEMA W/WO KUB 717.50

XR C-SPINE 2-3 VIEWS 897.00

XR C-SPINE 2-3 VIEWS 897.00

XR C-SPINE 2-3 VIEWS 897.00

XR C-SPINE 6 + V 897.00

XR C-SPINE 6 + V 897.00

XR C-SPINE 6 + V 897.00

XR C-SPINE SINGLE VIEW 198.00

XR C-SPINE SINGLE VIEW 198.00

XR C-SPINE SINGLE VIEW 198.00

XR CYSTOGRAM 3 + V 939.00

XR CYSTOGRAPHY 939.00

XR CYSTOURETHRO RETRO 726.50

XR CYSTOURETHRO VDNG 939.50

XR DIAG MAMMO BI 490.50

XR DIAG MAMMO BIL 490.50

XR DIAG MAMMO LT 388.50

XR DIAG MAMMO LT 388.50

XR DIAG MAMMO RT 388.50

XR DIAG MAMMO RT 388.50

XR DIAG SPOT COMP BIL 490.50

XR DIAG SPOT COMP BIL 490.50

XR DIAG SPOT COMP BIL 490.50

XR DIAG SPOT COMP LT 388.50

XR DIAG SPOT COMP LT 388.50

XR DIAG SPOT COMP RT 388.50

XR DIAG SPOT COMP RT 388.50

XR DILAT NEPHROSTOMY 6,331.50

XR ELBOW 2 VIEWS RT 289.50

XR ELBOW 2 VWS LT 289.50

XR ELBOW 2 VWS LT 289.50

XR ELBOW 2 VWS RT 289.50

Page 139: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR ELBOW 2 VWS RT 289.50

XR ELBOW 3 + V LT 316.00

XR ELBOW COMP STUDY L 316.00

XR ELBOW COMP STUDY R 316.00

XR ERCP 805.50

XR ERCP BILIARY ONLY 733.50

XR ERCP PANCREAS ONLY 733.50

XR ESOPHAGUS (BA SWAL 717.50

XR ESOPHAGUS BARIUM SW 717.50

XR EYE FOREIGN BODY BI 544.50

XR FACIAL BONES < 3 V 390.50

XR FACIAL BONES < 3 V 390.50

XR FACIAL BONES < 3 V 390.50

XR FACIAL BONES COMPLETE 476.50

XR FACIAL BONES COMPLETE 476.50

XR FACIAL BONES COMPLETE 476.50

XR FB CHILD NOSE TO RECT 459.50

XR FB CHILD NOSE TO RECT 459.50

XR FB CHILD NOSE TO RECT 459.50

XR FEMUR 1 VIEWS LT 289.50

XR FEMUR 1 VIEWS LT 289.50

XR FEMUR 1 VIEWS LT 289.50

XR FEMUR 1 VIEWS RT 289.50

XR FEMUR 1 VIEWS RT 289.50

XR FEMUR 1 VIEWS RT 289.50

XR FEMUR 2 VIEWS LT 289.50

XR FEMUR 2 VWS LT 289.50

XR FEMUR 2 VWS RT 289.50

XR FEMUR BI 579.00

XR FEMUR BILATERAL 579.00

XR FEMURE 1 VIEW RT 289.50

XR FEMURE 1 VIEWS LT 289.50

XR FINGER BILAT COMP 596.00

XR FINGER(S) 2 + V BI 596.00

XR FINGER(S) 2 + V LT 298.00

XR FINGER(S) 2 + V RT 298.00

XR FINGER(S) BILAT COMP 596.00

XR FINGERS LT 298.00

XR FINGERS LT 298.00

XR FINGERS RT 298.00

XR FINGERS RT 298.00

XR FLUORO CHEST 0-60 MIN 769.00

XR FLUORO NDL 909.50

XR FLUOROSCOPY 0-60 MIN 769.00

XR FLURO CHEST 769.00

XR FLUROSCOPIC GUIDAN 909.50

XR FOOT 2 VIEWS BI 544.50

XR FOOT 2 VIEWS BI 544.50

XR FOOT 2 VIEWS BI 544.50

XR FOOT 2 VIEWS LT 272.25

Page 140: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR FOOT 2 VIEWS RT 272.25

XR FOOT 2 VWS LT 272.25

XR FOOT 2 VWS RT 272.25

XR FOOT 3 + V BI 596.00

XR FOOT 3 + V BI 596.00

XR FOOT 3 + V LT 298.00

XR FOOT 3 + V LT 298.00

XR FOOT 3 + V LT 298.00

XR FOOT 3 + V RT 298.00

XR FOOT 3 + V RT 298.00

XR FOOT 3 + V RT 298.00

XR FOOT 3+ V BI 596.00

XR FOOT 3+ V BI 596.00

XR FOOT OS CALCIS LT 298.00

XR FOOT OS CALCIS RT 298.00

XR FOREARM 2 VIEWS BI 596.00

XR FOREARM 2 VIEWS LT 298.00

XR FOREARM 2 VIEWS RT 298.00

XR FOREARM 2 VWS LT 298.00

XR FOREARM 2 VWS RT 298.00

XR FOREARM BILAT COMP 596.00

XR FOREARM BILAT COMP 596.00

XR HAND 2 V BI 596.00

XR HAND 2 V LT 298.00

XR HAND 2 V RT 298.00

XR HAND 3 + V BI 298.00

XR HAND 3 + V LT 298.00

XR HAND 3 + V RT 298.00

XR HAND BILAT LIMITED 596.00

XR HAND BILAT LMTD 596.00

XR HAND COMP STUDY BIL 596.00

XR HAND COMP STUDY BIL 596.00

XR HAND COMP STUDY LT 298.00

XR HAND COMP STUDY RT 298.00

XR HAND LIMITED LT 298.00

XR HAND LIMITED RT 298.00

XR HIP BI W/PELVIS 325.00

XR HIP BILAT W/PELVIS 325.00

XR HIP BILAT W/PELVIS 325.00

XR HIP PELVIS LT 1 V LTD 289.50

XR HIP PELVIS LT 1V LMT 289.50

XR HIP PELVIS LT 4+ V 325.00

XR HIP PELVIS LT 4+ V 325.00

XR HIP PELVIS LT 4+ V 325.00

XR HIP PELVIS LT 4+V 325.00

XR HIP PELVIS LT COMP 476.50

XR HIP PELVIS LT COMP 476.50

XR HIP PELVIS RT 1 V LMT 289.50

XR HIP PELVIS RT 1V LMTD 289.50

XR HIP PELVIS RT 4+ V 325.00

Page 141: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR HIP PELVIS RT 4+ V 325.00

XR HIP PELVIS RT 4+V 325.00

XR HIP PELVIS RT 4+V 325.00

XR HIP PELVIS RT COMP 476.50

XR HIP PELVIS RT COMPL 476.50

XR HIP ROUTINE LT 476.50

XR HIP ROUTINE RT 476.50

XR HIP SINGLE VW LT 289.50

XR HIP SINGLE VW RT 289.50

XR HIP UNI 1 V LT 289.50

XR HIP UNI 1 V RT 289.50

XR HIP UNI 2 + V LT 476.50

XR HIP UNI 2 + V RT 476.50

XR HIPS BI 325.00

XR HIPS BI 325.00

XR HIPS BI 325.00

XR HUMERUS 2 + V BI 544.50

XR HUMERUS 2 + V LT 272.50

XR HUMERUS 2 + V RT 272.50

XR HUMERUS BILATERAL 544.50

XR HUMERUS BILATERAL 544.50

XR HUMERUS LT 272.50

XR HUMERUS RT 272.50

XR HYSTEROSALPINGOGRA 939.50

XR HYSTROSALPNGOGRAM 939.50

XR INJ HYSTEROSALPING 150.00

XR IVP HYPERTENSION 767.50

XR KNEE 1 OR 2 V BI 544.50

XR KNEE 1 OR 2 V LT 272.25

XR KNEE 1 OR 2 V RT 272.25

XR KNEE 3 V BI 1,547.00

XR KNEE 3 V BIL 1,547.00

XR KNEE 3 V LT 429.50

XR KNEE 3 V RT 429.50

XR KNEE 4 + V BI 1,547.00

XR KNEE 4 + V LT 773.50

XR KNEE 4 + V RT 773.50

XR KNEE AP STAND BI 289.50

XR KNEE BIL COMP W SPEC 1,547.00

XR KNEE BILAT COMPL 1,547.00

XR KNEE BILAT COMPL 1,547.00

XR KNEE BILAT COMPw SPEC 1,547.00

XR KNEE BILAT LMTD 544.50

XR KNEE BILAT LMTD 544.50

XR KNEE COMP STUDY LT 429.50

XR KNEE COMP STUDY RT 429.50

XR KNEE LIMITED LT 272.25

XR KNEE LIMITED RT 272.25

XR KNEE W/ SPECIAL VW 773.50

XR KNEE W/ SPECIAL VW 773.50

Page 142: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR KNEES BOTH STANDI 289.50

XR KNEES BOTH STANDIN 289.50

XR L SPINE FLEX/EXT ONLY 897.00

XR L SPINE FLEX/EXT ONLY 897.00

XR leg length study 354.50

XR LOOPOGRAM 1,708.00

XR LOOPOGRAM 1,708.00

XR LOW EXT-INFANT LT 298.00

XR LOW EXT-INFANT RT 298.00

XR L-SPINE 2/3 VIEWS 897.00

XR L-SPINE 2/3 VIEWS 897.00

XR L-SPINE 2/3 VIEWS 897.00

XR L-SPINE 4 + VIEW 515.50

XR L-SPINE 4 + VIEW 515.50

XR L-SPINE 4 + VIEWS 515.50

XR L-SPINE BEND ONLY 897.00

XR L-SPINE W/BEND VIEW 476.50

XR L-SPINE W/BEND VIEW 476.50

XR L-SPINE W/BEND VIEW 476.50

XR LT ANKLE 2 VWS 272.50

XR LT ANKLE 3 VIEWS 298.00

XR LT CLAVICLE 298.00

XR LT ELBOW COMP STU 316.00

XR LT FEMUR 2 VWS 289.50

XR LT FOOT 2 VWS 272.25

XR LT FOOT OS CALCIS 298.00

XR LT FOREARM 2 VWS 298.00

XR LT HAND COMP STUD 298.00

XR LT HAND LIMITED 298.00

XR LT HIP COMPLETE S 476.50

XR LT HIP SINGLE VIE 289.50

XR LT HUMERUS 272.50

XR LT KNEE COMPLETE 429.50

XR LT KNEE LIMITED 272.25

XR LT KNEE W/SPECIAL 773.50

XR LT LOWER EXT INFA 298.00

XR LT RIB UNILATERAL 343.50

XR LT SCAPULA 310.00

XR LT SHOULDER COMP 395.00

XR LT SHOULDER LIMIT 272.50

XR LT TIB/FIB 2 VWS 298.00

XR LT UPPER EXT INFA 477.00

XR LT WRIST 2 VWS 272.50

XR LT WRIST COMP STU 298.00

XR MAMMO BREAST TISS 1,707.50

XR MAMMO DUCTOGRAM SINGL 659.50

XR MAMMO MULT DUCTOGR 659.50

XR MANDIBLE <4v 476.50

XR MANDIBLE <4V 476.50

XR MANDIBLE <4v 476.50

Page 143: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR MANDIBLE COMP 476.50

XR MANDIBLE COMP 476.50

XR MANDIBLE COMP 476.50

XR MASTOIDS COMPLET 476.50

XR MASTOIDS COMP 476.50

XR MASTOIDS COMPLET 476.50

XR MRI WATER VIEWS 544.50

XR MRI WATERS VIEW 544.50

XR MYELOGR SPINE 2/M REG 2,985.50

XR MYELOGRAM L-SPINE 2,985.50

XR NASAL BONES COMP 315.00

XR NASAL BONES COMP 315.00

XR NASAL BONES COMP 315.00

XR NECK SOFT TISSUE 289.50

XR NECK SOFT TISSUE 289.50

XR NECK SOFT TISSUE 289.50

XR ORBITS COMP, 4 + V 476.50

XR ORBITS COMP, 4 + V 476.50

XR ORBITS COMP, 4 + V 476.50

XR PARANASAL SINUSES <3V 313.50

XR PARANASAL SINUSES <3V 313.50

XR PARANASAL SINUSES <3V 313.50

XR PARANASAL SINUSES COMP 487.00

XR PARANASAL SINUSES COMP 487.00

XR PELVIS 1 OR 2 VIE 375.00

XR PELVIS 1/2 VIEWS 375.00

XR PELVIS 1-2 VWS 375.00

XR PELVIS 3 + V 476.50

XR PELVIS MIN 3 V 476.50

XR PELVIS MIN 3V 476.50

XR POSTEROANT CHEST M 537.00

XR RETROGRADE URETHRO 726.50

XR RIB RT M 3 V W CXR1 V 537.00

XR RIB RT MIN 3V W CXR1V 537.00

XR RIBS BILAT 3V 476.50

XR RIBS BILAT 3V 476.50

XR RIBS BILAT 3V 476.50

XR RIBS LT M 3 VW/CXR1 V 537.00

XR RIBS LT MIN3V W CXR1 537.00

XR RIBS UNI 2 V LT 343.50

XR RIBS UNI 2 V RT 343.50

XR RIBS UNI W/CXR 3+V LT 537.00

XR RIBS UNI W/CXR 3+V RT 537.00

XR RIBS UNILATERAL LT 343.50

XR RIBS UNILATERAL RT 343.50

XR RIBS/CHEST BILAT 4V 484.50

XR RIBS/CHEST BILAT 4V 484.50

XR RIBS/CHEST BILAT 4V 484.50

XR RT ANKLE 2 VWS 272.50

XR RT ANKLE 3 VWS 298.00

Page 144: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR RT CLAVICLE 298.00

XR RT ELBOW COMP STU 316.00

XR RT FOOT 2 VWS 272.25

XR RT FOOT OS CALCIS 298.00

XR RT FOREARM 2 VWS 298.00

XR RT HAND COMP STUD 298.00

XR RT HAND LIMITED 298.00

XR RT HIP COMPLETE S 476.50

XR RT HIP SINGLE VIE 289.50

XR RT HUMERUS 272.50

XR RT KNEE COMPLETE 429.50

XR RT KNEE LIMITED 272.25

XR RT KNEE W/SPECIAL 773.50

XR RT LOWER EXT INFA 298.00

XR RT RIB UNILATERAL 343.50

XR RT SCAPULA 310.00

XR RT SHOULDER COMP 395.00

XR RT SHOULDER LIMIT 272.50

XR RT TIB/FIB 2 VWS 298.00

XR RT UPPER EXT INFA 477.00

XR RT WRIST 2 VWS 272.50

XR RT WRIST COMP STU 298.00

XR SACR/COCCYX 2V BI 746.00

XR SACRUM AND COCCYX 298.00

XR SACRUM AND COCCYX 298.00

XR SACRUM/COCCYX 2 + V 298.00

XR SC JOINTS 3 + V 378.00

XR SC JOINTS 3 + V 378.00

XR SC JOINTS 3 + V 378.00

XR SCAPULA BILATERAL 620.00

XR SCAPULA BILATERAL 620.00

XR SCAPULA BLATERAL 620.00

XR SCAPULA COMP BI 620.00

XR SCAPULA COMP LT 310.00

XR SCAPULA COMP RT 310.00

XR SCAPULA LT 310.00

XR SCAPULA RT 310.00

XR SCREENING MAMMO BIL 485.50

XR SCREENING MAMMO BIL 485.50

XR SCREENING MAMMO LT 485.50

XR SCREENING MAMMO LT 485.50

XR SCREENING MAMMO RT 485.50

XR SCREENING MAMMO RT 485.50

XR SHOULDER 1 V BI 544.50

XR SHOULDER 1 V LT 272.50

XR SHOULDER 1 V RT 272.50

XR SHOULDER 2 + V BI 790.00

XR SHOULDER 2 + V LT 395.00

XR SHOULDER 2 + V RT 395.00

XR SHOULDER BILAT COMP 790.00

Page 145: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR SHOULDER BILAT COMP 790.00

XR SHOULDER BILAT LMTD 544.50

XR SHOULDER BILAT LMTD 544.50

XR SHOULDER COMP LT 395.00

XR SHOULDER COMP RT 395.00

XR SHOULDER LTD LT 272.50

XR SHOULDER LTD RT 272.50

XR SI JOINTS 2V LT 373.00

XR SI JOINTS 2V LT 373.00

XR SI JOINTS 2V LT 373.00

XR SI JOINTS 2V RT 373.00

XR SI JOINTS 2V RT 373.00

XR SI JOINTS 2V RT 373.00

XR SI JOINTS 3 + V 476.50

XR SI JOINTS 3 + V BI 612.00

XR SINUSES 3 + V 487.00

XR SKULL < 4 V 897.00

XR SKULL < 4 V 897.00

XR SKULL < 4 V 897.00

XR SKULL 4 + V 499.50

XR SKULL 4 + V 499.50

XR SKULL 4 + V 499.50

XR SM BOWEL 354.50

XR SMALL BOWEL/ENTERO 1,300.00

XR SMALL BOWEL/ENTERO 1,300.00

XR SMALL INTESTINE 354.50

XR SPINE SCOLIOSIS 395.00

XR SPINE CERVICAL 4 V 499.50

XR SPINE CERVICAL 4 V 499.50

XR SPINE CERVICAL 4 V 499.50

XR SPINE SCOLIOSIS 395.00

XR SPINE SCOLIOSIS 395.00

XR SPINE SURV STUDY 2/3V 794.50

XR SPINE SURV STUDY 2/3V 794.50

XR SPINE SURVEY STUDY 794.50

XR SPINE THOR/LUMB 6+ V 393.00

XR SPINE THOR/LUMB 6+ V 393.00

XR SPINE THORACIC 3 V 476.50

XR STEREO CONFIRM TM LT 388.50

XR STEREO CONFIRM TM RT 388.50

XR STERNUM 320.50

XR STERNUM 320.50

XR STERNUM 2 + V 320.50

XR STERO BRST BUNDLE LT 4,090.50

XR STERO BRST BUNDLE RT 4,090.50

XR STERO LOCAL DISCON L 585.00

XR STERO LOCAL DISCON L 585.00

XR STERO LOCAL DISCON R 585.00

XR SURGICAL SPECIMEN 1,707.50

XR SURGICAL SPECIMEN 1,707.50

Page 146: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR SWLW FUNC W/C&V 476.50

XR SWLW FUNC W/C+V 476.50

XR TIB/FIB 2V RT 298.00

XR TIB/FIB INFNT BILAT 596.00

XR TIB/FIB INFNT BILAT 596.00

XR TIBIA and FIBULA 2 V LT 298.00

XR TIBIA AND FIBULA 2 V RT 298.00

XR TIBIA/FIBULA 2 V BI 596.00

XR TIBIA/FIBULA 2 V LT 298.00

XR T-L-SPINE 2 VIEWS 289.50

XR T-L-SPINE 2 VIEWS 289.50

XR T-L-SPINE 2 VIEWS 289.50

XR TMJ BILAT 386.50

XR TMJ BILAT 386.50

XR TMJ BILAT 386.50

XR TOE(S) 2 + V BI 579.00

XR TOE(S) 2 + V LT 289.50

XR TOE(S) 2 + V RT 289.50

XR TOE(S) BILAT COMP 579.00

XR TOE(S) BILAT COMP 579.00

XR TOES LT 289.50

XR TOES LT 289.50

XR TOES RT 289.50

XR TOES RT 289.50

XR T-SPINE 2 VIEWS 476.50

XR T-SPINE 2 VIEWS 476.50

XR T-SPINE 2 VIEWS 476.50

XR T-SPINE 3 VIEWS 476.50

XR T-SPINE 3 VIEWS 476.50

XR T-SPINE 4 + VIEWS 476.50

XR T-SPINE 4 + VIEWS 476.50

XR T-SPINE 4 + VIEWS 476.50

XR T-SPINE SINGLE VIEW 198.00

XR T-SPINE SINGLE VIEW 198.00

XR T-SPINE SINGLE VIEW 198.00

XR U GI W/KUB 717.50

XR U GI/SM BOWEL 939.00

XR UE INFANT BI MIN 2V 953.50

XR UE INFANT BL MIN 2V 953.50

XR UGI W/AIR SM BOWEL FT 1,056.00

XR UGI W/AIR W/KUB 717.50

XR UGI W/AIR W/KUB 717.50

XR UGI W/AIR W/SM INTEST 1,056.00

XR UGI W/KUB 717.50

XR UGI W/SMALL INTESTINE 939.00

XR UP EXTREM INFANT2V BI 953.50

XR UP EXTREM INFANT2V RT 477.00

XR UPPER EXT-INFANT L 477.00

XR UPPER EXT-INFANT R 477.00

XR UROGRAM ANTEGRADE 1,708.00

Page 147: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

XR VENOGRAM EXT UNIL LT 3,136.50

XR VENOGRAM EXT UNIL RT 3,136.50

XR VOIDING CYSTOGRAM 939.50

XR WRIST 2 VIEWS BI 544.50

XR WRIST 2 VIEWS LT 272.50

XR WRIST 2 VIEWS RT 272.50

XR WRIST 2 VWS LT 272.50

XR WRIST 2 VWS RT 272.50

XR WRIST 3 + V BI 596.00

XR WRIST 3 + V LT 298.00

XR WRIST 3 + V RT 298.00

XR WRIST BILAT COMP 596.00

XR WRIST BILAT COMP 596.00

XR WRIST BILAT LMTD 544.50

XR WRIST BILAT LMTD 544.50

XR WRIST COMP STUDY L 298.00

XR WRIST COMP STUDY R 298.00

XR-FISTULA SINUS STUD 1,708.00

XTRASORB 4X5 386.50

XTRASORB 6X9 442.00

YEAST ID 57.50

YEAST ID 62.00

ZAFIRLUKAST 20 MG TABLET 4.09

ZANAMIVIR 5 MG Diskhaler 100.54

ZICONOTIDE 1 MCG/0.01ML 13.97

ZICONOTIDE 1 MCG/0.04ML 3.28

ZINC 101.50

ZINC OXIDE 50 GM POWDER 151.94

ZINC OXIDE OINT 28.35GM 4.37

ZINC PROTOPROPHYRIN 56.00

ZINC SULFATE 220 MG CAP 1.26

ZIPRASIDONE 10 MG DOSE 84.66

ZIPRASIDONE 20 MG CAP 14.46

ZIPRASIDONE 40 MG CAP 14.46

ZIPRASIDONE 60 MG CAP 16.38

ZIPRASIDONE 80 MG CAP 16.38

ZOLEDRONIC ACI 5MG/100ML 511.20

ZOLEDRONIC ACID 1MG DOSE 306.72

ZOLMITRIPTAN 2.5 MG TAB 34.93

ZOLPIDEM 5 MG TAB 5.72

ZOLPIDEM 10 MG TAB 5.72

ZONISAMIDE 98.00

ZONISAMIDE 100 MG CAP 2.00

ZONISAMIDE 25 MG CAP 1.65

ZOSTER (SHINGLES) VAC 299.00

ZOSTER (SHINGLES) VAC 299.00

ZOSTER (SHINGLES) VAC 299.00

ZOSTER 19,400UNIT/0.65ML 3,623.83

ZOSTER(SHINGLES) VAC 299.00

ZOSTER(SHINGLES) VACCINE 299.00

Page 148: Description Charge Amount - Thomas Healthacyclovir 5 mg dose nb 32.04 acyclovir 5% oint 30gm 566.30 acyclovir 5% oint 5gm 199.34 acyclovir 800 mg tablet 5.65 adacel tdap 76.00 adacel

MIS.COC.BD.ZCUS.zcus.d.steve.proc.dept.list.name

ZOSYN 1.125GM DO 2.25 P 29.33

ZOSYN 1.125GM DO 3.375 P 38.34

ZOSYN 1.125GM DO 3.375 V 23.36

ZOSYN 1.125GM DO 4.5 V 29.92

ZOSYN 125GM DO 2.25 V 19.00