Rev Code CALCIUM & MAGNESUIM TAB $0.29 LACTINEX TAB …

Rev CodeCALCIUM & MAGNESUIM TAB $0.29LACTINEX TAB [KEPT IN FRI $0.29VITAMIN C CHEWABLE TAB [5 $0.29ACETAMINOPHEN TAB 325 MG $0.79ACETAMINOPHEN TAB 500 MG $0.79ASPIRIN EC-ORANGE TAB [32 $0.79ASPIRIN TAB 325 MG $0.79ASPIRIN CHEWABLE TAB [81M $0.79ASPIRIN EC TAB [81MG] $0.79BISACODYL EC TAB [5MG] $0.79CALCIUM CARBONATE CHW TAB $0.79DOCUSATE SOD. LIQUID [60 $0.79DIPHENHYDRAMINE CAP [25MG $0.79DIPHENHYDRAMINE SOLU [12. $0.79DOCUSATE CALCIUM CAP [24O $0.79DOCUSATE SODIUM CAP [100M $0.79bacitracin zinc oint (1/32 oz pkg) $0.79FERROUS SULFATE TAB [325 $0.79FIBER LAXATIVE TAB (GENER $0.79GINKGO BILOBA CAP [60MG] $0.79IBUPROFEN TAB [200MG] $0.79NAPROXEN TAB [220MG] $0.79PEPTO-BISMOL CHEWABLE TAB $0.79PSEUDOEPHEDRINE HCL TAB [ $0.79THERAPEUTIC -MULTI-VIT WI $0.79TRIPLE ANTIBIOTIC UNIT DO $0.79SODIUM BICARBONATE TAB [1 $0.79VITAMIN C TAB [500MG] $0.79VITAMIN E CAP [400 IU ] $0.79ZINC TAB [50MG] $0.79ZINC SULFATE CAP [220MG] $0.79OCUVITE TAB $0.79CHLORASEPTIC LOZ CHERRY [ $0.79DOCUSATE NA/ SENNOSIDES T $0.79SENNOSIDES TAB [8.6MG] $0.79GUAIFENESIN SYRUP [DOSE] $0.79CALCIUM CITRATE TAB [200M $0.79CALCIUM CARBONATE/D TAB $0.79MULTIPLE VITAMINS W/ MINE $0.79FERROUS GLUCONATE TAB [32 $0.79

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SALONPAS PATCH [20] $0.79Thiamine tab 100mg $0.79CHOLECALCIFEROL TAB *DOSE 1000IU* $0.79vitamin b6 100mg bottle $0.79Excedrin Tab $0.79FAMOTIDINE TAB [20MG] $0.90SERTRALINE TAB [ 25MG] $0.90SIMVASTATIN TAB [ 20MG] $0.90SERTRALINE TAB [ 50MG] $0.90METHOCARBAMOL TAB [500MG] $0.95MAALOX SUSP [ 30ML DOSE] $1.00ACETAMINOPHEN ELIXIR [160 $1.40CITRUCEL ORANGE [DOSE] $1.40LACTASE TAB $1.40METAMUCIL PACKET [SF] $1.40MILK OF MAG [30ML DOSE] $1.40LACTOBACILLUS TAB [KEPT I $1.40GUAIFENESIN ER TAB [ 600M $1.40GUAIFENESIN DM SYRUP [DOS $1.40ANTACID SUSPENSION [30ML $1.40IBUPROFEN SUSP [100MG/5ML $1.40MELATONIN ORAL TAB [3MG] $1.40LAB FOLLOW UP WITH INSTRUCTIONS FOR MEDI $1.40MULTIPLE VITAMINS W/ MINERALS CAP * SING $1.40SERTRALINE TAB [100MG] $1.65BISACODYL SUPP [10MG] $1.80GLYCERIN PEDIATRIC SUPP $1.80GLYCERIN ADULT SUPP $1.80FRUITY CHEWS TAB $2.00SAFELINE INJECT SITE O.P. $2.00POT PHOS MONO-SOD PHPS DI & MONOPHOSPHA $2.00ACETAMINOPHEN SUPP 120 MG $2.30ACETAMINOPHEN SUPP [325MG $2.30ACETAMINOPHEN SUPP [650MG $2.30SILVER NITRATE APPLICATOR $2.40DIGOXIN TAB [0.125MG] $2.50DIGOXIN TAB [0.25MG] $2.50DIPHENHYDRAMINE CAP [50MG $2.58LISINOPRIL TAB [10MG] $2.60NIACIN ER TAB (500MG) J2360 $2.60ASCRIPTIN TAB [325MG] $2.62METFORMIN TAB [ 500MG] $2.62

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LISINOPRIL TAB [ 5MG] $2.62HCTZ TAB [25MG] $2.63TETRACYCLINE CAP [250MG] $2.63LORAZEPAM TAB [0.5MG] $2.64MAGNESIUM OXIDE TAB [400M $2.64meclizine Tab (12.5 mg) $2.64CYCLOBENZAPRINE TAB [10MG $2.65LORAZEPAM TAB [1MG] $2.66METFORMIN TAB [1000MG] $2.67AMLODIPINE TAB [10MG] $2.68FUROSEMIDE TAB [20MG] $2.68HYDRALAZINE TAB [10MG] $2.69DIAZEPAM TAB [2MG] $2.69METOCLOPRAMIDE HCL TAB [1 $2.70LITHIUM CARBONATE CAP [150MG] $2.72GABAPENTIN CAP [100MG] $2.72HYDRALAZINE TAB [25MG] $2.73PHOSLO TAB [667MG] $2.73TRAZODONE TAB [ 50MG] $2.74DONEPEZIL TAB [10MG] $2.75DONEPEZIL TAB [ 5MG] $2.75LITHIUM CARBONATE CAP [30 $2.77DILTIAZEM HCL TAB [30MG] $2.78TRIHEXYPHENIDYL TAB [2MG] $2.78GABAPENTIN CAP [300MG] $2.80CLONIDINE TAB [0.1MG] $2.86PREDNISONE TAB [10MG] $2.86PREDNISONE TAB [20MG] $2.87METOPROLOL TAB [25MG] $2.88CIPROFLOXACIN TAB [250MG] $2.88SULFASALAZINE TAB [500MG] $2.88Dexamethasone 0.75 mg Tab $2.88PREDNISONE TAB [ 5MG] $2.89PREDNISONE TAB [ 1MG] $2.89AMOXICILLIN CAP [250MG] $2.91FUROSEMIDE TAB [80MG] $2.91AMILORIDE TAB [5MG] $2.91PAROXETINE HCL TAB [20MG] $2.91POLY-IRON CAP [150 FORTE] $2.93DILTIAZEM HCL TAB [60MG] $2.94ALLOPURINOL TAB [100MG] $2.96HALOPERIDOL TAB [0.5 MG] $2.96

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GLYBURIDE TAB [2.5MG] $2.97HYDROXYZINE HCL TAB [25MG $2.97IBUPROFEN TAB [600MG] $2.97MEDROXYPROGESTERONE TAB [ $2.98AMITRIPTYLINE TAB [10MG] $2.99DIAZEPAM TAB [5MG] $3.00HYDROXYZINE PAM CAP [50MG $3.00PROPOXYPHENE-N/ APAP TAB $3.00ZYRTEC TAB [10MG] $3.00PROPOXYPHENE HCL CAP [65M $3.00ANTACID ALUM/MAG/SIMETH SUSP DOUBLE STR. $3.00METOCLOPRAMIDE HCL TAB [ $3.02HYDROCORTISONE TAB [ 5 MG $3.03PROPRANOLOL TAB [10MG] $3.04Chlordiazepoxide 5 mg Cap $3.05ACETAMINOPHEN/CODEINE TAB $3.06FOLIC ACID TAB [1MG] $3.06GLIPIZIDE TAB [5MG] $3.06TMP-SMX DS TAB 800/160MG $3.07ESTRADIOL TAB [1MG] $3.09CT NON-IONIC 240/ 1ML Q9966 $3.09METHADONE TAB [ 5MG] $3.10BENZTROPINE TAB [0.5MG] $3.10carbamazepine 100 mg chew tab $3.10IBUPROFEN TAB [400MG] $3.11MONTELUKAST SODIUM TAB [1 $3.11CHLORDIAZEPOXIDE CAP [10M $3.12IBUPROFEN TAB [800MG] $3.12INDOMETHACIN CAP [25MG] $3.12meclizine Tab (25 mg) $3.12GLIPIZIDE ER TAB [5MG] $3.13GLIPIZIDE ER TAB [2.5MG] $3.13DILTIAZEM CD CAP [180MG] $3.14HCTZ CAP [12.5MG] $3.16DILTIAZEM CD CAP [120MG] $3.17AMOXICILLIN CAP [500MG] $3.18NORTRIPTYLINE CAP [10mg] $3.18SPIRONOLACTONE TAB [25MG] $3.19METHIMAZOLE TAB [ 5MG] $3.19ASPIRIN SUPP [300MG] $3.20HALOPERIDOL TAB [1MG] $3.20PANTOPRAZOLE TAB [40MG] $3.20

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LEVOTHYROXINE TAB [ 25MCG $3.21LITHIUM ER TAB [300MG] $3.22PRIMIDONE TAB [50MG] $3.22MEDROXYPROGESTERONE TAB [ $3.23METHAZOLAMIDE TAB [25MG] $3.24LEVOTHYROXINE TAB [ 50MCG $3.27OXYBUTYNIN TAB [5MG] $3.28METHADONE TAB [10MG] $3.31ATORVASTATIN TAB [20MG] $3.31OXYCODONE TAB [5MG] $3.34LEVOTHYROXINE TAB [ 75MCG $3.35BENZONATATE CAP [100MG] $3.35ESTRADIOL TAB [0.5MG] $3.35METRONIDAZOLE TAB [250MG] $3.36HYDRALAZINE TAB [50MG] $3.37LEVOTHYROXINE TAB [100MCG $3.37QUETIAPINE TAB [100MG] $3.37VERAPAMIL TAB [80MG] $3.38WARFARIN SODIUM TAB [ 1MG $3.41FUROSEMIDE TAB [40MG] $3.41MINOXIDIL TAB [2.5MG] $3.41METHOCARBAMOL TAB [750MG] $3.41CARISOPRODOL TAB [350MG] $3.42HALOPERIDOL TAB [2MG] $3.43LEVOTHYROXINE TAB [ 88MCG $3.45HYDROCODONE/APAP 7.5/325 $3.45VENLAFAXINE ER CAP [37.5M $3.45CLINDAMYCIN CAP [150MG] $3.47WARFARIN SODIUM TAB [ 2.5 $3.48METOPROLOL TAB [50MG] $3.48AMITRIPTYLINE TAB [25MG] $3.49DOXEPIN HCL CAP [ 10MG] $3.49EVISTA TAB [60MG] $3.50ACYCLOVIR TAB [400MG] $3.50POTASSIUM CHLORIDE TAB [1 $3.51POTASSIUM CHLORIDE CAP [1 $3.51LISINOPRIL TAB [ 2.5MG] $3.52POTASSIUM CHLORIDE CAP [ $3.52CHLORDIAZEPOXIDE CAP [25M $3.54WARFARIN SODIUM TAB [ 5MG $3.54DICYCLOMINE TAB [20MG] $3.54LEVOTHYROXINE TAB [112MCG $3.55

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TRICOR TAB [48MG] $3.55POTASSIUM CHLORIDE TAB [2 $3.55ROPINIROLE TAB [1MG] $3.55TRIMETHOPRIM TAB [100MG] $3.56THEOPHYLLINE CR TAB [300M $3.57NITROGLYCERIN ER CAP [2.5 $3.57ATORVASTATIN TAB [40MG] $3.57ALPRAZOLAM TAB [0.25MG] $3.58DIPHENOXYLATE/ATROPINE TA $3.58THEOPHYLLINE CR TAB [200M $3.59HYDROmorphone TAB [2MG] $3.61LEVETIRACETAM TAB [500MG] $3.61METRONIDAZOLE TAB [500MG] $3.61HYDROmorphone TAB [4MG] $3.61LEVOTHYROXINE TAB [125MCG $3.62METHYLDOPA TAB [250MG] $3.63METHYLPHENIDATE TAB [ 5M $3.64LEVOTHYROXINE TAB [150MCG $3.64PHENYTOIN ER CAP [100MG] $3.64ALPRAZOLAM TAB [0.5MG] $3.65clonazePAM Oral Tab (0.5mg) $3.66LITHIUM CARB ER TAB [450M $3.67CALCITRIOL CAP [0.25MCG] $3.69LOSARTAN K+ TAB [100MG] $3.69METHIMAZOLE TAB [10MG] $3.69GLYBURIDE TAB [5MG] $3.70BUSPIRONE TAB [5MG] $3.70CARBIDOPA/LEVODOPA TAB 10 $3.70TRAZODONE TAB [100MG] $3.72HYDROCODONE/APAP 5/325 T $3.73ATENOLOL TAB [ 25MG] $3.74PHENOBARBITAL TAB [64.8MG $3.74SUCRALFATE TAB [1GM] $3.74LEVOTHYROXINE TAB [175MCG $3.75THYROID TAB [ 15MG] $3.75SPIRONOLACTONE TAB [50MG] $3.76TEMAZEPAM CAP [15MG] $3.76DOXEPIN HCL CAP [ 25MG] $3.77CARBIDOPA/LEVODOPA TAB 25 $3.78PENICILLIN VK TAB [250MG] $3.78TORSEMIDE TAB [20MG] $3.78METOPROLOL TAB [100MG] $3.78

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CARBIDOPA/LEVODOPA ER TAB $3.79TRAMADOL TAB [50MG] $3.80potassium phos mono-sod phos di & mono T $3.81HYOSCYAMINE SL/PO TAB [0. $3.82THYROID TAB [ 30MG] $3.83BACLOPHEN TAB [20MG] $3.83CARBIDOPA/LEVODOPA TAB 25 $3.83CEPHALEXIN CAP [250MG] $3.85NORTRIPTYLINE CAP [25MG] $3.87GLIMEPIRIDE TAB [2MG] $3.87ATENOLOL TAB [ 50MG] $3.88PROCHLORPERAZINE TAB [10M $3.88TRIAMTERENE/HCTZ 37.5/25MG $3.88PRAZOSIN CAP [1MG] $3.89LYRICA CAP [50MG ] $3.90ALLOPURINOL TAB [300MG] $3.93ONDANSETRON TAB/ODT [4MG] $3.95ESTRADIOL TAB [2MG] $3.96THYROID TAB [ 60MG] $3.97PROMETHAZINE TAB [25MG] $3.98THIORIDAZINE TAB [50MG] $3.98BENAZEPRIL TAB [10MG] $3.98MEMANTINE TAB [ 5MG] $3.98MEMANTINE TAB [10MG] $3.98FINASTERIDE TAB [5MG] $3.99DOXAZOSIN TAB [2MG] $4.00PHENYLEPH TAN./CHLORPHEN $4.00ED-HYDROCODONE/APAP TAB [ $4.00APAP/DICH/ISOMETH CAP $4.02PROBENECID TAB [500MG] $4.02SULINDAC TAB [150MG] $4.02PRIMIDONE TAB [250MG] $4.04NITROGLYCERIN SUBLINGUAL $4.09NITROGLYCERIN ER CAP [6.5 $4.10ALPRAZOLAM TAB [1MG] $4.11BENAZEPRIL TAB [20MG] $4.13FLUDROCORTISONE TAB [0.1M $4.13BENAZEPRIL TAB [ 5MG] $4.13LIOTHYRONINE TAB [25MCG] $4.13AMITRIPTYLINE TAB [50MG] $4.14LISINOPRIL TAB [20MG] $4.14DIPYRIDAMOLE TAB [25MG] $4.14

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CYPROHEPTADINE TAB [4MG] $4.15NIFEDIPINE CAP [10MG] $4.16VERAPAMIL ER TAB [120MG] $4.16DANTROLENE CAP [25MG] $4.16ISOSORBIDE DINITRATE TAB $4.18HYDROCORTISONE TAB [20 MG $4.18CHLORZOXAZONE TAB [500MG] $4.18HALOPERIDOL TAB [5MG] $4.19PENICILLIN VK TAB [500MG] $4.22bisoprolol-HCTZ Tab (10-6.25 mg) $4.27NIFEDIPINE CR TAB [30MG] $4.29AMILORIDE/HCTZ TAB 5/50 $4.30doxepin Cap (50 mg) $4.31GUANFACINE TAB [2MG] $4.32DEXAMETHASONE TAB [4MG] $4.34FOSINOPRIL TAB [10MG] $4.34LORAZEPAM TAB [2MG] $4.34METFORMIN TAB [ 850MG] $4.35TRANDOLAPRIL TAB [4MG] $4.36MISOPROSTOL TAB [200MCG] $4.36SULINDAC TAB [200MG] $4.37CHLORTHALIDONE TAB [25MG] $4.37CEPHALEXIN CAP [500MG] $4.39IMIPRAMINE TAB [50MG] $4.39GABAPENTIN CAP [400MG] $4.39QUINAPRIL TAB [10MG] $4.40QUINAPRIL TAB [5MG] $4.40MEGESTROL ACETATE TAB [40 $4.41ATENOLOL TAB [100MG] $4.44NAPROXEN TAB [500MG] $4.45CAPTOPRIL TAB [12.5MG] $4.46PYRIDOSTIGMINE TAB [60MG] $4.48TRIFLUOPERAZINE TAB [2MG] $4.50NABUMETONE TAB [500MG] $4.51GLYCOPYRROLATE TAB [1MG] $4.54PROPRANOLOL ER CAP [60MG] $4.56METFORMIN ER TAB [500MG] $4.57BUSPIRONE TAB [10MG] $4.58BISOPROLOL FUM TAB [5MG] $4.67CHLORPROMAZINE TAB [ 50MG $4.71CLOTRIMAZOLE TROCHE [10MG $4.71METHYLPREDNISOLONE TAB [4 $4.72

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METHYLPREDNISOLONE DOSEPA $4.72VERAPAMIL ER TAB [180MG] $4.73OXCARBAZEPINE TAB [150MG] $4.73TERAZOSIN HCL CAP [2MG] $4.74ENALAPRIL TAB [ 2.5MG] $4.76MOEXIPRIL TAB [15MG] $4.76THYROID TAB [ 90MG] $4.81PENTOXIFYLLINE TAB [400MG $4.82FELODIPINE ER TAB [5MG] $4.84FELODIPINE ER TAB [2.5MG] $4.84NORTRIPTYLINE CAP [50MG] $4.85PERPHENAZINE-AMITRIPTYLIN $4.88INDAPAMIDE TAB [2.5MG] $4.90LISINOPRIL TAB [40MG] $4.90BUPROPION TAB [ 75MG] $4.90LANSOPRAZOLE DR CAP [30M $4.92CARBAMAZEPINE TAB [200MG] $4.98HYOSCYAMINE SR TAB [0.375 $4.98TERAZOSIN HCL CAP [5MG] $4.99BETHANECHOL TAB [10MG] $4.99TERAZOSIN HCL CAP [1MG] $4.99THEREVAC SB ENEMA $5.00TOPROL-XL TAB [ 25MG] $5.00TOPROL-XL TAB [ 50MG] $5.00AMLODIPINE TAB [ 5MG] $5.05NATEGLINIDE TAB [60MG] $5.08ISOSORBIDE MONO ER TAB [3 $5.10VITAMIN D CAP [50000 IU] $5.11PROPAFENONE TAB [150MG] $5.11BUPROPION SR TAB [100MG] $5.12BUTALBITAL/APAP/CAFFEINE $5.12DIPYRIDAMOLE TAB [50MG] $5.15DANTROLENE CAP [50MG] $5.18METOPROLOL [SUCC] ER TAB $5.22DIVALPROEX DR TAB [250 MG $5.23CARBIDOPA/LEVODOPA ER TAB $5.30CILOSTAZOL TAB [100MG] $5.33RIMANTADINE TAB [100MG] $5.34ENALAPRIL TAB [ 5MG] $5.37TAMOXIFEN TAB [10MG] $5.44FLURBIPROFEN TAB [100MG] $5.44RIFAMPIN CAP [300MG] $5.45

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LOXAPINE CAP [25MG] $5.48ENALAPRIL TAB [10MG] $5.51BUPROPION SR TAB [150MG] $5.51BUPROPION TAB [100MG] $5.54VERAPAMIL ER (PM) CAP [10 $5.54AMANTADINE CAP [100MG] $5.63BUSPIRONE TAB [15MG] $5.63FLECAINIDE TAB [50MG] $5.63DILTIAZEM CD CAP [240MG] $5.68ZONISAMIDE CAP [100MG] $5.71METHENAMINE HIPPURATE TAB [1GM] $5.74CARVEDILOL TAB [ 3.125MG] $5.76CARVEDILOL TAB [25MG] $5.76Progesterone Caps 100 mg $5.80BUMETANIDE TAB [1MG] $5.81CARVEDILOL TAB [12.5MG] $5.81KETOROLAC TAB [10MG] $5.84HUMULIN 70/30 MIXTURE [UN $5.89HUMULIN NPH [UNITS] $5.89HUMULIN R [UNITS] $5.89ORPHENADRINE TAB [100MG] $5.89RISPERIDONE TAB [0.5MG] $5.93GEMFIBROZIL TAB [600MG] $5.99MAALOX SUSP [148ML] $6.00CARVEDILOL TAB [ 6.25MG] $6.00IBUPROFEN SUSP [100MG/5ML $6.00LIDOCAINE INJ [1% SINGLE $6.00LOSARTAN K+ TAB [ 50MG] $6.01NITROFURANTOIN CAP [50MG] $6.02LABETALOL TAB [100MG] $6.04DIPYRIDAMOLE TAB [75MG] $6.04selegiline hcl Tab 5 mg $6.07SENSORCAINE INJ 0.5% [SI $6.11PROPAFENONE TAB [225MG] $6.11SOTALOL HCL TAB [ 80MG] $6.14METHENAMINE MANDELATE TAB $6.17FENOFIBRATE TAB [160MG] $6.18GABAPENTIN TAB [600MG] $6.19BACLOFEN TAB [10MG] $6.24FLUOXETINE CAP [10MG] $6.25CITALOPRAM TAB [10 MG] $6.26METOLAZONE TAB [2.5MG] $6.30

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FLUOXETINE CAP [20MG] $6.35ROPINIROLE TAB [0.5MG] $6.38SENSORCAINE-MPF INJ 0.5% $6.38ROPINIROLE TAB [2MG ] $6.38dicloxacillin 500 mg $6.38VERAPAMIL ER TAB [240MG] $6.43TIZANIDINE TAB [4MG] $6.45ROPINIROLE TAB [3MG] $6.48OMEPRAZOLE ER CAP [20MG] $6.48WARFARIN SODIUM TAB [ 2MG $6.50ZETIA TAB [10MG] $6.55PAROXETINE HCL TAB [10MG] $6.56DILTIAZEM CD CAP [300MG] $6.58FLUVOXAMINE TAB [100MG] $6.59BETHANECHOL TAB [25MG] $6.64BUDESONIDE SR CAP [3MG/24 $6.64HUMALOG [UNITS] $6.65WARFARIN SODIUM TAB [ 3MG $6.65MIRTAZAPINE TAB OD [30MG] $6.65WARFARIN SODIUM TAB [ 4MG $6.65CITALOPRAM TAB [20MG] $6.67PHENAZOPYRIDINE HCL TAB [ $6.68AMLODIPINE-BENAZEPRIL CAP $6.70TIZANIDINE TAB [2MG] $6.70MIRTAZAPINE TAB [15MG] $6.71OXYBUTYNIN XL TAB [5MG] $6.76OXCARBAZEPINE TAB [300MG] $6.77DICLOFENAC K+ TAB [50MG T $6.78UROCIT-K CAPLET [10MEQ] $6.78ENALAPRIL TAB [20MG] $6.79KETOPROFEN TAB [75MG] $6.83MIRTAZAPINE TAB [30MG] $6.83ACETAZOLAMIDE TAB [250MG] $6.97ETODOLAC ER TAB [400MG] $7.00MILK OF MAG [473ML ECF O $7.00PERCOCET TAB 5/325MG $7.00TOPROL-XL TAB [100MG] $7.00ONDANSETRON TAB [8MG] $7.00PHENCLOR TANNATE PED SUSP $7.00BUMETANIDE TAB [2MG] $7.05INDOMETHACIN ER CAP [75MG $7.20GABAPENTIN TAB [800MG] $7.23

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PRAMIPEXOLE TAB [0.5MG] $7.28PRAMIPEXOLE TAB [1.5mg] $7.28AVANDIA TAB [2MG] $7.39MELOXICAM TAB [7.5MG] $7.41ATACAND TAB [16MG] $7.42RAZADYNE ER TAB [8MG] $7.43NITROFURANTOIN CAP [100MG $7.47EPSOM SALT USP [16 OZ] $7.50SIMVASTATIN TAB [ 40MG] $7.54DOXYCYCLINE CAP [100MG] $7.59oxybutynin ER (10 mg) $7.60MORPHINE SULF SUPPOSITORY $7.62FAMOTIDINE TAB [40MG] $7.68BISOPROLOL/HCTZ TAB [2.5/ $7.72BISOPROLOL/HCTZ TAB [5/6. $7.72CHOLESTYRAMINE PWD PKT [4GMS-SINGLE DOSE $7.72TOLTERODINE TARTRATE TAB $7.76SOTALOL HCL TAB [120MG] $7.80CEVIMELINE HCL CAP [30MG] $7.91EVAC CONTAINER 1000 $8.00DAP Venipuncture $8.00NS 1000ML BAG O.P. $8.00TRAMADOL-APAP TAB 37.5-32 $8.09GLIMEPIRIDE TAB [1MG] $8.17ZALEPLON CAP [5MG] $8.22IRBESARTAN TAB [300MG] $8.22DIVALPROEX ER TAB [500 MG $8.23METOPROLOL [SUCC] ER TAB $8.23WARFARIN SODIUM TAB [ 7.5 $8.24CLINDAMYCIN CAP [300MG] $8.26QUETIAPINE TAB [ 25MG] $8.26irbesartan-HCTZ 150-12.5 mg $8.26CEFADROXIL CAP [500MG] $8.27Lyrica 150 mg $8.27CLONAZEPAM TAB [2MG] $8.34AMOXICILLIN/CLAVUL TAB [5 $8.37HYDROCODONE/APAP 10/325 T $8.38QUINAPRIL TAB [20MG] $8.39GLIMEPIRIDE TAB [4MG] $8.41METOPROLOL [SUCC] ER TAB $8.42WARFARIN SODIUM TAB [10MG $8.45BENGAY CREAM [57GM] $8.50

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CLONAZEPAM TAB [0.5MG] $8.51RISPERIDONE TAB [0.25MG] $8.54MIDODRINE TAB [ 5MG] $8.54DOXAZOSIN TAB [4MG] $8.61ROXICET TAB 5/325MG $8.62OXYCODONE/APAP TAB 5-325M $8.62NADOLOL TAB [40MG] $8.72LACTULOSE SYRUP [10GM/15M $8.78VALSARTAN TAB [ 40MG] $8.79AZITHROMYCIN TAB [250MG] $8.80SODIUM CHLORIDE HYPERTONIC SVN [7%/4ML] $8.86GLUCOVANCE TAB 5MG/500MG $8.92ACEBUTOLOL CAP 400 MG $8.93HYDROXYCHLOROQUINE TAB [2 $8.99XOPENEX 1.25MG 3ML DOSE $9.00ED-SILVER SULFADIAZINE CREAM *dose* $9.00EVACUATION CONTAINER 250 $9.00LYRICA CAP [75MG] $9.01CHLORPROMAZINE TAB [ 10MG $9.01BAG BALM OINT [10 OZ] $9.02TAMSULOSIN CAP [0.4 MG] $9.02RIVASTIGMINE CAP [ 1.5MG] $9.04SVN SALINE TREATMENT $9.08RIVASTIGMINE CAP [3MG] $9.08LOVASTATIN TAB [40MG] $9.12fluorescein sodium Ophth. Strip (1) $9.18FEXOFENADINE TAB [180MG] $9.20ESCITALOPRAM TAB [10MG] $9.21KAOPECTATE LIQ REGULAR [D $9.22CLOPIDOGREL TAB [75 MG] $9.26PREPARATION-H SUPP [EACH] $9.28RAMIPRIL CAP [ 2.5MG] $9.30MUCINEX DM ER TAB [600-30 $9.35aspirin tab (81mg x 4 tabs) $9.36MORPHINE SULFATE ER/SR TA $9.40RAMIPRIL CAP [ 5MG] $9.44THYROID TAB [120MG] $9.50NEOMYCIN TAB [500MG] $9.56LORATADINE TAB [10MG] $9.56RISPERIDONE TAB [1MG] $9.57ESCITALOPRAM TAB [20MG] $9.58ED-DIPHENHYDRAMINE CAP [5 $9.60

13

LOPERAMIDE CAP [2MG] $9.67THEO-24 ER CAP [400MG] $9.69FOLTX (GENERIC) TAB $9.72VENLAFAXINE ER CAP [75MG] $9.73RIVASTIGMINE CAP [4.5MG] $9.73TOPIRAMATE TAB [ 25MG] $9.76RAMIPRIL CAP [10MG] $9.76loperamide susp 1mg/7.5ml $9.77SODIUM POLYSTYRENE SUSP [ $9.82SULFACETAMIDE OPHTH [10% $9.84DEPAKOTE SPR CAP [125MG] $9.84URISPAS TAB [100MG] $9.85CYTOTEC TAB [100MCG] $9.89BUPROPION XL 24HR TAB [30 $9.89BUPROPION XL 24HR TAB [15 $9.90NITRO-BID OINT PACKET [2% $9.92ACETAMINOPHEN/COD [120/12 $9.93PRAVASTATIN TAB [80MG] $9.93PRAVASTATIN TAB [40MG] $9.93NEFAZODONE TAB [100MG] $9.94AVAPRO TAB [150MG] $10.00IPECAC SYP [30ML BOTTLE] $10.00IV TUBING O.P. $10.00DIOVAN TAB [ 80MG] $10.01METAXALONE TAB [800MG] $10.08ACETAZOLAMIDE ER CAP [500 $10.09METHYLPHENIDATE TAB [10MG $10.09XYLOCAINE INJ [0.5% SINGL $10.09LEUCOVOR TAB [ 5MG] $10.16LAMOTRIGINE TAB [100MG] $10.17oxyCODONE IR TAB [**15MG**] $10.17VALSARTAN TAB [160MG] $10.25PROMETHAZINE PLAIN SYRUP $10.25CLARITHROMYCIN ER TAB [50 $10.26XYLOCAINE W/EPI INJ [0.5% $10.26LIDOCAINE INJ [2% SINGLE $10.31AMOXICILLIN/CLAVUL TAB [8 $10.33ZYVOX TAB [600MG] $10.34CEFUROXIME TAB [250MG] $10.35DILTIAZEM INJ [ 5ML VIAL] $10.38CIPROFLOXACIN TAB [500MG] $10.40COLESTID TAB [1GM] $10.42

14

AMMONIA AROMATIC AMP [.33 $10.43CEFDINIR CAP [300MG] $10.43SENSORCAINE INJ 0.25% [S $10.45CHLORDIAZEPOXIDE/CLIDINIU $10.47BETADINE 5% OPHTH [PREP S $10.50RANITIDINE TAB [150MG] $10.52DESMOPRESSIN TAB [0.1MG] $10.69TRIAZOLAM TAB [0.25MG] $10.75FLUOXETINE CAP [40MG] $10.77CARBAMIDE PEROXIDE EAR DR $10.81LEVALBUTEROL SVN [1.25MG/ $10.90CLORAZEPATE DIPOT TAB [7. $10.91TERBUTALINE TAB [2.5MG] $10.93PROMETHAZINE /COD SYR [D $10.99DAP ESR $11.00DAP Fecal occult blood $11.00DAP Uric acid $11.00VITAMIN C CHEWABLE TAB [5 $11.00MAALOX QD TAB [ ASST BTL] $11.00CHARCOCAPS CAPS [260MG] $11.00CYCLOSPORINE CAP [100MG] $11.02DIPHENHYDRAMINE SOLU [12. $11.05GUAIFENESIN SYRUP [118ML] $11.07ALBENZA TAB [200MG] $11.09ONDANSETRON INJ [ 2MG/ML J2405 $11.09ZAFIRLUKAST TAB [20MG] $11.13PAROXETINE ER TAB [12.5MG $11.14CHERRY SYRUP [60ML] $11.25MAGNESIUM CITRATE ORAL SO $11.29PHENYTOIN SUSP [125MG/5ML $11.31NICOTINE PATCH [14MG] $11.35NICOTINE PATCH [ 7MG] $11.35VITAMIN D TAB [400 IU BTL $11.36ALBUTEROL SVN [ 0.083% 2. $11.38LIDOCAINE W/EPI INJ [1% 1 $11.43ATROPINE INJ [0.4MG/ML 1M J0461 $11.44sodium polystrene Powder *Dose* (15 gm/ $11.46bupivicaine-epi 0.5% 30mL vial $11.47VITAMIN B-12 TAB [100MCG $11.49PAROXETINE ER TAB [25MG] $11.52MICARDIS TAB [40MG] $11.54AMINOPHYLLINE [25MG/ML 20 $11.57

15

DOXEPIN HCL CAP [150MG] $11.66SALINE NASAL SOLN [0.65% $11.68LANTUS INSULIN [UNITS] $11.70SODIUM CHLORIDE INJ 0.9% [10ML P-F] $11.70NOVOLOG [UNITS] $11.74MORPHINE SULFATE ER/SR TA $11.74XYLOCAINE W/EPI INJ [2% S $11.78OXYTOCIN INJ [10 UNITS/ML $11.78CALAMINE LOTION [4OZ] $11.81CHLORASEPTIC LOZ CHERRY [ $11.81CETIRIZINE TAB [10MG] $11.82CLARITHROMYCIN TAB [500MG $11.82LEVEMIR-DETEMIR *UNITS* $11.85SENSORCAINE INJ 0.25% W/ $11.86propranolol soln 40 mg/5ml $11.89PETROLATUM WHITE [106GM] $11.92CEPASTAT LOZENGES CHERRY $11.94WITCH HAZEL-GLYCERIN CLEA $11.94GALANTAMINE ER CAP [24MG] $11.96DOUBLE ANTIBIOTIC OINTMEN $11.99AVAPRO TAB [300MG] $12.00EUCERIN CREAM [4OZ] $12.00DIOVAN TAB [ 40MG] $12.00TUSSIONEX SUSP [DOSE] $12.00DIOVAN TAB [160MG] $12.00ALTERNAGEL SUSP [12 OZ] $12.00FIBER CHOICE [BTL] $12.00oxyCODONE-apap Tab (10-325 mg] $12.00DEXAMETHASONE INJ [ 4MG/M $12.07RACEPINEPHRINE SVN [2.25% $12.10SENSORCAINE INJ 0.25% [M $12.13METHOTREXATE TAB [2.5MG] $12.17KETOCONAZOLE TAB [200MG] $12.20KETOROLAC INJ [30MG/ML J1885 $12.26TEVETEN HCT TAB 600-12.5 $12.27SORBITOL SOLN [70% SOLN 6 $12.29MIDAZOLAM INJ [1MG/ML 2ML J2250 $12.29ANBESOL GEL [7.1GM] $12.33VITAMIN D3 TAB [1000IU BO $12.34FAMOTIDINE INJ [20MG/2ML] $12.34GALANTAMINE ER CAP [16MG] $12.37MEBENDAZOLE CHW TAB [100M $12.39

16

CEPACOL LOZ REG CHERRY SF $12.41DEXAMETHASONE ELIXIR [ 0. $12.42CELEBREX CAP [100MG] $12.43PEPTO-BISMOL ORIGINAL LIQ $12.44ACETAMINOPHEN DROPS 80 MG $12.49VALACYCLOVIR HCL TAB [500 $12.53ASACOL/DELZICOL CAP [400M $12.55GUAIFENESIN AC (CODEINE) $12.58AYR SALINE GEL NASAL [14. $12.60POLYETHYLENE GLYCOL [3350 $12.62QUETIAPINE TAB [ 50MG] $12.68THIAMINE TAB [100MG BTL] $12.72CLORAZEPATE DIPOT TAB [3. $12.75TERBUTALINE TAB [5MG] $12.80HYDROCORTISONE CREME [0.5 $12.81ERYTHROMYCIN DR CAP [250M $12.90MIDAZOLAM INJ (5MG/ML 1ML) $12.95KETOROLAC INJ [60MG/2ML 2 J1885 $12.95CULTURELLE CAP [BTL 30] $12.96CEFPODOXIME PROXETIL TAB $12.96JEVITY PLUS $13.00SEROQUEL TAB [ 25MG] $13.00TUSSI-12 S SUSPENSION [DO $13.0012 CC SYRINGES BOX O.P. $13.00MG-PLUS PROTEIN TAB [BTL] $13.00SIGN LANGUAGE/ORAL INTERPRETER 15 MINUTE T1013 $13.00SANCTURA TAB [20MG] $13.07ALBUTEROL SYRUP [2MG/5ML $13.11ATACAND TAB [ 4MG] $13.11DIPHENHYDRAMINE INJ [50MG J1200 $13.11CHLORAL HYDRATE [500MG/5M $13.26TOPIRAMATE TAB [100MG] $13.27CENESTIN TAB [0.625MG] $13.27CEFPROZIL TAB [250MG] $13.29ANTACID SUSPENSION DS [35 $13.29METOCLOPRAMIDE INJ [10MG/ $13.30SODIUM CHLORIDE INJ .9% BACT 30ML] $13.30COLA SYRUP [BTL] $13.34GADOLINIUM PER ML A9579 $13.39LUBRIFRESH PM OPTH OINT $13.41CORNSTARCH $13.42WELCHOL TAB [625MG] $13.42

17

vitamin a-beta carotene Cap (10,000 unit $13.42QUININE SULFATE CAP [324M $13.45STARLIX TAB [120MG] $13.45CALCIUM-MAGNESIUM-ZINC TA $13.47SALINE FLUSH HEP $13.50HEPARIN LINE FLUSH $13.50Sterile Saline Flush $13.50EYE STREAM IRRIGATION [ DOSE] $13.51RALOXIFENE HCL TAB [60MG] $13.55LITTLE NOSES NASAL DROPS $13.61VISINE SOL 0.05% OPTH [15 $13.63CHLORASEPTIC SPRAY [177ML $13.67ZOLPIDEM TAB [10MG] $13.67ZOLPIDEM TAB [ 5MG] $13.67SORE THROAT SPR CHERRY [W $13.67GLUTOSE 15 TUBE $13.75OMEPRAZOLE DR/ER CAP [40MG] $13.77ORAMORPH SR TAB [60MG] $13.80HYDROCORTISONE CREAM [1% $13.81MINERAL OIL [473ML] $13.81WATER FOR INJ [20ML SDV] $13.81VASELINE JELLY [1.75OZ] $13.81URSODIOL CAP [300MG] $13.89COUGH DROPS (SUGAR FREE) $13.90GAVISCON LIQUID [360ML] $14.00MIDODRINE TAB [10MG] $14.00SEQ SAME DRUG IV PUSH- TX 96376 $14.00FERROUS GLUCONATE TAB [32 $14.02MYOFLEX CREAM [10%] $14.06ED-IBUPROFEN SUSP [100/5M $14.07KAOPECTATE LIQ REGULAR [B $14.18NEO-SYNEPHRINE NOSE SPRAY $14.18OXYMETAZOLINE HCL NASAL S $14.18celecoxib Cap (200 mg) $14.25NITROGLYCERIN PATCH [0.2M $14.32CHLORPROMAZINE TAB [ 25MG $14.34ANTACID SUSPENSION [355ML $14.35AMOXICILLIN/CLAVULANATE E $14.39CASTOR OIL [59ML] $14.39MAGNESIUM OXIDE TAB [500M $14.41SIMETHICONE TAB [80MG] $14.42duloxetine DR Cap (60 mg) $14.44

18

SIMETHICONE CAP [125MG] $14.47MELATONIN ES [5MG] $14.47SODIUM CHLORIDE 0.9% [20ML P-F] $14.54OXYCONTIN CR TAB [10MG] $14.57HYDROXYZINE HCL SYR [10MG $14.58AMIODARONE INJ [150MG/3ML J0282 $14.59ORAJEL GEL $14.67duloxetine DR Cap (30 mg) $14.67PAIN RELIEVING RUB [85GMG $14.68TEVETEN TAB [600MG ] $14.72MORPHINE SULFATE ER/SR TA $14.75ERYTHROMYCIN OPHTHALMIC OINTMENT 5 MG $14.76GRISEOFULVIN ULTRAMICROSI $14.77MYCOPHENOLATE TAB [500MG] $14.80CREON CAP [24000] $14.81AMIODARONE TAB [200MG] $14.81IPRATROPIUM BR SVN [ 0.5M $14.84SENSORCAINE-MPF INJ 0.25% $14.84ZINC OXIDE OINT [60GM TUB $14.86ACETAMINOPHEN ELIXIR [160 $14.87MULTIVITAMIN CHEWABLE TAB $14.87TOLTERODINE TARTRATE ER CAP [4MG] $14.94IBUPROFEN SUSP [100MG/5ML $14.96PROBIOTIC LACTO TAB [BTL] $15.00chlorhexidine gluc oral rinse Sol 15 mL $15.00BACITRACIN ZINC OINTMENT $15.02LACRI-LUBE OPHTH OINT S.O $15.10DIPHENHYDRAMINE CREAM [2 $15.11ACETAMIN. [500MG - DIPHEN $15.14VITAMIN B-12 TAB [1000MCG $15.18NITROGLYCERIN PATCH [0.1M $15.19NITROGLYCERIN PATCH [0.4M $15.20CALCIUM CITRATE WITH D TA $15.22MULTI-VITAMIN LIQUID [237 $15.22CALCIUM CITRATE TAB [250M $15.23DILAUDID INJ [2MG/ML] J1170 $15.24DOXYLAMINE TAB [25MG BTL] $15.30LOPERAMIDE A-D LIQUID [12 $15.32TRICOR TAB [145MG] $15.38GUAIFENESIN DM SYRUP [118 $15.47PHENOBARBITAL ELIXIR [20M $15.49CORICIDIN HBP COUGH AND C $15.60

19

LIDOCAINE VISCOUS/DIPHENH $15.63BIOTENE DRY MTH ORAL RINS $15.63GERITOL LIQUID [360ML BO $15.66AVEENO BATH TREATMENT [1 $15.71b complex vitamins Oral Cap $15.75LORAZEPAM INJ [2MG/ML] J2060 $15.76SAW PALMETTO CAP [500MG B $15.79AQUAPHOR OINT [50GM TUBE] $15.80THERAPEUTIC BATH OIL $15.81BYSTOLIC TAB [10MG] $15.82AVODART CAP [0.5MG] $15.87MICARDIS HCT TAB [80/25MG $15.88MICARDIS TAB [80MG] $15.88MAGNESIUM SULF *IVPB* (2gm/NS50ml) $15.97LESCOL CAP [40MG] $15.99DAP CBC $16.00DAP Ferritin $16.00DAP Pregnancy test Qualitative $16.00DAP PSA $16.00GOLD BOND POWDER 283GM $16.00BYSTOLIC TAB [ 5MG] $16.00MIRAPEX TAB [ 0.125MG] $16.00LAMISIL *AT* AF SPRAY [BT $16.00FLUCONAZOLE TAB [100 MG] $16.07NIASPAN ER TAB [500MG] $16.11NICOTINE PATCH [21MG] $16.18LANSINOH BREAST CREAM [60 $16.20CYANOCOBALAMIN TAB [1000M $16.21esoMEPRAZOLE DR CAP 40MG $16.21ZIPRASIDONE CAP [20MG] $16.23ZIPRASIDONE CAP [40MG] $16.24FISH OIL OMEGA-3 CAP [100 $16.25TERBUTALINE SULF. INJ [1M $16.28BUTORPHANOL INJ 2MG/ML [ $16.28METOPROLOL INJ [1MG/ML 5M $16.28ED-APAP/CODEINE TAB [300- $16.30PHENYTOIN INJ [50MG/ML 5M J1165 $16.31DESITIN GENERIC DIAPER RA $16.32STOMACH RELIEF CAPLET [B $16.33CRESTOR TAB [10MG] $16.35METRONIDAZOLE IV [500MG 1 $16.36VICKS VAPORUB CREAM [100G $16.38

20

LIDOCAINE JELLY [2% 1 DOS $16.39CALCIUM LIQUID SOFTGELS [ $16.39activated charcoal Caps (260 mg) $16.40Tinactin Spray $16.43MENTHOLATUM REG [JAR 30GM $16.47VITAMIN D CAP [5000 IU B $16.47PROMETHAZINE INJ [25MG/M J2550 $16.49PROMETHAZINE INJ [50MG/M J2550 $16.49TEGRETOL XR TAB [400MG] $16.56TRIPLE ANTIBIOTIC OINTMEN $16.68ED-APAP/CODEINE SOLN [120 $16.72IPRATROPIUM-ALBUTEROL SVN $16.73TEKTURNA TAB [150MG] $16.73GLUCOSAMINE CAP [500MG] $16.75GUAIFENESIN SYRUP [473ML] $16.94DIPRIVAN INJ [10MG/ML] J2704 $16.95MIRAPEX TAB [1.5MG] $17.00SINGULAIR TAB [10MG] $17.00SINGULAIR CHEWABLE TAB [4 $17.00CORONER SALICYLATE 80329 $17.00ACETAMINOPHEN/COD [120/12 $17.06VITAMIN E OIL $17.09LEVOBUNOLOL OPHTH [0.5% 1 $17.10GOLD BOND POWDER [283GM] $17.13KCl 40 mEq/100 mL NS J3480 $17.14PREDNISOLONE SYR [15MG/5M $17.17VIACTIVE CHEWABLE [CARMEL $17.21BENICAR TAB [20MG] $17.21AGGRENOX CAP [200-25MG] $17.23DETROL LA CAP [4MG] $17.30GABITRIL TAB [12MG] $17.31PIOGLITAZONE HCL TAB [15M $17.36MORPHINE SULF INJ [ 2MG/M J2270 $17.38PREMARIN TAB [0.3MG] $17.48PREMARIN TAB [0.625MG] $17.48PREMARIN TAB [1.25MG] $17.48PEPTO-BISMOL ORIGINAL LIQ $17.60ASPERCREME CRM [142GM] $17.61FENTANYL AMP 2 ML J3010 $17.67CIPROFLOXACIN I.V. SOL D5 J0744 $17.70DETROL TAB [1MG] $17.73PENTASA CR CAP [500MG] $17.79

21

PROMETHAZINE-DM SYRUP [6. $17.93ED-AMOXICILLIN CAP [500MG $17.93TOPAMAX TAB [25MG] $17.99CALMOSEPTINE OINTMENT [TU $18.00GI COCKTAIL [20ML] $18.00LIDOCAINE VISCOUS [ 2% 20 $18.00LIPITOR TAB [10MG] $18.00MAGNESIUM SULF 50% [10ML $18.00AMITIZA CAP [24MCG] $18.00ED-PHENYLEPH TAN./CHLORPH $18.00SENSORCAINE INJ 0.5% W/E $18.01TEARS NATURALE SOL II OPH $18.08LIDOCAINE MPF Inj (1 % amp 5 ml) $18.11MORPHINE SULF INJ [ 4MG/M J2270 $18.32Brilinta 90 mg tab $18.44THERMOTABS TAB [BTL] $18.46MORPHINE SULF INJ [10MG/M J2270 $18.51MARCAINE SPINAL INJ [2ML] $18.52HYOSCYAMINE SO4 DROPS [15 $18.58DITROPAN XL TAB [15MG] $18.63RANEXA TAB [500MG] $18.66MINERAL ICE THERAPY [8OZ] $18.74ANTABUSE TAB [250MG] $18.81GENTEAL OPHTH GEL [1 TUBE $18.87PROPOFOL INJ [10MG/ML 20M J2704 $18.87PRADAXA CAP [150MG] $18.92BUPIVACAINE 0.5% [5MG/ML $18.95LEXAPRO TAB [10MG] $19.00MOBIC TAB [7.5MG] $19.00LEXAPRO TAB [20MG] $19.0022G 1" NEEDLES BOX O.P. $19.00SODIUM CHLORIDE TAB [1GM $19.14SODIUM CHLORIDE TAB [1GM] $19.14KLOR-CON POWDER PACKET [2 $19.15GLUCOSAMINE-CHONDROITIN C $19.18GLYCERIN 99.5% USP [118ML $19.21AMIODARONE *VIAL* [150MG/3ML INJ] $19.30TEKTURNA TAB [300MG] $19.41ED-PROMETHAZINE TAB [25MG $19.44FENTANYL AMP [250MCG/5ML J3010 $19.45DEMEROL INJ [ 25MG/ML INJ J2175 $19.46CHLOROPROCAINE-MFP 3% SDV $19.52

22

PHENOL EZ SWABS $19.65DIAMOX SEQUELS CAP [500MG $19.70BUPIVACAINE 0.25% [2.5MG $19.79OLANZAPINE TAB [2.5MG] $19.86CIPROFLOXACIN I.V. SOL D5 J0744 $19.86MAGNESIUM SULF *IVPB* (12gm/NS 50ml) $19.90LAMISIL *AT* CREAM [1% 12 $19.91DEMEROL INJ [ 50MG/ML INJ J2175 $19.91ACETAMINOPHEN CAP 650 MG $19.92KETOROLAC INJ [15MG/ML J1885 $19.95PED HEPATITIS B VACCINE A $20.00CYMBALTA CAP [30MG] $20.02FERROUS SULFATE ELIXER [2 $20.14ONDANSETRON INJ [2MG/ML J2405 $20.20ACETAMINOPHEN ELIXIR [160 $20.22DYRENIUM CAP [50MG] $20.32ED-IBUPROFEN TAB [600MG # $20.33CRESTOR TAB [20MG] $20.36MANNITOL [12.5GM/50ML 25 $20.38NAPHCON-A EYE DROPS [15M $20.50PIOGLITAZONE HCL TAB [45M $20.50LIDOCAINE INJ [1% MDV 50M $20.55TUSSIONEX GENERIC ER [DOS $20.55polyethylene glycol COLON PREP KIT $20.56LIDOCAINE INJ [10MG/ML 50 $20.57STALEVO TAB 150 $20.72STALEVO TAB 50 $20.72PRADAXA CAP [ 75MG] $20.72MORPHINE SULFATE ER/SR TA $20.76SIMETHICONE DROPS [30ML] $20.83COMTAN TAB [200MG] $20.84ENALAPRILAT INJ [2.5MG/2M $20.88ITRACONAZOLE CAP [100MG] $20.92FUROSEMIDE INJ [ 40MG/4ML J1940 $20.98DAP Lipid profile $21.00DAP TSH $21.00DAP Free T4 $21.00PITOCIN INJ [10 U/ML 1ML] $21.00PLAVIX TAB [ 75MG] $21.00SEROQUEL TAB [100MG] $21.00PATIENT CREDIT $21.00SEROQUEL TAB [ 50MG] $21.00

23

DAYPRO TAB [600MG] $21.09APIXABAN TAB [5 MG] $21.10ELIQUIS TAB 2.5 MG $21.10lido 1% 20 mL $21.24GOLD BOND FOOT POWDER [11 $21.35BUMETANIDE INJ [0.25MG/ML $21.39FLUOROURICIL INJ [500MG/1 $21.46lidocaine 2% 5 ml $21.46OXYCONTIN CR TAB [20MG] $21.53FERROUS SULFATE ER TAB [1 $21.67LYRICA CAP [25MG] $21.72cetirizine 5mg/5ml $21.73ARTHROTEC TAB 50/0.2MG $21.76PSYLLIUM CAP [0.52GM BOT $21.79TEMAZEPAM CAP [7.5MG] $21.91PHENYTOIN INJ [50MG/ML 2M $22.00RISPERDAL TAB [0.5MG] $22.00VALTREX TAB [ 500MG] $22.00ISOFLURANE INHALANT [1 DO $22.00PROMETHAZINE INJ [12.5MG J2550 $22.00hydrocodon/apap 7.5mg #6 surgery $22.02NEXIUM CAP [40MG] $22.06TERBINAFINE TAB 250 MG $22.14FAMCICLOVIR TAB [500MG] $22.17CLORPACTIN WCS-90 POWDER $22.32POTASSIUM CHL INJ [20MEQ $22.54POTASSIUM CHLORIDE [20MEQ/NS 100ml] J3480 $22.54LIDOCAINE INJ [2% MDV 20M $22.93OLANZAPINE TAB [5MG] $22.98TRACTION BANDAGES $23.00AUGMENTIN XR TAB [1000MG] $23.00CYMBALTA CAP [60MG] $23.00PRW35: SKIN STAPLER 35 WIDE $23.00EKG TRACING- RHC 93005 $23.00LIDOCAINE INJ [2% 5ML SYR $23.06FUROSEMIDE INJ [ 20MG/2ML J1940 $23.06SODIUM ACETATE [2MEQ/ML 2 $23.12LABETALOL INJ [5MG/ML DO $23.15PROTONIX INJ [40MG] $23.19FOSPHENYTOIN INJ [50MG/ML $23.40ED-promethazine/codeine syr (60 mL BTL) $23.43COREG CR CAP [10MG] $23.57

24

ED-DIPHENOXYLATE/ATROPINE $23.62SENSORCAINE INJ 0.5% [MD $23.70ED-ONDANSETRON TAB/ODT [4MG #6] $23.70COLCHICINE TAB [0.6MG] $23.78LIDOCAINE W/EPI INJ [1% 1 $23.90Asacol HD 800mg $23.99LEFLUNOMIDE TAB [20MG] $24.00RISPERDAL TAB [1 MG] $24.00LIPITOR TAB [20MG] $24.00UNISOM/VITAMIN B-6 ANTI-N $24.00SO AFB SENS STREPTOMYCIN 87190 $24.00SO AFB SENS ISONIAZID 87190 $24.00SO AFB SENS RIFAMPIN 87190 $24.00SO AFB SENS ETHAMBUTOL 87190 $24.00SO AFB SENS PZA 87190 $24.00NALBUPHINE INJ [10MG/ML] J2300 $24.01MIDAZOLAM SYRUP [2MG/ML 2 $24.02HYDROmorphone Inj (1 mg/mL) $24.05ERYTHROMYCIN BASE FILMTAB $24.08FLUCONAZOLE TAB [150MG] $24.10PHENYTOIN [ 500MG/NS 100ml] $24.17PREPARATION H OINT [28GM] $24.23rocuronium bromide *DOSE 10 mg/mL* $24.27rocuronium bromide 10 MG $24.27PHENYLEPHRINE INJ [1% 10 $24.34DDAVP TAB [0.2MG] $24.76TMP-SMX SUSP [DOSE] $24.89EVACUATION CONTAINER 1000 $25.00AR-7220: SUTURE FIBERWIRE $25.00AR-7200: SUTURE FIBERWIRE $25.00DNX12: DERMABOND SKIN ADHESIVE 0.7ML $25.005921-034-136: PURPLE 34" TOURNIQUET CUFF $25.00AR-7250: 0 FIBERWIRE $25.00AMOXICILLIN 200MG/5ML SUS $25.02ED-AMOXICILLIN SUSP [200/ $25.02ACTONEL TAB [5MG] $25.16lidocaine Inj PF (0.5% SDV 50 mL) $25.22LEVOFLOXACIN TAB [250MG] $25.33SKELAXIN TAB [800MG] $25.41DRONABINOL CAP [5MG] $25.51ED-HYDROCODONE/APAP [5/325 #6] $25.68HYDROCERIN CREAM [4OZ] $25.78

25

potassium chloride (60 mEq/NS 500 mL) J3480 $25.78DAP CMP $26.00DAP Glycohemoglobin A1c $26.00DAP Protime/INR $26.00DAP Urinalysis $26.00BASIC LIFE SUPPORT MILEAG A0380 $26.00AMB HOSP/AIRP PER MILE A0425 $26.00AMB HOSP/HOSP PER MILE A0425 $26.00AMB RES/HOSP PER MILE A0425 $26.00AMB RES/SNF PER MILE A0425 $26.00AMB SNF TO HOSP PER MILE A0425 $26.00AMB ACC SCENE/HOSP P MILE A0425 $26.00AMB SNF TO DIALY PER MILE A0425 $26.00AMB SNF/DIALY FAC P MILE A0425 $26.00AMB/OTHER TO HOSP PER MI A0425 $26.00AMB HOSP TO RES PER MILE A0425 $26.00AMB SNF TO OTHER SNF/P MI A0425 $26.00AMB HOSP TO SNF A0425 $26.00NON-COVERD MILES A0888 $26.00AMOXICILLIN 400MG/5ML SUS $26.14ED-AMOXICILLIN SUSP [400/ $26.14Water for inj (100 ml SDV) $26.14METHOTREXATE INJ [25MG/ML J9250 $26.14HYDROCOD/APAP ELIX [7.5/3 $26.21BENICAR TAB [40MG] $26.40BENICAR HCT TAB 40-25MG $26.40TAMIFLU CAP [75MG] $26.44ED-TRAMADOL TAB [50MG #6] $26.59SENSORCAINE INJ 0.25% W/ $26.85ED-HYOSCYAMINE SL TAB [ 0 $26.86VITAMIN K1 INJ [1MG/0.5ML $26.86ED-Penicillin VK 250mg #6 pack $26.86ULORIC TAB [40MG] $26.96VACCINE ADMINISTRATION $27.00ACTOS TAB [15MG] $27.00CAPILLARY COLLECTION 36416 $27.00PREGNANCY TEST - URINE 81025 $27.00URINE VOLUME/TIMED 81050 $27.00SO URINE VOLUME SENDOUT 81050 $27.00SO URINE VOLUME-ARUP 81050 $27.00URINE VOLUME CREAT TIMED 81050 $27.00NUPERCAINAL OINT [1% 28.4 $27.04

26

ED-LORAZEPAM TAB [1MG #6] $27.10HEPARIN INJ [5000 USP U $27.22

$27.22ENALAPRILAT INJ [1.25MG/M $27.51MAGNESIUM SO4 INJ [5GM/10 $27.51PROMETHAZINE VC/COD SYR $27.65SODIUM BICARB 4.2% [10 ML $27.65ERYTHROMYCIN OPHTH OINT [ $27.68LEUCOVOR TAB [25MG] $27.72SUFENTANIL INJ [50MCG/ML $27.88SODIUM CHLORIDE INJ [4MEQ $27.90HYPERTONIC SODIUM CHLORIDE 3% [ 250ml] $27.90aCYclovir *IVPB* (500MG/100ML NS) $27.94EVACULATED BOTTLE $28.00MICRONEFRIN [11.25MG/ML . $28.00AR-6564: CANNULA PARTIALLY THRD 5.75 $28.00AR-6570: 7MM TWIST IN CANNULA $28.002N07A: GORTEX CV-2 SUTURE $28.005921-044-136: 44" TOURNIQUET CUFF $28.00POTASSIUM CHL INJ [40MEQ $28.02POTASSIUM CHLORIDE [40MEQ/NS 250ml] J3480 $28.02TOVIAZ TAB [8MG] $28.09Toviaz TAB [4MG] $28.09PRISTIQ SR TAB [50MG] $28.12MINERAL OIL SDV [25ML] $28.12SENSORCAINE INJ 0.5% W/E $28.15BANANA BAG NS 1000ml $28.50LEUCOVORIN INJ [100MG VIA $28.59TRIAMCINOLONE CRM [0.1% 1 $28.59BUDESONIDE RESPULES [0.5M $28.60BUDESONIDE RESPULES [ 0.5 $28.60PROCHLORPERAZINE SUPP [25 $28.946000-006-000: INSTRUMENT BATTERY $29.00MICROSCOPIC ONLY- URINE 81015 $29.00URINE VOLUME TIMED MALB 81050 $29.00CO2- TOTAL BLOOD 82374 $29.00HEMATOCRIT MICRO SPUN 85013 $29.00DETROL LA CAP [2MG] $29.13FAMOTIDINE BAG [20MG INJ $29.24LACTATED RINGER'S [500ML] $29.36PROMETHAZINE PLAIN SYRUP $29.51FLUCONAZOLE PREMIX [200 M J1450 $29.56

27

EUCERIN LOTION [8OZ] $29.69FUROSEMIDE INJ [100MG/10 J1940 $29.80VENIPUNCTURE 36415 $30.00URINE DIPSTICK 81002 $30.00CHLORIDE- BLOOD 82435 $30.00GLUCOSE- REAGENT STRIP 82948 $30.00GLUCOSE STRIP 82948 $30.00H PYLORI 86677 $30.00SPEC COLLECT -RESEARCH 99001 $30.00EPINEPHRINE [1:10000 10 M J0171 $30.06LABETALOL INJ [5MG/ML 20M $30.10TIMOLOL MAL OPHTH [0.5% 5 $30.21XYLOCAINE W/EPI INJ [0.5% $30.50BICALUTAMIDE TAB [ 50MG] $30.79PANCURONIUM INJ [2MG/ML 2 $30.90DEXAMETHASONE INJ [10MG/M $31.14VECURONIUM INJ [10MG] $31.18Edrophonium Chl 150mg/15ml $31.54oxymetazoline nasal spray ER $31.72ALAWAY EYE DROPS [10ML] $31.81ZANTAC PREMIX BAG [50MG/5 $31.90OT ELECRIC STIM- 15 MIN 97032 $31.93Propylene Glycol Lubricant ophth Drops ( $31.99LIDOCAINE INJ [2% 5ML SYR $32.00ZYPREXA TAB [ 2.5MG] $32.00NM-400U-0423: INJECTORFORCE MAX NEEDLE $32.003045: VENAFLOW THIGH CUFF $32.00Albumin- CSF Fluid 82042 $32.00TOTAL PROTEIN SERUM 84155 $32.00PROTEIN - BODY FLUID 84155 $32.00SO PEP TOTAL PROTEIN 84155 $32.00SO TOTAL PROTEIN W/PNL 1 84155 $32.00SODIUM- SERUM 84295 $32.00BLOOD SMEAR W/O WBC DIFF 85008 $32.00SO HGB EVAL - HGB 85014 $32.00SO ARC RARE AG PT SRM EAC 86904 $32.00DOBUTAMINE HCL INJ [250MG $32.23OXYCONTIN CR TAB [40MG] $32.24PERMETHRIN LOT [1% 60ML] $32.33ATROPINE SYR [1MG/10ML A $32.34ASPERCREME CRM [85GM] $32.35BENEFIBER POWDER SF [8.3O $32.48

28

ERY-TAB EC TAB [333MG] $32.54GLYCOPYRROLATE INJ [0.2M $32.69PREP H HC CREAM $32.73FUNGI-NAIL SOLN [30ML] $32.94GEODON CAP [20MG] $33.00ZYRTEC-D ER TAB [5-120MG $33.00ALBUMIN SERUM 82040 $33.00SO HGB EVAL - RBC 85041 $33.00SO BART QUINT IGG SCRN 86611 $33.00SO BART QUINT IGM SCRN 86611 $33.00SO BART HENSE IGM SCRN 86611 $33.00CARHART DEODORANT POWDER $33.16HYDROCORTISONE SUPP [25MG $33.18FUROSEMIDE *IVPB* [100mg/NS100ml] $33.34ED-CYCLOBENZAPRINE TAB [10MG #6] $33.50LEVOFLOXACIN INJ [500MG P J1956 $33.56KETAMINE INJ [100MG/ML DO $33.63

$33.63$33.63

FIBER LAXATIVE TAB [500MG $33.63LUTEIN ORAL CAP [20MG] $33.84WHEELCHAIR MGMT-15MIN 97542 $33.99MOD SEDATION ADDL 15 MINS 99157 $33.99LEVOFLOXACIN INJ [750MG P J1956 $33.99925.ZDK: ZERO PILLOW $34.00Venipuncture for Blood Culture 36415 $34.00CORONER -URINE DRUG SCREEN 80306 $34.00XYLOCAINE W/EPI INJ [2% M $34.02ALENDRONATE SODIUM TAB [7 $34.14MORPHINE SOLN [20MG/5ML O $34.25MICONAZOLE NITRATE VAG CR $34.26bumetanide 5mg drip $34.28ENOXAPARIN SODIUM SYR [ 3 J1650 $34.29NEO-SYNEPHRINE INJ [1% A $34.42DIPRIVAN INJ [10MG/ML 50M J2704 $34.42SOLU-MEDROL INJ [ 40MG A J2920 $34.49ENOXAPARIN SODIUM SYR [ 6 J1650 $34.51XYLOCAINE MPF INJ [2% 1 A $34.55ED-HYDROCODONE/APAP [10/325 #6] $34.64TOBRAMYCIN SOAKER [40MG/M J3260 $34.94HALOPERIDOL INJ [5MG/ML J1630 $35.02DIGOXIN INJ [0.25MG/ML 2M J1160 $35.41

29

ACETIC ACID SOL IRR [ .2 $35.56TERBINAFINE HCL CREAM[1% $35.59LUNESTA TAB [2MG] $35.66XYLOCAINE MPF INJ [4% 1 A $35.67DEMEROL INJ [100MG/ML INJ J2175 $35.72CEFTRIAXONE INJ [250MG] J0696 $35.74SELSUN BLUE BALANCED SHAM $35.89ARICEPT TAB [ 5MG] $36.00VALTREX TAB [1000MG] $36.00AR-6572: CANNULA SYSTEM 8.25MMIDX9CM $36.00BILIRUBIN TOTAL 82247 $36.00BILIRUBIN NEONATAL -TOTAL 82247 $36.00CALCIUM SERUM 82310 $36.00ALKALINE PHOSPHATASE 84075 $36.00HEMATOCRIT - AUTOMATED 85014 $36.00EPOC Hematocrit POCT 85014 $36.00VENIPUNCTURE UNDER 3 36400 $36.05ALBUTEROL SYRUP [2MG/5ML $36.19ED-ALBUTEROL SYR [2MG/5ML $36.19adenosine Inj (12 mg/4 ml) $36.47SELSUN LOTION [2.5%] $36.49FLUMAZENIL INJ [0.1MG/ML $36.58cefTRIAXone *IVPB* [ 500 mg/NS 50 mL] $36.60CEFTRIAXONE INJ [500MG] J0696 $36.60DAP Iron/IBC $37.00CEFAZOLIN ADDV [1GM] J0690 $37.00ceFAZOLin *IVPB* [1GM/NS 50ml] $37.04ED-CEPHALEXIN CAP [500MG $37.23ALBUTEROL SVN [0.083% 2.5 $37.30TOBRAMYCIN INJ [40MG/ML 2 J3260 $37.38LIDOCAINE/PRILOCAINE CRM $37.44ETOMIDATE INJ [2MG/ML 10M $37.53HYPERTONIC SODIUM CHLORIDE 3% [ 500ml] $37.60CALCIUM CL INJ [10% 13.6 $37.81PREDNISOLONE SYR [5MG/5ML $37.93SEROQUEL TAB [200MG] $38.00HEMOCULT 1-3 82270 $38.00OCCULT BLD FECES 1-3 TEST 82272 $38.00GLUCOSE 1 HR 82947 $38.00GLUCOSE-GTT-FAST 82947 $38.00GTT 90 Min Spec 82947 $38.00BUN - SERUM 84520 $38.00

30

Urea Nitrogen Urine 84540 $38.00WBC COUNT AUTOMATED 85048 $38.00SO Q FEVER IGG P1 SCN 86638 $38.00SO Q FEVER IGG P2 SCRN 86638 $38.00SO Q FEVER IGM P1 SCRN 86638 $38.00SO Q FEVER IGM P2 SCRN 86638 $38.00X-RAY ORBITS SCREENING 70030 $38.11MIDAZOLAM INJ [5MG/ML VI J2250 $38.31PROMETHAZINE /COD SYR [1 $38.41ED-TMP-SMX DS TAB [800/16 $38.79CEFTRIAXONE INJ [1GM] J0696 $38.98GEODON CAP [60MG] $39.00PROCALAMINE 3% 1000 $39.00SO IBS BDNF 82397 $39.00SO IBS TIMP-1 82397 $39.00SO IBS IL-1 BETA 82397 $39.00SO IBS GRO-a 82397 $39.00SO IBS N-GAL 82397 $39.00SO IBS TWEAK 82397 $39.00CHOLESTEROL- SERUM 82465 $39.00POTASSIUM- SERUM 84132 $39.00SO ALLERGEN D.PTERONYSSIN 86003 $39.00SO ALLERGEN RED TOP GRASS 86003 $39.00SO ALLERGEN COCKROACH 86003 $39.00SO ALLERGEN CLADOSPOR.HER 86003 $39.00SO ALLERGEN MAPLE BOX E 86003 $39.00SO ALLERGEN ALDER 86003 $39.00SO ALLERGEN OAK 86003 $39.00SO ALLERGEN ELM 86003 $39.00SO ALLERGEN - BIRCH 86003 $39.00SO ALLERGEN - MULBERRY 86003 $39.00SO ALLERGEN WALNUT 86003 $39.00SO ALLERGEN SESAME 86003 $39.00SO ALLERGEN SCALLOP 86003 $39.00SO ALLERGEN ASCARIS 86003 $39.00SO ALLERGEN STACHBOT IGE 86003 $39.00SO SALMONELLA O TYPE D 86768 $39.00SO SALMONELLA H TYPE D 86768 $39.00SO SALMONELLA H TYPE A 86768 $39.00SO SALMONELLA H TYPE B 86768 $39.00SO SALMONELLA O TYPE VI 86768 $39.00SO CHLAMYDIA STAIN W/CULT 87140 $39.00

31

NESACAINE-MPF [3% SDV 20M $39.27AMINOCAPROIC ACID 250MG/M $39.48AMPICILLIN *IVPB* [1000MG/50ML NS] $39.59SILVER SULFADIAZINE CREAM $39.60CERAVE CREAM [16OZ JAR] $39.80ED-ERYTHROMYCIN OPHTHALMIC OINTMENT 5MG $39.80PHENYTOIN [1000MG/NS 250ml] $39.83AMMONIUM LACTATE CR. 12% $39.89CYANOCOBALAMIN INJ [1000M $39.96ACTOS TAB [30MG] $40.00UA W/ RX MICRO/C&S 81003 $40.00UA BIOCHEM ONLY 81003 $40.00GLUCOSE-GTT 4HR 82952 $40.00GLUCOSE-GTT 5HR 82952 $40.00SO HGB EVAL - HCT 85018 $40.00SPECIMEN SHIP/HANDLING 99001 $40.00AMPICILLIN INJ [500MG] J0290 $40.00BENEFIBER ULTRA TAB [BTL $40.09BETASEPT 4% SURGICAL SRUB $40.21LIDOCAINE/D5W INJ [4MG/ML $40.53PROMETHAZINE SUP [25MG] $40.72PROMETHAZINE SUP [12.5MG $40.72DROPERIDOL INJ [2.5MG/ML J1790 $40.772296-3-125: LONG MED BLADE $41.00vaccination administration charge G0008 $41.00vaccination administration pneumococcal G0009 $41.00vaccination administration Prevnar 13 ch G0009 $41.00AMPICILLIN/SULBACTAM ADDV J0295 $41.00VANCOMYCIN ADDV [1GM] J3370 $41.00INFLUENZA ADM. FEE Q2038 $41.00CETACAINE SPRAY [1 DOSE] $41.24AMOXICILLIN 200MG/5ML SUS $41.40ceFAZOLin *IVPB* [2GM/NS 100ml] $41.59VALPROIC ACID SYRUP [250/ $41.61RANITIDINE HCL [25MG/ML M $41.84CEFAZOLIN INJ [1GM SDV] J0690 $41.90EL STIM ELECTRODES P SET $42.00AST (SGOT) 84450 $42.00ALT (SGPT) 84460 $42.00URIC ACID - SERUM 84550 $42.00URIC ACID - URINE 84560 $42.00MANUAL DIFF W/CBC 85007 $42.00

32

ALLERGEN RAGWEED COMMON 86003 $42.00ALLERGEN CEDAR MOUNTAIN 86003 $42.00CULTURE-STOOL-E.COLI 0157 87046 $42.00CULTURE-STOOL-CAMPYLOBACT 87046 $42.00CULTURE -STOOL-YERSINIA 87046 $42.00CULTURE - STOOL-VIBRIO 87046 $42.00CV STRESS TEST PHYSICIAN 93016 $42.00ED-DICLOFENAC K+ TAB [50M $42.02VANCOMYCIN INJ [500MG] J3370 $42.05LIDODERM TOPICAL PATCH [5 $42.20LIDOCAINE TOPICAL PATCH 5 $42.20TRIAMCINOLONE CRM [0.1% 8 $42.63BENZOIN COMPOUND TINCTURE $42.70TOBRADEX OPHTH SUSP [0.3% $42.71ACTOS TAB [45MG] $43.00ICY HOT CREAM [90GM] $43.06PROPRANOLOL INJ [1MG/ML] $43.06AMOXICILLIN 400MG/5ML SUS $43.82METAMUCIL SF [DOSE] $43.92DOBUTAMINE/D5W PREMIX BAG J1250 $43.920210-114-100: INTERPULSE HANDPIECE $44.00ZYPREXA TAB [ 7.5MG] $44.001885-500-24: 24" KNEE IMMOBILIZER $44.00AR-6430: DUAL WAVE OUTFLOW TUBE $44.00BILIRUBIN INDIRECT 82248 $44.00BILIRUBIN DIRECT 82248 $44.00PHOSPHORUS INORGANIC 84100 $44.00HEMOGLOBIN 85018 $44.00SO ARC INCUBAT W/ENZYMES 86971 $44.00SO FUNG SENS 5-FLUCYTOSIN 87186 $44.00SO FUNG SENS AMPHOTER B 87186 $44.00SO FUNG SENS ANIDULAFUNGI 87186 $44.00SO FUNG SENS CASPOFUNGIN 87186 $44.00SO FUNG SENS MICAFUNGIN 87186 $44.00SO FUNG SENS FLUCONAZOLE 87186 $44.00SO FUNG SENS ITRACONAZOLE 87186 $44.00SO FUNG SENS POSACONAZOLE 87186 $44.00SO FUNG SENS VORICONAZOLE 87186 $44.00IMMUN-ADM SQ-IM- 1 VACCIN 90471 $44.001000406-00: ATRIUM MESH 4x6 C1781 $44.00CAPSAICIN CRM [60GM] $44.32CEFTRIAXONE INJ [2GM] J0696 $44.81

33

TRIAMCINOLONE OINT[0.5% 1 $44.86LEG CRAMPS TAB (BTL) $44.93VACUUM BOTTLE $45.00HYDROXYZINE HCL SYR [1OMG $45.00CLINDAMYCIN *IVPB* [600MG/NS 50ml] $45.03CLINDAMYCIN INJ [600MG 4M $45.20CRITIC-AID SKIN PASTE [18 $45.31LUMBAR PUCTURE TRAY $45.32THERAPY ACTIVITY -15MIN 97530 $45.32TUBERSOL TEST [5 T.U.] $45.41AZITHROMYCIN INJ [500MG] J0456 $45.46SO ALBUMIN- URINE 82042 $46.00SO BILIRUBIN -AMN FLD 82143 $46.00EPOC GFR - POCT 82565 $46.00PH BODY FLUID- NOT BLOOD 83986 $46.00SO SODIUM - OTHER FLUID 84302 $46.00SO THYROXINE -TOTAL(T4) 84436 $46.00SO T4 - TOTAL 84436 $46.00SO WBC W/CD4/CD8 85048 $46.00ESR/SED RATE -AUTOMATED 85652 $46.00AMPICILLIN/SULBACTAM ADDV J0295 $46.00NOREPINEPHRINE INJ [1MG/M $46.30CHLORHEXIDINE GLUCONATE S $46.30EPINEPHRINE INJ [0.1MG/ML J0171 $46.30DEXTROSE SYRINGE [50% 50M $46.36NASACORT AQ NASAL SPRAY [ $46.41GENTAMICIN INJ [40MG/ML 2 J1580 $46.45SO AMYLASE w/ISOENZYMES 82150 $47.00SO CRYOGLOBULIN -QUAL 82595 $47.00SO REDUCE SUBST -FECAL 82945 $47.00Immunoassay for antibodies, Ql, rgt strp 86328 $47.00Coronavirus 2293-Film array Resp panel 87633 $47.00Coronavirus HKV1-Film array Resp panel 87633 $47.00Coronavirus NL63-Film array Resp panel 87633 $47.00Coronavirus OC43-Film array Resp panel 87633 $47.00Influenza A/H3-Film array Resp panel 87633 $47.00Influenza A/2009-H1-Film array Resp pane 87633 $47.00Human metapneumovirus-Film array Resp pa 87633 $47.00Human Rhino/Enterovirus-Film array Resp 87633 $47.00Parainfluenza 1-Film array Resp panel 87633 $47.00Parainfluenza 2-Film array Resp panel 87633 $47.00Parainfluenza 3-Film array Resp panel 87633 $47.00

34

Parainfluenza 4-Film array Resp panel 87633 $47.00RSV-Film array Resp panel 87633 $47.00Adenovirus- Film Array Resp panel 87633 $47.00dexaMETHASONE 0/S CONC. [INTNESOL 1MG/ML $47.10DILTIAZEM INJ [25ML FOR I $47.38DILTIAZEM NS 100ml DRIP [125MG/125ml] $47.38APPLY STATIC FINGER SPLIN 29130 $47.38THER IVNTJ W/FOCUS COG FUNCTION 97127 $47.38CIPROFLOXACIN INJ [400MG J0744 $47.55AMPICILLIN-SULBACTAM *IVPB* [1.5GM/100ml $47.62AMPICILLIN/SULBACTAM [1.5 J0295 $47.62FLORASTOR CAP [250MG BTL $48.002794N: COBAN2 LITE COMPRESSION $48.00URINE GLUCOSE FASTING 81005 $48.00URINE GLUCOSE HALF HR 81005 $48.00URINE GLUCOSE 1 HR 81005 $48.00URINE GLUCOSE 2 HR 81005 $48.00SPECIFIC GRAVITY 81005 $48.00PROTEIN DIPSTIX UA 81005 $48.00KETONES URINE 81005 $48.00BILIRUBIN URINE 81005 $48.00CREATININE SERUM 82565 $48.00CREATININE URINE 82570 $48.00CREATININE -URINE VMA 82570 $48.00SO UR CREAT W/ELECT RDM 82570 $48.00GLUCOSE FAST/PP/RANDOM 82947 $48.00PROTIME 85610 $48.00SO ANA TITER 86039 $48.00SO ANA TITER W/PNL 86039 $48.00RPR- QUALITATIVE 86592 $48.00SO ARC ABO 86900 $48.00BLOOD TYPE RH 86901 $48.00SO ARC RH 86901 $48.00SO O/P SPECIAL STAIN 87209 $48.00NUTRITION ED- REASSMNT 97803 $48.00MNT SUBS TX FOR CHANGE DX G0270 $48.00M/S OVS ADDITIONAL HRS G0378 $48.00Dextrose Infant Syringe 25% 10ml $48.01CALCIUM GLUCONATE INJ [10 J0610 $48.03DL-ALPHA TOCOPHERYL ACETATE CAP (1000 un $48.08TRIAMCINOLONE CRM [0.025% $48.64Biofreeze Gel (4%) $48.82

35

KENALOG INJ [40MG/1ML 1ML J3301 $48.93SODIUM CHLORIDE SOL 0.9% IRR 3000 $49.00VLOCL0024: V-LOC 180 ABS SUTURE $49.00SO CALCIUM W/PTH 82310 $49.00SO CREAT W/TOBRA TROUGH 82565 $49.00SO CREAT W/TOBRA PEAK 82565 $49.00SO URINE CREATININE 82570 $49.00UR CREAT W/MICROALB 82570 $49.00FERRITIN LEVEL 82728 $49.00GLUCOSE 1HR >DOSE 82950 $49.00GLUCOSE 2 HR>DOSE 82950 $49.00GLUCOSE 2HR >DOSE 82950 $49.00GAMMA GTP- SERUM 82977 $49.00SO ALK PHOS FOR ISOS 84075 $49.00SO POTASSIUM- OTHER FLUID 84132 $49.00SODIUM - URINE 84300 $49.00SO ASO TITER 86060 $49.00SO ASPERG FLAVUS PPT-AB 86331 $49.00SO ASPERG FUM #2 PPT-AB 86331 $49.00SO ASPERG FUM #3 PPT-AB 86331 $49.00SO ASPERG FUM #1 PPT-AB 86331 $49.00SO ASPERG FUM #6 PPT-AB 86331 $49.00SO AEROBAS PULLU PPT-AB 86331 $49.00SO PIGEON SERUM PPT-AB 86331 $49.00SO MICROPOLY FAENI PPT-AB 86331 $49.00SO SACCH VIRIDIS PPT-AB 86331 $49.00SO THERMO CANDIDUS PPT-AB 86331 $49.00SO THERMO SACCHARI PPT-AB 86331 $49.00SO THERMO VULGARIS PPT-AB 86331 $49.00SO BART QUINT IGG TITER 86611 $49.00SO BART QUINT IGM TITER 86611 $49.00SO BART HENSE IGM TITER 86611 $49.00SO BART HENSE IGG TITER 86611 $49.00SO CHLAM PSITT IGG 86631 $49.00SO CHLAM PSITT IGA 86631 $49.00SO HERPES SIMPLX-1 IGM 86695 $49.00SO HEP B SURFACE ANTIBODY 86706 $49.00SO HEPATITIS A IGM 86709 $49.00BLOOD TYPE ABO 86900 $49.00SO HEP B SURFACE ANTIGEN 87340 $49.00DESFERAL INJ [500MG] $49.15MURO-128 OPTH SOLN [2% 1 $49.50

36

LR/REGLAN/DHE 1000ML $50.000408-800-100: FLYTE HOOD W/PEEL AWAY $50.00RHC PROTHROMBIN TIME 85610 $50.00HEPARIN DRIP [25000U IN $50.12cefTRIAXone *IVPB* [1 gm/NS 50 mL] $50.13cefazolin 3gm/100mL J0690 $50.22ABREVA CREAM 10% [2GM] $50.24NAROPIN 0.2% FEMORAL BLOC J2795 $50.32SOLU-MEDROL INJ [ 125MG A J2930 $50.37PHENOBARBITAL ELIXIR [20M $50.42ceftazidime 1gm $50.64OCCULT BLOOD- STOOL 1-3 82274 $51.00OCCULT BLOOD SINGLE 82274 $51.00SO ANA TITER 86039 $51.00OCTREOTIDE ACETATE INJ [0 $51.44THIAMINE INJ [100MG/1ML] J3411 $51.48thiamine *IVPB* (100 mg/ml 2ml ) J3411 $51.48M/S EXTEND RECOVER >6HRS $51.50ARTHROGRAM TRAY $51.50TOMO DIGITAL BREAST SCREEN RT UNILATERAL 77063 $51.50TOMO DIGITAL BREAST SCREEN LT UNILATERAL 77063 $51.50TOMO DIGITAL BREAST SCREEN IMPLANTS RT 77063 $51.50TOMO DIGITAL BREAST SCREEN IMPLANTS LT 77063 $51.50MA TOMO UNILAT OR BILAT DIAGNOSTIC G0279 $51.50ANTIPYRINE/BENZOCAINE OTI $51.52ED-ANTIPYRINE-BENZOCAINE $51.52UREA CREAM 20% [3OZ TUBE] $51.70phenylephrine inj 100 mcg/1 ml Premix J2370 $51.70ENOXAPARIN SODIUM SYR [ 4 J1650 $51.81ENOXAPARIN SODIUM SYR [10 J1650 $51.87ACYCLOVIR SODIUM INJ [500 J0133 $51.94CENTRAL LINE DRESSING KIT $52.00DAP Vitamin D-25 Hydroxy $52.00AMPICILLIN *IVPB* [2000MG /100ML NS] $52.00SODIUM CHLORIDE 0.45% [1000] $52.00SODIUM CHLORIDE 0.9% [500ML] $52.00EZ10G: ENDOLOOP O PSDII LIGATURE 18" $52.00SO ALDOLASE 82085 $52.00SO FOLATE LEVEL 82746 $52.00LDH BLOOD 83615 $52.00LDH BODY FLUID 83615 $52.00SO LDH W/ISOENZYMES 83615 $52.00

37

POTASSIUM- URINE 84133 $52.00SO PREALBUMIN 84134 $52.00RETIC COUNT - FLOW CYTO. 85045 $52.00SO ANA for COMPLETE 86038 $52.00SO ANA 86038 $52.00SO CENTROMERE ANTIBODY 86038 $52.00SO ANA SCREEN W/PNL 86038 $52.00SO ANA COMPLETE RX LUPUS 86038 $52.00C-REACTIVE PROTEIN 86140 $52.00EKG- INTERPRETATION ONLY 93010 $52.00MVI-12 INJ [10ML INJ SDV] $52.20potassium chloride oral liq 10% *Dose* ( $52.36COLON PREP (1 Bottle of Magnesium Citrat $52.47AMERIGEL OINT DRESSING [T $52.49TETRACAINE OPHTH SOL [0.5 $52.69ACETYLCYSTEINE [30ML VIA $52.70BETAMETHASONE PHOSPH/BETA $53.00NUTRITION ED- INT 15 MIN 97802 $53.00XYLOCAINE MPF INJ [0.5% S $53.82LEVETIRACETAM INJ [500/5 J1953 $53.86SEROQUEL XR TAB [300MG] $54.00DEXT 5% IN WATER [500ML] $54.00KETONES- SERUM- QUAL. 82009 $54.00SO AMMONIA URINE 82140 $54.00SO MAGNESIUM URINE 83735 $54.00PHOSPHORUS- URINE 84105 $54.00SO SODIUM - FECES 84302 $54.00SO SULFATE URINE 84392 $54.00SO SICKLE CELL SCREEN 85660 $54.00SO FUNGUS ID 87106 $54.00GRAM STAIN - SPUTUM 87205 $54.00GRAM STAIN- DIRECT- FIRST 87205 $54.00GRAM STAIN - SPUTUM 87205 $54.00GRAM STAIN-OTHER #1 87205 $54.00GRAM STAIN- OTHER #2 87205 $54.00GRAM STAIN-DIRECT-ADD'L 87205 $54.00KOH PREP 87220 $54.00SO KOH EXAM 87220 $54.00SO CULTURE- INFLU B 87254 $54.00SO CULTURE - INFLU A 87254 $54.00DEPO-MEDROL INJ [40MG/ML $54.15Clindamycin premix 600mg/50ml NS $54.64

38

CEFTAZIDIME ADDV [1GM] J0713 $54.96BIOPSY TRAY W LID $55.00ED-KETOROLAC TAB [10MG] $55.09DEXAMETHASONE ELIXIR [0.5 $55.52REFRESH PLUS OPHTH [0.5% $55.66ED-ORPHENADRINE ER TAB [1 $55.68CEFUROXIME *IVPB* [1.5GM/NS 50ml] $55.94CEFUROXIME INJ [1.5GM SDV J0697 $55.94MIRALAX POW [3350 NF 255G $56.00hyperKALEMIA SOLUTION $56.00DEXT 5% IN WATER [1000ML] $56.00SODIUM CHLORIDE 0.9% [1000ML] $56.00AR-7209T: TIGERSTICK #2 TIGERWIRE $56.00AR-7209: #2 FIBERSTICK $56.00AR-7237-7: FIBERTAPE $56.00SO CERULOPLASMIN 82390 $56.00SO COPPER- SERUM 82525 $56.00SO MAGNESIUM - FECES 83735 $56.00URINE URIC ACID 84560 $56.00PLATELET COUNT AUTOMATED 85049 $56.00SO ALLERGEN STACHBOT IGG 86001 $56.00SO ALLERGEN ASPER NIG IGG 86001 $56.00SO ANA SCREEN - ARUP 86038 $56.00SO PHOSTIDYLSERINE IGG 86148 $56.00SO PHOSTIDYLSERINE IGM 86148 $56.00SO PHOSTIDYLSERINE IGA 86148 $56.00SO HEP B CORE AB- IGM 86705 $56.00SO HERPES CULTURE TYPING 87140 $56.00WET PREP 87210 $56.00SO CHLAMYDIA DNA PROBE 87490 $56.00SO CHLAMYDIA DNA PB ONLY 87490 $56.00SO NEISS GONO DNA PROBE 87590 $56.00SURGICAL PATH GROSS 88300 $56.00CRYSTALS BODY FLUID 89060 $56.00LIDOCAINE VISCOUS [2% 20M $56.02GUAIFENESIN AC (CODEINE) $56.70POLYMYXIN B-TRIMETHOPRIM $56.88OFLOXACIN OPHTH SOLN [0.3 $56.96SO AFB CONC INF AGT 87015 $57.00STREP SCREEN DIRECT 87430 $57.00CLINDAMYCIN PHOSPHATE *IVPB* [900MG/NS50 $57.56MEROPENEM [500MG INJ] J2185 $57.56

39

TAZICEF INJ ADDV [1GM] J0713 $57.83LACTATED RINGER'S [1000ML $58.00ER PHYS INS NON INDWELLING BLADDER CATH 51701 $58.00SO CHLORIDE-URINE 82436 $58.00SO GROWTH HORMONE HUMAN 83003 $58.00SO LDL -DIRECT MEASURE 83721 $58.00SO OSMOLALITY- BLOOD 83930 $58.00SO TRANSFERRIN 84466 $58.00SO Pineapple (f210) IgE 86003 $58.00SO Kiwi fruit (f84) IgE 86003 $58.00SO ALLERGEN - IGE EA 86003 $58.00SO ALLERGEN - GLUTEN IGE 86003 $58.00SO ALLERGEN - ALFALFA 86003 $58.00SO ALLERGN ASPERGLS NIGR 86003 $58.00SO ALLERGEN - CANDIDA 86003 $58.00SO ALLERGEN - CAT 86003 $58.00SO ALLERGEN - DUST 86003 $58.00SO ALLERGEN - JUNIPER 86003 $58.00SO ALLERGEN - OLIVE 86003 $58.00SO ALLERGEN-RUSS.THISTLE 86003 $58.00SO ALLERGEN-SAGEBRUSH 86003 $58.00SO ALLERGEN-TIMOTHY GRASS 86003 $58.00SO ALLERGEN-COW'S MILK 86003 $58.00SO ALLERGEN-WHEAT 86003 $58.00SO ALLERGEN-EGGS WHOLE 86003 $58.00SO ALLERGEN-ALTERNARIA 86003 $58.00SO ALLERGEN-CORN FOOD 86003 $58.00SO ALLERGEN-TOMATOES 86003 $58.00SO ALLERGEN-KOCHIA 86003 $58.00SO ALLERGEN-BERMUDA GRASS 86003 $58.00SO ALLERGEN-COTTONWOOD 86003 $58.00SO ALLERGEN-COCKELBUR 86003 $58.00SO ALLERGEN-PIGWEED/REDRT 86003 $58.00SO ALLERGEN-DOG HAIR 86003 $58.00SO ALLERGEN-D.FARINAE 86003 $58.00SO ALLERGEN-ASPERGLS FUMA 86003 $58.00SO ALLERGEN HORMODENDRIUM 86003 $58.00SO ALLERGEN OAT 86003 $58.00SO ALLERGEN ORANGE 86003 $58.00SO ALLERGEN LEMON 86003 $58.00SO ALLERGEN MOUSE 86003 $58.00SO ALLERGEN LATEX 86003 $58.00

40

SO ALLERGEN CHOCOLATE 86003 $58.00SO ALLERGEN PENICILLIN 86003 $58.00SO ALLERGEN SOY 86003 $58.00SO ALLERGEN BARLEY 86003 $58.00SO ALLERGEN BANANA 86003 $58.00SO ALLERGEN YEAST BAKERS 86003 $58.00SO ALLERGEN PEA GREEN 86003 $58.00SO ALLERGEN- PORK 86003 $58.00SO ALLERGEN PEANUT 86003 $58.00SO ALLERGEN POTATO WHITE 86003 $58.00SO ALLERGEN RICE 86003 $58.00SO ALLERGEN RYE 86003 $58.00SO ALLERGEN STRAWBERRY 86003 $58.00SO ALLERGEN BEAN NAVY/WHI 86003 $58.00SO ALLERGEN EGG WHITE 86003 $58.00SO ALLERGEN CLAM 86003 $58.00SO ALLERGEN SHRIMP 86003 $58.00SO ALLERGEN LOBSTER 86003 $58.00SO ALLERGEN CRAB 86003 $58.00SO ALLERGEN HALIBUT 86003 $58.00SO ALLERGEN SALMON 86003 $58.00SO ALLERGEN TUNA 86003 $58.00SO ALLERGEN -CODFISH 86003 $58.00SO COMPLEMENT C1 86160 $58.00SO COMPLEMENT C2 86160 $58.00SO ENA- SSA(Ro) ANTIBODY 86235 $58.00SO ENA- SSB(La) ANTIBODY 86235 $58.00SO LYME DISEASE ANTIBODY 86618 $58.00SO HEP B E ANTIBODY 86707 $58.00SO FTA ABS- CONFIRMATORY 86780 $58.00SO VARICELLA ZOSTER IGG 86787 $58.00SO VARICELLA ZOSTER IGM 86787 $58.00SO THYROGLOB AB 86800 $58.00SO THYROGLOBULIN AB 86800 $58.00VANCOMYCIN INJ [1GM] J3370 $58.38DAKIN'S SOLUTION [0.25% 1 $58.39meropenem *IVPB* ( range 500 mg to 1000 $58.61CLEOCIN ADDV [600MG] $59.00DEXT 5% 0.9% NACL [1000ML $59.00DEXT 5% .45% NACL [1000ML $59.00Albumin pleural fluid 82042 $59.00EYE STREAM IRRIGATION [1 OZ BTL] $59.40

41

ceFOTAXime *IVPB* [2GM/NS 50ml] $59.63CEFOTAXIME SODIUM ADDV [2 J0698 $59.63ICAPS CAP [BOX 60] $59.66AMPICILLIN-SULBACTAM *IVPB* [3GM/100ml N J0290 $59.93AMPICILLIN/SULBACTAM [3GM J0295 $59.93XYLOCAINE MPF INJ [1.5% S $59.99MORPHINE SOLN [20MG/5ML O $60.00DEXT 5% .20% NACL [1000ML $60.00DEXT 10% [1000ML] $60.00SODIUM CHLORIDE SOL 0.9% IRR 500 $60.00COLLECT BLD 36415 $60.00SO IBUPROFEN LEVEL 80329 $60.00SO AFP MATERNAL 82105 $60.00SO AFP TUMOR & AFP-L3 82107 $60.00SO IGG - ARUP 82784 $60.00SO IGG LEVEL 82784 $60.00SO IGM LEVEL 82784 $60.00SO IGM LEVEL 82784 $60.00SO IGM - ARUP 82784 $60.00SO IGG SERUM 82784 $60.00SO IGA TOTAL PROMETHEUS 82784 $60.00SO IGA LEVEL 82784 $60.00SO IGA 82784 $60.00SO IGE LEVEL 82785 $60.00SO GLIADIN IGA 83516 $60.00SO GLIADIN IGG 83516 $60.00IRON LEVEL 83540 $60.00SO OSMOLALITY- URINE 83935 $60.00SO ACID PHOS- PROSTATE 84066 $60.00SO PROLACTIN LEVEL 84146 $60.00Triglycerides Pleural fluid 84478 $60.00SO T3 - REVERSE 84482 $60.00SO BART HENSEL IGG SCRN 86611 $60.00SO HEP B CORE AB- TOTAL 86704 $60.00SO O/P DIRECT SMEAR 87177 $60.00NASAL SMR FOR EOSINOPHILS 89190 $60.00SEQ IV PUSH SAME DRUG 96376 $60.00ER PHYS LACER SIMPLE- DERMABOND G0168 $60.00FENTANYL PATCH [ 25MCG/HR $60.41atropine inj 1mg/ml J0461 $60.69DOPAMINE IN D5W PREMIX BA J1265 $61.11MULTITRACE-4 CONC INJ [1M $61.42

42

clindamycin 600mg/50ml premix $61.92DAP General Health Panel $62.00DEXT 5% IN WATER [50ML AD $62.00DEXT 5% .45% NACL--20MEQ $62.00DEXT 5% IN LR 1000 ML $62.000206-015-000: CEMENT MIXING BOWL $62.00SO CORTISOL- SERUM 80400 $62.00UA w/ MICROSCOPIC EXAM 81001 $62.00CALCUIM- URINE 82340 $62.00SO CORTISOL SERUM FIRST ADDL. 82533 $62.00SO CORTISOL SERUM EACH AFTER 2 82533 $62.00SO IGA - CSF. 82784 $62.00SO IGG - CSF 82784 $62.00SO IGM - CSF 82784 $62.00GLUCOSE CSF 82945 $62.00GLUCOSE BODY FLUID 82945 $62.00SO ALLERGEN-MUCOR 86003 $62.00SO ALLERGEN - RUSS OLIVE 86003 $62.00SO ALLERGEN - WILLOW 86003 $62.00SO COMPLEMENT - TOT CH50 86162 $62.00SO ANTI-dsDNA ANTIBDY -IgG 86225 $62.00SO ANTI-ds DNA IGG 86225 $62.00SO SS-A (Ro) ANTIBODIES 86235 $62.00SO SS-B (La) ANTIBODIES 86235 $62.00SO SJOGREN-SSA(Ro) AB 86235 $62.00SO SJOGREN-SSB(La) AB 86235 $62.00SO HERPES SIMPLX-2 IGM 86696 $62.00SO HEP A AB TOTAL 86708 $62.00SO PARVOVIRUS - IGM 86747 $62.00SO PARVOVIRUS - IGG 86747 $62.00SO HLA B-27 86812 $62.00SO HLA SINGLE ANTIGEN 86812 $62.00COOMBS- DIRECT 86880 $62.00A&D OINMENT [1LB] $62.50TIMOLOL MAL OPHTH [0.25% $62.50SULFAMETH/TRIMETH INJ [80 $62.67LEVAQUIN TAB [250MG] $63.00SO AMIKACIN LEVEL 80150 $63.00SO PROCAINAMINDE LEVEL 80192 $63.00AMMONIA LEVEL 82140 $63.00SO B2 MICROGLOBULIN 82232 $63.00SO BETA-2 MICROGLOB-ARUP 82232 $63.00

43

SO PSEUDOCHOLINESTERASE 82480 $63.00CREATINE KINASE (CK) 82550 $63.00SO CK W/ISOENZYMES 82550 $63.00IGA SERUM 82784 $63.00SO FSH LEVEL 83001 $63.00SO LUTENIZING HORMONE -LH 83002 $63.00SO PHOSPHORUS - FECES 84100 $63.00SO T3 UPTAKE (RT3U) 84479 $63.00SO CMV IGM 86645 $63.00SO EPS BARR EARLY AG 86663 $63.00SO HERPES SIMPLEX I-IGG 86695 $63.00SO HERPES SIMPLEX II- IGG 86696 $63.00ID RESISTENT STAPH 87077 $63.00FELBATOL TAB [400MG] $63.11TAMIFLU O/SUSP [6MG/ML 60 $63.18ENABLEX TAB [15MG] $63.37ENABLEX TAB [ 7.5MG] $63.37AMPICILLIN INJ [1GM] J0290 $63.59MICROALB EXCRETION 24H 82043 $64.00MICROALBUMIN RANDOM URINE 82043 $64.00MICROALBUMIN - URINE 82043 $64.00SO CAROTENE LEVEL 82380 $64.00HDL-DIRECT MEASURE 83718 $64.00TRIGLYCERIDES- SERUM 84478 $64.00SO VAP TRIGLYCERIDE 84478 $64.00PROTIME SUBSTITUTE PLASMA 85611 $64.00SO dsDNA ANTIBODIES 86225 $64.00SO MYCOPLASMA ANTIBODY 86738 $64.00SO HEPATITIS C ANTIBODY 86803 $64.00SO HEP B E ANTIGEN 87350 $64.00VESICARE TAB [5MG] $64.01AERDS 2 (btl 120) $64.28PONARIS NASAL EMOLLIENT [ $64.41ROZEREM TAB [8MG] $64.52ATRACURIUM INJ [10MG/ML 1 $64.66Pantoprazole Inj *BOLUS IVPB* [80mg/NS10 $64.66Pantoprazole Inj *IVPB* [80mg/NS100ml] $64.66INCENTIVE SPIROMETER/RESP $65.00SO AFP AMNIOTIC FLD 82106 $65.00SO CARCINOEMBRYONIC AG 82378 $65.00SO CORTISOL FREE- URINE 82530 $65.00SO CORTISOL-FREE SERUM 82530 $65.00

44

SO CREATINE 24HR URINE 82540 $65.00SO DHEA-S LEVEL 82627 $65.00SO GASTRIN LEVEL 82941 $65.00SO LDH ISOENZYMES 83625 $65.00SO PEP TOT PROTEIN-ARUP 84155 $65.00SO T PROT W/ELECT RDM 84156 $65.00SO TOT PROTEIN - URINE 84156 $65.00SO UR PROTEIN QUANT 84156 $65.00SO UR PEP PROTEIN ARUP 84156 $65.00SO TESTOSTERONE - FREE 84402 $65.00SO VMA - URINE 84585 $65.00SO B-HCG- TRIPLE SCREEN 84702 $65.00SO PROTEINASE 3 AB 86021 $65.00SO C ANCA TITER 86021 $65.00SO P-ANCA TITER 86021 $65.00SO P-ANCA ATYPICAL TITER 86021 $65.00SO CA 27.29 ANTIGEN 86300 $65.00SO CA-125 ANTIGEN 86304 $65.00SO BACT.AG- CSF- EACH 86403 $65.00Listeria Antibody CF Serum 86609 $65.00SO RUBELLA ANTIBODY IGM 86762 $65.00BACT ID. GRAM NEGATIVE 87077 $65.00BACT ID. GRAM POSITIVE 87077 $65.00BACT.ID. - ADD'L ORG. 87077 $65.00BACT.ID -IMMUNO-ADD'L ORG 87077 $65.00BACT-ID-IMMUNO-FIRST ORG. 87077 $65.00ID VANCO RESISTENT 87077 $65.00XYLOCAINE MPF W/EPI INJ [ $65.09LANSOPRAZOLE DISINTEGRATI $65.28SO Campylobacter culture 87046 $66.00SUB OVS CARE - L 1 99224 $66.00AMPICILLIN INJ [250MG] J0290 $66.00ZINACEF ADDV [1.5GM] J0697 $66.00ZINACEF INJ [1.5GM] J0697 $66.00SYMBYAX CAP [6-25MG] $66.43cefTRIAXone *IVPB* [2 gm/NS 50 mL] $66.43ED-DEXAMETHASONE ELIXIR [ $66.55HYPERTONIC SODIUM CHLORIDE 3% [1000ML] $66.69SODIUM BICARB 8.4% [50MEQ $66.82PHENCLOR TANNATE PED SUSP $67.00AR-6410: ARTHRO PUMP TUBING $67.00SO LIDOCAINE LEVEL 80176 $67.00

45

SO ANGIOTEN CONVERT ENZYM 82164 $67.00SO APOLIPOPROTEIN-B 82172 $67.00Apolipoprotein A1 82172 $67.00SO CALCIUM IONIZ W/PTH 82330 $67.00SO CALCIUM -IONIZED 82330 $67.00SO CHLORIDE - FECES 82438 $67.00SO LEAD URINE 83655 $67.00SO IBD CRP 86140 $67.00SO VDRL-CSF 86592 $67.00SO EPS BARR VCA -IGG 86665 $67.00SO EPS BARR VCA - IGM 86665 $67.00SARS-CoV-2 Serology Ab (IgG) Immunoassay 86769 $67.00BACT. ID HNID 87077 $67.00PRESERVISION AREDS CAP [1 $67.07SULAR CR TAB [20MG] $67.73GAIT TRAINING I - 15 MIN 97116 $67.98NM ISOTOPE TC99m-MAA A9540 $67.98TIMENTIN ADDV [3.1GM] $68.00DEXT 5% IN WATER PF [100/150ML] $68.001607-2-35: 4.0MM EGG BURR SAW BLADE $68.00PYRUVIC ACID (PYRUVATE) 84210 $68.00PREVACID SOLUTAB [30MG] $68.27ATROPINE SYR [0.05MG/ML 5 $68.39ACTIDOSE-AQUA BTL [120ML $68.62ACTIDOSE/SORBITOL BTL [ $68.62BETADINE 5% OPHTH PREP ST $68.64CIPROFLOXACN OPHTH SOLN 0 $68.98FLUCONACOLE 400mg IVPB J1450 $68.98ED-ERYTHROMYCIN-SULFISOX $69.00SODIUM CHLORIDE INJ 0.9% [50/100] $69.00FIT TESTING FOR COMPANYS $69.00SO AMITRYPTYLINE 80335 $69.00SO PROTHROMBIN IGG 83520 $69.00SO PROTHROMBIN IGM 83520 $69.00SO MYOGLOBIN URINE 83874 $69.00SO VITAMIN E A-TOCOPHEROL 84446 $69.00SO VITAMIN A RETINOL 84590 $69.00SO ANTITHROMB III -ACTVITY 85300 $69.00SO CA 19-9 ANTIGEN 86301 $69.00DECALCIFY TISSUE PATH COM 88311 $69.00SODIUM BICARB 8.4% [10MEQ $69.20EXELON PATCH [ 4.6MG/24HR $69.33

46

LIDOCAINE OINT [5% 1 DOSE $69.45BETIMOL 0.5% OPHTH SOLN [ $69.70SODIUM CHLORIDE 0.9%/20ME $70.00Rheumatoid Factor Qualitative 86430 $70.00XM Archive Tissue Molecular Analysis 88363 $70.00ESMOLOL INJ [10MG/ML 10ML $70.62Insulin Drip Hum R 100 units $70.84ONGLYZA TAB [5MG] $70.87SODIUM CHLORIDE INJ 0.9% [100/150] $71.00Alpha-1-Antitrypsin Phenotype 82104 $71.00SO ESTRIOL LEVEL 82677 $71.00SO FECAL FAT - QUAL 82705 $71.00SO MYLEOPEROXIDASE AB 83876 $71.00SO ZINC SERUM 84630 $71.00SO C-PEPTIDE 84681 $71.00RETICULIN IGG 86255 $71.00SO ANTI-SMOOTH MUSCLE AB 86255 $71.00SO ENDOMYCIAL TITER 86256 $71.00RETICULIN TITER IGG 86256 $71.00RHEUMATOID FACTOR TITER 86431 $71.00SO CHLAM PSITT IGM 86632 $71.00SO HEPATITIS - delta ABDY 86692 $71.00BACT ID - UA - FIRST 87088 $71.00BACT ID- UA ADDL 87088 $71.00SO HBSAG CONFIRMATION 87341 $71.00SO ROTAVIRUS 87425 $71.00SO LEGIONELLA AG URINE 87449 $71.00SO CRYPTOCOCCUS AG - CSF 87449 $71.00ICUT ALLERGY TES DRUG/ 95024 $71.00FELBATOL TAB [600MG] $71.09POLYMYXIN B INJ [500000U $71.38NYSTATIN CREAM [100000 U $71.50EPINEPHRINE AMP [1:1000 1 J0171 $71.50PREVIDENT 5000 BOOSTER + $71.75SOLU-CORTEF INJ [ 100MG A J1720 $71.97WOUND VAC $72.00FUNCT SELF CARE TRT-15MIN 97535 $72.10HYDROCOD/APAP ELIX [7.5/3 $72.33POTASSIUM PHOSPHATE INJ [ $72.48MYSOLINE TAB [50MG] $72.65HYPERAL TUBING $73.00DEXT 50% [500ML/1000ML P $73.00

47

AR-8500BC: BONE CUTTER 5.0MMX13CM $73.00AR-8500COT: BUR OVAL CLEARCUT 5.0MMX13C $73.00SO ARSENIC URINE 82175 $73.00SO CITRATE-URINE 82507 $73.00SO GLIADIN AB IGA 83516 $73.00SO GLIADIN AB IGG 83516 $73.00IRON BINDING CAPACITY 83550 $73.00MAGNESIUM LEVEL 83735 $73.00SO MERCURY URINE 83825 $73.00SO ALPHA 2 MACROGLOBULIN 83883 $73.00VMACID 24HR WITH CR #1 84585 $73.00SO ASPERGILLUS AB - CF 86606 $73.00SO ASPERGILLUS AB - ID 86606 $73.00SO GIARDIA ANTIGEN 87328 $73.00CAMPY DIRECT BY EIA 87899 $73.00AMPICILLIN INJ (2GM] J0290 $73.00AQUA GLYCOLIC HAND-BODY L $73.09ERYTHROMYCIN OPHTH OINT [ $73.16ED-ERYTHROMYCIN OPTH $73.16ACETAMINOPHEN/COD [120/12 $73.29HETASTARCH INJ [6%/NACL 5 $73.34CEFTRIAXONE IN DEXTROSE D J0696 $73.43ER PHYS INSERT FOLEY CATH SIM 51702 $74.00SO DRUG SCREEN/NIDA 80306 $74.00B-HCG- URINE- QUALITATIVE 81025 $74.00SO LEAD BLOOD INDUSTRIAL 83655 $74.00SO ZINC PROTOPORPHYRIN QN 84202 $74.00B-HCG -SERUM QUALITATIVE 84703 $74.00SO CHROMATIN(NUCLEOSOM)AB 86235 $74.00SO CA 15-3 86300 $74.00MONOSCREEN 86308 $74.00SO MICROSOMAL AB(TPO) 86376 $74.00SO TPO/MICROSOMAL AB 86376 $74.00COCCIDIOIDES SEROLOGY PANEL 86635 $74.00SO ARC PHENOTYP RBC AG EA 86905 $74.00SO TISSUE CULT-AMNIOTIC 88235 $74.00BUPRENEX AMP [0.3MG/ML] $74.03VITAMIN B-6 INJ [100MG/ML $74.16ULTRASOUND -15 MIN $74.16IMIPENEM/CILASTATIN SODIU $74.45IMIPENEM/CILASTATIN *IVPB* (500mg/100ml $74.45EFFIENT TAB [10MG] $74.60

48

VALPROIC ACID SYRUP [250/ $74.72calcium gluconate*IVPB* (4.65 mEq 10%/1 J0610 $74.94IV FILTER SET $75.00DIFFICULT DRAW MIDLINES 36410 $75.00SO LAMOTRIGINE-LAMICTAL 80299 $75.00SO FLECAINIDE LEVEL 80299 $75.00LDH - Pleural fluid 83615 $75.00SO MERCURY BLOOD 83825 $75.00SO PTT 85730 $75.00SO MITOCHONDRIAL AB TITER 86256 $75.00SO MUMPS AB - IGG 86735 $75.00SO MUMPS AB - IGM 86735 $75.00SO WEST NILE CSF IGG 86789 $75.00SO AFB SMEAR 87206 $75.00TRADJENTA TAB [5MG] $75.08NALOXONE INJ [0.4MG/ML] J2310 $75.85CENTESIS 5FR CATHETER (OSC-5F-10T) $76.00LITHIUM LEVEL 80178 $76.00SO A-1-ANTITRYP W/PHENOTP 82104 $76.00SO CALCITONIN LEVEL 82308 $76.00SO GLUCAGON LEVEL 82943 $76.00Hemoglobin- Free - Plasma 83051 $76.00SO 5'NUCLEOTIDASE 83915 $76.00SO pH - FECES 83986 $76.00SO PH- OTHER FLUID 83986 $76.00SO IGF-1 INSULIN-LIKE GRO 84305 $76.00SO ENA - RNP-IgG ANTIBODY 86235 $76.00SO ENA- SMITH ANTIBODY 86235 $76.00SO LYME WEST BLOT IGG 86617 $76.00SO LYME WEST BLOT IGM 86617 $76.00SO HIV-1 WEST.BLOT 86689 $76.00SO ARC DAT 86880 $76.00MOD SED SAME PHY/QHP <5 YRS 99151 $76.00MOD SED OTH PHY/QHP >5- 15 MIN 99155 $76.00MOD SED OTH PHY/QHP 5 / > 15 MIN 99156 $76.00MOD SED OTH PHY/QHP ADDL 15 MIN 99157 $76.00AMPICILLIN ADDV [1GM] J0290 $76.00XARELTO TAB [10MG] $76.17XARELTO TAB [20MG] $76.17XARELTO ORAL TAB [15MG] $76.17NIMBEX INJ [2MG/ML 5ML VI $76.23SITAGLIPTIN PHOSPHATE TAB [100MG] $76.67

49

SITAGLIPTIN PHOSPHATE TAB [ 50MG] $76.67PIPERACILLIN/TAZOBACTAM *IVPB* (2.25gm/ $76.81DRESSING CHANGE SUPPLY $77.00FUNGIZONE INJ [50MG VIAL] $77.00AR-1606: STAR SLEEVE $77.00DECALCIFY TISSUE TECH COM 88311 $77.00TOMO DIGITAL BREAST SCREEN BILAT 77063 $77.25TOMO DIGITAL BREAST SCREENING IMPLANTS B 77063 $77.25NM ISOTOPE TC99M-DTPA A9567 $77.25Muro 128 Ophth Oint 5% $77.55ADENOCARD INJ [6MG/2ML] J0153 $77.62DILAUDID PCA [0.2MG/ML OR $77.93SO LEVETIRACETAM-KEPPRA 80177 $78.00DRUG SCREEN NON TLC/DEVICE 80305 $78.00SO INDICAN- URINE 81005 $78.00SO ALUMINUM LEVEL 82108 $78.00SO LIPOPROTEIN A 82172 $78.00SO FRUCTOSAMINE 82985 $78.00LEAD SCREEN 83655 $78.00SO LIGHT CHAIN LAMBD - SER 83883 $78.00SO LIGHT CHAIN KAPPA - SER. 83883 $78.00SO C-REACT PROT - ULTRA SEN 86141 $78.00COLD AGGLUTININ- SCREEN 86157 $78.00SO RF W/CRYO PNL 86431 $78.00SO B.PERTUSS - IGG - PT 86615 $78.00SO B.PERTUSS - IGA - PT 86615 $78.00SO WEST NILE CSF IGM 86788 $78.00COMPATIBLE UNIT SCRN MMH 86904 $78.00MICROSPORIA SPORE CONCENT 87015 $78.00CULTURE - GROUP B STREP 87081 $78.00G/C SCREEN 87081 $78.00Fungal Stain, Calcofluor, Misc. 87206 $78.00MRSA-SA SCRN PCR 87641 $78.00SEMEN PRESENCE TESTING 89321 $78.00PFT SPIROMETRY PRE 94010 $78.00PULM SCREEN/ OCC HEALTH 94375 $78.00M/S OVS HIGH ACUITY ADDL HOURS G0378 $78.00HALDOL INJ [5MG/ML 1ML AM J1630 $78.00NEUROMUSCLR RE-ED -15 MIN 97112 $78.28GRANULEX SPRAY [113GM] $78.37LATANOPROST OPHTH SOLN [2 $78.48POLYETHYLENE GLYCOL [3350 $78.85

50

SODIUM CHLORIDE SOL 0.9% IRR 2000 $79.00SO CLOZAPINE 80159 $79.00SO AMYLASE ISO PANCREATIC 82150 $79.00CBC W/AUTO COMPLETE DIFF 85025 $79.00CBC HEMOGRAM 85027 $79.00SO VISCOSITY - SERUM 85810 $79.00SHIGA-LIKE TOXIN 2 - EIA 87427 $79.00SHIGA-LIKE TOXIN 1 - EIA 87427 $79.00DT LESS THAN 7 YRS IM 90702 $79.00MORPHINE SULFATE CONC. SO $79.06CAPSAICIN-HP CREME [42.5G $79.20INTRALIPID INJ 20% [250ML $79.66NEO/POLY/DEX OPHTH SUSP [ $80.00ARTERIAL PUNCTURE LAB 36600 $80.00SO INSULIN LEVEL 83525 $80.00SO INSULIN ISI FASTING 83525 $80.00SO INSULIN LEVEL 30MIN 83525 $80.00SO INSULIN LEVEL 60MIN 83525 $80.00SO INSULIN LEVEL 90MIN 83525 $80.00SO INSULIN LEVEL 120MIN 83525 $80.00SO OLIGLOCLONAL AB 83916 $80.00SO OXALATE - URINE 83945 $80.00SO GLYCOMARK 84378 $80.00SO TRYPSIN - FECAL - RANDOM 84488 $80.00SO FETAL RBC SCREEN 85460 $80.00Urine - Eosinophil count 85999 $80.00SO CARDIOLIPIN SCN/RX 86147 $80.00SO RNP ANTIBODIES 86235 $80.00SO SMITH ANTIBODIES 86235 $80.00SO ENA- SCL-70 ANTIBODY 86235 $80.00SO RNP-IgG ANTIBODY 86235 $80.00SO CHLAMYDIA AB IGG 86631 $80.00SO HISTOPLASMA AB 86698 $80.00SO ROCKY MTN SPOT IGM 86757 $80.00SO ROCKY MTN SPOT IGG 86757 $80.00ANAEROBE ID - FIRST ORG. 87076 $80.00ANAEROBE ID- ADD'L ORG. 87076 $80.00SO HERPES CULT W/TYPE 87255 $80.00SO CRYPTOSPORIDIUM AG 87328 $80.00CEFTAZIDIME ADDV [2GM] J0713 $80.02BREAST CORE BIOPSY TRAY $80.34LEVALBUTEROL SVN [1.25MG/ $80.50

51

INFLUENZA INJ AGES 36 MONTHS AND OLDER I $80.62ARTERIAL PUNCTURE - ABG 36600 $81.00GLYCATED HEMOGLOBIN 83036 $81.00SPEC STAIN GP-2 PATH COMP 88313 $81.00SPACER FOR INHALER $81.22CEFAZOLIN DDS [1GM IN DEX J0690 $81.53FENTANYL PATCH [ 12MCG/HR $81.59tobramycin IVPB/50 mL (less than 400mg) J3260 $81.72SO NORPACE LEVEL 80299 $82.00SO ACTH 82024 $82.00PTT/APTT 85730 $82.00SO ENA- Jo1 ANTIBODY 86235 $82.00SO IMMUNOELECTRO URINE 86335 $82.00SO IFE - URINE 86335 $82.00SO COCCIDIOIDES AB 86635 $82.00SO E.HISTOLYTICA AB 86753 $82.00Streptococcus pneumoniae Ag, Urine 87899 $82.00DIETARY SVCS DIABETIC G0108 $82.00PROMETHAZINE SUP [50MG] $82.26SODIUM CHLORIDE 0.9% [250ML] $83.005DCS: SCISSOR ENDOPATH CURVED 5MM $83.00COLLECT BLD FROM IMPLANTED PORT 36591 $83.00SO CYCLOSPORINE LEVEL 80158 $83.00SO NEURONTIN(GABAPEN) 80299 $83.00Alcohol, Isopropyl 80320 $83.00ETHANOL LEVEL BLOOD 80320 $83.00Alcohol Methyl Blood 80320 $83.00VITAMIN D 25 HYDROXY 82306 $83.00SO IGG SUBCLASS -1-2-3 OR 4 82787 $83.00SO ALK PHOS BONE SPECIFIC 84075 $83.00SO FREE T3 84481 $83.00SO ANCA SCRN RX TITER 86021 $83.00SO CD4 T-CELL COUNT 86361 $83.00SO N.GONORRHOEAE AB IGG 86609 $83.00SO B.PERTUSS - IGM 86615 $83.00SO B.PERTUSS - IGG 86615 $83.00SO B.PERTUSS - IGA 86615 $83.00SO C.DIFF CULTURE W/RX TX 87081 $83.00VALPROATE INJ [500MG/5ML $83.18MOUTHWASH/RINSE- MAGIC WA $83.62TAZICEF INJ ADDV [2GM] J0713 $83.97SO SEX HORMONE BIND GLOB 84270 $84.00

52

SO PLT W/CD4/CD8 85049 $84.00SO IGA PLATELET CIRCULATE 86022 $84.00SO IGG PLATELET CIRCULATE 86022 $84.00SO IGM PLATELET CIRCULATE 86022 $84.00SO ENA SCREEN 86235 $84.00RUBELLA ANTIBODY IGG 86762 $84.00SO TETANUS ANTIBODY 86774 $84.00BACTERIA SENSITIVITY POSITIVE ORGANISM 87186 $84.00BACTERIA SENSITIVITY- GRAM NEGATIVE 87186 $84.00BACTERIA SENSITIVITY- MICRO STREP 87186 $84.00BACTERIA SENS -ADD'L ORG. 87186 $84.00MICROSPORDIA SPORE SMEAR 87207 $84.00E.Coli 0157 Shigatoxin 87335 $84.00MEROPENEM [1000MG INJ] $84.34SILDENAFIL TAB 20MG $84.35NITROGLYCERIN IN D5W [100 $84.38SUPRAX TAB [400MG] $84.74DEXT 5% IN WATER [250ML] $85.00BASIC METABOLIC PANEL 80048 $85.00SO ARSENIC BLOOD 82175 $85.00SO VITAMIN C-ASCORBIC AC 82180 $85.00SO BILE ACIDS TOTAL 82239 $85.00SO PORPHOBILINOGEN QUANT 84110 $85.00SO FUNGUS CULTURE - SKIN 87101 $85.00SO FUNGUS CULTURE- OTHER 87102 $85.00SO FUNGUS CULTURE - MISC 87102 $85.00SO FUNGUS CULTURE- BLOOD 87103 $85.00SPERM PRESENCE 89300 $85.00SPERM COUNT- POST VAS. 89310 $85.00SULFAMETH/TRIMETH PED SUS $85.01TMP-SMX SUSP [60ML] $85.01NAFCILLIN SOD INJ [1GM VI $85.06INFLUENZA INJ AGES 18 TO 64 INTRADERMAL 90662 $85.59AR-1008: ACL LIGAMENT STAPLE $86.00AMITRIPTYLIN 80330 $86.00ANTIDREPRESSIANT TRICYCLIC 80335 $86.00SO NORTRIPTYLINE LEVEL 80345 $86.00SO HYDROCODONE LEVEL 80361 $86.00SO B-HYDROXYBUTYRIC ACID 82010 $86.00SO AMINOLEV.ACID-DELTA-UA 82135 $86.00SO VITAMIN D 1 25 DIHYDRO 82652 $86.00SO LIPASE -URINE RANDOM 83690 $86.00

53

SO MYELIN BASIC PROTEIN 83873 $86.00SO RENIN PLASMA 84244 $86.00SO THYROGLOBULIN 84432 $86.00SO LEUKOCYTE ALK PHOS 85540 $86.00SO LEGIONELLA AB TITER 86713 $86.00SO TOXOPLASMA- IgM 86778 $86.00SO VIRAL CULTURE 87252 $86.00ENTAMOEBA Ag 87336 $86.00BELLADONNA & PHENOBARBITA $86.15NOREPINEPHRINE [4mg/250ml D5W] $86.33VERAPAMIL INJ [2.5MG/ML 2 $86.39EXERCISE I- 15 MIN 97110 $86.52GENTAMICIN OPHTH SOLN [0. $86.62ED-GENTAMICIN SULFATE OPH $86.62TRILYTE SOLN [4L SOD CHLO $86.90ELECTROLYTES 4 80051 $87.00SO PHENOBARB W/PRIM-MYSOL 80184 $87.00SO HGB EVAL CHROMATOGRAPH 83021 $87.00SO HOMOCYSTINE - CARDIO 83090 $87.00INSULIN FREE 83527 $87.00Magnesium RBC 83735 $87.00BLEEDING TIME - TEMPLATE 85002 $87.00SO RUBEOLA ABDY - IGG 86765 $87.00MORPHINE SULF PCA [1MG/ML $87.07CEFAZOLIN DDS [2GM IN DEX J0690 $87.66DEPO-MEDROL INJ [80MG/ML $87.74NEOSTIGMINE [1:1000 DOSE $87.81PHYS SUBSQ HOSPITAL CARE DAY 99231 $88.00ZOSYN INJ [3.375GM] J2543 $88.00MEPERIDINE PCA [10MG/ML] J2175 $88.02PROCHLORPERAZINE INJ [5MG J0780 $88.42AMYLASE BLOOD 82150 $89.00AMYLASE URINE 82150 $89.00AMYLASE -BODY FLUID 82150 $89.00SO GLUCOSE-6-PHOS DEHYD 82955 $89.00SO PROT ELEC W/PNL 1 84165 $89.00SO ELECTROPHOR URINE 84166 $89.00SO UR PROT ELEC RDM 84166 $89.00Zinc RBC 84630 $89.00SO FACTOR VII 85230 $89.00SO IMMUNOELECTRO SERUM 86334 $89.00SO IFE-SERUM-ARUP 86334 $89.00

54

BRUCELLA AB (IGG) 86622 $89.00BRUCELLA AB (IGM) 86622 $89.00SO TRICHINELLA IBB 86784 $89.00MRSA Screen 87081 $89.00ORPHENADRINE CIRTRATE INJ J2360 $89.50SSKI sol. 1gm/1ml 30ml BT $89.75WATER STERILE IRR 1000 $90.00SODIUM CHLORIDE SOL 0.9% IRR 1000 $90.00SO IBD DNA ATG16L1 81479 $90.00SO IBD DNA ECM1 81479 $90.00SO IBD NKX2-3 81479 $90.00SO IBD DNA STAT3 81479 $90.00SO RBC FOLATE 82747 $90.00SO IGG W/SUBCLASSES 82784 $90.00SO HISTONE AB 83516 $90.00FIBRINOGEN- ACTIVITY 85384 $90.00LYSOZYME LEVEL 85549 $90.00THROMIN TIME - PLASMA 85670 $90.00ALLERGY PANEL 14 - PEDS 86003 $90.00SO DIPTHERIA ANTIBODY 86648 $90.00SO B.PERTUSSIS CULTURE 87081 $90.00CULTURE- UA -W/COL CT 87086 $90.00STREP SCRN-GROUP B -VAGINA 87802 $90.00TIMENTIN INJ [3.1GM] $90.10TOBRAMYCIN OPHTH SOL [0.3 $90.10MANNITOL [20% SOLN 500ML] $90.80NYSTATIN ORAL SUSP BOTTLE 120ML 100000 $90.95HYSTERO TRAY $91.00FLUTTER DEVICE RESP $91.00sildenafil 20 mg tablets $91.00ER PHYS NG TUBE PLMT 43752 $91.00LIPID PANEL 80061 $91.00HYDROXYCHLOROQUINE 80299 $91.00SO MITOCHONDRIAL M2 AB 83516 $91.00SO LIPOPROTEIN (a) 83695 $91.00PSA- TOTAL DIAGNOSTIC 84153 $91.00PSA W/REFLEX FREE PSA 84153 $91.00PSA SCREEN ANNUAL 84153 $91.00PSA - TOTAL W/FREE 84153 $91.00SO ANTIMITROCHONDRIAL AB 86255 $91.00SO STRONGYLOIDES IGG 86682 $91.00Treponema Pallidum Antibody 86780 $91.00

55

TRANSDERM-SCOP PATCH [1.5 $91.21GUIDE WIRE C1769 $91.25UROXATRAL TAB [10MG] $91.27GOLYTELY SOLN [4L] $91.30CALCIUM CL INJ [10% 10ML $91.98BACITRACIN ZINC OINTMENT $92.00THERAPY EXCERCISE- 15 MIN 97110 $92.70NEUROMUSCLR RE-ED -15 MIN 97112 $92.70AMPICILLIN *IVPB* [2000MG /100ML NS] $92.81CEFUROXIME DDS [1.5GM/DEX J0697 $92.98PHYS SBSQ OBSV CARE/DAY 15 MIN 99224 $93.00ACTIDOSE-AQUA BTL [240ML $93.64ACTIDOSE/SORBITOL BTL [2 $93.64POTASSIUM PHOSPHATES *IVDRIP* [20MMOLES/ $93.85METHYLERGONOVINE MALEATE $93.86POLYTRIM O/SOLN 10 $94.00CEPHALEXIN SUSP [125MG/5M $94.00C.diff toxins A/B -Stool 87324 $94.00THERA STRG ENDUR G0237 $94.00FECAL OCCULT BLOOT TEST G0328 $94.00POTASSIUM PHOSPHATES *IVDRIP* [20MMOLES/ $94.23ondansetron sol (4mg/5ml) $94.73SUCCINYLCHOLINE INJ [20ML $94.81TRANEXAMIC ACID INJ [1000 $94.90LEVOPHED BIT INJ [1MG/ML $95.89Infuvite Adult Vitamins Injection $95.89ERYTHRO/SULFISOX SUSP [20 $96.00SO CHOLINESTERASE- RBC 82482 $96.00SO COPPER-24HR URINE 82525 $96.00SO CK ISOEMZYMES 82552 $96.00SO KETOSTEROIDS-17 24 HR 83586 $96.00SO METANEPHRINE RDM W/CRE 83835 $96.00SO METANEPHRINES URINE 83835 $96.00SO KAPPA LIGHT CHAINS UA 83883 $96.00SO LAMBDA LIGHT CHAINS UA 83883 $96.00Kappa/Lambda LT chains ratio 24UR 83883 $96.00SO OSTEOCALCIN 83937 $96.00SO FACTOR 13 - QUAL 85291 $96.00SO HEXAG PHASE CONFIRM 85598 $96.00SO COMPLEMENT C4 86160 $96.00SO Q FEVER IGG P1 TITER 86638 $96.00SO Q FEVER IGG P2 TITER 86638 $96.00

56

SO W NILE VIRUS IGM 86788 $96.00SO W NILE VIRUS IGG 86789 $96.00ANTIBODY SCREEN 86850 $96.00CEFTRIAXONE ADDV [1GM] J0696 $96.00IV NITROGLICERIN TUBING $97.00FECAL LEUKO-FERRIN 83630 $97.00LIPASE LEVEL 83690 $97.00THYROXINE- FREE(Free T4) 84439 $97.00CBC HEMOGRAM w/MAN DIFF 85025 $97.00CBC W/RX MAN DIFF 85025 $97.00CELL COUNT- BODY FLUID 89051 $97.00RE-EVALUATION $97.85PT RE-EVAL EXT PLAN CARE 97164 $97.85PROMETHAZINE VC/COD SYR $97.88Cadmium Blood 82300 $98.00SO EPS BARR EBNA 86664 $98.00SURGICAL PATH GROSS 88300 $98.00NAROPIN 0.5% [5MG/ML INJ J2795 $98.61PIPERACILLIN/TAZOBACTAM (3.375gm/100ml N $98.97PIPERACILLIN/TAZOBACTAM A J2543 $98.97Allergy Panel 13, Stinging Insect Group 86003 $99.00SO HEP PANEL ACUTE 80074 $100.00TRILEPTAL OXCARBAZEPIN 80299 $100.00SO ESTROGEN - TOTAL 82672 $100.00SO IBD 4A-FLAX2 83520 $100.00SO IBD FLAX 83520 $100.00SO IBD VEGF 83520 $100.00SO CROHN ANTI-12 ELISA 83520 $100.00INSULIN RESPONSE TO GLUCOSE 83525 $100.00SO FIBRIN MONOMER 85362 $100.00SO DRVVT CONFIRM RX 85597 $100.00SO DRVVT RX MIX 85613 $100.00SO DIL RUSS VIP VENOM SCN 85613 $100.00SO HPV PAPILLOMA 87623 $100.00FLOW CYTO ADD-ON TECH FEE 88185 $100.00PLAVIX TAB [300MG] $100.02PROMETHAZINE /COD SYR [ $100.20DIPRIVAN INJ [10MG/ML 10 J2704 $100.86MD-GASTROVIEW SOLN [120ML $101.00SO HYDROXYPROGESTERONE 17 83498 $101.00Gastric Parietal Cell Ab, ELISA 83516 $101.00VANCOMYCIN ORAL [1000MG/8 J3370 $101.79

57

VANCOMYCIN [RANGE 0.5-1.25 gm/NS 250 mL] $101.80VANCOMYCIN [RANGE ABOVE 1.25-2 mg/NS 500 $101.80DOXEPIN 80335 $102.00IMIPRAMINE 80335 $102.00SO BENZODIAZEPINES SERUM 80346 $102.00SO IBD ICAM 82397 $102.00SO IBD VCAM 82397 $102.00SO IBD SAA 82397 $102.00SO F-ACTIN (SM) AB 83516 $102.00SO VITAMIN B-6 PYRIDOXINE 84207 $102.00SO COMPLEMENT C3 86160 $102.00SO TOXOCARA AB IGG 86682 $102.00GENTAMICIN *IVPB/50ml* [LESS THAN 400MG/ $102.27KATZ EXTRACTOR $103.00NEPTUNE 2-4 PORT MANIFOLD $103.00NEPTUNE 2-4 PORT MANIFOLD $103.00NYSTATIN CREAM [100000 U $103.00AZITHROMYCIN *IVPB* [500 mg/NS 250 mL] $103.78SILVER SULFADIAZINE CREAM $103.79ED-SILVER SULFADIAZINE CR $103.79itralipid 20% 500 mL $103.88SO FLOW CYTO CONSULT LTD 80500 $104.00SO SEROTONIN -WHOLE BLOOD 84260 $104.00SO POTASSIUM - FECES 84311 $104.00SO VIP/VASO.INTESTIN.PEP. 84586 $104.00CYCLOSPORA ISOSPORA CONCE 87015 $104.00CYCLOSPORA ISOSPORA SMEAR 87207 $104.00SO CRYSTALS IN FLUID 89060 $104.00ANTIBIOTIC ADDTN'L HR 96366 $104.00ADDN'L HR ANTIBIOTICS TX 96366 $104.002ND ANTIBIOTIC INF-ER 96367 $104.002ND ANTIBIOTIC INF- OP 96367 $104.00CONCURRENT 2ND IV SITE 96368 $104.00CONCURRENT 2ND IV SITE 96368 $104.00SEQ IV PUSH- NEW DRUG 96375 $104.00SEQ IV PUSH - NEW DRUG 96375 $104.00IV PUSH SEQ DRUG- TX 96376 $104.00FENTANYL PCA [10MCG/ML] J3010 $104.54HYDROXYZINE INJ [50MG/1ML J3410 $104.62APPLY STATIC SHORTARM SPL 29125 $105.06LACTULOSE SYRUP [10GM/15M $105.66SO PRIMIDONE/MYSOLINE 80188 $106.00

58

Methamphetamine & Metabolite - quant- ur 80324 $106.00SO CATECHOLAMINES PLASMA 82383 $106.00SO NTx URINE (OSTEOMARK) 82523 $106.00SO DHEA UNCONJUGATED 82626 $106.00SO 5HIAA/SEROTONIN -URINE 83497 $106.00SO PROTEIN C FUNCTIONAL 85303 $106.00SO INFLUENZAE A AB 86710 $106.00SO INFLUENZAE B AB 86710 $106.00SO LEPTOSPIRA AB 86720 $106.00SO TOXOPLASMA IGG 86777 $106.00SO HUMAN HERPES 6 IGG 86790 $106.00SO HUMAN HERPES 6 IGM 86790 $106.00COOMBS- INDIRECT 86886 $106.00SO H.PYLORI ANTIGEN 87338 $106.00Influenza A-Film array Resp panel 87633 $106.00Influenza B-Film array Resp panel 87633 $106.00STREP SCRN-GROUP A-THROAT 87651 $106.00OBSERV/ICU HOURLY G0378 $106.00AZITHROMYCIN SUSP [100MG/ $106.16AZITHROMYCIN SUSP [200MG/ $106.16PROCALAMINE IV [3% 1000ML $106.33AVELOX TAB [400MG] $106.51ED-TMP-SMX SUSP [200-40/5 $106.86VENIPUNCTURE 3 & YOUNGER, REQUIRES SKILL 36400 $107.00SO CARBOXYHEMOGLOBIN LVL 82375 $107.00SO IBD CBIR1 83520 $107.00SO IBD ASCA IGG 83520 $107.00SO IBD OMPC IGA 83520 $107.00SO IBD NEUTROPHIL AUTOAB 83520 $107.00SO LACTATE - LACTIC ACID 83605 $107.00Reticulin screen IgA 86255 $107.00Reticulin titer IgA 86256 $107.00Thyroid Peroxidase Antibodies 86376 $107.00TISSUE EXAM PATHOLOGIST 2 88302 $107.00SO SPECIAL STAIN GRP II 88313 $107.00FLUCONAZOLE SUSP [40MG/ML $107.06FLUCONAZOLE SUSP [10MG/ML $107.06US Definity Contrast Q9957 $107.12EXELON PATCH [9.5MG/24HR $107.28CREATININE CLEARANCE 82575 $108.00Heparin Anti-Xa assay 85520 $108.00HEP B SURFACE AB QUAVL 86706 $108.00

59

OLANZAPINE 15MG TAB $108.48TSH -THYROID STIM.HORMONE 84443 $109.00TSH REFLEXIVE FT4 84443 $109.00SO LIVER-KIDNE MICRO-1 86376 $109.00SO CMV IGG 86644 $109.00SO GIARDIA AB - SERUM 86674 $109.00MEGESTROL AC SUSP [40MG/ $109.26SO FECAL FAT- QUANT. 82710 $110.00PSA FREE 84154 $110.00SO ELECTROPHORESIS SERUM 84165 $110.00SO SPEP ARUP 84165 $110.00SO Q FEVER IGM P2 TITER 86638 $110.00SO Q FEVER IGM P1 TITER 86638 $110.00VANCOMYCIN [RANGE ABOVE 2-3 gm/NS 500 mL $110.13AR-8150PP-45: POWERPICK 45 DEG $111.006191-1-010: SIMPLEX CEMENT $111.00COMP MET PANEL 80053 $111.00VITAMIN B-12 82607 $111.00HISTOCHEMSTAIN ADD ON 88314 $111.00ENZYME HISTOCHEM 88319 $111.00SO CROHN DNA C2104T R702W 88346 $111.00SO CROHN DNA G2722C G908R 88346 $111.00SO CROHN DNA 3020insC 88346 $111.00IM INJ OF SUBSTANCE/DRUG 96372 $111.00SUB OVS CARE- L 2 99225 $111.00AR-8400TD: TORPEDO 4.0MM X 13CM C1713 $111.00OTH RESP PROC INDIV G0238 $111.00ENOXAPARIN SODIUM SYR [12 J1650 $111.53BACITRACIN-POLYMYX.B OPTH $111.64HEPATIC PANEL 80076 $112.00PH BLOOD 82800 $112.00SO NEURONAL AB YO 83516 $112.00SO ANNA IMMUNO HU 83516 $112.00SO ANNA IMMUNO RI 83516 $112.00SO NEURONAL AB HU 83516 $112.00SO NEURONAL AB RI 83516 $112.00SO IBD ASCA IGA 83520 $112.00PTT SUBSTITUTE PLASMA 85732 $112.00SO PLATELET AB INDIRECT 86022 $112.00SO IGM PLATELET ASSOCIATE 86023 $112.00SO IGG PLATELET ASSOCIATE 86023 $112.00SO IGA PLATELET ASSOCIATE 86023 $112.00

60

SO ARC PRETREAT RBC 86970 $112.00RABBIES VACCINATION IM 90675 $112.00SQ/ IM MEDS TX 96372 $112.00SQ/IM MEDS 96372 $112.00PHENOBARBITAL INJ [65MG/1 J2515 $112.11SO ALPHA-1-ANTITRYPS -TOT. 82103 $113.00SO HYDROXYPROLINE 24HR 83505 $113.00SO C1q COMPLEMENT COMPONT 86160 $113.00PULMONARY STRESS TEST 94618 $113.00SO TYPSIN-LIKE ACT -SERUM 83519 $114.00SO PARAINFLU 3 BY PCR 87798 $114.00SO PARAINFLU 2 BY PCR 87798 $114.00SO PARAINFLU 1 BY PCR 87798 $114.00EDECRIN TAB [25MG] $114.10PROVIGIL TAB [100MG] $114.12DIAZEPAM INJ [5MG/ML 2ML] J3360 $114.84UNA BOOT $115.00AR-7237: FIBERTAPE $115.00QUINIDINE LEVEL 80194 $115.00SO CODEINE LEVEL 80361 $115.00SO TESTOSTERONE TOT W/PNL 84403 $115.00TESTOSTERONE LEVEL 84403 $115.00CBG (TRANSCORTIN) 84449 $115.00SO ANTI-ss DNA IGG 86226 $115.00SO BACT.AG QUANT BY RIA 86403 $115.00SO CHLAMYDIA CULTURE 87110 $115.00SO FLOW CYTO-EA ADDL MARK 88185 $115.00TEMNO BIOPSY NEEDLE 18G X 6 CM $115.14ELEC STIMULATION -15 MIN $115.36IONTOPHORESIS -15 MIN $115.36AMOXICILLIN/CLAVUL SUSP [ $115.96O2 INP/OVS/SWG < 12 HRS $116.00PEAK FLOW METER/RESP $116.00SALICYLATE LEVEL 80329 $116.00SO HAPTOGLOBIN 83010 $116.00SO ANTI-GLOM BASE MEMB 83520 $116.00SO FACTOR 11 85270 $116.00C1 Esterase Inhibitor Protein 86160 $116.00SO RSV ANTIBODY 86756 $116.00CULTURE- STOOL-SAL/SHIG 87045 $116.00CULTURE- ANY OTHER SOURCE 87070 $116.00CULTURE- THROAT 87070 $116.00

61

CULTURE - NASAL 87070 $116.00CULTURE -SURGERY-FIRST 87070 $116.00CULTURE-SURGERY -ADDL 87070 $116.00CULTURE-ASPIRATE -FIRST 87070 $116.00CULTURE -ASPIRATE -ADDL 87070 $116.00CULTURE - SPUTUM 87070 $116.00CULTURE -ANY SAME -ADD'L 87070 $116.00CULTURE - VAGINAL 87070 $116.00AMPICILLIN ADDV [2GM] J0290 $116.00Infanrix DTaP 90700 $116.54PIPERACILLIN/TAZOBACTAM *IVPB* (4.5gm/10 J2543 $116.69HYDROCOD/APAP ELIX [7.5/3 $116.83SO CHROMIUM SERUM 82495 $117.00SO ERYTHROPOIENTIN LEVEL 82668 $117.00SO ESTRONE LEVEL 82679 $117.00PORPHYSIN FRAC QUAT URINE 84120 $117.00SO SEROTONIN - SERUM 84260 $117.00T4 (THYROXINE) FREE Direct Dialysis 84439 $117.00SO PURKINJO CELL AB TITER 86256 $117.00SO ANNA RX TITER 86256 $117.00SO HANTAVIRUS AB-IGG 86790 $117.00SO HANTAVIRUS AB-IGM 86790 $117.00TETRACAINE OPHTH SOL [0.5 $117.11KETOCONAZOLE SHAMPOO [2% $117.40MASSAGE - 15 MIN 97124 $117.42ED-AMOXICILLIN & K CLAVUL TAB [875MG#6] $117.61SO FELBAMATE 80299 $118.00SO OXYCODONE SERUM LEVEL 80361 $118.00BRAC1 81215 $118.00BRAC2 81217 $118.00SO N-Telopeptide (NTx) 24HR Urine 82523 $118.00GTT/INSULIN+DOSE 82951 $118.00GLUCOSE TOLERANCE - 3 HOUR 82951 $118.00SO HGB ELECTROPHORESIS 83020 $118.00SO T-TRANSGLUTAM IGG P 83516 $118.00SO TISSUE TRANSGL IGG Q 83516 $118.00SO TISSUE TRANSGLU IGA Q 83516 $118.00SO T-TRANSGLUTAM - IGA P 83516 $118.00SO INTERLEUKIN 2 83520 $118.00SO INTERLEUKIN 8 83520 $118.00SO MANGANESE LEVEL 83785 $118.00MICROPROTEIN CSF/BODY FLD 83873 $118.00

62

SO RUSSELL VIPER VENOM TM 85612 $118.00CONFIDENTIAL PATIENT PAY 86703 $118.00SO N.MENINGITIDIS A - AB 86741 $118.00SO N.MENINGITIDIS C- AB 86741 $118.00SO ARC ANTIGEN TYPE/UNIT 86902 $118.00SAT CHECK SINGLE 94760 $118.00HYDRATION ADDN'L HR- ER 96361 $118.00HYDRATION ADDN'L HR- TX 96361 $118.00MOD SED SAME PHY/QHP ADDL 15 MIN 99153 $118.00HIV 1 / HIV 2 G0432 $118.00paliperidone ER tab 6 mg $118.40SILVASORB HYDROGEL [TUBE] $118.52NICARdipine *IVPB* (25 mg/ 250 ml NS = 0 $118.73ISTALOL OPH SOLN 0.5% $119.00SO TOPIRAMATE LEVEL 80201 $119.00SO ENCEPH - CALIFORNIA AB 86651 $119.00SO ENCEPH - E EQUINE AB 86652 $119.00SO ENCEPH - ST LOUIS AB 86653 $119.00SO ENCEPH - W EQUINE AB 86654 $119.00SARS-CoV-2 RNA RT-PCR 87635 $119.00CYTOPATH C/V THIN LAYER 88142 $119.00FLOW CYTO 2-8 MARKERS PRO 88187 $119.00MA LOCALIZATION RIGHT 1ST LESION 19281 $119.48MA LOCALIZATION LEFT 1ST LESION 19281 $119.48MA LOCALIZATION RIGHT 2ND LESION 19282 $119.48MA LOCALIZATION LEFT 2ND LESION 19282 $119.48US BREAST LOCAL 1ST LT 19285 $119.48RT US BREAST LOCAL 1ST 19285 $119.48US BREAST LOCAL 2ND LT 19286 $119.48RT US BREAST LOCAL 2ND 19286 $119.48DIGOXIN LEVEL 80162 $120.00SO PREGNENOLONE 84140 $120.00HIV 1/2 AG/AB G0432 $120.00HYDROCODONE POLST-CHLORPH $120.93SO COUMADIN-WARFARIN LVL 80299 $121.00Hemoglobinopathy Evaluation 83021 $121.00SO HISTAMINE - 24H URINE 83088 $121.00SO FACTOR II ACTIVITY 85210 $121.00SO FACTOR V ACTIVITY 85220 $121.00SO FACTOR 9 85250 $121.00SO FACTOR X ACTIVITY 85260 $121.00SO FACTOR 12 85280 $121.00

63

SO CRYOCRIT IMMUNODIFFUSN 86329 $121.00SO MONO CELL AG - GUANT 86356 $121.00SO TULAREMIA AB 86668 $121.00SO ARC ANTIBODY SCREEN 86850 $121.00SO ARC RH PHENOTYP COMP 86906 $121.00INFED [50MG/ML 2ML] J1750 $121.00TET/DIP ADLT INJ [5-2LF A 90715 $121.17FLUORO GUIDED NDL PLACMNT 77002 $122.57FLUORO GUIDE SPINE INJ 77003 $122.57SURGIFOAM GELATIN SPONGE 8 X 12.5 CM $123.0011-1422: ICEMAN COOLER W/UNIV LOOP $123.00SO VAP CHOLESTEROL 83701 $123.00TISSUE EXAM PATHOLOGIST-5 88305 $123.00MOLECULAR PATH INTERPRET G0452 $123.00ARIPiprazole Tab (5 mg) $123.07DOXYCYCLINE INJ [100MG 10 $123.22DOXYCYCLINE *IVDRIP* [100MG/NS 250ML] $123.22SUPRANE INHALANT [1 DOSE $123.86ARIPiprazole Tab [15 MG] $123.97SO T-TRANSGLUTAMINASE IGA 83516 $124.00SO VITAMIN B1 THIAMINE 84425 $124.00SO AFB ORGANISM ID 87118 $124.00IRRIGA IMPLNTD VENOUS ACCESS DRUG DELI 96523 $124.00ARIPiprazole Oral Tab [10 MG] $124.09ER PHY LEVEL 1 EXAM 99281 $125.00THORA/PACACENTESIS TRAY $125.66SOLU-CORTEF INJ [ 250MG A J1720 $125.86Stonerisk Diagnostic Panel $126.00RENAL PANEL 80069 $126.00HU AB SCREEN W/TITER 86255 $126.00THEOPHYLLINE LEVEL 80198 $127.00SO TRYPSIN 83519 $127.00SO C1 INHIBITOR FUNCTIONA 83520 $127.00SO HYALURONIC ACID 83520 $127.00COMPATIBILITY- AHG 86922 $127.00CLONIDINE TTS-1 PATCH [0. $127.87MODAFINIL TAB [200MG] $128.50CYCLOMYDRIL 1% OPHTH SOL $128.74MA POST CLIP PLACEMENT RT 19281 $128.75MA POST CLIP PLACEMENT LT 19281 $128.75DYNAMIC ACTIVITY - 15MIN 97530 $128.75GELFOAM SPONGE SIZE 50 $128.88

64

PHENOBARBITAL LEVEL 80184 $129.00DILANTIN/PHENYTOIN LEVEL 80185 $129.00SO CATECHOLAMINES- URINE 82384 $129.00CYSTATIN C 82610 $129.00SO ESTRADIOL HI SENS 82670 $129.00SO TRYPTASE 83520 $129.00SO PORPHRINS- URINE QUANT 84120 $129.00SO TESTOSTERON WOMAN/CHIL 84403 $129.00SO HEPATITIS E IGM 86790 $129.00US RT BREAST LIMITED 76642 $129.78US LT BREAST LIMITED 76642 $129.78SPLINT/SHORT ARM $130.00SO IGF BIND.PROTEIN 3 83519 $130.00H.PYLORI- IGG- SERUM 86677 $130.00C.DIFFICLE ANTIGEN - STOOL 87449 $130.00INSITU HYBRIDIZATION PATH 88368 $130.00DEBRIDE I <= 20 SQ CM 97597 $130.81CAST-SHORT ARM $131.00PRIMAXIN ADDV [500MG] $131.00INSERT OF NON-DWELL CATH 51701 $131.00SO LIPOPROTEIN ELECTROPH 83700 $131.00SO PURKINJO CELL AB SCREE 86255 $131.00SO ANNA IGG SCREEN 86255 $131.00SO C.DIFF CYTOTOXIN ASSAY 87230 $131.00Boron Blood 83018 $132.00RANITIDINE HCL DUTIP SYRU $132.99LEVAQUIN TAB [750MG] $133.00SO BARBITURATE CONFIRM UA 80307 $133.00SO OSMOLARITY FECES 84999 $133.00SO CARDIOLIPIN IGM 86147 $133.00SO CARDIOLIPIN IGG 86147 $133.00SO CARDIOLIPIN IGA 86147 $133.00SO CYSTICERCOSIS IGG 86682 $133.00INJ IV PUSH MEDS TX 96374 $133.00INJ IV PUSH MEDS ER 96374 $133.00CABERGOLINE TAB [0.5MG] $133.11ASTRAMORPH (DURAMORPH) AM $133.60MORPHINE SULFATE PF VIAL J2274 $133.60RAPID RHINO 4.5/ 5.5 $134.00THORENC TRAY NON-DP $134.00D-DIMER TEST QUANT. 85379 $134.00SO RUBEOLA IGM 86765 $134.00

65

SO ARC ELUTION 86860 $134.00SO ARC DIFF ADS EA 86978 $134.00ED-AZITHROMYCIN SUSP [100MG/5ML 15ML BTL $134.07NAFCILLIN SOD INJ [2GM VI $134.46ETHYL CHLORIDE SPRAY [3.5 $134.50PROTAMINE INJ [50MG/5ML S $134.50MOD SEDATION <5 YEARS OLD 99155 $134.93MOD SEDATION 5YRS OR OLDER 99156 $134.93RESUS BAG /RESP $135.0072202674: KNOT PUSHER SUTURE $135.00VALPROIC ACID LEVEL 80164 $135.00SO COTININE-NICOTININE 80323 $135.00SO ALDOSTERONE LEVEL 82088 $135.00SO IODINE URINE 82542 $135.00SO ETHYLENE GLYCOL 82693 $135.00SO PROINSULIN LEVEL 84206 $135.00HPYLORI AgG- IgG - IgA - IgM 86677 $135.00HPYLORI AB IgM 86677 $135.00HPYLORI AB IgG 86677 $135.00HPYLORI AB IgA 86677 $135.00PHYS US Echocardiography Limited 93308 $135.00PHYS US LIMITED ECHO PRO FEE 93308 $135.00LT SHOULDER 1 VIEW 73020 $135.96RT SHOULDER 1 VIEW 73020 $135.96CEFDINIR SUSP [125MG/5ML] $135.97Cystine 24 hour Urine 82131 $136.00GENTAMICIN OPHTH OINT [0. $136.08CEPHALEXIN SUSP [250/5ML $136.62NM Tc-99m Sulfur Colloid A9541 $136.99BACK TABLE COVER $137.00Hepatits E Ab - IgG $137.00AR-1595T: DRILL PIN TIGHTROPE $137.00SO HVA HOMOVANILLIC ACID 83150 $137.00SO ANTI-MULLERIAN HORMONE 83520 $137.00SO THROMBIN-ANTITHROM CPX 83520 $137.00SO ACTIVAT PROTEIN C-RES 85307 $137.00CYTOPATH CELL ENHANCE PRO 88112 $137.00Urorisk Diagnostic Profile $138.00SO TACROLIMUS/PROGRAF LVL 80197 $138.00PROGRAF/TACROLIMUS CHEM 80197 $138.00SO MYCOPHENOLIC ACID G 80299 $138.00SO STONE ANAYSIS 82365 $138.00

66

SO SILVER-SERUM 83018 $138.00Cobalt blood 83018 $138.00BLOOD SMEAR INTERPRETATIO 85060 $138.00SO B2 GLYCOPROTEIN IGM 86146 $138.00SO B2 GLYCOPROTEIN IGA 86146 $138.00SO B2 GLYCOPROTEIN IGG 86146 $138.00SO AFB CULTURE 87116 $138.00CYSTO CONRAY 250ML Q9958 $138.02SO ENDOMYCIAL SCREEN 86255 $139.00SO ENDOMYCIAL SCREEN 86255 $139.00Aspergillus antigen, EIA serum 87305 $139.00IMMUNNOHISTO AB SLIDE 88341 $139.00CHEST WALL MANIPULATION 94668 $139.00TRIHEXYPHENIDYL TAB [5MG $139.43PACU ADDL 15 MIN RECOVERY $140.00SPECIAL ANESTHESIA SERVIC 99100 $140.08DEXT 5%/HEPARIN [25000U $141.00Alpha-1 Antitrypsin Mutation (Genetics) 81332 $141.00Histamine Release (Chronic Urticaria) 86343 $141.00Hep C Ab w/reflex to HCV - RNA Quant PCR 86803 $141.00ED-DOXYCYCLINE CAP [100MG $141.27TEGRETOL/CARBAMAZ. LEVEL 80156 $142.00SPEC STAIN GP-2 TECH COMP 88313 $142.00FLUPHENAZINE DECON. INJ [ J2680 $142.39RADIOLOGY PACK $142.49BETOPTIC-S 0.25% OPHTH SU $142.65LORAZEPAM ORAL CONC [2MG/ $142.98CKMB QUANTITATIVE 82553 $143.00Cardio IQ Lipoprotein fractionation 83704 $143.00ARC AB ID PANEL 86870 $143.00SO ARC AGT CROSSMATCH 86922 $143.00IMMINOHIST AB + SLIDE PRO 88344 $143.00ADM OF ANESTHETIC/ #UNITS $143.17COLONOSCOPY ANESTHESIA 00811 $143.17COLONOSCOPY ANESTHESIA SCREENING 00812 $143.17EGD & COLONOSCOPY (SAME TIME) 00813 $143.17NYSTATIN POWDER [100000 $143.36CEFTIZOXIME INJ [1GM] $144.00SO NICOTINE - URINE 80323 $144.00SO NOREPINEPHRINE-SERUM 82542 $144.00SO SPECIAL STAIN HIST/FRZ 88314 $144.00MDI/DPI TX 94640 $144.00

67

SVN TX 94640 $144.00CONTINUOUS INHALATION TREATMENT (1ST HR) 94644 $144.00FLUTTER EDUCATION 94664 $144.00DEMNSTRAT/EVAL PT USE OF INHALER 94664 $144.00GAS DILUTATION OR WASHOUT 4 LUNG VOLUMES 94727 $144.00PSA Post prostatectomy 84153 $145.00Growth Hormone Antibody 86277 $145.00SO INTRINSIC FACT.BLK AB 86340 $145.00FLO CYTO 9-15 MARKERS PRO 88188 $145.00SPEC STAIN GP-1 TECH COMP 88312 $145.00SODIUM BICARB Drip[(150mEq/1000ml D5W] $145.36PREDNISOLONE SYR [5MG/5ML $145.83AVLN/NAIL PLT SMPL EA ADD 11732 $146.00Sirolimus, LC/MS/MS 80195 $146.00Chronic urticaria IgE Ab (anti-IgE IgG) 83520 $146.00MYOGLOBIN - QUANT. 83874 $146.00SO PROGESTERONE 84144 $146.00B-HCG - QUANTITATIVE 84702 $146.00SO PROTEIN C AG - TOTAL 85302 $146.00Zinc Transporter 8 (ZnT8) Antibody 86341 $146.00SO B-CELLS - TOTAL 86355 $146.00SO NATURAL KILL CELL -TOT. 86357 $146.00CULTURE - ANAEROBIC 87075 $146.00CULTURE -ANAEROBIC-ADD'L 87075 $146.00CEDAX CAP [400MG] $146.74ER PHY CMPLX RPR F/C/C/M/N/AX/G/H/F+ 5CM 13133 $147.00PTH-related protein (PTH-rP) 83519 $147.00Octreotide Acetate Inj 500 mcg/250 ml NS $147.57ISOPTO HYOSCINE OPTH SOLN $147.60ISOPTO HYOSCINE OPTH SOLN $147.60AMOXICILLIN/CLAVUL SUSP [ $147.69SO CORTISOL-SALIVA 82533 $148.00Myelin-Associated Glypro (MAG) Ab (IgM) 83520 $148.00SO PARATHYROID HORMONE 83970 $148.00SO PTH W/IONIZED CALCIUM 83970 $148.00PTH W/O CALCIUM 83970 $148.00PLATELET FUNCTION TEST 85576 $148.00TISSUE EXAM PATHOLOGIST-4 88304 $148.00IMMUNOHISTOCHEM PATH 88342 $148.00SINUSES > 3 VIEWS 70210 $148.32FENTANYL PATCH [ 50MCG/HR $148.48LEVONORGESTREL [1.5MG] $148.90

68

PRENATAL COMP 80055 $149.00SO D-DIMER - QUANT. 85379 $149.00SO HTLV I/II AB 86790 $149.00SO IBD IFA PERINUCLEAR 88346 $149.00SO IBD DNASE SENS 88346 $149.00TOBRADEX OPHTH OINT [O.3% $149.349001: NEEDLE EZ-IO 25MM BLUE $150.00SO OPIATE CONFIRM UA 80361 $150.00SO IGF2-INSULIN-LIKE GRO 83519 $150.00SO THYROID STIMULATE IGG 84445 $150.00CPT INITIAL FLUTTER/PERCUTION 94667 $150.00acetAZOLAMIDE sodium Inj (500 mg mix wit $150.27SO TOCAINIDE/LIDOCA LEVEL 80176 $151.00SO LACOSAMIDE-VIMPAT 80299 $151.00SO ZONISAMIDE-ZONEGRAN 80299 $151.00MDMA/MDA CONFIRMATION 80307 $151.00METHADONE CONFIRMATION 80358 $151.00RNA POLYMERASE 3 ANTIBODY 83520 $151.00Ganglioside GM-1 Ab (IgG, IgM) EIA 83520 $151.00SO ARC RETIC SEPARATION 86972 $151.00RSV ANTIGEN SCREEN 87420 $151.00PHYS HOSPITAL DISCHRGE MNGT 30 MIN< 99238 $151.00SODIUM PHOSPHATE [45MMP 1 $151.10CHLORPROMAZINE INJ [25MG $151.49MYELOGRAM TRAY $152.00NM SESTAMIBI A9500 $152.44NM ISOTOPE I-123 100 mc A9516 $152.44ED-HYOSCYAMINE DROPS [0.1 $152.46ACETIC ACID 2% OTIC [15ML] $152.50AR-13991N: SUREFIRE SCORPION NEEDLE $153.00ER PHYS I&D FINGER ABSCESS 26010 $153.00PHYS DRAIN EXTERNAL EAR LESION 69000 $153.0014.3.3 ETA PROTEIN 83520 $153.00SO PROTHROMB FRAG 1.2 83520 $153.00Soluble Liver Antigen (SLA) Autoantibody 83520 $153.00SO THYROGLOBULIN - RIA 84432 $153.00BONE NEEDLE 11G $153.02BONE NEEDLE 13G $153.02FENTANYL PATCH [ 75MCG/HR $153.26phytonadione 10 mg/50 ml NS $153.28NEO/POLY B/HYDROCORT OTIC $153.48MINNESOTA SOLUTION [BOTTL $154.00

69

HOSPITALIST US VASCULAR ACCESS MIDLINE 36410 $154.00TISSUE EXAM TECH COMP 2 88302 $154.00TET/DIP PED INJ [5-2LF] $154.26MA POST CLIP PLACEMENT BILATERAL 19281 $154.50ED US VASCULAR ACCESS MIDLINE PLACEMENT 36410 $154.50ED US ABDOMINAL AORTA 76706 $154.50US VACULAR ACCESS 76937 $154.50PHYS DEST PREMALIG LSN 2-14 17003 $155.00FSH PEDIATRICS 83001 $155.00Iodine - serum/plasma 83789 $155.00Vitamin B2 (Riboflavin) 84252 $155.00GENTAMICIN - TROUGH 80170 $156.00GENTAMICIN - PEAK 80170 $156.00LH PEDIATRICS 83002 $156.00SO GLUTM ACID DECARBXY-65 86341 $156.00Islet Cell Antibody Screen w/ reflex 86341 $156.00SO BLASTOMYCES AB 86612 $156.00SO CHLAMYDIA-GC MO SCREEN 87800 $156.00DEBRIDE II > 20 SQ CM $157.59Olanzapine Inj J2358 $157.90CHEST TUBE $158.00EMLA CREAM [2.5% 30GM W\O $158.00VANCOMYCIN -TROUGH 80202 $158.00VANCOMYCIN - PEAK 80202 $158.00SO ESTRADIOL LEVEL 82670 $158.00TSH w/ HAMA Treatment 84443 $158.00SO PROTEIN S ACTIVITY 85306 $158.00SO CYCLIC CITRU PEP AB 86200 $158.00Chlamydophila pneumo-Film array Resp pan 87486 $158.00Betamethasone 0.1% oint 45gm $158.01Risperidone 80342 $159.00SO PROMETHEUS 6MMP METAB 82542 $159.00SO PROMETHEUS 6TGN METAB 82542 $159.00SO ALK PHOS ISOENZYMES 84080 $159.00TROPONIN I - QUANT. 84484 $159.00SO FACTOR VIII -VWF - RCoF 85245 $159.00SO FACTOR VIII - VWF - AG 85246 $159.00SO PROTEIN S - TOTAL 85305 $159.00SO HEPARIN LO MOLEC WT 85520 $159.00SO HIV-2 ELISA 86702 $159.00SEMEN ANALYSIS- COMPLETE 89320 $159.00DELIVERY INST PACK $160.00

70

ER DRESSING CHANGE $160.00APPLICATION OF FIGURE 8 29049 $160.00ED EAR WAS W/ REMOVAL BY INSTRUMENT 69210 $160.00TOBRAMYCIN TROUGH 80200 $160.00TOBRAMYCIN PEAK 80200 $160.00SO T3 - TOTAL 84480 $160.00SO PLAVIX P2Y12 PLT FUNCT 85576 $160.00SO CHROMOGRANIN A 86316 $160.00SO T-CELLS - TOTAL 86359 $160.00COOL/HEAT AEROSL HR 94644 $160.00INFUSION IV ADDL HR 96415 $160.00PHYS OBSERVATION CARE DISCHARGE 99217 $160.00ALCAINE OPHTH [ .5%--15ML $160.13IPRATROPIUM BR SVN [0.5MG $160.56SPLINT SHORT ARM 29125 $161.00FOREARM SPLINT 29125 $161.00SO ANDROSTENEDIONE 82157 $161.00Dexamethasone Supp test (DST) 1 spec. 82533 $161.00SO CD-2 CELL MARKER 88184 $161.00SO CD-3 CELL MARKER 88184 $161.00SO CD-5 CELL MARKER 88184 $161.00SO CD-7 CELL MARKER 88184 $161.00SO CD-8 CELL MARKER 88184 $161.00SO CD-16 CELL MARKER 88184 $161.00SO CD-56 CELL MARKER 88184 $161.00SO CD-57 CELL MARKER 88184 $161.00NITRO-BID OINT TUBE [2% 3 $161.82SO RAPAMYCIN/SIROLIMUS 80195 $162.00SO DIHYDROTESTOSTERONE 80327 $162.00PORPHYRINS - FRACTIONATED- PLASMA 82542 $162.00SO HISTAMINE - PLASMA 83088 $162.00GLOMERULAR BASEMENT MEMBRANE AbIgG GMB 83520 $162.00PENTOTHAL KIT [500MG] $162.86N.GONORRHOEA BY PCR GX 87591 $163.00SUB OVS CARE- L 3 99226 $163.00PAMIDRONATE DISODIUM INJ J2430 $163.37LT ANKLE STRESS 77071 $164.80RT ANKLE STRESS 77071 $164.80CT NON-IONIC 350/ 50ML Q9967 $164.80SO TRIMETHOPRIM LEVEL 82542 $165.00SO CRYOCRIT IMMUNOFIXAT 86334 $165.00CHLAMYDIA BY PCR GX 87491 $165.00

71

DIABETIC COUNSELEING S9465 $165.00NUTRITIONAL COUNSELING S9470 $165.00IV PUMP TUBING $166.00SO NEUTROPHIL ANTIBODY 86021 $166.00PATH CONSULT INTRAOP ADDL 88332 $166.00NEO/POLY B/DEXAMETH OPHT $166.90NEO/POLY B/DEXAMETHASONE $166.90CEFTRIAXONE ADDV [2GM] J0696 $168.00PROMETHAZINE VC/COD SYR $168.11TERCONAZOLE-7 VAGINAL CR $168.84atropine ophth 1% drops (2 mL) $169.06MOMETASONE FUROATE OINT 0 $169.06UNNA BOOT 29580 $170.00Coenzyme Q10 82542 $170.00SO FREE KAPPA LIGHT CHNS 83883 $170.00SO FREE LAMBDA LIGHT CHNS 83883 $170.00CULTURE BLOOD 87040 $170.00CULTURE- BLOOD-ADD'L 87040 $170.00ULTANE INHALANT [1 DOSE 2 $170.93SO RIBOSOMAL P AB 83516 $171.00TR TREATMENT ROOM CLASS 1 99211 $172.00RECOVERY PHASE II PER HR/MAX 6HRS $172.01PHASE II PACU PER HR/ MAX 6HRS $173.00PORPHYRINS TOTAL PLASMA 82542 $173.00VERTEBROPLASTY KIT $173.56BARD MARQUEE BIOPSY 14G X 13CM $174.00BREAST CORE BX TRAY-CLIPS $175.10AR-6068-45L: 45 DEG CURVED L LASSO $176.00AR-6068-45R: 45 DEG CURV RT SUT LASSO $176.00SO C-TELOPEPTIDE (CTX) 82523 $176.00CHLORAMPHENICOL [1GM 15ML $176.63ED-AZITHROMYCIN TAB [250M $176.63HPVDNA HI/LO RECTAL SWAB 87623 $177.00HPV ORARISK ORAL DNA 87623 $177.00HISTOCHEMSTAIN ADD ON 88314 $177.00SOLU-MEDROL INJ [ 500MG A J2930 $177.20CEFEPIME INJ [2GM] J0692 $177.78cefepime 2gm/NS 50 mL J0692 $177.80PHYS FLOW CYTO >16 MARKERS 88189 $178.00SO TPMT 6-METHYL-THIOGUNI 82542 $179.00FUNGIZONE INJ [50MG] $179.50LEE-WHITE CLOTTING TIME 85345 $181.00

72

Liver Cytosol (LC-1) Autoantibodies 86376 $181.00FLU A- FLU B- H1N1- PCR 87502 $181.00US BREAST BX ADDL LESION LT 19084 $181.28US RT BREAST BIOPSY ADDTL LESION 19084 $181.28LIDOCAINE TOPICAL SOLN [4 $181.30AK-DILATE OPHTH SOLN [10% $181.30METRISET $182.00ER PHYS IUD REMOVAL 58301 $182.00AVP ARGININE VASOPRESSIN 84588 $182.00VON WILLEBRAND FACTOR AG 85246 $182.00SO NOROVIRUS - STOOL 87449 $182.00+IMMUNOHIST/CYTO CHEM ADD 88341 $183.00AMOXICILLIN/CLAVUL SUSP [ $183.62CAST FINGER 29086 $184.00NASAL/TRACH SUCTION 31720 $184.00ER PHYS I&D VULVA/PERINEAL ABSCES 56405 $184.00SO METANEPHRINES- PLASMA 83835 $184.00SO POLIO VIRUS AB TYPE 1 86382 $184.00SO POLIO VIRUS AB TYPE 2 86382 $184.00SO POLIO VIRUS AB TYPE 3 86382 $184.00NAROPIN 0.2% FEMORAL BLOC J2795 $184.14CLOTRIMAZOLE CRM [1% 45GM $184.36LEG LENGTH 77073 $185.00SO INHIBIN A 86336 $185.00ELBOW 2 VIEWS LT 73070 $185.40ELBOW 2 VIEWS RT 73070 $185.40HYDROCOD/APAP ELIX [7.5/3 $185.80279-351-250: 50-S SERFAS ENERGY $186.00AR-13995N: SCORPION NEEDLE $186.00ER PHYS DRSG/DEBRIDE W/O ANES - SM 16020 $186.00LONG LEG SPLINT 29505 $186.00ER PHYS US ABD LIMITED 76705 $186.00Procollagen Type I Intact N term Prop 83519 $186.00RISTOCETIN COFACTOR 85245 $186.00RISTOCETIN CO FACTOR 85245 $186.00SPEC STAIN GP-1 PATH COMP 88312 $186.00GENTAMICIN SUL [0.1% 15GM $186.27DERMABOND $187.00SO SULFONAMIDE LEVEL 80299 $187.00SO FENTANYL LEVEL 80361 $187.00ED-AMOXICILLIN & K CLAV S $187.46MYCOPHENOLIC ACID 80180 $188.00

73

ACETAMINOPHEN 80299 $188.00ACETAMINOPHEN 4HR/RDM 80329 $188.00ACETOMINOPHEN 12HR 80329 $188.00SO HISTO/CYTO ENZYMES 88319 $188.00ANALGASICS NON-OPIOIDS G0480 $188.00ACETAMINOPHEN 12 HR G0480 $188.00HUMULIN 70/30 MIXTURE [5 $188.21CERVICAL X-RAY SPINE 1 VIEW 72020 $188.49THORACIC X-RAY SPINE 1 VIEW 72020 $188.49LUMBAR X-RAY SPINE 1 VIEW 72020 $188.49amino acid electrolyte/ dext 50 (10 %/50 $189.00ER PHY FEE SHORT ARM SPLINT 29125 $189.00ER PHYS LONG LEG SPLINT 29505 $189.00THER/PROPH/DIAG IV INF INIT 96365 $189.00THER/PROPH/DIAG IV INF INIT TX 96365 $189.00SO ACETYL RECEPT BIND AB 83519 $190.00SO ACETYL RECEP BLOC AB 83519 $190.00SO ACETYL RECEP MOD AB 83519 $190.00TRAb ( TSH receptor binding antibody) 83519 $190.00SO METHYLMALONIC ACID 83921 $190.00SO CORTISONE URINE 83789 $191.00Mycoplasma pneumo-Film array Resp panel 87581 $191.00IPRATROPIUM NASAL SPRAY [ $191.02PHOSPHA 250 NEUTRAL TAB [ $191.27ED-CEFDINIR SUSP [125MG/5 $192.06CICLOPIROX OLAMINE CRM [0.77% 30GM] $192.46XIFAXAN TAB [550MG] $192.50HIP/PELVIS INF/CH 73501 $192.61LT HIP 1 VIEW 73501 $192.61RT HIP 1 VIEW 73501 $192.61LT HIP OR 73501 $192.61RT HIP OR 73501 $192.61LT HIP 1 VIEW- WITH PELVIS 73501 $192.61RT HIP 1 VIEW- WITH PELVIS 73501 $192.61RT FEMUR 1 VIEW 73551 $192.61LT FEMUR 1 VIEW 73551 $192.61SO PROPOXYPHENE LEVEL 80361 $193.00FLOW CYTO 1-MARKER TC 88184 $193.00LURASIDONE HCL TAB [40MG] $193.31LURASIDONE HCL TAB [80MG] $193.31HYSTERO CATHETER $194.00SO ECHINOCOCCUS GRAN AB 86682 $194.00

74

SO HIV RNA QUANT 87536 $195.00SO OPIATES- SERUM LEVEL 80361 $196.00SO INTERLUKIN 6 82397 $196.00SO OSMOTIC FRAGILITY 85557 $196.00Shiga Toxin by PCR 87798 $196.00E. COLI 0157 PCR 87798 $196.00KETOCONAZOLE CRM [2% 30GM $196.10MA UNI SCREENING RIGHT 77067 $196.73MA UNI SCREENING LEFT 77067 $196.73SO INT'FERON B IGG W/RX 83520 $197.00B NEURO PEPTIDE 83880 $197.00NEO/POLY B/BAC OPHTH/OINT $197.64VON WILLEBRAND AG MULTIMERIC 85247 $198.00INFLUENZA DNA AMP PROBE 87502 $198.00TERAZOL-7 VAG CREAM [0.4 $198.54X-RAY FINGER 73140 $198.79LT TOES 73660 $198.79RT TOES 73660 $198.79EVEROLIMUS 80169 $199.00SO ADENOVIRUS BY PCR 87798 $199.00ER PHY LEVEL 2 EXAM 99282 $199.00TPN AMINO ACID/DEXTROSE [2000ML] $199.32LIDOCAINE/PRILOCAINE CRM $199.77US INFANT HIPS 76885 $200.00HYDROCODONE POLST-CHLORPH $200.90LT HAND 2 VIEWS 73120 $201.88RT HAND 2 VIEWS 73120 $201.88ZOMETA INJ [4MG] J3489 $202.90NM TC99M LABELED RBC A9560 $202.91TRACH TUBE NON-CUFFED $203.00FOLIC ACID INJ [5MG/ML MD $203.40SO RSV BY PCR 87798 $204.00PATH CONSULT INTRAOP ADDL 88332 $204.00LT WRIST 2 VIEWS 73100 $204.97RT WRIST 2 VIEWS 73100 $204.97LT ANKLE LIMITED 73600 $204.97RT ANKLE LIMITED 73600 $204.97FACTOR VIII ACTIVITY -CLOTTING 85240 $205.00EKG - TRACING ONLY 93005 $205.00VASOLEX OINTMENT [TUBE] $205.60VOLTAREN GEL [1% GEL 100G $205.85CT PERFUSION W CONTRAST 0042T $206.00

75

ER PHYS ID PERIANAL ABSCESS SUPERFICIAL 46050 $206.00US BREAST BILAT LIMITED 76642 $206.00SO FACTOR VIII:C 85240 $206.00TISSUE EXAM TECH COMP 4 88304 $206.00PHYS OVS DISCHARGE 99217 $206.00PHYS INITIAL HOSPITAL CARE 99222 $206.00ER CLASS I 99281 $206.00CLONIDINE FOR EPIDURAL IN J0735 $206.50moxifloxacin IVPB (400 mg/250 mL) J2280 $206.79AMIODARONE 360MG/200ML D5W $207.82SPLINT-BUCKS TRACT $208.00PHYS INITIAL OBSERVATION PER DAY 30 MIN< 99218 $208.00SO CD4 CD8 T-CELLS 86360 $209.00CL/HT AEROSL ADDTNL HR 94645 $209.00CONTINUOUS INHALATION TX (ADTL HR) 94645 $209.00SAT CHECK MULT/ WALKING 94761 $209.00TDAP VACCINE .5 ML 90715 $209.06CLONIDINE TTS-2 PATCH [0. $209.25PHYS INITIAL HOSP CARE/DAY 30 MIN 99221 $210.00LT FOOT LIMITED 73620 $210.12RT FOOT LIMITED 73620 $210.12SO ARC AB-ID EA PNL-MEDIA 86870 $211.00SO CHROM ANYLS-AMNIO ADDL 88280 $211.00ER PHYS GASTRIC INTUBATION 43753 $212.00SO DEOYCORTICOSTERONE 82633 $212.00STRESS TEST READ 93018 $212.00US ABDOMEN LIMITED 76705 $212.18ED US ABD LTD FAST 76705 $212.18US Abdominal Aorta 76706 $212.18EPHEDRINE SULF AMP [50MG/ $212.79DORIBAX INJ [500MG] J1267 $212.82ER PHYS TRIG PNT 3 OR MORE MUSCLE 20553 $213.00DRAINAGE FINGER ABCESS 26010 $213.00CLOSED TRMT DIS FINGER 26770 $213.00ER PHYS CAST FINGER 29086 $213.00FINGER SPLINT 29130 $213.00ER PHYS STRAPPING UNNA BOOT 29580 $213.00ER PHYS REMOVAL FULL ARM/FULL LEG CAST 29705 $213.00LACER SIMPLE- DERMABOND G0168 $213.00ACETAMINOPHEN IV $213.13ZYVOX SOL [600MG/300ML] J2020 $213.14ELECTRODE 1 STEP ZOL PAD $214.00

76

Pain Management Antipsychotics w/conf. 80307 $214.00Med Match confirmation Opiates urine G0480 $214.00Med Match confirmation Amphetamines ur G0480 $214.00MA DIAGNOSTIC UNILAT LT IMPLANTS MAMMO 77065 $214.24MA DIAGNOSTIC UNILAT RT IMPLANTS MAMMO 77065 $214.24PT EVAL LOW COMPLEX 20 MIN 97161 $214.24PT EVAL MOD COMP 30 MIN 97162 $214.24PT EVAL HIGH COMP 45 MIN 97163 $214.24ER PHYS CONTROL NASAL BLEED ANTERIOR SMP 30901 $215.00BIOPSY NEEDLE -RAD $216.00EPOC ABG - POCT 82803 $216.00PATH INTRAOP 1-BLOC PATH 88331 $216.00US CRANIAL 76506 $216.30VITAMIN K1 INJ [10MG/ML-- $216.90RSV-RNA Qualitative Real time PCR 87798 $217.00IMMUNHISTO AB SLIDE 88341 $217.00GASTROGRAFIN ORAL SOL [12 $217.56ER PHYS AVULSION/NAIL PLT0 - SIMPLE 11730 $218.00PHLEBOTOMY- THERAPEUTIC 99195 $218.00DIPHENOXYLATE/ATROPINE SO $218.50M00558370: ESOPHOGEAL BALLOON DILATOR $219.00SODIUM POLYSTYRENE SUSP [ $221.00ER PHYS I & D ABCESS SIMPLE 10060 $221.00ER PHYS TX FINGER FX 26750 $221.00SO TB QUANTIFERON GOLD 86480 $221.00POWER PICC CATHETER C1725 $221.06ARTERIAL CATHETERIZATION 36620 $221.45ER PHYS LONG ARM SPLINT 29105 $222.00SPLINT SHORT LEG 29515 $222.00TUMOR IMMUNOHISTO PATH 88360 $222.00LT HEEL XRAY 73650 $222.48RT HEEL 73650 $222.48SO INSULIN ANTIBODIES 86337 $223.00IMMINOHIST AB + SLIDE TC 88344 $223.00EPOGEN [3000 U/ML 1ML S J0885 $223.38OT EVAL LOW COMPLEX 30 MIN 97165 $223.51OT RE-EVAL EST PLAN CARE 97168 $223.51Leukemia/ Lymphoma Evaluation 88184 $224.00LIDOCAINE OINT [5% 1 DOSE $224.50VENOFER INJ [20MG/ML 5ML] J1756 $224.50Evaluation of speech fluency 92521 $224.54REMOVAL SKIN TAGS <15 11200 $225.00

77

ER PHYS CONTROL OF NOSEBLEED 30906 $225.00C.DIFF TOX B GENE-PCR 87493 $225.00CHEST 1 VIEW XRY 71045 $225.57ER PHYS CUTDOWN VENI PUNCT 36425 $226.00SO THYROTROP BD INHB IMM 83519 $226.00PATH INTRAOP 1-BLOC TECH 88331 $228.00INTRAOP CYTO PATH CSLT TC 88333 $228.00Omnipaque 300 mg/50 mL Q9967 $228.67SPLINT SHORT LEG $229.00SO PARVOVIRUS-HUMAN- PCR 87798 $229.00ENZYME HISTOCHEM 88319 $229.00NEO/POLY B/ GRAM OPHTH SO $229.04SO TET.HYD.ALDOSTERON-U 82542 $230.00Hepatitis D Virus RNA Qualitative PCR 87798 $230.00TRI-MARK BREAST MARKER $230.10SPEECH TREATMENT (1) 92507 $230.72CELESTONE SOLUSPAN INJ [6 $230.98ER PHY STRAP SHLDR IMM 29240 $231.00ASPIRATION FLUID ABSCESS 10160 $231.75CHEST XRY 2 VIEW 71046 $231.75LACER 2.5 CM SIMPLE S/N/AX/GEN/TRNK 12001 $232.00Protein S Antigen - Free 85306 $232.00NECK/SOFT TISSU XRY 70360 $232.78LT KNEE LIMITED 73560 $232.78RT KNEE LIMITED 73560 $232.78OXYGEN $233.00SO INHIBIN B 83520 $233.00SO NMDA RECP AB CSF TITER 86256 $233.00IMMUNOHISTOCHEM TECH 88342 $233.00ALBUTEROL HFA INHALER [8.5] $233.28GEODON INJ [20MG/ML VIAL] J3486 $233.61ER PHYS REMOVE FB PHARYNX 42809 $234.00UREA CLEARANCE 84545 $234.00PELVIS XRY 72170 $234.84ABD SINGLE VIEW 74018 $234.84ENDO SLEEVE-CB11LT $235.00BLOOD GASES 82803 $235.00BLOOD GASES 82803 $235.00SO TMPT ENZYME ACTIVITY 82657 $236.00HYDROXYZINE HCL TAB 10 MG $236.96SILVER SULFADIAZINE CREAM $237.43EPOGEN [2000 U/ML 1ML S J0885 $239.45

78

INFLUENZA INJ AGE 65 AND 90662 $239.66LT CLAVICAL 73000 $239.99RT CLAVICAL 73000 $239.99MA UNILATERAL RIGHT DIAGNOSTIC SAME DAY 77065 $239.99MA UNILATERAL LEFT DIAGNOSTIC SAME DAY 77065 $239.99MA UNILATERAL RIGHT MAMMOGRAM 77065 $239.99MA UNILATERAL LEFT MAMMOGRAM 77065 $239.99EVAC-SUBUNG HEMATOMA 11740 $240.00SO ENTEROVIRUS-PCR-CSF 87798 $241.00SO PLAC (Lp-PLA2) 83698 $242.00NEO/POLY/BAC/HC OPHTH OIN $242.68CPAP MASK SM-MED-LG $243.00ER PHYS 2.6-7.5CM SIMPLE F/E/E/N/L/M 12013 $243.00SO MERCAPTOPURINE 80299 $243.00LT FOREARM 73090 $243.08RT FOREARM 73090 $243.08fentaNYL patch ( 37.5 mcg/hr) $243.63CONT DRUG ADMIN-HOSPITAL 01996 $245.14B.PERTUSSIS BY PCR 87798 $246.00SO B.PARAPERTUSSIS BY PCR 87798 $246.00DOXAPRAM INJ [20MG/ML 20 $246.10OT EVAL MOD COMPLES 45 MIN 97166 $246.17CT NON-IONIC 350 / 75ML Q9967 $246.17IPRATROPIUM-ALBUTEROL SVN $246.96BLOOD PUMP SET $247.00AR-1589RT: TIGHTROPE BUTTON EXTENDER $247.00SKULL LIMITED XRY 70250 $247.20ER PHYS DISTAL RADIAL FRACTURE 25605 $248.00ER PHYS METATASEAL FRACTURE 28475 $248.00ER PHY TOE FRACTURE 28515 $248.00SO HLA DR-A COMPLETE 86817 $248.00SO HLA DR-B COMPLETE 86817 $248.00ARIXTRA [2.5MG 0.5ML PRE J1652 $248.75SO CANDIDA ALBICANS AB 86628 $249.00ER PHY LEVEL 3 EXAM 99283 $249.00HYLENEX INJ 150 UNITS/ML $249.56C P M PAD $250.00TUMOR IMMUNOHISTO TECH 88360 $250.00PREVALON MATTS 3242 $252.00PHYS CRITICAL CARE ADD 30 99292 $253.00FACIAL BONES LTD X 70140 $253.38ropivacaine 0.2% femoral/epidural block J2795 $253.66

79

MethylPREDNISolone *IVPB* (SUCC. 1000mg/ $253.88SOLU-MEDROL INJ [1000MG) J2930 $253.88TRIM SKIN LESION 11055 $254.00MA SCREENING BILATERAL IMPLANTS 77067 $255.44MA MAMMOGRAM SCREENING BILATERAL 77067 $255.44MA BCC BILAT SCREENING MAMMOGRAM 77067 $255.44MA SCREENING MAMMO BILAT IMPLANTS 77067 $255.44MA SCREENING MAMMO RT IMPLANTS 77067 $255.44MA SCREENING MAMMO LT IMPLANTS 77067 $255.44STERN CLAVIC XRY 71130 $256.47LT HUMERUS 73060 $256.47RT HUMERUS 73060 $256.47ED US OPHTHALMIC FOREIGN BODY LOCALIZE 76529 $257.50ER PHYS FNA BX W/US GUIDIANCE 10005 $258.00ER PHYS EXCISION - SKIN LESION 11400 $258.00ER PHYS TX INGROWN NAIL 11765 $258.00SPLINT LONG ARM 29105 $258.00ER PHYS STRAPPING WRIST 29260 $258.00ER PHYS REMOVE FB EYE 65205 $258.00ER PHYS REMOVAL FB XTRNL EYE 65220 $258.00ER PHYS REMOVE FB EYELID 67938 $258.00ER PHYS REMOVE FB XTRNL AUDITORY CANAL 69200 $258.00ER PHYS REMOVAL EAR CERUMEN 69210 $258.00ER PHYS US FB EYE 76529 $258.00EPOC panel - POCT (11 tests) 80051 $258.00SO JC VIRUS PER QUAL 87798 $258.00ASPERGILLUS DNA QUAL PCR 87798 $258.00SCAPULA RT XRAY 73010 $258.53SCAPULA LT XRAY 73010 $258.53XENADERM OINT [60GM] $258.63REMOVAL F/B EYE 65220 $259.00INVANZ ADDV [1GM] J1335 $259.00TIBIA LT 73590 $259.56RT TIBIA/FIBULA 73590 $259.56LT WRIST 3 VIEWS 73110 $260.59RT WRIST 3 VIEWS 73110 $260.59LT HAND COMPLETE 73130 $260.59RT HAND COMPLETE 73130 $260.59LT FOOT 73630 $260.59RT FOOT 73630 $260.59PLETHYSMOGRAPHY VOLUME/RESISTANCE 94726 $261.00TCC EZ CAST (TCC 23051) $262.00

80

MEPHYTON TAB [5MG] $262.34LT ANKLE COMPLETE 73610 $262.65RT ANKLE COMPLETE 73610 $262.65ER PHYS LACER <2.5CM S/A/T/EXT 12031 $263.00H. Pylori urease breath test 83013 $263.00ENTRO VIRUS RNA QUAL PCR 87498 $264.00ER PHYS INSERT COMPL CATH $265.00PT II GENE 20210TIER1 81240 $265.00CLOTRIMAZOLE/BETAMETHASON $265.61ER PHYS TRIM SKIN LESION 11055 $266.00ER PHYS REMOVAL SKIN TAGS 11200 $266.00DEBRIDE NAIL 11720 $266.00REPAIR OF NAIL BED 11760 $266.00ER PHYS CL TX FINGER FX EACH 26755 $266.00ER PHYS TOE DISCLOCATION 28630 $266.00ER PHYS TOE STRAPPING 29550 $266.00ER PHYS CUTDOWN VENI PUNCT 36410 $266.00ER PHYS ESOPHAGOSCOPY W REMOVAL OF FB 43215 $266.00ER PHYS CHANGE CYSTOSTOMY TUBE- SIMPLE 51705 $266.00ER PHYS REMOVAL IMPACTED CERUMEN LAVAGE 69209 $266.00ER PHYS DEBRIDE WOUND <= 20 SQ CM 97597 $266.00ER PHYS DEBRIDE WOUND EA ADDL 20 SQ CM 97598 $266.00SPLINT/LONG ARM $267.00SO ETHANOL -BREATH 82075 $267.00NASAREL NASAL SPRAY [25MC $267.48BETAMETHASONE VAL 0.1% LO $267.70EFUDEX CREAM [5% 40 GRAM] $267.70ED US SOFT TISSUE 76882 $267.80US RT LMTD UPR EXT NON VASCULAR 76882 $267.80US LT LIMITED LOWER EXT LMT/SFT TISSUE 76882 $267.80US EXTREMITY NON VASCULAR LMT RT 76882 $267.80US EXTREMITY NON VASCULAR LMT LT 76882 $267.80RED BLOOD CELL ANTIGEN TYPING 86905 $268.00HEMO VAC SET $269.00PHYS HOME SLEEP TEST/TYPE 3 95806 $269.00TOBRAMYCIN-DEXAMETHASONE $269.72SO CALPROTECTIN-FECAL 83993 $270.00NASAL BONES XRY 70160 $270.89STERNUM XRY 71120 $270.89ACROMIOCLAVICULAR 73050 $270.89RT FEMUR 2/ > VIEWS 73552 $270.89LT FEMUR 2/ > VIEWS 73552 $270.89

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US ECHOCARDIOGRAPHY LIMITED 93308 $270.89ED US Echocardiography Limited 93308 $270.89PENICILLIN G PROCAINE IM $271.28LT ELBOW 3 VIEWS 73080 $271.92RT ELBOW 3 VIEWS 73080 $271.92ULTIVA INJ [1MG] $273.28LEVALBUTEROL MDI [200 DOSES] $273.82OT EVAL HIGH COMPLEX 60 MIN 97167 $273.98SO VITAMIN K LEVEL 84597 $274.00CAST FOREARM 29075 $275.00TISSUE EXAM TECH COMP-5 88305 $275.00PRO US Echocardiography 93306 $276.00TAP BLOCK UNILATERAL INJ 64486 $276.04CHEST 3 VIEWS 71047 $276.04LT HIP 2/3 VIEWS WITH PELVIS 73502 $276.04RT HIP 2/3 VIEWS WITH PELVIS 73502 $276.04RECOMBIVAX HB INJ [10MCG $277.06EVAL SPEECH SOUND PRODUCTION 92522 $277.07SPEECH SOUND LANG COMP 92523 $277.07CLOTRIMAZOLE SOLUTION [1 $277.53S I JOINTS XRY 72202 $278.10SACRUM AND COCCYX 72220 $278.10PHYS OBSERVATION/INPT HOSP CARE 40 MIN 99234 $279.00EMERGENCY ANESTHESIA 99140 $279.13FLUTICASONE NASAL SPR [50 $279.47BONE AGE STUDIES 77072 $280.16BIOPSY SOFT TISSUE 20206 $282.22DEBRIDE INFECTED SKIN 11000 $283.00ED US BLADDER 76857 $283.25US BLADDER 76857 $283.25HOSPITALIST US BLADDER 76857 $283.25SO HIV PHENO DRUG RESIST 87900 $284.00PLASMA PROCESSING FEE P9017 $284.00US ABI 93923 $284.28FREAMINE 8.5% TPN 5 $285.00LT SHOULDER 73030 $285.31RT SHOULDER 73030 $285.31SO HERPES SIMPLEX BY PCR 87529 $286.00HALOPERIDOL ORAL SOLN [2M $286.85CLONIDINE TTS-3 PATCH [0. $287.00LT KNEE 3 VIEWS 73562 $287.37RT KNEE 3 VIEWS 73562 $287.37

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CIPRO SUSP [250MG/5ML 100 $288.82ER PHYS EXCISION B9 <0.5CM LESION 11420 $289.00SO GALACTOKINASE(B) 82759 $289.00SPINE THRC LMBR JT 72080 $290.46ACYCLOVIR SUSP [200MG/5ML $290.87SO AFB AMP PROBE PCR 87556 $291.00IV HYDRATION INITIAL- ER 96360 $291.00IV HYDRATION INITIAL-TX 96360 $291.00SPINE ENTIRE AP & LAT 72082 $291.49FENTANYL PATCH [100MCG/HR $291.86PELVIS COMP XRY 72190 $292.52SWALLOWING TREAT (1) 92526 $292.52OXIMETRY OVERNITE 94762 $293.00ER PHYS REMOVAL FB SKIN SUBQ SIMPLE 10120 $294.00INFUSION IV 1 HR 96413 $295.00PHYS OBSERVATION CARE 30 MIN 99218 $295.00OVS ADMIT/DISC L 1 99234 $295.00EPOGEN [4000 U/ML 1ML S J0885 $295.00EPOGEN [40000 U/ML 1ML S J0885 $295.00Strep. pneumo IgG Ab 23 serotypes- MAID 86317 $296.00SO HIV RNA QL PCR 87535 $296.00PREDNISOLONE SYR [15MG/5M $297.42ED-ALBUTEROL INHALER HFA $297.44Myocardial Perfusion Spect Pro 78452 $298.00GENERAL HEALTH PANEL 80050 $298.00TRIAMCINOLONE DENTAL PAST $298.62ER PHYS REMOVAL GAUNLET/BOOT/CAST 29700 $299.00MULTIPURPOSE DRAINIAGE CATH 8.5 FR $300.00ARM IMMOBOL SMALL $301.00ER PHYS CLOSED TRMT DIS FINGER 26770 $301.00BIOPSY SKIN LESION 11100 $301.79THORAVAC AN50 $302.00VACUUM EXTRACTOR DEL $302.00BURN SHEET $302.00ER PHYS I&D PERIRECTAL ABCESS 46040 $302.00ER PHYS I&D OF PILONIDAL CYST SIM 10080 $303.00ER PHYS INCISION OF THROM HEMORRH 46083 $303.00TISSUE EXAM PATHOLOGIST-7 88307 $303.00SPINE CERVICAL < 3 VIEWS 72040 $303.85NM ISOTOPE MDP A9503 $303.85NM ISOTOPE CHOLETEC >15mC A9537 $303.85MOD SED SAME PHY/QHP 5/> YRS -1ST 15 MIN 99152 $304.00

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ER PHYS DISLOCATION LITTLE TOE 28660 $305.00SALIVART SYN SALIVA $305.38CLOBETASOL PROPIONATE SOL $305.60NOVOLIN 70/30 MIXTURE [1 $305.93Novolin R $305.93SHEET ARTHROSCOPE $308.00SO PHENOTHIAZINE"THORAZN" 80342 $308.00CEDAX SUSP [90MG/5ML 60M $308.20ER PHYS TX SUPERFICIAL WOUND 12021 $309.00US ADDITIONAL BREAST ASPIRATION SITE 19001 $309.00PHYS REMOVE FB UPPR ARM 24200 $309.00ER PHYS LOWER EXTREMITY LONG LEG CAST 29345 $309.00ABDOMEN KUB/UPRIGHT 2 VIEW 74019 $309.00ED US CHEST 76604 $309.00US CHEST 76604 $309.00US RT UPR EXT NON-VASCULAR COMPLETE 76881 $309.00US LT COMPLETE JOINT OF ARM OR LEG 76881 $309.00US RT LOWER EXT NON-VAS COMPLETE 76881 $309.00US LT COMPLETE JOINT OF ARM OR LEG 76881 $309.00SO CARNITINE LEVEL 82379 $309.00Vascular Endothelial Growth Factor- VEGF 83520 $309.00ACTH Stimulation , 2 specimens Cortisol 82533 $310.00NASAL HEMOSTAT KIT $311.00TRAY-BONE MARROW $311.00TRAY-DISC-ASP-BIOPSY $311.00INJ MAJOR JOINT 20610 $311.06AR-1927BF: BIO CORKSCREW 5.5 C1713 $312.00NM KINEVAC (SINCALIDE) ISOTOPE J2805 $312.09SO ELASTASE-1 PANCREATIC 82656 $313.00MA DIAGNOSITIC BILAT IMIPLANTS MAMMO 77066 $313.12MA MAMMOGRAM DIAGNOSTIC BILATERAL 77066 $313.12MA DIAGNOSTIC BILAT MAMMOGRAM SAME DAY 77066 $313.12MA BCC DIAGNOSTIC MAMMOGRAM 77066 $313.12MA DIAGNOSTIC MAMMO BILAT 77066 $313.12RIFAMPIN INJ [600MG] $313.30TESTOSTERONE ENANTHATE IM $314.32SUMATRIPTAN SUCC. INJ [6M J3030 $314.50SO HCV GENOTYP PCR PROBE 87902 $315.00FLUOROMETHOLONE OPHTH SUS $315.44BETAMETHASONE DIPROP 0.05 $315.72MITY VAC PUMP $316.00DRSG/DEBRIDE - W/O ANES SM 16020 $316.00

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MUPIROCIN OINTMENT [2% 2 $316.30ARM/SHOULDER IMMOB/UNIVER $317.00REMOVE FB - INTRANASAL 30300 $317.00ER PHYS CUTDOWN VENI PUNCT 36420 $317.00IMMUNOHISTO/CYTO CHEM 88342 $317.00PHYS PROLONGED INPT SERVICES 99356 $317.00LAP CHOLEY PAK $318.00ER PHYS NTMD RPR N-HF/GENIT 2.5CM/< 12041 $318.00DRSG/DEBRIDE W/O ANES - MED 16025 $318.00PROCAINAMIDE INJ [500MG/M $318.17TAP BLOCK BILATERAL INJ 64488 $318.27NM ISOTOPE BONE SCAN A9561 $318.27thrombin topical solution $318.53ER PHYS COMPLEX REPAIR 13122 $319.00ER PHYS TRIG POINT INJ 1-2 MUSC S 20552 $319.00ER PHYS ASPIRATION/INJ SM JOINT 20600 $319.00ER PHYS ASPIRATE/INJ JT/BIRS WO US 20605 $319.00ER PHYS ASP/INJ MAJOR JOINT 20610 $319.00TX FINGER FX 26750 $319.00ER PHYS CLOSED TX TOE 28495 $319.00ER PHYS APPLICATION CAST FIGURE OF 8 29049 $319.00STRAPPING SHOULDER 29240 $319.00I & D PERIRECTAL ABCESS 46040 $319.00REMOVAL IMPACTED CERUMEN- LAVAGE 69209 $319.00Bacterial pathogens panel by PCR 87505 $319.00ER PHYS NON-SELECTIVE DEBRIDE W/O ANESTH 97602 $319.00PANCRELIPASE CAP [5000 UN $319.47DESONIDE CREAM [0.05% 60G $319.54NOREPINEPHRINE [8mg/100ml NS] $319.83ACRRONIOCLAVICLR SP $322.00ER PHYS CLOSED TX NASAL FX WO STABILIZAT 21315 $322.00Hep B Virus DNA - Quant PCR w/reflex 87517 $322.00ZYMAR OPHTH DROPS [0.3% 5 $322.06LIDOCAINE/HYDROCORTISONE $322.89HYDROCORTISONE CREAM [2.5 $322.89PHYS INTUBATION 31500 $323.00ABDUCTION PILLOW $324.00CAST SHORT LEG 29405 $324.00PT NON SELECTIVE DEBRIDEMENT 97602 $324.45US BREAST RT CYST ASPIRATION 19000 $327.54US BREAST LT CYST ASPIRATION 19000 $327.54CT NON-IONIC 350/ 100 ML Q9967 $327.54

85

DESOXIMETASONE CRM [0.25% $327.78DAWSON MUELLER DRAINAGE CATH 12FR $328.00TRAY-PARACENTESIS $328.00LACER <2.5CM S/A/T/EXT 12031 $328.00LACER REPAIR INTERMEIATE S/A/T/E 2.6-7 12032 $328.00MTHFR METHYLENETRAHYDROFOLATE 81291 $328.00Rheumatoid Factor IgA,IgG,IgM 83520 $328.00VIAGRA TAB [50MG] $328.97SPINE LUMBAR 2 VIEW 72100 $329.60HUMULIN 70/30 MIXTURE [1 $329.69HUMULIN NPH [ VIAL ECF O $329.69HUMULIN R [10ML VIAL ECF $329.69ER PHYS LACER 2.5CM SIMPLE F/E/E/N/L/M 12011 $330.00X-RAY SMALL INTESTINE FOLLOW THROUGH STU 74248 $330.00MICRODISSECTION MAN 88381 $330.00MICRODISSECTION MAN 88381 $330.00US TRANSVAGINAL OB 76817 $331.66US TRANSVAGINAL PELVIC 76830 $331.66MEGESTROL AC SUSP [40MG/ $332.39TRACAR-35LNS $333.00CYTOPATH EVAL FNA 88173 $333.00Bacterial detection by PCR 87801 $334.00DEXAMETHASONE SOD OPHTH [ $334.26CAST-LEG SHORT $335.00STAPLER-TL90 $335.00DEBRIDE WOUND <= 20 SQ CM 97597 $335.00NON-SELECTIVE DEBRIDE W/O ANESTH 97602 $335.00ER PHYS INTMD RPR FACE/MM 2.5 CM/&lt 12051 $336.00TETRACAINE HCL SPINAL [1% $336.57LT KNEE 4 + VIEWS 73564 $336.81RT KNEE 4 + VIEWS 73564 $336.81SO GALACTOSE-1-PHOS - RBC 84378 $337.00ALBUMIN HUMAN 25% 50ML #1 P9047 $337.00ALBUMINHUMAN 25% 50ML #2 P9047 $337.00ALBUMIN HUMAN 25% 50ML #3 P9047 $337.00ALBUMIN HUMAN 25% 50ML #4 P9047 $337.00TREATMENT METATARSAL FX/DISLOCATION 28475 $338.00ER PHY WALKING BOOT 29425 $338.00REMOVAL F/B EYE CONJUNCTIVAL SUPERFICIAL 65205 $338.00CYTOPATH EVAL FNA 88173 $338.00DIFFUSION CAPACITY (DLCO) 94729 $338.00LIDOCAINE JELLY [2% TUBE] $338.55

86

T M JOINTS 70330 $338.87QUIXIN OPTH SOLN [0.5% 5M $339.63OMINICON $340.00HYDRO INSUFF IRRIGATION $340.00Isovue-250 100 ml Q9966 $340.92TROCAR 11MM-B11LPH $341.00CAST LONG ARM 29065 $341.00SO N-TELOPEP-X-LINK SERUM 82523 $341.00BUTRANS DIS [ 5MCG/HR] $341.84ARROW INTRO KIT $342.00ER PHYS CLSD-METATARSAL W/O MANIP 28470 $342.00Darbepoetin Inj (10mcg/0.4ml) $342.87TRAY TRACOTOMY $344.00INTMD RPR FACE/MM >30.0 CM 12057 $344.00HLA-B5701 TYPING 81381 $344.00CYTOPATH CELL ENHANCE TC 88112 $344.00ORBITS 70200 $344.02AIR ANKLE SPLINT/RIGHT $345.00SPINE THORACIC/SWIM 72072 $345.05US OB LIMITED MEASURE 76816 $345.05naloxone IVPB 2 mg/ 500 $345.24PHYSOSTIGMINE [1MG/1ML 2M $346.69TRAY BONE BIOPSY $348.006625-127-105: PRECISION SAW BLADE $348.00LT RIBS 71101 $349.17RT RIBS 71101 $349.17INJECTION INTERMEDIATE JOINT W US 20606 $350.00US INJECTION MAJOR JOINT W US 20611 $350.00PROCALCITONIN 84145 $350.00WOUND VAC SERVICES < / = 50 CM 97605 $350.00INJ FORAMENT EPIDURAL L/S ADDL LVLS 64484 $350.20Cervical/Thoracic Facet Injection Lvl 2 64491 $350.20Cervical/Thoracic Facet Inj Lvl 3+ 64492 $350.20Lumbar/Sacral Facet Inj Level 2 64494 $350.20Lumbar/Sacral Facet Inj Level 3+ 64495 $350.20PARANASAL SINUS XRY 70220 $350.20CHEST 4 VIEW XRY 71048 $350.20TOBRADEX OPHTH SUSP [0.3% $350.57CAST-LONG ARM $351.00ER PHYS REPAIR OF NAIL BED 11760 $351.00ER PHYS CRITICAL CARE ADDL 30 MIN 99292 $351.00TROCAR-B12LPH $352.00

87

ER PHYS I&D UP ARM/ELBOW 23931 $352.00SO NMDA RECEPTOR AB CSF 86255 $353.00US PELVIC 76856 $354.32AVULSION/NAIL PLT SIMPLE 11730 $355.00FLUOCINONIDE CREAM [0.05 $355.29AR-1204AS-85: 8.5MM FLIP CUTTER $356.00AR-1204AS-80: 8.0MM FLIP CUTTER $356.00ER PHYS RPR INTERMEDIATE S/A/T/E 2.6-7. 12032 $356.00INSITU HYBRIDIZATION TECH 88368 $356.00M/S OVS 1 HR G0378 $356.00FLUOCINONIDE TOPICAL SOLN $358.38MANDIBLE XRY 70110 $359.47STERILE TALC POWD 5GM $359.50NAROPIN 0.2% FEMORAL BLOC J2795 $359.79CAUTERY SUPPLIES $360.00ER PHYS 2.6-7.5CM SIMPLE S/N/AX/GEN/TRNK 12002 $360.00SUGAMMADEX 200mg/2ml inj $360.36HIPS BILATERAL 73521 $360.50MILLER ABBOTT TUBE $361.00SPLINT LEG LONG 29505 $361.00Kappa/ Lambda lc/f ratio re to imm 83883 $361.00SO EPS BARR DNA QN PCR 87799 $361.00ER CLASS II 99282 $361.00RhoGam J2790 $361.69SULFACETAMIDE/SULFLUR 10-5 $361.89PNEUMOCOCCAL 23 VACCINE 90732 $361.95NIFEDEPINE/HC CREAM 2/2.5 [30GM] $362.27SPINE BENDING 2/3 VIEWS 72120 $362.56SO HEP C RNA-PCR-QUAL 87521 $363.00PILOCARPINE HCL OPHTH [1% $363.32ET CO2 MONITORING 94770 $365.00INJ WRIST ARTHROGRAM 25246 $365.65C SPINE 4-5 VIEWS 72050 $365.65US OB LIMITED 76815 $365.65DXA BONE DENSITY STUDY 77080 $365.65BUTRANS DIS [10MCG/HR] $365.94buprenorphine Patch weekly * 10 mcg/hr b $365.94HYDRALAZINE INJ [20MG/ML $366.14CORTROSYN INJ [0.25MG] J0834 $366.61FACIAL BONES XRY 70150 $367.71BCR-ABL1 Gene Qnt PCR P190 81207 $368.00BONIVA INJ [3MG/3ML KIT] J1740 $368.50

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TRAY-THOR W/ NEEDLE $369.00ASPIRATOR $369.00TISSUE EXAM PATHOLOGIST-9 88309 $370.00CT NON-IONIC 300 50 ML Q9967 $370.80Microslide Consultation 88323 $371.00Precedex $371.38BENTYL INJ [10MG/ML] J0500 $371.63CICLOPIROX GEL [0.77% 30G $371.88CATH FOGERTY IRR $372.00CATH ARTERIAL EMBOL 4FR $372.00CATH ARTERIAL EMBOL 3FR $372.00CATH FROGERTY IRRIG 6FR $372.00ER PHYS AVLN/NAIL PLT - SMPL EA ADD 11732 $372.00ER PHYS EVACUATION SUBUNGUAL HEMATOMA 11740 $372.00ER PHYS CAST HAND & LOWER FOREARM 29085 $372.00ER PHYS APPLICATION FINGER SPLINT 29130 $372.00ER PHYS APPLICATION SHORT LEG CAST 29405 $372.00ER PHYS APPLICATION SHORT LEG SPLINT 29515 $372.00ER PHY FEE/KNEE IMMOBILIZER 29530 $372.00ER PHYS ANKLE STRAPPING 29540 $372.00ER PHYS CTRL NASAL HEMO ANT - CMPLX 30903 $372.00PROF ECHO TRANSTHO W/WO CONT 93308 $372.00ER PHYS FRACTURE PHALANGEAL 26720 $373.00ER PHYS TRMT FX TOE W/O MANI 28490 $373.00TESTOSTERONE CYPIONATE IM $373.50ER PHYS PUSH TRANSFUSION 36440 $374.00SO (1-3) BETA-D-GLUCAN FU 84311 $374.00Remicade ( Infliximab) Act and Neut. Ab 86352 $374.00ER PHY LEVEL 4 EXAM 99284 $374.00PERITONEAL LAV KIT $375.00US ECHO LIMITED SPECTRAL DOPPLER 93321 $375.00CHOLESTYRAMINE PWD [378GM $375.66ALDARA CREAM [ 5%] $375.70ER PHYS CRTL NASAL HEMOR/POSTERIO 30905 $376.00MA SURGERY SPECIMAN 76098 $378.01FORTICAL SPRAY [200 IU/SP $378.90ER PHYS INCISION/DRAIN/HEMATOMA 10140 $379.00DRSG/DEBRIDE W/O ANES - LG 16030 $379.00ER PHYS REMOVAL FB INTRANASAL 30300 $379.00ER PHYS REMOVAL FB NOSE W ANESTH 30310 $379.00Isovue-M 300 Q9967 $379.45PIHYS NITIAL OBSERVATION CARE/DAY 50 MIN 99219 $381.00

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PHYS OBSERVATION CARE 50 MIN 99219 $381.00Clindamycin Phosphate topical 1 % Gel (3 $381.64NEOSPORIN GU IRR [MDV 5M $382.50ER PHYS FNA W/O IMAGING 10021 $383.00Varicella Zoster Virus Quant. PCR 87799 $383.00PROTOPAM CHLORIDE INJ [1G J2730 $383.04AZELASTINE OPTH DROP [0.0 $383.15SKULL XRY 70260 $383.16ERYTHROMYCIN INJ [500MG] J1364 $384.13HIP PACK $386.00HIP PAC $386.00TRAY-THOR W/CATH $387.00SO PROSTAGLANDIN D2 URINE 84150 $387.00INSITU HYBRID (FISH) TC 88365 $387.00SPINE THORACIC COMP XRAY 72074 $387.28AZELASTINE HCL NASAL SPRA $387.36CAST LONG LEG 29345 $388.00ORTHOPEDIC PACK $389.00WEDGE EXC - INGROWN NAIL 11765 $389.00SO ALPHA-GALACTOSIDAS -SER 84311 $390.00CLOBETASOL CREAM [0.05% 3 $390.03DANTRIUM IV INJ [20MG] $391.43LITHIUM CITRATE SYR [8MEQ $391.63LINDANE LOTION [1% 2OZ] $391.71LINDANE SHAMPOO [1% 2OZ] $391.71ZOMIG NASAL SPRAY [5MG 1- $392.79NM MAG3 Tc-99m A9562 $393.46ER PHYS TX SUPERFICIAL WOUND SIMPLE 12020 $395.00CMPLX RPR F/C/C/M/N/AX/G/H/F 1.1-2.5 CM 13131 $395.00REPEAT CONTROL OF NOSEBLEED 30906 $395.00Leptospira DNA Qualitative PCR 87798 $395.00DEPO-ESTRADIOL INJ [5MG/M $395.54HOME SLEEP TEST/TYPE 3 95806 $396.00FLU A & B BY PCR 87502 $397.00ALBUMINAR (ALBURX 25) IN P9047 $397.30SPIRIVA CAP HANDIHALER [5 $397.98CATH FOGTY VEN EMB $398.00CATH FOGTY VEN THROM $398.00SUCTION-IRR SIMPULS $398.00CAST- LONG LEG $399.00SUPRAPUBIC CATH $399.00HAND BILATERAL LIMITED 73120 $404.00

90

SO JC VIRUS - PCR QUANT 87798 $405.00OCUFLOX OPTH [0.3% 5 ML] $405.48NM LEXISCAN J2785 $405.82PREDNISOLONE OPHTH DROPS $406.44TISSUE EXAM TECH COMP-7 88307 $408.00CANDIDIA ALBICANS SKIN TE $408.34PICC LINE INSERTION >5YRS 36569 $409.00PHYS OVS ADMIT/DISCH L 2 99235 $409.00FISTULAGRAM/SINUS X 76080 $410.97SURGI-LAV $411.00PLEUR EVAC $412.00ER PHYS INTMD RPR N-HF/GENIT2.6-7.5 12042 $412.00ER PHYS TX WRIST BONE FRACTURE 25630 $412.00ER PHYS TRMT PATELLAR DISLOCATION 27560 $412.00PHYS TATTOO STOMACH (UNLISTED PROCEDURE) 43999 $412.00PHYS COLONOSCOPY W/ TATTOO 45381 $412.00CATH ANTERIAL EMBOL 5FR $413.00INJ HIP ARTHROGRAM 27093 $414.06INJ KNEE ARTHROGRAM 27370 $414.06US ECHO COLOR DOPPLER 93325 $414.06CILOXAN OPHTH SOLN 0.3% $414.78CATH CENTRAL VENOUS M/L $415.00BIOPSY FORCEP W/NEE $415.00Chronic Urticaria Panel 2 Comp. $415.00US BREAST LT 76641 $415.09RT US BREAST 76641 $415.09US BREAST BCC LT 76641 $415.09RT US BREAST BCC 76641 $415.09TROCAR 35NLT $416.00ER PHYS KNUCKLE DISLOCATION 26705 $417.00RIBS BILATERAL XRY 71111 $417.15JAK 2 GENE 81270 $418.00ISOPTO CARPINE OPHTH SOLN $419.62ciprofloxacin oral susp (500 mg/5 ml bt $419.76ABDOMEN 3+VIEWS 74021 $421.27ABDOMEN COMP XRY 74022 $421.27US AMNIOCENTESIS 76946 $421.27Amphetamine-Dextroamphet ER CAP [30MG] $422.56ER PHYS TX CLOSED ELBOW DISLOCATE 24600 $423.00X-RAY INJ INTERMEDIATE JOINT 20605 $423.33DENAVIR CR. [1% CR. 1.5GM $423.65CLOTRIMAZOLE/BETAMETHASON $424.47

91

RESPIRATORY MONITORING $425.00INTMD RPR N-HF/GENIT 2.5CM/< 12041 $425.00INTMD RPR N-HF/GENIT2.6-7.5 12042 $425.00INTMD RPR FACE/MM 12.6-20 CM 12055 $425.00REDUCTION/NURSEMAID ELBOW 24640 $425.00LONG ARM SPLINT 29105 $425.00ER SHORT LEG SPLINT 29515 $425.00SO WEST NILE PCR CSF 87798 $425.00INFLOW TUBING $426.00TROCAR-355L $426.00ER PHYS 7.6-12.5CM SMPLE S/N/AX/GEN/TRNK 12004 $426.00VIGAMOX OPHTH DROPS [0.5% $426.89AMB.TREATMENT & RELEASE A0999 $427.00RELISTOR INJ [12/0.6ML] J2212 $427.38LUMIGAN OPHTH DROPS [0.03 $427.47levothyroxine Inj 100 mcg $427.49AZASITE SOL 1% OPHTH [BT $428.19I & D SIMPLE ABCESS 10060 $429.00ESOPHAGUS XRY 74220 $429.51ER PHYS 5.1-7.5CM SIMPLE F/E/E/N/L/M 12014 $430.00CT Isovue-370 100ml Q9967 $430.80GASTRIC LAVAGE KIT $431.00CATH BILARY PROBE 5FR $431.00ED Contrl nasal hemorrhage-anterior-simp 30901 $431.00GASTRIC INTUBATION 43753 $433.00ZYMAXID OPHTH DROPS [0.5% $433.88ASP/INJ MAJOR JOINT 20610 $434.00ER PHYS FRACTURE CALVICLE 23500 $434.00ER PHYS ABSCES PERITONSILLAR 42700 $434.00SO HEMOCHROMATOSIS DNA 81256 $434.00INJ SHOULDER ARTHRO 23350 $434.66NM THYROID UPTAKE 78012 $434.66BACITRACIN OPH OINTMENT $434.88METRONIDAZOLE VAGINAL [0. $436.42ASP/ INJ INTERMEDIATE JNT 20605 $437.00AR-2323BCC: BIO-COMP SWVLCK CLD 5.5X19.1 $438.00ED FNA W/O IMAGING 10021 $438.00LACER 2.6-7.5 CM SIMPLE S/N/AX/GEN/TRNK 12002 $438.00AR-1923BC: BIO-COMP-SITE PLCK 2.9X15.5MM C1713 $438.00ER PHYS DRSG/DEBRIDE W/O ANES - LG 16030 $439.00STAPLE RELOADER $440.00Iron Sucrose *IVPB* [200MG/NS 100ml] $440.50

92

BONE SURVEY MET 77075 $440.84TROCAR 512ON $443.00ASP/ABCESS HEMATOMA/CYST 10160 $444.00NITROPRESS [50MG/2ML IV F $445.30Nitroprusside [50mg/250ml D5W] $445.30Coxsackie B (1-6) Antibodies serum 86658 $446.00umeclidinium and vilanterol 62.5 mcg-25 $446.55QVAR HFA AERO INHAL [40MC $446.626197-9-010: TOBRAMYCIN CEMENT $447.00LACER 2.5 CM SIMPLE F/E/E/N/L/M 12011 $447.00ER PHYS KNUCKLE DISLOC W ANESTHES 26705 $447.00TOBI NEB [300MG/5ML] $448.77ER PHYS RPR INTERMEDIATE S/A/T/E 7.6-12 12034 $449.00ER PHYS INTMD RPR FACE/MM 2.6-5.0 CM 12052 $449.00D.H.E. 45 INJ [1MG/ML] J1110 $449.84DORZOLAMIDE-TIMOLOL OPHTH $449.86CLOSED TX ULNAR SHAFT FRACTURE W/O MANIP 25530 $450.00CLOSED TX ULNAR SHAFT FRACTURE W/MANIPUL 25535 $450.00TX FX RADIUS/ULNA W/O MANIPULATION 25560 $450.00TREAMENT OF THUMB DISLOCATION 26641 $450.00TX CLOSED HIP DISLOCATION W/O ANESTHESIA 27250 $450.00DISCOGRAPHY CERV/THOR SPINE 72285 $450.00DISKOGRAPY LUMBAR 72295 $450.00US SOFT TISSUE CHEST AND/OR UPPER BACK 76604 $450.00US SOFT TISSUE ABD WALL AND/OR LOWER BAC 76705 $450.00X-RAY SNIFF TEST 76000 $450.11FLUOROSCOPY INDEPN UP TO 1HR 76000 $450.11SO JCV AB INHIBITION 86790 $451.00BETAMETHASONE DIPROP 0.05 $451.19REMOVAL PHARYNX FOREIGN BODY 42809 $452.003D RENDER W/INTRP POSTPROCESS 76377 $452.00ERTAPENEM *IVPB* [1GM/NS 50ml] $452.50INVANZ INJ [1GM] J1335 $452.50PEPCID LIQ [40MG/5ML 50ML $454.00PERMETHRIN CRM 5% [60GM] $454.00SO FACTOR V LEIDEN TIER 1 81241 $454.00TRACHEOSTOMY TUBE $455.00I&D PILONIDA CYST - SIMPLE 10080 $455.00CTRL NASAL HEMOR-ANT-CMPL 30903 $455.00NYSTATIN/TRIAM CR [30GM] $455.16GLYCOPYRROLATE INJ [0.2MG $455.87TROCAR-512SD $457.00

93

MIOCHOL-E INTRAOCULAR [1 $457.13INTRAOP CYTO PATH CSLT-PR 88333 $458.00M/S OVS HIGH ACUITY FIRST HOUR G0378 $458.00INTUBATION 31500 $458.35PHYS OVS ADMIT/DISCH L 3 99236 $459.00PACU 30 MIN RECOVERY $460.00AR-2324BCM: 4.75 SWIVEL LOCK C1713 $460.00SPINE CERVI/CMP XRY 72052 $461.44SPINE LUMBAR 4 VIEW 72110 $461.44BICILLIN L-A INJ [ 60000 $461.91LACER 2.6- 7.5 CM SIMPLE F/E/E/N/L/M 12013 $463.00NM CARDIOLITE <40 MILLICU A9500 $463.50ER PHYS REDUCT/NURSEMAID ELBOW 24640 $464.00NG TUBE PLMT BY DR 43752 $464.00SO THIOPUR MTHYLTR-TIER 1 81401 $464.00ER PHYS CMPLX RPR S/A/L 1.1-2.5 CM 13120 $465.00SO HIV GENO DRUG RESIST 87901 $468.00SO DNA ANALYSIS 88182 $470.00ER PHYS INTUBATION 31500 $474.00CATH CYSTIC DUCT CH $475.00STAPLE RELOADER $476.00Zika Virus RNA Qualitative - PCR 87798 $476.00ER PHYS ASP/ABCESS - HEMATOMA/ CYST 10160 $478.00INTMD RPR FACE/MM 2.5 CM/&lt 12051 $478.00REMOVAL OF FOREIGN BODY- ARM 24200 $478.00ED HUMEROUS OR ELBOW PROCEDURE 24999 $478.00ER PHYS APPLICATION OF RIGID LEG CAST 29445 $478.00BLD ADMIN 1 UNIT 36430 $478.00BLD ADMIN FEE 1 UNIT 36430 $478.00ASPIRATION/INJ SM JOINT 20600 $479.00Braf Gene 81210 $480.00VITAMIN D CAP [50000 IU $480.50LACER 7.6-12.5 CM SIMPLE S/N/AX/GEN/TRNK 12004 $481.00LACER 5.1-7.5 CM SIMPLE F/E/E/N/L/M 12014 $481.00Change desrcription to match $483.00ER PHYS I&D ABCESS COMP/MULTI 10061 $484.00ER PHYS EXC- NAIL & MATRIX PERM 11750 $484.00ER PHYS REMOVE FB/MUSC/TEND/SHE 20520 $484.00ADDUCTOR CANEL BLOCK INJ 64447 $484.10ER PHYS DISLOC METACARPOPHALANGEA 26700 $485.00Change PEG Tube w/out imaging 43760 $486.00ED Change of Cystostomy tube simple 51705 $486.00

94

BCR-ABL1 Gene Qnt PCR P210 81206 $486.00JAK2 V617F Qualitative Leumeta 81270 $487.00SO CHROMOSOM ANYLS PERIPH 88230 $489.00Kras Gene Additional variants Path 81276 $490.00PFT SPIRO PRE AND POST 94060 $490.0072202468: FAST FIX 360 CURVED NEEDLE $493.00KNEE BILAT 2 VIEW 73560 $493.37BICILLIN C-R INJ [1.2MU/2 J0558 $493.60BICILLIN C-R INJ [900/300 $493.61ER PHY LEVEL 5 EXAM 99285 $495.00ZOSTAVAX INJ [0.65ML] $495.79ER PHYS CLOSED TX ULNAR SHAFT FX WO MANI 25530 $496.00SO BK VIRUS PCR PLASMA 87799 $496.00SO BK VIRUS QT- URINE 87799 $496.00SO BK VIRUS QT BLOOD 87799 $496.00BLEPHAMIDE OPHTH OINT S.O $497.35sodium polystrene Powder *Bottle* (15 gm $498.50CTRL NASAL HEMOR-POSTERIO 30905 $499.00BRIMONIDINE 0.2% OPHTH [ $499.09US FNA ADD LESION 10006 $500.00OVS ADMIT LEVEL 3 99220 $500.00REMOVAL/BIVALVING FULL ARM/FULL LEG CAST 29705 $501.00SO AQUAPORIN-4 RECP AB 83516 $502.00HUMALOG [10ML VIAL ECF O $502.96PHYS CRITICAL CARE 30-74 MIN 99291 $503.00ER PHYS INTMD RPR N-HF/GENIT7.6-12.5 12044 $504.00CLOSED TX HUMERUS FRACTURE 24576 $504.00PHYS CARDIOVERSION 92960 $507.00INTMD RPR N-HF/GENIT12.6-20 12045 $508.00LACER 7.6-12.5 CM SIMPLE F/E/E/N/L/M 12015 $510.00Olopatadine HCl Ophthalmic Solution 0.2 $510.82TREATMENT OF TOE FX 28515 $511.00SO RECEPTOR ASSY-ESTROGEN 84233 $511.00SO RECEPTOR ASSY-PROGEST 84234 $511.00Iron Sucrose [300MG/NS 250ml] $512.50acetylcysteine IV in D5W J0132 $512.50LACER 20.1-30.0CM SIMPLE S/N/AX/GEN/TRNK 12006 $513.00EMB CATH $514.00ER PHYS FRACTURE LOWER LEG 27825 $514.00PHYS INCISION REMOVE FB SUBQ TISS SIMPLE 10120 $515.00PHYS DEBRIDE MUSCLE/FASCIA EA ADD 20SQCM 11046 $515.00PHYS REMOVAL SKIN TAGS ANY AREA UP TO 15 11200 $515.00

95

PHYS SHAVE SKIN LESION .5cm OR LESS 11310 $515.00PHYS EXC B9 S/N/H/F/G 1.1-2.0 cm 11422 $515.00ASPIRATION/ INJ OF JOINT 20605 $515.00ER PHYS SHORT ARM CAST 29075 $515.00PHYS THORACENTESIS WO IMAGING 32554 $515.00PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO 55000 $515.00FL FEEDING TUBE INS 74340 $515.00US BREAST BILAT COMPLETE 76641 $515.00LACER 12.6-20.0CM SIMPLE S/N/AX/GEN/TRNK 12005 $516.00ER PHYS LIGTN OF EXTEMITY ART 37618 $516.00zoster vac recomb adjuvanted (0.5 ml) $517.23ADVAIR DISKUS 250/50MCG [ $518.32ADVAIR DISKUS 100/50MCG [ $518.32METRONIDAZOLE CREAM [0.75 $518.55LANTUS INSULIN [10ML VIA $518.90SO CMV QUANT BY PCR 87497 $519.00SO CMV QUANT PCR BLOOD 87497 $519.00APIDRA (RAPID ACTING) IN $519.61VCUG XRY 74455 $520.15HUMALOG 75/25 MIXTURE [10 $520.96ER PHYS CARDIOVERSION 92960 $522.00ACTIVASE INJ [CATHFLO 2MG J2997 $522.78INJ FORAMEN EPIDURAL L/S BILAT ADDL LVLS 64484 $525.30Cervical/Thoracic Facet Inj Lvl 2 Bilate 64491 $525.30Cervical/Thoracic Facet Inj Lvl 3+ Bilat 64492 $525.30Lumbar/Sacral Facet Inj Lvl 2 Bilateral 64494 $525.30Lumbar/Sacral Facet Inj Lvl 3+ Bilateral 64495 $525.30DISSECTOR-5DCD $526.00PHY ABDOMINAL PARACENTESIS W/O IMAGE GU 49082 $526.00ER PHYS TX FX RADIUS/ULNA W/O MANIP 25560 $527.00NOVOLOG INJ [100/ML 10ML $529.34CYSTROGRAM XRAY 74450 $529.42SMALL BOWEL XRY 74250 $530.45ER PHYS DEBRIDE INFECTED SKIN 11000 $531.00INTMD RPR N-HF/GENIT7.6-12.5 12044 $531.00INTMD RPR FACE/MM 2.6-5.0 CM 12052 $531.00INTMD RPR FACE/MM 7.6-12.5CM 12054 $531.00ER PHYS CMPLX RPR TRUNK 1.1-2.5 CM 13100 $531.00ER PHYS REPAIR COMPLEX TRUNK EA ADD 5 CM 13102 $531.00CMPLX RPR S/A/L 2.6-7.5CM 13121 $531.00CMPLX RPR E/N/E/L 1.1-2.5CM 13151 $531.00TREATMENT OF NASAL FX 21320 $531.00

96

CLOSED TX TMJ DISLOCATION 21480 $531.00ER PHYS JAW TX DISLOCATION 21480 $531.00TMT OF DIST ELBOW WO ANET 24600 $531.00CLOSED TX DISLOC ELBOW 24605 $531.00TENDON REPAIR-FOREARM 25260 $531.00CLOSED TX FOREARM FX 25565 $531.00DISLOC METACARPOPHALANGEA 26700 $531.00FX WITH MANIP PHALANX 26725 $531.00CL TX FINGER FRACTURE EACH 26755 $531.00TENDON REPAIR INFRAPATELL 27380 $531.00CLSD REDU PROX TIBIAL FX 27532 $531.00CLOSED REDUCT DISLOC KNEE 27552 $531.00DISLOCATION LITTLE TOE 28660 $531.00ER PHY REMOVE TUNNELED CV CATH W/O PORT 36589 $531.00INCISION & DRAINAGE 46050 $531.00I&D VULVA/ PERINEAL ABSCE 56405 $531.00ER PHYS CATERY CERVIX 57510 $531.00SCISSORS-DCS12 $532.00US UPPER EXTREMITY ARTERIAL RT 93931 $532.51US UPPER EXTREMITY ARTERIAL LT 93931 $532.51ER PHYS12.6-20.0CM SMPLE S/N/AX/GEN/TRNK 12005 $533.00ASMANEX AER [220MCG 30] $533.05ER PHYS REMOVAL FOOT FOREIGN BODY 28190 $534.00US THYROID/NECK 76536 $534.57LUMBAR PUNCTURE 62270 $535.60US BIOPHYS PROFILE 76818 $537.66SWALLOWING EVAL COMP (2) 92610 $537.66SWALLOWING EVAL FLOU COM2 92611 $537.66CHANTIX STARTER TAB PAK $539.91ER PHYS RPR INTERMED S/A/T/E 12.6-20.0CM 12035 $540.00CORTISPORIN 1% OINT [15 $542.54US DRAINAGE RT LEG 27603 $545.90US DRAINAGE LT LEG 27603 $545.90PNEUMOTHORAX SET $546.00ER PHYS COMPLEX WOUND REPAIR 2.5-7.5 CM 13121 $546.00LACER 12.6-20.0 CM SIMPLE F/E/E/N/L/M 12016 $547.00BAL IN OIL AMP [100MG/ML $547.58NOVOLOG 70/30 MIXTURE [EC $548.71HOSPITALIST US ARTERIAL LINE 36620 $550.00LT WRIST ARTHRO 73115 $552.08RT WRIST ARTHRO 73115 $552.08ER PHYS LUMBAR PUNCTURE 62270 $553.00

97

WATER STERILE IRR 1000 CASE $557.00EPINEPHRINE INJ [0.3MG A J0171 $557.00TYGACIL INJ [50MG] $558.35ER PHYS INTMD RPR FACE/MM 5.1-7.5 CM 12053 $559.00DISP TROCAR $560.00Mycobacteria PCR, culture and smear, res $560.00SO HEP C RNA-PCR-QUANT 87522 $560.00Huntington Disease Mutation Analysis 81401 $562.00BIOPSY SHOULDER SOFT TISSUE 23066 $562.38L SPINE COMPLETE + ADD VIEWS 72114 $562.38HYSTROSALPINGOGRAM 74740 $562.38ER PHYS TENDON REPAIR 26370 $563.00ER PHYS THUMB DISLOCATION 26641 $563.00TREAT TOE DISLOCATION 28635 $563.00TREAT TOE DISLOCATION 28635 $563.00INCISION THROMBOSED HEMORRHOID EXTERNAL 46083 $563.00LEVEMIR INSULIN [VIAL] $563.16US OB LIMITED/MEASURE/2 76816 $563.41CLOSED REDUCT WRIST 25605 $564.00LUMBAR PUNCTURE 62270 $565.47L PUNCTURE MYELOGRAM 62304 $565.47PHYS I & D ABSCESS SIMPLE 10060 $567.00INCISION DRAINAGE ABSCESS 10060 $567.00PHYS I & D HEMATOMA SEROMA/ FLUID 10140 $567.00PHYS PUNCTURE ASPIRATION ABSCESS HEMATOM10160 $567.00PHYS DEBRIDEMENT REPAIR/MUSCLE 11043 $567.00PHYS ADD 20 SQ CM TISSUE 11045 $567.00PHYS PARING BNGN HYPERKERATITIC LSN >4 11057 $567.00PHYS BX SKIN SUBQ MUCOUS MEMBRANE 1 LES 11100 $567.00PHYS SHAVE BX DERMAL T/A/L .5CM OF LESS 11300 $567.00PHYS SHAVE BX SKIN LESION 0.6-1.0 CM 11301 $567.00PHYS EX TRUNK EXT B9 0.5CM< 11400 $567.00PHYS COMPLEX WOUND REPAIR ADD 5CM 13122 $567.00ER PHYS REPAIR COMPLX EYE/NOSE/EAR/LIP 13153 $567.00PHYS DESTRUCTION PREMALIG LESION 1ST 17000 $567.00ASP/INJ MAJOR JT 20610 $567.00ASPIRATION OR INJ OF LARGE JOINT 20610 $567.00PHYS THORACENTESIS W IMAGING 32555 $567.00PHYS DILATION OF ESOPHAGUS 43450 $567.00PHYS REMOVAL OF ANAL TAGS 46230 $567.00ER PHYS EXC THROMOSED HEMORRHOID 46320 $567.00PHYS REMOVAL HEMORRHOID CLOT 46320 $567.00

98

PHYS NEEDLE BX LIVER ADD-ON 47001 $567.00PHYS I & D BARTHOLINS GLAND 56420 $567.00US SCROTAL 76870 $567.53KNEE DISLOCATION TREATMENT 27550 $569.00JAK2 V617F Qualitative Exon 12 81403 $569.00JAK2 V617F Qualitative Exon13 81403 $569.00COcaine 20% SOLUTION [10ml] $569.98CRITICAL CARE ADD/30 MIN 99292 $571.00METHYLENE BLUE [1% 10ML S $572.30methylene blue (1% 100 mg/10 mL) $572.30LACER 20.1-30.0 CM SIMPLE F/E/E/N/L/M 12017 $573.00INJ DRAINAGE ASP C-T SPINE OR CORD 62320 $573.71INSITU HYBRID (FISH) PRO 88365 $574.00CHEK2 sequencing and deletion/duplicatio 81479 $577.00THORACENTESIS W IMAGING 32555 $578.86ER PHYS 7.6-12.5 CM SIMPEL F/E/E/N/L/M 12015 $583.00LACER REPAIR INTERMEDIATE S/A/T/E 7.6-12 12034 $584.00INTMD RPR FACE/MM 5.1-7.5 CM 12053 $584.00ER PHYS THORACENTESIS PLEURA WO IMAGING 32554 $584.00ESOPHAGOSCOPY W REMOVAL OF FB 43215 $584.00ER PHYS PARACENTESIS W IMAGING GUIDANCE 49083 $584.00REMOVAL FOREIGN BODY EXTERNAL EAR 69200 $584.00ER PHYS CMPLX RPR E/N/E/L 1.1-2.5CM 13151 $585.00BRINZOLAMIDE-BRIMONIDINE OPHTH SUSP. [1- $585.36STAPLER-XR60G $586.00STAPLE TX60B $587.00REMOVAL TUNNELED CV CATH W/O PORT/PMP 36589 $587.00BELLADONNA & PHENOBARBITA $590.91TREAT DISLOCATION/FX SHOULDER 23665 $591.00ASPIRATION PLEURA W/O IMG 32554 $591.00PHYS PICC LINE INSERTION >5YRS 36573 $591.22US THYROID CYST ASPIRATION 60300 $591.22INTEGRILIN INJ [2MG/ML 10 J1327 $592.61KNEE BILAT 3 VIEW 73562 $594.31ER PHYS INTMD RPR N-HF/GENIT12.6-20 12045 $596.00ER PHY RPR F/C/C/M/N/AX/G/H/F 1-2.5 CM 13131 $596.00US GUIDE NEEDLE PLACEMENT 76942 $596.00CMPLX RPR F/C/C/M/N/AX/G/H/F ADDTNL 5CM 13133 $597.00THORACENTESE PLEURA W IMAGING 32555 $597.00TISSUE EXAM TECH COMP-9 88309 $597.00EVIVA STANDARD NEEDLE $600.00NRAS Gene variants Exon 2&3 81311 $603.00

99

SO HEPTIMAX HCV RNA 87522 $603.00ED-ZOMIG NASAL SPRAY [5MG $606.28HIV-1 GENOTYPE 87901 $607.00ER PHYS I& REMOVE FB SUBQ COMP 10121 $608.00TREAT RADIUS FRACTURE 24655 $609.00ER PHYS ED PICC LINE PLACEMENT 36569 $609.00US OB 76805 $609.76BICILLIN L-A INJ [1200000 $610.95SO MOPATH LEVEL 2 - CROHN 81401 $611.00BARIUM ENEMA 74270 $611.82CUTTER-TR35W $613.00ON-Q C-BLOC PUMP A4306 $613.00bupivacaine liposome 1MG injection (10ml $614.49PHYS GASTROI W REMOVAL FB 43247 $615.00ED FNA BX W/ US GUIDANCE 10005 $616.00TIMOLOL GEL SOL OPHTH [0. $616.86indigo tindisulfonate Amp (0.8 % 40 mg/5 $617.23PHYS DEBRIDEMENT INFECTED SKIN UP TO 10% 11000 $618.00PHYS SHAVING LESION S/N/H/F/G 1.1-2.0 CM 11307 $618.00PHYS SHVG SKIN LN F/E/E/N/L/M 1.1-2.0CM 11312 $618.00PHYS EXCISION BENIGN F/E/E/N/L/M 0.5CM< 11440 $618.00PHYS MUSCLE BIOPSY SUPERFICIAL 20200 $618.00ER PHYS HUMERUS & ELBOW FRACTURE 24576 $618.00PHYS DX BRONCHOSCOPE/WASH 31622 $618.00PHYS I & D PERIANAL ABSCESS SUPERFICIAL 46050 $618.00PHYS INCISION THROM HEMORRHOID 46083 $618.00PHYS ABD PARACENTESIS 49083 $618.00PHYS EXCISION BARTHOLIN'S GLAND LESION 56740 $618.00DRAINAGE EXTERNAL EAR ABSCESS 69000 $618.00ER CLASS III 99283 $618.00APPLIER $620.00LACER OVER 30CM SIMPLE S/N/AX/GEN/TRNK 12007 $620.00TX SUPERFICIAL WOUND; SIMPLE CLOSURE 12020 $620.00SUPRAX SUSP [100/5ML 50M $620.97TOBRAMYCIN INJ [1.2GM] $621.00CPAP/BiPAP VENT 94660 $623.00STAPLER-XR60B $631.00LT US LWR ARTERIES 93926 $632.42RT US LWR ARTERIES 93926 $632.42TRIFLURIDINE OPH DROPS [1 $632.73ER PHYS TRMT FRACTURE RADIUS W/O 25600 $633.00ER PHYS RPR INTERMED S/A/T/E 20.1-30.0CM 12036 $634.00

100

LACER RPR INTERMED S/A/T/E 12.6-20.0CM 12035 $637.00PERCUT PINNING OF THUMB 26650 $637.00REMOVAL FOREIGN BODY FOOT 28190 $637.00BLD OPT ADMIN FEE 2 UNIT 36430 $637.00ED BLD ADMIN FEE 2 UNITS 36430 $637.00PHYS ER SPINAL TAP W DRAINAGE OF FLUID 62272 $637.00Aquaporin-4 (AQP4) Ab NMO-IgG Elisa 83516 $637.00DELESTROGEN INJ [20MG/ML J1380 $637.04CPR-RESPIRATORY ARREST 92950 $639.63SO NEUROMYO OPT NMO AB 86255 $640.00CUTTER-TLC55 $641.00ER PHYS TENDON REPR-FOREARM PRI 25260 $641.00US RENAL 76770 $645.81SO KRAS MUTATION ANALYSIS 81275 $647.00Microsatellite Instability Path 81301 $647.00SONOHYSTEROGRAM 76831 $649.93X-RAY CATH/ DRAIN REMOVAL 49422 $650.00BONIVA TAB [150MG] $650.08ER PHYS SEC CLOSURE SURG WOUND DEHSN 13160 $651.00Flovent Diskus 100mcg (60 doses) $656.31ER PHYS REDUCTION/ANKLE FRAC/MAN 27810 $658.00LT SHOULD ARTHROGRAM 73040 $658.17RT SHOULD ARTHROGRAM 73040 $658.17TX SUPERFICIAL WOUND WITH PACKING 12021 $659.00INTMD RPR N-HF/GENIT20.1-30 12046 $659.00INTMD RPR FACE/MM 20.1-30.0 12056 $659.00CPR 92950 $659.00CPR 92950 $659.00ER PHYS CARDIOPULMONARY RESUSCITATION 92950 $659.00TRAVATAN OPHTH SOLN [0.00 $660.28MAXITROL OPHTH OINT [0.1% $663.34US OB MULTI GESTATION 76810 $664.35ER PHYS FRACTURE METACARPAL 26600 $665.00Clopidogrel Plavix 81225 $665.00WOUND VAC SERVICES > 50CM 97606 $665.00LT US EXT VEINS 93971 $666.41RT US EXT VEINS 93971 $666.41UPPER G I XRY 74246 $669.50PHYS I & D PILONIDAL CYST SIMPLE 10080 $670.00PHYS EXC BRST LES PREOP PLMT RAD EA ADD 19126 $670.00ARTHROCENTESIS ASP JOINT W US 20611 $670.00PHYS TREAT RADIUS FRACTURE 24655 $670.00

101

ER PHYS INTMD RPR FACE/MM 7.6-12.5CM 12054 $671.00VASOPRESSIN INJ [20U/ML 1 $672.30PHYS DEBRD BONE MUS FAC 20 SQ CM OR LESS 11044 $674.00ER PHYS 20.1-30.0CM SMPL S/N/AX/GEN/TRNK 12006 $676.00ER PHY CRITICAL CARE 99291 $683.00POLAR PACK UNIT $685.00ER PHYS KNEE DISLOCATION TREATMENT 27550 $685.00PHYS COLONOSCOPY HIGH RISK G0105 $685.00PREMPRO TAB [0.45MG/1.5MG $689.91ER PHYS INTMD RPR N-HF/GENIT20.1-30 12046 $690.00ER PHYS CMPLX RPR TRUNK 2.6-7.5 CM 13101 $690.00ER PHYS DEBRIDE MED BURN 16025 $690.00ER PHYS TREAT DISLOCATION/FX SHOULDER 23665 $690.00ER PHYS FX RADIUS/ULNA W MANIPULATION 25565 $690.00PHYS EXC SPERMATOCELE W/WO EPIDIDYMECTOM54840 $696.00SANTYL OINTMENT [250 UNIT $696.63KNEE BILAT 4 VIEW 73564 $697.31TRIG PNT 1-2 MUSCLE (S) 20552 $700.00CLTX CARPO/METACARPAL FX DISLC THUMB W/M 26645 $700.00clobetasol propionate oint 0.05% $703.10LUMIGAN OPHTH DROPS [0.01 $703.40ER PHYS CLOSED TX DISLOC ANKLE 27840 $704.00LT KNEE ARTHROGRAM 73580 $706.58RT KNEE ARTHROGRAM 73580 $706.58PHY EXC MALIG LESION S/N/H/F/G 3.1-4.CM 11624 $707.00PREVNAR13 VACCINE INJ [0. 90670 $708.02DEPO-PROVERA INJ [150MG/M $709.90cefTARoline *IVPB* (600mg/100ml NS) $710.30TEFLARO INJ [600MG] J0712 $710.30NM RENAL FUNCTION STUDY 78725 $710.70ER PHYS CLOSD TX SHOULDER DISCLOC 23655 $711.00REPAIR ACHILLES TENDON OPEN 27650 $711.00ER PHYS 12.6-20.0 CM SIMPLE F/E/E/N/L/M 12016 $714.00LIDODERM TOPICAL PATCH [5 $715.00NERVE BLOCK FASCIA ILIACA 64450 $715.85GENICULAR NERVE BLOCK 64450 $715.85MOMETASONE-FORMOTEROL INHALER 200-5MCG [ $716.65AMPUTATION OF FINGER 26951 $718.00PHYS EXC BENIGN 1.1-2.0 CM T/A/L 11402 $721.00PHYS EXCISION BENIGN S/N/H/F/G .6-1CM 11421 $721.00PHYS EXC H/F/NK/SP B9+MARG>4 CM 11426 $721.00PHY EXC MAL LES T/A/L 1.1-2.0CM 11602 $721.00

102

PHYS EXCISION PILONIDAL CYST SIMPLE 11770 $721.00PHY SIMPLE CLOSE SUPERFICIAL WOUND DHIS 12020 $721.00PHYS REPAIR INTERMED S/A/T/E 2.6-7.5 CM 12032 $721.00ER TX PHYS CLOSED HIP DISLOC W/O ANES 27250 $721.00PHYS I&D BURSA FOOT 28001 $721.00PHYS DIAGNOSTIC ESOPHAGOSCOPY 43191 $721.00PHY ESOPHAGOSCOPY W BX SINGLE OR MULTIPL 43193 $721.00PHYS UPPER GI ENDOSCOPY 43197 $721.00PHYS EGD W/ BIOPSY SINGLE/MULTIPLE 43239 $721.00PHYS SIGMOIDSCOPY 45330 $721.00PHYS SIGMOIDOSCOPY DIAGNOSTIC 45330 $721.00PHYS SLITTING OF PREPUCE EXCEPT NEWBORN 54001 $721.00GENICULAR NERVE ABLATION 64640 $721.00tafluprost ophth soln 0.0015% (3 x 10 si $724.21STRESS TEST/MMH 93016 $726.00STRESS TEST/OTHER DR'S 93016 $726.00PATANOL OPHTH SOLN [0.1% $726.70ER PHYS INTMD RPR S/TR/EXT >30.0 CM 12037 $727.00CILOXAN 0.3% OPHTH OINT [ $728.74IV PYELOGRAM/XRY 74400 $732.33ER PHYS NSERTION CHEST TUBE 32551 $736.00US ECHOCARDIOGRAPHY W BUBBLE STUDY 93306 $740.57US ECHOCARDIOGRAPHY 93306 $740.57INTUBATION 31500 $742.00INTUBATION ETT 31500 $742.00INTUBATION ET EMER 31500 $742.00INTUBATION EMERG ET 31500 $742.00CLOSED TX PROX HUMERAL FX 23605 $743.00DISLOCATION SHOULDER - TX 23650 $743.00CLOSED TX RADIAL SHAFT FX 25505 $743.00TRMT FRACTURED RADIUS W/O 25600 $743.00CLOSED TX OF MP JT W MANI 26742 $743.00TX CLOSED HIP DISLOCATION 27252 $743.00CLOSED TX HIP DISLOCATION 27265 $743.00CLOSED TX HIP DISLOCATION 27266 $743.00TRMT PATELLAR DISLOCATION 27560 $743.00SO CHROM ANALYS 15-20 88262 $744.00ER PHYS DISLOCATION SHOULD 23650 $745.00ER PHYS FX WITH MANIP/PHA 26725 $745.00ER PHYS FX CLTX PROX FIBULA/SHFT 27780 $745.00INSERTION OF CHEST TUBE 32551 $745.00THORACOSTOMY 32551 $745.00

103

ER PHYS PERICARDOICENTESIS 33010 $745.00PHYS DILATION AND CURETTAGE 58120 $749.00PHYS UGI-ENDO DIR GASTRI TUBE 43246 $754.00PHYS COLONOSCOPY FLX DX 45378 $754.00PHYS SCREENING COLONOSCOPY G0121 $754.00US BILAT DUPLEX UPPER EXT 93930 $768.38US ABDOMEN 76700 $772.50PHYS EXC B9 LES F/E/E/N/L/M 2.1-3.0 CM 11443 $773.00PHYS REPAIR INTER F/E/E/N/L/MUC 2.5CM< 12051 $773.00PHYS DESTRUCT BENIGN LESION 1-14 17110 $773.00HUMERUS FX 23605 $773.00PHYS ESOPHAGOSCOPY FLEXIBLE TRANSORAL DX43200 $773.00PHYS ESOPHEGOSCOPY W BIOPSY 43202 $773.00PHYS EDG TRANSORAL BIOPSY 43239 $773.00PHYS ESOPH EDG DILATION BALLOON 43249 $773.00PHYS UPR GI ENDO W ESO DILITA 43249 $773.00PHYS SIGMOIDOSCOPY FLX W BAND LIGATIONS 45350 $773.00PHYS HEMORRHOIDECTOMY RUBBER BAND LIG 46221 $773.00TOBRADEX OPHTH OINT [O.3% $775.28POTASSIUM CHLORIDE LIQ 10 $776.80ER PHYS OVER 30CM SIMPLE S/N/AX/GEN/TRNK 12007 $777.00US FNA FIRST LESION 10005 $779.71LEUKOREDUCED RBC PROC FEE P9016 $780.00SUC-IRR TUBING $785.00ER PHYS INTMD RPR N-HF/GENIT >30.0CM 12047 $785.00ER PHYS NTMD RPR FACE/MM 12.6-20 CM 12055 $785.00PHYS COLONOSCOPY W TATTOO 45381 $787.00CMPLX RPR E/N/E/L 2.6-7.5CM 13152 $789.00CLOSED TX ANKLE FX 27818 $792.00LIDOCAINE TOPICAL PATCH 5 $794.77BAKER TIBE PED $796.00APPLICATION RIGID TOTAL LEG CAST 29445 $796.00BAKER TUBES $797.00ER PHY/SUTURE TENDON 26418 $797.00PHYS SIGMOIDOSCOPY WITH BX 45331 $799.00HIP ARTHROGRAM LT 73525 $799.28HIP ATHRORGRAM RT 73525 $799.28ER PHYS 2.5 CM SIMPLE S/N/AX/GEN/TRNK 12001 $800.00PHYS SIMPLE REPAIR S/N/AX/G/TRUNK 2.5CM< 12001 $800.00CHOLANGIOGRAM T TUBE INJ 47531 $800.00ER PHYS FRACTRUE MALLEOLUS 27760 $805.00ER PHYS FRACTURE FIBULA 27786 $805.00

104

Myelin oligodendrocyte Glycopro Ab CSF 86255 $809.00AGGRASTAT PREMIX [12.5MG J3246 $811.54PHYS EXC MAL LESION F/E/E/N/L 3.1-4.0CM 11644 $812.00PHY REMOVE TUNNELED INTRAPERITONEAL CATH49422 $812.00ER PHYS RML F/B INTRAOC ANT CHAMBER EYE 65235 $812.00ALREX 0.2% OPHTH SUSP [5M $812.02PHYS EXC TUMOR FACE/SCALP SUBQ 2CM > 21012 $820.00UNLISTED ABD PROCEDURE 49999 $821.00NEXIUM DR PACKET [40MG B $821.55PHYS COLONOSCOPY W BIOPSY 45380 $822.00PHYS COLONSOCOPY W/ HOT BIOPSY 45384 $822.00CHLORPROMAZINE TAB [200MG $822.80DISCMONITOR PROBE $823.00PHYS EXC MAL LESION F/E/E/N/L 2.1-3.0CM 11643 $824.00PHYS ARTHROCENTESIS ASP JOINT W US 20611 $824.00PICC LINE PLACEMENT 5 YRS OLDER 36573 $824.00PHYS EDG W/FOREIGN BODY REMOVE 43215 $824.00PHYS TRANSORAL EGD DX 43235 $824.00PHYS TRANSORAL EGD DX 43235 $824.00PHYS EGD W GASTRIC/DUOD STRICTURE 43245 $824.00PHYS GASTROI W/ REMOVAL FB 43247 $824.00PHYS EGD W/ HOT BIOPSY 43250 $824.00PHYS EGD W/ HOT BIOPSY 43250 $824.00PHYS DILATGION OF RECTAL STRICTURE 45910 $824.00PHYS IMPLANTATION OF MESH 49568 $824.00INJ NERVE BLOCK -SOMATIC NERVES 64415 $824.00NERVE BLOCK INJ AXILLARY 64417 $824.00NERVE BLOCK INJ FEM CONT INF 64448 $824.00CT ANGIO UPPER EXT UNI/BILAT 73206 $824.00PHYS COLONOSCOPY SCN-LO RSK PT G0121 $824.00FORADIL CAP AEROLIZE INHA $824.84PHYS EXC TUMOR SFT TISSUE NECK SUBQ <3CM 21555 $828.00COcaine 10% SOLUTION [10ml] $831.70PHYS EXC TMR THIGH/KNEE SUBQ 3CM > 27337 $834.00DESOWEN LOT [0.05%] $837.58ADVAIR DISKUS 500/50MCG [ $839.43Symbicort Inh Aer 160-4.5 $840.44NM PARATHYROID SCAN 78070 $840.48US BREAST BX 1ST LESION LT 19083 $844.60RT US BREAST BX 1ST LESION 19083 $844.60NM SENTINEL NODE 38792 $844.60PHYS EXC BACK/FLANK LESS 3CM 21930 $845.00

105

CIPRODEX 0.3-0.1% OTIC SU $845.45Iron Sucrose [500MG/NS 250ml] $848.50TX THIGH FX GROWTH PLATE 27517 $849.00ER SPINAL TAP W FLUID 62272 $849.00HOSPITALIST THORACENTESIS W IMAGING 32555 $850.00NEXIUM CAP [40MG BTL OF 3 $851.66ESTRACE VAGINAL CREAM $852.03PHYS INCISION OF RECTAL ABSCES 46045 $858.00MUSK QUANT AB TITERS TEST 83519 $859.00QVAR HFA AERO INHAL [80MC $864.24RABAVERT INJ SDV [2.5 IU/ $864.49ER PHYS 20.1-30.0CM SIMPLE F/E/E/N/L/M 12017 $865.00PHYS EXC TUMOR TISSUE SUBQ ABD WALL <3CM 22902 $865.00ER PHYS CLOSED TX RADIAL SHAFT FX W0 25500 $867.00oFLAXACIN OTIC SOLUTION [0.3% 10ML] $872.47BARIUM ENEMA/AIR CN 74280 $874.47ER PHYS THORACENTESE W IMAGING 32555 $876.00BLD ADMIN FEE 3 UNITS 36430 $876.00ED BLD ADMIN FEE 3 UNITS 36430 $876.00PHYS EGD W/ SNARE POLYECTOMY 43251 $876.00PHYS EXC MALIG +MARGINS T/A/L 4.0CM+ 11606 $883.00REPAIR FINGER TENDON 26418 $884.00US ART/BILAT LOWER EXT 93925 $886.83RESTASIS EMUL OPHTH DROP $886.88ENDO CLIP $887.00GLUCAGON INJ [1MG W/DILUE J1610 $887.65BECONASE-AQ NASAL IN 0.04 $888.58PHYS EDG W CONTROL OF BLEEDING 43255 $889.00PHYS EGD W/ CTRL OF BLEEDING 43255 $889.00PHYS HEMORRHOIDECTOMY- EXT 46250 $889.00ACULAR OPHTH SOLN [0.5%] $889.86LACER OVER 30.0 CM SIMPLE F/E/E/N/L/M 12018 $892.00ER PHYS INTMD RPR FACE/MM 20.1-30.0 12056 $894.00LIDOCAINE OINT [5% 35.44 $895.15FLUOXETINE LIQ [20MG/5ML $897.18MRI T-SPINE LMT 72146 $900.00MRI L SPINE LMT 72148 $900.00THROMBIN TOPICAL SPRAY KI $900.10PINCH SKIN GRAFT < 2CM 15050 $901.00CLOSED TX RADIAL SHAFT FRACTURE W/O MANI 25500 $901.00ER PHYS CLOSED TX RADIAL SHAFT FX 25505 $901.00perfllutren lipid microsphere inj $901.01

106

ADVAIR DISKUS 100/50MCG [ $902.58PHYS EXC TUMOR THIGH/KNEE SUBQ <3CM 27327 $903.00FLECTOR TOPICAL PATCH [1. $903.62amPHOTERicin B LIPOSOME SUSP [50MG] $904.42PIMECROLIMUS 1% CRM [30GM] $905.65Trelegy Ellipta $906.07EPOGEN [10000 U/ML 1ML S J0885 $906.46ER PHYS TRACHEOSTOMEY EMERGENT 31605 $908.00ZOLEDRONIC ACID INJ [5MG/ J3489 $908.50PANCRELIPASE CAP [10500 UNITS BTL] $909.40MIACALCIN NASAL [200 IU/D $909.95PROGRAF CAP [0.5MG BTL] J7507 $913.35ROPIVACAINE [2MG/ML PAIN BALL 550ML] J2795 $916.96US CAROTIDS 93880 $919.79SO CHROM ANALYS- AMNIOTIC 88269 $921.00EPIPEN SYRINGE [0.3MG] J0171 $921.41MRA LWR EXT LT W OR W/O 73725 $923.00MRA LWR EXT RT W OR W/O 73725 $923.00BLEPHAMIDE OPHTH SUSP [10 $925.10SOLCUTRANS $926.00PHYS DEBRIDEMENT SUBCT TISSUE 20 SQ CM 11042 $927.00PHYS EXC BENIGN LESION T/A/L 2.1-3.0 cm 11403 $927.00PHYS BENIGN LESION 3.1-4.0 CM 11404 $927.00PHYS EXC BENIGN LESION S/N/H/F/G .5CM< 11420 $927.00PHYS EXC BENIGN 2.1-3.0 CM S/N/H/F/G 11423 $927.00PHYS EXC MAL LES T/A/L 0.6-1.0 CM 11601 $927.00PHYS EXC MALIGNANT TRUNK/EXT 2.1-3CM 11603 $927.00PHY EXC MALIGNANT LES S/N/H/F/G 1.1-2.0 11622 $927.00PHYS EXC MALIG F/E/E/N/L 0.5 CM< 11640 $927.00PHYS EXC MALIG F/E/E/N/L 1.1 to 2.0 cm 11642 $927.00PHYS INTMD RPR S/TR/EXT 7.6-12.5CM 12034 $927.00PHYS COMPLEX REPAIR 1.1-2.5 CM 13131 $927.00PHY EXC TMR SFT TIS FACE/SCLP SUBQ <2CM 21011 $927.00APPLICATION OF FOREARM CAST 29075 $927.00APPLICATION LONG LEG SPLINT 29505 $927.00PHYS REMOVAL TUNNELED CV ACCESS PORT 36590 $927.00PHYS REPLACMENT G TUBE 43762 $927.00PHYS COLONSOCOPY THRU STOMA 44388 $927.00PHYS APPENDECTOMY DURING OTHER SURGERY 44955 $927.00PHYS FX DIAGNOSTIC COLONSCOPY 45378 $927.00PHYS COLONOSCOPY W/FB REMOVAL 45379 $927.00PHYS COLONOSCOPY W/ HOT BIOPSY 45384 $927.00

107

PHYS COLONOSCOPY W/ DILATION 45386 $927.00PHYS DESTR LESION ANUS SIMPL SURG EXC 46922 $927.00PHYS VASECTOMY 55250 $927.00ER CLASS IV 99284 $927.00DESOXIMETASONE CRM [0.05% $927.10TREAT KNUCKLE DISLOCATION 26705 $928.00NM MECKELS GI 78290 $934.21PHYS HEMORRHOIDECTOMY INT/EXT 46260 $935.00ARANESP SOL [40MCG/0.4ML J0881 $937.30INJ TRIG PNT 3/MORE MUSCL 20553 $940.00PHYS EXC TUMOR BACK/FLANK SUBQ 3CM> 21931 $940.00BETOPTIC-S 0.25% OPHTH SU $940.10PHYS EXC BREAST LESION PLACMNT RAD MARK 19125 $941.00EPIDURAL BLOOD PATCH 62273 $941.42EPIDERAL BLOOD OR CLOT PATCH 62273 $941.42PHYS AMPUTATION METATARSAL W TOE SINGLE 28810 $942.00DULERA HFA INHALER 100-5 $942.55PREMARIN INJ [25MG/5ML] J1410 $943.42ESTROGENS-CONJUGATED INJ J1410 $943.42ER PHYS ED PINCH SKIN GRAFT < 2CM 15050 $946.00ER PHYS CLOSED TX ULNAR SHAFT FX W MANI 25535 $946.00ER PHYS CMPLX RPR E/N/E/L 2.6-7.5CM 13152 $948.00NEUPOGEN INJ [300MCG 1ML J1442 $953.00CIPRO HC OTIC [10ML] $956.10SYMBICORT INH AER [ 80-4. $964.85US EXTREM VEN/BILAT 93970 $968.20ER PHYS RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM 13132 $969.00ER PHYS EPIDERAL BLOOD OR CLOT PATCH 62273 $970.00CLOBETASOL PROP SHAMPOO [118ML BTL] $971.73TREATMENT WRIST DISLOCATION 25690 $974.00EPIDURAL INJECT L-S SPINE 62323 $976.44CT SINUS W/O 70486 $978.50PHYS EXC BENIGN LESION T/A/L over 4.0 cm 11406 $979.00PHYS EXC SFT TIS FOREARM/WRIST SUBQ 3CM> 25071 $979.00PHYS EXC TUMOR SOFT LEG/ANKLE SUBQ <3CM 27618 $979.00AZOPT SUS 1% OPHTH [10ML] $984.52ER PHYS FRACTURE METACARPAL 26605 $990.00SO JCV STRATIFY AB W/RX 86790 $991.00ENVISAN PAK $992.00CURVED NEEDLE 11G $993.95ENVISAN PAK $994.00PHYS EXC TMR SFT TIS FOREARM SUBQ <3CM 25075 $997.00

108

NJX INTERLAMINAR LMBR/SAC 62322 $1,002.19NERVE BLOCK ILIO-ING NERVES 64425 $1,002.19INJ NERVE BLOCK SCIATIC NERVE 64445 $1,002.19NERVE BLOCK INJ FEM SINGLE 64447 $1,002.19EPOGEN [20000 U/ML 1ML M J0885 $1,003.30ER PHYS INTMD RPR FACE/MM >30.0 CM 12057 $1,006.00ED US CENTRAL LINE PLACEMENT 36556 $1,009.40bupivacaine liposome Inj 1 mg (20ml) $1,011.04ER PHYS SUTURE TENDON 27380 $1,012.00NM RENAL SCAN 78701 $1,013.52CMPLX RPR TRUNK 1.1-2.5 CM 13100 $1,014.00CMPLX RPR TRUNK 2.6-7.5 CM 13101 $1,014.00CMPLX RPR S/A/L 1.1-2.5 CM 13120 $1,014.00Tracheostomy emergency- cricothyroid me 31605 $1,014.00SYMBICORT INH AER [160-4. $1,015.90ER PHYS FRACTURE HUMERUS 24505 $1,019.00LACER RPAIR INTERMED S/A/T/E 20.1-30.0CM 12036 $1,020.00ER PHYS OVER 30CM SIMPLE F/E/E/N/L/M 12018 $1,025.00PHYS HEMORRHOIDECTOMY- SIMPLE 46255 $1,026.00PHYS COMPLEX WOUND REPAIR 2.5-7.5 CM 13121 $1,030.00EXC BREAST TISSUE OPEN 1 LESION 19120 $1,030.00PHYS EXC TMR NECK/ANT THORAX SUBQ 3> 21552 $1,030.00umeclidinium bromide Inhal (62 5 mcg) $1,039.88Humulin R U-500 $1,042.06I&REMOVE FB - SUBQ SIMPLE 10120 $1,044.00VENTILATOR INITIAL 94002 $1,044.00VENTILATOR/DAY 94003 $1,044.00PHYS I&D LEG/ANKLE ABSCESS/HEMATOMA 27603 $1,045.00PHYS I&D PERIRECTAL ABSCESS 46040 $1,049.00BLD OPT ADMIN FEE 4 UNITS 36430 $1,050.00ED BLD ADMIN FEE 4 UNITS 36430 $1,050.00NM LUNG PERFUSION 78580 $1,053.69EPIDURAL INJ L-S SPINE 62322 $1,055.75US Echocardiography w/ Contrast C8929 $1,058.84EPIDURAL INJECT SACROILIAC JOINT 27096 $1,060.90PHYS COLONOSCOPY FLEX WITH ABL 91117 $1,061.00US VASCULAR ABD + 93975 $1,063.99PHYS COLONOSCOPY WITH SNARE 44394 $1,064.00HEMABATE INJ [250 MCG/ML] $1,071.80CMPLX RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM 13132 $1,076.00Cardioversion - EXTERNAL 92960 $1,082.00US PARACENTESIS NO IMAGING 49082 $1,085.00

109

STENT DOUBLE J 6.0X26CM $1,087.00PHYS EXC TUMOR LEG/ANKLE LESS THAN 5CM 27619 $1,093.00ECONAZOLE CREAM [1%] $1,095.25ER PHYS TREATMENT OF THIGH FX 27502 $1,102.00NM LIVERSPLEEN FLOW 78216 $1,102.10SWING BED ROOM CHG $1,104.00DESONIDE LOTION [0.05% 11 $1,104.53ISTALOL OPHTH SOLN [0.5% $1,105.00NM GI BLEED 78278 $1,115.49ACTONEL TAB [150MG ] $1,116.50NM THYROID UPTAKE & IMAGING 78014 $1,118.58ADVAIR DISKUS 250/50MCG [ $1,119.40COMBIGAN OPHTH SOL 0.2/0. $1,119.42BALSALAZIDE DISODIUM CAP 750 $1,128.05RABIES VACCINE (IMOVAX) I $1,131.00PHYS I &D ABSCESS COMPLICATED 10061 $1,133.00PHYS BX OF BREAST OPEN INCISIONAL 19101 $1,133.00PHYS BX/EXC LYMPH NODE OPEN SUPERFICIAL 38500 $1,133.00PHYS COLONOSCOPY W/ BIOPSY 45380 $1,133.00PHYS COLONOSCOPY W/ SNARE PLYP 45385 $1,133.00PHYS COLONOSCOPY W/ SNARE PLYP 45385 $1,133.00PHYS COLONOSCOPY W ABLATION 45388 $1,133.00PHYS COLONOSCOPY W BAND LIGATION 45398 $1,133.00PHYS DEST INTERNAL HEMORRHOID(S) CAUTERY 46930 $1,133.00PHYS CIRCUMCISION AGE 28 DAYS/OLDER 54161 $1,133.00IRRAD.RBC -LEUKORED. P9040 $1,136.00Spinal puncture lumbar diagnostic 62270 $1,141.00SUCT-IRR ELECTRODE $1,152.00CAPEX 0.01% SHAMPOO $1,154.65CYANIDE ANTI KIT PKG UNIT $1,157.70celecoxib Cap (100 mg btl) $1,159.48PREMARIN VAGINAL CREAM $1,185.23LUMBAR INJECTION DISCOGRAPHY 62290 $1,200.00CERVICAL/THORACIC INJECTION DISCOGRAPHY 62291 $1,200.00DEBRIDEMENT OPEN FX 11010 $1,202.00EPIDURAL INJ C-T SPINE 62321 $1,202.01PHYS INCISION BONE CORTEX FOOT 28005 $1,203.00SEREVENT DISKUS [50MCG 60 $1,205.98FLOVENT HFA INHALER 220MC $1,211.22PHYS METATARSECTOMY 28140 $1,216.00EXC. NAIL & MATRIX - PERM 11750 $1,217.00Myositis AssessR plus Jo-1 Ab panel 83516 $1,219.00

110

PHYS ING HERNIA 5YRS/>INCARCERATED 49507 $1,221.00LR RBC IRRAD CMV NEG FEE P9058 $1,223.00MYRBETRIQ ER TAB [50MG] $1,223.63ER PHYS CLOSED TX HIP DISLOCATION 27266 $1,228.00SHAVE SKIN LESION .5 CM 11300 $1,236.00PHYS EXC MALIG LESION F/E/E/N/L .6-1.0CM 11641 $1,236.00PHYS EXC MALIGNANT LES F/E/E/N/L >4CM 11646 $1,236.00DESTRUCT B9 LESION 17110 $1,236.00PHYS MASTOTOMY W EXPLORE OF ABSCESS DEEP19020 $1,236.00BX BREAST W STEROTACTIC ADD LESION 19082 $1,236.00BX BREAST W ULTRASOUND EACH ADD 19084 $1,236.00BX BREAST W MRI ADD LESION 19086 $1,236.00PHYS EXC TUMOR SHOULDER 3CM> 23071 $1,236.00PHYS EXC TUMOR SOFT TISS UP ARM/ELB 3CM> 24071 $1,236.00PHYS THORACOSTOMY 32551 $1,236.00PHYS INSERTION NON -TUNNELED CATH 36556 $1,236.00PHYS INSERTION NON-TUNNEL CV CATH 36556 $1,236.00PHYS INSERT TUNNELED CV CATH W SUBQ PORT 36561 $1,236.00EGD DIAGNOSITC BRUSH WASH 43235 $1,236.00REPLACEMENT G TUBE 43762 $1,236.00DIAGNOSTIC COLONOSCOPY 45378 $1,236.00COLONOSCOPY SUBMUCOUS NJX 45381 $1,236.00PHYS COLONOSCOPY W/ CTRL BLEED 45382 $1,236.00PHYS REMOVAL OF ANAL FISSURE 46200 $1,236.00PHYS HEMORRHOID W FISSURECTO 46257 $1,236.00PHYS LAPS ABD PRT OMN DX 49320 $1,236.00PHYS LAPAROSCOPY SURG W BX SINGLE/MULTI 49321 $1,236.00REMOVE TUNNELED INTRAPERITONEAL CATHETER49422 $1,236.00HERNIA IMPLANT MESH 49568 $1,236.00PHYS SIMPLE EPIGASTRIC REPAIR HERNIA 49570 $1,236.00ER CLASS V 99285 $1,236.00COLONOSCOPY- HI RSK PT G0105 $1,236.00PHYS COLONOSCOPY SCR-HI RSK PT G0105 $1,236.00MYELOGRAM L SPINE 72265 $1,241.15ATROVENT INHALER HFA [12. $1,242.67LUMIGAN OPHTH DROPS [0.01 $1,248.90DARBEPOETIN INJ [ 60MCG/0.3ML] $1,261.00BAYGAM INJ $1,267.50EXCISION B9 <0.5CM LESION 11420 $1,276.00INSERT CEN VEN CATH 36556 $1,277.20HOSPITALIST US CENTRAL LINE 36556 $1,277.20LIP REAPIR 40650 $1,287.00

111

COMBIVENT RESPIMAT INHALE $1,287.85Gastrointestinal Pathogen Panel PCR fec. $1,288.00AMB RES/HOSP BASE A0428 $1,289.00AMB HOSP/AIRPORT BASE A0428 $1,289.00AMB RES/SNF BASE A0428 $1,289.00AMB ACC SCENE/HOSP BASE A0428 $1,289.00AMB HOSP/ HOSP BASE A0428 $1,289.00AMB HOSP/DIALY FAC BASE A0428 $1,289.00AMB SNF/DIALY FAC BASE A0428 $1,289.00AMB SNF TO HOSP BASE A0428 $1,289.00AMB/ OTHER TO HOSP BASE A0428 $1,289.00AMB HOSP TO RESIDENCE BAS A0428 $1,289.00AMB SNF TO OTHER SNF A0428 $1,289.00AMB HOSP TO SNF A0428 $1,289.00TRAUMA RES TO HOSPITAL A0429 $1,289.00TRAUMA HOSPITAL TO AIRPRT A0429 $1,289.00TRAUMA RES TO LONGTERM FA A0429 $1,289.00TRAUMA ACCIDENT TO HOSP A0429 $1,289.00TRAUMA HOSP TO HOSP A0429 $1,289.00TRAUMA HOSP TO DIALYSIS A0429 $1,289.00TRAUMA LONGTERM TO DIALYS A0429 $1,289.00TRAUMA LONGTERM TO HOSP A0429 $1,289.00TRAUMA OTHER AMBULANCE TRANSFER A0429 $1,289.00TRAUMA HOSP TO RES A0429 $1,289.00TRAUMA LTC TO LTC A0429 $1,289.00TRAUMA HOSP TO LTC A0429 $1,289.00BYETTA INJ [10MCG/DOSE] $1,289.77BYETTA INJ [ 5MCG/DOSE] $1,289.78PHYS ID DEEP ABSC HEMATOMA THIGH/KNEE 27301 $1,298.00PHYS EXC TMR BACK/FLANK SUBFAS <5CM 21932 $1,313.00CLOSED TX DISL SHOULDER 23655 $1,316.00NICOTROL INHALER [168CART $1,320.68PHY EXC TUMOR SOFT TIS ABD WALL SUBQ 3CM 22903 $1,339.00PHYS RPR 1ST INGUN HRNA 6MO-<5YRS REDUC 49500 $1,339.00PHYS REMOVAL OF TESTIS 54520 $1,339.00PHYS EXCISION HYDROCELE UNILATERAL 55040 $1,339.00TAZORAC GEL [0.1% 30GM] $1,342.17PERITONEAL DRAINAGE CATHETER C1729 $1,342.50Film Array Respiratory Panel- IHC $1,343.00CENTRAL VENOUS CATH REMOV 36590 $1,344.00PHENTOLAMINE INJ [5MG/2ML $1,345.95MRI HAND LT W/O 73218 $1,349.00

112

MRI HAND RT W/O 73218 $1,349.00MRI FOREARM LT W/O 73218 $1,349.00MRI FOREARM RT W/O 73218 $1,349.00MRI UPPER ARM LT W/O 73218 $1,349.00MRI UPPER ARM RT W/O 73218 $1,349.00MRI WRIST LT W/O 73221 $1,350.00MRI WRIST RT W/O 73221 $1,350.00MRI ELBOW LT W/O 73221 $1,350.00MRI ELBOW RT W/O 73221 $1,350.00MRI SHOULDER LT W/O 73221 $1,350.00MRI SHOULDER RT W/O 73221 $1,350.00THORACIC MYELOGRAM 72255 $1,350.33ER PHYS AMPUTATION OF FINGER 26951 $1,351.00NM GASTRIC EMPTYING 78264 $1,354.45ER PHYS FRAC/MET FIXATION 26607 $1,363.00CT FACIAL WO 70486 $1,368.87DAPTOmycin *IV Push* (500 mg) J0878 $1,368.95DAPTOmycin * IVPB* (500 mg/NS 50mL) J0878 $1,368.95SPIRIVA CAP HANDIHALER [3 $1,374.23FERAHEME INJ [510MG/17ML] $1,386.00US BIOPSY LYMPH NODE 38505 $1,390.50CT BIOPSY LYMPH NODE 38505 $1,390.50BIOPSY LYMPH NODE 38505 $1,390.50TREATMENT OF THIGH FX 27502 $1,391.00Cervical/Thoracic Facet Injection Lvl 1 64490 $1,395.65Lumbar/Sacral Facet Inj Level 1 64493 $1,395.65NM LIVER SPECT 78205 $1,398.74Aranesp 60mcg $1,401.70ER PHYS CLOSED ELBOW DISLOCATION 24605 $1,402.00PHY LAPAROSCOPY W/RMVL ADNEXAL STRUCTURE58661 $1,409.00PARACENTESIS WITH IMAGING 49083 $1,419.00HOSPITALIST PARACENTESIS W IMAGING 49083 $1,419.00INJ FORAMEN EPIDURAL L/S 64483 $1,420.37M/S ROOM CHG SEMI-PVT $1,423.46NM DMSA 78700 $1,430.67STAPLER-CDH29 $1,432.00ESTRING RING [2MG] $1,435.18PHYS EXC TUMOR ABD WALL SUBFASC <5CM 22900 $1,442.00PHYS EXC SFT TIS ABD WALL SUBFASC 5CM> 22901 $1,442.00SIGMOIDOSCOPY AND BIOPSY 45331 $1,442.00PHYS REPAIR INITIAL FEM HERNIA REDUCIBLE 49550 $1,442.00ED PARACENTESIS WITH IMAGING GUIDANCE 49083 $1,462.00

113

BIOPSY LUNG/MEDICASTINUM 32405 $1,462.60NM REN/FLO/FUNCTION 78707 $1,462.60SWING BED HIGH ACUITY $1,463.00GUAIFEN/PSEUODEPHEDRINE T $1,471.00FX HUMERUS 24505 $1,474.00ENDO CLIP $1,476.00MRI HAND RT WITH 73218 $1,476.00MRI FEMUR RT WITH 73219 $1,476.00MRI HAND LT WITH 73219 $1,476.00MRI FOREARM LT WITH 73219 $1,476.00MRI FOREARM RT WITH 73219 $1,476.00MRI UPPER ARM LT WITH 73219 $1,476.00MRI UPER ARM RT WITH 73219 $1,476.00MRI WRIST RIGHT ARTHROGRAM 73222 $1,477.00MRI WRIST LEFT ARTHROGRAM 73222 $1,477.00MRI WRIST LT WITH 73222 $1,477.00MRI WRIST RT WITH 73222 $1,477.00MRI ELBOW LT WITH 73222 $1,477.00MRI ELBOW RT WITH 73222 $1,477.00MRI SHOULDER ARTHROGRAM LT 73222 $1,477.00MRI SHOULDER ARTHROGRAM RT 73222 $1,477.00CUTTER-ATW35 $1,482.00CT HEAD WO 70450 $1,487.32CT LT SHOULDER W/O 73200 $1,490.41CT LT HAND W/O 73200 $1,490.41CT RT HAND WI/O 73200 $1,490.41CT LT WRIST W/O 73200 $1,490.41CT RT WRIST W/O 73200 $1,490.41CT LT FOREARM W/O 73200 $1,490.41CT RT FOREARM W/O 73200 $1,490.41CT LT ELBOW W/O 73200 $1,490.41CT RT ELBOW W/O 73200 $1,490.41CT LT HUMERUS W/O 73200 $1,490.41CT RT HUMERUS W/O 73200 $1,490.41CT RT SHOULDER W/O 73200 $1,490.41BIOPSY RENAL 50200 $1,520.28ER PHYS INS NON-TUNNELED CATH 36556 $1,524.00CT LT FOOT W/O 73700 $1,527.49CT RT FOOT W/O 73700 $1,527.49CT LT ANKLE W/O 73700 $1,527.49CT RT ANKLE W/O 73700 $1,527.49CT LT TIBIA/FIBULA W/O 73700 $1,527.49

114

CT RT TIBIA/FIBULA W/O 73700 $1,527.49CT LT KNEE W/O 73700 $1,527.49CT RT KNEE W/O 73700 $1,527.49CT LT FEMUR W/O 73700 $1,527.49CT RT FEMUR W/O 73700 $1,527.49CT LT HIP W/O 73700 $1,528.52CT RT HIP W/O 73700 $1,528.52NITROFURANTOIN SUSP [25MG $1,532.81RISPERDAL CONSTA SYR [25M $1,534.00BIOPSY BONE SUPERFICIAL 20220 $1,536.76BIOPSY LIVER 47000 $1,536.76C MYELOGRAM 72240 $1,536.76PROTOPIC OINTMENT [0.1%] $1,539.95PUNCTURE DRAINAGE OF LESION 10160 $1,545.00DEB SUBQ TISSUE ADD ON 11045 $1,545.00DEBRIDEMENT MUSCLE & FASCIA EA ADDL 20CM 11046 $1,545.00PHY EXCISION LESION TR EXT .6-1CM BENIGN 11401 $1,545.00EXC MALIGNANT LESION OVER 4 CM F/E/E/N/L 11646 $1,545.00PHYS PILONIDAL CYST EXTENSIVE 11771 $1,545.00EXC TUMORE SOFT TISS BACK/FLANK 5 CM 21933 $1,545.00PHYS AMP F/TH 1/2 JT/PHALANX- NEURECT 26951 $1,545.00PHYS AMPUTATION OF TOE JOINT 28820 $1,545.00ATHROSCOPY SHOULDER BICEP TENDON 29828 $1,545.00PHYS BX/EXC LYMPHOPEN DEEP AXI NODE 38525 $1,545.00EGD BALLOON DILATION ESOPHAGUS 43249 $1,545.00COLONOSCOPY W BAND LIGATION 45398 $1,545.00PHYS UNLISTED PROCEDURE ANUS 46999 $1,545.00ABD PARACENTESIS W IMAGING SURGERY 49083 $1,545.00PHYS REPAIR 1ST FEM HERNIA INCARCERATED 49553 $1,545.00PELVIC EXAMINATION UNDER ANESTHESIA 57410 $1,545.00PHYS LAPAROSCOPY TUBAL CAUTERY 58670 $1,545.00CT ANGIO HEAD 70496 $1,545.00COLONOSCOPY- LO RSK G0121 $1,545.00ZEMAIRA IV INJ [1000MG VI J0256 $1,558.50ADVAIR DISKUS 500/50MCG [ $1,562.80CT NECK WO 70490 $1,568.69CT PELVIS WO 72192 $1,568.69ER PHYS TX CLOSED HIP DISLOCATION 27252 $1,576.00CT ORBIT/ EAR / FOSSA W/O 70480 $1,587.23CT FACIAL W 70487 $1,588.26PHYS EXC TUMOR SFT THIGH/KNEE SBFSC 5CM 27339 $1,589.00BIOPSY ABD/PELIVS SOFT TISSUE DEEP 49180 $1,591.35

115

CT CHEST W/O CONTRAST 71250 $1,591.35CT CHEST HIGH RESOLUTIONS 71250 $1,591.35CT CHEST LOW DOSE W/O G0297 $1,591.35NEUPOGEN INJ [480MCG 0.8M J1442 $1,602.78CT ABDOMEN WO 74150 $1,607.83INTEGRILIN INJ [0.75MG/ML J1327 $1,640.65PHY DBRDMT SKN SUBQ NECRO INFCT GEN/ABDL 11006 $1,648.00FINGER FX EACH WITH MANIPULATION 26727 $1,648.00PHYS LAP APPENDECTOMY 44970 $1,648.00COLONOSCOPY W LESION REMOVAL BX HOT 45384 $1,648.00PHYS INGUN HERNIA 5> REDUCIBLE 49505 $1,648.00PHYS RPR UMBILICAL HRNA >5yrs REDUCIBLE 49585 $1,648.00CT ANGIO LOWER EXT W OR WO DYE 73706 $1,648.00MRA CHEST W OR WO 71555 $1,652.00CT HEAD W 70460 $1,653.15CT NEEDLE PLACEMENT 77012 $1,658.30ALS 1- RES TO HOSPTIAL A0427 $1,665.00ALS 1-ACCIDENT TO HOSP A0427 $1,665.00ALS 1-HOSPITAL TO HOSPITAL A0427 $1,665.00ALS 1-HOSITAL TO AIRPORT A0427 $1,665.00ALS 1 -LTC TO HOSPITAL A0427 $1,665.00ALS-HOSPITAL TO RES A0427 $1,665.00ALS 1-OTHER AMBULANCE TRANSFER A0427 $1,665.00Tetanus immune globulin 250 units J1670 $1,677.70ENDO CLIP $1,684.00NM MUGA SCAN 78472 $1,688.17PLEURX PERITONEAL CATHERTER KIT $1,699.50BLADDER DRAIN W SUPRAPUBIC CATH 51102 $1,705.00CT ORBIT/ EAR/ FOSSA/ W DYE 70481 $1,707.74EXC TUMOR SOFT TISS ARM/ ELBOW 24075 $1,708.00EXC FOOT LESION 28090 $1,708.00REMOVAL TUNNELED CV CATH 36590 $1,708.00immune globulin ( 5 gm vial) J1459 $1,712.52CT LT HAND WITH 73201 $1,727.31CT LT WRIST WITH 73201 $1,727.31CT RT WRIST WITH 73201 $1,727.31CT LT FOREARM WITH 73201 $1,727.31CT RT FOREARM WITH 73201 $1,727.31CT LT ELBOW WITH 73201 $1,727.31CT RT ELBOW WITH 73201 $1,727.31CT LT HUMERUS WITH 73201 $1,727.31CT RT HUMERUS WITH 73201 $1,727.31

116

CT RT HAND WITH 73201 $1,728.34CT LT SHOULDER WITH 73201 $1,728.34CT RT SHOULDER WITH 73201 $1,728.34REMOVE FB/MUSC/TEND SHE 20520 $1,735.00REPAIR NAIL BED 11760 $1,751.00BREAST BIOPSY OPEN INCISIONAL 19101 $1,751.00PHYS EXC TMR BACK/FLANK SUBFAS 5CM> 21933 $1,751.00CLSD TX SHOULDER DISLC W MANI 23655 $1,751.00LOWER LEG FRACTURE 27825 $1,751.00AMPUTATION TOE INTERPHALANGEAL JOINT 28825 $1,751.00TONSILLECTOMY OVER 12 YRS OLD 42826 $1,751.00COLONOSCOPY W BX SINGLE OR MULTIPLE 45380 $1,751.00COLONOSCOPY W LESION RML BY SNARE 45385 $1,751.00PHYS RECURRNET INGUINAL HERNIA REDUCIBLE 49520 $1,751.00PHYS REREPAIR INCIS/ VENT HERN REDUBIBLE 49565 $1,751.00PHYS UMBILICAL HERNIA >5 yrs INCARCERAT 49587 $1,751.00PHYS ANTERIOR COLPORRAPHY RPR 57240 $1,751.00CT ANGIO NECK 70498 $1,751.00CT ANGIO CHEST 71275 $1,751.00CLOSED REDUCTION OF RIGHT DISTAL FX 25605 $1,770.00NM TESTICULAR SCAN 78761 $1,774.69CT T SPINE WO 72128 $1,779.84PHYS PART MASTECTOMY WITH AXILLARY NODES 19302 $1,781.00CT L SPINE WO 72131 $1,791.17PLT/PHERESED/PROCESS FEE P9034 $1,793.00TREATMENT ANAL FISTULA SUBQ 46270 $1,800.00CT ANGIO ABD AORTA W RUNOFF 75635 $1,802.50M/S RM HIGH AQUITY $1,815.89PROGRAF CAP [1MG BTL] J7507 $1,818.22CT C SPINE W/O 72125 $1,820.01ER CRITICAL CARE 30-74 MI 99291 $1,822.00CT NECK W 70491 $1,834.43MRI FOOT LT W/O - NON JT 73718 $1,844.00MRI FOOT RT W/O - NON JT 73718 $1,844.00MRI LOWER LEG LT W/O - NON JT 73718 $1,844.00MRI LOWER LEG RT W/O - NON JT 73718 $1,844.00MRI THIGH LT W/O - NON JT 73718 $1,844.00MRI THIGH RT W/O - NON JT 73718 $1,844.00MRI ANKLE LT W/O 73721 $1,844.00MRI ANKLE RT W/O 73721 $1,844.00MRI KNEE LT W/O 73721 $1,844.00MRI KNEE RT W/O 73721 $1,844.00

117

MRI HIP LT W/O 73721 $1,844.00MRI HIP RT W/O 73721 $1,844.00CT LT HAND WITH & W/O 73202 $1,844.73CT RT HAND WITH & W/O 73202 $1,844.73CT LT WRIST WITH & W/O 73202 $1,844.73CT RT WRIST WITH & W/O 73202 $1,844.73CT LT FOREARM WITH & W/O 73202 $1,844.73CT RT FOREARM WITH & W/O 73202 $1,844.73CR LT ELBOW WITH & W/O 73202 $1,844.73CT RT ELBOW WITH & W/O 73202 $1,844.73CT LT HUMERUS WITH & W/O 73202 $1,844.73CT RT HUMERUS WITH & W/O 73202 $1,844.73CT LT SHOULDER WITH&W/O 73202 $1,844.73CT RT SHOULDER WITH&W/O 73202 $1,844.73CT PELVIS W 72193 $1,847.82CT SHOULDER ZB 73200 $1,850.00INCISION REMOVAL FB TISSUE 10120 $1,854.00DEBRIDEMENT BONE MUSCLE 20SQ 11044 $1,854.00SKIN TAG REMOVAL 11200 $1,854.00PHYS SPLT AUTOGRAFT T/A/L 1ST 100CM/1% 15100 $1,854.00PHY SPLIT AGRFT F/S/H/F/G/M/D GT1ST 100C 15120 $1,854.00ARTHROCENTESIS ASPIRATION JOINT 20600 $1,854.00REMOVAL OF DEEP BONE IMPLANT 20680 $1,854.00TONSILLECTOMY & ADENOIDECTOMY <12 42820 $1,854.00EGD PLACEMENT GASTROSTOMY TUBE 43246 $1,854.00EGD W/ HOT BIOPSY 43250 $1,854.00SURGICAL TX OF ANAL FISTULA SUBCUTANEOUS 46270 $1,854.00PHY RECURRENT INGUNIAL HERNIA STRANGULAT 49521 $1,854.00PHYS REPAIR INCISIONAL/ VENTRAL HERNIA 49560 $1,854.00PHY REPAIR EPIGASTRIC HERNIA INCARCERAT 49572 $1,854.00PHYS VAGINAL HYSTERECTOMY UTERUS 250 GM< 58260 $1,854.00CT ANGIO ABD W/WO 74175 $1,854.00MAXAIR AUTOHALER [14 GM 0 $1,887.23CT CHEST W 71260 $1,890.05LYMPHAZURIN BLUE INJ [1% $1,895.58NM MYOCARDIAL PERF SPECT 78452 $1,909.62CT LT FOOT WITH 73701 $1,935.37CT RT FOOT WITH 73701 $1,935.37CT LT ANKLE WITH 73701 $1,935.37CT RT ANKLE WITH 73701 $1,935.37CT LT TIBAL/FIBULA WITH 73701 $1,935.37CT RT TIBIA/FIBULA WITH 73701 $1,935.37

118

CT LT KNEE WITH 73701 $1,935.37CT RT KNEE WITH 73701 $1,935.37CT LT FEMUR WITH 73701 $1,935.37CT RT FEMUR WITH 73701 $1,935.37CT LT HIP WITH 73701 $1,935.37CT RT HIP WITH 73701 $1,935.37CT ABDOMEN W 74160 $1,942.58EXC BENIGN LESION 1.1 TO 2.0 CM 11402 $1,957.00EGD BX TRANSORAL SINGLE OR MULTIPLE 43239 $1,957.00EXC ANAL EXT TAG OR PIPILLA 46220 $1,957.00VERTEBROPLASTY AUTOPLEX HV C1713 $1,960.61VERTEBROPLASTY ADDL LEVEL (C-T OR L) 22512 $1,967.30PHYS INCISIONAL HERNIA INCARCERATED 49561 $1,968.00CT HEAD W/WO 70470 $1,973.48CT FACIAL W/WO 70488 $1,988.93PHYS RPR RECURRNT INCIS/VNT HERN INCARCE 49566 $1,991.00PHYS MASTECTOMY SIMPLE COMPLETE 19303 $2,002.00CT LT FOOT WITH & W/ 73702 $2,005.41CT RT FOOT WITH & W/O 73702 $2,005.41CT LT ANKLE WITH & W/O 73702 $2,005.41CT RT ANKLE WITH & W/O 73702 $2,005.41CT LT TIBIA/FIBULA WITH & W/O 73702 $2,005.41CT RT TIBIA/FIBULA WITH & W/O 73702 $2,005.41CT LT KNEE WITH & W/O 73702 $2,005.41CT RT KNEE WITH & W/O 73702 $2,005.41CT LT FEMUR WITH & W/O 73702 $2,005.41CT RT FEMUR WITH & W/O 73702 $2,005.41CT LT HIP W&W/O 73702 $2,005.41CT RT HIP W&W/O 73702 $2,005.41NM LIMITED BONE 78300 $2,006.44CT ORBIT/ EAR/ FOSSA W & WO 70482 $2,010.56DIAGNOSTIC SIGMOIDOSCOPY 45330 $2,019.00CT T-SPINE WITH 72129 $2,026.01PHYS EXCISE ANUS TAG/PAPILLA 46220 $2,027.00NM VENTILATION LUNG SCAN 78579 $2,030.13NM VENT & PERF LUNG SCAN 78582 $2,030.13CT NECK W/WO 70492 $2,031.16MRI PELVIS W/O 72195 $2,041.00MRA NECK W/O 70547 $2,057.00PHY EXC TMR SFT TIS NECK THRX SUBFS 5CM> 21554 $2,060.00PHYS INSERT SPINE FIXATION DEVICE 22845 $2,060.00PHYS AMPUTATION THIGH THROUGH FEMUR 27590 $2,060.00

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SUTURE EACH ADDITIONAL NERVE 64837 $2,060.00MRA BRAIN W/O 70544 $2,081.00MRI C SPINE WITH 72142 $2,081.00REMOVAL OF HEMRRHOID CLOT 46320 $2,087.00FOREIGN BODY REMOVAL FROM EYE 65235 $2,087.00Cervical/Thoracic Facet Inj Lvl 1 Bilate 64490 $2,093.99Lumbar/Sacral Facet Inj Level 1 Bilatera 64493 $2,093.99ANTIZOL 1.5GM INJ $2,097.00CT C SPINE W 72126 $2,105.32CT L SPINE W 72132 $2,107.38IRRAD PLATELET PHERES P9037 $2,111.00INJ FORAMEN EPIDURAL L/S BILATERAL 64483 $2,130.04INJ FEMORAL NERVE, INF BY CATH 64448 $2,131.07NM WHOLE BODY BONE 78306 $2,132.10CT C SPINE W & W/O 72127 $2,152.70EXC TUMOR SOFT TISSUE FACE/SCALP 2 CM 21012 $2,163.00EXCISION TUMOR SOFT TISSUE BACK 21931 $2,163.00CLOSED REDUCTION RADIUS/ULNA 25605 $2,163.00INCISION OF METATARSAL 28308 $2,163.00INSERT NON TUNNEL CV CATH 36556 $2,163.00TONSILLECTOMY & ADENOIDECTOMY AGE 12> 42821 $2,163.00PHYS LAP CHOLECYSTECTOMY 47562 $2,163.00MRA NECK W 70548 $2,181.00NM HEPATOBILIARY IMAGING 78226 $2,192.87MRA BRAIN W 70545 $2,206.00MRI LOWER LEG LT W 73719 $2,213.00MRI FOOT LT WITH 73719 $2,213.00MRI FOOT RT WITH 73719 $2,213.00MRI LOWER LEG RT WITH 73719 $2,213.00MRI FEMUR LT WITH 73719 $2,213.00MRI KNEE LT WITH 73722 $2,213.00MRI KNEE RT WITH 73722 $2,213.00BYDUREON PEN $2,214.05MRI ANKLE RT WITH 73722 $2,215.00MRI ANKLE LT WITH 73722 $2,215.00MRI HIP LT WITH 73722 $2,215.00MRI HIP RT WITH 73722 $2,215.00CT PELVIS W/WO 72194 $2,224.80PHYS CHOLECYSTECTOMY W CHOL 47605 $2,241.00DRAINAGE PELVIS 26990 $2,251.58MYELOGRAM MULTIPLE LEVELS 72270 $2,251.58CLOSED TX NASAL FRACTURE W/O STABILIZATI 21315 $2,252.00

120

CT CHEST W/WO 71270 $2,254.67DEB SKIN BONE AT FRACTURE SITE 11012 $2,266.00LACERATION 2.5CM OR LESS 12001 $2,266.00PHYS TROCHANTERIC PRESSURE ULCER 15956 $2,266.00EXCISION BREAST LESION 19125 $2,266.00PHYS ALLOGRAFT FOR SPINE 20930 $2,266.00REMOVE ELBOW LESION 24120 $2,266.00EGD CONTROL BLEEDING 43255 $2,266.00APPENDECTOMY ADD ON 44955 $2,266.00COLONSCOPY FLEXIBLE W CONTROL BLEEDING 45382 $2,266.00DX LAP ABDOMEN, PERITONEUM W OR WO SPEC 49320 $2,266.00PHYS LAPRO FULG/EXC OVARY 58662 $2,271.00MRI CHEST W/O 71550 $2,278.00MRA ABD W OR WO 74185 $2,285.00CT L SPINE W/WO 72133 $2,305.14DOVONEX 0.005% CRM [60G $2,314.50METACARPAL FRACTURE WITH HARDWARE 26608 $2,318.00MRI TMJ 70336 $2,322.00ARANESP SOL [100MCG/ML] J0881 $2,330.50ALS 2 - RES TO HOSP A0433 $2,334.00ALS 2 - ACC SCENE TO HOSP A0433 $2,334.00ALS 2 - HOSP TO HOSP A0433 $2,334.00ALS 2 - HOSP TO AIRPORT A0433 $2,334.00ALS 2 - LTC TO HOSP A0433 $2,334.00ALS 2 - OTHER AMBULANCE TRANSER A0433 $2,334.00CT ABDOMEN W/WO 74170 $2,345.31BIOPSY ANORECTAL WALL 45100 $2,364.88DRAINAGE OF SKIN ABSCESS 10060 $2,369.00DEBRIDE SKIN AT FX SITE 11010 $2,369.00DEB SUBQ TISSUE 20 SQ CM 11042 $2,369.00FX PHALANX WITH MANIPULATION 26725 $2,369.00TREAT FINGER DISLOCATION REQ ANESTHESIA 26775 $2,369.00TX FINGER DISLOCATION OPEN 26785 $2,369.00AMPUTATION OF FINGER 26951 $2,369.00EGD FLEXIBLE FOREIGN BODY REMOVAL 43247 $2,369.00EGD ENDO MUCOSAL RESECTION 43254 $2,369.00SPINCTEROTOMY ANAL DIVISION SPHINCTER 46080 $2,369.00PHYS ANTERPOST COLPORRAHPHY W/ CYSTO 57260 $2,369.00PHYS REMOVAL OF OVARY(S)/TUBE(S) 58720 $2,369.00CARPAL TUNNEL SURGERY 64721 $2,369.00PHYS LAP CHOLECYSTECTOMY W/CHOL 47563 $2,380.00Rabies Immune Globulin 300 IU / 2 mL 96372 $2,398.30

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DULAGLUTIDE SOLUTION PEN INJECTOR [0.75M $2,400.40DULAGLUTIDE PEN INJECTOR [1.5MG/0.5ML X $2,400.40MRCP S8037 $2,410.00SENSIPAR TAB [30MG TAB BO $2,428.60NM BONESCAN 3PHRASE 78315 $2,442.13MRI BRAIN WO 70551 $2,445.00MRI FOOT LT W & W/O 73720 $2,460.00MRI FOOT RT W & W/O 73720 $2,460.00MRI LOWER LEG LT WITH & W/O 73720 $2,460.00MRI LOWER LEG RT WITH & W/O 73720 $2,460.00MRI THIGH LT WITH & W/O 73720 $2,460.00MRI THIGH RT WITH & W/O 73720 $2,460.00MRI ANKLE LT WITH & W/O 73723 $2,460.00MRI ANKLE RT WITH & W/O 73723 $2,460.00MRI KNEE LT WITH & W/O 73723 $2,460.00MRI KNEE RT WITH & W/O 73723 $2,460.00MRI HIP LT WITH & W/O 73723 $2,460.00MRI HIP RT WITH & W/O 73723 $2,460.00MRI NECK FACE ORBIT WO DYE 70540 $2,461.00MRI ABD W/O 74181 $2,471.00CT ANGIO ABD/PEL W/WO 74174 $2,472.00MRI C SPINE W/O CONT 72141 $2,485.00MRI L SPINE W/O 72148 $2,500.00MRI PELVIS W 72196 $2,500.00MRI THORACIC SPINE W/O CONTRAST 72146 $2,502.00MRA NECK W & W/O 70549 $2,531.00Faslodex 250mg/5ml injection J9395 $2,541.00ZOVIRAX 5% CREAM [5GM TU $2,541.38OBSTETRICAL CARE VAG DELIVERY 59409 $2,557.00ABSCESS COMPLICATED 10061 $2,575.00REMOVAL OF GROWTH OF TRUCK, ARMS, OR LEG 11401 $2,575.00EXC MALIGNANT LESION 3.1-4.0 CM 11624 $2,575.00PHYS MASTECTOMY PARTIAL 19301 $2,575.00APPLY BONE FIXATION DEVICE 20690 $2,575.00TENDON GRAFT 20924 $2,575.00EXC TUMOR SOFT TISSUE FACE/SCALP <2cm 21011 $2,575.00PHYS INJ BIOMECHANICAL DEVICE 22853 $2,575.00DRAINAGE OF ARM BURSA 23931 $2,575.00EXC TUMOR SOFT TISSUE FOREARM 25075 $2,575.00INCISE FINGER TENDON SHEATH 26055 $2,575.00EXPLORE/TREAT FINGER JOINT 26075 $2,575.00EXC HAND LES SC 1.5 CM 26111 $2,575.00

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EXCISION LISION TDN HAND/FINGER 26160 $2,575.00PARTIAL EXC FINGER BONE 26236 $2,575.00CLOSED TX METACARPAL FX W MANIPULATION 26605 $2,575.00FINGER FRACTURE EACH 26742 $2,575.00EXCISION TUMOR SOFT TISSUE 27327 $2,575.00CLOSED TX OF TIBIA FRACTURE 27752 $2,575.00CLOSED TX OF BROKEN ANKLE WITH MANIPULAT 27762 $2,575.00TREAT METATARSAL FRACTURE 28476 $2,575.00SHAVING SHOULDER BONE 29826 $2,575.00THORACOSTOMY 32551 $2,575.00PHYS BX LYMP OPEN DEEP CERVICAL NODE 38510 $2,575.00UNLISTED PROCEDURE (CHANGE DESCRIPTION) 43999 $2,575.00UNLISTED PROCEDURE - ADD DESCRIPTION IN 46999 $2,575.00CIRCUMCISION AGE >28 DAYS 54161 $2,575.00DRAINAGE OF HYDROCELE 55000 $2,575.00ER PHYS VAGINAL DELIVERY 59409 $2,575.00REPAIR OF HAND OR FOOT NERVE 64834 $2,575.00UNLISTED RENAME PROCEDURE CODE 64999 $2,575.00PHYS MODF RADICAL MASTECTOMY 19307 $2,592.00MRI ABD W/ CONTRAST 74182 $2,641.00INCISION & DRAIN HEMATOMA 10140 $2,643.00ICCU ROOM $2,678.00MRI NECK & FACE W CONTRAST 70542 $2,679.00DAPTOmycin * IVPB* (range greater than 5 J0878 $2,705.40VECTICAL OINT [3MCG/GM 10 $2,734.15X-RAY DRAINAGE CATH VISCERA 49405 $2,758.34X-RAY DRAINAGE CATH RETROPERITONEAL 49406 $2,758.34MRI T SPINE W 72147 $2,779.00EXCISION RADIAL HEAD 24130 $2,781.00OPEN TX DISTAL PHALANGEAL FRACTURE EACH 26765 $2,781.00PHYS RESECTION SM INSTESTINE 44120 $2,781.00MRI PELVIS W/WO 72197 $2,791.00RITUXAN INJ [100MG] J9310 $2,827.05MRI L SPINE W 72149 $2,872.00VASECTOMY 55250 $2,884.00LIRAGLUTIDE INJ [1.2mg] $2,912.08MRI BRAIN W STEM W CONTRAST 70552 $2,941.00PHYS LAVH BSO 58552 $2,950.00MRI HAND LT W & W/O 73220 $2,955.00MRI HAND RT WTH & W/O 73220 $2,955.00MRI FOREARM LT W & W/O 73220 $2,955.00MRI FOREARM RT W & W/O 73220 $2,955.00

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MRI UPPER ARM LT W & W/O 73220 $2,955.00MRI UPPER ARM RT W & W/O 73220 $2,955.00MRI WRIST LT W & W/O 73223 $2,955.00MRI WRIST RT W & W/O 73223 $2,955.00MRI ELBOW LT WITH & W/O 73223 $2,955.00MRI ELBOW RT W & W/O 73223 $2,955.00MRI SHOULDER LT WITH & W/O 73223 $2,955.00MRI SHOULDER RT WITH & W/O 73223 $2,955.00MIACALCIN [200 I.U./ML D J0630 $2,989.55CT ABD/PELVIS W/O 74176 $2,999.36EXC BREAST TISSUE OPEN 19120 $3,090.00PHYS RAD RESCT TUMOR TISS BACK/FLANK 5CM 21936 $3,090.00RML TISSUE OR BONE AT ELBOW W TENDO RPR 24359 $3,090.00TREAT KNEE FRACTURE 27535 $3,090.00UNLISTED ARTHROSCOPY PROCEDURE 29999 $3,090.00INTMD RPR N-HF/GENIT >30.0CM 12047 $3,152.00Sec'd clsr of surg wd or dehisce + 13160 $3,152.00BX RT BREAST W STEREOTACTIC 1ST LESION 19081 $3,193.00BX L BREAST W STEREOTACTIC 1ST LESION 19081 $3,193.00BX BREAST W MRI 1ST LESION 19085 $3,193.00EXC MALIGNANT LESION 11644 $3,200.00PHYS TONSILLECTOMY ADENOIDECTOMY <12 42820 $3,200.00PROCRIT INJ [40000U/ML 1 J0885 $3,215.50FERUmoxytol [510MG/17ML] $3,222.75MRI CHEST WITH AND WITHOUT 71552 $3,264.00EXC MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM 11603 $3,296.00BX BREAST W ULTRASOUND 1ST LESION 19083 $3,296.00PHYS SPINE BONE ALGRFT STURCT ADD ON 20931 $3,296.00EXC NECK SOFT TIS 3 CM 21552 $3,296.00OPEN TX CLAVICLE DISLOCATION 23550 $3,296.00EXC ARM ELBOW SOFT TISSUE 3 CM 24071 $3,296.00EXC LESION TENDON SHEATH FOREARM/WRIST 25110 $3,296.00TX THUMB FRACTURE 26650 $3,296.00AMPUTATION OF FINGER/THUMB 26952 $3,296.00EXC THIGH KNEE SOFT TISSUE 3 CM 27337 $3,296.00OP TX KNEE CAP FRACTURE 27524 $3,296.00EXC TUMOR SOFT TISSUE LEG/ANKLE 27632 $3,296.00REPAIR OF TIBIA 27720 $3,296.00OPEN TX DISTAL TIBOFIBULAR JOINT 27829 $3,296.00KNEE ARTHROSCOPY SYNOVECTOMY LIMITED 29875 $3,296.00I&D PERIRECTAL ABSCESS 46040 $3,296.00INCISION OF ANAL SPHINCTER 46080 $3,296.00

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EXC THROMBOSED HEMORRHOID 46320 $3,296.00REMOVE EPIDYMIS LESION 54840 $3,296.00TYMPANOSTOMY 69436 $3,296.00MRI NECK ORBITS FACE W & WO DYE 70543 $3,389.00MRI FACE ORBIT & NECK WO & W DYE 70543 $3,389.00PENLAC SOLN [8% 6.6ML] $3,389.78omalizumab prefilled syringe (150 mg/ml) J2357 $3,393.95immune globulin (10 gm vial) J1459 $3,425.04Ferric Carboxymalt*IVPB* 750MG/NS250ML J1439 $3,427.50MRI ABD W/WO CONTRAST 74183 $3,445.00ARANESP SOL [150MCG/ML] J0881 $3,491.50MRI L SPINE W/WO 72158 $3,493.00MRI BRAIN W/WO 70553 $3,513.00I&REMOVE FB - SUBQ COMP 10121 $3,527.00MRI T SPINE W/WO 72157 $3,560.00VASOPRESSIN DRIP [120units/240ML= 0.5u/m $3,564.58OPEN TX CARPAL SCAPHOID FX 25628 $3,600.00RPR WOUND SCALP NECK UNDERARM LEGS -20CM12005 $3,605.00INSERT SPINE FIXATION DEVICE ADD ON 22845 $3,605.00EXC TUMOR SOFT TISSUE SHOULDER 23071 $3,605.00ELBOW REPAIR PERC 24357 $3,605.00TREAT HUMERUS FRACTURE 24535 $3,605.00TREAT HUMERUS FRACTURE OPEN 24545 $3,605.00OPEN TX FX RAD INTRA-ARTICUL 25608 $3,605.00CLOSED TX CARPAL BONE FRACTURE 25635 $3,605.00OPEN FX ULNAR STYLOID 25652 $3,605.00PARTIAL EXCISION BONE METACARPAL 26230 $3,605.00EXC TUMOR SOFT TISSUE THIGH/KNEE 5 CM 27339 $3,605.00REPAIR ACHILLES TENDON 27650 $3,605.00RPR TENDON FOOT EXTENSOR EACH 28208 $3,605.00ARTHROSCOPY SHOULDER DEBRIDEMENT 29822 $3,605.00CARPAL TUNNEL WRIST ENDOSCOPY 29848 $3,605.00BIOPSY/ REMOVAL LYMPH NODES 38500 $3,605.00BX / EXCISION LYMPH NODES OPEN DEEP CERV 38510 $3,605.00BX EXC LYMPH NODE OPEN DEEP AXILLARY NOD 38525 $3,605.00FREEING OF BOWEL ADHESION 44005 $3,605.00PHY LAPSCOPIC COLECTOMY PTL W ANASTOMOSI44204 $3,605.00LAP SURGICAL WITH BIOPSY 49321 $3,605.00MRI C SPINE W/WO 72156 $3,631.00CT ABD/PELVIS WITH CONTRAST 74177 $3,649.29Thyrogen 1.1 mg vial J3240 $3,658.36Anavip 1 vial $3,668.50

125

REPAIR FINGER TENDON 26418 $3,708.00DRAINAGE CATH TUNNELED ABDOMEN 49418 $3,800.00QUADRICEPS HAMSTRING RUPTURE PRIMARY 27385 $3,811.00HEMORRHOIDECTOMY 46255 $3,811.00HEMORRHOIDECTOMY 46260 $3,811.00PROLIA PFS SOL INJ [60MG J0897 $3,844.88OPEN TX UNLAR FRACTURE PROXIMAL END 24685 $3,914.00PRP TORN LIGAMENT KNEE COLLATERAL 27405 $3,914.00EXCISION LESION TENDON SHEALTH 27630 $3,914.00EXC ABD TUMOR SOFT TISSUE 22903 $4,120.00REPAIR LEG TENDON EACH 27658 $4,120.00OPEN TX ANKLE FRACTURE 27766 $4,120.00PARTIAL REMOVAL COLLAR BONE AT SHOULDER 29824 $4,120.00ADD SURGERY DESCRIPTION 49999 $4,120.00REVISE ULNAR NERVE AT ELBOW 64718 $4,120.00ARANESP SOL [300MCG/0.6ML J0881 $4,188.10INC AND DRAINAGE OF HEMATOMA FLUID 10140 $4,234.00REMOVAL OF CYST AT WRIST 25111 $4,326.00EXC HAND SOFT TISSUE LESS THAN 1.5 CM 26115 $4,326.00REPAIR HAND JOINT 26540 $4,326.00OPEN BIOPSY EXC INGUINOFEMORAL NODES 38531 $4,326.00CHOLECYSTECTOMY W CHOLANGIOGRAPHY 47605 $4,326.00EXCISION HYDROCELE UNILATERAL 55040 $4,326.00DEBRIDE MUSCLE OR FASCIA 20SQ OR LESS 11043 $4,360.00CMPLX RPR 2.6CM - 7.5CM 13132 $4,360.00EXC ABD SOFT TISSUE < 3CM 22902 $4,360.00RPR OF FIBROUS TISSUE OF FOOT 29893 $4,360.00CENTRAL VENOUS TUNNELED CV CATH 36561 $4,360.00INCISION OF TENDON SHEATH 25000 $4,378.00ZOVIRAX 5% OINTMENT [30GM $4,397.50SKIN AFRAFT TRNK / ARMS / LEG 15100 $4,429.00REPAIR OF ANKLE LIGAMENT 27698 $4,429.00OPEN TREATMENT OF BROKEN ANKLE 27814 $4,429.00KNEE ARTHROSCOPY ABRASION 29879 $4,429.00HYSTEROSCOPY / ENDOMETRIAL ABLATION 58563 $4,429.00CT ABD/PELVIS W & W/O 74178 $4,433.12BX BILAT BREAST W STEREO 19081 $4,500.00FOMEPIZOLE SOD INJ [1.5GM J1451 $4,508.50CLOSED TX RADIAL SHAFT FX W MANIP 25505 $4,635.00TREAT FX RAD EXTRA ARTICUL 25607 $4,635.00UNLISTED PROCEDURE (ADD DESCRIPTION) 25999 $4,635.00THIGH FRACTURE SURGERY 27245 $4,635.00

126

TREATMENT OF THIGH FRACTURE 27514 $4,635.00OPEN TX OF BROKEN ANKLE 27792 $4,635.00OPEN TX FRACTURE DISTAL TIBIA 27827 $4,635.00REMOVAL OF METATARSAL 28110 $4,635.00AMPUTATION TOE AND METATARSAL 28810 $4,635.00SHOULDER ARTHROSCOPY 29806 $4,635.00ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYN BX 29870 $4,635.00ARTHROSCOPY KNEE JOINT 29882 $4,635.00KNEE ARTHROSCOPY 29888 $4,635.00SEPTOPLASTY 30520 $4,635.00EXPLORATION OF ABDOMEN 49000 $4,635.00INGUINAL HERNIA RED 5 AND OLDER 49505 $4,635.00RPR INGUINAL HERNIA INCARC AGE 5> 49507 $4,635.00RPR RECURRNT HERNIA INCARCERATED 49566 $4,635.00RPR EPIGASTRIC HERNIA REDUCE 49570 $4,635.00UMBILICAL HERNIA RPR INCARCERATED 49587 $4,635.00LAPAROSCOPY REMOVAL OVARIES AND TUBES 58661 $4,635.00EXC GANGLION WRIST 25112 $4,637.00ARANESP SOL [200MCG/ML] J0881 $4,652.50RENVELA PACKET [0.8GM BOX $4,827.42RENVELA TAB [800MG TAB BT $4,827.43REPAIR OF HAMMERTOE 28285 $4,841.00ROTATOR CUFF REPAIR 29827 $4,924.00RPR RECRT INGUINAL HERNIA ANY AGE 49520 $4,944.00LUPRON DEPOT INJ [ 7.5MG J9217 $5,001.30INJ BIOMECHANICAL DEVICE 22853 $5,150.00BILAT CARPAL TUNNEL WRIST 29848 $5,150.00KNEE ARTHROSCOPY 29877 $5,150.00VERTEBROPLASTY C-T SPINE 22510 $5,172.66VERTEBROPLASTY L/S SPINE 22511 $5,172.66PHYS LAMINOTMY W DCMPRSN NRV E ADDL 63035 $5,356.00ZOLADEX IMPLANT [10.8MG J9202 $5,453.50CORRECTION OF BUNION 28297 $5,465.00Evenity 2x105mg/1.17mL $5,483.50LACER INTMD RPR S/TR/EXT >30.0 CM 12037 $5,629.00ALLOGRAFT FOR SPINE SURGERY 20930 $5,665.00PHYS ADDL NECK SPINE FUSION 22552 $5,665.00PHYS CERVICAL ARTIFICIAL DISKECTOMY 22856 $5,665.00PHYS SECOND LEVEL CERVICAL DISKECTOMY 22858 $5,665.00FIXATION OF SHOULDER 23700 $5,665.00ARTHROPLASTY WRIST JOINTS 25447 $5,665.00OPEN TX TIBAL SHAFT FX W PLATE AND SCREW 27758 $5,665.00

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CHOLECYSTECTOMY 47600 $5,665.00RPR ING HERNIA INIT REDUCE 49500 $5,665.00RPR VENTRAL HERN INCARCERATED 49561 $5,665.00RPR UMBILICAL HERNIA REDUCIBLE > 5 YR 49585 $5,665.00ANTERIOR COLPORRHAPHY 57240 $5,665.00LAMINOTOMY SINGLE LUMBAR 63042 $5,665.00REMOVE SPINAL LAMINA ADD ON 63048 $5,665.00PHYS NEUROPLASTY/ TRANSPOSITION ULNAR NE 64718 $5,665.00FLULVESTRANT PFS [500MG - 2X250MG/5ML] J9395 $5,825.65MIACALCIN [200 I.U./ML E $5,970.60MASTECTOMY PARTIAL REMOVAL 19301 $6,386.00ILEOSTOMY/ JEJUNOSTOMY 44310 $6,386.00LAPAROSCOPIC CHOLECYSTECTOMY 47562 $6,386.00KNEE FRACTURE OPEN 27536 $6,489.00RETAVASE [HALF KIT] J2993 $6,523.32KNEE ARTHROSCOPY LATERAL RELEASE 29873 $6,541.00KNEE ARTHROSCOPY W MENISCECTOMY 29880 $6,541.00KNEE ARTHROSCOPY 29881 $6,541.00LAPAROSCOPIC APPENDECTOMY 44970 $6,541.00LAP CHOLECYSTECTOMY W CHOLANGIOGRAPHY 47563 $6,541.00MASTECTOMY SIMPLE COMPLETE 19303 $6,695.00REPAIR TENDON/ MUSCLE UPPER ARM 24341 $6,695.00OPEN TX ULNAR SHAFT FRACTURE 25545 $6,695.00TREAT THIGH FRACTURE WITH HARDWARE 27235 $6,695.00THIGH FRACTURE 27240 $6,695.00RECONSTRUCTION KNEE 27427 $6,695.00FUSION OF BIG TOE JOINT 28750 $6,695.00ARTHROSCOPY SHOULDER SLAP LESION 29807 $6,695.00REPAIR LIVER WOUND 47350 $6,695.00ANTERPOSTERIOR COPORRHAPHY COMBINED 57260 $6,695.00immune globulin (20 gm vial) J1459 $6,850.08MASTECTOMY PARTIAL W LYMPH NODES 19302 $6,901.00REMOVAL OF BREAST AND UNDERARM LYMPH NOD19307 $6,901.00THIGH FRACTURE 27244 $6,901.00FUSION OF ANKLE JOINT OPEN 27870 $6,901.00OPEN TX THIGH FRACTURE 27236 $7,004.00XGEVA INJ [120MG/1.7ML] $7,065.25RECONSTRUCTION KNEE 27428 $7,107.00OPEN REPAIR OF ROTATOR CUFF 23410 $7,210.00OPEN REDUCTION RADIAL FX 25609 $7,210.00SENSIPAR TAB [90MG BTL] $7,268.80OPEN TX CLAVICULAR FX INTERNAL FIXATION 23515 $7,365.00

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PHYS PERQ VERTEBRAL AUGMENTATION 22514 $7,416.00OPEN TX METACARPAL FRACTURE 26615 $7,416.00OPEN TX SHFT FX WITH 27506 $7,416.00AMPUTATION THIGH THRU FEMUR OPEN 27592 $7,416.00COLECTOMY PATRIAL W ANASTOMOSIS 44140 $7,416.00IMPLANTATION OF EPIDURAL NEUROSTIMULATOR 63650 $7,416.00Kcentra 1000 unit kit $7,508.50VETEBRAL AUGMENTATION ADDITIONAL LEVELS 22515 $7,725.00PHYS NECK SPINE FUSE & REMOVE BEL C2 22551 $7,725.00PHYS LUMBAR SPINE FUSION 22612 $7,725.00REPAIR OF RUPTURED TENDON 24342 $7,725.00OPEN TX FRACTURE DISTAL TIBIA & FIBULA 27828 $7,725.00PHYS LOW BACK DISK SURGERY 63030 $7,725.00REMOVE SPINAL LAMINA 1 LMBR 63047 $7,725.00AMPUTATION OF LOWER LEG 27880 $8,240.00REPAIR VENTRAL HERNIA REDUCIBLE 49560 $8,240.00TREAT FX OPEN ULNA/RADIUS 25575 $8,755.00AMPUTATION OF TOE 28820 $8,755.00REMOVAL OF SMALL INTESTINE 44120 $8,755.00SANDOSTATIN KIT LAR INJ [ $9,363.80CROFAB INJ IV $9,602.50SPINE BONE ALGRFT STRUCT ADD ON 20931 $10,300.00PERQ VERTEBRAL AUGMENTATION 22514 $10,300.00ADDL NECK SPINE FUSION 22552 $10,300.00SECOND LEVEL CERVICAL DISKECTOMY 22858 $10,300.00LAMINOTOMY SINGLE LUMBAR 63042 $10,300.00REMOVE SPINAL LAMINAL ADD ON 63048 $10,300.00INSERTION OR REPLACE SPINAL NEUROSTIMULA 63685 $10,300.00TOTAL KNEE JOINT $10,613.00FORTEO INJ [20MCG/DOSE 75 J3110 $10,802.00TOTAL SHOULDER JOINT 23472 $10,815.00LAMINOTOMY WITH DECOMPRESSION ADD ON 63035 $10,815.00DIGIFAB INJ [40MG] J1162 $11,471.50darbepoetin alfa 500 mcg/1 ml J0881 $11,618.50REVISE REPLACE KNEE JOINT 27487 $11,845.00IDARUCIZUMAB IV SOLUTION [5GM/100ML] $12,028.90THORACIC VERTEBRAL AUGMENTATION 22513 $12,360.00LUMBAR VETEBRAL AUGMENTATION 22514 $12,360.00CERVICAL ARTIFICIAL DISKECTOMY 22856 $12,360.00REMOVE SPINAL LAMINA 1 LMBR 63047 $12,360.00SHOULDER ARTHROPLASTY 23470 $12,566.00NECK SPINE FUSE & REMOV BEL C2 22551 $13,390.00

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tocilizumab 400mg/20mL J3262 $13,843.30TOTAL HIP REPLACEMENT 27130 $13,905.00TOTAL KNEE ARTHROPLASTY 27447 $13,905.00RITUXAN INJ [500MG] J9310 $14,101.30abatacept 4 x 250 mg Vials (1000 mg ) J0129 $14,115.30LUPRON DEPOT INJ [22.5MG J9217 $14,986.88LUMBAR SPINE FUSION 22612 $15,450.00LOW BACK DISK SURGERY 63030 $15,450.00ANDEXXA INJ per 10mg J7169 $16,508.50interferon Beta-1A Inj (30mcg/0.5 mL 4pk $17,471.50TNKase INJ (50mg w/DIL) J2997 $18,665.08NEULASTA INJ [6MG/0.6ML] J2505 $18,701.68BILATERAL TOTAL KNEE ARTHROPLASTY 27447 $19,055.00LUPRON DEPOT INJ [30MG KI J9217 $19,979.68VEDOLIZUMAB INJ 1 MG 300 mg J3380 $20,191.45COPAXONE SYRINGE [20MG BO J1595 $21,350.50ACTIVASE INJ [100MG W/DIL J2997 $26,409.58REMICADE SDV [100MG] J1745 $28,036.10ocrelizumab 300 mg J2350 $48,758.50ocrelizumab 600 mg J2350 $97,508.50

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