Unique ID Item Name CPT NWHSH Price Schedule5311040 31579 Laryngoscopy w/stroboscopy 315795229750 86850 PPD 950045311039 92507 Therapy Speech 925075311038 92521 Evaluation of Speech Fluency 925215229749 95004 Environ or Food SPT 950045229748 95017 Venoms SPT or ID 950175229747 95018 Drugs/Bio SPT or ID 950185229746 95024 Environ ID 950245205428 95115 Single Injection 951155205427 95117 Multiple Injections 951174514755 95145 Venom Prep 1 951454514754 95146 Venom Prep 2 951464514753 95147 Venom Prep 3 951474514752 95148 Venom Prep 4 951484514751 95149 Venom Prep 5 951494514750 95165 Prep of Antigen 951655205426 95165 Prep of Antigen 951655205425 95180 Cluster Shots 951805205424 99070 SB (SLIT) 990701545767 99283 - Level 3 99283 4955310806 A4263 Permanent, long term, non-dissolvable lacrim5310885 A4264 Permanent implantable contraceptive intratub5310884 A4561 Pessary,rubber,any type5310883 A4562 Pessary,non rubber,any type5310805 A4565 Slings5310747 A4570 Splint4285896 A4580 Cast supplies (e.g. plaster)4285895 A4590 Special casting material (e.g. fiberglass)5310658 A4650 Implantable radiation dosimeter, each5310803 A9270 Non-covered item or service5205423 A9270 Sublingual5310657 A9500 Technetium tc-99m sestamibi, diagnostic, per5310656 A9503 Technetium tc-99m medronate, diagnostic, per5310655 A9516 Iodine i-123 sodium iodide, diagnostic, per5310654 A9530 Iodine i-131 sodium iodide solution, therape5310653 A9537 Technetium tc-99m mebrofenin, diagnostic, pe5310652 A9538 Technetium tc-99m pyrophosphate, diagnostic,5310651 A9539 Technetium tc-99m pentetate, diagnostic, per5310650 A9541 Technetium tc-99m sulfur colloid, diagnostic5310649 A9579 Injection, gadolinium-based magnetic resonan4123261 Ankle Gauntlet Lace Up4123260 Ankle Inflatable or Gel4123259 Ankle Stirrup4276413 Ankle splint 295154123258 Ankle/Foot Adjustable Splint1557775 Apply steristrips1557776 Apply skin adhesive4255022 Assist with procedure4614917 Blood patch4123257 Boxer Wrist Splint

The hospital charges on this list are the rates established before any negotiated discounts with patients, payers or insurance companies. Please call Northwest Hills Surgical Hospital at 512-346-1994 for an estimate of your self-pay fee if you do not have

insurance, or for an etimate of the fee your insurance has negotited on your behalf. Please keep in mind insurance rates/allowables and this list of established rates are different.

The items on this charge list are current as of January 1, 2019

1297775 Calibrated volume control chamber5370291 Cane4123255 Cervical Collar Miami J4285759 Cervical Collar Philadelphia Applied4123254 Cock up wrist splint4607654 Continuous irrigation 517005370290 Crutches4255105 Debridement4123252 Don Jouy Dual TLSO4608001 Double Sugar Tong 291055229998 Ear lobe 364161297772 Electronic, syringe1297773 Electronic, pulsatile1297774 Electronic, peristaltic1297770 Extension set1297771 Extension loop4123250 Figure 81297769 Filter4123249 Finger splint4608000 Finger splint,static 291306080449 HBO Extremity Study Unilateral 3+ Levels 939226080450 HBO Extremity Study Unilateral 1-2 Levels 939226080451 HBO Extremity Study Bilateral 3+ Levels 939236080452 HBO Extremity Study Bilateral 1-2 Levels 939224123248 Humeral Brace4610959 Indwelling/Continuous 517022702317 Initial Admin Charge 90471 904711297768 Injection/Access port4247120 Insert new site 366804247152 Insert new site4632786 Insert new tube5283167 Insert6512499 Insert 366804123246 Knee Brace with Adjustable Joints4123247 Knee Brace Rigid without Joints4123245 Knee immobilizer1297767 Manual5704168 Metered dose inhaler 946404622988 Neo-Tee5268955 PHY-BRONCHODILATION RESPONSE PRE AND POST BD 940605268954 PHY-C0 DIFFUSE CAPACITY 947295268953 PHY-CONTINUOUS OVERNIGHT PULSE OXIMETRY 947625268952 PHY-MAXIMUM BREATHING CAPACITY/MVV 942005268950 PHY-PULMONARY FUNCTION TEST PLETHYSOMGRAPHY 947265268951 PHY-PULMONARY FUNCTION TEST BY GAS 947275268949 PHY-SPIROMETRY 940104123244 Pelvic Binder1557773 Place sutures1557774 Place staples4123243 Post Op Shoe4276409 Posterior Slab with Stirrup Short 295154276410 Posterior Slab with Stirrup Long 295054276411 Posterior Short Leg Splint 295154276412 Posterior Long Leg Splint 295054607998 Posterior Short Arm Splint 291254607999 Posterior Long Arm Splint 291056050166 Pulse Oximeter

4285894 Q4001 Casting supplies, body cast adult, with or w4285893 Q4006 Cast supplies, long arm cast, adult (11 year4285891 Q4009 Cast supplies, short arm cast, adult (11 yea4285890 Q4010 Cast supplies, short arm cast, adult (11 yea5310631 Q4011 Cast supplies, short arm cast, pediatric (0-4285888 Q4013 Cast supplies, gauntlet cast (includes lower4285887 Q4014 Cast supplies, gauntlet cast (includes lower5310630 Q4015 Cast supplies, gauntlet cast (includes lower5310629 Q4016 Cast supplies, gauntlet cast (includes lower5310753 Q4019 Cast supplies, long arm splint, pediatric (05310752 Q4023 Cast supplies, short arm splint, pediatric (4285883 Q4030 Cast supplies, long leg cast, adult (11 year4285881 Q4037 Cast supplies, short leg cast, adult (11 yea4285880 Q4038 Cast supplies, short leg cast, adult (11 yea5310628 Q4040 Cast supplies, short leg cast, pediatric (0-5310751 Q4044 Cast supplies, long leg splint, pediatric (05310750 Q4047 Cast supplies, short leg splint, pediatric (5310749 Q4048 Cast supplies, short leg splint, pediatric (4285878 Q4050 Cast supplies, for unlisted types and materi5310802 Q4101 Apligraf, per square centimeter5310801 Q4107 Graftjacket, per square centimeter4568848 Reconstruction of nail4123242 Reddie Knee Brace4123241 Rib Binder4123239 Short Arm Brace4123238 Shoulder immobilizer4123237 Single Shoulder Splint4123236 Sling and swathe5704166 Small volume nebulizer4123235 Soft cervical collar1297766 Solid cannula top1297765 Stopcock4255054 Subungual hematoma4607997 Sugar Tong 291255310877 T1999 Miscellaneous therapeutic items and supplies4246936 Temperature Probe4610953 Temperature Probe4123234 Thumb spica4607996 Thumb spica 291254204071 Trauma 1 (full)4204072 Trauma 2 (partial)4607636 Tube inserted4607995 Ulnar Gutter 291254607994 Volar Splint 291255370289 Walker4123232 Walking Boot Non-inflatable4123233 Walking Boot Inflatable4123231 Wheaton Splint4123230 Wraptor with Speed Laces2702318 Yes 906583018314 Yes4663008 868705336565 740004663006 869004630041 868704663007 868605404105 92586

4630040 86901 105336561 710105336577533657846300432718315 119204607762 112015336589 759895336586 704982888314 7701353365855336587 759845336590 770035336592 770124654511 <BLANK>4654512 <BLANK>4654513 <BLANK>4654514 <BLANK>5336579 770533998352 <BLANK>5336567 742355336573 770035336574 770025336568 743405413057 747405336560 205015336562 516005336563 242205336564 233505336572 252465336580 622845336582 270935336583 273705336584 276485336598 583404663011 869458067674 876405191626 878045336600 770215336599 721975336569 744255397083 925585336566 741904663010466301246300454663009 869654630042 869716110309 7219546630134654515 <BLANK>5336559 703905336591 760804630044 869855336571 744555336570 744505336594 75989

5336597 769465336581 769425336595 768305336575 760806929761 735605336576 760806655835 841326655836 824356655837 829476655838 845206655888 828036655886 823301379881 Anesthesia Time interval - SN 0-60 + 157940094 Prothrombin and INR POC7267079 E0162 ARBC CPD 450 LR Irr7266926 E0162 DRBC CPD 450 LR Irr7266543 E0162 RBC CPD 450 LR Irr7267080 E0164 ARBC CPD 450 LR7266927 E0164 DRBC CPD 450 LR7266544 E0164 RBC CPD 450 LR7267083 E0179 ARBC CPD 500 LR Irr7266930 E0179 DRBC CPD 500 LR Irr7266547 E0179 RBC CPD 500 LR Irr7267084 E0181 ARBC CPD 500 LR7266931 E0181 DRBC CPD 500 LR7266548 E0181 RBC CPD 500 LR7267087 E0207 ARBC CPDA1 450 LR Irr7266934 E0207 DRBC CPDA1 450 LR Irr7266551 E0207 RBC CPDA1 450 LR Irr7267088 E0209 ARBC CPDA1 450 LR7266935 E0209 DRBC CPDA1 450 LR7266552 E0209 RBC CPDA1 450 LR7267091 E0224 ARBC CPDA1 500 LR Irr7266938 E0224 DRBC CPDA1 500 LR Irr7266555 E0224 RBC CPDA1 500 LR Irr7267092 E0226 ARBC CPDA1 500 LR7266939 E0226 DRBC CPDA1 500 LR7266556 E0226 RBC CPDA1 500 LR7267096 E0257 ARBC CP2D 450 LR Irr7266943 E0257 DRBC CP2D 450 LR Irr7266560 E0257 RBC CP2D 450 LR Irr7267097 E0259 ARBC CP2D 450 LR7266944 E0259 DRBC CP2D 450 LR7266561 E0259 RBC CP2D 450 LR7267100 E0274 ARBC CP2D 500 LR Irr7266947 E0274 DRBC CP2D 500 LR Irr7266564 E0274 RBC CP2D 500 LR Irr7267101 E0276 ARBC CP2D 500 LR7266948 E0276 DRBC CP2D 500 LR7266565 E0276 RBC CP2D 500 LR7267105 E0307 ARBC CPD AS1 450 LR Irr7266952 E0307 DRBC CPD AS1 450 LR Irr7266569 E0307 RBC CPD AS1 450 LR Irr7267106 E0311 ARBC CPD AS1 450 LR7266953 E0311 DRBC CPD AS1 450 LR7266570 E0311 RBC CPD AS1 450 LR7267109 E0332 ARBC CPD AS1 500 LR Irr

7267073 E0332 DRBC CPD AS1 500 LR Irr7266573 E0332 RBC CPD AS1 500 LR Irr7267110 E0336 ARBC CPD AS1 500 LR7266956 E0336 DRBC CPD AS1 500 LR7266574 E0336 RBC CPD AS1 500 LR7267113 E0357 ARBC CP2D AS3 450 LR Irr7266959 E0357 DRBC CP2D AS3 450 LR Irr7266577 E0357 RBC CP2D AS3 450 LR Irr7267114 E0361 ARBC CP2D AS3 450 LR7266960 E0361 DRBC CP2D AS3 450 LR7266578 E0361 RBC CP2D AS3 450 LR7267117 E0379 ARBC CP2D AS3 500 LR Irr7266963 E0379 DRBC CP2D AS3 500 LR Irr7266658 E0379 RBC CP2D AS3 500 LR Irr7267118 E0382 ARBC CP2D AS3 500 LR7266964 E0382 DRBC CP2D AS3 500 LR7266659 E0382 RBC CP2D AS3 500 LR7267120 E0398 ARBC CPD AS5 450 LR Irr7266966 E0398 DRBC CPD AS5 450 LR Irr7266662 E0398 RBC CPD AS5 450 LR Irr7267177 E0401 ARBC CPD AS5 450 LR7266663 E0401 RBC CPD AS5 450 LR7267180 E0420 ARBC CPD AS5 500 LR Irr7266970 E0420 DRBC CPD AS5 500 LR Irr7266666 E0420 RBC CPD AS5 500 LR Irr7267181 E0424 ARBC CPD AS5 500 LR7266971 E0424 DRBC CPD AS5 500 LR7266667 E0424 RBC CPD AS5 500 LR7266673 E0661 Aph RBC CP2D AS3 LR Irr7266976 E0661 Aph DRBC CP2D AS3 LR Irr7267191 E0661 Aph ARBC CP2D AS3 LR Irr7266674 E0668 Aph RBC CP2D AS3 LR Irr 17266977 E0668 Aph DRBC CP2D AS3 LR Irr 17267192 E0668 Aph ARBC CP2D AS3 LR Irr 17266675 E0669 Aph RBC CP2D AS3 LR Irr 27266978 E0669 Aph DRBC CP2D AS3 LR Irr 27267193 E0669 Aph ARBC CP2D AS3 LR Irr 27266678 E0678 Aph RBC CP2D AS3 LR7266981 E0678 Aph DRBC CP2D AS3 LR7267196 E0678 Aph ARBC CP2D AS3 LR7266679 E0685 Aph RBC CP2D AS3 LR 17267076 E0685 Aph DRBC CP2D AS3 LR 17267197 E0685 Aph ARBC CP2D AS3 LR 17266680 E0686 Aph RBC CP2D AS3 LR 27266982 E0686 Aph DRBC CP2D AS3 LR 27267198 E0686 Aph ARBC CP2D AS3 LR 27267127 E0773 Thawed FFP CPD7267128 E0782 Thawed FFP CPD Irr7267129 E0785 Thawed FFP CPDA17267130 E0794 Thawed FFP CPDA1 Irr7267131 E0797 Thawed FFP CP2D7267132 E0806 Thawed FFP CP2D Irr7267133 E1237 Thawed Aph FFP ACDA7267134 E1286 Thawed Aph FFP ACDA Irr7267135 E1291 Thawed Aph FFP ACDA Irr <200 mL7267136 E1295 Thawed Aph FFP ACDA Irr 200-400 mL7267137 E1299 Thawed Aph FFP ACDA Irr 400-600 mL

7267138 E1301 Thawed Aph FFP ACDA Irr >600 mL7267139 E1310 Thawed Aph FFP ACDA <200 mL7267140 E1314 Thawed Aph FFP ACDA 200-400 mL7267141 E1318 Thawed Aph FFP ACDA 400-600 mL7267142 E1320 Thawed Aph FFP ACDA >600 mL7267143 E1325 Thawed Aph FFP NaCitrate7267144 E1374 Thawed Aph FFP Irr NaCitrate7267145 E2116 Thawed Aph Plasma ACDB <24h7267146 E2225 Thawed Aph Plasma ACDA Irr <200 mL7267147 E2231 Thawed Aph Plasma ACDA Irr 200-4007267148 E2237 Thawed Aph Plasma ACDA Irr 400-6007267149 E2243 Thawed Aph Plasma ACDA Irr >600 mL7267150 E2260 Thawed Aph Plasma ACDA <200 mL7267151 E2266 Thawed Aph Plasma ACDA 200-400 mL7267152 E2272 Thawed Aph Plasma ACDA 400-600 mL7267153 E2278 Thawed Aph Plasma ACDA >600 mL7267154 E2284 Thawed Aph Plasma ACDA <24h7267156 E2454 Thawed Aph Plasma NaCitrate <24h7267157 E2684 Thawed Plasma CPD7267158 E2697 Thawed Plasma CPD Irr7267159 E2699 Thawed Plasma CPD Irr <24h7267160 E2700 Thawed Plasma CPD Cryo Red7267161 E2701 Thawed Plasma CPD <24h7267162 E2702 Thawed Plasma CPDA17267163 E2715 Thawed Plasma CPDA1 Irr7267165 E2717 Thawed Plasma CPDA1 Irr <24h7267164 E2718 Thawed Plasma CPDA1 Cryo Red7267166 E2719 Thawed Plasma CPDA1 <24h7267167 E2720 Thawed Plasma CP2D7267168 E2733 Thawed Plasma CP2D Irr7267169 E2735 Thawed Plasma CP2D Irr <24h7267170 E2736 Thawed Plasma CP2D Cryo Red7267171 E2737 Thawed Plasma CP2D <24h7267172 E2754 Thawed Plasma ACDB CryoRed7266759 E2940 Aph Plt ACDA7266760 E3045 Aph Plt ACDA Irr7266761 E3046 Aph Plt ACDA LR Irr7266762 E3047 Aph Plt ACDA LR Irr PlasRed7266763 E3049 Aph Plt ACDA LR Irr PlasRed 17266764 E3050 Aph Plt ACDA LR Irr PlasRed 27266765 E3051 Aph Plt ACDA LR Irr PlasRed 37266766 E3056 Aph Plt ACDA LR Irr 17266767 E3057 Aph Plt ACDA LR Irr 27266768 E3062 Aph Plt ACDA Irr PlasRed7266769 E3064 Aph Plt ACDA Irr PlasRed 17266770 E3065 Aph Plt ACDA Irr PlasRed 27266771 E3066 Aph Plt ACDA Irr PlasRed 37266772 E3071 Aph Plt ACDA Irr 17266773 E3072 Aph Plt ACDA Irr 27266774 E3073 Aph Plt ACDA Irr 37266775 E3077 Aph Plt ACDA LR7266776 E3078 Aph Plt ACDA LR PlasRed7266777 E3080 Aph Plt ACDA LR PlasRed 17266778 E3081 Aph Plt ACDA LR PlasRed 27266779 E3082 Aph Plt ACDA LR PlasRed 37266780 E3087 Aph Plt ACDA LR 17266781 E3088 Aph Plt ACDA LR 2

7266782 E3089 Aph Plt ACDA LR 37266783 E3093 Aph Plt ACDA PlasRed7266784 E3095 Aph Plt ACDA PlasRed 17266785 E3096 Aph Plt ACDA PlasRed 27266786 E3097 Aph Plt ACDA PlasRed 37266787 E3102 Aph Plt ACDA 17266855 E3103 Aph Plt ACDA 27266856 E3104 Aph Plt ACDA 37266857 E3108 Aph Plt ACDB7266858 E3213 Aph Plt ACDB Irr7266859 E3214 Aph Plt ACDB LR Irr7266860 E3215 Aph Plt ACDB LR Irr PlasRed7266861 E3217 Aph Plt ACDB LR Irr PlasRed 17266862 E3218 Aph Plt ACDB LR Irr PlasRed 27266863 E3219 Aph Plt ACDB LR Irr PlasRed 37266864 E3224 Aph Plt ACDB LR Irr 17266865 E3225 Aph Plt ACDB LR Irr 27266866 E3226 Aph Plt ACDB LR Irr 37266867 E3230 Aph Plt ACDB Irr Plas Red7266868 E3232 Aph Plt ACDB Irr Plas Red 17266869 E3233 Aph Plt ACDB Irr Plas Red 27266870 E3234 Aph Plt ACDB Irr Plas Red 37266871 E3239 Aph Plt ACDB Irr 17266872 E3240 Aph Plt ACDB Irr 27266873 E3241 Aph Plt ACDB Irr 37266874 E3245 Aph Plt ACDB LR7266875 E3246 Aph Plt ACDB LR PlasRed7266876 E3248 Aph Plt ACDB LR PlasRed 17266877 E3249 Aph Plt ACDB LR PlasRed 27266878 E3250 Aph Plt ACDB LR PlasRed 37266879 E3255 Aph Plt ACDB LR 17266880 E3256 Aph Plt ACDB LR 27266881 E3257 Aph Plt ACDB LR 37266882 E3261 Aph Plt ACDB PlasRed7266883 E3263 Aph Plt ACDB PlasRed 17266884 E3264 Aph Plt ACDB PlasRed 27266885 E3265 Aph Plt ACDB PlasRed 37266886 E3270 Aph Plt ACDB 17266887 E3271 Aph Plt ACDB 27266888 E3539 Aph Plt Washed7266889 E3540 Aph Plt Washed Irr7266890 E3541 Aph Plt Washed LR Irr7266891 E3543 Aph Plt Washed LR Irr 17266892 E3544 Aph Plt Washed LR Irr 27266893 E3545 Aph Plt Washed LR Irr 37266894 E3550 Aph Plt Washed Irr 17266895 E3551 Aph Plt Washed Irr 27266896 E3552 Aph Plt Washed Irr 37266897 E3556 Aph Plt Washed LR7266898 E3558 Aph Plt Washed LR 17266899 E3559 Aph Plt Washed LR 27266900 E3560 Aph Plt Washed LR 37266901 E3565 Aph Plt Washed 17266902 E3566 Aph Plt Washed 27266903 E3567 Aph Plt Washed 37267122 E3579 Thawed Cryo 5007267123 E3581 Thawed Cryo AHF

7267124 E3582 Thawed Cryo AHF Irr7267187 E3591 Thawed Pooled Cryo7267188 E3592 Thawed Pooled Cryo Open7267189 E3593 Thawed Pooled Cryo Irr Open7267190 E3594 Thawed Pooled Cryo Irr7267125 E3599 Thawed Aph Cryo7266685 E4144 Aph RBC Washed LR7266987 E4144 Aph DRBC Washed LR7267203 E4144 Aph ARBC Washed LR7266686 E4145 Aph RBC Washed LR Irr7266988 E4145 Aph DRBC Washed LR Irr7267204 E4145 Aph ARBC Washed LR Irr7266581 E4272 Aph RBC CP2D LR Irr7267055 E4272 Aph DRBC CP2D LR Irr7267209 E4272 Aph ARBC CP2D LR Irr7266582 E4279 Aph RBC CP2D LR Irr 17267056 E4279 Aph DRBC CP2D LR Irr 17267210 E4279 Aph ARBC CP2D LR Irr 17266583 E4280 Aph RBC CP2D LR Irr 27267057 E4280 Aph DRBC CP2D LR Irr 27267211 E4280 Aph ARBC CP2D LR Irr 27266584 E4289 Aph RBC CP2D LR7267058 E4289 Aph DRBC CP2D LR7267212 E4289 Aph ARBC CP2D LR7266585 E4296 Aph RBC CP2D LR 17267059 E4296 Aph DRBC CP2D LR 17267213 E4296 Aph ARBC CP2D LR 17266586 E4297 Aph RBC CP2D LR 27267060 E4297 Aph DRBC CP2D LR 27267214 E4297 Aph ARBC CP2D LR 27266587 E4362 Aph RBC ACDA LR Irr7267061 E4362 Aph DRBC ACDA LR Irr7267215 E4362 Aph ARBC ACDA LR Irr7266588 E4369 Aph RBC ACDA LR Irr 17267062 E4369 Aph DRBC ACDA LR Irr 17267216 E4369 Aph ARBC ACDA LR Irr 17266589 E4370 Aph RBC ACDA LR Irr 27267063 E4370 Aph DRBC ACDA LR Irr 27267217 E4370 Aph ARBC ACDA LR Irr 27266590 E4379 Aph RBC ACDA LR7267064 E4379 Aph DRBC ACDA LR7267218 E4379 Aph ARBC ACDA LR7266591 E4386 Aph RBC ACDA LR 17267065 E4386 Aph DRBC ACDA LR 17267289 E4386 Aph ARBC ACDA LR 17266592 E4387 Aph RBC ACDA LR 27267066 E4387 Aph DRBC ACDA LR 27267219 E4387 Aph ARBC ACDA LR 27267220 E4519 ARBC Deglyc LR7267067 E4519 DRBC Deglyc LR7266593 E4519 RBC Deglyc LR7267222 E4521 ARBC Deglyc LR Irr7267069 E4521 DRBC Deglyc LR Irr7266595 E4521 RBC Deglyc LR Irr7266598 E4526 Aph RBC ACDA AS1 LR Irr7267072 E4526 Aph DRBC ACDA AS1 LR Irr7267225 E4526 Aph ARBC ACDA AS1 LR Irr

7266599 E4527 Aph RBC ACDA AS1 LR Irr 17266991 E4527 Aph DRBC ACDA AS1 LR Irr 17267226 E4527 Aph ARBC ACDA AS1 LR Irr 17266600 E4528 Aph RBC ACDA AS1 LR Irr 27266992 E4528 Aph DRBC ACDA AS1 LR Irr 27267290 E4528 Aph ARBC ACDA AS1 LR Irr 27266601 E4531 Aph RBC ACDA AS1 LR7266993 E4531 Aph DRBC ACDA AS1 LR7267227 E4531 Aph ARBC ACDA AS1 LR7266602 E4532 Aph RBC ACDA AS1 LR 17266994 E4532 Aph DRBC ACDA AS1 LR 17267228 E4532 Aph ARBC ACDA AS1 LR 17266603 E4533 Aph RBC ACDA AS1 LR 27266995 E4533 Aph DRBC ACDA AS1 LR 27267229 E4533 Aph ARBC ACDA AS1 LR 27266608 E4538 Aph RBC ACDA AS3 LR Irr7267000 E4538 Aph DRBC ACDA AS3 LR Irr7267234 E4538 Aph ARBC ACDA AS3 LR Irr7266609 E4539 Aph RBC ACDA AS3 LR Irr 17267001 E4539 Aph DRBC ACDA AS3 LR Irr 17267291 E4539 Aph ARBC ACDA AS3 LR Irr 17266610 E4540 Aph RBC ACDA AS3 LR Irr 27267002 E4540 Aph DRBC ACDA AS3 LR Irr 27267235 E4540 Aph ARBC ACDA AS3 LR Irr 27266613 E4543 Aph RBC ACDA AS3 LR7267005 E4543 Aph DRBC ACDA AS3 LR7267238 E4543 Aph ARBC ACDA AS3 LR7266614 E4544 Aph RBC ACDA AS3 LR 17267006 E4544 Aph DRBC ACDA AS3 LR 17267239 E4544 Aph ARBC ACDA AS3 LR 17266615 E4545 Aph RBC ACDA AS3 LR 27267007 E4545 Aph DRBC ACDA AS3 LR 27267240 E4545 Aph ARBC ACDA AS3 LR 27266618 E4560 Aph RBC Washed LR Irr 17267010 E4560 Aph DRBC Washed LR Irr 17267292 E4560 Aph ARBC Washed LR Irr 17266619 E4561 Aph RBC Washed LR Irr 27267011 E4561 Aph DRBC Washed LR Irr 27267243 E4561 Aph ARBC Washed LR Irr 27266622 E4564 Aph RBC Washed LR 17267014 E4564 Aph DRBC Washed LR 17267246 E4564 Aph ARBC Washed LR 17266623 E4565 Aph RBC Washed LR 27267015 E4565 Aph DRBC Washed LR 27267247 E4565 Aph ARBC Washed LR 27267020 E4582 Aph DRBC Deglyc LR Irr7267251 E4582 Aph ARBC Deglyc LR Irr7266629 E4583 Aph RBC Deglyc LR Irr 17267021 E4583 Aph DRBC Deglyc LR Irr 17267252 E4583 Aph ARBC Deglyc LR Irr 17266630 E4584 Aph RBC Deglyc LR Irr 27267022 E4584 Aph DRBC Deglyc LR Irr 27267253 E4584 Aph ARBC Deglyc LR Irr 27266633 E4587 Aph RBC Deglyc LR7267025 E4587 Aph DRBC Deglyc LR7267256 E4587 Aph ARBC Deglyc LR7266634 E4588 Aph RBC Deglyc LR 1

7267026 E4588 Aph DRBC Deglyc LR 17267257 E4588 Aph ARBC Deglyc LR 17266635 E4589 Aph RBC Deglyc LR 27267027 E4589 Aph DRBC Deglyc LR 27267258 E4589 Aph ARBC Deglyc LR 27267261 E4633 ARBC Deglyc Rej LR7267030 E4633 DRBC Deglyc Rej LR7266638 E4633 RBC Deglyc Rej LR7267262 E4634 ARBC Deglyc Rej LR Irr7267031 E4634 DRBC Deglyc Rej LR Irr7266639 E4634 RBC Deglyc Rej LR Irr7266904 E4635 Aph Plt ACDA <3 X log 117266905 E4636 Aph Plt ACDA <3 X log 11 17266906 E4637 Aph Plt ACDA <3 X log 11 27266908 E4639 Aph Plt ACDA Irr <3 X log 117266907 E4640 Aph Plt ACDA Irr <3 X log 11 17266909 E4643 Aph Plt ACDA LR <3 X log 117266910 E4644 Aph Plt ACDA LR <3 X log 11 17266911 E4645 Aph Plt ACDA LR <3 X log 11 27266912 E4647 Aph Plt ACDA LR Irr <3 X log 117266913 E4648 Aph Plt ACDA LR Irr <3 X log 11 17266914 E4649 Aph Plt ACDA LR Irr <3 X log 11 27266915 E4650 Aph Plt ACDA LR Irr <3 X log 11 37267173 E4713 Thawed Aph FFP ACDA 17267174 E4717 Thawed Aph FFP ACDA 27267175 E4721 Thawed Aph FFP ACDA 37266641 E5114 Aph RBC CPDA1 LR Irr7267034 E5114 Aph DRBC CPDA1 LR Irr7267265 E5114 Aph ARBC CPDA1 LR Irr7266691 E5115 Aph RBC CPDA1 LR Irr 17267035 E5115 Aph DRBC CPDA1 LR Irr 17267266 E5115 Aph ARBC CPDA1 LR Irr 17266642 E5116 Aph RBC CPDA1 LR Irr 27267036 E5116 Aph DRBC CPDA1 LR Irr 27267267 E5116 Aph ARBC CPDA1 LR Irr 27266643 E5117 Aph RBC CPDA1 LR7267037 E5117 Aph DRBC CPDA1 LR7267268 E5117 Aph ARBC CPDA1 LR7266644 E5118 Aph RBC CPDA1 LR 17267038 E5118 Aph DRBC CPDA1 LR 17267269 E5118 Aph ARBC CPDA1 LR 17266645 E5119 Aph RBC CPDA1 LR 27267039 E5119 Aph DRBC CPDA1 LR 27267270 E5119 Aph ARBC CPDA1 LR 27267271 E5155 ARBC CPDA1 LR LV7267040 E5155 DRBC CPDA1 LR LV7266646 E5155 RBC CPDA1 LR LV7267272 E5156 ARBC CPDA1 LR LV Acadj7267041 E5156 DRBC CPDA1 LR LV Acadj7266647 E5156 RBC CPDA1 LR LV Acadj7267275 E5169 ARBC Washed LR7267044 E5169 DRBC Washed LR7266650 E5169 RBC Washed LR7267276 E5170 ARBC Washed LR Irr7267045 E5170 DRBC Washed LR Irr7266692 E5170 RBC Washed LR Irr7267126 E5256 Thawed Cryo

7267176 E5273 Thawed Aph FFP CP2D7267279 E5376 ARBC CPDA1 LR Irr LV7267286 E5376 DRBC CPDA1 LR Irr LV7266653 E5376 RBC CPDA1 LR Irr LV7267280 E5555 ARBC CPDA1 LR Irr LV Acadj7267048 E5555 DRBC CPDA1 LR Irr LV Acadj7266654 E5555 RBC CPDA1 LR Irr LV Acadj7266655 E6653 Aph RBC Deglyc AS3 LR 17267049 E6653 Aph DRBC Deglyc AS3 LR 17267281 E6653 Aph ARBC Deglyc AS3 LR 17266693 E6654 Aph RBC Deglyc AS3 LR 27267050 E6654 Aph DRBC Deglyc AS3 LR 27267282 E6654 Aph ARBC Deglyc AS3 LR 27266656 E6655 Aph RBC Deglyc AS3 LR Irr 17267051 E6655 Aph DRBC Deglyc AS3 LR Irr 17267283 E6655 Aph ARBC Deglyc AS3 LR Irr 17266694 E6656 Aph RBC Deglyc AS3 LR Irr 27267052 E6656 Aph DRBC Deglyc AS3 LR Irr 27267284 E6656 Aph ARBC Deglyc AS3 LR Irr 27266916 E7001 Aph Plt ACDA PASC LR7266917 E7002 Aph Plt ACDA PASC LR 17266918 E7003 Aph Plt ACDA PASC LR 27266919 E7004 Aph Plt ACDA PASC LR 37266920 E7005 Aph Plt ACDA PASC LR Irr7266921 E7006 Aph Plt ACDA PASC LR Irr 17266922 E7007 Aph Plt ACDA PASC LR Irr 27266923 E7008 Aph Plt ACDA PASC LR Irr 31378504 RhIG4512063 zzArterial Blood Gases with Oximetry (Respiratory) 828054512075 zzArterial Blood Gas without Co-ox(Respiratory) pH 828034512077 zzArterial Oximetry only (Respiratory) 828105274748 zzArterial pH (Respiratory) 828004512087 zzCapillary Blood Gas without Co-ox (Respiratory) 828034512089 zzCapillary Oximetry only (Respiratory) 828104512091 zzCapillary Blood Gases with Oximetry (Respiratory 828055274750 zzCapillary pH (Respiratory) 828005274796 zzCarboxyhemoglobin (Respiratory) 823754512090 zzCord Venous Blood Gases with Oximetry (Respirato 828054512092 zzCord Venous Oximetry only (Respiratory) 828104512093 zzCord Arterial Blood Gas without co-ox (Respirato 828034512094 zzCord Arterial Oximetry only (Respiratory) 828104512095 zzCord Venous Blood Gas without co-ox (Respiratory 828034512096 zzCord Arterial Blood Gases with Oximetry (Respira 828055274757 zzCord Arterial pH (Respiratory) 828005274773 zzCord Venous pH (Respiratory) 828005274795 zzMethemoglobin (Respiratory) 830504512081 zzMixed Venous Blood Gas without co-ox (Respirator 828034512083 zzMixed Venous Oximetry only (Respiratory) 828104512084 zzMixed Venous Blood Gases with Oximetry (Respirat 828055274751 zzMixed Venous pH (Respiratory) 828004512079 zzVenous Blood Gases with Oximetry (Respiratory) 828054620136 zzVenous Blood Gases without Co-ox (Respiratory) p 828034623227 zzVenous Oximetry only (Respiratory) 828105274749 zzVenous pH (Respiratory) 828005258098 12 LEAD EKG INTERPRETATION & REPORT 93010 3821059907

Electrocardiogram

4232823 BODY COMPOSITION Units6532165 CALL BACK ECHO BUBBLE STUDY 933084232818 CARDIAC REHAB PII W/O ECG MTR Units 937974232820 CARDIAC REHAB PII W/O ECG MTR Units w KX 937974232821 CARDIAC REHAB PHASE III Units4232825 CARDIAC REHAB PIV PART TIME Units4232827 CARDIAC REHAB PIV FULL TIME Units4232831 CARDIAC REHAB PHASE I-ABR Units5258401 CARDIAC DOPPLER ECHO - COMPLETE 933205258402 CARDIAC DOPPLER ECHO - LIMITED/FOLLOW UP 933215258403 CARDIAC DOPPLER ECHO - COLOR FLOW MAPPING 933255258405 CARDIAC STRESS EKG W/ ECHO BY ECHO DEPARTMENT5259050 CARDIAC STRESS EKG - TRACING ONLY 930174232833 CARDIC REHAB PII W/ECG MNTR Units 937984232845 CARDIC REHAB PII W/ECG MNTR Units w/ KX 937985258099 CARDIOVASCULAR STRESS EKG W/ ECHO-REPORT ONLY 930184157775 Cardiac Rehab Phase I Units41577764232829 EDUCATION & COUNSELING Units51196155129944 Routine ECG 12 leads tracing only 930055129945 Rhythm ECG 1-3 leads tracing only 930415129946 Holter scanning analysis w/ report 12-48 hrs 932265129947 Holter recording up to 48 hours 932255129948 ECG real-time 2D5129949 Cardiovascular stress test trace 930175377246 Routine ECG 12 lead/15 lead tracing only 930055664184 Cardiovascular stress EKG w/ echo - EKG tracing4185151 Echocardiogram Limited 933077940095 Echocardiogram Complete 933062322786 Electrocardiogram 12 Lead 93005 2004232806 FACILTY EST PATIENT E/M LEVEL 1 Units 992114232808 FACILTY EST PATIENT E/M LEVEL 2 Units 992124232810 FACILTY EST PATIENT E/M LEVEL 3 Units 992134232812 FACILTY EST PATIENT E/M LEVEL 4 Units 992144232814 FACILTY EST PATIENT E/M LEVEL 5 Units 992154232843 PERIPHERAL ARTERIAL DISEASE REHAB Units 936684232846 PIV FULL TIME PULMONARY REHAB Units4232850 PIV FULL TIME PULMONARY REHAB w/ KX4232848 PIV PART TIME PULMONARY REHAB Units4232841 PULMONARY REHAB - 1 HOUR SESS Units4232839 RESPIRATORY THERAPY- EA 15 MIN Units5258101 RHYTHM STRIP INTERPRETATION AND REPORT 930424232835 THERP EXERCISE TEACHING 30 MIN Units5259052 TRANSTHORACIC CARDIAC ECHO - CONGENITAL LIMITED 933045259053 TRANSTHORACIC CARDIAC ECHO - LIMITED/FOLLOW UP 933085259054 TRANSTHORACIC CARDIAC ECHO W/ DOPPLER - COMPLETE 933062750323 936602388680 Electrocardiogram (ECG) Routine 12-Lead, I&R only,4189085 zzInjection, morphine sulfate, up to 10 mg3262314 Consult to Crisis Work4117455 3125959224 12 Lead ECG Tracing 930051928297 96360- Hydration, first hour 96360 4151928298 96361- Hydration, each additional hour 96361 1301928299 96365- IV tx, first hour 5301928300 96366- IV tx, each additional hour

1928301 96367- IV tx, sequential infusion 96367 154.921928302 96368- IV tx, concurrent infusion 228.787974016 93670 - Sc Ther Infusion Addl Hr 96370 101.341928303 96372- Subq/IM Injection 1707974017 96373 - Ther/Proph/Diag Inj Ia 96373 523.81928305 96374- IV Injection, single/initial 3101928306 96375- IV Injection, add new drug 1551928307 96376- IV Injection, add same drug 162.758021064 96379 - Ther/Prop/Diag Inj/Inf Proc 96379 101.341179802 DCP_GENERIC7974012 93000 EKG - 12 lead with interpertation and report 93000 3824122933 Foreign Body Removal, Intermediate F00114126010

89613980340658034205 Arthrocentesis, aspiration and/or injection, small 20604 9958034206 Arthrocentesis, aspiration and/or injection, small 20600 15208034207 Arthrocentesis, aspiration and/or injection, major 20610 9958034208 Arthrocentesis, aspiration and/or injection, inter 20606 9958034209 Arthrocentesis, aspiration and/or injection, inter 20605 99580340468034210 Arthrotomy, knee, with exploration, drainage, or r 27310 7104.7880340408034211 Puncture aspiration of abscess, hematoma, bulla, o 10160 15208034212 Fine needle aspiration; without imaging guidance 10021 1520412567680340188034095 Initial treatment, first degree burn, when no more 16000 15208034096 Dressings and/or debridement of partial-thickness 16025 11308034097 Dressings and/or debridement of partial-thickness 16020 9952315214 9296080340308034098 Cardioversion, elective, electrical conversion of 92961 1402.538034099 Cardioversion, elective, electrical conversion of 92960 1402.53803405180340898034325 Application of short leg splint (calf to foot) 29515 364.958034326 Application of short leg cast (below knee to toes) 29425 643.238034327 Application of short leg cast (below knee to toes) 29405 643.238034328 Application of long leg cast (thigh to toes) 29345 643.238034329 Application of long leg splint (thigh to ankle or 29505 364.958034330 Application, cast; shoulder to hand (long arm) 29065 15208034331 Application, cast; hand and lower forearm (gauntle 29085 364.658034332 Application, cast; elbow to finger (short arm) 29075 643.238034333 Application of short arm splint (forearm to hand); 29125 15208034334 Application of short arm splint (forearm to hand); 29126 291.458034335 Application of long arm splint (shoulder to hand) 29105 364.658034336 Application of finger splint; static 29130 158.948034337 Application of finger splint; dynamic 29131 1006.5803401980340848034105 Removal impacted cerumen requiring instrumentation 69210 13308034106 Removal impacted cerumen using irrigation/lavage, 69209 158.948034052803405380340718034072

80340828034090803409180340928034338 Closed treatment of calcaneal fracture; with manip 28405 633.678034339 Closed treatment of calcaneal fracture; without ma 28400 582.278034340 Closed treatment of fracture, phalanx or phalanges 28510 582.278034341 Closed treatment of fracture, phalanx or phalanges 28515 13308034342 Closed treatment of interphalangeal joint dislocat 28660 582.278034343 Closed treatment of metatarsal fracture; without m 28470 582.278034344 Closed treatment of fracture great toe, phalanx or 28495 582.278034345 Closed treatment of metatarsophalangeal joint disl 28630 582.278034346 Closed treatment of talus fracture; without manipu 28430 582.278034347 Open treatment of fracture, great toe, phalanx or 28505 81158034348 Closed treatment of fracture great toe, phalanx or 28490 582.278034349 Closed treatment of metatarsal fracture; with mani 28475 582.278034350 Closed treatment of talus fracture; with manipulat 28435 3547.298034351 Closed treatment of trimalleolar ankle fracture; w 27816 582.278034352 Closed treatment of trimalleolar ankle fracture; w 27818 3547.298034353 Closed treatment of tibial shaft fracture (with or 27752 3547.298034354 Closed treatment of tibial shaft fracture (with or 27750 582.278034355 Closed treatment of tibial fracture, proximal (pla 27530 282.278034356 Closed treatment of tibial fracture, proximal (pla 27532 7104.788034357 Closed treatment of supracondylar or transcondylar 27501 582.278034358 Closed treatment of proximal fibula or shaft fract 27780 2338034359 Closed treatment of proximal fibula or shaft fract 27781 1662.758034360 Closed treatment of posterior malleolus fracture; 27767 582.278034361 Closed treatment of posterior malleolus fracture; 27768 3547.298034362 Closed treatment of patellar fracture, without man 27520 582.278034363 Closed treatment of patellar dislocation; without 27560 582.278034364 Closed treatment of patellar dislocation; requirin 27562 582.278034365 Closed treatment of medial malleolus fracture; wit 27760 582.278034366 Closed treatment of medial malleolus fracture; wit 27762 3547.298034367 Closed treatment of knee dislocation; without anes 27550 582.278034368 Closed treatment of intercondylar spine(s) and/or 27538 582.278034369 Closed treatment of fracture of weight bearing art 27825 3547.298034370 Closed treatment of fracture of weight bearing art 27824 582.278034371 Closed treatment of femoral shaft fracture, with m 27502 3547.298034372 Closed treatment of femoral fracture, distal end, 27510 3547.298034373 Closed treatment of femoral fracture, distal end, 27508 582.278034374 Closed treatment of distal fibular fracture (later 27788 582.278034375 Closed treatment of distal fibular fracture (later 27786 582.278034376 Closed treatment of distal femoral epiphyseal sepa 27517 3547.298034377 Closed treatment of bimalleolar ankle fracture (eg 27810 3547.298034378 Closed treatment of bimalleolar ankle fracture (eg 27808 582.278034379 Closed treatment of ankle dislocation; without ane 27840 582.278034380 Closed treatment of ankle dislocation; requiring a 27842 3547.298034381 Treatment of spontaneous hip dislocation (developm 27257 3547.298034382 Closed treatment of post hip arthroplasty dislocat 27265 582.278034383 Closed treatment of post hip arthroplasty dislocat 27266 3547.298034384 Closed treatment of intertrochanteric, peritrochan 27240 582.278034385 Closed treatment of hip dislocation, traumatic; wi 27250 582.278034386 Closed treatment of hip dislocation, traumatic; re 27252 3547.298034387 Closed treatment of femoral fracture, proximal end 27230 582.278034388 Closed treatment of acetabulum (hip socket) fractu 27222 582.278034389 Closed treatment of vertebral fracture(s) and/or d 22315 89658034390 Open treatment of interphalangeal joint dislocatio 26785 2716.54

8034391 Closed treatment of phalangeal shaft fracture, pro 26725 9958034392 Closed treatment of phalangeal shaft fracture, pro 26720 7558034393 Closed treatment of metacarpophalangeal dislocatio 26705 26308034394 Closed treatment of metacarpophalangeal dislocatio 26700 15208034395 Closed treatment of metacarpal fracture, single; w 26600 15208034396 Closed treatment of metacarpal fracture, single; w 26605 11308034397 Closed treatment of interphalangeal joint dislocat 26775 39258034398 Closed treatment of interphalangeal joint dislocat 26770 15208034399 Closed treatment of distal phalangeal fracture, fi 26755 15208034400 Closed treatment of distal phalangeal fracture, fi 26750 15208034401 Closed treatment of carpometacarpal fracture dislo 26645 12858034402 Closed treatment of carpometacarpal dislocation, t 26641 15208034403 Closed treatment of carpometacarpal dislocation, o 26670 15208034404 Closed treatment of articular fracture, involving 26742 21708034405 Closed treatment of articular fracture, involving 26740 14008034406 Closed treatment of sternoclavicular dislocation; 23525 16708034407 Closed treatment of shoulder dislocation, with sur 23675 22258034408 Closed treatment of shoulder dislocation, with man 23655 39258034409 Closed treatment of shoulder dislocation, with man 23650 9958034410 Closed treatment of shoulder dislocation, with fra 23665 31758034411 Closed treatment of scapular fracture; without man 23570 9958034412 Closed treatment of scapular fracture; with manipu 23575 24108034413 Closed treatment of proximal humeral (surgical or 23605 64158034414 Closed treatment of proximal humeral (surgical or 23600 13308034415 Closed treatment of greater humeral tuberosity fra 23620 13308034416 Closed treatment of clavicular fracture; without m 23500 9958034417 Closed treatment of clavicular fracture; with mani 23505 48108034418 Closed treatment of acromioclavicular dislocation; 23540 9958034419 Closed treatment of acromioclavicular dislocation; 23545 46308034420 Closed treatment of temporomandibular dislocation; 21480 9958034421 Closed treatment of nasal septal fracture, with or 21337 48258034422 Closed treatment of nasal bone fracture; without s 21315 42858034423 Closed treatment of nasal bone fracture without ma 21310 11308034424 Treatment of closed elbow dislocation; without ane 24600 10008034425 Treatment of closed elbow dislocation; requiring a 24605 54958034426 Closed treatment of ulnar styloid fracture 25650 15208034427 Closed treatment of ulnar shaft fracture; without 25530 13308034428 Closed treatment of ulnar shaft fracture; with man 25535 28408034429 Closed treatment of ulnar fracture, proximal end; 24670 9958034430 Closed treatment of ulnar fracture, proximal end; 24675 21808034431 Closed treatment of trans-scaphoperilunar type of 25680 11308034432 Closed treatment of supracondylar or transcondylar 24535 58508034433 Closed treatment of supracondylar or transcondylar 24530 9958034434 Closed treatment of radial shaft fracture; without 25500 13308034435 Closed treatment of radial shaft fracture; with ma 25505 31758034436 Closed treatment of radial shaft fracture and clos 25520 41658034437 Closed treatment of radial head subluxation in chi 24640 15208034438 Closed treatment of radial head or neck fracture; 24650 13308034439 Closed treatment of radial head or neck fracture; 24655 21408034440 Closed treatment of radial and ulnar shaft fractur 25560 7558034441 Closed treatment of radial and ulnar shaft fractur 25565 25858034442 Closed treatment of Monteggia type of fracture dis 24620 48108034443 Closed treatment of lunate dislocation, with manip 25690 55608034444 Closed treatment of humeral shaft fracture; withou 24500 10658034445 Closed treatment of humeral shaft fracture; with m 24505 30408034446 Closed treatment of humeral epicondylar fracture, 24565 12758034447 Closed treatment of humeral epicondylar fracture, 24560 995

8034448 Closed treatment of humeral condylar fracture, med 24577 36258034449 Closed treatment of humeral condylar fracture, med 24576 9958034450 Closed treatment of distal radioulnar dislocation 25675 23308034451 Closed treatment of distal radial fracture (eg, Co 25605 25508034452 Closed treatment of distal radial fracture (eg, Co 25600 8008034453 Closed treatment of carpal scaphoid (navicular) fr 25624 73658034454 Closed treatment of carpal scaphoid (navicular) fr 25622 15208034455 Closed treatment of carpal bone fracture (excludin 25635 40958034456 Closed treatment of carpal bone fracture (excludin 25630 133080340478034213 Repair, complex, trunk; each additional 5 cm or le8034214 Repair, complex, trunk; 2.6 cm to 7.5 cm8034215 Repair, complex, trunk; 1.1 cm to 2.5 cm 13100 24008034216 Repair, complex, scalp, arms, and/or legs; each ad 13122 1320.248034217 Repair, complex, scalp, arms, and/or legs; 2.6 cm 13121 15858034218 Repair, complex, forehead, cheeks, chin, mouth, ne 13131 793.18034219 Repair, complex, forehead, cheeks, chin, mouth, ne 13132 21408034220 Repair, complex, forehead, cheeks, chin, mouth, ne 13133 9958034221 Repair, complex, eyelids, nose, ears and/or lips; 13153 15858034222 Repair, complex, eyelids, nose, ears and/or lips; 13152 2005803404880340498034223 Debridement, subcutaneous tissue (includes epiderm 11045 13008034224 Debridement, subcutaneous tissue (includes epiderm 11042 793.18034225 Debridement, open wound, including topical applica 97597 4958034226 Debridement, muscle and/or fascia (includes epider 11043 793.18034227 Debridement, bone (includes epidermis, dermis, sub 11044 866.258034228 Debridement of nail(s) by any method(s); 1 to 5 11720 15208034229 Debridement of extensive eczematous or infected sk 11000 19858034230 Debridement including removal of foreign material 11012 866.258034231 Debridement including removal of foreign material 11010 250080340118034467 Spinal puncture, lumbar, diagnostic 62270 12808034468 Arterial puncture, withdrawal of blood for diagnos 36600 133080340798034232 Blepharotomy, drainage of abscess, eyelid 67700 13308034233 Drainage external ear, abscess or hematoma; simple 69000 14208034234 Drainage external ear, abscess or hematoma; compli 69005 52208034235 Drainage external auditory canal, abscess 69020 17458034236 Drainage of scrotal wall abscess 55100 35508034237 Drainage of finger abscess; simple 26010 15208034238 Drainage of finger abscess; complicated 26011 1472.638034239 Drainage of abscess of palate, uvula 42000 113051990495367566 Routine ECG 12 lead/15 lead tracing only 9300580340838034100 Rhythm ECG, 1-3 leads; with interpretation and rep 93040 3828034101 Rhythm ECG, 1-3 leads; tracing only without interp 93041 2158034102 Electrocardiogram, routine ECG with at least 12 le 93000 3828034103 Electrocardiogram, routine ECG with at least 12 le 93005 20080340428034116 Nasopharyngoscopy with endoscope (separate procedu 92511 4268034117 Nasal endoscopy, diagnostic, unilateral or bilater 31231 9958034118 Laryngoscopy, flexible fiberoptic; with removal of 31577 21708034119 Laryngoscopy, direct, operative, with foreign body 31530 54008034120 Laryngoscopy direct, with or without tracheoscopy; 31515 54005099691

80340648034204 Injection, epidural, of blood or clot patch 62273 20058034020803403980340858034107 Removal of foreign body from pharynx 42809 13308034108 Removal foreign body from external auditory canal; 69200 291.458034109 Removal foreign body from external auditory canal; 69205 59058034110 Removal foreign body, intranasal; requiring genera 30310 49058034111 Removal foreign body, intranasal; office type proc 30300 152080340108034121 Repositioning of a naso- or oro-gastric feeding tu 43761 22008034122 Replacement of gastrostomy or cecostomy (or other 49450 18408034123 Replacement of gastro-jejunostomy tube, percutaneo 49452 27608034124 Replacement of duodenostomy or jejunostomy tube, p 49451 22308034125 Naso- or oro-gastric tube placement, requiring phy 43752 13308034126 Change of gastrostomy tube, percutaneous, without 43760 99580340868034240 Excision of thrombosed hemorrhoid, external 46320 62058034241 Incision of thrombosed hemorrhoid, external 46083 629.49412556380340238034242 Incision and drainage, upper arm or elbow area; bu 23931 52208034243 Incision and drainage, perianal abscess, superfici 46050 31208034244 Incision and drainage, deep abscess, bursa, or hem 27301 57358034245 Incision and drainage, complex, postoperative woun 10180 55408034246 Incision and drainage of vaginal hematoma; obstetr 57022 32558034247 Incision and drainage of submucosal abscess, rectu 45005 62058034248 Incision and drainage of pilonidal cyst; simple 10080 1570.868034249 Incision and drainage of pilonidal cyst; complicat 10081 32558034250 Incision and drainage of ischiorectal and/or perir 46040 62058034251 Incision and drainage of hematoma, seroma or fluid 10140 1472.638034252 Incision and drainage of abscess; simple or single 10060 7558034253 Incision and drainage of abscess; complicated or m 10061 11708034254 Incision and drainage abscess; peritonsillar 42700 203580340248034255 Incision and removal of foreign body, subcutaneous 10120 20008034256 Incision and removal of foreign body, subcutaneous 10121 486080340508034257 Repair, intermediate, wounds of scalp, axillae, tr 12035 17558034258 Repair, intermediate, wounds of scalp, axillae, tr 12031 852.638034259 Repair, intermediate, wounds of scalp, axillae, tr 12036 26908034260 Repair, intermediate, wounds of scalp, axillae, tr 12032 8658034261 Repair, intermediate, wounds of scalp, axillae, tr 12037 51508034262 Repair, intermediate, wounds of scalp, axillae, tr 12034 11758034263 Repair, intermediate, wounds of neck, hands, feet 12045 13008034264 Repair, intermediate, wounds of neck, hands, feet 12041 526.598034265 Repair, intermediate, wounds of neck, hands, feet 12042 8958034266 Repair, intermediate, wounds of neck, hands, feet 12044 12158034267 Repair, intermediate, wounds of neck, hands, feet 12046 11308034268 Repair, intermediate, wounds of face, ears, eyelid 12055 11308034269 Repair, intermediate, wounds of face, ears, eyelid 12051 8558034270 Repair, intermediate, wounds of face, ears, eyelid 12053 9808034271 Repair, intermediate, wounds of face, ears, eyelid 12054 11308034272 Repair, intermediate, wounds of face, ears, eyelid 12052 82536235058034066

8034273 Closure of laceration, vestibule of mouth; 2.5 cm 40830 15208034274 Closure of laceration, vestibule of mouth; over 2. 40831 18958034275 Intraoral incision and drainage of abscess, cyst, 41000 42858034276 Drainage of abscess, cyst, hematoma, vestibule of 40800 15208034277 Repair lip, full thickness; over one-half vertical 40654 38458034278 Repair lip, full thickness; vermilion only 40650 20208034279 Repair of laceration of tongue, floor of mouth, ov 41252 18958034280 Repair of laceration 2.5 cm or less; floor of mout 41250 1130415729180340258034281 Tube thoracostomy, includes connection to drainage 32551 35358034282 Replacement, complete, of a peripherally inserted 36584 31108034283 Pleural drainage, percutaneous, with insertion of 32556 3889.418034284 Insertion of peripherally inserted central venous 36568 44708034285 Insertion of peripherally inserted central venous 36569 1993.418034286 Insertion of peripherally inserted central venous 36571 7365

886303803402680340808034287 Avulsion of nail plate, partial or complete, simpl 11730 15208034288 Evacuation of subungual hematoma 11740 15208034289 Excision of nail and nail matrix, partial or compl 11750 866.258034290 Repair of nail bed 11760 375.388034291 Repair blood vessel, direct; lower extremity 35226 1570.868034292 Repair blood vessel, direct; upper extremity 35206 6878.2880340778034112 Control nasal hemorrhage, posterior, with posterio 30906 5168034113 Control nasal hemorrhage, anterior, simple (limite 30901 755412556480340218034022803402780340288034043803404480340458034067803406880340698034078803408180340878034127 Unlisted procedure, rectum 45999 1945.448034128 Removal of fecal impaction or foreign body (separa 45915 39158034129 Gastric intubation and aspiration(s) therapeutic, 43753 13008034130 Esophagoscopy, flexible, transoral; with removal o 43215 35658034131 Esophagogastroduodenoscopy, flexible, transoral; w 43247 25258034132 Anoscopy; with removal of foreign body 46608 31458034189 Introduction of any hemostatic agent or pack for s 57180 15208034190 Removal of foreign body, foot; subcutaneous 28190 30158034191 Unlisted procedure, skin, mucous membrane and subc 17999 23558034192 Removal of foreign body, upper arm or elbow area; 24200 30558034193 Aspiration of bladder; with insertion of suprapubi 51102 51858034194 Irrigation of corpora cavernosa for priapism 54220 9958034195 Unlisted procedure, male genital system 55899 629.498034196 Unlisted procedure, urinary system 53899 629.498034197 Bladder irrigation, simple, lavage and/or instilla 51700 629.49

8034198 Unlisted procedure, pharynx, adenoids, or tonsils 42999 5168034293 Mastotomy with exploration or drainage of abscess, 19020 52208034294 Nasal/sinus endoscopy, surgical; with control of n 31238 54008034295 Control nasal hemorrhage, posterior, with posterio 30905 9958034296 Control nasal hemorrhage, anterior, complex (exten 30903 9958034297 Suture of recent wound, eyelid, involving lid marg 67930 50208034298 Unlisted procedure, dentoalveolar structures 41899 27258034299 Application of a uniplane (pins or wires in 1 plan 20690 130558034300 Removal of foreign body in muscle or tendon sheath 20520 37758034301 Exploration of penetrating wound (separate procedu 20103 34008034302 Arthrotomy, elbow, including exploration, drainage 24000 82358034303 Repair, tendon or muscle, upper arm or elbow, each 24341 120558034304 Unlisted procedure, vascular surgery 37799 17058034041803407380340938034114 Unlisted procedure, nose 30999 31608034115 Unlisted procedure, external ear 69399 5168034457 Wedging of cast (except clubfoot casts) 29740 643.238034458 Unlisted procedure, casting or strapping 29799 364.658034459 Unlisted procedure, musculoskeletal system, genera 20999 139008034460 Unlisted procedure, leg or ankle 27899 32108034461 Unlisted procedure, humerus or elbow 24999 582.278034462 Unlisted procedure, hands or fingers 26989 59108034463 Unlisted procedure, femur or knee 27599 67102315264412593780340708034305 Removal of foreign body, intraocular; from anterio 65235 46608034306 Removal of foreign body, external eye; corneal, wi 65220 15208034307 Removal of foreign body, external eye; corneal, wi 65222 15208034308 Removal of foreign body, external eye; conjunctiva 65205 15208034309 Removal of foreign body, external eye; conjunctiva 65210 15208034310 Removal of embedded foreign body, eyelid 67938 208080340888034311 Treatment of superficial wound dehiscence; simple 12020 32208034312 Simple repair of superficial wounds of scalp, neck 12005 11308034313 Simple repair of superficial wounds of scalp, neck 12001 375.388034314 Simple repair of superficial wounds of scalp, neck 12002 15208034315 Simple repair of superficial wounds of scalp, neck 12004 7558034316 Simple repair of superficial wounds of scalp, neck 12007 11308034317 Simple repair of superficial wounds of scalp, neck 12006 11308034318 Simple repair of superficial wounds of face, ears, 12016 11308034319 Simple repair of superficial wounds of face, ears, 12011 15208034320 Simple repair of superficial wounds of face, ears, 12017 11308034321 Simple repair of superficial wounds of face, ears, 12015 7558034322 Simple repair of superficial wounds of face, ears, 12018 11308034323 Simple repair of superficial wounds of face, ears, 12014 7558034324 Simple repair of superficial wounds of face, ears, 12013 152080340298034464 Strapping; shoulder 29240 158.858034465 Strapping; knee 29530 158.948034466 Strapping; hand or finger 29280 82.68412599380340318034469 Transcatheter therapy, venous infusion for thrombo 37212 6878.288034470 Irrigation of implanted venous access device for d 96523 158.94

8034471 Ipecac or similar administration for individual em 99175 443.522314941412535580340768034104 Temporary transcutaneous pacing 92953 1402.5380340628034199 Insertion of non-indwelling bladder catheter 51701 291.458034200 Insertion of temporary indwelling bladder catheter 51703 370.358034201 Insertion of temporary indwelling bladder catheter 51702 13308034202 Change of cystostomy tube; simple 51705 152080340948034472 Unlisted vaccine/toxoid 90749 920.438034473 Immunization administration (includes percutaneous 90471 1558034474 Immunization administration (includes percutaneous 90472 154.9280340638034203 Declotting by thrombolytic agent of implanted vasc 36593 10052389449 Emergency Department Visit Limited/Minor Prob 9928 99281 2002389450 Emergency Department Visit Low/Moder Severity 9928 99282 3252389451 Emergency Department Visit Moderate Severity 99283 99283 4952389452 Emergency Department Visit High/Urgent Severity 99 99284 968.582389453 Emergency Dept Visit High Severity+Threat Funcj 99 99285 11758021061 ER Visit (Phys) Level 1 992818021062 ER Visit (Phys) Level 2 992828021063 ER Visit (Phys) Level 3 992838032708 Sleep Study Paramaters W/T 958108032709 Sleep Testing Record 958058032710 Sleep w/ Airway Pres 958118074561 83516 IMMUNOASSAY NONANTIBODY 835168074564 84482 844828074563 85307 ASSAY ACTIVATED PROTEIN C 853078074562 86003 ALLG SPEC IGE CRUDE XTRC EA 860038074565 86060 ANTISTREPTOLYSIN O TITER 860608074567 86664 EPSTEIN-BARR NUCLEAR ANTIGEN 866648074568 86665 EPSTEIN-BARR CAPSID VCA 866658074566 86800 THYROGLOBULIN ANTIBODY 868008064534 ABO Group & Rh Type IP 869017908541 Acute Hepatitis Panel 800744123305 AFP, Tumor Marker, Serum (ARUP) 821068064540 AFP, Tumor Marker, Serum (ARUP) IP 82106

633655 ANA Screen with reflex to ENA 86038 46.788047415 ANA Screen, IFA, w/REFL Titer and Pattern 86038 46.788064551 ANA Screen w/ Reflex to ENA IP 860387940028 Ab Screen 869008064486 Ab Screen IP 86900

633631 ACT 853477939987 ALT 844608064543 Alanine Aminotransferase IP 844607939988 Albumin Level 820408064546 Albumin Level IP 820408064549 Albumin/Creatinine Ratio Urine IP7939989 Amylase Level 82150 25.087940031 Anti-HBs 873408064555 Anti-HBs IP 873408036378 Arterial Blood Gas 82803 142.757940033 Arthritis Panel II IP8064558 Arthritis IP7940034 Autoimmune Panel 85316

8064564 Autoimmune Panel IP7939975 Basic Metabolic Panel 80048 32.758064565 Basic Metabolic Panel IP 80048 32.754192197 Beta hCG Urine POC 810257939974 Beta hCG Quantitative 847027939990 Beta hCG Qualitative 847037940022 Beta hCG Qualitative Urine 810258064571 Beta hCG Qualitative IP 847038064573 Beta hCG Qualitative Urine IP 810258064575 Beta hCG Quantitative IP 847021147891 HCO3 Ven 828037208187 HCO3 Cap 828037412712 HCO3 Art 828034242724 Bleeding Time 850028064576 Bleeding Time IP 850027506540 Blood Gas Arterial IP 828034240538 Body Fluid Differential 890517939993 C-Reactive Protein 86140 20.027939994 C-Reactive Protein High Sensitivity 86141 50.118064494 C-Reactive Protein High Sensitivity IP 861418064497 C-Reactive Protein IP 861408036466 CBC 85025 39.098036536 CBC (H/H, RBC, INDICES, WBC, PLT) 85027 25.057932542 CBC w/ Manual Diff 850228064578 CBC w/ Differential IP 85025 39.098064579 CBC w/ Manual Differential IP 850328064580 CBC w/o Differential IP 85027 25.053798345 CBC w/o Diff 85027 25.058009666 CK-MB 82553 225.738047419 CK-MB Index8036388 CTNI (Troponins) 84484 38.097939991 Calcium Level Total 823108064577 Calcium Level Total IP 823108064582 Chlamdia, Amplified, Swab IP 874917940037 Chlamydia, Aptima 87491 131.347940038 Chlamydia/GC, Aptima IP 87491 131.342086303 Chloride 824357939992 Cholesterol IP 824657940025 Clostridium difficile ToXin 874938064488 Clostridium Difficile Toxin IP 874937939973 Comprehensive Metabolic Panel 80053 40.898064489 Comprehensive Metabolic Panel IP 80053 40.897939972 Creatinine 82565 14.827939995 Creatine Kinase 822507940023 Creatinine Clearance 825757940039 Creatinine/GFR IP 82565 19.768064501 Creatinine IP 825657939966 Culture, Blood 870407939968 Culture, Urine, Routine 87086 31.247940040 Culture, Aerobic IP 870457940042 Culture, Aerobic Bacteria 87070 33.337940047 Culture, Group A Strep 87880 46.427940048 Culture, Group B Strep 87802 46.427940054 Culture, Viral, Non-Respiratory 87252 308036472 Culture, Aerobic & Anaerobic IP 870738036474 Culture, Aerobic w/o Gram Stain IP 870468047093 Culture, Aerobic & Anaerobic w/ Gram Stain 87070 33.33

8047116 Culture, Anaerobic Bacteria w/ Gram Stain 87075 36.68064507 Culture, Aerobic Bacteria IP 870758064509 Culture, Anaerobe IP 870768064512 Culture, Blood IP 870778064516 Culture, Fungal IP 870718064520 Culture, Fungus, Blood IP 870868064525 Culture, Genital IP 870818064529 Culture, Group A Strep IP 871028064533 Culture, Herpes Simplex IP 871868064535 Culture, Mycoplasma/Ureaplasma IP 871858064538 Culture, Routine IP 872058064541 Culture, Sputum IP 872068064545 Culture, Stool IP 871168064548 Culture, Throat IP 873298064550 Culture, Urine IP 870868064554 Culture, Viral, Non-Respiratory IP 872528064556 Culture/Smear AFB IP 871167908546 D-Dimer 853797939996 DHEA Sulfate 82627 35.712924315 Drug Screen 803077908547 Drug Screen Urine 80305 758064559 Drug Screen Urine IP 803051902793 ESR Westergren 85652 10.28064490 ESR Westergren IP 85652 10.27939971 Electrolyte Panel 80051 27.148064487 Electrolyte Panel IP 80051 27.147939997 Estradiol Level 826708047092 Estradiol 826707940056 Fecal Leukocytes IP 89055

633789 Fecal Occult Blood (Guaiac) 82272 12.64123037 Fecal Occult Blood (Fecal Immunochemical Test - FI 82274 61.558064496 Fecal Occult Blood (Fecal Immunochemical Test - FI 822748064498 Fecal Occult Blood (Guaiac) IP 822724123047 Fecal WBC 822747939998 Ferritin 827287939999 Folate Level 82746 308064502 Folate Level IP 827467940000 Free T4 84439 34.98064503 Free T4 Level IP 844397940057 Fungal Stain 87206 16.538064504 Fungal Stain IP 872057940001 Gentamicin Level Peak 801707940002 Gentamicin Level Trough 801707940058 Giardia, Direct Detect IP 873297908550 Glucose Fasting 82947 14.827940026 Glucose (POCT) IP 829628064508 Glucose Fasting IP 829477940059 Gram Stain IP 872058036540 HCG, Total, Qn 847028036541 HDL IP 837188036543 HIV 1/2 Antigen/Antibody, 4th Gen. w/ REFL 86703 53.087939977 HIV Ag/Ab Combo 1/2 (Diagnostic) IP 873897939978 HIV Ag/Ab Combo 1/2 Screen 873893454426 HIV Antibody 1/2 (exposure only) 86703 53.083454429 HSV Glycoprotein I IgG 86695 51.043454326 Helicobacter pylori Antibody IgG 866778064514 Helicobacter Pylori Antibody IgG IP 86677

633742 Hematocrit 85014 9.161148184 Hct 85014 9.161635636 Hct 850148064515 Hematocrit IP 85014 9.16

633741 Hemoglobin 85018 9.161148187 Hgb 85018 9.161628899 Hemoglobin and Hematocrit1635635 Hgb 850184192198 Hemoglobin A1c (POCT) 830367940003 Hemoglobin A1c 830368064517 Hemoglobin A1c IP 830367940004 Hepatic Function Panel 80076 31.68064521 Hepatic Function Panel IP 80076

633752 Hepatitis B Surface Antigen 87340 277939976 Hepatitis A Antibody IgM 86709 43.567940005 Hepatitis B Surface Antibody 86706 41.587940006 Hepatitis C Antibody 87520 77.618036542 Hepatitis B Surface Antigen w/REFL Confirm 873408047104 Hepatitis C AB w/REFL to HCV RNA, Qn, PCR 87520 77.618064523 Hepatitis A Antibody IgM IP 867098064524 Hepatitis B Surface Antibody IP 867068064526 Hepatitis B Surface Antigen IP 873408064528 Hepatitis C Antibody IP 87520

633758 Homocysteine Total 830903454331 IgA 300827843454332 IgG 827847940062 Influenza A/B Ag 87400 46.428064530 Influenza A/B Ag IP 874003454335 Insulin Level Total 83525 66.967940063 Iron Deficiency Panel IP 835407940007 Iron Level 83540 127940008 Iron Level and TIBC 83550 218064493 Iron Level and TIBC IP 835508064499 Iron Level IP 835408047422 Iron and Total Iron Binding Capacity 83550 217939979 Lactate Dehydrogenase 836158064505 Lactate Dehydrogenase IP 836157940009 Lipase Level 83690 247940010 Lipid Panel 800618064511 Lipid Panel IP 800617939980 Lithium Level 801788064519 Lithium Level IP 801787939981 Luteinizing Hormone 830028064532 Luteinizing Hormone IP 830028037271 Magnesium 83735 188047418 MMR (IgG) (Measles, Mumps, Rubella) 86762 55.697940065 MMR Titers IP 867658064553 MRSA Swab of the Nares IP 876418036527 Magnesium Level 83735 184184836 Miscellaneous Lab Test8064649 Miscellaneous Test IP

633785 Mononucleosis Screen 86663 50.778064544 Mononucleosis Screen IP 866638047328 Mycobacteria, Culture, w/ Fluorochrome Smear 87116 41.838064560 NG, Amplified, Swab IP 875918064563 NG, Amplified, Urine IP 875927940069 Ova and Parasites 82177

8064569 Ova and Parasites IP 821777412706 pCO2 Art 828037208186 pCO2 Cap 828031147885 pCO2 Ven 828037412709 pO2 Art 828037208185 pO2 Cap 828031147888 pO2 Ven 828037939985 PSA Diagnostic 84153 71.28064584 PSA Diagnostic IP 841537939986 PSA Screening 84153 71.28064585 PSA Screening IP 841538047094 PSA, Total 84153

607683 Pain Assessment Adult7940070 Parasite Ag Profile, Stool 87169 16.537384545 PTT 85730 188047102 Partial Thromboplastin Time, Activated 85730 188064570 Partial Thromboplastin Time IP 857308036181 Pathology Tissue Request7939982 Phenytoin Level Free and Total IP 801857940011 Phosphorus Level IP 841007940024 Platelet Count IP 85049

631568 Potassium Lvl 84132 17.727939970 Potassium Level 84132 17.798064574 Potassium Level IP 841327939983 Prealbumin 841347940012 Progesterone Level 84144 80.748047412 Progesterone, LC/MS/MS 84144 80.747940013 Prolactin Level 84146 74.998064581 Prolactin Level IP 841467939984 Prostate Specific Antigen Free And Total IP 84154

633816 Protein Electrophoresis IP 841654123036 PT 85610 14.757939969 Prothrombin Time and INR IP 85610 14.758036547 Prothrombin Time-INR 85610 14.757940014 Quantiferon Gold-TB 864807940076 RSV Rapid IP 87807 46.42

633820 RPR 865927810541 RPR Titer 86592 16.537940075 Rapid Strep w/RefleX 87880 46.428064495 Rapid Strep w/Reflex IP 878807940015 Renal Function Panel 80069 33.618064500 Renal Function Panel IP 800693454466 Reticulocyte Count with Immature Reticulocyte Frac 850458064572 Reticulocyte Count with Immature Reticulocyte Frac 850453454344 Rheumatoid Factor 86430 21.958064506 Rheumatoid Factor IP 864307940077 Rubella Ab 86762 55.698064510 Rubella Ab IP 867628036398 SO2 828108047103 Sed Rate by Modified Westergren, Manual 85652 10.28037364 Serotonin, Serum

631569 Sodium Lvl 84295 18.628064491 T-Spot TB IP 864817940016 T3 Free 84481 65.568064513 T3 Free IP 844818064518 T3 Total IP 844808047114 T3, Free 84481 65.56

8036553 T3, Total 844807940017 T3,Total 844808047107 T4, Free 84439 34.98036511 TSH 84443 65.018064650 TSH w/Free T4 Reflex IP 844433170320 Testosterone Level Total (Male) 84403 99.913454414 Testosterone Level Free (Male) 84402 98.568036557 Testosterone, FR(Dialysis) & Total (LC/MS/MS) 84402 98.568047411 Testosterone, Total, LC/MS/MS 84403 99.918064522 Testosterone Level Free (Male) IP 844028064527 Testosterone Level Total (Male) IP 844032924319 Thrombin Time 856707940018 Thyroid PeroXidase Antibodies 86376 56.327940019 Thyroid Stimulating Hormone 84443 65.017940078 Thyroid Panel I (T3,T4) IP 844797940079 Thyroid Panel III, HYPO (FTI, TSH) IP8047420 Thyroid Panel 844798064536 Thyroid Stimulating Hormone IP 844431147877 CO2 Totl Art 828031147897 CO2 Totl Ven 828037412737 CO2 Totl Cap 828037940020 T4 84436 26.598064539 Total T4 Level IP 844368047108 Triglycerides IP 844781634892 Troponin I 844847940080 Type/Crossmatch (units) 86920 106.928067689 Type/Crossmatch (units) IP7940081 Type/Screen (pre-transfusion) 86922 275.358067679 Type/Screen (pre-transfusion) IP

633864 Urinalysis Microscopic 81015633857 Urea Nitrogen Urine IP 84540633858 Uric Acid 84450 20.02

8064552 Uric Acid IP 844503455592 Urinalysis with Culture if Indicated 87086 31.244123061 Urinalysis w/ Microscopic IP 81001 12.244192196 Urinalysis (POCT) IP 810018047095 Urinalysis, Complete 81001 12.248064557 Urinalysis w/ Culture if Indicated IP 870868064561 Vaginal Pathogen Panel IP

633867 Valproic Acid Level IP 801641634896 Vancomycin Level Peak 802021634897 Vancomycin Level Trough 802028036516 Vancomycin, Trough 802023454356 Varicella Zoster Antibody IgG 86787 31.658036408 Venous Blood Gas 82803 142.75

633871 Vitamin B12 Level 82607 364240407 Vitamin D 25 Hydroxy Level 82306 105.168047413 Vitamin D, 25-OH, Total, IA 82306 105.168047421 Vitamin B12/Folate, Serum Panel 82607 368064562 Vitamin B12 Level IP 826078064566 Vitamin D 25-Hydroxy Level IP 823067940060 hCG Qualitative 847032182297 zPlatelet Count 850491148021 zUrinalysis with Culture if Indicated 810031148022 zUrinalysis with Microscopic if Indicated 810034242286 zzRENAL FUNCTION PANEL4241981 zzTRIGLYCERIDES

41259814125982272437027243714125923 365924125983 365925367494 INF Bld Drw CVC/PICC6130717 Blood Draw CVC/PICC w/ Procedure6130718 Blood Draw CVC/PICC Procedure Only 365926144168 Blood Draw Implt Dev w/ Procedure6144169 Blood Draw Implt Dev 3659127243645256290 TRANSFUSION, > 4 HOURS 364305256291 TRANSFUSION, <4 HOURS 364304125932 964502724365 3659341253505076946 EST PT IV THPY VST LVL 5 992155076947 EST PT IV THPY VST LVL 4 992145076948 EST PT IV THPY VST LVL 3 992135076949 EST PT IV THPY VST LVL 2 992125076950 EST PT IV THPY VST LVL 1 992114125899 904714125900 904722724368 365564125354 517014125904 517205284556 360005284582412590227243664125925 992115077061 Insert PICC w/o Port >=5 yrs 365695077062 Insert PICC w/o Port <5 yrs 365682724372 965234125924 965234125985 365844125897 365754125934 865802724369 9919541259224125984 364152724352 964162724347 964172724345 964132724346 964152724348 964092724349 964115367477 INF/C IV Push Each Addt'l Drug2724350 964012724351 964025367483 INF/NC IV Push Each Add'l Same Drug62248256224827541132854113295411330

54113315411332541133354113355411334

297645 API20C 87106634214 AFS 87206634221 Amik 87181294941 Amoxicillin/Clavulanate 87181634300 Amox/Cla 87181294939 Ampicillin/Sulbactam 87181634301 Ampho 87181634299 Amp 87181634014 ANI 87076634016 AR 87206634297 Azith 87181634296 Azl 87181634295 Azt 87181634025 bLac 87185634293 Bet 87185

7036183 C AFB Blood 870461207772 C Blood 870757036211 C Sterility 870717036214 C Stool Surv 870717036260 C Strep 870717036263 C Synovial Fluid 87071

634030 CAMP 87077634292 Carb 87181634291 Cefac 87181634290 Cefman 87181634289 Cefaz 87181634320 Cefd 87181634288 Cefep 87181634287 Cefet 87181634286 Cefix 87181634285 Cefm 87181634284 Cefon 87181634283 Cefper 87181634282 Cefo 87181634281 Cefot 87181634280 Cefox 87181634279 Cefpod 87181634278 Cefp 87181634277 Cefsul 87181634276 Ceftaz 87181634305 Ceftib 87181634275 Ceftiz 87181634274 Ceftri 87181634322 Cefpir 87181634035 Crystal 87077634034 CTA 87077634051 DFA 87270634053 ECO157 LTX 87335634080 GT 87210634217 GS 87205297662 GNI 87077297663 GPI 87077

634081 Gram 87205634093 II 87210294944 KB 87184634325 Levo 87181294946 MIC 87186634115 MAFS 87206634311 Moxi 87181634239 Pen 87181634143 Pyr 87077634148 Sal VI 87147634149 Sal Poly 87147634157 Sal D 87147634165 Shig A 87147634166 Shig D 87147634167 Shig C 87147634168 Shig B 87147634065 FunSlide 87107634179 StrpA 87147634183 StrpB 87147634182 StrpC 87147634181 StrpF 87147634180 StrpG 87147297693 ST 87158634173 SpneAg 87147634227 Tetra 87181634198 Tre 87106634222 Vanc 87181297694 YBC 87077

2388936 zzMult sleep latency/analy/interp 95805 958056873924 zzMlt Sleep Latency/Maint of Wakefulness Tstg 9580 95805461374846140486771713461389046137044613810461373046137294613891461375046137064613819461396046137014613702461396146137514613889461382046137524613808461389246139594613749461375346138094614046

461404746137035205775 978045205723 97802520571952058005205741 97803520572452057765205777520577852057994614050461370546140493622838 291263622840 291313623261 291253623264 291303622816 971131373442 OT Attended E-Stim Units 970321749463174947417494852520297 CN 100% impaired2520298 CM At least 80% but less than 100% impaired2520299 CL At least 60% but less than 80% impaired2520300 CK At least 40% but less than 60% impaired2520301 CJ At least 20% but less than 40% impaired2520302 CI At least 1% but less than 20% impaired2520303 CH 0% impaired2520304 CN 100% impaired2520305 CM At least 80% but less than 100% impaired2520306 CL At least 60% but less than 80% impaired2520307 CK At least 40% but less than 60% impaired2520308 CJ At least 20% but less than 40% impaired2520309 CI At least 1% but less than 20% impaired2520310 CH 0% impaired2520311 CN 100% impaired2520312 CM At least 80% but less than 100% impaired2520313 CL At least 60% but less than 80% impaired2520314 CK At least 40% but less than 60% impaired2520315 CJ At least 20% but less than 40% impaired2520316 CI At least 1% but less than 20% impaired2520317 CH 0% impaired1749458174946917494802520318 CN 100% impaired2520319 CM At least 80% but less than 100% impaired2520320 CL At least 60% but less than 80% impaired2520321 CK At least 40% but less than 60% impaired2520322 CJ At least 20% but less than 40% impaired2520323 CI At least 1% but less than 20% impaired2520324 CH 0% impaired2520325 CN 100% impaired2520326 CM At least 80% but less than 100% impaired

2520327 CL At least 60% but less than 80% impaired2520328 CK At least 40% but less than 60% impaired2520329 CJ At least 20% but less than 40% impaired2520330 CI At least 1% but less than 20% impaired2520331 CH 0% impaired2520332 CN 100% impaired2520333 CM At least 80% but less than 100% impaired2520334 CL At least 60% but less than 80% impaired2520335 CK At least 40% but less than 60% impaired2520336 CJ At least 20% but less than 40% impaired2520337 CI At least 1% but less than 20% impaired2520338 CH 0% impaired1749459174947017494812520339 CN 100% impaired2520340 CM At least 80% but less than 100% impaired2520341 CL At least 60% but less than 80% impaired2520342 CK At least 40% but less than 60% impaired2520343 CJ At least 20% but less than 40% impaired2520344 CI At least 1% but less than 20% impaired2520345 CH 0% impaired2520346 CN 100% impaired2520347 CM At least 80% but less than 100% impaired2520348 CL At least 60% but less than 80% impaired2520349 CK At least 40% but less than 60% impaired2520350 CJ At least 20% but less than 40% impaired2520351 CI At least 1% but less than 20% impaired2520352 CH 0% impaired2520353 CN 100% impaired2520354 CM At least 80% but less than 100% impaired2520355 CL At least 60% but less than 80% impaired2520356 CK At least 40% but less than 60% impaired2520357 CJ At least 20% but less than 40% impaired2520358 CI At least 1% but less than 20% impaired2520359 CH 0% impaired1373452 OT Cognitive Skills Development Units 975321373453 OT Community, Work Reintegration Units 975371373567 OT Contrast Bath Units 970344238047 970144238180 9703242383774238187423804813736734238046 970394238106137393513739361373451 97150 1763623167362337736233814238051423837842380894238332

13739311373932137393313739348048008 9716736233821373443 OT Iontophoresis Units 970338048007 971651373444 OT Manual Therapy Units 971401373445 OT Massage Units 971241749464174947517494862520360 CN 100% impaired2520361 CM At least 80% but less than 100% impaired2520362 CL At least 60% but less than 80% impaired2520363 CK At least 40% but less than 60% impaired2520364 CJ At least 20% but less than 40% impaired2520365 CI At least 1% but less than 20% impaired2520366 CH 0% impaired2520367 CN 100% impaired2520368 CM At least 80% but less than 100% impaired2520369 CL At least 60% but less than 80% impaired2520370 CK At least 40% but less than 60% impaired2520371 CJ At least 20% but less than 40% impaired2520372 CI At least 1% but less than 20% impaired2520373 CH 0% impaired2520374 CN 100% impaired2520375 CM At least 80% but less than 100% impaired2520376 CL At least 60% but less than 80% impaired2520377 CK At least 40% but less than 60% impaired2520378 CJ At least 20% but less than 40% impaired2520379 CI At least 1% but less than 20% impaired2520380 CH 0% impaired1749457174946817494792520381 CN 100% impaired2520382 CM At least 80% but less than 100% impaired2520383 CL At least 60% but less than 80% impaired2520384 CK At least 40% but less than 60% impaired2520385 CJ At least 20% but less than 40% impaired2520386 CI At least 1% but less than 20% impaired2520387 CH 0% impaired2520388 CN 100% impaired2520389 CM At least 80% but less than 100% impaired2520390 CL At least 60% but less than 80% impaired2520391 CK At least 40% but less than 60% impaired2520392 CJ At least 20% but less than 40% impaired2520393 CI At least 1% but less than 20% impaired2520394 CH 0% impaired2520395 CN 100% impaired2520396 CM At least 80% but less than 100% impaired2520397 CL At least 60% but less than 80% impaired2520398 CK At least 40% but less than 60% impaired2520399 CJ At least 20% but less than 40% impaired2520400 CI At least 1% but less than 20% impaired

2520401 CH 0% impaired8048004 971664238181 971121373446 OT Neuromuscular Reeducation Units 971123622821 925261373573 OT Orthotic Management, Train Units 977601749461174947217494832520402 CN 100% impaired2520403 CM At least 80% but less than 100% impaired2520404 CL At least 60% but less than 80% impaired2520405 CK At least 40% but less than 60% impaired2520406 CJ At least 20% but less than 40% impaired2520407 CI At least 1% but less than 20% impaired2520408 CH 0% impaired2520409 CN 100% impaired2520410 CM At least 80% but less than 100% impaired2520411 CL At least 60% but less than 80% impaired2520412 CK At least 40% but less than 60% impaired2520413 CJ At least 20% but less than 40% impaired2520414 CI At least 1% but less than 20% impaired2520415 CH 0% impaired2520416 CN 100% impaired2520417 CM At least 80% but less than 100% impaired2520418 CL At least 60% but less than 80% impaired2520419 CK At least 40% but less than 60% impaired2520420 CJ At least 20% but less than 40% impaired2520421 CI At least 1% but less than 20% impaired2520422 CH 0% impaired1373447 9701841945131373669 OT Physical Performance Test 977501373575 OT Prosthetic Management, Train Units 977611373548 97168 1101373569 OT Self Care, Home Management Units 975351749460174947117494822520423 CN 100% impaired2520424 CM At least 80% but less than 100% impaired2520425 CL At least 60% but less than 80% impaired2520426 CK At least 40% but less than 60% impaired2520427 CJ At least 20% but less than 40% impaired2520428 CI At least 1% but less than 20% impaired2520429 CH 0% impaired2520430 CN 100% impaired2520431 CM At least 80% but less than 100% impaired2520432 CL At least 60% but less than 80% impaired2520433 CK At least 40% but less than 60% impaired2520434 CJ At least 20% but less than 40% impaired2520435 CI At least 1% but less than 20% impaired2520436 CH 0% impaired2520437 CN 100% impaired2520438 CM At least 80% but less than 100% impaired2520439 CL At least 60% but less than 80% impaired2520440 CK At least 40% but less than 60% impaired

2520441 CJ At least 20% but less than 40% impaired2520442 CI At least 1% but less than 20% impaired2520443 CH 0% impaired1373568 OT Sensory Integrative Techniques Units 975331749462174947317494842520444 CN 100% impaired2520445 CM At least 80% but less than 100% impaired2520446 CL At least 60% but less than 80% impaired2520447 CK At least 40% but less than 60% impaired2520448 CJ At least 20% but less than 40% impaired2520449 CI At least 1% but less than 20% impaired2520450 CH 0% impaired2520451 CN 100% impaired2520452 CM At least 80% but less than 100% impaired2520453 CL At least 60% but less than 80% impaired2520454 CK At least 40% but less than 60% impaired2520455 CJ At least 20% but less than 40% impaired2520456 CI At least 1% but less than 20% impaired2520457 CH 0% impaired2520458 CN 100% impaired2520459 CM At least 80% but less than 100% impaired2520460 CL At least 60% but less than 80% impaired2520461 CK At least 40% but less than 60% impaired2520462 CJ At least 20% but less than 40% impaired2520463 CI At least 1% but less than 20% impaired2520464 CH 0% impaired1373449 OT Therapeutic Exercise Units 971101373450 OT Therapeutic Activities Units 975301373448 OT Ultrasound Units 970351373553 970164238333 97799137392513739264238199423841436231664238105423833142384151373570 OT Wheelchair Management Units 975421373554 9702213735711373552 97014

619588 Occupational Therapy Evaluation and Treatment Acut7982580 Mod Sedation 1st 15 minutes (pt<5yrs) 991517982581 Mod Sedation 1st 15 minutes (pt 5 or older)) 991527982582 Mod Sedation add'l 15 mintes 991536822307 Ped crit care transport 99466 (25) 994667980971 Follow Up Medical Consult 1 992317982578 Follow Up Medical Consult 2 992327982579 Follow UP Medical Consult 3 992337940129 Arterial Blood Gas iSTAT7940119 B-Type Natriuretic Peptide iSTAT 83880 179.5

607617 Blood Glucose Monitoring POC7940116 Blood Glucose iSTAT

7940113 Blood Urea Nitrogen iSTAT7940120 CK-MB iSTAT 82553 225.737940121 CTNI (Troponins) iSTAT7940131 Chem 8 iSTAT 80047 32.757940112 Chloride iSTAT7940115 Creatinine iSTAT7940126 HCO3 iSTAT7940118 Hematocrit iSTAT7940117 Hemoglobin iSTAT8082740 Hemoglobin and Hematocrit iSTAT7940114 Ionized Calcium iSTAT 52.887940128 Lactate iSTAT7940124 PO2 iSTAT7940111 Potassium iSTAT7940127 SO2 iSTAT7940110 Sodium iSTAT7940125 TCO2

607619 Urine Dipstick POC 81003607621 Urine Pregnancy Test POC

7940130 Venous Blood Gas iSTAT7940123 pCO2 iSTAT7940122 pH iSTAT42352354235190 9760242352974235281423528342352854235287423528942352914235293423529542352374235186 975974235188 975983496345 295811373918 971131374008 9775513740291374113 909011749491174950017495092520465 CN 100% impaired2520466 CM At least 80% but less than 100% impaired2520467 CL At least 60% but less than 80% impaired2520468 CK At least 40% but less than 60% impaired2520469 CJ At least 20% but less than 40% impaired2520470 CI At least 1% but less than 20% impaired2520471 CH 0% impaired2520472 CN 100% impaired2520473 CM At least 80% but less than 100% impaired2520474 CL At least 60% but less than 80% impaired2520475 CK At least 40% but less than 60% impaired2520476 CJ At least 20% but less than 40% impaired2520477 CI At least 1% but less than 20% impaired

2520478 CH 0% impaired2520746 CN 100% impaired2520747 CM At least 80% but less than 100% impaired2520748 CL At least 60% but less than 80% impaired2520749 CK At least 40% but less than 60% impaired2520750 CJ At least 20% but less than 40% impaired2520751 CI At least 1% but less than 20% impaired2520752 CH 0% impaired4235384423525342353605242898423525142353803470353 959921749492174950117495102520479 CN 100% impaired2520480 CM At least 80% but less than 100% impaired2520481 CL At least 60% but less than 80% impaired2520482 CK At least 40% but less than 60% impaired2520483 CJ At least 20% but less than 40% impaired2520484 CI At least 1% but less than 20% impaired2520485 CH 0% impaired2520486 CN 100% impaired2520487 CM At least 80% but less than 100% impaired2520488 CL At least 60% but less than 80% impaired2520489 CK At least 40% but less than 60% impaired2520490 CJ At least 20% but less than 40% impaired2520491 CI At least 1% but less than 20% impaired2520492 CH 0% impaired2520493 CN 100% impaired2520494 CM At least 80% but less than 100% impaired2520495 CL At least 60% but less than 80% impaired2520496 CK At least 40% but less than 60% impaired2520497 CJ At least 20% but less than 40% impaired2520498 CI At least 1% but less than 20% impaired2520499 CH 0% impaired4235206 297991374118 975371374011 970341374032 2936552430113470356 970241374009 970324235196 970144235200 9701442353254235323423532742353281374035 1254235388423535042353464235348

4235239423524142352424235245423529942353014235303423530542353073470348 9703942353621374013 97116 951374125 97150 1764235338423534242353444235340423524742352498047993 971631374111 970103470358 970261373909 97033423526742352694235271423527742352634235265423536842352734235279423525542353648048002 97161 115423539042353921373910 97140 951373912 970121749490174949917495082520500 CN 100% impaired2520501 CM At least 80% but less than 100% impaired2520502 CL At least 60% but less than 80% impaired2520503 CK At least 40% but less than 60% impaired2520504 CJ At least 20% but less than 40% impaired2520505 CI At least 1% but less than 20% impaired2520506 CH 0% impaired2520528 CN 100% impaired2520529 CM At least 80% but less than 100% impaired2520530 CL At least 60% but less than 80% impaired2520531 CK At least 40% but less than 60% impaired2520532 CJ At least 20% but less than 40% impaired2520533 CI At least 1% but less than 20% impaired2520534 CH 0% impaired2520535 CN 100% impaired

2520536 CM At least 80% but less than 100% impaired2520537 CL At least 60% but less than 80% impaired2520538 CK At least 40% but less than 60% impaired2520539 CJ At least 20% but less than 40% impaired2520540 CI At least 1% but less than 20% impaired2520541 CH 0% impaired8047992 971624235192 976065137345 976075137347 976081373913 97112 95419452642353091374015 977621374120 977601749494174950317495122520550 CN 100% impaired2520551 CM At least 80% but less than 100% impaired2520552 CL At least 60% but less than 80% impaired2520553 CK At least 40% but less than 60% impaired2520554 CJ At least 20% but less than 40% impaired2520555 CI At least 1% but less than 20% impaired2520556 CH 0% impaired2520557 CN 100% impaired2520558 CM At least 80% but less than 100% impaired2520559 CL At least 60% but less than 80% impaired2520560 CK At least 40% but less than 60% impaired2520561 CJ At least 20% but less than 40% impaired2520562 CI At least 1% but less than 20% impaired2520563 CH 0% impaired2520739 CN 100% impaired2520740 CM At least 80% but less than 100% impaired2520741 CL At least 60% but less than 80% impaired2520742 CK At least 40% but less than 60% impaired2520743 CJ At least 20% but less than 40% impaired2520744 CI At least 1% but less than 20% impaired2520745 CH 0% impaired4235370423537242353744235376423537842353581373914 9701841947401374017 977504235194 9776142352294235231423538613739151374018 29445423531942353214235311

4235313423531542353171374117 975351749493174950217495112520507 CN 100% impaired2520508 CM At least 80% but less than 100% impaired2520509 CL At least 60% but less than 80% impaired2520510 CK At least 40% but less than 60% impaired2520511 CJ At least 20% but less than 40% impaired2520512 CI At least 1% but less than 20% impaired2520513 CH 0% impaired2520514 CN 100% impaired2520515 CM At least 80% but less than 100% impaired2520516 CL At least 60% but less than 80% impaired2520517 CK At least 40% but less than 60% impaired2520518 CJ At least 20% but less than 40% impaired2520519 CI At least 1% but less than 20% impaired2520520 CH 0% impaired2520521 CN 100% impaired2520522 CM At least 80% but less than 100% impaired2520523 CL At least 60% but less than 80% impaired2520524 CK At least 40% but less than 60% impaired2520525 CJ At least 20% but less than 40% impaired2520526 CI At least 1% but less than 20% impaired2520527 CH 0% impaired1373916 975331374034 294051374352 292401374353 292601374354 292801374355 295201374356 295301374357 295401374358 295504235202 292001749495174950417495132520564 CN 100% impaired2520565 CM At least 80% but less than 100% impaired2520566 CL At least 60% but less than 80% impaired2520567 CK At least 40% but less than 60% impaired2520568 CJ At least 20% but less than 40% impaired2520569 CI At least 1% but less than 20% impaired2520570 CH 0% impaired2520571 CN 100% impaired2520572 CM At least 80% but less than 100% impaired2520573 CL At least 60% but less than 80% impaired2520574 CK At least 40% but less than 60% impaired2520575 CJ At least 20% but less than 40% impaired2520576 CI At least 1% but less than 20% impaired2520577 CH 0% impaired2520578 CN 100% impaired2520579 CM At least 80% but less than 100% impaired

2520580 CL At least 60% but less than 80% impaired2520581 CK At least 40% but less than 60% impaired2520582 CJ At least 20% but less than 40% impaired2520583 CI At least 1% but less than 20% impaired2520584 CH 0% impaired3470350 6455042353561374020 97110 951374031 97530 954235184 971241374021 970353470360 970284235204 295801374023 970164235351423535242353544235382423536642353304235332423533442353361373917 97542 951374112 970223470354 970223470368 97597

619590 Physical Therapy Evaluation and Treatment Acute689595 Physical Therapy Treatment Acute

4512678451267951472755191390 Sleep Study Attended 95807 958075191391 Pulse Oximetry, Overnight 94762 947625191392 Polysomnography 4+ parameters, under 6 yrs 95782 957825191393 Polysomnography 4+ parameters w/PAP, under 6 yrs 957835191394 Polysomnography 4+ parameters w/PAP 95811 958115191395 Polysomnography 4+ parameters 95810 958105191396 Polysomnography 1-3 parameters 95808 958085191397 Multiple Sleep Latency Test 95805 958055191398 Misc Sleep Procedure5191399 Home Sleep Study Unattended 95806 958065191400 EEG w/Video, Per 24 Hours 95951 959515191401 At-home Pulse Oximetry, Overnight 94762 947625191402 Actigraphy Testing 95803 958035191409 Sleep Study Attended or PAP Nap 95807 958075191410 Polysomnography 4+ parameters, under 6 yrs 95782 957825191411 Polysomnography 4+ parameters w/PAP, under 6 yrs 957835191412 Polysomnography 4+ parameters w/PAP 95811 958115191413 Polysomnography 4+ parameters 95810 958105191414 Polysomnography 1-3 parameters 95808 958085191415 Multi Sleep Latency Test 95805 958055191416 Home Sleep Study Unattended 95806 958066230171 9476246724085403964 36000 IV Access 360004613677 92559

4656986 989603020045424152942416654663119 V5243 - MONAURAL HEARING AID (ITC)4663120 V5242 - MONAURAL HEARING AID (CIC)4663121 V5060 - MONAURAL HEARING AID (BTE)4663122 V5050 - MONAURAL HEARING AID (ITE)4663123 V5040 - HEARING AID MONAURAL BONE COND5274122 V5249 - BINAURAL HEARING AID (ITC)5274123 V5248 - BINAURAL HEARING AID (CIC)5274124 V5140 - BINAURAL HEARING AID (BTE)5274125 V5130 - BINAURAL HEARING AID (ITE)42416585268637 92548 -52 - SENSORY ORGANIZATION TEST 925575268639 92547 - VERTICAL ELECTRODES (ENG ONLY) 925475268641 92545 - OSCILLATING TRACKING TEST WITH RECORDING 925455268642 92544 - OPTOKINETIC NYSTAGMUS WITH RECORDING 925445268643 92542 - POSITIONAL NYSTAGMUS TEST MINIMUM 4 POSITI 925425268644 92541 - SPONTANEOUS NYSTAGMUS TEST W/RECORDING 925415268645 92540 - VESTIBULAR EVALUATION COMPLETE 4 9254042327184281679 92604 COCHL IMP >=7YR SUBQ PROG 926044281680 92603 COCHL IMP >=7YR INIT PROG 926034281681 92602 COCHL IMP <7YR SUBQ PROG 926024281682 92601 COCHL IMP <7YR INIT PROG 9260142327194280745 92551 - PURE TONE SCREENING - AIR ONLY 925514280746 92552 - PURE TONE THRESHOLD - AIR ONLY 925524280747 92555 - SPEECH AUDIOMETRY THRESHOLD 925554280748 92556 - SPEECH AUDIOMETRY THRESHOLD W/SPEECH RECOG 925565274591 92620 - EVAL CENTRAL AUD FUNCTION W/REPORT INITIAL 926205274592 92582 - CONDITIONING PLAY AUDIOMETRY 925825274593 92579 - VISUAL REINFORCEMENT AUDIOMETRY (VRA) 925795274596 92570 - ACOUS IMMITTANCE: TYMP/AC REFLEX/AC REFLEX 925705274597 92568 - ACOUSTIC REFLEX THRESHOLD TESTING5274598 92567 - TYMPANOMETRY (IMPEDANCE TESTING) 925675274601 92557 - COMPREHENSIVE AUDIOMETRY EVAL & SPEECH REC 925575274602 92553 - PURE TONE THRESHOLD - AIR AND BONE 925535274603 92550 - TYMPANOMETRY & REFLEX THRESHOLD 92550424153042415385274224 V5257 - DIGITAL MONAURAL HEARING AID (BTE)5274225 V5256 - DIGITAL MONAURAL HEARING AID (ITE)5274226 V5255 - DIGITAL MONAURAL HEARING AID (ITC)5274227 V5254 - DIGITAL MONAURAL HEARING AID (CIC)5274339 V5261 - DIGITAL BINAURAL HEARING AID (BTE)5274340 V5260 - DIGITAL BINAURAL HEARING AID (ITE)5274341 V5259 - DIGITAL BINAURAL HEARING AID (ITC)5274342 V5258 - DIGITAL BINAURAL HEARING AID (CIC)42415365269230 92586 - AUDITORY EVOKED RESPONSE LIMITED 925865269232 92585 - ABR COMPREHENSIVE FREQUENCY SPECIFIC 925855269233 92584 - ELECTROCOCHLEOGRAPHY 92584423271642327174241531

42416614281209 Z1190 MONAURAL HEARING AID Z11904281210 Z1187 MISC. SUPPLIES Z11874281211 Z1064 DIGITAL MON HEARING AID Z10644281212 Z1063 DIGITAL BIN HEARING AID Z10634281213 Z1021 BINAURAL HEARING AID Z10214281214 V5299 EAR PLUGS/PROTECTION MON4281215 V5274 ASSIST LISTEN DEVICE4281216 V5266 HEARING AID BATTERIES4281217 V5264 EARMOLD EACH4281218 V5040 HA MON BONE COND V50404281219 V5014 HEAR AID REPAIR/HOUR V50144281220 V5014 HEAR AID REPAIR SERV CHG V50144281221 V5011 HEARING AID FIT & COUNSEL V50114281222 L8692 AUDITRY OSEOINTGRTD DVICE L86924281223 92593 HEARING AID CHECK BI 925934281225 92591 HEAR AID EXAM/SEL BI 925924281732 99201 OFFICE/VISIT 10 MIN NEW 992014281733 92625 TINNITUS ASSESSMENT 926254281734 92621 EV CNT AUD FNC EA ADD 15 926214281735 92591 HEAR AID EXAM/SEL BI 925914281736 92588 OAE COM DIAG 12 FREQ I&R 925884281737 92587 OAE LMTD 3-6 FREQ I&R 925874281738 92586 AUD EVOKED RESP/CNS LIMITED 925864281739 92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) 925794281740 92571 FILTERED SPEECH TEST 925714281741 92570 ACOU IMIT TEST: TYMP & AC REFLEX & AC REFLEX 925704281742 92568 ACOUSTIC REFLEX TESTING 925684281743 92557 BASIC COMP AUDIOMTRY 1EAR 925574281744 92557 BASIC COMP AUDIOMETRY 925574281745 92553 P/T THRESHOLD (AIR/BONE) 925534281746 92550 TYMPNOMTY & REFLEX THRESH 9255042979255268608 99211 - Hearing Aid Follow-Up 992115269439 V5011 - HEARING AID FIT & COUNSEL5269442 92593 - HEARING AID CHECK BINAURAL 925925269443 92592 - HEARING AID CHECK MONAURAL 925925274493 V5014 - HEARING AID REPAIR-MFG5274494 V5014 - HEARING AID REPAIR/HOUR5274495 V5014 - HEARING AID REPAIR SERVICE CHARGE5274573 V5299 - EAR PLUGS/PROTECTION MON5274574 V5274 - ASSISTIVE LISTENING DEVICE5274575 V5266 - HEARING AID BATTERIES5274576 V5264 - EARMOLD EACH42979245269143 95864 - SPONTANEOUS EMG 4 EXTREMITIES 05269147 92585 - AUDITORY EVOKED RESPONSE COMPREHENSIVE 9258542327204280060 92700 - UNLISTED AUDIOLOGY PROCEDURE5284101 99070 - AUDIOLOGY SUPPLIES 990705284102 1025Z AUD CONTRACT SVS42327154279501 2149Z SEDATION 1ST 30MIN 2149Z4279502 1975Z MISC AUDIOLOGY PROCEDURE 1975Z4279503 1025Z AUD CONTRACT SVS 1025Z42416605274016 92588 - OAE COMPREHENSIVE MINIMUM OF 12 FREQUENCIE 92588

5274017 92587 - OAE LIMITED 3-6 FREQUENCIES 925875274018 92558 - OAE SCREENING AUTO ANALYSIS (NEWBORN) 9255841949014279987 92584 ELECTROCOCHLEOGRAPHY 925844279988 92567 TYMPANOMETRY (IMPEDANCE) 925674279990 92548 SENSORY ORGANIZATION TEST 925484279991 92547 VERTICAL ELECTRODES 925474279993 92545 OSCIL TRACK TEST W/RCD 925454279994 92544 OPTO NYSTAGMUS W/RCD 925444279995 92543 CALORIC VEST TEST W/RCD EACH IRRIGATION (MAX4279996 92542 ENG POS NYSTAG TST W/RCD 925424279997 92541 SPONT NYSTAGMUS TST W/RCD 925414279998 92540 VESTIBULAR EVAL COMPLTE 4 925401235813 992924614032 946454195241 769464593919 Biophysical Profile 768184593923 NST 590254614941 BST4615069 OCT/CST4615070 Amniocentesis4615071 AFI 7681541572926519938 206006519939 206056519940 206106519941 2061230202106519924 117302389596 83880 06188377 908476188378 9084662249116188374 908326188375 908346188376 9083762249126188379 908536224797 9084962249108042442 83880 179.851067818 84520 15.298042426 84520 15.2952057555259443 4-8 Hours 364305259444 1-4 Hours 36430 1520

681592 <BLANK> 82947 14.821648634 Blood Glucose, Capillary1648636 Blood Glucose, Capillary466397151466615230102 Arterial (Puncture) 366005286784 Capillary (Puncture) 364165286785 Venous (Puncture) 3641562249226242165 Total Bilirubin 822486242166 Sodium 84295

6242167 Potassium 841326242168 Lactate 836056242169 Ionized Calcium 823306242170 Glucose 829476242171 Chloride 8243510498371370524137052613705288043152 Packed red blood cells 15208043153 Red blood cells (preoperative autologous) 15208043154 Red blood cells (postoperative autologous) 15208043159 O positive 36430 15208043160 O negative 36430 15208043161 B positive 36430 15208043162 B negative 36430 15208043163 AB positive 36430 15208043164 AB negative 36430 15208043165 A positive 36430 15208043166 A negative 36430 15208043177 Initiate8043178 Discontinue8043185 Leukocytes reduced 15208043195 Fresh Frozen Plasma 5958043196 Cryoprecipitate8043197 Whole blood 15208043198 Platelets (single donor) 15208043199 Platelets (random donor) 152062249026290603 #16290604 #225962838042440 82553 225.7341950575244677 Verbalizes understanding5244678 Needs practice/supervision5244679 Needs further teaching5244680 Demonstrates4194666419505662661888042438 CTNI Result1099781 82330 52.8825963322314937 929606519952

786036 946675230208 Breathing/coughing techniques8042424 82435 18.62651995512598481555769 99291 - Critical Care 992911555770 99215 - EP Level 5 992151555771 99214 - EP Level 4 992141555772 99213 - EP Level 3 992131555773 99212 - EP Level 2 992121555774 99211- EP Level 1 99211

1555775 99205 - NP Level 5 992051555776 99204 - NP Level 4 992041555777 99203 - NP Level 3 992031555778 99202 - NP Level 2 992021555779 99201 - NP Level 1 992014652596 9518046139216897125 Cooling cap46526481067822 82565 14.8231903314206572 54206573 44206574 34206575 24206576 165199606771701137067825962854616263 Vaginal, vacuum assist45168295198955 Department Placing Line6481611 ICU6481612 Med5147406 9896041946684290999 Yes4614815 No259722146526574662547 Dialysis Catheter5256362 Hemodialysis5256363 Continuous veno-venous hemodialysis 90937419502838113004616035 Yes6519935 160206519936 1602545680275283065 WADA TEST W/EEG MONITOR: 95958 959585283066 VISUAL EVOKED POTENTIAL TEST: 95930 959305283067 REPETITIVE STIMULUS: 95937 959375283068 NRV CNDCTN STDS, 9-10 ST: 95911 959115283069 NRV CNDCTN STDS, 7-8 ST: 95910 959105283070 NRV CNDCTN STDS, 5-6 ST: 95909 959095283071 NRV CNDCTN STDS, 3-4 ST: 95908 959085283072 NRV CNDCTN STDS, 13-14 ST: 95913 959135283073 NRV CNDCTN STDS, 1-2 ST: 95907 959075283074 NRV CNDCTN STDS, 11-12 ST: 95912 959125283080 FUNCTNL MAPPING ADD HOUR: 95962 959625283081 FUNCTNL MAPPING 1ST HOUR: 95961 959615283082 ELECTROCORTICOGRAM: 95829 958295283083 EEG W/VIDEO 3-12 HRS: 95951-52 959515283084 EEG W/VID INIT 13-24 HRS: 95951 959515283085 EEG W/VID ADDTL 13-24 HRS5283086 EEG W/O VID INIT 13-24 HR: 95956 95956

5283087 EEG W/O VID ADL 13-24 HRS5283088 EEG W/O VID 3-12 HOURS: 95956-52 959565283089 EEG SLEEP: 95822 958225283090 EEG NONINTRACRANIAL SURG: 95955 959555283091 EEG MISC PROCEDURE: Open Code5283092 EEG IDENTIFY 24 HR: 95950 959505283093 EEG EXTENDED 40-60MN: 95812 958125283094 EEG EXTENDED > 1HR: 95813 958135283095 EEG CEREBRAL DEATH EVAL: 95824 958245283096 EEG A & D: 95816 958165283097 EEG A & A: 95819 958195283098 DIGITAL SPIKE ANALYSIS: 95957 959575283099 CSF EEG PRTBLE UNAT 24 HR: 95953 959535283100 AUTO NERV FUNC TEST SUDO: 95923 9592341950805242577 Needs practice/supervision42382924238322423844442384454642516 Ed-Asthma Controlling Asthma Symptoms4195055423827542382934238294423830442384314643024 Ed-Tobacco Resource for Helping you Quit25965814614875 Transcutaneous4614876 Gas sampling

7865015284048 Intubated5284049 Reintubated13707086519925 1174041947861372823 8906038111456473930 Yes6519958

7827906140943 Pediasure w/o Fiber 240 mL6140944 Pediasure w/ Fiber 240 mL6140945 Peptamen Jr. 1000 mL6839721 Impact with Fiber (1 liter)6839722 Similac Liquid Protein Fortifier61202986120265 GROUND IV TUBING/SOLUTIONS61202786120279612028061202816120282612028361202846120285

612028661202876120288612028961202906120291612029261202936120294612029561202976198345 Suction Canisters6198346 Sam Splint6198348 PED Disposable O2 Probes6198349 IO Cath/Solutions6198350 Immobilizer Side Blocks6198351 Defib Pads6198352 C Collar/Immobilizer Pads6198353 Back Raft Long Board Mattress6830281 GROUND MISCELLANEOUS OTHER25963946266403 Esopho-gastric tamponade (Blakemore)61202968042447 82803 155.558042448 82803 155.558042436 HCT Result 85014 9.168042434 HGB Result 85018 9.161099785 85014 9.1641949404616067 Placed651995925961996266389 Assist with procedure424361138111446519961419472241947244194987419526941952704195297 Ther/Proph/Diag Inj SC/IM 963714195304 Replace PICC Cath 365844195305 Pre Procedure RN Service4195307 Patient Encounter Charge4195309 Nursing Assist Imaging4195310 MISC SUPPLY4195311 Misc Procedure4195314 IV Start Imaging RN4195318 Insert Temp Bladder Cath 517024195319 Insert PICC w/o Port >=5 yrs 365694195320 Insert PICC w/o Port <5 yrs 365684195321 Insert Non-Tunnel CVC >=5 yrs 365564195330 Declot Vascular Device 365934195331 Collect Blood from PICC 365924195334 Botox Injection4195335 Blood Transfusion Service 36430

4195336 Blood Draw Implt Dev w/ Procedure4195337 Blood Draw CVC/PICC w/ Procedure4195709 EST PATIENT LVL V4195710 EST PATIENT LVL IV4195711 EST PATIENT LVL III4195712 EST PATIENT LVL II4195713 EST PATIENT LVL I42384054642259 Remove CVC w/o Port/Pump 365894644186 Misc Supply4644187 Introducer/Sheath4644188 Guide Wire Level 24644189 Guide Wire Level 14644190 Catheter Inf Per/Cent/Midline4644191 Cath Hemodialysis Short-Term4644973 Aerosol Therapy 946404645228 Blood Draw Implt Assist Lab 365914645229 External Cardioversion 929606519945 904716519919 100606519920 100616519923 101406519937 205506519932 120316519933 120326519934 12051415729065199532390198 83605 155.55

886281 6227036235555258671 PEP 946405258672 PAP 946405258673 EZPAP 9464046785965283138 490706 - Amniocentesis Kit5283139 490052 - Handling & Conveyance Specimen 99000419512013728314616102 Hemorrhage balloon placed4194709137023216927445146120 Pass 947615146122 Fail 947615396628 Otoacoustic emissions 925585396629 Auditory brainstem response 925866156176 Otoacoustic emissions (charge) 925586156177 Auditory brainstem response (charge) 92586465293942895774639599 Local4639600 Pudendal6519947 99211

751484 Orientation Assessment 654108042455 82803 155.558042456 82803 155.55

25962225256288 Continuous cycler peritoneal dialysis (CCPD) 909455256289 Continuous ambulatory peritoneal dialysis (CAPD) 909998037627 82803 155.551407954 PT Neuromuscular Reeducation 9711652741005310934 Interrogation ICM In-Person 93290 932905310938 ICD Device Interrogation Person 93289 9328946571884192802 950442596333381108338111624622987 To labor pool4655266 Cervical Ripening Balloon placed (Double Balloon)8042458 82800 142.758042422 84132 17.7246571891099817 85610 14.7541947064194710419476541949264195029461396246140524614877 Yes4620066 Yes 317204621049 Yes4622846 Subsequent4622847 Initial46525605242470 Yes5259479 Yes 947995267128 Body plethysmography (throacic gas volume) 947265267129 Bronchoprovocation 940705267130 Diffusion (DLCO) 947295267131 Flow volume loop pediatric 943755267132 Gas dilution 947275267133 Maximum breathing capacity, Maximal voluntary vent 942005267134 MIP/MEP 947995267135 Non-invasive continuous ear/pulse oximetry 947605267136 Oxygen w/CO2 output 946815267137 PFT-Stress test/complex 946215267138 PFT-Stress test/simple 946205267139 Spirometry before & after 940605267140 Total vital capacity 941505268603 Level 5 992155268604 Level 4 992145268605 Level 3 992135268606 Level 2 992125268607 Level 1 992115274349 Spirometry 940106082208 Diagnostic lab suction659968965996907005856 Yes

7005877 Yes6519926 117506519921 101206519922 101216519943 652206519944 652226519927 11760

7858584614443 Specialty BiPAP or CPAP mask4622795 Tracheostomy tube/device5245701 Nasal Prongs5245702 NICO sensor5245703 PIKO meter5245704 Pulmonary retrieval basket5245705 Speaking valve L850152559558042444 82810 142.7546571726519956 990706519928 120016519929 120026519930 120116519931 1201365199578037608 Sodium Result 84295 18.62381106938110705274964 Nitrogen 946405275216 Nitric oxide treatment diagnostic5275217 Nitric daily4194927 94610651995446526458042451 82803 155.55465264262661862315265 325541099789 85018 9.16

8862881557765 Knee immobilizer applied1557766 Orthopedic shoe applied1557767 Wrist splint applied2740315 Cast, long applied2902341 Cervical collar, soft applied2902370 Crutches dispensed41951934615165 Transvaginal 768174615166 Abdominal, per nurse25963186399565 Urometer - Labor & Delivery7692722 81003 8.691372524 81025 24.48

8962571309776 Belt6519942 3641546422738042428 82330 52.88

8102013 iSTAT CTNI Charge 84484 38.093324319 82800

8962891301791 Pouch, nondrainable1301792 Pouch, drainable1301793 Pouch deodorant1301794 Pouch cover1301795 One piece system1301796 Irrigation set1301797 Hypoallergenic paper tape1301798 Cut to fit1301799 Belt4631387 zzAMB Peripheral IV Insertion NO Infusion465717062249086264669 Established Patient Visit, Level 1 992116264670 Established Patient Visit, Level 2 992126264671 Established Patient Visit, Level 3 992136264672 Established Patient Visit, Level 4 992146264673 Established Patient Visit, Level 5 9921562248776224878 364156224879 364306224880 365936224881 965236224903 365916224904 365926224905 360006224829 964136224830 964156224831 964096224832 96411622487462248756224876622487362244126242257 Encounter charge622487262248706224871622490662249072120846 Observation Surgery 1104651548 Inpatient Surgery 42007974065 Inpatient W/O Surgery 42007974067 Observation W/O Surgery 1107974069 Outpatient in a Bed Surgery 1107974071 Phase 37441755 alpra5Tab7932573 Aspirin Enteric Coated8065702 Alcohol 62% 62 % Soln-Nasal8095159 Amino Acids 4.25% with 5% Dextrose 4.25% with 5% D7932556 Ammonia7932557 Ammonia 1 Unit Misc7932572 Benzocaine 20 % Tube8098877 Bupivacaine 0.5% 0.5 % Pump

2791955 C1 esterase inhibitor, human8044628 ceFAZolin 2 g/50 mL Sol301832130183227444206 dapto500Inj7444760 dobut1D5W2507444764 dobut4D5W2507444807 dopa16D5W2507444902 dulox30CapDR7932583 Desfluraane 1 unit Misc4632928463295846329594633007463321146332827441230 D5Water500mL7441231 D5Water250mL7441241 D5w2NaClKCl20mEq1000mL7441234 D5Water50mL7932559 Diphenhydramine 2 % Spray7940137 Dr. Curran’s ortho cocktail 47 mL Soln7940139 Dr. Gustavel and Dr. Tadje’s ortho cocktail 50.257940145 Dr. Holly’s total hip ortho cocktail 50 mL Soln7940141 Dr. Miller’s ortho cocktail 50 mL Soln7940149 Dr. Nicola’s total knee ortho cocktail 225.3 mL So7940143 Dr. Sean Hassinger & Dr. Holley’s total knee ortho7940147 Dr. Spelich’s ortho cocktail 49 mL Soln7445253 epi1Soln107445254 epi15InjKit7445255 epi03InjKit7445257 epi1Soln17445259 epi1Soln307445271 epilido1:1000001Soln107445273 epilido1:1000001Soln307445277 epilido1:1000002Soln207445280 epilido1:2000005Soln507445281 epilido1:2000001PFSoln107445282 epilido1:2000001PFSoln307445286 epilido1:2000002PFSoln107445287 epilido1:2000002PFSoln204652000465205946520604652071465225046522514633163463328746332884632929463296046330084633009463321246332834632930

463316246332134633284463328546332867932567 Gelfilm7932547 Gelfoam 12 - 7 mm Sponge SZ 12 Foam7932549 Gelfoam SZ 100 SZ 100 Foam7932570 Gelfoam SZ 50 SZ 50 Foam7446649 hydromorph2NaCl09Soln1007446656 hydromorph2NaCl09Soln507446666 hydromorph1Soln17446680 hydromorph10NaCl0950mL7446684 hydromorph2Tab7446687 hydromorph2Soln17446695 hydromorph4Soln12791564 LORazepam7447615 loraz5Tab7447616 loraz1Tab7447621 loraz2Soln17441212 D5w45NaClKCl20mEq1000mL7441213 NaCl45KCl20mEq1000mL7441214 NaCl9KCl20mEq1000mL7441219 D5w9NaClKCl20mEq1000mL7441220 D5w45NaCl1000mL7441223 D5w9NaCl1000mL7441226 D5LR1000mL7441229 D5Water1000mL7441233 D5Water100mL7441236 D5WaterKCl20mEq1000mL7441268 NaCl451000mL7441272 NaCl950mL7441273 NaCl9100mL7441275 NaCl9250mL7441276 NaCl9500mL7441277 NaCl91000mL7441282 LR500mL7441283 LR1000mL7441281 LR250mL8068420 Lidocaine 1% 1 % Injection7448457 multivitsSoln107448465 multivitsTab7448493 multivitswMineralsTab7448646 nife10Cap7448867 IRRintraocularPlus5007448868 IRRintraocular158066219 Ortho Joint Cocktail - Ropivacaine8066220 Ortho Joint Cocktail - Ropivacaine 49.25 mL Soln8066323 Ortho Joint Cocktail - Bupivacaine8066324 Ortho Joint Cocktail - Bupivacaine 49.25 mL Soln8066341 ORTHO JOINT COCKTAIL - BUPIVACAINE8085447 Ortho Joint Cocktail - Bupivacaine 49.25 mL Soln8085581 Ortho Joint Cocktail - Ropivacaine 49.25 mL Soln7926556 Petrolatum lip balm N/A Ointment7932560 Petrolatum lip balm7938932 Phenylephrine 100 mg/mL 10 mL Syringe7930545 Probiotic

7930546 Probiotic 1 each Tab7449940 RHo(D)immuneglobulin1500Soln7449942 RHo(D)immuneglobulin15002Soln28087745 Ropivacaine 0.2% 0.2 % Injection8088270 Ropivacaine 0.2% 0.2 % Injection7450611 sufe50Soln17450713 suma25Tab7450716 suma50Tab7450717 suma6Soln57932584 Syrpalta7926551 Sodium chloride 0.65%2790942 Sodium Chloride 0.45% with KCl 20 mEq/L2791043 Sodium Chloride 0.9% with KCl 20 mEq/L7441269 NaCl45500mL7926552 Sodium chloride 0.65% 0.65 % Drops7926553 Sodium chloride 0.9% 0.9 % Injection7930541 sugammadex 100 mg/mL Sol8088962 Sugammadex 100 mg/mL Soln7932553 Surgicel Hemostat 2" x 3"7932554 Surgicel Hemostat 2" x 3" 2" x 3" Pad7932585 Syrpalta 480 mL Misc3644345 TNF MED8087270 Tumescent Solution 1 bag Injection7926555 Vitamin E 400 IU Cap7441561 acetaz500Inj7441336 acet10Soln7441337 acet120Supp7441340 acet1605Liq1187441344 acet1605Liq57441348 acet1605Liq1207441349 acet325Supp7441350 acet325Tab7441351 acet500Tab7441356 acet650Supp7441363 acetaspcaff5025065Tab7441365 acetbutcaff3005040Cap7441485 acetcodeine120125Liq107441498 acetcodeine120125Liq57441502 acetcodeine30030Tab7441524 acethydro32510Tab7441526 acethydro3255Tab7441527 acethydro32575Tab7441531 acethydro3257515Soln157441539 acetoxy32510Tab7441541 acetoxy3255Tab7441545 acetoxy32575Tab7441557 acettraM325375Tab7924540 acetaminophen 160 mg/5 mL Sus7932562 acetaminophen 160 mg/5 mL Liq7441589 acyc400Tab7441607 aden3Soln27441610 aden3Soln47441627 albumhum5Soln2507441631 albut1253Soln37441645 albut253Soln37441651 albutCFCfree90Aero187441652 albutCFCfree90Aero67

7441654 albutCFCfree90Aero87441655 albutCFCfree90Aero857441656 albutipra2553Soln38064645 albuterol 90 mcg/inh Aer7441676 alfentanil5Soln27441677 alfentanil5Soln57441699 allop100Tab7441776 alteplase2Inj7441791 alumhydroxmaghydroxsime200200205307441792 alumhydroxmaghydroxsime2002002053557441814 alvi12Cap7441867 amlod5Tab7441835 aminocaacid250Soln207441839 aminophyl25Soln107441849 amiodarone50Soln37441852 amitrip10Tab7441855 amitrip25Tab7441941 amoxi250Cap7441949 amoxi500Cap7441971 amoxiclav500125Tab7441975 amoxiclav875125Tab7441994 ampi1gInj7442006 ampi500Inj7442007 ampisulbac1g5gInj7442009 ampisulbac2g1gInj7442046 apix25Tab7442099 ascorbicacid500TabChew7442100 ascorbicacid500Tab7442117 asp325DRTab7442118 asp325Tab7442123 asp81TabChew7442125 asp81DRTab7442157 aten25Tab7442168 ator10Tab7442169 ator20Tab7442181 atra10Soln107442182 atra10Soln57442184 atro0.1Soln107442187 atro04Soln17442188 atro04Soln207442195 atro1Oint357442197 atro1Soln27442235 azith1005Liq157442241 azith250Tab7442250 bacit50000Inj7442252 bacit500Oint357442253 bacit500Oint7442254 bacit500Oint147442256 bacit500Oint287442261 bacitzinc500Oint7442263 bacitzinc500Oint157442269 bacitneomypolymyB400355000Oint7442272 bacitneomypolymyB400355000Oint157442275 bacitneomypolymyB400355000Oint2847442294 bacl10Tab7442323 barisulfate21Susp4507442369 bellaopi16260Supp

7442419 benz20Spry577442445 benzment1536Loz7442446 benzment154Loz7930542 benzocaine topical 20% Spr7442601 beta6InjSusp57442639 bethan25Tab7938847 bevicizumab 1.25 mg/mL 0.05 mL Syringe7442665 bisacodyl10Supp7442666 bisacodyl5DRTab7442722 brim2Soln57442860 bupiva25Soln507442864 bupiva25PFSoln107442867 bupiva25PFSoln307442882 bupiva5Soln1207442886 bupiva5Soln307442893 bupiva5Soln507442902 bupiva5PFSoln307442906 bupiva075PFSoln107442908 bupiva075PFSoln307442909 bupiva075D825PFSoln27442910 bupivalipo13Susp207442912 bupivaEPI251:200000PFSoln107442913 bupivaEPI251:200000PFSoln307442915 bupivaEPI51:200000Soln507442916 bupivaEPI51:200000PFSoln107442917 bupivaEPI51:200000PFSoln308068609 bupivacaine liposome 1.3% (13.3 mg/mL) Sus8073514 bupivacaine liposome 1.3% 1.3% (13.3 mg/mL) Inject7442955 bupren03Soln17442996 butorph1Soln17442997 butorp10Spry257443013 caffcitrate20Soln37443018 caffsodbenzo125125Soln27443042 calcit25Cap7443075 calcarbo1250(500elementalcalc)Tab7443077 calcarbo12505(100elementalcalc)Susp4737443083 calcarbo500(200elementalcalc)TabChew7443087 calcarbo750TabChew7443102 cacl100Soln107443109 calgucon100Soln102793052 canakinumab7443213 capto25Tab7443219 carbac01Soln157443281 caris350Tab7443288 carv125Tab7443320 cefaz1Inj7443321 cefaz1Soln507443324 cefaz2gSoln507443326 cefaz500Inj7443359 cefOX1Inj7443360 cefOX1Soln507443362 cefOX2Inj7443380 cefTAZ1Inj7443382 cefTAZ2Inj7443392 ceftriax1Inj7443393 ceftriax1Soln507443395 ceftriax2Inj

7443396 ceftriax2Soln507443316 cefad500Cap7443334 cefep1gInj7443336 cefep2gInj7443337 cefep2g100Soln1007443338 cefep2g50Soln7443354 cefote1gInj7443410 cefur750Inj7443412 celec100Cap7443413 celec200Cap7443419 ceph1255Liq1007443421 ceph250Cap7443425 ceph500Cap7443438 cetir10Tab7930544 cetirizine 10 mg Tab7443454 charcoal50gSusp2407443483 chlordiaze25Cap7926542 chlorhexidine topical 0.12% Liq7443650 chlorpromaz25Tab7443676 cholec400Cap7443679 cholec5000Cap7443680 cholec5000Tab7443751 cipro2Soln7443754 cipro03Soln257443755 cipro03Soln57443757 cipro10Soln407443760 cipro200D5W1007443763 cipro400D5W2007443765 cipro500Tab7443767 cipro750Tab7443768 ciprodexameth031Susp757443777 cital10Tab7443793 citricacidsodcitrate3345005Soln307443794 citricacidsodcitrate3345005Soln4737443826 clin150Cap7443827 clin150Soln27443828 clin150Soln47443829 clin150Soln67443830 clin2Crm407443832 clin300Cap7443834 clin600D5W507443837 clin900D5W508045919 clindamycin 600 mg-5%/50 mL Sol8045920 clindamycin 900 mg-5%/50 mL Sol7443886 clonid1Tab7443893 clonid100Soln107443881 clonazePAM5Tab7443883 clonazePAM1Tab7443896 clopid75Tab7443903 clotri1Crm157443905 clotri1Crm307443969 cocaine4Soln47444067 conjugatedestrogens0625gCrm307444123 cyclobenz10Tab7444127 cyclobenz5Tab2791483 cyclopentolate-phenylephrine ophthalmic7444130 cyclopen1Soln15

7444131 cyclopen1Soln27444135 cyclopen2Soln27444136 cyclopen2Soln57444132 cyclopen1Soln57444196 dantro20Inj7444259 desfLiq2407444278 desmo4Soln107444277 desmo4Soln17444322 dexameth10Soln17444324 dexameth10PFSoln17444325 dexameth2Tab7444326 dexameth4Tab7444327 dexameth4Soln17444329 dexameth4Soln307444330 dexameth4Soln57444335 dexamethneomypolymyB13510000Oint357444336 dexamethneomypolymyB13510000Susp57444340 dexamethtobramycin103Susp257444364 dexmed100Soln27444480 dextromguaif101005Liq107444482 dextromguaif101005Liq1207444506 dextromguaif2020010Liq107444556 diatrizoatemegluminediatrizoatesod6610andSoln1207444557 diatrizoatemegluminediatrizoatesod6610andSoln307444567 diaz5Soln107444568 diaz5Soln27444560 diaz10Tab7444564 diaz5Tab7444595 dicycl10Cap7444621 dig250Soln27444655 dilti5Soln57444683 diphen1255Liq1207444701 diphen25Cap7444703 diphen25Tab7444707 diphen50Soln12790449 diphtheria/tetanus/pertussis,acel/polio 906962793171 diphtheria/tetanus/pertussis,acel/hepB/polio 907237444783 docucalc240Cap7444784 docusod100Cap7444792 docusenna5086Tab7444824 doxap20Soln207444869 doxycyhyclate100Tab7444875 doxycymonohydrate100Cap7444876 doxycymonohydrate100Tab7445248 ephed50Soln17926543 ePHEDrine 50 mg/mL Sol7938845 ePHEDrine 10 mg/mL-NaCl 0.9% Injection7445246 ephed50NaCl09Soln102793037 ecallantide7444928 edroph10Soln157445091 emolStk4257445092 emolStk457445158 emolOint10g7932561 Petrolatum lip balm 1 unit Tube7445223 enalat125Soln17445232 enox30Soln037445234 enox40Soln04

7445272 epilido1:1000001Soln207445274 epilido1:1000001Soln507445312 ergocalciferol50000Cap7445320 erta1gInj7445322 erythro5Oint357445345 esci10Tab7445353 esmol10Soln107445381 estrad05TWFilmER7445382 estrad05WFilmER7445387 estrad1TWFilmER7445388 estrad1WFilmER7445391 estrad5Tab7445396 estrad1Tab7445404 estradcypionate5Soln57445488 etom2Soln107445489 etom2Soln207445514 ezet10Tab7445530 famo10Soln27445533 famo20Tab7445536 famo20Soln507445545 fatemul20Emul2507445642 fent50Soln27445646 fent50Soln57445683 ferricsubsulfateSoln8mL7445702 ferroussulfate325Tab7445707 fexo180Tab7445711 fexo60Tab7445744 flucon100Tab7445748 flucon200NaCl091007445759 flum1Soln57445796 fluorescein1Test7445797 fluorescein10Soln52790739 flurbiprofen ophthalmic5120197 flurbiprofen/baclofen/lidocaine topical7445890 flurb03Soln257445906 flutic50Spry167445931 folicacid5Soln107445930 folicacid1Tab7445945 fonda25Soln57445976 fosphen500Soln107445981 furos10Soln27445982 furos10Soln47445985 furos20Tab7445986 furos40Tab7445990 gaba100Cap7445994 gaba2505Soln67445995 gaba300Cap7446004 gadobenatedimeglumine529Soln107446006 gadobenatedimeglumine529Soln157446007 gadobenatedimeglumine529Soln207446008 gadobenatedimeglumine529Soln57446010 gadob60472Soln107446020 gadod287Soln57446025 gadopentetatedimeglumine469Soln157446026 gadopentetatedimeglumine469Soln207446027 gadopentetatedimeglumine469Soln57446060 gatiflo5Soln25

7446073 gent03Oint357446075 gent03Soln57446077 gent10Soln27446083 gent40Soln27446087 gent80NaCl091007446114 glip5Tab7446118 glucagonrecombinant1Inj7446127 glucose25Soln107446135 glucose40Gel387446137 glucose50Soln507446148 glyb5Tab7446157 glycerinadultSupp7446177 glycineIRR15Soln30007446179 glyco2Soln17446182 glyco2Soln52793103 goserelin7446192 gramineomypolymyB02517510000Soln107446218 guaif400Tab2792198 haemophilus b conjugate (PRP-OMP) vaccine 906477446300 halop5Soln17446317 heparin10000Soln17446322 heparin1000Soln17446323 heparin1000Soln107446325 heparin1000Soln307446328 heparin2NaCl09Soln10007446329 heparin2NaCl09Soln5007446342 heparin5000Soln17446356 heparinflush100Soln17446360 heparinflush100Soln57446371 hepatitisBadultvaccine20Susp17446380 hepatitisBpediatricvaccine105Susp5mL7446384 hetastarch60NaCl095007446406 hyaluronidase150Soln17446410 hydral20Soln17446735 hydrOXYzinehydrochlor25Tab7446736 hydrOXYzinehydrochlor25Soln17446737 hydrOXYzinehydrochlor50Tab7446742 hydrOXYzinepamoate25Cap7446743 hydrOXYzinepamoate50Cap7446416 hydroc25Tab7446483 hydrocort5Crm307446491 hydrocort1Crm28357446492 hydrocort1Crm2847446493 hydrocort1Crm307446530 hydrocort100preservativefreeInj7446555 hydrocort25Supp7446556 hydrocort250preservativefreeInj7446627 hydrogenperoxide3Soln2377446641 hydrogenperoxide3Soln4807446720 hydroxypropylmethylcellulose25Soln157446747 hyos125SLTab7446748 hyos125Tab7446770 ibup100TabChew7446773 ibup1005Susp1187446782 ibup1005Susp57446787 ibup200Tab7446788 ibup400Tab

7446792 ibup600Tab2793278 immune globulin intramuscular7446874 indigo8Soln57446880 indocyan25Inj7446885 indom50Supp7446891 influenzavirusvaccineinactivatedPFquadrivalentSusp7446893 influenzavirusvaccineinactivatedquadrivalentSusp52791394 insulin aspart2792455 insulin regular7446903 insulinaspart100Soln107446909 insulinglargine100Soln107446910 insulinglargine100Soln37446913 insulinisophane100humanrecombinantSusp107446915 insulinisophaneinsulinregular7030humanrecombinantS7446917 insulinlispro100Soln107446919 insulinlispro100Soln37446926 insulinregular100humanrecombinantSoln107446927 insulinregular100humanrecombinantSoln37446944 iodine2Tinc4737446953 iodinepotassiumiodide510andSoln157446962 iodix270Soln507446964 iodix320Soln1007446971 iohex180Soln107446978 iohex240Soln507446979 iohex300Soln107446980 iohex300Soln1007446982 iohex300Soln1507446985 iohex300Soln507446988 iohex350Soln1007446990 iohex350Soln1507447003 iopam61Soln1007447080 ipra500Soln257447114 isopropylalcohol70Liq4737447167 ketamine100Soln57447172 ketamine50Soln107447193 ketor5Soln37447194 ketor5Soln57447195 ketor10Tab7447196 ketor15Soln17447198 ketor30Soln17447199 ketor30Soln28064646 ketorolac ophthalmic 0.5% Sol7447202 labe100Tab7447207 labe5Soln207447208 labe5Soln47447324 latano005Soln257447371 levetri100Soln57447376 levetri1000NaCl0751007447380 levetri500Tab7447381 levetri500NaCl0821007447369 levalbut1253Soln37447409 levoflox750Soln1507447398 levoflox25Soln207447404 levoflox250Tab7447406 levoflox500Tab7447407 levoflox500Soln1007447426 levothy100Tab

7447430 levothy125Tab7447445 levothy50Tab7447424 levothy100Cap2792769 lidocaine 2 g in Dextrose 5% in Water 250 mL7447452 lido04D5WSoln5007447453 lido5Soln507447454 lido5PFSoln507447460 lido1Soln107447462 lido1Soln207447466 lido1Soln507447470 lido1PFSoln307447471 lido1PFSoln57447476 lido15PFSoln207447477 lido2Soln107447479 lido2Soln207447481 lido2Soln507447482 lido2PFSoln107447483 lido2PFSoln27447484 lido2PFSoln57447487 lido2Gel307447488 lido2Gel57447505 lido4PFSoln57447507 lido4Soln507447514 lido5Oint35447447517 lido5D75WSoln27447520 lidoprilocaine2525Crm57924541 lidocaine 2% preservative-free Sol7926545 lidocaine topical 2% Sol7926546 lidocaine topical 4% Sol7926554 lidocaine topical 4% Sol7930549 lidocaine topical 2% Sol8044413 lidocaine 1% 1 % Injection8066328 lidocaine 1 % Injection7447539 linez2Soln3007447559 lisin10Tab7447561 lisin20Tab7447563 lisin40Tab7447597 loper2Cap7447599 loper2Tab7447607 lorat10Tab7447613 loratPSE10240TabER7447631 losar50Tab7447685 magcitrate1745g30Liq2967447686 magcitrate1745g30Liq3007447697 maghydrox8Susp307447708 magoxide400(2413elementalmag)Tab7447733 magsulfate40Soln507447738 magsulfate50Soln28093779 magnesium hydroxide 8% 8 % Susp7447731 magsulfate40Soln1007447768 mann20Soln5007447769 mann25Soln502790227 measles/mumps/rubella/varicella virus vaccine 907107447782 measlesmumpsrubellavirusvaccineInj102792709 mechlorethamine7447790 mecli25TabChew7447822 melox15Tab

7447874 meperi10Soln307447878 meperi100Soln17447880 meperi25Soln17447881 meperi50Tab7447883 meperi50Soln57447884 meperi50Soln17447888 meperi75Soln18047475 meperidine 50 mg Tab7447891 mepivac15PFSoln307447893 mepivac2PFSoln207447923 metrom500Tab7447948 metha10Tab7447967 methocar500Tab7448099 methylpred1gPFInj7448101 methylpred125PFInj7448103 methylpred2gInj7448107 methylpred4Tab7448109 methylpred40PFInj7448110 methylpred40InjSusp17448113 methylpred500Inj7448116 methylpred80InjSusp17448063 methyleneblue10Soln17448066 methylergon2Soln18046542 methylene blue 5 mg Ampule7448124 metoclop10Tab7448134 metoclop5Soln27448142 metopsuccinate50TabER7448143 metoptartrate1Soln57448145 metoptartrate25Tab7448146 metoptartrate50Tab7448159 metronid250Tab7448162 metronid500100Soln1007448231 midaz1Soln27448234 midaz1PFSoln27448235 midaz1PFSoln57448247 midaz2Syrp1187448248 midaz2Syrp57448279 mineraloilEnema1337448282 mineraloilLiq107448288 mineraloilLiq257448330 mitomy2Kit7448351 montelu10Tab7448360 morp1PFSoln107448361 morp1PFSoln307448366 morp1NaCl09Soln1007448378 morp10Soln17448381 morp10PFSoln17448386 morp15Tab7448387 morp15TabER7448394 morp2PFSoln17448422 morp4PFSoln17930543 morphine 15 mg/8 hr Tab7448451 moxi5Soln37450893 therapeuticmultivitswMineralsTab7448499 mupiro2Crm307448502 mupiro2Oint227448505 mycophenolatemofetil250Cap

7448517 nafc1Inj7448536 nalo04Soln17448559 naprox500Tab7448593 neomypolymyBsulfate40200000IrrSoln17448594 neomypolymyBsulfate40200000IrrSoln207448596 neos5Soln10IV7448597 neos1Soln107448598 neos1Soln57448599 neos1Soln10IV7448638 nicotine14FilmER7448641 nicotine21FilmER7448682 nitrogly04Tab7448690 nitrogly10100D5W2507448692 nitrogly2Oint17448694 nitrogly2Oint307448699 nitrogly5Soln107930548 nitroglycerin 200 mcg/mL-D5% Sol7448702 nitropru25Soln27510540 non-formulary (medication)7448715 norepine1Soln47448747 nystatin100000Susp57448754 nystatintriam1000001Oint157448774 ocularlubricantOint357448775 ocularlubricantOint77448776 ocularlubricantSoln7448778 ocularlubricantSoln157448779 ocularlubricantSoln307448783 ocularlubricantpreservedSoln157448792 oflox03Soln57448840 omep20CapDR7448841 omep20DRTab7448842 omep40CapDR7448847 onabotA100Inj7448850 ondan2Soln27448854 ondan4TabDis2790761 oxyCODONE-acetaminophen7448927 oxycod10TabER7448931 oxycod20TabER7448939 oxycod5Tab7448941 oxycod55Soln57448921 oxybu5Tab7448926 oxychlor2gPwdrRecon27448949 oxymetaz05Spry157448951 oxymetaz05Spry308068328 oxymetazoline nasal 0.05% Spr7448970 oxyto10Soln17449061 panto40DRTab7449062 panto40Inj7449065 papa30Soln27449139 pentafluotetrafluoSpry1057449187 petroOint307449195 phenaz200Tab7932571 Phenazopyridine HCl 97.5 Tab7449223 phenol14Spry1777449233 phenolLiq2407930547 phenol topical - Liq7449275 phenyle10Soln1

7449279 phenyle10Soln57449282 phenyle25Soln157449283 phenyle25Soln27449315 phenyt50Soln57449320 physiologicalIrrSoln(LR)10007449322 physiologicalIrrSoln(LR)30007449331 physos1Soln27449334 phyton10Soln17449338 pilo1Soln157449341 pilo2Soln157449360 piperatazo3g0375gInj7449363 piperatazo4g5Inj2791752 pneumococcal 23-polyvalent vaccine7449384 pneumococcal13valentconjugatevaccineSusp57449385 pneumococcal23polyvalentvaccineSoln57449397 polyethyleneglycol3350PwdrRecon7449400 polyethyleneglycol3350PwdrRecon177449402 polyethyleneglycol3350PwdrRecon2387449403 polyethyleneglycol3350PwdrRecon2497449407 polyethyleneglycol3350PwdrRecon5107449417 polymyBsulfate500000Inj7449443 potassiumchloride10mEqTabER7449444 potassiumchloride10mEqSoln1007449448 potassiumchloride2mEqSoln107449450 potassiumchloride2mEqSoln207449459 potassiumchloride20mEq15Liq4737449466 potassiumchloride40mEq100Soln1007449488 potassiumphosphate3mmolSoln157449460 potassiumchloride20mEqNaCl09Soln2507449501 povidoneiodine10Oint307449516 povidoneiodine5Soln302791189 pramlintide7449619 predniSONE10Tab7449624 predniSONE5Tab7449606 prednisoloneacetate1Susp57449636 preg25Cap7449638 preg50Cap7449639 preg75Cap7449632 preg150Cap7449670 procain100Soln107449676 prochlorp25Supp7449677 prochlorp5Tab7449678 prochlorp5Soln27449691 prom125Supp7449692 prom125Tab7449693 prom25Supp7449694 prom25Tab7449696 prom25Soln17449717 propar5Soln157449719 propofol10Emul100premix7449720 propofol10Emul207449721 propofol10Emul507449725 propran1Soln17449740 protamine10Soln257449741 protamine10Soln57449753 pseudo30Tab7449772 psyllium34g12gPwdrRecon

7449794 psyllium34g58gPwdrRecon2837449817 psyllium35g58gPwdrRecon7450028 ropin1Tab2791781 rabies vaccine, human diploid cell 906757449878 racepin225Soln7449903 rani150Tab7449904 rani25Soln22791089 regadenoson7449920 remif1Inj8047947 remifentanil 12.5 mcg Injection2792956 rimabotulinumtoxinB7450004 rivar10Tab7450014 riza10TabDis7450015 riza10Tab7450018 rocur10Soln107450019 rocur10Soln57450058 ropiv2Soln1007450060 ropiv2Soln207450061 ropiv2Soln2007450067 ropiv2Soln5007450068 ropiv2Soln5507450071 ropiv2Soln7007450085 ropiv5Soln207450088 ropiv5Soln307450099 ropiv75Soln208047270 ropivacaine 0.2% Sol7450233 scop15TDFilmER7450278 sert50Tab7450284 sevofluraneLiq2507450297 silvernitrateStk7450301 silversulfa1Crm257450304 silversulfa1Crm507450319 sime4006Liq307450321 sime80TabChew7450325 simv10Tab7450326 simv20Tab7450352 sodbicarbo42Soln107450356 sodbicarbo84Soln107450357 sodbicarbo84Soln507450363 sodbiphosphatesodphosphate7g19gEnema1337450375 sodchlor065Spry1047450378 sodchlor065Spry457450383 sodchlor09Soln3Inh7450386 sodchlor09Soln107450387 sodchlor09Soln1007450391 sodchlor09Soln207450392 sodchlor09Soln37450393 sodchlor09Soln57450399 sodchlor09IrrSoln2507450401 sodchlor09IrrSoln30007450403 sodchlor09IrrSoln5007450408 sodchlor1000Tab7450425 sodchlorbacteriostatic09Soln107450426 sodchlorbacteriostatic09Soln207450427 sodchlorbacteriostatic09Soln307450438 sodchondroitinhyaluronate4030Soln57450458 sodhyaluronate10IntraarticularSoln25

7450461 sodhyaluronate10Liq557450462 sodhyaluronate10Liq0857450465 sodhyaluronate14Liq557450500 sodpolystyrenesulfonate15g60Susp4807450502 sodpolystyrenesulfonate15g60Susp608035763 sodium chondroitin-hyaluronate ophthalmic - Kit8047289 sodium chloride bacteriostatic 0.9% 0.9 % Injectio7450537 sorb3IrrSoln30007450577 sterilewaterSoln107450578 sterilewaterSoln1007450579 sterilewaterSoln10007450592 sterilewaterIrrSoln20007450596 sterilewaterIrrSoln5007450604 succinyl20Soln107926549 sugammadex 100 mg/mL Sol7450701 sulfamtrime800160Tab7450742 tamsul4Cap7450773 temaz15Cap7510541 TNFMED7938859 template non-formulary (continuous) N/A Misc7938860 template non-formulary (intermittent) N/A Misc7450807 terbut1Soln12793225 tetanus-diphth toxoids (Td) adult/adol7450842 Adacel7450843 tetanusdiphtheriatoxoids(Td)adultadolescent225Susp7450849 tetracaine5Soln157450850 tetracaine5Soln27450852 tetracaine5Soln57450896 thiamine100Soln27450895 thiamine100Tab7450915 thrombinbovine5000PwdrRecon7450921 thrombinrecombinant5000PwdrRecon7450987 tizan4Tab7450990 tobra03Soln57450991 tobra12gInj7450994 tobra40Soln27451082 trama50Tab8087595 traMADol 50 mg Susp7451098 trazo100Tab7451103 trazo50Tab7451092 tranexamicacid100Soln107451093 tranexamicacid650Tab7451172 triam40Susp17451177 triamcinoloneacetonide40InjSusp17451178 triamcinoloneacetonide40InjSusp107451208 trimethobenz100Soln27451244 tropicamide1Soln157451245 tropicamide1Soln27451250 trypanblue06Soln57451251 trypanblue15Soln57451252 tuberculinpurifiedproteinderivative5tuberculin1Int7451382 vals320Tab7451383 vals40Tab7451385 vanco1Inj7451386 vanco1D5W2007451410 vanco500Inj7451411 vanco500D5W100

7451412 vanco750Inj7451413 vanco750D5W1507451387 vanco1D5W2507451389 vanco1NaCl092507451430 vaso20Soln17451432 vecu10Inj7451434 vecu20Inj2793258 velaglucerase alfa7451447 vela75CapER7451456 vera25Soln22791584 vitamin E7451562 vitE400Cap7451580 vitEwmixedtocopherols400Cap7926550 vitamin E alpha 100 intl units Cap7451598 warf2Tab7451602 warf5Tab7451831 zolp10Tab7451835 zolp5Tab8062336 99212 Limited Complexity8062337 99213 Low Complexity8062338 99214 Moderate Complexity

675830 Aerosol Treatment13708715396725 Subsequent 946405396726 Initial 9464010579422678300 Initial 94660

675850 Incentive Spirometry Respiratory4185159 Meter Dose Inhaler Initial Setup4185177 METER DOSE INHALER INITIAL SETUP46137315274683 Level 5 - Eval and/or Sx & Pt to ED/Admitted 992155274684 Level 4 - Eval and/or Sx & New Orders 992145274685 Level 3 - Eval and/or Sx & Contact MD/LIP 992135274686 Level 2 - Eval and/or Sx 992125274687 Level 1- Eval only (no Tx) 9921110579431058125 <BLANK> 94667419456341945644194912419510241952284514789 Initial 992114514844 Subsequent45669284612030 Initial day4612031 Subsequent day46136894613723461394946139504614357 Subsequent day4614358 Initial day4622735 Yes46430264643030

4644683465242651471865230164 Yes 946405242521 Initial 946675242522 Yes5242523 Subsequent 946685245796 Yes 946645259270 Yes 946695259565 Yes5259652 Yes5259743 Yes5266987 Yes5324597 RT Assist5324598 RT Intubation534965253496535396782 Yes 366205397048 Subsequent 946405397049 Initial 946405397112 Subsequent 946405397113 Initial 946405474451 Inpatient subsequent5474452 Inpatient initial 992115474453 ED patient5702196 Limited 946605702197 CPAP daily 94660595920759592096014165 Yes6014170 Yes626619062662066266207626620862662096266210626621162662126266213626621462662156266240 RT CHARGE Asthma Controlling Symptoms6266266 RT CHARGE COPD Assessment/Treatment62662876266288