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Disclaimer

The information contained in this Charge Description Master (CDM) listing is specific to Capital Region Medical Center. The charges in this CDM were valid on April 1, 2018 and will be updated annually. Charges may have changed since that date due to changes in technology, the addition or elimination of services or changes made by the manufacturers and suppliers, including the cost of goods and services. This CDM includes all standard items that are available and potentially chargeable to CRMC Health Care patients, insurers, guarantors. The charges contained in this CDM are the same for all patients of CRMC regardless of insurance carrier or coverage. The charges do not reflect expected payment. Capital Region provides a self-pay discount for our patients who are uninsured along with options for additional financial assistance for our patients meeting income, resource, and medical need eligibility criteria.

For information on Financial Assistance eligibility please visit our web page or contact Financial Counseling department at 573-632-5029.

Please note that the bill for a hospital stay or an outpatient service includes many CDM items, including charges for accommodations and/or use of special facilities such as the operating room, supplies, devices, procedures, diagnostic tests such as radiology, laboratory tests, and pharmaceuticals.

Due to the wide range of services that may be provided during a patient’s outpatient visit or hospital stay, this CDM should not be utilized to estimate the full estimate or final patient charges in advance of a visit or stay. Patients may contact Financial Counseling to request an estimate of patient financial responsibility prior to receiving services. Please provide CPT code(s) for service you are inquiring about.

CHG DESC CHG CODE MASTER FEE

0007000102 ADMITTED DELIVERED $1,260.000007005335 AMNIOINFUSION $410.000007005002 BIRTHING FEE $2,787.000007005242 CORD BLOOD PH $176.000007230144 DELIVERY OXYGEN $150.000007005339 EXTERNAL CEPHALIC VERSION $4,391.000007005119 FINGERSTICK BLOOD SUGAR/D $59.00

INPATIENT REHAB PRIVATE ROOM $944.00INPATIENT REHAB SEMI PRIVATE ROOM $807.00INTENSIVE CARE UNIT $2,426.00

0007005267 INTRAN IUPC $366.00MEDICAL/SURGICAL UNIT PRIVATE ROOM $1,417.00MEDICAL/SURGICAL UNIT SEMI PRIVATE R$1,266.00

0007005259 NON STRESS TEST $315.00NURSERY-NEWBORN NORMAL $955.00

0007005338 OB LABOR CHECK (5 HRS OR LESS) $125.000007005337 OB OBSERVATION (6 HRS OR MORE) $125.00

OBSTETRICS $1,454.000006530007 PACU ADD'L 30 MIN $268.000006530003 PACU ADD'L STAFF/30 MIN $209.000006530006 PACU BASE CHARGE $801.00

PCU $1,614.00PEDIATRICS PRIVATE ROOM $1,154.00PEDIATRCIS SEMI PRIVATE ROOM $1,075.00

Disclaimer

This section includes standard charges for room and board at CRMC Health Care facility. Room charges will vary based on patient acuity, nurse to patient ratios, and various monitoring and equipment needs. At CRMC, the daily room charge may include commonly used supplies and procedures. The daily room and board charges include general duty nursing care, standard bed/mattress, routine personal convenience and hygiene items, most routine "floor stock", items that would be generally available to all patients, local phone calls, television, dietary and housekeeping. Items or services that are special ordered by physicians are generally not included in the daily room charge. Most treatments or services provided by ancillary departments - such as respiratory therapy, laboratory, rehabilitation, etc. - are separate distinct services that are required to bill separately.


0000071253 ADAPTER AIRWAY STR W/O FILTER $32.000000022796 ADAPTER FLEXIBLE BRONCH $32.000000013990 AEROVENT HOLDING CHAMBER $20.000000016215 AIRWAY EXCHANGE CATH $208.000000016213 AIRWAY EXCHANGE CATH 3.4MM $204.000000008504 AIRWAY LMA SUPREME SIZE 4 $75.000000016299 AIRWAY LMA UNIQUE SIZE 3 $48.000000028492 AIRWAY NASAL 18FR RED RUBBER $29.000000028493 AIRWAY NASAL 20FR RED RUBBER $29.000000000319 AIRWAY NASAL 22F RED RUBBER $29.000000000327 AIRWAY NASAL 24F RED RUBBER $29.000000200590 AIRWAY NASAL 26F RUBBER ST $51.000000200592 AIRWAY NASAL 28F RUBBER ST $51.000000000328 AIRWAY NASAL 30F RED RUBBER $29.000000000335 AIRWAY NASAL 34F RED RUBBER $53.000000000331 AIRWAY NASAL 36F RED RUBBER $29.000000016328 AIRWAY NASAL NON LATEX 26 $20.000000016329 AIRWAY NASAL NON LATEX 28 $20.000000002943 AIRWAY NASAL ST. LATEX 32F $29.000000002944 AIRWAY NASAL ST. LATEX 36F $29.004800000004 ANES GENERAL 1ST 15 MIN $226.004800000005 ANES GENERAL EA ADD'L 15 MIN $181.004800000008 ANES LOCAL 1ST 15 MIN $139.004800000009 ANES LOCAL EA ADD'L 15 MIN $129.004800000006 ANES REGIONAL 1ST 15 MIN $181.004800000007 ANES REGIONAL EA ADD'L 15 MIN $139.000003530004 ANESTHESIOLOGY GENERAL 1ST HR $879.000003530005 ANESTHESIOLOGY GENERAL ADD 30 $356.000003530008 ANESTHESIOLOGY LOCAL 1ST HOUR $530.000003530009 ANESTHESIOLOGY LOCAL ADD 30 MI $252.000003530006 ANESTHESIOLOGY REGIONAL 1ST HR $704.000003530007 ANESTHESIOLOGY REGIONAL ADD 30 $268.000000000003 ARMBOARD BENDABLE DALE ADULT $34.000000000005 ARMBOARD BENDABLE DALE PED $25.000000000004 ARMBOARD BENDABLE DALE S ADULT $25.000003530011 ARTERIAL LINE INSERT $268.000000026696 AUTOTOME RX 39 CUT WIRE 20MM $771.000000091356 BAG RESUSCITATOR INFANT $60.000000013880 BITE BLOCK $19.00

This section includes standard charges for Anesthesia related services provided at CRMC Health Care. These charges do not include services provided by the anesthesiologist for services and will be billed separtley for their professional service.

Disclaimer

0000026266 BLANKET BAIR HUG UPPER BODY $37.000000106452 BLANKET BAIR HUGGER FULL BODY $29.000000016208 BREATHING CIRCUIT LATEX FREE $18.000000046677 BREATHING CIRCUIT PEDS L/F 2L $17.000000016234 BREATHING CIRCUIT PEDS. L/F $23.000000201190 CANISTER MEDI-SORB $42.000003530016 CARDIOVERSION $696.000000026282 CATH CV FEMORAL ART LINE $84.000000200882 CATH CVC MULTI LUMEN BLUE 7FR $217.000000002027 CATH SWAN GANZ QUADTRIPLE $338.000000001473 CATHETER C-V 2 LUMEN $123.000000023013 CATHETER EPIDURAL PERIFIX $32.000000114481 CATHETER SV02/CCO/VIP $934.000000001471 CENTRAL VENOUS KIT 2 LUMEN $366.000003530010 CENTRAL VENOUS LINE INSERT $1,430.000003530012 CHEST TUBE INSERT $824.000000031374 CHLORAPREP W/TINT TEAL 10.5ML $20.000000005961 CLAMP TRANSDUCER $183.004800000002 CONSC SEDTN AGE 5/+ 10-22 MIN $405.004800000003 CONSCIOUS SEDATION, < 5 YRS. $405.004800000001 CONSCIOUS SEDTN EA ADDL 15 MIN $107.000000071121 CRICITHYROTOMY MELKER KIT $718.000000200266 CUFF BP DISP. ADULT LONG $19.000000200134 CUFF BP DISP. LG LONG 44-60 CM $20.000000200171 CUFF BP DISP. SM. ADULT $18.000003530013 DIAGNOSTIC LUMBAR PUNCTURE $983.000000010484 DRESSING BIOPATCH BLUE 1" W/ $30.000000103977 ELECTRODE H59P PED/INFANT $57.000000022600 FILTER PALL BLOOD $41.000000033334 GUIDE WIRE PTFE 145CM 3MM $57.000000006139 INTUBATION SET RETROGRADE $382.000000101334 IV SET PC4 W/PORT L/F $19.000000200884 KIT ARTERIAL LINE $104.000000200302 KIT MONITOR TRANSPAC IV 84 $48.000000200074 KIT PRESSURE MONITOR TRIF $155.000000093257 MASK LARYNGEAL DISP SZ 4 $34.000000111211 MASK RESUSCITATOR ADULT 40" $40.000000016265 NEEDLE SPINAL 22G X 6 $65.000000016267 NEEDLE STIMEX 22G X 2-1/8 $39.000000055552 NEEDLE STIMUPLEX 21G X 100MM $63.000000026184 NEEDLE STIMUPLEX 22G X 2 $48.000000022642 NEEDLE WHITACRE 25G X 3 1/2 $23.000000022640 NEEDLE WHITACRE 27G X 3 1/2 $23.000000016218 ORTHO WRIST SUPPORT ART LINE $27.000000111229 RESUSCITATOR W/ MASK PEDS $77.000000013947 RESUSCITATOR W/MASK INFANT L/F $88.000000003642 SENSOR BIS QUATRO $89.00

0000201006 SENSOR PROBE ADULT DISP $48.000000200517 SENSOR PROBE CHILD DISP $50.000000200523 SENSOR PROBE INFANT DISP $60.000000101829 SET 2C8571 FILTER CONTINU FLO $20.000000101834 SET 2C8862 CLEARLINK BURETROL $32.000000101823 SET 4C8723 BLOOD Y W/HAND PUMP $27.000000023010 SURCH LIGHT 15 $78.000000002873 TRACHEAL TUBE INTRODUCER 15F $272.000000100982 TRAY ANESTHESIA SPINAL 25G $71.000000200007 TRAY EPIDURAL CONTINUOUS 18G $114.000000016258 TRAY LTA KIT $27.000000013886 TUBE CHANGER $35.000000016284 TUBE ENDOBRONCHIAL 35F LEFT $231.000000016275 TUBE ENDOBRONCHIAL 35FR RT $248.000000016288 TUBE ENDOBRONCHIAL 37F LEFT $231.000000016276 TUBE ENDOBRONCHIAL 37FR RT $248.000000016286 TUBE ENDOBRONCHIAL 39F LEFT $231.000000016274 TUBE ENDOBRONCHIAL 39FR RT $248.000000010875 TUBE ENDOBRONCIAL 32F LEFT $248.000000004058 TUBE ET CUFFED 10.0 $71.000000016294 TUBE ET CUFFED 6.0 NASAL $27.000000003116 TUBE ET CUFFED 6.0 ORAL $27.000000003117 TUBE ET CUFFED 6.5 ORAL $27.000000016290 TUBE ET CUFFED 7.0 NASAL $27.000000001208 TUBE ET CUFFED 7.0 ORAL $27.000000016298 TUBE ET CUFFED 7.0 REINFORCED $87.000000016292 TUBE ET CUFFED 7.5 NASAL $27.000000001758 TUBE ET CUFFED 7.5 ORAL $27.000000016293 TUBE ET CUFFED 8.0 NASAL $27.000000016300 TUBE ET CUFFED 8.0 REINFORCED $87.000000016302 TUBE ET CUFFED 9MM REINFORCED $99.000000066852 TUBE ET CUFFED NASAL 6.5 $27.000000031497 TUBE ET CUFFED ORAL 8.0 $27.000000001194 TUBE ET LASER SHIELD 5.5 $366.000000001195 TUBE ET LASER SHIELD 5.5 $458.000000002874 TUBE ET LASER SHIELD 6.0 $492.000000022469 TUBE ET LASER SHIELD 6.5 $492.000000022468 TUBE ET LASER SHIELD 7.5 $382.000000022542 TUBE ET LASER SHIELD 8 $458.000000003245 TUBE ET LASERSHIELD 7.0 $492.000000084431 TUBE ET PERFORMED CUFFED 5.5 $32.000000084429 TUBE ET PREFORMED CUFFED 4.5 $32.000000084430 TUBE ET PREFORMED CUFFED 5.0 $32.000000108381 TUBE ET UNCUFFED 2.5 $20.000000107854 TUBE ET UNCUFFED 3.0 $20.000000108027 TUBE ET UNCUFFED 3.5 $20.000000108035 TUBE ET UNCUFFED 4.0 $20.00

0000031561 TUBE SALEM SUMP 10FR 48" $19.000000102194 TUBE SALEM SUMP 16FR 48" $19.000000105031 TUBE SALEM SUMP 18FR 48" $19.000000016304 TUBE UNIVENT ENDBRONC 6 $543.000000016306 TUBE UNIVENT ENDBRONC 7 $428.000000016308 TUBE UNIVENT ENDBRONC 8 $612.000000026267 TUBING HOTLINE FLUID WARMER $61.000000022737 TUBING SET LEVEL 1 WARMER $132.000000106450 VALVE ANTI-REFLEX $29.000000022402 VALVE BX FLEX INTUB SCOPE $267.000000044226 WATER TRAP AQUAKNOT 11 $36.00


0002830039 AIRWAY TREATMENT MANAGEMENT $294.000002804755 APPLICATION ON-BODY INJECTOR $59.000002804754 BLOOD COLLECTION FROM PICC $160.000002804699 BLOOD DRAW FOR LAB, HEEL STICK $29.000002804652 BLOOD/BLOOD PRODUCT TRANSFUSIO $1,222.000002804752 BONE MARROW ASPIRATE-ADD ON $176.000002804745 BONE MARROW BX W/ ASPIRATION $2,705.000002804738 CHEMO ADMIN EA.ADD'L SEQUENTIA $787.000002804737 CHEMO ADMIN EA.ADD'L SUBSTANCE $239.000002804736 CHEMO ADMIN HORMONAL ANTINEOPL $239.000002801124 CHEMO ADMIN INITIAL SUBSTANCE/ $239.000002801125 CHEMO ADMIN NON-HORMONAL ANTIN $239.000002804615 CHEMO INF FIRST HR $787.000002804727 CHEMO INFUSION ADD'L HOURS $135.000002804743 CHEMO INTO CNS $648.000002804744 CI CHEMO W/ PUMP $648.000002804729 COLLECTION OF BLOOD VIA VAD $71.000002804730 DECLOT VASCULAR DEVICE $322.000002804718 ESTABLISHED PT BRIEF $111.000002830037 ESTABLISHED PT COMPLEX $193.000002801082 ESTABLISHED PT EXTENDED $145.000002804719 ESTABLISHED PT INTERMEDIATE $136.000002801058 ESTABLISHED PT LIMITED $113.000002810201 ESTABLISHED-MINIMAL $111.000002804724 IM ANTIBIOTIC INJECTION $75.000002804748 INITIAL IMMUNIZATION-HEP B $60.000002804725 INITIAL IMMUNIZATION-INFLUENZA $60.000002804750 INITIAL IMMUNIZATION-OTHER $60.000002804746 INITIAL IMMUNIZATION-PNEUMONIA $60.000002804723 INJECTION THERAPEUTIC IVP $212.000002804735 INJECTION THERAPEUTIC IVP EA.A $228.000002804672 INJECTION THERAPEUTIC SQ/IM $75.000002804739 IRRIGATION IMPLANTED VAD FOR D $107.000002804732 IV INFUSION HYDRATION EA ADD'L $114.000002804731 IV INFUSION HYDRATION UP TO ON $533.000002804722 IV INFUSION THERAPY ADD'L HOUR $114.000002804733 IV INFUSION THERAPY ADD'L SEQU $533.000002804734 IV INFUSION THERAPY CONCURRENT $533.000002804680 IV INFUSION THERAPY FIRST HR $533.000002804720 NEW PT BRIEF $117.00

DisclaimerThis section includes standard charges for infusions performed in the Goldschmidt Cancer Center provided by CRMC Health Care.

0002801108 NEW PT COMPLEX $298.000002801090 NEW PT EXTENDED $219.000002801074 NEW PT INTERMEDIATE $166.000002801066 NEW PT LIMITED $126.000002801065 NURSE VISIT - NO CHARGE $0.000002804698 PHLEBOTOMY DRAW $21.000002804742 REFILL PORTABLE PUMP $478.000002804715 RHYTHM STRIP $101.000002804753 SPINAL FLUID TAP DIAGNOSTIC $983.000002804749 SUBSEQ IMMUNIZATION-HEP B $60.000002804726 SUBSEQ IMMUNIZATION-INFLUENZA $60.000002804751 SUBSEQ IMMUNIZATION-OTHER $60.000002804747 SUBSEQ IMMUNIZATION-PNEUMONIA $60.000002830036 THERAPEUTIC PHLEBOTOMY $151.00

CHARGE CODE CHARGE DESCRIPTON MASTER FEE0001400003 AMBULATORY EEG(16 CHANNEL)24HR $2,942.000001240357 CARDIAC ECHO $564.00E001240449 CARDIAC EX LIMIT BUBBLE W/ CON $974.000001240448 CARDIAC EX LIMIT BUBBLE W/O C $974.000001240437 CARDIAC EXAM-LIMITED W/ CONTR $0.00E001240437 CARDIAC EXAM-LIMITED W/ CONTR $974.000001240373 CARDIAC EXAM-LIMITED W/O CONTR $974.000001240454 COMPARTMNT PRESSURE MEASUREMNT $1,464.000001240442 COMPLETE ECHO, TRANSTHOR, PEDS $1,675.00E001240439 COMPLETE ECHO-TRANSTHR W/CONTR $1,675.000001240365 COMPLETE ECHO-TRANSTHR W/O CON $1,675.000001240447 DEFINITY IMAGING(CONTRAST) 2ML $325.000001240426 DOBUTAMINE STRESS TEST $900.00E001240427 DOBUTAMINE STRESS W/ECHO $900.000001240430 ECHO STRESS W/O CONTRAST $679.00E001240445 ECHO W/ BUBBLE W/ CONTRAST $1,675.000001240446 ECHO W/ BUBBLE W/O CONTRAST $1,675.000001400002 EEG 20-40 MIN. SLEEP DEPRIVED $1,463.000001400006 EEG 20-40 MINUTES $1,463.000001400005 EEG 41-60 MIN SLEEP DEPRIVED $1,904.000001400001 EEG 41-60 MINUTES $1,904.000001400004 EEG EXTENDED MONITORING > 1 HR $633.000001400007 EEG; INCLUDING AWAKE & ASLEEP $1,463.000001240019 EKG - 12/15 LEAD $0.00E001240019 EKG - 12/15 LEAD $287.00

Disclaimer

These services will require an interpretation by a radiologist. CRMC Physicians will bill separately for their professional service.

0001240424 EKG INTERPRETATION $41.00E001240432 EKG WITH & WITHOUT MAGNET $287.000001240433 HOLTER-CONNECT/DISCON/RECORD $236.000001240434 HOLTER-SCAN ANALYSIS W/REPORT $236.000001230000 STRESS TEST $900.000001240413 TEE INTRA OPERATIVE W/O CONTR $1,573.000001240450 TEE INTRAOP W/BUBBLE W/O CONTR $1,573.00E001240441 TEE W/ CONTRAST $1,573.00E001240453 TEE W/BUBBLE W/CONTRAST $1,573.000001240452 TEE W/BUBBLE W/O CONTRAST $1,573.000001240415 TEE W/O CONTRAST $1,573.00E001240425 TREADMILL STRESS TEST W/ECHO $679.00


0001901438 CARDIOPULMONARY RESUSCITATION $1,109.000001930982 ABBOTT HI-TORQUE PILOT 180&300 $413.000001930286 ANGIOSEAL $886.000001930437 ATTAIN ACCESS MODEL 6218 EP CA $682.000001930867 ATTAIN COMMAND GUDIE CATHETER $804.000001930433 ATTAIN VENOGRAM BALLOON CATH 6 $454.000001930106 BALLOON APEX/EMERGE $1,487.000001930427 BALLOON INTERVENT.TECH CUTTING $2,635.000001930294 BALLOON NC RANGER CCL $1,239.000001930897 BALLOON SPRINTER ALL SIZES $607.000001930835 BALLOON-STERLING MONO BSCI PV $1,128.000001930881 BIOSENSE WEBSTER EP CATHETER $765.000001930976 BSCI CROSSBOSS CATHETER $2,014.000001930977 BSCI STINGRAY CATHETER $2,500.000001930869 CATH 4F PIG, JR, JL $54.000001930865 CATH 6F EXPORT $1,590.000001930826 CATH ANGIOJET SPIROFLEX/VG $4,009.000001930792 CATH ATLANTIS IVUS BSCI $1,998.000001930906 CATH GUIDELINER VASCULAR SOL $1,259.000001930803 CATH RESPONSE EP 6F $1,690.000001930907 CATH TERUMO TRANSRADIAL $175.000001930063 CATH-5F & 6F JL4/JR4 CCL $67.000001930067 CATH-6F IMA-JL-JR-MP/A2-AR/NTR $61.000001930060 CATH-6F LCB-RCB CCL $107.000001930068 CATH-6F PIG 110CM-45 $60.000001930033 CATH-7F AL-JL-JR-AIMP $87.000001930605 CATH-BSCI MACH 1 GUIDE ALL SIZ $334.000001930744 CATH-COOK 5F SIM1 100CM CCL $101.000001930839 CATH-COOK CALIBRATED PIG 5F $416.000001930069 CATH-EZ PAK AR-JR CCL $223.000001930464 CATH-GUIDE SCIMED MACH1 CCL $307.000001930296 CATH-GUIDE USCI 8F CCL $364.000001931024 CELL CONNECTIVITY PM/ICD BSCI $200.000001931011 CELL CONNECTIVITY PM/ICD MEDTR $105.000001931010 CELL CONNECTIVITY PM/ICD ST JU $210.000001930661 CONSC SEDTN AGE 5/+ 10-22 MIN $405.000001931036 CONSCIOUS SEDTN EA ADDL 15 MIN $107.000001930150 CONTRAST MEDIA 200CC $1.000001930151 CONTRAST MEDIA 50CC $1.000001930805 CONTRAST-CONRAY 60% 50CC $60.000001904046 CORONARY - BYPASS $2,797.000001904063 CORONARY ONLY $2,797.00

This section includes standard charges for CRMC Health Care's Cardiac Cath Lab Disclaimer

0001930043 DILATOR USCI 6-9 FR CCL $45.000001930896 D-STAT DRY BANDAGE $230.000001930973 DSTAT FLOWABLE HEMOSTATIC $358.000001930535 EMBOLIZATION PROTECTIVE SYSTEM $4,058.000001930298 FEMOSTOP $423.000001930913 FFR; EACH ADDL VESSEL $278.000001930912 FFR; INITIAL VESSEL $345.000001931000 GEN ADVISASR SURESCAN A3SR01 $8,650.000001930926 GEN BIV ICD REMOVE & REPLACE $89,643.000001931017 GEN BSCI ESSENTIO DR-DUAL $12,200.000001931021 GEN BSCI ESSENTIO MRI DUAL $11,400.000001931016 GEN BSCI ESSENTIO SR-SNGLE $8,820.000001931028 GEN BSCI INOGEN ICD D142 DUAL $26,000.000001930920 GEN DUAL REMOVE & REPLACE $26,706.000001930922 GEN ICD DUAL REMOVE & REPLACE $89,643.000001930921 GEN ICD SINGLE REMOVE & REPLAC $89,643.000001931019 GEN MEDT AMPLIA MRI CRT SURESC $57,512.000001931009 GEN MEDT EVERA XT DR ICD-DUAL $31,874.000001931031 GEN MEDT VISIA MRI ICD DVFB1D1 $32,040.000001931023 GEN MEDT VISIA MRI ICD VR-SING $40,750.000001931008 GEN MEDT VIVA XT CRT-D $41,595.000001930919 GEN SINGLE REMOVE & REPLACE $24,369.000001931041 GEN SJM FORTIFY ASSURA ICD VR $24,000.000001931025 GEN ST JUDE ELIPSE DR ICD DUAL $28,400.000001931038 GEN ST JUDE MED ASSURITY MRI D $8,200.000001931037 GEN ST JUDE MED ASSURITY MRI S $7,600.000001931013 GEN ST JUDE MEDICAL ASSURITY $7,560.000001931007 GEN ST JUDE MEDICL ASSURITY DR $7,600.000001930959 GEN-ADVISA DR MRI SURESCAN A2D $9,878.000001931042 GEN-AZURE XT MRI SURESCAN DUAL $8,000.000001931044 GEN-AZURE XT MRI SURESCAN SNGL $6,300.000001931020 GEN-BSCI INOGEN ICD D140 SINGL $35,300.000001930798 GENERATOR MEDTRONIC ADAPTA DR $12,537.000001930796 GENERATOR MEDTRONIC ADAPTA SR $12,825.000001931026 GEN-MEDT ICD EVERA MRI XT-DUAL $42,596.000001930985 GUARDIAN TUOHY BORST $154.000001930964 GUIDEZILLA BSCI 6F CATHETER $1,086.000001930857 IAB-DATASCOPE 50CC PERCOR STAT $2,141.000001930859 IAB-DATASCOPE FIDELITY ALL SZ $2,249.000001930858 IAB-DATASCOPE LINEAR ALL SIZES $2,365.000001930104 INFLATION KIT-ADV $256.000001930537 INS/REP LEAD W/INS PICD DUAL $104,339.000001930489 INS/REP LEAD W/INS PICD SINGLE $104,339.000001931049 INTRACARDIAC ECG AT OP $676.000001930779 INTRAVASC US CORONARY-DX TX EA $4,295.000001930778 INTRAVASC US CORONARY-DX TX IN $7,496.000001930265 INTRODUCER 10.5FR SPLIT WITH $278.00

0001930046 INTRODUCER 5F 6F & 7F CCL $61.000001930263 INTRODUCER 6FR 23CM CCL $175.000001930327 INTRODUCER 7F SPLIT SHEATH W/V $320.000001930088 INTRODUCER 8F HEMOQUAT CCL $75.000001930221 INTRODUCER 8F LONG SET CCL $185.000001930458 INTRODUCER 8F SPLIT W/VALVE,SI $300.000001930264 INTRODUCER 9F SPLIT WITH CCL $278.000001930461 INTRODUCER ARROW 6FR 45CM CCL $375.000001930462 INTRODUCER ARROW 8FR 45CM CCL $375.000001930386 INTRODUCER CORDIS AVANTI PLUS $89.000001930908 INTRODUCER TRANSRADIAL 6FR $197.000001930275 IRRIGATION POUCH-CCL $50.000001931029 L BSCI INGEVITY L7740 45CM $1,125.000001931030 L BSCI INGEVITY L7741 59 CM $1,125.000001930963 LANGSTON VASC SOL DUAL LUMN PG $536.000001930787 LEAD GUIDANT ENDOTAK 0174/0185 $11,850.000001930831 LEAD MED 4194 ATTAIN COR SINUS $6,266.000001930270 LEAD-5FR TEMPORARY PACEMAKER B $444.000001930810 LEAD-BSCI ENDOTAK RELINC G0185 $11,151.000001930466 LEAD-GUIDANT BIPOLAR V LEAD 58 $3,332.000001930900 LEAD-MEDT 5806 M45, 52, 58CM $1,824.000001930852 LEAD-MEDTRONIC 4195 ATTAIN CS $6,505.000001930300 LEAD-MEDTRONIC 5092/4092/4592 $2,947.000001930494 LEAD-MEDTRONIC AICD 6947 CCL $12,733.000001930399 LEAD-MEDTRONIC CAPSUREFIX 5076 $2,769.000001930496 LEAD-MEDTRONIC COR SINUS 4193 $6,266.000001930541 LEAD-PACESETTER TRENDIL SDX 16 $2,520.000001930891 LEAD-ST JUDE 1258T 86CM $5,789.000001930929 LEAD-ST JUDE 1948 ISOFLEX 58 $1,775.000001930915 LEAD-ST JUDE 2088TC 52CM $1,775.000001930916 LEAD-ST JUDE 2088TC 58CM $1,775.00E001930904 LEFT & RIGHT HEART CATH COR $15,873.00E001930905 LEFT & RIGHT HEART CATH COR BY $19,689.000001930887 LEFT & RIGHT HEART CATH COR LV $19,942.00E001904045 LEFT AND RIGHT HEART CATH $13,581.000001930902 LEFT HEART CATH COR $15,971.000001930886 LEFT HEART CATH COR BY $17,290.000001930903 LEFT HEART CATH COR BY LV $17,290.000001930885 LEFT HEART CATH COR LV $15,971.000001930890 LEFT HEART CATH LV $14,2670001930894 LOOP RECORDER-REVEAL LINQ $10,590.00E001930888 LT & RT HEART CATH COR BY LV $19,689.000001930983 MERIT/ENDOLOGIX ENSNARE RETRIE $1,114.000001931046 MICRA TCP SYSTEM MC1VRO1 $21,5000001930999 MICROCATHETER THREADER $1,100.000001930223 NAMIC CUSTOM KIT $302.000001930250 NAMIC WASTE BAG $57.00

0001930056 NEEDLE-7CM PERC $16.000001931022 PEAK PLASMABLADE 4.0 $718.000001930932 PERC ANGIOPLASTY; 1ST ARTERY $14,517.000001930933 PERC ANGIOPLASTY; ADDL ARTERY $14,157.000001930942 PERC CARD ANGIO/ATHRECT 1 ART $26,989.000001930944 PERC CARD DES/ATH/ANGIO 1VSL $21,498.000001930950 PERC CARD REVASC CHRONIC DES 1 $21,498.000001930947 PERC CARD REVASC MI BMS 1 VSL $21,498.000001930948 PERC CARD REVASC MI DES 1 VSL $21,498.000001930938 PERC REVASC BYP GRAFT BMS 1VSL $21,498.000001930939 PERC REVASC BYP GRAFT DES 1VSL $21,498.000001930941 PERC REVASC BYP GRAFT DES ADDL $21,498.000001930934 PERC STENT BMS W/ANGIO 1 VSL $21,498.000001930936 PERC STENT BMS W/ANGIO ADDL $21,498.000001930935 PERC STENT DES W/ANGIO 1 VSL $21,498.000001930937 PERC STENT DES W/ANGIO ADDL $21,498.000001931048 PERQ TRANSCATH SEPTAL REDUXN $19,689.000001930889 PHARM. AGENT ADMIN. $44.000001930911 PRESSURE WIRE AERIS $1,862.000001930825 PROC PT CORONARY THROMBECTOMY $9,393.000001930132 PROC.-ACTIVATED CLOT TIME CC $122.000001930367 PROC.-CARDIOVERSION CCL $696.000001930477 PROC.-EP-EVAL OF AICD GENERATO $1,058.000001930475 PROC.-EP-EVAL OF AICD LEADS ON $1,007.000001930481 PROC.-EP-INSERT LEAD 1 CHAMBER $7,051.000001930483 PROC.-EP-REPAIR 1 LEAD $3,200.000001901462 PROC.-IAB INSERTION INPT ONLY $6,554.000001930519 PROC.-INSERT ADD'L VENT LEAD W $14,901.000001930429 PROC.-INSERT ADD'L VENTRIC.LEA $14,901.000001904066 PROC.-INSERT SWAN GANZ CCL $3,275.000001904069 PROC.-LOOP RECORDER EXPLANT $3,131.000001904070 PROC.-LOOP RECORDER INSERT C $8,164.000001930001 PROC.-PACEMAKER-EXTERNAL CCL $779.000001901636 PROC.-PACEMAKER-TEMP.EXTERNAL $779.000001930210 PROC.-PACER INSERT ATRIAL CC $12,675.000001930227 PROC.-PACER INSERT DUAL $15,501.000001930211 PROC.-PACER INSERT VENTRIC $12,675.000001930213 PROC.-PACER LEAD REV. SNGL CCL $3,200.000001930141 PROC.-PERICARDIOCENTESIS INITI $9,033.000001930230 PROC.-RELOCATE PACER POCKET $3,490.000001930523 PROC.-REMOVE DUAL PACER LEAD $3,005.000001930521 PROC.-REMOVE PACEMAKER GENERAT $7,051.000001930522 PROC.-REMOVE SGL PACER LEAD C $3,156.000001930520 PROC.-REPOSITION VENTRICULAR L $3,156.000001930237 PROC.-TEMPORARY PACEMAKER INSE $11,609.000001930276 PROC.-TILT TABLE TEST CCL $1,162.000001930709 PROC.-VENOGRAM EXTREMITY LT S& $1,760.00

0001930966 RADIAL WRIST SUPPORT REF#29980 $37.000001930988 RENEGADE STC DELIVERABLE SHEAT $1,109.000001930883 RIGHT HEART CATH COR $11,038.000001930884 RIGHT HEART CATH COR BY $14,0590001930401 ROTABLATE ADVANCER $606.000001930400 ROTABLATE BURR $2,700.000001931027 SAMURAI/MARVEL GUIDEWR 180&300 $298.000001930872 SH INTRODUCER 6F COOK FLEXOR $273.000001930534 SHEATH 11 FRENCH W/VALVE & SID $286.000001930878 SHEATH,4F TRANSRADIAL PRELUDE $207.000001930601 SHEATH-BSCI PINNACLE DESTINATI $435.000001930742 SHEATH-INTRODUCER SET COOK MPI $162.000001931039 SJM MRI LPA 1200 TENDRIL 52&58 $963.000001931004 SJM UNIFY ASSURA 3357-40C CELL $32,400.000001930509 SMART CAPOLINE W/O2-ADULT CC $65.000001930862 ST.JUDE DURATA 7120 RV LEAD $11,059.000001930849 STENT - BSCI PROMUS DES ALL SZ $5,363.000001931043 STENT ABBOTT XIENCE SIERRA DES $2,210.000001930425 STENT BSCI LIBERTE/EXPRESS $2,821.000001931045 STENT SYNERGY DES $2,138.000001930876 STENT, ACS MINIVISION MONO ALL $2,723.000001930590 STENT-BSCI EXPRESS (PV) ALL SI $2,904.000001930984 TERUMO INT SH 8F 45 CM $333.000001930956 TERUMO RAD HYDRO SHEATH 5&6 FR $196.000001930972 TERUMO RUNTHROUGH GUIDEWIRE $280.000001931047 TRANSCATH PACING SYS INSERT $36,802.000001930974 TYRX RESORBABLE ANTIBIOTIC ENV $2,239.000001931006 UPGRADE PM TO BI-V ICD W/EXIST $93,652.000001930967 VASCULAR BAND VASC SOLUTIONS $73.000001930817 VISIPAQUE 150CC $2.000001931040 W COOK MANDRIL MICROPUNC 60CM $128.000001930978 WIRE ASAHI CONFIANZA $277.000001930979 WIRE ASAHI MIRACLE BROS 12-300 $277.000001930981 WIRE CORSAIR ASAHI 135X150 CM $413.000001930895 WIRE, KINETIX ALL TYPES/SIZES $366.000001930076 WIRE-025-145-3MMJ $87.000001930271 WIRE-025-260-3MM SWAN-CCL $91.000001930125 WIRE-032-145CM J-8953 $155.000001930041 WIRE-035-145CM J 7042 CCL $61.000001930119 WIRE-035-175CM-STR-5 $61.000001930077 WIRE-035-260CM-3MM J $160.000001930083 WIRE-035-260CM-STR 8633 $75.000001930042 WIRE-038-260CM-STR-J $160.000001930850 WIRE-ABBOTT ASAHI $476.000001930801 WIRE-ABBOTT WIGGLE 300CM, 2CM $433.000001930314 WIRE-ACS BMW .014 190CM CCL $548.000001930344 WIRE-ACS HI TORQUE ES 300CM C $440.00

0001930868 WIRE-BSCI ADD WIRE $1,552.000001930597 WIRE-BSCI AMPLATZ SUPERSTIFF 0 $235.000001930592 WIRE-BSCI GLIDEWIRE CCL $223.000001930596 WIRE-BSCI MAGIC TORQUE 035/260 $315.000001930594 WIRE-BSCI ROSEN 035/180/1.5MMJ $69.000001930593 WIRE-BSCI STIFF GLIDEWIRE CCL $223.000001930292 WIRE-CHOICE GUIDEWIRE CCL $440.000001930328 WIRE-COOK AMPLATZ EXTRA STIFF $143.000001930419 WIRE-ROTAWIRE EX SUPPORT CCL $690.000001930410 WIRE-ROTAWIRE FLOPPY GOLD 325C $726.000001930388 WIRE-SCIMED CHOICE FLOPPY C $434.000001930408 WIRE-SCIMED LUGE MOD SUPPORT 3 $501.000001930256 WIRE-WHOLE WIRE GUIDE $331.00


0004190001 CR PHASE II EX MONITORED VISIT $217.000004190035 CR PHASE II - PLAN OF CARE $217.000004190002 I/P CARDIAC REHAB VISIT $217.000004190021 PR-PULM. REHAB INTERS (HR) $256.000004190023 PULMONARY REHAB HR/SESSION $256.000004190036 SUPERVISED EXERCISE THER (PAD) $155.00

This section includes standard charges for CRMC Health Care's Cardiac Rehabillitation therapy services

Disclaimer


0007831144 ABD/PERITONEO PARACENTESIS OR $1,825.000007831285 AMPUTATE FING/TH SGL; W DIR CL $4,195.000007831327 AMPUTN FINGR PRIM/SEC W V-Y FL $4,212.000007831040 APPICATION LONG ARM SPLINT $318.000007831039 APPICATION SHORT ARM SPLINT $298.000007831042 APPLICATION FINGER SPLINT STAT $181.000007831047 APPLICATION LONG LEG SPLINT $318.000007831045 APPLICATION SHORT LEG CAST $356.000007831046 APPLICATION SHORT LEG SPLINT $298.000007831274 APPLY LONG ARM CAST $600.000007831211 ARTERIAL CATH-SAMPLE/MONITOR $268.000007831149 ARTHROCENTESIS ASP.&/OR INJ IN $1,232.000007831114 ASPIRATION AND/OR IRRIG.MAJOR $1,260.000007831104 AVULSION NAIL PLATE SIMPLE SIN $322.000007831320 AVULSION NAIL PLATE, EACH ADDL $162.000007831278 BLADDER SCAN PV RESIDUAL URINE $172.000007831343 BLOOD DRAW FOR LAB, HEEL STICK $27.000007830001 BLOOD DRAW-FOR LAB $21.000007831318 BX SKIN, SQ, MUCOUS;SNG LESION $603.000007806029 CARDIOVERSION ELECTIVE $696.000007831048 CASTING OR STRAPPING UNLISTED $298.000007831151 CHANGE GASTROSTOMY TUBE/PEG TU $580.000007831196 CHANGE OF CYSTOSTOMY TUBE SIMP $590.000007831300 CHEM CAUT GRANULATED TISSUE $473.000007831339 CHEST TUBE W/O IMAGE GUIDANCE $3,935.000007831142 CL RED BI-MAL ANKLE FX W MNPL $2,127.000007831332 CL RED DISTAL TIBIA FX $3,525.000007831292 CL REP S/A/L 1.1 CM-2.5 CM $670.000007831216 CL TX DISTL FIB FX W/ MANIP. $446.000007831341 CL TX ELBOW DISLOC W ANES $3,722.000007831215 CL TX KNEE DISL; W/O ANESTH $446.000007831326 CL TX KNEE DISLOC REQ ANSTH $3,175.000007831200 CL TX MEATCARP DISL W/M,W/O AN $471.000007831275 CL TX METACARPAL FX, W/ MANIP $394.000007831319 CL TX PATELLAR DISLOC W/ANESTH $724.000007831140 CL TX POST HIP DISLOCATION W/O $516.00

This section includes standard charges for emergency-related services provided at CRMC Health Care. Emergency room visits also may require diagnostic tests such as laboratory or radiology imaging. Please refer to those sections for charges related to those services. Emergency room charges do not include services provided by the emergency room physician. Emergency Physicians will bill separately for their professional service thru Team Health.

Disclaimer

0007831282 CL TX POSTOP HIP DISLOC W ANES $3,412.000007831139 CL TX PROX HUMERAL FX.W/MANIP. $2,145.000007831280 CL TX PROX TIB-FIB JNT DISL,W/ $365.000007831266 CL TX SHLDR DISL W MANIP;W ANE $4,000.000007831157 CL TX TIBIAL SHAFT FX.W/MAN.W $2,145.000007831214 CL TX TRMA HIP DISLOC W/O ANE $446.000007831160 CL TX ULNAR SHAFT FX.W/MANIPUL $471.000007831310 CLOSED RED RADIAL HEAD/NECK FX $2,127.000007831128 CLOSED TX DISTAL PHALANGEAL FX $524.000007831064 CLOSED TX ELBOW DISLOCATION W/ $516.000007831098 CLOSED TX FINGER FX W/MANIP,W/ $533.000007831061 CLOSED TX FINGER JOINT DISLOCA $516.000007831066 CLOSED TX MANDIBLE DISLOCATION $459.000007831123 CLOSED TX METACARPOPHALANGEAL $516.000007831107 CLOSED TX PATELLAR DISLOCATION $522.000007831118 CLOSED TX RADIAL & ULNAR SHAFT $2,127.000007831062 CLOSED TX RADIAL HEAD CHILD W/ $516.000007831041 CLOSED TX SHOULDER DISLOCATION $516.000007831081 CLOSED TX THUMB DISLOCATION W/ $516.000007831133 CLOSED TX TOE FX,OTHER THEN GR $524.000007831063 CLOSED TX TOE JOINT DISLOCATIO $516.000007831125 CLOSED TX TRIMALLEOLAR ANKLE F $2,127.000007831152 CLOSED TX.ANKLE DISLOCATION W/ $668.000007831131 CLSD TX RADIUS/ULNA W/ OR W/O $2,127.000007831298 COLLECT BLOOD SPEC FROM PICC $160.000007831187 COLLECT BLOOD SPEC VIA IMPLANT $166.000007831194 CONS SED<AGE 5,BY ANES 10-22 M $405.000007831075 CONSC SED AGE 5/OLDR 10-22 MIN $405.000007831177 CONSC SED AGE5/+BY ANES 10-22 $405.000007831188 CONSC SEDATION EACH +15 MIN $107.000007831178 CONSC SEDTN +15 MIN BY ANESTH $107.000007831179 CONSC SEDTN <AGE 5 10-22 MIN $405.000007831049 CONTROL NASAL HEMORRHAGE ANTER $396.000007831126 CONTROL NASAL HEMORRHAGE POSTE $396.000007831193 CONTROL NASAL HEMORRHAGE,ANTER $327.000007809018 CPR/CODE $1,109.000000014884 CROWN MOLAR SS D-UR-7 $27.000007831346 D&C TREAT INCOMPLETE ABORTION $6,199.000007831222 DEBR, EXZ/INF SKIN, 10% BS $769.000007831313 DEBRIDE NAIL, ANY METHOD; 1-5 $198.000007831307 DESTRUCT 1-14 BENIGN LESIONS $269.000007831259 DR ABSC CYST HEMAT-MOUTH,SIMPL $902.000007831268 DRAIN EXTERNAL EAR; SIMPLE $902.000007831254 DRAIN FINGER ABSC; SIMPLE $385.000007831181 DRAINAGE SCROTAL WALL ABSCESS $4,251.000007831206 ED TRAUMA/CRIT CARE W/MODIFIER $2,012.000007830029 ED TRAUMA/CRITICAL CARE $2,012.00

0007831251 ED TRIAGE $0.000007831335 ENDOMETRIAL BX $422.000007831240 EPI BLOOD PATCH $1,260.000007830008 ER LEVEL 1 $166.000007831201 ER LEVEL 1 W/MODIFIER $166.000007830007 ER LEVEL 2 $195.000007831202 ER LEVEL 2 W/ MODIFIER $195.000007830006 ER LEVEL 3 $431.000007831203 ER LEVEL 3 W/ MODIFIER $431.000007830005 ER LEVEL 4 $706.000007831204 ER LEVEL 4 W/ MODIFIER $706.000007830004 ER LEVEL 5 $1,019.000007831205 ER LEVEL 5 W/ MODIFIER $1,019.000007830003 ER SANE EVAL $706.000007831099 EVACUATE SUBUNGUAL HEMATOMA $185.000007831340 EXC VAGINAL POLYP/CYST $6,266.000007831077 EXCISION NAIL AND NAIL MATRIX $1,057.000007831244 EXTENSOR TENDON REPAIR, EACH $3,958.000007830000 FLEX SIGMOIDOSCOPE $1,119.000007831331 FORESKIN REDUCTION $626.000007831347 HUMERUS OR ELBOW, UNLISTED $592.000007831095 I & D ABS,CYST,HEMATOMA DENTAL $482.000007831030 I & D ABSCESS COMPLICATED OR M $455.000007831094 I & D ABSCESS EYELID, BLEPHARO $855.000007831093 I & D ABSCESS SIMPLE $447.000007831112 I & D BARTHOLIN GLAND ABCESS $730.000007831135 I & D VULVA OR PERINEAL ABCESS $730.000007831217 I&D ABSCESS, PERITONSILLAR $615.000007831236 I&D EPDIDIYMIS,TESTIS/SCROTAL $5,565.000007831271 I&D HEMATOMA/FLUID $2,856.000007831228 I&D PERIRECTAL/ISCHIAL ABSCESS $5,447.000007831218 I&D PILONID CYST, COMPLEX $2,784.000007831231 I&D PILONID CYST, SIMPLE $902.000007831238 I&D; PERIANAL ABSCESS $3,511.000007831020 IM/SUBQ INJECTION $75.000007831056 IMMUNIZATION ADMIN. ONE VACCIN $60.000007831158 IMMUNIZATION ADMIN.EA.ADD'L VA $60.000007831087 INC./REMOVAL FOREIGN BODY SUBQ $447.000007831132 INCISION OF THROMBOSED HEMORRH $560.000007831253 INGROWN NAIL REMOVAL $490.000007831189 INITIAL TX FIRST DEGREE BURN $230.000007831325 INJ ANES FACIAL NERVE $265.000007831243 INJ ANESTH;GREAT OCCIPITAL NRV $1,167.000007831305 INJ SINGLE TENDON SHEATH $600.000007831085 INJ.ANESTHETIC AGENT PERIPH NE $1,436.000007831130 INJ.ANESTHETIC AGENT TRIGEMINA $1,167.000007831167 INJECTION SNGL/MULTI TRIGGER P $612.00

0007831124 INSERT NON-TUNNELED CNTRL VENO $3,054.000007831080 INSERT TEMP BLADDER CATH IN/OU $166.000007831051 INSERT TEMP BLADDER CATHETER $256.000007831263 INTMD WND REPAIR N-HF/GENIT $847.000007831055 INTRODUCTION NEEDLE/INTRACATH $235.000007831247 INTUBATION $958.000007831348 IRRGTN CORPORA CAVERNOSA,PRIAP $608.000007831208 IRRIG DRUG DELIVERY DEVICE $107.000007831110 IRRIGATION CORPORA CAVERNOSA $664.000007831169 IV INFUSION HYDRATION EA.ADD'L $114.000007831168 IV INFUSION HYDRATION FIRST HR $533.000007831171 IV INFUSION THERAPEUTIC ADD'L $533.000007831180 IV INFUSION THERAPY CONCURRENT $533.000007831076 IV INFUSION THERAPY EA.ADD'L H $114.000007831053 IV INFUSION THERAPY FIRST HR $533.000007831170 IVP INJ THERAPEUTIC EA.ADD'L S $228.000007831221 IVP INJECT TX/DX SAME DRUG ADD $107.000007831019 IVP INJECTION THERAPEUTIC/DX $212.000007831334 LARYNGOSCOPY DIRECT,DIAGNOSTIC $3,675.000007831156 LAYER CL WOUND FA,EAR,EYELID,N $516.000007831164 LAYER CL WOUND FA,EAR,EYELID,N $495.000007831068 LAYER CL.WND FAC,EAR,EYELI,NOS $474.000007831091 LAYER CL.WND FAC,EAR,EYELI,NOS $455.000007831071 LAYER CL.WND NECK,HAND,FEET 2. $474.000007831097 LAYER CL.WND NECK,HAND,FEET 2. $455.000007831070 LAYER CL.WND SCALP, TRUNK 20.1 $507.000007831069 LAYER CL.WND SCALP,AXILLAE,TRU $474.000007831096 LAYER CL.WND SCALP,TRUNK 2.5 C $455.000007831090 LAYER CL.WND SCALP,TRUNK 7.6-1 $495.000007831184 LAYER CL.WND SCLP,AXILLAE,TRUN $516.000007831250 LEFT W/O BEING SEEN (LWBS) $0.000007831330 LIP, UNLISTED PROCEDURE $515.000007831102 LUMBAR PUNCTURE DIAGNOSTIC $983.000007831059 NASAL SURGERY $482.000007831022 OMT 1-2 BODY REGIONS $75.000007831306 PACEMAKER INTERROGATION $123.000007831345 PARACENTESIS ABD W/O IMG GDNC $1,825.000007831333 PARING CORN, SNGL LESION $391.000007831186 PLACEMENT NEEDLE INTRAOSSEOUS $520.000007831054 PUNCTURE ASPIRATION ABCESS,HEM $753.000007831322 RECTUM, UNLISTED PROCEDURE $1,498.000007831073 REM FOREIGN BODY EXT EYE,CORNE $607.000007831086 REM FOREIGN BODY,CORNEA W/O SL $588.000007831154 REMOVAL FB FOOT SUBCUTANEOUS $1,047.000007831109 REMOVAL FB INTRANASAL PROCED.O $184.000007831111 REMOVAL FB MUSCLE/TENDON SHEAT $2,124.000007831052 REMOVAL FOREIGN BODY EXT.EYE C $263.00

0007831192 REMOVAL OF IUD $632.000007831089 REMOVE FB EXT.AUDITORY CANAL W $175.000007831264 REMOVE FULL ARM/LEG CAST $296.000007831103 REMOVE IMPACTED CERUMEN ONE OR $107.000007831252 REMOVE SKIN TAGS; UP TO 15 $424.000007831148 REP COMPL FACE NO/EAR/LIP/EYE $451.000007831117 REP COMPLEX EYELIDS,NOSE,EARS, $1,422.000007831137 REP COMPLEX FOREH,CHEEK,CHIN,H $455.000007831100 REP COMPLEX FOREHE,CHEEK,CHN,M $474.000007831190 REP COMPLX SCALP,ARMS,AND/OR L $769.000007831191 REP COMPLX SCLP,ARM,&/OR LEG E $451.000007831230 REP LACER 2.5CM< FLR MOUTH/ANT $291.000007831294 REP LIP FT;>1/2 V HGT OR COMPL $1,742.000007831198 REP SMPL SUPRF FA,EAR,EYELID,N $530.000007831034 REP SUPERFICIAL FACE EYE EAR N $455.000007831035 REP SUPERFICIAL FACE EYE EAR N $474.000007831036 REP SUPERFICIAL FACE EYE EAR N $495.000007831031 REP SUPERFICIAL SCALP NCK TRNK $455.000007831101 REP SUPERFICIAL SCALP NCK TRNK $551.000007831032 REP SUPERFICIAL SCALP NECK TRU $474.000007831033 REP SUPERFICIAL SCALP NECK TRU $495.000007831127 REP WOUNDS/FACE, EARS, EYELIDS $516.000007831234 REPAIR LIP, FT;VERMILLION ONLY $1,842.000007831120 REPAIR NAIL BED $769.000007831224 SIMPLE BLADDER IRRIGATE,LAVAGE $519.000007831072 SIMPLE REP.WND SCALP,NECK, TRU $516.000007831165 SIMPLE REP.WND SCLP,NCK,AX,EXT $533.000007831277 SLCT WND DEBRIDEMENT 20CM OR < $237.000007831329 SMALL INTESTINE PROC, UNLISTED $2,026.000007831296 STRAPPING - UNNA BOOT $446.000007831134 STRAPPING ANKLE AND/OR FOOT AN $298.000007831043 STRAPPING SHOULDER $339.000007831249 SUTURE REMOVAL $0.000007800305 TEMPORARY TRANSCUTANEOUS PACIN $779.000007831309 THORACENTESIS, W/O IMAGING $824.000007831108 THORACOSTOMY W/ OR W/O WATER S $2,621.000007831209 THROMB,CEREBRAL BY IV INFUSION $545.000007800306 THROMBOLYSIS, CORONARY; BY INT $620.000007831321 TOOTH EXTRACTION $394.000007800296 TRANSFUSION, BLOOD OR BLOOD CO $1,222.000007831037 TREATMENT BURN W/O ANESTHESIA $307.000007831074 TX GASTRIC INTUBATE & ASPIRATE $468.000007831237 TX SPRFCL WND DEHISCENCE; SMPL $1,085.000007831276 TX SUPERFICIAL WOUND DEHISCENC $890.000007831328 UNLISTED PROC TRACHEA/BRONCHI $425.000007831308 UNLISTED SKIN, SUBQ PROCEDURE $279.000007831261 UNLISTED VASCULAR PROCEDURE $965.00


0006104394 24HR REFLUX STUDY $2,431.000000017562 ACQUIRE FNB 22G $1,086.000000017563 ACQUIRE FNB 25G $1,086.000000017561 ADVANIX DUIDENAL BEND 10 X 15 $359.000000017560 ADVANIX DUODENAL BEND 10 X 12 $359.000000017557 ADVANIX DUODENAL BEND 10 X 5 $359.000000017558 ADVANIX DUODENAL BEND 10 X 7 $359.000000017559 ADVANIX DUODENAL BEND 10 X 9 $359.000000018337 ADVANIX DUODENAL BEND 7 X 9 $359.000000018332 ADVANIX DUODENAL BEND 8.5 X 9 $359.000006104402 AGILE PATENCY CAPSULE $392.000000012411 ANOSCOPE DISP SMALL W/LIGHT $15.000007930229 ANOSCOPY W CONTROL BLEEDING $1,443.000007930228 ANOSCOPY W DILATION $2,344.000007930227 ANOSCOPY, W W/O BRUSHING $172.000000016495 BALLOON BRONCH ULTRASONIC $106.000000014689 BALLOON CATHETER EXPRESS $4,750.000000008944 BALLOON CRE 10-12 WIRE $792.000000008931 BALLOON CRE 10-12MM $723.000000008946 BALLOON CRE 12-15 WIRE $792.000000008930 BALLOON CRE 12-15MM $564.000000008940 BALLOON CRE 15-18 WIRE $792.000000008932 BALLOON CRE 15-18MM $564.000000008935 BALLOON CRE 18-19-20 $564.000000008936 BALLOON CRE 6-8 WIRE $792.000000008942 BALLOON CRE 8-10 WIRE $792.000000013125 BALLOON CRE-COLONIC 18-20 $792.000000017574 BALLOON DILAT BILIARY 10-12MM $743.000000017575 BALLOON DILAT BILIARY 12-15MM $743.000000017554 BALLOON EXTRACTOR PRO RX 12-15 $399.000000017553 BALLOON EXTRACTOR PRO RX 9-12 $399.000000017550 BALLOON HURRICAN RX DILAT 4X4 $658.000000017552 BALLOON HURRICANE RX DILA 4X10 $658.000000013183 BALLOON HURRICANE RX DILAT 4X6 $658.000000013184 BALLOON HURRICANE RX DILAT 4X8 $658.000000013143 BALLOON INFLATION SYRINGE $146.000000017710 BALLOON LINEAR EUS $1,277.000000017709 BALLOON RADIAL EUS $1,277.000000005307 BALLOON SIZING BARRX 33.7MM $825.000006104405 BANDING OF HEMORRHOID $1,430.000007930234 BARRX HALO ABLATION $6,186.000000017566 BASKET TRAPEZOID LITHO 1.5MM $725.00

This section includes standard charges for endoscopy charges at CRMCDisclaimer

0000017547 BASKET TRAPEZOID RX LITH 2.5MM $725.000007930166 BLOCK - CAROTID SINUS $1,260.000007930167 BLOCK - CELIAC PLEXUS $1,260.000007930154 BLOCK - FACIAL $265.000007930155 BLOCK - ILIOINGUINAL/HYPOGASTR $1,260.000007930156 BLOCK - INTERCOSTAL - REGIONAL $1,260.000007930157 BLOCK - INTERCOSTAL - SINGLE $1,260.000007930168 BLOCK - LUMBAR/THORACIC $1,695.000007930158 BLOCK - PARAVERTEBRAL - C/T EA $1,260.000007930159 BLOCK - PARAVERTEBRAL - SINGLE $1,260.000007930160 BLOCK - PHRENIC $1,260.000007930161 BLOCK - PUDENDAL $1,200.000007930169 BLOCK - SPHENOPALATINE GANGLIO $1,260.000007930162 BLOCK - SPINAL ACCESSORY $670.000007930170 BLOCK - STELLATE GANGLION $1,695.000007930163 BLOCK - SUPRASCAPULAR $1,260.000007930164 BLOCK - TRIGEMINAL $1,167.000007930165 BLOCK - VAGUS $1,260.000007930247 BLOOD (OR PRODUCT) ADMIN/DAILY $1,222.000007930240 BRAVO WIRELESS PH MONITORING $1,207.000007930185 BRONCH W TRANSBRONCH ASP BR BX $2,615.000007930184 BRONCH W TRANSBRONCH LUNG BX $2,615.000006104063 BRONCHOSCOPY DX W W/O WASHING $2,615.000007930183 BRONCHOSCOPY W BRONCHIAL BX $2,615.000007930181 BRONCHOSCOPY W BRUSHINGS $2,615.000007930182 BRONCHOSCOPY W LAVAGE $2,615.000000016570 BRUSH CYTOLOGY $58.000000005036 BRUSH CYTOLOGY 23MMX240CM $51.000007930235 BRUSH CYTOLOGY BIONCH 1MM $47.000000007446 BRUSH MICROBIOLOGY 1MM $28.000000005030 BRUSH PEG CLEANING $50.000000013135 BRUSH RX CYTOLOGY $378.000000017565 CANNULA CONTOUR 5-4-3 TIP $171.000000003977 CAPSULE AGILE PATENCY $146.000000014770 CAPSULE BRAVO PH $676.000000004438 CAPSULE ENDOSCOPE DELIVERY $529.000000005116 CAPSULE GIVEN M2A $1,709.000000005296 CATH ABLATION HALO 360 22MM $2,746.000000005298 CATH ABLATION HALO 360 25MM $2,746.000000005300 CATH ABLATION HALO 360 28MM $2,746.000000005304 CATH ABLATION HALO 360 31MM $2,746.000000011348 CATH RFA ENDOSCOPIC CHANNEL $2,928.000000005313 CATHETER ABLATION HALO 90 $1,726.000000011343 CATHETER RFA FOCAL ULTRA LONG $2,928.000000016744 C-CLAMP FOR PEG TUBE 20FR $30.000006104287 CHNG GASTROSTOMY TUBE W/O ENDO $580.000000015444 CLIP CHANNEL ROTO 2.8MM 230CM $528.00

0000055512 CLOTEST RAPID UREASE TEST $50.000007930218 COLON W HT BX/BIPOLAR POLYPECT $2,304.000006104022 COLONOSCOPY DX, W W/O BRUSHING $2,304.000007930248 COLONOSCOPY FECAL TRANSPLANT $3,068.000007930217 COLONOSCOPY W ABLATION POLYP $2,304.000007930220 COLONOSCOPY W BALLOON DILATION $2,304.000007930214 COLONOSCOPY W BX $2,304.000007930176 COLONOSCOPY W CONTROL OF BLEED $3,480.000007930215 COLONOSCOPY W INJECTION $2,304.000007930219 COLONOSCOPY W SNARE POLYPECT $2,304.000007930221 COLONOSCOPY W STENT $6,577.000007930204 COLONOSCOPY,STOMA W SNARE POLY $2,304.000007930203 COLONOSCOPY,STOMA W W/O BRUSH $2,304.000000201004 CONRAY 60% 50ML $36.000007930244 CONS SEDTN AGE 5/+ 10-22 MIN $405.000007930245 CONSCIOUS SEDTN EA ADDL 15 MIN $107.000007930172 CONSOLE USE ALONE $537.000000013013 CRE DILATOR WIRE 6-8 MM $704.000000013014 CRE DILATOR WIRE 8-10 MM $704.000000012615 CUFF ENDOCUFF PURPLE $113.000000017573 DELIVERY SYSTEM NAVIFLEX 10FR $280.000007930223 DILATION ANAL SPHINCTER U ANES $5,934.000007930224 DILATION RECTAL STRICTURE ANES $5,934.000006104048 EGD DX $2,217.000007930200 EGD W ABLATION TUMOR $2,217.000007930195 EGD W BALLOON DILATATION $2,217.000007930191 EGD W BAND LIGATION VARICES $2,217.000007930190 EGD W BIOPSY, BIOPSIES $2,217.000007930198 EGD W CONTROL OF BLEEDING $2,217.000007930194 EGD W DILATATION OVER GUIDE WR $2,217.000006104246 EGD W GASTROTOMY TUBE $2,217.000007930193 EGD W REMOVAL FB $2,217.000007930199 EGD W STENT PLACEMENT $6,577.000007930189 EGD W SUBMUCOSAL INJECTION $2,217.000007930196 EGD W TUMOR REMOV W HT BX/CAUT $2,217.000007930197 EGD W TUMOR REMOVAL, SNARE $2,217.000007930243 EGD W/ BOTOX INJECTION $2,217.000007930236 EGD W/ JEJUNOSTOMY TUBE PLACE $3,896.000007930242 EGD W/TISSUE ABLATION W/APC $2,454.000006104407 ENDO MEDICAL VISIT $111.000006104204 ENDO RETRO CHOLANGROPANCREATOG $3,150.000007930250 ENDOBRONCHIAL ULTRASOUND(EBUS) $7,038.000006104387 ENDOSCOPY PROCEDURE $2,445.000006104388 ENDOSCOPY RECOVERY 30 MIN $151.000006104389 ENDOSCOPY RECOVERY 60 MIN $235.000007930202 ENTEROSCOPY,INC ILEUM W W/O BX $2,454.000007930186 ESOPHAGOSCOPY DX, W W/O BRUSH $2,217.00

0007930177 ESOPHAGOSCOPY W CONTROL BLEED $3,480.000007930246 ESOPHAGUS IMPEDANCE FUNCT TEST $1,361.000007930187 ESOPHGOSCOPY, W REMOVAL FB $2,217.000006104393 ESPHOGEAL MOTILITY $2,431.000007930226 EXC EXT HEMORRHOID TAGS $5,934.000007930239 FLEX SIGMOIDOSCOPY W/ REMOV FB $2,344.000000056854 FORCEP BIOPSY JUMBO 240CM $155.000000013130 FORCEP BRONCH 1.8 CUP $214.000000013159 FORCEP BX RADIAL JAW 4 240CM $56.000000013128 FORCEP HOT BIOPSY $98.000000005115 FORCEP MULTI BITE $208.000000012895 FORCEPS BIOPSY ENDOJAW 2.8MM $36.000000015378 FORCEPS BIOPSY ENDOJAW 2MM $75.000000016651 FORCEPS GRASPING RAT TOOTH $217.000007930233 GASTRO TUBE INSERT,PERCUT W FL $2,217.000000071453 GUARDUS OVERTUBE 25CM $529.000000017564 GUIDEWIRE NOVAGOLD .018, 480CM $481.000000005308 HALO CAP SMALL $137.000000005312 HALO GUIDEWIRE $447.000007930225 HEMORRHOID, SIMPLE LIGATURE $1,502.000007930232 HEMORRHOIDOPEXY, STAPLING $7,938.000000018125 HEMOSPRAY 7FR 2.8MM 220CM $2,930.000000114657 INFUSION SET SAFETY 20G X 1.5" $33.000000016353 INJECTORSX 2MM SINGLE USE $108.000003302390 JAGWIRE REVOLUTION ANG 025/260 $468.000003302389 JAGWIRE REVOLUTION STR 025/260 $468.000000200988 KIT GASTRIC LAVAGE 34FR $230.000000012598 KIT PULL PEG SAFETY 20FR $333.000000012599 KIT PULL PEG SAFETY 24FR $333.000007930179 LARYNGOSCOPY FLEXIBLE DX $470.000007930178 LARYNGOSCOPY, DIRECT, W BIOPSY $5,989.000007930231 LIGATION INT HEMORRHOID, MULTI $3,126.000007930230 LIGATION INT HEMORRHOID,SINGLE $3,126.000006104396 M2A VIDEO CAPSULE STUDY $2,106.000007930249 MINOR PROCEDURE CHARGE $0.000000018081 NAVIPRO WIRE 0.25 260CM $349.000000016568 NEEDLE ASPIRATION 19GA $731.000000018122 NEEDLE ASPIRATION 19GA $561.000000016567 NEEDLE ASPIRATION 21GA $641.000000016569 NEEDLE ASPIRATION 22GA $641.000000017701 NEEDLE ASPIRATION EUS 19GA $2,000.000000017702 NEEDLE ASPIRATION EUS 22GA $2,000.000000017556 NEEDLE KNIFE RX $513.000000013132 NEEDLE SCLERO 25G 230CM $170.000000013816 NEEDLE TRANSBRONCHIAL 21G $153.000007930175 OMNIPAQUE 350 30CC $123.000000007350 OVERTUBE ENTRADA OVERTUBE 40CM $479.00

0000103960 PAD ELECTROSURGICAL W/CORD SPL $18.000000013164 PEG KIT 20F SAFETY $397.000000013171 PEG KIT 24F SAFETY $397.000000014816 PEG TUBE DUOPA 15 FR 35MM $412.000006104404 PEG TUBE REMOVAL $111.000000013177 PEG TUBE REPL 20F $183.000000013178 PEG TUBE REPL 22FR $183.000000013180 PEG TUBE REPL. 24FR $183.000000077144 POLYLOOP OLYMPUS DISP $312.000000063254 POLYP TRAP $50.000000013192 PROBE APC CIRCUMFERENTIAL 2.3 $750.000000008344 PROBE ERBELIFT FLEXIBLE 1.3MM $245.000000013010 PROBE FIAPC 2.3 SIDE FIRE $750.000000015624 PROBE FIAPC 2.3 STRAIGHT FIRE $588.000000013144 PROBE GOLD 7F $617.000000013101 PROBE GOLD INJECTION $845.000000013032 PROBE PH COMFORTEC 2CH $279.000007930206 PROCTOSIGMOID W SNARE POLYPECT $2,344.000007930205 PROCTOSIGMOID, W W/O BRUSH $1,443.000007930174 PUMP REFILL $478.000000017569 PUSHER PANCREATIC STENT 5FR $183.000000008857 RAPTOR GRASPING DEVICE 2.4MM $376.000007930222 REDUCT RECTAL PROLAP U ANESTH $1,502.000000056898 RESOLUTION CLIP DEVICE $619.000000077881 RETRIEVAL BASKET ROTATABLE $339.000000033193 RETRIEVAL DEVICE ROTH NET $339.000000006476 RETRIEVAL TWISTER POLYP 25MM $339.000000077882 ROTATABLE FOOD BOLUS $339.000000005005 ROTH FOREIGN BODY NET 230CM $351.000000033179 ROTH NET FOOD BOLUS 160CM $405.000000013152 RX LOCKING DEVICE/CAP OLYMPUS $48.000000017546 RX SPHINCTERTOME DREAMTOME 44 $1,108.000000017548 RX SPHINCTGERTOME JAGTOME 39 $832.000000016571 SHEATH GUIDE KIT 105CM $350.000007930209 SIGMOID W HT BX, BIPOLAR POLY $2,344.000007930210 SIGMOID W SUBMUCOSAL INJECTION $1,443.000007930212 SIGMOID W/ ABLATION $2,344.000007930241 SIGMOID W/HALO FOR CNTRL BLEED $3,480.000006104089 SIGMOIDOSCOPY DX W W/O BRUSH $1,443.000007930208 SIGMOIDOSCOPY W BIOPSY $1,443.000007930211 SIGMOIDOSCOPY W SNARE POLYPECT $2,344.000006104406 SIGMOIDOSCOPY W/ BLEED CONTROL $2,303.000000016406 SNARE CAPTIVATOR 15MM STIFF $39.200000062359 SNARE DUCK BILL 25MM $108.000000013064 SNARE DUCKBILL-15 $108.000000006798 SNARE EXACTO COLD 9MM $88.000000013067 SNARE HEX 13MM $79.00

0000013107 SNARE HEX 27MM $79.000000013140 SNARE OVAL 11MM $79.000000013121 SNARE OVAL 13MM $79.000000013129 SNARE OVAL 27MM $79.000000015443 SNARE ROUND 10MM STIFF $39.000000018124 SNARE ROUND 10MM STIFF $64.000000016352 SNARE SNAREMASTER 25CM $87.000000012898 SNARE SOFT SNAREMASTER 15MM $40.000000044230 SNARE SPIRAL WIRE 20MM DISP $120.000000093315 SNARE SYSTEM HEXAGONAL 25G $401.000000008938 SNARE, ROTATABLE 13MM $93.000000061384 SNARE, ROTATABLE 20MM $93.000000013058 SPEEDBAND BANDERS $529.000000017571 STENT ADVANIX BILIARY DP 10X3 $188.000000017572 STENT ADVANIX BILIARY DP 10X5 $188.000003302499 STENT BILIARY 10MMX60MM PLAT 8 $3,357.000000018000 STENT BILIARY 30FR X 6CM METAL $4,984.000000017568 STENT PANCREATIC LEAD BARB 5X3 $268.000000000454 STENT ULTRAFLEX 18MMX23MMX12CM $3,779.000000093311 SUCTION DEVICE DIRECT BIOVAC $405.000000008342 SYRINGE ERBELIFT CONTROL 10ML $38.000000013202 SYRINGE SPOT MARKER 5CC $98.000000017555 SYRINGE STERIFLATE 60CC $143.000000018338 TIP RX ERCP CANNULA TAPER $248.000000055657 TUBE FEEDING JEJUNAL 12F $380.000000055654 TUBE FEEDING JEJUNAL 9F $416.000000005029 TUBE FEEDING Y-PORT 20FR $39.000000014817 TUBE JEJUN DUOPA 9FR 120CM $290.000000071493 TUBE MINNESOTA 18FR 4 LUMEN $1,204.000000009792 TUBE REACH OVERTUBE 80CM $1,012.000000007239 TUBE REPL 20F RIGHT ANGLE $119.000000018339 TUBE REPL 24F RIGHT ANGLE $119.000000017549 WIRE DREAMWIRE .035, 260CM $469.000000017551 WIRE JAGWIRE .025, 260CM $340.00


0002231458 ARTERIAL PUNCTURE-RADIAL $166.000003693020 A PULMONARY STRESS TEST/SIMPLE $240.000003693026 ABG W/ ELECTROLYTES (ADULT) $451.000003693016 ABG/IICA $451.000003693017 ABG/LACTATE $451.000004010022 AQUATIC THERAPEUTIC EX (15MIN) $135.000004497671 ASSESSMENT OF APHASIA $297.000003630048 BEDSIDE SPIROMETRY (A) $401.000003631025 BEDSIDE SPIROMETRY (P) $401.000003630027 BRONCHIAL PROVOCATION STUDY (A $1,119.000003693033 CAPILLARY GAS $451.000003630057 CARBON MONOXIDE (CARBOXYHGB) Q $114.000004005184 CMC THUMB BRACE $80.000004002648 COBAN (PER ROLL) $10.000004006261 COGNITIVE THER INTERV (15 MIN) $109.000004006259 COGNITIVE THER INTERVEN(VISIT) $433.000004006029 COMMUNITY/WORK RE-ENTRY $114.000004006030 COMMUNITY/WORK RE-ENTRY $107.000004010018 COMPRESSION PUMP (VISIT) $133.000003631016 CONT.BROCHODILATOR DELIVERY IN $204.000003630101 CONT.BRONCHODILATOR DELIVERY D $1,386.000003631031 CONTINUOUS AEROSOL SYS. INIT $204.000003631032 CONTINUOUS AEROSOL SYS. SUB $204.000004006046 CONTRAST BATHS $114.000003693036 CORD BLOOD GASES, ARTERIAL $451.000003693035 CORD BLOOD GASES, VENOUS $451.000003693027 CORD PH $176.000003691755 CPR (A) $1,109.000003631002 CPR (P) $1,109.000004002655 CYLINDRICAL FOAM (PER INCH) $3.000004006096 DEBRIDEMENT SELECTIVE W/O ANES $459.000004006097 DEBRIDEMENT SELECTIVE W/O ANES $4,237.000003630066 DIFFUSION STUDY $393.000003631028 DIFFUSION STUDY (P) $393.000004002649 DIGIT EXTENSION SPLINT $49.000004006055 ELECTRICAL STIM - UNATTENDED $83.000004006194 ELECTRICAL STIM-CONSTANT (15M) $87.00

This section includes standard charges for CRMC Health Care's full range of inpatient therapy services including physical therapy, occupational therapy, speech therapy, children's therapy, aquatic therapy, pediatric inpatient rehabilitation, pelvic pain, neurological rehabilitation, and other specialized therapies.

Disclaimer

0003693003 EMERGENT BIPAP INITIAL (A) $848.000003631041 EMERGENT BIPAP INITIAL (P) $848.000003693005 EMERGENT BIPAP SUBSEQUENT (A) $848.000003693002 EMERGENT CPAP INITIAL (A) $848.000003631040 EMERGENT CPAP INITIAL (P) $848.000003693004 EMERGENT CPAP SUBSEQUENT (A) $848.000003630067 END TIDAL CO2 MONITORING SYS.S $453.000003631001 ENDOTRACHEAL INTUBATE OR ASSIS $958.000003630084 ENDOTRACHEAL INTUBATION OR ASS $958.000004497746 EVAL SPEECH GENERAT DEVICE EA. $186.000004497701 EVAL SPEECH GENERATING DEVICE $371.000004497712 EVAL TO PRESCRIBE VOICE PROSTH $494.000004497719 EVAL, BEDSIDE SWALLOW $312.000004497720 EVAL, VIDEO SWALLOW $444.000003693006 EXP.PRES.VALVE THERAPY INITIAL $294.000003693007 EXP.PRES.VALVE THERAPY SUBSEQU $198.000004497750 FAMILY CONF. - ST (PER 15 MIN) $75.000004005146 FLUIDOTHERAPY $83.000004006064 FUNCTIONAL CAPACITY EVAL $139.000004006095 GAIT BELT $30.000003693032 GLUCOSE $50.000004006045 GROUP THERAPY $107.000004497129 GROUP THERAPY $219.000004006017 HAND GONIOMETRIC MEASUREMENTS $91.000003691391 HYPERTONIC SPUTUM INDUCTION (A $294.000003631015 HYPERTONIC SPUTUM INDUCTION (P $294.000003692008 IICA $230.000004497087 INDIVIDUAL TREATMENT $212.000003693031 IONIZED CALCIUM $50.000004005025 IONTOPHORESIS $176.000004006083 JOB SITE EVALUATION $107.000003693030 LACTATE $50.000003693130 LACTATE-VENOUS $50.000003630050 LUNG VOLUMES $530.000003631026 LUNG VOLUMES (P) $530.000004006060 MANUAL THERAPY $108.000004006146 MANUAL THERAPY $108.000003630006 MDI INSTRUCTION INITIAL (A) $204.000003631010 MDI INSTRUCTION INITIAL (P) $204.000003692021 MDI TREATMENT SUBSEQUENT (A) $294.000003631011 MDI TREATMENT SUBSEQUENT (P) $294.000003693011 MDI TX.W/MECH.VENTILATION INIT $294.000003693012 MDI TX.W/MECH.VENTILATION SUBS $294.000003630041 MECHANICAL VENTILATION INITIAL $1,207.000003631044 MECHANICAL VENTILATION INITIAL $1,207.000003691805 MECHANICAL VENTILATION SUBSEQU $1,094.000003630055 MIP/MEP $215.00

0003631027 MIP/MEP (P) $215.000004006025 NEUROMUSCULAR RE-ED $114.000004006028 NEUROMUSCULAR RE-ED $114.000003630065 NON-EMERGENT BIPAP INITIAL (A) $848.000003691811 NON-EMERGENT BIPAP SUBSEQUENT $848.000003630094 NON-EMERGENT CPAP INITIAL (A) $848.000003630095 NON-EMERGENT CPAP SUBSEQUENT ( $848.000004006067 O.T. EVALUATION $407.000004006068 O.T. EVALUATION $283.000004497751 OP COGNITIVE TEST PER HOUR $297.000004006152 ORTHO/PROSTHET TRAIN (15 MIN) $125.000004006263 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000004006074 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000004006077 ORTHOTIC INITIAL TRAIN(15 MIN) $1190004006151 ORTHOTIC MANAGEMENT/TRAINING $119.000004006256 OT EVALUATION - HIGH $502.000004006254 OT EVALUATION - LOW $298.000004006255 OT EVALUATION - MODERATE $386.000004006182 OT MMT HAND MUSCLE TEST MANUAL $91.000004006183 OT MMT LIMB/TRUNK MUSCLE TEST $101.000004006180 OT MMT TOTAL BODY W/HAND $168.000004006181 OT MMT TOTAL BODY W/O HAND $142.000004006257 OT RE-EVALUATION $166.000004006184 OT ROM MEASUREMENT W/HAND $91.000004006185 OT ROM MEASUREMENT W/O HAND $74.000004003783 OT SCHOOL MILEAGE (#MILES TO) $0.540004003780 OT SCHOOL MILEAGE(#MILES FROM) $0.540004003789 OT SCHOOL-SCR-2 ADM TIME(15MIN $12.000004003787 OT SCHOOL-SCR-2 EVAL (15 MIN) $18.000004003788 OT SCHOOL-SCR-2 TRMNT(15 MIN) $16.250003630010 OXIMETRY STUDY-NOCTURNAL/DAILY $243.000003691615 OXYGEN DAILY (A) $603.000003631033 OXYGEN DAILY (P) $603.000003630034 OXYGEN USE/OTHER DEPARTMENTS $108.000003631034 OXYHOOD INITIAL (P) $179.000004005138 PARAFFIN BATH $102.000003691870 PEAK FLOW (A) $401.000003630014 PENTAMIDINE TX $302.000003691367 PERCUS./VIBRAT&POST.DRG=<3 POS $198.000003692019 PERCUS./VIBRAT&POST.DRG=<3 POS $198.000003693038 PH CAPILLARY $176.000004006189 PHYSICAL CAPACITY PROFILE-COMP $140.000004006086 PHYSICAL PERFORMANCE TEST $139.000003630019 POINT OF CARE BLOOD GAS ANALYS $451.000003693029 POTASIUM $50.000003693013 PRE/POST SPIROMETRY (A) $247.000003631047 PRE/POST SPIROMETRY (P) $247.00

0004002653 PROFLEX SPLINT $36.000004006053 PROSTHET INITIAL TRAIN(15 MIN) $125.000003691409 PULSE OX DAILY (A) $243.000003631022 PULSE OX DAILY (P) $243.000003630007 PULSE OX DISCHARGE O2 DESAT.ST $230.000003692007 R HEART-OXYGEN SAT STUDY $226.000004002654 RESTING HAND SPLINT - PREFAB $74.000004005186 REVERSE KNUCKLE BENDER SPLINT $52.000004002651 ROBBY SPLINT $35.000004006021 SELFCARE/HOME MANAGEMENT $101.000004006022 SELFCARE/HOME MANAGEMENT $101.000004006145 SENSORY INTEGRATIVE TECHNIQUE $107.000003631006 SM.VOL.NEBULIZER TX INITIAL(P) $294.000003631007 SM.VOL.NEBULIZER TX SUBSEQUENT $294.000003691292 SM.VOL.NEBULIZER TX.INITIAL (A $294.000003692024 SM.VOL.NEBULIZER TX.SUBSEQUENT $294.000003693015 SMOKING COUNSELING >10 MIN (A) $63.000003693014 SMOKING COUNSELING 3-10 MIN (A $49.000003693028 SODIUM $50.000004010019 SPLINT MATERIAL $59.000004005185 SPRING FINGER EXTENSION $40.000004497777 ST EVAL OF FLUENCY $312.000004497779 ST EVAL OF SPEECH LANGUAGE $312.000004497778 ST EVAL OF SPEECH PRODUCTION $312.000004497780 ST EVAL OF VOICE $312.000003631046 SURFACTANT ADMINISTRATION (P) $294.000004497241 SWALLOW TREATMENT $212.000004002652 TENNIS ELBOW SPLINT $20.000004006082 TENS/NMES $252.000004006018 THERAPEUTIC ACTIVITIES $121.000004006019 THERAPEUTIC ACTIVITIES $121.000004006071 THERAPEUTIC EXERCISE $120.000004006073 THERAPEUTIC EXERCISE $120.000004002341 THERATUBING (PER FOOT) $5.000004002069 THEROPLAST (4 OZ. CONTAINER) $5.000003692031 TRACHEOSTOMY TUBE CHANGE (A) $688.000004497705 TRAINING SPEECH GENERATING DEV $289.000004497695 TRAINING USE VOICE PROSTHETIC $219.000004005187 ULTRASOUND (15 MIN) $87.000004010017 ULTRASOUND WITH ELEC. STIM (15 $87.000003693034 VENOUS BLOOD GAS $451.000004006037 WHEEL CHAIR TRAINING $107.000004006038 WHEEL CHAIR TRAINING $107.000004005180 WHIRLPOOL $83.000004006094 WORK CONDITIONING-ADDITIONAL 1 $143.000004006093 WORK CONDITIONING-INITIAL 2 HR $428.00


0007940009 OP IV INFUSION THERAPY 1ST HR $533.000007940086 COMPL BIO AGENT IV INF 16-60 $787.000007940087 COMPL BIO AGENT IV INF ADDL HR $135.000007940064 INITIAL IMMUNIZATION-HEP B $60.000007940053 INITIAL IMMUNIZATION-INFLUENZA $51.000007940066 INITIAL IMMUNIZATION-OTHER $60.000007940068 INITIAL IMMUNIZATION-PNEUMONIA $60.000007940080 IV INFUSION THERAPY ADD'L SEQ $533.000007940011 OP BLOOD/PRODUCT ADMIN/DAILY $1,222.000007940033 OP COLL BLOOD BY VEINPUNCT $21.000007940035 OP COLLECT BLOOD VIA VAD $71.000007940036 OP COLLECT OF BLODD VIA PICC $160.000007940032 OP IRRIG.IMPLANT VENOUS ACCESS $107.000007940028 OP IV INFUS HYDRATION 1ST HR $533.000007940029 OP IV INFUSION HYDRATE EA ADD $114.000007940010 OP IV INFUSION THERAPY EA ADDL $114.000007940037 OP IV PUSH, EA ADDL NEW DRUG $228.000007940061 OP IV PUSH, EA ADDL, SAME DRUG $107.000007940013 OP MEDICATION INJECT IM/SUBQ $75.000007940014 OP MEDICATION INJECT IV PUSH $212.000007940065 SUBSEQ IMMUNIZATION-HEP B $60.000007940067 SUBSEQ IMMUNIZATION-OTHER $60.00

Disclaimer

This section includes standard charges for infusion procedures provided in outpatient by CRMC Health Care.

CHARGE CODE CHARGE DESCRIPTONMASTER FEE

0002220933 *ALPHA FETOPROTEIN-MU $191.000002254123 100-300 INTERPHASE-AML FISH PA $180.000002220386 11-DEOXYCORTISOL, QUANT $143.000002231332 14.3.3 ETA PROTEIN Q $160.000002231371 17 KETO (17-KETOST 24H Q) $85.000002231340 17-HYDROXYPREGNENOLONE $103.000002224908 5-FLUOROCYTOSINE(5-FC) $271.000002255245 5FU TOXICITY (5-FLUOROURACIL) $609.000002231375 5-HIAA URINE RANDOM $125.000002231285 A-1-ANTITRYPSIN RAND FECES Q $117.000002263678 ABID, ENZYME (MVRBC) $69.000002230112 ABL MUTATION, CML Q $598.000002263578 ABO (MVRBC) $54.000002247136 ACE, CSF $74.000002233443 ACETAMINOPHEN SERUM $114.000002238012 ACETONE URINE $27.000002250213 ACHR BIND (ACHR PROF) $86.000002226256 ACHR BINDING AB $147.000002223933 ACHR BLOCK (ACHR PROF) $74.000002226260 ACHR BLOCKING AB $147.000002223947 ACHR MOD (ACHR PROF) $74.000002264089 ACHR MODULATING AB $147.000002267734 ACID HGB ELECT (HGB CASCADE) $57.000002223954 ACID PHOS - * $78.000002223975 ACID PHOS PROSTATIC - * $96.000002225019 ACTH-PLASMA $446.000002223155 ACTIVATED PROTEIN C RESISTANCE $263.000002262556 ACYLCARNITINE QT PROF, PLASMA $277.000002262701 ACYLGLYCINES, QUANT, URINE $346.000002263345 ADAMTS13 ACTIVITY $305.000002230201 ADDL ALLRG (AL FOOD REFX Q) $11.000002242178 ADENOSINE DEAMINASE PLEURL FLD $224.000002261423 ADENOVIRUS DNA, QUAL PCR $129.000002252005 ADENOVIRUS GROUP $107.000002231417 ADENOVIRUS QUAL PCR Q $400.000002221289 ADENOVIRUS, QT PCR $390.000002225050 ADH (ANTIDIURETICHORM.) $306.00

This section includes standard charges for laboratory-related services provided at CRMC Health Care. Hospital laboratory charges do not include services provided by the pathologist for interpretation of the specimen. Often, a pathologist service may involve a biopsy or tissue analysis. Physicians will bill separately for their professional service.

Disclaimer

0002234037 AFB CULTURE $143.000002227178 AFB ID BY MALDI $204.000002224345 AFB ISOLATION-REF $277.000002234011 AFB SCREEN $56.000002234015 AFB SLIDE - REFERENCE $56.000002234021 AFB STAIN ONLY $56.000002224367 AFB SUSCEPTABILITY-REF $150.000002236156 AFB-KINYOUN'S STAIN $83.000002231242 AFP & AFP-L3 $142.000002254445 AFP QUAD SCREEN $291.000002262801 AFP WITH AFP L3% $267.000002268778 AFP, PERITONEAL FLUID-MAYO $271.000002263989 AG SCR PT PLAS ADDL (MVRBC) $48.000002263789 AG SCR PT PLASMA 1ST (MVRBC) $48.000002220267 AG TYPE EA UNIT(MV AG RARA-FDA $128.000002220278 AG TYPE PT (MV AG RARE-FDA) $128.000002238053 AGGLUTINATIONS COLD $74.000002264545 A-GLOB HBA1&2 DEL (HGB CASADE) $595.000002231273 AL ADDL (AL TREE NUT PAN Q) $30.000002231250 AL BARLEY IGE Q $57.000002231260 AL BARLEY IGG Q $121.000002231257 AL CHICKEN MEAT IGE Q $57.000002231258 AL COCOA IGE Q $57.000002231263 AL CODFISH IGG Q $121.000002231272 AL FIRST (AL TREE NUT PAN Q) $30.000002231268 AL LETTUCE IGG Q $121.000002231259 AL MAIZE/CORN IGE Q $57.000002231267 AL MALT IGG Q $121.000002231251 AL OAT IGE Q $57.000002231261 AL OAT OGG Q $121.000002231254 AL ORANGE IGE Q $57.000002230876 AL PAPRIKA-SWEET PEPPER $57.000002231262 AL PEANUT IGG Q $121.000002231253 AL PORK IGE Q $57.000002231265 AL PORK IGG Q $121.000002231255 AL POTATO IGE Q $57.000002231266 AL RYE IGG Q $121.000002231342 AL STRAWBERRY Q $57.000002231252 AL TOMATO IGE Q $57.000002231256 AL YEAST IGE Q $57.000002231269 AL YEAST IGG Q $121.000002231357 ALB CSF (IGG SYNTH CSF Q) $27.000002231356 ALB S (IGG SYNTH CSF Q) $22.000002240109 ALBUMIN $54.000002222445 ALBUMIN (A G RATIO) $54.000002240111 ALBUMIN, BODY FLUID $57.000002257467 ALBUMIN, CSF (CSF PROT AN) $45.00

0002257456 ALBUMIN, SERUM (CSF PROT AN) $44.000002256189 ALCIAN BLUE STAIN $109.000002231769 ALCOHOL ETHYL-URINE $79.000002200002 ALCOHOL, BREATH CONFIRMATION $35.000002231736 ALCOHOL-ETHYL-BLOOD $114.000002226405 ALDOLASE $132.000002231329 ALDOST (ALDOST/RENIN Q) $71.000002221901 ALDOSTERONE (ALDO-RENIN) $129.000002225035 ALDOSTERONE-SERUM $103.000002225704 ALDOSTERONE-URINE $165.000002267745 ALK HGB ELECT (HGB CASCADE) $48.000002231229 ALK IHC (CARIS ALK/PD1 PROF) $175.000002264478 ALK REARRANGEMENT, FISH $510.000002240257 ALKALINE PHOSPHATASE $54.000002239103 ALKALINE PHOSPHATASE (ALK P IS $79.000002239114 ALKALINE PHOSPHATASE ISOENZYME $79.000002231168 ALL. 1ST (AL PAN 15 Q) $24.000002231169 ALL. ADDL (AL PAN 15 Q) $24.000002267445 ALLERG IGE,ADDL HYPERSEN PNEUM $10.000002230685 ALLERGEN (EGG COMP Q) $36.000002231011 ALLERGEN (IGG4 FOOD PAN VI Q) $26.000002230715 ALLERGEN (MILK COMP Q) $29.000002230746 ALLERGEN (PEANUT COMP Q) $32.000002229656 ALLERGEN 1ST (IGG4 FOOD Q) $68.000002265723 ALLERGEN 1ST (RAST COMP FOOD) $25.000002228901 ALLERGEN 1ST (RAST MOLDS) $17.000002230757 ALLERGEN ADD (PEANUT COMP Q) $32.000002231023 ALLERGEN ADD(IGG4 FOOD PAN VI $26.000002230696 ALLERGEN ADDL (EGG COMP Q) $36.000002229667 ALLERGEN ADDL (IGG4 FOOD Q) $68.000002230724 ALLERGEN ADDL (MILK COMP Q) $29.000002228912 ALLERGEN ADDL (RAST MOLDS) $17.000002265734 ALLERGEN EA ADDL(RAST COMP FOO $25.000002267434 ALLERGEN IGE(HYPERSENS PNEUM) $10.000002268189 ALLERGEN IGG4 ADDL COMP FOOD $13.000002268178 ALLERGEN IGG4-COMP FOOD IGG4 $13.000002220045 ALLERGEN SP IGE (HYPERSENS PNE $10.000002260367 ALLERGEN SPEC IGE(RAST NUT MIX $25.000002257256 ALLERGEN SPEC IGE,1ST(RASTFOOD $25.000002257301 ALLERGEN SPEC IGE,1ST(RASTPEDI $20.000002260378 ALLERGEN SPEC IGE,ADDL(RAST NU $25.000002257267 ALLERGEN SPEC IGE,ADDL(RASTFOO $25.000002257312 ALLERGEN SPEC IGE,ADDL(RASTPED $20.000002229012 ALLERGEN, 1ST (RAST COMP2) $13.000002229023 ALLERGEN, ADDL (RAST COMP 2) $13.000002265445 ALLERGEN, ADD-ONE $48.000002253234 ALLERGEN, APPLE $48.00

0002269734 ALLERGEN, CASHEW $54.000002261278 ALLERGEN, CRAB $48.000002253223 ALLERGEN, ORANGE $48.000002228556 ALLERGEN, REGION 8 $17.000002228578 ALLERGEN, REGION 8, ADDL $17.000002261289 ALLERGEN, SHRIMP $48.000002261301 ALLERGEN, STRAWBERRY $48.000002265434 ALLERGEN, WALNUT $40.000002252038 ALLERGEN,BROCCOLI $48.000002263967 ALLOGENIC ADSORPT ADDL (MVRBC) $147.000002263656 ALLOGENIC ADSORPTION 1ST(MVRBC $147.000002231410 ALLRGN IGG (HYPERSENS PNL Q) $21.000002231411 ALLRGN IGGADD(HYPERSENS PNL Q) $21.000002269067 ALMOND ALLRGN, IMMUNOCAP $65.000002225791 ALPHA 1 ANTITRYP, FECES $195.000002221205 ALPHA FETOPROTEIN- TUMOR MARK $163.000002221183 ALPHA FETOPROTEIN, MATERNAL $163.000002263312 ALPHA GALACTOSIDASE, SERUM $578.000002223501 ALPHA GLOB HBA1&HBA2 DEL/DUP $690.000002257201 ALPHA SUBUNIT-PIT.GLYCOP.HORMO $359.000002261701 ALPHA-1-ACID GLYCOPROTEIN $160.000002251527 ALPHA1-ANTITRYPSIN PHENOTYPING $92.000002225068 ALPHA1-ANTITRYPSIN TOTAL $62.000002223512 ALPHA-GAL, IGE $132.000002226756 ALPHA-GALACTOSIDASE,LEUKOCYTES $455.000002247282 ALPHA-GLUCOSIDASE, FIBROBLASTS $353.000002225889 ALPHA-L-IDURONIDASE, BLOOD $464.000002231422 ALRGN 1ST (ALPH GAL P Q) $39.000002231423 ALRGN ADDL (ALPHA GAL P Q) $39.000002251807 ALS-ACID LABILE SUBUNIT $135.000002227901 ALT (LIVR FIBR HCV) $51.000002224671 ALT (NASH FIBRO) $42.000002231132 ALT SGPT $54.000002227882 ALUMINUM LEVEL $340.000002226603 AMIKACIN, PEAK $108.000002268734 AMIKACIN, TROUGH $121.000002231404 AMINO ACID PLASMA $173.000002255978 AMINO ACID,RAN U,QNT(U AM AC R $470.000002226850 AMINO ACID-PLASMA-QUANTITATIVE $1,007.000002225803 AMINOLEVULINIC ACID $146.000002231241 AMIODARONE $129.000002228088 AMIODARONE (CORDORONE) $176.000002226736 AMITRIPTYLINE-NOR. $135.000002231264 AMMONIA PLASMA $114.000002228812 AMPA-R AB IF TITER CSF $174.000002226056 AMPHET 1/2 (URDRUGCOMP) $53.000002225057 AMPHET U (AMPHET CONF QT, U) $52.00

0002267845 AMPHETAM CONFIRMATION, URINE $116.000002231415 AMPHETAMINE W CONF Q $120.000002231333 AMPHETAMINES CONF-MEC Q $175.000002225210 AMPHETAMINES, CONFIRM, BLD $143.000002228778 AMPHIPHYSIN WBLOT CSF $368.000002231058 AMYLASE BLOOD $60.000002240423 AMYLASE BODY FLUID $59.000002225696 AMYLASE FRACTIONATION $82.000002231278 AMYLASE PERITONEAL FL Q $119.000002252812 AMYLASE SERUM, REF $82.000002232374 AMYLASE, URINE RANDOM/TIMED $93.000002235401 ANA - * $87.000002261912 ANA (ANA COMP BF) $44.000002258656 ANA (ANA COMP) $45.000002230690 ANA (SLE B) $54.000002259678 ANA BY FLUORESCENCE $51.000002261867 ANA COMP, BODY FLUID $0.000002261923 ANA TIER (ANA COMP BF) $20.000002231210 ANABOLIC STEROID SCR Q $208.000002229523 ANCA SCREEN FIRST(ANCA PAN Q) $46.000002229534 ANCA SCREEN FIRST(ANCA PANELQ $46.000002224167 ANCA TITER, RFX (IBD PROF) $125.000002224700 ANDROSTENDEDIONE $345.000002227031 ANGIOTENSIN 1 CONVERTING ENZYM $198.000002222667 ANIT-IGA ANTIBODY $299.000002222267 ANNA TITER, IGG $147.000002229060 ANTI DNASE-B-TITER $109.000002261312 ANTIADRENAL ABS, QUANT $81.000002234291 ANTIBIOTIC SENS W/MIC MIC B $63.000002234292 ANTIBIOTIC SENS W/MIC MIC B AD $63.000002234268 ANTIBIOTIC SENS W/MIC MIC U $63.000002234269 ANTIBIOTIC SENS W/MIC MIC U AD $63.000002237088 ANTIBODY ELUTION $166.000002263745 ANTIBODY ELUTION (MVRBC) $206.000002263612 ANTIBODY ID 1ST (MVRBC) $163.000002263934 ANTIBODY ID ADDL (MVRBC) $163.000002237014 ANTIBODY INDENTIFICATION $158.000002263923 ANTIBODY SCR ADDL (MVRBC) $133.000002263601 ANTIBODY SCREEN 1ST (MVRBC) $133.000002237246 ANTIBODY SCREEN-RBC $60.000002263623 ANTIBODY TITER 1ST (MVRBC) $154.000002248725 ANTIBODY TITER, B&B $103.000002263945 ANTIBODYTITER ADDL (MVRBC) $154.000002224222 ANTI-CARDIOLIPIN IGA $122.000002246757 ANTI-CARDIOLIPIN IGA(ANTICRDIO $82.000002246746 ANTI-CARDIOLIPIN IGG(ANTICRDIO $82.000002246768 ANTI-CARDIOLIPIN IGM(ANTICRDIO $82.00

0002226067 ANTIDEP CLS 3-5 (URDRUGCOMP) $53.000002226089 ANTIDEP NOS (URDRUGCOMP) $53.000002254412 ANTI-DNA DS (ANA COMP) $40.000002226140 ANTI-DNA-DOUBLE STRAND $142.000002226264 ANTI-DNA-SINGLE STRAND $147.000002226298 ANTI-GBM, FIRST AB $108.000002255534 ANTI-GBM, QUAL, MULTI-STEP $103.000002237162 ANTIGEN SCREEN/UNIT ANTIGLOB $107.000002264801 ANTIGEN TEST, REFLEXED BY REF $110.000002264834 ANTI-GLIADDIN IGG $67.000002227431 ANTI-GLIADIN ABS,(CELIAC PROF) $70.000002227420 ANTI-GLIADIN ABS,IGA (CELIAC P $70.000002253923 ANTIGLIADIN IGA (CELIAC SCR) $77.000002221752 ANTI-GLIADIN, IGA $67.000002221773 ANTI-GLIADIN, IGG $67.000002242590 ANTIHISTONE ANTIBODIES $189.000002264989 ANTI-JO 1 (MYOSITIS AB 2) $91.000002228955 ANTI-JO-1 $196.000002226173 ANTI-MITOCHONDRIAL ANTIBODY $143.000002262056 ANTI-MULLERIAN HORMONE $199.000002230412 ANTIMYELOPEROXIDASE (MPO) ABS- $268.000002228016 ANTIPANCREATIC ISLET CELLS $217.000002230423 ANTIPROTEINASE 3 (PR3) ABS-ANC $268.000002235380 ANTI-SCL-70 $180.000002235356 ANTI-SM/RNP ANTIBODY, IGG $198.000002229052 ANTI-SMOOTH MUSCLE $208.000002267534 ANTI-SMOOTH MUSCLE TITER $132.000002241856 ANTI-SSA(RO)(SJOGRENS) $40.000002241867 ANTI-SSB(LA)(SJOGRENS) $40.000002253345 ANTI-STRIATED MUSCLE ANTIBODY $189.000002226132 ANTI-THYROID MICROSOMAL ANTIBO $119.000002262656 ANTI-XA RFLX (LUPUSANTI STAT) $132.000002229134 APL PANEL, FISH $980.000002222300 APOLIOPOROTEIN A $147.000002230957 APOLIPO (LIPID INFLAM Q) $62.000002224578 APOLIPO (NASH FIBRO) $122.000002222321 APOLIPOPROTEIN B $87.000002266923 APOLIPOPROTEIN E, 2 MUTATIONS $218.000002225823 AQUAPORIN-4 IGG AB CSF W RFX $555.000002225834 AQUAPORIN-4 IGG B CSF TITER $308.000002261267 AQUAPORIN-4 RECEPTOR AB $702.000002226478 ARENAL 21-HYDROXYLASE AB $157.000002268323 ARGININE VASOPRESSING HORMONE $137.000002231235 ARSENIC (HVY MET BLD Q) $49.000002244702 ARSENIC LEVEL (HVY MET U) $81.000002243101 ARSENIC LEVEL-HEAVY METALS BLO $162.000002253723 ARSENIC PROFILE, URINE $0.00

0002259645 ARSENIC, BLOOD $147.000002257367 ARSENIC, FRACTIONATED (FLX) $278.000002252578 ARSENIC, HAIR $162.000002253734 ARSENIC, URINE (FOR PROFILE) $139.000002251216 ARSENIC, URINE (HVY MET II) $74.000002250757 ARTANE LEVEL (TRIHEXYTHENIDYL) $260.000002254812 ASA DEFICIENCY $416.000002225845 ASCORBIC ACID (VITAMIN C) $140.000002238665 ASO SCREEN $62.000002238152 ASO TITER (ASOT) $82.000002231407 ASP AB (HYPERSENS PNL Q) $45.000002267478 ASPERG.AB(HYPERSENS PNEUM) $16.000002267489 ASPERG.AB,ADDL.HYPERSENS PNEUM $16.000002229434 ASPERGILLUS AB SCREEN $68.000002245899 ASPERGILLUS ABS (FUNG ABS) $50.000002237642 ASPERGILLUS ANTIBODIES QUANTIT $0.000002245505 ASPERGILLUS ANTIBODY (ASP QUAN $74.000002245511 ASPERGILLUS ANTIBODY (ASP QUAN $74.000002221412 ASPERGILLUS GALACTOMANNAN AG $183.000002227934 AST (LIVR FIBR HCV) $50.000002224660 AST (NASH FIBRO) $41.000002240273 AST SGOT $56.000002228815 AT3 ACTIVITY (AT4 FUNC) $31.000002228823 AT3 AG ACTIVITY (AT3 FUNC) $58.000002221689 AT3 ENZYME ACTIVITY $92.000002245998 ATAXIA EVALUATION, COMPLETE $0.000002267778 A-THAL HBA1&2 (HGB CASCADE) $937.000002227489 ATYP P-ANCA (ANCA PANEL-LC) $42.000002235219 AURAMINE-RHODAMINE STAIN $366.000002263634 AUTOADSORPTION 1ST (MVRBC) $147.000002263956 AUTOADSORPTION ADDL (MVRBC) $147.000002227601 AUTOIMMUNE DYSAUTONOMIA EVA $0.000002220010 AUTOPSY $806.000002236560 AUTOPSY TO M.U. $2,884.000002225170 AUTOPSY-BODY (REF) $2,660.000002235208 AUTOPSY-ORGANS MICRO $1,334.000002263223 B CELLS, TOTAL (LYMPH SS 5) $71.000002262756 B CELLS,TOTAL(IMMUNODEF PANEL) $122.000002269034 B. MICROTI AB ADDL (BABESIA M) $98.000002269023 B. MICROTI AB FIRST(BABESIA M) $98.000002253989 B. PERTUSSIS IGG/M/A QUANT $0.000002254012 B. PERTUSSIS, AB, ADDITIONAL $87.000002254001 B. PERTUSSIS, FIRST AB QUANT $87.000002243993 B12 (B12/FOLATE) $119.000002239358 B12 ONLY $119.000002239341 B12/FOLATE SERUM $0.000002231124 B2-GLYCO (LUPUS PHOSPHO Q) $46.00

0002231130 B2-GLYCO ADD (LUPUS PHOSPHO Q) $46.000002269012 BABESIA MICROTI ABS, IGG/IGM $0.000002231408 BACT IGG (HYPERSENS PNL Q) $39.000002231409 BACT IGG ADD (HPERSENS PNL Q) $39.000002224356 BACTERIAL ID-REF $165.000002252967 BACTRIM LEVEL $289.000002267878 BARBITUR CONFIRMATIOIN, URINE $116.000002231334 BARBITURATES CONF-MEC Q $133.000002269578 BARBITURATES, CONF/QT $126.000002225269 BARBITURATES, CONFIRM, BLD $143.000002256012 BARTONELA QUINTANA ABS,IGG/IGM $0.000002259634 BARTONELLA HENS. PCR, PB $1,146.000002256023 BARTONELLA QUINTANA ABS, IGG $75.000002256034 BARTONELLA QUINTANA ABS,IGM $75.000002251476 BARTONELLA,DNA PCR $387.000002240026 BASIC METABOLIC PANEL $67.000002253001 BASIC METABOLIC W/IONIZED CALC $92.000002257923 B-CELL CLONALITY, PCR $0.000002229634 B-CELL INTERP (B-CELL CLON Q) $38.000002266367 BCR-ABL 1 MAJOR (P210) QUANT $592.000002228934 BCR-ABL1 MAJOR BP $267.000002228945 BCR-ABL1 MINOR BP $236.000002224312 BCR-ABL1 TK INHIB RES NXT GEN $1,119.000002228923 BCR-ABL1 TRANSCRIPT DETECTION $0.000002220834 BCR-ABL1,RT-PCR, QUAL CML/ALL $592.000002258278 BEDSIDE GLUCOSE $0.00E002258278 BEDSIDE GLUCOSE $18.000002220342 BENADRYL (DIPHENHYDRAMINE) LVL $155.000002226101 BENZODIAZE 1-12 (URDRUGCOMP) $53.000002267823 BENZODIAZE CONFIRMATION, URINE $116.000002225293 BENZODIAZEPAM, CONFIRM, BLD $143.000002229112 BENZODIAZEPINE, QUANT, URINE $257.000002226645 BETA 2 MICROGLOBULIN $252.000002269934 BETA GLOB SEQ $0.000002259889 BETA GLOBULIN SEQUENCING $783.000002229701 BETA-2 GLYCO 1ST(B2 GLYCO ABS $125.000002229712 BETA-2 GLYCO ADD(B2 GLYCO ABS $125.000002243314 BETA-2 GLYCOPROTEIN IGG $81.000002243336 BETA-2 GLYCOPROTEIN IGG/IGM $0.000002243325 BETA-2 GLYCOPROTEIN IGM $81.000002229967 BETA-2 TRANSFERRIN $494.000002254167 BETA-2 TRANSFERRIN $0.000002229478 BETA-2-GLYCOPROTEIN I IGG AB $79.000002229489 BETA-2-GLYCOPROTEIN I IGM AB $79.000002221423 BETA-D-GLUCAN $292.000002226767 BETA-GLUCOSIDASE, LUEKOCYTES $580.000002231720 BETAHYDROXYBUTERIC ACID $252.00

0002231482 BF-URIC ACID $41.000002231471 BF-VOLUME $27.000002231471 BF-VOLUME $27.000002267767 B-GLOB GENE SEQ (HGB CASCADE) $823.000002267756 B-GLOB HBB MUTAT (HGB CASCADE) $383.000002261367 BHCG QT TUMOR MKR $209.000002225867 BHCG-ISTAT $117.000002266901 BHL DRAW ONLY $37.000002231360 BICARB, URINE RANDOM $82.000002229003 BILE ACIDS $425.000002232341 BILIRUBIN CORD $54.000002231215 BILIRUBIN TOTAL $54.000002231181 BILIRUBIN, DIRECT $31.000002224589 BILIT (NASH FIBRO) $40.000002254778 BK QUANTIATION PCR $521.000002264101 BK/JC VIRUS PCR $0.000002227423 BLASTOMYCES, IMMUNODIFFUSION $48.000002245921 BLASTOMYCOSIS ABS (FUNG ABS) $44.000002238801 BLOOD, URINE CHEM STRIP $57.000002261622 BNP $235.000002238830 BODY FLUID CRYSTALS $62.000002240613 BODY FLUID DIRECT BILIRUBIN $54.000002240592 BODY FLUID TOTAL BILIRUBIN $56.000002249047 BONE MARROW CULTURE $120.000002234944 BONE MARROW DIFF/CELL COUNT $166.000002262078 BONE SPECIFIC ALK PHOS $168.000002229342 BORDETELLA PERTUSSIS-FA $345.000002222845 BP 180 (BP 180 & BP 230) $162.000002222856 BP 230 (BP 180 & BP 230) $162.000002263001 BRAF GENE $0.000002229312 BRAF MUTATION ANALYSIS $355.000002231447 BRAF Q $507.000002231448 BRAF V600E Q $838.000002268534 BRAF, V600E, ARUP $543.000002236644 BREAST CANCER PROFILE $0.000002224735 BREAST CANCER PROGNOSTIC (BCP) $0.000002231405 BROMIDE $131.000002226439 BROMIDES SERUM $128.000002257112 BRUCELLA AB (FEBAGG) $15.000002237540 BRUCELLA ABORTUS ABS, IGG $114.000002242112 BRUCELLA ABORTUS ABS, IGM $114.000002263856 BT, AG PT-II (MVRBC) $83.000002263878 BT, AG PT-III (MVRBC) $98.000002263901 BT, AG PT-IV (MVRBC) $142.000002263834 BT, AG, PT-I (MVRBC) $69.000002263845 BT, RBC AG DNR-1 (MVRBC) $69.000002263867 BT, RBC AG DNR-II (MVRBC) $83.00

0002263889 BT, RBC AG DNR-III (MVRBC) $98.000002263912 BT, RBC AG DNR-IV (MVRBC) $142.000002242067 B-TYPE NATIURETIC PEPTIDE (BNP $235.000002222834 BULLOUS PEMPHIGOID 180/230 AG $0.000002231428 BULLOUS PEMPHIGOLD BP180 Q $124.000002231426 BULLOUS PEMPHIGOLD BP230 Q $110.000002240224 BUN $56.000002249233 BUN (iSTAT) $20.000002253645 BUN, BODY FLUID $56.000002226112 BUPRENORPHINE (URDRUGCOMP) $53.000002266212 C 5 (COMPLEMENT 5) $152.000002268601 C. PNEUMONIA (RVP) $66.000002221725 C/A 20-25 (CHROMO BLD ONC) $234.000002226712 C/A 20-25 CELLS (C/A ONC) $234.000002256345 C/A 20-25, C/A BLD OR BM $240.000002221745 C/A INTERP (CHROMO BLD ONC) $44.000002256356 C/A INTERP, C/A BLD OR BM $45.000002265667 C1 ESTERASE INHIBITOR FUNCTION $133.000002252137 C1 FUNCTION $297.000002230701 C3 (SLE B) $53.000002230712 C4 (SLE B) $53.000002268012 C4 ACYLCARNITINE, QT URINE $365.000002225634 C4 BY NEPHELOMETRY-MAYO $78.000002269156 CA 125 (ROMA ASSAY) $287.000002231454 CA 15-20CELLS0 (CA POC Q) $539.000002227320 CA 19-9 (CARBOHYDRATE ANTIGEN) $129.000002229745 CA 20-25 (CA HEM MALIG Q) $669.000002230778 CA 27.29 (CANCER ANTIGEN) $155.000002231455 CA POC INTERP (CA POC Q) $124.000002249255 CA, IONIZED (iSTAT) $41.000002227338 CA-125(CANCER ANTIGEN125) $129.000002246089 CADASIL EVALUATION, COMPLETE $0.000002253456 CADMIUM, URINE $0.000002253467 CADMIUM, URINE (CADMIUM U) $146.000002251227 CADMIUM, URINE (HVY MET II) $88.000002226371 CADMIUM-BLOOD $104.000002225951 CAFFEINE LEVEL-SERUM $116.000002225126 CALCITONIN BY RIA $416.000002221801 CALCIUM (PHTI W CALCIUM) $54.000002255367 CALCIUM (PTHI W/ CALCIUM) $42.000002266878 CALCIUM, URINE (U CA-CRT RATIO $45.000002232385 CALCIUM, URINE 24 HR $82.000002266867 CALCIUM/CREAT RATIO, URINE $0.000002240232 CALCIUM-SERUM $54.000002240240 CALCIUM-URINE $74.000002266134 CALIF ENCEPHALITIS AB CSF,IGM $41.000002255745 CALPROTECTIN, FECAL $434.00

0002269912 CALRETICULIN EXON 9 MUTATE PCR $477.000002225767 CAMPY ANTIGEN $50.000002251718 CANCER ANTIGEN 15-3 $160.000002262289 CANDIDA AB (CANDID ABS) $57.000002262301 CANDIDA AB ADDL (CANDID ABS) $57.000002262278 CANDIDA ABS $0.000002228260 CANDIDA ALBICANS ANTIBODY $126.000002267601 CANDIDA ANTIGEN DETECTION $186.000002259589 CANDIDA DNA PROBE $60.000002226889 CANDIDA SPECIES NAA(VAG PAN NA $56.000002226123 CANNABIN SYN 1-3 (URDRUGCOMP) $53.000002229034 CANNABINOIDS,SYNTHETIC QT $158.000002269956 CAPILLARY ELECTROPH REFLEXED $135.000002223691 CARBAMAZEPINE EPOXIDE $237.000002224531 CARBAMAZEPINE -FREE $67.000002230801 CARBAMAZEPINE TOTAL AND FREE $0.000002230790 CARBAMAZEPINE, TOTAL (REF) $73.000002230985 CARBAMAZIPINE-TEGRETOL $114.000002229334 CARBOHYD DEF TRANSFER-ALC USE $226.000002231101 CARDIO (LUPUS PHOSPHO Q) $46.000002231112 CARDIO ADD (LUPUS PHOSPHO Q) $46.000002230913 CARDIO IQ APOE GENOTYPE $534.000002228710 CARDIOLIPIN IGG (PHOSPHOLIP) $90.000002228718 CARDIOLIPIN IGM (PHOSPHOLIP) $90.000002231243 CARIS ERBB2 CISH $474.000002231244 CARIS ZB227 $3,859.000002251516 CARISOPRODOL & MEPROBAMATE $70.000002257078 CARNITINE, FREE $114.000002257089 CARNITINE, TOTAL $252.000002226355 CAROTENE LEVEL $139.000002251961 CAT SCRATCH ABS $110.000002229276 CAT SCRATCH ANTIBODIES $110.000002230812 CAT SCRATCH DISEASE ANTIBODIES $0.000002225142 CATECHOLAMINES,FREE,24HR $109.000002225092 CATECHOLAMINES-PLASMA $212.000002236680 CATHEPSIN-D $308.000002234633 CBC AUTO DIFF-PRENATAL $0.000002234702 CBC AUTO W/MAN DIFF $66.000002234508 CBC WITH AUTO DIFF. $66.000002228212 CBC-BHRT PANEL $10.000002226745 CCND1 FISH TO CSI LAB $350.000002243411 CCP-CYCLIC CITRULLINATED PEPTI $155.000002263256 CD4/CD8 (LYMPH SS 5) $71.000002230264 CD4/CD8 PROFILE $0.000002225667 CD57 NK CELLS $0.000002229401 CDT AG (CDT TOX SCR) $38.000002239192 CEA $176.00

0002231302 CEA PANCREATIC FL Q $192.000002258678 CEA, FLUID $114.000002227466 CELIAC DISEASE COMPREHENSIVE $0.000002256567 CELIAC DISEASE, PEDIATRIC AB $0.000002261056 CELIAC GENETICS PANEL $0.000002226589 CELIAC GENO(HLA-DQ2 & HLA-DQ8) $0.000002253901 CELIAC SCREEN W REFLEX $0.000002269401 CELIAC SEROLOGY PROMETHEUS CLN $0.000002264034 CELL ANTIGEN,ADDL,(LAD PANEL) $87.000002264023 CELL ANTIGEN,FIRST,(LAD PANEL) $87.000002234789 CELL COUNT FLUID $82.000002234722 CELL COUNT--CSF $82.000002234801 CELL-ADDITIONAL INDICIES $0.000002264001 CENTROMERE ANTIBODY $53.000002230609 CENTROMERE B Q $67.000002226801 CERULOPLASMIN $109.000002228612 CF PROFILE, 32 MUT. DNA ANALYS $877.000002225545 CFTR (PANCREAT. PANEL) $974.000002240018 CHEM. SCREEN 20-VETERINARY SA $82.000002263667 CHEM. TREAT. RBC'S (MVRBC) $133.000002267345 CHEMILLUM (IBD SGI DIAG) $38.000002267356 CHEMILLUM ADDL (IBD SGI DIAG) $38.000002226301 CHIKUNG IGG (CHIKUNGUNYA ABS) $133.000002226312 CHIKUNG IGM (CHIKUNGUNYA ABS) $133.000002226289 CHIKUNGUNYA ABS $0.000002220612 CHLAMYDIA - DNA SDA $137.000002231396 CHLAMYDIA (CHL-GCTH Q) $40.000002258089 CHLAMYDIA ABS, BY IFA $0.000002223867 CHLAMYDIA BY TMA $147.000002258101 CHLAMYDIA IGG (CHLAM ABS) $53.000002258112 CHLAMYDIA IGG ADDL (CHLAM ABS) $53.000002258123 CHLAMYDIA IGM (CHLAM ABS) $56.000002258134 CHLAMYDIA IGM ADDL (CHLAM ABS) $56.000002231457 CHLAMYDIA TRACH RNA,TMA $60.000002250938 CHLAMYDIA/GC, DNA SDA $0.000002231348 CHLORIDE $51.000002252734 CHLORIDE, BODY FLUID $51.000002222069 CHLORIDE, CSF $96.000002231868 CHLORIDE, URINE RANDOM/TIMED $71.000002252071 CHLORIDE,FECAL $206.000002224605 CHOL (NASH FIBRO) $35.000002245700 CHOLESTEROL LDL DIRECT $79.000002231520 CHOLESTEROL-HDL $79.000002233039 CHOLESTEROL-TOTAL $51.000002246356 CHOLESTEROL-TOTAL BODY FLUID $56.000002226462 CHOLINESTERASE SERUM $47.000002220232 CHROM. ANALY. POC 15-20 CELLS $301.00

0002236555 CHROM. ANALY. POC INTERP $56.000002266201 CHROMATIN (SLE B) $51.000002264467 CHROMATIN ANTIBODY, IGG $144.000002264778 CHROMATOG., (TPMT ENZ) $146.000002226389 CHROMIUM SERUM $311.000002265878 CHROMIUM, URINE $66.000002265478 CHROMO 20-25 CELL(CA-LYMPH NOD $293.000002265412 CHROMO AN 20-25(CA SOLID TUMOR $377.000002265423 CHROMO AN INTRP(CA SOLID TUMOR $63.000002256401 CHROMO AN.INTERP/RP(CHROMO BL $312.000002265456 CHROMO. ANALY. LYMPH NODE $0.000002243048 CHROMOGRANIN A $297.000002256323 CHROMOSOME AN, BLD OR BM $0.000002256367 CHROMOSOME AN. ROUTINE BLOOD $0.000002256389 CHROMOSOME AN.15-20(CHROMO B $605.000002243554 CHROMOSOME AN-AFF (C/A AF) $508.000002226689 CHROMOSOME ANALY. ONC (PATH) $0.000002265389 CHROMOSOME ANALYS, SOLID TUMO $0.000002227112 CHROMOSOME ANALYSIS, BLOOD $0.000002228070 CHROMOSOME ANALYSIS-AMNIOTIC $0.000002220230 CHROMOSOME STUDY(POC) $0.000002253678 CHYLOMICRON SCREEN, BODY FLUID $114.000002227122 CITRATE LEVEL, URINE $159.000002226023 C-KIT MUTATION ANALYS-PTH $578.000002231472 C-KIT MUTATION Q $1,275.000002233120 CK-MB-MONOCLONAL $155.000002240265 CK-TOTAL $56.000002244667 CK-TOTAL (CK ISO) $75.000002264178 CLIA (IBD SGI) $40.000002227589 CLIA AB (ENTYVIO LVL & ABS) $259.000002264189 CLIA, ADDL (IBD SGI) $40.000002231341 CLOBAZAM $143.000002228445 CLOBAZAM, QUANT $262.000002231353 CLONAZEPAM $170.000002227114 CLONAZEPAM SERUM $176.000002222945 CLOPIDOGREL CYP2C19 $545.000002229412 CLOS AG (CDT TOX SCR) $38.000002227734 CLOSTRIDIUM DIFFICLE TOXIN-SCR $268.000002223012 CLOTTING FACTOR II $429.000002221338 CLOTTING FACTOR IX SEND OUT $113.000002222932 CLOTTING FACTOR V $236.000002229680 CLOTTING FACTOR VII $159.000002221349 CLOTTING FACTOR VIII SEND OUT $88.000002229698 CLOTTING FACTOR X $129.000002229706 CLOTTING FACTOR XI $117.000002229714 CLOTTING FACTOR XII $290.000002229715 CLOTTING FACTOR XIII $429.00

0002231154 CLOZAPINE (CLOZARIL) SERUM $185.000002228223 CMP-BHRT PANEL $14.000002223942 CMV ABS, IGG - TORCH IGG $75.000002223966 CMV ABS, IGM - TORCH IGM $88.000002228187 CMV IGG TITER $53.000002228005 CMV IGM TITER $53.000002246654 CMV QUAL, PCR $216.000002238243 CMV QUANT, PCR $264.000002227056 CMV, IGG & IGM $0.000002230977 CMV-CYTOMEGALOVIRUS CULTURE $291.000002259656 COBALT, SERUM/PLASMA $98.000002265889 COBALT, URINE $121.000002226412 COCAINE CONF, QUANT URINE $175.000002267834 COCAINE CONFIRMATION, URINE $116.000002231338 COCAINE CONF-MEC Q $175.000002225345 COCAINE, CONFIRM, BLD $143.000002245932 COCCIDIODOMYCOSIS ABS (FUNG AB $39.000002260012 COLLAGEN ADP (PFA-100) $215.000002222378 COLLAGEN CROSS LINKS(NTX URINE $162.000002260001 COLLAGEN EPI (PFA-100) $215.000002238478 COLORECTAL CANCER SCREEN, ICT $44.000002268167 COMP FOOD ALLERGEN, IGG4 $0.000002240349 COMP METAB PANEL $79.000002262956 COMP METAB PANEL-POC $103.000002237253 COMPATIBILITY I SPIN $279.000002237055 COMPATIBILITY-ANTIGLOBULIN $256.000002225134 COMPLEMENT C.Q.-SERUM $129.000002225159 COMPLEMENT C-2 PLASMA $324.000002225175 COMPLEMENT C-3 SERUM $65.000002225745 COMPLEMENT C3a $126.000002225191 COMPLEMENT C-4 $65.000002225756 COMPLEMENT C4a $186.000002225183 COMPLEMENT SERUM TOTAL CH50 $70.000002248010 COMPLEMENT-C1-ESTERASE INHIBIT $133.000002226034 COMPREHENSIVE DRUG PANEL,URIN $0.000002268123 CONCENTRA(CRYPTOSP.ISOSP,CYCLO $29.000002224123 CONCENTRATE (MICROSPORIDIA ST) $34.000002230023 CONCENTRATION OF INFECTIOUS AG $60.000002262401 CONNEXIN 26 (GJB2) SEQUENCING $1,056.000002267523 CONSULT MU MUSCLE BX $328.000002237022 COOMBS DIRECT $54.000002231144 COPEPTIN Q $120.000002226470 COPPER SERUM $189.000002230578 COPPER U 24HR Q $159.000002227098 COPPER URINE QUANTITATIVE $97.000002236611 COPPER, QUANTITATIVE, TISSUE ( $383.000002224301 COPPER, RBC $162.00

0002222401 COPPER. FREE (DIRECT) $157.000002239431 CORTISOL AM $119.000002266789 CORTISOL FREE (ADRENAL STRESS) $67.000002262267 CORTISOL FREE SERUM $318.000002266801 CORTISOL FREE,ADDL(ADRENAL STR $67.000002239442 CORTISOL PM $119.000002239226 CORTISOL RANDOM $119.000002225225 CORTISOL URINE FREE QUANTITATI $297.000002251895 CORTISOL, SALIVARY $140.000002249123 CORTISOL-3, ADDITION SPECIMENS $154.000002249112 CORTISOL-3, FIRST SPECIMEN $154.000002268301 COTININE SCREEN, SER/PL $93.000002229169 COUMADIN LEVEL $189.000002222359 COXSACKIE A AB $126.000002255901 COXSACKIE VIRUS B $0.000002255912 COXSACKIE VIRUS B, 1ST AB $33.000002229318 COXSACKIEVIRUS-B SINGLE ANTIBO $33.000002225100 C-PEPTIDE $260.000002239242 CPK ISOENZYMES $0.000002244678 CPK ISOENZYMES (CK ISO) $75.000002265823 CPM FISH (MAYO) $0.000002238269 C-REACTIVE PROTEIN $62.000002220314 CREAT (ANAB) $54.000002249244 CREAT (iSTAT) $20.000002231290 CREAT (U URIC ACID R Q) $70.000002224768 CREAT CLEARANCE U COMPONENTS $114.000002228039 CREATINE LEVEL $180.000002220359 CREATININE (17-KETOSTEROIDS) $53.000002253745 CREATININE (ARSENIC PROFILE) $44.000002253478 CREATININE (CADMIUM U) $39.000002224724 CREATININE (U MALB 24HR) $23.000002266889 CREATININE, U (U CA-CRT RATIO) $40.000002251238 CREATININE, URINE (HVY MET II) $23.000002240208 CREATININE, URINE RANDOM/TIMED $74.000002240522 CREATININE-BODY FLUID $80.000002240190 CREATININE-SERUM $56.000002244656 CREATININE-URINE MALB/CREAT $74.000002228767 CRMP-5-IGG WBLOT CSF $368.000002227356 CROHN DISEASE PROGNOSTIC PANEL $0.000002265789 CROHN'S AB (CROHNS PROG) $104.000002265801 CROHN'S AB, ADDL (CROHNS PROG) $104.000002269523 CROHN'S PROG, PROMETH.RFXD $0.000002265778 CROHN'S PROGNOSTIC PANEL $0.000002269456 CROHN'S PROGNOSTIC, PROMETHEU $0.000002267389 CRP (IBD SGI DIAG) $16.000002264289 CRP (IBD SGI) $17.000002230978 CRP (LIPID INFLAM Q) $42.00

0002238272 CRP-CARDIAC- HIGH SENSITIVITY $87.000002231373 CRT (17-KETOST 24H Q) $39.000002231315 CRT (MALB/CRT 24Q) $67.000002238285 CRYOGLOBULINS $140.000002238137 CRYPTOCOCCAL ANTIGEN $88.000002226445 CRYPTOCOCCCUS AG URINE $258.000002243846 CRYPTOCOCCUS ANTIGEN, SERUM TO $155.000002268112 CRYPTOSP.ISOSP.CYCLOSPORA STAI $0.000002253701 CRYPTOSPORIDIUM $50.000002262934 CRYPTOSPORIDIUM AG, EIA $122.000002230845 CRYPTOSPORIDIUM SMEAR, STOOL $0.000002257445 CSF PROTEIN ANALY (MS PROFILE) $0.000002221667 CSF3R MUTATION ANALYSIS $792.000002234243 CSF-INDIA INK $96.000002239630 CSF-OLIGOCLONAL BANDS $136.000002238939 CSF-VDRL TO REF LAB $59.000002260567 CTX (C-TELOPEPTIDE,B-C-L) $217.000002231164 CULT AFB BLD/BM Q $152.000002268656 CULT ANAEROBE (C BF) $56.000002231163 CULT FUNGUS BLD/BM Q $119.000002268634 CULT TISS, ANAEROBE (C TISSUE) $60.000002234491 CULTURE ID, AEROBIC $60.000002234492 CULTURE ID, AEROBIC ADDL $60.000002234481 CULTURE ID, ANAEROBIC $60.000002234482 CULTURE ID, ANAEROBIC ADDL $60.000002234425 CULTURE-ANAEROB (C WND ANA) $56.000002234300 CULTURE-BETA STREP A $75.000002234383 CULTURE-BLOOD $120.000002234433 CULTURE-BLOOD CATH TIP $114.000002234409 CULTURE-BODY FLUID $67.000002234197 CULTURE-BRONCH QUANT. $426.000002234995 CULTURE-BRONCHIAL $74.000002234391 CULTURE-CSF $101.000002234984 CULTURE-ENVIRONMENTAL $119.000002234359 CULTURE-EYE/EAR $101.000002234086 CULTURE-FUNGUS $119.000002234367 CULTURE-GENITAL $107.000002234131 CULTURE-NOSE $101.000002234342 CULTURE-SPUTUM $107.000002234417 CULTURE-STOOL $71.000002234334 CULTURE-THROAT $101.000002234793 CULTURE-TISSUE $73.000002234326 CULTURE-URINE $107.000002234375 CULTURE-WOUND $114.000002234062 CULTURE-WOUND W/ANAEROBE $67.000002226488 CYANIDE BLOOD $140.000002227791 CYCLOSPORIN LEVEL $147.00

0002221033 CYCLOSPORIN-MU $159.000002226323 CYSTATIN C $219.000002227262 CYSTINE-URINE-QUANT. $162.000002231325 CYTO 100-300 (FISH A/D Q) $370.000002230356 CYTO 100-300 (FISH AML M3 Q) $214.000002230089 CYTO 100-300 (FISH CLM-ALL Q) $280.000002230145 CYTO 100-300 (FISH HG LYMPH Q) $401.000002260056 CYTO 100-300 (FISH MDS PANEL) $184.000002231296 CYTO 100-300 (FISH MYEL,RFX Q) $731.000002231379 CYTO 100-300 (RF FISH MYELO Q) $288.000002231380 CYTO 100-300 ADD(RF FISH MYE Q $288.000002260067 CYTO 100-300 ADDL(FISH MDS PAN $184.000002260756 CYTO 100-300 ADDL,FISH LYM AGG $182.000002231295 CYTO 100-300(FISH MYEL,RFX Q) $731.000002231384 CYTO 100-300(RF FISH MYE CEP Q $305.000002231300 CYTO 100-300(RF FISH MYEL IGHQ $313.000002230156 CYTO 100-300ADD(FISH HG LYMPQ $401.000002231465 CYTO 25-99(ALK 2P23 REAR FIS Q $145.000002231469 CYTO 25-99(ROS1(6Q22)REAR FISQ $230.000002231466 CYTO 25-99A(ALK 2023 REAR FISQ $145.000002230334 CYTO DNA (FISH AML M3 Q) $100.000002230001 CYTO DNA (FISH CML-ALL Q) $131.000002230134 CYTO DNA (FISH HG LYMPH Q) $187.000002231292 CYTO DNA (FISH MYEL, RFX Q) $341.000002231298 CYTO DNA (RF FISH MYEL IGH Q) $146.000002231294 CYTO DNA ADD (FISH MYEL,RFX Q) $341.000002231299 CYTO DNA ADD (RF FISH MYEL IGH $146.000002230345 CYTO DNA ADDL (FISH AML M3 Q) $100.000002230012 CYTO DNA ADDL (FISH CML-ALL Q) $131.000002260045 CYTO DNA PROBE ADDL(FISH MDS P $101.000002260034 CYTO DNA PROBE(FISH MDS PANEL) $101.000002231464 CYTO DNA(ALK 2P23 REAR FISH Q $82.000002231468 CYTO DNA(ROS1(6Q22) REAR FISHQ $129.000002231324 CYTO GEN (FISH A/D Q) $172.000002260078 CYTO INTER/REP(FISH MDS PANEL) $385.000002235109 CYTO PAP-GYN SCR/MCR DX (GYN) $81.000002235112 CYTO PAP-GYN SCR-MCR ANNUAL $81.000002231301 CYTO100-300 ADD(RF FISH MYEL I $313.000002231470 CYTO25-99A(ROS1(6Q22)REAR FISQ $230.000002268834 CYTOGEN 100-300 (FISH TCR A-D) $320.000002260623 CYTOGEN 100-300 ADDL, FISH ALL $177.000002260823 CYTOGEN 100-300 ADDL, FISH MPD $175.000002260612 CYTOGEN 100-300, FISH ALL $177.000002260745 CYTOGEN 100-300, FISH LYM AGG $182.000002260812 CYTOGEN 100-300, FISH MPD $175.000002231377 CYTOGEN 1ST (RF FISH MEYLO Q) $134.000002231382 CYTOGEN 1ST(RF FISH MYEL CEP Q $142.00

0002231378 CYTOGEN ADD (RF FISH MYELO Q) $134.000002231383 CYTOGEN ADD(RF FISH MYE CEP Q) $142.000002265845 CYTOGEN DNA ADDL (CPM FISH) $84.000002268812 CYTOGEN DNA PRB (FISH TCR A-D) $171.000002268823 CYTOGEN DNA PRBADD(FISH TCR AD $171.000002265834 CYTOGEN DNA PROBE (CPM FISH) $384.000002243587 CYTOGEN INTER/REPORT (C/A AF) $67.000002244324 CYTOGEN, DNA FISH METAPHASE $185.000002244256 CYTOGEN, INT/RPT FISH GENERIC $160.000002244245 CYTOGEN,100-300 FISH GENERIC $339.000002244335 CYTOGEN,INT/RPT FISH METAPHASE $154.000002244093 CYTOGEN. 100-300 (FISH MM) $227.000002260901 CYTOGEN. 100-300 (PML-FISH) $248.000002236550 CYTOGEN. TIS CULT, C/A POC $339.000002244104 CYTOGEN.100-300 ADDL (FISH MM) $227.000002244223 CYTOGENETICS, DNA (10-30) $289.000002244200 CYTOGENETICS, DNA PROBE $195.000002227382 CYTO-GY THINPREP (TPREP) $158.000002227387 CYTO-GY THINPRP(TPREP CC)ANN'L $158.000002235125 CYTOLOGY CELL BLOCK-ANY SOURCE $116.000002226556 CYTOLOGY CELLULAR ENHANCE TECH $110.000002235059 CYTOLOGY NON-GYN PAP ADD. SPEC $60.000002235042 CYTOLOGY NON-GYN PAP W/O CELL $135.000002227390 CYTOLOGY PAP-NON-GYN THIN PREP $158.000002235022 CYTOLOGY SPECIMEN $0.000002254356 CYTOLOGY-FINE NEEDLE ASPIRATE $205.000002224978 CYTOPATH,FNA ADEQ 1ST EVAL $275.000002224997 CYTOPATH,FNA ADEQ ADDL EVAL $228.000002263723 DAT 1ST (MVRBC) $104.000002263978 DAT ADDL (MVRBC) $104.000002234957 D-DIMER, QUANTITATIVE $129.000002226660 DEHYDROEPIANDOSTERONE $249.000002221361 DEHYDROEPIANDOSTERONE-SULFATE $249.000002268345 DENGUE FEVER AB, IGG.IGM $0.000002222310 DEOXYPYRIDINOLINE (DPD) CROSS- $150.000002268501 DEXAMETHASON LEVEL $162.000002231416 DEXAMETHASONE $146.000002231312 DHEA Q $86.000002266812 DHEA SULFATE (ADRENAL STRESS) $88.000002268745 DIAZEPAM & NORDIAZEPAM $116.000002234778 DIFFERENTIAL-CBC $31.000002239267 DIGOXIN $128.000002253523 DIHYDROTESTOSTERONE $114.000002231926 DILANTIN LEVEL BLOOD $119.000002230623 DILANTIN,FREE - REF LAB $136.000002225612 DIPHTHERIAE CULTURE $170.000002250598 DIPTHERIA ANTITOXIN ANTIBODIES $103.00

0002226734 DISOPYRAMIDE $98.000002220233 DIURETIC SCREEN $298.000002269623 DMPK,DYS MYOTONIC PROT. KINASE $767.000002269367 DNA AMP,(EHRL ANAPLASMA) $333.000002269378 DNA AMP,ADD(EHRL ANAPLASMA) $333.000002268034 DNA CELL CYCLE ANALYSIS, PB $147.000002220167 DNA PR 1ST (FPOC FISH) $107.000002220156 DNA PR ADDL (FPOC FISH) $107.000002258167 DNA PROBE (FISH CLL) $108.000002244071 DNA PROBE (FISH MM) $125.000002260889 DNA PROBE (PML FISH) $135.000002258178 DNA PROBE ADDL (FISH CLL) $108.000002244082 DNA PROBE ADDL (FISH MM) $125.000002260601 DNA PROBE ADDL, FISH ALL $98.000002260734 DNA PROBE ADDL, FISH LYM AGG $98.000002260801 DNA PROBE ADDL, FISH MPD $96.000002254101 DNA PROBE, AML FISH PANEL $97.000002260589 DNA PROBE, FISH ALL $98.000002260723 DNA PROBE, FISH LYM AGG $98.000002260789 DNA PROBE, FISH MPD $96.000002254112 DNA PROBE-ADDL, AML FISH PANEL $97.000002265223 DNA PROBE-NOS (RVP) $66.000002231365 DNASE-B AB Q $63.000002260167 DOXEPIN & METABOLITES $158.000002237296 DRAW & HOLD $21.000002220303 DRG SC LIST B (ANAB) $219.000002265267 DRUG ABUSE SCREEN 8 $87.000002231307 DRUG GEN TOX PANEL BLD Q $499.000002231306 DRUG LEVEL (ADALIMUMAB Q) $224.000002269601 DRUG QUANT (IFX CONC, ABS) $313.000002224601 DRUG SCREEN MECONIUM $135.000002230377 DRUG SCREEN, COLLECT ONLY $20.000002230377 DRUG SCREEN, COLLECT ONLY $20.000002265256 DRUG SCREEN, COMPREH. URINE $139.000002230399 DRUG SCREEN,DOT, CORPORATE HEA $50.000002230393 DRUG SCREEN,NON-DOT WITH MRO, $50.000002230388 DRUG SCREEN,NON-DOT, CORPORAT $50.000002251751 DRUG SCREEN,QUAL $334.000002220413 DRUG SCREEN-BLOOD-8 DRUGS $144.000002220415 DRUG SCREEN-HAIR SPECIMEN $0.000002247813 DRVTT (PHOSPHOLIP) $250.000002256812 DRVVT (LUPUS W REFLEX) $115.000002266634 DRVVT (MAYO-LUPUSANTI) $172.000002244689 DRVVT CONFIRM (LUPUSANTI) $186.000002234750 DRVVT MIX (LUPUSANTI) $120.000002229423 DRVVT SCR RFX CONFIRMATION $83.000002230689 DSDNA (SLE B) $61.00

0002267801 E TEST SENSITIVITY - UMHC $84.000002231351 E.CHAFF.DNA PCR Q $182.000002266145 EASTERN EQ ENCEPH AB CSF, IGM $41.000002265167 EBER, FISH-MAYO $217.000002231224 EBV DNA QT PCR Q $286.000002228336 ECHOVIRUS ANTIBODIES $0.000002247479 ECHOVIRUS ANTIBODIES (ECHOVIR $96.000002247483 ECHOVIRUS ANTIBODIES (ECHOVIR $96.000002269612 ECLIA (IFX CONC, ABS) $323.000002259001 EGFR MUTATION ANALYSIS, PB $0.000002231456 EGFR MUTATION COBAS Q $1,836.000002231462 EGFR MUTATION Q $743.000002226567 EGFR T790M MUTATION DETECTION $732.000002259013 EGFR VARIANT (EGFR ANALYSIS) $758.000002258456 EGRF FISH MUTATION-TISSUE $0.000002227545 EHRL IGG (TICK PROF) $36.000002227556 EHRL IGM (TICK PROF) $36.000002269356 EHRLICHIA & ANAPLASMA PCR $0.000002222218 EHRLICHIA BY PCR $382.000002229508 EHRLICHIA-IGG $76.000002229510 EHRLICHIA-IGM $76.000002228456 ELANE $0.000002269856 ELCIA (ANTI-ADALIMUMAB) $331.000002233161 ELECTROLYTES SERUM $59.000002248385 ELECTRON MIC-RENAL MAYO $1,023.000002226401 ELISA ASSAY (ENTYVIO ABS) $204.000002264056 ELISA, 1ST, (FIBROSPECT) $196.000002264067 ELISA, ADDL (FIBROSPECT) $196.000002269445 EMA IGA (CELIAC SERO) $236.000002243001 EM-DIAGNOSTIC (STRUCTURAL) REF $1,157.000002265278 EML4/ALK TRANSLOCATION PCR $602.000002227945 ENCEPH AUTOIMMUNE EVAL, CSF $0.000002227453 ENDOMYSIAL IGA (CELIAC) $132.000002231222 ENDOMYSIAL SCR RF TITER Q $167.000002231223 ENDOMYSIAL TITER Q $284.000002227801 ENFD CONS W COMP REV HX $395.000002227778 ENFD CONS W SLIDE PREP $395.000002227789 ENFD CONS W USS PROF $395.000002227756 ENFD CONSULT-OUTSIDE SLIDE $395.000002227812 ENFD MORPHOMETRIC ANALYSIS $1,036.000002227823 ENFD-CONGO RED STAIN $191.000002227845 ENFD-IHC EACH ADDL $275.000002227834 ENFD-IHC SINGLE $275.000002221656 ENTAMOEBA HISTOLYTICA Ab,IgG $109.000002257223 ENTEROVIRUS (POLIO ABS) $84.000002257234 ENTEROVIRUS ADDL (POLIO ABS) $84.000002242212 ENTEROVIRUS BY PCR $338.00

0002261434 ENTEROVIRUS, PCR (NON BLOOD) $457.000002264789 ENZ ACT (TPMT ENZ) $146.000002234565 EOSINOPHIL COUNT $57.000002234557 EOSINOPHIL,NASAL SMEAR $57.000002227745 EPIDERM.NERVE FIBER DENS-TISS $560.000002224038 EPSTEIN BARR EARLY AG(EBV ACUT $74.000002223996 EPSTEIN BARR NUC AG(EBV ACUTE) $74.000002227767 EPSTEIN BARR VIR. (EA) IGG $74.000002226215 EPSTEIN BARR VIR. (VCA) IGG $74.000002221316 EPSTEIN BARR VIRUS, ACUTE $0.000002246848 EPSTEIN BARR, QUAL PCR $188.000002223345 EPSTEIN BARR, QUANT PCR $324.000002255934 EPSTEIN BARR, VCA (EBV ACUTE) $74.000002255945 EPSTEIN BARR,VCA ADDL(EBV ACU) $74.000002227775 EPSTEIN-BARR VIR. (VCA) IGM $74.000002221648 ERA/PRA PARAFFIN $0.000002243925 ERA-TUMOR ANALYSIS $428.000002231232 ERBB1 (CARIS ERBB1-PDL1-TRK PR $175.000002225621 ERYTHROPOIETIN SERUM $239.000002225601 ESCITALOPRAM QNT (LEXAPRO) $256.000002225209 ESTRADIOL SERUM $133.000002264934 ESTRADIOL, SENSITIVE $151.000002228234 ESTRADIOL-BHRT PANEL $35.000002239309 ESTRIOL SERUM $98.000002225233 ESTROGENS TOTAL SERUM $377.000002255345 ESTROGENS, FRACTIONATED $143.000002228408 ESTRONE, SERUM $160.000002247965 ETHYLENE GLYCOL $159.000002223378 EUGLOBULIN LYSIS TIME $179.000002222589 EVEROLIMUS $199.000002248294 EXTRACT NUC AB ADDL (ANA COMP) $66.000002248283 EXTRACT. NUC AB (ANA COMP) $66.000002225945 FABRY DISEASE ANALY (FABRZ) $1,260.000002266667 FAC 8 ACT (MAYO-VWF PRO) $238.000002265967 FAC V (FAC V INHIB) $250.000002265978 FAC V INHIB (FAC V INHIB) $230.000002265923 FACTOR II (FAC II INHIB) $241.000002265945 FACTOR II BETHESDA(RF FAC II $290.000002227078 FACTOR II DNA (THROMB RISK) $178.000002235000 FACTOR II DNA ANALYSIS $178.000002265934 FACTOR II INHIB (FACII INHIB) $239.000002265912 FACTOR II INHIBITOR SCREEN $0.000002265989 FACTOR V BETHESDA(RF FAC V BET $290.000002265956 FACTOR V INHIBITOR SCREEN $0.000002227089 FACTOR V LEIDEN (THROMB RISK) $221.000002242634 FACTOR V LEIDEN MUTATION $221.000002266523 FACTOR VIII ACT (VWF MULTIMER) $45.00

0002257245 FACTOR VIII ACT (VWF PROF) $56.000002266601 FACTOR VIII ACT-MAYO $371.000002266545 FACTOR VIII AG (VWF MULTIMER) $74.000002231369 FACTOR VIII AG Q $250.000002261378 FACTOR VIII ANTIGEN $321.000002265245 FACTOR VIII INHIBITOR,REFLEXED $227.000002266012 FACTOR X (FAC X INHIB) $250.000002266034 FACTOR X BETHESDA(RF FAC X BET $290.000002266023 FACTOR X INHIB (FAC X INHIB) $230.000002266001 FACTOR X INHIBITOR SCREEN $0.000002253445 FACTOR XIII ACTIVITY $92.000002260556 FACTR VIII ACT FLX BETHESDA QT $136.000002220056 FAM MUT SEQ-RET $498.000002227106 FAT-FECAL, QUANTITATIVE $236.000002238871 FAT-FECAL-QUAL. $128.000002230389 FC (PNH FLAER Q) $769.000002230404 FC ADDL (PNH FLAER Q) $65.000002230415 FC ADDL 2 (PNH FLAER Q) $65.000002234896 FDP (FIBRIN DEGRAD. PRODUCTS) $151.000002257101 FEBRILE AGG (AB PANEL) $0.000002221121 FELBAMATE $154.000002226134 FENTANYL (URDRUGCOMP) $53.000002223189 FERNING TEST $40.000002225241 FERRITIN LEVEL $132.000002237137 FETAL BLEED $101.000002231146 FETAL HEMOGLOBIN Q $142.000002237403 FETAL HGB % $120.000002233872 FETAL MATURITY PANEL $181.000002234888 FIBRINOGEN ACTIVITY $119.000002262645 FIBRINOGEN RFLX(LUPUSANTI STAT $152.000002247294 FIBROBLAST CULTURE $733.000002252302 FIBRONECTIN, FETAL TO CRH $552.000002264045 FIBROSPECT II $0.000002230189 FIRST ALLRG (AL FOOD REFX Q) $11.000002264889 FISH (ADDL) (NHL FISH) $493.000002269745 FISH (FISH CLL) $409.000002264878 FISH (NHL FISH) $493.000002268967 FISH (UROVYSION) $423.000002258189 FISH 100-300 (FISH CLL) $196.000002258201 FISH 100-300 ADDL (FISH CLL) $196.000002224189 FISH 1ST (AGGRES B-CELL) $383.000002224223 FISH 1ST (FISH ALL) $410.000002251034 FISH 510452-CLN $0.000002224201 FISH ADDL (AGGRES B-CELL) $383.000002224234 FISH ADDL (FISH ALL) $410.000002224212 FISH ALL BLD OR BM $0.000002228423 FISH AML $0.00

0002222689 FISH AUTO INITIAL (FISH MDS) $247.000002258467 FISH AUTOMATED (EGRF FISH) $330.000002258156 FISH CLL PANEL $0.000002222678 FISH MDS, CLARIENT $0.000002222701 FISH MPHM (FISH MDS) $149.000002222723 FISH MPHM ADD/SPEC (FISH MDS) $149.000002226989 FISH MPHM EA ADD (FISH MDS) $62.000002222778 FISH MULT MYELOMA, CLARIENT $0.000002268801 FISH TCR A-D 14QLL.2 $0.000002260578 FISH, ALL (ACUTE LYMPH. LEUK.) $0.000002223212 FISH, CML (BCR-ABL1) $486.000002223123 FISH, EOSINOPHILIA PANEL $0.000002260712 FISH, LYMPHOMA (AGGRESSIVE) $0.000002260778 FISH, MPD (MYELOPROLIF DISORD) $0.000002266589 FISH, QT ADDL (PML/RARA) $428.000002266578 FISH, QT FIRST (PML/RARA) $428.000002250989 FISH,10-30 METAPHASES $0.000002251112 FISH,INDIVIDUAL-MAYO $734.000002226845 FISH-AGGRESSIVE B-CELL PANEL $0.000002229896 FLECAINIDE $92.000002256856 FLOW 1ST MARK-LYMPH(BLD/BM) $335.000002256867 FLOW 2ND MRK-LYMPH (BLD/BM) $36.000002256878 FLOW ADD'L MRK-LYMPH (BLD/BM) $36.000002265589 FLOW CYT 1ST MKR (ANTI-IGE REC $335.000002265601 FLOW CYT 2ND MKR (ANTI-IGE REC $44.000002265612 FLOW CYT ADDL MKR(ANTI-IGE REC $44.000002266045 FLOW CYT MRK, STAT CHARGE $153.000002243279 FLOW CYTO 1ST $335.000002243280 FLOW CYTO 2ND $44.000002243281 FLOW CYTO ADDL $44.000002243422 FLOW CYTOMETRY-ADDITIONAL ABS $172.000002243303 FLOW CYTOMETRY-BLOOD SPECIMEN $0.000002256834 FLOW CYTOMETRY-LYMPHOMA(BLD/ $0.000002224378 FLUCONAZOLE QUANT $184.000002249145 FLUNITRAZEPAM (ROHYPNOL) $385.000002223367 FLUNTRAZEPAM METAB CONFIRM $323.000002231049 FLUOR AB (PARANEO CSF Q) $287.000002231067 FLUOR AB ADD (PARANEO CSF Q) $287.000002227645 FLUOR AB SC (AUTOIMM DYSAUTO) $134.000002227978 FLUOR AB SCR ADDL (ENCEPH AUTO $102.000002227967 FLUOR AB SCR(ENCEPH AUTO EVAL) $102.000002261478 FLUOR AB TITER, EA AB-PARANEO $109.000002261489 FLUOR AB TITER,EA AB,ADL-PARAN $109.000002250158 FLUOR NONINFECT AB TITER 1ST $87.000002250169 FLUOR NON-INFECT AB TITER,1ST $87.000002261901 FLUOR. AB (ANA COMP BF) $47.000002268689 FLUORESC AB (PARANEO CSF) $165.00

0002268701 FLUORESC AB ADDL (PARANEO CSF) $165.000002268289 FLUORESC SCR(MYASTH GRAVIS PAN $135.000002249256 FLUORIDE $235.000002261712 FLUROESCENT AB SCRN,(IBD PROF) $56.000002261633 FOLATE $114.000002239366 FOLATE ONLY $114.000002244004 FOLATE, SERUM (B12/FOLATE) $114.000002228625 FOLIC ACID-RBC $126.000002229467 FOOD ALLERGEN ADDL $11.000002229456 FOOD ALLERGEN FIRST $11.000002224278 FOUNDATION ONE, GENETIC ASSAY $5,322.000002242490 FRAGILE X SYNDROME, CYTOGENIC $508.000002247637 FRANCISELLA AB, IGG $66.000002252170 FRANCISELLA AB, IGM $66.000002252181 FRANCISELLA TULAREMIA ABS $126.000002262578 FRANCISELLA TULARENIS IGG/IGM $0.000002233286 FREE HEMOGLOBIN $125.000002254334 FREE KAPPA LT CHAINS $191.000002260501 FREE KAPPA/LAMBDA LT CH, URINE $0.000002254345 FREE LAMDA LT CHAINS $191.000002254323 FREE LIGHT CHAINS, KAPPA/LAMDA $0.000002225761 FREE T 3 LEVEL $382.000002233275 FREE T 4 LEVEL $87.000002261600 FREE T3 $96.000002237279 FRESH FROZEN PLASMA THAW EA. U $102.000002229789 FRUCTOSAMINE $97.000002263356 FSH (FSH & LH) $136.000002225258 FSH SERUM $136.000002228245 FSH-BHRT PANEL $23.000002238368 FTA TO REF. $201.000002227389 FUNG AB NOS(CROHN DIS PROGNOS) $82.000002238277 FUNGAL ABS, RFX BLASTOMYCES ID $0.000002248578 FUNGAL ANTIBODIES (ASCA PROF) $220.000002248589 FUNGAL ANTIBODIES (ASCA PROF) $220.000002231352 FUNGITELL Q $369.000002261723 FUNGUS AB, (IBD PROF) $53.000002261734 FUNGUS AB, ADDL (IBD PROF) $53.000002234232 FUNGUS ID, ROUTINE $83.000002227201 FUNGUS ID, YEAST $67.000002234445 FUNGUS STAIN ONLY $92.000002236230 FUNGUS STAIN-GROCOTT (GMS) $88.000002234442 FUNGUS STAIN-REF. $92.000002228834 GABA-B-R AB IF TITER CSF $174.000002226145 GABAPENTIN (URDRUGCOMP) $53.000002223091 GABAPENTIN LEVEL $394.000002231303 GABAPENTIN Q $164.000002248210 GABITRIL (TIAGABET) LEVEL $278.00

0002231279 GAD-35 AB Q $158.000002227989 GAD65 (ENCEPH AUTO EVAL) $152.000002225789 GAD65 AB ASSAY, RFLX, MAYO $392.000002243012 GAD65 ANTIBODIES $216.000002231438 GAD-NEURO SYND AB TEST $482.000002228734 GADOLINIUM, SERUM $272.000002228745 GADOLINIUM, URINE $292.000002249025 GALACITOL-SUGARS (EMORY GENETI $177.000002228252 GALACTOSE-1-PUTRANSFERASE $185.000002267189 GALACTOSEMIA QT (GALT PANEL) $412.000002256201 GALT PANEL(GAL.ENZ ACT& 9 MUT) $0.000002257478 GAMMAGLOB IGM (CSF PROT AN) $48.000002257489 GAMMAGLOB IGM,ADDL(CSF PROT A $48.000002266223 GANGLIOSIDE ABS $212.000002226901 GARDNERELLA NAA(VAG PAN NAA) $56.000002259601 GARDNERELLA VAGINALIS,DNA PROB $60.000002225274 GASTRIN $86.000002267945 GASTRIN, ADDITIONAL $86.000002261134 GASTRO STROMAL TUMOR MUTATIO $0.000002237709 GASTROCCULT FOR BLOOD & PH $74.000002221534 GASTROINTESTINAL PATHOGEN PNL $721.000002268712 GATA 3 $428.000002226789 GAUCHER DISEASE FULL GENE ANAL $1,737.000002231398 GC (CHL-GCTH Q) $40.000002234252 GC SCREEN $101.000002267245 GENE REARRANGE,IGH(B-CELL PCR) $404.000002267256 GENE REARRANGE,IGK(B-CELL PCR) $404.000002230010 GENERAL HEALTH SCREEN $0.000002231276 GENOTY (HIV-1 GENOTYPE Q) $452.000002227334 GENOTYPE (HCV G3 NS5A) $687.000002224267 GENOTYPE (HCV NS5A) $687.000002232312 GENT PEAK $114.000002232332 GENT RANDOM $114.000002232321 GENT TROUGH $114.000002227923 GGT (LIVR FIBR HCV) $67.000002224627 GGT (NASH FIBRO) $57.000002231173 GGTP $54.000002253712 GIARDIA $50.000002252834 GIARDIA ABS, IFA, SERUM $191.000002222123 GIST, G-INTEST STROMAL TUM MUT $0.000002256589 GLIADIN IGG, CELIAC PEDIATRIC $56.000002264856 GLIADIN PROF (IGA/IGG) $0.000002229501 GLOMERULAR BASEMENT MEM IGG $151.000002223682 GLUCAGON LEVEL $205.000002226778 GLUCOPSYCHOSINE, BLOOD SPOT $309.000002231033 GLUCOSE $39.000002224616 GLUCOSE (NASH FIBRO) $33.00

0002231453 GLUCOSE BODY FLUID $39.000002231442 GLUCOSE PP $39.000002231431 GLUCOSE RANDOM $39.000002230231 GLUCOSE S-100GM 3H $33.000002230062 GLUCOSE SERUM 3H $33.000002230063 GLUCOSE SERUM 4H $33.000002230074 GLUCOSE SERUM 5H $33.000002230085 GLUCOSE SERUM 6H $33.000002230051 GLUCOSE S-F H 2H $88.000002233856 GLUCOSE TOLERANCE 1 HOUR $59.000002231192 GLUCOSE, 1ST HR-INCOMPLETE GTT $59.000002226363 GLUCOSE-6-PDH $107.000002231645 GLUCOSE--CSF $129.000002238842 GLUCOSE-URINE $59.000002234145 GRAM STAIN 2 $51.000002236164 GRAM STAIN-HISTO $83.000002234144 GRAM STAIN-MICRO $51.000002265634 GROSS/MICRO L IV, MU MUSCLE BX $236.000002266734 GROUP B CUL SCR(GRP B STREP DN $21.000002266745 GROUP B DNA (GRP B STREP DNA) $110.000002238962 GROUP B STREP ANTIGEN $66.000002266723 GROUP B STREP DNA AMP $0.000002225282 GROWTH HORMONE $88.000002231277 GROWTH HORMONE Q $88.000002228378 H PYLORI AB IGM $72.000002267612 H PYLORI BREATH TEST $225.000002238947 H. INFLUENZAE ANTIGEN $66.000002251917 H. PYLORI, STOOL, EIA $126.000002222767 H.INFLUENZA B AB,IGG $119.000002226231 HAM'S TEST-ACID HEMOLYSIN $158.000002243678 HANTAVIRUS ABS LGG $101.000002223641 HANTAVIRUS ABS LGG/LGM W REFLE $0.000002243667 HANTAVIRUS ABS LGM $101.000002224638 HAPTOGLOB (NASH FIBRO) $99.000002226223 HAPTOGLOBIN LEVEL $107.000002220976 HCG TITER-MU $191.000002220748 HCG, POC $34.000002239770 HCG-SERUM $83.000002239796 HCG-TITER-SERUM $209.000002238681 HCG-URINE $59.000002234983 HCT FLUID $88.000002230768 HCV GENO NS5A RES Q $712.000002227301 HCV GENOTYPE 3 NS5A DRUG RESIS $982.000002227667 HCV GENOTYPE, REFLEX NS5A $527.000002226667 HCV HI-RESOL GENOTYPE SEQ $615.000002224245 HCV NS5A DRUG RESISTANCE $0.000002227678 HCV NS5A, REFLEXED $748.00

0002268667 HE4 (HUMAN EDIDID. PROTEIN 4) $320.000002269167 HE4 (ROMA ASSAY) $287.000002263512 HEALTH FAIR CHOL $3.000002263478 HEALTH FAIR CMP $5.500002263489 HEALTH FAIR CMP PLUS(CMP CHG) $3.500002263556 HEALTH FAIR CMP PLUS(LIPID CHG $3.500002263545 HEALTH FAIR GLUCOSE, F $3.000002263534 HEALTH FAIR HGB A1C $9.000002263501 HEALTH FAIR LIPID $5.000002263523 HEALTH FAIR PSA $11.000002263561 HEALTH FAIR TSH $13.000002268312 HEALTH FAIR, SPECIAL-CHEM ONLY $10.000002228997 HEAVY METALS PANEL-BLOOD $0.000002226520 HEAVY METALS PANEL-URINE $0.000002251205 HEAVY METALS PROFILE II,URINE $0.000002263434 HEINZ BODY STAIN $82.000002245393 HELICOBACTER PYLORI, ADD'L $91.000002245389 HELICOBACTER PYLORI, FIRST $91.000002234466 HELICOBACTER SCREEN $57.000002228870 HELICOBACTER-PYLORI IGA $91.000002228872 HELICOBACTER-PYLORI IGG $91.000002245378 HELICOBACTER-PYLORI IGM,IGG,IG $0.000002234658 HEMATOCRIT $48.000002230567 HEMOCHROMATOSIS GENE ANALYSIS $172.000002234659 HEMOGLOBIN $48.000002226348 HEMOGLOBIN A1C $98.000002225647 HEMOGLOBIN A2 (and F) $79.000002231145 HEMOGLOBIN A2 QUANT Q $206.000002265112 HEMOGLOBIN, SERUM FREE $97.000002220289 HEMOGLOBIN, URINE $101.000002223891 HEMOGLOBINOPATHY PROFILE $179.000002238392 HEMOSIDERIN URINE $186.000002268145 HEMPPHILIA A (F8) SEQUENCING $2,153.000002260967 HEP A AB IGM (HEPATITIS PAN 1) $29.000002245262 HEP B CORE AB (HEP B PROF) $113.000002260945 HEP B CORE AB (HEPATITIS PAN 1 $31.000002245273 HEP B CORE IGM (HEP B PROF) $119.000002260956 HEP B CORE IGM(HEPATITIS PAN 1 $31.000002245284 HEP B SURF AB (HEP B PROF) $87.000002245306 HEP B SURF AG (HEP B PROF) $83.000002260978 HEP B SURF AG(HEPATITIS PAN 1) $27.000002229931 HEP B SURF AG-PRENATAL $0.000002245295 HEP BE AB (HEP B PROF) $109.000002245317 HEP BE AG (HEP B PROF) $109.000002248959 HEP C VIR RNA PCR RFX GENO $236.000002231414 HEPARIN ANTI-XA $480.000002252379 HEPARIN ANTI-XA $203.00

0002222867 HEPARIN ANTI-XA, BOONE $126.000002237502 HEPARIN-INDUCED PLATELET ABS $519.000002240651 HEPATIC FUNCT PANEL A $79.000002245249 HEPATITIS A AB (HEP A PROF) $114.000002225308 HEPATITIS A ANTIBODY $114.000002222281 HEPATITIS A ANTIBODY, IGM $125.000002245251 HEPATITIS A B IGM (HEP A PROF) $114.000002223306 HEPATITIS A PROFILE $0.000002229250 HEPATITIS A, B, & C PROFILE $357.000002223285 HEPATITIS B & C PROFILE $0.000002244904 HEPATITIS B CORE AB(HBVHCVPROF $113.000002227001 HEPATITIS B CORE AB, IGM $78.000002225316 HEPATITIS B CORE ANTIBODY $113.000002244915 HEPATITIS B CORE-IGM(HBVHCVPRO $119.000002227856 HEPATITIS B GENOTYPE $513.000002225332 HEPATITIS B PROFILE-COMPREHENS $0.000002246282 HEPATITIS B QUANTITATIVE, VIRA $178.000002265501 HEPATITIS B SURF AB, QUANT $119.000002221394 HEPATITIS B SURFACE AG $83.000002225324 HEPATITIS B SURFACE ANTIBODY $87.000002244937 HEPATITIS BE AB(HBVHCVPROF) $109.000002244974 HEPATITIS BE AG(HBVHCVPROF) $109.000002220384 HEPATITIS BE ANTIBODY $109.000002227049 HEPATITIS BE ANTIGEN $163.000002244926 HEPATITIS BS AB(HBVHCVPROF) $87.000002244893 HEPATITIS BS AG(HBVHCVPROF) $83.000002230208 HEPATITIS C AB(HBVHCVPROF) $126.000002261845 HEPATITIS C ANTIBODY $79.000002241345 HEPATITIS C GENOTYPING $527.000002223415 HEPATITIS C VIRUS RNA PCR $240.000002225856 HEPATITIS DELTA ANTIBODY $86.000002267512 HEPATITIS E AB, IGG $123.000002267501 HEPATITIS E AB, IGM $130.000002260934 HEPATITIS PANEL I $0.000002225365 HEPATITIS PROFILE A & B ACUTE $0.000002222812 HEP-INDUCED-PF4 (HIT PF4) $531.000002227023 HER2 ANALY, GASTROESOPHAGEAL $0.000002243881 HER-2 NEU ANALYSIS $0.000002230955 HER-2 NEU BY FISH METHOD $654.000002220737 HER-2/NEU, SERUM $291.000002267789 HERED FETAL HGB (HGB CASCADE) $406.000002225412 HEROIN METAB (OPIATES QT U) $93.000002226156 HEROIN METAB (URDRUGCOMP) $53.000002265756 HERPES SIMPLEX 1 (TORCH IGG) $70.000002265767 HERPES SIMPLEX 2 (TORCH IGG) $79.000002241188 HERPES SIMPLEX DIRECT DETECTIO $74.000002242201 HERPES SIMPLEX TYPE II - IGG $143.00

0002250724 HERPES SIMPLEX VIRUS CULT/TYPE $138.000002229189 HERPES VIRUS 6 AB, IGG $159.000002229145 HERPES VIRUS 7 AB, IGG/IGM $0.000002229178 HERPES VIRUS 7 DNA, QT, RT PCR $490.000002229156 HERPES VIRUS 7 IGG $183.000002229167 HERPES VIRUS 7 IGM $183.000002229756 HERPES VIRUS 8 DNA, RT-PCR $451.000002229767 HERPES VIRUS 8 IGG AB IFA Q $257.000002238275 HF CRP CARDIAC (HS) $18.000002267545 HGB EVAL REFLX CASCADE $57.000002267795 HGB LEPORE (HGB CASCADE) $375.000002263801 HGB S NEG SCR (MVRBC) $104.000002225373 HIAA-URINE $223.000002231425 HISTAMINE Q $108.000002224556 HISTAMINE, URINE $165.000002266456 HISTAMINE, WHOLE BLOOD $125.000002229631 HISTAMINE-PLASMA $89.000002265645 HISTOCHEM ENZ ST (MUSCLE BX MU $698.000002220723 HISTOCHEM ENZST,ADDL(MUSCLE BX $698.000002265656 HISTOCHEM ST (MUSCLE BX MU) $275.000002220712 HISTOCHEM ST, ADDL(MUSCLE BX M $275.000002220034 HISTOCHEM STAIN II $92.000002231281 HISTOPL AB (HISTOPL CF Q) $52.000002231283 HISTOPL AB ADDL(HISTOPL CF Q) $52.000002263401 HISTOPLASMA AB (HISTOPL AB CF) $69.000002263389 HISTOPLASMA AB BY CF $0.000002263412 HISTOPLASMA AB,ADDL(HIST AB CF $69.000002245943 HISTOPLASMA ABS (FUNG ABS) $42.000002237600 HISTOPLASMA ABS, BY ID $147.000002257701 HISTOPLASMA ABS,ADDL(FUNG ABS) $42.000002227152 HISTOPLASMA ANTIGEN EIA $187.000002250927 HISTOPLASMA ANTIGEN SERUM $238.000002231326 HISTOPLASMA CAPSUL ID Q $229.000002266501 HISTORICALLY AG NEG-MVRBC $73.000002226074 HIV 1 AB CONF, WB $467.000002225801 HIV 1,2 COMBO AB/AG W REFLEX $86.000002231362 HIV AB 1 (RF HIV AB DIFF Q) $51.000002231363 HIV AB 2 (RF HIV AB DIFF Q) $78.000002228601 HIV RAPID AB/AG 1/2 COMBO $194.000002250686 HIV-1 , GENOTYPE $802.000002241358 HIV-1 BY REVEAL RAPID $209.000002225860 HIV-1&2 ANTIBODY SCREEN $86.000002268023 HIV-2 AB, IB (RFLX CONFIRM) $185.000002257356 HIV-2 AB, IMMUNOBLOT $227.000002225875 HIV-2 ANTIBODIES BY EIA $340.000002222151 HIV-I-RNA-VIRAL LOAD $340.000002223334 HIV-PRENATAL $0.00

0002251267 HLA A DISEASE ASSOCIATION $532.000002226124 HLA B27 $140.000002225934 HLA DRB1,3,4,5,DQB1 (IR) $282.000002267078 HLA II TYP (CELIAC GENETICS) $410.000002226612 HLA II TYP 1 LOC ADDL(CELIAC $149.000002226601 HLA II TYP 1 LOC(CELIAC GENO) $149.000002226623 HLA II TYP ALLEL H(CELIAC GENO $133.000002267089 HLA II TYP,ADDL(CELIAC GENETIC $410.000002221327 HLA-B27 GENOTYPING, PCR $212.000002231208 HLA-B-5701 $283.000002268234 HLA-B5701 GENOTYPING $269.000002225956 HLA-DR GENO $479.000002228948 HOMOCYSTINE, PLASMA OR SERUM $81.000002221144 HPV BY PCR, TISSUE $329.000002269312 HPV HIGH RISK GENO,16&18,45 $192.000002244448 HPV HIGH RISK ONLY $140.000002252192 HSV 1 & 2,SPECIFIC AB,IGG-CLNT $0.000002230301 HSV 1 IGG (HSV 1/2 IGG Q) $103.000002230625 HSV 1 IGG (HSV AB PAN CFS Q) $67.000002230267 HSV 1 IGM (HSV 1/2 IGM Q) $39.000002230635 HSV 1 IGM (HSV AB PAN CSF Q) $67.000002252203 HSV 1, SPECIFIC AB, IGG $79.000002230312 HSV 2 IGG (HSV 1/2 IGG Q) $151.000002230647 HSV 2 IGG (HSV AB PAN CSF Q) $97.000002230657 HSV 2 IGM (HSV AB PAN CSF Q) $97.000002230278 HSV 2 IGM (HSV1/2 IGM Q) $57.000002231346 HSV 2 INHIBITION Q $362.000002252214 HSV 2, SPECIFIC AB,IGG $113.000002231162 HSV CULTURE Q $138.000002266845 HSV DNA AMP (HSV DNA BY PCR) $108.000002266856 HSV DNA AMP,ADDL(HSV DNA BY PC $108.000002266834 HSV DNA PCR $0.000002229607 HSV I & II, IGG $63.000002229599 HSV I & II, IGM $63.000002223777 HSV IGG - TORCH IGG $75.000002223812 HSV IGM - TORCH IGM $75.000002231475 HSV1 (HSV 1&2 DNA Q) $191.000002231476 HSV2 (HSV 1&2 DNA Q) $191.000002246293 HTLV I & II ABS PRELIMINARY $235.000002257212 HTLV I/II AB, WESTERN BLOT $239.000002245800 HUNTINGTON'S DISEASE BY PCR $462.000002225399 HVA (HOMOVANILLIC ACID) $180.000002225415 HYDROXCORTICOSTEROIDS-17 $252.000002225425 HYDROXYPREGNENOLONE - 17 $339.000002225571 HYDROXYPROGESTERONE-17-RIA $331.000002223312 HYDROXYPROLINE, LC/MS PLASMA $306.000002267423 HYPERSENS PNEUMONITIS PANEL $0.00

0002240406 IBCT (IRON PANEL) $47.000002246481 IBD PROFILE $0.000002264167 IBD SGI DIAGNOSTIC $0.000002255956 ID ENZYME CONSTITUENT, EA(PTH) $385.000002267456 IDF (HYPERSENS PNEUM) $14.000002267467 IDF,ADDL(HYPERSENS PNEUM) $14.000002220892 IEP - CSF $0.000002250089 IEP SERUM, CLIENT $0.000002250078 IEP U (IEP U24/RAN) $0.000002269512 IF AB IND(CROHNS PROG PROMETH) $52.000002267412 IF AB INDIRECT (IB SGI DIAG) $45.000002229901 IFA (PLA2R Q) $272.000002230506 IFA (RF PARANEO CBAIFA Q) $1,060.000002231202 IFA 1ST(RF PARANEO CBA CSF) $636.000002230518 IFA ADD(RF PARANEO CBAIFA Q) $1,060.000002231203 IFA ADDL(RF PARANEO CBA CSF) $636.000002260545 IFA URINE (FR LT CHAINS UR) $177.000002254189 IFE,OTHER,BETA-2 TRANSFERRIN $142.000002254178 IFE,SERUM BETA-2 TRANSFERRIN $109.000002229801 IGA (IGA SUBCLASSES Q) $80.000002222389 IGA BY NEPHELOMETRY $89.000002256578 IGA, CELIAC PEDIATRIC $29.000002229001 IGE (RAST COMP 2) $39.000002265712 IGE (RAST COMP FOOD) $54.000002228889 IGE (RAST MOLDS) $52.000002257289 IGE (RAST) $83.000002225449 IGE BY RIA $54.000002251906 IGF-1, INSULIN-LIKE GROWTH FAC $480.000002254278 IGF-BP3(INSULIN-LIKE GF BIND#) $136.000002230212 IGG (IGG SUBCLASSES Q) $31.000002229823 IGG ADD (IGA SUBCLASSES Q) $70.000002229812 IGG EA (IGA SUBCLASSES Q) $70.000002231006 IGG SUBCLASSES-(1-4) $0.000002227817 IGG SUBCLASSES-FRACTIONATED EA $27.000002231433 IGG,IGA (IGG, IGA DIRECT IF Q) $313.000002231434 IGG,IGAADD(IGG,IGA DIRECT IFQ) $36.000002229601 IGH AMP (B-CELL CLON Q) $327.000002264901 IGH/BCL-1 FISH (CYCLIN-D1) $0.000002229612 IGK REARR (B-CELL CLON Q) $257.000002261934 IGVH MUTATION $749.000002224757 IHC 1ST (BCP) $428.000002231228 IHC 1ST (CARIS MI PROF) $224.000002224886 IHC 1ST (PD-L1) $428.000002267591 IHC AB STAIN (MISMATCH REPAIR) $428.000002231226 IHC ADD (CARIS MI PROF) $50.000002231227 IHC ADD, EACH (CARIS MI PROF) $50.000002224791 IHC ADDL (BCP) $428.00

0002224897 IHC ADDL (PD-L1) $63.000002248402 IHC ADDL-RENAL MAYO $74.000002267578 IHC SLIDE EA (MISMATCH) $63.000002267589 IHC SLIDE EA,ADDL (MISMATCH) $63.000002222494 IHC SPECIAL STAIN, BM $248.000002248410 IHC, EA ADDL-RENAL MAYO $74.000002268556 IHC, EACH ADDL $143.000002268545 IHC, FIRST $428.000002248396 IHC-RENAL MAYO $360.000002231420 IMMUNE CPLX DETECT BY CIQ Q $165.000002231305 IMMUNO (ADALIMUMAB Q) $208.000002269478 IMMUNO (CROHNS PROG PROMETH) $34.000002229889 IMMUNO (PLA2R Q) $351.000002231309 IMMUNO (PLT AB SCR Q) $61.000002231311 IMMUNO ADDL (PLT AB SCR Q) $61.000002236677 IMMUNO FLUORESCENT STUDY-PB TO $457.000002229256 IMMUNO NON AB (PEMPHIGUS) $34.000002229267 IMMUNO NON AB (PEMPHIGUS) $34.000002227634 IMMUNO QT (AUTOIMM DYSAUTO) $156.000002268256 IMMUNO-(MYASTH GRAVIS PAN) $129.000002261467 IMMUNO, QNT, NON AB-PARANEO $108.000002268267 IMMUNO,ADD'L(MYASTH GRAVIS PA $129.000002220443 IMMUNO. INF AGENT (14-3-3 PROT $135.000002269489 IMMUNOADD(CROHNS PROG PROME $34.000002261401 IMMUNOASSAY - ANNEXIN V $205.000002269423 IMMUNOASSAY (CELIAC SERO) $25.000002227367 IMMUNOASSAY (CROHN DIS PROGNO $78.000002267112 IMMUNOASSAY (CROHNS PROG) $53.000002227501 IMMUNOASSAY (NEUTCYTO) $67.000002269545 IMMUNOASSAY (RF CROHNS PROG) $135.000002229845 IMMUNOASSAY (SENS-MOTOR Q) $21.000002267378 IMMUNOASSAY ADD(IBD SGI DIAG) $36.000002227512 IMMUNOASSAY ADDL (NEUTCYTO) $67.000002227378 IMMUNOASSAY ADDL(CROHN DIS PR $78.000002229856 IMMUNOASSAY ADDL(SENS-MOTOR $21.000002264201 IMMUNOASSAY QT (IBD SGI) $38.000002264212 IMMUNOASSAY QT, ADDL (IBD SGI) $38.000002267367 IMMUNOASSAY(IBD SGI DIAG) $36.000002261412 IMMUNOASSAY, ADDL-ANNEXIN V $205.000002269434 IMMUNOASSAY,ADDL (CELIAC SERO) $25.000002267123 IMMUNOASSAY,ADDL (CROHNS PROG $53.000002251505 IMMUNOASSAY,QT ADDL PNEUMO IM $11.000002251498 IMMUNOASSSAY,QT,1ST,PNEUMO IM $11.000002262745 IMMUNODEFICIENCY PANEL, LYMPH $0.000002250114 IMMUNOFIX (IEP, SERUM) $82.000002251067 IMMUNOFIX, (CSF IEP) $74.000002250067 IMMUNOFIX, (IEP U 24/RAN) $74.00

0002261691 IMMUNOFIX, REFLEX (IEP CSF) $82.000002257023 IMMUNOFIX, REFLEXED (SPEP) $82.000002250151 IMMUNOFIX,REFLEX (UPEP 24/RAN) $82.000002229234 IMMUNOFLR AB 1ST (PEMPHIGUS) $498.000002229245 IMMUNOFLR AB ADDL (PEMPHIGUS) $68.000002231358 IMMUNOG (IGG SYNTH CSF Q) $36.000002231359 IMMUNOG 2 (IGG SYNTH CSF Q) $36.000002269412 IMMUNOGLOB (CELIAC SERO) $12.000002253912 IMMUNOGLOB A (CELIAC SCRN) $41.000002229466 IMMUNOGLOBULIN D $206.000002229375 IMMUNOGLOBULIN A $162.000002252889 IMMUNOGLOBULIN A (CELIAC) $37.000002246826 IMMUNOGLOBULIN A (IGG,A,M) $162.000002246782 IMMUNOGLOBULIN A (IGG,A,M,E) $162.000002246804 IMMUNOGLOBULIN E (IGG,A,M,E) $135.000002222207 IMMUNOGLOBULIN IGG/IGA/IGM (IG $0.000002239622 IMMUNOGLOBULIN IGG/IGA/IGM/IG $0.000002229920 IMMUNOGLOBULIN-G $155.000002246815 IMMUNOGLOBULIN-G (IGG,A,M) $154.000002246779 IMMUNOGLOBULIN-G (IGG,A,M,E) $154.000002229912 IMMUNOGLOBULIN-M $155.000002246837 IMMUNOGLOBULIN-M (IGG,A,M) $154.000002246793 IMMUNOGLOBULIN-M (IGG,A,M,E) $154.000002236701 IMMUNOHISTOCHEMISTRY TO REF (I $428.000002236402 IN SITU (BCP) PTH $370.000002236406 IN SITU, ADDL (BCP) PTH $336.000002230400 INDIRECT FLUORESCENT ABS-ANCA $268.000002220325 INFL DNA AMP (INFL RNA,RT-PCR) $168.000002220336 INFL DNA AMP ADDL(INFL RNA,RT- $42.000002220348 INFL DNA AMP ADDL+(INFL RNA,RT $42.000002230902 INFLIXIMAB $355.000002269589 INFLIXIMAB (IFX) CONC & ABS $0.000002230594 INFLU A&B QL PCR Q $418.000002238200 INFLUENZA A&B PANEL $0.000002257156 INFLUENZA A&B, IGG/IGM $0.000002257167 INFLUENZA AB (INFLU A&B AB QT) $45.000002257178 INFLUENZA AB ADDL(INFLU AB QT) $45.000002258767 INFLUENZA AMP (INFLU RT-PCR) $181.000002258778 INFLUENZA AMP ADDL(INFLU RT-PC $181.000002258756 INFLUENZA RNA, QUAL RT-PCR $0.000002238212 INFLUENZA-A-ANTIGEN (PANEL) $88.000002238215 INFLUENZA-B-ANTIGEN (PANEL) $88.000002262689 INHIB SCRN RFLX(LUPUSANTI STAT $155.000002231439 INHIBIN A $112.000002256067 INHIBIN A $223.000002231440 INHIBIN B $165.000002256078 INHIBIN B $281.00

0002222467 INHIBITOR SCREEN (BHC REFLX) $140.000002220178 IN-SITU 1-300 (FPOC FISH) $196.000002256289 INSULIN ANTIBODIES, SERUM $122.000002225456 INSULIN LEVEL $114.000002226611 INSULIN LEVEL TOLERANCE FIRST $50.000002226629 INSULIN LEVEL-TOLERANCE, EACH $50.000002263323 INSULIN, 3 SPECIMENS $0.000002253489 INSULIN, 4 SPECIMENS $0.000002260234 INSULIN, FREE & TOTAL $0.000002260245 INSULIN, FREE (INS FREE TOTAL) $45.000002229441 INSULIN, TOTAL (INS FREE TOT) $62.000002255723 INSULIN-1ST OF 6 SPECIMENS $39.000002255712 INSULIN-6 SPECIMENS $0.000002255734 INSULIN-EA ADD'L OF 6 SPECIMEN $39.000002264523 INTERFERON B NEUT. AB W RFX $341.000002268101 INTERFERON GAMMA BY MAFD $198.000002268078 INTERLEUKIN 1 BETA BY MAFD $198.000002268089 INTERLEUKIN 10 BY MAFD $198.000002265745 INTERLEUKIN 5 BY MAFD $219.000002261023 INTERLEUKIN 6 BY MAFD $194.000002231441 INTERLEUKIN-2 RECEPTOR $239.000002252778 INTERLEUKIN-2 RECEPTOR ALPHA $614.000002231147 INTERLEUKIN-6 Q $183.000002230367 INTERP (FISH AML M3 Q) $134.000002260489 INTERP (ZAP-70 FLOW CYT) $87.000002220489 INTERP/REP (FPOC FISH) $109.000002265856 INTERP/REPORT (CPM FISH) $408.000002258212 INTERP/REPORT (FISH CLL) $86.000002244115 INTERP/REPORT (FISH MM) $109.000002260912 INTERP/REPORT (PML FISH) $123.000002260634 INTERP/REPORT, FISH ALL $374.000002260767 INTERP/REPORT, FISH LYM AGG $99.000002260834 INTERP/REPORT, FISH MPD $365.000002254134 INTERP/REPORT-AML FISH PANEL $99.000002265489 INTERP/REPT (CA-LYMPH NODE) $50.000002226723 INTERPRETATION (C/A ONC) $44.000002250482 INTRAOPERATIVE CONSULT $275.000002250493 INTRAOPERATIVE CONSULT ADDTL $228.000002251146 INTRAOPERATIVE CONSULT-GROSS $275.000002225928 INTRINSIC FACTOR-ANTIBODY $177.000002266712 IODIDE, SERUM OR PLASMA $143.000002221405 IODINE, SERUM $276.000002230322 IONIZED CALCIUM-REFERENCE LAB $115.000002230322 IONIZED CALCIUM-REFERENCE LAB $115.000002259323 IONIZED MAGNESIUM $146.000002240166 IRON $54.000002240395 IRON (IRON PANEL) $54.00

0002231413 IRON BINDING CAPACITY $47.000002240384 IRON PANEL $0.000002236222 IRON STAIN-GOMORI'S $109.000002254078 IRON STAIN-REF LAB $238.000002222251 IRON, QUANT. PARAFFIN BLOCK $537.000002231460 ISH MAN (HER2 NEU FISH Q) $376.000002231461 ISH MAN ADDL (HER2 NEU FISH Q) $376.000002269701 ISH, 1ST (NEO-SITE MELANOMA) $250.000002269712 ISH, ADDL (NEO-SITE MELANOMA) $250.000002220138 ISH, EA ADDL PROBE (BM TC) $146.000002220135 ISH, EA PROBE (BM TC) $146.000002227656 ISLET CEL AB (AUTOIMM DYSAUTO) $219.000002231078 ISLET CELL (PARANEO CSF Q) $504.000002231199 ISLET CELL (RF PARANEO WB CSF) $293.000002230479 ISLET CELL AB(RF PARANEO WB Q) $236.000002245987 ISOHEMAGGLUTININ TITER $236.000001030498 ISS CHG, APHE PLR, LR, IRR $2,788.000001030479 ISS CHG; RBC, LR, WASHED $574.000002269556 ITRACONAZOLE, QUANT $179.000002262323 JAK2 EXON12 MUTATION $623.000002251157 JAK2 V617 MUTATION ANALYSIS $457.000002231156 JAK2V617F CASCADE Q $351.000002264112 JC AB (JC/BK PCR) $392.000002258267 JC VIRUS QUAL, PCR $486.000002245555 KEPPRA LEVEL (LEVETIRACETAM) $177.000002226167 KETAMIN/NORKET. (URDRUGCOMP) $53.000002263334 KETAMINE, SERUM/PLASMA $201.000002231710 KETONES-BLOOD $27.000002220370 KETOSTEROIDS-17, URINE $0.000002225472 KETOSTEROIDS-17-TOTAL $123.000002224857 KI-67 (MIB1) BREAST IHC $428.000002222095 KI-67 (MIB1) IHC $248.000002264667 KIDNEY STONE RISK PANEL $0.000002222189 KIT GENE TGT SEQ (GIST) $618.000002234185 KOH PREP $66.000002268923 KRAS MUTATION $601.000002231444 KRAS VAR (KRAS MUTATION Q) $179.000002231445 KRAS VAR 2 (KRAS MUTATION Q) $179.000002261256 LACOSAMIDE (VIMPAT) LEVEL $307.000002232015 LACTIC ACID $50.000002232026 LACTIC ACID, CSF $198.000002226923 LACTOBACILLUS,NAA(VAG PAN NAA) $56.000002269389 LACTOFERRIN, FECAL $88.000002249058 LACTOFERRIN, FECAL, QUALITATIV $306.000002224045 LACTOFERRIN,FECAL,QUANTITATIVE $133.000002266267 LACTOFERRIN,STOOL,QUANTITATIVE $305.000002226967 LACTOSE TOLERANCE $0.00

0002261589 LACTOSE, ADD'L SAMPLES $17.000002261567 LACTOSE, FIRST 3 SAMPLES $45.000002261578 LACTOSE, FOURTH SAMPLE $17.000002241199 LAMELLAR BODIES $159.000002221099 LAMICTAL LEVEL $67.000002234581 LAP (LEUKOCYTE ALKALINE PHOS.) $108.000002240281 LDH $54.000002250735 LDH (LDH ISOENZYME) $47.000002240434 LDH BODY FLUID $86.000002240445 LDH CSF $86.000002250746 LDH FRACTIONS (LDH ISOENZYME) $91.000002239705 LDH ISOENZYMES $0.000002231236 LEAD (HVY MET BLD Q) $35.000002226538 LEAD LEVEL $116.000002221449 LEAD LEVEL, PEDIATRIC $116.000002244724 LEAD LEVEL, URINE (HVY MET U) $53.000002243112 LEAD LEVEL-HEAVY METALS BLOOD $162.000002225878 LEAD, FINGERSTICK FILTER PAPER $94.000002251249 LEAD, URINE (HVY MET II) $50.000002230993 LEFLUNOMIDE METAB Q $210.000002221589 LEFLUNOMIDE METABOLITE $166.000002251123 LEGIONELLA SPECIES CULTURE $137.000002237659 LEGIONELLA-ANTIGEN-URINE $223.000002222081 LEGOINELLA T ABS $63.000002269723 LEPTIN, SERUM 83520 $172.000002228138 LEPTOSPIRA ABS,IGM BY DOT BLOT $338.000002264012 LEUKOCYTE ADHESION DEF PANEL $0.000002230167 LEUKOVANTAGE MDS $3,885.000002268934 LEVEL IV,MAYO RENAL WET TISSUE $522.000002263701 LEWIS/P1 PLAS NEUT (MVRBC) $177.000002263367 LH ( FSH & LH) $140.000002233651 LIDOCAINE,SERUM $143.000002231165 LIPASE $67.000002221434 LIPASE, BODY FLUID $117.000002230935 LIPID PAN (LIPID INFLAM Q) $49.000002260856 LIPID PANEL (NMR LIPOPRO) $67.000002251012 LIPID PROF FOR LIPO ELECTROPHR $83.000002231504 LIPID PROFILE W/CORONARY RISK $143.000002228256 LIPID-BHRT PANEL $17.000002230989 LIPOPROT PLA2 (LIPID INFLAM Q) $136.000002230968 LIPOPROT Q (LIPID INFLAM Q) $42.000002230946 LIPOPROT QT (LIPID INFLAM Q) $74.000002248022 LIPOPROTEIN (A) (LITTLE A) $121.000002251000 LIPOPROTEIN ELECTROPHORES,CLN $0.000002251023 LIPOPROTEIN ELECTROPHORESIS $71.000002229678 LIPOPROTEIN FRACT,ION MOBILITY $67.000002260867 LIPOPROTEIN NMR (NMR LIPOPROF) $151.00

0002268956 LIQ PREP (UROVYSION) $251.000002226546 LITHIUM $57.000002252335 LITHIUM, STAT TO SMHC $168.000002268156 LIVER CYTOSOL(LC-1)AUTOANTIBDY $282.000002227867 LIVER FIBROSIS HCV $0.000002220067 LIVER FIBROSIS TEST,CHRONICHCV $324.000002245723 LIVER-KIDNEY(LKM) MICROSOMAL A $102.000002261656 LORAZEPAM $181.000002225778 LP-PLA2(LIPOPROT-ASSOC PHA2) $140.000002266612 LUPUS ANTICOAG PROF-MAYO $0.000002262612 LUPUS INHIBITOR W RFLX $0.000002221692 LUPUS PROF B (SLE B) $0.000002256801 LUPUS W REFLEX $0.000002225498 LUTENIZING HORMONE $140.000002223465 LUTENIZING HORMONE & FSH $0.000002258789 LYME ABS, CSF $159.000002227534 LYME DIS (TICK PROF) $59.000002252280 LYME DISEASE ANTIBODY $92.000002241801 LYME DISEASE BY PCR $217.000002228658 LYME DISEASE-WESTERN BLOT $0.000002244148 LYME DISEASE-WESTERN BLOT-IGG $75.000002244159 LYME DISEASE-WESTERN BLOT-IGM $75.000002267901 LYME, RFLXD IGG WEST.BLOT $75.000002267912 LYME, RFLXD IGM WEST.BLOT $75.000002252745 LYMPHOCYTE PROLIF MITOGENSLPM $0.000002263212 LYMPHOCYTE SUBSET PANEL 5 $0.000002258734 LYMPHOCYTE TRANSFORM ADDL(LPM $217.000002258723 LYMPHOCYTE TRANSFORMATION(LPM $217.000002220373 LYSOZYME - (MURAMIDASE) $108.000002231287 M AVIUM MIC PANEL Q $263.000002268512 M PNEUMO (RVP) $66.000002229367 M/MET FISH (AGGR B-CEL FISH) $407.000002229378 M/MET FISH ADD(AGGR B-CEL FISH $407.000002224921 M/PH IS MANUAL (MDS EXT FISH) $408.000002224932 M/PH ISH COMP ASST(MDS EXT FIS $408.000002223134 M/PHMET ISH (FISH EOS) $474.000002223145 M/PHMET ISH ADDL (FISH EOS) $474.000002222789 M/PHMETRIC (FISH MM-CLAR.) $493.000002227045 M/PHMETRIC (HER2 GASTROESOPHA $173.000002222801 M/PHMETRIC ADDL (FISH MM-CLAR) $493.000002226856 M/PHMETRIC(FISH AGGR B CELL) $428.000002226867 M/PHMETRIC-ADD(FISH AGGR B CEL $428.000002267654 M/PHMT ISH QT/SEM(HER2-NEU AN) $428.000002236404 M/PHMTRC ALYS ISH (BCP) $48.000002260223 MACRO EXAM PREP W/INTRAOP (MA $40.000002260212 MACRO EXAM PREP-MAMMAPRINT $54.000002258534 MAG AB IGM (MOTORNEU) $83.00

0002240323 MAGNESIUM SERUM $56.000002254789 MAGNESIUM, URINE $78.000002234607 MALARIA SMEAR $147.000002231225 MALARIA/BABESAI/OTH PARASITE Q $75.000002231314 MALB (MALB/CRT 24 Q) $75.000002227858 MANGANESE, BLOOD $135.000002234775 MANUAL BLOOD SMEAR EXAM W/O $0.000002260456 MARKER 1 (ZAP-70 FLOW CYT) $254.000002260467 MARKER ADDL 1(ZAP-70 FLOW CYT) $60.000002260478 MARKER ADDL 2(ZAP-70 FLOW CYT) $60.000002235136 MATURATION INDEX-CYTO $39.000002236695 MAYO CONSULT-COMPREHENSIVE $690.000002236653 MAYO CONSULT-PTH BLOCK $690.000002236621 MAYO CONSULT-PTH SLIDE ONLY $690.000002225079 MDMA U (AMPHET CONF QT, U) $52.000002224919 MDS EXTENDED FISH PANEL $0.000002260023 MDS PANEL BY FISH $0.000002231148 MEASLES AB, IGG Q $67.000002222960 MEPERDINE SERUM $235.000002228956 MERCAPTOPURINE, SERUM/PLASMA $151.000002231237 MERCURY (HVY MET BLD Q) $41.000002231317 MERCURY, BLOOD Q $61.000002246957 MERCURY, HAIR $521.000002244735 MERCURY, URINE (HVY MET U) $70.000002251256 MERCURY,URINE (HVY MET II) $63.000002228633 MERCURY-BLOOD $305.000002243123 MERCURY-HEAVY METALS, BLOOD $162.000002228623 MET EXON 14 MUTATION ANALYSIS $666.000002242045 METANEPHRINE,FRACTIONATED PLAS $151.000002255878 METANEPHRINES, URINE QUANT $188.000002248000 METHOTREXATE $175.000002228930 METHYLMALONIC ACID $353.000002260923 METHYLMALONIC ACID, URINE $97.000002225090 METHYLP U (AMPHET CONF QT, U) $52.000002226178 METHYLPHENIDATE (URDRUGCOMP) $53.000002264912 M-FISH (CYCLIN-D1) $230.000002264923 M-FISH ADDL, (CYCLIN-D1) $230.000002229123 MIC SENSITIVITY MU, EACH $61.000002223389 MIC-ANAEROBE TO REF LAB $109.000002259025 MICRO DISSECT (EGFR ANALYSIS) $59.000002224713 MICROALBUMIN (U MALB 24HR) $28.000002244645 MICROALBUMIN QUANT (MALB/CREA $132.000002224693 MICROALBUMIN, 24 HR URINE $0.000002252357 MICROALBUMIN,TIMED URINE,REF $132.000002244634 MICROALBUMIN/CREATININE RATIO $0.000002229997 MICROALBUMIN-URINE $132.000002221267 MICRODISSECT (MSI BY PCR) $42.00

0002269989 MICRODISSECT MAN (NRAS DETECT) $44.000002259156 MICRODISSECTION (EGFR MUTATION $172.000002261189 MICRODISSECTION (GIST MUT) $408.000002222145 MICRODISSECTION (GIST) $634.000002224112 MICROSPORIDIA STAIN $0.000002267567 MISMATCH REPAIR PROTEINS, IHC $0.000002220767 MIXING ASSAY, PT $0.000002220812 MIXING ASSAY, PTT $0.000002263067 MLH1 PROMOTER $0.000002263134 MMR IMMUNITY $0.000002269945 MO PATH L 4 (BETA GLOB SEQ) $827.000002269978 MO PATH L5 (NRAS DETECT) $199.000002228701 MOG-IGG1 FACS ASSAY $628.000002228723 MOG-IGG1 FACS, TITER $152.000002267178 MOLEC PATH INT/REP(GALT PANEL) $412.000002269534 MOLEC PTH L2 (RF CROHNS PROG) $243.000002225678 MONO CELL AG (CD57 NK CELLS) $62.000002220501 MONO CELL AG (NK CELL PANEL) $44.000002220567 MONO CELL AG ADDL (NK CELL PAN $44.000002238442 MONO SLIDE $44.000002247073 MONOMUC. CELL AG (PNH) $168.000002266478 MONONUC CELL AG,1ST(PNH FLAER) $150.000002266489 MONONUC CELL AG,ADDL(PNH FLAER $150.000002247084 MONONUC. CELL AG ADDL (PNH) $168.000002267101 MOPATH 2 (CROHNS PROG) $21.000002228467 MOPATH L5 (ELANE) $1,860.000002229945 MOPATH L6 (TP53 SEQ DEL/DUP Q) $476.000002267323 MOPATH UNLIST (IBD SGI DIAG) $28.000002267334 MOPATH UNLIST ADD(IBD SGI DIAG $28.000002225578 MOPTH (PANCREAT. PANEL) $947.000002225556 MOPTH L5 (PANCREAT. PANEL) $974.000002225567 MOPTH L5 ADDL (PANCREAT PANEL) $974.000002224835 MORPH IS COMP (BCP) $428.000002224846 MORPH ISH COMP (BCP) $428.000002236400 MORPH TUMOR (BCP) PTH $214.000002258479 MORPH. IN-SITU QT(EGFR FISH) $330.000002224156 MORPH/M ADDL FISH CLL $409.000002224145 MORPH/M FISH CLL $409.000002228401 MORPHEMETRIC (FISH AML) $450.000002228412 MORPHEMETRIC ADDL (FISH AML) $450.000002250638 MOTOR SENSORY-NEUROPATHY PRO $0.000002223456 MPL CODON 515 MUTATION DETECT $612.000002231209 MPL MUTATION ANALYSIS $349.000002227434 MPO ABS (ANCA PANEL-LC) $50.000002269467 MPTH L2, CROHNS PROG PROMETH $60.000002262923 MRSA SCREEN $78.000002262930 MRSA SCREEN, ADDL $78.00

0002221743 MSH-ALPHA(MELANOCYTE STIM HOR $309.000002261323 MSH-BETA(MELANOCYTE STIM HORM $394.000002261334 MSH-GAMMA(MELANOCYTE STIM HO $394.000002231449 MSI (MICROSAT INSTAB) Q $213.000002221256 MSI (MSI BY PCR) $645.000002221245 MSI BY PCR $0.000002227101 MTHFR (THROMB RISK) $158.000002246189 MTHFR-METHYLENETETRAHYDROFOL $158.000002236172 MUCICARMINE STAIN-HAYER $83.000002242945 MUCOPOLYSACCHARIDES, URINE QT $208.000002266556 MULTIMERIC (VWF MULTIMER) $74.000002244060 MULTIPLE MYELOMA FISH PANEL $0.000002263145 MUMPS (MMR IMMUNITY) $53.000002221764 MUMPS ABS IGM $86.000002221785 MUMPS ASB IGG $86.000002236131 MUSCLE STUDY-E.M. TO MUMC $3,305.000002231424 MUSHROOM (F212) IGE $54.000002220701 MV AB ELUT W LISS WASH $202.000002228656 MV ABID-PLT AB $84.000002228667 MV HLA AB I&II AB QUAL $239.000002228678 MV HLA-A MOLEC PHENOYTYPE PER $362.000002228689 MV ISXM $309.000002220645 MV PRETREAT RC ADSORP $158.000002220687 MV PRETREAT W CHEM/DRG $174.000002228645 MV XM AHG $186.000002228634 MV XM INCUBATE $186.000002263992 MVRBC RBC MOLEC PHENOTYPING $487.000002268245 MYASTHENIA GRAVIS PAN $0.000002227167 MYCOBACTERIUM TB-DNA PROBE $159.000002253501 MYCOPHENOLIC ACID & METABOLITE $230.000002230467 MYCOPLASMA ANTIBODY-IGG TO REF $58.000002230478 MYCOPLASMA ANTIBODY-IGM TO RE $58.000002228567 MYCOPLASMA ANTIBODY-IGM/IGG $0.000002226978 MYCOPLASMA GENITALIUM, NAA $142.000002269289 MYD88 L265P MUT BY PCR, QT $517.000002231392 MYD88 MUTATION ANALYSIS Q $440.000002225623 MYELIN ASSOC GLYCO(MAG AB,IGM) $140.000002225605 MYELIN BASIC PROTEIN CSF $119.000002229867 MYELIN OLICG. CLYCO SER RFX $857.000002228389 MYELOID MALIG. MUTATION BY NGS $3,833.000002222240 MYELOPERIOXIDASE ABS $151.000002238467 MYOGLOBIN QUALITATIVE $116.000002243444 MYOGLOBIN QUANTITATIVE, URINE $226.000002225043 MYOGLOBIN, SERUM $133.000002264945 MYOSITIS AB 2 PANEL $0.000002264956 MYOSITIS AB,1ST(MYOSITIS AB 2) $59.000002264967 MYOSITIS AB,ADDL(MYOSITIS AB2) $59.00

0002245522 MYSOLINE $0.000002220695 N GONORRHEA - DNA SDA $137.000002238970 N. MENINGITIDIS ANTIGEN $66.000002238996 N. MENINGITIDIS-A&Y $66.000002238988 N. MENINGITIDIS-GROUP B $66.000002264123 NAP QT (BK/JC PCR) $477.000002263267 NARCOLEPSY HLA-DQB1 GENOTYPE $351.000002224567 NASH FIBROSURE $0.000002220467 NATURAL KILLER CELL PANEL $0.000002269689 NEO-SITE MELANOMA PANEL FISH $0.000002224649 NEPH (NASH FIBRO) $107.000002264078 NEPH. (FIBROSPECT) $206.000002227878 NEPHALOMETRY (LIVR FIBR HCV) $126.000002260523 NEPHELOMETRY,ADDL(FR LT CH UR) $86.000002260512 NEPHELOMETRY,FIRST(FR LT CH UR $86.000002265134 NEUROKININ A (SUBSTANCE K) $381.000002229904 NEURON SPECIFIC ENDLASE (NSE) $268.000002267923 NEURONAL NUC AB,IGG,IMMUNOBLO $203.000002250649 NEUROPATH,IMMUNOASSAY,FIRST $40.000002250664 NEUROPATHY,FLUORESCENT $47.000002250653 NEUROPATHY,IMMUNOASSAY,ADDTL $40.000002247674 NEUTROPHIL ANTIBODY $219.000002264867 NHL-FISH $0.000002262067 NIACIN (VITAMIN B3) $198.000002230366 NICKEL, SERUM $212.000002230366 NICKEL, SERUM $212.000002256001 NICOTINE & METABOLITES, URINE $186.000002229345 NK CELL KIR $567.000002263234 NK CELLS, TOTAL (LYMPH SS 5) $71.000002262767 NK CELLS,TOTAL(IMMUNODEF PANEL $122.000002225689 NK TOTAL (CD57 NK CELLS) $122.000002224089 NMDA G CSF $279.000002224101 NMDA G CSF TITER $206.000002231207 NMDA RECEPTOR SER OR CSF $683.000002228848 NMDA-R AB IF TITER CSF $174.000002267623 N-METHYLHISTAMINE, URINE $322.000002228789 NMO/AQP4 FACS CSF $345.000002228801 NMO/AQP4 FACS TITER CSF $151.000002260845 NMR LIPOPROFILE $0.000002250578 NOROVIRUS GI/GII PCR $345.000002228712 NORTRIPTYLINE $118.000002262823 NPM1 MUTATION BY PCR $519.000002269967 NRAS DETECT PYROSEQUENCING $0.000002229787 NRAS GENE VARIANT 2&3 (NRAS) $574.000002231446 NRAS MUTATION Q $357.000002231316 N-TELOPEPTIDE, SERUM Q $180.000002261856 N-TELOPEPTIDE,CROSS-LINKED,SER $255.00

0002230857 NT-PRO BNP $126.000002231390 NUC AG (MYOSITIS AB Q) $30.000002231400 NUC AG (SYS SLERO 12 Q) $131.000002231240 NUC AG A ADDL(SM,SM/RNP ABS Q) $47.000002231239 NUC AG AB (SM,SM/RNP ABS Q) $47.000002231391 NUC AG ADD (MYOSITIS AB Q) $30.000002231401 NUC AG ADD (SYS SCLERO 12 Q) $131.000002261878 NUCLEAR AG AB (ANA COMP BF) $57.000002261889 NUCLEAR AG AB,ADDL(ANA COMP BF $57.000002226884 NUCLEOTIDASE-5 $103.000002253689 O & P SCREEN $0.000002234201 O&P - REF LAB $48.000002241534 O&P STAIN - REF LAB $94.000002238483 OCCULT BLOOD, FECAL $31.000002238456 OCCULT BLOOD, FECAL, ICT $44.000002238793 OCCULT BLOOD, GASTRIC $48.000002228501 OLIGOSACCHARIDE SCR, URINE $470.000002258256 ONCOTYPE DX-GENOMIC HEALTH INC $7,797.00E002270015 OPIATES $125.000002225434 OPIATES (OPIATES QT U) $93.000002223401 OPIATES (U OPIATES QUANT) $80.000002226189 OPIATES 1/MORE (URDRUGCOMP) $53.000002267867 OPIATES CONFIRMATION, URINE $116.000002231337 OPIATES CONF-MEC Q $175.00E002270017 OPIATES W CONFIRMATION S/P $4.000002225367 OPIATES, CONFIRM, BLD $143.000002225401 OPIATES, QUANT URINE $0.000002265701 OPIATES, QUANT, URINE $0.000002265123 OPIATES,CONFIRMATION SERUM/PLA $0.000002226201 OPIOIDS & OPIATES (URDRUGCOMP) $53.000002225037 OR/CT CYTO EXAM EA ADDL SITE $228.000002225018 OR/CT CYTO EXAM INITIAL SITE $275.000002250978 ORGANIC ACID,PLASMA $577.000002224515 ORGANIC ACIDS, QUALITATIVE $412.000002231389 OSMOLALITY SERUM $74.000002231397 OSMOLALITY, URINE RANDOM/TIMED $74.000002231071 OSMOLALITY-BODY FLUID $74.000002231046 OSMOLALITY-STOOL $135.000002222590 OSMOTIC FRAGILITY-REF $99.000002231418 OSTEOCALCIN Q $110.000002248363 OSTEOCALCIN, SERUM $154.000002262889 OVA1 $1,053.000002229323 OXALATE, SERUM $147.000002225688 OXALATE-URINE 24 HOUR $83.000002267889 OXIDIZED LDL $186.000002223423 OXYCODONE (U OPIATES QUANT) $80.000002225445 OXYCODONE SCR (OPIATES QT U) $93.00

E002270016 OXYCODONE SCREEN $125.000002225378 OXYCODONE, CONFIRM, BLD $143.000002265867 OXYCONTIN SCREEN, URINE $50.000002232205 P K U-PHENYLALANINE $183.000002268567 P1 NEUT (MVRBC) $159.000002269501 PANCA (CROHNS PROG PROMETH) $336.000002267401 PANCA (IBD SGI DIAG) $294.000002227467 P-ANCA TITER (ANCA PANEL-LC) $42.000002227478 P-ANCA TITER (ANCA PANEL-LC) $42.000002265145 PANCREASTATIN $327.000002249069 PANCREATIC ELASTASE, FECAL $254.000002252291 PANCREATIC POLYPEPTIDE $315.000002225534 PANCREATITIS PANEL, SEQ $0.000002268212 PARAINFL AB (PARAINF IGG-IGM) $61.000002268223 PARAINFL AB,ADDL(PARAINF IGG-I $61.000002268201 PARAINFLUENZA, ABS, IGG/IGM $0.000002228756 PARANEO AUTOAB WBLOT CSF $368.000002268678 PARANEOPL AB EVAL, CSF-MAYO $0.000002261545 PARANEOPLASTIC AB EVALUATION $0.000002255378 PARATHYROID HORMONE INTACT $282.000002220518 PARATHYROID PROFILE $0.000002226165 PARIETAL CELL ANTIBODY $168.000002247062 PAROXYMAL NOCTURNAL HEMOGLO $0.000002231478 PARVOVIRUS B19 DNA QT PCR Q $182.000002259301 PARVOVIRUS B-19, PCR $261.000002227163 PARVOVIRUS BI9 (PROFILE) IG G/ $0.000002247685 PARVOVIRUS BY PCR, PARAFFIN BL $277.000002241645 PARVOVIRUS-IGG $115.000002229862 PARVOVIRUS-IGM $115.000002269112 PAS (RENAL MAYO) $201.000002236180 PAS STAIN-MCMANNUS $102.000002231134 PATH CONS (LUPUS PHOSPHO Q) $74.000002227012 PCA3-PROSTATE CANCER GENE 3 $618.000002267812 PCP CONFIRMATION, URINE $116.000002231336 PCP CONF-MEC Q $175.000002225467 PCP QUANT, URINE $167.000002225356 PCP, CONFIRM, BLD $143.000002228489 PD2T-POMPE DIS 2ND-TIER NB SCR $286.000002222223 PDGFRA GENE (GIST) $618.000002231230 PD-L1 (22C3)(CARIS ALK/PD-L1 P $175.000002224868 PD-L1 BY IHC $0.000002269056 PEANUT ALLRGN, IMMUNOCAP $65.000002269089 PECAN ALLRGN, IMMUNOCAP $65.000002229223 PEMPHIGUS ANTIBODY PANEL $0.000002223746 PEPSINOGEN I (PGI) $335.000002223766 PEPSINOGEN II (PGII) $411.000002234758 PERIPHERAL SMEAR TO PATHOLOGIS $62.00

0002259989 PFA-100 (PLATELET FUNCT ASSAY) $0.000002238713 PH BODY FLUID (NOT BLOOD) $35.000002238772 PH URINE $39.000002258234 PHAGOCYTOPHILUM IGG $184.000002258245 PHAGOCYTOPHILUM IGM $184.000002231436 PHEN(PHENYL & TYROSINE Q) $131.000002245533 PHENOBARB (MYSOLINE) $50.000002233336 PHENOBARB SERUM QUANT $114.000002231275 PHENOTYP (HIV-1 GENOTYPE Q) $229.000002227323 PHENOTYPE (HCV G3 NS5A) $348.000002224256 PHENOTYPE (HCV NS5A) $348.000002268523 PHENYLALAMINE MONITOR, PLASMA $104.000002262978 PHENYLALANINE $133.000002262967 PHENYLALANINE & TYROSINE $0.000002238701 PH-GASTRIC $57.000002237105 PHLEBOTOMY-THERAPEUTIC $151.000002252247 PHOSPHOLIPIDS, SERUM $97.000002240315 PHOSPHORUS $54.000002240307 PHOSPHORUS-URINE QUANTITATIVE $57.000002238864 PH-STOOL $59.000002264745 PINP-PROC TYP 1 INT N-TRM PROP $333.000002234227 PINWORM STUDY $57.000002267934 PIVKA-II $242.000002228012 PLA2R AUTOANTIBODY $170.000002263712 PLAS NEUT-NO CHEM. (MVRBC) $147.000002235010 PLASMINOGEN $235.000002245610 PLASMINOGEN ACTIVATOR INHIBITO $275.000002251851 PLASMODIUM SP DNA BY PCR $255.000002268445 PLASMODIUM SPECIES $263.000002229067 PLATELET ABS IGG/IGM,DIRECT $0.000002251884 PLATELET ANTIBODY COMPREHENSV $0.000002250023 PLATELET ANTIBODY ID, ADD'L $247.000002250012 PLATELET ANTIBODY ID, FIRST $247.000002229089 PLATELET ANTIBODY IGG, DIRECT $62.000002229101 PLATELET ANTIBODY IGM, DIRECT $62.000002229056 PLATELET ANTIBODY INDIRECT $174.000002234623 PLATELET COUNT $56.000002260101 PLT AB (SEROT REL ASSAY) $286.000002260123 PLT AB ADDL (SEROT REL ASSAY) $286.000002264978 PM/SCL (MYOSITIS AB 2) $66.000002268045 PM/SCL-100 AB IGG $160.000002260878 PML FISH-PROMYELOCYTIC LEUK. $0.000002266567 PML/RARA T(15;17) CLARIENT LAB $0.000002262667 PNA RFLX (LUPUSANTI STAT) $152.000002251487 PNEUMOCOCCAL IMMUN PNL 23 SER $0.000002266467 PNH PANEL, RBC & WBC (FLAER) $0.000002220323 PNH WBC $0.00

0002254023 POLOVIRUS ABS $0.000002241578 POOLING PLATELETS OR OTHER BLO $184.000002248674 PORPHOBILINOGEN-UR RANDOM QU $128.000002226652 PORPHYRINS QUANTITATIVE 24 HOU $150.000002246862 PORPHYRINS, SERUM $102.000002247172 PORPHYRINS, TOTAL RBC $87.000002223356 PORPHYRINS,FRACTIONATED PLASMA $393.000002251773 PORPHYRINS,PLASMA $339.000002225795 PORPHYRIN--STOOL $251.000002231335 POTASSIUM, FECAL $70.000002232080 POTASSIUM, URINE RANDOM/TIMED $66.000002231330 POTASSIUM-SERUM $51.000002231387 PR AB (MYOSITIS AB Q) $43.000002231388 PR AB ADD (MYOSITIS AB Q) $43.000002227445 PR3 ABS (ANCA PANEL-LC) $50.000002243936 PRA-TUMOR ANALYSIS $428.000002229011 PRE-ALBUMIN $87.000002226212 PREGABALIN (URDRUGCOMP) $53.000002265623 PREGNENOLONE $109.000002238101 PRENATAL PROFILE $499.000002226045 PRESUMV DRG ANLYZ(URDRUGCOMP $117.000002263689 PRETREATMENT (MVRBC) $69.000002245544 PRIMIDONE (MYSOLINE) $60.000002231402 PRO WB (SYS SCLERO 12 Q) $192.000002231403 PRO WB ADD (SYS SCLERO 12 Q) $192.000002243082 PROC & STORAGE; AUTOLOGOUS $184.000002226769 PROCAINAMIDE-N-ACET. $263.000002261834 PROCALCITONIN $350.000002221845 PROGESTERONE $88.000002228434 PROGESTERONE-BHRT PANEL $26.000002225548 PROGESTERONE-RIA $283.000002247835 PROINSULIN $471.000002225522 PROLACTIN-RIA $162.000002253545 PRO-PREDICTR 6MP METABOLITES $0.000002240113 PROSTATIC SPECIFIC ANTIGEN* $136.000002261689 PROT ELECTROPHOR (CSF PEP) $44.000002251056 PROT E-PHORESIS (CSF IEP) $74.000002250056 PROT E-PHORESIS (IEP U 24/RAN) $81.000002250103 PROT E-PHORESIS (IEP,SERUM) $81.000002251045 PROT T (CSF IEP) $27.000002250092 PROT T (IEP, SERUM) $29.000002230459 PROT WB (RF PARANEO WB Q) $291.000002230459 PROT WB (RF PARANEO WB Q) $291.000002231197 PROT WB 1ST(RF PARANEO WB CSF) $293.000002231198 PROT WB ADD(RF PARANEO WB CSF) $293.000002230468 PROT WB ADDL (RF PARANEO WB Q) $291.000002222456 PROTEIN (A G RATIO) $54.00

0002260534 PROTEIN (FR LT CHAINS UR) $25.000002240412 PROTEIN BODY FLUID $87.000002223243 PROTEIN C & S ANTIGEN $0.000002244792 PROTEIN C ANTIGEN (PROT C&S) $62.000002229540 PROTEIN C FUNCTIONAL $312.000002260989 PROTEIN C, TOTAL ANTIGEN $66.000002231629 PROTEIN CSF $121.000002239762 PROTEIN ELECTROPH (SPEP) $77.000002256423 PROTEIN ELECTROPHESIS, SERUM $0.000002261667 PROTEIN ELECTROPHORESIS, CSF $0.000002250147 PROTEIN E-PHORESIS (UPEP24/RAN $87.000002244803 PROTEIN S ANTIGEN (PROT C&S) $60.000002242801 PROTEIN S, FREE $195.000002221472 PROTEIN S, TOTAL ANTIGEN $66.000002253245 PROTEIN S-FUNCTIONAL $139.000002250136 PROTEIN T (UPEP 24HR/RAN $31.000002250045 PROTEIN T, (IEP U 24/RAN) $29.000002220432 PROTEIN W. BLOT (14-3-3 PROT) $62.000002261678 PROTEIN, CSF (CSF PEP) $14.000002267989 PROTEIN, URINE (POC) $37.000002241122 PROTEIN, URINE RANDOM/TIMED $82.000002240133 PROTEIN-TOTAL $54.000002228096 PSA (PROSTATIC SPECIFIC AG) $136.000002237315 PSA FREE (PSA FREE N TOTL) $180.000002221461 PSA TOTAL (PSA FREE N TOTL) $180.000002230456 PSA, FREE & TOTAL $0.000002228267 PSA-BHRT PANEL $23.000002228098 PSA-PROSTATIC SPECIFIC AG CARE $136.000002220523 PT (LUPUS W REFLEX) $48.000002262623 PT (LUPUSANTI STAT) $59.000002266623 PT (MAYO-LUPUSANTI) $73.000002220778 PT (MIXING ASSAY PT) $69.000002234862 PT (PROTHROMBIN TIME) $47.000002269001 PT FRAGMENT 1+2 MOAB $181.000002220801 PT SUBST (MIXING ASSAY PT) $60.000002265156 PT, MIX (LUPUSANTI) $63.000002231231 PTEN, CARIS $175.000002246594 PTH HORMONE-RELATED PEPTIDE $331.000002255356 PTH INTACT WITH CALCIUM $0.000002262601 PTH, INTACT, FNA $113.000002221812 PTHI (PTHI W CALCIUM) $174.000002221734 PTHI WITH CALCIUM $0.000002231368 PTH-RELATED PROTEIN Q $161.000002224393 PTT - LA MIX (LUPUSANTI) $114.000002262634 PTT (LUPUS ANTI STAT) $87.000002220545 PTT (LUPUS REFLEX) $73.000002266645 PTT (MAYO-LUPUSANTI) $109.00

0002220823 PTT (MIXING ASSAY PTT) $41.000002234870 PTT (PARTIAL THROMBO. TIME) $51.000002234748 PTT (PHOSPHOLIP) $171.000002220845 PTT SUBST (MIXING ASSAY PTT) $44.000002220878 PTT SUBST ADDL (MIX ASSAY PTT) $44.000002256823 PTT, SUBST(LUPUS W REFLEX) $79.000002263567 PUCHTLERS MOD OF BENNHOLD ST $205.000002258523 PYRUVIC ACID, BLOOD $113.000002221578 Q FEVER ANTIBODIES $0.000002231216 Q FVR ABS 1ST (Q FEVER ABS Q) $166.000002231217 Q FVR ABS ADDL (Q FEVER ABS Q) $160.000002266756 Q-FEVER ABS (Q-FEVER ABS) $97.000002266767 Q-FEVER ABS,ADDL (Q-FEVER ABS) $97.000002223056 Q-FEVER, IGG PHS I TITER $150.000002223089 Q-FEVER, IGG PHS II TITER $150.000002223101 Q-FEVER, IGM PHS I TITER $150.000002223112 Q-FEVER, IGM PHS II TITER $150.000002269845 QT DRUG ASSAY(ANTI-ADALIMUMAB $322.000002226378 QUANT DRUG ASSAY (ENTYVIO ABS) $277.000002259389 QUANTIFERON-TB GOLD, BLOOD $251.000002238541 R.A. LATEX $62.000002238558 R.A.LATEX TITER QUANTIT $86.000002237699 RA FACTOR, BODY FLUID $97.000002223434 RABIES AB, IGG $126.000002226634 RABIES ANTIBODY SCREEN $162.000002263812 RARE UNIT IMPORT FEE (MVRBC) $300.000002268856 RAST 1ST (RAST SHELL FISH) $19.000002268867 RAST ADDL (RAST SHELL FISH) $19.000002225982 RAST CINNAMON, IGE $66.000002228878 RAST PROFILE, MOLDS $0.000002260356 RAST PROFILE, NUT MIX $0.000002245767 RAST PROFILE-ZONE 10 EACH (RAS $27.000002245778 RAST PROFILE-ZONE 10 EACH (RAS $27.000002222501 RAST, ALMOND $56.000002269789 RAST, AUREOBAS. PULLULANS $82.000002268789 RAST, AVOCADO $48.000002263201 RAST, BANANA $42.000002222601 RAST, BIRCH TREE $56.000002228523 RAST, CEPHALOSPORIUM $62.000002226489 RAST, COD IGE $63.000002228982 RAST, COMPREHENSIVE 2 $0.000002258989 RAST, COMPREHENSIVE PROFILE $0.000002226523 RAST, EGG WHITE IGE $63.000002226534 RAST, EGG YOLK IGE $76.000002228534 RAST, ENGLISH PLANTAIN IGE $60.000002253656 RAST, GLUTEN $48.000002222512 RAST, GRAPE $56.00

0002222623 RAST, GRAPEFRUIT $56.000002255312 RAST, GREEN BELL PEPPER $48.000002269767 RAST, HELMINTHOSPORIUM $60.000002255323 RAST, LEMON $48.000002222634 RAST, LIME $56.000002226501 RAST, LOBSTER IGE $66.000002268912 RAST, MILK $36.000002227889 RAST, MOUNTAIN CEDAR TREE, IGE $67.000002269778 RAST, MUCOR RACEMOSUS $82.000002228512 RAST, MUSHROOM IGE $62.000002222567 RAST, NECTARINE $119.000002220456 RAST, ONION $56.000002222523 RAST, PEACH $56.000002269045 RAST, PEANUT ALLERGEN $36.000002226945 RAST, PECAN NUT IGE $60.000002257278 RAST, PED PROF I $0.000002225912 RAST, PINE NUT $66.000002268001 RAST, PINEAPPLE ALLERGEN $40.000002225923 RAST, PISTACHIO $76.000002222545 RAST, PLUM $56.000002227701 RAST, RED CEDAR TREE, IGE $60.000002222889 RAST, RED DYE IGE $56.000002228545 RAST, RESPIRATORY REGION 8 IGE $0.000002268845 RAST, SHELL FISH $0.000002255334 RAST, TOMATO $48.000002226545 RAST, WHEAT IGE $67.000002262901 RAST,AM. COCKROACH $35.000002262912 RAST,GERMAN COCKROACH $35.000002227712 RAST,WALNUT TREE IGE $60.000002226956 RAST,WATERMELON IGE $62.000002228067 RAST-ALTERNARIA ALTERNATA IGE $60.000002228078 RAST-BERMUDA GRASS IGE $60.000002256556 RAST-CARROT $48.000002254367 RAST-CASEIN $48.000002253578 RAST-CAT HAIR/DANDER, STANDARD $48.000002228189 RAST-COMMON RAGWEED IGE $60.000002228023 RAST-CORN IGE $60.000002228045 RAST-D.FARINAE IGE $60.000002228056 RAST-D.PTERONYSSINUS IGE $60.000002253601 RAST-DOG HAIR/DANDER $48.000002228101 RAST-ELM TRESS IGE $60.000002227908 RAST-FOOD PROFILE $0.000002228123 RAST-GIANT RAGWEED IGE $60.000002220799 RAST-INHALENT PROFILE $469.000002228134 RAST-JUNE GRASS (KY) IGE $60.000002220795 RAST-LATEX $48.000002228089 RAST-MAPLE TREE IGE $60.00

0002262534 RAST-MSG (MONOSODIUM GLUT.) $77.000002228034 RAST-OAK TREE IGE $60.000002228145 RAST-PEN.G (MAJOR) IGE $60.000002228156 RAST-PEN.V (MINOR) IGE $60.000002228167 RAST-ROUGH PIGWEED IGE $60.000002228178 RAST-RYE IGE $60.000002263378 RAST-SEAFOOD $102.000002254378 RAST-SOYBEAN $48.000002228201 RAST-TIMOTHY GRASS IGE $60.000002237287 RBC ANTIGEN-OTHER $114.000002247327 RBC, MAGNESIUM $140.000002231286 REDUCING SUBST STOOL Q $46.000002238853 REDUCING SUBST-URINE $59.000002225478 REFERENCE FUNGAL ID,NON-ROUTIN $194.000002248424 RENAL BX TIS CONSULT-MAYO $682.000002240067 RENAL PANEL $96.000002246602 RENIN (ALDO-RENIN) $73.000002231331 RENIN (ALDOST/RENIN RATIO Q) $39.000002239788 RENIN LEVEL $60.000002258401 RESPIRATORY AB PROFILE II (D) $0.000002268578 RESPVIR 12-25 TARGETS (RVP) $608.000002267634 RETIC/SICKLE SEP (MVRBC) $132.000002234664 RETICULOCYTE COUNT $62.000002236198 RETICULUM STAIN-WILDER'S $109.000002222951 REVERSE T3 $73.000002230565 RF ACHR MOD Q $137.000002231190 RF AMPAR2 CBA CSF $1,059.000002231412 RF AMPHETAMINE QT U Q $110.000002231151 RF ANA TITER & PATTERN $84.000002231205 RF ANNA3 TITER CSF $1,059.000002230526 RF ANNA3 TITER QRF $1,059.000002231189 RF AONAR1 CBA CSF $1,059.000002231187 RF AQAP4 CSF $879.000002231204 RF AQAP4 IGG TITER CSF $879.000002230488 RF AQUAPORIN 4 IGG $503.000002231233 RF ATYP P-ANCA TITER Q $160.000002231157 RF CALR9 Q $480.000002231211 RF C-ANCA TITER Q $166.000002231194 RF CASPR2 CBA CSF $1,059.000002231180 RF CENTROM (RF TIER 3) $67.000002231172 RF CHROM (RF TIER 1) $119.000002231394 RF COAG CONSULT Q $156.000002231160 RF CSF3R Q $284.000002231150 RF DRVVT 1:1 MIX $139.000002231149 RF DRVVT CONFIRM $130.000002231170 RF DSDNA AB (RF TIER 1) $74.000002231191 RF GABABR CBA CSG $1,059.00

0002231184 RF HEPAIGM $53.000002231183 RF HEXAG, PH. CONFIRM $161.000002231366 RF HSV 1 IGM TITER Q $106.000002231367 RF HSV 2 IGM TITER Q $111.000002231284 RF HSV TYPE 1 Q $126.000002231155 RF HSV TYPING Q $126.000002231161 RF IFE SER Q $53.000002231158 RF JAK2 EXON12 Q $454.000002231177 RF JO-1 AB (RF TIER 2) $53.000002231193 RF LGI1 CBA CSF $1,059.000002231159 RF MPL MUTATION Q $349.000002231188 RF NMDAR1 CSF $1,059.000002231152 RF P190 BCR ABL1 $200.000002231153 RF P210 $200.000002231212 RF P-ANCA TITER Q $160.000002231206 RF PCA2 TITER CSF $1,059.000002230536 RF PURKINJE CELL Q $1,059.000002231218 RF Q FVR I IGG TITER Q $114.000002231220 RF Q FVR I IGM TITER Q $126.000002231219 RF Q FVR II IGG TITER Q $114.000002231221 RF Q FVR II IGM TITER Q $126.000002231182 RF RIBOSOMAL (RF TIER 3) $119.000002231185 RF RMSF IGG TITER $160.000002231186 RF RMSF IGM TITER $177.000002231171 RF RNP AB (RF TIER 1) $84.000002231176 RF SCL-70 (RF TIER 2) $53.000002231174 RF SM AB (RF TIER 1) $70.000002231175 RF SM/RNP AB (RF TIER 1) $66.000002231178 RF SSA RO (RF TIER 2) $58.000002231179 RF SSB AB (RF TIER 2) $58.000002230547 RF STRIATED MUSC Q $84.000002231195 RF VGKC CSF $543.000002263589 RH (MVRBC) $54.000002237097 RH IMM GLOB $339.000002263823 RH PHENOTYPE (MVRBC) $147.000002264145 RHINOVIRUS RNA, QUAL, PCR $453.000002227612 RIA NON-AB (AUTOIMM DYSAUTO) $165.000002268278 RIA NONAB (MYASTH GRAVIS PAN $150.000002227623 RIA NON-AB ADDL(AUTOIMM DYSAU $165.000002261456 RIA NONAB, ADL-PARANEOPLASTIC $113.000002261445 RIA NONANTIBODY-PARANEOPLASTIC $113.000002220807 RIBOFLAVIN LEVEL (VIT B2) $135.000002257123 RICKETSIA AB (FEBAGG) $31.000002257134 RICKETSIA AB ADDL (FEBAGG) $31.000002266701 RISPERIDONE & METABOLITE $193.000002225837 RISTOCETIN - COFACTOR $224.000002266534 RISTOCETIN (VWF MULTIMER) $74.00

0002244858 RISTOCETIN-COFACTOR (VWF PROF) $88.000002227567 RMSF IGG (TICK PROF) $67.000002227578 RMSF IGM (TICK PROF) $67.000002267556 RNA POLYMERASE III AB, IGG $151.000002268056 RNP (UI) AB, IGG $51.000002229532 ROCKY MOUNTAIN SPOTTED F.-IGM $80.000002237576 ROCKY MTN SPOT FEVER, IGG $103.000002222878 ROM, RUPTURE OF MEMBRANES $145.000002229923 ROMA Q $739.000002269134 ROMA, RISK OVARIAN MALIGNANCY $0.000002220201 ROS1 BY FISH $784.000002247095 ROTAVIRUS ANTIGEN STOOL $63.000002238566 RPR $44.000002238163 RPR-PRENATAL $0.000002258412 RSV AB (RESP PROF II) $79.000002258423 RSV AB ADDL (RESP PROF II) $79.000002237634 RSV ANTIGEN (RESP. SYN. VIRUS) $114.000002229978 RSV RNA RT-PCR Q $420.000002263156 RUBELLA (MMR IMMUNITY) $59.000002231349 RUBELLA 1ST (RUB IGG-IGM Q) $67.000002231350 RUBELLA 2ND(RUB IGG-IGM Q) $67.000002222393 RUBELLA AB IGM $41.000002223900 RUBELLA ABS, IGG - TORCH IGG $78.000002223920 RUBELLA ABS, IGM - TORCH IGM $75.000002238582 RUBELLA SCREEN-IMMUNITY $79.000002238184 RUBELLA-PRENATAL $0.000002263167 RUBEOLA (MMR IMMUNITY) $53.000002223562 RUBEOLA ANTI. IGG TITER $53.000002223573 RUEBEOLA AB, IGM $176.000002231095 RUSS VIPER (LUPUS PHOSPHO Q) $17.000002265178 RVP (RESP VIRUS PANEL) $0.000002265812 S CERV (CROHNS PROG) $75.000002238954 S. PNEUMONIAE ANTIGEN $66.000002248567 SACCHAROMYCES CEREVISIAE PROFI $0.000002233047 SALICYLATE LEVEL-BLOOD $101.000002257145 SALMONELLA AB (FEBAGG) $20.000002257189 SALMONELLA AB ADDL (FEBAGG) $20.000002230894 SAMPLE COLLECT-CHAIN OF CUSTOD $50.000002230886 SAMPLE HANDLING AND SHIPPING $111.000002256412 SCHISTOSOMA AB, IGG $199.000002244691 SCT- MIX (LUPUSANTI) $114.000002226234 SEDATIVE HYPNOTIC (URDRUGCOMP $53.000002234680 SEDIMENTATION RATE (ESR) $56.000002231200 SELENIUM, BLOOD $188.000002229847 SENSITIVITY FUNGUS/YEAST, EASH $147.000002260089 SEROT REL HEP DEPEND PLT AB $0.000002225381 SEROTONIN BLOOD $121.00

0002222656 SERTRALINE & METAB, URINE $207.000002256645 SEX HORMONE BIND GLOB(TSTBIOSH $75.000002228856 SEX HORMONE BINDING GLOBULIN(T $311.000002224943 SF2B1 MUTATION $478.000002220401 SHBG(TEST BIO SHBG MALE ADULT) $60.000002259356 SHIGA TOXIN, EIA $0.000002259367 SHIGA TOXIN, FIRST $44.000002259378 SHIGA TOXIN, SECOND $44.000002267723 SICKLE CELL SOL (HGB CASCADE) $99.000002234714 SICKLE HB. SCREEN $54.000002223489 SILICON QUANT $206.000002269123 SILVER (RENAL MAYO) $201.000002234643 SILVER STAIN REF $366.000002256445 SINGLE DRUG CONFIRM, QUAL $79.000002243100 SIROLIMUS (RAPAMUNE) LEVEL, BL $155.000002241878 SJOGREN'S ANTIBODIES $0.000002226245 SKEL MUS RELAX (URDRUGCOMP) $53.000002221545 SLIDE CONSULT, REF $177.000002268489 SLIDE REVIEW,MAYO PATH CONSULT $191.000002231427 SMA CARRIER SCREEIN $813.000002224134 SMEAR STAIN (MICROSPORIDIA ST) $65.000002258667 SMITH(ENA)AB,IGG(ANA COMP RFLX $63.000002221756 SMOOTH MUSCLE ANTIBODY TITER $138.000002252723 SODIUM, BODY FLUID $51.000002231310 SODIUM, FECAL $70.000002232106 SODIUM, URINE RANDOM/TIMED $66.000002231322 SODIUM-SERUM $51.000002268978 SOLUBLE FIBRIN MONOMER $116.000002222717 SOLUBLE TRANSFERRIN RECEPTOR $308.000002266189 SOMATOSTATIN $217.000002268134 SPECIAL ST(CRYPTOSP.ISOSP.CYCL $54.000002259167 SPECIAL STAIN-REF LAB MAYO $255.000002237677 SPECIFIC GRAV. SYNOV $59.000002238889 SPECIFIC GRAVITY FLUID $59.000002238751 SPECIFIC GRAVITY, UR $57.000002220623 SPERM ABS (SPERM ABS IGA IGG) $96.000002220634 SPERM ABS ADDL(SPERM ABS IGA I $96.000002220601 SPERM ABS IGA IGG $0.000002238640 SPERM COUNT POST VASECTOMY $59.000002238624 SPERM COUNT WITH MOTILITY $162.000002226278 SPINAL MUSC ATROPHY (SMA)ANALY $441.000002262678 STARCLOT RFLX (LUPUSANTI STAT) $155.000002252082 STEINER STAIN,B&B $114.000002266156 STL ENCEPHALITIS AB, CSF, IGM $41.000002236511 STONE ANALYSIS $172.000002231450 STONE ANALYSIS Q $90.000002237527 STOOL FOR REDUCING SUBSTANCE $57.00

0002234219 STOOL LUEKOCYTE EXAM $48.000002262567 STREP PNEU AG URINE $142.000002234094 STREP SCREEN-GROUP A $74.000002238418 STREP-GROUP B SCREEN $128.000002222978 STRIATED MUSC AB TITER $145.000002229212 STRONGYLOIDES AB, IGG $154.000002225489 SUBCLASS IGG4 $170.000002227723 SUBSTANCE P $259.000002269278 SULFATE, URINE 24 HR $69.000002231880 SULFONYLUREA, PLASMA $220.000002263734 SUPER DAT (MVRBC) $104.000002236036 SURGICAL PATHOLOGY $0.000002231248 SUSCEPTIBILITY Q $57.000002238834 SYNOVIAL FLUID VOLUME $17.000002239895 T 3 UPTAKE $57.000002245698 T 3 UPTAKE REF LAB (THY PAN RF $34.000002239838 T 4 RIA $56.000002245687 T 4 RIA-REF LAB (THY PAN RF) $35.000002256789 T CELL ABSOLUTE(CD4/CD8 PANEL) $231.000002256778 T CELLS TOTAL (CD4/CD8 PANEL) $231.000002263245 T CELLS, TOTAL (LYMPH SS 5) $71.000002262789 T CELLS,ABS/RATIO(IMMUNO PANEL $122.000002262778 T CELLS,TOTAL(IMMUNODEF PANEL) $122.000002231477 T VAG DNA TMA PAP VIAL Q $221.000002228278 T3 FREE-BHRT PANEL $21.000002220331 T3-HORMONE TRIIODOTHYRONINE $139.000002264734 T4 FREE, EQUIL DIALYSIS $143.000002228289 T4 TOTAL-BHRT PANEL $9.000002220235 TACROLIMUS LEVEL $508.000002220237 TACROLIMUS LEVEL TO MU $508.000002225986 TAPENTADOL, QT URINE $158.000002259178 TAY-SACHS DISEASE,MUTATE ANAL $236.000002269178 TAY-SACHS DNA ANALYSIS $585.000002243393 T-CELL CLONALITY BY PCR, TISSU $0.000002257801 T-CELL RECEPT GENE R-PCR,TISSU $0.000002230835 TCR (TCRB PCR Q) $690.000002230792 TCR (TCRG PCR Q) $461.000002220945 TCR BETA REARRANGEMENT PCR $834.000002220889 TCR GAMMA REARRANGEMENT PCR $557.000002220956 TCR GENE REARR PANEL PCR $0.000002221212 TCRB (TCR REARR PANEL PCR) $739.000002229556 TCRB AMP (T-CELL CLON Q) $573.000002229567 TCRB ANALYSIS (T-CELL CLON Q) $573.000002229578 TCRB INTERP (T-CELL CLON Q) $65.000002221223 TCRG (TCR REARR PANEL PCR) $713.000002231452 TCULT (CA POC Q) $608.000002220391 TEST BIO & SHBG, ADULT MALE $0.00

0002228301 TEST FREE-REF-BHRT PANEL $32.000002228312 TEST TOTAL-REF-BHRT PANEL $32.000002220412 TEST(TEST BIO SHBG MALE ADULT) $71.000002228323 TEST-INHOUSE-BHRT PANEL $32.000002221923 TESTOSTERONE $109.000002259667 TESTOSTERONE, FREE, FEM/CHILD $185.000002256634 TESTOSTERONE,BIOAVAIL/SHBG,F/C $0.000002256656 TESTOSTERONE,TOTAL(TESTBIOSHBG $87.000002229964 TESTOSTERONE-FREE $158.000002239062 TESTOSTERONE-FREE & TOTAL $0.000002239040 TESTOSTERONE-FREE (GROUP) $158.000002225506 TESTOSTERONE-RIA SERUM $160.000002226325 TESTOSTERONE-TOTAL (GROUP) $160.000002250587 TETANUS ANTIBODY PROFILE $0.000002250605 TETANUS ANTITOXIN ANTIBODIES $103.000002230101 TETANUS ANTITOXIOD Q $66.000002225723 TGFB-TRANSFORM GROWTH FAC BET $142.000002228001 THALLIUM, URINE $162.000002225112 THC CONFIRM, QT, U $167.000002267856 THC CONFIRMATION, URINE $116.000002231339 THC CONF-MEC Q $175.000002225389 THC, CONFIRM, BLD $143.000002232163 THEOPHYLLINE $103.000002264623 THIOPURINE METABOLITES $688.000002234935 THROMBIN TIME $121.000002268989 THROMBIN/ATIII COMPLEX $302.000002227067 THROMBOTIC RISK PAN, INHERITED $0.000002222056 THYROGLOB AB (THYABS) $69.000002267978 THYROGLOB AB SCR(THYROG TUMR M $146.000002267967 THYROGLOB TUMOR MKR(THYROG T $147.000002246724 THYROGLOBULIN AB (THYABS) $119.000002241767 THYROGLOBULIN AB(THYRO PANEL) $78.000002221912 THYROGLOBULIN ANTIBODY $69.000002226207 THYROGLOBULIN ANTIBODY $82.000002241778 THYROGLOBULIN PANEL $0.000002267956 THYROGLOBULIN TUMOR MKR, SERU $0.000002221001 THYROGLOBULIN(THYROGLOB PANEL $78.000002225734 THYROGLOBULIN, FNA $136.000002262545 THYROGLOBULIN,TUMOR MARKER(P $393.000002222045 THYROID ANTIBODIES $0.000002263423 THYROID ANTIBODIES $0.000002245676 THYROID PANEL REF LAB (THY PAN $0.000002225993 THYROID STIMULATING IMMUNOGLO $181.000002225589 THYROXINE-BIND. GLOB. $129.000002227523 TICK PROFILE CLIENT $0.000002225901 TIN, TOTAL, WHOLE BLOOD $219.000002226701 TIS CULT (C/A ONC) $237.00

0002229734 TISS CULT (CA HEM MALIG Q) $665.000002265467 TISS CULT (CA-LYMPH NODE) $298.000002265401 TISS CULT, (CA SOLID TUMOR) $447.000002221723 TISS CULT,C/A (CHROMO BLD ONC) $237.000002268645 TISS HOMOGEN (C TISSUE) $51.000002252789 TISSUE CONSULT & RPT, REFER IN $70.000002236636 TISSUE CONSULT-MAYO $690.000002236651 TISSUE CONSULT-MU $902.000002256334 TISSUE CULT, C/A BLD OR BM $243.000002256378 TISSUE CULT,LYMPH (CHROMO BLD) $564.000002243543 TISSUE CULTURE,PLACENTA(C/A AF $248.000002236149 TISSUE EXAM DECAL SPECIMEN $116.000002250479 TISSUE EXAM FROZEN SECT ADDL $275.000002236123 TISSUE EXAM FROZEN SECTION $320.000002236102 TISSUE EXAM GR/MICRO LEVEL 2 $98.000002236065 TISSUE EXAM GR/MICRO LEVEL 3 $103.000002236301 TISSUE EXAM GR/MICRO LEVEL 4 $133.000002236312 TISSUE EXAM GR/MICRO LEVEL 5 $160.000002236323 TISSUE EXAM GR/MICRO LEVEL 6 $204.000002236081 TISSUE EXAM GROSS ONLY LEVEL I $79.000002250457 TISSUE TRANSGLUTAMINASE (IG G) $256.000002221456 TITANIUM QT, SERUM/PLASMA $226.000002231327 TMAO Q $138.000002227345 TMPMT METABOLITES $225.000002232304 TOBRA PEAK $158.000002233062 TOBRA RANDOM $158.000002233051 TOBRA TROUGH $158.000002231480 TOBRAMYCIN, PEAK $180.000002231479 TOBRAMYCIN, TROUGH $180.000002222016 TOPIRAMATE LEVEL (TOPAMAX) $59.000002238921 TORCH PANEL, IGG $0.000002263189 TORCH PANEL, IGM $0.000002231355 TOTAL C02 $62.000002256433 TOTAL PROTEIN (SPEP) $27.000002231344 TOXO IGG (TOXIGG-IGM Q) $102.000002231345 TOXO IGM (TOXO IGG-IGM Q) $102.000002223167 TOXOCARA AB $123.000002222006 TOXOPLASMA AB IGG $59.000002228120 TOXOPLASMA AB IGM $59.000002223980 TOXOPLASMA AB, IGG - TORCH IGG $78.000002224006 TOXOPLASMA AB, IGM - TORCH IGM $75.000002253534 TOXOPLASMA GONDII PCR $444.000002227401 TP53 SOMATIC MUTATION $613.000002264767 TPMT ENZYME ACTIVITY $0.000002251378 TPMT GENOTYPE $439.000002231374 TPMT METABOLITES Q $143.000002251356 TPMT-THIOPURINE METH ERYTHRO $688.00

0002222067 TPO (THYABS) $62.000002246713 TPO ABS (THYABS) $82.000002221978 TPO, THYROID PEROXIDASE ABS $62.000002228334 TPO-BHRT PANEL $18.000002226267 TRAMADOL (URDRUGCOMP) $137.000002224289 TRAMADOL, PAIN MGMT CONF $167.000002225431 TRANSFERRIN $204.000002237422 TRANSFUSION REACTION $0.000002262312 TRANSPORT STAT BBK $451.000002223722 TREPONEMA PALLIDUM ANTIBODIES $66.000002224190 TRH - THYRIOD RELEASING HORMO $482.000002223223 TRICHINELLA AB $158.000002222412 TRICHOMONAS VAGINALIS, DNA $146.000002259612 TRICHOMONAS VAGINALIS,DNA PROB $60.000002226912 TRICHOMONAS,NAA(VAG PAN NAA) $56.000002269101 TRICHROME (RENAL MAYO) $201.000002224067 TRICHROME STAIN, REF $92.000002236206 TRICHROME STAIN-MASSON'S $109.000002269189 TRICYCLIC ANTIDEPRESS QT SER/P $370.000002224682 TRIG (NASH FIBRO) $47.000002232171 TRIGLYCERIDES $54.000002246367 TRIGLYCERIDES, BODY FLUID $54.000002230612 TRILEPTAL (OXCARBAZEPINE) $132.000002231213 TRK A/B/C (CARIS ERBB1-PDL1-TR $175.000002269823 TROPHERYMA WHIPPELI DNA PCR $405.000002239299 TROPONIN I $312.000002220865 TROPONIN-T REFERENCE LAB $121.000002223256 TRYPANOSOMA CRUZI AB IGG $109.000002225162 TRYPSIN, SERUM $123.000002264134 TRYPSIN-LIKE IMMUNOREACTIVITY $159.000002244059 TRYPTASE $273.000002223785 TSH THIRD GENERATION - REF LAB $199.000002228345 TSH-BHRT PANEL $21.000002239275 TSH-THYROID STIMULATING H $101.000002256601 TTG IGG, CELIAC PEDIATRIC $56.000002253934 T-TRANSGLUT. IGA (CELIAC SCR) $77.000002242056 T-TRANSGLUTAMINASE (TTG) IGA $119.000002252867 T-TRANSGLUTAMINASE IGA(CELIAC) $70.000002252878 T-TRANSGLUTAMINASE IGG(CELIAC) $70.000002231459 TUM HISTO (HER2 NEU-FISH Q) $199.000002227034 TUMOR IHC (HER2 GASTROESOPHA) $305.000002267667 TUMOR IHC (HER2-NEU ANALY) $428.000002236351 TUMOR IHC, C ASST (BCP) $370.000002236362 TUMOR IHC, C ASST ADDL (BCP) $370.000002268067 TUMOR NECROSIS FACTOR-ALPHA $198.000002237063 TYPE ABO GROUP $47.000002237464 TYPE ABO-PRENATAL $0.00

0002237152 TYPE RHO-PRENATAL $0.000002237238 TYPE-RH0 $47.000002262989 TYROSINE $83.000002231437 TYROSINE (PHENYL & TYROSINE Q) $113.000002264678 U CALCIUM (STONE RISK) $25.000002264689 U CITRATE (STONE RISK) $108.000002264701 U OXALATE (STONE RISK) $53.000002264712 U URIC ACID (STONE RISK) $17.000002238748 UA W/C&S IF INDICATED $56.000002230846 UNL CHEM (TCRB PCR Q) $75.000002230803 UNL CHEM (TCRG PCR Q) $52.000002229956 UNL MOPATH(TP53 SEQ DEL/DUP Q) $394.000002228478 UNLISTED MOPATH (ELANE) $1,860.000002250125 UPEP 24HR URINE B&B $0.000002225936 UREA CLEARANCE $60.000002227912 UREA NIT (LIVR FIBR HCV) $37.000002240174 UREA NITROGEN,URINE RAND/TIMED $129.000002253623 UREAPLASMA/MYCOPLASMA HOMIN $188.000002240299 URIC ACID $54.000002231289 URIC ACID RAND(U URIC ACID R Q $58.000002240125 URIC ACID, URINE 24 HR. $54.000002238715 URINALYSIS CHEMICAL W/O MICROS $37.000002238723 URINALYSIS ROUTINE WITH MICROS $56.000002263467 URINE DIPSTICK, POINT OF CARE $21.000002260201 URINE IODINE $292.000002238731 URINE MICRO. $27.000002232114 URINE VOL. MEASURE $27.000002238764 UROBILINOGEN FECES $88.000002268945 UROVYSION $0.000002265578 URTICARIA-INDUCE BASO.ACTIVATE $0.000002230663 V ZOSTER AB CSF Q $142.000002254056 V ZOSTER ABS, ADDITIONAL $75.000002254045 V ZOSTER ABS, FIRST $75.000002254034 V ZOSTER IGG/IGM ABS $0.000002259578 VAG PATHOGENS, DNA PROBES $0.000002226878 VAGINITIS PANEL, NAA $0.000002251367 VALLEY FEVER $152.000002226785 VALPORIC ACID-DEPAKENE SERUM $114.000002253978 VAN GIESON'S STAIN $226.000002226090 VANCO PEAK $129.000002233612 VANCO RANDOM $129.000002233601 VANCO TROUGH $129.000002264534 VANCO-RESIST ENTERO. CULTURE $51.000002228468 VARICELLA ZOSTER IGG $75.000002228476 VARICELLA ZOSTER IGM $75.000002231364 VARICELLA ZOSTER IGM AB Q $61.000002231419 VARICELLA ZOSTER QL PCR Q $163.00

0002242789 VARICELLA-ZOSTER CULTURE $0.000002261012 VARICELLA-ZOSTER,DFA FLX CULT $220.000002220431 VASOACTIVE INTESTINAL POLYPRPT $115.000002258745 VDRL TITER, CSF $135.000002226367 VEDOLIZUMAB ABS (ENTYVIO ABS) $0.000002222645 VEGF, VASC.ENDO.GROWTH FACTOR $346.000002230878 VENIPUNCTURE-ROUTINE $21.000002252049 VERY LONG CHAIN FATTY ACIDS $255.000002227956 VGKC AUTOAB(ENCEPH AUTO EVAL) $152.000002231166 VIRAL CULT, NON-GENITAL Q $125.000002242767 VIRAL TISSUE CULTURE (VARICELL $73.000002268356 VIRUS AB (DENGUE FVR IG/IM) $71.000002268367 VIRUS AB ADD(DENGUE FVR 1G/1M) $71.000002241234 VIRUS CULTURE-GENERAL (REF LAB $63.000002230234 VIRUS ISOL (HSV/VZOST CULT Q) $142.000002230245 VIRUS ISOL ADDL(HSV/VZOST CULT $142.000002242778 VIRUS ISOLATION; SHELL VIAL(VA $56.000002229243 VISCOSITY-SERUM $97.000002228356 VIT B12-BHRT PANEL $19.000002228367 VIT D25-BHRT PANEL $37.000002229854 VITAMIN A $139.000002227247 VITAMIN B1 (THIAMINE) LEVEL $297.000002252236 VITAMIN B1 (THIAMINE),BLOOD $243.000002261611 VITAMIN B12 $119.000002223806 VITAMIN B12 UNSATURATED $249.000002227684 VITAMIN B6--PLASMA $57.000002268434 VITAMIN B7 (BIOTIN) $181.000002220312 VITAMIN D 25 OH D3 $170.000002228492 VITAMIN D-1, 25 DIHY $385.000002250556 VITAMIN D2 & D3 $87.000002231318 VITAMIN D2, D3 Q $90.000002229565 VITAMIN E $154.000002251840 VITAMIN K1, SERUM $141.000002221701 VMA 24 HOUR URINE $155.000002246300 VOLATILES, BLOOD $273.000002247954 VOLTAGE-GATED CALCIUM CHANNEL $698.000002222572 VON WILLIBRAND MULTIMER $312.000002248034 VONWILLIBRAND ANTIGEN $194.000002244836 VONWILLIBRAND PROFILE $0.000002268334 VORICONAZOLE, QUANTITATIVE $140.000002266689 VWF ACT (MAYO-VWF PRO) $389.000002266678 VWF AG (MAYO-VWF PRO) $389.000002244869 VWF AG (VWF PROF) $88.000002250257 VWF AG-VWF CLEAVING PROTEASE $305.000002226423 VWF COLLAGEN BINDING $299.000002266512 VWF MULTIMERIC $0.000002266656 VWF PROFILE-MAYO $0.00

0002269078 WALNUT ALLRGN, IMMUNOCAP $65.000002234540 WBC $54.000002256767 WBC (CD4/CD8 PANEL) $39.000002234672 WBC DIFF BUFFY COAT $54.000002220334 WBG AG (PNH WBC) $129.000002220345 WBG AG ADDL (PNH WBC) $129.000002266167 WEST EQ ENCEPHALITS,AB CSF,IGM $41.000002266178 WEST NILE VIRUS AB CSF, IGM $79.000002266112 WEST NILE VIRUS AB SERUM, IGM $79.000002250779 WEST NILE VIRUS BY PCR-CLN $0.000002250785 WEST NILE VIRUS, IGM BY PCR $167.000002246271 WEST NILE VIRUS, PCR, CSF $434.000002250796 WEST NILE VIRUS,IGG BY PCR $146.000002234169 WET PREP (MICRO) $51.000002231321 WNV IGG(WNV IGG/IGM Q) $50.000002231320 WNV IGM(WNV IGG/IGM Q) $58.000002235268 WRIGHT'S/GIEMSA STAIN-CYTOLOGY $54.000002234519 YEAST SCREEN ONLY $44.000002261645 YEAST SENSITIVITY, SINGLE DRUG $170.000002260445 ZAP-70 BY FLOW CYTOMETRY $0.000002226777 ZARONTIN-ETHOSUXIMIDE $132.000002235039 ZIEHL-NEELSON STAIN, ACID FAST $366.000002226012 ZIKA MAC-ELISA IGM $229.000002226345 ZIKA VIRUS 1ST(ZIKA VIRUS RNA) $197.000002226356 ZIKA VIRUS 2ND(ZIKA VIRUS RNA) $197.000002226334 ZIKA VIRUS RNA $0.000002227234 ZINC PROTOPORPHYRIN (ZPP), BLD $60.000002226975 ZINC SERUM $225.000002223556 ZINC, RBC $147.000002258701 ZINC, URINE $122.000002269301 ZINC, WHOLE BLOOD $135.000002248592 ZONEGRAN $167.00


0003740121 ADL'S (SELF CARE-HOME MANAGEME $101.000003730121 ADL'S (SELF CARE-HOME MANAGEME $101.000003730177 ANODYNE TREATMENT OUTPATIENT P $17.000003730206 AQUATIC THERAPEUTIC EX (15MIN) $135.000003700866 AQUATIC THERAPEUTIC EXERCISE $135.000003720060 AQUATIC THERAPEUTIC EXERCISE $135.000003720140 AQUATIC THERAPY (VISIT) $135.000003730136 ARM LYMPHEDEMA BANDAGING KIT F $142.000003730131 ARTIFLEX PER ROLL 10CM $7.000003730131 ARTIFLEX PER ROLL 10CM $7.000003730132 ARTIFLEX PER ROLL 15CM $8.000004497672 ASSESSMENT OF APHASIA $297.000003730200 ASSIST TECH EVAL EA 15 MIN $125.000003720120 ATHLETIC EVAL (VISIT) $175.000003720121 ATHLETIC RE-EVAL (VISIT) $101.000003720105 ATHLETIC TAPE $7.000003720257 ATHLETIC TRAIN RE-EVALUATION $135.000003720256 ATHLETIC TRAINING - HIGH $184.000003720254 ATHLETIC TRAINING - LOW $184.000003720255 ATHLETIC TRAINING - MODERATE $184.000003720170 CANALITH REPOSITIONING (VISIT) $102.000003730225 CANALITH REPOSITIONING (VISIT) $102.000003740170 CANALITH REPOSITIONING (VISIT) $102.000003730087 CERVICAL ROLL $37.000003730087 CERVICAL ROLL $37.000004497668 COGNITIVE PERFORMANCE TESTING $297.000004497787 COGNITIVE THER INTERV (15 MIN) $109.000004497785 COGNITIVE THER INTERVEN(VISIT) $433.000004006029 COMMUNITY/WORK RE-ENTRY $107.000004006030 COMMUNITY/WORK RE-ENTRY $107.000003730056 COMPRESSION PUMP $133.000003720056 COMPRESSION PUMP $133.000003740056 COMPRESSION PUMP $133.000003720136 COMPRESSION PUMP (VISIT) $133.000003740099 CONSTANT ELECTRICAL STIM $87.000003720099 CONSTANT ELECTRICAL STIM $87.000003730099 CONSTANT ELECTRICAL STIM $87.000003720137 CONSTANT ELECTRICAL STIM (15 M $87.00

DisclaimerThis section includes standard charges for CRMC Health Care's full range of out patient therapy services including physical therapy, occupational therapy, speech therapy, children's therapy, aquatic therapy, pediatric outpatient rehabilitation, pelvic pain, neurological rehabilitation, and other specialized therapies.

0004006046 CONTRAST BATHS $114.000003730018 CONTRAST BATHS $114.000003720018 CONTRAST BATHS $114.000003740018 CONTRAST BATHS $114.000003720138 CONTRAST BATHS (15 MIN) $114.000003730199 COSMETIC DECONGESTION (EA 15M) $28.000003740174 DEBRIDEMENT SELECTIVE W/O ANES $237.000004006096 DEBRIDEMENT SELECTIVE W/O ANES $459.000004006097 DEBRIDEMENT SELECTIVE W/O ANES $237.000003730173 DEBRIDEMENT SELECTIVE W/O ANES $459.000003730174 DEBRIDEMENT SELECTIVE W/O ANES $237.000003720147 DEBRIDEMENT SELECTIVE W/O ANES $459.000003720148 DEBRIDEMENT SELECTIVE W/O ANES $237.000003720149 DEBRIDEMENT SELECTIVE W/O ANES $459.000003720150 DEBRIDEMENT SELECTIVE W/O ANES $237.000003740173 DEBRIDEMENT SELECTIVE W/O ANES $459.000004497669 DISABILITY DETERMINATION $285.510004497670 DISABILITY DETERMINATION $285.510003730203 DISABILITY DETERMINATION EVAL $163.000004497922 ECSE SP BLAIR OAKS $37.500003730130 ELASTOMULL PER PIECE 6"" $5.000003740055 ELECTRICAL STIM $83.000003730055 ELECTRICAL STIM $83.000003720055 ELECTRICAL STIM $83.000004006055 ELECTRICAL STIM - UNATTENDED $83.000003740201 ELECTRICAL STIM-PELVIC FLOOR $87.000003730201 ELECTRICAL STIM-PELVIC FLOOR $87.000003720023 ELECTRODES $49.000003740023 ELECTRODES $52.000003730184 ERGONOMIC TRAVEL EXPENSE $3.000004497663 EVAL OF VOICE (VISIT) $312.000004497664 EVAL SPEECH LANGUAGE (VISIT) $312.000004497665 EVAL SPEECH PRODUCTION (VISIT) $312.000004497788 EVAL VOICE PROSTHETIC DEVICE $297.000004497724 EVAL, FEEDING SWALLOW $297.000003740061 EVALUATION $283.000004497666 EVALUATION OF FLUENCY (VISIT) $312.000003730205 FCE-ERGOSCIENCE CANCEL $0.000003740107 FLUIDOTHERAPY $83.000003730107 FLUIDOTHERAPY $83.000003730107 FLUIDOTHERAPY $83.000004006064 FUNCTIONAL CAPACITY EVAL $139.000003730103 FUNCTIONAL CAPACITY EVAL 15 MI $139.000003730103 FUNCTIONAL CAPACITY EVAL 15 MI $139.000004006095 GAIT BELT $30.000003720017 GAIT TRAINING $103.000003730017 GAIT TRAINING $103.00

0003720126 GAIT TRAINING (15 MIN) $103.000003700859 GAIT TRAINING I $103.000004006045 GROUP THERAPY $107.000004497426 GROUP THERAPY - PEDIATRIC $219.000003720096 GROUP THERAPY (VISIT) $107.000003720127 GROUP THERAPY (VISIT) $107.000003730096 GROUP THERAPY VISIT $107.000003740096 GROUP THERAPY VISIT $107.000004497783 GROUP TREATMENT - 15 MIN $20.000003700865 GROUP-THERAPEUTIC PROCEDURES $107.000004006017 HAND GONIOMETRIC MEASUREMENTS $91.000003730133 IDEALBINDE PER ROLL 15CM $16.000004497782 INDIVIDUAL TREATMENT - 15 MIN $37.500003730047 IONTOPHORESIS $176.000003720047 IONTOPHORESIS $176.000003740047 IONTOPHORESIS $176.000003720141 IONTOPHORESIS (15 MIN) $176.000003730134 ISOBAND PER ROLL 20CM $20.000003730109 JOB SITE EVAL 15 $107.000003720116 JOB SITE EVAL 15 MIN $107.000004006083 JOB SITE EVALUATION $107.000003730135 KOMPREX KIDNEY PER BOX SM $6.000003730085 LUMBAR ROLL $37.000003730085 LUMBAR ROLL $37.000003720161 MANUAL MUSCLE TEST HAND $91.000003720160 MANUAL MUSCLE TEST LIMB/TRUNK $101.000004006060 MANUAL THERAPY $108.000003730094 MANUAL THERAPY $108.000003700863 MANUAL THERAPY $108.000003720094 MANUAL THERAPY $108.000003740094 MANUAL THERAPY $108.000004006146 MANUAL THERAPY $108.000003720128 MANUAL THERAPY (15 MIN) $108.000003720015 MASSAGE $114.000003730015 MASSAGE $114.000003720129 MASSAGE (15 MIN) $114.000004497781 MEDICAID SWALLOW/FEED TX(15MIN $40.000003730189 MMT HAND MUSCLE TEST MANUAL $91.000003720153 MMT HAND MUSCLE TEST MANUAL $91.000003740189 MMT HAND MUSCLE TEST MANUAL $91.000003740190 MMT LIMB/TRUNK MUSCLE TEST MAN $101.000003720154 MMT LIMB/TRUNK MUSCLE TEST MAN $101.000003730190 MMT LIMB/TRUNK MUSCLE TEST MAN $101.000003730187 MMT TOTAL BODY W/HAND $168.000003720151 MMT TOTAL BODY W/HAND $168.000003720162 MMT TOTAL BODY W/HAND $168.000003740187 MMT TOTAL BODY W/HAND $168.00

0003740188 MMT TOTAL BODY W/O HAND $142.000003720152 MMT TOTAL BODY W/O HAND $142.000003720163 MMT TOTAL BODY W/O HAND $142.000003730188 MMT TOTAL BODY W/O HAND $142.000004006025 NEUROMUSCULAR RE-ED $114.000004006028 NEUROMUSCULAR RE-ED $114.000003730091 NEUROMUSCULAR RE-EDUCATION $114.000003700861 NEUROMUSCULAR RE-EDUCATION $114.000003720091 NEUROMUSCULAR RE-EDUCATION $114.000003740091 NEUROMUSCULAR RE-EDUCATION $114.000003720130 NEUROMUSCULAR RE-EDUCATION (15 $114.000004006066 O.T. EVALUATION $283.000004003752 O.T. SCHOOL THERAPY (15 MIN) $15.250004006014 OCCUPATIONAL THERAPY RE-EVAL $158.000003730186 ON-SITE EDUCATION $111.000003730139 ON-SITE PT COMPANY VISIT $158.000003730139 ON-SITE PT COMPANY VISIT $158.000004497673 OP ASSESS OF APHASIA PER HR $297.000004497680 OP AUDIOMETRIC SCREEN $107.000004497714 OP EVAL NON SPEECH GEN DEVICE $470.000004497717 OP EVAL ORAL/PHARYGEAL SWALLOW $297.000004497745 OP EVAL SP GEN DEVICE ADDL 30 $186.000004497700 OP EVAL SPEECH GEN DEVICE HR $371.000004497718 OP EVAL VIDEOFLUROSCOP SWALLOW $444.000004497624 OP INDIVIDUAL TREATMENT (30) $223.000004497749 OP INDIVIDUAL TREATMENT (45) $329.000004497683 OP INDIVIDUAL TREATMENT (60) $437.000004497698 OP TX NONSPEECH GEN DEVICE $219.000004497704 OP TX SPEECH GENERATING DEVICE $289.000004497238 OP TX SWALLOWING/ORAL FUNCTION $212.000004006152 ORTHO/PROSTHET TRAIN (15 MIN) $125.000003740254 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000003702259 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000003720258 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000003720259 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000003730026 ORTHOT/PROSTHET TRAIN (15 MIN) $125.000003720073 ORTHOTECS-FOOT-CUSTOM $204.000003720117 ORTHOTECS-FOOT-CUSTOM II $267.000004006074 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000003730048 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000003700864 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000003720048 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000003720132 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000003740048 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000004006077 ORTHOTIC INITIAL TRAIN(15 MIN) $119.000004006151 ORTHOTIC MANAGEMENT/TRAINING $119.000003740193 ORTHOTIC/PROSTHETIC CHECKOUT15 $74.00

0003730073 ORTHOTICS (FOOT) CUSTOM I $204.000003740073 ORTHOTICS (FOOT) CUSTOM I $194.000003730117 ORTHOTICS (FOOT) CUSTOM II $267.000003720108 ORTHOTICS (FOOT) PREFABRICATED $52.000003702256 OT EVALUATION - HIGH $502.000003702254 OT EVALUATION - LOW $298.000003702255 OT EVALUATION - MODERATE $386.000004003783 OT MILEAGE (# OF MILES) $0.540004003780 OT MILEAGE FROM SCHOOL (MILES) $0.540004003786 OT- NUMBER OF KIDS $0.000003702257 OT RE-EVALUATION $166.000004003785 OT-PRE SCHOOL THERAPY (15 MIN) $16.250003730072 OVERDOOR PULLEY $14.000004497418 PEDIATRIC SPEECH THERAPY $107.000003730194 PHYSICAL CAPACITY PROFILE-COMP $140.000003740090 PHYSICAL PERFORMANCE TEST $139.000004006086 PHYSICAL PERFORMANCE TEST $139.000003700858 PHYSICAL PERFORMANCE TEST $139.000003720090 PHYSICAL PERFORMANCE TEST $139.000003730090 PHYSICAL PERFORMANCE TEST $139.000003720124 PHYSICAL PERFORMANCE TEST (15 $139.000003720061 PHYSICAL THERAPY EVALUATION $283.000003791001 PHYSICAL THERAPY EVALUATION $283.000003700857 PHYSICAL THERAPY RE-EVALUATION $158.000003720089 PHYSICAL THERAPY RE-EVALUATION $158.000003740089 PHYSICAL THERAPY RE-EVALUATION $166.000003730185 POST-JOB OFFER SCREENING $37.000004006053 PROSTHET INITIAL TRAIN(15 MIN) $125.000003730105 PROSTHET INITIAL TRAIN(15 MIN) $125.000003702258 PROSTHET INITIAL TRAIN(15 MIN) $125.000003720109 PROSTHET INITIAL TRAIN(15 MIN) $125.000003740105 PROSTHET INITIAL TRAIN(15 MIN) $119.000003730252 PT EVALUATION - HIGH $502.000003702252 PT EVALUATION - HIGH $502.000003720252 PT EVALUATION - HIGH $502.000003740252 PT EVALUATION - HIGH $502.000003740250 PT EVALUATION - LOW $298.000003702250 PT EVALUATION - LOW $298.000003720250 PT EVALUATION - LOW $298.000003730250 PT EVALUATION - LOW $298.000003730251 PT EVALUATION - MODERATE $386.000003702251 PT EVALUATION - MODERATE $386.000003720251 PT EVALUATION - MODERATE $386.000003740251 PT EVALUATION - MODERATE $386.000003793781 PT MILEAGE (# OF MILES) $0.540003793780 PT MILEAGE FROM SCHOOL (MILES) $0.540003740253 PT RE-EVALUATION $166.00

0003702253 PT RE-EVALUATION $166.000003720253 PT RE-EVALUATION $166.000003730253 PT RE-EVALUATION $166.000003700885 PT SCHOOL THERAPY (15 MIN) $15.250003793784 PT SCHOOL-SCR-2 ADM TIME(15MIN $12.000003793782 PT SCHOOL-SCR-2 EVAL(15MIN) $18.000003793783 PT SCHOOL-SCR-2 TRMNT(15 MIN) $16.250003700887 PT-PRESCHOOL (15 MIN) $15.250003720072 REHAB PULLEY $14.000003720165 ROM HAND $91.000003720164 ROM LIMB OR TRUNK $74.000003740191 ROM MEASUREMENT W/ HAND $91.000003730191 ROM MEASUREMENT W/HAND $91.000003720155 ROM MEASUREMENT W/HAND $91.000003740192 ROM MEASUREMENT W/O HAND $74.000003720156 ROM MEASUREMENT W/O HAND $74.000003730192 ROM MEASUREMENT W/O HAND $74.000003730127 ROSIDAL K PER ROLL 10CM $14.000003730128 ROSIDAL K PER ROLL 12CM $17.000003730125 ROSIDAL K PER ROLL 6CM $11.000003730125 ROSIDAL K PER ROLL 6CM $11.000003730126 ROSIDAL K PER ROLL 8CM $13.000004006021 SELFCARE/HOME MANAGEMENT $101.000004006022 SELFCARE/HOME MANAGEMENT $101.000004006145 SENSORY INTEGRATIVE TECHNIQUE $107.000004497728 SPEECH THERAPY TREATMENT (15MI $107.000003730084 SPLINT MATERIAL $53.000003730084 SPLINT MATERIAL $53.000003740084 SPLINT MATERIAL $50.000003720146 SPORTS MED EVAL FOR REHAB PROG $184.000004497931 ST ADMIN COLE R-5 (15 MIN) $12.000004497929 ST EVAL COLE R-5 (15 MIN) $30.000004497923 ST EVAL OF FLUENCY $297.000004497925 ST EVAL OF SPEECH LANGUAGE $312.000004497924 ST EVAL OF SPEECH PRODUCTION $312.000004497926 ST EVAL OF VOICE $312.000004497230 ST MILEAGE FROM SCHOOL (MILES) $0.540004497791 ST SCHOOL-CCR-1 ADM TIME(15MN) $12.000004497789 ST SCHOOL-CCR-1 EVAL (15 MIN) $30.000004497792 ST SCHOOL-CCR-1 GROUP $10.000004497790 ST SCHOOL-CCR-1 IND TRMNT(15 M $20.000004497927 ST SENSORY INTEGRAT TECH (15 M $107.000004497930 ST TREATMENT COLE R-5 (15 MIN) $20.000004497240 SWALLOW TREATMENT $212.000003720050 TAPING $54.000003730050 TAPING $54.000003720133 TAPING (VISIT) $54.00

0003720142 TENS/NMES (VISIT) $252.000003720051 TENS/NMES APPLIC (V) $252.000003730051 TENS/NMES APPLIC (V) $252.000003740051 TENS/NMES APPLIC(V) $265.000003740092 THERAPEUTIC ACTIVITIES $121.000004006018 THERAPEUTIC ACTIVITIES $121.000003700862 THERAPEUTIC ACTIVITIES $121.000003720092 THERAPEUTIC ACTIVITIES $121.000003730092 THERAPEUTIC ACTIVITIES $121.000004006019 THERAPEUTIC ACTIVITIES $121.000003720134 THERAPEUTIC ACTIVITIES (15 MIN $121.000004006071 THERAPEUTIC EXERCISE $120.000003730066 THERAPEUTIC EXERCISE $120.000003700860 THERAPEUTIC EXERCISE $120.000003720066 THERAPEUTIC EXERCISE $120.000003740066 THERAPEUTIC EXERCISE $120.000004006073 THERAPEUTIC EXERCISE $120.000003720135 THERAPEUTIC EXERCISE (15 MIN) $120.000003740054 TRACTION MECHANICAL $147.000003720054 TRACTION MECHANICAL $147.000003730054 TRACTION MECHANICAL $147.000003730129 TRANSELAST PER PIECE 6CM $4.000004497237 TRAVEL - MILEAGE $0.540004497723 TX SPEECH GENERATING DEVICE $289.000003730068 ULTRASOUND $87.000003720068 ULTRASOUND $87.000003740068 ULTRASOUND $87.000003720143 ULTRASOUND (15 MIN) $87.000003740069 ULTRASOUND W/ELEC STIM $87.000003720069 ULTRASOUND W/ELEC STIM $87.000003730069 ULTRASOUND W/ELEC STIM $87.000003720144 ULTRASOUND WITH ELECTRICAL (15 $87.000003740123 VAGINAL/RECTAL ELECTRODE $97.000004006037 WHEEL CHAIR TRAINING $107.000004006038 WHEEL CHAIR TRAINING $107.000003700867 WHEELCHAIR TRAINING $107.000003730204 WHEELCHAIR TRAINING 15 MIN $107.000003740204 WHEELCHAIR TRAINING 15 MIN $107.000003740058 WHIRLPOOL $83.000003720058 WHIRLPOOL $83.000003730058 WHIRLPOOL $83.000003720145 WHIRLPOOL (VISIT) $83.000003730111 WORK CONDITIONING + 1 HOUR $143.000003730111 WORK CONDITIONING + 1 HOUR $143.000003730110 WORK CONDITIONING 2 HOURS $428.000003730110 WORK CONDITIONING 2 HOURS $428.000004006094 WORK CONDITIONING-ADDITIONAL 1 $143.00

0004006093 WORK CONDITIONING-INITIAL 2 HR $428.00


PHA BILL CODE/ ACT PHA DESCRIPTION/ UNIT COST/424410 Y ABACAVIR SULFATE 300 MG TAB (N 0.107425709 Y ABATACEPT 250 MG/10 ML VIAL 750.99425164 Y ABCIXIMAB INJ 10 MG/5 ML VIAL 669.08

Y ABOBOTULINUMTOXINA 500 UNIT VI 818.5424607 Y ACAMPROSATE CALCIUM 333 MG TAB 0.006424304 Y ACARBOSE 50 MG TAB (NF) 0.77426891 Y ACEBUTOLOL 200 MG CAP (NF) 1.39428281 Y ACETAMINOPHEN 1,000MG/100 ML V 10.98426660 Y ACETAMINOPHEN 120 MG SUPP 0.25428043 Y ACETAMINOPHEN 300MG/CODIENE 30 0.1426386 Y ACETAMINOPHEN 325 MG SUPP 0.484426507 Y ACETAMINOPHEN 325 MG TAB 0.0142426508 Y ACETAMINOPHEN 500 MG TAB 0.03426001 Y ACETAMINOPHEN 650 MG SUPP 0.52426395 Y ACETAMINOPHEN 80 MG CHEW 0.04424321 Y ACETAMINOPHEN SOLN 325 MG/10.1 0.5636426833 Y ACETAMINOPHEN SOLN 650MG/20ML 0.24424661 Y ACETAMINOPHEN SUSP 160 MG/5 ML 2.11426997 Y ACETAMINOPHEN/CODEINE 120/12MG 0.37426137 Y acetaZOLAMIDE 250 MG TAB 1.82425052 Y acetaZOLAMIDE SODIUM 500 MG VI 15.67427213 Y ACETIC ACID 0.25% IRRIG SOLN 1 1.49428443 Y ACETIC ACID 0.25% IRRIG SOLN 1 1.49424698 Y ACETIC ACID 5% IRRIG SOLN 50 M 1.96

Y ACETIC ACID/ALUMINUM ACETATE 6 44.96427180 Y ACETIC ACID/HYDROCORT OTIC 10 195.39424423 Y ACETOHYDROXAMIC ACID 250 MG TA 1.34425670 Y ACETYLCYSTEINE (FOR IV USE) 60 0.4963427312 Y ACETYLCYSTEINE 10% INHAL SOLN 1.53427112 Y ACETYLCYSTEINE 20% INHAL SOLN 3.57426245 Y ACIDOPHILUS (LACTOBACILLUS) 1 0.0283424411 Y ACITRETIN 25 MG CAP (NF) 25.46429328 Y ACYCLOVIR (CLINIC) 400 MG TAB 0.0879429498 Y ACYCLOVIR 200 MG CAP 0.092429072 Y ACYCLOVIR 500 MG/10 ML VIAL 0.438

This section includes the cost and not the charge for pharmaceutical-related services provided at CRMC Health Care. We use the Average Whole Sale Price to determine cost. Most are based on units used determined by weight and units prescribed. These charges also are including medical supplies, medical equipment and devices, and prescribed medications. Pharmeuctical-related services are typically used in the delivery of services such as surgery, diagnostic testing, hospital admission, clinic visit.

Disclaimer

429127 Y ACYCLOVIR 800 MG TAB 0.1638427244 Y ACYCLOVIR OINT 15 GM TUBE 287.09427244 Y ACYCLOVIR OINT 5 GM TUBE 102.27429272 Y ACYCLOVIR SUSP 200 MG/5 ML CUP 0.55425194 Y ADENOSINE 3 MG/ML 20 ML VIAL ( 49.35425428 Y ADENOSINE 3 MG/ML 30 ML VIAL ( 65.8425353 Y ADENOSINE 6 MG/2 ML VIAL 6.856428304 Y ADO-TRASTUZUMAB EMTANSINE 100 2773.57428395 Y ADO-TRASTUZUMAB EMTANSINE 160 4504.27428288 Y AFLIBERCEPT 100 MG/4 ML VIAL 825428289 Y AFLIBERCEPT 200 MG/8 ML VIAL 1650424311 Y AL HYDROX/MG HYDROX/SIMET 30 M 0.39425315 Y ALBUMIN HUMAN 25% (12.5 GM/50 36.64425114 Y ALBUMIN HUMAN 5% (12.5 GM/250 27.28424191 Y ALBUTEROL 1.25 MG/3 ML NEB SOL 1.18427537 Y ALBUTEROL 2.5 MG/0.5 ML NEB SO 0.34427294 Y ALBUTEROL 2.5 MG/3 ML NEB SOLN 0.22427227 Y ALBUTEROL HFA INHALER 17 GM IN 47.86427333 Y ALBUTEROL SOLN FOR NEB 20 ML B 8.42426632 Y ALBUTEROL SULF 2 MG TAB (NF) 0.09424392 Y ALBUTEROL SULF SR 4 MG TAB (NF 0.71426932 Y ALBUTEROL SYRUP 2 MG/5 ML CUP 0.043428279 Y ALBUTEROL/IPRATROPIUM 2.5/0.5M 0.22427141 Y ALBUTEROL/IPRATROPIUM INH 14.7 138.64427589 Y ALCLOMETASONE DIP CREAM 15 GM 9.85425339 Y ALCOHOL USP 5 ML VIAL (NF) 29.16424075 Y ALDESLEUKIN FOR IV SOLN 220000 947.22428384 Y ALEMTUZUMAB 12 MG/1.2 ML VIAL 20749.84427440 Y ALENDRONATE 10 MG TAB (NF) 2.71424366 Y ALENDRONATE 70 MG TAB (NF) 0.71428071 Y ALFENTANIL 2500 MCG/5 ML AMP ( 2.402424584 Y ALFUZOSIN HCL 10 MG TAB (NF) 3.53427672 Y ALISKIREN HEMIFUMARATE 150 MG 2.37426530 Y ALLOPURINOL 100 MG TAB 0.054426531 Y ALLOPURINOL 300 MG TAB 0.08428170 Y ALMOTRIPTAN MALATE 12.5 MG TAB 21.42428167 Y ALMOTRIPTAN MALATE 6.25 MG TAB 21.42428213 Y ALPHANATE 1,000 IU/10 ML 1017.23428410 Y ALPHANATE 250 IU/5 ML VIAL 0.8428303 Y ALPHANATE 500 IU/5 ML 370426638 Y ALPRAZolam 0.25 MG TAB 0.04426682 Y ALPRAZolam 0.5 MG TAB 0.04429350 Y ALPRAZolam SR 1 MG TABCR (NF) 0.39429352 Y ALPRAZolam SR 2 MG TABCR (NF) 0.39429353 Y ALPRAZolam SR 3 MG TABCR (NF) 1.07425648 Y ALPROSTADIL 500 MCG/ 1ML VIAL 36.24425651 Y ALTEPLASE INJ 10 MG/10 ML SYR 826.7

425320 Y ALTEPLASE RECOMBINANT 100 MG/1 7257.94425482 Y ALTEPLASE RECOMBINANT 2 MG/2 M 65425462 Y ALTEPLASE RECOMBINANT 50 MG/50 1300.64424421 Y ALUM HYDROX/MG CARBONATE SUSP 0.25426672 Y ALUM HYDROX/MG CARBONATE TAB 1 0.0003427066 Y ALUM SULF/CALC ACET PWD 1 PKT 0.5817427616 Y ALUMINUM CHLOR HEXAHYDRATE 100 7.27426023 Y ALUMINUM HYDROXIDE GEL SUSP 1, 0.22426264 Y ALUMINUM/MAGNESIUM/SIMETH SUSP 1.4424721 Y ALVIMOPAN 12 MG CAP 66.27426933 Y AMANTADINE 100 MG/10 ML SYRUP 0.07426452 Y AMANTADINE HCL 100 MG CAP 0.54425233 Y AMIFOSTINE 500 MG/10 ML VIAL 154.6429000 Y AMIKACIN SULFATE 500 MG/2 ML V 3.63426928 Y aMILoride 5MG/HCTZ 50MG TAB (N 0.0346426942 Y aMILoride HCL 5 MG TAB 0.68425566 Y AMINO ACID INFUSION 10% 2,000 20.56424195 Y AMINO ACIDS 4.25%/D10W 1000 ML 17.75424196 Y AMINO ACIDS 4.25%/D10W 2000 ML 35.49428203 Y AMINO ACIDS 4.25%/D20W 1000 ML 37.05424197 Y AMINO ACIDS 4.25%/D5W 1000ML C 17.45424197 Y AMINO ACIDS 4.25%/D5W 2000ML C 34.92424198 Y AMINO ACIDS 5%/D15W 1000ML CLI 40.12424198 Y AMINO ACIDS 5%/D15W 2000ML CLI 40.12424199 Y AMINO ACIDS 5%/D20W 2000 ML CL 40.68375098 Y AMINO ACIDS INFUSION 10% 1,000 10.26426018 Y AMINOCAPROIC ACID 500 MG TAB ( 0.96425007 Y AMINOCAPROIC ACID INJ 5,000 MG 0.88425009 Y AMINOPHYLLINE 500 MG/20ML VIAL 0.4424589 Y AMIODARONE 100 MG TAB (NF) 2.33425447 Y AMIODARONE 150 MG/3 ML VIAL 1.22426708 Y AMIODARONE 200 MG TAB 0.23425654 Y AMIODARONE 450 MG/9 ML VIAL 2.68428425 Y AMIODARONE IN D5W DRIP 360 MG/ 43.35426175 Y AMITRIPTYLINE HCL 10 MG TAB 0.05426176 Y AMITRIPTYLINE HCL 25 MG TAB 0.05426296 Y AMLODIPINE BESYLATE 10 MG TAB 0.1424387 Y AMLODIPINE BESYLATE 2.5 MG TAB 0.12426202 Y AMLODIPINE BESYLATE 5 MG TAB 0.07428197 Y AMLODIPINE/BENAZEPRIL 10 MG/20 4428198 Y AMLODIPINE/BENAZEPRIL 10 MG/40 4.41428199 Y AMLODIPINE/BENAZEPRIL 2.5 MG/1 3.2428200 Y AMLODIPINE/BENAZEPRIL 5 MG/10 3.26424413 Y AMLODIPINE/BENAZEPRIL 5 MG/20 2.24427188 Y AMMONIA AROMATIC INHAL 0.33 ML 0.0135427044 Y AMMONIUM LACTATE LOTION 225 AP 3.81426135 Y AMOXAPINE 25 MG TAB (NF) 0.21

429203 Y AMOXICILLIN 125MG/5ML SUSP 100 1.39430002 Y AMOXICILLIN 125MG/5ML SUSP 100 1.39430003 Y AMOXICILLIN 125MG/5ML SUSP 150 2.39430003 Y AMOXICILLIN 125MG/5ML SUSP 150 2.39429296 Y AMOXICILLIN 200MG/5ML SUSP 50M 1.83430004 Y AMOXICILLIN 200MG/5ML SUSP 50M 1.83430005 Y AMOXICILLIN 200MG/5ML SUSP 75M 3429100 Y AMOXICILLIN 250 MG CAP 0.09429202 Y AMOXICILLIN 250MG/5ML SUSP 100 1.75430008 Y AMOXICILLIN 250MG/5ML SUSP 100 1.75430001 Y AMOXICILLIN 250MG/5ML SUSP 150 2.3430001 Y AMOXICILLIN 250MG/5ML SUSP 150 2.3429295 Y AMOXICILLIN 400MG/5ML SUSP 50M 1.52430009 Y AMOXICILLIN 400MG/5ML SUSP 50M 1.52429297 Y AMOXICILLIN 400MG/5ML SUSP 75M 1.63429193 Y AMOXICILLIN 500 MG CAP 0.16429293 Y AMOXICILLIN 875 MG TAB 0.25429496 Y AMOXICILLIN/CLAV 250/125 TAB ( 0.0923429264 Y AMOXICILLIN/CLAV 250MG/5ML SUS 60.6429301 Y AMOXICILLIN/CLAV 400MG/5ML SUS 11.32429497 Y AMOXICILLIN/CLAV 500/125 TAB 0.45429289 Y AMOXICILLIN/CLAV 600MG/5ML SUS 0.0037429011 Y AMOXICILLIN/CLAV 875/125 TAB 0.064428113 Y AMPHETAMINE 5 MG TAB (NF) 0.15428110 Y AMPHETAMINE SR 5 MG 4.46429010 Y AMPHOTERICIN B 50 MG/10 ML VIA 9.73429136 Y AMPHOTERICIN B LIPOSOME 50 MG 152.2429237 Y AMPICILLIN 1 GM/8 ML VIAL 4.05429279 Y AMPICILLIN 2 GM/16 ML VIAL 6.34429103 Y AMPICILLIN 250 MG CAP (NF) 0.27429169 Y AMPICILLIN 500 MG CAP (NF) 0.11427644 Y AMPICILLIN 500 MG/2 ML-FOR IM 1.968429171 Y AMPICILLIN 500 MG/5 ML (INFANT 1.968429231 Y AMPICILLIN/SULBACTAM 1.5 GM/10 1.73429098 Y AMPICILLIN/SULBACTAM 3 GM/10 M 3.37424415 Y ANAGRELIDE HCL 0.5 MG CAP (NF) 0.11427342 Y ANALGESIC BALM 30 GM TUBE 1.22426620 Y ANASTROZOLE 1 MG TAB 0.57428475 Y ANGIOTENSIN II ACETATE 2.5 MG/ 1500428475 Y ANTICOAGULANT CITRATE DEXTROSE 14424187 Y ANTIHEMOPHILIC FACTOR 1238 IU/ 931.98424187 Y ANTIHEMOPHILIC FACTOR 1400 IU/ 931.98424188 Y ANTIHEMOPHILIC FACTOR 1743 IU/ 1312.15424189 Y ANTIHEMOPHILIC FACTOR 992 IU/1 746.79428328 Y APIXABAN 2.5 MG TAB 3.48428332 Y APIXABAN 5 MG TAB 3.48427161 Y APLIGRAF CULT SKIN SUBST 1295

424552 Y APREPITANT 125 MG CAP 136.91428445 Y APREPITANT 130 MG/18 ML VIAL 235.55424551 Y APREPITANT 80 MG CAP 88.83424137 Y APREPITANT TRI PACK (NF) 321.33425769 Y ARFORMOTEROL 15 MCG/2 ML NEB S 5.74427694 Y ARGATROBAN INJ 250 MG/2.5 ML V 1022.23424666 Y ARGININE 500 MG TAB (NF) 0.04424574 Y ARIPIPRAZOLE 10 MG TAB 14.72424560 Y ARIPIPRAZOLE 15 MG TAB 14.72424603 Y ARIPIPRAZOLE 5 MG TAB 1.2853428455 Y ARSENIC TRIOXIDE 12 MG/ 6 ML A 836.827427281 Y ARTIFICIAL TEARS OP OINT 4 APP 2.79427102 Y ARTIFICIAL TEARS OP SOLN 15 ML 0.54428375 Y ASCORBIC ACID 25,000 MG/50 ML 57.18426046 Y ASCORBIC ACID 500 MG TAB 0.03425738 Y ASCORBIC ACID SYRUP 500 MG/5 M 0.07426044 Y ASPIRIN 300 MG SUPP 1.43426535 Y ASPIRIN 325 MG TAB 0.01426173 Y ASPIRIN 325 MG TABEC 0.04426619 Y ASPIRIN 400MG/CAFFEINE 32MG TA 0.1426045 Y ASPIRIN 600 MG SUPP 1.48426440 Y ASPIRIN 81 MG CHEW 0.02426340 Y ASPIRIN 81 MG EC TAB 0.03426047 Y ASPIRIN/ALUMINA/MAGNESIA 325 M 0.0137424416 Y ASPIRIN/DIPYRIDAMOLE SR CAP 2.95430016 Y ATENOLOL 100 MG TAB (NF) 0.03426688 Y ATENOLOL 25 MG TAB 0.06426610 Y ATENOLOL 50 MG TAB 0.03428396 Y ATEZOLIZUMAB 1200 MG/20 ML VIA 8620424621 Y ATOMOXETINE 25 MG CAP (NF) 4.89424595 Y ATOMOXETINE 40 MG CAP (NF) 5.11424526 Y ATOMOXETINE 60 MG CAP (NF) 5.11424302 Y ATORVASTATIN 10 MG TAB 2.92424306 Y ATORVASTATIN 20 MG TAB 4.38424714 Y ATORVASTATIN 40 MG TAB 4.38429366 Y ATORVASTATIN 80 MG TAB 4.17424394 Y ATOVAQUONE SUSP 750 MG/5 ML UD 21.86425019 Y ATROPINE 0.4 MG/1 ML VIAL 3.16425018 Y ATROPINE 1 MG/1 ML VIAL 0.23425191 Y ATROPINE 1 MG/10 ML SYRINGE 1.47427015 Y ATROPINE 1% OP SOLN 15 ML BTL 18.26428447 Y AVELUMAB 200 MG/10 ML VIAL 1549.46424119 Y AZACITIDINE 100 MG/10 ML VIAL 350.74424145 Y AZACITIDINE 100 MG/4 ML VIAL 350.74424083 Y AZATHIOPRINE 100 MG/20 ML VIAL 47.01426751 Y AZATHIOPRINE 50 MG TAB 0.27427523 Y AZELASTINE NASAL SPRAY 137 MCG 70.73

427546 Y AZELASTINE OPHTH 6 ML BTL (NF) 66.37429107 Y AZITHROMYCIN 250 MG TAB 0.91429070 Y AZITHROMYCIN 500 MG/5 ML VIAL 1.219429007 Y AZITHROMYCIN POWDER 1 GM PACKE 12.83429023 Y AZITHROMYCIN SUSP 100 MG/5 ML 10.29429071 Y AZITHROMYCIN SUSP 200 MG/5 ML 10.29429494 Y AZTREONAM 1 GM/10 ML VIAL 22.842429321 Y AZTREONAM/DEXTROSE 1 GM/50 ML 6427613 Y BACITRACIN 500 U/GM OINT 1 GM 0.11425291 Y BACITRACIN IM 50000 UNIT VIAL 9.14427024 Y BACITRACIN OINT 30 GM TUBE 1.83427471 Y BACITRACIN OP OINT 3.5 GM TUBE 88.28425688 Y BACLOFEN (NF) 2,000 MCG/ML KIT 640426767 Y BACLOFEN 10 MG TAB 0.19425688 Y BACLOFEN IT 40 MG/20 ML KIT 860425534 Y BAG EMPTY PLASTIC 1000 ML 1.56375132 Y BAG EMPTY PLASTIC 150 ML 2.14425571 Y BAG EMPTY PLASTIC 250 ML 1.88425557 Y BAG FOR EPIDURAL DRUG 7.65424649 Y BAICALIN/CATECHIN CAP 250 MG C 1.3427196 Y BALANCED SALT SOLN OP IRRIG 15 2.42424418 Y BALSALAZIDE 750 MG CAP (NF) 0.0044

Y BANATROL PLUS POWDER PACKET 0.75428176 Y BECLOMETHASONE DIP 120 SPRAY/2 131.4

Y BECLOMETHASONE DIPROPIONATE 40 94.75Y BECLOMETHASONE DIPROPIONATE 80 126.86

428215 Y BELIMUMAB 120 MG VIAL 431428216 Y BELIMUMAB 400 MG VIAL 1436.64426160 Y BELLADONNA ALK/PHENOBARBITAL 1 0.05426162 Y BELLADONNA ALK/PHENOBARBITAL 1 0.1428064 Y BELLADONNA ALKALOID/OPIUM 60 M 16.05426087 Y BENAZEPRIL HCL 10 MG TAB 0.0937428234 Y BENDAMUSTINE 25 MG/5 ML VIAL 445.41428234 Y BENDAMUSTINE 25 MG/ML MDV 545.04425725 Y BENECALORIE LIQUID 41.3 GM CAN 1.19425721 Y BENEPROTEIN POWDER 227 GM CAN 9.45427627 Y BENOXINATE HCL/FLUORESCEIN NA 4.8428464 Y BENRALIZUMAB 30 MG/ML SYR 4752.11427527 Y BENZOCAIN PASTE 14 APPL/7 GM T 3.84427303 Y BENZOCAINE SPRAY 60 ML CAN 22.4427040 Y BENZOCAINE/MENTHOL 18 LOZG/PKG 0.5427028 Y BENZOCAINE/MENTHOL SPRAY 56 ML 3.98427566 Y BENZOCAINE/RESORCINOL CR 30 GM 0.0026427274 Y BENZOIN COMPOUND TINC 60 ML BT 2.68426470 Y BENZONATATE 100 MG CAP 0.26425778 Y BENZOYL PEROXIDE 5% WASH 142 G 10.77426758 Y BENZTROPINE 1 MG TAB 0.3723

425034 Y BENZTROPINE 2 MG/2 ML AMP 45.71425122 Y BERACTANT (LUNG SURFACTANT) IN 429.22427606 Y BETAMET DIPROP 0.05% OINT 50 G 5.89425032 Y BETAMETHASONE 12 MG/2 ML DOSE 33.95427241 Y BETAMETHASONE DIP 0.05% CR 15 1.39427555 Y BETAMETHASONE DIP 0.05% CREAM 51.31427174 Y BETAMETHASONE VAL 0.1% CREAM 1 11.14426348 Y BETAXOLOL 10 MG TAB (NF) 0.63427358 Y BETAXOLOL HCL 0.25% OP SUSP 10 110.12427359 Y BETAXOLOL HCL 0.5% OP SOLN 5 M 34.62426512 Y BETHANECHOL CHL 10 MG TAB 0.34426513 Y BETHANECHOL TAB 25 MG TAB (NF) 0.3424115 Y BEVACIZUMAB 100 MG/4 ML VIAL 567.6424116 Y BEVACIZUMAB 400 MG/16ML VIAL 2270.4424279 Y BICALUTAMIDE TAB 50 MG TAB (NF 1.04427506 Y BIMATOPROST (0.03%) OP SOLU 2. 72.65426169 Y BISACODYL SUPP 10 MG SUPP 0.12426064 Y BISACODYL TAB 5 MG TABEC 0.0256426416 Y BISMUTH SUBSALICYLATE CHEW TAB 0.051426692 Y BISMUTH SUBSALICYLATE SUSP 524 1.29424388 Y BISOPROLOL FUMARATE 5 MG TAB ( 0.36426057 Y BISOPROLOL/HCTZ 10/6.25MG TAB 0.19424432 Y BISOPROLOL/HCTZ 5/6.25MG TAB ( 0.045425637 Y BIVALIRUDIN INJ 250 MG/5 ML VI 815.54424001 Y BLEOMYCIN SULFATE 15 UNIT/5 ML 31.34427364 Y BLOOD GLUCOSE CALIBRATION LIQ 9.6425772 Y BOOST 237 ML BTL 1424120 Y BORTEZOMIB 3.5 MG/1.4 ML VIAL 1603424120 Y BORTEZOMIB 3.5 MG/3.5 ML VIAL 1254.53

Y BOTULINUM TOXIN COSMETIC INJ 5 331Y BOTULINUM TOXIN COSTMETIC 100 601

425050 Y BOTULINUM TOXIN TYPE A 100 UNI 579425050 Y BOTULINUM TOXIN TYPE A 200 UNI 1202428310 Y BRENTUXIMAB VEDOTIN 50 MG/10 M 7375427573 Y BRIMONIDINE 0.15% OP SOLU 5 ML 64.11427170 Y BRIMONIDINE 0.2% OP SOLU 5 ML 3.51427507 Y BRINZOLAMIDE 1% OP SUSP 10 ML 91.97428431 Y BRIVARACETAM 100 MG TAB 15.66426943 Y BROMOCRIPTINE MESYLATE 2.5 MG 0.86424618 Y BROMPHEN 1MG/PHENYLEPHRINE 2.5 1.3427445 Y BUDESONIDE 0.25 MG/2 ML NEB SO 6.15427444 Y BUDESONIDE 0.5 MG/2 ML NEB SOL 6.94424623 Y BUDESONIDE 3 MG CAP 11.88427431 Y BUDESONIDE 32 MCG/ACT NASAL (N 89.39427522 Y BUDESONIDE POWD AERO 0.4 GM IN 94.1428123 Y BUDESONIDE/FORMOTEROL 160/4.5 205.73428126 Y BUDESONIDE/FORMOTEROL 160/4.5 1.54

428124 Y BUDESONIDE/FORMOTEROL 80/4.5 I 179.99428125 Y BUDESONIDE/FORMOTEROL 80/4.5 P 1.34426641 Y BUMETANIDE 0.5 MG TAB (NF) 0.12426642 Y BUMETANIDE 1 MG TAB 0.15425242 Y BUMETANIDE 1 MG/4 ML VIAL 0.5825425344 Y BUMETANIDE 2.5 MG/10 ML VIAL 0.26424162 Y BUPIVACAINE 0.25 % SDV (SW ORT 2.19425223 Y BUPIVACAINE 0.25% SDV 30 ML V 1.24425701 Y BUPIVACAINE 0.25% MDV (CLINIC) 4.34425607 Y BUPIVACAINE 0.5% (ON-Q PAIN BA 4.34425224 Y BUPIVACAINE 0.5% SDV 30 ML VIA 1.5425198 Y BUPIVACAINE 0.75% SDV 30 ML VI 2.12428302 Y BUPIVACAINE LIPOSOME 266 MG/20 272.18428465 Y BUPIVACAINE LIPOSOME/PF 13.3 M 204425271 Y BUPIVACAINE/DEXT SPINAL 0.75% 1.16428444 Y BUPIVACAINE/EPI 0.25 MDV 50 ML 11.59425375 Y BUPIVACAINE/EPI 0.25% SDV 10 M 1.27425375 Y BUPIVACAINE/EPI 0.25% SDV 30 M 2.02425355 Y BUPIVACAINE/EPI 0.5% MDV 50 ML 3.57425355 Y BUPIVACAINE/EPI 0.5% SDV 30 ML 1.3428423 Y BUPRENORPHINE HCL 2 MG TAB.SUB 0.9203426835 Y buPROPion 100 MG TAB (NF) 0.17424294 Y buPROPion 100 MG TABSR 0.71424285 Y buPROPion 150 MG TABSR 0.44426845 Y buPROPion 75 MG TAB (NF) 0.16426939 Y busPIRone 5 MG TAB 0.26428427 Y BUSPIRONE HCL 10 MG TABLET 0.06424002 Y BUSULFAN 2 MG TAB (nf) 3.58426198 Y BUTALBITAL 50/ASPIRIN 325/CAFF 0.0019426184 Y BUTALBITAL/APAP/CAFFEINE TAB 1.5427094 Y BUTORPHANOL NASAL SPRAY 25 MG/ 18.84425489 Y BUTORPHANOL TARTRATE 1 MG/ML V 2.08425201 Y BUTORPHANOL TARTRATE 2 MG/ML V 1.23428132 Y CABAZITAXEL 60 MG/6 ML VIAL (N 9842.82427557 Y CADEXOMER IODINE GEL 40 GM TUB 35.6425650 Y CAFFEINE CITRATED 20 MG/ML VIA 44.6233425443 Y CAFFEINE/SODIUM BENZOATE 500 M 8.815427341 Y CALAMINE LOTION 120 ML BTL 0.71425318 Y CALCITONIN INJ 200 IU/ML VIAL 42.76427612 Y CALCITONIN,SALMON,SYNTH NS 3.8 49.86426710 Y CALCITRIOL 0.25 MCG CAP 0.59427661 Y CALCITRIOL 0.5MG CAP (NF) 1.06425145 Y CALCITRIOL 1 MCG/1 ML AMP 3.4426330 Y CALCIUM 250MG/VITAMIN D 125IU 0.04427693 Y CALCIUM ACETATE 667 MG CAP (NF 0.68426880 Y CALCIUM CARBONATE CHEWABLE 500 0.07426297 Y CALCIUM CARBONATE SUSP 1,250 M 0.34

425027 Y CALCIUM CHLORIDE 10% SYRINGE 1 1.72425027 Y CALCIUM CHLORIDE SYRINGE 14 ME 1.72425028 Y CALCIUM GLUCONATE 10% 0.465 ME 4.1425615 Y CALCIUM GLUCONATE 10% 0.465 ME 1426539 Y CALCIUM POLYCARBOPHIL 625 MG T 0.11424356 Y CANDESARTAN 16 MG TAB (NF) 1.98424647 Y CANDESARTAN/HCTZ 16/12.5MG TAB 2.67425212 Y CANDIDA ALBICANS SKIN TEST 0.1 167.32424097 Y CAPECITABINE 500 MG TAB (NF) 23.02427369 Y CAPSAICIN 0.025% CREAM 60 GM T 8.13428470 Y CAPTOPRIL (NF) 50 MG TAB 0.0016426673 Y CAPTOPRIL 12.5 MG TAB 0.05426624 Y CAPTOPRIL 25 MG TAB 0.07426750 Y CAPTOPRIL/HCTZ 25MG/15MG TAB ( 0.0486427077 Y CARBACHOL 1.5% OP SOLN 15 ML B 12.41424420 Y carBAMazepine 100 MG SR TABCR 0.45424580 Y carBAMazepine 200 MG SR CAP (N 1.49424455 Y CARBAMAZEPINE 200 MG SR TAB 0.67426652 Y CARBAMAZEPINE 200 MG TAB 0.0754424585 Y CARBAMAZEPINE 300 MG SR CAP (N 1.49426344 Y carBAMazepine SUSP 100 MG/5 ML 0.52427057 Y CARBAMIDE PEROXIDE 6.5% OTIC S 1.14424382 Y CARBIDOPA 25 MG TAB (NF) 2.12426139 Y CARBIDOPA/LEVO 50MG/200MG TABC 0.46426532 Y CARBIDOPA/LEVODOPA 10/100 MG T 0.0025426653 Y CARBIDOPA/LEVODOPA 25/100 MG T 0.0027426501 Y CARBIDOPA/LEVODOPA 25/100 MG T 0.0057426541 Y CARBIDOPA/LEVODOPA 25/250 TAB 0.0044424048 Y CARBOplatin 150 MG/15ML VIAL 10.83424121 Y CARBOplatin 450 MG/45 ML VIAL 34.66424052 Y CARBOplatin 50 MG/5ML VIAL 5.18424123 Y CARBOplatin 600 MG/60ML VIAL 42.93425121 Y CARBOPROST TROMETHAMINE 250 MC 180428139 Y CARFILZOMIB INJ (NF) 60 MG/30 1691.16426434 Y CARISOPRODOL 350 MG TAB 0.14424003 Y CARMUSTINE 100 MG VIAL 133.42427512 Y CARTEOLOL HCL 1% OP SOLN 5 ML 5.36427647 Y CARVEDILOL 10 MG CR TABLET (NF 3.68424437 Y CARVEDILOL 3.125 MG TAB 0.0744424315 Y CARVEDILOL 6.25 MG TAB 0.1429313 Y CASPOFUNGIN 50 MG/10 ML VIAL ( 193.92429312 Y CASPOFUNGIN 70 MG/10 ML VIAL ( 193.92426083 Y CASTOR OIL 95% 60 ML BTL 1.47429338 Y CEFACLOR 250 MG CAP (NF) 1.33429339 Y CEFACLOR 500 MG CAP (NF) 1.78429190 Y CEFACLOR SUSP 250 MG/5 ML BTL 11.99429499 Y CEFADROXIL 500 MG CAP (NF) 0.26

429022 Y ceFAZolin 1 GM/10 ML VIAL 0.72429097 Y ceFAZolin/DEXTROSE 1 GM/50 ML 2.93425585 Y ceFAZolin/DEXTROSE 1 GM/50 ML 3.06428368 Y ceFAZolin/DEXTROSE 2 GM/100 ML 5.73428439 Y CEFAZOLIN/METRONIDAZOLE 1 GM/5 2429306 Y CEFDINIR 300 MG CAP 1.18429298 Y CEFDINIR SUSP 125 MG/5 ML BTL 15.12429320 Y CEFDINIR SUSP 250 MG/5 ML BTL 28.62429033 Y CEFEPIME 1 GM/10 ML VIAL (NF) 2.632429144 Y CEFEPIME 2 GM/20 ML VIAL (NF) 34.779428338 Y CEFEPIME/D5W 2 GM/100 ML BAG ( 42.58429219 Y CEFIXIME SUSP 100 MG/5 ML BTL 118.06429062 Y CEFOTAXIME 1000 MG/10 ML VIAL 1.16427645 Y CEFOTAXIME 1000 MG/3.33 ML-FOR 1.16429341 Y CEFOTETAN 1 GM VIAL (NF) 8.74429051 Y CEFOXITIN 1 GM/10 ML VIAL (NF) 0.2352428291 Y CEFPROZIL 125 MG/5 ML 75ML BTL 22.95429342 Y CEFPROZIL 250 MG TAB (NF) 0.73429003 Y CEFPROZIL 250 MG/5 ML 75ML BTL 15.65429343 Y CEFPROZIL 500 MG TAB (NF) 1.38428218 Y CEFTAROLINE 400 MG/20 ML VIAL 145.28428229 Y CEFTAROLINE 600 MG/20 ML VIAL 39.28429234 Y CEFTAZIDIME 1 GM/10 ML VIAL 3.06425741 Y CEFTAZIDIME 1000 MG/3.56 ML-FO 3.06425729 Y CEFTAZIDIME 2 GM/20 ML VIAL 4.15429120 Y CEFTAZIDIME/D5W 1 GM/50 ML BAG 13.58429094 Y CEFTRIAXONE 1 GM/10 ML VIAL 1.29429258 Y CEFTRIAXONE 250 MG/1 ML VIAL ( 0.67429093 Y CEFTRIAXONE 500 MG/1.43 ML VIA 0.85427667 Y CEFTRIAXONE BULK 1 GM/10 ML VI 14.82429118 Y CEFTRIAXONE PREMIX 1 GM/50 ML 1.42424172 Y CEFTRIAXONE/DEXTROSE 1 GM/50 M 8.51429083 Y CEFUROXIME 750 MG/7.5 ML VIAL 6.56429209 Y CEFUROXIME AXETIL 250 MG TAB ( 0.24429344 Y CEFUROXIME AXETIL 500 MG TAB ( 0.37429260 Y CEFUROXIME AXETIL SUSP 125 MG/ 67.49429345 Y CEFUROXIME SOD 1.5 GM VIAL (NF 2.82424324 Y CELECOXIB 100 MG CAP 2.19424358 Y CELECOXIB 200 MG CAP 3.59429128 Y CEPHALEXIN 250 MG CAP 0.0734429167 Y CEPHALEXIN 500 MG CAP 0.13424720 Y CEPHALEXIN SUSP 125 MG/5 ML 10 4.4430017 Y CEPHALEXIN SUSP 125 MG/5 ML 10 4.4429131 Y CEPHALEXIN SUSP 250 MG/5 ML 10 13.5430019 Y CEPHALEXIN SUSP 250 MG/5 ML 10 4.12

Y CERTOLIZUMAB (CCMA-ONLY) 400 M 2713.25427508 Y CETAPHIL MOISTURIZING LOTION 4 5.2

426445 Y CETIRIZINE 10 MG TAB (NF) 0.071424406 Y CETIRIZINE SYRUP 5 MG/5 ML CUP 0.1424118 Y CETUXIMAB 100 MG/50 ML VIAL 473.81424141 Y CETUXIMAB 200 MG/100 ML VIAL 947.61426645 Y CHARCOAL ACTIVATED LIQD AQUA 5 7.74426082 Y CHARCOAL/SORBITOL SUSP 50 GM/2 6.98424004 Y CHLORAMBUCIL 2 MG TAB 3.1426255 Y chlordiazePOXIDE 10 MG CAP 0.13426256 Y chlordiazePOXIDE 25 MG CAP 0.14426254 Y chlordiazePOXIDE 5 MG CAP 0.17426253 Y CHLORDIAZEPOXIDE/CLIDINIUM CAP 0.0015427378 Y CHLORHEXIDINE 0.12% ORAL RINSE 2.05428265 Y CHLORHEXIDINE GLUCONATE 0.12% 0.59424441 Y CHLOROPHYLLIN COPPER COMPLEX 1 0.54424440 Y CHLOROPHYLLIN COPPER COMPLEX 3 0.17425248 Y CHLOROPROCAINE MPF 2% (NF) 6.81425123 Y CHLOROPROCAINE MPF 3% 20 ML VI 7.6426159 Y CHLOROTHIAZIDE 500 MG TAB (NF) 0.18425385 Y CHLOROTHIAZIDE SOD 500 MG/20 M 274.78426895 Y CHLOROTHIAZIDE SUSP 250 MG/5 M 0.93426816 Y CHLORPHEN/HYDROCOD POLIST SUSP 2.93426088 Y CHLORPHENIRAMINE 4 MG TAB 0.04426749 Y chlorproMAZINE 10 MG TAB (NF) 0.2425783 Y chlorproMAZINE 100 MG TAB (NF) 0.23426476 Y chlorproMAZINE HCL 25 MG TAB ( 0.17425167 Y chlorproMAZINE HCL 50 MG/2 ML 1.74426133 Y CHLORPROPAMIDE 100 MG TAB 0.073426134 Y CHLORPROPAMIDE 250 MG TAB 0.24426674 Y CHLORTHALIDONE 25 MG TAB 0.1426909 Y CHLORZOXAZONE TAB (NF) 500 MG 0.14426594 Y CHOLESTYRAMINE POWD 4 GM PACK 1.76424363 Y CILOSTAZOL 100 MG TAB 0.25429372 Y CIMETIDINE 200 MG TAB (NF) 0.11429373 Y CIMETIDINE 300 MG TAB (NF) 0.0423429374 Y CIMETIDINE 400 MG TAB (NF) 0.04424700 Y CINACALCET 60 MG TAB (NF) 24427587 Y CIPRO/DEXA OTIC SUSP 7.5 ML BT 109.16429244 Y CIPROFLOXACIN 200 MG/20 ML VIA 0.2935429207 Y CIPROFLOXACIN 250 MG TAB (NF) 0.0007424712 Y CIPROFLOXACIN 400 MG/200 ML PR 6.14429485 Y CIPROFLOXACIN 400 MG/40 ML VIA 1.55429486 Y CIPROFLOXACIN 500 MG TAB (NF) 0.15429346 Y CIPROFLOXACIN 750 MG TAB (NF) 0.23427509 Y CIPROFLOXACIN HCL 0.3% OP OINT 74.64427371 Y CIPROFLOXACIN HCL 0.3% OP SOL 3.21427547 Y CIPROFLOXACIN/HC OTIC 10 ML BT 109.16425039 Y CISATRACURIUM 10 MG/5 ML VIAL 9.45

425784 Y CISATRACURIUM 20 MG/10 ML VIAL 19.84425604 Y CISATRACURIUM 200 MG/20 ML VIA 223.7424029 Y CISplatin 50 MG/50 ML VIAL 9.32424348 Y CITALOPRAM 20 MG TAB 0.06425749 Y CITALOPRAM TAB 10 MG TAB 0.44424732 Y CITRATE DEXTROSE SOLUTION INJ 33.33424619 Y CITRIC ACID/SOD BIC/POT BICARB 0.11426870 Y CITRIC ACID/SODIUM CITRATE SOL 0.27424100 Y CLADRIBINE 10 MG/10 ML VIAL 218.82429309 Y CLARITHROMYCIN 250 MG TAB (NF) 1.06429315 Y CLARITHROMYCIN 500 MG SR TAB ( 2.38429246 Y CLARITHROMYCIN 500 MG TAB 0.8507429270 Y CLARITHROMYCIN SUSP 125 MG/5 M 36.45428340 Y CLEVIDIPINE 25 MG/50 ML VIAL 62.06427101 Y CLINDAMYCIN 1% GEL 60 GM TUBE 26.02427095 Y CLINDAMYCIN 1% TOP LOTION 60 M 29.51429114 Y CLINDAMYCIN 150 MG CAP 0.27427060 Y CLINDAMYCIN 2% VAG CREAM 40 GM 25429331 Y CLINDAMYCIN 900 MG/6 ML VIAL 17.51429061 Y CLINDAMYCIN 900 MG/6 ML VIAL 2.72429008 Y CLINDAMYCIN PED SUSP 75 MG/5 M 48.14429115 Y CLINDAMYCIN/D5W 900 MG/50 ML B 14.93425588 Y CLINDAMYCIN/NS 900 MG/56 ML BA 4.43427130 Y CLOBETASOL 0.05% CREAM 30 GM T 2.49427668 Y CLOBETASOL 0.05% OINT 30 GM TU 2.44427564 Y CLOBETASOL 0.05% SOLN 50 ML BT 5.54424424 Y CLOMIPRAMINE HCL 25 MG CAP (NF 0.07426903 Y CLONAZEPAM 0.5 MG TAB 0.0448426084 Y CLONIDINE 0.1 MG TAB 0.0457424331 Y CLONIDINE 0.3 MG TAB 0.085424719 Y CLONIDINE 1000 MCG/10 ML INJ ( 25.91427495 Y CLONIDINE HCL 0.1 MG PATCH 18.92427494 Y CLONIDINE HCL 0.2 MG PATCH 31.86424310 Y CLOPIDOGREL 75 MG TAB 5.28427665 Y CLOPIDOGREL TAB 300 MG TAB (CA 21.14426575 Y CLORAZEPATE 3.75 MG TAB 0.0006426495 Y CLORAZEPATE 7.5 MG TAB 0.0009427104 Y CLOTRIMAZOLE 1% CREAM 30 GM TU 1.64427209 Y CLOTRIMAZOLE 1% SOLN 10 ML BTL 0.022426906 Y CLOTRIMAZOLE 10 MG TROC 0.0135427355 Y CLOTRIMAZOLE VAG CREAM 45 GM T 0.0015427467 Y CLOTRIMAZOLE/BETAMETHASONE CR 5.32427379 Y CLOTRIMAZOLE/BETAMETHASONE LOT 72.45426809 Y CLOZAPINE 100 MG TAB 0.0255426422 Y CLOZAPINE 25 MG TAB (NF) 0.0098427510 Y COAL TAR 2% 120 ML SHAM 0.0003424688 Y COBALAM/FOLATE/PYRIDOXAL TAB ( 0.88

428079 Y COCAINE 4% TOPICAL SOLN 4 ML B 0.905428103 Y COCAINE HCL 4% TOPICAL SOLN 10 0.377428011 Y CODEINE SULF 30 MG TAB 0.0032426099 Y COLCHICINE 0.6 MG TAB 4.72424391 Y COLESEVELAM 625 MG TAB 0.45424408 Y COLESTIPOL 1 GM TAB (NF) 0.0045428385 Y COLISTIN (COLISTIMETHATE) 150 10.5428309 Y COLLAGENASE CLOSTRIDIUM 0.9 MG 3750.08427511 Y COLLAGENASE OINT 250UNITS/GM 3 189.6428440 Y COLLAGENASE OINT 250UNITS/GM U 173.75426701 Y COLONOSCOPY PREP SOLN 4000 ML 4.2428152 Y COLONOSCOPY PREP SOLN 4000 ML 10.46

Y COMPOUND VEHICLE SUSP (ORA-PLU 0.03425739 Y CONTRAST IODINE 60 ML BTL 30.8

Y COPPER (PARAGARD) IUD - CLINIC 747.86426947 Y CORTISONE ACETATE 25MG TAB (NF 0.0028425190 Y COSYNTROPIN 0.25 MG/VIAL 59.59427304 Y CROMOLYN SOD 20 MG/2 ML NEB (N 1.865427398 Y CROMOLYN SODIUM 4% NEB SOLN 26 0.008425657 Y CROTALIDAE ANTIVENIN POLYVALEN 2329.86424609 Y CYANOCOBALAMIN 1000 MCG TAB 0.008425179 Y CYANOCOBALAMIN 1000 MCG/1 ML V 3.384426553 Y CYCLOBENZAPRINE 10 MG TAB 0.06427055 Y CYCLOPENTOLATE 1% OPTH SOLN 2 1.8424064 Y CYCLOPHOSPHAMIDE 1000 MG/50 ML 512.12428355 Y CYCLOPHOSPHAMIDE 2000 MG/100 M 1024.24424036 Y CYCLOPHOSPHAMIDE 25 MG TAB (NF 0.96424184 Y CYCLOPHOSPHAMIDE 50 MG TABLET 1.77424005 Y CYCLOPHOSPHAMIDE 500MG/25ML VI 9.55427603 Y CYCLOSPORINE 0.05% 0.4ML 30 EA 2.83425137 Y CYCLOSPORINE IV 50 MG/ML 5 ML 9.518425736 Y CYCLOSPORINE MODIFIED (NEORAL) 265.23424109 Y CYCLOSPORINE MODIFIED (NEORAL) 1.23424101 Y CYCLOSPORINE MODIFIED (NEORAL) 0.063426188 Y CYCLOSPORINE NON MODIFIED (SAN 0.1326426784 Y CYCLOSPORINE NON MODIFIED (SAN 0.86424297 Y CYCLOSPORINE NON MODIFIED 500M 0.1186426343 Y CYPROHEPTADINE 4 MG TAB 0.0011425495 Y CYSTEINE 500 MG/10 ML VIAL (NF 0.181424086 Y CYTARABINE INJ 100 MG/5 ML VIA 0.211424103 Y CYTARABINE INJ 2 GM/20 ML VIAL 16.55424006 Y CYTARABINE INJ 500 MG/10 ML VI 4.18425503 Y D5 1/4 NS 1000 ML BAG 0.74425516 Y D5W ELECTROLYTE 148 1000 ML BA 1.25424176 Y DABIGATRAN 150 MG CAPSULE 2.95428225 Y DABIGATRAN 75 MG CAP 3.19424007 Y DACARBAZINE 200 MG/20 ML VIAL 7.33

424067 Y DACTINomycin INJ 0.5 MG VIAL 1228.7428143 Y DALBAVANCIN HCL 500 MG/25 ML V 1441.28428153 Y DALTEPARIN SODIUM 2500 UNIT/0. 12.83428154 Y DALTEPARIN SODIUM 5000 UNIT/0. 20.82426579 Y DANAZOL CAP 200 MG CAP 3.37426856 Y DANTROLENE 100 MG CAP (NF) 0.0181426762 Y DANTROLENE 25 MG CAP (NF) 0.0097425413 Y DANTROLENE SODIUM 20 MG VIAL 64.25426265 Y DAPSONE 100 MG TAB (NF) 0.0017426825 Y DAPSONE 25 MG TAB (NF) 0.0016429324 Y DAPTOmycin 500 MG/10 ML VIAL 145.58428397 Y DARATUMUMAB 100 MG/5 ML VIAL 460.29428398 Y DARATUMUMAB 400 MG/20 ML VIAL 1841.15425602 Y DARBEPOETIN ALFA 100 MCG/0.5 M 396.52424190 Y DARBEPOETIN ALFA 150 MCG/0.3 M 457.47425629 Y DARBEPOETIN ALFA 200 MCG/0.4 M 630.65425622 Y DARBEPOETIN ALFA 25 MCG/0.42 M 286.91425679 Y DARBEPOETIN ALFA 300 MCG/0.6 M 860.72424157 Y DARBEPOETIN ALFA 40 MCG/0.4 ML 158.6075425687 Y DARBEPOETIN ALFA 500 MCG/1 ML 1434.54425494 Y DARBEPOETIN ALFA 60 MCG/0.3 ML 951.04424646 Y DARIFENACIN 15 MG TBER (NF) 0.0943427652 Y DARIFENACIN 7.5 MG TAB (NF) 3.1424049 Y DAUNOrubicin 20 MG/4 ML VIAL 25.29424129 Y DECITABINE 50 MG/10 ML VIAL 1537.9425441 Y DEFEROXAMINE MESYLATE 500 MG V 6.38428382 Y DEGARELIX 120 MG/3 ML SYR INJ 686.17428369 Y DEGARELIX 80 MG/4 ML SYR INJ 466.18429217 Y DEMECLOCYCLINE 150 MG TAB 1.4816424181 Y DENOSUMAB 120 MG/1.7 ML VIAL 1604.63424167 Y DENOSUMAB 60 MG/1 ML SYR 1076.92428448 Y DENTURE ADHESIVE CREAM 68GM TU 3.93428370 Y DERMAGRAFT CULT SKIN SUBST 5X5 1250424686 Y DESFLURANE INHAL SOLN 240 ML B 137.58426552 Y DESIPRAMINE 25 MG TAB 0.0022426581 Y DESIPRAMINE 50 MG TAB (NF) 0.25424511 Y DESLORATADINE 5 MG TAB (NF) 0.0248425119 Y DESMOPRESSIN (PER ML) 4 MCG/ML 18.79427147 Y DESMOPRESSIN ACETATE 0.01% 0.1 1.958424445 Y DESMOPRESSIN ACETATE 0.1 MG TA 0.0285424610 Y DESMOPRESSIN ACETATE 0.2 MG TA 0.0411425365 Y DESMOPRESSIN ACETATE INJ 4 MCG 3.89427501 Y DESONIDE 0.05% CREAM 15 GM TUB 0.0073427602 Y DESONIDE 0.05% LOTION 120 GM B 0.0009427610 Y DESOXIMETASONE 0.05% GEL 15 GM 0.0653424695 Y DESVENLAFAXINE SUCCINATE 50 MG 3.32427360 Y DEXAMETHASONE 0.1% OP SOLN 5 M 47.86

426130 Y DEXAMETHASONE 0.5 MG TAB 0.0653425399 Y DEXAMETHASONE 120 MG/30 ML (CL 20.87426576 Y DEXAMETHASONE 4 MG TAB 0.11424341 Y DEXAMETHASONE CONCENTRATE 1 MG 20.28426798 Y DEXAMETHASONE ELIX 0.5 MG/5ML 0.0006425193 Y DEXAMETHASONE SOD PHOS 10 MG/M 1.5792425040 Y DEXAMETHASONE SOD PHOS 4 MG/1 0.6204425399 Y DEXAMETHASONE SOD PHOS 4 MG/ML 0.818428469 Y DEXAMETHASONE SOD PHOS PF 10 M 1.5792424703 Y DEXLANSOPRAZOLE 60 MG CAPCR (N 3.66428316 Y DEXMEDETOMIDINE IN NS 200 MCG/ 67.94428312 Y DEXMEDETOMIDINE IN NS 400 MCG/ 129.68425030 Y DEXRAZOXANE 250 MG/25 ML VIAL 126.43425120 Y DEXRAZOXANE 500 MG/50 ML VIAL 260428045 Y DEXTROAMPHETAMINE 5 MG TAB 0.001425509 Y DEXTROSE 10% 1000 ML BAG 0.76425522 Y DEXTROSE 10% 250 ML BAG 1.65425563 Y DEXTROSE 10% W SOD CHL 0.2% 25 5.4425511 Y DEXTROSE 20% 500 ML BAG 1.2425307 Y DEXTROSE 25% 2.5 GM/10 ML SYR 2.81425512 Y DEXTROSE 5% 100 ML BAG 0.85425500 Y DEXTROSE 5% 1000 ML BAG 0.7425530 Y DEXTROSE 5% 250 ML BAG 0.6425562 Y DEXTROSE 5% 250 ML DEHP/PVC FR 2.17425502 Y DEXTROSE 5% 50 ML BAG 0.85425501 Y DEXTROSE 5% 500 ML BAG 0.55425532 Y DEXTROSE 5% W SOD CHL 0.2% 250 0.65425504 Y DEXTROSE 5%/0.45% SOD CHL 1000 0.7425525 Y DEXTROSE 5%/0.45% SOD CHL 250 0.0003425505 Y DEXTROSE 5%/0.9% SOD CHL 1000 0.7425531 Y DEXTROSE 5%/0.9% SOD CHL 250 M 0.7425506 Y DEXTROSE 5%/0.9% SOD CHL 500 M 0.61425507 Y DEXTROSE 5%/LACTATED RINGERS 1 0.8425051 Y DEXTROSE 50% 25 GM/50 ML SYR 5.15425236 Y DEXTROSE 50% 50 ML VIAL 1.02428294 Y DEXTROSE 50% 500 ML BAG 4.67425172 Y DIAZEPAM 10 MG/2 ML SYRINGE 22.37426517 Y DIAZEPAM 2 MG TAB 0.0006426518 Y DIAZEPAM 5 MG TAB 0.07427390 Y DIAZEPAM RECTAL GEL DEL SYSTEM 193.08427135 Y DIBUCAINE 1% OINT 30 GM TUBE 6.03427699 Y DICLOFENAC EPOLAMINE 1.3% PATC 23.61428205 Y DICLOFENAC GEL 100 GM TUBE (NF 29.34428161 Y DICLOFENAC POTASSIUM 50 MG TAB 0.08427366 Y DICLOFENAC SOD 0.1% OP SOLN 2. 4.7428169 Y DICLOFENAC SOD 100 MG TABSR (N 0.31426763 Y DICLOFENAC SOD 50 MG TABEC 0.0009

426768 Y DICLOFENAC SOD 75 MG TABSR 0.17429170 Y DICLOXACILLIN 250 MG CAP 0.0021426059 Y DICYCLOMINE 10 MG CAP 0.463425024 Y DICYCLOMINE 20 MG/2 ML AMP 19.85425730 Y DIDANOSINE 200 MG CAP 3.84426146 Y DIGOXIN 0.125 MG TAB 0.1426147 Y DIGOXIN 0.25 MG TAB 0.1425055 Y DIGOXIN 0.5MG/2 ML AMP 0.65425343 Y DIGOXIN IMMUNE FAB INJ 40 MG/4 497.92426648 Y DIGOXIN SOLN 0.05 MG/ML 60ML B 0.0051425367 Y DIHYDROERGOTAMINE MESYLATE 1 M 19.11428202 Y DILTIAZEM 125 MG/25 ML VIAL 2.82428331 Y DILTIAZEM 25 MG/5 ML VIAL 1.2426639 Y DILTIAZEM 30 MG TAB 0.0007425392 Y DILTIAZEM 50 MG/10 ML VIAL 1.46426681 Y DILTIAZEM 60 MG TAB 0.0012426081 Y DILTIAZEM 90 MG TAB (NF) 0.0015426115 Y DILTIAZEM CD 120 MG CAPCR 0.0072426136 Y DILTIAZEM CD 180 MG CAPCR 0.89426582 Y DILTIAZEM CD 240 MG CAPCR 1.15426009 Y DILTIAZEM CD 300 MG CAPCR (NF) 0.0153424538 Y DILTIAZEM LA 120 MG TABSR (NF) 0.059424535 Y DILTIAZEM LA 180 MG TABSR (NF) 0.0623424536 Y DILTIAZEM LA 240 MG TABSR (NF) 0.0696424537 Y DILTIAZEM LA 360 MG TABSR (NF) 4.62426871 Y DILTIAZEM LA 60 MG CAPCR (NF) 0.0026426783 Y DILTIAZEM LA 90 MG CAPCR (NF) 0.0036428483 Y dilTIAZem/NS 125 MG/125 ML BAG 3.82426167 Y DIMENHYDRINATE 50 MG TAB (NF) 0.0001427061 Y DINOPROSTONE 10 MG INSERT 186.49427400 Y DINOPROSTONE 20 MG SUPP 3124.19425793 Y DIPH,PERTUS(ACEL),TET,POLIO/PF 38.23427476 Y DIPHENHYDRAMINE 2% CREAM 30 GM 2.1426056 Y DIPHENHYDRAMINE 2.5MG/1ML BULK 0.16426054 Y DIPHENHYDRAMINE 25 MG CAP 0.03425023 Y DIPHENHYDRAMINE 50 MG/1 ML VIA 0.5452426120 Y DIPHENHYDRAMINE ELIXIR 25 MG/1 0.196427681 Y DIPHENHYDRAMINE/MAALOX/LIDOCAI 5426712 Y DIPHENOXYLATE/ATROPINE LIQ 5 M 0.0016426257 Y DIPHENOXYLATE/ATROPINE TAB 0.23425426 Y DIPHTH/TETANUS/ACEL. PERTUSSIS 17.7426349 Y DIPYRIDAMOLE 25 MG TAB 0.0019426684 Y DIPYRIDAMOLE 50 MG TAB (NF) 0.0029426678 Y DIPYRIDAMOLE 75 MG TAB (NF) 0.0038425425 Y DIPYRIDAMOLE IV SOLN 5 MG/ML 1 1.62426546 Y DISOPYRAMIDE 100 MG CAP (NF) 0.0025426772 Y DISOPYRAMIDE 100 MG CAPCR (NF) 0.0111

426216 Y DISOPYRAMIDE 150 MG CAPCR (NF) 0.0074425204 Y DOBUTAMINE 250 MG/20ML VIAL 2.4375047 Y DOBUTAMINE/D5W 1000 MG/250 ML 12.5424080 Y DOCETAXEL 20 MG/2 ML ML 108.87424081 Y DOCETAXEL 80 MG/8 ML VIAL 435.48427571 Y DOCOSANOL CREAM 2 GM TUBE 2.92

O000428150 Y DOCUSATE CALCIUM 240 MG CAP (N 0.22426097 Y DOCUSATE SODIUM 100 MG CAP 0.03426782 Y DOCUSATE SODIUM LIQD 100 MG/10 0.5486424351 Y DOFETILIDE 125 MCG CAP (NF) 0.046424352 Y DOFETILIDE 250 MCG CAP (NF) 3.9605424307 Y DOLASETRON 100 MG TAB (NF) 5.68425131 Y DOLASETRON IV 100 MG/5 ML VIAL 37.93425132 Y DOLASETRON IV 12.5 MG/0.625 ML 15.19426992 Y DONEPEZIL 5 MG TAB 3.76425486 Y DOPAMINE INJ 200 MG/5 ML VIAL 1.36425221 Y DOPAMINE INJ 400 MG/5 ML VIAL 1.36375046 Y DOPAMINE/D5W DRIP 800 MG BAG 15.41427688 Y DORIPENEM 500 MG/10 ML VIAL 25.35427046 Y DORZOLAMIDE HCL 2% OP SOLN 10 17.37428434 Y DOSI-FUSER 150D2 (150ML) 41428414 Y DOSI-FUSER 250D2 (250ml) 41428414 Y DOSI-FUSER 250D5 (250ml) 41425063 Y DOXAPRAM 400 MG/20 ML VIAL 21.89426090 Y DOXAZOSIN 1 MG TAB (NF) 0.0109426074 Y DOXAZOSIN 2 MG TAB 0.1426079 Y DOXAZOSIN 4 MG TAB (NF) 0.0015426429 Y DOXEPIN 10 MG CAP 0.0008426430 Y DOXEPIN 25 MG CAP 0.09426826 Y DOXEPIN CONC 10 MG/ML 120ML BT 0.0007428354 Y DOXOrubicin HCL INJ 2 MG/ML 10 12.57424011 Y DOXOrubicin HCL INJ 2 MG/ML 25 19.36424010 Y DOXOrubicin HCL INJ 2 MG/ML 5 3.99424095 Y DOXOrubicin HCL LIPOSOME 2 MG/ 2484.07424085 Y DOXOrubicin HCL LIPOSOME INJ 2 7.547424148 Y DOXOrubicin LYO INJ 2 MG/ML VI 19.36429158 Y DOXYCYCLINE 100 MG CAP 0.84429037 Y DOXYCYCLINE 100 MG/10 ML VIAL 13.28424692 Y DOXYCYCLINE 20 MG TAB (NF) 0.33429157 Y DOXYCYCLINE 50 MG CAP 0.0012428335 Y DOXYLAMINE 25 MG TABLET 0.12428094 Y DRONABINOL 2.5 MG CAP 1.78428093 Y DRONABINOL 5 MG CAP (NF) 6.9424728 Y DRONEDARONE 400 MG TAB 3.43425087 Y DROPERIDOL (RESTRICTED) 2.5 MG 3.11424596 Y DULOXETINE 20 MG CAP 2.94424597 Y DULOXETINE 30 MG CAP 0.0314

428438 Y DURVALUMAB 120 MG/2.4 ML VIAL 834.92428437 Y DURVALUMAB 500 MG/10 ML VIAL 3478.81424583 Y DUTASTERIDE 0.5 MG CAP (NF) 3.26427040 Y DYCLONINE 18 LOZG/PKG 1.9427491 Y ECONAZOLE NITRATE 1% CR 30 GM 6.23424155 Y ECULIZUMAB 300 MG/30 ML VIAL 5571.47425469 Y EDROPHONIUM CHLORIDE 10 MG/ML 22.18424482 Y EFAVIRENZ 200 MG CAP (NF) 0.0502428171 Y ELETRIPTAN HYDROBROMIDE 20 MG 21.28428172 Y ELETRIPTAN HYDROBROMIDE 40 MG 21.28427331 Y EMPTY PCA VIAL 4.54427317 Y EMPTY STERILE VIAL 10 ML 12.25427271 Y EMPTY VIAL STERILE 30 ML 15.43428319 Y EMTRICITABINE/TENOFOVIR 200/30 40.82426707 Y ENALAPRIL 10 MG TAB (NF) 0.18426714 Y ENALAPRIL 2.5 MG TAB (NF) 0.0005426706 Y ENALAPRIL 5 MG TAB 0.0006425342 Y ENALAPRILAT DIHYDRATE 1.25 MG/ 1.12427655 Y ENOXAPARIN 100 MG/1 ML DOSE (3 52425217 Y ENOXAPARIN 100 MG/1 ML SYR 9.344425490 Y ENOXAPARIN 120 MG/0.8ML SYR 47.44425491 Y ENOXAPARIN 150 MG/1 ML SYR 14.006425419 Y ENOXAPARIN 30 MG/0.3 ML SYR 2.844425166 Y ENOXAPARIN 40 MG/0.4 ML SYR 3.732425465 Y ENOXAPARIN 60 MG/0.6 ML SYR 23.72425461 Y ENOXAPARIN 80 MG/0.8 ML SYR 31.62

Y ENOXAPARIN DOSING 1 MG/KG 15.54Y ENOXAPARIN DOSING 1.5 MG/KG 15.54

425770 Y ENSURE 237 ML BTL 1424374 Y ENTACAPONE 200 MG TAB 1.98425068 Y EPHEDRINE SULFATE INJ 50 MG/ML 2.33428379 Y EPHEDRINE/NS 25 MG/5ML SYR 25.42425002 Y EPINEPHRINE 1 MG/1 ML INJ 8.223425303 Y EPINEPHRINE 1 MG/10 ML SYRINGE 4.023425352 Y EPINEPHRINE 30 MG/30 ML VIAL 50.93427193 Y EPINEPHRINE HCL 1:1000 (CLINIC 283.05425686 Y EPINEPHRINE HCL 1:2000 (CLINIC 141425446 Y EPINEPHRINE PF 1 MG/1 ML AMP ( 2.43424099 Y EPIRUBICIN 50 MG/25 ML VIAL 31.61425406 Y EPOETIN ALFA 10000 UNITS/1 ML 91.35425144 Y EPOETIN ALFA 20000 UNITS/ML VI 229.96425379 Y EPOETIN ALFA 4000 UNITS/ML VIA 58.35425662 Y EPOETIN ALFA 40000 UNITS/ML VI 365.39425632 Y EPTIFIBATIDE 20 MG/10 ML VIAL 87.51425633 Y EPTIFIBATIDE 75 MG/100 ML VIAL 273.86426132 Y ERGOCALCIFEROL 50000 INTLU CAP 0.71424180 Y ERIBULIN MESYLATE 1 MG/2 ML VI 850

424128 Y ERLOTINIB 150 MG TAB (NF) 3.149429291 Y ERTAPENEM 1 GM/10 ML VIAL (NF) 49.43427624 Y ERYTHROMYCIN BASE (CLINIC) 3.5 13.13429116 Y ERYTHROMYCIN BASE 250 MG TAB 9.106429192 Y ERYTHROMYCIN ETHYLSUCC SUSP 20 0.0004429307 Y ERYTHROMYCIN LACTOBIONATE 500 9.73427349 Y ERYTHROMYCIN OP OINT 5 MG/GM 1 3.83424489 Y ESCITALOPRAM 10 MG TAB 0.21425415 Y ESMOLOL 100 MG/10 ML VIAL 2.91425488 Y ESMOLOL 2500 MG/250 ML BAG 124.4424622 Y ESOMEPRAZOLE 20 MG CAP (NF) 2.21424468 Y ESOMEPRAZOLE 40 MG CAPCR (NF) 2.21425707 Y ESOMEPRAZOLE IV 40 MG/5 ML VIA 5.5424517 Y ESTAZOLAM 2 MG TAB (NF) 0.0135427460 Y ESTRADIOL (3 DAY) 0.05 MG PATC 7.42427461 Y ESTRADIOL (3 DAY) 0.1 MG PATCH 1.4312426995 Y ESTRADIOL 1 MG TAB 0.0003425016 Y ESTRADIOL CYPIONATE IM IN OIL 15.934425634 Y ESTRADIOL VALERATE IM IN OIL 2 123.82427548 Y ESTRADIOL/NORETHINDR PATCH (NF 6.42424051 Y ESTRAMUSTINE 140 MG CAP (NF) 0.0399427146 Y ESTROGEN, CONJ. VAG CREAM 60 A 334.21426378 Y ESTROGENS CONJUGATED 0.3 MG TA 0.01426379 Y ESTROGENS CONJUGATED 0.625 MG 1.57426380 Y ESTROGENS CONJUGATED 1.25 MG T 0.0105425130 Y ESTROGENS CONJUGATED 25 MG/5 M 90.64424329 Y ESTROPIPATE 0.75 MG TAB (NF) 0.0083424608 Y ESZOPICLONE 2 MG TAB (NF) 0.0315424640 Y ESZOPICLONE 3 MG TAB (NF) 0.0383429253 Y ETHAMBUTOL 400 MG TAB (NF) 1.21424602 Y ETHINYL ESTRAD/NORGESTIMATE 28 24.81424466 Y ETHINYL ESTRADIOL/NORGESTIMATE 25.54427145 Y ETHYL CHLORIDE AER SP (CLINIC) 26.25426179 Y ETIDRONATE 200 MG TAB (NF) 0.0363428155 Y ETODOLAC 200 MG CAP (NF) 0.24426006 Y ETODOLAC 300 MG CAP (NF) 0.0011428156 Y ETODOLAC 400 MG TAB (NF) 0.1428158 Y ETODOLAC 400 MG TABSR (NF) 0.42428160 Y ETODOLAC 600 MG TABCR (NF) 1.02425255 Y ETOMIDATE 40 MG/20 ML VIAL 5.84

Y ETONOGESTREL (NEXPLANON) 68 MG 872.49428360 Y ETOPOSIDE 20 MG/ML 25ML VIAL 24.96424055 Y ETOPOSIDE 50 MG CAP (NF) 1.4985424035 Y ETOPOSIDE INJ 100 MG/5 ML VIAL 3.8427278 Y EUCERIN CREAM 120 GM JAR 1.87425732 Y EUCERIN CREAM 454 GM JAR (NF) 8425555 Y EVACUATED CONTAINER 250 ML BTL 1.71

425578 Y EVACUATED CONTAINER 500 ML BTL 2.3424124 Y EXEMESTANE 25 MG TAB (NF) 0.2426425689 Y EXENATIDE 10 MCG/0.04 ML CARTR 267.83427211 Y EYE IRRIGATION 30 ML BTL 15.44424508 Y EZETIMIBE 10 MG TAB 0.81425664 Y FACTOR VIIA,RECOMB 1,000 MCG/2 1670428282 Y FACTOR VIIA,RECOMB 2,000 MCG/3 2900428283 Y FACTOR VIIA,RECOMB 5,000 MCG/6 8350428420 Y FACTOR VIII (ADVATE) 3,175 IU/ 3397.25424168 Y FACTOR VIII 1,110 IU/10 ML VIA 674.88424182 Y FACTOR VIII 1050 IU/10ML MONOC 778.68424729 Y FACTOR VIII 555 IU/10 ML VIAL 632424183 Y FACTOR VIII 895 IU/10 ML MONOC 0.62428393 Y FACTOR X COMPLEX HUMAN 500 UNI 665429290 Y FAMCICLOVIR 250 MG TAB (NF) 4.67429370 Y FAMOTIDINE 10 MG TAB (NF) 0.07426716 Y FAMOTIDINE 20 MG TAB 0.07425306 Y FAMOTIDINE 20 MG/2 ML VIAL 0.66375163 Y FAT EMULSION IV 20% 250 ML BAG 8.4428271 Y FEBUXOSTAT 40 MG TABLET (NF) 5.17424402 Y FELODIPINE 2.5 MG TABSR (NF) 0.0109426449 Y FELODIPINE 5 MG TABSR (NF) 1.09429363 Y FENOFIBRATE 145 MG TAB (NF) 3.91424407 Y FENOFIBRATE 160 MG TAB (NF) 0.0243429359 Y FENOFIBRATE 43 MG CAP (NF) 1.38429362 Y FENOFIBRATE 48 MG TAB (NF) 1.3429364 Y FENOFIBRATE 50 MG TAB (NF) 1.77429361 Y FENOFIBRATE 54 MG TAB (NF) 0.74424612 Y FENOFIBRATE 67 MG CAP 0.0073429360 Y FENOFIBRATE CAP 130 MG CAP (NF 4.48424613 Y FENOFIBRATE MICRONIZED 200 MG 3.13424716 Y FENOFIBRIC 135 MG CAP (NF) 1.55425456 Y FENOLDOPAM MESYLATE 10 MG/ML A 51.55428165 Y FENOPROFEN CALCIUM 400 MG CAP 0.95428162 Y FENOPROFEN CALCIUM 600 MG TAB 0.72428090 Y fentaNYL 100 MCG PATCH 3.398428118 Y fentaNYL 100 MCG PATCH (MYLAN) 3.398428057 Y fentaNYL 100 MCG/2 ML VIAL 0.67428005 Y fentaNYL 1000 MCG/20 ML VIAL 0.218428105 Y fentaNYL 12 MCG/HR PATCH 2.246428274 Y FENTANYL 2 MCG/ML & ROPIVACAIN 43.19428085 Y fentaNYL 25 MCG PATCH 0.918428051 Y fentaNYL 250 MCG/5 ML INJ 1.06428025 Y fentaNYL 400 MCG LOLIPOP (NF) 0.692428086 Y fentaNYL 50 MCG PATCH 1.678428029 Y fentaNYL 600 MCG LOLIPOP (NF) 0.8476428030 Y fentaNYL 800 MCG LOLIPOP (NF) 1.0043

428142 Y FERRIC CARBOXYMALTOSE 750 MG/1 772.21425479 Y FERRIC GLUCONATE COMPLX 12.5 M 21.65427200 Y FERRIC SUBSULFATE GEL 8 GM BTL 11.81426196 Y FERROUS GLUCONATE 325 MG TAB 0.03424561 Y FERROUS SULFATE 15 MG/1 ML BTL 2.72426194 Y FERROUS SULFATE 325 MG TAB 0.03

Y FERUMOXYTOL 510 MG/17 ML VIAL 437.41424479 Y FEXOFENADINE 180 MG TAB (NF) 0.0231424330 Y FEXOFENADINE 60 MG TAB (NF) 0.46424480 Y FEXOFENADINE 60M/PSEUD 120MG S 1.25428226 Y FIDAXOMICIN 200 MG TAB 136.15425383 Y FILGRASTIM 300 MCG/1 ML VIAL 221.34425381 Y FILGRASTIM 480 MCG/1.6 ML VIAL 447.3427492 Y FILTER 0.22 MICRON PF2000 1.74424448 Y FINASTERIDE 1 MG TAB (NF) 0.0593426224 Y FINASTERIDE 5 MG TAB 0.96427365 Y FINGER STICK GLUCOSE CHARGE 0.5426515 Y FLAVOXATE 100 MG TAB 0.92426680 Y FLECAINIDE 100 MG TAB 0.0046429230 Y FLUCONAZOLE 100 MG TAB 0.2430024 Y FLUCONAZOLE 150 MG TAB (EMP) 0.25429308 Y FLUCONAZOLE SUSP 40 MG/ML 35ML 16.34429283 Y FLUCONAZOLE/SODIUM CHLORIDE 10 0.0069429490 Y FLUCONAZOLE/SODIUM CHLORIDE 20 8.68429304 Y FLUCONAZOLE/SODIUM CHLORIDE 40 0.0023428212 Y FLUCYTOSINE 500 MG CAP (NF) 42.18424065 Y FLUDARABINE PHOSPHATE 50 MG/2 85.45426200 Y FLUDROCORTISONE 0.1 MG TAB 0.005425387 Y FLUMAZENIL 0.5 MG/5 ML VIAL 4.09427570 Y FLUNISOLIDE 0.025% NASAL INH 2 0.0708427514 Y FLUOCINOLONE 0.01% SHAMPOO 120 0.0048427166 Y FLUOCINOLONE 0.025% CREAM 15 G 0.0033427165 Y FLUOCINOLONE ACET 0.01% CREAM 0.0026427100 Y FLUOCINONIDE 0.05% CREAM 15 GM 12.57427236 Y FLUOCINONIDE 0.05% OINT 15 GM 1.66427208 Y FLUORESCEIN STRIP 1 MG 0.11427220 Y FLUOROMETHOLONE 0.1% OPTH SUSP 66.74428388 Y FLUOROURACIL 1000 MG/20 ML VIA 4.64428412 Y FLUOROURACIL 2,500 MG/50 ML VI 7.4427516 Y FLUOROURACIL 5% CREAM 40 GM TU 0.1107428413 Y FLUOROURACIL 5,000 MG/100 ML V 15.27424012 Y FLUOROURACIL INJ 50 MG/ML 10 M 1.65426234 Y FLUOXETINE 10 MG CAP 0.09426745 Y FLUOXETINE 20 MG CAP 0.11426119 Y FLUOXETINE 20 MG/5 ML LIQUID U 0.13424510 Y FLUOXETINE HCL 90 MG DSPK (NF) 5.5225426761 Y FLUOXYMESTERONE 10 MG TAB 0.0231

426912 Y FLUPHENAZINE 1 MG TAB (NF) 0.0008426337 Y FLUPHENAZINE 2.5 MG TAB (NF) 0.0014428266 Y FLUPHENAZINE 5 MG TAB (NF) 0.08425616 Y FLUPHENAZINE DECANOATE INJ 25 62.37429355 Y FLURAZEPAM 15 MG CAP (NF) 0.04429356 Y FLURAZEPAM 30 MG CAP (NF) 0.06427297 Y FLURBIPROFEN 0.03% OPTH SOLN 2 0.6426808 Y FLURBIPROFEN 100 MG TAB (NF) 0.0019424047 Y FLUTAMIDE 125 MG CAP (NF) 0.0095427088 Y FLUTICASONE 0.05% NASAL SPRAY 17.48425752 Y FLUTICASONE 0.05% NASAL SPRAY 17.48427078 Y FLUTICASONE 44MCG INHALER (NF) 88.16427453 Y FLUTICASONE INH 44 MCG PUFF CH 1427595 Y FLUTICASONE INHALER 110 MCG/IN 118.05427452 Y FLUTICASONE INHLAER 110 PUFF C 1424624 Y FLUVASTATIN 20 MG CAP (NF) 0.0185424534 Y FLUVASTATIN 80 MG TAB (NF) 0.0237424293 Y FLUVOXAMINE 100 MG TAB (NF) 0.0034426026 Y FLUVOXAMINE 50 MG TAB 0.0063424501 Y FOLIC AC/VIT B/VIT C COMPLEX T 0.47426201 Y FOLIC ACID 1 MG TAB 0.07425073 Y FOLIC ACID 5 MG/1 ML VIAL 0.071424683 Y FOMEPIZOLE 1500 MG/1.5 ML VIAL 680.75425665 Y FONDAPARINUX 2.5 MG/0.5 ML INJ 10.613428381 Y FONDAPARINUX 5 MG/0.4 ML INJ ( 109.13425781 Y FONDAPARINUX 7.5 MG/0.6 ML INJ 54.15424691 Y FORMOTEROL 20 MCG/2 ML NEB SOL 5.74427543 Y FORMOTEROL FUMARATE 12 MCG KIT 33.98424169 Y FOSAPREPITANT DIMEGLUMINE 150 267.76428327 Y FOSFOMYCIN TROMETHAMINE 3 GM P 53.62426276 Y FOSINOPRIL 10 MG TAB 0.0035426998 Y FOSINOPRIL 20 MG TAB (NF) 0.0035425053 Y FOSPHENYTOIN 100 PE/2 ML VIAL 1.59425054 Y FOSPHENYTOIN 500 PE/10 ML VIAL 1.75428173 Y FROVATRIPTAN 2.5 MG TAB (NF) 22.71424146 Y FULVESTRANT 250 MG/5 ML SYR IN 880.26425351 Y FUROSEMIDE 100 MG/10 ML VIAL 2.92426510 Y FUROSEMIDE 10MG/ML ORAL SOLN, 0.0011426247 Y FUROSEMIDE 20 MG TAB 0.05425092 Y FUROSEMIDE 20 MG/2 ML VIAL 1.97426248 Y FUROSEMIDE 40 MG TAB 0.05425245 Y FUROSEMIDE 40 MG/4 ML VIAL 2.6056426562 Y FUROSEMIDE 80 MG TAB 0.06426593 Y GABAPENTIN 100 MG CAP 3.12426502 Y GABAPENTIN 300 MG CAP 0.3424327 Y GABAPENTIN 400 MG CAP 0.13424485 Y GABAPENTIN LIQ 250 MG/5 ML UDC 0.0004

424385 Y GALANTAMINE 4 MG TAB 0.0388425386 Y GANCICLOVIR 500 MG/10 ML VIAL 63.21427634 Y GATIFLOXACIN 0.03% OP SOL (NF) 50.26427375 Y GELATIN OP FILM 1 EA SPNG 5.71427194 Y GELATIN SPONGE 2x6CM SIZE 12-7 4.48427195 Y GELATIN SPONGE 8x12.5CM SIZE 1 26.67427633 Y GELATIN TOPICAL POWDER 1 GM UN 62.61424079 Y GEMCITABINE INJ 1,000 MG/26.3 39.95424078 Y GEMCITABINE INJ 200 MG/5.3 ML 20.12426961 Y GEMFIBROZIL 600 MG TAB (NF) 0.0016429024 Y GENTAMICIN (BULK) 40 MG/1 ML V 0.2695429266 Y GENTAMICIN (FOR PYXIS STOCK ON 2.2427463 Y GENTAMICIN 0.1% CR 30 APPL/15 0.0046427073 Y GENTAMICIN 0.1% OINT 30 APPL/1 33.01427340 Y GENTAMICIN 0.3% OP OINT 3.5 GM 10.43427074 Y GENTAMICIN 0.3% OP SOL 5 ML BT 4.63428207 Y GENTAMICIN 120 MG/100 ML PREMI 1.29429012 Y GENTAMICIN 80 MG/2 ML VIAL 0.8016428206 Y GENTAMICIN 80 MG/50 ML PREMIX 1.29429323 Y GENTAMICIN IN SODIUM CHLORIDE 2.82425775 Y GENTIAN VIOLET SOLN 60 ML BTL 4.6424571 Y GLIMEPIRIDE 1 MG TAB 0.04424404 Y GLIMEPIRIDE 2 MG TAB 0.1426831 Y GLIMEPIRIDE 4 MG TAB 0.13424671 Y GLIPIZIDE 10 MG TAB (CLINIC) 0.04426930 Y GLIPIZIDE 5 MG TAB 0.05426371 Y GLIPIZIDE 5 MG TABCR 0.19424449 Y GLIPIZIDE SR 2.5 MG TAB 0.0143425075 Y GLUCAGON 1 MG/1 ML VIAL 162.53425716 Y GLUCERNA 1.0 CAL 1,000 ML BTL 3.17425727 Y GLUCERNA 1.2 1000 ML BTL 2.43425715 Y GLUCERNA RTH 1000 ML BTL 2.43425797 Y GLUCERNA SHAKE 237 ML CAN 1.45424651 Y GLUCOSAMINE/CHONDROITIN 1 CAP 0.63424598 Y GLUCOSE 4 GM CHEW 0.025427052 Y GLUCOSE 40% GEL 15 GM TUBE 3.07426694 Y glyBURIDE 2.5 MG TAB 0.15426204 Y glyBURIDE 3 MG TAB (NF) 0.0002426662 Y glyBURIDE 5 MG TAB 0.23426208 Y GLYCERIN ADULT SUPP 0.07427582 Y GLYCERIN GEL PADS 1 EA PKG (NF 3.27426391 Y GLYCERIN PEDIATRIC 1.2 GM SUPP 0.008426207 Y GLYCERIN SOLN 2.27425229 Y GLYCOPYRROLATE 0.4 MG/2 ML VIA 13.45426415 Y GLYCOPYRROLATE 1 MG TAB 0.0104428386 Y GLYCOPYRROLATE 1 MG/5 ML SYR 7.9428317 Y GOLIMUMAB 50 MG/4 ML VIAL 1151.34

424022 Y GOSERELIN ACETATE 10.8 MG SYR 976.3424056 Y GOSERELIN ACETATE 3.6 MG SYR 325.43424308 Y GRANISETRON 1 MG TAB (NF) 23.375425427 Y GRANISETRON 1 MG/1 ML VIAL (NF 11.67429211 Y GRISEOFULVIN ULTRAMICROSIZE 25 0.0205426418 Y GUAIFENESIN 100 MG/CODEINE 10M 0.24426210 Y GUAIFENESIN 200 MG/10 ML UDC 0.167424549 Y GUAIFENESIN 600 MG TABCR 0.09426615 Y GUAIFENESIN/DEXTROMETHORPHAN T 0.19426421 Y GUAIFENESIN/DM 200 MG/20 MG 10 0.186426799 Y guanFACINE 1 MG TAB 0.0007427669 Y GUAR GUM 1 PKT 0.3427640 Y GUM PKG 0.9427641 Y GUM SUGARFREE PKG 0.9425673 Y HAEMOPH B POLYSACCH CONJ VACC 24.65428151 Y HALFLYTELY BOWEL PREP KIT (NF) 38.52427517 Y HALOBETASOL 0.05% CREAM 15 GM 0.1313426211 Y HALOPERIDOL 0.5 MG TAB (NF) 0.0006426212 Y HALOPERIDOL 1 MG TAB 0.09426563 Y HALOPERIDOL 5 MG TAB 0.0013425214 Y HALOPERIDOL 5 MG/1 ML VIAL 0.6324425614 Y HALOPERIDOL DECONATE INJ 50 MG 43.56426213 Y HALOPERIDOL ORAL CONC 2 MG/1 M 0.0146427666 Y HALOPERIDOL ORAL CONC 2 MG/1 M 4.38426886 Y HEMORRHOIDAL SUPP 0.0075425672 Y HEP B VACCINE/DP(A)T-POLIO 0.5 54.52425613 Y HEPARIN 100 UNIT/10ML PF FLUSH 0.57425078 Y HEPARIN 1000 UNIT/1 ML (1 ML) 0.86425484 Y HEPARIN 1000 UNITS/1 ML (10 ML 3.25425208 Y HEPARIN 50 UNIT/5 ML PF FLUSH 5.54425680 Y HEPARIN 500 UNIT/5 ML FLUSH SY 0.44425397 Y HEPARIN 500 UNIT/5 ML FLUSH VL 1.26425079 Y HEPARIN 5000 UNIT/1 ML VIAL 1.83428339 Y HEPARIN DRIP 25,000 UNIT/250 M 5.73375147 Y HEPARIN/D5W DRIP 25,000 UNIT/2 14

Y HEPATITIS A & B VACCINE (TWINR 75.12425061 Y HEPATITIS A VACCINE INJ 1,440 49.664425624 Y HEPATITIS A VACCINE(PEDS) 720 23.34425623 Y HEPATITIS B IMMUNE GLOBULIN 0. 69.84425305 Y HEPATITIS B IMMUNE GLOBULIN 1 150.44425165 Y HEPATITIS B VACCINE (RECOMBIN) 14.98

Y HEPATITIS B VACCINE (RECOMBIN) 40.91375123 Y HETASTARCH 6%/NACL 500 ML BAG 16.22427394 Y HEXACHLOROPHENE 3% LIQ 150 ML 0.0007427081 Y HOMATROPINE 5% OP SOLN 5 ML BT 0.108

Y HONEY 44 ML PASTE..ML. 13.89425691 Y HUMAN PAPILLOMAVIRUS VACC,QVAL 197.99

427687 Y HUMATE P 509 IU/10 ML F-VIII I 0.75427646 Y HYALURONATE 10 MG/ML SYR (NF) 503.52

Y HYALURONATE SODIUM 10 MG/ML SY 70Y HYALURONATE SODIUM, STABILIZED 738.39

426031 Y HYDRALAZINE 10 MG TAB 0.17426032 Y HYDRALAZINE 25 MG TAB 0.21425013 Y HYDRALAZINE HCL INJ 20 MG/ML V 4.22424559 Y HYDROCHLOROTHIAZIDE 12.5 MG CA 0.13426220 Y HYDROCHLOROTHIAZIDE 25 MG TAB 0.0004426221 Y HYDROCHLOROTHIAZIDE 50 MG TAB 0.0006428307 Y HYDROCODONE 10MG/APAP 325MG TA 0.26428311 Y HYDROCODONE 5MG/ACETAMIN 217MG 3.82428109 Y HYDROCODONE 5MG/APAP 325MG TAB 0.17428406 Y HYDROCODONE 7.5MG/ACETAMIN 325 2.35428308 Y HYDROCODONE 7.5MG/APAP 325MG T 0.24424617 Y HYDROCODONE/IBUPR 7.5-200 TAB 0.0167427079 Y HYDROCORTISONE 1% CREAM 30 GM 0.97427005 Y HYDROCORTISONE 2.5% CREAM 30 G 0.0016427462 Y HYDROCORTISONE 2.5% RECTAL CRM 0.0053426367 Y HYDROCORTISONE 20 MG TAB 0.0015426030 Y HYDROCORTISONE ACETATE 25 MG S 0.0066427049 Y HYDROCORTISONE ENEMA 100 MG/60 0.0086425150 Y HYDROCORTISONE INJ 100 MG/2 ML 3.93427618 Y HYDROCORTISONE MICRO 10 GM POW 21.28425151 Y HYDROCORTISONE SOD 500 MG VIAL 15.39428361 Y HYDROMORPHONE 12 MG SR TAB 12.9428048 Y HYDROMORPHONE 2 MG TAB 0.19428050 Y HYDROMORPHONE 2 MG/1 ML INJ 0.89428055 Y HYDROMORPHONE 4 MG TAB 0.0027428231 Y HYDROMORPHONE 500 MG/50 ML VIA 93.86428242 Y HYDROMORPHONE 8 MG SR TAB 8.91428104 Y HYDROMORPHONE HP 10 MG/1 ML 2.04428098 Y HYDROMORPHONE HP 50 MG/5 ML 80.61429318 Y HYDROMORPHONE PCA 30 MG/30 ML 21.75426879 Y HYDROXYCHLOROQUINE 200 MG TAB 0.0017426049 Y HYDROXYZINE 10 MG TAB 0.18425177 Y HYDROXYZINE 50 MG/1 ML VIAL 2.67426522 Y HYDROXYZINE PAMOATE 25 MG CAP 0.0006426521 Y HYDROXYZINE PAMOATE 50 MG CAP 0.0006426760 Y HYDROXYZINE SYRUP 10 MG/5 ML U 0.0001425458 Y HYLAN G-F 20 INJ (CLINIC) 16 M 259.01424713 Y HYLAN G-F 20 INJ (CLINIC) 48 M 460.6424450 Y HYOSCYAMINE DROPS 0.125MG/ML 1 0.1566424393 Y HYOSCYAMINE SULF 0.375 MG TABS 0.0006424711 Y HYOSCYAMINE SULFATE 0.125 MG/5 0.2424711 Y HYOSCYAMINE SULFATE 0.125 MG/5 0.2425183 Y HYOSCYAMINE SULFATE 0.5 MG/1 M 26.96

425183 Y HYOSCYAMINE SULFATE 0.5 MG/1 M 26.96426958 Y IBUPROFEN 200 MG TAB 0.03424313 Y IBUPROFEN 200 MG/10 ML SUSP UD 0.85426294 Y IBUPROFEN 400 MG TAB 0.04426574 Y IBUPROFEN 600 MG TAB 0.0005426810 Y IBUPROFEN 600 MG/30 ML SUSP 12 2.83426523 Y IBUPROFEN 800 MG TAB 0.07425459 Y IBUTILIDE FUMARATE 0.1 MG/ML 1 102.53

Y IDARUCIZUMAB 2.5 GM/50 ML VIAL 1741.25424044 Y IFOSFAMIDE 1000 MG/20 ML VIAL 28.56424108 Y IFOSFAMIDE 3000 MG/60 ML VIAL 526.26429091 Y IMIPENEM/CILASTATIN 250 MG/10 16.85429089 Y IMIPENEM/CILASTATIN 500 MG/10 31.72426488 Y IMIPRAMINE 10 MG TAB 0.0014426489 Y IMIPRAMINE 25 MG TAB 0.0022428408 Y IMMUNE GLOBULIN (GAMMAGARD SD- 1152.77428409 Y IMMUNE GLOBULIN (GAMMAGARD SD- 576.39425074 Y IMMUNE GLOBULIN (HUMAN) INJ 2 5.705428326 Y IMMUNE GLOBULIN-GAMUNEX-C (HUM 773.81428285 Y IMMUNE GLOBULIN-GAMUNEX-C (HUM 80.793428325 Y IMMUNE GLOBULIN-GAMUNEX-C (HUM 1615.86428357 Y IMMUNE GLOBULIN-GAMUNEX-C (HUM 2808.48428403 Y IMMUNE GLOBULIN-OCTAGAM (HUMAN 680428404 Y IMMUNE GLOBULIN-OCTAGAM (HUMAN 1360428402 Y IMMUNE GLOBULIN-OCTAGAM (HUMAN 340428480 Y IMMUNE GLOBULIN-PRIVIGEN (HUMA 1330428481 Y IMMUNE GLOBULIN-PRIVIGEN (HUMA 2660428479 Y IMMUNE GLOBULIN-PRIVIGEN (HUMA 665428478 Y IMMUNE GLOBULIN-PRIVIGEN (HUMA 332.5426770 Y INDAPAMIDE 2.5 MG TAB 0.0007428419 Y INDOCYANINE GREEN 25 MG VIAL 65.79426231 Y INDOMETHACIN 25 MG CAP 0.0008426630 Y INDOMETHACIN 75 MG CAPCR (NF) 0.0135425460 Y INDOMETHACIN INJ 1 MG VIAL 432.77424091 Y INFLIXIMAB 100MG/10 ML VIAL 1096.74428430 Y INFLIXIMAB-DYYB 100 MG/10 ML V 516.67425262 Y INFLUENZA (6 MONTHS AND OLDER) 13.3425262 Y INFLUENZA (ADULT) VACCINE/PF ( 17.126428353 Y INFLUENZA (HIGH DOSE ADULT) VA 40.1425621 Y INFLUENZA (MDV) VACCINE 45 MCG 14.42425678 Y INFLUENZA (PEDIATRIC) VACCINE/ 17.126427597 Y INFLUENZA NASAL VACCINE (LIVE) 23.7425216 Y INSULIN (humaLOG) 1 UNIT/0.01 4.5425492 Y INSULIN (humaLOG) 75/25 100 UN 4.5425468 Y INSULIN (humaLOG) SLIDING SCAL 4.5425735 Y INSULIN (humuLIN) REGULAR 500 15.34427677 Y INSULIN (LANTUS) 100 UNIT/1 ML 34.55

425661 Y INSULIN (LANTUS) 100 UNIT/1 ML 8425697 Y INSULIN (novoLIN) 70/30 100 UN 1.11425695 Y INSULIN (novoLIN) NPH 1 UNIT/0 1.1425090 Y INSULIN (novoLIN) REG SLIDING 1.1425696 Y INSULIN (novoLIN) REGULAR 100 1.1425638 Y INSULIN (novoLOG) 100 UNIT/1 M 4.291427676 Y INSULIN (novoLOG) 100 UNIT/1 M 15.91425643 Y INSULIN (novoLOG) 70/30 100 UN 4.41425639 Y INSULIN (novoLOG) SLIDING SCAL 4.41427679 Y INSULIN (novoLOG) SLIDING SCAL 15.9427678 Y INSULIN NOVOLOG 70/30 1 UNIT/0 15.91118200 Y IODIXANOL 32000 MG/100 ML BTL 51.68

7547026 Y IOHEXOL 15,000 MG/50 ML BTL 3.39428140 Y IPILIMUMAB 200 MG/40 ML VIAL 25096.28428141 Y IPILIMUMAB 50 MG/10 ML VIAL 6274.07427076 Y IPRATROPIUM 0.03% NASAL SPRAY 0.0603427520 Y IPRATROPIUM 0.06% NASAL SPRAY 0.2073427380 Y IPRATROPIUM 0.5 MG/2.5 ML NEB 0.17427287 Y IPRATROPIUM 12.9 GM INHALER (N 73.88427448 Y IPRATROPIUM PUFF (NF) 73.88424314 Y IRBESARTAN 150 MG TAB 1.44424063 Y IRINOTECAN 20 MG/ML 5 ML VIAL 38.42424093 Y IRINOTECAN INJ 20 MG/ML 2 ML V 9.73428477 Y IRINOTECAN LIPOSOMAL 43 MG/10 1958425085 Y IRON DEXTRAN INJ 50 MG/ML 2 ML 20.62427686 Y IRON SUCROSE INJ 20 MG/ML VIAL 32.09427539 Y ISOFLURANE INHAL SOLN 100 ML B 32.22429180 Y ISONIAZID 100 MG TAB 0.0008429181 Y ISONIAZID 300 MG TAB 0.0011425266 Y ISOPROTERENOL 0.2 MG/1 ML AMP 12.64426240 Y ISOSORBIDE DINITRATE 10 MG TAB 0.03426586 Y ISOSORBIDE DINITRATE 20 MG TAB 0.0003426241 Y ISOSORBIDE DINITRATE 40 MG TAB 0.0042426966 Y ISOSORBIDE MONONITRATE 30 MG T 0.0028426352 Y ISOSORBIDE MONONITRATE 60 MG T 0.0021425478 Y ISOSULFAN BLUE 1% SC SOLN 6 ML 481.39429106 Y ITRACONAZOLE 100 MG CAP (NF) 0.277427103 Y IV FLUID TRANSFER DEVICE (ISM4 39.18425576 Y IV, VENTED SPIKE ADAPTER EA 1.01428358 Y IVERMECTIN 3 MG TABLET (NF) 3.41424135 Y IXABEPILONE 15 MG/7.5 ML VIAL 896.61424136 Y IXABEPILONE 45 MG/22.5 ML VIAL 2689.83425726 Y JEVITY 1.2 RTH 1000 ML BTL 2.25425780 Y JEVITY 1.5 RTH 1,000 ML BTL 6.45375161 Y KCL 20MEQ/D5/.45 SOD CHL 1,000 1.05375051 Y KCL 40MEQ/D5/.45 SOD CHL 1,000 1.1428436 Y KETAMINE 100 MG/10 ML SYR 6.7

428115 Y KETAMINE 200 MG/20 ML VIAL 11.67428411 Y KETAMINE 50 MG/ML SYR 5.72425312 Y KETAMINE 500 MG/5 ML VIAL 7.33427009 Y KETOCONAZOLE 2% SHAMPOO 120 ML 0.001429187 Y KETOCONAZOLE 200 MG TAB (NF) 0.009427373 Y KETOCONAZOLE CREAM 15 GM TUBE 0.0366426406 Y KETOPROFEN 200 MG CAPCR (NF) 0.02426776 Y KETOPROFEN 50 MG CAP (NF) 0.0016428168 Y KETOPROFEN 75 MG CAP (NF) 0.11425737 Y KETOROLAC 0.4% OP SOLN 100 DRO 111.5426164 Y KETOROLAC 10 MG TAB (NF) 0.0012425424 Y KETOROLAC 30 MG/1 ML VIAL 0.7704425368 Y KETOROLAC 60 MG/2 ML VIAL (ER) 0.9208427569 Y KETOTIFEN .025% OPTH SOLU 5 ML 4.92424365 Y LABETALOL 100 MG TAB 0.15425796 Y LABETALOL 100 MG/20 ML VIAL 1.46426747 Y LABETALOL 200 MG TAB 0.0024428270 Y LACOSAMIDE 100 MG TABLET 12.02428137 Y LACOSAMIDE 200 MG/20 ML VIAL 23.43428241 Y LACOSAMIDE 50 MG TAB 4.56428305 Y LACOSAMIDE SOLN 100 MG/10 ML ( 8.9426922 Y LACTASE ENZYME 3000 UNIT TAB 0.001425513 Y LACTATED RINGER'S 1000 ML BAG 0.75425519 Y LACTATED RINGER'S 500 ML BAG 0.65425582 Y LACTATED RINGER'S DEHP FREE 25 0.65427643 Y LACTIC ACID (VSL #3) 1 PKT (NF 2.1424590 Y LACTOBACILLUS RHAMNOSUS CAP (N 0.0146426679 Y LACTULOSE 20 GM/30 ML SYRUP UD 0.0283424676 Y LACTULOSE 20GM PKT (NF) 1.58424377 Y LACTULOSE SOLUTION 158 GM/237 2.82424299 Y LAMIVUDINE 150 MG TAB (NF) 6.19424389 Y LAMOTRIGINE 100 MG TAB 3.39424286 Y LAMOTRIGINE 25 MG TAB 0.032427387 Y LANCET DEVICE 200 EA BOX 29.18427329 Y LANOLIN OINT 30GM TUBE 5.7427479 Y LANOLIN, OXYQUINOLON OINT 70GM 0.0004427097 Y LANOLIN/MINERAL OIL LOTION 255 0.0001428416 Y LANREOTIDE 120 MG/0.5 ML SYR 6806424615 Y LANSOPRAZOLE 15 MG TABDP (NF) 0.0603424305 Y LANSOPRAZOLE 30 MG CAPCR (NF) 0.023424581 Y LANSOPRAZOLE 30 MG TABDP (NF) 4.19427656 Y LANTHANUM 500 MG (NF) 3.88427650 Y LANTHANUM CARB 1000 MG (NF) 3.88427148 Y LATANOPROST 0.005% OP SOLN 2.5 5.25424429 Y LEFLUNOMIDE 10 MG TAB (NF) 0.0136424342 Y LEFLUNOMIDE 20 MG TAB 0.0136424431 Y LETROZOLE 2.5 MG TAB (NF) 0.2556

425407 Y LEUCOVORIN CALCIUM 100 MG/10 M 5.29424163 Y LEUCOVORIN CALCIUM 15 MG TAB ( 4.59424144 Y LEUCOVORIN CALCIUM 200 MG/20 M 4.77425627 Y LEUCOVORIN CALCIUM 350 MG/17.5 5.84426218 Y LEUCOVORIN CALCIUM 5 MG TAB (N 0.0306425628 Y LEUCOVORIN CALCIUM 500 MG/50 M 9.65425675 Y LEUPROLIDE ACETATE (3 MO) 11.2 1449.49428290 Y LEUPROLIDE ACETATE 15 MG PED K 1706.62424016 Y LEUPROLIDE ACETATE 22.5 MG KIT 1736.29428466 Y LEUPROLIDE ACETATE 22.5MG KIT 329.73424147 Y LEUPROLIDE ACETATE 30 MG KIT 2818.36425404 Y LEUPROLIDE ACETATE 7.5 MG KIT 578.77425389 Y LEUPROLIDE ACETATE DEPOT 3.75 1224.45427542 Y LEVALBUTEROL 0.63 MG/3 ML NEB 4.56427446 Y LEVALBUTEROL 1.25 MG/3 ML NEB 4.56428373 Y LEVETIRACETAM 1,000 MG TAB 0.33425776 Y LEVETIRACETAM 1000 MG/10 ML SO 2.51424453 Y LEVETIRACETAM 250 MG TAB 0.0155424486 Y LEVETIRACETAM 500 MG TAB 1.9427648 Y LEVETIRACETAM 500 MG/5 ML VIAL 26.26427262 Y LEVOBUNOLOL 0.5% OP SOLN 5 ML 0.054427659 Y LEVOCARNITINE 1 GM/5 ML VIAL 9.73424362 Y LEVOCARNITINE 330 MG TAB 0.0053425767 Y LEVOCETIRIZINE 5 MG TAB (NF) 2.26427574 Y LEVOFLOXACIN 0.5% OP SOLN 5 ML 1.594429133 Y LEVOFLOXACIN 250 MG TAB 0.21429121 Y LEVOFLOXACIN 250 MG/50 ML BAG 4.62429036 Y LEVOFLOXACIN 500 MG TAB 0.1981429123 Y LEVOFLOXACIN 500 MG/100 ML BAG 4.62429044 Y LEVOFLOXACIN 500 MG/20 ML VIAL 12.14429300 Y LEVOFLOXACIN 750 MG TAB 18.81429299 Y LEVOFLOXACIN 750 MG/150 ML BAG 4.62

Y LEVONORGESTREL (KYLEENA) EACH 781.71Y LEVONORGESTREL (MIRENA) IUD (C 781.71Y LEVONORGESTREL 1 EACH IUD (SKY 643.23

427525 Y LEVONORGESTREL 1.5 MG CONTRACE 28.69426454 Y LEVOTHYROXINE 100 MCG TAB 0.15428230 Y LEVOTHYROXINE 100 MCG/5 ML VIA 52.33424364 Y LEVOTHYROXINE 125 MCG TAB 0.17426455 Y LEVOTHYROXINE 150 MCG TAB 0.17426715 Y LEVOTHYROXINE 25 MCG TAB 0.08426453 Y LEVOTHYROXINE 50 MCG TAB 0.13426527 Y LEVOTHYROXINE 75 MCG TAB 0.0014424376 Y LEVOTHYROXINE 88 MCG TAB 0.0008424296 Y LID/EPI/TET TOPICAL SOL 3 ML S 2427598 Y LIDOCAINE (LMX) 4% CREAM 5 ML 2.86425207 Y LIDOCAINE 0.5% SDV 50 ML VIAL 2.31

425275 Y LIDOCAINE 1% MDV 20 ML VIAL 0.912425267 Y LIDOCAINE 1% SDV 30 ML VIAL 1.87425330 Y LIDOCAINE 100 MG/5ML SYRINGE 1.5427382 Y LIDOCAINE 2% JELLY 120 APPL/6 3.48427474 Y LIDOCAINE 2% JELLY UROJET 20 M 6.4424425277 Y LIDOCAINE 2% MDV 20 ML VIAL 0.78425684 Y LIDOCAINE 2% MDV INJ 50 ML VIA 2.19428467 Y LIDOCAINE 2% SDV 2 ML VIAL 1.56425326 Y LIDOCAINE 2% SDV 5 ML VIAL 1.21427182 Y LIDOCAINE 2% VISCOUS 100ML BTL 10.34427224 Y LIDOCAINE 2% VISCOUS 20ML UDC 0.65427528 Y LIDOCAINE 4% PATCH 1.1427368 Y LIDOCAINE 4% RT 5 ML AMP 1.292427275 Y LIDOCAINE 4% TOP SOLN 50ML BTL 3.16427528 Y LIDOCAINE 5% PATCH 2.624425340 Y LIDOCAINE 5%/D7.5W PF AMP 4425656 Y LIDOCAINE 50 MG/5 ML PED SYR 1.99375149 Y LIDOCAINE 8 MG/ML IN D5W 250ML 2.41427619 Y LIDOCAINE POWDER 25 GM BTL 12.35425278 Y LIDOCAINE/EPI 0.5%-1:200,000 5 2.15425279 Y LIDOCAINE/EPI 1%-1:100,000 20 1.95424697 Y LIDOCAINE/EPI 2% 34 MG/1.7 ML 0.8425222 Y LIDOCAINE/EPI 2%-1:200,000 PF 6.57428371 Y LIDOCAINE/MAALOX/HYOSCYAMINE 5 1.81429326 Y LINCOMYCIN 300 MG/1 ML 10ML VI 71.87429025 Y LINCOMYCIN 600 MG/2 ML VIAL (N 19.01428177 Y LINDANE SHAMPOO 60 APPL/60 ML 106.48429161 Y LINEZOLID 600 MG TAB 3.33429162 Y LINEZOLID 600 MG/300 ML IVPB 97.34429317 Y LINEZOLID SUSP 100 MG/5 ML 150 372.7426396 Y LIOTHYRONINE 25 MCG TAB 0.0075426227 Y LISINOPRIL 10 MG TAB 0.07424557 Y LISINOPRIL 2.5 MG TAB 0.0005426528 Y LISINOPRIL 20 MG TAB 0.1426897 Y LISINOPRIL 5 MG TAB 0.0006426607 Y LITHIUM 300 MG TAB 0.0019426812 Y LITHIUM SR 300 MG TAB (NF) 0.002424568 Y LITHIUM SR 450MG TAB (NF) 0.43426545 Y LOPERAMIDE 2 MG CAP 0.68424625 Y LOPINAVIR 200MG/RITONAVIR 50MG 5.4426317 Y LORATADINE 10 MG TAB 0.23424675 Y LORATADINE 10 MG TABDP (NF) 0.83424347 Y LORATADINE 10/PSEUDO 240 SR TA 0.062429365 Y LORATADINE 5/PSEUDOEPHEDRINE 1 0.96424390 Y LORATADINE SYRUP 10 MG/10 ML U 0.0003426677 Y LORAZEPAM 0.5 MG TAB 0.06426568 Y LORAZEPAM 1 MG TAB 0.06

425376 Y LORAZEPAM 2 MG/1 ML INJ 1.82425175 Y LORAZEPAM 20 MG/10 ML VIAL 5.11426588 Y LOSARTAN 25 MG TAB 0.015426840 Y LOSARTAN 50 MG TAB 1.5426636 Y LOSARTAN/HCTZ 50/12.5 (NF) 0.05427544 Y LOTEPREDNOL 0.2% OP SUSP 5 ML 1.556427562 Y LOTEPREDNOL 0.5% OP SOLN 5 ML 1.16429367 Y LOVASTATIN 10 MG TAB (NF) 0.08429368 Y LOVASTATIN 40 MG TAB (NF) 0.18426841 Y LOXAPINE 10 MG CAP (NF) 0.0053426805 Y LOXAPINE 25 MG CAP (NF) 0.0081424277 Y LOXAPINE 5 MG CAP (NF) 0.0048424667 Y LUBIPROSTONE 24 MCG CAP 3.03425782 Y LUBIPROSTONE 8 MCG CAP 3.4427593 Y LUBRICATING OPHTH OINT 3.5GM T 1.65428296 Y LURASIDONE 40 MG TAB (NF) 15.82427554 Y MAFENIDE ACET CR 85 MG/GM 120 0.0028426266 Y MAGNESIUM CITRATE 296 ML BTL 1426791 Y MAGNESIUM OXIDE 400 MG TAB 0.07425097 Y MAGNESIUM SULF 1 GM/2 ML VIAL 1.655425112 Y MAGNESIUM SULF 40.6 MEQ/10 ML 0.58425573 Y MAGNESIUM SULF IV PREMIX BAG 1 4.44428322 Y MAGNESIUM SULF IV PREMIX BAG 2 6.78428239 Y MAGNESIUM SULF IV PREMIX BAG 4 3.48428133 Y MAGNESIUM SULF PROTOCOL 1 GM/1 4.44375050 Y MAGNESIUM SULF/STERILE H20 PRE 3.91427277 Y MAGNESIUM SULFATE GRANULES 454 0.95375157 Y MANNITOL 20% IV SOLN 250 ML BA 8.15375091 Y MANNITOL 20% IV SOLN 500 ML BA 0.0007425098 Y MANNITOL 25% 12.5 GM/50 ML VIA 1.66425690 Y MEASLES,MUMPS,RUB,VARICELLA/PF 192.43425445 Y MEASLES,MUMPS,RUBELLA VACCINE 66.631424709 Y MEBENDAZOLE 100 MG CHEW TAB (N 3424062 Y MECHLORETHAMINE 10 MG/20 ML VI 144.83426027 Y MECLIZINE 12.5 MG TAB 0.07426028 Y MECLIZINE 25 MG TAB 0.6426946 Y MECLOFENAMATE 100 MG CAP (NF) 0.0073425081 Y MEDROXYPROGES. AC 1000MG/2.5ML 156.73425048 Y MEDROXYPROGEST.AC 150 MG/ML VI 74.46424463 Y MEDROXYPROGESTERONE 2.5 MG TAB 0.0063426203 Y MEDROXYPROGESTERONE 5 MG TAB 0.0006424038 Y MEGESTROL 40 MG TAB 0.34426320 Y MEGESTROL 400 MG/10 ML UDC 0.95428342 Y MELATONIN 1 MG TABLET 0.02424338 Y MELATONIN 3 MG TAB (NF) 0.06428341 Y MELATONIN 5 MG TABLET 0.02424644 Y MELOXICAM 15 MG TAB 0.0003

424481 Y MELOXICAM 7.5 MG TAB 0.0276424070 Y MELPHALAN 50 MG/10 ML VIAL (NF 1191.32424572 Y MEMANTINE 10 MG TAB 0.0208424565 Y MEMANTINE 5 MG TAB 0.0208428433 Y MENINGOCOCCAL B VACC,4-COMP/PF 132.19425481 Y MENINGOCOCCAL POLYSACC VAC A, 115.78425669 Y MENINGOCOCCAL POLYSACC VAC A/C 105.086426457 Y MENTHOL/PHENOL LOZENGE 2.23427183 Y MENTHOL/ZINC OXIDE POWDER 283 2.27428020 Y MEPERIDINE 100MG/1 ML SYR 1.2428017 Y MEPERIDINE 25 MG/1 ML SYR 0.96428015 Y MEPERIDINE 50 MG TAB (NF) 0.0144428018 Y MEPERIDINE 50 MG/1 ML SYR 0.84428019 Y MEPERIDINE 75 MG/1 ML SYR (NF) 1.17428082 Y MEPERIDINE PCA 300 MG/30 ML (N 8428394 Y MEPOLIZUMAB 100 MG VIAL 2525426279 Y MEPROBAMATE 200 MG TAB 0.0106424193 Y MEROPENEM 1 GM 9.06424192 Y MEROPENEM 500 MG/10 ML VIAL 13.77427306 Y MESALAMINE 4GM ENEMA 12.57426322 Y MESALAMINE SR CAPS 250 MG X2 5 0.0082426295 Y MESALAMINE SR TAB(NF) 400 MG T 3.32425358 Y MESNA 1000 MG/10 ML VIAL 17.9424593 Y METAXALONE 800 MG TAB (NF) 0.0229424337 Y METFORMIN 1000 MG TAB 0.0017426469 Y METFORMIN 500 MG TAB 0.0555424521 Y METFORMIN 500 MG TABSR 0.1425370 Y METHACHOLINE 100 MG/5 ML INH V 42.69428119 Y METHADONE 10 MG TAB 0.25428102 Y METHADONE 40 MG ODT TAB (NF) 0.0028428065 Y METHADONE 5 MG TAB 0.0022429137 Y METHENAMINE 1 GM TAB (NF) 0.0136424588 Y METHIMAZOLE 5 MG TAB 0.34426875 Y METHOCARBAMOL 500 MG TAB 0.0007426413 Y METHOCARBAMOL 750 MG TAB (NF) 0.05426877 Y METHOTREXATE 2.5 MG TAB 0.045424126 Y METHOTREXATE 250 MG/10 ML VIAL 6.91424018 Y METHOTREXATE 50 MG/2 ML VIAL 2.87424104 Y METHOTREXATE SOD INJ 25 MG/ML 0.0207427664 Y METHYLCELLULOSE (WITH SUGAR) 4 11.45424460 Y METHYLCELLULOSE 500 MG TAB 0.0011426012 Y METHYLDOPA 250 MG TAB 0.0015428130 Y METHYLENE BLUE 10 MG/1 ML VIAL 4.86425408 Y METHYLENE BLUE 10 ML VIAL 2.82426285 Y METHYLERGONOVINE 0.2 MG TAB (N 0.0079425099 Y METHYLERGONOVINE 0.2 MG/1 ML V 3.65424693 Y METHYLNALTREXONE INJ 12 MG/0.6 95.43

428037 Y METHYLPHENIDATE 10 MG TAB 0.07428036 Y METHYLPHENIDATE 5 MG TAB 0.0007428003 Y METHYLPHENIDATE SR 20 MG TABCR 0.23425046 Y METHYLPRED (DEPO) ACETATE 40 M 6.56425047 Y METHYLPRED (DEPO) ACETATE 80 M 11.6912425703 Y METHYLPRED ACETATE 400 MG/10 M 60.22425378 Y METHYLPRED ACETATE 400 MG/5 ML 50.69425154 Y METHYLPREDNISOLONE (SOLU) 125 3.1425153 Y METHYLPREDNISOLONE (SOLU) 40 M 2.76425606 Y METHYLPREDNISOLONE 1000 MG/8 M 36.51424677 Y METHYLPREDNISOLONE 4MG TABLET 0.79425155 Y METHYLPREDNISOLONE 500 MG/4 ML 11.05424577 Y METHYLPREDNISOLONE DOSEPAK 4 M 16.84424312 Y METHYLPREDNISOLONE DOSEPAK 4 M 0.0038426616 Y METOCLOPRAMIDE 10 MG TAB 0.1425234 Y METOCLOPRAMIDE 10 MG/2 ML VIAL 0.32426675 Y METOCLOPRAMIDE SYRUP 10 MG/10 0.157426316 Y METOLAZONE 2.5 MG TAB 2.55426590 Y METOLAZONE 5 MG TAB 0.0063425258 Y METOPROLOL 5 MG/5 ML VIAL 1.37426353 Y METOPROLOL SUCCINATE SR 100 MG 0.0109424507 Y METOPROLOL SUCCINATE SR 25 MG 0.74426325 Y METOPROLOL SUCCINATE SR 50 MG 0.75424586 Y METOPROLOL TARTRATE 25 MG TAB 0.09426572 Y METOPROLOL TARTRATE 50 MG TAB 0.08429330 Y METRONIDAZOLE (CLINIC) 500 MG 0.05427502 Y METRONIDAZOLE 0.75% CREAM 45 G 0.0575427576 Y METRONIDAZOLE 0.75% TOP GEL 45 132.923427503 Y METRONIDAZOLE 0.75% VAG GEL 70 72.4429173 Y METRONIDAZOLE 250 MG TAB 0.0005429311 Y METRONIDAZOLE 500 MG TAB 0.09429056 Y METRONIDAZOLE 500 MG/100 ML BA 1.26426923 Y MEXILETINE 150 MG CAP (NF) 0.0017426709 Y MEXILETINE 200 MG CAP 0.0019426889 Y MEXILETINE 250 MG CAP (NF) 0.0028428278 Y MICAFUNGIN 100 MG/5 ML VIAL (N 77.3427242 Y MICONAZOLE 2% CR 30 GM TUBE 0.001427111 Y MICONAZOLE 2% VAG CR 47.7 GM T 0.0013427003 Y MICONAZOLE 200 MG VAG SUPPOS 1.9633425298 Y MIDAZOLAM 10 MG/2 ML VIAL 0.62425452 Y MIDAZOLAM 2 MG/2 ML VIAL 0.38428042 Y MIDAZOLAM 25 MG/5 ML VIAL 2.78425077 Y MIDAZOLAM 5 MG/1 ML (ORAL PED) 0.802428114 Y MIDAZOLAM 5 MG/5 ML VIAL 0.68424361 Y MIDODRINE 2.5 MG TAB 0.012424370 Y MIDODRINE 5 MG TAB 0.0241425790 Y MIGLITOL 50 MG TAB (NF) 0.98

426288 Y MILK OF MAGNESIA CONC 10ML CUP 0.167428240 Y MILNACIPRAN 100 MG TAB (NF) 1.95428286 Y MILNACIPRAN 50 MG TAB (NF) 2.3425213 Y MILRINONE/DEX 200 MCG/ML 100ML 0.011426290 Y MINERAL OIL 30 ML UDC 0.0273427291 Y MINERAL OIL LIGHT-STERILE 25 M 3.92429262 Y MINOCYCLINE 100 MG CAP (NF) 0.007426067 Y MINOXIDIL 10 MG TAB 0.46426818 Y MINOXIDIL 2.5 MG TAB 0.0025424340 Y MIRTAZAPINE 15 MG TAB 0.24424373 Y MIRTAZAPINE 15 MG TABDP 0.0493424339 Y MIRTAZAPINE 30 MG TABDP (NF) 0.051424591 Y MISOPROSTOL (1/4 OF 100MCG) 25 0.35426788 Y MISOPROSTOL 200 MCG TAB 0.0134424020 Y mitoMYcin 20 MG/20 ML VIAL 53.87424019 Y mitoMYcin 5 MG/10 ML VIAL 16.63424058 Y mitoXANtrone 20 MG/10 ML VIAL 393.75424090 Y mitoXANtrone 25 MG/12.5 ML VIA 421.88424636 Y MODAFINIL 100 MG TAB (NF) 11.28424518 Y MOEXIPRIL 15MG TAB (NF) 0.0124424425 Y MOEXIPRIL 7.5 MG TAB (NF) 0.0119428362 Y MOMETASONE 100 MCG INHALER 167.98428363 Y MOMETASONE 100 MCG PUFF CHARGE 1428364 Y MOMETASONE 200 MCG INHALER 140.52428365 Y MOMETASONE 200 MCG PUFF CHARGE 1.17427651 Y MOMETASONE 50 MCG 17 GM NASPR 71.9427605 Y MOMETASONE FUROATE 0.24 GM INH 87.73428405 Y MOMETASONE TWISTHALER 110 MCG 155.79428347 Y MOMETASONE/FORMOTEROL 100/5 IN 146.87428348 Y MOMETASONE/FORMOTEROL 100/5 PU 1.22428345 Y MOMETASONE/FORMOTEROL 200/5 IN 146.87428346 Y MOMETASONE/FORMOTEROL 200/5 PU 1.22424309 Y MONTELUKAST 10 MG TAB 3.94424520 Y MONTELUKAST 4 MG CHEW (NF) 0.0943428060 Y MORPHINE 10 MG SUPPOS 0.0466428028 Y MORPHINE 10 MG/1 ML VIAL 1.09428066 Y MORPHINE 15 MG/1 ML MDV (NF) 8.99428087 Y MORPHINE 2 MG/1 ML INJ 0.76428088 Y MORPHINE 4 MG/1 ML INJ 0.79428068 Y MORPHINE IMMEDIATE RELEASE 15 0.0023428000 Y MORPHINE ORAL CONC 20 MG/1 ML 0.009428022 Y MORPHINE ORAL SOLN 10 MG/5 ML 0.9428377 Y MORPHINE ORAL SOLN PEDIATRIC 0 0.02428097 Y MORPHINE PCA 150 MG/30 ML 10.45428078 Y MORPHINE PCA 30 MG/30 ML 8.77428006 Y MORPHINE PF 10 MG/10 ML VIAL 4.48428058 Y MORPHINE PF 5 MG/10 ML VIAL 3.74

428424 Y MORPHINE SULFATE 8 MG/ML VIAL 1.03428084 Y MORPHINE SUSTAINED REL 100 MG 0.0155428083 Y MORPHINE SUSTAINED REL 15 MG 0.0034428080 Y MORPHINE SUSTAINED REL 30 MG 0.66428081 Y MORPHINE SUSTAINED REL 60 MG 0.0127425317 Y MORRHUATE SODIUM 5% 50 MG/ML V 58.34427580 Y MOXIFLOXACIN 0.5% OPH SOLN 3 M 81.25429286 Y MOXIFLOXACIN 400 MG TAB (NF) 0.3196425710 Y MOXIFLOXACIN 400 MG/250 ML BAG 34.33426962 Y MULTIVITAMIN LIQ 15 ML UDC 0.16424638 Y MULTIVITAMINS CHEW TABLET (NF) 0.0002424685 Y MULTIVITAMINS DROPS 50 ML BTL 1.61425497 Y MULTIVITAMINS INJ PEDS 5 ML VI 5.59427439 Y MULTIVITAMINS/IRON DROPS 50 ML 0.0006426472 Y MULTIVITAMINS/MINERALS TAB 0.05425210 Y MULTIVITAMINS-12 10 ML VIAL 3.23427459 Y MUPIROCIN 2% CR 15 GM TUBE 91.15427458 Y MUPIROCIN 2% NA OINT 1 GM (NF 59.53427335 Y MUPIROCIN 2% OINT 22 GM TUBE 5.42424645 Y MYCOPHENOLATE 250 MG CAP 0.0266426481 Y NABUMETONE 500 MG TAB 0.56427660 Y N-ACETYLCYSTEINE/METAFOL/METHY 1.43426637 Y NADOLOL 40 MG TAB 0.21429046 Y NAFCILLIN 1 GM/10 ML VIAL 8.6429132 Y NAFCILLIN 2 GM/10 ML VIAL 16.69425205 Y NalBUPHine 10 MG/ML AMP (NF) 0.9425472 Y NalBUPHine 20 MG/1 ML AMP 2.3428391 Y NALOXEGOL 12.5 MG TAB 8.71428392 Y NALOXEGOL TAB (NF) 25 MG TABLE 8.71425107 Y nalOXone 0.4 MG/1 ML INJ 5.21427658 Y nalOXone 2 MG/2 ML INJ 11.6428482 Y NALOXONE 4 MG/10 ML INJ 37.47427254 Y NAPHAZOLINE/PHENIRAMINE OPHTH 4.37426309 Y NAPROXEN 250 MG TAB 0.07426597 Y NAPROXEN 375 MG TAB 0.09424295 Y NAPROXEN 500 MG TAB 0.13428174 Y NARATRIPTAN HCL 1 MG TAB (NF) 26.29428175 Y NARATRIPTAN HCL 2.5 MG TAB (NF 26.29428272 Y NATALIZUMAB 300 MG/15 ML VIAL 4465.64424422 Y NATEGLINIDE 120 MG TAB (NF) 0.0113427675 Y NEBIVOLOL 5 MG TAB 1.68427691 Y NEBIVOLOL HCL 10 MG TAB 1.43427692 Y NEBIVOLOL HCL 2.5 MG TAB 1.45426500 Y NEFAZODONE 100 MG TAB (NF) 0.0078426029 Y NEFAZODONE 150 MG TAB (NF) 0.0081427125 Y NEO/POLYMYX/BACITRACIN OP OINT 42.53427126 Y NEO/POLYMYX/GRAMICIDIN OP SOL 16

427053 Y NEOM/POLYMYX/BACITR/HC OP OINT 1.5429140 Y NEOMYCIN 500 MG TAB 0.0076429197 Y NEOMYCIN SULFATE 1 GM POWD 0.047427389 Y NEOMYCIN/HC/COLIS OTIC 5 ML BT 31.27427051 Y NEOMYCIN/POLYMYX/BACI/HC OINT 0.18427124 Y NEOMYCIN/POLYMYX/BACITR OINT 3 4.26427123 Y NEOMYCIN/POLYMYX/BACITR OINT P 0.11427106 Y NEOMYCIN/POLYMYXIN/DEXAMETH OP 13.08427105 Y NEOMYCIN/POLYMYXIN/DEXAMETH OP 10.87427253 Y NEOMYCIN/POLYMYXIN/HYDROCORT O 105.3427054 Y NEOMYCIN/POLYMYXIN/HYDROCORT O 76.16428383 Y NEOSTIGMINE (OR DOSE) INJ 6.57425134 Y NEOSTIGMINE 10 MG/10 ML VIAL 65.67425717 Y NEPRO 237 ML CAN 1.07425609 Y NESIRITIDE 1500 MCG/5 ML INJ ( 637.71425610 Y NESIRITIDE 6 MCG/1 ML SYR (NF) 462.4425731 Y NEVIRAPINE 200 MG TAB (NF) 6.55430050 Y NEXIUM 20 MG CAPCR (NF) 0.008430060 Y NEXIUM 20 MG CAPCR (NF) 0.0026430051 Y NEXIUM 40 MG CAPCR (NF) 0.008430061 Y NEXIUM 40 MG CAPCR (NF) 0.0026424673 Y NEXIUM 40 MG CAPCR (NF) 0.21424456 Y NIACIN (NIASPAN) 500 MG TABCR 0.0169424500 Y NIACIN 250 MG CAPCR 0.0002426314 Y NIACIN 50 MG TAB 0.01426780 Y NIACIN 500 MG CAPCR 0.0003426786 Y niCARdipine 20 MG CAP (NF) 0.0006426849 Y niCARdipine 30 MG CAP (NF) 0.09

Y NICARDIPINE HCL 25 MG/10 ML VI 4424161 Y niCARdipine/NS 20 MG/200 ML BA 82.94427551 Y NICOTINE 0.5 MG/SPRAY 10 ML BT 1.151427356 Y NICOTINE 14 MG PATCH 1.56427351 Y NICOTINE 21 MG PATCH 1.18427353 Y NICOTINE 7 MG PATCH 0.97426806 Y NICOTINE POLACRILEX 2 MG GUM 0.0042427585 Y NICOTINE POLACRILEX 2 MG LOZG 0.0062424525 Y NICOTINE POLACRILEX 4 MG GUM 0.21427586 Y NICOTINE POLACRILEX 4 MG LOZG 0.0062426611 Y NIFEdipine 10 MG CAP 0.75426813 Y NIFEdipine 30 MG TABCR 0.87426549 Y NIFEdipine 60 MG TABCR 1.6614426996 Y niMODipine 30 MG CAP (NF) 6.38428472 Y NITAZOXANIDE 100MG/5ML SUSP 60 490.37424684 Y NITAZOXANIDE 500 MG TAB (NF) 16.58429294 Y NITROFURANTOIN MACRO 100 MG CA 0.72429255 Y NITROFURANTOIN MACRO 25 MG CAP 0.0083429134 Y NITROFURANTOIN MACRO 50 MG CAP 0.0063

427299 Y NITROGLYCERIN 0.1 MG PATCH 0.59427233 Y NITROGLYCERIN 0.2 MG PATCH 0.4117427298 Y NITROGLYCERIN 0.3 MG PATCH 0.076427261 Y NITROGLYCERIN 0.4 MG PATCH 0.0163426689 Y NITROGLYCERIN 0.4 MG SL TAB 0.29427496 Y NITROGLYCERIN 0.6 MG PATCH 0.0293427592 Y NITROGLYCERIN 2% OINT 1 GM PKT 0.33427134 Y NITROGLYCERIN 2% OINT 30 GM TU 3.89427282 Y NITROGLYCERIN 400 MCG/SPRAY 4. 186.22425706 Y NITROGLYCERIN 50 MG/10 ML VIAL 3.5375138 Y NITROGLYCERIN/DEX 50 MG/250 ML 12.6425110 Y NITROPRUSSIDE 50 MG/2 ML VIAL 745.23428337 Y NIVOLUMAB 100 MG/10 ML VIAL 2398428336 Y NIVOLUMAB 40 MG/4 ML VIAL 959.2429371 Y NIZATIDINE 150 MG CAP (NF) 0.24425093 Y NOREPINEPHRINE 4 MG/4 ML VIAL 1.62426843 Y NORETHINDRONE 5 MG TAB (NF) 0.0274427568 Y NORFLURANE SPRAY 103.5 GM CAN 26.48424699 Y NORGESTREL/ETHINYL ESTRADIOL 2 47.66426941 Y NORTRIPTYLINE 10 MG CAP 0.0007426051 Y NORTRIPTYLINE 25 MG CAP (NF) 0.0021427363 Y NOVA TEST STRIPS 50 EA BOX 25.48427137 Y NYSTATIN 100,000 UNIT/GM CREAM 20.4427114 Y NYSTATIN 100,000 UNIT/GM PWD 1 4.67429142 Y NYSTATIN 100,000 UNIT/ML SUSP 2.71429141 Y NYSTATIN 500,000 UNIT TAB (NF) 0.0041424174 Y NYSTATIN SUSP 500,000 UNITS/5 0.51427113 Y NYSTATIN/TRIAMCINOLONE CREAM 3 1.5428359 Y OBINUTUZUMAB 1,000 MG/40 ML VI 5301.9428442 Y OCRELIZUMAB 300MG/10ML VIAL 6250425402 Y OCTREOTIDE ACETATE 0.1 MG/1 ML 3.4425429 Y OCTREOTIDE ACETATE 0.5 MG/1 ML 41.33424160 Y OCTREOTIDE LAR DEPOT 20 MG SYR 2156.67424156 Y OCTREOTIDE LAR DEPOT INJ 30 MG 3935.95427381 Y OFLOXACIN 0.3% OP SOLN 5 ML BT 0.176

Y OFLOXACIN 0.3% OTIC 5 ML BTL ( 13.59425693 Y OLANZapine 10 MG/2 ML VIAL 28.63424567 Y OLANZapine 2.5 MG TAB 5.58424430 Y OLANZapine 5 MG TABDP (NF) 0.242424503 Y OLMESARTAN 20 MG TAB 1.23424530 Y OLMESARTAN 5 MG TAB (NF) 0.0393427526 Y OLOPATADINE 0.1% OP SOLN 5 ML 28.79429242 Y OLSALAZINE 250 MG CAP (NF) 0.0044428324 Y OMALIZUMAB 150 MG VIAL 1084.66424627 Y OMEGA-3 ACID ETHYL ESTERS 1 GM 1.12426807 Y OMEPRAZOLE 20 MG CAP (NF) 0.21427638 Y OMEPRAZOLE 20MG/BICARB 10MEQ 1 3

425798 Y OMEPRAZOLE MAGNESIUM 20 MG TAB 0.74424657 Y OMEPRAZOLE/SODIUM BICARB 40 MG 0.0686425373 Y ONDANSETRON 2 MG/ML 20ML VIAL 0.33426291 Y ONDANSETRON 4 MG ODT 0.1723425417 Y ONDANSETRON 4 MG/2 ML VIAL 0.3308424529 Y ONDANSETRON 8 MG ODT 0.37424175 Y ON-Q PAIN BAG 100ML (PMO12-A) 105424178 Y ON-Q PAIN BAG 400ML (P400x4d) 292.8424175 Y ON-Q PAIN BAG 400ML (PMO26-A) 255424178 Y ON-Q PAIN BAG 600 ML (CB6001) 525424178 Y ON-Q PAIN BAG 600ML DUAL SELEC 292.8425788 Y ORAMAGIC RINSE (CLINIC USE) 21 19.88425789 Y ORAMAGIC W/ BENZOCAINE RINSE 2 19.88426965 Y ORPHENADRINE 100 MG TABCR (NF 0.005425111 Y ORPHENADRINE CITRATE INJ 60 MG 4.28424346 Y OSELTAMIVIR 75 MG CAP 0.66424555 Y OSELTAMIVIR SUSP 6 MG/1 ML 60M 134.68425718 Y OSMOLITE 1.0 CAL 1000 ML BTL 1.67429336 Y OXACILLIN 1 GM VIAL (NF) 8.6429335 Y OXACILLIN 2 GM VIAL (NF) 16.69424105 Y OXALIPLATIN 100MG/20 ML VIAL 134.28424106 Y OXALIPLATIN 50 MG/10 ML VIAL 65.8424544 Y OXANDROLONE 10 MG TAB (NF) 0.272426282 Y OXAPROZIN 600 MG TAB (NF) 0.0011426425 Y OXAZEPAM 10 MG CAP (NF) 0.0018426426 Y OXAZEPAM 15 MG CAP (NF) 0.0031424477 Y OXcarbazepine 150 MG TAB 0.0118424194 Y OXcarbazepine SUSP (NF) 300 MG 6.79425733 Y OXYBUTYNIN 3.9 MG PATCH (NF) 12.19426550 Y OXYBUTYNIN 5 MG TAB (NF) 0.0008424368 Y OXYBUTYNIN 5 MG TABCR (NF) 0.0286428002 Y OXYCODONE 10 MG TABCR 0.05428007 Y OXYCODONE 20 MG TABCR 2.38428046 Y OXYCODONE 20 MG/1 ML CONC 4.06428016 Y OXYCODONE 5 MG/5 ML SOLN UDC 1.686428053 Y OXYCODONE 5MG/ACETAMIN 325MG T 0.1428023 Y OXYCODONE 80 MG TABCR 9.26428013 Y OXYCODONE IR 5 MG TAB 0.19427004 Y OXYMETAZOLINE 0.05% NASAL SPRA 2427524 Y OXYQUINOLINE VAGINAL GEL 113.4 15.22425158 Y OXYTOCIN INJ 10 UNIT/ML VIAL 0.7425659 Y OXYTOCIN/LACTATED RINGERS 20 U 5.25424096 Y PACLITAXEL 6 MG/ML 25ML VIAL 77.22424069 Y PACLITAXEL 6 MG/ML 5 ML VIAL 6.33424084 Y PACLITAXEL 6 MG/ML 50ML VIAL 41.82424130 Y PACLITAXEL PROTEIN-BOUND 100 M 908.38428300 Y PALIPERIDONE 156 MG/ML KIT (NF 1345.11

427642 Y PALIPERIDONE 3 MG TAB 9.44425473 Y PALIVIZUMAB 100 MG/1 ML VIAL 1972.04425474 Y PALIVIZUMAB FOR 50 MG/0.5 ML V 1044.35425671 Y PALONOSETRON HCL 0.25 MG/5 ML 210.16425396 Y PAMIDRONATE 30 MG/10 ML VIAL 11.07426794 Y PANCRELIPASE 12000 UNITS CAP 1.49424336 Y PANCRELIPASE 24000 UNITS CAP 2.11425608 Y PANCURONIUM 10 MG/10 ML VIAL 0.83425252 Y PANCURONIUM 10 MG/5 ML VIAL (N 2.28424132 Y PANITUMUMAB 100 MG/5 ML VL (NF 3298.34424131 Y PANITUMUMAB 400 MG/20 ML VL (N 3298.34425768 Y PANTOPRAZOLE 20 MG TABSR 0.31424475 Y PANTOPRAZOLE 40 MG TABSR (NF) 0.0022425631 Y PANTOPRAZOLE 40 MG/10 ML VIAL 3.51428243 Y PANTOPRAZOLE/BICARB SUSP 20 MG 3425113 Y PAPAVERINE 60 MG/2 ML VIAL 10.15425515 Y PARENTERAL ELECTROLYTE-148 1,0 1.25425568 Y PARENTERAL ELECTROLYTE-A 500 M 1.44425215 Y PARENTERAL ELECTROLYTES 20 ML 0.11424490 Y PAROXETINE 12.5 MG TABCR (NF) 0.0836426260 Y PAROXETINE 20 MG TAB 0.0066428269 Y PAROXETINE SUSP (NF) 10 MG/5 M 3.85428344 Y PCC-4 1,000 UNIT/40 ML VIAL 1330428343 Y PEGFILGRASTIM 6 MG/0.6 ML KIT 4290.73425603 Y PEGFILGRASTIM 6 MG/0.6ML SYR 4189.05424107 Y PEGINTERFERON ALPHA 2b 180 MCG 523.51428407 Y PEMBROLIZUMAB 100 MG/4 ML VIAL 4446.5424139 Y PEMETREXED 100 MG/4 ML VIAL 499.63424117 Y PEMETREXED 500 MG/20 ML VIAL 2498.11427600 Y PENCICLOVIR 1% CREAM 1.5 GM TU 9.6429149 Y PENICILLIN G BENZATHINE IM SUS 135.112429302 Y PENICILLIN G POT/DEXTROSE 3 MU 0.0306429028 Y PENICILLIN G POTASSIUM 20 MU/4 8.38429027 Y PENICILLIN G POTASSIUM 5 MU/10 4.61429150 Y PENICILLIN G PROCAINE INJ 600, 23.93429292 Y PENICILLIN G SODIUM 5 MMU/VIAL 35.41429340 Y PENICILLIN V POTASSIUM 250 MG 0.32429148 Y PENICILLIN V POTASSIUM SUSP 25 0.0002427177 Y PENTAMIDINE ISETHIONATE NEBU S 92.8428280 Y PENTAZOCINE/NALOXONE TABLET 1.75424566 Y PENTOSAN 100 MG CAP (NF) 0.0242426989 Y PENTOXIFYLLINE 400 MG TABCR 0.0011428476 Y PERAMIVIR 200 MG/20 ML VIAL 316.66424545 Y PERINDOPRIL 2 MG TAB (NF) 0.0116427056 Y PERMETHRIN 1% LOTION 120 ML BT 0.0005427534 Y PERMETHRIN CREAM 60 GM TUBE 0.0018426945 Y PERPHENAZINE 2 MG TAB 0.0027

428277 Y PERTUZUMAB 420 MG/14 ML VIAL 4407.82427175 Y PETROLATUM 5GM PKT 0.09427175 Y PETROLATUM OINT 16.8 GM TUBE 1.91426392 Y PHENAZOPYRIDINE 100 MG TAB 0.0006424554 Y PHENELZINE 15 MG TAB 0.75426358 Y PHENOBARBITAL 16.2 MG TAB (NF) 0.02426359 Y PHENOBARBITAL 32.4 MG TAB 0.2426362 Y PHENOBARBITAL ELIX 20 MG/5 ML 0.764425118 Y PHENOBARBITAL SOD 65 MG/1 ML V 1.27427043 Y PHENOL 1.4% SPRAY 180 ML BTL 1.01427621 Y PHENOL LIQD 500 ML BTL 5424289 Y PHENTERMINE 15 MG CAP (NF) 0.2421425142 Y PHENTOLAMINE 5 MG/1 ML VIAL 23.51427132 Y PHENYLEPHRINE 0.25% NASAL SPRA 0.0012427133 Y PHENYLEPHRINE 0.5% NASAL SPRAY 3.5427240 Y PHENYLEPHRINE 1% NASAL SPRAY 1 3.93427131 Y PHENYLEPHRINE 10% OP SOLN 5 ML 38.18425108 Y PHENYLEPHRINE 10MG/1 ML VIAL 0.38427268 Y PHENYLEPHRINE 2.5% OP SOLN 3 M 0.1633424164 Y PHENYLEPHRINE HCL 10 MG TAB (N 0.04428380 Y PHENYLEPHRINE HCL/NS 1000 MCG/ 5.48424556 Y PHENYLEPHRINE/PYRILAMINE TAB ( 0.0212426151 Y PHENYTOIN 100 MG CAP 0.49425056 Y PHENYTOIN 100 MG/2 ML AMP (NF) 1.24425057 Y PHENYTOIN 250 MG/5 ML AMP (NF) 1.45426339 Y PHENYTOIN 30 MG CAP (NF) 0.0025426441 Y PHENYTOIN 50MG CHEW (NF) 0.0026426537 Y PHENYTOIN SUSP 100 MG/4 ML CUP 0.83425264 Y PHYSOSTIGMINE 2 MG/2 ML AMP 3.79425434 Y PHYTONADIONE 1 MG/0.5 ML INJ 3.58425015 Y PHYTONADIONE 10 MG/1 ML INJ 38.8524426278 Y PHYTONADIONE 5 MG TAB 56.08427082 Y PILOCARPINE 1% OP SOLN 15 ML B 0.0053427083 Y PILOCARPINE 2% OP SOLN 15 ML B 0.018427085 Y PILOCARPINE 4% OP SOLN 15 ML B 16.8426432 Y PILOCARPINE 5 MG TAB (NF) 0.0125427504 Y PIMECROLIMUS 1% CREAM 30 GM TU 0.061424354 Y PIOGLITAZONE 30 MG TAB 1.7424355 Y PIOGLITAZONE 45 MG TAB 1.9424186 Y PIPERACILLIN/TAZOBACTAM 2.25 G 10.34429284 Y PIPERACILLIN/TAZOBACTAM 2.25 G 6.69425587 Y PIPERACILLIN/TAZOBACTAM 3.375 14.38427657 Y PIPERACILLIN/TAZOBACTAM 3.375 10.58427662 Y PIPERACILLIN/TAZOBACTAM 4.5 GM 13.4

Y PIPERONYL BUTOXIDE/PYRETHRINS 13.24426968 Y PIROXICAM 10 MG CAP (NF) 0.0011424185 Y PITAVASTATIN 2 MG TAB (NF) 3.21

425463 Y PNEUMOCOCCAL 13-VALENT 16 MCG/ 169.1425211 Y PNEUMOCOCCAL VACCINE POLYVALEN 88.8427193 Y PODOPHYLLIN RESIN 25% SOLN 15 95.31

Y POLIDOCANOL 2 ML (CLINIC USE O 110.99425453 Y POLIOVIRUS VACCINE INACTIVATED 283.63424502 Y POLYETHYLENE GLYCOL POWDER 17 1.18

Y POLYETHYLENE GLYCOL POWDER 510 11.82425290 Y POLYMYXIN B SULFATE 500,000 UN 10.97427594 Y POLYMYXIN/TRIMETHOPRIM OP 10 M 0.271428323 Y POSACONAZOLE 200 MG/5 ML SUSP 46.6425257 Y POTASSIUM ACETATE 40 MEQ/20 ML 0.41428463 Y POTASSIUM BICARB/CIT AC EFF 20 0.4375044 Y POTASSIUM CHL 10 MEQ/50 ML PRE 1.54428295 Y POTASSIUM CHL 20 MEQ/100 ML PR 1.46426592 Y POTASSIUM CHLORIDE 10 MEQ TABC 0.1426769 Y POTASSIUM CHLORIDE 20 MEQ TABC 0.3426425127 Y POTASSIUM CHLORIDE 40MEQ/20ML 3.39426369 Y POTASSIUM CHLORIDE LIQ (NF) 20 0.1046424639 Y POTASSIUM CITRATE 10 MEQ TABSR 0.0045427626 Y POTASSIUM HYDROXIDE 10% SOL 50 5426857 Y POTASSIUM PHOS/SODIUM PHOS PWD 0.0043425185 Y POTASSIUM PHOSPHATE 15 MM/5 ML 1.31428233 Y POTASSIUM PROTOCOL CENTRAL 1.54428235 Y POTASSIUM PROTOCOL PERIPHERAL 1.54427029 Y POVIDONE IODINE 1% OINT 30 GM 1.36427031 Y POVIDONE IODINE 10% SOLN 120 M 1.21425626 Y PRALIDOXIME CHLORIDE 1 GM VIAL 84.32424343 Y PRAMIPEXOLE 0.125 MG TAB 0.28424344 Y PRAMIPEXOLE 0.25 MG TAB (NF) 0.0172424319 Y PRAMIPEXOLE 0.5 MG TAB 0.21427231 Y PRAMOXINE 1%,MINERAL OIL OINT 70427109 Y PRAMOXINE HYDROCORT FOAM 10 GM 65.69424730 Y PRASUGREL HYDROCHLORIDE 10 MG 5.3426025 Y PRAVASTATIN 10 MG TAB (NF) 0.0311426165 Y PRAVASTATIN 20 MG TAB (NF) 0.6428208 Y PRAVASTATIN 40 MG TAB (NF) 0.25426556 Y PRAZOSIN 1 MG CAP 0.0011425787 Y PRAZOSIN 5 MG CAP (NF) 0.33427068 Y prednisoLONE 0.125% OPHTH 5 ML 0.638427069 Y prednisoLONE 1% OPHTH 5 ML BTL 0.128426303 Y prednisoLONE 15 MG/5 ML UDC 50.57427311 Y prednisoLONE/GENTAMIC OP SUSP 0.788426374 Y predniSONE 2.5 MG TAB (NF) 0.0006426376 Y predniSONE 20 MG TAB 0.1413426375 Y predniSONE 5 MG TAB 0.03426865 Y predniSONE SOLN 5 MG/5 ML (NF) 0.0011426373 Y predniSONE TAB 1 MG TAB 0.15

426560 Y predniSONE TAB 10 MG TAB 0.041424634 Y PREGABALIN 25 MG CAP 0.018424628 Y PREGABALIN 50 MG CAP 1.8424633 Y PREGABALIN 75 MG CAP 0.018426565 Y PRENATAL VITAMIN TAB 0.12424697 Y PRILOCAINE/EPINEPH INJ 72 MG/1 0.8424689 Y PRIMAQUINE PHOSPHATE 26.3 MG T 1.04428315 Y PRIMATRIX 4X4 962.5428315 Y PRIMATRIX 6X6 2886426982 Y PRIMIDONE 250 MG TAB (NF) 0.0036426944 Y PRIMIDONE 50 MG TAB 0.45426098 Y PROBENE 500MG/COLCHICINE 0.5MG 0.0057426058 Y PROBENECID 500 MG TAB 0.0033425618 Y PROCAINAMIDE 1000 MG/10 ML VIA 0.23424031 Y PROCARBAZINE 50 MG CAP (NF) 0.4544426102 Y PROCHLORPERAZINE 10 MG TAB 0.1425036 Y PROCHLORPERAZINE 10 MG/2 ML 1.75426107 Y PROCHLORPERAZINE 25MG SUPPOSIT 5.98427696 Y PROGESTERONE 200 MG CAP (NF) 2.56426817 Y PROMETH/PHENYLEPHR/CODEINE 10M 0.71426988 Y PROMETHAZINE 25 MG TAB 0.11425116 Y PROMETHAZINE 25 MG/1 ML VIAL 0.74426356 Y PROMETHAZINE 25MG SUPPOS 0.502425117 Y PROMETHAZINE 50 MG/1 ML VIAL ( 1.5692424275 Y PROMETHAZINE PLAIN SYRUP 6.25 2.83424632 Y PROMETHAZINE/CODEINE SYRUP 10 0.09425723 Y PROMOTE WITHOUT FIBER 1,000 ML 1.8426123 Y PROPAFENONE 150 MG TAB 0.0045427269 Y PROPARACAINE 0.5% OP SOLN 15 M 23.01425666 Y PROPOFOL 1000 MG/100 ML VIAL 9.34425348 Y PROPOFOL 200 MG/20 ML VIAL 1.87425398 Y PROPOFOL 500 MG/50 ML VIAL 4.67425088 Y PROPRANOLOL 1 MG/1 ML VIAL 2.28426229 Y PROPRANOLOL 10 MG TAB 0.05426555 Y PROPRANOLOL 20 MG TAB (NF) 0.05426230 Y PROPRANOLOL 40 MG TAB 0.0004425759 Y PROPRANOLOL 80 MG TAB (NF) 0.04426727 Y PROPRANOLOL SR 120MG CAP (NF) 0.0168426910 Y PROPRANOLOL SR 60MG CAP (NF) 0.0116426987 Y PROPRANOLOL SR 80 MG CAP (NF) 0.0135427608 Y PROPYLENE GLY/PEG400 OS 300 DR 8.02426389 Y PROPYLTHIOURACIL 50 MG TAB (NF 0.0014425100 Y PROTAMINE 250 MG/25 ML VIAL 10.22425136 Y PROTAMINE 50 MG/5 ML VIAL 3.18424694 Y PROVENTIL HFA INHALER 6.7 GM I 44.14426401 Y PSEUDOEPH/CPM/DM 5 ML BTL (NF) 0.0002426447 Y PSEUDOEPHEDRINE 30 MG TAB 0.0008

424472 Y PSYLLIUM 1.7 GM WAFR (NF) 0.0062426284 Y PSYLLIUM GRANULES 1 PACKET (NF 0.0076428366 Y PURAPLY AM 2X4 SHEET 896428372 Y PURAPLY AM 5X5 SHEET 2800428367 Y PURAPLY AM 6X9 SHEET 2700429208 Y PYRAZINAMIDE 500 MG TAB 0.0115425141 Y PYRIDOSTIGMINE 10 MG/2 ML AMP 22.26426281 Y PYRIDOSTIGMINE 60 MG TAB (NF) 0.27426070 Y PYRIDOSTIGMINE SYRUP 60 MG/5 M 0.0002425322 Y PYRIDOXINE 100 MG/1 ML VIAL 5.75426393 Y PYRIDOXINE 50 MG TAB 0.0001428334 Y PYRIDOXINE HCL 25 MG TABLET (N 0.01424417 Y QUETIAPINE 100 MG TAB 0.0285424371 Y QUETIAPINE 25 MG TAB 0.0166426140 Y QUINAPRIL 10 MG TAB 0.45426479 Y QUINAPRIL 20 MG TAB (NF) 0.46424353 Y QUINAPRIL 5 MG TAB (NF) 0.46426398 Y QUINIDINE GLUCONATE SR 324 MG 0.0093426402 Y quinIDINE SULFATE 200 MG TAB 0.0008426551 Y quinIDINE SULFATE 300 MG TAB ( 0.0024426404 Y QUININE SULFATE 324 MG CAP (NF 3.4424434 Y RABEprazole 20 MG TABEC (NF) 0.0413428468 Y RABIES IMMUNE GLOBULIN (HUMAN) 2297.09425605 Y RABIES IMMUNE GLOBULIN (HUMAN) 1453.89425435 Y RABIES IMMUNE GLOBULIN (HUMAN) 722.54428352 Y RABIES VACCINE PF 2.5 IU/1 ML 270.55427283 Y RACEMIC EPINEPHRINE 2.25% NEB 1.17424359 Y RALOXIFENE 60 MG TAB 3.8428318 Y RALTEGRAVIR 400 MG TABLET 17.92425795 Y RAMELTEON 8 MG TAB (NF) 4.14426465 Y RAMIPRIL 2.5 MG CAP 0.1173426351 Y RAMIPRIL 5 MG CAP 1.32428145 Y RAMUCIRUMAB 100 MG/10 ML VIAL 1020428378 Y RAMUCIRUMAB 500 MG/50 ML VIAL 5304426651 Y RANITIDINE 150 MG TAB (NF) 0.02429376 Y RANITIDINE 50 MG/2 ML VIAL (NF 0.81426062 Y RANITIDINE SYRUP 150 MG/10 ML 1424648 Y RANOLAZINE 500 MG TABSR 3.27424153 Y RASBURICASE 1.5 MG/1 ML VIAL 528.85424154 Y RASBURICASE 7.5 MG/5 ML VIAL 2644.3428044 Y REMIFENTANIL 2 MG/5 ML VIAL 2.051424325 Y REPAGLINIDE 0.5 MG TAB (NF) 0.0092428446 Y REPAGLINIDE 1 MG TABLET 0.0034424326 Y REPAGLINIDE 2 MG TAB 0.0092426428 Y RESERPINE 0.25 MG TAB (NF) 0.7428422 Y RESLIZUMAB 100 MG/10 ML VIAL 860425188 Y RHO(D) IMMUNE GLOB 300 MCG/2 M 73.18

425189 Y RHO(D) IMMUNE GLOB 5000 UNITS/ 857.75427695 Y RHO(D) IMMUNE GLOBULIN 300 MCG 114.76429057 Y RIFABUTIN 150 MG CAP (NF) 0.0621429268 Y RIFAMPIN 150 MG CAP 1.06429176 Y RIFAMPIN 300 MG CAP 0.97429491 Y RIFAMPIN 600 MG/10 ML VIAL 36.96424616 Y RIFAXIMIN 200 MG TAB 8.07428129 Y RIFAXIMIN 550 MG TAB 18.16426326 Y RIMANTADINE 100 MG TAB (NF) 0.012424515 Y RISEDRONATE 35 MG TAB (NF) 4.045424396 Y RISEDRONATE 5 MG TAB (NF) 0.077424578 Y risperiDONE 0.25 MG TAB 0.0485426355 Y risperiDONE 1 MG TAB 0.54429288 Y RITONAVIR 100 MG CAP (NF) 8.34424088 Y RITUXIMAB 100 MG/10 ML VIAL 835.22424089 Y RITUXIMAB 500 MG/50 ML VIAL 4176.1428128 Y RIVAROXABAN 10 MG TABLET 5.84428237 Y RIVAROXABAN 15 MG TABLET 6.31428238 Y RIVAROXABAN 20 MG TABLET 6.31424399 Y RIVASTIGMINE 1.5 MG CAP 0.0252424398 Y RIVASTIGMINE 3 MG CAP (NF) 0.0252427673 Y RIVASTIGMINE 4.6 MG PATCH 5.43424470 Y RIZATRIPTAN 10 MG TABDP 10.1733424469 Y RIZATRIPTAN 5 MG TAB (NF) 10.1733425418 Y ROCURONIUM 50 MG/5 ML VIAL 3.39428264 Y ROFLUMILAST 500 MCG TAB 8.06428232 Y ROMIPLOSTIM 250 MCG/0.5 ML VIA 1165.1424292 Y rOPINIRole 0.25 MG TAB 0.58424369 Y rOPINIRole 2 MG TAB 0.26425641 Y ROPIVACAINE 0.5% 20 ML VIAL 5.8844425658 Y ROPIVACAINE 200 MG/100 ML VIAL 16.68425640 Y ROPIVACAINE 40 MG/20 ML VIAL 5.24424334 Y ROSIGLITAZONE 2 MG TAB (NF) 0.0315424335 Y ROSIGLITAZONE 4 MG TAB (NF) 2.81424540 Y ROSUVASTATIN 10 MG TAB (NF) 2.25424562 Y ROSUVASTATIN 20 MG TAB (NF) 2.25424569 Y ROSUVASTATIN 5 MG TAB (NF) 2.48424656 Y ROTAVIRUS SYRINGE 1 ML SYR 87.2424708 Y SACCHAROMYCES BOULARDII 250 MG 0.6428417 Y SACUBITRIL/VALSARTAN 24/26 MG 6.2745428418 Y SACUBITRIL/VALSARTAN 49/51 MG 6.2745427232 Y SALINE 0.65% NASAL SOLN 45 ML 0.67427293 Y SALIVA SUBSTITUTE 45 ML BTL (N 4.28425734 Y SALIVA SUBSTITUTION COMBO 30 A 172.23427556 Y SALMETEROL INHALER 50 MCG/INH 83.26427682 Y SALMETEROL/FLUTICA 115/21 INH 192.46427680 Y SALMETEROL/FLUTICA 230/21 INH 253.15

427689 Y SALMETEROL/FLUTICA 45/21 INH ( 154.9427690 Y SALMETEROL/FLUTICA 45/21 PUFF 1.29427536 Y SALMETEROL/FLUTICASONE 100/50 154.9427590 Y SALMETEROL/FLUTICASONE 250/50 192.46427535 Y SALMETEROL/FLUTICASONE 500/50 253.15426890 Y SALSALATE 500 MG TAB (NF) 0.0002426735 Y SALSALATE 750 MG TAB (NF) 0.0003424138 Y SARGRAMOSTIM 250 MCG/1 ML VIAL 180.91428120 Y SAXAGLIPTIN 5 MG TAB (NF) 5.95425401 Y SCOPOLAMINE 0.4 MG/1 ML VIAL ( 4.37427320 Y SCOPOLAMINE 1.5 MG PATCH 18.65424122 Y SECRETIN 16 MCG VIAL (NF) 415426866 Y SELEGILINE 5 MG TAB (NF) 0.0063427531 Y SELENIUM 2.5% LOTION 120 ML BT 0.0002426423 Y SENNA 8.6 MG TAB 0.05426900 Y SENNA SYRUP 8.8 MG/5 ML UDBTL 0.0001426268 Y SENNA/DOCUSATE TAB 0.0003426149 Y SERTRALINE 50 MG TAB 0.12424599 Y SERTRALINE ORAL CONC 20 MG/1 M 0.61425549 Y SET EXT/FILTER 0.22 MIC 2C8671 3.2425540 Y SET, BASIC NONVENTED (2C8425) 2.04425539 Y SET, EPIDURAL (21-7108-24) 3.44425550 Y SET, FILTER 1.2MIC EXT (2C1103 2.07428313 Y SET, NARCOTIC (1C8109S) 3.44375126 Y SET, PCA (#3559) 4.77425535 Y SET, PUMP FILTER NON-VENT TPN 3.2425547 Y SET, PUMP IV (2C6537) 1.01425544 Y SET, PUMP VENTED (2C8541) 3.29425538 Y SET, SECONDARY IV (2C7461) 0.82425545 Y SET, SYRINGE PUMP (2C9201) 1.04425556 Y SET, -TAXANE IV (2C7557/2C8858 9424467 Y SEVELAMER 400 MG CAP (NF) 1.03424620 Y SEVELAMER 800 MG TAB (NF) 2.35427540 Y SEVOFLURANE INHAL SOLN 250 ML 76.22424655 Y SILDENAFIL 20 MG TAB 0.102424641 Y SILDENAFIL 25 MG TAB (NF) 0.3116428122 Y SILVER NITRATE 0.5% SOLN 960 M 1.73427402 Y SILVER NITRATE SWABS 0.4549427295 Y SILVER SULFADIAZINE 1% CR 25 G 5.61427155 Y SILVER SULFADIAZINE 1% CR 400 21.65427159 Y SILVER SULFADIAZINE 1% CR 50 G 3.31426307 Y SIMETHICONE 80 MG CHEW TAB 0.04426700 Y SIMETHICONE LIQUID 20 MG/0.3 M 1.86427628 Y SIMPLE SYRUP LIQD 9.89426252 Y SIMVASTATIN 10 MG TAB (NF) 0.0272424681 Y SIMVASTATIN 20 MG TAB (NF) 0.05424287 Y SIMVASTATIN 40 MG TAB (NF) 0.1426

424679 Y SIMVASTATIN 5 MG TAB (NF) 0.04429369 Y SIMVASTATIN 80 MG TAB (NF) 0.29425412 Y SINCALIDE 5 MCG VIAL 66.74424563 Y SIROLIMUS 1 MG TAB (NF) 0.0687424670 Y SITAGLIPTIN 100 MG TAB 11.94424722 Y SITAGLIPTIN 25 MG TAB 5.39427160 Y SKIN ADHESIVE (DERMABOND) 1 AP 18.31428432 Y SKIN ADHESIVE (SKIN AFFIX) 1 A 10.7425575 Y SOD CHL 0.9% 100 ML MINI BAG 2.2425292 Y SOD CHL BACTERIOSTATIC 30 ML V 0.44425337 Y SOD CHLOR 3.6%/EPINEPH0.005% 1 3425282 Y SODIUM ACETATE INJ 2 MEQ/ML 20 0.0225425442 Y SODIUM BICARBONATE 4% 2.4 MEQ/ 3.42425109 Y SODIUM BICARBONATE 4.2% 10 ML 3.05426116 Y SODIUM BICARBONATE 650 MG TAB 0.05425241 Y SODIUM BICARBONATE 8.4% 10 ML 0.286425361 Y SODIUM BICARBONATE 8.4% 50 MEQ 8.2425147 Y SODIUM BICARBONATE 8.4% 50 ML 2.55425561 Y SODIUM CHL 0.9% + KCL 20MEQ 1, 1.1427093 Y SODIUM CHL 5% HYPERTONIC OP SO 0.0466425521 Y SODIUM CHLORIDE 0.45% 1000 ML 0.66425529 Y SODIUM CHLORIDE 0.45% 500 ML B 0.61425711 Y SODIUM CHLORIDE 0.9% 10 ML SYR 0.36425254 Y SODIUM CHLORIDE 0.9% 10 ML VIA 0.68425523 Y SODIUM CHLORIDE 0.9% 100 ML BA 0.85425517 Y SODIUM CHLORIDE 0.9% 1000 ML B 0.6425520 Y SODIUM CHLORIDE 0.9% 150 ML BA 0.6425668 Y SODIUM CHLORIDE 0.9% 20 ML VIA 0.54425527 Y SODIUM CHLORIDE 0.9% 250 ML BA 1.1313429332 Y SODIUM CHLORIDE 0.9% 250 ML DE 2.98425712 Y SODIUM CHLORIDE 0.9% 3 ML SYR 0.3427119 Y SODIUM CHLORIDE 0.9% 3ML NEB 0.114425526 Y SODIUM CHLORIDE 0.9% 50 ML BAG 1.19425293 Y SODIUM CHLORIDE 0.9% 50 ML VIA 1.07425518 Y SODIUM CHLORIDE 0.9% 500 ML BA 1.19424702 Y SODIUM CHLORIDE 0.9% 500 ML DE 3.98427265 Y SODIUM CHLORIDE 0.9% IRRIG 1,0 1.16427478 Y SODIUM CHLORIDE 0.9% IRRIG 250 0.0002427336 Y SODIUM CHLORIDE 0.9% IRRIG 3,0 4.55424177 Y SODIUM CHLORIDE 14.6% 2.5 MEQ/ 0.55425400 Y SODIUM CHLORIDE 23.4% 4 MEQ/ML 4.21425560 Y SODIUM CHLORIDE 3% 500 ML BAG 0.59426034 Y SODIUM CHLORIDE BUFFERED (NF) 0.0004425579 Y SODIUM CITRATE 4% 250 ML BAG 6.55427423 Y SODIUM HYPOCHLOR 1/2 STR 0.25% 9.02428426 Y SODIUM HYPOCHLOR 1/4 STR 0.125 9.4427468 Y SODIUM HYPOCHLOR FULL STR 0.5% 9.02

428214 Y SODIUM HYPOCHLORITE 5.25% 50 M 0.5427620 Y SODIUM METABISULFITE POWDER 50 9.75425251 Y SODIUM PHOSPHATE 3 MM/ML 15 ML 0.574426655 Y SODIUM POLYSTYRENE SULFONATE 1 5.603428421 Y SODIUM TETRADECYL 1% 20 MG/2 M 57.8425390 Y SODIUM THIOSULFATE 25% 50 ML 2 3.21424642 Y SOLIFENACIN 10 MG TAB (NF) 0.0953424637 Y SOLIFENACIN 5 MG TAB (NF) 0.0953425649 Y SOMATROPIN 0.4 MG/1 ML SYRINGE 24.39426728 Y SORBITOL 70% SOLN 30 ML CUP 0.036426225 Y SOTALOL 80 MG TAB 0.13428374 Y SPIRONOLACTONE 100 MG TAB (NF) 0.5426010 Y SPIRONOLACTONE 25 MG TAB 0.24429274 Y STAVUDINE 40 MG CAP (NF) 0.0873424179 Y STREPTOMYCIN SULFATE 1 GM/5 ML 10.21427238 Y STRONG IODINE SOLUTION 15 ML B 21.61428387 Y SUCCINYLCHOLINE 200 MG/10 ML S 9.48425138 Y SUCCINYLCHOLINE 200 MG/10 ML V 1.44426609 Y SUCRALFATE 1 GM TAB 0.22428077 Y SUFentanil 100 MCG/2 ML AMP (N 4.43428070 Y SUFentanil 250 MCG/5 ML AMP (N 11.31427225 Y SULFACET/PREDNIS OP OINT 3.5 G 3.2427033 Y SULFACET/PREDNIS OPHTH SOLN 5 0.314427158 Y SULFACETAMIDE 10% OPHTH SOLN 1 1.26427588 Y SULFACETAMIDE LOTION 25 GM BTL 0.064427157 Y SULFACETAMIDE OPHTH OINT 10% 3 1.6427032 Y SULFANILAMIDE VAGINAL CR 120 G 0.0033429109 Y SULFASALAZINE 500 MG TAB 0.0006426754 Y SULFASALAZINE EC TAB 500 MG TA 0.0019426557 Y SULINDAC 150 MG TAB (NF) 0.0028426558 Y SULINDAC 200 MG TAB (NF) 0.0036424487 Y SUMATRIPTAN 25 MG TAB (NF) 0.72424542 Y SUMATRIPTAN 50 MG TAB (NF) 1.7055425403 Y SUMATRIPTAN 6 MG/0.5 ML VIAL 9.54427649 Y SWEET OIL (NF) 6375084 Y SYRINGE SOD CHLORIDE 0.9% 1427632 Y TABLET CRUSHER 7.4427631 Y TABLET CUTTER 6427559 Y TACROLIMUS 0.1% 60 GM TUBE (NF 0.0366428121 Y TACROLIMUS 0.5 MG CAP 1.38424170 Y TACROLIMUS 1 MG CAP 2.77427466 Y TALC INTRAPLEURAL AER POWD 4 G 125.5427127 Y TALC,STERILE POWDER 5 GM VIAL 89424021 Y TAMOXIFEN 10 MG TAB 0.013424318 Y TAMSULOSIN HCL 0.4 MG CAP 0.32428356 Y TAPENTADOL 50 MG TAB 3.8429319 Y TELITHROMYCIN 400 MG TAB (NF) 0.0775

425792 Y TELMISARTAN 20 MG TAB (NF) 2.58424533 Y TELMISARTAN 40 MG TAB (NF) 2.58426606 Y TEMAZEPAM 15 MG CAP 0.09424111 Y TEMOZOLOMIDE 100 MG TAB (NF) 214424171 Y TEMOZOLOMIDE 140 MG CAP (NF) 248.23424112 Y TEMOZOLOMIDE 20 MG TAB (NF) 5.678424134 Y TEMSIROLIMUS 30 MG/3 ML VIAL 1189.6425635 Y TENECTEPLASE 50 MG/10 ML SOLN 2317.39424550 Y TENOFOVIR 300 MG TAB (NF) 0.4816426236 Y TERAZOSIN 1 MG CAP 0.15426242 Y TERAZOSIN 5 MG CAP 0.0033424587 Y TERBINAFINE 250 MG TAB (NF) 0.336425230 Y TERBUTALINE 1 MG/1 ML VIAL 1.45426559 Y TERBUTALINE 2.5 MG TAB 0.0023426065 Y TERBUTALINE 5 MG TAB 0.0033427193 Y TESTOSTERONE CYPIONAT INJ 200 44.5428127 Y TESTOSTERONE CYPIONATE 100 MG/ 10.46425161 Y TESTOSTERONE CYPIONATE IM 200 10.46427623 Y TESTOSTERONE GEL 5 GM/PACKET ( 7.318425674 Y TET, DIPH, ACEL PERTUSIS VAC 0 31.13425704 Y TET,RED.DIPH,ACEL PERTUSIS VAC 32.75425162 Y TETANUS IMMUNE GLOBULIN (HUM) 311.3425327 Y TETANUS/DIPHTHERIA TOX ADSORB 25.186425060 Y TETANUS/DIPHTHERIA TOX PEDI 0. 17.95427168 Y TETRACAINE 0.5% OP SOLN 80 DRO 9.61425124 Y TETRACAINE SPINAL 1% 2 ML AMP 9.13427276 Y TETRACAINE TOPICAL 2% 30 ML BT 14.69427270 Y TETRACAINE/BENZOCAINE SPRAY 56 40.85429163 Y TETRACYCLINE 250 MG CAP (NF) 0.0004427178 Y TETRAHYDROZOLINE 0.05% OPHTH 1 0.0033426178 Y THEOPHYLLINE ELIXIR 80 MG/15 M 2.35428217 Y THEOPHYLLINE SR 12HR 100 MG TA 0.13426633 Y THEOPHYLLINE SR 12HR 200 MG TA 0.0019426634 Y THEOPHYLLINE SR 12HR 300 MG TA 0.11426828 Y THEOPHYLLINE SR 24HR 200MG CAP 0.0058426736 Y THEOPHYLLINE SR 24HR 300 MG CA 0.0072426475 Y THIAMINE 100 MG TAB 0.03425203 Y THIAMINE INJ 200 MG/2 ML VIAL 6.22426273 Y THIORIDAZINE 10 MG TAB 0.0012426275 Y THIORIDAZINE 25 MG TAB (NF) 0.0017426311 Y THIOTHIXENE 2 MG CAP (NF) 0.0016426852 Y THIOTHIXENE 5 MG CAP (NF) 0.0018427367 Y THROMBIN (BOVINE) 20000 UNIT V 210.7427216 Y THROMBIN (BOVINE) 5000 UNIT VI 53.43427324 Y THROMBIN (BOVINE) SPRAY 20000 221.25424723 Y THROMBIN FROZEN 10 ML SYR 505.5424724 Y THROMBIN FROZEN 4 ML SYRINGE 205.5

426696 Y THYROID 60 MG TAB 0.0019425786 Y TIAGABINE 2 MG TAB (NF) 1428236 Y TICAGRELOR 90 MG TAB 4.81426127 Y TICLOPIDINE 250 MG TAB (NF) 0.52429316 Y TIGECYCLINE 50 MG/5 ML VIAL (N 58.07427447 Y TIMOLOL 0.25% OP GEL-FORMING 2 0.682427288 Y TIMOLOL 0.25% OP SOLN 5 ML BTL 2.52424328 Y TIMOLOL 0.5% OP GEL-FORMING 5 35.23427289 Y TIMOLOL 0.5% OP SOLN 5 ML BTL 3.12426604 Y TIMOLOL 10 MG TAB (NF) 0.0025427609 Y TIMOLOL MALEATE/DORZOLAMIDE OP 9.61427581 Y TIOTROPIUM 18MCG INHALER 56.05428297 Y TIROFIBAN 12.5 MG/250 ML BAG 370.88428298 Y TIROFIBAN 5 MG/100 ML BAG 177.12424320 Y TIZANIDINE 4 MG TAB 0.0031427250 Y TOBRAMYCIN 0.3% OPHTH OINT 3.5 66.78429492 Y TOBRAMYCIN 1.2 GM POWDER VIAL 490.63429026 Y TOBRAMYCIN 40 MG/ML VIAL (NF) 14.93427226 Y TOBRAMYCIN OPHTH SOLN 0.3% 5 M 3.51427469 Y TOBRAMYCIN/DEXAMETH OPHTH OINT 201.27427428 Y TOBRAMYCIN/DEXAMETH OPHTH SUSP 30.86425777 Y TOBRAMYCIN/LOTEPRED OP SOLN 5 75.27424151 Y TOCILIZUMAB INJ 200 MG/10 ML V 645.74424152 Y TOCILIZUMAB INJ 400 MG/20 ML V 1291.48424150 Y TOCILIZUMAB INJ 80 MG/4 ML VIA 258.3426328 Y TOLBUTAMIDE 500 MG TAB (NF) 0.16427258 Y TOLNAFTATE 1% CR 15 GM TUBE 0.0033424316 Y TOLTERODINE SR 2MG TAB (NF) 0.0926428219 Y TOLVAPTAN 15 MG TAB (NF) 357.81424397 Y TOPIRAMATE 100 MG TAB 0.0753424367 Y TOPIRAMATE 25 MG TAB 0.0276424027 Y TOPOTECAN 4 MG/4 ML VIAL 282.03427442 Y TORSEMIDE 20 MG TAB (NF) 0.55428400 Y TRABECTEDIN 1 MG/20 ML 2700425238 Y TRACE METALS 1 ML VIAL 48.97426473 Y TRAMADOL 50 MG TAB 0.0525424654 Y TRAMADOL SR 200 MG TAB (NF) 5.15424484 Y TRANDOLAPRIL 1 MG TAB (NF) 0.0105424492 Y TRANDOLAPRIL 2 MG TAB (NF) 0.0105424491 Y TRANDOLAPRIL 4 MG TAB (NF) 0.0105424465 Y TRANDOLAPRIL/VERAPAMIL 2/180 T 0.0193424658 Y TRANDOLAPRIL/VERAPAMIL 4/240 T 0.0193428287 Y TRANEXAMIC 650 MG TAB (NF) 4.66428320 Y TRANEXAMIC ACID 1,000 MG/10 ML 26.1424493 Y TRANYLCYPROMINE 10 MG TAB (NF) 0.0084424087 Y TRASTUZUMAB 21 MG/ML BULK VIAL 171.84428415 Y TRASTUZUMAB 21 MG/ML SDV 1426.17

427545 Y TRAVOPROST 0.004% OP SOLN (NF) 8.7426618 Y TRAZODONE 50 MG TAB 0.0004425785 Y TRETINOIN 0.025% CR 20 GM TUBE 10.98427011 Y TRIAMCINOLONE 0.025% CR 15 GM 2.24427201 Y TRIAMCINOLONE 0.025% CR 80 GM 0.0001427012 Y TRIAMCINOLONE 0.1% CR 15 GM TU 1.94424687 Y TRIAMCINOLONE 0.1% CR 454 GM J 12.55427205 Y TRIAMCINOLONE 0.1% CR 80 GM TU 0.0001425774 Y TRIAMCINOLONE 0.1% OINT 454 GM 6.17427385 Y TRIAMCINOLONE 0.1% OINT 80 GM 6.79427096 Y TRIAMCINOLONE 0.1% ORABASE 5 G 25.48427013 Y TRIAMCINOLONE 0.5% CR 15 GM TU 0.53425129 Y TRIAMCINOLONE 200 MG/5 ML VIAL 41.41425017 Y TRIAMCINOLONE 40 MG/1 ML VIAL 8.79427193 Y TRIAMCINOLONE 400 MG/10ML VIAL 66.66425350 Y TRIAMCINOLONE 50 MG/5 ML VIAL 9.84427169 Y TRIAMCINOLONE AQ NASAL 16.5 GM 101.37426832 Y TRIAMTERENE 50 MG CAP (NF) 0.0092426170 Y TRIAMTERENE/HCTZ 50-25 MG CAP 1.94426711 Y TRIAMTERENE/HCTZ 75-50 MG TAB 0.0006429357 Y TRIAZOLAM 0.125 MG TAB (NF) 0.16429358 Y TRIAZOLAM 0.25 MG TAB (NF) 0.13427622 Y TRICHLORACETIC ACID 15 ML BTL 55.45426228 Y TRIFLUOPERAZINE 1 MG TAB (NF) 0.0021426759 Y TRIFLUOPERAZINE 5 MG CAP (NF) 0.0028427671 Y TRIFLURIDINE 1% OP SOLN 7.5 ML 96.25426040 Y TRIHEXYPHENIDYL 2 MG TAB 0.0017429182 Y TRIMETH/SULFAMET 80/400MG/10ML 5429058 Y TRIMETH/SULFAMETH 160/800MG IV 4.3429111 Y TRIMETH/SULFAMETHOX 160/800 MG 0.25429110 Y TRIMETH/SULFAMETHOX 80/400 MG 0.0006425168 Y TRIMETHOBENZAMIDE 200 MG/2 ML 2.07424576 Y TRIMETHOBENZAMIDE 300 MG CAP ( 0.008426002 Y TRIPROLIDINE PSE TAB (NF) 0.0002428329 Y TRIPTORELIN PAMOATE 11.25 MG/2 458.11427318 Y TROPICAMIDE 1% OPHTH SOLN 2 ML 9.91428301 Y TROSPIUM 20MG TABLET 1.86425128 Y TUBERCULIN, PPD INJ 5 TU/0.1 M 67.42

Y TUMESCENT (VEIN CLINIC) 1,000 14.3348425724 Y TWOCAL HN 237 ML CAN 1.45424158 Y TYPHOID VACCINE 25 MCG/0.5 ML 87.18427601 Y UREA 20% CR (NF) 85 GM TUBE 0.0011426878 Y URSODIOL 300 MG CAP 3.2127428401 Y USTEKINUMAB 130 MG/26 ML VIAL 1600424494 Y VALACYCLOVIR 500 MG TAB (NF) 0.0465427635 Y VALGANCICLOVIR 450 MG TAB (NF) 14.85425493 Y VALPROATE 500 MG/5 ML VIAL 1.528

426199 Y VALPROIC ACID 125 MG EC (NF) 0.006426974 Y VALPROIC ACID 250 MG CAP (NF) 0.0021426973 Y VALPROIC ACID 250 MG EC (NF) 0.0117424653 Y VALPROIC ACID 250 MG SR TAB 0.39424570 Y VALPROIC ACID 500 MG SR TAB 0.0218424317 Y VALSARTAN 80 MG TAB 1.66429269 Y VANCOMYCIN 1000 MG/20 ML VIAL 2.95429240 Y VANCOMYCIN 500 MG/10 ML VIAL 2.79429322 Y VANCOMYCIN BULK 1000 MG/20 ML 16.82428306 Y VANCOMYCIN HCL/D5W 500 MG/100 7.86425779 Y VANCOMYCIN IV 1,000 MG/200 ML 8.91429195 Y VANCOMYCIN ORAL LIQUID 500 MG/ 2.04424664 Y VARENICLINE 0.5 MG TAB 2.18424663 Y VARENICLINE 1 MG TAB 2.18425692 Y VARICELLA VACC/PF 19400 UNIT/1 204.245425049 Y VARICELLA VIRUS VACCINE LIVE 1 115.96425250 Y VASOPRESSIN 20 UNIT/ 1 ML VIAL 1.02427663 Y VECURONIUM BROMIDE 10 MG/10 ML 1.74428333 Y VEDOLIZUMAB 300 MG VIAL 5420.72424345 Y VENLAFAXINE IMMEDIATE RELEASE 0.0161426035 Y VENLAFAXINE IMMEDIATE RELEASE 0.0303426366 Y VENLAFAXINE IMMEDIATE RELEASE 0.38424505 Y VENLAFAXINE SR 37.5 MG CAP 2.86424395 Y VENLAFAXINE SR 75 MG CAP 3.2426292 Y VERAPAMIL 120 MG CAPCR 0.0039426614 Y VERAPAMIL 120 MG TAB 0.0009426994 Y VERAPAMIL 180 MG TABCR 0.19426667 Y VERAPAMIL 40 MG TAB (NF) 0.0015425225 Y VERAPAMIL 5 MG/2 ML VIAL 14.72426613 Y VERAPAMIL 80 MG TAB 0.0005

Y VIAL2BAG 13MM TRANSFER DEVICE 1.85Y VIAL2BAG 20MM TRANSFER DEVICE 1.85

424024 Y VINBLASTINE 10 MG/10 ML VIAL 9.59424025 Y VINCRISTINE 1 MG/1 ML VIAL 3.88424092 Y VINCRISTINE 2 MG/2 ML VIAL 9.4424077 Y VINORELBINE 10 MG/1 ML VIAL 13.23424076 Y VINORELBINE 50 MG/5 ML VIAL 66.55428138 Y VITAL 1.5 CAL 1,000 ML/BTL 10428454 Y VITAL AF 1.2 CAL LIQUID RTH 10 8.8427002 Y VITAMIN A & D OINT 60 GM TUBE 1.78424519 Y VITAMIN A 10000 INT. UNIT CAP 0.0002424710 Y VITAMIN A PALMITATE 100000 UNI 18.93428376 Y VITAMIN B-COMPLEX MDV 1ML DOSE 5.88428210 Y VITAMIN D 1000 UNIT TAB 0.04424428 Y VITAMIN D 400 UNIT TAB 0.02428351 Y VITAMIN D 5000 UNIT CAP 0.02428284 Y VITAMIN D DROPS 400 UNIT/1 ML 5.27

424300 Y VITAMIN E 400 IU CAP 0.07427193 Y VIVONEX RTF LIQ 250 ML CAN 5.11424173 Y VORICONAZOLE 200 MG TAB 42.84427670 Y VORICONAZOLE 200 MG/20 ML VIAL 116.3427674 Y VORICONAZOLE SUSP 200 MG/5 ML 575.12426482 Y WARFARIN 1 MG TAB 0.0004426938 Y WARFARIN 2 MG TAB 0.05426109 Y WARFARIN 2.5 MG TAB 0.0004424349 Y WARFARIN 3 MG TAB 0.05426110 Y WARFARIN 5 MG TAB 0.05426111 Y WARFARIN 7.5 MG TAB 0.07425294 Y WATER BACTERIOSTATIC 30 ML VIA 0.47427629 Y WATER FOR IRRIGATION,BOTTLE 10 0.9425369 Y WATER STERILE 1,000 ML BAG 0.9425475 Y WATER STERILE 10 ML VIAL 0.7252425567 Y WATER STERILE 2,000 ML BAG 2.45375135 Y WATER STERILE 50 ML SYRINGE 1425295 Y WATER STERILE 50 ML VIAL 1.26426984 Y ZAFIRLUKAST 20 MG TAB 1.2429354 Y ZALEPLON 5 MG CAP (NF) 3.78427173 Y ZANAMIVIR DISK INHALER 5 MG 51.75429223 Y ZIDOVUDINE 100 MG CAP 1.86429156 Y ZIDOVUDINE 200 MG/20 ML VIAL 26.06429155 Y ZIDOVUDINE 50 MG/ 5 ML SYRUP 2 0.0007424497 Y ZILEUTON 600 MG TAB (NF) 2427064 Y ZINC OX 40%/COD LIVER OIL OINT 1.2425794 Y ZINC OXIDE (BOUDREAUX BUTT PAS 1.93427185 Y ZINC OXIDE 20% OINT 30 GM TUBE 2.58426587 Y ZINC SULFATE 220 MG CAP 0.0012428453 Y ZINC SULFATE CAP 50 MG CAPSULE 0.0194424514 Y ZIPRASIDONE 20 MG CAP 6.47427654 Y ZIPRASIDONE 20 MG/ML VIAL (NF) 13.15424504 Y ZIPRASIDONE 40 MG CAP (NF) 0.0535424452 Y ZIPRASIDONE 60 MG CAP (NF) 0.0778425612 Y ZOLEDRONIC 4 MG/5ML VIAL 862.36425714 Y ZOLEDRONIC 5 MG/100 ML BTL 206.8428144 Y ZOLEDRONIC ACID 4 MG/100 ML BA 94.96424301 Y ZOLMITRIPTAN 2.5 MG TAB (NF) 2.5133426338 Y ZOLPIDEM 5 MG TAB 0.07424690 Y ZOLPIDEM CR 12.5 MG TAB (NF) 3.86424579 Y ZONISAMIDE 100 MG CAP (NF) 0.0208428435 Y ZOSTER VACCINE/PF INJ 0.5 ML/V 128.913


0006200053 EPI BLOOD PATCH $1,260.000007940088 BLADDER SCAN PV RESIDUAL URINE $172.000006200072 BLOCK - ADDUCTOR CANAL $860.000006200073 BLOCK - AXILLARY $684.000006200067 BLOCK - FEMORAL, POST OP $860.000006200065 BLOCK - INTERSCALENE, POST OP $468.000006200066 BLOCK - POPLITEL, POST OP $903.000006200071 BLOCK - SUPRACLAVICULAR $468.000006200070 BLOOD (OR PRODUCT) ADMIN/DAILY $1,222.000006200069 COLLECT BLOOD BY VENIPUNCTURE $21.000006200058 HOLDING AREA - COMPLEX II $446.000006200060 HOLDING AREA LEVEL III $550.000006200059 HOLDING AREA SIMPLE $356.000006200068 INJ/CATH PLACE, EPIDURAL, L/S $1,119.000007940055 MINOR PROCEDURE CHARGE $0.000007940046 NEG PRESSURE WND TRMNT < 50CM $223.000007940047 NEG PRESSURE WND TRMNT > 50 CM $331.000007940000 OP CLINIC CONSULT ROOM FEE $111.000007940008 OP FOLEY CATH INSERTION $256.000007940001 OP MEDICAL VISIT $111.000007940084 SKIN SUB GRAFT TRNK/ARM/LEG $4,377.000007940078 STOMAL CONSULT LEVEL III $136.000007940074 THERASKIN LARGE 2"X3" (SQ CM) $2,000.000007940075 THERASKIN SMALL 1"X2" (SQ CM) $1,495.00

Disclaimer

This section includes standard charges for pre operative testing provided by CRMC Health Care.


0001500037 ACCUFORM MOLD $771.000001500074 APPLY INTERSTITUAL COMP $2,853.000001500027 BLOCK CHARGE COMPLEX $602.000001500026 BLOCK CHARGE INTERMEDIATE $368.000001500025 BLOCK CHARGE SIMPLE $271.000001500053 BOLUS TREATMENT DEVICE $771.000001500089 BRACHY ISO PLAN INT. $740.000001500068 BRACHYTHERAPY ISODOSE PLAN COM $830.000001500093 CBCT IMAGE GUIDANCE $339.000001500012 CENTRAL AXIS CALCULATION (CAX) $287.000001500019 CONTINUING PHYSICS $448.000001500045 CT FOR RT PLANNING $590.000001500054 CT GUIDANCE FOR RT FIELD PLCMT $590.000001500087 ELECT BRACHYTHERAPY-PART BRST $7,051.000001500024 ELECTRON CUT-0UT $771.000001500098 ELECTRONIC BRACHYTHERAPY PROC $20,852.000001500059 ESTABLISHED PATIENT - LEVEL 1 $111.000001500058 ESTABLISHED PATIENT - LEVEL 2 $113.000001500057 ESTABLISHED PATIENT - LEVEL 3 $129.000001500056 ESTABLISHED PATIENT - LEVEL 4 $145.000001500055 ESTABLISHED PATIENT - LEVEL 5 $193.000001500039 EYE SHIELD $771.000001500034 IMRT ISODOSE PLAN $5,045.000001500096 IMRT TX DELIVERY - SIMPLE $1,622.000001500033 IMRT TX DELIVERY-COMPLEX $2,023.000001500015 ISODOSE PLAN COMPLEX $2,580.000001500013 ISODOSE PLAN SIMPLE $1,031.000001500016 ISODOSE PLAN TOTAL BODY $1,099.000001500022 MASK CONSTRUCTION $771.000001500094 MEGAVOLTAGE TX, >1MEV; COMPLEX $433.000001500091 MEGAVOLTAGE TX, >1MEV; SIMPLE $302.000001500092 MEGAVOLTAGE TX,>1MEV; INTERMED $374.000001500090 MLC DEVICE IMRT,DESIGN & CONST $6,914.000001500041 NASOPHARYNGOSCOPY $410.000001500063 NEW PT LEVEL 1 $117.000001500062 NEW PT LEVEL 2 $126.000001500061 NEW PT LEVEL 3 $166.000001500064 NEW PT LEVEL 4 $219.000001500060 NEW PT LEVEL 5 $298.000001500049 PHYSICS CONSULT $551.00

DisclaimerThis section includes standard charges for CRMC Health Care's full range of outpatient radation therapy services

0001500088 PLACE/REMOVE APPLICATOR FOR RT $5,496.000001500028 PORT FILMS $204.000001500097 RAD THER VERIFICATION SIMULATN $583.000001500067 REMOVAL IMPACTED CERUMEN $107.000001500100 RESPIRATORY MANAGEMENT IMAGING $339.000001500099 RESPIRATORY MOTION MANAGE SIM $858.000001500101 SBRT TX $4,403.000001500035 SIMPLE TREATMENT DEVICE $348.000001500010 SIMULATION COMPLEX $1,047.000001500009 SIMULATION INTERMEDIATE $879.000001500008 SIMULATION SIMPLE $583.000001500032 SPECIAL TELETHERAPY PORT PLAN $1,099.000001500031 SPECIAL TREATMENT PROCEDURE $2,371.000001500095 STEREOSCOPIC GUIDANCE $339.000001500085 SUPERVISION OF HANDLING SOURCE $132.000001500011 THREE-DIMENSIONAL $3,725.000001500017 TLD CALCULATON $492.000001500020 TREATMENT DEVICES COMPLEX $771.000001500082 ULTRASOUND GUIDANCE NEEDLE PLA $282.000001500029 VAC-LOC BAG $771.000001500079 VENIPUNCTURE $21.00

CHARGE CODE CHARGE DESCRIPTON MASTER FEE0002154218 3D IMAGING $73.000002154228 3D IMAGING, DIAG, BILATERAL $73.000002154227 3D IMAGING, DIAG, UNILATERAL $40.000002457026 8FR NEPHROSTOMY TUBE $347.000001640671 ABDOMEN LTD (SPECIFY) $963.000002151009 ABDOMEN TWO VIEWS $571.000002151017 ABDOMEN, 1 VIEW $428.000001640515 ABDOMEN-COMPLETE $1,225.000001650860 ABDOMINAL MESENTERIC DOPPLER $963.000001650118 ABI BILAT (1-2 LEVELS) $269.000001650879 ABI UNILATERAL LT (1-2 LEVELS) $236.000001650880 ABI UNILATERAL RT (1-2 LEVELS) $236.00E002456991 ABSCESSOGRAM $209.000002456992 ABSCESSOGRAM S&I $900.000002457047 ACCESS KIT $312.000001650898 ACHIEVE BIOPSY NEEDLE $150.000002150704 ACROMIOCLAVICULAR JNTS. $456.000002154134 ADJUST FEEDING TUBE $0.00E002154134 ADJUST FEEDING TUBE $898.000001640374 ADRENAL-ABD LTD $963.000002456941 ALL PURPOSE DRAINAGE CATHETER $409.000001640254 AMNIOCENTESIS GUIDANCE $616.000002457022 ANG AB/PEL/RUN OFF W/WO IV CON $3,648.000001530116 ANG PEL/RUN-OFF W/ IV CONTRAST $1,717.000002457037 ANG PEL/RUN-OFF W/ W/O IV CONT $3,648.000002457023 ANG PEL/RUN-OFF W/IV CONTRAST $1,717.000002456988 ANGIO AB/PEL/RUN OFF W/IV CON $1,197.000001530108 ANGIO AB/PEL/RUN OFF W/IV CON $1,197.000002456980 ANGIO ABD&PELVIS W/IV CONTRAST $2,150.000001530104 ANGIO ABD&PELVIS W/IV CONTRAST $2,150.000001530105 ANGIO ABD&PELVIS W/WO IV CONTR $2,150.000002456981 ANGIO ABD&PELVIS W/WO IV CONTR $2,150.000002456861 ANGIO BIL UP EXT W/ IV CNTRAST $2,431.000002456909 ANGIO LT UP EXT W/ IV CNTRAST $2,431.000002456857 ANGIO PELVIS W & W/O $2,431.000002456908 ANGIO RT UP EXT W/ IV CNTRAST $2,431.00

Disclaimer

This section includes standard charges for Capital Region Medical Centers full range of diagnostic imaging services including CT, MRI, ultrasound, nuclear medicine and mammograms.These services will require an interpretation by a radiologist. CRMC Physicians will bill separately for their professional service.

0002154045 ANKLE LEFT (XR) $407.000002154147 ANKLE LEFT, 2 VIEW (XR) $298.000002154044 ANKLE RIGHT (XR) $407.000002154148 ANKLE RIGHT, 2 VIEW (XR) $298.000001640440 AORTA DUPLEX $746.000001650864 AORTA SCREEN - MEDICARE $362.000002453630 ARROW PNEUMOTHORAX KIT $676.00E001650878 ART SEG PHY UP & LOW (3-4 LVLS $885.000001650100 ART SEG PHYS LOW BIL (3-4LVLS) $885.000001641512 ART SEG PHYS LOW LT (3-4LVLS) $355.000001641511 ART SEG PHYS LOW RT (3-4 LVLS) $355.000001650878 ART SEG PHYS UP & LOW(3-4 LVL) $0.000001650114 ART SEG PHYS UP BIL (3-4 LVLS) $885.000001641524 ART SEG PHYS UP LT (3-4 LVLS) $355.000001641523 ART SEG PHYS UP RT (3-4 LVLS) $355.000001650266 ART SEG PHYSIO BLE W/POST EXE $346.000001650881 ART SET PHY UNI ADDL(3-4 LVLS) $381.000001650857 ARTERIAL COMPRESSION REPAIR $1,119.000001650142 ARTERIAL DUPLEX LOWER BILAT $960.000001641514 ARTERIAL DUPLEX LOWER LT $483.000001650241 ARTERIAL DUPLEX LOWER LTD BILA $355.000001641513 ARTERIAL DUPLEX LOWER RIGHT $483.000001630009 ARTERIAL DUPLEX UPPER BILAT $651.000001650853 ARTERIAL DUPLEX UPPER LTD BILA $355.000001641515 ARTERIAL DUPLEX UPPER RIGHT $355.000001641516 ARTERIL DUPLEX UPPER LEFT $355.00E002152081 ARTHROGRAM ANKLE LEFT $1,250.00E002152088 ARTHROGRAM ANKLE RIGHT $1,250.00E002152082 ARTHROGRAM ELBOW LEFT $1,250.00E002152089 ARTHROGRAM ELBOW RIGHT $1,250.00E002152084 ARTHROGRAM KNEE LEFT $1,250.00E002152091 ARTHROGRAM KNEE RIGHT $1,250.00E002152080 ARTHROGRAM SHOULDER LEFT $1,250.00E002152087 ARTHROGRAM SHOULDER RIGHT $1,250.00E002152085 ARTHROGRAM TEMPORAMANDIBULAR L $1,250.00E002152092 ARTHROGRAM TEMPORAMANDIBULAR R $1,250.00E002152086 ARTHROGRAM WRIST LEFT $1,250.00E002152093 ARTHROGRAM WRIST RIGHT $1,250.000001650871 ASP/PUNCT ABCESS OR HEMATOMA $0.00E001650871 ASP/PUNCT ABCESS OR HEMATOMA $753.000001650870 ASP/PUNCT ABCESS/HERNIA ADD'L $753.000002457045 AUTOPLEX CEMENT INJ $1,688.000002457017 AVA FLEX VERTEBRO INJ NEEDLE $2,000.000002457018 AVA VERTEBRO PREP TRAY $336.000002457019 AVA VERTEBRO PROCEDURE TRAY $1,726.000002457020 AVAMAX VERTEBRO BIOPSY NEEDLE $336.000001650862 BACK SOFT TISSUE UPPER $723.00

0002457025 BENTSON WIRE 145CM $123.000002453579 BIL LOW EXT W & W/O IV CNTRAS $1,180.000002453561 BIL LOW EXT W/ IV CNTRAST $1,246.000002453553 BIL LOW EXT W/O IV CNTRAST $1,207.000002453546 BIL UP EXT W & W/O IV CNTRAST $1,333.000002453538 BIL UP EXT W/ IV CONTRAST $1,301.000002453520 BIL UPPER EXT W/O CONTRAST $1,207.000002457024 BILAT SACROPLASTY W/ S&I $7,282.000002456985 BILAT SI JOINT INJ INCL GUIDE $1,936.000002154164 BILATERAL RIBS (NO CXR) $308.00E002456977 BIOPSY BONE, DEEP $4,604.000001650854 BIOPSY NEEDLE(BARD) $133.000002456943 BIOPSY TRAY $51.000001640473 BLADDER-PELVIS LTD $771.000002556908 BLOOD VOLUME WHOLE $1,278.000002555712 BONE - 3 PHASE $1,662.000002150902 BONE AGE $223.00E002457039 BONE MARROW BX W/ ASP $2,705.000002556876 BONE MARROW IMAGING LIMITED $1,140.000002555449 BONE SCAN LIMITED $668.000002556901 BONE SCAN MULTIPLE AREAS $1,052.000002555605 BONE SPECT $2,606.000002555035 BONE THERAPY ADMIN $2,406.000002555183 BONE WHOLE BODY A & P $1,332.000002556915 BRAIN DEATH PERFUSION STUDY $1,139.000001540024 BRAIN IMAGING, PET, METABOLIC $4,776.00E002457015 BRAIN PERFUSION $130.000002555662 BRAIN SPECT W/DIAMOX $3,386.000002555696 BRAIN SPECT W/O DIAMOX $3,386.000001520179 BREAST BILAT WWO IV CONT W/CAD $2,378.00E001520179 BREAST BILAT WWO IV CONT W/CAD $2,213.000001640457 BREAST BILATERAL $0.000001650891 BREAST BX LT GUIDANCE CLIP ADD $1,180.000001650889 BREAST BX LT W/GUIDANCE & CLIP $2,355.000001650890 BREAST BX RT GUIDANCE CLIP ADD $1,180.000001650888 BREAST BX RT W/GUIDANCE & CLIP $2,355.000001650872 BREAST CYST ASP ADD'L $402.000001650875 BREAST CYST ASP BILATERAL $0.00E001650875 BREAST CYST ASP BILATERAL $1,132.000001650873 BREAST CYST ASPIRATION LEFT $0.00E001650873 BREAST CYST ASPIRATION LEFT $1,132.000001650874 BREAST CYST ASPIRATION RIGHT $0.00E001650874 BREAST CYST ASPIRATION RIGHT $1,132.000002556841 BREAST IMAGING $639.000001641510 BREAST LEFT US $296.000001650893 BREAST LT NEEDLE LOC $902.000001650894 BREAST LT NEEDLE LOC ADD'L $168.00

0001641509 BREAST RIGHT US $296.000001650892 BREAST RT NEEDLE LOC $902.000001650895 BREAST RT NEEDLE LOC ADD'L $168.000001640458 BREAST SURGICAL SPECIMAN $554.000001650901 BREAST, BILAT, US, COMPLETE $668.000001650900 BREAST, LT, US, COMPLETE $446.000001650899 BREAST, RT, US, COMPLETE $446.000001650876 BUTTOCK SOFT TISSUE $771.00E002456964 BX ADRENAL/RETROPERITONEAL/ABD $2,481.00E002457005 BX DISC $3,884.00E002456965 BX LIVER RANDOM OR MASS $2,454.00E002456966 BX LUNG/MEDIASTINUM $2,481.00E002456967 BX LYMPH NODE SUPERFICIAL $2,043.000001641533 BYPASS GRAFT SURV LOWER BILAT $564.000001641535 BYPASS GRAFT SURV LOWER LEFT $483.000001641534 BYPASS GRAFT SURV LOWER RIGHT $483.000001641532 BYPASS GRAFT SURV UPPER BILAT $577.000001641537 BYPASS GRAFT SURV UPPER LEFT $355.000001641536 BYPASS GRAFT SURV UPPER RIGHT $355.000001520199 CAD MRI BREAST $54.000002152320 C-ARM MORE THAN ONE HOUR $790.000002130092 C-ARM UP TO 1 HOUR $534.000001650753 CAROTID DOPPLER BILATERAL $1,834.000001641518 CAROTID LEFT $882.000001641517 CAROTID RIGHT $882.000007530544 CENTRAL SUPPLY MISC $321.000002457002 CERV/THOR FACET INJ 1ST LVL $1,834.000002150605 CERVICAL SPINE - 2 OR 3 VIEWS $620.000002150597 CERVICAL SPINE 1 VIEW $344.000002150506 CERVICAL SPINE- 4 OR 5 VIEWS $738.000002130003 CERVICAL SPINE 6+ VIEWS $843.000002456931 CERVICAL SPINE POST MYELOG $1,384.000002430015 CERVICAL SPINE W/O LIMITED $393.000001640721 CHEST $702.000002150308 CHEST - SINGLE VIEW $497.000002150324 CHEST (4 OR MORE VIEWS) $557.000002456978 CHEST HIGH RESOLUTION $1,320.000001530117 CHEST HIGH RESOLUTION $1,320.000001530113 CHEST LUNG CA LIMITED DIAGNOST $393.000002152650 CHEST TUBE INSERTION $922.000002150316 CHEST TWO VIEWS $530.000002150310 CHEST W/APICALORDOTI $867.000002152411 CHOLANGIOGRAM, OPERATIVE $1,165.000002154047 CLAVICLE LEFT (XR) $393.000002154046 CLAVICLE RIGHT (XR) $393.000002154216 CLIP $351.000002150514 COCCYX $520.00

0002151033 COLON (BARIUM ENEMA) $933.000002151041 COLON/AIR CONTRAST $1,134.000001640697 COMMON BILE DUCT-ABD LTD $963.000002154132 CONRAY IV CONTRAST 50ML $2.000002457032 CONSC SEDTN AGE 5/+ 10-22 MIN $405.000002457033 CONSCIOUS SEDTN EA ADDL 15 MIN $107.000002457028 COOK ACCESS KIT $312.000002457046 COOK DRAIN POUCH $107.000002457027 COOK DRAINAGE POUCH $107.000002556855 CR-51 RBC SURVIVAL PHARM CHG $1,521.000002556538 CR-51 RBC VOLUME PHARM CHG PER $2,187.000002226434 CREATININE, POC-CT $20.000002556886 CSF MULT DAY LEAKAGE LOCALIZE $2,720.000002556885 CSF MULT DAY SHUNT EVAL $2,720.000002556884 CSF MULT DAY VENTRIGULOGRAPHY $2,720.000002456956 CT ABD/PELVIS W/O CONTRAST $2,637.000001530100 CT ABD/PELVIS W/O CONTRAST $2,637.000001530102 CT ABD/PELVIS W/WO CONTRAST $3,391.000002456958 CT ABD/PELVIS W/WO CONTRAST $3,391.000002456957 CT ABD/PELVIS WITH CONTRAST $3,086.000001530101 CT ABD/PELVIS WITH CONTRAST $3,086.000002456863 CT ANGIO LE W CONTRAST $2,817.000002456862 CT ANGIO LE W/O & W CONTRAST $2,817.000002457000 CT GASTROGRAFIN $4.000001530109 CT GASTROGRAFIN $3.000001530025 CT MAXILLOFACIAL AREA WITH CON $1,207.00E002456961 CT NEEDLE ASPIRATION $753.000002456960 CT RAD DRAIN GUIDE $1,064.000001530094 CT SW: 3D REFORMAT NON-INDEP $167.000001530011 CT SW: ABDOMEN LIMITED $393.000001530044 CT SW: ABDOMEN WITH AND W/O $1,698.000001530013 CT SW: ABDOMEN WITH CONTRAST $1,546.000001530012 CT SW: ABDOMEN WITHOUT CONTR $1,320.000001530067 CT SW: ANGIO ABDOMEN WITH & W/ $2,431.000001530068 CT SW: ANGIO ABDOMEN WITH CON $2,431.000001530069 CT SW: ANGIO ABDOMEN WITHOUT $2,431.000001530054 CT SW: ANGIO CHEST WITH & W/O $2,431.000001530053 CT SW: ANGIO CHEST WITH CONT $2,431.000001530055 CT SW: ANGIO CHEST WITHOUT CON $2,431.000001530063 CT SW: ANGIO HEAD WITH & W/O $2,431.000001530064 CT SW: ANGIO HEAD WITH CONT $2,431.000001530062 CT SW: ANGIO LOWER EXT BIL W $2,817.000001530061 CT SW: ANGIO LOWER EXT BIL W & $2,817.000001530065 CT SW: ANGIO NECK WITH & W/O $2,431.000001530066 CT SW: ANGIO NECK WITH CONTR $2,431.000001530056 CT SW: ANGIO PELVIS WITH & W/O $2,431.000001530057 CT SW: ANGIO PELVIS WITH CONT $2,431.00


0001530058 CT SW: ANGIO PELVIS WITHOUT $2,431.000001530093 CT SW: ANGIO UE LEFT W/ CONT $2,431.000001530092 CT SW: ANGIO UE LEFT W/& W/O $2,431.000001530059 CT SW: ANGIO UE RIGHT W & W/O $2,431.000001530060 CT SW: ANGIO UE RIGHT WITH C $2,431.000001530073 CT SW: BONE MINERAL DENSITY $719.000001530005 CT SW: CERVICAL SPINE LIMITED $393.000001530046 CT SW: CERVICAL SPINE WITH & W $1,499.000001530032 CT SW: CERVICAL SPINE WITH CON $1,384.000001530031 CT SW: CERVICAL SPINE WITHOUT $1,384.000001530111 CT SW: FACIAL W/O IV CONTRAST $1,071.000001530112 CT SW: FACIAL WITH IV CONTRAST $1,207.000001530091 CT SW: GUIDANCE $557.000001530071 CT SW: GUIDANCE ABLATION $980.000001530019 CT SW: HEAD WITH CONTRAST $1,351.000001530020 CT SW: HEAD WITHOUT AND WITH $1,421.000001530018 CT SW: HEAD WITHOUT CONTRAST $1,155.000001530090 CT SW: INVASIVE PROCEDURE PA $1,825.000001530080 CT SW: LOWER EXTREMITY LEFT $1,246.000001530083 CT SW: LOWER EXTREMITY LEFT $393.000001530081 CT SW: LOWER EXTREMITY LEFT $1,207.000001530082 CT SW: LOWER EXTREMITY LEFT $1,180.000001530010 CT SW: LOWER EXTREMITY RIGHT $393.000001530042 CT SW: LOWER EXTREMITY RIGHT $1,246.000001530041 CT SW: LOWER EXTREMITY RIGHT $1,207.000001530043 CT SW: LOWER EXTREMITY RIGHT $1,180.000001530007 CT SW: LUMBAR SPINE LIMITED $393.000001530047 CT SW: LUMBAR SPINE WITH & W/O $1,499.000001530036 CT SW: LUMBAR SPINE WITH CON $1,384.000001530035 CT SW: LUMBAR SPINE WITHOUT $1,384.000001530002 CT SW: MAXILLOFACIAL LIMITED $393.000001530026 CT SW: MAXILLOFACIAL WITH & WO $1,421.000001530024 CT SW: MAXILLOFACIAL WITHOUT $1,071.000001530003 CT SW: NECK SOFT TISSUE LIMIT $393.000001530029 CT SW: NECK SOFT TISSUE WITH $1,421.000001530027 CT SW: NECK SOFT TISSUE WITH $1,096.000001530028 CT SW: NECK SOFT TISSUE WITH $1,246.000001530001 CT SW: ORBIT LIMITED $393.000001530023 CT SW: ORBIT WITH & WITHOUT $1,400.000001530022 CT SW: ORBIT WITH CONTRAST $1,207.000001530021 CT SW: ORBIT WITHOUT CONTRAST $1,124.000001530096 CT SW: ORBIT,SELLA,MID/INNER $1,207.000001530097 CT SW: ORBIT,SELLA,MID/INNER $1,124.000001530098 CT SW: ORBIT,SELLA,MID/INR E $1,400.000001530008 CT SW: PELVIS LIMITED $393.000001530037 CT SW: PELVIS WITH & WITHOUT $1,544.000001530017 CT SW: PELVIS WITH CONTRAST $1,554.00

0001530016 CT SW: PELVIS WITHOUT CONTRAST $1,320.000001530070 CT SW: PERCUTANEOUS ABLATION $9,711.000001530074 CT SW: SELLA LIMITED $393.000001530075 CT SW: TEMPORAL BONES LIMITED $393.000001530006 CT SW: THORACIC SPINE LIMITED $393.000001530048 CT SW: THORACIC SPINE WITH & W $1,312.000001530034 CT SW: THORACIC SPINE WITH CON $1,384.000001530033 CT SW: THORACIC SPINE WITHOUT $1,384.000001530004 CT SW: THORAX LIMITED $393.000001530030 CT SW: THORAX WITH & WITHOUT $1,771.000001530015 CT SW: THORAX WITH CONTRAST $1,488.000001530014 CT SW: THORAX WITHOUT CONTRAST $1,320.000001530076 CT SW: UPPER EXTREMITY LEFT $1,301.000001530077 CT SW: UPPER EXTREMITY LEFT $1,207.000001530078 CT SW: UPPER EXTREMITY LEFT $393.000001530079 CT SW: UPPER EXTREMITY LEFT $1,333.000001530009 CT SW: UPPER EXTREMITY RIGHT $393.000001530040 CT SW: UPPER EXTREMITY RIGHT $1,333.000001530038 CT SW: UPPER EXTREMITY RIGHT $1,207.000001530039 CT SW: UPPER EXTREMITY RIGHT $1,301.000001530086 CT SW: VENIPUNCTURE $21.000002456935 CT: 3D REFORMAT NON-INDEPENDEN $167.000002430030 CT: ABDOMEN LIMITED $393.000002453587 CT: ABDOMEN WITH AND WITHOUT C $1,698.000002453025 CT: ABDOMEN WITH CONTRAST $1,546.000002453017 CT: ABDOMEN WITHOUT CONTRAST $1,320.000002456868 CT: ANGIO ABDOMEN WITH AND WIT $2,431.000002456869 CT: ANGIO ABDOMEN WITH CONTRAS $2,431.000002456855 CT: ANGIO CHEST WITH AND WITHO $2,431.000002456854 CT: ANGIO CHEST WITH CONTRAST $2,431.000002456864 CT: ANGIO HEAD WITH AND WITHOU $2,431.000002456865 CT: ANGIO HEAD WITH CONTRAST $2,431.000002456913 CT: ANGIO LOWER EXTREMITY LEFT $2,431.000002456911 CT: ANGIO LOWER EXTREMITY LEFT $2,431.000002456910 CT: ANGIO LOWER EXTREMITY RIGH $2,431.000002456912 CT: ANGIO LOWER EXTREMITY RIGH $2,431.000002456866 CT: ANGIO NECK WITH AND WITHOU $2,431.000002456867 CT: ANGIO NECK WITH CONTRAST $2,431.000002456858 CT: ANGIO PELVIS WITH CONTRAST $2,431.000002456934 CT: ANGIO SURGICAL PLANNING $2,371.000002453637 CT: CERVICAL SPINE WITH AND WI $1,499.000002453462 CT: CERVICAL SPINE WITH CONTRA $1,384.000002453454 CT: CERVICAL SPINE WITHOUT CON $1,384.000002456963 CT: CHOLEYCYSTOSTOMY TUBE $3,145.000002456928 CT: FACIAL LIMITED $393.000002456929 CT: FACIAL WITH AND WITHOUT CO $1,421.000002456930 CT: FACIAL WITH CONTRAST $1,207.00

0002456927 CT: FACIAL WITHOUT CONTRAST $1,071.000002453223 CT: GUIDANCE $557.000002456872 CT: GUIDANCE ABLATION $980.000002453348 CT: HEAD WITH AND WITHOUT CONT $1,421.000002453116 CT: HEAD WITH CONTRAST $1,351.000002453108 CT: HEAD WITHOUT CONTRAST $1,155.000002456920 CT: IAC WITH AND WITHOUT CONTR $1,400.000002456919 CT: IAC WITH CONTRAST $1,207.000002456918 CT: IAC WITHOUT CONTRAST $1,124.000002456916 CT: INVASIVE PROCEDURE BIOPSY $0.00E002456916 CT: INVASIVE PROCEDURE BIOPSY $638.000002456917 CT: INVASIVE PROCEDURE DRAIN $0.00E002456917 CT: INVASIVE PROCEDURE DRAIN $638.000002456922 CT: INVASIVE PROCEDURE PARACEN $1,825.000002453504 CT: LUMBAR SPINE WITH CONTRAST $1,384.000002453496 CT: LUMBAR SPINE WITHOUT CONTR $1,384.000002430009 CT: NECK SOFT TISSUE LIMITED $393.000002453439 CT: NECK SOFT TISSUE WITH & WI $1,421.000002453421 CT: NECK SOFT TISSUE WITH CONT $1,246.000002453413 CT: NECK SOFT TISSUE WITHOUT C $1,096.000002456887 CT: ORBIT WITH AND WITHOUT CON $1,400.000002456879 CT: ORBIT/SELLA W/O IV CONTRST $1,124.000002456883 CT: ORBIT/SELLA WITH IV CONTR $1,207.000002453082 CT: PELVIS WITH CONTRAST $1,554.000002453074 CT: PELVIS WITHOUT CONTRAST $1,320.000002456871 CT: PERCUTANEOUS ABLATION LIVE $0.00E002456871 CT: PERCUTANEOUS ABLATION LIVE $9,711.000002456889 CT: POSTERIOR FOSSA WITH AND W $1,400.000002456888 CT: SELLA WITH AND WITHOUT CON $1,400.000002456949 CT: SIALOGRAM INJECTION $578.000002456948 CT: SIALOGRAM S&I $0.00E002456948 CT: SIALOGRAM S&I $1,092.000002456924 CT: SINUS LIMITED $393.000002456925 CT: SINUS WITH AND WITHOUT CON $1,421.000002456926 CT: SINUS WITH CONTRAST $1,207.000002456923 CT: SINUS WITHOUT CONTRAST $1,071.000002456886 CT: TEMP BONES/POS FOSS W/IV $1,207.000002456882 CT: TEMP BONES/POS FOSS WO IV $1,124.000002456876 CT: TEMPORAL BONES LIMITED $393.000002456890 CT: TEMPORAL BONES W & W/O CON $1,400.000002453652 CT: THORACIC SPINE WITH AND WI $1,312.000002453488 CT: THORACIC SPINE WITH CONTRA $1,384.000002453470 CT: THORACIC SPINE WITHOUT CON $1,384.000002430012 CT: THORAX LIMITED W/O IV CONT $393.000002453447 CT: THORAX WITH & WITHOUT CONT $1,771.000002453058 CT: THORAX WITH CONTRAST $1,488.000002453041 CT: THORAX WITHOUT CONTRAST $1,320.00

0002456892 CT: UPPER EXTREMITY LEFT W/O C $1,207.000002456891 CT: UPPER EXTREMITY RIGHT W/O $1,207.000002151306 CYSTOGRAM $0.00E002151306 CYSTOGRAM $746.00E002151322 CYSTOGRAM VOIDING $742.000002151322 CYSTOGRAM, VOIDING $0.00E002152429 CYSTOURETHROGRAM $369.000002152429 CYSTOURETHROGRAM, RETRO. $0.000001670001 DEXA APPENDICULAR SKELETON $182.000001670002 DEXA AXIAL SKELET W/ FX ASSESS $291.000001670000 DEXA AXIAL SKELETON $291.000001670003 DEXA VERTEBRAL FX ASSESSMENT $182.000002457038 DISC BIOPSY $670.00E002456983 DRAIN APPENDICEAL $4,101.00E002456999 DRAIN CATHETER EXCHANGE $1,684.000002456998 DRAIN, PER/RET VAG/REC W/GUIDE $4,101.000002456997 DRAIN, PERIT/RETR PERC W/GUIDE $4,101.000002456996 DRAIN, VISCER PERC W/GUIDE $4,101.000001650858 DUPLEX SCAN HEMODIALYSIS $1,071.000002154049 ELBOW LEFT (XR) $387.000002154048 ELBOW RIGHT (XR) $387.000001640978 ENDO RECTAL $825.00E002456972 EPIDURAL BLOOD PATCH $1,260.000002152692 ERCP BILIARY & PANCREATIC DUCT $1,584.000002154130 ERCP BILIARY DUCTAL SYSTEM S&I $107.000002154131 ERCP PANCREATIC DUCTAL SYSTEM $107.000002151066 ESOPHAGUS $564.000002457034 EXTERNAL BILIARY DRAIN PLACEMT $6,619.000002457042 FACET INJ LUM/SAC SECOND LEVEL $917.000002457049 FACET INJ LUM/SAC THIRD+ LEVEL $917.000002456995 FACET INJ. LUM/SAC, BILAT SING $2,750.000002152700 FACET INJECTION $790.000002150175 FACIAL BONE XRAY (2 VIEWS) $387.000002150019 FACIAL BONES XRAY $473.000002456946 FASCIAL DILATOR LARGE $44.000002456945 FASCIAL DILATOR SMALL $38.000002154141 FB REMOVAL FOOT DEEP $3,762.000002154142 FB REMOVAL FOOT DEEP $3,762.000002154137 FEEDING TUBE PLACEMENT $612.000002154051 FEMUR LEFT (XR), 2+ VIEWS $469.000002154154 FEMUR LT, 1 VIEW (XR) $186.000002154050 FEMUR RIGHT (XR), 2+ VIEWS $469.000002154153 FEMUR RT, 1 VIEW (XR) $186.000002456986 FINE NEEDLE ASPIRAT W CT GUIDE $1,486.000001641571 FINE NEEDLE ASPIRATION $1,486.00E001641571 FINE NEEDLE ASPIRATION $885.00E002456986 FINE NEEDLE ASPIRATION $885.00

0001641572 FINE NEEDLE ASPIRATION ADD'L $466.000002457048 FINE NEEDLE ASPIRATION,EA ADDL $466.000002152130 FISTULA TRACT STUDY $900.00E002457007 FISTULA TRACT STUDY $900.000002152304 FLUORO GUIDANCE OF NEEDLE $1,338.000002130226 FLUORO GUIDANCE VAD DEVICE $1,065.00E002154087 FLUORO GUIDED JOINT INJECTION $9,248.000002152321 FLUOROSCOPY W/BRONCH $790.000002152452 FLUOROSCOPY-UP TO 1 HR $790.000001650867 FOLLOW UP STUDY (SPECIFY) $255.000002154053 FOOT LEFT (XR) $387.000002154052 FOOT RIGHT (XR) $387.000002154055 FOREARM LEFT (XR) $393.000002154054 FOREARM RIGHT (XR) $393.000001650887 FOREIGN BODY REMOVAL - THIGH $0.00E001650887 FOREIGN BODY REMOVAL-THIGH $5,569.000002154202 GALACTOGRAM INJECTION $128.00E002154201 GALACTOGRAM MULTI DUCT $767.00E002154200 GALACTOGRAM SINGLE DUCT $767.000001640507 GALLBLADDER-ABD LTD $963.000002556397 GALLIUM 67 PER MCI $229.000002555456 GALLIUM INFLAMMATORY WB $1,895.000002530010 GALLIUM SCAN LIMITED $1,327.000002556881 GALLIUM TUMOR SCAN MULT DAY WB $4,272.000002556856 GALLIUM TUMOR SCAN SING DAY WB $1,205.000002555520 GASTRIC EMPTY $1,463.000002150230 GASTROGRAFIN $3.000002555423 GI BLEED SCAN $1,498.000002152668 GI TUBE PLACEMENT $0.00E002152668 GI TUBE PLACEMENT $811.000001520210 GLUCAGON $537.780001650902 GUIDE CATH FLUID DRAINAGE $1,092.000002151159 GUIDE WIRE AMPLATZ $235.000002154057 HAND LEFT (XR) $387.000002154056 HAND RIGHT (XR) $387.000001530000 HEAD LIMITED $393.000001640291 HEAD/NECK $771.000002154059 HEEL LEFT (XR) $387.000002154058 HEEL RIGHT (XR) $387.000002810744 HEPATOBILARY W/ PHARM INTERV $1,088.000002810743 HEPATOBILARY W/O PHARM INTERV $1,088.000002154096 HIP 1 VIEW LT $570.000002154156 HIP 1 VIEW LT W/ PELVIS $570.000002130009 HIP 1 VIEW RT $570.000002154155 HIP 1 VIEW RT W/ PELVIS $570.000002154158 HIP 2-3 VIEW LT W/ PELVIS $686.000002154157 HIP 2-3 VIEW RT W/ PELVIS $686.00

0002154093 HIP 2-3 VIEWS LT $686.000002154092 HIP 2-3 VIEWS RT $686.000002154160 HIP 4+ VIEW LT $731.000002154149 HIP 4+ VIEW LT WITH PELVIS $731.000002154159 HIP 4+ VIEW RT $731.000002154150 HIP 4+ VIEW RT WITH PELVIS $731.000002154143 HIP BILAT 2 VIEWS W/O PELVIS $381.000002154151 HIP BILAT 3-4 VIEW W/ PELVIS $482.000002154152 HIP BILAT 5+ VIEW W/ PELVIS $585.000002154161 HIP BILATERAL 3-4 VIEW $482.000002154162 HIP BILATERAL 5+ VIEW $585.000002150209 HIP BILATERAL W/ PELVIS 2 VIEW $381.000002556873 HMPAO WBC LIMITED $1,327.000002555829 HMPAO WBC WB $1,895.000002154061 HUMERUS LEFT (XR) $405.000002154060 HUMERUS RIGHT (XR) $405.000002152346 HYSTEROSALPINGOGRAM $0.000001650886 HYSTEROSONOGRAM INTRODUCTION $103.00E002152346 HYSTERSALPINGOGRAM $1,054.000001641505 HYSTERSONOGRAM US $0.00E001641505 HYSTERSONOGRAM US $1,054.000002810740 I-123 MIBG UP TO 15MCI $9,050.000002556894 I-123 MIBG WB MULT DAY $4,272.000002556899 I-123 MIBG WB SNG DAY $1,205.000002556520 I-125 PLASMA VOLUME PER TEST $1,026.000002556887 I131 IODIDE CAP, RX PER MCI $160.000002810737 I131 LIQUID DIAGNOSTIC PER MCI $107.000002810738 I131 LIQUID DIAGNOSTIC PER MCI $107.000002810736 I131 LIQUID THERAPEUTIC PERMCI $107.000002810739 I131 LIQUID THERAPEUTIC PERMCI $107.000002556895 I-131 MIBG IOBEN DIAG 0.5MCI $7,761.000002556900 I-MIBG SPECT $2,445.000002556363 IN 111 PENTETATE PER .5 MCI $1,533.00E002556892 IN WBC BN MARROW LIMITED SIMUL $1,327.00E002556891 IN WBC BN MARROW WB SIMILT $1,895.000002556454 IN-111 LABELED WBC PER STUDY $3,837.000002556703 IN-111 PENTETREOTIDE UPTO 6MCI $6,318.000002810741 IN-111 WBC SCAN LIMITED $1,327.000001640253 INFERIOR VENA CAVA $746.000002130030 INJ CHOLANGIO, NEW ACC, W/S&I $6,619.000002130032 INJ CYSTOGRAM $113.000002130029 INJ CYSTOGRAM-VOID $113.000002130033 INJ CYSTOURETHROGRAM $113.000002130025 INJ DISCOGRAM-LUMBAR $93.000002130024 INJ HYSTOSALPINOGRAM $103.000002130218 INJ LOOPOGRAM $143.000002456975 INJ LUMB SACRAL (CAUDAL) W/GU $1,823.00

0002130220 INJ PROCEDURE ANKLE ARTHROGRAP $101.000002130221 INJ PROCEDURE ELBOW ARTHROGRAP $101.000002130222 INJ PROCEDURE HIP ARTHROGRAPHY $101.000002130223 INJ PROCEDURE KNEE ARTHROGRAPH $101.000002130035 INJ PROCEDURE SHOULDER ARTHROG $101.000002130224 INJ PROCEDURE TEMPORAMANDIBULA $101.000002130225 INJ PROCEDURE WRIST ARTHROGRAP $101.000002130068 INJ PX FISTULA TRACT $230.000002457003 INJ TRANS FORAM LUMB 1ST LEVEL $1,834.000002457004 INJ TRANS FORAM LUMB 2ND LEVEL $917.000002130036 INJ VENOGRAM $143.000002457001 INJECT CERV/THOR FACET 2ND LVL $917.000002456979 INJECT CERVICAL EPIDURAL W/GUI $1,823.000002457006 INJECTION FISTULA TRACT $230.000002130028 INJECTION FOR MYELOGRAPHY $91.00E002457021 INJECTION/ASPIRATION HIP $1,260.00E002457035 INTERCOSTAL NERVE BLK MULTI W/ $1,260.000001650882 INTRAOPERATIVE GUIDANCE $225.000001641546 INTRODUCER ASAP CORE BX NEEDLE $93.000001641544 INTRODUCER CO-AXIAL $69.000002154097 INTRODUCTION LONG GASTROINTEST $872.000001641506 INVASIVE PROCEDURE CHARGE $1,200.00E001641504 INVASIVE PROCEDURE CHARGE W/R $1,260.000001641504 INVASIVE PROCEDURE CHARGE W/RE $0.00E002453224 INVASIVE PROCEDURE CT $638.000002556858 IN-WIII WBC SCAN WB $1,895.000002556041 IODINE-1-131 IODIDE CAP, DX $283.000002556857 ISOTOPE HANDLING $132.000002151363 IVP $885.000002151355 IVP, DRIP W/O TOMO. $696.000001640465 KIDNEY RENAL ART DOPPLER $963.000001650866 KIDNEY TRANSPLANT W/DOPP $344.000001640466 KIDNEY-RETRO LTD $746.000002154063 KNEE AP AND LAT VIEW LEFT (XR) $171.000002154062 KNEE AP AND LAT VIEW RIGHT (XR $171.000002130083 KNEE AP AND LAT VIEWS $171.000002130095 KNEE BILAT/STANDING $517.000002154067 KNEE FOUR VIEWS LEFT (XR) $446.000002154066 KNEE FOUR VIEWS RIGHT (XR) $446.000002154145 KNEE, 3 VIEWS, LEFT (XR) $308.000002154146 KNEE, 3 VIEWS, RIGHT (XR) $308.000002150722 LEFT FINGERS $387.000002150831 LEFT TOES $402.000002154083 LEG LENGTH STUDY $396.000002556875 LIVER SPECT W/ VASCULAR FLOW $1,380.000001640408 LIVER-ABD LTD $963.000002555175 LIVER-SPLEEN PLANAR SCAN $806.00

E001641570 LMYPH NODE BIOPSY $2,043.000002154098 LOOPOGRAM $1,205.000002456902 LOW EXT LT W & W/O IV CNTRAST $1,180.000002456900 LOW EXT LT W/ IV CNTRAST $1,246.000002456898 LOW EXT LT W/O IV CNTRAST $1,207.000002456915 LOW EXT LT W/O IV CNTRST LMTD $393.000002456901 LOW EXT RT W & W/O IV CNTRAST $1,180.000002456897 LOW EXT RT W/O IV CNTRAST $1,207.000002456914 LOW EXT RT W/O IV CNTRST LMTD $393.000002456899 LOWER EXT RT W/ CONTRAST $1,246.000002154081 LOWER EXTREMITY INFANT LEFT (X $287.000002154080 LOWER EXTREMITY INFANT RIGHT ( $287.00E002130020 LUMBAR $2,242.000002457008 LUMBAR PUNCTURE $983.000002150549 LUMBAR SPINE - LAIDLAW $682.000002150613 LUMBAR SPINE 2 VIEWS $525.000002150548 LUMBAR SPINE FIVE VIEWS $682.000002150555 LUMBAR SPINE FLEX/EXT $544.000002456932 LUMBAR SPINE POST MYELOGRA $1,384.000002453645 LUMBAR SPINE W & W/O $1,499.000002430019 LUMBAR SPINE W/O LIMITED $393.000002556874 LUNG PERF W/ VENT ONE OR MULTI $1,575.000002555084 LUNG PERFUSION $1,149.000001530106 LUNG SCREENING $328.000002556859 LUNG SPLIT FUNC PERFUS & VENT $1,188.000002556902 LUNG SPLIT FUNC PERFUSION ONLY $855.000002555134 LUNG VENT SCAN $1,020.000001641570 LYMPH NODE BIOPSY $0.000002556910 LYMPHOSCINTIGRAPHY LYMPHEDEMA $1,399.000001641564 MAMMO MARKER BREAST CLIP $351.000001650897 MAMMO MARKER BREAST CLIP $277.000002150301 MAMMO NEEDLE LOC SUP $163.00E002154118 MAMMO SCREEN DIGITAL LT W/ $227.00E002154113 MAMMOGRAM DIAGNOSTIC DIG B $403.00E002154115 MAMMOGRAM DIAGNOSTIC DIGITAL L $355.00E002154114 MAMMOGRAM DIAGNOSTIC DIGITAL R $355.00E002154107 MAMMOGRAM SCREEN DIGITAL BIL W $311.00E002154116 MAMMOGRAM SCREEN DIGITAL BIL W $311.00E002154109 MAMMOGRAM SCREEN DIGITAL LT W/ $227.00E002154108 MAMMOGRAM SCREEN DIGITAL RT W/ $227.00E002154117 MAMMOGRAM SCREEN DIGITAL RT W/ $227.000002152726 MAMMOGRAM: SURGICAL SPECIMEN $527.000001650896 MAMMONTONE NEEDLE $726.000002150035 MANDIBLE XRAY $456.000002150043 MASTOIDS XRAY $573.000002430006 MAXILLOFAC LIMITED $393.000002453405 MAXILLOFACIAL AREA W & W/O CON $1,421.00

0002453397 MAXILLOFACIAL AREA W/CONTRAST $1,207.000002453389 MAXILLOFACIAL W/O CONTR $1,071.000002555407 MECKLES DIVERTICULUM $755.000002150010 MEDIPORT FLOW STUDY $588.00E002457029 MEDIUM JOINT INJECTION $1,232.000002152296 METASTATIC SERIES $791.000002456844 MISC. CAT SCAN $346.000001520200 MR VENOGRAM HEAD W/O $1,029.000001520061 MRA: ABDOMEN WITH CONTRAST $2,156.000001520071 MRA: ABDOMEN WITHOUT CONTRAST $1,861.000001550071 MRA: ABDOMEN WITHOUT CONTRAST $980.000001550187 MRA: CHEST W/ & W/O CONTRAST $2,324.000001550178 MRA: CHEST W/O CONTRAST $980.000001520187 MRA: CHEST WITH AND WITHOUT C $2,324.000001520016 MRA: CHEST WITH CONTRAST $2,156.000001550016 MRA: CHEST WITH CONTRAST $2,156.000001520178 MRA: CHEST WITHOUT CONTRAST $1,861.000001550006 MRA: HEAD W/ & W/O CONTRAST $1,772.000001550005 MRA: HEAD WITH CONTRAST $1,362.000001550004 MRA: HEAD WITHOUT CONTRAST $1,861.000001520004 MRA: HEAD WITHOUT CONTRAST $1,861.000001520072 MRA: LEFT FEMUR WITH CONTRAST $980.000001520158 MRA: LEFT FEMUR WITHOUT CONTR $944.000001520074 MRA: LEFT FOOT WITH CONTRAST $980.000001520160 MRA: LEFT FOOT WITHOUT CONTRA $944.000001520080 MRA: LEFT HAND WITH CONTRAST $980.000001520166 MRA: LEFT HAND WITHOUT CONTRA $980.000001520078 MRA: LEFT HUMERUS WITH CONTRA $980.000001520164 MRA: LEFT HUMERUS WITHOUT CON $980.000001520079 MRA: LEFT RADIUS_ULNA WITH CO $980.000001520165 MRA: LEFT RADIUS_ULNA WITHOUT $980.000001520193 MRA: LEFT TIBIA_FIBULA W & W/ $2,324.000001520073 MRA: LEFT TIBIA_FIBULA WITH C $980.000001520159 MRA: LEFT TIBIA_FIBULA WITHOU $980.000001520057 MRA: LOWER EXTREMITIES WITH C $2,156.000001520056 MRA: LOWER EXTREMITIES WITHOU $1,861.000001550009 MRA: NECK W/ & W/O CONTRAST $2,324.000001520009 MRA: NECK WITH & WITHOUT CONT $2,324.000001520008 MRA: NECK WITH CONTRAST $1,362.000001550007 MRA: NECK WITHOUT CONTRAST $1,861.000001520030 MRA: PELVIS WITH CONTRAST $2,156.000001520180 MRA: PELVIS WITHOUT CONTRAST $1,861.000001520075 MRA: RIGHT FEMUR WITH CONTRAS $980.000001520161 MRA: RIGHT FEMUR WITHOUT CONT $944.000001520077 MRA: RIGHT FOOT WITH CONTRAST $980.000001520163 MRA: RIGHT FOOT WITHOUT CONTR $944.000001520083 MRA: RIGHT HAND WITH CONTRAST $2,213.00

0001520169 MRA: RIGHT HAND WITHOUT CONTR $2,213.000001520081 MRA: RIGHT HUMERUS WITH CONTR $2,213.000001520167 MRA: RIGHT HUMERUS WITHOUT CO $980.000001520082 MRA: RIGHT RADIUS_ULNA WITH C $2,213.000001520168 MRA: RIGHT RADIUS_ULNA WITHOU $2,213.000001520192 MRA: RIGHT TIBIA_FIBULA W & W $2,324.000001520076 MRA: RIGHT TIBIA_FIBULA WITH $980.000001520162 MRA: RIGHT TIBIA_FIBULA WITHO $944.000001520026 MRA: SPINAL CANAL WITH CONTRA $980.000001520177 MRA: SPINAL CANAL WITHOUT CON $980.000002153389 MRA: AT FOUNDATION $3,812.000001520064 MRI SPECTROSCOPY $936.000001520194 MRI: 3D REFORMAT NON-INDEPEND $167.000001550060 MRI: ABDOMEN W/ & W/O CONTRAS $2,324.000001520060 MRI: ABDOMEN WITH & WITHOUT C $2,324.000001520059 MRI: ABDOMEN WITH CONTRAST $2,053.000001550058 MRI: ABDOMEN WITHOUT CONTRAST $1,861.000001520058 MRI: ABDOMEN WITHOUT CONTRAST $1,861.000001520053 MRI: ANY JOINT LOWER EXT. W/C $2,053.000001520054 MRI: ANY JOINT LOWER EXT. W/O $2,213.000001520041 MRI: ANY JOINT UPPER EXT. W/O $2,213.000001520039 MRI: ANY JOINT UPPER EXTREMIT $2,053.000001520066 MRI: BIOPSY TRAY $71.000001520176 MRI: BREAST BILATERAL WITHOUT $1,861.000001550019 MRI: CERVICAL SPINE W/ & W/O $2,324.000001550018 MRI: CERVICAL SPINE W/ CONTRA $2,156.000001550017 MRI: CERVICAL SPINE W/O CONTR $1,861.000001520019 MRI: CERVICAL SPINE WITH & WI $2,324.000001520018 MRI: CERVICAL SPINE WITH CONT $2,156.000001520017 MRI: CERVICAL SPINE WITHOUT C $1,861.000001550015 MRI: CHEST W/ & W/O CONTRAST $2,324.000001520015 MRI: CHEST WITH & WITHOUT CON $2,324.000001520014 MRI: CHEST WITH CONTRAST $2,156.000001550013 MRI: CHEST WITHOUT CONTRAST $1,861.000001520013 MRI: CHEST WITHOUT CONTRAST $1,861.000001550185 MRI: FACE W/ & W/O CONTRAST $2,324.000001520185 MRI: FACE WITH & WITHOUT CONT $2,324.000001520181 MRI: FACE WITHOUT CONTRAST $1,861.000001520068 MRI: FLUOROSCOPY_ARTHROGRAM $500.000001520191 MRI: GUIDANCE FOR NEEDLE PLAC $1,488.000001550012 MRI: HEAD W/ & W/O CONTRAST $2,324.000001520012 MRI: HEAD WITH & WITHOUT CONT $2,324.000001520011 MRI: HEAD WITH CONTRAST $2,156.000001550011 MRI: HEAD WITH CONTRAST $2,156.000001520010 MRI: HEAD WITHOUT CONTRAST $1,861.000001550010 MRI: HEAD WITHOUT CONTRAST $1,861.000001550196 MRI: IAC $842.00

0001520196 MRI: IAC $842.000001550092 MRI: LEFT ANKLE W/ & W/O CONT $2,324.000001550098 MRI: LEFT ANKLE W/O CONTRAST $1,861.000001520092 MRI: LEFT ANKLE WITH & W/O CO $2,324.000001520086 MRI: LEFT ANKLE WITH CONTRAST $2,053.000001520098 MRI: LEFT ANKLE WITHOUT CONTR $1,861.000001550115 MRI: LEFT ELBOW W/O CONTRAST $1,861.000001520103 MRI: LEFT ELBOW WITH & WITHOU $2,324.000001520109 MRI: LEFT ELBOW WITH CONTRAST $2,156.000001520115 MRI: LEFT ELBOW WITHOUT CONTR $1,861.000001550128 MRI: LEFT FEMUR W/O & W CONTR $2,324.000001520128 MRI: LEFT FEMUR W/O & W CONTR $2,324.000001550134 MRI: LEFT FEMUR W/O CONTRAST $1,861.000001520122 MRI: LEFT FEMUR WITH CONTRAST $2,053.000001550122 MRI: LEFT FEMUR WITH CONTRAST $2,156.000001520134 MRI: LEFT FEMUR WITHOUT CONTR $1,861.000001550130 MRI: LEFT FOOT W/O & W CONTRA $2,324.000001520130 MRI: LEFT FOOT W/O & W CONTRA $2,324.000001550136 MRI: LEFT FOOT W/O CONTRAST $1,861.000001520124 MRI: LEFT FOOT WITH CONTRAST $2,156.000001520136 MRI: LEFT FOOT WITHOUT CONTRA $1,861.000001550142 MRI: LEFT HAND W/ & W/O CONTR $2,324.000001550154 MRI: LEFT HAND W/O CONTRAST $1,772.000001520142 MRI: LEFT HAND WITH & WITHOUT $2,324.000001520148 MRI: LEFT HAND WITH CONTRAST $2,053.000001520154 MRI: LEFT HAND WITHOUT CONTRA $1,861.000001550090 MRI: LEFT HIP W/ & W/O CONTRA $2,324.000001550096 MRI: LEFT HIP W/O CONTRAST $1,861.000001520090 MRI: LEFT HIP WITH & W/O CONT $2,324.000001550084 MRI: LEFT HIP WITH CONTRAST $2,156.000001520084 MRI: LEFT HIP WITH CONTRAST $2,156.000001520096 MRI: LEFT HIP WITHOUT CONTRAS $1,861.000001550140 MRI: LEFT HUMERUS W/ & W/O CO $2,324.000001520140 MRI: LEFT HUMERUS WITH & WITH $2,324.000001520146 MRI: LEFT HUMERUS WITH CONTRA $2,053.000001520152 MRI: LEFT HUMERUS WITHOUT CON $1,861.000001550091 MRI: LEFT KNEE W/ & W/O CONTR $2,324.000001550097 MRI: LEFT KNEE W/O CONTRAST $1,861.000001520091 MRI: LEFT KNEE WITH & W/O CON $2,324.000001520085 MRI: LEFT KNEE WITH CONTRAST $2,053.000001520097 MRI: LEFT KNEE WITHOUT CONTRA $1,861.000001550102 MRI: LEFT SHOULDER W/ & W/O C $2,324.000001550108 MRI: LEFT SHOULDER W/ CONTRAS $2,156.000001520102 MRI: LEFT SHOULDER WITH & WIT $2,324.000001520108 MRI: LEFT SHOULDER WITH CONTR $2,156.000001520114 MRI: LEFT SHOULDER WITHOUT CO $1,861.000001550129 MRI: LEFT TIBIA FIBULA W/&W/O $2,324.00

0001550135 MRI: LEFT TIBIA FIBULA W/O CO $1,861.000001520129 MRI: LEFT TIBIA_FIBULA WITH & $2,324.000001520123 MRI: LEFT TIBIA_FIBULA WITH C $2,053.000001520135 MRI: LEFT TIBIA_FIBULA WITHOU $1,861.000001550141 MRI: LEFT ULNA RADIUS W/& W/O $2,324.000001550153 MRI: LEFT ULNA RADIUS W/O CON $1,861.000001520141 MRI: LEFT ULNA_RADIUS WITH & $2,324.000001520147 MRI: LEFT ULNA_RADIUS WITH CO $2,053.000001520153 MRI: LEFT ULNA_RADIUS WITHOUT $1,861.000001550104 MRI: LEFT WRIST W/ & W/O CON $2,324.000001520104 MRI: LEFT WRIST WITH & WITHOU $2,324.000001550110 MRI: LEFT WRIST WITH CONTRAST $2,156.000001520110 MRI: LEFT WRIST WITH CONTRAST $2,156.000001520116 MRI: LEFT WRIST WITHOUT CONTR $1,861.000001520046 MRI: LOWER EXTREMITY W/CONTRA $2,053.000001520048 MRI: LOWER EXTREMITY W/O & W $2,213.000001520025 MRI: LUMBAR SPINE W & W/O CON $2,324.000001550025 MRI: LUMBAR SPINE W/ & W/O CO $2,324.000001550024 MRI: LUMBAR SPINE W/ CONTRAST $2,156.000001550023 MRI: LUMBAR SPINE W/O CONTRAS $1,861.000001520023 MRI: LUMBAR SPINE W/O CONTRAS $1,861.000001520024 MRI: LUMBAR SPINE WITH CONTRA $2,156.000001550186 MRI: NECK W/ & W/O CONTRAST $2,324.000001550182 MRI: NECK W/O CONTRAST $1,861.000001520186 MRI: NECK WITH & WITHOUT CONT $2,324.000001520182 MRI: NECK WITHOUT CONTRAST $1,861.000001520195 MRI: OMNIPAQUE 350 $1.000001550003 MRI: ORBIT W/ & W/O CONTRAST $2,324.000001520003 MRI: ORBIT WITH & WITHOUT CON $2,324.000001520001 MRI: ORBIT WITHOUT CONTRAST $1,861.000001550001 MRI: ORBIT WITHOUT CONTRAST $1,861.000001550029 MRI: PELVIS W & W/O CONTRAST $2,324.000001520029 MRI: PELVIS W & W/O CONTRAST $2,324.000001520028 MRI: PELVIS WITH CONTRAST $2,156.000001550027 MRI: PELVIS WITHOUT CONTRAST $1,861.000001520027 MRI: PELVIS WITHOUT CONTRAST $1,861.000001520197 MRI: PITUITARY $842.000001550197 MRI: PITUITARY $842.000001550095 MRI: RIGHT ANKLE W/ & W/O CON $2,324.000001550101 MRI: RIGHT ANKLE W/O CONTRAST $1,861.000001520095 MRI: RIGHT ANKLE WITH & WITHO $2,324.000001520089 MRI: RIGHT ANKLE WITH CONTRAS $2,053.000001520101 MRI: RIGHT ANKLE WITHOUT CONT $1,861.000001550106 MRI: RIGHT ELBOW W/ & W/O CON $2,324.000001550112 MRI: RIGHT ELBOW W/ CONTRAST $2,156.000001550118 MRI: RIGHT ELBOW W/O CONTRAST $1,861.000001520106 MRI: RIGHT ELBOW WITH & WITHO $2,324.00

0001520112 MRI: RIGHT ELBOW WITH CONTRAS $2,156.000001520118 MRI: RIGHT ELBOW WITHOUT CONT $1,861.000001550131 MRI: RIGHT FEMUR W/ & W/O CON $2,324.000001550137 MRI: RIGHT FEMUR W/O CONTRAST $1,861.000001520131 MRI: RIGHT FEMUR WITH & WITHO $2,324.000001520125 MRI: RIGHT FEMUR WITH CONTRAS $2,053.000001520137 MRI: RIGHT FEMUR WITHOUT CONT $1,861.000001550133 MRI: RIGHT FOOT W/ & W/O CONT $2,324.000001550139 MRI: RIGHT FOOT W/O CONTRAST $1,861.000001520133 MRI: RIGHT FOOT WITH & WITHOU $2,324.000001520127 MRI: RIGHT FOOT WITH CONTRAST $2,156.000001520139 MRI: RIGHT FOOT WITHOUT CONTR $1,861.000001550145 MRI: RIGHT HAND W/& W/O CONTR $2,324.000001550157 MRI: RIGHT HAND W/O CONTRAST $1,861.000001520145 MRI: RIGHT HAND WITH & WITHOU $2,324.000001520151 MRI: RIGHT HAND WITH CONTRAST $2,053.000001520157 MRI: RIGHT HAND WITHOUT CONTR $1,861.000001550093 MRI: RIGHT HIP W/ & W/O CONTR $2,324.000001550099 MRI: RIGHT HIP W/O CONTRAST $1,861.000001520093 MRI: RIGHT HIP WITH & WIITHOU $2,324.000001550087 MRI: RIGHT HIP WITH CONTRAST $2,156.000001520087 MRI: RIGHT HIP WITH CONTRAST $2,156.000001520099 MRI: RIGHT HIP WITHOUT CONTRA $1,861.000001550143 MRI: RIGHT HUMERUS W/& W/O CO $2,324.000001550155 MRI: RIGHT HUMERUS W/O CONTRA $1,861.000001520143 MRI: RIGHT HUMERUS WITH & WIT $2,324.000001520149 MRI: RIGHT HUMERUS WITH CONTR $2,053.000001520155 MRI: RIGHT HUMERUS WITHOU CON $1,861.000001550094 MRI: RIGHT KNEE W/ & W/O CONT $2,324.000001550100 MRI: RIGHT KNEE W/O CONTRAST $1,861.000001520094 MRI: RIGHT KNEE WITH & WIITHO $2,324.000001520088 MRI: RIGHT KNEE WITH CONTRAST $2,053.000001520100 MRI: RIGHT KNEE WITHOUT CONTR $1,861.000001550105 MRI: RIGHT SHOULDER W/ & W/O $2,324.000001550111 MRI: RIGHT SHOULDER W/ CONTRA $2,156.000001550117 MRI: RIGHT SHOULDER W/O CONTR $1,861.000001520105 MRI: RIGHT SHOULDER WITH & WI $2,324.000001520111 MRI: RIGHT SHOULDER WITH CONT $2,156.000001520117 MRI: RIGHT SHOULDER WITHOUT C $1,861.000001550132 MRI: RIGHT TIBIA FIBULA W/ CO $2,324.000001550138 MRI: RIGHT TIBIA FIBULA W/O C $1,861.000001520126 MRI: RIGHT TIBIA_FIBULA WITH $2,053.000001520132 MRI: RIGHT TIBIA_FIBULA WITH $2,324.000001520138 MRI: RIGHT TIBIA_FIBULA WITHO $1,861.000001550144 MRI: RIGHT ULNA RADIUS W/&W/O $2,324.000001520144 MRI: RIGHT ULNA_RADIUS WITH & $2,324.000001520150 MRI: RIGHT ULNA_RADIUS WITH C $2,053.00

0001520156 MRI: RIGHT ULNA_RADIUS WITHOU $1,861.000001550107 MRI: RIGHT WRIST W/ & W/O CON $2,324.000001550119 MRI: RIGHT WRIST W/O CONTRAST $1,861.000001520107 MRI: RIGHT WRIST WITH & WITHO $2,324.000001520113 MRI: RIGHT WRIST WITH CONTRAS $2,156.000001520119 MRI: RIGHT WRIST WITHOUT CONT $1,861.000001520000 MRI: TEMPORAMANDIBULAR JOINT $1,772.000001520022 MRI: THORACIC SPINE W & W/O C $2,324.000001550022 MRI: THORACIC SPINE W & W/O C $2,324.000001550021 MRI: THORACIC SPINE W/ CONTRA $2,156.000001550020 MRI: THORACIC SPINE W/O CONTR $1,861.000001520021 MRI: THORACIC SPINE WITH CONT $2,156.000001520020 MRI: THORACIC SPINE WITHOUT C $1,861.000001520035 MRI: UPPER EXTREMITY W/O & W $2,213.000001520033 MRI: UPPER EXTREMITY WITH CON $2,053.000001520031 MRI: UPPER EXTREMITY WITHOUT $1,772.000002153351 MRI: AT FOUNDATION $2,859.000001520207 MRI: FACE/NECK W & W/O CON $2,324.000001520203 MRI: FACE/NECK W/O CONTRAST $1,861.000001550114 MRI: LEFT SHOULDER W/O CONTRAS $1,861.000001520205 MRI: ORBIT/FACE W & W/O CON $2,324.000001520201 MRI: ORBIT/FACE W/O CONTRAST $1,861.000001520204 MRI: ORBIT/FACE/NECK W/O CON $1,861.000001520206 MRI: ORBIT/NECK W & W/O CON $2,324.000001520202 MRI: ORBIT/NECK W/O CONTRAST $1,861.000001520211 MRI:IAC ONLY W & W/O CONTRAST $2,324.000001520208 MRI:ORBIT/FACE/NECK W& W/O CON $2,324.000001520212 MRI:PITUITARY ONLY W & W/O CON $2,324.000002555282 MUGA REST $1,512.000001520209 MULTIHANCE MRI CONTRAST MEDIA $8.00E002456973 MUSCLE BIOPSY PERCUTANEOUS $2,076.000001641580 MUSCLE NEEDLE BIOPSY $0.00E001641580 MUSCLE NEEDLE BIOPSY $2,076.000001641579 MUSCULOSKELETAL LIMITED $1,040.000001540025 MYCARDIAL IMAGING, PET METABOL $4,776.00E002151892 MYELOGRAM LUMBAR $1,452.00E002151926 MYELOGRAM THORACIC $787.000002151876 MYELOGRAM, CERV. $0.00E002151876 MYELOGRAM, CERVICAL $2,135.000002151918 MYELOGRAM, COMPLETE $0.00E002151918 MYELOGRAM, COMPLETE $1,662.000002151892 MYELOGRAM, LUMBAR $0.000002151926 MYELOGRAM, THORACIC $0.000002555266 MYOCARD HOT SPOT PLNR $987.000002556897 MYOCARD SPECT MUL W/WO WM & EF $3,061.000002556898 MYOCARD SPECT SNG W/WO WM & EF $3,061.000002556904 MYOCARDIAL VIABILITY $3,061.00

0002556124 NA IODIDE 123 PER 100 UCI CAPS $449.000002150050 NASAL BONES $387.000002150027 NECK, SOFT TISSUE $369.000001641545 NEEDLE ASAP CORE BX $242.000001641543 NEEDLE BIOPENSE CORE BX 18G 10 $242.000001641548 NEEDLE CHIBA BX 22G $56.00E001640997 NEEDLE LOC - US $600.00E002154208 NEEDLE LOC ADD'L LESION - LT $638.00E002154209 NEEDLE LOC ADD'L LESION - RT $638.000002154224 NEEDLE LOC LEFT $1,389.000002154226 NEEDLE LOC LEFT ADD'L $168.00E002154203 NEEDLE LOC LT $638.000002154223 NEEDLE LOC RIGHT $1,389.000002154225 NEEDLE LOC RIGHT ADD'L $168.00E002154204 NEEDLE LOC RT $638.000002154217 NEEDLE LOC WIRE $825.000002456938 NEEDLE PRECUT $389.000001641547 NEEDLE TEMNO CO=AXIAL 18-11 $243.000002456939 NEEDLE TROCAR $88.000002457031 NEPH TUBE EXCHANGE $2,735.000002456994 NEPHRO TUBE PLACE W/S&I $4,580.000002457030 NERVE ROOT INJECTION $1,834.000002154099 NG TUBE PLACEMENT W/FLUORO GUI $612.000002556913 NON-HEU TC-99M ADD-ON/DOSE $11.000002555185 OCTREOSCAN SPECT $2,445.000002556896 OCTREOSCAN WB MULT DAY W SPEC $4,272.000002556880 OCTREOSCAN WHOLE BODY MULT DAY $4,272.000001530099 OMNIPAQUE 25ML $2.000002152825 OMNIPAQUE 350 100CC $1.000002152826 OMNIPAQUE 350 30CC $1.000002152827 OMNIPAQUE 350 50CC $1.000001520198 OMNISCAN $10.000002150076 OPTIC FORAMINA $344.000002430003 ORB/SEL/EAR LIMITED $393.000002453371 ORBIT,SELLA,POS.FOSSA,EAR W&W/ $1,400.000002453355 ORBIT,SELLA,POS.FOSSA,EAR W/O $1,124.000002453363 ORBIT,SELLA,POS.FOSSA,IN.EAR W $1,207.000002150068 ORBITS $456.000001640481 PANCREAS-ABD LTD $963.000002556837 PARATHYROID SCAN/PLANAR $560.000002556889 PARATHYROID SPECT SCAN $2,568.000001641578 PAROTID-SALIVARY GLAND BIOPSY $0.00E001641578 PAROTID-SALIVARY GLAND BIOPSY $2,099.000002154069 PATELLA, LEFT 2 VIEW $171.000002154139 PATELLA, LEFT 5 VIEWS $446.000002154068 PATELLA, RIGHT 2 VIEW $171.000002154140 PATELLA, RIGHT 5 VIEWS $446.00

0001641549 PEDIATRIC/INFANT HIPS DYNAMIC $393.000002150563 PELVIS - 1 VIEW $392.000002150670 PELVIS FIVE VIEWS $571.000001640572 PELVIS LIMITED SPECIFY $771.000001640549 PELVIS TRANS ABD COMPLETE $1,040.000001640812 PELVIS TRANS VAG $1,054.000002453512 PELVIS W & W/O IV CNTRAST $1,544.000002430021 PELVIS W/O IV CNTRAST LMTD $393.000001650506 PENILE FLOW $945.000001640499 PENIS-PELVIS LTD $771.000001540022 PET F-18 FLUORO-D-GLUCOSE (FDG $847.000001540026 PET F-18 FLUORO-D-GLUCOSE (FDG $847.000001540029 PET/CT BRAIN ALZHEIMERS $4,776.000001540028 PET/CT LIMITED AREA (HEAD/NECK $4,776.000001540030 PET/CT SKULLBASE TO THIGH $4,776.000001540027 PET/CT WHOLE BODY $4,776.000002556906 PLASMA VOLUME(MASS)(I125 ALBU) $2,636.000001640861 PLEURAL EFF LOC $723.000002456990 PLUERAL DRAIN W/INDWELL CATH $2,029.000001640952 PLYORUS-ABD LTD $963.000002456942 PNEUMOTHORAX KIT $365.000002152487 PORTABLE CHEST EXAM $497.00E002154231 POST PROCEDURE DIAG MAMM BILAT $403.00E002154229 POST PROCEDURE DIAG MAMM LEFT $355.00E002154230 POST PROCEDURE DIAG MAMM RIGHT $355.000001641574 PREG BPP $576.000001641573 PREG BPP ADD'L $576.000001641576 PREG FETAL MAT EVAL ADD'L<14WK $217.000001641575 PREG FETAL MAT EVAL ADD'L>14WK $217.000001641577 PREG FETAL MATERNAL EVAL<14WKS $428.000001640523 PREG FETAL MATERNAL EVAL>14WKS $1,040.000001640795 PREG TRANSVAG $699.000001641569 PREG TRANSVAG LIMITED $699.000001650865 PREG UMBILICAL DOPPLER $199.000001640531 PREGNANCY RE-EXAM $661.000001650863 PREGNANCY RE-EXAM ADD'L $661.000001640622 PREGNANCY-LIMITED $255.000001650885 PROCEDURE DONE IN DEPT BY PHYS $0.000002151298 PYELOGRAM, RETROGRADE $651.000002810746 RA 223 XOFIGO ONE TREAT DOSE $20,921.000002556903 RA 223 XOFIGO PER MICROCURIE $365.000001650869 RAD DRAIN GUIDE US $1,064.000002555614 RBC HEMANGIOMA $2,772.000002556907 RBC VOLUME (MASS) (CR51) $2,734.000002152684 REHABILITATION SWALLOW STUDY $790.00E002456987 RENAL BIOPSY $2,514.000002555027 RENAL FUNCTION W/O PHARM.INTER $1,099.00

0002555028 RENAL MULT.W/WO PHARM.INTERVEN $2,188.000002555639 RENAL W/PHARM INTERV/LASIX $1,099.000002556888 RENAL W/PHARM/ENAL/ACE SINGLE $1,099.000001641581 RETROPERITONEAL,COMPLETE $840.000002150340 RIBS, BIL (PA CXR INCLUDED) $640.000002154095 RIBS, LEFT (PA CXR INCLUDED) $525.000002154094 RIBS, RIGHT (PA CXR INCLUDED) $525.000002150332 RIBS, UNILATERAL LT ( NO CXR) $525.000002154144 RIBS, UNILATERAL RT (NO CXR) $525.000002150721 RIGHT FINGERS $387.000002150830 RIGHT TOES $402.000002456947 ROSEN GUIDE WIRE $59.000002556272 RVEF 1ST PASS PHARM $0.00E002556272 RVEF 1ST PASS PHARM $502.000002150589 SACROILLIAC JOINTS $738.000002150571 SACRUM $520.000002154135 SACRUM & COCCYX $520.000002810742 SALIVARY GLAND IMAGING/FUNCT $828.000002154079 SCAPULA LEFT (XR) $473.000002154078 SCAPULA RIGHT (XR) $473.000002154163 SCOLIOSIS 2 VIEW $848.000002150654 SCOLIOSIS SERIES, 1 VIEW $669.000002556846 SENTINEL NODE IMAGE $1,399.000002154071 SHOULDER LEFT (XR) $483.000002154070 SHOULDER RIGHT (XR) $483.000002456984 SI JOINT INJ. INLCUDES GUIDE $1,785.000002152403 SIALOGRAM $1,092.000002556865 SINCALIDE 5MCG INJ $242.000002154033 SINGLE VIEW OF SPINE - SPECIFY $344.000002150084 SINUSES (PARANASAL) COMPLETE $645.000002154138 SINUSES < 3 VIEWS $170.000002154133 SKELETAL SURVEY $434.000002150100 SKULL $740.000002150092 SKULL (2 VIEWS) $434.000002556838 SM 153 LEXIDRONAN PER 150MCI $27,734.000002151158 SMALL BOWEL ENEMA $917.000002151157 SMALL BOWEL SERIES $756.000001640366 SMALL PARTS $1,040.000001540031 SODIUM FLUORIDE F-18 $847.000002556836 SODIUM P 32 PER MCI $473.000002457036 SOFT TISSUE DRAIN W/CATH PLACE $1,092.00E002457040 SOFT TISSUE MASS BIOPSY $2,076.000001650877 SOFT TISSUE-LOW BACK $963.000002556872 SPHINCT ODDI DYSFUNCTION $1,088.000002150662 SPINE COMPLETE- MINIMUM 2 VIEW $848.000001640424 SPLEEN-ABD LTD $963.000002556912 SPLENIC LOCALIZATION W/TC-DRBC $1,332.00

0002556035 SR 98 CHLORIDE PER MCI $6,050.000002154220 STEREOTACTIC BREAST LT $2,355.000002154222 STEREOTACTIC BREAST LT ADD'L $1,180.000002154219 STEREOTACTIC BREAST RT $2,355.000002154221 STEREOTACTIC BREAST RT ADD'L $1,180.00E002154212 STEREOTACTIC BREAST-LT $1,057.00E002154214 STEREOTACTIC BREAST-RT $1,057.000002150373 STERNO CLAVICULAR $252.000002150365 STERNUM $571.00E002456974 SUPERFICIAL BONE BIOPSY $2,165.00E002456951 SUPERIOR VENA CAVA CT $1,488.000002556914 TC99 LYMPHOSEEK TILMANOCEPT PT $1,265.00E002556082 TC99M ALBUMIN AGGR TO 10 MCI $511.00E002556660 TC99M BICISATE UP TO 25 MCI $2,766.000002556828 TC99M DEPREOTIDE PER VIAL $1,877.00E002556828 TC99M DEPREOTIDE PER VIAL $1,877.00E002556132 TC99M DTPA AEROSOL UP TO 75MCI $559.00E002556652 TC99M EXAMETAZIME PER DOSE (BR $1,548.000002556827 TC99M EXAMETAZINE PER DOSE (WB $0.00E002556827 TC99M EXAMETAZINE PER DOSE (WB $1,869.00E002556911 TC99M HEAT DAMAGED RBC'S $660.00E002556421 TC99M LABELED RBC PER TEST $341.00E002556207 TC99M LABELED RBC UP TO 30 MCI $416.00E002556890 TC99M LABELED WBC (CERETEC) $3,128.00E002556777 TC99M MAG3/STUDY UP TO 15 MCI $1,259.00E002556157 TC99M MEBROFENIN UP TO 15 MCI $304.00E002556181 TC99M OXIDRONATE PER DOSE $166.00E002556025 TC99M PENETATE RENAL TO 25 MCI $262.00E002556801 TC99M SESTAMIBI PER ONE SYRING $554.00E002556842 TC99M SESTAMIBI PER ONE SYRING $537.00E002556860 TC99M SESTAMIBI PER TWO SYRING $1,107.00E002556315 TC99M SODIUM PERTECHNETATE PER $133.00E002556785 TC99M SUCCIMER UP TO 10 MCI $1,162.00E002556905 TC99M SUL COLOID SENTINEL NODE $1,108.00E002556512 TC99M SULFUR COLLOID TO 20 MCI $264.000002456936 TEMNO BIOPSY NEEDLE 18GA $329.000002456937 TEMNO BIOPSY NEEDLE 20GA $373.000001530115 TEMP BONES/POS FOSS W/IV CONT $1,207.000002150126 TEMPEROMANDIBULAR JOINTS $608.000001530114 TEMPORAL BONES W & W/O IV CONT $1,400.000001530110 TEMPORAL BONES W/O IV CONTRAST $1,124.000001640432 TESTICLES $1,040.000002555381 TESTICULAR SCAN $1,396.000002556314 THALLIUM PER MCI $181.000002456989 THORA ASP/DRAIN W/IMAGING $1,454.000002456940 THORACENTESIS KIT $227.000002150522 THORACIC SPINE $632.00

0002456933 THORACIC SPINE POST MYELOG $1,384.000002430017 THORACIC SPINE W/O LIMITED $393.000002154136 THORACOLUMBAR, 2 VIEWS $160.000001640606 THYROID $771.000002555241 THYROID ABLATION CARCINOMA $955.000001640257 THYROID ASPIRATION BX $1,486.00E001640257 THYROID ASPIRATION BX $885.00E002456976 THYROID BIOPSY $1,171.000002556883 THYROID CA IMAG DIAG WBMD $2,414.000002556909 THYROID CA IMAG DIAG WBSD $2,414.000002555688 THYROID CA IMAG PST-TX WBSD $2,414.000001650903 THYROID CORE BIOPSY $0.00E001650903 THYROID CORE BIOPSY $1,171.000002555043 THYROID THERAPY INITIAL HYPERT $955.000002500002 THYROID THERAPY REPEAT HYPERTH $955.000002555126 THYROID, SINGLE/MULTI UPTAKE $530.000002154073 TIBIA AND FIBULA LEFT (XR) $414.000002154072 TIBIA AND FIBULA RIGHT (XR) $414.000002152213 TOMOGRAMS- LINEAR EXAM $184.00E002457016 TRIGGER POINT INJ 1 OR 2 SITES $612.000001650855 TRU CUT BIOPSY NEEDLE $99.000002456944 TRU-CLOSE DRAINAGE SYSTEM $128.00E002457041 TUNNELLED DRAIN LUNG W/ S&I $7,787.000002457043 TUNNELLED DRAIN REMOVAL $369.000002151199 UGI WITH AIR $1,006.000002151207 UGI WITH SMALL BOWEL $977.000001640614 ULTRASOUND GUIDED NEEDLE PLACE $977.000002456896 UP EXT LT W & W/O IV CNTRAST $1,333.000002456894 UP EXT LT W/ IV CONTRAST $1,301.000002456895 UP EXT RT W & W/O IV CNTRAST $1,333.000002456893 UP EXT RT W/ IV CONTRAST $1,301.000002456878 UPPER EXT LT W/O LIMITED $393.000002456877 UPPER EXT RIGHT W/O LIMITED $393.000002154075 UPPER EXTREMITY 2V INFANT-LT $369.000002154074 UPPER EXTREMITY 2V INFANT-RT $369.000002151181 UPPER G.I. $819.000001640317 UPPER QUADRANT-ABD LTD(SPECIFY $963.000002810748 UREA BREATH TEST ANALYSIS $297.00E002810747 UREA BREATH TEST C-14 ACQ $596.000002457044 URESIL 600CC DRAIN BAG $36.000001650868 VASCULAR ACCESS GUIDANCE $1,140.000001640805 VASCULAR GROIN BILAT $564.000001650883 VASCULAR GROIN LEFT $483.000001650884 VASCULAR GROIN RIGHT $483.00E002152379 VENOGRAM BILATERAL $2,106.00E002152361 VENOGRAM UNILATERAL $1,760.000002152379 VENOGRAM, BILATERAL $0.00

0002152361 VENOGRAM, UNILATERAL $0.000001650183 VENOUS DUPLEX LOW BILAT $1,746.000001641522 VENOUS DUPLEX LOW LEFT $970.000001641521 VENOUS DUPLEX LOW RIGHT $970.000001630013 VENOUS DUPLEX LOWER LTD BILAT $355.000001650187 VENOUS DUPLEX UPPER BILAT $1,746.000001641520 VENOUS DUPLEX UPPER LEFT $970.000001630012 VENOUS DUPLEX UPPER LTD BILAT $355.000001641519 VENOUS DUPLEX UPPER RIGHT $970.000001630016 VENOUS MAPPING $970.000001641566 VENOUS REFLUX LOWER BILAT $1,746.000001641567 VENOUS REFLUX LOWER LEFT $970.000001641568 VENOUS REFLUX LOWER RIGHT $970.000002457011 VERTEBRO ADD THOR/LUMBAR W/S&I $8,303.000002457014 VERTEBRO CAV ADD TH/LUM W/S&I $21,659.000002457013 VERTEBRO CAVITY LUMBAR,W/S&I $21,659.000002457012 VERTEBRO CAVITY THORACIC,W/S&I $21,659.000002457010 VERTEBROPLASTY LUMBAR, W/S&I $8,303.000002457009 VERTEBROPLASTY THORACIC, W/S&I $8,303.000001530087 VISIPAQUE 320 - 100 ML $2.000001530088 VISIPAQUE 320 - 50 ML $2.000001530089 VISIPAQUE 320 - 75 ML $2.000002154077 WRIST LEFT (XR) $405.000002154076 WRIST RIGHT (XR) $405.000002150142 ZYGOMAS XRAY $473.00


0003690917 MULTI SLEEP LATENCY TESTING $1,293.000003690919 POLYSOMNOGRAPHY W/ CPAP $4,396.000003690918 POLYSOMNOGRAPHY W/O CPAP $3,518.000003692036 SLEEP STUDY < 6 YEARS W/O CPAP $3,518.000003692037 SLEEP STUDY <6 YRS W CPAP/BPAP $4,396.000003692032 SLEEP STUDY W/RECORDING ATTEND $533.000003692034 UNATTENDED SLEEP STUDY $633.00

Disclaimer

This section includes standard charges for Sleep Lab procedures provided by CRMC Health Care.


0001930195 ABCESS, FISTUAL OR SINUS TRACT $302.000001930190 ABORTED ANGIO PROCEDURE $428.000001904121 ABSCESS/CYST DRAINAGE, LIVER $711.000001904136 ABSCESSOGRAM TUBE CHECK IR $209.000001902498 ADJUST DOBHOFF $898.000001901511 ADJUST TUNNELED PLEURAL DRAIN $1,360.000001904466 ADMIRAL PTA ALL SIZES $3,000.000001901492 AMPLATZ GUIDEWIRE 145 $160.000001901490 AMPLATZ GUIDEWIRE 180 $216.000001901493 AMPLATZ GUIDEWIRE 260 $216.000001904247 ANCEL SHEATH ALL SIZES $302.000001930182 ANGIO ABDM 2/3 ORD ADD'L $357.000001930191 ANGIO AORTA $1,541.000001930179 ANGIO EXISTING CATH/TC THERAPY $1,548.000001901080 ANGIO EXTREM B1-LAT $3,259.000001904099 ANGIO PELVIC $3,036.000001904060 ANGIO THOR 2/3 ADDITIONAL $375.000001904088 ANGIOGRAPHY ABDOMINAL 1ST ORDE $1,795.000001904089 ANGIOGRAPHY ABDOMINAL 1ST ORDE $2,561.000001904090 ANGIOGRAPHY ABDOMINAL 2ND ORDE $2,268.000001904091 ANGIOGRAPHY ABDOMINAL 2ND ORDE $3,238.000001904092 ANGIOGRAPHY ABDOMINAL 3RD ORDE $2,676.000001901431 ANGIOGRAPHY SI $3,207.000001904079 ANGIOGRAPHY THORACIC 1ST ORDER $2,245.000001904080 ANGIOGRAPHY THORACIC 1ST ORDER $2,245.000001904085 ANGIOGRAPHY THORACIC 1ST ORDER $3,206.000001904081 ANGIOGRAPHY THORACIC 2ND ORDER $2,681.000001904082 ANGIOGRAPHY THORACIC 2ND ORDER $2,681.000001904086 ANGIOGRAPHY THORACIC 2ND ORDER $3,826.000001904083 ANGIOGRAPHY THORACIC 3RD ORDER $3,030.000001904084 ANGIOGRAPHY THORACIC 3RD ORDER $3,030.000001904087 ANGIOGRAPHY THORACIC 3RD ORDER $4,325.000001904071 ANGIOSEAL IR LAB $785.000001902139 AORTOFEMORAL BILATERAL $4,000.000001904105 AORTOGRAM THORACIC BY SERIALOG $6,717.000001904171 ARTERIAL BLOOD PRESSURE IR $268.000001904172 ARTERIAL OCCLUSIVE DEVICE PLAC $57.000001902188 ARTERIO ADD'L VESSELS $1,906.000001902287 ARTERIO EXTREMITY - LEFT $3,057.000001930183 ARTERIO EXTREMITY-RIGHT $3,057.00

This section includes standard charges for CRMC Health Care's special procedures including blood administration.

Disclaimer

0001902170 ARTERIOGRAM CEREBRAL BILATERAL $3,565.000001902147 ARTERIOGRAM RENAL BILATERAL $9,498.000001902220 ARTERIOGRAM, PULMONARY BILATER $4,314.000001902261 ARTERIOGRAM, VISCERAL $6,717.000001904436 ARTHOCENTESIS SMALL JOINT $983.000001930196 ARTHROCENTESIS LARGE JOINT $1,260.000001904419 ARTHROGRAM ELBOW $101.000001904290 ARTHROGRAM HIP $101.000001904397 ARTHROGRAM INJ HIP BILAT $188.000001904395 ARTHROGRAM INJ WRIST BILAT $188.000001904275 ARTHROGRAM KNEE INJECTION $101.000001904169 ASPIRATION PUNCTURE ABCESS/CYS $753.000001904168 ASPIRATION SUBCU HEMATOMA/CYST $753.000001904301 AVA FLEX VERTEBRO INJECT NEEDL $2,000.000001904300 AVA VERTEBRO PROCEDURE TRAY $1,726.000001904302 AVAMAX VERTEBRO BIOPSY NEEDLE $336.000001904457 BALLOON DILATE URTRL STRIX,S&I $549.000001902693 BILIARY DILATATION $1,065.000001904453 BILIARY DRAIN CATH INT-EXT,S&I $6,619.000001930185 BILLIARY DIL PROC W/O STENT $3,145.000001930186 BILLIARY DIL PROC W/STENT $2,995.000001904370 BIOPSY ABDOMEN/RETROPERITONEAL $2,481.000001902938 BIOPSY TRANSCATHETER $6,717.000001904392 BONE BIOPSY SUPERFICIAL $2,165.000001904482 BONE MARROW ASPIRATION $1,853.000001901515 BONE MARROW BX AND ASPIRATION $2,705.000001901516 BONE MARROW CORE BIOPSY $3,297.000001904246 BOSTON BALLOON XXL $1,052.000001904451 BREAST BIOPSY W/GUIDANCE LT $2,355.000001904452 BREAST BIOPSY W/GUIDANCE RT $2,355.000001904368 BREAST BX CORE W/O GUIDE $2,124.000001904437 BREAST CYST ASPIRATION $1,132.000001904450 BREAST CYST ASPIRATION ADD'L $402.000001904357 CAROTID STENT THORAC W/S&I $10,493.000001930202 CATH ANGIOJET XPEEDIOR $3,434.000001930204 CATH ANJIOJET DVX $3,057.000001930203 CATH ANJIOJET SPIROFLEX $4,681.000001901494 CATH ANJIOJET SPIROFLEX VG $4,009.000001904424 CATH DRAIN W/ S& I SOFT TISSUE $1,092.000001904434 CATH DRAIN W/ S&I RETRO/PERI $4,101.000001904433 CATH DRAIN W/ S&I VISCERAL $4,101.000001904435 CATH DRAIN W/S&I R/P/TRV/TRR $4,101.000001904441 CATH KMP 65CM $53.000001904267 CATH KUMPE 40CM 4FR $226.000001901427 CATH UPPER/LOWER EXTREM INTRO $974.000001904211 CATHETER C2 65 $219.000001904213 CATHETER GLIDE STR 120 $240.00

0001904216 CATHETER IM 100 $51.000001904210 CATHETER PIG 100 $87.000001904439 CATHETER PIG SIZING $207.000001904217 CATHETER QUICKCROSS ALL $588.000001904212 CATHETER SIM 1 100 $96.000001904407 C-CAROTID+EXTRACRAN BIL W/S&I $11,721.000001904380 C-CAROTID+EXTRACRAN UNI W/S&I $7,814.000001904408 C-CAROTID+INTRACRAN BIL W/S&I $11,721.000001904382 C-CAROTID+INTRACRAN UNI W/S&I $7,814.000001904248 CELECT IVC FILTER $3,742.000001904258 CELIAC INJECTION $3,645.000001901503 CHEMO EMBOLIZATION INJECTION $469.000001904454 CHG NEPHROURETERAL CATH W/S&I $3,671.000001902488 CHOLANGIOGRAM, T-TUBE $1,180.000001904126 CHOLEDOCHAL STENT IR $3,156.000001904220 COIL NESTER ALL SIZES $377.000001904219 COIL TORNADO ALL SIZES $408.000001904161 CONSC SEDTN AGE 5/+ 10-22 MIN $405.000001904481 CONSCIOUS SEDTN EA ADDL 15 MIN $107.000001904486 CONVERT G TUBE TO GJ TUBE $3,935.000001904456 CONVERT NEPHROSTOMY CATH W/S&I $2,672.000001904341 D STAT DRY $230.000001904097 DECLOTTING BY THROMBOLYTIC AGE $322.000001904363 DEEP BONE BIOPSY $4,604.000001904438 DIALYSIS CATHETER (TEMPORARY) $315.000001930383 DISCOGRAM, CERVICAL OR THORACI $2,355.000001902489 DISCOGRAM, LUMBAR $2,355.000001904160 EMBO COIL NESTER IR $440.000001904159 EMBO COIL TORNADO IR $476.000001904430 EMBO W/ S&I ART NO HEM/MASS $29,628.000001904432 EMBO W/ S&I ART/VEIN/HEM $29,628.000001904431 EMBO W/ S&I MASS/INFARCT/ISCH $29,628.000001904429 EMBO W/ S&I VEIN NO HEM $29,628.000001904134 EMBOSPHERE 300-500 IR $823.000001904133 EMBOSPHERE 500-700 IR $823.000001904132 EMBOSPHERE 700-900 IR $823.000001901508 EPIDURAL BLOOD PATCH $1,260.000001902490 ERCP BILIARY + PANCREATIC $1,379.000001904228 EV3 CATH SNARE 25 $1,164.000001904227 EV3 CATH SNARE 35 $1,109.000001904280 EV3 INFUSION CATH 10 CM $428.000001904279 EV3 INFUSION CATH 20 CM $383.000001904231 EVERCROSS PTA<150 $404.000001904347 EVERCROSS PTA>150 $495.000001904110 EXCHANGE PREVIOUSLY PLACED CYS $1,684.000001904127 EXCHNGE BILIARY DR CATH,S&I $6,619.000001904390 EXT CAROTID UNI+EXTRACRAN W/SI $706.00

0001904316 FACET INJ C/T 2ND LVL $917.000001901512 FACET INJ C/T 3RD LVL $917.000001904402 FACET INJ C/T BILAT 1ST LEVEL $2,397.000001904404 FACET INJ C/T BILAT 2ND LEVEL $1,199.000001904393 FACET INJ C/T BILAT 3RD LEVEL $1,199.000001904314 FACET INJ C/T SNG LVL $1,834.000001904317 FACET INJ L/S 2ND LVL $917.000001904403 FACET INJ L/S BILAT 1ST LEVEL $2,397.000001904405 FACET INJ L/S BILAT 2ND LEVEL $1,199.000001904394 FACET INJ L/S BILAT 3RD LEVEL $1,199.000001904315 FACET INJ L/S SNG LVL $1,834.000001901514 FACET INJECTION L/S 3RD $917.000001904421 FB REMOVAL FOOT DEEP $3,762.000001904414 FB REMOVAL MUSCLE OR TENDON $2,124.000001904329 FEM/POP ATHERECTOMY & STENT $22,753.000001904326 FEM/POP SYSTEM ANGIOPLASTY $10,076.000001904327 FEM/POP SYSTEM ATHERECTOMY $13,968.000001904328 FEM/POP SYSTEM STENT $13,968.000001930169 FILTER PLACEMENT IVC $10,490.000001904360 FILTER REMOVAL IVC $3,106.000001904221 FILTER SPIDE FX ALL $2,718.000001904164 FILTER VENA CAVA DUAL IR $3,292.000001904492 FINE NEEDLE ASP W FLUORO,EA AD $466.000001904418 FINE NEEDLE ASPIR W US,EA ADDL $466.000001904491 FINE NEEDLE ASPIRAT W FLUORO $1,486.000001904417 FINE NEEDLE ASPIRATION DX $1,486.000001902212 FISTULA TRAC STUDY $900.000001904245 FLEXIMA DRAIN ALL PURPOSE $341.000001904244 FLEXIMA DRAIN NEPHROSTOMY $347.000001904119 FLUORO - CONTRAST GUIDED $552.000001904154 FLUORO GUIDANCE CENTRAL/PERIPH $1,065.000001902491 FLUORO NON-RAD $819.000001902238 FLUORO UP TO 1 HOUR $790.000001901498 FOGARTY BALLOON 5 FR $369.000001930192 FOLLOW-UP CARE VISIT $136.000001904188 FOXHOLLOW SILVERHAWK ALL SIZES $8,075.000001904365 GASTRIC/J TUBE INJECT FOR EVAL $529.000001902102 GASTRO TUBE CHANGE $580.000001902492 GI TUBE PLACEMENT $811.000001904207 GLIDE CATH ANGLE 100 $238.000001904440 GLIDE CATH ANGLE 120 $175.000001904206 GLIDE CATH ANGLE 65 $240.000001904215 GLIDECATH STR 100 $240.000001904214 GLIDECATH STR 65 $240.000001904240 GLIDEWIRE STD ANGLED .035 180 $209.000001904241 GLIDEWIRE STD ANGLED .035 260 $236.000001904239 GLIDEWIRE STIFF ANGLE .035 260 $247.00

0001904238 GLIDEWIRE STR .035 150 $158.000001904237 GLIDEWIRE STR .035 260 $236.000001902578 GREENFIELD VC FILTER $3,443.000001904344 GROSHONG ALL LENGTHS $1,514.000001904465 GROUNDING PAD NEUTRAL $118.000001904442 GUIDE CATH IM $186.000001904443 GUIDE CATH RDC $186.000001901610 GUIDE WIRE .035 SOFTWIRE (BENT $123.000001902477 GUIDE WIRE .035-260 $185.000001902469 GUIDE WIRE .035SS $158.000001902451 GUIDE WIRE GLIDE $121.000001904111 GUIDEWIRE 018/3/180 IR $476.000001901499 GUIDEWIRE NITREX $277.000001901501 GUIDEWIRE THRUWAY $448.000001901500 GUIDEWIRE TORQUE 180 $682.000001901502 GUIDEWIRE TORQUE 260 $682.000001904148 GUIDEWIRE TRANSEND IR $824.000001904467 HAWKONE LS $6,750.000001904167 HEPATIC VENOUS W/PRESSURES IR $2,925.000001901488 IC VENACAVA SUP OR INF. $1,242.000001904409 I-CAROTID+INTRACRAN BIL W/S&I $24,328.000001904384 I-CAROTID+INTRACRAN UNI W/S&I $12,775.000001904366 ICAST $5,547.000001904323 ILIAC ANGIOPLASTY ADDL $6,685.000001904321 ILIAC ANGIOPLASTY INITIAL $10,076.000001904325 ILIAC ATHERECTOMY $24,776.000001904324 ILIAC STENT ADDL $11,239.000001904322 ILIAC STENT INITIAL $11,239.000001930168 INF. VENACAVAGRAM $3,057.000001904222 INFUSION SYSTEM 5/90/10 $979.000001904223 INFUSION SYSTEM 5/90/20 $979.000001904224 INFUSION SYSTEM 5/90/5 $908.000001902494 INJ DISCOGRAM-LUMBAR $93.000001904061 INJ PROC. VENOGRAM $143.000001904367 INJECTION CHEMO CSF W/PUNCTURE $648.000001904295 INJECTION FISTULA/SINUS TRACT $230.000001904289 INJECTION LOOPOGRAM $143.000001904319 INJECTION THROMBIN $606.000001904339 INSERT BLADDER CATH COMPLICATE $302.000001902431 INSERT CENTRAL VENOUS CATH NON $3,054.000001904135 INSERT CENTRAL VENOUS CATH TUN $2,928.000001904129 INSERT VENOUS ACCESS DEVICE I $847.000001904117 INSERTION TRANSVEN INTRAHEPATI $3,305.000001901509 INTERCOSTAL NERVE BLOCK $1,260.000001901510 INTERCOSTAL NERVE BLOCK MULTI $1,260.000001904406 INTERMEDIATE JOINT INJ BILAT $2,344.000001904318 INTERMEDIATE JOINT INJECTION $1,232.00

0001904485 INTERNAL MAMMARY ANGIO $6,872.000001904480 INTRO CATH DIALYSIS CIRCUIT $1,071.000001904098 INTRO RETRO BRACHIAL ARTERY (I $256.000001904162 INTRODUCTION LONG GI TUBE IR $830.000001904184 INTRVASC US, NON-COR,1ST W/S&I $4,969.000001904185 INTRVASC US,NON-COR,ADD W/S&I $4,715.000001904354 IRL VAG PROC, OTHER SPECIFIED $39.000001030498 ISS CHG, APHE PLR, LR, IRR $2,788.000001030103 ISS CHG; APHE RBC, LR, IRR $878.000001030139 ISS CHG; CRYOPRECIPITATE $198.000001030424 ISS CHG; DIR RBC, IRRAD $1,293.000001030097 ISS CHG; FRESH FROZEN PLASMA $324.000001030154 ISS CHG; PLTS,PHER,LEUK. REDUC $2,788.000001030030 ISS CHG; RBC, LEUK. REDUCED $878.000001030457 ISS CHG; RBC, LR, CMV-,IRRAD $1,323.000001030479 ISS CHG; RBC, LR, WASHED $574.000001030188 ISS CHG;FACTOR 8 RECOMB,PER IU $302.000001030468 ISS CHG;PLTS,PHER,LR,CMV-,IRRA $2,831.000001904489 IVAS ACCESS CANNULA $175.000001904487 IVAS BONE BX KIT $249.000001901496 IVC FILTER BIRDSNEST $2,755.000001904235 J GUIDE WIRE ALL SIZES $39.000001904361 J TUBE EXCHANGE $1,610.000001904362 J TUBE PLACEMENT $3,275.000001904282 JOSTENT $6,117.000001902495 J-TUBE EXCHANGE GASTROSTOMY $552.000001902496 J-TUBE PLACEMENT GASTROSTOMY $855.000000017751 KIT CEMENT INJECT AUTOPLEX HV $2,025.000000017750 KIT CEMENT INJECTOR AUTOPLEX $1,688.000001904340 L/T PARAVERTEBRAL SYMP INJ. $1,802.000001904077 LOOPOGRAM S&I $1,205.000001904170 L-SPINE PAIN INJECTION IR $1,823.000001904364 LUMBAR PUNCTURE THERAPEUTIC $983.000001904157 LUMBAR PUNCTURE W/O INJECTION $983.000001904320 LYMPH NODE BIOPSY SUPERFICIAL $2,043.000001904252 MECH THROBECTOMY VENOUS INITL $9,864.000001904253 MECH THROBECTOMY VENOUS SUB $9,864.000001904250 MECHANICAL THROMBECTOMY ADD $9,864.000001901495 MECHANICAL THROMBECTOMY PRIME $10,000.000001904251 MECHANICAL THROMBECTOMY SECOND $9,864.000001904351 MEDIPORT FLOW STUDY $588.000001904416 MUSCLE BIOPSY PERCUTANEOUS $2,076.000001930200 MYELOGRAM, CERVICAL SPINE S&I $2,135.000001930198 MYELOGRAM, COMPLETE $1,662.000001930197 MYELOGRAM, LUMBAR $1,452.000001930199 MYELOGRAM, THORACIC $787.000001904445 MYELOGRAPHY, W/S&I, CERVICAL $1,961.00

0001904448 MYELOGRAPHY, W/S&I, COMPLETE $2,079.000001904446 MYELOGRAPHY, W/S&I, THORACIC $1,961.000001904447 MYELOGRAPHY, W/S&I,LUMBOSACRAL $1,961.000001904342 NANOCROSS PTA 150MM OR GREATER $1,205.000001904229 NANOCROSS PTA<150MM $989.000001902577 NEEDLE ACCESS $194.000001904455 NEPHROSTOGRAM, EXIST ACC,W/S&I $1,595.000001904076 NEPHROSTOGRAM, NEW ACC, W/S&I $3,144.000001904053 NEPHROSTOMY EXCHANGE W/S&I $2,735.000001904052 NEPHROSTOMY INTRO W/ S&I $4,580.000001904449 NEPHROSTOMY TUBE REMOVAL $1,670.000001904471 NERVE BLOCK PERIPHERAL NERVE $1,436.000001904278 NG/OG PLACE (INCLUDES DOBHOFF) $612.000001904338 OCCIPITAL NERVE INJECTION $1,042.000001904208 OMNI CATHETER $56.000001904209 OMNI FLUSH CATHETER $102.000001904281 OMNISCAN $11.000001904475 OUTBACK $3,790.000001904268 OUTPATIENT VISIT MODERATE $113.000001904181 P.T.ATHERECTOMY VISCERAL S&I I $2,212.000001904196 P.T.ILIAC ATHERECTOMY BIL IR $25,233.000001904145 PARACENTESIS INITIAL IR $1,825.000001904146 PARACENTESIS SUBSEQUENT IR $1,080.000001904078 PERC CHOLECYSTOSTOMY $3,145.000001902100 PERC PLACEMENT GASTRO $2,043.000001902253 PERCU DRAIN BILIARY, EXT,W/S&I $6,619.000001902352 PERCU DRAIN CATH EXE $1,141.000001902337 PERCU DRAIN GUIDE $1,064.000001930163 PERCU URET STENT EXE $890.000001930162 PERCU URETERAL STENT $2,497.000001930167 PERCU. IVC FILTER RSI $776.000001904232 PERCUSTAY $57.000001904296 PERCUTANEOUS LIVER BIOPSY $2,454.000001904123 PERCUTANEOUS PLACEMENT ENTEROC $407.000001904294 PERMACATH $1,440.000001904293 PERMACATH PLACEMENT $6,376.000001904226 PICC DUAL LUMEN $402.000001904151 PICC PLACEMENT IR $5,395.000001904369 PICC REPAIR $1,537.000001904225 PICC SINGLE LUMEN $383.000001904345 PICC TRIPLE LUMEN $495.000001904311 PLEURODESIS $1,385.000001904356 PLEUR-X REMOVAL ABD $5,787.000001904355 PLEUR-X REMOVAL LUNG $965.000001904459 PLMT NEPHROURETERAL CATH,W/S&I $4,580.000001904376 PLUERAL TUBE INDWELL W/S&I $2,029.000001904271 PLUER-X DRAINAGE KIT $258.00

0001904270 PLUER-X INSERT KIT ABD $1,670.000001904269 PLUER-X INSERT KIT LUNG $1,670.000001904230 POWERCROSS PTA<150MM $718.000001904346 POWERCROSS PTA>150MM $940.000001904242 PT2 GUIDEWIRE $388.000001902697 PTC CATH PLACEMENT $2,177.000001902696 PTC CHOLEANG INJ,NEW ACC W/S&I $6,619.000001904109 PULMONARY, SELECTIVE (IR) $428.000001904415 REMOVAL GI TUBE OBSTRUCTION $1,549.000001904131 REMOVE TUNNELED CENTRAL ACCESS $847.000001904107 RENAL UNILATERAL (IR) $6,332.000001904130 REPLACE NONTUNNEL PICC IR $198.000001904149 REPLACE NON-TUNNELED CVL $3,295.000001904202 REPLACE PERCUTANEOUS G-TUBE $843.000001904152 REPLACE PICC IR $4,345.000001904124 REPOSITION CVC CATHETER IR $1,213.000001904165 REPOSITION CVL/PICC $2,112.000001904462 RFA CERV/THORAC 1ST LVL W/S&I $4,233.000001904463 RFA CERV/THORACIC ADD'L LEVEL $2,119.000001904460 RFA LUMBAR 1ST LEVEL W/S&I $4,233.000001904461 RFA LUMBAR ADD'L LEVEL $2,119.000001904310 RFA PERIPHERAL NERVE $2,499.000001930208 ROSEN GUIDE WIRE CURVED $83.000001904343 ROSEN WIRE 80CM $56.000001904420 S & I ARTHROGRAM ELBOW $1,313.000001904398 S&I ARTHROGRAM HIP BILAT $2,498.000001904291 S&I ARTHROGRAM HIP LEFT $1,313.000001904292 S&I ARTHROGRAM HIP RIGHT $1,313.000001904277 S&I ARTHROGRAM KNEE, LT $1,313.000001904276 S&I ARTHROGRAM KNEE, RT $1,313.000001904396 S&I ARTHROGRAM WRIST BILAT $4,207.000001904423 S&I RENAL VENOGRAM-UNILATERAL $7,441.000001904205 S&I SHOULDER ARTHROGRAM-LT $1,313.000001904204 S&I SHOULDER ARTHROGRAM-RT $1,313.000001904298 SACROILIAC JOINT INJECTION-LT $1,785.000001904399 SACROILIAC JOINT INJECTION-RT $1,785.000001901505 SACROPLASTY $5,385.000001904114 SEL.CATH PLACEMENT,VENOUSE SYS $437.000001904166 SELECTIVE CATH PLACE VENOUS 2N $115.000001904218 SHEATH PINNACLE ALL $114.000001904201 SHOULDER ARTHOROGRAM INJ $101.000001904125 SHUNTOGRAM IR $115.000001930170 SP CATHETER W WIRE $832.000001904444 SPECIAL CATH 5FR 65CM $109.000001904468 SPINAL CORD STIMULATOR TRIAL $15,938.000001904470 SPINAL STIM ACCESSORY KIT $550.000001904469 SPINAL STIM TRIAL LEADS $1,800.00

0001904474 STELLATE GANGLION INJECTION $1,695.000001902695 STENT $6,750.000001901489 STENT PARAMOUNT ALL SIZES $2,113.000001901491 STENT PROTEGE < 100MM $2,718.000001930205 STENT PROTEGE > 100MM $3,084.000001930207 STENT VISIPRO ALL SIZES $2,113.000001904425 STENT W/ S& I INT ARTERY $30,554.000001904426 STENT W/ S&I ADD ARTERY $14,779.000001904428 STENT W/ S&I ADD VEIN $14,779.000001904427 STENT W/ S&I INT VEIN $30,554.000001930206 STENT ZILVER ALL SIZES $3,218.000001930181 STENT-URETERAL (IR) $709.000001904147 STIFF SHAFT 260 GLIDEWIRE IR $228.000001904410 SUBCLAV BIL+IPSLAT VERTS W/S&I $14,877.000001904386 SUBCLAVIAN+IPSLAT VERTS W/S&I $7,814.000001904422 SUBMANDIBULAR BIOPSY $2,099.000001902592 T TUBE INJ, EXIST ACC, W/ S&I $3,580.000001902942 T TUBE REINSERTION W/S&I $6,619.000001904413 TENDON ORIGIN/INSERTION INJECT $600.000001904412 TENDON SHEATH LIGAMENT INJECT $600.000001904401 TFESI LUM/SAC ADD LEVEL BILAT $1,700.000001904400 TFESI LUM/SAC SNG LEVEL BILAT $2,110.000001904378 THORA W/IMAGING DIAGNOSTIC $1,454.000001904377 THORA W/IMAGING THERAPEUTIC $1,454.000001904379 THORACIC AORTA W/S&I $7,814.000001904203 THORACIC PAIN INJECT W/GUIDANC $1,823.000001904371 THROMBOLYSIS ART W/S&I DAY 1 $6,263.000001904372 THROMBOLYSIS VEN W/S&I DAY 1 $6,263.000001904374 THROMBOLYSIS,ART OR VEN CESSAT $6,173.000001904373 THROMBOLYSIS,ART OR VEN INCLUS $6,173.000001904335 TIB/PER ATHER EACH ADDL $13,968.000001904337 TIB/PER ATHER+STENT EACH ADDL $22,753.000001904331 TIB/PER ATHERECT INITIAL $25,233.000001904333 TIB/PER ATHERECT&STENT INITIAL $22,753.000001904330 TIB/PER PTA INITIAL $10,076.000001904334 TIB/PER PTE EACH ADDL $6,559.000001904336 TIB/PER STENT EACH ADDL $11,239.000001904332 TIB/PER STENT INITIAL $25,233.000001904254 TOE ARTHROGRAM $456.000001904348 TOTAL ABCESSION DRAIN $325.000001904375 TRANSCATH RETRIEVAL VASC FB $7,842.000001901429 TRANSCATH THERAPY $7,007.000001904116 TRANSCATHETER BIOPSY S&I IR $955.000001904308 TRANSFOR INJ LUMB/SAC ADDL LVL $917.000001904307 TRANSFOR INJ LUMB/SAC SGL LVL $1,834.000001904199 TRANSLUM ANGIOPL NON LAS CATH $1,140.000001904313 TRIGGER POINT INJECTION 1-2 $612.00

0001904312 TRIGGER POINT INJECTION 3+ $638.000001904476 TRLUML ANGIOPLASTY 1ST ARTERY $7,611.000001904478 TRLUML ANGIOPLASTY 1ST VEIN $7,611.000001904477 TRLUML ANGIOPLASTY ADDL ARTERY $2,589.000001904479 TRLUML ANGIOPLASTY ADDL VEIN $2,589.000001904249 TULIP IVC FILTER $2,932.000001904163 TUNNELED CICV ACCESS WITH PUMP $6,997.000001904352 TUNNELED CVL W/ PORT REMOVAL $3,042.000001904272 TUNNELED DRAIN INSERT ABD $7,787.000001904273 TUNNELED DRAIN INSERT LUNG $7,787.000001904297 TURBOHAWK CATHETER ALL SIZES $7,769.000001904142 ULTRASOUND GUIDANCE IR $977.000001904458 URETERAL STENT PRQ, NEW, W/S&I $6,930.000001904112 URETERL STENT PRQ, EXIST,W/S&I $6,820.000001902499 URETEROSTOMY TUBE CHANGE $1,539.000001904153 US GUIDANCE VASCULAR ACCESS I $1,140.000001904473 US GUIDED LARGE JOINT INJ/ASP $1,816.000001904483 US GUIDED MEDIUM JOINT INJ/ASP $1,498.000001904484 US GUIDED SMALL JOINT INJ/ASP $676.000001904490 US MUSCULOSKELETAL LIMITED $1,040.000001904353 UTERINE FIBROID EMBOLIZATION $28,236.000001902154 VENACAVAGRAM SUPERIOR $2,724.000001904115 VENO HEPATIC NO PRESSURE S&I I $2,911.000001904128 VENOGOGRAPHY EXTREMITY BILATER $2,106.000001930177 VENOGRAM EXT V. $1,760.000001904464 VENOM CANNULA ALL SIZES $179.000001930164 VENOUS SAMPLING $2,911.000001930188 VENOUS SAMPLING CATH-CAVA $1,334.000001930187 VENOUS SAMPLING CATH-VEIN $1,065.000001904411 VERTEBRAL W/CIRCULAT BIL W/S&I $24,328.000001904388 VERTEBRAL W/CIRCULAT UNI W/S&I $12,775.000001904304 VERTEBRO ADD THOR/LUMBAR W/S&I $8,303.000001901504 VERTEBRO CAV ADD TH/LUM W/S&I $21,659.000001901507 VERTEBRO CAVITY LUMBAR,W/S&I $21,659.000001901506 VERTEBRO CAVITY THORACIC,W/S&I $21,659.000001904305 VERTEBROPLASTY LUMBAR, W/S&I $8,303.000001904303 VERTEBROPLASTY THORACIC,W/S&I $8,303.000001904234 VIABAHN STENT ALL SIZES $8,540.000001904264 WIRE ANGLED GLIDE 150CM $150.000001904260 WIRE COPE .018 145CM $203.000001904259 WIRE COPE .018 60CM $161.000001904261 WIRE ROSEN 145CM $75.000001904262 WIRE ROSEN 160CM $79.000001904265 WIRE STIFF ANGLED GLIDE 150CM $228.000001904283 WRIST ARTHROGRAM BILATERAL $185.000001904288 WRIST ARTHROGRAM INJECTION RT $101.000001904286 WRIST ARTHROGRAM S&I BILATERAL $4,205.00

0001904285 WRIST ARTHROGRAM S&I LEFT $2,212.000001904287 WRIST ARTHROGRAM S&I RIGHT $2,212.000001904284 WRIST ARTHROGRAM UNILATERAL $101.00

CHARGE CODE CHARGE DESCRIPTONMASTER FEE

0007530234 7F SPLIT SHEATH W/VALVE $320.000007510035 ABD PADS 10 X 8 $13.000007501349 ABDUCTION PILLOW (DISP) $208.000007500663 ACE WRAP 2"" $9.000007510159 ACE WRAP 3"" $9.000007500671 ACE WRAP 4"" $10.000007519051 ACE WRAP 6"" $11.000007530027 ACS BMW WIRE .014 190CM $628.000007530025 ACS MULT8I-LINK 15MM STENT $4,759.000007530026 ACS MULTI-LINK 25MM STENT $5,968.000007530549 ACTICOAT $54.000760200590 AIRWAY NASAL 26F RED RUBBER $60.000760200592 AIRWAY NASAL 28F RED RUBBER $60.000007531241 AIRWAY, NASO 26F $60.000007531240 AIRWAY, NASO 28F $60.000007531006 AIRWAY, NASOPHAR 28F $44.000007500291 AIRWAY-BERMAN $23.000007530133 ALGISITE 3X3 $29.000007530124 ALGISITE 5X5 $50.000007530065 ALGISITE ROPE $40.000007530445 ALL DRESS 4X4 $17.000007530451 ALL DRESS 6X8 $25.000007503915 ALOE VESTA PERI SPRAY $13.000007501859 AMINOSYN 3.5M $36.000007501752 ANKLE BRACE - AIR STIRUP AIRCO $254.000007501601 ANKLE SUPPORT MED $99.000007530449 ANTERIOR CHAMBER LENS $550.000007530079 AQUACEL 3/4 X 18 $48.000007530078 AQUACEL 4X4 $40.000007501364 ARM ELEVATOR-CUT AWAY (UNIVERS $65.000007501372 ARM SLING SMALL $20.000007530539 ASTRINGYN GEL 8 GM $81.000007530476 BAK FUSION CAGE $6,306.000007531266 BAND. PLAST. FAST 3"" $16.000007514475 BANDAGE ACE 6"" DBL $29.000007530553 BANDAGE ACE STERILE $29.00

Disclaimer

This section includes standard supply-related charges for CRMC Health Care that are billed separately. Other supply-related items may be part of the floor stock and included in the daily room or procedure charge. Unique or custom supply items, such as implants or devices, may not be included in this standard charges listing due to their uniqueness or custom requirements.

0007510241 BANDAGE ELASTIKON 4 $56.000007530510 BANDAGE ESMARK 4"" $25.000007510266 BANDAGE KLING N/S 2"", 3"" & 4 $11.000007513062 BANDAGE KLING N/S 6"" $15.000000105961 BANDAGE TUBIGRIP 3" (D) $16.000760105959 BANDAGE TUBIGRIP 3-1/2" (E) $20.000760105963 BANDAGE TUBIGRIP 4" (F) $21.000007530690 BANDAGE, ACE DOUBL 6 $73.000007531166 BANDAGE, COBAN 2"" $19.000007530099 BANDAGE, COBAN 4"" $31.000007530092 BANDAGE, COBAN 6"" $42.000007531200 BANDAGE, COBAN 6"" $35.000007530886 BANDAGE, GAUZE 6"" $23.000007530818 BANDAGE, PLASTER 4"" $29.000007530819 BANDAGE, PLASTER 6"" $29.000007517022 BANDAID 2 INCH--1 $8.000007503865 BEAR HUGGER MACHINE (PER DAY) $104.000007534260 BED CUSHION SOFT CARE 3 LAYER $175.000007515117 BENZOIN AMPULE $11.000007510720 BETADINE DRSG. $11.000007531282 BETADINE OINTMENT PACK $14.000007501719 BINDER ABD CONT MED $79.000007501721 BINDER ABD ECONOMY LG $87.000007501691 BINDER ABD STANDARD MED $75.000007501693 BINDER ABD STD X-LG $79.000007501331 BINDER ABD X-LG $65.000007534217 BIOGLUE (OR) $2,241.000007534213 BONE DOWEL SPINETECH $1,812.000007530659 BOOT DEM W/SPLING L BX $331.000007530665 BOOT DEM W/SPLINT M BX $331.000007530668 BOOT DEM W/SPLINT X BX $362.000760111249 BOOT MULTI STD/LG. $255.000007530651 BOOT SOFT -CARE GAYMAR $117.000760111251 BOOT SOFT-CARE GAYMAR $99.000007500190 BOOTCAST ROCKER LG $47.000007500191 BOOTCAST ROCKER MED $50.000007500193 BOOTCAST ROCKER SMALL $50.000007530511 BOVIC TIP DISP $54.000007530478 BOVIE CLEANER PAD $12.000007534510 BRA SURGICAL SUPPORT 2X-LARGE $199.000007534511 BRA SURGICAL SUPPORT 3X-LARGE/ $227.000007534507 BRA SURGICAL SUPPORT LARGE $186.000007534509 BRA SURGICAL SUPPORT MEDIUM $181.000007534508 BRA SURGICAL SUPPORT X-LARGE $204.000007501749 BRACE KNEE LARGE $91.000007501748 BRACE KNEE MEDIUM $91.000007501718 BRACE KNEE SMALL $91.00

0007503410 BRACE, AIR ANKLE LEFT $202.000760106567 BREAST PUMPING SYSTEM $146.000007501793 BUCK TRACTION SMALL $91.000007532157 CANNISTER VAC W/GEL $193.000007531386 CANNULA INNER SHIL #4 $23.000007531385 CANNULA INNER SHIL #6 $23.000007531384 CANNULA INNER SHIL #8 $23.000007531448 CANNULA-HYDRO DISSECTION $21.000007530045 CAPSUREFIX 4568 LEAD MEDTRONIC $3,112.000007530055 CAPSUREFIX 5068 LEAD MEDTRONIC $3,112.000760200514 CAST PLASTER SPLINT 3X15 $29.000760200518 CAST PLASTER SPLINT 5 X 30 $53.000007531154 CAST SHOE SMALL $62.000007530976 CAST SHOE, LARGE $108.000007530855 CAST SHOE, MEDIUM $87.000007531342 CASTING TAPE 2"" $33.000007501158 CASTING, FIBERGLASS 3"" $70.000007501166 CASTING, FIBERGLASS 4"" $78.000007501133 CASTING, WEBRIL 3"" $11.000007501141 CASTING, WEBRIL 4"" $21.000007518814 CAST--LONG ARM $123.000007518830 CAST--LONG LEG $140.000007518806 CAST--SHORT ARM $97.000007518822 CAST--SHORT LEG $123.000007530639 CATH OLBERT URETER $1,409.000007501597 CATH SECURE $12.000007530977 CATH, NELATON 10FR $42.000007511256 CATH. GUIDE $47.000760114481 CATHETER SV02/CCO/VIP $1,002.000007532078 CATHETER, YUEH CENTESIS $198.000007530179 CEMENT MIX BOWL $262.000007500002 CENTRAL SUPPLY $0.000007530529 CENTRAL SUPPLY MISC $0.000007501788 CERV COLLAR LARGE $110.000007501787 CERV COLLAR MED $122.000007501422 CERVICAL COLLAR SMALL $126.000007501430 CLAVICLE STRAPS $57.000007502529 CMI EXTRACTOR $133.000007510258 COBAN 4"" BANDAGE $19.000007501448 COCK UP SPLINT-XSML $67.000007530842 COLLAR CERV PHIL LG $243.000007531033 COLLAR CERV PHIL MED $243.000007501732 COLLAR FOAM $31.000007501768 COLLAR FOAM LARGE $44.000007501731 COLLAR FOAM SMALL $44.000007530984 COLOSTMY PO ALL SIZE $21.000007520893 COMPRESSION SCREW $41.00

0007534216 CONNECTOR TRANSVERSE INSERT SP $498.000007534215 CONNECTOR TRANSVERSE NUT SPINE $333.000007534214 CONNECTOR TRANSVERSE SPINETECH $1,222.000007530490 CONRAY 60% $31.000007530377 CORNEA IMPLANT $4,715.000007531316 CREAM MOISTURE BARR $48.000007530469 CROSSLINK $3,190.000007501760 CRUTCHES $146.000000375018 D-10-S.9 1000 $108.000000375017 D-10-W 1000 $91.000000375019 D-20-W 500 $110.000000375015 D-5-LR 1000 $98.000000375016 D-5-LR 500 $81.000000375009 D-5-S .225 1000 $87.000000375011 D-5-S.45 1000 $87.000000375087 D-5-S.45 250 $74.000000375012 D-5-S.9 1000 $87.000000375020 D-5-W 100 $73.000000375006 D-5-W 1000 $78.000000375127 D-5-W 250 ML $70.000000375008 D-5-W 50 $73.000000375007 D-5-W 500 $70.000000375154 DEX 5% SOD CHL 0.2% 250ML $74.000000375158 DEX 5% SOD CL 0.2% 500 ML $74.000000375041 DEXTROSE 10% 250ML $77.000007500005 DIASTAT D47200 $2,166.000007530877 DOME PASTE BAND $60.000007516008 DOME'S PASTE (UNA BOOT) $96.000007530642 DRAPE HAND $73.000007530188 DRAPE INCISE 10 X 16 $54.000007530407 DRESS ADAPTIC NON-ADHESIVE $77.000760110916 DRESS NU-GEL 6 X 8 $36.000760107593 DRESSING ALGISITE 12 $25.000760107589 DRESSING ALGISITE 4X4 $20.000760107869 DRESSING FIBRACOL 4"X4-3/8 $48.000007530237 DRESSING GLASSCOCK $91.000007500124 DRESSING KNEE POST OP LARGE 1 $146.000007500125 DRESSING KNEE POST OP MED 187 $135.000007500123 DRESSING KNEE POST OP SM 1876 $135.000007500128 DRESSING KNEE UNIV 19 INCH 188 $154.000007500129 DRESSING KNEE UNIV 24 INCH $172.000760107757 DRESSING PROFORE 4 $70.000760107759 DRESSING SETOPRESS WRAP 4 $59.000007531314 DRESSING SPONGE 2X2 $12.000007500100 DRESSING TRANS 4X4 3/4 $10.000007500011 DRESSING TRANSPARENT 10X12 TEG $11.000007500012 DRESSING TRANSPARENT 10X25 TEG $15.00

0007532159 DRESSING VAC GRANUFOAM MED $172.000007532160 DRESSING VAC GRANUFOAM THIN $247.000007532156 DRESSING VAC VERSAFOAM LARGE $220.000007532056 DRESSING XERO 1X8 $8.000007532057 DRESSING XERO 5X9 $8.000007530874 DRESSING, NON-AD 3X3 $13.000007531031 DRESSING, SURGIC 8X6 $21.000007512056 DRESSING, TRANSPARENT 6X7 $13.000007518798 DRESSING-TUBE GAUZE $17.000007512015 DRSG ADAPTIC 3 X 8 $23.000007512007 DRSG. ADAPTIC 3X3 $12.000007512031 DRSG-TELFA 3 X 8 AND 3 X 4 $8.000007503873 DUO-DERM C.G.F. $56.000007503881 DUO-DERM EXTRA THIN $19.000007530752 DURAPREP $45.000007500060 EAKINS WOUND MANAGER $181.000007503279 EASI-LAV GASTRIC LAVAGE KIT $551.000007531350 ELASTIC NET SIZE 7 $70.000007501471 ELBOW SPLINTS POSTERIOR-ALL SI $129.000007501786 ELBOW SUPPORT ELASTIC LG $21.000000375025 ELEC M/D5W 1000 $114.000000375026 ELEC R 1000ML $113.000000375027 ELEC R/D5W 1000 $114.000007530898 ELEVATOR, FOOT $196.000007530686 ENDO GIA INST $3,037.000007530684 ENDO SHEARS 5MM $977.000007530433 ESMARK-STERILE OR $25.000007530325 FEMORAL BRUSH $79.000007518848 FIBERGLASS TAPE 2 INCH (PER RO $78.000007518855 FIBERGLASS TAPE 3 INCH (PER RO $99.000007518863 FIBERGLASS TAPE 4 INCH (PER RO $128.000007530147 FIBROCAL 4X4 $48.000007501489 FINGER SPLINTS $35.000000055228 FOLLOWER WOVEN PHILLIPS 14FR $233.000007531477 FOOT COMP UNDER CAST $219.000000107853 GAIT BELT 54" $25.000000107857 GAIT BELT 72" $26.000760200028 GARMENT FOOT LG FLOWTRON $146.000760200549 GARMENT FOOT STANDARD FLOWTRON $146.000760118241 GARMENT SCD CALF EXTRA LARGE $174.000760200655 GARMENT SCD CALF STANDARD $101.000760200705 GARMENT SCD THIGH LARGE $252.000760200711 GARMENT SCD THIGH STANDARD $172.000760116589 GARMENT SDC CALF LARGE $137.000007510274 GAUZE STERILE 2"" $9.000007501824 GAUZE STERILE 3"" $9.000007513070 GAUZE STERILE 4"" $10.00

0007501825 GAUZE STERILE 6 INCH $11.000007512601 GAUZE, 4X4 10'S STERILE $19.000007512585 GAUZE, 4X4 2'S STERILE $11.000007530881 GAUZE, SPONGE 4X4 ST $19.000007530900 GAUZE, VASELINE 3X18 $16.000007512635 GAUZE, VASOLINE 1/2 X 72 $15.000007512627 GAUZE, VASOLINE 1X36 $15.000007512619 GAUZE, VASOLINE 3X9 $12.000007530164 GAUZE, ZEROFORM $15.000007519879 GELFOAM LARGE $81.000007519861 GELFOAM SMALL $40.000007511307 GLIDE WIRE $161.000007500220 GORTEX SRD06005045L OR $2,213.000007530158 GRAFT GORE TEX TRR 4 $3,071.000007530615 GU-GLIDEWIRE MICROVAS $237.000007530014 GU-GUIDEWIRE MV/COOK $78.000007511382 GUIDE PIN RICHARDS $67.000007519895 GUIDE URETERO WIRE $75.000007504178 GUIDE WIRE .032-.035 A-150 $108.000007530662 GUIDE WIRE CAN SCREW 3.0-4.0-4 $99.000007530661 GUIDE WIRE CAN SCREW 7.3 $108.000007504161 GUIDE WIRE TAD $496.000007502438 HALO THORACIC VEST COMBINATION $5,298.000007530640 HEAD BAR DRAPE $16.000760103548 HEEL PROTECTOR PREVALON $242.000007531255 HEMOCULT TEST $13.000007530104 HICKMAN CATHETER $824.000007530533 HIP POSITIONER $98.000007509996 HOME HEALTH SUPPLIES $0.000007530273 HYDROGEL LEADS $61.000007512759 HYDROGEN PEROXIDE $17.000007530491 HYPAQUE 20% $48.000007503550 HYPAQUE 60% $29.000007530302 IMAGYN OUTFLOW CANNULA $31.000007530280 IMAGYN SHEATH $403.000007500132 IMMOBILIZER SHOULDER LG $31.000007500131 IMMOBILIZER SHOULDER MED $31.000007500133 IMMOBILIZER SHOULDER XL $31.000007530852 IMMOBILIZER, ARM/SHO $147.000007530409 IMPLANT TUBE-PE T SILICONE-OR $65.000000114650 INFUSION SET 20GA X .75" $27.000760114652 INFUSION SET SAFETY 20G X 1" $34.000760114657 INFUSION SET SAFETY 20G X 1.5" $34.000007512882 INVALID CUSHION-DONUT $13.000007530550 IODOSORB $50.000007530448 IOL 121UV (STORZ) $550.000007530560 IOL 127UV (STORZ) $516.00

0007531424 IOL ALCON LABS $796.000007530687 IOL P434 (STORZ) $516.000007530559 IOL P507UV (STORZ $516.000760101813 IV 1A0062 DEXTROSE 5% 250ML $21.000760101811 IV 1A0213 DEXTROSE 20% 500ML $21.000760101795 IV 1A0694 INTRO 50MG D5W 250ML $27.000760101800 IV 1A8502 EMPTY BOTTLE 250ML $21.000760101803 IV 1A8504 EVACUATED CONT 1L $19.000760101812 IV 1B6624 TRAVASOL 10% 1000ML $66.000760101849 IV 1B6626P TRAVASOL 10% INJ. $128.000760101778 IV 2B0062Q D5W 250ML $21.000760101773 IV 2B0063Q D5W 500ML $21.000760101756 IV 2B0064X D5W 1000ML $21.000760101799 IV 2B0086 D5W 50ML $21.000760101801 IV 2B0087 DRW 100ML $21.000760101847 IV 2B0162Q DEX 10% W/250ML $21.000760101776 IV 2B0164X D10W 1000ML $21.000760101810 IV 2B0296H DEXTROSE 70% 2000ML $48.000760101783 IV 2B0793 DOBUTAMINE 1000MG/D5 $63.000760101779 IV 2B0802 HEP 25000U SC 0.45 $21.000760101846 IV 2B0821 POTASSIUM CHL 10 $21.000760101781 IV 2B0846 DOPAMINE 800MG D5W $57.000760101758 IV 2B1064X D5 SOC CHLOR 0.9% $21.000760101754 IV 2B1074 D5 SOD CHL 0.45% $21.000760101784 IV 2B1092Q D5 SOD CHL 0.2% 250 $20.000760101755 IV 2B1094X D5 SOD CHLOR 0.225% $21.000760101769 IV 2B1306 SOD CHL 0.9% 5ML $21.000760101770 IV 2B1307 SOD CHL 0.9% 100ML $21.000760101759 IV 2B1314X SOD CHLOR 0.45% $21.000760101771 IV 2B1321 SOD CHL 0.9% 150ML $21.000760101772 IV 2B1322Q SOD CHL 0.9% 250ML $21.000760101753 IV 2B1323Q SODIUM CHL 0.9% 500 $21.000760100297 IV 2B1324X SOD CHL 0.9% 1000ML $21.000760101752 IV 2B1654 SOD CHL 0.45 1000 $21.000760101838 IV 2B1674X D5SC 0.45% KCL 40 $21.000760118584 IV 2B1764X POT CHL 0.9% 1000ML $21.000760101792 IV 2B2073Q D5 LR 500ML $21.000760101757 IV 2B2074X D5 LR 1000ML $21.000760101788 IV 2B2323Q LACT RINGERS 500ML $21.000760101760 IV 2B2324X LACTATED RINGERS $21.000760101751 IV 2B2534 PLASMA LYTE 148 1000 $21.000760101851 IV 2B2543Q PLASMA LYTE A $21.000760101750 IV 2B2574X PLASMA LYTE 56 D5W $21.000760101806 IV 2B6012 INTRALIPID 10% 250ML $47.000760101802 IV 2B6013 INTRALIPID 10% 500ML $42.000760101808 IV 2B6022 INTRALIPID 20% 250ML $39.000760101804 IV 2B6023 INTRALIPID 20% 500ML $63.00

0760101824 IV 2B6554 TRAVESOL 3.5% $35.000760101761 IV 2B7114X WATER FOR IRRG 1000 $21.000760101762 IV 2B7117 WATER FOR IRRIG 3000 $35.000760101763 IV 2B7127 SOD CHL IRRIG 3000ML $35.000760101764 IV 2B7317 GLYCINE IRRIG 3000ML $40.000760101814 IV 2B8086 ALL IN ONE 2000ML $35.000760101816 IV 2B8087 ALL IN ONE 3000ML $41.000760101842 IV 2C8750 CLEAR LINK BLOOD SET $25.000760101828 IV 2D5632Q MANNITOL 20% 250ML $56.000760101832 IV 2N9060 FLOLINK IV ACCESS $21.000007531439 JELLY LUBRICATING LGE $12.000007530581 JELLY LUBRICATING SMALL $17.000007513161 KERLIX GAUZE RLS. $25.000007513146 KERLIX SUPER SPONGES 10'S $9.000007513153 KERLIX SUPER SPONGES 2'S $11.000760200302 KIT MONITOR TRANSPAC IV 84 $54.000007532158 KIT MOUTH CARE Q-CARE CLEANSER $171.000007532154 KIT MULTILUMEN 535FR $368.000760200074 KIT PRESSURE MONITOR TRIF $171.000007501521 KNEE DRESSING NEOPRINE $423.000007531437 KNEE IMMOB-RANGER $545.000007501810 KNEE SUPPORT HINGE LG $87.000007501539 KNEE SUPPORT-VELCRO $78.000000375034 LACTATED RINGERS 500 ML $81.000007501554 LEG SPLINTS POSTERIOR SHORT $255.000007501547 LEG SPLINTS POSTERIOR-LONG $235.000000375021 LR 1000 $103.000007530514 LUMBAR-SACRAL CORSET $425.000007530551 MEPITEL 2X3 $37.000007530552 MEPITEL 3X4 $48.000007530556 MEPITEL 4X8 $88.000007530557 MEPITEL 9X12 $205.000007530457 MESALT 4X4 $36.000007530647 MESH COMPOSIX 10X13 $5,429.000007530643 MESH COMPOSIX 4X6 $1,542.000007530645 MESH COMPOSIX 6X8 $2,598.000007530646 MESH COMPOSIX 8X10 $4,297.000007534208 MESH COMPOSIX KUGEL MED OVAL $2,355.000007534207 MESH COMPOSIX KUGEL SM OVAL $1,648.000007534209 MESH COMPOSIX LARGE CIRCLE $2,264.000007530743 MESH PROLENE 3X5 SPM 35W $145.000007531080 MULTI-LUMEN CATH $457.000007500812 NASAL AIRWAY $47.000007531351 NASAL PACKING 8.0 CM $38.000007510804 NEEDLE BIOPSY BIOPTY CUT 18 G $103.000760100155 NEEDLE HUBER 19G X 1-1/4 $34.000760100153 NEEDLE HUBER 19G X 3/4 $34.00

0760200068 NEEDLE HUBER 20G X 1 $34.000760100151 NEEDLE HUBER 22G X 1 $34.000007519457 NU GAUZE IOD 1/2"" $31.000007513807 NU GAUZE IODO 1"" BTL. $35.000007513815 NU GAUZE PLAIN 1/2"" $25.000007519440 NU GAUZE PLAIN 1"" BTL. $38.000007501826 NUGAUZE 1/4 X 5 $25.000007503907 NUGEL 3 X 3 $21.000007503899 NUGEL 6 X 8 $47.000007530405 NUGEL COLLAGEN 90G $25.000007534211 NUT LOCKING SPINETECH $521.000007530100 OPERATING ROOM MISC $0.000007530212 OR SKIN MARKER $15.000760200025 ORTHO ABDOMINAL BINDER 30-45 $48.000760200029 ORTHO ABDOMINAL BINDER 46-62 $48.000760200262 ORTHO ARM SLING CHILD $25.000760200676 ORTHO ARM SLING LARGE $20.000760200678 ORTHO ARM SLING MEDIUM $20.000760200674 ORTHO ARM SLING SMALL $20.000760111476 ORTHO BRACE ANKLE UNIVERSAL $103.000760201170 ORTHO CAST SHOE LARGE $34.000760201166 ORTHO CAST SHOE MEDIUM $34.000760111922 ORTHO COCK UP SPLINT LG LT $63.000760111914 ORTHO COCK UP SPLINT LG RT $63.000760111906 ORTHO COCK UP SPLINT M LT $63.000760111898 ORTHO COCK UP SPLINT M RT $63.000760111880 ORTHO COCK UP SPLINT SM LT $63.000760111872 ORTHO COCK UP SPLINT SM RT $63.000760112482 ORTHO COLLAR CERV MIAMI LARGE $238.000760112484 ORTHO COLLAR CERV MIAMI MED $238.000760112477 ORTHO COLLAR CERV MIAMI SLEND $238.000760112479 ORTHO COLLAR CERV MIAMI SMALL $238.000760112473 ORTHO COLLAR CERV MIAMI STOUT $238.000007534504 ORTHO COLLAR CERV. MIAMI J.MED $238.000007534505 ORTHO COLLAR CERV. MIAMI J.SLE $238.000007534506 ORTHO COLLAR CERV. MIAMI J.SMA $238.000007534503 ORTHO COLLAR CERV. MIAMI J.STO $238.000760200251 ORTHO COLLAR CERVICAL UNIV. $31.000760200680 ORTHO ELEVATOR FOOT $59.000760103465 ORTHO HEEL PADS $25.000760200210 ORTHO IMMOBOLIZER ARM SHOULDER $35.000760200212 ORTHO KNEE IMMOB.20 $70.000760200022 ORTHO KNEE IMMOB.22 $73.000760201160 ORTHO KNEE IMMOB.26 $171.000760112060 ORTHO PHIL CERVICAL COLLAR LRG $63.000760112052 ORTHO PHIL CERVICAL COLLAR MED $63.000760112045 ORTHO PHIL CERVICAL COLLAR SM. $63.00

0760200250 ORTHO SHOE POST OP MENS LG $29.000760200246 ORTHO SHOE POST OP MENS MED $29.000760200260 ORTHO SHOE POST OP WOMENS LGE $29.000760200208 ORTHO SHOE POST OP WOMENS MED $29.000760200258 ORTHO SHOE POST OP WOMENS SM $29.000760201164 ORTHO SPLINT BUCKS TRACTION $89.000760200230 ORTHO SPLINT COLLES LG LT $34.000760200238 ORTHO SPLINT COLLES LG RT $34.000760200202 ORTHO SPLINT COLLES MED LEFT $34.000760200220 ORTHO SPLINT COLLES MED RIGHT $29.000760200209 ORTHO SPLINT WRIST INFANT LF $25.000760200211 ORTHO SPLINT WRIST LG RT $47.000760200234 ORTHO SPLINT WRIST MED LT $47.000760200222 ORTHO SPLINT WRIST MED RT $47.000760200016 ORTHO STRAP CLAVICLE INFANT $45.000760200018 ORTHO STRAP CLAVICLE LG $45.000760200254 ORTHO STRAP CLAVICLE MED $45.000760200252 ORTHO STRAP CLAVICLE SM $45.000760200264 ORTHO STRAP CLAVICLE XL $48.000006530046 ORTHO SUPPORT LARGE $29.000760102707 ORTHO SUPPORT LARGE SWIM $31.000760104125 ORTHO SUPPORT MEDIUM $31.000006530045 ORTHO SUPPORT MEDIUM $29.000760104133 ORTHO SUPPORT SMALL $31.000006530044 ORTHO SUPPORT SMALL $33.000006530047 ORTHO SUPPORT X-LARGE $14.000006530048 ORTHO SUPPORT XX-LARGE $14.000007511686 OSTOMY 2 3/4 STERILE 020930 $37.000007511645 OSTOMY 4 INCH STERILE 020934 $87.000007530735 OSTOMY ACTIVE LIFE POUCH 12: $29.000007500045 OSTOMY ACTIVE POUCH $16.000760105841 OSTOMY ADHESIVE PASTE $29.000007530731 OSTOMY BARRIER WIPES $50.000760200697 OSTOMY BARRIER WIPES ALLKARE $50.000007530730 OSTOMY CLAMP $12.000007530747 OSTOMY DURAHESIVE 1 3/4"" FLAN $23.000760105992 OSTOMY DURAHESIVE 1-3/4 FLANGE $23.000007530729 OSTOMY IRRIGATION CONE $66.000760105908 OSTOMY IRRIGATION CONE $66.000007530748 OSTOMY IRRIGATION SLEEVE 2 3/4 $23.000007518541 OSTOMY PASTE 1839-01 $33.000007530768 OSTOMY POUCH COLOSTOMY 2 3/4"" $12.000007530751 OSTOMY POUCH UROSTOMY 1 3/4"" $14.000760200690 OSTOMY PROTECTIVE OINTMENT $31.000007530716 OSTOMY PROTECTIVE STOMASIVE PO $20.000007530715 OSTOMY SEAL EAKIN $20.000760105887 OSTOMY SEAL EAKIN $20.00

0007534254 OSTOMY STOMAHESIVE 8X8 BARRIER $47.000760201222 OSTOMY STOMAHESIVE 8X8 BARRIER $47.000007530734 OSTOMY SUR-FIT DURA 2 3/4"" $18.000007530749 OSTOMY SUR-FIT POUCH 1 3/4"" $14.000007530763 OSTOMY SUR-FIT POUCH 4"" $17.000007530741 OSTOMY SUR-FIT STOMSIVE 4"" $33.000007530744 OSTOMY UROSTOMY 2 3/4"" SUR-FI $18.000007513765 PACEMAKER LEAD-TEMP. $445.000760102939 PACKING GAUZE IODO 1 $21.000760102921 PACKING GAUZE IODO 1/2" $19.000760102962 PACKING GAUZE PLAIN 1 $19.000760102963 PACKING IODOFORM 2" $20.000760200780 PAD DUOTHERM 15X22 $31.000760200776 PAD DUOTHERM 18 X 26 $35.000760200778 PAD DUOTHERM 25 X 64 $75.000007530940 PAD, MATERNITY STER $10.000760106435 PERCUTANEOUS 9FR. SHEATH $194.000007500106 PEROXIDE $11.000007501570 PHIL CERVICAL COLLAR $147.000007501747 PILLOW ABDUCTION SMALL $237.000007530071 PIN COVER, OR $11.000007518764 PIN RIORDIN FIXATION $62.000007519473 PLASTER BANDAGE 2"" $11.000007513856 PLASTER BANDAGE 3"" $11.000007519481 PLASTER BANDAGE 4"" $15.000007519499 PLASTER BANDAGE 6"" $19.000007517451 PLASTER SPLINT ROLLS 3"" (PER $35.000007517469 PLASTER SPLINT ROLLS 4"" (PER $15.000007517527 PLASTER SPLINT ROLLS 5"" (PER $47.000007517477 PLASTER SPLINT ROLLS 6"" (PER $15.000007502594 PLATE SUPRA COND FEMUR $1,965.000007503220 PLATES-DCP 20MM $468.000007503139 PLATES-DYNAMIC COMPRESSION $569.000007502941 PLATES-SPECIAL (SPOON) 240.5-2 $777.000000112885 POSITIONER BODY 24"X8.5"X11" $51.000007532155 POST OP BRA $158.000007501588 POST OP SHOES MENS 9-11 $37.000007501792 POST OP SHOES LADIES 6-8 $37.000007501791 POST OP SHOES LADIES 8-10 $37.000007501790 POST OP SHOES MENS 11+ $37.000007501789 POST OP SHOES MENS 7-9 $37.000007530251 POUCH IRRIGATION (3M) $78.000760200479 POWDER PROTECTIVE STOMAHESIVE $20.000007503311 PRIMAPORE 10X3 1/4 $15.000007503303 PRIMAPORE 7X3 1/4 $15.000007503295 PRIMAPORE SMALL $10.000007517436 REINFORCING STRIPS FIBERGLASS $108.00

0007530867 RIB BELT, UNIV MENS $61.000007501605 RIBBELT CONTOUR MED $38.000007501609 RIBBELT STANDARD LG $40.000007534212 ROD CONNECTING 5.5X20 SPINETEC $1,159.000007530472 ROTICULATOR 55 $1,657.000007530532 RT SPEAKING VALVE TRACHEOSTOMY $360.000007530530 RT SPEAKING VALVE VENTILATOR $360.000007531403 SAW BLADE $334.000007530446 SCREW CORTEX 35MM $56.000007534210 SCREW VERTEBRAL SPINETECH $2,468.000007502602 SCREW-AMBI HEX DRIVE BONE 4.5M $226.000007514904 SCROTAL SUPPORT-SUSPENSORY ALL $42.000007531336 SEEDS MISC SUPPLY $0.000007534500 SENSOR PROBE ADULT DISPOSABLE $56.000007534502 SENSOR PROBE CHILD DISPOSABLE $56.000007534501 SENSOR PROBE INFANT DISPOSABLE $67.000007530058 SET IV PC4 W/PORT $48.000007530543 SETOPRESS $12.000007500197 SHOE CAST ROCKER MED $38.000007501869 SHOULDER IMMOBILIZER VELPEAU S $29.000007501612 SHOULDER IMMOBILIZERS-STANDARD $91.000007531149 SHOULDER IMMOBOLIZER $73.000007501802 SHUR CLENS AND OPTISPORE SPONG $23.000007530952 SILVER NITRATE STICKS $17.000007531085 SKIN BARRIERS $25.000007530953 SKIN GEL $29.000007531992 SKIN MESHER PLATE $163.000007530228 SKIN PROTECTANT PAST $31.000007500188 SLING ARM ELEVATOR $47.000007501744 SLING ARM LARGE $31.000007501746 SLING ARM MEDIUM $29.000007501743 SLING ARM PEDS $29.000007501688 SLING FOREARM LG $29.000007501689 SLING FOREARM MED $29.000007501690 SLING FOREARM SMALL $29.000007530369 SLING, ULTRA X-LG $314.000007530766 SLIPPER SHOWER NON-SKID LG $41.000007530717 SLIPPER SHOWER NON-SKID MED $41.000007530728 SLIPPER SHOWER NON-SKID X-LG $41.000000375036 SOD CHL .9 150 $70.000000375037 SOD CHL .45 1000 $78.000000375081 SOD CHL .9 100 $73.000000375030 SOD CHL .9 1000 $73.000000375031 SOD CHL .9 500 $70.000000375106 SOD CHL 0.9% 250 $70.000000375105 SOD CHL 0.9% 50 PF $73.000000375114 SODIUM CHLORIDE .45% 500RL $73.00

0000427336 SODIUM CHLORIDE 0.9% 3000 IRRI $0.000000375113 SODIUM LACTATE $120.000007530075 SOF FOAM 4X5 $17.000007530074 SOF FOAM 4X8 $21.000007517519 SPANDAGE NETTING 10 INCH (PER $23.000007517485 SPANDAGE NETTING 3"" & 5"" (PE $11.000007517493 SPANDAGE NETTING 7 INCH (PER F $15.000007517501 SPANDAGE NETTING 9 INCH (PER F $15.000760200877 SPEAKING VALVE TRACH $314.000760200873 SPEAKING VALVE VENTILATOR $269.000007530507 SPECIALITY BED $320.000007500118 SPLIN CLAVICLE SMALL $41.000007531153 SPLINT BUCK TRACTION $241.000007500116 SPLINT CLAVICLE LG $40.000007500117 SPLINT CLAVICLE MED $45.000007500120 SPLINT CLAVICLE XL $42.000007500121 SPLINT CLAVICLE XSM $40.000007501759 SPLINT COCKUP LEFT LARGE $65.000007501763 SPLINT COCKUP LEFT MED $65.000007501765 SPLINT COCKUP LEFT SMALL $65.000007501762 SPLINT COCKUP LEFT XSML $65.000007501761 SPLINT COCKUP RIGHT LARGE $65.000007501764 SPLINT COCKUP RIGHT MED $65.000007501766 SPLINT COCKUP RIGHT SMALL $65.000007501696 SPLINT COLLES LEFT LARGE $93.000007501697 SPLINT COLLES LEFT MED $83.000007501698 SPLINT COLLES LEFT SMALL $83.000007501699 SPLINT COLLES RIGHT LG $83.000007501700 SPLINT COLLES RIGHT MED $83.000007501701 SPLINT COLLES RIGHT SM $89.000007501682 SPLINT FINGER 4 PRONG LG $12.000007501683 SPLINT FINGER 4 PRONG MED $12.000007501684 SPLINT FINGER 4 PRONG SMALL $12.000007501705 SPLINT FINGER BASEBALL $25.000007501706 SPLINT FINGER FOLD OVER LG $15.000007501707 SPLINT FINGER FOLD OVER MED $13.000007501708 SPLINT FINGER FOLDOVER SM $15.000007501702 SPLINT FINGER FROG MED $15.000007501704 SPLINT FINGER FROG SMALL $16.000007501876 SPLINT FINGER GUTTER LARGE $12.000007501875 SPLINT FINGER GUTTER MEDIUM $12.000007501874 SPLINT FINGER GUTTER SMALL $12.000007501673 SPLINT FINGER LONG MED $13.000007501674 SPLINT FINGER NARROW LONG $11.000007501676 SPLINT FINGER STRAIGHT LONG $16.000007501677 SPLINT FINGER STRAIGHT NARROW $12.000007501678 SPLINT FINGER STRAP $17.00

0007501675 SPLINT FINGER WIDE LONG $11.000007501655 SPLINT FOREARM LEFT MED $56.000007501656 SPLINT FOREARM LEFT SMALL $48.000007501659 SPLINT FOREARM RIGHT LARGE $31.000007501660 SPLINT FOREARM RIGHT MED $29.000007501662 SPLINT FOREARM RIGHT SMALL $29.000007501670 SPLINT LEG POST MED $70.000007531212 SPLINT PLASTER 4X15 $23.000007531119 SPLINT ROLL OCL 3"" $41.000007501796 SPLINT WRIST LARGE $29.000007501797 SPLINT WRIST MED $25.000007501798 SPLINT WRIST SMALL $21.000007517444 SPLINT-SUGAR TONG 2 INCH (PER $21.000007531082 SPONGE KERLIX SUPER $19.000007503329 SPRING WIRE GUIDE $40.000007534200 SR10 GUIDEWIRE $605.000007511353 ST. FLUTED 5059-222 $208.000007530336 STAPLER FACIA $377.000007511371 STEINMAN PIN $56.000007517360 STOCINETTE FIBERGLASS 2"" (PER $15.000007511394 STOCKINET 4 INCH $298.000007517378 STOCKINETTE FIBERGLASS 3"" (PE $17.000007517386 STOCKINETTE FIBERGLASS 4"" (PE $23.000007517394 STOCKINETTE FIBERGLASS 6"" (PE $19.000007530486 STOCKINETTE MED $67.000007514870 STOCKINETTE,STERILE 2,3,&4 INC $29.000007514847 STOCKINETTE-IMP-STERILE $83.000007500705 STOCKINETTE-STER/UNSTR $35.000006530051 STOCKING THIGH HIGH LARGE $27.000006530050 STOCKING THIGH HIGH MEDIUM $18.000006530049 STOCKING THIGH HIGH SMALL $18.000006530052 STOCKING THIGH HIGH X-LARGE $39.000007501773 SUPPORT ELBOW ELASTIC MED $23.000007501733 SUPPORT ELBOW ELASTIC SM $21.000007501709 SUPPORT KNEE PATELLAR LG $185.000007530083 SUREPRESS $12.000007532135 SURGICAL SUPPORT BRA $89.000007530205 SURGICEL 2X3 $145.000007530206 SURGICEL 4X8 $263.000007500150 SURGICEL LARGE $137.000007500135 SURGICEL SMALL $38.000007530623 SURGINEEDLE REG $195.000007530479 SYRINGE TOOMEY $21.000007500008 TEGADERM TRANS DRESSING 2X2 $8.000007500007 TEGADERM TRANSPARENT 20X30 DRE $11.000007501620 THUMB SPLINTS-LEWIN ST $78.000007530069 TIELLE $44.00

0007530070 TIELLE 5 7/8 $50.000760108312 TRACH PERCUTANEOUS 7.0MM KIT $1,195.000760108311 TRACH PERCUTANEOUS 8.0MM KIT $1,195.000007530130 TRAY, LAPAROSCOPY $545.000007530841 TRAY, SUCTION CATH $21.000007530624 TROCAR DISP 10M $593.000007530419 TROCAR DISP 10MM $654.000007530418 TROCAR DISP 5MM $537.000007502545 T-SCREWS $870.000760102131 TUBE COLON N/S 22F $57.000760105726 TUBE FEEDING 10FR $42.000007530931 TUBE, TRACHCANNULA 4 $392.000007530086 TUBIGRIP C 2 3/4 $27.000007530150 TUBIGRIP D 3"" $31.000007530085 TUBIGRIP E 3 1/2 $25.000007532077 ULTRA SLING $269.000007503110 UN REAM TIB NAIL $2,886.000760107599 UNNA BOOT 3" X 10 YDS $35.000007532055 UNSTERILE SUPPLY $61.000007530482 UTILITY DRAPE $13.000760200606 VALVE HEIMLICH CHEST DRAIN $56.000007503287 VENI LOOP $11.000007511389 WEBRAP 3 INCH $12.000007511390 WEBRAP 4 INCH $12.000007501830 WEBRIL 6"" $65.000007519507 WEBRIL TWO INCH $87.000007517402 WEBRIL WRAP 2"" (PER ROLL) FIB $16.000007517410 WEBRIL WRAP 3"" (PER ROLL) FIB $25.000007517428 WEBRIL WRAP 4"" (PER ROLL) FIB $33.00

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