[xls]sutter medical center general memorial - ca · web viewoxybutynin 1mg/ml syrup (peds)...

AB 1045 - List of 25 CommonOutpatient Procedures for 2011

AB 1045 (May 2011)

Hospital Name: Sutter Memorial Hospital-SMCOSHPD Facility No: 106341052Effective Date of Charges: June 1, 2011Evaluation & Management Services (CPT Codes 99201-99499)

Emergency Room Visit, Level 2 99282 794.00Emergency Room Visit, Level 3 99283 1,322.00Emergency Room Visit, Level 4 99284 2,025.00Laboratory & Pathology Services (CPT Codes 80048-89356)

Basic Metabolic Panel 80048 225.00Comprehensive Metabolic Panel 80053 284.00Lipid Panel 80061 364.00Creatine Kinase (CK), (CPK), Total 82550 172.00Blood Gas Analysis, including 02 saturation 82805 422.00Thyroid Stimulating Hormone 84443 450.00Troponin, Quantitative 84484 265.00Complete Blood Count, with differential WBC, automated 85025 205.00Complete Blood Count, automated 85027 172.00Prothrombin Time 85610 106.00Partial Thromboplastin Time 85730 159.00Radiology Services (CPT Codes 70010-79999)

CT Scan, Head or Brain, without contrast 70450 2,507.00X-Ray, Chest, two views 71020 220.00X-Ray, Lumbo Sacral, four views 72110 422.00CT Scan, Pelvis, with contrast 72193 3,821.00CT Scan, Abdomen, with contrast 74160 4,348.00Ultrasound, Abdomen, Complete 76700 911.00Ultrasound, OB, 14 weeks or more, single fetus, transabdominal 76805 911.00Mammography, Screening, Bilateral 77057 496.00Medicine Services (CPT Codes 90281-99607)

Electrocardiogram 12 Lead Tracing Only 93005 263.00Echocardiography, complete 93307 1,957.00Inhalation Treatment, pressurized or nonpressurized 94640 250.00Surgery Services (CPT Codes 10021-69990)

Arthroscopy, Knee, with meniscectomy (medial or lateral) 29881Arthroscopy, Shoulder, with partial acromioplasty 29826Carpal Tunnel Surgery 64721Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984Colonoscopy, diagnostic 45378 5,609.30Colonoscopy, with biopsy 45380Colonoscopy, with lesion removal, by snare technique 45385 5,312.04Discission, secondary membranous cataract, laser surgery 66821Endoscopy, Upper GI, with biopsy 43239 8,086.61Endoscopy, Upper GI, diagnostic 43235 5,147.38Excision, Breast Lesion 19120Hernia Repair, Inguinal, 5 years and older 49505 17,466.19Injection, Diagnostic or Therapeutic substance, epidural, sacral 62311Injection, Anesthetic or Steroid, transforaminal epidural, sacral 64483Laparoscopic Cholecystectomy 47562Tympanostomy (insert ventilating tube, general anesthesia) 69436 10,116.56Tonsillectomy with Adenoidectomy, less than 12 years old 42820 14,538.63Count of Reported Procedures (minimum 25 required) 32

2011 CPT Code

Outpatient Charge Amount

2011 CPT Code

2011 CPT Code

2011 CPT Code

2011 CPT Code

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BILLING DESCRIPTION DEPARTMENT DESCRIPTION

1711308 AD AUDIOMETRY COMP $374.00 $255.00 $161.75 17 AMBULATORY SERVICES (MISC1711316 AD AUDIOMETRY COMP $374.00 $255.00 $219.75 17 AMBULATORY SERVICES (MISC1710342 AD AUDIOMETRY COMP $374.00 $255.00 $161.75 17 AMBULATORY SERVICES (MISC1712041 AD AUDIOMETRY SCREENING $98.00 17 AMBULATORY SERVICES (MISC1710060 AD E-ACOUST ANALY H AID $84.00 $57.00 $90.75 17 AMBULATORY SERVICES (MISC1710532 AD EVAL ABR $688.00 $469.00 $355.25 17 AMBULATORY SERVICES (MISC1710839 AD EVAL ABR $688.00 $469.00 17 AMBULATORY SERVICES (MISC1710938 AD EVAL ABR $688.00 $469.00 $31.00 17 AMBULATORY SERVICES (MISC1710847 AD EVAL ABR $688.00 $469.00 $311.50 17 AMBULATORY SERVICES (MISC1710078 AD EVAL HEAR AID BIN $239.00 $163.00 $135.50 17 AMBULATORY SERVICES (MISC1711571 AD EVAL OAE $199.00 17 AMBULATORY SERVICES (MISC1712033 AD EVAL PEDS >3 VRA $242.00 17 AMBULATORY SERVICES (MISC1710425 AD EVAL SP/LNG/COM/AUD 30 $351.00 $240.00 $25.00 17 AMBULATORY SERVICES (MISC1710557 AD HEAR AID CHECK BIN $389.00 $265.00 $71.25 17 AMBULATORY SERVICES (MISC1711753 AD HEAR AID REPAIR $300.00 17 AMBULATORY SERVICES (MISC1711746 AD HEAR AID REPAIR $500.00 17 AMBULATORY SERVICES (MISC1711563 AD SCRN OAE $155.00 17 AMBULATORY SERVICES (MISC1711951 AD SCRN OAE $155.00 17 AMBULATORY SERVICES (MISC1711944 AD SCRN OAE $155.00 17 AMBULATORY SERVICES (MISC1710524 AD SCRN PURE TONE AIR $101.00 $69.00 $77.00 17 AMBULATORY SERVICES (MISC1712215 AD SP THRESHOLD/ DISCRIM $53.00 17 AMBULATORY SERVICES (MISC1710540 AD TEST ELECTROACOUST BIN $150.00 $102.00 $57.00 17 AMBULATORY SERVICES (MISC1712256 AD TEST ELECTROACOUST MON $80.00 17 AMBULATORY SERVICES (MISC1711027 AD TEST ELECTROACOUST MON $80.00 $54.00 $34.00 17 AMBULATORY SERVICES (MISC1710854 AD TYMPANOMETRY $164.00 $112.00 $56.00 17 AMBULATORY SERVICES (MISC1720846 AUD OSSEO DEV EX SND PROC 17 AMBULATORY SERVICES (MISC1712231 EAR MOLD/INSERT NOT DISP 17 AMBULATORY SERVICES (MISC1720663 EPSDT HEARING AID 17 AMBULATORY SERVICES (MISC1720671 EPSDT HEARING AID 17 AMBULATORY SERVICES (MISC1712199 EVAL DIFFICULT TO TEST PA $127.12 17 AMBULATORY SERVICES (MISC1712272 FUNCTIONAL GAIN TESTING $130.00 17 AMBULATORY SERVICES (MISC1790278 HA BATTERIES (EACH) $0.70 17 AMBULATORY SERVICES (MISC1711589 HEARING AID ACCESSORY $35.00 17 AMBULATORY SERVICES (MISC1720838 HEARING AID ACCESSORY 17 AMBULATORY SERVICES (MISC1712017 HEARING AID ACCESSORY $18.00 17 AMBULATORY SERVICES (MISC1711613 HEARING AID ACCESSORY $6.00 17 AMBULATORY SERVICES (MISC1711621 HEARING AID ACCESSORY $4.00 17 AMBULATORY SERVICES (MISC

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1711597 HEARING AID ACCESSORY $8.00 17 AMBULATORY SERVICES (MISC1711662 HEARING AID ACCESSORY $90.00 17 AMBULATORY SERVICES (MISC1711605 HEARING AID ACCESSORY $12.00 17 AMBULATORY SERVICES (MISC1711647 HEARING AID ACCESSORY $18.00 17 AMBULATORY SERVICES (MISC1711654 HEARING AID ACCESSORY $9.00 17 AMBULATORY SERVICES (MISC1711688 HEARING AID ACCESSORY $59.00 17 AMBULATORY SERVICES (MISC1711985 HEARING AID ACCESSORY $47.00 17 AMBULATORY SERVICES (MISC1712025 HEARING AID ACCESSORY 17 AMBULATORY SERVICES (MISC1711639 HEARING AID ACCESSORY $7.00 17 AMBULATORY SERVICES (MISC1720556 HEARING AID BINAURAL CIC $795.00 17 AMBULATORY SERVICES (MISC1720713 HEARING AID BINAURAL CIC $935.00 17 AMBULATORY SERVICES (MISC1720689 HEARING AID BTE $1,900.00 17 AMBULATORY SERVICES (MISC1720739 HEARING AID MONAURAL CIC $795.00 17 AMBULATORY SERVICES (MISC1720820 HEARING AID NOC $3,800.00 17 AMBULATORY SERVICES (MISC1720721 HEARING AID PROG BIN CIC $2,395.00 17 AMBULATORY SERVICES (MISC1720747 HEARING AID PROG MON CIC $935.00 17 AMBULATORY SERVICES (MISC1720754 HEARING ID DIGIT MON CIC $2,395.00 17 AMBULATORY SERVICES (MISC1712132 INITIAL AUDIO OFFICE VISI $107.25 17 AMBULATORY SERVICES (MISC1712140 INITIAL AUDIO OFFICE VISI $97.50 17 AMBULATORY SERVICES (MISC1712157 INITIAL AUDIO OFFICE VISI $87.75 17 AMBULATORY SERVICES (MISC1718782 METHADONE 5MG PO 17 AMBULATORY SERVICES (MISC1710326 S NSTRL AD CUSTOM EARMOLD $70.00 $70.00 $45.50 17 AMBULATORY SERVICES (MISC1710946 S NSTRL AD CUSTOM EARMOLD $65.00 $65.00 $65.00 17 AMBULATORY SERVICES (MISC1710961 S NSTRL AD HEAR AID BIN B $2,693.00 $2,693.00 $1,473.00 17 AMBULATORY SERVICES (MISC1710995 S NSTRL AD HEAR AID MON B $3,521.00 $3,521.00 $1,926.00 17 AMBULATORY SERVICES (MISC1720572 S NSTRL AD HEAR AID REPAI $131.00 17 AMBULATORY SERVICES (MISC1712124 S NSTRL BASIC DIG HEAR AI $2,200.00 17 AMBULATORY SERVICES (MISC1720705 S NSTRL BASIC MONAURAL DI $1,272.00 17 AMBULATORY SERVICES (MISC1720622 S NSTRL EASY LISTEN SYS $900.00 17 AMBULATORY SERVICES (MISC1720234 S NSTRL FM AUDITORY TRAI $1,402.50 $1,402.50 17 AMBULATORY SERVICES (MISC1720374 S NSTRL HEARING AID $3,800.00 $3,800.00 17 AMBULATORY SERVICES (MISC1720010 S NSTRL HEARING AID $1,140.00 $1,140.00 17 AMBULATORY SERVICES (MISC1720333 S NSTRL HEARING AID $2,400.00 17 AMBULATORY SERVICES (MISC1711001 S NSTRL HEARING AID BONE $1,864.00 17 AMBULATORY SERVICES (MISC1720192 S NSTRL HEARING AID BTE $808.50 $808.50 17 AMBULATORY SERVICES (MISC1720341 S NSTRL HEARING AID DIGIT $4,800.00 17 AMBULATORY SERVICES (MISC1720176 S NSTRL HEARING AID POWER $2,800.00 $2,800.00 17 AMBULATORY SERVICES (MISC

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1720366 S NSTRL HEARING AID POWER $2,280.00 $2,280.00 17 AMBULATORY SERVICES (MISC1720143 S NSTRL HEARING AID PROGR $1,900.00 $1,900.00 17 AMBULATORY SERVICES (MISC1720564 S NSTRL HEARING AID RECAS $75.00 17 AMBULATORY SERVICES (MISC1711738 S NSTRL HEARING AID REMOT $293.00 17 AMBULATORY SERVICES (MISC1720002 S NSTRL HEARING AID STAND $1,100.00 $1,100.00 17 AMBULATORY SERVICES (MISC1720804 S NSTRL ITE/ITC DIG $710.00 17 AMBULATORY SERVICES (MISC1720762 S NSTRL ITE/ITC DIG $520.00 17 AMBULATORY SERVICES (MISC1720770 S NSTRL ITE/ITC DIG $710.00 17 AMBULATORY SERVICES (MISC1720788 S NSTRL ITE/ITC DIG $2,175.00 17 AMBULATORY SERVICES (MISC1720796 S NSTRL ITE/ITC DIG $520.00 17 AMBULATORY SERVICES (MISC1720812 S NSTRL ITE/ITC DIG $2,175.00 17 AMBULATORY SERVICES (MISC1712249 S NSTRL SWIMMOLD FABRICAT $42.30 17 AMBULATORY SERVICES (MISC1712207 SP RECEPT/DECTECT/RECOG T $22.69 17 AMBULATORY SERVICES (MISC1712181 SUBSEQUENT AUDIO OFF VISI $48.75 17 AMBULATORY SERVICES (MISC1712165 SUBSEQUENT AUDIO OFFICE V $58.50 17 AMBULATORY SERVICES (MISC1712173 SUBSEQUENT OFFICE VISIT $48.75 17 AMBULATORY SERVICES (MISC1712223 TYMP/ACOUTIC IMMITANCE TE $49.44 17 AMBULATORY SERVICES (MISC4740106 AB ELUTION $184.00 $184.00 47 BLOOD SERVICES4740056 AB ID $170.00 $170.00 47 BLOOD SERVICES4740064 AB SCRN $50.00 $50.00 47 BLOOD SERVICES4740007 ABO TYP $20.00 $20.00 47 BLOOD SERVICES4740114 AG TYP PT RBC EA 47 BLOOD SERVICES4720520 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720454 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720637 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720728 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720496 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720991 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720249 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721122 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721056 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721130 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721338 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721734 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721668 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720793 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721601 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES

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4720025 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721890 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720280 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721858 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720348 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720405 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721577 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721775 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720397 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720389 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720355 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720363 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720371 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721569 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4722021 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721940 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721957 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721965 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721973 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721981 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721999 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720546 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720538 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720512 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720504 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720462 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4722013 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720413 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4722039 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721551 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721783 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720488 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721635 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720470 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720330 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720447 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720439 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES

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4720694 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720934 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720819 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721759 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4740635 ALT (SGPT) $30.00 $30.00 47 BLOOD SERVICES4730016 APHERESIS RBC $950.00 $950.00 47 BLOOD SERVICES4730008 APHERESIS WBC $950.00 $950.00 47 BLOOD SERVICES4722344 ASSAY TEST BLOOD FECAL $88.88 47 BLOOD SERVICES4722096 BETA HCG QN $87.92 47 BLOOD SERVICES4740122 BLOOD TYPE ANTGN DONOR EA 47 BLOOD SERVICES4722146 CA 15 3 (27.29) $116.28 47 BLOOD SERVICES4722138 CA 19 9 $121.52 47 BLOOD SERVICES4722229 CARDIOLIPIN IGA AB $145.56 47 BLOOD SERVICES4722211 CARDIOLIPIN IGG AB $148.56 47 BLOOD SERVICES4722203 CARDIOLIPIN IGM AB $148.56 47 BLOOD SERVICES4740627 CMV AB $42.00 $42.00 47 BLOOD SERVICES4740643 CMV AB $35.00 $35.00 47 BLOOD SERVICES4740080 COMPATIBILITY TEST AHG $65.00 $65.00 47 BLOOD SERVICES4740130 COMPATIBILITY TEST AHG 47 BLOOD SERVICES4722112 C-PEPTIDE $121.52 47 BLOOD SERVICES4710091 CRYO PS $109.00 $109.00 47 BLOOD SERVICES4722187 CULT HERPES $152.24 47 BLOOD SERVICES4722328 CULT LEGIONELLA $50.28 47 BLOOD SERVICES4740320 CYTOTOXIC AB SCRN STND $190.00 $190.00 47 BLOOD SERVICES4740312 CYTOTOXIC PRA SCRN QUICK $120.00 $120.00 47 BLOOD SERVICES4722047 DHEA SULFATE $129.84 47 BLOOD SERVICES4722195 DRG SCRN MULTI CLASS IMM $80.44 47 BLOOD SERVICES4722104 ERYTHROPOIETIN $109.80 47 BLOOD SERVICES4710455 FFP DR PS $132.00 47 BLOOD SERVICES4710471 FFP DR PS $44.00 47 BLOOD SERVICES4710463 FFP DR PS $396.00 47 BLOOD SERVICES4710117 FFP PS $379.00 $379.00 47 BLOOD SERVICES4710109 FFP PS $109.00 $109.00 47 BLOOD SERVICES4710125 FFP PS $52.00 $52.00 47 BLOOD SERVICES4710497 FFP PS $96.00 47 BLOOD SERVICES4710489 FFP SD PS $150.00 47 BLOOD SERVICES4740478 FRZN BLD FREEZING W PREP $1,180.00 $1,180.00 47 BLOOD SERVICES

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4722088 GROWTH HORMONE $97.36 47 BLOOD SERVICES4740684 HB CORE AB TOTAL $40.00 $40.00 47 BLOOD SERVICES4740692 HBS AB $40.00 $40.00 47 BLOOD SERVICES4740700 HBs AG $40.00 $40.00 47 BLOOD SERVICES4740718 HCV AB $45.00 $45.00 47 BLOOD SERVICES4740726 HCV AB CONF $75.00 $75.00 47 BLOOD SERVICES4740189 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740197 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740205 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740247 HLA TYP A B C MULTI AG $100.00 $100.00 47 BLOOD SERVICES4740254 HLA TYP A B OR C SGL $50.00 $50.00 47 BLOOD SERVICES4740213 HLA TYPE DR/DQ MULTI AG $335.00 $335.00 47 BLOOD SERVICES4740221 HLA TYPE DR/DQ MULTI AG $335.00 $335.00 47 BLOOD SERVICES4740650 HTLV 1 AB $40.00 $40.00 47 BLOOD SERVICES4722062 IGF-1 $124.16 47 BLOOD SERVICES4722070 IGFBP 3 $78.92 47 BLOOD SERVICES4722120 INSULIN $66.76 47 BLOOD SERVICES4722336 LDL BY DIRECT MEASURE $55.72 47 BLOOD SERVICES4710406 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710430 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710422 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710414 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4740353 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740338 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740346 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740239 MOL DX AMP TR N ACD EA SQ 47 BLOOD SERVICES4722237 MYOGLOBIN $75.44 47 BLOOD SERVICES4710174 PHER L/D HLA MATCHED PS $453.00 $453.00 47 BLOOD SERVICES4710166 PHER L/D HLA MATCHED PS $1,338.00 $1,338.00 47 BLOOD SERVICES4710182 PHER L/D HLA MATCHED PS $949.00 $949.00 47 BLOOD SERVICES4710190 PHER L/D PS $902.00 $902.00 47 BLOOD SERVICES4710158 PHER PS $902.00 $902.00 47 BLOOD SERVICES4710141 PLTC L/D PS $112.00 $112.00 47 BLOOD SERVICES4710133 PLTC PS $99.00 $99.00 47 BLOOD SERVICES4722153 PSA TOTAL $107.40 47 BLOOD SERVICES4710216 RBC L/D DG/WASHED PS 47 BLOOD SERVICES4710034 RBC L/D DG/WASHED PS $395.00 $395.00 47 BLOOD SERVICES

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4710257 RBC L/D DG/WASHED PS 47 BLOOD SERVICES4710042 RBC L/D PS $320.00 $320.00 47 BLOOD SERVICES4740072 RBC PRETRTMT CHEM/DRG $105.00 $105.00 47 BLOOD SERVICES4740890 RBC PRETRTMT DENSITY GRAD $200.00 $200.00 47 BLOOD SERVICES4710067 RBC PS $117.00 $117.00 47 BLOOD SERVICES4710208 RBC PS $150.00 $150.00 47 BLOOD SERVICES4710018 RBC PS $320.00 $320.00 47 BLOOD SERVICES4710000 RBC PS $306.00 $306.00 47 BLOOD SERVICES4710240 RBC PS 47 BLOOD SERVICES4710059 RBC PS $107.00 $107.00 47 BLOOD SERVICES4740015 RH TYP $20.00 $20.00 47 BLOOD SERVICES4710315 RHO D MINI 50MCG IJ $118.00 $118.00 47 BLOOD SERVICES4710331 RHO D MINI 50MCG IJ $54.00 $54.00 47 BLOOD SERVICES4710323 RHO D MINI 50MCG IJ $32.25 $32.25 47 BLOOD SERVICES4740668 RPR NON-TREPNML AB QL $30.00 $30.00 47 BLOOD SERVICES4722286 RUBEOLA AB IGG $75.24 47 BLOOD SERVICES4722294 RUBEOLA AB IGM $75.24 47 BLOOD SERVICES4740049 SER PRETRTMT ABSORB 47 BLOOD SERVICES4740031 SER PRETRTMT ABSORB 47 BLOOD SERVICES4722245 SICKLE CL SCRN $32.24 47 BLOOD SERVICES4740981 SPEC HANDL FEE 47 BLOOD SERVICES4740973 SPEC HANDL TO REF LAB 47 BLOOD SERVICES4722161 THYROGLOBULIN $93.80 47 BLOOD SERVICES4722302 THYROID PEROXIDASE AB $85.00 47 BLOOD SERVICES4740676 TOXOPLAS AB $42.00 $42.00 47 BLOOD SERVICES4722310 TREPONEMA PALLIDUM AB $77.36 47 BLOOD SERVICES4722054 TSH $98.12 47 BLOOD SERVICES4722252 VZV AB $75.24 47 BLOOD SERVICES4722260 VZV AB IGG $75.24 47 BLOOD SERVICES4722278 VZV AB IGM $75.24 47 BLOOD SERVICES4710026 WASHED RBC PS $345.00 $345.00 47 BLOOD SERVICES4710083 WB PS $161.00 $161.00 47 BLOOD SERVICES4710075 WB PS $321.00 $321.00 47 BLOOD SERVICES4710232 WB PS 47 BLOOD SERVICES4710224 WB PS 47 BLOOD SERVICES3562774 CA ANGIO CAROTD CERE BIL $4,596.00 35 CARDIAC CATH LAB3562766 CA ANGIO CAROTD CERE UNI $4,120.00 35 CARDIAC CATH LAB

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SEQ 200 AMOUNT

DEPARTMENT CODE

3562790 CA ANGIO CAROTD CERV BIL $4,261.00 35 CARDIAC CATH LAB3562782 CA ANGIO CAROTD CERV UNI $3,949.00 35 CARDIAC CATH LAB3562824 CA ANGIO CAROTD XTL BIL $7,363.00 35 CARDIAC CATH LAB3562105 CA ANGIO CAROTD XTL UNI $3,956.00 35 CARDIAC CATH LAB3562758 CA ANGIO CERVICOCEREBRAL $3,668.00 35 CARDIAC CATH LAB3562600 CA ANGIO EXT BIL $4,526.00 $3,901.00 35 CARDIAC CATH LAB3562659 CA ANGIO EXT UNI $4,003.00 $3,450.00 35 CARDIAC CATH LAB3569209 CA ANGIO FU EXISTING CATH $882.00 $760.00 35 CARDIAC CATH LAB3569787 CA ANGIO IL W HC $94.00 $81.00 35 CARDIAC CATH LAB3568458 CA ANGIO PULM BIL SELECT $3,699.00 $3,188.00 35 CARDIAC CATH LAB3568409 CA ANGIO PULM NONSELECT $4,078.00 $3,847.00 35 CARDIAC CATH LAB3568508 CA ANGIO PULM UNI SELECT $3,535.00 $3,047.00 35 CARDIAC CATH LAB3568607 CA ANGIO RENL BIL $4,362.00 $3,759.00 35 CARDIAC CATH LAB3569779 CA ANGIO RENL BIL W HC $94.00 $81.00 35 CARDIAC CATH LAB3568656 CA ANGIO RENL UNI $3,863.00 $3,329.00 35 CARDIAC CATH LAB3569761 CA ANGIO RENL UNI W HC $94.00 $81.00 35 CARDIAC CATH LAB3562808 CA ANGIO VERTEBRAL $3,964.00 35 CARDIAC CATH LAB3569654 CA ANGIO VISCERAL $3,933.00 $3,390.00 35 CARDIAC CATH LAB3561859 CA AORTOGRAM ABD BIL EXT $3,761.00 $3,242.00 35 CARDIAC CATH LAB3561800 CA AORTOGRAM ABD W SER $3,644.00 $3,141.00 35 CARDIAC CATH LAB3561958 CA AORTOGRAM THOR W SER $3,660.00 $3,154.00 35 CARDIAC CATH LAB3561909 CA AORTOGRAM THOR W/O SER $5,416.00 $4,667.00 35 CARDIAC CATH LAB3562550 CA EMBOL TX $18,713.00 $16,127.00 35 CARDIAC CATH LAB3569886 CA ENDOVAS REPR ABD AO $1,108.00 $955.00 35 CARDIAC CATH LAB3569704 CA FLUOR CVAD PLC/RMV/RPR $1,826.00 35 CARDIAC CATH LAB3569258 CA IVC FILTER PLACE $10,987.00 $9,469.00 35 CARDIAC CATH LAB3560034 CA IVUS NONCO ADD $3,535.00 35 CARDIAC CATH LAB3560026 CA IVUS NONCO INI $3,597.00 35 CARDIAC CATH LAB3560851 CA PLACE OCC DEV VEIN ART $2,093.00 35 CARDIAC CATH LAB3569894 CA PLACE PROS REPR AAA $336.00 $289.00 35 CARDIAC CATH LAB3561552 CA PTA PERIPH ART W S&I $4,331.00 $3,733.00 35 CARDIAC CATH LAB3561602 CA PTA PRPH ART W S&I ADD $2,599.00 $2,631.00 35 CARDIAC CATH LAB3569688 CA PTA PULM ART EA ADDL $2,052.00 35 CARDIAC CATH LAB3569670 CA PTA PULM ART SNGL $3,941.00 35 CARDIAC CATH LAB3561651 CA PTA RENL VISC $4,440.00 $3,827.00 35 CARDIAC CATH LAB3561701 CA PTA VISC ADD $2,567.00 $2,213.00 35 CARDIAC CATH LAB3562709 CA RETRIEVAL VASCULAR FB $3,519.00 $3,033.00 35 CARDIAC CATH LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3569977 CA STNT INTRVAS W S&I EA $3,660.00 $3,154.00 35 CARDIAC CATH LAB3569159 CA TRANSCATHETER TX IV $16,372.00 $14,110.00 35 CARDIAC CATH LAB3569795 CA TRANSCATHETER TX IV 35 CARDIAC CATH LAB3569407 CA VENOGRAM EXT BIL $1,951.00 $1,681.00 35 CARDIAC CATH LAB3569456 CA VENOGRAM EXT UNI $1,764.00 $1,520.00 35 CARDIAC CATH LAB3569308 CA VENOGRAM IVC $3,465.00 $2,986.00 35 CARDIAC CATH LAB3560018 CA VENOGRAM SIN JUGULAR $3,582.00 $3,087.00 35 CARDIAC CATH LAB3569357 CA VENOGRAM SVC $3,504.00 $3,020.00 35 CARDIAC CATH LAB3564457 CAC CATH ABD LOW 1ST $1,548.00 $1,277.00 35 CARDIAC CATH LAB3564507 CAC CATH ABD LOW 2ND $4,477.00 $3,694.00 35 CARDIAC CATH LAB3564556 CAC CATH ABD LOW 3RD $6,011.00 $4,961.00 35 CARDIAC CATH LAB3567708 CAC CATH ABD LOW ADD $134.00 $111.00 35 CARDIAC CATH LAB3564606 CAC CATH THOR 1ST ART $638.00 $526.00 35 CARDIAC CATH LAB3564655 CAC CATH THOR 2ND ART $711.00 $586.00 35 CARDIAC CATH LAB3564754 CAC CATH THOR 3RD ART $1,900.00 $1,792.00 35 CARDIAC CATH LAB3564903 CAC EMBOL OCC NONHEAD NEC $2,328.00 $1,921.00 35 CARDIAC CATH LAB3564960 CAC EXTCRAN CV STENT ADD $7,427.00 35 CARDIAC CATH LAB3564952 CAC EXTCRAN CV STENT INIT $24,941.00 35 CARDIAC CATH LAB3560117 CAC FEM/POPL REVAS W/ATHR $22,537.00 $21,470.00 35 CARDIAC CATH LAB3560125 CAC FEM/POPL REVAS W/STNT $26,368.00 $22,052.00 35 CARDIAC CATH LAB3560109 CAC FEM/POPL REVAS W/TLA $1,163.00 $959.00 35 CARDIAC CATH LAB3560133 CAC FEM/POPL RVSC ST/ATHR $43,411.00 $38,830.00 35 CARDIAC CATH LAB3560067 CAC ILIAC REVASC $3,878.00 $3,040.00 35 CARDIAC CATH LAB3560083 CAC ILIAC REVASC ADD-ON $6,477.00 $5,671.00 35 CARDIAC CATH LAB3560075 CAC ILIAC REVASC W/STENT $24,752.00 $20,400.00 35 CARDIAC CATH LAB3560091 CAC ILIAC RVSC W/STNT ADD $15,934.00 $13,609.00 35 CARDIAC CATH LAB3569860 CAC INC GRN UNI ENDO PROS $12,910.04 $10,641.94 35 CARDIAC CATH LAB3568763 CAC INJ EXT VENOGRAM $2,870.00 $2,366.00 35 CARDIAC CATH LAB3569662 CAC INS NON-TUN CV CATH<5 $2,159.00 35 CARDIAC CATH LAB3569696 CAC INS NON-TUN CV CATH5+ $2,217.00 35 CARDIAC CATH LAB3566254 CAC INTRO BRACH ART $262.00 $217.00 35 CARDIAC CATH LAB3562816 CAC INTRO CAROTD VERT ART $423.00 35 CARDIAC CATH LAB3566205 CAC INTRO CATH AORTA $1,108.00 $1,045.00 35 CARDIAC CATH LAB3566304 CAC INTRO CATH IVC /SVC $319.00 $263.00 35 CARDIAC CATH LAB3566353 CAC INTRO CATH PULM $1,962.00 $1,617.00 35 CARDIAC CATH LAB3566759 CAC INTRO EXT ART $258.00 35 CARDIAC CATH LAB3566700 CAC INTRO IVC FILTER $11,020.00 $9,094.00 35 CARDIAC CATH LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3566155 CAC IVCH RETRIEVE FB $1,021.00 $843.00 35 CARDIAC CATH LAB3560059 CAC IVUS NONCO ADD $216.00 35 CARDIAC CATH LAB3560042 CAC IVUS NONCO INI $295.00 35 CARDIAC CATH LAB3569803 CAC NONTHROMBOLYSIS IV 35 CARDIAC CATH LAB3569852 CAC PLACE SENSR ENDO REPR $12,910.04 $10,641.94 35 CARDIAC CATH LAB3563251 CAC PTA AORTIC $1,245.00 $1,026.00 35 CARDIAC CATH LAB3563301 CAC PTA BRACHIOCEPH EA $3,552.00 $2,786.00 35 CARDIAC CATH LAB3563509 CAC PTA RENL VISC $1,796.00 $1,482.00 35 CARDIAC CATH LAB3567153 CAC PULM ART L/R $2,168.00 $1,700.00 35 CARDIAC CATH LAB3567203 CAC PULM ART SEG SUB $1,190.00 $1,123.00 35 CARDIAC CATH LAB3569837 CAC REPR AAA W MBD PROS $12,910.04 $10,641.94 35 CARDIAC CATH LAB3569829 CAC REPR AAA W MODULAR $12,910.04 $10,641.94 35 CARDIAC CATH LAB3569845 CAC REPR AAA W UNIBODY $12,910.04 $10,641.94 35 CARDIAC CATH LAB3569878 CAC REPR AAA/IL PROS INI $12,910.04 $10,641.94 35 CARDIAC CATH LAB3567302 CAC SELECT CATH 1ST VEN $396.00 $343.00 35 CARDIAC CATH LAB3567351 CAC SELECT CATH 2ND VEN $464.00 $383.00 35 CARDIAC CATH LAB3567450 CAC STNT INTRAVS ADDL PRC $5,797.00 $4,784.00 35 CARDIAC CATH LAB3567401 CAC STNT INTRAVS INIT PRC $17,214.00 $14,206.00 35 CARDIAC CATH LAB3560208 CAC TB/PR REVSC TRAN/STNT $15,777.00 $13,640.00 35 CARDIAC CATH LAB3560182 CAC TIB/PER REVASC ADD-ON $6,320.00 $5,702.00 35 CARDIAC CATH LAB3560158 CAC TIB/PER REVASC W/ATHR $24,016.00 $22,466.00 35 CARDIAC CATH LAB3560166 CAC TIB/PER REVASC W/STNT $28,926.00 $24,164.00 35 CARDIAC CATH LAB3560141 CAC TIB/PER REVASC W/TLA $3,721.00 $3,071.00 35 CARDIAC CATH LAB3560174 CAC TIB/PR REVSC STNT/ATH $44,890.00 $39,826.00 35 CARDIAC CATH LAB3560216 CAC TIB/PR RVSC STNT/ATHR $19,640.00 $17,201.00 35 CARDIAC CATH LAB3560190 CAC TIBPR RVSC W/ATHR ADD $10,183.00 $9,263.00 35 CARDIAC CATH LAB3564978 CAC TRNCTH STNT CCA W/PRO $3,586.00 35 CARDIAC CATH LAB3564986 CAC TRNCTH STNT CCA WO/PR $3,308.00 35 CARDIAC CATH LAB3569811 EKG 12 LEAD TRACING $301.00 $108.00 $151.50 35 CARDIAC CATH LAB3559929 PALONOSETRON INJ 25 MCG 35 CARDIAC CATH LAB3620358 CA 2D TEE W-W/O F W/CON I $1,714.00 36 CARDIOLOGY/CARDIOVASCULAR3620333 CA 2D TTE W-W/O CON CMPLT $1,579.00 36 CARDIOLOGY/CARDIOVASCULAR3620341 CA 2D TTE W-W/O CON FU/LS $804.00 36 CARDIOLOGY/CARDIOVASCULAR3620069 CA ECHO 2D CMP NO SPC/DOP $2,271.00 $1,957.00 $1,000.75 36 CARDIOLOGY/CARDIOVASCULAR3620226 CA ECHO 2D LTD $1,623.00 36 CARDIOLOGY/CARDIOVASCULAR3620200 CA ECHO CNGNITL ANOM CMPL $1,628.00 36 CARDIOLOGY/CARDIOVASCULAR3620218 CA ECHO CNGNITL ANOM LTD $1,943.00 36 CARDIOLOGY/CARDIOVASCULAR

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3620002 CA ECHO DPPLER CMPL $1,007.00 $868.00 $120.50 36 CARDIOLOGY/CARDIOVASCULAR3620036 CA ECHO DPPLER COLOR FLOW $780.00 $673.00 $416.00 36 CARDIOLOGY/CARDIOVASCULAR3620119 CA ECHO TEE CNGNITL ANOM $3,051.00 $2,630.00 $1,446.75 36 CARDIOLOGY/CARDIOVASCULAR3620184 CA ECHO TRANSESOPHAGEAL $2,553.00 $2,553.00 $843.00 36 CARDIOLOGY/CARDIOVASCULAR3620374 CA IJ IVP SME DRG EA >30M $220.00 36 CARDIOLOGY/CARDIOVASCULAR3620366 CA TEE W-W/O FL W/CON CCA $2,062.00 36 CARDIOLOGY/CARDIOVASCULAR3620390 CA TTE DPLR CMPLT WO CON $2,783.00 $1,537.25 36 CARDIOLOGY/CARDIOVASCULAR3620317 CA TTE W-W/O FL W/CON COM $1,628.00 36 CARDIOLOGY/CARDIOVASCULAR3620325 CA TTE W-W/O FL W/CON F/U $834.00 36 CARDIOLOGY/CARDIOVASCULAR3610011 CARDIAC REHAB W EKG $84.00 $84.00 36 CARDIOLOGY/CARDIOVASCULAR3610227 CARDIAC REHAB W EKG $74.50 36 CARDIOLOGY/CARDIOVASCULAR3620382 CARDIAC REHAB WO EKG $263.00 36 CARDIOLOGY/CARDIOVASCULAR3610219 CARDIAC REHAB WO EKG $300.00 36 CARDIOLOGY/CARDIOVASCULAR3610201 CARDIAC REHAB WO EKG $180.00 36 CARDIOLOGY/CARDIOVASCULAR3610037 CARDIAC REHAB WO EKG $240.00 $240.00 36 CARDIOLOGY/CARDIOVASCULAR3620010 CARDIAC STRESS TEST $983.00 $352.00 $339.75 36 CARDIOLOGY/CARDIOVASCULAR3620051 EKG 12 LEAD TRACING $301.00 $108.00 $151.50 36 CARDIOLOGY/CARDIOVASCULAR3620044 EKG 1-3 LEAD TRACING ONLY $148.00 $53.00 $96.25 36 CARDIOLOGY/CARDIOVASCULAR3620143 EKG SIGNAL AVERAGED $1,419.00 $509.00 $395.25 36 CARDIOLOGY/CARDIOVASCULAR3620085 EXT ECG CONT RCRD/STR 48H $689.00 $247.00 $437.00 36 CARDIOLOGY/CARDIOVASCULAR3620309 INJ IVP SAME DRG EA >30M $238.00 36 CARDIOLOGY/CARDIOVASCULAR3620234 INJ IVP SNGL/INIT DRG $249.00 $89.00 36 CARDIOLOGY/CARDIOVASCULAR3610029 MAINTENANCE CARDIAC REHAB $54.00 $54.00 36 CARDIOLOGY/CARDIOVASCULAR3612488 RHO D H SD 100 IU IJ 36 CARDIOLOGY/CARDIOVASCULAR3620291 S STRL DEFIBRILLATOR PADS $53.25 36 CARDIOLOGY/CARDIOVASCULAR3612306 TENECTEPLASE 1MG IJ 36 CARDIOLOGY/CARDIOVASCULAR3620275 US DPPLER ECHO FETAL $521.00 $370.00 36 CARDIOLOGY/CARDIOVASCULAR3620283 US DPPLER ECHO FETAL FU $299.00 $212.00 36 CARDIOLOGY/CARDIOVASCULAR3620259 US ECHO FETAL $1,721.00 $1,220.00 36 CARDIOLOGY/CARDIOVASCULAR3620267 US ECHO FETAL FU REPEAT $1,048.00 $743.00 36 CARDIOLOGY/CARDIOVASCULAR3451291 AICD DUAL CHAMBER $24,000.00 34 CATH LAB SCH3452109 AICD DUAL CHAMBER $24,000.00 34 CATH LAB SCH3452265 AICD DUAL CHAMBER $24,000.00 34 CATH LAB SCH3452190 AICD DUAL CHAMBER $21,000.00 34 CATH LAB SCH3451739 AICD DUAL CHAMBER $6,750.00 34 CATH LAB SCH3451655 AICD DUAL CHAMBER $36,236.00 34 CATH LAB SCH3451671 AICD DUAL CHAMBER $32,865.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3451689 AICD DUAL CHAMBER $45,843.00 34 CATH LAB SCH3451697 AICD DUAL CHAMBER $1,348.00 34 CATH LAB SCH3451705 AICD DUAL CHAMBER $7,584.00 34 CATH LAB SCH3451341 AICD DUAL CHAMBER $33,236.00 34 CATH LAB SCH3451721 AICD DUAL CHAMBER $10,112.00 34 CATH LAB SCH3451945 AICD DUAL CHAMBER $37,778.00 34 CATH LAB SCH3452042 AICD DUAL CHAMBER $37,922.00 34 CATH LAB SCH3451929 AICD DUAL CHAMBER $35,343.00 34 CATH LAB SCH3452034 AICD DUAL CHAMBER $36,236.00 34 CATH LAB SCH3451275 AICD DUAL CHAMBER $21,000.00 34 CATH LAB SCH3451283 AICD DUAL CHAMBER $22,500.00 34 CATH LAB SCH3451994 AICD DUAL CHAMBER $35,056.00 34 CATH LAB SCH3451713 AICD DUAL CHAMBER $9,101.00 34 CATH LAB SCH3451135 AICD DUAL CHAMBER $21,000.00 34 CATH LAB SCH3452299 AICD DUAL CHAMBER $22,500.00 34 CATH LAB SCH3451069 AICD DUAL CHAMBER $45,337.00 34 CATH LAB SCH3451887 AICD DUAL CHAMBER $42,143.00 34 CATH LAB SCH3452018 AICD OTHER THAN SING/DUAL $33,000.00 34 CATH LAB SCH3451952 AICD OTHER THAN SING/DUAL $30,000.00 34 CATH LAB SCH3452273 AICD OTHER THAN SING/DUAL $30,000.00 34 CATH LAB SCH3452208 AICD OTHER THAN SING/DUAL $27,000.00 34 CATH LAB SCH3452000 AICD OTHER THAN SING/DUAL $27,000.00 34 CATH LAB SCH3452091 AICD OTHER THAN SING/DUAL $38,933.00 34 CATH LAB SCH3452125 AICD OTHER THAN SING/DUAL $44,505.00 34 CATH LAB SCH3452133 AICD OTHER THAN SING/DUAL $45,255.00 34 CATH LAB SCH3451333 AICD SINGLE CHAMBER $30,759.00 34 CATH LAB SCH3452257 AICD SINGLE CHAMBER $19,500.00 34 CATH LAB SCH3452216 AICD SINGLE CHAMBER $18,750.00 34 CATH LAB SCH3452232 AICD SINGLE CHAMBER $19,500.00 34 CATH LAB SCH3451085 AICD SINGLE CHAMBER $5,056.00 34 CATH LAB SCH3451606 AICD SINGLE CHAMBER $14,157.00 34 CATH LAB SCH3451663 AICD SINGLE CHAMBER $30,337.00 34 CATH LAB SCH3451267 AICD SINGLE CHAMBER $28,062.00 34 CATH LAB SCH3451259 AICD SINGLE CHAMBER $25,028.00 34 CATH LAB SCH3451242 AICD SINGLE CHAMBER $18,000.00 34 CATH LAB SCH3451234 AICD SINGLE CHAMBER $19,500.00 34 CATH LAB SCH3451143 AICD SINGLE CHAMBER $18,000.00 34 CATH LAB SCH

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3451325 AICD SINGLE CHAMBER $31,254.00 34 CATH LAB SCH3451614 AICD SINGLE CHAMBER $25,281.00 34 CATH LAB SCH3451309 AICD SINGLE CHAMBER $27,883.00 34 CATH LAB SCH3451630 AICD SINGLE CHAMBER $27,809.00 34 CATH LAB SCH3451648 AICD SINGLE CHAMBER $26,141.00 34 CATH LAB SCH3451317 AICD SINGLE CHAMBER $33,708.00 34 CATH LAB SCH3451622 AICD SINGLE CHAMBER $20,225.00 34 CATH LAB SCH3452182 AICD SINGLE CHAMBER $16,500.00 34 CATH LAB SCH3414802 CA BIOPSY ENDOMYOCARDIAL $1,443.00 $1,191.00 34 CATH LAB SCH3417078 CA CARDIOVERSION INTERNAL $1,771.00 34 CATH LAB SCH3413051 CA CARDIOVERT ELCTVE EXT $3,449.00 $2,973.00 34 CATH LAB SCH3410560 CA CINE/VIDEO $1,155.00 34 CATH LAB SCH3417557 CA CORNRY ART/GRFT ANGIO $13,722.00 $11,324.00 34 CATH LAB SCH3417540 CA CORNRY ARTRY ANGIO S&I $11,623.00 $9,591.00 34 CATH LAB SCH3417581 CA CORONRY ART ANGIO LHC $24,471.00 $20,194.00 34 CATH LAB SCH3417565 CA CORONRY ART ANGIO RHC $18,739.00 $15,464.00 34 CATH LAB SCH3416740 CA CPR $1,142.00 34 CATH LAB SCH3417177 CA DPPLR W STRESS ADD VSL $980.00 $850.00 34 CATH LAB SCH3417169 CA DPPLR W STRESS INI $2,064.00 $1,703.00 34 CATH LAB SCH3416989 CA EP 3D MAPPING $710.00 $612.00 34 CATH LAB SCH3412103 CA EP ABLTN AV NDE/CNDCTN $3,995.00 $3,443.00 34 CATH LAB SCH3412152 CA EP ABLTN OF SVT $5,853.00 $5,044.00 34 CATH LAB SCH3412202 CA EP ABLTN OF VT $6,383.00 $5,501.00 34 CATH LAB SCH3413564 CA EP EVAL COMP W INDUCT $4,339.00 $3,739.00 34 CATH LAB SCH3416922 CA EP EVAL ICD LEADS $5,931.00 $5,111.00 34 CATH LAB SCH3416930 CA EP EVAL ICD LEADS/GEN $5,892.00 $5,078.00 34 CATH LAB SCH3412509 CA EP EVAL PACING ICD $3,715.00 $3,201.00 34 CATH LAB SCH3413549 CA EP EVAL W L ATR PACING $788.00 $679.00 34 CATH LAB SCH3416948 CA EP EVAL W L VENT PACNG $1,147.00 $989.00 34 CATH LAB SCH3414257 CA EP HIS BUNDLE RECORD $1,576.00 $1,359.00 34 CATH LAB SCH3417102 CA EP IC ECHO W INTRVNTN $1,046.00 $901.00 34 CATH LAB SCH3417292 CA EP IND/TRM ARRHYTH PPM $1,093.00 $942.00 34 CATH LAB SCH3416955 CA EP MAP VENT/ATR TACHY $2,169.00 $1,870.00 34 CATH LAB SCH3416971 CA EP PRG PCNG POST RX $1,061.00 $915.00 34 CATH LAB SCH3416401 CA EP TILT TABLE TEST $1,373.00 $1,184.00 34 CATH LAB SCH3417508 CA ICD 1L INTR DV EV W RP $384.63 $317.04 34 CATH LAB SCH3417466 CA ICD 1L PG EV/AD WO RPG $193.30 $159.34 34 CATH LAB SCH

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3417417 CA ICD 1L PG EV/AD WO RPG $460.00 $397.00 34 CATH LAB SCH3417474 CA ICD 2L PG EV/AD NO PRG $193.30 $159.34 34 CATH LAB SCH3417425 CA ICD 2L PG EV/AD NO PRG $531.00 $457.00 34 CATH LAB SCH3417482 CA ICD MLT LD PROG EV/ADJ $288.93 $238.16 34 CATH LAB SCH3417003 CA INJ IVP SNGL/INIT DRG $623.00 $537.00 34 CATH LAB SCH3417623 CA INJ L VENTR/ARTL ANGIO $3,211.00 $2,650.00 34 CATH LAB SCH3417631 CA INJ R VENTR/ARTL ANGIO $2,952.00 $2,436.00 34 CATH LAB SCH3417649 CA INJ SUPRVLV AORTOGRPHY $4,271.00 $3,653.00 34 CATH LAB SCH3417656 CA INJECT PULM HRT CATH $4,379.00 $3,614.00 34 CATH LAB SCH3416443 CA IVUS CORO ADD VSL $1,904.00 $1,641.00 34 CATH LAB SCH3416450 CA IVUS CORO INI VSL $3,761.00 $3,242.00 34 CATH LAB SCH3417599 CA L HRT ART/GRFT ANGIO $26,570.00 $21,927.00 34 CATH LAB SCH3416815 CA LFT CATH TRNSPTL PUNCT $19,839.00 34 CATH LAB SCH3417524 CA LT HRT CATH W/VENTGRHY $24,471.00 $20,194.00 34 CATH LAB SCH3417375 CA NON-SURG SEPTAL RDC TX $65,296.00 $56,273.00 34 CATH LAB SCH3410552 CA NON-SURG SEPTAL RDC TX $65,296.00 $56,273.00 34 CATH LAB SCH3417490 CA PC 2L INTG DV EV WO RP $384.63 $317.04 34 CATH LAB SCH3417383 CA PCR 1L PG EV/AD WO RPG $382.00 $330.00 34 CATH LAB SCH3417433 CA PCR 1L PG EV/AD WO RPG $193.30 $159.34 34 CATH LAB SCH3417391 CA PCR 2L PG EV/AD WO RPG $193.30 $159.34 34 CATH LAB SCH3417441 CA PCR 2L PG EV/AD WO RPG $193.30 $159.34 34 CATH LAB SCH3417409 CA PCR MLT LD PROG EV/ADJ $515.00 $444.00 34 CATH LAB SCH3417458 CA PCR MLT LD PROG EV/ADJ $288.93 $444.00 34 CATH LAB SCH3417318 CA PLACE DRG EL STNT ADDL $22,423.00 34 CATH LAB SCH3417300 CA PLACE DRG EL STNT SNGL $37,861.00 34 CATH LAB SCH3417185 CA PLACE OCC DEV VEIN ART $2,093.00 $1,804.00 34 CATH LAB SCH3416880 CA PLACE RAD DEL DEVICE $1,100.00 $948.00 34 CATH LAB SCH3416906 CA PM INSERT $1,405.00 34 CATH LAB SCH3412905 CA PTC ATHERCTMY ADD VSL $1,194.00 $1,029.00 34 CATH LAB SCH3412954 CA PTC ATHERCTMY SNGL VSL $4,581.00 $3,948.00 34 CATH LAB SCH3413259 CA PTCA ADD VSL $1,085.00 $935.00 34 CATH LAB SCH3413200 CA PTCA SNGL VSL $4,152.00 $3,578.00 34 CATH LAB SCH3417573 CA R HRT ART/GRFT ANGIO $20,838.00 $17,197.00 34 CATH LAB SCH3417615 CA R&L ART/VENT ANGIO BYP $33,686.00 $27,800.00 34 CATH LAB SCH3417607 CA R&L ART/VENTRCL ANGIO $31,587.00 $24,090.00 34 CATH LAB SCH3417532 CA R&L HRT CA W/VENTRCL $31,587.00 $26,067.00 34 CATH LAB SCH3416831 CA RHC CNGNITL ANMLES $7,427.00 34 CATH LAB SCH

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SEQ 200 AMOUNT

DEPARTMENT CODE

3416849 CA RHC/LHC CNGNITL ANMLES $20,453.00 34 CATH LAB SCH3416864 CA RHC/TS LHC OPN SEP CNG $19,638.00 34 CATH LAB SCH3417516 CA RIGHT HEART CATH $7,116.00 $5,873.00 34 CATH LAB SCH3416005 CA SEPTOSTMY ATR TV METHD $13,305.00 $11,467.00 34 CATH LAB SCH3416203 CA STENT IC SNGL VSL PRC $5,572.00 $4,802.00 34 CATH LAB SCH3416252 CA STNT IC ADD VSL PRC $1,522.00 $1,311.00 34 CATH LAB SCH3416898 CA THROMBECTOMY CORO PRC $1,202.00 $1,036.00 34 CATH LAB SCH3413606 CA THROMBLYSIS CORO INFSN $2,622.00 $2,260.00 34 CATH LAB SCH3417110 CA TRANSCATH CLOSURE ASD $2,909.00 34 CATH LAB SCH3417128 CA TRANSCATH CLOSURE VSD $26,792.00 34 CATH LAB SCH3416609 CA VALVULOPLSTY AORTC PRC $10,535.00 $9,079.00 34 CATH LAB SCH3416625 CA VALVULOPLSTY MITRL PRC $10,886.00 $9,382.00 34 CATH LAB SCH3416641 CA VALVULOPLSTY PULM PRC $8,443.00 $7,277.00 34 CATH LAB SCH3417193 CAC EP REPAIR SNGL LEAD $1,695.00 34 CATH LAB SCH3416419 CAC IMPLANT CARD EVNT RCD $5,400.00 $4,456.00 34 CATH LAB SCH3417367 CAC INS/REP LEADS INS PG $32,372.00 34 CATH LAB SCH3417359 CAC INS/REP LEADS INS PG $15,350.00 34 CATH LAB SCH3412962 CAC INS/REP LEADS INS PG $15,158.00 34 CATH LAB SCH3417045 CAC INSERT ELECT DUAL $6,034.00 34 CATH LAB SCH3415304 CAC INSERT ELECT SNGL $10,572.00 $8,725.00 34 CATH LAB SCH3414703 CAC INSERT IABP PRC $727.00 $571.00 34 CATH LAB SCH3417144 CAC INSERT LD PRIOR PACER $1,577.00 34 CATH LAB SCH3415205 CAC INSERT PACER DUAL LDS $16,044.00 $13,240.00 34 CATH LAB SCH3416435 CAC INSERT PACER GEN DUAL $10,770.00 $8,888.00 34 CATH LAB SCH3415254 CAC INSERT PACER GEN SNGL $9,121.00 $7,527.00 34 CATH LAB SCH3415106 CAC INSERT PACER TMP SNGL $4,389.00 $3,622.00 34 CATH LAB SCH3417037 CAC INSERT PACER W 3RD LD $1,282.00 34 CATH LAB SCH3415353 CAC INSERT PACER/ELEC VNT $13,816.00 $11,401.00 34 CATH LAB SCH3417094 CAC INSERT PACER/ELECATR $15,449.00 34 CATH LAB SCH3415700 CAC PERICARDIOCENT INI $11,078.00 $8,691.00 34 CATH LAB SCH3417136 CAC REPO LD/PRIOR PACER $1,254.00 $1,035.00 34 CATH LAB SCH3417268 CAC REPO PRIOR LV LEAD $1,506.00 $1,181.00 34 CATH LAB SCH3417151 CAC REPO PRIOR LV LEAD $1,433.00 $1,181.00 34 CATH LAB SCH3417052 CAC REPR ELECT DUAL $3,369.00 34 CATH LAB SCH3417227 CAC RMV ICD ELEC TV EXTRC $3,507.00 $2,894.00 34 CATH LAB SCH3417250 CAC RMV ICD ELEC TV EXTRC $3,507.00 $2,751.00 34 CATH LAB SCH3417060 CAC RMV ICD ELEC TV EXTRC $3,338.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3416914 CAC RMV ICD PACING GEN SQ $8,098.00 $6,683.00 34 CATH LAB SCH3416427 CAC RMVL CARD EVNT RCDR $1,392.00 34 CATH LAB SCH3415403 CAC RMVL PERM PACER GEN $9,209.00 $7,599.00 34 CATH LAB SCH3417243 CAC RMVL TV PACR ELC DUAL $2,685.00 $2,107.00 34 CATH LAB SCH3417235 CAC RMVL TV PACR ELC SNGL $1,934.00 $1,596.00 34 CATH LAB SCH3412517 CAC RVSN PCKT PACING ICD $6,111.00 34 CATH LAB SCH3415510 CAC RVSN/REL POCKET/PACER $4,783.00 34 CATH LAB SCH3417342 CAC SC/DC ICD GENRATR CHG $15,350.00 34 CATH LAB SCH3417334 CAC SC/DC ICD GENRATR CHG $15,350.00 34 CATH LAB SCH3412665 CAC SC/DC ICD GENRATR CHG $15,350.00 34 CATH LAB SCH3415031 CAC UPGRD PACE SNGL DUAL $14,757.00 $12,178.00 34 CATH LAB SCH3442316 CATH BLN DILATE NOVSC $680.00 34 CATH LAB SCH3430550 CATH EP ABLT 3D VC MP $2,268.00 $2,140.00 34 CATH LAB SCH3442308 CATH EP ABLT 3D VC MP $5,000.00 34 CATH LAB SCH3432259 CATH EP ABLT 3D VC MP $3,008.00 $2,838.00 34 CATH LAB SCH3431806 CATH EP ABLT 3D VC MP $1,194.00 $1,126.00 34 CATH LAB SCH3430709 CATH EP ABLT 3D VC MP $2,733.00 $2,578.00 34 CATH LAB SCH3442746 CATH EP ABLT 3D VC MP $8,750.00 34 CATH LAB SCH3442464 CATH EP ABLT 3D VC MP $2,625.00 34 CATH LAB SCH3441714 CATH EP ABLT 3D VC MP $3,244.00 34 CATH LAB SCH3432879 CATH EP ABLTN NOCOOL $13,000.00 34 CATH LAB SCH3442373 CATH EP DX NO3D GT19 $403.75 34 CATH LAB SCH3432598 CATH EP DX NO3D LT20 $1,576.00 34 CATH LAB SCH3432366 CATH EP DX NO3D LT20 $1,456.00 34 CATH LAB SCH3431657 CATH EP DX NO3D LT20 $3,913.00 $3,691.00 34 CATH LAB SCH3432663 CATH EP DX NO3D LT20 $907.00 34 CATH LAB SCH3432424 CATH EP DX NO3D LT20 $2,101.00 34 CATH LAB SCH3442035 CATH EP DX NO3D LT20 $1,910.00 34 CATH LAB SCH3442092 CATH EP DX NO3D LT20 $3,076.00 34 CATH LAB SCH3462322 CATH EP DX NO3D LT20 $1,671.00 34 CATH LAB SCH3432473 CATH EP DX NO3D LT20 $3,357.00 34 CATH LAB SCH3442779 CATH EP DX NO3D LT20 $2,625.00 34 CATH LAB SCH3431459 CATH EP DX NO3D LT20 $2,261.00 $2,133.00 34 CATH LAB SCH3432390 CATH EP DX NO3D LT20 $2,458.00 34 CATH LAB SCH3432432 CATH EP DX NO3D LT20 $1,332.00 34 CATH LAB SCH3432408 CATH EP DX NO3D LT20 $3,104.00 34 CATH LAB SCH3430758 CATH EP DX NO3D LT20 $2,949.00 $2,783.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3431350 CATH EP DX NO3D LT20 $3,228.00 $3,045.00 34 CATH LAB SCH3431400 CATH EP DX NO3D LT20 $621.00 $586.00 34 CATH LAB SCH3431905 CATH EP DX NO3D LT20 $2,261.00 $2,133.00 34 CATH LAB SCH3430600 CATH EP DX NO3D LT20 $955.00 $901.00 34 CATH LAB SCH3432689 CATH EP DX NO3D LT20 $1,456.00 34 CATH LAB SCH3432606 CATH EP DX NO3D LT20 $2,268.00 34 CATH LAB SCH3432614 CATH EP DX NO3D LT20 $2,163.00 34 CATH LAB SCH3432622 CATH EP DX NO3D LT20 $2,163.00 34 CATH LAB SCH3432630 CATH EP DX NO3D LT20 $2,030.00 34 CATH LAB SCH3432648 CATH EP DX NO3D LT20 $2,065.00 34 CATH LAB SCH3442076 CATH EP DX NO3D LT20 $2,556.00 34 CATH LAB SCH3432671 CATH EP DX NO3D LT20 $716.00 34 CATH LAB SCH3432697 CATH EP DX NO3D LT20 $2,985.00 34 CATH LAB SCH3441763 CATH EP DX NO3D LT20 $2,316.00 34 CATH LAB SCH3442043 CATH EP DX NO3D LT20 $1,552.00 34 CATH LAB SCH3441755 CATH EP DX NO3D LT20 $1,839.00 34 CATH LAB SCH3432655 CATH EP DX NO3D LT20 $955.00 34 CATH LAB SCH3442167 CATH EP DXABLTN COOL TP $3,919.00 34 CATH LAB SCH3442159 CATH EP DXABLTN COOL TP $3,638.00 34 CATH LAB SCH3442472 CATH EP DXABLTN COOL TP $6,375.00 34 CATH LAB SCH3442209 CATH EP DXABLTN COOL TP $4,214.00 34 CATH LAB SCH3442829 CATH EP DXABLTN COOL TP $3,910.00 34 CATH LAB SCH3432317 CATH EP DXABLTN COOL TP $2,556.00 34 CATH LAB SCH3432812 CATH EP DXABLTN COOL TP $2,733.00 34 CATH LAB SCH3442118 CATH EP DXABLTN COOL TP $3,520.00 34 CATH LAB SCH3442357 CATH EP DXABLTN COOL TP $3,737.50 34 CATH LAB SCH3442001 CATH EP DXABLTN COOL TP $5,337.00 34 CATH LAB SCH3442241 CATH EP DXABLTN COOL TP $8,427.00 34 CATH LAB SCH3442753 CATH EP DXABLTN COOL TP $2,750.00 34 CATH LAB SCH3441946 CATH GUIDING $276.00 34 CATH LAB SCH3440500 CATH GUIDING $276.00 $260.00 34 CATH LAB SCH3441748 CATH GUIDING $279.00 34 CATH LAB SCH3432051 CATH GUIDING $1,194.00 $1,126.00 34 CATH LAB SCH3442019 CATH GUIDING $1,700.00 34 CATH LAB SCH3432549 CATH GUIDING $287.00 34 CATH LAB SCH3432531 CATH GUIDING $52.71 34 CATH LAB SCH3442100 CATH GUIDING $220.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3432556 CATH GUIDING $287.00 34 CATH LAB SCH3441698 CATH GUIDING $239.00 34 CATH LAB SCH3442498 CATH GUIDING $5,075.00 34 CATH LAB SCH3432861 CATH GUIDING 34 CATH LAB SCH3432564 CATH GUIDING $287.00 34 CATH LAB SCH3440401 CATH GUIDING $276.00 $260.00 34 CATH LAB SCH3451044 CATH GUIDING $2,781.00 34 CATH LAB SCH3442340 CATH GUIDING $2,275.00 34 CATH LAB SCH3432416 CATH GUIDING $263.00 34 CATH LAB SCH3430337 CATH GUIDING $287.00 34 CATH LAB SCH3432374 CATH GUIDING $1,890.00 34 CATH LAB SCH3432382 CATH GUIDING $2,125.00 34 CATH LAB SCH3442233 CATH GUIDING $1,671.00 34 CATH LAB SCH3441995 CATH GUIDING $216.00 34 CATH LAB SCH3441979 CATH GUIDING $2,419.00 34 CATH LAB SCH3441961 CATH GUIDING $6,180.00 34 CATH LAB SCH3442084 CATH GUIDING $587.00 34 CATH LAB SCH3441912 CATH GUIDING $240.00 34 CATH LAB SCH3441508 CATH GUIDING $436.00 $411.00 34 CATH LAB SCH3432705 CATH GUIDING $263.00 34 CATH LAB SCH3432846 CATH GUIDING $552.50 34 CATH LAB SCH3440054 CATH GUIDING $267.00 $252.00 34 CATH LAB SCH3451051 CATH GUIDING $11,629.00 34 CATH LAB SCH3440302 CATH GUIDING $287.00 $270.00 34 CATH LAB SCH3440351 CATH GUIDING $276.00 $260.00 34 CATH LAB SCH3461936 CATH GUIDING $7,725.00 34 CATH LAB SCH3442183 CATH GUIDING $1,194.00 34 CATH LAB SCH3441680 CATH GUIDING $430.00 34 CATH LAB SCH3442449 CATH GUIDING $2,987.50 34 CATH LAB SCH3442613 CATH GUIDING $1,750.00 34 CATH LAB SCH3442456 CATH GUIDING $2,737.50 34 CATH LAB SCH3440001 CATH GUIDING TRANSIT $1,750.00 34 CATH LAB SCH3442704 CATH INF PER CEN MID NOHD $2,800.00 34 CATH LAB SCH3442761 CATH INF PER CEN MID NOHD $5,987.50 $5,987.50 34 CATH LAB SCH3442605 CATH INTRACARDIAC ECHO $4,237.50 34 CATH LAB SCH3442050 CATH INTRACARDIAC ECHO $6,600.00 34 CATH LAB SCH3442720 CATH INTRACARDIAC ECHO $3,325.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3440120 CATH INTRAVASCULAR US $65.00 34 CATH LAB SCH3432457 CATH INTRAVASCULAR US $2,517.00 34 CATH LAB SCH3442522 CATH INTRAVASCULAR US $2,800.00 34 CATH LAB SCH3442324 CATH INTRAVASCULAR US $6,000.00 34 CATH LAB SCH3441672 CATH INTRAVASCULAR US $2,328.00 34 CATH LAB SCH3442514 CATH INTRAVASCULAR US $2,275.00 34 CATH LAB SCH3442175 CATH OCCLUSION $3,000.00 34 CATH LAB SCH3442332 CATH THROMB/EMBOLCTMY $2,082.50 34 CATH LAB SCH3462215 CATH THROMB/EMBOLCTMY $48.00 34 CATH LAB SCH3442407 CATH THROMB/EMBOLCTMY $2,082.50 34 CATH LAB SCH3442647 CATH THROMB/EMBOLCTMY $4,300.00 34 CATH LAB SCH3460508 CATH THROMB/EMBOLCTMY $3,160.00 $2,981.00 34 CATH LAB SCH3462223 CATH THROMB/EMBOLCTMY $3,795.00 34 CATH LAB SCH3441664 CATH THROMB/EMBOLCTMY $4,003.00 34 CATH LAB SCH3472388 CATH THROMB/EMBOLCTMY $3,237.50 34 CATH LAB SCH3472040 CATH THROMB/EMBOLCTMY $4,480.00 34 CATH LAB SCH3442530 CATH THROMB/EMBOLCTMY $3,487.50 34 CATH LAB SCH3442431 CATH TRNSL ANGIO LASER $4,687.50 34 CATH LAB SCH3442670 CATH TRNSLML ATHR DIR $4,187.50 34 CATH LAB SCH3442142 CATH TRNSLML ATHR ROT $7,487.50 34 CATH LAB SCH3442597 CATH TRNSLML ATHR ROT $6,987.50 34 CATH LAB SCH3432853 CATH TRNSLML ATHR ROT $8,225.00 34 CATH LAB SCH3442191 CATH TRNSLML ATHR ROT $3,076.00 34 CATH LAB SCH3441615 CATH TRNSLML ATHR ROT $3,449.00 $3,254.00 34 CATH LAB SCH3442795 CATH TRNSLML ATHR ROT $7,987.50 $7,987.50 34 CATH LAB SCH3441904 CATH TRNSLML ATHR ROT $4,916.00 34 CATH LAB SCH3441102 CATH TRNSML ANGIO NOLASR $1,194.00 $1,126.00 34 CATH LAB SCH3442506 CATH TRNSML ANGIO NOLASR $1,062.50 34 CATH LAB SCH3442837 CATH TRNSML ANGIO NOLASR $1,062.50 34 CATH LAB SCH3440237 CATH TRNSML ANGIO NOLASR $1,074.00 34 CATH LAB SCH3442589 CATH TRNSML ANGIO NOLASR $3,146.00 34 CATH LAB SCH3442803 CATH TRNSML ANGIO NOLASR $629.00 $629.00 34 CATH LAB SCH3442738 CATH TRNSML ANGIO NOLASR $1,062.50 34 CATH LAB SCH3442621 CATH TRNSML ANGIO NOLASR $488.75 34 CATH LAB SCH3442225 CATH TRNSML ANGIO NOLASR $1,074.00 34 CATH LAB SCH3430055 CATH TRNSML ANGIO NOLASR $176.00 $166.00 34 CATH LAB SCH3442555 CATH TRNSML ANGIO NOLASR $913.75 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3440252 CATH TRNSML ANGIO NOLASR $213.00 $201.00 34 CATH LAB SCH3431855 CATH TRNSML ANGIO NOLASR $377.00 $356.00 34 CATH LAB SCH3441607 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3442654 CATH TRNSML ANGIO NOLASR $531.25 34 CATH LAB SCH3442027 CATH TRNSML ANGIO NOLASR $1,062.50 34 CATH LAB SCH3470903 CATH TRNSML ANGIO NOLASR $3,146.00 $2,968.00 34 CATH LAB SCH3441623 CATH TRNSML ANGIO NOLASR $1,194.00 $1,126.00 34 CATH LAB SCH3442662 CATH TRNSML ANGIO NOLASR $913.75 34 CATH LAB SCH3441987 CATH TRNSML ANGIO NOLASR $1,433.00 34 CATH LAB SCH3441953 CATH TRNSML ANGIO NOLASR $1,910.00 34 CATH LAB SCH3441359 CATH TRNSML ANGIO NOLASR $1,819.00 $1,716.00 34 CATH LAB SCH3441789 CATH TRNSML ANGIO NOLASR $845.00 34 CATH LAB SCH3442290 CATH TRNSML ANGIO NOLASR $2,226.00 34 CATH LAB SCH3430410 CATH TRNSML ANGIO NOLASR $1,433.00 34 CATH LAB SCH3432507 CATH TRNSML ANGIO NOLASR $5,618.00 34 CATH LAB SCH3430360 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3430352 CATH TRNSML ANGIO NOLASR $583.00 $550.00 34 CATH LAB SCH3431053 CATH TRNSML ANGIO NOLASR $1,194.00 $1,126.00 34 CATH LAB SCH3430001 CATH TRNSML ANGIO NOLASR $1,168.75 $1,168.75 34 CATH LAB SCH3440062 CATH TRNSML ANGIO NOLASR $2,149.00 34 CATH LAB SCH3440005 CATH TRNSML ANGIO NOLASR $1,194.00 $1,126.00 34 CATH LAB SCH3441201 CATH TRNSML ANGIO NOLASR $1,624.00 $1,532.00 34 CATH LAB SCH3442886 CATH TRNSML ANGIO NOLASR $1,062.50 $828.75 34 CATH LAB SCH3442126 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3442639 CATH TRNSML ANGIO NOLASR $701.25 34 CATH LAB SCH3441151 CATH TRNSML ANGIO NOLASR $430.00 $405.00 34 CATH LAB SCH3432572 CATH TRNSML ANGIO NOLASR $931.00 34 CATH LAB SCH3442845 CATH TRNSML ANGIO NOLASR 34 CATH LAB SCH3462561 CATH TRNSML ANGIO NOLASR $1,585.25 34 CATH LAB SCH3440070 CATH TRNSML ANGIO NOLASR $1,313.00 34 CATH LAB SCH3442878 CATH TRNSML ANGIO NOLASR $1,062.50 $828.72 34 CATH LAB SCH3441631 CATH TRNSML ANGIO NOLASR $1,819.00 34 CATH LAB SCH3441649 CATH TRNSML ANGIO NOLASR $1,338.75 34 CATH LAB SCH3441599 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3462397 CATH TRNSML ANGIO NOLASR $3,736.00 34 CATH LAB SCH3441581 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3441573 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3442712 CATH TRNSML ANGIO NOLASR $701.25 34 CATH LAB SCH3441771 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3441797 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3441805 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3441920 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3441052 CATH TRNSML ANGIO NOLASR $1,194.00 $1,126.00 34 CATH LAB SCH3442415 CATH TRNSML ANGIO NOLASR $1,071.00 34 CATH LAB SCH3441730 CATH TRNSML ANGIO NOLASR $1,194.00 34 CATH LAB SCH3420072 CON LOCM 300-349S I 1ML $5.80 34 CATH LAB SCH3420080 CON LOCM 300-349S I 1ML $7.80 34 CATH LAB SCH3417284 CS SAME MD ADD 15M $105.00 34 CATH LAB SCH3417276 CS SAME MD GT5YR 0-30M $156.00 34 CATH LAB SCH3451473 DUAL CHAMB RR PACEMAKER $7,050.00 34 CATH LAB SCH3451960 DUAL CHAMB RR PACEMAKER $6,600.00 34 CATH LAB SCH3452281 DUAL CHAMB RR PACEMAKER $7,050.00 34 CATH LAB SCH3452174 DUAL CHAMB RR PACEMAKER $7,050.00 34 CATH LAB SCH3451978 DUAL CHAMB RR PACEMAKER $10,500.00 34 CATH LAB SCH3451507 DUAL CHAMB RR PACEMAKER $4,702.00 34 CATH LAB SCH3451515 DUAL CHAMB RR PACEMAKER $6,674.00 34 CATH LAB SCH3452307 DUAL CHAMB RR PACEMAKER $6,000.00 34 CATH LAB SCH3451747 DUAL CHAMB RR PACEMAKER $10,500.00 34 CATH LAB SCH3451465 DUAL CHAMB RR PACEMAKER $6,600.00 34 CATH LAB SCH3451457 DUAL CHAMB RR PACEMAKER $6,000.00 34 CATH LAB SCH3451937 DUAL CHAMB RR PACEMAKER $9,430.00 34 CATH LAB SCH3451499 DUAL CHAMB RR PACEMAKER $10,112.00 34 CATH LAB SCH3452166 DUAL CHAMB RR PACEMAKER $6,600.00 34 CATH LAB SCH3451481 DUAL CHAMB RR PACEMAKER $7,079.00 34 CATH LAB SCH3451226 DUAL CHAMB RR PACEMAKER $6,600.00 34 CATH LAB SCH3452026 DUAL CHAMB RR PACEMAKER $9,270.00 34 CATH LAB SCH3452067 DUAL CHAMB RR PACEMAKER $8,081.00 34 CATH LAB SCH3451754 DUAL CHAMB RR PACEMAKER $6,812.00 34 CATH LAB SCH3452117 DUAL CHAMB RR PACEMAKER $6,000.00 34 CATH LAB SCH3452141 DUAL CHAMB RR PACEMAKER $10,327.50 34 CATH LAB SCH3451762 DUAL CHAMB RR PACEMAKER $7,129.00 34 CATH LAB SCH3451770 DUAL CHAMB RR PACEMAKER $10,104.00 34 CATH LAB SCH3451788 DUAL CHAMB RR PACEMAKER $5,387.00 34 CATH LAB SCH3440708 EMBOLIZ PROTECT SYS $125.00 $118.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3472057 EMBOLIZ PROTECT SYS $343.00 34 CATH LAB SCH3441557 EMBOLIZ PROTECT SYS $290.00 $274.00 34 CATH LAB SCH3472255 EMBOLIZ PROTECT SYS $400.00 34 CATH LAB SCH3472230 EMBOLIZ PROTECT SYS $344.00 34 CATH LAB SCH3472586 EMBOLIZ PROTECT SYS $2,800.00 34 CATH LAB SCH3472248 EMBOLIZ PROTECT SYS $433.00 34 CATH LAB SCH3460516 EP ICAR FX CV GD IN SHTH $100.00 34 CATH LAB SCH3460169 EP ICAR FX CV GD IN SHTH $239.00 34 CATH LAB SCH3461910 EP ICAR FX CV GD IN SHTH $716.00 34 CATH LAB SCH3462330 EP ICAR FX CV GD IN SHTH $352.75 34 CATH LAB SCH3462124 EP ICAR FX CV GD IN SHTH $573.00 34 CATH LAB SCH3462512 EP ICAR FX CV GD IN SHTH $451.25 34 CATH LAB SCH3462298 EP ICAR FX CV GD IN SHTH $740.00 34 CATH LAB SCH3462413 EP ICAR FX CV GD IN SHTH $246.00 34 CATH LAB SCH3462066 EP ICAR FX CV GD IN SHTH $1,433.00 34 CATH LAB SCH3462660 EP STEER GUID INTRO/SHTH $3,000.00 34 CATH LAB SCH3450509 EVENT RECORDER CARDIAC $10,441.00 34 CATH LAB SCH3460904 GUIDEWIRE $97.00 $92.00 34 CATH LAB SCH3462371 GUIDEWIRE $382.00 34 CATH LAB SCH3462199 GUIDEWIRE $63.00 34 CATH LAB SCH3461308 GUIDEWIRE $275.00 $259.00 34 CATH LAB SCH3462645 GUIDEWIRE $340.00 34 CATH LAB SCH3461753 GUIDEWIRE $425.00 $401.00 34 CATH LAB SCH3460219 GUIDEWIRE $382.00 34 CATH LAB SCH3461977 GUIDEWIRE $183.00 $172.00 34 CATH LAB SCH3460268 GUIDEWIRE $430.00 34 CATH LAB SCH3461050 GUIDEWIRE $184.00 $174.00 34 CATH LAB SCH3462025 GUIDEWIRE $2,364.00 34 CATH LAB SCH3442134 GUIDEWIRE $3,638.00 34 CATH LAB SCH3462314 GUIDEWIRE $240.00 34 CATH LAB SCH3440203 GUIDEWIRE $287.00 $270.00 34 CATH LAB SCH3461100 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3460284 GUIDEWIRE $430.00 34 CATH LAB SCH3462280 GUIDEWIRE $250.00 34 CATH LAB SCH3460276 GUIDEWIRE $430.00 34 CATH LAB SCH3461357 GUIDEWIRE $439.00 $414.00 34 CATH LAB SCH3460292 GUIDEWIRE $430.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3462488 GUIDEWIRE $510.00 34 CATH LAB SCH3460706 GUIDEWIRE $257.00 $242.00 34 CATH LAB SCH3461654 GUIDEWIRE $244.00 $230.00 34 CATH LAB SCH3460854 GUIDEWIRE $86.00 $81.00 34 CATH LAB SCH3460359 GUIDEWIRE $621.00 $586.00 34 CATH LAB SCH3462348 GUIDEWIRE $255.00 34 CATH LAB SCH3462447 GUIDEWIRE $425.00 34 CATH LAB SCH3460409 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3462652 GUIDEWIRE $361.25 34 CATH LAB SCH3462306 GUIDEWIRE $425.00 34 CATH LAB SCH3462272 GUIDEWIRE $439.00 34 CATH LAB SCH3462181 GUIDEWIRE $80.00 34 CATH LAB SCH3462173 GUIDEWIRE $36.00 34 CATH LAB SCH3462108 GUIDEWIRE $788.00 34 CATH LAB SCH3462264 GUIDEWIRE $159.00 34 CATH LAB SCH3462405 GUIDEWIRE $578.00 34 CATH LAB SCH3462033 GUIDEWIRE $203.00 34 CATH LAB SCH3462454 GUIDEWIRE $1,445.00 34 CATH LAB SCH3462504 GUIDEWIRE $395.25 34 CATH LAB SCH3462520 GUIDEWIRE $104.16 34 CATH LAB SCH3462538 GUIDEWIRE $233.75 34 CATH LAB SCH3462587 GUIDEWIRE $369.75 34 CATH LAB SCH3462629 GUIDEWIRE $1,750.00 34 CATH LAB SCH3462637 GUIDEWIRE $2,782.50 34 CATH LAB SCH3440179 GUIDEWIRE $3,301.00 34 CATH LAB SCH3440153 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3462496 GUIDEWIRE $293.25 34 CATH LAB SCH3461159 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3460250 GUIDEWIRE $43.00 $40.00 34 CATH LAB SCH3461902 GUIDEWIRE $52.00 $49.00 34 CATH LAB SCH3461944 GUIDEWIRE $439.00 34 CATH LAB SCH3461993 GUIDEWIRE $382.00 34 CATH LAB SCH3462009 GUIDEWIRE $63.00 34 CATH LAB SCH3460052 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3460458 GUIDEWIRE $28.00 $27.00 34 CATH LAB SCH3461555 GUIDEWIRE $382.00 $360.00 34 CATH LAB SCH3461704 GUIDEWIRE $224.00 $211.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3461852 GUIDEWIRE $432.00 $407.00 34 CATH LAB SCH3461209 GUIDEWIRE $325.00 $306.00 34 CATH LAB SCH3460003 GUIDEWIRE $458.00 $432.00 34 CATH LAB SCH3461613 GUIDEWIRE $78.75 34 CATH LAB SCH3461621 GUIDEWIRE $118.75 34 CATH LAB SCH3460001 GUIDEWIRE $637.50 $637.50 34 CATH LAB SCH3460326 GUIDEWIRE $430.00 34 CATH LAB SCH3462017 GUIDEWIRE $59.00 34 CATH LAB SCH3460334 GUIDEWIRE $454.00 34 CATH LAB SCH3460318 GUIDEWIRE $430.00 34 CATH LAB SCH3460342 GUIDEWIRE $525.00 34 CATH LAB SCH3461407 GUIDEWIRE $587.00 $554.00 34 CATH LAB SCH3472032 IMP FILTER VENA CAVA $2,854.00 34 CATH LAB SCH3451028 IMP FILTER VENA CAVA $3,200.00 34 CATH LAB SCH3471935 IMP FILTER VENA CAVA $3,213.00 34 CATH LAB SCH3472743 IMP FILTER VENA CAVA $3,000.00 34 CATH LAB SCH3472685 IMP GRAFT VASCULAR $5,550.00 34 CATH LAB SCH3472719 IMP GRAFT VASCULAR $15,812.50 34 CATH LAB SCH3472727 IMP GRAFT VASCULAR $13,037.50 34 CATH LAB SCH3472677 IMP GRAFT VASCULAR $7,490.00 34 CATH LAB SCH3472669 IMP GRAFT VASCULAR $4,717.50 34 CATH LAB SCH3472701 IMP GRAFT VASCULAR $4,717.50 34 CATH LAB SCH3472560 IMP GRAFT VASCULAR $6,487.50 34 CATH LAB SCH3472529 IMP GRAFT VASCULAR $24,875.00 34 CATH LAB SCH3472552 IMP GRAFT VASCULAR $5,737.50 34 CATH LAB SCH3472545 IMP GRAFT VASCULAR $5,735.50 34 CATH LAB SCH3472651 IMP GRAFT VASCULAR $20,530.00 34 CATH LAB SCH3472628 IMP GRAFT VASCULAR $20,925.00 34 CATH LAB SCH3472644 IMP GRAFT VASCULAR $6,775.00 34 CATH LAB SCH3472537 IMP GRAFT VASCULAR $6,487.50 34 CATH LAB SCH3472305 IMP SEPTAL DEFECT SYSTEM $3,000.00 34 CATH LAB SCH3472180 IMP SEPTAL DEFECT SYSTEM $10,000.00 34 CATH LAB SCH3472594 IMP SEPTAL DEFECT SYSTEM $14,372.50 34 CATH LAB SCH3472693 IMP SEPTAL DEFECT SYSTEM $4,580.00 34 CATH LAB SCH3451077 IMP SEPTAL DEFECT SYSTEM $8,427.00 34 CATH LAB SCH3472206 IMP SEPTAL DEFECT SYSTEM $2,808.00 34 CATH LAB SCH3460656 INTRO/SHEATH NON-LASER $300.00 $283.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3460953 INTRO/SHEATH NON-LASER $573.00 $541.00 34 CATH LAB SCH3462363 INTRO/SHEATH NON-LASER $616.25 34 CATH LAB SCH3462470 INTRO/SHEATH NON-LASER $340.00 34 CATH LAB SCH3461639 INTRO/SHEATH NON-LASER $113.76 34 CATH LAB SCH3460201 INTRO/SHEATH NON-LASER $59.00 $55.00 34 CATH LAB SCH3461928 INTRO/SHEATH NON-LASER $406.00 $383.00 34 CATH LAB SCH3462041 INTRO/SHTH GD FX CRV NOPL $71.00 34 CATH LAB SCH3462157 INTRO/SHTH GD FX CRV NOPL $53.00 34 CATH LAB SCH3461605 INTRO/SHTH GD FX CRV NOPL $129.00 $122.00 34 CATH LAB SCH3462058 INTRO/SHTH GD FX CRV NOPL $120.00 34 CATH LAB SCH3462140 INTRO/SHTH GD FX CRV NOPL $58.00 34 CATH LAB SCH3460805 INTRO/SHTH GD FX CRV NOPL $45.00 $43.00 34 CATH LAB SCH3472636 INTRO/SHTH GD FX CRV NOPL $9,662.50 34 CATH LAB SCH3462603 INTRO/SHTH GD FX CRV NOPL $335.75 34 CATH LAB SCH3462546 INTRO/SHTH GD FX CRV NOPL $474.76 34 CATH LAB SCH3462553 INTRO/SHTH GD FX CRV NOPL $1,287.75 34 CATH LAB SCH3462595 INTRO/SHTH GD FX CRV NOPL $1,126.25 34 CATH LAB SCH3462256 INTRO/SHTH GD FX CRV NOPL $406.00 34 CATH LAB SCH3462249 INTRO/SHTH GD FX CRV NOPL $430.00 34 CATH LAB SCH3462611 INTRO/SHTH GD FX CRV NOPL $1,003.00 34 CATH LAB SCH3462165 INTRO/SHTH GD FX CRV NOPL $253.00 34 CATH LAB SCH3462132 INTRO/SHTH GD FX CRV NOPL $48.00 34 CATH LAB SCH3451986 LEAD AICD ENDO DUAL COIL $6,750.00 34 CATH LAB SCH3452224 LEAD AICD ENDO DUAL COIL $6,750.00 34 CATH LAB SCH3451150 LEAD AICD ENDO DUAL COIL $9,101.00 34 CATH LAB SCH3452059 LEAD AICD ENDO DUAL COIL $10,281.00 34 CATH LAB SCH3451358 LEAD AICD ENDO DUAL COIL $1,685.00 34 CATH LAB SCH3451366 LEAD AICD ENDO DUAL COIL $1,601.00 34 CATH LAB SCH3451374 LEAD AICD ENDO DUAL COIL $4,214.00 34 CATH LAB SCH3451390 LEAD AICD ENDO DUAL COIL $11,983.00 34 CATH LAB SCH3451382 LEAD AICD ENDO DUAL COIL $9,101.00 34 CATH LAB SCH3451408 LEAD AICD ENDO SINGL COIL $6,750.00 34 CATH LAB SCH3451416 LEAD AICD NON SING/DUAL $6,733.00 34 CATH LAB SCH3451176 LEAD AICD NON SING/DUAL $1,433.00 34 CATH LAB SCH3451911 LEAD CORONARY VENOUS $3,750.00 34 CATH LAB SCH3452075 LEAD CORONARY VENOUS $2,700.00 34 CATH LAB SCH3452083 LEAD CORONARY VENOUS $3,362.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3452315 LEAD CORONARY VENOUS $2,700.00 34 CATH LAB SCH3452158 LEAD CORONARY VENOUS $3,000.00 34 CATH LAB SCH3499977 LEAD CORONARY VENOUS $1,966.00 34 CATH LAB SCH3451168 LEAD PMKR TRANSVENOUS VDD $750.00 34 CATH LAB SCH3451549 LEAD PMKR TRANSVENOUS VDD $750.00 34 CATH LAB SCH3451093 LEAD PMKR TRANSVENOUS VDD $750.00 34 CATH LAB SCH3451838 LEAD PMKR TRANSVENOUS VDD $750.00 34 CATH LAB SCH3451820 LEAD PMKR TRANSVENOUS VDD $1,138.00 34 CATH LAB SCH3451804 LEAD PMKR TRANSVENOUS VDD $2,191.00 34 CATH LAB SCH3451598 LEAD PMKR TRANSVENOUS VDD $1,492.00 34 CATH LAB SCH3451580 LEAD PMKR TRANSVENOUS VDD $1,028.00 34 CATH LAB SCH3451572 LEAD PMKR TRANSVENOUS VDD $1,025.00 34 CATH LAB SCH3451846 LEAD PMKR TRANSVENOUS VDD $1,348.00 34 CATH LAB SCH3451564 LEAD PMKR TRANSVENOUS VDD $834.00 34 CATH LAB SCH3451556 LEAD PMKR TRANSVENOUS VDD $949.00 34 CATH LAB SCH3451531 LEAD PMKR TRANSVENOUS VDD $1,252.00 34 CATH LAB SCH3451523 LEAD PMKR TRANSVENOUS VDD $910.00 34 CATH LAB SCH3451812 LEAD PMKR TRANSVENOUS VDD $1,685.00 34 CATH LAB SCH3452240 LEAD PMKR TRANSVENOUS VDD $1,450.00 34 CATH LAB SCH3451440 PACEMAKER SGL CHAMBR RR $6,900.00 34 CATH LAB SCH3451796 PACEMAKER SGL CHAMBR RR $6,450.00 34 CATH LAB SCH3451119 PACEMAKER SGL CHAMBR RR $6,450.00 34 CATH LAB SCH3451218 PACEMAKER SGL CHAMBR RR $6,900.00 34 CATH LAB SCH3451200 PACEMAKER SGL CHAMBR RR $5,545.00 34 CATH LAB SCH3451192 PACEMAKER SGL CHAMBR RR $5,850.00 34 CATH LAB SCH3451184 PACEMAKER SGL CHAMBR RR $6,450.00 34 CATH LAB SCH3451432 PACEMAKER SGL CHAMBR RR $6,450.00 34 CATH LAB SCH3451101 PACEMAKER SGL CHAMBR RR $5,850.00 34 CATH LAB SCH3451424 PACEMAKER SGL CHAMBR RR $5,850.00 34 CATH LAB SCH3451127 PACEMAKER SGL CHAMBR RR $6,900.00 34 CATH LAB SCH3451903 PACEMKR NO SGL/DUAL CHAMB $10,500.00 34 CATH LAB SCH3452323 PACEMKR NO SGL/DUAL CHAMB $9,750.00 34 CATH LAB SCH3442217 PROBE CRYOABLATION $2,360.00 34 CATH LAB SCH3440658 RET DEV INSERTABLE $2,143.00 $2,022.00 34 CATH LAB SCH3462579 RET DEV INSERTABLE $1,232.50 34 CATH LAB SCH3462355 RET DEV INSERTABLE $358.00 34 CATH LAB SCH3491818 S IMP ATTAIN 6215-80 $211.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3492261 S IMP CPS LEAD DEL SYSTEM $3,150.00 34 CATH LAB SCH3472073 S IMP INTRA COIL $3,371.00 34 CATH LAB SCH3492089 S IMP LEAD DELIVERY SYSTE $3,539.00 34 CATH LAB SCH3451853 S IMP MEDTRONIC LD ADAP $1,194.00 34 CATH LAB SCH3451861 S IMP MEDTRONIC LD END C $267.00 34 CATH LAB SCH3451879 S IMP MEDTRONIC SERVICE $240.00 34 CATH LAB SCH3481884 S IMP PERCLOSE KNOT PUSHE $107.00 34 CATH LAB SCH3472149 S IMP WALLGRAFT 34 CATH LAB SCH3459955 S INV DVC CARDIAC DEVICE $11,237.50 34 CATH LAB SCH3459963 S INV DVC CARDIAC DEVICE $977.50 34 CATH LAB SCH3459989 S INV DVC CARDIAC DEVICE $0.01 34 CATH LAB SCH3459997 S INV DVC CARDIAC DEVICE 34 CATH LAB SCH3472784 S INV DVC CHOICE #P040012 $5,758.00 34 CATH LAB SCH3472792 S INV DVC CHOICE TRIAL $5,375.00 34 CATH LAB SCH3459971 S INV DVC COATED WDEL SYS $7,163.00 34 CATH LAB SCH3442852 S INV DVC DEFINITIVE CA++ $7,987.50 $7,987.50 34 CATH LAB SCH3442787 S INV DVC DEFINITIVE CA++ $7,487.50 34 CATH LAB SCH3472730 S INV DVC EDUCATE P060033 $5,250.00 34 CATH LAB SCH3442811 S INV DVC EX3 DEFINITIVE $7,987.50 34 CATH LAB SCH3472750 S INV DVC NOCOAT WDEL SYS $3,325.00 34 CATH LAB SCH3442860 S INV DVC WILDCAT $0.01 34 CATH LAB SCH3480258 S NSTRL 02 CANNULA NASAL $3.00 $3.00 34 CATH LAB SCH3492113 S NSTRL ICD MNG SYS $3,150.00 34 CATH LAB SCH3480902 S NSTRL OXISENSOR $58.00 $55.00 34 CATH LAB SCH3490752 S NSTRL PADS GROUNDING $15.00 $14.00 34 CATH LAB SCH3441722 S PCR TRANS PACING SYS $1,433.00 34 CATH LAB SCH3442696 S STRL $30,000.00 34 CATH LAB SCH3492097 S STRL CABLE $740.00 34 CATH LAB SCH3442258 S STRL ACCUNET EMBOLIC PR $4,354.00 34 CATH LAB SCH3442480 S STRL AGIOGUARD EMBOLIC $3,875.00 34 CATH LAB SCH3492055 S STRL AMPLATZER SIZING P $32.00 34 CATH LAB SCH3462231 S STRL ANGIOJET PUMPSET $1,074.00 34 CATH LAB SCH3482122 S STRL ARTICF RETRACTION $637.50 34 CATH LAB SCH3481058 S STRL BIOPTOME $836.00 $788.00 34 CATH LAB SCH3432523 S STRL CA 6FR DAIG $53.00 34 CATH LAB SCH3492162 S STRL CABLE ADAPTOR TP $89.00 34 CATH LAB SCH3492204 S STRL CABLE CHILLI $637.50 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3492105 S STRL CABLE CONN 14 POLE $1,194.00 34 CATH LAB SCH3492147 S STRL CABLE CRYOCATH CO- $430.00 34 CATH LAB SCH3492139 S STRL CABLE CRYOCATH ELE $955.00 34 CATH LAB SCH3492253 S STRL CANNULATOR CPS $295.00 34 CATH LAB SCH3432796 S STRL CATH 4FR $69.00 34 CATH LAB SCH3432721 S STRL CATH 4FR 5FR 6FR $121.00 34 CATH LAB SCH3432804 S STRL CATH 4FR COR-PAC $242.00 34 CATH LAB SCH3430105 S STRL CATH 4FR COR-PAC $242.00 $228.00 34 CATH LAB SCH3432739 S STRL CATH 4FR VCF $86.00 34 CATH LAB SCH3432747 S STRL CATH 5FR NIH $77.00 34 CATH LAB SCH3432754 S STRL CATH 5FR PIG $112.00 34 CATH LAB SCH3432762 S STRL CATH 6FR STR $112.00 34 CATH LAB SCH3432770 S STRL CATH 7FR COOK $77.00 34 CATH LAB SCH3432820 S STRL CATH BOSTON SCI 6F $46.00 34 CATH LAB SCH3432788 S STRL CATH CORO 4FR $112.00 34 CATH LAB SCH3432580 S STRL CATH DIAG 6FR $53.48 34 CATH LAB SCH3442381 S STRL CATH DUAL LUMEN $1,253.75 34 CATH LAB SCH3442688 S STRL CATH DUAL LUMEN $956.25 34 CATH LAB SCH3432838 S STRL CATH DUAL LUMEN PI $548.25 34 CATH LAB SCH3441938 S STRL CATH PIG GSC $592.00 34 CATH LAB SCH3430154 S STRL CATH USCI LEHMAN $251.00 $237.00 34 CATH LAB SCH3430501 S STRL CATHETER DAIG 5FR $53.48 $53.48 34 CATH LAB SCH3442282 S STRL CATHETER MULTI TRA $171.00 34 CATH LAB SCH3442266 S STRL CATHETER PEDI 3FR $112.00 34 CATH LAB SCH3442274 S STRL CATHETER PEDI 4FR $106.00 34 CATH LAB SCH3432499 S STRL CATHETER PIGTAIL 5 $77.00 $72.00 34 CATH LAB SCH3491388 S STRL CATHETER THERMODIL $235.00 $222.00 34 CATH LAB SCH3491537 S STRL CAUTERY PENCIL $19.00 $18.00 34 CATH LAB SCH3491974 S STRL CONN CABLE $1,409.00 34 CATH LAB SCH3492048 S STRL CONN CABLE $860.00 34 CATH LAB SCH3491842 S STRL CONN CABLE $382.00 34 CATH LAB SCH3492386 S STRL CONN CABLE $722.50 34 CATH LAB SCH3491941 S STRL CONN CABLE $836.00 34 CATH LAB SCH3492345 S STRL CONN CABLE $671.50 34 CATH LAB SCH3491834 S STRL CONN CABLE $406.00 34 CATH LAB SCH3492279 S STRL CONN CABLE $637.50 34 CATH LAB SCH3491958 S STRL CONN CABLE $860.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3491990 S STRL CONN CABLE 15 PIN $573.00 34 CATH LAB SCH3491917 S STRL CONN CABLE 6 POLE $716.00 34 CATH LAB SCH3491933 S STRL CONN CABLE 6 TO 9 $716.00 34 CATH LAB SCH3491925 S STRL CONN CABLE 9 POLE $836.00 34 CATH LAB SCH3491909 S STRL CONN CABLE 9 POLE $836.00 34 CATH LAB SCH3491982 S STRL CONN CABLE NAVI-ST $1,409.00 34 CATH LAB SCH3492030 S STRL CONN CABLE PLUG $716.00 34 CATH LAB SCH3492022 S STRL CONN CABLE REDEL $1,074.00 34 CATH LAB SCH3491875 S STRL CONN CABLES $501.00 34 CATH LAB SCH3491891 S STRL CONN CABLES OCTA $501.00 34 CATH LAB SCH3492014 S STRL CONNECTOR CABLE HA $645.00 34 CATH LAB SCH3491859 S STRL CONNECTOR CABLE VI $454.00 34 CATH LAB SCH3491867 S STRL CONNECTOR CABLES B $406.00 34 CATH LAB SCH3491883 S STRL CONNECTOR CABLES H $501.00 34 CATH LAB SCH3420031 S STRL CONTRAST ISOVUE 10 $579.00 34 CATH LAB SCH3420023 S STRL CONTRAST ISOVUE 50 $289.00 34 CATH LAB SCH3420049 S STRL CONTRAST VISIPAQUE $389.00 34 CATH LAB SCH3420056 S STRL CONTRAST VISIPAQUE $778.00 34 CATH LAB SCH3491115 S STRL DEFIBRILLATOR PADS $53.25 34 CATH LAB SCH3460151 S STRL DILATOR $28.00 $26.00 34 CATH LAB SCH3462116 S STRL DILATOR VESSEL COO $30.00 34 CATH LAB SCH3491446 S STRL DISC COMPRESSOR $31.00 $29.00 34 CATH LAB SCH3481967 S STRL DRIVE CORONARY $1,313.00 $1,239.00 34 CATH LAB SCH3482064 S STRL DURMABOND $111.00 34 CATH LAB SCH3442399 S STRL EMBO SHIELD $3,625.00 34 CATH LAB SCH3492303 S STRL ENSITE ELEC KIT $3,325.00 34 CATH LAB SCH3481991 S STRL EXT REAR CORONARY $478.00 $451.00 34 CATH LAB SCH3492311 S STRL FLOWSEAL $680.00 34 CATH LAB SCH3462207 S STRL GRIP SCI MED $35.00 34 CATH LAB SCH3492295 S STRL HEMOBAND $233.75 34 CATH LAB SCH3490067 S STRL HEMOSTASE $637.50 34 CATH LAB SCH3482056 S STRL HEMOVALVE $123.00 34 CATH LAB SCH3481207 S STRL HEMOVALVE Y $106.00 $100.00 34 CATH LAB SCH3481504 S STRL HEMOVLV $32.00 $30.00 34 CATH LAB SCH3481942 S STRL ICD LEAD ADAPTOR K $421.00 34 CATH LAB SCH3492352 S STRL IMP PRES MON SET $216.13 34 CATH LAB SCH3491610 S STRL INFLATION DEV $382.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3491412 S STRL INTRO LNG 8FR $203.00 $191.00 34 CATH LAB SCH3491206 S STRL JELCO CATH $6.00 $6.00 34 CATH LAB SCH3492246 S STRL KIT CPS $118.75 34 CATH LAB SCH3462421 S STRL LEAD SELOX SR 60 $975.00 34 CATH LAB SCH3482023 S STRL LOCALISA ELECTRODE $836.00 34 CATH LAB SCH3492063 S STRL LV17 ADAPTOR $1,433.00 34 CATH LAB SCH3492071 S STRL LV-IS ADAPTOR $590.00 34 CATH LAB SCH3481652 S STRL MANIFOLD 4 PORT $58.00 $55.00 34 CATH LAB SCH3480209 S STRL MANIFOLD DISPOSABL $32.00 $30.00 34 CATH LAB SCH3480407 S STRL MANIFOLD DISPOSABL $39.00 $37.00 34 CATH LAB SCH3482080 S STRL MEDRAD MANIFOLD $59.06 34 CATH LAB SCH3482106 S STRL MEDRAD MLT USE MAN $41.40 34 CATH LAB SCH3482098 S STRL MEDRAD SNGL USE M $121.13 34 CATH LAB SCH3451895 S STRL MEDTRONIC PACING C $112.00 34 CATH LAB SCH3460011 S STRL MICROSNARE RETRIEV $2,143.00 $2,022.00 34 CATH LAB SCH3491602 S STRL MOTOR DRIVE UNIT $473.00 34 CATH LAB SCH3481355 S STRL NDL JELCO $8.00 $8.00 34 CATH LAB SCH3481454 S STRL NDL POTTS VASCULAR $27.00 $25.00 34 CATH LAB SCH3481108 S STRL NEEDLE COOK VASCUL $23.00 $22.00 34 CATH LAB SCH3491826 S STRL OMEGA PRESSURE DIS $23.00 34 CATH LAB SCH3430907 S STRL PACEMAKER/HIS CABL $406.00 $383.00 34 CATH LAB SCH3491420 S STRL PACEMAKER/HIS CABL $382.00 $360.00 34 CATH LAB SCH3481959 S STRL PACK ACS PRIORITY $240.00 34 CATH LAB SCH3491552 S STRL PADTAC ELECTS $133.00 34 CATH LAB SCH3492154 S STRL PATCH NEPTUNE $160.00 34 CATH LAB SCH3432515 S STRL PEDI VESSEL SIZING $382.50 34 CATH LAB SCH3482031 S STRL PERIVAC $677.00 34 CATH LAB SCH3492196 S STRL POLAR NITRUS CARTR $239.00 34 CATH LAB SCH3460672 S STRL PONT PLUG $425.00 34 CATH LAB SCH3481975 S STRL POWER PK CORONARY $310.00 $293.00 34 CATH LAB SCH3490554 S STRL PRESSURE LINE 36 I $9.00 $9.00 34 CATH LAB SCH3481306 S STRL PROBE RECT.TEMP $15.00 $14.00 34 CATH LAB SCH3442365 S STRL PROXIS FILTER $3,000.00 34 CATH LAB SCH3492006 S STRL PULLBACK SLEDGE $187.00 34 CATH LAB SCH3492360 S STRL PWR PULSE KIT Y SE $166.25 34 CATH LAB SCH3491966 S STRL REFSTAR ELEC KIT $1,433.00 34 CATH LAB SCH3482007 S STRL ROTABLATOR ADVANCE $888.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3492170 S STRL SEALING ADAPTER $263.00 34 CATH LAB SCH3482049 S STRL SMART NEEDLE $406.00 34 CATH LAB SCH3462462 S STRL SNARE RETRIEVAL $1,678.75 34 CATH LAB SCH3442548 S STRL SPIDERFX $2,875.00 34 CATH LAB SCH3472339 S STRL STENT INTRACOIL $2,949.00 34 CATH LAB SCH3482015 S STRL STERILE CONCEPTS B $597.00 $563.00 34 CATH LAB SCH3491354 S STRL SUT $28.00 $27.00 34 CATH LAB SCH3492121 S STRL SYVEK PATCH $377.00 34 CATH LAB SCH3492220 S STRL TOLL BYPASS VALUE $78.75 34 CATH LAB SCH3460557 S STRL TOOL INSERTION ACS $17.00 $16.00 34 CATH LAB SCH3492238 S STRL TOOL SLITTER $95.00 34 CATH LAB SCH3442423 S STRL TORNUS CATHETER $2,432.50 34 CATH LAB SCH3490216 S STRL TR BAND $956.25 34 CATH LAB SCH3492329 S STRL TRACKBACK $403.75 34 CATH LAB SCH3481918 S STRL TRANSSEPTAL NEEDLE $1,074.00 34 CATH LAB SCH3481009 S STRL TRAY HEART CATH SM $214.00 $202.00 34 CATH LAB SCH3482072 S STRL TRAY PACEMAKER $267.75 34 CATH LAB SCH3491438 S STRL TRNDCR DISP $55.00 $52.00 34 CATH LAB SCH3492287 S STRL TUBING SET $255.00 34 CATH LAB SCH3492378 S STRL TUBING SET $318.75 $318.75 34 CATH LAB SCH3492212 S STRL TUBING SET CHILLI $213.75 34 CATH LAB SCH3480555 S STRL TY HEART CATH LG $531.25 $531.25 34 CATH LAB SCH3492188 S STRL UNIVERSAL SLITTER $133.00 34 CATH LAB SCH3461803 S STRL USCI OBTURATOR $25.00 $24.00 34 CATH LAB SCH3480852 S STRL VLV ACS DUOSTAT $123.00 $116.00 34 CATH LAB SCH3490851 S STRL VLV ACS HEMOSTATIC $177.00 $167.00 34 CATH LAB SCH3481900 S STRL VLV CO-PILOT $262.00 34 CATH LAB SCH3460300 S STRL WIRE CLIP TORQUER $59.00 $56.00 34 CATH LAB SCH3491453 S STRL WIRE TUREMO 035 $183.00 $172.00 34 CATH LAB SCH3472610 STENT COATD/COV W/DEL SYS $4,875.00 34 CATH LAB SCH3472321 STENT COATD/COV W/DEL SYS $7,303.00 34 CATH LAB SCH3472511 STENT COATD/COV W/DEL SYS $5,250.00 34 CATH LAB SCH3472297 STENT COATD/COV W/DEL SYS $7,163.00 34 CATH LAB SCH3472396 STENT COATD/COV W/DEL SYS $5,750.00 34 CATH LAB SCH3472461 STENT COATD/COV W/DEL SYS $6,375.00 34 CATH LAB SCH3472602 STENT COATD/COV W/DEL SYS $4,875.00 34 CATH LAB SCH3472768 STENT COATD/COV W/DEL SYS $5,250.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3472776 STENT COATD/COV W/DEL SYS $5,750.00 34 CATH LAB SCH3472735 STENT COATD/COV W/DEL SYS $7,163.00 34 CATH LAB SCH3472271 STENT COATD/COV W/DEL SYS $4,199.00 34 CATH LAB SCH3471927 STENT COATD/COV W/DEL SYS $4,199.00 34 CATH LAB SCH3472131 STENT COATD/COV W/DEL SYS $5,478.00 34 CATH LAB SCH3470101 STENT COATD/COV W/DEL SYS $2,282.00 34 CATH LAB SCH3472479 STENT COATD/COV W/DEL SYS $7,425.00 34 CATH LAB SCH3472453 STENT NOCOAT W DEL SYS $3,325.00 34 CATH LAB SCH3471984 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472164 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472198 STENT NOCOAT W DEL SYS $2,694.00 34 CATH LAB SCH3472024 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472404 STENT NOCOAT W DEL SYS $2,625.00 34 CATH LAB SCH3472115 STENT NOCOAT W DEL SYS $6,728.00 34 CATH LAB SCH3471828 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472016 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472289 STENT NOCOAT W DEL SYS $4,513.00 34 CATH LAB SCH3472354 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3472263 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471992 STENT NOCOAT W DEL SYS $3,272.00 34 CATH LAB SCH3472008 STENT NOCOAT W DEL SYS $2,360.00 34 CATH LAB SCH3470002 STENT NOCOAT W DEL SYS $3,301.00 $3,114.00 34 CATH LAB SCH3471125 STENT NOCOAT W DEL SYS $5,497.00 34 CATH LAB SCH3472222 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3471976 STENT NOCOAT W DEL SYS $3,716.00 34 CATH LAB SCH3472172 STENT NOCOAT W DEL SYS $3,250.00 34 CATH LAB SCH3472107 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472156 STENT NOCOAT W DEL SYS $2,809.00 34 CATH LAB SCH3472065 STENT NOCOAT W DEL SYS $3,638.00 34 CATH LAB SCH3471109 STENT NOCOAT W DEL SYS $3,476.00 34 CATH LAB SCH3471968 STENT NOCOAT W DEL SYS $3,325.00 34 CATH LAB SCH3471893 STENT NOCOAT W DEL SYS $3,792.00 34 CATH LAB SCH3472123 STENT NOCOAT W DEL SYS $4,831.00 34 CATH LAB SCH3471950 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471943 STENT NOCOAT W DEL SYS $3,298.00 34 CATH LAB SCH3470051 STENT NOCOAT W DEL SYS $3,225.00 $3,042.00 34 CATH LAB SCH3472099 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3472081 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471133 STENT NOCOAT W DEL SYS $6,257.00 34 CATH LAB SCH3472446 STENT NOCOAT W DEL SYS $5,375.00 34 CATH LAB SCH3472370 STENT NOCOAT W DEL SYS $6,320.00 34 CATH LAB SCH3472420 STENT NOCOAT W DEL SYS $4,987.50 34 CATH LAB SCH3472362 STENT NOCOAT W DEL SYS $5,758.00 34 CATH LAB SCH3472438 STENT NOCOAT W DEL SYS $3,375.00 34 CATH LAB SCH3471042 STENT NOCOAT W DEL SYS $3,982.00 34 CATH LAB SCH3471059 STENT NOCOAT W DEL SYS $4,487.00 34 CATH LAB SCH3472347 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3472578 STENT NOCOAT W DEL SYS $3,325.00 34 CATH LAB SCH3471075 STENT NOCOAT W DEL SYS $5,246.00 34 CATH LAB SCH3471117 STENT NOCOAT W DEL SYS $4,487.00 34 CATH LAB SCH3472313 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3417011 USC INJ INTRA-ARTERIAL $162.00 $115.00 34 CATH LAB SCH3481892 VASCULAR CLOSURE DEVICE $1,194.00 34 CATH LAB SCH3481868 VASCULAR CLOSURE DEVICE $1,074.00 34 CATH LAB SCH3472412 VASCULAR CLOSURE DEVICE $850.00 34 CATH LAB SCH3482114 VASCULAR CLOSURE DEVICE $1,593.75 34 CATH LAB SCH3432713 VASCULAR CLOSURE DEVICE $931.00 34 CATH LAB SCH6527154 AEROSOL TX DEMO/EVAL $131.00 65 CHILDREN SERVICES6527147 AEROSOL TX SUBSQ $54.00 65 CHILDREN SERVICES6591440 ANLZE INFSN PUMP NO REPRG $538.00 $414.00 65 CHILDREN SERVICES6592893 ANLZE INFSN PUMP W REPROG $673.00 65 CHILDREN SERVICES6591333 ANORECTAL MANOMETRY $489.00 $375.00 65 CHILDREN SERVICES6590244 ASPIRATION BONE MARROW $407.00 $312.00 65 CHILDREN SERVICES6550446 AUD CASE CONF WA 15 MIN $31.00 65 CHILDREN SERVICES6591366 BIOPSY SKIN LESION EA ADD $63.00 $55.00 65 CHILDREN SERVICES6591358 BIOPSY SKIN LESION SNGL $124.00 $95.00 65 CHILDREN SERVICES6516397 BLOOD DRAW GT 3 W MD/NP $32.00 65 CHILDREN SERVICES6516413 BLOOD DRAW LT 3 FEM/JUG $32.00 65 CHILDREN SERVICES6516421 BLOOD DRAW LT 3 OTHER VN $32.00 65 CHILDREN SERVICES6516405 BLOOD DRAW LT 3 SCALP VN $32.00 65 CHILDREN SERVICES6591176 BLOOD TRANSFUSN 2-4 HR $596.00 65 CHILDREN SERVICES6591184 BLOOD TRANSFUSN 4-6 HR $937.00 65 CHILDREN SERVICES6591192 BLOOD TRANSFUSN GT 6HR $1,153.00 65 CHILDREN SERVICES6591200 BLOOD TRANSFUSN LT 2 HR $341.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6590228 BX BM NDL/TROCAR $439.99 $334.78 65 CHILDREN SERVICES6592406 BX LIVER $327.00 65 CHILDREN SERVICES6505028 CARD PHONE CONSULT 15 MIN $44.00 65 CHILDREN SERVICES6590921 CASE CONF 15 MIN LCSW $45.00 $34.00 65 CHILDREN SERVICES6590780 CASE CONF 15 MIN RN $45.00 $34.00 65 CHILDREN SERVICES6533145 CASE CONF GI (OTHER0/CCS $34.00 65 CHILDREN SERVICES6531032 CASE CONFERENCE GI D/CCS $49.00 65 CHILDREN SERVICES6533038 CASE CONFERENCE GI LCSW/C $32.00 65 CHILDREN SERVICES6592877 CECOSTOMY TUBE CHG WO CON $286.48 $186.16 65 CHILDREN SERVICES6591531 CHEM ADDL SEQ INF 0-60MN $285.00 65 CHILDREN SERVICES6532154 CHEM CAUT GRANUL TISSUE $74.00 65 CHILDREN SERVICES6591283 CHEM HORMON ANTINEO SQ/IM $2,320.00 65 CHILDREN SERVICES6591309 CHEM IVP EA ADDL DRG $72.00 65 CHILDREN SERVICES6591291 CHEM IVP SNGL/INIT DRG $410.90 65 CHILDREN SERVICES6591275 CHEM NO-HORM ANTNEO SQ/IM $512.14 65 CHILDREN SERVICES6590509 CHEMO CNS W/SPINAL PUNC $1,081.00 $827.00 65 CHILDREN SERVICES6590301 CHEMO IA PUSH $182.00 $139.00 65 CHILDREN SERVICES6592372 CHEMODENERVTN NECK MUSCLE $257.00 65 CHILDREN SERVICES6592414 CHEMODENERVTN NECK MUSCLE $257.00 65 CHILDREN SERVICES6592380 CHEMODENERVTN TRUNK/EXT $379.00 65 CHILDREN SERVICES6592422 CHEMODENERVTN TRUNK/EXT $286.00 65 CHILDREN SERVICES6591341 CHNG G TUBE WO IMAG/GD $242.00 $185.00 65 CHILDREN SERVICES6532147 CHNG G TUBE WO IMAG/GD $106.00 65 CHILDREN SERVICES6592869 CIRCUM 28 DAYS OR OLDER $392.74 $304.60 65 CHILDREN SERVICES6590269 COLLECT BLD VNS ACCES DVC $124.00 $95.00 65 CHILDREN SERVICES6526099 COMPREHENSIVE REPORT $115.00 65 CHILDREN SERVICES6550503 COMPREHENSIVE REPORT $115.00 65 CHILDREN SERVICES6561104 COMPREHENSIVE REPORT $121.00 65 CHILDREN SERVICES6516025 COMPREHENSIVE REPORT $115.00 65 CHILDREN SERVICES6506109 COMPREHENSIVE REPORT $115.00 65 CHILDREN SERVICES6586077 COMPREHENSIVE REPORT $115.00 65 CHILDREN SERVICES6516363 COMPREHENSIVE REPORT $97.00 65 CHILDREN SERVICES6544555 COMPREHENSIVE REPORT $95.00 65 CHILDREN SERVICES6576011 COMPREHENSIVE REPORT $109.00 65 CHILDREN SERVICES6511067 COMPUTER DATA ANALYSIS $151.00 $151.00 65 CHILDREN SERVICES6541072 COMPUTER DATA ANALYSIS $136.00 $123.00 65 CHILDREN SERVICES6571095 COMPUTER DATA ANALYSIS $178.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6521074 COMPUTER DATA ANALYSIS $151.00 $151.00 65 CHILDREN SERVICES6571319 COMPUTER DATA ANALYSIS $160.00 65 CHILDREN SERVICES6560874 COMPUTER DATA ANALYSIS $160.00 65 CHILDREN SERVICES6531131 COMPUTER DATA ANALYSIS $151.00 $151.00 65 CHILDREN SERVICES6581052 COMPUTER DATA ANALYSIS $160.00 65 CHILDREN SERVICES6511232 COMPUTER DATA ANALYSIS $160.00 65 CHILDREN SERVICES6551089 COMPUTER NUTR ANALYSIS $151.00 65 CHILDREN SERVICES6501118 COMPUTER NUTR ANALYSIS $151.00 65 CHILDREN SERVICES6506000 COORDINATOR FEE $142.00 65 CHILDREN SERVICES6526008 COORDINATOR FEE $142.00 65 CHILDREN SERVICES6550487 COORDINATOR FEE $142.00 65 CHILDREN SERVICES6516009 COORDINATOR FEE $142.00 65 CHILDREN SERVICES6591127 COORDINATOR FEE $264.00 $199.00 65 CHILDREN SERVICES6586069 COORDINATOR FEE $142.00 65 CHILDREN SERVICES6516355 COORDINATOR FEE $129.00 65 CHILDREN SERVICES6544506 COORDINATOR FEE $126.00 65 CHILDREN SERVICES6576003 COORDINATOR FEE $145.00 65 CHILDREN SERVICES6550131 CPP CASE CONF-ENT (30MIN) $98.00 65 CHILDREN SERVICES6550149 CPP CASE CONF-GEN (30MIN) $98.00 65 CHILDREN SERVICES6550156 CPP CASE CONF-MD (30 MIN) $98.00 65 CHILDREN SERVICES6550180 CPP CASE CONF-PED (30MIN) $79.00 65 CHILDREN SERVICES6550164 CPP CASE CON-ORAL SUR 30M $98.00 65 CHILDREN SERVICES6550206 CPP CASE CON-PL SUR-30MIN $98.00 65 CHILDREN SERVICES6590384 DECLOT VASC DEVICE $212.00 $162.00 65 CHILDREN SERVICES6560650 DEV EXAM ROOM, 150 MIN $260.00 65 CHILDREN SERVICES6560668 DEV EXAM ROOM, 180 MIN $331.00 65 CHILDREN SERVICES6561096 DEV PERIODIC INTERIM RPT $71.00 65 CHILDREN SERVICES6560536 DEV PT CONF 15MIN/CCS $31.00 65 CHILDREN SERVICES6560528 DEV SPEC CASE CONF EA 15 $46.00 65 CHILDREN SERVICES6566004 DEV ZERO CHARGE SERVICE 65 CHILDREN SERVICES6560601 DEV. COORDINATOR FEE $160.00 65 CHILDREN SERVICES6580104 DIABETES TEACHING PACKET $512.00 $387.00 65 CHILDREN SERVICES6592935 DILATE ANAL SPHINC W/ANES $1,081.00 65 CHILDREN SERVICES6592927 DRESSNG CHG OT/BRN W/ANES $1,081.00 65 CHILDREN SERVICES6591408 EDUC REMEDIATION 20-30 $94.00 $72.00 65 CHILDREN SERVICES6591416 EDUC REMEDIATION 45-50 $204.00 $176.00 65 CHILDREN SERVICES6516454 ENZYME CELL ACT NON-RAD $306.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6516439 ENZYME CELL ACT RAD $315.00 65 CHILDREN SERVICES6522080 EVAL PPS NURSE/CCS $42.00 65 CHILDREN SERVICES6573190 EXAM ROOM - 120 MIN $149.00 65 CHILDREN SERVICES6573174 EXAM ROOM - 60 MIN $74.00 65 CHILDREN SERVICES6583173 EXAM ROOM - 60 MIN $85.00 65 CHILDREN SERVICES6573182 EXAM ROOM - 90 MIN $121.00 65 CHILDREN SERVICES6550735 EXAM ROOM 120 MIN/CCS $198.00 65 CHILDREN SERVICES6576060 EXAM ROOM 120 MIN/CCS $200.00 65 CHILDREN SERVICES6544373 EXAM ROOM 120MIN/CCS $187.00 65 CHILDREN SERVICES6550743 EXAM ROOM 150 MIN/CCS $230.00 65 CHILDREN SERVICES6576078 EXAM ROOM 150MIN CCS $234.00 65 CHILDREN SERVICES6544381 EXAM ROOM 150MIN/CCS $218.00 65 CHILDREN SERVICES6550750 EXAM ROOM 180 MIN/CCS $305.00 65 CHILDREN SERVICES6576086 EXAM ROOM 180MIN CCS $301.00 65 CHILDREN SERVICES6544399 EXAM ROOM 180MIN/CCS $277.00 65 CHILDREN SERVICES6550594 EXAM ROOM 60 MIN/CCS $98.00 65 CHILDREN SERVICES6576045 EXAM ROOM 60 MIN/CCS $100.00 65 CHILDREN SERVICES6544357 EXAM ROOM 60MIN/CCS $93.00 65 CHILDREN SERVICES6550727 EXAM ROOM 90 MIN/CCS $146.00 65 CHILDREN SERVICES6576052 EXAM ROOM 90 MIN/CCS $146.00 65 CHILDREN SERVICES6544365 EXAM ROOM 90MIN/CCS $138.00 65 CHILDREN SERVICES6550511 EXAM ROOM FIRST 30MIN/CCS $60.00 65 CHILDREN SERVICES6544340 EXAM ROOM FIRST 30MIN/CCS $54.00 65 CHILDREN SERVICES6560445 EXAM ROOM FRST 30 MIN/CCS $64.00 65 CHILDREN SERVICES6576037 EXAM ROOM FRST 30 MIN/CCS $58.00 65 CHILDREN SERVICES6591135 EXAM ROOM UP TO 30 MIN $90.00 $68.00 65 CHILDREN SERVICES6516124 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6536064 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6526065 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6506067 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6560643 EXAM ROOM, 120 MIN/CCS $220.00 65 CHILDREN SERVICES6586036 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6541163 EXAM ROOM, 120 MIN/CCS $198.00 65 CHILDREN SERVICES6573414 EXAM ROOM, 120 MIN/CCS $200.00 65 CHILDREN SERVICES6571152 EXAM ROOM, 120 MIN/CCS $200.00 65 CHILDREN SERVICES6516322 EXAM ROOM, 120 MIN/CCS $220.00 65 CHILDREN SERVICES6526073 EXAM ROOM, 150 MIN/CCS $230.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6506075 EXAM ROOM, 150 MIN/CCS $230.00 65 CHILDREN SERVICES6516132 EXAM ROOM, 150 MIN/CCS $230.00 65 CHILDREN SERVICES6536072 EXAM ROOM, 150 MIN/CCS $230.00 65 CHILDREN SERVICES6586044 EXAM ROOM, 150 MIN/CCS $234.00 65 CHILDREN SERVICES6516330 EXAM ROOM, 150 MIN/CCS $234.00 65 CHILDREN SERVICES6526081 EXAM ROOM, 180 MIN/CCS $305.00 65 CHILDREN SERVICES6586051 EXAM ROOM, 180 MIN/CCS $301.00 65 CHILDREN SERVICES6516140 EXAM ROOM, 180 MIN/CCS $305.00 65 CHILDREN SERVICES6536080 EXAM ROOM, 180 MIN/CCS $305.00 65 CHILDREN SERVICES6516348 EXAM ROOM, 180 MIN/CCS $301.00 65 CHILDREN SERVICES6506083 EXAM ROOM, 180 MIN/CCS $305.00 65 CHILDREN SERVICES6571137 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6560452 EXAM ROOM, 60 MIN/CCS $110.00 65 CHILDREN SERVICES6536023 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6541148 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6506026 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6526024 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6516058 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6586010 EXAM ROOM, 60 MIN/CCS $98.00 65 CHILDREN SERVICES6573398 EXAM ROOM, 60 MIN/CCS $100.00 65 CHILDREN SERVICES6516306 EXAM ROOM, 60 MIN/CCS $110.00 65 CHILDREN SERVICES6506059 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6536056 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6560635 EXAM ROOM, 90 MIN/CCS $160.00 65 CHILDREN SERVICES6526057 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6516116 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6586028 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6571145 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6541155 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6573406 EXAM ROOM, 90 MIN/CCS $146.00 65 CHILDREN SERVICES6516314 EXAM ROOM, 90 MIN/CCS $160.00 65 CHILDREN SERVICES6571129 EXAM ROOM, FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6526016 EXAM ROOM, FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6536015 EXAM ROOM, FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6586002 EXAM ROOM, FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6541130 EXAM ROOM, FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6573380 EXAM ROOM, FRST 30 MIN/CC $58.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6516298 EXAM ROOM, FRST 30 MIN/CC $64.00 65 CHILDREN SERVICES6506018 EXAM ROOM,FRST 30 MIN/CC $60.00 65 CHILDREN SERVICES6516033 EXAM ROOM,FRST 30 MIN/CCS $60.00 65 CHILDREN SERVICES6573166 EXAM ROOM-UP TO 30 MIN $63.00 65 CHILDREN SERVICES6590608 F/U VISIT 30 MIN DIETITIA $90.00 $68.00 65 CHILDREN SERVICES6590905 F/U VISIT 30 MIN LCSW $90.00 $68.00 65 CHILDREN SERVICES6590764 F/U VISIT 30 MIN RN $90.00 $68.00 65 CHILDREN SERVICES6532030 FACILITY SPEC CHG RN CCON $36.00 65 CHILDREN SERVICES6515134 FAMILY CONFERENCE/CCS $127.00 65 CHILDREN SERVICES6592919 FORESKIN MANIPULATION $297.00 $228.00 65 CHILDREN SERVICES6516280 FREE RESEARCH LAB TEST 65 CHILDREN SERVICES6515241 GC CASE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6550461 GC CSE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6515035 GC FAMILY-GRP CONSEL/CCS $82.00 65 CHILDREN SERVICES6550420 GENETIC COUN VISIT 30-CCS $54.00 65 CHILDREN SERVICES6545040 GENETIC COUNSELING 15 MN $88.00 65 CHILDREN SERVICES6545032 GENETIC COUNSELING 30 MN $160.34 65 CHILDREN SERVICES6585012 GENETIC COUNSELING/CCS $127.00 65 CHILDREN SERVICES6505036 GENETIC COUNSELING/CCS $127.00 65 CHILDREN SERVICES6550792 GENETICS CASE CONF/CCS $105.00 65 CHILDREN SERVICES6536098 GI COMPRE RPT $115.00 65 CHILDREN SERVICES6536007 GI COORDINATOR FEE/CCS $142.00 65 CHILDREN SERVICES6591374 GLUCOSE FINGERSTICK $11.00 $8.00 65 CHILDREN SERVICES6575021 GRP EXERCISE SPEC-15 MIN 65 CHILDREN SERVICES6575039 GRP EXERCISE SPEC-30 MIN 65 CHILDREN SERVICES6575047 GRP EXERCISE SPEC-45 MIN 65 CHILDREN SERVICES6575005 GRP EXERCISE SPEC-60 MIN 65 CHILDREN SERVICES6573489 GRP MNT SESSION-15/CCS $76.00 65 CHILDREN SERVICES6573497 GRP MNT SESSION-30/CCS $80.00 65 CHILDREN SERVICES6573505 GRP MNT SESSION-45/CCS $86.00 65 CHILDREN SERVICES6571376 GRP MNT SESSION-60/CCS $90.00 65 CHILDREN SERVICES6572077 GRP NP SESSION-15/CCS $38.00 65 CHILDREN SERVICES6572085 GRP NP SESSION-30/CCS $46.00 65 CHILDREN SERVICES6572093 GRP NP SESSION-45/CCS $53.00 65 CHILDREN SERVICES6572101 GRP NP SESSION-60/CCS $59.00 65 CHILDREN SERVICES6572127 GRP NP SESSION-60/EPSDT $59.00 65 CHILDREN SERVICES6573513 GRP SW SESSION-15/CCS $25.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6573521 GRP SW SESSION-30/CCS $31.00 65 CHILDREN SERVICES6573539 GRP SW SESSION-45/CCS $34.00 65 CHILDREN SERVICES6573547 GRP SW SESSION-60/CCS $41.00 65 CHILDREN SERVICES6555346 HC PRO PHONE CALL 11-20M $68.00 65 CHILDREN SERVICES6527220 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6518054 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6506133 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6545156 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6567093 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6589063 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6538045 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6592588 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6576136 HC PRO PHONE CALL 11-20M $60.00 65 CHILDREN SERVICES6538052 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6527238 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6576144 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6518062 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6589071 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6545164 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6567101 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6506141 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6592596 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6555353 HC PRO PHONE CALL 21-30M $90.00 65 CHILDREN SERVICES6555338 HC PRO PHONE CALL 5-10M $34.00 65 CHILDREN SERVICES6527212 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6589055 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6518047 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6576128 HC PRO PHONE CALL 5-10M $34.00 65 CHILDREN SERVICES6538037 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6545149 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6567085 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6592570 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6506125 HC PRO PHONE CALL 5-10M $30.00 65 CHILDREN SERVICES6553200 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6583009 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6503163 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6544167 HEALTH/BEHV INITIAL EA 15 $68.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6573323 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6513303 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6573471 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6512198 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6533228 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6523203 HEALTH/BEHV INITIAL EA 15 $66.00 65 CHILDREN SERVICES6553218 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6573331 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6513311 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6544175 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6523211 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6583017 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6513196 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6503171 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6533236 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6573430 HEALTH/BEHV REASSES EA 15 $64.00 65 CHILDREN SERVICES6590053 HEM/ONC PROC RM FIRST HR $575.00 $435.00 65 CHILDREN SERVICES6563050 HLTH/BEH INTRV,FAM/15M $64.00 65 CHILDREN SERVICES6563043 HLTH/BEH INTRV,FAM/PT/15M $64.00 65 CHILDREN SERVICES6563035 HLTH/BEH INTRV,GRP/15M $25.00 65 CHILDREN SERVICES6563027 HLTH/BEH INTRV,IND,EA 15M $64.00 65 CHILDREN SERVICES6563001 HLTH/BEHAV INIT ASSES 15M $66.00 65 CHILDREN SERVICES6563019 HLTH/BEHAV RE-ASSES 15M $64.00 65 CHILDREN SERVICES6503213 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6583058 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6544217 HLTH/BHV INT FAM/NO PT 15 $57.00 65 CHILDREN SERVICES6553259 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6513238 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6573422 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6573372 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6513352 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6523252 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6533277 HLTH/BHV INT FAM/NO PT 15 $64.00 65 CHILDREN SERVICES6533269 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6503205 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6544209 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6553242 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6573463 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6573364 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6523245 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6583041 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6513345 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6513220 HLTH/BHV INT FAM/PT EA 15 $64.00 65 CHILDREN SERVICES6503197 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6583033 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6544191 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6572119 HLTH/BHV INTERV GRP EA 15 $15.00 65 CHILDREN SERVICES6513337 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6573356 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6573455 HLTH/BHV INTERV GRP EA 15 $12.00 65 CHILDREN SERVICES6553234 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6533251 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6513212 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6523237 HLTH/BHV INTERV GRP EA 15 $25.00 65 CHILDREN SERVICES6553226 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6573448 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6544183 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6503189 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6513204 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6513329 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6533244 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6573349 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6523229 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6583025 HLTH/BHV INTERV IND EA 15 $64.00 65 CHILDREN SERVICES6591234 HYDRATN INFSN EA ADD HR $137.00 65 CHILDREN SERVICES6591226 HYDRATN INFSN INIT 31-60M $196.00 65 CHILDREN SERVICES6591572 IMMUN ADMIN EA ADD VACCNE $35.00 65 CHILDREN SERVICES6591564 IMMUN ADMIN SGL VACCNE $35.00 65 CHILDREN SERVICES6590376 INF CHEM IA EA ADDL HR $285.00 $218.00 65 CHILDREN SERVICES6590368 INF CHMO INTRA ART 16-60M $571.00 $437.00 65 CHILDREN SERVICES6591267 INFSN W/MED ADD SEQ 16-60 $97.60 65 CHILDREN SERVICES6591481 INFSN W/MED CONCURRENT $1,643.00 65 CHILDREN SERVICES6591259 INFSN W/MED EA ADD HR $262.02 65 CHILDREN SERVICES6591242 INFUSION W/MED 16-60MN $557.40 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6590160 INFUSION/TREATMENT ROOM $184.00 $140.00 65 CHILDREN SERVICES6590327 INFUSN CHEMO 0-60 MN $293.00 $224.00 65 CHILDREN SERVICES6590335 INFUSN CHEMO EA ADD HR $172.00 $131.00 65 CHILDREN SERVICES6541189 INITIAL ASSESS-15MIN/EPSD $68.00 65 CHILDREN SERVICES6515266 INITIAL ASSESS-15MIN/EPSD $63.00 65 CHILDREN SERVICES6512206 INITIAL ASSESS-15MIN/EPSD $81.00 65 CHILDREN SERVICES6511299 INITIAL ASSESS-15MIN/EPSD $63.00 65 CHILDREN SERVICES6573257 INITIAL ASSESS-60MIN/EPSD $292.00 65 CHILDREN SERVICES6573208 INITIAL ASSESS-60MIN/EPSD $268.00 65 CHILDREN SERVICES6513378 INITIAL ASSESS-60MIN/EPSD $268.00 65 CHILDREN SERVICES6571160 INITIAL NUTR ASSESS/EPSDT $59.00 65 CHILDREN SERVICES6592844 INJ BLOOD/CLOT PATCH $322.61 $209.64 65 CHILDREN SERVICES6591457 INJ EPID CERV THOR $337.00 65 CHILDREN SERVICES6591317 INJ IVP ADDL SEQ NEW DRG $60.00 65 CHILDREN SERVICES6590442 INJ IVP SNGL/INIT DRG $69.00 $53.00 65 CHILDREN SERVICES6591168 INJECTION IM/SQ EA $86.00 65 CHILDREN SERVICES6592430 INSERT CATH NONINDWLLNG $171.00 65 CHILDREN SERVICES6592398 INSERT CATH NONINDWLLNG $233.00 65 CHILDREN SERVICES6592786 INSERT DRUG IMPLANT $350.00 65 CHILDREN SERVICES6506034 INTERIM REPORT $74.00 65 CHILDREN SERVICES6536031 INTERIM REPORT $74.00 65 CHILDREN SERVICES6586085 INTERIM REPORT $74.00 65 CHILDREN SERVICES6526032 INTERIM REPORT $74.00 65 CHILDREN SERVICES6550495 INTERIM REPORT $74.00 65 CHILDREN SERVICES6544563 INTERIM REPORT $63.00 65 CHILDREN SERVICES6576029 INTERIM REPORT $71.00 65 CHILDREN SERVICES6516371 INTERIM REPORT $64.00 65 CHILDREN SERVICES6516017 INTERIM REPORT $74.00 65 CHILDREN SERVICES6527170 IPPB DEMO/EVAL $54.00 65 CHILDREN SERVICES6527162 IPV DEMO/EVAL $54.00 65 CHILDREN SERVICES6591325 IRRIG IMPLNTD VNS ACC DVC $208.00 65 CHILDREN SERVICES6592505 LEVEL 1 EST PATIENT $175.00 65 CHILDREN SERVICES6564058 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6544118 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6514459 LEVEL 1 EST PATIENT $175.00 65 CHILDREN SERVICES6564124 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6514178 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6584056 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6504112 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6524136 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6514301 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6574073 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6534168 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6545222 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6554158 LEVEL 1 EST PATIENT $182.00 65 CHILDREN SERVICES6592455 LEVEL 1 NEW PATIENT $129.00 65 CHILDREN SERVICES6592703 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6514426 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592687 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592604 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592661 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592646 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592620 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6545172 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592729 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592745 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592760 LEVEL 1 NEW PATIENT $182.00 65 CHILDREN SERVICES6592513 LEVEL 2 EST PATIENT $203.00 65 CHILDREN SERVICES6514442 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6564132 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6574081 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6584064 LEVEL 2 EST PATIENT $203.00 65 CHILDREN SERVICES6524144 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6564066 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6545230 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6514319 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6544126 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6554166 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6514186 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6504120 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6554224 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6554232 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6534176 LEVEL 2 EST PATIENT $211.00 65 CHILDREN SERVICES6545180 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6592463 LEVEL 2 NEW PATIENT $149.00 65 CHILDREN SERVICES6592737 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592752 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592695 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592679 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592778 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6514418 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592711 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592653 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592638 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6592612 LEVEL 2 NEW PATIENT $211.00 65 CHILDREN SERVICES6514194 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6592349 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6514327 LEVEL 3 EST PATIENT $108.00 65 CHILDREN SERVICES6592521 LEVEL 3 EST PATIENT $170.00 65 CHILDREN SERVICES6564140 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6584072 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6554174 LEVEL 3 EST PATIENT $231.00 65 CHILDREN SERVICES6514434 LEVEL 3 EST PATIENT $347.00 65 CHILDREN SERVICES6591622 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6564074 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6504138 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6524151 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591747 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591804 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6544134 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591861 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6534184 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591689 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6574099 LEVEL 3 EST PATIENT $108.00 65 CHILDREN SERVICES6592281 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591929 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6545248 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6591986 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6592224 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6592166 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6592042 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6592109 LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6545198 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591838 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592190 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591952 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591770 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6514400 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592315 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591598 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591655 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592133 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592018 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592075 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6592471 LEVEL 3 NEW PATIENT $170.00 65 CHILDREN SERVICES6592257 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591713 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6591895 LEVEL 3 NEW PATIENT $241.00 65 CHILDREN SERVICES6514368 LEVEL 4 EST PATIENT $470.00 65 CHILDREN SERVICES6554208 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6524185 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6584106 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6545255 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6544142 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6534218 LEVEL 4 EST PATIENT $427.00 65 CHILDREN SERVICES6504146 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6504161 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6514202 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6524169 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6514335 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6514228 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6544613 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6534192 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591879 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592232 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591630 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591937 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591994 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6584080 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6574123 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6564082 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591697 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592059 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6574107 LEVEL 4 EST PATIENT $169.00 65 CHILDREN SERVICES6564108 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592539 LEVEL 4 EST PATIENT $283.00 65 CHILDREN SERVICES6592117 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591812 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6591754 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592356 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592299 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6592174 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6554182 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6573232 LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6545206 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6514392 LEVEL 4 NEW PATIENT $240.00 65 CHILDREN SERVICES6592026 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592083 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591606 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591788 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591846 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591721 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592489 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592323 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592141 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592265 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591663 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591903 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6591960 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6592208 LEVEL 4 NEW PATIENT $399.00 65 CHILDREN SERVICES6564116 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6524193 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6574131 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6554216 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6534226 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6504054 LEVEL 5 EST PATIENT $518.00 65 CHILDREN SERVICES6584114 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6544159 LEVEL 5 EST PATIENT $412.00 65 CHILDREN SERVICES6591820 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592125 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6591648 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592182 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6544621 LEVEL 5 EST PATIENT $529.00 65 CHILDREN SERVICES6534200 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6591705 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6591887 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592000 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6591945 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6524177 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6574115 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592067 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6554190 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6514210 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6513022 LEVEL 5 EST PATIENT $429.00 $170.00 65 CHILDREN SERVICES6512008 LEVEL 5 EST PATIENT $429.00 $148.00 65 CHILDREN SERVICES6511042 LEVEL 5 EST PATIENT $429.00 $148.00 65 CHILDREN SERVICES6554026 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6591762 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6514236 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592547 LEVEL 5 EST PATIENT $303.00 65 CHILDREN SERVICES6584098 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6564090 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6514343 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6514376 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592364 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6545263 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6571038 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592307 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6592240 LEVEL 5 EST PATIENT $429.00 65 CHILDREN SERVICES6502041 LEVEL 5 EST PATIENT $429.00 $148.00 65 CHILDREN SERVICES6504153 LEVEL 5 EST PATIENT $261.00 65 CHILDREN SERVICES6591671 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6591739 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6591614 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592216 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6591853 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6591978 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592091 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6591796 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6591911 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592158 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592273 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592497 LEVEL 5 NEW PATIENT $303.00 65 CHILDREN SERVICES6592331 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6514384 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6545214 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6592034 LEVEL 5 NEW PATIENT $429.00 65 CHILDREN SERVICES6516447 LSD SCRN SERUM $314.00 65 CHILDREN SERVICES6590459 LUMBAR PUNCTURE DX $297.00 $228.00 65 CHILDREN SERVICES6527121 MDI/NEB DEMO/EVAL $42.00 $42.00 65 CHILDREN SERVICES6571178 MED NUT THERAPY/EPSDT 15 $58.00 65 CHILDREN SERVICES6571327 MED NUTR TX EA 15 $63.00 65 CHILDREN SERVICES6571210 MED NUTR TX EA 15 $53.00 65 CHILDREN SERVICES6571350 MED NUTR TX EA 15 $63.00 65 CHILDREN SERVICES6521165 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6551097 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6581003 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6501241 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6561120 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6511273 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6511182 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6531156 MED NUTR TX EA 15 $59.00 65 CHILDREN SERVICES6571301 MED NUTR TX GP EA 30 $53.00 65 CHILDREN SERVICES6571228 MED NUTR TX REASMNT EA 15 $69.00 65 CHILDREN SERVICES6571368 MED NUTR TX REASMNT EA 15 $69.00 65 CHILDREN SERVICES6571335 MED NUTR TX REASMNT EA 15 $69.00 65 CHILDREN SERVICES6551105 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6521173 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6531164 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6511190 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6511281 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6561138 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6571343 MED NUTR TX REASMNT EA 15 $63.00 65 CHILDREN SERVICES6501258 MED NUTR TX REASMNT EA 15 $57.00 65 CHILDREN SERVICES6581011 MED NUTR TX REASMNT EA 15 $69.00 65 CHILDREN SERVICES6511604 MET ZERO CHARGE SERVICE 65 CHILDREN SERVICES6518013 MISC CHEM TEST 65 CHILDREN SERVICES6516470 MISC CHEM TEST 65 CHILDREN SERVICES6541197 MNT- INDIV -15MIN/EPSDT $62.00 65 CHILDREN SERVICES6515274 MNT-INDIV-15MIN/EPSDT $57.00 65 CHILDREN SERVICES6512214 MNT-INDIV-15MIN/EPSDT $77.00 65 CHILDREN SERVICES6511307 MNT-INDIV-15MIN/EPSDT $57.00 65 CHILDREN SERVICES6516173 MOL DX AMP TR N ACD EA SQ $69.00 65 CHILDREN SERVICES6516181 MOL DX ENZ DIG EA ENZ TX $69.00 65 CHILDREN SERVICES6516199 MOL DX GL ELCTR SEP EA NA $69.00 65 CHILDREN SERVICES6516207 MOL DX INTERP & RPT $69.00 65 CHILDREN SERVICES6516165 MOL DX ISO/EXTN EA NA TYP $69.00 65 CHILDREN SERVICES6550719 NASOPHARYNGOSCOPY $246.00 65 CHILDREN SERVICES6592794 NG TUBE PLC W FLUORO $242.97 65 CHILDREN SERVICES6560460 NP CASE CONF EA 15 MIN $39.00 65 CHILDREN SERVICES6550800 ORAL SURG CASE CONF/CCS $105.00 65 CHILDREN SERVICES6550040 ORAL SURGERY VISIT $241.00 65 CHILDREN SERVICES6550818 ORTHODONTICS CS CONF/CCS $90.00 65 CHILDREN SERVICES6544514 OT CASE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6544225 OT EVAL 15 $180.00 65 CHILDREN SERVICES6544233 OT EVAL 30 $237.00 65 CHILDREN SERVICES6544241 OT EVAL 45 $295.00 65 CHILDREN SERVICES6544258 OT EVAL 60 $242.00 65 CHILDREN SERVICES6544423 OT EVAL ADD 15/CCS $53.00 65 CHILDREN SERVICES6544415 OT EVAL INIT 30/CCS $130.00 65 CHILDREN SERVICES6544266 OT RE-EVAL 15 $162.00 65 CHILDREN SERVICES6544274 OT RE-EVAL 30 $162.00 65 CHILDREN SERVICES6544449 OT TREAT ADD 15/CCS $53.00 65 CHILDREN SERVICES6544431 OT TREAT INIT 30/CCS $114.00 65 CHILDREN SERVICES6560593 OTHER AHP ASSESS/INTERV $88.00 65 CHILDREN SERVICES6505010 OTHR CASE CONF EA 15 MIN $25.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6585004 OTHR CASE CONF EA 15 MIN $26.00 65 CHILDREN SERVICES6525026 OTHR CASE CONF EA 15 MIN $25.00 65 CHILDREN SERVICES6515233 OTHR CASE CONF EA 15 MIN $26.00 65 CHILDREN SERVICES6535025 OTHR CASE CONF EA 15 MIN $25.00 65 CHILDREN SERVICES6515027 OTHR CASE CONF EA 15 MIN $25.00 65 CHILDREN SERVICES6550776 OTOLARYNGOLY CS CONF/CCS $105.00 65 CHILDREN SERVICES6550065 OTOLOGIC VISIT $241.00 65 CHILDREN SERVICES6506042 PCD ZERO CHARGE SERVICE 65 CHILDREN SERVICES6550826 PED DENTIST CASE CONF/CCS $90.00 65 CHILDREN SERVICES6545057 PED GEN EXAM RM - 60 MIN/ $98.00 65 CHILDREN SERVICES6545073 PED GEN EXAM RM -120 MIN/ $179.34 65 CHILDREN SERVICES6545065 PED GEN EXAM RM -90 MIN/C $139.20 65 CHILDREN SERVICES6545024 PED GEN EXAM RM UP TO 30 $60.00 65 CHILDREN SERVICES6545081 PED GEN TEL CONSLT-GC EA1 $49.34 65 CHILDREN SERVICES6545016 PED GEN VISIT-GC 30 MIN/C $110.00 65 CHILDREN SERVICES6550784 PEDIATRIC CASE CONF/CCS $92.00 65 CHILDREN SERVICES6550073 PEDIATRIC VISIT $241.00 65 CHILDREN SERVICES6567069 PEDS PHYS/TEAM CONF 30 $72.00 65 CHILDREN SERVICES6518021 PEDS PHYS/TEAM CONF 30 $72.00 65 CHILDREN SERVICES6576102 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6545123 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6527196 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6589048 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6538011 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6567051 PEDS PHYS/TEAM CONF 30 $77.00 65 CHILDREN SERVICES6534101 PEDS PHYS/TEAM CONF 30 $77.00 $77.00 65 CHILDREN SERVICES6506158 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6554091 PEDS PHYS/TEAM CONF 30 $315.00 65 CHILDREN SERVICES6592554 PEDS PHYS/TEAM CONF 30 $64.00 65 CHILDREN SERVICES6555312 PEDS PHYS/TEAM CONF 30 $72.00 65 CHILDREN SERVICES6514244 PEN ZERO CHARGE SERVICE 65 CHILDREN SERVICES6550198 PF DENTAL CASE PRES $104.00 $77.00 65 CHILDREN SERVICES6550081 PF DENTAL CONSULT $104.00 $77.00 65 CHILDREN SERVICES6550032 PF LEVEL 3 EST PATIENT $241.00 $241.00 65 CHILDREN SERVICES6560395 PF LEVEL 3 EST PATIENT $241.00 65 CHILDREN SERVICES6560676 PF LEVEL 4 EST PATIENT $399.00 65 CHILDREN SERVICES6550172 PF ORTHODONTIST CASE PRES $104.00 $77.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6550057 PF ORTHODONTIST CONSULT $104.00 $77.00 65 CHILDREN SERVICES6550842 PF TELEPHONE CONSULT 15 $42.00 65 CHILDREN SERVICES6536049 PGI ZERO CHARGE SERVICE 65 CHILDREN SERVICES6590574 PH ESOPH NASAL CATH ELECT $2,074.00 $1,539.00 65 CHILDREN SERVICES6591424 PHLEBOTOMY THERAPEUTIC $210.00 $161.00 65 CHILDREN SERVICES6574032 PHLP F-UP/EPSDT CASE CONF $344.00 65 CHILDREN SERVICES6571293 PHLP GRP MNT/EPSDT 15MIN $3.00 65 CHILDREN SERVICES6573307 PHLP GRP SW/EPSDT 60MIN $18.00 65 CHILDREN SERVICES6576094 PHLP ZERO CHARGE SERVICE 65 CHILDREN SERVICES6515258 PHONE CONSLT 15MIN-GC/CCS $48.00 65 CHILDREN SERVICES6582027 PHONE CONSLT 15MIN-NP/CCS $66.00 65 CHILDREN SERVICES6522098 PHONE CONSLT 15MIN-NP/CCS $63.00 65 CHILDREN SERVICES6532022 PHONE CONSLT 15MIN-NP/CCS $69.00 65 CHILDREN SERVICES6502025 PHONE CONSLT 15MIN-NP/CCS $63.00 65 CHILDREN SERVICES6512081 PHONE CONSLT 15MIN-NP/CCS $69.00 65 CHILDREN SERVICES6560437 PHONE CONSLT 15MIN-NP/CCS $71.00 65 CHILDREN SERVICES6544571 PHONE CONSLT 15MIN-OT/CCS $62.00 65 CHILDREN SERVICES6544597 PHONE CONSLT 15MIN-PT/CCS $57.00 65 CHILDREN SERVICES6511109 PHONE CONSLT 15MIN-RD/CCS $46.00 65 CHILDREN SERVICES6541171 PHONE CONSLT 15MIN-RD/CCS $54.00 65 CHILDREN SERVICES6501027 PHONE CONSLT 15MIN-RD/CCS $46.00 65 CHILDREN SERVICES6571111 PHONE CONSLT 15MIN-RD/CCS $52.00 65 CHILDREN SERVICES6560908 PHONE CONSLT 15MIN-RD/CCS $54.00 65 CHILDREN SERVICES6581045 PHONE CONSLT 15MIN-RD/CCS $48.00 65 CHILDREN SERVICES6521108 PHONE CONSLT 15MIN-RD/CCS $46.00 65 CHILDREN SERVICES6531024 PHONE CONSLT 15MIN-RD/CCS $52.00 65 CHILDREN SERVICES6511224 PHONE CONSLT 15MIN-RD/CCS $54.00 65 CHILDREN SERVICES6550248 PHONE CONSLT 15MIN-RD/CCS $55.00 65 CHILDREN SERVICES6550289 PHONE CONSLT 15MIN-RN/CCS $65.00 65 CHILDREN SERVICES6544589 PHONE CONSLT 15MIN-RN/CCS $63.00 65 CHILDREN SERVICES6512156 PHONE CONSLT 15MIN-RN/CCS $64.00 65 CHILDREN SERVICES6527030 PHONE CONSLT 15MIN-RT/CCS $46.00 65 CHILDREN SERVICES6560429 PHONE CONSLT 15MIN-SLP/CC $54.00 65 CHILDREN SERVICES6550313 PHONE CONSLT 15MIN-SW/CCS $53.00 65 CHILDREN SERVICES6503023 PHONE CONSLT 15MIN-SW/CCS $48.00 65 CHILDREN SERVICES6544605 PHONE CONSLT 15MIN-SW/CCS $57.00 65 CHILDREN SERVICES6583082 PHONE CONSLT 15MIN-SW/CCS $52.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6573158 PHONE CONSLT 15MIN-SW/CCS $52.00 65 CHILDREN SERVICES6560494 PHONE CONSLT 15MIN-SW/CCS $57.00 65 CHILDREN SERVICES6565006 PHONE CONSLT 15MIN-SW/CCS $82.00 65 CHILDREN SERVICES6533020 PHONE CONSLT 15MIN-SW/CCS $48.00 65 CHILDREN SERVICES6523062 PHONE CONSLT 15MIN-SW/CCS $48.00 65 CHILDREN SERVICES6513261 PHONE CONSLT 15MIN-SW/CCS $57.00 65 CHILDREN SERVICES6513055 PHONE CONSLT 15MIN-SW/CCS $48.00 65 CHILDREN SERVICES6555155 PHONE CONSLT 15MN-SLP/CCS $59.00 65 CHILDREN SERVICES6550123 PHONE CONSULT - CPP PHYSI $42.00 65 CHILDREN SERVICES6525125 PHONE CONSULT 15MIN/CCS $59.00 65 CHILDREN SERVICES6560411 PHYSICIAN CASE CONF/CCS $82.00 65 CHILDREN SERVICES6550834 PHYSICIAN CASE CONF/CCS $105.00 65 CHILDREN SERVICES6550099 PHYSICIAN VISIT $241.00 65 CHILDREN SERVICES6550768 PLASTIC SUR CASE CONF/CCS $105.00 65 CHILDREN SERVICES6550586 PLASTIC SURGERY VISIT $241.00 65 CHILDREN SERVICES6527139 PPS ZERO CHARGE SERVICE 65 CHILDREN SERVICES6544753 PRM ZERO CHARGE SERVICE 65 CHILDREN SERVICES6590012 PROC RM 1ST HR (1PED STF) $575.00 $435.00 65 CHILDREN SERVICES6590020 PROC RM ADDL 15 MIN $144.00 $108.00 65 CHILDREN SERVICES6564017 PROLONG F-F SVC, EA 30MIN $100.00 65 CHILDREN SERVICES6564009 PROLONG F-F SVC, FIRST HR $199.00 65 CHILDREN SERVICES6524094 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6534127 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6514269 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6574057 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6504070 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6554117 PROLONG SVC F-F ADDL 30MN $100.00 65 CHILDREN SERVICES6514137 PROLONG SVC F-F ADDL 30MN $92.00 65 CHILDREN SERVICES6584015 PROLONG SVC F-F ADDL 30MN $92.00 65 CHILDREN SERVICES6544076 PROLONG SVC F-F ADDL 30MN $119.00 65 CHILDREN SERVICES6524086 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6574040 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6554109 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6514251 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6534119 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6504062 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES6584007 PROLONG SVC F-F FIRST HR $197.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6544068 PROLONG SVC F-F FIRST HR $180.00 65 CHILDREN SERVICES6514129 PROLONG SVC F-F FIRST HR $183.00 65 CHILDREN SERVICES6567010 PSY TEST SCORE 15 MN $60.00 65 CHILDREN SERVICES6567028 PSY WRITE REPORT 15 MN $60.00 65 CHILDREN SERVICES6567002 PSYO TESTING/HR $265.00 65 CHILDREN SERVICES6544548 PT CASE CONF EA 15 MIN $28.00 65 CHILDREN SERVICES6544282 PT EVAL 15 $108.00 65 CHILDREN SERVICES6544290 PT EVAL 30 $144.00 65 CHILDREN SERVICES6544308 PT EVAL 45 $180.00 65 CHILDREN SERVICES6544316 PT EVAL 60 $216.00 65 CHILDREN SERVICES6544464 PT EVAL ADD 15/CCS $87.00 65 CHILDREN SERVICES6544456 PT EVAL INIT 30/CCS $177.00 65 CHILDREN SERVICES6544324 PT RE-EVAL 15 $86.00 65 CHILDREN SERVICES6544332 PT RE-EVAL 30 $129.00 65 CHILDREN SERVICES6544480 PT TREAT ADD 15/CCS $57.00 65 CHILDREN SERVICES6544472 PT TREAT INIT 30/CCS $161.00 65 CHILDREN SERVICES6561112 PT TREATMENT-ADD 15 MIN $38.00 65 CHILDREN SERVICES6560569 PT/OT TESTING FIRST 30MIN $91.00 65 CHILDREN SERVICES6560544 PT/OT TESTING, ADD 15 MIN $42.00 65 CHILDREN SERVICES6591390 PULSE OXIMETRY MULTIPLE $79.00 $63.00 65 CHILDREN SERVICES6502124 PULSE OXIMETRY SINGLE $42.00 65 CHILDREN SERVICES6591382 PULSE OXIMETRY SINGLE $30.00 $23.00 65 CHILDREN SERVICES6518005 PULSE OXIMETRY SINGLE $42.00 65 CHILDREN SERVICES6582068 PULSE OXIMETRY SINGLE $42.00 65 CHILDREN SERVICES6560015 PULSE OXIMETRY SINGLE $42.00 65 CHILDREN SERVICES6538003 PULSE OXIMETRY SINGLE $42.00 65 CHILDREN SERVICES6527006 PULSE OXIMETRY SINGLE $46.00 65 CHILDREN SERVICES6571285 PWM GRP MNT CCS SESSION $81.00 65 CHILDREN SERVICES6573315 PWM GRP SW VISIT-60MIN $211.00 65 CHILDREN SERVICES6573240 PWM SW VISIT-30MIN (CCS) $57.00 65 CHILDREN SERVICES6501035 RD CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6521116 RD CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6550255 RD CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6511117 RD CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6581037 RD CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6511216 RD CASE CONF EA 15 MIN $26.00 65 CHILDREN SERVICES6571244 RD CASE CONF EA 15 MIN $26.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6560890 RD CASE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6571103 RD VISIT/CCS-30 MIN $64.00 65 CHILDREN SERVICES6541122 RD VISIT/CCS-30 MIN $64.00 65 CHILDREN SERVICES6574156 RD/NP/SW GRP SESSION-CCS $31.00 65 CHILDREN SERVICES6592901 REM SUTURES W/ANES $1,081.00 $827.00 65 CHILDREN SERVICES6592802 REMOVAL FB SUBQ TISS SMPL $112.00 65 CHILDREN SERVICES6592828 REMOVE DRUG IMPLANT $367.20 65 CHILDREN SERVICES6592836 REMOVE W INS DRUG IMPLANT $481.48 65 CHILDREN SERVICES6591580 REMV TUNN CV CATH W/O PT $264.00 65 CHILDREN SERVICES6591432 RFL/MAINT IMP PMP SYSTMC $259.00 $199.00 65 CHILDREN SERVICES6550297 RN CASE CONF EA 15 MIN $34.00 65 CHILDREN SERVICES6512149 RN CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6544530 RN CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6572036 RN CASE CONF EA 15 MIN $36.00 65 CHILDREN SERVICES6582019 RN CASE CONF EA 15 MIN $36.00 65 CHILDREN SERVICES6522106 RN CASE CONF EA 15 MIN $39.00 65 CHILDREN SERVICES6502033 RN CASE CONF EA 15 MIN $39.00 65 CHILDREN SERVICES6512099 RN CASE CONF EA 15 MIN $39.00 65 CHILDREN SERVICES6527048 RT CASE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6580039 S STRL CRANI ACCESS KIT $676.00 $511.00 65 CHILDREN SERVICES6589006 SCS ZERO CHARGE SERVICE 65 CHILDREN SERVICES6592810 SELF MGMT ED 1PT 30M $285.20 65 CHILDREN SERVICES6550453 SLP CASE CONF WA 15 MIN $31.00 65 CHILDREN SERVICES6555197 SP EVAL FNX SWALL 15 $215.00 65 CHILDREN SERVICES6555205 SP EVAL FNX SWALL 30 $288.00 65 CHILDREN SERVICES6555213 SP EVAL FNX SWALL 45 $323.00 65 CHILDREN SERVICES6555031 SP EVAL FNX SWALL 60 $417.00 65 CHILDREN SERVICES6555015 SP EVAL SP/LNG/COM/AUD 15 $323.00 65 CHILDREN SERVICES6555221 SP EVAL SP/LNG/COM/AUD 15 $100.00 65 CHILDREN SERVICES6555304 SP EVAL SP/LNG/COM/AUD 30 $299.00 65 CHILDREN SERVICES6555023 SP EVAL SP/LNG/COM/AUD 45 $253.00 65 CHILDREN SERVICES6555049 SP EVAL SP/LNG/COM/AUD 90 $507.00 65 CHILDREN SERVICES6555239 SP SP EVAL 15 $100.00 65 CHILDREN SERVICES6555247 SP SP EVAL 30 $299.00 65 CHILDREN SERVICES6555148 SP SP/LANG THER EA 30 $180.00 65 CHILDREN SERVICES6555163 SP THER SP/LANG EA 60 $199.00 65 CHILDREN SERVICES6555254 SP TX SP/LANG/COM IND 15 $144.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6555288 SP TX SP/LANG/COM IND 30 $165.00 65 CHILDREN SERVICES6555262 SP TX SP/LANG/COM IND 45 $216.00 65 CHILDREN SERVICES6555296 SP TX SP/LANG/COM IND 60 $187.00 65 CHILDREN SERVICES6555189 SP TX SWALL/ORAL FNX 15 $144.00 65 CHILDREN SERVICES6555270 SP TX SWALL/ORAL FNX 30 $180.00 65 CHILDREN SERVICES6555130 SP TX SWALL/ORAL FNX 45 $216.00 65 CHILDREN SERVICES6516223 SPEC HANDL COURIER $79.00 65 CHILDREN SERVICES6516215 SPEC HANDL COURIER $79.00 65 CHILDREN SERVICES6516231 SPEC HANDL COURIER $79.00 65 CHILDREN SERVICES6527188 SPIROMETRY $92.00 65 CHILDREN SERVICES6503031 SW CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6523070 SW CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6550321 SW CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6560502 SW CASE CONF EA 15 MIN $31.00 65 CHILDREN SERVICES6513063 SW CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6583074 SW CASE CONF EA 15 MIN $32.00 65 CHILDREN SERVICES6513253 SW CASE CONF EA 15 MIN $27.00 65 CHILDREN SERVICES6544522 SW CASE CONF EA 15 MIN $28.00 65 CHILDREN SERVICES6573265 SW CASE CONF EA 15 MIN $27.00 65 CHILDREN SERVICES6565022 TELEPHONE CONSLT 30 $145.00 65 CHILDREN SERVICES6565014 TELEPHONE CONSULT 15 $82.00 65 CHILDREN SERVICES6560841 TELEPHONE CONSULT 15 $54.00 65 CHILDREN SERVICES6565030 TELEPHONE CONSULT GT 30 $226.00 65 CHILDREN SERVICES6560551 TEST DEVELOPMNTL EXTENDED $285.00 65 CHILDREN SERVICES6573216 THRPY- INDIV -60MIN/EPSDT $255.00 65 CHILDREN SERVICES6513360 THRPY-INDIV-60MIN/EPSDT $255.00 65 CHILDREN SERVICES6516249 TISSUE CULT SKIN/SOLID BX $359.00 65 CHILDREN SERVICES6516272 TISSUE CULT SKIN/SOLID BX $298.00 65 CHILDREN SERVICES6516264 TISSUE CULT SKIN/SOLID BX $283.00 65 CHILDREN SERVICES6518039 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6506117 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6589030 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6527204 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6589014 TM CONF W/O PT BY HC PRO $100.00 65 CHILDREN SERVICES6576110 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6592562 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES6545131 TM CONF W/O PT BY HC PRO $64.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6567077 TM CONF W/O PT BY HC PRO $72.00 65 CHILDREN SERVICES6567036 TM CONF W/O PT BY HC PRO $100.00 65 CHILDREN SERVICES6555320 TM CONF W/O PT BY HC PRO $72.00 65 CHILDREN SERVICES6538029 TM CONF W/O PT BY HC PRO $72.00 65 CHILDREN SERVICES6592885 TUBE THORACOSTOMY $264.59 $171.93 65 CHILDREN SERVICES6516256 UREAPLSMA CULTURE $138.00 65 CHILDREN SERVICES6591218 VENIPUNCTURE $10.00 65 CHILDREN SERVICES6516389 VENIPUNCTURE $18.00 65 CHILDREN SERVICES6567119 VISIT 30 MIN - N/CCS $86.00 65 CHILDREN SERVICES6511091 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6521090 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6550230 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6531008 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6501019 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6581029 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6571236 VISIT 30 MIN-D/CCS $59.00 65 CHILDREN SERVICES6560882 VISIT 30 MIN-D/CCS $59.00 65 CHILDREN SERVICES6511208 VISIT 30 MIN-D/CCS $64.00 65 CHILDREN SERVICES6533004 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6503015 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6550305 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6523047 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6560510 VISIT 30 MIN-L/CCS $65.00 65 CHILDREN SERVICES6513048 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6583066 VISIT 30 MIN-L/CCS $64.00 65 CHILDREN SERVICES6544407 VISIT 30 MIN-L/CCS $71.00 65 CHILDREN SERVICES6573141 VISIT 30 MIN-L/CCS $60.00 65 CHILDREN SERVICES6513246 VISIT 30 MIN-L/CCS $65.00 65 CHILDREN SERVICES6522072 VISIT 30 MIN-N/CCS $86.00 65 CHILDREN SERVICES6532014 VISIT 30 MIN-N/CCS $86.00 65 CHILDREN SERVICES6502017 VISIT 30 MIN-N/CCS $86.00 65 CHILDREN SERVICES6550271 VISIT 30 MIN-N/CCS $88.00 65 CHILDREN SERVICES6512073 VISIT 30 MIN-N/CCS $86.00 65 CHILDREN SERVICES6582001 VISIT 30 MIN-N/CCS $86.00 65 CHILDREN SERVICES6544498 VISIT 30 MIN-N/CCS $91.00 65 CHILDREN SERVICES6572010 VISIT 30 MIN-N/CCS $85.00 65 CHILDREN SERVICES6512131 VISIT 30 MIN-N/CCS $94.00 65 CHILDREN SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6527022 VISIT 30 MIN-RT/CCS $46.00 65 CHILDREN SERVICES6515290 VISIT 30MIN-GC (CCS) $104.00 65 CHILDREN SERVICES6585038 VISIT 30MIN-GC (CCS) $96.48 65 CHILDREN SERVICES6515282 VISIT 30MIN-GC (CCS) $119.00 65 CHILDREN SERVICES6525034 VISIT 30MIN-GS (CCS) $131.00 $119.00 65 CHILDREN SERVICES6585020 VISIT 30MIN-GS (CCS) $119.00 65 CHILDREN SERVICES6531016 VISIT GI DIETITIAN/CCS $42.00 65 CHILDREN SERVICES6533012 VISIT GI LCSW/CCS $42.00 65 CHILDREN SERVICES6515019 VISIT PENS OTHER ALLIE $42.00 65 CHILDREN SERVICES6523054 VISIT PPS LCSW/CCS $42.00 65 CHILDREN SERVICES6574149 WEIGHT MANAGE NPP SESSION $36.00 65 CHILDREN SERVICES6550552 XR CEPHALOGRAM ORDO $96.00 65 CHILDREN SERVICES6550560 XR CEPHALOGRAM ORDO $26.00 65 CHILDREN SERVICES6550545 XR DENTAL FULL EXAM $234.00 $178.00 65 CHILDREN SERVICES6550685 ZERO CHARGE SERVICE 65 CHILDREN SERVICES6573224 ZERO CHARGE SERVICE 65 CHILDREN SERVICES6571186 ZERO CHARGE SERVICE 65 CHILDREN SERVICES4800140 AB ELUTION $337.00 $337.00 $113.30 48 CLINICAL LAB4800132 AB ID $516.00 $516.00 $381.25 48 CLINICAL LAB4800124 AB SCRN $278.00 $278.00 $138.30 48 CLINICAL LAB4800033 ABO TYP $79.00 $79.00 $63.85 48 CLINICAL LAB4800520 ABO TYP $79.00 48 CLINICAL LAB4860052 ACETAMINOPHEN $542.00 $542.00 $23.00 48 CLINICAL LAB4861506 AFP TUMOR MARKER $450.00 $4.95 48 CLINICAL LAB4800173 AG TYP PT RBC EA $99.00 $99.00 48 CLINICAL LAB4850103 ALBUMIN SERUM/PLASMA/BLD $132.00 $132.00 $6.96 48 CLINICAL LAB4850111 ALBUMIN UR 24HR $139.00 48 CLINICAL LAB4860557 ALCOHOL (ETHANOL) $291.00 $291.00 $23.00 48 CLINICAL LAB4860508 ALCOHOL (ETHANOL) UR $291.00 $291.00 $28.07 48 CLINICAL LAB4850152 ALK PHOSPHATASE $139.00 $139.00 $7.28 48 CLINICAL LAB4850202 ALT (SGPT) $139.00 $139.00 $7.44 48 CLINICAL LAB4850251 AMMONIA $390.00 $390.00 $20.51 48 CLINICAL LAB4860060 AMPHETAMINE SCRN $98.00 48 CLINICAL LAB4850301 AMYLASE $506.00 $506.00 $9.21 48 CLINICAL LAB4850350 AMYLASE FLD $506.00 $506.00 $5.75 48 CLINICAL LAB4850400 AST (SGOT) $139.00 $139.00 $7.28 48 CLINICAL LAB4820494 AUTO DIFF WBC COUNT $172.00 48 CLINICAL LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4860078 BARBITURATES SCRN $98.00 48 CLINICAL LAB4852653 BASIC METBLC PNL TOTAL CA $225.00 $225.00 $11.91 48 CLINICAL LAB4860086 BENZODIAZEPINE SCRN $98.00 48 CLINICAL LAB4850475 BILIRUBIN DIRECT $132.00 $132.00 $7.06 48 CLINICAL LAB4850509 BILIRUBIN NEONATAL $132.00 $132.00 $7.06 48 CLINICAL LAB4820502 BLD SMR EXAM W MAN DIFF $93.00 $93.00 $112.15 48 CLINICAL LAB4820528 BLD SMR EXAM WO MAN DIFF 48 CLINICAL LAB4830089 BLEEDING TIME TEST $1,012.00 $1,012.00 $144.60 48 CLINICAL LAB4830097 BLEEDING TIME TEST $1,012.00 $1,012.00 $83.95 48 CLINICAL LAB4840302 BODY FLUID PH NOS $93.00 $93.00 $5.75 48 CLINICAL LAB4852950 BUN $106.00 $106.00 $5.56 48 CLINICAL LAB4861753 C REACTIVE PROTEIN $139.00 $6.00 48 CLINICAL LAB4861548 CA 125 $556.00 $5.44 48 CLINICAL LAB4850657 CALCIUM $139.00 $139.00 $7.26 48 CLINICAL LAB4850707 CALCIUM FLD $139.00 $139.00 $20.40 48 CLINICAL LAB4850715 CALCIUM UR 24HR $159.00 48 CLINICAL LAB4860458 CANNABINOID SCRN $98.00 $98.00 $28.07 48 CLINICAL LAB4860102 CARBAMAZEPINE TOTAL $390.00 $390.00 $20.49 48 CLINICAL LAB4820106 CBC AUTO $172.00 $172.00 $14.40 48 CLINICAL LAB4820205 CBC AUTO W AUTO DIFF WBC $205.00 $205.00 $10.94 48 CLINICAL LAB4861563 CEA $509.00 $4.95 48 CLINICAL LAB4840146 CELL CNT FLD W/ DIFF $145.00 $145.00 $32.65 48 CLINICAL LAB4851002 CHLORIDE $126.00 $126.00 $6.47 48 CLINICAL LAB4851150 CHLORIDE FLD $132.00 $132.00 $90.30 48 CLINICAL LAB4860953 CHLORIDE SWEAT $132.00 $132.00 48 CLINICAL LAB4851200 CHLORIDE UR 24HR $132.00 $132.00 $20.70 48 CLINICAL LAB4851259 CHOLESTEROL $119.00 $119.00 $6.13 48 CLINICAL LAB4860151 CK MB FRACTION $311.00 $311.00 $16.25 48 CLINICAL LAB4851309 CK TOTAL $172.00 $172.00 $9.17 48 CLINICAL LAB4830105 CLOT RETRACTION $99.00 $99.00 $41.40 48 CLINICAL LAB4851358 CO2 (BICARBONATE) $132.00 $132.00 $6.88 48 CLINICAL LAB4860128 COCAINE SCRN $98.00 48 CLINICAL LAB4810065 COLD AGGLUTININ TTR $218.00 48 CLINICAL LAB4800298 COMPATIBILITY TEST AHG $417.00 $417.00 $220.25 48 CLINICAL LAB4800306 COMPATIBILITY TEST AHG $417.00 $417.00 $170.20 48 CLINICAL LAB4800280 COMPATIBILITY TEST IS $463.00 $463.00 $220.25 48 CLINICAL LAB4861738 COMPLEMENT C3 $324.00 $6.00 48 CLINICAL LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4861746 COMPLEMENT C4 $324.00 $6.00 48 CLINICAL LAB4850970 COMPR MET PNL $284.00 $284.00 $14.87 48 CLINICAL LAB4800249 COOMBS DIRECT IG $145.00 $145.00 $120.75 48 CLINICAL LAB4800231 COOMBS DIRECT POLY $145.00 $145.00 $120.75 48 CLINICAL LAB4800157 COOMBS IND EACH AB TITER $139.00 $139.00 $154.70 48 CLINICAL LAB4861589 CORTISOL TOTAL $436.00 $1.00 48 CLINICAL LAB4861811 C-REACTIVE PROTEIN HS $344.00 48 CLINICAL LAB4851408 CREATININE $139.00 $139.00 $7.22 48 CLINICAL LAB4851481 CREATININE CLEARANCE $251.00 48 CLINICAL LAB4851457 CREATININE FLD $139.00 $139.00 $71.00 48 CLINICAL LAB4851473 CREATININE UR 24HR $139.00 48 CLINICAL LAB4851465 CREATININE UR TIM $139.00 48 CLINICAL LAB4840153 CRYSTAL ID TISS/FLD NO UR $284.00 $284.00 $25.05 48 CLINICAL LAB4861779 CYCLOSPORINE $483.00 48 CLINICAL LAB4830170 D DIMER QN $271.00 $87.11 48 CLINICAL LAB4830063 D DIMER SEMI QN/QL $192.00 $192.00 $87.10 48 CLINICAL LAB4860201 DIGOXIN $357.00 $357.00 $18.69 48 CLINICAL LAB4851507 ELECTROLYTE PNL FLD $185.00 $185.00 $9.87 48 CLINICAL LAB4840187 EOSINOPHILS SMR NASAL $126.00 48 CLINICAL LAB4861597 ESTRADIOL (E2) $747.00 $6.00 48 CLINICAL LAB4870176 FERN TEST $124.00 48 CLINICAL LAB4861605 FERRITIN $364.00 $2.18 48 CLINICAL LAB4851523 FETAL FIBRONECTIN $1,726.00 $1,726.00 $450.00 48 CLINICAL LAB4820411 FETAL RBC SMR (K B) $205.00 $205.00 $6.10 48 CLINICAL LAB4800264 FETAL SCRN ROSETTE $179.00 $179.00 $219.95 48 CLINICAL LAB4830055 FIBRIN DEGRAD PROD $185.00 $185.00 $54.65 48 CLINICAL LAB4830071 FIBRIN MONOMERS $231.00 $231.00 $46.50 48 CLINICAL LAB4830022 FIBRINOGEN $225.00 $225.00 $37.95 48 CLINICAL LAB4861621 FOLATE $390.00 $2.18 48 CLINICAL LAB4861225 FREE T4 $238.00 48 CLINICAL LAB4861647 FSH $496.00 $1.73 48 CLINICAL LAB4860656 GENTAMICIN $436.00 $436.00 $23.07 48 CLINICAL LAB4851556 GGT $192.00 $192.00 $10.13 48 CLINICAL LAB4851606 GLUCOSE $106.00 $106.00 $5.52 48 CLINICAL LAB4851655 GLUCOSE CSF $106.00 $106.00 $11.50 48 CLINICAL LAB4851754 GLUCOSE FLD $106.00 $106.00 $108.95 48 CLINICAL LAB4851705 GLUCOSE UR QN $106.00 $106.00 $71.00 48 CLINICAL LAB

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SEQ 200 AMOUNT

DEPARTMENT CODE

4851614 GTT 2HR 1ST 3 SPEC $344.00 48 CLINICAL LAB4851622 GTT ADDED SAMPLE $106.00 48 CLINICAL LAB4861373 HAV AB IGM $304.00 $12.93 48 CLINICAL LAB4861365 HAV AB TOTAL $331.00 $4.74 48 CLINICAL LAB4861381 HB CORE AB IGM $317.00 $15.21 48 CLINICAL LAB4861407 HBS AB $284.00 $2.96 48 CLINICAL LAB4861399 HBs AG $278.00 $4.03 48 CLINICAL LAB4861431 HBS AG NEUTRALIZATION $186.00 48 CLINICAL LAB4861415 HCV AB $384.00 $10.97 48 CLINICAL LAB4851770 HDL CHOLESTEROL $218.00 $218.00 48 CLINICAL LAB4820304 HEMATOCRIT $66.00 $66.00 $26.75 48 CLINICAL LAB4820312 HEMATOCRIT SPUN $66.00 $66.00 $7.20 48 CLINICAL LAB4820353 HEMOGLOBIN $66.00 $66.00 $26.75 48 CLINICAL LAB4840161 HEMOGLOBIN F (APT) $159.00 $159.00 $108.40 48 CLINICAL LAB4861761 HEMOGLOBIN GLYCOSYLTD A1C $258.00 $13.66 48 CLINICAL LAB4830154 HEPARIN NEUTRALIZATION $317.00 $317.00 $12.65 48 CLINICAL LAB4852000 HEPATIC FUNCTION PNL $218.00 $218.00 $11.49 48 CLINICAL LAB4861423 HEPATITIS PNL ACUTE $1,237.00 $43.14 48 CLINICAL LAB4810057 HETEROPHILE AB SCRN $139.00 $139.00 $104.10 48 CLINICAL LAB4861456 HIV 1/HIV 2 AB $364.00 $55.00 48 CLINICAL LAB4861464 HIV 1/HIV 2 AB $364.00 $150.00 48 CLINICAL LAB4861787 HOMOCYSTINE $450.00 48 CLINICAL LAB4851762 IGA $251.00 48 CLINICAL LAB4851788 IGG $251.00 48 CLINICAL LAB4851796 IGM $251.00 48 CLINICAL LAB4870127 INFLUENZA AG A OR B EACH $324.00 $324.00 $13.07 48 CLINICAL LAB4870119 INFLUENZA AG A OR B EACH $324.00 $324.00 $13.07 48 CLINICAL LAB4851804 IRON $172.00 $172.00 $9.12 48 CLINICAL LAB4851812 IRON BINDING CAPACITY $231.00 48 CLINICAL LAB4800488 IRRADIATION BLD PROD EA $390.00 $390.00 $56.95 48 CLINICAL LAB4800579 IRRADIATION BLD PROD EA $390.00 48 CLINICAL LAB4850053 KETONES QL $119.00 $119.00 $5.75 48 CLINICAL LAB4851820 LACTIC ACID $284.00 48 CLINICAL LAB4851853 LDH $159.00 $159.00 $8.50 48 CLINICAL LAB4851903 LDH FLD $159.00 $159.00 $7.05 48 CLINICAL LAB4820460 LEUK ALK PHOS $231.00 $231.00 $134.55 48 CLINICAL LAB4861662 LH $496.00 $1.73 48 CLINICAL LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4861902 LIPASE $185.00 $6.00 48 CLINICAL LAB4851929 LIPID PNL $364.00 $364.00 $18.85 48 CLINICAL LAB4851952 LITHIUM $179.00 $179.00 $9.30 48 CLINICAL LAB4852059 MAGNESIUM $179.00 $179.00 $9.43 48 CLINICAL LAB4820296 MAN CELL CT EA $112.00 48 CLINICAL LAB4860706 METHOTREXATE $1,145.00 $1,145.00 $86.25 48 CLINICAL LAB4840575 MICRO EXAM UR 48 CLINICAL LAB4852075 MICROALBUMIN UR RAN $152.00 $1.93 48 CLINICAL LAB4860854 NAPA ONLY $1,145.00 $1,145.00 $119.90 48 CLINICAL LAB4861472 NATRIURETIC PEPTIDE $906.00 $47.77 48 CLINICAL LAB4899969 NEWBORN SCRN PANEL $6.00 $6.00 $6.00 48 CLINICAL LAB4840252 OCCLT BLD STL QL MULT SPC $86.00 $86.00 $9.20 48 CLINICAL LAB4860722 OPIATES SCRN $98.00 48 CLINICAL LAB4852109 OSMOLALITY SER $179.00 $179.00 $11.31 48 CLINICAL LAB4852208 OSMOLALITY UR $185.00 $185.00 $11.31 48 CLINICAL LAB4860748 PCP SCRN $98.00 48 CLINICAL LAB4860755 PHENOBARBITAL $304.00 $304.00 $16.12 48 CLINICAL LAB4860805 PHENYTOIN TOTAL $357.00 $357.00 $18.66 48 CLINICAL LAB4852257 PHOSPHORUS (PO4) $126.00 $126.00 $6.67 48 CLINICAL LAB4830162 PLT AGGREGATION EA AGENT $668.00 $172.90 48 CLINICAL LAB4820270 PLT CNT AUTO $119.00 $66.00 48 CLINICAL LAB4852307 POTASSIUM $126.00 $126.00 $6.47 48 CLINICAL LAB4852356 POTASSIUM FLD $126.00 $126.00 $71.00 48 CLINICAL LAB4852372 POTASSIUM UR 24 HR $112.00 48 CLINICAL LAB4861910 PREALBUMIN $390.00 $390.00 48 CLINICAL LAB4860821 PREG TEST QN BLD $403.00 $403.00 48 CLINICAL LAB4840351 PREGNANCY SCRN UR $172.00 $172.00 $23.00 48 CLINICAL LAB4861670 PROLACTIN $516.00 $6.00 48 CLINICAL LAB4852505 PROTEIN TOTAL BLOOD $99.00 $99.00 $11.50 48 CLINICAL LAB4852455 PROTEIN TOTAL BLOOD $99.00 $99.00 $5.16 48 CLINICAL LAB4852554 PROTEIN TOTAL FLD $99.00 $99.00 $8.05 48 CLINICAL LAB4852604 PROTEIN UR QN RAN $99.00 $99.00 $4.70 48 CLINICAL LAB4852620 PROTEIN UR QN TIM $99.00 48 CLINICAL LAB4830014 PROTHROMBIN TIME $106.00 $106.00 $5.53 48 CLINICAL LAB4830147 PROTHROMBIN TIME $106.00 $106.00 $23.00 48 CLINICAL LAB4861696 PSA FREE $489.00 $489.00 $75.00 48 CLINICAL LAB4861688 PSA TOTAL DIAG $489.00 $15.00 48 CLINICAL LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4861613 PTH INTACT $678.00 48 CLINICAL LAB4830006 PTT PLAS OR WB $159.00 $159.00 $8.45 48 CLINICAL LAB4830139 PTT PLAS OR WB $159.00 $159.00 $23.00 48 CLINICAL LAB4830121 PTT PLAS OR WB $273.00 $162.00 $97.75 48 CLINICAL LAB4830113 PTT SUBSTITUTION EA $172.00 $172.00 $42.25 48 CLINICAL LAB4820759 RBC OSMOTIC FRAG INCUB $296.00 $239.00 $119.90 48 CLINICAL LAB4820908 RBC OSMOTIC FRAG UNINCUB $339.00 $273.00 $60.40 48 CLINICAL LAB4820700 RBC OSMOTIC FRAG UNINCUB $326.00 $263.00 $131.95 48 CLINICAL LAB4852661 RENAL FUNCTION PNL $231.00 $231.00 $12.22 48 CLINICAL LAB4820809 RETICYTE/HGB CONCENTRATE $112.00 $112.00 $6.05 48 CLINICAL LAB4800041 RH TYP $79.00 $79.00 $63.85 48 CLINICAL LAB4800538 RH TYP $79.00 48 CLINICAL LAB4862645 RHEUMATOID FCTR QN $152.00 $0.31 48 CLINICAL LAB4810016 RPR NON-TREPNML AB QL $112.00 $112.00 $38.55 48 CLINICAL LAB4810032 RPR TTR NON-TREPNML AB QN $119.00 48 CLINICAL LAB4870168 RSV AG EIA $324.00 48 CLINICAL LAB4861795 RUBELLA AB IGG $384.00 $20.00 48 CLINICAL LAB4800504 S STRL BLOOD WRMING COILS $182.00 $147.00 $74.20 48 CLINICAL LAB4860904 SALICYLATE $192.00 $192.00 $23.00 48 CLINICAL LAB4820858 SEDIMENTATION RATE MAN $93.00 $93.00 $3.80 48 CLINICAL LAB4840419 SEMEN SPERM PRESENCE/MOT $324.00 48 CLINICAL LAB4840427 SEMN ANLYS VOL/CT/MOT/DIF $324.00 48 CLINICAL LAB4800165 SER PRETRTMT ABSORB $499.00 $402.00 $202.10 48 CLINICAL LAB4800561 SICKLE CL SCRN $145.00 48 CLINICAL LAB4880100 SKIN TEST CANDIDA $225.00 $225.00 $70.15 48 CLINICAL LAB4880209 SKIN TEST COCCI $106.00 $106.00 $70.15 48 CLINICAL LAB4880308 SKIN TEST HISTO $173.00 $140.00 $70.15 48 CLINICAL LAB4870010 SMR GRAM STAIN 48 CLINICAL LAB4870259 SMR WET MOUNT $112.00 $112.00 $17.25 48 CLINICAL LAB4840203 SMR WRIGHT STAIN $112.00 $112.00 $9.20 48 CLINICAL LAB4852703 SODIUM $126.00 $126.00 $6.77 48 CLINICAL LAB4852802 SODIUM UR RAN $132.00 $132.00 $8.05 48 CLINICAL LAB4840450 SPEC GRAVITY FLD $66.00 $66.00 $5.45 48 CLINICAL LAB4870200 STREP GRP A AG EIA $324.00 $324.00 $144.35 48 CLINICAL LAB4852851 SWEAT COLLECTION 48 CLINICAL LAB4861217 T3 UPTAKE $172.00 48 CLINICAL LAB4861803 TACROLIMUS (FK506) $370.00 $88.50 48 CLINICAL LAB

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4861712 TESTOSTERONE TOTAL $688.00 $6.00 48 CLINICAL LAB4800363 THAWING PROD PER UNIT $179.00 $179.00 $70.15 48 CLINICAL LAB4861001 THEOPHYLLINE $377.00 $377.00 $19.91 48 CLINICAL LAB4830030 THROMBIN TIME $152.00 $152.00 $38.55 48 CLINICAL LAB4830048 THROMBIN TIME $152.00 $152.00 $38.55 48 CLINICAL LAB4861258 THYROXINE (T4) $185.00 $185.00 $107.25 48 CLINICAL LAB4861100 TOBRAMYCIN $430.00 $430.00 $22.68 48 CLINICAL LAB4852901 TRIGLYCERIDE $152.00 $152.00 $8.05 48 CLINICAL LAB4861191 TROPONIN I QN $265.00 $265.00 $13.85 48 CLINICAL LAB4861209 TSH $450.00 $450.00 $23.64 48 CLINICAL LAB4880506 TUBERCULN SKIN TEST INTRA $180.00 $153.00 $70.15 48 CLINICAL LAB4853024 UR NITROGEN UR RAN $126.00 48 CLINICAL LAB4853032 UR NITROGEN UR TIMED $126.00 48 CLINICAL LAB4853008 URIC ACID $119.00 $119.00 $6.36 48 CLINICAL LAB4853016 URIC ACID FLD $126.00 48 CLINICAL LAB4840500 URNALYSIS AUTO W/ MICRO $86.00 $86.00 $13.80 48 CLINICAL LAB4840559 URNALYSIS AUTO W/O MICRO $60.00 $60.00 $3.16 48 CLINICAL LAB4840526 URNALYSIS AUTO W/O MICRO $60.00 $60.00 $13.80 48 CLINICAL LAB4840583 URNALYSIS AUTO W/O MICRO $60.00 48 CLINICAL LAB4840443 URNALYSIS MAN W/O MICRO $66.00 48 CLINICAL LAB4840609 URNALYSIS QL OR SEMI QL $60.00 $60.00 $32.20 48 CLINICAL LAB4840435 URNALYSIS QL OR SEMI QL $60.00 48 CLINICAL LAB4840617 URNALYSIS VOL MEASURE $79.00 48 CLINICAL LAB4861308 VALPROIC ACID $364.00 $364.00 $19.06 48 CLINICAL LAB4861357 VANCOMYCIN $799.00 $799.00 $19.06 48 CLINICAL LAB4899951 VENIPUNCTURE $62.00 $62.00 48 CLINICAL LAB4861522 VITAMIN B12 $403.00 $2.18 48 CLINICAL LAB4820288 WBC CNT AUTO $66.00 $66.00 48 CLINICAL LAB4900031 S STRL TUBING ECMO PEDS $2,279.00 49 CLINICAL LAB - CORE4900023 S STRL NDL MONOPTY 18GX2 $152.00 49 CLINICAL LAB - CORE4900015 S STRL NDL TEMNO 18GX 15C $157.00 49 CLINICAL LAB - CORE6836142 AMB GLUC MON SQ MINM 72HR $453.00 68 DIABETES SERVICES6821128 AMB GLUC MON SQ MINM 72HR $419.00 68 DIABETES SERVICES6820575 ANTEP HEALTH ED GP 15M $126.31 68 DIABETES SERVICES6820674 ANTEP NUTR GROUP 15 $46.79 68 DIABETES SERVICES6820542 CLIENT ORIENTATION 15M $126.31 68 DIABETES SERVICES6836134 COMPREHENSIVE REPORT $115.00 68 DIABETES SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6821136 COMPUTER DATA ANALYSIS $78.00 68 DIABETES SERVICES6832299 COMPUTER DATA ANALYSIS $65.00 68 DIABETES SERVICES6831101 COMPUTER DATA ANALYSIS $151.00 $151.00 68 DIABETES SERVICES6836001 COORDINATOR FEE $142.00 68 DIABETES SERVICES6836183 DIAB TRNG SVCS GRP EA 30 $38.66 68 DIABETES SERVICES6820740 DIAB TRNG SVCS IND EA 30 $142.00 68 DIABETES SERVICES6820112 DIABETES TEAM VISIT > 120 $232.00 $219.00 68 DIABETES SERVICES6820104 DIABETES TEAM VISIT > 150 $299.00 $282.00 68 DIABETES SERVICES6820120 DIABETES TEAM VISIT > 180 $348.00 $328.00 68 DIABETES SERVICES6820526 DIABETES TEAM VISIT > 40 $67.00 68 DIABETES SERVICES6820518 DIABETES TEAM VISIT > 90 $183.00 68 DIABETES SERVICES6832307 DIGITL DATA ANLYS GT 30MN $114.00 68 DIABETES SERVICES6821144 DIGITL DATA ANLYS GT 30MN $124.00 68 DIABETES SERVICES6835177 EX SPEC CONF 15MIN/CCS 68 DIABETES SERVICES6835169 EX SPEC FITNESS VISIT 68 DIABETES SERVICES6835185 EX SPEC FITNSS INTERV, GR 68 DIABETES SERVICES6836050 EXAM ROOM, 120 MIN/CCS $198.00 68 DIABETES SERVICES6836068 EXAM ROOM, 150 MIN/CCS $230.00 68 DIABETES SERVICES6836076 EXAM ROOM, 180 MIN/CCS $305.00 68 DIABETES SERVICES6836035 EXAM ROOM, 60 MIN/CCS $98.00 68 DIABETES SERVICES6836043 EXAM ROOM, 90 MINUTES $146.00 68 DIABETES SERVICES6836027 EXAM ROOM,FRST 30 MIN/CCS $60.00 68 DIABETES SERVICES6820567 F/U ANTEP HEALTH ED I 15M $126.31 68 DIABETES SERVICES6820666 F/U ANTEP NUTR INDIV 15M $60.75 68 DIABETES SERVICES6820633 F/U PSYCHO ANTEP GP 15M $48.07 68 DIABETES SERVICES6820625 F/U PSYCHO ANTEP INDIV 15 $126.31 68 DIABETES SERVICES6832190 GLUCOSE BLD REAGENT STRIP $14.00 $11.00 68 DIABETES SERVICES6836225 HC PRO PHONE CALL 11-20M $60.00 68 DIABETES SERVICES6836233 HC PRO PHONE CALL 21-30M $90.00 68 DIABETES SERVICES6836217 HC PRO PHONE CALL 5-10M $34.00 68 DIABETES SERVICES6833255 HEALTH/BEHV INITIAL EA 15 $66.00 68 DIABETES SERVICES6833263 HEALTH/BEHV REASSES EA 15 $64.00 68 DIABETES SERVICES6833305 HLTH/BHV INT FAM/NO PT 15 $64.00 68 DIABETES SERVICES6833297 HLTH/BHV INT FAM/PT EA 15 $64.00 68 DIABETES SERVICES6833289 HLTH/BHV INTERV GRP EA 15 $25.00 68 DIABETES SERVICES6833271 HLTH/BHV INTERV IND EA 15 $64.00 68 DIABETES SERVICES6834212 INFUSION W/MED 16-60MN $192.00 68 DIABETES SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6834196 INFUSION W/MED 16-60MN $44.00 68 DIABETES SERVICES6820955 INIT COMP ASSESS/CP 90M $306.38 68 DIABETES SERVICES6820559 INIT HEALTH ED ASSESS/CP $126.31 68 DIABETES SERVICES6820963 INIT HEALTH ED ASSESS/CP $285.34 68 DIABETES SERVICES6820658 INIT NUTR ASSESS/CP 15M $55.86 68 DIABETES SERVICES6820971 INIT NUTR ASSESS/CP 30M $111.72 68 DIABETES SERVICES6820617 INIT PSYCHO ASSESS/CP 15M $126.31 68 DIABETES SERVICES6820989 INIT PSYCHO ASSESS/CP 30M $285.34 68 DIABETES SERVICES6834188 INSULIN PUMP THER EDUC $98.00 68 DIABETES SERVICES6834204 INSULIN PUMP THER EDUC $33.00 68 DIABETES SERVICES6834311 INSULN PUMP TX PRCTM 1/CC $104.00 68 DIABETES SERVICES6834329 INSULN PUMP TX PRCTM 2/CC $156.00 68 DIABETES SERVICES6836019 INTERIM REPORT $74.00 68 DIABETES SERVICES6834279 LEVEL 1 EST PATIENT $182.00 68 DIABETES SERVICES6821201 LEVEL 1 EST PATIENT $147.00 68 DIABETES SERVICES6821276 LEVEL 1 NEW PATIENT $147.00 68 DIABETES SERVICES6834378 LEVEL 1 NEW PATIENT $182.00 68 DIABETES SERVICES6834287 LEVEL 2 EST PATIENT $211.00 68 DIABETES SERVICES6821219 LEVEL 2 EST PATIENT $203.00 68 DIABETES SERVICES6834360 LEVEL 2 NEW PATIENT $211.00 68 DIABETES SERVICES6821284 LEVEL 2 NEW PATIENT $171.00 68 DIABETES SERVICES6821227 LEVEL 3 EST PATIENT $195.00 68 DIABETES SERVICES6834295 LEVEL 3 EST PATIENT $108.00 68 DIABETES SERVICES6821292 LEVEL 3 NEW PATIENT $195.00 68 DIABETES SERVICES6834352 LEVEL 3 NEW PATIENT $241.00 68 DIABETES SERVICES6821235 LEVEL 4 EST PATIENT $399.00 68 DIABETES SERVICES6834170 LEVEL 4 EST PATIENT $399.00 68 DIABETES SERVICES6820534 LEVEL 4 EST PATIENT $324.00 68 DIABETES SERVICES6834303 LEVEL 4 EST PATIENT $399.00 68 DIABETES SERVICES6821300 LEVEL 4 NEW PATIENT $324.00 68 DIABETES SERVICES6834345 LEVEL 4 NEW PATIENT $399.00 68 DIABETES SERVICES6821243 LEVEL 5 EST PATIENT $429.00 68 DIABETES SERVICES6834162 LEVEL 5 EST PATIENT $429.00 68 DIABETES SERVICES6833073 LEVEL 5 EST PATIENT $429.00 $148.00 68 DIABETES SERVICES6833081 LEVEL 5 EST PATIENT $429.00 $170.00 68 DIABETES SERVICES6834014 LEVEL 5 EST PATIENT $429.00 $429.00 68 DIABETES SERVICES6834055 LEVEL 5 EST PATIENT $429.00 $539.00 68 DIABETES SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6820013 LEVEL 5 EST PATIENT $429.00 $287.00 68 DIABETES SERVICES6821318 LEVEL 5 NEW PATIENT $348.00 68 DIABETES SERVICES6834337 LEVEL 5 NEW PATIENT $429.00 68 DIABETES SERVICES6831218 MED NUTR TX EA 15 $63.00 68 DIABETES SERVICES6820807 MED NUTR TX EA 15 $63.00 68 DIABETES SERVICES6821110 MED NUTR TX GP EA 30 $53.00 68 DIABETES SERVICES6831234 MED NUTR TX GP EA 30 $58.00 68 DIABETES SERVICES6831226 MED NUTR TX REASMNT EA 15 $69.00 68 DIABETES SERVICES6820773 MED NUTR TX REASMNT EA 15 $69.00 68 DIABETES SERVICES6820799 MED NUTRI THERAPY 30MIN $51.00 68 DIABETES SERVICES6820781 MED NUTRI THERAPY 60MIN $67.00 68 DIABETES SERVICES6820765 MED NUTRI THERAPY 90 MIN $183.00 68 DIABETES SERVICES6835029 OTHR CASE CONF EA 15 MIN $31.00 68 DIABETES SERVICES6820641 PAST PARTUM PSYCHO 15M $126.31 68 DIABETES SERVICES6834089 PED DIAB 3HR CLASS/CCS $96.00 68 DIABETES SERVICES6831036 PED DIAB. VISIT >90 MIN-D $244.00 68 DIABETES SERVICES6834071 PEDS DIAB CLASS/NON-CCS $71.00 $71.00 68 DIABETES SERVICES6834048 PEDS PHYS/TEAM CONF 30 $74.00 $74.00 68 DIABETES SERVICES6836191 PEDS PHYS/TEAM CONF 30 $72.00 68 DIABETES SERVICES6820591 PERINATAL ED GP 15M $48.07 68 DIABETES SERVICES6820583 PERINATAL ED INDIV 15M $126.31 68 DIABETES SERVICES6831168 PHONE CONSLT 15MIN-RD/CCS $46.00 68 DIABETES SERVICES6832141 PHONE CONSLT 15MIN-RN/CCS $60.00 68 DIABETES SERVICES6833149 PHONE CONSLT 15MIN-SW/CCS $52.00 68 DIABETES SERVICES6820468 PHONE CONSULT > 15 $28.00 $26.00 68 DIABETES SERVICES6835151 PHONE CONSULT 15MIN-O/CCS $41.00 68 DIABETES SERVICES6820682 POST PARTUM NUTR INDIV $60.75 68 DIABETES SERVICES6820609 POSTPARTUM HEALTH ED 15M $126.31 68 DIABETES SERVICES6834238 PROLONG SVC F-F ADDL 30MN $100.00 68 DIABETES SERVICES6821268 PROLONG SVC F-F ADDL 30MN $100.00 68 DIABETES SERVICES6834220 PROLONG SVC F-F FIRST HR $197.00 68 DIABETES SERVICES6821250 PROLONG SVC F-F FIRST HR $198.00 68 DIABETES SERVICES6831176 RD CASE CONF EA 15 MIN $32.00 68 DIABETES SERVICES6832158 RN CASE CONF EA 15 MIN $36.00 68 DIABETES SERVICES6836175 SELF MGMT ED 1PT 30M $144.00 68 DIABETES SERVICES6831242 SELF MGMT ED 1PT 30M $125.25 68 DIABETES SERVICES6836159 SELF MGMT ED 2-4PT 30M $144.00 68 DIABETES SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6831259 SELF MGMT ED 2-4PT 30M $96.14 68 DIABETES SERVICES6834386 SELF MGMT ED 2-4PT 30M $60.91 68 DIABETES SERVICES6836167 SELF MGMT ED 5-8PT 30M $86.00 68 DIABETES SERVICES6831267 SELF MGMT ED 5-8PT 30M $46.79 68 DIABETES SERVICES6834394 SELF MGMT ED 5-8PT 30M $45.00 68 DIABETES SERVICES6833156 SW CASE CONF EA 15 MIN $32.00 68 DIABETES SERVICES6836209 TM CONF W/O PT BY HC PRO $64.00 68 DIABETES SERVICES6832208 URNALYSIS MAN W/ MICRO $21.00 $21.00 68 DIABETES SERVICES6820419 VISIT > 25 - N $51.00 $48.00 68 DIABETES SERVICES6820401 VISIT > 60 - N $183.00 $173.00 68 DIABETES SERVICES6820278 VISIT > 60 - S $116.00 $109.00 68 DIABETES SERVICES6831150 VISIT 30 MIN-D/CCS $64.00 68 DIABETES SERVICES6833131 VISIT 30 MIN-L/CCS $64.00 68 DIABETES SERVICES6832133 VISIT 30 MIN-N/CCS $86.00 68 DIABETES SERVICES0663708 ACCESS AV DIAL GRFT EVAL $1,614.00 $1,199.00 06 DIAG IMAGING PROCEDURES0661181 ACCESS AV DIAL GRFT PROC $752.00 06 DIAG IMAGING PROCEDURES0622134 CA ANGIO EXT UNI $4,003.00 06 DIAG IMAGING PROCEDURES0622142 CA ARTHRO HIP BIL $1,397.00 $1,204.00 06 DIAG IMAGING PROCEDURES0622183 CA ARTHRO SHOULDER BI $1,600.00 $1,379.00 06 DIAG IMAGING PROCEDURES0637140 CA CARDIAC STRES TEST $2,455.00 $2,116.00 06 DIAG IMAGING PROCEDURES0675611 CA ECHO 2D CMP NO SPC/DOP $2,271.00 06 DIAG IMAGING PROCEDURES0675884 CA ECHO TRANSESOPHAGEAL $2,553.00 $2,553.00 06 DIAG IMAGING PROCEDURES0665596 CA INJ IVP ADL SQ NEW DRG $537.00 06 DIAG IMAGING PROCEDURES0662338 CA NDL PLACE $3,192.00 06 DIAG IMAGING PROCEDURES0675827 CA TTE DPLR CMPLT WO CON $1,500.00 06 DIAG IMAGING PROCEDURES0668681 CAC ART CATH MNTRNG PERC $32.00 $25.00 06 DIAG IMAGING PROCEDURES0665109 CAC NONTHROMBOLYSIS IV $1,152.00 $904.00 06 DIAG IMAGING PROCEDURES0644930 CT 3D RENDER W/O POSTPROS $1,228.00 06 DIAG IMAGING PROCEDURES0644914 CT 3D RENDER W/POSTPROCES $1,105.00 06 DIAG IMAGING PROCEDURES0646182 CT ABD & PELVIS 1+ REGION $9,813.00 06 DIAG IMAGING PROCEDURES0646174 CT ABD & PELVIS W/CON $7,253.00 06 DIAG IMAGING PROCEDURES0646166 CT ABD & PELVIS W/O CON $5,441.00 06 DIAG IMAGING PROCEDURES0646208 CT ABD W/CON $5,185.00 $4,348.00 06 DIAG IMAGING PROCEDURES0646158 CT ABD W/O CON $3,640.00 $3,052.00 06 DIAG IMAGING PROCEDURES0646109 CT ABD W-W/O CON $7,092.00 $5,946.00 06 DIAG IMAGING PROCEDURES0641449 CT BONE DENSITY STDY APPN $390.00 06 DIAG IMAGING PROCEDURES0641431 CT BONE DENSTY STDY AXIAL $2,759.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0641423 CT BONE LENGTH STDY $441.00 $369.00 06 DIAG IMAGING PROCEDURES0641605 CT BRAIN W CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0641555 CT BRAIN W/O CON $2,990.00 $2,507.00 06 DIAG IMAGING PROCEDURES0641563 CT BRAIN W/O CON $2,990.00 06 DIAG IMAGING PROCEDURES0641506 CT BRAIN W-W/O CON $4,766.00 $3,997.00 06 DIAG IMAGING PROCEDURES0648725 CT CARDIAC SCORING $1,601.00 06 DIAG IMAGING PROCEDURES0648774 CT COLONOSCOPY SCRN $801.00 06 DIAG IMAGING PROCEDURES0646950 CT CS DIFF MD ADD 15M $266.00 06 DIAG IMAGING PROCEDURES0646943 CT CS DIFF MD GT5YR 0-30M $598.00 06 DIAG IMAGING PROCEDURES0646935 CT CS DIFF MD LT5YR 0-30M $722.00 06 DIAG IMAGING PROCEDURES0646927 CT CS SAME MD ADD 15M $266.00 06 DIAG IMAGING PROCEDURES0646919 CT CS SAME MD GT5YR 0-30M $664.00 06 DIAG IMAGING PROCEDURES0646901 CT CS SAME MD LT5YR 0-30M $444.92 06 DIAG IMAGING PROCEDURES0646224 CT DRN W CATH PLACE PRC $1,480.00 06 DIAG IMAGING PROCEDURES0642835 CT EXT LOW W CON $4,651.00 $3,900.00 06 DIAG IMAGING PROCEDURES0642827 CT EXT LOW W/O CON $3,734.00 $3,131.00 06 DIAG IMAGING PROCEDURES0642819 CT EXT LOW W-W/O CON $6,182.00 $5,183.00 06 DIAG IMAGING PROCEDURES0642934 CT EXT UPP W CON $4,615.00 $3,869.00 06 DIAG IMAGING PROCEDURES0642926 CT EXT UPP W/O CON $3,726.00 $3,125.00 06 DIAG IMAGING PROCEDURES0642918 CT EXT UPP W-W/O CON $6,167.00 $5,171.00 06 DIAG IMAGING PROCEDURES0642751 CT GUIDANCE TISSUE ABLTN $6,976.00 06 DIAG IMAGING PROCEDURES0662312 CT GUIDANCE TISSUE ABLTN $6,976.00 06 DIAG IMAGING PROCEDURES0662320 CT GUIDE NDL PLACEMENT $1,050.00 06 DIAG IMAGING PROCEDURES0641407 CT GUIDE NDL PLACEMENT $4,715.39 $1,025.00 06 DIAG IMAGING PROCEDURES0646851 CT GUIDE RAD TX FIELDS $2,773.00 $2,325.00 06 DIAG IMAGING PROCEDURES0648758 CT LUNG SCREENING $3,871.00 06 DIAG IMAGING PROCEDURES0643908 CT MAXILLOFACIAL W CON $4,781.00 $4,009.00 06 DIAG IMAGING PROCEDURES0643858 CT MAXILLOFACIAL W/O CON $3,900.00 $3,270.00 06 DIAG IMAGING PROCEDURES0643809 CT MAXILLOFACIAL W-W/O $5,972.00 $5,008.00 06 DIAG IMAGING PROCEDURES0644054 CT NEC W CON $4,600.00 $3,857.00 06 DIAG IMAGING PROCEDURES0644005 CT NEC W/O CON $3,698.00 $3,100.00 06 DIAG IMAGING PROCEDURES0643957 CT NEC W-W/O CON $5,792.00 $4,856.00 06 DIAG IMAGING PROCEDURES0644757 CT ORBIT SELLA FOSA W-W/O $6,492.00 $5,444.00 06 DIAG IMAGING PROCEDURES0644807 CT ORBIT SELLA FOSSA W $5,590.00 $4,687.00 06 DIAG IMAGING PROCEDURES0644856 CT ORBIT/SELLA/FOSSA W/O $4,730.00 $3,966.00 06 DIAG IMAGING PROCEDURES0644708 CT PELV W CON $4,557.00 $3,821.00 06 DIAG IMAGING PROCEDURES0644658 CT PELV W/O CON $3,669.00 $3,076.00 06 DIAG IMAGING PROCEDURES

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DEPARTMENT CODE

0644609 CT PELV W-W/O CON $6,088.00 $5,105.00 06 DIAG IMAGING PROCEDURES0641472 CT PERFUSION W/CON CBF $8,816.00 06 DIAG IMAGING PROCEDURES0646455 CT SPINE CERV W CON $4,810.00 $4,033.00 06 DIAG IMAGING PROCEDURES0646406 CT SPINE CERV W/O CON $3,885.00 $3,258.00 06 DIAG IMAGING PROCEDURES0646356 CT SPINE CERV W-W/O CON $6,052.00 $5,074.00 06 DIAG IMAGING PROCEDURES0646604 CT SPINE LUMB W CON $4,802.00 $4,027.00 06 DIAG IMAGING PROCEDURES0646554 CT SPINE LUMB W/O CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0646505 CT SPINE LUMB W-W/O CON $6,059.00 $5,080.00 06 DIAG IMAGING PROCEDURES0646752 CT SPINE THOR W CON $4,810.00 $4,033.00 06 DIAG IMAGING PROCEDURES0646703 CT SPINE THOR W/O CON $3,878.00 $3,252.00 06 DIAG IMAGING PROCEDURES0646653 CT SPINE THOR W-W/O $6,073.00 $5,093.00 06 DIAG IMAGING PROCEDURES0646802 CT STEREOTACTIC LOC $12,443.00 $10,433.00 06 DIAG IMAGING PROCEDURES0643601 CT THORAX W CON $4,802.00 $4,027.00 06 DIAG IMAGING PROCEDURES0643569 CT THORAX W CON $4,802.00 06 DIAG IMAGING PROCEDURES0643551 CT THORAX W/O CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0643502 CT THORAX W-W/O $6,059.00 $5,080.00 06 DIAG IMAGING PROCEDURES0646315 CT VERTPLASTY EA BDY CT $290.00 06 DIAG IMAGING PROCEDURES0641332 CTA ABD W RUNOFF W-W/O $6,133.00 06 DIAG IMAGING PROCEDURES0646216 CTA ABD W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0643627 CTA CHST NOCORO W-W/O CON $6,032.00 06 DIAG IMAGING PROCEDURES0642850 CTA EXT LOW W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0642959 CTA EXT UPP W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0641621 CTA HEAD W-W/O CON $6,687.00 06 DIAG IMAGING PROCEDURES0644070 CTA NEC W-W/O CON $6,721.00 06 DIAG IMAGING PROCEDURES0644724 CTA PELV W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0642744 CTC ABLTN CRYO OPN LIVER $4,297.00 06 DIAG IMAGING PROCEDURES0648782 CTC ABLTN LIVER RF PRC $4,297.00 06 DIAG IMAGING PROCEDURES0642736 CTC ABLTN RENAL RF PRC $2,753.00 06 DIAG IMAGING PROCEDURES0647560 CTC ABSCSS CYST LIVER PRC $245.00 06 DIAG IMAGING PROCEDURES0642462 CTC ASP BREAST ADD $160.00 06 DIAG IMAGING PROCEDURES0642454 CTC ASP BREAST CYST $347.00 06 DIAG IMAGING PROCEDURES0667253 CTC ASP RENL CYST $130.00 $101.00 06 DIAG IMAGING PROCEDURES0642488 CTC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0643015 CTC ASPIRATON BONE MARROW $2,100.00 06 DIAG IMAGING PROCEDURES0643023 CTC BONE MARROW ASP W/BX $2,559.00 06 DIAG IMAGING PROCEDURES0648139 CTC BX ABD RETROPE $468.00 06 DIAG IMAGING PROCEDURES0642538 CTC BX BM NDL/TROCAR $1,581.00 06 DIAG IMAGING PROCEDURES

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DEPARTMENT CODE

0648006 CTC BX BONE DEEP $2,475.00 06 DIAG IMAGING PROCEDURES0648105 CTC BX BONE SUPER $549.00 06 DIAG IMAGING PROCEDURES0648113 CTC BX BRAIN W BURR HOLE $3,656.00 06 DIAG IMAGING PROCEDURES0648261 CTC BX EXCSN LYMPH NODE $715.00 06 DIAG IMAGING PROCEDURES0648410 CTC BX GALLBLADDER FOSSA $1,252.00 06 DIAG IMAGING PROCEDURES0642686 CTC BX HIP $1,582.00 $1,299.00 06 DIAG IMAGING PROCEDURES0648147 CTC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0648154 CTC BX LUNG MEDIASTNM $128.00 06 DIAG IMAGING PROCEDURES0662148 CTC BX LYMPH NODE OPEN $4,383.00 $3,676.00 06 DIAG IMAGING PROCEDURES0642603 CTC BX LYMPH NODE SUPER $378.00 06 DIAG IMAGING PROCEDURES0642637 CTC BX OF OVARY(S) $713.00 06 DIAG IMAGING PROCEDURES0648170 CTC BX PANCREAS $3,684.00 06 DIAG IMAGING PROCEDURES0642645 CTC BX PROSTATE $661.00 06 DIAG IMAGING PROCEDURES0648204 CTC BX RENL $2,180.00 06 DIAG IMAGING PROCEDURES0642702 CTC BX SOFT TISS HIP DEEP $1,156.00 06 DIAG IMAGING PROCEDURES0642470 CTC BX STEREO ASPIR HEAD $4,044.00 06 DIAG IMAGING PROCEDURES0642694 CTC BX THYROID $529.00 06 DIAG IMAGING PROCEDURES0648659 CTC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0642991 CTC EXCHANGE DRN CATH $3,976.00 06 DIAG IMAGING PROCEDURES0642405 CTC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0648279 CTC FORAMN EPI C/T W IMG $799.00 06 DIAG IMAGING PROCEDURES0643205 CTC FORAMN EPI L/S W IMG $1,005.00 $758.00 06 DIAG IMAGING PROCEDURES0648287 CTC FRMN EPI C/T IMG ADD $799.00 06 DIAG IMAGING PROCEDURES0643254 CTC FRMN EPI L/S IMG ADL $1,005.00 $758.00 06 DIAG IMAGING PROCEDURES0644393 CTC FX NASAL TURBINT THER $455.75 06 DIAG IMAGING PROCEDURES0643155 CTC IJ FACET L/S 2 LVL $223.00 $175.00 06 DIAG IMAGING PROCEDURES0643056 CTC INJ CON ABSCSS $574.00 06 DIAG IMAGING PROCEDURES0643106 CTC INJ FACET L/S 1 LVL $518.00 $406.00 06 DIAG IMAGING PROCEDURES0640110 CTC INJ SI JT ANES/STROID $9,051.14 $9,051.14 06 DIAG IMAGING PROCEDURES0648402 CTC INJ SINOGRAM $494.00 06 DIAG IMAGING PROCEDURES0643312 CTC INTRO CATH IVC SVC $680.00 06 DIAG IMAGING PROCEDURES0647453 CTC PARACENT ABD INI $533.00 06 DIAG IMAGING PROCEDURES0647461 CTC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0643478 CTC PNMNSTOMY W DRN PRC $3,566.00 06 DIAG IMAGING PROCEDURES0648808 CTC PR RF ABLT RNL TUMR U $15,563.00 $12,178.00 06 DIAG IMAGING PROCEDURES0644369 CTC PROBE NL DUCT W/BALLN $1,400.00 06 DIAG IMAGING PROCEDURES0647487 CTC PUNCTURE DRN LESION $333.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

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DEPARTMENT CODE

0644385 CTC REMV TUNN CV CATH W/O $532.00 06 DIAG IMAGING PROCEDURES0649566 CTC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0621383 CYSTOMETROGRAM W/UP $911.00 06 DIAG IMAGING PROCEDURES0621391 CYSTOMETROGRAM W/VP $916.00 06 DIAG IMAGING PROCEDURES0669036 IR 3D RENDER W/POSTPROCES $951.00 $951.00 06 DIAG IMAGING PROCEDURES0661140 IR ABSCSS FIST SIN TRACT $566.00 06 DIAG IMAGING PROCEDURES0661157 IR ANGIO ADD VESSEL EA $2,636.00 $2,636.00 06 DIAG IMAGING PROCEDURES0661207 IR ANGIO ADRENAL BIL $4,558.00 $4,300.00 06 DIAG IMAGING PROCEDURES0661256 IR ANGIO ADRENAL UNI $3,183.00 $5,755.00 06 DIAG IMAGING PROCEDURES0661355 IR ANGIO BRACH $3,121.00 $3,121.00 06 DIAG IMAGING PROCEDURES0662155 IR ANGIO CAROTD CERE BIL $3,662.00 $3,662.00 06 DIAG IMAGING PROCEDURES0662254 IR ANGIO CAROTD CERE UNI $3,283.00 $3,283.00 06 DIAG IMAGING PROCEDURES0662205 IR ANGIO CAROTD CERV BIL $3,394.00 $3,394.00 06 DIAG IMAGING PROCEDURES0662304 IR ANGIO CAROTD CERV UNI $3,146.00 $3,146.00 06 DIAG IMAGING PROCEDURES0661405 IR ANGIO CAROTD XTL BIL $3,544.00 $3,544.00 06 DIAG IMAGING PROCEDURES0661454 IR ANGIO CAROTD XTL UNI $3,152.00 $3,152.00 06 DIAG IMAGING PROCEDURES0661504 IR ANGIO CERVICOCEREBRAL $2,922.00 $2,922.00 06 DIAG IMAGING PROCEDURES0662601 IR ANGIO EXT BIL $3,606.00 $3,606.00 06 DIAG IMAGING PROCEDURES0662650 IR ANGIO EXT UNI $3,189.00 $3,189.00 06 DIAG IMAGING PROCEDURES0669200 IR ANGIO FU EXISTING CATH $703.00 $703.00 06 DIAG IMAGING PROCEDURES0668350 IR ANGIO PELV SELECT $3,152.00 $3,152.00 06 DIAG IMAGING PROCEDURES0668459 IR ANGIO PULM BIL SELECT $4,881.00 $2,947.00 06 DIAG IMAGING PROCEDURES0668400 IR ANGIO PULM NONSELECT $3,028.00 $3,028.00 06 DIAG IMAGING PROCEDURES0668509 IR ANGIO PULM UNI SELECT $2,816.00 $2,816.00 06 DIAG IMAGING PROCEDURES0668608 IR ANGIO RENL BIL $3,475.00 $3,475.00 06 DIAG IMAGING PROCEDURES0668657 IR ANGIO RENL UNI $3,077.00 $3,077.00 06 DIAG IMAGING PROCEDURES0668905 IR ANGIO SPINAL SELECT $3,152.00 $5,915.00 06 DIAG IMAGING PROCEDURES0669606 IR ANGIO VERTEBRAL $3,158.00 $3,158.00 06 DIAG IMAGING PROCEDURES0669655 IR ANGIO VISCERAL $3,133.00 $3,133.00 06 DIAG IMAGING PROCEDURES0661850 IR AORTOGRAM ABD BIL EXT $2,997.00 $2,997.00 06 DIAG IMAGING PROCEDURES0661801 IR AORTOGRAM ABD W SER $2,903.00 $2,903.00 06 DIAG IMAGING PROCEDURES0661959 IR AORTOGRAM THOR W SER $2,916.00 $2,916.00 06 DIAG IMAGING PROCEDURES0661900 IR AORTOGRAM THOR W/O SER $4,315.00 $4,315.00 06 DIAG IMAGING PROCEDURES0622100 IR ARTHRO ANKLE BIL $1,175.00 $1,175.00 06 DIAG IMAGING PROCEDURES0622126 IR ARTHRO ELBOW BI $1,107.00 $1,107.00 06 DIAG IMAGING PROCEDURES0661975 IR ARTHRO SI JNT $814.00 06 DIAG IMAGING PROCEDURES0622225 IR ARTHRO WRIST BIL $1,237.00 $1,237.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

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SEQ 200 AMOUNT

DEPARTMENT CODE

0661306 IR AV DIALYSIS SHUNT IMAG $3,830.00 $3,830.00 06 DIAG IMAGING PROCEDURES0662007 IR BILI DRN INT XTL $3,082.00 $5,506.00 06 DIAG IMAGING PROCEDURES0662056 IR BILI DRN PRC $2,997.00 $5,451.00 06 DIAG IMAGING PROCEDURES0662064 IR BILI DUCT DILATE PRC $1,380.00 06 DIAG IMAGING PROCEDURES0662080 IR BRONCHOGRAM BIL $300.00 06 DIAG IMAGING PROCEDURES0662072 IR BRONCHOGRAM UNI $197.00 06 DIAG IMAGING PROCEDURES0662106 IR BX TRANSCATHETER $5,782.00 $10,517.00 06 DIAG IMAGING PROCEDURES0668707 IR CATH RENL PELV PRC $1,430.00 $1,430.00 06 DIAG IMAGING PROCEDURES0662361 IR CHEMO CNS W/SPINL PUNC $2,486.00 06 DIAG IMAGING PROCEDURES0662387 IR CHEMO IA PUSH $1,647.00 06 DIAG IMAGING PROCEDURES0662379 IR CHEMO IA PUSH $1,647.00 06 DIAG IMAGING PROCEDURES0662429 IR CHOL EXISTING CATH $653.00 06 DIAG IMAGING PROCEDURES0662403 IR CHOL TRANSHEPAT PRC $1,330.00 $1,330.00 06 DIAG IMAGING PROCEDURES0667733 IR CINE/VIDEO COMPLEMENT $107.00 06 DIAG IMAGING PROCEDURES0662437 IR CISTERNOGRAM $2,229.00 06 DIAG IMAGING PROCEDURES0662445 IR CORPORA CAVERNOSOGRAM $740.00 06 DIAG IMAGING PROCEDURES0662858 IR CS DIFF MD GT5YR 0-30M $147.00 06 DIAG IMAGING PROCEDURES0662841 IR CS DIFF MD GT5YR 0-30M $293.00 06 DIAG IMAGING PROCEDURES0662833 IR CS DIFF MD LT5YR 0-30M $363.00 06 DIAG IMAGING PROCEDURES0662825 IR CS SAME MD ADD 15M $189.00 06 DIAG IMAGING PROCEDURES0662817 IR CS SAME MD GT5YR 0-30M $399.00 06 DIAG IMAGING PROCEDURES0662809 IR CS SAME MD LT5YR 0-30M $455.00 06 DIAG IMAGING PROCEDURES0668327 IR CYSTOGRAM 3V OR MORE $716.00 06 DIAG IMAGING PROCEDURES0668301 IR DILATE NEPHROSTOMY $1,380.00 $1,380.00 06 DIAG IMAGING PROCEDURES0662452 IR DISKOGRAM CERV THOR $1,623.00 $1,623.00 06 DIAG IMAGING PROCEDURES0662502 IR DISKOGRAM LUMB $1,585.00 $1,585.00 06 DIAG IMAGING PROCEDURES0661108 IR DRN W CATH PLACE PRC $1,274.00 $1,274.00 06 DIAG IMAGING PROCEDURES0662551 IR EMBOL TX $9,969.00 $18,134.00 06 DIAG IMAGING PROCEDURES0662635 IR ENDO BILI DUCT $2,423.00 06 DIAG IMAGING PROCEDURES0661058 IR ENDOVAS REPR ABD AO $883.00 06 DIAG IMAGING PROCEDURES0662577 IR EPIDUROGRAM $1,094.00 06 DIAG IMAGING PROCEDURES0668673 IR EXCHNGE INTRAVAS CATH $2,375.00 06 DIAG IMAGING PROCEDURES0662585 IR FALLOPN TUBE TRANSCERV $428.00 06 DIAG IMAGING PROCEDURES0667741 IR FLUOR CVAD PLC/RMV/RPR $1,455.00 06 DIAG IMAGING PROCEDURES0662718 IR FLUORO 1HR OR LES $850.00 06 DIAG IMAGING PROCEDURES0662692 IR FLUORO GUIDE SPINE INJ $497.00 06 DIAG IMAGING PROCEDURES0662536 IR FLUORO NDL PLACE $727.00 06 DIAG IMAGING PROCEDURES

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SEQ 200 AMOUNT

DEPARTMENT CODE

0668806 IR GALACTOGRAM 1 DUCT $354.00 06 DIAG IMAGING PROCEDURES0662684 IR HYSTEROSALPINGOGRAM $951.00 06 DIAG IMAGING PROCEDURES0665612 IR INJ IVP SNGL/INIT DRG $496.00 06 DIAG IMAGING PROCEDURES0665646 IR INJECTION IM/SQ EA $58.00 06 DIAG IMAGING PROCEDURES0669259 IR IVC FILTER PLACE $6,934.00 $12,613.00 06 DIAG IMAGING PROCEDURES0667931 IR IVUS NONCO ADD $311.00 06 DIAG IMAGING PROCEDURES0667923 IR IVUS NONCO INI $618.00 06 DIAG IMAGING PROCEDURES0668269 IR LYMPHANGIO ABD UNI $827.00 06 DIAG IMAGING PROCEDURES0668251 IR LYMPHANGIO PELV BIL $5,047.00 $4,762.00 06 DIAG IMAGING PROCEDURES0662353 IR PERC TUBE/CATH CHNG $1,132.00 $2,059.00 06 DIAG IMAGING PROCEDURES0660852 IR PLACE OCC DEV VEIN ART $1,667.00 $1,667.00 06 DIAG IMAGING PROCEDURES0661066 IR PLACE PROS REPR AAA $267.00 06 DIAG IMAGING PROCEDURES0669051 IR PORTOGRAM W HEM EVAL $2,816.00 $2,816.00 06 DIAG IMAGING PROCEDURES0668376 IR PORTOGRAM W/O HEM EVAL $2,860.00 06 DIAG IMAGING PROCEDURES0661553 IR PTA PERIPH ART W S&I $4,520.00 $8,222.00 06 DIAG IMAGING PROCEDURES0661603 IR PTA PRPH ART W S&I ADD $2,432.00 $4,424.00 06 DIAG IMAGING PROCEDURES0661652 IR PTA RENL VISC $4,784.00 $8,702.00 06 DIAG IMAGING PROCEDURES0661751 IR PTA VEN $4,512.00 $8,207.00 06 DIAG IMAGING PROCEDURES0661702 IR PTA VISC ADD $1,904.00 $3,463.00 06 DIAG IMAGING PROCEDURES0668558 IR RENL CYST STDY $821.00 $821.00 06 DIAG IMAGING PROCEDURES0662700 IR RETRIEVAL VASCULAR FB $4,272.00 $7,771.00 06 DIAG IMAGING PROCEDURES0668855 IR SHUNTOGRAM NONVASC $1,094.00 $1,094.00 06 DIAG IMAGING PROCEDURES0668939 IR SIALOGRAM $243.00 06 DIAG IMAGING PROCEDURES0668954 IR SPLENOPORTOGRAM $7,883.00 $7,883.00 06 DIAG IMAGING PROCEDURES0660902 IR STNT INTRVAS W S&I EA $2,916.00 $2,916.00 06 DIAG IMAGING PROCEDURES0669150 IR TRANSCATHETER TX IV $9,180.00 $16,698.00 06 DIAG IMAGING PROCEDURES0669101 IR URETERAL STENT PRC $1,436.00 $1,436.00 06 DIAG IMAGING PROCEDURES0666115 IR URETHROCYSTOGRAM VOID $1,175.00 06 DIAG IMAGING PROCEDURES0668319 IR UROGRAM ANTEGRADE $890.00 06 DIAG IMAGING PROCEDURES0674432 IR US VASC ACCESS ADD ON $305.00 06 DIAG IMAGING PROCEDURES0668756 IR VEN SAMPLING $2,798.00 $2,798.00 06 DIAG IMAGING PROCEDURES0669275 IR VENOGRAM ADRENAL BIL $1,705.00 06 DIAG IMAGING PROCEDURES0669283 IR VENOGRAM ADRENAL UNI $1,705.00 06 DIAG IMAGING PROCEDURES0669374 IR VENOGRAM EPID $1,705.00 06 DIAG IMAGING PROCEDURES0669408 IR VENOGRAM EXT BIL $1,554.00 $1,554.00 06 DIAG IMAGING PROCEDURES0669457 IR VENOGRAM EXT UNI $1,405.00 $1,405.00 06 DIAG IMAGING PROCEDURES0669382 IR VENOGRAM HEP W EVAL $2,810.00 06 DIAG IMAGING PROCEDURES

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SEQ 200 AMOUNT

DEPARTMENT CODE

0669390 IR VENOGRAM HEP W/O EVAL $4,818.00 06 DIAG IMAGING PROCEDURES0669309 IR VENOGRAM IVC $2,760.00 $2,760.00 06 DIAG IMAGING PROCEDURES0669465 IR VENOGRAM ORBITAL $129.00 06 DIAG IMAGING PROCEDURES0669507 IR VENOGRAM RENL BIL $3,059.00 $3,059.00 06 DIAG IMAGING PROCEDURES0669556 IR VENOGRAM RENL UNI $2,816.00 $2,816.00 06 DIAG IMAGING PROCEDURES0669481 IR VENOGRAM SAG SINUS $5,274.00 06 DIAG IMAGING PROCEDURES0669473 IR VENOGRAM SIN JUGULAR $2,854.00 06 DIAG IMAGING PROCEDURES0669358 IR VENOGRAM SVC $2,791.00 $2,791.00 06 DIAG IMAGING PROCEDURES0669226 IR VRTPLSTY EA BDY FLUORO $3,873.00 06 DIAG IMAGING PROCEDURES0664284 IRC ABLTN PEL/HIP RF PRC $25,744.00 06 DIAG IMAGING PROCEDURES0660829 IRC ABLTN RENAL RF PRC $4,475.00 06 DIAG IMAGING PROCEDURES0663054 IRC ABSCSS CYST LIVER PRC $245.00 $192.00 06 DIAG IMAGING PROCEDURES0663062 IRC ABSCSS DRN PELV PRC $5,015.00 06 DIAG IMAGING PROCEDURES0663153 IRC ABSCSS DRN RENL $5,906.00 $4,388.00 06 DIAG IMAGING PROCEDURES0663187 IRC ABSCSS DRN RETROPE $5,876.00 06 DIAG IMAGING PROCEDURES0663203 IRC ABSCSS DRN SUBDIAP $5,906.00 $4,388.00 06 DIAG IMAGING PROCEDURES0661223 IRC ADRENAL BIOPSY $3,330.37 06 DIAG IMAGING PROCEDURES0666180 IRC ASP BLADDER SP CATH $646.00 06 DIAG IMAGING PROCEDURES0664235 IRC ASP BREAST ADD $160.00 06 DIAG IMAGING PROCEDURES0664227 IRC ASP BREAST CYST $378.00 06 DIAG IMAGING PROCEDURES0667659 IRC ASP RENL CYST $237.00 $283.00 06 DIAG IMAGING PROCEDURES0663682 IRC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0662478 IRC ASPIRATON BONE MARROW $843.00 06 DIAG IMAGING PROCEDURES0663757 IRC BILI CATH CHNG $2,124.00 $1,662.00 06 DIAG IMAGING PROCEDURES0663856 IRC BILI ENDO W STENT $569.00 $445.00 06 DIAG IMAGING PROCEDURES0663906 IRC BILI STENT PLACE $934.00 $731.00 06 DIAG IMAGING PROCEDURES0664003 IRC BILI STONE EXTRACT $889.00 $696.00 06 DIAG IMAGING PROCEDURES0664441 IRC BRONCH W BX $1,195.00 06 DIAG IMAGING PROCEDURES0664052 IRC BX ABD RETROPE $468.00 $366.00 06 DIAG IMAGING PROCEDURES0664029 IRC BX BM NDL/TROCAR $536.00 06 DIAG IMAGING PROCEDURES0662528 IRC BX BONE SUPER $549.00 $430.00 06 DIAG IMAGING PROCEDURES0664086 IRC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0662114 IRC BX LUNG MEDIASTNM $127.79 $100.00 06 DIAG IMAGING PROCEDURES0672519 IRC BX LYMPH NODE OPEN $3,774.00 $3,676.00 06 DIAG IMAGING PROCEDURES0662122 IRC BX LYMPH NODE SUPER $714.62 $559.19 06 DIAG IMAGING PROCEDURES0662627 IRC BX MUSCLE $977.00 06 DIAG IMAGING PROCEDURES0664201 IRC BX PANCREAS $1,665.00 $1,303.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0664250 IRC BX PLEURA $385.00 $301.00 06 DIAG IMAGING PROCEDURES0664276 IRC BX PROSTATE $774.00 06 DIAG IMAGING PROCEDURES0664300 IRC BX RENL $2,180.00 $1,706.00 06 DIAG IMAGING PROCEDURES0664292 IRC BX SALIVARY GLAND NDL $333.00 06 DIAG IMAGING PROCEDURES0661231 IRC BX SPLEEN $2,093.00 $1,407.74 06 DIAG IMAGING PROCEDURES0664391 IRC BX THIGH/KNE SFT TISS $751.00 06 DIAG IMAGING PROCEDURES0664409 IRC BX THYROID $245.00 $192.00 06 DIAG IMAGING PROCEDURES0662544 IRC BX VERT OPN LUMB/CERV $751.00 06 DIAG IMAGING PROCEDURES0662569 IRC BX VERT OPN THORACIC $1,695.00 06 DIAG IMAGING PROCEDURES0664458 IRC CATH ABD LOW 1ST $5,112.00 $3,798.00 06 DIAG IMAGING PROCEDURES0664508 IRC CATH ABD LOW 2ND $6,134.00 $4,558.00 06 DIAG IMAGING PROCEDURES0664557 IRC CATH ABD LOW 3RD $7,361.00 $5,469.00 06 DIAG IMAGING PROCEDURES0667709 IRC CATH ABD LOW ADD $587.00 $459.00 06 DIAG IMAGING PROCEDURES0667642 IRC CATH PORTAL VEIN PRC $2,603.00 06 DIAG IMAGING PROCEDURES0664607 IRC CATH THOR 1ST ART $4,718.00 $3,505.00 06 DIAG IMAGING PROCEDURES0664656 IRC CATH THOR 2ND ART $5,662.00 $4,207.00 06 DIAG IMAGING PROCEDURES0664755 IRC CATH THOR 3RD ART $6,794.00 $5,048.00 06 DIAG IMAGING PROCEDURES0664706 IRC CATH THOR ADD ART $718.00 $562.00 06 DIAG IMAGING PROCEDURES0669119 IRC CHANGE URET STNT EXT $2,604.00 $2,525.00 06 DIAG IMAGING PROCEDURES0666941 IRC CHANGE URET STNT INT $5,617.00 $5,617.00 06 DIAG IMAGING PROCEDURES0668178 IRC CHG G-TUBE TO G-J PRC $4,075.00 06 DIAG IMAGING PROCEDURES0660951 IRC CHG STENT VIA TRNSURL $524.00 06 DIAG IMAGING PROCEDURES0666610 IRC CHNG G TUBE WO IMG/GD $1,521.00 06 DIAG IMAGING PROCEDURES0666172 IRC CHNG G TUBE WO IMG/GD $903.00 06 DIAG IMAGING PROCEDURES0667600 IRC CHNGE URETR TUBE/STNT $176.00 $138.00 06 DIAG IMAGING PROCEDURES0668285 IRC CON IJ G/COLON TUBE $691.00 $541.00 06 DIAG IMAGING PROCEDURES0667949 IRC CYST W/INS URTL STENT $1,890.00 06 DIAG IMAGING PROCEDURES0666693 IRC CYSTO TUBE CHNG CMPLX $493.00 06 DIAG IMAGING PROCEDURES0666685 IRC CYSTO TUBE CHNG SMPL $844.00 06 DIAG IMAGING PROCEDURES0667980 IRC CYSTO W/TX UR STRICTR $479.00 06 DIAG IMAGING PROCEDURES0668012 IRC CYSTO W/UR UTL STR TX $1,052.00 06 DIAG IMAGING PROCEDURES0667725 IRC DECLOT VASC DEVICE $123.00 06 DIAG IMAGING PROCEDURES0666537 IRC DECLOT VASC DEVICE $123.00 06 DIAG IMAGING PROCEDURES0663666 IRC DECLOT XTL CAN W BLN $248.00 06 DIAG IMAGING PROCEDURES0664870 IRC DL IC VASOSPSM INIT $772.00 06 DIAG IMAGING PROCEDURES0664896 IRC DL IC VSPSM ADD-ON DF $544.00 06 DIAG IMAGING PROCEDURES0664888 IRC DL IC VSPSM ADD-ON SM $272.00 06 DIAG IMAGING PROCEDURES

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0663021 IRC DRN ABSCESS COMP/MULT $256.00 06 DIAG IMAGING PROCEDURES0663039 IRC DRN ABSCESS SMPL/SNGL $386.55 $302.48 06 DIAG IMAGING PROCEDURES0665166 IRC DRN APPNCL ABSCSS OPN $1,993.00 06 DIAG IMAGING PROCEDURES0664904 IRC EMBOL OCC NONHEAD NEC $1,163.00 $910.00 06 DIAG IMAGING PROCEDURES0664813 IRC EMBOL UTERINE FIBROID $15,656.00 $11,632.00 06 DIAG IMAGING PROCEDURES0663815 IRC ENDO RENL W URET CATH $815.00 $638.00 06 DIAG IMAGING PROCEDURES0667873 IRC ENDO SB W JEJ TUB PRC $380.00 06 DIAG IMAGING PROCEDURES0669846 IRC ERCP DX W/WO SPEC $1,085.00 06 DIAG IMAGING PROCEDURES0669853 IRC ERCP RMVL CALC $1,608.00 06 DIAG IMAGING PROCEDURES0669879 IRC ERCP W/BIOPSY $1,141.00 06 DIAG IMAGING PROCEDURES0665059 IRC ESOPH DILATE RETRO $1,617.00 $1,220.00 06 DIAG IMAGING PROCEDURES0664573 IRC EXCHANGE DRN CATH $1,358.00 06 DIAG IMAGING PROCEDURES0664219 IRC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0622761 IRC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0665877 IRC FORAMN EPI C/T W IMG $817.00 06 DIAG IMAGING PROCEDURES0665901 IRC FORAMN EPI L/S W IMG $838.00 $655.00 06 DIAG IMAGING PROCEDURES0665885 IRC FRMN EPI C/T IMG ADD $330.00 06 DIAG IMAGING PROCEDURES0665950 IRC FRMN EPI L/S IMG ADL $357.00 $280.00 06 DIAG IMAGING PROCEDURES0665554 IRC IJ FACET L/S 2 LVL $223.00 $175.00 06 DIAG IMAGING PROCEDURES0664474 IRC IJ PV FACET C/T 1 LVL $554.00 06 DIAG IMAGING PROCEDURES0664466 IRC IJ SCLER SOL SNGL VN $454.00 06 DIAG IMAGING PROCEDURES0665992 IRC IJ W/FLUOR EVAL CVAD $403.00 06 DIAG IMAGING PROCEDURES0665919 IRC INJ AIR CON PERITNL $475.00 06 DIAG IMAGING PROCEDURES0665372 IRC INJ C1 C2 MYELOGRAM $466.00 06 DIAG IMAGING PROCEDURES0665208 IRC INJ CELIAC PLEX BLK $592.00 $463.00 06 DIAG IMAGING PROCEDURES0665257 IRC INJ CHOL TRANSHEPAT $130.00 $101.00 06 DIAG IMAGING PROCEDURES0665307 IRC INJ CHOL VIA CATH $50.00 $39.00 06 DIAG IMAGING PROCEDURES0665638 IRC INJ CON ABSCSS $574.00 06 DIAG IMAGING PROCEDURES0666107 IRC INJ CYSTO RETRO $349.00 $273.00 06 DIAG IMAGING PROCEDURES0665323 IRC INJ CYSTO VCUG $3,149.00 06 DIAG IMAGING PROCEDURES0665331 IRC INJ DACROCYSTOGRAM $2,229.00 06 DIAG IMAGING PROCEDURES0665356 IRC INJ DISKOGRAM CERV $884.00 $692.00 06 DIAG IMAGING PROCEDURES0665406 IRC INJ DISKOGRAM LUMB $959.00 $751.00 06 DIAG IMAGING PROCEDURES0665448 IRC INJ EPID CERV THOR $1,645.00 06 DIAG IMAGING PROCEDURES0665455 IRC INJ EPID L/S $885.00 $693.00 06 DIAG IMAGING PROCEDURES0665505 IRC INJ FACET L/S 1 LVL $518.00 $406.00 06 DIAG IMAGING PROCEDURES0661017 IRC INJ FACET L/S 3 LVL $229.00 $179.00 06 DIAG IMAGING PROCEDURES

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0665653 IRC INJ ILEAL CONDUIT $274.00 $214.00 06 DIAG IMAGING PROCEDURES0665752 IRC INJ LYMPHANGIO $3,706.00 $2,797.00 06 DIAG IMAGING PROCEDURES0665737 IRC INJ MYELOGRAM $720.00 06 DIAG IMAGING PROCEDURES0665851 IRC INJ NEPHROGRAM $364.00 $285.00 06 DIAG IMAGING PROCEDURES0666008 IRC INJ NRV BLK SCTC SNGL $884.00 $884.00 06 DIAG IMAGING PROCEDURES0667865 IRC INJ NRV INTCOSTL MULT $925.00 06 DIAG IMAGING PROCEDURES0664516 IRC INJ NRV INTCOSTL SNGL $486.00 06 DIAG IMAGING PROCEDURES0665968 IRC INJ PANCREAT INTRAOP $342.00 06 DIAG IMAGING PROCEDURES0660118 IRC INJ SI JNT ANES/STRD $7,591.10 $7,791.82 06 DIAG IMAGING PROCEDURES0665430 IRC INJ SPINE W CATH L/S $583.00 06 DIAG IMAGING PROCEDURES0665687 IRC INJ TND SHEATH/LG $147.00 06 DIAG IMAGING PROCEDURES0665661 IRC INJ TRG PT 1 OR 2 MCL $108.00 06 DIAG IMAGING PROCEDURES0665679 IRC INJ TRIG PT GT 2 MCL $120.00 06 DIAG IMAGING PROCEDURES0666099 IRC INJ URETHROCYST CHAIN $1,491.00 06 DIAG IMAGING PROCEDURES0664243 IRC INJ/ASP GANGLION CYST $133.00 06 DIAG IMAGING PROCEDURES0661009 IRC INS ID ABD/PEL RT PER $1,784.00 $1,396.00 06 DIAG IMAGING PROCEDURES0660977 IRC INS ID RT THOR PERC $2,101.00 $1,644.00 06 DIAG IMAGING PROCEDURES0666198 IRC INS INTRA ART PUMP $2,013.00 06 DIAG IMAGING PROCEDURES0667782 IRC INS NON-TUN CV CATH<5 $779.00 06 DIAG IMAGING PROCEDURES0667790 IRC INS NON-TUN CV CATH5+ $637.00 06 DIAG IMAGING PROCEDURES0666362 IRC INS PICC W/O PORT 5+ $904.00 06 DIAG IMAGING PROCEDURES0666370 IRC INS PICC W/O PORT LT5 $1,080.00 06 DIAG IMAGING PROCEDURES0666388 IRC INS PICC W/PORT 5+YRS $5,968.00 06 DIAG IMAGING PROCEDURES0666396 IRC INS PICC W/PORT LT 5 $5,968.00 06 DIAG IMAGING PROCEDURES0660985 IRC INS PLRO AGT INTL DAY $187.00 $146.00 06 DIAG IMAGING PROCEDURES0660993 IRC INS PLRO AGT SUBQ DAY $166.00 $130.00 06 DIAG IMAGING PROCEDURES0667808 IRC INS TUN CV NO PRT LT5 $4,593.00 06 DIAG IMAGING PROCEDURES0667667 IRC INS TUNN CV DEV 5+ $8,267.00 06 DIAG IMAGING PROCEDURES0667675 IRC INS TUNN CV DEV LT 5 $7,127.00 06 DIAG IMAGING PROCEDURES0667816 IRC INS TUNN CV NO PORT5+ $4,133.00 06 DIAG IMAGING PROCEDURES0662411 IRC INSRT PLEURAL CATH $2,902.00 $2,271.00 06 DIAG IMAGING PROCEDURES0667097 IRC INTERDISC PERC ASP DX $655.00 $513.00 06 DIAG IMAGING PROCEDURES0664847 IRC INTRACRAN ANGIOPLSTY $1,760.00 06 DIAG IMAGING PROCEDURES0664862 IRC INTRACRN ANGIO W/STNT $1,901.00 06 DIAG IMAGING PROCEDURES0666263 IRC INTRO AORTA $854.00 06 DIAG IMAGING PROCEDURES0666255 IRC INTRO BRACH ART $2,883.00 $2,142.00 06 DIAG IMAGING PROCEDURES0666206 IRC INTRO CATH AORTA $3,932.00 $2,921.00 06 DIAG IMAGING PROCEDURES

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0666453 IRC INTRO CATH BILI DRN $862.00 $675.00 06 DIAG IMAGING PROCEDURES0666297 IRC INTRO CATH FALLOPN $947.00 06 DIAG IMAGING PROCEDURES0666552 IRC INTRO CATH FALLOPN 06 DIAG IMAGING PROCEDURES0666305 IRC INTRO CATH IVC/SVC $3,887.00 $2,888.00 06 DIAG IMAGING PROCEDURES0666354 IRC INTRO CATH PULM $1,109.00 $824.00 06 DIAG IMAGING PROCEDURES0666404 IRC INTRO CATH RENL PELV $281.00 $220.00 06 DIAG IMAGING PROCEDURES0666750 IRC INTRO EXT ART $3,246.00 $2,412.00 06 DIAG IMAGING PROCEDURES0666602 IRC INTRO G TUBE LONG $50.00 06 DIAG IMAGING PROCEDURES0666701 IRC INTRO IVC FILTER $1,024.00 $801.00 06 DIAG IMAGING PROCEDURES0666909 IRC INTRO NEPHROSTOMY $286.00 $224.00 06 DIAG IMAGING PROCEDURES0666958 IRC INTRO STENT CATH URET $333.00 $261.00 06 DIAG IMAGING PROCEDURES0666156 IRC IVCH RETRIEVE FB $5,429.00 $4,248.00 06 DIAG IMAGING PROCEDURES0665760 IRC LAP BAND ADJ/INJ/ASP $2,940.00 06 DIAG IMAGING PROCEDURES0665711 IRC LAP REV ADJ GAST DVC $1,665.00 06 DIAG IMAGING PROCEDURES0665703 IRC LUMBAR PUNCTURE DX $457.00 $358.00 06 DIAG IMAGING PROCEDURES0667006 IRC NEPHROSTOMY MANOMETRY $200.00 $478.00 06 DIAG IMAGING PROCEDURES0667055 IRC NEPHROSTOMY TUBE CHNG $3,854.00 $2,864.00 06 DIAG IMAGING PROCEDURES0666677 IRC NG TUBE PLC W FLUORO $50.00 06 DIAG IMAGING PROCEDURES0667378 IRC OPN INTRVAS STENT ADD $218.00 06 DIAG IMAGING PROCEDURES0667360 IRC OPN INTRVS STENT INIT $502.00 06 DIAG IMAGING PROCEDURES0663518 IRC OPN TRANS ANGIO RENAL $1,863.00 06 DIAG IMAGING PROCEDURES0667105 IRC PARACENT ABD INI $533.00 $417.00 06 DIAG IMAGING PROCEDURES0667113 IRC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0666982 IRC PERC VERT AUG ADD VRT $353.00 06 DIAG IMAGING PROCEDURES0664953 IRC PERM EMBOL OCC CNS $1,384.00 $1,083.00 06 DIAG IMAGING PROCEDURES0666412 IRC PLACE G-TUBE PERC $1,174.00 06 DIAG IMAGING PROCEDURES0666479 IRC PLC CECSTMY TUBE PERC $7,145.00 06 DIAG IMAGING PROCEDURES0666438 IRC PLC DUD/JEJ TUBE PERC $2,464.00 06 DIAG IMAGING PROCEDURES0662882 IRC PLC IP CATH DLYS OPN $594.00 $576.00 06 DIAG IMAGING PROCEDURES0662866 IRC PLC IP CATH DLYS OPN $607.00 $475.00 06 DIAG IMAGING PROCEDURES0662395 IRC PLC IP CATH DLYS OPN $607.00 $475.00 06 DIAG IMAGING PROCEDURES0664763 IRC PNMNSTOMY W DRN OPN $3,226.00 06 DIAG IMAGING PROCEDURES0667840 IRC PNMNSTOMY W DRN PRC $695.00 06 DIAG IMAGING PROCEDURES0660837 IRC PRC CRY ABLA RNAL TUM $20,713.00 $16,208.00 06 DIAG IMAGING PROCEDURES0666974 IRC PRC VRT AUG LUMB 1VRT $909.00 06 DIAG IMAGING PROCEDURES0666966 IRC PRC VRT AUG THOR 1VRT $938.00 06 DIAG IMAGING PROCEDURES0664854 IRC PRM EMBL OCC HEAD NEC $1,107.00 $866.00 06 DIAG IMAGING PROCEDURES

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0664987 IRC PROCTOSIGMOID W/DIL $2,540.00 06 DIAG IMAGING PROCEDURES0664979 IRC PROCTOSIGMOIDOSCPY DX $245.00 06 DIAG IMAGING PROCEDURES0665570 IRC PRQ SACRAL AUG BIL IJ $4,396.06 $3,695.00 06 DIAG IMAGING PROCEDURES0665562 IRC PRQ SACRAL AUG UNI IJ $4,396.06 $3,695.00 06 DIAG IMAGING PROCEDURES0667832 IRC PSEUDOANEURYSM INJ $428.00 06 DIAG IMAGING PROCEDURES0663252 IRC PTA AORTIC $2,040.00 $1,516.00 06 DIAG IMAGING PROCEDURES0663302 IRC PTA BRACHIOCEPH EA $2,808.00 $2,086.00 06 DIAG IMAGING PROCEDURES0661173 IRC PTA BRACHIOCEPH EA $15,472.00 06 DIAG IMAGING PROCEDURES0663500 IRC PTA RENL VISC $6,650.00 $4,941.00 06 DIAG IMAGING PROCEDURES0663609 IRC PTA VEN $1,792.00 $1,331.00 06 DIAG IMAGING PROCEDURES0667154 IRC PULM ART L/R $1,166.00 $866.00 06 DIAG IMAGING PROCEDURES0667204 IRC PULM ART SEG SUB $1,144.00 $850.00 06 DIAG IMAGING PROCEDURES0668723 IRC REM TUNN CVA DEV W PT $675.00 06 DIAG IMAGING PROCEDURES0660969 IRC REMOVE LUNG CATHETER $371.00 $290.00 06 DIAG IMAGING PROCEDURES0667618 IRC REMOVE URET STNT INT $10,392.00 06 DIAG IMAGING PROCEDURES0667014 IRC REMV RNL TUBE W/FLUOR $1,399.00 06 DIAG IMAGING PROCEDURES0669580 IRC REMV TUNN CV CATH W/O $364.00 06 DIAG IMAGING PROCEDURES0663765 IRC REPLACE CATH ONLY CV $1,741.00 $1,362.00 06 DIAG IMAGING PROCEDURES0666420 IRC REPLACE G/C TUBE PERC $5,120.00 06 DIAG IMAGING PROCEDURES0666487 IRC REPLACE G-J TUBE PERC $845.00 06 DIAG IMAGING PROCEDURES0668566 IRC REPR CV CATH W/O PORT $600.00 06 DIAG IMAGING PROCEDURES0667428 IRC REPS PREV PLC CV CATH $380.00 06 DIAG IMAGING PROCEDURES0661025 IRC REV INTRATHCL P/P RES $395.00 06 DIAG IMAGING PROCEDURES0669598 IRC RMV TNLD INPRTNL CATH $531.00 06 DIAG IMAGING PROCEDURES0668517 IRC RMVL INTHCL/EPID CATH $504.00 06 DIAG IMAGING PROCEDURES0663542 IRC RMVL INTRA ART PUMP $917.00 06 DIAG IMAGING PROCEDURES0662726 IRC RMVL KDY STN PRC GT 2 $4,252.00 06 DIAG IMAGING PROCEDURES0662734 IRC RMVL KDY STN PRC/LES2 $2,980.00 06 DIAG IMAGING PROCEDURES0667691 IRC RPLC COMP NON-TUNN CV $826.00 06 DIAG IMAGING PROCEDURES0667683 IRC RPLC COMP TUN CV CATH $4,593.00 06 DIAG IMAGING PROCEDURES0667717 IRC RPLC COMP TUN CV W/PT $8,749.00 06 DIAG IMAGING PROCEDURES0666446 IRC RPLC DUD/JEJ TUBE PRC $5,424.00 06 DIAG IMAGING PROCEDURES0667584 IRC RVSN AVS FIST OPN W/O $974.00 06 DIAG IMAGING PROCEDURES0666164 IRC RVSN INTRA ART PUMP $1,222.00 06 DIAG IMAGING PROCEDURES0667303 IRC SELECT CATH 1ST VEN $2,332.00 $1,733.00 06 DIAG IMAGING PROCEDURES0667352 IRC SELECT CATH 2ND VEN $1,399.00 $1,039.00 06 DIAG IMAGING PROCEDURES0667451 IRC STNT INTRAVS ADDL PRC $5,968.00 $4,434.00 06 DIAG IMAGING PROCEDURES

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0667402 IRC STNT INTRAVS INIT PRC $13,117.00 $9,746.00 06 DIAG IMAGING PROCEDURES0667907 IRC SYNOVIAL BX IP JOINT $713.00 06 DIAG IMAGING PROCEDURES0667915 IRC SYNOVIAL BX MCP JOINT $731.00 06 DIAG IMAGING PROCEDURES0663773 IRC TEMP BAL ARTERIAL OCC $720.00 06 DIAG IMAGING PROCEDURES0669564 IRC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0663484 IRC THORACENTESIS W TUBE $531.00 06 DIAG IMAGING PROCEDURES0667543 IRC THROMBECTOMY AVS FIST $7,794.00 06 DIAG IMAGING PROCEDURES0665158 IRC THROMBOLYSIS IV NONCO $436.00 $341.00 06 DIAG IMAGING PROCEDURES0667527 IRC TIPS INSERTION $1,170.00 06 DIAG IMAGING PROCEDURES0667493 IRC TIPS REVISION $23,034.00 06 DIAG IMAGING PROCEDURES0667956 IRC TRNCTH STNT CCA W/PRO $1,907.00 $1,907.00 06 DIAG IMAGING PROCEDURES0663005 IRC TUBE THORACOSTOMY $205.00 $161.00 06 DIAG IMAGING PROCEDURES0664961 IRC UP GI ENDO W/TUBE PLC $801.00 06 DIAG IMAGING PROCEDURES0667501 IRC VEN ANAST PORT OPN $1,850.00 $1,448.00 06 DIAG IMAGING PROCEDURES0666149 IRC VERTEPLASTY ADD PRC $299.00 06 DIAG IMAGING PROCEDURES0666131 IRC VERTEPLASTY LUMB PRC $3,965.00 06 DIAG IMAGING PROCEDURES0666123 IRC VERTEPLASTY THOR PRC $4,320.00 06 DIAG IMAGING PROCEDURES0654939 MR 3D RENDER W/O POSTPROS $513.00 06 DIAG IMAGING PROCEDURES0654921 MR 3D RENDER W/POSTPROCES $461.00 06 DIAG IMAGING PROCEDURES0652099 MR ABD W CON $3,941.00 06 DIAG IMAGING PROCEDURES0652107 MR ABD W/O CON $3,144.00 $3,561.00 06 DIAG IMAGING PROCEDURES0652115 MR ABD W-W/O CON $5,243.00 06 DIAG IMAGING PROCEDURES0652156 MR BONE MARROW $3,416.00 $2,578.00 06 DIAG IMAGING PROCEDURES0652800 MR BRAIN W STEM W CON $3,928.00 $4,448.00 06 DIAG IMAGING PROCEDURES0652750 MR BRAIN W STEM W/O CON $3,563.00 $4,035.00 06 DIAG IMAGING PROCEDURES0652701 MR BRAIN W STEM W-W/O CON $5,056.00 $5,725.00 06 DIAG IMAGING PROCEDURES0652180 MR BREAST BIL W-W/O CON $4,072.00 06 DIAG IMAGING PROCEDURES0652214 MR BREAST CAD MRI ADD-ON $51.00 06 DIAG IMAGING PROCEDURES0652172 MR BREAST UNI W-W/O CON $3,314.00 06 DIAG IMAGING PROCEDURES0654012 MR CARD MRI MORPH WO CON $2,698.00 06 DIAG IMAGING PROCEDURES0654061 MR CARD MRI MORPH W-W/O $3,907.00 06 DIAG IMAGING PROCEDURES0654079 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654020 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654046 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654095 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654038 MR CARD MRI W/STRESS IMG $4,154.00 06 DIAG IMAGING PROCEDURES0654087 MR CARD MRI W/STRSS W-W/O $4,860.00 06 DIAG IMAGING PROCEDURES

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0652255 MR CHEST W/O CON $3,949.00 $4,472.00 06 DIAG IMAGING PROCEDURES0652388 MR CHEST W-W/O CON $5,972.17 $6,762.68 06 DIAG IMAGING PROCEDURES0651349 MR CS DIFF MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0651372 MR CS DIFF MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0651364 MR CS DIFF MD LT5YR 0-30M $302.00 06 DIAG IMAGING PROCEDURES0651380 MR CS DIFF MD LT5YR 0-30M $302.00 06 DIAG IMAGING PROCEDURES0635987 MR CS SAME MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0651331 MR CS SAME MD GT5YR 0-30M $277.00 06 DIAG IMAGING PROCEDURES0651323 MR CS SAME MD LT5YR 0-30M $329.00 06 DIAG IMAGING PROCEDURES0652529 MR EXT LOW JNT W-W/O CON $4,962.00 06 DIAG IMAGING PROCEDURES0652503 MR EXT LOW JT W/O CON $3,452.00 $3,909.00 06 DIAG IMAGING PROCEDURES0652438 MR EXT LOW W/O CON $3,533.00 06 DIAG IMAGING PROCEDURES0652453 MR EXT LOW W-W/O CON $5,261.00 $5,957.00 06 DIAG IMAGING PROCEDURES0652644 MR EXT UPP JNT W CON $3,663.00 06 DIAG IMAGING PROCEDURES0652651 MR EXT UPP JNT W/O CON $3,380.00 $3,827.00 06 DIAG IMAGING PROCEDURES0652669 MR EXT UPP JNT W-W/O CON $6,234.00 06 DIAG IMAGING PROCEDURES0652594 MR EXT UPP NO JNT W/CON $3,904.00 06 DIAG IMAGING PROCEDURES0652586 MR EXT UPP NO JNT W/O CON $3,606.00 06 DIAG IMAGING PROCEDURES0652602 MR EXT UPP NO JNT W-W/O $5,261.00 $5,957.00 06 DIAG IMAGING PROCEDURES0654962 MR GUIDE NDL PLACE $2,843.00 06 DIAG IMAGING PROCEDURES0654988 MR GUIDE VISCL TISS ABLTN $1,860.00 06 DIAG IMAGING PROCEDURES0653121 MR ORBIT FACE NEC W CON $3,844.00 06 DIAG IMAGING PROCEDURES0653204 MR ORBIT FACE NEC W/O CON $3,503.00 $3,967.00 06 DIAG IMAGING PROCEDURES0653147 MR ORBIT FACE NEC W-W/O $5,197.00 06 DIAG IMAGING PROCEDURES0653303 MR PELV W CON 06 DIAG IMAGING PROCEDURES0653295 MR PELV W/O CON $3,554.00 06 DIAG IMAGING PROCEDURES0653311 MR PELV W-W/O CON $5,234.00 06 DIAG IMAGING PROCEDURES0654947 MR SPECTROSCOPY $3,102.00 06 DIAG IMAGING PROCEDURES0653501 MR SPINE CERV W CON $3,925.00 $4,445.00 06 DIAG IMAGING PROCEDURES0653451 MR SPINE CERV W/O CON $3,138.00 $3,554.00 06 DIAG IMAGING PROCEDURES0653600 MR SPINE CERV W-W/O CON $4,977.00 $5,636.00 06 DIAG IMAGING PROCEDURES0653709 MR SPINE LUMB W CON $3,916.00 $4,434.00 06 DIAG IMAGING PROCEDURES0653659 MR SPINE LUMB W/O CON $3,211.00 $3,636.00 06 DIAG IMAGING PROCEDURES0653758 MR SPINE LUMB W-W/O $4,971.00 $5,629.00 06 DIAG IMAGING PROCEDURES0653907 MR SPINE THOR W CON $3,491.00 $3,953.00 06 DIAG IMAGING PROCEDURES0653857 MR SPINE THOR W/O CON $3,214.00 $3,639.00 06 DIAG IMAGING PROCEDURES0653808 MR SPINE THOR W-W/O $4,649.00 $5,264.00 06 DIAG IMAGING PROCEDURES

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0652776 MR VENOGRAM BRAIN $6,195.00 06 DIAG IMAGING PROCEDURES0652123 MRA ABD W-W/O CON $2,891.00 06 DIAG IMAGING PROCEDURES0652404 MRA CHEST W-W/O CON $2,871.00 $3,251.00 06 DIAG IMAGING PROCEDURES0652552 MRA EXT LOW W-W/O CON $3,574.00 $2,715.00 06 DIAG IMAGING PROCEDURES0655522 MRA HEAD W CON $4,284.00 06 DIAG IMAGING PROCEDURES0655506 MRA HEAD W/O CON $4,311.00 06 DIAG IMAGING PROCEDURES0652834 MRA HEAD W-W/O CON $4,490.00 $7,759.00 06 DIAG IMAGING PROCEDURES0655548 MRA HEAD W-W/O CON $6,852.00 06 DIAG IMAGING PROCEDURES0657528 MRA NEC W CON $4,510.00 06 DIAG IMAGING PROCEDURES0657502 MRA NEC W/O CON $4,299.00 06 DIAG IMAGING PROCEDURES0657544 MRA NEC W-W/O CON $6,852.00 06 DIAG IMAGING PROCEDURES0653352 MRA PELV W-W/O CON $3,888.00 $4,402.00 06 DIAG IMAGING PROCEDURES0650812 MRA SPINAL CANAL W/CON $4,200.00 06 DIAG IMAGING PROCEDURES0650820 MRA SPINAL CANAL W/O CON $4,400.00 06 DIAG IMAGING PROCEDURES0650838 MRA SPINAL CANAL W-WO CON $4,565.00 06 DIAG IMAGING PROCEDURES0650861 MRA UPPER EXT W/CON $4,400.00 06 DIAG IMAGING PROCEDURES0650895 MRA UPPER EXT W/CON LT $4,400.00 06 DIAG IMAGING PROCEDURES0650911 MRA UPPER EXT W/CON RT $4,400.00 06 DIAG IMAGING PROCEDURES0650879 MRA UPPER EXT W/O CON $4,565.00 06 DIAG IMAGING PROCEDURES0650937 MRA UPPER EXT W/O CON LT $4,565.00 06 DIAG IMAGING PROCEDURES0650929 MRA UPPER EXT W/O CON RT $4,565.00 06 DIAG IMAGING PROCEDURES0650887 MRA UPPER EXT W-WO CON $4,600.00 06 DIAG IMAGING PROCEDURES0650960 MRA UPPER EXT W-WO CON LT $4,600.00 06 DIAG IMAGING PROCEDURES0650945 MRA UPPER EXT W-WO CON RT $4,600.00 06 DIAG IMAGING PROCEDURES0622506 MRC BX BONE DEEP $2,539.00 $2,396.00 06 DIAG IMAGING PROCEDURES0652693 MRC BX STEREO ASPIR HEAD $4,044.00 06 DIAG IMAGING PROCEDURES0653956 MRI OF TMJ(S) $3,084.00 $3,492.00 06 DIAG IMAGING PROCEDURES0675702 NI AORTA IVC IL CMPL $1,949.00 $1,796.00 06 DIAG IMAGING PROCEDURES0675355 NI DIAL ACCES $1,796.00 $1,655.00 06 DIAG IMAGING PROCEDURES0676379 NI DPPLER EXT VEINS BIL $1,018.00 $938.00 06 DIAG IMAGING PROCEDURES0675942 NI DPPLER EXTRACRAN BIL $876.00 $807.00 06 DIAG IMAGING PROCEDURES0675108 NI DUPLEX ABD PELV CMPL $2,712.00 $2,499.00 06 DIAG IMAGING PROCEDURES0675157 NI DUPLEX ABD PELV LTD $1,463.00 $1,349.00 06 DIAG IMAGING PROCEDURES0675462 NI DUPLEX EXT LOW BIL $2,690.00 $2,478.00 06 DIAG IMAGING PROCEDURES0675470 NI DUPLEX EXT LOW UNI $1,719.00 06 DIAG IMAGING PROCEDURES0675801 NI DUPLEX EXT UPP BIL $2,106.00 $1,940.00 06 DIAG IMAGING PROCEDURES0675306 NI DUPLEX EXT UPP UNI $1,409.00 $1,298.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0676403 NI DUPLEX EXT VEINS BIL $2,077.00 $1,913.00 06 DIAG IMAGING PROCEDURES0676452 NI DUPLEX EXT VEINS UNI $1,365.00 $1,258.00 06 DIAG IMAGING PROCEDURES0676387 NI DUPLEX EXT VEINS UNI 06 DIAG IMAGING PROCEDURES0675850 NI DUPLEX EXTRACRAN BIL $2,062.00 $1,900.00 06 DIAG IMAGING PROCEDURES0675843 NI DUPLEX EXTRACRAN UNI $1,398.00 06 DIAG IMAGING PROCEDURES0675603 NI EXT ART COMP BIL3+ LV $1,580.00 $1,456.00 06 DIAG IMAGING PROCEDURES0675413 NI EXT ART LTD BIL 1-2 LV $1,051.00 $969.00 06 DIAG IMAGING PROCEDURES0675405 NI EXT ART LTD BIL 1-2 LV $1,051.00 $969.00 06 DIAG IMAGING PROCEDURES0675439 NI EXT LOW W STRS CMP BIL $1,967.00 06 DIAG IMAGING PROCEDURES0676254 NI INTRACRAN CMPL $2,522.00 $2,324.00 06 DIAG IMAGING PROCEDURES0676304 NI INTRACRAN LTD $1,675.00 $1,544.00 06 DIAG IMAGING PROCEDURES0675504 NI PENILE VESSELS CMPL $1,066.00 $982.00 06 DIAG IMAGING PROCEDURES0675553 NI PENILE VESSELS LTD $1,415.00 $1,067.00 06 DIAG IMAGING PROCEDURES0631002 NM ABSCSS LOC LTD $1,876.00 $1,876.00 06 DIAG IMAGING PROCEDURES0631101 NM ABSCSS LOC WB $3,756.00 $3,756.00 06 DIAG IMAGING PROCEDURES0631309 NM ADRENAL $4,881.00 $4,881.00 06 DIAG IMAGING PROCEDURES0639450 NM APLY INTRSTL RAD SMPL $1,438.00 06 DIAG IMAGING PROCEDURES0631457 NM BONE MARROW LTD $1,741.00 $1,741.00 06 DIAG IMAGING PROCEDURES0631507 NM BONE MARROW MULTI $2,318.00 $2,318.00 06 DIAG IMAGING PROCEDURES0631556 NM BONE MARROW WB $2,672.00 $2,672.00 06 DIAG IMAGING PROCEDURES0631408 NM BONE SCAN LTD $1,801.00 $1,801.00 06 DIAG IMAGING PROCEDURES0631804 NM BONE SCAN MULTI AREAS $2,383.00 $2,383.00 06 DIAG IMAGING PROCEDURES0631903 NM BONE SCAN W SPECT $2,507.00 $2,229.00 06 DIAG IMAGING PROCEDURES0631952 NM BONE SCAN WB $2,652.00 $2,652.00 06 DIAG IMAGING PROCEDURES0631853 NM BONE THREE PHASE $3,667.00 $3,667.00 06 DIAG IMAGING PROCEDURES0634550 NM BOWEL (MECKELS) $3,517.00 $3,517.00 06 DIAG IMAGING PROCEDURES0632059 NM BRAIN CISTERNOGRAM $3,761.00 $3,761.00 06 DIAG IMAGING PROCEDURES0632406 NM BRAIN CSF SHUNT EVAL $3,557.00 $3,557.00 06 DIAG IMAGING PROCEDURES0632257 NM BRAIN FLOW ONLY $2,065.00 $2,065.00 06 DIAG IMAGING PROCEDURES0632158 NM BRAIN GT3 STAT V W/FLW $3,622.00 $3,622.00 06 DIAG IMAGING PROCEDURES0632109 NM BRAIN GT3 STATIC VW $2,139.00 $2,139.00 06 DIAG IMAGING PROCEDURES0632356 NM BRAIN LT4 STAT V W/FLW $2,348.00 $2,348.00 06 DIAG IMAGING PROCEDURES0632307 NM BRAIN LT4 STATIC VW $1,890.00 $1,426.00 06 DIAG IMAGING PROCEDURES0632208 NM BRAIN W TOMO SPECT $3,836.00 $3,836.00 06 DIAG IMAGING PROCEDURES0633701 NM CARDIAC SHUNT EVAL $2,010.00 $2,010.00 06 DIAG IMAGING PROCEDURES0635938 NM CS DIFF MD ADD 15M $140.00 06 DIAG IMAGING PROCEDURES0635961 NM CS DIFF MD ADD 15M $140.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0635946 NM CS DIFF MD LT5YR 0-30M $377.00 06 DIAG IMAGING PROCEDURES0635920 NM CS SAME MD GT5YR 0-30M $458.00 06 DIAG IMAGING PROCEDURES0635912 NM CS SAME MD LT5YR 0-30M $543.00 06 DIAG IMAGING PROCEDURES0632075 NM CSF FLOW W SPECT $778.00 06 DIAG IMAGING PROCEDURES0636779 NM CSF FLOW W SPECT $1,207.00 $968.00 06 DIAG IMAGING PROCEDURES0632455 NM CSF LEAKAGE DETECT $3,701.00 $3,701.00 06 DIAG IMAGING PROCEDURES0632653 NM CYSTOGRAM VOIDING $2,348.00 $2,348.00 06 DIAG IMAGING PROCEDURES0632752 NM ESOPH MOTILITY $860.00 $1,191.00 06 DIAG IMAGING PROCEDURES0632869 NM GASTRIC EMPTYING $3,080.00 06 DIAG IMAGING PROCEDURES0632901 NM GASTROESOPH REFLUX $2,662.00 $2,662.00 06 DIAG IMAGING PROCEDURES0633008 NM GI BLEEDING SCAN $3,687.00 $3,687.00 06 DIAG IMAGING PROCEDURES0633107 NM HEART 1S PASS SNGL $2,149.00 $2,149.00 06 DIAG IMAGING PROCEDURES0633222 NM HEART BLOOD POOL SPECT $2,756.00 06 DIAG IMAGING PROCEDURES0633156 NM HEART GATED MULTIVIEW $3,443.00 $3,115.00 06 DIAG IMAGING PROCEDURES0633149 NM HEART GATED SNGL $2,637.00 06 DIAG IMAGING PROCEDURES0633552 NM HEART MI PLANAR $2,418.00 $1,824.00 06 DIAG IMAGING PROCEDURES0633602 NM HEART MI W EF $2,328.00 $2,328.00 06 DIAG IMAGING PROCEDURES0633651 NM HEART MI W SPECT $2,657.00 $2,657.00 06 DIAG IMAGING PROCEDURES0633354 NM HEART MP MULTI PLANAR $1,677.00 $1,677.00 06 DIAG IMAGING PROCEDURES0638379 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0636886 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0633750 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0633057 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0636878 NM HEART MP SNGL PLANAR $1,995.00 $1,995.00 06 DIAG IMAGING PROCEDURES0636852 NM HEART MP SNGL W SPEC $2,139.00 $2,139.00 06 DIAG IMAGING PROCEDURES0633800 NM HEPATOBILIARY DUCTAL $3,557.00 $3,557.00 06 DIAG IMAGING PROCEDURES0631051 NM INFLAM LOCAL W SPECT $3,806.00 $3,806.00 06 DIAG IMAGING PROCEDURES0635581 NM INTRA-ARTICULAR TX $385.00 06 DIAG IMAGING PROCEDURES0639476 NM INTRSTIT RADIAT CMPLX $3,478.00 06 DIAG IMAGING PROCEDURES0633826 NM IV IJ RA DRUG DX STUDY $493.00 $493.00 06 DIAG IMAGING PROCEDURES0635185 NM K FLOW/FUNCT MULTIPLE $3,696.00 06 DIAG IMAGING PROCEDURES0634808 NM K FLOW/FUNCT W/DRUG $1,602.00 $1,602.00 06 DIAG IMAGING PROCEDURES0635219 NM K FLOW/FUNCT W/O DRG $2,428.00 06 DIAG IMAGING PROCEDURES0634907 NM KIDNEY IMAGING MORPHOL $1,920.00 $1,920.00 06 DIAG IMAGING PROCEDURES0635151 NM KIDNEY IMAGING SPECT $2,488.00 $2,488.00 06 DIAG IMAGING PROCEDURES0635052 NM KIDNEY IMAGING W/FLOW $2,363.00 $2,363.00 06 DIAG IMAGING PROCEDURES0634006 NM LIVER FNCTN STDY $1,110.00 $1,110.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0634253 NM LIVER SPLEEN STATIC $2,090.00 $2,090.00 06 DIAG IMAGING PROCEDURES0634303 NM LIVER SPLEEN W FLOW $1,353.00 $1,353.00 06 DIAG IMAGING PROCEDURES0634055 NM LIVER STATIC $2,020.00 $2,020.00 06 DIAG IMAGING PROCEDURES0634154 NM LIVER W SPECT $2,512.00 $2,512.00 06 DIAG IMAGING PROCEDURES0634105 NM LIVER W VASCULAR FLOW $2,264.00 $2,264.00 06 DIAG IMAGING PROCEDURES0639831 NM LOADING RAD SOURCE $488.00 06 DIAG IMAGING PROCEDURES0634352 NM LUNG PERF $2,209.00 $2,209.00 06 DIAG IMAGING PROCEDURES0634477 NM LUNG PERF VENT $3,537.00 06 DIAG IMAGING PROCEDURES0634493 NM LUNG QUAN DIFF FNCTN $3,935.00 06 DIAG IMAGING PROCEDURES0634444 NM LUNG VENT MULTI $2,303.00 06 DIAG IMAGING PROCEDURES0634402 NM LUNG VENT W GAS $2,144.00 $2,144.00 06 DIAG IMAGING PROCEDURES0634451 NM LUNG VENTI1V $1,564.00 $1,476.00 06 DIAG IMAGING PROCEDURES0634501 NM LYMPHATIC PATHWAY $3,622.00 $3,622.00 06 DIAG IMAGING PROCEDURES0635615 NM MONOCLONAL AB IV INFSN $1,259.00 06 DIAG IMAGING PROCEDURES0634600 NM PARATHYROID $1,642.00 $1,642.00 06 DIAG IMAGING PROCEDURES0637439 NM PARATHYROID $1,642.00 $1,642.00 06 DIAG IMAGING PROCEDURES0634659 NM PLASMA VOLUME MULTI $928.00 $701.00 06 DIAG IMAGING PROCEDURES0634782 NM PLATELET SURVIVAL STDY $540.00 06 DIAG IMAGING PROCEDURES0639104 NM RADIAT DOSIMETRY CALC $512.00 06 DIAG IMAGING PROCEDURES0634709 NM RED CELL MASS MULTI $1,055.00 $1,055.00 06 DIAG IMAGING PROCEDURES0634758 NM RED CELL SURVIVAL $3,455.00 $2,607.00 06 DIAG IMAGING PROCEDURES0634857 NM RENL FNCTN NONIMAG $1,045.00 $1,045.00 06 DIAG IMAGING PROCEDURES0633818 NM RP DACRYOCYSTOGRAM $436.00 06 DIAG IMAGING PROCEDURES0635268 NM SALIVARY ASP $4,539.00 06 DIAG IMAGING PROCEDURES0635250 NM SALIVARY GLND W SER $1,333.00 $1,333.00 06 DIAG IMAGING PROCEDURES0635334 NM SCHILLING W INT FACTR $502.00 06 DIAG IMAGING PROCEDURES0635326 NM SCHILLING WO INT FACTR $891.00 06 DIAG IMAGING PROCEDURES0635409 NM SPLEEN $1,549.00 $1,169.00 06 DIAG IMAGING PROCEDURES0635458 NM TESTICULR IMGNG W FLOW $2,199.00 $2,199.00 06 DIAG IMAGING PROCEDURES0636001 NM THYROID IMAG ONLY $1,756.00 $1,756.00 06 DIAG IMAGING PROCEDURES0635953 NM THYROID IMAG UPT MULTI $1,358.00 $1,358.00 06 DIAG IMAGING PROCEDURES0635979 NM THYROID IMAG UPT SNGL $2,592.00 06 DIAG IMAGING PROCEDURES0636050 NM THYROID IMAG W FLOW $718.00 $677.00 06 DIAG IMAGING PROCEDURES0635839 NM THYROID METS LTD $2,249.00 06 DIAG IMAGING PROCEDURES0636274 NM THYROID METS UPT $741.00 $741.00 06 DIAG IMAGING PROCEDURES0636100 NM THYROID METS WB $3,493.00 $3,493.00 06 DIAG IMAGING PROCEDURES0636159 NM THYROID SUPP STIM $718.00 $542.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0636209 NM THYROID UPTAKE MULTI $980.00 $980.00 06 DIAG IMAGING PROCEDURES0636258 NM THYROID UPTAKE SNGL $776.00 $776.00 06 DIAG IMAGING PROCEDURES0636357 NM TUMOR LOC LTD W RP $1,950.00 $1,950.00 06 DIAG IMAGING PROCEDURES0636407 NM TUMOR LOC MULTI W RP $2,657.00 $2,657.00 06 DIAG IMAGING PROCEDURES0636456 NM TUMOR LOC SPECT W RP $3,811.00 $3,811.00 06 DIAG IMAGING PROCEDURES0636514 NM TUMOR LOC WB SNGL DAY $3,587.00 06 DIAG IMAGING PROCEDURES0636480 NM TUMOR LOC WB SNGL DAY $3,587.00 06 DIAG IMAGING PROCEDURES0635607 NM TX INTRACAVITY $896.00 $896.00 06 DIAG IMAGING PROCEDURES0635656 NM TX RADIOPHARM IV ADM $806.00 $806.00 06 DIAG IMAGING PROCEDURES0635508 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635557 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635904 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635854 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635805 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0634667 NM UREA TEST C14 ACQ $159.00 06 DIAG IMAGING PROCEDURES0634675 NM UREA TEST C14 ANALYSIS $1,358.00 06 DIAG IMAGING PROCEDURES0632802 NM VASCULAR FLOW NCARDIO $1,841.00 $1,841.00 06 DIAG IMAGING PROCEDURES0631119 NM VEN THROMBOSIS ACUTE $1,276.00 06 DIAG IMAGING PROCEDURES0636555 NM VENOGRAM BIL $2,281.00 $1,721.00 06 DIAG IMAGING PROCEDURES0636605 NM VENOGRAM UNI $1,970.00 $1,970.00 06 DIAG IMAGING PROCEDURES0634378 NM VENT/PER REBRTH/WASHOU $3,751.00 06 DIAG IMAGING PROCEDURES0635300 NM VIT B12 COMBINED $985.00 $985.00 06 DIAG IMAGING PROCEDURES0633958 NM VP SHUNT PATENCY $2,587.00 $2,587.00 06 DIAG IMAGING PROCEDURES0634774 NM WB VOL DETERMINATION $1,249.00 06 DIAG IMAGING PROCEDURES0636464 NM WHOLE BODY 2+ DAYS $6,701.00 06 DIAG IMAGING PROCEDURES0633842 NMC INJ ASP SHUNT $253.00 06 DIAG IMAGING PROCEDURES0633834 NMC INJ VP SHUNT $177.00 06 DIAG IMAGING PROCEDURES0633891 NMC INSERT CATH TMP SMPL $288.00 06 DIAG IMAGING PROCEDURES0633909 NMC INTRO CAROTD VERT ART 06 DIAG IMAGING PROCEDURES0633875 NMC NODE IDENTIFICATION $88.00 06 DIAG IMAGING PROCEDURES0667139 PLT AGGREGATION EA AGENT $668.00 06 DIAG IMAGING PROCEDURES0648790 PRQ RF ABLAT TX PUL TUMOR $12,235.00 $9,574.00 06 DIAG IMAGING PROCEDURES0681056 PS BRAIN METBLC EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0681155 PS BRAIN PERF EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0683714 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0682179 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0682161 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0684662 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0684050 PS HEART METBLC EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0684100 PS HEART PERF MULTI $1,150.00 06 DIAG IMAGING PROCEDURES0684159 PS HEART PERF SNGL $1,150.00 06 DIAG IMAGING PROCEDURES0684829 PS LIMITED AREA $1,150.00 06 DIAG IMAGING PROCEDURES0684845 PS SKULL TO MID THIGH $1,150.00 06 DIAG IMAGING PROCEDURES0684860 PS/CT ATT ANAT LOC LTD $1,150.00 06 DIAG IMAGING PROCEDURES0684886 PS/CT SKULL-THGH $1,150.00 06 DIAG IMAGING PROCEDURES0684902 PS/CT WHOLE BODY $1,150.00 06 DIAG IMAGING PROCEDURES0699520 RO APLY INTRACV RAD CMPLX $4,186.00 06 DIAG IMAGING PROCEDURES0699512 RO APLY INTRACV RAD INTRM $3,242.00 06 DIAG IMAGING PROCEDURES0699504 RO APLY INTRACV RAD SMPL $2,760.00 06 DIAG IMAGING PROCEDURES0699462 RO APLY INTRSTL RAD INTRM $898.00 06 DIAG IMAGING PROCEDURES0699454 RO APLY INTRSTL RAD SMPL $463.00 06 DIAG IMAGING PROCEDURES0699165 RO BRACHY DOSE PLAN CMPLX $2,803.00 06 DIAG IMAGING PROCEDURES0699140 RO BRACHY DOSE PLAN INTRM $2,180.00 06 DIAG IMAGING PROCEDURES0699124 RO BRACHY DOSE PLAN SMPL $1,581.00 06 DIAG IMAGING PROCEDURES0699629 RO CONSULT CONT MED PHYSC $908.00 06 DIAG IMAGING PROCEDURES0699801 RO DOSIMETRY SPECIAL $309.00 06 DIAG IMAGING PROCEDURES0698514 RO DSIGN MLC DEV FOR IMRT $800.00 06 DIAG IMAGING PROCEDURES0699926 RO DVCS CONSTRUCT CMPLX 4 $1,513.00 06 DIAG IMAGING PROCEDURES0699918 RO DVCS CONSTRUCT INTRM $340.00 06 DIAG IMAGING PROCEDURES0699900 RO DVCS CONSTRUCT SMPL $827.00 06 DIAG IMAGING PROCEDURES0699421 RO IMRT DLVR EA SESSION $8,570.00 06 DIAG IMAGING PROCEDURES0699405 RO INFUSE RADIOELMNT SOLN $283.00 06 DIAG IMAGING PROCEDURES0699850 RO INTRSTIT RADIAT CMPLX $4,316.00 06 DIAG IMAGING PROCEDURES0699470 RO INTRSTIT RADIAT CMPLX $4,316.00 06 DIAG IMAGING PROCEDURES0699579 RO ISODOSE PLAN CMPLX $1,081.00 06 DIAG IMAGING PROCEDURES0699561 RO ISODOSE PLAN INTRM $716.00 06 DIAG IMAGING PROCEDURES0699553 RO ISODOSE PLAN SMPL $550.00 06 DIAG IMAGING PROCEDURES0699835 RO LOADING RAD SOURCE $605.00 06 DIAG IMAGING PROCEDURES0699645 RO RAD PORT FILM(S) $247.00 06 DIAG IMAGING PROCEDURES0699272 RO RAD TX 2 AREA 11-19MEV $3,063.00 06 DIAG IMAGING PROCEDURES0699256 RO RAD TX 2 AREA 1-5MEV $445.00 06 DIAG IMAGING PROCEDURES0699264 RO RAD TX 2 AREA 6-10MEV $2,766.00 06 DIAG IMAGING PROCEDURES0699280 RO RAD TX 2 AREA GT 19MEV $445.00 06 DIAG IMAGING PROCEDURES0699322 RO RAD TX 3/MORE 11-19MEV $4,038.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0699306 RO RAD TX 3/MORE 1-5MEV $496.00 06 DIAG IMAGING PROCEDURES0699314 RO RAD TX 3/MORE 6-10MEV $3,618.00 06 DIAG IMAGING PROCEDURES0699330 RO RAD TX 3/MORE GT 19MEV $4,057.00 06 DIAG IMAGING PROCEDURES0699223 RO RAD TX SNGL 11-19MEV $2,266.00 06 DIAG IMAGING PROCEDURES0699207 RO RAD TX SNGL 1-5MEV $378.00 06 DIAG IMAGING PROCEDURES0699215 RO RAD TX SNGL 6-10MEV $2,044.00 06 DIAG IMAGING PROCEDURES0699231 RO RAD TX SNGL GT 19MEV $378.00 06 DIAG IMAGING PROCEDURES0699355 RO RAD TX SUPERFICIAL $438.00 06 DIAG IMAGING PROCEDURES0699108 RO RADIAT DOSIMETRY CALC $636.00 06 DIAG IMAGING PROCEDURES0699603 RO RADIATION PHYSICS CNSL $1,889.00 06 DIAG IMAGING PROCEDURES0699660 RO SIMULATION 3D $10,881.00 06 DIAG IMAGING PROCEDURES0699702 RO SIMULATION SMPL $2,457.00 06 DIAG IMAGING PROCEDURES0699819 RO SPECIAL PORT PLAN BODY $1,062.00 06 DIAG IMAGING PROCEDURES0699827 RO SPECIAL TX PROCEDURE $1,920.00 06 DIAG IMAGING PROCEDURES0624452 S STRL RF TALON PROBE $2,295.00 06 DIAG IMAGING PROCEDURES0667287 SREP S/N/A/G/TR/E 2.5CM/< $345.00 06 DIAG IMAGING PROCEDURES0672253 US ABD CMPL $1,286.00 $911.00 06 DIAG IMAGING PROCEDURES0673004 US AMNIOCENTESIS $283.00 $201.00 06 DIAG IMAGING PROCEDURES0674713 US AMNIOCENTESIS $283.00 $201.00 06 DIAG IMAGING PROCEDURES0673152 US ASP OVA $492.00 $492.00 06 DIAG IMAGING PROCEDURES0674606 US BIO PROFILE W NONSTRES $911.00 $646.00 06 DIAG IMAGING PROCEDURES0674150 US BIO PROFILE WO NOSTRES $709.00 06 DIAG IMAGING PROCEDURES0673558 US BREAST UNI OR BIL $871.00 $617.00 06 DIAG IMAGING PROCEDURES0672766 US BX ENDOMYOCARDIAL $1,399.00 $1,320.00 06 DIAG IMAGING PROCEDURES0673608 US CHEST $779.00 $552.00 06 DIAG IMAGING PROCEDURES0673707 US CRYOSURGERY $3,902.00 $2,766.00 06 DIAG IMAGING PROCEDURES0671339 US CS DIFF MD ADD 15M $186.00 06 DIAG IMAGING PROCEDURES0671305 US CS DIFF MD ADD 15M $186.00 06 DIAG IMAGING PROCEDURES0671313 US CS DIFF MD LT5YR 0-30M $506.00 06 DIAG IMAGING PROCEDURES0671321 US CS SAME MD ADD 15M $186.00 06 DIAG IMAGING PROCEDURES0671297 US CS SAME MD GT5YR 0-30M $466.00 06 DIAG IMAGING PROCEDURES0671347 US CS SAME MD LT5YR 0-30M $553.00 06 DIAG IMAGING PROCEDURES0673756 US DPPLER ECHO FETAL $521.00 $370.00 06 DIAG IMAGING PROCEDURES0673806 US DPPLER ECHO FETAL FU $425.00 $401.00 06 DIAG IMAGING PROCEDURES0672303 US ECHO ABD LTD $992.00 $703.00 06 DIAG IMAGING PROCEDURES0674127 US ECHO FETAL $1,721.00 $1,220.00 06 DIAG IMAGING PROCEDURES0674184 US ECHO FETAL FU REPEAT $730.00 $689.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0674044 US ECHO INF HIPS $1,351.00 06 DIAG IMAGING PROCEDURES0674069 US ECHO INF HIPS LTD $187.00 06 DIAG IMAGING PROCEDURES0672154 US ECHO RETROPE LTD $1,078.00 $764.00 06 DIAG IMAGING PROCEDURES0674143 US ENCEPHALOGRAM $1,144.00 $811.00 06 DIAG IMAGING PROCEDURES0674200 US FETAL TRANSFUSION IUT $201.00 06 DIAG IMAGING PROCEDURES0674259 US FU STDY $921.00 $653.00 06 DIAG IMAGING PROCEDURES0670851 US GDE PRNCHYML TISS ABLN $850.00 06 DIAG IMAGING PROCEDURES0667857 US GDE PRNCHYML TISS ABLN $850.00 06 DIAG IMAGING PROCEDURES0674309 US GUIDANCE INTRAOP $202.00 $144.00 06 DIAG IMAGING PROCEDURES0674192 US GUIDE ART PSEUDOANEUR $2,743.00 06 DIAG IMAGING PROCEDURES0674903 US HEAD & NEC SFT TISSUE $1,134.00 $804.00 06 DIAG IMAGING PROCEDURES0674937 US INTRO INTERSTITIAL TX $810.00 06 DIAG IMAGING PROCEDURES0672733 US NDL PLACE $2,070.00 $1,467.00 06 DIAG IMAGING PROCEDURES0673103 US NDL PLACE $1,470.00 06 DIAG IMAGING PROCEDURES0674564 US OB 1ST TRI 1 GEST $1,058.00 06 DIAG IMAGING PROCEDURES0674572 US OB 1ST TRI EA GEST $385.00 06 DIAG IMAGING PROCEDURES0674630 US OB AFTR 1ST TRI 1 GEST $1,286.00 $911.00 06 DIAG IMAGING PROCEDURES0674721 US OB AFTR 1ST TRI EA GES $633.00 $448.00 06 DIAG IMAGING PROCEDURES0674580 US OB DTLD FTL EXAM 1 GES $1,331.00 06 DIAG IMAGING PROCEDURES0674598 US OB DTLD FTL EXM EA GES $1,463.00 06 DIAG IMAGING PROCEDURES0674663 US OB FU/REEVAL EA FETUS $946.00 $671.00 06 DIAG IMAGING PROCEDURES0674697 US OB LTD 1/MORE FETUSES $769.00 $545.00 06 DIAG IMAGING PROCEDURES0674747 US OB TRANSVAGINAL $250.00 06 DIAG IMAGING PROCEDURES0674507 US PELV CMPL NONOB $1,154.00 $818.00 06 DIAG IMAGING PROCEDURES0674523 US PELV LTD FU NONOB $1,073.00 $761.00 06 DIAG IMAGING PROCEDURES0674556 US PERICARDIOCENT $774.00 $549.00 06 DIAG IMAGING PROCEDURES0674754 US RADIATION FIELD PLACE $338.00 $319.00 06 DIAG IMAGING PROCEDURES0672808 US RETROPE CMPL $1,245.00 $883.00 06 DIAG IMAGING PROCEDURES0674275 US SAL INFN SONOHYSTERGHY $1,144.00 06 DIAG IMAGING PROCEDURES0674820 US SPINAL CANAL $952.00 $674.00 06 DIAG IMAGING PROCEDURES0674846 US TESTICULAR SCROTUM $1,169.00 $829.00 06 DIAG IMAGING PROCEDURES0672881 US TRANSPLNT KDNY W/DPPLR $1,448.00 06 DIAG IMAGING PROCEDURES0673855 US TRANSRECTAL $1,397.00 $990.00 06 DIAG IMAGING PROCEDURES0673905 US TRANSVAGINAL $250.00 $250.00 06 DIAG IMAGING PROCEDURES0675017 US US MOBILE 06 DIAG IMAGING PROCEDURES0674218 US VILLUS SAMPLING $795.00 06 DIAG IMAGING PROCEDURES0673962 US XTR NON-VASC COMPLETE $892.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0673970 US XTR NON-VASC LMTD $682.00 06 DIAG IMAGING PROCEDURES0670836 USC ABLTN CRYO OPN LIVER $4,297.00 06 DIAG IMAGING PROCEDURES0670844 USC ABLTN PROSTATE CRYO $3,752.00 06 DIAG IMAGING PROCEDURES0670828 USC ABLTN RENAL RF PRC $4,475.00 06 DIAG IMAGING PROCEDURES0673376 USC ABSCSS DRN PELV PRC $3,434.00 06 DIAG IMAGING PROCEDURES0673335 USC ABSCSS DRN PERITNL $5,953.00 06 DIAG IMAGING PROCEDURES0672949 USC ABSCSS DRN RENL $588.00 06 DIAG IMAGING PROCEDURES0673384 USC ABSCSS DRN RETROPE $3,067.00 06 DIAG IMAGING PROCEDURES0673350 USC ABSCSS DRN SUBDIAP $3,334.00 06 DIAG IMAGING PROCEDURES0672956 USC AMNIOCENTESIS DX $329.00 $258.00 06 DIAG IMAGING PROCEDURES0672063 USC ASP BREAST ADD $47.00 06 DIAG IMAGING PROCEDURES0672055 USC ASP BREAST CYST $347.00 06 DIAG IMAGING PROCEDURES0673228 USC ASP RENL CYST $130.00 06 DIAG IMAGING PROCEDURES0672493 USC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0673251 USC ASP THYROID CYST $329.00 06 DIAG IMAGING PROCEDURES0677666 USC BREAST NDL WIRE $628.00 06 DIAG IMAGING PROCEDURES0672758 USC BX ABD RETROPE $468.00 $366.00 06 DIAG IMAGING PROCEDURES0672592 USC BX BM NDL/TROCAR $660.00 06 DIAG IMAGING PROCEDURES0672600 USC BX BONE SUPER $549.00 06 DIAG IMAGING PROCEDURES0671909 USC BX BREAST VAC ASSIST $2,770.00 06 DIAG IMAGING PROCEDURES0679800 USC BX BREAST W IMAG $392.00 $308.00 06 DIAG IMAGING PROCEDURES0672584 USC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0647750 USC BX LYMPH NODE OPEN $3,072.00 $2,178.00 06 DIAG IMAGING PROCEDURES0672634 USC BX OF OVARY(S) $713.00 06 DIAG IMAGING PROCEDURES0672675 USC BX RENL $2,180.00 $1,706.00 06 DIAG IMAGING PROCEDURES0672576 USC BX SOFT TISS NEC THOR $756.00 06 DIAG IMAGING PROCEDURES0672790 USC BX THYROID $245.00 $192.00 06 DIAG IMAGING PROCEDURES0672972 USC CORDOCENTESIS IUT $709.00 06 DIAG IMAGING PROCEDURES0673368 USC DRN ABD ABSCSS OPN $2,011.00 06 DIAG IMAGING PROCEDURES0673301 USC DRN ABSCESS COMP/MULT $256.00 06 DIAG IMAGING PROCEDURES0673343 USC DRN PANC PSEUDOCYST $3,334.00 06 DIAG IMAGING PROCEDURES0673921 USC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0674036 USC EXCHANGE DRN CATH $280.00 06 DIAG IMAGING PROCEDURES0672485 USC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0679001 USC INJ CON ABSCSS $157.00 06 DIAG IMAGING PROCEDURES0671032 USC INJ INTRA-ARTERIAL $150.00 $106.00 06 DIAG IMAGING PROCEDURES0676007 USC INJ PENILE CAVERNOUS $328.00 $247.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0671107 USC INJ SINOGRAM $494.00 06 DIAG IMAGING PROCEDURES0674325 USC INS PICC W/O PORT 5+ $1,207.00 06 DIAG IMAGING PROCEDURES0674317 USC INS PICC W/O PORT LT5 $1,329.00 06 DIAG IMAGING PROCEDURES0674788 USC LAP ABLATION RF LIVER $3,652.00 06 DIAG IMAGING PROCEDURES0674796 USC LAP ABLTN CRYO LIVER $3,653.00 06 DIAG IMAGING PROCEDURES0674408 USC NEPHROSTOMY TUBE CHNG $3,854.00 $2,864.00 06 DIAG IMAGING PROCEDURES0671628 USC PARACENT ABD INI $2,413.00 06 DIAG IMAGING PROCEDURES0671644 USC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0676056 USC PENILE PLETHYSMOGRAM $1,787.00 $1,348.00 06 DIAG IMAGING PROCEDURES0674945 USC PLC NDL PROSTATE INST $2,436.00 06 DIAG IMAGING PROCEDURES0676585 USC PSEUDOANEURYSM INJ $428.00 $335.00 06 DIAG IMAGING PROCEDURES0674283 USC SAL INFN SONOHYSTER $419.00 06 DIAG IMAGING PROCEDURES0674879 USC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0674960 USC URINE CAPACITY MEASUR $101.00 06 DIAG IMAGING PROCEDURES0676353 USC VASOTOMY FOR VASOGRAM 06 DIAG IMAGING PROCEDURES0672980 USC VILLUS SAMPLING $528.00 06 DIAG IMAGING PROCEDURES0669242 VENIPUNCTURE $62.00 06 DIAG IMAGING PROCEDURES0677641 VESSEL MAP HEMO ACCESS $2,640.00 06 DIAG IMAGING PROCEDURES0621698 XR ABD 1V AP $286.00 $177.00 06 DIAG IMAGING PROCEDURES0621706 XR ABD 1V AP $286.00 $177.00 06 DIAG IMAGING PROCEDURES0621763 XR ABD CMPL DECUB ERECT $464.00 $287.00 06 DIAG IMAGING PROCEDURES0621789 XR ABD CMPL W 1V CHEST $566.00 $351.00 06 DIAG IMAGING PROCEDURES0621797 XR ABD W OBLIQUES CONE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0625103 XR ABSCSS FIST SIN TRACT $621.00 06 DIAG IMAGING PROCEDURES0621862 XR AC JNT $457.00 $283.00 06 DIAG IMAGING PROCEDURES0621912 XR ANKLE 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0621920 XR ANKLE 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0621904 XR ANKLE 3V OR MORE $402.00 $249.00 06 DIAG IMAGING PROCEDURES0622167 XR ARTHRO KNEE $1,698.00 $1,052.00 06 DIAG IMAGING PROCEDURES0622209 XR ARTHRO TMJ $956.00 $902.00 06 DIAG IMAGING PROCEDURES0622308 XR BE THRP $1,841.00 $1,140.00 06 DIAG IMAGING PROCEDURES0622340 XR BE W AIR CON $2,762.00 $1,710.00 06 DIAG IMAGING PROCEDURES0625582 XR BILE STONE EXTRACTION $241.00 06 DIAG IMAGING PROCEDURES0622803 XR BONE AGE STDY $239.00 $148.00 06 DIAG IMAGING PROCEDURES0622845 XR BONE LENGTH STDY $416.00 $258.00 06 DIAG IMAGING PROCEDURES0622886 XR BONE SURVEY CMPL $1,309.00 $811.00 06 DIAG IMAGING PROCEDURES0622860 XR BONE SURVEY INF $1,098.00 $680.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0622902 XR BONE SURVEY LTD $818.00 $507.00 06 DIAG IMAGING PROCEDURES0627604 XR CALCANEOUS 2V OR MORE $334.00 $207.00 06 DIAG IMAGING PROCEDURES0623165 XR CEPHALOGRAM ORDO $98.00 $92.00 06 DIAG IMAGING PROCEDURES0623207 XR CHEMO CNS W/SPINL PUNC $2,727.00 06 DIAG IMAGING PROCEDURES0623223 XR CHEST 1V $259.00 $160.00 06 DIAG IMAGING PROCEDURES0623264 XR CHEST 1V $259.00 $160.00 06 DIAG IMAGING PROCEDURES0623355 XR CHEST 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0623280 XR CHEST 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0623389 XR CHEST 2V W AP LORDOTIC $430.00 $266.00 06 DIAG IMAGING PROCEDURES0623322 XR CHEST 2V W FLUORO $859.00 $532.00 06 DIAG IMAGING PROCEDURES0623405 XR CHEST 2V W OBLIQUES $539.00 $334.00 06 DIAG IMAGING PROCEDURES0623413 XR CHEST 4V CMPL $539.00 06 DIAG IMAGING PROCEDURES0623421 XR CHEST 4V MORE W FLUORO $1,166.00 $722.00 06 DIAG IMAGING PROCEDURES0623058 XR CHEST SPECIAL V EA $402.00 06 DIAG IMAGING PROCEDURES0623561 XR CHOL EXISTING CATH $716.00 $443.00 06 DIAG IMAGING PROCEDURES0623520 XR CHOL IN OR $627.00 $389.00 06 DIAG IMAGING PROCEDURES0623546 XR CHOL IN OR ADD SET $375.00 $232.00 06 DIAG IMAGING PROCEDURES0623587 XR CHOL TRANSHEPAT PRC $1,459.00 $904.00 06 DIAG IMAGING PROCEDURES0623603 XR CHOLECYSTOGRAM ORAL $887.00 $549.00 06 DIAG IMAGING PROCEDURES0623629 XR CHOLECYSTOGRAM ORAL FU $1,266.00 $1,195.00 06 DIAG IMAGING PROCEDURES0610568 XR CINE/VIDEO $1,009.00 06 DIAG IMAGING PROCEDURES0623686 XR CINE/VIDEO COMPLEMENT $522.00 $493.00 06 DIAG IMAGING PROCEDURES0623710 XR CISTERNOGRAM $1,493.00 06 DIAG IMAGING PROCEDURES0623702 XR CISTERNOGRAM $1,493.00 $925.00 06 DIAG IMAGING PROCEDURES0623769 XR CLAVICLE CMPL $348.00 $215.00 06 DIAG IMAGING PROCEDURES0622324 XR CONTRAST ENEMA $2,012.00 $1,246.00 06 DIAG IMAGING PROCEDURES0629899 XR CORPORA CAVERNOSOGRAM $153.00 06 DIAG IMAGING PROCEDURES0624767 XR CS DIFF MD ADD 15M $251.00 06 DIAG IMAGING PROCEDURES0624742 XR CS DIFF MD GT5YR 0-30M $565.00 06 DIAG IMAGING PROCEDURES0624734 XR CS DIFF MD LT5YR 0-30M $682.00 06 DIAG IMAGING PROCEDURES0624726 XR CS SAME MD ADD 15M $251.00 06 DIAG IMAGING PROCEDURES0624718 XR CS SAME MD GT5YR 0-30M $627.00 06 DIAG IMAGING PROCEDURES0624700 XR CS SAME MD LT5YR 0-30M $745.00 06 DIAG IMAGING PROCEDURES0623868 XR CYSTOGRAM 3V OR MORE $1,118.00 $693.00 06 DIAG IMAGING PROCEDURES0627430 XR DACRYOCYSTOGRAPHY $129.00 06 DIAG IMAGING PROCEDURES0623926 XR DENTAL FULL EXAM $1,000.00 $1,000.00 06 DIAG IMAGING PROCEDURES0623942 XR DENTAL PARTIAL EXAM $477.00 $296.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0623967 XR DENTAL SNGL FILM $340.00 $257.00 06 DIAG IMAGING PROCEDURES0622951 XR DEXA APPEN $321.00 06 DIAG IMAGING PROCEDURES0636977 XR DEXA AXIAL SKELETON $968.00 $600.00 06 DIAG IMAGING PROCEDURES0621466 XR DEXA AXIAL SKELETON $968.00 06 DIAG IMAGING PROCEDURES0627075 XR DISKOGRAM CERV THOR $2,000.00 06 DIAG IMAGING PROCEDURES0627083 XR DISKOGRAM LUMB $1,739.00 06 DIAG IMAGING PROCEDURES0623983 XR DUODENOGRAM HYPOTONIC $743.00 $701.00 06 DIAG IMAGING PROCEDURES0622969 XR DXA BONE DENS VRT FRAC $355.00 06 DIAG IMAGING PROCEDURES0624049 XR ELBOW 2V $348.00 $215.00 06 DIAG IMAGING PROCEDURES0624007 XR ELBOW 3V OR MORE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0624221 XR ENTEROCLYSIS TUBE PRC $1,909.00 $1,182.00 06 DIAG IMAGING PROCEDURES0626135 XR EPIDUROGRAM $1,200.00 06 DIAG IMAGING PROCEDURES0624320 XR ERCP BILI PANC DUCT 06 DIAG IMAGING PROCEDURES0624304 XR ERCP PANC DUCT $1,207.00 $748.00 06 DIAG IMAGING PROCEDURES0624429 XR ESOPH $1,153.00 $557.00 06 DIAG IMAGING PROCEDURES0624106 XR EXAM OF MIDDLE EAR $365.00 06 DIAG IMAGING PROCEDURES0626747 XR EXT INF LOW LES 1YR $368.00 06 DIAG IMAGING PROCEDURES0624825 XR FACIAL BONE 3V OR MORE $518.00 $321.00 06 DIAG IMAGING PROCEDURES0624841 XR FACIAL BONE LES 3V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0625137 XR FALLOPN TUBE TRANSCERV $428.00 06 DIAG IMAGING PROCEDURES0624809 XR FB IN EYE $348.00 $215.00 06 DIAG IMAGING PROCEDURES0625467 XR FB LOC CHLD $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625483 XR FB RMVL ESOPH $1,309.00 $1,235.00 06 DIAG IMAGING PROCEDURES0624908 XR FEMUR 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0625004 XR FINGER(S) 2V OR MOR BI $260.00 $175.00 06 DIAG IMAGING PROCEDURES0625186 XR FLUOR CVAD PLC/RMV/RPR $1,596.00 06 DIAG IMAGING PROCEDURES0625053 XR FLUORO 1-2 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625251 XR FLUORO 1HR OR LES $1,664.00 $1,030.00 06 DIAG IMAGING PROCEDURES0625228 XR FLUORO 1HR OR LES $1,664.00 $1,030.00 06 DIAG IMAGING PROCEDURES0662668 XR FLUORO 1HR OR LES $1,664.00 06 DIAG IMAGING PROCEDURES0625061 XR FLUORO 2-3 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625079 XR FLUORO 3-4 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625087 XR FLUORO 4-5 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625095 XR FLUORO 5-6 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625194 XR FLUORO GUIDE SPINE INJ $518.00 06 DIAG IMAGING PROCEDURES0620153 XR FLUORO NDL PLACE $732.00 06 DIAG IMAGING PROCEDURES0622746 XR FLUORO NDL PLACE $798.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0625335 XR FOOT 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625327 XR FOOT 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625301 XR FOOT 3V OR MORE $396.00 $245.00 06 DIAG IMAGING PROCEDURES0625400 XR FOREARM 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0625517 XR GALACTOGRAM 1 DUCT $934.00 $579.00 06 DIAG IMAGING PROCEDURES0625509 XR GALACTOGRAM MULTI $1,289.00 $798.00 06 DIAG IMAGING PROCEDURES0623827 XR GI TUBE INSERT LONG $1,514.00 $938.00 06 DIAG IMAGING PROCEDURES0625616 XR HAND 2V $334.00 $207.00 06 DIAG IMAGING PROCEDURES0625608 XR HAND 3V OR MORE $402.00 $249.00 06 DIAG IMAGING PROCEDURES0625699 XR HIP OR $361.00 $224.00 06 DIAG IMAGING PROCEDURES0605709 XR HIP UNI 1V $293.00 $182.00 06 DIAG IMAGING PROCEDURES0625673 XR HIP UNI 2V OR MORE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0625707 XR HIP UNI 2V OR MORE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0625665 XR HIPS BIL 2V W PELV $464.00 $287.00 06 DIAG IMAGING PROCEDURES0625814 XR HUMERUS 2V OR MORE $355.00 $220.00 06 DIAG IMAGING PROCEDURES0623181 XR HYSTEROSALPINGOGRAM $1,043.00 $646.00 06 DIAG IMAGING PROCEDURES0624403 XR INTRALUMINAL DILATE $1,664.00 $1,030.00 06 DIAG IMAGING PROCEDURES0626846 XR IVP W DRIP + OR BOLUS $1,589.00 $984.00 06 DIAG IMAGING PROCEDURES0626861 XR IVP W-W/O TOMOGRAM $1,507.00 $933.00 06 DIAG IMAGING PROCEDURES0626820 XR IVP W-W/O TOMOGRAM $1,507.00 $933.00 06 DIAG IMAGING PROCEDURES0622829 XR JNT SURVEY 1V $450.00 $279.00 06 DIAG IMAGING PROCEDURES0626937 XR KNEE 1 OR 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0626911 XR KNEE 1 OR 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0626903 XR KNEE 4V OR MORE $511.00 $317.00 06 DIAG IMAGING PROCEDURES0626960 XR KNEES STANDING AP $396.00 $245.00 06 DIAG IMAGING PROCEDURES0627000 XR LARYNGOGRAM W CON $1,730.00 $1,306.00 06 DIAG IMAGING PROCEDURES0627109 XR MAMMO DX BIL $1,101.00 $680.00 06 DIAG IMAGING PROCEDURES0627174 XR MAMMO DX CAD ADD-ON $143.00 06 DIAG IMAGING PROCEDURES0627166 XR MAMMO DX DIG BILAT $1,790.00 06 DIAG IMAGING PROCEDURES0627190 XR MAMMO DX DIG UNILAT $1,415.00 06 DIAG IMAGING PROCEDURES0627141 XR MAMMO DX UNI $859.00 $530.00 06 DIAG IMAGING PROCEDURES0623009 XR MAMMO GDE NDL EA LES $511.00 $317.00 06 DIAG IMAGING PROCEDURES0627125 XR MAMMO SCRN $804.00 $496.00 06 DIAG IMAGING PROCEDURES0627182 XR MAMMO SCRN CAD ADD-ON $143.00 06 DIAG IMAGING PROCEDURES0627133 XR MAMMO SCRN DIG BILAT $1,542.00 06 DIAG IMAGING PROCEDURES0626879 XR MAN APP STRS ANY JNT $81.00 06 DIAG IMAGING PROCEDURES0627208 XR MANDIBLE 4V OR MORE $471.00 $291.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0627224 XR MANDIBLE LES 4V $389.00 $241.00 06 DIAG IMAGING PROCEDURES0627240 XR MASTOIDS 3V OR MORE $540.00 $540.00 06 DIAG IMAGING PROCEDURES0627265 XR MASTOIDS LES 3V $340.00 $340.00 06 DIAG IMAGING PROCEDURES0627307 XR MYELOGRAM CERV $3,143.00 $1,136.00 06 DIAG IMAGING PROCEDURES0627349 XR MYELOGRAM LUMB $1,753.00 $1,800.00 06 DIAG IMAGING PROCEDURES0627380 XR MYELOGRAM POST FOSSA $1,934.00 $1,824.00 06 DIAG IMAGING PROCEDURES0627364 XR MYELOGRAM THOR $1,657.00 $1,026.00 06 DIAG IMAGING PROCEDURES0627323 XR MYELOGRM 1 OR MORE REG $2,701.00 $1,672.00 06 DIAG IMAGING PROCEDURES0627406 XR NASAL BONES 3V OR MORE $416.00 $258.00 06 DIAG IMAGING PROCEDURES0627448 XR NEC SOFT TISSUE $327.00 $203.00 06 DIAG IMAGING PROCEDURES0627547 XR OPTIC FORAMINA $436.00 $270.00 06 DIAG IMAGING PROCEDURES0627562 XR ORBITS 4V OR MORE $525.00 $325.00 06 DIAG IMAGING PROCEDURES0627588 XR ORTHOPANTOGRAM $198.00 $122.00 06 DIAG IMAGING PROCEDURES0627620 XR PACEMAKER INSERT $1,228.00 $760.00 06 DIAG IMAGING PROCEDURES0627752 XR PELV 1 OR 2V $307.00 $190.00 06 DIAG IMAGING PROCEDURES0627786 XR PELV 1 OR 2V $307.00 $190.00 06 DIAG IMAGING PROCEDURES0627745 XR PELV 1 OR 2V $307.00 $190.00 06 DIAG IMAGING PROCEDURES0627703 XR PELV 3V OR MORE $511.00 $317.00 06 DIAG IMAGING PROCEDURES0625749 XR PELV HIP 2V INF CHLD $491.00 06 DIAG IMAGING PROCEDURES0627794 XR PELVIMETRY $423.00 06 DIAG IMAGING PROCEDURES0627687 XR PERINEOGRAM $197.00 06 DIAG IMAGING PROCEDURES0627695 XR PERITONEOGRAM $177.00 06 DIAG IMAGING PROCEDURES0627844 XR PHARYNGEAL SPEECH EVAL $948.00 $587.00 06 DIAG IMAGING PROCEDURES0622365 XR PHARYNX OR ESOPH CERV $1,037.00 $642.00 06 DIAG IMAGING PROCEDURES0627869 XR PHARYNXLARYNX W FLUORO $1,077.00 $667.00 06 DIAG IMAGING PROCEDURES0621821 XR RADIO ABSORPTIOMETRY $104.00 06 DIAG IMAGING PROCEDURES0627901 XR RIBS BIL 3V $477.00 $296.00 06 DIAG IMAGING PROCEDURES0627984 XR RIBS BIL W PA CXR $634.00 06 DIAG IMAGING PROCEDURES0627943 XR RIBS UNI 2V $375.00 $232.00 06 DIAG IMAGING PROCEDURES0628123 XR SACRUM COCCYX 2 V MORE $361.00 $224.00 06 DIAG IMAGING PROCEDURES0628180 XR SALIVARY GLAND CALC $505.00 $313.00 06 DIAG IMAGING PROCEDURES0628206 XR SCAPULA CMPL $355.00 $220.00 06 DIAG IMAGING PROCEDURES0628164 XR SELLA TURCICA $348.00 06 DIAG IMAGING PROCEDURES0628958 XR SHOULDER 1V $280.00 $173.00 06 DIAG IMAGING PROCEDURES0628289 XR SHOULDER 1V $280.00 $173.00 06 DIAG IMAGING PROCEDURES0628263 XR SHOULDER 2V OR MORE $355.00 $220.00 06 DIAG IMAGING PROCEDURES0629915 XR SHUNTOGRAM NONVASC $1,200.00 $743.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0628107 XR SI JNT 1 OR 2V $361.00 $224.00 06 DIAG IMAGING PROCEDURES0628008 XR SI JNT 3V OR MORE $436.00 $270.00 06 DIAG IMAGING PROCEDURES0628198 XR SIALOGRAM $1,418.00 06 DIAG IMAGING PROCEDURES0627646 XR SIN PARA 3V OR MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0627661 XR SIN PARA LES 3V $375.00 $232.00 06 DIAG IMAGING PROCEDURES0628909 XR SKULL 4V OR MORE $532.00 $329.00 06 DIAG IMAGING PROCEDURES0628941 XR SKULL LES 4V $423.00 $262.00 06 DIAG IMAGING PROCEDURES0624205 XR SM BOWEL ENTEROCLYSIS $5,428.00 $3,362.00 06 DIAG IMAGING PROCEDURES0628982 XR SM BOWEL SERIES $1,412.00 $874.00 06 DIAG IMAGING PROCEDURES0627257 XR SPECIMEN SURGICAL $192.00 06 DIAG IMAGING PROCEDURES0629501 XR SPECIMEN SURGICAL $198.00 $122.00 06 DIAG IMAGING PROCEDURES0629063 XR SPINE C 4V & FLEX/EXT $839.00 $519.00 06 DIAG IMAGING PROCEDURES0629097 XR SPINE CERV 2-3V $457.00 $283.00 06 DIAG IMAGING PROCEDURES0629089 XR SPINE CERV 2-3V $457.00 $283.00 06 DIAG IMAGING PROCEDURES0629048 XR SPINE CERV 4V OR MORE $641.00 $397.00 06 DIAG IMAGING PROCEDURES0629253 XR SPINE LUMB 2-3V $491.00 $304.00 06 DIAG IMAGING PROCEDURES0629220 XR SPINE LUMB 2-3V $491.00 $304.00 06 DIAG IMAGING PROCEDURES0629162 XR SPINE LUMB 4V OR MORE $682.00 $422.00 06 DIAG IMAGING PROCEDURES0629188 XR SPINE LUMB 4V W BEND $948.00 $587.00 06 DIAG IMAGING PROCEDURES0629147 XR SPINE LUMB BEND ONLY $668.00 $414.00 06 DIAG IMAGING PROCEDURES0629261 XR SPINE SCOLIOSIS STNDNG $430.00 $266.00 06 DIAG IMAGING PROCEDURES0629287 XR SPINE SCOLIOSIS SUP ER $580.00 $359.00 06 DIAG IMAGING PROCEDURES0629022 XR SPINE SNGL V CERV $280.00 $173.00 06 DIAG IMAGING PROCEDURES0629139 XR SPINE SNGL V LUMB $280.00 06 DIAG IMAGING PROCEDURES0629030 XR SPINE SNGL V LUMB $280.00 06 DIAG IMAGING PROCEDURES0629311 XR SPINE SNGL V THOR $280.00 06 DIAG IMAGING PROCEDURES0629303 XR SPINE SURVEY ENTIRE $859.00 $532.00 06 DIAG IMAGING PROCEDURES0629329 XR SPINE THOR 2V $396.00 $245.00 06 DIAG IMAGING PROCEDURES0629352 XR SPINE THOR 2V $396.00 06 DIAG IMAGING PROCEDURES0629345 XR SPINE THOR 3V $471.00 $291.00 06 DIAG IMAGING PROCEDURES0629360 XR SPINE THOR 4V OR MORE $586.00 $407.00 06 DIAG IMAGING PROCEDURES0629402 XR SPINE THOR LUMB 2V $423.00 $262.00 06 DIAG IMAGING PROCEDURES0623025 XR STEREO LOC EA LESION $1,650.00 $1,022.00 06 DIAG IMAGING PROCEDURES0629428 XR STERNOCLAVIC 3V MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0629444 XR STERNUM 2V OR MORE $389.00 $241.00 06 DIAG IMAGING PROCEDURES0624460 XR SWALLOWING FNCTN $1,118.00 $693.00 06 DIAG IMAGING PROCEDURES0629600 XR TIBIA FIBULA 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0629527 XR TMJ BIL $614.00 $380.00 06 DIAG IMAGING PROCEDURES0629543 XR TMJ UNI $375.00 $232.00 06 DIAG IMAGING PROCEDURES0629667 XR TOE(S) 2V OR MORE BIL $260.00 $175.00 06 DIAG IMAGING PROCEDURES0629741 XR TOMOGRAM $1,759.00 $1,090.00 06 DIAG IMAGING PROCEDURES0629725 XR TOMOGRAM CMPLX UNI $2,666.00 $1,651.00 06 DIAG IMAGING PROCEDURES0629790 XR UGI W AIR CON $1,582.00 06 DIAG IMAGING PROCEDURES0629816 XR UGI W AIR CON KUB $1,814.00 $1,123.00 06 DIAG IMAGING PROCEDURES0629824 XR UGI W AIR CON SM BOWEL $2,496.00 $1,546.00 06 DIAG IMAGING PROCEDURES0629832 XR UGI W KUB $1,446.00 $895.00 06 DIAG IMAGING PROCEDURES0629840 XR UGI W SM BOWEL $2,264.00 $1,402.00 06 DIAG IMAGING PROCEDURES0629808 XR UGI W/O KUB $1,303.00 $807.00 06 DIAG IMAGING PROCEDURES0629865 XR URETHROCYSTOGRAM $1,043.00 $646.00 06 DIAG IMAGING PROCEDURES0629873 XR URETHROCYSTOGRAM VOID $1,289.00 $798.00 06 DIAG IMAGING PROCEDURES0627505 XR UROGRAM ANTEGRADE $893.00 $553.00 06 DIAG IMAGING PROCEDURES0629881 XR UROGRAM RETRO $1,909.00 $1,182.00 06 DIAG IMAGING PROCEDURES0629907 XR VASOGRAM VESICULOGRAM $1,166.00 $722.00 06 DIAG IMAGING PROCEDURES0629980 XR WRIST 2V $368.00 $228.00 06 DIAG IMAGING PROCEDURES0629956 XR WRIST 2V $368.00 $228.00 06 DIAG IMAGING PROCEDURES0629949 XR WRIST 3V OR MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0622043 XRC ASP BREAST ADD $47.00 $37.00 06 DIAG IMAGING PROCEDURES0622001 XRC ASP BREAST CYST $347.00 $272.00 06 DIAG IMAGING PROCEDURES0622068 XRC ASP RENL CYST $130.00 06 DIAG IMAGING PROCEDURES0622076 XRC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0622373 XRC ASPIRATON BONE MARROW $660.00 06 DIAG IMAGING PROCEDURES0626028 XRC BREAST NDL WIRE $515.00 $403.00 06 DIAG IMAGING PROCEDURES0623082 XRC BREAST NDL WIRE ADD $205.00 $161.00 06 DIAG IMAGING PROCEDURES0626408 XRC BRNCH W CON SEG BRNCH $1,064.00 $832.00 06 DIAG IMAGING PROCEDURES0622555 XRC BX ABD RETROPE $468.00 06 DIAG IMAGING PROCEDURES0622514 XRC BX BM NDL/TROCAR $660.00 06 DIAG IMAGING PROCEDURES0622720 XRC BX BONE DEEP $2,587.00 $2,024.00 06 DIAG IMAGING PROCEDURES0622522 XRC BX BONE SUPER $549.00 $430.00 06 DIAG IMAGING PROCEDURES0622548 XRC BX BREAST PRC W/O $867.00 $867.00 06 DIAG IMAGING PROCEDURES0622480 XRC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0622589 XRC BX LUNG MEDIASTNM $2,061.00 $1,944.00 06 DIAG IMAGING PROCEDURES0622449 XRC BX LYMPH NODE OPEN $4,140.00 $2,564.00 06 DIAG IMAGING PROCEDURES0622621 XRC BX MUSCLE $977.00 $765.00 06 DIAG IMAGING PROCEDURES0622670 XRC BX RENL $2,180.00 06 DIAG IMAGING PROCEDURES

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SEQ 200 AMOUNT

DEPARTMENT CODE

0622795 XRC BX SKIN LESION EA ADD $98.00 06 DIAG IMAGING PROCEDURES0622787 XRC BX SKIN LESION SNGL $259.00 06 DIAG IMAGING PROCEDURES0622779 XRC BX SOFT TISS NEC THOR $756.00 06 DIAG IMAGING PROCEDURES0622696 XRC BX THYROID $245.00 06 DIAG IMAGING PROCEDURES0621326 XRC CHNG G TUBE WO IMG/GD $362.00 06 DIAG IMAGING PROCEDURES0629857 XRC CYSTOMETROGRAM CMPLX $1,237.00 06 DIAG IMAGING PROCEDURES0625558 XRC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0626150 XRC ERCP BLN DILATION $1,338.00 06 DIAG IMAGING PROCEDURES0624312 XRC ERCP DX W/WO SPEC $1,085.00 06 DIAG IMAGING PROCEDURES0624163 XRC ERCP INS BIL/PAN TUBE $679.00 06 DIAG IMAGING PROCEDURES0624155 XRC ERCP INS NASO TUBE $1,338.00 06 DIAG IMAGING PROCEDURES0624361 XRC ERCP RETRO DESTRUCTN $1,800.00 06 DIAG IMAGING PROCEDURES0624353 XRC ERCP RMVL CALC $1,608.00 06 DIAG IMAGING PROCEDURES0624171 XRC ERCP RMVL FB/CHNG $1,474.00 06 DIAG IMAGING PROCEDURES0624379 XRC ERCP W/ABLATION $1,339.00 06 DIAG IMAGING PROCEDURES0624338 XRC ERCP W/BIOPSY $1,141.00 06 DIAG IMAGING PROCEDURES0624346 XRC ERCP W/SPHINC/PAPIL $1,339.00 06 DIAG IMAGING PROCEDURES0622423 XRC EXCSN BREAST W LOC $3,285.00 $3,285.00 06 DIAG IMAGING PROCEDURES0626341 XRC FORAMN EPI C/T W IMG $817.00 $639.00 06 DIAG IMAGING PROCEDURES0626325 XRC FORAMN EPI L/S W IMG $838.00 $655.00 06 DIAG IMAGING PROCEDURES0626184 XRC IJ FACET L/S 2 LVL $223.00 $175.00 06 DIAG IMAGING PROCEDURES0626168 XRC IJ PV FACET C/T 1 LVL $554.00 $434.00 06 DIAG IMAGING PROCEDURES0623033 XRC IMAG LOC CLIP W BX $418.00 06 DIAG IMAGING PROCEDURES0625905 XRC INJ ARTHRO ANKLE $554.00 $434.00 06 DIAG IMAGING PROCEDURES0625921 XRC INJ ARTHRO ELBOW $527.00 $413.00 06 DIAG IMAGING PROCEDURES0625947 XRC INJ ARTHRO HIP $632.00 $1,858.00 06 DIAG IMAGING PROCEDURES0625962 XRC INJ ARTHRO KNEE $580.00 $454.00 06 DIAG IMAGING PROCEDURES0625988 XRC INJ ARTHRO SHOULDER $515.00 $403.00 06 DIAG IMAGING PROCEDURES0626002 XRC INJ ARTHRO WRIST $511.00 $400.00 06 DIAG IMAGING PROCEDURES0626564 XRC INJ ASP SHUNT $187.00 $147.00 06 DIAG IMAGING PROCEDURES0626424 XRC INJ BLOOD PATCH $1,709.00 $445.00 06 DIAG IMAGING PROCEDURES0626044 XRC INJ C1 C2 MYELOGRAM $248.00 $194.00 06 DIAG IMAGING PROCEDURES0626630 XRC INJ CYSTO RETRO $349.00 06 DIAG IMAGING PROCEDURES0626069 XRC INJ CYSTO VCUG $772.00 $604.00 06 DIAG IMAGING PROCEDURES0626085 XRC INJ DACROCYSTOGRAM $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626101 XRC INJ DISKOGRAM CERV $2,967.00 $201.00 06 DIAG IMAGING PROCEDURES0626127 XRC INJ DISKOGRAM LUMB $959.00 $751.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0625863 XRC INJ DUCT GALACTOGRAM $484.00 $379.00 06 DIAG IMAGING PROCEDURES0626143 XRC INJ EPIDL L/S $885.00 $693.00 06 DIAG IMAGING PROCEDURES0626580 XRC INJ HIP W ANESTHESIA $779.00 $610.00 06 DIAG IMAGING PROCEDURES0626218 XRC INJ ILEAL CONDUIT $274.00 06 DIAG IMAGING PROCEDURES0626440 XRC INJ MAJOR JNT BURSA $198.00 $155.00 06 DIAG IMAGING PROCEDURES0626267 XRC INJ MYELOGRAM $720.00 $563.00 06 DIAG IMAGING PROCEDURES0626507 XRC INJ NRV BLK SCTC SNGL $324.00 $254.00 06 DIAG IMAGING PROCEDURES0626283 XRC INJ NRV BLK SUBARACH $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626374 XRC INJ PANCREAT INTRAOP $342.00 06 DIAG IMAGING PROCEDURES0620138 XRC INJ SI JNT ANES/STRD $5,293.05 $8,547.17 06 DIAG IMAGING PROCEDURES0626473 XRC INJ SI JNT ARTHROGRAM $5,041.00 06 DIAG IMAGING PROCEDURES0626481 XRC INJ SIALOGRAM $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626523 XRC INJ SINOGRAM $441.00 $345.00 06 DIAG IMAGING PROCEDURES0626549 XRC INJ TRANSTRACH BRONCH $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626622 XRC INJ URETHROCYST CHAIN $1,491.00 06 DIAG IMAGING PROCEDURES0621524 XRC INS NON-TUN CV CATH<5 $3,512.00 06 DIAG IMAGING PROCEDURES0621532 XRC INS NON-TUN CV CATH5+ $3,512.00 06 DIAG IMAGING PROCEDURES0621656 XRC INS PICC W/O PORT 5+ $904.00 06 DIAG IMAGING PROCEDURES0621649 XRC INS PICC W/O PORT LT5 $1,080.00 06 DIAG IMAGING PROCEDURES0621672 XRC INS PICC W/PORT 5+YRS $5,363.00 06 DIAG IMAGING PROCEDURES0621664 XRC INS PICC W/PORT LT 5 $7,559.00 06 DIAG IMAGING PROCEDURES0621540 XRC INS TUN CV NO PRT LT5 $3,512.00 06 DIAG IMAGING PROCEDURES0621615 XRC INS TUNN CV DEV 5+ $7,106.00 06 DIAG IMAGING PROCEDURES0621607 XRC INS TUNN CV DEV LT 5 $4,644.00 06 DIAG IMAGING PROCEDURES0621557 XRC INS TUNN CV NO PORT5+ $3,512.00 06 DIAG IMAGING PROCEDURES0621417 XRC INSERT CATH TMP CMPLX $176.00 06 DIAG IMAGING PROCEDURES0621409 XRC INSERT CATH TMP SMPL $288.00 06 DIAG IMAGING PROCEDURES0610626 XRC INSERT PACER W AV LDS 06 DIAG IMAGING PROCEDURES0626705 XRC INTRO CATH FALLOPN $419.00 $328.00 06 DIAG IMAGING PROCEDURES0626697 XRC INTRO CATH IVC /SVC $2,263.00 06 DIAG IMAGING PROCEDURES0627026 XRC LP THRP $598.00 $468.00 06 DIAG IMAGING PROCEDURES0626242 XRC LUMBAR PUNCTURE DX $457.00 $358.00 06 DIAG IMAGING PROCEDURES0627802 XRC PARACENT ABD INI $533.00 $417.00 06 DIAG IMAGING PROCEDURES0627828 XRC PARACENT ABD SUBSQ $517.00 $404.00 06 DIAG IMAGING PROCEDURES0627497 XRC REMV RNL TUBE W/FLUOR $1,399.00 06 DIAG IMAGING PROCEDURES0627893 XRC REMV TUNN CV CATH W/O $532.00 06 DIAG IMAGING PROCEDURES0621334 XRC REPO NASO/ORO G TUBE $202.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0627976 XRC REPS PREV PLC CV CATH $380.00 06 DIAG IMAGING PROCEDURES0627935 XRC RPLC CMP PICC W/O $819.00 06 DIAG IMAGING PROCEDURES0627877 XRC RPLC COMP NON-TUNN CV $826.00 06 DIAG IMAGING PROCEDURES0626200 XRC SAL INFN SONOHYSTER $419.00 $328.00 06 DIAG IMAGING PROCEDURES0629568 XRC THORACENTESIS $455.00 $877.51 06 DIAG IMAGING PROCEDURES0623488 XRC THORACENTESIS W TUBE $531.00 $416.00 06 DIAG IMAGING PROCEDURES0624239 XRC TUBE PLACE JEJUNUM $408.00 06 DIAG IMAGING PROCEDURES0621375 XRC URODYNAMICS EMG $695.00 06 DIAG IMAGING PROCEDURES0623884 XRC UROFLOWMETRY COMPLEX $201.00 06 DIAG IMAGING PROCEDURES0621367 XRC VP STUDY INTRA-ABDOM $207.00 06 DIAG IMAGING PROCEDURES1974609 US BIO PROFILE W NONSTRES $911.00 $646.00 19 DIAG IMAGING PROCEDURES O1974666 US OB FU/REEVAL EA FETUS $946.00 $671.00 19 DIAG IMAGING PROCEDURES O1974690 US OB LTD 1/MORE FETUSES $769.00 $545.00 19 DIAG IMAGING PROCEDURES O0851113 ADENOSINE DX 30 MG IJ $293.00 08 DIAG IMAGING SUPP (NON-IN0858233 BRACHY SOURCE YTTRIUM 90 $23,596.00 08 DIAG IMAGING SUPP (NON-IN0824151 CON LOCM 300-349S I 1ML $70.00 08 DIAG IMAGING SUPP (NON-IN0851014 DIPYRIDAMOLE/10MG IJ $21.00 08 DIAG IMAGING SUPP (NON-IN0827006 METHYLENE BLUE $33.00 08 DIAG IMAGING SUPP (NON-IN0898619 REGADENOSON 0.1MG IJ $900.00 08 DIAG IMAGING SUPP (NON-IN0851485 RP C14 UREA/TEST $76.00 08 DIAG IMAGING SUPP (NON-IN0851493 RP CO57 CYANO DX PO 1UCI $469.00 08 DIAG IMAGING SUPP (NON-IN0851519 RP CO57 CYANO DX PO 1UCI $469.00 08 DIAG IMAGING SUPP (NON-IN0851527 RP CR51 CHROMTE DX 250UCI $291.00 08 DIAG IMAGING SUPP (NON-IN0852509 RP DX I-131 CAP PER MCI $430.00 $405.00 08 DIAG IMAGING SUPP (NON-IN0852525 RP DX I131 SOD SOL/MCI $356.00 08 DIAG IMAGING SUPP (NON-IN0855486 RP DX TC99M ARCTMMB 45MCI $2,335.00 08 DIAG IMAGING SUPP (NON-IN0851709 RP GALLIUM GA-67 DX 1 MCI $72.00 $68.00 08 DIAG IMAGING SUPP (NON-IN0852368 RP I123 MIBG $2,949.00 08 DIAG IMAGING SUPP (NON-IN0852012 RP I123 MIBG $225.00 08 DIAG IMAGING SUPP (NON-IN0852822 RP I125 IOTHLMAT DX 10UCI $475.00 08 DIAG IMAGING SUPP (NON-IN0852400 RP I125/10UCI $328.00 $310.00 08 DIAG IMAGING SUPP (NON-IN0852814 RP I131 DX 1UCI MAX 100 $356.00 08 DIAG IMAGING SUPP (NON-IN0852707 RP I131 MIBG DX 0.5MCI $2,058.00 $1,941.00 08 DIAG IMAGING SUPP (NON-IN0852756 RP I131 NP 59MCI $899.00 $848.00 08 DIAG IMAGING SUPP (NON-IN0852467 RP I131 TOSITUMOMAB DX DS $4,740.00 08 DIAG IMAGING SUPP (NON-IN0852475 RP I131 TOSITUMOMAB RX DS $41,470.00 08 DIAG IMAGING SUPP (NON-IN0853101 RP IN111 CITRATE/VL $859.00 $811.00 08 DIAG IMAGING SUPP (NON-IN

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0853200 RP IN111 DTPA/0.5MCI $885.00 $834.00 08 DIAG IMAGING SUPP (NON-IN0853630 RP IN111 IBRITUM DX 5MCI $3,809.00 08 DIAG IMAGING SUPP (NON-IN0853648 RP IN111 OCTREOSC DX 6MCI $2,800.00 08 DIAG IMAGING SUPP (NON-IN0853002 RP IN111 ONCSCNT DX 6MCI $4,813.00 $4,540.00 08 DIAG IMAGING SUPP (NON-IN0853408 RP IN111 OXYQIN DX 0.5MCI $739.00 $697.00 08 DIAG IMAGING SUPP (NON-IN0853309 RP IN111 PRSTSCN DX 10MCI $2,688.00 $2,536.00 08 DIAG IMAGING SUPP (NON-IN0854018 RP P32 CHROMIC RX 1MCI $1,381.00 08 DIAG IMAGING SUPP (NON-IN0854026 RP P32 SODIUM PHO RX 1MCI $469.00 08 DIAG IMAGING SUPP (NON-IN0855502 RP SR89 TX PER MCI $839.00 $792.00 08 DIAG IMAGING SUPP (NON-IN0854109 RP SR89 TX PER MCI $2,175.00 $2,052.00 08 DIAG IMAGING SUPP (NON-IN0855056 RP TC99M ACUTECT DX 20MCI $1,281.00 08 DIAG IMAGING SUPP (NON-IN0856708 RP TC99M BICISAT DX 25MCI $835.00 $788.00 08 DIAG IMAGING SUPP (NON-IN0855601 RP TC99M CERETEC DX 25MCI $839.00 $792.00 08 DIAG IMAGING SUPP (NON-IN0855759 RP TC99M DISFNIN DX 15MCI $98.00 08 DIAG IMAGING SUPP (NON-IN0856757 RP TC99M FANOLSO DX 25MCI $1,800.00 08 DIAG IMAGING SUPP (NON-IN0856104 RP TC99M GLUCEPT DX 25MCI $62.00 $58.00 08 DIAG IMAGING SUPP (NON-IN0856203 RP TC99M HSA/DS $135.00 $128.00 08 DIAG IMAGING SUPP (NON-IN0856302 RP TC99M MAA DX 10MCI $140.00 $140.00 08 DIAG IMAGING SUPP (NON-IN0856500 RP TC99M MDP 1-30MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0855700 RP TC99M MEBROFN DX 15MCI $98.00 $93.00 08 DIAG IMAGING SUPP (NON-IN0856401 RP TC99M MERTIAT DX 15MCI $2,130.00 $2,130.00 08 DIAG IMAGING SUPP (NON-IN0856609 RP TC99M MYOVIEW DX 40MCI $227.00 $227.00 08 DIAG IMAGING SUPP (NON-IN0856005 RP TC99M PENTETA DX 25MCI $82.00 $78.00 08 DIAG IMAGING SUPP (NON-IN0855908 RP TC99M PENTETA DX 25MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0851501 RP TC99M PENTETA DX 25MCI $325.00 $307.00 08 DIAG IMAGING SUPP (NON-IN0855007 RP TC99M PERTEC DX EA MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0856807 RP TC99M PYROPHO DX 25MCI $115.00 $108.00 08 DIAG IMAGING SUPP (NON-IN0856906 RP TC99M RBC/TAG DX 30MCI $177.00 $167.00 08 DIAG IMAGING SUPP (NON-IN0855551 RP TC99M SC FLT DX 20MCI $204.00 08 DIAG IMAGING SUPP (NON-IN0855304 RP TC99M SESTMBI DX 40MCI $248.00 $248.00 08 DIAG IMAGING SUPP (NON-IN0855809 RP TC99M SUCCIMR DX 10MCI $258.00 $244.00 08 DIAG IMAGING SUPP (NON-IN0857003 RP TC99M SULFR/C DX 20MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0857102 RP TC99M SULFR/C DX 20MCI $164.00 $155.00 08 DIAG IMAGING SUPP (NON-IN0858001 RP TL-201 DX PER MCI $82.00 $78.00 08 DIAG IMAGING SUPP (NON-IN0852541 RP TX I-131 CAP PER MCI $54.00 08 DIAG IMAGING SUPP (NON-IN0852574 RP TX I131 SOD SOL/MCI $35.00 08 DIAG IMAGING SUPP (NON-IN0852459 RP TX IODINE-125 PER MCI $70.00 08 DIAG IMAGING SUPP (NON-IN

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0858225 RP XE133 DX 10MCI 08 DIAG IMAGING SUPP (NON-IN0857607 RP Y90 IBRITUM RX 40MCI $32,975.00 08 DIAG IMAGING SUPP (NON-IN0859009 S NSTRL NM AEROSOL KIT $56.00 $52.00 08 DIAG IMAGING SUPP (NON-IN0858506 S NSTRL NM BILE BAG $33.00 08 DIAG IMAGING SUPP (NON-IN0820050 S STRL BREAST BIOPSY CLIP $599.00 08 DIAG IMAGING SUPP (NON-IN0820068 S STRL BREAST BX CLIP $186.00 08 DIAG IMAGING SUPP (NON-IN0887067 S STRL CATH 12F 2CC BLN $109.58 08 DIAG IMAGING SUPP (NON-IN0887042 S STRL CATH TRIP 7.4F 40C $88.41 08 DIAG IMAGING SUPP (NON-IN0887026 S STRL CATH TRIP 7F 30CM $79.17 08 DIAG IMAGING SUPP (NON-IN0882506 S STRL CT BIOP GUN ADV $151.00 $142.00 08 DIAG IMAGING SUPP (NON-IN0883504 S STRL CT NDL 18GA 150MM $107.00 $101.00 08 DIAG IMAGING SUPP (NON-IN0883884 S STRL CT NDL BIOP $273.00 $258.00 08 DIAG IMAGING SUPP (NON-IN0884049 S STRL CT NDL BIOP $131.00 $123.00 08 DIAG IMAGING SUPP (NON-IN0883827 S STRL CT NDL BIOP ASAP $164.00 $155.00 08 DIAG IMAGING SUPP (NON-IN0883868 S STRL CT NDL BIOP ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0883843 S STRL CT NDL BIOP ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0883801 S STRL CT NDL BIOP ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0884304 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0884403 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0884361 S STRL CT NDL CHIBA $39.00 $37.00 08 DIAG IMAGING SUPP (NON-IN0884387 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0884320 S STRL CT NDL CHIBA $50.00 $47.00 08 DIAG IMAGING SUPP (NON-IN0885004 S STRL CT NDL COAXIAL BX $97.00 $92.00 08 DIAG IMAGING SUPP (NON-IN0885202 S STRL CT NDL HAVEL $77.00 $73.00 08 DIAG IMAGING SUPP (NON-IN0885806 S STRL CT NDL PERCU $126.00 $119.00 08 DIAG IMAGING SUPP (NON-IN0885400 S STRL CT NDL TLA $119.00 $112.00 08 DIAG IMAGING SUPP (NON-IN0884064 S STRL CT NEEDLE BX SUR $121.00 $114.00 08 DIAG IMAGING SUPP (NON-IN0888008 S STRL CT TY BIOP $83.00 $79.00 08 DIAG IMAGING SUPP (NON-IN0893271 S STRL ENTEROCLYSIS CATH $910.00 08 DIAG IMAGING SUPP (NON-IN0858704 S STRL FEEDING TUBE 8FR $2.00 08 DIAG IMAGING SUPP (NON-IN0887109 S STRL LEAK POINT STRIPS $78.75 08 DIAG IMAGING SUPP (NON-IN0887000 S STRL LEAK POINT STRIPS $73.24 08 DIAG IMAGING SUPP (NON-IN0884346 S STRL NEEDLE CHIBA 20G $57.00 $54.00 08 DIAG IMAGING SUPP (NON-IN0858357 S STRL NM CATH FOELY 10 $28.00 08 DIAG IMAGING SUPP (NON-IN0858407 S STRL NM CATH FOLEY 12FR $28.00 08 DIAG IMAGING SUPP (NON-IN0858308 S STRL NM CATH FOLEY 8FR $28.00 08 DIAG IMAGING SUPP (NON-IN0858753 S STRL NM CYSTO IRRIG $20.00 08 DIAG IMAGING SUPP (NON-IN

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0858274 S STRL NM TRAY GLIASTE AC $931.00 08 DIAG IMAGING SUPP (NON-IN0858258 S STRL NM TY CATH $14.00 08 DIAG IMAGING SUPP (NON-IN0895532 S STRL NONIONIC CONTRAST $154.00 $145.00 08 DIAG IMAGING SUPP (NON-IN0887083 S STRL TRANSDUCER W/UPP $361.25 08 DIAG IMAGING SUPP (NON-IN0888503 S STRL US AMINO TRAY $72.00 08 DIAG IMAGING SUPP (NON-IN0888016 S STRL US TY BIOP $77.00 $72.00 08 DIAG IMAGING SUPP (NON-IN0887125 S STRL Y INJ IV ADMIN SET $30.24 08 DIAG IMAGING SUPP (NON-IN0851444 SINCALIDE 5MCG IJ $338.00 08 DIAG IMAGING SUPP (NON-IN0854059 SM 153 LEXIDRONAM 150MCI $3,596.00 $3,596.00 08 DIAG IMAGING SUPP (NON-IN0851352 THYROTROPIN 1.1MG VL IJ $1,238.00 08 DIAG IMAGING SUPP (NON-IN0276873 CATH ABLTN NOCARD ENDVS $5,476.00 02 DIAGNOSTIC IMAGING SUPP (0276865 CATH ABLTN NOCARD ENDVS $5,476.00 02 DIAGNOSTIC IMAGING SUPP (0281758 CATH DRAINAGE $81.00 $77.00 02 DIAGNOSTIC IMAGING SUPP (0281808 CATH DRAINAGE $391.00 $391.00 02 DIAGNOSTIC IMAGING SUPP (0282855 CATH DRAINAGE $520.00 02 DIAGNOSTIC IMAGING SUPP (0282152 CATH DRAINAGE $330.00 $330.00 02 DIAGNOSTIC IMAGING SUPP (0282004 CATH DRAINAGE $424.00 $424.00 02 DIAGNOSTIC IMAGING SUPP (0281956 CATH DRAINAGE $373.00 02 DIAGNOSTIC IMAGING SUPP (0282103 CATH DRAINAGE $260.00 $260.00 02 DIAGNOSTIC IMAGING SUPP (0282053 CATH DRAINAGE $449.00 $449.00 02 DIAGNOSTIC IMAGING SUPP (0281857 CATH DRAINAGE $373.00 $373.00 02 DIAGNOSTIC IMAGING SUPP (0282756 CATH DRAINAGE $445.00 $445.00 02 DIAGNOSTIC IMAGING SUPP (0282509 CATH DRAINAGE $520.00 $520.00 02 DIAGNOSTIC IMAGING SUPP (0282301 CATH DRAINAGE $350.00 02 DIAGNOSTIC IMAGING SUPP (0281907 CATH DRAINAGE $362.00 $362.00 02 DIAGNOSTIC IMAGING SUPP (0234690 CATH GUIDING $1,284.00 $1,284.00 02 DIAGNOSTIC IMAGING SUPP (0234344 CATH GUIDING $495.00 $495.00 02 DIAGNOSTIC IMAGING SUPP (0287375 CATH GUIDING $484.59 02 DIAGNOSTIC IMAGING SUPP (0234328 CATH GUIDING $496.00 $496.00 02 DIAGNOSTIC IMAGING SUPP (0234443 CATH GUIDING $447.00 $447.00 02 DIAGNOSTIC IMAGING SUPP (0234542 CATH GUIDING $471.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (0234526 CATH GUIDING $471.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (0287680 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0234310 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0234302 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0234351 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0234401 CATH GUIDING $344.00 $344.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0234336 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0287326 CATH GUIDING $633.25 02 DIAGNOSTIC IMAGING SUPP (0287219 CATH GUIDING $1,266.50 02 DIAGNOSTIC IMAGING SUPP (0287433 CATH GUIDING $1,253.75 02 DIAGNOSTIC IMAGING SUPP (0287425 CATH GUIDING $935.00 02 DIAGNOSTIC IMAGING SUPP (0287417 CATH GUIDING $1,266.50 02 DIAGNOSTIC IMAGING SUPP (0287409 CATH GUIDING $1,253.75 02 DIAGNOSTIC IMAGING SUPP (0287391 CATH GUIDING $499.12 02 DIAGNOSTIC IMAGING SUPP (0287383 CATH GUIDING $484.59 02 DIAGNOSTIC IMAGING SUPP (0287367 CATH GUIDING $122.31 02 DIAGNOSTIC IMAGING SUPP (0287359 CATH GUIDING $484.58 02 DIAGNOSTIC IMAGING SUPP (0287458 CATH GUIDING $2,135.00 02 DIAGNOSTIC IMAGING SUPP (0287334 CATH GUIDING $382.00 02 DIAGNOSTIC IMAGING SUPP (0287466 CATH GUIDING $2,012.50 02 DIAGNOSTIC IMAGING SUPP (0287318 CATH GUIDING $382.50 02 DIAGNOSTIC IMAGING SUPP (0287300 CATH GUIDING $85.31 02 DIAGNOSTIC IMAGING SUPP (0287292 CATH GUIDING $484.00 02 DIAGNOSTIC IMAGING SUPP (0287284 CATH GUIDING $240.13 02 DIAGNOSTIC IMAGING SUPP (0287276 CATH GUIDING $382.50 02 DIAGNOSTIC IMAGING SUPP (0287268 CATH GUIDING $2,243.50 02 DIAGNOSTIC IMAGING SUPP (0287250 CATH GUIDING $1,984.50 02 DIAGNOSTIC IMAGING SUPP (0287243 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0287235 CATH GUIDING $1,147.50 02 DIAGNOSTIC IMAGING SUPP (0287227 CATH GUIDING $2,928.50 02 DIAGNOSTIC IMAGING SUPP (0287342 CATH GUIDING $392.06 02 DIAGNOSTIC IMAGING SUPP (0287631 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0287763 CATH GUIDING $2,553.65 02 DIAGNOSTIC IMAGING SUPP (0287755 CATH GUIDING $1,957.55 02 DIAGNOSTIC IMAGING SUPP (0287748 CATH GUIDING $1,483.80 02 DIAGNOSTIC IMAGING SUPP (0287730 CATH GUIDING $2,102.35 02 DIAGNOSTIC IMAGING SUPP (0287722 CATH GUIDING $2,039.80 02 DIAGNOSTIC IMAGING SUPP (0287714 CATH GUIDING $2,097.38 02 DIAGNOSTIC IMAGING SUPP (0287706 CATH GUIDING $1,972.00 02 DIAGNOSTIC IMAGING SUPP (0287698 CATH GUIDING $531.25 02 DIAGNOSTIC IMAGING SUPP (0287672 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0287441 CATH GUIDING $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0287649 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0287474 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0287623 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0287557 CATH GUIDING $2,550.00 02 DIAGNOSTIC IMAGING SUPP (0287540 CATH GUIDING $1,750.00 02 DIAGNOSTIC IMAGING SUPP (0287532 CATH GUIDING $2,222.50 02 DIAGNOSTIC IMAGING SUPP (0287524 CATH GUIDING $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0287516 CATH GUIDING $2,928.25 02 DIAGNOSTIC IMAGING SUPP (0287508 CATH GUIDING $2,928.25 02 DIAGNOSTIC IMAGING SUPP (0287664 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0287482 CATH GUIDING $531.25 02 DIAGNOSTIC IMAGING SUPP (0246173 CATH GUIDING $1,593.75 02 DIAGNOSTIC IMAGING SUPP (0287656 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0252015 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0252726 CATH GUIDING $650.00 02 DIAGNOSTIC IMAGING SUPP (0252718 CATH GUIDING $1,366.00 02 DIAGNOSTIC IMAGING SUPP (0252700 CATH GUIDING $1,366.00 02 DIAGNOSTIC IMAGING SUPP (0252130 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252114 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252098 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252072 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0268433 CATH GUIDING $1,275.00 02 DIAGNOSTIC IMAGING SUPP (0252031 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0246355 CATH GUIDING $3,062.50 02 DIAGNOSTIC IMAGING SUPP (0246405 CATH GUIDING $2,275.00 02 DIAGNOSTIC IMAGING SUPP (0246397 CATH GUIDING $2,275.00 02 DIAGNOSTIC IMAGING SUPP (0246363 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0246348 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0287490 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0246207 CATH GUIDING $1,925.00 02 DIAGNOSTIC IMAGING SUPP (0246181 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0252056 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0246215 CATH GUIDING $2,100.00 02 DIAGNOSTIC IMAGING SUPP (0271502 CATH GUIDING $2,625.00 02 DIAGNOSTIC IMAGING SUPP (0232520 CATH INF PER CEN MID NOHD $1,719.00 02 DIAGNOSTIC IMAGING SUPP (0232546 CATH INF PER CEN MID NOHD $793.00 02 DIAGNOSTIC IMAGING SUPP (0276972 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0276980 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0276998 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277004 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277012 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277038 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277020 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0282640 CATH INTRAVASCULAR US $7,500.00 02 DIAGNOSTIC IMAGING SUPP (0231209 CATH OCCLUSION $496.00 $496.00 02 DIAGNOSTIC IMAGING SUPP (0287573 CATH OCCLUSION $2,875.00 02 DIAGNOSTIC IMAGING SUPP (0287607 CATH OCCLUSION $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0287599 CATH OCCLUSION $3,395.00 02 DIAGNOSTIC IMAGING SUPP (0287581 CATH OCCLUSION $2,875.00 02 DIAGNOSTIC IMAGING SUPP (0246199 CATH OCCLUSION $2,852.50 02 DIAGNOSTIC IMAGING SUPP (0286351 CATH THROMB/EMBOLCTMY $612.00 02 DIAGNOSTIC IMAGING SUPP (0276923 CATH THROMB/EMBOLCTMY $3,737.50 02 DIAGNOSTIC IMAGING SUPP (0276964 CATH THROMB/EMBOLCTMY $3,377.50 02 DIAGNOSTIC IMAGING SUPP (0234427 CATH THROMB/EMBOLCTMY $115.00 $115.00 02 DIAGNOSTIC IMAGING SUPP (0234633 CATH THROMB/EMBOLCTMY $3,491.25 02 DIAGNOSTIC IMAGING SUPP (0234658 CATH THROMB/EMBOLCTMY $3,491.25 02 DIAGNOSTIC IMAGING SUPP (0276949 CATH THROMB/EMBOLCTMY $3,312.50 02 DIAGNOSTIC IMAGING SUPP (0276956 CATH THROMB/EMBOLCTMY $3,075.00 02 DIAGNOSTIC IMAGING SUPP (0276931 CATH THROMB/EMBOLCTMY $1,700.00 02 DIAGNOSTIC IMAGING SUPP (0234070 CATH TRNSML ANGIO NOLASR $100.00 $95.00 02 DIAGNOSTIC IMAGING SUPP (0234021 CATH TRNSML ANGIO NOLASR $115.00 $109.00 02 DIAGNOSTIC IMAGING SUPP (0234088 CATH TRNSML ANGIO NOLASR $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (0234708 CATH TRNSML ANGIO NOLASR $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (0233569 CATH TRNSML ANGIO NOLASR $1,314.00 $1,239.00 02 DIAGNOSTIC IMAGING SUPP (0234047 CATH TRNSML ANGIO NOLASR $119.00 $112.00 02 DIAGNOSTIC IMAGING SUPP (0234765 CATH TRNSML ANGIO NOLASR $47.00 $45.00 02 DIAGNOSTIC IMAGING SUPP (0231340 CATH TRNSML ANGIO NOLASR $1,550.00 $1,462.00 02 DIAGNOSTIC IMAGING SUPP (0231324 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0234245 CATH TRNSML ANGIO NOLASR $253.00 $239.00 02 DIAGNOSTIC IMAGING SUPP (0234195 CATH TRNSML ANGIO NOLASR $253.00 $238.00 02 DIAGNOSTIC IMAGING SUPP (0231647 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0268565 CATH TRNSML ANGIO NOLASR $297.00 $297.00 02 DIAGNOSTIC IMAGING SUPP (0234823 CATH TRNSML ANGIO NOLASR $68.00 $64.00 02 DIAGNOSTIC IMAGING SUPP (0234120 CATH TRNSML ANGIO NOLASR $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0235002 CATH TRNSML ANGIO NOLASR $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (

A1


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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0231548 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0234187 CATH TRNSML ANGIO NOLASR $110.00 $104.00 02 DIAGNOSTIC IMAGING SUPP (0234260 CATH TRNSML ANGIO NOLASR $279.00 02 DIAGNOSTIC IMAGING SUPP (0234583 CATH TRNSML ANGIO NOLASR $65.00 $62.00 02 DIAGNOSTIC IMAGING SUPP (0233585 CATH TRNSML ANGIO NOLASR $1,447.00 02 DIAGNOSTIC IMAGING SUPP (0234906 CATH TRNSML ANGIO NOLASR $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0231043 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0232009 CATH TRNSML ANGIO NOLASR $1,305.00 $1,231.00 02 DIAGNOSTIC IMAGING SUPP (0233403 CATH TRNSML ANGIO NOLASR $1,182.00 02 DIAGNOSTIC IMAGING SUPP (0233528 CATH TRNSML ANGIO NOLASR $1,089.00 02 DIAGNOSTIC IMAGING SUPP (0231381 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0232728 CATH TRNSML ANGIO NOLASR $961.00 02 DIAGNOSTIC IMAGING SUPP (0231506 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0232066 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0231662 CATH TRNSML ANGIO NOLASR $1,020.00 $962.00 02 DIAGNOSTIC IMAGING SUPP (0231142 CATH TRNSML ANGIO NOLASR $851.00 $803.00 02 DIAGNOSTIC IMAGING SUPP (0233163 CATH TRNSML ANGIO NOLASR $1,019.00 02 DIAGNOSTIC IMAGING SUPP (0233544 CATH TRNSML ANGIO NOLASR $1,314.00 $1,239.00 02 DIAGNOSTIC IMAGING SUPP (0231068 CATH TRNSML ANGIO NOLASR $851.00 $803.00 02 DIAGNOSTIC IMAGING SUPP (0231100 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0232843 CATH TRNSML ANGIO NOLASR $961.00 02 DIAGNOSTIC IMAGING SUPP (0235127 CATH TRNSML ANGIO NOLASR $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0232884 CATH TRNSML ANGIO NOLASR $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232041 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232082 CATH TRNSML ANGIO NOLASR $1,733.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232108 CATH TRNSML ANGIO NOLASR $1,733.00 $1,733.00 02 DIAGNOSTIC IMAGING SUPP (0232124 CATH TRNSML ANGIO NOLASR $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232140 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232165 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0233205 CATH TRNSML ANGIO NOLASR $1,083.00 02 DIAGNOSTIC IMAGING SUPP (0232686 CATH TRNSML ANGIO NOLASR $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0282632 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0282624 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0232769 CATH TRNSML ANGIO NOLASR $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0282616 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0233486 CATH TRNSML ANGIO NOLASR $1,089.00 02 DIAGNOSTIC IMAGING SUPP (0235085 CATH TRNSML ANGIO NOLASR $97.00 $91.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0233247 CATH TRNSML ANGIO NOLASR $1,019.00 02 DIAGNOSTIC IMAGING SUPP (0233122 CATH TRNSML ANGIO NOLASR $1,083.00 02 DIAGNOSTIC IMAGING SUPP (0235101 CATH TRNSML ANGIO NOLASR $97.00 $92.00 02 DIAGNOSTIC IMAGING SUPP (0233288 CATH TRNSML ANGIO NOLASR $1,083.00 02 DIAGNOSTIC IMAGING SUPP (0232801 CATH TRNSML ANGIO NOLASR $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232645 CATH TRNSML ANGIO NOLASR $961.00 02 DIAGNOSTIC IMAGING SUPP (0233551 CATH TRNSML ANGIO NOLASR $1,447.00 02 DIAGNOSTIC IMAGING SUPP (0233429 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0235143 CATH TRNSML ANGIO NOLASR $91.00 $86.00 02 DIAGNOSTIC IMAGING SUPP (0233502 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0234054 CATH TRNSML ANGIO NOLASR $224.00 02 DIAGNOSTIC IMAGING SUPP (0233536 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0233049 CATH TRNSML ANGIO NOLASR $1,083.00 02 DIAGNOSTIC IMAGING SUPP (0233460 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0231126 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0233361 CATH TRNSML ANGIO NOLASR $1,182.00 02 DIAGNOSTIC IMAGING SUPP (0234955 CATH TRNSML ANGIO NOLASR $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0234625 CATH TRNSML ANGIO NOLASR $64.00 $60.00 02 DIAGNOSTIC IMAGING SUPP (0268540 CATH TRNSML ANGIO NOLASR $660.00 $660.00 02 DIAGNOSTIC IMAGING SUPP (0234500 CATH TRNSML ANGIO NOLASR $447.00 $421.00 02 DIAGNOSTIC IMAGING SUPP (0234468 CATH TRNSML ANGIO NOLASR $474.00 $447.00 02 DIAGNOSTIC IMAGING SUPP (0234005 CATH TRNSML ANGIO NOLASR $110.00 $103.00 02 DIAGNOSTIC IMAGING SUPP (0233080 CATH TRNSML ANGIO NOLASR $1,019.00 02 DIAGNOSTIC IMAGING SUPP (0231480 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0231605 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0231589 CATH TRNSML ANGIO NOLASR $929.00 $876.00 02 DIAGNOSTIC IMAGING SUPP (0231563 CATH TRNSML ANGIO NOLASR $1,061.00 $1,001.00 02 DIAGNOSTIC IMAGING SUPP (0232926 CATH TRNSML ANGIO NOLASR $1,019.00 02 DIAGNOSTIC IMAGING SUPP (0232967 CATH TRNSML ANGIO NOLASR $1,084.00 02 DIAGNOSTIC IMAGING SUPP (0233007 CATH TRNSML ANGIO NOLASR $1,017.00 02 DIAGNOSTIC IMAGING SUPP (0231522 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0231621 CATH TRNSML ANGIO NOLASR $988.00 $932.00 02 DIAGNOSTIC IMAGING SUPP (0231464 CATH TRNSML ANGIO NOLASR $1,050.00 $991.00 02 DIAGNOSTIC IMAGING SUPP (0231449 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0231407 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0233320 CATH TRNSML ANGIO NOLASR $1,019.00 02 DIAGNOSTIC IMAGING SUPP (0233346 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (

A1


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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0274506 CATH URETERAL $499.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (0225102 CON HOCM 300-349MG/ML 1ML $55.00 $55.00 02 DIAGNOSTIC IMAGING SUPP (0225003 CON LOCM 350-399S I 1ML $74.00 $54.00 02 DIAGNOSTIC IMAGING SUPP (0246264 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0276832 EMBOLIZ PROTECT SYS $3,875.00 02 DIAGNOSTIC IMAGING SUPP (0246272 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246256 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246249 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246280 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0263186 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263129 EP ICAR FX CV GD IN SHTH $261.00 $246.00 02 DIAGNOSTIC IMAGING SUPP (0263202 EP ICAR FX CV GD IN SHTH $235.00 $222.00 02 DIAGNOSTIC IMAGING SUPP (0263103 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263145 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263228 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263087 EP ICAR FX CV GD IN SHTH $264.00 $249.00 02 DIAGNOSTIC IMAGING SUPP (0267302 GUIDEWIRE $85.00 $81.00 02 DIAGNOSTIC IMAGING SUPP (0268045 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0267203 GUIDEWIRE $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0267245 GUIDEWIRE $241.00 $227.00 02 DIAGNOSTIC IMAGING SUPP (0268003 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0267708 GUIDEWIRE $88.00 $88.00 02 DIAGNOSTIC IMAGING SUPP (0267807 GUIDEWIRE $77.00 $77.00 02 DIAGNOSTIC IMAGING SUPP (0268524 GUIDEWIRE $570.00 $570.00 02 DIAGNOSTIC IMAGING SUPP (0268060 GUIDEWIRE $156.00 $156.00 02 DIAGNOSTIC IMAGING SUPP (0268086 GUIDEWIRE $156.00 $156.00 02 DIAGNOSTIC IMAGING SUPP (0267260 GUIDEWIRE $156.00 $148.00 02 DIAGNOSTIC IMAGING SUPP (0268144 GUIDEWIRE $262.00 $262.00 02 DIAGNOSTIC IMAGING SUPP (0285007 GUIDEWIRE $374.00 02 DIAGNOSTIC IMAGING SUPP (0268169 GUIDEWIRE $818.00 $818.00 02 DIAGNOSTIC IMAGING SUPP (0268227 GUIDEWIRE $788.00 $788.00 02 DIAGNOSTIC IMAGING SUPP (0268508 GUIDEWIRE $570.00 $570.00 02 DIAGNOSTIC IMAGING SUPP (0268847 GUIDEWIRE $599.00 $599.00 02 DIAGNOSTIC IMAGING SUPP (0268706 GUIDEWIRE $112.00 $112.00 02 DIAGNOSTIC IMAGING SUPP (0268102 GUIDEWIRE $253.00 $253.00 02 DIAGNOSTIC IMAGING SUPP (0268268 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (0268318 GUIDEWIRE $119.70 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0268300 GUIDEWIRE $236.98 02 DIAGNOSTIC IMAGING SUPP (0268292 GUIDEWIRE $340.00 02 DIAGNOSTIC IMAGING SUPP (0268284 GUIDEWIRE $1,113.00 02 DIAGNOSTIC IMAGING SUPP (0268276 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (0268326 GUIDEWIRE $129.34 02 DIAGNOSTIC IMAGING SUPP (0252197 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0246165 GUIDEWIRE $1,062.50 02 DIAGNOSTIC IMAGING SUPP (0246223 GUIDEWIRE $935.00 02 DIAGNOSTIC IMAGING SUPP (0268805 GUIDEWIRE $639.00 $639.00 02 DIAGNOSTIC IMAGING SUPP (0268649 GUIDEWIRE $57.00 $57.00 02 DIAGNOSTIC IMAGING SUPP (0268490 GUIDEWIRE $978.78 02 DIAGNOSTIC IMAGING SUPP (0268482 GUIDEWIRE $1,358.60 02 DIAGNOSTIC IMAGING SUPP (0268367 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0268474 GUIDEWIRE $813.96 02 DIAGNOSTIC IMAGING SUPP (0252155 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0252171 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0268334 GUIDEWIRE $561.00 02 DIAGNOSTIC IMAGING SUPP (0268458 GUIDEWIRE $1,238.45 02 DIAGNOSTIC IMAGING SUPP (0268441 GUIDEWIRE $978.89 02 DIAGNOSTIC IMAGING SUPP (0268425 GUIDEWIRE $1,041.25 02 DIAGNOSTIC IMAGING SUPP (0268417 GUIDEWIRE $1,466.25 02 DIAGNOSTIC IMAGING SUPP (0268409 GUIDEWIRE $871.25 02 DIAGNOSTIC IMAGING SUPP (0268391 GUIDEWIRE $1,360.00 02 DIAGNOSTIC IMAGING SUPP (0268375 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0268359 GUIDEWIRE $403.75 02 DIAGNOSTIC IMAGING SUPP (0268342 GUIDEWIRE $561.00 02 DIAGNOSTIC IMAGING SUPP (0268466 GUIDEWIRE $938.83 02 DIAGNOSTIC IMAGING SUPP (0268383 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0276915 GUIDEWIRE $855.95 02 DIAGNOSTIC IMAGING SUPP (0276907 GUIDEWIRE $1,697.88 02 DIAGNOSTIC IMAGING SUPP (0252734 GUIDEWIRE $245.00 02 DIAGNOSTIC IMAGING SUPP (0268128 GUIDEWIRE $247.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0268029 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0267104 GUIDEWIRE $7.00 $7.00 02 DIAGNOSTIC IMAGING SUPP (0267005 GUIDEWIRE $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0276899 GUIDEWIRE $938.83 02 DIAGNOSTIC IMAGING SUPP (0268250 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0276881 GUIDEWIRE $978.78 02 DIAGNOSTIC IMAGING SUPP (0285155 IMP CATH HD/PRTNL LNG TRM $1,697.00 $1,697.00 02 DIAGNOSTIC IMAGING SUPP (0283093 IMP TISSUE MARKER $170.00 02 DIAGNOSTIC IMAGING SUPP (0287615 INTRO/SHEATH NON-LASER $161.50 02 DIAGNOSTIC IMAGING SUPP (0276840 INTRO/SHEATH NON-LASER $440.73 02 DIAGNOSTIC IMAGING SUPP (0263343 INTRO/SHTH GD FX CRV NOPL $190.00 $179.00 02 DIAGNOSTIC IMAGING SUPP (0263327 INTRO/SHTH GD FX CRV NOPL $103.00 $98.00 02 DIAGNOSTIC IMAGING SUPP (0263285 INTRO/SHTH GD FX CRV NOPL $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0263368 INTRO/SHTH GD FX CRV NOPL $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0263301 INTRO/SHTH GD FX CRV NOPL $59.00 $55.00 02 DIAGNOSTIC IMAGING SUPP (0246413 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0246371 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0246389 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0276857 RET DEV INSERTABLE $2,401.25 02 DIAGNOSTIC IMAGING SUPP (0254656 S IMP EMBOLIC COIL $5,390.00 02 DIAGNOSTIC IMAGING SUPP (0254516 S IMP EMBOLIC COIL $3,920.00 02 DIAGNOSTIC IMAGING SUPP (0254524 S IMP EMBOLIC COIL $4,018.00 02 DIAGNOSTIC IMAGING SUPP (0254532 S IMP EMBOLIC COIL $3,822.00 02 DIAGNOSTIC IMAGING SUPP (0254607 S IMP EMBOLIC COIL $5,782.00 02 DIAGNOSTIC IMAGING SUPP (0254615 S IMP EMBOLIC COIL $5,292.00 02 DIAGNOSTIC IMAGING SUPP (0254623 S IMP EMBOLIC COIL $5,243.00 02 DIAGNOSTIC IMAGING SUPP (0254722 S IMP EMBOLIC COIL $2,940.00 02 DIAGNOSTIC IMAGING SUPP (0254649 S IMP EMBOLIC COIL $5,463.50 02 DIAGNOSTIC IMAGING SUPP (0254482 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254664 S IMP EMBOLIC COIL $5,561.50 02 DIAGNOSTIC IMAGING SUPP (0254672 S IMP EMBOLIC COIL $5,463.50 02 DIAGNOSTIC IMAGING SUPP (0254680 S IMP EMBOLIC COIL $5,512.50 02 DIAGNOSTIC IMAGING SUPP (0254698 S IMP EMBOLIC COIL $5,904.50 02 DIAGNOSTIC IMAGING SUPP (0254706 S IMP EMBOLIC COIL $5,218.50 02 DIAGNOSTIC IMAGING SUPP (0254631 S IMP EMBOLIC COIL $5,341.00 02 DIAGNOSTIC IMAGING SUPP (0254409 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254326 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254334 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254342 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254359 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254367 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254375 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0254508 S IMP EMBOLIC COIL $3,528.00 02 DIAGNOSTIC IMAGING SUPP (0254391 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254490 S IMP EMBOLIC COIL $3,577.00 02 DIAGNOSTIC IMAGING SUPP (0254417 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254425 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254433 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254441 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254466 S IMP EMBOLIC COIL $3,158.75 02 DIAGNOSTIC IMAGING SUPP (0254474 S IMP EMBOLIC COIL $3,918.75 02 DIAGNOSTIC IMAGING SUPP (0254730 S IMP EMBOLIC COIL $3,291.75 02 DIAGNOSTIC IMAGING SUPP (0254383 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0254714 S IMP EMBOLIC COIL $3,291.75 02 DIAGNOSTIC IMAGING SUPP (0254748 S IMP EMBOLIC COIL $3,074.45 02 DIAGNOSTIC IMAGING SUPP (0254755 S IMP EMBOLIC COIL $2,805.25 02 DIAGNOSTIC IMAGING SUPP (0254292 S IMP EMBOLIC COIL 02 DIAGNOSTIC IMAGING SUPP (0252668 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252585 S IMP EMBOLIC COIL $2,755.00 02 DIAGNOSTIC IMAGING SUPP (0252593 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0252601 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252619 S IMP EMBOLIC COIL $2,905.00 02 DIAGNOSTIC IMAGING SUPP (0252627 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252635 S IMP EMBOLIC COIL $2,890.00 02 DIAGNOSTIC IMAGING SUPP (0254318 S IMP EMBOLIC COIL $2,805.25 02 DIAGNOSTIC IMAGING SUPP (0252650 S IMP EMBOLIC COIL $2,905.00 02 DIAGNOSTIC IMAGING SUPP (0252551 S IMP EMBOLIC COIL $2,453.00 02 DIAGNOSTIC IMAGING SUPP (0252676 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252684 S IMP EMBOLIC COIL $2,695.00 02 DIAGNOSTIC IMAGING SUPP (0252692 S IMP EMBOLIC COIL $2,695.00 02 DIAGNOSTIC IMAGING SUPP (0252643 S IMP EMBOLIC COIL $2,845.00 02 DIAGNOSTIC IMAGING SUPP (0252239 S IMP EMBOLIC COIL $2,430.00 02 DIAGNOSTIC IMAGING SUPP (0252577 S IMP EMBOLIC COIL $3,845.00 02 DIAGNOSTIC IMAGING SUPP (0252213 S IMP EMBOLIC COIL $2,408.00 02 DIAGNOSTIC IMAGING SUPP (0252569 S IMP EMBOLIC COIL $2,363.00 02 DIAGNOSTIC IMAGING SUPP (0252544 S IMP EMBOLIC COIL $2,385.00 02 DIAGNOSTIC IMAGING SUPP (0254227 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254151 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254169 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0254177 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254185 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254193 S IMP EMBOLIC COIL 02 DIAGNOSTIC IMAGING SUPP (0254136 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254219 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254128 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (0254235 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254243 S IMP EMBOLIC COIL $4,361.00 02 DIAGNOSTIC IMAGING SUPP (0254250 S IMP EMBOLIC COIL $4,532.50 02 DIAGNOSTIC IMAGING SUPP (0254268 S IMP EMBOLIC COIL $4,532.00 02 DIAGNOSTIC IMAGING SUPP (0254276 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254284 S IMP EMBOLIC COIL $2,940.00 02 DIAGNOSTIC IMAGING SUPP (0254201 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254045 S IMP EMBOLIC COIL $3,626.00 02 DIAGNOSTIC IMAGING SUPP (0254300 S IMP EMBOLIC COIL $2,805.25 02 DIAGNOSTIC IMAGING SUPP (0254003 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254011 S IMP EMBOLIC COIL $4,361.00 02 DIAGNOSTIC IMAGING SUPP (0254144 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254037 S IMP EMBOLIC COIL $3,822.00 02 DIAGNOSTIC IMAGING SUPP (0254052 S IMP EMBOLIC COIL $3,920.00 02 DIAGNOSTIC IMAGING SUPP (0254060 S IMP EMBOLIC COIL 02 DIAGNOSTIC IMAGING SUPP (0254078 S IMP EMBOLIC COIL $2,731.75 02 DIAGNOSTIC IMAGING SUPP (0254086 S IMP EMBOLIC COIL $2,878.75 02 DIAGNOSTIC IMAGING SUPP (0254094 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (0254102 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254110 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254029 S IMP EMBOLIC COIL $3,724.00 02 DIAGNOSTIC IMAGING SUPP (0271569 S IMP EMBOLIC COIL $4,362.50 02 DIAGNOSTIC IMAGING SUPP (0271726 S IMP EMBOLIC COIL $4,087.50 02 DIAGNOSTIC IMAGING SUPP (0271650 S IMP EMBOLIC COIL $4,337.50 02 DIAGNOSTIC IMAGING SUPP (0271585 S IMP EMBOLIC COIL $4,375.00 02 DIAGNOSTIC IMAGING SUPP (0271593 S IMP EMBOLIC COIL $4,362.50 02 DIAGNOSTIC IMAGING SUPP (0271601 S IMP EMBOLIC COIL $4,262.50 02 DIAGNOSTIC IMAGING SUPP (0271619 S IMP EMBOLIC COIL $4,237.50 02 DIAGNOSTIC IMAGING SUPP (0271627 S IMP EMBOLIC COIL $4,250.00 02 DIAGNOSTIC IMAGING SUPP (0271742 S IMP EMBOLIC COIL $3,875.00 02 DIAGNOSTIC IMAGING SUPP (0271643 S IMP EMBOLIC COIL $4,150.00 02 DIAGNOSTIC IMAGING SUPP (

A1


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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0271734 S IMP EMBOLIC COIL $3,937.50 02 DIAGNOSTIC IMAGING SUPP (0271668 S IMP EMBOLIC COIL $4,362.50 02 DIAGNOSTIC IMAGING SUPP (0271676 S IMP EMBOLIC COIL $4,337.50 02 DIAGNOSTIC IMAGING SUPP (0271684 S IMP EMBOLIC COIL $4,262.50 02 DIAGNOSTIC IMAGING SUPP (0271692 S IMP EMBOLIC COIL $4,150.00 02 DIAGNOSTIC IMAGING SUPP (0271700 S IMP EMBOLIC COIL $4,187.50 02 DIAGNOSTIC IMAGING SUPP (0271718 S IMP EMBOLIC COIL $8,250.00 02 DIAGNOSTIC IMAGING SUPP (0271635 S IMP EMBOLIC COIL $4,187.50 02 DIAGNOSTIC IMAGING SUPP (0271551 S IMP EMBOLIC COIL $4,462.20 02 DIAGNOSTIC IMAGING SUPP (0271114 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271031 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271049 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271056 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271064 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271072 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271080 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271577 S IMP EMBOLIC COIL $4,437.50 02 DIAGNOSTIC IMAGING SUPP (0271106 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271122 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271130 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271148 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271155 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271163 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271171 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271098 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271023 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271015 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271205 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271460 S IMP EMBOLIC COIL $2,900.00 02 DIAGNOSTIC IMAGING SUPP (0271189 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271395 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271403 S IMP EMBOLIC COIL $2,850.00 02 DIAGNOSTIC IMAGING SUPP (0271411 S IMP EMBOLIC COIL $2,900.00 02 DIAGNOSTIC IMAGING SUPP (0271429 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271437 S IMP EMBOLIC COIL $2,900.00 02 DIAGNOSTIC IMAGING SUPP (0271379 S IMP EMBOLIC COIL $2,725.00 02 DIAGNOSTIC IMAGING SUPP (0271452 S IMP EMBOLIC COIL $2,850.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0271361 S IMP EMBOLIC COIL $4,087.50 02 DIAGNOSTIC IMAGING SUPP (0271478 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271486 S IMP EMBOLIC COIL $2,850.00 02 DIAGNOSTIC IMAGING SUPP (0271494 S IMP EMBOLIC COIL $2,900.00 02 DIAGNOSTIC IMAGING SUPP (0271510 S IMP EMBOLIC COIL $4,187.50 02 DIAGNOSTIC IMAGING SUPP (0271528 S IMP EMBOLIC COIL $4,112.50 02 DIAGNOSTIC IMAGING SUPP (0271536 S IMP EMBOLIC COIL $4,487.50 02 DIAGNOSTIC IMAGING SUPP (0271544 S IMP EMBOLIC COIL $4,387.50 02 DIAGNOSTIC IMAGING SUPP (0271445 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271288 S IMP EMBOLIC COIL $3,825.00 02 DIAGNOSTIC IMAGING SUPP (0271213 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271221 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271239 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271247 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271254 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271387 S IMP EMBOLIC COIL $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0271270 S IMP EMBOLIC COIL $3,912.50 02 DIAGNOSTIC IMAGING SUPP (0271197 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271296 S IMP EMBOLIC COIL $3,970.50 02 DIAGNOSTIC IMAGING SUPP (0271304 S IMP EMBOLIC COIL $4,087.50 02 DIAGNOSTIC IMAGING SUPP (0271312 S IMP EMBOLIC COIL $4,125.00 02 DIAGNOSTIC IMAGING SUPP (0271320 S IMP EMBOLIC COIL $3,937.50 02 DIAGNOSTIC IMAGING SUPP (0271338 S IMP EMBOLIC COIL $4,025.00 02 DIAGNOSTIC IMAGING SUPP (0271346 S IMP EMBOLIC COIL $3,975.00 02 DIAGNOSTIC IMAGING SUPP (0271353 S IMP EMBOLIC COIL $4,050.00 02 DIAGNOSTIC IMAGING SUPP (0271262 S IMP EMBOLIC COIL $3,850.00 02 DIAGNOSTIC IMAGING SUPP (0255141 S IMP EV3 AX 3D COIL 3X4 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255158 S IMP EV3 AX 3D COIL 3X6 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255166 S IMP EV3 AX 3D COIL 3X8 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255182 S IMP EV3 AX 3D COIL 4X12 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255174 S IMP EV3 AX 3D COIL 4X8 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255190 S IMP EV3 AX 3D COIL 5X10 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255208 S IMP EV3 AX 3D COIL 5X15 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255216 S IMP EV3 AX 3D COIL 6X15 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255315 S IMP EV3 AX 3D COIL 6X20 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255224 S IMP EV3 AX 3D COIL 7X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255307 S IMP EV3 AX 3D COIL 7X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0255232 S IMP EV3 AX 3D COIL 8X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255240 S IMP EV3 AX 3D COIL 8X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255257 S IMP EV3 AX 3D COIL 9X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255265 S IMP EV3 AX 3D COIL 9X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255000 S IMP EV3 AX HLX COIL 2X1 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255372 S IMP EV3 AX HLX COIL 2X2 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255018 S IMP EV3 AX HLX COIL 2X3 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255026 S IMP EV3 AX HLX COIL 2X4 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255364 S IMP EV3 AX HLX COIL 2X6 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255034 S IMP EV3 AX HLX COIL 2X8 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255042 S IMP EV3 AX HLX COIL 3X4 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255059 S IMP EV3 AX HLX COIL 3X6 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255356 S IMP EV3 AX HLX COIL 3X8 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255349 S IMP EV3 AX HLX COIL 4X8 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255273 S IMP EV3 AX3D COIL 10X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255281 S IMP EV3 AX3D COIL 10X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255299 S IMP EV3 AX3D COIL 12X40 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255067 S IMP EV3 AXHLX COIL 4X10 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255075 S IMP EV3 AXHLX COIL 4X12 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255083 S IMP EV3 AXHLX COIL 5X15 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255091 S IMP EV3 AXHLX COIL 5X20 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255109 S IMP EV3 AXHLX COIL 6X20 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255117 S IMP EV3 AXHLX COIL 7X30 02 DIAGNOSTIC IMAGING SUPP (0255331 S IMP EV3 AXHLX COIL 8X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255323 S IMP EV3 AXHLX COIL 9X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255125 S IMP EV3 AXHLXCOIL 10X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255133 S IMP EV3 AXHLXCOIL 12X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0243246 S IMP IR EMBOLI COIL $197.00 $186.00 02 DIAGNOSTIC IMAGING SUPP (0243147 S IMP IR EMBOLI COIL 3X60 $375.00 $354.00 02 DIAGNOSTIC IMAGING SUPP (0243162 S IMP IR EMBOLI COIL PUSH $473.00 $446.00 02 DIAGNOSTIC IMAGING SUPP (0287201 S IMP IR VASC CLOS VASOSE $931.00 02 DIAGNOSTIC IMAGING SUPP (0287144 S IMP IR VASCULAR CLOSER $310.00 $293.00 02 DIAGNOSTIC IMAGING SUPP (0287102 S IMP IR VASCULAR CLOSURE $240.00 $227.00 02 DIAGNOSTIC IMAGING SUPP (0246009 S IMP IR VENA CAVA FTR $2,387.00 $2,251.00 02 DIAGNOSTIC IMAGING SUPP (0252122 S IMP NR GDC 3MM X 8CM $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252148 S IMP NR GDC 4MM X 10C $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252163 S IMP NR GDC 5MM X 15C $6,405.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0252320 S NSTRL NR STENT/NEURO 3 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252346 S NSTRL NR STENT/NEURO 4 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252361 S NSTRL NR STENT/NEURO 4 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0264473 S STRL ABLATION PROBE $3,960.00 02 DIAGNOSTIC IMAGING SUPP (0229195 S STRL ACCESS KIT MICRO P $127.75 02 DIAGNOSTIC IMAGING SUPP (0252270 S STRL ASPIRATION TUBING $332.00 02 DIAGNOSTIC IMAGING SUPP (0261107 S STRL DILATOR 18FR $36.00 $34.00 02 DIAGNOSTIC IMAGING SUPP (0242503 S STRL EMBLOIC LIQUID $16,250.00 02 DIAGNOSTIC IMAGING SUPP (0243394 S STRL EMBOLIC LIQUID $5,237.50 02 DIAGNOSTIC IMAGING SUPP (0232280 S STRL IR BLN AUGMENTATIO $3,000.00 02 DIAGNOSTIC IMAGING SUPP (0235309 S STRL IR CATH H1 $100.00 02 DIAGNOSTIC IMAGING SUPP (0243063 S STRL IR CATH TRACKER $1,366.00 $1,288.00 02 DIAGNOSTIC IMAGING SUPP (0235200 S STRL IR CATH TRACKER 18 $331.00 02 DIAGNOSTIC IMAGING SUPP (0221523 S STRL IR CONTRAST NC 1 02 DIAGNOSTIC IMAGING SUPP (0261420 S STRL IR DLTR 10FR $36.00 02 DIAGNOSTIC IMAGING SUPP (0261008 S STRL IR DLTR 11FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261024 S STRL IR DLTR 12FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261040 S STRL IR DLTR 13FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261065 S STRL IR DLTR 14FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261081 S STRL IR DLTR 16FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261206 S STRL IR DLTR 20FR $36.00 $34.00 02 DIAGNOSTIC IMAGING SUPP (0261222 S STRL IR DLTR 22FR $57.00 $54.00 02 DIAGNOSTIC IMAGING SUPP (0261248 S STRL IR DLTR 28FR $57.00 $54.00 02 DIAGNOSTIC IMAGING SUPP (0261305 S STRL IR DLTR 5FR $33.00 $31.00 02 DIAGNOSTIC IMAGING SUPP (0261321 S STRL IR DLTR 6FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0261347 S STRL IR DLTR 7FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0261362 S STRL IR DLTR 8FR $33.00 $31.00 02 DIAGNOSTIC IMAGING SUPP (0261388 S STRL IR DLTR 9FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0243220 S STRL IR EMBOLI COIL $114.00 $108.00 02 DIAGNOSTIC IMAGING SUPP (0243204 S STRL IR EMBOLI COIL $262.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0243188 S STRL IR EMBOLI COIL $114.00 $108.00 02 DIAGNOSTIC IMAGING SUPP (0243105 S STRL IR EMBOLI COIL 2 $342.00 $322.00 02 DIAGNOSTIC IMAGING SUPP (0243345 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243329 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243287 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243303 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0241067 S STRL IR FLO-SWITCH $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0283101 S STRL IR HI-PRESSURE TB $21.00 $19.00 02 DIAGNOSTIC IMAGING SUPP (0241083 S STRL IR INDEFLATOR $234.00 $220.00 02 DIAGNOSTIC IMAGING SUPP (0263004 S STRL IR INTRO 5FR $106.00 $100.00 02 DIAGNOSTIC IMAGING SUPP (0263020 S STRL IR INTRO 6FR $106.00 $100.00 02 DIAGNOSTIC IMAGING SUPP (0263046 S STRL IR INTRO 7FRX25 $336.00 $317.00 02 DIAGNOSTIC IMAGING SUPP (0263061 S STRL IR INTRO BALKIN $185.00 $174.00 02 DIAGNOSTIC IMAGING SUPP (0284208 S STRL IR NDL 18GA THIN $32.00 $30.00 02 DIAGNOSTIC IMAGING SUPP (0234641 S STRL IR NDL TLA $62.00 $58.00 02 DIAGNOSTIC IMAGING SUPP (0285403 S STRL IR SET FEED TUBE $262.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0285353 S STRL IR SET LIVER BIOP $340.00 02 DIAGNOSTIC IMAGING SUPP (0285452 S STRL IR SET MICRO PUNC $135.00 $127.00 02 DIAGNOSTIC IMAGING SUPP (0285809 S STRL IR SET RING TRAN $1,366.00 $1,288.00 02 DIAGNOSTIC IMAGING SUPP (0285700 S STRL IR SNARE 10MM $1,644.00 $1,551.00 02 DIAGNOSTIC IMAGING SUPP (0285759 S STRL IR SNARE 25MM $1,644.00 $1,551.00 02 DIAGNOSTIC IMAGING SUPP (0244046 S STRL IR STONE BSKT $867.00 $818.00 02 DIAGNOSTIC IMAGING SUPP (0241125 S STRL IR T-FASTENER B-M $245.00 $231.00 02 DIAGNOSTIC IMAGING SUPP (0252742 S STRL IR TIPSS SET $2,135.00 02 DIAGNOSTIC IMAGING SUPP (0241166 S STRL IR TORQUE DEV $53.00 $50.00 02 DIAGNOSTIC IMAGING SUPP (0245506 S STRL IR TORQUE DEV $43.00 $40.00 02 DIAGNOSTIC IMAGING SUPP (0245605 S STRL IR TRNDCR NAMIC $97.00 $92.00 02 DIAGNOSTIC IMAGING SUPP (0266007 S STRL IR TUBE GASTRO $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266106 S STRL IR TUBE GASTRO $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266148 S STRL IR TUBE GJ 16FR $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266163 S STRL IR TUBE GJ 22FR $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266205 S STRL IR TUBE JEJU $931.00 $878.00 02 DIAGNOSTIC IMAGING SUPP (0286005 S STRL IR TY ANGIO $400.00 $377.00 02 DIAGNOSTIC IMAGING SUPP (0286203 S STRL IR TY PNEUMOTHORAX $183.00 $173.00 02 DIAGNOSTIC IMAGING SUPP (0286302 S STRL IR TY THORA $216.00 $204.00 02 DIAGNOSTIC IMAGING SUPP (0253468 S STRL NR CEMENT KIT 11GA $617.50 02 DIAGNOSTIC IMAGING SUPP (0252049 S STRL NR GDC 5MM X 10C $1,361.00 02 DIAGNOSTIC IMAGING SUPP (0253104 S STRL NR KYPHOPAK 15/3 $9,615.00 02 DIAGNOSTIC IMAGING SUPP (0253153 S STRL NR KYPHOPAK 15/3 $6,539.00 02 DIAGNOSTIC IMAGING SUPP (0253203 S STRL NR KYPHOPAK 20/3 $9,615.00 02 DIAGNOSTIC IMAGING SUPP (0253252 S STRL NR KYPHOPAK 20/3 $6,539.00 02 DIAGNOSTIC IMAGING SUPP (0253450 S STRL NR KYPHX BONE $3,779.00 02 DIAGNOSTIC IMAGING SUPP (0253401 S STRL NR KYPHX TOOL KIT $3,539.00 02 DIAGNOSTIC IMAGING SUPP (0253476 S STRL NR NDL BX 13GA 19C $235.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0264465 S STRL RF PROBE 2CMX15CM $758.00 02 DIAGNOSTIC IMAGING SUPP (0264523 S STRL RF PROBE 3.5CMX15C $1,152.00 02 DIAGNOSTIC IMAGING SUPP (0264481 S STRL RF PROBE 3CMX15CM $983.00 02 DIAGNOSTIC IMAGING SUPP (0264549 S STRL RF PROBE 4CMX15CM $1,348.00 02 DIAGNOSTIC IMAGING SUPP (0252254 S STRL SUCTION CANISTER/F $200.00 02 DIAGNOSTIC IMAGING SUPP (0241026 S STRL TUBE $60.00 02 DIAGNOSTIC IMAGING SUPP (0272104 STENT COAT/COV NO DEL SYS $630.00 02 DIAGNOSTIC IMAGING SUPP (0276626 STENT NOCOAT W DEL SYS $2,531.00 $2,531.00 02 DIAGNOSTIC IMAGING SUPP (0276105 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276022 STENT NOCOAT W DEL SYS $4,061.00 $4,061.00 02 DIAGNOSTIC IMAGING SUPP (0276162 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276469 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276287 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276006 STENT NOCOAT W DEL SYS $4,061.00 $4,061.00 02 DIAGNOSTIC IMAGING SUPP (0276824 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276543 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276527 STENT NOCOAT W DEL SYS $3,959.00 $3,959.00 02 DIAGNOSTIC IMAGING SUPP (0276501 STENT NOCOAT W DEL SYS $4,836.00 $4,836.00 02 DIAGNOSTIC IMAGING SUPP (0276485 STENT NOCOAT W DEL SYS $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276246 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276048 STENT NOCOAT W DEL SYS $4,170.00 02 DIAGNOSTIC IMAGING SUPP (0276063 STENT NOCOAT W DEL SYS $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276089 STENT NOCOAT W DEL SYS $3,134.00 $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276121 STENT NOCOAT W DEL SYS $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276147 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276188 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276329 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276220 STENT NOCOAT W DEL SYS $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276428 STENT NOCOAT W DEL SYS $3,357.00 $3,357.00 02 DIAGNOSTIC IMAGING SUPP (0276261 STENT NOCOAT W DEL SYS $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276816 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276303 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276345 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276360 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276402 STENT NOCOAT W DEL SYS $3,357.00 $3,357.00 02 DIAGNOSTIC IMAGING SUPP (0276204 STENT NOCOAT W DEL SYS $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0252452 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0252437 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252494 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252486 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252478 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252312 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252528 STENT NOCOAT W DEL SYS $11,632.50 02 DIAGNOSTIC IMAGING SUPP (0252460 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252536 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252445 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (0252379 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252387 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252395 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252411 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252429 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (0276717 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0276766 STENT NOCOAT W DEL SYS $6,237.50 02 DIAGNOSTIC IMAGING SUPP (0276808 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276568 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276584 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276790 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0252510 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0276774 STENT NOCOAT W DEL SYS $5,625.00 02 DIAGNOSTIC IMAGING SUPP (0276758 STENT NOCOAT W DEL SYS $5,375.00 02 DIAGNOSTIC IMAGING SUPP (0276741 STENT NOCOAT W DEL SYS $6,237.50 02 DIAGNOSTIC IMAGING SUPP (0276733 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0276725 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0276600 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276683 STENT NOCOAT W DEL SYS $3,696.00 02 DIAGNOSTIC IMAGING SUPP (0276782 STENT NOCOAT W DEL SYS $5,625.00 02 DIAGNOSTIC IMAGING SUPP (0274902 STENT NO-COAT/COV W/O DEL $3,876.00 02 DIAGNOSTIC IMAGING SUPP (0274845 STENT NO-COAT/COV W/O DEL $3,795.00 $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274829 STENT NO-COAT/COV W/O DEL $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274860 STENT NO-COAT/COV W/O DEL $3,522.00 02 DIAGNOSTIC IMAGING SUPP (0274803 STENT NO-COAT/COV W/O DEL $4,023.00 $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274886 STENT NO-COAT/COV W/O DEL $2,630.00 $2,630.00 02 DIAGNOSTIC IMAGING SUPP (0276642 STENT NO-COR TMP W/DL SYS $3,600.00 02 DIAGNOSTIC IMAGING SUPP (0276667 STENT NON-COR TMP W/O DEL $3,200.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5020482 ANTI CITRATE DEXTROSE A $43.13 50 DIALYSIS SERVICES5020052 APHERESIS PLASMA $11,743.00 $7,354.00 50 DIALYSIS SERVICES5020664 APHERESIS PLASMA $11,743.00 50 DIALYSIS SERVICES5020441 CA GLUCONATE 10ML IJ $42.18 50 DIALYSIS SERVICES5020540 COLL BLD PICC/CNTRL LN $264.00 50 DIALYSIS SERVICES5020318 CRYOPRESERVE/STORAGE CELL $3,335.00 $2,089.00 50 DIALYSIS SERVICES5020557 DECLOT VASC DEVICE $450.00 50 DIALYSIS SERVICES5050331 DIALYS CAPD IP $532.00 $333.00 50 DIALYSIS SERVICES5050026 DIALYS CAPD IP $532.00 $333.00 50 DIALYSIS SERVICES5050307 DIALYS CAPD OP $362.00 50 DIALYSIS SERVICES5050067 DIALYS CCPD IP $1,843.00 $1,154.00 50 DIALYSIS SERVICES5020326 DIALYS EMER ESRD HOSP OP $1,470.50 50 DIALYSIS SERVICES5050018 DIALYS HEMO IP $3,059.00 $1,916.00 50 DIALYSIS SERVICES5050059 DIALYS HEMO IP $3,059.00 $1,916.00 50 DIALYSIS SERVICES5050091 DIALYS HEMOPERFUSION IP $6,972.00 $4,366.00 50 DIALYSIS SERVICES5040357 DIALYSIS HEMO OUTPT $1,424.00 50 DIALYSIS SERVICES5050299 DIALYSIS HEMO OUTPT $1,424.00 50 DIALYSIS SERVICES5030820 DIAZEPAM 5MG IJ 50 DIALYSIS SERVICES5020656 HARVST ALLOGENC STEM CELL $3,076.00 $1,927.00 50 DIALYSIS SERVICES5020649 HARVST AUTO STEM CELL $2,871.00 $1,798.00 50 DIALYSIS SERVICES5020433 HEPARIN 1000U IJ $6.24 50 DIALYSIS SERVICES5020623 INJ IVP SAME DRG EA >30M $98.33 50 DIALYSIS SERVICES5020607 INJ IVP SNGL/INIT DRG $146.00 50 DIALYSIS SERVICES5020466 INJECTION IM/SQ EA $207.00 50 DIALYSIS SERVICES5020474 LEVEL 1 EST PATIENT $540.00 50 DIALYSIS SERVICES5020565 LEVEL 1 EST PATIENT $540.00 50 DIALYSIS SERVICES5020599 LEVEL 1 NEW PATIENT $540.00 50 DIALYSIS SERVICES5020581 LEVEL 2 EST PATIENT $600.00 50 DIALYSIS SERVICES5020573 LEVEL 2 NEW PATIENT $600.00 50 DIALYSIS SERVICES5020508 MAGNESIUM SO4 500MG IJ $30.90 50 DIALYSIS SERVICES5020417 NA CL 0.9% 1000CC $3.96 50 DIALYSIS SERVICES5020425 NA CL 0.9% 250CC $3.51 50 DIALYSIS SERVICES5020342 S STRL BIOPATCH 1" $27.37 50 DIALYSIS SERVICES5020524 S STRL BLOOD SET Y-TYPE $10.68 50 DIALYSIS SERVICES5020359 S STRL BLOOD WARMING TBNG $55.09 50 DIALYSIS SERVICES5020490 S STRL CATH FISTULA NEEDL $2.99 50 DIALYSIS SERVICES5020334 S STRL CATH INSYTE $11.62 50 DIALYSIS SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5020367 S STRL KIT AUTO PBSC $1,045.00 50 DIALYSIS SERVICES5020409 S STRL KIT EXTND LIFE PLT $892.50 50 DIALYSIS SERVICES5020706 S STRL KIT RBC EXCH SET $892.50 50 DIALYSIS SERVICES5020698 S STRL KIT RBC EXCH SET $1,045.00 50 DIALYSIS SERVICES5020391 S STRL KIT RBC EXCH SET $1,045.00 50 DIALYSIS SERVICES5020375 S STRL KIT THRPTC PLSM EX $997.50 50 DIALYSIS SERVICES5020672 S STRL KIT THRPTC PLSM EX $997.50 50 DIALYSIS SERVICES5020631 S STRL KIT WBC - FC 50 DIALYSIS SERVICES5020383 S STRL KIT WBC/ PERIPH ST $1,026.00 50 DIALYSIS SERVICES5020680 S STRL KIT WBC/ PERIPH ST $1,026.00 50 DIALYSIS SERVICES5020201 S STRL PALL BLOOD FILTER $35.65 $35.65 50 DIALYSIS SERVICES5020532 VENIPUNCTURE $21.00 50 DIALYSIS SERVICES3840238 AD EVAL ABR $1,289.00 $1,114.00 38 EEG3840618 AD EVAL ABR $1,163.00 $1,114.00 38 EEG3810231 AD EVAL ABR $1,163.00 38 EEG3810074 AD EVAL ABR $1,197.00 $1,114.00 $386.00 38 EEG3840733 AD EVAL ABR $1,163.00 $1,114.00 38 EEG3820180 CPAP INITIAL DAY $746.00 38 EEG3820172 CPAP SUBSEQUENT DAY $169.00 38 EEG3874922 EEG ALL NIGHT RECORDING $1,013.00 38 EEG3810033 EEG AWAKE AND ASLEEP $1,505.00 $1,300.00 $541.50 38 EEG3810025 EEG AWAKE AND ASLEEP $1,505.00 $1,300.00 $505.75 38 EEG3810116 EEG AWAKE AND ASLEEP $1,505.00 $1,219.00 $541.50 38 EEG3874971 EEG AWAKE AND DROWSY $1,147.00 38 EEG3874930 EEG DIGITAL ANALYSIS $1,013.00 38 EEG3810082 EEG DURING SURGERY $1,718.00 $1,485.00 $769.00 38 EEG3840295 EEG GT 1 HR $1,606.00 $1,387.00 38 EEG3840790 EEG INSERT SPHEN ELECTR $304.00 38 EEG3874997 EEG MONITOR AMB EA 24HR $1,149.00 38 EEG3874948 EEG MONITOR W/DRG/ACTIVTN $682.00 38 EEG3830031 EEG RCD/INTRP/24HR UNATT $3,567.00 $3,416.00 38 EEG3874963 EEG RCD/INTRP/24HR UNATT $3,567.00 38 EEG3840675 EEG RCD/INTRP/24HR UNATT $3,567.00 $3,416.00 38 EEG3810058 EEG SLEEP $1,969.00 $1,701.00 38 EEG3874989 EEG UP TO 1HR $434.00 38 EEG3830015 EEG W/VIDEO RCRD/24HR $6,883.00 $5,360.00 38 EEG3830106 ELCTRDE STIM BRAIN ADD HR $2,444.00 38 EEG

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3830056 ELECTROCORTICOGRAM SURG $519.00 $1,685.00 38 EEG3840709 ELECTROCORTICOGRAM SURG 38 EEG3840691 ELECTROCORTICOGRAM SURG $1,039.00 $1,685.00 38 EEG3810355 ELECTROCORTICOGRAM SURG $1,039.00 38 EEG3810371 ELECTROCORTICOGRAM SURG $3,117.00 38 EEG3810363 ELECTROCORTICOGRAM SURG $2,078.00 38 EEG3840840 EMG ANAL/URETHRAL SPHNCTR $445.00 38 EEG3874849 EMG ANAL/URETHRAL SPHNCTR $1,153.00 38 EEG3875028 EMG ANAL/URETHRAL SPHNCTR $1,153.00 38 EEG3810306 EMG FOUR LIMBS $1,272.00 38 EEG3874831 EMG FOUR LIMBS $1,235.00 38 EEG3840832 EMG FOUR LIMBS $1,235.00 38 EEG3810330 EMG HEAD OR NECK BIL $2,408.00 38 EEG3810348 EMG HEAD OR NECK UNI $2,483.00 38 EEG3840865 EMG ONE FIBER $330.00 38 EEG3810272 EMG ONE LIMB $230.00 38 EEG3840808 EMG ONE LIMB $230.00 38 EEG3810298 EMG THREE LIMBS $767.00 38 EEG3840824 EMG THREE LIMBS $790.00 38 EEG3840816 EMG TWO LIMBS $1,240.00 38 EEG3810280 EMG TWO LIMBS $1,240.00 38 EEG3840907 H REFLX TEST GSTR/SOL UNI $132.00 38 EEG3820255 LEVEL 1 EST PATIENT $147.00 38 EEG3820198 LEVEL 2 EST PATIENT $171.00 38 EEG3840881 MTR NRV CNDCT STDY W/F EA $113.00 38 EEG3874880 MTR NRV CNDCT STDY W/F EA $113.00 38 EEG3875010 MTR NRV CNDCT STDY W/F EA $113.00 38 EEG3840915 NEURMSC JUNCTION TEST EA $371.00 38 EEG3830072 NEUROLOGICAL PROCEDURE $1,985.00 $1,714.00 38 EEG3840717 NEUROLOGICAL PROCEDURE $1,985.00 $1,714.00 38 EEG3874955 NEUROLOGICAL PROCEDURE $1,985.00 38 EEG3840873 NRV MOTOR CONDUCT STDY EA $111.00 38 EEG3875002 NRV MOTOR CONDUCT STDY EA $111.00 38 EEG3874898 NRV SNSRY CONDUCT STDY EA $88.00 38 EEG3840899 NRV SNSRY CONDUCT STDY EA $88.00 38 EEG3810181 NRV TEST IOP EA HOUR $5,628.00 38 EEG3810199 NRV TEST IOP EA HOUR $7,036.00 38 EEG

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3810173 NRV TEST IOP EA HOUR $4,221.00 38 EEG3810165 NRV TEST IOP EA HOUR $2,814.00 38 EEG3810157 NRV TEST IOP EA HOUR $1,407.00 38 EEG3820263 OXYGEN $25.00 38 EEG3820164 OXYGEN $25.00 38 EEG3810140 POLYSOM W/CPAP $2,865.00 38 EEG3810512 S STRL ELECT DEPTH (SD-8) $1,365.00 38 EEG3810504 S STRL ELECT EEG PLATINUM $49.00 38 EEG3810538 S STRL ELECT GRID (20/25) $3,134.00 38 EEG3810520 S STRL ELECT GRID (TW-16) $2,669.00 38 EEG3810546 S STRL ELECT GRID (TW-32) $3,731.00 38 EEG3810553 S STRL ELECT GRID (TW-64) $4,603.00 38 EEG3810561 S STRL ELECT STRIP (8/10) $2,924.00 38 EEG3810496 S STRL PASSING NDL $317.00 38 EEG3840089 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3810215 SEP LOWER LIMBS BIL $1,983.00 38 EEG3840279 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3840097 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3840105 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3840261 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3840469 SEP TRUNK/HEAD $1,868.00 $1,614.00 38 EEG3840485 SEP TRUNK/HEAD $1,868.00 $1,614.00 38 EEG3840162 SEP UPPER LIMBS BIL $1,970.00 $1,702.00 38 EEG3840170 SEP UPPER LIMBS BIL $1,970.00 $1,702.00 38 EEG3810207 SEP UPPER LIMBS BIL $1,970.00 38 EEG3810132 SLEEP STUDY ATTENDED $1,895.00 $1,637.00 $657.25 38 EEG3840931 SLP STUDY UNATD FULL ANAL $750.00 38 EEG3840923 SLP STUDY UNATD LTD ANAL $500.00 38 EEG3840857 STIMULUS EVOKED RESPONSE $445.00 38 EEG3840212 VISUAL EVOKED POTENT TEST $1,266.00 $1,094.00 38 EEG3810066 VISUAL EVOKED POTENT TEST $1,266.00 $1,094.00 $319.00 38 EEG5510938 ADMIN IMMUN EA ADD VACC $90.00 55 ER/URGENT CARE/TRAUMA5510920 ADMIN IMMUN SGL VACC $87.00 55 ER/URGENT CARE/TRAUMA5510755 AEROSOL TX SUBSQ $163.00 55 ER/URGENT CARE/TRAUMA5511001 ALCOHOL (ETHANOL) BREATH $145.00 55 ER/URGENT CARE/TRAUMA5511027 ARTERIAL PUNCTURE $154.00 55 ER/URGENT CARE/TRAUMA5510474 BLOOD TRANSFUSN 2-4 HR $1,889.00 55 ER/URGENT CARE/TRAUMA

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5510482 BLOOD TRANSFUSN 4-6 HR $2,970.00 55 ER/URGENT CARE/TRAUMA5510490 BLOOD TRANSFUSN GT 6HR $3,653.00 55 ER/URGENT CARE/TRAUMA5510664 BLOOD TRANSFUSN LT 2 HR $1,081.00 55 ER/URGENT CARE/TRAUMA5510045 CARDIOVERT ELECTIVE EXT $1,208.00 $1,208.00 55 ER/URGENT CARE/TRAUMA5542113 CATH INF PER CEN MID NOHD $118.79 55 ER/URGENT CARE/TRAUMA5542139 CATH INF PER CEN MID NOHD $41.97 55 ER/URGENT CARE/TRAUMA5542121 CATH INF PER CEN MID NOHD $190.00 55 ER/URGENT CARE/TRAUMA5510961 CATH SPECIMEN COLL SGL PT $103.00 55 ER/URGENT CARE/TRAUMA5511191 COLL BLD IMP VEN ACCS DEV $394.00 55 ER/URGENT CARE/TRAUMA5570221 COLL BLD PICC/CNTRL LN $264.00 55 ER/URGENT CARE/TRAUMA5510417 CPR $400.00 55 ER/URGENT CARE/TRAUMA5510904 CS DIFF MD ADD 15M $101.00 55 ER/URGENT CARE/TRAUMA5510896 CS DIFF MD GT5YR 0-30M $226.00 55 ER/URGENT CARE/TRAUMA5510888 CS DIFF MD LT5YR 0-30M $273.00 55 ER/URGENT CARE/TRAUMA5510870 CS SAME MD ADD 15M $91.00 55 ER/URGENT CARE/TRAUMA5510862 CS SAME MD GT5YR 0-30M $177.00 55 ER/URGENT CARE/TRAUMA5510854 CS SAME MD LT5YR 0-30M $189.00 55 ER/URGENT CARE/TRAUMA5510979 DRG SCRN MULTI PPE $51.00 55 ER/URGENT CARE/TRAUMA5510383 ED CC 1ST 30-74 MN $2,923.00 55 ER/URGENT CARE/TRAUMA5511167 ED CC 1ST 30-74 MN W/PROC $2,923.00 55 ER/URGENT CARE/TRAUMA5510391 ED CC EA ADD 30 MN $970.00 55 ER/URGENT CARE/TRAUMA5510334 ED LEVEL 1 $515.00 55 ER/URGENT CARE/TRAUMA5511118 ED LEVEL 1 W/PROC $515.00 55 ER/URGENT CARE/TRAUMA5510342 ED LEVEL 2 $794.00 55 ER/URGENT CARE/TRAUMA5511126 ED LEVEL 2 W/PROC $794.00 55 ER/URGENT CARE/TRAUMA5510359 ED LEVEL 3 $1,322.00 55 ER/URGENT CARE/TRAUMA5511134 ED LEVEL 3 W/PROC $1,322.00 55 ER/URGENT CARE/TRAUMA5510367 ED LEVEL 4 $2,025.00 55 ER/URGENT CARE/TRAUMA5511142 ED LEVEL 4 W/PROC $2,025.00 55 ER/URGENT CARE/TRAUMA5510375 ED LEVEL 5 $2,427.00 55 ER/URGENT CARE/TRAUMA5511159 ED LEVEL 5 W/PROC $2,427.00 55 ER/URGENT CARE/TRAUMA5510441 ED PROC MAJOR $1,143.00 55 ER/URGENT CARE/TRAUMA5510425 ED PROC MINOR $476.00 55 ER/URGENT CARE/TRAUMA5510268 EKG 12 LEAD TRACING ONLY $263.00 $263.00 55 ER/URGENT CARE/TRAUMA5510409 GLUCOSE FINGERSTICK $31.00 55 ER/URGENT CARE/TRAUMA5542097 GUIDEWIRE $103.79 55 ER/URGENT CARE/TRAUMA5510821 HYDRATN INFSN EA ADD HR $434.00 55 ER/URGENT CARE/TRAUMA

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5510813 HYDRATN INFSN INIT 31-60M $621.00 55 ER/URGENT CARE/TRAUMA5511175 HYDRATN INFSN INIT 31-60M $621.00 55 ER/URGENT CARE/TRAUMA5511068 INFLUENZA H1N1 VACC ADMIN $21.64 $21.64 55 ER/URGENT CARE/TRAUMA5510847 INFSN W/MED ADD SEQ 16-60 $425.00 55 ER/URGENT CARE/TRAUMA5511050 INFSN W/MED CONCURRENT $378.00 55 ER/URGENT CARE/TRAUMA5511043 INFSN W/MED EA ADD HR $357.00 55 ER/URGENT CARE/TRAUMA5510839 INFUSION W/MED 16-60MN $621.00 55 ER/URGENT CARE/TRAUMA5511209 INFUSION W/MED 16-60MN $577.00 55 ER/URGENT CARE/TRAUMA5570205 INJ IVP ADDL SEQ NEW DRG $188.00 55 ER/URGENT CARE/TRAUMA5511225 INJ IVP ADL SQ NEW DRG $175.00 55 ER/URGENT CARE/TRAUMA5570239 INJ IVP SAME DRG EA >30M $77.00 55 ER/URGENT CARE/TRAUMA5510615 INJ IVP SNGL/INIT DRG $218.00 55 ER/URGENT CARE/TRAUMA5511183 INJ IVP SNGL/INIT DRG $218.00 55 ER/URGENT CARE/TRAUMA5510607 INJECTION IM/SQ EA $274.00 55 ER/URGENT CARE/TRAUMA5542105 INTRO/SHEATH NON-LASER $163.82 55 ER/URGENT CARE/TRAUMA5542089 INTRO/SHEATH NON-LASER $46.69 55 ER/URGENT CARE/TRAUMA5541677 LIDO/EPI $119.00 55 ER/URGENT CARE/TRAUMA5541669 LIDOCAINE $119.00 55 ER/URGENT CARE/TRAUMA5541818 NA BICARB $136.00 55 ER/URGENT CARE/TRAUMA5541339 NA CL 0.9% 500ML $5.00 55 ER/URGENT CARE/TRAUMA5510672 OPHTHALMOLOGY EXAM $112.00 55 ER/URGENT CARE/TRAUMA5511035 PHLEBOTOMY THERAPEUTIC $648.00 55 ER/URGENT CARE/TRAUMA5510995 PREGNANCY SCRN UR $74.00 55 ER/URGENT CARE/TRAUMA5541537 S NSTRL BLANKET WARMER $45.00 55 ER/URGENT CARE/TRAUMA5541446 S NSTRL KIT, HEART NEB $71.00 55 ER/URGENT CARE/TRAUMA5541487 S NSTRL MASK AEROSOL, PED $4.00 55 ER/URGENT CARE/TRAUMA5541511 S NSTRL MASK NON-REBREATH $11.00 55 ER/URGENT CARE/TRAUMA5541495 S NSTRL MASK O2, ADLT $4.00 55 ER/URGENT CARE/TRAUMA5541503 S NSTRL MASK O2, PED $5.00 55 ER/URGENT CARE/TRAUMA5541651 S NSTRL METER, PEAK FLOW $57.00 55 ER/URGENT CARE/TRAUMA5541461 S NSTRL NASAL CAN, INF $18.00 55 ER/URGENT CARE/TRAUMA5541453 S NSTRL NASAL CAN, PED $11.00 55 ER/URGENT CARE/TRAUMA5541404 S NSTRL NASAL CANULA 7 FT $4.00 55 ER/URGENT CARE/TRAUMA5541529 S NSTRL NEB, HAND HELD $5.00 55 ER/URGENT CARE/TRAUMA5540570 S NSTRL PAD, PORTA $84.00 $80.00 55 ER/URGENT CARE/TRAUMA5541438 S NSTRL PADS, PACING $172.00 55 ER/URGENT CARE/TRAUMA5541974 S NSTRL RESUSCITATION BAG $114.00 55 ER/URGENT CARE/TRAUMA

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5541743 S STRL ABD PARACENT TY $279.00 55 ER/URGENT CARE/TRAUMA5542014 S STRL BOUGIE TRACH TUBE $275.00 55 ER/URGENT CARE/TRAUMA5541248 S STRL CATH AIRWAY $165.00 55 ER/URGENT CARE/TRAUMA5541313 S STRL CATH NASAL $184.00 55 ER/URGENT CARE/TRAUMA5540349 S STRL CAUTERY PENCIL $37.00 $34.00 55 ER/URGENT CARE/TRAUMA5541255 S STRL COMBITUBE $485.00 55 ER/URGENT CARE/TRAUMA5542154 S STRL COOK NEEDLE $23.43 55 ER/URGENT CARE/TRAUMA5541750 S STRL CRICO TY $843.00 55 ER/URGENT CARE/TRAUMA5541214 S STRL DERMABOND $134.00 55 ER/URGENT CARE/TRAUMA5541727 S STRL DISP CHEST TUBE TY $108.00 55 ER/URGENT CARE/TRAUMA5541735 S STRL DISP CUT DOWN TY $137.00 55 ER/URGENT CARE/TRAUMA5541768 S STRL DISP TRACH TY $659.00 55 ER/URGENT CARE/TRAUMA5541784 S STRL DISP VAG TY $80.00 55 ER/URGENT CARE/TRAUMA5541776 S STRL ER DEL TY $95.00 55 ER/URGENT CARE/TRAUMA5541966 S STRL FLUID WARMER TUBIN $75.00 55 ER/URGENT CARE/TRAUMA5541990 S STRL FOLEY TRAY WITH ME $72.00 55 ER/URGENT CARE/TRAUMA5540505 S STRL KIT GASTRIC LAVAGE $83.00 $78.00 55 ER/URGENT CARE/TRAUMA5542022 S STRL LARYNGEAL MASK AIR $78.00 55 ER/URGENT CARE/TRAUMA5541396 S STRL MASK NON-REBREATH $10.00 55 ER/URGENT CARE/TRAUMA5542030 S STRL MICROFINE SUTURE S $145.00 55 ER/URGENT CARE/TRAUMA5541263 S STRL MORGAN LENS $67.00 55 ER/URGENT CARE/TRAUMA5541289 S STRL NASAL DRESS $160.00 55 ER/URGENT CARE/TRAUMA5541792 S STRL NASAL SET $37.00 55 ER/URGENT CARE/TRAUMA5542048 S STRL NASAL/TONSIL BL TR $310.00 55 ER/URGENT CARE/TRAUMA5540596 S STRL NDL, SPINAL DISP. $8.00 $8.00 55 ER/URGENT CARE/TRAUMA5542147 S STRL RADIAL CATH KIT $60.11 55 ER/URGENT CARE/TRAUMA5541941 S STRL SCV02 CENTRAL LINE $1,361.00 55 ER/URGENT CARE/TRAUMA5541230 S STRL SET CRICO CATH $382.00 55 ER/URGENT CARE/TRAUMA5541222 S STRL SET RETRGRDE INTUB $239.00 55 ER/URGENT CARE/TRAUMA5541321 S STRL SPECULUM $8.00 55 ER/URGENT CARE/TRAUMA5541610 S STRL STPLR, SKIN $7.00 55 ER/URGENT CARE/TRAUMA5541578 S STRL SUT, ETL-FS NDL $13.00 55 ER/URGENT CARE/TRAUMA5541586 S STRL SUT, ETL-P NDL $25.00 55 ER/URGENT CARE/TRAUMA5541594 S STRL SUT, VIC $31.00 55 ER/URGENT CARE/TRAUMA5570213 S STRL TEMP SENSING FOLEY $133.42 55 ER/URGENT CARE/TRAUMA5541719 S STRL THORACOTOMY TY $239.00 55 ER/URGENT CARE/TRAUMA5542162 S STRL TRANVEN PACING ELE $541.87 55 ER/URGENT CARE/TRAUMA

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5541479 S STRL TY, LACERATION $42.00 55 ER/URGENT CARE/TRAUMA5542055 S STRL VASELINE GAUZE PKG $6.00 55 ER/URGENT CARE/TRAUMA5542006 S STRL WORD CATHETER $99.00 55 ER/URGENT CARE/TRAUMA5541693 S STRL WOUND IRR SET $8.00 55 ER/URGENT CARE/TRAUMA5541701 S STRL WOUND IRR SET $11.00 55 ER/URGENT CARE/TRAUMA5541628 S STRL XEROFORM DRESS $1.00 55 ER/URGENT CARE/TRAUMA5540463 SEMI-RIGID 2PC CERV CLR $88.00 $83.00 55 ER/URGENT CARE/TRAUMA5541800 SEMI-RIGID 2PC CERV CLR $101.00 55 ER/URGENT CARE/TRAUMA5541982 SURGICEL $186.00 55 ER/URGENT CARE/TRAUMA5510458 TEMP TRANSCUTANEOUS PACE $630.00 55 ER/URGENT CARE/TRAUMA5510680 THROMBOLYSIS CORO IV $2,536.00 55 ER/URGENT CARE/TRAUMA5510946 TUBERCULN SKIN TEST INTRA $78.00 55 ER/URGENT CARE/TRAUMA5510987 URNALYSIS MAN W/O MICRO $31.00 55 ER/URGENT CARE/TRAUMA5570270 VENI <3YR SCALP VEIN MD $161.00 55 ER/URGENT CARE/TRAUMA5570288 VENI <3YRS AGE MD SKILL $161.00 55 ER/URGENT CARE/TRAUMA5511019 VENIPUNCTURE $25.00 55 ER/URGENT CARE/TRAUMA5300504 NM RADIATION PHYSICS CNSL 53 GAMMA KNIFE NEUROSCIENCE5300546 RO DVCS CONSTRUCT CMPLX 2 53 GAMMA KNIFE NEUROSCIENCE5300520 RO DVCS CONSTRUCT CMPLX 2 53 GAMMA KNIFE NEUROSCIENCE5300538 RO DVCS CONSTRUCT CMPLX 2 53 GAMMA KNIFE NEUROSCIENCE5300553 RO DVCS CONSTRUCT CMPLX 2 53 GAMMA KNIFE NEUROSCIENCE5300496 RO SIMULATION 3D 53 GAMMA KNIFE NEUROSCIENCE5300314 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300306 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300488 RO SIMULATION 3D 53 GAMMA KNIFE NEUROSCIENCE5300322 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300470 RO SIMULATION 3D 53 GAMMA KNIFE NEUROSCIENCE5300512 RO SPECIAL TX PROCEDURE 53 GAMMA KNIFE NEUROSCIENCE5300462 RO SRS MLTSRC CO 60 CPLX 53 GAMMA KNIFE NEUROSCIENCE5300223 RO SRS MLTSRC CO 60 CPLX $18,944.00 53 GAMMA KNIFE NEUROSCIENCE5300454 RO SRS MLTSRC CO 60 INTM 53 GAMMA KNIFE NEUROSCIENCE5300215 RO SRS MLTSRC CO 60 INTM $18,944.00 53 GAMMA KNIFE NEUROSCIENCE5300447 RO SRS MLTSRC CO 60 STND 53 GAMMA KNIFE NEUROSCIENCE5300207 RO SRS MLTSRC CO 60 STND $18,944.00 53 GAMMA KNIFE NEUROSCIENCE1569797 FLUPHENAZINE 15 HEALTH & NUTRITION SVS6170187 ADHESION BARRIER SPINAL $1,056.13 61 IP OB/GYN SVS6170203 AMNIOCENTESIS DX $270.00 61 IP OB/GYN SVS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6130249 CIRCUMCISION $258.00 $258.00 61 IP OB/GYN SVS6110340 CPLX GENRL ANES ADD 15M $513.00 61 IP OB/GYN SVS6110332 CPLX GENRL ANES FIRST 30M $1,357.00 61 IP OB/GYN SVS6120711 CPLX PACU ADD 15M $428.00 $428.00 61 IP OB/GYN SVS6120885 CPLX PACU FIRST 30M $792.00 61 IP OB/GYN SVS6120992 CPR $216.00 61 IP OB/GYN SVS6110167 CRNA EPIDURAL MANAGEMENT $777.00 $777.00 61 IP OB/GYN SVS6120547 CST (CONTRAC STRESS TEST) $632.00 $632.00 61 IP OB/GYN SVS6121578 DELIVERY NON-LDR 61 IP OB/GYN SVS6120224 DELIVERY VAGINAL LEVEL 1 $3,664.00 $3,664.00 61 IP OB/GYN SVS6120018 DELIVERY VAGINAL LEVEL 2 $4,187.00 $4,187.00 61 IP OB/GYN SVS6121008 EKG 1-3 LEAD TRACING ONLY $70.00 61 IP OB/GYN SVS6121339 EXTERNAL VERSION $1,079.00 61 IP OB/GYN SVS6120901 EXTERNAL VERSION $1,079.00 61 IP OB/GYN SVS6121453 GLUCOSE FINGERSTICK $17.00 61 IP OB/GYN SVS6170088 HYDRATN INFSN EA ADD HR $235.00 61 IP OB/GYN SVS6170070 HYDRATN INFSN INIT 31-60M $336.00 61 IP OB/GYN SVS6170112 INFSN W/MED ADD SEQ 16-60 $230.00 61 IP OB/GYN SVS6170104 INFSN W/MED EA ADD HR $235.00 61 IP OB/GYN SVS6170096 INFUSION W/MED 16-60MN $336.00 61 IP OB/GYN SVS6110316 INJ BLOOD PATCH $467.00 61 IP OB/GYN SVS6120950 INJ BLOOD PATCH $467.00 61 IP OB/GYN SVS6170120 INJ IVP ADDL SEQ NEW DRG $102.00 61 IP OB/GYN SVS6170153 INJ IVP SAME DRG EA >30M $42.00 61 IP OB/GYN SVS6121487 INJECTION IM/SQ EA $148.00 61 IP OB/GYN SVS6121586 INSERT CERVICAL DILATOR 61 IP OB/GYN SVS6121594 INSRT BAKRI POSTPARTM BLN $726.00 61 IP OB/GYN SVS6120927 LABOR LEVEL 1 / HR-IP $486.00 61 IP OB/GYN SVS6120919 LABOR LEVEL 2 / HR-IP $608.00 61 IP OB/GYN SVS6120257 LACTATE RINGERS TO 1000CC $88.92 $88.92 61 IP OB/GYN SVS6121362 LEVEL 1 EST PATIENT $401.00 61 IP OB/GYN SVS6121354 LEVEL 1 NEW PATIENT $401.00 61 IP OB/GYN SVS6121388 LEVEL 2 EST PATIENT $512.00 61 IP OB/GYN SVS6121370 LEVEL 2 NEW PATIENT $512.00 61 IP OB/GYN SVS6121404 LEVEL 3 EST PATIENT $538.00 61 IP OB/GYN SVS6121396 LEVEL 3 NEW PATIENT $538.00 61 IP OB/GYN SVS6121420 LEVEL 4 EST PATIENT $712.00 61 IP OB/GYN SVS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6121412 LEVEL 4 NEW PATIENT $712.00 61 IP OB/GYN SVS6121446 LEVEL 5 EST PATIENT $932.00 61 IP OB/GYN SVS6121438 LEVEL 5 NEW PATIENT $932.00 61 IP OB/GYN SVS6110118 MAC ADD 15M $112.00 $112.00 61 IP OB/GYN SVS6110308 MAC FIRST 30M $445.00 61 IP OB/GYN SVS6120141 NST (NON-STRESS TEST) $373.00 $373.00 61 IP OB/GYN SVS6121081 NST MULTI GEST $694.00 $694.00 61 IP OB/GYN SVS6120133 OCT (OXYTOCIN CHLNG TEST) $632.00 $632.00 61 IP OB/GYN SVS6121016 PULSE OXIMETRY-SINGLE $52.00 61 IP OB/GYN SVS6110324 PULSE OXIMETRY-SINGLE $52.00 61 IP OB/GYN SVS6110290 REG ADD 15M $174.00 61 IP OB/GYN SVS6110282 REG FIRST 30M $439.00 61 IP OB/GYN SVS6170195 S NSTRL SLEEVE SCD KNEE $94.50 61 IP OB/GYN SVS6121511 S NSTRL SPECULUM $7.35 61 IP OB/GYN SVS6170260 S STRL ALEXIS O C/S RETR $216.75 $216.75 61 IP OB/GYN SVS6170278 S STRL ALEXIS O C/S RETR $284.75 61 IP OB/GYN SVS6100010 S STRL DERMABOND PEN $127.54 61 IP OB/GYN SVS6100028 S STRL SURGICAL $247.60 61 IP OB/GYN SVS6121198 S STRL AMNIHOOK $4.62 61 IP OB/GYN SVS6120463 S STRL AUTO SUTURE $41.74 $41.74 61 IP OB/GYN SVS6170229 S STRL BAKRI BALLOON CATH $867.00 61 IP OB/GYN SVS6140206 S STRL BLOOD WARMER COIL $75.00 $71.00 61 IP OB/GYN SVS6140529 S STRL BLOOF FILTER $298.00 61 IP OB/GYN SVS6121180 S STRL CATHETER RED ROBIN $2.93 61 IP OB/GYN SVS6140438 S STRL COMB SPINAL EPIDUR $56.00 $56.00 61 IP OB/GYN SVS6120430 S STRL DELEE, MUCOUS TRAP $66.83 $66.83 61 IP OB/GYN SVS6140040 S STRL ENDOTRACH TUBE $30.00 $28.00 61 IP OB/GYN SVS6110076 S STRL EPDRL TY $132.00 $132.00 61 IP OB/GYN SVS6140495 S STRL EPIDURAL NEEDLE $25.00 61 IP OB/GYN SVS6140149 S STRL ESOPH STETH W/TEMP $47.00 $44.00 61 IP OB/GYN SVS6121172 S STRL FETAL SCALP ELECTR $19.38 61 IP OB/GYN SVS6121156 S STRL FILTER PALL/LEUKOC $325.00 61 IP OB/GYN SVS6121560 S STRL FOLEY CATH W/BAG $41.11 61 IP OB/GYN SVS6121552 S STRL INTERCEED $1,106.70 61 IP OB/GYN SVS6121164 S STRL INTRAUTERINE PRESS $112.82 61 IP OB/GYN SVS6140487 S STRL IV CATH $13.00 61 IP OB/GYN SVS6120331 S STRL JELL ABBO ANGIOPRN $37.00 $35.00 61 IP OB/GYN SVS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6140396 S STRL KIT CVP 04301 $149.00 $141.00 61 IP OB/GYN SVS6110258 S STRL KIT CVP CATH $229.00 $216.00 61 IP OB/GYN SVS6121230 S STRL MERSILENE $181.00 61 IP OB/GYN SVS6140255 S STRL NASAL CAN $11.00 $10.00 61 IP OB/GYN SVS6121214 S STRL OX NASAL CANNULA $12.00 61 IP OB/GYN SVS6140792 S STRL OXYGEN FACE MASK $3.25 61 IP OB/GYN SVS6121297 S STRL PAD-GROUNDING $12.48 61 IP OB/GYN SVS6121305 S STRL PENCIL-BOVIE $17.00 61 IP OB/GYN SVS6140248 S STRL SALEM SUMP $12.00 $11.00 61 IP OB/GYN SVS6140172 S STRL SKIN TEMP PROBE $30.00 $28.00 61 IP OB/GYN SVS6110019 S STRL SPINAL NEEDLE $31.00 $31.00 61 IP OB/GYN SVS6110068 S STRL SPINAL TRAY $73.00 $73.00 61 IP OB/GYN SVS6140107 S STRL SUCTION CATHETER $2.00 $2.00 61 IP OB/GYN SVS6120794 S STRL SUTURES ADDL $25.00 $23.00 61 IP OB/GYN SVS6140461 S STRL SYRINGE GLASS 5 CC $38.00 $38.00 61 IP OB/GYN SVS6140099 S STRL T & A SUC TIP $11.00 $10.00 61 IP OB/GYN SVS6121222 S STRL THERMAL BLANKET $37.65 61 IP OB/GYN SVS6120273 S STRL TRANSF PUMP TUBE $43.00 $40.00 61 IP OB/GYN SVS6140784 S STRL TRANSF PUMP TUBE $43.00 61 IP OB/GYN SVS6121545 S STRL ULTRAFOAM $185.54 61 IP OB/GYN SVS6120422 S STRL VAC EXTRACTOR $126.68 $126.68 61 IP OB/GYN SVS6170179 S STRL VISCERA RETAINER $94.50 61 IP OB/GYN SVS6140388 S STRL WARMING BLANKET $143.00 $135.00 61 IP OB/GYN SVS6121271 S STRL WING CLIPS $69.00 61 IP OB/GYN SVS6121248 S STRL YANKAUR SUCTION $12.00 61 IP OB/GYN SVS6140156 S STRLL EPIDURAL NDL CATH $105.00 $105.00 61 IP OB/GYN SVS6110266 S STRLL PROBE PULSE OXIME $108.00 $102.00 61 IP OB/GYN SVS6110035 STND GENRL ANES ADD 15M $251.00 $251.00 61 IP OB/GYN SVS6110274 STND GENRL ANES FIRST 30M $491.00 61 IP OB/GYN SVS6120695 STND PACU LVL 1 ADD 15M $394.00 $394.00 61 IP OB/GYN SVS6120877 STND PACU LVL 1 FIRST 30M $557.00 61 IP OB/GYN SVS6120984 SURG LVL 1 ADD 15M $434.00 61 IP OB/GYN SVS6120893 SURG LVL 1 FIRST 30M $1,689.00 61 IP OB/GYN SVS6170252 SURG LVL 2 ADD 15M $546.00 61 IP OB/GYN SVS6120968 SURG LVL 2 FIRST 30M $1,869.00 61 IP OB/GYN SVS6120174 SURG LVL 3 ADD 15M $633.00 $633.00 61 IP OB/GYN SVS6120976 SURG LVL 3 FIRST 30M $2,914.00 61 IP OB/GYN SVS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

6120935 TRANSFUSION SRV FETAL $1,311.00 61 IP OB/GYN SVS6121321 TRANSFUSION SRV FETAL $1,311.00 61 IP OB/GYN SVS6170054 US AMNIOCENTESIS $83.00 61 IP OB/GYN SVS6170211 US AMNIOCENTESIS $316.00 61 IP OB/GYN SVS6170005 US BIO PROFILE W NONSTRES $911.00 $646.00 61 IP OB/GYN SVS6170047 US BIO PROFILE W NONSTRES $911.00 $646.00 61 IP OB/GYN SVS6170062 US FETAL TRANSFUSION IUT $2,047.00 61 IP OB/GYN SVS6170039 US OB LTD 1/MORE FETUSES $769.00 $545.00 61 IP OB/GYN SVS6170245 US OB MID CEREBRAL ARTERY $761.00 61 IP OB/GYN SVS6170237 US OB UMBILLICAL ARTERY $768.00 61 IP OB/GYN SVS6121461 VENIPUNCTURE $9.00 61 IP OB/GYN SVS9550369 DECLOT VASC DEVICE $212.00 $162.00 95 IV THERAPY9550427 INFUSN CHEMO 0-60 MN $293.00 $224.00 95 IV THERAPY9550260 INS PICC W/O PORT 5+ YR $1,037.00 $1,037.00 95 IV THERAPY9550336 INS PICC W/O PORT 5+ YR $730.00 $559.00 95 IV THERAPY9550385 PHLEBOTOMY THERAPEUTIC $210.00 $161.00 95 IV THERAPY9551540 REPR CV CATH W/O PORT $609.00 95 IV THERAPY9551557 S STRL 5F 3 PORT PWR PICC $594.00 $594.00 95 IV THERAPY9530049 S STRL DRESS BIOPATCH $32.00 95 IV THERAPY9530098 S STRL DRESS SURGICEL $103.00 95 IV THERAPY9530015 S STRL INTR KIT 3FR SL $330.00 95 IV THERAPY9530023 S STRL INTRO SAF KIT $330.00 95 IV THERAPY9530056 S STRL KIT MIDLINE CATH $235.00 95 IV THERAPY9530114 S STRL KIT NDL GUIDE $85.00 95 IV THERAPY9530064 S STRL KIT PICC CATH $396.00 95 IV THERAPY9530072 S STRL KIT PICC CATH 2 $564.00 95 IV THERAPY9551524 S STRL KIT PICC POWER 2 L $564.00 95 IV THERAPY9551532 S STRL KIT PICC POWER 3 L $594.00 95 IV THERAPY9530106 S STRL KIT SHEATH PROBE $47.00 95 IV THERAPY9530031 S STRL MICRO INTRODUCER $330.00 95 IV THERAPY9530080 S STRL NDL PORTA-CATH $37.00 95 IV THERAPY4000055 ALPHA 2 ANTIPLASMIN $205.00 $205.00 $109.99 40 LAB4000204 AT3 ACTIVITY $317.00 $317.00 $75.00 40 LAB4000253 AT3 AG IMMUNOLOGIC $291.00 $291.00 $36.00 40 LAB4040960 B CELLS TOTAL COUNT $676.00 $676.00 $50.00 40 LAB4040457 CD34 TOTAL COUNT $676.00 $676.00 $50.00 40 LAB4040929 CELL MARKR INTERPRET 16+ $100.00 $100.00 40 LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4040903 CELL MARKR INTERPRET 2-8 $80.00 $80.00 40 LAB4040911 CELL MARKR INTERPRET 9-15 $90.00 $90.00 40 LAB4040895 CELL MARKR TECH EA ADDL $35.00 $25.00 40 LAB4040887 CELL MARKR TECH ONLY 1ST $135.00 $50.00 40 LAB4050464 CHRMOSOM ADD CL CNT EA $43.00 40 LAB4050233 CHRMOSOM ADD KARY EA $115.00 40 LAB4050647 CHRMOSOM CNT/KARY $1,535.00 40 LAB4050332 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $770.75 40 LAB4050274 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $419.25 40 LAB4050084 CHRMOSOM CNT/KARY $769.00 $372.00 40 LAB4050076 CHRMOSOM CNT/KARY $769.00 $295.50 40 LAB4050399 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $510.00 40 LAB4050092 CHRMOSOM CNT/KARY $769.00 $440.00 $275.00 40 LAB4050100 CHRMOSOM CNT/KARY $769.00 $810.00 $540.00 40 LAB4050118 CHRMOSOM CNT/KARY $769.00 $535.00 $370.00 40 LAB4050688 CHRMOSOM CNT/KARY 40 LAB4050217 CHRMOSOM CNT/KARY $2,174.00 $2,174.00 $657.25 40 LAB4050126 CHRMOSOM CNT/KARY $2,174.00 $2,174.00 $367.50 40 LAB4050605 CHRMOSOM CNT/KARY $2,174.00 $2,174.00 $597.50 40 LAB4050134 CHRMOSOM HI RESD BND $174.00 $140.00 $121.00 40 LAB4050514 CHRMOSOM HI RESD BND $649.00 $524.00 $453.25 40 LAB4050142 CHRMOSOM HI RESD BND $519.00 $419.00 $362.00 40 LAB4050720 COL CHROM/MASS SPEC QNT 40 LAB4050548 CYTGNTC STUDY $632.00 $632.00 $46.50 40 LAB4040358 DNA ANALYSIS $170.00 $170.00 $133.50 40 LAB4050829 DNA PRB CYTGNTC >100 $275.00 40 LAB4050811 DNA PRB CYTGNTC 10 30 $266.00 $56.25 40 LAB4050803 DNA PRB CYTGNTC EA $266.00 $56.25 40 LAB4000402 EUGLOBULIN LYSIS $225.00 $225.00 $43.18 40 LAB4000451 FCTR II $351.00 $351.00 $96.60 40 LAB4000659 FCTR IX $509.00 $509.00 $96.60 40 LAB4000501 FCTR V $470.00 $470.00 $96.60 40 LAB4000550 FCTR VII $476.00 $476.00 $96.60 40 LAB4000600 FCTR VIII $476.00 $476.00 $96.60 40 LAB4001608 FCTR VIII VW $615.00 $615.00 $107.53 40 LAB4001558 FCTR VIII VW AG $615.00 $615.00 $102.64 40 LAB4000709 FCTR X $476.00 $476.00 $96.60 40 LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4000154 FCTR XA AB CHROMGN $317.00 $317.00 $103.00 40 LAB4000758 FCTR XI $476.00 $476.00 $96.60 40 LAB4000808 FCTR XII $516.00 $516.00 $96.60 40 LAB4000857 FCTR XIII SCRN $238.00 $238.00 $87.15 40 LAB4000907 FIBRINOGEN QN $225.00 $225.00 $42.25 40 LAB4040952 NATURAL KILLER CELLS $70.00 $70.00 $50.00 40 LAB4001400 PHOSPHLPD NUTRLZTN PLTLT $483.00 $483.00 $62.21 40 LAB4000956 PHOSPHLPD NUTRLZTN PLTLT $483.00 $483.00 $85.00 40 LAB4001251 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 40 LAB4001053 PLT AGGREGATION EA AGENT $668.00 $668.00 $80.85 40 LAB4001103 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 40 LAB4001202 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 40 LAB4001301 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 40 LAB4001152 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 40 LAB4001459 PROTEIN C ACTIVITY $370.00 $370.00 $125.00 40 LAB4001509 PROTEIN S ACTIVITY $410.00 $410.00 $140.00 40 LAB4000303 PTT SUBSTITUTION EA $172.00 $172.00 $94.75 40 LAB4001350 PTT SUBSTITUTION EA $172.00 $172.00 $159.78 40 LAB4040408 RETICULOCYTE AUTO $106.00 $106.00 $28.75 40 LAB4000352 RUSSELL VIPER VENOM DILU $258.00 $258.00 $62.21 40 LAB4060554 S STRL FTPADSEQUENTIALLG $248.46 40 LAB4060562 S STRL FTPADSEQUENTIALREG $248.46 40 LAB4040879 SERVICES AFTER OFFICE HRS $225.00 $212.00 $200.00 40 LAB4060547 SPEC HANDL TO REF LAB $79.00 $79.00 40 LAB4040804 T LYMPH CD4 (HELPER) CNT $648.00 $50.00 40 LAB4040978 T LYMPH CD4/8 CNT&RATIO $240.00 $50.00 40 LAB4040853 T LYMPH CD4/8 CNT&RATIO $240.00 $75.00 40 LAB4040937 T LYMPH TOT CNT $70.00 $70.00 $50.00 40 LAB4050225 TISSUE CULT AMNIO/CVS $666.00 40 LAB4050621 TISSUE CULT AMNIO/CVS $666.00 40 LAB4050340 TISSUE CULT BM/BLD $843.00 40 LAB4050282 TISSUE CULT LYMPH $719.00 40 LAB4050407 TISSUE CULT SKIN/SOLID BX $586.00 40 LAB4171187 CELL MARKR INTERPRET 16+ $19.24 41 LAB (CONTINUED)4171195 CELL MARKR TECH EA ADDL $15.11 41 LAB (CONTINUED)4171179 CELL MARKR TECH EA ADDL $8.55 41 LAB (CONTINUED)4171161 CELL MARKR TECH ONLY 1ST $14.96 41 LAB (CONTINUED)

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4170742 CHEM HISTOCHEMISTRY $408.00 41 LAB (CONTINUED)4170759 COPPER $133.56 41 LAB (CONTINUED)4170320 CYTOLOGY CONCENTRATION $408.00 $408.00 $75.00 41 LAB (CONTINUED)4170692 CYTOLOGY FLD $734.00 41 LAB (CONTINUED)4170288 CYTOLOGY PREP & INTERP $461.00 $461.00 $75.00 41 LAB (CONTINUED)4170767 CYTOLOGY SEL CELL ENHANCE $293.00 41 LAB (CONTINUED)4170528 CYTOLOGY UNLISTED $138.00 $130.00 41 LAB (CONTINUED)4170007 CYTP EVL FNA 1ST EVL EA $293.00 $293.00 41 LAB (CONTINUED)4170684 CYTP EVL FNA 1ST EVL EA $298.00 41 LAB (CONTINUED)4170023 DECALCIFICATION $195.00 $195.00 41 LAB (CONTINUED)4170841 DNA CL CYCLE $110.00 41 LAB (CONTINUED)4170551 DNA HISTOGRAM $62.00 $59.00 $38.33 41 LAB (CONTINUED)4170973 DNA PRB CYTGNTC >100 $74.17 41 LAB (CONTINUED)4171070 DNA PRB CYTGNTC >100 $145.20 41 LAB (CONTINUED)4170999 DNA PRB CYTGNTC >100 $60.00 41 LAB (CONTINUED)4170957 DNA PRB CYTGNTC >100 $180.00 41 LAB (CONTINUED)4171088 DNA PRB CYTGNTC >100 $202.20 41 LAB (CONTINUED)4170981 DNA PRB CYTGNTC EA $30.00 41 LAB (CONTINUED)4170940 DNA PRB CYTGNTC EA $60.00 41 LAB (CONTINUED)4171211 ENZYME CELL ACT NON-RAD $155.00 41 LAB (CONTINUED)4170429 ENZYME HISTOCHEMISTRY $426.00 $426.00 41 LAB (CONTINUED)4133864 IMMUNOFIX SER 41 LAB (CONTINUED)4170189 IMMUNOHISTOCHEMISTRY $311.00 $311.00 41 LAB (CONTINUED)4170171 IMMUNOHISTOCHEMISTRY $311.00 $311.00 41 LAB (CONTINUED)4170874 IMMUNOHISTOCHEMISTRY $97.50 41 LAB (CONTINUED)4170650 IMMUNOHISTOCHEMISTRY $84.00 $79.00 $52.00 41 LAB (CONTINUED)4170825 IMMUNOHISTOCHEMISTRY $84.17 41 LAB (CONTINUED)4170833 IMMUNOHISTOCHEMISTRY $84.17 41 LAB (CONTINUED)4170858 IMMUNOHISTOCHEMISTRY $116.95 41 LAB (CONTINUED)4170916 IMMUNOHISTOCHEMISTRY $107.10 41 LAB (CONTINUED)4170924 IMMUNOHISTOCHEMISTRY $142.90 41 LAB (CONTINUED)4170932 IN SITU HYBRIDIZ EA PROBE $142.90 41 LAB (CONTINUED)4170908 IN SITU HYBRIDIZ EA PROBE $192.00 41 LAB (CONTINUED)4170866 IN SITU HYBRIDIZ EA PROBE $330.00 41 LAB (CONTINUED)4171203 INSITU HYBRIDIZATION MAN $132.50 41 LAB (CONTINUED)4170114 INTERP BM SMR $899.00 $899.00 $298.75 41 LAB (CONTINUED)4170817 INTRAOP CYTOPATH CON ADDL $516.00 41 LAB (CONTINUED)

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SEQ 200 AMOUNT

DEPARTMENT CODE

4170809 INTRAOP CYTOPATH CON INIT $847.00 41 LAB (CONTINUED)4170643 IRON $145.91 $145.91 $145.91 41 LAB (CONTINUED)4171104 ML DX AMP TR NA EA SQ GT2 $33.00 41 LAB (CONTINUED)4171096 MOL DX AMP TR N ACD 2SEQ $62.00 41 LAB (CONTINUED)4171062 MOL DX AMP TR N ACD EA SQ $28.00 41 LAB (CONTINUED)4171021 MOL DX AMP TR N ACD EA SQ $72.00 41 LAB (CONTINUED)4171138 MOL DX AMP TR N ACD EA SQ $35.00 41 LAB (CONTINUED)4171120 MOL DX ENZ DIG EA ENZ TX $19.98 41 LAB (CONTINUED)4171054 MOL DX EXTN EA NA TYP $10.00 41 LAB (CONTINUED)4171047 MOL DX INTERP & RPT $30.00 41 LAB (CONTINUED)4171013 MOL DX ISO/EXT PRFD EA NA $20.00 41 LAB (CONTINUED)4171112 MOL DX LYS CLLS EA SPEC $26.00 41 LAB (CONTINUED)4171039 MOL DX SEP/ID HI RS EA NA $26.00 41 LAB (CONTINUED)4171146 MUTATION ID BY SEQ EA SEG $33.36 41 LAB (CONTINUED)4170064 OUTSD SLIDE CONSULT PREP $87.00 $82.00 $87.00 41 LAB (CONTINUED)4170130 PATH FRZN SECTION 1 BLK $399.00 $399.00 41 LAB (CONTINUED)4170148 PATH FRZN SECTION ADD $213.00 $213.00 41 LAB (CONTINUED)4170569 RECEPT ASSAY ESTROGEN $62.00 $59.00 $38.33 41 LAB (CONTINUED)4170577 RECEPT ASSAY PROGEST $62.00 $59.00 $38.33 41 LAB (CONTINUED)4170734 SPEC STAIN GRP I MICR I/R $142.00 41 LAB (CONTINUED)4170726 SPEC STAIN GRP I MICR I/R $142.00 41 LAB (CONTINUED)4170460 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170478 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170494 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170486 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170502 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170585 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $150.00 41 LAB (CONTINUED)4170718 SPEC STAIN GRP II INTRP/R $151.00 41 LAB (CONTINUED)4170510 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170197 SPEC STAIN GRP II INTRP/R $151.00 $151.00 41 LAB (CONTINUED)4170015 SURG PATH LVL I $216.00 $216.00 41 LAB (CONTINUED)4170031 SURG PATH LVL II $493.00 $493.00 $300.00 41 LAB (CONTINUED)4170411 SURG PATH LVL III $632.00 $632.00 41 LAB (CONTINUED)4170080 SURG PATH LVL IV $915.00 $915.00 $300.00 41 LAB (CONTINUED)4170106 SURG PATH LVL V $1,514.00 $1,514.00 $550.00 41 LAB (CONTINUED)4170072 SURG PATH LVL VI $2,108.00 $2,108.00 $550.00 41 LAB (CONTINUED)4170353 SURG PATH UNLISTED 41 LAB (CONTINUED)

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SEQ 200 AMOUNT

DEPARTMENT CODE

4170403 SURG PATH UNLISTED $85.00 $85.00 41 LAB (CONTINUED)4170452 SURG PATH UNLISTED $85.00 $85.00 41 LAB (CONTINUED)4170437 SURG PATH UNLISTED $85.00 $85.00 41 LAB (CONTINUED)4170395 SURG PATH UNLISTED $85.00 $85.00 $10.75 41 LAB (CONTINUED)4170379 SURG PATH UNLISTED $85.00 $85.00 $11.60 41 LAB (CONTINUED)4170445 SURG PATH UNLISTED $85.00 $85.00 41 LAB (CONTINUED)1130160 ADMIN INFLUENZA VACC $70.00 11 MISC NURSING CHARGES1130152 ADMIN PNEUMOCOCCAL VACC $70.00 11 MISC NURSING CHARGES1130566 CHEMO TX ADMN PRTL CAVITY $1,883.00 11 MISC NURSING CHARGES1120120 IMMUN ADMIN EA ADD VACCNE 11 MISC NURSING CHARGES1130483 OBS ADMIN INFLUENZA VACC $66.00 11 MISC NURSING CHARGES1130491 OBS ADMIN PNEUMOCOCAL VAC $30.00 11 MISC NURSING CHARGES1130673 OBS APP SPLNT SHRT ARM ST $569.00 11 MISC NURSING CHARGES1130624 OBS APPLY LONG ARM SPLINT $569.00 11 MISC NURSING CHARGES1130632 OBS APPLY LONG LEG SPLINT $569.00 11 MISC NURSING CHARGES1130186 OBS BLADDER IRRIG SMPL $101.00 11 MISC NURSING CHARGES1130004 OBS BLADDER IRRIG SMPL 11 MISC NURSING CHARGES1130012 OBS BLOOD TRANSFSN 2-4 HR $1,161.00 11 MISC NURSING CHARGES1130194 OBS BLOOD TRANSFSN 2-4 HR $1,161.00 11 MISC NURSING CHARGES1130020 OBS BLOOD TRANSFSN 4-6 HR $1,825.00 11 MISC NURSING CHARGES1130202 OBS BLOOD TRANSFSN 4-6 HR $1,825.00 11 MISC NURSING CHARGES1130038 OBS BLOOD TRANSFSN GT 6HR $2,245.00 11 MISC NURSING CHARGES1130210 OBS BLOOD TRANSFSN GT 6HR $2,245.00 11 MISC NURSING CHARGES1130046 OBS BLOOD TRANSFSN LT 2HR $664.00 11 MISC NURSING CHARGES1130228 OBS BLOOD TRANSFSN LT 2HR $664.00 11 MISC NURSING CHARGES1130509 OBS BONE MARROW ASP W/BX $439.00 11 MISC NURSING CHARGES1130459 OBS CARDIOVERT ELECT EXT $743.00 11 MISC NURSING CHARGES1130236 OBS CATH SPEC COLL SGL PT $10.00 11 MISC NURSING CHARGES1130590 OBS CL TX VT FX WO MANIP $110.00 11 MISC NURSING CHARGES1130517 OBS COL BLD PICC/CNTRL LN $85.00 11 MISC NURSING CHARGES1130244 OBS COLL BLD VNS ACCS DVC $242.00 11 MISC NURSING CHARGES1130251 OBS CPR $471.00 11 MISC NURSING CHARGES1130269 OBS DECLOT VASC DEVICE $115.00 11 MISC NURSING CHARGES1130665 OBS DRN ABSCESS SMPL/SNGL $361.00 11 MISC NURSING CHARGES1130277 OBS EKG 12 LEAD TRACING $162.00 11 MISC NURSING CHARGES1130285 OBS HYDRAT INF EA ADD HR $267.00 11 MISC NURSING CHARGES1130053 OBS HYDRAT INF EA ADD HR $267.00 11 MISC NURSING CHARGES

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SEQ 200 AMOUNT

DEPARTMENT CODE

1130293 OBS HYDRTN INF INIT 31-60 $382.00 11 MISC NURSING CHARGES1130061 OBS HYDRTN INF INIT 31-60 $382.00 11 MISC NURSING CHARGES1130301 OBS IJ IVP ADL SQ NEW DRG $116.00 11 MISC NURSING CHARGES1130079 OBS IJ IVP ADL SQ NEW DRG $116.00 11 MISC NURSING CHARGES1130319 OBS INF W/MED ADDSQ 16-60 $261.00 11 MISC NURSING CHARGES1130087 OBS INF W/MED ADDSQ 16-60 $261.00 11 MISC NURSING CHARGES1130327 OBS INF W/MED EA ADD HR $267.00 11 MISC NURSING CHARGES1130095 OBS INF W/MED EA ADD HR $267.00 11 MISC NURSING CHARGES1130541 OBS INFLU H1N1 VACC ADMIN $21.64 11 MISC NURSING CHARGES1130111 OBS INFSN W/MED 16-60MN $382.00 11 MISC NURSING CHARGES1130343 OBS INFSN W/MED 16-60MN $382.00 11 MISC NURSING CHARGES1130103 OBS INFSN W/MED CONCURRNT $382.00 11 MISC NURSING CHARGES1130335 OBS INFSN W/MED CONCURRNT $382.00 11 MISC NURSING CHARGES1130475 OBS INFUSN CHEM EA ADD HR $775.00 11 MISC NURSING CHARGES1130467 OBS INFUSN CHEMO 0-60 MN $893.00 11 MISC NURSING CHARGES1130350 OBS INJ IVP SNGL/INIT DRG $134.00 11 MISC NURSING CHARGES1130129 OBS INJ IVP SNGL/INIT DRG $134.00 11 MISC NURSING CHARGES1130608 OBS INJ MAJOR JNT BURSA $153.00 11 MISC NURSING CHARGES1130368 OBS INJECTION IM/SQ EA $168.00 11 MISC NURSING CHARGES1130137 OBS INJECTION IM/SQ EA $168.00 11 MISC NURSING CHARGES1130145 OBS INS NON-TUN CV CATH5+ $595.00 11 MISC NURSING CHARGES1130376 OBS INS NON-TUN CV CATH5+ $595.00 11 MISC NURSING CHARGES1130384 OBS INS PICC AGE 5 YRS/> $843.00 11 MISC NURSING CHARGES1130392 OBS INSERT CATH TMP SMPL $269.00 11 MISC NURSING CHARGES1130400 OBS INSRT BLADDER CATH $383.00 11 MISC NURSING CHARGES1130582 OBS IVP SME DRG EA >30M $37.00 11 MISC NURSING CHARGES1130640 OBS LAC SMPL 2.6-7.5CM $269.76 11 MISC NURSING CHARGES1130525 OBS LARYNGOSCOPY DX $966.00 11 MISC NURSING CHARGES1130558 OBS LUMBAR PUNCTURE DX $373.00 11 MISC NURSING CHARGES1130533 OBS PARACENT ABD INI $497.00 11 MISC NURSING CHARGES1130418 OBS PLACE NEEDLE IN VEIN $78.00 11 MISC NURSING CHARGES1130426 OBS PULSE OX MULTIPLE $153.00 11 MISC NURSING CHARGES1130434 OBS PULSE-OX OVRNITE CONT $211.00 11 MISC NURSING CHARGES1130442 OBS VENIPUNCTURE $11.00 11 MISC NURSING CHARGES1130657 OBSERVATION PER HOUR $220.00 11 MISC NURSING CHARGES6250013 OTOACOUSTC RESCREEN $280.00 62 NEONATAL/NEWBORN SERVICES6020069 CST (CONTRAC STRESS TEST) $647.00 $799.00 60 OP OB/GYN SVS

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SEQ 200 AMOUNT

DEPARTMENT CODE

6020143 GLUCOSE FINGERSTICK $17.00 60 OP OB/GYN SVS6020515 INFSN W/MED EA ADD HR $235.00 60 OP OB/GYN SVS6020507 INFUSION W/MED 16-60MN $336.00 60 OP OB/GYN SVS6020168 INJ IVP SNGL/INIT DRG $118.00 60 OP OB/GYN SVS6020150 INJECTION IM/SQ EA $148.00 60 OP OB/GYN SVS6020010 NST (NON-STRESS TEST) $373.00 $373.00 60 OP OB/GYN SVS6020374 NST MULTI GEST $694.00 60 OP OB/GYN SVS6020028 OCT (OXYTOCIN CHLNG TEST) $632.00 $632.00 60 OP OB/GYN SVS6020432 S STRL IV CATHETER OP $37.00 60 OP OB/GYN SVS6070007 US BIO PROFILE W NONSTRES $266.00 60 OP OB/GYN SVS6070056 US BIO PROFILE WO NOSTRES $207.00 60 OP OB/GYN SVS6070031 US OB FU/REEVAL EA FETUS $285.00 60 OP OB/GYN SVS6070023 US OB LTD 1/MORE FETUSES $225.00 60 OP OB/GYN SVS6070064 US OB UMBILLICAL ARTERY 60 OP OB/GYN SVS6020184 VENIPUNCTURE $9.00 60 OP OB/GYN SVS1810837 METHADONE 5MG PO 18 PHYSICIAN/CLINICIAN SERVI3021193 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3021227 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3021201 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3021136 AEROSOL TX DEMO/EVAL $642.00 30 PULMONARY SERVICES3020021 AEROSOL TX SUBSQ $250.00 $250.00 30 PULMONARY SERVICES3021219 AEROSOL TX SUBSQ $250.00 30 PULMONARY SERVICES3021235 AEROSOL TX SUBSQ $250.00 30 PULMONARY SERVICES3020567 AEROSOL TX SUBSQ $298.00 $135.00 30 PULMONARY SERVICES3010212 AIRWAY RESISTANCE $320.00 $144.00 30 PULMONARY SERVICES3030202 ARTERIAL PUNCTURE $281.00 30 PULMONARY SERVICES3010527 ARTERIAL PUNCTURE $281.00 30 PULMONARY SERVICES3021516 BD CONTINUOUS INITIAL DAY $1,421.00 30 PULMONARY SERVICES3021573 BD CONTINUOUS SUBSQ DAY $165.00 30 PULMONARY SERVICES3021367 BLD GAS ART $358.00 30 PULMONARY SERVICES3020047 BLD GASES W/O2 SAT $560.00 $422.00 30 PULMONARY SERVICES3021060 BLD GASES W/O2 SAT $541.00 30 PULMONARY SERVICES3021359 BODY FLUID PH NOS $320.00 30 PULMONARY SERVICES3020096 BREATH HYDROGEN TEST $528.00 $713.00 30 PULMONARY SERVICES3010014 BRONCHIAL PROVOCATION $1,933.00 $1,460.00 30 PULMONARY SERVICES3010451 BRONCHOSCOPY $1,652.00 30 PULMONARY SERVICES3010469 BRONCHOSCOPY INTERVENTN $1,867.00 30 PULMONARY SERVICES

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SEQ 200 AMOUNT

DEPARTMENT CODE

3021078 CALCIUM IONIZED $343.00 $517.00 30 PULMONARY SERVICES3030228 CAPILLARY PUNCTURE 30 PULMONARY SERVICES3050978 CBT 1ST HOUR $371.00 $342.00 30 PULMONARY SERVICES3050986 CBT EACH ADDL HOUR $165.00 $137.00 30 PULMONARY SERVICES3021029 CHLORIDE $166.00 30 PULMONARY SERVICES3010089 CO DIFFUSING CAPACITY $624.00 $282.00 30 PULMONARY SERVICES3051141 CO DIFFUSING CAPACITY $150.00 30 PULMONARY SERVICES3020666 CPAP/BIPAP INITIAL DAY $2,511.00 $1,134.00 30 PULMONARY SERVICES3021318 CPAP/BIPAP INITIAL DAY $2,511.00 30 PULMONARY SERVICES3021748 CPAP/BIPAP INITIAL DAY $288.24 30 PULMONARY SERVICES3021755 CPAP/BIPAP INITIAL DAY $2,511.00 30 PULMONARY SERVICES3051083 CPAP/BIPAP INITIAL DAY $288.24 30 PULMONARY SERVICES3020070 CPAP/BIPAP SUBSEQUENT DAY $2,511.00 $1,134.00 30 PULMONARY SERVICES3020203 CPAP/BIPAP SUBSEQUENT DAY $2,219.00 30 PULMONARY SERVICES3051091 CPAP/BIPAP SUBSEQUENT DAY $144.12 30 PULMONARY SERVICES3020443 CPT INITIAL $508.00 $230.00 30 PULMONARY SERVICES3020914 CPT INITIAL $508.00 30 PULMONARY SERVICES3020435 CPT INITIAL $340.00 $230.00 30 PULMONARY SERVICES3021599 CPT INITIAL $340.00 30 PULMONARY SERVICES3021607 CPT INITIAL $508.00 30 PULMONARY SERVICES3021581 CPT INITIAL $508.00 30 PULMONARY SERVICES3020625 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3020450 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3020237 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3021615 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3021623 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3021631 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3020005 EKG 12 LEAD TRACING $480.00 $217.00 30 PULMONARY SERVICES3021144 ETCO2 INIT DAY $982.00 30 PULMONARY SERVICES3010550 ETCO2 INIT DAY $982.00 30 PULMONARY SERVICES3010063 ETCO2 SUBSQ DAY $982.00 $444.00 30 PULMONARY SERVICES3010113 FUNCTIONAL RES CAP/VOL $515.00 $232.00 30 PULMONARY SERVICES3050994 GASTROESOPH REFLUX TEST $3,060.00 30 PULMONARY SERVICES3050911 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3051273 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3051307 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3020260 HELIOX THERAPY SUBSQ TX $4,455.00 $3,366.00 30 PULMONARY SERVICES

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SEQ 200 AMOUNT

DEPARTMENT CODE

3021052 HEMATOCRIT $88.00 30 PULMONARY SERVICES3020039 INHALATION TX PENTAMIDINE $445.00 $201.00 30 PULMONARY SERVICES3030558 INTUBATION ET EMERGENCY $325.00 30 PULMONARY SERVICES3020930 IPPB DEMO/EVAL $642.00 30 PULMONARY SERVICES3020948 IPPB TX SUBSEQUENT $298.00 30 PULMONARY SERVICES3020310 IPV DEMO/EVAL $642.00 $290.00 30 PULMONARY SERVICES3021425 IPV DEMO/EVAL $642.00 30 PULMONARY SERVICES3020757 IPV SUBSEQUENT $298.00 $135.00 30 PULMONARY SERVICES3021433 IPV SUBSEQUENT $298.00 30 PULMONARY SERVICES3010121 MAXIMAL VOLUNTARY VENT $369.00 $167.00 30 PULMONARY SERVICES3021110 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021466 MDI/NEB DEMO/EVAL $250.00 30 PULMONARY SERVICES3021508 MDI/NEB DEMO/EVAL $445.00 30 PULMONARY SERVICES3021490 MDI/NEB DEMO/EVAL $445.00 30 PULMONARY SERVICES3021482 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021474 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021458 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021441 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3020328 MDI/NEB SUBSQ $250.00 $250.00 30 PULMONARY SERVICES3021524 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021532 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021540 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021557 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021565 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3050895 NITRIC OXIDE $10,112.00 30 PULMONARY SERVICES3050879 NITRIC OXIDE $13,483.00 30 PULMONARY SERVICES3020385 OXYGEN $1,227.00 $1,158.00 30 PULMONARY SERVICES3050929 OXYGEN $1,337.00 30 PULMONARY SERVICES3020484 OXYGEN $1,937.00 $1,827.00 30 PULMONARY SERVICES3050952 OXYGEN $2,111.00 30 PULMONARY SERVICES3050135 OXYGEN $107.00 $101.00 30 PULMONARY SERVICES3050937 OXYGEN $1,049.00 30 PULMONARY SERVICES3051216 OXYGEN $1,337.00 30 PULMONARY SERVICES3051174 OXYGEN $2,111.00 30 PULMONARY SERVICES3010170 OXYGEN UPTAKE COMPLEX $1,274.00 $1,218.00 30 PULMONARY SERVICES3021342 PH BLD $217.00 30 PULMONARY SERVICES3021011 POTASSIUM $166.00 30 PULMONARY SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3010675 PULMONARY STRESS COMPLEX $1,395.00 30 PULMONARY SERVICES3010667 PULMONARY STRESS SIMPLE 30 PULMONARY SERVICES3010006 PULSE OXIMETRY MULTIPLE $455.00 $205.00 30 PULMONARY SERVICES3030145 PULSE OXIMETRY MULTIPLE $455.00 30 PULMONARY SERVICES3010618 PULSE OXIMETRY MULTIPLE $455.00 30 PULMONARY SERVICES3010147 PULSE OXIMETRY SINGLE $175.00 $79.00 30 PULMONARY SERVICES3010600 PULSE OXIMETRY SINGLE $175.00 30 PULMONARY SERVICES3010626 PULSE OX-OVERNIGHT CONT $628.00 30 PULMONARY SERVICES3010154 PULSE OX-OVERNIGHT CONT $628.00 $284.00 30 PULMONARY SERVICES3050044 S NSTRL DISP RESUS BAG $148.00 $139.00 30 PULMONARY SERVICES3050960 S NSTRL FLUTTER THER DEVI $337.00 30 PULMONARY SERVICES3050564 S NSTRL FTR EXCHANGE $25.00 30 PULMONARY SERVICES3050580 S NSTRL HEADGEAR BIPAP $187.00 30 PULMONARY SERVICES3050598 S NSTRL HFOV PT CIRCUIT $615.00 30 PULMONARY SERVICES3050119 S NSTRL MDI SPACER $43.00 $41.00 30 PULMONARY SERVICES3050150 S NSTRL OXYHOOD $86.00 $81.00 30 PULMONARY SERVICES3050168 S NSTRL PEAK FLOW METER $110.00 $104.00 30 PULMONARY SERVICES3050945 S NSTRL POP THERAPY DEVIC $337.00 30 PULMONARY SERVICES3051331 S NSTRL SPIROMTR INCNTV $175.00 30 PULMONARY SERVICES3050200 S NSTRL THERAPY VEST $225.00 $212.00 30 PULMONARY SERVICES3050226 S NSTRL TRANSP TRANSCUTAN $104.00 $98.00 30 PULMONARY SERVICES3050416 S STRL BAGS STR WATER $12.00 30 PULMONARY SERVICES3050010 S STRL CAN $26.00 $25.00 30 PULMONARY SERVICES3050424 S STRL CANNULA INFANT $17.00 30 PULMONARY SERVICES3050432 S STRL CANNULA PEDIATRIC $10.00 30 PULMONARY SERVICES3050440 S STRL CIRCUIT BIPAP $395.00 30 PULMONARY SERVICES3050465 S STRL CIRCUIT IPPB DISP $13.00 30 PULMONARY SERVICES3050473 S STRL CIRCUIT NEO TRANS $53.00 30 PULMONARY SERVICES3050481 S STRL CIRCUIT PEDI VENT $58.00 30 PULMONARY SERVICES3050507 S STRL CIRCUIT VENT MRI $45.00 30 PULMONARY SERVICES3050275 S STRL CONT MED NEB CIR $50.00 30 PULMONARY SERVICES3050036 S STRL CONT VENT TUBE $129.00 $122.00 30 PULMONARY SERVICES3030442 S STRL DRILL BIT TPS 30 PULMONARY SERVICES3050572 S STRL FLOW GENERATOR $227.00 30 PULMONARY SERVICES3050846 S STRL FORCEP BX $307.00 30 PULMONARY SERVICES3050556 S STRL FTR DISP BBT $24.00 30 PULMONARY SERVICES3050002 S STRL HAND HELD NEB TUBE $27.00 $25.00 30 PULMONARY SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3050051 S STRL HI FREQ VENT TUBI $402.00 $379.00 30 PULMONARY SERVICES3050077 S STRL INTUB TY $83.00 $78.00 30 PULMONARY SERVICES3050093 S STRL MASK $26.00 $25.00 30 PULMONARY SERVICES3050606 S STRL MASK AEROSOL PED $4.00 30 PULMONARY SERVICES3050614 S STRL MASK BIPAP $212.00 30 PULMONARY SERVICES3050622 S STRL MASK NON-REBREATH $11.00 30 PULMONARY SERVICES3050101 S STRL MASK NONREBREATHER $9.00 $9.00 30 PULMONARY SERVICES3050630 S STRL MASK SIMPLE PED $5.00 30 PULMONARY SERVICES3050648 S STRL MASK TRACH PED $6.00 30 PULMONARY SERVICES3050655 S STRL MASK VENTURI ADLT $14.00 30 PULMONARY SERVICES3050663 S STRL MASK VENTURI PED $12.00 30 PULMONARY SERVICES3050705 S STRL NEB PNEUMATIC $20.00 30 PULMONARY SERVICES3050127 S STRL OXISENSOR PROBE $124.00 $117.00 30 PULMONARY SERVICES3050739 S STRL PERCUSSOR NEOCUS $17.00 30 PULMONARY SERVICES3050903 S STRL PERCUTANEOUS CATH $3,220.00 30 PULMONARY SERVICES3050754 S STRL SPACER MDI $64.00 30 PULMONARY SERVICES3050762 S STRL SPIROMETER PED $61.00 30 PULMONARY SERVICES3050770 S STRL SWIVEL ADPTR TRACH $7.00 30 PULMONARY SERVICES3050796 S STRL TRACH T W/FLEX TUB $4.00 30 PULMONARY SERVICES3050218 S STRL TRACHEA COLLAR $27.00 $25.00 30 PULMONARY SERVICES3050812 S STRL TUBING SET BUNNELL $23.00 30 PULMONARY SERVICES3050713 S STRLL NEB PNEUMATIC $25.00 30 PULMONARY SERVICES3020229 SLEEP STUDY ATTENDED $6,157.00 $2,781.00 30 PULMONARY SERVICES3021003 SODIUM $166.00 30 PULMONARY SERVICES3010238 SPIROMETRY $1,116.00 $504.00 30 PULMONARY SERVICES3010709 SPIROMETRY $1,116.00 30 PULMONARY SERVICES3051109 SPIROMETRY $499.00 30 PULMONARY SERVICES3010220 SPIROMETRY PRE/POST BD $1,445.00 $652.00 30 PULMONARY SERVICES3010659 SPIROMETRY PRE/POST BD $1,379.00 30 PULMONARY SERVICES3051166 SPIROMETRY PRE/POST BD $275.00 30 PULMONARY SERVICES3020617 SPUTUM INDCTN VIA AEROSOL $901.00 $407.00 30 PULMONARY SERVICES3021649 SPUTUM INDCTN VIA AEROSOL $901.00 30 PULMONARY SERVICES3021334 SUCTION NASOTRACHEAL $191.00 30 PULMONARY SERVICES3021151 TCM INITIAL DAY $2,380.00 30 PULMONARY SERVICES3010261 TCM SUBSEQUENT DAY $1,968.00 $889.00 30 PULMONARY SERVICES3030111 THER PROC RESP FNCTN 15M $85.00 30 PULMONARY SERVICES3021326 THER PROC RESP FNCTN GRP $246.00 30 PULMONARY SERVICES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3030178 THER PROC STRNTH/ENDR 15M $85.00 30 PULMONARY SERVICES3010253 THORACIC GAS VOLUME $1,265.00 $571.00 30 PULMONARY SERVICES3051158 THORACIC GAS VOLUME $300.00 30 PULMONARY SERVICES3010329 TRACHEOBRONCH-EST TRACH $232.00 30 PULMONARY SERVICES3020963 VENT MGMNT CNP INIT DAY $5,020.00 30 PULMONARY SERVICES3020971 VENT MGMNT CNP SUBSQ DAY $5,020.00 30 PULMONARY SERVICES3021268 VENT MGMNT INIT NEO/PEDS $4,695.00 30 PULMONARY SERVICES3020708 VENT MGMNT INITIAL $4,093.00 $1,848.00 30 PULMONARY SERVICES3021409 VENT MGMNT INITIAL $4,095.00 $1,851.00 30 PULMONARY SERVICES3020732 VENT MGMNT INITIAL HF $4,807.00 $2,277.00 30 PULMONARY SERVICES3021722 VENT MGMNT INITIAL HF $4,807.00 30 PULMONARY SERVICES3020161 VENT MGMNT SUBSEQUENT $3,338.00 $1,508.00 30 PULMONARY SERVICES3021417 VENT MGMNT SUBSEQUENT $3,340.00 $1,510.00 30 PULMONARY SERVICES3020278 VENT MGMNT SUBSEQUENT HF $5,109.00 $2,419.00 30 PULMONARY SERVICES3021730 VENT MGMNT SUBSEQUENT HF $3,338.00 30 PULMONARY SERVICES3021276 VENT MGMNT SUBSQ NEO/PEDS $4,368.00 30 PULMONARY SERVICES3010188 VITAL CAPACITY $299.00 $135.00 30 PULMONARY SERVICES3010683 VITAL CAPACITY $299.00 30 PULMONARY SERVICES2810232 CARDIOVERT ELECTIVE EXT $1,983.00 28 RECOVERY SVS2810281 CPLX PACU ADD 15M $1,400.00 $770.00 28 RECOVERY SVS2810273 CPLX PACU FIRST 30M $2,821.00 $1,552.00 28 RECOVERY SVS2810240 INJ BLOOD PATCH $1,417.00 28 RECOVERY SVS2820132 S STRL AMBU BAG $155.00 $117.00 28 RECOVERY SVS2820801 S STRL DRAIN URINEMETER $63.00 $47.00 28 RECOVERY SVS2820082 S STRL KIT SUC CATH 14FR $5.00 $3.00 28 RECOVERY SVS2820116 S STRL SUCTION, YANKAUR $27.00 $21.00 28 RECOVERY SVS2810265 STND PACU LVL 2 ADD 15M $493.00 $271.00 28 RECOVERY SVS2810257 STND PACU LVL 2 FIRST 30M $1,304.00 $718.00 28 RECOVERY SVS2820827 VENIPUNCTURE $28.00 $26.00 28 RECOVERY SVS4230793 11 DEOXYCORTICOSTERONE $49.00 42 REFERENCE LAB4230009 11 DEOXYCORTISOL $8.25 42 REFERENCE LAB4230017 17 OH CORTICOSTEROIDS $31.15 42 REFERENCE LAB4230033 17 OH PREGNENOLONE $33.25 42 REFERENCE LAB4259867 17 OH PROGESTRONE $14.50 42 REFERENCE LAB4230041 17 OH PROGESTRONE $24.75 42 REFERENCE LAB4230066 5 HIAA UR $15.60 42 REFERENCE LAB4230058 5 NUCLEOTIDASE $16.05 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4230074 ACE (ANGIOTN CONVR ENZ) $12.00 42 REFERENCE LAB4235768 ACETYCHOLINE REC MOD AB $50.66 42 REFERENCE LAB4235743 ACETYLCHOLINE REC BIND AB $50.66 42 REFERENCE LAB4234233 ACETYLCHOLINE REC BLCK AB $48.00 42 REFERENCE LAB4235750 ACETYLCHOLINE REC BLCK AB $50.66 42 REFERENCE LAB4230082 ACETYLCHOLINE RECEPT AB $45.00 42 REFERENCE LAB4230108 ACID PHOS PROSTATIC $9.75 42 REFERENCE LAB4230124 ACTH $18.00 42 REFERENCE LAB4234019 ACTIN AB IGG $13.00 42 REFERENCE LAB4234258 ACYLCARNITINES QN EA $86.00 42 REFERENCE LAB4234241 ACYLCARNITINES QN EA $86.00 42 REFERENCE LAB4230132 ADENOVIRUS AB $22.00 42 REFERENCE LAB4256541 ADENOVIRUS DFA $216.00 $146.00 42 REFERENCE LAB4232898 ADENOVIRUS DFA $22.00 42 REFERENCE LAB4230280 ADH (VASOPRESSIN) $25.00 42 REFERENCE LAB4256707 AFB CULT $194.00 42 REFERENCE LAB4232823 AFB CULT $10.54 42 REFERENCE LAB4250684 AFB ISOLATE ID $30.87 $30.87 $30.87 42 REFERENCE LAB4250411 AFP AMNIOTIC FLD $30.00 $30.00 $30.00 42 REFERENCE LAB4250429 AFP AMNIOTIC FLD 42 REFERENCE LAB4230140 AFP TUMOR MARKER $11.00 42 REFERENCE LAB4256616 AG DETECT EIA MULT STEP $216.00 42 REFERENCE LAB4234761 AG DETECT EIA MULT STEP $24.00 42 REFERENCE LAB4230736 AG DETECT EIA MULT STEP $8.25 42 REFERENCE LAB4231940 AG DETECT NOS DNA AMP $85.00 42 REFERENCE LAB4233045 AG DETECT NOS EIA 1 STEP $29.40 42 REFERENCE LAB4230728 AG DETECT NOS EIA 1 STEP $23.00 42 REFERENCE LAB4232815 AG DETECT NOS EIA 1 STEP $47.16 42 REFERENCE LAB4233409 ALBUMIN FLD $9.00 42 REFERENCE LAB4233417 ALBUMIN SERUM/PLASMA/BLD $9.00 42 REFERENCE LAB4230165 ALDOLASE $8.50 42 REFERENCE LAB4230173 ALDOSTERONE $36.00 42 REFERENCE LAB4230181 ALK PHOS ISOENZYMES $17.00 42 REFERENCE LAB4234266 ALK PHOSPHATASE $29.49 42 REFERENCE LAB4231825 ALLERGEN SPECIFIC IGE QN $5.93 42 REFERENCE LAB4230199 ALPHA 1 ANTITRYPSIN $13.25 42 REFERENCE LAB4272100 ALPHA 1 ANTITRYPSIN $78.44 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4233458 ALPHA 2 ANTIPLASMIN $50.50 42 REFERENCE LAB4230215 ALUMINUM $22.00 42 REFERENCE LAB4234464 AMEBIC AB $19.00 42 REFERENCE LAB4230223 AMIKACIN $22.00 42 REFERENCE LAB4234274 AMIKACIN PK $15.00 42 REFERENCE LAB4234282 AMIKACIN TR $15.00 42 REFERENCE LAB4233078 AMINO ACIDS CSF >5 QN $96.50 42 REFERENCE LAB4233094 AMINO ACIDS CSF >5 QN $131.00 42 REFERENCE LAB4233086 AMINO ACIDS CSF >5 QN $164.26 42 REFERENCE LAB4230249 AMINO ACIDS MULT QL $62.78 42 REFERENCE LAB4254983 AMINO ACIDS PLAS >5 QN $150.00 $150.00 $150.00 42 REFERENCE LAB4230231 AMINO ACIDS SGL QN $49.00 42 REFERENCE LAB4254991 AMINO ACIDS UR >5 QN $150.00 $150.00 $150.00 42 REFERENCE LAB4230256 AMINO ACIDS UR MULT QL $19.00 42 REFERENCE LAB4232195 AMIODARONE $14.75 42 REFERENCE LAB4271995 ANA (ANTI NUCLEAR AB) $216.00 42 REFERENCE LAB4268009 ANA (ANTI NUCLEAR AB) $216.00 42 REFERENCE LAB4230272 ANA (ANTI NUCLEAR AB) $7.27 42 REFERENCE LAB4230553 ANA (ANTI NUCLEAR AB) $19.00 42 REFERENCE LAB4256756 ANA (ANTI NUCLEAR AB) 42 REFERENCE LAB4231692 ANA (ANTI NUCLEAR AB) $13.10 42 REFERENCE LAB4233136 ANA TTR $9.00 42 REFERENCE LAB4234290 ANCA IBD SCREEN $64.50 42 REFERENCE LAB4230264 ANDROSTENEDIONE $21.00 42 REFERENCE LAB4235529 ANDROSTENEDIONE $21.00 42 REFERENCE LAB4233961 ANDROSTENEDIONE $180.00 42 REFERENCE LAB4272001 ANTI DNA DBL STRAND $247.00 42 REFERENCE LAB4230835 ANTI DNA DBL STRAND $12.00 42 REFERENCE LAB4268017 ANTI DNA DBL STRAND $23.00 42 REFERENCE LAB4256764 ANTI DNA DBL STRAND 42 REFERENCE LAB4231718 ANTI DNA DBL STRAND $13.10 42 REFERENCE LAB4230843 ANTI DNA SINGL STRAND $31.15 42 REFERENCE LAB4256822 ANTI RNP AB 42 REFERENCE LAB4268074 ANTI RNP AB $23.00 42 REFERENCE LAB4272050 ANTI RNP AB $322.00 42 REFERENCE LAB4234985 ANTI SM AB $18.00 42 REFERENCE LAB4231650 ANTINEUTROPHILIC AB $28.50 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4272118 APOLIPOPROTEIN A1 $82.32 42 REFERENCE LAB4272126 APOLIPOPROTEIN B $82.32 42 REFERENCE LAB4233193 ARSENIC BLD $19.00 42 REFERENCE LAB4230306 ARSENIC UR $16.50 42 REFERENCE LAB4235222 ARSENIC UR $9.42 42 REFERENCE LAB4232708 ASCORBIC ACID $14.00 42 REFERENCE LAB4232427 ASO SCRN $9.75 42 REFERENCE LAB4270005 ASO TTR $116.00 42 REFERENCE LAB4230314 ASPERGILLUS AB $6.17 42 REFERENCE LAB4272159 ASSAY OF LIPOPROTEIN(A) $76.64 42 REFERENCE LAB4233466 AT3 AG IMMUNOLOGIC $26.00 42 REFERENCE LAB4230363 B PERTUSSIS/PARAPERT DFA $10.00 42 REFERENCE LAB4232948 B PERTUSSIS/PARAPERT DFA $26.00 42 REFERENCE LAB4279071 B/P-PERTUSSIS DNA QUL PCR $148.17 42 REFERENCE LAB4233110 BACTERIAL AG EA AG $16.50 42 REFERENCE LAB4230348 BENZODIAZEPINES $8.25 42 REFERENCE LAB4234530 BETA 2 GLYCOPROTN I AB EA $22.91 42 REFERENCE LAB4233482 BETA 2 GLYCOPROTN I AB EA $23.15 42 REFERENCE LAB4231148 BETA HCG QN $11.00 42 REFERENCE LAB4230330 BETA2 MICROGLOBULIN $19.95 42 REFERENCE LAB4272134 BETA2 MICROGLOBULIN $94.48 42 REFERENCE LAB4234662 BILE ACIDS TOTAL $112.00 42 REFERENCE LAB4259883 BIOTINIDASE ASSAY $14.50 42 REFERENCE LAB4233904 BIOTINIDASE ASSAY $53.57 42 REFERENCE LAB4234357 BIOTINIDASE ASSAY $108.08 42 REFERENCE LAB4234365 BK VIRUS DNA QUANT PCR $224.40 42 REFERENCE LAB4230355 BLASTOMYCES AB $19.35 42 REFERENCE LAB4235305 BLD CNT RBC AUTO $5.04 42 REFERENCE LAB4230967 BLD FATTY ACIDS $15.00 42 REFERENCE LAB4234332 BORELLIA BURG AMP PRB $125.00 42 REFERENCE LAB4230389 BORRELIA BURGD CONF $19.46 42 REFERENCE LAB4235495 BRUCELLA AB $10.50 42 REFERENCE LAB4230397 BRUCELLA AB $18.87 42 REFERENCE LAB4255311 C DIFFICILE TOXIN EIA $216.00 $216.00 $13.00 42 REFERENCE LAB4230686 C PEPTIDE $16.00 42 REFERENCE LAB4230694 C REACTIVE PROTEIN $9.74 42 REFERENCE LAB4230413 C1 ESTERASE INHIBITOR $17.00 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4270104 CA 15 3 (27.29) $371.00 42 REFERENCE LAB4235255 CADMIUM $9.42 42 REFERENCE LAB4233276 CAFFEINE $25.00 42 REFERENCE LAB4234415 CAFFEINE $20.00 42 REFERENCE LAB4232286 CALC ANALYSIS INFRARED $25.00 42 REFERENCE LAB4233037 CALC ANALYSIS INFRARED $25.00 42 REFERENCE LAB4230470 CALCITONIN $27.50 42 REFERENCE LAB4270203 CALCIUM IONIZED $243.00 42 REFERENCE LAB4230488 CALCIUM IONIZED $10.00 42 REFERENCE LAB4234225 CAMPLYOBACTER AB $65.00 42 REFERENCE LAB4256913 CANDIDA DNA DIR PROBE $49.60 42 REFERENCE LAB4235636 CARBOXYHEMOGLOBIN QN $52.90 42 REFERENCE LAB4235487 CARDIOLIPIN AB $22.91 42 REFERENCE LAB4256194 CARDIOLIPIN AB $29.10 42 REFERENCE LAB4233524 CARDIOLIPIN IGA AB $23.14 42 REFERENCE LAB4233508 CARDIOLIPIN IGG AB $23.14 42 REFERENCE LAB4233516 CARDIOLIPIN IGM AB $23.14 42 REFERENCE LAB4230504 CARNITINE FREE & TOTAL $31.00 42 REFERENCE LAB4230512 CAROTENE $15.00 42 REFERENCE LAB4230538 CATECHOL FRAC PLAS $25.00 42 REFERENCE LAB4230520 CATECHOL FRAC PLAS $27.50 42 REFERENCE LAB4235065 CATECHOL FRAC UR $13.75 42 REFERENCE LAB4235552 CATECHOLAMINES PLAS $13.75 42 REFERENCE LAB4230546 CEA $9.75 42 REFERENCE LAB4272068 CENTROMERE AB $252.00 42 REFERENCE LAB4256830 CENTROMERE AB 42 REFERENCE LAB4268082 CENTROMERE AB $23.00 42 REFERENCE LAB4270302 CERULOPLASMIN $190.00 42 REFERENCE LAB4230561 CERULOPLASMIN $9.75 42 REFERENCE LAB4234597 CHLAMYD PNEUMO AMP PRB $135.00 42 REFERENCE LAB4230587 CHLAMYDIA AB $17.50 42 REFERENCE LAB4234647 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234639 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234654 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234621 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB4234613 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB4234605 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

4255402 CHLAMYDIA AG DFA $181.00 $146.00 $13.00 42 REFERENCE LAB4234787 CHLAMYDIA CULT $58.50 42 REFERENCE LAB4255329 CHLAMYDIA CULT $299.00 $241.00 $27.73 42 REFERENCE LAB4259891 CHLAMYDIA TRACH AMP PRB $216.00 42 REFERENCE LAB4234589 CHLAMYDIA TRACH AMP PRB $30.00 42 REFERENCE LAB4255238 CHLAMYDIA TRACH DIR PRB $358.00 $358.00 $13.00 42 REFERENCE LAB4234449 CHLORIDE OTHER SOURCE $8.00 42 REFERENCE LAB4230603 CHOLINESTERASE RBC $24.00 42 REFERENCE LAB4234563 CHOLINESTERASE SER $7.75 42 REFERENCE LAB4230595 CHOLINESTERASE SER $24.75 42 REFERENCE LAB4235453 CHRMOSOM CNT/KARY 42 REFERENCE LAB4234522 CITRATE UR 24HR $18.00 42 REFERENCE LAB4235586 CMV AB IGG $11.00 42 REFERENCE LAB4230611 CMV AB IGG $11.00 42 REFERENCE LAB4232435 CMV AB IGG $8.68 42 REFERENCE LAB4235594 CMV AB IGM $11.00 42 REFERENCE LAB4230629 CMV AB IGM $11.00 42 REFERENCE LAB4232443 CMV AB IGM $8.68 42 REFERENCE LAB4235602 CMV AMP PRB $87.50 42 REFERENCE LAB4233912 CMV AMP PRB $87.50 42 REFERENCE LAB4232807 COCCI AB COMP FIX $47.16 42 REFERENCE LAB4232369 COCCI IMMUNO DIFFUSION $43.20 42 REFERENCE LAB4230637 COCCIDIOIDES AB $25.25 42 REFERENCE LAB4234688 COCCIDIOIDES AB IGG $43.50 42 REFERENCE LAB4234696 COCCIDIOIDES AB IGM $43.50 42 REFERENCE LAB4230405 COMPLEMENT C2 $17.00 42 REFERENCE LAB4279089 COMPLEMENT C3 $7.38 42 REFERENCE LAB4230421 COMPLEMENT C3 $8.00 42 REFERENCE LAB4231700 COMPLEMENT C3 $13.10 42 REFERENCE LAB4279097 COMPLEMENT C4 $7.38 42 REFERENCE LAB4230439 COMPLEMENT C4 $8.00 42 REFERENCE LAB4234670 COMPLEMENT C6 $33.25 42 REFERENCE LAB4230645 COMPLEMENT TOT (CH50) $11.00 42 REFERENCE LAB4279105 COMPLEMENT TOT (CH50) $12.24 42 REFERENCE LAB4230652 COPPER $15.00 42 REFERENCE LAB4234308 COPPER $15.00 42 REFERENCE LAB4230660 CORTISOL FREE SER $21.25 42 REFERENCE LAB

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4234316 CORTISOL FREE UR $21.25 42 REFERENCE LAB4230678 CORTISOL TOTAL $11.14 42 REFERENCE LAB4230702 CREATINE UR 24HR $13.00 42 REFERENCE LAB4235891 CREATININE FLD $10.50 42 REFERENCE LAB4235560 CREATININE UR $13.75 42 REFERENCE LAB4235073 CREATININE UR $13.75 42 REFERENCE LAB4235271 CREATININE UR RAN $9.42 42 REFERENCE LAB4270401 CRYOGLOB QL OR SEMI QL $28.00 42 REFERENCE LAB4230710 CRYOGLOB QL OR SEMI QL $7.00 42 REFERENCE LAB4231056 CRYOGLOBULIN QN $6.55 42 REFERENCE LAB4256517 CRYPTO AG DFA $216.00 42 REFERENCE LAB4256624 CRYPTOCOCCAL AG TTR AGGL $77.00 42 REFERENCE LAB4233169 CRYPTOCOCCAL AG TTR AGGL $16.50 42 REFERENCE LAB4230744 CRYPTOCOCCUS AB $25.00 42 REFERENCE LAB4256731 CRYPTOSPORIDIUM $216.00 42 REFERENCE LAB4256251 CULT BACT AEROBIC ID $146.00 42 REFERENCE LAB4256277 CULT BACT AEROBIC ID $146.00 42 REFERENCE LAB4232872 CULT BACT AEROBIC ID $28.00 42 REFERENCE LAB4256285 CULT BETA STREP A ONLY $119.00 42 REFERENCE LAB4250544 CULT BLD BACTERIA $186.00 $186.00 $13.00 42 REFERENCE LAB4256376 CULT CATHETER TIP $155.00 42 REFERENCE LAB4235628 CULT CMV $20.00 42 REFERENCE LAB4232880 CULT CMV $50.00 42 REFERENCE LAB4256368 CULT CSF $155.00 42 REFERENCE LAB4250585 CULT ENVIRONMENT $11.32 $11.32 42 REFERENCE LAB4256418 CULT FLUID $155.00 42 REFERENCE LAB4256426 CULT FLUID (ANAEROBIC) $168.00 42 REFERENCE LAB4250510 CULT FUNGUS BLD $159.00 $159.00 42 REFERENCE LAB4250528 CULT FUNGUS OTHER SOURCE $150.00 $150.00 $13.00 42 REFERENCE LAB4256921 CULT FUNGUS YEAST ID $44.00 42 REFERENCE LAB4256269 CULT FUNGUS YEAST ID $157.00 42 REFERENCE LAB4250536 CULT GC SCRN $119.00 $119.00 $13.00 42 REFERENCE LAB4256293 CULT GRP B STREP SCRN $119.00 42 REFERENCE LAB4232856 CULT HERPES $21.40 42 REFERENCE LAB4279030 CULT LEGIONELLA $30.00 42 REFERENCE LAB4234852 CULT LEGIONELLA $30.00 42 REFERENCE LAB4256319 CULT LOWER RESPIRATORY $155.00 42 REFERENCE LAB

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4256384 CULT MISC $155.00 42 REFERENCE LAB4256939 CULT MISC $74.63 42 REFERENCE LAB4234795 CULT MISC $84.63 42 REFERENCE LAB4256392 CULT MRSA SCRN $119.00 42 REFERENCE LAB4256327 CULT OTHER SOURCE AEROBIC $155.00 42 REFERENCE LAB4232922 CULT RSV $65.00 42 REFERENCE LAB4256434 CULT SCRN B PERTUSSUS $119.00 42 REFERENCE LAB4250627 CULT STL SALM & SHIG $168.00 $168.00 $13.00 42 REFERENCE LAB4250635 CULT STL YERSINIA EA PLT $9.56 $9.56 $9.56 42 REFERENCE LAB4256301 CULT THROAT $155.00 42 REFERENCE LAB4256335 CULT TISSUE (ANAEROBIC) $168.00 42 REFERENCE LAB4250569 CULT UR ID EACH ISOLATE $146.00 $146.00 $13.00 42 REFERENCE LAB4256400 CULT VRE SCRN $119.00 42 REFERENCE LAB4256350 CULT WND/ABSCESS ANAEROBE $168.00 42 REFERENCE LAB4256343 CULT WOUND AEROBIC $155.00 42 REFERENCE LAB4232849 CULTVIRAL $30.00 42 REFERENCE LAB4230751 CYANIDE $27.85 42 REFERENCE LAB4234340 CYANIDE SCRN $44.87 42 REFERENCE LAB4230769 CYCLIC AMP $80.00 42 REFERENCE LAB4234431 CYCLIC CITRUNILATED PEPTI $35.00 42 REFERENCE LAB4253308 CYCLOSPORINE $31.00 $31.00 $31.00 42 REFERENCE LAB4234373 CYSTATIN C $54.00 42 REFERENCE LAB4230777 CYSTICERCOSIS AB $50.00 42 REFERENCE LAB4230785 DELTA ALA $31.15 42 REFERENCE LAB4234399 DEOXYRIBNUCLEASE AB $16.00 42 REFERENCE LAB4230801 DESIPRAMINE $26.11 42 REFERENCE LAB4230827 DHEA $25.00 42 REFERENCE LAB4230819 DHEA SULFATE $12.00 42 REFERENCE LAB4234571 DIBUCAINE NUMBER $7.75 42 REFERENCE LAB4234407 DIHYDROTESTOSTERONE $30.00 42 REFERENCE LAB4234712 DIPTHERIA AB $25.12 42 REFERENCE LAB4230850 DOXEPIN $22.00 42 REFERENCE LAB4256657 DRG CONF $75.00 42 REFERENCE LAB4256640 DRG SCRN BLD VOLATILES $18.00 42 REFERENCE LAB4255030 DRG SCRN QL CHROM EA $33.00 $33.00 $33.00 42 REFERENCE LAB4254249 DRG SCRN QL CHROM EA $15.00 $15.00 $15.00 42 REFERENCE LAB4271979 EBV AB EARLY AG $45.82 42 REFERENCE LAB

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DEPARTMENT CODE

4256871 EBV AB EARLY AG $45.82 42 REFERENCE LAB4271987 EBV AB EBNA $53.45 42 REFERENCE LAB4256889 EBV AB EBNA $53.45 42 REFERENCE LAB4230868 EBV AB EBNA $14.45 42 REFERENCE LAB4230876 EBV AB VCA $12.00 42 REFERENCE LAB4234456 EBV DNA QNT PCR $129.00 42 REFERENCE LAB4271953 EBV VCA AB IGG $63.38 42 REFERENCE LAB4256855 EBV VCA AB IGG $63.38 42 REFERENCE LAB4271961 EBV VCA AB IGM $63.38 42 REFERENCE LAB4256863 EBV VCA AB IGM $63.38 42 REFERENCE LAB4233979 ELASTASE RIA $240.00 42 REFERENCE LAB4256152 ELECTRON MICROSCOPY $177.23 42 REFERENCE LAB4251518 ENA AB $21.00 $21.00 $21.00 42 REFERENCE LAB4230959 ENA AB $20.41 42 REFERENCE LAB4234472 ENDOMYSIAL AB SCRN $22.00 42 REFERENCE LAB4230884 ENTEROVIRUS AB $21.24 42 REFERENCE LAB4234001 ENTEROVIRUS RNA QUAL PCR $250.00 42 REFERENCE LAB4256137 ENZYME HISTOCHEMISTRY $62.45 42 REFERENCE LAB4230892 ERYTHROPOIETIN $20.43 42 REFERENCE LAB4235651 ESTRADIOL (E2) $17.00 42 REFERENCE LAB4230900 ESTRADIOL (E2) $19.55 42 REFERENCE LAB4230918 ESTRIOL $17.00 42 REFERENCE LAB4235669 ESTRIOL $17.00 42 REFERENCE LAB4230926 ESTROGEN TOTAL $26.00 42 REFERENCE LAB4230934 ESTRONE $27.00 42 REFERENCE LAB4235644 ESTRONE $17.00 42 REFERENCE LAB4230942 ETHOSUXIMIDE $17.10 42 REFERENCE LAB4233532 EUGLOBULIN LYSIS $41.40 42 REFERENCE LAB4230975 FAT STL QL $17.80 42 REFERENCE LAB4231684 FAT STL QN $44.80 42 REFERENCE LAB4233805 FCTR II $127.50 42 REFERENCE LAB4233540 FCTR II $78.00 42 REFERENCE LAB4250312 FCTR INHIBITOR TEST $72.50 $121.00 42 REFERENCE LAB4233656 FCTR INHIBITOR TEST $117.00 42 REFERENCE LAB4250064 FCTR INHIBITOR TEST $232.00 $232.00 $232.00 42 REFERENCE LAB4233672 FCTR INHIBITOR TEST $114.30 42 REFERENCE LAB4233649 FCTR INHIBITOR TEST $110.00 42 REFERENCE LAB

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4250056 FCTR INHIBITOR TEST $60.00 $60.00 $60.00 42 REFERENCE LAB4233581 FCTR IX $67.50 42 REFERENCE LAB4233847 FCTR IX $127.50 42 REFERENCE LAB4233813 FCTR V $127.50 42 REFERENCE LAB4233557 FCTR V $49.00 42 REFERENCE LAB4233821 FCTR VII $127.50 42 REFERENCE LAB4233565 FCTR VII $59.00 42 REFERENCE LAB4233573 FCTR VIII $45.00 42 REFERENCE LAB4233839 FCTR VIII $127.50 42 REFERENCE LAB4233771 FCTR VIII VW AG $59.00 42 REFERENCE LAB4250320 FCTR VIII VW AG $72.50 $121.00 42 REFERENCE LAB4233789 FCTR VIII VW MULTIMER $69.00 42 REFERENCE LAB4250072 FCTR VIII VW MULTIMER $135.00 $135.00 $135.00 42 REFERENCE LAB4233854 FCTR X $127.50 42 REFERENCE LAB4233599 FCTR X $59.00 42 REFERENCE LAB4233607 FCTR XI $49.00 42 REFERENCE LAB4233862 FCTR XI $127.50 42 REFERENCE LAB4233615 FCTR XII $49.00 42 REFERENCE LAB4233870 FCTR XII $127.50 42 REFERENCE LAB4233623 FCTR XIII $40.00 42 REFERENCE LAB4233888 FCTR XIII SCRN $50.00 42 REFERENCE LAB4230157 FEBRILE AGGLUTINS $13.20 42 REFERENCE LAB4230983 FERRITIN $8.25 42 REFERENCE LAB4233631 FIBRINOGEN QN $15.00 42 REFERENCE LAB4230991 FLUOR AB SCRN EA AB SCRN $15.00 42 REFERENCE LAB4231726 FLUOR AB SCRN EA AB SCRN $13.10 42 REFERENCE LAB4231015 FOLATE $5.70 42 REFERENCE LAB4231007 FOLATE RBC $19.90 42 REFERENCE LAB4232336 FREE T4 $8.30 42 REFERENCE LAB4235677 FREE T4 $22.00 42 REFERENCE LAB4231023 FRUCTOSAMINE $10.25 42 REFERENCE LAB4231031 FSH $8.75 42 REFERENCE LAB4234027 FSH PEDI 3RD GENE $28.50 42 REFERENCE LAB4232559 FTA ABS (TPPA) $8.85 42 REFERENCE LAB4231049 G6PD QN $14.00 42 REFERENCE LAB4256905 GARDNER VAG DNA DIR PROBE $49.60 42 REFERENCE LAB4234068 GASTRIC PARIETAL CELL AB $17.00 42 REFERENCE LAB

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DEPARTMENT CODE

4231064 GASTRIN $15.00 42 REFERENCE LAB4259909 GC AMP PRB $216.00 42 REFERENCE LAB4255246 GC DIR PRB $358.00 $358.00 $13.00 42 REFERENCE LAB4231072 GIARDIA AG DFA $25.00 42 REFERENCE LAB4256509 GIARDIA AG DFA $216.00 42 REFERENCE LAB4235537 GLIADIN AB IGA $30.00 42 REFERENCE LAB4234035 GLIADIN AB IGA $14.25 42 REFERENCE LAB4234043 GLIADIN AB IGG $14.25 42 REFERENCE LAB4231080 GLUCAGON $25.00 42 REFERENCE LAB4279006 GLUCOSE FINGERSTICK 42 REFERENCE LAB4234142 GNTYP NA HIV1 RVRS T/P RG $280.00 42 REFERENCE LAB4231106 GROWTH HORMONE $12.50 42 REFERENCE LAB4231114 GROWTH HORMONE $12.50 42 REFERENCE LAB4256723 H PYLORI (NOT STL) EIA $216.00 42 REFERENCE LAB4231171 H PYLORI AB IGG $10.00 42 REFERENCE LAB4231122 H PYLORI AB TOTAL $16.00 42 REFERENCE LAB4256749 H PYLORI STL EIA $110.00 $65.00 42 REFERENCE LAB4234076 HALOPERIDOL $22.00 42 REFERENCE LAB4270708 HAPTOGLOBIN QN $225.00 42 REFERENCE LAB4231130 HAPTOGLOBIN QN $10.00 42 REFERENCE LAB4231205 HAV AB IGM $10.00 42 REFERENCE LAB4231197 HAV AB TOTAL $8.75 42 REFERENCE LAB4231213 HB CORE AB IGM $11.25 42 REFERENCE LAB4231221 HB CORE AB IGM $8.90 42 REFERENCE LAB4272191 HB CORE AB TOTAL $70.40 42 REFERENCE LAB4231239 HB CORE AB TOTAL $10.75 42 REFERENCE LAB4231304 HBE AB $10.00 42 REFERENCE LAB4231247 HBE AB $8.90 42 REFERENCE LAB4231312 Hbe AG $10.00 42 REFERENCE LAB4231254 Hbe AG $8.90 42 REFERENCE LAB4231270 HBS AB $8.90 42 REFERENCE LAB4231262 HBS AB $9.50 42 REFERENCE LAB4231296 HBs AG $8.90 42 REFERENCE LAB4231288 HBs AG $8.25 42 REFERENCE LAB4233326 HBS AG $16.99 42 REFERENCE LAB4231320 HCV AB $9.74 42 REFERENCE LAB4231155 HCV AB CONF $66.00 42 REFERENCE LAB

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4233144 HCV AB CONF $73.50 42 REFERENCE LAB4231338 HDV (DELTA) AB $25.00 42 REFERENCE LAB4230298 HEAVY METALS BLD QN EA $37.80 42 REFERENCE LAB4231775 HEAVY METALS BLD QN EA $16.67 42 REFERENCE LAB4235263 HEAVY METALS UR QN EA $9.42 42 REFERENCE LAB4235321 HEMATOCRIT $5.04 42 REFERENCE LAB4235313 HEMOGLOBIN $5.04 42 REFERENCE LAB4259842 HEMOGLOBIN FRACTION QN $14.50 42 REFERENCE LAB4235339 HEMOGLOBIN FRACTION QN $5.04 42 REFERENCE LAB4231098 HEMOGLOBIN GLYCOSYLTD A1C $8.08 42 REFERENCE LAB4231189 HEMOGLOBIN PLAS $14.65 42 REFERENCE LAB4230090 HEMOLYSIN ACID (HAM'S) $42.50 42 REFERENCE LAB4233300 HEMOSIDERIN QL $17.34 42 REFERENCE LAB4233102 HEP B PCR QN $95.45 42 REFERENCE LAB4234084 HEP C VIRAL RNA GENOTYPE $80.00 42 REFERENCE LAB4234092 HEP C VIRAL RNA QL TMA $87.25 42 REFERENCE LAB4231163 HEP C VIRUS PCR QN $92.86 42 REFERENCE LAB4256962 HEP C VIRUS PCR QN $180.84 42 REFERENCE LAB4233797 HEPARIN ASSAY $82.00 42 REFERENCE LAB4233474 HEPARIN ASSAY $76.50 42 REFERENCE LAB4234829 HEPATITIS E AB IGG $47.00 42 REFERENCE LAB4234837 HEPATITIS E AB IGM $47.00 42 REFERENCE LAB4232799 HGB ELECTRO $25.00 42 REFERENCE LAB4231346 HISTAMINE $66.50 42 REFERENCE LAB4234100 HISTO CAPSULATUM AG EIA $87.00 42 REFERENCE LAB4256111 HISTO STAIN FRZN SECT I/R $18.94 42 REFERENCE LAB4272076 HISTONE AB $322.00 42 REFERENCE LAB4268090 HISTONE AB $23.00 42 REFERENCE LAB4256848 HISTONE AB 42 REFERENCE LAB4233953 HISTOPLAS AB $40.50 42 REFERENCE LAB4231353 HISTOPLAS AB $18.47 42 REFERENCE LAB4231379 HIV 1 QN PCR ULTRA $76.30 42 REFERENCE LAB4234118 HIV 1 RNA VIRAL LOAD PCR $175.00 42 REFERENCE LAB4231387 HIV 1/HIV 2 AB $8.75 42 REFERENCE LAB4233318 HIV AB CONF WESTERN BLOT $23.00 42 REFERENCE LAB4233128 HIV AB CONF WESTERN BLOT $75.50 42 REFERENCE LAB4231445 HIV AB CONF WESTERN BLOT $20.75 42 REFERENCE LAB

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DEPARTMENT CODE

4231361 HIV P24 AG $23.50 42 REFERENCE LAB4231395 HLA B27 $25.00 42 REFERENCE LAB4272209 HOMOCYSTINE $94.28 42 REFERENCE LAB4233334 HOMOCYSTINE $20.19 42 REFERENCE LAB4231403 HOMOVANILLIC ACID (HVA) $10.50 42 REFERENCE LAB4272092 HPV AMP PRB $98.08 42 REFERENCE LAB4270757 HPV AMP PRB $534.00 42 REFERENCE LAB4231429 HSV 1 AB IGG $15.00 42 REFERENCE LAB4232468 HSV AB $8.68 42 REFERENCE LAB4231411 HSV AB $24.10 42 REFERENCE LAB4232450 HSV AB $8.68 42 REFERENCE LAB4234159 HSV AB IGM $17.10 42 REFERENCE LAB4279022 HSV AB IGM TITER $17.10 42 REFERENCE LAB4233946 HSV AMP PRB $109.25 42 REFERENCE LAB4232989 HSV TYP 1 DFA $19.05 42 REFERENCE LAB4231437 HTLV 1 AB $38.45 42 REFERENCE LAB4234126 HTLV I/II WESTERN BLOT $23.28 42 REFERENCE LAB4234134 HTLV I/II WESTERN BLOT $23.28 42 REFERENCE LAB4231452 HYDROXYPROLINE FREE $48.30 42 REFERENCE LAB4231460 HYDROXYPROLINE TOTAL $50.98 42 REFERENCE LAB4235545 IGA $30.00 42 REFERENCE LAB4231478 IGD $21.00 42 REFERENCE LAB4232518 IGE $21.50 42 REFERENCE LAB4233425 IGG $9.00 42 REFERENCE LAB4231494 IGG SUBCLASSES $43.95 42 REFERENCE LAB4231502 IMMUNE COMPLEX CIQ BIND $16.25 42 REFERENCE LAB4230496 IMMUNOASSAY NONINFECT $23.50 42 REFERENCE LAB4233359 IMMUNOASSAY NONINFECT $20.00 42 REFERENCE LAB4250353 IMMUNOASSAY NOT SPEC $65.00 42 REFERENCE LAB4231510 IMMUNOASSAY NOT SPEC $42.00 42 REFERENCE LAB4231551 IMMUNOASSAY NOT SPEC $84.53 42 REFERENCE LAB4256202 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4256228 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4256210 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4230447 IMMUNOASSAY TUM AG EA $15.25 42 REFERENCE LAB4230454 IMMUNOASSAY TUM AG EA $15.30 42 REFERENCE LAB4230462 IMMUNOASSAY TUM AG EA $15.00 42 REFERENCE LAB

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4234555 IMMUNOASSAY TUM AG EA $29.00 42 REFERENCE LAB4272142 IMMUNOFIX SER $109.00 42 REFERENCE LAB4233151 IMMUNOFIX UR $25.00 42 REFERENCE LAB4272175 IMMUNOFIX UR $143.50 42 REFERENCE LAB4256145 IMMUNOFL STDY DRCT EA ANT $23.15 42 REFERENCE LAB4259875 IMMUNOREACTIV TRYPSINOGEN $14.50 42 REFERENCE LAB4256483 INDIA INK PREP CSF $75.00 42 REFERENCE LAB4232971 INFECT AGENT DETECT DFA $29.40 42 REFERENCE LAB4233011 INFECT AGENT DETECT DFA $18.04 42 REFERENCE LAB4272258 INFLU A H1N1 RNA RT PCR $627.00 $627.00 42 REFERENCE LAB4231528 INFLUENZA A AB $16.00 42 REFERENCE LAB4256558 INFLUENZA A DFA $216.00 $146.00 42 REFERENCE LAB4232906 INFLUENZA A DFA $12.50 42 REFERENCE LAB4256566 INFLUENZA B DFA $216.00 $146.00 42 REFERENCE LAB4232963 INFLUENZA B DFA $12.50 42 REFERENCE LAB4234191 INHIBIN A $50.00 42 REFERENCE LAB4231544 INSULIN $10.50 42 REFERENCE LAB4231536 INSULIN ANTIBODIES $41.08 42 REFERENCE LAB4234209 INSULIN FREE $29.00 42 REFERENCE LAB4234183 INSULIN GROWTH FCTR $60.00 42 REFERENCE LAB4234175 INTRINSIC FCTR AB $23.00 42 REFERENCE LAB4233003 IRON $7.75 42 REFERENCE LAB4231569 ISLET CL AB $25.00 42 REFERENCE LAB4256814 JO 1 AB 42 REFERENCE LAB4272043 JO 1 AB $252.00 42 REFERENCE LAB4268066 JO 1 AB $23.00 42 REFERENCE LAB4230025 KETOSTEROIDS 17 TOTAL $18.50 42 REFERENCE LAB4256491 KOH PREP SKIN HAIR NAIL $75.00 42 REFERENCE LAB4272027 LA (SS B) AB $322.00 42 REFERENCE LAB4268041 LA (SS B) AB $23.00 42 REFERENCE LAB4256798 LA (SS B) AB 42 REFERENCE LAB4234845 LACTOFERRIN FECAL QL $62.50 42 REFERENCE LAB4234381 LATEX HEVEA BRAZILIE IGE $7.35 42 REFERENCE LAB4231585 LDH ISOENZYMES $14.75 42 REFERENCE LAB4231593 LEAD BLD $9.20 42 REFERENCE LAB4231601 LEAD BLD $16.00 42 REFERENCE LAB4235230 LEAD UR $9.42 42 REFERENCE LAB

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4231619 LEGIONELLA AB IGG $11.50 42 REFERENCE LAB4231627 LEGIONELLA AB IGM $35.00 42 REFERENCE LAB4234753 LEGIONELLA PNEUMO DFA $35.00 42 REFERENCE LAB4231635 LEPTOSPIRA AN $32.00 42 REFERENCE LAB4231643 LEUCINE AMINOPEOTIDASE $32.00 42 REFERENCE LAB4231668 LH $15.00 42 REFERENCE LAB4235149 LH PEDI 3RD GENE $16.50 42 REFERENCE LAB4233052 LIDOCAINE $40.55 42 REFERENCE LAB4231676 LIPASE $6.50 42 REFERENCE LAB4279048 LIPID PNL $18.85 42 REFERENCE LAB4279055 LIPOPROTEIN (A) $18.82 42 REFERENCE LAB4279063 LIPOPROTEIN BLD BY NMR $44.40 42 REFERENCE LAB4235792 LIPROPROT BLD HI FRAC/QNT $16.00 42 REFERENCE LAB4235735 LONG CHAIN FATTY ACIDS $50.66 42 REFERENCE LAB4230371 LYME DISEASE AB $19.46 42 REFERENCE LAB4235503 LYME DISEASE AB IGG WB $22.72 42 REFERENCE LAB4235511 LYME DISEASE AB IGM WB $22.72 42 REFERENCE LAB4234894 M TB AMP PRB 42 REFERENCE LAB4254736 MAGNESIUM UR $179.00 $179.00 $6.30 42 REFERENCE LAB4259859 MASS SPECT/TANDEM QN NES $14.75 42 REFERENCE LAB4234548 MASS SPECT/TANDEM QN NES $26.00 42 REFERENCE LAB4231783 MERCURY $30.00 42 REFERENCE LAB4233268 MERCURY $49.00 42 REFERENCE LAB4235248 MERCURY $9.42 42 REFERENCE LAB4233201 MERCURY $18.00 42 REFERENCE LAB4233250 MERCURY $19.50 42 REFERENCE LAB4235776 METANEPHRINES BLOOD $148.00 42 REFERENCE LAB4231791 METANEPHRINES UR $28.00 42 REFERENCE LAB4234860 METHYLMALONIC ACID QN $31.49 42 REFERENCE LAB4234878 METHYLMALONIC ACID UR $59.00 42 REFERENCE LAB4231809 MICROALBUMIN UR 24HR $10.00 42 REFERENCE LAB4231817 MICROSOMAL AB $11.77 42 REFERENCE LAB4231742 MICROSOMAL AB $13.10 42 REFERENCE LAB4235131 MICROSOMAL AB $15.00 42 REFERENCE LAB4252714 MISC CHEM TEST 42 REFERENCE LAB4234217 MISC CHEM TEST $98.00 $95.00 42 REFERENCE LAB4270500 ML DX AMP TR NA EA SQ GT2 $81.97 42 REFERENCE LAB

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DEPARTMENT CODE

4233383 ML DX AMP TR NA EA SQ GT2 $15.34 42 REFERENCE LAB4235354 MOL DX AMP TR N ACD 2SEQ 42 REFERENCE LAB4235107 MOL DX AMP TR N ACD 2SEQ $27.00 42 REFERENCE LAB4235404 MOL DX AMP TR N ACD 2SEQ 42 REFERENCE LAB4256681 MOL DX AMP TR N ACD EA SQ $25.00 42 REFERENCE LAB4235834 MOL DX AMP TR N ACD EA SQ $17.43 42 REFERENCE LAB4250205 MOL DX AMP TR N ACD EA SQ $49.88 42 REFERENCE LAB4233995 MOL DX AMP TR N ACD EA SQ $5.08 42 REFERENCE LAB4230579 MOL DX AMP TR N ACD EA SQ $4.29 42 REFERENCE LAB4235172 MOL DX AMP TR N ACD EA SQ $30.37 42 REFERENCE LAB4232344 MOL DX AMP TR N ACD EA SQ $11.87 42 REFERENCE LAB4233235 MOL DX DT/SLT BLT EA NA $5.08 42 REFERENCE LAB4271912 MOL DX ENZ DIG EA ENZ TX $71.00 42 REFERENCE LAB4235180 MOL DX ENZ DIG EA ENZ TX $30.37 42 REFERENCE LAB4250221 MOL DX ENZ DIG EA ENZ TX $6.00 42 REFERENCE LAB4235842 MOL DX ENZ DIG EA ENZ TX $17.43 42 REFERENCE LAB4231957 MOL DX ENZ DIG EA ENZ TX $11.87 42 REFERENCE LAB4256665 MOL DX EXTN EA NA TYP $20.00 42 REFERENCE LAB4231973 MOL DX EXTN EA NA TYP $11.87 42 REFERENCE LAB4256673 MOL DX GL ELCTR SEP EA NA $15.00 42 REFERENCE LAB4235370 MOL DX GL ELCTR SEP EA NA 42 REFERENCE LAB4235420 MOL DX GL ELCTR SEP EA NA 42 REFERENCE LAB4250239 MOL DX GL ELCTR SEP EA NA $10.00 42 REFERENCE LAB4231981 MOL DX GL ELCTR SEP EA NA $11.87 42 REFERENCE LAB4271946 MOL DX INTERP & RPT $14.00 42 REFERENCE LAB4256699 MOL DX INTERP & RPT $80.00 42 REFERENCE LAB4235388 MOL DX INTERP & RPT 42 REFERENCE LAB4235867 MOL DX INTERP & RPT $17.43 42 REFERENCE LAB4235719 MOL DX INTERP & RPT $65.00 42 REFERENCE LAB4250247 MOL DX INTERP & RPT $13.96 42 REFERENCE LAB4231965 MOL DX INTERP & RPT $11.87 42 REFERENCE LAB4233391 MOL DX INTERP & RPT $15.34 42 REFERENCE LAB4235115 MOL DX INTERP & RPT $27.00 42 REFERENCE LAB4235438 MOL DX INTERP & RPT 42 REFERENCE LAB4235214 MOL DX INTERP & RPT $30.37 42 REFERENCE LAB4271904 MOL DX ISO/EXT PRFD EA NA $14.00 42 REFERENCE LAB4270518 MOL DX ISO/EXT PRFD EA NA $19.60 42 REFERENCE LAB

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4235347 MOL DX ISO/EXT PRFD EA NA 42 REFERENCE LAB4233219 MOL DX ISO/EXT PRFD EA NA $5.08 42 REFERENCE LAB4235396 MOL DX ISO/EXT PRFD EA NA 42 REFERENCE LAB4233367 MOL DX ISO/EXT PRFD EA NA $15.34 42 REFERENCE LAB4235826 MOL DX ISO/EXT PRFD EA NA $17.43 42 REFERENCE LAB4235081 MOL DX ISO/EXT PRFD EA NA $27.00 42 REFERENCE LAB4250213 MOL DX ISO/EXT PRFD EA NA $11.97 42 REFERENCE LAB4235685 MOL DX ISO/EXT PRFD EA NA $65.00 42 REFERENCE LAB4235164 MOL DX ISO/EXT PRFD EA NA $30.37 42 REFERENCE LAB4250288 MOL DX MUT ID TRNSCRP $6.00 42 REFERENCE LAB4271938 MOL DX MUT SCN 1 SEG EA $300.00 42 REFERENCE LAB4250270 MOL DX MUT SCN 1 SEG EA $6.00 42 REFERENCE LAB4271920 MOL DX NUC ACID PRB $70.00 42 REFERENCE LAB4270526 MOL DX NUC ACID PRB $9.37 42 REFERENCE LAB4250262 MOL DX NUC ACID PRB $11.97 42 REFERENCE LAB4235123 MOL DX NUC ACID PRB $27.00 42 REFERENCE LAB4233375 MOL DX NUC ACID PRB $15.34 42 REFERENCE LAB4233243 MOL DX NUC ACID PRB $5.08 42 REFERENCE LAB4235693 MOL DX REV TRANSCRIPT $65.00 42 REFERENCE LAB4235099 MOL DX REV TRANSCRIPT $27.00 42 REFERENCE LAB4235362 MOL DX SEP/ID HI RS EA NA 42 REFERENCE LAB4235412 MOL DX SEP/ID HI RS EA NA 42 REFERENCE LAB4235198 MOL DX SEP/ID HI RS EA NA $30.37 42 REFERENCE LAB4234050 MUCOPOLYSACCH ACID QNT $90.00 42 REFERENCE LAB4231833 MUMPS AB $9.00 42 REFERENCE LAB4231841 MURAMIDASE $18.00 42 REFERENCE LAB4235701 MUTATION ID BY SEQ EA SEG $65.00 42 REFERENCE LAB4235206 MUTATION ID OLA/SBCE/ASPE $30.37 42 REFERENCE LAB4235859 MUTATION ID OLA/SBCE/ASPE $17.43 42 REFERENCE LAB4234886 MYCOPHENOLIC ACID $80.00 42 REFERENCE LAB4231866 MYCOPLAS AB $30.00 42 REFERENCE LAB4234779 MYCOPLAS CULT $30.00 42 REFERENCE LAB4255394 MYCOPLAS CULT $27.72 $27.72 $27.72 42 REFERENCE LAB4231874 MYELIN BASIC PROTEIN CSF $19.00 42 REFERENCE LAB4231882 MYOGLOBIN $26.50 42 REFERENCE LAB4231890 MYOGLOBIN UR $15.00 42 REFERENCE LAB4230322 NATRIURETIC PEPTIDE $73.01 42 REFERENCE LAB

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4259826 NB GENETIC SCR GALACT $14.50 42 REFERENCE LAB4231908 NORTRIPTYLINE $16.40 42 REFERENCE LAB4234910 NTELOPEPTIDE SERUM $95.00 42 REFERENCE LAB4256533 OCCULT BLD GASTRIC QL $57.00 42 REFERENCE LAB4231916 OLIGOCLONAL BANDS CSF $17.50 42 REFERENCE LAB4231924 ORGANIC ACIDS QN TOTAL $125.00 42 REFERENCE LAB4254272 OVA & PARASITES W CONC $159.00 $159.00 $13.00 42 REFERENCE LAB4231932 OXALATE UR $12.00 42 REFERENCE LAB4234928 OXYCARBAZEPINE $27.00 42 REFERENCE LAB4234423 P ANCA TITER $16.62 42 REFERENCE LAB4234936 PANCREATIC ELASTASE $168.00 42 REFERENCE LAB4232955 PARAINFLUENZA DFA $70.20 42 REFERENCE LAB4256574 PARAINFLUENZA TYP 1 FA $216.00 $146.00 42 REFERENCE LAB4256582 PARAINFLUENZA TYP 2 FA $216.00 $146.00 42 REFERENCE LAB4256590 PARAINFLUENZA TYP 3 FA $216.00 $146.00 42 REFERENCE LAB4233920 PARVOVIRUS B 19 DNA PCR $85.00 42 REFERENCE LAB4232781 PARVOVIRUS B19 AB $30.00 42 REFERENCE LAB4232153 PCR ID $14.25 42 REFERENCE LAB4231999 PHENOTHIAZINE $20.00 42 REFERENCE LAB4232005 PHENYLALANINE BLOOD $37.50 42 REFERENCE LAB4259800 PHENYLALANINE BLOOD $12.00 42 REFERENCE LAB4270880 PHENYTOIN FREE $57.69 42 REFERENCE LAB4230116 PHOSHATASE ACID TOTAL $12.00 42 REFERENCE LAB4233664 PHOSPHLPD NUTRLZTN PLTLT $46.73 42 REFERENCE LAB4235479 PHOSPHOLIPID AB $22.91 42 REFERENCE LAB4233490 PHOSPHOLIPID AB $23.14 42 REFERENCE LAB4256236 PHOSPHOLIPID AB $29.10 42 REFERENCE LAB4232013 PHOSPHOROUS UR RAN $6.61 42 REFERENCE LAB4234803 PHOSPHORUS UR TIM $28.92 42 REFERENCE LAB4251013 PINWORM CELLOPHANE TAPE $13.00 $13.00 $13.00 42 REFERENCE LAB4250254 PLSMG $120.00 42 REFERENCE LAB4250197 PLSMG ACTIVATOR INHIBITOR $130.00 $130.00 $130.00 42 REFERENCE LAB4250189 PLSMG ACTIVATOR INHIBITOR $140.00 $140.00 $140.00 42 REFERENCE LAB4250296 PLT AB DIR IGG $29.67 42 REFERENCE LAB4250023 PLT AB DRG INDUCED $29.33 $29.33 $30.15 42 REFERENCE LAB4233441 PLT AB HEPARIN $60.00 42 REFERENCE LAB4235289 PLT AB HEPARIN $147.00 42 REFERENCE LAB

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4250031 PLT AB INDIRECT $31.00 $31.00 $31.00 42 REFERENCE LAB4235578 PNEUMOCYSTIS CARINII DFA $20.25 42 REFERENCE LAB4232021 PORPHOBILINOGEN QN $25.00 42 REFERENCE LAB4232047 PORPHYRINS UR QN&FX $46.50 42 REFERENCE LAB4235156 POTASSIUM FECES $8.00 42 REFERENCE LAB4232054 PREALBUMIN $9.75 42 REFERENCE LAB4279014 PREGNANCY SCRN UR 42 REFERENCE LAB4232062 PREGNANEDIOL $51.50 42 REFERENCE LAB4232070 PREGNENOLONE $36.50 42 REFERENCE LAB4234704 PRIMIDONE $80.32 42 REFERENCE LAB4232088 PRIMIDONE $85.00 42 REFERENCE LAB4233987 PROCAINAMIDE & NAPA $84.75 42 REFERENCE LAB4232096 PROGESTERONE $99.75 42 REFERENCE LAB4232104 PROINSULIN $126.00 42 REFERENCE LAB4232112 PROLACTIN $14.15 42 REFERENCE LAB4232039 PROPHOBILINOGEN UR QL $21.50 42 REFERENCE LAB4233698 PROTEIN C AG $35.00 42 REFERENCE LAB4250148 PROTEIN C AG $119.00 $119.00 $119.00 42 REFERENCE LAB4233060 PROTEIN ELECTRO SER $12.00 42 REFERENCE LAB4232120 PROTEIN ELECTRO SER $20.00 42 REFERENCE LAB4272167 PROTEIN ELECTRO SER $105.00 42 REFERENCE LAB4272183 PROTEIN ELECTRO UR $87.22 42 REFERENCE LAB4230207 PROTEIN NEPHELOMET $29.00 42 REFERENCE LAB4250163 PROTEIN S ACTIVITY $86.50 $86.50 $86.50 42 REFERENCE LAB4233706 PROTEIN S AG TOTAL $35.00 42 REFERENCE LAB4250155 PROTEIN S AG TOTAL $86.50 $86.50 $86.50 42 REFERENCE LAB4233714 PROTEIN S FREE $91.00 42 REFERENCE LAB4232138 PROTEIN TOTAL FLD $8.50 42 REFERENCE LAB4233722 PROTHROMBIN TIME $7.86 42 REFERENCE LAB4233730 PROTHROMBIN TIME SUBT EA $26.10 42 REFERENCE LAB4232773 PROTOPORPHYRIN RBC $15.65 42 REFERENCE LAB4232146 PSA TOTAL DIAG $23.50 42 REFERENCE LAB4232161 PTH C TERMINAL $39.00 42 REFERENCE LAB4270906 PTH INTACT $738.00 42 REFERENCE LAB4234944 PTH RELATED PROTEIN $55.00 42 REFERENCE LAB4233748 PTT PLAS OR WB $6.77 42 REFERENCE LAB4233755 PTT SUBSTITUTION EA $20.00 42 REFERENCE LAB

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4232179 PYRUVATE BLD $15.00 42 REFERENCE LAB4232187 Q FEVER AB $7.50 42 REFERENCE LAB4235875 Q FEVER IGG TITER $11.25 42 REFERENCE LAB4232203 QUINIDINE $21.00 42 REFERENCE LAB4271003 QUINIDINE $220.00 42 REFERENCE LAB4234324 RAPID HSV CX W/REFLEX $21.00 42 REFERENCE LAB4232211 RENIN $16.50 42 REFERENCE LAB4250171 REPTILASE TEST $105.00 $105.00 $105.00 42 REFERENCE LAB4271045 RHEUMATOID FCTR QN $102.00 42 REFERENCE LAB4272084 RHEUMATOID FCTR QN $102.00 42 REFERENCE LAB4232229 RHEUMATOID FCTR QN $7.50 42 REFERENCE LAB4232682 RIBOFLAVIN $55.00 42 REFERENCE LAB4234167 RIBOSOMAL P AB $33.00 42 REFERENCE LAB4235883 RICKETTSIA AB $11.25 42 REFERENCE LAB4233342 RICKETTSIA AB $15.00 42 REFERENCE LAB4233763 RISTOCETIN COFACTOR $60.00 42 REFERENCE LAB4233896 RISTOCETIN COFACTOR $87.00 42 REFERENCE LAB4268033 RO(SS A) AB $23.00 42 REFERENCE LAB4256780 RO(SS A) AB 42 REFERENCE LAB4255345 ROTAVIRUS AG EIA $216.00 $216.00 $13.00 42 REFERENCE LAB4232237 ROTAVIRUS AG EIA $20.00 42 REFERENCE LAB4256608 RSV DFA $216.00 $216.00 42 REFERENCE LAB4232930 RSV DFA $24.00 42 REFERENCE LAB4232245 RUBELLA AB $11.75 42 REFERENCE LAB4232476 RUBELLA AB IGG $8.68 42 REFERENCE LAB4232484 RUBELLA AB IGM $8.68 42 REFERENCE LAB4232252 RUBEOLA AB $13.90 42 REFERENCE LAB4256244 RUSSELL VIPER VENOM DILU $29.10 42 REFERENCE LAB4250338 S STRL KIT CRICOTHYROT AD $372.00 42 REFERENCE LAB4250346 S STRL KIT CRICOTHYROT PD $451.00 42 REFERENCE LAB4272035 SCL 70 AB $322.00 42 REFERENCE LAB4256806 SCL 70 AB 42 REFERENCE LAB4268058 SCL 70 AB $23.00 42 REFERENCE LAB4231759 SCL 70 AB $13.10 42 REFERENCE LAB4234969 SELENIUM $25.50 42 REFERENCE LAB4250601 SER BACTERICIDAL TTR $40.00 $40.00 $40.00 42 REFERENCE LAB4256632 SER BACTERICIDAL TTR $144.00 42 REFERENCE LAB

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4232260 SEROTONIN BLD $49.00 42 REFERENCE LAB4234977 SEROTONIN RELEASE ASSAY $234.00 42 REFERENCE LAB4235297 SEROTONIN RELEASE ASSAY 42 REFERENCE LAB4231577 SIALIC ACID $18.50 42 REFERENCE LAB4232278 SICKLE CL SCRN $9.75 42 REFERENCE LAB4233433 SIROLIMUS $55.00 42 REFERENCE LAB4231734 SJOGRENS AB $13.10 42 REFERENCE LAB4272019 SMITH AB $322.00 42 REFERENCE LAB4256772 SMITH AB 42 REFERENCE LAB4268025 SMITH AB $23.00 42 REFERENCE LAB4231858 SMOOTH MUSCLE AB SCRN $17.00 42 REFERENCE LAB4233284 SMOOTH MUSCLE AB SCRN $13.10 42 REFERENCE LAB4256715 SMR AFB STAIN $97.00 42 REFERENCE LAB4232831 SMR AFB STAIN $10.54 42 REFERENCE LAB4256442 SMR GRAM STAIN $75.00 42 REFERENCE LAB4256947 SMR GRAM STAIN $54.88 42 REFERENCE LAB4231767 SMR MALARIA $37.50 42 REFERENCE LAB4234902 SODIUM OTHER SOURCE $8.00 42 REFERENCE LAB4231486 SOMATOMEDIN C $25.00 42 REFERENCE LAB4256103 SPEC STAIN GRP II INTRP/R $38.39 42 REFERENCE LAB4233292 STRIATED MUSCLE AB SCRN $13.10 42 REFERENCE LAB4234951 SUGARS QL EA SPEC $10.50 42 REFERENCE LAB4256178 SURG PATH LVL III $60.00 42 REFERENCE LAB4256186 SURG PATH LVL III $60.00 42 REFERENCE LAB4256129 SURG PATH LVL IV $40.75 42 REFERENCE LAB4256160 SURG PATH UNLISTED $87.50 42 REFERENCE LAB4255170 SUSCEPT BY MLC $59.00 $59.00 $59.00 42 REFERENCE LAB4250700 SUSCEPT BY MLC $50.00 $50.00 $50.00 42 REFERENCE LAB4250577 SUSCEPT MIC PER PLATE $155.00 $155.00 $13.00 42 REFERENCE LAB4250668 SUSCEPT MIC PER PLATE $130.00 $105.00 $72.00 42 REFERENCE LAB4250692 SUSCEPT MYCOBACT PROPORT $41.16 $41.16 $41.16 42 REFERENCE LAB4233177 SUSCEPT MYCOBACT PROPORT $100.00 42 REFERENCE LAB4235784 T LYMPH TOT CNT $24.75 42 REFERENCE LAB4271102 T3 FREE $69.00 42 REFERENCE LAB4232302 T3 FREE $14.12 42 REFERENCE LAB4232310 T3 REVERSE $29.00 42 REFERENCE LAB4271201 T3 TOTAL $252.00 42 REFERENCE LAB

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4232328 T3 TOTAL $9.75 42 REFERENCE LAB4255006 TACROLIMUS (FK506) $75.00 $75.00 $75.00 42 REFERENCE LAB4234746 TESTOSTERONE FREE $19.00 42 REFERENCE LAB4232377 TESTOSTERONE FREE $10.90 42 REFERENCE LAB4234738 TESTOSTERONE TOTAL $19.00 42 REFERENCE LAB4232385 TESTOSTERONE TOTAL $13.22 42 REFERENCE LAB4256954 TESTOSTERONE TOTAL $108.99 42 REFERENCE LAB4234720 TETANUS AB $25.12 42 REFERENCE LAB4232393 TETANUS AB $20.00 42 REFERENCE LAB4234993 THIOCYANATE $63.00 42 REFERENCE LAB4232351 THYR BINDING GLOB (TBG) $18.25 42 REFERENCE LAB4235818 THYR STIM IG $71.25 42 REFERENCE LAB4232401 THYROGLOBULIN $19.75 42 REFERENCE LAB4271300 THYROGLOBULIN AB $66.00 42 REFERENCE LAB4232419 THYROGLOBULIN AB $10.00 42 REFERENCE LAB4271607 THYROID PEROXIDASE AB $126.00 42 REFERENCE LAB4235446 TISSUE CULT LYMPH 42 REFERENCE LAB4235008 TOPIRAMATE $35.00 42 REFERENCE LAB4271409 TOXOPLAS AB IGG $256.00 42 REFERENCE LAB4232492 TOXOPLAS AB IGG $8.68 42 REFERENCE LAB4232526 TOXOPLAS AB IGG $12.32 42 REFERENCE LAB4232500 TOXOPLAS AB IGM $8.68 42 REFERENCE LAB4271508 TOXOPLAS AB IGM $256.00 42 REFERENCE LAB4232534 TOXOPLAS AB IGM $8.75 42 REFERENCE LAB4233938 TOXOPLASMOSIS PCR $105.00 42 REFERENCE LAB4235016 TOXOPLASMOSIS QUAL PCR $105.00 42 REFERENCE LAB4271706 TRANSFERRIN $230.00 42 REFERENCE LAB4232542 TRANSFERRIN $11.00 42 REFERENCE LAB4235032 TRANSGLUTAMINASE AB IGA $14.25 42 REFERENCE LAB4235024 TRANSGLUTAMINASE AB IGA $14.25 42 REFERENCE LAB4256897 TRICHOMONAS VAG DIR PROBE $49.60 42 REFERENCE LAB4235800 TRIGLYCERIDE $16.00 42 REFERENCE LAB4235040 TRYPTASE $49.00 42 REFERENCE LAB4259834 TSH $14.50 42 REFERENCE LAB4232997 TSH $34.50 42 REFERENCE LAB4232567 TYROSINE $37.50 42 REFERENCE LAB4259818 TYROSINE $11.00 42 REFERENCE LAB

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4232575 UROBILINOGEN UR QN $5.93 42 REFERENCE LAB4232617 VASOACT INTEST PEPT (VIP) $49.00 42 REFERENCE LAB4232609 VDRL CSF NON-TREPML AB QL $6.00 42 REFERENCE LAB4232625 VIRUS AB NOT SPEC $15.00 42 REFERENCE LAB4270807 VIRUS AB NOT SPEC $230.00 42 REFERENCE LAB4235610 VIRUS CULT SHELL VIAL $20.00 42 REFERENCE LAB4232633 VISCOSITY $15.00 42 REFERENCE LAB4232641 VITAMIN A $15.77 42 REFERENCE LAB4232658 VITAMIN B1 (THIAMINE) $20.00 42 REFERENCE LAB4235057 VITAMIN B1 (THIAMINE) $25.00 42 REFERENCE LAB4232666 VITAMIN B12 $5.70 42 REFERENCE LAB4232674 VITAMIN B12 BINDING CAP $15.00 42 REFERENCE LAB4232690 VITAMIN B6 $18.00 42 REFERENCE LAB4232716 VITAMIN D (125 DI HYDROX) $35.00 42 REFERENCE LAB4232724 VITAMIN D 25HYDROXY $20.19 42 REFERENCE LAB4272266 VITAMIN D 25HYDROXY $530.00 $530.00 42 REFERENCE LAB4232732 VITAMIN E $15.75 42 REFERENCE LAB4232740 VITAMIN K $60.00 42 REFERENCE LAB4232757 VMA UR $19.50 42 REFERENCE LAB4232583 VZV AB $25.00 42 REFERENCE LAB4232591 VZV AB $21.25 42 REFERENCE LAB4271805 VZV AB $196.00 42 REFERENCE LAB4232914 VZV DFA $23.00 42 REFERENCE LAB4234506 WEST NILE CSF $56.00 42 REFERENCE LAB4234480 WEST NILE VIRUS AB IGG $24.50 42 REFERENCE LAB4234498 WEST NILE VIRUS AB IGM $24.50 42 REFERENCE LAB4234811 WEST NILE VIRUS RNA PCR $292.50 42 REFERENCE LAB4235727 YERSINIA AB $9.00 42 REFERENCE LAB4232765 ZINC $15.00 42 REFERENCE LAB4234514 ZONISAMIDE (ZONEGRAN[TM]) $49.50 42 REFERENCE LAB3220423 AD EVL SP/LNG/COM/AUD 120 $675.00 $460.00 32 REHAB SERVICES3220126 AD EVL SP/LNG/COM/AUD 120 $675.00 $460.00 32 REHAB SERVICES3212222 FO PIP/DIP W/JOINT/SPRING 32 REHAB SERVICES3212156 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212289 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212164 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212248 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES

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3212172 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212271 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212180 HFO W/O JOINTS PF 32 REHAB SERVICES3210770 OT ADL TRAIN EA 15 $153.00 $63.00 32 REHAB SERVICES3212636 OT ADL TRAIN INIT 30 $280.00 $116.00 32 REHAB SERVICES3211059 OT APP SPLNT FINGER DYN $205.00 $85.00 32 REHAB SERVICES3211042 OT APP SPLNT FINGER STA $141.00 $58.00 32 REHAB SERVICES3211034 OT APP SPLNT SHRT ARM DYN $330.00 $136.00 32 REHAB SERVICES3211026 OT APP SPLNT SHRT ARM DYN $330.00 $136.00 32 REHAB SERVICES3211646 OT APP SPLNT SHRT ARM STA 32 REHAB SERVICES3221199 OT COGNTVE SKIL DEV EA 15 $153.00 $63.00 32 REHAB SERVICES3210788 OT COMMUNITY REINT EA 15 $153.00 $63.00 32 REHAB SERVICES3231883 OT COMMUNITY REINT EA 15 $153.00 $63.00 32 REHAB SERVICES3211638 OT CONTRAST BATH INIT 30 32 REHAB SERVICES3211158 OT CONTRAST BATHS EA 15 $77.00 $32.00 32 REHAB SERVICES3211620 OT CONTRAST BATHS EA 15 32 REHAB SERVICES3211653 OT DEBRIDE SKIN FULL 32 REHAB SERVICES3212479 OT DYSPHAGIA TRT ADD 15 $153.00 $63.00 32 REHAB SERVICES3212487 OT DYSPHAGIA TRT INIT 30 $306.00 $126.00 32 REHAB SERVICES3210580 OT E-STIM EA 15 $153.00 $63.00 32 REHAB SERVICES3211679 OT E-STIM MANUAL INIT 30 32 REHAB SERVICES3211273 OT EVAL 120 $1,327.00 32 REHAB SERVICES3211307 OT EVAL 15 $166.00 $68.00 32 REHAB SERVICES3211315 OT EVAL 30 $332.00 $137.00 32 REHAB SERVICES3211323 OT EVAL 45 $498.00 $205.00 32 REHAB SERVICES3211133 OT EVAL 60 $663.00 $273.00 32 REHAB SERVICES3211331 OT EVAL 75 $829.00 $342.00 32 REHAB SERVICES3211349 OT EVAL 90 $995.00 $410.00 32 REHAB SERVICES3210267 OT EVAL ADD 15 $166.00 $68.00 32 REHAB SERVICES3211596 OT EVAL BRIEF 32 REHAB SERVICES3211588 OT EVAL COMPREHENSIVE 32 REHAB SERVICES3211570 OT EVAL EXTENDED 32 REHAB SERVICES3212495 OT EVAL FNX SWALL 15 $166.00 $68.00 32 REHAB SERVICES3211356 OT EVAL FNX SWALL 15 32 REHAB SERVICES3212503 OT EVAL FNX SWALL 30 $332.00 $137.00 32 REHAB SERVICES3211364 OT EVAL FNX SWALL 30 32 REHAB SERVICES3211372 OT EVAL FNX SWALL 45 32 REHAB SERVICES

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3212610 OT EVAL FNX SWALL 45 $498.00 32 REHAB SERVICES3212511 OT EVAL FNX SWALL 60 $663.00 $273.00 32 REHAB SERVICES3210259 OT EVAL INIT 30 $332.00 $137.00 32 REHAB SERVICES3211562 OT EVAL INTERMEDIATE 32 REHAB SERVICES3211554 OT EVAL LTD 32 REHAB SERVICES3211257 OT EVAL MTN FLUOR SWA 120 $1,592.00 32 REHAB SERVICES3212628 OT EVAL MTN FLUOR SWA 120 $656.00 32 REHAB SERVICES3212552 OT EVAL MTN FLUOR SWAL 15 $199.00 $82.00 32 REHAB SERVICES3212560 OT EVAL MTN FLUOR SWAL 30 $398.00 $164.00 32 REHAB SERVICES3212578 OT EVAL MTN FLUOR SWAL 45 $597.00 $246.00 32 REHAB SERVICES3212586 OT EVAL MTN FLUOR SWAL 60 $796.00 $328.00 32 REHAB SERVICES3212594 OT EVAL MTN FLUOR SWAL 75 $995.00 $410.00 32 REHAB SERVICES3212602 OT EVAL MTN FLUOR SWAL 90 $1,194.00 $492.00 32 REHAB SERVICES3211091 OT EVAL SWALL & ORAL 15 $166.00 $68.00 32 REHAB SERVICES3212461 OT EXTREMITY TEST ADD 15 $166.00 32 REHAB SERVICES3212453 OT EXTREMITY TEST INT 30 $332.00 32 REHAB SERVICES3211695 OT IONTOPHORESIS EA 15 32 REHAB SERVICES3211687 OT IONTOPHORESIS INIT 30 32 REHAB SERVICES3211190 OT MANUAL THER EA 15 $164.00 32 REHAB SERVICES3211703 OT MANUAL TRACT INIT 30 32 REHAB SERVICES3211729 OT MYOFAC/SOFT MOB 30 32 REHAB SERVICES3210648 OT NEUROMUSC REED EA 15 $164.00 $68.00 32 REHAB SERVICES3211737 OT NEUROMUSC REED INIT 30 $252.00 32 REHAB SERVICES3212446 OT ORT/PRO/ADL CK ADD 15 $153.00 32 REHAB SERVICES3212438 OT ORT/PRO/ADL CK INIT 30 $306.00 32 REHAB SERVICES3211778 OT ORTHOTIC FAB INIT 30 32 REHAB SERVICES3211786 OT ORTHOTIC TRAIN EA 15 32 REHAB SERVICES3211794 OT ORTHOTIC TRAIN INIT 30 32 REHAB SERVICES3210564 OT PARAFFIN BATH 15 $77.00 $32.00 32 REHAB SERVICES3210697 OT PROC THER GP 15 $115.00 $47.00 32 REHAB SERVICES3211406 OT PROC THER GP 30 $230.00 $95.00 32 REHAB SERVICES3211414 OT PROC THER GP 45 $344.00 $142.00 32 REHAB SERVICES3211422 OT PROC THER GP 60 $230.00 $95.00 32 REHAB SERVICES3211752 OT PROSTH TRAIN EA 15 32 REHAB SERVICES3211745 OT PROSTH TRAIN INIT 30 32 REHAB SERVICES3211471 OT RE-EVAL 15 32 REHAB SERVICES3211141 OT RE-EVAL 15 $149.00 $62.00 32 REHAB SERVICES

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DEPARTMENT CODE

3211489 OT RE-EVAL 30 32 REHAB SERVICES3211497 OT RE-EVAL 60 32 REHAB SERVICES3211505 OT RE-EVAL 75 32 REHAB SERVICES3211513 OT RE-EVAL 90 32 REHAB SERVICES3211521 OT RE-EVAL ADD 15 32 REHAB SERVICES3211539 OT RE-EVAL INIT 30 32 REHAB SERVICES3210929 OT SENS INTEGRATION EA 15 $115.00 32 REHAB SERVICES3211604 OT THER ACT ADD 15 $160.00 32 REHAB SERVICES3210762 OT THER ACT EA 15 $153.00 $63.00 32 REHAB SERVICES3211265 OT THER ACT EA 15 $153.00 32 REHAB SERVICES3211612 OT THER ACT INIT 30 $243.00 32 REHAB SERVICES3211547 OT THER ACT INIT 30 $306.00 $126.00 32 REHAB SERVICES3210630 OT THER EX EA 15 $153.00 $63.00 32 REHAB SERVICES3211802 OT THER EX INIT 30 $277.00 32 REHAB SERVICES3210671 OT THER MASSAGE EA 15 $115.00 $47.00 32 REHAB SERVICES3211810 OT THER MASSAGE INIT 30 32 REHAB SERVICES3210069 OT TREAT ADD 15 $153.00 $63.00 32 REHAB SERVICES3210051 OT TREAT INIT 30 $306.00 $126.00 32 REHAB SERVICES3211109 OT TX SWALL/ORAL FNX 105 $1,071.00 $442.00 32 REHAB SERVICES3212529 OT TX SWALL/ORAL FNX 105 $178.00 $442.00 32 REHAB SERVICES3212537 OT TX SWALL/ORAL FNX 30 $306.00 $126.00 32 REHAB SERVICES3212545 OT TX SWALL/ORAL FNX 60 $612.00 $252.00 32 REHAB SERVICES3210606 OT ULTRASOUND EA 15 $134.00 $55.00 32 REHAB SERVICES3211828 OT ULTRASOUND INIT 30 32 REHAB SERVICES3210556 OT VASOPNEUMATIC 15 $93.00 $38.00 32 REHAB SERVICES3211836 OT VASOPNEUMATIC 15 32 REHAB SERVICES3211760 OT WHIRLPOOL 15 32 REHAB SERVICES3210796 OT WHLCHR MNG/TRAIN EA 15 $153.00 $63.00 32 REHAB SERVICES3240611 PT ADL TRAIN ADD 15 $88.00 32 REHAB SERVICES3240629 PT ADL TRAIN EA 15 $114.00 32 REHAB SERVICES3241304 PT ADL TRAIN INIT 30 $257.00 $140.00 32 REHAB SERVICES3240637 PT CONTRAST BATH INIT 30 $322.00 32 REHAB SERVICES3238763 PT DEBRIDE <=1ST 20 SQ/CM $298.00 $141.00 32 REHAB SERVICES3238771 PT DEBRIDE EA ADD 20 SQ/M $298.00 $141.00 32 REHAB SERVICES3240207 PT DEBRIDE NON-SELECT 60 $487.00 $266.00 32 REHAB SERVICES3235348 PT DEBRIDE SKIN FULL $402.00 $215.00 32 REHAB SERVICES3235298 PT DEBRIDE SKIN FULL $402.00 $215.00 32 REHAB SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3235306 PT DEBRIDE SKIN PARTIAL $224.00 $120.00 32 REHAB SERVICES3235355 PT DEBRIDE SKIN PARTIAL $224.00 $120.00 32 REHAB SERVICES3235314 PT DEBRIDE SKIN/TISSUE $178.00 $95.00 32 REHAB SERVICES3235363 PT DEBRIDE SKIN/TISSUE $178.00 $95.00 32 REHAB SERVICES3232014 PT DEBRIDE/DRESS INIT 30 $354.00 $189.00 32 REHAB SERVICES3240116 PT E-STIM EA 15 $85.00 $46.00 32 REHAB SERVICES3240645 PT E-STIM MANUAL INIT 30 $218.00 32 REHAB SERVICES3232402 PT E-STIM SUP INIT 30 $241.00 $132.00 32 REHAB SERVICES3235066 PT EVAL 120 $1,190.00 32 REHAB SERVICES3232469 PT EVAL 15 $126.00 $67.00 32 REHAB SERVICES3232477 PT EVAL 30 $298.00 $159.00 32 REHAB SERVICES3232485 PT EVAL 45 $446.00 $239.00 32 REHAB SERVICES3232261 PT EVAL 60 $595.00 $318.00 32 REHAB SERVICES3232493 PT EVAL 75 $744.00 $398.00 32 REHAB SERVICES3232501 PT EVAL 90 $893.00 $477.00 32 REHAB SERVICES3231925 PT EVAL ADD 15 $149.00 $80.00 32 REHAB SERVICES3241254 PT EVAL BRIEF $123.00 $71.00 32 REHAB SERVICES3241262 PT EVAL COMPREHENSIVE $243.00 $133.00 32 REHAB SERVICES3241270 PT EVAL EXTENDED $494.00 $270.00 32 REHAB SERVICES3240652 PT EVAL FNX CAPACITY 120 $431.00 32 REHAB SERVICES3231917 PT EVAL INIT 30 $298.00 $159.00 32 REHAB SERVICES3241288 PT EVAL INTERMEDIATE $424.00 $232.00 32 REHAB SERVICES3241296 PT EVAL LTD $267.00 $146.00 32 REHAB SERVICES3240660 PT EXER GP ADD 15 $132.00 32 REHAB SERVICES3240678 PT EXER GP INIT 30 $262.00 32 REHAB SERVICES3240686 PT FNX ACT INIT 30 $235.00 32 REHAB SERVICES3231750 PT GAIT TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240694 PT GAIT TRAIN INIT 30 $258.00 32 REHAB SERVICES3240702 PT GP ED PER SESSION $133.00 32 REHAB SERVICES3240710 PT GYM PER PRIOR AUTH $131.00 32 REHAB SERVICES3240728 PT IND INSTRUCT INIT 30 $218.00 32 REHAB SERVICES3240736 PT IONTOPHORESIS INIT 30 $241.00 32 REHAB SERVICES3240744 PT JOB SITE ASSESS 60 $385.00 32 REHAB SERVICES3240751 PT JOINT MOB EA VISIT $249.00 32 REHAB SERVICES3240769 PT MANUAL TRACT INIT 30 $217.00 32 REHAB SERVICES3240777 PT MECH TRACT 30 $187.00 32 REHAB SERVICES3240785 PT MYOFAC/SOFT MOB 30 $223.00 32 REHAB SERVICES

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SEQ 200 AMOUNT

DEPARTMENT CODE

3231743 PT NEUROMUSC REED EA 15 $147.00 $79.00 32 REHAB SERVICES3240793 PT NEUROMUSC REED INIT 30 $234.00 32 REHAB SERVICES3240512 PT NP WOUND TX <=50 CM 15 $122.00 32 REHAB SERVICES3241155 PT NP WOUND TX <=50 CM 15 $122.00 32 REHAB SERVICES3241171 PT NP WOUND TX <=50 CM 30 $219.00 32 REHAB SERVICES3240538 PT NP WOUND TX <=50 CM 30 $219.00 32 REHAB SERVICES3240553 PT NP WOUND TX <=50 CM 45 $402.00 32 REHAB SERVICES3241197 PT NP WOUND TX <=50 CM 45 $402.00 32 REHAB SERVICES3240579 PT NP WOUND TX <=50 CM 60 $518.00 32 REHAB SERVICES3241213 PT NP WOUND TX <=50 CM 60 $518.00 32 REHAB SERVICES3241239 PT NP WOUND TX <=50 CM 90 $664.00 32 REHAB SERVICES3240595 PT NP WOUND TX <=50 CM 90 $664.00 32 REHAB SERVICES3240520 PT NP WOUND TX >50 CM 15 $117.00 32 REHAB SERVICES3241163 PT NP WOUND TX >50 CM 15 $117.00 32 REHAB SERVICES3240546 PT NP WOUND TX >50 CM 30 $260.00 32 REHAB SERVICES3241189 PT NP WOUND TX >50 CM 30 $260.00 32 REHAB SERVICES3240561 PT NP WOUND TX >50 CM 45 $444.00 32 REHAB SERVICES3241205 PT NP WOUND TX >50 CM 45 $444.00 32 REHAB SERVICES3240587 PT NP WOUND TX >50 CM 60 $568.00 32 REHAB SERVICES3241221 PT NP WOUND TX >50 CM 60 $568.00 32 REHAB SERVICES3240603 PT NP WOUND TX >50 CM 90 $716.00 32 REHAB SERVICES3241247 PT NP WOUND TX >50 CM 90 $716.00 32 REHAB SERVICES3240801 PT ORTHOTIC FAB INIT 30 $210.00 32 REHAB SERVICES3240819 PT ORTHOTIC TRAIN ADD 15 $162.00 32 REHAB SERVICES3231834 PT ORTHOTIC TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240827 PT ORTHOTIC TRAIN INIT 30 $195.00 32 REHAB SERVICES3240835 PT PARAFFIN BATH 15 $77.00 32 REHAB SERVICES3231792 PT PROC THER GP 15 $103.00 $55.00 32 REHAB SERVICES3232550 PT PROC THER GP 30 $206.00 $110.00 32 REHAB SERVICES3232568 PT PROC THER GP 45 $309.00 $165.00 32 REHAB SERVICES3232576 PT PROC THER GP 60 $412.00 $220.00 32 REHAB SERVICES3240843 PT PROC/MOD ADD 15 $107.00 32 REHAB SERVICES3240850 PT PROSTH TRAIN ADD 15 $128.00 32 REHAB SERVICES3231859 PT PROSTH TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240868 PT PROSTH TRAIN INIT 30 $253.00 32 REHAB SERVICES3232626 PT RE-EVAL 15 $134.00 $72.00 32 REHAB SERVICES3232634 PT RE-EVAL 30 $268.00 $143.00 32 REHAB SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3232279 PT RE-EVAL 45 $402.00 $215.00 32 REHAB SERVICES3232642 PT RE-EVAL 60 $536.00 $286.00 32 REHAB SERVICES3232394 PT SENS INTEGRATION EA 15 $147.00 32 REHAB SERVICES3230281 PT SINGLE PROC ADD 15 $137.00 $73.00 32 REHAB SERVICES3230257 PT SINGLE PROC INIT 30 $275.00 $147.00 32 REHAB SERVICES3240421 PT THER ACT ADD 15 $92.00 $50.00 32 REHAB SERVICES3231867 PT THER ACT EA 15 $137.00 $73.00 32 REHAB SERVICES3235074 PT THER ACT EA 15 $137.00 32 REHAB SERVICES3232691 PT THER ACT INIT 30 $275.00 $147.00 32 REHAB SERVICES3231735 PT THER EX EA 15 $137.00 $73.00 32 REHAB SERVICES3240876 PT THER EX INIT 30 $207.00 32 REHAB SERVICES3240462 PT THER MASSAGE INIT 30 $251.00 32 REHAB SERVICES3230364 PT TREAT COMBO ADD 15 $137.00 $73.00 32 REHAB SERVICES3230331 PT TREAT COMBO INIT 30 $275.00 $147.00 32 REHAB SERVICES3240470 PT TRN BIOFD ANY MODAL 30 $268.00 32 REHAB SERVICES3240066 PT ULTRASOUND EA 15 $112.00 $61.00 32 REHAB SERVICES3240488 PT ULTRASOUND INIT 30 $227.00 32 REHAB SERVICES3240496 PT VASOPNEUMATIC 30 $107.00 32 REHAB SERVICES3235322 PT WHIRLPOOL 15 $69.00 $37.00 32 REHAB SERVICES3235371 PT WHIRLPOOL 15 $69.00 $37.00 32 REHAB SERVICES3235389 PT WHIRLPOOL 30 $137.00 $73.00 32 REHAB SERVICES3240504 PT WHIRLPOOL 30 $222.00 32 REHAB SERVICES3235330 PT WHIRLPOOL 30 $137.00 $73.00 32 REHAB SERVICES3231891 PT WHLCHR MNG/TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3212099 S OT WHF W/O JT PREFAB 32 REHAB SERVICES3212115 S OT WHFO RIGID W/O JNTS 32 REHAB SERVICES3212123 S OT WHFO RIGID W/O JNTS 32 REHAB SERVICES3221306 SP EVAL 105 $923.00 $457.00 32 REHAB SERVICES3221447 SP EVAL 105 $923.00 $457.00 32 REHAB SERVICES3221314 SP EVAL 120 $1,055.00 $522.00 32 REHAB SERVICES3221322 SP EVAL 15 $132.00 $65.00 32 REHAB SERVICES3221330 SP EVAL 30 $264.00 $131.00 32 REHAB SERVICES3221348 SP EVAL 45 $396.00 $196.00 32 REHAB SERVICES3220332 SP EVAL 60 $527.00 $261.00 32 REHAB SERVICES3221355 SP EVAL 75 $659.00 $327.00 32 REHAB SERVICES3221363 SP EVAL 90 $791.00 $392.00 32 REHAB SERVICES3221157 SP EVAL APHASIA HR $527.00 $261.00 32 REHAB SERVICES

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SEQ 999 AMOUNT

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SEQ 200 AMOUNT

DEPARTMENT CODE

3222072 SP EVAL FNX SWALL 105 $923.00 $457.00 32 REHAB SERVICES3221371 SP EVAL FNX SWALL 105 $780.00 $399.00 32 REHAB SERVICES3238748 SP EVAL FNX SWALL 120 $854.00 $437.00 32 REHAB SERVICES3228665 SP EVAL FNX SWALL 120 $1,055.00 32 REHAB SERVICES3228749 SP EVAL FNX SWALL 120 $1,055.00 32 REHAB SERVICES3221389 SP EVAL FNX SWALL 120 $854.00 $437.00 32 REHAB SERVICES3221397 SP EVAL FNX SWALL 15 $241.00 $123.00 32 REHAB SERVICES3221686 SP EVAL FNX SWALL 30 $264.00 $131.00 32 REHAB SERVICES3221405 SP EVAL FNX SWALL 30 $286.00 $146.00 32 REHAB SERVICES3221413 SP EVAL FNX SWALL 45 $396.00 $196.00 32 REHAB SERVICES3221223 SP EVAL FNX SWALL 60 $527.00 $261.00 32 REHAB SERVICES3221421 SP EVAL FNX SWALL 60 $465.00 $238.00 32 REHAB SERVICES3228632 SP EVAL FNX SWALL 75 $659.00 $327.00 32 REHAB SERVICES3221439 SP EVAL FNX SWALL 90 $791.00 $392.00 32 REHAB SERVICES3221454 SP EVAL LANG 120 $1,055.00 $522.00 32 REHAB SERVICES3221462 SP EVAL LANG 15 $132.00 $65.00 32 REHAB SERVICES3221470 SP EVAL LANG 30 $264.00 $131.00 32 REHAB SERVICES3221488 SP EVAL LANG 45 $396.00 $196.00 32 REHAB SERVICES3220340 SP EVAL LANG 60 $527.00 $261.00 32 REHAB SERVICES3221496 SP EVAL LANG 60 $522.00 $267.00 32 REHAB SERVICES3221504 SP EVAL LANG 75 $659.00 $327.00 32 REHAB SERVICES3221512 SP EVAL LANG 90 $791.00 $392.00 32 REHAB SERVICES3222007 SP EVAL MTN FLUOR SWA 105 $1,108.00 $549.00 32 REHAB SERVICES3221520 SP EVAL MTN FLUOR SWA 105 $1,145.00 $585.00 32 REHAB SERVICES3228616 SP EVAL MTN FLUOR SWA 120 $1,266.00 $627.00 32 REHAB SERVICES3228780 SP EVAL MTN FLUOR SWA 120 $627.00 32 REHAB SERVICES3228707 SP EVAL MTN FLUOR SWA 120 $1,266.00 32 REHAB SERVICES3221538 SP EVAL MTN FLUOR SWAL 15 $136.00 $70.00 32 REHAB SERVICES3221546 SP EVAL MTN FLUOR SWAL 30 $332.00 $170.00 32 REHAB SERVICES3222031 SP EVAL MTN FLUOR SWAL 30 $316.00 $157.00 32 REHAB SERVICES3222049 SP EVAL MTN FLUOR SWAL 45 $475.00 $235.00 32 REHAB SERVICES3221553 SP EVAL MTN FLUOR SWAL 45 $413.00 $211.00 32 REHAB SERVICES3228764 SP EVAL MTN FLUOR SWAL 60 $313.00 32 REHAB SERVICES3221561 SP EVAL MTN FLUOR SWAL 60 $667.00 $341.00 32 REHAB SERVICES3222015 SP EVAL MTN FLUOR SWAL 60 $633.00 $313.00 32 REHAB SERVICES3222023 SP EVAL MTN FLUOR SWAL 75 $791.00 $392.00 32 REHAB SERVICES3221579 SP EVAL MTN FLUOR SWAL 75 $812.00 $415.00 32 REHAB SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

3221587 SP EVAL MTN FLUOR SWAL 75 $979.00 $500.00 32 REHAB SERVICES3222056 SP EVAL MTN FLUOR SWAL 90 $949.00 $470.00 32 REHAB SERVICES3228772 SP EVAL MTN FLUOR SWAL 90 $470.00 32 REHAB SERVICES3221611 SP EVAL SP/LNG/COM/AUD 15 $154.00 $79.00 32 REHAB SERVICES3221629 SP EVAL SP/LNG/COM/AUD 30 $264.00 $131.00 32 REHAB SERVICES3221637 SP EVAL SP/LNG/COM/AUD 45 $396.00 $196.00 32 REHAB SERVICES3221645 SP EVAL SP/LNG/COM/AUD 60 $527.00 $261.00 32 REHAB SERVICES3228640 SP EVAL SP/LNG/COM/AUD 60 $527.00 32 REHAB SERVICES3221652 SP EVAL SP/LNG/COM/AUD 75 $659.00 $327.00 32 REHAB SERVICES3228624 SP EVAL SP/LNG/COM/AUD 90 $791.00 32 REHAB SERVICES3221108 SP EVAL SP/LNG/COM/AUD 90 $791.00 $392.00 32 REHAB SERVICES3221660 SP EVAL SP/LNG/COM/AUD 90 $791.00 $392.00 32 REHAB SERVICES3221678 SP EVAL SWALL & ORAL 15 $132.00 $65.00 32 REHAB SERVICES3228798 SP EVAL SWALL & ORAL 30 $494.00 $253.00 32 REHAB SERVICES3221694 SP EVAL SWALL & ORAL 45 $396.00 $196.00 32 REHAB SERVICES3221702 SP EVAL SWALL & ORAL 60 $527.00 $261.00 32 REHAB SERVICES3222064 SP EVL SP/LNG/COM/AUD 105 $923.00 $457.00 32 REHAB SERVICES3228715 SP EVL SP/LNG/COM/AUD 120 $1,055.00 32 REHAB SERVICES3221603 SP EVL SP/LNG/COM/AUD 120 $1,157.00 $592.00 32 REHAB SERVICES3220365 SP SP/LANG THER EA 30 $243.00 $121.00 32 REHAB SERVICES3220381 SP THER SP/LANG EA 60 $487.00 $241.00 32 REHAB SERVICES3220019 SP THER SP/LANG GRP 60 $365.00 $181.00 32 REHAB SERVICES3220522 SP THER SSAC PER VISIT $302.00 $165.00 32 REHAB SERVICES3221876 SP TX SP/LANG/COM GP 15 $73.00 $37.00 32 REHAB SERVICES3221884 SP TX SP/LANG/COM GP 30 $155.00 $79.00 32 REHAB SERVICES3221892 SP TX SP/LANG/COM GP 45 $186.00 $95.00 32 REHAB SERVICES3221801 SP TX SP/LANG/COM IND 15 $122.00 $60.00 32 REHAB SERVICES3221819 SP TX SP/LANG/COM IND 30 $243.00 $121.00 32 REHAB SERVICES3221827 SP TX SP/LANG/COM IND 45 $365.00 $181.00 32 REHAB SERVICES3221116 SP TX SP/LANG/COM IND 60 $487.00 $241.00 32 REHAB SERVICES3228657 SP TX SP/LANG/COM IND 60 $487.00 32 REHAB SERVICES3228723 SP TX SP/LANG/COM IND 60 $487.00 32 REHAB SERVICES3221835 SP TX SP/LANG/COM IND 75 $608.00 $301.00 32 REHAB SERVICES3221843 SP TX SP/LANG/COM IND 90 $730.00 $362.00 32 REHAB SERVICES3221926 SP TX SWALL/ORAL FNX 105 $853.00 $436.00 32 REHAB SERVICES3228673 SP TX SWALL/ORAL FNX 105 $852.00 32 REHAB SERVICES3221934 SP TX SWALL/ORAL FNX 120 $973.00 $482.00 32 REHAB SERVICES

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SEQ 200 AMOUNT

DEPARTMENT CODE

3221942 SP TX SWALL/ORAL FNX 15 $122.00 $60.00 32 REHAB SERVICES3221959 SP TX SWALL/ORAL FNX 30 $243.00 $121.00 32 REHAB SERVICES3221967 SP TX SWALL/ORAL FNX 45 $365.00 $181.00 32 REHAB SERVICES3221975 SP TX SWALL/ORAL FNX 60 $487.00 $241.00 32 REHAB SERVICES3228756 SP TX SWALL/ORAL FNX 60 $487.00 $241.00 32 REHAB SERVICES3221231 SP TX SWALL/ORAL FNX 75 $608.00 $301.00 32 REHAB SERVICES3221983 SP TX SWALL/ORAL FNX 75 $608.00 $301.00 32 REHAB SERVICES3221991 SP TX SWALL/ORAL FNX 90 $730.00 $362.00 32 REHAB SERVICES3212339 WHFO ADDL IP EXT W/MP EXT 32 REHAB SERVICES3212198 WHFO ADDL THUMB ABDUCTION 32 REHAB SERVICES3212214 WHFO NONTORSN JNT PREFAB 32 REHAB SERVICES3212255 WHFO NONTORSN JNT PREFAB 32 REHAB SERVICES3212149 WHFO NONTORSN JNT PREFAB 32 REHAB SERVICES3212206 WHFO THUMB IP EXT ASST W 32 REHAB SERVICES5120043 DIALYS CAPD HM 51 RENAL SERVICES5120084 DIALYS CAPD OP 51 RENAL SERVICES5110077 DIALYS CCPD IP 51 RENAL SERVICES5110069 DIALYS CCPD IP $1,772.00 $1,018.00 $187.00 51 RENAL SERVICES5120050 DIALYS HEMO HM 51 RENAL SERVICES5110010 DIALYS HEMO IP $2,941.00 $1,690.00 $311.00 51 RENAL SERVICES5120027 DIALYS TRAIN EA SESS CAPD 51 RENAL SERVICES5120092 DIALYS TRAIN EA SESS CCPD 51 RENAL SERVICES5110093 SERVICE CALL/SUPPORT SERV 51 RENAL SERVICES5110101 WAITING TIME 51 RENAL SERVICES0005777 BEAR EXAM $125.00 00 ROOM & BED0058503 NEWBORN ECMO $22,212.00 00 ROOM & BED0098004 NEWBORN LEVEL I $1,588.00 00 ROOM & BED0098251 NEWBORN LEVEL I $1,588.00 00 ROOM & BED0096008 NEWBORN LEVEL I $1,588.00 00 ROOM & BED0028506 NEWBORN LEVEL II $6,400.00 00 ROOM & BED0038505 NEWBORN LEVEL III $8,400.00 00 ROOM & BED0048504 NEWBORN LEVEL IV $13,000.00 00 ROOM & BED0005017 OBSERVATION PER HOUR $220.00 00 ROOM & BED0005264 OBSERVATION PER HOUR $220.00 00 ROOM & BED0009514 OBSERVATION PER HOUR $220.00 00 ROOM & BED0005769 OBSERVATION PER HOUR $220.00 00 ROOM & BED0004267 OBSERVATION PER HOUR $220.00 00 ROOM & BED

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SEQ 200 AMOUNT

DEPARTMENT CODE

0004010 OBSERVATION PER HOUR $220.00 00 ROOM & BED0009001 OBSERVATION PER HOUR $220.00 00 ROOM & BED0002519 OBSERVATION PER HOUR $220.00 00 ROOM & BED0009266 OBSERVATION PER HOUR $220.00 00 ROOM & BED0002261 OBSERVATION PER HOUR $220.00 00 ROOM & BED0005512 OBSERVATION PER HOUR $220.00 00 ROOM & BED0000976 ROOM BOARD SUB-ACUTE $1,726.00 00 ROOM & BED0072504 ROOM CCU $9,312.00 00 ROOM & BED0072256 ROOM ICU $10,039.00 00 ROOM & BED0065755 ROOM ICU INTERM $5,928.00 00 ROOM & BED0062257 ROOM ICU INTERM $5,928.00 00 ROOM & BED0062505 ROOM ICU INTERM $5,928.00 00 ROOM & BED0034504 ROOM ICU INTERM PEDIATRIC $7,745.00 00 ROOM & BED0074500 ROOM ICU PEDIATRICS $9,393.00 00 ROOM & BED0074252 ROOM ICU PEDIATRICS $9,393.00 00 ROOM & BED0029504 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0016253 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0016501 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025759 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0019505 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025007 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0049502 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015008 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015750 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0045500 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025254 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025502 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015255 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015503 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0021006 ROOM OB/MATERNAL $4,017.00 00 ROOM & BED0019257 ROOM OB/MATERNAL $1.00 00 ROOM & BED0012005 ROOM OB/MATERNAL $4,017.00 00 ROOM & BED0011007 ROOM OB/MATERNAL $4,017.00 00 ROOM & BED0022004 ROOM OB/MATERNAL $4,017.00 00 ROOM & BED0029009 ROOM OB/MATERNAL $4,017.00 00 ROOM & BED0029256 ROOM OB/MATERNAL $1.00 00 ROOM & BED0024000 ROOM PEDIATRIC $5,738.00 00 ROOM & BED

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0024257 ROOM PEDIATRIC $5,738.00 00 ROOM & BED0014001 ROOM PEDIATRIC $5,738.00 00 ROOM & BED0014258 ROOM PEDIATRIC $5,738.00 00 ROOM & BED0014100 ROOM PEDIATRIC $5,301.00 00 ROOM & BED0024109 ROOM PEDIATRIC $5,301.00 00 ROOM & BED0024505 ROOM PEDIATRIC $5,738.00 00 ROOM & BED0014506 ROOM PEDIATRIC $5,738.00 00 ROOM & BED0089003 ROOM SPECIAL CARE $5,427.00 00 ROOM & BED0055251 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0055004 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0052506 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0052258 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0055756 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0400556 CATH HD SHORT TERM $449.00 $449.00 04 SUPPLIES - CS0401505 CERVICAL FOAM COLLAR $37.00 $35.00 04 SUPPLIES - CS0412585 CERVICAL FOAM COLLAR $432.00 04 SUPPLIES - CS0412593 CERVICAL FOAM COLLAR $995.00 04 SUPPLIES - CS0412577 CERVICAL PLASTIC COLLAR $480.00 04 SUPPLIES - CS0412239 CERVICAL PLASTIC COLLAR $150.00 $113.00 04 SUPPLIES - CS0412221 CERVICAL PLASTIC COLLAR $150.00 $113.00 04 SUPPLIES - CS0412700 PL SHOE INS W ANKLE JNTS $424.00 04 SUPPLIES - CS0413229 S IMP KNEE JOINT DROP LOC $171.00 04 SUPPLIES - CS0497826 S NSTRL SLEEVE KNEE LG S $173.38 04 SUPPLIES - CS0404756 S NSTRL TRNDCR 02 $114.00 $114.00 04 SUPPLIES - CS0411363 S NSTRL AMBU BAGS, DISP $123.00 $116.00 04 SUPPLIES - CS0400895 S NSTRL BAG LEG LG DISP $15.00 $14.00 04 SUPPLIES - CS0405274 S NSTRL BAG RESUSITATION $39.00 $39.00 04 SUPPLIES - CS0403204 S NSTRL BAG URINIMETER $51.00 $48.00 04 SUPPLIES - CS0497974 S NSTRL BARRIER FLANGE LI $17.88 04 SUPPLIES - CS0498071 S NSTRL BARRIER MBL 1 3/4 $10.00 04 SUPPLIES - CS0498089 S NSTRL BARRIER MBL 2 1/4 $10.00 04 SUPPLIES - CS0498097 S NSTRL BARRIER MBL 2 3/4 $10.00 04 SUPPLIES - CS0412213 S NSTRL BELT OSTY $34.00 04 SUPPLIES - CS0408237 S NSTRL BNDG UNNA BOOT $38.00 $36.00 04 SUPPLIES - CS0497651 S NSTRL BOOT ANKLE DROP 04 SUPPLIES - CS0405761 S NSTRL CATHETER RADIAL $51.00 $48.00 04 SUPPLIES - CS0413450 S NSTRL CLEANS PRNEAL SK8 $10.00 04 SUPPLIES - CS

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SEQ 200 AMOUNT

DEPARTMENT CODE

0497693 S NSTRL CROWN HIFIX PIN $1,764.00 04 SUPPLIES - CS0497701 S NSTRL CROWN HIFIX PIN $1,764.00 04 SUPPLIES - CS0412023 S NSTRL FLNG 5X5 W/ 2-1/4 $21.00 04 SUPPLIES - CS0412031 S NSTRL FLNG 5X5 W/ 2-3/4 $21.00 04 SUPPLIES - CS0497677 S NSTRL HALO AIRFLO VEST $3,360.00 04 SUPPLIES - CS0497669 S NSTRL HALO AIRFLOW VEST $3,360.00 04 SUPPLIES - CS0497685 S NSTRL HALO EX LG VEST $2,646.00 04 SUPPLIES - CS0497719 S NSTRL HALO HEAD POS. SP $493.00 04 SUPPLIES - CS0497750 S NSTRL HALO RING PED. LG $714.00 04 SUPPLIES - CS0497743 S NSTRL HALO RING PED. LG $1,764.00 04 SUPPLIES - CS0497735 S NSTRL HALO VEST CHILD $2,884.00 04 SUPPLIES - CS0497727 S NSTRL HALO VEST TODDLER $2,884.00 04 SUPPLIES - CS0400671 S NSTRL INCENTIVE SPIRO $23.00 $21.00 04 SUPPLIES - CS0412064 S NSTRL IRRIG SLEEVE $23.00 04 SUPPLIES - CS0412098 S NSTRL IRRIGATOR WITH S $111.00 04 SUPPLIES - CS0413245 S NSTRL KNEE ORTHOSIS $718.00 04 SUPPLIES - CS0407213 S NSTRL LINE ART $75.00 $71.00 04 SUPPLIES - CS0413104 S NSTRL MASK BILI MED $19.00 04 SUPPLIES - CS0413120 S NSTRL MASK BILI PREMI $15.00 04 SUPPLIES - CS0413112 S NSTRL MASK BILI SMALL $16.00 04 SUPPLIES - CS0405431 S NSTRL MASK BILIRUBIN $21.00 $20.00 04 SUPPLIES - CS0404137 S NSTRL MASK TRACHEOSTOM $6.00 $6.00 04 SUPPLIES - CS0400689 S NSTRL NASAL CAN 25FT $10.00 $10.00 04 SUPPLIES - CS0400663 S NSTRL NASAL CAN 7FT $3.00 $3.00 04 SUPPLIES - CS0407056 S NSTRL NASAL OLIVE $17.00 $16.00 04 SUPPLIES - CS0400648 S NSTRL NEBULIZER HND HLD $5.53 $6.00 04 SUPPLIES - CS0413443 S NSTRL OINTMT PROTEC2-N1 $14.00 04 SUPPLIES - CS0401174 S NSTRL PAD HYPOTHERMIA $59.00 $56.00 04 SUPPLIES - CS0406967 S NSTRL PAD K THERM DISP $59.00 $55.00 04 SUPPLIES - CS0410910 S NSTRL PAD L THERM DISP $88.00 $83.00 04 SUPPLIES - CS0413476 S NSTRL PAD PEDS PACING E $112.00 04 SUPPLIES - CS0408260 S NSTRL PADS PACE AID PK $148.00 $140.00 04 SUPPLIES - CS0412015 S NSTRL POUCH BARRIER $16.00 04 SUPPLIES - CS0412007 S NSTRL POUCH BARRIER $17.00 04 SUPPLIES - CS0412049 S NSTRL POUCH DRAIN $11.00 04 SUPPLIES - CS0412056 S NSTRL POUCH DRAIN W/2- $11.00 04 SUPPLIES - CS0498048 S NSTRL POUCH DRN FT 1.75 $8.00 04 SUPPLIES - CS

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SEQ 200 AMOUNT

DEPARTMENT CODE

0498055 S NSTRL POUCH DRN FT 2.75 $8.00 04 SUPPLIES - CS0498030 S NSTRL POUCH DRNBL 2.25 $8.00 04 SUPPLIES - CS0497966 S NSTRL POUCH DRNBL OVER $13.00 04 SUPPLIES - CS0498022 S NSTRL POUCH ONE PC DRNB $9.00 04 SUPPLIES - CS0412155 S NSTRL POUCH ONE-PIECE $8.32 04 SUPPLIES - CS0413070 S NSTRL POUCH OSTY 1-3/4 $30.00 04 SUPPLIES - CS0413062 S NSTRL POUCH OSTY 4" $62.00 04 SUPPLIES - CS0413682 S NSTRL POUCH OSTY PCHKN $10.14 04 SUPPLIES - CS0497982 S NSTRL POUCH OSTY POUCHK $13.56 04 SUPPLIES - CS0416230 S NSTRL POUCH POUCHINS PE $10.53 04 SUPPLIES - CS0412072 S NSTRL POUCH UROSTY $16.00 04 SUPPLIES - CS0404699 S NSTRL POUCH, UROSTOMY $30.00 $28.00 04 SUPPLIES - CS0403741 S NSTRL PROBE TEMP ESOPH $41.00 $38.00 04 SUPPLIES - CS0412569 S NSTRL PROSTHETIC SHTH $180.00 04 SUPPLIES - CS0405423 S NSTRL PUMP BREAST DBL $44.00 $42.00 04 SUPPLIES - CS0402347 S NSTRL SILVER NITRATE $3.00 $2.00 04 SUPPLIES - CS0403188 S NSTRL SOCK ANTI EMBOL $45.00 $42.00 04 SUPPLIES - CS0413237 S NSTRL SPLINT HAND WRIST $417.00 04 SUPPLIES - CS0402578 S NSTRL STOCKING TED NYL $26.00 $25.00 04 SUPPLIES - CS0413641 S NSTRL SUPPORT STERNUM $375.00 04 SUPPLIES - CS0412122 S NSTRL TAIL CLOSURES CU $9.00 04 SUPPLIES - CS0405571 S NSTRL THORACIC RIB BELT $37.00 $35.00 04 SUPPLIES - CS0412619 S NSTRL TLSO CMPS JKT $2,854.00 04 SUPPLIES - CS0404269 S NSTRL TRANSDUCER OXYGE $107.00 $101.00 04 SUPPLIES - CS0404228 S NSTRL TRNDCR O2 ADLT $85.00 $80.00 04 SUPPLIES - CS0404236 S NSTRL TRNDCR O2 INF $107.00 $101.00 04 SUPPLIES - CS0404244 S NSTRL TRNDCR O2 PED $85.00 $80.00 04 SUPPLIES - CS0404202 S NSTRL TUBING 02 CONNEC 04 SUPPLIES - CS0497610 S NSTRL UROSTY POUCH $29.00 04 SUPPLIES - CS0497834 S NSTRL VALVE FARRELL $43.47 04 SUPPLIES - CS0497602 S NSTRL WAFER SEAL $22.00 04 SUPPLIES - CS0408377 S ORTHO BINDER ABD $50.00 $47.00 04 SUPPLIES - CS0413203 S ORTHO BOOT HEEL $103.00 04 SUPPLIES - CS0413195 S ORTHO BOS OVERLAP BRACE $3,796.00 04 SUPPLIES - CS0402487 S ORTHO BUCKS TRACT BOOT $65.00 $101.00 04 SUPPLIES - CS0403279 S ORTHO CUSTOM SUPPORT 04 SUPPLIES - CS0412858 S ORTHO LS SURG SUPPORT $496.00 04 SUPPLIES - CS

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DEPARTMENT CODE

0412643 S ORTHO ORTHOSIS,LS SURG $491.00 04 SUPPLIES - CS0403162 S ORTHO POST OP SHOE $31.00 04 SUPPLIES - CS0409102 S ORTHO SHOE CAST $49.00 $46.00 04 SUPPLIES - CS0412726 S ORTHO SHOE, PLASTAZOTE $358.00 04 SUPPLIES - CS0402362 S ORTHO SLING ARM ADLT $14.00 $13.00 04 SUPPLIES - CS0400804 S ORTHO SLING ARM CHILD $23.00 $21.00 04 SUPPLIES - CS0402370 S ORTHO SPLINT ARM COLLE $32.00 $30.00 04 SUPPLIES - CS0406298 S ORTHO SPLINT FINGER GU $6.00 $6.00 04 SUPPLIES - CS0402446 S ORTHO SPLNT ARM ADLT $44.00 $41.00 04 SUPPLIES - CS0402453 S ORTHO SPLNT FINGER $8.00 $7.00 04 SUPPLIES - CS0402461 S ORTHO SPLNT FINGER $24.00 $23.00 04 SUPPLIES - CS0402503 S ORTHO SPLNT FRARM YTH $52.00 $49.00 04 SUPPLIES - CS0402495 S ORTHO SPLNT LEG THOMAS $316.00 $298.00 04 SUPPLIES - CS0400747 S ORTHO SUPPORT ABDOMINA $48.00 $46.00 04 SUPPLIES - CS0412882 S OT ADD AK SOFT INTERFC $344.00 04 SUPPLIES - CS0412718 S OT ADD BK SOFT INTERFC $314.00 04 SUPPLIES - CS0412767 S OT ADD UPPR EXT SOCK FX $113.00 04 SUPPLIES - CS0412684 S OT AFO PTR SLD ANK PLS $857.00 04 SUPPLIES - CS0412676 S OT AFO SNGL UPRIGHT CUS $990.00 04 SUPPLIES - CS0412973 S OT EO DBL UPRT FORE CUS $327.00 04 SUPPLIES - CS0412957 S OT HALO CERV JKT VEST $356.00 04 SUPPLIES - CS0412650 S OT HO POST OP JNTS PF $2,720.00 04 SUPPLIES - CS0412692 S OT KAFO FX FEMORAL CUS $2,258.00 04 SUPPLIES - CS0412668 S OT KO ADJ KNEE JT RGD $1,972.00 04 SUPPLIES - CS0410092 S OT KO IMMOB CNVS LONG $110.00 $104.00 04 SUPPLIES - CS0410100 S OT KO IMMOB CNVS LONG $99.00 $93.00 04 SUPPLIES - CS0412379 S OT NON-PNEUM WALK BOOT $163.00 04 SUPPLIES - CS0412775 S OT PNEU ANK CTRL SPLINT $324.00 04 SUPPLIES - CS0412791 S OT PNEU FULL LEG SPLNT $513.00 04 SUPPLIES - CS0412783 S OT PNEUM WALKING BOOT $877.00 04 SUPPLIES - CS0403311 S OT SO FIG 8 ABDC REST $24.00 $23.00 04 SUPPLIES - CS0497628 S OT SO FIG 8 ABDC REST $327.00 04 SUPPLIES - CS0412734 S OT SO FIG 8 ABDC REST $235.00 04 SUPPLIES - CS0412601 S OT TLSO 2 PC W LINER $629.00 04 SUPPLIES - CS0412635 S OT TLSO 2 PC W LINER $3,592.00 04 SUPPLIES - CS0412627 S OT TLSO HYPEREXT RGD PF $1,464.00 04 SUPPLIES - CS0412817 S OT TLSO PF 1 PC W LINER $3,639.00 04 SUPPLIES - CS

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SEQ 200 AMOUNT

DEPARTMENT CODE

0412759 S OT UPP EXTM FXO HUMERAL $1,095.00 04 SUPPLIES - CS0412965 S OT WHFO RIGID W/O JNTS $836.00 04 SUPPLIES - CS0412809 S PR INIT RIGID DRESS BK $3,781.00 04 SUPPLIES - CS0412825 S PR SHRINKER BK $2,890.00 04 SUPPLIES - CS0400051 S STRL $56.00 $56.00 04 SUPPLIES - CS0404640 S STRL ADAPTOR PRESSURE $3.00 $3.00 04 SUPPLIES - CS0405142 S STRL BAG DRAIN EDMS 7 $123.00 $116.00 04 SUPPLIES - CS0409417 S STRL BAG DRAINAGE $115.00 $109.00 04 SUPPLIES - CS0400283 S STRL BAG LEG FREEDOM- $45.00 $43.00 04 SUPPLIES - CS0408930 S STRL BAG URINE PEDI $8.00 $7.00 04 SUPPLIES - CS0406900 S STRL BAG URINE PEDI 2 $17.00 $16.00 04 SUPPLIES - CS0400788 S STRL BROVIAC REPAIR K $377.00 $356.00 04 SUPPLIES - CS0498147 S STRL CAN INR PERCT 7MM $16.00 04 SUPPLIES - CS0498139 S STRL CAN INR PERCT 8MM $14.00 04 SUPPLIES - CS0498154 S STRL CAN INR PERCT 9MM $15.00 04 SUPPLIES - CS0476259 S STRL CANISTER VAC WITH $178.00 04 SUPPLIES - CS0412320 S STRL CANNULA ARTERIAL $716.00 04 SUPPLIES - CS0407924 S STRL CANNULA DUAL LUM $793.00 $748.00 04 SUPPLIES - CS0490011 S STRL CAP 15MM TRACH T $36.00 04 SUPPLIES - CS0413492 S STRL CATH 10FR TRCH SUC $45.00 04 SUPPLIES - CS0413500 S STRL CATH 12FR TRCH SUC $58.00 04 SUPPLIES - CS0401448 S STRL CATH 14F TRACH SUC $51.00 $51.00 04 SUPPLIES - CS0498238 S STRL CATH 2 LMN UMBI 5F $114.00 04 SUPPLIES - CS0497842 S STRL CATH 6F TRACH SUC $76.00 04 SUPPLIES - CS0413484 S STRL CATH 8FR TRCH SUC $81.00 04 SUPPLIES - CS0412924 S STRL CATH ANGIO $4.00 04 SUPPLIES - CS0401331 S STRL CATH CONDOM-NON LA $6.00 $5.00 04 SUPPLIES - CS0405670 S STRL CATH COOK 2 LMN $290.00 $273.00 04 SUPPLIES - CS0405738 S STRL CATH ELECATH ECMO $268.00 $253.00 04 SUPPLIES - CS0410118 S STRL CATH EXTERNAL ALL $7.00 $7.00 04 SUPPLIES - CS0405050 S STRL CATH FEMALE SELF-C $3.00 $3.00 04 SUPPLIES - CS0405639 S STRL CATH FILIFORM GU D $152.00 $143.00 04 SUPPLIES - CS0401398 S STRL CATH FOLEY 3 WAY A $65.00 $61.00 04 SUPPLIES - CS0401349 S STRL CATH FOLEY 6FR SIL $92.00 $87.00 04 SUPPLIES - CS0407973 S STRL CATH FOLEY 8FR-10F $52.00 $49.00 04 SUPPLIES - CS0401380 S STRL CATH FOLEY ALL $36.00 $34.00 04 SUPPLIES - CS0401307 S STRL CATH FOLEY COUDE A $77.00 $73.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0405613 S STRL CATH FOLEY COUNCIL $97.00 $91.00 04 SUPPLIES - CS0401315 S STRL CATH FOLEY SIL 16- $28.00 $27.00 04 SUPPLIES - CS0401299 S STRL CATH FOLEY SIL 8-1 $50.00 $47.00 04 SUPPLIES - CS0413526 S STRL CATH HERMETIC VENT $380.00 04 SUPPLIES - CS0498105 S STRL CATH IV INSYTE $10.00 04 SUPPLIES - CS0498113 S STRL CATH IV INSYTE SHL $14.00 04 SUPPLIES - CS0411967 S STRL CATH LOFRIC $17.00 04 SUPPLIES - CS0408583 S STRL CATH NUTRA FEED $84.00 $80.00 04 SUPPLIES - CS0402099 S STRL CATH PLUG/TUBE $3.00 $2.00 04 SUPPLIES - CS0401422 S STRL CATH ROBINSON 16FR $22.00 $21.00 04 SUPPLIES - CS0403949 S STRL CATH SLIC 7FR X 8" $53.00 $50.00 04 SUPPLIES - CS0413138 S STRL CATH STAMEY SUPRA $153.00 04 SUPPLIES - CS0413146 S STRL CATH STAMEY SUPRA $156.00 04 SUPPLIES - CS0400275 S STRL CATH STR NON/LATEX $5.00 $4.00 04 SUPPLIES - CS0409920 S STRL CATH SWAN VIP $268.00 $253.00 04 SUPPLIES - CS0497818 S STRL CATH SWANZ CCO/SV $871.00 04 SUPPLIES - CS0407387 S STRL CATH THREMO $268.00 $253.00 04 SUPPLIES - CS0409532 S STRL CATH TROCAR CHEST $80.00 $76.00 04 SUPPLIES - CS0408799 S STRL CATH UMB 4FR $894.00 $844.00 04 SUPPLIES - CS0405720 S STRL CATH UMBILICAL 5 & $66.00 $62.00 04 SUPPLIES - CS0405159 S STRL CATH VENOUS DUAL $656.00 $619.00 04 SUPPLIES - CS0476218 S STRL CATH VENOUS SCVO2 $956.00 04 SUPPLIES - CS0407452 S STRL CATHETER BROVIAC $380.00 $359.00 04 SUPPLIES - CS0412361 S STRL CATHETER CATHGRA $36.00 04 SUPPLIES - CS0405688 S STRL CATHETER COOK 1 $173.00 $163.00 04 SUPPLIES - CS0401455 S STRL CATHETER SUCTION $6.00 $6.00 04 SUPPLIES - CS0405779 S STRL CATHETER SUCTION $36.00 $34.00 04 SUPPLIES - CS0401463 S STRL CATHETER SUCTION $20.00 $19.00 04 SUPPLIES - CS0408344 S STRL CATHETER VIP SWA $256.00 $242.00 04 SUPPLIES - CS0407700 S STRL CLAMP BROVIAC $8.00 $8.00 04 SUPPLIES - CS0407627 S STRL CLAMP BULL DOG $33.00 $31.00 04 SUPPLIES - CS0403873 S STRL CNTNR EVAC $10.00 $9.00 04 SUPPLIES - CS0403501 S STRL CREAM ILEX $30.00 $28.00 04 SUPPLIES - CS0413054 S STRL CVR WND 2X2 WARM $375.00 04 SUPPLIES - CS0413039 S STRL CVR WND 4X4 SAC $375.00 04 SUPPLIES - CS0413021 S STRL CVR WND 6X6 SAC $375.00 04 SUPPLIES - CS0413047 S STRL CVR WND 6X8 WARM $375.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0409797 S STRL DILATOR VESSEL 5F $47.00 $47.00 04 SUPPLIES - CS0413567 S STRL DISC CMPRSR 3 FNGR $63.00 04 SUPPLIES - CS0413625 S STRL DISC CPMRS W/ALGIN $192.00 04 SUPPLIES - CS0405100 S STRL DISCS COMPRESSOR $40.00 $38.00 04 SUPPLIES - CS0407429 S STRL DRAIN CHEST $323.00 $304.00 04 SUPPLIES - CS0410951 S STRL DRAIN CHEST PLUERE $190.00 $179.00 04 SUPPLIES - CS0413369 S STRL DRESS ALGINATE 4X4 $25.00 04 SUPPLIES - CS0413344 S STRL DRESS ALLDRESS 4X4 $9.00 04 SUPPLIES - CS0413351 S STRL DRESS ALLDRESS 8X8 $13.00 04 SUPPLIES - CS0498261 S STRL DRESS AQUAGUARD5X5 $9.42 04 SUPPLIES - CS0498279 S STRL DRESS AQUAGUARD9X9 $11.90 04 SUPPLIES - CS0413377 S STRL DRESS FM 4X4W/OADH $25.00 04 SUPPLIES - CS0413385 S STRL DRESS FM ADH 2.5X3 $28.00 04 SUPPLIES - CS0413393 S STRL DRESS FM ADH 4X4.5 $32.00 04 SUPPLIES - CS0401711 S STRL DRESS GAUZE VSLN $10.00 $10.00 04 SUPPLIES - CS0413401 S STRL DRESS HYDR AD2 3/4 $16.00 04 SUPPLIES - CS0413419 S STRL DRESS HYDR ADH 4X4 $23.00 04 SUPPLIES - CS0413435 S STRL DRESS HYDR SAC6.4X $44.00 04 SUPPLIES - CS0413427 S STRL DRESS HYDR W/O 4X4 $17.00 04 SUPPLIES - CS0498337 S STRL DRESS HYROFERA BLU $40.00 04 SUPPLIES - CS0412510 S STRL DRESS KIT LG CA/5 $876.00 04 SUPPLIES - CS0412494 S STRL DRESS KIT MED CA/5 $726.00 04 SUPPLIES - CS0412460 S STRL DRESS KIT SM CA/10 $1,043.00 04 SUPPLIES - CS0412478 S STRL DRESS KIT SM CA/5 $576.00 04 SUPPLIES - CS0401984 S STRL DRESS NUGAUZE $18.00 $23.00 04 SUPPLIES - CS0406165 S STRL DRESS PK VAG $14.00 $14.00 04 SUPPLIES - CS0401695 S STRL DRESS PKG IODO 1" $23.00 $29.00 04 SUPPLIES - CS0401687 S STRL DRESS PKG IODO 1/2 $20.00 $25.00 04 SUPPLIES - CS0401679 S STRL DRESS PKG IODO 1/4 $19.00 $24.00 04 SUPPLIES - CS0401703 S STRL DRESS PKG IODO 2" $32.00 $44.00 04 SUPPLIES - CS0408948 S STRL DRESS SURG 1/2X2 $40.00 $37.00 04 SUPPLIES - CS0406371 S STRL DRESS SURGICEL 2X3 $71.00 $67.00 04 SUPPLIES - CS0401729 S STRL DRESS VASELINE $6.00 $6.00 04 SUPPLIES - CS0401737 S STRL DRESS VASELINE $9.00 $8.00 04 SUPPLIES - CS0401745 S STRL DRESS XEROFORM $9.00 $8.00 04 SUPPLIES - CS0401596 S STRL DRESS XEROFORM $6.00 $6.00 04 SUPPLIES - CS0401554 S STRL DRESSING ADAPTIC $3.00 $3.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

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SEQ 200 AMOUNT

DEPARTMENT CODE

0476283 S STRL DRESSING FOAM VAC $166.00 04 SUPPLIES - CS0476242 S STRL DRESSING FOAM VAC $200.00 04 SUPPLIES - CS0476275 S STRL DRESSING FOAM VAC $131.00 04 SUPPLIES - CS0406116 S STRL DRESSING PK PLAI $18.00 $25.00 04 SUPPLIES - CS0416214 S STRL DRESSING SOLOSITE $39.50 04 SUPPLIES - CS0498063 S STRL DRG LAYR SILVR 4X5 $48.00 04 SUPPLIES - CS0476309 S STRL DRN FUHRMAN PLEURA $307.00 04 SUPPLIES - CS0498220 S STRL DRS ANTIMIC W/SLVR $214.00 04 SUPPLIES - CS0498121 S STRL DRSG BIO ANTIMI $31.28 04 SUPPLIES - CS0497636 S STRL DRSG BURN ACTICOAT $62.00 04 SUPPLIES - CS0412262 S STRL DRSG COMFEEL 4X4 $15.00 04 SUPPLIES - CS0498246 S STRL DRSG MEDIHONEY 2X2 $23.00 04 SUPPLIES - CS0476291 S STRL DRSG VAC SOFT FOAM $54.11 04 SUPPLIES - CS0413534 S STRL EXTRNL CSF DRNG SY $616.00 04 SUPPLIES - CS0402149 S STRL FEEDER HYBERMAN $72.00 $68.00 04 SUPPLIES - CS0400820 S STRL FEEDING TUBE/GAS $52.00 $49.00 04 SUPPLIES - CS0407965 S STRL FEMOSTOP $398.00 $375.00 04 SUPPLIES - CS0497859 S STRL FILIFORM COUDE/STR $145.59 04 SUPPLIES - CS0497891 S STRL FOLLOWER BOUGIE 12 $211.57 04 SUPPLIES - CS0497867 S STRL FOLLOWER BOUGIE 14 $216.84 04 SUPPLIES - CS0497909 S STRL FOLLOWER BOUGIE 16 $216.84 04 SUPPLIES - CS0497917 S STRL FOLLOWER BOUGIE 18 $216.84 04 SUPPLIES - CS0497925 S STRL FOLLOWER BOUGIE 20 $216.84 04 SUPPLIES - CS0497933 S STRL FOLLOWER BOUGIE 22 $211.57 04 SUPPLIES - CS0497883 S STRL FOLLOWER BOUGIE10F $211.57 04 SUPPLIES - CS0408682 S STRL FOLLOWER GU $259.00 $244.00 04 SUPPLIES - CS0497875 S STRL FOLLOWER OPEN ALL $240.98 04 SUPPLIES - CS0497941 S STRL FOLLOWER PHILLIP C $218.58 04 SUPPLIES - CS0401992 S STRL GAUZE PLN 1 PKNG $20.00 $25.00 04 SUPPLIES - CS0407221 S STRL GDWR .021 UMI $63.00 $60.00 04 SUPPLIES - CS0404988 S STRL GEL INTRASITE $39.00 $37.00 04 SUPPLIES - CS0498212 S STRL GEL SILVASORB $31.28 04 SUPPLIES - CS0413252 S STRL GUIDE WIRE .035 X $36.00 04 SUPPLIES - CS0497768 S STRL HALO SKULL PIN $714.00 04 SUPPLIES - CS0401901 S STRL HICKMAN REPAIR $314.00 $296.00 04 SUPPLIES - CS0401885 S STRL HICKMAN REPAIR $314.00 $296.00 04 SUPPLIES - CS0401893 S STRL HICKMAN REPAIR 2 $314.00 $296.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0409771 S STRL INSTRUMENT TRAY $28.00 $27.00 04 SUPPLIES - CS0403808 S STRL INTRODUCER SHEAT $108.00 $102.00 04 SUPPLIES - CS0413690 S STRL KIT ART LINE 20GA $105.00 04 SUPPLIES - CS0408831 S STRL KIT CARC OUTPUT $65.00 $61.00 04 SUPPLIES - CS0412395 S STRL KIT CATH ARRWGD $310.00 04 SUPPLIES - CS0412403 S STRL KIT CATH ARRWGD $310.00 04 SUPPLIES - CS0412387 S STRL KIT CATH AWGD $326.00 04 SUPPLIES - CS0409789 S STRL KIT CATH INSERT $435.00 $410.00 04 SUPPLIES - CS0413518 S STRL KIT CRANIAL ACCESS $1,132.00 04 SUPPLIES - CS0408393 S STRL KIT CVP $351.00 $331.00 04 SUPPLIES - CS0408252 S STRL KIT CVP MULTILUMEN $128.49 $128.49 04 SUPPLIES - CS0410704 S STRL KIT ELECT PACE $656.00 $619.00 04 SUPPLIES - CS0413658 S STRL KIT FECAL SYSTEM F $1,126.25 04 SUPPLIES - CS0497784 S STRL KIT GASTMY SKIN LE $403.75 04 SUPPLIES - CS0402271 S STRL KIT HEMOFILTER N $591.00 $558.00 04 SUPPLIES - CS0403675 S STRL KIT INT JUG PUNC $97.00 $92.00 04 SUPPLIES - CS0403899 S STRL KIT PERC SHTH 8.5F $197.00 $186.00 04 SUPPLIES - CS0403881 S STRL KIT PERCUT SHTH 6F $161.00 $152.00 04 SUPPLIES - CS0403360 S STRL KIT PRESSURE MONT $84.00 $84.00 04 SUPPLIES - CS0404491 S STRL KIT REP HKMN $352.00 $332.00 04 SUPPLIES - CS0407718 S STRL KIT REPAIR BROVI $331.00 $312.00 04 SUPPLIES - CS0404475 S STRL KIT REPAIR HICK $602.00 $568.00 04 SUPPLIES - CS0413161 S STRL KIT SM VAC DRESS 04 SUPPLIES - CS0416222 S STRL KIT SUBDURAL EVAC $3,750.00 04 SUPPLIES - CS0406421 S STRL KIT TRANSV ELECT $656.00 $619.00 04 SUPPLIES - CS0497792 S STRL KIT TRIPLE TRANSDU $143.69 04 SUPPLIES - CS0405936 S STRL MANNIFOLD, 3 WAY $111.00 $105.00 04 SUPPLIES - CS0407353 S STRL MON TUBING/TRANS $56.00 $56.00 04 SUPPLIES - CS0412353 S STRL NDL BN MRRW BIOP $58.00 04 SUPPLIES - CS0401919 S STRL NDL COOK $18.00 $17.00 04 SUPPLIES - CS0405092 S STRL NDL HUBER $42.00 $39.00 04 SUPPLIES - CS0407957 S STRL NDL IL ASPIRAT $101.00 $95.00 04 SUPPLIES - CS0405001 S STRL NDL ILLINO/ILIAC $53.00 $50.00 04 SUPPLIES - CS0404996 S STRL NDL JAMSHIDI $157.00 $148.00 04 SUPPLIES - CS0498204 S STRL NDL WHTCR SPNL 22G $26.56 04 SUPPLIES - CS0498170 S STRL NDLGRPRPLUS22GAX1 04 SUPPLIES - CS0405019 S STRL NEEDLE 13GA X 4" $122.00 $115.00 04 SUPPLIES - CS

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SEQ 200 AMOUNT

DEPARTMENT CODE

0403402 S STRL NEEDLE SPINAL DI $11.00 $10.00 04 SUPPLIES - CS0413583 S STRL NEPTUNE PAD $143.00 04 SUPPLIES - CS0406652 S STRL O2 NEO LUNG MEMBN $2,666.00 $2,515.00 04 SUPPLIES - CS0400085 S STRL OXISENOR D-20 $85.00 $80.00 04 SUPPLIES - CS0400077 S STRL OXISENOR D-25 $85.00 $80.00 04 SUPPLIES - CS0400093 S STRL OXISENOR I-20 $107.00 $101.00 04 SUPPLIES - CS0400069 S STRL OXISENOR R-15 $107.00 $101.00 04 SUPPLIES - CS0403014 S STRL OXYGENATOR PEDS $2,689.00 $2,537.00 04 SUPPLIES - CS0405894 S STRL PACK DAILY ECMO $82.00 $77.00 04 SUPPLIES - CS0408500 S STRL PAD HYPO THERMIA $104.00 $98.00 04 SUPPLIES - CS0498253 S STRL PASTE TUBE MEDIHON $59.00 04 SUPPLIES - CS0413468 S STRL PATCH HEMOSTATIS 3 $377.00 04 SUPPLIES - CS0402065 S STRL PATCHES EYE BLACK $9.00 $9.00 04 SUPPLIES - CS0498295 S STRL PICC CATHETER $107.35 04 SUPPLIES - CS0498311 S STRL PICC INTRODUCER $55.00 04 SUPPLIES - CS0498303 S STRL PICC PROCEDURE KIT $504.35 04 SUPPLIES - CS0408542 S STRL PIGTAIL MCBR 12" $16.00 $15.00 04 SUPPLIES - CS0408294 S STRL PLASTIBELL CIRCI $11.00 $10.00 04 SUPPLIES - CS0408658 S STRL PLEURAL DRN SET $243.00 $229.00 04 SUPPLIES - CS0404566 S STRL PLUG DECANN $27.00 $26.00 04 SUPPLIES - CS0405910 S STRL PLUG ECMO MX491 $3.00 $2.00 04 SUPPLIES - CS0400846 S STRL PORTEX INNER CAN $17.00 $16.00 04 SUPPLIES - CS0400879 S STRL PORTEX TRACH TUBE $160.00 $151.00 04 SUPPLIES - CS0498287 S STRL POSIFLOW CONNECTOR $135.00 04 SUPPLIES - CS0416164 S STRL POUCH OSTY PCHKNS $12.29 04 SUPPLIES - CS0407197 S STRL PUMP BREAST M/E $32.00 $30.00 04 SUPPLIES - CS0416172 S STRL PUNCH 2.0 SKIN BIO $9.00 04 SUPPLIES - CS0416180 S STRL PUNCH 3.0 SKIN BIO $9.00 04 SUPPLIES - CS0416198 S STRL PUNCH 4.0 SKIN BIO $9.00 04 SUPPLIES - CS0404749 S STRL ROPE KALTOSTAT $27.00 $25.00 04 SUPPLIES - CS0413542 S STRL RPLCMNT EXTRNL CSF $129.00 04 SUPPLIES - CS0403386 S STRL SCREW MOUTH $65.00 $61.00 04 SUPPLIES - CS0403220 S STRL SET ART COMP REG $146.00 $138.00 04 SUPPLIES - CS0408724 S STRL SET ARTERIAL COM $74.00 $70.00 04 SUPPLIES - CS0412452 S STRL SET BLOOD PUMP $8.00 04 SUPPLIES - CS0403071 S STRL SET BOLUS FEEDING $57.00 $54.00 04 SUPPLIES - CS0476333 S STRL SET CATH ARTERY SH $49.57 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0403865 S STRL SET CATH RADIAL $51.00 $48.00 04 SUPPLIES - CS0408336 S STRL SET COSET STOPCOCK $65.00 $62.00 04 SUPPLIES - CS0413633 S STRL SET CRICOTHYROTOMY $461.00 04 SUPPLIES - CS0401836 S STRL SET CVP MANOMETER $48.00 $46.00 04 SUPPLIES - CS0400812 S STRL SET CYSTO IRR HEAD $22.00 $20.00 04 SUPPLIES - CS0405456 S STRL SET CYSTO IRRIGA $22.00 $21.00 04 SUPPLIES - CS0402180 S STRL SET DRAIN FOLEY $22.00 $21.00 04 SUPPLIES - CS0403790 S STRL SET DRESS 3 PIECE $28.00 $27.00 04 SUPPLIES - CS0402255 S STRL SET GAVAGE 8PK D $30.00 $29.00 04 SUPPLIES - CS0405852 S STRL SET GAVAGE PN DI $5.00 $4.00 04 SUPPLIES - CS0407023 S STRL SET INCISION & D $34.00 $32.00 04 SUPPLIES - CS0416248 S STRL SET INFUS PWRLC 20 $37.00 04 SUPPLIES - CS0402206 S STRL SET PNEUMOTHORAX $362.00 $342.00 04 SUPPLIES - CS0403089 S STRL SET SECUR-LOK EX $57.00 $54.00 04 SUPPLIES - CS0405845 S STRL SET TRANSMISSION $33.00 $31.00 04 SUPPLIES - CS0403329 S STRL SET TUBE THORA $24.00 $23.00 04 SUPPLIES - CS0497800 S STRL SET VENOUS ACC 2 L $248.00 04 SUPPLIES - CS0405415 S STRL SHELL BREAST $47.00 $44.00 04 SUPPLIES - CS0406272 S STRL SLEEVE KNEE SEQUEN $115.00 $108.00 04 SUPPLIES - CS0400234 S STRL SLEEVE THIGH LARGE $200.00 $189.00 04 SUPPLIES - CS0410746 S STRL SLEEVE THIGH SEQUE $167.00 $158.00 04 SUPPLIES - CS0400101 S STRL SLEEVE THIGH SMALL $158.00 $149.00 04 SUPPLIES - CS0410753 S STRL SLEEVE THIGH STRL $151.00 $142.00 04 SUPPLIES - CS0416206 S STRL SOL .9 NACL 500ML $4.00 04 SUPPLIES - CS0402727 S STRL SOL .9% NS IRR $37.00 $35.00 04 SUPPLIES - CS0403261 S STRL SOL ACETIC ACID $11.00 $10.00 04 SUPPLIES - CS0403170 S STRL SOL H20 IRR 1000ML $7.00 $6.00 04 SUPPLIES - CS0403451 S STRL SOL HEP SOD .9% $18.00 $17.00 04 SUPPLIES - CS0406090 S STRL SOL NS 500CC BTL $6.00 $6.00 04 SUPPLIES - CS0401976 S STRL SOLUTION NS IRR $7.00 $6.00 04 SUPPLIES - CS0402263 S STRL SPECIAL ORDER ITEM 04 SUPPLIES - CS0400523 S STRL STPLR SKIN DISP $52.00 $49.00 04 SUPPLIES - CS0498188 S STRL SUC KIT CATH 5FR $3.55 04 SUPPLIES - CS0406389 S STRL SUTURES AMPS $10.00 $10.00 04 SUPPLIES - CS0404574 S STRL TRACH INNER CAN $23.00 $22.00 04 SUPPLIES - CS0498162 S STRL TRACH TUBE INTRDRC $245.00 04 SUPPLIES - CS0497958 S STRL TRAY AMNIOCENTESIS $55.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0476325 S STRL TRAY CATH 16F CUDE $50.00 04 SUPPLIES - CS0413328 S STRL TRAY CATH MHRKR $354.00 04 SUPPLIES - CS0413336 S STRL TRAY CATH MHRKR 10 $354.00 04 SUPPLIES - CS0413310 S STRL TRAY CATH MHRKR 8F $354.00 04 SUPPLIES - CS0411801 S STRL TRAY CV 4FR 5CM $188.00 $177.00 04 SUPPLIES - CS0411793 S STRL TRAY CV 5FR 13CM $159.00 $150.00 04 SUPPLIES - CS0408823 S STRL TRAY CVP 4FR 13C $200.00 $189.00 04 SUPPLIES - CS0408906 S STRL TRAY CVP 4FR 8CM $209.00 $197.00 04 SUPPLIES - CS0498014 S STRL TRAY FOLEY 16F TMP $127.00 04 SUPPLIES - CS0406561 S STRL TRAY SOFT TISSUE $185.00 $175.00 04 SUPPLIES - CS0406512 S STRL TRAY SPINAL/MYLO $62.00 $58.00 04 SUPPLIES - CS0406546 S STRL TRAY SUBCL 10FR $401.00 $378.00 04 SUPPLIES - CS0406595 S STRL TRAY THORACENTESIS $128.00 $128.00 04 SUPPLIES - CS0498006 S STRL TRAY THORACENTESIS $172.86 04 SUPPLIES - CS0476317 S STRL TRAY URINE MTR 16F $58.00 04 SUPPLIES - CS0413559 S STRL TRNDR TRANSPAC W/S $50.00 04 SUPPLIES - CS0414102 S STRL TUBE 5F SIL ENTRL $76.23 04 SUPPLIES - CS0414110 S STRL TUBE 8F SIL ENTRL $78.23 04 SUPPLIES - CS0406637 S STRL TUBE CHEST $83.00 $79.00 04 SUPPLIES - CS0400309 S STRL TUBE CHEST $326.00 $307.00 04 SUPPLIES - CS0406660 S STRL TUBE ENDOTRACH M $19.00 $17.00 04 SUPPLIES - CS0406645 S STRL TUBE ENDOTRACH P $15.00 $14.00 04 SUPPLIES - CS0406694 S STRL TUBE ENTRIFLEX 8 $109.00 $103.00 04 SUPPLIES - CS0413674 S STRL TUBE FDG CRFL 6FX3 $77.02 04 SUPPLIES - CS0413666 S STRL TUBE FDG CRFL 8FX4 $99.49 04 SUPPLIES - CS0404681 S STRL TUBE FEED INFANT $3.00 $2.00 04 SUPPLIES - CS0405951 S STRL TUBE HEMOCHRON $6.00 $6.00 04 SUPPLIES - CS0400721 S STRL TUBE NASPHGL $60.00 $57.00 04 SUPPLIES - CS0403113 S STRL TUBE RECTAL RUBBER $31.00 $29.00 04 SUPPLIES - CS0407130 S STRL TUBE REPLOGLE #10 $51.00 $48.00 04 SUPPLIES - CS0403121 S STRL TUBE SALEM SUMP $13.00 $12.00 04 SUPPLIES - CS0401356 S STRL TUBE STOMACH ALL $3.00 $2.00 04 SUPPLIES - CS0413609 S STRL TUBE TRACH CARE 6F $73.00 04 SUPPLIES - CS0413617 S STRL TUBE TRACH CARE 8F $73.00 04 SUPPLIES - CS0406728 S STRL TUBE TRACH H 1 $496.00 $468.00 04 SUPPLIES - CS0403147 S STRL TUBE TRACH J $195.00 $184.00 04 SUPPLIES - CS0406884 S STRL TUBE TRACH SHILE $204.00 $192.00 04 SUPPLIES - CS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

0403154 S STRL TUBE TRACH SHILEY $239.00 $226.00 04 SUPPLIES - CS0406702 S STRL TUBE TRACHEA BIV $201.00 $189.00 04 SUPPLIES - CS0498196 S STRL TUBEETCUFMPHY2.0MM $6.50 04 SUPPLIES - CS0403030 S STRL TUBING ECMO OXYG $2,100.00 $1,981.00 04 SUPPLIES - CS0476267 S STRL TUBING PAD CLAMP C $103.00 04 SUPPLIES - CS0403915 S STRL TY BONE MARROW $294.00 $277.00 04 SUPPLIES - CS0405027 S STRL TY BONE MARROW $177.00 $167.00 04 SUPPLIES - CS0402925 S STRL TY CATH FOLEY DISP $15.00 $14.00 04 SUPPLIES - CS0402115 S STRL TY CATH FOLEY PREM $57.00 $54.00 04 SUPPLIES - CS0402909 S STRL TY CATH URETHRAL W $19.00 $18.00 04 SUPPLIES - CS0408815 S STRL TY LACERATION ER $85.00 $80.00 04 SUPPLIES - CS0410076 S STRL TY LUMBAR PUNC $69.00 $69.00 04 SUPPLIES - CS0412940 S STRL TY SAF PNEUMOTHO $333.00 04 SUPPLIES - CS0406553 S STRL TY SOFT TISS #18G $185.00 $175.00 04 SUPPLIES - CS0410043 S STRL TY THORA/PERICAR $559.00 $527.00 04 SUPPLIES - CS0400325 S STRL UNIT TRACH MIST $11.00 $10.00 04 SUPPLIES - CS0412528 S STRL VAC CANISTER KIT $1,134.00 04 SUPPLIES - CS0412551 S STRL VAC KIT ISOLYSER $749.00 04 SUPPLIES - CS0412536 S STRL VAC.CANISTER KIT $626.00 04 SUPPLIES - CS0408633 S STRL VALVE ANTI-REFLU $40.00 $37.00 04 SUPPLIES - CS0407734 S STRL VLV CHEST DRAIN $69.00 $65.00 04 SUPPLIES - CS0410928 S STRL VLV LOPEZ $14.00 $14.00 04 SUPPLIES - CS0408849 S STRL VLV ROTA ECMO HEMO $151.00 $142.00 04 SUPPLIES - CS0400614 S STRL VLV TRACH SPEAK $231.00 $218.00 04 SUPPLIES - CS0498329 S STRL WIRE GUIDE $117.75 04 SUPPLIES - CS0413575 S STRL WIRE TEMP CARDIAC $71.00 04 SUPPLIES - CS0406926 S STRL XYLOCAINE 1 20CC $9.00 $9.00 04 SUPPLIES - CS0407478 S STRL XYLOCAINE TUBE $74.00 $70.00 04 SUPPLIES - CS0401182 WHFO PREFAB WRIST COCK-UP $9.00 $8.00 04 SUPPLIES - CS0412742 WHFO PREFAB WRIST COCK-UP $237.00 04 SUPPLIES - CS0341586 CA ANGIO IL W HC $94.00 03 SUPPLIES-EQUIP/RENTAL2261550 CATH BLN DILATE NOVSC $633.25 22 SURGICAL SUPPLIES I/P2297752 CATH BLN TIS DSCT NOVSC $424.50 22 SURGICAL SUPPLIES I/P2297471 CATH BLN TIS DSCT NOVSC $1,252.75 22 SURGICAL SUPPLIES I/P2297745 CATH BLN TIS DSCT NOVSC $648.25 22 SURGICAL SUPPLIES I/P2298487 CATH DRAINAGE $225.25 22 SURGICAL SUPPLIES I/P2296903 CATH DRAINAGE $102.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2261212 CATH HD SHORT TERM $1,976.25 22 SURGICAL SUPPLIES I/P2294957 CATH HD SHORT TERM $346.75 22 SURGICAL SUPPLIES I/P2210219 CATH INF PER CEN MID NOHD $9.00 $9.00 22 SURGICAL SUPPLIES I/P2205631 CATH INF PER CEN MID NOHD $233.25 22 SURGICAL SUPPLIES I/P2212876 CATH INF PER CEN MID NOHD $249.25 22 SURGICAL SUPPLIES I/P2211399 CATH INF PER CEN MID NOHD $232.75 $232.75 22 SURGICAL SUPPLIES I/P2213171 CATH INF PER CEN MID NOHD $248.50 22 SURGICAL SUPPLIES I/P2205623 CATH INF PER CEN MID NOHD $871.25 22 SURGICAL SUPPLIES I/P2210425 CATH INF PER CEN MID NOHD $132.00 $125.00 22 SURGICAL SUPPLIES I/P2213031 CATH INF PER CEN MID NOHD $253.00 22 SURGICAL SUPPLIES I/P2298339 CATH INF PER CEN MID NOHD $1,182.25 22 SURGICAL SUPPLIES I/P2212850 CATH INF PER CEN MID NOHD $51.50 22 SURGICAL SUPPLIES I/P2298321 CATH INF PER CEN MID NOHD $717.50 22 SURGICAL SUPPLIES I/P2212462 CATH INF PER CEN MID NOHD $96.50 22 SURGICAL SUPPLIES I/P2212520 CATH INF PER CEN MID NOHD $172.00 22 SURGICAL SUPPLIES I/P2298198 CATH INF PER CEN MID NOHD $399.50 22 SURGICAL SUPPLIES I/P2213189 CATH INF PER CEN MID NOHD $317.00 22 SURGICAL SUPPLIES I/P2211407 CATH INF PER CEN MID NOHD $319.00 $301.00 22 SURGICAL SUPPLIES I/P2210193 CATH INF PER CEN MID NOHD $102.75 $102.75 22 SURGICAL SUPPLIES I/P2210037 CATH INF PER CEN MID NOHD $162.75 $162.75 22 SURGICAL SUPPLIES I/P2298313 CATH INF PER CEN MID NOHD $465.00 22 SURGICAL SUPPLIES I/P2294122 CATH INF PER CEN MID NOHD $1,976.25 22 SURGICAL SUPPLIES I/P2213114 CATH INF PER CEN MID NOHD $1,938.00 22 SURGICAL SUPPLIES I/P2211605 CATH INF PER CEN MID NOHD $85.00 $80.00 22 SURGICAL SUPPLIES I/P2298206 CATH INF PER CEN MID NOHD $266.00 22 SURGICAL SUPPLIES I/P2262012 CATH INTRASPINAL $1,275.00 22 SURGICAL SUPPLIES I/P2298297 CATH OCCLUSION $1,772.25 22 SURGICAL SUPPLIES I/P2295632 CATH THROMB/EMBOLCTMY $850.00 22 SURGICAL SUPPLIES I/P2297513 CON TISS HUMAN INC FASCIA $3,525.00 22 SURGICAL SUPPLIES I/P2206779 CONN TISS NON-HUMAN $1,517.00 22 SURGICAL SUPPLIES I/P2295020 EP ICAR FX CV GD IN SHTH $212.50 22 SURGICAL SUPPLIES I/P2295038 EP ICAR FX CV GD IN SHTH $310.25 22 SURGICAL SUPPLIES I/P2296994 GENERATOR NEURO NO-RECHRG $13,493.00 22 SURGICAL SUPPLIES I/P2210433 GUIDEWIRE $53.25 $53.25 22 SURGICAL SUPPLIES I/P2292548 GUIDEWIRE $345.50 $323.00 22 SURGICAL SUPPLIES I/P2294882 GUIDEWIRE $148.00 22 SURGICAL SUPPLIES I/P2206019 GUIDEWIRE $164.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2298479 GUIDEWIRE $218.50 22 SURGICAL SUPPLIES I/P2263317 GUIDEWIRE $68.25 22 SURGICAL SUPPLIES I/P2297455 GUIDEWIRE $935.00 22 SURGICAL SUPPLIES I/P2297364 GUIDEWIRE $255.00 22 SURGICAL SUPPLIES I/P2263325 GUIDEWIRE $95.00 22 SURGICAL SUPPLIES I/P2293884 GUIDEWIRE $187.75 $187.75 22 SURGICAL SUPPLIES I/P2261220 IMP CATH HD/PRTNL LNG TRM $765.00 22 SURGICAL SUPPLIES I/P2207769 IMP GRAFT VASCULAR $1,633.00 22 SURGICAL SUPPLIES I/P2207777 IMP GRAFT VASCULAR $5,125.00 22 SURGICAL SUPPLIES I/P2206373 IMP GRAFT VASCULAR $3,414.00 22 SURGICAL SUPPLIES I/P2296861 IMP GRAFT VASCULAR $2,377.00 22 SURGICAL SUPPLIES I/P2206266 IMP GRAFT VASCULAR $9,750.00 22 SURGICAL SUPPLIES I/P2206662 IMP GRAFT VASCULAR $1,967.00 22 SURGICAL SUPPLIES I/P2206258 IMP GRAFT VASCULAR $2,009.00 22 SURGICAL SUPPLIES I/P2206647 IMP GRAFT VASCULAR $3,063.00 22 SURGICAL SUPPLIES I/P2260859 IMP MESH $1,156.75 22 SURGICAL SUPPLIES I/P2262590 IMP MESH $4,680.00 22 SURGICAL SUPPLIES I/P2294148 IMP MESH $3,100.00 22 SURGICAL SUPPLIES I/P2294783 IMP MESH $4,125.00 22 SURGICAL SUPPLIES I/P2294023 IMP MESH $1,509.00 22 SURGICAL SUPPLIES I/P2294155 IMP MESH $2,758.00 22 SURGICAL SUPPLIES I/P2294163 IMP MESH $1,960.00 22 SURGICAL SUPPLIES I/P2260057 IMP MESH $2,028.00 $2,028.00 22 SURGICAL SUPPLIES I/P2297521 IMP PROSTHESIS BREAST $5,618.00 22 SURGICAL SUPPLIES I/P2291904 INTRO/SHEATH NON-LASER $468.25 $450.25 22 SURGICAL SUPPLIES I/P2293975 INTRO/SHEATH NON-LASER $198.50 $185.25 22 SURGICAL SUPPLIES I/P2296986 LEAD EXT PACING/NEUROSTIM $2,782.50 22 SURGICAL SUPPLIES I/P2296978 LEAD NEUROSTIMULATOR $5,957.00 22 SURGICAL SUPPLIES I/P2297893 MORCELLATOR $2,341.00 22 SURGICAL SUPPLIES I/P2207405 PROBE CRYOABLATION $7,163.00 22 SURGICAL SUPPLIES I/P2262566 PROBE CRYOABLATION $10,099.00 22 SURGICAL SUPPLIES I/P2262574 PROBE CRYOABLATION $1,806.00 22 SURGICAL SUPPLIES I/P2207389 PROBE CRYOABLATION $10,388.00 22 SURGICAL SUPPLIES I/P2207397 PROBE CRYOABLATION $5,500.00 22 SURGICAL SUPPLIES I/P2262772 PROBE CRYOABLATION $12,125.00 22 SURGICAL SUPPLIES I/P2297000 REP DEV URINARY W/SLING $2,725.00 22 SURGICAL SUPPLIES I/P2292688 RET DEV INSERTABLE $3,223.00 $3,223.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2297109 RET DEV INSERTABLE $1,821.00 22 SURGICAL SUPPLIES I/P2290195 RET DEV INSERTABLE $1,012.50 $1,012.50 22 SURGICAL SUPPLIES I/P2207009 S IMP AB VENTRICLE $112,500.00 22 SURGICAL SUPPLIES I/P2297562 S IMP BONE GRAFT INFUSE $13,520.00 22 SURGICAL SUPPLIES I/P2297547 S IMP BONE GRAFT INFUSE $8,628.00 22 SURGICAL SUPPLIES I/P2297554 S IMP BONE GRAFT INFUSE $12,233.00 22 SURGICAL SUPPLIES I/P2297166 S IMP BONE PRO OSTEON $1,929.00 22 SURGICAL SUPPLIES I/P2260867 S IMP CHR GUT 3-0 PS-2 $26.75 22 SURGICAL SUPPLIES I/P2206183 S IMP CONDUIT AORTIC $8,939.00 22 SURGICAL SUPPLIES I/P2206225 S IMP DACRON FELT, 6X6 $171.00 22 SURGICAL SUPPLIES I/P2294908 S IMP GDWR PTFE COAT $85.00 22 SURGICAL SUPPLIES I/P2291276 S IMP GRAFTON CRUNCH 15CC $4,225.00 22 SURGICAL SUPPLIES I/P2293587 S IMP HEART VALVE $9,750.00 $9,750.00 22 SURGICAL SUPPLIES I/P2291672 S IMP HEMASHIELD GRAFT $613.00 $578.00 22 SURGICAL SUPPLIES I/P2295079 S IMP KIT CAMINO PRESS M $2,122.00 22 SURGICAL SUPPLIES I/P2297307 S IMP LAP-BAND SYS $7,640.00 22 SURGICAL SUPPLIES I/P2207413 S IMP LEFT VENTRICULAR $178,750.00 22 SURGICAL SUPPLIES I/P2207751 S IMP LVAD $218,750.00 22 SURGICAL SUPPLIES I/P2206191 S IMP PATCH DACRON DBL V $1,198.50 22 SURGICAL SUPPLIES I/P2208130 S IMP PATCH GRAFT $3,413.00 $3,413.00 22 SURGICAL SUPPLIES I/P2206233 S IMP PATCH PERI 5X5 $807.50 22 SURGICAL SUPPLIES I/P2206241 S IMP PATCH PERI NO REACT $1,551.25 22 SURGICAL SUPPLIES I/P2206969 S IMP PERICARDIUM LG $2,310.00 22 SURGICAL SUPPLIES I/P2206977 S IMP PERICARDIUM MED $1,750.00 22 SURGICAL SUPPLIES I/P2208254 S IMP PERIGUARD $1,891.00 22 SURGICAL SUPPLIES I/P2207652 S IMP PLATE $1,904.00 22 SURGICAL SUPPLIES I/P2207637 S IMP PLATE $1,309.00 22 SURGICAL SUPPLIES I/P2207645 S IMP PLATE $1,598.00 22 SURGICAL SUPPLIES I/P2260362 S IMP PRESSURE VLV $998.00 $942.00 22 SURGICAL SUPPLIES I/P2260107 S IMP RESER CSF-VNTRCLR $1,415.50 $1,360.75 22 SURGICAL SUPPLIES I/P2207702 S IMP RING $6,000.00 22 SURGICAL SUPPLIES I/P2207348 S IMP RING $4,500.00 22 SURGICAL SUPPLIES I/P2207330 S IMP RING $5,250.00 22 SURGICAL SUPPLIES I/P2206050 S IMP RING ANNULOPLASTY $3,095.00 22 SURGICAL SUPPLIES I/P2206068 S IMP RING ANNULOPLASTY $4,740.00 22 SURGICAL SUPPLIES I/P2206886 S IMP RING ANNULOPLASTY M $4,500.00 22 SURGICAL SUPPLIES I/P2206787 S IMP RING EDWARDS ANNULO $4,750.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2207595 S IMP SEWING CUFF $2,725.00 22 SURGICAL SUPPLIES I/P2292472 S IMP SOFT TISS PATCH $2,620.00 $3,206.00 22 SURGICAL SUPPLIES I/P2291888 S IMP STENT URETER FIRLIT $146.75 $119.75 22 SURGICAL SUPPLIES I/P2260339 S IMP STENT UTERAL $484.50 $544.00 22 SURGICAL SUPPLIES I/P2293900 S IMP SURGICAL MEMBRANE $2,496.00 $2,496.00 22 SURGICAL SUPPLIES I/P2293751 S IMP SYRINGO-PERIT SHUNT $2,895.00 $2,550.00 22 SURGICAL SUPPLIES I/P2293603 S IMP TUBE GOODE T 1.1.M $138.75 $138.75 22 SURGICAL SUPPLIES I/P2207900 S IMP VALUE $7,493.00 22 SURGICAL SUPPLIES I/P2206134 S IMP VALUE HEART $10,660.00 22 SURGICAL SUPPLIES I/P2206118 S IMP VALUE HEART ST. JU $10,203.00 22 SURGICAL SUPPLIES I/P2206076 S IMP VALUE HOMOGRAFT $17,318.00 22 SURGICAL SUPPLIES I/P2206084 S IMP VALUE PRCDL AORTIC $8,325.00 22 SURGICAL SUPPLIES I/P2208148 S IMP VALVE $8,843.00 $8,843.00 22 SURGICAL SUPPLIES I/P2208064 S IMP VALVE $8,843.00 22 SURGICAL SUPPLIES I/P2207660 S IMP VALVE $12,400.00 22 SURGICAL SUPPLIES I/P2207686 S IMP VALVE $8,325.00 22 SURGICAL SUPPLIES I/P2207678 S IMP VALVE $11,700.00 22 SURGICAL SUPPLIES I/P2208155 S IMP VALVE $8,100.00 $8,100.00 22 SURGICAL SUPPLIES I/P2206126 S IMP VALVE $12,030.00 22 SURGICAL SUPPLIES I/P2206993 S IMP VALVE HEART SJ BIOC $8,268.00 22 SURGICAL SUPPLIES I/P2206720 S IMP VALVE HEART ST JUDE $11,523.00 22 SURGICAL SUPPLIES I/P2207090 S IMP VALVE HEART THERMAF $8,025.00 22 SURGICAL SUPPLIES I/P2206894 S IMP VALVE PULOMNIC COND $10,955.00 22 SURGICAL SUPPLIES I/P2296960 S IMP VERTGRAFT BULLET $9,228.00 22 SURGICAL SUPPLIES I/P2213213 S INV DVC $6,122.50 22 SURGICAL SUPPLIES I/P2200053 S NSTRL BALLOON PUMP KIT $2,940.00 $2,940.00 22 SURGICAL SUPPLIES I/P2212983 S NSTRL BLANKET WARM PED $79.50 22 SURGICAL SUPPLIES I/P2207785 S NSTRL DISPLAY MODULE $7,000.00 22 SURGICAL SUPPLIES I/P2297448 S NSTRL ELECT LEVEEN RF $3,141.00 22 SURGICAL SUPPLIES I/P2296549 S NSTRL HOODS DISP FOR T4 $107.00 22 SURGICAL SUPPLIES I/P2207793 S NSTRL POCKET PACK $743.75 22 SURGICAL SUPPLIES I/P2261873 S NSTRL SLING $246.50 22 SURGICAL SUPPLIES I/P2298578 S NSTRL SPLINT ORTHOGLASS $44.00 22 SURGICAL SUPPLIES I/P2298545 S NSTRL SPLINT ORTHOGLASS $23.00 22 SURGICAL SUPPLIES I/P2298552 S NSTRL SPLINT ORTHOGLASS $32.00 22 SURGICAL SUPPLIES I/P2298560 S NSTRL SPLINT ORTHOGLASS $35.00 22 SURGICAL SUPPLIES I/P2295988 S ORTHO ULTRASLING $133.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2207694 S SCRW $199.50 22 SURGICAL SUPPLIES I/P2298693 S STRL $497.00 22 SURGICAL SUPPLIES I/P2262434 S STRL ABLAT DVC $2,900.00 22 SURGICAL SUPPLIES I/P2207926 S STRL ABLATION PEN $5,750.00 22 SURGICAL SUPPLIES I/P2262137 S STRL ACC KIT $446.25 22 SURGICAL SUPPLIES I/P2263101 S STRL ACCESS KIT $183.00 22 SURGICAL SUPPLIES I/P2261006 S STRL ACCESS KIT MICRO $95.00 22 SURGICAL SUPPLIES I/P2261022 S STRL ACCESS STH SET URE $492.75 22 SURGICAL SUPPLIES I/P2263309 S STRL ACCESSORY KIT $1,679.00 22 SURGICAL SUPPLIES I/P2299097 S STRL ACCESSORY KIT COSE $209.50 22 SURGICAL SUPPLIES I/P2200210 S STRL ACCESSORY LINE $223.00 $210.00 22 SURGICAL SUPPLIES I/P2262046 S STRL ADAPT $232.25 22 SURGICAL SUPPLIES I/P2262756 S STRL ADHESIVE $115.50 22 SURGICAL SUPPLIES I/P2200426 S STRL ADLT MEMBRANE $1,317.50 $1,317.50 22 SURGICAL SUPPLIES I/P2200434 S STRL ADLT TUBE PK $1,025.25 $1,025.25 22 SURGICAL SUPPLIES I/P2212652 S STRL AIRWAY ESOPHAGEAL $211.50 22 SURGICAL SUPPLIES I/P2212017 S STRL AIRWAY EXCHANGER $234.75 22 SURGICAL SUPPLIES I/P2212389 S STRL AIRWAY INTUBATOR $20.00 22 SURGICAL SUPPLIES I/P2241511 S STRL ALBUMIN 5%/50ML $105.00 22 SURGICAL SUPPLIES I/P2210722 S STRL AMBU BAG, DISP $39.50 $39.50 22 SURGICAL SUPPLIES I/P2263432 S STRL ANTENNA $340.00 22 SURGICAL SUPPLIES I/P2261360 S STRL APP FLOSEAL $244.00 22 SURGICAL SUPPLIES I/P2262327 S STRL APPLC $343.50 22 SURGICAL SUPPLIES I/P2299188 S STRL APPLICATOR KIT HEM $485.25 22 SURGICAL SUPPLIES I/P2212900 S STRL ART MONITOR SET $133.00 22 SURGICAL SUPPLIES I/P2297646 S STRL ARTHROKNIFE SHEATH $251.00 22 SURGICAL SUPPLIES I/P2295665 S STRL ARTHROWAND $637.50 22 SURGICAL SUPPLIES I/P2213221 S STRL ATOMIZER $30.75 22 SURGICAL SUPPLIES I/P2297836 S STRL ATTAIN OTW LEAD GD $1,966.00 22 SURGICAL SUPPLIES I/P2200616 S STRL A-V LOOP 3/8 X 3/8 $595.00 22 SURGICAL SUPPLIES I/P2211795 S STRL BACTERIAL FTR $4.50 $4.50 22 SURGICAL SUPPLIES I/P2290294 S STRL BAG URINARY DRAIN $15.75 $14.50 22 SURGICAL SUPPLIES I/P2298651 S STRL BAHA BIOPSY PUNCH $123.00 22 SURGICAL SUPPLIES I/P2298628 S STRL BAHA DRILL $935.00 22 SURGICAL SUPPLIES I/P2298636 S STRL BAHA HEALING CAP $339.00 22 SURGICAL SUPPLIES I/P2298644 S STRL BAHA SERMATOME BLA $306.00 22 SURGICAL SUPPLIES I/P2290344 S STRL BAND FALOPE RING $216.50 $216.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2296655 S STRL BARIUM STR $318.75 22 SURGICAL SUPPLIES I/P2207587 S STRL BARRIER $1,695.75 22 SURGICAL SUPPLIES I/P2262483 S STRL BASKET $993.50 22 SURGICAL SUPPLIES I/P2298891 S STRL BASKET STONE RETRI $892.50 22 SURGICAL SUPPLIES I/P2207629 S STRL BATTERY $361.25 22 SURGICAL SUPPLIES I/P2263424 S STRL BATTERY $361.25 22 SURGICAL SUPPLIES I/P2298917 S STRL BATTERY F/AUTO-DRI $267.75 22 SURGICAL SUPPLIES I/P2205565 S STRL BIOGLUE 10 ML $2,797.00 22 SURGICAL SUPPLIES I/P2206365 S STRL BIOGLUE 5MM $2,319.00 22 SURGICAL SUPPLIES I/P2262285 S STRL BIRTH CONTROL SYS $3,875.00 22 SURGICAL SUPPLIES I/P2263275 S STRL BIRTH CONTROL SYS $2,275.00 22 SURGICAL SUPPLIES I/P2262053 S STRL BLADE $1,143.75 22 SURGICAL SUPPLIES I/P2213270 S STRL BLADE $87.50 22 SURGICAL SUPPLIES I/P2263184 S STRL BLADE $233.75 22 SURGICAL SUPPLIES I/P2263168 S STRL BLADE $104.25 22 SURGICAL SUPPLIES I/P2263127 S STRL BLADE $429.75 22 SURGICAL SUPPLIES I/P2263549 S STRL BLADE $331.50 22 SURGICAL SUPPLIES I/P2263598 S STRL BLADE $331.50 22 SURGICAL SUPPLIES I/P2263416 S STRL BLADE $436.00 22 SURGICAL SUPPLIES I/P2262863 S STRL BLADE $1,092.25 $1,092.25 22 SURGICAL SUPPLIES I/P2298131 S STRL BLADE BEAVER MICRO $17.25 22 SURGICAL SUPPLIES I/P2261923 S STRL BLADE EXPLANT $2,756.25 22 SURGICAL SUPPLIES I/P2297760 S STRL BLADE INFER TURB $622.50 22 SURGICAL SUPPLIES I/P2205680 S STRL BLADE OSCIL LINVAT $340.00 22 SURGICAL SUPPLIES I/P2298933 S STRL BLADE SAW AUTO-DRI $852.50 22 SURGICAL SUPPLIES I/P2298941 S STRL BLADE SAW AUTO-DRI $314.25 22 SURGICAL SUPPLIES I/P2295533 S STRL BLADE SHAVER LARYN $1,371.00 22 SURGICAL SUPPLIES I/P2298024 S STRL BLADE SILVER BULLE $637.00 22 SURGICAL SUPPLIES I/P2205706 S STRL BLADE STERNAL SAW $35.25 22 SURGICAL SUPPLIES I/P2298305 S STRL BLADE TI HELICAL $2,065.00 22 SURGICAL SUPPLIES I/P2211191 S STRL BLANKET BAIR HUG $37.75 $37.75 22 SURGICAL SUPPLIES I/P2212991 S STRL BLANKET WARMER $137.75 22 SURGICAL SUPPLIES I/P2260206 S STRL BLE ADPTR HARMONIC $240.00 $226.00 22 SURGICAL SUPPLIES I/P2297489 S STRL BLE BEAVER MINI $12.00 22 SURGICAL SUPPLIES I/P2294825 S STRL BLE BOVIE $31.00 22 SURGICAL SUPPLIES I/P2296747 S STRL BLE GRAFT HARVEST $740.50 22 SURGICAL SUPPLIES I/P2205698 S STRL BLE SAW OSCILLAT $41.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2295525 S STRL BLE SHAVER XOMED $639.00 22 SURGICAL SUPPLIES I/P2262301 S STRL BLOCKER $1,017.25 22 SURGICAL SUPPLIES I/P2211803 S STRL BLOOD FTR $41.00 $41.50 22 SURGICAL SUPPLIES I/P2207421 S STRL BLOOD PUMP ASSIST $18,000.00 22 SURGICAL SUPPLIES I/P2205524 S STRL BLOWER/MISTER $212.50 22 SURGICAL SUPPLIES I/P2290468 S STRL BNDG ESMARCH $13.25 $13.25 22 SURGICAL SUPPLIES I/P2296739 S STRL BONE FILLER DEV $488.75 22 SURGICAL SUPPLIES I/P2298677 S STRL BONE MILL BOWL $765.00 22 SURGICAL SUPPLIES I/P2294551 S STRL BONESOURCE 25GMS $6,333.00 22 SURGICAL SUPPLIES I/P2212579 S STRL BRACH PLEXUS SET $24.00 22 SURGICAL SUPPLIES I/P2211209 S STRL BRONCH CATH TUBE $220.25 $220.25 22 SURGICAL SUPPLIES I/P2211134 S STRL BRONCH CATH TUBE $238.00 $238.00 22 SURGICAL SUPPLIES I/P2263358 S STRL BRUSH $332.75 22 SURGICAL SUPPLIES I/P2290542 S STRL BSKT GEMINI $814.00 $812.25 22 SURGICAL SUPPLIES I/P2262699 S STRL BURR $340.00 22 SURGICAL SUPPLIES I/P2298958 S STRL BURR AUTO-DRIVER $93.75 22 SURGICAL SUPPLIES I/P2298966 S STRL BURR AUTO-DRIVER 4 $220.25 22 SURGICAL SUPPLIES I/P2298032 S STRL BURR PEDIATRIC RND $637.00 22 SURGICAL SUPPLIES I/P2294726 S STRL BURR ROUND FLUTED $340.00 22 SURGICAL SUPPLIES I/P2261048 S STRL BURR VISAO CVD FIN $1,028.50 22 SURGICAL SUPPLIES I/P2261063 S STRL BURR VISAO DIAMOND 22 SURGICAL SUPPLIES I/P2261055 S STRL BURR VISAO ULTRA $301.00 22 SURGICAL SUPPLIES I/P2200475 S STRL BVS ATRIAL CAN $2,725.00 $2,725.00 22 SURGICAL SUPPLIES I/P2211514 S STRL C.O. INJ KIT $63.00 $59.00 22 SURGICAL SUPPLIES I/P2206704 S STRL CABLE PACING TEMP $59.00 22 SURGICAL SUPPLIES I/P2205748 S STRL CAN AORTIC $136.00 22 SURGICAL SUPPLIES I/P2205771 S STRL CAN CARDIOPLEGIA $83.00 22 SURGICAL SUPPLIES I/P2205789 S STRL CAN CORONARY PER $97.00 22 SURGICAL SUPPLIES I/P2205813 S STRL CAN SAPHENOUS VEIN $28.25 22 SURGICAL SUPPLIES I/P2205839 S STRL CAN VENOUS FEM $897.25 22 SURGICAL SUPPLIES I/P2205862 S STRL CAN VENOUS RETURN $123.50 22 SURGICAL SUPPLIES I/P2205847 S STRL CAN VENOUS ST $115.00 22 SURGICAL SUPPLIES I/P2207181 S STRL CANN AORTIC FLEX $239.00 22 SURGICAL SUPPLIES I/P2207173 S STRL CANN AORTIC FLEX $239.00 22 SURGICAL SUPPLIES I/P2207140 S STRL CANN ARTERIAL $338.00 22 SURGICAL SUPPLIES I/P2206761 S STRL CANN ARTERIAL 1-PC $248.00 22 SURGICAL SUPPLIES I/P2205714 S STRL CANN ARTERIAL 1-PC $307.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2207314 S STRL CANN EMBO'X $1,806.25 22 SURGICAL SUPPLIES I/P2261337 S STRL CANN MINI 2/3MM $379.50 22 SURGICAL SUPPLIES I/P2207322 S STRL CANN VEN 3-STAGE $361.25 22 SURGICAL SUPPLIES I/P2207165 S STRL CANN VENOUS ANG $289.00 22 SURGICAL SUPPLIES I/P2207157 S STRL CANN VENOUS R/A $255.00 22 SURGICAL SUPPLIES I/P2263200 S STRL CANNISTER $52.50 22 SURGICAL SUPPLIES I/P2208239 S STRL CANNULA $46.50 22 SURGICAL SUPPLIES I/P2207736 S STRL CANNULA $218.50 22 SURGICAL SUPPLIES I/P2207728 S STRL CANNULA $197.75 22 SURGICAL SUPPLIES I/P2262152 S STRL CANNULA $185.25 22 SURGICAL SUPPLIES I/P2263218 S STRL CANNULA $218.50 22 SURGICAL SUPPLIES I/P2263614 S STRL CANNULA $213.75 22 SURGICAL SUPPLIES I/P2263564 S STRL CANNULA $223.25 22 SURGICAL SUPPLIES I/P2205722 S STRL CANNULA AORTIC DLP $88.00 22 SURGICAL SUPPLIES I/P2205755 S STRL CANNULA AORTIC FLE $89.25 22 SURGICAL SUPPLIES I/P2208023 S STRL CANNULA ARTERIAL $1,955.01 22 SURGICAL SUPPLIES I/P2205763 S STRL CANNULA ARTERY MAM $60.25 22 SURGICAL SUPPLIES I/P2206985 S STRL CANNULA FEM ARTERI $935.00 22 SURGICAL SUPPLIES I/P2205805 S STRL CANNULA RETROGRADE $269.25 22 SURGICAL SUPPLIES I/P2206852 S STRL CANNULA RETROGRADE $309.00 22 SURGICAL SUPPLIES I/P2295103 S STRL CANNULA SHLDR DION $105.00 22 SURGICAL SUPPLIES I/P2205870 S STRL CANNULA VENOUS 2-S $123.25 22 SURGICAL SUPPLIES I/P2205854 S STRL CANNULA VENOUS R/A $139.25 22 SURGICAL SUPPLIES I/P2299030 S STRL CAP REDUCER TROCAR $36.75 22 SURGICAL SUPPLIES I/P2291698 S STRL CAPIO SUT CAP DEV $1,609.75 $1,471.50 22 SURGICAL SUPPLIES I/P2260925 S STRL CARC IMBLR SYS $3,126.00 22 SURGICAL SUPPLIES I/P2212025 S STRL CARC OUTPUT BRIDGE $54.00 22 SURGICAL SUPPLIES I/P2200236 S STRL CARDIO LINE 1/4" $39.00 $39.00 22 SURGICAL SUPPLIES I/P2200137 S STRL CARDIO RESER $326.00 $308.00 22 SURGICAL SUPPLIES I/P2208072 S STRL CARDIOPLEG $394.25 22 SURGICAL SUPPLIES I/P2200095 S STRL CARDIOTOMY $149.00 $141.00 22 SURGICAL SUPPLIES I/P2210979 S STRL CARDIOTOMY $129.00 22 SURGICAL SUPPLIES I/P2261709 S STRL CARTRIDGE $811.50 22 SURGICAL SUPPLIES I/P2263143 S STRL CARTRIDGE $811.50 22 SURGICAL SUPPLIES I/P2294353 S STRL CARTRIDGE ETS - FL $666.25 $1,153.25 22 SURGICAL SUPPLIES I/P2263051 S STRL CATH $265.25 22 SURGICAL SUPPLIES I/P2263044 S STRL CATH $228.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2262418 S STRL CATH $152.00 22 SURGICAL SUPPLIES I/P2213247 S STRL CATH $109.25 $109.25 22 SURGICAL SUPPLIES I/P2263366 S STRL CATH $303.50 22 SURGICAL SUPPLIES I/P2298248 S STRL CATH ATTAIN DELIVE $955.00 22 SURGICAL SUPPLIES I/P2262228 S STRL CATH BALLOON $2,556.00 22 SURGICAL SUPPLIES I/P2261204 S STRL CATH CHOLANGIOGRAM $467.25 22 SURGICAL SUPPLIES I/P2207983 S STRL CATH ENDOPLEG $5,188.01 22 SURGICAL SUPPLIES I/P2207975 S STRL CATH ENDOVENT $3,550.01 22 SURGICAL SUPPLIES I/P2212470 S STRL CATH EPDRL DUPEN $1,595.00 22 SURGICAL SUPPLIES I/P2296663 S STRL CATH FOLEY SIL 6FR $114.50 22 SURGICAL SUPPLIES I/P2298180 S STRL CATH GROSHONG 5FR $564.00 22 SURGICAL SUPPLIES I/P2212835 S STRL CATH GUARD SLEEVE $57.25 22 SURGICAL SUPPLIES I/P2208031 S STRL CATH IMPELLA $37,500.01 22 SURGICAL SUPPLIES I/P2212637 S STRL CATH O2 $4.50 22 SURGICAL SUPPLIES I/P2208007 S STRL CATH QUICK DRAW $1,807.25 22 SURGICAL SUPPLIES I/P2298230 S STRL CATH RF ABLAT VNUS $2,958.00 22 SURGICAL SUPPLIES I/P2262442 S STRL CATH SINUS $531.25 22 SURGICAL SUPPLIES I/P2298826 S STRL CATH SUPRAPUBIC RU $291.25 22 SURGICAL SUPPLIES I/P2298800 S STRL CATH TRAUMA $578.00 22 SURGICAL SUPPLIES I/P2298172 S STRL CATH TRAY GLIASITE $6,461.00 22 SURGICAL SUPPLIES I/P2296382 S STRL CATH TY URINE BAG $35.50 22 SURGICAL SUPPLIES I/P2205458 S STRL CATHETER VENTRICUL $147.25 22 SURGICAL SUPPLIES I/P2261253 S STRL CAUTERY $977.50 22 SURGICAL SUPPLIES I/P2262731 S STRL CAUTERY $124.25 22 SURGICAL SUPPLIES I/P2296275 S STRL CAUTERY ELEC $29.50 22 SURGICAL SUPPLIES I/P2298164 S STRL CAUTERY NDL PT INS $35.50 22 SURGICAL SUPPLIES I/P2296051 S STRL CAUTERY PENCIL $62.00 22 SURGICAL SUPPLIES I/P2298818 S STRL CAUTERY TIP ISOCOO $1,496.00 22 SURGICAL SUPPLIES I/P2200533 S STRL CDI SENSOR SET $482.25 $482.25 22 SURGICAL SUPPLIES I/P2297968 S STRL CECOSTOMY CATH SET $686.50 22 SURGICAL SUPPLIES I/P2210797 S STRL CELL SAVER KIT $274.75 22 SURGICAL SUPPLIES I/P2200103 S STRL CELL SAVER SET $274.75 $274.75 22 SURGICAL SUPPLIES I/P2291433 S STRL CHR GUT 3-0,27" $14.50 $14.50 22 SURGICAL SUPPLIES I/P2296887 S STRL CHR GUT 4-10 18" $29.50 22 SURGICAL SUPPLIES I/P2296259 S STRL CHR GUT 7-0 18" $81.00 22 SURGICAL SUPPLIES I/P2292035 S STRL CHR GUT, 0,36" $14.75 $14.75 22 SURGICAL SUPPLIES I/P2291417 S STRL CHR GUT,0,18" $52.50 $52.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2292696 S STRL CHR GUT,0,18" $68.00 $64.00 22 SURGICAL SUPPLIES I/P2294429 S STRL CHR GUT,0,36",T-20 $15.50 $15.50 22 SURGICAL SUPPLIES I/P2291391 S STRL CHR GUT,1,18",MO-4 $109.75 $109.75 22 SURGICAL SUPPLIES I/P2293835 S STRL CHR GUT,1,27",BP $31.00 $31.00 22 SURGICAL SUPPLIES I/P2291524 S STRL CHR GUT,1,36",CT-1 $15.25 $15.25 22 SURGICAL SUPPLIES I/P2291409 S STRL CHR GUT,2-0,18" $55.00 $55.00 22 SURGICAL SUPPLIES I/P2291516 S STRL CHR GUT,2-0,36" $15.00 $15.00 22 SURGICAL SUPPLIES I/P2292811 S STRL CHR GUT,3-0,36" $15.00 $15.00 22 SURGICAL SUPPLIES I/P2291052 S STRL CHR GUT,4-0,18" $56.00 $54.75 22 SURGICAL SUPPLIES I/P2291722 S STRL CHR GUT,4-0,27" $14.50 $13.00 22 SURGICAL SUPPLIES I/P2293595 S STRL CHR GUT,5-0,18" $27.00 $27.00 22 SURGICAL SUPPLIES I/P2290989 S STRL CHR GUT,5-0,18"P-3 $27.50 $27.50 22 SURGICAL SUPPLIES I/P2290716 S STRL CHR GUT,6-0,18" $27.50 $27.50 22 SURGICAL SUPPLIES I/P2293934 S STRL CHROMIC GUT,0,27", $44.00 $39.25 22 SURGICAL SUPPLIES I/P2291615 S STRL CHROMIC GUT,1,18", $94.25 $94.25 22 SURGICAL SUPPLIES I/P2293538 S STRL CHROMIC GUT,1,18"T $53.25 $53.25 22 SURGICAL SUPPLIES I/P2292860 S STRL CHROMIC GUT,4-0,27 $14.50 $14.50 22 SURGICAL SUPPLIES I/P2291144 S STRL CHROMIC GUT,6-0,18 $32.75 $32.75 22 SURGICAL SUPPLIES I/P2261097 S STRL CINCH WHIPKNOT $317.50 22 SURGICAL SUPPLIES I/P2205896 S STRL CLAMP JAW SPRING 6 $32.00 22 SURGICAL SUPPLIES I/P2262749 S STRL CLIP $122.00 22 SURGICAL SUPPLIES I/P2261675 S STRL CLIP $97.50 22 SURGICAL SUPPLIES I/P2208247 S STRL CLIP $2,888.00 22 SURGICAL SUPPLIES I/P2261469 S STRL CLIP LAPRA TY $320.50 22 SURGICAL SUPPLIES I/P2297091 S STRL CLIP LIGA SM/MED $58.50 22 SURGICAL SUPPLIES I/P2261618 S STRL CLOSURE SYS $491.00 22 SURGICAL SUPPLIES I/P2260354 S STRL COIL EXPANDER $238.00 $238.00 22 SURGICAL SUPPLIES I/P2260800 S STRL COLLAGEN HEMOSTAT $185.50 22 SURGICAL SUPPLIES I/P2262723 S STRL COLTALYST $850.00 22 SURGICAL SUPPLIES I/P2212595 S STRL CON'T NERVE BLOCK $236.50 22 SURGICAL SUPPLIES I/P2261667 S STRL CONTRAST $168.25 22 SURGICAL SUPPLIES I/P2261832 S STRL CONTRAST $105.00 22 SURGICAL SUPPLIES I/P2261386 S STRL CORD AEM $63.00 22 SURGICAL SUPPLIES I/P2291466 S STRL CORE-TEX,CV-2,36" $101.75 $95.50 22 SURGICAL SUPPLIES I/P2261089 S STRL COSEAL 2ML $1,379.25 22 SURGICAL SUPPLIES I/P2299089 S STRL COSEAL 4ML $1,831.25 22 SURGICAL SUPPLIES I/P2212058 S STRL CRICOTHYROTOMY KIT $621.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2200517 S STRL CTG HEPARIN ASSAY $64.00 $60.00 22 SURGICAL SUPPLIES I/P2295673 S STRL CUSA EXCEL EXT $1,825.50 22 SURGICAL SUPPLIES I/P2260958 S STRL CUSA EXCEL TUBE $1,096.50 22 SURGICAL SUPPLIES I/P2260982 S STRL CUSA EXCEL WRENCH $240.75 22 SURGICAL SUPPLIES I/P2260966 S STRL CUSA EXT MICRO TIP $2,069.00 22 SURGICAL SUPPLIES I/P2210045 S STRL CUTDOWN CATHETER $25.00 $24.00 22 SURGICAL SUPPLIES I/P2262129 S STRL CUTTER $340.00 22 SURGICAL SUPPLIES I/P2263036 S STRL CUTTER $425.00 22 SURGICAL SUPPLIES I/P2294361 S STRL CUTTER ETS - FLEX $1,779.50 $2,585.00 22 SURGICAL SUPPLIES I/P2211282 S STRL CVP MANOMETER $53.75 $53.50 22 SURGICAL SUPPLIES I/P2294809 S STRL DERMABOND $103.00 22 SURGICAL SUPPLIES I/P2291847 S STRL DERMALON, 4-0, 18" $26.00 $11.25 22 SURGICAL SUPPLIES I/P2213015 S STRL DETECTOR END-TID $42.50 22 SURGICAL SUPPLIES I/P2298263 S STRL DEVICE GRFT RETENT $2,520.00 22 SURGICAL SUPPLIES I/P2262160 S STRL DIL TUBE $1,160.25 22 SURGICAL SUPPLIES I/P2261014 S STRL DILATION SET RENAL $860.25 22 SURGICAL SUPPLIES I/P2262079 S STRL DILATOR $3,489.00 22 SURGICAL SUPPLIES I/P2262087 S STRL DILATOR $3,047.00 22 SURGICAL SUPPLIES I/P2262798 S STRL DILATOR $232.00 $276.25 22 SURGICAL SUPPLIES I/P2262855 S STRL DILATOR $956.25 $956.25 22 SURGICAL SUPPLIES I/P2298404 S STRL DISC LAP ENDO $1,721.25 22 SURGICAL SUPPLIES I/P2207116 S STRL DISSECTOR LUMITIP $4,625.00 22 SURGICAL SUPPLIES I/P2263267 S STRL DRAIN $46.50 22 SURGICAL SUPPLIES I/P2263341 S STRL DRAIN $60.50 22 SURGICAL SUPPLIES I/P2262525 S STRL DRAIN $181.50 22 SURGICAL SUPPLIES I/P2205961 S STRL DRAIN CHEST PLEURA $158.00 22 SURGICAL SUPPLIES I/P2294874 S STRL DRAIN PENROSE SIL $23.00 22 SURGICAL SUPPLIES I/P2296374 S STRL DRESS OWENS 3 X 8 $4.25 22 SURGICAL SUPPLIES I/P2213197 S STRL DRESSING $33.00 22 SURGICAL SUPPLIES I/P2263069 S STRL DRESSING $46.00 22 SURGICAL SUPPLIES I/P2263192 S STRL DRESSING $1,525.00 22 SURGICAL SUPPLIES I/P2263085 S STRL DRESSING $10.50 22 SURGICAL SUPPLIES I/P2261451 S STRL DRILL $403.75 22 SURGICAL SUPPLIES I/P2263465 S STRL DRILL $420.75 22 SURGICAL SUPPLIES I/P2263408 S STRL DRILL $474.25 22 SURGICAL SUPPLIES I/P2263457 S STRL DRILL BIT $335.75 22 SURGICAL SUPPLIES I/P2298701 S STRL DRILL BIT 5.0 X 30 $1,849.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2297463 S STRL DRILL BIT DISCVR $2,118.00 22 SURGICAL SUPPLIES I/P2298735 S STRL DRILL BIT THREE-FL $837.00 22 SURGICAL SUPPLIES I/P2298727 S STRL DRILL BIT THREE-FL $588.50 22 SURGICAL SUPPLIES I/P2298743 S STRL DRILL BIT THREE-FL $979.50 22 SURGICAL SUPPLIES I/P2298750 S STRL DRILL BIT THREE-FL $950.25 22 SURGICAL SUPPLIES I/P2298719 S STRL DRILL BIT THREE-FL $387.50 22 SURGICAL SUPPLIES I/P2297026 S STRL DRILL BIT TPS 22 SURGICAL SUPPLIES I/P2297414 S STRL DRILL CANN SCP 2.9 $1,117.25 22 SURGICAL SUPPLIES I/P2297422 S STRL DRILL DEPUY TWIST $413.00 22 SURGICAL SUPPLIES I/P2261121 S STRL DRILL F/SUTURE TAK $340.00 22 SURGICAL SUPPLIES I/P2295814 S STRL DRILL KIN SCREW $287.00 22 SURGICAL SUPPLIES I/P2261287 S STRL DRILL PAC $1,146.00 22 SURGICAL SUPPLIES I/P2298925 S STRL DRILL PILOT AUTO-D $466.00 22 SURGICAL SUPPLIES I/P2296556 S STRL DRILL SET GRAFT $1,070.00 22 SURGICAL SUPPLIES I/P2297935 S STRL DRSG/STENT MEROGEL $318.75 22 SURGICAL SUPPLIES I/P2262210 S STRL DURASEAL $2,170.00 22 SURGICAL SUPPLIES I/P2205136 S STRL ELECT CARC $52.75 22 SURGICAL SUPPLIES I/P2294049 S STRL ELECT COLLINS $584.50 22 SURGICAL SUPPLIES I/P2292605 S STRL ELECT FASTPATCH $170.00 $161.00 22 SURGICAL SUPPLIES I/P2296648 S STRL ELECT SUBDERMAL $340.00 22 SURGICAL SUPPLIES I/P2207371 S STRL ELECTRODE $212.50 22 SURGICAL SUPPLIES I/P2263259 S STRL ELECTRODE $597.25 22 SURGICAL SUPPLIES I/P2206621 S STRL ELECTRODE CARDIAC $57.25 22 SURGICAL SUPPLIES I/P2212751 S STRL ENDO BLOCK SET $620.50 22 SURGICAL SUPPLIES I/P2297992 S STRL ENDO CUTTER RELOAD $710.50 22 SURGICAL SUPPLIES I/P2295590 S STRL ENDO ILLUMINAT 20G $111.00 22 SURGICAL SUPPLIES I/P2208015 S STRL ENDOCLAMP $7,538.01 22 SURGICAL SUPPLIES I/P2297943 S STRL ENT REFERENCE BAND $33.00 22 SURGICAL SUPPLIES I/P2211571 S STRL EPDRL CATH W/NDL $101.00 $96.00 22 SURGICAL SUPPLIES I/P2211563 S STRL EPDRL CATH W/O NDL $33.00 $33.00 22 SURGICAL SUPPLIES I/P2211175 S STRL EPDRL FTR $8.75 $8.75 22 SURGICAL SUPPLIES I/P2211415 S STRL EPDRL TY $96.50 $96.50 22 SURGICAL SUPPLIES I/P2261998 S STRL EPI-DISC $616.25 22 SURGICAL SUPPLIES I/P2211290 S STRL ESOPH STETH W/TEMP $13.75 $13.75 22 SURGICAL SUPPLIES I/P2213205 S STRL ET TUBE $212.50 22 SURGICAL SUPPLIES I/P2210706 S STRL ET TUBE - RAE $26.00 $26.00 22 SURGICAL SUPPLIES I/P2210698 S STRL ET TUBE- HI-LO $10.25 $10.25 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2212660 S STRL ET TUBE UNCUFFED $6.50 22 SURGICAL SUPPLIES I/P2212074 S STRL ETAEL TUBE - MLT $38.00 22 SURGICAL SUPPLIES I/P2295863 S STRL ETB 2 12-18" TIES $78.00 22 SURGICAL SUPPLIES I/P2295871 S STRL ETB 2 3-30" TIES $77.25 22 SURGICAL SUPPLIES I/P2296895 S STRL ETB 2 MO-7 27" $111.75 22 SURGICAL SUPPLIES I/P2295889 S STRL ETB 2 MO-7 3-30" $91.00 22 SURGICAL SUPPLIES I/P2296812 S STRL ETB 2-0 18" SH $56.75 22 SURGICAL SUPPLIES I/P2296119 S STRL ETB 3-0 30" $74.50 22 SURGICAL SUPPLIES I/P2207579 S STRL ETHIBOND $23.50 22 SURGICAL SUPPLIES I/P2261154 S STRL ETHIBOND 0 30" CT- $58.75 22 SURGICAL SUPPLIES I/P2298396 S STRL ETHIBOND 2-0 30" R $12.25 22 SURGICAL SUPPLIES I/P2206407 S STRL ETHIBOND 4-0 X204 $29.25 22 SURGICAL SUPPLIES I/P2206399 S STRL ETHIBOND 4-0 X551 $23.25 22 SURGICAL SUPPLIES I/P2206415 S STRL ETHIBOND 4-0 X551 $216.25 22 SURGICAL SUPPLIES I/P2299006 S STRL ETHILON 10 18" CSB $106.00 22 SURGICAL SUPPLIES I/P2292779 S STRL ETHILON,2,60" TIES $12.00 22 SURGICAL SUPPLIES I/P2295897 S STRL ETL 2-0 PS 18" $23.00 22 SURGICAL SUPPLIES I/P2293421 S STRL ETL 3-0 18PC-5 $25.75 $23.00 22 SURGICAL SUPPLIES I/P2296242 S STRL ETL 5-0 18"S-24DA $56.00 22 SURGICAL SUPPLIES I/P2294411 S STRL ETL,4-0,18",CPS-3 $25.75 $25.75 22 SURGICAL SUPPLIES I/P2262244 S STRL EXT GUIDE $233.75 22 SURGICAL SUPPLIES I/P2261642 S STRL EXT TUBING $52.75 22 SURGICAL SUPPLIES I/P2207561 S STRL FELT $518.50 22 SURGICAL SUPPLIES I/P2212538 S STRL FEM ART CATH SET $60.00 22 SURGICAL SUPPLIES I/P2212892 S STRL FEM ARTERY SET $143.00 22 SURGICAL SUPPLIES I/P2261303 S STRL FIAXATION DEVICE $569.00 22 SURGICAL SUPPLIES I/P2206001 S STRL FIBER LASER HOLMIU $9,875.00 22 SURGICAL SUPPLIES I/P2261162 S STRL FIBERWARE #0 $97.25 22 SURGICAL SUPPLIES I/P2295129 S STRL FIBERWIRE #2 $81.50 22 SURGICAL SUPPLIES I/P2298123 S STRL FIBERWIRE #2-0 $89.25 22 SURGICAL SUPPLIES I/P2299055 S STRL FIBERWIRE #5 $142.50 22 SURGICAL SUPPLIES I/P2207611 S STRL FILTER $28.75 22 SURGICAL SUPPLIES I/P2261725 S STRL FLOSEAL $1,433.75 22 SURGICAL SUPPLIES I/P2260990 S STRL FOLEY CATH TY $12.00 22 SURGICAL SUPPLIES I/P2298982 S STRL FORCEP BIOPSY URET $1,410.25 22 SURGICAL SUPPLIES I/P2260503 S STRL FORCEP MICRO GRIP $587.00 $554.00 22 SURGICAL SUPPLIES I/P2212967 S STRL FTR BLOOD HEMA PED $8.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2212777 S STRL FTR CONICAL 5MIC $6.00 22 SURGICAL SUPPLIES I/P2294098 S STRL GDWR BRONCHIAL $75.00 22 SURGICAL SUPPLIES I/P2298438 S STRL GORE-TEX CV-4 $99.00 22 SURGICAL SUPPLIES I/P2207058 S STRL GORE-TEX SUTURE CV $114.75 22 SURGICAL SUPPLIES I/P2290930 S STRL GORE-TEX,CV-2,36" $106.00 $98.25 22 SURGICAL SUPPLIES I/P2291540 S STRL GORE-TEX,CV-3,36" $102.00 $102.00 22 SURGICAL SUPPLIES I/P2291664 S STRL GORE-TEX,CV-5,24" $109.25 $104.50 22 SURGICAL SUPPLIES I/P2262178 S STRL GRASPER $118.75 22 SURGICAL SUPPLIES I/P2212819 S STRL GRIPPER NDL $37.00 22 SURGICAL SUPPLIES I/P2263473 S STRL GUIDE $1,487.50 22 SURGICAL SUPPLIES I/P2262251 S STRL GUIDE CATH $1,572.50 22 SURGICAL SUPPLIES I/P2263119 S STRL GUIDEWIRE $218.00 22 SURGICAL SUPPLIES I/P2262491 S STRL GUIDEWIRE $442.00 22 SURGICAL SUPPLIES I/P2299147 S STRL GUIDEWIRE BLUNT SE $391.00 22 SURGICAL SUPPLIES I/P2298685 S STRL GUIDEWIRE THRD 2.5 $226.75 22 SURGICAL SUPPLIES I/P2207363 S STRL HANDLE $363.50 22 SURGICAL SUPPLIES I/P2207124 S STRL HANDPIECE ISOLATOR $13,733.00 22 SURGICAL SUPPLIES I/P2207306 S STRL HANDPIECE PEARL TM $8,250.00 22 SURGICAL SUPPLIES I/P2262392 S STRL HARMONIC $1,154.75 22 SURGICAL SUPPLIES I/P2297430 S STRL HEALOS STRIP $4,800.00 22 SURGICAL SUPPLIES I/P2200129 S STRL HEMOCONCENTRATOR $323.00 $323.00 22 SURGICAL SUPPLIES I/P2208049 S STRL HEMOSTASE $680.00 22 SURGICAL SUPPLIES I/P2263283 S STRL HEMOSTAT $637.50 22 SURGICAL SUPPLIES I/P2262830 S STRL HOLDER $171.50 $171.50 22 SURGICAL SUPPLIES I/P2208114 S STRL HOLSTER $1,678.75 $1,678.75 22 SURGICAL SUPPLIES I/P2262236 S STRL ILLUM SYS $1,610.75 22 SURGICAL SUPPLIES I/P2213049 S STRL INCENTIVE SPIROME $15.00 22 SURGICAL SUPPLIES I/P2200277 S STRL INF TUBE PK $1,243.25 $1,243.25 22 SURGICAL SUPPLIES I/P2201127 S STRL INFANT MEMBRANE $3,449.00 22 SURGICAL SUPPLIES I/P2261816 S STRL INFILTRATION KIT $80.00 22 SURGICAL SUPPLIES I/P2262277 S STRL INFLAT DVC $316.75 22 SURGICAL SUPPLIES I/P2211019 S STRL INFUSOR TUBE SET $123.00 $123.00 22 SURGICAL SUPPLIES I/P2298990 S STRL INSERT HOT SHEARS $95.00 22 SURGICAL SUPPLIES I/P2205953 S STRL INSERT HYDRAJAW $59.00 22 SURGICAL SUPPLIES I/P2205581 S STRL INSERT JAW EVERGRI $76.25 22 SURGICAL SUPPLIES I/P2296390 S STRL INSERT JAW GRIP $95.00 22 SURGICAL SUPPLIES I/P2296135 S STRL INSERT LAPSNC $267.75 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2261378 S STRL INSERT SCISSOR $355.00 22 SURGICAL SUPPLIES I/P2263150 S STRL INSERTION KIT $743.75 22 SURGICAL SUPPLIES I/P2298065 S STRL INSERTION TUBE SET $3,022.00 22 SURGICAL SUPPLIES I/P2208056 S STRL INSERTS SUTURE GD $332.25 22 SURGICAL SUPPLIES I/P2290088 S STRL INST PURSESTRING $500.75 $500.75 22 SURGICAL SUPPLIES I/P2295848 S STRL INTRASPINAL CATH $468.00 22 SURGICAL SUPPLIES I/P2295830 S STRL INTRASPINAL REFILL $133.00 22 SURGICAL SUPPLIES I/P2261857 S STRL INTRODUCER $53.00 22 SURGICAL SUPPLIES I/P2261782 S STRL INTRODUCER $232.75 22 SURGICAL SUPPLIES I/P2213163 S STRL INTRODUCER $230.75 22 SURGICAL SUPPLIES I/P2298461 S STRL INTRODUCER SHEATH $98.50 22 SURGICAL SUPPLIES I/P2261600 S STRL INTUB SET $340.00 22 SURGICAL SUPPLIES I/P2263028 S STRL IRRIG TUBING $95.00 22 SURGICAL SUPPLIES I/P2297638 S STRL ISOVU-200 5OML $111.25 22 SURGICAL SUPPLIES I/P2296358 S STRL ISOVUE-300 61 50ML $53.50 22 SURGICAL SUPPLIES I/P2213288 S STRL IV CATH $148.75 22 SURGICAL SUPPLIES I/P2211266 S STRL J-WIRE FIXED CORE $6.00 $6.00 22 SURGICAL SUPPLIES I/P2208080 S STRL KIT $216.75 22 SURGICAL SUPPLIES I/P2207603 S STRL KIT $2,582.00 22 SURGICAL SUPPLIES I/P2262475 S STRL KIT $743.75 22 SURGICAL SUPPLIES I/P2298271 S STRL KIT ASPIRATION $935.00 22 SURGICAL SUPPLIES I/P2297844 S STRL KIT CAMINO SUB/ICP $2,460.50 22 SURGICAL SUPPLIES I/P2294528 S STRL KIT GASTMY SKIN $432.50 22 SURGICAL SUPPLIES I/P2206035 S STRL KIT HARVEST VEIN $2,413.50 22 SURGICAL SUPPLIES I/P2210417 S STRL KIT RADIAL ARTERY $48.00 $48.00 22 SURGICAL SUPPLIES I/P2296507 S STRL KIT TROCAR W/SLV $548.00 22 SURGICAL SUPPLIES I/P2298149 S STRL KNIFE BAYONETED ME $1,494.75 22 SURGICAL SUPPLIES I/P2261147 S STRL KNOT PUSHER $499.50 22 SURGICAL SUPPLIES I/P2207082 S STRL KNOT PUSHER $718.25 22 SURGICAL SUPPLIES I/P2263440 S STRL K-WIRE $142.50 22 SURGICAL SUPPLIES I/P2296713 S STRL KYPHX INFLAT BONE $2,988.00 22 SURGICAL SUPPLIES I/P2296705 S STRL KYPHX INFLAT SYR $484.50 22 SURGICAL SUPPLIES I/P2296721 S STRL KYPHX INTRO KIT $2,875.00 22 SURGICAL SUPPLIES I/P2296697 S STRL KYPHX NDL 11GA $142.50 22 SURGICAL SUPPLIES I/P2297349 S STRL LAP CALIB TUBE $597.00 22 SURGICAL SUPPLIES I/P2297323 S STRL LAP-BAND ACCESS PT $2,340.00 22 SURGICAL SUPPLIES I/P2297331 S STRL LAP-BAND ACCESS PT $59.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2298222 S STRL LAPROSCOPIC PK NDL $1,168.75 22 SURGICAL SUPPLIES I/P2294114 S STRL LAPSNC ENDO $954.50 22 SURGICAL SUPPLIES I/P2260438 S STRL LAPSNC KIT LAP $1,762.00 $1,662.00 22 SURGICAL SUPPLIES I/P2291706 S STRL LAURUS POLY, 0,48" $144.50 $144.50 22 SURGICAL SUPPLIES I/P2297695 S STRL LEAD SERVICE KIT $240.00 22 SURGICAL SUPPLIES I/P2294213 S STRL LEEP ELECT $63.00 22 SURGICAL SUPPLIES I/P2205441 S STRL LEFT HEART VENT, I $96.25 22 SURGICAL SUPPLIES I/P2210086 S STRL LEYKOCYTE FTR $160.00 $99.00 22 SURGICAL SUPPLIES I/P2297661 S STRL LIGASURE DIVIDER $1,636.25 22 SURGICAL SUPPLIES I/P2297653 S STRL LIGASURE ELECTRODE $637.50 22 SURGICAL SUPPLIES I/P2298602 S STRL LIGASURE SEALER DI $1,886.00 22 SURGICAL SUPPLIES I/P2298669 S STRL LIGHT PANEL F/RETR $296.75 22 SURGICAL SUPPLIES I/P2262111 S STRL LOCKING DEVICE $2,054.25 22 SURGICAL SUPPLIES I/P2262145 S STRL LOCKING DEVICE $1,933.75 22 SURGICAL SUPPLIES I/P2262780 S STRL LOOP $1,487.50 $1,487.50 22 SURGICAL SUPPLIES I/P2261444 S STRL LOOP WIRE $133.00 22 SURGICAL SUPPLIES I/P2297059 S STRL MAGNET IPG CONTROL $239.00 22 SURGICAL SUPPLIES I/P2297901 S STRL MAMMOSITE $7,163.00 22 SURGICAL SUPPLIES I/P2240935 S STRL MANIFOLD 2-PORT $18.50 $18.50 22 SURGICAL SUPPLIES I/P2240943 S STRL MANIFOLD 4-PORT $32.50 $32.50 22 SURGICAL SUPPLIES I/P2299170 S STRL MANIPULATOR UTERIN $138.75 22 SURGICAL SUPPLIES I/P2240836 S STRL MANNITOL 500 CC $55.50 $55.50 22 SURGICAL SUPPLIES I/P2263093 S STRL MARKER $52.50 22 SURGICAL SUPPLIES I/P2206563 S STRL MAXN 7-0 6127-01 $111.00 22 SURGICAL SUPPLIES I/P2206555 S STRL MAXON 6-0 6139-11 $110.00 22 SURGICAL SUPPLIES I/P2206571 S STRL MAXON 7-0 6169-01 $171.00 22 SURGICAL SUPPLIES I/P2292720 S STRL MAXON,0,36",T-12 $31.25 $33.75 22 SURGICAL SUPPLIES I/P2260511 S STRL MEASURING DEV $27.50 $27.50 22 SURGICAL SUPPLIES I/P2297984 S STRL MEDICAL ADHESIVE $213.00 22 SURGICAL SUPPLIES I/P2260065 S STRL MERSILENE,5MM $141.50 $126.00 22 SURGICAL SUPPLIES I/P2291813 S STRL MERSILENE,5MM $144.25 $144.25 22 SURGICAL SUPPLIES I/P2298107 S STRL METRIX DISP TUBE $833.00 22 SURGICAL SUPPLIES I/P2296945 S STRL MICRO TARGET CABLE $510.00 22 SURGICAL SUPPLIES I/P2296937 S STRL MICRO TARGET ELECT $467.50 22 SURGICAL SUPPLIES I/P2262665 S STRL MIXER TIP $190.00 22 SURGICAL SUPPLIES I/P2296200 S STRL MON 0 CT 36" $12.00 22 SURGICAL SUPPLIES I/P2296267 S STRL MON 2-0 UR-5 27" $14.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2294650 S STRL MON 4-0 27" RB-1 $12.50 22 SURGICAL SUPPLIES I/P2294668 S STRL MON 5-0 18" P-1 $29.75 22 SURGICAL SUPPLIES I/P2296820 S STRL MON 5-0 27"RB-1 $15.00 22 SURGICAL SUPPLIES I/P2294676 S STRL MON 6-0 18"P-3 $28.75 22 SURGICAL SUPPLIES I/P2296838 S STRL MON 6-0 27" TF $19.00 22 SURGICAL SUPPLIES I/P2290955 S STRL MON, 3-0, 36, CT-1 $13.00 $12.75 22 SURGICAL SUPPLIES I/P2290948 S STRL MON,2-0,36",CT-1 $13.25 $13.00 22 SURGICAL SUPPLIES I/P2200566 S STRL MONITORING LINE $71.00 $67.00 22 SURGICAL SUPPLIES I/P2200590 S STRL MONO DEL LINE $70.00 22 SURGICAL SUPPLIES I/P2298388 S STRL MONOCRYL 3-0 18" P $29.75 22 SURGICAL SUPPLIES I/P2212413 S STRL MUCOSAL ATOMIZER $24.00 22 SURGICAL SUPPLIES I/P2290492 S STRL MYRINGOTOMY TUBE $186.25 $186.25 22 SURGICAL SUPPLIES I/P2211902 S STRL NASAL CAN $35.00 $33.00 22 SURGICAL SUPPLIES I/P2212090 S STRL NASAL CAN - ADLT $3.00 22 SURGICAL SUPPLIES I/P2262517 S STRL NDL $228.00 22 SURGICAL SUPPLIES I/P2261881 S STRL NDL $38.00 22 SURGICAL SUPPLIES I/P2261634 S STRL NDL $722.50 22 SURGICAL SUPPLIES I/P2262681 S STRL NDL $425.00 22 SURGICAL SUPPLIES I/P2205649 S STRL NDL ASPIRATOR DISP $44.00 22 SURGICAL SUPPLIES I/P2261139 S STRL NDL DELIVERY SYS $1,318.25 22 SURGICAL SUPPLIES I/P2213148 S STRL NDL ECHOTIP $40.00 22 SURGICAL SUPPLIES I/P2212405 S STRL NDL GUIDE KIT $101.25 22 SURGICAL SUPPLIES I/P2295731 S STRL NDL INSUFFLAT $149.50 22 SURGICAL SUPPLIES I/P2262715 S STRL NDL KIT $190.75 22 SURGICAL SUPPLIES I/P2263374 S STRL NDL KIT $276.25 22 SURGICAL SUPPLIES I/P2298503 S STRL NDL KIT F/DEFLUX I $216.75 22 SURGICAL SUPPLIES I/P2213155 S STRL NDL SPINAL $68.50 22 SURGICAL SUPPLIES I/P2212330 S STRL NEEDLE HYPO DISP $2.00 22 SURGICAL SUPPLIES I/P2298040 S STRL NEEDLE JAMSHIDI BI $136.00 22 SURGICAL SUPPLIES I/P2211183 S STRL NERVE STIMULAT NDL $49.25 $49.25 22 SURGICAL SUPPLIES I/P2210532 S STRL NERVE STIMULAT PAD $5.50 $10.00 22 SURGICAL SUPPLIES I/P2200087 S STRL NORMOSOL $12.75 $12.75 22 SURGICAL SUPPLIES I/P2295798 S STRL NYL 10-0 12" $108.00 22 SURGICAL SUPPLIES I/P2295780 S STRL NYL 10-0 12" CU-2 $108.00 22 SURGICAL SUPPLIES I/P2211159 S STRL O2 MASK $5.00 $5.00 22 SURGICAL SUPPLIES I/P2262459 S STRL OBTURATOR $118.75 22 SURGICAL SUPPLIES I/P2261352 S STRL OCCLUDER $254.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2206027 S STRL OCCLUDER CORONARY $170.00 22 SURGICAL SUPPLIES I/P2213064 S STRL ORTHOPAT AUTOTRANS $1,694.00 22 SURGICAL SUPPLIES I/P2213072 S STRL ORTHOPAT BLOOD INF $47.75 22 SURGICAL SUPPLIES I/P2213098 S STRL ORTHOPAT INTRAOP S $103.75 22 SURGICAL SUPPLIES I/P2213106 S STRL ORTHOPAT POSTOP SU $61.00 22 SURGICAL SUPPLIES I/P2213080 S STRL ORTHOPAT WASTE BAG $62.25 22 SURGICAL SUPPLIES I/P2211613 S STRL OXIMETER PROBE $55.00 $55.00 22 SURGICAL SUPPLIES I/P2201143 S STRL OXYGENATOR $1,147.50 22 SURGICAL SUPPLIES I/P2297703 S STRL PACING CABLES DISP $112.00 22 SURGICAL SUPPLIES I/P2299162 S STRL PACK VNS ACCESSORY $1,872.50 22 SURGICAL SUPPLIES I/P2263382 S STRL PAD $30.75 22 SURGICAL SUPPLIES I/P2206753 S STRL PAD DEFIB ZOLL STE $164.75 22 SURGICAL SUPPLIES I/P2263077 S STRL PAIN PUMP $1,613.25 22 SURGICAL SUPPLIES I/P2296614 S STRL PANACRYL 0 36" $18.00 22 SURGICAL SUPPLIES I/P2296523 S STRL PANACRYL 1 48" $51.00 22 SURGICAL SUPPLIES I/P2260842 S STRL PANACRYL 1 CTX 36 $20.00 22 SURGICAL SUPPLIES I/P2296598 S STRL PANACRYL 2 27" $32.00 22 SURGICAL SUPPLIES I/P2297687 S STRL PASSER SHUNT 60CM $539.50 22 SURGICAL SUPPLIES I/P2261071 S STRL PASSER SUT $531.25 22 SURGICAL SUPPLIES I/P2290252 S STRL PD TRANSFER SET $166.00 $166.00 22 SURGICAL SUPPLIES I/P2294692 S STRL PDS 3-0 27" RB-1 $16.25 22 SURGICAL SUPPLIES I/P2294700 S STRL PDS 3-0 27" RB-1 22 SURGICAL SUPPLIES I/P2294684 S STRL PDS 4-0 27" RB-1 $14.25 22 SURGICAL SUPPLIES I/P2206530 S STRL PDS 4-0 D6776 $85.00 22 SURGICAL SUPPLIES I/P2295558 S STRL PDS 5-0 18" PS-2 $29.50 22 SURGICAL SUPPLIES I/P2293413 S STRL PDS 6-0 30 BV-1 $73.25 $63.75 22 SURGICAL SUPPLIES I/P2294502 S STRL PDS 6-0 30" BV D/A $55.75 $54.00 22 SURGICAL SUPPLIES I/P2291862 S STRL PDS 7-0 24 BV-1 $72.75 $72.75 22 SURGICAL SUPPLIES I/P2292191 S STRL PDS,0,18",ENDO $114.25 $494.25 22 SURGICAL SUPPLIES I/P2292829 S STRL PDS,3-0,27",FS-2 $20.00 $19.50 22 SURGICAL SUPPLIES I/P2291870 S STRL PDS,4-0,18",P-3 $28.75 $27.75 22 SURGICAL SUPPLIES I/P2291235 S STRL PDS,4-0,27",RB-1 $15.75 $15.25 22 SURGICAL SUPPLIES I/P2292449 S STRL PDS,5-0,18",P-3 $28.50 $25.25 22 SURGICAL SUPPLIES I/P2290591 S STRL PDS,5-0,30",RB-2 $33.00 $32.00 22 SURGICAL SUPPLIES I/P2290732 S STRL PDS,O,CT $10.75 $10.50 22 SURGICAL SUPPLIES I/P2200293 S STRL PED MEMBRANE $1,742.50 $1,742.50 22 SURGICAL SUPPLIES I/P2200269 S STRL PED TUBE PK $1,224.75 $1,224.75 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2206712 S STRL PEDS MYTHERM CARDI $488.75 22 SURGICAL SUPPLIES I/P2207108 S STRL PEN ISOLATOR $4,563.00 22 SURGICAL SUPPLIES I/P2212124 S STRL PERCUTANEOUS NDL $38.25 22 SURGICAL SUPPLIES I/P2200228 S STRL PERFUSION CONNECTO $19.00 $18.00 22 SURGICAL SUPPLIES I/P2290278 S STRL PHARMALAST $453.00 $453.00 22 SURGICAL SUPPLIES I/P2293843 S STRL PIN VISE $263.50 $263.50 22 SURGICAL SUPPLIES I/P2298016 S STRL PINCH-ON TOOL $89.00 22 SURGICAL SUPPLIES I/P2292621 S STRL PLAIN GUT,0,54" TI $12.75 $11.75 22 SURGICAL SUPPLIES I/P2262640 S STRL PLASMA CONC $2,104.00 22 SURGICAL SUPPLIES I/P2241156 S STRL PLASMANATE, 50CC $58.00 $55.00 22 SURGICAL SUPPLIES I/P2207934 S STRL PLATELET KIT $1,367.50 22 SURGICAL SUPPLIES I/P2294643 S STRL PLEDGET 3/8 X 3/16 $24.00 22 SURGICAL SUPPLIES I/P2205995 S STRL PLEDGET OVAL 6X4.5 $57.75 22 SURGICAL SUPPLIES I/P2206381 S STRL PLEDGETS $26.25 22 SURGICAL SUPPLIES I/P2296846 S STRL PLN GUT 5-0 18" $30.00 22 SURGICAL SUPPLIES I/P2291821 S STRL PLN GUT, 3-0, 18" $53.25 $52.25 22 SURGICAL SUPPLIES I/P2293009 S STRL PLN GUT,3-0,54" $12.75 $12.75 22 SURGICAL SUPPLIES I/P2292241 S STRL PLN GUT,4-0,27" $14.50 $14.50 22 SURGICAL SUPPLIES I/P2291045 S STRL PLN GUT,4-0,27" $14.50 $13.00 22 SURGICAL SUPPLIES I/P2294833 S STRL POLYSORB ENDO $99.75 22 SURGICAL SUPPLIES I/P2261410 S STRL PORT $219.50 22 SURGICAL SUPPLIES I/P2261402 S STRL PORT $363.25 22 SURGICAL SUPPLIES I/P2261568 S STRL PORT $256.50 22 SURGICAL SUPPLIES I/P2263176 S STRL PORT $1,934.00 22 SURGICAL SUPPLIES I/P2262384 S STRL PORT $100.50 22 SURGICAL SUPPLIES I/P2298586 S STRL PORT BLUNT TRISTAR $305.25 22 SURGICAL SUPPLIES I/P2212975 S STRL PORT HEMA ACCESS $15.25 22 SURGICAL SUPPLIES I/P2207132 S STRL POSITIONER ATTACHM $1,959.25 22 SURGICAL SUPPLIES I/P2206944 S STRL POSITIONER HEART $2,103.75 22 SURGICAL SUPPLIES I/P2298594 S STRL POUCH SURGICAL TIS $259.25 22 SURGICAL SUPPLIES I/P2296341 S STRL PRCDL KIT $651.75 22 SURGICAL SUPPLIES I/P2296077 S STRL PREFTR SMOKE EVAC $38.00 22 SURGICAL SUPPLIES I/P2212884 S STRL PRESSURE MONITOR $386.00 22 SURGICAL SUPPLIES I/P2210110 S STRL PRESSURE MONITORIN $11.25 $11.25 22 SURGICAL SUPPLIES I/P2207710 S STRL PRIMER PACK $425.00 22 SURGICAL SUPPLIES I/P2260792 S STRL PRO 1 30" CT-1 $13.25 22 SURGICAL SUPPLIES I/P2297133 S STRL PRO 10-0 9090 $101.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2294510 S STRL PRO 2-0 48" SH $26.50 $26.50 22 SURGICAL SUPPLIES I/P2260784 S STRL PRO 3-0 36" V-7 DA $32.25 22 SURGICAL SUPPLIES I/P2205029 S STRL PRO 5-0 27 RB-2 DA $25.75 22 SURGICAL SUPPLIES I/P2205045 S STRL PRO 5-0 30 RB-2 DA $25.75 22 SURGICAL SUPPLIES I/P2205052 S STRL PRO 6-0 24" CC D/A $58.75 22 SURGICAL SUPPLIES I/P2205060 S STRL PRO 6-0 30 C-1 D/A $33.50 22 SURGICAL SUPPLIES I/P2206332 S STRL PRO 7-0 BV175-7 $109.25 22 SURGICAL SUPPLIES I/P2292662 S STRL PRO, 0, 30" $17.50 $17.50 22 SURGICAL SUPPLIES I/P2290963 S STRL PRO, 0, 30", CT $13.50 $13.50 22 SURGICAL SUPPLIES I/P2291912 S STRL PRO, 2-0,18",FS $14.50 $14.00 22 SURGICAL SUPPLIES I/P2291136 S STRL PRO, 3-0, 36" $26.50 $23.50 22 SURGICAL SUPPLIES I/P2293264 S STRL PRO, 5-0, 18" PS-2 $26.00 $26.00 22 SURGICAL SUPPLIES I/P2292886 S STRL PRO,1,30",CT $13.75 $12.50 22 SURGICAL SUPPLIES I/P2291714 S STRL PRO,3-0,30",FSL $15.25 $13.50 22 SURGICAL SUPPLIES I/P2291599 S STRL PRO,3-0,48",SH,D/A $25.75 $25.75 22 SURGICAL SUPPLIES I/P2293439 S STRL PRO,4-0, 24", TF $27.50 $27.50 22 SURGICAL SUPPLIES I/P2292001 S STRL PRO,5-0,18",PS-3 $26.00 $26.00 22 SURGICAL SUPPLIES I/P2260172 S STRL PRO,6-0,18",RB-2 $26.25 $24.50 22 SURGICAL SUPPLIES I/P2291383 S STRL PRO,6-0,24",BV-1 $51.50 $51.50 22 SURGICAL SUPPLIES I/P2291375 S STRL PRO,6-0,30",BV-12 $51.50 $51.50 22 SURGICAL SUPPLIES I/P2291268 S STRL PRO,8-0,18" $109.25 $109.25 22 SURGICAL SUPPLIES I/P2262822 S STRL PROBE $429.25 $429.25 22 SURGICAL SUPPLIES I/P2206357 S STRL PROBE ABLATION FL $7,163.00 22 SURGICAL SUPPLIES I/P2296630 S STRL PROBE DOPPLER $631.25 22 SURGICAL SUPPLIES I/P2295947 S STRL PROBE ELECTRO TAC $1,330.25 22 SURGICAL SUPPLIES I/P2260560 S STRL PROBE FIBEROPTIC $146.00 $138.00 22 SURGICAL SUPPLIES I/P2205607 S STRL PROBE TIP DOPPLER $282.00 22 SURGICAL SUPPLIES I/P2294759 S STRL PROCEED $780.00 22 SURGICAL SUPPLIES I/P2205003 S STRL PROLENE 4-0 36" RB $23.50 22 SURGICAL SUPPLIES I/P2205011 S STRL PROLENE 4-0 36" SH $25.75 22 SURGICAL SUPPLIES I/P2206449 S STRL PROLENE 4-0 8526 $25.75 22 SURGICAL SUPPLIES I/P2205037 S STRL PROLENE 5-0 36" RB $26.50 22 SURGICAL SUPPLIES I/P2205078 S STRL PROLENE 7-0 27" CC $58.75 22 SURGICAL SUPPLIES I/P2206506 S STRL PROLENE 7-0 8703 $52.25 22 SURGICAL SUPPLIES I/P2206514 S STRL PROLENE 7-0 M8733 $219.25 22 SURGICAL SUPPLIES I/P2206522 S STRL PROLENE 8-0 M8743 $250.00 22 SURGICAL SUPPLIES I/P2293769 S STRL PROLENE, 5-0,24",T $27.25 $27.25 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2291995 S STRL PROLENE,3-0,18" FS $15.25 $15.25 22 SURGICAL SUPPLIES I/P2291243 S STRL PROLENE,5-0,18",RB $26.00 $26.00 22 SURGICAL SUPPLIES I/P2205409 S STRL PUMP SUMP LT HEART $51.75 22 SURGICAL SUPPLIES I/P2263226 S STRL PUNCH $318.75 22 SURGICAL SUPPLIES I/P2205664 S STRL PUNCH AORTIC $107.00 22 SURGICAL SUPPLIES I/P2200392 S STRL PURGE LINE $65.00 $61.00 22 SURGICAL SUPPLIES I/P2297539 S STRL QUICK PRESSURE MON $390.25 22 SURGICAL SUPPLIES I/P2201119 S STRL QUICK PRIME LINE $39.00 22 SURGICAL SUPPLIES I/P2298099 S STRL RADIANCE LIGHT ROD $1,638.00 22 SURGICAL SUPPLIES I/P2261261 S STRL REDUCER $49.00 22 SURGICAL SUPPLIES I/P2212371 S STRL REFLECT 02 TRNDCR $175.75 22 SURGICAL SUPPLIES I/P2200244 S STRL REINFUSION BAG $62.50 $62.50 22 SURGICAL SUPPLIES I/P2213007 S STRL RELIEF BAND $637.50 22 SURGICAL SUPPLIES I/P2206845 S STRL RELOAD LINEAR NO $762.25 22 SURGICAL SUPPLIES I/P2261964 S STRL REPAIR KIT $2,103.75 22 SURGICAL SUPPLIES I/P2261527 S STRL RESECT DVC $8,255.00 22 SURGICAL SUPPLIES I/P2297075 S STRL RESECTOSCOPE LOOP $275.00 22 SURGICAL SUPPLIES I/P2201150 S STRL RESERVOIR $548.25 22 SURGICAL SUPPLIES I/P2261808 S STRL RETRACTOR $349.25 22 SURGICAL SUPPLIES I/P2261790 S STRL RETRACTOR $101.25 22 SURGICAL SUPPLIES I/P2261766 S STRL RETRACTOR $213.75 22 SURGICAL SUPPLIES I/P2207991 S STRL RETRACTOR $1,190.01 22 SURGICAL SUPPLIES I/P2298537 S STRL RETRACTOR INFLATAB $473.00 22 SURGICAL SUPPLIES I/P2205615 S STRL RETRACT-O-TAPE $79.25 22 SURGICAL SUPPLIES I/P2212009 S STRL RETROGRADE SET 22 SURGICAL SUPPLIES I/P2211985 S STRL RETROGRADE SET $502.00 $482.75 22 SURGICAL SUPPLIES I/P2298073 S STRL ROD PLUG REMOVAL $238.00 22 SURGICAL SUPPLIES I/P2298081 S STRL ROD SEG REMOVAL $599.25 22 SURGICAL SUPPLIES I/P2296796 S STRL SCOPE WARMER SEAL $28.00 22 SURGICAL SUPPLIES I/P2261279 S STRL SCREW SCHANZ $135.50 22 SURGICAL SUPPLIES I/P2208122 S STRL SEALANT $1,835.25 $1,835.25 22 SURGICAL SUPPLIES I/P2262368 S STRL SEALANT $2,130.50 22 SURGICAL SUPPLIES I/P2262350 S STRL SEALANT $1,124.75 22 SURGICAL SUPPLIES I/P2263010 S STRL SEALER $2,019.00 22 SURGICAL SUPPLIES I/P2263630 S STRL SEALER $2,275.00 22 SURGICAL SUPPLIES I/P2262707 S STRL SEALING DVC $2,003.00 22 SURGICAL SUPPLIES I/P2213239 S STRL SENSOR $255.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2213130 S STRL SENSOR OX CEREBRAL $694.25 22 SURGICAL SUPPLIES I/P2211126 S STRL SEQUESTORING KIT $276.50 22 SURGICAL SUPPLIES I/P2293066 S STRL SET DLTR DISP $344.00 $324.00 22 SURGICAL SUPPLIES I/P2297794 S STRL SET DRN UR/METER $34.50 22 SURGICAL SUPPLIES I/P2211027 S STRL SET PLTLET CONC $11.25 $11.25 22 SURGICAL SUPPLIES I/P2213056 S STRL SET SYR ALARIS $25.00 22 SURGICAL SUPPLIES I/P2260248 S STRL SET TUBE MALIS IRR $104.75 $104.75 22 SURGICAL SUPPLIES I/P2260230 S STRL SET URINEMETER $35.25 $32.25 22 SURGICAL SUPPLIES I/P2295541 S STRL SHAVER SUBGLOTTIC $1,425.00 22 SURGICAL SUPPLIES I/P2262533 S STRL SHEAR $142.25 22 SURGICAL SUPPLIES I/P2261535 S STRL SHEAR $1,346.25 22 SURGICAL SUPPLIES I/P2261774 S STRL SHEARS $1,847.50 22 SURGICAL SUPPLIES I/P2261592 S STRL SHEARS $1,593.75 22 SURGICAL SUPPLIES I/P2263291 S STRL SHEARS $1,766.00 22 SURGICAL SUPPLIES I/P2298909 S STRL SHEARS ACE HARMONI $1,594.50 22 SURGICAL SUPPLIES I/P2294817 S STRL SHEARS ENDO MINI $773.25 22 SURGICAL SUPPLIES I/P2298842 S STRL SHEARS HARMONIC SC $1,782.25 22 SURGICAL SUPPLIES I/P2263481 S STRL SHEATH $257.00 22 SURGICAL SUPPLIES I/P2261394 S STRL SHEATH AEM $76.25 22 SURGICAL SUPPLIES I/P2262103 S STRL SHEATH LASER $5,650.00 22 SURGICAL SUPPLIES I/P2261949 S STRL SHIELD $722.50 22 SURGICAL SUPPLIES I/P2211332 S STRL SHTH CATH $57.00 $54.00 22 SURGICAL SUPPLIES I/P2212827 S STRL SHTH INTRO SET $112.00 22 SURGICAL SUPPLIES I/P2205516 S STRL SHUNT ANASTAFLO $247.75 22 SURGICAL SUPPLIES I/P2292894 S STRL SHUNT CAROTID $1,886.50 $1,993.25 22 SURGICAL SUPPLIES I/P2205433 S STRL SHUNT GOTT $980.50 22 SURGICAL SUPPLIES I/P2261113 S STRL SILK 0 FSL $11.25 22 SURGICAL SUPPLIES I/P2260826 S STRL SILK 2-0 1/2 CVD $144.00 22 SURGICAL SUPPLIES I/P2296184 S STRL SILK 2-0 18" PS-2 $19.50 22 SURGICAL SUPPLIES I/P2296788 S STRL SILK 2-0 30" KS $9.25 22 SURGICAL SUPPLIES I/P2291300 S STRL SILK 5-0 30"CV-301 $15.00 $15.00 22 SURGICAL SUPPLIES I/P2291193 S STRL SILK, 3-0, 30", RB $9.75 $9.75 22 SURGICAL SUPPLIES I/P2291789 S STRL SILK, 4-0, 18", P- $20.75 $20.75 22 SURGICAL SUPPLIES I/P2293280 S STRL SILK,2-0,18",SH $47.75 $42.50 22 SURGICAL SUPPLIES I/P2291656 S STRL SILK,3-0,18",RB-1 $55.00 $55.00 22 SURGICAL SUPPLIES I/P2293306 S STRL SILK,3-0,18"FS-1 $20.50 $20.50 22 SURGICAL SUPPLIES I/P2291367 S STRL SILK,3-0,30" TIES $13.50 $13.50 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2290864 S STRL SILK,4-0,30",SH $9.00 $9.00 22 SURGICAL SUPPLIES I/P2292738 S STRL SILK,4-0,30"CV-301 $15.00 $13.25 22 SURGICAL SUPPLIES I/P2290906 S STRL SILK,5-0,18",P-3 $20.75 $20.75 22 SURGICAL SUPPLIES I/P2293645 S STRL SIMMS IRR NOZZLE $3.00 $2.00 22 SURGICAL SUPPLIES I/P2213023 S STRL SITE RITE SHEATH K $30.25 22 SURGICAL SUPPLIES I/P2207918 S STRL SIZER $51.75 22 SURGICAL SUPPLIES I/P2296192 S STRL SIZER BREAST IMP $209.00 22 SURGICAL SUPPLIES I/P2263390 S STRL SLEEVE $195.25 22 SURGICAL SUPPLIES I/P2297919 S STRL SLEEVE VERASTEP $287.25 22 SURGICAL SUPPLIES I/P2262095 S STRL SNARE $2,595.25 22 SURGICAL SUPPLIES I/P2292670 S STRL SOG-GRIP HEMOSTAT $260.25 $231.75 22 SURGICAL SUPPLIES I/P2262426 S STRL SOL $829.50 22 SURGICAL SUPPLIES I/P2292225 S STRL SOL COLLINS $1,168.75 $260.75 22 SURGICAL SUPPLIES I/P2291128 S STRL SOL RINGERS IRR $15.00 $15.00 22 SURGICAL SUPPLIES I/P2210136 S STRL SPINAL NDL $31.00 $29.00 22 SURGICAL SUPPLIES I/P2212553 S STRL SPINAL NDL SET $54.25 22 SURGICAL SUPPLIES I/P2210128 S STRL SPINAL NDL, BD $11.00 $11.00 22 SURGICAL SUPPLIES I/P2211241 S STRL SPINAL TY $66.25 22 SURGICAL SUPPLIES I/P2296689 S STRL SPONGE FEM CANAL $126.75 22 SURGICAL SUPPLIES I/P2262657 S STRL SPRAY KIT $166.25 22 SURGICAL SUPPLIES I/P2299063 S STRL SPRAY KIT TISSOMAT $229.00 22 SURGICAL SUPPLIES I/P2262673 S STRL SPRAY TIP $154.50 22 SURGICAL SUPPLIES I/P2262319 S STRL SPRAYER $224.50 22 SURGICAL SUPPLIES I/P2205102 S STRL ST STEEL WIRE $58.50 22 SURGICAL SUPPLIES I/P2205094 S STRL ST STEEL WIRE 2 20 $59.75 22 SURGICAL SUPPLIES I/P2205086 S STRL ST STEEL WIRE 5 18 $71.50 22 SURGICAL SUPPLIES I/P2206613 S STRL ST STEEL WIRE FSLX $13.00 22 SURGICAL SUPPLIES I/P2206936 S STRL STABILIZER TISSUE $3,448.00 22 SURGICAL SUPPLIES I/P2298446 S STRL STAP ENDOGIA ROTIC $719.25 22 SURGICAL SUPPLIES I/P2299022 S STRL STAPL CRTRDG PROX $525.00 22 SURGICAL SUPPLIES I/P2299014 S STRL STAPL PROX LINEAR $997.75 22 SURGICAL SUPPLIES I/P2208221 S STRL STAPLE CARTRIDGE $605.50 22 SURGICAL SUPPLIES I/P2298867 S STRL STAPLE CARTRIDGE C $1,117.00 22 SURGICAL SUPPLIES I/P2261683 S STRL STAPLER $1,802.00 22 SURGICAL SUPPLIES I/P2263135 S STRL STAPLER $2,056.00 22 SURGICAL SUPPLIES I/P2262939 S STRL STAPLER $1,988.25 22 SURGICAL SUPPLIES I/P2261758 S STRL STAPLER $223.25 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2261691 S STRL STAPLER $2,116.50 22 SURGICAL SUPPLIES I/P2208213 S STRL STAPLER $1,513.75 22 SURGICAL SUPPLIES I/P2262954 S STRL STAPLER $1,822.50 22 SURGICAL SUPPLIES I/P2298859 S STRL STAPLER CONTOUR 3. $1,985.00 22 SURGICAL SUPPLIES I/P2298354 S STRL STAPLER LDS POWERE $1,204.75 22 SURGICAL SUPPLIES I/P2206837 S STRL STAPLER LINEAR NO $3,021.00 22 SURGICAL SUPPLIES I/P2206878 S STRL STAPLER LINEAR W/S $1,882.75 22 SURGICAL SUPPLIES I/P2298347 S STRL STAPLER TA45 $462.00 22 SURGICAL SUPPLIES I/P2212306 S STRL STATLOCK $21.00 22 SURGICAL SUPPLIES I/P2212280 S STRL STATLOCK DIALYSIS $39.00 22 SURGICAL SUPPLIES I/P2212314 S STRL STATLOCK UNIV + DR $59.00 22 SURGICAL SUPPLIES I/P2298453 S STRL STAY ELASTIC BLUNT $198.00 22 SURGICAL SUPPLIES I/P2295822 S STRL STAY ELSTC (SL) $35.00 22 SURGICAL SUPPLIES I/P2290690 S STRL STENT $448.00 22 SURGICAL SUPPLIES I/P2295749 S STRL STEP PORT $422.00 22 SURGICAL SUPPLIES I/P2299048 S STRL STICK KIT MINI 4FR $212.75 22 SURGICAL SUPPLIES I/P2212546 S STRL STIMEX INSTD NDL $41.75 22 SURGICAL SUPPLIES I/P2220176 S STRL STONE BASKET 22 SURGICAL SUPPLIES I/P2260677 S STRL STPLR 55-3.5 PI $631.50 22 SURGICAL SUPPLIES I/P2293363 S STRL STPLR ENDO GIA $908.25 $908.25 22 SURGICAL SUPPLIES I/P2299113 S STRL STYLET RF ABLATION $2,100.00 22 SURGICAL SUPPLIES I/P2212256 S STRL SUC ASPIRATION $62.00 22 SURGICAL SUPPLIES I/P2210631 S STRL SUC ASPIRATOR $54.00 22 SURGICAL SUPPLIES I/P2291896 S STRL SUC CATH FLEX $190.00 $190.00 22 SURGICAL SUPPLIES I/P2200202 S STRL SUC/VENT LINES $224.00 $211.00 22 SURGICAL SUPPLIES I/P2205425 S STRL SUCKER INTRAC PED $59.00 22 SURGICAL SUPPLIES I/P2200111 S STRL SUCTION ASPIRATOR $54.00 $54.00 22 SURGICAL SUPPLIES I/P2210862 S STRL SUCTION CATH $2.00 $2.00 22 SURGICAL SUPPLIES I/P2205417 S STRL SUMP INTRACARC 1/4 $63.25 22 SURGICAL SUPPLIES I/P2261493 S STRL SUR=T VICRYL $76.50 22 SURGICAL SUPPLIES I/P2291219 S STRL SURGIDAC,0,48" $200.75 $200.75 22 SURGICAL SUPPLIES I/P2290914 S STRL SURGILENE 6-0, 18" $26.25 $26.25 22 SURGICAL SUPPLIES I/P2262962 S STRL SUT $110.00 22 SURGICAL SUPPLIES I/P2262467 S STRL SUT $33.75 22 SURGICAL SUPPLIES I/P2262293 S STRL SUT $15.75 22 SURGICAL SUPPLIES I/P2262186 S STRL SUT $61.75 22 SURGICAL SUPPLIES I/P2261972 S STRL SUT $154.50 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2262020 S STRL SUT $26.00 22 SURGICAL SUPPLIES I/P2262038 S STRL SUT $10.75 22 SURGICAL SUPPLIES I/P2261899 S STRL SUT $35.00 22 SURGICAL SUPPLIES I/P2261840 S STRL SUT $403.75 22 SURGICAL SUPPLIES I/P2261824 S STRL SUT $23.50 22 SURGICAL SUPPLIES I/P2261741 S STRL SUT $110.00 22 SURGICAL SUPPLIES I/P2262004 S STRL SUT $211.50 22 SURGICAL SUPPLIES I/P2261980 S STRL SUT $154.50 22 SURGICAL SUPPLIES I/P2261931 S STRL SUT $13.50 22 SURGICAL SUPPLIES I/P2261907 S STRL SUT $52.25 22 SURGICAL SUPPLIES I/P2263234 S STRL SUT $137.75 22 SURGICAL SUPPLIES I/P2263242 S STRL SUT $212.50 22 SURGICAL SUPPLIES I/P2263002 S STRL SUT $218.50 22 SURGICAL SUPPLIES I/P2263333 S STRL SUT $102.50 22 SURGICAL SUPPLIES I/P2262376 S STRL SUT $99.75 22 SURGICAL SUPPLIES I/P2262558 S STRL SUT $99.75 22 SURGICAL SUPPLIES I/P2262541 S STRL SUT $235.75 22 SURGICAL SUPPLIES I/P2262194 S STRL SUT $12.00 22 SURGICAL SUPPLIES I/P2262343 S STRL SUT $147.25 22 SURGICAL SUPPLIES I/P2262871 S STRL SUT $117.25 $113.75 22 SURGICAL SUPPLIES I/P2262889 S STRL SUT $102.50 $99.50 22 SURGICAL SUPPLIES I/P2262897 S STRL SUT $107.50 $104.25 22 SURGICAL SUPPLIES I/P2262905 S STRL SUT $117.25 $113.75 22 SURGICAL SUPPLIES I/P2262913 S STRL SUT $180.50 22 SURGICAL SUPPLIES I/P2262764 S STRL SUT $13.75 22 SURGICAL SUPPLIES I/P2296168 S STRL SUT LASSO 45 DEG $595.00 22 SURGICAL SUPPLIES I/P2298974 S STRL SUT LASSO BANANA $552.50 22 SURGICAL SUPPLIES I/P2263606 S STRL SUT PASSER 22 SURGICAL SUPPLIES I/P2263556 S STRL SUT PASSER $296.75 22 SURGICAL SUPPLIES I/P2260370 S STRL SUT PASSER SHUTTLE $152.00 $152.00 22 SURGICAL SUPPLIES I/P2297406 S STRL SUT PASSING WIRE $318.75 22 SURGICAL SUPPLIES I/P2261519 S STRL SUT PROLENE $26.25 22 SURGICAL SUPPLIES I/P2263572 S STRL SUT SAVER $161.50 22 SURGICAL SUPPLIES I/P2263622 S STRL SUT SAVER $161.50 22 SURGICAL SUPPLIES I/P2261436 S STRL SUT TIGERWIRE $104.50 22 SURGICAL SUPPLIES I/P2261428 S STRL SUT TIGERWIRE $228.00 22 SURGICAL SUPPLIES I/P2292654 S STRL SUT VIC 4-0,18" $26.75 $23.75 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2261477 S STRL SUT VICRYL $12.25 22 SURGICAL SUPPLIES I/P2261626 S STRL SUT VICRYL $56.00 22 SURGICAL SUPPLIES I/P2261485 S STRL SUT VICRYL $52.25 22 SURGICAL SUPPLIES I/P2261733 S STRL SUTURE $62.50 22 SURGICAL SUPPLIES I/P2261188 S STRL SUTURE WHIP $213.75 22 SURGICAL SUPPLIES I/P2211928 S STRL SWAN-GANZ, 09802 $141.50 $141.50 22 SURGICAL SUPPLIES I/P2262202 S STRL TACKER $1,198.50 22 SURGICAL SUPPLIES I/P2262970 S STRL TACKER $1,985.75 22 SURGICAL SUPPLIES I/P2262988 S STRL TACKER $1,890.00 22 SURGICAL SUPPLIES I/P2262996 S STRL TACKER $2,295.00 22 SURGICAL SUPPLIES I/P2206795 S STRL TEMP PACING WIRE $279.75 22 SURGICAL SUPPLIES I/P2205334 S STRL TFE POLYMER PLEDG $60.25 22 SURGICAL SUPPLIES I/P2205342 S STRL TFE POLYMER PLEDGE $80.25 22 SURGICAL SUPPLIES I/P2297174 S STRL THERMA SPLNT $73.50 22 SURGICAL SUPPLIES I/P2295046 S STRL TIBIAL FIXATION P $318.75 22 SURGICAL SUPPLIES I/P2205144 S STRL TIC 1 30" T-29 D/A $68.00 22 SURGICAL SUPPLIES I/P2205235 S STRL TIC 2-0 30 CV-305 $760.25 22 SURGICAL SUPPLIES I/P2205300 S STRL TIC 2-0 30" CV-305 $41.00 22 SURGICAL SUPPLIES I/P2205185 S STRL TIC 2-0 30" CV-305 $428.00 22 SURGICAL SUPPLIES I/P2205193 S STRL TIC 2-0 30" CV-331 $315.50 22 SURGICAL SUPPLIES I/P2206340 S STRL TIC 2-0 30" Y-31 $743.25 22 SURGICAL SUPPLIES I/P2205219 S STRL TIC 2-0 36" $98.75 22 SURGICAL SUPPLIES I/P2205169 S STRL TIC 2-0 36" $95.00 22 SURGICAL SUPPLIES I/P2205292 S STRL TIC 2-0 36" $72.25 22 SURGICAL SUPPLIES I/P2205276 S STRL TIC 2-0 36"DT-5 BL $53.75 22 SURGICAL SUPPLIES I/P2260883 S STRL TIC 3-0 T-15 18" $13.00 22 SURGICAL SUPPLIES I/P2293371 S STRL TIC, 2-0,30"TIES $43.25 $22.25 22 SURGICAL SUPPLIES I/P2290872 S STRL TIC,0,30",T-56 $37.75 $36.75 22 SURGICAL SUPPLIES I/P2291961 S STRL TIC,2-0,30",DT-5 $23.25 $23.25 22 SURGICAL SUPPLIES I/P2291938 S STRL TIC,3-0,30" TIES $39.75 $35.25 22 SURGICAL SUPPLIES I/P2294395 S STRL TIC,3-0,30",CV-307 $57.00 $55.25 22 SURGICAL SUPPLIES I/P2293561 S STRL TIC,3-0,30"DTE-7 $72.75 $72.75 22 SURGICAL SUPPLIES I/P2293967 S STRL TIC,4-0,24" $39.75 $36.75 22 SURGICAL SUPPLIES I/P2291730 S STRL TIC,4-0,30",CV-301 $20.00 $20.00 22 SURGICAL SUPPLIES I/P2291490 S STRL TIC,4-0,30",TE-7 $57.25 $55.50 22 SURGICAL SUPPLIES I/P2292506 S STRL TIC,5-0,30",CV-301 $74.75 $69.75 22 SURGICAL SUPPLIES I/P2291623 S STRL TIC,6-0,30",TE-1 $69.75 $69.75 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2205268 S STRL TICRON 2-0 30" DT- $54.50 22 SURGICAL SUPPLIES I/P2205227 S STRL TICRON 2-0 30" DT- $70.00 22 SURGICAL SUPPLIES I/P2205201 S STRL TICRON 2-0 36" DT- $103.00 22 SURGICAL SUPPLIES I/P2205151 S STRL TICRON 2-0 36" DT- $88.75 22 SURGICAL SUPPLIES I/P2205250 S STRL TICRON 2-0 36" DT- $482.75 22 SURGICAL SUPPLIES I/P2205243 S STRL TICRON 2-0 36" DT- $318.50 22 SURGICAL SUPPLIES I/P2298529 S STRL TICRON 2-0 48" SK $113.50 22 SURGICAL SUPPLIES I/P2206910 S STRL TICRON 3-0 30" CV $30.50 22 SURGICAL SUPPLIES I/P2206605 S STRL TICRON 5-0 3139-21 $53.50 22 SURGICAL SUPPLIES I/P2206597 S STRL TICRON 5-0 3291-21 $94.00 22 SURGICAL SUPPLIES I/P2293579 S STRL TICRON, 5-0,36",T- $36.00 $36.00 22 SURGICAL SUPPLIES I/P2260750 S STRL TOOL TUNNELING VAG $1,602.25 22 SURGICAL SUPPLIES I/P2212868 S STRL TOUHY NDL $37.00 22 SURGICAL SUPPLIES I/P2295574 S STRL TRANS FIX PIN $646.00 22 SURGICAL SUPPLIES I/P2212504 S STRL TRANS PACING ELECT $675.25 22 SURGICAL SUPPLIES I/P2213262 S STRL TRANSDUCER $273.75 22 SURGICAL SUPPLIES I/P2212264 S STRL TRANSFER LINE $52.00 22 SURGICAL SUPPLIES I/P2261956 S STRL TRAY $932.50 22 SURGICAL SUPPLIES I/P2200301 S STRL TRI LINE TRNDCR $143.75 $143.75 22 SURGICAL SUPPLIES I/P2297398 S STRL TRIGEN DRILL 4.0MM $433.50 22 SURGICAL SUPPLIES I/P2297372 S STRL TRIGEN GUIDE ROD $405.00 22 SURGICAL SUPPLIES I/P2297380 S STRL TRIGEN PILOT DRILL $454.75 22 SURGICAL SUPPLIES I/P2260131 S STRL TRNDCR, NON-FLUSH $42.50 $42.50 22 SURGICAL SUPPLIES I/P2295699 S STRL TROCAR & CAN $206.50 22 SURGICAL SUPPLIES I/P2261105 S STRL TROCAR DIL TIP $271.50 22 SURGICAL SUPPLIES I/P2297711 S STRL TROCAR ENDO 2/3MM $336.50 22 SURGICAL SUPPLIES I/P2295855 S STRL TROCAR ENDOPATH $396.00 22 SURGICAL SUPPLIES I/P2200442 S STRL TUBE 3/8" X 6' $57.00 $54.00 22 SURGICAL SUPPLIES I/P2210250 S STRL TUBE BLOOD PUMP $33.00 $32.00 22 SURGICAL SUPPLIES I/P2210268 S STRL TUBE BLOOD WARM $55.00 $64.50 22 SURGICAL SUPPLIES I/P2211910 S STRL TUBE BRONCH $259.25 $259.25 22 SURGICAL SUPPLIES I/P2293512 S STRL TUBE COLLAR VENT $58.75 $84.00 22 SURGICAL SUPPLIES I/P2212322 S STRL TUBE ENDO TRACH $675.75 22 SURGICAL SUPPLIES I/P2210078 S STRL TUBE ET $9.25 $9.25 22 SURGICAL SUPPLIES I/P2210474 S STRL TUBE ET LASER $267.00 $267.00 22 SURGICAL SUPPLIES I/P2212348 S STRL TUBE ET NIM 2XL $1,147.50 22 SURGICAL SUPPLIES I/P2210375 S STRL TUBE ET REINFORCED $96.00 $46.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2261659 S STRL TUBE FEED $526.50 22 SURGICAL SUPPLIES I/P2299105 S STRL TUBE FEEDING NASAL $397.75 22 SURGICAL SUPPLIES I/P2296143 S STRL TUBE GASTRIC 34FR $64.75 22 SURGICAL SUPPLIES I/P2202893 S STRL TUBE KIT VAC ASS $102.25 22 SURGICAL SUPPLIES I/P2293777 S STRL TUBE MYRINGOTOMY $74.50 $63.00 22 SURGICAL SUPPLIES I/P2296093 S STRL TUBE SMOKE EVAC $52.75 22 SURGICAL SUPPLIES I/P2297778 S STRL TUBE STRGHT IRRIG $84.00 22 SURGICAL SUPPLIES I/P2290823 S STRL TUBE TRACH PED $163.00 $163.00 22 SURGICAL SUPPLIES I/P2297927 S STRL TUBE TRANSGASTRIC $945.75 22 SURGICAL SUPPLIES I/P2213122 S STRL TUBE UNIVENT CUFFE $595.00 22 SURGICAL SUPPLIES I/P2294577 S STRL TUBE VENT MORETZ $138.75 22 SURGICAL SUPPLIES I/P2294569 S STRL TUBE VENT SHEEHY $143.50 22 SURGICAL SUPPLIES I/P2299121 S STRL TUBE VENT ULTRASIL $54.75 22 SURGICAL SUPPLIES I/P2260297 S STRL TUBG TAB W/HNDL $29.50 $27.00 22 SURGICAL SUPPLIES I/P2261717 S STRL TUBING $31.75 22 SURGICAL SUPPLIES I/P2207355 S STRL TUBING $403.75 22 SURGICAL SUPPLIES I/P2262400 S STRL TUBING $646.00 22 SURGICAL SUPPLIES I/P2262921 S STRL TUBING $227.50 22 SURGICAL SUPPLIES I/P2262947 S STRL TUBING $44.25 22 SURGICAL SUPPLIES I/P2261865 S STRL TUBING $126.00 22 SURGICAL SUPPLIES I/P2261915 S STRL TUBING $99.75 22 SURGICAL SUPPLIES I/P2208163 S STRL TUBING $213.75 22 SURGICAL SUPPLIES I/P2263531 S STRL TUBING $199.50 22 SURGICAL SUPPLIES I/P2262848 S STRL TUBING $327.25 $171.50 22 SURGICAL SUPPLIES I/P2296671 S STRL TUBING 7/8" LASER $74.00 22 SURGICAL SUPPLIES I/P2261196 S STRL TUBING AMOKE EVAC $96.75 22 SURGICAL SUPPLIES I/P2261030 S STRL TUBING COOLANT SET $194.75 22 SURGICAL SUPPLIES I/P2298784 S STRL TUBING F/HEMOVAC $133.00 22 SURGICAL SUPPLIES I/P2262269 S STRL TUBING HP $78.75 22 SURGICAL SUPPLIES I/P2295095 S STRL TUBING INTELIJET $312.50 22 SURGICAL SUPPLIES I/P2201135 S STRL TUBING PACK $1,869.00 22 SURGICAL SUPPLIES I/P2208262 S STRL TUBING PACK $2,195.00 22 SURGICAL SUPPLIES I/P2298214 S STRL TUBING PK SUGAR BA $640.00 22 SURGICAL SUPPLIES I/P2205367 S STRL TYWRAPS $9.00 22 SURGICAL SUPPLIES I/P2206324 S STRL U CLIP REMOVAL TOO $239.00 22 SURGICAL SUPPLIES I/P2297505 S STRL U-CLIP 2/PK $156.75 22 SURGICAL SUPPLIES I/P2297497 S STRL U-CLIP 8/PK $510.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2293819 S STRL URET DRAIN BAG $53.00 $53.00 22 SURGICAL SUPPLIES I/P2220150 S STRL URETERAL STENT 22 SURGICAL SUPPLIES I/P2205888 S STRL VASCUCLAMP $28.75 22 SURGICAL SUPPLIES I/P2295707 S STRL VENTRIC KIT $1,656.25 22 SURGICAL SUPPLIES I/P2293918 S STRL VENTRICULOSCOPE NE $276.00 $261.00 22 SURGICAL SUPPLIES I/P2260941 S STRL VENTRICULOSTOM KIT $1,317.25 22 SURGICAL SUPPLIES I/P2212397 S STRL VESSEL DLTR $78.75 22 SURGICAL SUPPLIES I/P2296101 S STRL VESSEL LOOP LNG $19.00 22 SURGICAL SUPPLIES I/P2212934 S STRL VIAL ADAPT PREPIER $8.00 22 SURGICAL SUPPLIES I/P2296218 S STRL VIC 0 18" TIES $40.75 22 SURGICAL SUPPLIES I/P2297042 S STRL VIC 0 27" CT-3 $11.75 22 SURGICAL SUPPLIES I/P2291474 S STRL VIC 0 36" V-34 $18.50 $18.50 22 SURGICAL SUPPLIES I/P2260834 S STRL VIC 0 CT 36" $12.25 22 SURGICAL SUPPLIES I/P2291987 S STRL VIC 4-0 18" P-2 $26.25 $23.25 22 SURGICAL SUPPLIES I/P2294601 S STRL VIC 5-0 18" P-2 $26.25 22 SURGICAL SUPPLIES I/P2260818 S STRL VIC 7-0 BV-1 18" $63.00 22 SURGICAL SUPPLIES I/P2297141 S STRL VIC 8-0 V130-5 $104.00 22 SURGICAL SUPPLIES I/P2295715 S STRL VIC O CTX 36" DYED $12.50 22 SURGICAL SUPPLIES I/P2293629 S STRL VIC,0,18",ENDO $97.25 $71.75 22 SURGICAL SUPPLIES I/P2293546 S STRL VIC,0,36",CT $12.50 $12.50 22 SURGICAL SUPPLIES I/P2292431 S STRL VIC,0,54",REEL $13.00 $13.00 22 SURGICAL SUPPLIES I/P2292332 S STRL VIC,0,54",TIE $12.25 $12.25 22 SURGICAL SUPPLIES I/P2292522 S STRL VIC,1,27",CT,8/PK $62.75 $55.75 22 SURGICAL SUPPLIES I/P2291326 S STRL VIC,1,36",CT-1 $12.50 $12.50 22 SURGICAL SUPPLIES I/P2294437 S STRL VIC,2-0,36",CT $12.50 $12.50 22 SURGICAL SUPPLIES I/P2293686 S STRL VIC,2-0,54" TIE $12.00 $10.75 22 SURGICAL SUPPLIES I/P2291011 S STRL VIC,2-0,54"REEL $13.25 $12.25 22 SURGICAL SUPPLIES I/P2294478 S STRL VIC,3-0,27",PS-1 $24.75 $24.75 22 SURGICAL SUPPLIES I/P2294445 S STRL VIC,3-0,27",RB-1 $12.75 $12.75 22 SURGICAL SUPPLIES I/P2291425 S STRL VIC,3-0,27",SH-1 $12.50 $12.50 22 SURGICAL SUPPLIES I/P2293496 S STRL VIC,3-0,36",CT-1 $12.25 $12.25 22 SURGICAL SUPPLIES I/P2292282 S STRL VIC,3-0,54"REEL $13.00 $13.00 22 SURGICAL SUPPLIES I/P2290641 S STRL VIC,4-0,18" TIES $49.25 $49.25 22 SURGICAL SUPPLIES I/P2291631 S STRL VIC,4-0,27",TF $13.75 $13.75 22 SURGICAL SUPPLIES I/P2293298 S STRL VIC,5-0,27",TF $13.75 $12.75 22 SURGICAL SUPPLIES I/P2293942 S STRL VIC,6-0,18",S-14 $56.50 $50.25 22 SURGICAL SUPPLIES I/P2293637 S STRL VIC,6-0,18"P-3 $23.75 $23.75 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2292571 S STRL VIC,6-0,8",S-24 $54.50 $48.25 22 SURGICAL SUPPLIES I/P2298776 S STRL VICRYL 2-0 27" CT $12.00 22 SURGICAL SUPPLIES I/P2298156 S STRL VICRYL 2-0 J839 $59.50 22 SURGICAL SUPPLIES I/P2298768 S STRL VICRYL 3-0 27" CT $13.00 22 SURGICAL SUPPLIES I/P2298412 S STRL VICRYL PLUS 0 CT-1 $12.00 22 SURGICAL SUPPLIES I/P2298420 S STRL VICRYL PLUS 2-0 CT $12.25 22 SURGICAL SUPPLIES I/P2291854 S STRL VICRYL, 6-0, 18" P $23.75 $23.75 22 SURGICAL SUPPLIES I/P2294452 S STRL VICRYL,4-0,18",RB- $61.75 $61.75 22 SURGICAL SUPPLIES I/P2291532 S STRL VITAL VIEW $451.00 $426.00 22 SURGICAL SUPPLIES I/P2298495 S STRL WAND TURBINATE $956.25 22 SURGICAL SUPPLIES I/P2262061 S STRL WORKSTATION $1,585.25 22 SURGICAL SUPPLIES I/P2261543 S STRL WRENCH $97.75 22 SURGICAL SUPPLIES I/P2207520 VAD BATTERY CLIP IP $2,750.00 22 SURGICAL SUPPLIES I/P2207512 VAD BATTERY HOLSTER IP $1,678.75 22 SURGICAL SUPPLIES I/P2207959 VAD BELT/VEST IP $1,466.25 22 SURGICAL SUPPLIES I/P2207967 VAD CONSOLIDATED BAG IP $1,381.25 22 SURGICAL SUPPLIES I/P2207462 VAD EMER PWR PK COMBO IP $2,975.00 22 SURGICAL SUPPLIES I/P2207454 VAD LITH-ION BATTERY IP $6,250.00 22 SURGICAL SUPPLIES I/P2207744 VAD MICRPSR CU COMBO IP $11,250.00 22 SURGICAL SUPPLIES I/P2207496 VAD MOD BAT SYS CONT IP $1,126.25 22 SURGICAL SUPPLIES I/P2207553 VAD POWER MOD CABLE IP $3,325.00 22 SURGICAL SUPPLIES I/P2208106 VAD PWR MOD DC CAB IP $956.25 $956.25 22 SURGICAL SUPPLIES I/P2208270 VAD PWR MODULE REPLCMNT $1,009.50 22 SURGICAL SUPPLIES I/P2207546 VAD PWR PK COMBO IP $11,700.00 22 SURGICAL SUPPLIES I/P2207942 VAD SHOWER COVER IP $1,912.50 22 SURGICAL SUPPLIES I/P2207504 VAD TRAVEL CASE IP $680.00 22 SURGICAL SUPPLIES I/P2208288 VAD UNIV BATT CHRGE REPLC $1,009.50 22 SURGICAL SUPPLIES I/P2208098 VAD UNIV BATT CHRGER IP $10,800.00 22 SURGICAL SUPPLIES I/P2390631 ADHESION BARRIER SPINAL $1,092.25 $1,056.25 23 SURGICAL SUPPLIES I/P (CO2309128 ADHESION BARRIER SPINAL $1,184.25 $1,020.00 23 SURGICAL SUPPLIES I/P (CO2330322 AICD DUAL CHAMBER $26,124.00 23 SURGICAL SUPPLIES I/P (CO2330413 AICD DUAL CHAMBER $41,292.00 23 SURGICAL SUPPLIES I/P (CO2331098 AICD DUAL CHAMBER $37,778.00 23 SURGICAL SUPPLIES I/P (CO2330330 AICD DUAL CHAMBER $27,809.00 23 SURGICAL SUPPLIES I/P (CO2330348 AICD DUAL CHAMBER $29,495.00 23 SURGICAL SUPPLIES I/P (CO2330355 AICD DUAL CHAMBER $30,337.00 23 SURGICAL SUPPLIES I/P (CO2330363 AICD DUAL CHAMBER $33,652.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2330371 AICD DUAL CHAMBER $34,551.00 23 SURGICAL SUPPLIES I/P (CO2330389 AICD DUAL CHAMBER $36,236.00 23 SURGICAL SUPPLIES I/P (CO2330397 AICD DUAL CHAMBER $37,922.00 23 SURGICAL SUPPLIES I/P (CO2330405 AICD DUAL CHAMBER $39,607.00 23 SURGICAL SUPPLIES I/P (CO2330421 AICD DUAL CHAMBER $42,978.00 23 SURGICAL SUPPLIES I/P (CO2330439 AICD DUAL CHAMBER $44,663.00 23 SURGICAL SUPPLIES I/P (CO2330447 AICD DUAL CHAMBER $46,349.00 23 SURGICAL SUPPLIES I/P (CO2331106 AICD OTHER THAN SING/DUAL $30,000.00 23 SURGICAL SUPPLIES I/P (CO2330496 AICD SINGLE CHAMBER $21,068.00 23 SURGICAL SUPPLIES I/P (CO2330538 AICD SINGLE CHAMBER $27,809.00 23 SURGICAL SUPPLIES I/P (CO2330462 AICD SINGLE CHAMBER $16,011.00 23 SURGICAL SUPPLIES I/P (CO2330470 AICD SINGLE CHAMBER $17,697.00 23 SURGICAL SUPPLIES I/P (CO2330579 AICD SINGLE CHAMBER $34,551.00 23 SURGICAL SUPPLIES I/P (CO2330488 AICD SINGLE CHAMBER $19,382.00 23 SURGICAL SUPPLIES I/P (CO2330587 AICD SINGLE CHAMBER $36,236.00 23 SURGICAL SUPPLIES I/P (CO2330561 AICD SINGLE CHAMBER $32,865.00 23 SURGICAL SUPPLIES I/P (CO2330504 AICD SINGLE CHAMBER $22,753.00 23 SURGICAL SUPPLIES I/P (CO2330512 AICD SINGLE CHAMBER $24,438.00 23 SURGICAL SUPPLIES I/P (CO2330520 AICD SINGLE CHAMBER $26,124.00 23 SURGICAL SUPPLIES I/P (CO2330546 AICD SINGLE CHAMBER $29,495.00 23 SURGICAL SUPPLIES I/P (CO2330454 AICD SINGLE CHAMBER $14,326.00 23 SURGICAL SUPPLIES I/P (CO2391688 AICD SINGLE CHAMBER $37,778.00 23 SURGICAL SUPPLIES I/P (CO2335081 CARDIOLIPIN IGG AB $23.14 23 SURGICAL SUPPLIES I/P (CO2312619 CATH BLN DILATE NOVSC $1,171.00 $1,152.00 23 SURGICAL SUPPLIES I/P (CO2312635 CATH BLN DILATE NOVSC $1,152.00 $1,140.75 23 SURGICAL SUPPLIES I/P (CO2307742 CATH DRAINAGE $32.25 $31.00 23 SURGICAL SUPPLIES I/P (CO2307734 CATH DRAINAGE $46.50 $44.75 23 SURGICAL SUPPLIES I/P (CO2313336 CATH DRAINAGE $42.00 $42.00 23 SURGICAL SUPPLIES I/P (CO2315554 CATH DRAINAGE $51.50 $51.50 23 SURGICAL SUPPLIES I/P (CO2307759 CATH DRAINAGE $81.75 $77.00 23 SURGICAL SUPPLIES I/P (CO2315505 CATH DRAINAGE $40.25 $40.25 23 SURGICAL SUPPLIES I/P (CO2315539 CATH DRAINAGE $36.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2315638 CATH DRAINAGE $157.00 $148.00 23 SURGICAL SUPPLIES I/P (CO2315620 CATH DRAINAGE $55.00 $52.00 23 SURGICAL SUPPLIES I/P (CO2312684 CATH DRAINAGE $60.50 $60.50 23 SURGICAL SUPPLIES I/P (CO2307916 CATH DRAINAGE $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO2312890 CATH HD SHORT TERM $367.75 $367.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

DEPARTMENT CODE

2312874 CATH HD SHORT TERM $756.75 $471.50 23 SURGICAL SUPPLIES I/P (CO2313229 CATH INF PER CEN MID NOHD $649.00 $613.00 23 SURGICAL SUPPLIES I/P (CO2313468 CATH INF PER CEN MID NOHD $63.00 $63.00 23 SURGICAL SUPPLIES I/P (CO2313013 CATH INF PER CEN MID NOHD $607.25 $607.25 23 SURGICAL SUPPLIES I/P (CO2312361 CATH INF PER CEN MID NOHD $525.50 $525.50 23 SURGICAL SUPPLIES I/P (CO2313021 CATH INF PER CEN MID NOHD $401.00 $378.00 23 SURGICAL SUPPLIES I/P (CO2313641 CATH INF PER CEN MID NOHD $993.25 $993.25 23 SURGICAL SUPPLIES I/P (CO2312569 CATH INF PER CEN MID NOHD $301.00 $284.00 23 SURGICAL SUPPLIES I/P (CO2325710 CATH INF PER CEN MID NOHD $2,030.00 23 SURGICAL SUPPLIES I/P (CO2350767 CATH INTRASPINAL $2,432.50 $2,432.50 23 SURGICAL SUPPLIES I/P (CO2312783 CATH OCCLUSION $1,143.25 $973.25 23 SURGICAL SUPPLIES I/P (CO2312809 CATH SP/CYSTOSCOPIC $203.00 $203.00 23 SURGICAL SUPPLIES I/P (CO2312437 CATH THROMB/EMBOLCTMY $171.00 $171.00 23 SURGICAL SUPPLIES I/P (CO2312429 CATH THROMB/EMBOLCTMY $306.00 $306.00 23 SURGICAL SUPPLIES I/P (CO2312460 CATH THROMB/EMBOLCTMY $99.75 $99.75 23 SURGICAL SUPPLIES I/P (CO2313484 CATH URETERAL $218.50 $212.50 23 SURGICAL SUPPLIES I/P (CO2312742 CATH URETERAL $57.00 $55.75 23 SURGICAL SUPPLIES I/P (CO2312965 CATH URETERAL $55.75 $55.75 23 SURGICAL SUPPLIES I/P (CO2326452 CON TISS HUMAN INC FASCIA $2,712.50 23 SURGICAL SUPPLIES I/P (CO2325983 CON TISS HUMAN INC FASCIA $2,485.00 23 SURGICAL SUPPLIES I/P (CO2320711 CON TISS HUMAN INC FASCIA $1,148.00 $1,148.00 23 SURGICAL SUPPLIES I/P (CO2325777 CONN TISS NON-HUMAN $1,535.00 23 SURGICAL SUPPLIES I/P (CO2320067 CONN TISS NON-HUMAN $1,466.25 $1,329.50 23 SURGICAL SUPPLIES I/P (CO2320075 CONN TISS NON-HUMAN $2,383.00 $2,212.25 23 SURGICAL SUPPLIES I/P (CO2325546 CONN TISS NON-HUMAN $1,763.75 23 SURGICAL SUPPLIES I/P (CO2325785 CONN TISS, NON-HUMAN $2,363.00 23 SURGICAL SUPPLIES I/P (CO2330918 DUAL CHAMB RR PACEMAKER $7,163.00 23 SURGICAL SUPPLIES I/P (CO2330934 DUAL CHAMB RR PACEMAKER $8,848.00 23 SURGICAL SUPPLIES I/P (CO2330892 DUAL CHAMB RR PACEMAKER $5,478.00 23 SURGICAL SUPPLIES I/P (CO2325470 GENERATOR NEURO NO-RECHRG $21,296.00 23 SURGICAL SUPPLIES I/P (CO2303303 GENERATOR NEURO NO-RECHRG $11,692.50 $11,692.50 23 SURGICAL SUPPLIES I/P (CO2322246 GRAFT, VASCULAR $2,283.00 $2,154.00 23 SURGICAL SUPPLIES I/P (CO2318186 GUIDEWIRE $187.00 $187.00 23 SURGICAL SUPPLIES I/P (CO2363422 GUIDEWIRE $212.50 23 SURGICAL SUPPLIES I/P (CO2363414 GUIDEWIRE $142.25 23 SURGICAL SUPPLIES I/P (CO2312221 IMP CATH HD/PRTNL LNG TRM $1,615.00 23 SURGICAL SUPPLIES I/P (CO2312882 IMP CATH HD/PRTNL LNG TRM $968.75 $968.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2326478 IMP COCHLEAR DEVICE $40,534.00 23 SURGICAL SUPPLIES I/P (CO2326486 IMP COCHLEAR DEVICE $38,625.00 23 SURGICAL SUPPLIES I/P (CO2320877 IMP GRAFT VASCULAR $2,912.00 $2,912.00 23 SURGICAL SUPPLIES I/P (CO2320745 IMP GRAFT VASCULAR $2,635.00 $2,573.00 23 SURGICAL SUPPLIES I/P (CO2325595 IMP GRAFT VASCULAR $10,800.00 23 SURGICAL SUPPLIES I/P (CO2322303 IMP GRAFT VASCULAR $1,974.00 $1,974.00 23 SURGICAL SUPPLIES I/P (CO2320059 IMP GRAFT VASCULAR $3,185.00 23 SURGICAL SUPPLIES I/P (CO2325553 IMP GRAFT VASCULAR $952.00 23 SURGICAL SUPPLIES I/P (CO2325579 IMP GRAFT VASCULAR $9,750.00 23 SURGICAL SUPPLIES I/P (CO2325587 IMP GRAFT VASCULAR $10,800.00 23 SURGICAL SUPPLIES I/P (CO2391043 IMP GRAFT VASCULAR $1,981.00 $1,981.00 23 SURGICAL SUPPLIES I/P (CO2325561 IMP GRAFT VASCULAR $9,750.00 23 SURGICAL SUPPLIES I/P (CO2320497 IMP GRAFT VASCULAR $3,040.00 23 SURGICAL SUPPLIES I/P (CO2321156 IMP GRAFT VASCULAR $2,744.00 23 SURGICAL SUPPLIES I/P (CO2322287 IMP GRAFT VASCULAR $2,191.00 $2,191.00 23 SURGICAL SUPPLIES I/P (CO2325603 IMP GRAFT VASCULAR $9,775.00 23 SURGICAL SUPPLIES I/P (CO2325629 IMP GRAFT VASCULAR $13,350.00 23 SURGICAL SUPPLIES I/P (CO2325611 IMP GRAFT VASCULAR $9,944.00 23 SURGICAL SUPPLIES I/P (CO2320471 IMP GRAFT VASCULAR $2,662.50 23 SURGICAL SUPPLIES I/P (CO2325439 IMP GRAFT VASCULAR $1,496.00 23 SURGICAL SUPPLIES I/P (CO2326239 IMP GRAFT VASCULAR $11,563.00 23 SURGICAL SUPPLIES I/P (CO2326247 IMP GRAFT VASCULAR $12,375.00 23 SURGICAL SUPPLIES I/P (CO2322295 IMP GRAFT VASCULAR $599.25 $599.25 23 SURGICAL SUPPLIES I/P (CO2326221 IMP GRAFT VASCULAR $7,875.00 23 SURGICAL SUPPLIES I/P (CO2368116 IMP INT FX PLATE/METL MSH $1,849.25 23 SURGICAL SUPPLIES I/P (CO2368132 IMP INT FX PLATE/METL MSH $2,441.00 23 SURGICAL SUPPLIES I/P (CO2368124 IMP INT FX PLATE/METL MSH $2,233.00 23 SURGICAL SUPPLIES I/P (CO2368140 IMP INT FX PLATE/METL MSH $614.00 23 SURGICAL SUPPLIES I/P (CO2321859 IMP MESH $221.00 $263.50 23 SURGICAL SUPPLIES I/P (CO2321842 IMP MESH $378.25 $378.25 23 SURGICAL SUPPLIES I/P (CO2324747 IMP MESH $2,799.00 23 SURGICAL SUPPLIES I/P (CO2363448 IMP MESH $5,410.00 23 SURGICAL SUPPLIES I/P (CO2324614 IMP MESH $3,475.00 23 SURGICAL SUPPLIES I/P (CO2363430 IMP MESH $2,799.00 23 SURGICAL SUPPLIES I/P (CO2321883 IMP MESH $180.50 $180.50 23 SURGICAL SUPPLIES I/P (CO2321867 IMP MESH $2,772.00 $2,153.00 23 SURGICAL SUPPLIES I/P (CO2321834 IMP MESH $639.75 $639.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2353696 IMP MESH $9,259.00 23 SURGICAL SUPPLIES I/P (CO2353621 IMP MESH $3,984.00 23 SURGICAL SUPPLIES I/P (CO2353639 IMP MESH $4,070.00 23 SURGICAL SUPPLIES I/P (CO2353647 IMP MESH $8,371.00 23 SURGICAL SUPPLIES I/P (CO2325264 IMP MESH $841.50 23 SURGICAL SUPPLIES I/P (CO2325256 IMP MESH $420.75 23 SURGICAL SUPPLIES I/P (CO2353654 IMP MESH $12,170.00 23 SURGICAL SUPPLIES I/P (CO2353662 IMP MESH $7,577.00 23 SURGICAL SUPPLIES I/P (CO2353670 IMP MESH $12,137.00 23 SURGICAL SUPPLIES I/P (CO2353688 IMP MESH $10,842.00 23 SURGICAL SUPPLIES I/P (CO2309961 IMP PORT INDWELLING $1,134.00 $1,070.00 23 SURGICAL SUPPLIES I/P (CO2301208 IMP PORT INDWELLING $1,891.00 $1,784.00 23 SURGICAL SUPPLIES I/P (CO2309953 IMP PORT INDWELLING $1,253.75 $1,253.75 23 SURGICAL SUPPLIES I/P (CO2312767 IMP PORT INDWELLING $1,021.00 $963.00 23 SURGICAL SUPPLIES I/P (CO2301224 IMP PORT INDWELLING $1,021.00 $963.00 23 SURGICAL SUPPLIES I/P (CO2326403 IMP PROSTHESIS BREAST $3,244.00 23 SURGICAL SUPPLIES I/P (CO2322394 IMP PROSTHESIS BREAST $2,596.00 $2,449.00 23 SURGICAL SUPPLIES I/P (CO2326379 IMP PROSTHESIS BREAST $2,556.00 23 SURGICAL SUPPLIES I/P (CO2326387 IMP PROSTHESIS BREAST $3,230.00 23 SURGICAL SUPPLIES I/P (CO2326361 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2326395 IMP PROSTHESIS BREAST $3,441.00 23 SURGICAL SUPPLIES I/P (CO2326346 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2326288 IMP PROSTHESIS BREAST $2,163.00 23 SURGICAL SUPPLIES I/P (CO2326320 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2326312 IMP PROSTHESIS BREAST $3,146.00 23 SURGICAL SUPPLIES I/P (CO2326304 IMP PROSTHESIS BREAST $2,360.00 23 SURGICAL SUPPLIES I/P (CO2326296 IMP PROSTHESIS BREAST $3,146.00 23 SURGICAL SUPPLIES I/P (CO2326353 IMP PROSTHESIS BREAST $2,360.00 23 SURGICAL SUPPLIES I/P (CO2322386 IMP PROSTHESIS BREAST $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2326338 IMP PROSTHESIS BREAST $2,163.00 23 SURGICAL SUPPLIES I/P (CO2382380 IMP SEALANT PULMON LIQUID $890.75 23 SURGICAL SUPPLIES I/P (CO2382398 IMP SEALANT PULMON LIQUID $1,800.00 23 SURGICAL SUPPLIES I/P (CO2322329 IMP VOCAL CORD SYNTH $1,552.00 23 SURGICAL SUPPLIES I/P (CO2330686 INTRO/SHEATH NON-LASER $7,163.00 23 SURGICAL SUPPLIES I/P (CO2318350 INTRO/SHEATH NON-LASER $203.75 $203.75 23 SURGICAL SUPPLIES I/P (CO2309144 INTRO/SHEATH NON-LASER $262.00 $247.00 23 SURGICAL SUPPLIES I/P (CO2309151 INTRO/SHEATH NON-LASER $6.25 $6.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2301919 INTRO/SHEATH NON-LASER $1,542.75 $1,542.75 23 SURGICAL SUPPLIES I/P (CO2330595 INTRO/SHEATH NON-LASER $1,390.00 23 SURGICAL SUPPLIES I/P (CO2330629 INTRO/SHEATH NON-LASER $2,107.00 23 SURGICAL SUPPLIES I/P (CO2330736 INTRO/SHEATH NON-LASER $11,376.00 23 SURGICAL SUPPLIES I/P (CO2330637 INTRO/SHEATH NON-LASER $2,949.00 23 SURGICAL SUPPLIES I/P (CO2330694 INTRO/SHEATH NON-LASER $8,006.00 23 SURGICAL SUPPLIES I/P (CO2330678 INTRO/SHEATH NON-LASER $6,320.00 23 SURGICAL SUPPLIES I/P (CO2330660 INTRO/SHEATH NON-LASER $5,478.00 23 SURGICAL SUPPLIES I/P (CO2330652 INTRO/SHEATH NON-LASER $4,635.00 23 SURGICAL SUPPLIES I/P (CO2330702 INTRO/SHEATH NON-LASER $8,848.00 23 SURGICAL SUPPLIES I/P (CO2330603 INTRO/SHEATH NON-LASER $1,475.00 23 SURGICAL SUPPLIES I/P (CO2330645 INTRO/SHEATH NON-LASER $3,792.00 23 SURGICAL SUPPLIES I/P (CO2330611 INTRO/SHEATH NON-LASER $1,559.00 23 SURGICAL SUPPLIES I/P (CO2330728 INTRO/SHEATH NON-LASER $10,534.00 23 SURGICAL SUPPLIES I/P (CO2330744 INTRO/SHEATH NON-LASER $12,219.00 23 SURGICAL SUPPLIES I/P (CO2331049 INTRO/SHEATH NON-LASER $1,643.00 23 SURGICAL SUPPLIES I/P (CO2330710 INTRO/SHEATH NON-LASER $9,691.00 23 SURGICAL SUPPLIES I/P (CO2331130 LD PCR NO TV VDD SNGL PAS $3,325.00 23 SURGICAL SUPPLIES I/P (CO2331197 LEAD CORONARY VENOUS $4,000.00 23 SURGICAL SUPPLIES I/P (CO2331221 LEAD CORONARY VENOUS $6,000.00 23 SURGICAL SUPPLIES I/P (CO2331072 LEAD CORONARY VENOUS $4,000.00 23 SURGICAL SUPPLIES I/P (CO2303295 LEAD EXT PACING/NEUROSTIM $2,433.00 $2,433.00 23 SURGICAL SUPPLIES I/P (CO2325280 LEAD NEUROSTIMULATOR $11,460.00 23 SURGICAL SUPPLIES I/P (CO2303337 LEAD NEUROSTIMULATOR $3,475.00 $3,475.00 23 SURGICAL SUPPLIES I/P (CO2303352 LEAD NEUROSTIMULATOR $4,200.00 $4,200.00 23 SURGICAL SUPPLIES I/P (CO2303311 LEAD NEUROSTIMULATOR $4,750.00 $4,750.00 23 SURGICAL SUPPLIES I/P (CO2303345 LEAD NEUROSTIMULATOR $3,475.00 $3,475.00 23 SURGICAL SUPPLIES I/P (CO2326619 LEAD NEUROSTIMULATOR $7,528.00 23 SURGICAL SUPPLIES I/P (CO2330777 LEAD PMKR TRANSVENOUS VDD $885.00 23 SURGICAL SUPPLIES I/P (CO2331007 PACEMAKER SGL CHAMBR RR $7,163.00 23 SURGICAL SUPPLIES I/P (CO2330983 PACEMAKER SGL CHAMBR RR $5,478.00 23 SURGICAL SUPPLIES I/P (CO2330991 PACEMAKER SGL CHAMBR RR $6,320.00 23 SURGICAL SUPPLIES I/P (CO2330975 PACEMAKER SGL CHAMBR RR $4,635.00 23 SURGICAL SUPPLIES I/P (CO2331015 PACEMAKER SGL CHAMBR RR $8,006.00 23 SURGICAL SUPPLIES I/P (CO2331031 PACEMAKER SGL CHAMBR RR $9,691.00 23 SURGICAL SUPPLIES I/P (CO2331023 PACEMAKER SGL CHAMBR RR $8,848.00 23 SURGICAL SUPPLIES I/P (CO2331213 PACEMKR NO SGL/DUAL CHAMB $9,750.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2326544 PENILE PROST INFLAT $2,083.00 23 SURGICAL SUPPLIES I/P (CO2326494 PENILE PROST INFLAT $10,716.00 23 SURGICAL SUPPLIES I/P (CO2326502 PENILE PROST INFLAT $3,483.00 23 SURGICAL SUPPLIES I/P (CO2367555 S ANCHR $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367563 S ANCHR $1,445.00 23 SURGICAL SUPPLIES I/P (CO2367571 S ANCHR $1,615.00 23 SURGICAL SUPPLIES I/P (CO2367548 S ANCHR $1,615.00 23 SURGICAL SUPPLIES I/P (CO2367506 S ANCHR $1,273.00 23 SURGICAL SUPPLIES I/P (CO2367472 S ANCHR BIOCOMPST SUTTAK $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367498 S ANCHR BIOSWIVELOCK 5.5M $1,508.75 23 SURGICAL SUPPLIES I/P (CO2367241 S ANCHR ENDOBUTTON $1,071.00 23 SURGICAL SUPPLIES I/P (CO2391019 S IMP ANCH ARTHREX-CORKSC $828.75 $828.75 23 SURGICAL SUPPLIES I/P (CO2363638 S IMP ANCH BIO-ABORBABLE $1,041.25 23 SURGICAL SUPPLIES I/P (CO2363471 S IMP ANCH FASTAK 2.8X11. $701.25 23 SURGICAL SUPPLIES I/P (CO2360311 S IMP ANCH GII W/SUT THRE $1,381.25 $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367233 S IMP ANCHOR $1,445.00 23 SURGICAL SUPPLIES I/P (CO2367225 S IMP ANCHOR SUT TWIN FIX $1,278.75 23 SURGICAL SUPPLIES I/P (CO2325694 S IMP ANEURX AORTIC EXT C $2,275.00 23 SURGICAL SUPPLIES I/P (CO2325686 S IMP ANEURX ILIAC EXT CU $2,275.00 23 SURGICAL SUPPLIES I/P (CO2353449 S IMP ATLANTIS CANC SCREW $1,293.25 23 SURGICAL SUPPLIES I/P (CO2353456 S IMP ATLANTIS CANC SCREW $1,653.75 23 SURGICAL SUPPLIES I/P (CO2353464 S IMP ATLANTIS PLATE AC $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353472 S IMP ATLANTIS PLATE AC $4,170.75 23 SURGICAL SUPPLIES I/P (CO2353480 S IMP ATLANTIS PLT AC $4,569.00 23 SURGICAL SUPPLIES I/P (CO2353498 S IMP ATLANTIS PLT AC $4,569.00 23 SURGICAL SUPPLIES I/P (CO2367035 S IMP BLADE SPIRAL $2,324.00 23 SURGICAL SUPPLIES I/P (CO2326429 S IMP BONE CHIPS $5,158.00 23 SURGICAL SUPPLIES I/P (CO2326114 S IMP BONE CHIPS CANC $2,293.00 23 SURGICAL SUPPLIES I/P (CO2362911 S IMP BONE CORNERSTONE $2,800.00 23 SURGICAL SUPPLIES I/P (CO2326270 S IMP BONE CORTICAL WEDGE $3,581.00 23 SURGICAL SUPPLIES I/P (CO2326080 S IMP BONE FEM STRUT $4,668.00 23 SURGICAL SUPPLIES I/P (CO2326064 S IMP BONE FEM STRUT $2,440.00 23 SURGICAL SUPPLIES I/P (CO2326072 S IMP BONE FEM STRUT $3,108.00 23 SURGICAL SUPPLIES I/P (CO2326023 S IMP BONE FEMUR PROX $10,638.00 23 SURGICAL SUPPLIES I/P (CO2326031 S IMP BONE FEMUR PROX $6,585.00 23 SURGICAL SUPPLIES I/P (CO2320315 S IMP BONE FEMUR STRUT $4,660.00 $4,660.00 23 SURGICAL SUPPLIES I/P (CO2320323 S IMP BONE FIBULA SEGMENT $1,966.00 $1,855.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2326098 S IMP BONE HEMI PELVIS $9,927.00 23 SURGICAL SUPPLIES I/P (CO2325991 S IMP BONE ILIAC WEDGE 1 $3,402.00 23 SURGICAL SUPPLIES I/P (CO2320042 S IMP BONE ILLIAC CREST $3,080.00 $2,989.00 23 SURGICAL SUPPLIES I/P (CO2320117 S IMP BONE PATELLA WEDGE $2,558.00 $2,558.00 23 SURGICAL SUPPLIES I/P (CO2320091 S IMP BONE PATELLA WEDGE $3,273.00 $3,273.00 23 SURGICAL SUPPLIES I/P (CO2325454 S IMP BONE PRO OST CORAL $1,978.00 23 SURGICAL SUPPLIES I/P (CO2325462 S IMP BONE PRO OST CORAL $2,792.00 23 SURGICAL SUPPLIES I/P (CO2320174 S IMP BONE PRO OSTEON $3,188.00 $2,655.00 23 SURGICAL SUPPLIES I/P (CO2320166 S IMP BONE PRO OSTEON $3,512.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2320158 S IMP BONE PRO OSTEON $3,905.00 $3,684.00 23 SURGICAL SUPPLIES I/P (CO2325447 S IMP BONE PRO OSTEON C. $1,036.00 23 SURGICAL SUPPLIES I/P (CO2352789 S IMP BONE SYNTHES SPACER $9,915.00 23 SURGICAL SUPPLIES I/P (CO2326056 S IMP BONE TIBIA PROX $10,638.00 23 SURGICAL SUPPLIES I/P (CO2320216 S IMP BONE, BILATERAL CO $7,648.00 $7,648.00 23 SURGICAL SUPPLIES I/P (CO2320018 S IMP BONE, CHIPPED $2,036.00 $1,938.00 23 SURGICAL SUPPLIES I/P (CO2320224 S IMP BONE, CHIPS $2,783.00 $3,304.00 23 SURGICAL SUPPLIES I/P (CO2320273 S IMP BONE, DISTAL FEMUR $10,638.00 $10,638.00 23 SURGICAL SUPPLIES I/P (CO2320281 S IMP BONE, FEM HEAD $3,220.00 $2,730.00 23 SURGICAL SUPPLIES I/P (CO2320331 S IMP BONE, GRAFTON GEL $3,244.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2320349 S IMP BONE, HEMI CONDYLE $3,838.00 $3,838.00 23 SURGICAL SUPPLIES I/P (CO2326841 S IMP B-T-B HEMI W/QUAD $5,688.00 23 SURGICAL SUPPLIES I/P (CO2367522 S IMP BUTTON KIT $2,975.00 23 SURGICAL SUPPLIES I/P (CO2363653 S IMP CABLE W/CRIMP $2,007.00 23 SURGICAL SUPPLIES I/P (CO2353506 S IMP CABLE W/O BEAD $1,499.50 23 SURGICAL SUPPLIES I/P (CO2367092 S IMP CAP END 12MM $778.50 23 SURGICAL SUPPLIES I/P (CO2367050 S IMP CAP END F/LOCKING S $811.50 23 SURGICAL SUPPLIES I/P (CO2367043 S IMP CAP END F/SPIRAL BL $866.25 23 SURGICAL SUPPLIES I/P (CO2367068 S IMP CAP END F/TIB NAIL $548.25 23 SURGICAL SUPPLIES I/P (CO2367076 S IMP CAP END F/TIB NAIL $1,027.00 23 SURGICAL SUPPLIES I/P (CO2367084 S IMP CAP END F/TIB NAIL $588.50 23 SURGICAL SUPPLIES I/P (CO2363679 S IMP CERCLAGE BUTTON $672.50 23 SURGICAL SUPPLIES I/P (CO2363661 S IMP CERCLAGE POST PIN $672.50 23 SURGICAL SUPPLIES I/P (CO2354405 S IMP CHARITE ARTIFICIAL $9,150.00 23 SURGICAL SUPPLIES I/P (CO2354413 S IMP CHARITE ARTIFICIAL $2,625.00 23 SURGICAL SUPPLIES I/P (CO2367530 S IMP CINCH $1,211.25 23 SURGICAL SUPPLIES I/P (CO2352805 S IMP CLAMP CERVIFIX $2,473.00 23 SURGICAL SUPPLIES I/P (CO2352813 S IMP CLAMP CERVIFIX $1,787.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2352797 S IMP CLAMP MEDIAL/LAT $2,651.00 23 SURGICAL SUPPLIES I/P (CO2353175 S IMP CLICK'X 3-D SCREW $2,187.00 23 SURGICAL SUPPLIES I/P (CO2353167 S IMP CLICK'X LOCKING CAP $954.00 23 SURGICAL SUPPLIES I/P (CO2353092 S IMP CLICK'X LOW PRO $3,336.00 23 SURGICAL SUPPLIES I/P (CO2353134 S IMP CLICK'X ROD SOFT $834.00 23 SURGICAL SUPPLIES I/P (CO2353100 S IMP CLICK'X ROD SOFT $850.00 23 SURGICAL SUPPLIES I/P (CO2353126 S IMP CLICK'X ROD SOFT 6 $637.00 23 SURGICAL SUPPLIES I/P (CO2353118 S IMP CLICK'X ROD SOFT 6 $422.00 23 SURGICAL SUPPLIES I/P (CO2353142 S IMP CLICK'X SCREW $2,029.50 23 SURGICAL SUPPLIES I/P (CO2353159 S IMP CLICK'X SCREW $1,969.00 23 SURGICAL SUPPLIES I/P (CO2352821 S IMP CONN ROD PRL TIT $1,888.25 23 SURGICAL SUPPLIES I/P (CO2352839 S IMP CONN ROD PRL TIT $2,473.00 23 SURGICAL SUPPLIES I/P (CO2353324 S IMP CROSSLINK PLT SCREW $576.50 23 SURGICAL SUPPLIES I/P (CO2322824 S IMP CSLP 1-LEVEL PLT $2,957.75 $2,055.00 23 SURGICAL SUPPLIES I/P (CO2322832 S IMP CSLP 2-LEVEL PLT $2,980.25 23 SURGICAL SUPPLIES I/P (CO2322840 S IMP CSLP 3-LEVEL PLT $3,121.50 23 SURGICAL SUPPLIES I/P (CO2352771 S IMP CSLP 4-LEVEL PLT $3,373.50 23 SURGICAL SUPPLIES I/P (CO2341519 S IMP CSLP LOCKING SCREW $95.00 $121.00 23 SURGICAL SUPPLIES I/P (CO2353076 S IMP CSLP SCREW EXPAN $765.00 23 SURGICAL SUPPLIES I/P (CO2353084 S IMP CSLP SCREW EXPAN $963.00 23 SURGICAL SUPPLIES I/P (CO2322873 S IMP CSLP SCREW EXPAN $765.00 $1,003.75 23 SURGICAL SUPPLIES I/P (CO2322865 S IMP CSLP SCREW EXPAN $765.00 $718.00 23 SURGICAL SUPPLIES I/P (CO2353068 S IMP CSLP SM STAT $2,970.25 23 SURGICAL SUPPLIES I/P (CO2353043 S IMP CSLP SM STAT ONE $2,731.75 23 SURGICAL SUPPLIES I/P (CO2353050 S IMP CSLP SM STAT TWO $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353019 S IMP CSLP VA 1-LEVEL PLT $2,731.25 23 SURGICAL SUPPLIES I/P (CO2353027 S IMP CSLP VA 2-LEVEL PLT $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353035 S IMP CSLP VA 3-LEVEL PLT $3,216.00 23 SURGICAL SUPPLIES I/P (CO2314953 S IMP DACRON MESH, 6 X 6 $268.00 $253.00 23 SURGICAL SUPPLIES I/P (CO2325819 S IMP DBX PUTTY 1CC $928.75 23 SURGICAL SUPPLIES I/P (CO2364289 S IMP END F/TROCH NAIL $661.50 23 SURGICAL SUPPLIES I/P (CO2326411 S IMP EXPANDER TISS $3,371.00 23 SURGICAL SUPPLIES I/P (CO2326007 S IMP FEM CROSS SECTION $2,345.00 23 SURGICAL SUPPLIES I/P (CO2322345 S IMP GRAFT VASCULAR 23 SURGICAL SUPPLIES I/P (CO2344067 S IMP HIP TOTAL APEX HOLE $671.50 23 SURGICAL SUPPLIES I/P (CO2343168 S IMP HIP TOTAL FEM ACET $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343143 S IMP HIP TOTAL FEM ACET $2,556.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2340099 S IMP HIP TOTAL FEM ACET $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2340115 S IMP HIP TOTAL FEM ACET $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2340107 S IMP HIP TOTAL FEM ACET $3,343.00 $3,154.00 23 SURGICAL SUPPLIES I/P (CO2343176 S IMP HIP TOTAL FEM ACET $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343150 S IMP HIP TOTAL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343317 S IMP HIP TOTAL FEM ACET $1,672.00 23 SURGICAL SUPPLIES I/P (CO2343184 S IMP HIP TOTAL FEM ACET $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343192 S IMP HIP TOTAL FEM ACET $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343200 S IMP HIP TOTAL FEM ACET $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343226 S IMP HIP TOTAL FEM ACET $4,916.00 23 SURGICAL SUPPLIES I/P (CO2343234 S IMP HIP TOTAL FEM ACET $5,197.00 23 SURGICAL SUPPLIES I/P (CO2343242 S IMP HIP TOTAL FEM ACET $5,478.00 23 SURGICAL SUPPLIES I/P (CO2343259 S IMP HIP TOTAL FEM ACET $5,758.00 23 SURGICAL SUPPLIES I/P (CO2343267 S IMP HIP TOTAL FEM ACET $6,039.00 23 SURGICAL SUPPLIES I/P (CO2343275 S IMP HIP TOTAL FEM ACET $6,320.00 23 SURGICAL SUPPLIES I/P (CO2343309 S IMP HIP TOTAL FEM ACET $1,194.00 23 SURGICAL SUPPLIES I/P (CO2343325 S IMP HIP TOTAL FEM ACET $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343333 S IMP HIP TOTAL FEM ACET $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343341 S IMP HIP TOTAL FEM ACET $2,556.00 23 SURGICAL SUPPLIES I/P (CO2343358 S IMP HIP TOTAL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343366 S IMP HIP TOTAL FEM ACET $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343374 S IMP HIP TOTAL FEM ACET $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343382 S IMP HIP TOTAL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343390 S IMP HIP TOTAL FEM ACET $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343408 S IMP HIP TOTAL FEM ACET $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343416 S IMP HIP TOTAL FEM ACET $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343424 S IMP HIP TOTAL FEM ACET $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343432 S IMP HIP TOTAL FEM ACET $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343291 S IMP HIP TOTAL FEM ACET $6,882.00 23 SURGICAL SUPPLIES I/P (CO2340172 S IMP HIP TOTAL FEM BIPOL $1,672.00 $1,577.00 23 SURGICAL SUPPLIES I/P (CO2340198 S IMP HIP TOTAL FEM BIPOL $2,163.00 $2,041.00 23 SURGICAL SUPPLIES I/P (CO2340206 S IMP HIP TOTAL FEM BIPOL $2,556.00 $2,412.00 23 SURGICAL SUPPLIES I/P (CO2340214 S IMP HIP TOTAL FEM BIPOL $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2343614 S IMP HIP TOTAL FEM BIPOL $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343622 S IMP HIP TOTAL FEM BIPOL $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343630 S IMP HIP TOTAL FEM BIPOL $2,949.00 23 SURGICAL SUPPLIES I/P (CO2340271 S IMP HIP TOTAL FEM HEAD $1,194.00 $1,127.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2340289 S IMP HIP TOTAL FEM HEAD $1,672.00 $1,577.00 23 SURGICAL SUPPLIES I/P (CO2340313 S IMP HIP TOTAL FEM HEAD $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2343580 S IMP HIP TOTAL FEM HEAD $5,478.00 23 SURGICAL SUPPLIES I/P (CO2343473 S IMP HIP TOTAL FEM HEAD $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343481 S IMP HIP TOTAL FEM HEAD $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343499 S IMP HIP TOTAL FEM HEAD $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343507 S IMP HIP TOTAL FEM HEAD $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343515 S IMP HIP TOTAL FEM HEAD $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343523 S IMP HIP TOTAL FEM HEAD $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343531 S IMP HIP TOTAL FEM HEAD $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343549 S IMP HIP TOTAL FEM HEAD $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343556 S IMP HIP TOTAL FEM HEAD $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343457 S IMP HIP TOTAL FEM HEAD $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343572 S IMP HIP TOTAL FEM HEAD $5,197.00 23 SURGICAL SUPPLIES I/P (CO2343440 S IMP HIP TOTAL FEM HEAD $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343564 S IMP HIP TOTAL FEM HEAD $4,916.00 23 SURGICAL SUPPLIES I/P (CO2343465 S IMP HIP TOTAL FEM HEAD $2,556.00 23 SURGICAL SUPPLIES I/P (CO2343036 S IMP HIP TOTAL FEM STEM $9,972.00 23 SURGICAL SUPPLIES I/P (CO2342905 S IMP HIP TOTAL FEM STEM $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342913 S IMP HIP TOTAL FEM STEM $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342921 S IMP HIP TOTAL FEM STEM $6,882.00 23 SURGICAL SUPPLIES I/P (CO2342939 S IMP HIP TOTAL FEM STEM $7,163.00 23 SURGICAL SUPPLIES I/P (CO2342947 S IMP HIP TOTAL FEM STEM $7,444.00 23 SURGICAL SUPPLIES I/P (CO2342954 S IMP HIP TOTAL FEM STEM $7,725.00 23 SURGICAL SUPPLIES I/P (CO2342962 S IMP HIP TOTAL FEM STEM $8,006.00 23 SURGICAL SUPPLIES I/P (CO2342970 S IMP HIP TOTAL FEM STEM $8,287.00 23 SURGICAL SUPPLIES I/P (CO2342988 S IMP HIP TOTAL FEM STEM $8,567.00 23 SURGICAL SUPPLIES I/P (CO2342996 S IMP HIP TOTAL FEM STEM $8,848.00 23 SURGICAL SUPPLIES I/P (CO2343002 S IMP HIP TOTAL FEM STEM $9,129.00 23 SURGICAL SUPPLIES I/P (CO2343028 S IMP HIP TOTAL FEM STEM $9,691.00 23 SURGICAL SUPPLIES I/P (CO2342871 S IMP HIP TOTAL FEM STEM $5,478.00 23 SURGICAL SUPPLIES I/P (CO2343044 S IMP HIP TOTAL FEM STEM $10,253.00 23 SURGICAL SUPPLIES I/P (CO2343051 S IMP HIP TOTAL FEM STEM $10,534.00 23 SURGICAL SUPPLIES I/P (CO2343069 S IMP HIP TOTAL FEM STEM $10,815.00 23 SURGICAL SUPPLIES I/P (CO2343077 S IMP HIP TOTAL FEM STEM $11,096.00 23 SURGICAL SUPPLIES I/P (CO2343085 S IMP HIP TOTAL FEM STEM $11,376.00 23 SURGICAL SUPPLIES I/P (CO2343093 S IMP HIP TOTAL FEM STEM $11,657.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2343101 S IMP HIP TOTAL FEM STEM $11,938.00 23 SURGICAL SUPPLIES I/P (CO2343119 S IMP HIP TOTAL FEM STEM $12,219.00 23 SURGICAL SUPPLIES I/P (CO2343127 S IMP HIP TOTAL FEM STEM $12,500.00 23 SURGICAL SUPPLIES I/P (CO2343010 S IMP HIP TOTAL FEM STEM $9,410.00 23 SURGICAL SUPPLIES I/P (CO2342756 S IMP HIP TOTAL FEM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342715 S IMP HIP TOTAL FEM STEM $1,672.00 23 SURGICAL SUPPLIES I/P (CO2342723 S IMP HIP TOTAL FEM STEM $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342897 S IMP HIP TOTAL FEM STEM $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342749 S IMP HIP TOTAL FEM STEM $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342889 S IMP HIP TOTAL FEM STEM $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342764 S IMP HIP TOTAL FEM STEM $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342772 S IMP HIP TOTAL FEM STEM $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342780 S IMP HIP TOTAL FEM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342798 S IMP HIP TOTAL FEM STEM $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342806 S IMP HIP TOTAL FEM STEM $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342814 S IMP HIP TOTAL FEM STEM $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342822 S IMP HIP TOTAL FEM STEM $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342830 S IMP HIP TOTAL FEM STEM $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342848 S IMP HIP TOTAL FEM STEM $4,635.00 23 SURGICAL SUPPLIES I/P (CO2342855 S IMP HIP TOTAL FEM STEM $4,916.00 23 SURGICAL SUPPLIES I/P (CO2342863 S IMP HIP TOTAL FEM STEM $5,197.00 23 SURGICAL SUPPLIES I/P (CO2342731 S IMP HIP TOTAL FEM STEM $2,163.00 23 SURGICAL SUPPLIES I/P (CO2344059 S IMP HIP TTL DYNAMIC LO $1,037.00 23 SURGICAL SUPPLIES I/P (CO2343135 S IMP HIP TTL FEM ACET C $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343218 S IMP HIP TTL FEM ACET C $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343283 S IMP HIP TTL FEM ACET C $6,601.00 23 SURGICAL SUPPLIES I/P (CO2340180 S IMP HIP TTL FEM BIPO C $2,149.00 $2,028.00 23 SURGICAL SUPPLIES I/P (CO2343598 S IMP HIP TTL FEM CENTRA $200.00 23 SURGICAL SUPPLIES I/P (CO2343606 S IMP HIP TTL FEM CENTRA $358.00 23 SURGICAL SUPPLIES I/P (CO2352201 S IMP HOOK LAMINA FRONT $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352219 S IMP HOOK LAMINA RT/LT $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352847 S IMP HOOK TIT CERVIFIX $2,123.50 23 SURGICAL SUPPLIES I/P (CO2363349 S IMP H-PLT SYN EXT $990.50 23 SURGICAL SUPPLIES I/P (CO2330751 S IMP ICD LEAD S/C $5,478.00 23 SURGICAL SUPPLIES I/P (CO2330553 S IMP ICD S/C $31,180.00 23 SURGICAL SUPPLIES I/P (CO2321206 S IMP IMP 0-50 $134.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2321214 S IMP IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2321222 S IMP IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2321230 S IMP IMP 1101-1200 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2321248 S IMP IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2321255 S IMP IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2321263 S IMP IMP 1401-1500 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2321271 S IMP IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2321289 S IMP IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2321297 S IMP IMP 1601-1700 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2321305 S IMP IMP 1701-1800 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2321313 S IMP IMP 1801-1900 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2321321 S IMP IMP 1901-2000 $5,478.00 $2,067.00 23 SURGICAL SUPPLIES I/P (CO2321339 S IMP IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2321347 S IMP IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2321354 S IMP IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2321370 S IMP IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2321388 S IMP IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2321396 S IMP IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2321404 S IMP IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2321412 S IMP IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2321420 S IMP IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2321438 S IMP IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2321446 S IMP IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2321453 S IMP IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2321461 S IMP IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2321479 S IMP IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2321487 S IMP IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2321495 S IMP IMP 951-1000 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2363836 S IMP IMP BIO-TRANS PLLA $1,228.25 23 SURGICAL SUPPLIES I/P (CO2321149 S IMP IMP CAUSSE TEF PIST $283.00 $283.00 23 SURGICAL SUPPLIES I/P (CO2390649 S IMP IMP EAR MCGEE $476.50 $476.50 23 SURGICAL SUPPLIES I/P (CO2321180 S IMP IMP HAPEX $1,320.25 $1,320.25 23 SURGICAL SUPPLIES I/P (CO2321172 S IMP IMP HAPEX CENTERED $1,320.25 $1,320.25 23 SURGICAL SUPPLIES I/P (CO2362937 S IMP IMP TRANSFIX ARTHRE $671.50 23 SURGICAL SUPPLIES I/P (CO2321529 S IMP IMP WEHRS INCUS $1,208.00 $1,208.00 23 SURGICAL SUPPLIES I/P (CO2321727 S IMP IMP WEHRS INCUS DBL $1,200.50 $1,200.50 23 SURGICAL SUPPLIES I/P (CO2380756 S IMP IMP, COLLAGEN (W/SY $1,671.00 $1,576.00 23 SURGICAL SUPPLIES I/P (CO2321362 S IMP IMPLANT 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2363695 S IMP INTERMED HTO PLT $3,350.00 23 SURGICAL SUPPLIES I/P (CO2340495 S IMP JOINT IMP 0-50 $134.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2340503 S IMP JOINT IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2340511 S IMP JOINT IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2340529 S IMP JOINT IMP 1101-1200 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2340537 S IMP JOINT IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2340545 S IMP JOINT IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2340552 S IMP JOINT IMP 1401-1500 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2340560 S IMP JOINT IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2340594 S IMP JOINT IMP 1701-1800 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2340636 S IMP JOINT IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2340644 S IMP JOINT IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2340651 S IMP JOINT IMP 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2340669 S IMP JOINT IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2340677 S IMP JOINT IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2340685 S IMP JOINT IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2340693 S IMP JOINT IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2340701 S IMP JOINT IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2340719 S IMP JOINT IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2340727 S IMP JOINT IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2340735 S IMP JOINT IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2340743 S IMP JOINT IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2340750 S IMP JOINT IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2340768 S IMP JOINT IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2340776 S IMP JOINT IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2340784 S IMP JOINT IMP 951-1000 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2340578 S IMP JOINT IMPLANT 151- $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2340586 S IMP JOINT IMPLANT 1601 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2340602 S IMP JOINT IMPLANT 1801 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2340610 S IMP JOINT IMPLANT 1901 $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2340628 S IMP JOINT IMPLANT 201- $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2342079 S IMP KNEE TOTAL FEM COMP $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342095 S IMP KNEE TOTAL FEM COMP $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342103 S IMP KNEE TOTAL FEM COMP $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342111 S IMP KNEE TOTAL FEM COMP $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342129 S IMP KNEE TOTAL FEM COMP $4,635.00 23 SURGICAL SUPPLIES I/P (CO2342137 S IMP KNEE TOTAL FEM COMP $4,916.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2342145 S IMP KNEE TOTAL FEM COMP $5,197.00 23 SURGICAL SUPPLIES I/P (CO2342152 S IMP KNEE TOTAL FEM COMP $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342160 S IMP KNEE TOTAL FEM COMP $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342178 S IMP KNEE TOTAL FEM COMP $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342186 S IMP KNEE TOTAL FEM COMP $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342202 S IMP KNEE TOTAL FEM COMP $6,882.00 23 SURGICAL SUPPLIES I/P (CO2342210 S IMP KNEE TOTAL FEM COMP $7,163.00 23 SURGICAL SUPPLIES I/P (CO2342228 S IMP KNEE TOTAL FEM COMP $7,444.00 23 SURGICAL SUPPLIES I/P (CO2342236 S IMP KNEE TOTAL FEM COMP $7,725.00 23 SURGICAL SUPPLIES I/P (CO2342244 S IMP KNEE TOTAL FEM COMP $8,006.00 23 SURGICAL SUPPLIES I/P (CO2342251 S IMP KNEE TOTAL FEM COMP $8,287.00 23 SURGICAL SUPPLIES I/P (CO2342269 S IMP KNEE TOTAL FEM COMP $8,567.00 23 SURGICAL SUPPLIES I/P (CO2342277 S IMP KNEE TOTAL FEM COMP $8,848.00 23 SURGICAL SUPPLIES I/P (CO2342285 S IMP KNEE TOTAL FEM COMP $9,129.00 23 SURGICAL SUPPLIES I/P (CO2342293 S IMP KNEE TOTAL FEM COMP $9,410.00 23 SURGICAL SUPPLIES I/P (CO2342301 S IMP KNEE TOTAL FEM COMP $9,691.00 23 SURGICAL SUPPLIES I/P (CO2342194 S IMP KNEE TOTAL FEM COMP $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342061 S IMP KNEE TOTAL FEM COMP $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342087 S IMP KNEE TOTAL FEM COMP $3,511.00 23 SURGICAL SUPPLIES I/P (CO2344174 S IMP KNEE TOTAL FEM UNIC $5,604.00 23 SURGICAL SUPPLIES I/P (CO2342590 S IMP KNEE TOTAL PAT COMP $1,672.00 23 SURGICAL SUPPLIES I/P (CO2342616 S IMP KNEE TOTAL PAT COMP $2,163.00 23 SURGICAL SUPPLIES I/P (CO2342608 S IMP KNEE TOTAL PAT COMP $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342624 S IMP KNEE TOTAL PAT COMP $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342632 S IMP KNEE TOTAL PAT COMP $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342640 S IMP KNEE TOTAL PAT COMP $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342657 S IMP KNEE TOTAL PAT COMP $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342665 S IMP KNEE TOTAL PAT COMP $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342673 S IMP KNEE TOTAL PAT COMP $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342681 S IMP KNEE TOTAL PAT COMP $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342699 S IMP KNEE TOTAL PAT COMP $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342707 S IMP KNEE TOTAL PAT COMP $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342533 S IMP KNEE TOTAL TIB ALL $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342541 S IMP KNEE TOTAL TIB ALL $2,163.00 23 SURGICAL SUPPLIES I/P (CO2342558 S IMP KNEE TOTAL TIB ALL $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342566 S IMP KNEE TOTAL TIB ALL $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342574 S IMP KNEE TOTAL TIB ALL $3,343.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2342582 S IMP KNEE TOTAL TIB ALL $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342335 S IMP KNEE TOTAL TIB INS $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342368 S IMP KNEE TOTAL TIB INSE $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342343 S IMP KNEE TOTAL TIB INSE $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342350 S IMP KNEE TOTAL TIB INSE $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342319 S IMP KNEE TOTAL TIB INSE $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342327 S IMP KNEE TOTAL TIB INSE $2,949.00 23 SURGICAL SUPPLIES I/P (CO2341147 S IMP KNEE TOTAL TIB INSE $2,556.00 $2,412.00 23 SURGICAL SUPPLIES I/P (CO2341154 S IMP KNEE TOTAL TIB INSE $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2341162 S IMP KNEE TOTAL TIB INSE $3,343.00 $3,154.00 23 SURGICAL SUPPLIES I/P (CO2341139 S IMP KNEE TOTAL TIB INSE $2,163.00 $2,041.00 23 SURGICAL SUPPLIES I/P (CO2341121 S IMP KNEE TOTAL TIB INSE $2,149.00 $2,028.00 23 SURGICAL SUPPLIES I/P (CO2342426 S IMP KNEE TOTAL TIB PLA $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342442 S IMP KNEE TOTAL TIB PLA $4,635.00 23 SURGICAL SUPPLIES I/P (CO2342483 S IMP KNEE TOTAL TIB PLT $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342376 S IMP KNEE TOTAL TIB PLT $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342384 S IMP KNEE TOTAL TIB PLT $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342392 S IMP KNEE TOTAL TIB PLT $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342400 S IMP KNEE TOTAL TIB PLT $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342418 S IMP KNEE TOTAL TIB PLT $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342434 S IMP KNEE TOTAL TIB PLT $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342459 S IMP KNEE TOTAL TIB PLT $4,916.00 23 SURGICAL SUPPLIES I/P (CO2342475 S IMP KNEE TOTAL TIB PLT $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342491 S IMP KNEE TOTAL TIB PLT $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342509 S IMP KNEE TOTAL TIB PLT $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342517 S IMP KNEE TOTAL TIB PLT $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342525 S IMP KNEE TOTAL TIB PLT $6,882.00 23 SURGICAL SUPPLIES I/P (CO2342467 S IMP KNEE TOTAL TIB PLT $5,197.00 23 SURGICAL SUPPLIES I/P (CO2341113 S IMP KNEE TOTAL TIB PLT $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2344158 S IMP KNEE TTL DIST/PROX $2,785.00 23 SURGICAL SUPPLIES I/P (CO2344141 S IMP KNEE TTL FEM STEM $954.75 23 SURGICAL SUPPLIES I/P (CO2344166 S IMP KNEE TTL TIB FLUT $3,342.00 23 SURGICAL SUPPLIES I/P (CO2344182 S IMP KNEE TTL TIB UNICOM $3,913.00 23 SURGICAL SUPPLIES I/P (CO2363406 S IMP K-WIRE SYN TIT $63.25 23 SURGICAL SUPPLIES I/P (CO2363398 S IMP K-WIRE SYN W/TROCAR $50.00 23 SURGICAL SUPPLIES I/P (CO2350833 S IMP K-WIRE, ACE $121.00 $121.00 23 SURGICAL SUPPLIES I/P (CO2330314 S IMP LEAD ADAPTER $1,194.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2330306 S IMP LEAD END CAP $267.00 23 SURGICAL SUPPLIES I/P (CO2321818 S IMP MATCH STICKS $1,275.00 $901.00 23 SURGICAL SUPPLIES I/P (CO2322428 S IMP MESH MARLEX 3 X 6 $513.00 $484.00 23 SURGICAL SUPPLIES I/P (CO2321875 S IMP MESH TRELEX 10X14" $1,051.00 $991.00 23 SURGICAL SUPPLIES I/P (CO2367100 S IMP NAIL CANN FEM $3,270.00 23 SURGICAL SUPPLIES I/P (CO2367118 S IMP NAIL CANN TIB $3,165.00 23 SURGICAL SUPPLIES I/P (CO2367258 S IMP NAIL ELASTIC $1,237.25 23 SURGICAL SUPPLIES I/P (CO2360493 S IMP ORTHO IMP 0-50 $147.00 $139.00 23 SURGICAL SUPPLIES I/P (CO2360501 S IMP ORTHO IMP 1001-1100 $3,244.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2360519 S IMP ORTHO IMP 101-150 $656.00 $619.00 23 SURGICAL SUPPLIES I/P (CO2360527 S IMP ORTHO IMP 1101-1200 $3,553.00 $3,352.00 23 SURGICAL SUPPLIES I/P (CO2360535 S IMP ORTHO IMP 1201-1300 $3,862.00 $3,644.00 23 SURGICAL SUPPLIES I/P (CO2360543 S IMP ORTHO IMP 1301-1400 $4,171.00 $3,935.00 23 SURGICAL SUPPLIES I/P (CO2360568 S IMP ORTHO IMP 1501-1600 $4,789.00 $4,518.00 23 SURGICAL SUPPLIES I/P (CO2360576 S IMP ORTHO IMP 151-200 $920.00 $868.00 23 SURGICAL SUPPLIES I/P (CO2360584 S IMP ORTHO IMP 1601-1700 $5,098.00 $4,810.00 23 SURGICAL SUPPLIES I/P (CO2360592 S IMP ORTHO IMP 1701-1800 $5,407.00 $5,101.00 23 SURGICAL SUPPLIES I/P (CO2360600 S IMP ORTHO IMP 1801-1900 $5,716.00 $5,393.00 23 SURGICAL SUPPLIES I/P (CO2360618 S IMP ORTHO IMP 1901-2000 $6,025.00 $5,684.00 23 SURGICAL SUPPLIES I/P (CO2360626 S IMP ORTHO IMP 201-250 $1,181.00 $1,115.00 23 SURGICAL SUPPLIES I/P (CO2360634 S IMP ORTHO IMP 251-300 $1,445.00 $1,363.00 23 SURGICAL SUPPLIES I/P (CO2360642 S IMP ORTHO IMP 301-350 $1,707.00 $1,610.00 23 SURGICAL SUPPLIES I/P (CO2360659 S IMP ORTHO IMP 351-400 $1,970.00 $1,859.00 23 SURGICAL SUPPLIES I/P (CO2360667 S IMP ORTHO IMP 401-450 $2,232.00 $2,106.00 23 SURGICAL SUPPLIES I/P (CO2360675 S IMP ORTHO IMP 451-500 $2,496.00 $2,354.00 23 SURGICAL SUPPLIES I/P (CO2360683 S IMP ORTHO IMP 501-550 $2,272.00 $2,143.00 23 SURGICAL SUPPLIES I/P (CO2360691 S IMP ORTHO IMP 51-100 $394.00 $372.00 23 SURGICAL SUPPLIES I/P (CO2360709 S IMP ORTHO IMP 551-600 $2,488.00 $2,347.00 23 SURGICAL SUPPLIES I/P (CO2360717 S IMP ORTHO IMP 601-650 $2,704.00 $2,551.00 23 SURGICAL SUPPLIES I/P (CO2360725 S IMP ORTHO IMP 651-700 $2,921.00 $2,755.00 23 SURGICAL SUPPLIES I/P (CO2360733 S IMP ORTHO IMP 701-750 $3,137.00 $2,959.00 23 SURGICAL SUPPLIES I/P (CO2360741 S IMP ORTHO IMP 751-800 $3,353.00 $3,163.00 23 SURGICAL SUPPLIES I/P (CO2360758 S IMP ORTHO IMP 801-850 $3,569.00 $3,367.00 23 SURGICAL SUPPLIES I/P (CO2360766 S IMP ORTHO IMP 851-900 $3,786.00 $3,571.00 23 SURGICAL SUPPLIES I/P (CO2360774 S IMP ORTHO IMP 901-950 $4,002.00 $3,775.00 23 SURGICAL SUPPLIES I/P (CO2360782 S IMP ORTHO IMP 951-1000 $4,218.00 $3,980.00 23 SURGICAL SUPPLIES I/P (CO2360550 S IMP ORTHO IMPLANT 1401 $4,480.00 $4,227.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2363562 S IMP PANEL KINAMED $771.00 23 SURGICAL SUPPLIES I/P (CO2363570 S IMP PANEL KINAMED $1,542.00 23 SURGICAL SUPPLIES I/P (CO2364065 S IMP PANEL LACTOSORB 50 $2,635.50 23 SURGICAL SUPPLIES I/P (CO2322436 S IMP PATCH GORETEX CARDI $1,261.00 $1,189.00 23 SURGICAL SUPPLIES I/P (CO2322451 S IMP PATCH GRAFT, 2 X 3 $646.00 $610.00 23 SURGICAL SUPPLIES I/P (CO2325975 S IMP PATCH HEMACAROTID U $390.25 23 SURGICAL SUPPLIES I/P (CO2325231 S IMP PATCH MONO CUSP $4,986.00 23 SURGICAL SUPPLIES I/P (CO2326015 S IMP PATELLA TEND W/QUAD $10,138.00 23 SURGICAL SUPPLIES I/P (CO2325306 S IMP PERICARDIUM PERIGU $716.00 23 SURGICAL SUPPLIES I/P (CO2360956 S IMP PIN ACE STEINMAN $84.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2360824 S IMP PIN HEWSON $118.75 $118.75 23 SURGICAL SUPPLIES I/P (CO2331064 S IMP PIN PLUG PCMKR $478.00 23 SURGICAL SUPPLIES I/P (CO2360899 S IMP PIN RUSH MEDULLARY $447.50 $414.50 23 SURGICAL SUPPLIES I/P (CO2360907 S IMP PIN RUSH MEDULLARY $480.75 $372.75 23 SURGICAL SUPPLIES I/P (CO2360915 S IMP PIN RUSH MEDULLARY $368.00 $278.50 23 SURGICAL SUPPLIES I/P (CO2360931 S IMP PIN STNMAN PLN $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2360949 S IMP PIN STNMAN THREADED $127.50 $127.50 23 SURGICAL SUPPLIES I/P (CO2363364 S IMP PIN SYN BUTTRESS $261.25 23 SURGICAL SUPPLIES I/P (CO2367860 S IMP PLATE $803.25 23 SURGICAL SUPPLIES I/P (CO2367803 S IMP PLATE $201.00 23 SURGICAL SUPPLIES I/P (CO2367993 S IMP PLATE $872.00 23 SURGICAL SUPPLIES I/P (CO2367969 S IMP PLATE $214.25 23 SURGICAL SUPPLIES I/P (CO2368033 S IMP PLATE $396.00 23 SURGICAL SUPPLIES I/P (CO2367902 S IMP PLATE $884.00 23 SURGICAL SUPPLIES I/P (CO2367985 S IMP PLATE $680.75 23 SURGICAL SUPPLIES I/P (CO2368009 S IMP PLATE $680.75 23 SURGICAL SUPPLIES I/P (CO2367894 S IMP PLATE $788.00 23 SURGICAL SUPPLIES I/P (CO2367324 S IMP PLATE $590.25 23 SURGICAL SUPPLIES I/P (CO2367332 S IMP PLATE $1,029.00 23 SURGICAL SUPPLIES I/P (CO2367340 S IMP PLATE $1,555.25 23 SURGICAL SUPPLIES I/P (CO2367357 S IMP PLATE $1,557.00 23 SURGICAL SUPPLIES I/P (CO2367399 S IMP PLATE $3,620.00 23 SURGICAL SUPPLIES I/P (CO2367407 S IMP PLATE $4,091.00 23 SURGICAL SUPPLIES I/P (CO2367977 S IMP PLATE $321.25 23 SURGICAL SUPPLIES I/P (CO2367878 S IMP PLATE $803.25 23 SURGICAL SUPPLIES I/P (CO2367910 S IMP PLATE $635.00 23 SURGICAL SUPPLIES I/P (CO2367928 S IMP PLATE $703.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2367936 S IMP PLATE $1,302.50 23 SURGICAL SUPPLIES I/P (CO2367944 S IMP PLATE $3,110.00 23 SURGICAL SUPPLIES I/P (CO2368017 S IMP PLATE $3,068.00 23 SURGICAL SUPPLIES I/P (CO2368025 S IMP PLATE $814.75 23 SURGICAL SUPPLIES I/P (CO2368041 S IMP PLATE $615.75 23 SURGICAL SUPPLIES I/P (CO2368058 S IMP PLATE $709.50 23 SURGICAL SUPPLIES I/P (CO2367951 S IMP PLATE $2,043.00 23 SURGICAL SUPPLIES I/P (CO2367753 S IMP PLATE $988.25 23 SURGICAL SUPPLIES I/P (CO2367696 S IMP PLATE $2,100.00 23 SURGICAL SUPPLIES I/P (CO2367704 S IMP PLATE $2,660.00 23 SURGICAL SUPPLIES I/P (CO2367712 S IMP PLATE $1,966.00 23 SURGICAL SUPPLIES I/P (CO2367720 S IMP PLATE $1,881.00 23 SURGICAL SUPPLIES I/P (CO2367746 S IMP PLATE $2,969.00 23 SURGICAL SUPPLIES I/P (CO2367852 S IMP PLATE $612.00 23 SURGICAL SUPPLIES I/P (CO2367761 S IMP PLATE $1,105.00 23 SURGICAL SUPPLIES I/P (CO2367779 S IMP PLATE $1,232.50 23 SURGICAL SUPPLIES I/P (CO2367787 S IMP PLATE $2,450.00 23 SURGICAL SUPPLIES I/P (CO2367811 S IMP PLATE $313.75 23 SURGICAL SUPPLIES I/P (CO2367829 S IMP PLATE $386.50 23 SURGICAL SUPPLIES I/P (CO2367837 S IMP PLATE $971.50 23 SURGICAL SUPPLIES I/P (CO2367845 S IMP PLATE $612.00 23 SURGICAL SUPPLIES I/P (CO2367738 S IMP PLATE $2,258.00 23 SURGICAL SUPPLIES I/P (CO2368066 S IMP PLATE $753.50 23 SURGICAL SUPPLIES I/P (CO2364305 S IMP PLATE ADAPT LO PRO $946.50 23 SURGICAL SUPPLIES I/P (CO2364313 S IMP PLATE ADAPT LO PRO $1,163.00 23 SURGICAL SUPPLIES I/P (CO2364230 S IMP PLATE AMBI CLASSIC $1,442.75 23 SURGICAL SUPPLIES I/P (CO2367183 S IMP PLATE BURR HOLE 2.0 $758.75 23 SURGICAL SUPPLIES I/P (CO2354710 S IMP PLATE CERV L1 $2,800.00 23 SURGICAL SUPPLIES I/P (CO2354728 S IMP PLATE CERV L2 $3,150.00 23 SURGICAL SUPPLIES I/P (CO2354736 S IMP PLATE CERV L3 $3,500.00 23 SURGICAL SUPPLIES I/P (CO2354744 S IMP PLATE CERV L4 $3,850.00 23 SURGICAL SUPPLIES I/P (CO2367142 S IMP PLATE COMPRESSION 2 $1,138.00 23 SURGICAL SUPPLIES I/P (CO2367159 S IMP PLATE DBL Y 2.0MM $599.75 23 SURGICAL SUPPLIES I/P (CO2363943 S IMP PLATE DEPUY CALCAN $1,764.00 23 SURGICAL SUPPLIES I/P (CO2367217 S IMP PLATE DOG BONE $986.25 23 SURGICAL SUPPLIES I/P (CO2367126 S IMP PLATE FACIAL 16MM I $639.50 23 SURGICAL SUPPLIES I/P (CO2367282 S IMP PLATE L $248.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2367134 S IMP PLATE L 2.0MM EXTEN $968.25 23 SURGICAL SUPPLIES I/P (CO2363687 S IMP PLATE LC-DCP STRAI $1,902.00 23 SURGICAL SUPPLIES I/P (CO2324754 S IMP PLATE MAXILLOFACIA $926.25 23 SURGICAL SUPPLIES I/P (CO2324648 S IMP PLATE MAXILLOFACIA $1,898.00 23 SURGICAL SUPPLIES I/P (CO2325165 S IMP PLATE MAXILLOFACIA $3,168.00 23 SURGICAL SUPPLIES I/P (CO2367209 S IMP PLATE PRE-BENT 1.6M $1,156.00 23 SURGICAL SUPPLIES I/P (CO2367308 S IMP PLATE STR $257.75 23 SURGICAL SUPPLIES I/P (CO2364180 S IMP PLATE SYN LCP 1/3 T $744.00 23 SURGICAL SUPPLIES I/P (CO2364131 S IMP PLATE SYN RECON 11- $1,840.50 23 SURGICAL SUPPLIES I/P (CO2364149 S IMP PLATE SYN RECON 15- $1,895.00 23 SURGICAL SUPPLIES I/P (CO2364115 S IMP PLATE SYN RECON 3- $1,571.00 23 SURGICAL SUPPLIES I/P (CO2364123 S IMP PLATE SYN RECON 7-1 $1,881.75 23 SURGICAL SUPPLIES I/P (CO2363265 S IMP PLATE SYN STRAIGHT $946.75 23 SURGICAL SUPPLIES I/P (CO2364198 S IMP PLATE SYNTHES LCP 3 $1,617.50 23 SURGICAL SUPPLIES I/P (CO2364172 S IMP PLATE SYNTHES RECON $2,021.00 23 SURGICAL SUPPLIES I/P (CO2367290 S IMP PLATE T $248.50 23 SURGICAL SUPPLIES I/P (CO2367274 S IMP PLATE TUBULAR $394.25 23 SURGICAL SUPPLIES I/P (CO2367191 S IMP PLATE X 1.2MM $686.25 23 SURGICAL SUPPLIES I/P (CO2363984 S IMP PLT FIBULA COMP $655.00 23 SURGICAL SUPPLIES I/P (CO2361129 S IMP PLT AMBI $1,795.50 $1,795.50 23 SURGICAL SUPPLIES I/P (CO2361145 S IMP PLT AMBI $1,838.50 $1,838.50 23 SURGICAL SUPPLIES I/P (CO2361137 S IMP PLT AMBI ALL $1,960.50 $1,960.50 23 SURGICAL SUPPLIES I/P (CO2361087 S IMP PLT AMBI ALL DEGREE $2,098.75 $2,098.75 23 SURGICAL SUPPLIES I/P (CO2361095 S IMP PLT AMBI ALL DEGREE $1,939.50 $1,939.50 23 SURGICAL SUPPLIES I/P (CO2361103 S IMP PLT AMBI ALL DEGREE $1,329.50 $1,329.50 23 SURGICAL SUPPLIES I/P (CO2361111 S IMP PLT AMBI ALL DEGREE $1,448.50 $1,448.50 23 SURGICAL SUPPLIES I/P (CO2363554 S IMP PLT BOX KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2363505 S IMP PLT BURR HOLE $365.00 23 SURGICAL SUPPLIES I/P (CO2362606 S IMP PLT CONDYLAR BUTT $2,027.00 $1,913.00 23 SURGICAL SUPPLIES I/P (CO2324895 S IMP PLT CRANI BOX 1.3 $1,014.00 23 SURGICAL SUPPLIES I/P (CO2325066 S IMP PLT CRANI BURR $1,077.00 $920.75 23 SURGICAL SUPPLIES I/P (CO2324770 S IMP PLT CRANI STR $261.00 23 SURGICAL SUPPLIES I/P (CO2324762 S IMP PLT CRANI STR $204.00 23 SURGICAL SUPPLIES I/P (CO2324853 S IMP PLT CRANI STRUT $1,801.00 23 SURGICAL SUPPLIES I/P (CO2324861 S IMP PLT CRANI X-1.3 $1,036.25 23 SURGICAL SUPPLIES I/P (CO2324812 S IMP PLT CRANI Y X 1.3 $1,036.25 23 SURGICAL SUPPLIES I/P (CO2363927 S IMP PLT DEPUY AC 3.5 $542.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2363950 S IMP PLT DEPUY META LG $1,262.25 23 SURGICAL SUPPLIES I/P (CO2363968 S IMP PLT DEPUY META SM $828.75 23 SURGICAL SUPPLIES I/P (CO2363935 S IMP PLT DEPUY SPIDER $340.00 23 SURGICAL SUPPLIES I/P (CO2363919 S IMP PLT DEPUY TUBLR $275.00 23 SURGICAL SUPPLIES I/P (CO2363216 S IMP PLT DHS BARREL $1,914.25 23 SURGICAL SUPPLIES I/P (CO2361541 S IMP PLT FACE CHIN $899.50 $822.50 23 SURGICAL SUPPLIES I/P (CO2361533 S IMP PLT FACE MAXI $975.50 $914.25 23 SURGICAL SUPPLIES I/P (CO2361608 S IMP PLT FACE MICRO H $668.25 $822.50 23 SURGICAL SUPPLIES I/P (CO2361707 S IMP PLT FACE MINI Y $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO2363489 S IMP PLT FACE QUAD $785.50 23 SURGICAL SUPPLIES I/P (CO2363539 S IMP PLT H SHAPE KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2324663 S IMP PLT MAX ORBITAL $2,616.00 23 SURGICAL SUPPLIES I/P (CO2325157 S IMP PLT MAX STR FX $2,029.00 23 SURGICAL SUPPLIES I/P (CO2325116 S IMP PLT MAX. LC-DCP $2,066.00 23 SURGICAL SUPPLIES I/P (CO2325140 S IMP PLT MAX. STR FX $1,902.00 23 SURGICAL SUPPLIES I/P (CO2324952 S IMP PLT MAX.FAC ADAP $1,358.75 23 SURGICAL SUPPLIES I/P (CO2325082 S IMP PLT MAX.FAC COMP $1,534.00 23 SURGICAL SUPPLIES I/P (CO2324713 S IMP PLT MAX.FAC DBL $621.00 23 SURGICAL SUPPLIES I/P (CO2324820 S IMP PLT MAX.FAC DBL Y $918.00 23 SURGICAL SUPPLIES I/P (CO2324978 S IMP PLT MAX.FAC ORBITAL $1,252.50 23 SURGICAL SUPPLIES I/P (CO2324622 S IMP PLT MAX.FAC STRUT $1,832.00 23 SURGICAL SUPPLIES I/P (CO2324846 S IMP PLT MAX.FAC T $927.50 23 SURGICAL SUPPLIES I/P (CO2324721 S IMP PLT MAX.FAC X $808.00 23 SURGICAL SUPPLIES I/P (CO2325041 S IMP PLT MAX.FAC X $1,003.75 23 SURGICAL SUPPLIES I/P (CO2325025 S IMP PLT MAX.FAC Y $1,003.75 23 SURGICAL SUPPLIES I/P (CO2325132 S IMP PLT MAX.LC-DCP $2,066.00 23 SURGICAL SUPPLIES I/P (CO2324739 S IMP PLT MAXILLO $590.00 23 SURGICAL SUPPLIES I/P (CO2325173 S IMP PLT MAXILLO $3,420.00 23 SURGICAL SUPPLIES I/P (CO2325124 S IMP PLT MAXILLO LC-DCP $1,902.00 23 SURGICAL SUPPLIES I/P (CO2325108 S IMP PLT MAXILLO.LC-DCP $2,093.00 23 SURGICAL SUPPLIES I/P (CO2324671 S IMP PLT MAXILLOFACE $897.50 23 SURGICAL SUPPLIES I/P (CO2324796 S IMP PLT MAXILLOFACE $926.25 23 SURGICAL SUPPLIES I/P (CO2324697 S IMP PLT MAXILLOFACE $901.75 23 SURGICAL SUPPLIES I/P (CO2324655 S IMP PLT MAXILLOFACE $995.50 23 SURGICAL SUPPLIES I/P (CO2324630 S IMP PLT MAXILLOFACE $2,056.00 23 SURGICAL SUPPLIES I/P (CO2325009 S IMP PLT MAXILLOFACE $1,048.50 23 SURGICAL SUPPLIES I/P (CO2324986 S IMP PLT MAXILLOFACE $991.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2363976 S IMP PLT MEDIAL PILON $1,338.75 23 SURGICAL SUPPLIES I/P (CO2363513 S IMP PLT ST 2H 1.6MM $159.00 23 SURGICAL SUPPLIES I/P (CO2363521 S IMP PLT ST KINAMED $325.00 23 SURGICAL SUPPLIES I/P (CO2363190 S IMP PLT SYN 1/3 TUBLR $279.25 23 SURGICAL SUPPLIES I/P (CO2363224 S IMP PLT SYN 95DEG $2,518.00 23 SURGICAL SUPPLIES I/P (CO2363182 S IMP PLT SYN BROAD $1,274.75 23 SURGICAL SUPPLIES I/P (CO2363208 S IMP PLT SYN CLOVERLEAF $1,319.50 23 SURGICAL SUPPLIES I/P (CO2363299 S IMP PLT SYN CONDYLAR $1,217.00 23 SURGICAL SUPPLIES I/P (CO2363307 S IMP PLT SYN L-BUTTRES $1,644.75 23 SURGICAL SUPPLIES I/P (CO2363166 S IMP PLT SYN LC-DCP $666.50 23 SURGICAL SUPPLIES I/P (CO2363232 S IMP PLT SYN LC-DCP TIT $1,103.25 23 SURGICAL SUPPLIES I/P (CO2363240 S IMP PLT SYN LC-DCP TIT $1,460.75 23 SURGICAL SUPPLIES I/P (CO2363174 S IMP PLT SYN NARROW $841.75 23 SURGICAL SUPPLIES I/P (CO2363158 S IMP PLT SYN SEMI-TUBLR $338.50 23 SURGICAL SUPPLIES I/P (CO2363273 S IMP PLT SYN STR TIT $1,034.25 23 SURGICAL SUPPLIES I/P (CO2363281 S IMP PLT SYN STR TIT $1,125.75 23 SURGICAL SUPPLIES I/P (CO2363257 S IMP PLT SYN STR TIT $822.50 23 SURGICAL SUPPLIES I/P (CO2363547 S IMP PLT X SHAPE KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2361376 S IMP PLT, ACE STR $786.25 $786.25 23 SURGICAL SUPPLIES I/P (CO2361384 S IMP PLT, ACE STR $845.75 $845.75 23 SURGICAL SUPPLIES I/P (CO2361335 S IMP PLT, ACE STR $913.75 $913.75 23 SURGICAL SUPPLIES I/P (CO2361343 S IMP PLT, ACE STR $977.50 $977.50 23 SURGICAL SUPPLIES I/P (CO2361350 S IMP PLT, ACE STR $658.75 $658.75 23 SURGICAL SUPPLIES I/P (CO2361368 S IMP PLT, ACE STR $714.00 $714.00 23 SURGICAL SUPPLIES I/P (CO2361392 S IMP PLT, ACE TUB $304.50 $304.50 23 SURGICAL SUPPLIES I/P (CO2361566 S IMP PLT, FACE MICRO $643.25 $658.25 23 SURGICAL SUPPLIES I/P (CO2361574 S IMP PLT, FACE MICRO $690.00 $646.50 23 SURGICAL SUPPLIES I/P (CO2361582 S IMP PLT, FACE MICRO $1,001.25 $1,013.75 23 SURGICAL SUPPLIES I/P (CO2361590 S IMP PLT, FACE MICRO $493.50 $493.50 23 SURGICAL SUPPLIES I/P (CO2361632 S IMP PLT, FACE MICRO T $657.50 $646.50 23 SURGICAL SUPPLIES I/P (CO2361640 S IMP PLT, FACE MICRO Y $668.25 $627.25 23 SURGICAL SUPPLIES I/P (CO2361673 S IMP PLT, FACE MINI $1,282.50 $1,205.00 23 SURGICAL SUPPLIES I/P (CO2361681 S IMP PLT, FACE MINI $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO2361657 S IMP PLT, FACE MINI $805.50 $757.25 23 SURGICAL SUPPLIES I/P (CO2361699 S IMP PLT, FACE MINI L $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO2361665 S IMP PLT,FACE MINI $612.25 $573.75 23 SURGICAL SUPPLIES I/P (CO2352854 S IMP PLT/ROD OCCIPITAL $4,231.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2324945 S IMP PLT4 CRANI BOX $1,003.75 23 SURGICAL SUPPLIES I/P (CO2361822 S IMP PLUG BONE SILASTIC $680.00 $680.00 23 SURGICAL SUPPLIES I/P (CO2361848 S IMP PLUG CEMENT UNIV $499.75 $612.00 23 SURGICAL SUPPLIES I/P (CO2323970 S IMP PRCDL PATCH GRAFT 1 $1,313.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2364297 S IMP REATTACHMENT DEVICE $4,678.00 23 SURGICAL SUPPLIES I/P (CO2363604 S IMP ROD ENDER $1,116.50 23 SURGICAL SUPPLIES I/P (CO2354330 S IMP ROD ISOBAR 170-270M $1,275.00 23 SURGICAL SUPPLIES I/P (CO2354348 S IMP ROD ISOBAR 300MM $1,700.00 23 SURGICAL SUPPLIES I/P (CO2354314 S IMP ROD ISOBAR 45-85MM $1,041.25 23 SURGICAL SUPPLIES I/P (CO2354322 S IMP ROD ISOBAR 95-150MM $1,041.25 23 SURGICAL SUPPLIES I/P (CO2354306 S IMP ROD ISOBAR SEMI-RIG $4,000.00 23 SURGICAL SUPPLIES I/P (CO2354462 S IMP ROD PREBENT LEGACY $850.00 23 SURGICAL SUPPLIES I/P (CO2352888 S IMP ROD TIT CERVIFIX $1,509.50 23 SURGICAL SUPPLIES I/P (CO2352870 S IMP ROD TIT CERVIFIX $200.00 23 SURGICAL SUPPLIES I/P (CO2352862 S IMP ROD TIT CERVIFIX 3 $190.00 23 SURGICAL SUPPLIES I/P (CO2367514 S IMP SCREW $956.25 23 SURGICAL SUPPLIES I/P (CO2367167 S IMP SCREW 1.6MM AUTO-D $231.25 23 SURGICAL SUPPLIES I/P (CO2363463 S IMP SCREW ACE $998.75 23 SURGICAL SUPPLIES I/P (CO2341444 S IMP SCREW ACE CORTICAL $686.50 $686.50 23 SURGICAL SUPPLIES I/P (CO2341261 S IMP SCREW AMBI BONE $78.50 $78.50 23 SURGICAL SUPPLIES I/P (CO2341279 S IMP SCREW AMBI COMP $125.75 $125.75 23 SURGICAL SUPPLIES I/P (CO2341287 S IMP SCREW AMBI LAG $845.25 $845.25 23 SURGICAL SUPPLIES I/P (CO2341295 S IMP SCREW AMBI LAG $903.25 $903.25 23 SURGICAL SUPPLIES I/P (CO2342038 S IMP SCREW ARTHREX $549.00 $518.00 23 SURGICAL SUPPLIES I/P (CO2363588 S IMP SCREW BONE 1.6MM $110.00 23 SURGICAL SUPPLIES I/P (CO2344133 S IMP SCREW BONE ZIMM $410.50 23 SURGICAL SUPPLIES I/P (CO2354470 S IMP SCREW BREAK OFF HEX $425.00 23 SURGICAL SUPPLIES I/P (CO2344125 S IMP SCREW CANC $415.75 23 SURGICAL SUPPLIES I/P (CO2364024 S IMP SCREW CANC FTH $161.50 23 SURGICAL SUPPLIES I/P (CO2352904 S IMP SCREW CANC TIT $334.50 23 SURGICAL SUPPLIES I/P (CO2352912 S IMP SCREW CANC TIT $373.25 23 SURGICAL SUPPLIES I/P (CO2367001 S IMP SCREW CANN 7.3 MM 1 $1,093.00 23 SURGICAL SUPPLIES I/P (CO2354447 S IMP SCREW CANN M/A LEGA $3,000.00 23 SURGICAL SUPPLIES I/P (CO2363992 S IMP SCREW CANN/CANC $650.25 23 SURGICAL SUPPLIES I/P (CO2363612 S IMP SCREW CLIP AMBI HIP $373.00 23 SURGICAL SUPPLIES I/P (CO2367266 S IMP SCREW CORTEX $141.00 23 SURGICAL SUPPLIES I/P (CO2324481 S IMP SCREW CORTEX $251.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2324150 S IMP SCREW CORTEX $262.00 23 SURGICAL SUPPLIES I/P (CO2324242 S IMP SCREW CORTEX 1.3MM $235.50 23 SURGICAL SUPPLIES I/P (CO2324333 S IMP SCREW CORTEX 1.5MM $224.50 23 SURGICAL SUPPLIES I/P (CO2341352 S IMP SCREW CORTICAL $425.00 $425.00 23 SURGICAL SUPPLIES I/P (CO2363828 S IMP SCREW DELTA BIO-IN $824.50 23 SURGICAL SUPPLIES I/P (CO2364008 S IMP SCREW DEPUY CANC L $161.50 23 SURGICAL SUPPLIES I/P (CO2353183 S IMP SCREW DISCVRY $2,315.25 23 SURGICAL SUPPLIES I/P (CO2324283 S IMP SCREW EMER 1.7MM $318.25 23 SURGICAL SUPPLIES I/P (CO2324572 S IMP SCREW EMER MAX.FAC $412.00 23 SURGICAL SUPPLIES I/P (CO2324192 S IMP SCREW EMER MAX.FAC $351.00 23 SURGICAL SUPPLIES I/P (CO2341576 S IMP SCREW FACE MAXI SAF $260.00 $241.00 23 SURGICAL SUPPLIES I/P (CO2341600 S IMP SCREW FACE MICRO $247.00 $241.00 23 SURGICAL SUPPLIES I/P (CO2341378 S IMP SCREW INTER ACL $454.00 $428.00 23 SURGICAL SUPPLIES I/P (CO2354454 S IMP SCREW M/A LEGACY $2,625.00 23 SURGICAL SUPPLIES I/P (CO2367415 S IMP SCREW NUT $687.25 23 SURGICAL SUPPLIES I/P (CO2341691 S IMP SCREW OSTEO CORT $807.50 $465.50 23 SURGICAL SUPPLIES I/P (CO2344109 S IMP SCREW PINNACLE CAN $313.25 23 SURGICAL SUPPLIES I/P (CO2341360 S IMP SCREW STEROTAXIC $652.00 $652.00 23 SURGICAL SUPPLIES I/P (CO2362986 S IMP SCREW SYN CANC $96.00 23 SURGICAL SUPPLIES I/P (CO2363026 S IMP SCREW SYN CANC $159.25 23 SURGICAL SUPPLIES I/P (CO2362994 S IMP SCREW SYN CANC $91.50 23 SURGICAL SUPPLIES I/P (CO2363034 S IMP SCREW SYN CANC $171.50 23 SURGICAL SUPPLIES I/P (CO2363059 S IMP SCREW SYN CANTED $837.00 23 SURGICAL SUPPLIES I/P (CO2363067 S IMP SCREW SYN CANTED $844.25 23 SURGICAL SUPPLIES I/P (CO2363075 S IMP SCREW SYN CANTED $1,093.00 23 SURGICAL SUPPLIES I/P (CO2363083 S IMP SCREW SYN COMP $194.00 23 SURGICAL SUPPLIES I/P (CO2362960 S IMP SCREW SYN CORTEX $105.25 23 SURGICAL SUPPLIES I/P (CO2363125 S IMP SCREW SYN CORTEX $196.00 23 SURGICAL SUPPLIES I/P (CO2363117 S IMP SCREW SYN CORTEX $228.75 23 SURGICAL SUPPLIES I/P (CO2363091 S IMP SCREW SYN CORTEX $303.25 23 SURGICAL SUPPLIES I/P (CO2363109 S IMP SCREW SYN CORTEX $318.00 23 SURGICAL SUPPLIES I/P (CO2362978 S IMP SCREW SYN CORTEX $106.25 23 SURGICAL SUPPLIES I/P (CO2363133 S IMP SCREW SYN CORTEX T $338.00 23 SURGICAL SUPPLIES I/P (CO2363141 S IMP SCREW SYN LAG $1,546.00 23 SURGICAL SUPPLIES I/P (CO2364222 S IMP SCREW SYN LOCKING 3 $522.75 23 SURGICAL SUPPLIES I/P (CO2363042 S IMP SCREW SYN MALLEOLAR $153.25 23 SURGICAL SUPPLIES I/P (CO2363000 S IMP SCREW SYN SHAFT 3.5 $102.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2363018 S IMP SCREW SYN SHAFT 4.5 $94.25 23 SURGICAL SUPPLIES I/P (CO2363901 S IMP SCREW TENODESIS $1,338.75 23 SURGICAL SUPPLIES I/P (CO2352896 S IMP SCREW TIT CERVIFIX $344.50 23 SURGICAL SUPPLIES I/P (CO2344117 S IMP SCREW TOTAL HIP $471.00 23 SURGICAL SUPPLIES I/P (CO2341410 S IMP SCREW, ACE CANCELL $726.75 $726.75 23 SURGICAL SUPPLIES I/P (CO2341428 S IMP SCREW, ACE CORTICAL $166.25 $142.50 23 SURGICAL SUPPLIES I/P (CO2341436 S IMP SCREW, ACE CORTICAL $726.75 $726.75 23 SURGICAL SUPPLIES I/P (CO2341535 S IMP SCREW, BONE HERBERT $1,266.50 $1,171.25 23 SURGICAL SUPPLIES I/P (CO2341568 S IMP SCREW, FACE MAXI $238.50 $221.75 23 SURGICAL SUPPLIES I/P (CO2341592 S IMP SCREW, FACE MICRO $224.00 $221.75 23 SURGICAL SUPPLIES I/P (CO2341618 S IMP SCREW, FACE MINI $231.25 $222.25 23 SURGICAL SUPPLIES I/P (CO2341683 S IMP SCREW, OSTEOTOMY C $487.75 $487.75 23 SURGICAL SUPPLIES I/P (CO2341402 S IMP SCREW,ACE CANCELL $554.00 $523.00 23 SURGICAL SUPPLIES I/P (CO2343879 S IMP SHLD TOTAL GLENOID $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343838 S IMP SHLD TOTAL GLENOID $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343846 S IMP SHLD TOTAL GLENOID $2,556.00 23 SURGICAL SUPPLIES I/P (CO2343861 S IMP SHLD TOTAL GLENOID $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343887 S IMP SHLD TOTAL GLENOID $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343895 S IMP SHLD TOTAL GLENOID $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343903 S IMP SHLD TOTAL GLENOID $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343911 S IMP SHLD TOTAL GLENOID $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343929 S IMP SHLD TOTAL GLENOID $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343937 S IMP SHLD TOTAL GLENOID $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343960 S IMP SHLD TOTAL GLENOID $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343853 S IMP SHLD TOTAL GLENOID $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343747 S IMP SHLD TOTAL HUM HEAD $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343754 S IMP SHLD TOTAL HUM HEAD $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343770 S IMP SHLD TOTAL HUM HEAD $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343796 S IMP SHLD TOTAL HUM HEAD $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343804 S IMP SHLD TOTAL HUM HEAD $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343812 S IMP SHLD TOTAL HUM HEAD $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343820 S IMP SHLD TOTAL HUM HEAD $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343655 S IMP SHLD TOTAL HUM STEM $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343663 S IMP SHLD TOTAL HUM STEM $2,556.00 23 SURGICAL SUPPLIES I/P (CO2344091 S IMP SHLD TOTAL HUM STEM $6,601.00 23 SURGICAL SUPPLIES I/P (CO2344075 S IMP SHLD TOTAL HUM STEM $6,039.00 23 SURGICAL SUPPLIES I/P (CO2343713 S IMP SHLD TOTAL HUM STEM $3,230.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2344083 S IMP SHLD TOTAL HUM STEM $6,320.00 23 SURGICAL SUPPLIES I/P (CO2344018 S IMP SHLD TTL HUMERAL ST $4,916.00 23 SURGICAL SUPPLIES I/P (CO2344026 S IMP SHLD TTL HUMERAL ST $5,197.00 23 SURGICAL SUPPLIES I/P (CO2344034 S IMP SHLD TTL HUMERAL ST $5,478.00 23 SURGICAL SUPPLIES I/P (CO2344042 S IMP SHLD TTL HUMERAL ST $5,758.00 23 SURGICAL SUPPLIES I/P (CO2344000 S IMP SHLD TTL HUMERAL ST $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343994 S IMP SHLD TTL HUMERAL ST $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343978 S IMP SHLD TTL HUMERAL ST $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343986 S IMP SHLD TTL HUMREAL ST $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343739 S IMP SHOULDER TTL HUM H $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343762 S IMP SHOULDER TTL HUM H $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343788 S IMP SHOULDER TTL HUM H $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343648 S IMP SHOULDER TTL HUM S $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343671 S IMP SHOULDER TTL HUM S $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343689 S IMP SHOULDER TTL HUM S $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343697 S IMP SHOULDER TTL HUM S $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343705 S IMP SHOULDER TTL HUM S $2,949.00 23 SURGICAL SUPPLIES I/P (CO2367795 S IMP SHUNT $9,350.00 23 SURGICAL SUPPLIES I/P (CO2322014 S IMP SHUNT CAROTID BYPAS $403.75 $403.75 23 SURGICAL SUPPLIES I/P (CO2322048 S IMP SHUNT CAROTID SUNDT $1,445.00 $1,445.00 23 SURGICAL SUPPLIES I/P (CO2325520 S IMP SHUNT DELTA UNITIZE $4,133.00 23 SURGICAL SUPPLIES I/P (CO2325298 S IMP SHUNT PROGRAMMABLE $8,563.00 23 SURGICAL SUPPLIES I/P (CO2343721 S IMP SHUOLDER TTL HUM S $3,511.00 23 SURGICAL SUPPLIES I/P (CO2367027 S IMP SLEEVE LOCKING $1,520.50 23 SURGICAL SUPPLIES I/P (CO2326262 S IMP SPACER LORDOTIC ACF $3,603.00 23 SURGICAL SUPPLIES I/P (CO2326890 S IMP SPACER PARALALEL A $2,638.00 23 SURGICAL SUPPLIES I/P (CO2326916 S IMP SPACER PLIF $6,590.00 23 SURGICAL SUPPLIES I/P (CO2326924 S IMP SPACER T-PLIF $10,650.00 23 SURGICAL SUPPLIES I/P (CO2354439 S IMP SPACER VERTEBRAL CA $10,810.25 23 SURGICAL SUPPLIES I/P (CO2354421 S IMP SPACER VERTEBRAL CA $7,406.75 23 SURGICAL SUPPLIES I/P (CO2351807 S IMP SPINE IMP 0-25 $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2351815 S IMP SPINE IMP 1001-1100 $3,244.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2351823 S IMP SPINE IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2351831 S IMP SPINE IMP 1101-1200 $3,553.00 $3,352.00 23 SURGICAL SUPPLIES I/P (CO2351849 S IMP SPINE IMP 1201-1300 $3,862.00 $3,644.00 23 SURGICAL SUPPLIES I/P (CO2351856 S IMP SPINE IMP 1301-1400 $4,177.00 $3,941.00 23 SURGICAL SUPPLIES I/P (CO2351864 S IMP SPINE IMP 1401-1500 $4,480.00 $4,227.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2351872 S IMP SPINE IMP 1501-1600 $4,789.00 $4,518.00 23 SURGICAL SUPPLIES I/P (CO2351880 S IMP SPINE IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2351898 S IMP SPINE IMP 1601-1700 $5,098.00 $4,810.00 23 SURGICAL SUPPLIES I/P (CO2351906 S IMP SPINE IMP 1701-1800 $5,346.00 $5,043.00 23 SURGICAL SUPPLIES I/P (CO2351914 S IMP SPINE IMP 1801-1900 $5,716.00 $5,393.00 23 SURGICAL SUPPLIES I/P (CO2351922 S IMP SPINE IMP 1901-2000 $6,025.00 $5,684.00 23 SURGICAL SUPPLIES I/P (CO2351930 S IMP SPINE IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2351948 S IMP SPINE IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2351955 S IMP SPINE IMP 26-50 $200.00 $189.00 23 SURGICAL SUPPLIES I/P (CO2351963 S IMP SPINE IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2351971 S IMP SPINE IMP 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2351989 S IMP SPINE IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2351997 S IMP SPINE IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2352003 S IMP SPINE IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2352011 S IMP SPINE IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2352029 S IMP SPINE IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2352037 S IMP SPINE IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2352045 S IMP SPINE IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2352052 S IMP SPINE IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2352060 S IMP SPINE IMP 751-800 $3,353.00 $3,163.00 23 SURGICAL SUPPLIES I/P (CO2352078 S IMP SPINE IMP 801-850 $3,569.00 $3,367.00 23 SURGICAL SUPPLIES I/P (CO2352086 S IMP SPINE IMP 851-900 $3,786.00 $3,571.00 23 SURGICAL SUPPLIES I/P (CO2352094 S IMP SPINE IMP 901-950 $4,002.00 $3,775.00 23 SURGICAL SUPPLIES I/P (CO2352102 S IMP SPINE IMP 951-1000 $4,218.00 $3,980.00 23 SURGICAL SUPPLIES I/P (CO2354694 S IMP SPINE ROD $1,041.00 23 SURGICAL SUPPLIES I/P (CO2354488 S IMP SPN LUMB L1 $11,025.00 23 SURGICAL SUPPLIES I/P (CO2354496 S IMP SPN LUMB L2 $15,925.00 23 SURGICAL SUPPLIES I/P (CO2354512 S IMP SPNE CERV L1 $5,250.00 23 SURGICAL SUPPLIES I/P (CO2354504 S IMP SPNE CERV L1 $4,000.00 23 SURGICAL SUPPLIES I/P (CO2325678 S IMP STENT GRAFT ANEURX $2,725.00 23 SURGICAL SUPPLIES I/P (CO2325660 S IMP STENT GRAFT ANEURX $2,500.00 23 SURGICAL SUPPLIES I/P (CO2325652 S IMP STENT GRAFT ANEURX $8,483.00 23 SURGICAL SUPPLIES I/P (CO2325645 S IMP STENT GRAFT ANEURX $8,146.00 23 SURGICAL SUPPLIES I/P (CO2303162 S IMP STENT URET CONTOUR $888.25 $888.25 23 SURGICAL SUPPLIES I/P (CO2303139 S IMP STENT URETERAL 4.8 $484.50 $538.50 23 SURGICAL SUPPLIES I/P (CO2303154 S IMP STENT URETERAL SNGL $1,483.25 $815.25 23 SURGICAL SUPPLIES I/P (CO2331056 S IMP STERILE SLEVE PCMKR $89.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2364271 S IMP SYN TROCHANTERIC NA $3,330.00 23 SURGICAL SUPPLIES I/P (CO2353712 S IMP SYNMESH END RING $2,009.00 23 SURGICAL SUPPLIES I/P (CO2353704 S IMP SYNMESH END RING $803.75 23 SURGICAL SUPPLIES I/P (CO2353738 S IMP SYNMESH LOCK SCREW $113.00 23 SURGICAL SUPPLIES I/P (CO2353720 S IMP SYNMESH STD RING $1,089.25 23 SURGICAL SUPPLIES I/P (CO2364263 S IMP TI LOCKING 5.0MM $760.25 23 SURGICAL SUPPLIES I/P (CO2363620 S IMP TIBIAL ACL PIN SET $616.25 23 SURGICAL SUPPLIES I/P (CO2364214 S IMP T-PLATE SYN LCP OBL $1,710.50 23 SURGICAL SUPPLIES I/P (CO2364206 S IMP T-PLATE SYNTHES LCP $1,827.00 23 SURGICAL SUPPLIES I/P (CO2363315 S IMP T-PLT SYN 4-8-H $1,329.00 23 SURGICAL SUPPLIES I/P (CO2363596 S IMP T-PLT SYN OBLIQUE $955.25 23 SURGICAL SUPPLIES I/P (CO2363323 S IMP T-PLT SYN SM $566.50 23 SURGICAL SUPPLIES I/P (CO2363331 S IMP T-PLT SYN TI $1,044.00 23 SURGICAL SUPPLIES I/P (CO2352532 S IMP TRANS-CONN CLAMP $1,016.00 $946.50 23 SURGICAL SUPPLIES I/P (CO2352375 S IMP TRANS-CONN CLAMP $636.50 $636.50 23 SURGICAL SUPPLIES I/P (CO2363869 S IMP TRIGEN KNEE NAIL $3,468.00 23 SURGICAL SUPPLIES I/P (CO2363877 S IMP TRIGEN KNEE NAIL $3,432.00 23 SURGICAL SUPPLIES I/P (CO2363844 S IMP TRIGEN NAIL CAP $588.75 23 SURGICAL SUPPLIES I/P (CO2363885 S IMP TRIGEN SCREW CAPT $1,267.00 23 SURGICAL SUPPLIES I/P (CO2363893 S IMP TRIGEN SCREW CAPTU $752.25 23 SURGICAL SUPPLIES I/P (CO2363851 S IMP TRIGEN TROCH NAIL $5,244.00 23 SURGICAL SUPPLIES I/P (CO2353381 S IMP TSRH STAPLE 2-HOLE $950.00 23 SURGICAL SUPPLIES I/P (CO2361921 S IMP TSRH TI CROSSLINK $3,229.75 $3,229.75 23 SURGICAL SUPPLIES I/P (CO2361947 S IMP TSRH TI, CROSSLINK $2,861.00 $2,861.00 23 SURGICAL SUPPLIES I/P (CO2362077 S IMP TSRH TIT, CROSSLIN $2,801.75 $2,801.75 23 SURGICAL SUPPLIES I/P (CO2353407 S IMP TSRH-3D CONNECTOR $1,700.00 23 SURGICAL SUPPLIES I/P (CO2353746 S IMP TSRH-3D ROD $850.00 23 SURGICAL SUPPLIES I/P (CO2353415 S IMP TSRH-3D ROD 250MM $1,711.25 23 SURGICAL SUPPLIES I/P (CO2353431 S IMP TSRH-3D SCREW $1,985.00 23 SURGICAL SUPPLIES I/P (CO2353399 S IMP TSRH-3D SET SCREW $425.00 23 SURGICAL SUPPLIES I/P (CO2326908 S IMP TUTOPLAST PERICARDI $1,170.00 23 SURGICAL SUPPLIES I/P (CO2352128 S IMP UNIV BAR CLOSED $2,106.75 $2,106.75 23 SURGICAL SUPPLIES I/P (CO2352136 S IMP UNIV BAR OPEN TRANS $2,107.00 $2,107.00 23 SURGICAL SUPPLIES I/P (CO2352995 S IMP UNIV CLAMP BAR $451.50 23 SURGICAL SUPPLIES I/P (CO2352144 S IMP UNIV CLAMP F/OPEN $2,107.00 $2,107.00 23 SURGICAL SUPPLIES I/P (CO2352169 S IMP UNIV CLAMP W/NUT $3,474.00 $3,474.00 23 SURGICAL SUPPLIES I/P (CO2352409 S IMP UNIV CONN CLAMP $1,236.25 $1,236.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2352185 S IMP UNIV CONN PARALLEL $2,044.00 $2,076.50 23 SURGICAL SUPPLIES I/P (CO2352227 S IMP UNIV HOOK $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352235 S IMP UNIV HOOK PEDICLE $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352243 S IMP UNIV HOOK PEDICLE $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352391 S IMP UNIV HOOK TRANS $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352250 S IMP UNIV HOOK TRANS $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352276 S IMP UNIV ROD HARD 100- $850.00 $1,067.25 23 SURGICAL SUPPLIES I/P (CO2352284 S IMP UNIV ROD HARD 50MM $542.75 $542.75 23 SURGICAL SUPPLIES I/P (CO2352987 S IMP UNIV ROD HARD 75MM $816.00 23 SURGICAL SUPPLIES I/P (CO2352318 S IMP UNIV ROD SOFT 100- $1,067.25 $1,067.25 23 SURGICAL SUPPLIES I/P (CO2352326 S IMP UNIV ROD SOFT 50MM $542.75 $542.75 23 SURGICAL SUPPLIES I/P (CO2352334 S IMP UNIV ROD SOFT 75MM $816.00 $816.00 23 SURGICAL SUPPLIES I/P (CO2352979 S IMP UNIV SCREW SCHANZ $1,113.75 23 SURGICAL SUPPLIES I/P (CO2352938 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352946 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352953 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352961 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352367 S IMP UNIV SCREW SIDE $2,116.75 $1,669.00 23 SURGICAL SUPPLIES I/P (CO2352193 S IMP UNIV SPINE 1/2 RING $832.25 $832.25 23 SURGICAL SUPPLIES I/P (CO2353001 S IMP UNIV SPINE COLLAR $644.75 23 SURGICAL SUPPLIES I/P (CO2352268 S IMP UNIV SPINE NUT 11MM $212.50 $261.00 23 SURGICAL SUPPLIES I/P (CO2352557 S IMP UNIV SPINE STPL $1,848.25 $1,848.25 23 SURGICAL SUPPLIES I/P (CO2352540 S IMP UNIV SPINE WASHER $163.00 $163.00 23 SURGICAL SUPPLIES I/P (CO2326569 S IMP URIN SPHINCT PROS A $8,413.00 23 SURGICAL SUPPLIES I/P (CO2354520 S IMP VERT ALIF BN $6,463.00 23 SURGICAL SUPPLIES I/P (CO2354546 S IMP VERT ALIF CRBN FBR $7,850.00 23 SURGICAL SUPPLIES I/P (CO2354553 S IMP VERT ALIF MTL $8,438.00 23 SURGICAL SUPPLIES I/P (CO2354538 S IMP VERT ALIF PK $7,088.00 23 SURGICAL SUPPLIES I/P (CO2354645 S IMP VERT CERV BN $2,625.00 23 SURGICAL SUPPLIES I/P (CO2354660 S IMP VERT CERV CRBN FBR $3,063.00 23 SURGICAL SUPPLIES I/P (CO2354678 S IMP VERT CERV MTL $1,873.00 23 SURGICAL SUPPLIES I/P (CO2354652 S IMP VERT CERV PK $3,413.00 23 SURGICAL SUPPLIES I/P (CO2354561 S IMP VERT PLIF BN $5,125.00 23 SURGICAL SUPPLIES I/P (CO2354587 S IMP VERT PLIF CRBN FBR $5,188.00 23 SURGICAL SUPPLIES I/P (CO2354595 S IMP VERT PLIF MTL $5,263.00 23 SURGICAL SUPPLIES I/P (CO2354579 S IMP VERT PLIF PK $5,480.00 23 SURGICAL SUPPLIES I/P (CO2354603 S IMP VERT TLIF BN $7,200.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2354629 S IMP VERT TLIF CRBN FBR $6,600.00 23 SURGICAL SUPPLIES I/P (CO2354637 S IMP VERT TLIF MTL $6,725.00 23 SURGICAL SUPPLIES I/P (CO2354611 S IMP VERT TLIF PK $6,138.00 23 SURGICAL SUPPLIES I/P (CO2325363 S IMP VERTGRAFT FIB SHAFT $3,335.00 23 SURGICAL SUPPLIES I/P (CO2325538 S IMP VLV BURR HOLE DELTA $2,608.00 23 SURGICAL SUPPLIES I/P (CO2367670 S IMP WASHER $293.25 23 SURGICAL SUPPLIES I/P (CO2367688 S IMP WASHER $142.50 23 SURGICAL SUPPLIES I/P (CO2367019 S IMP WASHER 13.0 MM $130.75 23 SURGICAL SUPPLIES I/P (CO2362317 S IMP WASHER ACE $121.25 $121.25 23 SURGICAL SUPPLIES I/P (CO2353191 S IMP WASHER COMPASS $595.00 23 SURGICAL SUPPLIES I/P (CO2362671 S IMP WASHER ROCKWOOD $235.00 23 SURGICAL SUPPLIES I/P (CO2362275 S IMP WASHER SOFT TISS $425.00 $425.00 23 SURGICAL SUPPLIES I/P (CO2362309 S IMP WASHER SPIKED $508.00 $491.75 23 SURGICAL SUPPLIES I/P (CO2363372 S IMP WASHER SYN $128.50 23 SURGICAL SUPPLIES I/P (CO2363380 S IMP WASHER SYN $577.50 23 SURGICAL SUPPLIES I/P (CO2362655 S IMP WASHER THICK 9/16 $248.00 23 SURGICAL SUPPLIES I/P (CO2362325 S IMP WASHER, ACE CUP $175.75 $175.75 23 SURGICAL SUPPLIES I/P (CO2362333 S IMP WASHER, ACE FLAT 4 $108.00 $108.00 23 SURGICAL SUPPLIES I/P (CO2363646 S IMP WIRE MOUNT PLT $672.50 23 SURGICAL SUPPLIES I/P (CO2363356 S IMP Y-PLT SYN TI $994.25 23 SURGICAL SUPPLIES I/P (CO2344190 S INV DVC HIP TTL FEM POR $3,890.00 23 SURGICAL SUPPLIES I/P (CO2369981 S INV DVC ORTHPDIC DEVICE $0.01 23 SURGICAL SUPPLIES I/P (CO2369999 S INV DVC ORTHPDIC DEVICE 23 SURGICAL SUPPLIES I/P (CO2331114 S LD ICD ENDOCRD 1 COIL $11,875.00 23 SURGICAL SUPPLIES I/P (CO2331122 S LD ICD ENDOCRD 1 COIL $7,875.00 23 SURGICAL SUPPLIES I/P (CO2331189 S LD PCR NO TV SNGL PAS $3,625.00 23 SURGICAL SUPPLIES I/P (CO2331171 S LD PCR NO TV SNGL PAS $3,375.00 23 SURGICAL SUPPLIES I/P (CO2331163 S LD PCR NO TV SNGL PAS $3,125.00 23 SURGICAL SUPPLIES I/P (CO2331155 S LD PCR NO TV SNGL PAS $2,875.00 23 SURGICAL SUPPLIES I/P (CO2331148 S LD PCR NO TV SNGL PAS $2,625.00 23 SURGICAL SUPPLIES I/P (CO2330850 S LD PCR PACEMAKER LEAD $1,559.00 23 SURGICAL SUPPLIES I/P (CO2330769 S LD PCR TV VDD SNGL PASS $801.00 23 SURGICAL SUPPLIES I/P (CO2330876 S LD PCR TV VDD SNGL PASS $1,726.00 23 SURGICAL SUPPLIES I/P (CO2330884 S LD PCR TV VDD SNGL PASS $2,233.00 23 SURGICAL SUPPLIES I/P (CO2330868 S LD PCR TV VDD SNGL PASS $1,643.00 23 SURGICAL SUPPLIES I/P (CO2330785 S LD PCR TV VDD SNGL PASS $969.00 23 SURGICAL SUPPLIES I/P (CO2330793 S LD PCR TV VDD SNGL PASS $1,053.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2330801 S LD PCR TV VDD SNGL PASS $1,138.00 23 SURGICAL SUPPLIES I/P (CO2330819 S LD PCR TV VDD SNGL PASS $1,222.00 23 SURGICAL SUPPLIES I/P (CO2330827 S LD PCR TV VDD SNGL PASS $1,306.00 23 SURGICAL SUPPLIES I/P (CO2330835 S LD PCR TV VDD SNGL PASS $1,390.00 23 SURGICAL SUPPLIES I/P (CO2330843 S LD PCR TV VDD SNGL PASS $1,475.00 23 SURGICAL SUPPLIES I/P (CO2360360 S NSTRL CAST SPLNT SYS $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2360378 S NSTRL CAST SPLNT SYS $75.25 $75.25 23 SURGICAL SUPPLIES I/P (CO2360394 S NSTRL CAST TAPE $16.25 $16.25 23 SURGICAL SUPPLIES I/P (CO2360386 S NSTRL CAST TAPE $21.75 $21.75 23 SURGICAL SUPPLIES I/P (CO2360410 S NSTRL FELT ORTHO ZIMMER 23 SURGICAL SUPPLIES I/P (CO2361012 S NSTRL PLSTR BNDG 2"X3" $4.75 $4.75 23 SURGICAL SUPPLIES I/P (CO2361020 S NSTRL PLSTR BNDG 4"X6" $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2361038 S NSTRL PLSTR ROLLS 4" $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2361053 S NSTRL PLSTR SPLNTS $4.25 $4.25 23 SURGICAL SUPPLIES I/P (CO2361061 S NSTRL PLSTR SPLNTS $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2318418 S ORTHO IMBLR SLING $24.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2318384 S OT KO IMMOB CNVS LONG $59.00 $59.00 23 SURGICAL SUPPLIES I/P (CO2318392 S OT KO IMMOB CNVS LONG $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2318400 S OT SO FIG 8 ABDC CNVS $43.00 $43.00 23 SURGICAL SUPPLIES I/P (CO2330926 S PCR 2 CHMBR RATE RESP $8,006.00 23 SURGICAL SUPPLIES I/P (CO2330942 S PCR 2 CHMBR RATE RESP $9,691.00 23 SURGICAL SUPPLIES I/P (CO2330959 S PCR 2 CHMBR RATE RESP $10,534.00 23 SURGICAL SUPPLIES I/P (CO2330967 S PCR 2 CHMBR RATE RESP $16,433.00 23 SURGICAL SUPPLIES I/P (CO2331080 S PCR 2 CHMBR RATE RESP $9,430.00 23 SURGICAL SUPPLIES I/P (CO2331205 S PCR 2 CHMBR RR $8,392.50 23 SURGICAL SUPPLIES I/P (CO2330900 S PCR PACER 2 CHMBR RATE $6,320.00 23 SURGICAL SUPPLIES I/P (CO2368074 S SCRW $216.75 23 SURGICAL SUPPLIES I/P (CO2368090 S SCRW $240.25 23 SURGICAL SUPPLIES I/P (CO2367589 S SCRW $637.50 23 SURGICAL SUPPLIES I/P (CO2367662 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2367365 S SCRW $224.75 23 SURGICAL SUPPLIES I/P (CO2367316 S SCRW $127.75 23 SURGICAL SUPPLIES I/P (CO2367647 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2367381 S SCRW $232.75 23 SURGICAL SUPPLIES I/P (CO2367639 S SCRW $467.50 23 SURGICAL SUPPLIES I/P (CO2367621 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2367597 S SCRW $935.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2367605 S SCRW $1,275.00 23 SURGICAL SUPPLIES I/P (CO2367654 S SCRW $637.50 23 SURGICAL SUPPLIES I/P (CO2367431 S SCRW $840.75 23 SURGICAL SUPPLIES I/P (CO2368108 S SCRW $276.25 23 SURGICAL SUPPLIES I/P (CO2367423 S SCRW $603.00 23 SURGICAL SUPPLIES I/P (CO2368082 S SCRW $218.00 23 SURGICAL SUPPLIES I/P (CO2367449 S SCRW $738.25 23 SURGICAL SUPPLIES I/P (CO2367456 S SCRW $1,242.75 23 SURGICAL SUPPLIES I/P (CO2367464 S SCRW $1,107.50 23 SURGICAL SUPPLIES I/P (CO2367373 S SCRW $153.25 23 SURGICAL SUPPLIES I/P (CO2367613 S SCRW $446.25 23 SURGICAL SUPPLIES I/P (CO2354702 S SCRW CERV $850.00 23 SURGICAL SUPPLIES I/P (CO2354686 S SCRW PEDICLE $3,430.00 23 SURGICAL SUPPLIES I/P (CO2360006 S STRL AGEE WRIST JACK $3,387.50 $3,387.50 23 SURGICAL SUPPLIES I/P (CO2310191 S STRL ARCH BARS ERICH 5" $57.00 $54.00 23 SURGICAL SUPPLIES I/P (CO2310233 S STRL BAG BECKER DRAIN $170.00 $170.00 23 SURGICAL SUPPLIES I/P (CO2310258 S STRL BAG DRAIN BILE $33.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2352466 S STRL BIPOLAR CUT FORCEP $1,785.00 $1,695.75 23 SURGICAL SUPPLIES I/P (CO2310845 S STRL BLADE, BEAVER #591 $95.00 $90.00 23 SURGICAL SUPPLIES I/P (CO2311603 S STRL BLANKET WARM CVR $97.00 $92.00 23 SURGICAL SUPPLIES I/P (CO2310837 S STRL BLE BEAVER $65.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2310860 S STRL BLE BEAVER 6910 $48.00 $46.00 23 SURGICAL SUPPLIES I/P (CO2310878 S STRL BLE BEAVER DEBAKEY $18.00 $17.00 23 SURGICAL SUPPLIES I/P (CO2310886 S STRL BLE BEAVER EAR $31.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2310894 S STRL BLE BEAVER EAR 72 $78.00 $73.00 23 SURGICAL SUPPLIES I/P (CO2310928 S STRL BLE BEAVER LAMELLA $77.00 $72.00 23 SURGICAL SUPPLIES I/P (CO2310936 S STRL BLE BEAVER MINI RN $11.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2310944 S STRL BLE BEAVER MINI SH $39.00 $37.00 23 SURGICAL SUPPLIES I/P (CO2310795 S STRL BLE CARPAL TUNNEL $850.00 $850.00 23 SURGICAL SUPPLIES I/P (CO2310985 S STRL BLE CASPER DOWEL $797.00 $752.00 23 SURGICAL SUPPLIES I/P (CO2311025 S STRL BLE CRANIOTOME $231.75 $231.75 23 SURGICAL SUPPLIES I/P (CO2311033 S STRL BLE DERMA BROWN $204.25 $189.50 23 SURGICAL SUPPLIES I/P (CO2311058 S STRL BLE DYONICS $284.00 $268.00 23 SURGICAL SUPPLIES I/P (CO2311108 S STRL BLE GATOR SHAVER $284.00 $268.00 23 SURGICAL SUPPLIES I/P (CO2311124 S STRL BLE KARLIN SPINAL $200.00 $200.00 23 SURGICAL SUPPLIES I/P (CO2311132 S STRL BLE MINI DRIVER $45.00 $42.00 23 SURGICAL SUPPLIES I/P (CO2311140 S STRL BLE MINI DYONICS $263.00 $263.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2311157 S STRL BLE MINI STRYKER $155.50 $268.75 23 SURGICAL SUPPLIES I/P (CO2311165 S STRL BLE MVR VITRECTOMY $117.00 $111.00 23 SURGICAL SUPPLIES I/P (CO2311173 S STRL BLE OSTEOTOME $586.50 $586.50 23 SURGICAL SUPPLIES I/P (CO2311082 S STRL BLE OSTEOTOME $420.75 $420.75 23 SURGICAL SUPPLIES I/P (CO2311215 S STRL BLE SAW $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2311181 S STRL BLE SAW GIGLI 20" $111.25 $111.25 23 SURGICAL SUPPLIES I/P (CO2311207 S STRL BLE SAW MICRO $29.00 $28.00 23 SURGICAL SUPPLIES I/P (CO2311272 S STRL BLE SAW PATELLAR $377.00 $356.00 23 SURGICAL SUPPLIES I/P (CO2311280 S STRL BLE SAW RECIPRO $273.50 $273.50 23 SURGICAL SUPPLIES I/P (CO2311298 S STRL BLE SAW SAGITTAL $209.00 $223.25 23 SURGICAL SUPPLIES I/P (CO2311314 S STRL BLE SPIRAL FLUTED $257.00 $242.00 23 SURGICAL SUPPLIES I/P (CO2311322 S STRL BLE STERNAL SAW $35.25 $35.25 23 SURGICAL SUPPLIES I/P (CO2311330 S STRL BLE SUPER $37.50 $37.50 23 SURGICAL SUPPLIES I/P (CO2311355 S STRL BLE SURGICAL $2.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2370195 S STRL BLE SYNVASIVE RIB $209.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2311389 S STRL BLE TORQUE WRENCH $210.00 $198.00 23 SURGICAL SUPPLIES I/P (CO2311413 S STRL BLE URETHROTOME $814.50 $814.50 23 SURGICAL SUPPLIES I/P (CO2310472 S STRL BNDG ESMARCH $18.75 $18.75 23 SURGICAL SUPPLIES I/P (CO2311645 S STRL BONE WAX $23.00 $23.00 23 SURGICAL SUPPLIES I/P (CO2311660 S STRL BOOT SUT YELLOW $15.00 $14.50 23 SURGICAL SUPPLIES I/P (CO2310555 S STRL BSKT SEGURA STONE $814.00 $812.25 23 SURGICAL SUPPLIES I/P (CO2311744 S STRL BURR AESCULAP $162.25 $162.25 23 SURGICAL SUPPLIES I/P (CO2311777 S STRL BURR MIDAS REX $397.00 $444.25 23 SURGICAL SUPPLIES I/P (CO2311785 S STRL BURR OSTEON $399.50 $399.50 23 SURGICAL SUPPLIES I/P (CO2311827 S STRL BURR SURGAIR X-LNG $68.50 $107.25 23 SURGICAL SUPPLIES I/P (CO2311850 S STRL BUTTON PRYPRO 14MM $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2311892 S STRL BYRD DLTR $894.75 $894.75 23 SURGICAL SUPPLIES I/P (CO2311900 S STRL BYRD DLTR SHTH SET $561.00 $561.00 23 SURGICAL SUPPLIES I/P (CO2311918 S STRL CABLE SONGER $1,972.25 $1,972.25 23 SURGICAL SUPPLIES I/P (CO2311926 S STRL CABLE SONGER $1,874.25 $1,874.25 23 SURGICAL SUPPLIES I/P (CO2312031 S STRL CAN CANNULOC $84.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2363455 S STRL CAN SHLD CONCEPT $89.00 23 SURGICAL SUPPLIES I/P (CO2312148 S STRL CAN SHLDR UNIV $118.75 $118.75 23 SURGICAL SUPPLIES I/P (CO2370328 S STRL CAN WATER CAUTERY $176.00 $166.00 23 SURGICAL SUPPLIES I/P (CO2313039 S STRL CATH CARC PUDENZ $715.50 $715.50 23 SURGICAL SUPPLIES I/P (CO2312395 S STRL CATH COUDE $55.75 $63.00 23 SURGICAL SUPPLIES I/P (CO2312403 S STRL CATH COUNCIL TIP 5 $62.00 $63.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2313088 S STRL CATH ERCP $231.75 $231.75 23 SURGICAL SUPPLIES I/P (CO2313187 S STRL CATH FOLEY 3 WAY $49.00 $50.00 23 SURGICAL SUPPLIES I/P (CO2312478 S STRL CATH FOLEY 30CC $23.25 $25.00 23 SURGICAL SUPPLIES I/P (CO2312494 S STRL CATH FOLEY 5CC $23.00 $22.00 23 SURGICAL SUPPLIES I/P (CO2313153 S STRL CATH FOLEY PEDI $36.00 $39.00 23 SURGICAL SUPPLIES I/P (CO2313161 S STRL CATH FOLEY SIL 12 $32.50 $32.50 23 SURGICAL SUPPLIES I/P (CO2313724 S STRL CATH HD SHORT TERM $433.50 $433.50 23 SURGICAL SUPPLIES I/P (CO2312544 S STRL CATH HICKMAN HMDLY $994.50 $994.50 23 SURGICAL SUPPLIES I/P (CO2391415 S STRL CATH INTRO SUPRA $91.50 $89.75 23 SURGICAL SUPPLIES I/P (CO2312676 S STRL CATH LUMBOPERIT $2,327.50 $2,327.50 23 SURGICAL SUPPLIES I/P (CO2312726 S STRL CATH PERIT RFLX $1,083.75 $1,083.75 23 SURGICAL SUPPLIES I/P (CO2312791 S STRL CATH ROBINSON RED $3.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2313716 S STRL CATH SUC SUMP 10FR $55.25 $53.25 23 SURGICAL SUPPLIES I/P (CO2312833 S STRL CATH TAUT OPERATIV $148.50 $148.50 23 SURGICAL SUPPLIES I/P (CO2312825 S STRL CATH T-TUBE $47.00 $44.00 23 SURGICAL SUPPLIES I/P (CO2312908 S STRL CATH TY URINE METE $63.00 $57.75 23 SURGICAL SUPPLIES I/P (CO2312932 S STRL CATH VNTRCLR HOLTE $516.50 $447.50 23 SURGICAL SUPPLIES I/P (CO2313518 S STRL CATH VNTRCLR PUDEN $612.00 $573.75 23 SURGICAL SUPPLIES I/P (CO2308500 S STRL CAUTERIZING PENCIL $18.75 $18.75 23 SURGICAL SUPPLIES I/P (CO2313898 S STRL CAUTERY $76.75 $60.50 23 SURGICAL SUPPLIES I/P (CO2313856 S STRL CAUTERY ELEC BLE $20.00 $20.00 23 SURGICAL SUPPLIES I/P (CO2313864 S STRL CAUTERY ELEC NDL $20.50 $20.50 23 SURGICAL SUPPLIES I/P (CO2313849 S STRL CAUTERY ELEC TIP $12.00 $11.00 23 SURGICAL SUPPLIES I/P (CO2313914 S STRL CAUTERY TIP TEFLON $36.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2313955 S STRL CEMENT BONE $435.50 $435.50 23 SURGICAL SUPPLIES I/P (CO2313963 S STRL CEMENT BONE $378.50 $367.50 23 SURGICAL SUPPLIES I/P (CO2313971 S STRL CEMENT BONE $287.50 $279.00 23 SURGICAL SUPPLIES I/P (CO2364040 S STRL CEMENT BONE $367.25 23 SURGICAL SUPPLIES I/P (CO2325793 S STRL CEMENT BONE 5CC $3,465.00 23 SURGICAL SUPPLIES I/P (CO2313948 S STRL CEMENT BONE 60/30 $474.00 $474.00 23 SURGICAL SUPPLIES I/P (CO2325801 S STRL CEMENT BONE CRS $6,097.50 23 SURGICAL SUPPLIES I/P (CO2313997 S STRL CEMENT BOWL $215.75 $215.75 23 SURGICAL SUPPLIES I/P (CO2314003 S STRL CEMENT BWL/CRTRDG $444.25 $430.75 23 SURGICAL SUPPLIES I/P (CO2314045 S STRL CEMENT GUN $78.00 $78.00 23 SURGICAL SUPPLIES I/P (CO2314052 S STRL CEMENT GUN $87.50 $87.50 23 SURGICAL SUPPLIES I/P (CO2314029 S STRL CEMENT GUN $101.25 $101.25 23 SURGICAL SUPPLIES I/P (CO2314037 S STRL CEMENT GUN NOZZLE $92.25 $92.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2314094 S STRL CHR GUT, 7-0, 18" $96.50 $96.50 23 SURGICAL SUPPLIES I/P (CO2314102 S STRL CHR GUT,0,27",SH $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2304368 S STRL CHR GUT,1,60"TP-1 $21.50 $21.50 23 SURGICAL SUPPLIES I/P (CO2314110 S STRL CHR GUT,2-0,27",SH $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2314136 S STRL CHR GUT,3-0,18" $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2314144 S STRL CHR GUT,3-0,27"T-5 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2314151 S STRL CHR GUT,4-0,18" $26.75 $26.75 23 SURGICAL SUPPLIES I/P (CO2391050 S STRL CHR GUT,4-0,18" $26.75 $26.75 23 SURGICAL SUPPLIES I/P (CO2314169 S STRL CHR GUT,4-0,54"TIE $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2370443 S STRL CHR GUT,5-0,18" $63.75 $63.75 23 SURGICAL SUPPLIES I/P (CO2314193 S STRL CLAMP JAW SPRING $32.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2314201 S STRL CLAMP SOFT JAW $74.25 $74.25 23 SURGICAL SUPPLIES I/P (CO2314268 S STRL CLIP $40.00 $38.25 23 SURGICAL SUPPLIES I/P (CO2320430 S STRL CLIP ANEURYSM $1,248.00 $1,248.00 23 SURGICAL SUPPLIES I/P (CO2320422 S STRL CLIP ANEURYSM $1,343.00 $1,267.00 23 SURGICAL SUPPLIES I/P (CO2320521 S STRL CLIP LIGA LG $29.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2320547 S STRL CLIP LIGA MED $17.50 $17.50 23 SURGICAL SUPPLIES I/P (CO2320554 S STRL CLIP LIGA MED/LG $27.00 $27.00 23 SURGICAL SUPPLIES I/P (CO2320562 S STRL CLIP LIGA SM $17.50 $17.50 23 SURGICAL SUPPLIES I/P (CO2314318 S STRL CLO TEST $37.00 $35.00 23 SURGICAL SUPPLIES I/P (CO2314326 S STRL COLLAR, PHILLY $72.50 $72.50 23 SURGICAL SUPPLIES I/P (CO2314623 S STRL CORD BIPOLAR DISP $19.50 $20.00 23 SURGICAL SUPPLIES I/P (CO2326932 S STRL CRS BONE CEMENT $2,120.75 23 SURGICAL SUPPLIES I/P (CO2314813 S STRL CRTRDG GIA 60 TIT $237.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2312312 S STRL CTG ENDO GIA $403.50 $403.50 23 SURGICAL SUPPLIES I/P (CO2312320 S STRL CTG ENDOHERNIA $330.25 $330.25 23 SURGICAL SUPPLIES I/P (CO2312338 S STRL CTG GIA 80 MULTI $351.75 $351.75 23 SURGICAL SUPPLIES I/P (CO2314896 S STRL CURETTE VAC $12.75 $22.00 23 SURGICAL SUPPLIES I/P (CO2391639 S STRL CUSA PAK MICRO TIP $1,557.00 $1,469.00 23 SURGICAL SUPPLIES I/P (CO2314912 S STRL DACRON FELT, 6 X 6 $190.00 $190.00 23 SURGICAL SUPPLIES I/P (CO2325835 S STRL DBX PUTTY 10CC $3,491.00 23 SURGICAL SUPPLIES I/P (CO2325827 S STRL DBX PUTTY 5CC $3,175.00 23 SURGICAL SUPPLIES I/P (CO2315034 S STRL DELTA SHUNT SYS $3,574.00 $3,574.00 23 SURGICAL SUPPLIES I/P (CO2391118 S STRL DERM, 4-0, 18" $20.75 $20.75 23 SURGICAL SUPPLIES I/P (CO2391126 S STRL DERM, 6-0, 18" $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2390144 S STRL DERMACARRIER $148.25 $138.00 23 SURGICAL SUPPLIES I/P (CO2391100 S STRL DERMALON, 5-0, 18" $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2315141 S STRL DEV ANTI FLING $29.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2315174 S STRL DEX II 4-0,18",T-5 $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2391324 S STRL DEX II, 4-0,27" $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2363810 S STRL DISTRACT PIN $118.75 23 SURGICAL SUPPLIES I/P (CO2313609 S STRL DOVER FOLEY 6F, 8F $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2315471 S STRL DRAIN BLAKE RND $85.25 $85.25 23 SURGICAL SUPPLIES I/P (CO2315570 S STRL DRAIN J-P Y CONN $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2315596 S STRL DRAIN PENROSE $3.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2310506 S STRL DRAIN TUBE SHEPARD $39.75 $39.75 23 SURGICAL SUPPLIES I/P (CO2315687 S STRL DRAIN, CHEST THORA $158.00 $158.00 23 SURGICAL SUPPLIES I/P (CO2316164 S STRL DRESS ADAPTIC 3X8 $2.75 $2.75 23 SURGICAL SUPPLIES I/P (CO2317063 S STRL DRESS GUAZE VSLN $2.25 $4.00 23 SURGICAL SUPPLIES I/P (CO2316248 S STRL DRESS OWENS 8 X 12 $59.50 $63.00 23 SURGICAL SUPPLIES I/P (CO2316289 S STRL DRESS XEROFORM $2.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2316297 S STRL DRESS XEROFORM $3.50 $2.75 23 SURGICAL SUPPLIES I/P (CO2317071 S STRL DRESS, VASELINE $4.25 $6.00 23 SURGICAL SUPPLIES I/P (CO2316263 S STRL DRESSING TEGADERM $10.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2316339 S STRL DRILL 5"LX3/8" DIA $90.00 $85.00 23 SURGICAL SUPPLIES I/P (CO2316347 S STRL DRILL 8"LX1/4" DIA $258.00 $243.00 23 SURGICAL SUPPLIES I/P (CO2316404 S STRL DRILL BIT $764.00 $721.00 23 SURGICAL SUPPLIES I/P (CO2316412 S STRL DRILL BIT $803.25 $803.25 23 SURGICAL SUPPLIES I/P (CO2316354 S STRL DRILL BIT $358.50 $334.75 23 SURGICAL SUPPLIES I/P (CO2324069 S STRL DRILL BIT CRANI $620.25 23 SURGICAL SUPPLIES I/P (CO2325090 S STRL DRILL BIT TPS 23 SURGICAL SUPPLIES I/P (CO2316396 S STRL DRILL BIT, ACE $314.50 $314.50 23 SURGICAL SUPPLIES I/P (CO2316388 S STRL DRILL BIT, ACE $314.50 $314.50 23 SURGICAL SUPPLIES I/P (CO2316511 S STRL DRILL BIT, ZIMMER $415.00 $392.00 23 SURGICAL SUPPLIES I/P (CO2316537 S STRL DRILL FLEX $977.50 $888.25 23 SURGICAL SUPPLIES I/P (CO2316545 S STRL DRILL GU 2.4X180MM $522.75 $522.75 23 SURGICAL SUPPLIES I/P (CO2316552 S STRL DRILL SURGAIR WIRE $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2316578 S STRL DRILL TWIST $161.75 $149.50 23 SURGICAL SUPPLIES I/P (CO2316594 S STRL DRILL TWIST AMBI $104.00 $98.00 23 SURGICAL SUPPLIES I/P (CO2317097 S STRL DRILL WIRE PASS $157.75 $157.75 23 SURGICAL SUPPLIES I/P (CO2315125 S STRL EITHILON,4-0,30" $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2317196 S STRL ELECT ACROMIO $253.00 $239.00 23 SURGICAL SUPPLIES I/P (CO2314565 S STRL ELECT CORD-FULG $35.25 $33.00 23 SURGICAL SUPPLIES I/P (CO2317204 S STRL ELECT MENISEC STD $142.50 $142.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2317246 S STRL ENDO BUTTON PAK $1,726.75 $1,726.75 23 SURGICAL SUPPLIES I/P (CO2308591 S STRL ENDO CATCH $355.25 $355.25 23 SURGICAL SUPPLIES I/P (CO2325900 S STRL ENDO CUTTER $1,450.50 23 SURGICAL SUPPLIES I/P (CO2308641 S STRL ENDO DISSECTOR $368.50 $307.00 23 SURGICAL SUPPLIES I/P (CO2308617 S STRL ENDOCLIP M/L 5MM $888.00 $695.00 23 SURGICAL SUPPLIES I/P (CO2308633 S STRL ENDOCLOSE $213.00 $213.00 23 SURGICAL SUPPLIES I/P (CO2317394 S STRL ENDOSCOPE SPEC $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2317568 S STRL ERASER TIP $35.75 $35.75 23 SURGICAL SUPPLIES I/P (CO2317600 S STRL ERASER TIP 23GA $174.00 $164.00 23 SURGICAL SUPPLIES I/P (CO2304715 S STRL ETB,0,18"TIES $5.50 $5.50 23 SURGICAL SUPPLIES I/P (CO2304756 S STRL ETB,0,30",SH $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2304723 S STRL ETB,0,30"TIES $8.25 $8.25 23 SURGICAL SUPPLIES I/P (CO2304665 S STRL ETB,1,30",MO-7 $25.00 $24.00 23 SURGICAL SUPPLIES I/P (CO2304673 S STRL ETB,2,27",OS-4 $253.25 $233.50 23 SURGICAL SUPPLIES I/P (CO2304707 S STRL ETB,2-0,18"TIES $11.50 $11.50 23 SURGICAL SUPPLIES I/P (CO2304749 S STRL ETB,2-0,30",SH $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2304699 S STRL ETB,3-0,18"TIES $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2304731 S STRL ETB,3-0,30",SH $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2304764 S STRL ETB,3-0,30"RB-1 $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2304681 S STRL ETB,5,30",V-37 $73.75 $73.75 23 SURGICAL SUPPLIES I/P (CO2317618 S STRL ETL,0,60"TIES $9.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2304871 S STRL ETL,10-0,5",BV75-4 $100.00 $100.00 23 SURGICAL SUPPLIES I/P (CO2304962 S STRL ETL,10-0,8",CS-B-6 $111.00 $105.00 23 SURGICAL SUPPLIES I/P (CO2304897 S STRL ETL,11-0,5",BV50-3 $114.00 $114.00 23 SURGICAL SUPPLIES I/P (CO2317626 S STRL EVACUATOR BLADDER $119.75 $100.25 23 SURGICAL SUPPLIES I/P (CO2308773 S STRL EXPAND TISS MCGHAN $3,301.00 $3,114.00 23 SURGICAL SUPPLIES I/P (CO2370013 S STRL EXTRACTOR STONE $262.00 $247.00 23 SURGICAL SUPPLIES I/P (CO2308823 S STRL FLEXI-LUM $111.25 $111.25 23 SURGICAL SUPPLIES I/P (CO2313633 S STRL FOLEY CATH, TRATTN $396.75 $396.75 23 SURGICAL SUPPLIES I/P (CO2370039 S STRL FORCEPS GRASP $778.25 $782.00 23 SURGICAL SUPPLIES I/P (CO2317725 S STRL FTR PRE-FTR $123.00 $116.00 23 SURGICAL SUPPLIES I/P (CO2380608 S STRL GAS, C3F8/SF6 $388.00 $366.00 23 SURGICAL SUPPLIES I/P (CO2362481 S STRL GAUGE PINS $416.50 $416.50 23 SURGICAL SUPPLIES I/P (CO2318525 S STRL GIA 80 TIT MF 3.8 $682.25 $682.25 23 SURGICAL SUPPLIES I/P (CO2305035 S STRL GORE-TEX,CV-6,24" $101.75 $101.75 23 SURGICAL SUPPLIES I/P (CO2321099 S STRL GRASPER SUT 45 $1,041.25 $1,011.50 23 SURGICAL SUPPLIES I/P (CO2318111 S STRL GUIDE PIN AMBI $131.25 $131.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2318129 S STRL GUIDE PIN, ACE $161.00 $152.00 23 SURGICAL SUPPLIES I/P (CO2312585 S STRL GUIDE WIRE ARTHREX $187.00 23 SURGICAL SUPPLIES I/P (CO2318244 S STRL HALL BURR $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2312841 S STRL HD/PERITNL LNG TRM $223.50 $223.50 23 SURGICAL SUPPLIES I/P (CO2312817 S STRL HD/PRITNL SHRT TRM $1,144.50 $784.00 23 SURGICAL SUPPLIES I/P (CO2313054 S STRL HD/PRITNL SHRT TRM $528.50 $355.25 23 SURGICAL SUPPLIES I/P (CO2318293 S STRL HELICAL LOOP BSKT $1,755.25 $1,755.25 23 SURGICAL SUPPLIES I/P (CO2318301 S STRL HEMORRHAGE PIN $797.00 $797.00 23 SURGICAL SUPPLIES I/P (CO2370088 S STRL HEMOSTAT SURG 2X2 $168.75 $150.50 23 SURGICAL SUPPLIES I/P (CO2370096 S STRL HEMOSTAT SURGICEL $260.00 $231.75 23 SURGICAL SUPPLIES I/P (CO2309029 S STRL HNDL WIRE GUIDE $1,157.25 $1,157.25 23 SURGICAL SUPPLIES I/P (CO2309060 S STRL HOLLISTER, BRIDGE $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2318335 S STRL HOOD PROVISION $88.00 $83.00 23 SURGICAL SUPPLIES I/P (CO2309094 S STRL HOOKS DURA DISP $77.50 $77.50 23 SURGICAL SUPPLIES I/P (CO2309375 S STRL HOT KNIFE NEONATE $605.75 $605.75 23 SURGICAL SUPPLIES I/P (CO2318434 S STRL INF FEEDING TUBE $9.50 $9.50 23 SURGICAL SUPPLIES I/P (CO2318467 S STRL INSERT SAFE JAW $85.50 $85.50 23 SURGICAL SUPPLIES I/P (CO2318517 S STRL INSTR GIA 60 TIT M $442.00 $442.00 23 SURGICAL SUPPLIES I/P (CO2318533 S STRL INSTR INTRALUM $1,209.00 $1,209.00 23 SURGICAL SUPPLIES I/P (CO2318608 S STRL INSTR SURGICLIP $261.50 $261.50 23 SURGICAL SUPPLIES I/P (CO2318616 S STRL INSTR TA30-3.5/4.8 $424.00 $424.00 23 SURGICAL SUPPLIES I/P (CO2318624 S STRL INSTR TA30-V3 TIT $459.50 $459.50 23 SURGICAL SUPPLIES I/P (CO2370104 S STRL INSTRUMENT BIOPSY $116.75 $116.75 23 SURGICAL SUPPLIES I/P (CO2350783 S STRL INTRASPINAL ROD $430.00 $405.00 23 SURGICAL SUPPLIES I/P (CO2318707 S STRL IRR SIMPULSE SUC $171.25 $171.25 23 SURGICAL SUPPLIES I/P (CO2315794 S STRL IRRIGATION POUCH 3 $32.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2309227 S STRL KIT BONE MAR COLT $1,209.75 $1,209.75 23 SURGICAL SUPPLIES I/P (CO2309243 S STRL KIT DRAINAGE ICP $854.25 $854.25 23 SURGICAL SUPPLIES I/P (CO2309250 S STRL KIT FILL MCGHAN $52.50 $52.50 23 SURGICAL SUPPLIES I/P (CO2319184 S STRL KIT LAP CHOLE $1,149.00 $1,084.00 23 SURGICAL SUPPLIES I/P (CO2309342 S STRL KIT SUC CATH 14FR $3.00 $3.00 23 SURGICAL SUPPLIES I/P (CO2341048 S STRL KNEE TOTAL SAW BL $209.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2309409 S STRL K-PAD DISP $30.25 $30.25 23 SURGICAL SUPPLIES I/P (CO2319192 S STRL LAP CHOLE KIT $1,264.00 $1,264.00 23 SURGICAL SUPPLIES I/P (CO2319564 S STRL LAPOROSCOPIC KIT $1,627.00 $1,535.00 23 SURGICAL SUPPLIES I/P (CO2390946 S STRL LAPSNC DISSECTOR $107.75 $149.50 23 SURGICAL SUPPLIES I/P (CO2319010 S STRL LAPSNC ENDO CLIP $431.75 $431.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2319085 S STRL LAPSNC ENDO CLIP $403.00 $380.00 23 SURGICAL SUPPLIES I/P (CO2319028 S STRL LAPSNC INSTR $415.75 $415.75 23 SURGICAL SUPPLIES I/P (CO2319150 S STRL LAPSNC INSTR ENDO $933.00 $933.00 23 SURGICAL SUPPLIES I/P (CO2319135 S STRL LAPSNC INSTR ENDO $303.25 $736.00 23 SURGICAL SUPPLIES I/P (CO2319226 S STRL LAPSNC NDL $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO2319242 S STRL LAPSNC SEAL ENDO $133.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2319267 S STRL LAPSNC STRYKE-FLO $109.25 $109.25 23 SURGICAL SUPPLIES I/P (CO2319317 S STRL LAPSNC SYS TACKER $1,820.25 $1,820.25 23 SURGICAL SUPPLIES I/P (CO2319606 S STRL LASER FIBER ENDO $403.75 $403.75 23 SURGICAL SUPPLIES I/P (CO2314300 S STRL LEAD CLIPPERS $267.50 $238.00 23 SURGICAL SUPPLIES I/P (CO2319663 S STRL LENS GLIDE $29.00 $28.00 23 SURGICAL SUPPLIES I/P (CO2325934 S STRL LINEAR CUTTER ENDO $1,779.50 23 SURGICAL SUPPLIES I/P (CO2308914 S STRL LITE HNDLS $5.00 $4.00 23 SURGICAL SUPPLIES I/P (CO2319721 S STRL LITE PIPE W/PIK $277.00 $261.00 23 SURGICAL SUPPLIES I/P (CO2308492 S STRL LOOP BALL/CUTTING $580.75 $580.75 23 SURGICAL SUPPLIES I/P (CO2319754 S STRL LOOPS VESSEL $10.75 $10.50 23 SURGICAL SUPPLIES I/P (CO2310571 S STRL MEASURING KIT $454.00 23 SURGICAL SUPPLIES I/P (CO2305209 S STRL MERSILENE,4-0,18" $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2305191 S STRL MERSILENE,5-0,18" $53.75 $51.75 23 SURGICAL SUPPLIES I/P (CO2305183 S STRL MERSILENE,5MM,36" $282.25 $240.25 23 SURGICAL SUPPLIES I/P (CO2309615 S STRL MICRODISSECT NDL $171.00 $171.00 23 SURGICAL SUPPLIES I/P (CO2319853 S STRL MON 3-0 27"PS-1 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2319861 S STRL MON 3-0,27"SH $12.25 $11.75 23 SURGICAL SUPPLIES I/P (CO2305266 S STRL MON,2-0,27",SH $12.25 $11.75 23 SURGICAL SUPPLIES I/P (CO2305324 S STRL MON,2-0,27",UR-6 $14.00 $13.50 23 SURGICAL SUPPLIES I/P (CO2305290 S STRL MON,4-0,18",P-3 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305316 S STRL MON,4-0,18",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305274 S STRL MON,4-0,27",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305308 S STRL MON,5-0,18",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305282 S STRL MONOCRYL,5-0,18",P $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2309763 S STRL NASAL PK XOMED $82.00 $72.75 23 SURGICAL SUPPLIES I/P (CO2319911 S STRL NDL BX NASHOLD $1,296.25 $1,296.25 23 SURGICAL SUPPLIES I/P (CO2319937 S STRL NDL BX TRU-CUT $95.50 $95.50 23 SURGICAL SUPPLIES I/P (CO2319945 S STRL NDL CHEMO/CHIBA $46.50 $46.50 23 SURGICAL SUPPLIES I/P (CO2309649 S STRL NDL SUT $26.00 $26.00 23 SURGICAL SUPPLIES I/P (CO2300127 S STRL NERVE STIMULATER $220.25 $223.25 23 SURGICAL SUPPLIES I/P (CO2309656 S STRL NOZZLE HANDPIECE $316.75 $316.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2325868 S STRL NUROLON 0 CT-2 $58.25 23 SURGICAL SUPPLIES I/P (CO2305365 S STRL NUROLON,1,18",OS-8 $40.50 $40.50 23 SURGICAL SUPPLIES I/P (CO2303766 S STRL NUROLON,4-0,18"TF $76.00 $76.00 23 SURGICAL SUPPLIES I/P (CO2305423 S STRL NYL,10-0,12",AU-5 $131.75 $131.75 23 SURGICAL SUPPLIES I/P (CO2300226 S STRL OTHER MISC $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2300309 S STRL OTHER MISC $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2300283 S STRL OTHER MISC $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2300218 S STRL OTHER MISC $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2300234 S STRL OTHER MISC $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2300291 S STRL OTHER MISC $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2300184 S STRL OTHER MISC $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2300259 S STRL OTHER MISC $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2300275 S STRL OTHER MISC $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2300481 S STRL OTHER MISC $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2300242 S STRL OTHER MISC $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2300168 S STRL OTHER MISC 0 - 10 $33.00 $31.00 23 SURGICAL SUPPLIES I/P (CO2300192 S STRL OTHER MISC 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2300200 S STRL OTHER MISC 11 - 19 $89.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2300267 S STRL OTHER MISC 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2300325 S STRL OTHER MISC 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2300317 S STRL OTHER MISC 20-49 $187.00 $176.00 23 SURGICAL SUPPLIES I/P (CO2300333 S STRL OTHER MISC 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2300341 S STRL OTHER MISC 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2300358 S STRL OTHER MISC 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2300366 S STRL OTHER MISC 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2300374 S STRL OTHER MISC 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2300382 S STRL OTHER MISC 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2300390 S STRL OTHER MISC 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2300408 S STRL OTHER MISC 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2300416 S STRL OTHER MISC 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2300424 S STRL OTHER MISC 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2300432 S STRL OTHER MISC 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2300440 S STRL OTHER MISC 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2300457 S STRL OTHER MISC 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2300465 S STRL OTHER MISC 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2300473 S STRL OTHER MISC 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2309789 S STRL PAD C-CLAMP $12.00 $11.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2309821 S STRL PAD ELECTROSURG GR $52.50 $52.50 23 SURGICAL SUPPLIES I/P (CO2300812 S STRL PAD GROUNDING $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2309854 S STRL PAD MAG INST LG $39.00 $36.00 23 SURGICAL SUPPLIES I/P (CO2309862 S STRL PAD MAG NDL SM $5.75 $5.75 23 SURGICAL SUPPLIES I/P (CO2309797 S STRL PADS DEFIB $97.00 $97.00 23 SURGICAL SUPPLIES I/P (CO2300895 S STRL PAK VITRECTOMY $788.00 $743.00 23 SURGICAL SUPPLIES I/P (CO2300945 S STRL PDS,0,27",CT-1 $14.25 $14.00 23 SURGICAL SUPPLIES I/P (CO2391423 S STRL PDS,0,27",CT-2 $15.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2300986 S STRL PDS,0,27",FS-2 $19.50 $19.00 23 SURGICAL SUPPLIES I/P (CO2305522 S STRL PDS,1,27",DT-1 $14.75 $14.25 23 SURGICAL SUPPLIES I/P (CO2305548 S STRL PDS,1,27"0S-6 (Z53 $18.50 $16.75 23 SURGICAL SUPPLIES I/P (CO2305530 S STRL PDS,1,36",CTX $16.75 $16.25 23 SURGICAL SUPPLIES I/P (CO2305563 S STRL PDS,1,54,TPB-1 $29.50 $28.75 23 SURGICAL SUPPLIES I/P (CO2300960 S STRL PDS,2-0,27",CT-1 $14.25 $13.75 23 SURGICAL SUPPLIES I/P (CO2305555 S STRL PDS,3-0,18",SH $84.50 $84.50 23 SURGICAL SUPPLIES I/P (CO2305514 S STRL PDS,3-0,27",CT-1 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2301042 S STRL PEN SKIN REG TIP $3.75 $3.75 23 SURGICAL SUPPLIES I/P (CO2309904 S STRL PERFORATOR CRANI $947.75 $947.75 23 SURGICAL SUPPLIES I/P (CO2360808 S STRL PIN BEATH $101.00 $95.00 23 SURGICAL SUPPLIES I/P (CO2360816 S STRL PIN CAL GUIDE PLN $35.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2360832 S STRL PIN K-WIRE $35.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2360840 S STRL PIN K-WIRE $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO2360857 S STRL PIN MAYFIELD SKULL $119.25 $119.25 23 SURGICAL SUPPLIES I/P (CO2300705 S STRL PK ADAPTIC 1/2" $22.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2300721 S STRL PK IODO $12.75 $19.75 23 SURGICAL SUPPLIES I/P (CO2300762 S STRL PK OXYCEL COTTON $217.00 $205.00 23 SURGICAL SUPPLIES I/P (CO2300770 S STRL PK OXYCEL GAUZE $164.00 $155.00 23 SURGICAL SUPPLIES I/P (CO2300788 S STRL PK PLN $11.25 $16.75 23 SURGICAL SUPPLIES I/P (CO2309755 S STRL PK RHINO ROCKET $119.25 $112.25 23 SURGICAL SUPPLIES I/P (CO2309771 S STRL PK VAG 2" $15.25 $15.25 23 SURGICAL SUPPLIES I/P (CO2301166 S STRL PLEDGET OVAL 6X4.5 $63.00 $63.00 23 SURGICAL SUPPLIES I/P (CO2301125 S STRL PLN GUT 2-0,27T-12 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2301133 S STRL PLN GUT 3-0,27CT-1 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2301141 S STRL PLN GUT, 3-0,27" $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2305605 S STRL PLN GUT, 6-0 18" $30.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2370393 S STRL PLN GUT,2-0,54" $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2305597 S STRL PLN GUT,6-0,18" $80.25 $80.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2301158 S STRL PLSTC ANEURO/CRANI $3,133.00 $3,041.00 23 SURGICAL SUPPLIES I/P (CO2309938 S STRL PLUG CATH/TUBE $2.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2301190 S STRL PLUG CEMENT BUCK $499.75 $612.00 23 SURGICAL SUPPLIES I/P (CO2309086 S STRL POUCH CLAMP $5.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2309078 S STRL POUCH CUT-TO-FIT $12.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2301257 S STRL POUCH STERI INST $11.00 $11.00 23 SURGICAL SUPPLIES I/P (CO2301265 S STRL POUCH SURGICAL $218.50 $212.00 23 SURGICAL SUPPLIES I/P (CO2303691 S STRL PRO 3-0, 36", SH $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2301505 S STRL PRO, HS-7,5-0,24" $72.50 $72.50 23 SURGICAL SUPPLIES I/P (CO2301513 S STRL PRO,0,30",MO-6 $17.75 $17.75 23 SURGICAL SUPPLIES I/P (CO2301521 S STRL PRO,0,30",SH $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2303675 S STRL PRO,1,TP-1,60" $21.50 $21.50 23 SURGICAL SUPPLIES I/P (CO2305761 S STRL PRO,10-0,6" $75.25 $75.25 23 SURGICAL SUPPLIES I/P (CO2305738 S STRL PRO,10-0,8",STC-6 $58.75 $58.75 23 SURGICAL SUPPLIES I/P (CO2305894 S STRL PRO,3-0,18",PC-5 $28.25 $28.25 23 SURGICAL SUPPLIES I/P (CO2306009 S STRL PRO,4-0,30" $52.50 $46.25 23 SURGICAL SUPPLIES I/P (CO2305852 S STRL PRO,4-0,36",RB-1 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2305845 S STRL PRO,5-0,36",RB-1 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2305969 S STRL PRO,7-0,24",RB-2 $58.75 $58.75 23 SURGICAL SUPPLIES I/P (CO2307361 S STRL PROBE ABC W/3"TIP $433.50 $421.00 23 SURGICAL SUPPLIES I/P (CO2309995 S STRL PROBE CAUTERY $314.00 $297.00 23 SURGICAL SUPPLIES I/P (CO2301364 S STRL PROBE COHRNT ENDO $779.25 $779.25 23 SURGICAL SUPPLIES I/P (CO2309987 S STRL PROBE LAPSNC ABC $704.00 $704.00 23 SURGICAL SUPPLIES I/P (CO2301414 S STRL PROBE LITHO WOLF $1,076.00 $1,044.75 23 SURGICAL SUPPLIES I/P (CO2310019 S STRL PROBE MYOCARDIAL $919.00 $867.00 23 SURGICAL SUPPLIES I/P (CO2301448 S STRL PROBE NIM-2 FLUSH $403.25 $404.50 23 SURGICAL SUPPLIES I/P (CO2370252 S STRL PROLENE, 2-0,30",K $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2391290 S STRL PROLENE,3-0,30",SH $13.00 $13.00 23 SURGICAL SUPPLIES I/P (CO2303717 S STRL PROLENE,5-0,18",C- $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2305993 S STRL PROLENE,6-0,18",BV $51.25 $51.25 23 SURGICAL SUPPLIES I/P (CO2303733 S STRL PROLENE,6-0,18",C- $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2303758 S STRL PROLENE,7-0,18",BV $52.25 $52.25 23 SURGICAL SUPPLIES I/P (CO2301562 S STRL PUMP SL ACTION $223.50 $219.50 23 SURGICAL SUPPLIES I/P (CO2362630 S STRL REAMER ARTHREX $871.25 $871.25 23 SURGICAL SUPPLIES I/P (CO2325918 S STRL RELOAD ENDO CUT $710.50 23 SURGICAL SUPPLIES I/P (CO2301653 S STRL RESER BLAKE DRAIN $115.00 $108.00 23 SURGICAL SUPPLIES I/P (CO2310134 S STRL RESER JP $31.00 $31.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2301679 S STRL RESER OMMAYA $1,670.25 $1,559.75 23 SURGICAL SUPPLIES I/P (CO2308708 S STRL RETRACT LAP $520.00 $491.00 23 SURGICAL SUPPLIES I/P (CO2301737 S STRL RETRACTOR FISH $109.75 $109.75 23 SURGICAL SUPPLIES I/P (CO2301745 S STRL RETRACTOR IRIS $127.00 $120.00 23 SURGICAL SUPPLIES I/P (CO2301869 S STRL SCISSOR VERT MICRO $315.00 $297.00 23 SURGICAL SUPPLIES I/P (CO2390607 S STRL SET CYSTO IRR 1 $16.50 $19.25 23 SURGICAL SUPPLIES I/P (CO2301943 S STRL SET IRRIG CYSTO $45.00 $51.50 23 SURGICAL SUPPLIES I/P (CO2302008 S STRL SHEARS LAPAROSONIC $1,915.25 $1,487.50 23 SURGICAL SUPPLIES I/P (CO2302438 S STRL SHOE DARBY $57.25 $57.25 23 SURGICAL SUPPLIES I/P (CO2322022 S STRL SHUNT $209.00 23 SURGICAL SUPPLIES I/P (CO2322006 S STRL SHUNT $229.50 $229.50 23 SURGICAL SUPPLIES I/P (CO2302479 S STRL SILK 2-0 12' REEL $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2325884 S STRL SILK ENDO 0 7" $99.75 23 SURGICAL SUPPLIES I/P (CO2325876 S STRL SILK ENDO 2-0 48" $99.75 23 SURGICAL SUPPLIES I/P (CO2391340 S STRL SILK, 0, 12' REEL $7.25 $7.25 23 SURGICAL SUPPLIES I/P (CO2302453 S STRL SILK, 0, 30", T-5 $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2391316 S STRL SILK, 4-0, 18"TIES $10.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2302578 S STRL SILK, 4-0, 30" $9.75 $9.75 23 SURGICAL SUPPLIES I/P (CO2302586 S STRL SILK, 5-0,30" $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2302602 S STRL SILK, 6-0, 30" $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2306322 S STRL SILK,0,18"TIES,6/P $4.00 $4.00 23 SURGICAL SUPPLIES I/P (CO2306355 S STRL SILK,0,30"TIES $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2306363 S STRL SILK,1,30"TIES $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2302461 S STRL SILK,2,30",MH, (K8 $10.25 $10.25 23 SURGICAL SUPPLIES I/P (CO2306074 S STRL SILK,2-0,18"FS $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2306348 S STRL SILK,2-0,30"TIES $13.25 $13.25 23 SURGICAL SUPPLIES I/P (CO2302537 S STRL SILK,3-0,18" TIES $8.50 $8.50 23 SURGICAL SUPPLIES I/P (CO2302511 S STRL SILK,3-0,18",SH $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2306082 S STRL SILK,3-0,30",KS $9.25 $9.25 23 SURGICAL SUPPLIES I/P (CO2302560 S STRL SILK,4-0,18",SH,8/ $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2302644 S STRL SLING ZIMMER (ALL) $39.50 $39.50 23 SURGICAL SUPPLIES I/P (CO2302677 S STRL SMOOTH LIGAMENT $1,121.75 $1,121.75 23 SURGICAL SUPPLIES I/P (CO2302685 S STRL SNARE WIRE $11.00 $11.00 23 SURGICAL SUPPLIES I/P (CO2381630 S STRL SOLUTION BSS PLUS $246.00 $232.00 23 SURGICAL SUPPLIES I/P (CO2381655 S STRL SOLUTION GLYCINE 1 $33.00 $31.00 23 SURGICAL SUPPLIES I/P (CO2302750 S STRL SPHERE SIL W/CONF $293.25 $293.25 23 SURGICAL SUPPLIES I/P (CO2361855 S STRL SPLNT NASAL $179.50 $179.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2303048 S STRL STAYS ELSTC $230.50 $230.50 23 SURGICAL SUPPLIES I/P (CO2303147 S STRL STENT URETERAL DBL $773.00 $729.00 23 SURGICAL SUPPLIES I/P (CO2302917 S STRL STPL CART $807.50 $807.50 23 SURGICAL SUPPLIES I/P (CO2303006 S STRL STPLR SKIN 35W $42.00 $40.00 23 SURGICAL SUPPLIES I/P (CO2303014 S STRL STPLR VERSATACK $598.25 $598.25 23 SURGICAL SUPPLIES I/P (CO2303030 S STRL STPLS CTG TA $237.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2303527 S STRL STRIPPER VEIN $130.75 $130.75 23 SURGICAL SUPPLIES I/P (CO2303600 S STRL SUC/COAGULATOR $55.25 $42.50 23 SURGICAL SUPPLIES I/P (CO2362440 S STRL SURGICAL STEEL,4-0 $49.00 $49.00 23 SURGICAL SUPPLIES I/P (CO2317113 S STRL SURGICEL FIBRILLAR $638.75 23 SURGICAL SUPPLIES I/P (CO2316990 S STRL SURGICEL FIBRILLAR $511.00 23 SURGICAL SUPPLIES I/P (CO2316891 S STRL SURGICEL FIBRILLAR $277.75 23 SURGICAL SUPPLIES I/P (CO2391282 S STRL SURGLN,4-0,18"CE-4 $15.25 $15.25 23 SURGICAL SUPPLIES I/P (CO2304293 S STRL SUT CHR 636 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304327 S STRL SUT CHR 790 $57.75 $57.75 23 SURGICAL SUPPLIES I/P (CO2304335 S STRL SUT CHR 794 $70.50 $70.50 23 SURGICAL SUPPLIES I/P (CO2304400 S STRL SUT CHR U202 $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2304434 S STRL SUT CHR U246 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2304541 S STRL SUT DEX 1 60" TIES $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2304632 S STRL SUT DEX 9248-51 $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2304814 S STRL SUT ETL $23.50 $23.50 23 SURGICAL SUPPLIES I/P (CO2315091 S STRL SUT ETL 1629H $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315083 S STRL SUT ETL 1663G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304798 S STRL SUT ETL 1667/662 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304806 S STRL SUT ETL 1673 $23.50 $23.50 23 SURGICAL SUPPLIES I/P (CO2304822 S STRL SUT ETL 1698 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304830 S STRL SUT ETL 1714 $55.25 $55.25 23 SURGICAL SUPPLIES I/P (CO2304848 S STRL SUT ETL 1716 $55.25 $55.25 23 SURGICAL SUPPLIES I/P (CO2304855 S STRL SUT ETL 2808 $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2304863 S STRL SUT ETL 2809 $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2304905 S STRL SUT ETL 470 $19.50 $19.50 23 SURGICAL SUPPLIES I/P (CO2304913 S STRL SUT ETL 490 $20.75 $20.75 23 SURGICAL SUPPLIES I/P (CO2304939 S STRL SUT ETL 661 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315133 S STRL SUT ETL 698G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315117 S STRL SUT ETL 699G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304947 S STRL SUT ETL 7707 $98.25 $98.25 23 SURGICAL SUPPLIES I/P (CO2304954 S STRL SUT ETL 824 $16.25 $16.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2305027 S STRL SUT GORE-TEX 6K02 $112.00 $106.50 23 SURGICAL SUPPLIES I/P (CO2319820 S STRL SUT MERSILENE $23.25 $23.25 23 SURGICAL SUPPLIES I/P (CO2305167 S STRL SUT MERSILENE 1778 $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2305217 S STRL SUT MERSILENE R690 $21.25 $21.25 23 SURGICAL SUPPLIES I/P (CO2305225 S STRL SUT MERSILENE R770 $94.75 $94.75 23 SURGICAL SUPPLIES I/P (CO2305332 S STRL SUT MON Y935 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305357 S STRL SUT NUROLON C584 $72.75 $72.75 23 SURGICAL SUPPLIES I/P (CO2305449 S STRL SUT PASSER $218.50 $218.50 23 SURGICAL SUPPLIES I/P (CO2305498 S STRL SUT PDS Z316 $15.00 $14.50 23 SURGICAL SUPPLIES I/P (CO2305506 S STRL SUT PDS Z317 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2305571 S STRL SUT PDS Z880 $29.25 $28.50 23 SURGICAL SUPPLIES I/P (CO2305589 S STRL SUT PDS Z997 $72.00 $72.00 23 SURGICAL SUPPLIES I/P (CO2305662 S STRL SUT PLN 686 $27.50 $27.50 23 SURGICAL SUPPLIES I/P (CO2305670 S STRL SUT PLN 770 $57.75 $57.75 23 SURGICAL SUPPLIES I/P (CO2305688 S STRL SUT PLN N863 $11.50 $11.50 23 SURGICAL SUPPLIES I/P (CO2305811 S STRL SUT PRO 7761 $84.50 $84.50 23 SURGICAL SUPPLIES I/P (CO2305829 S STRL SUT PRO 788 $97.50 $97.50 23 SURGICAL SUPPLIES I/P (CO2305837 S STRL SUT PRO 8424 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2303709 S STRL SUT PRO 8521H $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2303683 S STRL SUT PRO 8523H $25.50 $25.50 23 SURGICAL SUPPLIES I/P (CO2305886 S STRL SUT PRO 8629 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2305910 S STRL SUT PRO 8682 $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2305944 S STRL SUT PRO 8698 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2305951 S STRL SUT PRO 8699 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2303741 S STRL SUT PRO 8706H $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2303725 S STRL SUT PRO 8720H $34.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2306025 S STRL SUT RETENT BOLSTER $39.50 $39.50 23 SURGICAL SUPPLIES I/P (CO2306033 S STRL SUT RETENT BRIDGE $34.75 $34.75 23 SURGICAL SUPPLIES I/P (CO2306041 S STRL SUT RETRIEVER $430.00 $405.00 23 SURGICAL SUPPLIES I/P (CO2306116 S STRL SUT SILK 1687 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2302594 S STRL SUT SILK 639G $21.50 $21.50 23 SURGICAL SUPPLIES I/P (CO2306249 S STRL SUT SILK 683 $11.50 $11.50 23 SURGICAL SUPPLIES I/P (CO2306272 S STRL SUT SILK 735 $19.75 $19.75 23 SURGICAL SUPPLIES I/P (CO2306280 S STRL SUT SILK 765 $46.75 $46.75 23 SURGICAL SUPPLIES I/P (CO2306298 S STRL SUT SILK 768 $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2306306 S STRL SUT SILK 769 $46.75 $46.75 23 SURGICAL SUPPLIES I/P (CO2302487 S STRL SUT SILK A185H $8.50 $8.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2302552 S STRL SUT SILK C054T $54.75 $54.75 23 SURGICAL SUPPLIES I/P (CO2306389 S STRL SUT SILK CO84 $55.25 $55.25 23 SURGICAL SUPPLIES I/P (CO2302529 S STRL SUT SILK K832H $8.75 $8.75 23 SURGICAL SUPPLIES I/P (CO2302495 S STRL SUT SILK K833H $8.75 $8.75 23 SURGICAL SUPPLIES I/P (CO2306397 S STRL SUT SILK K881 $10.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2306405 S STRL SUT SILK K882 $10.50 $10.50 23 SURGICAL SUPPLIES I/P (CO2302545 S STRL SUT SILK LA53G $8.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2302503 S STRL SUT SILK LA54G $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2306488 S STRL SUT TEVDEK 7-946 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2306496 S STRL SUT TEVDEK 7-947 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2306504 S STRL SUT TEVDEK 7-950 $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2306546 S STRL SUT VIC 10-0 V960G $63.50 $63.50 23 SURGICAL SUPPLIES I/P (CO2315281 S STRL SUT VIC J110T $47.00 $47.00 23 SURGICAL SUPPLIES I/P (CO2315216 S STRL SUT VIC J113T $28.50 $28.50 23 SURGICAL SUPPLIES I/P (CO2306645 S STRL SUT VIC J270 $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315182 S STRL SUT VIC J415H $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315299 S STRL SUT VIC J416H $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2315257 S STRL SUT VIC J417H $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2315331 S STRL SUT VIC J426H $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2315265 S STRL SUT VIC J427H $24.75 $24.75 23 SURGICAL SUPPLIES I/P (CO2315356 S STRL SUT VIC J493G $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2315307 S STRL SUT VIC J494G $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2306744 S STRL SUT VIC J571 $54.75 $54.75 23 SURGICAL SUPPLIES I/P (CO2306777 S STRL SUT VIC J718 $39.75 $39.75 23 SURGICAL SUPPLIES I/P (CO2315232 S STRL SUT VIC J775 $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2315224 S STRL SUT VIC J880T $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315349 S STRL SUT VIC J935H $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2315208 S STRL SUT VIC J978H $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2306827 S STRL SUT VIC J979 $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2306835 S STRL SUT VIC J980 $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2304350 S STRL SUTURE CHROMIC G12 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304418 S STRL SUTURE CHROMIC U20 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304988 S STRL SUTURE GORE-TEX 3N $91.75 $91.75 23 SURGICAL SUPPLIES I/P (CO2307122 S STRL SYRINGE 70CC FNGR $8.00 $7.00 23 SURGICAL SUPPLIES I/P (CO2313096 S STRL THROMB/EMBOLECTOMY $165.00 $156.00 23 SURGICAL SUPPLIES I/P (CO2307304 S STRL TIC,0,30"CV-305 $30.50 $29.75 23 SURGICAL SUPPLIES I/P (CO2307312 S STRL TIC,0,30"TIES,7/PK $23.25 $18.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2306538 S STRL TIC,2,36",T-12 $52.25 $50.75 23 SURGICAL SUPPLIES I/P (CO2391084 S STRL TIC,2-0,18"TIES $30.75 $23.50 23 SURGICAL SUPPLIES I/P (CO2391076 S STRL TIC,3-0,18"TIES $35.25 $29.50 23 SURGICAL SUPPLIES I/P (CO2307320 S STRL TIC,4-0,18"TIES $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2306512 S STRL TIC,5,30",C-20 $54.25 $56.00 23 SURGICAL SUPPLIES I/P (CO2391092 S STRL TICRON,0,18"TIES,1 $30.75 $23.75 23 SURGICAL SUPPLIES I/P (CO2307379 S STRL TIP IRRIG/SUC $60.75 $60.75 23 SURGICAL SUPPLIES I/P (CO2307353 S STRL TIP SIMPULSE $55.75 $55.75 23 SURGICAL SUPPLIES I/P (CO2307486 S STRL TRACH TUBE $410.25 $399.50 23 SURGICAL SUPPLIES I/P (CO2307502 S STRL TRACH TUBE $209.75 $209.75 23 SURGICAL SUPPLIES I/P (CO2307510 S STRL TRACH VENT $287.00 $270.00 23 SURGICAL SUPPLIES I/P (CO2307536 S STRL TRACT SHLD $187.75 $187.75 23 SURGICAL SUPPLIES I/P (CO2307528 S STRL TRACT SHLD KIT $299.75 $299.75 23 SURGICAL SUPPLIES I/P (CO2307544 S STRL TRACT STRIP $20.00 $19.00 23 SURGICAL SUPPLIES I/P (CO2307569 S STRL TRAP STONE CATCH $22.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2325959 S STRL TROCAR ENDO 10-12M $219.50 23 SURGICAL SUPPLIES I/P (CO2325942 S STRL TROCAR ENDOPATH $197.00 23 SURGICAL SUPPLIES I/P (CO2307700 S STRL TROCAR THORACOPORT $218.75 $218.75 23 SURGICAL SUPPLIES I/P (CO2307718 S STRL TUBE BAKER $1,285.25 $1,261.25 23 SURGICAL SUPPLIES I/P (CO2307809 S STRL TUBE GASTMY MIC $187.50 $187.50 23 SURGICAL SUPPLIES I/P (CO2307791 S STRL TUBE GASTRO $752.00 $752.00 23 SURGICAL SUPPLIES I/P (CO2307825 S STRL TUBE LARYNGECTOMY $221.25 $211.75 23 SURGICAL SUPPLIES I/P (CO2307882 S STRL TUBE SALUM SUMP $21.50 $27.00 23 SURGICAL SUPPLIES I/P (CO2325850 S STRL TUBE VENT DURAVENT $102.00 23 SURGICAL SUPPLIES I/P (CO2307619 S STRL TY, COLLAGEN NDL $111.75 $111.75 23 SURGICAL SUPPLIES I/P (CO2308203 S STRL UMBILICAL TAPE,1/8 $10.75 $10.75 23 SURGICAL SUPPLIES I/P (CO2308229 S STRL UNISHUNT SYS $1,993.00 $1,993.00 23 SURGICAL SUPPLIES I/P (CO2308369 S STRL VIC 7-0 18 TG140-8 $62.25 $62.25 23 SURGICAL SUPPLIES I/P (CO2308344 S STRL VIC, 2-0, 27" UR-6 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2308351 S STRL VIC, 4-0, 18" $27.75 $24.75 23 SURGICAL SUPPLIES I/P (CO2315190 S STRL VIC,0,18" TIES $30.50 $30.50 23 SURGICAL SUPPLIES I/P (CO2304640 S STRL VIC,0,27" $62.75 $62.75 23 SURGICAL SUPPLIES I/P (CO2304657 S STRL VIC,0,27",CT $60.75 $60.75 23 SURGICAL SUPPLIES I/P (CO2306694 S STRL VIC,0,27",SH $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2306751 S STRL VIC,0,27",UR-6 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2306629 S STRL VIC,0,36",CT-1 $10.75 $10.75 23 SURGICAL SUPPLIES I/P (CO2306801 S STRL VIC,1,36",CT $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2306819 S STRL VIC,1,36",CTX $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2306785 S STRL VIC,2-0,18",CTX $60.00 $60.00 23 SURGICAL SUPPLIES I/P (CO2306702 S STRL VIC,2-0,27",FS-1 $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2306686 S STRL VIC,2-0,27",UR-5 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2306611 S STRL VIC,2-0,36",CT-1 $11.00 $11.00 23 SURGICAL SUPPLIES I/P (CO2315273 S STRL VIC,3-0,18",SH $61.50 $61.50 23 SURGICAL SUPPLIES I/P (CO2306710 S STRL VIC,3-0,27".PSL $30.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2306595 S STRL VIC,4-0,27",SH-1 $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315364 S STRL VIC,5-0,18"PS-2 $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2306728 S STRL VIC,6-0,18" $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2391407 S STRL VICRYL, 2-0, 36", $18.00 $18.00 23 SURGICAL SUPPLIES I/P (CO2315240 S STRL VICRYL,2-0,18" TIE $47.75 $47.75 23 SURGICAL SUPPLIES I/P (CO2306769 S STRL VICRYL,2-0,18",OS- $38.75 $38.75 23 SURGICAL SUPPLIES I/P (CO2307023 S STRL VICRYL,3-0,36"SH,D $22.75 $22.75 23 SURGICAL SUPPLIES I/P (CO2315380 S STRL VICRYL,5-0,27",RB- $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2308377 S STRL VICRYL,8-0,8",TG14 $67.00 $67.00 23 SURGICAL SUPPLIES I/P (CO2308328 S STRL VLV LEVEEN ASCITES $1,686.50 $1,686.50 23 SURGICAL SUPPLIES I/P (CO2362390 S STRL WIRE SS 18-24 GA $36.00 $36.00 23 SURGICAL SUPPLIES I/P (CO2362408 S STRL WIRE SS 26-30 GA $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2362432 S STRL WIRE SUT 4-0 FS-2 $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2302891 S STRL WIRE, 3-0, 18" $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2302909 S STRL WIRE, 5, 18" $70.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2315109 S STRL WIRE,2-0,18" $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2313401 S STRLCYSTO-DRAIN $368.00 $347.00 23 SURGICAL SUPPLIES I/P (CO2326593 URINARY SPHINCTER PROSTH $2,048.00 23 SURGICAL SUPPLIES I/P (CO2013548 AD EVAL ABR $2,088.00 20 SURGICAL SVCS IP PROCEDUR2013563 AD EVAL ABR $3,820.00 20 SURGICAL SVCS IP PROCEDUR2013480 AD EVAL ABR $1,390.00 20 SURGICAL SVCS IP PROCEDUR2013472 AD EVAL ABR $1,027.00 20 SURGICAL SVCS IP PROCEDUR2013555 AD EVAL ABR $2,824.00 20 SURGICAL SVCS IP PROCEDUR2013522 AD EVAL ABR $1,141.00 20 SURGICAL SVCS IP PROCEDUR2013514 AD EVAL ABR $3,438.00 20 SURGICAL SVCS IP PROCEDUR2013506 AD EVAL ABR $2,542.00 20 SURGICAL SVCS IP PROCEDUR2013498 AD EVAL ABR $1,879.00 20 SURGICAL SVCS IP PROCEDUR2013530 AD EVAL ABR $1,544.00 20 SURGICAL SVCS IP PROCEDUR2040160 ANORECTAL MANOMETRY $1,919.00 $1,423.00 20 SURGICAL SVCS IP PROCEDUR2040335 BX LIVER $3,002.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2040301 CA ECHO TRANSESOPHAGEAL $1,849.00 20 SURGICAL SVCS IP PROCEDUR2040376 CAPSULE ENDOSCOPY $2,384.00 20 SURGICAL SVCS IP PROCEDUR2013183 CELL SAVER SERVICE $5,261.00 20 SURGICAL SVCS IP PROCEDUR2040244 COLONOSCOPY $2,871.00 20 SURGICAL SVCS IP PROCEDUR2040251 COLONOSCOPY INTERVENTN $3,406.00 20 SURGICAL SVCS IP PROCEDUR2021459 CPLX GENRL ANES ADD 15M $702.00 $423.00 20 SURGICAL SVCS IP PROCEDUR2021442 CPLX GENRL ANES FIRST 30M $1,312.00 $790.00 20 SURGICAL SVCS IP PROCEDUR2013209 CX CASE OR $1,886.00 20 SURGICAL SVCS IP PROCEDUR2060069 ECT W NECESSRY MONITORING $1,177.00 20 SURGICAL SVCS IP PROCEDUR2040053 EGD $2,775.00 $2,058.00 20 SURGICAL SVCS IP PROCEDUR2040343 EGD INTERVENTN $2,979.00 20 SURGICAL SVCS IP PROCEDUR2013571 EMG ANAL/URETHRAL SPHNCTR $1,153.00 20 SURGICAL SVCS IP PROCEDUR2013456 EMG FOUR LIMBS $1,452.00 20 SURGICAL SVCS IP PROCEDUR2013290 EMG HEAD OR NECK BIL $2,408.00 20 SURGICAL SVCS IP PROCEDUR2013282 EMG HEAD OR NECK UNI $2,483.00 20 SURGICAL SVCS IP PROCEDUR2013308 EMG ONE FIBER $445.00 20 SURGICAL SVCS IP PROCEDUR2013316 EMG ONE LIMB $230.00 20 SURGICAL SVCS IP PROCEDUR2013449 EMG THREE LIMBS $1,282.00 20 SURGICAL SVCS IP PROCEDUR2013324 EMG TWO LIMBS $1,131.00 20 SURGICAL SVCS IP PROCEDUR2040178 ERCP $2,422.00 $1,797.00 20 SURGICAL SVCS IP PROCEDUR2040269 ERCP INTERVENTN $6,084.00 20 SURGICAL SVCS IP PROCEDUR2040152 ESOPHAGEAL MOTLTY 2D DATA $3,311.00 $2,456.00 $1,940.00 20 SURGICAL SVCS IP PROCEDUR2040079 ESOPHAGOSCOPY INTERVENTN $6,233.00 $4,624.00 20 SURGICAL SVCS IP PROCEDUR2040277 GASTROSCOPY $1,750.00 20 SURGICAL SVCS IP PROCEDUR2040285 GASTROSCOPY INTERVENTN $3,500.00 20 SURGICAL SVCS IP PROCEDUR2013217 H REFLX TEST GSTR/SOL UNI $132.00 20 SURGICAL SVCS IP PROCEDUR2040145 INS PH CAPSULE GERD MUCOS $2,246.00 $1,666.00 20 SURGICAL SVCS IP PROCEDUR2040350 INS PH CAPSULE GERD MUCOS $2,246.00 20 SURGICAL SVCS IP PROCEDUR2021475 MAC/REG ADD 15M $535.00 $322.00 20 SURGICAL SVCS IP PROCEDUR2021491 MAC/REG ADD 15M NONOR $538.00 20 SURGICAL SVCS IP PROCEDUR2021467 MAC/REG FIRST 30M $1,105.00 $666.00 20 SURGICAL SVCS IP PROCEDUR2021483 MAC/REG FIRST 30M NONOR $1,085.00 20 SURGICAL SVCS IP PROCEDUR2013464 MTR NRV CNDCT STDY W/F EA $113.00 20 SURGICAL SVCS IP PROCEDUR2013274 NRV MOTOR CONDUCT STDY EA $100.00 20 SURGICAL SVCS IP PROCEDUR2013332 NRV SNSRY CONDUCT STDY EA $88.00 20 SURGICAL SVCS IP PROCEDUR2013225 NRV TEST IOP EA HOUR $1,407.00 20 SURGICAL SVCS IP PROCEDUR2013233 NRV TEST IOP EA HOUR $2,814.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2013241 NRV TEST IOP EA HOUR $4,221.00 20 SURGICAL SVCS IP PROCEDUR2013258 NRV TEST IOP EA HOUR $5,628.00 20 SURGICAL SVCS IP PROCEDUR2013266 NRV TEST IOP EA HOUR $7,036.00 20 SURGICAL SVCS IP PROCEDUR2040327 PARACENT ABD INI $1,328.00 20 SURGICAL SVCS IP PROCEDUR2030302 PERFUSION SERVICE $7,660.00 20 SURGICAL SVCS IP PROCEDUR2000016 REMV TUNN CV CATH W/O $906.00 20 SURGICAL SVCS IP PROCEDUR2013407 SEP LOWER LIMBS BIL $2,396.00 20 SURGICAL SVCS IP PROCEDUR2013381 SEP LOWER LIMBS BIL $1,617.00 20 SURGICAL SVCS IP PROCEDUR2013399 SEP LOWER LIMBS BIL $1,968.00 20 SURGICAL SVCS IP PROCEDUR2013431 SEP TRUNK/HEAD $2,157.00 20 SURGICAL SVCS IP PROCEDUR2013415 SEP TRUNK/HEAD $1,455.00 20 SURGICAL SVCS IP PROCEDUR2013423 SEP TRUNK/HEAD $1,772.00 20 SURGICAL SVCS IP PROCEDUR2013365 SEP UPPER LIMBS BIL $2,579.00 20 SURGICAL SVCS IP PROCEDUR2013340 SEP UPPER LIMBS BIL $1,737.00 20 SURGICAL SVCS IP PROCEDUR2013357 SEP UPPER LIMBS BIL $2,117.00 20 SURGICAL SVCS IP PROCEDUR2013373 SEP UPPER LIMBS BIL $3,142.00 20 SURGICAL SVCS IP PROCEDUR2040038 SIGMOIDOSCOPY $1,476.00 $1,095.00 20 SURGICAL SVCS IP PROCEDUR2040293 SIGMOIDOSCOPY INTERVENTN $2,922.00 20 SURGICAL SVCS IP PROCEDUR2013589 STIMULUS EVOKED RESPONSE $445.00 20 SURGICAL SVCS IP PROCEDUR2021517 STND ANES ADD 15M NONOR $547.00 20 SURGICAL SVCS IP PROCEDUR2021509 STND ANES FIRST 30M NONOR $1,078.00 20 SURGICAL SVCS IP PROCEDUR2021525 STND GENRL ANES ADD 15M $566.00 $341.00 20 SURGICAL SVCS IP PROCEDUR2021434 STND GENRL ANES FIRST 30M $1,142.00 $688.00 20 SURGICAL SVCS IP PROCEDUR2010874 SURG LVL 1 ADD 15M $1,482.00 $1,355.00 20 SURGICAL SVCS IP PROCEDUR2013118 SURG LVL 1 FIRST 30M $3,474.00 20 SURGICAL SVCS IP PROCEDUR2010940 SURG LVL 2 ADD 15M $1,757.00 $1,605.00 20 SURGICAL SVCS IP PROCEDUR2013126 SURG LVL 2 FIRST 30M $4,376.00 20 SURGICAL SVCS IP PROCEDUR2010957 SURG LVL 3 ADD 15M $1,989.00 $1,818.00 20 SURGICAL SVCS IP PROCEDUR2013134 SURG LVL 3 FIRST 30M $5,306.00 20 SURGICAL SVCS IP PROCEDUR2013159 SURG LVL 4 ADD 15M $2,111.00 20 SURGICAL SVCS IP PROCEDUR2013142 SURG LVL 4 FIRST 30M $6,219.00 20 SURGICAL SVCS IP PROCEDUR2030336 SURG LVL 5 ADD 15M $2,644.00 20 SURGICAL SVCS IP PROCEDUR2013175 SURG LVL 5 ADD 15M $2,644.00 20 SURGICAL SVCS IP PROCEDUR2030310 SURG LVL 5 FIRST 30M $6,500.00 20 SURGICAL SVCS IP PROCEDUR2013167 SURG LVL 5 FIRST 30M $6,500.00 20 SURGICAL SVCS IP PROCEDUR2040319 THORACENTESIS $1,135.00 20 SURGICAL SVCS IP PROCEDUR2040368 US TRANSRECTAL $933.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2536761 COSOPT 10ML 25 SURGICAL SVS O/P2536928 NA BICARB MOUTHWASH 25 SURGICAL SVS O/P2536845 POSACONAZOLE LIQ 105ML 25 SURGICAL SVS O/P2610137 CPLX PACU ADD 15M $1,400.00 $770.00 26 SURGICAL SVS O/P (CONTINU2610129 CPLX PACU FIRST 30M $2,821.00 $1,552.00 26 SURGICAL SVS O/P (CONTINU2630135 CYST/URETSCP/PYLSCP LITHO $4,209.00 26 SURGICAL SVS O/P (CONTINU2630150 LITHO ESWL BILAT $18,181.00 26 SURGICAL SVS O/P (CONTINU2630143 LITHO ESWL UNILAT $14,488.00 26 SURGICAL SVS O/P (CONTINU2610095 STND PACU LVL 1 ADD 15M $431.00 $237.00 26 SURGICAL SVS O/P (CONTINU2610111 STND PACU LVL 2 ADD 15M $493.00 $271.00 26 SURGICAL SVS O/P (CONTINU2610087 STND PACU LVL 2 FIRST 30M $1,304.00 $717.00 26 SURGICAL SVS O/P (CONTINU2610103 STND PACU LVL 2 FIRST 30M $1,304.00 $717.00 26 SURGICAL SVS O/P (CONTINU2610038 VENIPUNCTURE $28.00 $26.00 26 SURGICAL SVS O/P (CONTINU5260104 BIOIMPED PHY CARD ANALYS $68.00 52 TRANSPLANT SERVICES5210414 EXTERNAL CARDIO ASSIST $630.00 $482.00 52 TRANSPLANT SERVICES5210018 HEART ACQUISITION $45,506.00 $42,930.00 52 TRANSPLANT SERVICES5220504 KIDNEY ACQUISITION CADAV $42,135.00 $39,750.00 52 TRANSPLANT SERVICES5220520 KIDNEY ACQUISITION LIVE $42,135.00 52 TRANSPLANT SERVICES5260203 LEVEL 1 EST PATIENT $57.00 52 TRANSPLANT SERVICES5260658 LEVEL 1 EST PATIENT $57.00 52 TRANSPLANT SERVICES5260500 LEVEL 1 EST PATIENT $57.00 52 TRANSPLANT SERVICES5210059 LEVEL 1 EST PATIENT $147.00 $113.00 52 TRANSPLANT SERVICES5260351 LEVEL 1 EST PATIENT $175.00 52 TRANSPLANT SERVICES5220066 LEVEL 1 EST PATIENT $147.00 $113.00 52 TRANSPLANT SERVICES5230073 LEVEL 1 EST PATIENT $147.00 $113.00 52 TRANSPLANT SERVICES5260401 LEVEL 1 NEW PATIENT $57.00 52 TRANSPLANT SERVICES5260708 LEVEL 1 NEW PATIENT $57.00 52 TRANSPLANT SERVICES5210380 LEVEL 1 NEW PATIENT $147.00 $113.00 52 TRANSPLANT SERVICES5260252 LEVEL 1 NEW PATIENT $57.00 52 TRANSPLANT SERVICES5260559 LEVEL 1 NEW PATIENT $175.00 52 TRANSPLANT SERVICES5230016 LEVEL 1 NEW PATIENT $147.00 $113.00 52 TRANSPLANT SERVICES5260195 LEVEL 2 EST PATIENT $87.00 52 TRANSPLANT SERVICES5260492 LEVEL 2 EST PATIENT $87.00 52 TRANSPLANT SERVICES5230081 LEVEL 2 EST PATIENT $171.00 $131.00 52 TRANSPLANT SERVICES5260344 LEVEL 2 EST PATIENT $87.00 52 TRANSPLANT SERVICES5210026 LEVEL 2 EST PATIENT $171.00 $131.00 52 TRANSPLANT SERVICES5220074 LEVEL 2 EST PATIENT $203.00 $131.00 52 TRANSPLANT SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5260641 LEVEL 2 EST PATIENT $87.00 52 TRANSPLANT SERVICES5260393 LEVEL 2 NEW PATIENT $203.00 52 TRANSPLANT SERVICES5260245 LEVEL 2 NEW PATIENT $87.00 52 TRANSPLANT SERVICES5260690 LEVEL 2 NEW PATIENT $203.00 52 TRANSPLANT SERVICES5260542 LEVEL 2 NEW PATIENT $203.00 52 TRANSPLANT SERVICES5230024 LEVEL 2 NEW PATIENT $171.00 $131.00 52 TRANSPLANT SERVICES5210398 LEVEL 2 NEW PATIENT $171.00 $131.00 52 TRANSPLANT SERVICES5260484 LEVEL 3 EST PATIENT $231.00 52 TRANSPLANT SERVICES5260187 LEVEL 3 EST PATIENT $231.00 52 TRANSPLANT SERVICES5260633 LEVEL 3 EST PATIENT $231.00 52 TRANSPLANT SERVICES5210067 LEVEL 3 EST PATIENT $195.00 $149.00 52 TRANSPLANT SERVICES5260336 LEVEL 3 EST PATIENT $231.00 52 TRANSPLANT SERVICES5220082 LEVEL 3 EST PATIENT $195.00 $149.00 52 TRANSPLANT SERVICES5230099 LEVEL 3 EST PATIENT $195.00 $149.00 52 TRANSPLANT SERVICES5260385 LEVEL 3 NEW PATIENT $231.00 52 TRANSPLANT SERVICES5260534 LEVEL 3 NEW PATIENT $231.00 52 TRANSPLANT SERVICES5260682 LEVEL 3 NEW PATIENT $231.00 52 TRANSPLANT SERVICES5260237 LEVEL 3 NEW PATIENT $231.00 52 TRANSPLANT SERVICES5210406 LEVEL 3 NEW PATIENT $195.00 $149.00 52 TRANSPLANT SERVICES5230032 LEVEL 3 NEW PATIENT $195.00 $149.00 52 TRANSPLANT SERVICES5260179 LEVEL 4 EST PATIENT $384.00 52 TRANSPLANT SERVICES5210075 LEVEL 4 EST PATIENT $324.00 $248.00 52 TRANSPLANT SERVICES5260625 LEVEL 4 EST PATIENT $384.00 52 TRANSPLANT SERVICES5260476 LEVEL 4 EST PATIENT $384.00 52 TRANSPLANT SERVICES5260328 LEVEL 4 EST PATIENT $384.00 52 TRANSPLANT SERVICES5220090 LEVEL 4 EST PATIENT $324.00 $248.00 52 TRANSPLANT SERVICES5230107 LEVEL 4 EST PATIENT $324.00 $248.00 52 TRANSPLANT SERVICES5260674 LEVEL 4 NEW PATIENT $346.00 52 TRANSPLANT SERVICES5260229 LEVEL 4 NEW PATIENT $384.00 52 TRANSPLANT SERVICES5260377 LEVEL 4 NEW PATIENT $384.00 52 TRANSPLANT SERVICES5210034 LEVEL 4 NEW PATIENT $324.00 $248.00 52 TRANSPLANT SERVICES5260526 LEVEL 4 NEW PATIENT $384.00 52 TRANSPLANT SERVICES5230057 LEVEL 4 NEW PATIENT $324.00 $248.00 52 TRANSPLANT SERVICES5260161 LEVEL 5 EST PATIENT $412.00 52 TRANSPLANT SERVICES5210083 LEVEL 5 EST PATIENT $348.00 $266.00 52 TRANSPLANT SERVICES5260617 LEVEL 5 EST PATIENT $412.00 52 TRANSPLANT SERVICES5260310 LEVEL 5 EST PATIENT $412.00 52 TRANSPLANT SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

5230115 LEVEL 5 EST PATIENT $412.00 $266.00 52 TRANSPLANT SERVICES5220108 LEVEL 5 EST PATIENT $348.00 $266.00 52 TRANSPLANT SERVICES5260468 LEVEL 5 EST PATIENT $412.00 52 TRANSPLANT SERVICES5210042 LEVEL 5 NEW PATIENT $348.00 $266.00 52 TRANSPLANT SERVICES5260369 LEVEL 5 NEW PATIENT $468.00 52 TRANSPLANT SERVICES5260211 LEVEL 5 NEW PATIENT $412.00 52 TRANSPLANT SERVICES5260666 LEVEL 5 NEW PATIENT $468.00 52 TRANSPLANT SERVICES5260518 LEVEL 5 NEW PATIENT $468.00 52 TRANSPLANT SERVICES5230065 LEVEL 5 NEW PATIENT $348.00 $266.00 52 TRANSPLANT SERVICES5250006 PANCREAS ACQUISITION $47,191.00 $44,520.00 52 TRANSPLANT SERVICES5260724 PULMONARY STRESS SIMPLE $3,492.00 $1,577.00 52 TRANSPLANT SERVICES5260740 VAD BATERY CLIPS RPLCMNT $1,530.00 52 TRANSPLANT SERVICES5260799 VAD BATT CHARGR COMBO RPL $10,800.00 52 TRANSPLANT SERVICES5260716 VAD BATTERY OT LITH REPL $2,000.00 52 TRANSPLANT SERVICES5260757 VAD BELT/VEST/BAG REPL $1,678.75 52 TRANSPLANT SERVICES5260856 VAD BELT/VEST/BAG REPL $400.00 52 TRANSPLANT SERVICES5260872 VAD LITH-ION BATTERY REPL $800.00 52 TRANSPLANT SERVICES5260773 VAD MICRPRSR CU COMBO REP $11,250.00 52 TRANSPLANT SERVICES5260849 VAD MICRPRSR CU ELEC REP $13,500.00 52 TRANSPLANT SERVICES5260864 VAD MONITOR ELEC/PNEU RPL $3,500.00 52 TRANSPLANT SERVICES5260815 VAD MONTR CBL ELC/PNU RPL $1,275.00 52 TRANSPLANT SERVICES5260831 VAD MONTR CBL ELC/PNU RPL $1,700.00 52 TRANSPLANT SERVICES5260807 VAD PWR MOD CABLE REPLMNT $3,325.00 52 TRANSPLANT SERVICES5260823 VAD PWR MOD DC INPUT CAB $926.25 52 TRANSPLANT SERVICES5260781 VAD PWR MODULE REPLCMNT $14,700.00 52 TRANSPLANT SERVICES5260765 VAD SHOWER COVER RPLCMNT $1,912.50 52 TRANSPLANT SERVICES5260732 VAD STABLIZATION BELT REP $425.00 52 TRANSPLANT SERVICES2400042 CATH BLN DILATE NOVSC $935.00 242400034 CATH BLN DILATE NOVSC $1,117.00 242400331 CATH BLN DILATE NOVSC $973.25 242400315 CATH BLN DILATE NOVSC $616.25 242400422 CATH BLN DILATE NOVSC $255.00 242400968 CATH BLN DILATE NOVSC $956.25 242400760 CATH DRAINAGE $919.00 242420917 CON TISS HUMAN INC FASCIA $8,358.00 242421972 CON TISS HUMAN INC FASCIA $6,240.00 242420909 CON TISS HUMAN INC FASCIA $3,953.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2420891 CON TISS HUMAN INC FASCIA $2,467.50 242421980 CON TISS HUMAN INC FASCIA $9,747.00 242421964 CON TISS HUMAN INC FASCIA $3,250.00 242421048 CONN TISS NON-HUMAN $905.25 242421956 CONN TISS NON-HUMAN $11,844.00 242421337 GEN NRSTIM RECHG BAT SY $23,250.00 242421360 GEN NRSTIM RECHG BAT SY $27,750.00 242421345 GEN NRSTIM RECHG BAT SY $24,750.00 242421352 GEN NRSTIM RECHG BAT SY $26,250.00 242421188 GENERATOR NEURO NO-RECHRG $27,983.00 242421295 GENERATOR NEURO NO-RECHRG $21,750.00 242421279 GENERATOR NEURO NO-RECHRG $18,750.00 242421808 GENERATOR NEURO NO-RECHRG $27,735.00 242421261 GENERATOR NEURO NO-RECHRG $17,250.00 242421303 GENERATOR NEURO NO-RECHRG $23,250.00 242421311 GENERATOR NEURO NO-RECHRG $24,750.00 242421253 GENERATOR NEURO NO-RECHRG $15,750.00 242421246 GENERATOR NEURO NO-RECHRG $14,250.00 242421238 GENERATOR NEURO NO-RECHRG $12,750.00 242421329 GENERATOR NEURO NO-RECHRG $26,250.00 242421287 GENERATOR NEURO NO-RECHRG $20,250.00 242400570 GUIDEWIRE $679.00 242400620 GUIDEWIRE $764.25 242421196 IMP GRAFT VASCULAR $4,328.00 242422137 IMP GRAFT VASCULAR $5,208.00 242421022 IMP GRAFT VASCULAR $6,553.00 242420990 IMP GRAFT VASCULAR $1,279.25 242421006 IMP GRAFT VASCULAR $2,535.00 242421675 IMP GRAFT VASCULAR $6,898.00 242421014 IMP GRAFT VASCULAR $5,908.00 242421915 IMP GRAFT VASCULAR $2,184.00 $2,184.00 242422012 IMP GRAFT VASCULAR $4,238.00 242422020 IMP GRAFT VASCULAR $2,783.00 242421162 IMP GRAFT VASCULAR $3,008.00 242420230 IMP MESH $805.75 242421832 IMP MESH $4,508.00 242420404 IMP MESH $1,594.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2420982 IMP MESH $2,058.00 242420966 IMP MESH $1,777.00 242420958 IMP MESH $968.25 242421683 IMP MESH $974.25 242420644 IMP MESH $2,069.00 242420412 IMP MESH $1,908.00 242420396 IMP MESH $3,648.00 242420388 IMP MESH $5,403.00 242420370 IMP MESH $4,325.00 242420362 IMP MESH $1,739.00 242420354 IMP MESH $3,409.00 242420347 IMP MESH $2,692.00 242421030 IMP MESH $1,349.00 242420321 IMP MESH $612.25 242422038 IMP MESH $1,960.00 242420313 IMP MESH $793.25 242420305 IMP MESH $3,920.00 242420339 IMP MESH $1,824.00 242421097 IMP MESH $2,093.00 242421154 IMP MESH $4,027.00 242421121 IMP MESH $4,104.00 242421113 IMP MESH $3,002.00 242421147 IMP MESH $3,376.00 242421139 IMP MESH $2,191.00 242421089 IMP MESH $3,318.00 242421071 IMP MESH $2,256.00 242421063 IMP MESH $2,093.00 242421055 IMP MESH $1,526.00 242421105 IMP MESH $2,765.00 242420297 IMP PORT INDWELLING $2,095.00 242420289 IMP PORT INDWELLING $2,192.00 242420214 IMP PORT INDWELLING $1,466.25 242420875 IMP PORT INDWELLING $2,082.50 242421618 IMP PT PROGR NEUROSTIM $2,875.00 242421634 IMP PT PROGR NEUROSTIM $3,375.00 242421584 IMP PT PROGR NEUROSTIM $2,975.00 242421667 IMP PT PROGR NEUROSTIM $6,125.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2421600 IMP PT PROGR NEUROSTIM $2,625.00 242421659 IMP PT PROGR NEUROSTIM $5,875.00 242421642 IMP PT PROGR NEUROSTIM $3,625.00 242421568 IMP PT PROGR NEUROSTIM $2,275.00 242421816 IMP PT PROGR NEUROSTIM $2,433.00 242421626 IMP PT PROGR NEUROSTIM $3,125.00 242421576 IMP PT PROGR NEUROSTIM $2,625.00 242421592 IMP PT PROGR NEUROSTIM $3,325.00 242420784 IMP,BONE CEMENT $1,190.00 242422152 LD PCR NO TV VDD SNGL PAS $1,912.50 242421527 LEAD EXT PACING/NEUROSTIM $3,325.00 242421501 LEAD EXT PACING/NEUROSTIM $2,625.00 242421519 LEAD EXT PACING/NEUROSTIM $2,975.00 242421493 LEAD EXT PACING/NEUROSTIM $2,275.00 242421535 LEAD EXT PACING/NEUROSTIM $3,975.00 242421485 LEAD NEUROSTIMULATOR $9,225.00 242421436 LEAD NEUROSTIMULATOR $7,375.00 242421477 LEAD NEUROSTIMULATOR $8,925.00 242421469 LEAD NEUROSTIMULATOR $9,625.00 242421444 LEAD NEUROSTIMULATOR $7,625.00 242421428 LEAD NEUROSTIMULATOR $6,875.00 242421410 LEAD NEUROSTIMULATOR $6,625.00 242421402 LEAD NEUROSTIMULATOR $5,875.00 242421394 LEAD NEUROSTIMULATOR $5,125.00 242421386 LEAD NEUROSTIMULATOR $4,875.00 242421378 LEAD NEUROSTIMULATOR $3,375.00 242421451 LEAD NEUROSTIMULATOR $8,875.00 249450537 LYMPHOCYTE IGG 500MG 949450487 LYMPHOCYTE IGG 500MG 949450495 LYMPHOCYTE IGG 500MG 949450503 LYMPHOCYTE IGG 500MG 949450511 LYMPHOCYTE IGG 500MG 949450529 LYMPHOCYTE IGG 500MG 949450545 LYMPHOCYTE IGG 500MG 949450552 LYMPHOCYTE IGG 500MG 949450560 LYMPHOCYTE IGG 500MG 949450578 LYMPHOCYTE IGG 500MG 94

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

9450586 LYMPHOCYTE IGG 500MG 949450594 LYMPHOCYTE IGG 500MG 949450602 LYMPHOCYTE IGG 500MG 949450628 LYMPHOCYTE IGG 500MG 949470675 LYMPHOCYTE IGG 500MG 942421543 NEUROSTIM LEAD TEST KIT $3,375.00 242421550 NEUROSTIM LEAD TEST KIT $3,625.00 242420826 REP DEV URINARY W/SLING $3,025.00 242421170 REP DEV URINARY W/SLING $2,590.00 242421725 S ANCHR CORKSCREW $1,041.25 242420750 S GRAFT VASCULAR $17,250.00 242420073 S IMP ACHILLES TNDN W/CAL $3,478.00 242422095 S IMP ADAPT $3,465.00 242422087 S IMP ADAPT $2,103.75 242421840 S IMP ANTERIOR VAG $4,588.00 242420222 S IMP AUTO CULT CHONDRCYT $32,640.00 242420636 S IMP BAHA ABUTMENT W/FLA $5,014.00 242420628 S IMP BAHA SOUND PROCESSO $7,023.00 242420859 S IMP BONE $2,690.00 242421758 S IMP BONE $3,025.00 242421741 S IMP BONE $3,455.00 242421691 S IMP BONE $2,975.00 242420867 S IMP BONE $3,024.00 242420842 S IMP BONE $2,793.00 242421220 S IMP BONE $2,663.50 242421212 S IMP BONE $2,303.00 242421204 S IMP BONE $2,166.50 242420586 S IMP BONE FIBULA SHAFT $2,083.00 242420925 S IMP BONE GRAFT $3,185.00 242420669 S IMP BONE GRAFT OP-1 $12,188.00 242421998 S IMP BONE MATRIX $3,476.00 242421824 S IMP BONE MATRIX $1,820.00 242420818 S IMP BONE MATRIX $3,310.00 242421949 S IMP BONE SPACER $8,075.00 242421931 S IMP BONE SPACER $10,100.00 242421923 S IMP BONE SPACER $3,330.00 242421899 S IMP BONE SPACER $3,330.00 $3,140.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2420065 S IMP B-T-B-HEMI W/O QUAD $5,418.00 242420883 S IMP CATH LUMBAR $726.25 242420594 S IMP CATH VENT EVD ANTIB $1,503.50 242422004 S IMP CEMENT $1,577.25 242420719 S IMP CEMENT BONE IMPACT $3,194.00 242420651 S IMP CEMENT SMART SET $1,103.25 242400778 S IMP CLOSURE VASC $680.00 242420743 S IMP EAR STAPES PISTON $896.50 242420768 S IMP FOAM PACK VITOSS 5C $2,608.00 242420776 S IMP FOAM PK VITOSS 10C $3,725.00 242420701 S IMP GRAFT CHAMBER I/C 1 $3,925.00 242420693 S IMP GRAFT CHAMBER I/C 1 $2,613.00 242420685 S IMP GRAFT CHAMBER I/C 5 $1,960.00 242420420 S IMP GRAFT TISSUE CELLEC $4,863.00 242420578 S IMP GRAFTON FLEX $3,350.00 242420008 S IMP GRANULES CERAMIC RE $2,410.00 242420248 S IMP HEALOS II 1-STRIP $2,856.00 242421717 S IMP INFUSE $4,315.00 242421709 S IMP INFUSE $3,066.00 242420172 S IMP LEAD ANCHOR SLEEVE $213.00 242422103 S IMP LEAD ECT $828.75 242422079 S IMP MASTERGRAFT $9,625.00 242422061 S IMP MASTERGRAFT $3,150.00 242422053 S IMP MASTERGRAFT $2,646.00 242422046 S IMP MASTERGRAFT $1,003.00 242421782 S IMP MESH $1,185.75 242421857 S IMP PELVIC FLOOR $5,450.00 242422111 S IMP PF REPAIR KIT $4,638.00 242421733 S IMP PUTTY $850.00 242420974 S IMP PUTTY $1,717.00 242420941 S IMP PUTTY $2,758.00 242421865 S IMP PUTTY 10CC $10,500.00 242421873 S IMP PUTTY 5CC $5,563.00 242420677 S IMP PUTTY TCP 15CC $2,975.00 242421790 S IMP RPR URN INCN SLNG $3,850.00 242420800 S IMP SHUNT PROGRAMMABLE $9,996.00 242420529 S IMP SHUNT STRATA UNITIZ $9,465.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2420164 S IMP SILO VENTRAL WALL $1,062.50 242420727 S IMP SLING SYS SPARC $3,025.00 242400026 S IMP STENT BLR FLEXIMA $510.00 242420453 S IMP STENT GRAFT CONVERS $5,618.00 242420446 S IMP STENT GRAFT ILIAC L $7,584.00 242420461 S IMP STENT GRAFT ILIAC L $4,214.00 242420438 S IMP STENT GRAFT MAIN BO $12,472.00 242420479 S IMP STENT GRAFT MAIN BO $4,214.00 242420487 S IMP STENT GRAFT OCCLUDE $3,343.00 242420271 S IMP STENT GRFT EXT $6,523.00 242420503 S IMP STNT GRFT LEG CONTR $9,373.00 242420495 S IMP STNT GRFT TRUNK IPS $12,179.00 242420834 S IMP TENDON $4,088.00 242422129 S IMP VAG SUPPORT $4,763.00 242420735 S MESH IMPLANT $1,976.00 242400083 S STRL BALLOON CATH $453.00 242401040 S STRL BASKET $315.50 242400646 S STRL BIOP FORCEP $171.00 242400190 S STRL BIOP FORCEP LYNX $57.25 242400232 S STRL CAN ERCP CONTOUR $213.75 242400927 S STRL CANNULA NASAL $4.75 242401065 S STRL CATH ACCESS $2,660.00 242400885 S STRL CATH ANAL MANOMETR $223.25 242400877 S STRL CATH BALLOON DIL $531.25 242400893 S STRL CATH BALLOON DIL $998.75 242400976 S STRL CATH MOTILITY $255.00 242400398 S STRL CATH PH 2-SENSOR $246.50 242400406 S STRL CATH PH SL SENSOR $185.25 242400257 S STRL CATH TANDEM XL $250.75 242400059 S STRL CLOTEST $37.50 242400356 S STRL COLON DECOMP SET $574.50 242400828 S STRL ENDO SMARTCAP $63.00 242400299 S STRL ERCP CAN METAL TIP $118.75 242400950 S STRL FORCEP $86.75 242401008 S STRL FORCEP $185.00 242401024 S STRL FORCEP $552.50 242401073 S STRL FORCEP $2,104.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2400992 S STRL FORCEP $97.25 242401016 S STRL FORCEP $254.75 242401032 S STRL FORCEP $189.75 242400695 S STRL FTR MEMBRANE APC $53.00 242400125 S STRL GASTMY TUBE $235.50 242400562 S STRL GASTRIC LAVAGE KIT $45.00 242400539 S STRL GUIDE WIRE TRACER $387.00 242400901 S STRL GUIDEWIRE SUPRACOR $340.00 242400471 S STRL HEATER PROBE $510.00 242400380 S STRL INDIA INK IN SOL $104.50 242400984 S STRL INFLAT DVC $301.75 242400844 S STRL INJ GOLD PROBE $913.75 242400943 S STRL INTRO SYS $321.75 242400133 S STRL JEJUNAL FEED TUBE $573.75 242400273 S STRL LIGATOR SUPERVIEW $584.50 242400679 S STRL LITHOTRIPTOR CABLE $567.75 242400166 S STRL LITHOTRIPTOR MECH $1,363.25 242400737 S STRL LOCKING DEV $49.00 242400430 S STRL NASAL BLR DRAINAGE $476.00 242400463 S STRL NDL KNIFE HUIBR $573.75 242400935 S STRL OVERTUBE $701.25 242400596 S STRL PEG CLEANING BRUSH $52.50 242400075 S STRL PEG KIT $397.50 242400661 S STRL POLYP RETRIEVAL $382.50 242400109 S STRL POLYPECTOMY SNARE $99.00 242401057 S STRL PROBE $1,530.00 242400687 S STRL PROBE FLEXIBLE APC $882.75 242400711 S STRL RET BSKT TRAPEZOID $1,100.75 242400067 S STRL SCLEROTHERAPY NDL $171.00 242400786 S STRL SPHINCTERTOME $1,936.00 242400240 S STRL STONETOME SHORTNOS $1,270.75 242400372 S STRL SUC POLYP TRAP $43.25 242400307 S STRL SYR/GAUGE ASSY $142.50 242401081 S STRL TUBING $133.00 242400489 S STRL WIRE BSKT SOFT $659.50 242401099 STENT COATD/COV W/DEL SYS $5,375.00 242401107 STENT COATD/COV W/DEL SYS $5,948.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

DEPARTMENT CODE

2400018 STENT NOCOAT W DEL SYS $3,475.00 242400869 STENT NOCOAT W DEL SYS $5,625.00 242401115 STENT NOCOAT W DEL SYS $4,125.00 242401123 STENT NOCOAT W DEL SYS $548.25 242400851 STENT NOCOAT W DEL SYS $3,988.00 242400752 STENT NOCOAT W DEL SYS $476.00 242400703 STENT NOCOAT W DEL SYS $5,988.00 242421881 SYNTHETIC IMP URINARY 1ML $1,352.75 $1,275.00 242420537 SYNTHETIC IMP URINARY 1ML $4,523.00 242422145 SYNTHETIC IMP URINARY 1ML $1,105.00 243319449 TIGECYCLINE 1MG IJ 330773002 US AMNIOCENTESIS $333.00 $408.00 070774604 US BIO PROFILE W NONSTRES $266.00 $266.00 070774745 US FETAL TRANSFUSION IUT $2,047.00 070774638 US OB AFTR 1ST TRI 1 GEST $375.00 $375.00 070774729 US OB AFTR 1ST TRI EA GES $507.00 $655.00 070774695 US OB FU/REEVAL EA FETUS $285.00 $368.00 070774737 US OB LTD 1/MORE FETUSES $462.00 $596.00 07

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AB 1045 - List of 25 CommonOutpatient Procedures for 2011

AB 1045 (May 2011)

Hospital Name: Sutter General Hospital-SMCOSHPD Facility No: 106341051Effective Date of Charges: June 1, 2011Evaluation & Management Services (CPT Codes 99201-99499)

Emergency Room Visit, Level 2 99282 794.00Emergency Room Visit, Level 3 99283 1,322.00Emergency Room Visit, Level 4 99284 2,025.00Laboratory & Pathology Services (CPT Codes 80048-89356)

Basic Metabolic Panel 80048 225.00Comprehensive Metabolic Panel 80053 284.00Lipid Panel 80061 364.00Creatine Kinase (CK), (CPK), Total 82550 172.00Blood Gas Analysis, including 02 saturation 82805 845.00Thyroid Stimulating Hormone 84443 450.00Troponin, Quantitative 84484 265.00Complete Blood Count, with differential WBC, automated 85025 205.00Complete Blood Count, automated 85027 172.00Prothrombin Time 85610 106.00Partial Thromboplastin Time 85730 159.00Radiology Services (CPT Codes 70010-79999)

CT Scan, Head or Brain, without contrast 70450 2,507.00X-Ray, Chest, two views 71020 220.00X-Ray, Lumbo Sacral, four views 72110 422.00CT Scan, Pelvis, with contrast 72193 3,821.00CT Scan, Abdomen, with contrast 74160 4,348.00Ultrasound, Abdomen, Complete 76700 911.00Ultrasound, OB, 14 weeks or more, single fetus, transabdominal 76805 911.00Mammography, Screening, Bilateral 77057Medicine Services (CPT Codes 90281-99607)

Electrocardiogram 12 Lead Tracing Only 93005 262.00Echocardiography, complete 93307 1,957.00Inhalation Treatment, pressurized or nonpressurized 94640 250.00Surgery Services (CPT Codes 10021-69990)

Arthroscopy, Knee, with meniscectomy (medial or lateral) 29881 19,535.70Arthroscopy, Shoulder, with partial acromioplasty 29826 28,540.72Carpal Tunnel Surgery 64721 15,036.40Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984Colonoscopy, diagnostic 45378 3,036.69Colonoscopy, with biopsy 45380Colonoscopy, with lesion removal, by snare technique 45385Discission, secondary membranous cataract, laser surgery 66821Endoscopy, Upper GI, with biopsy 43239Endoscopy, Upper GI, diagnostic 43235 4,442.48Excision, Breast Lesion 19120 16,803.19Hernia Repair, Inguinal, 5 years and older 49505 21,135.17Injection, Diagnostic or Therapeutic substance, epidural, sacral 62311 8,695.43Injection, Anesthetic or Steroid, transforaminal epidural, sacral 64483 5,005.24Laparoscopic Cholecystectomy 47562 22,833.01Tympanostomy (insert ventilating tube, general anesthesia) 69436Tonsillectomy with Adenoidectomy, less than 12 years old 42820Count of Reported Procedures (minimum 25 required) 34

2011 CPT Code

Outpatient Charge Amount

2011 CPT Code

2011 CPT Code

2011 CPT Code

2011 CPT Code

Average Charge Amount

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BILLING DESCRIPTION DEPARTMENT DESCRIPTION

1711746 AD HEAR AID REPAIR $250.00 17 AMBULATORY SERVICES (MISC1711753 AD HEAR AID REPAIR $500.00 17 AMBULATORY SERVICES (MISC1790278 HA BATTERIES (EACH) $0.70 17 AMBULATORY SERVICES (MISC4740106 AB ELUTION $184.00 $184.00 47 BLOOD SERVICES4740056 AB ID $170.00 $170.00 47 BLOOD SERVICES4740064 AB SCRN $50.00 $50.00 47 BLOOD SERVICES4740007 ABO TYP $20.00 $20.00 47 BLOOD SERVICES4740114 AG TYP PT RBC EA 47 BLOOD SERVICES4720090 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721270 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721122 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721130 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721148 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721155 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721163 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721171 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721189 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721197 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721205 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721213 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721221 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721239 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721247 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721411 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721338 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720785 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721395 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721387 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721379 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721361 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721254 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721346 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721262 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721320 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721312 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721304 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721296 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721288 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721098 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721353 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720850 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721114 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720918 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES

CHARGE CODE

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DEPARTMENT CODE

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4720900 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720892 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720884 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720934 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720868 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720942 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720843 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720835 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720827 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720819 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720801 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720793 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720876 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721023 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721429 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721080 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721072 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721064 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721056 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720926 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721031 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721106 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721015 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721007 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720074 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720983 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720967 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720959 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721049 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721908 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721759 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721767 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721775 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721783 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721791 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721809 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721817 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721825 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721833 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721841 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721858 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721866 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4721874 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES

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4720165 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720173 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720181 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720199 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720207 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720082 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720686 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720579 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720587 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720595 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720603 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720611 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720629 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720637 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720645 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720769 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720561 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720678 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720652 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720694 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720702 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720710 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720728 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720736 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720744 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720751 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720447 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720116 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720660 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720496 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720454 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720462 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720470 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720488 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720553 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720504 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720512 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720520 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720546 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4720538 ALLERGEN SPECIFIC IGE QN $30.48 47 BLOOD SERVICES4740635 ALT (SGPT) $30.00 $30.00 47 BLOOD SERVICES4730016 APHERESIS RBC $950.00 $950.00 47 BLOOD SERVICES4730008 APHERESIS WBC $950.00 $950.00 47 BLOOD SERVICES

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4722344 ASSAY TEST BLOOD FECAL $88.88 47 BLOOD SERVICES4722096 BETA HCG QN $87.92 47 BLOOD SERVICES4740122 BLOOD TYPE ANTGN DONOR EA 47 BLOOD SERVICES4722146 CA 15 3 (27.29) $116.28 47 BLOOD SERVICES4722138 CA 19 9 $121.52 47 BLOOD SERVICES4722229 CARDIOLIPIN IGA AB $145.56 47 BLOOD SERVICES4722211 CARDIOLIPIN IGG AB $148.56 47 BLOOD SERVICES4722203 CARDIOLIPIN IGM AB $148.56 47 BLOOD SERVICES4740627 CMV AB $42.00 $42.00 47 BLOOD SERVICES4740643 CMV AB $35.00 $35.00 47 BLOOD SERVICES4740130 COMPATIBILITY TEST AHG 47 BLOOD SERVICES4740080 COMPATIBILITY TEST AHG $65.00 $65.00 47 BLOOD SERVICES4722112 C-PEPTIDE $121.52 47 BLOOD SERVICES4710091 CRYO PS $109.00 $109.00 47 BLOOD SERVICES4722187 CULT HERPES $152.24 47 BLOOD SERVICES4722328 CULT LEGIONELLA $50.28 47 BLOOD SERVICES4740320 CYTOTOXIC AB SCRN STND $190.00 $190.00 47 BLOOD SERVICES4740312 CYTOTOXIC PRA SCRN QUICK $120.00 $120.00 47 BLOOD SERVICES4722047 DHEA SULFATE $129.84 47 BLOOD SERVICES4722195 DRG SCRN MULTI CLASS IMM $80.44 47 BLOOD SERVICES4722104 ERYTHROPOIETIN $109.80 47 BLOOD SERVICES4710463 FFP DR PS $396.00 47 BLOOD SERVICES4710471 FFP DR PS $44.00 47 BLOOD SERVICES4710455 FFP DR PS $132.00 47 BLOOD SERVICES4710117 FFP PS $379.00 $379.00 47 BLOOD SERVICES4710109 FFP PS $109.00 $109.00 47 BLOOD SERVICES4710125 FFP PS $52.00 $52.00 47 BLOOD SERVICES4710497 FFP PS $96.00 47 BLOOD SERVICES4710489 FFP SD PS $150.00 47 BLOOD SERVICES4740478 FRZN BLD FREEZING W PREP $1,180.00 $1,180.00 47 BLOOD SERVICES4722088 GROWTH HORMONE $97.36 47 BLOOD SERVICES4740684 HB CORE AB TOTAL $40.00 $40.00 47 BLOOD SERVICES4740692 HBS AB $40.00 $40.00 47 BLOOD SERVICES4740700 HBs AG $40.00 $40.00 47 BLOOD SERVICES4740718 HCV AB $45.00 $45.00 47 BLOOD SERVICES4740726 HCV AB CONF $75.00 $75.00 47 BLOOD SERVICES4740247 HLA TYP A B C MULTI AG $100.00 $100.00 47 BLOOD SERVICES4740189 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740205 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740197 HLA TYP A B C MULTI AG $225.00 $225.00 47 BLOOD SERVICES4740254 HLA TYP A B OR C SGL $50.00 $50.00 47 BLOOD SERVICES4740213 HLA TYPE DR/DQ MULTI AG $335.00 $335.00 47 BLOOD SERVICES4740221 HLA TYPE DR/DQ MULTI AG $335.00 $335.00 47 BLOOD SERVICES

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4740650 HTLV 1 AB $40.00 $40.00 47 BLOOD SERVICES4722062 IGF-1 $124.16 47 BLOOD SERVICES4722070 IGFBP 3 $78.92 47 BLOOD SERVICES4722120 INSULIN $66.76 47 BLOOD SERVICES4722336 LDL BY DIRECT MEASURE $55.72 47 BLOOD SERVICES4710422 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710430 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710414 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4710406 LEUK TRANSFUSION $920.00 $774.00 47 BLOOD SERVICES4740346 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740338 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740353 LYMPHOCYTOTOX TTR $60.00 $60.00 47 BLOOD SERVICES4740239 MOL DX AMP TR N ACD EA SQ 47 BLOOD SERVICES4722237 MYOGLOBIN $75.44 47 BLOOD SERVICES4710166 PHER L/D HLA MATCHED PS $1,338.00 $1,338.00 47 BLOOD SERVICES4710182 PHER L/D HLA MATCHED PS $949.00 $949.00 47 BLOOD SERVICES4710174 PHER L/D HLA MATCHED PS $453.00 $453.00 47 BLOOD SERVICES4710190 PHER L/D PS $902.00 $902.00 47 BLOOD SERVICES4710158 PHER PS $902.00 $902.00 47 BLOOD SERVICES4710141 PLTC L/D PS $112.00 $112.00 47 BLOOD SERVICES4710133 PLTC PS $99.00 $99.00 47 BLOOD SERVICES4722153 PSA TOTAL $107.40 47 BLOOD SERVICES4710257 RBC L/D DG/WASHED PS $293.00 $293.00 47 BLOOD SERVICES4710034 RBC L/D DG/WASHED PS $395.00 $395.00 47 BLOOD SERVICES4710216 RBC L/D DG/WASHED PS 47 BLOOD SERVICES4710042 RBC L/D PS $320.00 $320.00 47 BLOOD SERVICES4740072 RBC PRETRTMT CHEM/DRG $105.00 $105.00 47 BLOOD SERVICES4740890 RBC PRETRTMT DENSITY GRAD $200.00 $200.00 47 BLOOD SERVICES4710208 RBC PS $150.00 $150.00 47 BLOOD SERVICES4710000 RBC PS $306.00 $306.00 47 BLOOD SERVICES4710240 RBC PS 47 BLOOD SERVICES4710067 RBC PS $117.00 $117.00 47 BLOOD SERVICES4710059 RBC PS $107.00 $107.00 47 BLOOD SERVICES4710018 RBC PS $320.00 $320.00 47 BLOOD SERVICES4740015 RH TYP $20.00 $20.00 47 BLOOD SERVICES4710315 RHO D MINI 50MCG IJ $118.00 $118.00 47 BLOOD SERVICES4710323 RHO D MINI 50MCG IJ $32.25 $32.25 47 BLOOD SERVICES4710331 RHO D MINI 50MCG IJ $54.00 $54.00 47 BLOOD SERVICES4740668 RPR NON-TREPNML AB QL $30.00 $30.00 47 BLOOD SERVICES4722286 RUBEOLA AB IGG $75.24 47 BLOOD SERVICES4722294 RUBEOLA AB IGM $75.24 47 BLOOD SERVICES4740049 SER PRETRTMT ABSORB 47 BLOOD SERVICES4740031 SER PRETRTMT ABSORB 47 BLOOD SERVICES

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4722245 SICKLE CL SCRN $32.24 47 BLOOD SERVICES4740981 SPEC HANDL FEE 47 BLOOD SERVICES4740973 SPEC HANDL TO REF LAB 47 BLOOD SERVICES4722161 THYROGLOBULIN $93.80 47 BLOOD SERVICES4722302 THYROID PEROXIDASE AB $85.00 47 BLOOD SERVICES4740676 TOXOPLAS AB $42.00 $42.00 47 BLOOD SERVICES4722310 TREPONEMA PALLIDUM AB $77.36 47 BLOOD SERVICES4722054 TSH $98.12 47 BLOOD SERVICES4722252 VZV AB $75.24 47 BLOOD SERVICES4722260 VZV AB IGG $75.24 47 BLOOD SERVICES4722278 VZV AB IGM $75.24 47 BLOOD SERVICES4710026 WASHED RBC PS $345.00 $345.00 47 BLOOD SERVICES4710224 WB PS 47 BLOOD SERVICES4710083 WB PS $161.00 $161.00 47 BLOOD SERVICES4710075 WB PS $321.00 $321.00 47 BLOOD SERVICES4710232 WB PS 47 BLOOD SERVICES3569704 CA FLUOR CVAD PLC/RMV/RPR $1,826.00 35 CARDIAC CATH LAB SCH3560034 CA IVUS NONCO ADD $3,535.00 35 CARDIAC CATH LAB SCH3560026 CA IVUS NONCO INI $3,597.00 35 CARDIAC CATH LAB SCH3560851 CA PLACE OCC DEV VEIN ART $2,093.00 35 CARDIAC CATH LAB SCH3569688 CA PTA PULM ART EA ADDL $2,052.00 35 CARDIAC CATH LAB SCH3569670 CA PTA PULM ART SNGL $3,941.00 35 CARDIAC CATH LAB SCH3560059 CAC IVUS NONCO ADD $206.00 35 CARDIAC CATH LAB SCH3560042 CAC IVUS NONCO INI $281.00 35 CARDIAC CATH LAB SCH3560133 IRC FEM/POP REVSC ST/ATHR $43,411.00 $38,830.00 35 CARDIAC CATH LAB SCH3560117 IRC FEM/POPL REVAS W/ATHR $22,537.00 $21,470.00 35 CARDIAC CATH LAB SCH3560125 IRC FEM/POPL REVAS W/STNT $26,368.00 $22,052.00 35 CARDIAC CATH LAB SCH3560109 IRC FEM/POPL REVAS W/TLA $1,163.00 $959.00 35 CARDIAC CATH LAB SCH3560067 IRC ILIAC REVASC $3,878.00 $3,040.00 35 CARDIAC CATH LAB SCH3560083 IRC ILIAC REVASC ADD-ON $6,477.00 $5,671.00 35 CARDIAC CATH LAB SCH3560075 IRC ILIAC REVASC W/STENT $24,752.00 $20,400.00 35 CARDIAC CATH LAB SCH3560091 IRC ILIAC REVS W/STNT ADD $15,934.00 $13,609.00 35 CARDIAC CATH LAB SCH3560208 IRC TB/PR OP/PR REVS STNT $15,777.00 $13,640.00 35 CARDIAC CATH LAB SCH3560216 IRC TB/PR REVS STENT/ATHR $19,640.00 $17,201.00 35 CARDIAC CATH LAB SCH3560190 IRC TB/PR REVS W/ATHR ADD $10,183.00 $9,263.00 35 CARDIAC CATH LAB SCH3560174 IRC TIB/PER REVAS ST/ATHR $44,890.00 $39,826.00 35 CARDIAC CATH LAB SCH3560182 IRC TIB/PER REVASC ADD-ON $6,320.00 $5,702.00 35 CARDIAC CATH LAB SCH3560158 IRC TIB/PER REVASC W/ATHR $24,016.00 $22,466.00 35 CARDIAC CATH LAB SCH3560166 IRC TIB/PER REVASC W/STNT $28,926.00 $24,164.00 35 CARDIAC CATH LAB SCH3560141 IRC TIB/PER REVASC W/TLA $3,721.00 $3,071.00 35 CARDIAC CATH LAB SCH3620358 CA 2D TEE W-W/O F W/CON I $1,714.00 36 CARDIOLOGY/CARDIOVASCULAR3620333 CA 2D TTE W-W/O CON CMPLT $1,579.00 36 CARDIOLOGY/CARDIOVASCULAR3620341 CA 2D TTE W-W/O CON FU/LS $804.00 36 CARDIOLOGY/CARDIOVASCULAR

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3620069 CA ECHO 2D CMP NO SPC/DOP $2,271.00 $1,957.00 $838.00 $2,053.00 36 CARDIOLOGY/CARDIOVASCULAR3620226 CA ECHO 2D LTD $1,623.00 36 CARDIOLOGY/CARDIOVASCULAR3620200 CA ECHO CNGNITL ANOM CMPL $1,628.00 36 CARDIOLOGY/CARDIOVASCULAR3620002 CA ECHO DPPLER CMPL $1,007.00 $868.00 $120.00 $905.00 36 CARDIOLOGY/CARDIOVASCULAR3620036 CA ECHO DPPLER COLOR FLOW $780.00 $673.00 $416.00 36 CARDIOLOGY/CARDIOVASCULAR3620184 CA ECHO TRANSESOPHAGEAL $2,553.00 $2,553.00 $2,553.00 $2,553.00 36 CARDIOLOGY/CARDIOVASCULAR3620374 CA IJ IVP SME DRG EA >30M $220.00 36 CARDIOLOGY/CARDIOVASCULAR3620366 CA TEE W-W/O FL W/CON CCA $2,062.00 36 CARDIOLOGY/CARDIOVASCULAR3620390 CA TTE DPLR CMPLT WO CON $2,783.00 $1,537.25 36 CARDIOLOGY/CARDIOVASCULAR3620317 CA TTE W-W/O FL W/CON COM $1,628.00 36 CARDIOLOGY/CARDIOVASCULAR3620325 CA TTE W-W/O FL W/CON F/U $834.00 36 CARDIOLOGY/CARDIOVASCULAR3620010 CARDIAC STRESS TEST $983.00 $352.00 $340.00 $1,334.00 36 CARDIOLOGY/CARDIOVASCULAR3620051 EKG 12 LEAD TRACING $301.00 $108.00 $152.00 $408.00 36 CARDIOLOGY/CARDIOVASCULAR3620044 EKG 1-3 LEAD TRACING ONLY $148.00 $53.00 $96.00 $201.00 36 CARDIOLOGY/CARDIOVASCULAR3620143 EKG SIGNAL AVERAGED $1,419.00 $509.00 $395.00 $1,926.00 36 CARDIOLOGY/CARDIOVASCULAR3620085 EXT ECG CONT RCRD/STR 48H $689.00 $247.00 $437.00 $935.00 36 CARDIOLOGY/CARDIOVASCULAR3620309 INJ IVP SAME DRG EA >30M $238.00 36 CARDIOLOGY/CARDIOVASCULAR3417185 CA PLACE OCC DEV VEIN ART $2,093.00 34 CATH LAB SCH3412962 CAC INS/REP LEADS INS PG $15,158.00 34 CATH LAB SCH3412665 CAC SC/DC ICD GENRATR CHG $15,350.00 34 CATH LAB SCH3450509 EVENT RECORDER CARDIAC $10,441.00 34 CATH LAB SCH3451028 IMP FILTER VENA CAVA $3,200.00 34 CATH LAB SCH3472032 IMP FILTER VENA CAVA $2,854.00 34 CATH LAB SCH3471935 IMP FILTER VENA CAVA $3,213.00 34 CATH LAB SCH3452240 LEAD PMKR TRANSVENOUS VDD $1,450.00 34 CATH LAB SCH3472784 S INV DVC CHOICE P040012 $5,758.00 34 CATH LAB SCH3459971 S INV DVC COATED WDEL SYS $7,163.00 34 CATH LAB SCH3442787 S INV DVC DEFINITIVE CA++ $7,487.50 34 CATH LAB SCH3472750 S INV DVC NOCOAT WDEL SYS $3,325.00 34 CATH LAB SCH3462231 S STRL ANGIOJET PUMPSET $1,074.00 34 CATH LAB SCH3460581 S STRL BIL SD 5X15 150 34 CATH LAB SCH3460524 S STRL BIL SD 5X15 90 34 CATH LAB SCH3460599 S STRL BIL SD 5X19 150 34 CATH LAB SCH3460532 S STRL BIL SD 5X19 90 34 CATH LAB SCH3460664 S STRL BIL SD 6X14 150 34 CATH LAB SCH3460540 S STRL BIL SD 6X14 90 $2,625.00 34 CATH LAB SCH3460615 S STRL BIL SD 6X18 150 34 CATH LAB SCH3460649 S STRL BIL SD 6X18 90 34 CATH LAB SCH3460623 S STRL BIL SD 7X15 150 34 CATH LAB SCH3460565 S STRL BIL SD 7X15 90 34 CATH LAB SCH3460631 S STRL BIL SD 7X19 150 34 CATH LAB SCH3460573 S STRL BIL SD 7X19 90 34 CATH LAB SCH3460672 S STRL PONT PLUG $425.00 34 CATH LAB SCH

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SEQ 300 AMOUNT

DEPARTMENT CODE

3470101 STENT COATD/COV W/DEL SYS $2,282.00 34 CATH LAB SCH3472271 STENT COATD/COV W/DEL SYS $4,199.00 34 CATH LAB SCH3472297 STENT COATD/COV W/DEL SYS $7,163.00 34 CATH LAB SCH3472321 STENT COATD/COV W/DEL SYS $7,303.00 34 CATH LAB SCH3472396 STENT COATD/COV W/DEL SYS $5,750.00 34 CATH LAB SCH3471927 STENT COATD/COV W/DEL SYS $4,199.00 34 CATH LAB SCH3472354 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3472313 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472263 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472222 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3472198 STENT NOCOAT W DEL SYS $2,694.00 34 CATH LAB SCH3472404 STENT NOCOAT W DEL SYS $2,625.00 34 CATH LAB SCH3472347 STENT NOCOAT W DEL SYS $2,949.00 34 CATH LAB SCH3472370 STENT NOCOAT W DEL SYS $6,320.00 34 CATH LAB SCH3472362 STENT NOCOAT W DEL SYS $5,758.00 34 CATH LAB SCH3472172 STENT NOCOAT W DEL SYS $3,250.00 34 CATH LAB SCH3472289 STENT NOCOAT W DEL SYS $4,513.00 34 CATH LAB SCH3471125 STENT NOCOAT W DEL SYS $5,497.00 34 CATH LAB SCH3472164 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471976 STENT NOCOAT W DEL SYS $3,716.00 34 CATH LAB SCH3472156 STENT NOCOAT W DEL SYS $2,809.00 34 CATH LAB SCH3471950 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471943 STENT NOCOAT W DEL SYS $3,298.00 34 CATH LAB SCH3471893 STENT NOCOAT W DEL SYS $3,792.00 34 CATH LAB SCH3471992 STENT NOCOAT W DEL SYS $3,272.00 34 CATH LAB SCH3471133 STENT NOCOAT W DEL SYS $6,257.00 34 CATH LAB SCH3471984 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471117 STENT NOCOAT W DEL SYS $4,487.00 34 CATH LAB SCH3471109 STENT NOCOAT W DEL SYS $3,476.00 34 CATH LAB SCH3471075 STENT NOCOAT W DEL SYS $5,246.00 34 CATH LAB SCH3471059 STENT NOCOAT W DEL SYS $4,487.00 34 CATH LAB SCH3471042 STENT NOCOAT W DEL SYS $3,982.00 34 CATH LAB SCH3470051 STENT NOCOAT W DEL SYS $3,225.00 $3,042.00 34 CATH LAB SCH3470002 STENT NOCOAT W DEL SYS $3,301.00 $3,114.00 34 CATH LAB SCH3471828 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472008 STENT NOCOAT W DEL SYS $2,360.00 34 CATH LAB SCH3472016 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472024 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472081 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3472123 STENT NOCOAT W DEL SYS $4,831.00 34 CATH LAB SCH3472065 STENT NOCOAT W DEL SYS $3,638.00 34 CATH LAB SCH3472107 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH3471968 STENT NOCOAT W DEL SYS $1,208.00 34 CATH LAB SCH

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3472115 STENT NOCOAT W DEL SYS $6,728.00 34 CATH LAB SCH3472099 STENT NOCOAT W DEL SYS $3,301.00 34 CATH LAB SCH4800140 AB ELUTION $337.00 $337.00 $113.30 $317.00 48 CLINICAL LAB4800132 AB ID $516.00 $516.00 $381.25 $558.00 48 CLINICAL LAB4800124 AB SCRN $278.00 $278.00 $138.30 $317.00 48 CLINICAL LAB4800033 ABO TYP $79.00 $79.00 $63.85 $83.00 48 CLINICAL LAB4800520 ABO TYP $79.00 48 CLINICAL LAB4860052 ACETAMINOPHEN $542.00 $542.00 $23.00 $538.00 48 CLINICAL LAB4861506 AFP TUMOR MARKER $450.00 $4.95 48 CLINICAL LAB4800173 AG TYP PT RBC EA $99.00 $99.00 48 CLINICAL LAB4850103 ALBUMIN SERUM/PLASMA/BLD $132.00 $132.00 $6.96 $131.00 48 CLINICAL LAB4850111 ALBUMIN UR 24HR $139.00 48 CLINICAL LAB4860557 ALCOHOL (ETHANOL) $291.00 $291.00 $23.00 $290.00 48 CLINICAL LAB4860508 ALCOHOL (ETHANOL) UR $291.00 $291.00 $28.07 $290.00 48 CLINICAL LAB4850152 ALK PHOSPHATASE $139.00 $139.00 $7.28 $138.00 48 CLINICAL LAB4850202 ALT (SGPT) $139.00 $139.00 $7.44 $138.00 48 CLINICAL LAB4850251 AMMONIA $390.00 $390.00 $20.51 $386.00 48 CLINICAL LAB4860060 AMPHETAMINE SCRN $98.00 48 CLINICAL LAB4850301 AMYLASE $506.00 $506.00 $9.21 $485.00 48 CLINICAL LAB4850350 AMYLASE UR 2HR $506.00 $506.00 $5.75 $485.00 48 CLINICAL LAB4850400 AST (SGOT) $139.00 $139.00 $7.28 $138.00 48 CLINICAL LAB4820494 AUTO DIFF WBC COUNT $172.00 48 CLINICAL LAB4860078 BARBITURATES SCRN $98.00 48 CLINICAL LAB4852653 BASIC METBLC PNL TOTAL CA $225.00 $225.00 $11.91 $227.00 48 CLINICAL LAB4860086 BENZODIAZEPINE SCRN $98.00 48 CLINICAL LAB4850475 BILIRUBIN DIRECT $132.00 $132.00 $7.06 48 CLINICAL LAB4850509 BILIRUBIN NEONATAL $132.00 $132.00 $7.06 $131.00 48 CLINICAL LAB4820502 BLD SMR EXAM W MAN DIFF $93.00 $93.00 $112.15 $90.00 48 CLINICAL LAB4820528 BLD SMR EXAM WO MAN DIFF 48 CLINICAL LAB4830089 BLEEDING TIME TEST $1,012.00 $1,012.00 $144.60 $972.00 48 CLINICAL LAB4830097 BLEEDING TIME TEST $1,012.00 $1,012.00 $83.95 $972.00 48 CLINICAL LAB4840302 BODY FLUID PH NOS $93.00 $93.00 $5.75 $96.00 48 CLINICAL LAB4852950 BUN $106.00 $106.00 $5.56 $103.00 48 CLINICAL LAB4861753 C REACTIVE PROTEIN $139.00 $6.00 48 CLINICAL LAB4861548 CA 125 $556.00 $5.44 48 CLINICAL LAB4850657 CALCIUM $139.00 $139.00 $7.26 $138.00 48 CLINICAL LAB4850707 CALCIUM FLD $139.00 $139.00 $20.40 $138.00 48 CLINICAL LAB4850715 CALCIUM UR 24HR $159.00 48 CLINICAL LAB4860458 CANNABINOID SCRN $98.00 $98.00 $28.07 $94.00 48 CLINICAL LAB4860102 CARBAMAZEPINE TOTAL $390.00 $390.00 $20.49 $386.00 48 CLINICAL LAB4820106 CBC AUTO $172.00 $172.00 $14.40 $172.00 48 CLINICAL LAB4820205 CBC AUTO W AUTO DIFF WBC $205.00 $205.00 $10.94 $207.00 48 CLINICAL LAB4861563 CEA $509.00 $69.00 48 CLINICAL LAB

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SEQ 100 AMOUNT

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SEQ 300 AMOUNT

DEPARTMENT CODE

4840146 CELL CNT FLD W/ DIFF $145.00 $145.00 $32.65 $145.00 48 CLINICAL LAB4851002 CHLORIDE $126.00 $126.00 $6.47 $124.00 48 CLINICAL LAB4851150 CHLORIDE FLD $132.00 $132.00 $90.30 $131.00 48 CLINICAL LAB4860953 CHLORIDE SWEAT $132.00 $132.00 $398.75 $131.00 48 CLINICAL LAB4851200 CHLORIDE UR 24HR $132.00 $132.00 $20.70 $131.00 48 CLINICAL LAB4851259 CHOLESTEROL $119.00 $119.00 $6.13 $117.00 48 CLINICAL LAB4860151 CK MB FRACTION $311.00 $311.00 $16.25 $310.00 48 CLINICAL LAB4851309 CK TOTAL $172.00 $172.00 $9.17 $172.00 48 CLINICAL LAB4830105 CLOT RETRACTION $99.00 $99.00 $41.40 $96.00 48 CLINICAL LAB4851358 CO2 (BICARBONATE) $132.00 $132.00 $6.88 $131.00 48 CLINICAL LAB4860128 COCAINE SCRN $98.00 48 CLINICAL LAB4810065 COLD AGGLUTININ TTR $218.00 $218.00 48 CLINICAL LAB4800298 COMPATIBILITY TEST AHG $417.00 $417.00 $220.25 $400.00 48 CLINICAL LAB4800306 COMPATIBILITY TEST AHG $417.00 $417.00 $170.20 $400.00 48 CLINICAL LAB4800280 COMPATIBILITY TEST IS $463.00 $463.00 $220.25 $476.00 48 CLINICAL LAB4861738 COMPLEMENT C3 $324.00 $6.00 48 CLINICAL LAB4861746 COMPLEMENT C4 $324.00 $6.00 48 CLINICAL LAB4850970 COMPR MET PNL $284.00 $284.00 $14.87 48 CLINICAL LAB4800249 COOMBS DIRECT IG $145.00 $145.00 $120.75 $145.00 48 CLINICAL LAB4800231 COOMBS DIRECT POLY $145.00 $145.00 $120.75 $145.00 48 CLINICAL LAB4800157 COOMBS IND EACH AB TITER $139.00 $139.00 $154.70 $138.00 48 CLINICAL LAB4861589 CORTISOL TOTAL $436.00 $1.00 48 CLINICAL LAB4861811 C-REACTIVE PROTEIN HS $344.00 48 CLINICAL LAB4851408 CREATININE $139.00 $139.00 $7.22 $138.00 48 CLINICAL LAB4851481 CREATININE CLEARANCE $251.00 48 CLINICAL LAB4851457 CREATININE FLD $139.00 $139.00 $71.00 $138.00 48 CLINICAL LAB4851473 CREATININE UR 24HR $139.00 48 CLINICAL LAB4851465 CREATININE UR TIM $139.00 48 CLINICAL LAB4840153 CRYSTAL ID TISS/FLD NO UR $284.00 $284.00 $25.05 $303.00 48 CLINICAL LAB4861779 CYCLOSPORINE $483.00 48 CLINICAL LAB4830170 D DIMER QN $271.00 $87.11 48 CLINICAL LAB4830063 D DIMER SEMI QN/QL $192.00 $192.00 $87.10 $193.00 48 CLINICAL LAB4860201 DIGOXIN $357.00 $357.00 $18.69 $352.00 48 CLINICAL LAB4851507 ELECTROLYTE PNL FLD $185.00 $185.00 $9.87 $186.00 48 CLINICAL LAB4840187 EOSINOPHILS SMR NASAL $126.00 48 CLINICAL LAB4861597 ESTRADIOL (E2) $747.00 $6.00 48 CLINICAL LAB4870176 FERN TEST $124.00 48 CLINICAL LAB4861605 FERRITIN $364.00 $2.18 48 CLINICAL LAB4851523 FETAL FIBRONECTIN $1,726.00 $1,726.00 $170.00 48 CLINICAL LAB4820411 FETAL RBC SMR (K B) $205.00 $205.00 $6.10 $207.00 48 CLINICAL LAB4800264 FETAL SCRN ROSETTE $179.00 $179.00 $219.95 $179.00 48 CLINICAL LAB4830055 FIBRIN DEGRAD PROD $185.00 $185.00 $54.65 $186.00 48 CLINICAL LAB4830071 FIBRIN MONOMERS $231.00 $231.00 $46.50 $227.00 48 CLINICAL LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

4830022 FIBRINOGEN $225.00 $225.00 $37.95 $227.00 48 CLINICAL LAB4861621 FOLATE $390.00 $2.18 48 CLINICAL LAB4861225 FREE T4 $238.00 48 CLINICAL LAB4861647 FSH $496.00 $1.73 48 CLINICAL LAB4860656 GENTAMICIN $436.00 $436.00 $23.07 $434.00 48 CLINICAL LAB4851556 GGT $192.00 $192.00 $10.13 $193.00 48 CLINICAL LAB4851606 GLUCOSE $106.00 $106.00 $5.52 $103.00 48 CLINICAL LAB4851655 GLUCOSE CSF $106.00 $106.00 $11.50 $103.00 48 CLINICAL LAB4851754 GLUCOSE FLD $106.00 $106.00 $108.95 $103.00 48 CLINICAL LAB4851705 GLUCOSE UR QN $106.00 $106.00 $71.00 $103.00 48 CLINICAL LAB4851614 GTT 2HR 1ST 3 SPEC $344.00 48 CLINICAL LAB4851622 GTT ADDED SAMPLE $106.00 48 CLINICAL LAB4861373 HAV AB IGM $304.00 $12.93 48 CLINICAL LAB4861365 HAV AB TOTAL $331.00 $4.74 48 CLINICAL LAB4861381 HB CORE AB IGM $317.00 $15.21 48 CLINICAL LAB4861407 HBS AB $284.00 $2.96 48 CLINICAL LAB4861399 HBs AG $278.00 $4.03 48 CLINICAL LAB4861431 HBS AG NEUTRALIZATION $186.00 48 CLINICAL LAB4861415 HCV AB $384.00 $10.97 48 CLINICAL LAB4851770 HDL CHOLESTEROL $218.00 $218.00 48 CLINICAL LAB4820304 HEMATOCRIT $66.00 $66.00 $26.75 $62.00 48 CLINICAL LAB4820312 HEMATOCRIT SPUN $66.00 $66.00 $7.20 $62.00 48 CLINICAL LAB4820353 HEMOGLOBIN $66.00 $66.00 $26.75 $62.00 48 CLINICAL LAB4840161 HEMOGLOBIN F (APT) $159.00 $159.00 $108.40 48 CLINICAL LAB4861761 HEMOGLOBIN GLYCOSYLTD A1C $258.00 $13.66 48 CLINICAL LAB4830154 HEPARIN NEUTRALIZATION $317.00 $317.00 $12.65 $317.00 48 CLINICAL LAB4852000 HEPATIC FUNCTION PNL $218.00 $218.00 $11.49 $221.00 48 CLINICAL LAB4861423 HEPATITIS PNL ACUTE $1,237.00 $186.00 48 CLINICAL LAB4810057 HETEROPHILE AB SCRN $139.00 $139.00 $104.10 $138.00 48 CLINICAL LAB4861456 HIV 1/HIV 2 AB $364.00 $55.00 48 CLINICAL LAB4861464 HIV 1/HIV 2 AB $364.00 $150.00 48 CLINICAL LAB4861787 HOMOCYSTINE $450.00 48 CLINICAL LAB4851762 IGA $251.00 48 CLINICAL LAB4851788 IGG $251.00 48 CLINICAL LAB4851796 IGM $251.00 48 CLINICAL LAB4870119 INFLUENZA AG A OR B EACH $324.00 $324.00 $13.07 48 CLINICAL LAB4870127 INFLUENZA AG A OR B EACH $324.00 $324.00 $13.07 48 CLINICAL LAB4851804 IRON $172.00 $172.00 $9.12 $172.00 48 CLINICAL LAB4851812 IRON BINDING CAPACITY $231.00 48 CLINICAL LAB4800579 IRRADIATION BLD PROD EA $390.00 48 CLINICAL LAB4800488 IRRADIATION BLD PROD EA $390.00 $390.00 $56.95 $476.00 48 CLINICAL LAB4850053 KETONES QL $119.00 $119.00 $5.75 $117.00 48 CLINICAL LAB4851820 LACTIC ACID $284.00 48 CLINICAL LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

4851853 LDH $159.00 $159.00 $8.50 $159.00 48 CLINICAL LAB4851903 LDH FLD $159.00 $159.00 $7.05 $159.00 48 CLINICAL LAB4820460 LEUK ALK PHOS $231.00 $231.00 $134.55 $227.00 48 CLINICAL LAB4861662 LH $496.00 $1.73 48 CLINICAL LAB4861902 LIPASE $185.00 $6.00 48 CLINICAL LAB4851929 LIPID PNL $364.00 $364.00 $18.85 48 CLINICAL LAB4851952 LITHIUM $179.00 $179.00 $9.30 $179.00 48 CLINICAL LAB4852059 MAGNESIUM $179.00 $179.00 $9.43 $179.00 48 CLINICAL LAB4820296 MAN CELL CT EA $112.00 48 CLINICAL LAB4860706 METHOTREXATE $1,145.00 $1,145.00 $86.25 $1,099.00 48 CLINICAL LAB4840575 MICRO EXAM UR 48 CLINICAL LAB4852075 MICROALBUMIN UR RAN $152.00 $1.93 48 CLINICAL LAB4860854 NAPA ONLY $1,145.00 $1,145.00 $119.90 $1,099.00 48 CLINICAL LAB4861472 NATRIURETIC PEPTIDE $502.00 $47.77 48 CLINICAL LAB4899969 NEWBORN SCRN PANEL $6.00 $6.00 $6.00 $6.00 48 CLINICAL LAB4840252 OCCLT BLD STL QL MULT SPC $86.00 $86.00 $9.20 $90.00 48 CLINICAL LAB4860722 OPIATES SCRN $98.00 48 CLINICAL LAB4852109 OSMOLALITY SER $179.00 $179.00 $11.31 $179.00 48 CLINICAL LAB4852208 OSMOLALITY UR $185.00 $185.00 $25.00 $179.00 48 CLINICAL LAB4860748 PCP SCRN $98.00 48 CLINICAL LAB4860755 PHENOBARBITAL $304.00 $304.00 $16.12 $303.00 48 CLINICAL LAB4860805 PHENYTOIN TOTAL $357.00 $357.00 $18.66 $352.00 48 CLINICAL LAB4852257 PHOSPHORUS (PO4) $126.00 $126.00 $6.67 $124.00 48 CLINICAL LAB4830162 PLT AGGREGATION EA AGENT $668.00 $172.90 48 CLINICAL LAB4820270 PLT CNT AUTO $119.00 $16.00 48 CLINICAL LAB4852307 POTASSIUM $126.00 $126.00 $6.47 $124.00 48 CLINICAL LAB4852356 POTASSIUM FLD $126.00 $126.00 $71.00 $124.00 48 CLINICAL LAB4852372 POTASSIUM UR 24 HR $112.00 48 CLINICAL LAB4861910 PREALBUMIN $390.00 $390.00 48 CLINICAL LAB4860821 PREG TEST QN BLD $403.00 $403.00 $172.50 48 CLINICAL LAB4840351 PREGNANCY SCRN UR $172.00 $172.00 $23.00 $166.00 48 CLINICAL LAB4861670 PROLACTIN $516.00 $6.00 48 CLINICAL LAB4852505 PROTEIN TOTAL BLOOD $99.00 $99.00 $11.50 $96.00 48 CLINICAL LAB4852455 PROTEIN TOTAL BLOOD $99.00 $99.00 $5.16 $96.00 48 CLINICAL LAB4852554 PROTEIN TOTAL FLD $99.00 $99.00 $8.05 $96.00 48 CLINICAL LAB4852604 PROTEIN UR QN RAN $99.00 $99.00 $4.70 $96.00 48 CLINICAL LAB4852620 PROTEIN UR QN TIM $99.00 48 CLINICAL LAB4830014 PROTHROMBIN TIME $106.00 $106.00 $5.53 $103.00 48 CLINICAL LAB4830147 PROTHROMBIN TIME $106.00 $106.00 $23.00 $103.00 48 CLINICAL LAB4861696 PSA FREE $489.00 $489.00 $75.00 48 CLINICAL LAB4861688 PSA TOTAL DIAG $489.00 $4.95 48 CLINICAL LAB4861613 PTH INTACT $678.00 48 CLINICAL LAB4830006 PTT PLAS OR WB $159.00 $159.00 $8.45 $159.00 48 CLINICAL LAB

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

4830121 PTT PLAS OR WB $273.00 $162.00 $98.00 $215.00 48 CLINICAL LAB4830139 PTT PLAS OR WB $159.00 $159.00 $23.00 $159.00 48 CLINICAL LAB4830113 PTT SUBSTITUTION EA $172.00 $172.00 $42.25 $172.00 48 CLINICAL LAB4820759 RBC OSMOTIC FRAG INCUB $296.00 $239.00 $119.90 $263.00 48 CLINICAL LAB4820908 RBC OSMOTIC FRAG UNINCUB $339.00 $273.00 $60.40 $301.00 48 CLINICAL LAB4820700 RBC OSMOTIC FRAG UNINCUB $326.00 $263.00 $131.95 $290.00 48 CLINICAL LAB4852661 RENAL FUNCTION PNL $231.00 $231.00 $12.22 48 CLINICAL LAB4820809 RETICYTE/HGB CONCENTRATE $112.00 $112.00 $6.05 $117.00 48 CLINICAL LAB4800041 RH TYP $79.00 $79.00 $63.85 $159.00 48 CLINICAL LAB4800538 RH TYP $79.00 48 CLINICAL LAB4862645 RHEUMATOID FCTR QN $152.00 $0.31 48 CLINICAL LAB4810016 RPR NON-TREPNML AB QL $112.00 $112.00 $38.55 $110.00 48 CLINICAL LAB4810032 RPR TTR NON-TREPNML AB QN $119.00 $119.00 48 CLINICAL LAB4870168 RSV AG EIA $324.00 48 CLINICAL LAB4861795 RUBELLA AB IGG $384.00 $20.00 48 CLINICAL LAB4800504 S STRL BLOOD WRMING COILS $182.00 $147.00 $74.20 $162.00 48 CLINICAL LAB4860904 SALICYLATE $192.00 $192.00 $23.00 $186.00 48 CLINICAL LAB4820858 SEDIMENTATION RATE MAN $93.00 $93.00 $3.80 $96.00 48 CLINICAL LAB4840419 SEMEN SPERM PRESENCE/MOT $324.00 48 CLINICAL LAB4840427 SEMN ANLYS VOL/CT/MOT/DIF $324.00 48 CLINICAL LAB4800165 SER PRETRTMT ABSORB $499.00 $402.00 $202.10 $444.00 48 CLINICAL LAB4800561 SICKLE CL SCRN $145.00 48 CLINICAL LAB4880100 SKIN TEST CANDIDA $225.00 $225.00 $70.15 $241.00 48 CLINICAL LAB4880209 SKIN TEST COCCI $106.00 $106.00 $70.15 $200.00 48 CLINICAL LAB4880308 SKIN TEST HISTO $173.00 $140.00 $70.15 $154.00 48 CLINICAL LAB4870010 SMR GRAM STAIN 48 CLINICAL LAB4870259 SMR WET MOUNT $112.00 $112.00 $17.25 $110.00 48 CLINICAL LAB4840203 SMR WRIGHT STAIN $112.00 $112.00 $9.20 $110.00 48 CLINICAL LAB4852703 SODIUM $126.00 $126.00 $6.77 $131.00 48 CLINICAL LAB4852802 SODIUM UR RAN $132.00 $132.00 $8.05 $131.00 48 CLINICAL LAB4840450 SPEC GRAVITY FLD $66.00 $66.00 $5.45 $69.00 48 CLINICAL LAB4870200 STREP GRP A AG EIA $324.00 $324.00 $144.35 $317.00 48 CLINICAL LAB4852851 SWEAT COLLECTION 48 CLINICAL LAB4861217 T3 UPTAKE $172.00 48 CLINICAL LAB4861803 TACROLIMUS (FK506) $370.00 $88.50 48 CLINICAL LAB4861712 TESTOSTERONE TOTAL $688.00 $6.00 48 CLINICAL LAB4800363 THAWING PROD PER UNIT $179.00 $179.00 $70.15 $172.00 48 CLINICAL LAB4861001 THEOPHYLLINE $377.00 $377.00 $19.91 $379.00 48 CLINICAL LAB4830030 THROMBIN TIME $152.00 $152.00 $38.55 $152.00 48 CLINICAL LAB4830048 THROMBIN TIME $152.00 $152.00 $38.55 $152.00 48 CLINICAL LAB4861258 THYROXINE (T4) $185.00 $185.00 $107.25 $186.00 48 CLINICAL LAB4861100 TOBRAMYCIN $430.00 $430.00 $22.68 $427.00 48 CLINICAL LAB4852901 TRIGLYCERIDE $152.00 $152.00 $8.05 $152.00 48 CLINICAL LAB

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SEQ 300 AMOUNT

DEPARTMENT CODE

4861191 TROPONIN I QN $265.00 $13.85 48 CLINICAL LAB4861209 TSH $450.00 $450.00 $23.64 $448.00 48 CLINICAL LAB4880506 TUBERCULN SKIN TEST INTRA $180.00 $152.00 $70.15 $203.00 48 CLINICAL LAB4853024 UR NITROGEN UR RAN $126.00 48 CLINICAL LAB4853032 UR NITROGEN UR TIMED $126.00 48 CLINICAL LAB4853008 URIC ACID $119.00 $119.00 $6.36 $117.00 48 CLINICAL LAB4853016 URIC ACID FLD $126.00 48 CLINICAL LAB4840500 URNALYSIS AUTO W/ MICRO $86.00 $86.00 $13.80 $83.00 48 CLINICAL LAB4840559 URNALYSIS AUTO W/O MICRO $60.00 $60.00 $3.16 $62.00 48 CLINICAL LAB4840583 URNALYSIS AUTO W/O MICRO $60.00 48 CLINICAL LAB4840526 URNALYSIS AUTO W/O MICRO $60.00 $60.00 $13.80 48 CLINICAL LAB4840443 URNALYSIS MAN W/O MICRO $66.00 48 CLINICAL LAB4840609 URNALYSIS QL OR SEMI QL $60.00 $60.00 $32.20 $55.00 48 CLINICAL LAB4840435 URNALYSIS QL OR SEMI QL $60.00 48 CLINICAL LAB4840617 URNALYSIS VOL MEASURE $79.00 48 CLINICAL LAB4861308 VALPROIC ACID $364.00 $364.00 $19.06 $359.00 48 CLINICAL LAB4861357 VANCOMYCIN $799.00 $799.00 $19.06 $769.00 48 CLINICAL LAB4899951 VENIPUNCTURE $62.00 $62.00 48 CLINICAL LAB4861522 VITAMIN B12 $403.00 $2.18 48 CLINICAL LAB4820288 WBC CNT AUTO $66.00 $10.00 48 CLINICAL LAB4900031 S STRL TUBING ECMO PEDS $2,279.00 49 CLINICAL LAB - CORE4900023 S STRL NDL MONOPTY 18GX2 $152.00 49 CLINICAL LAB - CORE4900015 S STRL NDL TEMNO 18GX 15C $157.00 49 CLINICAL LAB - CORE6821128 AMB GLUC MON SQ MINM 72HR $419.00 68 DIABETES SERVICES6820740 DIAB TRNG SVCS IND EA 30 $142.00 68 DIABETES SERVICES6821144 DIGITL DATA ANLYS GT 30MN $124.00 68 DIABETES SERVICES6821201 LEVEL 1 EST PATIENT $147.00 68 DIABETES SERVICES6821276 LEVEL 1 NEW PATIENT $147.00 68 DIABETES SERVICES6821284 LEVEL 2 NEW PATIENT $171.00 68 DIABETES SERVICES6821219 LEVEL 2 NEW PATIENT $171.00 68 DIABETES SERVICES6821227 LEVEL 3 EST PATIENT $195.00 68 DIABETES SERVICES6821292 LEVEL 3 NEW PATIENT $195.00 68 DIABETES SERVICES6821235 LEVEL 4 EST PATIENT $324.00 68 DIABETES SERVICES6821300 LEVEL 4 NEW PATIENT $324.00 68 DIABETES SERVICES6821243 LEVEL 5 EST PATIENT $348.00 68 DIABETES SERVICES6821318 LEVEL 5 NEW PATIENT $348.00 68 DIABETES SERVICES6820807 MED NUTR TX EA 15 $63.00 68 DIABETES SERVICES6821110 MED NUTR TX GP EA 30 $53.00 68 DIABETES SERVICES6820773 MED NUTR TX REASMNT EA 15 $69.00 68 DIABETES SERVICES6821102 PF OP P MD SRV WPT ADD 30 $73.00 68 DIABETES SERVICES6821268 PROLONG SVC F-F ADDL 30MN $100.00 68 DIABETES SERVICES6821250 PROLONG SVC F-F FIRST HR $198.00 68 DIABETES SERVICES0663708 ACCESS AV DIAL GRFT EVAL $1,614.00 $1,199.00 $1,199.00 06 DIAG IMAGING PROCEDURES

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SEQ 300 AMOUNT

DEPARTMENT CODE

0661181 ACCESS AV DIAL GRFT PROC $752.00 06 DIAG IMAGING PROCEDURES0622134 CA ANGIO EXT UNI $4,003.00 06 DIAG IMAGING PROCEDURES0637140 CA CARDIAC STRES TEST $2,455.00 $2,116.00 06 DIAG IMAGING PROCEDURES0675611 CA ECHO 2D CMP NO SPC/DOP $2,271.00 06 DIAG IMAGING PROCEDURES0675678 CA ECHO 2D LTD $1,623.00 06 DIAG IMAGING PROCEDURES0675694 CA ECHO 2D W STRES $2,708.00 06 DIAG IMAGING PROCEDURES0675645 CA ECHO DPPLER CMPL $1,007.00 06 DIAG IMAGING PROCEDURES0675637 CA ECHO DPPLER COLOR FLOW $780.00 06 DIAG IMAGING PROCEDURES0665596 CA INJ IVP ADL SQ NEW DRG $537.00 06 DIAG IMAGING PROCEDURES0662338 CA NDL PLACE $3,192.00 06 DIAG IMAGING PROCEDURES0675827 CA TTE DPLR CMPLT WO CON $1,500.00 06 DIAG IMAGING PROCEDURES0668681 CAC ART CATH MNTRNG PERC $32.00 $25.00 $1,248.00 06 DIAG IMAGING PROCEDURES0665109 CAC NONTHROMBOLYSIS IV $1,152.00 $950.00 $1,357.00 06 DIAG IMAGING PROCEDURES0644930 CT 3D RENDER W/O POSTPROS $1,228.00 06 DIAG IMAGING PROCEDURES0644914 CT 3D RENDER W/POSTPROCES $1,105.00 06 DIAG IMAGING PROCEDURES0646182 CT ABD & PELVIS 1+ REGION $9,813.00 06 DIAG IMAGING PROCEDURES0646174 CT ABD & PELVIS W/CON $7,253.00 06 DIAG IMAGING PROCEDURES0646166 CT ABD & PELVIS W/O CON $5,441.00 06 DIAG IMAGING PROCEDURES0646208 CT ABD W/CON $5,185.00 $4,348.00 06 DIAG IMAGING PROCEDURES0646158 CT ABD W/O CON $3,640.00 $3,052.00 06 DIAG IMAGING PROCEDURES0646109 CT ABD W-W/O CON $7,092.00 $5,946.00 06 DIAG IMAGING PROCEDURES0641449 CT BONE DENSITY STDY APPN $390.00 06 DIAG IMAGING PROCEDURES0640144 CT BONE DENSTY STDY AXIAL $2,759.00 06 DIAG IMAGING PROCEDURES0641431 CT BONE DENSTY STDY AXIAL $2,759.00 06 DIAG IMAGING PROCEDURES0641423 CT BONE LENGTH STDY $441.00 $369.00 06 DIAG IMAGING PROCEDURES0641605 CT BRAIN W CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0641555 CT BRAIN W/O CON $2,990.00 $2,507.00 06 DIAG IMAGING PROCEDURES0641563 CT BRAIN W/O CON $2,990.00 06 DIAG IMAGING PROCEDURES0641506 CT BRAIN W-W/O CON $4,766.00 $3,997.00 06 DIAG IMAGING PROCEDURES0648725 CT CARDIAC SCORING $1,601.00 06 DIAG IMAGING PROCEDURES0623686 CT CINE/VIDEO COMPLEMENT $522.00 $493.00 06 DIAG IMAGING PROCEDURES0648774 CT COLONOSCOPY SCRN $801.00 06 DIAG IMAGING PROCEDURES0646950 CT CS DIFF MD ADD 15M $266.00 06 DIAG IMAGING PROCEDURES0646943 CT CS DIFF MD GT5YR 0-30M $598.00 06 DIAG IMAGING PROCEDURES0646935 CT CS DIFF MD LT5YR 0-30M $722.00 06 DIAG IMAGING PROCEDURES0646927 CT CS SAME MD ADD 15M $266.00 06 DIAG IMAGING PROCEDURES0646919 CT CS SAME MD GT5YR 0-30M $664.00 06 DIAG IMAGING PROCEDURES0646901 CT CS SAME MD LT5YR 0-30M $444.92 06 DIAG IMAGING PROCEDURES0646224 CT DRN W CATH PLACE PRC $1,480.00 06 DIAG IMAGING PROCEDURES0642835 CT EXT LOW W CON $4,651.00 $3,900.00 06 DIAG IMAGING PROCEDURES0642827 CT EXT LOW W/O CON $3,734.00 $3,131.00 06 DIAG IMAGING PROCEDURES0642819 CT EXT LOW W-W/O CON $6,182.00 $5,183.00 06 DIAG IMAGING PROCEDURES0642934 CT EXT UPP W CON $4,615.00 $3,869.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0642926 CT EXT UPP W/O CON $3,726.00 $3,125.00 06 DIAG IMAGING PROCEDURES0642918 CT EXT UPP W-W/O CON $6,167.00 $5,171.00 06 DIAG IMAGING PROCEDURES0662312 CT GUIDANCE TISSUE ABLTN $6,976.00 06 DIAG IMAGING PROCEDURES0642751 CT GUIDANCE TISSUE ABLTN $6,976.00 06 DIAG IMAGING PROCEDURES0662320 CT GUIDE NDL PLACEMENT $1,050.00 06 DIAG IMAGING PROCEDURES0641407 CT GUIDE NDL PLACEMENT $4,715.39 $1,025.00 06 DIAG IMAGING PROCEDURES0640193 CT GUIDE RAD TX FIELDS $2,773.00 06 DIAG IMAGING PROCEDURES0646851 CT GUIDE RAD TX FIELDS $2,773.00 $2,325.00 06 DIAG IMAGING PROCEDURES0643338 CT LTD OR FU STDY $2,983.00 $2,501.00 06 DIAG IMAGING PROCEDURES0648758 CT LUNG SCREENING $3,871.00 06 DIAG IMAGING PROCEDURES0643908 CT MAXILLOFACIAL W CON $4,781.00 $4,009.00 06 DIAG IMAGING PROCEDURES0643858 CT MAXILLOFACIAL W/O CON $3,900.00 $3,270.00 06 DIAG IMAGING PROCEDURES0643809 CT MAXILLOFACIAL W-W/O $5,972.00 $5,008.00 06 DIAG IMAGING PROCEDURES0644054 CT NEC W CON $4,600.00 $3,857.00 06 DIAG IMAGING PROCEDURES0644005 CT NEC W/O CON $3,698.00 $3,100.00 06 DIAG IMAGING PROCEDURES0643957 CT NEC W-W/O CON $5,792.00 $4,856.00 06 DIAG IMAGING PROCEDURES0644757 CT ORBIT SELLA FOSA W-W/O $6,492.00 $5,444.00 06 DIAG IMAGING PROCEDURES0644807 CT ORBIT SELLA FOSSA W $5,590.00 $4,687.00 06 DIAG IMAGING PROCEDURES0644856 CT ORBIT/SELLA/FOSSA W/O $4,730.00 $3,966.00 06 DIAG IMAGING PROCEDURES0644708 CT PELV W CON $4,557.00 $3,821.00 06 DIAG IMAGING PROCEDURES0644658 CT PELV W/O CON $3,669.00 $3,076.00 06 DIAG IMAGING PROCEDURES0644609 CT PELV W-W/O CON $6,088.00 $5,105.00 06 DIAG IMAGING PROCEDURES0641472 CT PERFUSION W/CON CBF $8,816.00 06 DIAG IMAGING PROCEDURES0646455 CT SPINE CERV W CON $4,810.00 $4,033.00 06 DIAG IMAGING PROCEDURES0646406 CT SPINE CERV W/O CON $3,885.00 $3,258.00 06 DIAG IMAGING PROCEDURES0646356 CT SPINE CERV W-W/O CON $6,052.00 $5,074.00 06 DIAG IMAGING PROCEDURES0646604 CT SPINE LUMB W CON $4,802.00 $4,027.00 06 DIAG IMAGING PROCEDURES0646554 CT SPINE LUMB W/O CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0646505 CT SPINE LUMB W-W/O CON $6,059.00 $5,080.00 06 DIAG IMAGING PROCEDURES0646752 CT SPINE THOR W CON $4,810.00 $4,033.00 06 DIAG IMAGING PROCEDURES0646703 CT SPINE THOR W/O CON $3,878.00 $3,252.00 06 DIAG IMAGING PROCEDURES0646653 CT SPINE THOR W-W/O $6,073.00 $5,093.00 06 DIAG IMAGING PROCEDURES0646802 CT STEREOTACTIC LOC $12,443.00 $10,433.00 06 DIAG IMAGING PROCEDURES0643601 CT THORAX W CON $4,802.00 $4,027.00 06 DIAG IMAGING PROCEDURES0643569 CT THORAX W CON $4,802.00 06 DIAG IMAGING PROCEDURES0643551 CT THORAX W/O CON $3,871.00 $3,246.00 06 DIAG IMAGING PROCEDURES0643502 CT THORAX W-W/O $6,059.00 $5,080.00 06 DIAG IMAGING PROCEDURES0646315 CT VERTPLASTY EA BDY CT $290.00 06 DIAG IMAGING PROCEDURES0641332 CTA ABD W RUNOFF W-W/O $6,133.00 06 DIAG IMAGING PROCEDURES0646216 CTA ABD W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0643627 CTA CHST NOCORO W-W/O CON $6,032.00 06 DIAG IMAGING PROCEDURES0642850 CTA EXT LOW W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0642959 CTA EXT UPP W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0641621 CTA HEAD W-W/O CON $6,687.00 06 DIAG IMAGING PROCEDURES0644070 CTA NEC W-W/O CON $6,721.00 06 DIAG IMAGING PROCEDURES0644724 CTA PELV W-W/O CON $5,599.00 06 DIAG IMAGING PROCEDURES0642744 CTC ABLTN CRYO OPN LIVER $4,297.00 06 DIAG IMAGING PROCEDURES0648782 CTC ABLTN LIVER RF PRC $4,297.00 06 DIAG IMAGING PROCEDURES0642736 CTC ABLTN RENAL RF PRC $2,753.00 06 DIAG IMAGING PROCEDURES0647560 CTC ABSCSS CYST LIVER PRC $245.00 06 DIAG IMAGING PROCEDURES0647628 CTC ABSCSS DRN PELV PRC $4,385.00 $3,258.00 06 DIAG IMAGING PROCEDURES0647701 CTC ABSCSS DRN PERITNL $5,943.00 06 DIAG IMAGING PROCEDURES0647669 CTC ABSCSS DRN RENL $4,191.00 06 DIAG IMAGING PROCEDURES0647743 CTC ABSCSS DRN RETROPE $3,955.00 $2,939.00 06 DIAG IMAGING PROCEDURES0647784 CTC ABSCSS DRN SUBDIAP $4,299.00 $3,194.00 06 DIAG IMAGING PROCEDURES0642462 CTC ASP BREAST ADD $160.00 06 DIAG IMAGING PROCEDURES0642454 CTC ASP BREAST CYST $347.00 06 DIAG IMAGING PROCEDURES0648204 CTC ASP RENL CYST $130.00 06 DIAG IMAGING PROCEDURES0642488 CTC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0643015 CTC ASPIRATON BONE MARROW $2,100.00 06 DIAG IMAGING PROCEDURES0643023 CTC BONE MARROW ASP W/BX $2,559.00 06 DIAG IMAGING PROCEDURES0648139 CTC BX ABD RETROPE $468.00 $366.00 06 DIAG IMAGING PROCEDURES0642538 CTC BX BM NDL/TROCAR $1,581.00 06 DIAG IMAGING PROCEDURES0648006 CTC BX BONE DEEP $2,475.00 06 DIAG IMAGING PROCEDURES0648105 CTC BX BONE SUPER $549.00 06 DIAG IMAGING PROCEDURES0648113 CTC BX BRAIN W BURR HOLE $3,656.00 06 DIAG IMAGING PROCEDURES0648261 CTC BX EXCSN LYMPH NODE $715.00 06 DIAG IMAGING PROCEDURES0648410 CTC BX GALLBLADDER FOSSA $1,252.00 06 DIAG IMAGING PROCEDURES0642686 CTC BX HIP $1,582.00 $1,299.00 06 DIAG IMAGING PROCEDURES0648147 CTC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0648154 CTC BX LUNG MEDIASTNM $128.00 06 DIAG IMAGING PROCEDURES0662148 CTC BX LYMPH NODE OPEN $4,383.00 $3,676.00 06 DIAG IMAGING PROCEDURES0642603 CTC BX LYMPH NODE SUPER $378.00 06 DIAG IMAGING PROCEDURES0640060 CTC BX MUSCLE $977.00 06 DIAG IMAGING PROCEDURES0648162 CTC BX NASOPHARNYX $1,880.00 $702.00 06 DIAG IMAGING PROCEDURES0642637 CTC BX OF OVARY(S) $713.00 06 DIAG IMAGING PROCEDURES0648170 CTC BX PANCREAS $3,684.00 06 DIAG IMAGING PROCEDURES0648196 CTC BX PLEURA $385.00 06 DIAG IMAGING PROCEDURES0642645 CTC BX PROSTATE $661.00 06 DIAG IMAGING PROCEDURES0642678 CTC BX RENL $2,180.00 06 DIAG IMAGING PROCEDURES0642702 CTC BX SOFT TISS HIP DEEP $1,156.00 06 DIAG IMAGING PROCEDURES0642470 CTC BX STEREO ASPIR HEAD $4,044.00 06 DIAG IMAGING PROCEDURES0642694 CTC BX THYROID $245.00 06 DIAG IMAGING PROCEDURES0648659 CTC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0642991 CTC EXCHANGE DRN CATH $3,976.00 06 DIAG IMAGING PROCEDURES0642405 CTC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0648279 CTC FORAMN EPI C/T W IMG $799.00 06 DIAG IMAGING PROCEDURES0643205 CTC FORAMN EPI L/S W IMG $1,005.00 $758.00 $715.00 06 DIAG IMAGING PROCEDURES0648287 CTC FRMN EPI C/T IMG ADD $799.00 06 DIAG IMAGING PROCEDURES0643254 CTC FRMN EPI L/S IMG ADL $1,005.00 $758.00 $715.00 06 DIAG IMAGING PROCEDURES0647503 CTC I&D SFT TS ABCS SBFCL $688.00 $538.00 06 DIAG IMAGING PROCEDURES0643155 CTC IJ FACET L/S 2 LVL $223.00 $175.00 $715.00 06 DIAG IMAGING PROCEDURES0643056 CTC INJ CON ABSCSS $574.00 06 DIAG IMAGING PROCEDURES0643106 CTC INJ FACET L/S 1 LVL $518.00 $406.00 $2,421.00 06 DIAG IMAGING PROCEDURES0640110 CTC INJ SI JT ANES/STROID $7,589.41 $9,051.14 06 DIAG IMAGING PROCEDURES0648402 CTC INJ SINOGRAM $494.00 06 DIAG IMAGING PROCEDURES0643312 CTC INTRO CATH IVC SVC $680.00 06 DIAG IMAGING PROCEDURES0647453 CTC PARACENT ABD INI $533.00 $417.00 06 DIAG IMAGING PROCEDURES0647461 CTC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0643478 CTC PNMNSTOMY W DRN PRC $3,566.00 06 DIAG IMAGING PROCEDURES0648808 CTC PR RF ABLT RNL TUMR U $15,563.00 $12,178.00 06 DIAG IMAGING PROCEDURES0647487 CTC PUNCTURE DRN LESION $333.00 06 DIAG IMAGING PROCEDURES0644385 CTC REMV TUNN CV CATH W/O $532.00 06 DIAG IMAGING PROCEDURES0649566 CTC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0621383 CYSTOMETROGRAM W/UP $911.00 06 DIAG IMAGING PROCEDURES0621391 CYSTOMETROGRAM W/VP $916.00 06 DIAG IMAGING PROCEDURES0669036 IR 3D RENDER W/POSTPROCES $951.00 $927.00 $1,829.00 06 DIAG IMAGING PROCEDURES0661140 IR ABSCSS FIST SIN TRACT $566.00 06 DIAG IMAGING PROCEDURES0661157 IR ANGIO ADD VESSEL EA $2,636.00 $2,568.00 $6,308.00 06 DIAG IMAGING PROCEDURES0661207 IR ANGIO ADRENAL BIL $4,558.00 $4,300.00 06 DIAG IMAGING PROCEDURES0661256 IR ANGIO ADRENAL UNI $3,183.00 $5,755.00 06 DIAG IMAGING PROCEDURES0661355 IR ANGIO BRACH $3,121.00 $3,040.00 06 DIAG IMAGING PROCEDURES0662155 IR ANGIO CAROTD CERE BIL $3,662.00 $3,567.00 $6,521.00 06 DIAG IMAGING PROCEDURES0662254 IR ANGIO CAROTD CERE UNI $3,283.00 $3,198.00 $6,467.00 06 DIAG IMAGING PROCEDURES0662205 IR ANGIO CAROTD CERV BIL $3,394.00 $3,307.00 $6,521.00 06 DIAG IMAGING PROCEDURES0662304 IR ANGIO CAROTD CERV UNI $3,146.00 $3,065.00 06 DIAG IMAGING PROCEDURES0661405 IR ANGIO CAROTD XTL BIL $3,544.00 $3,452.00 06 DIAG IMAGING PROCEDURES0661454 IR ANGIO CAROTD XTL UNI $3,152.00 $3,071.00 06 DIAG IMAGING PROCEDURES0661504 IR ANGIO CERVICOCEREBRAL $2,922.00 $2,847.00 06 DIAG IMAGING PROCEDURES0662601 IR ANGIO EXT BIL $3,606.00 $3,513.00 $6,462.00 06 DIAG IMAGING PROCEDURES0662650 IR ANGIO EXT UNI $3,189.00 $3,107.00 06 DIAG IMAGING PROCEDURES0669200 IR ANGIO FU EXISTING CATH $703.00 $684.00 $791.00 06 DIAG IMAGING PROCEDURES0668350 IR ANGIO PELV SELECT $3,152.00 $3,071.00 $6,437.00 06 DIAG IMAGING PROCEDURES0668459 IR ANGIO PULM BIL SELECT $4,881.00 $2,871.00 $6,516.00 06 DIAG IMAGING PROCEDURES0668400 IR ANGIO PULM NONSELECT $3,028.00 $2,950.00 06 DIAG IMAGING PROCEDURES0668509 IR ANGIO PULM UNI SELECT $2,816.00 $2,744.00 $6,462.00 06 DIAG IMAGING PROCEDURES0668608 IR ANGIO RENL BIL $3,475.00 $3,386.00 $6,526.00 06 DIAG IMAGING PROCEDURES0668657 IR ANGIO RENL UNI $3,077.00 $2,998.00 $6,447.00 06 DIAG IMAGING PROCEDURES0668905 IR ANGIO SPINAL SELECT $3,152.00 $5,915.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0669606 IR ANGIO VERTEBRAL $3,158.00 $3,077.00 $6,462.00 06 DIAG IMAGING PROCEDURES0669655 IR ANGIO VISCERAL $3,133.00 $3,053.00 06 DIAG IMAGING PROCEDURES0661850 IR AORTOGRAM ABD BIL EXT $2,997.00 $2,919.00 $6,813.00 06 DIAG IMAGING PROCEDURES0661801 IR AORTOGRAM ABD W SER $2,903.00 $2,829.00 $6,437.00 06 DIAG IMAGING PROCEDURES0661959 IR AORTOGRAM THOR W SER $2,916.00 $2,841.00 $6,447.00 06 DIAG IMAGING PROCEDURES0661900 IR AORTOGRAM THOR W/O SER $4,315.00 $4,203.00 $6,343.00 06 DIAG IMAGING PROCEDURES0622100 IR ARTHRO ANKLE BIL $1,175.00 $1,145.00 06 DIAG IMAGING PROCEDURES0622126 IR ARTHRO ELBOW BI $1,107.00 $1,078.00 06 DIAG IMAGING PROCEDURES0661975 IR ARTHRO SI JNT $814.00 06 DIAG IMAGING PROCEDURES0661306 IR AV DIALYSIS SHUNT IMAG $3,830.00 $3,731.00 $964.00 06 DIAG IMAGING PROCEDURES0662007 IR BILI DRN INT XTL $3,082.00 $5,606.00 $5,606.00 06 DIAG IMAGING PROCEDURES0662056 IR BILI DRN PRC $2,997.00 $5,452.00 $5,452.00 06 DIAG IMAGING PROCEDURES0662064 IR BILI DUCT DILATE PRC $1,380.00 06 DIAG IMAGING PROCEDURES0662080 IR BRONCHOGRAM BIL $300.00 06 DIAG IMAGING PROCEDURES0662072 IR BRONCHOGRAM UNI $197.00 06 DIAG IMAGING PROCEDURES0662106 IR BX TRANSCATHETER $5,782.00 $10,517.00 06 DIAG IMAGING PROCEDURES0668707 IR CATH RENL PELV PRC $1,430.00 $1,393.00 $2,106.00 06 DIAG IMAGING PROCEDURES0662361 IR CHEMO CNS W/SPINL PUNC $2,486.00 06 DIAG IMAGING PROCEDURES0662379 IR CHEMO IA PUSH $1,647.00 06 DIAG IMAGING PROCEDURES0662387 IR CHEMO IA PUSH $1,647.00 06 DIAG IMAGING PROCEDURES0662429 IR CHOL EXISTING CATH $653.00 06 DIAG IMAGING PROCEDURES0662403 IR CHOL TRANSHEPAT PRC $1,330.00 $1,296.00 06 DIAG IMAGING PROCEDURES0667733 IR CINE/VIDEO COMPLEMENT $107.00 06 DIAG IMAGING PROCEDURES0662437 IR CISTERNOGRAM $2,229.00 06 DIAG IMAGING PROCEDURES0662445 IR CORPORA CAVERNOSOGRAM $740.00 06 DIAG IMAGING PROCEDURES0662858 IR CS DIFF MD GT5YR 0-30M $147.00 06 DIAG IMAGING PROCEDURES0662841 IR CS DIFF MD GT5YR 0-30M $293.00 06 DIAG IMAGING PROCEDURES0662833 IR CS DIFF MD LT5YR 0-30M $363.00 06 DIAG IMAGING PROCEDURES0662825 IR CS SAME MD ADD 15M $189.00 06 DIAG IMAGING PROCEDURES0662817 IR CS SAME MD GT5YR 0-30M $399.00 06 DIAG IMAGING PROCEDURES0662809 IR CS SAME MD LT5YR 0-30M $455.00 06 DIAG IMAGING PROCEDURES0668327 IR CYSTOGRAM 3V OR MORE $716.00 06 DIAG IMAGING PROCEDURES0668301 IR DILATE NEPHROSTOMY $1,380.00 $1,345.00 06 DIAG IMAGING PROCEDURES0662452 IR DISKOGRAM CERV THOR $1,623.00 $1,581.00 $4,331.00 06 DIAG IMAGING PROCEDURES0662502 IR DISKOGRAM LUMB $1,585.00 $1,544.00 06 DIAG IMAGING PROCEDURES0661108 IR DRN W CATH PLACE PRC $1,274.00 $1,242.00 $1,755.00 06 DIAG IMAGING PROCEDURES0662551 IR EMBOL TX $9,969.00 $18,133.00 06 DIAG IMAGING PROCEDURES0662635 IR ENDO BILI DUCT $2,423.00 06 DIAG IMAGING PROCEDURES0661058 IR ENDOVAS REPR ABD AO $883.00 06 DIAG IMAGING PROCEDURES0662577 IR EPIDUROGRAM $1,094.00 06 DIAG IMAGING PROCEDURES0668673 IR EXCHNGE INTRAVAS CATH $2,375.00 06 DIAG IMAGING PROCEDURES0662585 IR FALLOPN TUBE TRANSCERV $428.00 06 DIAG IMAGING PROCEDURES0667741 IR FLUOR CVAD PLC/RMV/RPR $1,455.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0662718 IR FLUORO 1HR OR LES $850.00 06 DIAG IMAGING PROCEDURES0662692 IR FLUORO GUIDE SPINE INJ $497.00 06 DIAG IMAGING PROCEDURES0662536 IR FLUORO NDL PLACE $727.00 06 DIAG IMAGING PROCEDURES0668806 IR GALACTOGRAM 1 DUCT $354.00 06 DIAG IMAGING PROCEDURES0662684 IR HYSTEROSALPINGOGRAM $951.00 06 DIAG IMAGING PROCEDURES0665612 IR INJ IVP SNGL/INIT DRG $496.00 06 DIAG IMAGING PROCEDURES0665646 IR INJECTION IM/SQ EA $58.00 06 DIAG IMAGING PROCEDURES0669259 IR IVC FILTER PLACE $6,934.00 $12,613.00 $12,613.00 06 DIAG IMAGING PROCEDURES0667931 IR IVUS NONCO ADD $311.00 06 DIAG IMAGING PROCEDURES0667923 IR IVUS NONCO INI $618.00 06 DIAG IMAGING PROCEDURES0668269 IR LYMPHANGIO ABD UNI $827.00 06 DIAG IMAGING PROCEDURES0668251 IR LYMPHANGIO PELV BIL $5,047.00 $4,762.00 06 DIAG IMAGING PROCEDURES0662353 IR PERC TUBE/CATH CHNG $1,132.00 $2,059.00 06 DIAG IMAGING PROCEDURES0660852 IR PLACE OCC DEV VEIN ART $1,667.00 $1,624.00 06 DIAG IMAGING PROCEDURES0661066 IR PLACE PROS REPR AAA $267.00 06 DIAG IMAGING PROCEDURES0669051 IR PORTOGRAM W HEM EVAL $2,816.00 $2,744.00 $6,481.00 06 DIAG IMAGING PROCEDURES0668376 IR PORTOGRAM W/O HEM EVAL $2,860.00 06 DIAG IMAGING PROCEDURES0661553 IR PTA PERIPH ART W S&I $4,520.00 $8,222.00 $8,222.00 06 DIAG IMAGING PROCEDURES0661603 IR PTA PRPH ART W S&I ADD $2,432.00 $4,424.00 $4,424.00 06 DIAG IMAGING PROCEDURES0661652 IR PTA RENL VISC $4,784.00 $8,702.00 $8,702.00 06 DIAG IMAGING PROCEDURES0661751 IR PTA VEN $4,512.00 $8,207.00 $8,207.00 06 DIAG IMAGING PROCEDURES0661702 IR PTA VISC ADD $1,904.00 $3,463.00 06 DIAG IMAGING PROCEDURES0668558 IR RENL CYST STDY $821.00 $799.00 06 DIAG IMAGING PROCEDURES0662700 IR RETRIEVAL VASCULAR FB $4,272.00 $7,771.00 $7,771.00 06 DIAG IMAGING PROCEDURES0668855 IR SHUNTOGRAM NONVASC $1,094.00 $1,066.00 06 DIAG IMAGING PROCEDURES0668939 IR SIALOGRAM $243.00 06 DIAG IMAGING PROCEDURES0668954 IR SPLENOPORTOGRAM $7,883.00 $7,680.00 06 DIAG IMAGING PROCEDURES0660902 IR STNT INTRVAS W S&I EA $2,916.00 $2,841.00 06 DIAG IMAGING PROCEDURES0669168 IR STNT INTRVAS W S&I EA $2,916.00 $2,841.00 06 DIAG IMAGING PROCEDURES0669150 IR TRANSCATHETER TX IV $13,043.00 $12,707.00 $10,629.00 06 DIAG IMAGING PROCEDURES0669101 IR URETERAL STENT PRC $1,436.00 $1,399.00 $2,106.00 06 DIAG IMAGING PROCEDURES0666115 IR URETHROCYSTOGRAM VOID $1,175.00 06 DIAG IMAGING PROCEDURES0668319 IR UROGRAM ANTEGRADE $890.00 06 DIAG IMAGING PROCEDURES0674432 IR US VASC ACCESS ADD ON $305.00 06 DIAG IMAGING PROCEDURES0668756 IR VEN SAMPLING $2,798.00 $2,726.00 $6,338.00 06 DIAG IMAGING PROCEDURES0669275 IR VENOGRAM ADRENAL BIL $1,705.00 06 DIAG IMAGING PROCEDURES0669283 IR VENOGRAM ADRENAL UNI $1,705.00 06 DIAG IMAGING PROCEDURES0669374 IR VENOGRAM EPID $1,705.00 06 DIAG IMAGING PROCEDURES0669408 IR VENOGRAM EXT BIL $1,554.00 $1,514.00 06 DIAG IMAGING PROCEDURES0669457 IR VENOGRAM EXT UNI $1,405.00 $1,369.00 $583.00 06 DIAG IMAGING PROCEDURES0669382 IR VENOGRAM HEP W EVAL $2,810.00 06 DIAG IMAGING PROCEDURES0669390 IR VENOGRAM HEP W/O EVAL $4,818.00 06 DIAG IMAGING PROCEDURES0669309 IR VENOGRAM IVC $2,760.00 $2,689.00 $6,432.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0669465 IR VENOGRAM ORBITAL $129.00 06 DIAG IMAGING PROCEDURES0669507 IR VENOGRAM RENL BIL $3,059.00 $2,980.00 $6,491.00 06 DIAG IMAGING PROCEDURES0669556 IR VENOGRAM RENL UNI $2,816.00 $2,744.00 $6,432.00 06 DIAG IMAGING PROCEDURES0669481 IR VENOGRAM SAG SINUS $5,274.00 06 DIAG IMAGING PROCEDURES0669473 IR VENOGRAM SIN JUGULAR $2,854.00 06 DIAG IMAGING PROCEDURES0669358 IR VENOGRAM SVC $2,791.00 $2,719.00 $6,432.00 06 DIAG IMAGING PROCEDURES0669226 IR VRTPLSTY EA BDY FLUORO $3,873.00 06 DIAG IMAGING PROCEDURES0664284 IRC ABLTN PEL/HIP RF PRC $25,744.00 06 DIAG IMAGING PROCEDURES0660829 IRC ABLTN RENAL RF PRC $4,475.00 06 DIAG IMAGING PROCEDURES0663054 IRC ABSCSS CYST LIVER PRC $245.00 $192.00 $5,950.00 06 DIAG IMAGING PROCEDURES0661132 IRC ABSCSS CYST LIVER PRC $245.00 $192.00 06 DIAG IMAGING PROCEDURES0663062 IRC ABSCSS DRN PELV PRC $5,015.00 06 DIAG IMAGING PROCEDURES0663104 IRC ABSCSS DRN PERITNL $6,618.00 $4,917.00 $4,917.00 06 DIAG IMAGING PROCEDURES0663153 IRC ABSCSS DRN RENL $5,906.00 $4,388.00 $4,388.00 06 DIAG IMAGING PROCEDURES0663187 IRC ABSCSS DRN RETROPE $5,876.00 06 DIAG IMAGING PROCEDURES0663203 IRC ABSCSS DRN SUBDIAP $5,906.00 $4,388.00 06 DIAG IMAGING PROCEDURES0661223 IRC ADRENAL BIOPSY $3,330.37 06 DIAG IMAGING PROCEDURES0666180 IRC ASP BLADDER SP CATH $646.00 06 DIAG IMAGING PROCEDURES0664235 IRC ASP BREAST ADD $160.00 06 DIAG IMAGING PROCEDURES0664227 IRC ASP BREAST CYST $378.00 06 DIAG IMAGING PROCEDURES0667659 IRC ASP RENL CYST $237.00 $283.00 06 DIAG IMAGING PROCEDURES0667253 IRC ASP RENL CYST $130.00 $101.00 $316.00 06 DIAG IMAGING PROCEDURES0663682 IRC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0662478 IRC ASPIRATON BONE MARROW $843.00 06 DIAG IMAGING PROCEDURES0663757 IRC BILI CATH CHNG $2,124.00 $1,662.00 $7,480.00 06 DIAG IMAGING PROCEDURES0663856 IRC BILI ENDO W STENT $569.00 $445.00 06 DIAG IMAGING PROCEDURES0663906 IRC BILI STENT PLACE $934.00 $731.00 $2,516.00 06 DIAG IMAGING PROCEDURES0664003 IRC BILI STONE EXTRACT $889.00 $696.00 $2,418.00 06 DIAG IMAGING PROCEDURES0664441 IRC BRONCH W BX $1,195.00 06 DIAG IMAGING PROCEDURES0664052 IRC BX ABD RETROPE $468.00 $366.00 $1,538.00 06 DIAG IMAGING PROCEDURES0664029 IRC BX BM NDL/TROCAR $536.00 06 DIAG IMAGING PROCEDURES0662528 IRC BX BONE SUPER $549.00 $430.00 $2,259.00 06 DIAG IMAGING PROCEDURES0664086 IRC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0662114 IRC BX LUNG MEDIASTNM $127.79 $100.00 06 DIAG IMAGING PROCEDURES0672519 IRC BX LYMPH NODE OPEN $3,774.00 $3,676.00 06 DIAG IMAGING PROCEDURES0662122 IRC BX LYMPH NODE SUPER $714.52 $559.19 06 DIAG IMAGING PROCEDURES0662627 IRC BX MUSCLE $977.00 06 DIAG IMAGING PROCEDURES0664201 IRC BX PANCREAS $1,665.00 $1,303.00 $3,940.00 06 DIAG IMAGING PROCEDURES0664250 IRC BX PLEURA $385.00 $301.00 $863.00 06 DIAG IMAGING PROCEDURES0664276 IRC BX PROSTATE $774.00 06 DIAG IMAGING PROCEDURES0664300 IRC BX RENL $2,180.00 $1,706.00 $638.00 06 DIAG IMAGING PROCEDURES0664292 IRC BX SALIVARY GLAND NDL $333.00 06 DIAG IMAGING PROCEDURES0661231 IRC BX SPLEEN $2,093.00 $1,407.74 06 DIAG IMAGING PROCEDURES

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0664391 IRC BX THIGH/KNE SFT TISS $751.00 06 DIAG IMAGING PROCEDURES0664409 IRC BX THYROID $245.00 $192.00 $692.00 06 DIAG IMAGING PROCEDURES0662544 IRC BX VERT OPN LUMB/CERV $751.00 06 DIAG IMAGING PROCEDURES0662569 IRC BX VERT OPN THORACIC $1,695.00 06 DIAG IMAGING PROCEDURES0664458 IRC CATH ABD LOW 1ST $5,112.00 $3,798.00 $3,798.00 06 DIAG IMAGING PROCEDURES0664508 IRC CATH ABD LOW 2ND $6,134.00 $4,558.00 $4,558.00 06 DIAG IMAGING PROCEDURES0664557 IRC CATH ABD LOW 3RD $7,361.00 $5,469.00 $5,469.00 06 DIAG IMAGING PROCEDURES0667709 IRC CATH ABD LOW ADD $587.00 $459.00 $1,325.00 06 DIAG IMAGING PROCEDURES0667642 IRC CATH PORTAL VEIN PRC $2,603.00 06 DIAG IMAGING PROCEDURES0664607 IRC CATH THOR 1ST ART $4,718.00 $3,505.00 $3,505.00 06 DIAG IMAGING PROCEDURES0664656 IRC CATH THOR 2ND ART $5,662.00 $4,207.00 $4,207.00 06 DIAG IMAGING PROCEDURES0664755 IRC CATH THOR 3RD ART $6,794.00 $5,048.00 $5,048.00 06 DIAG IMAGING PROCEDURES0664706 IRC CATH THOR ADD ART $718.00 $562.00 $1,611.00 06 DIAG IMAGING PROCEDURES0669119 IRC CHANGE URET STNT EXT $2,604.00 $2,525.00 06 DIAG IMAGING PROCEDURES0666941 IRC CHANGE URET STNT INT $5,617.00 $5,617.00 06 DIAG IMAGING PROCEDURES0668178 IRC CHG G-TUBE TO G-J PRC $4,075.00 06 DIAG IMAGING PROCEDURES0660951 IRC CHG STENT VIA TRNSURL $524.00 06 DIAG IMAGING PROCEDURES0666610 IRC CHNG G TUBE WO IMG/GD $1,521.00 06 DIAG IMAGING PROCEDURES0666172 IRC CHNG G TUBE WO IMG/GD $903.00 06 DIAG IMAGING PROCEDURES0667600 IRC CHNGE URETR TUBE/STNT $176.00 $138.00 $524.00 06 DIAG IMAGING PROCEDURES0668285 IRC CON IJ G/COLON TUBE $691.00 $541.00 06 DIAG IMAGING PROCEDURES0667949 IRC CYST W/INS URTL STENT $1,890.00 06 DIAG IMAGING PROCEDURES0666693 IRC CYSTO TUBE CHNG CMPLX $493.00 06 DIAG IMAGING PROCEDURES0666685 IRC CYSTO TUBE CHNG SMPL $844.00 06 DIAG IMAGING PROCEDURES0667980 IRC CYSTO W/TX UR STRICTR $479.00 06 DIAG IMAGING PROCEDURES0668012 IRC CYSTO W/UR UTL STR TX $1,052.00 06 DIAG IMAGING PROCEDURES0667725 IRC DECLOT VASC DEVICE $123.00 06 DIAG IMAGING PROCEDURES0666537 IRC DECLOT VASC DEVICE $123.00 06 DIAG IMAGING PROCEDURES0663666 IRC DECLOT XTL CAN W BLN $248.00 06 DIAG IMAGING PROCEDURES0664870 IRC DL IC VASOSPSM INIT $772.00 06 DIAG IMAGING PROCEDURES0664896 IRC DL IC VSPSM ADD-ON DF $544.00 06 DIAG IMAGING PROCEDURES0664888 IRC DL IC VSPSM ADD-ON SM $272.00 06 DIAG IMAGING PROCEDURES0663021 IRC DRN ABSCESS COMP/MULT $256.00 06 DIAG IMAGING PROCEDURES0663039 IRC DRN ABSCESS SMPL/SNGL $387.00 06 DIAG IMAGING PROCEDURES0665166 IRC DRN APPNCL ABSCSS OPN $1,993.00 06 DIAG IMAGING PROCEDURES0664904 IRC EMBOL OCC NONHEAD NEC $1,163.00 $910.00 $2,927.00 06 DIAG IMAGING PROCEDURES0664813 IRC EMBOL UTERINE FIBROID $15,656.00 $11,632.00 06 DIAG IMAGING PROCEDURES0663815 IRC ENDO RENL W URET CATH $815.00 $638.00 06 DIAG IMAGING PROCEDURES0667873 IRC ENDO SB W JEJ TUB PRC $380.00 06 DIAG IMAGING PROCEDURES0669846 IRC ERCP DX W/WO SPEC $1,085.00 06 DIAG IMAGING PROCEDURES0669853 IRC ERCP RMVL CALC $1,608.00 06 DIAG IMAGING PROCEDURES0669879 IRC ERCP W/BIOPSY $1,141.00 06 DIAG IMAGING PROCEDURES0665059 IRC ESOPH DILATE RETRO $1,617.00 $1,220.00 $1,151.00 06 DIAG IMAGING PROCEDURES

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0664573 IRC EXCHANGE DRN CATH $1,358.00 06 DIAG IMAGING PROCEDURES0664219 IRC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0622761 IRC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0665877 IRC FORAMN EPI C/T W IMG $817.00 06 DIAG IMAGING PROCEDURES0665901 IRC FORAMN EPI L/S W IMG $838.00 $655.00 $3,911.00 06 DIAG IMAGING PROCEDURES0665885 IRC FRMN EPI C/T IMG ADD $330.00 06 DIAG IMAGING PROCEDURES0665950 IRC FRMN EPI L/S IMG ADL $357.00 $280.00 $1,627.00 06 DIAG IMAGING PROCEDURES0665554 IRC IJ FACET L/S 2 LVL $223.00 $175.00 $1,053.00 06 DIAG IMAGING PROCEDURES0664474 IRC IJ PV FACET C/T 1 LVL $554.00 06 DIAG IMAGING PROCEDURES0664466 IRC IJ SCLER SOL SNGL VN $454.00 06 DIAG IMAGING PROCEDURES0665992 IRC IJ W/FLUOR EVAL CVAD $403.00 06 DIAG IMAGING PROCEDURES0665919 IRC INJ AIR CON PERITNL $475.00 06 DIAG IMAGING PROCEDURES0665372 IRC INJ C1 C2 MYELOGRAM $466.00 06 DIAG IMAGING PROCEDURES0665208 IRC INJ CELIAC PLEX BLK $592.00 $463.00 06 DIAG IMAGING PROCEDURES0665257 IRC INJ CHOL TRANSHEPAT $130.00 $101.00 06 DIAG IMAGING PROCEDURES0665307 IRC INJ CHOL VIA CATH $50.00 $39.00 06 DIAG IMAGING PROCEDURES0665638 IRC INJ CON ABSCSS $574.00 06 DIAG IMAGING PROCEDURES0666107 IRC INJ CYSTO RETRO $349.00 $273.00 $1,132.00 06 DIAG IMAGING PROCEDURES0665323 IRC INJ CYSTO VCUG $3,149.00 06 DIAG IMAGING PROCEDURES0665331 IRC INJ DACROCYSTOGRAM $2,229.00 06 DIAG IMAGING PROCEDURES0665356 IRC INJ DISKOGRAM CERV $884.00 $692.00 $2,942.00 06 DIAG IMAGING PROCEDURES0665406 IRC INJ DISKOGRAM LUMB $959.00 $751.00 $3,535.00 06 DIAG IMAGING PROCEDURES0665448 IRC INJ EPID CERV THOR $1,645.00 06 DIAG IMAGING PROCEDURES0665455 IRC INJ EPID L/S $885.00 $693.00 $2,114.00 06 DIAG IMAGING PROCEDURES0665976 IRC INJ EXT VENOGRAM $2,405.00 06 DIAG IMAGING PROCEDURES0665505 IRC INJ FACET L/S 1 LVL $518.00 $406.00 $3,411.00 06 DIAG IMAGING PROCEDURES0661017 IRC INJ FACET L/S 3 LVL $229.00 $179.00 06 DIAG IMAGING PROCEDURES0665653 IRC INJ ILEAL CONDUIT $274.00 $214.00 06 DIAG IMAGING PROCEDURES0665752 IRC INJ LYMPHANGIO $3,706.00 $2,797.00 $2,639.00 06 DIAG IMAGING PROCEDURES0665737 IRC INJ MYELOGRAM $720.00 06 DIAG IMAGING PROCEDURES0665851 IRC INJ NEPHROGRAM $364.00 $285.00 $1,330.00 06 DIAG IMAGING PROCEDURES0666008 IRC INJ NRV BLK SCTC SNGL $884.00 $884.00 $884.00 06 DIAG IMAGING PROCEDURES0667865 IRC INJ NRV INTCOSTL MULT $925.00 06 DIAG IMAGING PROCEDURES0664516 IRC INJ NRV INTCOSTL SNGL $486.00 06 DIAG IMAGING PROCEDURES0665968 IRC INJ PANCREAT INTRAOP $342.00 06 DIAG IMAGING PROCEDURES0660118 IRC INJ SI JNT ANES/STRD $7,591.10 $7,791.82 06 DIAG IMAGING PROCEDURES0665430 IRC INJ SPINE W CATH L/S $583.00 06 DIAG IMAGING PROCEDURES0665687 IRC INJ TND SHEATH/LG $147.00 06 DIAG IMAGING PROCEDURES0665661 IRC INJ TRG PT 1 OR 2 MCL $108.00 06 DIAG IMAGING PROCEDURES0665679 IRC INJ TRIG PT GT 2 MCL $120.00 06 DIAG IMAGING PROCEDURES0666057 IRC INJ URETERO PYELOGRAM $727.00 $569.00 $2,462.00 06 DIAG IMAGING PROCEDURES0666099 IRC INJ URETHROCYST CHAIN $1,491.00 06 DIAG IMAGING PROCEDURES0664243 IRC INJ/ASP GANGLION CYST $133.00 06 DIAG IMAGING PROCEDURES

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0661009 IRC INS ID ABD/PEL RT PER $1,784.00 $1,396.00 06 DIAG IMAGING PROCEDURES0660977 IRC INS ID RT THOR PERC $2,101.00 $1,644.00 06 DIAG IMAGING PROCEDURES0666198 IRC INS INTRA ART PUMP $2,013.00 06 DIAG IMAGING PROCEDURES0667782 IRC INS NON-TUN CV CATH<5 $779.00 06 DIAG IMAGING PROCEDURES0667790 IRC INS NON-TUN CV CATH5+ $637.00 06 DIAG IMAGING PROCEDURES0666362 IRC INS PICC W/O PORT 5+ $904.00 06 DIAG IMAGING PROCEDURES0666370 IRC INS PICC W/O PORT LT5 $1,080.00 06 DIAG IMAGING PROCEDURES0666388 IRC INS PICC W/PORT 5+YRS $5,968.00 06 DIAG IMAGING PROCEDURES0666396 IRC INS PICC W/PORT LT 5 $5,968.00 06 DIAG IMAGING PROCEDURES0660985 IRC INS PLRO AGT INTL DAY $187.00 $146.00 06 DIAG IMAGING PROCEDURES0660993 IRC INS PLRO AGT SUBQ DAY $166.00 $130.00 06 DIAG IMAGING PROCEDURES0667808 IRC INS TUN CV NO PRT LT5 $4,593.00 06 DIAG IMAGING PROCEDURES0667667 IRC INS TUNN CV DEV 5+ $8,267.00 06 DIAG IMAGING PROCEDURES0667675 IRC INS TUNN CV DEV LT 5 $7,127.00 $5,295.00 06 DIAG IMAGING PROCEDURES0667816 IRC INS TUNN CV NO PORT5+ $4,133.00 06 DIAG IMAGING PROCEDURES0662411 IRC INSRT PLEURAL CATH $2,902.00 $2,271.00 $7,099.00 06 DIAG IMAGING PROCEDURES0667097 IRC INTERDISC PERC ASP DX $655.00 $513.00 06 DIAG IMAGING PROCEDURES0664847 IRC INTRACRAN ANGIOPLSTY $1,760.00 06 DIAG IMAGING PROCEDURES0664862 IRC INTRACRN ANGIO W/STNT $1,901.00 06 DIAG IMAGING PROCEDURES0666263 IRC INTRO AORTA $854.00 06 DIAG IMAGING PROCEDURES0666255 IRC INTRO BRACH ART $2,883.00 $2,142.00 06 DIAG IMAGING PROCEDURES0666800 IRC INTRO CAROTD VERT ART $1,872.00 $1,391.00 06 DIAG IMAGING PROCEDURES0666206 IRC INTRO CATH AORTA $3,932.00 $2,921.00 $2,921.00 06 DIAG IMAGING PROCEDURES0666453 IRC INTRO CATH BILI DRN $862.00 $675.00 $2,482.00 06 DIAG IMAGING PROCEDURES0666297 IRC INTRO CATH FALLOPN $947.00 06 DIAG IMAGING PROCEDURES0666305 IRC INTRO CATH IVC/SVC $3,887.00 $2,888.00 $2,888.00 06 DIAG IMAGING PROCEDURES0666354 IRC INTRO CATH PULM $1,109.00 $824.00 $824.00 06 DIAG IMAGING PROCEDURES0666404 IRC INTRO CATH RENL PELV $281.00 $220.00 $5,052.00 06 DIAG IMAGING PROCEDURES0666750 IRC INTRO EXT ART $3,246.00 $2,412.00 $2,412.00 06 DIAG IMAGING PROCEDURES0666602 IRC INTRO G TUBE LONG $50.00 06 DIAG IMAGING PROCEDURES0666701 IRC INTRO IVC FILTER $1,024.00 $801.00 $13,858.00 06 DIAG IMAGING PROCEDURES0666909 IRC INTRO NEPHROSTOMY $286.00 $224.00 $3,136.00 06 DIAG IMAGING PROCEDURES0666958 IRC INTRO STENT CATH URET $333.00 $261.00 $10,819.00 06 DIAG IMAGING PROCEDURES0666156 IRC IVCH RETRIEVE FB $5,429.00 $4,248.00 $1,284.00 06 DIAG IMAGING PROCEDURES0665760 IRC LAP BAND ADJ/INJ/ASP $2,940.00 06 DIAG IMAGING PROCEDURES0665711 IRC LAP REV ADJ GAST DVC $1,665.00 06 DIAG IMAGING PROCEDURES0665703 IRC LUMBAR PUNCTURE DX $457.00 $358.00 $1,483.00 06 DIAG IMAGING PROCEDURES0667006 IRC NEPHROSTOMY MANOMETRY $200.00 $478.00 06 DIAG IMAGING PROCEDURES0667055 IRC NEPHROSTOMY TUBE CHNG $3,854.00 $2,864.00 $2,864.00 06 DIAG IMAGING PROCEDURES0666677 IRC NG TUBE PLC W FLUORO $50.00 06 DIAG IMAGING PROCEDURES0667378 IRC OPN INTRVAS STENT ADD $218.00 06 DIAG IMAGING PROCEDURES0667360 IRC OPN INTRVS STENT INIT $502.00 06 DIAG IMAGING PROCEDURES0663518 IRC OPN TRANS ANGIO RENAL $1,863.00 06 DIAG IMAGING PROCEDURES

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0667105 IRC PARACENT ABD INI $533.00 $417.00 $1,973.00 06 DIAG IMAGING PROCEDURES0667113 IRC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0666982 IRC PERC VERT AUG ADD VRT $353.00 06 DIAG IMAGING PROCEDURES0664953 IRC PERM EMBOL OCC CNS $1,384.00 $1,083.00 $3,416.00 06 DIAG IMAGING PROCEDURES0666412 IRC PLACE G-TUBE PERC $1,174.00 06 DIAG IMAGING PROCEDURES0666479 IRC PLC CECSTMY TUBE PERC $7,145.00 06 DIAG IMAGING PROCEDURES0666438 IRC PLC DUD/JEJ TUBE PERC $2,464.00 06 DIAG IMAGING PROCEDURES0662866 IRC PLC IP CATH DLYS OPN $607.00 $475.00 $1,408.00 06 DIAG IMAGING PROCEDURES0662882 IRC PLC IP CATH DLYS OPN $594.00 $576.00 06 DIAG IMAGING PROCEDURES0662395 IRC PLC IP CATH DLYS OPN $607.00 $475.00 $1,407.00 06 DIAG IMAGING PROCEDURES0664763 IRC PNMNSTOMY W DRN OPN $3,226.00 06 DIAG IMAGING PROCEDURES0667840 IRC PNMNSTOMY W DRN PRC $8,403.00 06 DIAG IMAGING PROCEDURES0660837 IRC PRC CRY ABLA RNAL TUM $20,713.00 $16,208.00 06 DIAG IMAGING PROCEDURES0666974 IRC PRC VRT AUG LUMB 1VRT $909.00 06 DIAG IMAGING PROCEDURES0666966 IRC PRC VRT AUG THOR 1VRT $938.00 06 DIAG IMAGING PROCEDURES0664854 IRC PRM EMBL OCC HEAD NEC $1,107.00 $866.00 $2,734.00 06 DIAG IMAGING PROCEDURES0664987 IRC PROCTOSIGMOID W/DIL $2,540.00 06 DIAG IMAGING PROCEDURES0664979 IRC PROCTOSIGMOIDOSCPY DX $245.00 06 DIAG IMAGING PROCEDURES0665570 IRC PRQ SACRAL AUG BIL IJ $4,396.06 $3,695.00 06 DIAG IMAGING PROCEDURES0665562 IRC PRQ SACRAL AUG UNI IJ $4,395.06 $3,695.00 06 DIAG IMAGING PROCEDURES0667832 IRC PSEUDOANEURYSM INJ $428.00 06 DIAG IMAGING PROCEDURES0663252 IRC PTA AORTIC $2,040.00 $1,516.00 06 DIAG IMAGING PROCEDURES0663302 IRC PTA BRACHIOCEPH EA $2,808.00 $2,086.00 $2,086.00 06 DIAG IMAGING PROCEDURES0661173 IRC PTA BRACHIOCEPH EA $15,472.00 06 DIAG IMAGING PROCEDURES0663500 IRC PTA RENL VISC $6,650.00 $4,941.00 $4,941.00 06 DIAG IMAGING PROCEDURES0663609 IRC PTA VEN $1,792.00 $1,331.00 $1,331.00 06 DIAG IMAGING PROCEDURES0667154 IRC PULM ART L/R $1,166.00 $866.00 $866.00 06 DIAG IMAGING PROCEDURES0667204 IRC PULM ART SEG SUB $1,144.00 $850.00 $850.00 06 DIAG IMAGING PROCEDURES0668723 IRC REM TUNN CVA DEV W PT $675.00 06 DIAG IMAGING PROCEDURES0660969 IRC REMOVE LUNG CATHETER $371.00 $290.00 06 DIAG IMAGING PROCEDURES0667618 IRC REMOVE URET STNT INT $10,392.00 06 DIAG IMAGING PROCEDURES0667014 IRC REMV RNL TUBE W/FLUOR $1,399.00 06 DIAG IMAGING PROCEDURES0669580 IRC REMV TUNN CV CATH W/O $364.00 06 DIAG IMAGING PROCEDURES0663765 IRC REPLACE CATH ONLY CV $1,741.00 $1,362.00 $5,429.00 06 DIAG IMAGING PROCEDURES0666420 IRC REPLACE G/C TUBE PERC $5,120.00 06 DIAG IMAGING PROCEDURES0666487 IRC REPLACE G-J TUBE PERC $845.00 06 DIAG IMAGING PROCEDURES0668566 IRC REPR CV CATH W/O PORT $600.00 06 DIAG IMAGING PROCEDURES0667428 IRC REPS PREV PLC CV CATH $380.00 06 DIAG IMAGING PROCEDURES0661025 IRC REV INTRATHCL P/P RES $395.00 06 DIAG IMAGING PROCEDURES0669598 IRC RMV TNLD INPRTNL CATH $531.00 06 DIAG IMAGING PROCEDURES0668517 IRC RMVL INTHCL/EPID CATH $504.00 06 DIAG IMAGING PROCEDURES0663542 IRC RMVL INTRA ART PUMP $917.00 06 DIAG IMAGING PROCEDURES0662726 IRC RMVL KDY STN PRC GT 2 $4,252.00 06 DIAG IMAGING PROCEDURES

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0662734 IRC RMVL KDY STN PRC/LES2 $2,980.00 06 DIAG IMAGING PROCEDURES0667691 IRC RPLC COMP NON-TUNN CV $826.00 06 DIAG IMAGING PROCEDURES0667683 IRC RPLC COMP TUN CV CATH $4,593.00 06 DIAG IMAGING PROCEDURES0667717 IRC RPLC COMP TUN CV W/PT $8,749.00 06 DIAG IMAGING PROCEDURES0666446 IRC RPLC DUD/JEJ TUBE PRC $5,424.00 06 DIAG IMAGING PROCEDURES0667584 IRC RVSN AVS FIST OPN W/O $974.00 06 DIAG IMAGING PROCEDURES0666164 IRC RVSN INTRA ART PUMP $1,222.00 06 DIAG IMAGING PROCEDURES0667303 IRC SELECT CATH 1ST VEN $2,332.00 $1,733.00 $1,733.00 06 DIAG IMAGING PROCEDURES0667352 IRC SELECT CATH 2ND VEN $1,399.00 $1,039.00 $1,039.00 06 DIAG IMAGING PROCEDURES0667451 IRC STNT INTRAVS ADDL PRC $5,968.00 $4,434.00 06 DIAG IMAGING PROCEDURES0667402 IRC STNT INTRAVS INIT PRC $13,117.00 $9,746.00 06 DIAG IMAGING PROCEDURES0667907 IRC SYNOVIAL BX IP JOINT $713.00 06 DIAG IMAGING PROCEDURES0667915 IRC SYNOVIAL BX MCP JOINT $731.00 06 DIAG IMAGING PROCEDURES0663773 IRC TEMP BAL ARTERIAL OCC $720.00 06 DIAG IMAGING PROCEDURES0669564 IRC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0663484 IRC THORACENTESIS W TUBE $531.00 06 DIAG IMAGING PROCEDURES0667543 IRC THROMBECTOMY AVS FIST $7,794.00 06 DIAG IMAGING PROCEDURES0667469 IRC THROMBOLYSIS CEREB IV $590.00 $462.00 06 DIAG IMAGING PROCEDURES0665158 IRC THROMBOLYSIS IV NONCO $436.00 $341.00 $1,261.00 06 DIAG IMAGING PROCEDURES0667527 IRC TIPS INSERTION $1,170.00 06 DIAG IMAGING PROCEDURES0667493 IRC TIPS REVISION $23,034.00 06 DIAG IMAGING PROCEDURES0667956 IRC TRNCTH STNT CCA W/PRO $1,907.00 $1,907.00 06 DIAG IMAGING PROCEDURES0663005 IRC TUBE THORACOSTOMY $205.00 $161.00 06 DIAG IMAGING PROCEDURES0664961 IRC UP GI ENDO W/TUBE PLC $801.00 06 DIAG IMAGING PROCEDURES0667501 IRC VEN ANAST PORT OPN $1,850.00 $1,448.00 $5,196.00 06 DIAG IMAGING PROCEDURES0667634 IRC VEN CATH BLOOD SAMPLE $232.00 06 DIAG IMAGING PROCEDURES0666149 IRC VERTEPLASTY ADD PRC $299.00 06 DIAG IMAGING PROCEDURES0666131 IRC VERTEPLASTY LUMB PRC $3,965.00 06 DIAG IMAGING PROCEDURES0666123 IRC VERTEPLASTY THOR PRC $4,320.00 06 DIAG IMAGING PROCEDURES0654939 MR 3D RENDER W/O POSTPROS $513.00 06 DIAG IMAGING PROCEDURES0654921 MR 3D RENDER W/POSTPROCES $461.00 06 DIAG IMAGING PROCEDURES0652099 MR ABD W CON $4,299.00 06 DIAG IMAGING PROCEDURES0652107 MR ABD W/O CON $3,144.00 $3,561.00 06 DIAG IMAGING PROCEDURES0652115 MR ABD W-W/O CON $5,243.00 06 DIAG IMAGING PROCEDURES0652156 MR BONE MARROW $3,416.00 $2,578.00 06 DIAG IMAGING PROCEDURES0652800 MR BRAIN W STEM W CON $3,928.00 $4,448.00 06 DIAG IMAGING PROCEDURES0652750 MR BRAIN W STEM W/O CON $3,563.00 $4,035.00 06 DIAG IMAGING PROCEDURES0652701 MR BRAIN W STEM W-W/O CON $5,056.00 $5,725.00 06 DIAG IMAGING PROCEDURES0652180 MR BREAST BIL W-W/O CON $4,072.00 06 DIAG IMAGING PROCEDURES0652214 MR BREAST CAD MRI ADD-ON $51.00 06 DIAG IMAGING PROCEDURES0652172 MR BREAST UNI W-W/O CON $3,314.00 06 DIAG IMAGING PROCEDURES0654012 MR CARD MRI MORPH WO CON $2,698.00 06 DIAG IMAGING PROCEDURES0654061 MR CARD MRI MORPH W-W/O $3,907.00 06 DIAG IMAGING PROCEDURES

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0654095 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654020 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654046 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654079 MR CARD MRI VEL FLW MAP $657.00 06 DIAG IMAGING PROCEDURES0654038 MR CARD MRI W/STRESS IMG $4,154.00 06 DIAG IMAGING PROCEDURES0654087 MR CARD MRI W/STRSS W-W/O $4,860.00 06 DIAG IMAGING PROCEDURES0652370 MR CHEST W CON $4,398.00 06 DIAG IMAGING PROCEDURES0652255 MR CHEST W/O CON $3,949.00 $4,472.00 06 DIAG IMAGING PROCEDURES0650572 MR CHEST W/O CON $3,949.00 06 DIAG IMAGING PROCEDURES0652388 MR CHEST W-W/O CON $5,972.00 06 DIAG IMAGING PROCEDURES0651372 MR CS DIFF MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0651364 MR CS DIFF MD GT5YR 0-30M $250.00 06 DIAG IMAGING PROCEDURES0651380 MR CS DIFF MD LT5YR 0-30M $302.00 06 DIAG IMAGING PROCEDURES0651349 MR CS SAME MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0635987 MR CS SAME MD ADD 15M $111.00 06 DIAG IMAGING PROCEDURES0651331 MR CS SAME MD GT5YR 0-30M $277.00 06 DIAG IMAGING PROCEDURES0651323 MR CS SAME MD LT5YR 0-30M $329.00 06 DIAG IMAGING PROCEDURES0652529 MR EXT LOW JNT W-W/O CON $4,962.00 06 DIAG IMAGING PROCEDURES0652503 MR EXT LOW JT W/O CON $3,452.00 $3,909.00 06 DIAG IMAGING PROCEDURES0652438 MR EXT LOW W/O CON $3,533.00 06 DIAG IMAGING PROCEDURES0652453 MR EXT LOW W-W/O CON $5,261.00 $5,957.00 06 DIAG IMAGING PROCEDURES0652644 MR EXT UPP JNT W CON $3,663.00 06 DIAG IMAGING PROCEDURES0652651 MR EXT UPP JNT W/O CON $3,380.00 $3,827.00 06 DIAG IMAGING PROCEDURES0652669 MR EXT UPP JNT W-W/O CON $6,234.00 06 DIAG IMAGING PROCEDURES0652594 MR EXT UPP NO JNT W/CON $3,904.00 06 DIAG IMAGING PROCEDURES0652586 MR EXT UPP NO JNT W/O CON $3,606.00 06 DIAG IMAGING PROCEDURES0652602 MR EXT UPP NO JNT W-W/O $5,261.00 $5,957.00 06 DIAG IMAGING PROCEDURES0654962 MR GUIDE NDL PLACE $2,843.00 06 DIAG IMAGING PROCEDURES0654988 MR GUIDE VISCL TISS ABLTN $1,860.00 06 DIAG IMAGING PROCEDURES0653121 MR ORBIT FACE NEC W CON $3,844.00 06 DIAG IMAGING PROCEDURES0653204 MR ORBIT FACE NEC W/O CON $3,503.00 $3,967.00 06 DIAG IMAGING PROCEDURES0653147 MR ORBIT FACE NEC W-W/O $5,197.00 06 DIAG IMAGING PROCEDURES0653303 MR PELV W CON 06 DIAG IMAGING PROCEDURES0653295 MR PELV W/O CON $3,554.00 06 DIAG IMAGING PROCEDURES0653311 MR PELV W-W/O CON $5,234.00 06 DIAG IMAGING PROCEDURES0654947 MR SPECTROSCOPY $3,102.00 06 DIAG IMAGING PROCEDURES0653501 MR SPINE CERV W CON $3,925.00 $4,445.00 06 DIAG IMAGING PROCEDURES0653451 MR SPINE CERV W/O CON $3,138.00 $3,554.00 06 DIAG IMAGING PROCEDURES0653600 MR SPINE CERV W-W/O CON $4,977.00 $5,636.00 06 DIAG IMAGING PROCEDURES0653709 MR SPINE LUMB W CON $3,916.00 $4,434.00 06 DIAG IMAGING PROCEDURES0653659 MR SPINE LUMB W/O CON $3,211.00 $3,636.00 06 DIAG IMAGING PROCEDURES0653758 MR SPINE LUMB W-W/O $4,971.00 $5,629.00 06 DIAG IMAGING PROCEDURES0653907 MR SPINE THOR W CON $3,491.00 $3,953.00 06 DIAG IMAGING PROCEDURES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0653857 MR SPINE THOR W/O CON $3,214.00 $3,639.00 06 DIAG IMAGING PROCEDURES0653808 MR SPINE THOR W-W/O $4,649.00 $5,264.00 06 DIAG IMAGING PROCEDURES0652776 MR VENOGRAM BRAIN $6,195.00 06 DIAG IMAGING PROCEDURES0652123 MRA ABD W-W/O CON $2,891.00 06 DIAG IMAGING PROCEDURES0652404 MRA CHEST W-W/O CON $2,871.00 $3,251.00 06 DIAG IMAGING PROCEDURES0652552 MRA EXT LOW W-W/O CON $3,574.00 $2,715.00 06 DIAG IMAGING PROCEDURES0655522 MRA HEAD W CON $4,284.00 06 DIAG IMAGING PROCEDURES0655506 MRA HEAD W/O CON $4,284.00 06 DIAG IMAGING PROCEDURES0655548 MRA HEAD W-W/O CON $6,852.00 06 DIAG IMAGING PROCEDURES0652834 MRA HEAD W-W/O CON $4,490.00 $7,759.00 06 DIAG IMAGING PROCEDURES0657528 MRA NEC W CON $4,510.00 06 DIAG IMAGING PROCEDURES0657502 MRA NEC W/O CON $4,299.00 06 DIAG IMAGING PROCEDURES0657544 MRA NEC W-W/O CON $6,852.00 06 DIAG IMAGING PROCEDURES0653352 MRA PELV W-W/O CON $3,888.00 $4,402.00 06 DIAG IMAGING PROCEDURES0650812 MRA SPINAL CANAL W/CON $4,200.00 06 DIAG IMAGING PROCEDURES0650820 MRA SPINAL CANAL W/O CON $4,400.00 06 DIAG IMAGING PROCEDURES0650838 MRA SPINAL CANAL W-WO CON $4,565.00 06 DIAG IMAGING PROCEDURES0650861 MRA UPPER EXT W/CON $4,400.00 06 DIAG IMAGING PROCEDURES0650895 MRA UPPER EXT W/CON LT $4,400.00 06 DIAG IMAGING PROCEDURES0650911 MRA UPPER EXT W/CON RT $4,400.00 06 DIAG IMAGING PROCEDURES0650879 MRA UPPER EXT W/O CON $4,565.00 06 DIAG IMAGING PROCEDURES0650937 MRA UPPER EXT W/O CON LT $4,565.00 06 DIAG IMAGING PROCEDURES0650929 MRA UPPER EXT W/O CON RT $4,565.00 06 DIAG IMAGING PROCEDURES0650887 MRA UPPER EXT W-WO CON $4,600.00 06 DIAG IMAGING PROCEDURES0650960 MRA UPPER EXT W-WO CON LT $4,600.00 06 DIAG IMAGING PROCEDURES0650945 MRA UPPER EXT W-WO CON RT $4,600.00 06 DIAG IMAGING PROCEDURES0652693 MRC BX STEREO ASPIR HEAD $4,044.00 06 DIAG IMAGING PROCEDURES0653956 MRI OF TMJ(S) $3,084.00 $3,492.00 06 DIAG IMAGING PROCEDURES0675702 NI AORTA IVC IL CMPL $1,949.00 $1,796.00 $1,077.00 06 DIAG IMAGING PROCEDURES0675215 NI AORTA IVC IL LTD $1,093.00 $860.00 06 DIAG IMAGING PROCEDURES0675355 NI DIAL ACCES $1,796.00 $1,655.00 06 DIAG IMAGING PROCEDURES0676478 NI DPPLER EXT VEINS BIL $1,018.00 $938.00 06 DIAG IMAGING PROCEDURES0676379 NI DPPLER EXT VEINS BIL $1,018.00 $938.00 06 DIAG IMAGING PROCEDURES0675942 NI DPPLER EXTRACRAN BIL $876.00 $807.00 06 DIAG IMAGING PROCEDURES0675108 NI DUPLEX ABD PELV CMPL $2,712.00 $2,499.00 $1,822.00 06 DIAG IMAGING PROCEDURES0675157 NI DUPLEX ABD PELV LTD $1,463.00 $1,349.00 $1,034.00 06 DIAG IMAGING PROCEDURES0675462 NI DUPLEX EXT LOW BIL $2,690.00 $2,478.00 06 DIAG IMAGING PROCEDURES0675470 NI DUPLEX EXT LOW UNI $1,719.00 06 DIAG IMAGING PROCEDURES0675801 NI DUPLEX EXT UPP BIL $2,106.00 $1,940.00 $1,279.00 06 DIAG IMAGING PROCEDURES0675306 NI DUPLEX EXT UPP UNI $1,409.00 $1,298.00 06 DIAG IMAGING PROCEDURES0676403 NI DUPLEX EXT VEINS BIL $2,077.00 $1,913.00 $1,253.00 06 DIAG IMAGING PROCEDURES0676452 NI DUPLEX EXT VEINS UNI $1,365.00 $1,258.00 06 DIAG IMAGING PROCEDURES0675850 NI DUPLEX EXTRACRAN BIL $2,062.00 $1,900.00 $1,327.00 06 DIAG IMAGING PROCEDURES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0675843 NI DUPLEX EXTRACRAN UNI $1,398.00 06 DIAG IMAGING PROCEDURES0675603 NI EXT ART COMP BIL3+ LV $1,580.00 $1,456.00 $962.00 06 DIAG IMAGING PROCEDURES0675413 NI EXT ART LTD BIL 1-2 LV $1,051.00 $969.00 06 DIAG IMAGING PROCEDURES0675405 NI EXT ART LTD BIL 1-2 LV $1,051.00 $969.00 $962.00 06 DIAG IMAGING PROCEDURES0675439 NI EXT LOW W STRS CMP BIL $1,967.00 06 DIAG IMAGING PROCEDURES0676254 NI INTRACRAN CMPL $2,522.00 $2,324.00 $1,610.00 06 DIAG IMAGING PROCEDURES0676304 NI INTRACRAN LTD $1,675.00 $1,544.00 $1,012.00 06 DIAG IMAGING PROCEDURES0675504 NI PENILE VESSELS CMPL $1,066.00 $982.00 $681.00 06 DIAG IMAGING PROCEDURES0675553 NI PENILE VESSELS LTD $1,415.00 $1,067.00 06 DIAG IMAGING PROCEDURES0631002 NM ABSCSS LOC LTD $1,876.00 $1,876.00 06 DIAG IMAGING PROCEDURES0631101 NM ABSCSS LOC WB $3,756.00 $3,756.00 06 DIAG IMAGING PROCEDURES0632828 NM ADDL IMAGING/FUSION $203.00 06 DIAG IMAGING PROCEDURES0631309 NM ADRENAL $4,881.00 $4,881.00 06 DIAG IMAGING PROCEDURES0639450 NM APLY INTRSTL RAD SMPL $1,438.00 06 DIAG IMAGING PROCEDURES0631457 NM BONE MARROW LTD $1,741.00 $1,741.00 06 DIAG IMAGING PROCEDURES0631507 NM BONE MARROW MULTI $2,318.00 $2,318.00 06 DIAG IMAGING PROCEDURES0631556 NM BONE MARROW WB $2,672.00 $2,672.00 06 DIAG IMAGING PROCEDURES0631408 NM BONE SCAN LTD $1,801.00 $1,801.00 06 DIAG IMAGING PROCEDURES0631804 NM BONE SCAN MULTI AREAS $2,383.00 $2,383.00 06 DIAG IMAGING PROCEDURES0631903 NM BONE SCAN W SPECT $2,507.00 $2,300.00 06 DIAG IMAGING PROCEDURES0631952 NM BONE SCAN WB $2,652.00 $2,652.00 06 DIAG IMAGING PROCEDURES0631853 NM BONE THREE PHASE $3,667.00 $3,667.00 06 DIAG IMAGING PROCEDURES0634550 NM BOWEL (MECKELS) $3,517.00 $3,517.00 06 DIAG IMAGING PROCEDURES0632059 NM BRAIN CISTERNOGRAM $3,761.00 $3,761.00 06 DIAG IMAGING PROCEDURES0632406 NM BRAIN CSF SHUNT EVAL $3,557.00 $3,557.00 06 DIAG IMAGING PROCEDURES0632257 NM BRAIN FLOW ONLY $2,065.00 $2,065.00 06 DIAG IMAGING PROCEDURES0632158 NM BRAIN GT3 STAT V W/FLW $3,622.00 $3,622.00 06 DIAG IMAGING PROCEDURES0632109 NM BRAIN GT3 STATIC VW $2,139.00 $2,139.00 06 DIAG IMAGING PROCEDURES0632356 NM BRAIN LT4 STAT V W/FLW $2,348.00 $2,348.00 06 DIAG IMAGING PROCEDURES0632307 NM BRAIN LT4 STATIC VW $1,890.00 $1,426.00 06 DIAG IMAGING PROCEDURES0632208 NM BRAIN W TOMO SPECT $3,836.00 $3,836.00 06 DIAG IMAGING PROCEDURES0633701 NM CARDIAC SHUNT EVAL $2,010.00 $2,010.00 06 DIAG IMAGING PROCEDURES0635938 NM CS DIFF MD ADD 15M $140.00 06 DIAG IMAGING PROCEDURES0635961 NM CS DIFF MD ADD 15M $140.00 06 DIAG IMAGING PROCEDURES0635946 NM CS DIFF MD LT5YR 0-30M $377.00 06 DIAG IMAGING PROCEDURES0635920 NM CS SAME MD GT5YR 0-30M $458.00 06 DIAG IMAGING PROCEDURES0635912 NM CS SAME MD LT5YR 0-30M $543.00 06 DIAG IMAGING PROCEDURES0632075 NM CSF FLOW W SPECT $778.00 06 DIAG IMAGING PROCEDURES0636779 NM CSF FLOW W SPECT $1,207.00 $968.00 06 DIAG IMAGING PROCEDURES0632455 NM CSF LEAKAGE DETECT $3,701.00 $3,701.00 06 DIAG IMAGING PROCEDURES0632653 NM CYSTOGRAM VOIDING $2,348.00 $2,348.00 06 DIAG IMAGING PROCEDURES0632752 NM ESOPH MOTILITY $860.00 $1,191.00 06 DIAG IMAGING PROCEDURES0632869 NM GASTRIC EMPTYING $3,080.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0632901 NM GASTROESOPH REFLUX $2,662.00 $2,662.00 06 DIAG IMAGING PROCEDURES0633008 NM GI BLEEDING SCAN $3,687.00 $3,687.00 06 DIAG IMAGING PROCEDURES0633107 NM HEART 1S PASS SNGL $2,149.00 $2,149.00 $2,576.00 06 DIAG IMAGING PROCEDURES0633222 NM HEART BLOOD POOL SPECT $2,756.00 06 DIAG IMAGING PROCEDURES0633156 NM HEART GATED MULTIVIEW $3,443.00 $3,115.00 06 DIAG IMAGING PROCEDURES0633149 NM HEART GATED SNGL $2,637.00 06 DIAG IMAGING PROCEDURES0633552 NM HEART MI PLANAR $2,418.00 $1,824.00 06 DIAG IMAGING PROCEDURES0633602 NM HEART MI W EF $2,328.00 $2,328.00 06 DIAG IMAGING PROCEDURES0633651 NM HEART MI W SPECT $2,657.00 $2,657.00 06 DIAG IMAGING PROCEDURES0633354 NM HEART MP MULTI PLANAR $1,677.00 $1,677.00 06 DIAG IMAGING PROCEDURES0638379 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0633750 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0636886 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0633057 NM HEART MP MULTI W SPECT $4,139.00 $4,139.00 06 DIAG IMAGING PROCEDURES0636878 NM HEART MP SNGL PLANAR $1,995.00 $1,995.00 06 DIAG IMAGING PROCEDURES0636852 NM HEART MP SNGL W SPEC $2,139.00 $2,139.00 06 DIAG IMAGING PROCEDURES0633800 NM HEPATOBILIARY DUCTAL $3,557.00 $3,557.00 06 DIAG IMAGING PROCEDURES0631051 NM INFLAM LOCAL W SPECT $3,806.00 $3,806.00 06 DIAG IMAGING PROCEDURES0635581 NM INTRA-ARTICULAR TX $385.00 06 DIAG IMAGING PROCEDURES0639476 NM INTRSTIT RADIAT CMPLX $3,478.00 06 DIAG IMAGING PROCEDURES0633826 NM IV IJ RA DRUG DX STUDY $493.00 $493.00 06 DIAG IMAGING PROCEDURES0635185 NM K FLOW/FUNCT MULTIPLE $3,696.00 06 DIAG IMAGING PROCEDURES0634808 NM K FLOW/FUNCT W/DRUG $1,602.00 $1,602.00 06 DIAG IMAGING PROCEDURES0634816 NM K FLOW/FUNCT W/DRUG $1,602.00 $1,602.00 06 DIAG IMAGING PROCEDURES0635219 NM K FLOW/FUNCT W/O DRG $2,428.00 06 DIAG IMAGING PROCEDURES0634907 NM KIDNEY IMAGING MORPHOL $1,920.00 $1,920.00 $1,474.00 06 DIAG IMAGING PROCEDURES0635151 NM KIDNEY IMAGING SPECT $2,488.00 $2,488.00 06 DIAG IMAGING PROCEDURES0635052 NM KIDNEY IMAGING W/FLOW $2,363.00 $2,363.00 06 DIAG IMAGING PROCEDURES0634006 NM LIVER FNCTN STDY $1,110.00 $1,110.00 06 DIAG IMAGING PROCEDURES0634253 NM LIVER SPLEEN STATIC $2,090.00 $2,090.00 06 DIAG IMAGING PROCEDURES0634303 NM LIVER SPLEEN W FLOW $1,353.00 $1,353.00 06 DIAG IMAGING PROCEDURES0634055 NM LIVER STATIC $2,020.00 $2,020.00 06 DIAG IMAGING PROCEDURES0634154 NM LIVER W SPECT $2,512.00 $2,512.00 06 DIAG IMAGING PROCEDURES0634105 NM LIVER W VASCULAR FLOW $2,264.00 $2,264.00 06 DIAG IMAGING PROCEDURES0639831 NM LOADING RAD SOURCE $488.00 06 DIAG IMAGING PROCEDURES0634352 NM LUNG PERF $2,209.00 $2,209.00 06 DIAG IMAGING PROCEDURES0634477 NM LUNG PERF VENT $3,537.00 06 DIAG IMAGING PROCEDURES0634493 NM LUNG QUAN DIFF FNCTN $3,935.00 06 DIAG IMAGING PROCEDURES0634444 NM LUNG VENT MULTI $2,303.00 06 DIAG IMAGING PROCEDURES0634402 NM LUNG VENT W GAS $2,144.00 $2,144.00 06 DIAG IMAGING PROCEDURES0634436 NM LUNG VENT W GAS MULTI $2,463.00 $2,463.00 06 DIAG IMAGING PROCEDURES0634451 NM LUNG VENTI1V $1,564.00 $1,476.00 06 DIAG IMAGING PROCEDURES0634501 NM LYMPHATIC PATHWAY $3,622.00 $3,622.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0635615 NM MONOCLONAL AB IV INFSN $1,259.00 06 DIAG IMAGING PROCEDURES0637173 NM NM MOBILE 06 DIAG IMAGING PROCEDURES0634600 NM PARATHYROID $1,642.00 $1,642.00 06 DIAG IMAGING PROCEDURES0637439 NM PARATHYROID $1,642.00 $1,642.00 06 DIAG IMAGING PROCEDURES0634659 NM PLASMA VOLUME MULTI $928.00 $701.00 06 DIAG IMAGING PROCEDURES0634782 NM PLATELET SURVIVAL STDY $540.00 06 DIAG IMAGING PROCEDURES0639104 NM RADIAT DOSIMETRY CALC $512.00 06 DIAG IMAGING PROCEDURES0634709 NM RED CELL MASS MULTI $1,055.00 $1,055.00 06 DIAG IMAGING PROCEDURES0634758 NM RED CELL SURVIVAL $3,455.00 $2,607.00 06 DIAG IMAGING PROCEDURES0634857 NM RENL FNCTN NONIMAG $1,045.00 $1,045.00 06 DIAG IMAGING PROCEDURES0633818 NM RP DACRYOCYSTOGRAM $436.00 06 DIAG IMAGING PROCEDURES0635268 NM SALIVARY ASP $4,539.00 06 DIAG IMAGING PROCEDURES0635250 NM SALIVARY GLND W SER $1,333.00 $1,333.00 06 DIAG IMAGING PROCEDURES0635334 NM SCHILLING W INT FACTR $502.00 06 DIAG IMAGING PROCEDURES0635326 NM SCHILLING WO INT FACTR $891.00 06 DIAG IMAGING PROCEDURES0635409 NM SPLEEN $1,549.00 $1,169.00 06 DIAG IMAGING PROCEDURES0635458 NM TESTICULR IMGNG W FLOW $2,199.00 $2,199.00 06 DIAG IMAGING PROCEDURES0636001 NM THYROID IMAG ONLY $1,756.00 $1,756.00 06 DIAG IMAGING PROCEDURES0635953 NM THYROID IMAG UPT MULTI $1,358.00 $1,358.00 06 DIAG IMAGING PROCEDURES0635979 NM THYROID IMAG UPT SNGL $2,592.00 06 DIAG IMAGING PROCEDURES0636050 NM THYROID IMAG W FLOW $718.00 $677.00 06 DIAG IMAGING PROCEDURES0635839 NM THYROID METS LTD $2,249.00 06 DIAG IMAGING PROCEDURES0636274 NM THYROID METS UPT $741.00 $741.00 06 DIAG IMAGING PROCEDURES0636100 NM THYROID METS WB $3,493.00 $3,493.00 06 DIAG IMAGING PROCEDURES0636159 NM THYROID SUPP STIM $718.00 $542.00 06 DIAG IMAGING PROCEDURES0636209 NM THYROID UPTAKE MULTI $980.00 $980.00 06 DIAG IMAGING PROCEDURES0636258 NM THYROID UPTAKE SNGL $776.00 $776.00 06 DIAG IMAGING PROCEDURES0636308 NM TUMOR LOC LTD W RP $1,950.00 $1,950.00 $1,667.00 06 DIAG IMAGING PROCEDURES0636407 NM TUMOR LOC MULTI W RP $2,657.00 $2,657.00 06 DIAG IMAGING PROCEDURES0636456 NM TUMOR LOC SPECT W RP $3,811.00 $3,811.00 06 DIAG IMAGING PROCEDURES0636514 NM TUMOR LOC WB SNGL DAY $3,587.00 $3,587.00 06 DIAG IMAGING PROCEDURES0636480 NM TUMOR LOC WB SNGL DAY $3,587.00 06 DIAG IMAGING PROCEDURES0635607 NM TX INTRACAVITY $896.00 $896.00 06 DIAG IMAGING PROCEDURES0635631 NM TX RADIOPHARM IV ADM $806.00 06 DIAG IMAGING PROCEDURES0635656 NM TX RADIOPHARM IV ADM $806.00 $806.00 06 DIAG IMAGING PROCEDURES0635805 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635557 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635854 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635904 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0635508 NM TX RADIOPHARM ORAL ADM $741.00 $741.00 06 DIAG IMAGING PROCEDURES0634667 NM UREA TEST C14 ACQ $159.00 06 DIAG IMAGING PROCEDURES0634675 NM UREA TEST C14 ANALYSIS $1,358.00 06 DIAG IMAGING PROCEDURES0632802 NM VASCULAR FLOW NCARDIO $1,841.00 $1,841.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0631119 NM VEN THROMBOSIS ACUTE $1,276.00 06 DIAG IMAGING PROCEDURES0636555 NM VENOGRAM BIL $2,281.00 $1,721.00 06 DIAG IMAGING PROCEDURES0636605 NM VENOGRAM UNI $1,970.00 $1,970.00 06 DIAG IMAGING PROCEDURES0634378 NM VENT/PER REBRTH/WASHOU $3,751.00 06 DIAG IMAGING PROCEDURES0635300 NM VIT B12 COMBINED $985.00 $985.00 06 DIAG IMAGING PROCEDURES0633958 NM VP SHUNT PATENCY $2,587.00 $2,587.00 06 DIAG IMAGING PROCEDURES0634774 NM WB VOL DETERMINATION $1,249.00 06 DIAG IMAGING PROCEDURES0636464 NM WHOLE BODY 2+ DAYS $6,701.00 06 DIAG IMAGING PROCEDURES0633842 NMC INJ ASP SHUNT $253.00 06 DIAG IMAGING PROCEDURES0633834 NMC INJ VP SHUNT $177.00 06 DIAG IMAGING PROCEDURES0633891 NMC INSERT CATH TMP SMPL $288.00 06 DIAG IMAGING PROCEDURES0633875 NMC NODE IDENTIFICATION $88.00 06 DIAG IMAGING PROCEDURES0667139 PLT AGGREGATION EA AGENT $668.00 06 DIAG IMAGING PROCEDURES0648790 PRQ RF ABLAT TX PUL TUMOR $12,235.00 $9,574.00 06 DIAG IMAGING PROCEDURES0681056 PS BRAIN METBLC EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0681155 PS BRAIN PERF EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0682161 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0682179 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0683714 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0684662 PS FULL BODY $1,150.00 06 DIAG IMAGING PROCEDURES0684050 PS HEART METBLC EVAL $1,150.00 06 DIAG IMAGING PROCEDURES0684100 PS HEART PERF MULTI $1,150.00 06 DIAG IMAGING PROCEDURES0684159 PS HEART PERF SNGL $1,150.00 06 DIAG IMAGING PROCEDURES0684829 PS LIMITED AREA $1,150.00 06 DIAG IMAGING PROCEDURES0684845 PS SKULL TO MID THIGH $1,150.00 06 DIAG IMAGING PROCEDURES0684860 PS/CT ATT ANAT LOC LTD $1,150.00 06 DIAG IMAGING PROCEDURES0684886 PS/CT SKULL-THGH $1,150.00 06 DIAG IMAGING PROCEDURES0684902 PS/CT WHOLE BODY $1,150.00 06 DIAG IMAGING PROCEDURES0699520 RO APLY INTRACV RAD CMPLX $4,186.00 06 DIAG IMAGING PROCEDURES0699512 RO APLY INTRACV RAD INTRM $3,242.00 06 DIAG IMAGING PROCEDURES0699504 RO APLY INTRACV RAD SMPL $2,760.00 06 DIAG IMAGING PROCEDURES0699462 RO APLY INTRSTL RAD INTRM $898.00 06 DIAG IMAGING PROCEDURES0699454 RO APLY INTRSTL RAD SMPL $463.00 06 DIAG IMAGING PROCEDURES0699165 RO BRACHY DOSE PLAN CMPLX $2,803.00 06 DIAG IMAGING PROCEDURES0699140 RO BRACHY DOSE PLAN INTRM $2,180.00 06 DIAG IMAGING PROCEDURES0699124 RO BRACHY DOSE PLAN SMPL $1,581.00 06 DIAG IMAGING PROCEDURES0699629 RO CONSULT CONT MED PHYSC $908.00 06 DIAG IMAGING PROCEDURES0699801 RO DOSIMETRY SPECIAL $309.00 06 DIAG IMAGING PROCEDURES0698514 RO DSIGN MLC DEV FOR IMRT $800.00 06 DIAG IMAGING PROCEDURES0699926 RO DVCS CONSTRUCT CMPLX 4 $1,513.00 06 DIAG IMAGING PROCEDURES0699918 RO DVCS CONSTRUCT INTRM $340.00 06 DIAG IMAGING PROCEDURES0699900 RO DVCS CONSTRUCT SMPL $827.00 06 DIAG IMAGING PROCEDURES0699421 RO IMRT DLVR EA SESSION $8,570.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0699405 RO INFUSE RADIOELMNT SOLN $283.00 06 DIAG IMAGING PROCEDURES0699470 RO INTRSTIT RADIAT CMPLX $4,316.00 06 DIAG IMAGING PROCEDURES0699850 RO INTRSTIT RADIAT CMPLX $4,316.00 06 DIAG IMAGING PROCEDURES0699579 RO ISODOSE PLAN CMPLX $1,081.00 06 DIAG IMAGING PROCEDURES0699561 RO ISODOSE PLAN INTRM $716.00 06 DIAG IMAGING PROCEDURES0699553 RO ISODOSE PLAN SMPL $550.00 06 DIAG IMAGING PROCEDURES0699835 RO LOADING RAD SOURCE $605.00 06 DIAG IMAGING PROCEDURES0699645 RO RAD PORT FILM(S) $247.00 06 DIAG IMAGING PROCEDURES0699272 RO RAD TX 2 AREA 11-19MEV $3,063.00 06 DIAG IMAGING PROCEDURES0699256 RO RAD TX 2 AREA 1-5MEV $445.00 06 DIAG IMAGING PROCEDURES0699264 RO RAD TX 2 AREA 6-10MEV $2,766.00 06 DIAG IMAGING PROCEDURES0699280 RO RAD TX 2 AREA GT 19MEV $445.00 06 DIAG IMAGING PROCEDURES0699322 RO RAD TX 3/MORE 11-19MEV $4,038.00 06 DIAG IMAGING PROCEDURES0699306 RO RAD TX 3/MORE 1-5MEV $496.00 06 DIAG IMAGING PROCEDURES0699314 RO RAD TX 3/MORE 6-10MEV $3,618.00 06 DIAG IMAGING PROCEDURES0699330 RO RAD TX 3/MORE GT 19MEV $4,057.00 06 DIAG IMAGING PROCEDURES0699223 RO RAD TX SNGL 11-19MEV $2,266.00 06 DIAG IMAGING PROCEDURES0699207 RO RAD TX SNGL 1-5MEV $378.00 06 DIAG IMAGING PROCEDURES0699215 RO RAD TX SNGL 6-10MEV $2,044.00 06 DIAG IMAGING PROCEDURES0699231 RO RAD TX SNGL GT 19MEV $378.00 06 DIAG IMAGING PROCEDURES0699355 RO RAD TX SUPERFICIAL $438.00 06 DIAG IMAGING PROCEDURES0699108 RO RADIAT DOSIMETRY CALC $636.00 06 DIAG IMAGING PROCEDURES0699603 RO RADIATION PHYSICS CNSL $1,889.00 06 DIAG IMAGING PROCEDURES0699660 RO SIMULATION 3D $10,881.00 06 DIAG IMAGING PROCEDURES0699702 RO SIMULATION SMPL $2,457.00 06 DIAG IMAGING PROCEDURES0699819 RO SPECIAL PORT PLAN BODY $1,062.00 06 DIAG IMAGING PROCEDURES0699827 RO SPECIAL TX PROCEDURE $1,920.00 06 DIAG IMAGING PROCEDURES0624452 S STRL RF TALON PROBE $2,295.00 06 DIAG IMAGING PROCEDURES0667287 SREP S/N/A/G/TR/E 2.5CM/< $345.00 06 DIAG IMAGING PROCEDURES0672253 US ABD CMPL $1,286.00 $911.00 $1,246.00 06 DIAG IMAGING PROCEDURES0673004 US AMNIOCENTESIS $283.00 $201.00 $920.00 06 DIAG IMAGING PROCEDURES0673152 US ASP OVA $492.00 $464.00 06 DIAG IMAGING PROCEDURES0674606 US BIO PROFILE W NONSTRES $911.00 $646.00 $1,074.00 06 DIAG IMAGING PROCEDURES0674150 US BIO PROFILE WO NOSTRES $709.00 06 DIAG IMAGING PROCEDURES0673558 US BREAST UNI OR BIL $871.00 $617.00 $681.00 06 DIAG IMAGING PROCEDURES0672766 US BX ENDOMYOCARDIAL $1,399.00 $1,320.00 06 DIAG IMAGING PROCEDURES0673608 US CHEST $779.00 $552.00 $825.00 06 DIAG IMAGING PROCEDURES0673707 US CRYOSURGERY $3,902.00 $2,766.00 $3,714.00 06 DIAG IMAGING PROCEDURES0671339 US CS DIFF MD ADD 15M $186.00 06 DIAG IMAGING PROCEDURES0671321 US CS DIFF MD GT5YR 0-30M $419.00 06 DIAG IMAGING PROCEDURES0671313 US CS DIFF MD LT5YR 0-30M $506.00 06 DIAG IMAGING PROCEDURES0671305 US CS SAME MD ADD 15M $186.00 06 DIAG IMAGING PROCEDURES0671297 US CS SAME MD GT5YR 0-30M $466.00 06 DIAG IMAGING PROCEDURES

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SEQ 300 AMOUNT

DEPARTMENT CODE

0671347 US CS SAME MD LT5YR 0-30M $553.00 06 DIAG IMAGING PROCEDURES0673756 US DPPLER ECHO FETAL $521.00 $370.00 06 DIAG IMAGING PROCEDURES0673806 US DPPLER ECHO FETAL FU $425.00 $401.00 06 DIAG IMAGING PROCEDURES0672931 US DRN W CATH PLACE PRC $1,038.00 06 DIAG IMAGING PROCEDURES0672303 US ECHO ABD LTD $992.00 $703.00 $892.00 06 DIAG IMAGING PROCEDURES0674127 US ECHO FETAL $1,721.00 $1,220.00 06 DIAG IMAGING PROCEDURES0674184 US ECHO FETAL FU REPEAT $730.00 $689.00 06 DIAG IMAGING PROCEDURES0674044 US ECHO INF HIPS $1,351.00 06 DIAG IMAGING PROCEDURES0674069 US ECHO INF HIPS LTD $187.00 06 DIAG IMAGING PROCEDURES0672154 US ECHO RETROPE LTD $1,078.00 $764.00 $892.00 06 DIAG IMAGING PROCEDURES0674143 US ENCEPHALOGRAM $1,144.00 $811.00 $920.00 06 DIAG IMAGING PROCEDURES0674200 US FETAL TRANSFUSION IUT $201.00 06 DIAG IMAGING PROCEDURES0674259 US FU STDY $921.00 $653.00 06 DIAG IMAGING PROCEDURES0670851 US GDE PRNCHYML TISS ABLN $850.00 06 DIAG IMAGING PROCEDURES0667857 US GDE PRNCHYML TISS ABLN $1,312.00 06 DIAG IMAGING PROCEDURES0674309 US GUIDANCE INTRAOP $202.00 $144.00 06 DIAG IMAGING PROCEDURES0674192 US GUIDE ART PSEUDOANEUR $2,743.00 06 DIAG IMAGING PROCEDURES0674903 US HEAD & NEC SFT TISSUE $1,134.00 $804.00 $886.00 06 DIAG IMAGING PROCEDURES0674937 US INTRO INTERSTITIAL TX $810.00 06 DIAG IMAGING PROCEDURES0672733 US NDL PLACE $2,070.00 $1,467.00 06 DIAG IMAGING PROCEDURES0673103 US NDL PLACE $1,470.00 06 DIAG IMAGING PROCEDURES0674564 US OB 1ST TRI 1 GEST $1,058.00 06 DIAG IMAGING PROCEDURES0674572 US OB 1ST TRI EA GEST $385.00 06 DIAG IMAGING PROCEDURES0674630 US OB AFTR 1ST TRI 1 GEST $1,286.00 $911.00 $1,395.00 06 DIAG IMAGING PROCEDURES0674721 US OB AFTR 1ST TRI EA GES $633.00 $448.00 $1,475.00 06 DIAG IMAGING PROCEDURES0674580 US OB DTLD FTL EXAM 1 GES $1,331.00 06 DIAG IMAGING PROCEDURES0674598 US OB DTLD FTL EXM EA GES $1,463.00 06 DIAG IMAGING PROCEDURES0674663 US OB FU/REEVAL EA FETUS $946.00 $671.00 $828.00 06 DIAG IMAGING PROCEDURES0674697 US OB LTD 1/MORE FETUSES $769.00 $545.00 06 DIAG IMAGING PROCEDURES0674747 US OB TRANSVAGINAL $250.00 06 DIAG IMAGING PROCEDURES0674507 US PELV CMPL NONOB $1,154.00 $818.00 $969.00 06 DIAG IMAGING PROCEDURES0674523 US PELV LTD FU NONOB $1,073.00 $761.00 $644.00 06 DIAG IMAGING PROCEDURES0674556 US PERICARDIOCENT $774.00 $549.00 06 DIAG IMAGING PROCEDURES0670703 US RADIATION FIELD PLACE $914.00 $307.00 06 DIAG IMAGING PROCEDURES0674754 US RADIATION FIELD PLACE $338.00 $319.00 06 DIAG IMAGING PROCEDURES0672808 US RETROPE CMPL $1,245.00 $883.00 $1,230.00 06 DIAG IMAGING PROCEDURES0674275 US SAL INFN SONOHYSTERGHY $1,144.00 06 DIAG IMAGING PROCEDURES0674820 US SPINAL CANAL $952.00 $674.00 06 DIAG IMAGING PROCEDURES0674846 US TESTICULAR SCROTUM $1,169.00 $829.00 $958.00 06 DIAG IMAGING PROCEDURES0672881 US TRANSPLNT KDNY W/DPPLR $1,448.00 06 DIAG IMAGING PROCEDURES0673855 US TRANSRECTAL $1,397.00 $990.00 $1,246.00 06 DIAG IMAGING PROCEDURES0670752 US TRANSRECTAL $1,397.00 06 DIAG IMAGING PROCEDURES0673905 US TRANSVAGINAL $250.00 $250.00 $995.00 06 DIAG IMAGING PROCEDURES

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DEPARTMENT CODE

0670018 US US MOBILE 06 DIAG IMAGING PROCEDURES0674218 US VILLUS SAMPLING $795.00 06 DIAG IMAGING PROCEDURES0673962 US XTR NON-VASC COMPLETE $892.00 06 DIAG IMAGING PROCEDURES0673970 US XTR NON-VASC LMTD $682.00 06 DIAG IMAGING PROCEDURES0670836 USC ABLTN CRYO OPN LIVER $4,297.00 06 DIAG IMAGING PROCEDURES0670844 USC ABLTN PROSTATE CRYO $3,752.00 06 DIAG IMAGING PROCEDURES0670828 USC ABLTN RENAL RF PRC $4,475.00 06 DIAG IMAGING PROCEDURES0672501 USC ABSCSS CYST LIVER PRC $245.00 $192.00 06 DIAG IMAGING PROCEDURES0673376 USC ABSCSS DRN PELV PRC $3,434.00 06 DIAG IMAGING PROCEDURES0673335 USC ABSCSS DRN PERITNL $5,953.00 06 DIAG IMAGING PROCEDURES0672949 USC ABSCSS DRN RENL $588.00 06 DIAG IMAGING PROCEDURES0673384 USC ABSCSS DRN RETROPE $3,067.00 06 DIAG IMAGING PROCEDURES0673350 USC ABSCSS DRN SUBDIAP $3,334.00 06 DIAG IMAGING PROCEDURES0672956 USC AMNIOCENTESIS DX $329.00 $258.00 06 DIAG IMAGING PROCEDURES0672063 USC ASP BREAST ADD $47.00 06 DIAG IMAGING PROCEDURES0672055 USC ASP BREAST CYST $347.00 06 DIAG IMAGING PROCEDURES0673228 USC ASP RENL CYST $130.00 06 DIAG IMAGING PROCEDURES0672493 USC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0673251 USC ASP THYROID CYST $329.00 06 DIAG IMAGING PROCEDURES0677666 USC BREAST NDL WIRE $628.00 06 DIAG IMAGING PROCEDURES0670406 USC BREAST NDL WIRE ADD $205.00 $161.00 06 DIAG IMAGING PROCEDURES0672758 USC BX ABD RETROPE $468.00 $366.00 06 DIAG IMAGING PROCEDURES0672592 USC BX BM NDL/TROCAR $660.00 06 DIAG IMAGING PROCEDURES0672600 USC BX BONE SUPER $549.00 06 DIAG IMAGING PROCEDURES0671909 USC BX BREAST VAC ASSIST $2,770.00 06 DIAG IMAGING PROCEDURES0679800 USC BX BREAST W IMAG $392.00 $308.00 06 DIAG IMAGING PROCEDURES0622530 USC BX BREAST W IMAG $635.00 06 DIAG IMAGING PROCEDURES0672584 USC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0647750 USC BX LYMPH NODE OPEN $3,072.00 $2,178.00 06 DIAG IMAGING PROCEDURES0672535 USC BX MUSCLE $977.00 $1,415.00 06 DIAG IMAGING PROCEDURES0672634 USC BX OF OVARY(S) $713.00 06 DIAG IMAGING PROCEDURES0670075 USC BX PANCREAS $1,665.00 $1,303.00 06 DIAG IMAGING PROCEDURES0670083 USC BX PLEURA $1,094.00 $409.00 06 DIAG IMAGING PROCEDURES0672550 USC BX PROSTATE $647.00 $567.00 06 DIAG IMAGING PROCEDURES0672675 USC BX RENL $2,180.00 $1,706.00 06 DIAG IMAGING PROCEDURES0672576 USC BX SOFT TISS NEC THOR $756.00 06 DIAG IMAGING PROCEDURES0672790 USC BX THYROID $245.00 $192.00 06 DIAG IMAGING PROCEDURES0672972 USC CORDOCENTESIS IUT $709.00 06 DIAG IMAGING PROCEDURES0673368 USC DRN ABD ABSCSS OPN $2,011.00 06 DIAG IMAGING PROCEDURES0673301 USC DRN ABSCESS COMP/MULT $256.00 06 DIAG IMAGING PROCEDURES0673343 USC DRN PANC PSEUDOCYST $3,334.00 06 DIAG IMAGING PROCEDURES0673921 USC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0674036 USC EXCHANGE DRN CATH $280.00 06 DIAG IMAGING PROCEDURES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0672485 USC FNA W IMAG GUIDANCE $403.00 06 DIAG IMAGING PROCEDURES0679001 USC INJ CON ABSCSS $157.00 06 DIAG IMAGING PROCEDURES0670323 USC INJ DUCT GALACTOGRAM $216.00 $172.00 06 DIAG IMAGING PROCEDURES0671032 USC INJ INTRA-ARTERIAL $150.00 $106.00 06 DIAG IMAGING PROCEDURES0676007 USC INJ PENILE CAVERNOUS $328.00 $247.00 $233.00 06 DIAG IMAGING PROCEDURES0671107 USC INJ SINOGRAM $494.00 06 DIAG IMAGING PROCEDURES0674325 USC INS PICC W/O PORT 5+ $1,207.00 06 DIAG IMAGING PROCEDURES0674317 USC INS PICC W/O PORT LT5 $1,329.00 06 DIAG IMAGING PROCEDURES0674788 USC LAP ABLATION RF LIVER $3,652.00 06 DIAG IMAGING PROCEDURES0674796 USC LAP ABLTN CRYO LIVER $3,653.00 06 DIAG IMAGING PROCEDURES0674408 USC NEPHROSTOMY TUBE CHNG $3,854.00 $2,864.00 $2,864.00 06 DIAG IMAGING PROCEDURES0671628 USC PARACENT ABD INI $2,413.00 06 DIAG IMAGING PROCEDURES0671644 USC PARACENT ABD SUBSQ $517.00 06 DIAG IMAGING PROCEDURES0676056 USC PENILE PLETHYSMOGRAM $1,787.00 $1,348.00 06 DIAG IMAGING PROCEDURES0674945 USC PLC NDL PROSTATE INST $2,436.00 06 DIAG IMAGING PROCEDURES0676585 USC PSEUDOANEURYSM INJ $428.00 $335.00 06 DIAG IMAGING PROCEDURES0674283 USC SAL INFN SONOHYSTER $419.00 06 DIAG IMAGING PROCEDURES0674879 USC THORACENTESIS $455.00 06 DIAG IMAGING PROCEDURES0674960 USC URINE CAPACITY MEASUR $101.00 06 DIAG IMAGING PROCEDURES0676353 USC VASOTOMY FOR VASOGRAM 06 DIAG IMAGING PROCEDURES0672980 USC VILLUS SAMPLING $528.00 06 DIAG IMAGING PROCEDURES0669242 VENIPUNCTURE $62.00 06 DIAG IMAGING PROCEDURES0677641 VESSEL MAP HEMO ACCESS $2,640.00 06 DIAG IMAGING PROCEDURES0621698 XR ABD 1V AP $286.00 $177.00 06 DIAG IMAGING PROCEDURES0621706 XR ABD 1V AP $286.00 $177.00 06 DIAG IMAGING PROCEDURES0621763 XR ABD CMPL DECUB ERECT $464.00 $287.00 06 DIAG IMAGING PROCEDURES0621789 XR ABD CMPL W 1V CHEST $566.00 $351.00 06 DIAG IMAGING PROCEDURES0621797 XR ABD W OBLIQUES CONE $457.00 06 DIAG IMAGING PROCEDURES0625103 XR ABSCSS FIST SIN TRACT $621.00 06 DIAG IMAGING PROCEDURES0621862 XR AC JNT $457.00 $283.00 06 DIAG IMAGING PROCEDURES0621912 XR ANKLE 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0621938 XR ANKLE 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0621920 XR ANKLE 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0621904 XR ANKLE 3V OR MORE $402.00 $249.00 06 DIAG IMAGING PROCEDURES0622142 XR ARTHRO HIP BIL $1,397.00 $1,204.00 06 DIAG IMAGING PROCEDURES0622167 XR ARTHRO KNEE $1,698.00 $1,052.00 06 DIAG IMAGING PROCEDURES0622183 XR ARTHRO SHOULDER BI $1,600.00 $1,379.00 06 DIAG IMAGING PROCEDURES0622209 XR ARTHRO TMJ $956.00 $902.00 06 DIAG IMAGING PROCEDURES0622225 XR ARTHRO WRIST BIL $1,237.00 $1,205.00 06 DIAG IMAGING PROCEDURES0622308 XR BE THRP $1,841.00 $1,140.00 06 DIAG IMAGING PROCEDURES0622340 XR BE W AIR CON $2,762.00 $1,710.00 06 DIAG IMAGING PROCEDURES0620807 XR BE W AIR CON $2,762.00 06 DIAG IMAGING PROCEDURES0625582 XR BILE STONE EXTRACTION $241.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

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SEQ 300 AMOUNT

DEPARTMENT CODE

0624387 XR BILI DUCT DILATE PRC $554.00 $180.00 06 DIAG IMAGING PROCEDURES0622803 XR BONE AGE STDY $239.00 $148.00 06 DIAG IMAGING PROCEDURES0622845 XR BONE LENGTH STDY $416.00 $258.00 06 DIAG IMAGING PROCEDURES0622886 XR BONE SURVEY CMPL $1,309.00 $811.00 06 DIAG IMAGING PROCEDURES0622860 XR BONE SURVEY INF $1,098.00 $680.00 06 DIAG IMAGING PROCEDURES0622902 XR BONE SURVEY LTD $818.00 $507.00 06 DIAG IMAGING PROCEDURES0627604 XR CALCANEOUS 2V OR MORE $334.00 $207.00 06 DIAG IMAGING PROCEDURES0623165 XR CEPHALOGRAM ORDO $98.00 $92.00 06 DIAG IMAGING PROCEDURES0623207 XR CHEMO CNS W/SPINL PUNC $2,727.00 06 DIAG IMAGING PROCEDURES0623223 XR CHEST 1V $259.00 $160.00 $240.00 06 DIAG IMAGING PROCEDURES0623264 XR CHEST 1V $259.00 $160.00 $240.00 06 DIAG IMAGING PROCEDURES0623355 XR CHEST 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0623389 XR CHEST 2V W AP LORDOTIC $430.00 $266.00 06 DIAG IMAGING PROCEDURES0623322 XR CHEST 2V W FLUORO $859.00 $532.00 06 DIAG IMAGING PROCEDURES0623405 XR CHEST 2V W OBLIQUES $539.00 $334.00 06 DIAG IMAGING PROCEDURES0623413 XR CHEST 4V CMPL $539.00 06 DIAG IMAGING PROCEDURES0623421 XR CHEST 4V MORE W FLUORO $1,166.00 $722.00 06 DIAG IMAGING PROCEDURES0623058 XR CHEST SPECIAL V EA $402.00 06 DIAG IMAGING PROCEDURES0623561 XR CHOL EXISTING CATH $716.00 $443.00 06 DIAG IMAGING PROCEDURES0623520 XR CHOL IN OR $627.00 $389.00 06 DIAG IMAGING PROCEDURES0623546 XR CHOL IN OR ADD SET $375.00 $232.00 06 DIAG IMAGING PROCEDURES0623587 XR CHOL TRANSHEPAT PRC $1,459.00 $904.00 06 DIAG IMAGING PROCEDURES0623603 XR CHOLECYSTOGRAM ORAL $887.00 $549.00 06 DIAG IMAGING PROCEDURES0623629 XR CHOLECYSTOGRAM ORAL FU $1,266.00 $1,195.00 06 DIAG IMAGING PROCEDURES0610568 XR CINE/VIDEO 06 DIAG IMAGING PROCEDURES0623710 XR CISTERNOGRAM $1,493.00 06 DIAG IMAGING PROCEDURES0623769 XR CLAVICLE CMPL $348.00 $215.00 06 DIAG IMAGING PROCEDURES0622324 XR CONTRAST ENEMA $2,012.00 $1,246.00 06 DIAG IMAGING PROCEDURES0629899 XR CORPORA CAVERNOSOGRAM $153.00 06 DIAG IMAGING PROCEDURES0624767 XR CS DIFF MD ADD 15M $251.00 06 DIAG IMAGING PROCEDURES0624742 XR CS DIFF MD GT5YR 0-30M $565.00 06 DIAG IMAGING PROCEDURES0624734 XR CS DIFF MD LT5YR 0-30M $682.00 06 DIAG IMAGING PROCEDURES0624726 XR CS SAME MD ADD 15M $251.00 06 DIAG IMAGING PROCEDURES0624718 XR CS SAME MD GT5YR 0-30M $627.00 06 DIAG IMAGING PROCEDURES0624700 XR CS SAME MD LT5YR 0-30M $745.00 06 DIAG IMAGING PROCEDURES0623868 XR CYSTOGRAM 3V OR MORE $1,118.00 $693.00 06 DIAG IMAGING PROCEDURES0627430 XR DACRYOCYSTOGRAPHY $129.00 06 DIAG IMAGING PROCEDURES0623926 XR DENTAL FULL EXAM $1,000.00 $1,000.00 06 DIAG IMAGING PROCEDURES0623942 XR DENTAL PARTIAL EXAM $477.00 $296.00 06 DIAG IMAGING PROCEDURES0623967 XR DENTAL SNGL FILM $340.00 $257.00 06 DIAG IMAGING PROCEDURES0622951 XR DEXA APPEN $321.00 06 DIAG IMAGING PROCEDURES0621466 XR DEXA AXIAL SKELETON $968.00 06 DIAG IMAGING PROCEDURES0636977 XR DEXA AXIAL SKELETON $968.00 $600.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

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SEQ 300 AMOUNT

DEPARTMENT CODE

0627521 XR DILATE NEPHROSTOMY $1,884.00 06 DIAG IMAGING PROCEDURES0627083 XR DISKOGRAM LUMB $1,739.00 06 DIAG IMAGING PROCEDURES0623983 XR DUODENOGRAM HYPOTONIC $743.00 $701.00 06 DIAG IMAGING PROCEDURES0622969 XR DXA BONE DENS VRT FRAC $355.00 06 DIAG IMAGING PROCEDURES0624049 XR ELBOW 2V $348.00 $215.00 06 DIAG IMAGING PROCEDURES0624007 XR ELBOW 3V OR MORE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0624288 XR ENDO BILI DUCT $2,658.00 $1,646.00 06 DIAG IMAGING PROCEDURES0624221 XR ENTEROCLYSIS TUBE PRC $1,909.00 $1,182.00 06 DIAG IMAGING PROCEDURES0626135 XR EPIDUROGRAM $1,200.00 06 DIAG IMAGING PROCEDURES0624320 XR ERCP BILI PANC DUCT 06 DIAG IMAGING PROCEDURES0624304 XR ERCP PANC DUCT $1,207.00 $748.00 06 DIAG IMAGING PROCEDURES0624429 XR ESOPH $1,153.00 $557.00 06 DIAG IMAGING PROCEDURES0624106 XR EXAM OF MIDDLE EAR $365.00 06 DIAG IMAGING PROCEDURES0626747 XR EXT INF LOW LES 1YR $368.00 06 DIAG IMAGING PROCEDURES0626762 XR EXT INF UPP LES 1YR $361.00 06 DIAG IMAGING PROCEDURES0624825 XR FACIAL BONE 3V OR MORE $518.00 $321.00 06 DIAG IMAGING PROCEDURES0624841 XR FACIAL BONE LES 3V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0625137 XR FALLOPN TUBE TRANSCERV $428.00 06 DIAG IMAGING PROCEDURES0624809 XR FB IN EYE $348.00 $215.00 06 DIAG IMAGING PROCEDURES0625467 XR FB LOC CHLD $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625483 XR FB RMVL ESOPH $1,309.00 $1,235.00 06 DIAG IMAGING PROCEDURES0624908 XR FEMUR 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0625004 XR FINGER(S) 2V OR MOR BI $260.00 $175.00 06 DIAG IMAGING PROCEDURES0625186 XR FLUOR CVAD PLC/RMV/RPR $1,596.00 06 DIAG IMAGING PROCEDURES0625053 XR FLUORO 1-2 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625251 XR FLUORO 1HR OR LES $1,664.00 $1,030.00 06 DIAG IMAGING PROCEDURES0662668 XR FLUORO 1HR OR LES $1,664.00 06 DIAG IMAGING PROCEDURES0625228 XR FLUORO 1HR OR LES $1,664.00 $1,030.00 $1,275.00 06 DIAG IMAGING PROCEDURES0625061 XR FLUORO 2-3 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625079 XR FLUORO 3-4 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625087 XR FLUORO 4-5 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625095 XR FLUORO 5-6 HRS $1,923.00 06 DIAG IMAGING PROCEDURES0625194 XR FLUORO GUIDE SPINE INJ $546.00 06 DIAG IMAGING PROCEDURES0622746 XR FLUORO NDL PLACE $798.00 06 DIAG IMAGING PROCEDURES0620153 XR FLUORO NDL PLACE $732.00 06 DIAG IMAGING PROCEDURES0625335 XR FOOT 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625327 XR FOOT 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES0625301 XR FOOT 3V OR MORE $396.00 $245.00 06 DIAG IMAGING PROCEDURES0625400 XR FOREARM 2V $341.00 $211.00 06 DIAG IMAGING PROCEDURES0625517 XR GALACTOGRAM 1 DUCT $934.00 $579.00 $859.00 06 DIAG IMAGING PROCEDURES0625509 XR GALACTOGRAM MULTI $1,289.00 $798.00 $1,179.00 06 DIAG IMAGING PROCEDURES0623827 XR GI TUBE INSERT LONG $1,514.00 $938.00 06 DIAG IMAGING PROCEDURES0625616 XR HAND 2V $334.00 $207.00 06 DIAG IMAGING PROCEDURES

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SEQ 300 AMOUNT

DEPARTMENT CODE

0625608 XR HAND 3V OR MORE $402.00 $249.00 06 DIAG IMAGING PROCEDURES0625699 XR HIP OR $361.00 $224.00 $331.00 06 DIAG IMAGING PROCEDURES0625707 XR HIP UNI 1V $293.00 $182.00 06 DIAG IMAGING PROCEDURES0625673 XR HIP UNI 2V OR MORE $457.00 $283.00 06 DIAG IMAGING PROCEDURES0625665 XR HIPS BIL 2V W PELV $464.00 $287.00 06 DIAG IMAGING PROCEDURES0625814 XR HUMERUS 2V OR MORE $355.00 $220.00 06 DIAG IMAGING PROCEDURES0623181 XR HYSTEROSALPINGOGRAM $1,043.00 $646.00 06 DIAG IMAGING PROCEDURES0624403 XR INTRALUMINAL DILATE $1,664.00 $1,030.00 06 DIAG IMAGING PROCEDURES0626846 XR IVP W DRIP + OR BOLUS $1,589.00 $984.00 06 DIAG IMAGING PROCEDURES0626861 XR IVP W-W/O TOMOGRAM $1,507.00 $933.00 06 DIAG IMAGING PROCEDURES0622829 XR JNT SURVEY 1V $450.00 $279.00 06 DIAG IMAGING PROCEDURES0626937 XR KNEE 1 OR 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0626911 XR KNEE 1 OR 2V $355.00 $220.00 06 DIAG IMAGING PROCEDURES0626887 XR KNEE 3V $443.00 $275.00 06 DIAG IMAGING PROCEDURES0626903 XR KNEE 4V OR MORE $511.00 $317.00 06 DIAG IMAGING PROCEDURES0626960 XR KNEES STANDING AP $396.00 $245.00 06 DIAG IMAGING PROCEDURES0627000 XR LARYNGOGRAM W CON $1,730.00 $1,306.00 06 DIAG IMAGING PROCEDURES0627117 XR MAMMO DX BIL $1,101.00 06 DIAG IMAGING PROCEDURES0627109 XR MAMMO DX BIL $1,101.00 $680.00 06 DIAG IMAGING PROCEDURES0627174 XR MAMMO DX CAD ADD-ON $143.00 06 DIAG IMAGING PROCEDURES0627166 XR MAMMO DX DIG BILAT $1,790.00 06 DIAG IMAGING PROCEDURES0627190 XR MAMMO DX DIG UNILAT $1,415.00 06 DIAG IMAGING PROCEDURES0627141 XR MAMMO DX UNI $859.00 $530.00 06 DIAG IMAGING PROCEDURES0627158 XR MAMMO DX UNI $859.00 06 DIAG IMAGING PROCEDURES0623009 XR MAMMO GDE NDL EA LES $511.00 $317.00 06 DIAG IMAGING PROCEDURES0671057 XR MAMMO GDE NDL EA LES $511.00 $317.00 06 DIAG IMAGING PROCEDURES0627125 XR MAMMO SCRN $804.00 $496.00 06 DIAG IMAGING PROCEDURES0627182 XR MAMMO SCRN CAD ADD-ON $143.00 06 DIAG IMAGING PROCEDURES0627133 XR MAMMO SCRN DIG BILAT $1,542.00 06 DIAG IMAGING PROCEDURES0626879 XR MAN APP STRS ANY JNT $81.00 06 DIAG IMAGING PROCEDURES0627208 XR MANDIBLE 4V OR MORE $471.00 $291.00 06 DIAG IMAGING PROCEDURES0627224 XR MANDIBLE LES 4V $389.00 $241.00 06 DIAG IMAGING PROCEDURES0627240 XR MASTOIDS 3V OR MORE $540.00 $540.00 06 DIAG IMAGING PROCEDURES0627265 XR MASTOIDS LES 3V $340.00 $340.00 06 DIAG IMAGING PROCEDURES0627307 XR MYELOGRAM CERV $1,757.00 $1,757.00 06 DIAG IMAGING PROCEDURES0627349 XR MYELOGRAM LUMB $1,753.00 $1,085.00 06 DIAG IMAGING PROCEDURES0627380 XR MYELOGRAM POST FOSSA $1,934.00 $1,824.00 06 DIAG IMAGING PROCEDURES0627364 XR MYELOGRAM THOR $1,657.00 $1,026.00 06 DIAG IMAGING PROCEDURES0627323 XR MYELOGRM 1 OR MORE REG $2,701.00 $1,672.00 06 DIAG IMAGING PROCEDURES0627406 XR NASAL BONES 3V OR MORE $416.00 $258.00 06 DIAG IMAGING PROCEDURES0627448 XR NEC SOFT TISSUE $327.00 $203.00 06 DIAG IMAGING PROCEDURES0627547 XR OPTIC FORAMINA $436.00 $270.00 06 DIAG IMAGING PROCEDURES0627562 XR ORBITS 4V OR MORE $525.00 $325.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0627588 XR ORTHOPANTOGRAM $198.00 $122.00 06 DIAG IMAGING PROCEDURES0627620 XR PACEMAKER INSERT $1,228.00 $760.00 06 DIAG IMAGING PROCEDURES0627752 XR PELV 1 OR 2V $307.00 $190.00 06 DIAG IMAGING PROCEDURES0627786 XR PELV 1 OR 2V $307.00 06 DIAG IMAGING PROCEDURES0627745 XR PELV 1 OR 2V $307.00 $190.00 06 DIAG IMAGING PROCEDURES0627703 XR PELV 3V OR MORE $511.00 $317.00 06 DIAG IMAGING PROCEDURES0625749 XR PELV HIP 2V INF CHLD $491.00 06 DIAG IMAGING PROCEDURES0627794 XR PELVIMETRY $423.00 06 DIAG IMAGING PROCEDURES0627687 XR PERINEOGRAM $197.00 06 DIAG IMAGING PROCEDURES0627695 XR PERITONEOGRAM $177.00 06 DIAG IMAGING PROCEDURES0627844 XR PHARYNGEAL SPEECH EVAL $948.00 $587.00 06 DIAG IMAGING PROCEDURES0622365 XR PHARYNX OR ESOPH CERV $1,037.00 $642.00 06 DIAG IMAGING PROCEDURES0627869 XR PHARYNXLARYNX W FLUORO $1,077.00 $667.00 06 DIAG IMAGING PROCEDURES0621821 XR RADIO ABSORPTIOMETRY $104.00 06 DIAG IMAGING PROCEDURES0627901 XR RIBS BIL 3V $477.00 $296.00 06 DIAG IMAGING PROCEDURES0627984 XR RIBS BIL W PA CXR $634.00 06 DIAG IMAGING PROCEDURES0627950 XR RIBS UNI & PA CHEST $457.00 $283.00 06 DIAG IMAGING PROCEDURES0627943 XR RIBS UNI 2V $375.00 $232.00 06 DIAG IMAGING PROCEDURES0628123 XR SACRUM COCCYX 2 V MORE $361.00 $224.00 06 DIAG IMAGING PROCEDURES0628180 XR SALIVARY GLAND CALC $505.00 $313.00 06 DIAG IMAGING PROCEDURES0628206 XR SCAPULA CMPL $355.00 $220.00 06 DIAG IMAGING PROCEDURES0628164 XR SELLA TURCICA $348.00 06 DIAG IMAGING PROCEDURES0628958 XR SHOULDER 1V $280.00 $173.00 06 DIAG IMAGING PROCEDURES0628289 XR SHOULDER 1V $280.00 $173.00 06 DIAG IMAGING PROCEDURES0628263 XR SHOULDER 2V OR MORE $355.00 $220.00 06 DIAG IMAGING PROCEDURES0629915 XR SHUNTOGRAM NONVASC $1,200.00 $743.00 06 DIAG IMAGING PROCEDURES0628107 XR SI JNT 1 OR 2V $361.00 $224.00 06 DIAG IMAGING PROCEDURES0628008 XR SI JNT 3V OR MORE $436.00 $270.00 06 DIAG IMAGING PROCEDURES0628198 XR SIALOGRAM $1,418.00 06 DIAG IMAGING PROCEDURES0627646 XR SIN PARA 3V OR MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0627661 XR SIN PARA LES 3V $375.00 $232.00 06 DIAG IMAGING PROCEDURES0628909 XR SKULL 4V OR MORE $532.00 $329.00 06 DIAG IMAGING PROCEDURES0628941 XR SKULL LES 4V $423.00 $262.00 06 DIAG IMAGING PROCEDURES0624205 XR SM BOWEL ENTEROCLYSIS $5,428.00 $3,362.00 06 DIAG IMAGING PROCEDURES0628982 XR SM BOWEL SERIES $1,412.00 $874.00 06 DIAG IMAGING PROCEDURES0629501 XR SPECIMEN SURGICAL $198.00 $122.00 06 DIAG IMAGING PROCEDURES0627257 XR SPECIMEN SURGICAL $192.00 06 DIAG IMAGING PROCEDURES0629063 XR SPINE C 4V & FLEX/EXT $839.00 $519.00 06 DIAG IMAGING PROCEDURES0629097 XR SPINE CERV 2-3V $457.00 $283.00 06 DIAG IMAGING PROCEDURES0629089 XR SPINE CERV 2-3V $457.00 $283.00 06 DIAG IMAGING PROCEDURES0629048 XR SPINE CERV 4V OR MORE $641.00 $397.00 06 DIAG IMAGING PROCEDURES0629253 XR SPINE LUMB 2-3V $491.00 $304.00 $421.00 06 DIAG IMAGING PROCEDURES0629220 XR SPINE LUMB 2-3V $491.00 $304.00 $421.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0629162 XR SPINE LUMB 4V OR MORE $682.00 $422.00 06 DIAG IMAGING PROCEDURES0629188 XR SPINE LUMB 4V W BEND $948.00 $587.00 06 DIAG IMAGING PROCEDURES0629147 XR SPINE LUMB BEND ONLY $668.00 $414.00 06 DIAG IMAGING PROCEDURES0629261 XR SPINE SCOLIOSIS STNDNG $430.00 $266.00 06 DIAG IMAGING PROCEDURES0629287 XR SPINE SCOLIOSIS SUP ER $580.00 $359.00 06 DIAG IMAGING PROCEDURES0629022 XR SPINE SNGL V CERV $280.00 $173.00 $251.00 06 DIAG IMAGING PROCEDURES0629030 XR SPINE SNGL V LUMB $280.00 06 DIAG IMAGING PROCEDURES0629139 XR SPINE SNGL V LUMB $280.00 06 DIAG IMAGING PROCEDURES0629311 XR SPINE SNGL V THOR $280.00 06 DIAG IMAGING PROCEDURES0629303 XR SPINE SURVEY ENTIRE $859.00 $532.00 06 DIAG IMAGING PROCEDURES0629329 XR SPINE THOR 2V $396.00 $245.00 06 DIAG IMAGING PROCEDURES0629352 XR SPINE THOR 2V $396.00 06 DIAG IMAGING PROCEDURES0629345 XR SPINE THOR 3V $471.00 $291.00 06 DIAG IMAGING PROCEDURES0629360 XR SPINE THOR 4V OR MORE $586.00 $407.00 06 DIAG IMAGING PROCEDURES0629402 XR SPINE THOR LUMB 2V $423.00 $262.00 06 DIAG IMAGING PROCEDURES0671065 XR STEREO LOC EA LESION $1,650.00 06 DIAG IMAGING PROCEDURES0623025 XR STEREO LOC EA LESION $1,650.00 $1,022.00 06 DIAG IMAGING PROCEDURES0629428 XR STERNOCLAVIC 3V MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0629444 XR STERNUM 2V OR MORE $389.00 $241.00 06 DIAG IMAGING PROCEDURES0624460 XR SWALLOWING FNCTN $1,118.00 $693.00 06 DIAG IMAGING PROCEDURES0629600 XR TIBIA FIBULA 2V $327.00 $203.00 06 DIAG IMAGING PROCEDURES0629527 XR TMJ BIL $614.00 $380.00 06 DIAG IMAGING PROCEDURES0629543 XR TMJ UNI $375.00 $232.00 06 DIAG IMAGING PROCEDURES0629667 XR TOE(S) 2V OR MORE BIL $260.00 $175.00 06 DIAG IMAGING PROCEDURES0629741 XR TOMOGRAM $1,759.00 $1,090.00 06 DIAG IMAGING PROCEDURES0629717 XR TOMOGRAM CMPLX BIL $3,778.00 $2,340.00 06 DIAG IMAGING PROCEDURES0629725 XR TOMOGRAM CMPLX UNI $2,666.00 $1,651.00 06 DIAG IMAGING PROCEDURES0629790 XR UGI W AIR CON $1,582.00 $980.00 06 DIAG IMAGING PROCEDURES0629816 XR UGI W AIR CON KUB $1,814.00 $1,123.00 06 DIAG IMAGING PROCEDURES0629824 XR UGI W AIR CON SM BOWEL $2,496.00 $1,546.00 06 DIAG IMAGING PROCEDURES0629832 XR UGI W KUB $1,446.00 $895.00 06 DIAG IMAGING PROCEDURES0629840 XR UGI W SM BOWEL $2,264.00 $1,402.00 06 DIAG IMAGING PROCEDURES0629808 XR UGI W/O KUB $1,303.00 $807.00 06 DIAG IMAGING PROCEDURES0629865 XR URETHROCYSTOGRAM $1,043.00 $646.00 06 DIAG IMAGING PROCEDURES0629873 XR URETHROCYSTOGRAM VOID $1,289.00 $798.00 06 DIAG IMAGING PROCEDURES0627505 XR UROGRAM ANTEGRADE $893.00 $553.00 06 DIAG IMAGING PROCEDURES0629881 XR UROGRAM RETRO $1,909.00 $1,182.00 $1,568.00 06 DIAG IMAGING PROCEDURES0629907 XR VASOGRAM VESICULOGRAM $1,166.00 $722.00 06 DIAG IMAGING PROCEDURES0629980 XR WRIST 2V $368.00 $228.00 06 DIAG IMAGING PROCEDURES0629956 XR WRIST 2V $368.00 $228.00 06 DIAG IMAGING PROCEDURES0629949 XR WRIST 3V OR MORE $464.00 $287.00 06 DIAG IMAGING PROCEDURES0622043 XRC ASP BREAST ADD $47.00 $37.00 06 DIAG IMAGING PROCEDURES0622001 XRC ASP BREAST CYST $347.00 $272.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0622076 XRC ASP SPINAL CYST PRC $1,788.00 06 DIAG IMAGING PROCEDURES0622373 XRC ASPIRATON BONE MARROW $660.00 06 DIAG IMAGING PROCEDURES0624247 XRC BILI ENDO W/O STENT $2,053.00 $1,802.00 06 DIAG IMAGING PROCEDURES0624262 XRC BILI STONE RMVL $2,246.00 $1,969.00 06 DIAG IMAGING PROCEDURES0626028 XRC BREAST NDL WIRE $515.00 $403.00 06 DIAG IMAGING PROCEDURES0623082 XRC BREAST NDL WIRE ADD $205.00 $161.00 06 DIAG IMAGING PROCEDURES0626408 XRC BRNCH W CON SEG BRNCH $1,064.00 $832.00 06 DIAG IMAGING PROCEDURES0622555 XRC BX ABD RETROPE $468.00 $366.00 06 DIAG IMAGING PROCEDURES0622514 XRC BX BM NDL/TROCAR $660.00 06 DIAG IMAGING PROCEDURES0622720 XRC BX BONE DEEP $2,587.00 $2,024.00 06 DIAG IMAGING PROCEDURES0622522 XRC BX BONE SUPER $549.00 $430.00 06 DIAG IMAGING PROCEDURES0622548 XRC BX BREAST PRC W/O $867.00 $867.00 06 DIAG IMAGING PROCEDURES0622480 XRC BX LIVER $1,204.00 06 DIAG IMAGING PROCEDURES0622571 XRC BX LIVER W MAJOR $1,251.00 $1,098.00 06 DIAG IMAGING PROCEDURES0622589 XRC BX LUNG MEDIASTNM $2,061.00 $1,944.00 06 DIAG IMAGING PROCEDURES0622449 XRC BX LYMPH NODE OPEN $4,140.00 $2,564.00 06 DIAG IMAGING PROCEDURES0622621 XRC BX MUSCLE $977.00 $765.00 06 DIAG IMAGING PROCEDURES0622670 XRC BX RENL $2,180.00 06 DIAG IMAGING PROCEDURES0622795 XRC BX SKIN LESION EA ADD $98.00 06 DIAG IMAGING PROCEDURES0622787 XRC BX SKIN LESION SNGL $259.00 06 DIAG IMAGING PROCEDURES0622779 XRC BX SOFT TISS NEC THOR $756.00 06 DIAG IMAGING PROCEDURES0622696 XRC BX THYROID $245.00 $192.00 06 DIAG IMAGING PROCEDURES0621326 XRC CHNG G TUBE WO IMG/GD $362.00 06 DIAG IMAGING PROCEDURES0629857 XRC CYSTOMETROGRAM CMPLX $1,237.00 06 DIAG IMAGING PROCEDURES0625558 XRC ENDO SB W JEJ TUB PRC $726.00 06 DIAG IMAGING PROCEDURES0626150 XRC ERCP BLN DILATION $1,338.00 06 DIAG IMAGING PROCEDURES0624312 XRC ERCP DX W/WO SPEC $1,085.00 06 DIAG IMAGING PROCEDURES0624163 XRC ERCP INS BIL/PAN TUBE $679.00 06 DIAG IMAGING PROCEDURES0624155 XRC ERCP INS NASO TUBE $1,338.00 06 DIAG IMAGING PROCEDURES0624361 XRC ERCP RETRO DESTRUCTN $1,800.00 06 DIAG IMAGING PROCEDURES0624353 XRC ERCP RMVL CALC $1,608.00 06 DIAG IMAGING PROCEDURES0624171 XRC ERCP RMVL FB/CHNG $1,474.00 06 DIAG IMAGING PROCEDURES0624379 XRC ERCP W/ABLATION $1,339.00 06 DIAG IMAGING PROCEDURES0624338 XRC ERCP W/BIOPSY $1,141.00 06 DIAG IMAGING PROCEDURES0624346 XRC ERCP W/SPHINC/PAPIL $1,339.00 06 DIAG IMAGING PROCEDURES0624601 XRC ESOPH DILATE BLN <30M $951.00 $951.00 06 DIAG IMAGING PROCEDURES0624650 XRC ESOPH DILATE BLN >30M $1,251.00 $1,251.00 06 DIAG IMAGING PROCEDURES0622423 XRC EXCSN BREAST W LOC $3,285.00 $3,285.00 06 DIAG IMAGING PROCEDURES0626341 XRC FORAMN EPI C/T W IMG $817.00 $639.00 06 DIAG IMAGING PROCEDURES0626325 XRC FORAMN EPI L/S W IMG $838.00 $655.00 06 DIAG IMAGING PROCEDURES0626309 XRC FRMN EPI C/T IMG ADD $330.00 $258.00 06 DIAG IMAGING PROCEDURES0626184 XRC IJ FACET L/S 2 LVL $223.00 $175.00 06 DIAG IMAGING PROCEDURES0626168 XRC IJ PV FACET C/T 1 LVL $554.00 $434.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0623033 XRC IMAG LOC CLIP W BX $418.00 06 DIAG IMAGING PROCEDURES0625905 XRC INJ ARTHRO ANKLE $554.00 $434.00 06 DIAG IMAGING PROCEDURES0625921 XRC INJ ARTHRO ELBOW $527.00 $413.00 06 DIAG IMAGING PROCEDURES0625947 XRC INJ ARTHRO HIP $632.00 $1,858.00 06 DIAG IMAGING PROCEDURES0625962 XRC INJ ARTHRO KNEE $580.00 $454.00 06 DIAG IMAGING PROCEDURES0625988 XRC INJ ARTHRO SHOULDER $515.00 $403.00 06 DIAG IMAGING PROCEDURES0626002 XRC INJ ARTHRO WRIST $511.00 $400.00 06 DIAG IMAGING PROCEDURES0626564 XRC INJ ASP SHUNT $187.00 $147.00 06 DIAG IMAGING PROCEDURES0626424 XRC INJ BLOOD PATCH $1,709.00 $445.00 06 DIAG IMAGING PROCEDURES0626044 XRC INJ C1 C2 MYELOGRAM $248.00 $194.00 06 DIAG IMAGING PROCEDURES0626630 XRC INJ CYSTO RETRO $349.00 06 DIAG IMAGING PROCEDURES0626069 XRC INJ CYSTO VCUG $772.00 $604.00 06 DIAG IMAGING PROCEDURES0626085 XRC INJ DACROCYSTOGRAM $2,229.00 $201.00 06 DIAG IMAGING PROCEDURES0626101 XRC INJ DISKOGRAM CERV $2,967.00 $201.00 06 DIAG IMAGING PROCEDURES0626127 XRC INJ DISKOGRAM LUMB $959.00 $751.00 06 DIAG IMAGING PROCEDURES0625863 XRC INJ DUCT GALACTOGRAM $484.00 $379.00 06 DIAG IMAGING PROCEDURES0626143 XRC INJ EPIDL L/S $885.00 $693.00 06 DIAG IMAGING PROCEDURES0626580 XRC INJ HIP W ANESTHESIA $779.00 $610.00 06 DIAG IMAGING PROCEDURES0626218 XRC INJ ILEAL CONDUIT $274.00 06 DIAG IMAGING PROCEDURES0626440 XRC INJ MAJOR JNT BURSA $198.00 $155.00 06 DIAG IMAGING PROCEDURES0626267 XRC INJ MYELOGRAM $720.00 $563.00 06 DIAG IMAGING PROCEDURES0626507 XRC INJ NRV BLK SCTC SNGL $324.00 $254.00 06 DIAG IMAGING PROCEDURES0626283 XRC INJ NRV BLK SUBARACH $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626374 XRC INJ PANCREAT INTRAOP $342.00 06 DIAG IMAGING PROCEDURES0620112 XRC INJ SI JNT ANES/STRD $5,293.05 $8,547.17 06 DIAG IMAGING PROCEDURES0620138 XRC INJ SI JNT ANES/STRD $5,298.05 $8,547.17 06 DIAG IMAGING PROCEDURES0626473 XRC INJ SI JNT ARTHROGRAM $5,041.00 06 DIAG IMAGING PROCEDURES0626481 XRC INJ SIALOGRAM $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626523 XRC INJ SINOGRAM $441.00 $345.00 06 DIAG IMAGING PROCEDURES0626549 XRC INJ TRANSTRACH BRONCH $213.00 $201.00 06 DIAG IMAGING PROCEDURES0626622 XRC INJ URETHROCYST CHAIN $1,491.00 06 DIAG IMAGING PROCEDURES0621524 XRC INS NON-TUN CV CATH<5 $3,512.00 06 DIAG IMAGING PROCEDURES0621532 XRC INS NON-TUN CV CATH5+ $3,512.00 06 DIAG IMAGING PROCEDURES0621656 XRC INS PICC W/O PORT 5+ $904.00 06 DIAG IMAGING PROCEDURES0621649 XRC INS PICC W/O PORT LT5 $1,080.00 06 DIAG IMAGING PROCEDURES0621672 XRC INS PICC W/PORT 5+YRS $5,363.00 06 DIAG IMAGING PROCEDURES0621664 XRC INS PICC W/PORT LT 5 $7,559.00 06 DIAG IMAGING PROCEDURES0621540 XRC INS TUN CV NO PRT LT5 $3,512.00 06 DIAG IMAGING PROCEDURES0621615 XRC INS TUNN CV DEV 5+ $7,106.00 06 DIAG IMAGING PROCEDURES0621607 XRC INS TUNN CV DEV LT 5 $4,644.00 06 DIAG IMAGING PROCEDURES0621557 XRC INS TUNN CV NO PORT5+ $3,512.00 06 DIAG IMAGING PROCEDURES0621417 XRC INSERT CATH TMP CMPLX $176.00 06 DIAG IMAGING PROCEDURES0621409 XRC INSERT CATH TMP SMPL $288.00 06 DIAG IMAGING PROCEDURES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0610626 XRC INSERT PACER W AV LDS 06 DIAG IMAGING PROCEDURES0626671 XRC INTRO CAROTD VERT ART 06 DIAG IMAGING PROCEDURES0626655 XRC INTRO CATH BILI DRN $1,774.00 $1,800.00 06 DIAG IMAGING PROCEDURES0626689 XRC INTRO CATH FALLOPN $419.00 $328.00 06 DIAG IMAGING PROCEDURES0626697 XRC INTRO CATH IVC /SVC $2,263.00 06 DIAG IMAGING PROCEDURES0627026 XRC LP THRP $598.00 $468.00 06 DIAG IMAGING PROCEDURES0626242 XRC LUMBAR PUNCTURE DX $457.00 $358.00 06 DIAG IMAGING PROCEDURES0627802 XRC PARACENT ABD INI $533.00 $417.00 06 DIAG IMAGING PROCEDURES0627828 XRC PARACENT ABD SUBSQ $517.00 $404.00 06 DIAG IMAGING PROCEDURES0627497 XRC REMV RNL TUBE W/FLUOR $1,399.00 06 DIAG IMAGING PROCEDURES0627893 XRC REMV TUNN CV CATH W/O $532.00 06 DIAG IMAGING PROCEDURES0621334 XRC REPO NASO/ORO G TUBE $202.00 06 DIAG IMAGING PROCEDURES0627976 XRC REPS PREV PLC CV CATH $380.00 06 DIAG IMAGING PROCEDURES0627935 XRC RPLC CMP PICC W/O $819.00 06 DIAG IMAGING PROCEDURES0627877 XRC RPLC COMP NON-TUNN CV $826.00 06 DIAG IMAGING PROCEDURES0626200 XRC SAL INFN SONOHYSTER $419.00 $328.00 06 DIAG IMAGING PROCEDURES0629568 XRC THORACENTESIS $455.00 $877.51 06 DIAG IMAGING PROCEDURES0623488 XRC THORACENTESIS W TUBE $531.00 $416.00 06 DIAG IMAGING PROCEDURES0624239 XRC TUBE PLACE JEJUNUM $408.00 06 DIAG IMAGING PROCEDURES0621375 XRC URODYNAMICS EMG $695.00 06 DIAG IMAGING PROCEDURES0623884 XRC UROFLOWMETRY COMPLEX $201.00 06 DIAG IMAGING PROCEDURES0621367 XRC VP STUDY INTRA-ABDOM $207.00 06 DIAG IMAGING PROCEDURES1974609 US BIO PROFILE W NONSTRES $911.00 $646.00 19 DIAG IMAGING PROCEDURES O1974666 US OB FU/REEVAL EA FETUS $946.00 $671.00 19 DIAG IMAGING PROCEDURES O1974690 US OB LTD 1/MORE FETUSES $769.00 $545.00 19 DIAG IMAGING PROCEDURES O0851113 ADENOSINE DX 30 MG IJ $293.00 08 DIAG IMAGING SUPP (NON-IN0858233 BRACHY SOURCE YTTRIUM 90 $23,596.00 08 DIAG IMAGING SUPP (NON-IN0887406 CATH DRAINAGE $415.00 $391.00 08 DIAG IMAGING SUPP (NON-IN0824300 CON HOCM <=149MG/ML 1ML $175.00 $164.00 08 DIAG IMAGING SUPP (NON-IN0824151 CON LOCM 300-349S I 1ML $70.00 08 DIAG IMAGING SUPP (NON-IN0851014 DIPYRIDAMOLE/10MG IJ $21.00 08 DIAG IMAGING SUPP (NON-IN0851204 HEPARIN 1000U IJ $12.00 08 DIAG IMAGING SUPP (NON-IN0850131 NM HEART MI PLANAR $1,142.00 08 DIAG IMAGING SUPP (NON-IN0850123 NM TUMOR LOC LTD W RP $1,950.00 08 DIAG IMAGING SUPP (NON-IN0850172 NM VASCULAR FLOW NCARDIO 08 DIAG IMAGING SUPP (NON-IN0898619 REGADENOSON 0.1MG IJ $900.00 08 DIAG IMAGING SUPP (NON-IN0851485 RP C14 UREA/TEST $76.00 08 DIAG IMAGING SUPP (NON-IN0851493 RP CO57 CYANO DX PO 1UCI $469.00 08 DIAG IMAGING SUPP (NON-IN0851519 RP CO57 CYANO DX PO 1UCI $469.00 08 DIAG IMAGING SUPP (NON-IN0851527 RP CR51 CHROMTE DX 250UCI $291.00 08 DIAG IMAGING SUPP (NON-IN0852509 RP DX I-131 CAP PER MCI $430.00 $405.00 08 DIAG IMAGING SUPP (NON-IN0852525 RP DX I131 SOD SOL/MCI $356.00 08 DIAG IMAGING SUPP (NON-IN0855486 RP DX TC99M ARCTMMB 45MCI $2,335.00 08 DIAG IMAGING SUPP (NON-IN

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SEQ 300 AMOUNT

DEPARTMENT CODE

0851709 RP GALLIUM GA-67 DX 1 MCI $72.00 $68.00 08 DIAG IMAGING SUPP (NON-IN0852004 RP I123 DX 100UCI TO 999 $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0852020 RP I123 DX 100UCI TO 999 $1.00 08 DIAG IMAGING SUPP (NON-IN0852012 RP I123 MIBG $225.00 08 DIAG IMAGING SUPP (NON-IN0852368 RP I123 MIBG $2,949.00 08 DIAG IMAGING SUPP (NON-IN0852822 RP I125 IOTHLMAT DX 10UCI $475.00 08 DIAG IMAGING SUPP (NON-IN0852400 RP I125/10UCI $328.00 $310.00 08 DIAG IMAGING SUPP (NON-IN0852814 RP I131 DX 1UCI MAX 100 $356.00 08 DIAG IMAGING SUPP (NON-IN0852707 RP I131 MIBG DX 0.5MCI $2,058.00 $1,941.00 08 DIAG IMAGING SUPP (NON-IN0852756 RP I131 NP 59MCI $899.00 $848.00 08 DIAG IMAGING SUPP (NON-IN0852467 RP I131 TOSITUMOMAB DX DS $4,740.00 08 DIAG IMAGING SUPP (NON-IN0852475 RP I131 TOSITUMOMAB RX DS $41,470.00 08 DIAG IMAGING SUPP (NON-IN0853101 RP IN111 CITRATE/VL $859.00 $811.00 08 DIAG IMAGING SUPP (NON-IN0853200 RP IN111 DTPA/0.5MCI $1,990.00 $1,878.00 08 DIAG IMAGING SUPP (NON-IN0853630 RP IN111 IBRITUM DX 5MCI $3,809.00 08 DIAG IMAGING SUPP (NON-IN0853648 RP IN111 OCTREOSC DX 6MCI $2,800.00 08 DIAG IMAGING SUPP (NON-IN0853002 RP IN111 ONCSCNT DX 6MCI $4,813.00 $4,540.00 08 DIAG IMAGING SUPP (NON-IN0853408 RP IN111 OXYQIN DX 0.5MCI $1,918.00 $1,810.00 08 DIAG IMAGING SUPP (NON-IN0853309 RP IN111 PRSTSCN DX 10MCI $2,688.00 $2,536.00 08 DIAG IMAGING SUPP (NON-IN0854018 RP P32 CHROMIC RX 1MCI $1,381.00 08 DIAG IMAGING SUPP (NON-IN0854026 RP P32 SODIUM PHO RX 1MCI $469.00 08 DIAG IMAGING SUPP (NON-IN0854109 RP SR89 TX PER MCI $2,175.00 $2,052.00 08 DIAG IMAGING SUPP (NON-IN0855502 RP SR89 TX PER MCI $839.00 $792.00 08 DIAG IMAGING SUPP (NON-IN0855056 RP TC99M ACUTECT DX 20MCI $1,281.00 08 DIAG IMAGING SUPP (NON-IN0856708 RP TC99M BICISAT DX 25MCI $835.00 $788.00 08 DIAG IMAGING SUPP (NON-IN0855601 RP TC99M CERETEC DX 25MCI $839.00 $792.00 08 DIAG IMAGING SUPP (NON-IN0855759 RP TC99M DISFNIN DX 15MCI $98.00 08 DIAG IMAGING SUPP (NON-IN0856757 RP TC99M FANOLSO DX 25MCI $1,800.00 08 DIAG IMAGING SUPP (NON-IN0856104 RP TC99M GLUCEPT DX 25MCI $62.00 $58.00 08 DIAG IMAGING SUPP (NON-IN0856203 RP TC99M HSA/DS $135.00 $128.00 08 DIAG IMAGING SUPP (NON-IN0856302 RP TC99M MAA DX 10MCI $140.00 $140.00 08 DIAG IMAGING SUPP (NON-IN0856500 RP TC99M MDP 1-30MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0855700 RP TC99M MEBROFN DX 15MCI $98.00 $93.00 08 DIAG IMAGING SUPP (NON-IN0857300 RP TC99M MERALUMA $494.00 08 DIAG IMAGING SUPP (NON-IN0856401 RP TC99M MERTIAT DX 15MCI $2,130.00 $2,130.00 08 DIAG IMAGING SUPP (NON-IN0856609 RP TC99M MYOVIEW DX 40MCI $227.00 $227.00 08 DIAG IMAGING SUPP (NON-IN0856005 RP TC99M PENTETA DX 25MCI $82.00 $78.00 08 DIAG IMAGING SUPP (NON-IN0855908 RP TC99M PENTETA DX 25MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0851501 RP TC99M PENTETA DX 25MCI $325.00 $307.00 08 DIAG IMAGING SUPP (NON-IN0855007 RP TC99M PERTEC DX EA MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0856807 RP TC99M PYROPHO DX 25MCI $115.00 $108.00 08 DIAG IMAGING SUPP (NON-IN0856906 RP TC99M RBC/TAG DX 30MCI $177.00 $167.00 08 DIAG IMAGING SUPP (NON-IN0855551 RP TC99M SC FLT DX 20MCI $342.00 08 DIAG IMAGING SUPP (NON-IN

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0855304 RP TC99M SESTMBI DX 40MCI $248.00 $248.00 08 DIAG IMAGING SUPP (NON-IN0855809 RP TC99M SUCCIMR DX 10MCI $258.00 $244.00 08 DIAG IMAGING SUPP (NON-IN0857102 RP TC99M SULFR/C DX 20MCI $164.00 $155.00 08 DIAG IMAGING SUPP (NON-IN0857003 RP TC99M SULFR/C DX 20MCI $66.00 $62.00 08 DIAG IMAGING SUPP (NON-IN0858001 RP TL-201 DX PER MCI $82.00 $78.00 08 DIAG IMAGING SUPP (NON-IN0852541 RP TX I-131 CAP PER MCI $54.00 08 DIAG IMAGING SUPP (NON-IN0852574 RP TX I131 SOD SOL/MCI $35.00 08 DIAG IMAGING SUPP (NON-IN0852459 RP TX IODINE-125 PER MCI $70.00 08 DIAG IMAGING SUPP (NON-IN0858225 RP XE133 DX 10MCI 08 DIAG IMAGING SUPP (NON-IN0858209 RP XE133 DX 10MCI $407.00 $384.00 08 DIAG IMAGING SUPP (NON-IN0857607 RP Y90 IBRITUM RX 40MCI $32,975.00 08 DIAG IMAGING SUPP (NON-IN0859009 S NSTRL NM AEROSOL KIT $56.00 $52.00 08 DIAG IMAGING SUPP (NON-IN0820050 S STRL BREAST BIOPSY CLIP $599.00 08 DIAG IMAGING SUPP (NON-IN0820068 S STRL BREAST BX CLIP $186.00 08 DIAG IMAGING SUPP (NON-IN0887067 S STRL CATH 12F 2CC BLN $109.58 08 DIAG IMAGING SUPP (NON-IN0887000 S STRL CATH DUAL 7F 30CM $73.24 08 DIAG IMAGING SUPP (NON-IN0887042 S STRL CATH TRIP 7.4F 40C $88.41 08 DIAG IMAGING SUPP (NON-IN0887026 S STRL CATH TRIP 7F 30CM $79.17 08 DIAG IMAGING SUPP (NON-IN0883504 S STRL CT NDL 18GA 150MM $107.00 $101.00 08 DIAG IMAGING SUPP (NON-IN0883520 S STRL CT NDL 21GA 150MM $134.00 $126.00 08 DIAG IMAGING SUPP (NON-IN0884049 S STRL CT NDL BIOP $131.00 $123.00 08 DIAG IMAGING SUPP (NON-IN0883827 S STRL CT NDL BIOP ASAP $164.00 $155.00 08 DIAG IMAGING SUPP (NON-IN0883868 S STRL CT NDL BIOP ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0883801 S STRL CT NDL BIOP ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0883843 S STRL CT NDL BIOSPY ASAP $235.00 $222.00 08 DIAG IMAGING SUPP (NON-IN0884361 S STRL CT NDL CHIBA $39.00 $37.00 08 DIAG IMAGING SUPP (NON-IN0884346 S STRL CT NDL CHIBA $57.00 $54.00 08 DIAG IMAGING SUPP (NON-IN0884304 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0884320 S STRL CT NDL CHIBA $50.00 $47.00 08 DIAG IMAGING SUPP (NON-IN0884387 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0884403 S STRL CT NDL CHIBA $48.00 $45.00 08 DIAG IMAGING SUPP (NON-IN0885004 S STRL CT NDL COAXIAL BX $97.00 $92.00 08 DIAG IMAGING SUPP (NON-IN0885202 S STRL CT NDL HAVEL $77.00 $73.00 08 DIAG IMAGING SUPP (NON-IN0885608 S STRL CT NDL OSTYCUT $264.00 $249.00 08 DIAG IMAGING SUPP (NON-IN0885806 S STRL CT NDL PERCU $126.00 $119.00 08 DIAG IMAGING SUPP (NON-IN0885400 S STRL CT NDL TLA $119.00 $112.00 08 DIAG IMAGING SUPP (NON-IN0888008 S STRL CT TY BIOP $83.00 $79.00 08 DIAG IMAGING SUPP (NON-IN0893271 S STRL ENTEROCLYSIS CATH $910.00 $858.00 08 DIAG IMAGING SUPP (NON-IN0887109 S STRL LEAK POINT STRIPS $78.75 08 DIAG IMAGING SUPP (NON-IN0858274 S STRL NM TRAY GLIASITE A $931.00 08 DIAG IMAGING SUPP (NON-IN0887083 S STRL TRANSDUCER W/UPP $361.25 08 DIAG IMAGING SUPP (NON-IN0892505 S STRL TY THORACENTISIS $203.00 $191.00 08 DIAG IMAGING SUPP (NON-IN0888016 S STRL US TY BIOP $77.00 $72.00 08 DIAG IMAGING SUPP (NON-IN

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document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0887125 S STRL Y INJ IV ADMIN SET $30.24 08 DIAG IMAGING SUPP (NON-IN0850107 SINCALIDE 5MCG IJ $4,232.00 08 DIAG IMAGING SUPP (NON-IN0851444 SINCALIDE 5MCG IJ $338.00 08 DIAG IMAGING SUPP (NON-IN0854059 SM 153 LEXIDRONAM 150MCI $3,596.00 08 DIAG IMAGING SUPP (NON-IN0851352 THYROTROPIN 1.1MG VL IJ $1,238.00 08 DIAG IMAGING SUPP (NON-IN0276865 CATH ABLTN NOCARD ENDVS $5,476.00 02 DIAGNOSTIC IMAGING SUPP (0276873 CATH ABLTN NOCARD ENDVS $5,476.00 02 DIAGNOSTIC IMAGING SUPP (0282152 CATH DRAINAGE $330.00 $330.00 02 DIAGNOSTIC IMAGING SUPP (0282004 CATH DRAINAGE $424.00 $424.00 02 DIAGNOSTIC IMAGING SUPP (0281808 CATH DRAINAGE $391.00 $391.00 02 DIAGNOSTIC IMAGING SUPP (0281956 CATH DRAINAGE $373.00 $373.00 02 DIAGNOSTIC IMAGING SUPP (0282855 CATH DRAINAGE $520.00 02 DIAGNOSTIC IMAGING SUPP (0282301 CATH DRAINAGE $350.00 02 DIAGNOSTIC IMAGING SUPP (0281857 CATH DRAINAGE $373.00 $373.00 02 DIAGNOSTIC IMAGING SUPP (0281907 CATH DRAINAGE $362.00 $362.00 02 DIAGNOSTIC IMAGING SUPP (0282103 CATH DRAINAGE $260.00 $260.00 02 DIAGNOSTIC IMAGING SUPP (0282509 CATH DRAINAGE $520.00 $520.00 02 DIAGNOSTIC IMAGING SUPP (0282053 CATH DRAINAGE $449.00 $449.00 02 DIAGNOSTIC IMAGING SUPP (0282756 CATH DRAINAGE $445.00 $445.00 02 DIAGNOSTIC IMAGING SUPP (0234690 CATH GUIDING $1,284.00 $1,284.00 02 DIAGNOSTIC IMAGING SUPP (0234328 CATH GUIDING $496.00 $496.00 02 DIAGNOSTIC IMAGING SUPP (0246207 CATH GUIDING $1,925.00 02 DIAGNOSTIC IMAGING SUPP (0287284 CATH GUIDING $240.13 02 DIAGNOSTIC IMAGING SUPP (0246173 CATH GUIDING $1,593.75 02 DIAGNOSTIC IMAGING SUPP (0234344 CATH GUIDING $495.00 $495.00 02 DIAGNOSTIC IMAGING SUPP (0287656 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0234351 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0287326 CATH GUIDING $633.25 02 DIAGNOSTIC IMAGING SUPP (0287482 CATH GUIDING $531.25 02 DIAGNOSTIC IMAGING SUPP (0287425 CATH GUIDING $935.00 02 DIAGNOSTIC IMAGING SUPP (0252015 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0234302 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0287649 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0287623 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0287557 CATH GUIDING $2,550.00 02 DIAGNOSTIC IMAGING SUPP (0287540 CATH GUIDING $1,750.00 02 DIAGNOSTIC IMAGING SUPP (0246363 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0287748 CATH GUIDING $1,483.80 02 DIAGNOSTIC IMAGING SUPP (0287375 CATH GUIDING $484.59 02 DIAGNOSTIC IMAGING SUPP (0287391 CATH GUIDING $499.12 02 DIAGNOSTIC IMAGING SUPP (0287490 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0234310 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (0234336 CATH GUIDING $2,103.75 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0287318 CATH GUIDING $382.50 02 DIAGNOSTIC IMAGING SUPP (0287292 CATH GUIDING $484.00 02 DIAGNOSTIC IMAGING SUPP (0287334 CATH GUIDING $382.00 02 DIAGNOSTIC IMAGING SUPP (0287300 CATH GUIDING $85.31 02 DIAGNOSTIC IMAGING SUPP (0287763 CATH GUIDING $2,553.65 02 DIAGNOSTIC IMAGING SUPP (0252726 CATH GUIDING $650.00 02 DIAGNOSTIC IMAGING SUPP (0287250 CATH GUIDING $1,984.50 02 DIAGNOSTIC IMAGING SUPP (0287243 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0287235 CATH GUIDING $1,147.50 02 DIAGNOSTIC IMAGING SUPP (0287227 CATH GUIDING $2,928.50 02 DIAGNOSTIC IMAGING SUPP (0287219 CATH GUIDING $1,266.50 02 DIAGNOSTIC IMAGING SUPP (0287268 CATH GUIDING $2,243.50 02 DIAGNOSTIC IMAGING SUPP (0287367 CATH GUIDING $122.31 02 DIAGNOSTIC IMAGING SUPP (0287532 CATH GUIDING $2,222.50 02 DIAGNOSTIC IMAGING SUPP (0287524 CATH GUIDING $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0287516 CATH GUIDING $2,928.25 02 DIAGNOSTIC IMAGING SUPP (0287508 CATH GUIDING $2,928.25 02 DIAGNOSTIC IMAGING SUPP (0287474 CATH GUIDING $1,092.25 02 DIAGNOSTIC IMAGING SUPP (0287466 CATH GUIDING $2,012.50 02 DIAGNOSTIC IMAGING SUPP (0287458 CATH GUIDING $2,135.00 02 DIAGNOSTIC IMAGING SUPP (0287441 CATH GUIDING $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0287433 CATH GUIDING $1,253.75 02 DIAGNOSTIC IMAGING SUPP (0287417 CATH GUIDING $1,266.50 02 DIAGNOSTIC IMAGING SUPP (0287672 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0287383 CATH GUIDING $484.59 02 DIAGNOSTIC IMAGING SUPP (0287755 CATH GUIDING $1,957.55 02 DIAGNOSTIC IMAGING SUPP (0287359 CATH GUIDING $484.58 02 DIAGNOSTIC IMAGING SUPP (0287276 CATH GUIDING $382.50 02 DIAGNOSTIC IMAGING SUPP (0287342 CATH GUIDING $392.06 02 DIAGNOSTIC IMAGING SUPP (0287631 CATH GUIDING $2,006.90 02 DIAGNOSTIC IMAGING SUPP (0287664 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0287680 CATH GUIDING $2,796.50 02 DIAGNOSTIC IMAGING SUPP (0287698 CATH GUIDING $531.25 02 DIAGNOSTIC IMAGING SUPP (0287706 CATH GUIDING $1,972.00 02 DIAGNOSTIC IMAGING SUPP (0287714 CATH GUIDING $2,097.38 02 DIAGNOSTIC IMAGING SUPP (0287722 CATH GUIDING $2,039.80 02 DIAGNOSTIC IMAGING SUPP (0287730 CATH GUIDING $2,102.35 02 DIAGNOSTIC IMAGING SUPP (0287409 CATH GUIDING $1,253.75 02 DIAGNOSTIC IMAGING SUPP (0252700 CATH GUIDING $1,366.00 02 DIAGNOSTIC IMAGING SUPP (0234401 CATH GUIDING $344.00 $344.00 02 DIAGNOSTIC IMAGING SUPP (0234443 CATH GUIDING $447.00 $447.00 02 DIAGNOSTIC IMAGING SUPP (0234526 CATH GUIDING $471.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (0234542 CATH GUIDING $471.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0268433 CATH GUIDING $1,275.00 02 DIAGNOSTIC IMAGING SUPP (0252718 CATH GUIDING $1,366.00 02 DIAGNOSTIC IMAGING SUPP (0271502 CATH GUIDING $2,625.00 02 DIAGNOSTIC IMAGING SUPP (0252130 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252114 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252098 CATH GUIDING $997.50 02 DIAGNOSTIC IMAGING SUPP (0252072 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0252056 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0252031 CATH GUIDING $495.00 02 DIAGNOSTIC IMAGING SUPP (0246405 CATH GUIDING $2,275.00 02 DIAGNOSTIC IMAGING SUPP (0246397 CATH GUIDING $2,275.00 02 DIAGNOSTIC IMAGING SUPP (0246355 CATH GUIDING $3,062.50 02 DIAGNOSTIC IMAGING SUPP (0246348 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0246215 CATH GUIDING $2,100.00 02 DIAGNOSTIC IMAGING SUPP (0246181 CATH GUIDING $1,912.50 02 DIAGNOSTIC IMAGING SUPP (0232520 CATH INF PER CEN MID NOHD $1,719.00 02 DIAGNOSTIC IMAGING SUPP (0232546 CATH INF PER CEN MID NOHD $793.00 02 DIAGNOSTIC IMAGING SUPP (0276972 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277004 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277020 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277038 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0276998 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0276980 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0277012 CATH INF PER CEN MID NOHD $5,987.50 02 DIAGNOSTIC IMAGING SUPP (0282640 CATH INTRAVASCULAR US $7,500.00 02 DIAGNOSTIC IMAGING SUPP (0231209 CATH OCCLUSION $496.00 $496.00 02 DIAGNOSTIC IMAGING SUPP (0287581 CATH OCCLUSION $2,875.00 02 DIAGNOSTIC IMAGING SUPP (0246199 CATH OCCLUSION $2,852.50 02 DIAGNOSTIC IMAGING SUPP (0287573 CATH OCCLUSION $2,875.00 02 DIAGNOSTIC IMAGING SUPP (0287599 CATH OCCLUSION $3,395.00 02 DIAGNOSTIC IMAGING SUPP (0287607 CATH OCCLUSION $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0286351 CATH THROMB/EMBOLCTMY $612.00 02 DIAGNOSTIC IMAGING SUPP (0234427 CATH THROMB/EMBOLCTMY $115.00 $115.00 02 DIAGNOSTIC IMAGING SUPP (0234633 CATH THROMB/EMBOLCTMY $3,491.25 02 DIAGNOSTIC IMAGING SUPP (0276956 CATH THROMB/EMBOLCTMY $3,075.00 02 DIAGNOSTIC IMAGING SUPP (0234658 CATH THROMB/EMBOLCTMY $3,491.25 02 DIAGNOSTIC IMAGING SUPP (0276931 CATH THROMB/EMBOLCTMY $1,700.00 02 DIAGNOSTIC IMAGING SUPP (0276949 CATH THROMB/EMBOLCTMY $3,312.50 02 DIAGNOSTIC IMAGING SUPP (0276923 CATH THROMB/EMBOLCTMY $3,737.50 02 DIAGNOSTIC IMAGING SUPP (0276964 CATH THROMB/EMBOLCTMY $3,377.50 02 DIAGNOSTIC IMAGING SUPP (0231142 CATH TRNSML ANGIO NOLASR $851.00 $803.00 02 DIAGNOSTIC IMAGING SUPP (0231647 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0231100 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (

A1


document.xls

of 569


SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0231548 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0231324 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0231126 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0233528 CATH TRNSML ANGIO NOLASR $1,089.00 $1,027.00 02 DIAGNOSTIC IMAGING SUPP (0231043 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0231068 CATH TRNSML ANGIO NOLASR $851.00 $803.00 02 DIAGNOSTIC IMAGING SUPP (0233122 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0233585 CATH TRNSML ANGIO NOLASR $1,447.00 02 DIAGNOSTIC IMAGING SUPP (0232728 CATH TRNSML ANGIO NOLASR $961.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0268565 CATH TRNSML ANGIO NOLASR $297.00 $297.00 02 DIAGNOSTIC IMAGING SUPP (0231480 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0231084 CATH TRNSML ANGIO NOLASR $1,136.00 $1,071.00 02 DIAGNOSTIC IMAGING SUPP (0231381 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0231662 CATH TRNSML ANGIO NOLASR $1,020.00 $962.00 02 DIAGNOSTIC IMAGING SUPP (0231464 CATH TRNSML ANGIO NOLASR $1,050.00 $991.00 02 DIAGNOSTIC IMAGING SUPP (0231407 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0231340 CATH TRNSML ANGIO NOLASR $1,550.00 $1,462.00 02 DIAGNOSTIC IMAGING SUPP (0232066 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0233247 CATH TRNSML ANGIO NOLASR $1,019.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0232801 CATH TRNSML ANGIO NOLASR $1,022.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232843 CATH TRNSML ANGIO NOLASR $961.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0232884 CATH TRNSML ANGIO NOLASR $1,022.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232926 CATH TRNSML ANGIO NOLASR $1,019.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0231449 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0233007 CATH TRNSML ANGIO NOLASR $1,017.00 $959.00 02 DIAGNOSTIC IMAGING SUPP (0233569 CATH TRNSML ANGIO NOLASR $1,314.00 $1,239.00 02 DIAGNOSTIC IMAGING SUPP (0233403 CATH TRNSML ANGIO NOLASR $1,182.00 $1,115.00 02 DIAGNOSTIC IMAGING SUPP (0233080 CATH TRNSML ANGIO NOLASR $1,019.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0231506 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0232645 CATH TRNSML ANGIO NOLASR $961.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0231522 CATH TRNSML ANGIO NOLASR $1,135.00 $1,070.00 02 DIAGNOSTIC IMAGING SUPP (0233320 CATH TRNSML ANGIO NOLASR $1,019.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0231621 CATH TRNSML ANGIO NOLASR $988.00 $932.00 02 DIAGNOSTIC IMAGING SUPP (0233486 CATH TRNSML ANGIO NOLASR $1,089.00 $1,027.00 02 DIAGNOSTIC IMAGING SUPP (0232108 CATH TRNSML ANGIO NOLASR $1,733.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232009 CATH TRNSML ANGIO NOLASR $1,305.00 $1,231.00 02 DIAGNOSTIC IMAGING SUPP (0232041 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0233544 CATH TRNSML ANGIO NOLASR $1,314.00 $1,239.00 02 DIAGNOSTIC IMAGING SUPP (0233346 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0282632 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0282616 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0268540 CATH TRNSML ANGIO NOLASR $660.00 $660.00 02 DIAGNOSTIC IMAGING SUPP (0231563 CATH TRNSML ANGIO NOLASR $1,061.00 $1,001.00 02 DIAGNOSTIC IMAGING SUPP (

A1


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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0231308 CATH TRNSML ANGIO NOLASR $1,139.00 $1,074.00 02 DIAGNOSTIC IMAGING SUPP (0233288 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0231365 CATH TRNSML ANGIO NOLASR $1,063.00 $1,003.00 02 DIAGNOSTIC IMAGING SUPP (0233502 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0233460 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0233445 CATH TRNSML ANGIO NOLASR $122.00 $115.00 02 DIAGNOSTIC IMAGING SUPP (0282624 CATH TRNSML ANGIO NOLASR $1,225.49 02 DIAGNOSTIC IMAGING SUPP (0233361 CATH TRNSML ANGIO NOLASR $1,182.00 $1,115.00 02 DIAGNOSTIC IMAGING SUPP (0233536 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0233163 CATH TRNSML ANGIO NOLASR $1,019.00 $961.00 02 DIAGNOSTIC IMAGING SUPP (0232140 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0231589 CATH TRNSML ANGIO NOLASR $929.00 $876.00 02 DIAGNOSTIC IMAGING SUPP (0231605 CATH TRNSML ANGIO NOLASR $1,064.00 $1,004.00 02 DIAGNOSTIC IMAGING SUPP (0233551 CATH TRNSML ANGIO NOLASR $1,447.00 02 DIAGNOSTIC IMAGING SUPP (0232025 CATH TRNSML ANGIO NOLASR $1,628.00 $1,536.00 02 DIAGNOSTIC IMAGING SUPP (0233429 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232124 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232165 CATH TRNSML ANGIO NOLASR $1,635.00 $1,635.00 02 DIAGNOSTIC IMAGING SUPP (0232686 CATH TRNSML ANGIO NOLASR $1,022.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232769 CATH TRNSML ANGIO NOLASR $1,022.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0232967 CATH TRNSML ANGIO NOLASR $1,084.00 $1,023.00 02 DIAGNOSTIC IMAGING SUPP (0233049 CATH TRNSML ANGIO NOLASR $1,083.00 $1,022.00 02 DIAGNOSTIC IMAGING SUPP (0274548 CATH URETERAL $520.00 $491.00 02 DIAGNOSTIC IMAGING SUPP (0274522 CATH URETERAL $420.00 $396.00 02 DIAGNOSTIC IMAGING SUPP (0274563 CATH URETERAL $499.00 $471.00 02 DIAGNOSTIC IMAGING SUPP (0225102 CON HOCM 300-349MG/ML 1ML $58.00 02 DIAGNOSTIC IMAGING SUPP (0223404 CON LOCM 300-349S I 1ML $308.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0225003 CON LOCM 350-399S I 1ML $74.00 $54.00 02 DIAGNOSTIC IMAGING SUPP (0246256 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246272 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246264 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0276832 EMBOLIZ PROTECT SYS $3,875.00 02 DIAGNOSTIC IMAGING SUPP (0246249 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0246280 EMBOLIZ PROTECT SYS $2,750.00 02 DIAGNOSTIC IMAGING SUPP (0263186 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263103 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263129 EP ICAR FX CV GD IN SHTH $261.00 $246.00 02 DIAGNOSTIC IMAGING SUPP (0263145 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263202 EP ICAR FX CV GD IN SHTH $235.00 $222.00 02 DIAGNOSTIC IMAGING SUPP (0263087 EP ICAR FX CV GD IN SHTH $264.00 $249.00 02 DIAGNOSTIC IMAGING SUPP (0263228 EP ICAR FX CV GD IN SHTH $223.00 $210.00 02 DIAGNOSTIC IMAGING SUPP (0263160 EP ICAR FX CV GD IN SHTH $235.00 $222.00 02 DIAGNOSTIC IMAGING SUPP (0263301 EP STEER GUID INTRO/SHTH $59.00 $55.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0263327 EP STEER GUID INTRO/SHTH $103.00 $98.00 02 DIAGNOSTIC IMAGING SUPP (0263343 EP STEER GUID INTRO/SHTH $190.00 $179.00 02 DIAGNOSTIC IMAGING SUPP (0263368 EP STEER GUID INTRO/SHTH $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0263285 EP STEER GUID INTRO/SHTH $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0268045 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0285007 GUIDEWIRE $374.00 02 DIAGNOSTIC IMAGING SUPP (0267708 GUIDEWIRE $88.00 $88.00 02 DIAGNOSTIC IMAGING SUPP (0268169 GUIDEWIRE $818.00 $818.00 02 DIAGNOSTIC IMAGING SUPP (0267807 GUIDEWIRE $77.00 $77.00 02 DIAGNOSTIC IMAGING SUPP (0268003 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0268060 GUIDEWIRE $156.00 $156.00 02 DIAGNOSTIC IMAGING SUPP (0268102 GUIDEWIRE $253.00 $253.00 02 DIAGNOSTIC IMAGING SUPP (0268086 GUIDEWIRE $156.00 $156.00 02 DIAGNOSTIC IMAGING SUPP (0268144 GUIDEWIRE $262.00 $262.00 02 DIAGNOSTIC IMAGING SUPP (0268706 GUIDEWIRE $112.00 $112.00 02 DIAGNOSTIC IMAGING SUPP (0268250 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (0268227 GUIDEWIRE $788.00 $788.00 02 DIAGNOSTIC IMAGING SUPP (0246165 GUIDEWIRE $1,062.50 02 DIAGNOSTIC IMAGING SUPP (0268508 GUIDEWIRE $570.00 $570.00 02 DIAGNOSTIC IMAGING SUPP (0268524 GUIDEWIRE $570.00 $570.00 02 DIAGNOSTIC IMAGING SUPP (0268417 GUIDEWIRE $1,466.25 02 DIAGNOSTIC IMAGING SUPP (0268029 GUIDEWIRE $169.00 $169.00 02 DIAGNOSTIC IMAGING SUPP (0268128 GUIDEWIRE $247.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0246223 GUIDEWIRE $935.00 02 DIAGNOSTIC IMAGING SUPP (0268367 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0268466 GUIDEWIRE $938.83 02 DIAGNOSTIC IMAGING SUPP (0268490 GUIDEWIRE $978.78 02 DIAGNOSTIC IMAGING SUPP (0268441 GUIDEWIRE $978.89 02 DIAGNOSTIC IMAGING SUPP (0268805 GUIDEWIRE $639.00 $639.00 02 DIAGNOSTIC IMAGING SUPP (0268649 GUIDEWIRE $57.00 $57.00 02 DIAGNOSTIC IMAGING SUPP (0268300 GUIDEWIRE $236.98 02 DIAGNOSTIC IMAGING SUPP (0268268 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (0276907 GUIDEWIRE $1,697.88 02 DIAGNOSTIC IMAGING SUPP (0268474 GUIDEWIRE $813.96 02 DIAGNOSTIC IMAGING SUPP (0268375 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0268409 GUIDEWIRE $871.25 02 DIAGNOSTIC IMAGING SUPP (0252734 GUIDEWIRE $245.00 02 DIAGNOSTIC IMAGING SUPP (0268276 GUIDEWIRE $5,255.00 02 DIAGNOSTIC IMAGING SUPP (0268284 GUIDEWIRE $1,113.00 02 DIAGNOSTIC IMAGING SUPP (0268292 GUIDEWIRE $340.00 02 DIAGNOSTIC IMAGING SUPP (0268318 GUIDEWIRE $119.70 02 DIAGNOSTIC IMAGING SUPP (0268326 GUIDEWIRE $129.34 02 DIAGNOSTIC IMAGING SUPP (0268334 GUIDEWIRE $561.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0268342 GUIDEWIRE $561.00 02 DIAGNOSTIC IMAGING SUPP (0268359 GUIDEWIRE $403.75 02 DIAGNOSTIC IMAGING SUPP (0268383 GUIDEWIRE $1,139.00 02 DIAGNOSTIC IMAGING SUPP (0252171 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0268391 GUIDEWIRE $1,360.00 02 DIAGNOSTIC IMAGING SUPP (0252197 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0276899 GUIDEWIRE $938.83 02 DIAGNOSTIC IMAGING SUPP (0276881 GUIDEWIRE $978.78 02 DIAGNOSTIC IMAGING SUPP (0252155 GUIDEWIRE $2,090.00 02 DIAGNOSTIC IMAGING SUPP (0276915 GUIDEWIRE $855.95 02 DIAGNOSTIC IMAGING SUPP (0268847 GUIDEWIRE $599.00 $599.00 02 DIAGNOSTIC IMAGING SUPP (0268482 GUIDEWIRE $1,358.60 02 DIAGNOSTIC IMAGING SUPP (0268458 GUIDEWIRE $1,238.45 02 DIAGNOSTIC IMAGING SUPP (0268425 GUIDEWIRE $1,041.25 02 DIAGNOSTIC IMAGING SUPP (0285155 IMP CATH HD/PRTNL LNG TRM $1,697.00 $1,697.00 02 DIAGNOSTIC IMAGING SUPP (0283093 IMP TISSUE MARKER $170.00 02 DIAGNOSTIC IMAGING SUPP (0276840 INTRO/SHEATH NON-LASER $440.73 02 DIAGNOSTIC IMAGING SUPP (0287615 INTRO/SHEATH NON-LASER $161.50 02 DIAGNOSTIC IMAGING SUPP (0246371 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0246413 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0246389 RET DEV INSERTABLE $7,125.00 02 DIAGNOSTIC IMAGING SUPP (0276857 RET DEV INSERTABLE $2,401.25 02 DIAGNOSTIC IMAGING SUPP (0276691 S IMP CYPHER STENT $8,455.00 02 DIAGNOSTIC IMAGING SUPP (0271148 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271452 S IMP EMBOLIC COIL $2,850.00 02 DIAGNOSTIC IMAGING SUPP (0271031 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0254623 S IMP EMBOLIC COIL $5,243.00 02 DIAGNOSTIC IMAGING SUPP (0254755 S IMP EMBOLIC COIL $2,805.25 02 DIAGNOSTIC IMAGING SUPP (0254656 S IMP EMBOLIC COIL $5,390.00 02 DIAGNOSTIC IMAGING SUPP (0254615 S IMP EMBOLIC COIL $5,292.00 02 DIAGNOSTIC IMAGING SUPP (0271429 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271122 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271197 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271189 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271577 S IMP EMBOLIC COIL $4,437.50 02 DIAGNOSTIC IMAGING SUPP (0271593 S IMP EMBOLIC COIL $4,362.50 02 DIAGNOSTIC IMAGING SUPP (0252239 S IMP EMBOLIC COIL $2,430.00 02 DIAGNOSTIC IMAGING SUPP (0252544 S IMP EMBOLIC COIL $2,385.00 02 DIAGNOSTIC IMAGING SUPP (0252551 S IMP EMBOLIC COIL $2,453.00 02 DIAGNOSTIC IMAGING SUPP (0252569 S IMP EMBOLIC COIL $2,363.00 02 DIAGNOSTIC IMAGING SUPP (0252577 S IMP EMBOLIC COIL $3,845.00 02 DIAGNOSTIC IMAGING SUPP (0252585 S IMP EMBOLIC COIL $2,755.00 02 DIAGNOSTIC IMAGING SUPP (0252593 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0252213 S IMP EMBOLIC COIL $2,408.00 02 DIAGNOSTIC IMAGING SUPP (0252627 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0254193 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0252601 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0254102 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254110 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254128 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (0254136 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254144 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254151 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254169 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (0254086 S IMP EMBOLIC COIL $2,878.75 02 DIAGNOSTIC IMAGING SUPP (0254185 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254078 S IMP EMBOLIC COIL $2,731.75 02 DIAGNOSTIC IMAGING SUPP (0254201 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254219 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0254227 S IMP EMBOLIC COIL $3,809.75 02 DIAGNOSTIC IMAGING SUPP (0254235 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254243 S IMP EMBOLIC COIL $4,361.00 02 DIAGNOSTIC IMAGING SUPP (0254250 S IMP EMBOLIC COIL $4,532.50 02 DIAGNOSTIC IMAGING SUPP (0254268 S IMP EMBOLIC COIL $4,532.00 02 DIAGNOSTIC IMAGING SUPP (0254276 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254177 S IMP EMBOLIC COIL $3,503.50 02 DIAGNOSTIC IMAGING SUPP (0252635 S IMP EMBOLIC COIL $2,890.00 02 DIAGNOSTIC IMAGING SUPP (0252643 S IMP EMBOLIC COIL $2,845.00 02 DIAGNOSTIC IMAGING SUPP (0252650 S IMP EMBOLIC COIL $2,905.00 02 DIAGNOSTIC IMAGING SUPP (0252668 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252676 S IMP EMBOLIC COIL $2,950.00 02 DIAGNOSTIC IMAGING SUPP (0252684 S IMP EMBOLIC COIL $2,695.00 02 DIAGNOSTIC IMAGING SUPP (0252692 S IMP EMBOLIC COIL $2,695.00 02 DIAGNOSTIC IMAGING SUPP (0254094 S IMP EMBOLIC COIL $3,185.00 02 DIAGNOSTIC IMAGING SUPP (0252619 S IMP EMBOLIC COIL $2,905.00 02 DIAGNOSTIC IMAGING SUPP (0254003 S IMP EMBOLIC COIL $4,116.00 02 DIAGNOSTIC IMAGING SUPP (0254011 S IMP EMBOLIC COIL $4,361.00 02 DIAGNOSTIC IMAGING SUPP (0254029 S IMP EMBOLIC COIL $3,724.00 02 DIAGNOSTIC IMAGING SUPP (0254037 S IMP EMBOLIC COIL $3,822.00 02 DIAGNOSTIC IMAGING SUPP (0254045 S IMP EMBOLIC COIL $3,626.00 02 DIAGNOSTIC IMAGING SUPP (0254052 S IMP EMBOLIC COIL $3,920.00 02 DIAGNOSTIC IMAGING SUPP (0254060 S IMP EMBOLIC COIL $4,165.00 02 DIAGNOSTIC IMAGING SUPP (0254300 S IMP EMBOLIC COIL $2,805.25 02 DIAGNOSTIC IMAGING SUPP (0271478 S IMP EMBOLIC COIL $2,800.00 02 DIAGNOSTIC IMAGING SUPP (0271361 S IMP EMBOLIC COIL $4,087.50 02 DIAGNOSTIC IMAGING SUPP (0271379 S IMP EMBOLIC COIL $2,725.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE


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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0254474 S IMP EMBOLIC COIL $3,918.75 02 DIAGNOSTIC IMAGING SUPP (0254482 S IMP EMBOLIC COIL $3,464.30 02 DIAGNOSTIC IMAGING SUPP (0254490 S IMP EMBOLIC COIL $3,577.00 02 DIAGNOSTIC IMAGING SUPP (0254383 S IMP EMBOLIC COIL $3,327.10 02 DIAGNOSTIC IMAGING SUPP (0271015 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271023 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271049 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271056 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0271064 S IMP EMBOLIC COIL $3,237.50 02 DIAGNOSTIC IMAGING SUPP (0254292 S IMP EMBOLIC COIL $2,940.00 02 DIAGNOSTIC IMAGING SUPP (0255141 S IMP EV3 AX 3D COIL 3X4 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255158 S IMP EV3 AX 3D COIL 3X6 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255166 S IMP EV3 AX 3D COIL 3X8 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255182 S IMP EV3 AX 3D COIL 4X12 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255174 S IMP EV3 AX 3D COIL 4X8 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255190 S IMP EV3 AX 3D COIL 5X10 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255208 S IMP EV3 AX 3D COIL 5X15 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255216 S IMP EV3 AX 3D COIL 6X15 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255315 S IMP EV3 AX 3D COIL 6X20 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0255224 S IMP EV3 AX 3D COIL 7X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255307 S IMP EV3 AX 3D COIL 7X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255232 S IMP EV3 AX 3D COIL 8X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255240 S IMP EV3 AX 3D COIL 8X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255257 S IMP EV3 AX 3D COIL 9X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255265 S IMP EV3 AX 3D COIL 9X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255000 S IMP EV3 AX HLX COIL 2X1 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255372 S IMP EV3 AX HLX COIL 2X2 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255018 S IMP EV3 AX HLX COIL 2X3 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255026 S IMP EV3 AX HLX COIL 2X4 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255364 S IMP EV3 AX HLX COIL 2X6 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255034 S IMP EV3 AX HLX COIL 2X8 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255042 S IMP EV3 AX HLX COIL 3X4 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255059 S IMP EV3 AX HLX COIL 3X6 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255356 S IMP EV3 AX HLX COIL 3X8 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255349 S IMP EV3 AX HLX COIL 4X8 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255273 S IMP EV3 AX3D COIL 10X20 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255281 S IMP EV3 AX3D COIL 10X30 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255299 S IMP EV3 AX3D COIL 12X40 $1,350.00 02 DIAGNOSTIC IMAGING SUPP (0255067 S IMP EV3 AXHLX COIL 4X10 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255075 S IMP EV3 AXHLX COIL 4X12 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255083 S IMP EV3 AXHLX COIL 5X15 $910.00 02 DIAGNOSTIC IMAGING SUPP (0255091 S IMP EV3 AXHLX COIL 5X20 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255109 S IMP EV3 AXHLX COIL 6X20 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0255117 S IMP EV3 AXHLX COIL 7X30 02 DIAGNOSTIC IMAGING SUPP (0255331 S IMP EV3 AXHLX COIL 8X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255323 S IMP EV3 AXHLX COIL 9X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255125 S IMP EV3 AXHLXCOIL 10X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0255133 S IMP EV3 AXHLXCOIL 12X30 $1,000.00 02 DIAGNOSTIC IMAGING SUPP (0243246 S IMP IR EMBOLI COIL $197.00 $186.00 02 DIAGNOSTIC IMAGING SUPP (0243121 S IMP IR EMBOLI COIL 2X40 $375.00 $354.00 02 DIAGNOSTIC IMAGING SUPP (0243147 S IMP IR EMBOLI COIL 3X60 $375.00 $354.00 02 DIAGNOSTIC IMAGING SUPP (0243162 S IMP IR EMBOLI COIL PUSH $473.00 $446.00 02 DIAGNOSTIC IMAGING SUPP (0246009 S IMP IR G01 VENA CAVA FT $2,387.00 $2,251.00 02 DIAGNOSTIC IMAGING SUPP (0287201 S IMP IR VASC CLOS VASOSE $931.00 02 DIAGNOSTIC IMAGING SUPP (0287144 S IMP IR VASCULAR CLOSER $310.00 $293.00 02 DIAGNOSTIC IMAGING SUPP (0287102 S IMP IR VASCULAR CLOSURE $240.00 $227.00 02 DIAGNOSTIC IMAGING SUPP (0251405 S IMP NR GDC 12X30 COIL $1,966.00 02 DIAGNOSTIC IMAGING SUPP (0251447 S IMP NR GDC 16X30 COIL $2,104.00 02 DIAGNOSTIC IMAGING SUPP (0251629 S IMP NR GDC 2D COIL $2,025.00 02 DIAGNOSTIC IMAGING SUPP (0251686 S IMP NR GDC 2D COIL $2,163.00 02 DIAGNOSTIC IMAGING SUPP (0252122 S IMP NR GDC 3MM X 8CM $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252148 S IMP NR GDC 4MM X 10C $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252163 S IMP NR GDC 5MM X 15C $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0251504 S IMP NR GDC 5X2O 2D COIL $2,221.00 02 DIAGNOSTIC IMAGING SUPP (0251546 S IMP NR GDC 7X30 2D COIL $2,340.00 02 DIAGNOSTIC IMAGING SUPP (0251587 S IMP NR GDC 9X30 2D COIL $2,340.00 02 DIAGNOSTIC IMAGING SUPP (0251264 S IMP NR GDC COIL $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251280 S IMP NR GDC COIL $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251363 S IMP NR GDC COIL $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251488 S IMP NR GDC COIL $2,104.00 02 DIAGNOSTIC IMAGING SUPP (0251181 S IMP NR GDC SOFT COIL $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251082 S IMP NR GDC SOFT COIL $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251744 S IMP NR GDC SOFT COIL $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251769 S IMP NR GDC SOFT COIL $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251785 S IMP NR GDC SOFT COIL $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251140 S IMP NR GDC SOFT COIL $2,149.00 02 DIAGNOSTIC IMAGING SUPP (0281758 S NSTRL IR BAG DRAINAGE $81.00 $77.00 02 DIAGNOSTIC IMAGING SUPP (0252320 S NSTRL NR STENT/NEURO 3 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252361 S NSTRL NR STENT/NEURO 4 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0252346 S NSTRL NR STENT/NEURO 4 $6,405.00 02 DIAGNOSTIC IMAGING SUPP (0264473 S STRL ABLATION PROBE $3,960.00 02 DIAGNOSTIC IMAGING SUPP (0252270 S STRL ASPIRATION TUBING $332.20 02 DIAGNOSTIC IMAGING SUPP (0234021 S STRL CATH AORTIC FLUS $115.00 $109.00 02 DIAGNOSTIC IMAGING SUPP (0234047 S STRL CATH AORTIC FLUS $119.00 $112.00 02 DIAGNOSTIC IMAGING SUPP (0234088 S STRL CATH BERENSTINE $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (0242503 S STRL EMBLOIC LIQUID $16,250.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0243220 S STRL EMBO COIL SPRING $114.00 $108.00 02 DIAGNOSTIC IMAGING SUPP (0243188 S STRL EMBO COIL SPRING $114.00 $108.00 02 DIAGNOSTIC IMAGING SUPP (0243204 S STRL EMBO COIL SPRING $262.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0243394 S STRL EMBOLIC LIQUID $5,237.50 02 DIAGNOSTIC IMAGING SUPP (0232280 S STRL IR BLN AUGMENTATIO $3,000.00 02 DIAGNOSTIC IMAGING SUPP (0234005 S STRL IR CATH 5FR 65CM $110.00 $103.00 02 DIAGNOSTIC IMAGING SUPP (0234070 S STRL IR CATH BERENSTINE $100.00 $95.00 02 DIAGNOSTIC IMAGING SUPP (0234054 S STRL IR CATH BERMAN $224.00 02 DIAGNOSTIC IMAGING SUPP (0234260 S STRL IR CATH BERN GLD $279.00 02 DIAGNOSTIC IMAGING SUPP (0234120 S STRL IR CATH COBRA $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0234187 S STRL IR CATH COBRA $110.00 $104.00 02 DIAGNOSTIC IMAGING SUPP (0234245 S STRL IR CATH GLIDE $253.00 $239.00 02 DIAGNOSTIC IMAGING SUPP (0235309 S STRL IR CATH H1 $100.00 $95.00 02 DIAGNOSTIC IMAGING SUPP (0234583 S STRL IR CATH HOOK VISC $65.00 $62.00 02 DIAGNOSTIC IMAGING SUPP (0234625 S STRL IR CATH JB2 $64.00 $60.00 02 DIAGNOSTIC IMAGING SUPP (0234708 S STRL IR CATH MPA 5FR $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (0234765 S STRL IR CATH PIGTAIL $47.00 $45.00 02 DIAGNOSTIC IMAGING SUPP (0234823 S STRL IR CATH PIGTAIL $68.00 $64.00 02 DIAGNOSTIC IMAGING SUPP (0234955 S STRL IR CATH SIM1 5F100 $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0235002 S STRL IR CATH SIMMON 5FR $103.00 $97.00 02 DIAGNOSTIC IMAGING SUPP (0234906 S STRL IR CATH SIMMONS $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0235085 S STRL IR CATH STR $97.00 $91.00 02 DIAGNOSTIC IMAGING SUPP (0235127 S STRL IR CATH STR $94.00 $89.00 02 DIAGNOSTIC IMAGING SUPP (0235101 S STRL IR CATH STR $97.00 $92.00 02 DIAGNOSTIC IMAGING SUPP (0243048 S STRL IR CATH TRACKER $1,261.00 $1,189.00 02 DIAGNOSTIC IMAGING SUPP (0243022 S STRL IR CATH TRACKER 10 $1,219.00 $1,150.00 02 DIAGNOSTIC IMAGING SUPP (0235200 S STRL IR CATH TRACKER 18 $1,383.00 $313.00 02 DIAGNOSTIC IMAGING SUPP (0235226 S STRL IR CATH VENTURE $1,471.00 $1,388.00 02 DIAGNOSTIC IMAGING SUPP (0261289 S STRL IR DILATOR 4FR $37.00 $35.00 02 DIAGNOSTIC IMAGING SUPP (0261420 S STRL IR DLTR 10FR $36.00 $34.00 02 DIAGNOSTIC IMAGING SUPP (0261008 S STRL IR DLTR 11FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261024 S STRL IR DLTR 12FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261040 S STRL IR DLTR 13FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261065 S STRL IR DLTR 14FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261081 S STRL IR DLTR 16FR $38.00 $36.00 02 DIAGNOSTIC IMAGING SUPP (0261206 S STRL IR DLTR 20FR $36.00 $34.00 02 DIAGNOSTIC IMAGING SUPP (0261222 S STRL IR DLTR 22FR $57.00 $54.00 02 DIAGNOSTIC IMAGING SUPP (0261305 S STRL IR DLTR 5FR $33.00 $31.00 02 DIAGNOSTIC IMAGING SUPP (0261321 S STRL IR DLTR 6FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0261347 S STRL IR DLTR 7FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0261362 S STRL IR DLTR 8FR $33.00 $31.00 02 DIAGNOSTIC IMAGING SUPP (0261388 S STRL IR DLTR 9FR $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0243386 S STRL IR EMBO WIRE TAPER $630.00 $595.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0243105 S STRL IR EMBOLI COIL 2 $342.00 $322.00 02 DIAGNOSTIC IMAGING SUPP (0243329 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243303 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243345 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0243287 S STRL IR EMBOLI CONTOUR $394.00 $372.00 02 DIAGNOSTIC IMAGING SUPP (0241067 S STRL IR FLO-SWITCH $31.00 $29.00 02 DIAGNOSTIC IMAGING SUPP (0234195 S STRL IR GLIDE CATH $253.00 $238.00 02 DIAGNOSTIC IMAGING SUPP (0283101 S STRL IR HI-PRESSURE TB $21.00 $19.00 02 DIAGNOSTIC IMAGING SUPP (0241083 S STRL IR INDEFLATOR $234.00 $220.00 02 DIAGNOSTIC IMAGING SUPP (0263004 S STRL IR INTRO 5FR $106.00 $100.00 02 DIAGNOSTIC IMAGING SUPP (0263020 S STRL IR INTRO 6FR $106.00 $100.00 02 DIAGNOSTIC IMAGING SUPP (0263046 S STRL IR INTRO 7FRX25 $336.00 $317.00 02 DIAGNOSTIC IMAGING SUPP (0263061 S STRL IR INTRO BALKIN $185.00 $174.00 02 DIAGNOSTIC IMAGING SUPP (0241109 S STRL IR MONITORING TUB $16.00 $15.00 02 DIAGNOSTIC IMAGING SUPP (0284208 S STRL IR NDL 18GA THIN $32.00 $30.00 02 DIAGNOSTIC IMAGING SUPP (0284158 S STRL IR NDL SMART LG $368.00 $347.00 02 DIAGNOSTIC IMAGING SUPP (0234641 S STRL IR NDL TLA $62.00 $58.00 02 DIAGNOSTIC IMAGING SUPP (0285403 S STRL IR SET FEED TUBE $262.00 $247.00 02 DIAGNOSTIC IMAGING SUPP (0285056 S STRL IR SET GASTROJEJ $699.00 $660.00 02 DIAGNOSTIC IMAGING SUPP (0285353 S STRL IR SET LIVER BIOP $340.00 $321.00 02 DIAGNOSTIC IMAGING SUPP (0285452 S STRL IR SET MICRO PUNC $135.00 $127.00 02 DIAGNOSTIC IMAGING SUPP (0285809 S STRL IR SET RING TRANS $1,366.00 $1,288.00 02 DIAGNOSTIC IMAGING SUPP (0285700 S STRL IR SNARE 10 MM $1,644.00 $1,551.00 02 DIAGNOSTIC IMAGING SUPP (0285759 S STRL IR SNARE 25 MM $1,644.00 $1,551.00 02 DIAGNOSTIC IMAGING SUPP (0244061 S STRL IR STN BSKT SEGURA $1,024.00 $966.00 02 DIAGNOSTIC IMAGING SUPP (0244020 S STRL IR STONE BASKET $1,129.00 $1,066.00 02 DIAGNOSTIC IMAGING SUPP (0244046 S STRL IR STONE BSKT $867.00 $818.00 02 DIAGNOSTIC IMAGING SUPP (0244004 S STRL IR STONE BSKT 15 $893.00 $842.00 02 DIAGNOSTIC IMAGING SUPP (0235143 S STRL IR STR 5FR 80 $91.00 $86.00 02 DIAGNOSTIC IMAGING SUPP (0241125 S STRL IR T-FASTENER B-M $245.00 $231.00 02 DIAGNOSTIC IMAGING SUPP (0252742 S STRL IR TIPSS SET $2,135.00 02 DIAGNOSTIC IMAGING SUPP (0241166 S STRL IR TORQUE DEV $53.00 $50.00 02 DIAGNOSTIC IMAGING SUPP (0245506 S STRL IR TORQUE DEV $43.00 $40.00 02 DIAGNOSTIC IMAGING SUPP (0245605 S STRL IR TRNDCR NAMIC $97.00 $92.00 02 DIAGNOSTIC IMAGING SUPP (0266007 S STRL IR TUBE GASTRO $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266106 S STRL IR TUBE GASTRO $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266148 S STRL IR TUBE GJ 16FR $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0266163 S STRL IR TUBE GJ 22FR $657.00 $620.00 02 DIAGNOSTIC IMAGING SUPP (0286005 S STRL IR TY ANGIO $400.00 $377.00 02 DIAGNOSTIC IMAGING SUPP (0286203 S STRL IR TY PNEUMOTHORAX $183.00 $173.00 02 DIAGNOSTIC IMAGING SUPP (0286302 S STRL IR TY THORA $216.00 $204.00 02 DIAGNOSTIC IMAGING SUPP (0267203 S STRL IR WIRE AMPLATZ $194.00 $183.00 02 DIAGNOSTIC IMAGING SUPP (0267260 S STRL IR WIRE AMPLATZ $156.00 $148.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0267245 S STRL IR WIRE AMPLATZ $241.00 $227.00 02 DIAGNOSTIC IMAGING SUPP (0267302 S STRL IR WIRE BENTSON $85.00 $81.00 02 DIAGNOSTIC IMAGING SUPP (0267104 S STRL IR WIRE J MVBL $7.00 $7.00 02 DIAGNOSTIC IMAGING SUPP (0284257 S STRL NEEDLE WESTCOTT $62.00 $58.00 02 DIAGNOSTIC IMAGING SUPP (0253468 S STRL NR CEMENT KIT 11GA $617.50 02 DIAGNOSTIC IMAGING SUPP (0251389 S STRL NR GDC 10MM X 30 $1,966.00 02 DIAGNOSTIC IMAGING SUPP (0251603 S STRL NR GDC 10MM X30C $2,025.00 02 DIAGNOSTIC IMAGING SUPP (0251421 S STRL NR GDC 14MM X 30 $1,966.00 02 DIAGNOSTIC IMAGING SUPP (0251660 S STRL NR GDC 16MMX30CM $2,025.00 02 DIAGNOSTIC IMAGING SUPP (0251462 S STRL NR GDC 18MM X 30 $2,104.00 02 DIAGNOSTIC IMAGING SUPP (0251728 S STRL NR GDC 2MM X 2CM $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251025 S STRL NR GDC 2MM X 4CM $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251041 S STRL NR GDC 2MMX8CM S $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251066 S STRL NR GDC 3MMX4CM S $2,030.00 02 DIAGNOSTIC IMAGING SUPP (0251124 S STRL NR GDC 4MMX10CM $2,149.00 02 DIAGNOSTIC IMAGING SUPP (0251108 S STRL NR GDC 4MMX6CM S $2,149.00 02 DIAGNOSTIC IMAGING SUPP (0252049 S STRL NR GDC 5MM X 10C $1,361.00 02 DIAGNOSTIC IMAGING SUPP (0251165 S STRL NR GDC 5MMX12CM $2,149.00 02 DIAGNOSTIC IMAGING SUPP (0251223 S STRL NR GDC 5MMX15CM $2,149.00 02 DIAGNOSTIC IMAGING SUPP (0251520 S STRL NR GDC 6MM X 20C $2,340.00 02 DIAGNOSTIC IMAGING SUPP (0251207 S STRL NR GDC 6MMX15CM $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251306 S STRL NR GDC 8MM X 20C $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251322 S STRL NR GDC 8MM X 30C $2,268.00 02 DIAGNOSTIC IMAGING SUPP (0251561 S STRL NR GDC 8MM X 30C $2,340.00 02 DIAGNOSTIC IMAGING SUPP (0253104 S STRL NR KYPHOPAK 15/3 $9,615.00 02 DIAGNOSTIC IMAGING SUPP (0253153 S STRL NR KYPHOPAK 15/3 $6,539.00 02 DIAGNOSTIC IMAGING SUPP (0253252 S STRL NR KYPHOPAK 20/3 $6,539.00 02 DIAGNOSTIC IMAGING SUPP (0253203 S STRL NR KYPHOPAK 20/3 $9,615.00 02 DIAGNOSTIC IMAGING SUPP (0253450 S STRL NR KYPHX BONE $3,779.00 02 DIAGNOSTIC IMAGING SUPP (0253401 S STRL NR KYPHX TOOL KIT $3,539.00 02 DIAGNOSTIC IMAGING SUPP (0253476 S STRL NR NDL BX 13GA/19C $235.00 02 DIAGNOSTIC IMAGING SUPP (0264465 S STRL RF PROBE 2CMX15CM $758.00 02 DIAGNOSTIC IMAGING SUPP (0264523 S STRL RF PROBE 3.5CMX15C $1,152.00 02 DIAGNOSTIC IMAGING SUPP (0264481 S STRL RF PROBE 3CMX15CM $983.00 02 DIAGNOSTIC IMAGING SUPP (0264549 S STRL RF PROBE 4CMX15CM $1,348.00 02 DIAGNOSTIC IMAGING SUPP (0252254 S STRL SUCTION CANISTER/F $200.00 02 DIAGNOSTIC IMAGING SUPP (0241026 S STRL TUBE $60.00 02 DIAGNOSTIC IMAGING SUPP (0266205 S STRL TUBE TRANSGASTRI $931.00 $878.00 02 DIAGNOSTIC IMAGING SUPP (0276766 STENT NOCOAT W DEL SYS $6,237.50 02 DIAGNOSTIC IMAGING SUPP (0276626 STENT NOCOAT W DEL SYS $2,531.00 $2,531.00 02 DIAGNOSTIC IMAGING SUPP (0276246 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276683 STENT NOCOAT W DEL SYS $3,696.00 02 DIAGNOSTIC IMAGING SUPP (0276261 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 300 AMOUNT

DEPARTMENT CODE

0276188 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276147 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276428 STENT NOCOAT W DEL SYS $3,357.00 $3,357.00 02 DIAGNOSTIC IMAGING SUPP (0276501 STENT NOCOAT W DEL SYS $4,836.00 $4,836.00 02 DIAGNOSTIC IMAGING SUPP (0276287 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276048 STENT NOCOAT W DEL SYS $4,170.00 $4,170.00 02 DIAGNOSTIC IMAGING SUPP (0276162 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276022 STENT NOCOAT W DEL SYS $4,061.00 $4,061.00 02 DIAGNOSTIC IMAGING SUPP (0276600 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276527 STENT NOCOAT W DEL SYS $3,959.00 $3,959.00 02 DIAGNOSTIC IMAGING SUPP (0276345 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276329 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276303 STENT NOCOAT W DEL SYS $3,913.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276006 STENT NOCOAT W DEL SYS $4,061.00 $4,061.00 02 DIAGNOSTIC IMAGING SUPP (0276204 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276063 STENT NOCOAT W DEL SYS $3,134.00 $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276121 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276105 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276089 STENT NOCOAT W DEL SYS $3,134.00 $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276220 STENT NOCOAT W DEL SYS $3,134.00 $3,134.00 02 DIAGNOSTIC IMAGING SUPP (0276717 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0276824 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276816 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276808 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0276782 STENT NOCOAT W DEL SYS $5,625.00 02 DIAGNOSTIC IMAGING SUPP (0276758 STENT NOCOAT W DEL SYS $5,375.00 02 DIAGNOSTIC IMAGING SUPP (0276741 STENT NOCOAT W DEL SYS $6,237.50 02 DIAGNOSTIC IMAGING SUPP (0276360 STENT NOCOAT W DEL SYS $3,691.00 $3,691.00 02 DIAGNOSTIC IMAGING SUPP (0276725 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0271262 STENT NOCOAT W DEL SYS $3,850.00 02 DIAGNOSTIC IMAGING SUPP (0276584 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276568 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276543 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276485 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276469 STENT NOCOAT W DEL SYS $3,167.00 $3,167.00 02 DIAGNOSTIC IMAGING SUPP (0276774 STENT NOCOAT W DEL SYS $5,625.00 02 DIAGNOSTIC IMAGING SUPP (0276402 STENT NOCOAT W DEL SYS $3,357.00 $3,357.00 02 DIAGNOSTIC IMAGING SUPP (0276733 STENT NOCOAT W DEL SYS $13,000.00 02 DIAGNOSTIC IMAGING SUPP (0252445 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (0252536 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252528 STENT NOCOAT W DEL SYS $11,632.50 02 DIAGNOSTIC IMAGING SUPP (0252510 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252494 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0252486 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252478 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252452 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (0252437 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252429 STENT NOCOAT W DEL SYS $10,692.50 02 DIAGNOSTIC IMAGING SUPP (0252411 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252395 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252387 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0252379 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0252312 STENT NOCOAT W DEL SYS $14,987.50 02 DIAGNOSTIC IMAGING SUPP (0276790 STENT NOCOAT W DEL SYS $5,125.00 02 DIAGNOSTIC IMAGING SUPP (0252460 STENT NOCOAT W DEL SYS $10,927.50 02 DIAGNOSTIC IMAGING SUPP (0274829 STENT NO-COAT/COV W/O DEL $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274803 STENT NO-COAT/COV W/O DEL $4,023.00 $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274845 STENT NO-COAT/COV W/O DEL $3,795.00 $3,795.00 02 DIAGNOSTIC IMAGING SUPP (0274860 STENT NO-COAT/COV W/O DEL $3,522.00 02 DIAGNOSTIC IMAGING SUPP (0274886 STENT NO-COAT/COV W/O DEL $2,630.00 $2,630.00 02 DIAGNOSTIC IMAGING SUPP (0274902 STENT NO-COAT/COV W/O DEL $3,876.00 02 DIAGNOSTIC IMAGING SUPP (0276642 STENT NO-COR TMP W/DL SYS $3,600.00 $3,600.00 02 DIAGNOSTIC IMAGING SUPP (0276667 STENT NON-COR TMP W/O DEL $3,200.00 02 DIAGNOSTIC IMAGING SUPP (5020482 ANTI CITRATE DEXTROSE A $43.13 50 DIALYSIS SERVICES5050349 APHERESIS ADSORP/REINFUSE $7,076.00 $4,062.00 50 DIALYSIS SERVICES5020052 APHERESIS PLASMA $11,743.00 $7,354.00 50 DIALYSIS SERVICES5020664 APHERESIS PLASMA $11,743.00 50 DIALYSIS SERVICES5020185 APHERESIS PLATELET $7,621.00 $4,772.00 50 DIALYSIS SERVICES5020094 APHERESIS RBC $7,402.00 $4,635.00 50 DIALYSIS SERVICES5020169 APHERESIS WBC $7,223.00 $4,523.00 50 DIALYSIS SERVICES5020441 CA GLUCONATE 10ML IJ $42.18 50 DIALYSIS SERVICES5020540 COLL BLD PICC/CNTRL LN $264.00 50 DIALYSIS SERVICES5020318 CRYOPRESERVE STEM CELLS $3,383.50 $3,383.50 50 DIALYSIS SERVICES5020557 DECLOT VASC DEVICE $450.00 50 DIALYSIS SERVICES5050331 DIALYS CAPD IP $532.00 $333.00 50 DIALYSIS SERVICES5050067 DIALYS CCPD IP $1,843.00 $1,154.00 50 DIALYSIS SERVICES5020326 DIALYS EMER ESRD HOSP OP $1,470.50 50 DIALYSIS SERVICES5050018 DIALYS HEMO IP $3,059.00 $1,916.00 50 DIALYSIS SERVICES5050059 DIALYS HEMOFILTRATION IP $2,677.00 $1,676.00 50 DIALYSIS SERVICES5050091 DIALYS HEMOPERFUSION IP $6,972.00 $4,366.00 50 DIALYSIS SERVICES5050299 DIALYSIS HEMO OUTPT $1,424.00 50 DIALYSIS SERVICES5040282 DIALYSIS HEMO OUTPT $1,424.00 50 DIALYSIS SERVICES5030333 DIALYSIS HEMO OUTPT $971.00 50 DIALYSIS SERVICES5050323 DIALYSIS HEMO OUTPT $1,424.00 50 DIALYSIS SERVICES5040225 ESRD SYRINGE $1.00 50 DIALYSIS SERVICES5020656 HARVST ALLOGENC STEM CELL $3,076.00 $1,927.00 50 DIALYSIS SERVICES

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5020649 HARVST AUTO STEM CELL $2,871.00 $1,798.00 50 DIALYSIS SERVICES5020433 HEPARIN 1000U IJ $6.24 50 DIALYSIS SERVICES5020615 INJ IVP ADDL SEQ NEW DRG $148.00 50 DIALYSIS SERVICES5020623 INJ IVP SAME DRG EA >30M $98.33 50 DIALYSIS SERVICES5020607 INJ IVP SNGL/INIT DRG $146.00 50 DIALYSIS SERVICES5020466 INJECTION IM/SQ EA $207.00 50 DIALYSIS SERVICES5020565 LEVEL 1 EST PATIENT $540.00 50 DIALYSIS SERVICES5020474 LEVEL 1 EST PATIENT $540.00 50 DIALYSIS SERVICES5020599 LEVEL 1 NEW PATIENT $540.00 50 DIALYSIS SERVICES5020581 LEVEL 2 EST PATIENT $600.00 50 DIALYSIS SERVICES5020573 LEVEL 2 NEW PATIENT $600.00 50 DIALYSIS SERVICES5020508 MAGNESIUM SO4 500MG IJ $30.90 50 DIALYSIS SERVICES5020417 NA CL 0.9% 1000CC $3.96 50 DIALYSIS SERVICES5020425 NA CL 0.9% 250CC $3.51 50 DIALYSIS SERVICES5020342 S STRL BIOPATCH 1" $27.37 50 DIALYSIS SERVICES5020524 S STRL BLOOD SET Y-TYPE $10.68 50 DIALYSIS SERVICES5020359 S STRL BLOOD WARMING TBNG $55.09 50 DIALYSIS SERVICES5020490 S STRL CATH FISTULA NEEDL $2.99 50 DIALYSIS SERVICES5020334 S STRL CATH INSYTE $11.62 50 DIALYSIS SERVICES5020367 S STRL KIT AUTO PBSC $1,045.00 50 DIALYSIS SERVICES5020409 S STRL KIT EXTND LIFE PLT $892.50 50 DIALYSIS SERVICES5020391 S STRL KIT RBC EXCH SET $1,045.00 50 DIALYSIS SERVICES5020698 S STRL KIT RBC EXCH SET $1,045.00 50 DIALYSIS SERVICES5020706 S STRL KIT RBC EXCH SET $892.50 50 DIALYSIS SERVICES5020375 S STRL KIT THRPTC PLSM EX $997.50 50 DIALYSIS SERVICES5020672 S STRL KIT THRPTC PLSM EX $997.50 50 DIALYSIS SERVICES5020631 S STRL KIT WBC - FC $1,068.75 50 DIALYSIS SERVICES5020383 S STRL KIT WBC/ PERIPH ST $1,026.00 50 DIALYSIS SERVICES5020680 S STRL KIT WBC/ PERIPH ST 50 DIALYSIS SERVICES5020201 S STRL PALL BLOOD FTR $35.65 $35.65 50 DIALYSIS SERVICES5020532 VENIPUNCTURE $21.00 50 DIALYSIS SERVICES5040126 VX FLU SPLIT GT=3YRS IM $77.40 $105.00 50 DIALYSIS SERVICES5030127 VX FLU SPLIT GT=3YRS IM $77.40 50 DIALYSIS SERVICES5030655 VX HEP B ADULT IM $172.80 50 DIALYSIS SERVICES5040654 VX HEP B ADULT IM $172.80 50 DIALYSIS SERVICES3840238 AD EVAL ABR $1,289.00 $1,114.00 38 EEG3810231 AD EVAL ABR $1,163.00 38 EEG3810074 AD EVAL ABR $1,197.00 $1,114.00 38 EEG3840766 AD EVAL ABR $1,163.00 38 EEG3840733 AD EVAL ABR $1,163.00 $1,114.00 38 EEG3840246 AD EVAL ABR $1,163.00 $1,114.00 38 EEG3840550 AD EVAL ABR $1,163.00 $1,114.00 38 EEG3840618 AD EVAL ABR $1,163.00 $1,114.00 38 EEG

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3820156 CO2 MONITORING/ETCO2 $302.00 $261.00 38 EEG3820180 CPAP INITIAL DAY $773.00 38 EEG3820016 CPAP INITIAL DAY $597.00 $531.00 $279.00 38 EEG3820172 CPAP SUBSEQUENT DAY $169.00 38 EEG3874922 EEG ALL NIGHT RECORDING $1,013.00 38 EEG3810025 EEG AWAKE AND ASLEEP $1,565.00 $1,352.00 $506.00 38 EEG3810033 EEG AWAKE AND ASLEEP $1,565.00 $1,352.00 $542.00 38 EEG3810116 EEG AWAKE AND ASLEEP $1,505.00 $1,219.00 $542.00 38 EEG3810017 EEG AWAKE AND ASLEEP $1,565.00 $1,352.00 $96.00 38 EEG3830049 EEG AWAKE AND DROWSY $1,035.00 $991.00 38 EEG3874971 EEG AWAKE AND DROWSY $1,147.00 38 EEG3874930 EEG DIGITAL ANALYSIS $1,013.00 38 EEG3840295 EEG GT 1 HR $1,606.00 $1,387.00 38 EEG3840790 EEG INSERT SPHEN ELECTR $304.00 38 EEG3874997 EEG MONITOR AMB EA 24HR $1,149.00 38 EEG3874948 EEG MONITOR W/DRG/ACTIVTN $682.00 38 EEG3830031 EEG RCD/INTRP/24HR UNATT $3,567.00 $3,416.00 38 EEG3840675 EEG RCD/INTRP/24HR UNATT $3,567.00 $3,416.00 38 EEG3874963 EEG RCD/INTRP/24HR UNATT $3,955.00 38 EEG3810058 EEG SLEEP $1,969.00 $1,701.00 38 EEG3874989 EEG UP TO 1HR $434.00 38 EEG3830015 EEG W/VIDEO RCRD/24HR $6,883.00 $5,360.00 38 EEG3830064 ELCTRDE STIM BRAIN ADD HR $2,444.00 $2,111.00 38 EEG3840725 ELCTRDE STIM BRAIN ADD HR $2,444.00 $2,111.00 38 EEG3830130 ELCTRDE STIM BRAIN ADD HR $2,444.00 38 EEG3830106 ELCTRDE STIM BRAIN ADD HR $2,444.00 38 EEG3840691 ELECTROCORTICOGRAM SURG $1,039.00 $1,685.00 38 EEG3810355 ELECTROCORTICOGRAM SURG $1,039.00 38 EEG3810363 ELECTROCORTICOGRAM SURG $2,078.00 38 EEG3810371 ELECTROCORTICOGRAM SURG $3,117.00 38 EEG3840709 ELECTROCORTICOGRAM SURG $2,078.00 $1,685.00 38 EEG3874849 EMG ANAL/URETHRAL SPHNCTR $1,153.00 38 EEG3840840 EMG ANAL/URETHRAL SPHNCTR $445.00 38 EEG3875028 EMG ANAL/URETHRAL SPHNCTR $1,153.00 38 EEG3810306 EMG FOUR LIMBS $1,272.00 38 EEG3874831 EMG FOUR LIMBS $1,235.00 38 EEG3840832 EMG FOUR LIMBS $1,235.00 38 EEG3810330 EMG HEAD OR NECK BIL $2,408.00 38 EEG3810348 EMG HEAD OR NECK UNI $2,483.00 38 EEG3840865 EMG ONE FIBER $445.00 38 EEG3810272 EMG ONE LIMB $230.00 38 EEG3840808 EMG ONE LIMB $230.00 38 EEG3810298 EMG THREE LIMBS $790.00 38 EEG

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3840824 EMG THREE LIMBS $767.00 38 EEG3810280 EMG TWO LIMBS $1,240.00 38 EEG3840816 EMG TWO LIMBS $1,240.00 38 EEG3810256 H REFLX TEST GSTR/SOL UNI $132.00 38 EEG3840907 H REFLX TEST GSTR/SOL UNI $132.00 38 EEG3820255 LEVEL 1 EST PATIENT $147.00 38 EEG3820198 LEVEL 2 EST PATIENT $171.00 38 EEG3874880 MTR NRV CNDCT STDY W/F EA $113.00 38 EEG3875010 MTR NRV CNDCT STDY W/F EA $113.00 38 EEG3820073 MULT SLEEP LATENCY TEST $1,461.00 $1,261.00 $1,014.00 38 EEG3840915 NEURMSC JUNCTION TEST EA $371.00 38 EEG3874955 NEUROLOGICAL PROCEDURE $1,985.00 38 EEG3830072 NEUROLOGICAL PROCEDURE $1,985.00 $1,714.00 38 EEG3820040 NOCTURNAL PENILE TUMESCE $267.00 $252.00 $238.00 38 EEG3875002 NRV MOTOR CONDUCT STDY EA $111.00 38 EEG3840782 NRV MOTOR CONDUCT STDY EA $111.00 38 EEG3840873 NRV MOTOR CONDUCT STDY EA $111.00 38 EEG3874898 NRV SNSRY CONDUCT STDY EA $88.00 38 EEG3840485 NRV SNSRY CONDUCT STDY EA $88.00 $76.00 38 EEG3840899 NRV SNSRY CONDUCT STDY EA $88.00 38 EEG3810199 NRV TEST IOP EA HOUR $7,036.00 38 EEG3810173 NRV TEST IOP EA HOUR $4,221.00 38 EEG3810165 NRV TEST IOP EA HOUR $2,814.00 38 EEG3810157 NRV TEST IOP EA HOUR $1,407.00 38 EEG3810181 NRV TEST IOP EA HOUR $5,628.00 38 EEG3820263 OXYGEN $25.00 38 EEG3820057 PENILE PLETHYSMOGRAM $114.00 $108.00 $102.00 38 EEG3820024 POLYSOM GT 4 PARAM GT 6HR $2,280.00 $1,969.00 $1,766.00 38 EEG3820032 POLYSOM GT 4 PARAM GT 6HR $2,280.00 $1,969.00 $1,431.00 38 EEG3820115 POLYSOM GT 4 PARAM GT 6HR $2,280.00 38 EEG3820123 POLYSOM W/CPAP $2,865.00 38 EEG3820131 POLYSOM W/CPAP $2,865.00 38 EEG3810140 POLYSOM W/CPAP $2,865.00 38 EEG3820081 PULSE OX-OVERNIGHT CONT $193.00 $167.00 $215.00 38 EEG3820099 S NSTRL OXISENSOR PROBE D $71.00 $67.00 $63.25 38 EEG3810512 S STRL ELECT DEPTH (SD-8) $1,365.00 38 EEG3810504 S STRL ELECT EEG PLATINUM $49.00 38 EEG3810538 S STRL ELECT GRID (20/25) $3,134.00 38 EEG3810520 S STRL ELECT GRID (TW-16) $2,669.00 38 EEG3810546 S STRL ELECT GRID (TW-32) $3,731.00 38 EEG3810553 S STRL ELECT GRID (TW-64) $4,603.00 38 EEG3810561 S STRL ELECT STRIP (8/10) $2,924.00 38 EEG3810496 S STRL PASSING NDL $317.00 38 EEG

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3840089 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3840097 SEP LOWER LIMBS BIL $1,983.00 $1,713.00 38 EEG3810215 SEP LOWER LIMBS BIL $1,983.00 38 EEG3840261 SEP LOWER LIMBS BIL $1,970.00 $1,702.00 38 EEG3840105 SEP LOWER LIMBS BIL $1,970.00 $1,702.00 38 EEG3840477 SEP TRUNK/HEAD $1,868.00 $1,614.00 38 EEG3840469 SEP TRUNK/HEAD $1,868.00 $1,614.00 38 EEG3840162 SEP UPPER LIMBS BIL $1,970.00 $1,702.00 38 EEG3840170 SEP UPPER LIMBS BIL $1,970.00 $1,702.00 38 EEG3840279 SEP UPPER LIMBS BIL $1,970.00 $1,702.00 38 EEG3810207 SEP UPPER LIMBS BIL $1,970.00 38 EEG3820065 SLEEP STUDY ATTENDED $1,895.00 $1,637.00 $1,084.00 38 EEG3820149 SLEEP STUDY ATTENDED $1,895.00 $1,476.00 38 EEG3810132 SLEEP STUDY ATTENDED $1,895.00 $1,637.00 $657.00 38 EEG3820107 SLEEP STUDY UNATTENDED $1,058.00 38 EEG3840931 SLP STUDY UNATD FULL ANAL $750.00 38 EEG3840923 SLP STUDY UNATD LTD ANAL $225.00 38 EEG3840857 STIMULUS EVOKED RESPONSE $445.00 38 EEG3840212 VISUAL EVOKED POTENT TEST $1,266.00 $1,094.00 38 EEG3810066 VISUAL EVOKED POTENT TEST $1,266.00 $1,094.00 38 EEG3830023 WADA ACTIVATION TEST $3,057.00 $2,640.00 38 EEG5510938 ADMIN IMMUN EA ADD VACC $90.00 55 ER/URGENT CARE/TRAUMA5510920 ADMIN IMMUN SGL VACC $87.00 55 ER/URGENT CARE/TRAUMA5510755 AEROSOL TX SUBSQ $163.00 55 ER/URGENT CARE/TRAUMA5511001 ALCOHOL (ETHANOL) BREATH $145.00 55 ER/URGENT CARE/TRAUMA5511027 ARTERIAL PUNCTURE $127.00 55 ER/URGENT CARE/TRAUMA5510474 BLOOD TRANSFUSN 2-4 HR $1,889.00 55 ER/URGENT CARE/TRAUMA5510482 BLOOD TRANSFUSN 4-6 HR $2,970.00 55 ER/URGENT CARE/TRAUMA5510490 BLOOD TRANSFUSN GT 6HR $3,653.00 55 ER/URGENT CARE/TRAUMA5510664 BLOOD TRANSFUSN LT 2 HR $1,081.00 55 ER/URGENT CARE/TRAUMA5510045 CARDIOVERT ELECTIVE EXT $1,208.00 $1,202.00 55 ER/URGENT CARE/TRAUMA5542113 CATH INF PER CEN MID NOHD $118.79 55 ER/URGENT CARE/TRAUMA5542121 CATH INF PER CEN MID NOHD $190.00 55 ER/URGENT CARE/TRAUMA5542139 CATH INF PER CEN MID NOHD $41.97 55 ER/URGENT CARE/TRAUMA5510961 CATH SPECIMEN COLL SGL PT $103.00 55 ER/URGENT CARE/TRAUMA5511191 COLL BLD IMP VEN ACCS DEV $394.00 55 ER/URGENT CARE/TRAUMA5570221 COLL BLD PICC/CNTRL LN $264.00 55 ER/URGENT CARE/TRAUMA5510417 CPR $400.00 55 ER/URGENT CARE/TRAUMA5510904 CS DIFF MD ADD 15M $101.00 55 ER/URGENT CARE/TRAUMA5510896 CS DIFF MD GT5YR 0-30M $226.00 55 ER/URGENT CARE/TRAUMA5510888 CS DIFF MD LT5YR 0-30M $273.00 55 ER/URGENT CARE/TRAUMA5510870 CS SAME MD ADD 15M $91.00 55 ER/URGENT CARE/TRAUMA5510862 CS SAME MD GT5YR 0-30M $177.00 55 ER/URGENT CARE/TRAUMA

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5510854 CS SAME MD LT5YR 0-30M $189.00 55 ER/URGENT CARE/TRAUMA5510979 DRG SCRN MULTI PPE $95.00 55 ER/URGENT CARE/TRAUMA5510383 ED CC 1ST 30-74 MN $2,923.00 55 ER/URGENT CARE/TRAUMA5511167 ED CC 1ST 30-74 MN W/PROC $2,923.00 55 ER/URGENT CARE/TRAUMA5510391 ED CC EA ADD 30 MN $970.00 55 ER/URGENT CARE/TRAUMA5510334 ED LEVEL 1 $515.00 55 ER/URGENT CARE/TRAUMA5511118 ED LEVEL 1 W/PROC $515.00 55 ER/URGENT CARE/TRAUMA5510342 ED LEVEL 2 $794.00 55 ER/URGENT CARE/TRAUMA5511126 ED LEVEL 2 W/PROC $794.00 55 ER/URGENT CARE/TRAUMA5510359 ED LEVEL 3 $1,322.00 55 ER/URGENT CARE/TRAUMA5511134 ED LEVEL 3 W/PROC $1,322.00 55 ER/URGENT CARE/TRAUMA5510367 ED LEVEL 4 $2,025.00 55 ER/URGENT CARE/TRAUMA5511142 ED LEVEL 4 W/PROC $2,025.00 55 ER/URGENT CARE/TRAUMA5510375 ED LEVEL 5 $2,427.00 55 ER/URGENT CARE/TRAUMA5511159 ED LEVEL 5 W/PROC $2,427.00 55 ER/URGENT CARE/TRAUMA5510441 ED PROC MAJOR $1,143.00 55 ER/URGENT CARE/TRAUMA5510425 ED PROC MINOR $476.00 55 ER/URGENT CARE/TRAUMA5510268 EKG 12 LEAD TRACING ONLY $263.00 $262.00 55 ER/URGENT CARE/TRAUMA5510409 GLUCOSE FINGERSTICK $31.00 55 ER/URGENT CARE/TRAUMA5542097 GUIDEWIRE $103.79 55 ER/URGENT CARE/TRAUMA5510821 HYDRATN INFSN EA ADD HR $434.00 55 ER/URGENT CARE/TRAUMA5510813 HYDRATN INFSN INIT 31-60M $621.00 55 ER/URGENT CARE/TRAUMA5511175 HYDRATN INFSN INIT 31-60M $621.00 55 ER/URGENT CARE/TRAUMA5511068 INFLUENZA H1N1 VACC ADMIN $21.64 $21.64 55 ER/URGENT CARE/TRAUMA5510847 INFSN W/MED ADD SEQ 16-60 $425.00 55 ER/URGENT CARE/TRAUMA5511050 INFSN W/MED CONCURRENT $378.00 55 ER/URGENT CARE/TRAUMA5511043 INFSN W/MED EA ADD HR $357.00 55 ER/URGENT CARE/TRAUMA5510839 INFUSION W/MED 16-60MN $621.00 55 ER/URGENT CARE/TRAUMA5511209 INFUSION W/MED 16-60MN $577.00 55 ER/URGENT CARE/TRAUMA5570205 INJ IVP ADDL SEQ NEW DRG $188.00 55 ER/URGENT CARE/TRAUMA5511225 INJ IVP ADL SQ NEW DRG $175.00 55 ER/URGENT CARE/TRAUMA5570239 INJ IVP SAME DRG EA >30M $77.00 55 ER/URGENT CARE/TRAUMA5510615 INJ IVP SNGL/INIT DRG $218.00 55 ER/URGENT CARE/TRAUMA5511183 INJ IVP SNGL/INIT DRG $218.00 55 ER/URGENT CARE/TRAUMA5510607 INJECTION IM/SQ EA $274.00 55 ER/URGENT CARE/TRAUMA5542089 INTRO/SHEATH NON-LASER $46.69 55 ER/URGENT CARE/TRAUMA5542105 INTRO/SHEATH NON-LASER $163.82 55 ER/URGENT CARE/TRAUMA5541677 LIDO/EPI $119.00 55 ER/URGENT CARE/TRAUMA5541669 LIDOCAINE $119.00 55 ER/URGENT CARE/TRAUMA5541818 NA BICARB $136.00 55 ER/URGENT CARE/TRAUMA5541339 NA CL 0.9% 500ML $5.00 55 ER/URGENT CARE/TRAUMA5510672 OPHTHALMOLOGY EXAM $112.00 55 ER/URGENT CARE/TRAUMA5511035 PHLEBOTOMY THERAPEUTIC $648.00 55 ER/URGENT CARE/TRAUMA

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5510995 PREGNANCY SCRN UR $74.00 55 ER/URGENT CARE/TRAUMA5541537 S NSTRL BLANKET FULL BODY $45.00 55 ER/URGENT CARE/TRAUMA5541487 S NSTRL MASK AEROSOL, PED $4.00 55 ER/URGENT CARE/TRAUMA5541511 S NSTRL MASK NON-REBREATH $11.00 55 ER/URGENT CARE/TRAUMA5541495 S NSTRL MASK O2, ADLT $4.00 55 ER/URGENT CARE/TRAUMA5541503 S NSTRL MASK O2, PED $5.00 55 ER/URGENT CARE/TRAUMA5541651 S NSTRL METER, PEAK FLOW $57.00 55 ER/URGENT CARE/TRAUMA5541461 S NSTRL NASAL CAN, INF $18.00 55 ER/URGENT CARE/TRAUMA5541453 S NSTRL NASAL CAN, PED $11.00 55 ER/URGENT CARE/TRAUMA5541404 S NSTRL NASAL CANULA 7 FT $4.00 55 ER/URGENT CARE/TRAUMA5541529 S NSTRL NEB, HAND HELD $5.00 55 ER/URGENT CARE/TRAUMA5540570 S NSTRL PAD, PORTA $84.00 $80.00 55 ER/URGENT CARE/TRAUMA5541974 S NSTRL RESUSCIATION BAG $114.00 55 ER/URGENT CARE/TRAUMA5541743 S STRL ABD PARACENT TY $279.00 55 ER/URGENT CARE/TRAUMA5542014 S STRL BOUGIE TRACH TUBE $275.00 55 ER/URGENT CARE/TRAUMA5541313 S STRL CATH NASAL $184.00 55 ER/URGENT CARE/TRAUMA5541248 S STRL CATHETER COOK AIRW $165.00 55 ER/URGENT CARE/TRAUMA5540349 S STRL CAUTERY PENCIL $53.00 $50.00 55 ER/URGENT CARE/TRAUMA5541255 S STRL COMBITUBE $485.00 55 ER/URGENT CARE/TRAUMA5542154 S STRL COOK NEEDLE $23.43 55 ER/URGENT CARE/TRAUMA5541750 S STRL CRICO TY $843.00 55 ER/URGENT CARE/TRAUMA5541214 S STRL DERMABOND $134.00 55 ER/URGENT CARE/TRAUMA5541727 S STRL DISP CHEST TUBE TY $108.00 55 ER/URGENT CARE/TRAUMA5541735 S STRL DISP CUT DOWN TY $137.00 55 ER/URGENT CARE/TRAUMA5541768 S STRL DISP TRACH TY $659.00 55 ER/URGENT CARE/TRAUMA5541784 S STRL DISP VAG TY $80.00 55 ER/URGENT CARE/TRAUMA5541776 S STRL ER DEL TY $95.00 55 ER/URGENT CARE/TRAUMA5541966 S STRL FLUID WARMER TBING $75.00 55 ER/URGENT CARE/TRAUMA5541990 S STRL FOLEY TRAY WITH ME $72.00 55 ER/URGENT CARE/TRAUMA5540505 S STRL KIT GASTRIC LAVAGE $83.00 $78.00 55 ER/URGENT CARE/TRAUMA5541446 S STRL KIT HEART NEBULIZE $71.00 55 ER/URGENT CARE/TRAUMA5542022 S STRL LARYNGEAL MASK AIR $78.00 55 ER/URGENT CARE/TRAUMA5541396 S STRL MASK NON-REBREATH $10.00 55 ER/URGENT CARE/TRAUMA5542030 S STRL MICRO SUTURE SET $145.00 55 ER/URGENT CARE/TRAUMA5541263 S STRL MORGAN LENS $67.00 55 ER/URGENT CARE/TRAUMA5541289 S STRL NASAL DRESS $160.00 55 ER/URGENT CARE/TRAUMA5541792 S STRL NASAL SET $37.00 55 ER/URGENT CARE/TRAUMA5542048 S STRL NASAL/TONSIL BL TR $310.00 55 ER/URGENT CARE/TRAUMA5540596 S STRL NDL, SPINAL DISP. $8.00 $8.00 55 ER/URGENT CARE/TRAUMA5541438 S STRL PADS, PACING $172.00 55 ER/URGENT CARE/TRAUMA5542147 S STRL RADIAL CATH KIT $60.11 55 ER/URGENT CARE/TRAUMA5541941 S STRL SCV02 CENT LINE KI $1,361.00 55 ER/URGENT CARE/TRAUMA5541230 S STRL SET CRICO CATH $382.00 55 ER/URGENT CARE/TRAUMA

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5541222 S STRL SET RETRGRDE INTUB $239.00 55 ER/URGENT CARE/TRAUMA5541321 S STRL SPECULUM VAG $8.00 55 ER/URGENT CARE/TRAUMA5541610 S STRL STPLR, SKIN $7.00 55 ER/URGENT CARE/TRAUMA5541578 S STRL SUT, ETL FS NDL $13.00 55 ER/URGENT CARE/TRAUMA5541586 S STRL SUT, ETL-P NDL $25.00 55 ER/URGENT CARE/TRAUMA5541594 S STRL SUTURE, VICRYL $31.00 55 ER/URGENT CARE/TRAUMA5570213 S STRL TEMP SENSING FOLEY $133.42 55 ER/URGENT CARE/TRAUMA5541719 S STRL THORACOTOMY TY $239.00 55 ER/URGENT CARE/TRAUMA5542162 S STRL TRANVEN PACING ELE $541.87 55 ER/URGENT CARE/TRAUMA5541479 S STRL TY, LACERATION $42.00 55 ER/URGENT CARE/TRAUMA5542055 S STRL VASELINE GAUZE PKI $6.00 55 ER/URGENT CARE/TRAUMA5542006 S STRL WORD CATHETER $99.00 55 ER/URGENT CARE/TRAUMA5541693 S STRL WOUND IRR SET $8.00 55 ER/URGENT CARE/TRAUMA5541701 S STRL WOUND IRR SET $11.00 55 ER/URGENT CARE/TRAUMA5541628 S STRL XEROFORM DRESS $1.00 55 ER/URGENT CARE/TRAUMA5540463 SEMI-RIGID 2PC CERV CLR $88.00 $83.00 55 ER/URGENT CARE/TRAUMA5541800 SEMI-RIGID 2PC CERV CLR $101.00 55 ER/URGENT CARE/TRAUMA5541982 SURGICEL $72.00 55 ER/URGENT CARE/TRAUMA5510458 TEMP TRANSCUTANEOUS PACE $630.00 55 ER/URGENT CARE/TRAUMA5510680 THROMBOLYSIS CORO IV $2,536.00 55 ER/URGENT CARE/TRAUMA5510946 TUBERCULN SKIN TEST INTRA $78.00 55 ER/URGENT CARE/TRAUMA5510987 URNALYSIS MAN W/O MICRO $31.00 55 ER/URGENT CARE/TRAUMA5570270 VENI <3YR SCALP VEIN MD $161.00 55 ER/URGENT CARE/TRAUMA5570288 VENI <3YRS AGE MD SKILL $161.00 55 ER/URGENT CARE/TRAUMA5511019 VENIPUNCTURE $25.00 55 ER/URGENT CARE/TRAUMA5300561 CRANIAL TONGS/ST FRAME $304.00 53 GAMMA KNIFE NEUROSCIENCE5300504 NM RADIATION PHYSICS CNSL $1,522.00 53 GAMMA KNIFE NEUROSCIENCE5300405 RO DVCS CONSTRUCT CMPLX $1,513.00 53 GAMMA KNIFE NEUROSCIENCE5300520 RO DVCS CONSTRUCT CMPLX 2 $1,513.00 53 GAMMA KNIFE NEUROSCIENCE5300538 RO DVCS CONSTRUCT CMPLX 2 $1,513.00 53 GAMMA KNIFE NEUROSCIENCE5300546 RO DVCS CONSTRUCT CMPLX 2 $1,513.00 53 GAMMA KNIFE NEUROSCIENCE5300553 RO DVCS CONSTRUCT CMPLX 2 $1,513.00 53 GAMMA KNIFE NEUROSCIENCE5300496 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300470 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300488 RO SIMULATION 3D $10,881.00 53 GAMMA KNIFE NEUROSCIENCE5300512 RO SPECIAL TX PROCEDURE $1,920.00 53 GAMMA KNIFE NEUROSCIENCE5300462 RO SRS MLTSRC CO 60 CPLX $61,972.00 53 GAMMA KNIFE NEUROSCIENCE5300223 RO SRS MLTSRC CO 60 CPLX $58,910.00 53 GAMMA KNIFE NEUROSCIENCE5300454 RO SRS MLTSRC CO 60 INTM $54,076.00 53 GAMMA KNIFE NEUROSCIENCE5300215 RO SRS MLTSRC CO 60 INTM $51,404.00 53 GAMMA KNIFE NEUROSCIENCE5300447 RO SRS MLTSRC CO 60 STND $46,179.00 53 GAMMA KNIFE NEUROSCIENCE5300207 RO SRS MLTSRC CO 60 STND $43,897.00 53 GAMMA KNIFE NEUROSCIENCE1569797 FLUPHENAZINE $0.88 15 HEALTH & NUTRITION SVS

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470949 5% DEXTROSE/WATER 500 ML 94 IV THERAPY9431970 5% DEXTROSE/WATER 500 ML 94 IV THERAPY9489683 ABATACEPT 10MG IJ 94 IV THERAPY9490889 ACYCLOVIR 5 MG IJ 94 IV THERAPY9483686 ADALIMUMAB 20MG IJ 94 IV THERAPY9450875 ADMIN INFLUENZA VACC $82.00 94 IV THERAPY9450883 ADMIN PNEUMOCOCCAL VACC $37.00 94 IV THERAPY9489998 AGALSIDASE BETA 1 MG IJ 94 IV THERAPY9490582 AGALSIDASE BETA 1 MG IJ 94 IV THERAPY9483165 ALBUMIN 25%/50ML 94 IV THERAPY9461252 ALBUMIN 5%/250ML 94 IV THERAPY9489741 ALDESLEUKIN/SGL DOSE IJ 94 IV THERAPY9470543 ALEMTUZUMAB 10MG IV 94 IV THERAPY9483520 ALTEPLASE 1MG IJ 94 IV THERAPY9470592 AMIFOSTINE 500MG IJ 94 IV THERAPY9489782 AMIKACIN 100MG IJ 94 IV THERAPY9483173 AMPHO B LPD CMPLX 10MG IJ 94 IV THERAPY9480070 AMPICILLIN 500MG IJ 94 IV THERAPY9461245 AMPICILLIN/SULB 1.5GM IJ 94 IV THERAPY9431997 ANTI CITRATE DEXTROSE A 94 IV THERAPY9432386 ANTITHYMOCYT GLOBULN 25MG 94 IV THERAPY9491366 APAP/OXYCOD 94 IV THERAPY9470683 APREPITANT ORAL 5MG 94 IV THERAPY9491051 ARGININE 94 IV THERAPY9489592 ARSENIC TRIOXIDE 1MG IJ 94 IV THERAPY9489675 ASCORBIC ACID 500MG/ML 94 IV THERAPY9490103 ASPARAGINASE 10000U IJ 94 IV THERAPY9450404 ASPIRATION BONE MARROW $864.00 94 IV THERAPY9491275 ATROPINE SO4 0.01MG IJ 94 IV THERAPY9482241 AUROTHIOGLUCOSE 50MG IJ 94 IV THERAPY9491168 AZACITIDINE 1 MG IJ 94 IV THERAPY9470675 AZACITIDINE 1 MG IJ 94 IV THERAPY9483884 AZITHROMYCIN 500MG IJ 94 IV THERAPY9489840 AZTREONAM 500MG IJ 94 IV THERAPY9490970 BENDAMUSTINE HCL 1MG IJ 94 IV THERAPY9470691 BEVACIZUMAB PER 10MG IJ 94 IV THERAPY9470618 BEVACIZUMAB PER 10MG IJ 94 IV THERAPY9432022 BLADDER INSTILATION CHEMO $274.00 94 IV THERAPY9432352 BLEOMYCIN 15U IJ 94 IV THERAPY9470022 BLEOMYCIN 15U IJ 94 IV THERAPY9432071 BLEOMYCIN 15U IJ 94 IV THERAPY9431972 BLEOMYCIN 15U IJ 94 IV THERAPY9470725 BLEOMYCIN 15U IJ 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9450024 BLOOD TRANSFUSN 2-4 HR $1,427.00 94 IV THERAPY9450511 BLOOD TRANSFUSN 4-6 HR $2,244.00 94 IV THERAPY9450032 BLOOD TRANSFUSN GT 6HR $2,760.00 94 IV THERAPY9450016 BLOOD TRANSFUSN LT 2 HR $817.00 94 IV THERAPY9470634 BORTEZOMIB PER 0.1MG IJ 94 IV THERAPY9483488 BUMETANIDE 0.5MG IJ 94 IV THERAPY9450412 BX BM NDL/TROCAR $565.00 94 IV THERAPY9483322 CA GLUCONATE 10ML IJ 94 IV THERAPY9432477 CABAZITAXEL 1MG IJ 94 IV THERAPY9460270 CAPTOPRIL 25MG TAB 94 IV THERAPY9470048 CARBOPLATIN 50MG IJ 94 IV THERAPY9431975 CARBOPLATIN 50MG IJ 94 IV THERAPY9431973 CARBOPLATIN 50MG IJ 94 IV THERAPY9470011 CARMUSTINE 100MG IJ 94 IV THERAPY9483132 CASPOFUNGIN/5MG IJ 94 IV THERAPY9480203 CEFAZOLIN 500MG IJ 94 IV THERAPY9483496 CEFEPIME HCL 500MG IJ 94 IV THERAPY9480252 CEFOTAXIME 1GM IJ 94 IV THERAPY9480260 CEFOTETAN 500MG IJ 94 IV THERAPY9480278 CEFTAZIDIME 500MG IJ 94 IV THERAPY9480286 CEFTIZOXIME NA 500MG IJ 94 IV THERAPY9480294 CEFTRIAXONE 250MG IJ 94 IV THERAPY9480302 CEFUROXIME NA 750MG IJ 94 IV THERAPY9491267 CERTOLIZUMAB PEGOL 1MG IJ 94 IV THERAPY9451006 CETIRIZINE 94 IV THERAPY9470584 CETUXIMAB PER 10MG IJ 94 IV THERAPY9490798 CETUXIMAB PER 10MG IJ 94 IV THERAPY9450842 CHEM ADDL SEQ INF 0-60MN $805.00 94 IV THERAPY9450800 CHEM HORMON ANTINEO SQ/IM $315.00 94 IV THERAPY9450826 CHEM IVP EA ADDL DRG $738.00 94 IV THERAPY9450818 CHEM IVP SNGL/INIT DRG $786.00 94 IV THERAPY9450792 CHEM NO-HORM ANTNEO SQ/IM $315.00 94 IV THERAPY9450594 CHEMO CNS W/SPINAL PUNC $826.00 94 IV THERAPY9450602 CHEMO INJ BRAIN/HEART SQ $1,346.00 94 IV THERAPY9450628 CHEMO IV PMP INFSN GT 8HR $1,630.00 94 IV THERAPY9450578 CHEMO PLURAL CAV W/THOR $2,292.00 94 IV THERAPY9450586 CHEMOTX ADMN PRTL CAVITY $2,333.00 94 IV THERAPY9483454 CHLOROTHIAZIDE 500MG IJ 94 IV THERAPY9490400 CIDOFOVIR 375 MG IJ 94 IV THERAPY9480336 CIMETIDINE 300MG IJ 94 IV THERAPY9490038 CIMETIDINE ORAL TABLET 94 IV THERAPY9480328 CIPROFLOXACIN 200MG IJ 94 IV THERAPY9470063 CISPLATIN 10MG IJ 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9432048 CISPLATIN 10MG IJ 94 IV THERAPY9431977 CISPLATIN 10MG IJ 94 IV THERAPY9431976 CISPLATIN 10MG IJ 94 IV THERAPY9483801 CITRIC ACID 94 IV THERAPY9470733 CLADRIBINE/1MG IJ 94 IV THERAPY9480351 CLINDAMYCIN 300MG IJ 94 IV THERAPY9470766 CLOFARABINE 1MG IJ 94 IV THERAPY9489915 COLL BLD PICC/CNTRL LN $264.00 94 IV THERAPY9450396 COLLECT BLD VNS ACCES DVC $298.00 94 IV THERAPY9483835 CORTICORELN OVINE 1MCG IJ 94 IV THERAPY9491317 CORTROSYN 0.25MG IJ 94 IV THERAPY9480435 CYANOCOBALAMIN 1000MCG IJ 94 IV THERAPY9491002 CYCLOPHOSPHAMID 100MG IJ 94 IV THERAPY9470089 CYCLOPHOSPHAMID 100MG IJ 94 IV THERAPY9490467 CYCLOSPORINE 250MG IJ 94 IV THERAPY9491143 CYCLOSPORINE 25MG PO 94 IV THERAPY9470873 CYTARABINE 100MG IJ 94 IV THERAPY9490475 CYTARABINE LIPO 10MG IJ 94 IV THERAPY9410341 D10W 1000ML 94 IV THERAPY9470010 D10W 500ML 94 IV THERAPY9470940 D50W 50 ML 94 IV THERAPY9410101 D51/2NS 1000ML 94 IV THERAPY9489824 D51/2NS 500ML 94 IV THERAPY9490251 D51/4NS 1000ML 94 IV THERAPY9410184 D5LR 1000ML 94 IV THERAPY9410150 D5NS 1000ML 94 IV THERAPY9470013 D5NS 500ML 94 IV THERAPY9410028 D-5-W 1000 CC 94 IV THERAPY9470931 D5W 100ML 94 IV THERAPY9410069 D5W 250ML 94 IV THERAPY9431971 D5W 250ML 94 IV THERAPY9470923 D5W 50ML 94 IV THERAPY9470568 DACARBAZINE 100MG IJ 94 IV THERAPY9482548 DACLIZUMAB 25MG IJ 94 IV THERAPY9483421 DAPTOMYCIN 1MG IJ 94 IV THERAPY9490624 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9483082 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9490608 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9490632 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9483074 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9490616 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9491192 DARBEPOETIN 1MCG NON-ESRD 94 IV THERAPY9470170 DAUNORUBICIN 10MG IJ 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9491184 DECITABINE 1MG IJ 94 IV THERAPY9470899 DECITABINE 1MG IJ 94 IV THERAPY9550369 DECLOT VASC DEVICE $212.00 $162.00 95 IV THERAPY9450446 DECLOT VASC DEVICE $413.00 94 IV THERAPY9480468 DEFEROXAMINE 500MG IJ 94 IV THERAPY9432436 DEGARELIX 1MG IJ 94 IV THERAPY9432428 DEGARELIX 1MG IJ 94 IV THERAPY9432345 DENILEUKIN 300MCG IJ 94 IV THERAPY9432527 DENOSUMAB 1MG IJ 94 IV THERAPY9432329 DENOSUMAB 1MG IJ 94 IV THERAPY9480500 DESMOPRESSIN ACET 1MCG IJ 94 IV THERAPY9470012 DEXAMETHASONE 0.25MG PO 94 IV THERAPY9480518 DEXAMETHASONE PHOS 1MG IJ 94 IV THERAPY9470758 DEXRAZOXANE/250MG IJ 94 IV THERAPY9460247 DIAZEPAM 5MG IJ 94 IV THERAPY9480534 DIHYDROERGOTAMINE 1MG IJ 94 IV THERAPY9480559 DIPHENHYDRAMINE 50MG IJ 94 IV THERAPY9432758 DIPHENHYDRAMINE 50MG PO 94 IV THERAPY9483918 DMSO 50% INJ 94 IV THERAPY9490368 DOBUTAMINE 250MG IJ 94 IV THERAPY9432378 DOCETAXEL 1MG IJ 94 IV THERAPY9491135 DOCETAXEL 1MG IJ 94 IV THERAPY9491127 DOCETAXEL 1MG IJ 94 IV THERAPY9432008 DOCETAXEL 1MG IJ 94 IV THERAPY9483892 DOLASETRON MESYLT 10MG IJ 94 IV THERAPY9483470 DOPAMINE HCL 40 MG IJ 94 IV THERAPY9432212 DOXORUBICIN 10MG IJ 94 IV THERAPY9432238 DOXORUBICIN 10MG IJ 94 IV THERAPY9432220 DOXORUBICIN 10MG IJ 94 IV THERAPY9470196 DOXORUBICIN 10MG IJ 94 IV THERAPY9470717 DOXORUBICIN 10MG IJ 94 IV THERAPY9470204 DOXORUBICIN LIPID 10MG IJ 94 IV THERAPY9470205 DOXORUBICIN LIPID 10MG IJ 94 IV THERAPY9480575 DOXYCYCLINE HYCLATE 100MG 94 IV THERAPY9480583 DROPERIDOL 5MG IJ 94 IV THERAPY9432139 ENOXAPARIN 10MG IJ 94 IV THERAPY9432121 ENOXAPARIN 10MG IJ 94 IV THERAPY9482951 ENOXAPARIN 10MG IJ 94 IV THERAPY9432170 ENOXAPARIN 10MG IJ 94 IV THERAPY9432147 ENOXAPARIN 10MG IJ 94 IV THERAPY9432162 ENOXAPARIN 10MG IJ 94 IV THERAPY9432154 ENOXAPARIN 10MG IJ 94 IV THERAPY9431909 EP STEER GUID INTRO/SHTH $95.50 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9432493 EPINEPHRINE ADRL 0.1MG IJ 94 IV THERAPY9470808 EPIRUBICIN 2MG IJ 94 IV THERAPY9432055 EPIRUBICIN 2MG IJ 94 IV THERAPY9431996 EPIRUBICIN 2MG IJ 94 IV THERAPY9490673 EPOETIN NON-ESRD/1000U IJ 94 IV THERAPY9490665 EPOETIN NON-ESRD/1000U IJ 94 IV THERAPY9490657 EPOETIN NON-ESRD/1000U IJ 94 IV THERAPY9483348 ERTAPENEM 500MG IJ 94 IV THERAPY9491259 ERTAPENEM 500MG IJ 94 IV THERAPY9483603 ETANERCEPT 25MG IJ 94 IV THERAPY9491242 ETOPOSIDE 10MG IJ 94 IV THERAPY9491234 ETOPOSIDE 10MG IJ 94 IV THERAPY9432410 ETOPOSIDE 10MG IJ 94 IV THERAPY9491036 ETOPOSIDE 10MG IJ 94 IV THERAPY9432760 ETOPOSIDE 10MG IJ 94 IV THERAPY9432287 FACTOR 8 RECM/IU IJ 94 IV THERAPY9490418 FACTOR 8 RECM/IU IJ 94 IV THERAPY9483959 FAMOTIDINE 94 IV THERAPY9480898 FAMOTIDINE 20MG IJ 94 IV THERAPY9483355 FE GLUCONATE 12.5MG IJ 94 IV THERAPY9483025 FERRIC GLUC 62.5MG 94 IV THERAPY9431982 FERUMXYTL 1MG IJ NON-ESRD 94 IV THERAPY9481839 FILGRASTIM 300MCG IJ 94 IV THERAPY9481821 FILGRASTIM 480MCG IJ 94 IV THERAPY9490376 FLUCONAZOLE 200MG IJ 94 IV THERAPY9491218 FLUDARABINE 50MG IJ 94 IV THERAPY9432246 FLUDARABINE 50MG IJ 94 IV THERAPY9491226 FLUDARABINE 50MG IJ 94 IV THERAPY9490913 FLUDARABINE 50MG IJ 94 IV THERAPY9470246 FLUOROURACIL 500MG IJ 94 IV THERAPY9432089 FLUOROURACIL 500MG IJ 94 IV THERAPY9432097 FLUOROURACIL 500MG IJ 94 IV THERAPY9490822 FOLIC ACID 94 IV THERAPY9490004 FONDAPARINUX 0.5MG IJ 94 IV THERAPY9432519 FOSAPREPITANT 1MG IJ 94 IV THERAPY9490079 FOSAPREPITANT 1MG IJ 94 IV THERAPY9490293 FOSCARNET SOD 1000 MG IJ 94 IV THERAPY9470667 FULVESTRANT 25MG IJ 94 IV THERAPY9480971 FUROSEMIDE 20MG IJ 94 IV THERAPY9480963 FUROSEMIDE 20MG TAB 94 IV THERAPY9490053 GAMMA GLOBULIN IM IJ 1 CC 94 IV THERAPY9490277 GANCICLOVIR SOD 500 MG IJ 94 IV THERAPY9490681 GEMCITABINE 200MG IJ 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470253 GEMCITABINE 200MG IJ 94 IV THERAPY9432451 GEMCITABINE 200MG IJ 94 IV THERAPY9481102 GENTAMICIN 80MG IJ 94 IV THERAPY9491044 GLUCAGON HCL 1MG IJ 94 IV THERAPY9483223 GOLD NA THIOMAL 50MG IJ 94 IV THERAPY9483264 GOSERELIN/3.6MG IMPLNT 94 IV THERAPY9490947 GOSERELIN/3.6MG IMPLNT 94 IV THERAPY9432303 GRANISETRON 100MCG IJ 94 IV THERAPY9460064 GRANISETRON 1MG PO 94 IV THERAPY9431883 GUIDEWIRE $293.25 94 IV THERAPY9431875 GUIDEWIRE $199.50 94 IV THERAPY9490020 H PAPILLOMA VX 3 DOSE IM 94 IV THERAPY9490228 HALOPERIDOL 5MG IJ 94 IV THERAPY9460288 HCTZ 25MG PO 94 IV THERAPY9483694 HEMIN/1MG IJ 94 IV THERAPY9481144 HEP B IG HUMAN IM 94 IV THERAPY9480377 HEP LOCK FLUSH 10U IJ 94 IV THERAPY9432261 HEPAGAM B 0.5ML IV IJ 94 IV THERAPY9480369 HEPARIN 1000U IJ 94 IV THERAPY9483942 HETASTARCH 500ML 94 IV THERAPY9489758 HYALGAN PER DOSE IA 94 IV THERAPY9490855 HYALURONIDASE 150U IJ 94 IV THERAPY9432279 HYDRALAZINE 20MG IJ 94 IV THERAPY9450750 HYDRATN INFSN EA ADD HR $307.00 94 IV THERAPY9450743 HYDRATN INFSN INIT 31-60M $349.00 94 IV THERAPY9432402 HYDROCOD/APAP 94 IV THERAPY9460072 HYDROCODONE 5MG PO 94 IV THERAPY9481276 HYDROCORT NA SUC 100MG IJ 94 IV THERAPY9431995 HYDROMORPHONE 94 IV THERAPY9431994 HYDROMORPHONE 94 IV THERAPY9483975 HYDROMORPHONE 4MG IJ 94 IV THERAPY9451014 HYDROXYUREA 500MG PO 94 IV THERAPY9490426 HYDROXYZINE HCL 25MG IJ 94 IV THERAPY9483983 IBANDRONATE 1MG IJ 94 IV THERAPY9470001 IBUPROFEN 94 IV THERAPY9490483 IDARUBICIN/5MG IJ 94 IV THERAPY9460320 IFOSFAMIDE/1GM IJ 94 IV THERAPY9483181 IG CYTOMEGALOVIRUS VIAL 94 IV THERAPY9490095 IG RABIES IM/SUBCU 94 IV THERAPY9432485 IMIGLUCERASE 10UNITS IJ 94 IV THERAPY9481292 IMIPENEM/CILAST 250MG IJ 94 IV THERAPY9431979 IMM GLOB/VIVAGLB 100MG IJ 94 IV THERAPY9490129 IMM GLOB/VIVAGLB 100MG IJ 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9431978 IMM GLOB/VIVAGLB 100MG IJ 94 IV THERAPY9450693 IMMUN ADMIN EA ADD VACCNE $83.00 94 IV THERAPY9450685 IMMUN ADMIN SGL VACCNE $154.00 94 IV THERAPY9450123 INF CHEM IA EA ADDL HR $605.00 94 IV THERAPY9450115 INF CHEM INTRA ART PROLNG $1,106.00 94 IV THERAPY9450131 INF CHMO INTRA ART 16-60M $1,212.00 94 IV THERAPY9482118 INFLIXIMAB 10MG IJ 94 IV THERAPY9490954 INFLUENZA H1N1 VACC ADMIN $21.64 $21.64 94 IV THERAPY9450784 INFSN W/MED ADD SEQ 16-60 $308.00 94 IV THERAPY9450909 INFSN W/MED CONCURRENT $469.00 94 IV THERAPY9450776 INFSN W/MED EA ADD HR $303.00 94 IV THERAPY9450768 INFUSION W/MED 16-60MN $338.00 94 IV THERAPY9450073 INFUSN CHEMO 0-60 MN $893.00 94 IV THERAPY9550427 INFUSN CHEMO 0-60 MN $293.00 $224.00 95 IV THERAPY9450503 INFUSN CHEMO EA ADD HR $775.00 94 IV THERAPY9450834 INJ IVP ADDL SEQ NEW DRG $148.00 94 IV THERAPY9489956 INJ IVP SAME DRG EA >30M $98.33 94 IV THERAPY9450453 INJ IVP SNGL/INIT DRG $165.00 94 IV THERAPY9459744 INJ MAJOR JNT BURSA $191.00 94 IV THERAPY9450198 INJECTION IM/SQ EA $183.00 94 IV THERAPY9550260 INS PICC W/O PORT 5+ YR $478.00 $478.00 95 IV THERAPY9450636 INS PICC W/O PORT 5+ YR $1,037.00 94 IV THERAPY9550336 INS PICC W/O PORT 5+ YR $730.00 $559.00 95 IV THERAPY9450735 INSRT NON-TUNN CV CATH 5+ $1,186.00 94 IV THERAPY9450651 INSRT NON-TUNN CV CATH<5 $1,213.00 94 IV THERAPY9470907 INSULIN 5 UNITS IJ 94 IV THERAPY9483553 INTERFERON A-2B 1000KU IJ 94 IV THERAPY9483439 INTERFERON B-1A 11MCG IM 94 IV THERAPY9481425 INTERFERON B-1B 0.25MG IJ 94 IV THERAPY9490865 IRINOTECAN 20MG IJ 94 IV THERAPY9431974 IRINOTECAN 20MG IJ 94 IV THERAPY9470030 IRINOTECAN 20MG IJ 94 IV THERAPY9490864 IRINOTECAN 20MG IJ 94 IV THERAPY9490863 IRINOTECAN 20MG IJ 94 IV THERAPY9481441 IRON DEXTRAN 50 MG IJ 94 IV THERAPY9483140 IRON SUCROSE 1MG IJ 94 IV THERAPY9450859 IRRIG IMPLNTD VNS ACC DVC $294.00 94 IV THERAPY9483827 ITRACONAZOLE 50 MG IJ 94 IV THERAPY9490574 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9490558 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9490012 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9431991 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9431992 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY

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SEQ 300 AMOUNT

DEPARTMENT CODE

9490764 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9490566 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9431993 IVIG FLEBOGAMMA 500MG IJ 94 IV THERAPY9491085 IVIG GAMMAGARD L 500MG IJ 94 IV THERAPY9490517 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9490186 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9490525 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9490533 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9431985 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9431986 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9431988 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9490541 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9431987 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9431984 IVIG GAMUNEX 500MG IJ 94 IV THERAPY9483850 IVIG LYOPHILIZD 500MG NOS 94 IV THERAPY9483843 IVIG LYOPHILIZD 500MG NOS 94 IV THERAPY9432535 IVIG LYOPHILIZD 500MG NOS 94 IV THERAPY9491283 IVIG OCTOGAM 500MG IJ 94 IV THERAPY9490509 IVIG PRIVIGEN 500 MG IJ 94 IV THERAPY9490491 IVIG PRIVIGEN 500 MG IJ 94 IV THERAPY9490087 IVIG PRIVIGEN 500 MG IJ 94 IV THERAPY9490756 IXABEPILONE 1MG IJ 94 IV THERAPY9470018 K ACET 94 IV THERAPY9490350 K CL/2MEQ INJ 94 IV THERAPY9490327 K PHOS 94 IV THERAPY9489816 KETOROLAC 15MG IJ 94 IV THERAPY9410218 LACTATE RINGERS TO 1000CC 94 IV THERAPY9490939 LEUCOVORIN/50MG IJ 94 IV THERAPY9432204 LEUCOVORIN/50MG IJ 94 IV THERAPY9481476 LEUCOVORIN/50MG IJ 94 IV THERAPY9481474 LEUCOVORIN/50MG IJ 94 IV THERAPY9432188 LEUCOVORIN/50MG IJ 94 IV THERAPY9432196 LEUCOVORIN/50MG IJ 94 IV THERAPY9491077 LEUCOVORIN/50MG IJ 94 IV THERAPY9490897 LEUPROLIDE 7.5MG IJ 94 IV THERAPY9483207 LEUPROLIDE 7.5MG IJ 94 IV THERAPY9432725 LEUPROLIDE 7.5MG IJ 94 IV THERAPY9470002 LEUPROLIDE PER 1 MG 94 IV THERAPY9470956 LEUPROLIDE/3.75MG IJ 94 IV THERAPY9450164 LEVEL 1 EST PATIENT $496.00 94 IV THERAPY9540204 LEVEL 1 EST PATIENT $147.00 95 IV THERAPY9450529 LEVEL 1 NEW PATIENT $610.00 94 IV THERAPY9540154 LEVEL 1 NEW PATIENT $147.00 95 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9450461 LEVEL 2 EST PATIENT $678.00 94 IV THERAPY9540212 LEVEL 2 EST PATIENT $171.00 95 IV THERAPY9450537 LEVEL 2 NEW PATIENT $678.00 94 IV THERAPY9540162 LEVEL 2 NEW PATIENT $171.00 95 IV THERAPY9450479 LEVEL 3 EST PATIENT $746.00 94 IV THERAPY9540220 LEVEL 3 EST PATIENT $195.00 95 IV THERAPY9450545 LEVEL 3 NEW PATIENT $746.00 94 IV THERAPY9540170 LEVEL 3 NEW PATIENT $195.00 95 IV THERAPY9450487 LEVEL 4 EST PATIENT $814.00 94 IV THERAPY9540238 LEVEL 4 EST PATIENT $324.00 95 IV THERAPY9540188 LEVEL 4 NEW PATIENT $324.00 95 IV THERAPY9450552 LEVEL 4 NEW PATIENT $720.00 94 IV THERAPY9540246 LEVEL 5 EST PATIENT $348.00 95 IV THERAPY9450495 LEVEL 5 EST PATIENT $882.00 94 IV THERAPY9540196 LEVEL 5 NEW PATIENT $348.00 95 IV THERAPY9450560 LEVEL 5 NEW PATIENT $781.00 94 IV THERAPY9490384 LEVOFLOXACIN 250MG IJ 94 IV THERAPY9432709 LEVOFLOXACIN 250MG IJ 94 IV THERAPY9432717 LEVOFLOXACIN 250MG IJ 94 IV THERAPY9481524 LEVOTHYROXINE 94 IV THERAPY9480393 LIDOCAINE 94 IV THERAPY9489865 LINEZOLID/200MG IJ 94 IV THERAPY9470015 LOPERAMIDE 94 IV THERAPY9470016 LORATADINE 94 IV THERAPY9481558 LORAZEPAM 94 IV THERAPY9481557 LORAZEPAM 2MG IJ 94 IV THERAPY9450420 LUMBAR PUNCTURE DX $631.00 94 IV THERAPY9432733 LYMPHOCYTE INFUSE TRANSPL $5,669.00 94 IV THERAPY9482845 MAG SO4 500MG INJ 94 IV THERAPY9490137 MAGNESIUM SO4 500MG IJ 94 IV THERAPY9490236 MAGNESIUM SO4 500MG IJ 94 IV THERAPY9470003 MANNITOL 94 IV THERAPY9489964 MANNITOL 25% 50ML IJ 94 IV THERAPY9489766 MEDROXYPROGESTER 50MG IJ 94 IV THERAPY9470005 MEPERIDINE 94 IV THERAPY9470017 MEPERIDINE 100MG IJ 94 IV THERAPY9481565 MEPERIDINE HCL /100MG 94 IV THERAPY9483512 MEROPENEM 100 MG IJ 94 IV THERAPY9470857 MESNA 200MG IJ 94 IV THERAPY9491291 METHOTREXATE 50MG IJ 94 IV THERAPY9432691 METHOTREXATE 50MG IJ 94 IV THERAPY9489626 METHOTREXATE 5MG IJ 94 IV THERAPY9432295 METHYLNLTRXN 12MG/.6ML IJ 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9481649 METHYLPRED ACET 40MG IJ 94 IV THERAPY9481623 METHYLPRED ACET 80MG IJ 94 IV THERAPY9410382 METHYLPRED SUCC 125MG IJ 94 IV THERAPY9410390 METHYLPRED SUCC 40MG IJ 94 IV THERAPY9481672 METOCLOPRAMIDE 10MG IJ 94 IV THERAPY9490392 METRONIDAZOLE 500MG IJ 94 IV THERAPY9482035 MIDAZOLAM 1MG IJ 94 IV THERAPY9483231 MILRINONE/5MG IJ 94 IV THERAPY9491150 MISC INJECTION 94 IV THERAPY9490871 MISC ORAL LIQUID 94 IV THERAPY9460304 MISC ORAL SOLID 94 IV THERAPY9490442 MISC TOPICAL/RECTAL 94 IV THERAPY9470394 MITOMYCIN 5MG IJ 94 IV THERAPY9470402 MITOXANTRONE/5MG IJ 94 IV THERAPY9470004 MORPHINE 94 IV THERAPY9489907 MORPHINE 10MG IJ 94 IV THERAPY9490772 MOXIFLOXACIN 100 MG IJ 94 IV THERAPY9483900 MVI-12 94 IV THERAPY9483744 NA BICARBONATE 94 IV THERAPY9490301 NA BIPHOSPHATE 94 IV THERAPY9490210 NA CL 0.45% 1000ML 94 IV THERAPY9432618 NA CL 0.45% 500ML 94 IV THERAPY9432600 NA CL 0.45% 50ML 94 IV THERAPY9410333 NA CL 0.9% 1000CC 94 IV THERAPY9432675 NA CL 0.9% 1000CC 94 IV THERAPY9490459 NA CL 0.9% 100ML 94 IV THERAPY9432667 NA CL 0.9% 100ML 94 IV THERAPY9432659 NA CL 0.9% 100ML 94 IV THERAPY9432642 NA CL 0.9% 100ML 94 IV THERAPY9432501 NA CL 0.9% 150ML 94 IV THERAPY9410283 NA CL 0.9% 250CC 94 IV THERAPY9432634 NA CL 0.9% 250CC 94 IV THERAPY9432626 NA CL 0.9% 250CC 94 IV THERAPY9410291 NA CL 0.9% 500ML 94 IV THERAPY9432683 NA CL 0.9% 500ML 94 IV THERAPY9489808 NA CL 0.9% 50ML 94 IV THERAPY9432766 NA CL 3% 500ML 94 IV THERAPY9483710 NA THIOSULFATE 94 IV THERAPY9490061 NAFCILLIN 2GM IJ 94 IV THERAPY9490434 NALBUPHINE 10MG IJ 94 IV THERAPY9432543 NALOXONE 1MG IJ 94 IV THERAPY9489725 NATALIZUMAB 1MG INJ 94 IV THERAPY9470816 NM ADM/SUPPLY BEXXAR450MG $2,575.00 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9410226 NORMOSOL R 1000ML 94 IV THERAPY9432550 NTG 94 IV THERAPY9483728 NTG 94 IV THERAPY9490814 OCTREOTIDE DEPO 1MG IJ 94 IV THERAPY9490806 OCTREOTIDE DEPO 1MG IJ 94 IV THERAPY9483397 OCTREOTIDE DEPO 1MG IJ 94 IV THERAPY9483405 OCTREOTIDE NON DEPO 25MCG 94 IV THERAPY9432007 OLANZAPINE 94 IV THERAPY9489774 OMALIZUMAB PER 5MG IJ 94 IV THERAPY9431980 ONDANSETRON 4MG PO 94 IV THERAPY9481870 ONDANSETRON 8MG PO 94 IV THERAPY9481888 ONDANSETRON/1MG IJ 94 IV THERAPY9432584 ONDANSETRON/1MG IJ 94 IV THERAPY9432576 ONDANSETRON/1MG IJ 94 IV THERAPY9432592 ONDANSETRON/1MG IJ 94 IV THERAPY9432568 ONDANSETRON/1MG IJ 94 IV THERAPY9490780 OPRELVEKIN 5MG IJ 94 IV THERAPY9540030 OST SKNBAR NO CNV 4SQI $9.23 95 IV THERAPY9540048 OST SKNBAR NO CNV 4SQI $9.23 95 IV THERAPY9470824 OXALIPLATIN 0.5MG IJ 94 IV THERAPY9490731 OXALIPLATIN 0.5MG IJ 94 IV THERAPY9491119 OXALIPLATIN 0.5MG IJ 94 IV THERAPY9490996 OXALIPLATIN 0.5MG IJ 94 IV THERAPY9490988 OXALIPLATIN 0.5MG IJ 94 IV THERAPY9432105 PACLITAXEL 30MG IJ 94 IV THERAPY9432113 PACLITAXEL 30MG IJ 94 IV THERAPY9470428 PACLITAXEL 30MG IJ 94 IV THERAPY9431983 PACLITAXEL 30MG IJ 94 IV THERAPY9431981 PACLITAXEL 30MG IJ 94 IV THERAPY9470782 PACLTXL PROTN PART 1MG IJ 94 IV THERAPY9491176 PALONOSETRON INJ 25 MCG 94 IV THERAPY9483579 PALONOSETRON INJ 25 MCG 94 IV THERAPY9481896 PAMIDRONATE/30MG IJ 94 IV THERAPY9432311 PAMIDRONATE/30MG IJ 94 IV THERAPY9431989 PAMIDRONATE/30MG IJ 94 IV THERAPY9489857 PANITUMUMAB 10MG IJ 94 IV THERAPY9483991 PANTOPRAZOLE/VIAL IJ 94 IV THERAPY9490244 PCN G K 600,000U IJ 94 IV THERAPY9410374 PEG INTER ALFA 2-A 180MCG 94 IV THERAPY9483157 PEGFILGRASTIM 6MG IJ 94 IV THERAPY9470642 PEMETREXED PER 10MG IJ 94 IV THERAPY9489873 PENTAMIDINE 300MG IJ 94 IV THERAPY9491069 PENTOSTATIN/10MG IJ 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9550385 PHLEBOTOMY THERAPEUTIC $503.00 $503.00 95 IV THERAPY9450255 PHLEBOTOMY THERAPEUTIC $503.00 94 IV THERAPY9481938 PHYTONADIONE 1MG IJ 94 IV THERAPY9490962 PLERIXAFOR 1MG IJ 94 IV THERAPY9490111 POLYSTYRENE 94 IV THERAPY9491341 PRALATREXATE 1MG IJ 94 IV THERAPY9491333 PRALATREXATE 1MG IJ 94 IV THERAPY9460155 PREDNISONE 5MG PO 94 IV THERAPY9491358 PROBENECID 94 IV THERAPY9483819 PROCHLORPERAZINE 10MG IJ 94 IV THERAPY9460171 PROCHLORPERAZINE 10MG TAB 94 IV THERAPY9450867 PROLONGED IV INF REQ PUMP $1,970.00 94 IV THERAPY9410408 PROMETHAZINE 50 MG IJ 94 IV THERAPY9482019 PROTEINASE INHB 10MG IJ 94 IV THERAPY9490152 PYRIDOXINE HCL 100 MG IJ 94 IV THERAPY9432394 QUINAPRIL 94 IV THERAPY9490905 RANITIDINE 25MG IJ 94 IV THERAPY9450297 REFILL/MAINT PORTABL PUMP $549.00 94 IV THERAPY9450677 REMV TUNN CV CATH W/O PT $939.00 94 IV THERAPY9551540 REPR CV CATH W/O PORT $609.00 95 IV THERAPY9459769 REPR CV CATH W/O PORT $1,686.00 94 IV THERAPY9482530 RHO D H SD 100 IU IJ 94 IV THERAPY9491010 RHO D H SD 100 IU IJ 94 IV THERAPY9490749 RITUXIMAB 100MG IJ 94 IV THERAPY9470436 RITUXIMAB 100MG IJ 94 IV THERAPY9470915 RP I131 TOSITUMOMAB RX DS $41,470.00 94 IV THERAPY9450644 RPLC COMP NON-TUN CV CATH $1,463.00 94 IV THERAPY9450669 RPLC COMP PICC W/O $1,873.00 94 IV THERAPY9540121 S PR IRRIG SUPPLY SLEEVE $17.07 95 IV THERAPY9540139 S PR OST IR CO/CA W/WO BR $59.54 95 IV THERAPY9540063 S PR OST PCH DRN FP PLS $5.40 95 IV THERAPY9540071 S PR OST PCH DRN FP PLS $5.40 95 IV THERAPY9540055 S PR OST PCH DRN W/FP PLS $8.71 95 IV THERAPY9540089 S PR OST PCH ON FP PLS $8.00 95 IV THERAPY9540022 S PR OST SKIN BAR PWDR/OZ $26.38 95 IV THERAPY9540147 S PR OST SKN BAR PECTIN $26.38 95 IV THERAPY9540097 S PR OST SKN BAR SLD EXTD $19.38 95 IV THERAPY9540014 S PR OSTOMY BELT $18.69 95 IV THERAPY9540105 S PR PCH DRN EXTD WR CNVX $21.82 95 IV THERAPY9540113 S PR URN PCH EX WR BAR $21.50 95 IV THERAPY9540253 S SD TRANS FILM GT 48 SI $33.06 95 IV THERAPY9551557 S STRL 5F 3 PORT PWR PICC $594.00 $594.00 95 IV THERAPY9431750 S STRL APPL CHL SWABSTICK $6.39 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9430083 S STRL BLOOD SET Y-TYPE $10.68 94 IV THERAPY9432030 S STRL CATH FOLEY 3WAY $109.15 94 IV THERAPY9430190 S STRL CATH INSYT 20X11/4 $11.62 94 IV THERAPY9430216 S STRL CATH INSYTE $11.62 94 IV THERAPY9431594 S STRL CATH INSYTE $11.62 94 IV THERAPY9430182 S STRL CATH INSYTE 18 X 1 $11.62 94 IV THERAPY9430208 S STRL CATH INSYTE 22 1" $11.62 94 IV THERAPY9431628 S STRL CATH J&J PROTECTIV $13.12 94 IV THERAPY9431610 S STRL CATH J&J PROTECTIV $13.12 94 IV THERAPY9431602 S STRL CATH PROTECTIVE $13.12 94 IV THERAPY9430265 S STRL CATH SAF-T-INTIMA $20.29 94 IV THERAPY9430273 S STRL CATH SAF-T-INTIMA $20.29 94 IV THERAPY9431842 S STRL COBE BLD WARMER TU $46.75 94 IV THERAPY9431891 S STRL COVER PROBE SHEATH $53.34 94 IV THERAPY9530049 S STRL DRESS BIOPATCH $32.00 95 IV THERAPY9430331 S STRL DRESS BIOPATCH 1IN $27.37 94 IV THERAPY9430349 S STRL DRESS BIOPATCH 3/4 $26.33 94 IV THERAPY9530098 S STRL DRESS SURGICEL $103.00 95 IV THERAPY9430786 S STRL GROSHONG PICC 3FR $382.02 94 IV THERAPY9430778 S STRL GROSHONG PICC 5FR $549.16 94 IV THERAPY9430794 S STRL GROSHONG PICC KIT $343.82 94 IV THERAPY9439886 S STRL GROSHONG POWER PIC $2,501.00 94 IV THERAPY9430752 S STRL GRSHNG CATH REP 8 $496.63 94 IV THERAPY9430760 S STRL GRSHNG CATH RP 9.5 $496.63 94 IV THERAPY9430224 S STRL GRSHNG REP CON 8FR $62.53 94 IV THERAPY9430232 S STRL GRSHNG REP CON 9.5 $62.53 94 IV THERAPY9430745 S STRL GRSHNG REP KIT DL $306.00 94 IV THERAPY9530015 S STRL INTR KIT 3FR SNGL $330.00 95 IV THERAPY9430844 S STRL INTRO NDL PICC 4FR $94.53 94 IV THERAPY9430836 S STRL INTRO NEEDLE PICC $96.66 94 IV THERAPY9530023 S STRL INTRO SAF KIT $330.00 95 IV THERAPY9530056 S STRL KIT MIDLINE CATH $235.00 95 IV THERAPY9530114 S STRL KIT NDL GUIDE $85.00 95 IV THERAPY9530064 S STRL KIT PICC CATH $396.00 95 IV THERAPY9530072 S STRL KIT PICC CATH 2 $564.00 95 IV THERAPY9551524 S STRL KIT PICC POWER 2 L $564.00 95 IV THERAPY9551532 S STRL KIT PICC POWER 3 L $594.00 95 IV THERAPY9530106 S STRL KIT SHEATH PROBE $47.00 95 IV THERAPY9431560 S STRL MICRO INTRO KIT $235.90 94 IV THERAPY9530031 S STRL MICRO INTRODUCER $330.00 95 IV THERAPY9431800 S STRL MINI-STICK 5FR $198.71 94 IV THERAPY9431115 S STRL NDL GRIP 20GX3/4" $23.46 94 IV THERAPY9431123 S STRL NDL GRIP 22GX3/4" $34.62 94 IV THERAPY

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9530080 S STRL NDL PORTA-CATH $37.00 95 IV THERAPY9430091 S STRL NDLE BONE MARROW A $13.00 94 IV THERAPY9431834 S STRL PICC 4 FR. REPLACE $90.88 94 IV THERAPY9431651 S STRL SET IV SECONDARY B $8.69 94 IV THERAPY9431420 S STRL SET PHLEBTYM DONAT $33.63 94 IV THERAPY9431867 S STRL STERILE EVAC BOTTL $303.20 94 IV THERAPY9431792 S STRL SURGIFORM J&J $28.56 94 IV THERAPY9431859 S STRL THORACENTESIS TRAY $612.70 94 IV THERAPY9431818 S STRL TRANS COVERS 94 IV THERAPY9430109 S STRL TRAY BONE MAR ASP $115.06 94 IV THERAPY9431743 S STRL TRAY FULL GROSHONG $821.35 94 IV THERAPY9431727 S STRL TY FULL GROSHONG $618.88 94 IV THERAPY9431735 S STRL TY FULL GROSHONG $618.88 94 IV THERAPY9431552 S STRLL MICRO INTRO KIT 3 $253.66 94 IV THERAPY9431578 S STRLL MISCO INTRO KIT 5 $229.50 94 IV THERAPY9483462 SARGRAMOSTIM 50MCG IJ 94 IV THERAPY9489923 SC THER INFSN 16-60 MN $324.75 94 IV THERAPY9489931 SC THER INFSN ADDL HR $355.36 94 IV THERAPY9489949 SC THER INFSN ADDL PMP SU $1,539.12 94 IV THERAPY9470006 SIPULEUCEL-T PER INFUSION 94 IV THERAPY9490830 SMZ/TMP 10ML IJ 94 IV THERAPY9460312 SORBITOL 94 IV THERAPY9431826 SURGICELL DRESSING $113.15 94 IV THERAPY9432741 TELAVANCIN IJ 10 MG 94 IV THERAPY9491093 TEMSIROLIMUS 1MG IJ 94 IV THERAPY9483751 TESTOSTERONE CYP 100MG IJ 94 IV THERAPY9489881 THIAMINE HCL 100 MG IJ 94 IV THERAPY9450891 THORACENTESIS $1,848.00 94 IV THERAPY9489642 THYROTROPIN 1.1MG VL IJ 94 IV THERAPY9490335 TICAR/CLAV 3.1GM IJ 94 IV THERAPY9470832 TIGECYCLINE 1MG IJ 94 IV THERAPY9482365 TOBRAMYCIN 80MG IJ 94 IV THERAPY9431990 TOCILIZUMAB 1MG IJ 94 IV THERAPY9432006 TOCILIZUMAB 1MG IJ 94 IV THERAPY9432014 TOCILIZUMAB 1MG IJ 94 IV THERAPY9432444 TOPOTECAN 0.1MG IJ 94 IV THERAPY9431998 TOPOTECAN 0.1MG IJ 94 IV THERAPY9481755 TRACE ELEM-5 10ML IV 94 IV THERAPY9470261 TRASTUZUMAB 10MG IJ 94 IV THERAPY9491200 TRASTUZUMAB 10MG IJ 94 IV THERAPY9490848 TRIPTORELIN PA 3.75 MG IJ 94 IV THERAPY9489832 TUBERCULN SKIN TEST INTRA $60.22 94 IV THERAPY9431966 US VASC ACCESS ADD ON $113.00 94 IV THERAPY

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9491309 VALACYCLOVIR 94 IV THERAPY9489980 VALPROIC ACID 94 IV THERAPY9482415 VANCOMYCIN 500MG IJ 94 IV THERAPY9432469 VELAGLUCERASE ALFA 100U 94 IV THERAPY9450248 VENIPUNCTURE $13.00 94 IV THERAPY9470485 VINBLASTINE 1MG IJ 94 IV THERAPY9432063 VINCRISTINE 1MG IJ 94 IV THERAPY9470881 VINCRISTINE 1MG IJ 94 IV THERAPY9432253 VINORELBINE 10MG IJ 94 IV THERAPY9490921 VINORELBINE 10MG IJ 94 IV THERAPY9470410 VINORELBINE 10MG IJ 94 IV THERAPY9432337 VORICONAZOLE 10 MG IJ 94 IV THERAPY9483869 VX DTP DIP/TETTOX/PERTUS 94 IV THERAPY9483868 VX HEMOPH FLU B PRP-T 94 IV THERAPY9489584 VX HEP A ADULT IM 94 IV THERAPY9483371 VX HEP B ADULT IM 94 IV THERAPY9481979 VX IPV POLIOVIRUS SC/IM 94 IV THERAPY9490145 VX IPV POLIOVIRUS SC/IM 94 IV THERAPY9483777 VX MENINGOCOCCAL POLYSACC 94 IV THERAPY9489667 VX MMR 94 IV THERAPY9483561 VX PNMOCOCCL PLYSAC GT 2Y 94 IV THERAPY9482084 VX RABIES INTRAMUSCULAR 94 IV THERAPY9489600 VX TD PF GT 7Y IM 94 IV THERAPY9483645 VX TETANUS TOXOID 94 IV THERAPY9489691 VX TETANUS TOXOID 94 IV THERAPY9489659 VX VARICELLA VIRUS LIVE 94 IV THERAPY9489709 VX ZOSTER SC IJ 94 IV THERAPY9470020 WATER 94 IV THERAPY9470019 WATER IJ 1000ML 94 IV THERAPY9490046 ZOLEDRONIC RECLAST 1MG IJ 94 IV THERAPY9483249 ZOLEDRONIC ZOMETA 1MG IJ 94 IV THERAPY9490160 ZOSYN 1GM / 0.125GM IJ 94 IV THERAPY4000055 ALPHA 2 ANTIPLASMIN $205.00 $205.00 $109.99 $207.00 40 LAB4000204 AT3 ACTIVITY $317.00 $317.00 $75.00 $317.00 40 LAB4000253 AT3 AG IMMUNOLOGIC $291.00 $291.00 $36.00 $290.00 40 LAB4040960 B CELLS TOTAL COUNT $676.00 $676.00 $50.00 40 LAB4040457 CD34 TOTAL COUNT $676.00 $676.00 $50.00 40 LAB4040929 CELL MARKR INTERPRET 16+ $100.00 $100.00 40 LAB4040903 CELL MARKR INTERPRET 2-8 $80.00 $80.00 40 LAB4040911 CELL MARKR INTERPRET 9-15 $90.00 $90.00 40 LAB4040895 CELL MARKR TECH EA ADDL $35.00 $25.00 40 LAB4040887 CELL MARKR TECH ONLY 1ST $135.00 $50.00 40 LAB4050464 CHRMOSOM ADD CL CNT EA $43.00 40 LAB

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SEQ 300 AMOUNT

DEPARTMENT CODE

4050233 CHRMOSOM ADD KARY EA $115.00 40 LAB4050647 CHRMOSOM CNT/KARY $1,535.00 $1,535.00 $361.00 40 LAB4050332 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $770.75 $2,545.00 40 LAB4050274 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $419.25 $2,545.00 40 LAB4050100 CHRMOSOM CNT/KARY $769.00 $810.00 $540.00 $948.00 40 LAB4050092 CHRMOSOM CNT/KARY $769.00 $440.00 $275.00 $515.00 40 LAB4050084 CHRMOSOM CNT/KARY $769.00 $372.00 40 LAB4050076 CHRMOSOM CNT/KARY $769.00 $296.00 40 LAB4050399 CHRMOSOM CNT/KARY $3,333.00 $3,333.00 $510.00 $2,545.00 40 LAB4050118 CHRMOSOM CNT/KARY $769.00 $535.00 $370.00 $626.00 40 LAB4050217 CHRMOSOM CNT/KARY $2,174.00 $2,174.00 $657.25 $2,081.00 40 LAB4050605 CHRMOSOM CNT/KARY $2,174.00 $1,838.00 $597.50 $2,452.00 40 LAB4050688 CHRMOSOM CNT/KARY 40 LAB4050126 CHRMOSOM CNT/KARY $2,174.00 $2,174.00 $367.50 $2,081.00 40 LAB4050514 CHRMOSOM HI RESD BND $649.00 $524.00 $453.25 $613.00 40 LAB4050142 CHRMOSOM HI RESD BND $519.00 $419.00 $362.00 $490.00 40 LAB4050134 CHRMOSOM HI RESD BND $174.00 $140.00 $121.00 $164.00 40 LAB4050720 COL CHROM/MASS SPEC QNT 40 LAB4050548 CYTGNTC STUDY $632.00 $632.00 $46.50 $606.00 40 LAB4040358 DNA ANALYSIS $170.00 $170.00 $133.50 $170.00 40 LAB4050829 DNA PRB CYTGNTC >100 $275.00 40 LAB4050811 DNA PRB CYTGNTC 10 30 $266.00 $56.25 40 LAB4050803 DNA PRB CYTGNTC EA $266.00 $56.25 40 LAB4000402 EUGLOBULIN LYSIS $225.00 $225.00 $43.18 $221.00 40 LAB4000451 FCTR II $351.00 $351.00 $96.60 $345.00 40 LAB4000659 FCTR IX $509.00 $509.00 $96.60 $510.00 40 LAB4000501 FCTR V $470.00 $470.00 $96.60 $469.00 40 LAB4000550 FCTR VII $476.00 $476.00 $96.60 $476.00 40 LAB4000600 FCTR VIII $476.00 $476.00 $96.60 $476.00 40 LAB4001608 FCTR VIII VW $615.00 $615.00 $107.53 $614.00 40 LAB4001558 FCTR VIII VW AG $615.00 $615.00 $102.64 $614.00 40 LAB4000709 FCTR X $476.00 $476.00 $96.60 $476.00 40 LAB4000154 FCTR XA AB CHROMGN $317.00 $317.00 $103.00 $317.00 40 LAB4000758 FCTR XI $476.00 $476.00 $96.60 $476.00 40 LAB4000808 FCTR XII $516.00 $516.00 $96.60 $517.00 40 LAB4000857 FCTR XIII SCRN $238.00 $238.00 $87.15 $234.00 40 LAB4000907 FIBRINOGEN QN $225.00 $225.00 $42.25 $227.00 40 LAB4040952 NATURAL KILLER CELLS $70.00 $70.00 $50.00 40 LAB4001400 PHOSPHLPD NUTRLZTN PLTLT $483.00 $483.00 $62.21 $476.00 40 LAB4000956 PHOSPHLPD NUTRLZTN PLTLT $483.00 $483.00 $85.00 $476.00 40 LAB4001103 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 $683.00 40 LAB4001202 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 $683.00 40 LAB4001251 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 $683.00 40 LAB

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SEQ 300 AMOUNT

DEPARTMENT CODE

4001301 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 $683.00 40 LAB4001152 PLT AGGREGATION EA AGENT $668.00 $668.00 $60.00 $683.00 40 LAB4001053 PLT AGGREGATION EA AGENT $668.00 $668.00 $80.85 $683.00 40 LAB4001459 PROTEIN C ACTIVITY $370.00 $370.00 $125.00 $365.00 40 LAB4001509 PROTEIN S ACTIVITY $410.00 $410.00 $140.00 $407.00 40 LAB4001350 PTT SUBSTITUTION EA $172.00 $172.00 $159.78 $172.00 40 LAB4000303 PTT SUBSTITUTION EA $172.00 $172.00 $94.75 $172.00 40 LAB4040408 RETICULOCYTE AUTO $106.00 $106.00 $28.75 40 LAB4000352 RUSSELL VIPER VENOM DILU $258.00 $258.00 $62.21 $255.00 40 LAB4060554 S STRL FTPADSEQUENTIALLG $248.46 40 LAB4060562 S STRL FTPADSEQUENTIALREG $248.46 40 LAB4040879 SERVICES AFTER OFFICE HRS $225.00 $212.00 $200.00 40 LAB4060547 SPEC HANDL TO REF LAB $79.00 $79.00 40 LAB4040937 T LMPH TOT CNT $70.00 $70.00 $50.00 40 LAB4040804 T LYMPH CD4 (HELPER) CNT $648.00 $50.00 $622.00 40 LAB4040853 T LYMPH CD4/8 CNT&RATIO $240.00 $75.00 40 LAB4040978 T LYMPH CD4/8 CNT&RATIO $240.00 $50.00 40 LAB4050621 TISSUE CULT AMNIO/CVS $666.00 40 LAB4050225 TISSUE CULT AMNIO/CVS $666.00 40 LAB4050340 TISSUE CULT BM/BLD $843.00 40 LAB4050282 TISSUE CULT LYMPH $719.00 40 LAB4050407 TISSUE CULT SKIN/SOLID BX $586.00 40 LAB4171187 CELL MARKR INTERPRET 16+ $19.24 41 LAB (CONTINUED)4171195 CELL MARKR TECH EA ADDL $15.11 41 LAB (CONTINUED)4171179 CELL MARKR TECH EA ADDL $8.55 41 LAB (CONTINUED)4171161 CELL MARKR TECH ONLY 1ST $14.96 41 LAB (CONTINUED)4170742 CHEM HISTOCHEMISTRY $408.00 41 LAB (CONTINUED)4170759 COPPER $133.56 41 LAB (CONTINUED)4170320 CYTOLOGY CONCENTRATION $408.00 $408.00 $75.00 $392.00 41 LAB (CONTINUED)4170692 CYTOLOGY FLD $734.00 41 LAB (CONTINUED)4170288 CYTOLOGY PREP & INTERP $461.00 $461.00 $75.00 $443.00 41 LAB (CONTINUED)4170767 CYTOLOGY SEL CELL ENHANCE $293.00 41 LAB (CONTINUED)4170528 CYTOLOGY UNLISTED $138.00 $130.00 $85.00 $130.00 41 LAB (CONTINUED)4170007 CYTP EVL FNA 1ST EVL EA $293.00 $293.00 $180.00 $284.00 41 LAB (CONTINUED)4170684 CYTP EVL FNA 1ST EVL EA $298.00 41 LAB (CONTINUED)4170023 DECALCIFICATION $195.00 $195.00 $104.20 $187.00 41 LAB (CONTINUED)4170841 DNA CL CYCLE $110.00 41 LAB (CONTINUED)4170551 DNA HISTOGRAM $62.00 $59.00 $38.33 $59.00 41 LAB (CONTINUED)4171070 DNA PRB CYTGNTC >100 $145.20 41 LAB (CONTINUED)4171088 DNA PRB CYTGNTC >100 $202.20 41 LAB (CONTINUED)4170999 DNA PRB CYTGNTC >100 $60.00 41 LAB (CONTINUED)4170973 DNA PRB CYTGNTC >100 $74.17 41 LAB (CONTINUED)4170957 DNA PRB CYTGNTC >100 $180.00 41 LAB (CONTINUED)

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SEQ 300 AMOUNT

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4170940 DNA PRB CYTGNTC EA $60.00 41 LAB (CONTINUED)4170981 DNA PRB CYTGNTC EA $30.00 41 LAB (CONTINUED)4171211 ENZYME CELL ACT NON-RAD $155.00 41 LAB (CONTINUED)4170429 ENZYME HISTOCHEMISTRY $426.00 $426.00 $114.40 $406.00 41 LAB (CONTINUED)4133864 FCTR XI $127.50 41 LAB (CONTINUED)4170189 IMMUNOHISTOCHEMISTRY $311.00 $311.00 $203.20 $296.00 41 LAB (CONTINUED)4170171 IMMUNOHISTOCHEMISTRY $311.00 $311.00 $393.40 $296.00 41 LAB (CONTINUED)4170650 IMMUNOHISTOCHEMISTRY $84.00 $79.00 $52.00 $79.00 41 LAB (CONTINUED)4170833 IMMUNOHISTOCHEMISTRY $84.17 41 LAB (CONTINUED)4170825 IMMUNOHISTOCHEMISTRY $84.17 41 LAB (CONTINUED)4170924 IMMUNOHISTOCHEMISTRY $142.90 41 LAB (CONTINUED)4170916 IMMUNOHISTOCHEMISTRY $107.10 41 LAB (CONTINUED)4170858 IMMUNOHISTOCHEMISTRY $116.95 41 LAB (CONTINUED)4170874 IMMUNOHISTOCHEMISTRY 41 LAB (CONTINUED)4170932 IN SITU HYBRIDIZ EA PROBE $142.90 41 LAB (CONTINUED)4170908 IN SITU HYBRIDIZ EA PROBE $192.00 41 LAB (CONTINUED)4170866 IN SITU HYBRIDIZ EA PROBE $330.00 41 LAB (CONTINUED)4171203 INSITU HYBRIDIZATION MAN $132.50 41 LAB (CONTINUED)4170114 INTERP BM SMR $899.00 $899.00 $298.75 $1,324.00 41 LAB (CONTINUED)4170817 INTRAOP CYTOPATH CON ADDL $516.00 41 LAB (CONTINUED)4170809 INTRAOP CYTOPATH CON INIT $847.00 41 LAB (CONTINUED)4170643 IRON $145.91 $145.91 $145.91 $145.91 41 LAB (CONTINUED)4171104 ML DX AMP TR NA EA SQ GT2 $33.00 41 LAB (CONTINUED)4171096 MOL DX AMP TR N ACD 2SEQ $62.00 41 LAB (CONTINUED)4171062 MOL DX AMP TR N ACD EA SQ $28.00 41 LAB (CONTINUED)4171021 MOL DX AMP TR N ACD EA SQ $72.00 41 LAB (CONTINUED)4171138 MOL DX AMP TR N ACD EA SQ $35.00 41 LAB (CONTINUED)4171120 MOL DX ENZ DIG EA ENZ TX $19.98 41 LAB (CONTINUED)4171054 MOL DX EXTN EA NA TYP $10.00 41 LAB (CONTINUED)4171047 MOL DX INTERP & RPT $30.00 41 LAB (CONTINUED)4171013 MOL DX ISO/EXT PRFD EA NA $20.00 41 LAB (CONTINUED)4171112 MOL DX LYS CLLS EA SPEC $26.00 41 LAB (CONTINUED)4171039 MOL DX SEP/ID HI RS EA NA $26.00 41 LAB (CONTINUED)4171146 MUTATION ID BY SEQ EA SEG $33.36 41 LAB (CONTINUED)4170064 OUTSD SLIDE CONSULT PREP $87.00 $82.00 $87.00 $82.00 41 LAB (CONTINUED)4170130 PATH FRZN SECTION 1 BLK $399.00 $399.00 $299.60 $385.00 41 LAB (CONTINUED)4170148 PATH FRZN SECTION ADD $213.00 $213.00 $152.15 $207.00 41 LAB (CONTINUED)4170569 RECEPT ASSAY ESTROGEN $62.00 $59.00 $38.33 $59.00 41 LAB (CONTINUED)4170577 RECEPT ASSAY PROGEST $62.00 $59.00 $38.33 $59.00 41 LAB (CONTINUED)4170734 SPEC STAIN GRP I MICR I/R $142.00 41 LAB (CONTINUED)4170726 SPEC STAIN GRP I MICR I/R $142.00 41 LAB (CONTINUED)4170460 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $85.00 $147.00 41 LAB (CONTINUED)4170478 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $150.00 $147.00 41 LAB (CONTINUED)

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SEQ 300 AMOUNT

DEPARTMENT CODE

4170486 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $150.00 $147.00 41 LAB (CONTINUED)4170502 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $300.00 $147.00 41 LAB (CONTINUED)4170494 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $150.00 $147.00 41 LAB (CONTINUED)4170510 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $300.00 $147.00 41 LAB (CONTINUED)4170718 SPEC STAIN GRP II INTRP/R $151.00 41 LAB (CONTINUED)4170585 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $150.00 $147.00 41 LAB (CONTINUED)4170197 SPEC STAIN GRP II INTRP/R $151.00 $151.00 $102.00 $147.00 41 LAB (CONTINUED)4170015 SURG PATH LVL I $216.00 $216.00 $126.90 $365.00 41 LAB (CONTINUED)4170031 SURG PATH LVL II $493.00 $493.00 $300.00 $836.00 41 LAB (CONTINUED)4170411 SURG PATH LVL III $632.00 $632.00 $300.00 $1,070.00 41 LAB (CONTINUED)4170080 SURG PATH LVL IV $915.00 $915.00 $300.00 $1,551.00 41 LAB (CONTINUED)4170106 SURG PATH LVL V $1,514.00 $1,514.00 $550.00 $2,566.00 41 LAB (CONTINUED)4170072 SURG PATH LVL VI $2,108.00 $2,108.00 $550.00 $3,573.00 41 LAB (CONTINUED)4170395 SURG PATH UNLISTED $85.00 $85.00 $10.75 $81.00 41 LAB (CONTINUED)4170379 SURG PATH UNLISTED $85.00 $85.00 $11.60 $81.00 41 LAB (CONTINUED)4170403 SURG PATH UNLISTED $85.00 $85.00 $55.90 $81.00 41 LAB (CONTINUED)4170445 SURG PATH UNLISTED $85.00 $85.00 $48.15 $81.00 41 LAB (CONTINUED)4170452 SURG PATH UNLISTED $85.00 $85.00 $46.00 $81.00 41 LAB (CONTINUED)4170353 SURG PATH UNLISTED 41 LAB (CONTINUED)4170437 SURG PATH UNLISTED $85.00 $85.00 $28.15 $81.00 41 LAB (CONTINUED)1120104 ADMIN PNEUMOCOCCAL VACC $30.00 11 MISC NURSING CHARGES1130566 CHEMO TX ADMN PRTL CAVITY $1,883.00 11 MISC NURSING CHARGES1120120 IMMUN ADMIN EA ADD VACCNE $68.00 11 MISC NURSING CHARGES1130301 OBS ADMIN INFLUENZA VACC $89.00 11 MISC NURSING CHARGES1130319 OBS ADMIN PNEUMOCOCAL VAC $40.00 11 MISC NURSING CHARGES1130673 OBS APP SPLNT SHRT ARM ST $569.00 11 MISC NURSING CHARGES1130616 OBS APPLY LONG ARM SPLINT $569.00 11 MISC NURSING CHARGES1130624 OBS APPLY LONG LEG SPLINT $569.00 11 MISC NURSING CHARGES1130004 OBS BLADDER IRRIG SMPL $101.00 11 MISC NURSING CHARGES1130012 OBS BLOOD TRANSFSN 2-4 HR $1,161.00 11 MISC NURSING CHARGES1130020 OBS BLOOD TRANSFSN 4-6 HR $1,825.00 11 MISC NURSING CHARGES1130038 OBS BLOOD TRANSFSN GT 6HR $2,245.00 11 MISC NURSING CHARGES1130046 OBS BLOOD TRANSFSN LT 2HR $664.00 11 MISC NURSING CHARGES1130327 OBS BONE MARROW ASP W/BX $439.00 11 MISC NURSING CHARGES1130277 OBS CARDIOVERT ELECT EXT $1,109.00 11 MISC NURSING CHARGES1130053 OBS CATH SPEC COLL SGL PT $10.00 11 MISC NURSING CHARGES1130590 OBS CL TX VT FX WO MANIP $110.00 11 MISC NURSING CHARGES1130335 OBS COL BLD PICC/CNTRL LN $27.00 11 MISC NURSING CHARGES1130061 OBS COLL BLD VNS ACCS DVC $242.00 11 MISC NURSING CHARGES1130079 OBS CPR $417.00 11 MISC NURSING CHARGES1130087 OBS DECLOT VASC DEVICE $374.00 11 MISC NURSING CHARGES1130640 OBS DRN ABSCESS SMPL/SNGL $361.00 11 MISC NURSING CHARGES1130095 OBS EKG 12 LEAD TRACING $162.00 11 MISC NURSING CHARGES

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SEQ 300 AMOUNT

DEPARTMENT CODE

1130103 OBS HYDRAT INF EA ADD HR $178.00 11 MISC NURSING CHARGES1130111 OBS HYDRTN INF INIT 31-60 $143.00 11 MISC NURSING CHARGES1130129 OBS IJ IVP ADL SQ NEW DRG $339.00 11 MISC NURSING CHARGES1130137 OBS INF W/MED ADDSQ 16-60 $261.00 11 MISC NURSING CHARGES1130145 OBS INF W/MED EA ADD HR $267.00 11 MISC NURSING CHARGES1130541 OBS INFLU H1N1 VACC ADMIN $21.64 11 MISC NURSING CHARGES1130160 OBS INFSN W/MED 16-60MN $382.00 11 MISC NURSING CHARGES1130152 OBS INFSN W/MED CONCURRNT $382.00 11 MISC NURSING CHARGES1130293 OBS INFUSN CHEM EA ADD HR $775.00 11 MISC NURSING CHARGES1130285 OBS INFUSN CHEMO 0-60 MN $893.00 11 MISC NURSING CHARGES1130178 OBS INJ IVP SNGL/INIT DRG $134.00 11 MISC NURSING CHARGES1130608 OBS INJ MAJOR JNT BURSA $153.00 11 MISC NURSING CHARGES1130186 OBS INJECTION IM/SQ EA $168.00 11 MISC NURSING CHARGES1130194 OBS INS NON-TUN CV CATH5+ $973.00 11 MISC NURSING CHARGES1130202 OBS INS PICC AGE 5 YRS/> $1,548.00 11 MISC NURSING CHARGES1130210 OBS INSERT CATH TMP SMPL $366.00 11 MISC NURSING CHARGES1130228 OBS INSRT BLADDER CATH $192.00 11 MISC NURSING CHARGES1130582 OBS IVP SME DRG EA >30M $37.00 11 MISC NURSING CHARGES1130632 OBS LAC SMPL 2.6-7.5CM $269.76 11 MISC NURSING CHARGES1130525 OBS LARYNGOSCOPY DX $966.00 11 MISC NURSING CHARGES1130558 OBS LUMBAR PUNCTURE DX $373.00 11 MISC NURSING CHARGES1130533 OBS PARACENT ABD INI $497.00 11 MISC NURSING CHARGES1130236 OBS PLACE NEEDLE IN VEIN $100.00 11 MISC NURSING CHARGES1130244 OBS PULSE OX MULTIPLE $153.00 11 MISC NURSING CHARGES1130251 OBS PULSE-OX OVRNITE CONT $211.00 11 MISC NURSING CHARGES1130269 OBS VENIPUNCTURE $11.00 11 MISC NURSING CHARGES1260157 ABO TYP 12 ONCOLOGY SERVICES1260025 AFFILIATE SEARCH MGT FEE 12 ONCOLOGY SERVICES1260660 BACTERIAL AG EA AG 12 ONCOLOGY SERVICES1220706 BX ENDOMETRIUM NO DILATN $333.00 12 ONCOLOGY SERVICES1220912 BX VAG MUCOSA EXT $413.00 12 ONCOLOGY SERVICES1220656 BX VAG MUCOSA SMPL $267.00 12 ONCOLOGY SERVICES1220649 BX VLVA/PERIN 1 LESION $252.00 12 ONCOLOGY SERVICES1220854 BX VLVA/PERIN ADD LESN EA $114.00 12 ONCOLOGY SERVICES1220698 BX/LOCAL EXCSN CERV LSION $405.00 12 ONCOLOGY SERVICES1220862 CATH SPECIMEN COLL SGL PT $103.00 12 ONCOLOGY SERVICES1221050 CC 1ST 30-74MN W/PROC $808.00 12 ONCOLOGY SERVICES1220680 CERVIC COLP W CERVIX BX $434.00 12 ONCOLOGY SERVICES1260785 CHAGAS IGG 12 ONCOLOGY SERVICES1260124 CMV AB 12 ONCOLOGY SERVICES1250158 COLLECT BLD VNS ACCES DVC $124.00 12 ONCOLOGY SERVICES1210509 COLLECT BLD VNS ACCES DVC $124.00 $95.00 12 ONCOLOGY SERVICES1210285 COLLECT BLD VNS ACCES DVC $124.00 $95.00 12 ONCOLOGY SERVICES

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SEQ 300 AMOUNT

DEPARTMENT CODE

1250141 COLLECT BLD VNS ACCES DVC $109.00 12 ONCOLOGY SERVICES1220672 COLP CERVIX W BX & CURETT $465.00 12 ONCOLOGY SERVICES1220664 COLPOSCOPY OF CERVIX $330.00 12 ONCOLOGY SERVICES1220870 COLPOSCOPY OF VULVA $336.00 12 ONCOLOGY SERVICES1260769 CORD BLOOD UNIT & SHIPMNT 12 ONCOLOGY SERVICES1221043 CRITICAL CARE ADDL 30 MIN $361.00 12 ONCOLOGY SERVICES1221035 CRITICAL CR 1ST 30-74MN $808.00 12 ONCOLOGY SERVICES1260017 CUSTOM SEARCH SUPPORT 12 ONCOLOGY SERVICES1220847 DESTRUCT ANAL LSN SMP $773.00 12 ONCOLOGY SERVICES1220896 DESTRUCT ANAL LSN(S) EXT $1,599.00 12 ONCOLOGY SERVICES1220920 ENDOCERVICAL CURETTAGE $312.00 12 ONCOLOGY SERVICES1260041 FORMAL SEARCH 12 ONCOLOGY SERVICES1260678 FTA ABS (TPPA) 12 ONCOLOGY SERVICES1260553 HARVEST ALLGENC STEM CELL 12 ONCOLOGY SERVICES1260082 HB CORE AB TOTAL 12 ONCOLOGY SERVICES1260736 HBE AB 12 ONCOLOGY SERVICES1260694 HBE AB 12 ONCOLOGY SERVICES1260686 HBE AG 12 ONCOLOGY SERVICES1260710 HBS AB 12 ONCOLOGY SERVICES1260074 HBS AG 12 ONCOLOGY SERVICES1260728 HBS AG NEUTRALIZATION 12 ONCOLOGY SERVICES1260090 HCV AB 12 ONCOLOGY SERVICES1260181 HCV AB CONF 12 ONCOLOGY SERVICES1260744 HEP B VIRUS AMP PRB 12 ONCOLOGY SERVICES1260652 HEP C VIRUS AMP PRB 12 ONCOLOGY SERVICES1260751 HEP C VIRUS RNA QN 12 ONCOLOGY SERVICES1212224 HEPARIN 1000U IJ $10.00 $8.00 12 ONCOLOGY SERVICES1260645 HIV 1 AMP PRB 12 ONCOLOGY SERVICES1260108 HIV 1/HIV 2 AB 12 ONCOLOGY SERVICES1260702 HIV AB CONF WESTERN BLOT 12 ONCOLOGY SERVICES1260173 HIV P24 AG 12 ONCOLOGY SERVICES1260207 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260348 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260330 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260322 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260223 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260280 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260314 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260306 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260264 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260272 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260215 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260355 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES

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SEQ 300 AMOUNT

DEPARTMENT CODE

1260363 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260298 HLA TYP A B C MULTI AG 12 ONCOLOGY SERVICES1260066 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260470 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260520 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260512 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260504 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260496 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260488 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260231 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260249 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260256 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260462 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260454 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260413 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260371 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260389 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260397 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260405 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260447 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260421 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260439 HLA TYPE DR/DQ MULTI AG 12 ONCOLOGY SERVICES1260116 HTLV 1 AB 12 ONCOLOGY SERVICES1260140 HTLV II AB 12 ONCOLOGY SERVICES1220904 I&D BARTHLNS GLAND ABSCSS $380.00 12 ONCOLOGY SERVICES1220714 INJECTION IM/SQ EA $73.00 12 ONCOLOGY SERVICES1220623 INSERT CATH NONINDWLLNG $188.00 12 ONCOLOGY SERVICES1220631 INSERT CATH TEMP INDWLLNG $244.00 12 ONCOLOGY SERVICES1220771 LEVEL 1 EST PATIENT $62.00 12 ONCOLOGY SERVICES1250133 LEVEL 1 EST PATIENT 12 ONCOLOGY SERVICES1250059 LEVEL 1 EST PATIENT $65.74 12 ONCOLOGY SERVICES1220987 LEVEL 1 EST PT W/PROC $62.00 12 ONCOLOGY SERVICES1220722 LEVEL 1 NEW PATIENT $128.00 12 ONCOLOGY SERVICES1250000 LEVEL 1 NEW PATIENT $116.87 12 ONCOLOGY SERVICES1220938 LEVEL 1 NEW PT W/PROC $128.00 12 ONCOLOGY SERVICES1220789 LEVEL 2 EST PATIENT $129.00 12 ONCOLOGY SERVICES1250067 LEVEL 2 EST PATIENT $89.33 12 ONCOLOGY SERVICES1220995 LEVEL 2 EST PT W/PROC $129.00 12 ONCOLOGY SERVICES1250018 LEVEL 2 NEW PATIENT $175.32 12 ONCOLOGY SERVICES1220730 LEVEL 2 NEW PATIENT $220.00 12 ONCOLOGY SERVICES1220946 LEVEL 2 NEW PT W/PROC $220.00 12 ONCOLOGY SERVICES1220797 LEVEL 3 EST PATIENT $213.00 12 ONCOLOGY SERVICES1250075 LEVEL 3 EST PATIENT $109.57 12 ONCOLOGY SERVICES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1221001 LEVEL 3 EST PT W/PROC $213.00 12 ONCOLOGY SERVICES1220748 LEVEL 3 NEW PATIENT $316.00 12 ONCOLOGY SERVICES1250026 LEVEL 3 NEW PATIENT $366.59 12 ONCOLOGY SERVICES1220953 LEVEL 3 NEW PT W/PROC $316.00 12 ONCOLOGY SERVICES1250083 LEVEL 4 EST PATIENT $131.50 12 ONCOLOGY SERVICES1220805 LEVEL 4 EST PATIENT $316.00 12 ONCOLOGY SERVICES1221019 LEVEL 4 EST PT W/PROC $316.00 12 ONCOLOGY SERVICES1220755 LEVEL 4 NEW PATIENT $484.00 12 ONCOLOGY SERVICES1250034 LEVEL 4 NEW PATIENT $395.20 12 ONCOLOGY SERVICES1220961 LEVEL 4 NEW PT W/PROC $484.00 12 ONCOLOGY SERVICES1250091 LEVEL 5 EST PATIENT $349.12 12 ONCOLOGY SERVICES1260603 LEVEL 5 EST PATIENT 12 ONCOLOGY SERVICES1260579 LEVEL 5 EST PATIENT 12 ONCOLOGY SERVICES1220813 LEVEL 5 EST PATIENT $424.00 12 ONCOLOGY SERVICES1221027 LEVEL 5 EST PT W/PROC $424.00 12 ONCOLOGY SERVICES1250042 LEVEL 5 NEW PATIENT $525.09 12 ONCOLOGY SERVICES1220763 LEVEL 5 NEW PATIENT $603.00 12 ONCOLOGY SERVICES1220979 LEVEL 5 NEW PT W/PROC $603.00 12 ONCOLOGY SERVICES1220607 LIDO/EPI $119.00 12 ONCOLOGY SERVICES1220615 LIDOCAINE $41.00 12 ONCOLOGY SERVICES1260637 MARROW DNR AUTO BLD UNIT 12 ONCOLOGY SERVICES1260629 MARROW DONOR INFO SESSION 12 ONCOLOGY SERVICES1260611 MARROW DONOR W/U CANCEL 12 ONCOLOGY SERVICES1210541 NA CL FLUSH 1-3ML $5.00 $4.00 12 ONCOLOGY SERVICES1210566 NA CL VIALS/10CC $11.00 $8.00 12 ONCOLOGY SERVICES1260033 NON-NTWORK SEARCH MGT FEE 12 ONCOLOGY SERVICES1220839 OBTAIN SCREEN PAP SMEAR $137.00 12 ONCOLOGY SERVICES1260058 OTH REG ONE-TIME ACT FEE 12 ONCOLOGY SERVICES1260561 PBSC DONOR INFO SESSION 12 ONCOLOGY SERVICES1260587 PBSC DONOR W/U CANCEL 12 ONCOLOGY SERVICES1250117 PROLONG SVC F-F ADDL 30MN $125.00 12 ONCOLOGY SERVICES1250109 PROLONG SVC F-F FIRST HR $250.00 12 ONCOLOGY SERVICES1260165 RH TYP 12 ONCOLOGY SERVICES1260132 RPR NON-TREPNML AB QL 12 ONCOLOGY SERVICES1210939 S STRL CADD AMB INF PUMP $79.00 $59.00 12 ONCOLOGY SERVICES1220573 S STRL CATHETER $5.00 12 ONCOLOGY SERVICES1220599 S STRL CATHETER FOLEY $12.00 12 ONCOLOGY SERVICES1221316 S STRL DRAINAGE BAG FOLEY $12.00 12 ONCOLOGY SERVICES1210640 S STRL GROSHONG CATH $444.00 $335.00 12 ONCOLOGY SERVICES1221324 S STRL INSERT KIT FOLEY $24.00 12 ONCOLOGY SERVICES1210905 S STRL INTIMA IV CATH $18.00 $14.00 12 ONCOLOGY SERVICES1220557 S STRL VAGINAL DILATOR $26.00 12 ONCOLOGY SERVICES1220581 S STRL VAGINAL DILATOR $26.00 12 ONCOLOGY SERVICES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1250125 VENIPUNCTURE $59.00 12 ONCOLOGY SERVICES1220821 VENIPUNCTURE $59.00 12 ONCOLOGY SERVICES1260199 VENIPUNCTURE REF LAB 12 ONCOLOGY SERVICES1220888 VULVA COLPOSC W BX $447.00 12 ONCOLOGY SERVICES1260777 WEST NILE VIRUS NAT 12 ONCOLOGY SERVICES3021193 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3021201 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3021136 AEROSOL TX DEMO/EVAL $642.00 30 PULMONARY SERVICES3021227 AEROSOL TX DEMO/EVAL $275.00 30 PULMONARY SERVICES3020021 AEROSOL TX SUBSQ $250.00 $250.00 30 PULMONARY SERVICES3021219 AEROSOL TX SUBSQ $250.00 30 PULMONARY SERVICES3020567 AEROSOL TX SUBSQ $250.00 $135.00 30 PULMONARY SERVICES3021235 AEROSOL TX SUBSQ $285.00 30 PULMONARY SERVICES3010212 AIRWAY RESISTANCE $320.00 $144.00 30 PULMONARY SERVICES3030202 ARTERIAL PUNCTURE $281.00 30 PULMONARY SERVICES3010527 ARTERIAL PUNCTURE $281.00 30 PULMONARY SERVICES3021128 BD CONTINUOUS INITIAL DAY $1,421.00 30 PULMONARY SERVICES3021516 BD CONTINUOUS INITIAL DAY $1,421.00 30 PULMONARY SERVICES3021573 BD CONTINUOUS SUBSQ DAY $165.00 30 PULMONARY SERVICES3021367 BLD GAS ART $573.00 30 PULMONARY SERVICES3020047 BLD GASES W/O2 SAT $560.00 $845.00 30 PULMONARY SERVICES3021359 BODY FLUID PH NOS $103.00 30 PULMONARY SERVICES3020096 BREATH HYDROGEN TEST $528.00 $238.00 30 PULMONARY SERVICES3010014 BRONCHIAL PROVOCATION $1,933.00 $1,460.00 30 PULMONARY SERVICES3010451 BRONCHOSCOPY $1,652.00 30 PULMONARY SERVICES3010469 BRONCHOSCOPY INTERVENTN $1,867.00 30 PULMONARY SERVICES3030228 CAPILLARY PUNCTURE 30 PULMONARY SERVICES3050986 CBT EACH ADDL HOUR $165.00 $137.00 30 PULMONARY SERVICES3010089 CO DIFFUSING CAPACITY $624.00 $282.00 30 PULMONARY SERVICES3051141 CO DIFFUSING CAPACITY $150.00 30 PULMONARY SERVICES3020666 CPAP/BIPAP INITIAL DAY $2,511.00 $1,134.00 30 PULMONARY SERVICES3051083 CPAP/BIPAP INITIAL DAY $288.24 30 PULMONARY SERVICES3020187 CPAP/BIPAP INITIAL DAY $2,219.00 $1,051.00 30 PULMONARY SERVICES3021748 CPAP/BIPAP INITIAL DAY $288.24 30 PULMONARY SERVICES3021755 CPAP/BIPAP INITIAL DAY $2,511.00 30 PULMONARY SERVICES3020070 CPAP/BIPAP SUBSEQUENT DAY $2,511.00 $1,134.00 30 PULMONARY SERVICES3051091 CPAP/BIPAP SUBSEQUENT DAY $144.12 30 PULMONARY SERVICES3020443 CPT INITIAL $508.00 $230.00 30 PULMONARY SERVICES3020435 CPT INITIAL $340.00 $230.00 30 PULMONARY SERVICES3020914 CPT INITIAL $508.00 30 PULMONARY SERVICES3021599 CPT INITIAL $340.00 30 PULMONARY SERVICES3021607 CPT INITIAL $508.00 30 PULMONARY SERVICES3021581 CPT INITIAL $508.00 30 PULMONARY SERVICES

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3020450 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3020237 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3020625 CPT SUBSEQUENT $288.00 $130.00 30 PULMONARY SERVICES3021615 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3021623 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3021631 CPT SUBSEQUENT $288.00 30 PULMONARY SERVICES3020005 EKG 12 LEAD TRACING $480.00 $217.00 30 PULMONARY SERVICES3021144 ETCO2 INIT DAY $982.00 30 PULMONARY SERVICES3010550 ETCO2 INIT DAY $982.00 30 PULMONARY SERVICES3010063 ETCO2 SUBSQ DAY $982.00 $444.00 30 PULMONARY SERVICES3010113 FUNCTIONAL RES CAP/VOL $515.00 $232.00 30 PULMONARY SERVICES3051273 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3050911 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3051307 HELIOX THERAPY INIT TX $3,701.00 30 PULMONARY SERVICES3020260 HELIOX THERAPY SUBSQ TX $4,434.00 $3,346.00 30 PULMONARY SERVICES3020039 INHALATION TX PENTAMIDINE $445.00 $201.00 30 PULMONARY SERVICES3030558 INTUBATION ET EMERGENCY $325.00 30 PULMONARY SERVICES3020930 IPPB DEMO/EVAL $642.00 30 PULMONARY SERVICES3020948 IPPB TX SUBSEQUENT $298.00 30 PULMONARY SERVICES3020310 IPV DEMO/EVAL $642.00 $290.00 30 PULMONARY SERVICES3021425 IPV DEMO/EVAL $642.00 30 PULMONARY SERVICES3020757 IPV SUBSEQUENT $298.00 $135.00 30 PULMONARY SERVICES3021433 IPV SUBSEQUENT $298.00 30 PULMONARY SERVICES3010121 MAXIMAL VOLUNTARY VENT $369.00 $167.00 30 PULMONARY SERVICES3021110 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021441 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021458 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021490 MDI/NEB DEMO/EVAL $445.00 30 PULMONARY SERVICES3021508 MDI/NEB DEMO/EVAL $445.00 30 PULMONARY SERVICES3021474 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021482 MDI/NEB DEMO/EVAL $275.00 30 PULMONARY SERVICES3021466 MDI/NEB DEMO/EVAL $250.00 30 PULMONARY SERVICES3020328 MDI/NEB SUBSQ $250.00 $250.00 30 PULMONARY SERVICES3021524 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021540 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021565 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021532 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3021557 MDI/NEB SUBSQ $250.00 30 PULMONARY SERVICES3050895 NITRIC OXIDE $10,112.00 30 PULMONARY SERVICES3050879 NITRIC OXIDE $13,483.00 30 PULMONARY SERVICES3020385 OXYGEN $1,227.00 $1,158.00 30 PULMONARY SERVICES3050929 OXYGEN $1,337.00 30 PULMONARY SERVICES3020484 OXYGEN $1,937.00 $1,827.00 30 PULMONARY SERVICES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3050135 OXYGEN $107.00 $101.00 30 PULMONARY SERVICES3050952 OXYGEN $2,111.00 30 PULMONARY SERVICES3051174 OXYGEN $2,111.00 30 PULMONARY SERVICES3051216 OXYGEN $1,337.00 30 PULMONARY SERVICES3050937 OXYGEN $1,049.00 30 PULMONARY SERVICES3010170 OXYGEN UPTAKE COMPLEX $956.00 30 PULMONARY SERVICES3021342 PH BLD $217.00 30 PULMONARY SERVICES3010675 PULMONARY STRESS COMPLEX $1,395.00 30 PULMONARY SERVICES3010667 PULMONARY STRESS SIMPLE 30 PULMONARY SERVICES3010006 PULSE OXIMETRY MULTIPLE $455.00 $205.00 30 PULMONARY SERVICES3030145 PULSE OXIMETRY MULTIPLE $455.00 $462.00 30 PULMONARY SERVICES3010618 PULSE OXIMETRY MULTIPLE $455.00 30 PULMONARY SERVICES3010147 PULSE OXIMETRY SINGLE $175.00 $79.00 30 PULMONARY SERVICES3010600 PULSE OXIMETRY SINGLE $175.00 30 PULMONARY SERVICES3010626 PULSE OX-OVERNIGHT CONT $628.00 30 PULMONARY SERVICES3010154 PULSE OX-OVERNIGHT CONT $628.00 $284.00 30 PULMONARY SERVICES3050044 S NSTRL DISP RESUS BAG $148.00 $139.00 30 PULMONARY SERVICES3050960 S NSTRL FLUTTER THER DEVI $337.00 30 PULMONARY SERVICES3050564 S NSTRL FTR EXCHANGE $25.00 30 PULMONARY SERVICES3050580 S NSTRL HEADGEAR BIPAP $187.00 30 PULMONARY SERVICES3050598 S NSTRL HFOV PT.CIRCUIT $615.00 30 PULMONARY SERVICES3050119 S NSTRL MDI SPACER $43.00 $41.00 30 PULMONARY SERVICES3050150 S NSTRL OXYHOOD $86.00 $81.00 30 PULMONARY SERVICES3050168 S NSTRL PEAK FLOW METER $110.00 $104.00 30 PULMONARY SERVICES3050945 S NSTRL PEP THERAPY DEVIC $337.00 30 PULMONARY SERVICES3051331 S NSTRL SPIROMTR INCNTV $175.00 30 PULMONARY SERVICES3050200 S NSTRL THERAPY VEST $225.00 $212.00 30 PULMONARY SERVICES3050416 S STRL BAGS STERILE WATER $12.00 30 PULMONARY SERVICES3050838 S STRL BRUSH MICROVAS CYT $66.00 30 PULMONARY SERVICES3050440 S STRL CIRCUIT BIPAP $395.00 30 PULMONARY SERVICES3050465 S STRL CIRCUIT IPPB DISP $13.00 30 PULMONARY SERVICES3050473 S STRL CIRCUIT NEO TRANSP $53.00 30 PULMONARY SERVICES3050507 S STRL CIRCUIT VENT MRI $45.00 30 PULMONARY SERVICES3050275 S STRL CONT MED NEB CIR $96.00 30 PULMONARY SERVICES3050002 S STRL HAND HELD NEB TUBE $27.00 $25.00 30 PULMONARY SERVICES3050051 S STRL HI FREQ VENT TUBE $402.00 $379.00 30 PULMONARY SERVICES3050077 S STRL INTUB TY $83.00 $78.00 30 PULMONARY SERVICES3050085 S STRL IPV TUBE $129.00 $122.00 30 PULMONARY SERVICES3050614 S STRL MASK BIPAP $212.00 30 PULMONARY SERVICES3050127 S STRL OXISENSOR PROBE $124.00 $117.00 30 PULMONARY SERVICES3050903 S STRL PERCUTANEOUS CATH $3,220.00 30 PULMONARY SERVICES3050218 S STRL TRACHEA COLLAR $27.00 $25.00 30 PULMONARY SERVICES3050036 S STRL VENT CONT TUBE $129.00 $122.00 30 PULMONARY SERVICES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3020229 SLEEP STUDY ATTENDED $6,157.00 $2,781.00 30 PULMONARY SERVICES3010238 SPIROMETRY $1,116.00 $504.00 30 PULMONARY SERVICES3010709 SPIROMETRY $1,116.00 30 PULMONARY SERVICES3051109 SPIROMETRY $499.00 30 PULMONARY SERVICES3010220 SPIROMETRY PRE/POST BD $1,379.00 $652.00 30 PULMONARY SERVICES3051166 SPIROMETRY PRE/POST BD $275.00 30 PULMONARY SERVICES3010659 SPIROMETRY PRE/POST BD $1,379.00 30 PULMONARY SERVICES3020617 SPUTUM INDCTN VIA AEROSOL $901.00 $407.00 30 PULMONARY SERVICES3020609 SPUTUM INDCTN VIA AEROSOL $860.00 $407.00 30 PULMONARY SERVICES3021649 SPUTUM INDCTN VIA AEROSOL $901.00 30 PULMONARY SERVICES3021334 SUCTION NASOTRACHEAL $191.00 30 PULMONARY SERVICES3021151 TCM INITIAL DAY $2,380.00 30 PULMONARY SERVICES3010261 TCM SUBSEQUENT DAY $1,879.00 $889.00 30 PULMONARY SERVICES3030111 THER PROC RESP FNCTN 15M $85.00 30 PULMONARY SERVICES3021326 THER PROC RESP FNCTN GRP $246.00 30 PULMONARY SERVICES3030178 THER PROC STRNTH/ENDR 15M $85.00 30 PULMONARY SERVICES3010253 THORACIC GAS VOLUME $1,265.00 $571.00 30 PULMONARY SERVICES3051158 THORACIC GAS VOLUME $300.00 30 PULMONARY SERVICES3020294 TRACHEAL PUNCTURE PRC $6,406.00 30 PULMONARY SERVICES3021268 VENT MGMNT INIT NEO/PEDS $4,695.00 30 PULMONARY SERVICES3020708 VENT MGMNT INITIAL $4,093.00 $1,848.00 30 PULMONARY SERVICES3021409 VENT MGMNT INITIAL $4,095.00 $1,851.00 30 PULMONARY SERVICES3021722 VENT MGMNT INITIAL HF $4,807.00 30 PULMONARY SERVICES3020732 VENT MGMNT INITIAL HF $4,807.00 $2,277.00 30 PULMONARY SERVICES3020161 VENT MGMNT SUBSEQUENT $3,338.00 $1,508.00 30 PULMONARY SERVICES3021417 VENT MGMNT SUBSEQUENT $3,340.00 $1,510.00 30 PULMONARY SERVICES3020278 VENT MGMNT SUBSEQUENT HF $5,109.00 $2,419.00 30 PULMONARY SERVICES3021730 VENT MGMNT SUBSEQUENT HF $3,338.00 30 PULMONARY SERVICES3021276 VENT MGMNT SUBSQ NEO/PEDS $4,368.00 30 PULMONARY SERVICES3010188 VITAL CAPACITY $299.00 $135.00 30 PULMONARY SERVICES3010683 VITAL CAPACITY $299.00 30 PULMONARY SERVICES2810232 CARDIOVERT ELECTIVE EXT $1,983.00 28 RECOVERY SVS2810281 CPLX PACU ADD 15M $1,400.00 $770.00 28 RECOVERY SVS2810273 CPLX PACU FIRST 30M $2,821.00 $1,552.00 28 RECOVERY SVS2810240 INJ BLOOD PATCH $1,417.00 28 RECOVERY SVS2820132 S STRL AMBU BAG $155.00 $117.00 28 RECOVERY SVS2820470 S STRL CATHETER IV JELC $13.00 $10.00 28 RECOVERY SVS2820629 S STRL CATHETER TRAY PL $4.00 $3.00 28 RECOVERY SVS2820256 S STRL COLLAR TRACH $28.00 $21.00 28 RECOVERY SVS2820801 S STRL DRAIN URINEMETER $63.00 $47.00 28 RECOVERY SVS2820488 S STRL FTR BLOOD 20 MIC $61.00 $46.00 28 RECOVERY SVS2820900 S STRL GEMINI BLOOD SET $78.00 $59.00 28 RECOVERY SVS2820918 S STRL HAND HELD NEBULI $10.00 $8.00 28 RECOVERY SVS

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2830008 S STRL INCENTIVE SPIROM $31.00 $24.00 28 RECOVERY SVS2820082 S STRL KIT SUC CATH 14FR $6.00 $5.00 28 RECOVERY SVS2820983 S STRL PULSE OX PROBE $97.00 $73.00 28 RECOVERY SVS2820579 S STRL SET IV BLOOD Y P $31.00 $24.00 28 RECOVERY SVS2820678 S STRL TY CATH FOLEY $76.00 $57.00 28 RECOVERY SVS2810265 STND PACU LVL 2 ADD 15M $493.00 $271.00 28 RECOVERY SVS2810257 STND PACU LVL 2 FIRST 30M $1,304.00 $717.00 28 RECOVERY SVS2820827 VENIPUNCTURE $28.00 $26.00 28 RECOVERY SVS4230793 11 DEOXYCORTICOSTERONE $49.00 42 REFERENCE LAB4230009 11 DEOXYCORTISOL $8.25 42 REFERENCE LAB4230017 17 OH CORTICOSTEROIDS $31.15 42 REFERENCE LAB4230033 17 OH PREGNENOLONE $33.25 42 REFERENCE LAB4259867 17 OH PROGESTRONE $14.50 42 REFERENCE LAB4230041 17 OH PROGESTRONE $24.75 42 REFERENCE LAB4230066 5 HIAA UR $15.60 42 REFERENCE LAB4230058 5 NUCLEOTIDASE $16.05 42 REFERENCE LAB4230074 ACE (ANGIOTN CONVR ENZ) $12.00 42 REFERENCE LAB4235768 ACETYCHOLINE REC MOD AB $50.66 42 REFERENCE LAB4235743 ACETYLCHOLINE REC BIND AB $50.66 42 REFERENCE LAB4235750 ACETYLCHOLINE REC BLCK AB $50.66 42 REFERENCE LAB4234233 ACETYLCHOLINE REC BLCK AB $48.00 42 REFERENCE LAB4230082 ACETYLCHOLINE RECEPT AB $45.00 42 REFERENCE LAB4230108 ACID PHOS PROSTATIC $9.75 42 REFERENCE LAB4230124 ACTH $18.00 42 REFERENCE LAB4234019 ACTIN AB IGG $13.00 42 REFERENCE LAB4234241 ACYLCARNITINES QN EA $86.00 42 REFERENCE LAB4234258 ACYLCARNITINES QN EA $86.00 42 REFERENCE LAB4230132 ADENOVIRUS AB $22.00 42 REFERENCE LAB4256541 ADENOVIRUS DFA $216.00 $146.00 42 REFERENCE LAB4232898 ADENOVIRUS DFA $22.00 42 REFERENCE LAB4230280 ADH (VASOPRESSIN) $25.00 42 REFERENCE LAB4256707 AFB CULT $194.00 42 REFERENCE LAB4232823 AFB CULT $10.54 42 REFERENCE LAB4250684 AFB ISOLATE ID $30.87 $30.87 $30.87 $30.87 42 REFERENCE LAB4250411 AFP AMNIOTIC FLD $30.00 $30.00 $30.00 $30.00 42 REFERENCE LAB4250429 AFP AMNIOTIC FLD 42 REFERENCE LAB4230140 AFP TUMOR MARKER $11.00 42 REFERENCE LAB4256616 AG DETECT EIA MULT STEP $216.00 42 REFERENCE LAB4234761 AG DETECT EIA MULT STEP $24.00 42 REFERENCE LAB4230736 AG DETECT EIA MULT STEP $8.25 42 REFERENCE LAB4231940 AG DETECT NOS DNA AMP $85.00 42 REFERENCE LAB4233045 AG DETECT NOS EIA 1 STEP $29.40 42 REFERENCE LAB4230728 AG DETECT NOS EIA 1 STEP $23.00 42 REFERENCE LAB

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

4232815 AG DETECT NOS EIA 1 STEP $47.16 42 REFERENCE LAB4233409 ALBUMIN SERUM/PLASMA/BLD $132.00 42 REFERENCE LAB4233417 ALBUMIN SERUM/PLASMA/BLD $9.00 42 REFERENCE LAB4230165 ALDOLASE $8.50 42 REFERENCE LAB4230173 ALDOSTERONE $27.00 42 REFERENCE LAB4230181 ALK PHOS ISOENZYMES $17.00 42 REFERENCE LAB4234266 ALK PHOSPHATASE $29.49 42 REFERENCE LAB4231825 ALLERGEN SPECIFIC IGE QN $5.93 42 REFERENCE LAB4230199 ALPHA 1 ANTITRYPSIN $13.25 42 REFERENCE LAB4272100 ALPHA 1 ANTITRYPSIN $78.44 42 REFERENCE LAB4233458 ALPHA 2 ANTIPLASMIN $50.50 42 REFERENCE LAB4230215 ALUMINUM $22.00 42 REFERENCE LAB4234464 AMEBIC AB $19.00 42 REFERENCE LAB4230223 AMIKACIN $22.00 42 REFERENCE LAB4234274 AMIKACIN PK $15.00 42 REFERENCE LAB4234282 AMIKACIN TR $15.00 42 REFERENCE LAB4233094 AMINO ACIDS CSF >5 QN $131.00 42 REFERENCE LAB4233086 AMINO ACIDS CSF >5 QN $164.26 42 REFERENCE LAB4233078 AMINO ACIDS CSF >5 QN $96.50 42 REFERENCE LAB4230249 AMINO ACIDS MULT QL $62.78 42 REFERENCE LAB4254983 AMINO ACIDS PLAS >5 QN $150.00 $150.00 $150.00 $150.00 42 REFERENCE LAB4230231 AMINO ACIDS SGL QN $49.00 42 REFERENCE LAB4254991 AMINO ACIDS UR >5 QN $150.00 $150.00 $150.00 $150.00 42 REFERENCE LAB4230256 AMINO ACIDS UR MULT QL $19.00 42 REFERENCE LAB4232195 AMIODARONE $29.00 42 REFERENCE LAB4271995 ANA (ANTI NUCLEAR AB) $216.00 42 REFERENCE LAB4230553 ANA (ANTI NUCLEAR AB) $19.00 42 REFERENCE LAB4256756 ANA (ANTI NUCLEAR AB) $216.00 42 REFERENCE LAB4231692 ANA (ANTI NUCLEAR AB) $13.10 42 REFERENCE LAB4230272 ANA (ANTI NUCLEAR AB) $7.27 42 REFERENCE LAB4233136 ANA TTR $9.00 42 REFERENCE LAB4234290 ANCA IBD SCREEN $64.50 42 REFERENCE LAB4235529 ANDROSTENEDIONE $21.00 42 REFERENCE LAB4230264 ANDROSTENEDIONE $21.00 42 REFERENCE LAB4233961 ANDROSTENEDIONE $180.00 42 REFERENCE LAB4272001 ANTI DNA DBL STRAND $247.00 42 REFERENCE LAB4231718 ANTI DNA DBL STRAND $13.10 42 REFERENCE LAB4256764 ANTI DNA DBL STRAND $247.00 42 REFERENCE LAB4230835 ANTI DNA DBL STRAND $12.00 42 REFERENCE LAB4230843 ANTI DNA SINGL STRAND $31.15 42 REFERENCE LAB4272050 ANTI RNP AB $322.00 42 REFERENCE LAB4256822 ANTI RNP AB $271.00 42 REFERENCE LAB4234985 ANTI SM AB $18.00 42 REFERENCE LAB

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DEPARTMENT CODE

4231650 ANTINEUTROPHILIC AB $28.50 42 REFERENCE LAB4272118 APOLIPOPROTEIN A1 $82.32 42 REFERENCE LAB4272126 APOLIPOPROTEIN B $82.32 42 REFERENCE LAB4233193 ARSENIC BLD $19.00 42 REFERENCE LAB4230306 ARSENIC UR $16.50 42 REFERENCE LAB4235222 ARSENIC UR $9.42 42 REFERENCE LAB4232708 ASCORBIC ACID $14.00 42 REFERENCE LAB4232427 ASO SCRN $9.75 42 REFERENCE LAB4270005 ASO TTR $133.00 42 REFERENCE LAB4230314 ASPERGILLUS AB $6.17 42 REFERENCE LAB4272159 ASSAY OF LIPOPROTEIN(A) $76.64 42 REFERENCE LAB4233466 AT3 AG IMMUNOLOGIC $26.00 42 REFERENCE LAB4230363 B PERTUSSIS/PARAPERT DFA $10.00 42 REFERENCE LAB4232948 B PERTUSSIS/PARAPERT DFA $26.00 42 REFERENCE LAB4279071 B/P-PERTUSSIS DNA QUL PCR $148.17 42 REFERENCE LAB4233110 BACTERIAL AG EA AG $16.50 42 REFERENCE LAB4230348 BENZODIAZEPINES $8.25 42 REFERENCE LAB4234530 BETA 2 GLYCOPROTN I AB EA $22.91 42 REFERENCE LAB4233482 BETA 2 GLYCOPROTN I AB EA $23.15 42 REFERENCE LAB4231148 BETA HCG QN $11.00 42 REFERENCE LAB4230330 BETA2 MICROGLOBULIN $19.95 42 REFERENCE LAB4272134 BETA2 MICROGLOBULIN $94.48 42 REFERENCE LAB4234662 BILE ACIDS TOTAL $112.00 42 REFERENCE LAB4259883 BIOTINIDASE ASSAY $14.50 42 REFERENCE LAB4233904 BIOTINIDASE ASSAY $53.57 42 REFERENCE LAB4234357 BIOTINIDASE ASSAY $108.08 42 REFERENCE LAB4234365 BK VIRUS DNA QUANT PCR $224.40 42 REFERENCE LAB4230355 BLASTOMYCES AB $19.35 42 REFERENCE LAB4235305 BLD CNT RBC AUTO $5.04 42 REFERENCE LAB4230967 BLD FATTY ACIDS $15.00 42 REFERENCE LAB4234332 BORELLIA BURG AMP PRB $125.00 42 REFERENCE LAB4230389 BORRELIA BURGD CONF $19.46 42 REFERENCE LAB4235495 BRUCELLA AB $10.50 42 REFERENCE LAB4230397 BRUCELLA AB $18.87 42 REFERENCE LAB4255311 C DIFFICILE TOXIN EIA $216.00 $216.00 $13.00 $196.00 42 REFERENCE LAB4230686 C PEPTIDE $16.00 42 REFERENCE LAB4230694 C REACTIVE PROTEIN $9.74 42 REFERENCE LAB4230413 C1 ESTERASE INHIBITOR $17.00 42 REFERENCE LAB4270104 CA 15 3 (27.29) $371.00 42 REFERENCE LAB4235255 CADMIUM $9.42 42 REFERENCE LAB4233276 CAFFEINE $25.00 42 REFERENCE LAB4234415 CAFFEINE $20.00 42 REFERENCE LAB4232286 CALC ANALYSIS INFRARED $25.00 42 REFERENCE LAB

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4233037 CALC ANALYSIS INFRARED $25.00 42 REFERENCE LAB4230470 CALCITONIN $27.50 42 REFERENCE LAB4270203 CALCIUM IONIZED $243.00 42 REFERENCE LAB4230488 CALCIUM IONIZED $10.00 42 REFERENCE LAB4234225 CAMPLYOBACTER AB $65.00 42 REFERENCE LAB4256913 CANDIDA DNA DIR PROBE $49.60 42 REFERENCE LAB4235636 CARBOXYHEMOGLOBIN QN $52.90 42 REFERENCE LAB4235487 CARDIOLIPIN AB $22.91 42 REFERENCE LAB4256194 CARDIOLIPIN AB $29.10 42 REFERENCE LAB4233524 CARDIOLIPIN IGA AB $23.14 42 REFERENCE LAB4233508 CARDIOLIPIN IGG AB $23.14 42 REFERENCE LAB4233516 CARDIOLIPIN IGM AB $23.14 42 REFERENCE LAB4230504 CARNITINE FREE & TOTAL $31.00 42 REFERENCE LAB4230512 CAROTENE $15.00 42 REFERENCE LAB4230538 CATECHOL FRAC PLAS $25.00 42 REFERENCE LAB4230520 CATECHOL FRAC PLAS $27.50 42 REFERENCE LAB4235065 CATECHOL FRAC UR $13.75 42 REFERENCE LAB4235552 CATECHOLAMINES PLAS $13.75 42 REFERENCE LAB4230546 CEA $9.75 42 REFERENCE LAB4272068 CENTROMERE AB $322.00 42 REFERENCE LAB4256830 CENTROMERE AB $322.00 42 REFERENCE LAB4270302 CERULOPLASMIN $190.00 42 REFERENCE LAB4230561 CERULOPLASMIN $9.75 42 REFERENCE LAB4234597 CHLAMYD PNEUMO AMP PRB $135.00 42 REFERENCE LAB4230587 CHLAMYDIA AB $17.50 42 REFERENCE LAB4234647 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234639 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234654 CHLAMYDIA AB IGG $8.50 42 REFERENCE LAB4234613 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB4234605 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB4234621 CHLAMYDIA AB IGM $8.33 42 REFERENCE LAB4255402 CHLAMYDIA AG DFA $181.00 $146.00 $13.00 $18.00 42 REFERENCE LAB4234787 CHLAMYDIA CULT $58.50 42 REFERENCE LAB4255329 CHLAMYDIA CULT $299.00 $241.00 $27.73 $30.00 42 REFERENCE LAB4259891 CHLAMYDIA TRACH AMP PRB $216.00 42 REFERENCE LAB4234589 CHLAMYDIA TRACH AMP PRB $30.00 42 REFERENCE LAB4255238 CHLAMYDIA TRACH DIR PRB $358.00 $358.00 $13.00 $329.00 42 REFERENCE LAB4234449 CHLORIDE OTHER SOURCE $8.00 42 REFERENCE LAB4230603 CHOLINESTERASE RBC $24.00 42 REFERENCE LAB4234563 CHOLINESTERASE SER $7.75 42 REFERENCE LAB4230595 CHOLINESTERASE SER $24.75 42 REFERENCE LAB4235453 CHRMOSOM CNT/KARY $49.00 42 REFERENCE LAB4234522 CITRATE UR 24HR $18.00 42 REFERENCE LAB

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4235586 CMV AB IGG $11.00 42 REFERENCE LAB4230611 CMV AB IGG $11.00 42 REFERENCE LAB4232435 CMV AB IGG $8.68 42 REFERENCE LAB4235594 CMV AB IGM $11.00 42 REFERENCE LAB4230629 CMV AB IGM $11.00 42 REFERENCE LAB4232443 CMV AB IGM $8.68 42 REFERENCE LAB4233912 CMV AMP PRB $87.50 42 REFERENCE LAB4235602 CMV AMP PRB $87.50 42 REFERENCE LAB4232807 COCCI AB COMP FIX $47.16 42 REFERENCE LAB4232369 COCCI IMMUNO DIFFUSION $43.20 42 REFERENCE LAB4230637 COCCIDIOIDES AB $25.25 42 REFERENCE LAB4234688 COCCIDIOIDES AB IGG $43.50 42 REFERENCE LAB4234696 COCCIDIOIDES AB IGM $43.50 42 REFERENCE LAB4230405 COMPLEMENT C2 $17.00 42 REFERENCE LAB4279089 COMPLEMENT C3 $7.38 42 REFERENCE LAB4230421 COMPLEMENT C3 $8.00 42 REFERENCE LAB4231700 COMPLEMENT C3 $13.10 42 REFERENCE LAB4279097 COMPLEMENT C4 $7.38 42 REFERENCE LAB4230439 COMPLEMENT C4 $8.00 42 REFERENCE LAB4234670 COMPLEMENT C6 $33.25 42 REFERENCE LAB4230645 COMPLEMENT TOT (CH50) $11.00 42 REFERENCE LAB4279105 COMPLEMENT TOT (CH50) $12.24 42 REFERENCE LAB4230652 COPPER $15.00 42 REFERENCE LAB4234308 COPPER $15.00 42 REFERENCE LAB4230660 CORTISOL FREE SER $21.25 42 REFERENCE LAB4234316 CORTISOL FREE UR $21.25 42 REFERENCE LAB4230678 CORTISOL TOTAL $11.14 42 REFERENCE LAB4230702 CREATINE UR 24HR $13.00 42 REFERENCE LAB4235891 CREATININE FLD $10.50 42 REFERENCE LAB4235560 CREATININE UR $13.75 42 REFERENCE LAB4235073 CREATININE UR $13.75 42 REFERENCE LAB4235271 CREATININE UR RAN $9.42 42 REFERENCE LAB4270401 CRYOGLOB QL OR SEMI QL $28.00 42 REFERENCE LAB4230710 CRYOGLOB QL OR SEMI QL $7.00 42 REFERENCE LAB4231056 CRYOGLOBULIN QN $6.55 42 REFERENCE LAB4256517 CRYPTO AG DFA $216.00 42 REFERENCE LAB4256624 CRYPTOCOCCAL AG TTR AGGL $77.00 42 REFERENCE LAB4233169 CRYPTOCOCCAL AG TTR AGGL $16.50 42 REFERENCE LAB4230744 CRYPTOCOCCUS AB $25.00 42 REFERENCE LAB4256731 CRYPTOSPORIDIUM $216.00 42 REFERENCE LAB4256251 CULT BACT AEROBIC ID $146.00 42 REFERENCE LAB4256277 CULT BACT AEROBIC ID $146.00 42 REFERENCE LAB4232872 CULT BACT AEROBIC ID $28.00 42 REFERENCE LAB

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4256285 CULT BETA STREP A ONLY $119.00 42 REFERENCE LAB4250544 CULT BLD BACTERIA $186.00 $186.00 $13.00 $171.00 42 REFERENCE LAB4256376 CULT CATHETER TIP $155.00 42 REFERENCE LAB4235628 CULT CMV $20.00 42 REFERENCE LAB4232880 CULT CMV $50.00 42 REFERENCE LAB4256368 CULT CSF $155.00 42 REFERENCE LAB4250585 CULT ENVIRONMENT $11.32 $11.32 $11.32 42 REFERENCE LAB4256418 CULT FLUID $155.00 42 REFERENCE LAB4256426 CULT FLUID (ANAEROBIC) $168.00 42 REFERENCE LAB4250510 CULT FUNGUS BLD $159.00 $159.00 $149.00 42 REFERENCE LAB4250528 CULT FUNGUS OTHER SOURCE $150.00 $150.00 $13.00 $137.00 42 REFERENCE LAB4256921 CULT FUNGUS YEAST ID $44.00 42 REFERENCE LAB4256269 CULT FUNGUS YEAST ID $157.00 42 REFERENCE LAB4250536 CULT GC SCRN $119.00 $119.00 $13.00 $111.00 42 REFERENCE LAB4256293 CULT GRP B STREP SCRN $119.00 42 REFERENCE LAB4232856 CULT HERPES $21.40 42 REFERENCE LAB4279030 CULT LEGIONELLA $30.00 42 REFERENCE LAB4234852 CULT LEGIONELLA $30.00 42 REFERENCE LAB4256319 CULT LOWER RESPIRATORY $155.00 42 REFERENCE LAB4256384 CULT MISC $155.00 42 REFERENCE LAB4256939 CULT MISC $74.63 42 REFERENCE LAB4234795 CULT MISC $84.63 42 REFERENCE LAB4256392 CULT MRSA SCRN $119.00 42 REFERENCE LAB4256327 CULT OTHER SOURCE AEROBIC $155.00 42 REFERENCE LAB4232922 CULT RSV $65.00 42 REFERENCE LAB4256434 CULT SCRN B PERTUSSUS $119.00 42 REFERENCE LAB4250627 CULT STL SALM & SHIG $168.00 $168.00 $13.00 $154.00 42 REFERENCE LAB4250635 CULT STL YERSINIA EA PLT $9.56 $9.56 $9.56 $9.56 42 REFERENCE LAB4256301 CULT THROAT $155.00 42 REFERENCE LAB4256335 CULT TISSUE (ANAEROBIC) $168.00 42 REFERENCE LAB4250569 CULT UR ID EACH ISOLATE $146.00 $146.00 $13.00 $132.00 42 REFERENCE LAB4256400 CULT VRE SCRN $119.00 42 REFERENCE LAB4256350 CULT WND/ABSCESS ANAEROBE $168.00 42 REFERENCE LAB4256343 CULT WOUND AEROBIC $155.00 42 REFERENCE LAB4232849 CULTVIRAL $30.00 42 REFERENCE LAB4230751 CYANIDE $27.85 42 REFERENCE LAB4234340 CYANIDE SCRN $44.87 42 REFERENCE LAB4230769 CYCLIC AMP $27.50 42 REFERENCE LAB4234431 CYCLIC CITRUNILATED PEPTI $35.00 42 REFERENCE LAB4253308 CYCLOSPORINE $31.00 $31.00 $31.00 $31.00 42 REFERENCE LAB4234373 CYSTATIN C $54.00 42 REFERENCE LAB4230777 CYSTICERCOSIS AB $50.00 42 REFERENCE LAB4234746 CYSTINE UR QN $19.00 42 REFERENCE LAB

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4230785 DELTA ALA $28.00 42 REFERENCE LAB4234399 DEOXYRIBNUCLEASE AB $16.00 42 REFERENCE LAB4230801 DESIPRAMINE $26.11 42 REFERENCE LAB4230827 DHEA $25.00 42 REFERENCE LAB4230819 DHEA SULFATE $12.00 42 REFERENCE LAB4234571 DIBUCAINE NUMBER $7.75 42 REFERENCE LAB4234407 DIHYDROTESTOSTERONE $30.00 42 REFERENCE LAB4234712 DIPTHERIA AB $25.12 42 REFERENCE LAB4230850 DOXEPIN $22.00 42 REFERENCE LAB4256657 DRG CONF $75.00 42 REFERENCE LAB4256640 DRG SCRN BLD VOLATILES $18.00 42 REFERENCE LAB4255030 DRG SCRN QL CHROM EA $33.00 $33.00 $33.00 $33.00 42 REFERENCE LAB4254249 DRG SCRN QL CHROM EA $15.00 $15.00 $15.00 $15.00 42 REFERENCE LAB4271979 EBV AB EARLY AG $45.82 42 REFERENCE LAB4256871 EBV AB EARLY AG $45.82 42 REFERENCE LAB4271987 EBV AB EBNA $53.45 42 REFERENCE LAB4230868 EBV AB EBNA $14.45 42 REFERENCE LAB4256889 EBV AB EBNA $53.45 42 REFERENCE LAB4230876 EBV AB VCA $12.00 42 REFERENCE LAB4234456 EBV DNA QNT PCR $129.00 42 REFERENCE LAB4271953 EBV VCA AB IGG $63.38 42 REFERENCE LAB4256855 EBV VCA AB IGG $63.38 42 REFERENCE LAB4271961 EBV VCA AB IGM $63.38 42 REFERENCE LAB4256863 EBV VCA AB IGM $63.38 42 REFERENCE LAB4233979 ELASTASE RIA $240.00 42 REFERENCE LAB4256152 ELECTRON MICROSCOPY $177.23 42 REFERENCE LAB4230959 ENA AB $36.00 42 REFERENCE LAB4251518 ENA AB $21.00 $21.00 $21.00 $21.00 42 REFERENCE LAB4234472 ENDOMYSIAL AB SCRN $22.00 42 REFERENCE LAB4230884 ENTEROVIRUS AB $21.24 42 REFERENCE LAB4234001 ENTEROVIRUS RNA QUAL PCR $250.00 42 REFERENCE LAB4256137 ENZYME HISTOCHEMISTRY $62.45 42 REFERENCE LAB4230892 ERYTHROPOIETIN $20.43 42 REFERENCE LAB4230900 ESTRADIOL (E2) $19.55 42 REFERENCE LAB4235651 ESTRADIOL (E2) $17.00 42 REFERENCE LAB4235669 ESTRIOL $17.00 42 REFERENCE LAB4230918 ESTRIOL $17.00 42 REFERENCE LAB4230926 ESTROGEN TOTAL $26.00 42 REFERENCE LAB4235644 ESTRONE $17.00 42 REFERENCE LAB4230934 ESTRONE $27.00 42 REFERENCE LAB4230942 ETHOSUXIMIDE $17.10 42 REFERENCE LAB4233532 EUGLOBULIN LYSIS $41.40 42 REFERENCE LAB4230975 FAT STL QL $17.80 42 REFERENCE LAB

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4231684 FAT STL QN $44.80 42 REFERENCE LAB4233540 FCTR II $78.00 42 REFERENCE LAB4233805 FCTR II $127.50 42 REFERENCE LAB4250312 FCTR INHIBITOR TEST $72.50 $121.00 $121.00 42 REFERENCE LAB4233672 FCTR INHIBITOR TEST $114.30 42 REFERENCE LAB4250064 FCTR INHIBITOR TEST $232.00 $232.00 $232.00 $232.00 42 REFERENCE LAB4233656 FCTR INHIBITOR TEST $117.00 42 REFERENCE LAB4233649 FCTR INHIBITOR TEST $110.00 42 REFERENCE LAB4250056 FCTR INHIBITOR TEST $60.00 $60.00 $60.00 $60.00 42 REFERENCE LAB4233847 FCTR IX $127.50 42 REFERENCE LAB4233581 FCTR IX $67.50 42 REFERENCE LAB4233557 FCTR V $49.00 42 REFERENCE LAB4233813 FCTR V $127.50 42 REFERENCE LAB4233565 FCTR VII $59.00 42 REFERENCE LAB4233821 FCTR VII $127.50 42 REFERENCE LAB4233839 FCTR VIII $127.50 42 REFERENCE LAB4233573 FCTR VIII $45.00 42 REFERENCE LAB4250320 FCTR VIII VW AG $72.50 $121.00 42 REFERENCE LAB4233771 FCTR VIII VW AG $59.00 42 REFERENCE LAB4233789 FCTR VIII VW MULTIMER $69.00 42 REFERENCE LAB4250072 FCTR VIII VW MULTIMER $135.00 $135.00 $135.00 $135.00 42 REFERENCE LAB4233854 FCTR X $127.50 42 REFERENCE LAB4233599 FCTR X $59.00 42 REFERENCE LAB4233862 FCTR XI $127.50 42 REFERENCE LAB4233607 FCTR XI $49.00 42 REFERENCE LAB4233870 FCTR XII $127.50 42 REFERENCE LAB4233615 FCTR XII $49.00 42 REFERENCE LAB4233623 FCTR XIII $40.00 42 REFERENCE LAB4233888 FCTR XIII SCRN $50.00 42 REFERENCE LAB4230157 FEBRILE AGGLUTINS $13.20 42 REFERENCE LAB4230983 FERRITIN $8.25 42 REFERENCE LAB4233631 FIBRINOGEN QN $15.00 42 REFERENCE LAB4230991 FLUOR AB SCRN EA AB SCRN $15.00 42 REFERENCE LAB4231726 FLUOR AB SCRN EA AB SCRN $13.10 42 REFERENCE LAB4231015 FOLATE $5.70 42 REFERENCE LAB4231007 FOLATE RBC $19.90 42 REFERENCE LAB4232336 FREE T4 $8.30 42 REFERENCE LAB4235677 FREE T4 $22.00 42 REFERENCE LAB4231023 FRUCTOSAMINE $10.25 42 REFERENCE LAB4231031 FSH $8.75 42 REFERENCE LAB4234027 FSH PEDI 3RD GENE $28.50 42 REFERENCE LAB4232559 FTA ABS (TPPA) $8.85 42 REFERENCE LAB4231049 G6PD QN $14.00 42 REFERENCE LAB

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4256905 GARDNER VAG DNA DIR PROBE $49.60 42 REFERENCE LAB4234068 GASTRIC PARIETAL CELL AB $17.00 42 REFERENCE LAB4231064 GASTRIN $15.00 42 REFERENCE LAB4259909 GC AMP PRB $216.00 42 REFERENCE LAB4255246 GC DIR PRB $358.00 $358.00 $13.00 $329.00 42 REFERENCE LAB4256509 GIARDIA AG DFA $216.00 42 REFERENCE LAB4231072 GIARDIA AG DFA $25.00 42 REFERENCE LAB4235537 GLIADIN AB IGA $30.00 42 REFERENCE LAB4234035 GLIADIN AB IGA $14.25 42 REFERENCE LAB4234043 GLIADIN AB IGG $14.25 42 REFERENCE LAB4231080 GLUCAGON $25.00 42 REFERENCE LAB4279006 GLUCOSE FINGERSTICK 42 REFERENCE LAB4234142 GNTYP NA HIV1 RVRS T/P RG $280.00 42 REFERENCE LAB4231114 GROWTH HORMONE $12.50 42 REFERENCE LAB4231106 GROWTH HORMONE $12.50 42 REFERENCE LAB4256723 H PYLORI (NOT STL) EIA $216.00 42 REFERENCE LAB4231171 H PYLORI AB IGG $10.00 42 REFERENCE LAB4231122 H PYLORI AB TOTAL $16.00 42 REFERENCE LAB4256749 H PYLORI STL EIA $110.00 $65.00 42 REFERENCE LAB4234076 HALOPERIDOL $22.00 42 REFERENCE LAB4270708 HAPTOGLOBIN QN $225.00 42 REFERENCE LAB4231130 HAPTOGLOBIN QN $10.00 42 REFERENCE LAB4231205 HAV AB IGM $10.00 42 REFERENCE LAB4231197 HAV AB TOTAL $8.75 42 REFERENCE LAB4231213 HB CORE AB IGM $11.25 42 REFERENCE LAB4231221 HB CORE AB IGM $8.90 42 REFERENCE LAB4272191 HB CORE AB TOTAL $70.40 42 REFERENCE LAB4231239 HB CORE AB TOTAL $10.75 42 REFERENCE LAB4231304 HBE AB $10.00 42 REFERENCE LAB4231247 HBE AB $8.90 42 REFERENCE LAB4231312 Hbe AG $10.00 42 REFERENCE LAB4231254 Hbe AG $8.90 42 REFERENCE LAB4231262 HBS AB $9.50 42 REFERENCE LAB4231270 HBS AB $8.90 42 REFERENCE LAB4231296 HBs AG $8.90 42 REFERENCE LAB4231288 HBs AG $8.25 42 REFERENCE LAB4233326 HBS AG $16.99 42 REFERENCE LAB4231320 HCV AB $9.74 42 REFERENCE LAB4231155 HCV AB CONF $66.00 42 REFERENCE LAB4233144 HCV AB CONF $73.50 42 REFERENCE LAB4231338 HDV (DELTA) AB $25.00 42 REFERENCE LAB4230298 HEAVY METALS BLD QN EA $37.80 42 REFERENCE LAB4231775 HEAVY METALS BLD QN EA $16.67 42 REFERENCE LAB

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4235263 HEAVY METALS UR QN EA $9.42 42 REFERENCE LAB4235321 HEMATOCRIT $5.04 42 REFERENCE LAB4235313 HEMOGLOBIN $5.04 42 REFERENCE LAB4259842 HEMOGLOBIN FRACTION QN $14.50 42 REFERENCE LAB4235339 HEMOGLOBIN FRACTION QN $5.04 42 REFERENCE LAB4231098 HEMOGLOBIN GLYCOSYLTD A1C $8.08 42 REFERENCE LAB4231189 HEMOGLOBIN PLAS $14.65 42 REFERENCE LAB4230090 HEMOLYSIN ACID (HAM'S) $42.50 42 REFERENCE LAB4233300 HEMOSIDERIN QL $17.34 42 REFERENCE LAB4233102 HEP B PCR QN $95.45 42 REFERENCE LAB4234084 HEP C VIRAL RNA GENOTYPE $80.00 42 REFERENCE LAB4234092 HEP C VIRAL RNA QL TMA $87.25 42 REFERENCE LAB4231163 HEP C VIRUS PCR QN $80.00 42 REFERENCE LAB4256962 HEP C VIRUS PCR QN $180.84 42 REFERENCE LAB4233797 HEPARIN ASSAY $82.00 42 REFERENCE LAB4233474 HEPARIN ASSAY $76.50 42 REFERENCE LAB4234829 HEPATITIS E AB IGG $47.00 42 REFERENCE LAB4234837 HEPATITIS E AB IGM $47.00 42 REFERENCE LAB4232799 HGB ELECTRO $25.00 42 REFERENCE LAB4231346 HISTAMINE $66.50 42 REFERENCE LAB4234100 HISTO CAPSULATUM AG EIA $87.00 42 REFERENCE LAB4256111 HISTO STAIN FRZN SECT I/R $18.94 42 REFERENCE LAB4272076 HISTONE AB $322.00 42 REFERENCE LAB4256848 HISTONE AB $322.00 42 REFERENCE LAB4233953 HISTOPLAS AB $40.50 42 REFERENCE LAB4231353 HISTOPLAS AB $18.47 42 REFERENCE LAB4231379 HIV 1 QN PCR ULTRA $76.30 42 REFERENCE LAB4234118 HIV 1 RNA VIRAL LOAD PCR $175.00 42 REFERENCE LAB4231387 HIV 1/HIV 2 AB $8.75 42 REFERENCE LAB4231445 HIV AB CONF WESTERN BLOT $20.75 42 REFERENCE LAB4233318 HIV AB CONF WESTERN BLOT $23.00 42 REFERENCE LAB4233128 HIV AB CONF WESTERN BLOT $75.50 42 REFERENCE LAB4231361 HIV P24 AG $23.50 42 REFERENCE LAB4231395 HLA B27 $25.00 42 REFERENCE LAB4233334 HOMOCYSTINE $20.19 42 REFERENCE LAB4272209 HOMOCYSTINE $94.28 42 REFERENCE LAB4231403 HOMOVANILLIC ACID (HVA) $10.50 42 REFERENCE LAB4272092 HPV AMP PRB $98.08 42 REFERENCE LAB4270757 HPV AMP PRB $534.00 42 REFERENCE LAB4231429 HSV 1 AB IGG $15.00 42 REFERENCE LAB4232468 HSV AB $8.68 42 REFERENCE LAB4231411 HSV AB $24.10 42 REFERENCE LAB4232450 HSV AB $8.68 42 REFERENCE LAB

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4234159 HSV AB IGM $17.10 42 REFERENCE LAB4279022 HSV AB IGM TITER $17.10 42 REFERENCE LAB4233946 HSV AMP PRB $109.25 42 REFERENCE LAB4232989 HSV TYP 1 DFA $19.05 42 REFERENCE LAB4231437 HTLV 1 AB $38.45 42 REFERENCE LAB4234126 HTLV I/II WESTERN BLOT $23.28 42 REFERENCE LAB4234134 HTLV I/II WESTERN BLOT $23.28 42 REFERENCE LAB4231452 HYDROXYPROLINE FREE $48.30 42 REFERENCE LAB4231460 HYDROXYPROLINE TOTAL $50.98 42 REFERENCE LAB4235545 IGA $30.00 42 REFERENCE LAB4231478 IGD $21.00 42 REFERENCE LAB4232518 IGE $21.50 42 REFERENCE LAB4233425 IGG $9.00 42 REFERENCE LAB4231494 IGG SUBCLASSES $43.95 42 REFERENCE LAB4231502 IMMUNE COMPLEX CIQ BIND $16.25 42 REFERENCE LAB4230496 IMMUNOASSAY NONINFECT $23.50 42 REFERENCE LAB4233359 IMMUNOASSAY NONINFECT $20.00 42 REFERENCE LAB4250353 IMMUNOASSAY NOT SPEC $65.00 42 REFERENCE LAB4231510 IMMUNOASSAY NOT SPEC $28.50 42 REFERENCE LAB4231551 IMMUNOASSAY NOT SPEC $84.53 42 REFERENCE LAB4256202 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4256210 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4256228 IMMUNOASSAY NOT SPEC $29.10 42 REFERENCE LAB4234555 IMMUNOASSAY TUM AG EA $29.00 42 REFERENCE LAB4230447 IMMUNOASSAY TUM AG EA $15.25 42 REFERENCE LAB4230454 IMMUNOASSAY TUM AG EA $15.30 42 REFERENCE LAB4230462 IMMUNOASSAY TUM AG EA $15.00 42 REFERENCE LAB4272142 IMMUNOFIX SER $109.00 42 REFERENCE LAB4233151 IMMUNOFIX UR $25.00 42 REFERENCE LAB4272175 IMMUNOFIX UR $143.50 42 REFERENCE LAB4256145 IMMUNOFL STDY DRCT EA ANT $23.15 42 REFERENCE LAB4259875 IMMUNOREACTIV TRYPSINOGEN $14.50 42 REFERENCE LAB4256483 INDIA INK PREP CSF $75.00 42 REFERENCE LAB4232971 INFECT AGENT DETECT DFA $29.40 42 REFERENCE LAB4233011 INFECT AGENT DETECT DFA $18.04 42 REFERENCE LAB4272258 INFLU A H1N1 RNA RT PCR $627.00 $627.00 42 REFERENCE LAB4231528 INFLUENZA A AB $16.00 42 REFERENCE LAB4256558 INFLUENZA A DFA $216.00 $146.00 42 REFERENCE LAB4232906 INFLUENZA A DFA $12.50 42 REFERENCE LAB4256566 INFLUENZA B DFA $216.00 $146.00 42 REFERENCE LAB4232963 INFLUENZA B DFA $12.50 42 REFERENCE LAB4234191 INHIBIN A $50.00 42 REFERENCE LAB4231544 INSULIN $10.50 42 REFERENCE LAB

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4231536 INSULIN ANTIBODIES $41.08 42 REFERENCE LAB4234209 INSULIN FREE $29.00 42 REFERENCE LAB4234183 INSULIN GROWTH FCTR $60.00 42 REFERENCE LAB4234175 INTRINSIC FCTR AB $23.00 42 REFERENCE LAB4233003 IRON $7.75 42 REFERENCE LAB4231569 ISLET CL AB $25.00 42 REFERENCE LAB4272043 JO 1 AB $252.00 42 REFERENCE LAB4256814 JO 1 AB $271.00 42 REFERENCE LAB4230025 KETOSTEROIDS 17 TOTAL $18.50 42 REFERENCE LAB4256491 KOH PREP SKIN HAIR NAIL $75.00 42 REFERENCE LAB4272027 LA (SS B) AB $322.00 42 REFERENCE LAB4256798 LA (SS B) AB $322.00 42 REFERENCE LAB4234845 LACTOFERRIN FECAL QL $62.50 42 REFERENCE LAB4234381 LATEX HEVEA BRAZILIE IGE $7.35 42 REFERENCE LAB4231585 LDH ISOENZYMES $14.75 42 REFERENCE LAB4231593 LEAD BLD $9.20 42 REFERENCE LAB4231601 LEAD BLD $16.00 42 REFERENCE LAB4235230 LEAD UR $9.42 42 REFERENCE LAB4231619 LEGIONELLA AB IGG $11.50 42 REFERENCE LAB4231627 LEGIONELLA AB IGM $35.00 42 REFERENCE LAB4234753 LEGIONELLA PNEUMO DFA $35.00 42 REFERENCE LAB4231635 LEPTOSPIRA AN $32.00 42 REFERENCE LAB4231643 LEUCINE AMINOPEOTIDASE $32.00 42 REFERENCE LAB4231668 LH $15.00 42 REFERENCE LAB4235149 LH PEDI 3RD GENE $16.50 42 REFERENCE LAB4233052 LIDOCAINE $40.55 42 REFERENCE LAB4231676 LIPASE $6.50 42 REFERENCE LAB4279048 LIPID PNL $18.85 42 REFERENCE LAB4279055 LIPOPROTEIN (A) $18.82 42 REFERENCE LAB4279063 LIPOPROTEIN BLD BY NMR $44.40 42 REFERENCE LAB4235792 LIPROPROT BLD HI FRAC/QNT $16.00 42 REFERENCE LAB4235735 LONG CHAIN FATTY ACIDS $50.66 42 REFERENCE LAB4230371 LYME DISEASE AB $19.46 42 REFERENCE LAB4235503 LYME DISEASE AB IGG WB $22.72 42 REFERENCE LAB4235511 LYME DISEASE AB IGM WB $22.72 42 REFERENCE LAB4234894 M TB AMP PRB $99.00 42 REFERENCE LAB4254736 MAGNESIUM UR $179.00 $179.00 $6.30 $179.00 42 REFERENCE LAB4259859 MASS SPECT/TANDEM QN NES $14.75 42 REFERENCE LAB4234548 MASS SPECT/TANDEM QN NES $26.00 42 REFERENCE LAB4233201 MERCURY $18.00 42 REFERENCE LAB4231783 MERCURY $30.00 42 REFERENCE LAB4233250 MERCURY $19.50 42 REFERENCE LAB4235248 MERCURY $9.42 42 REFERENCE LAB

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4233268 MERCURY $49.00 42 REFERENCE LAB4235776 METANEPHRINES BLOOD $148.00 42 REFERENCE LAB4231791 METANEPHRINES UR $28.00 42 REFERENCE LAB4234860 METHYLMALONIC ACID QN $31.49 42 REFERENCE LAB4234878 METHYLMALONIC ACID UR $59.00 42 REFERENCE LAB4231809 MICROALBUMIN UR 24HR $10.00 42 REFERENCE LAB4235131 MICROSOMAL AB $15.00 42 REFERENCE LAB4231817 MICROSOMAL AB $8.28 42 REFERENCE LAB4231742 MICROSOMAL AB $13.10 42 REFERENCE LAB4252714 MISC CHEM TEST 42 REFERENCE LAB4234217 MISC CHEM TEST $98.00 $95.00 42 REFERENCE LAB4270500 ML DX AMP TR NA EA SQ GT2 $81.97 42 REFERENCE LAB4233383 ML DX AMP TR NA EA SQ GT2 $15.34 42 REFERENCE LAB4235354 MOL DX AMP TR N ACD 2SEQ $25.95 42 REFERENCE LAB4235404 MOL DX AMP TR N ACD 2SEQ $49.00 42 REFERENCE LAB4235107 MOL DX AMP TR N ACD 2SEQ $27.00 42 REFERENCE LAB4256681 MOL DX AMP TR N ACD EA SQ $25.00 42 REFERENCE LAB4250205 MOL DX AMP TR N ACD EA SQ $49.88 42 REFERENCE LAB4235172 MOL DX AMP TR N ACD EA SQ $30.37 42 REFERENCE LAB4233995 MOL DX AMP TR N ACD EA SQ $5.08 42 REFERENCE LAB4230579 MOL DX AMP TR N ACD EA SQ $4.29 42 REFERENCE LAB4235834 MOL DX AMP TR N ACD EA SQ $17.43 42 REFERENCE LAB4232344 MOL DX AMP TR N ACD EA SQ $11.87 42 REFERENCE LAB4233235 MOL DX DT/SLT BLT EA NA $5.08 42 REFERENCE LAB4271912 MOL DX ENZ DIG EA ENZ TX $71.00 42 REFERENCE LAB4250221 MOL DX ENZ DIG EA ENZ TX $6.00 42 REFERENCE LAB4235842 MOL DX ENZ DIG EA ENZ TX $17.43 42 REFERENCE LAB4231957 MOL DX ENZ DIG EA ENZ TX $11.87 42 REFERENCE LAB4235180 MOL DX ENZ DIG EA ENZ TX $30.37 42 REFERENCE LAB4256665 MOL DX EXTN EA NA TYP $20.00 42 REFERENCE LAB4231973 MOL DX EXTN EA NA TYP $11.87 42 REFERENCE LAB4256673 MOL DX GL ELCTR SEP EA NA $15.00 42 REFERENCE LAB4235370 MOL DX GL ELCTR SEP EA NA $29.95 42 REFERENCE LAB4231981 MOL DX GL ELCTR SEP EA NA $11.87 42 REFERENCE LAB4250239 MOL DX GL ELCTR SEP EA NA $10.00 42 REFERENCE LAB4235420 MOL DX GL ELCTR SEP EA NA $49.00 42 REFERENCE LAB4271946 MOL DX INTERP & RPT $14.00 42 REFERENCE LAB4256699 MOL DX INTERP & RPT $12.03 42 REFERENCE LAB4235388 MOL DX INTERP & RPT $29.95 42 REFERENCE LAB4233391 MOL DX INTERP & RPT $15.34 42 REFERENCE LAB4231965 MOL DX INTERP & RPT $11.87 42 REFERENCE LAB4235867 MOL DX INTERP & RPT $17.43 42 REFERENCE LAB4235438 MOL DX INTERP & RPT $49.00 42 REFERENCE LAB

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4235719 MOL DX INTERP & RPT $65.00 42 REFERENCE LAB4250247 MOL DX INTERP & RPT $13.96 42 REFERENCE LAB4235115 MOL DX INTERP & RPT $27.00 42 REFERENCE LAB4235214 MOL DX INTERP & RPT $30.37 42 REFERENCE LAB4271904 MOL DX ISO/EXT PRFD EA NA $14.00 42 REFERENCE LAB4250213 MOL DX ISO/EXT PRFD EA NA $11.97 42 REFERENCE LAB4235826 MOL DX ISO/EXT PRFD EA NA $17.43 42 REFERENCE LAB4235347 MOL DX ISO/EXT PRFD EA NA $29.95 42 REFERENCE LAB4235685 MOL DX ISO/EXT PRFD EA NA $65.00 42 REFERENCE LAB4235396 MOL DX ISO/EXT PRFD EA NA $49.00 42 REFERENCE LAB4235081 MOL DX ISO/EXT PRFD EA NA $27.00 42 REFERENCE LAB4235164 MOL DX ISO/EXT PRFD EA NA $30.37 42 REFERENCE LAB4233219 MOL DX ISO/EXT PRFD EA NA $5.08 42 REFERENCE LAB4233367 MOL DX ISO/EXT PRFD EA NA $15.34 42 REFERENCE LAB4270518 MOL DX ISO/EXT PRFD EA NA $19.60 42 REFERENCE LAB4250288 MOL DX MUT ID TRNSCRP $291.00 42 REFERENCE LAB4271938 MOL DX MUT SCN 1 SEG EA $300.00 42 REFERENCE LAB4250270 MOL DX MUT SCN 1 SEG EA $291.00 42 REFERENCE LAB4271920 MOL DX NUC ACID PRB $70.00 42 REFERENCE LAB4235123 MOL DX NUC ACID PRB $27.00 42 REFERENCE LAB4270526 MOL DX NUC ACID PRB $9.37 42 REFERENCE LAB4233243 MOL DX NUC ACID PRB $5.08 42 REFERENCE LAB4233375 MOL DX NUC ACID PRB $15.34 42 REFERENCE LAB4250262 MOL DX NUC ACID PRB $11.97 42 REFERENCE LAB4235693 MOL DX REV TRANSCRIPT $65.00 42 REFERENCE LAB4235099 MOL DX REV TRANSCRIPT $27.00 42 REFERENCE LAB4235362 MOL DX SEP/ID HI RS EA NA $29.95 42 REFERENCE LAB4235198 MOL DX SEP/ID HI RS EA NA $30.37 42 REFERENCE LAB4235412 MOL DX SEP/ID HI RS EA NA $49.00 42 REFERENCE LAB4234050 MUCOPOLYSACCH ACID QNT $90.00 42 REFERENCE LAB4231833 MUMPS AB $9.00 42 REFERENCE LAB4231841 MURAMIDASE $18.00 42 REFERENCE LAB4235701 MUTATION ID BY SEQ EA SEG $65.00 42 REFERENCE LAB4235859 MUTATION ID OLA/SBCE/ASPE $17.43 42 REFERENCE LAB4235206 MUTATION ID OLA/SBCE/ASPE $30.37 42 REFERENCE LAB4234886 MYCOPHENOLIC ACID $80.00 42 REFERENCE LAB4231866 MYCOPLAS AB $30.00 42 REFERENCE LAB4255394 MYCOPLAS CULT $27.72 $27.72 $27.72 $27.72 42 REFERENCE LAB4234779 MYCOPLAS CULT $30.00 42 REFERENCE LAB4231874 MYELIN BASIC PROTEIN CSF $19.00 42 REFERENCE LAB4231882 MYOGLOBIN $26.50 42 REFERENCE LAB4231890 MYOGLOBIN UR $15.00 42 REFERENCE LAB4230322 NATRIURETIC PEPTIDE $73.01 42 REFERENCE LAB

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4259826 NB GENETIC SCR GALACT $14.50 42 REFERENCE LAB4231908 NORTRIPTYLINE $16.40 42 REFERENCE LAB4234910 NTELOPEPTIDE SERUM $95.00 42 REFERENCE LAB4256533 OCCULT BLD GASTRIC QL $57.00 42 REFERENCE LAB4231916 OLIGOCLONAL BANDS CSF $17.50 42 REFERENCE LAB4231924 ORGANIC ACIDS QN TOTAL $125.00 42 REFERENCE LAB4254272 OVA & PARASITES W CONC $159.00 $159.00 $13.00 $145.00 42 REFERENCE LAB4231932 OXALATE UR $12.00 42 REFERENCE LAB4234928 OXYCARBAZEPINE $27.00 42 REFERENCE LAB4234423 P ANCA TITER $16.62 42 REFERENCE LAB4234936 PANCREATIC ELASTASE $168.00 42 REFERENCE LAB4232955 PARAINFLUENZA DFA $70.20 42 REFERENCE LAB4256574 PARAINFLUENZA TYP 1 FA $216.00 $146.00 42 REFERENCE LAB4256582 PARAINFLUENZA TYP 2 FA $216.00 $146.00 42 REFERENCE LAB4256590 PARAINFLUENZA TYP 3 FA $216.00 $146.00 42 REFERENCE LAB4233920 PARVOVIRUS B 19 DNA PCR $85.00 42 REFERENCE LAB4232781 PARVOVIRUS B19 AB $30.00 42 REFERENCE LAB4232153 PCR ID $14.25 42 REFERENCE LAB4231999 PHENOTHIAZINE $20.00 42 REFERENCE LAB4259800 PHENYLALANINE BLOOD $12.00 42 REFERENCE LAB4232005 PHENYLALANINE BLOOD $37.50 42 REFERENCE LAB4270880 PHENYTOIN FREE $57.69 42 REFERENCE LAB4230116 PHOSHATASE ACID TOTAL $12.00 42 REFERENCE LAB4233664 PHOSPHLPD NUTRLZTN PLTLT $46.73 42 REFERENCE LAB4235479 PHOSPHOLIPID AB $22.91 42 REFERENCE LAB4256236 PHOSPHOLIPID AB $29.10 42 REFERENCE LAB4233490 PHOSPHOLIPID AB $23.14 42 REFERENCE LAB4232013 PHOSPHOROUS UR RAN $6.61 42 REFERENCE LAB4234803 PHOSPHORUS UR TIM $28.92 42 REFERENCE LAB4251013 PINWORM CELLOPHANE TAPE $13.00 $13.00 $13.00 $13.00 42 REFERENCE LAB4250254 PLSMG $120.00 42 REFERENCE LAB4250197 PLSMG ACTIVATOR INHIBITOR $130.00 $130.00 $130.00 $130.00 42 REFERENCE LAB4250189 PLSMG ACTIVATOR INHIBITOR $140.00 $140.00 $140.00 $140.00 42 REFERENCE LAB4250296 PLT AB DIR IGG $29.67 42 REFERENCE LAB4250023 PLT AB DRG INDUCED $29.33 $29.33 $30.15 $29.33 42 REFERENCE LAB4233441 PLT AB HEPARIN $60.00 42 REFERENCE LAB4235289 PLT AB HEPARIN $147.00 42 REFERENCE LAB4250031 PLT AB INDIRECT $31.00 $31.00 $31.00 $31.00 42 REFERENCE LAB4233680 PLT NEUTRALIZATION $27.07 42 REFERENCE LAB4235578 PNEUMOCYSTIS CARINII DFA $20.25 42 REFERENCE LAB4232021 PORPHOBILINOGEN QN $25.00 42 REFERENCE LAB4232047 PORPHYRINS UR QN&FX $46.50 42 REFERENCE LAB4235156 POTASSIUM FECES $8.00 42 REFERENCE LAB

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4232054 PREALBUMIN $9.75 42 REFERENCE LAB4279014 PREGNANCY SCRN UR 42 REFERENCE LAB4232062 PREGNANEDIOL $51.50 42 REFERENCE LAB4232070 PREGNENOLONE $36.50 42 REFERENCE LAB4234704 PRIMIDONE $80.32 42 REFERENCE LAB4232088 PRIMIDONE $85.00 42 REFERENCE LAB4233987 PROCAINAMIDE & NAPA $84.75 42 REFERENCE LAB4232096 PROGESTERONE $99.75 42 REFERENCE LAB4232104 PROINSULIN $126.00 42 REFERENCE LAB4232112 PROLACTIN $14.15 42 REFERENCE LAB4232039 PROPHOBILINOGEN UR QL $21.50 42 REFERENCE LAB4233698 PROTEIN C AG $35.00 42 REFERENCE LAB4250148 PROTEIN C AG $119.00 $119.00 $119.00 $119.00 42 REFERENCE LAB4233060 PROTEIN ELECTRO SER $12.00 42 REFERENCE LAB4232120 PROTEIN ELECTRO SER $20.00 42 REFERENCE LAB4272167 PROTEIN ELECTRO SER $105.00 42 REFERENCE LAB4272183 PROTEIN ELECTRO UR $87.22 42 REFERENCE LAB4230207 PROTEIN NEPHELOMET $29.00 42 REFERENCE LAB4250163 PROTEIN S ACTIVITY $86.50 $86.50 $86.50 $86.50 42 REFERENCE LAB4233706 PROTEIN S AG TOTAL $35.00 42 REFERENCE LAB4250155 PROTEIN S AG TOTAL $86.50 $86.50 $86.50 $86.50 42 REFERENCE LAB4233714 PROTEIN S FREE $91.00 42 REFERENCE LAB4232138 PROTEIN TOTAL FLD $8.50 42 REFERENCE LAB4233722 PROTHROMBIN TIME $7.86 42 REFERENCE LAB4233730 PROTHROMBIN TIME SUBT EA $26.10 42 REFERENCE LAB4232773 PROTOPORPHYRIN RBC $15.65 42 REFERENCE LAB4232146 PSA TOTAL DIAG $23.50 42 REFERENCE LAB4232161 PTH C TERMINAL $39.00 42 REFERENCE LAB4270906 PTH INTACT $738.00 42 REFERENCE LAB4234944 PTH RELATED PROTEIN $55.00 42 REFERENCE LAB4233748 PTT PLAS OR WB $6.77 42 REFERENCE LAB4233755 PTT SUBSTITUTION EA $20.00 42 REFERENCE LAB4232179 PYRUVATE BLD $15.00 42 REFERENCE LAB4232187 Q FEVER AB $7.50 42 REFERENCE LAB4235875 Q FEVER IGG TITER $11.25 42 REFERENCE LAB4271003 QUINIDINE $220.00 42 REFERENCE LAB4232203 QUINIDINE $21.00 42 REFERENCE LAB4234324 RAPID HSV CX W/REFLEX $21.00 42 REFERENCE LAB4232211 RENIN $16.50 42 REFERENCE LAB4250171 REPTILASE TEST $105.00 $105.00 $105.00 $105.00 42 REFERENCE LAB4271045 RHEUMATOID FCTR QN $102.00 42 REFERENCE LAB4232229 RHEUMATOID FCTR QN $7.50 42 REFERENCE LAB4272084 RHEUMATOID FCTR QN $102.00 42 REFERENCE LAB

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4232682 RIBOFLAVIN $55.00 42 REFERENCE LAB4234167 RIBOSOMAL P AB $33.00 42 REFERENCE LAB4233342 RICKETTSIA AB $15.00 42 REFERENCE LAB4235883 RICKETTSIA AB $11.25 42 REFERENCE LAB4233763 RISTOCETIN COFACTOR $60.00 42 REFERENCE LAB4233896 RISTOCETIN COFACTOR $87.00 42 REFERENCE LAB4256780 RO(SS A) AB $322.00 42 REFERENCE LAB4232237 ROTAVIRUS AG EIA $20.00 42 REFERENCE LAB4255345 ROTAVIRUS AG EIA $216.00 $216.00 $13.00 $196.00 42 REFERENCE LAB4256608 RSV DFA $216.00 $216.00 42 REFERENCE LAB4232930 RSV DFA $24.00 42 REFERENCE LAB4232245 RUBELLA AB $11.75 42 REFERENCE LAB4232476 RUBELLA AB IGG $8.68 42 REFERENCE LAB4232484 RUBELLA AB IGM $8.68 42 REFERENCE LAB4232252 RUBEOLA AB $13.90 42 REFERENCE LAB4256244 RUSSELL VIPER VENOM DILU $29.10 42 REFERENCE LAB4250338 S STRL KIT CRICOTHYROT AD $372.00 42 REFERENCE LAB4250346 S STRL KIT CRICOTHYROT PD $451.00 42 REFERENCE LAB4231759 SCL 70 AB $13.10 42 REFERENCE LAB4272035 SCL 70 AB $322.00 42 REFERENCE LAB4256806 SCL 70 AB $322.00 42 REFERENCE LAB4234969 SELENIUM $25.50 42 REFERENCE LAB4250601 SER BACTERICIDAL TTR $40.00 $40.00 $40.00 $40.00 42 REFERENCE LAB4256632 SER BACTERICIDAL TTR $144.00 42 REFERENCE LAB4232260 SEROTONIN BLD $49.00 42 REFERENCE LAB4235297 SEROTONIN RELEASE ASSAY 42 REFERENCE LAB4234977 SEROTONIN RELEASE ASSAY $234.00 42 REFERENCE LAB4231577 SIALIC ACID $18.50 42 REFERENCE LAB4232278 SICKLE CL SCRN $9.75 42 REFERENCE LAB4233433 SIROLIMUS $55.00 42 REFERENCE LAB4231734 SJOGRENS AB $13.10 42 REFERENCE LAB4272019 SMITH AB $322.00 42 REFERENCE LAB4256772 SMITH AB $322.00 42 REFERENCE LAB4231858 SMOOTH MUSCLE AB SCRN $17.00 42 REFERENCE LAB4233284 SMOOTH MUSCLE AB SCRN $13.10 42 REFERENCE LAB4256715 SMR AFB STAIN $97.00 42 REFERENCE LAB4232831 SMR AFB STAIN $10.54 42 REFERENCE LAB4256442 SMR GRAM STAIN $75.00 42 REFERENCE LAB4256947 SMR GRAM STAIN $54.88 42 REFERENCE LAB4231767 SMR MALARIA $37.50 42 REFERENCE LAB4234902 SODIUM OTHER SOURCE $8.00 42 REFERENCE LAB4231486 SOMATOMEDIN C $25.00 42 REFERENCE LAB4256103 SPEC STAIN GRP II INTRP/R $38.39 42 REFERENCE LAB

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4233292 STRIATED MUSCLE AB SCRN $13.10 42 REFERENCE LAB4234951 SUGARS QL EA SPEC $10.50 42 REFERENCE LAB4256186 SURG PATH LVL III $60.00 42 REFERENCE LAB4256178 SURG PATH LVL III $60.00 42 REFERENCE LAB4256129 SURG PATH LVL IV $40.75 42 REFERENCE LAB4256160 SURG PATH UNLISTED $87.50 42 REFERENCE LAB4255170 SUSCEPT BY MLC $59.00 $59.00 $59.00 $59.00 42 REFERENCE LAB4250700 SUSCEPT BY MLC $50.00 $50.00 $50.00 $50.00 42 REFERENCE LAB4250577 SUSCEPT MIC PER PLATE $155.00 $155.00 $13.00 $141.00 42 REFERENCE LAB4250668 SUSCEPT MIC PER PLATE $130.00 $105.00 $72.00 $13.00 42 REFERENCE LAB4233177 SUSCEPT MYCOBACT PROPORT $100.00 42 REFERENCE LAB4250692 SUSCEPT MYCOBACT PROPORT $41.16 $41.16 $41.16 $41.16 42 REFERENCE LAB4235784 T LYMPH TOT CNT $24.75 42 REFERENCE LAB4271102 T3 FREE $69.00 42 REFERENCE LAB4232302 T3 FREE $14.12 42 REFERENCE LAB4232310 T3 REVERSE $29.00 42 REFERENCE LAB4271201 T3 TOTAL $252.00 42 REFERENCE LAB4232328 T3 TOTAL $9.75 42 REFERENCE LAB4255006 TACROLIMUS (FK506) $75.00 $75.00 $75.00 $75.00 42 REFERENCE LAB4232377 TESTOSTERONE FREE $10.90 42 REFERENCE LAB4234738 TESTOSTERONE TOTAL $19.00 42 REFERENCE LAB4232385 TESTOSTERONE TOTAL $13.22 42 REFERENCE LAB4256954 TESTOSTERONE TOTAL $108.99 42 REFERENCE LAB4232393 TETANUS AB $20.00 42 REFERENCE LAB4234720 TETANUS AB $25.12 42 REFERENCE LAB4234993 THIOCYANATE $63.00 42 REFERENCE LAB4232351 THYR BINDING GLOB (TBG) $18.25 42 REFERENCE LAB4235818 THYR STIM IG $71.25 42 REFERENCE LAB4232401 THYROGLOBULIN $19.75 42 REFERENCE LAB4271300 THYROGLOBULIN AB $66.00 42 REFERENCE LAB4232419 THYROGLOBULIN AB $8.28 42 REFERENCE LAB4271607 THYROID PEROXIDASE AB $126.00 42 REFERENCE LAB4235446 TISSUE CULT LYMPH $49.00 42 REFERENCE LAB4235008 TOPIRAMATE $35.00 42 REFERENCE LAB4271409 TOXOPLAS AB IGG $256.00 42 REFERENCE LAB4232526 TOXOPLAS AB IGG $12.32 42 REFERENCE LAB4232492 TOXOPLAS AB IGG $8.68 42 REFERENCE LAB4271508 TOXOPLAS AB IGM $256.00 42 REFERENCE LAB4232534 TOXOPLAS AB IGM $8.75 42 REFERENCE LAB4232500 TOXOPLAS AB IGM $8.68 42 REFERENCE LAB4233938 TOXOPLASMOSIS PCR $105.00 42 REFERENCE LAB4235016 TOXOPLASMOSIS QUAL PCR $105.00 42 REFERENCE LAB4271706 TRANSFERRIN $230.00 42 REFERENCE LAB

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4232542 TRANSFERRIN $11.00 42 REFERENCE LAB4235032 TRANSGLUTAMINASE AB IGA $14.25 42 REFERENCE LAB4235024 TRANSGLUTAMINASE AB IGA $14.25 42 REFERENCE LAB4256897 TRICHOMONAS VAG DIR PROBE $49.60 42 REFERENCE LAB4235800 TRIGLYCERIDE $16.00 42 REFERENCE LAB4235040 TRYPTASE $49.00 42 REFERENCE LAB4232997 TSH $34.50 42 REFERENCE LAB4259834 TSH $14.50 42 REFERENCE LAB4232567 TYROSINE $37.50 42 REFERENCE LAB4259818 TYROSINE $11.00 42 REFERENCE LAB4232575 UROBILINOGEN UR QN $5.93 42 REFERENCE LAB4232617 VASOACT INTEST PEPT (VIP) $49.00 42 REFERENCE LAB4232609 VDRL CSF NON-TREPML AB QL $6.00 42 REFERENCE LAB4232625 VIRUS AB NOT SPEC $15.00 42 REFERENCE LAB4270807 VIRUS AB NOT SPEC $230.00 42 REFERENCE LAB4235610 VIRUS CULT SHELL VIAL $20.00 42 REFERENCE LAB4232633 VISCOSITY $15.00 42 REFERENCE LAB4232641 VITAMIN A $15.77 42 REFERENCE LAB4232658 VITAMIN B1 (THIAMINE) $20.00 42 REFERENCE LAB4235057 VITAMIN B1 (THIAMINE) $25.00 42 REFERENCE LAB4232666 VITAMIN B12 $5.70 42 REFERENCE LAB4232674 VITAMIN B12 BINDING CAP $15.00 42 REFERENCE LAB4232690 VITAMIN B6 $18.00 42 REFERENCE LAB4232716 VITAMIN D (125 DI HYDROX) $35.00 42 REFERENCE LAB4232724 VITAMIN D 25HYDROXY $20.19 42 REFERENCE LAB4272266 VITAMIN D 25HYDROXY $530.00 $530.00 42 REFERENCE LAB4232732 VITAMIN E $15.75 42 REFERENCE LAB4232740 VITAMIN K $60.00 42 REFERENCE LAB4232757 VMA UR $13.75 42 REFERENCE LAB4232591 VZV AB $21.25 42 REFERENCE LAB4271805 VZV AB $196.00 42 REFERENCE LAB4232583 VZV AB $25.00 42 REFERENCE LAB4232914 VZV DFA $23.00 42 REFERENCE LAB4234506 WEST NILE CSF $56.00 42 REFERENCE LAB4234480 WEST NILE VIRUS AB IGG $24.50 42 REFERENCE LAB4234498 WEST NILE VIRUS AB IGM $24.50 42 REFERENCE LAB4234811 WEST NILE VIRUS RNA PCR $292.50 42 REFERENCE LAB4235727 YERSINIA AB $9.00 42 REFERENCE LAB4232765 ZINC $15.00 42 REFERENCE LAB4234514 ZONISAMIDE (ZONEGRAN[TM]) 42 REFERENCE LAB3261922 ACEL GRFT T/ARM/LEG/ADD $775.00 32 REHAB SERVICES3261914 ACEL GRFT TRNK/ARMS/LEGS $1,091.00 32 REHAB SERVICES3261880 ACEL GRFT, F/N/HF/G $1,041.00 32 REHAB SERVICES

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3261542 ACELL XGRAFT APP 100CM $1,022.90 32 REHAB SERVICES3261559 ACELL XGRAFT APP EA ADD $1,022.90 32 REHAB SERVICES3261021 ALLG CLT SK SUB EA AD 25C $336.87 32 REHAB SERVICES3262011 AMPUTATE TOE MTP JOINT $4,774.00 32 REHAB SERVICES3261146 APLIGRAF P/SQ/CM $93.00 32 REHAB SERVICES3261849 APP ACEL GRFT FNHFG ADD $1,041.00 32 REHAB SERVICES3261831 APP ACEL GRFT, FNHFG $1,041.00 32 REHAB SERVICES3261773 APP CULT DERM SUB FNHFG $477.00 32 REHAB SERVICES3261351 APP CULT SKIN SUBSTITUTE $363.82 32 REHAB SERVICES3261906 APP MULTLAY COMPR LWR LEG $295.00 32 REHAB SERVICES3261047 APP SKNALLOGRFT T/A/L ADD $3,196.61 32 REHAB SERVICES3261039 APP SKNALLOGRFT, T/ARM/LG $1,066.63 32 REHAB SERVICES3261575 APP TOTAL CONTACT CAST $395.37 32 REHAB SERVICES3261005 BIOPSY SKIN LESION EA ADD $198.28 32 REHAB SERVICES3261286 BIOPSY SKIN LESION SNGL $240.84 32 REHAB SERVICES3261997 BX MUSCLE SUPERFICIAL $4,287.00 32 REHAB SERVICES3261088 CHEM CAUT GRANUL TISSUE $255.96 32 REHAB SERVICES3262060 DEB BONE ADD-ON $1,752.00 32 REHAB SERVICES3262052 DEB MUSC/FASCIA ADD-ON $564.00 32 REHAB SERVICES3262045 DEB SUBQ TISSUE ADD-ON $564.00 32 REHAB SERVICES3262029 DEBRIDE <=1ST 20 SQ/CM $309.00 32 REHAB SERVICES3261245 DEBRIDE BN/MUS/FAS <=20CM $1,561.53 32 REHAB SERVICES3262037 DEBRIDE EA ADD 20 SQ/CM $309.00 32 REHAB SERVICES3261237 DEBRIDE MUS/FSCIA <=20CM $628.56 32 REHAB SERVICES3261294 DEBRIDE NAIL 1 TO 5 $199.80 32 REHAB SERVICES3261302 DEBRIDE NAIL 6 OR MORE $226.00 32 REHAB SERVICES3261229 DEBRIDE SQ TISS <=20CM $628.56 32 REHAB SERVICES3261765 DERMAGRAFT P/SQ/CM $115.00 32 REHAB SERVICES3261062 DESTRUCT 1ST PREMAL LSION $115.00 32 REHAB SERVICES3261070 DESTRUCTION 2-14 LESIONS $62.00 32 REHAB SERVICES3261195 DRAIN ABSCESS COMP/MULT $1,825.00 32 REHAB SERVICES3261187 DRAIN ABSCESS SMPL/SNGL $338.04 32 REHAB SERVICES3261989 DRAIN HEMATOMA/FLUID $3,093.00 32 REHAB SERVICES3262003 EX TR-EXT MLG-MRG 1.1-2CM $953.00 32 REHAB SERVICES3212222 FO PIP/DIP W/JOINT/SPRING $43.00 32 REHAB SERVICES3261112 GLUCOSE BLD REAGENT STRIP 32 REHAB SERVICES3261864 GRAFTJACKET EXP 1CC IJ $942.00 32 REHAB SERVICES3261856 GRAFTJACKET P/SQ/CM $271.00 32 REHAB SERVICES3261930 HARVEST CULTD SKIN GRAFT $771.00 32 REHAB SERVICES3212321 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212156 HFO NONTORSION JNT PREFAB $84.00 32 REHAB SERVICES3212164 HFO NONTORSION JNT PREFAB $105.00 32 REHAB SERVICES3212172 HFO NONTORSION JNT PREFAB $105.00 32 REHAB SERVICES

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DEPARTMENT CODE

3212248 HFO NONTORSION JNT PREFAB $85.00 32 REHAB SERVICES3212271 HFO NONTORSION JNT PREFAB $80.00 32 REHAB SERVICES3212289 HFO NONTORSION JNT PREFAB $105.00 32 REHAB SERVICES3212313 HFO NONTORSION JNT PREFAB 32 REHAB SERVICES3212180 HFO W/O JOINTS PF $39.00 32 REHAB SERVICES3261807 INS TISS EXP NOT BREAST $4,948.00 32 REHAB SERVICES3261898 INTEGRA BMWD GRFT P/SQ/CM $41.00 32 REHAB SERVICES3261872 INTEGRA FLOW WND 1CC IJ $2,629.00 32 REHAB SERVICES3261435 LEVEL 1 EST PATIENT $193.32 32 REHAB SERVICES3261385 LEVEL 1 NEW PATIENT $179.00 32 REHAB SERVICES3261443 LEVEL 2 EST PATIENT $213.84 32 REHAB SERVICES3261393 LEVEL 2 NEW PATIENT $198.00 32 REHAB SERVICES3261450 LEVEL 3 EST PATIENT $244.08 32 REHAB SERVICES3261401 LEVEL 3 NEW PATIENT $244.08 32 REHAB SERVICES3261468 LEVEL 4 EST PATIENT $406.08 32 REHAB SERVICES3261419 LEVEL 4 NEW PATIENT $406.08 32 REHAB SERVICES3261476 LEVEL 5 EST PATIENT $435.24 32 REHAB SERVICES3261427 LEVEL 5 NEW PATIENT $435.24 32 REHAB SERVICES3261492 LOPS FOLLOW UP VISIT $171.51 32 REHAB SERVICES3261484 LOPS INITIAL VISIT $171.51 32 REHAB SERVICES3261500 LOPS ROUTINE FOOT CARE $129.44 32 REHAB SERVICES3261583 NEG PRESS WOUND TX <=50CM $132.84 32 REHAB SERVICES3261591 NEG PRESS WOUND TX >50CM $142.56 32 REHAB SERVICES3261823 NI EXT ART LTD BIL 1-2 LV $336.00 32 REHAB SERVICES3261567 OASIS WOUND MATRIX $12.00 32 REHAB SERVICES3210770 OT ADL TRAIN EA 15 $153.00 $63.00 32 REHAB SERVICES3212636 OT ADL TRAIN INIT 30 $280.00 $116.00 32 REHAB SERVICES3211059 OT APP SPLNT FINGER DYN $205.00 $85.00 32 REHAB SERVICES3211042 OT APP SPLNT FINGER STA $141.00 $58.00 32 REHAB SERVICES3211026 OT APP SPLNT SHRT ARM DYN $330.00 $136.00 32 REHAB SERVICES3211034 OT APP SPLNT SHRT ARM DYN $330.00 $136.00 32 REHAB SERVICES3211646 OT APP SPLNT SHRT ARM STA $311.00 32 REHAB SERVICES3221199 OT COGNTVE SKIL DEV EA 15 $153.00 $63.00 32 REHAB SERVICES3210788 OT COMMUNITY REINT EA 15 $153.00 $63.00 32 REHAB SERVICES3211638 OT CONTRAST BATH INIT 30 $153.00 32 REHAB SERVICES3211620 OT CONTRAST BATHS EA 15 $77.00 32 REHAB SERVICES3211653 OT DEBRIDE SKIN FULL $330.00 32 REHAB SERVICES3212479 OT DYSPHAGIA TRT ADD 15 $153.00 $63.00 32 REHAB SERVICES3212487 OT DYSPHAGIA TRT INIT 30 $306.00 $126.00 32 REHAB SERVICES3210580 OT E-STIM EA 15 $153.00 $63.00 32 REHAB SERVICES3211679 OT E-STIM MANUAL INIT 30 $190.00 32 REHAB SERVICES3211976 OT E-STIM SUPERVISED 15 $153.00 32 REHAB SERVICES3211307 OT EVAL 15 $166.00 $68.00 32 REHAB SERVICES

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DEPARTMENT CODE

3211315 OT EVAL 30 $332.00 $137.00 32 REHAB SERVICES3211323 OT EVAL 45 $498.00 $205.00 32 REHAB SERVICES3211133 OT EVAL 60 $663.00 $273.00 32 REHAB SERVICES3211331 OT EVAL 75 $829.00 $342.00 32 REHAB SERVICES3211273 OT EVAL 90 $995.00 32 REHAB SERVICES3211349 OT EVAL 90 $995.00 $410.00 32 REHAB SERVICES3210267 OT EVAL ADD 15 $166.00 $68.00 $78.00 32 REHAB SERVICES3211596 OT EVAL BRIEF $332.00 32 REHAB SERVICES3211588 OT EVAL COMPREHENSIVE $498.00 32 REHAB SERVICES3211570 OT EVAL EXTENDED $663.00 32 REHAB SERVICES3211257 OT EVAL FNX SWALL 15 $166.00 $68.00 32 REHAB SERVICES3211356 OT EVAL FNX SWALL 15 $166.00 $68.00 32 REHAB SERVICES3212495 OT EVAL FNX SWALL 15 $166.00 $68.00 32 REHAB SERVICES3212503 OT EVAL FNX SWALL 30 $332.00 $137.00 32 REHAB SERVICES3211364 OT EVAL FNX SWALL 30 $332.00 $137.00 32 REHAB SERVICES3211091 OT EVAL FNX SWALL 45 $498.00 $205.00 32 REHAB SERVICES3211372 OT EVAL FNX SWALL 45 $498.00 $205.00 32 REHAB SERVICES3212610 OT EVAL FNX SWALL 45 $498.00 32 REHAB SERVICES3212511 OT EVAL FNX SWALL 60 $663.00 $273.00 32 REHAB SERVICES3210259 OT EVAL INIT 30 $332.00 $137.00 $159.00 32 REHAB SERVICES3211562 OT EVAL INTERMEDIATE $332.00 32 REHAB SERVICES3211554 OT EVAL LTD $307.00 32 REHAB SERVICES3212628 OT EVAL MTN FLUOR SWA 120 $656.00 32 REHAB SERVICES3212552 OT EVAL MTN FLUOR SWAL 15 $199.00 $82.00 32 REHAB SERVICES3212560 OT EVAL MTN FLUOR SWAL 30 $398.00 $164.00 32 REHAB SERVICES3212578 OT EVAL MTN FLUOR SWAL 45 $597.00 $246.00 32 REHAB SERVICES3212586 OT EVAL MTN FLUOR SWAL 60 $796.00 $328.00 32 REHAB SERVICES3212594 OT EVAL MTN FLUOR SWAL 75 $995.00 $410.00 32 REHAB SERVICES3212602 OT EVAL MTN FLUOR SWAL 90 $1,194.00 $492.00 32 REHAB SERVICES3212461 OT EXTREMITY TEST ADD 15 $166.00 32 REHAB SERVICES3212453 OT EXTREMITY TEST INT 30 $332.00 32 REHAB SERVICES3211695 OT IONTOPHORESIS EA 15 $169.00 32 REHAB SERVICES3211687 OT IONTOPHORESIS INIT 30 $281.00 32 REHAB SERVICES3211711 OT JOINT MOB EA VISIT $164.00 32 REHAB SERVICES3211190 OT MANUAL THER EA 15 $164.00 32 REHAB SERVICES3211703 OT MANUAL TRACT INIT 30 $269.00 32 REHAB SERVICES3211729 OT MYOFAC/SOFT MOB 30 $347.00 32 REHAB SERVICES3210648 OT NEUROMUSC REED EA 15 $164.00 $68.00 32 REHAB SERVICES3211737 OT NEUROMUSC REED INIT 30 $328.00 32 REHAB SERVICES3212446 OT ORT/PRO/ADL CK ADD 15 $153.00 32 REHAB SERVICES3212438 OT ORT/PRO/ADL CK INIT 30 $306.00 32 REHAB SERVICES3211778 OT ORTHOTIC FAB INIT 30 $328.00 32 REHAB SERVICES3211786 OT ORTHOTIC TRAIN EA 15 $153.00 32 REHAB SERVICES

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DEPARTMENT CODE

3211794 OT ORTHOTIC TRAIN INIT 30 $306.00 32 REHAB SERVICES3210564 OT PARAFFIN BATH 15 $77.00 $32.00 32 REHAB SERVICES3210697 OT PROC THER GP 15 $115.00 $47.00 32 REHAB SERVICES3211406 OT PROC THER GP 30 $230.00 $95.00 32 REHAB SERVICES3211414 OT PROC THER GP 45 $344.00 $142.00 32 REHAB SERVICES3211422 OT PROC THER GP 60 $230.00 $95.00 32 REHAB SERVICES3211448 OT PROC THER GP 90 $918.00 $378.00 32 REHAB SERVICES3211752 OT PROSTH TRAIN EA 15 $153.00 32 REHAB SERVICES3211745 OT PROSTH TRAIN INIT 30 $306.00 32 REHAB SERVICES3211471 OT RE-EVAL 15 $149.00 $62.00 32 REHAB SERVICES3211489 OT RE-EVAL 30 $299.00 $123.00 32 REHAB SERVICES3211141 OT RE-EVAL 45 $448.00 $185.00 32 REHAB SERVICES3211497 OT RE-EVAL 60 $597.00 $246.00 32 REHAB SERVICES3211521 OT RE-EVAL ADD 15 32 REHAB SERVICES3211539 OT RE-EVAL INIT 30 32 REHAB SERVICES3210929 OT SENS INTEGRATION EA 15 $115.00 $47.00 32 REHAB SERVICES3211604 OT THER ACT ADD 15 $153.00 32 REHAB SERVICES3210762 OT THER ACT EA 15 $153.00 $63.00 32 REHAB SERVICES3211612 OT THER ACT INIT 30 $306.00 32 REHAB SERVICES3211547 OT THER ACT INIT 30 $306.00 $126.00 32 REHAB SERVICES3210630 OT THER EX EA 15 $153.00 $63.00 32 REHAB SERVICES3211802 OT THER EX INIT 30 $306.00 32 REHAB SERVICES3210671 OT THER MASSAGE EA 15 $115.00 $47.00 32 REHAB SERVICES3211810 OT THER MASSAGE INIT 30 $230.00 32 REHAB SERVICES3210069 OT TREAT ADD 15 $153.00 $63.00 $68.00 32 REHAB SERVICES3210051 OT TREAT INIT 30 $306.00 $126.00 $136.00 32 REHAB SERVICES3212529 OT TX SWALL/ORAL FNX 105 $178.00 $442.00 32 REHAB SERVICES3211109 OT TX SWALL/ORAL FNX 105 $1,071.00 $442.00 32 REHAB SERVICES3212537 OT TX SWALL/ORAL FNX 30 $306.00 $126.00 32 REHAB SERVICES3212545 OT TX SWALL/ORAL FNX 60 $612.00 $252.00 32 REHAB SERVICES3210606 OT ULTRASOUND EA 15 $134.00 $55.00 32 REHAB SERVICES3211828 OT ULTRASOUND INIT 30 $268.00 32 REHAB SERVICES3211836 OT VASOPNEUMATIC 15 $93.00 32 REHAB SERVICES3210556 OT VASOPNEUMATIC 15 $93.00 $38.00 32 REHAB SERVICES3211760 OT WHIRLPOOL 15 $77.00 32 REHAB SERVICES3210796 OT WHLCHR MNG/TRAIN EA 15 $153.00 $63.00 32 REHAB SERVICES3240611 PT ADL TRAIN ADD 15 $137.00 32 REHAB SERVICES3240629 PT ADL TRAIN EA 15 $137.00 32 REHAB SERVICES3240397 PT ADL TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3261740 PT ADL TRAIN EA 15 $95.04 32 REHAB SERVICES3240603 PT ADL TRAIN INIT 30 $275.00 32 REHAB SERVICES3240405 PT COMMUNITY REINT EA 15 $137.00 $73.00 32 REHAB SERVICES3240637 PT CONTRAST BATH INIT 30 $137.00 32 REHAB SERVICES

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DEPARTMENT CODE

3240314 PT CONTRAST BATHS EA 15 $69.00 $37.00 32 REHAB SERVICES3238763 PT DEBRIDE <=1ST 20 SQ/CM $298.00 $141.00 32 REHAB SERVICES3238771 PT DEBRIDE EA ADD 20 SQ/M $298.00 $141.00 32 REHAB SERVICES3261658 PT DEBRIDE NON-SELECT 30 $143.64 32 REHAB SERVICES3240207 PT DEBRIDE NON-SELECT 60 $508.00 $272.00 32 REHAB SERVICES3235348 PT DEBRIDE SKIN FULL $402.00 $215.00 32 REHAB SERVICES3235298 PT DEBRIDE SKIN FULL $402.00 $215.00 32 REHAB SERVICES3232014 PT DEBRIDE SKIN PARTIAL $224.00 $120.00 32 REHAB SERVICES3261724 PT DEBRIDE SKIN PARTIAL $108.00 32 REHAB SERVICES3235355 PT DEBRIDE SKIN PARTIAL $224.00 $120.00 32 REHAB SERVICES3235306 PT DEBRIDE SKIN PARTIAL $224.00 $120.00 32 REHAB SERVICES3231982 PT DEBRIDE SKIN/TISSUE $178.00 $95.00 32 REHAB SERVICES3235314 PT DEBRIDE SKIN/TISSUE $178.00 $95.00 32 REHAB SERVICES3235363 PT DEBRIDE SKIN/TISSUE $178.00 $95.00 32 REHAB SERVICES3240116 PT E-STIM EA 15 $117.00 $62.00 32 REHAB SERVICES3231644 PT E-STIM EA 15 $117.00 $62.00 32 REHAB SERVICES3231685 PT E-STIM EA 15 $117.00 $62.00 32 REHAB SERVICES3240645 PT E-STIM MANUAL INIT 30 $227.00 32 REHAB SERVICES3240298 PT E-STIM SUPERVISED 15 $137.00 $73.00 32 REHAB SERVICES3240439 PT E-STIM SUPERVISED 15 $137.00 32 REHAB SERVICES3232402 PT E-STIM SUPERVISED 30 $275.00 $147.00 32 REHAB SERVICES3232469 PT EVAL 15 $126.00 $67.00 32 REHAB SERVICES3232477 PT EVAL 30 $298.00 $159.00 32 REHAB SERVICES3261633 PT EVAL 30 $232.20 32 REHAB SERVICES3232485 PT EVAL 45 $446.00 32 REHAB SERVICES3232261 PT EVAL 60 $595.00 $318.00 32 REHAB SERVICES3240017 PT EVAL 60 $595.00 $318.00 32 REHAB SERVICES3232493 PT EVAL 75 $744.00 $398.00 32 REHAB SERVICES3234507 PT EVAL 90 $893.00 $477.00 32 REHAB SERVICES3231925 PT EVAL ADD 15 $149.00 $80.00 32 REHAB SERVICES3240157 PT EVAL ADD 15 $149.00 $80.00 32 REHAB SERVICES3240512 PT EVAL BRIEF $149.00 32 REHAB SERVICES3240553 PT EVAL COMPREHENSIVE $446.00 32 REHAB SERVICES3261625 PT EVAL COMPREHENSIVE $299.16 32 REHAB SERVICES3240546 PT EVAL EXTENDED $595.00 32 REHAB SERVICES3231917 PT EVAL INIT 30 $298.00 $159.00 32 REHAB SERVICES3240140 PT EVAL INIT 30 $298.00 $159.00 32 REHAB SERVICES3261641 PT EVAL INIT 30 $113.40 32 REHAB SERVICES3240538 PT EVAL INTERMEDIATE $298.00 32 REHAB SERVICES3240520 PT EVAL LTD $278.00 32 REHAB SERVICES3240660 PT EXER GP ADD 15 $103.00 32 REHAB SERVICES3240678 PT EXER GP INIT 30 $206.00 32 REHAB SERVICES3240686 PT FNX ACT INIT 30 $275.00 32 REHAB SERVICES

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DEPARTMENT CODE

3231883 PT GAIT TRAIN ADD 15 $137.00 $73.00 32 REHAB SERVICES3231750 PT GAIT TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240348 PT GAIT TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240694 PT GAIT TRAIN INIT 30 $275.00 32 REHAB SERVICES3240702 PT GP ED PER SESSION $138.00 32 REHAB SERVICES3240710 PT GYM PER PRIOR AUTH $137.00 32 REHAB SERVICES3240728 PT IND INSTRUCT INIT 30 $275.00 32 REHAB SERVICES3240306 PT IONTOPHORESIS EA 15 $152.00 $81.00 32 REHAB SERVICES3240736 PT IONTOPHORESIS INIT 30 $252.00 32 REHAB SERVICES3240751 PT JOINT MOB EA VISIT $147.00 32 REHAB SERVICES3240363 PT MANUAL THER EA 15 $147.00 $79.00 32 REHAB SERVICES3240769 PT MANUAL TRACT INIT 30 $294.00 32 REHAB SERVICES3240264 PT MECH TRACT 15 $118.00 $63.00 32 REHAB SERVICES3240777 PT MECH TRACT 30 $195.00 32 REHAB SERVICES3240785 PT MYOFAC/SOFT MOB 30 $294.00 32 REHAB SERVICES3231743 PT NEUROMUSC REED EA 15 $147.00 $79.00 32 REHAB SERVICES3240330 PT NEUROMUSC REED EA 15 $147.00 $79.00 32 REHAB SERVICES3240793 PT NEUROMUSC REED INIT 30 $294.00 32 REHAB SERVICES3241155 PT NP WOUND TX <=50 CM 15 $122.00 32 REHAB SERVICES3241171 PT NP WOUND TX <=50 CM 30 $219.00 32 REHAB SERVICES3261674 PT NP WOUND TX <=50 CM 30 $197.64 32 REHAB SERVICES3241197 PT NP WOUND TX <=50 CM 45 $402.00 32 REHAB SERVICES3241213 PT NP WOUND TX <=50 CM 60 $518.00 32 REHAB SERVICES3241239 PT NP WOUND TX <=50 CM 90 $664.00 32 REHAB SERVICES3241163 PT NP WOUND TX >50 CM 15 $117.00 32 REHAB SERVICES3241189 PT NP WOUND TX >50 CM 30 $260.00 32 REHAB SERVICES3261682 PT NP WOUND TX >50 CM 30 32 REHAB SERVICES3241205 PT NP WOUND TX >50 CM 45 $444.00 32 REHAB SERVICES3241221 PT NP WOUND TX >50 CM 60 $568.00 32 REHAB SERVICES3241247 PT NP WOUND TX >50 CM 90 $716.00 32 REHAB SERVICES3240801 PT ORTHOTIC FAB INIT 30 $275.00 32 REHAB SERVICES3240819 PT ORTHOTIC TRAIN ADD 15 $137.00 32 REHAB SERVICES3240371 PT ORTHOTIC TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240827 PT ORTHOTIC TRAIN INIT 30 $275.00 32 REHAB SERVICES3240835 PT PARAFFIN BATH 15 $69.00 32 REHAB SERVICES3231792 PT PROC THER GP 15 $103.00 $55.00 32 REHAB SERVICES3240033 PT PROC THER GP 15 $103.00 $55.00 32 REHAB SERVICES3240041 PT PROC THER GP 15 32 REHAB SERVICES3232550 PT PROC THER GP 30 $206.00 $110.00 32 REHAB SERVICES3232568 PT PROC THER GP 45 $309.00 $165.00 32 REHAB SERVICES3232576 PT PROC THER GP 60 $412.00 $220.00 32 REHAB SERVICES3240843 PT PROC/MOD ADD 15 $137.00 32 REHAB SERVICES3240850 PT PROSTH TRAIN ADD 15 $137.00 32 REHAB SERVICES

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DEPARTMENT CODE

3240389 PT PROSTH TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3240868 PT PROSTH TRAIN INIT 30 $275.00 32 REHAB SERVICES3232626 PT RE-EVAL 15 $134.00 $72.00 32 REHAB SERVICES3232634 PT RE-EVAL 30 $268.00 $143.00 32 REHAB SERVICES3232279 PT RE-EVAL 45 $402.00 $215.00 32 REHAB SERVICES3232642 PT RE-EVAL 60 $536.00 $286.00 32 REHAB SERVICES3240587 PT RE-EVAL EXTENDED $536.00 32 REHAB SERVICES3240579 PT RE-EVAL INTERMEDIATE $268.00 32 REHAB SERVICES3240561 PT RE-EVAL LTD $226.00 32 REHAB SERVICES3232394 PT SENS INTEGRATION EA 15 $147.00 $79.00 32 REHAB SERVICES3230281 PT SINGLE PROC ADD 15 $137.00 $73.00 $120.00 32 REHAB SERVICES3230257 PT SINGLE PROC INIT 30 $275.00 $147.00 $243.00 32 REHAB SERVICES3261666 PT SINGLE PROC INIT 30 $309.00 32 REHAB SERVICES3240447 PT SOFT TISSUE MOB INIT30 $294.00 32 REHAB SERVICES3232212 PT STRAP UNNA BOOT $199.00 $106.00 32 REHAB SERVICES3240421 PT THER ACT ADD 15 $137.00 32 REHAB SERVICES3231867 PT THER ACT EA 15 $137.00 $73.00 32 REHAB SERVICES3240025 PT THER ACT EA 15 $137.00 $73.00 32 REHAB SERVICES3235074 PT THER ACT EA 15 $137.00 32 REHAB SERVICES3232691 PT THER ACT INIT 30 $275.00 $147.00 32 REHAB SERVICES3231735 PT THER EX EA 15 $137.00 $73.00 32 REHAB SERVICES3240322 PT THER EX EA 15 $137.00 $73.00 32 REHAB SERVICES3240876 PT THER EX INIT 30 $275.00 32 REHAB SERVICES3231776 PT THER MASSAGE EA 15 $147.00 $79.00 32 REHAB SERVICES3240355 PT THER MASSAGE EA 15 $147.00 $79.00 32 REHAB SERVICES3260395 PT THER MASSAGE EA 15 $147.00 $79.00 32 REHAB SERVICES3240462 PT THER MASSAGE INIT 30 $294.00 32 REHAB SERVICES3230364 PT TREAT COMBO ADD 15 $137.00 $73.00 $107.00 32 REHAB SERVICES3240173 PT TREAT COMBO ADD 15 $137.00 $73.00 $107.00 32 REHAB SERVICES3230331 PT TREAT COMBO INIT 30 $275.00 $147.00 $210.00 32 REHAB SERVICES3240165 PT TREAT COMBO INIT 30 $275.00 $147.00 $210.00 32 REHAB SERVICES3240470 PT TRN BIOFD ANY MODAL 30 $279.00 32 REHAB SERVICES3231701 PT ULTRASOUND EA 15 $117.00 $62.00 32 REHAB SERVICES3240066 PT ULTRASOUND EA 15 $117.00 $62.00 32 REHAB SERVICES3240488 PT ULTRASOUND INIT 30 $233.00 32 REHAB SERVICES3240272 PT VASOPNEUMATIC 15 $71.00 $38.00 32 REHAB SERVICES3240496 PT VASOPNEUMATIC 30 $112.00 32 REHAB SERVICES3240280 PT WHIRLPOOL 15 $69.00 $37.00 32 REHAB SERVICES3235322 PT WHIRLPOOL 15 $69.00 $37.00 32 REHAB SERVICES3235371 PT WHIRLPOOL 15 $69.00 $37.00 32 REHAB SERVICES3240504 PT WHIRLPOOL 30 $137.00 32 REHAB SERVICES3235330 PT WHIRLPOOL 30 $137.00 $73.00 32 REHAB SERVICES3261716 PT WHIRLPOOL 30 $47.00 32 REHAB SERVICES

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3235389 PT WHIRLPOOL 30 $137.00 $73.00 32 REHAB SERVICES3240413 PT WHLCHR MNG/TRAIN EA 15 $137.00 $73.00 32 REHAB SERVICES3261757 PUNCTURE DRN LESN $343.44 32 REHAB SERVICES3261815 REM TE WO INS PERM PROSTH $5,130.00 32 REHAB SERVICES3261328 REMOVE NAIL PLATE ADDL $141.97 32 REHAB SERVICES3261310 REMOVE NAIL PLATE SNGL $146.00 32 REHAB SERVICES3261336 RMVL NAIL BED $854.64 32 REHAB SERVICES3211893 S NSTRL CMC/THUMB PREFAB $28.25 32 REHAB SERVICES3211901 S NSTRL CMC/THUMB SUPPORT $11.52 32 REHAB SERVICES3211919 S NSTRL EDEMA GLOVE FULL $5.02 32 REHAB SERVICES3211927 S NSTRL ELBOW STRAP $17.70 32 REHAB SERVICES3211950 S NSTRL FINGER BUDDY STRA $16.67 32 REHAB SERVICES3211935 S NSTRL FINGER DIGITAL GE $3.80 32 REHAB SERVICES3211943 S NSTRL FINGER JOINT CINC $3.77 32 REHAB SERVICES3241148 S NSTRL FOAM ROLLER 6"X36 $25.68 32 REHAB SERVICES3211968 S NSTRL KINESIO TAPE 1 RO $16.63 32 REHAB SERVICES3241080 S NSTRL PULLEYS SHOULDER $17.37 32 REHAB SERVICES3241098 S NSTRL TAPING KIT KNEE H $28.25 32 REHAB SERVICES3241106 S NSTRL TAPING KIT KNEE S $3.22 32 REHAB SERVICES3211877 S NSTRL WRIST BRACER - PR $21.81 32 REHAB SERVICES3211885 S NSTRL WRIST SUPPORTS SO $16.67 32 REHAB SERVICES3212065 S OT EO DBL F/A CUFF FREE $706.00 32 REHAB SERVICES3212073 S OT EO DBL F/A EXT/FLEX $973.00 32 REHAB SERVICES3212099 S OT WHF W/O JT PREFAB $195.00 32 REHAB SERVICES3212115 S OT WHFO RIGID W/O JNTS $338.00 32 REHAB SERVICES3212123 S OT WHFO RIGID W/O JNTS $549.00 32 REHAB SERVICES3212081 S OT WHFO RIGID W/O JNTS $216.00 32 REHAB SERVICES3212016 S STRL DEMA SLEEVE 2" $1.50 32 REHAB SERVICES3212040 S STRL ELEC IONTO SGL USE $9.91 32 REHAB SERVICES3211984 S STRL ELECT E-STIM OVAL $8.69 32 REHAB SERVICES3211992 S STRL ELECT E-STIM RND D $7.53 32 REHAB SERVICES3212057 S STRL ELECT IONTOPHORESI $11.33 32 REHAB SERVICES3212032 S STRL KINESIOTAPE APPL $3.75 32 REHAB SERVICES3212008 S STRL SILICONE GEL SHEET $2.20 32 REHAB SERVICES3212024 S STRL TUBIGRIP 6" $11.25 32 REHAB SERVICES3261963 SKIN SPLT GRFT F/N/HF/G $5,868.00 32 REHAB SERVICES3261955 SKIN SPLT GRFT T/A/L ADD $5,868.00 32 REHAB SERVICES3261948 SKIN SPLT GRFT TRK/ARM/LG $5,868.00 32 REHAB SERVICES3261971 SKN SPL GRFT F/N/HF/G ADD $5,868.00 32 REHAB SERVICES3221306 SP EVAL 105 $923.00 $457.00 32 REHAB SERVICES3221314 SP EVAL 120 $1,055.00 $522.00 32 REHAB SERVICES3221322 SP EVAL 15 $132.00 $65.00 32 REHAB SERVICES3221330 SP EVAL 30 $264.00 $131.00 32 REHAB SERVICES

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SEQ 300 AMOUNT

DEPARTMENT CODE

3221348 SP EVAL 45 $396.00 $196.00 32 REHAB SERVICES3220332 SP EVAL 60 $527.00 $261.00 $337.00 32 REHAB SERVICES3221355 SP EVAL 75 $659.00 $327.00 32 REHAB SERVICES3221363 SP EVAL 90 $791.00 $392.00 32 REHAB SERVICES3221157 SP EVAL APHASIA HR $527.00 $261.00 32 REHAB SERVICES3221371 SP EVAL FNX SWALL 105 $923.00 $457.00 32 REHAB SERVICES3238748 SP EVAL FNX SWALL 120 $1,055.00 $522.00 32 REHAB SERVICES3228749 SP EVAL FNX SWALL 120 $1,055.00 $522.00 32 REHAB SERVICES3221389 SP EVAL FNX SWALL 120 $1,055.00 $522.00 32 REHAB SERVICES3221397 SP EVAL FNX SWALL 15 $132.00 $65.00 32 REHAB SERVICES3221686 SP EVAL FNX SWALL 30 $264.00 $131.00 32 REHAB SERVICES3221405 SP EVAL FNX SWALL 30 $264.00 $131.00 32 REHAB SERVICES3221413 SP EVAL FNX SWALL 45 $396.00 $196.00 32 REHAB SERVICES3221694 SP EVAL FNX SWALL 45 32 REHAB SERVICES3221223 SP EVAL FNX SWALL 60 $527.00 $261.00 32 REHAB SERVICES3221421 SP EVAL FNX SWALL 60 $527.00 $261.00 32 REHAB SERVICES3228632 SP EVAL FNX SWALL 75 $659.00 $327.00 32 REHAB SERVICES3221439 SP EVAL FNX SWALL 90 $791.00 $392.00 32 REHAB SERVICES3221454 SP EVAL LANG 120 $1,055.00 $522.00 32 REHAB SERVICES3221462 SP EVAL LANG 15 $132.00 $65.00 32 REHAB SERVICES3221470 SP EVAL LANG 30 $264.00 $131.00 32 REHAB SERVICES3221488 SP EVAL LANG 45 $396.00 $196.00 32 REHAB SERVICES3220340 SP EVAL LANG 60 $527.00 $261.00 $336.00 32 REHAB SERVICES3221496 SP EVAL LANG 60 $527.00 $261.00 32 REHAB SERVICES3221504 SP EVAL LANG 75 $659.00 $327.00 32 REHAB SERVICES3221512 SP EVAL LANG 90 $791.00 $392.00 32 REHAB SERVICES3221520 SP EVAL MTN FLUOR SWA 105 $1,108.00 $549.00 32 REHAB SERVICES3228616 SP EVAL MTN FLUOR SWA 120 $1,266.00 32 REHAB SERVICES3228640 SP EVAL MTN FLUOR SWA 120 $1,266.00 $627.00 32 REHAB SERVICES3228707 SP EVAL MTN FLUOR SWA 120 $1,266.00 $627.00 32 REHAB SERVICES3228780 SP EVAL MTN FLUOR SWA 120 $627.00 32 REHAB SERVICES3221538 SP EVAL MTN FLUOR SWAL 15 $158.00 $78.00 32 REHAB SERVICES3221546 SP EVAL MTN FLUOR SWAL 30 $316.00 $157.00 32 REHAB SERVICES3221553 SP EVAL MTN FLUOR SWAL 45 $475.00 $235.00 32 REHAB SERVICES3228764 SP EVAL MTN FLUOR SWAL 60 $313.00 32 REHAB SERVICES3221561 SP EVAL MTN FLUOR SWAL 60 $633.00 $313.00 32 REHAB SERVICES3221579 SP EVAL MTN FLUOR SWAL 75 $791.00 $392.00 32 REHAB SERVICES3221587 SP EVAL MTN FLUOR SWAL 90 $949.00 $470.00 32 REHAB SERVICES3228772 SP EVAL MTN FLUOR SWAL 90 $470.00 32 REHAB SERVICES3221611 SP EVAL SP/LNG/COM/AUD 15 $132.00 $65.00 32 REHAB SERVICES3221629 SP EVAL SP/LNG/COM/AUD 30 $264.00 $131.00 32 REHAB SERVICES3221637 SP EVAL SP/LNG/COM/AUD 45 $396.00 $196.00 32 REHAB SERVICES3221645 SP EVAL SP/LNG/COM/AUD 60 $527.00 $261.00 32 REHAB SERVICES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3221652 SP EVAL SP/LNG/COM/AUD 75 $659.00 $327.00 32 REHAB SERVICES3221108 SP EVAL SP/LNG/COM/AUD 75 $659.00 $327.00 32 REHAB SERVICES3221660 SP EVAL SP/LNG/COM/AUD 90 $791.00 $392.00 32 REHAB SERVICES3228624 SP EVAL SP/LNG/COM/AUD 90 $791.00 32 REHAB SERVICES3221678 SP EVAL SWALL & ORAL 15 $132.00 $65.00 32 REHAB SERVICES3228798 SP EVAL SWALL & ORAL 30 $494.00 $253.00 32 REHAB SERVICES3228806 SP EVAL SWALL & ORAL 45 $612.00 $313.00 32 REHAB SERVICES3228814 SP EVAL SWALL & ORAL 60 $989.00 $505.00 32 REHAB SERVICES3221603 SP EVL SP/LNG/COM/AUD 120 $1,055.00 $522.00 32 REHAB SERVICES3228715 SP EVL SP/LNG/COM/AUD 120 $1,055.00 $522.00 32 REHAB SERVICES3220365 SP SP/LANG THER EA 30 $243.00 $121.00 $178.00 32 REHAB SERVICES3220381 SP THER SP/LANG EA 60 $487.00 $241.00 $361.00 32 REHAB SERVICES3220522 SP THER SSAC PER VISIT $305.00 $168.00 32 REHAB SERVICES3221876 SP TX SP/LANG/COM GP 15 $91.00 $45.00 32 REHAB SERVICES3221884 SP TX SP/LANG/COM GP 30 $183.00 $90.00 32 REHAB SERVICES3221892 SP TX SP/LANG/COM GP 45 $274.00 $136.00 32 REHAB SERVICES3221215 SP TX SP/LANG/COM GP 60 $365.00 $181.00 32 REHAB SERVICES3221785 SP TX SP/LANG/COM IND 105 $852.00 $422.00 32 REHAB SERVICES3221793 SP TX SP/LANG/COM IND 120 $973.00 $482.00 32 REHAB SERVICES3221801 SP TX SP/LANG/COM IND 15 $122.00 $60.00 32 REHAB SERVICES3221819 SP TX SP/LANG/COM IND 30 $243.00 $121.00 32 REHAB SERVICES3221827 SP TX SP/LANG/COM IND 45 $365.00 $181.00 32 REHAB SERVICES3221116 SP TX SP/LANG/COM IND 60 $487.00 $241.00 32 REHAB SERVICES3228723 SP TX SP/LANG/COM IND 60 $487.00 $241.00 32 REHAB SERVICES3228731 SP TX SP/LANG/COM IND 60 32 REHAB SERVICES3221835 SP TX SP/LANG/COM IND 75 $608.00 $301.00 32 REHAB SERVICES3221843 SP TX SP/LANG/COM IND 90 $730.00 $362.00 32 REHAB SERVICES3221926 SP TX SWALL/ORAL FNX 105 $852.00 $422.00 32 REHAB SERVICES3221934 SP TX SWALL/ORAL FNX 120 $973.00 $482.00 32 REHAB SERVICES3221942 SP TX SWALL/ORAL FNX 15 $122.00 $60.00 32 REHAB SERVICES3221959 SP TX SWALL/ORAL FNX 30 $243.00 $121.00 32 REHAB SERVICES3221967 SP TX SWALL/ORAL FNX 45 $365.00 $181.00 32 REHAB SERVICES3228756 SP TX SWALL/ORAL FNX 60 $487.00 $241.00 32 REHAB SERVICES3221975 SP TX SWALL/ORAL FNX 60 $487.00 $241.00 32 REHAB SERVICES3221231 SP TX SWALL/ORAL FNX 60 $487.00 $241.00 32 REHAB SERVICES3221983 SP TX SWALL/ORAL FNX 75 $608.00 $301.00 32 REHAB SERVICES3261096 STRAP UNNA BOOT $249.48 32 REHAB SERVICES3261732 STRAP UNNA BOOT $190.00 32 REHAB SERVICES3261252 TRIM SKIN LESION SNGL $128.00 32 REHAB SERVICES3261260 TRIM SKIN LESIONS 2 TO 4 $159.00 32 REHAB SERVICES3261278 TRIM SKIN LESIONS OVER 4 $237.00 32 REHAB SERVICES3261104 VENIPUNCTURE 32 REHAB SERVICES3212149 WHFO NONTORSN JNT PREFAB $126.00 32 REHAB SERVICES

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3212214 WHFO NONTORSN JNT PREFAB $58.00 32 REHAB SERVICES3212255 WHFO NONTORSN JNT PREFAB $95.00 32 REHAB SERVICES3212263 WHFO NONTORSN JNT PREFAB $94.00 32 REHAB SERVICES3212305 WHFO NONTORSN JNT PREFAB 32 REHAB SERVICES3212107 WHFO PREFAB WRIST COCK-UP $64.00 32 REHAB SERVICES3261799 WND PREP CH/INF F/N/HF/G $1,024.00 32 REHAB SERVICES3261781 WND PREP CH/INF TR/ARM/LG $1,024.00 32 REHAB SERVICES3261054 XENOGRAFT APP ADDL 100CM $898.38 32 REHAB SERVICES3261369 XENOGRFT APP 100CM OR LES $898.38 32 REHAB SERVICES5110069 DIALYS CCPD IP $1,843.00 $1,154.00 $187.00 51 RENAL SERVICES5110077 DIALYS CCPD IP $1,843.00 $1,154.00 $187.00 51 RENAL SERVICES0007013 OBSERVATION PER HOUR $220.00 00 ROOM & BED0004010 OBSERVATION PER HOUR $220.00 00 ROOM & BED0005017 OBSERVATION PER HOUR $220.00 00 ROOM & BED0004267 OBSERVATION PER HOUR $220.00 00 ROOM & BED0005512 OBSERVATION PER HOUR $220.00 00 ROOM & BED0001016 OBSERVATION PER HOUR $220.00 00 ROOM & BED0002519 OBSERVATION PER HOUR $220.00 00 ROOM & BED0002014 OBSERVATION PER HOUR $220.00 00 ROOM & BED0044503 OBSERVATION PER HOUR $203.00 00 ROOM & BED0072009 ROOM ICU $10,039.00 00 ROOM & BED0072504 ROOM ICU $10,039.00 00 ROOM & BED0073007 ROOM ICU $10,039.00 00 ROOM & BED0083006 ROOM ICU $10,039.00 00 ROOM & BED0093005 ROOM ICU INTERM $5,928.00 00 ROOM & BED0014506 ROOM ICU INTERM $5,928.00 00 ROOM & BED0063008 ROOM ICU INTERM $5,928.00 00 ROOM & BED0062000 ROOM ICU INTERM $5,928.00 00 ROOM & BED0062505 ROOM ICU INTERM $5,928.00 00 ROOM & BED0065003 ROOM ICU INTERM $5,928.00 00 ROOM & BED0035501 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0027003 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0017004 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0024257 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0014258 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0014001 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0024000 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025502 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0033001 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0021006 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0025007 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015008 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0026203 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0012005 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0012500 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0015503 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0016253 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0021501 ROOM MED/SURG/GYN $3,972.00 00 ROOM & BED0035006 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0044008 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0044255 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0045005 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0045500 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0047001 ROOM MED/SURG/GYN $4,299.00 00 ROOM & BED0026302 ROOM SNF M/S DSNCT $1,000.00 00 ROOM & BED0026401 ROOM SNF M/S DSNCT $1,000.00 00 ROOM & BED0026500 ROOM SNF M/S DSNCT $1,000.00 00 ROOM & BED0026609 ROOM SNF M/S DSNCT $1,000.00 00 ROOM & BED0076208 ROOM SNF M/S DSNCT $750.00 00 ROOM & BED0086207 ROOM SNF M/S DSNCT $750.00 00 ROOM & BED0086306 ROOM SNF M/S DSTNCT BH $685.00 00 ROOM & BED0086405 ROOM SNF M/S DSTNCT BH $685.00 00 ROOM & BED0086504 ROOM SNF M/S DSTNCT BH $685.00 00 ROOM & BED0086603 ROOM SNF M/S DSTNCT BH $685.00 00 ROOM & BED0066209 ROOM SNF M/S DSTNCT BH $750.00 00 ROOM & BED0046508 ROOM SNF M/S NONDSTNCT $685.00 00 ROOM & BED0046409 ROOM SNF M/S NONDSTNCT $685.00 00 ROOM & BED0046300 ROOM SNF M/S NONDSTNCT $685.00 00 ROOM & BED0046607 ROOM SNF M/S NONDSTNCT $685.00 00 ROOM & BED0056606 ROOM SNF M/S NONDSTNCT BH $685.00 00 ROOM & BED0056309 ROOM SNF M/S NONDSTNCT BH $685.00 00 ROOM & BED0056408 ROOM SNF M/S NONDSTNCT BH $240.00 00 ROOM & BED0056507 ROOM SNF M/S NONDSTNCT BH $685.00 00 ROOM & BED0036004 ROOM SUBACUTE NON VENT $2,763.00 00 ROOM & BED0036103 ROOM SUBACUTE NON VENT $2,763.00 00 ROOM & BED0046003 ROOM SUBACUTE NON VENT $2,763.00 00 ROOM & BED0046102 ROOM SUBACUTE NON VENT $2,763.00 00 ROOM & BED0066001 ROOM SUBACUTE NON VENT BH $770.00 00 ROOM & BED0016006 ROOM SUBACUTE VENT $2,763.00 00 ROOM & BED0016105 ROOM SUBACUTE VENT $2,763.00 00 ROOM & BED0026005 ROOM SUBACUTE VENT $2,763.00 00 ROOM & BED0026104 ROOM SUBACUTE VENT $2,763.00 00 ROOM & BED0056002 ROOM SUBACUTE VENT BH $900.00 00 ROOM & BED0055004 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0054007 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0057000 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED

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SEQ 300 AMOUNT

DEPARTMENT CODE

0054502 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0053009 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0052001 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0054254 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0052506 ROOM TELEMETRY/SPEC CARE $4,667.00 00 ROOM & BED0400556 CATH HD SHORT TERM $449.00 $449.00 04 SUPPLIES - CS0401505 CERVICAL FOAM COLLAR $35.00 $33.00 04 SUPPLIES - CS0412585 CERVICAL FOAM COLLAR $432.00 04 SUPPLIES - CS0412593 CERVICAL FOAM COLLAR $995.00 04 SUPPLIES - CS0412221 CERVICAL PLASTIC COLLAR $150.00 $113.00 04 SUPPLIES - CS0412239 CERVICAL PLASTIC COLLAR $150.00 $113.00 04 SUPPLIES - CS0412577 CERVICAL PLASTIC COLLAR $480.00 04 SUPPLIES - CS0412700 PL SHOE INS W ANKLE JNTS $424.00 04 SUPPLIES - CS0413229 S IMP KNEE JNT DROP LOCK $171.00 04 SUPPLIES - CS0497826 S NSTRL SLEEVE KNEE LG S $173.38 04 SUPPLIES - CS0411363 S NSTRL AMBU BAGS, DISP $123.00 $116.00 04 SUPPLIES - CS0400887 S NSTRL BAG BILE REG DIS $37.00 $35.00 04 SUPPLIES - CS0400895 S NSTRL BAG LEG LG DISP $20.00 $19.00 04 SUPPLIES - CS0405274 S NSTRL BAG RESUSITATION $39.00 04 SUPPLIES - CS0403204 S NSTRL BAG URINIMETER $52.00 $49.00 04 SUPPLIES - CS0497974 S NSTRL BARRIER FLANGE LI $17.88 04 SUPPLIES - CS0498071 S NSTRL BARRIER MBL 1 3/4 $10.00 04 SUPPLIES - CS0498089 S NSTRL BARRIER MBL 2 1/4 $10.00 04 SUPPLIES - CS0498097 S NSTRL BARRIER MBL 2 3/4 $10.00 04 SUPPLIES - CS0410266 S NSTRL BARRIER OSTOMY 1 $85.00 $80.00 04 SUPPLIES - CS0412213 S NSTRL BELT OSTY $34.00 04 SUPPLIES - CS0407510 S NSTRL BNDG FLEXNET $5.00 $5.00 04 SUPPLIES - CS0407528 S NSTRL BNDG FLEXNET 6 $12.00 $11.00 04 SUPPLIES - CS0408237 S NSTRL BNDG UNNA BOOT $38.00 $36.00 04 SUPPLIES - CS0497651 S NSTRL BOOT ANKLE DROP $216.32 04 SUPPLIES - CS0404848 S NSTRL CANNULA INFANT $19.00 $18.00 04 SUPPLIES - CS0403253 S NSTRL CATH NASAL $198.00 $187.00 04 SUPPLIES - CS0413450 S NSTRL CLEANS PRNEAL SK8 $10.00 04 SUPPLIES - CS0497693 S NSTRL CROWN HIFIX PIN $1,764.00 04 SUPPLIES - CS0497701 S NSTRL CROWN HIFIX PIN $1,764.00 04 SUPPLIES - CS0410696 S NSTRL DRESSING UNNAL'S $38.00 $36.00 04 SUPPLIES - CS0412023 S NSTRL FLNG 5X5 W/ 2-1/4 $21.00 04 SUPPLIES - CS0412031 S NSTRL FLNG 5X5 W/ 2-3/4 $21.00 04 SUPPLIES - CS0497677 S NSTRL HALO AIRFLO VEST $3,360.00 04 SUPPLIES - CS0497669 S NSTRL HALO AIRFLOW VEST $3,360.00 04 SUPPLIES - CS0497685 S NSTRL HALO EX LG VEST $2,646.00 04 SUPPLIES - CS0497719 S NSTRL HALO HEAD POS. SP $493.00 04 SUPPLIES - CS0497750 S NSTRL HALO RING PED. LG $1,764.00 04 SUPPLIES - CS

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DEPARTMENT CODE

0497743 S NSTRL HALO RING PED. SM $1,764.00 04 SUPPLIES - CS0497735 S NSTRL HALO VEST CHILD $2,884.00 04 SUPPLIES - CS0497727 S NSTRL HALO VEST TODDLER $2,884.00 04 SUPPLIES - CS0400671 S NSTRL INCENTIVE SPIROM $23.00 $21.00 04 SUPPLIES - CS0412064 S NSTRL IRRIG SLEEVE $23.00 04 SUPPLIES - CS0413245 S NSTRL KNEE ORTHOSIS $718.00 04 SUPPLIES - CS0407213 S NSTRL LINE ART $75.00 $71.00 04 SUPPLIES - CS0404210 S NSTRL MASK OXYGEN DISP $5.00 $4.00 04 SUPPLIES - CS0404145 S NSTRL MASK REBREATHER $11.00 $11.00 04 SUPPLIES - CS0411587 S NSTRL METER FLOW $51.00 $48.00 04 SUPPLIES - CS0400689 S NSTRL NASAL CAN 25FT $10.00 $10.00 04 SUPPLIES - CS0400663 S NSTRL NASAL CAN 7FT $3.00 $3.00 04 SUPPLIES - CS0400697 S NSTRL NASAL CANNULA 50 $30.00 $29.00 04 SUPPLIES - CS0411595 S NSTRL NEB HEART MINI $87.00 $82.00 04 SUPPLIES - CS0400648 S NSTRL NEBULIZER HND HLD $5.53 04 SUPPLIES - CS0413443 S NSTRL OINTMT PROTEC2-N1 $14.00 04 SUPPLIES - CS0401174 S NSTRL PAD HYPOTHERMIA $74.00 $70.00 04 SUPPLIES - CS0410910 S NSTRL PAD K THERM DISP $88.00 $83.00 04 SUPPLIES - CS0406967 S NSTRL PAD K THERM DISP $59.00 $55.00 04 SUPPLIES - CS0413476 S NSTRL PAD PEDS PACING E $112.00 04 SUPPLIES - CS0408260 S NSTRL PADS PACE AID $148.00 $140.00 04 SUPPLIES - CS0412148 S NSTRL PASTE STOMA TUBE $47.00 04 SUPPLIES - CS0412155 S NSTRL POUCH OSTY LITTL $8.32 04 SUPPLIES - CS0416164 S NSTRL POUCH OSTY POUCH $12.29 04 SUPPLIES - CS0412007 S NSTRL POUCH BARRIER $17.00 04 SUPPLIES - CS0412015 S NSTRL POUCH BARRIER $16.00 04 SUPPLIES - CS0412049 S NSTRL POUCH DRAIN $11.00 04 SUPPLIES - CS0410308 S NSTRL POUCH DRAIN CUT $135.00 $127.00 04 SUPPLIES - CS0498048 S NSTRL POUCH DRN FT 1.75 $8.00 04 SUPPLIES - CS0498055 S NSTRL POUCH DRN FT 2.75 $8.00 04 SUPPLIES - CS0498030 S NSTRL POUCH DRNBL 2.25 $8.00 04 SUPPLIES - CS0497966 S NSTRL POUCH DRNBL OVER $13.00 04 SUPPLIES - CS0498022 S NSTRL POUCH ONE PC DRNB $9.00 04 SUPPLIES - CS0410282 S NSTRL POUCH OSTOMY 1 1 $87.00 $82.00 04 SUPPLIES - CS0413070 S NSTRL POUCH OSTY 1-3/4 $30.00 04 SUPPLIES - CS0413062 S NSTRL POUCH OSTY 4" $62.00 04 SUPPLIES - CS0413682 S NSTRL POUCH OSTY PCHKN $10.14 04 SUPPLIES - CS0497982 S NSTRL POUCH OSTY POUCHK $13.56 04 SUPPLIES - CS0416230 S NSTRL POUCH POUCHINS PE $10.53 04 SUPPLIES - CS0412072 S NSTRL POUCH UROSTY $16.00 04 SUPPLIES - CS0412080 S NSTRL POUCH UROSTY 04 SUPPLIES - CS0404699 S NSTRL POUCH, UROSTOMY $30.00 $28.00 04 SUPPLIES - CS0412163 S NSTRL POWDER PROTECTIV $35.00 04 SUPPLIES - CS

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DEPARTMENT CODE

0412569 S NSTRL PROSTHETIC SHTH $180.00 04 SUPPLIES - CS0409516 S NSTRL PUMP BREAST DBL $136.00 $128.00 04 SUPPLIES - CS0412098 S NSTRL S NSTRL IRR W/ S $111.00 04 SUPPLIES - CS0404137 S NSTRL S NSTRL MASK TRA $14.00 $13.00 04 SUPPLIES - CS0400630 S NSTRL S NSTRL NEBULIZ. $24.00 $22.00 04 SUPPLIES - CS0412056 S NSTRL S NSTRL POUCH DR $11.00 04 SUPPLIES - CS0403741 S NSTRL S NSTRL PROBE TE $41.00 $38.00 04 SUPPLIES - CS0412122 S NSTRL S NSTRL TAIL CLO $9.00 04 SUPPLIES - CS0402073 S NSTRL SHIELD EYE METAL $3.00 $3.00 04 SUPPLIES - CS0402347 S NSTRL SILVER NITRATE $3.00 $2.00 04 SUPPLIES - CS0403188 S NSTRL SOCK ANTI EMBOL $48.00 $46.00 04 SUPPLIES - CS0413237 S NSTRL SPLINT HAND WRIST $417.00 04 SUPPLIES - CS0400127 S NSTRL STRAP CATH LEG $26.00 $25.00 04 SUPPLIES - CS0413641 S NSTRL SUPPORT STERNUM $375.00 04 SUPPLIES - CS0409490 S NSTRL THORACIC RIB BELT $34.00 $32.00 04 SUPPLIES - CS0412619 S NSTRL TLSO CMPS JKT $2,854.00 04 SUPPLIES - CS0400051 S NSTRL TRNDCR 02 NEO/A $56.00 04 SUPPLIES - CS0404756 S NSTRL TRNDCR O2 $163.00 $154.00 04 SUPPLIES - CS0404228 S NSTRL TRNDCR O2 ADLT $85.00 $80.00 04 SUPPLIES - CS0404236 S NSTRL TRNDCR O2 INF $107.00 $101.00 04 SUPPLIES - CS0404244 S NSTRL TRNDCR O2 PED $85.00 $80.00 04 SUPPLIES - CS0404202 S NSTRL TUBING 02 CONNEC 04 SUPPLIES - CS0497610 S NSTRL UROSTY POUCH $29.00 04 SUPPLIES - CS0497834 S NSTRL VALVE FARRELL $43.47 04 SUPPLIES - CS0497602 S NSTRL WAFER SEAL $22.00 04 SUPPLIES - CS0408377 S ORTHO BINDER ABD $50.00 $47.00 04 SUPPLIES - CS0413203 S ORTHO BOOT HEEL $103.00 04 SUPPLIES - CS0413195 S ORTHO BOS OVERLAP BRACE $3,796.00 04 SUPPLIES - CS0413013 S ORTHO BUCKS TRACT $100.00 04 SUPPLIES - CS0402487 S ORTHO BUCKS TRACT BOOT $65.00 $96.00 04 SUPPLIES - CS0413005 S ORTHO BUCKS TRACTION B $91.00 04 SUPPLIES - CS0403279 S ORTHO CUSTOM SUPPORT 04 SUPPLIES - CS0412858 S ORTHO LS SURG SUPPORT $496.00 04 SUPPLIES - CS0412643 S ORTHO ORTHOSIS,LS SURG $491.00 04 SUPPLIES - CS0409102 S ORTHO SHOE CAST MED CU $49.00 $46.00 04 SUPPLIES - CS0412726 S ORTHO SHOE, PLASTAZOTE $358.00 04 SUPPLIES - CS0402362 S ORTHO SLING ARM ADLT $14.00 $13.00 04 SUPPLIES - CS0400804 S ORTHO SLING ARM CHILD $23.00 $21.00 04 SUPPLIES - CS0402446 S ORTHO SPLNT ARM ADLT $33.00 $32.00 04 SUPPLIES - CS0402370 S ORTHO SPLNT ARM COLLES $115.00 $108.00 04 SUPPLIES - CS0402453 S ORTHO SPLNT FINGER $6.00 $6.00 04 SUPPLIES - CS0402461 S ORTHO SPLNT FINGER $8.00 $8.00 04 SUPPLIES - CS0402503 S ORTHO SPLNT FRARM YTH $30.00 $29.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0402495 S ORTHO SPLNT LEG THOMAS $337.00 $318.00 04 SUPPLIES - CS0409094 S ORTHO SPLNT MASON ALLEN $53.00 $50.00 04 SUPPLIES - CS0409649 S ORTHO SPLNT SWISS $206.00 $194.00 04 SUPPLIES - CS0400747 S ORTHO SUPPORT ABDOMINA $48.00 $46.00 04 SUPPLIES - CS0412882 S OT ADD AK SOFT INTERFC $344.00 04 SUPPLIES - CS0412718 S OT ADD BK SOFT INTERFC $314.00 04 SUPPLIES - CS0412767 S OT ADD UPPR EXT SOCK FX $113.00 04 SUPPLIES - CS0412684 S OT AFO PTR SLD ANK PLS $857.00 04 SUPPLIES - CS0412676 S OT AFO SNGL UPRIGHT CUS $990.00 04 SUPPLIES - CS0412973 S OT EO DBL UPRT FORE CUS $327.00 04 SUPPLIES - CS0412957 S OT HALO CERV JKT VEST $356.00 04 SUPPLIES - CS0411983 S OT HO ABD CNTRL JNTS PF $1,624.00 04 SUPPLIES - CS0412650 S OT HO POST OP JNTS PF $2,720.00 04 SUPPLIES - CS0412692 S OT KAFO FX FEMORAL CUS $2,258.00 04 SUPPLIES - CS0412668 S OT KO ADJ KNEE JT RGD $1,972.00 04 SUPPLIES - CS0410092 S OT KO IMMOB CNVS LONG $110.00 $104.00 04 SUPPLIES - CS0410100 S OT KO IMMOB CNVS LONG $99.00 $93.00 04 SUPPLIES - CS0412379 S OT NON-PNEUM WALK BOOT $163.00 04 SUPPLIES - CS0412775 S OT PNEU ANK CTRL SPLINT $324.00 04 SUPPLIES - CS0412791 S OT PNEU FULL LEG SPLNT $513.00 04 SUPPLIES - CS0412783 S OT PNEUM WALKING BOOT $877.00 04 SUPPLIES - CS0401489 S OT SO ACRO/CLAV CNVS PF $32.00 $30.00 04 SUPPLIES - CS0403311 S OT SO FIG 8 ABDC REST $24.00 $23.00 04 SUPPLIES - CS0497628 S OT SO FIG 8 ABDC REST $327.00 04 SUPPLIES - CS0403337 S OT SO FIG 8 ABDC REST $54.00 $51.00 04 SUPPLIES - CS0412734 S OT SO FIG 8 ABDC REST $235.00 04 SUPPLIES - CS0412601 S OT TLSO 2 PC W LINER $629.00 04 SUPPLIES - CS0412635 S OT TLSO 2 PC W LINER $3,592.00 04 SUPPLIES - CS0412627 S OT TLSO HYPEREXT RGD PF $1,464.00 04 SUPPLIES - CS0412817 S OT TLSO PF 1 PC W LINER $3,639.00 04 SUPPLIES - CS0412759 S OT UPP EXTM FXO HUMERAL $1,095.00 04 SUPPLIES - CS0412965 S OT WHF LONG OPPN CUST $836.00 04 SUPPLIES - CS0412809 S PR INIT RIGID DRESS BK $3,781.00 04 SUPPLIES - CS0412825 S PR SHRINKER BK $2,890.00 04 SUPPLIES - CS0406595 S STRL TRAY THORACENTESI $128.00 $128.00 04 SUPPLIES - CS0407601 S STRL ADAPTER COBE MLL $9.00 $9.00 04 SUPPLIES - CS0405928 S STRL ADAPTER MALE-MAL $6.00 $6.00 04 SUPPLIES - CS0405605 S STRL ADAPTER R.O.S.E. $22.00 $20.00 04 SUPPLIES - CS0407619 S STRL ADAPTER SCREW CA $58.00 $55.00 04 SUPPLIES - CS0408054 S STRL ADAPTER UROSTOMY $12.00 $12.00 04 SUPPLIES - CS0404640 S STRL ADAPTOR PRESSURE $3.00 $3.00 04 SUPPLIES - CS0405464 S STRL AIRWAY BERMAN $3.00 $2.00 04 SUPPLIES - CS0400838 S STRL AIRWAY NASPHGL ALL $37.00 $35.00 04 SUPPLIES - CS

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DEPARTMENT CODE

0409409 S STRL BAG COLLECTION S $12.00 $11.00 04 SUPPLIES - CS0409417 S STRL BAG DRAINAGE $115.00 $109.00 04 SUPPLIES - CS0413542 S STRL BAG RPLCMNT EXTRNL $114.95 04 SUPPLIES - CS0400911 S STRL BAG URINE PEDI $8.00 $7.00 04 SUPPLIES - CS0405191 S STRL BAG, LEG EXTENSI $17.00 $16.00 04 SUPPLIES - CS0409524 S STRL BRIDGE CARC OUTPUT $65.00 $61.00 04 SUPPLIES - CS0498147 S STRL CAN INR PERCT 7MM $16.00 04 SUPPLIES - CS0498139 S STRL CAN INR PERCT 8MM 04 SUPPLIES - CS0498154 S STRL CAN INR PERCT 9MM $15.00 04 SUPPLIES - CS0476259 S STRL CANISTER VAC WITH $178.00 04 SUPPLIES - CS0412320 S STRL CANNULA ARTERIAL $716.00 04 SUPPLIES - CS0404962 S STRL CANULA INNER BLU $204.00 $192.00 04 SUPPLIES - CS0413492 S STRL CATH 10FR TRCH SUC $45.00 04 SUPPLIES - CS0413500 S STRL CATH 12FR TRCH SUC $58.00 04 SUPPLIES - CS0401448 S STRL CATH 14F TRACH SUC $51.00 $51.00 04 SUPPLIES - CS0498238 S STRL CATH 2 LMN UMBI 5F $114.00 04 SUPPLIES - CS0497842 S STRL CATH 6F TRACH SUC $76.00 04 SUPPLIES - CS0413484 S STRL CATH 8FR TRCH SUC $81.00 04 SUPPLIES - CS0411264 S STRL CATH AIRWAY $167.00 $158.00 04 SUPPLIES - CS0410118 S STRL CATH EXTERNAL ALL $7.00 $7.00 04 SUPPLIES - CS0401349 S STRL CATH FOLEY 6FR S $92.00 $87.00 04 SUPPLIES - CS0401315 S STRL CATH FOLEY SILIC $28.00 $27.00 04 SUPPLIES - CS0413526 S STRL CATH HERMETIC VENT $338.64 04 SUPPLIES - CS0498105 S STRL CATH IV INSYTE $10.00 04 SUPPLIES - CS0498113 S STRL CATH IV INSYTE SHL $14.00 04 SUPPLIES - CS0402099 S STRL CATH PLUG/TUBE $3.00 $2.00 04 SUPPLIES - CS0413146 S STRL CATH STAMEY SUPR $156.00 04 SUPPLIES - CS0413138 S STRL CATH STAMEY SUPRA $153.00 04 SUPPLIES - CS0400275 S STRL CATH STRAIGHT NO $5.00 $4.00 04 SUPPLIES - CS0401455 S STRL CATH SUC GLOVE $36.00 $34.00 04 SUPPLIES - CS0401463 S STRL CATH SUC GLOVE $4.00 $3.00 04 SUPPLIES - CS0409920 S STRL CATH SWAN VIP $268.00 $253.00 04 SUPPLIES - CS0497818 S STRL CATH SWANZ CCO/SV $871.00 04 SUPPLIES - CS0409532 S STRL CATH TROCAR CHEST $80.00 $76.00 04 SUPPLIES - CS0476218 S STRL CATH VENOUS SCVO2 $956.00 04 SUPPLIES - CS0412924 S STRL CATHER ANGIO $4.00 04 SUPPLIES - CS0401398 S STRL CATHETER FOLEY 3 $63.00 $60.00 04 SUPPLIES - CS0401380 S STRL CATHETER FOLEY A $34.00 $32.00 04 SUPPLIES - CS0401307 S STRL CATHETER FOLEY C $80.00 $75.00 04 SUPPLIES - CS0401323 S STRL CATHETER FOLEY S $31.00 $30.00 04 SUPPLIES - CS0401422 S STRL CATHETER ROBINSO $27.00 $26.00 04 SUPPLIES - CS0404632 S STRL CIRCUIT IPPB DISP $13.00 $12.00 04 SUPPLIES - CS0403873 S STRL CNTNR EVAC $10.00 $9.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0412171 S STRL COLLECTOR FECAL $33.00 04 SUPPLIES - CS0408617 S STRL CONN SIMM IRR $8.00 $7.00 04 SUPPLIES - CS0403436 S STRL CONN Y $10.00 $9.00 04 SUPPLIES - CS0408609 S STRL CONNECTOR STRAIG $24.00 $22.00 04 SUPPLIES - CS0413054 S STRL CVR WND 2X2 WARM $375.00 04 SUPPLIES - CS0413039 S STRL CVR WND 4X4 SAC $375.00 04 SUPPLIES - CS0413021 S STRL CVR WND 6X6 SAC $375.00 04 SUPPLIES - CS0413047 S STRL CVR WND 6X8 WARM $375.00 04 SUPPLIES - CS0409797 S STRL DILATOR VESSEL 5F $47.00 $47.00 04 SUPPLIES - CS0413625 S STRL DISC CMPRS W/ALGIN $192.00 04 SUPPLIES - CS0413567 S STRL DISC CMPRSR 3 FNGR $63.00 04 SUPPLIES - CS0410951 S STRL DRAIN CHEST PLUERE $190.00 $179.00 04 SUPPLIES - CS0401554 S STRL DRESS ADAPTIC 3X3 $3.00 $3.00 04 SUPPLIES - CS0401562 S STRL DRESS ADAPTIC 3X8 $6.00 $6.00 04 SUPPLIES - CS0413369 S STRL DRESS ALGINATE 4X4 $25.00 04 SUPPLIES - CS0413344 S STRL DRESS ALLDRESS 4X4 $9.00 04 SUPPLIES - CS0413351 S STRL DRESS ALLDRESS 8X8 $13.00 04 SUPPLIES - CS0412908 S STRL DRESS AQUACEL 2X2 $16.00 04 SUPPLIES - CS0498261 S STRL DRESS AQUAGUARD5X5 $9.42 04 SUPPLIES - CS0498279 S STRL DRESS AQUAGUARD9X9 $11.90 04 SUPPLIES - CS0413377 S STRL DRESS FM 4X4W/OADH $25.00 04 SUPPLIES - CS0413385 S STRL DRESS FM ADH 2.5X3 $28.00 04 SUPPLIES - CS0413393 S STRL DRESS FM ADH 4X4.5 $32.00 04 SUPPLIES - CS0401711 S STRL DRESS GAUZE VSLN $10.00 $10.00 04 SUPPLIES - CS0413401 S STRL DRESS HYDR AD2 3/4 $16.00 04 SUPPLIES - CS0413419 S STRL DRESS HYDR ADH 4X4 $23.00 04 SUPPLIES - CS0413435 S STRL DRESS HYDR SAC6.4X $44.00 04 SUPPLIES - CS0413427 S STRL DRESS HYDR W/O 4X4 $17.00 04 SUPPLIES - CS0498337 S STRL DRESS HYROFERA BLU $40.00 04 SUPPLIES - CS0412510 S STRL DRESS KIT LG CA/5 $876.00 04 SUPPLIES - CS0412478 S STRL DRESS KIT SM CA/5 $576.00 04 SUPPLIES - CS0401984 S STRL DRESS NUGAUZE $18.00 $23.00 04 SUPPLIES - CS0401695 S STRL DRESS PKG IODO 1" $23.00 $28.00 04 SUPPLIES - CS0401687 S STRL DRESS PKG IODO 1/2 $20.00 $25.00 04 SUPPLIES - CS0401679 S STRL DRESS PKG IODO 1/4 $19.00 $24.00 04 SUPPLIES - CS0401703 S STRL DRESS PKG IODO 2" $32.00 $39.00 04 SUPPLIES - CS0405530 S STRL DRESS SURG 6X8 $5.00 $5.00 04 SUPPLIES - CS0406371 S STRL DRESS SURGICEL 2X3 $71.00 $67.00 04 SUPPLIES - CS0404087 S STRL DRESS TAPE MEFIX $27.00 $26.00 04 SUPPLIES - CS0401737 S STRL DRESS VASELINE $6.00 $5.00 04 SUPPLIES - CS0401745 S STRL DRESS XEROFORM $10.00 $10.00 04 SUPPLIES - CS0401596 S STRL DRESS XEROFORM $5.00 $5.00 04 SUPPLIES - CS0412916 S STRL DRESSING AQUACEL $28.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0476283 S STRL DRESSING FOAM VAC $166.00 04 SUPPLIES - CS0476275 S STRL DRESSING FOAM VAC $131.00 04 SUPPLIES - CS0476242 S STRL DRESSING FOAM VAC $200.00 04 SUPPLIES - CS0404731 S STRL DRESSING KALTOST $24.00 $23.00 04 SUPPLIES - CS0412494 S STRL DRESSING KIT MED $726.00 04 SUPPLIES - CS0412460 S STRL DRESSING KIT SM $1,043.00 04 SUPPLIES - CS0404285 S STRL DRESSING RESTORE $24.00 $22.00 04 SUPPLIES - CS0416214 S STRL DRESSING SOLOSITE $39.50 04 SUPPLIES - CS0403634 S STRL DRESSING TRANSPA $3.00 $2.00 04 SUPPLIES - CS0498063 S STRL DRG LAYR SILVR 4X5 $48.00 04 SUPPLIES - CS0476309 S STRL DRN FUHRMAN PLEURA $307.00 04 SUPPLIES - CS0498220 S STRL DRS ANTIMIC W/SLVR $214.00 04 SUPPLIES - CS0498121 S STRL DRSG BIO ANTIMI $31.28 04 SUPPLIES - CS0497636 S STRL DRSG BURN ACTICOAT $62.00 04 SUPPLIES - CS0412262 S STRL DRSG COMFEEL 4X4 $15.00 04 SUPPLIES - CS0498246 S STRL DRSG MEDIHONEY 2X2 $23.00 04 SUPPLIES - CS0497990 S STRL DRSG OASIS 3X7 $190.57 04 SUPPLIES - CS0476291 S STRL DRSG VAC SOFT FOAM $54.11 04 SUPPLIES - CS0410670 S STRL ELECT PAD ADHSV $251.00 $237.00 04 SUPPLIES - CS0407254 S STRL EXTENSION W/STOP $28.00 $26.00 04 SUPPLIES - CS0400010 S STRL EZ FLOW NEBULIZE $50.00 04 SUPPLIES - CS0402149 S STRL FEEDER HYBERMAN $72.00 $68.00 04 SUPPLIES - CS0497859 S STRL FILIFORM COUDE/STR $145.59 04 SUPPLIES - CS0497891 S STRL FOLLOWER BOUGIE 12 $211.57 04 SUPPLIES - CS0497867 S STRL FOLLOWER BOUGIE 14 $216.84 04 SUPPLIES - CS0497909 S STRL FOLLOWER BOUGIE 16 $216.84 04 SUPPLIES - CS0497917 S STRL FOLLOWER BOUGIE 18 $216.84 04 SUPPLIES - CS0497925 S STRL FOLLOWER BOUGIE 20 $216.84 04 SUPPLIES - CS0497933 S STRL FOLLOWER BOUGIE 22 $211.57 04 SUPPLIES - CS0497883 S STRL FOLLOWER BOUGIE10F $211.57 04 SUPPLIES - CS0497875 S STRL FOLLOWER OPEN ALL $240.98 04 SUPPLIES - CS0497941 S STRL FOLLOWER PHILLIP C $218.58 04 SUPPLIES - CS0404707 S STRL GASTMY FEED TUBE $122.00 $115.00 04 SUPPLIES - CS0404988 S STRL GEL INTRASITE $39.00 $37.00 04 SUPPLIES - CS0498212 S STRL GEL SILVASORB $31.28 04 SUPPLIES - CS0413252 S STRL GUIDE WIRE .035 X $36.00 04 SUPPLIES - CS0409912 S STRL GUIDE WIRE ALL $81.00 $77.00 04 SUPPLIES - CS0497768 S STRL HALO SKULL PIN $714.00 04 SUPPLIES - CS0413690 S STRL KIT ART LINE 20GA $105.00 04 SUPPLIES - CS0409789 S STRL KIT CATH INSERT $435.00 $410.00 04 SUPPLIES - CS0413518 S STRL KIT CRANIAL ACCESS $1,007.25 04 SUPPLIES - CS0408393 S STRL KIT CVP ARROWGAR $351.00 $331.00 04 SUPPLIES - CS0410613 S STRL KIT CVP MULTI LU $234.00 $221.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0408252 S STRL KIT CVP MULTILUMEN $128.49 $128.49 04 SUPPLIES - CS0410704 S STRL KIT ELECT PACE $656.00 $619.00 04 SUPPLIES - CS0413534 S STRL KIT EXTRNL CSF DRN $548.25 04 SUPPLIES - CS0413658 S STRL KIT FECAL SYSTEM F $1,126.25 04 SUPPLIES - CS0497784 S STRL KIT GASTMY SKIN LV $403.75 04 SUPPLIES - CS0410639 S STRL KIT INLINE INJECT $65.00 $62.00 04 SUPPLIES - CS0403675 S STRL KIT INT JUG PUNC $95.00 $89.00 04 SUPPLIES - CS0410001 S STRL KIT PATIENT CPM $206.00 $195.00 04 SUPPLIES - CS0403899 S STRL KIT PERC SHTH 8.5F $197.00 $186.00 04 SUPPLIES - CS0403881 S STRL KIT PERCUT SHEAT $161.00 $152.00 04 SUPPLIES - CS0403360 S STRL KIT PRESSURE MONT $84.00 $84.00 04 SUPPLIES - CS0416222 S STRL KIT SUBDURAL EVAC $3,750.00 04 SUPPLIES - CS0497792 S STRL KIT TRIPLE TRANSDU $143.69 04 SUPPLIES - CS0400358 S STRL MASK VENTURI $14.00 $13.00 04 SUPPLIES - CS0407353 S STRL MON TUBING/TRANS $56.00 $56.00 04 SUPPLIES - CS0401919 S STRL NDL COOK $17.00 $16.00 04 SUPPLIES - CS0405092 S STRL NDL HUBER $42.00 $39.00 04 SUPPLIES - CS0404996 S STRL NDL JAMSHIDI $157.00 $148.00 04 SUPPLIES - CS0498204 S STRL NDL WHTCR SPNL 22G $26.56 04 SUPPLIES - CS0498170 S STRL NDLGRPRPLUS22GAX1 $26.69 04 SUPPLIES - CS0400085 S STRL OXISENOR D-20 $100.00 $94.00 04 SUPPLIES - CS0407817 S STRL PACK DELIVERY EM $53.00 $50.00 04 SUPPLIES - CS0406173 S STRL PADS BREAST NURS 04 SUPPLIES - CS0498253 S STRL PASTE TUBE MEDIHON $59.00 04 SUPPLIES - CS0413468 S STRL PATCH HEMOSTATIS 3 $377.00 04 SUPPLIES - CS0402065 S STRL PATCHES EYE BLACK $6.00 $5.00 04 SUPPLIES - CS0410688 S STRL PATCHES EYE MOIS $23.00 $22.00 04 SUPPLIES - CS0406215 S STRL PIPE CLEANERS ST $9.00 $8.00 04 SUPPLIES - CS0400846 S STRL PORTEX INNER CAN $17.00 $16.00 04 SUPPLIES - CS0400879 S STRL PORTEX TRACH TUBE $160.00 $151.00 04 SUPPLIES - CS0409458 S STRL POUCH PENIS RETR $20.00 $19.00 04 SUPPLIES - CS0407197 S STRL PUMP BREAST M/E $32.00 $30.00 04 SUPPLIES - CS0416172 S STRL PUNCH 2.0 SKIN BIO $9.00 04 SUPPLIES - CS0416180 S STRL PUNCH 3.0 SKIN BIO $9.00 04 SUPPLIES - CS0416198 S STRL PUNCH 4.0 SKIN BIO $9.00 04 SUPPLIES - CS0404749 S STRL ROPE KALTOSTAT $27.00 $25.00 04 SUPPLIES - CS0400192 S STRL SAFETY DRAIN CLO $16.00 $15.00 04 SUPPLIES - CS0400200 S STRL SAFETY DRAIN W/T $28.00 $26.00 04 SUPPLIES - CS0403220 S STRL SET ART COMP REG $146.00 $138.00 04 SUPPLIES - CS0412452 S STRL SET BLOOD PUMP $8.00 04 SUPPLIES - CS0476333 S STRL SET CATH ARTERY SH $49.57 04 SUPPLIES - CS0410126 S STRL SET CATH IRRG $43.00 $41.00 04 SUPPLIES - CS0403865 S STRL SET CATH RAD ART $54.00 $51.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0408336 S STRL SET COSET STOPCOCK $65.00 $62.00 04 SUPPLIES - CS0413633 S STRL SET CRICOTHYROTOMY $461.00 04 SUPPLIES - CS0401836 S STRL SET CVP MANOMETER $48.00 $46.00 04 SUPPLIES - CS0402180 S STRL SET DRAIN FOLEY $23.00 $21.00 04 SUPPLIES - CS0403790 S STRL SET DRESS 3 PIECE $28.00 $27.00 04 SUPPLIES - CS0416248 S STRL SET INFUS PWRLC 20 $37.00 04 SUPPLIES - CS0402206 S STRL SET PNEUMOTHORAX $415.00 $391.00 04 SUPPLIES - CS0404590 S STRL SET SUT $13.00 $12.00 04 SUPPLIES - CS0403857 S STRL SET SUT 2 PIECE $8.00 $7.00 04 SUPPLIES - CS0403329 S STRL SET TUBE THORA $24.00 $23.00 04 SUPPLIES - CS0497800 S STRL SET VENOUS ACC 2 L $248.00 04 SUPPLIES - CS0404665 S STRL SET VENTILATOR $22.00 $20.00 04 SUPPLIES - CS0406272 S STRL SLEEVE KNEE SEQUEN $115.00 $108.00 04 SUPPLIES - CS0400234 S STRL SLEEVE THIGH LARGE $200.00 $189.00 04 SUPPLIES - CS0410746 S STRL SLEEVE THIGH SEQUE $167.00 $158.00 04 SUPPLIES - CS0400101 S STRL SLEEVE THIGH SMALL $158.00 $149.00 04 SUPPLIES - CS0410753 S STRL SLEEVE THIGH STRL $151.00 $142.00 04 SUPPLIES - CS0416206 S STRL SOL .9 NACL 500ML $4.00 04 SUPPLIES - CS0402727 S STRL SOL .9% NS IRR $37.00 $35.00 04 SUPPLIES - CS0403451 S STRL SOL HEP SOD .9% $35.00 $33.00 04 SUPPLIES - CS0401976 S STRL SOL NS IRR 1000CC $6.00 $6.00 04 SUPPLIES - CS0403170 S STRL SOLUTION H20 IRR $7.00 $6.00 04 SUPPLIES - CS0404376 S STRL SPECULUM VAGINAL $8.00 $7.00 04 SUPPLIES - CS0410795 S STRL STAPLER SKIN 04 SUPPLIES - CS0405118 S STRL STOPCOCK COBE $12.00 $11.00 04 SUPPLIES - CS0408518 S STRL STYLET ENDOTRACH $24.00 $23.00 04 SUPPLIES - CS0498188 S STRL SUC KIT CATH 5FR $3.55 04 SUPPLIES - CS0409466 S STRL SUCTION TUBE ATT $15.00 $15.00 04 SUPPLIES - CS0409680 S STRL SUTURES SILK 3.0 $10.00 $9.00 04 SUPPLIES - CS0402651 S STRL SYRINGE 60CC ASE $3.00 $2.00 04 SUPPLIES - CS0404574 S STRL TRACH INNER CAN $23.00 $22.00 04 SUPPLIES - CS0498162 S STRL TRACH TUBE INTRDRC $245.00 04 SUPPLIES - CS0402115 S STRL TRAP CATHETER FO $57.00 $54.00 04 SUPPLIES - CS0406439 S STRL TRAY ABD PARACEN $94.00 $89.00 04 SUPPLIES - CS0497958 S STRL TRAY AMNIOCENTESIS $55.00 04 SUPPLIES - CS0476325 S STRL TRAY CATH 16F CUDE $50.00 04 SUPPLIES - CS0402925 S STRL TRAY CATH FOLEY $15.00 $14.00 04 SUPPLIES - CS0413336 S STRL TRAY CATH MHRKR 10 $354.00 04 SUPPLIES - CS0413328 S STRL TRAY CATH MHRKR 11 $354.00 04 SUPPLIES - CS0413310 S STRL TRAY CATH MHRKR 8F $354.00 04 SUPPLIES - CS0402909 S STRL TRAY CATH URETHR $20.00 $19.00 04 SUPPLIES - CS0413211 S STRL TRAY CHEST TUBE $108.00 04 SUPPLIES - CS0498014 S STRL TRAY FOLEY 16F TMP $127.00 04 SUPPLIES - CS

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SEQ 300 AMOUNT

DEPARTMENT CODE

0410076 S STRL TRAY LUMBAR PUNC $69.00 $69.00 04 SUPPLIES - CS0413302 S STRL TRAY QUINTON CATH $508.00 04 SUPPLIES - CS0498006 S STRL TRAY THORACENTESIS $172.86 04 SUPPLIES - CS0406603 S STRL TRAY THORACOTOMY $97.00 $92.00 04 SUPPLIES - CS0406611 S STRL TRAY TRACHEOTOMY $141.00 $133.00 04 SUPPLIES - CS0476317 S STRL TRAY URINE MTR 16F $58.00 04 SUPPLIES - CS0413559 S STRL TRNDR TRANSPAC W/S $44.74 04 SUPPLIES - CS0414102 S STRL TUBE 5F SIL ENTRL $78.23 04 SUPPLIES - CS0414110 S STRL TUBE 8F SIL ENTRL $78.23 04 SUPPLIES - CS0406637 S STRL TUBE CHEST ALL A $83.00 $79.00 04 SUPPLIES - CS0413674 S STRL TUBE FDG CRFL 6FX3 $77.02 04 SUPPLIES - CS0413666 S STRL TUBE FDG CRFL 8FX4 $99.49 04 SUPPLIES - CS0406694 S STRL TUBE FEEDING 8FRX4 $59.49 04 SUPPLIES - CS0403097 S STRL TUBE LEVINE ALL $58.00 $55.00 04 SUPPLIES - CS0410845 S STRL TUBE MINNESOTA $731.00 $690.00 04 SUPPLIES - CS0400721 S STRL TUBE NASPHGL $70.00 $66.00 04 SUPPLIES - CS0404954 S STRL TUBE PORTEX CUFF $204.00 $192.00 04 SUPPLIES - CS0411421 S STRL TUBE PORTEX CUFF $225.00 $212.00 04 SUPPLIES - CS0403113 S STRL TUBE RECTAL RUBBER $33.00 $32.00 04 SUPPLIES - CS0403121 S STRL TUBE SALEM SUMP $12.00 $12.00 04 SUPPLIES - CS0401356 S STRL TUBE STOMACH ALL $12.00 $11.00 04 SUPPLIES - CS0497776 S STRL TUBE TRACH 8. EX C $526.58 04 SUPPLIES - CS0413609 S STRL TUBE TRACH CARE 6F $73.00 04 SUPPLIES - CS0413617 S STRL TUBE TRACH CARE 8F $73.00 04 SUPPLIES - CS0403154 S STRL TUBE TRACH SHILEY $248.00 $234.00 04 SUPPLIES - CS0498196 S STRL TUBEETCUFMPHY2.0MM $6.50 04 SUPPLIES - CS0476267 S STRL TUBING PAD CLAMP-C $103.00 04 SUPPLIES - CS0403915 S STRL TY BONE MARROW $294.00 $277.00 04 SUPPLIES - CS0408815 S STRL TY LACERATION ER $85.00 $80.00 04 SUPPLIES - CS0411975 S STRL TY LIVER BIOP $192.00 04 SUPPLIES - CS0412940 S STRL TY SAF PNEUMOTHO $333.00 04 SUPPLIES - CS0410068 S STRL TY THORA DISP $129.00 $122.00 04 SUPPLIES - CS0410043 S STRL TY THORACENT/PERI $533.00 $503.00 04 SUPPLIES - CS0400325 S STRL UNIT TRACH MIST $11.00 $10.00 04 SUPPLIES - CS0403212 S STRL URINOMETER $85.00 $81.00 04 SUPPLIES - CS0412536 S STRL VAC CANISTER KIT $626.00 04 SUPPLIES - CS0412551 S STRL VAC KIT ISOLYSER $749.00 04 SUPPLIES - CS0412528 S STRL VAC.CANISTER KIT $1,134.00 04 SUPPLIES - CS0410738 S STRL VALVE ANTI-REFLU $40.00 $37.00 04 SUPPLIES - CS0410852 S STRL VENT TRACH HELSPER $190.00 $179.00 04 SUPPLIES - CS0407734 S STRL VLV CHEST DRAIN $69.00 $65.00 04 SUPPLIES - CS0410928 S STRL VLV LOPEZ $14.00 $14.00 04 SUPPLIES - CS0404400 S STRL VLV P.E.E.P. $105.00 $99.00 04 SUPPLIES - CS

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0400614 S STRL VLV TRACH SPEAK $231.00 $218.00 04 SUPPLIES - CS0401182 WHFO PREFAB WRIST COCK-UP $9.00 $8.00 04 SUPPLIES - CS0412742 WHFO PREFAB WRIST COCK-UP $237.00 04 SUPPLIES - CS0341586 CA ANGIO IL W HC $94.00 03 SUPPLIES-EQUIP/RENTAL2261550 CATH BLN DILATE NOVSC $633.25 22 SURGICAL SUPPLIES I/P2297471 CATH BLN TIS DSCT NOVSC $1,252.75 22 SURGICAL SUPPLIES I/P2297745 CATH BLN TIS DSCT NOVSC $648.25 22 SURGICAL SUPPLIES I/P2297752 CATH BLN TIS DSCT NOVSC $424.50 22 SURGICAL SUPPLIES I/P2298487 CATH DRAINAGE $225.25 22 SURGICAL SUPPLIES I/P2296903 CATH DRAINAGE $102.50 22 SURGICAL SUPPLIES I/P2294957 CATH HD SHORT TERM $346.75 22 SURGICAL SUPPLIES I/P2261212 CATH HD SHORT TERM $1,976.25 22 SURGICAL SUPPLIES I/P2210219 CATH INF PER CEN MID NOHD $9.00 $9.00 22 SURGICAL SUPPLIES I/P2211399 CATH INF PER CEN MID NOHD $232.75 $232.75 22 SURGICAL SUPPLIES I/P2213114 CATH INF PER CEN MID NOHD $1,938.00 22 SURGICAL SUPPLIES I/P2298198 CATH INF PER CEN MID NOHD $399.50 22 SURGICAL SUPPLIES I/P2212850 CATH INF PER CEN MID NOHD $51.50 22 SURGICAL SUPPLIES I/P2210425 CATH INF PER CEN MID NOHD $132.00 $125.00 22 SURGICAL SUPPLIES I/P2213189 CATH INF PER CEN MID NOHD $317.00 22 SURGICAL SUPPLIES I/P2213171 CATH INF PER CEN MID NOHD $248.50 22 SURGICAL SUPPLIES I/P2212462 CATH INF PER CEN MID NOHD $96.50 22 SURGICAL SUPPLIES I/P2212520 CATH INF PER CEN MID NOHD $172.00 22 SURGICAL SUPPLIES I/P2210193 CATH INF PER CEN MID NOHD $102.75 $102.75 22 SURGICAL SUPPLIES I/P2213031 CATH INF PER CEN MID NOHD $253.00 22 SURGICAL SUPPLIES I/P2298313 CATH INF PER CEN MID NOHD $465.00 22 SURGICAL SUPPLIES I/P2210037 CATH INF PER CEN MID NOHD $162.75 $162.75 22 SURGICAL SUPPLIES I/P2298321 CATH INF PER CEN MID NOHD $717.50 22 SURGICAL SUPPLIES I/P2211605 CATH INF PER CEN MID NOHD $85.00 $80.00 22 SURGICAL SUPPLIES I/P2298206 CATH INF PER CEN MID NOHD $266.00 22 SURGICAL SUPPLIES I/P2211407 CATH INF PER CEN MID NOHD $319.00 $301.00 22 SURGICAL SUPPLIES I/P2298339 CATH INF PER CEN MID NOHD $1,182.25 22 SURGICAL SUPPLIES I/P2294122 CATH INF PER CEN MID NOHD $1,976.25 22 SURGICAL SUPPLIES I/P2212876 CATH INF PER CEN MID NOHD $249.25 22 SURGICAL SUPPLIES I/P2262012 CATH INTRASPINAL $1,275.00 22 SURGICAL SUPPLIES I/P2295632 CATH THROMB/EMBOLCTMY $850.00 22 SURGICAL SUPPLIES I/P2263770 CATH TRNSML ANGIO NOLASR $531.25 22 SURGICAL SUPPLIES I/P2298297 CATH TRNSML ANGIO NOLASR $1,772.25 22 SURGICAL SUPPLIES I/P2297513 CON TISS HUMAN INC FASCIA $3,525.00 22 SURGICAL SUPPLIES I/P2295020 EP ICAR FX CV GD IN SHTH $212.50 22 SURGICAL SUPPLIES I/P2295038 EP ICAR FX CV GD IN SHTH $310.25 22 SURGICAL SUPPLIES I/P2296994 GENERATOR NEURO NO-RECHRG $13,493.00 22 SURGICAL SUPPLIES I/P2263317 GUIDEWIRE $68.25 22 SURGICAL SUPPLIES I/P2298479 GUIDEWIRE $218.50 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2294882 GUIDEWIRE $148.00 22 SURGICAL SUPPLIES I/P2263325 GUIDEWIRE $95.00 22 SURGICAL SUPPLIES I/P2297455 GUIDEWIRE $935.00 22 SURGICAL SUPPLIES I/P2293884 GUIDEWIRE $187.75 22 SURGICAL SUPPLIES I/P2297364 GUIDEWIRE $255.00 22 SURGICAL SUPPLIES I/P2210433 GUIDEWIRE $53.25 $53.25 22 SURGICAL SUPPLIES I/P2292548 GUIDEWIRE $345.50 22 SURGICAL SUPPLIES I/P2261220 IMP CATH HD/PRTNL LNG TRM $765.00 22 SURGICAL SUPPLIES I/P2296861 IMP GRAFT VASCULAR $2,377.00 22 SURGICAL SUPPLIES I/P2294163 IMP MESH $1,960.00 22 SURGICAL SUPPLIES I/P2294155 IMP MESH $2,758.00 22 SURGICAL SUPPLIES I/P2260057 IMP MESH $2,028.00 $2,028.00 22 SURGICAL SUPPLIES I/P2260859 IMP MESH $1,156.75 22 SURGICAL SUPPLIES I/P2294783 IMP MESH $4,125.00 22 SURGICAL SUPPLIES I/P2294023 IMP MESH $1,509.00 22 SURGICAL SUPPLIES I/P2294148 IMP MESH $3,100.00 22 SURGICAL SUPPLIES I/P2297521 IMP PROSTHESIS BREAST $5,618.00 22 SURGICAL SUPPLIES I/P2291904 INTRO/SHEATH NON-LASER $468.25 22 SURGICAL SUPPLIES I/P2297596 INTRO/SHEATH NON-LASER $1,190.00 22 SURGICAL SUPPLIES I/P2293975 INTRO/SHEATH NON-LASER $198.50 22 SURGICAL SUPPLIES I/P2240786 LACTATE RINGERS TO 1000CC $100.00 $94.00 22 SURGICAL SUPPLIES I/P2296978 LEAD NEUROSTIMULATOR $5,957.00 22 SURGICAL SUPPLIES I/P2240836 MANNITOL $55.50 $55.50 22 SURGICAL SUPPLIES I/P2297893 MORCELLATOR $2,341.00 22 SURGICAL SUPPLIES I/P2262566 PROBE CRYOABLATION $10,099.00 22 SURGICAL SUPPLIES I/P2262772 PROBE CRYOABLATION $12,125.00 22 SURGICAL SUPPLIES I/P2262574 PROBE CRYOABLATION $1,806.00 22 SURGICAL SUPPLIES I/P2297000 REP DEV URINARY W/SLING $2,725.00 22 SURGICAL SUPPLIES I/P2297109 RET DEV INSERTABLE $1,821.00 22 SURGICAL SUPPLIES I/P2292688 RET DEV INSERTABLE $3,223.00 22 SURGICAL SUPPLIES I/P2290195 RET DEV INSERTABLE $1,012.50 $1,012.50 22 SURGICAL SUPPLIES I/P2297554 S IMP BONE GRAFT INFUSE $12,233.00 22 SURGICAL SUPPLIES I/P2297547 S IMP BONE GRAFT INFUSE $8,628.00 22 SURGICAL SUPPLIES I/P2297562 S IMP BONE GRAFT INFUSE L $13,520.00 22 SURGICAL SUPPLIES I/P2297166 S IMP BONE PRO OSTEON $1,929.00 22 SURGICAL SUPPLIES I/P2294551 S IMP BONESOURCE 25GMS $6,333.00 22 SURGICAL SUPPLIES I/P2260933 S IMP CONNECTOR LUMBAR $230.00 22 SURGICAL SUPPLIES I/P2291276 S IMP GRAFTON CRUNCH 15CC $4,225.00 22 SURGICAL SUPPLIES I/P2293587 S IMP HEART VALVE $9,750.00 22 SURGICAL SUPPLIES I/P2291672 S IMP HEMASHIELD PATCH $613.00 22 SURGICAL SUPPLIES I/P2297307 S IMP LAP-BAND SYS $7,640.00 22 SURGICAL SUPPLIES I/P2296986 S IMP LEAD KIT EXT DBS $2,782.50 22 SURGICAL SUPPLIES I/P2208130 S IMP PATCH GRAFT $3,413.00 $3,413.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2208254 S IMP PERIGUARD $1,802.00 22 SURGICAL SUPPLIES I/P2260107 S IMP RESERVIOR CSF-VE $1,415.50 22 SURGICAL SUPPLIES I/P2292472 S IMP SOFT TISS PATCH $2,620.00 22 SURGICAL SUPPLIES I/P2291888 S IMP STENT URETHRAL $146.75 22 SURGICAL SUPPLIES I/P2260339 S IMP STENT UTERAL $484.50 $544.00 22 SURGICAL SUPPLIES I/P2293900 S IMP SURGICAL MEMBRANE $2,496.00 $2,496.00 22 SURGICAL SUPPLIES I/P2293751 S IMP SYRINGO-PERIT SHUNT $2,895.00 22 SURGICAL SUPPLIES I/P2208148 S IMP VALVE $8,843.00 $8,843.00 22 SURGICAL SUPPLIES I/P2208155 S IMP VALVE $8,100.00 $8,100.00 22 SURGICAL SUPPLIES I/P2296960 S IMP VERTGRAFT BULLET $9,228.00 22 SURGICAL SUPPLIES I/P2213213 S INV DVC $6,122.50 22 SURGICAL SUPPLIES I/P2207967 S NSTRL BAG $1,381.25 22 SURGICAL SUPPLIES I/P2207959 S NSTRL BELT $1,466.25 22 SURGICAL SUPPLIES I/P2212983 S NSTRL BLANKET WARM PED $79.50 22 SURGICAL SUPPLIES I/P2200103 S NSTRL CELL SAVER SET $248.00 22 SURGICAL SUPPLIES I/P2208098 S NSTRL CHARGER $10,800.00 $10,800.00 22 SURGICAL SUPPLIES I/P2297448 S NSTRL ELECT LEVEEN RF $3,141.00 22 SURGICAL SUPPLIES I/P2207942 S NSTRL SHOWER BAG $1,912.50 22 SURGICAL SUPPLIES I/P2263499 S NSTRL SLEEVE $94.50 22 SURGICAL SUPPLIES I/P2261873 S NSTRL SLING $246.50 22 SURGICAL SUPPLIES I/P2298578 S NSTRL SPLINT ORTHOGLASS $44.00 22 SURGICAL SUPPLIES I/P2298560 S NSTRL SPLINT ORTHOGLASS $35.00 22 SURGICAL SUPPLIES I/P2298552 S NSTRL SPLINT ORTHOGLASS $32.00 22 SURGICAL SUPPLIES I/P2298545 S NSTRL SPLINT ORTHOGLASS $23.00 22 SURGICAL SUPPLIES I/P2263507 S NSTRL STOCKING $17.75 22 SURGICAL SUPPLIES I/P2295988 S ORTHO ULTRA SLING $133.00 22 SURGICAL SUPPLIES I/P2262434 S STRL ABLAT DVC $2,900.00 22 SURGICAL SUPPLIES I/P2262137 S STRL ACC KIT $446.25 22 SURGICAL SUPPLIES I/P2263101 S STRL ACCESS KIT $183.00 22 SURGICAL SUPPLIES I/P2261006 S STRL ACCESS KIT MICRO $95.00 22 SURGICAL SUPPLIES I/P2261022 S STRL ACCESS STH SET URE $492.75 22 SURGICAL SUPPLIES I/P2263309 S STRL ACCESSORY KIT $1,679.00 22 SURGICAL SUPPLIES I/P2299097 S STRL ACCESSORY KIT COSE $209.50 22 SURGICAL SUPPLIES I/P2262046 S STRL ADAPT $232.25 22 SURGICAL SUPPLIES I/P2262756 S STRL ADHESIVE $115.50 22 SURGICAL SUPPLIES I/P2212652 S STRL AIRWAY ESOPHAGEAL $221.50 22 SURGICAL SUPPLIES I/P2212017 S STRL AIRWAY EXCHANGER $234.75 22 SURGICAL SUPPLIES I/P2210722 S STRL AMBU BAG, DISP $39.50 $39.50 22 SURGICAL SUPPLIES I/P2263432 S STRL ANTENNA $340.00 22 SURGICAL SUPPLIES I/P2261360 S STRL APP FLOSEAL $244.00 22 SURGICAL SUPPLIES I/P2262327 S STRL APPLC $343.50 22 SURGICAL SUPPLIES I/P2299188 S STRL APPLICATOR KIT HEM $485.25 22 SURGICAL SUPPLIES I/P2212751 S STRL ARNDT ENDOBRONCH $620.50 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2212900 S STRL ART MONITOR SET $133.00 22 SURGICAL SUPPLIES I/P2297646 S STRL ARTHROKNIFE SHEATH $251.00 22 SURGICAL SUPPLIES I/P2295665 S STRL ARTHROWAND $637.50 22 SURGICAL SUPPLIES I/P2213221 S STRL ATOMIZER $30.75 22 SURGICAL SUPPLIES I/P2297836 S STRL ATTAIN OTW LEAD GD $1,966.00 22 SURGICAL SUPPLIES I/P2211795 S STRL BACTERIAL FTR $4.50 $4.50 22 SURGICAL SUPPLIES I/P2290294 S STRL BAG URINARY DRAIN $15.75 $14.50 22 SURGICAL SUPPLIES I/P2298651 S STRL BAHA BIOPSY PUNCH $123.00 22 SURGICAL SUPPLIES I/P2298644 S STRL BAHA DERMATOME BLA $306.00 22 SURGICAL SUPPLIES I/P2298628 S STRL BAHA DRILL $935.00 22 SURGICAL SUPPLIES I/P2298636 S STRL BAHA HEALING CAP $339.00 22 SURGICAL SUPPLIES I/P2290344 S STRL BAND FALOPE RING $216.50 $216.50 22 SURGICAL SUPPLIES I/P2296655 S STRL BARIUM STR $318.75 22 SURGICAL SUPPLIES I/P2262483 S STRL BASKET $993.50 22 SURGICAL SUPPLIES I/P2298891 S STRL BASKET STONE RETRI $892.50 22 SURGICAL SUPPLIES I/P2263424 S STRL BATTERY $361.25 22 SURGICAL SUPPLIES I/P2298917 S STRL BATTERY F/AUTO-DRI $267.75 22 SURGICAL SUPPLIES I/P2263275 S STRL BIRTH CONTROL SYS $2,275.00 22 SURGICAL SUPPLIES I/P2262285 S STRL BIRTH CONTROL SYS $3,875.00 22 SURGICAL SUPPLIES I/P2213270 S STRL BLADE $87.50 22 SURGICAL SUPPLIES I/P2263127 S STRL BLADE $429.75 22 SURGICAL SUPPLIES I/P2262863 S STRL BLADE $1,092.25 $1,092.25 22 SURGICAL SUPPLIES I/P2263549 S STRL BLADE $331.50 22 SURGICAL SUPPLIES I/P2263168 S STRL BLADE $104.25 22 SURGICAL SUPPLIES I/P2263184 S STRL BLADE $233.75 22 SURGICAL SUPPLIES I/P2263416 S STRL BLADE $436.00 22 SURGICAL SUPPLIES I/P2262053 S STRL BLADE $1,143.75 22 SURGICAL SUPPLIES I/P2263713 S STRL BLADE $113.50 22 SURGICAL SUPPLIES I/P2260206 S STRL BLADE ADPTR HARM $240.00 $226.00 22 SURGICAL SUPPLIES I/P2298131 S STRL BLADE BEAVER MICRO $17.25 22 SURGICAL SUPPLIES I/P2297489 S STRL BLADE BEAVER MIN $12.00 22 SURGICAL SUPPLIES I/P2261923 S STRL BLADE EXPLANT $2,756.25 22 SURGICAL SUPPLIES I/P2297760 S STRL BLADE INFER TURB $622.50 22 SURGICAL SUPPLIES I/P2298941 S STRL BLADE SAW AUTO-DRI $314.25 22 SURGICAL SUPPLIES I/P2298933 S STRL BLADE SAW AUTO-DRI $852.50 22 SURGICAL SUPPLIES I/P2298024 S STRL BLADE SILVER BULLE $637.00 22 SURGICAL SUPPLIES I/P2298305 S STRL BLADE TI HELICAL $2,065.00 22 SURGICAL SUPPLIES I/P2211191 S STRL BLANKET BAIR HUG $37.75 $37.75 22 SURGICAL SUPPLIES I/P2212991 S STRL BLANKET WARMER $137.75 22 SURGICAL SUPPLIES I/P2294825 S STRL BLE BOVIE $31.00 22 SURGICAL SUPPLIES I/P2297026 S STRL BLE FULL RAD ORBIT 22 SURGICAL SUPPLIES I/P2296747 S STRL BLE GRAFT HARVEST $740.50 22 SURGICAL SUPPLIES I/P2295525 S STRL BLE SHAVER XOMED $639.00 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2262301 S STRL BLOCKER $1,017.25 22 SURGICAL SUPPLIES I/P2211803 S STRL BLOOD FTR $41.00 $41.50 22 SURGICAL SUPPLIES I/P2290468 S STRL BNDG ESMARCH $13.25 $13.25 22 SURGICAL SUPPLIES I/P2296739 S STRL BONE FILLER DEV $488.75 22 SURGICAL SUPPLIES I/P2298677 S STRL BONE MILL BOWL $765.00 22 SURGICAL SUPPLIES I/P2212579 S STRL BRACH PLEXUS SET $24.00 22 SURGICAL SUPPLIES I/P2211910 S STRL BRONCH CATH $259.25 $259.25 22 SURGICAL SUPPLIES I/P2211209 S STRL BRONCH CATH TUBE $220.25 $220.25 22 SURGICAL SUPPLIES I/P2211134 S STRL BRONCH CATH TUBE $238.00 $238.00 22 SURGICAL SUPPLIES I/P2263358 S STRL BRUSH $332.75 22 SURGICAL SUPPLIES I/P2290542 S STRL BSKT GEMINI $814.00 $812.25 22 SURGICAL SUPPLIES I/P2290575 S STRL BSKT STONE $605.00 $570.00 22 SURGICAL SUPPLIES I/P2262699 S STRL BURR $340.00 22 SURGICAL SUPPLIES I/P2263614 S STRL BURR $361.25 22 SURGICAL SUPPLIES I/P2298958 S STRL BURR AUTO-DRIVER $93.75 22 SURGICAL SUPPLIES I/P2298966 S STRL BURR AUTO-DRIVER 4 $220.25 22 SURGICAL SUPPLIES I/P2298032 S STRL BURR PEDIATRIC RND $637.00 22 SURGICAL SUPPLIES I/P2294726 S STRL BURR ROUND FLUTE $340.00 22 SURGICAL SUPPLIES I/P2261048 S STRL BURR VISAO CVD FIN $1,028.50 22 SURGICAL SUPPLIES I/P2261063 S STRL BURR VISAO DIAMOND $464.25 22 SURGICAL SUPPLIES I/P2261055 S STRL BURR VISAO ULTRA $301.00 22 SURGICAL SUPPLIES I/P2211514 S STRL C.O. INJ KIT $63.00 $59.00 22 SURGICAL SUPPLIES I/P2208106 S STRL CABLE $956.25 $956.25 22 SURGICAL SUPPLIES I/P2261337 S STRL CANN MINI 2/3MM $379.50 22 SURGICAL SUPPLIES I/P2263200 S STRL CANNISTER $52.50 22 SURGICAL SUPPLIES I/P2263564 S STRL CANNULA $223.25 22 SURGICAL SUPPLIES I/P2263218 S STRL CANNULA $218.50 22 SURGICAL SUPPLIES I/P2262152 S STRL CANNULA $185.25 22 SURGICAL SUPPLIES I/P2208239 S STRL CANNULA $46.50 22 SURGICAL SUPPLIES I/P2208023 S STRL CANNULA ARTERIAL $1,955.01 22 SURGICAL SUPPLIES I/P2295103 S STRL CANNULA SHLDR DION $105.00 22 SURGICAL SUPPLIES I/P2299030 S STRL CAP REDUCER TROCAR $36.75 22 SURGICAL SUPPLIES I/P2291698 S STRL CAPIO SUT CAP DEV $1,609.75 22 SURGICAL SUPPLIES I/P2212025 S STRL CARDIAC OUTPUT B $54.00 22 SURGICAL SUPPLIES I/P2210979 S STRL CARDIOTOMY $129.00 22 SURGICAL SUPPLIES I/P2261709 S STRL CARTRIDGE $811.50 22 SURGICAL SUPPLIES I/P2263143 S STRL CARTRIDGE $811.50 22 SURGICAL SUPPLIES I/P2262418 S STRL CATH $152.00 22 SURGICAL SUPPLIES I/P2263051 S STRL CATH $265.25 22 SURGICAL SUPPLIES I/P2263044 S STRL CATH $228.00 22 SURGICAL SUPPLIES I/P2263366 S STRL CATH $303.50 22 SURGICAL SUPPLIES I/P2213247 S STRL CATH $109.25 $109.25 22 SURGICAL SUPPLIES I/P2263754 S STRL CATH $403.75 22 SURGICAL SUPPLIES I/P

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2263747 S STRL CATH $52.50 22 SURGICAL SUPPLIES I/P2263739 S STRL CATH $213.50 22 SURGICAL SUPPLIES I/P2263721 S STRL CATH $52.50 22 SURGICAL SUPPLIES I/P2263663 S STRL CATH $61.50 22 SURGICAL SUPPLIES I/P2298248 S STRL CATH ATTAIN DEL $955.00 22 SURGICAL SUPPLIES I/P2262228 S STRL CATH BALLOON $2,556.00 22 SURGICAL SUPPLIES I/P2261204 S STRL CATH CHOLANGIOGRAM $467.25 22 SURGICAL SUPPLIES I/P2207983 S STRL CATH ENDOPLEG $5,188.01 22 SURGICAL SUPPLIES I/P2207975 S STRL CATH ENDOVENT $3,550.01 22 SURGICAL SUPPLIES I/P2212470 S STRL CATH EPDRL DUPEN $1,595.00 22 SURGICAL SUPPLIES I/P2296663 S STRL CATH FOLEY SIL 6 $118.00 22 SURGICAL SUPPLIES I/P2298180 S STRL CATH GROSHONG 5FR $564.00 22 SURGICAL SUPPLIES I/P2212835 S STRL CATH GUARD SLEEVE $57.25 22 SURGICAL SUPPLIES I/P2208031 S STRL CATH IMPELLA $37,500.01 22 SURGICAL SUPPLIES I/P2212637 S STRL CATH O2 $4.50 22 SURGICAL SUPPLIES I/P2208007 S STRL CATH QUICK DRAW $1,807.25 22 SURGICAL SUPPLIES I/P2298230 S STRL CATH RF ABLAT VNUS $2,958.00 22 SURGICAL SUPPLIES I/P2262442 S STRL CATH SINUS $531.25 22 SURGICAL SUPPLIES I/P2298826 S STRL CATH SUPRAPUBIC RU $291.25 22 SURGICAL SUPPLIES I/P2298800 S STRL CATH TRAUMA $578.00 22 SURGICAL SUPPLIES I/P2298172 S STRL CATH TRAY GLIASITE $6,461.00 22 SURGICAL SUPPLIES I/P2296382 S STRL CATH TY URINE BAG $35.50 22 SURGICAL SUPPLIES I/P2262731 S STRL CAUTERY $124.25 22 SURGICAL SUPPLIES I/P2261253 S STRL CAUTERY $977.50 22 SURGICAL SUPPLIES I/P2296275 S STRL CAUTERY ELEC $29.50 22 SURGICAL SUPPLIES I/P2298164 S STRL CAUTERY NDL PT INS $35.50 22 SURGICAL SUPPLIES I/P2296051 S STRL CAUTERY PENCIL W $62.00 22 SURGICAL SUPPLIES I/P2298818 S STRL CAUTERY TIP ISOCOO $1,496.00 22 SURGICAL SUPPLIES I/P2297968 S STRL CECOSTOMY CATH SET $686.50 22 SURGICAL SUPPLIES I/P2210797 S STRL CELL SAVER KIT $274.75 22 SURGICAL SUPPLIES I/P2296887 S STRL CHR GUT 4-10 18" $29.50 22 SURGICAL SUPPLIES I/P2296259 S STRL CHR GUT 7-0 18" $81.00 22 SURGICAL SUPPLIES I/P2291516 S STRL CHR GUT, 2-0,36" $15.00 22 SURGICAL SUPPLIES I/P2291052 S STRL CHR GUT, 4-0, 18" $56.00 22 SURGICAL SUPPLIES I/P2293595 S STRL CHR GUT, 5-0, 18" $27.00 $27.00 22 SURGICAL SUPPLIES I/P2291144 S STRL CHR GUT, 6-0, 18" $32.75 $32.75 22 SURGICAL SUPPLIES I/P2292696 S STRL CHR GUT,0,18" $68.00 22 SURGICAL SUPPLIES I/P2291417 S STRL CHR GUT,0,18" $52.50 22 SURGICAL SUPPLIES I/P2293934 S STRL CHR GUT,0,27" $44.00 22 SURGICAL SUPPLIES I/P2294429 S STRL CHR GUT,0,36",T-20 $15.50 $15.50 22 SURGICAL SUPPLIES I/P2293538 S STRL CHR GUT,1,18" $53.25 22 SURGICAL SUPPLIES I/P2291615 S STRL CHR GUT,1,18",CT-1 $94.25 22 SURGICAL SUPPLIES I/P2291524 S STRL CHR GUT,1,36",CT-1 $15.25 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2291409 S STRL CHR GUT,2-0,18" $55.00 22 SURGICAL SUPPLIES I/P2292811 S STRL CHR GUT,3-0,36" $15.00 22 SURGICAL SUPPLIES I/P2292860 S STRL CHR GUT,4-0,27" $14.50 $14.50 22 SURGICAL SUPPLIES I/P2291722 S STRL CHR GUT,4-0,27" $14.50 22 SURGICAL SUPPLIES I/P2290989 S STRL CHR GUT,5-0,18"P-3 $27.50 $27.50 22 SURGICAL SUPPLIES I/P2290716 S STRL CHR GUT,6-0,18" $27.50 $27.50 22 SURGICAL SUPPLIES I/P2291391 S STRL CHR,1,18",MO-4 $109.75 $109.75 22 SURGICAL SUPPLIES I/P2260867 S STRL CHROMIC GUT 3-0 $26.75 22 SURGICAL SUPPLIES I/P2291433 S STRL CHROMIC GUT 3-0, $14.50 22 SURGICAL SUPPLIES I/P2292035 S STRL CHROMIC GUT,0,36 $14.75 22 SURGICAL SUPPLIES I/P2261097 S STRL CINCH WHIPKNOT $317.50 22 SURGICAL SUPPLIES I/P2261675 S STRL CLIP $97.50 22 SURGICAL SUPPLIES I/P2262749 S STRL CLIP $122.00 22 SURGICAL SUPPLIES I/P2208247 S STRL CLIP $2,888.00 22 SURGICAL SUPPLIES I/P2261469 S STRL CLIP LAPRA TY $320.50 22 SURGICAL SUPPLIES I/P2297091 S STRL CLIP LIGA SM/MED $58.50 22 SURGICAL SUPPLIES I/P2261618 S STRL CLOSURE SYS $491.00 22 SURGICAL SUPPLIES I/P2260354 S STRL COIL EXPANDER $238.00 $238.00 22 SURGICAL SUPPLIES I/P2260800 S STRL COLLAGEN HEMOSTAT $185.50 22 SURGICAL SUPPLIES I/P2262723 S STRL COLTALYST $850.00 22 SURGICAL SUPPLIES I/P2212595 S STRL CON'T NERVE BLOC $236.50 22 SURGICAL SUPPLIES I/P2261832 S STRL CONTRAST $105.00 22 SURGICAL SUPPLIES I/P2261667 S STRL CONTRAST $168.25 22 SURGICAL SUPPLIES I/P2261386 S STRL CORD AEM $63.00 22 SURGICAL SUPPLIES I/P2261089 S STRL COSEAL 2ML $1,379.25 22 SURGICAL SUPPLIES I/P2299089 S STRL COSEAL 4ML $1,831.25 22 SURGICAL SUPPLIES I/P2212041 S STRL CPAP ADAPTER $136.00 22 SURGICAL SUPPLIES I/P2212058 S STRL CRICOTHYROTOMY KIT $621.50 22 SURGICAL SUPPLIES I/P2294353 S STRL CTG ETS - FLEX 35 $666.25 $1,153.25 22 SURGICAL SUPPLIES I/P2295673 S STRL CUSA EXCEL EXT $1,825.50 22 SURGICAL SUPPLIES I/P2260958 S STRL CUSA EXCEL TUBIN $1,096.50 22 SURGICAL SUPPLIES I/P2260982 S STRL CUSA EXCEL WRENCH $240.75 22 SURGICAL SUPPLIES I/P2260966 S STRL CUSA EXT MICRO TIP $2,069.00 22 SURGICAL SUPPLIES I/P2262129 S STRL CUTTER $340.00 22 SURGICAL SUPPLIES I/P2263036 S STRL CUTTER $425.00 22 SURGICAL SUPPLIES I/P2294361 S STRL CUTTER ETS - FLEX $1,779.50 $2,585.00 22 SURGICAL SUPPLIES I/P2211589 S STRL CVC KIT 04225 $143.00 $135.00 22 SURGICAL SUPPLIES I/P2211282 S STRL CVP MANOMETER $53.75 $53.50 22 SURGICAL SUPPLIES I/P2291847 S STRL DERM 4-0 18 CE-2 $26.00 $11.25 22 SURGICAL SUPPLIES I/P2294809 S STRL DERMABOND $103.00 22 SURGICAL SUPPLIES I/P2213015 S STRL DETECTOR END-TIDA $42.50 22 SURGICAL SUPPLIES I/P2298263 S STRL DEVICE GRFT RETENT $2,520.00 22 SURGICAL SUPPLIES I/P2262160 S STRL DIL TUBE $1,160.25 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2261014 S STRL DILATION SET RENAL $860.25 22 SURGICAL SUPPLIES I/P2262798 S STRL DILATOR $232.00 $276.25 22 SURGICAL SUPPLIES I/P2262087 S STRL DILATOR $3,047.00 22 SURGICAL SUPPLIES I/P2262855 S STRL DILATOR $956.25 $956.25 22 SURGICAL SUPPLIES I/P2262079 S STRL DILATOR $3,489.00 22 SURGICAL SUPPLIES I/P2298404 S STRL DISC LAP ENDO $1,721.25 22 SURGICAL SUPPLIES I/P2263341 S STRL DRAIN $60.50 22 SURGICAL SUPPLIES I/P2262525 S STRL DRAIN $181.50 22 SURGICAL SUPPLIES I/P2263267 S STRL DRAIN $46.50 22 SURGICAL SUPPLIES I/P2294874 S STRL DRAIN PENROSE SIL $23.00 22 SURGICAL SUPPLIES I/P2296374 S STRL DRESS OWENS 3 X 8 $4.25 22 SURGICAL SUPPLIES I/P2213197 S STRL DRESSING $33.00 22 SURGICAL SUPPLIES I/P2263523 S STRL DRESSING $190.00 22 SURGICAL SUPPLIES I/P2263192 S STRL DRESSING $1,525.00 22 SURGICAL SUPPLIES I/P2263085 S STRL DRESSING $10.50 22 SURGICAL SUPPLIES I/P2263069 S STRL DRESSING $46.00 22 SURGICAL SUPPLIES I/P2263689 S STRL DRESSING $340.75 22 SURGICAL SUPPLIES I/P2263465 S STRL DRILL $420.75 22 SURGICAL SUPPLIES I/P2263408 S STRL DRILL $474.25 22 SURGICAL SUPPLIES I/P2261451 S STRL DRILL $403.75 22 SURGICAL SUPPLIES I/P2263457 S STRL DRILL BIT $335.75 22 SURGICAL SUPPLIES I/P2298701 S STRL DRILL BIT 5.0 X 30 $1,849.50 22 SURGICAL SUPPLIES I/P2297463 S STRL DRILL BIT DISCVR $2,118.00 22 SURGICAL SUPPLIES I/P2298735 S STRL DRILL BIT THREE-FL $837.00 22 SURGICAL SUPPLIES I/P2298727 S STRL DRILL BIT THREE-FL $588.50 22 SURGICAL SUPPLIES I/P2298750 S STRL DRILL BIT THREE-FL $950.25 22 SURGICAL SUPPLIES I/P2298743 S STRL DRILL BIT THREE-FL $979.50 22 SURGICAL SUPPLIES I/P2298719 S STRL DRILL BIT THREE-FL $387.50 22 SURGICAL SUPPLIES I/P2297414 S STRL DRILL CANN SCP 2.9 $1,117.25 22 SURGICAL SUPPLIES I/P2297422 S STRL DRILL DEPUY TWIS $413.00 22 SURGICAL SUPPLIES I/P2261121 S STRL DRILL F/SUTURE TAK $340.00 22 SURGICAL SUPPLIES I/P2295814 S STRL DRILL KIN SCREW $287.00 22 SURGICAL SUPPLIES I/P2263648 S STRL DRILL KIT $743.75 22 SURGICAL SUPPLIES I/P2261287 S STRL DRILL PAC $1,146.00 22 SURGICAL SUPPLIES I/P2298925 S STRL DRILL PILOT AUTO-D $466.00 22 SURGICAL SUPPLIES I/P2296556 S STRL DRILL SET GRAFT $1,070.00 22 SURGICAL SUPPLIES I/P2297935 S STRL DRSG/STENT MEROGEL $318.75 22 SURGICAL SUPPLIES I/P2262210 S STRL DURASEAL $2,170.00 22 SURGICAL SUPPLIES I/P2296895 S STRL EHTIBOND 2MO-7 27" $111.75 22 SURGICAL SUPPLIES I/P2294049 S STRL ELECT COLLINS $584.50 22 SURGICAL SUPPLIES I/P2292605 S STRL ELECT FASTPATCH $170.00 22 SURGICAL SUPPLIES I/P2294064 S STRL ELECT FLEX FULGER $249.00 22 SURGICAL SUPPLIES I/P2296648 S STRL ELECT SUBDERMAL $340.00 22 SURGICAL SUPPLIES I/P

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2263259 S STRL ELECTRODE $597.25 22 SURGICAL SUPPLIES I/P2297992 S STRL ENDO CUTTER RELOAD $710.50 22 SURGICAL SUPPLIES I/P2208015 S STRL ENDOCLAMP $7,538.01 22 SURGICAL SUPPLIES I/P2210698 S STRL ENDOTRACH TUBE- $10.25 $10.25 22 SURGICAL SUPPLIES I/P2220010 S STRL ENDOTRACHEAL TUB $15.00 $14.00 22 SURGICAL SUPPLIES I/P2297943 S STRL ENT REFERENCE BAND $33.00 22 SURGICAL SUPPLIES I/P2211571 S STRL EPDRL CATH W/NDL $101.00 $96.00 22 SURGICAL SUPPLIES I/P2211563 S STRL EPDRL CATH W/O NDL $33.00 $33.00 22 SURGICAL SUPPLIES I/P2211175 S STRL EPDRL FTR $8.75 $8.75 22 SURGICAL SUPPLIES I/P2211415 S STRL EPDRL TY $96.50 $96.50 22 SURGICAL SUPPLIES I/P2220119 S STRL EPDRL TY $98.00 $92.00 22 SURGICAL SUPPLIES I/P2261998 S STRL EPI-DISC $616.25 22 SURGICAL SUPPLIES I/P2211290 S STRL ESOPH STETH W/TEMP $13.75 $13.75 22 SURGICAL SUPPLIES I/P2213205 S STRL ET TUBE $212.50 22 SURGICAL SUPPLIES I/P2210706 S STRL ET TUBE - RAE $26.00 22 SURGICAL SUPPLIES I/P2212660 S STRL ET TUBE UNCUFFED $6.50 22 SURGICAL SUPPLIES I/P2212074 S STRL ETAEL TUBE - MLT $38.00 22 SURGICAL SUPPLIES I/P2295863 S STRL ETB 2 12-18" TIES $78.00 22 SURGICAL SUPPLIES I/P2295871 S STRL ETB 2 3-30" TIES $77.25 22 SURGICAL SUPPLIES I/P2295889 S STRL ETB 2 MO-7 3-30" $91.00 22 SURGICAL SUPPLIES I/P2296812 S STRL ETB 2-0 18" SH $56.75 22 SURGICAL SUPPLIES I/P2296119 S STRL ETB 3-0 30" $74.50 22 SURGICAL SUPPLIES I/P2261154 S STRL ETHIBOND 0 30" CT2 $58.75 22 SURGICAL SUPPLIES I/P2298396 S STRL ETHIBOND 2-0 30" R $12.25 22 SURGICAL SUPPLIES I/P2293421 S STRL ETHILON,3-0,18", $25.75 22 SURGICAL SUPPLIES I/P2295897 S STRL ETL 2-0 PS 18" $23.00 22 SURGICAL SUPPLIES I/P2294411 S STRL ETL,4-0,18",CPS-3 $25.75 $25.75 22 SURGICAL SUPPLIES I/P2262244 S STRL EXT GUIDE $233.75 22 SURGICAL SUPPLIES I/P2261642 S STRL EXT TUBING $52.75 22 SURGICAL SUPPLIES I/P2212538 S STRL FEM ARTERIAL CAT $60.00 22 SURGICAL SUPPLIES I/P2212892 S STRL FEM ARTERY SET $143.00 22 SURGICAL SUPPLIES I/P2261303 S STRL FIAXATION DEVICE $569.00 22 SURGICAL SUPPLIES I/P2261162 S STRL FIBERWIRE #0 $97.25 22 SURGICAL SUPPLIES I/P2295129 S STRL FIBERWIRE #2 $81.50 22 SURGICAL SUPPLIES I/P2298123 S STRL FIBERWIRE #2-0 $89.25 22 SURGICAL SUPPLIES I/P2299055 S STRL FIBERWIRE #5 $142.50 22 SURGICAL SUPPLIES I/P2263671 S STRL FIBRIN GLUE $2,268.00 22 SURGICAL SUPPLIES I/P2261725 S STRL FLOSEAL $1,433.75 22 SURGICAL SUPPLIES I/P2260990 S STRL FOLEY CATH TY $12.00 22 SURGICAL SUPPLIES I/P2298982 S STRL FORCEP BIOPSY URET $1,410.25 22 SURGICAL SUPPLIES I/P2212967 S STRL FTR BLOOD HEMA PED $8.50 22 SURGICAL SUPPLIES I/P2212777 S STRL FTR CONICAL 5MIC $6.00 22 SURGICAL SUPPLIES I/P2294098 S STRL GDWR BRONCHIAL $75.00 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2294908 S STRL GDWR PTFE COAT.0 $85.00 22 SURGICAL SUPPLIES I/P2290930 S STRL GORE TEX,CV-2,36" $106.00 22 SURGICAL SUPPLIES I/P2298438 S STRL GORE-TEX CV-4 $99.00 22 SURGICAL SUPPLIES I/P2291466 S STRL GORE-TEX,CV-2,36" $101.75 22 SURGICAL SUPPLIES I/P2291540 S STRL GORE-TEX,CV-3,36" $102.00 22 SURGICAL SUPPLIES I/P2291664 S STRL GORE-TEX,CV-5,24" $109.25 22 SURGICAL SUPPLIES I/P2262178 S STRL GRASPER $118.75 22 SURGICAL SUPPLIES I/P2212819 S STRL GRIPPER NDL $37.00 22 SURGICAL SUPPLIES I/P2263473 S STRL GUIDE $1,487.50 22 SURGICAL SUPPLIES I/P2262251 S STRL GUIDE CATH $1,572.50 22 SURGICAL SUPPLIES I/P2262491 S STRL GUIDEWIRE $442.00 22 SURGICAL SUPPLIES I/P2263119 S STRL GUIDEWIRE $218.00 22 SURGICAL SUPPLIES I/P2298693 S STRL GUIDEWIRE CALIBRAT $497.00 22 SURGICAL SUPPLIES I/P2298685 S STRL GUIDEWIRE THRD 2.5 $226.75 22 SURGICAL SUPPLIES I/P2299147 S STRL GWIRE BLUNT SEXTAN $391.00 22 SURGICAL SUPPLIES I/P2262392 S STRL HARMONIC $1,154.75 22 SURGICAL SUPPLIES I/P2297430 S STRL HEALOS STRIP $4,800.00 22 SURGICAL SUPPLIES I/P2208049 S STRL HEMOSTASE $790.50 $790.50 22 SURGICAL SUPPLIES I/P2263283 S STRL HEMOSTAT $637.50 22 SURGICAL SUPPLIES I/P2262830 S STRL HOLDER $171.50 $171.50 22 SURGICAL SUPPLIES I/P2208114 S STRL HOLSTER $1,678.75 $1,678.75 22 SURGICAL SUPPLIES I/P2262236 S STRL ILLUM SYS $1,610.75 22 SURGICAL SUPPLIES I/P2213049 S STRL INCENTIVE SPIROMET $15.00 22 SURGICAL SUPPLIES I/P2261816 S STRL INFILTRATION KIT $80.00 22 SURGICAL SUPPLIES I/P2262277 S STRL INFLAT DVC $316.75 22 SURGICAL SUPPLIES I/P2263762 S STRL INFLATION DEVICE $158.50 22 SURGICAL SUPPLIES I/P2211019 S STRL INFUSOR TUBE SET $123.00 $123.00 22 SURGICAL SUPPLIES I/P2211142 S STRL INFUSOR TUBING $27.00 $26.00 22 SURGICAL SUPPLIES I/P2298990 S STRL INSERT HOT SHEARS $95.00 22 SURGICAL SUPPLIES I/P2296390 S STRL INSERT JAW GRIP $95.00 22 SURGICAL SUPPLIES I/P2296135 S STRL INSERT LAPSNC $267.75 22 SURGICAL SUPPLIES I/P2261378 S STRL INSERT SCISSOR $355.00 22 SURGICAL SUPPLIES I/P2263150 S STRL INSERTION KIT $743.75 22 SURGICAL SUPPLIES I/P2298065 S STRL INSERTION TUBE SET $3,022.00 22 SURGICAL SUPPLIES I/P2290088 S STRL INST PURSESTRING $500.75 $500.75 22 SURGICAL SUPPLIES I/P2295848 S STRL INTRASPINAL CATH $468.00 22 SURGICAL SUPPLIES I/P2295830 S STRL INTRASPINAL REFILL $133.00 22 SURGICAL SUPPLIES I/P2261857 S STRL INTRODUCER $53.00 22 SURGICAL SUPPLIES I/P2213163 S STRL INTRODUCER $230.75 22 SURGICAL SUPPLIES I/P2261782 S STRL INTRODUCER $232.75 22 SURGICAL SUPPLIES I/P2298461 S STRL INTRODUCER SHEATH $98.50 22 SURGICAL SUPPLIES I/P2261600 S STRL INTUB SET $340.00 22 SURGICAL SUPPLIES I/P2263028 S STRL IRRIG TUBING $95.00 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2297638 S STRL ISOVU-200 50ML $111.25 22 SURGICAL SUPPLIES I/P2296358 S STRL ISOVUE 300 61 50ML $53.50 22 SURGICAL SUPPLIES I/P2213288 S STRL IV CATH $148.75 22 SURGICAL SUPPLIES I/P2292399 S STRL JAG WIRE/BLR GDWR $597.00 22 SURGICAL SUPPLIES I/P2211266 S STRL J-WIRE FIXED CORE $3.00 $3.00 22 SURGICAL SUPPLIES I/P2262475 S STRL KIT $743.75 22 SURGICAL SUPPLIES I/P2298271 S STRL KIT ASPIRATOR $935.00 22 SURGICAL SUPPLIES I/P2295079 S STRL KIT CAMINO PRESS $2,122.00 22 SURGICAL SUPPLIES I/P2297844 S STRL KIT CAMINO SUB/ICP $2,460.50 22 SURGICAL SUPPLIES I/P2294528 S STRL KIT GASTMY SKIN $432.50 22 SURGICAL SUPPLIES I/P2210417 S STRL KIT RADIAL ARTERY $48.00 $48.00 22 SURGICAL SUPPLIES I/P2296507 S STRL KIT TROCAR $548.00 22 SURGICAL SUPPLIES I/P2298149 S STRL KNIFE BAYONETED ME $1,494.75 22 SURGICAL SUPPLIES I/P2261147 S STRL KNOT PUSHER $499.50 22 SURGICAL SUPPLIES I/P2263440 S STRL K-WIRE $142.50 22 SURGICAL SUPPLIES I/P2296713 S STRL KYPHX INFLAT BONE $2,988.00 22 SURGICAL SUPPLIES I/P2296705 S STRL KYPHX INFLAT SYR $484.50 22 SURGICAL SUPPLIES I/P2296721 S STRL KYPHX INTRO KIT $2,875.00 22 SURGICAL SUPPLIES I/P2296697 S STRL KYPHX NDL 11GA $142.50 22 SURGICAL SUPPLIES I/P2297349 S STRL LAP CALIB TUBE $597.00 22 SURGICAL SUPPLIES I/P2260586 S STRL LAPAROSCOPIC END $810.00 22 SURGICAL SUPPLIES I/P2297331 S STRL LAP-BAND ACCESS PT $59.00 22 SURGICAL SUPPLIES I/P2297323 S STRL LAP-BAND ACCESS PT $2,340.00 22 SURGICAL SUPPLIES I/P2298222 S STRL LAPROSCOPIC PK NDL $1,168.75 22 SURGICAL SUPPLIES I/P2294114 S STRL LAPSNC ENDO $954.50 22 SURGICAL SUPPLIES I/P2260438 S STRL LAPSNC KIT LAP $1,762.00 $1,662.00 22 SURGICAL SUPPLIES I/P2291706 S STRL LAURUS POLY, 0,48" $144.50 22 SURGICAL SUPPLIES I/P2297695 S STRL LEAD SERVICE KIT $240.00 22 SURGICAL SUPPLIES I/P2294213 S STRL LEEP ELECT $63.00 22 SURGICAL SUPPLIES I/P2210086 S STRL LEYKOCYTE FTR $160.00 $154.00 22 SURGICAL SUPPLIES I/P2297661 S STRL LIGASURE DIVIDER $1,636.25 22 SURGICAL SUPPLIES I/P2297653 S STRL LIGASURE ELECTRODE $637.50 22 SURGICAL SUPPLIES I/P2298602 S STRL LIGASURE SEALER DI $1,886.00 22 SURGICAL SUPPLIES I/P2298669 S STRL LIGHT PANEL F/RETR $296.75 22 SURGICAL SUPPLIES I/P2295517 S STRL LIGHT PANEL FIB OP $239.00 22 SURGICAL SUPPLIES I/P2262145 S STRL LOCKING DEVICE $1,933.75 22 SURGICAL SUPPLIES I/P2262111 S STRL LOCKING DEVICE $2,054.25 22 SURGICAL SUPPLIES I/P2262780 S STRL LOOP $1,487.50 $1,487.50 22 SURGICAL SUPPLIES I/P2261444 S STRL LOOP WIRE $133.00 22 SURGICAL SUPPLIES I/P2297059 S STRL MAGNET IPG CONTROL $239.00 22 SURGICAL SUPPLIES I/P2297901 S STRL MAMMOSITE $7,163.00 22 SURGICAL SUPPLIES I/P2240935 S STRL MANIFOLD 2-PORT $18.50 $18.50 22 SURGICAL SUPPLIES I/P2240943 S STRL MANIFOLD 4-PORT $32.50 $32.50 22 SURGICAL SUPPLIES I/P

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SEQ 300 AMOUNT

DEPARTMENT CODE

2299170 S STRL MANIPULATOR UTERIN $138.75 22 SURGICAL SUPPLIES I/P2263093 S STRL MARKER $52.50 22 SURGICAL SUPPLIES I/P2292720 S STRL MAXON,0,36",T-12 $31.25 $33.75 22 SURGICAL SUPPLIES I/P2260511 S STRL MEASURING DEV $27.50 $27.50 22 SURGICAL SUPPLIES I/P2297984 S STRL MEDICAL ADHESIVE $213.00 22 SURGICAL SUPPLIES I/P2291813 S STRL MERSILENE 5MM 12" $144.25 22 SURGICAL SUPPLIES I/P2260065 S STRL MERSILENE 5MM,12" $141.50 22 SURGICAL SUPPLIES I/P2298107 S STRL METRIX DISP TUBE $833.00 22 SURGICAL SUPPLIES I/P2296937 S STRL MICRO TARGET ELECT $467.50 22 SURGICAL SUPPLIES I/P2296945 S STRL MICRO TARGETING $510.00 22 SURGICAL SUPPLIES I/P2262665 S STRL MIXER TIP $190.00 22 SURGICAL SUPPLIES I/P2294650 S STRL MON 4-0 27" RB-1 $12.50 22 SURGICAL SUPPLIES I/P2296820 S STRL MON 5-0 27"RB-1 $15.00 22 SURGICAL SUPPLIES I/P2294676 S STRL MON 6-0 18" P-3 $28.75 22 SURGICAL SUPPLIES I/P2296838 S STRL MON 6-0 27" TF $19.00 22 SURGICAL SUPPLIES I/P2290955 S STRL MON,3-0,36",CT-1 $13.00 22 SURGICAL SUPPLIES I/P2296267 S STRL MONOCRYL 2-0 UR- $14.00 22 SURGICAL SUPPLIES I/P2298388 S STRL MONOCRYL 3-0 18" P $29.75 22 SURGICAL SUPPLIES I/P2294668 S STRL MONOCRYL 5-0 18" $29.75 22 SURGICAL SUPPLIES I/P2290948 S STRL MONOCRYL,2-0,36" $13.25 22 SURGICAL SUPPLIES I/P2290492 S STRL MYRINGOTOMY TUBE $186.25 $186.25 22 SURGICAL SUPPLIES I/P2211902 S STRL NASAL CAN $35.00 $33.00 22 SURGICAL SUPPLIES I/P2212090 S STRL NASAL CANNULA - $3.00 22 SURGICAL SUPPLIES I/P2261881 S STRL NDL $38.00 22 SURGICAL SUPPLIES I/P2261634 S STRL NDL $722.50 22 SURGICAL SUPPLIES I/P2262681 S STRL NDL $425.00 22 SURGICAL SUPPLIES I/P2262517 S STRL NDL $228.00 22 SURGICAL SUPPLIES I/P2263697 S STRL NDL $142.50 22 SURGICAL SUPPLIES I/P2261139 S STRL NDL DELIVERY SYS $1,318.25 22 SURGICAL SUPPLIES I/P2213148 S STRL NDL ECHOTIP $40.00 22 SURGICAL SUPPLIES I/P2212405 S STRL NDL GUIDE KIT $101.25 22 SURGICAL SUPPLIES I/P2295731 S STRL NDL INSUFFLAT $149.50 22 SURGICAL SUPPLIES I/P2262715 S STRL NDL KIT $190.75 22 SURGICAL SUPPLIES I/P2263374 S STRL NDL KIT $276.25 22 SURGICAL SUPPLIES I/P2298503 S STRL NDL KIT F/DEFLUX I $216.75 22 SURGICAL SUPPLIES I/P2213155 S STRL NDL SPINAL $68.50 22 SURGICAL SUPPLIES I/P2263515 S STRL NEBULIZER $7.00 22 SURGICAL SUPPLIES I/P2298040 S STRL NEEDLE JAMSHIDI BI $136.00 22 SURGICAL SUPPLIES I/P2211183 S STRL NERVE STIMULAT NDL $49.25 $49.25 22 SURGICAL SUPPLIES I/P2210532 S STRL NERVE STIMULAT PAD $5.50 $5.00 22 SURGICAL SUPPLIES I/P2295780 S STRL NYL 10-0 12" CU-2 $108.00 22 SURGICAL SUPPLIES I/P2295798 S STRL NYLON 10-0 12" A $108.00 22 SURGICAL SUPPLIES I/P2211159 S STRL O2 MASK $5.00 $5.00 22 SURGICAL SUPPLIES I/P

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2262459 S STRL OBTURATOR $118.75 22 SURGICAL SUPPLIES I/P2261352 S STRL OCCLUDER $254.50 22 SURGICAL SUPPLIES I/P2213064 S STRL ORTHOPAT AUTOTRANS $1,694.00 22 SURGICAL SUPPLIES I/P2213072 S STRL ORTHOPAT BLOOD INF $47.75 22 SURGICAL SUPPLIES I/P2213098 S STRL ORTHOPAT INTRAOP S $103.75 22 SURGICAL SUPPLIES I/P2213106 S STRL ORTHOPAT POSTOP SU $61.00 22 SURGICAL SUPPLIES I/P2213080 S STRL ORTHOPAT WASTE BAG $62.25 22 SURGICAL SUPPLIES I/P2263598 S STRL OSTEODRIVER $324.25 22 SURGICAL SUPPLIES I/P2211613 S STRL OXIMETER PROBE $55.00 $55.00 22 SURGICAL SUPPLIES I/P2297703 S STRL PACING CABLES DISP $112.00 22 SURGICAL SUPPLIES I/P2299162 S STRL PACK VNS ACCESSORY $1,872.50 22 SURGICAL SUPPLIES I/P2263382 S STRL PAD $30.75 22 SURGICAL SUPPLIES I/P2263077 S STRL PAIN PUMP $1,613.25 22 SURGICAL SUPPLIES I/P2296614 S STRL PANACRYL 0 36" $18.00 22 SURGICAL SUPPLIES I/P2296523 S STRL PANACRYL 1 48" $51.00 22 SURGICAL SUPPLIES I/P2260842 S STRL PANACRYL 1 CTX 36 $20.00 22 SURGICAL SUPPLIES I/P2296598 S STRL PANACRYL 2 27" $32.00 22 SURGICAL SUPPLIES I/P2297687 S STRL PASSER SHUNT 60CM $539.50 22 SURGICAL SUPPLIES I/P2261071 S STRL PASSER SUT $531.25 22 SURGICAL SUPPLIES I/P2290252 S STRL PD TRANSER SET $166.00 $166.00 22 SURGICAL SUPPLIES I/P2294692 S STRL PDS 3-0 27" RB-1 $16.25 22 SURGICAL SUPPLIES I/P2294700 S STRL PDS 3-0 27" RB-1 22 SURGICAL SUPPLIES I/P2294684 S STRL PDS 4-0 27" RB-1 $14.25 22 SURGICAL SUPPLIES I/P2295558 S STRL PDS 5-0 18" PS-2 $29.50 22 SURGICAL SUPPLIES I/P2291235 S STRL PDS 5-0 27" RB-1 $15.75 22 SURGICAL SUPPLIES I/P2294502 S STRL PDS 6-0 30" BV D/A $55.75 $54.00 22 SURGICAL SUPPLIES I/P2293413 S STRL PDS, 6-0,30" BV-1 $73.25 22 SURGICAL SUPPLIES I/P2292191 S STRL PDS,0,18" ENDOLOOP $114.25 22 SURGICAL SUPPLIES I/P2292829 S STRL PDS,3-0,27",FS-2 $20.00 22 SURGICAL SUPPLIES I/P2291870 S STRL PDS,4-0,18",P-3 $28.75 22 SURGICAL SUPPLIES I/P2292449 S STRL PDS,5-0,18",P-3 $28.50 22 SURGICAL SUPPLIES I/P2290591 S STRL PDS,5-0,30",RB-2 $33.00 $32.00 22 SURGICAL SUPPLIES I/P2291862 S STRL PDS,7-0,24",BV-1 $72.75 22 SURGICAL SUPPLIES I/P2290732 S STRL PDS,O,CT $10.75 $10.50 22 SURGICAL SUPPLIES I/P2212124 S STRL PERCUTANEOUS NDL $38.25 22 SURGICAL SUPPLIES I/P2290278 S STRL PHARMALAST $453.00 $453.00 22 SURGICAL SUPPLIES I/P2293843 S STRL PIN VISE $263.50 22 SURGICAL SUPPLIES I/P2298016 S STRL PINCH-ON TOOL $89.00 22 SURGICAL SUPPLIES I/P2291821 S STRL PLAIN GUT,3-0,18 $53.25 22 SURGICAL SUPPLIES I/P2293009 S STRL PLAIN GUT,3-0,54 $12.75 22 SURGICAL SUPPLIES I/P2291045 S STRL PLAIN GUT,4-0,27 $14.50 22 SURGICAL SUPPLIES I/P2262640 S STRL PLASMA CONC $2,104.00 22 SURGICAL SUPPLIES I/P2294643 S STRL PLEDGET 3/8 X 3/16 $24.00 22 SURGICAL SUPPLIES I/P

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2206381 S STRL PLEDGETS $26.50 22 SURGICAL SUPPLIES I/P2296846 S STRL PLN GUT 5-0 18"P $30.00 22 SURGICAL SUPPLIES I/P2292621 S STRL PLN GUT,0,54" $12.75 22 SURGICAL SUPPLIES I/P2292241 S STRL PLN GUT,3-0,27" $14.50 22 SURGICAL SUPPLIES I/P2290658 S STRL PLT OMEGA $1,039.00 $980.00 22 SURGICAL SUPPLIES I/P2294833 S STRL POLYSORB ENDOSTI $99.75 22 SURGICAL SUPPLIES I/P2262384 S STRL PORT $100.50 22 SURGICAL SUPPLIES I/P2263176 S STRL PORT $1,934.00 22 SURGICAL SUPPLIES I/P2261568 S STRL PORT $256.50 22 SURGICAL SUPPLIES I/P2261402 S STRL PORT $363.25 22 SURGICAL SUPPLIES I/P2261410 S STRL PORT $219.50 22 SURGICAL SUPPLIES I/P2298586 S STRL PORT BLUNT TRISTAR $305.25 22 SURGICAL SUPPLIES I/P2212975 S STRL PORT HEMA ACCESS $15.25 22 SURGICAL SUPPLIES I/P2298594 S STRL POUCH SURGICAL TIS $259.25 22 SURGICAL SUPPLIES I/P2296341 S STRL PRCDL KIT $651.75 22 SURGICAL SUPPLIES I/P2296077 S STRL PREFTR SMOKE EVAC $38.00 22 SURGICAL SUPPLIES I/P2212884 S STRL PRESSURE MONITOR $386.00 22 SURGICAL SUPPLIES I/P2260792 S STRL PRO 1 30" CT-1 $13.25 22 SURGICAL SUPPLIES I/P2260784 S STRL PRO 3-0 36" V-7 DA $32.25 22 SURGICAL SUPPLIES I/P2293264 S STRL PRO 5-0,18"PS2 $26.00 $26.00 22 SURGICAL SUPPLIES I/P2290963 S STRL PRO, 0, 30", CT $13.50 $13.50 22 SURGICAL SUPPLIES I/P2294510 S STRL PRO, 2-0, 48", SH $26.50 $26.50 22 SURGICAL SUPPLIES I/P2291714 S STRL PRO, 3-0,30", FSL $15.25 22 SURGICAL SUPPLIES I/P2292001 S STRL PRO, 5-0, 18" $26.00 22 SURGICAL SUPPLIES I/P2293769 S STRL PRO, 5-0,24" $27.25 22 SURGICAL SUPPLIES I/P2291375 S STRL PRO, 6-0, 30" $51.50 22 SURGICAL SUPPLIES I/P2291995 S STRL PRO,3-0,18",FS-2 $15.25 22 SURGICAL SUPPLIES I/P2291599 S STRL PRO,3-0,48",SH,D/A $25.75 22 SURGICAL SUPPLIES I/P2291243 S STRL PRO,5-0,18",RB-1 $26.00 22 SURGICAL SUPPLIES I/P2290914 S STRL PRO,6-0,18",P-1 $26.25 22 SURGICAL SUPPLIES I/P2291383 S STRL PRO,6-0,24",BV-1 $51.50 $51.50 22 SURGICAL SUPPLIES I/P2291268 S STRL PRO,8-0,18" $109.25 22 SURGICAL SUPPLIES I/P2262822 S STRL PROBE $429.25 $429.25 22 SURGICAL SUPPLIES I/P2296630 S STRL PROBE DOPPLER $631.25 22 SURGICAL SUPPLIES I/P2295947 S STRL PROBE ELECTRO TAC $1,330.25 22 SURGICAL SUPPLIES I/P2294759 S STRL PROCEED $780.00 22 SURGICAL SUPPLIES I/P2292662 S STRL PROLENE, 0, 30"V $17.50 $17.50 22 SURGICAL SUPPLIES I/P2292886 S STRL PROLENE,1,30",CT $13.75 22 SURGICAL SUPPLIES I/P2291912 S STRL PROLENE,2-0,18", $14.50 22 SURGICAL SUPPLIES I/P2291136 S STRL PROLENE,3-0,36", $26.50 22 SURGICAL SUPPLIES I/P2293439 S STRL PROLENE,4-0,24", $30.75 $30.75 22 SURGICAL SUPPLIES I/P2260172 S STRL PROLENE,6-0,18", $26.25 22 SURGICAL SUPPLIES I/P2263226 S STRL PUNCH $318.75 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2297539 S STRL QUICK PRESSURE $390.25 22 SURGICAL SUPPLIES I/P2263606 S STRL RASP $697.25 22 SURGICAL SUPPLIES I/P2261261 S STRL REDUCER $49.00 22 SURGICAL SUPPLIES I/P2212371 S STRL REFLECT 02 TRNDCR $175.75 22 SURGICAL SUPPLIES I/P2213007 S STRL RELIEF BAND $637.50 22 SURGICAL SUPPLIES I/P2261964 S STRL REPAIR KIT $2,103.75 22 SURGICAL SUPPLIES I/P2261527 S STRL RESECT DVC $8,255.00 22 SURGICAL SUPPLIES I/P2297075 S STRL RESECTOSCOPE LOOP $275.00 22 SURGICAL SUPPLIES I/P2261766 S STRL RETRACTOR $213.75 22 SURGICAL SUPPLIES I/P2207991 S STRL RETRACTOR $1,190.01 22 SURGICAL SUPPLIES I/P2261808 S STRL RETRACTOR $349.25 22 SURGICAL SUPPLIES I/P2261790 S STRL RETRACTOR $101.25 22 SURGICAL SUPPLIES I/P2298537 S STRL RETRACTOR INFLATAB $473.00 22 SURGICAL SUPPLIES I/P2211985 S STRL RETROGRADE SET $502.00 $482.75 22 SURGICAL SUPPLIES I/P2212009 S STRL RETROGRADE SET 22 SURGICAL SUPPLIES I/P2298073 S STRL ROD PLUG REMOVAL $238.00 22 SURGICAL SUPPLIES I/P2298081 S STRL ROD SEG REMOVAL SE $599.25 22 SURGICAL SUPPLIES I/P2261279 S STRL SCREW SCHANZ $135.50 22 SURGICAL SUPPLIES I/P2262350 S STRL SEALANT $1,124.75 22 SURGICAL SUPPLIES I/P2262368 S STRL SEALANT $2,130.50 22 SURGICAL SUPPLIES I/P2208122 S STRL SEALANT $1,799.50 $1,799.50 22 SURGICAL SUPPLIES I/P2263630 S STRL SEALER $2,275.00 22 SURGICAL SUPPLIES I/P2263010 S STRL SEALER $2,019.00 22 SURGICAL SUPPLIES I/P2262707 S STRL SEALING DVC $2,003.00 22 SURGICAL SUPPLIES I/P2213239 S STRL SENSOR $255.00 22 SURGICAL SUPPLIES I/P2213130 S STRL SENSOR OX CEREBRAL $694.25 22 SURGICAL SUPPLIES I/P2211126 S STRL SEQUESTORING KIT $276.50 22 SURGICAL SUPPLIES I/P2293066 S STRL SET DLTR DISP $344.00 22 SURGICAL SUPPLIES I/P2260230 S STRL SET DRAIN URINE $35.25 $32.25 22 SURGICAL SUPPLIES I/P2297794 S STRL SET DRN UR/METER $34.50 22 SURGICAL SUPPLIES I/P2294718 S STRL SET D-TACHA-TIP $478.00 22 SURGICAL SUPPLIES I/P2211027 S STRL SET PLTLET CONC $11.25 $11.25 22 SURGICAL SUPPLIES I/P2213056 S STRL SET SYR ALARIS $25.00 22 SURGICAL SUPPLIES I/P2260248 S STRL SET TUBE MALIS IRR $104.75 $104.75 22 SURGICAL SUPPLIES I/P2295533 S STRL SHAVER LARYNGEAL $1,371.00 22 SURGICAL SUPPLIES I/P2295541 S STRL SHAVER SUBGLOTTIC $1,425.00 22 SURGICAL SUPPLIES I/P2262533 S STRL SHEAR $142.25 22 SURGICAL SUPPLIES I/P2261535 S STRL SHEAR $1,346.25 22 SURGICAL SUPPLIES I/P2261774 S STRL SHEARS $1,847.50 22 SURGICAL SUPPLIES I/P2261592 S STRL SHEARS $1,593.75 22 SURGICAL SUPPLIES I/P2263291 S STRL SHEARS $1,766.00 22 SURGICAL SUPPLIES I/P2298909 S STRL SHEARS ACE HARMONI $1,594.50 22 SURGICAL SUPPLIES I/P2294817 S STRL SHEARS ENDO MINI $773.25 22 SURGICAL SUPPLIES I/P

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2298842 S STRL SHEARS HARMONIC SC $1,782.25 22 SURGICAL SUPPLIES I/P2263481 S STRL SHEATH $257.00 22 SURGICAL SUPPLIES I/P2261394 S STRL SHEATH AEM $76.25 22 SURGICAL SUPPLIES I/P2262103 S STRL SHEATH LASER $5,650.00 22 SURGICAL SUPPLIES I/P2261949 S STRL SHIELD $722.50 22 SURGICAL SUPPLIES I/P2211332 S STRL SHTH CATH $57.00 $54.00 22 SURGICAL SUPPLIES I/P2212827 S STRL SHTH INTRO SET $112.00 22 SURGICAL SUPPLIES I/P2292894 S STRL SHUNT CAROTID $1,886.50 22 SURGICAL SUPPLIES I/P2261113 S STRL SILK 0 FSL $11.25 22 SURGICAL SUPPLIES I/P2260826 S STRL SILK 2-0 1/2 CVD $144.00 22 SURGICAL SUPPLIES I/P2296184 S STRL SILK 2-0 18" PS-2 $19.50 22 SURGICAL SUPPLIES I/P2296788 S STRL SILK 2-0 30" KS $9.25 22 SURGICAL SUPPLIES I/P2291789 S STRL SILK 4-0 18" P-3 $20.75 $20.75 22 SURGICAL SUPPLIES I/P2291193 S STRL SILK, 3-0, 30" $9.75 22 SURGICAL SUPPLIES I/P2293280 S STRL SILK,2-0,18",SH, $47.75 22 SURGICAL SUPPLIES I/P2293306 S STRL SILK,3-0,18",FS- $20.50 $20.50 22 SURGICAL SUPPLIES I/P2291656 S STRL SILK,3-0,18",RB-1 $55.00 22 SURGICAL SUPPLIES I/P2291367 S STRL SILK,3-0,30"TIES $13.50 $13.50 22 SURGICAL SUPPLIES I/P2292738 S STRL SILK,4-0,30",C-1 $15.00 $13.25 22 SURGICAL SUPPLIES I/P2290864 S STRL SILK,4-0,30",T-5 $9.00 $9.00 22 SURGICAL SUPPLIES I/P2290906 S STRL SILK,5-0,18",P-3 $20.75 $20.75 22 SURGICAL SUPPLIES I/P2291300 S STRL SILK,5-0,30"C-1 $15.00 $15.00 22 SURGICAL SUPPLIES I/P2293645 S STRL SIMMS IRR NOZZLE $3.00 22 SURGICAL SUPPLIES I/P2213023 S STRL SITE RITE SHEATH K $30.25 22 SURGICAL SUPPLIES I/P2296192 S STRL SIZER BREAST IMP $209.00 22 SURGICAL SUPPLIES I/P2263390 S STRL SLEEVE $195.25 22 SURGICAL SUPPLIES I/P2297919 S STRL SLEEVE VERASTEP $287.25 22 SURGICAL SUPPLIES I/P2262095 S STRL SNARE $2,595.25 22 SURGICAL SUPPLIES I/P2292670 S STRL SOG-GRIP HEMOSTAT $260.25 22 SURGICAL SUPPLIES I/P2262426 S STRL SOL $829.50 22 SURGICAL SUPPLIES I/P2292225 S STRL SOL COLLINS $1,168.75 22 SURGICAL SUPPLIES I/P2291128 S STRL SOL RINGERS IRR $15.00 22 SURGICAL SUPPLIES I/P2211720 S STRL SOLUSET 150X60 $11.00 $11.00 22 SURGICAL SUPPLIES I/P2210136 S STRL SPINAL NDL $31.00 $29.00 22 SURGICAL SUPPLIES I/P2212553 S STRL SPINAL NDL SET $54.25 22 SURGICAL SUPPLIES I/P2210128 S STRL SPINAL NEEDLE, B $11.00 $11.00 22 SURGICAL SUPPLIES I/P2220101 S STRL SPINAL TRAY $56.00 $53.00 22 SURGICAL SUPPLIES I/P2211241 S STRL SPINAL TY $66.25 $66.25 22 SURGICAL SUPPLIES I/P2296689 S STRL SPONGE FEM CANAL $126.75 22 SURGICAL SUPPLIES I/P2262657 S STRL SPRAY KIT $166.25 22 SURGICAL SUPPLIES I/P2299063 S STRL SPRAY KIT TISSOMAT $229.00 22 SURGICAL SUPPLIES I/P2262673 S STRL SPRAY TIP $154.50 22 SURGICAL SUPPLIES I/P2262319 S STRL SPRAYER $224.50 22 SURGICAL SUPPLIES I/P

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SEQ 300 AMOUNT

DEPARTMENT CODE

2290583 S STRL STAINLESS STEEL $76.00 $72.00 22 SURGICAL SUPPLIES I/P2298446 S STRL STAP ENDOGIA ROTIC $719.25 22 SURGICAL SUPPLIES I/P2299022 S STRL STAPL CRTRDG PROX $525.00 22 SURGICAL SUPPLIES I/P2299014 S STRL STAPL PROX LINEAR $997.75 22 SURGICAL SUPPLIES I/P2208221 S STRL STAPLE CARTRIDGE $605.50 22 SURGICAL SUPPLIES I/P2298867 S STRL STAPLE CARTRIDGE C $1,117.00 22 SURGICAL SUPPLIES I/P2261758 S STRL STAPLER $223.25 22 SURGICAL SUPPLIES I/P2261683 S STRL STAPLER $1,802.00 22 SURGICAL SUPPLIES I/P2262954 S STRL STAPLER $1,822.50 22 SURGICAL SUPPLIES I/P2263135 S STRL STAPLER $2,056.00 22 SURGICAL SUPPLIES I/P2262939 S STRL STAPLER $1,988.25 22 SURGICAL SUPPLIES I/P2261691 S STRL STAPLER $2,116.50 22 SURGICAL SUPPLIES I/P2208213 S STRL STAPLER $1,513.75 22 SURGICAL SUPPLIES I/P2298859 S STRL STAPLER CONTOUR 3. $1,985.00 22 SURGICAL SUPPLIES I/P2298354 S STRL STAPLER LDS POWERE $1,204.75 22 SURGICAL SUPPLIES I/P2298347 S STRL STAPLER TA45 $462.00 22 SURGICAL SUPPLIES I/P2295822 S STRL STAY ELASTIC (SI $35.00 22 SURGICAL SUPPLIES I/P2298453 S STRL STAY ELASTIC BLUNT $198.00 22 SURGICAL SUPPLIES I/P2290690 S STRL STENT $448.00 $448.00 22 SURGICAL SUPPLIES I/P2295749 S STRL STEP PORT $422.00 22 SURGICAL SUPPLIES I/P2299048 S STRL STICK KIT MINI 4FR $212.75 22 SURGICAL SUPPLIES I/P2212546 S STRL STIMEX INSTD NDL $41.75 22 SURGICAL SUPPLIES I/P2220176 S STRL STONE BASKET $272.00 $257.00 22 SURGICAL SUPPLIES I/P2260677 S STRL STPLR $631.50 22 SURGICAL SUPPLIES I/P2260669 S STRL STPLR 30-3.5 PI $476.00 22 SURGICAL SUPPLIES I/P2293363 S STRL STPLR ENDO GIA $908.25 22 SURGICAL SUPPLIES I/P2299113 S STRL STYLET RF ABLATION $2,100.00 22 SURGICAL SUPPLIES I/P2210631 S STRL SUC ASPIRATOR $54.00 22 SURGICAL SUPPLIES I/P2291896 S STRL SUC CATH FLEX $190.00 22 SURGICAL SUPPLIES I/P2220093 S STRL SUC CATH T&A $12.00 $11.00 22 SURGICAL SUPPLIES I/P2212256 S STRL SUCTION ASP ASSE $62.00 22 SURGICAL SUPPLIES I/P2261493 S STRL SUR=T VICRYL $76.50 22 SURGICAL SUPPLIES I/P2297737 S STRL SURGICAL ILLUMINAT $406.00 22 SURGICAL SUPPLIES I/P2291219 S STRL SURGIDAC,0,48"(E $200.75 22 SURGICAL SUPPLIES I/P2262905 S STRL SUT $117.25 $113.75 22 SURGICAL SUPPLIES I/P2262913 S STRL SUT $180.50 22 SURGICAL SUPPLIES I/P2262871 S STRL SUT $117.25 $113.75 22 SURGICAL SUPPLIES I/P2262764 S STRL SUT $13.75 22 SURGICAL SUPPLIES I/P2262889 S STRL SUT $102.50 $99.50 22 SURGICAL SUPPLIES I/P2262038 S STRL SUT $10.75 22 SURGICAL SUPPLIES I/P2262343 S STRL SUT $147.25 22 SURGICAL SUPPLIES I/P2262897 S STRL SUT $107.50 $104.25 22 SURGICAL SUPPLIES I/P2262541 S STRL SUT $235.75 22 SURGICAL SUPPLIES I/P

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SEQ 300 AMOUNT

DEPARTMENT CODE

2263580 S STRL SUT $248.00 22 SURGICAL SUPPLIES I/P2261899 S STRL SUT $35.00 22 SURGICAL SUPPLIES I/P2262376 S STRL SUT $99.75 22 SURGICAL SUPPLIES I/P2262194 S STRL SUT $12.00 22 SURGICAL SUPPLIES I/P2261741 S STRL SUT $110.00 22 SURGICAL SUPPLIES I/P2261824 S STRL SUT $23.50 22 SURGICAL SUPPLIES I/P2261840 S STRL SUT $403.75 22 SURGICAL SUPPLIES I/P2263002 S STRL SUT $218.50 22 SURGICAL SUPPLIES I/P2263242 S STRL SUT $212.50 22 SURGICAL SUPPLIES I/P2261907 S STRL SUT $52.25 22 SURGICAL SUPPLIES I/P2263333 S STRL SUT $102.50 22 SURGICAL SUPPLIES I/P2262020 S STRL SUT $26.00 22 SURGICAL SUPPLIES I/P2263234 S STRL SUT $137.75 22 SURGICAL SUPPLIES I/P2262962 S STRL SUT $110.00 22 SURGICAL SUPPLIES I/P2262186 S STRL SUT $61.75 22 SURGICAL SUPPLIES I/P2262293 S STRL SUT $15.75 22 SURGICAL SUPPLIES I/P2262558 S STRL SUT $99.75 22 SURGICAL SUPPLIES I/P2262467 S STRL SUT $33.75 22 SURGICAL SUPPLIES I/P2208171 S STRL SUT $17.25 22 SURGICAL SUPPLIES I/P2208189 S STRL SUT $293.25 22 SURGICAL SUPPLIES I/P2208197 S STRL SUT $213.25 22 SURGICAL SUPPLIES I/P2208205 S STRL SUT $293.25 22 SURGICAL SUPPLIES I/P2262004 S STRL SUT $211.50 22 SURGICAL SUPPLIES I/P2261980 S STRL SUT $154.50 22 SURGICAL SUPPLIES I/P2261972 S STRL SUT $154.50 22 SURGICAL SUPPLIES I/P2261931 S STRL SUT $13.50 22 SURGICAL SUPPLIES I/P2263705 S STRL SUT $34.75 22 SURGICAL SUPPLIES I/P2263655 S STRL SUT $11.75 22 SURGICAL SUPPLIES I/P2296168 S STRL SUT LASSO 45 DEG $595.00 22 SURGICAL SUPPLIES I/P2298974 S STRL SUT LASSO BANANA $552.50 22 SURGICAL SUPPLIES I/P2263556 S STRL SUT PASSER $296.75 22 SURGICAL SUPPLIES I/P2260370 S STRL SUT PASSER SHUTTLE $152.00 $152.00 22 SURGICAL SUPPLIES I/P2297406 S STRL SUT PASSING WIRE $318.75 22 SURGICAL SUPPLIES I/P2261519 S STRL SUT PROLENE $26.25 22 SURGICAL SUPPLIES I/P2263572 S STRL SUT SAVER $161.50 22 SURGICAL SUPPLIES I/P2261428 S STRL SUT TIGERWIRE $228.00 22 SURGICAL SUPPLIES I/P2261436 S STRL SUT TIGERWIRE $104.50 22 SURGICAL SUPPLIES I/P2261626 S STRL SUT VICRYL $56.00 22 SURGICAL SUPPLIES I/P2261485 S STRL SUT VICRYL $52.25 22 SURGICAL SUPPLIES I/P2261477 S STRL SUT VICRYL $12.25 22 SURGICAL SUPPLIES I/P2261733 S STRL SUTURE $62.50 22 SURGICAL SUPPLIES I/P2261188 S STRL SUTURE SHIP $213.75 22 SURGICAL SUPPLIES I/P2211928 S STRL SWAN-GANZ KIT $141.50 $141.50 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2262988 S STRL TACKER $1,890.00 22 SURGICAL SUPPLIES I/P2262996 S STRL TACKER $2,295.00 22 SURGICAL SUPPLIES I/P2262202 S STRL TACKER $1,198.50 22 SURGICAL SUPPLIES I/P2262970 S STRL TACKER $1,985.75 22 SURGICAL SUPPLIES I/P2263622 S STRL TAP $493.50 22 SURGICAL SUPPLIES I/P2297174 S STRL THERMA SPLNT $73.50 22 SURGICAL SUPPLIES I/P2295046 S STRL TIBIAL FIXATION P $318.75 22 SURGICAL SUPPLIES I/P2260883 S STRL TIC 3-0 T-15 18" $13.00 22 SURGICAL SUPPLIES I/P2293579 S STRL TIC, 5-0, 36" $36.00 $36.00 22 SURGICAL SUPPLIES I/P2290872 S STRL TIC,0,30",T-56 $37.75 $36.75 22 SURGICAL SUPPLIES I/P2291961 S STRL TIC,2-0,30",DT-5 $23.25 $23.25 22 SURGICAL SUPPLIES I/P2294395 S STRL TIC,3-0,30",CV-307 $57.00 $55.25 22 SURGICAL SUPPLIES I/P2291938 S STRL TIC,3-0,30"TIES $39.75 22 SURGICAL SUPPLIES I/P2291730 S STRL TIC,4-0,30",CV-301 $20.00 $20.00 22 SURGICAL SUPPLIES I/P2291490 S STRL TIC,4-0,30",TE-7 $57.25 $55.50 22 SURGICAL SUPPLIES I/P2292506 S STRL TIC,5-0,30",CV-301 $74.75 $69.75 22 SURGICAL SUPPLIES I/P2291623 S STRL TIC,6-0,30",TE-1 $69.75 $69.75 22 SURGICAL SUPPLIES I/P2298529 S STRL TICRON 2-0 48" SK $113.50 22 SURGICAL SUPPLIES I/P2293371 S STRL TICRON,2-0,30" T $43.25 $22.25 22 SURGICAL SUPPLIES I/P2291573 S STRL TICRON,2-0,30",D $18.00 22 SURGICAL SUPPLIES I/P2293561 S STRL TICRON,3-0,30",D $72.75 $72.75 22 SURGICAL SUPPLIES I/P2293967 S STRL TICRON,4-0,24",9 $39.75 22 SURGICAL SUPPLIES I/P2260750 S STRL TOOL TUNNELING VAG $1,602.25 22 SURGICAL SUPPLIES I/P2212868 S STRL TOUHY NDL $37.00 22 SURGICAL SUPPLIES I/P2295574 S STRL TRANS FIX PIN $646.00 22 SURGICAL SUPPLIES I/P2212504 S STRL TRANS PACING ELECT $675.25 22 SURGICAL SUPPLIES I/P2213262 S STRL TRANSDUCER $273.75 22 SURGICAL SUPPLIES I/P2260131 S STRL TRANSDUCER, NON- $42.50 $42.50 22 SURGICAL SUPPLIES I/P2212264 S STRL TRANSFER LINE $52.00 22 SURGICAL SUPPLIES I/P2261956 S STRL TRAY $932.50 22 SURGICAL SUPPLIES I/P2297398 S STRL TRIGEN DRILL 4.0MM $433.50 22 SURGICAL SUPPLIES I/P2297372 S STRL TRIGEN GUIDE ROD $405.00 22 SURGICAL SUPPLIES I/P2297380 S STRL TRIGEN PILOT DRILL $454.75 22 SURGICAL SUPPLIES I/P2295699 S STRL TROCAR & CAN $206.50 22 SURGICAL SUPPLIES I/P2261105 S STRL TROCAR DIL TIP $271.50 22 SURGICAL SUPPLIES I/P2297711 S STRL TROCAR ENDO 2/3MM $336.50 22 SURGICAL SUPPLIES I/P2210250 S STRL TUBE BLOOD PUMP $33.00 $32.00 22 SURGICAL SUPPLIES I/P2293512 S STRL TUBE COLLAR VENT $58.75 22 SURGICAL SUPPLIES I/P2212322 S STRL TUBE ENDO TRACH $675.75 22 SURGICAL SUPPLIES I/P2210078 S STRL TUBE ET $9.25 $9.25 22 SURGICAL SUPPLIES I/P2210474 S STRL TUBE ET LASER $267.00 $267.00 22 SURGICAL SUPPLIES I/P2212348 S STRL TUBE ET NIM 2XL $1,147.50 22 SURGICAL SUPPLIES I/P2210375 S STRL TUBE ET REINFORCED $96.00 $96.00 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2261659 S STRL TUBE FEED $526.50 22 SURGICAL SUPPLIES I/P2299105 S STRL TUBE FEEDING NASAL $397.75 22 SURGICAL SUPPLIES I/P2296143 S STRL TUBE GASTRIC 34FR $64.75 22 SURGICAL SUPPLIES I/P2293603 S STRL TUBE GOODE T $138.75 22 SURGICAL SUPPLIES I/P2296671 S STRL TUBE LASER VAC $74.00 22 SURGICAL SUPPLIES I/P2293777 S STRL TUBE MYRINGOTOMY $74.50 22 SURGICAL SUPPLIES I/P2210110 S STRL TUBE PRESSURE MONT $11.25 $11.25 22 SURGICAL SUPPLIES I/P2296093 S STRL TUBE SMOKE EVAC $52.75 22 SURGICAL SUPPLIES I/P2297778 S STRL TUBE STRGHT IRRIG $84.00 22 SURGICAL SUPPLIES I/P2290823 S STRL TUBE TRACH PED $163.00 $163.00 22 SURGICAL SUPPLIES I/P2297927 S STRL TUBE TRANSGASTRIC $945.75 22 SURGICAL SUPPLIES I/P2213122 S STRL TUBE UNIVENT CUFFE $595.00 22 SURGICAL SUPPLIES I/P2294577 S STRL TUBE VENT MORETZ $138.75 22 SURGICAL SUPPLIES I/P2294569 S STRL TUBE VENT SHEEHY $143.50 22 SURGICAL SUPPLIES I/P2299121 S STRL TUBE VENT ULTRASIL $54.75 22 SURGICAL SUPPLIES I/P2260297 S STRL TUBG TAB W/HNDL $29.50 $27.00 22 SURGICAL SUPPLIES I/P2261717 S STRL TUBING $31.75 22 SURGICAL SUPPLIES I/P2262921 S STRL TUBING $227.50 22 SURGICAL SUPPLIES I/P2261915 S STRL TUBING $99.75 22 SURGICAL SUPPLIES I/P2263531 S STRL TUBING $199.50 22 SURGICAL SUPPLIES I/P2262400 S STRL TUBING $646.00 22 SURGICAL SUPPLIES I/P2262947 S STRL TUBING $44.25 22 SURGICAL SUPPLIES I/P2262848 S STRL TUBING $171.50 $171.50 22 SURGICAL SUPPLIES I/P2208163 S STRL TUBING $213.75 22 SURGICAL SUPPLIES I/P2261865 S STRL TUBING $126.00 22 SURGICAL SUPPLIES I/P2210268 S STRL TUBING BLOOD WAR $55.00 $64.50 22 SURGICAL SUPPLIES I/P2261030 S STRL TUBING COOLANT SET $194.75 22 SURGICAL SUPPLIES I/P2298784 S STRL TUBING F/HEMOVAC $133.00 22 SURGICAL SUPPLIES I/P2212207 S STRL TUBING GEMINI BL $8.00 22 SURGICAL SUPPLIES I/P2262269 S STRL TUBING HP $78.75 22 SURGICAL SUPPLIES I/P2295095 S STRL TUBING INTELIJET P $312.50 22 SURGICAL SUPPLIES I/P2208262 S STRL TUBING PACK $2,195.00 22 SURGICAL SUPPLIES I/P2298214 S STRL TUBING PK SUGAR BA $640.00 22 SURGICAL SUPPLIES I/P2261196 S STRL TUBING SMOKE EVAC $96.75 22 SURGICAL SUPPLIES I/P2297505 S STRL U-CLIP 2/PK $156.75 22 SURGICAL SUPPLIES I/P2297497 S STRL U-CLIP 8/PK $510.00 22 SURGICAL SUPPLIES I/P2293819 S STRL URET DRAIN BAG $53.00 $53.00 22 SURGICAL SUPPLIES I/P2220168 S STRL URETERAL CATHETE $32.00 $30.00 22 SURGICAL SUPPLIES I/P2220150 S STRL URETERAL STENT $943.00 $890.00 22 SURGICAL SUPPLIES I/P2210805 S STRL VENT CIRCUIT OHIO $6.00 $5.00 22 SURGICAL SUPPLIES I/P2295707 S STRL VENTRIC KIT $1,656.25 22 SURGICAL SUPPLIES I/P2260941 S STRL VENTRICULOSTOM KIT $1,317.25 22 SURGICAL SUPPLIES I/P2212397 S STRL VESSEL DLTR $78.75 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2296101 S STRL VESSEL LOOP LNG $19.00 22 SURGICAL SUPPLIES I/P2296218 S STRL VIC 0 18" TIES $40.75 22 SURGICAL SUPPLIES I/P2297042 S STRL VIC 0 27" CT-3 $11.75 22 SURGICAL SUPPLIES I/P2295715 S STRL VIC 0 CTX 36" DYED $12.50 22 SURGICAL SUPPLIES I/P2294601 S STRL VIC 5-0 18" P-2 $26.25 22 SURGICAL SUPPLIES I/P2291854 S STRL VIC 6-0 18" P-1 $23.75 22 SURGICAL SUPPLIES I/P2293942 S STRL VIC 6-0 18,S-14 $56.50 22 SURGICAL SUPPLIES I/P2260818 S STRL VIC 7-0 BV-1 18" $63.00 22 SURGICAL SUPPLIES I/P2297141 S STRL VIC 8-0 V130-5 $104.00 22 SURGICAL SUPPLIES I/P2260834 S STRL VIC O CT 36" $12.25 22 SURGICAL SUPPLIES I/P2292654 S STRL VIC, 4-0, 18" $26.75 22 SURGICAL SUPPLIES I/P2293546 S STRL VIC,0,36",CT $12.50 22 SURGICAL SUPPLIES I/P2292431 S STRL VIC,0,54" REEL $13.00 22 SURGICAL SUPPLIES I/P2292332 S STRL VIC,0,54",TIE $12.25 22 SURGICAL SUPPLIES I/P2292522 S STRL VIC,1,27",CT,8/PK $62.75 22 SURGICAL SUPPLIES I/P2291326 S STRL VIC,1,36",CT-1 $12.50 22 SURGICAL SUPPLIES I/P2294437 S STRL VIC,2-0,36",CT $12.50 $12.50 22 SURGICAL SUPPLIES I/P2293686 S STRL VIC,2-0,54" TIE $12.00 22 SURGICAL SUPPLIES I/P2291011 S STRL VIC,2-0,54"REEL $13.25 22 SURGICAL SUPPLIES I/P2294478 S STRL VIC,3-0,27",PS-1 $24.75 $24.75 22 SURGICAL SUPPLIES I/P2294445 S STRL VIC,3-0,27",RB-1 $12.75 $12.75 22 SURGICAL SUPPLIES I/P2291425 S STRL VIC,3-0,27",SH-1 $12.50 22 SURGICAL SUPPLIES I/P2293496 S STRL VIC,3-0,36",CT-1 $12.25 22 SURGICAL SUPPLIES I/P2292282 S STRL VIC,3-0,54"REEL $13.00 $13.00 22 SURGICAL SUPPLIES I/P2290641 S STRL VIC,4-0,18" TIES $49.25 $49.25 22 SURGICAL SUPPLIES I/P2291987 S STRL VIC,4-0,18",P-2 $26.25 22 SURGICAL SUPPLIES I/P2294452 S STRL VIC,4-0,18",RB-1 $61.75 $61.75 22 SURGICAL SUPPLIES I/P2291631 S STRL VIC,4-0,27",TF $13.75 22 SURGICAL SUPPLIES I/P2293298 S STRL VIC,5-0,27",TF $13.75 22 SURGICAL SUPPLIES I/P2298156 S STRL VICRYL 2-0 18" C-1 $59.50 22 SURGICAL SUPPLIES I/P2298776 S STRL VICRYL 2-0 27" CT $12.00 22 SURGICAL SUPPLIES I/P2298768 S STRL VICRYL 3-0 27" CT $13.00 22 SURGICAL SUPPLIES I/P2298412 S STRL VICRYL PLUS 0 CT-1 $12.00 22 SURGICAL SUPPLIES I/P2298420 S STRL VICRYL PLUS 2-0 CT $12.25 22 SURGICAL SUPPLIES I/P2293629 S STRL VICRYL,0,18",END $97.25 22 SURGICAL SUPPLIES I/P2291474 S STRL VICRYL,0,36",V-3 $18.50 22 SURGICAL SUPPLIES I/P2293637 S STRL VICRYL,6-0,18",P $21.25 $21.25 22 SURGICAL SUPPLIES I/P2292571 S STRL VICRYL,6-0,8",S- $54.50 22 SURGICAL SUPPLIES I/P2298495 S STRL WAND TURBINATE $956.25 22 SURGICAL SUPPLIES I/P2212496 S STRL WATERCHEK WATERT $64.00 22 SURGICAL SUPPLIES I/P2262061 S STRL WORKSTATION $1,585.25 22 SURGICAL SUPPLIES I/P2261543 S STRL WRENCH $97.75 22 SURGICAL SUPPLIES I/P2208270 VAD PWR MODULE REPLCMNT $1,009.50 22 SURGICAL SUPPLIES I/P

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2208288 VAD UNIV BATT CHRGE REPLC $1,009.50 22 SURGICAL SUPPLIES I/P2390631 ADHESION BARRIER SPINAL $1,092.25 $1,056.25 23 SURGICAL SUPPLIES I/P (CO2309128 ADHESION BARRIER SPINAL $1,184.25 $1,020.00 23 SURGICAL SUPPLIES I/P (CO2330447 AICD DUAL CHAMBER $46,349.00 23 SURGICAL SUPPLIES I/P (CO2330421 AICD DUAL CHAMBER $42,978.00 23 SURGICAL SUPPLIES I/P (CO2330322 AICD DUAL CHAMBER $26,124.00 23 SURGICAL SUPPLIES I/P (CO2330330 AICD DUAL CHAMBER $27,809.00 23 SURGICAL SUPPLIES I/P (CO2330348 AICD DUAL CHAMBER $29,495.00 23 SURGICAL SUPPLIES I/P (CO2330355 AICD DUAL CHAMBER $30,337.00 23 SURGICAL SUPPLIES I/P (CO2330363 AICD DUAL CHAMBER $33,652.00 23 SURGICAL SUPPLIES I/P (CO2330371 AICD DUAL CHAMBER $34,551.00 23 SURGICAL SUPPLIES I/P (CO2330389 AICD DUAL CHAMBER $36,236.00 23 SURGICAL SUPPLIES I/P (CO2330397 AICD DUAL CHAMBER $37,922.00 23 SURGICAL SUPPLIES I/P (CO2330405 AICD DUAL CHAMBER $39,607.00 23 SURGICAL SUPPLIES I/P (CO2330413 AICD DUAL CHAMBER $41,292.00 23 SURGICAL SUPPLIES I/P (CO2331098 AICD DUAL CHAMBER $37,778.00 23 SURGICAL SUPPLIES I/P (CO2330439 AICD DUAL CHAMBER $44,663.00 23 SURGICAL SUPPLIES I/P (CO2331106 AICD OTHER THAN SING/DUAL $30,000.00 23 SURGICAL SUPPLIES I/P (CO2330454 AICD SINGLE CHAMBER $14,326.00 23 SURGICAL SUPPLIES I/P (CO2330462 AICD SINGLE CHAMBER $16,011.00 23 SURGICAL SUPPLIES I/P (CO2330587 AICD SINGLE CHAMBER $36,236.00 23 SURGICAL SUPPLIES I/P (CO2330579 AICD SINGLE CHAMBER $34,551.00 23 SURGICAL SUPPLIES I/P (CO2330561 AICD SINGLE CHAMBER $32,865.00 23 SURGICAL SUPPLIES I/P (CO2330553 AICD SINGLE CHAMBER $31,180.00 23 SURGICAL SUPPLIES I/P (CO2330520 AICD SINGLE CHAMBER $26,124.00 23 SURGICAL SUPPLIES I/P (CO2330546 AICD SINGLE CHAMBER $29,495.00 23 SURGICAL SUPPLIES I/P (CO2330538 AICD SINGLE CHAMBER $27,809.00 23 SURGICAL SUPPLIES I/P (CO2330470 AICD SINGLE CHAMBER $17,697.00 23 SURGICAL SUPPLIES I/P (CO2330488 AICD SINGLE CHAMBER $19,382.00 23 SURGICAL SUPPLIES I/P (CO2330512 AICD SINGLE CHAMBER $24,438.00 23 SURGICAL SUPPLIES I/P (CO2330504 AICD SINGLE CHAMBER $22,753.00 23 SURGICAL SUPPLIES I/P (CO2391688 AICD SINGLE CHAMBER $37,778.00 23 SURGICAL SUPPLIES I/P (CO2330496 AICD SINGLE CHAMBER $21,068.00 23 SURGICAL SUPPLIES I/P (CO2312635 CATH BLN DILATE NOVSC $1,152.00 $1,140.75 23 SURGICAL SUPPLIES I/P (CO2312619 CATH BLN DILATE NOVSC $1,171.00 $1,152.00 23 SURGICAL SUPPLIES I/P (CO2315505 CATH DRAINAGE $40.25 $40.25 23 SURGICAL SUPPLIES I/P (CO2315554 CATH DRAINAGE $51.50 $51.50 23 SURGICAL SUPPLIES I/P (CO2307742 CATH DRAINAGE $32.25 $31.00 23 SURGICAL SUPPLIES I/P (CO2307734 CATH DRAINAGE $46.50 $44.75 23 SURGICAL SUPPLIES I/P (CO2315539 CATH DRAINAGE $36.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2312684 CATH DRAINAGE $60.50 $60.50 23 SURGICAL SUPPLIES I/P (CO2307759 CATH DRAINAGE $81.75 $77.00 23 SURGICAL SUPPLIES I/P (CO2307916 CATH DRAINAGE $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2315638 CATH DRAINAGE $157.00 $148.00 23 SURGICAL SUPPLIES I/P (CO2313336 CATH DRAINAGE $42.00 $42.00 23 SURGICAL SUPPLIES I/P (CO2315620 CATH DRAINAGE $55.00 $52.00 23 SURGICAL SUPPLIES I/P (CO2313054 CATH HD SHORT TERM $528.50 $355.25 23 SURGICAL SUPPLIES I/P (CO2312874 CATH HD SHORT TERM $756.75 $471.50 23 SURGICAL SUPPLIES I/P (CO2312890 CATH HD SHORT TERM $367.75 $367.75 23 SURGICAL SUPPLIES I/P (CO2313724 CATH HD SHORT TERM $433.50 $433.50 23 SURGICAL SUPPLIES I/P (CO2313021 CATH INF PER CEN MID NOHD $401.00 $378.00 23 SURGICAL SUPPLIES I/P (CO2312569 CATH INF PER CEN MID NOHD $301.00 $284.00 23 SURGICAL SUPPLIES I/P (CO2312361 CATH INF PER CEN MID NOHD $525.50 $525.50 23 SURGICAL SUPPLIES I/P (CO2313229 CATH INF PER CEN MID NOHD $649.00 $613.00 23 SURGICAL SUPPLIES I/P (CO2313468 CATH INF PER CEN MID NOHD $63.00 $63.00 23 SURGICAL SUPPLIES I/P (CO2313641 CATH INF PER CEN MID NOHD $993.25 $993.25 23 SURGICAL SUPPLIES I/P (CO2313013 CATH INF PER CEN MID NOHD $607.25 $607.25 23 SURGICAL SUPPLIES I/P (CO2325710 CATH INF PER CEN MID NOHD $2,030.00 23 SURGICAL SUPPLIES I/P (CO2350767 CATH INTRASPINAL $2,432.50 $2,432.50 23 SURGICAL SUPPLIES I/P (CO2312783 CATH OCCLUSION $1,143.25 $973.25 23 SURGICAL SUPPLIES I/P (CO2312809 CATH SP/CYSTOSCOPIC $203.00 $203.00 23 SURGICAL SUPPLIES I/P (CO2312437 CATH THROMB/EMBOLCTMY $171.00 $171.00 23 SURGICAL SUPPLIES I/P (CO2312429 CATH THROMB/EMBOLCTMY $306.00 $306.00 23 SURGICAL SUPPLIES I/P (CO2312460 CATH THROMB/EMBOLCTMY $99.75 $99.75 23 SURGICAL SUPPLIES I/P (CO2312742 CATH URETERAL $57.00 $55.75 23 SURGICAL SUPPLIES I/P (CO2312965 CATH URETERAL $55.75 $55.75 23 SURGICAL SUPPLIES I/P (CO2313484 CATH URETERAL $218.50 $212.50 23 SURGICAL SUPPLIES I/P (CO2325983 CON TISS HUMAN INC FASCIA $2,485.00 23 SURGICAL SUPPLIES I/P (CO2320711 CON TISS HUMAN INC FASCIA $1,148.00 $1,148.00 23 SURGICAL SUPPLIES I/P (CO2326452 CON TISS HUMAN INC FASCIA $2,712.50 23 SURGICAL SUPPLIES I/P (CO2325777 CONN TISS NON-HUMAN $1,535.00 23 SURGICAL SUPPLIES I/P (CO2325785 CONN TISS NON-HUMAN $2,363.00 23 SURGICAL SUPPLIES I/P (CO2320067 CONN TISS NON-HUMAN $1,466.25 $1,329.50 23 SURGICAL SUPPLIES I/P (CO2320075 CONN TISS NON-HUMAN $2,383.00 $2,212.25 23 SURGICAL SUPPLIES I/P (CO2325546 CONN TISS NON-HUMAN $1,763.75 23 SURGICAL SUPPLIES I/P (CO2330892 DUAL CHAMB RR PACEMAKER $5,478.00 23 SURGICAL SUPPLIES I/P (CO2331080 DUAL CHAMB RR PACEMAKER $9,430.00 23 SURGICAL SUPPLIES I/P (CO2331205 DUAL CHAMB RR PACEMAKER $8,392.50 23 SURGICAL SUPPLIES I/P (CO2330900 DUAL CHAMB RR PACEMAKER $6,320.00 23 SURGICAL SUPPLIES I/P (CO2330967 DUAL CHAMB RR PACEMAKER $16,433.00 23 SURGICAL SUPPLIES I/P (CO2330959 DUAL CHAMB RR PACEMAKER $10,534.00 23 SURGICAL SUPPLIES I/P (CO2330942 DUAL CHAMB RR PACEMAKER $9,691.00 23 SURGICAL SUPPLIES I/P (CO2330934 DUAL CHAMB RR PACEMAKER $8,848.00 23 SURGICAL SUPPLIES I/P (CO2330926 DUAL CHAMB RR PACEMAKER $8,006.00 23 SURGICAL SUPPLIES I/P (CO2330918 DUAL CHAMB RR PACEMAKER $7,163.00 23 SURGICAL SUPPLIES I/P (CO2325470 GENERATOR NEURO NO-RECHRG $21,296.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2303303 GENERATOR NEURO NO-RECHRG $11,692.50 $11,692.50 23 SURGICAL SUPPLIES I/P (CO2318186 GUIDEWIRE $187.00 $187.00 23 SURGICAL SUPPLIES I/P (CO2363422 GUIDEWIRE $212.50 23 SURGICAL SUPPLIES I/P (CO2363414 GUIDEWIRE $142.25 23 SURGICAL SUPPLIES I/P (CO2312221 IMP CATH HD/PRTNL LNG TRM $1,615.00 23 SURGICAL SUPPLIES I/P (CO2312882 IMP CATH HD/PRTNL LNG TRM $968.75 $968.75 23 SURGICAL SUPPLIES I/P (CO2326478 IMP COCHLEAR DEVICE $40,534.00 23 SURGICAL SUPPLIES I/P (CO2326486 IMP COCHLEAR DEVICE $38,625.00 23 SURGICAL SUPPLIES I/P (CO2320745 IMP GRAFT VASCULAR $2,635.00 $2,573.00 23 SURGICAL SUPPLIES I/P (CO2320877 IMP GRAFT VASCULAR $2,912.00 $2,912.00 23 SURGICAL SUPPLIES I/P (CO2325587 IMP GRAFT VASCULAR $10,800.00 23 SURGICAL SUPPLIES I/P (CO2325611 IMP GRAFT VASCULAR $11,850.00 23 SURGICAL SUPPLIES I/P (CO2325579 IMP GRAFT VASCULAR $9,750.00 23 SURGICAL SUPPLIES I/P (CO2320497 IMP GRAFT VASCULAR $3,365.00 23 SURGICAL SUPPLIES I/P (CO2326247 IMP GRAFT VASCULAR $12,375.00 23 SURGICAL SUPPLIES I/P (CO2326239 IMP GRAFT VASCULAR $11,563.00 23 SURGICAL SUPPLIES I/P (CO2325629 IMP GRAFT VASCULAR $13,350.00 23 SURGICAL SUPPLIES I/P (CO2325553 IMP GRAFT VASCULAR $1,058.25 23 SURGICAL SUPPLIES I/P (CO2325603 IMP GRAFT VASCULAR $11,850.00 23 SURGICAL SUPPLIES I/P (CO2325595 IMP GRAFT VASCULAR $10,800.00 23 SURGICAL SUPPLIES I/P (CO2325561 IMP GRAFT VASCULAR $9,750.00 23 SURGICAL SUPPLIES I/P (CO2326221 IMP GRAFT VASCULAR $7,875.00 23 SURGICAL SUPPLIES I/P (CO2391043 IMP GRAFT VASCULAR $2,128.00 $2,128.00 23 SURGICAL SUPPLIES I/P (CO2322295 IMP GRAFT VASCULAR $675.75 $675.75 23 SURGICAL SUPPLIES I/P (CO2320471 IMP GRAFT VASCULAR $3,030.00 23 SURGICAL SUPPLIES I/P (CO2322287 IMP GRAFT VASCULAR $2,590.00 $2,590.00 23 SURGICAL SUPPLIES I/P (CO2320059 IMP GRAFT VASCULAR $3,493.00 23 SURGICAL SUPPLIES I/P (CO2322303 IMP GRAFT VASCULAR $2,135.00 $2,135.00 23 SURGICAL SUPPLIES I/P (CO2322246 IMP GRAFT VASCULAR $2,283.00 $2,154.00 23 SURGICAL SUPPLIES I/P (CO2325439 IMP GRAFT VASCULAR $1,496.00 23 SURGICAL SUPPLIES I/P (CO2321156 IMP GRAFT VASCULAR $3,003.00 23 SURGICAL SUPPLIES I/P (CO2368140 IMP INT FX PLATE/METL MSH $614.00 23 SURGICAL SUPPLIES I/P (CO2368181 IMP INT FX PLATE/METL MSH $3,549.00 23 SURGICAL SUPPLIES I/P (CO2368116 IMP INT FX PLATE/METL MSH $1,849.25 23 SURGICAL SUPPLIES I/P (CO2368215 IMP INT FX PLATE/METL MSH $3,853.00 23 SURGICAL SUPPLIES I/P (CO2368173 IMP INT FX PLATE/METL MSH $3,673.00 23 SURGICAL SUPPLIES I/P (CO2368124 IMP INT FX PLATE/METL MSH $2,233.00 23 SURGICAL SUPPLIES I/P (CO2368199 IMP INT FX PLATE/METL MSH $2,877.00 23 SURGICAL SUPPLIES I/P (CO2368165 IMP INT FX PLATE/METL MSH $2,228.00 23 SURGICAL SUPPLIES I/P (CO2368207 IMP INT FX PLATE/METL MSH $2,945.00 23 SURGICAL SUPPLIES I/P (CO2368132 IMP INT FX PLATE/METL MSH $2,441.00 23 SURGICAL SUPPLIES I/P (CO2368272 IMP INT FX SCREW $426.25 23 SURGICAL SUPPLIES I/P (CO2368280 IMP INT FX SCREW $428.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2368256 IMP INT FX SCREW $171.50 23 SURGICAL SUPPLIES I/P (CO2368249 IMP INT FX SCREW $574.00 23 SURGICAL SUPPLIES I/P (CO2368264 IMP INT FX SCREW $841.00 23 SURGICAL SUPPLIES I/P (CO2368231 IMP INT FX SCREW $618.00 23 SURGICAL SUPPLIES I/P (CO2368223 IMP INT FX SCREW $497.00 23 SURGICAL SUPPLIES I/P (CO2321883 IMP MESH $180.50 $180.50 23 SURGICAL SUPPLIES I/P (CO2321859 IMP MESH $221.00 $263.50 23 SURGICAL SUPPLIES I/P (CO2321834 IMP MESH $639.75 $639.75 23 SURGICAL SUPPLIES I/P (CO2324614 IMP MESH $3,475.00 23 SURGICAL SUPPLIES I/P (CO2363448 IMP MESH $5,410.00 23 SURGICAL SUPPLIES I/P (CO2353647 IMP MESH $8,371.00 23 SURGICAL SUPPLIES I/P (CO2363430 IMP MESH $2,799.00 23 SURGICAL SUPPLIES I/P (CO2353696 IMP MESH $9,259.00 23 SURGICAL SUPPLIES I/P (CO2353688 IMP MESH $10,842.00 23 SURGICAL SUPPLIES I/P (CO2324747 IMP MESH $2,799.00 23 SURGICAL SUPPLIES I/P (CO2353670 IMP MESH $12,137.00 23 SURGICAL SUPPLIES I/P (CO2353662 IMP MESH $7,577.00 23 SURGICAL SUPPLIES I/P (CO2353639 IMP MESH $4,070.00 23 SURGICAL SUPPLIES I/P (CO2353621 IMP MESH $3,984.00 23 SURGICAL SUPPLIES I/P (CO2353654 IMP MESH $12,170.00 23 SURGICAL SUPPLIES I/P (CO2321842 IMP MESH $378.25 $378.25 23 SURGICAL SUPPLIES I/P (CO2321867 IMP MESH $2,772.00 $2,153.00 23 SURGICAL SUPPLIES I/P (CO2325264 IMP MESH $841.50 23 SURGICAL SUPPLIES I/P (CO2325256 IMP MESH $420.75 23 SURGICAL SUPPLIES I/P (CO2309961 IMP PORT INDWELLING $1,134.00 $1,070.00 23 SURGICAL SUPPLIES I/P (CO2301208 IMP PORT INDWELLING $1,891.00 $1,784.00 23 SURGICAL SUPPLIES I/P (CO2326353 IMP PROSTHESIS BREAST $2,360.00 23 SURGICAL SUPPLIES I/P (CO2322386 IMP PROSTHESIS BREAST $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2326403 IMP PROSTHESIS BREAST $3,244.00 23 SURGICAL SUPPLIES I/P (CO2326387 IMP PROSTHESIS BREAST $3,230.00 23 SURGICAL SUPPLIES I/P (CO2326379 IMP PROSTHESIS BREAST $2,556.00 23 SURGICAL SUPPLIES I/P (CO2326361 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2326395 IMP PROSTHESIS BREAST $3,441.00 23 SURGICAL SUPPLIES I/P (CO2326346 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2322394 IMP PROSTHESIS BREAST $2,596.00 $2,449.00 23 SURGICAL SUPPLIES I/P (CO2326304 IMP PROSTHESIS BREAST $2,360.00 23 SURGICAL SUPPLIES I/P (CO2326320 IMP PROSTHESIS BREAST $2,949.00 23 SURGICAL SUPPLIES I/P (CO2326288 IMP PROSTHESIS BREAST $2,163.00 23 SURGICAL SUPPLIES I/P (CO2326296 IMP PROSTHESIS BREAST $3,146.00 23 SURGICAL SUPPLIES I/P (CO2326338 IMP PROSTHESIS BREAST $2,163.00 23 SURGICAL SUPPLIES I/P (CO2326312 IMP PROSTHESIS BREAST $3,146.00 23 SURGICAL SUPPLIES I/P (CO2322329 IMP VOCAL CORD SYNTH $1,552.00 23 SURGICAL SUPPLIES I/P (CO2309151 INTRO/SHEATH NON-LASER $6.25 $6.25 23 SURGICAL SUPPLIES I/P (CO

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DEPARTMENT CODE

2309144 INTRO/SHEATH NON-LASER $262.00 $247.00 23 SURGICAL SUPPLIES I/P (CO2301919 INTRO/SHEATH NON-LASER $1,542.75 $1,542.75 23 SURGICAL SUPPLIES I/P (CO2318350 INTRO/SHEATH NON-LASER $203.75 $203.75 23 SURGICAL SUPPLIES I/P (CO2331130 LD PCR NO TV VDD SNGL PAS $3,325.00 23 SURGICAL SUPPLIES I/P (CO2331171 LD PCR NO TV VDD SNGL PAS $3,375.00 23 SURGICAL SUPPLIES I/P (CO2331163 LD PCR NO TV VDD SNGL PAS $3,125.00 23 SURGICAL SUPPLIES I/P (CO2331155 LD PCR NO TV VDD SNGL PAS $2,875.00 23 SURGICAL SUPPLIES I/P (CO2331148 LD PCR NO TV VDD SNGL PAS $2,625.00 23 SURGICAL SUPPLIES I/P (CO2331189 LD PCR NO TV VDD SNGL PAS $3,625.00 23 SURGICAL SUPPLIES I/P (CO2330702 LEAD AICD ENDO DUAL COIL $8,848.00 23 SURGICAL SUPPLIES I/P (CO2330736 LEAD AICD ENDO DUAL COIL $11,376.00 23 SURGICAL SUPPLIES I/P (CO2330744 LEAD AICD ENDO DUAL COIL $12,219.00 23 SURGICAL SUPPLIES I/P (CO2330694 LEAD AICD ENDO DUAL COIL $8,006.00 23 SURGICAL SUPPLIES I/P (CO2330710 LEAD AICD ENDO DUAL COIL $9,691.00 23 SURGICAL SUPPLIES I/P (CO2330660 LEAD AICD ENDO DUAL COIL $5,478.00 23 SURGICAL SUPPLIES I/P (CO2330728 LEAD AICD ENDO DUAL COIL $10,534.00 23 SURGICAL SUPPLIES I/P (CO2330629 LEAD AICD ENDO DUAL COIL $2,107.00 23 SURGICAL SUPPLIES I/P (CO2330637 LEAD AICD ENDO DUAL COIL $2,949.00 23 SURGICAL SUPPLIES I/P (CO2330611 LEAD AICD ENDO DUAL COIL $1,559.00 23 SURGICAL SUPPLIES I/P (CO2330645 LEAD AICD ENDO DUAL COIL $3,792.00 23 SURGICAL SUPPLIES I/P (CO2330652 LEAD AICD ENDO DUAL COIL $4,635.00 23 SURGICAL SUPPLIES I/P (CO2330603 LEAD AICD ENDO DUAL COIL $1,475.00 23 SURGICAL SUPPLIES I/P (CO2330595 LEAD AICD ENDO DUAL COIL $1,390.00 23 SURGICAL SUPPLIES I/P (CO2331049 LEAD AICD ENDO DUAL COIL $1,643.00 23 SURGICAL SUPPLIES I/P (CO2330678 LEAD AICD ENDO DUAL COIL $6,320.00 23 SURGICAL SUPPLIES I/P (CO2330686 LEAD AICD ENDO DUAL COIL $7,163.00 23 SURGICAL SUPPLIES I/P (CO2330751 LEAD AICD ENDO SINGL COIL $5,478.00 23 SURGICAL SUPPLIES I/P (CO2331114 LEAD AICD ENDO SINGL COIL $11,875.00 23 SURGICAL SUPPLIES I/P (CO2331122 LEAD AICD ENDO SINGL COIL $7,875.00 23 SURGICAL SUPPLIES I/P (CO2331221 LEAD CORONARY VENOUS $6,000.00 23 SURGICAL SUPPLIES I/P (CO2331072 LEAD CORONARY VENOUS $4,000.00 23 SURGICAL SUPPLIES I/P (CO2331197 LEAD CORONARY VENOUS $4,000.00 23 SURGICAL SUPPLIES I/P (CO2325280 LEAD NEUROSTIMULATOR $11,460.00 23 SURGICAL SUPPLIES I/P (CO2303337 LEAD NEUROSTIMULATOR $3,475.00 $3,475.00 23 SURGICAL SUPPLIES I/P (CO2303345 LEAD NEUROSTIMULATOR $3,475.00 $3,475.00 23 SURGICAL SUPPLIES I/P (CO2303311 LEAD NEUROSTIMULATOR $4,750.00 $4,750.00 23 SURGICAL SUPPLIES I/P (CO2303352 LEAD NEUROSTIMULATOR $4,200.00 $4,200.00 23 SURGICAL SUPPLIES I/P (CO2326619 LEAD NEUROSTIMULATOR $7,528.00 23 SURGICAL SUPPLIES I/P (CO2330843 LEAD PMKR TRANSVENOUS VDD $1,475.00 23 SURGICAL SUPPLIES I/P (CO2330769 LEAD PMKR TRANSVENOUS VDD $801.00 23 SURGICAL SUPPLIES I/P (CO2330884 LEAD PMKR TRANSVENOUS VDD $2,233.00 23 SURGICAL SUPPLIES I/P (CO2330876 LEAD PMKR TRANSVENOUS VDD $1,726.00 23 SURGICAL SUPPLIES I/P (CO2330868 LEAD PMKR TRANSVENOUS VDD $1,643.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2330850 LEAD PMKR TRANSVENOUS VDD $1,559.00 23 SURGICAL SUPPLIES I/P (CO2330835 LEAD PMKR TRANSVENOUS VDD $1,390.00 23 SURGICAL SUPPLIES I/P (CO2330819 LEAD PMKR TRANSVENOUS VDD $1,222.00 23 SURGICAL SUPPLIES I/P (CO2330827 LEAD PMKR TRANSVENOUS VDD $1,306.00 23 SURGICAL SUPPLIES I/P (CO2330793 LEAD PMKR TRANSVENOUS VDD $1,053.00 23 SURGICAL SUPPLIES I/P (CO2330801 LEAD PMKR TRANSVENOUS VDD $1,138.00 23 SURGICAL SUPPLIES I/P (CO2330785 LEAD PMKR TRANSVENOUS VDD $969.00 23 SURGICAL SUPPLIES I/P (CO2330777 LEAD PMKR TRANSVENOUS VDD $885.00 23 SURGICAL SUPPLIES I/P (CO2381754 NA CL IRRIG 500ML $29.00 $27.00 23 SURGICAL SUPPLIES I/P (CO2331023 PACEMAKER SGL CHAMBR RR $8,848.00 23 SURGICAL SUPPLIES I/P (CO2330983 PACEMAKER SGL CHAMBR RR $5,478.00 23 SURGICAL SUPPLIES I/P (CO2331007 PACEMAKER SGL CHAMBR RR $7,163.00 23 SURGICAL SUPPLIES I/P (CO2330975 PACEMAKER SGL CHAMBR RR $4,635.00 23 SURGICAL SUPPLIES I/P (CO2331015 PACEMAKER SGL CHAMBR RR $8,006.00 23 SURGICAL SUPPLIES I/P (CO2331031 PACEMAKER SGL CHAMBR RR $9,691.00 23 SURGICAL SUPPLIES I/P (CO2330991 PACEMAKER SGL CHAMBR RR $6,320.00 23 SURGICAL SUPPLIES I/P (CO2331213 PACEMKR NO SGL/DUAL CHAMB $9,750.00 23 SURGICAL SUPPLIES I/P (CO2326502 PENILE PROST INFLAT $3,483.00 23 SURGICAL SUPPLIES I/P (CO2326544 PENILE PROST INFLAT $2,083.00 23 SURGICAL SUPPLIES I/P (CO2326494 PENILE PROST INFLAT $10,716.00 23 SURGICAL SUPPLIES I/P (CO2367548 S ANCHR $1,615.00 23 SURGICAL SUPPLIES I/P (CO2367571 S ANCHR $1,615.00 23 SURGICAL SUPPLIES I/P (CO2367472 S ANCHR $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367563 S ANCHR $1,445.00 23 SURGICAL SUPPLIES I/P (CO2367555 S ANCHR $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367506 S ANCHR $1,273.00 23 SURGICAL SUPPLIES I/P (CO2367498 S ANCHR $1,508.75 23 SURGICAL SUPPLIES I/P (CO2367241 S ANCHR ENDOBUTTON $1,071.00 23 SURGICAL SUPPLIES I/P (CO2360139 S IMP ALTA GDWR $346.00 $326.00 23 SURGICAL SUPPLIES I/P (CO2360170 S IMP ALTA NAIL IM ROD $2,438.00 $2,300.00 23 SURGICAL SUPPLIES I/P (CO2360162 S IMP ALTA NAIL, IM RO $2,127.00 $2,007.00 23 SURGICAL SUPPLIES I/P (CO2360147 S IMP ALTA NAIL,IM ROD $371.00 $350.00 23 SURGICAL SUPPLIES I/P (CO2391019 S IMP ANCH ARTHREX-CORKSC $828.75 $828.75 23 SURGICAL SUPPLIES I/P (CO2363471 S IMP ANCH FASTAK 2.8X11. $701.25 23 SURGICAL SUPPLIES I/P (CO2360311 S IMP ANCH GII W/SUT THRE $1,381.25 $1,381.25 23 SURGICAL SUPPLIES I/P (CO2367233 S IMP ANCHOR $1,445.00 23 SURGICAL SUPPLIES I/P (CO2325694 S IMP ANEURX AORTIC EXT C $2,275.00 23 SURGICAL SUPPLIES I/P (CO2325686 S IMP ANEURX ILIAC EXT CU $2,275.00 23 SURGICAL SUPPLIES I/P (CO2353449 S IMP ATLANTIS CANC SCREW $1,293.25 23 SURGICAL SUPPLIES I/P (CO2353456 S IMP ATLANTIS CANC SCREW $1,653.75 23 SURGICAL SUPPLIES I/P (CO2353464 S IMP ATLANTIS PLT AC $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353480 S IMP ATLANTIS PLT AC $4,569.00 23 SURGICAL SUPPLIES I/P (CO2353472 S IMP ATLANTIS PLT AC $4,170.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2353498 S IMP ATLANTIS PLT AC $4,569.00 23 SURGICAL SUPPLIES I/P (CO2391506 S IMP BAK CAGES $5,337.00 $5,035.00 23 SURGICAL SUPPLIES I/P (CO2367035 S IMP BLADE SPIRAL $2,324.00 23 SURGICAL SUPPLIES I/P (CO2326429 S IMP BONE CHIPS $5,158.00 23 SURGICAL SUPPLIES I/P (CO2326114 S IMP BONE CHIPS CANC $2,293.00 23 SURGICAL SUPPLIES I/P (CO2320018 S IMP BONE CHIPS CANC $2,036.00 $1,938.00 23 SURGICAL SUPPLIES I/P (CO2362911 S IMP BONE CORNERSTONE $2,800.00 23 SURGICAL SUPPLIES I/P (CO2326270 S IMP BONE CORTICAL WEDGE $3,581.00 23 SURGICAL SUPPLIES I/P (CO2326064 S IMP BONE FEM STRUT $2,440.00 23 SURGICAL SUPPLIES I/P (CO2326072 S IMP BONE FEM STRUT $3,108.00 23 SURGICAL SUPPLIES I/P (CO2326080 S IMP BONE FEM STRUT $4,668.00 23 SURGICAL SUPPLIES I/P (CO2326023 S IMP BONE FEMUR PROX $10,638.00 23 SURGICAL SUPPLIES I/P (CO2326031 S IMP BONE FEMUR PROX $6,585.00 23 SURGICAL SUPPLIES I/P (CO2320315 S IMP BONE FEMUR STRUT $4,660.00 $4,660.00 23 SURGICAL SUPPLIES I/P (CO2320323 S IMP BONE FIBULA SEGMENT $1,966.00 $1,855.00 23 SURGICAL SUPPLIES I/P (CO2326098 S IMP BONE HEMI PELVIS $9,927.00 23 SURGICAL SUPPLIES I/P (CO2325991 S IMP BONE ILIAC WEDGE $3,402.00 23 SURGICAL SUPPLIES I/P (CO2320042 S IMP BONE ILLIAC CREST $3,080.00 $2,989.00 23 SURGICAL SUPPLIES I/P (CO2320091 S IMP BONE PATELLA WEDGE $3,273.00 $3,273.00 23 SURGICAL SUPPLIES I/P (CO2320117 S IMP BONE PATELLA WEDGE $2,558.00 $2,558.00 23 SURGICAL SUPPLIES I/P (CO2325447 S IMP BONE PRO OST COR $1,036.00 23 SURGICAL SUPPLIES I/P (CO2325454 S IMP BONE PRO OST COR $1,978.00 23 SURGICAL SUPPLIES I/P (CO2325462 S IMP BONE PRO OST CORAL $2,792.00 23 SURGICAL SUPPLIES I/P (CO2320158 S IMP BONE PRO OSTEON $3,905.00 $3,684.00 23 SURGICAL SUPPLIES I/P (CO2320166 S IMP BONE PRO OSTEON $3,512.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2320174 S IMP BONE PRO OSTEON $3,188.00 $3,140.00 23 SURGICAL SUPPLIES I/P (CO2352789 S IMP BONE SYNTHES SPACER $9,915.00 23 SURGICAL SUPPLIES I/P (CO2326056 S IMP BONE TIBIA PROX $10,638.00 23 SURGICAL SUPPLIES I/P (CO2320216 S IMP BONE, BLTRL CONDYLE $7,648.00 $7,648.00 23 SURGICAL SUPPLIES I/P (CO2320273 S IMP BONE, DISTAL FEMUR $10,638.00 $10,638.00 23 SURGICAL SUPPLIES I/P (CO2320026 S IMP BONE, DOWELS $2,162.00 $2,040.00 23 SURGICAL SUPPLIES I/P (CO2320281 S IMP BONE, FEM HEAD $3,220.00 $2,730.00 23 SURGICAL SUPPLIES I/P (CO2320331 S IMP BONE, GRAFTON GEL $3,244.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2320349 S IMP BONE, HEMI CONDYLE $3,838.00 $3,838.00 23 SURGICAL SUPPLIES I/P (CO2320224 S IMP BONE,CHIPS $2,783.00 $3,304.00 23 SURGICAL SUPPLIES I/P (CO2326841 S IMP B-T-B HEMI W/QUAD $5,688.00 23 SURGICAL SUPPLIES I/P (CO2367522 S IMP BUTTON KIT $2,975.00 23 SURGICAL SUPPLIES I/P (CO2363653 S IMP CABLE W/CRIMP $2,007.00 23 SURGICAL SUPPLIES I/P (CO2353506 S IMP CABLE W/O BEAD $1,499.50 23 SURGICAL SUPPLIES I/P (CO2367092 S IMP CAP END 12MM $778.50 23 SURGICAL SUPPLIES I/P (CO2367050 S IMP CAP END F/FLOCKING $811.50 23 SURGICAL SUPPLIES I/P (CO2367043 S IMP CAP END F/SPIRAL BL $866.25 23 SURGICAL SUPPLIES I/P (CO2367068 S IMP CAP END F/TIB NAIL $548.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2367076 S IMP CAP END F/TIB NAIL $1,027.00 23 SURGICAL SUPPLIES I/P (CO2367084 S IMP CAP END F/TIB NAIL $588.50 23 SURGICAL SUPPLIES I/P (CO2313518 S IMP CATHETER PUDENZ $612.00 $573.75 23 SURGICAL SUPPLIES I/P (CO2313039 S IMP CATHETER PUDENZ $715.50 $715.50 23 SURGICAL SUPPLIES I/P (CO2363679 S IMP CERCLAGE BUTTON $672.50 23 SURGICAL SUPPLIES I/P (CO2363661 S IMP CERCLAGE POST PIN $672.50 23 SURGICAL SUPPLIES I/P (CO2354405 S IMP CHARITE ARTIFICIAL $9,150.00 23 SURGICAL SUPPLIES I/P (CO2354413 S IMP CHARITE ARTIFICIAL $2,625.00 23 SURGICAL SUPPLIES I/P (CO2367530 S IMP CINCH $1,211.25 23 SURGICAL SUPPLIES I/P (CO2352805 S IMP CLAMP CERVIFIX $2,473.00 23 SURGICAL SUPPLIES I/P (CO2352813 S IMP CLAMP CERVIFIX $1,787.50 23 SURGICAL SUPPLIES I/P (CO2352797 S IMP CLAMP MEDIAL/LAT $2,651.00 23 SURGICAL SUPPLIES I/P (CO2353175 S IMP CLICK'X 3-D SCREW $2,187.00 23 SURGICAL SUPPLIES I/P (CO2353167 S IMP CLICK'X LOCKING $954.00 23 SURGICAL SUPPLIES I/P (CO2353092 S IMP CLICK'X LOW PRO $3,336.00 23 SURGICAL SUPPLIES I/P (CO2353100 S IMP CLICK'X ROD SOFT $850.00 23 SURGICAL SUPPLIES I/P (CO2353118 S IMP CLICK'X ROD SOFT $422.00 23 SURGICAL SUPPLIES I/P (CO2353126 S IMP CLICK'X ROD SOFT $637.00 23 SURGICAL SUPPLIES I/P (CO2353134 S IMP CLICK'X ROD SOFT $834.00 23 SURGICAL SUPPLIES I/P (CO2353142 S IMP CLICK'X SCREW $2,029.50 23 SURGICAL SUPPLIES I/P (CO2353159 S IMP CLICK'X SCREW $1,969.00 23 SURGICAL SUPPLIES I/P (CO2352839 S IMP CONN ROD PARALLEL $2,473.00 23 SURGICAL SUPPLIES I/P (CO2352821 S IMP CONN ROD PARL TIT $1,888.25 23 SURGICAL SUPPLIES I/P (CO2353324 S IMP CROSSLINK PLT SCREW $576.50 23 SURGICAL SUPPLIES I/P (CO2322832 S IMP CSLP 2-LEVEL PLT $2,980.25 $2,301.00 23 SURGICAL SUPPLIES I/P (CO2322840 S IMP CSLP 3-LEVEL PLT $3,121.50 $3,121.50 23 SURGICAL SUPPLIES I/P (CO2352771 S IMP CSLP 4-LEVEL PLT $3,373.50 23 SURGICAL SUPPLIES I/P (CO2341519 S IMP CSLP LOCKING SCREW $95.00 $121.00 23 SURGICAL SUPPLIES I/P (CO2322824 S IMP CSLP ONE-LEVEL P $2,957.75 $2,055.00 23 SURGICAL SUPPLIES I/P (CO2322865 S IMP CSLP SCREW EXPAN $765.00 $718.00 23 SURGICAL SUPPLIES I/P (CO2353076 S IMP CSLP SCREW EXPAN $765.00 23 SURGICAL SUPPLIES I/P (CO2322873 S IMP CSLP SCREW EXPAN $765.00 $1,003.75 23 SURGICAL SUPPLIES I/P (CO2353084 S IMP CSLP SCREW EXPAN $963.00 23 SURGICAL SUPPLIES I/P (CO2353043 S IMP CSLP SM STAT ONE $2,731.75 23 SURGICAL SUPPLIES I/P (CO2353068 S IMP CSLP SM STAT THR $2,970.25 23 SURGICAL SUPPLIES I/P (CO2353050 S IMP CSLP SM STAT TWO $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353019 S IMP CSLP VA 1-LEVEL PLT $2,731.25 23 SURGICAL SUPPLIES I/P (CO2353027 S IMP CSLP VA 2-LEVEL PLT $2,800.00 23 SURGICAL SUPPLIES I/P (CO2353035 S IMP CSLP VA 3-LEVEL PLT $3,216.00 23 SURGICAL SUPPLIES I/P (CO2368157 S IMP END CAP $885.00 23 SURGICAL SUPPLIES I/P (CO2364289 S IMP END CAP F/TROCH NAI $661.50 23 SURGICAL SUPPLIES I/P (CO2326411 S IMP EXPANDER TISS $3,371.00 23 SURGICAL SUPPLIES I/P (CO2326007 S IMP FEM CROSS SECTION $2,345.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2320885 S IMP GRAFT KNIT VELOU $2,206.00 $2,081.00 23 SURGICAL SUPPLIES I/P (CO2320893 S IMP GRAFT KNIT VELOU $1,602.00 $1,512.00 23 SURGICAL SUPPLIES I/P (CO2322345 S IMP GRAFT VASCULAR 23 SURGICAL SUPPLIES I/P (CO2322451 S IMP HEMASHIELD PATCH GR $646.00 $610.00 23 SURGICAL SUPPLIES I/P (CO2344067 S IMP HIP TOTAL APEX HOLE $671.50 23 SURGICAL SUPPLIES I/P (CO2344059 S IMP HIP TOTAL DYNAMIC L $1,037.00 23 SURGICAL SUPPLIES I/P (CO2343184 S IMP HIP TOTAL FEM ACET $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343424 S IMP HIP TOTAL FEM ACET $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343358 S IMP HIP TOTAL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343366 S IMP HIP TOTAL FEM ACET $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343275 S IMP HIP TOTAL FEM ACET $6,320.00 23 SURGICAL SUPPLIES I/P (CO2343382 S IMP HIP TOTAL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343416 S IMP HIP TOTAL FEM ACET $3,792.00 23 SURGICAL SUPPLIES I/P (CO2340107 S IMP HIP TOTAL FEM ACET $3,343.00 $3,154.00 23 SURGICAL SUPPLIES I/P (CO2343341 S IMP HIP TOTAL FEM ACET $2,556.00 23 SURGICAL SUPPLIES I/P (CO2340099 S IMP HIP TOTAL FEM ACET $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2340115 S IMP HIP TOTAL FEM ACET $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2343226 S IMP HIP TOTAL FEM ACET $4,916.00 23 SURGICAL SUPPLIES I/P (CO2343242 S IMP HIP TOTAL FEM ACET $5,478.00 23 SURGICAL SUPPLIES I/P (CO2343283 S IMP HIP TOTAL FEM ACET $6,601.00 23 SURGICAL SUPPLIES I/P (CO2343390 S IMP HIP TOTAL FEM ACET $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343135 S IMP HIP TOTAL FEM ACET $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343218 S IMP HIP TOTAL FEM ACET $4,635.00 23 SURGICAL SUPPLIES I/P (CO2340172 S IMP HIP TOTAL FEM BIPOL $1,672.00 $1,577.00 23 SURGICAL SUPPLIES I/P (CO2340180 S IMP HIP TOTAL FEM BIPOL $2,149.00 $2,028.00 23 SURGICAL SUPPLIES I/P (CO2340198 S IMP HIP TOTAL FEM BIPOL $2,163.00 $2,041.00 23 SURGICAL SUPPLIES I/P (CO2340206 S IMP HIP TOTAL FEM BIPOL $2,556.00 $2,412.00 23 SURGICAL SUPPLIES I/P (CO2340214 S IMP HIP TOTAL FEM BIPOL $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2343614 S IMP HIP TOTAL FEM BIPOL $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343622 S IMP HIP TOTAL FEM BIPOL $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343630 S IMP HIP TOTAL FEM BIPOL $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343606 S IMP HIP TOTAL FEM CENTR $358.00 23 SURGICAL SUPPLIES I/P (CO2343598 S IMP HIP TOTAL FEM CENTR $200.00 23 SURGICAL SUPPLIES I/P (CO2343556 S IMP HIP TOTAL FEM HE $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343440 S IMP HIP TOTAL FEM HE $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343549 S IMP HIP TOTAL FEM HE $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343473 S IMP HIP TOTAL FEM HE $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343515 S IMP HIP TOTAL FEM HE $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343564 S IMP HIP TOTAL FEM HE $4,916.00 23 SURGICAL SUPPLIES I/P (CO2343523 S IMP HIP TOTAL FEM HE $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343465 S IMP HIP TOTAL FEM HEAD $2,556.00 23 SURGICAL SUPPLIES I/P (CO2340271 S IMP HIP TOTAL FEM HEAD $1,194.00 $1,127.00 23 SURGICAL SUPPLIES I/P (CO2343481 S IMP HIP TOTAL FEM HEAD $3,343.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2343572 S IMP HIP TOTAL FEM HEAD $5,197.00 23 SURGICAL SUPPLIES I/P (CO2340289 S IMP HIP TOTAL FEM HEAD $1,672.00 $1,577.00 23 SURGICAL SUPPLIES I/P (CO2340313 S IMP HIP TOTAL FEM HEAD $3,736.00 $3,525.00 23 SURGICAL SUPPLIES I/P (CO2343507 S IMP HIP TOTAL FEM HEAD $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343457 S IMP HIP TOTAL FEM HEAD $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343499 S IMP HIP TOTAL FEM HEAD $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343531 S IMP HIP TOTAL FEM HEAD $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343580 S IMP HIP TOTAL FEM HEAD $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342970 S IMP HIP TOTAL FEM ST $8,287.00 23 SURGICAL SUPPLIES I/P (CO2342863 S IMP HIP TOTAL FEM ST $5,197.00 23 SURGICAL SUPPLIES I/P (CO2342772 S IMP HIP TOTAL FEM ST $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342814 S IMP HIP TOTAL FEM ST $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342731 S IMP HIP TOTAL FEM ST $2,163.00 23 SURGICAL SUPPLIES I/P (CO2342749 S IMP HIP TOTAL FEM ST $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342848 S IMP HIP TOTAL FEM ST $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343069 S IMP HIP TOTAL FEM ST $10,815.00 23 SURGICAL SUPPLIES I/P (CO2343077 S IMP HIP TOTAL FEM ST $11,096.00 23 SURGICAL SUPPLIES I/P (CO2343101 S IMP HIP TOTAL FEM ST $11,938.00 23 SURGICAL SUPPLIES I/P (CO2342954 S IMP HIP TOTAL FEM STEM $7,725.00 23 SURGICAL SUPPLIES I/P (CO2343002 S IMP HIP TOTAL FEM STEM $9,129.00 23 SURGICAL SUPPLIES I/P (CO2342830 S IMP HIP TOTAL FEM STEM $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342913 S IMP HIP TOTAL FEM STEM $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342897 S IMP HIP TOTAL FEM STEM $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342939 S IMP HIP TOTAL FEM STEM $7,163.00 23 SURGICAL SUPPLIES I/P (CO2342905 S IMP HIP TOTAL FEM STEM $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342988 S IMP HIP TOTAL FEM STEM $8,567.00 23 SURGICAL SUPPLIES I/P (CO2342780 S IMP HIP TOTAL FEM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342798 S IMP HIP TOTAL FEM STEM $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342871 S IMP HIP TOTAL FEM STEM $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342889 S IMP HIP TOTAL FEM STEM $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342962 S IMP HIP TOTAL FEM STEM $8,006.00 23 SURGICAL SUPPLIES I/P (CO2342723 S IMP HIP TOTAL FEM STEM $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342715 S IMP HIP TOTAL FEM STEM $1,672.00 23 SURGICAL SUPPLIES I/P (CO2343036 S IMP HIP TOTAL FEM STEM $9,972.00 23 SURGICAL SUPPLIES I/P (CO2342756 S IMP HIP TOTAL FEM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342764 S IMP HIP TOTAL FEM STEM $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342806 S IMP HIP TOTAL FEM STEM $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342822 S IMP HIP TOTAL FEM STEM $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342855 S IMP HIP TOTAL FEM STEM $4,916.00 23 SURGICAL SUPPLIES I/P (CO2342921 S IMP HIP TOTAL FEM STEM $6,882.00 23 SURGICAL SUPPLIES I/P (CO2342947 S IMP HIP TOTAL FEM STEM $7,444.00 23 SURGICAL SUPPLIES I/P (CO2342996 S IMP HIP TOTAL FEM STEM $8,848.00 23 SURGICAL SUPPLIES I/P (CO2343028 S IMP HIP TOTAL FEM STEM $9,691.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2343044 S IMP HIP TOTAL FEM STEM $10,253.00 23 SURGICAL SUPPLIES I/P (CO2343051 S IMP HIP TOTAL FEM STEM $10,534.00 23 SURGICAL SUPPLIES I/P (CO2343085 S IMP HIP TOTAL FEM STEM $11,376.00 23 SURGICAL SUPPLIES I/P (CO2343093 S IMP HIP TOTAL FEM STEM $11,657.00 23 SURGICAL SUPPLIES I/P (CO2343119 S IMP HIP TOTAL FEM STEM $12,219.00 23 SURGICAL SUPPLIES I/P (CO2343127 S IMP HIP TOTAL FEM STEM $12,500.00 23 SURGICAL SUPPLIES I/P (CO2343010 S IMP HIP TOTAL FEM STEM $9,410.00 23 SURGICAL SUPPLIES I/P (CO2343150 S IMP HIP TTL FEM ACET $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343374 S IMP HIP TTL FEM ACET $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343200 S IMP HIP TTL FEM ACET $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343408 S IMP HIP TTL FEM ACET $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343192 S IMP HIP TTL FEM ACET $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343168 S IMP HIP TTL FEM ACET $3,230.00 23 SURGICAL SUPPLIES I/P (CO2343432 S IMP HIP TTL FEM ACET $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343291 S IMP HIP TTL FEM ACET $6,882.00 23 SURGICAL SUPPLIES I/P (CO2343309 S IMP HIP TTL FEM ACET $1,194.00 23 SURGICAL SUPPLIES I/P (CO2343234 S IMP HIP TTL FEM ACET $5,197.00 23 SURGICAL SUPPLIES I/P (CO2343176 S IMP HIP TTL FEM ACET $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343259 S IMP HIP TTL FEM ACET $5,758.00 23 SURGICAL SUPPLIES I/P (CO2343267 S IMP HIP TTL FEM ACET $6,039.00 23 SURGICAL SUPPLIES I/P (CO2343317 S IMP HIP TTL FEM ACET $1,672.00 23 SURGICAL SUPPLIES I/P (CO2343325 S IMP HIP TTL FEM ACET $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343333 S IMP HIP TTL FEM ACET $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343143 S IMP HIP TTL FEM ACET $2,556.00 23 SURGICAL SUPPLIES I/P (CO2340123 S IMP HIP,TOTAL ACETAB $1,707.00 $1,610.00 23 SURGICAL SUPPLIES I/P (CO2352847 S IMP HOOK TIT CERVIFIX $2,123.50 23 SURGICAL SUPPLIES I/P (CO2363349 S IMP H-PLT SYN EXT $990.50 23 SURGICAL SUPPLIES I/P (CO2321206 S IMP IMP 0-50 $134.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2321214 S IMP IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2321222 S IMP IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2321230 S IMP IMP 1101-1200 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2321248 S IMP IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2321255 S IMP IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2321263 S IMP IMP 1401-1500 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2321271 S IMP IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2321289 S IMP IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2321297 S IMP IMP 1601-1700 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2321305 S IMP IMP 1701-1800 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2321313 S IMP IMP 1801-1900 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2321321 S IMP IMP 1901-2000 $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2321339 S IMP IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2321347 S IMP IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2321354 S IMP IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2321362 S IMP IMP 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2321370 S IMP IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2321388 S IMP IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2321396 S IMP IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2321404 S IMP IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2321412 S IMP IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2321420 S IMP IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2321438 S IMP IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2321446 S IMP IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2321453 S IMP IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2321461 S IMP IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2321479 S IMP IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2321487 S IMP IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2321495 S IMP IMP 951-1000 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2363836 S IMP IMP BIO-TRANS PLLA $1,228.25 23 SURGICAL SUPPLIES I/P (CO2321149 S IMP IMP CAUSSE TEF PIST $283.00 $283.00 23 SURGICAL SUPPLIES I/P (CO2390649 S IMP IMP EAR MCGEE $476.50 $746.50 23 SURGICAL SUPPLIES I/P (CO2321180 S IMP IMP HAPEX $1,320.25 $1,320.25 23 SURGICAL SUPPLIES I/P (CO2321172 S IMP IMP HAPEX CENTERED $1,320.25 $1,320.25 23 SURGICAL SUPPLIES I/P (CO2362937 S IMP IMP TRANSFIX ARTHRE $671.50 23 SURGICAL SUPPLIES I/P (CO2321727 S IMP IMP WEHRS INCUS DBL $1,200.50 $1,200.50 23 SURGICAL SUPPLIES I/P (CO2380756 S IMP IMP, COLLAGEN (W/SY $1,671.00 $1,576.00 23 SURGICAL SUPPLIES I/P (CO2321610 S IMP IMP, GREAT SILASTIC $872.00 $823.00 23 SURGICAL SUPPLIES I/P (CO2321735 S IMP IMPLANT, WRIST J $2,278.00 $2,149.00 23 SURGICAL SUPPLIES I/P (CO2321529 S IMP IMPLNT,WEHRS INC $1,208.00 $1,208.00 23 SURGICAL SUPPLIES I/P (CO2363695 S IMP INTERMED HTO PLT $3,350.00 23 SURGICAL SUPPLIES I/P (CO2340495 S IMP JOINT IMP 0-50 $134.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2340503 S IMP JOINT IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2340511 S IMP JOINT IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2340537 S IMP JOINT IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2340545 S IMP JOINT IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2340560 S IMP JOINT IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2340578 S IMP JOINT IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2340586 S IMP JOINT IMP 1601-1700 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2340602 S IMP JOINT IMP 1801-1900 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2340610 S IMP JOINT IMP 1901-2000 $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2340628 S IMP JOINT IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2340701 S IMP JOINT IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2340719 S IMP JOINT IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2340727 S IMP JOINT IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2340735 S IMP JOINT IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2340743 S IMP JOINT IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2340750 S IMP JOINT IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2340768 S IMP JOINT IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2340776 S IMP JOINT IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2340784 S IMP JOINT IMP 951-1000 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2340529 S IMP JOINT IMPLANT 11 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2340552 S IMP JOINT IMPLANT 14 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2340594 S IMP JOINT IMPLANT 17 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2340636 S IMP JOINT IMPLANT 25 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2340644 S IMP JOINT IMPLANT 30 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2340651 S IMP JOINT IMPLANT 35 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2340669 S IMP JOINT IMPLANT 40 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2340677 S IMP JOINT IMPLANT 45 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2340685 S IMP JOINT IMPLANT 50 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2340693 S IMP JOINT IMPLANT 51 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2342293 S IMP KNEE TOTAL FEM C $9,410.00 23 SURGICAL SUPPLIES I/P (CO2342061 S IMP KNEE TOTAL FEM C $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342251 S IMP KNEE TOTAL FEM C $8,287.00 23 SURGICAL SUPPLIES I/P (CO2342277 S IMP KNEE TOTAL FEM C $8,848.00 23 SURGICAL SUPPLIES I/P (CO2342129 S IMP KNEE TOTAL FEM COMP $4,635.00 23 SURGICAL SUPPLIES I/P (CO2342178 S IMP KNEE TOTAL FEM COMP $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342210 S IMP KNEE TOTAL FEM COMP $7,163.00 23 SURGICAL SUPPLIES I/P (CO2342194 S IMP KNEE TOTAL FEM COMP $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342095 S IMP KNEE TOTAL FEM COMP $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342202 S IMP KNEE TOTAL FEM COMP $6,882.00 23 SURGICAL SUPPLIES I/P (CO2342152 S IMP KNEE TOTAL FEM COMP $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342186 S IMP KNEE TOTAL FEM COMP $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342160 S IMP KNEE TOTAL FEM COMP $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342103 S IMP KNEE TOTAL FEM COMP $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342111 S IMP KNEE TOTAL FEM COMP $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342285 S IMP KNEE TOTAL FEM COMP $9,129.00 23 SURGICAL SUPPLIES I/P (CO2342301 S IMP KNEE TOTAL FEM COMP $9,691.00 23 SURGICAL SUPPLIES I/P (CO2342079 S IMP KNEE TOTAL FEM COMP $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342087 S IMP KNEE TOTAL FEM COMP $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342137 S IMP KNEE TOTAL FEM COMP $4,916.00 23 SURGICAL SUPPLIES I/P (CO2342145 S IMP KNEE TOTAL FEM COMP $5,197.00 23 SURGICAL SUPPLIES I/P (CO2342228 S IMP KNEE TOTAL FEM COMP $7,444.00 23 SURGICAL SUPPLIES I/P (CO2342236 S IMP KNEE TOTAL FEM COMP $7,725.00 23 SURGICAL SUPPLIES I/P (CO2342244 S IMP KNEE TOTAL FEM COMP $8,006.00 23 SURGICAL SUPPLIES I/P (CO2342269 S IMP KNEE TOTAL FEM COMP $8,567.00 23 SURGICAL SUPPLIES I/P (CO2344174 S IMP KNEE TOTAL FEM UNIC $5,604.00 23 SURGICAL SUPPLIES I/P (CO2342590 S IMP KNEE TOTAL PAT C $1,672.00 23 SURGICAL SUPPLIES I/P (CO2342608 S IMP KNEE TOTAL PAT C $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342707 S IMP KNEE TOTAL PAT C $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342616 S IMP KNEE TOTAL PAT COMP $2,163.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2342673 S IMP KNEE TOTAL PAT COMP $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342640 S IMP KNEE TOTAL PAT COMP $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342657 S IMP KNEE TOTAL PAT COMP $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342624 S IMP KNEE TOTAL PAT COMP $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342632 S IMP KNEE TOTAL PAT COMP $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342665 S IMP KNEE TOTAL PAT COMP $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342681 S IMP KNEE TOTAL PAT COMP $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342699 S IMP KNEE TOTAL PAT COMP $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342558 S IMP KNEE TOTAL TIB ALL $2,556.00 23 SURGICAL SUPPLIES I/P (CO2342541 S IMP KNEE TOTAL TIB ALL $2,163.00 23 SURGICAL SUPPLIES I/P (CO2342566 S IMP KNEE TOTAL TIB ALL $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342574 S IMP KNEE TOTAL TIB ALL $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342582 S IMP KNEE TOTAL TIB ALL $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342533 S IMP KNEE TOTAL TIB ALL $2,149.00 23 SURGICAL SUPPLIES I/P (CO2342343 S IMP KNEE TOTAL TIB I $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342335 S IMP KNEE TOTAL TIB INSE $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342327 S IMP KNEE TOTAL TIB INSE $2,949.00 23 SURGICAL SUPPLIES I/P (CO2341147 S IMP KNEE TOTAL TIB INSE $2,556.00 $2,412.00 23 SURGICAL SUPPLIES I/P (CO2341162 S IMP KNEE TOTAL TIB INSE $3,343.00 $3,154.00 23 SURGICAL SUPPLIES I/P (CO2342319 S IMP KNEE TOTAL TIB INSE $3,736.00 23 SURGICAL SUPPLIES I/P (CO2341154 S IMP KNEE TOTAL TIB INSE $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2342368 S IMP KNEE TOTAL TIB INSE $4,073.00 23 SURGICAL SUPPLIES I/P (CO2342350 S IMP KNEE TOTAL TIB INSE $3,792.00 23 SURGICAL SUPPLIES I/P (CO2341139 S IMP KNEE TOTAL TIB INSE $2,163.00 $2,041.00 23 SURGICAL SUPPLIES I/P (CO2341121 S IMP KNEE TOTAL TIB INSE $2,149.00 $2,028.00 23 SURGICAL SUPPLIES I/P (CO2342400 S IMP KNEE TOTAL TIB P $3,230.00 23 SURGICAL SUPPLIES I/P (CO2342418 S IMP KNEE TOTAL TIB P $3,511.00 23 SURGICAL SUPPLIES I/P (CO2342392 S IMP KNEE TOTAL TIB PLT $2,949.00 23 SURGICAL SUPPLIES I/P (CO2342434 S IMP KNEE TOTAL TIB PLT $4,354.00 23 SURGICAL SUPPLIES I/P (CO2342384 S IMP KNEE TOTAL TIB PLT $3,736.00 23 SURGICAL SUPPLIES I/P (CO2342442 S IMP KNEE TOTAL TIB PLT $4,635.00 23 SURGICAL SUPPLIES I/P (CO2342467 S IMP KNEE TOTAL TIB PLT $5,197.00 23 SURGICAL SUPPLIES I/P (CO2341113 S IMP KNEE TOTAL TIB PLT $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2342509 S IMP KNEE TOTAL TIB PLT $6,320.00 23 SURGICAL SUPPLIES I/P (CO2342459 S IMP KNEE TOTAL TIB PLT $4,916.00 23 SURGICAL SUPPLIES I/P (CO2342376 S IMP KNEE TOTAL TIB PLT $3,343.00 23 SURGICAL SUPPLIES I/P (CO2342426 S IMP KNEE TOTAL TIB PLT $3,792.00 23 SURGICAL SUPPLIES I/P (CO2342475 S IMP KNEE TOTAL TIB PLT $5,478.00 23 SURGICAL SUPPLIES I/P (CO2342483 S IMP KNEE TOTAL TIB PLT $5,758.00 23 SURGICAL SUPPLIES I/P (CO2342491 S IMP KNEE TOTAL TIB PLT $6,039.00 23 SURGICAL SUPPLIES I/P (CO2342517 S IMP KNEE TOTAL TIB PLT $6,601.00 23 SURGICAL SUPPLIES I/P (CO2342525 S IMP KNEE TOTAL TIB PLT $6,882.00 23 SURGICAL SUPPLIES I/P (CO2344182 S IMP KNEE TOTAL TIB UNIC $3,913.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2344158 S IMP KNEE TTL DIST/PROX $2,785.00 23 SURGICAL SUPPLIES I/P (CO2344141 S IMP KNEE TTL FEM STEM $954.75 23 SURGICAL SUPPLIES I/P (CO2344166 S IMP KNEE TTL TIB FLUTED $3,342.00 23 SURGICAL SUPPLIES I/P (CO2363406 S IMP K-WIRE SYN TIT $63.25 23 SURGICAL SUPPLIES I/P (CO2363398 S IMP K-WIRE SYN W/TROCAR $50.00 23 SURGICAL SUPPLIES I/P (CO2350833 S IMP K-WIRE, ACE $121.00 $121.00 23 SURGICAL SUPPLIES I/P (CO2330314 S IMP LEAD ADAPTER $1,194.00 23 SURGICAL SUPPLIES I/P (CO2330306 S IMP LEAD END CAP $267.00 23 SURGICAL SUPPLIES I/P (CO2321818 S IMP MATCH STICKS $1,275.00 $901.00 23 SURGICAL SUPPLIES I/P (CO2321875 S IMP MESH TRELEX 10X14" $1,051.00 $991.00 23 SURGICAL SUPPLIES I/P (CO2367100 S IMP NAIL CANN FEM $3,270.00 23 SURGICAL SUPPLIES I/P (CO2367118 S IMP NAIL CANN TIB $3,165.00 23 SURGICAL SUPPLIES I/P (CO2367258 S IMP NAIL ELASTIC $1,237.25 23 SURGICAL SUPPLIES I/P (CO2360477 S IMP NAIL TIBIA ALPHUTEC $624.00 $589.00 23 SURGICAL SUPPLIES I/P (CO2360493 S IMP ORTHO IMP 0-50 $134.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2360501 S IMP ORTHO IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2360519 S IMP ORTHO IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2360527 S IMP ORTHO IMP 1101-1200 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2360535 S IMP ORTHO IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO2360543 S IMP ORTHO IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2360550 S IMP ORTHO IMP 1401-1500 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2360568 S IMP ORTHO IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2360576 S IMP ORTHO IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2360584 S IMP ORTHO IMP 1601-1700 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2360592 S IMP ORTHO IMP 1701-1800 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2360600 S IMP ORTHO IMP 1801-1900 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2360618 S IMP ORTHO IMP 1901-2000 $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2360626 S IMP ORTHO IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2360634 S IMP ORTHO IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2360642 S IMP ORTHO IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2360659 S IMP ORTHO IMP 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2360667 S IMP ORTHO IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2360675 S IMP ORTHO IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2360683 S IMP ORTHO IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2360691 S IMP ORTHO IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2360709 S IMP ORTHO IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2360717 S IMP ORTHO IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2360725 S IMP ORTHO IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2360733 S IMP ORTHO IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2360741 S IMP ORTHO IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2360758 S IMP ORTHO IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2360766 S IMP ORTHO IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2360774 S IMP ORTHO IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2360782 S IMP ORTHO IMPLANT 95 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2363570 S IMP PANEL KINAMED $1,542.00 23 SURGICAL SUPPLIES I/P (CO2363562 S IMP PANEL KINAMED $771.00 23 SURGICAL SUPPLIES I/P (CO2364065 S IMP PANEL LACTOSORB 50 $2,635.50 23 SURGICAL SUPPLIES I/P (CO2325975 S IMP PATCH HEMACAROTID U $383.25 23 SURGICAL SUPPLIES I/P (CO2326015 S IMP PATELLA TEND W/QUAD $10,138.00 23 SURGICAL SUPPLIES I/P (CO2360956 S IMP PIN ACE STEINMAN $84.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2360824 S IMP PIN HEWSON $118.75 $118.75 23 SURGICAL SUPPLIES I/P (CO2331064 S IMP PIN PLUG PCMKR $478.00 23 SURGICAL SUPPLIES I/P (CO2360915 S IMP PIN RUSH MEDULLARY $368.00 $338.25 23 SURGICAL SUPPLIES I/P (CO2360907 S IMP PIN RUSH MEDULLARY $480.75 $444.25 23 SURGICAL SUPPLIES I/P (CO2360899 S IMP PIN RUSH MEDULLARY $447.50 $414.50 23 SURGICAL SUPPLIES I/P (CO2360949 S IMP PIN STNMAN THREADED $127.50 $127.50 23 SURGICAL SUPPLIES I/P (CO2363364 S IMP PIN SYN BUTTRESS $261.25 23 SURGICAL SUPPLIES I/P (CO2367860 S IMP PLATE $803.25 23 SURGICAL SUPPLIES I/P (CO2367407 S IMP PLATE $4,091.00 23 SURGICAL SUPPLIES I/P (CO2367894 S IMP PLATE $788.00 23 SURGICAL SUPPLIES I/P (CO2367696 S IMP PLATE $2,100.00 23 SURGICAL SUPPLIES I/P (CO2367753 S IMP PLATE $988.25 23 SURGICAL SUPPLIES I/P (CO2367332 S IMP PLATE $1,029.00 23 SURGICAL SUPPLIES I/P (CO2367324 S IMP PLATE $590.25 23 SURGICAL SUPPLIES I/P (CO2367357 S IMP PLATE $1,557.00 23 SURGICAL SUPPLIES I/P (CO2367928 S IMP PLATE $703.75 23 SURGICAL SUPPLIES I/P (CO2367340 S IMP PLATE $1,555.25 23 SURGICAL SUPPLIES I/P (CO2367910 S IMP PLATE $635.00 23 SURGICAL SUPPLIES I/P (CO2367746 S IMP PLATE $2,969.00 23 SURGICAL SUPPLIES I/P (CO2367852 S IMP PLATE $612.00 23 SURGICAL SUPPLIES I/P (CO2367761 S IMP PLATE $1,105.00 23 SURGICAL SUPPLIES I/P (CO2367779 S IMP PLATE $1,232.50 23 SURGICAL SUPPLIES I/P (CO2367902 S IMP PLATE $884.00 23 SURGICAL SUPPLIES I/P (CO2367803 S IMP PLATE $201.00 23 SURGICAL SUPPLIES I/P (CO2367811 S IMP PLATE $313.75 23 SURGICAL SUPPLIES I/P (CO2367829 S IMP PLATE $386.50 23 SURGICAL SUPPLIES I/P (CO2367845 S IMP PLATE $612.00 23 SURGICAL SUPPLIES I/P (CO2367720 S IMP PLATE $1,881.00 23 SURGICAL SUPPLIES I/P (CO2367399 S IMP PLATE $3,620.00 23 SURGICAL SUPPLIES I/P (CO2367837 S IMP PLATE $971.50 23 SURGICAL SUPPLIES I/P (CO2367738 S IMP PLATE $2,258.00 23 SURGICAL SUPPLIES I/P (CO2367704 S IMP PLATE $2,660.00 23 SURGICAL SUPPLIES I/P (CO2367712 S IMP PLATE $1,966.00 23 SURGICAL SUPPLIES I/P (CO2367878 S IMP PLATE $803.25 23 SURGICAL SUPPLIES I/P (CO2367985 S IMP PLATE $680.75 23 SURGICAL SUPPLIES I/P (CO2367936 S IMP PLATE $1,302.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2367944 S IMP PLATE $3,110.00 23 SURGICAL SUPPLIES I/P (CO2367969 S IMP PLATE $214.25 23 SURGICAL SUPPLIES I/P (CO2368009 S IMP PLATE $680.75 23 SURGICAL SUPPLIES I/P (CO2368025 S IMP PLATE $814.75 23 SURGICAL SUPPLIES I/P (CO2368041 S IMP PLATE $615.75 23 SURGICAL SUPPLIES I/P (CO2368058 S IMP PLATE $709.50 23 SURGICAL SUPPLIES I/P (CO2368066 S IMP PLATE $753.50 23 SURGICAL SUPPLIES I/P (CO2368017 S IMP PLATE $3,068.00 23 SURGICAL SUPPLIES I/P (CO2368033 S IMP PLATE $396.00 23 SURGICAL SUPPLIES I/P (CO2367951 S IMP PLATE $2,043.00 23 SURGICAL SUPPLIES I/P (CO2367977 S IMP PLATE $321.25 23 SURGICAL SUPPLIES I/P (CO2367993 S IMP PLATE $872.00 23 SURGICAL SUPPLIES I/P (CO2361343 S IMP PLATE ACE STR 3. $977.50 $977.50 23 SURGICAL SUPPLIES I/P (CO2364305 S IMP PLATE ADAPT LO PRO $946.50 23 SURGICAL SUPPLIES I/P (CO2364313 S IMP PLATE ADAPT LO PRO $1,163.00 23 SURGICAL SUPPLIES I/P (CO2364230 S IMP PLATE AMBI CLASSIC $1,442.75 23 SURGICAL SUPPLIES I/P (CO2361137 S IMP PLATE AMBISC 90D $1,960.50 $1,960.50 23 SURGICAL SUPPLIES I/P (CO2367183 S IMP PLATE BURR HOLE 2.0 $758.75 23 SURGICAL SUPPLIES I/P (CO2354710 S IMP PLATE CERV L1 $2,800.00 23 SURGICAL SUPPLIES I/P (CO2354728 S IMP PLATE CERV L2 $3,150.00 23 SURGICAL SUPPLIES I/P (CO2354736 S IMP PLATE CERV L3 $3,500.00 23 SURGICAL SUPPLIES I/P (CO2354744 S IMP PLATE CERV L4 $3,850.00 23 SURGICAL SUPPLIES I/P (CO2367142 S IMP PLATE COMPRESSION 2 $1,138.00 23 SURGICAL SUPPLIES I/P (CO2325066 S IMP PLATE CRANIAL BU $1,077.00 $920.75 23 SURGICAL SUPPLIES I/P (CO2367159 S IMP PLATE DBL Y 2.0MM $599.75 23 SURGICAL SUPPLIES I/P (CO2367217 S IMP PLATE DOG BONE $986.25 23 SURGICAL SUPPLIES I/P (CO2367126 S IMP PLATE FACIAL 16MM I $639.50 23 SURGICAL SUPPLIES I/P (CO2367282 S IMP PLATE L $248.50 23 SURGICAL SUPPLIES I/P (CO2367134 S IMP PLATE L 2.0MM EXTEN $968.25 23 SURGICAL SUPPLIES I/P (CO2324655 S IMP PLATE MAX.FAC OR $995.50 23 SURGICAL SUPPLIES I/P (CO2324630 S IMP PLATE MAX.FAC ST $2,056.00 23 SURGICAL SUPPLIES I/P (CO2324846 S IMP PLATE MAX.FAC T, $927.50 23 SURGICAL SUPPLIES I/P (CO2325041 S IMP PLATE MAX.FAC X, $1,003.75 23 SURGICAL SUPPLIES I/P (CO2325025 S IMP PLATE MAX.FAC Y, $1,003.75 23 SURGICAL SUPPLIES I/P (CO2325132 S IMP PLATE MAXILLOFAC $2,066.00 23 SURGICAL SUPPLIES I/P (CO2325173 S IMP PLATE MAXILLOFAC $3,420.00 23 SURGICAL SUPPLIES I/P (CO2324671 S IMP PLATE MAXILLOFAC $897.50 23 SURGICAL SUPPLIES I/P (CO2324697 S IMP PLATE MAXILLOFAC $901.75 23 SURGICAL SUPPLIES I/P (CO2367209 S IMP PLATE PRE-BENT 1.6M $1,156.00 23 SURGICAL SUPPLIES I/P (CO2367308 S IMP PLATE STR $257.75 23 SURGICAL SUPPLIES I/P (CO2363182 S IMP PLATE SYN BRD LC $1,274.75 23 SURGICAL SUPPLIES I/P (CO2363299 S IMP PLATE SYN CONDYL $1,217.00 23 SURGICAL SUPPLIES I/P (CO2363166 S IMP PLATE SYN LC-DCP $666.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2364180 S IMP PLATE SYN LCP 1/3 T $744.00 23 SURGICAL SUPPLIES I/P (CO2364131 S IMP PLATE SYN RECON 11 $1,840.50 23 SURGICAL SUPPLIES I/P (CO2364149 S IMP PLATE SYN RECON 15 $1,895.00 23 SURGICAL SUPPLIES I/P (CO2364115 S IMP PLATE SYN RECON 3 $1,571.00 23 SURGICAL SUPPLIES I/P (CO2364123 S IMP PLATE SYN RECON 7 $1,881.75 23 SURGICAL SUPPLIES I/P (CO2363158 S IMP PLATE SYN SEMI-T $338.50 23 SURGICAL SUPPLIES I/P (CO2364198 S IMP PLATE SYNTHES LCP 3 $1,617.50 23 SURGICAL SUPPLIES I/P (CO2352763 S IMP PLATE SYNTHES LO $2,324.00 23 SURGICAL SUPPLIES I/P (CO2364172 S IMP PLATE SYNTHES RECON $2,021.00 23 SURGICAL SUPPLIES I/P (CO2367290 S IMP PLATE T $248.50 23 SURGICAL SUPPLIES I/P (CO2367274 S IMP PLATE TUBULAR $394.25 23 SURGICAL SUPPLIES I/P (CO2367191 S IMP PLATE X 1.2MM $686.25 23 SURGICAL SUPPLIES I/P (CO2361582 S IMP PLATE, FACIAL MI $1,001.25 $1,013.75 23 SURGICAL SUPPLIES I/P (CO2361574 S IMP PLATE, FACIAL MI $690.00 $646.50 23 SURGICAL SUPPLIES I/P (CO2361483 S IMP PLATE,ALPHATEC L $1,093.00 $1,031.00 23 SURGICAL SUPPLIES I/P (CO2361509 S IMP PLATE,ANT CERVIC $2,084.00 $1,966.00 23 SURGICAL SUPPLIES I/P (CO2361665 S IMP PLATE,FACE MINI $612.25 $573.75 23 SURGICAL SUPPLIES I/P (CO2363984 S IMP PLT FIBULA COMP $655.00 23 SURGICAL SUPPLIES I/P (CO2361350 S IMP PLT ACE STR $658.75 $658.75 23 SURGICAL SUPPLIES I/P (CO2361129 S IMP PLT AMBI $1,795.50 $1,795.50 23 SURGICAL SUPPLIES I/P (CO2361103 S IMP PLT AMBI $1,329.50 $1,329.50 23 SURGICAL SUPPLIES I/P (CO2361145 S IMP PLT AMBI $1,838.50 $1,838.50 23 SURGICAL SUPPLIES I/P (CO2361095 S IMP PLT AMBI ALL DEGREE $1,939.50 $1,939.50 23 SURGICAL SUPPLIES I/P (CO2361087 S IMP PLT AMBI ALL DEGREE $2,098.75 $2,098.75 23 SURGICAL SUPPLIES I/P (CO2361111 S IMP PLT AMBI ALL DEGREE $1,448.50 $1,448.50 23 SURGICAL SUPPLIES I/P (CO2363554 S IMP PLT BOX KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2363505 S IMP PLT BURR HOLE $365.00 23 SURGICAL SUPPLIES I/P (CO2363943 S IMP PLT CALCANEAL $1,764.00 23 SURGICAL SUPPLIES I/P (CO2324895 S IMP PLT CRANI BOX 1.3 $1,014.00 23 SURGICAL SUPPLIES I/P (CO2324762 S IMP PLT CRANI STR $204.00 23 SURGICAL SUPPLIES I/P (CO2324770 S IMP PLT CRANI STR $261.00 23 SURGICAL SUPPLIES I/P (CO2324853 S IMP PLT CRANI STRUT $1,801.00 23 SURGICAL SUPPLIES I/P (CO2324861 S IMP PLT CRANI X-1.3 $1,036.25 23 SURGICAL SUPPLIES I/P (CO2324812 S IMP PLT CRANI Y X 1.3 $1,036.25 23 SURGICAL SUPPLIES I/P (CO2363927 S IMP PLT DEPUY AC 3.5 $542.00 23 SURGICAL SUPPLIES I/P (CO2363950 S IMP PLT DEPUY META LG $1,262.25 23 SURGICAL SUPPLIES I/P (CO2363968 S IMP PLT DEPUY META SM $828.75 23 SURGICAL SUPPLIES I/P (CO2363935 S IMP PLT DEPUY SPIDER $340.00 23 SURGICAL SUPPLIES I/P (CO2363919 S IMP PLT DEPUY TUBLR $275.00 23 SURGICAL SUPPLIES I/P (CO2363216 S IMP PLT DHS BARREL $1,914.25 23 SURGICAL SUPPLIES I/P (CO2361541 S IMP PLT FACE CHIN $899.50 $822.50 23 SURGICAL SUPPLIES I/P (CO2361533 S IMP PLT FACE MAXI $975.50 $914.25 23 SURGICAL SUPPLIES I/P (CO2361707 S IMP PLT FACE MINI Y $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2363489 S IMP PLT FACE QUAD $785.50 23 SURGICAL SUPPLIES I/P (CO2363539 S IMP PLT H SHAPE KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2325090 S IMP PLT LC-DCP $1,051.00 23 SURGICAL SUPPLIES I/P (CO2363687 S IMP PLT LC-DCP STR $1,902.00 23 SURGICAL SUPPLIES I/P (CO2324952 S IMP PLT MAX.FAC ADAP $1,358.75 23 SURGICAL SUPPLIES I/P (CO2325082 S IMP PLT MAX.FAC COMP $1,534.00 23 SURGICAL SUPPLIES I/P (CO2324820 S IMP PLT MAX.FAC DBL Y $918.00 23 SURGICAL SUPPLIES I/P (CO2324663 S IMP PLT MAX.FAC ORBIT $2,616.00 23 SURGICAL SUPPLIES I/P (CO2324978 S IMP PLT MAX.FAC ORBITAL $1,252.50 23 SURGICAL SUPPLIES I/P (CO2324622 S IMP PLT MAX.FAC STRUT $1,832.00 23 SURGICAL SUPPLIES I/P (CO2325108 S IMP PLT MAXIL. LC-DCP $2,093.00 23 SURGICAL SUPPLIES I/P (CO2325116 S IMP PLT MAXILLO $2,066.00 23 SURGICAL SUPPLIES I/P (CO2325165 S IMP PLT MAXILLO ANGLED $3,168.00 23 SURGICAL SUPPLIES I/P (CO2325124 S IMP PLT MAXILLO LC-DCP $1,902.00 23 SURGICAL SUPPLIES I/P (CO2325140 S IMP PLT MAXILLO. STR $1,902.00 23 SURGICAL SUPPLIES I/P (CO2325157 S IMP PLT MAXILLO.STR FX $2,029.00 23 SURGICAL SUPPLIES I/P (CO2324986 S IMP PLT MAXILLOFACE $991.50 23 SURGICAL SUPPLIES I/P (CO2325009 S IMP PLT MAXILLOFACE $1,048.50 23 SURGICAL SUPPLIES I/P (CO2324648 S IMP PLT MAXILLOFACE $1,898.00 23 SURGICAL SUPPLIES I/P (CO2324721 S IMP PLT MAXILLOFACE $808.00 23 SURGICAL SUPPLIES I/P (CO2324754 S IMP PLT MAXILLOFACE $926.25 23 SURGICAL SUPPLIES I/P (CO2324796 S IMP PLT MAXILLOFACE $926.25 23 SURGICAL SUPPLIES I/P (CO2363976 S IMP PLT MEDIAL PILON $1,338.75 23 SURGICAL SUPPLIES I/P (CO2363513 S IMP PLT ST 2H 1.6MM $159.00 23 SURGICAL SUPPLIES I/P (CO2363521 S IMP PLT ST KINAMED $325.00 23 SURGICAL SUPPLIES I/P (CO2363190 S IMP PLT SYN 1/3 TUBLR $279.25 23 SURGICAL SUPPLIES I/P (CO2363224 S IMP PLT SYN 95DEG $2,518.00 23 SURGICAL SUPPLIES I/P (CO2363208 S IMP PLT SYN CLOVERLEAF $1,319.50 23 SURGICAL SUPPLIES I/P (CO2363307 S IMP PLT SYN L-BUTTRES $1,644.75 23 SURGICAL SUPPLIES I/P (CO2363232 S IMP PLT SYN LC-DCP TIT $1,103.25 23 SURGICAL SUPPLIES I/P (CO2363240 S IMP PLT SYN LC-DCP TIT $1,460.75 23 SURGICAL SUPPLIES I/P (CO2363174 S IMP PLT SYN NARROW $841.75 23 SURGICAL SUPPLIES I/P (CO2363257 S IMP PLT SYN STR TIT $822.50 23 SURGICAL SUPPLIES I/P (CO2363281 S IMP PLT SYN STR TIT $1,125.75 23 SURGICAL SUPPLIES I/P (CO2363265 S IMP PLT SYN STR TIT $946.75 23 SURGICAL SUPPLIES I/P (CO2363273 S IMP PLT SYN STR TIT $1,034.25 23 SURGICAL SUPPLIES I/P (CO2363547 S IMP PLT X SHAPE KINAMED $284.00 23 SURGICAL SUPPLIES I/P (CO2361384 S IMP PLT, ACE STR $845.75 $845.75 23 SURGICAL SUPPLIES I/P (CO2361376 S IMP PLT, ACE STR $786.25 $786.25 23 SURGICAL SUPPLIES I/P (CO2361368 S IMP PLT, ACE STR $714.00 $714.00 23 SURGICAL SUPPLIES I/P (CO2361335 S IMP PLT, ACE STR $913.75 $913.75 23 SURGICAL SUPPLIES I/P (CO2361392 S IMP PLT, ACE TUB $304.50 $304.50 23 SURGICAL SUPPLIES I/P (CO2361491 S IMP PLT, ANT CERVICAL $2,173.00 $2,050.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2361590 S IMP PLT, FACE MICRO $493.50 $493.50 23 SURGICAL SUPPLIES I/P (CO2361566 S IMP PLT, FACE MICRO $643.25 $658.25 23 SURGICAL SUPPLIES I/P (CO2361608 S IMP PLT, FACE MICRO H $668.25 $822.50 23 SURGICAL SUPPLIES I/P (CO2361632 S IMP PLT, FACE MICRO T $657.50 $646.50 23 SURGICAL SUPPLIES I/P (CO2361640 S IMP PLT, FACE MICRO Y $668.25 $627.25 23 SURGICAL SUPPLIES I/P (CO2361657 S IMP PLT, FACE MINI $805.50 $757.25 23 SURGICAL SUPPLIES I/P (CO2361681 S IMP PLT, FACE MINI $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO2361673 S IMP PLT, FACE MINI $1,282.50 $1,205.00 23 SURGICAL SUPPLIES I/P (CO2361699 S IMP PLT, FACE MINI L $625.00 $585.25 23 SURGICAL SUPPLIES I/P (CO2361749 S IMP PLT, POST CERVICAL $1,356.00 $1,279.00 23 SURGICAL SUPPLIES I/P (CO2361780 S IMP PLT, SYNTHES 245 $821.00 $774.00 23 SURGICAL SUPPLIES I/P (CO2352854 S IMP PLT/ROD OCCIPITAL $4,231.00 23 SURGICAL SUPPLIES I/P (CO2324945 S IMP PLT4 CRANI BOX $1,003.75 23 SURGICAL SUPPLIES I/P (CO2361822 S IMP PLUG BONE SILASTIC $680.00 $680.00 23 SURGICAL SUPPLIES I/P (CO2301190 S IMP PLUG CEMENT 18.5 $499.75 $612.00 23 SURGICAL SUPPLIES I/P (CO2361848 S IMP PLUG CEMENT UNIV $499.75 $612.00 23 SURGICAL SUPPLIES I/P (CO2323970 S IMP PRCDL PATCH GRAFT 1 $1,313.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2364297 S IMP REATTACHMENT DEVICE $4,678.00 23 SURGICAL SUPPLIES I/P (CO2363604 S IMP ROD ENDER $1,116.50 23 SURGICAL SUPPLIES I/P (CO2354330 S IMP ROD ISOBAR 170-270M $1,275.00 23 SURGICAL SUPPLIES I/P (CO2354348 S IMP ROD ISOBAR 300MM $1,700.00 23 SURGICAL SUPPLIES I/P (CO2354314 S IMP ROD ISOBAR 45-85MM $1,041.25 23 SURGICAL SUPPLIES I/P (CO2354322 S IMP ROD ISOBAR 95-150MM $1,041.25 23 SURGICAL SUPPLIES I/P (CO2354306 S IMP ROD ISOBAR SEMI-RIG $4,000.00 23 SURGICAL SUPPLIES I/P (CO2354462 S IMP ROD PREBENT LEGACY $850.00 23 SURGICAL SUPPLIES I/P (CO2352862 S IMP ROD TIT CERVIFIX $190.00 23 SURGICAL SUPPLIES I/P (CO2352870 S IMP ROD TIT CERVIFIX $200.00 23 SURGICAL SUPPLIES I/P (CO2352888 S IMP ROD TIT CERVIFIX $1,509.50 23 SURGICAL SUPPLIES I/P (CO2321974 S IMP SCLERA, HUMAN PATCH $290.00 $274.00 23 SURGICAL SUPPLIES I/P (CO2321982 S IMP SCLERA, HUMAN WHOLE $666.00 $629.00 23 SURGICAL SUPPLIES I/P (CO2367514 S IMP SCREW $956.25 23 SURGICAL SUPPLIES I/P (CO2367167 S IMP SCREW 1.6MM AUTO-DR $231.25 23 SURGICAL SUPPLIES I/P (CO2363463 S IMP SCREW ACE $998.75 23 SURGICAL SUPPLIES I/P (CO2341444 S IMP SCREW ACE CORT C $686.50 $686.50 23 SURGICAL SUPPLIES I/P (CO2341477 S IMP SCREW ALPHA ORTHO $509.00 $480.00 23 SURGICAL SUPPLIES I/P (CO2341261 S IMP SCREW AMBI BONE $78.50 $78.50 23 SURGICAL SUPPLIES I/P (CO2341279 S IMP SCREW AMBI COMP $125.75 $125.75 23 SURGICAL SUPPLIES I/P (CO2341295 S IMP SCREW AMBI LAG $903.25 $903.25 23 SURGICAL SUPPLIES I/P (CO2341287 S IMP SCREW AMBI LAG $845.25 $845.25 23 SURGICAL SUPPLIES I/P (CO2342038 S IMP SCREW ARTHREX $549.00 $518.00 23 SURGICAL SUPPLIES I/P (CO2363588 S IMP SCREW BONE 1.6MM $110.00 23 SURGICAL SUPPLIES I/P (CO2344133 S IMP SCREW BONE ZIMM T $410.50 23 SURGICAL SUPPLIES I/P (CO2354470 S IMP SCREW BREAK OFF HEX $425.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2344125 S IMP SCREW CANC $415.75 23 SURGICAL SUPPLIES I/P (CO2364024 S IMP SCREW CANC FTH $161.50 23 SURGICAL SUPPLIES I/P (CO2364008 S IMP SCREW CANC LAG 4.0 $161.50 23 SURGICAL SUPPLIES I/P (CO2352912 S IMP SCREW CANC TIT $373.25 23 SURGICAL SUPPLIES I/P (CO2352904 S IMP SCREW CANCELLOUS $334.50 23 SURGICAL SUPPLIES I/P (CO2367001 S IMP SCREW CANN 7.3MM 16 $1,093.00 23 SURGICAL SUPPLIES I/P (CO2354447 S IMP SCREW CANN M/A LEGA $3,000.00 23 SURGICAL SUPPLIES I/P (CO2363992 S IMP SCREW CANN/CANC $650.25 23 SURGICAL SUPPLIES I/P (CO2362788 S IMP SCREW CANNULATED $451.00 23 SURGICAL SUPPLIES I/P (CO2342046 S IMP SCREW CANNULATED $406.00 $383.00 23 SURGICAL SUPPLIES I/P (CO2341964 S IMP SCREW CANTED $451.00 $426.00 23 SURGICAL SUPPLIES I/P (CO2363612 S IMP SCREW CLIP AMBI HIP $373.00 23 SURGICAL SUPPLIES I/P (CO2367266 S IMP SCREW CORTEX $141.00 23 SURGICAL SUPPLIES I/P (CO2324481 S IMP SCREW CORTEX $251.00 23 SURGICAL SUPPLIES I/P (CO2324242 S IMP SCREW CORTEX 1.3MM $235.50 23 SURGICAL SUPPLIES I/P (CO2324333 S IMP SCREW CORTEX 1.5MM $224.50 23 SURGICAL SUPPLIES I/P (CO2341352 S IMP SCREW CORTICAL $425.00 $425.00 23 SURGICAL SUPPLIES I/P (CO2363828 S IMP SCREW DELTA BIO $824.50 23 SURGICAL SUPPLIES I/P (CO2353183 S IMP SCREW DISCVRY $2,315.25 23 SURGICAL SUPPLIES I/P (CO2324283 S IMP SCREW EMER 1.7X4MM $318.25 23 SURGICAL SUPPLIES I/P (CO2324390 S IMP SCREW EMER 2.0MM $240.75 23 SURGICAL SUPPLIES I/P (CO2324192 S IMP SCREW EMER MAX.FAC $351.00 23 SURGICAL SUPPLIES I/P (CO2324572 S IMP SCREW EMER MAX.FAC $412.00 23 SURGICAL SUPPLIES I/P (CO2341576 S IMP SCREW FACE MAXI SAF $260.00 $241.00 23 SURGICAL SUPPLIES I/P (CO2341600 S IMP SCREW FACE MICRO $247.00 $241.00 23 SURGICAL SUPPLIES I/P (CO2341378 S IMP SCREW INTER ACL $454.00 $428.00 23 SURGICAL SUPPLIES I/P (CO2354454 S IMP SCREW M/A LEGACY $2,625.00 23 SURGICAL SUPPLIES I/P (CO2367415 S IMP SCREW NUT $687.25 23 SURGICAL SUPPLIES I/P (CO2342004 S IMP SCREW OMEGA CANC $89.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2341980 S IMP SCREW OMEGA COMP $107.00 $101.00 23 SURGICAL SUPPLIES I/P (CO2341998 S IMP SCREW OMEGA CORT $63.00 $59.00 23 SURGICAL SUPPLIES I/P (CO2323814 S IMP SCREW OMEGA SUPE $725.00 $684.00 23 SURGICAL SUPPLIES I/P (CO2341691 S IMP SCREW OSTEO CORT $807.50 $465.50 23 SURGICAL SUPPLIES I/P (CO2344109 S IMP SCREW PINNACLE CAN $313.25 23 SURGICAL SUPPLIES I/P (CO2341709 S IMP SCREW POST CERV $188.00 $177.00 23 SURGICAL SUPPLIES I/P (CO2341360 S IMP SCREW STEROTAXIC $652.00 $652.00 23 SURGICAL SUPPLIES I/P (CO2363026 S IMP SCREW SYN CANC $159.25 23 SURGICAL SUPPLIES I/P (CO2362994 S IMP SCREW SYN CANC $91.50 23 SURGICAL SUPPLIES I/P (CO2362986 S IMP SCREW SYN CANC $96.00 23 SURGICAL SUPPLIES I/P (CO2363034 S IMP SCREW SYN CANC $171.50 23 SURGICAL SUPPLIES I/P (CO2363075 S IMP SCREW SYN CANTED $1,093.00 23 SURGICAL SUPPLIES I/P (CO2363059 S IMP SCREW SYN CANTED $837.00 23 SURGICAL SUPPLIES I/P (CO2363067 S IMP SCREW SYN CANTED $844.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2363083 S IMP SCREW SYN COMP $194.00 23 SURGICAL SUPPLIES I/P (CO2362960 S IMP SCREW SYN CORTEX $105.25 23 SURGICAL SUPPLIES I/P (CO2362978 S IMP SCREW SYN CORTEX $106.25 23 SURGICAL SUPPLIES I/P (CO2363117 S IMP SCREW SYN CORTEX $228.75 23 SURGICAL SUPPLIES I/P (CO2363125 S IMP SCREW SYN CORTEX $196.00 23 SURGICAL SUPPLIES I/P (CO2363133 S IMP SCREW SYN CORTEX $338.00 23 SURGICAL SUPPLIES I/P (CO2363091 S IMP SCREW SYN CORTEX $303.25 23 SURGICAL SUPPLIES I/P (CO2363109 S IMP SCREW SYN CORTEX $318.00 23 SURGICAL SUPPLIES I/P (CO2363141 S IMP SCREW SYN LAG $1,546.00 23 SURGICAL SUPPLIES I/P (CO2364222 S IMP SCREW SYN LOCKING 3 $522.75 23 SURGICAL SUPPLIES I/P (CO2363042 S IMP SCREW SYN MALLEOLAR $153.25 23 SURGICAL SUPPLIES I/P (CO2363000 S IMP SCREW SYN SHAFT 3.5 $102.75 23 SURGICAL SUPPLIES I/P (CO2363018 S IMP SCREW SYN SHAFT 4.5 $94.25 23 SURGICAL SUPPLIES I/P (CO2363901 S IMP SCREW TENODESIS $1,338.75 23 SURGICAL SUPPLIES I/P (CO2364263 S IMP SCREW TI LOCKING 5. $760.25 23 SURGICAL SUPPLIES I/P (CO2352896 S IMP SCREW TIT CERVIFIX $344.50 23 SURGICAL SUPPLIES I/P (CO2344117 S IMP SCREW TOTAL HIP $387.50 23 SURGICAL SUPPLIES I/P (CO2341402 S IMP SCREW, ACE CANC $554.00 $523.00 23 SURGICAL SUPPLIES I/P (CO2341410 S IMP SCREW, ACE CANC $726.75 $726.75 23 SURGICAL SUPPLIES I/P (CO2341428 S IMP SCREW, ACE CORTICAL $166.25 $142.50 23 SURGICAL SUPPLIES I/P (CO2341436 S IMP SCREW, ACE CORTICAL $726.75 $726.75 23 SURGICAL SUPPLIES I/P (CO2341469 S IMP SCREW, ALPHATEC $87.00 $82.00 23 SURGICAL SUPPLIES I/P (CO2341535 S IMP SCREW, BONE HERBERT $1,266.50 $1,171.25 23 SURGICAL SUPPLIES I/P (CO2341568 S IMP SCREW, FACE MAXI $238.50 $221.75 23 SURGICAL SUPPLIES I/P (CO2341592 S IMP SCREW, FACE MICRO $224.00 $221.75 23 SURGICAL SUPPLIES I/P (CO2341618 S IMP SCREW, FACE MINI $231.25 $222.25 23 SURGICAL SUPPLIES I/P (CO2341683 S IMP SCREW, OSTEOTOMY $487.75 $487.75 23 SURGICAL SUPPLIES I/P (CO2343960 S IMP SHLD TOTAL GLENOID $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343911 S IMP SHLD TOTAL GLENOID $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343838 S IMP SHLD TOTAL GLENOID $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343846 S IMP SHLD TOTAL GLENOID $2,556.00 23 SURGICAL SUPPLIES I/P (CO2343853 S IMP SHLD TOTAL GLENOID $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343861 S IMP SHLD TOTAL GLENOID $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343887 S IMP SHLD TOTAL GLENOID $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343929 S IMP SHLD TOTAL GLENOID $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343937 S IMP SHLD TOTAL GLENOID $4,635.00 23 SURGICAL SUPPLIES I/P (CO2343879 S IMP SHLD TOTAL GLENOID $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343812 S IMP SHLD TOTAL HEM HEAD $4,354.00 23 SURGICAL SUPPLIES I/P (CO2343796 S IMP SHLD TOTAL HUM HEAD $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343788 S IMP SHLD TOTAL HUM HEAD $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343739 S IMP SHLD TOTAL HUM HEAD $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343747 S IMP SHLD TOTAL HUM HEAD $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343754 S IMP SHLD TOTAL HUM HEAD $3,736.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2343762 S IMP SHLD TOTAL HUM HEAD $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343804 S IMP SHLD TOTAL HUM HEAD $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343820 S IMP SHLD TOTAL HUM HEAD $4,635.00 23 SURGICAL SUPPLIES I/P (CO2344091 S IMP SHLD TOTAL HUM STEM $6,601.00 23 SURGICAL SUPPLIES I/P (CO2344075 S IMP SHLD TOTAL HUM STEM $6,039.00 23 SURGICAL SUPPLIES I/P (CO2343648 S IMP SHLD TOTAL HUM STEM $2,149.00 23 SURGICAL SUPPLIES I/P (CO2343655 S IMP SHLD TOTAL HUM STEM $2,163.00 23 SURGICAL SUPPLIES I/P (CO2343663 S IMP SHLD TOTAL HUM STEM $2,556.00 23 SURGICAL SUPPLIES I/P (CO2343671 S IMP SHLD TOTAL HUM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343689 S IMP SHLD TOTAL HUM STEM $3,343.00 23 SURGICAL SUPPLIES I/P (CO2343697 S IMP SHLD TOTAL HUM STEM $3,736.00 23 SURGICAL SUPPLIES I/P (CO2343705 S IMP SHLD TOTAL HUM STEM $2,949.00 23 SURGICAL SUPPLIES I/P (CO2343713 S IMP SHLD TOTAL HUM STEM $3,230.00 23 SURGICAL SUPPLIES I/P (CO2344083 S IMP SHLD TOTAL HUM STEM $6,320.00 23 SURGICAL SUPPLIES I/P (CO2343721 S IMP SHLD TOTAL HUM STEM $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343978 S IMP SHLD TTL HUMERAL ST $3,792.00 23 SURGICAL SUPPLIES I/P (CO2343986 S IMP SHLD TTL HUMERAL ST $4,073.00 23 SURGICAL SUPPLIES I/P (CO2343994 S IMP SHLD TTL HUMERAL ST $4,354.00 23 SURGICAL SUPPLIES I/P (CO2344000 S IMP SHLD TTL HUMERAL ST $4,635.00 23 SURGICAL SUPPLIES I/P (CO2344018 S IMP SHLD TTL HUMERAL ST $4,916.00 23 SURGICAL SUPPLIES I/P (CO2344026 S IMP SHLD TTL HUMERAL ST $5,197.00 23 SURGICAL SUPPLIES I/P (CO2344034 S IMP SHLD TTL HUMERAL ST $5,478.00 23 SURGICAL SUPPLIES I/P (CO2344042 S IMP SHLD TTL HUMERAL ST $5,758.00 23 SURGICAL SUPPLIES I/P (CO2343903 S IMP SHOULDER TTL GLE $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343895 S IMP SHOULDER TTL GLE $3,511.00 23 SURGICAL SUPPLIES I/P (CO2343770 S IMP SHOULDER TTL HUM $3,511.00 23 SURGICAL SUPPLIES I/P (CO2367795 S IMP SHUNT $9,350.00 23 SURGICAL SUPPLIES I/P (CO2322014 S IMP SHUNT CAROTID BYPAS $403.75 $403.75 23 SURGICAL SUPPLIES I/P (CO2322048 S IMP SHUNT CAROTID SUNDT $1,445.00 $1,445.00 23 SURGICAL SUPPLIES I/P (CO2325520 S IMP SHUNT DELTA UNITIZE $4,133.00 23 SURGICAL SUPPLIES I/P (CO2325298 S IMP SHUNT PROGRAMMABLE $8,563.00 23 SURGICAL SUPPLIES I/P (CO2367027 S IMP SLEEVE LOCKING $1,520.50 23 SURGICAL SUPPLIES I/P (CO2326262 S IMP SPACER LORDOTIC ACF $3,603.00 23 SURGICAL SUPPLIES I/P (CO2326890 S IMP SPACER PARALAL ACF $2,638.00 23 SURGICAL SUPPLIES I/P (CO2326916 S IMP SPACER PLIF $6,590.00 23 SURGICAL SUPPLIES I/P (CO2326924 S IMP SPACER T-PLIF $10,650.00 23 SURGICAL SUPPLIES I/P (CO2354421 S IMP SPACER VERTEBRAL CA $7,406.75 23 SURGICAL SUPPLIES I/P (CO2354439 S IMP SPACER VERTEBRAL CA $10,810.25 23 SURGICAL SUPPLIES I/P (CO2351807 S IMP SPINE IMP 0-25 $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2351815 S IMP SPINE IMP 1001-1100 $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2351823 S IMP SPINE IMP 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2351831 S IMP SPINE IMP 1101-1200 $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2351849 S IMP SPINE IMP 1201-1300 $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2351856 S IMP SPINE IMP 1301-1400 $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2351864 S IMP SPINE IMP 1401-1500 $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2351872 S IMP SPINE IMP 1501-1600 $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2351880 S IMP SPINE IMP 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2351898 S IMP SPINE IMP 1601-1700 $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2351906 S IMP SPINE IMP 1701-1800 $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2351914 S IMP SPINE IMP 1801-1900 $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2351922 S IMP SPINE IMP 1901-2000 $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2351930 S IMP SPINE IMP 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2351948 S IMP SPINE IMP 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2351955 S IMP SPINE IMP 26-50 $200.00 $189.00 23 SURGICAL SUPPLIES I/P (CO2351963 S IMP SPINE IMP 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2351971 S IMP SPINE IMP 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2351989 S IMP SPINE IMP 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2351997 S IMP SPINE IMP 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2352003 S IMP SPINE IMP 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2352011 S IMP SPINE IMP 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2352029 S IMP SPINE IMP 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2352037 S IMP SPINE IMP 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2352045 S IMP SPINE IMP 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2352052 S IMP SPINE IMP 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2352060 S IMP SPINE IMP 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2352078 S IMP SPINE IMP 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2352086 S IMP SPINE IMP 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2352094 S IMP SPINE IMP 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2352102 S IMP SPINE IMPLANT 95 $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2354694 S IMP SPINE ROD $1,041.00 23 SURGICAL SUPPLIES I/P (CO2352110 S IMP SPINE,BAR TRAN C $308.00 $290.00 23 SURGICAL SUPPLIES I/P (CO2352383 S IMP SPINE,TRAN CONNE $136.00 $128.00 23 SURGICAL SUPPLIES I/P (CO2354488 S IMP SPN LUMB L1 $11,025.00 23 SURGICAL SUPPLIES I/P (CO2354496 S IMP SPN LUMB L2 $15,925.00 23 SURGICAL SUPPLIES I/P (CO2354504 S IMP SPNE CERV L1 $4,000.00 23 SURGICAL SUPPLIES I/P (CO2354512 S IMP SPNE CERV L1 $5,250.00 23 SURGICAL SUPPLIES I/P (CO2325660 S IMP STENT GRAFT ANEURX $2,500.00 23 SURGICAL SUPPLIES I/P (CO2325652 S IMP STENT GRAFT ANEURX $8,483.00 23 SURGICAL SUPPLIES I/P (CO2325678 S IMP STENT GRAFT ANEURX $2,725.00 23 SURGICAL SUPPLIES I/P (CO2325645 S IMP STENT GRAFT ANEURX $8,146.00 23 SURGICAL SUPPLIES I/P (CO2303139 S IMP STENT URETERAL 4.8 $484.50 $538.50 23 SURGICAL SUPPLIES I/P (CO2303154 S IMP STENT URETERAL SNGL $1,483.25 $815.25 23 SURGICAL SUPPLIES I/P (CO2331056 S IMP STERILE SLEVE PCMKR $89.00 23 SURGICAL SUPPLIES I/P (CO2303295 S IMP STIMULATOR, SPINAL $2,433.00 $2,433.00 23 SURGICAL SUPPLIES I/P (CO2364271 S IMP SYN TROCHANTERIC NA $3,330.00 23 SURGICAL SUPPLIES I/P (CO2353704 S IMP SYNMESH END RING $803.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2353712 S IMP SYNMESH END RING $2,009.00 23 SURGICAL SUPPLIES I/P (CO2353738 S IMP SYNMESH LOCK SCREW $113.00 23 SURGICAL SUPPLIES I/P (CO2353720 S IMP SYNMESH STD RING $1,089.25 23 SURGICAL SUPPLIES I/P (CO2322527 S IMP SYNTHES SCREWS $1,939.00 $1,830.00 23 SURGICAL SUPPLIES I/P (CO2323830 S IMP SYNTHES VARIABLE $316.00 $298.00 23 SURGICAL SUPPLIES I/P (CO2322535 S IMP SYNTHES VARIABLE $316.00 $298.00 23 SURGICAL SUPPLIES I/P (CO2363620 S IMP TIBIAL ACL PIN SET $616.25 23 SURGICAL SUPPLIES I/P (CO2364214 S IMP T-PLATE SYN LCP OBL $1,710.50 23 SURGICAL SUPPLIES I/P (CO2364206 S IMP T-PLATE SYNTHES LCP $1,827.00 23 SURGICAL SUPPLIES I/P (CO2363315 S IMP T-PLT SYN 4-8-H $1,329.00 23 SURGICAL SUPPLIES I/P (CO2363596 S IMP T-PLT SYN OBLIQUE $955.25 23 SURGICAL SUPPLIES I/P (CO2363323 S IMP T-PLT SYN SM $566.50 23 SURGICAL SUPPLIES I/P (CO2363331 S IMP T-PLT SYN TI $1,044.00 23 SURGICAL SUPPLIES I/P (CO2352375 S IMP TRANS-CONN CLAMP $636.50 $636.50 23 SURGICAL SUPPLIES I/P (CO2352532 S IMP TRANS-CONN CLAMP $1,016.00 $946.50 23 SURGICAL SUPPLIES I/P (CO2363877 S IMP TRIGEN KNEE NAIL $3,432.00 23 SURGICAL SUPPLIES I/P (CO2363869 S IMP TRIGEN KNEE NAIL $3,468.00 23 SURGICAL SUPPLIES I/P (CO2363844 S IMP TRIGEN NAIL CAP $588.75 23 SURGICAL SUPPLIES I/P (CO2363885 S IMP TRIGEN SCREW CAPT $1,267.00 23 SURGICAL SUPPLIES I/P (CO2363893 S IMP TRIGEN SCREW CAPT $752.25 23 SURGICAL SUPPLIES I/P (CO2363851 S IMP TRIGEN TROCH NAIL $5,244.00 23 SURGICAL SUPPLIES I/P (CO2353407 S IMP TSRH 3-D CONN $1,700.00 23 SURGICAL SUPPLIES I/P (CO2361921 S IMP TSRH TI CROSSLINK $3,229.75 $3,229.75 23 SURGICAL SUPPLIES I/P (CO2362077 S IMP TSRH TI,CRSLINK PLT $2,801.75 $2,801.75 23 SURGICAL SUPPLIES I/P (CO2361947 S IMP TSRH TITANIUM,OF $2,861.00 $2,861.00 23 SURGICAL SUPPLIES I/P (CO2353415 S IMP TSRH-3D ROD 250MM $1,711.25 23 SURGICAL SUPPLIES I/P (CO2353746 S IMP TSRH-3D ROD PRE- $850.00 23 SURGICAL SUPPLIES I/P (CO2353431 S IMP TSRH-3D SCREW $1,985.00 23 SURGICAL SUPPLIES I/P (CO2353399 S IMP TSRH-3D SET SCREW $425.00 23 SURGICAL SUPPLIES I/P (CO2352128 S IMP UNIV BAR CLOSED $2,106.75 $2,106.75 23 SURGICAL SUPPLIES I/P (CO2352136 S IMP UNIV BAR OPEN TRANS $2,107.00 $2,107.00 23 SURGICAL SUPPLIES I/P (CO2352144 S IMP UNIV CLAMP $2,107.00 $2,107.00 23 SURGICAL SUPPLIES I/P (CO2352169 S IMP UNIV CLAMP W/NUT $3,474.00 $3,474.00 23 SURGICAL SUPPLIES I/P (CO2352409 S IMP UNIV CONN CLAMP $1,236.25 $1,236.25 23 SURGICAL SUPPLIES I/P (CO2352185 S IMP UNIV CONN PARALLEL $2,044.00 $2,076.50 23 SURGICAL SUPPLIES I/P (CO2352219 S IMP UNIV HOOK LAMINA $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352201 S IMP UNIV HOOK LAMINA $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352227 S IMP UNIV HOOK LAMINA $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352235 S IMP UNIV HOOK PEDICLE $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352243 S IMP UNIV HOOK PEDICLE $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352250 S IMP UNIV HOOK TRANS $1,925.75 $1,925.75 23 SURGICAL SUPPLIES I/P (CO2352391 S IMP UNIV HOOK TRANS $1,817.75 $1,817.75 23 SURGICAL SUPPLIES I/P (CO2352284 S IMP UNIV ROD HARD 50MM $542.75 $542.75 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2352987 S IMP UNIV ROD HARD 75MM $816.00 23 SURGICAL SUPPLIES I/P (CO2352276 S IMP UNIV ROD HD 100-500 $850.00 $1,067.25 23 SURGICAL SUPPLIES I/P (CO2352326 S IMP UNIV ROD SOFT 50MM $542.75 $542.75 23 SURGICAL SUPPLIES I/P (CO2352334 S IMP UNIV ROD SOFT 75MM $816.00 $816.00 23 SURGICAL SUPPLIES I/P (CO2352318 S IMP UNIV ROD ST 100-500 $1,067.25 $1,067.25 23 SURGICAL SUPPLIES I/P (CO2352979 S IMP UNIV SCREW SCHANZ $1,113.75 23 SURGICAL SUPPLIES I/P (CO2352953 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352946 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352961 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352938 S IMP UNIV SCREW SIDE $2,116.75 23 SURGICAL SUPPLIES I/P (CO2352367 S IMP UNIV SCREW SIDE $2,116.75 $1,669.00 23 SURGICAL SUPPLIES I/P (CO2352193 S IMP UNIV SPINE 1/2 RING $832.25 $832.25 23 SURGICAL SUPPLIES I/P (CO2353001 S IMP UNIV SPINE COLLAR $644.75 23 SURGICAL SUPPLIES I/P (CO2352268 S IMP UNIV SPINE NUT 11MM $212.50 $261.00 23 SURGICAL SUPPLIES I/P (CO2352540 S IMP UNIV SPINE WASHER $163.00 $163.00 23 SURGICAL SUPPLIES I/P (CO2352995 S IMP UNIV TRANS-CONN $451.50 23 SURGICAL SUPPLIES I/P (CO2326569 S IMP URIN SPHINCT PROS A $8,413.00 23 SURGICAL SUPPLIES I/P (CO2308328 S IMP VALVE, LEVEEN AS $1,686.50 $1,686.50 23 SURGICAL SUPPLIES I/P (CO2352565 S IMP VARIA ROD $316.00 $298.00 23 SURGICAL SUPPLIES I/P (CO2354520 S IMP VERT ALIF BN $6,463.00 23 SURGICAL SUPPLIES I/P (CO2354546 S IMP VERT ALIF CRBN FBR $7,850.00 23 SURGICAL SUPPLIES I/P (CO2354553 S IMP VERT ALIF MTL $8,438.00 23 SURGICAL SUPPLIES I/P (CO2354538 S IMP VERT ALIF PK $7,088.00 23 SURGICAL SUPPLIES I/P (CO2354645 S IMP VERT CERV BN $2,625.00 23 SURGICAL SUPPLIES I/P (CO2354660 S IMP VERT CERV CRBN FBR $3,063.00 23 SURGICAL SUPPLIES I/P (CO2354678 S IMP VERT CERV MTL $1,873.00 23 SURGICAL SUPPLIES I/P (CO2354652 S IMP VERT CERV PK $3,413.00 23 SURGICAL SUPPLIES I/P (CO2354561 S IMP VERT PLIF BN $5,125.00 23 SURGICAL SUPPLIES I/P (CO2354587 S IMP VERT PLIF CRBN FBR $5,188.00 23 SURGICAL SUPPLIES I/P (CO2354595 S IMP VERT PLIF MTL $5,263.00 23 SURGICAL SUPPLIES I/P (CO2354579 S IMP VERT PLIF PK $5,480.00 23 SURGICAL SUPPLIES I/P (CO2354603 S IMP VERT TLIF BN $7,200.00 23 SURGICAL SUPPLIES I/P (CO2354629 S IMP VERT TLIF CRBN FBR $6,600.00 23 SURGICAL SUPPLIES I/P (CO2354637 S IMP VERT TLIF MTL $6,725.00 23 SURGICAL SUPPLIES I/P (CO2354611 S IMP VERT TLIF PK $6,138.00 23 SURGICAL SUPPLIES I/P (CO2325363 S IMP VERTGRAFT FIB SHAFT $3,335.00 23 SURGICAL SUPPLIES I/P (CO2325538 S IMP VLV BURR HOLE DELTA $2,608.00 23 SURGICAL SUPPLIES I/P (CO2367670 S IMP WASHER $293.25 23 SURGICAL SUPPLIES I/P (CO2367688 S IMP WASHER $142.50 23 SURGICAL SUPPLIES I/P (CO2367019 S IMP WASHER 13.0 MM $130.75 23 SURGICAL SUPPLIES I/P (CO2362317 S IMP WASHER ACE $121.25 $121.25 23 SURGICAL SUPPLIES I/P (CO2362333 S IMP WASHER ACE FLAT $108.00 $108.00 23 SURGICAL SUPPLIES I/P (CO2353191 S IMP WASHER COMPASS $595.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2362671 S IMP WASHER ROCKWOOD $248.00 23 SURGICAL SUPPLIES I/P (CO2362275 S IMP WASHER SOFT TISS $425.00 $352.75 23 SURGICAL SUPPLIES I/P (CO2362309 S IMP WASHER SPIKED $508.00 $491.75 23 SURGICAL SUPPLIES I/P (CO2363372 S IMP WASHER SYN $128.50 23 SURGICAL SUPPLIES I/P (CO2363380 S IMP WASHER SYN $577.50 23 SURGICAL SUPPLIES I/P (CO2362655 S IMP WASHER THICK 9/16 $248.00 23 SURGICAL SUPPLIES I/P (CO2362325 S IMP WASHER, ACE CUP $175.75 $175.75 23 SURGICAL SUPPLIES I/P (CO2363646 S IMP WIRE MOUNT PLT $672.50 23 SURGICAL SUPPLIES I/P (CO2363356 S IMP Y-PLT SYN TI $994.25 23 SURGICAL SUPPLIES I/P (CO2344190 S INV DVC HIP TTL FEM POR $3,890.00 23 SURGICAL SUPPLIES I/P (CO2369999 S INV DVC ORTHPDIC DEVICE 23 SURGICAL SUPPLIES I/P (CO2369981 S INV DVC ORTHPDIC DEVICE $0.01 23 SURGICAL SUPPLIES I/P (CO2360360 S NSTRL CAST SPLNT SYS $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2360378 S NSTRL CAST SPLNT SYS $75.25 $75.25 23 SURGICAL SUPPLIES I/P (CO2360394 S NSTRL CAST TAPE $16.25 $16.25 23 SURGICAL SUPPLIES I/P (CO2360386 S NSTRL CAST TAPE $21.75 $21.75 23 SURGICAL SUPPLIES I/P (CO2360410 S NSTRL FELT ORTHO ZIMMER 23 SURGICAL SUPPLIES I/P (CO2361012 S NSTRL PLSTR BNDG 2"X3" $4.75 $4.75 23 SURGICAL SUPPLIES I/P (CO2361020 S NSTRL PLSTR BNDG 4"X6" $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2361038 S NSTRL PLSTR ROLL 4" $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2361061 S NSTRL PLSTR SPLNTS $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2302438 S NSTRL SHOE DARBY $57.25 $57.25 23 SURGICAL SUPPLIES I/P (CO2318418 S ORTHO IMBLR SLING $24.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2302644 S ORTHO SLING ZIMMER $39.50 $39.50 23 SURGICAL SUPPLIES I/P (CO2318384 S OT KO IMMOB CNVS LONG $59.00 $59.00 23 SURGICAL SUPPLIES I/P (CO2318400 S OT SO FIG 8 ABDC CNVS $43.00 $43.00 23 SURGICAL SUPPLIES I/P (CO2367597 S SCRW $935.00 23 SURGICAL SUPPLIES I/P (CO2367621 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2368074 S SCRW $216.75 23 SURGICAL SUPPLIES I/P (CO2367431 S SCRW $840.75 23 SURGICAL SUPPLIES I/P (CO2367316 S SCRW $127.75 23 SURGICAL SUPPLIES I/P (CO2367373 S SCRW $153.25 23 SURGICAL SUPPLIES I/P (CO2367639 S SCRW $467.50 23 SURGICAL SUPPLIES I/P (CO2367456 S SCRW $1,242.75 23 SURGICAL SUPPLIES I/P (CO2367423 S SCRW $603.00 23 SURGICAL SUPPLIES I/P (CO2367613 S SCRW $446.25 23 SURGICAL SUPPLIES I/P (CO2367449 S SCRW $738.25 23 SURGICAL SUPPLIES I/P (CO2367654 S SCRW $637.50 23 SURGICAL SUPPLIES I/P (CO2367589 S SCRW $637.50 23 SURGICAL SUPPLIES I/P (CO2367647 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2367662 S SCRW $166.25 23 SURGICAL SUPPLIES I/P (CO2367605 S SCRW $1,275.00 23 SURGICAL SUPPLIES I/P (CO2368082 S SCRW $218.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 300 AMOUNT

DEPARTMENT CODE

2367464 S SCRW $1,107.50 23 SURGICAL SUPPLIES I/P (CO2367381 S SCRW $232.75 23 SURGICAL SUPPLIES I/P (CO2367365 S SCRW $224.75 23 SURGICAL SUPPLIES I/P (CO2368090 S SCRW $240.25 23 SURGICAL SUPPLIES I/P (CO2368108 S SCRW $276.25 23 SURGICAL SUPPLIES I/P (CO2354702 S SCRW CERV $850.00 23 SURGICAL SUPPLIES I/P (CO2354686 S SCRW PEDICLE $3,430.00 23 SURGICAL SUPPLIES I/P (CO2360006 S STRL AGEE WRIST JACK $3,387.50 $3,387.50 23 SURGICAL SUPPLIES I/P (CO2363638 S STRL ANCHOR BIO-ABORB $1,041.25 23 SURGICAL SUPPLIES I/P (CO2310191 S STRL ARCH BARS ERICH 5" $53.75 $53.75 23 SURGICAL SUPPLIES I/P (CO2310258 S STRL BAG BILE 19OZ $33.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2310233 S STRL BAG BECKER DRAIN $170.00 $170.00 23 SURGICAL SUPPLIES I/P (CO2310639 S STRL BILIARY, BALLOON $1,024.00 $966.00 23 SURGICAL SUPPLIES I/P (CO2310654 S STRL BILIARY, GLIDE W $578.00 $546.00 23 SURGICAL SUPPLIES I/P (CO2310662 S STRL BILIARY, GUIDEWI $229.00 $216.00 23 SURGICAL SUPPLIES I/P (CO2352466 S STRL BIPOLAR CUT FORCEP $1,785.00 $1,695.75 23 SURGICAL SUPPLIES I/P (CO2311009 S STRL BLADE CONCAVE CR $373.00 $352.00 23 SURGICAL SUPPLIES I/P (CO2311033 S STRL BLADE DERMATOME $204.25 $189.50 23 SURGICAL SUPPLIES I/P (CO2311132 S STRL BLADE, MINI DRIV $45.00 $42.00 23 SURGICAL SUPPLIES I/P (CO2311421 S STRL BLADE,BEAVER 552 $30.00 $28.00 23 SURGICAL SUPPLIES I/P (CO2310837 S STRL BLE BEAVER $65.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2310845 S STRL BLE BEAVER 5910 $95.00 $90.00 23 SURGICAL SUPPLIES I/P (CO2310860 S STRL BLE BEAVER 6910 $48.00 $46.00 23 SURGICAL SUPPLIES I/P (CO2310878 S STRL BLE BEAVER DEBAKEY $18.00 $17.00 23 SURGICAL SUPPLIES I/P (CO2310886 S STRL BLE BEAVER EAR $31.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2310894 S STRL BLE BEAVER EAR 72 $78.00 $73.00 23 SURGICAL SUPPLIES I/P (CO2310928 S STRL BLE BEAVER LAMELLA $77.00 $72.00 23 SURGICAL SUPPLIES I/P (CO2310936 S STRL BLE BEAVER MINI RN $11.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2310944 S STRL BLE BEAVER MINI SH $39.00 $37.00 23 SURGICAL SUPPLIES I/P (CO2310795 S STRL BLE CARPAL TUNNEL $850.00 $850.00 23 SURGICAL SUPPLIES I/P (CO2310985 S STRL BLE CASPER DOWEL $797.00 $752.00 23 SURGICAL SUPPLIES I/P (CO2311025 S STRL BLE CRANI MARK V $231.75 $231.75 23 SURGICAL SUPPLIES I/P (CO2311058 S STRL BLE DYONICS $284.00 $268.00 23 SURGICAL SUPPLIES I/P (CO2311488 S STRL BLE EYE KNIFE $31.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2311108 S STRL BLE GATOR SHAVER $284.00 $268.00 23 SURGICAL SUPPLIES I/P (CO2311116 S STRL BLE HARMONIC SCLP $1,550.00 $1,462.00 23 SURGICAL SUPPLIES I/P (CO2311124 S STRL BLE KARLIN SPINAL $200.00 $200.00 23 SURGICAL SUPPLIES I/P (CO2311140 S STRL BLE MINI DYONICS $263.00 $263.00 23 SURGICAL SUPPLIES I/P (CO2311157 S STRL BLE MINI STRYKER $155.50 $268.75 23 SURGICAL SUPPLIES I/P (CO2311082 S STRL BLE OSTEOTOME $420.75 $420.75 23 SURGICAL SUPPLIES I/P (CO2311173 S STRL BLE OSTEOTOME $586.50 $561.00 23 SURGICAL SUPPLIES I/P (CO2311215 S STRL BLE SAW $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2311181 S STRL BLE SAW GIGLI 20" $111.25 $111.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2311207 S STRL BLE SAW MICRO $29.00 $28.00 23 SURGICAL SUPPLIES I/P (CO2311272 S STRL BLE SAW PATELLAR $377.00 $356.00 23 SURGICAL SUPPLIES I/P (CO2311280 S STRL BLE SAW RECIPRO $273.50 $273.50 23 SURGICAL SUPPLIES I/P (CO2311298 S STRL BLE SAW SAGITTAL $209.00 $223.25 23 SURGICAL SUPPLIES I/P (CO2311314 S STRL BLE SPIRAL FLUTED $257.00 $242.00 23 SURGICAL SUPPLIES I/P (CO2311322 S STRL BLE STERNAL SAW $35.25 $35.25 23 SURGICAL SUPPLIES I/P (CO2311330 S STRL BLE SUPER $37.50 $37.50 23 SURGICAL SUPPLIES I/P (CO2311355 S STRL BLE SURGICAL $2.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2370195 S STRL BLE SYNVASIVE RIB $209.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2311389 S STRL BLE TORQUE WRENCH $210.00 $198.00 23 SURGICAL SUPPLIES I/P (CO2311413 S STRL BLE URETHROTOME $814.50 $814.50 23 SURGICAL SUPPLIES I/P (CO2310472 S STRL BNDG ESMARCH $18.75 $18.75 23 SURGICAL SUPPLIES I/P (CO2311645 S STRL BONE, WAX $23.00 $23.00 23 SURGICAL SUPPLIES I/P (CO2311660 S STRL BOOT SUT YELLOW $15.00 $14.50 23 SURGICAL SUPPLIES I/P (CO2310555 S STRL BSKT SEGURA STONE $814.00 $812.25 23 SURGICAL SUPPLIES I/P (CO2311744 S STRL BURR AESCULAP $162.25 $162.25 23 SURGICAL SUPPLIES I/P (CO2311777 S STRL BURR MIDAS REX $397.00 $444.25 23 SURGICAL SUPPLIES I/P (CO2311785 S STRL BURR OSTEON $399.50 $399.50 23 SURGICAL SUPPLIES I/P (CO2311827 S STRL BURR SURGAIR X-LNG $68.50 $107.25 23 SURGICAL SUPPLIES I/P (CO2311850 S STRL BUTTON PRYPRO 14MM $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2311892 S STRL BYRD DLTR $894.75 $894.75 23 SURGICAL SUPPLIES I/P (CO2311900 S STRL BYRD DLTR SHTH SET $561.00 $561.00 23 SURGICAL SUPPLIES I/P (CO2311926 S STRL CABLE SONGER $1,874.25 $1,874.25 23 SURGICAL SUPPLIES I/P (CO2311918 S STRL CABLE SONGER $1,972.25 $1,972.25 23 SURGICAL SUPPLIES I/P (CO2312031 S STRL CAN CANNULOC $84.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2363455 S STRL CAN SHLD CONCEPT $89.00 23 SURGICAL SUPPLIES I/P (CO2312148 S STRL CAN SHLDR UNIV $118.75 $118.75 23 SURGICAL SUPPLIES I/P (CO2370328 S STRL CAN WATERS CAUTERY $176.00 23 SURGICAL SUPPLIES I/P (CO2312395 S STRL CATH COUDE $55.75 $63.00 23 SURGICAL SUPPLIES I/P (CO2312403 S STRL CATH COUNCIL TIP 5 $62.00 $63.25 23 SURGICAL SUPPLIES I/P (CO2313088 S STRL CATH ERCP $231.75 $231.75 23 SURGICAL SUPPLIES I/P (CO2313187 S STRL CATH FOLEY 3 WAY $49.00 $50.00 23 SURGICAL SUPPLIES I/P (CO2312478 S STRL CATH FOLEY 30CC $23.25 $25.00 23 SURGICAL SUPPLIES I/P (CO2313153 S STRL CATH FOLEY PEDI $36.00 $39.00 23 SURGICAL SUPPLIES I/P (CO2313161 S STRL CATH FOLEY SIL 12 $32.50 $32.50 23 SURGICAL SUPPLIES I/P (CO2312544 S STRL CATH HICKMAN HMDL $994.50 $994.50 23 SURGICAL SUPPLIES I/P (CO2312551 S STRL CATH HICKMAN VASC $741.00 $699.00 23 SURGICAL SUPPLIES I/P (CO2391415 S STRL CATH INTRO $91.50 $86.00 23 SURGICAL SUPPLIES I/P (CO2312676 S STRL CATH LUMBOPERIT $2,327.50 $2,327.50 23 SURGICAL SUPPLIES I/P (CO2312726 S STRL CATH PERIT RFLX $1,083.75 $1,083.75 23 SURGICAL SUPPLIES I/P (CO2312791 S STRL CATH ROBINSON RED $3.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2313716 S STRL CATH SUC SUMP 10FR $55.25 $53.25 23 SURGICAL SUPPLIES I/P (CO2312833 S STRL CATH TAUT OPERATIV $148.50 $148.50 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2312825 S STRL CATH T-TUBE (ALL $47.00 $44.00 23 SURGICAL SUPPLIES I/P (CO2312908 S STRL CATH TY URINE METE $63.00 $57.75 23 SURGICAL SUPPLIES I/P (CO2312932 S STRL CATH VNTRCLR HOLTE $516.50 $447.50 23 SURGICAL SUPPLIES I/P (CO2313096 S STRL CATHETER FOGARTY B $165.00 $156.00 23 SURGICAL SUPPLIES I/P (CO2312494 S STRL CATHETER, FOLEY $23.00 $22.00 23 SURGICAL SUPPLIES I/P (CO2308500 S STRL CAUTERIZING PENC $18.75 $18.75 23 SURGICAL SUPPLIES I/P (CO2313898 S STRL CAUTERY $76.75 $60.50 23 SURGICAL SUPPLIES I/P (CO2313856 S STRL CAUTERY ELEC BLE $20.00 $20.00 23 SURGICAL SUPPLIES I/P (CO2313864 S STRL CAUTERY ELEC NDL $20.50 $20.50 23 SURGICAL SUPPLIES I/P (CO2313914 S STRL CAUTERY TIP TEFLON $36.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2364040 S STRL CEMENT $367.25 23 SURGICAL SUPPLIES I/P (CO2313955 S STRL CEMENT BONE $435.50 $435.50 23 SURGICAL SUPPLIES I/P (CO2313963 S STRL CEMENT BONE $378.50 $367.50 23 SURGICAL SUPPLIES I/P (CO2313971 S STRL CEMENT BONE $287.50 $279.00 23 SURGICAL SUPPLIES I/P (CO2325793 S STRL CEMENT BONE 5CC $3,465.00 23 SURGICAL SUPPLIES I/P (CO2325801 S STRL CEMENT BONE CRS $6,097.50 23 SURGICAL SUPPLIES I/P (CO2313997 S STRL CEMENT BOWL $215.75 $215.75 23 SURGICAL SUPPLIES I/P (CO2314003 S STRL CEMENT BWL/CRTRDG $444.25 $430.75 23 SURGICAL SUPPLIES I/P (CO2314052 S STRL CEMENT GUN $76.00 $76.00 23 SURGICAL SUPPLIES I/P (CO2314045 S STRL CEMENT GUN $78.00 $78.00 23 SURGICAL SUPPLIES I/P (CO2314029 S STRL CEMENT GUN $100.50 $100.50 23 SURGICAL SUPPLIES I/P (CO2314037 S STRL CEMENT GUN NOZZLE $92.25 $92.25 23 SURGICAL SUPPLIES I/P (CO2314110 S STRL CHR GUT,2-0,27"T-5 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2314136 S STRL CHR GUT,3-0,18" $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2314144 S STRL CHR GUT,3-0,27",SH $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2314151 S STRL CHR GUT,4-0,18" $26.75 $26.75 23 SURGICAL SUPPLIES I/P (CO2391050 S STRL CHR GUT,4-0,18" $26.75 $26.75 23 SURGICAL SUPPLIES I/P (CO2314169 S STRL CHR GUT,4-0,54"TIE $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2370443 S STRL CHR GUT,5-0,18" $63.75 23 SURGICAL SUPPLIES I/P (CO2314102 S STRL CHROMIC GUT,0,27 $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2314094 S STRL CHROMIC GUT,7-0, $96.50 $96.50 23 SURGICAL SUPPLIES I/P (CO2314193 S STRL CLAMP JAW SPRING $32.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2314201 S STRL CLAMP SOFT JAW $74.25 $74.25 23 SURGICAL SUPPLIES I/P (CO2320422 S STRL CLIP ANEURYSM $1,343.00 $1,267.00 23 SURGICAL SUPPLIES I/P (CO2320430 S STRL CLIP ANEURYSM $1,248.00 $1,248.00 23 SURGICAL SUPPLIES I/P (CO2320521 S STRL CLIP LIGA LG $29.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2320547 S STRL CLIP LIGA MED $17.50 $17.50 23 SURGICAL SUPPLIES I/P (CO2320554 S STRL CLIP LIGA MED/LG $27.00 $27.00 23 SURGICAL SUPPLIES I/P (CO2320562 S STRL CLIP LIGA SM $17.50 $17.50 23 SURGICAL SUPPLIES I/P (CO2314268 S STRL CLIP SCALP RANEY $40.00 $38.25 23 SURGICAL SUPPLIES I/P (CO2314318 S STRL CLO TEST $37.00 $35.00 23 SURGICAL SUPPLIES I/P (CO2314326 S STRL COLLAR PHILLY $72.50 $72.50 23 SURGICAL SUPPLIES I/P (CO2314573 S STRL CONN TI 2-PART $601.00 $567.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2314615 S STRL CONVERTOR LAPORO $28.00 $26.00 23 SURGICAL SUPPLIES I/P (CO2314623 S STRL CORD BIPOLAR DISP $19.50 $20.00 23 SURGICAL SUPPLIES I/P (CO2326932 S STRL CRS BONE CEMENT $2,120.75 23 SURGICAL SUPPLIES I/P (CO2314813 S STRL CRTRDG GIA 60 TI $237.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2312312 S STRL CTG ENDO GIA $403.50 $403.50 23 SURGICAL SUPPLIES I/P (CO2312320 S STRL CTG ENDOHERNIA $330.25 $330.25 23 SURGICAL SUPPLIES I/P (CO2312338 S STRL CTG GIA 80 MULTI $351.75 $351.75 23 SURGICAL SUPPLIES I/P (CO2314896 S STRL CURETTE VAC $12.75 $22.00 23 SURGICAL SUPPLIES I/P (CO2391639 S STRL CUSA PAK MICRO TIP $1,557.00 $1,469.00 23 SURGICAL SUPPLIES I/P (CO2314912 S STRL DACRON FELT, 6 X 6 $171.00 $171.00 23 SURGICAL SUPPLIES I/P (CO2304475 S STRL DACRON,5-0,18",D-1 23 SURGICAL SUPPLIES I/P (CO2325835 S STRL DBX PUTTY 10CC $3,491.00 23 SURGICAL SUPPLIES I/P (CO2325819 S STRL DBX PUTTY 1CC $928.75 23 SURGICAL SUPPLIES I/P (CO2325827 S STRL DBX PUTTY 5CC $3,175.00 23 SURGICAL SUPPLIES I/P (CO2315034 S STRL DELTA SHUNT SYS $3,574.00 $3,574.00 23 SURGICAL SUPPLIES I/P (CO2391100 S STRL DERM, 5-0, 18" $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2391126 S STRL DERM, 6-0, 18" $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2390144 S STRL DERMACARRIER $148.25 $138.00 23 SURGICAL SUPPLIES I/P (CO2391118 S STRL DERMALON, 4-0, 1 $20.75 $20.75 23 SURGICAL SUPPLIES I/P (CO2315141 S STRL DEV ANTI FLING $29.00 $29.00 23 SURGICAL SUPPLIES I/P (CO2315174 S STRL DEX II 4-0,18",T-5 $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2391324 S STRL DEX II, 4-0,27" $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2390946 S STRL DISSECTOR BLUNG $107.75 $149.50 23 SURGICAL SUPPLIES I/P (CO2363810 S STRL DISTRACT PIN $118.75 23 SURGICAL SUPPLIES I/P (CO2313609 S STRL DOVER FOLEY 8F, 10 $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2315471 S STRL DRAIN BLAKE RND $85.25 $85.25 23 SURGICAL SUPPLIES I/P (CO2315570 S STRL DRAIN J-P Y CONN $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2315596 S STRL DRAIN PENROSE (A $3.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2310506 S STRL DRAIN TUBE SHEPARD $39.75 $39.75 23 SURGICAL SUPPLIES I/P (CO2315687 S STRL DRAIN, CHEST THO $158.00 $158.00 23 SURGICAL SUPPLIES I/P (CO2316164 S STRL DRESS ADAPTIC 3X8 $2.75 $2.75 23 SURGICAL SUPPLIES I/P (CO2317063 S STRL DRESS GUAZE VSLN $2.25 $4.00 23 SURGICAL SUPPLIES I/P (CO2316248 S STRL DRESS OWENS 8 X 12 $59.50 $63.00 23 SURGICAL SUPPLIES I/P (CO2316297 S STRL DRESSING XEROFOR $3.50 $2.75 23 SURGICAL SUPPLIES I/P (CO2316289 S STRL DRESSING XEROFOR $2.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2317071 S STRL DRESSING, VASELI $4.25 $6.00 23 SURGICAL SUPPLIES I/P (CO2316339 S STRL DRILL 5"LX3/8" DIA $90.00 $85.00 23 SURGICAL SUPPLIES I/P (CO2316347 S STRL DRILL 8"LX1/4" DIA $258.00 $243.00 23 SURGICAL SUPPLIES I/P (CO2316354 S STRL DRILL BIT $358.50 $334.75 23 SURGICAL SUPPLIES I/P (CO2316404 S STRL DRILL BIT $764.00 $721.00 23 SURGICAL SUPPLIES I/P (CO2316412 S STRL DRILL BIT $803.25 $803.25 23 SURGICAL SUPPLIES I/P (CO2324069 S STRL DRILL BIT CRANI $620.25 23 SURGICAL SUPPLIES I/P (CO2316511 S STRL DRILL BIT ZIM 3/8" $415.00 $392.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2316388 S STRL DRILL BIT, ACE $314.50 $314.50 23 SURGICAL SUPPLIES I/P (CO2316396 S STRL DRILL BIT, ACE $314.50 $314.50 23 SURGICAL SUPPLIES I/P (CO2316537 S STRL DRILL FLEX LONG $977.50 $888.25 23 SURGICAL SUPPLIES I/P (CO2316545 S STRL DRILL GU 2.4X180MM $522.75 $522.75 23 SURGICAL SUPPLIES I/P (CO2362663 S STRL DRILL HTO KIT $203.00 23 SURGICAL SUPPLIES I/P (CO2316552 S STRL DRILL SURGAIR WIRE $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2316578 S STRL DRILL TWIST $161.75 $149.50 23 SURGICAL SUPPLIES I/P (CO2316594 S STRL DRILL TWIST AMBI $104.00 $98.00 23 SURGICAL SUPPLIES I/P (CO2317097 S STRL DRILL WIRE PASS $157.75 $157.75 23 SURGICAL SUPPLIES I/P (CO2317196 S STRL ELECT ACROMIO $253.00 $239.00 23 SURGICAL SUPPLIES I/P (CO2314565 S STRL ELECT CORD-FULG $35.25 $33.00 23 SURGICAL SUPPLIES I/P (CO2317204 S STRL ELECT MENISEC STD $142.50 $142.50 23 SURGICAL SUPPLIES I/P (CO2317246 S STRL ENDO BUTTON PAK $1,726.75 $1,726.75 23 SURGICAL SUPPLIES I/P (CO2308591 S STRL ENDO CATCH $355.25 $355.25 23 SURGICAL SUPPLIES I/P (CO2325900 S STRL ENDO CUTTER $1,450.50 23 SURGICAL SUPPLIES I/P (CO2308641 S STRL ENDO DISSECTOR $368.50 $307.00 23 SURGICAL SUPPLIES I/P (CO2308617 S STRL ENDOCLIP M/L 5MM $888.00 $695.00 23 SURGICAL SUPPLIES I/P (CO2308633 S STRL ENDOCLOSE $213.00 $213.00 23 SURGICAL SUPPLIES I/P (CO2317394 S STRL ENDOSCOPE SPEC $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2317568 S STRL ERASER TIP $35.75 $35.75 23 SURGICAL SUPPLIES I/P (CO2304756 S STRL ETB,0,30",SH $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2304723 S STRL ETB,0,30"TIES $8.25 $8.25 23 SURGICAL SUPPLIES I/P (CO2304665 S STRL ETB,1,30",MO-7 $25.00 $24.00 23 SURGICAL SUPPLIES I/P (CO2304673 S STRL ETB,2,27",OS-4 $253.25 $233.50 23 SURGICAL SUPPLIES I/P (CO2304707 S STRL ETB,2-0,18"TIES $11.50 $11.50 23 SURGICAL SUPPLIES I/P (CO2304749 S STRL ETB,2-0,30"SH $12.00 $12.00 23 SURGICAL SUPPLIES I/P (CO2304681 S STRL ETB,5,30",V-37 $73.75 $73.75 23 SURGICAL SUPPLIES I/P (CO2304715 S STRL ETHIBOND,0,18"TI $5.50 $5.50 23 SURGICAL SUPPLIES I/P (CO2304871 S STRL ETHILON,10-0,5", $100.00 $100.00 23 SURGICAL SUPPLIES I/P (CO2317618 S STRL ETL,0,60" $9.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2304962 S STRL ETL,10-0,8",CS-B-6 $111.00 $105.00 23 SURGICAL SUPPLIES I/P (CO2315125 S STRL ETL,4-0,30",FSL $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2317626 S STRL EVACUATOR BLADDER $119.75 $100.25 23 SURGICAL SUPPLIES I/P (CO2308773 S STRL EXPAND TISS MCGHAN $3,301.00 $3,114.00 23 SURGICAL SUPPLIES I/P (CO2370013 S STRL EXTRACTOR STONE $262.00 $247.00 23 SURGICAL SUPPLIES I/P (CO2317675 S STRL FILIFORM WOVEN S $467.00 $441.00 23 SURGICAL SUPPLIES I/P (CO2308823 S STRL FLEXI-LUM $111.25 $111.25 23 SURGICAL SUPPLIES I/P (CO2313633 S STRL FOLEY CATH, TRATTN $396.75 $396.75 23 SURGICAL SUPPLIES I/P (CO2370039 S STRL FORCEPS GRASP $778.25 $782.00 23 SURGICAL SUPPLIES I/P (CO2317725 S STRL FTR PRE-FTR $123.00 $116.00 23 SURGICAL SUPPLIES I/P (CO2380608 S STRL GAS, C3F8/SF6 $388.00 $366.00 23 SURGICAL SUPPLIES I/P (CO2362481 S STRL GAUGE PINS $416.50 $416.50 23 SURGICAL SUPPLIES I/P (CO2318525 S STRL GIA 80 TIT MF 3.8 $682.25 $682.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2305035 S STRL GORE-TEX,CV-6,24 $101.75 $101.75 23 SURGICAL SUPPLIES I/P (CO2321099 S STRL GRASPER SUT 45 $1,041.25 $1,011.50 23 SURGICAL SUPPLIES I/P (CO2318111 S STRL GUIDE PIN AMBI $131.25 $131.25 23 SURGICAL SUPPLIES I/P (CO2391662 S STRL GUIDE PIN OMEGA $72.00 $68.00 23 SURGICAL SUPPLIES I/P (CO2318129 S STRL GUIDE PIN, ACE $161.00 $152.00 23 SURGICAL SUPPLIES I/P (CO2312585 S STRL GUIDE WIRE ARTHREX $187.00 23 SURGICAL SUPPLIES I/P (CO2318244 S STRL HALL BURR $74.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2309029 S STRL HANDLE FOR WIRE $1,157.25 $1,157.25 23 SURGICAL SUPPLIES I/P (CO2312841 S STRL HD/PERITNL LNG TRM $223.50 $223.50 23 SURGICAL SUPPLIES I/P (CO2312817 S STRL HD/PRITNL SHRT TRM $1,144.50 $784.00 23 SURGICAL SUPPLIES I/P (CO2318293 S STRL HELICAL LOOP BSKT $1,755.25 $1,755.25 23 SURGICAL SUPPLIES I/P (CO2318301 S STRL HEMORRHAGE PIN $797.00 $797.00 23 SURGICAL SUPPLIES I/P (CO2370088 S STRL HEMOSTAT SURG 2X2 $168.75 $150.50 23 SURGICAL SUPPLIES I/P (CO2370096 S STRL HEMOSTAT SURGICEL $260.00 $231.75 23 SURGICAL SUPPLIES I/P (CO2309060 S STRL HOLLISTER, BRIDGE $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2309078 S STRL HOLLISTER, CUT-T $12.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2314508 S STRL HOOK LAPAROSCOPI $112.00 23 SURGICAL SUPPLIES I/P (CO2309094 S STRL HOOKS DURA DISP $77.50 $77.50 23 SURGICAL SUPPLIES I/P (CO2309375 S STRL HOT KNIFE NEONATE $605.75 $605.75 23 SURGICAL SUPPLIES I/P (CO2318392 S STRL IMMOBILIZER SHOU $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2318434 S STRL INF FEEDING TUBE $9.50 $9.50 23 SURGICAL SUPPLIES I/P (CO2318467 S STRL INSERT SAFE JAW $85.50 $85.50 23 SURGICAL SUPPLIES I/P (CO2370104 S STRL INST BIOP MONOPTY $116.75 $116.75 23 SURGICAL SUPPLIES I/P (CO2318517 S STRL INSTR GIA 60 TIT $442.00 $442.00 23 SURGICAL SUPPLIES I/P (CO2318533 S STRL INSTR INTRALUM $1,209.00 $1,209.00 23 SURGICAL SUPPLIES I/P (CO2318608 S STRL INSTR SURGICLIP $261.50 $261.50 23 SURGICAL SUPPLIES I/P (CO2318616 S STRL INSTR TA30-3.5/4.8 $424.00 $424.00 23 SURGICAL SUPPLIES I/P (CO2318624 S STRL INSTR TA30-V3 TIT $459.50 $459.50 23 SURGICAL SUPPLIES I/P (CO2350783 S STRL INTRASPINAL ROD $430.00 $405.00 23 SURGICAL SUPPLIES I/P (CO2318707 S STRL IRR SIMPULSE SUC $171.25 $171.25 23 SURGICAL SUPPLIES I/P (CO2309227 S STRL KIT BONE MAR COLT $1,209.75 $1,209.75 23 SURGICAL SUPPLIES I/P (CO2309243 S STRL KIT DRAINAGE ICP $854.25 $854.25 23 SURGICAL SUPPLIES I/P (CO2309250 S STRL KIT FILL MCGHAN $52.50 $52.50 23 SURGICAL SUPPLIES I/P (CO2319184 S STRL KIT LAP CHOLE $1,149.00 $1,084.00 23 SURGICAL SUPPLIES I/P (CO2309342 S STRL KIT SUCTION CATH $3.00 $3.00 23 SURGICAL SUPPLIES I/P (CO2341048 S STRL KNEE TOTAL SAW BL $209.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2309409 S STRL K-PAD DISP $30.25 $30.25 23 SURGICAL SUPPLIES I/P (CO2319192 S STRL LAP CHOLE KIT $1,264.00 $1,264.00 23 SURGICAL SUPPLIES I/P (CO2319028 S STRL LAP, ETHICON CLI $415.75 $415.75 23 SURGICAL SUPPLIES I/P (CO2319358 S STRL LAPAROSCOPIC TRO $540.00 $509.00 23 SURGICAL SUPPLIES I/P (CO2318947 S STRL LAPAROSCOPIC,CHO $273.00 $258.00 23 SURGICAL SUPPLIES I/P (CO2319564 S STRL LAPOROSCOPIC KIT $1,627.00 $1,535.00 23 SURGICAL SUPPLIES I/P (CO2390870 S STRL LAPRSCPC CONVT $31.00 $29.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2319010 S STRL LAPSNC ENDO CLIP $431.75 $431.75 23 SURGICAL SUPPLIES I/P (CO2319150 S STRL LAPSNC INSTR ENDO $933.00 $933.00 23 SURGICAL SUPPLIES I/P (CO2319135 S STRL LAPSNC INSTR ENDO $303.25 $736.00 23 SURGICAL SUPPLIES I/P (CO2319226 S STRL LAPSNC NDL $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO2319242 S STRL LAPSNC SEAL ENDO $133.00 $126.00 23 SURGICAL SUPPLIES I/P (CO2325918 S STRL LAPSNC STRYKE-FLO $710.50 23 SURGICAL SUPPLIES I/P (CO2319267 S STRL LAPSNC SUC $109.25 $109.25 23 SURGICAL SUPPLIES I/P (CO2319317 S STRL LAPSNC SYS TACKER $1,820.25 $1,820.25 23 SURGICAL SUPPLIES I/P (CO2319606 S STRL LASER FIBER ENDO $403.75 $403.75 23 SURGICAL SUPPLIES I/P (CO2314300 S STRL LEAD CLIPPERS $267.50 $238.00 23 SURGICAL SUPPLIES I/P (CO2319663 S STRL LENS GLIDE $29.00 $28.00 23 SURGICAL SUPPLIES I/P (CO2325934 S STRL LINEAR CUTTER ENDO $1,779.50 23 SURGICAL SUPPLIES I/P (CO2319721 S STRL LITE PIPE W/PIK $277.00 $261.00 23 SURGICAL SUPPLIES I/P (CO2308492 S STRL LOOP BALL/CUTTING $580.75 $580.75 23 SURGICAL SUPPLIES I/P (CO2319754 S STRL LOOPS VESSEL $10.75 $10.50 23 SURGICAL SUPPLIES I/P (CO2321750 S STRL LUHR, DRILL BIT $376.00 $355.00 23 SURGICAL SUPPLIES I/P (CO2310571 S STRL MEASURING KIT $454.00 23 SURGICAL SUPPLIES I/P (CO2319820 S STRL MERSILENE,4-0,18 $23.25 $23.25 23 SURGICAL SUPPLIES I/P (CO2305209 S STRL MERSILENE,4-0,18" $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2305191 S STRL MERSILENE,5-0,18" $53.75 $51.75 23 SURGICAL SUPPLIES I/P (CO2305183 S STRL MERSILENE,5MM,36" $282.25 $240.25 23 SURGICAL SUPPLIES I/P (CO2309615 S STRL MICRODISSECT NDL $171.00 $171.00 23 SURGICAL SUPPLIES I/P (CO2319853 S STRL MON 3-0 27"PS-1 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2319861 S STRL MON 3-0,27"SH $12.25 $11.75 23 SURGICAL SUPPLIES I/P (CO2305266 S STRL MON,2-0,27",SH $12.25 $11.75 23 SURGICAL SUPPLIES I/P (CO2305324 S STRL MON,2-0,27",UR-6 $14.00 $13.50 23 SURGICAL SUPPLIES I/P (CO2305316 S STRL MON,4-0,18",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305274 S STRL MON,4-0,27",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305282 S STRL MON,5-0,18",P-3 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305308 S STRL MON,5-0,18",PS-2 $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2305290 S STRL MONOCRYL,4-O,18" $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2309763 S STRL NASAL PK XOMED $82.00 $72.75 23 SURGICAL SUPPLIES I/P (CO2319911 S STRL NDL BX NASHOLD $1,296.25 $1,296.25 23 SURGICAL SUPPLIES I/P (CO2319937 S STRL NDL BX TRU-CUT $95.50 $95.50 23 SURGICAL SUPPLIES I/P (CO2319945 S STRL NDL CHEMO/CHIBA $46.50 $46.50 23 SURGICAL SUPPLIES I/P (CO2309649 S STRL NDL SUT $27.75 $27.75 23 SURGICAL SUPPLIES I/P (CO2300127 S STRL NERVE STIMULATER $220.25 $223.25 23 SURGICAL SUPPLIES I/P (CO2309656 S STRL NOZZLE HANDPIECE $316.75 $316.75 23 SURGICAL SUPPLIES I/P (CO2303766 S STRL NURO,4-0,18",TF $76.00 $76.00 23 SURGICAL SUPPLIES I/P (CO2325868 S STRL NUROLON 0 CT-2 $58.25 23 SURGICAL SUPPLIES I/P (CO2305365 S STRL NUROLON,1,18" $40.50 $40.50 23 SURGICAL SUPPLIES I/P (CO2300309 S STRL OTHER MISC $5,478.00 $5,168.00 23 SURGICAL SUPPLIES I/P (CO2300226 S STRL OTHER MISC $3,511.00 $3,313.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2300283 S STRL OTHER MISC $4,916.00 $4,638.00 23 SURGICAL SUPPLIES I/P (CO2300218 S STRL OTHER MISC $3,230.00 $3,048.00 23 SURGICAL SUPPLIES I/P (CO2300184 S STRL OTHER MISC $2,949.00 $2,783.00 23 SURGICAL SUPPLIES I/P (CO2300234 S STRL OTHER MISC $3,792.00 $3,578.00 23 SURGICAL SUPPLIES I/P (CO2300481 S STRL OTHER MISC $3,835.00 $3,618.00 23 SURGICAL SUPPLIES I/P (CO2300291 S STRL OTHER MISC $5,197.00 $4,903.00 23 SURGICAL SUPPLIES I/P (CO2300259 S STRL OTHER MISC $4,354.00 $4,108.00 23 SURGICAL SUPPLIES I/P (CO2300242 S STRL OTHER MISC $4,073.00 $3,843.00 23 SURGICAL SUPPLIES I/P (CO2300275 S STRL OTHER MISC $4,635.00 $4,373.00 23 SURGICAL SUPPLIES I/P (CO2300168 S STRL OTHER MISC 0 - 10 $33.00 $31.00 23 SURGICAL SUPPLIES I/P (CO2300192 S STRL OTHER MISC 101-150 $597.00 $563.00 23 SURGICAL SUPPLIES I/P (CO2300200 S STRL OTHER MISC 11 - 19 $89.00 $84.00 23 SURGICAL SUPPLIES I/P (CO2300267 S STRL OTHER MISC 151-200 $836.00 $789.00 23 SURGICAL SUPPLIES I/P (CO2300325 S STRL OTHER MISC 201-250 $1,074.00 $1,013.00 23 SURGICAL SUPPLIES I/P (CO2300317 S STRL OTHER MISC 20-49 $187.00 $176.00 23 SURGICAL SUPPLIES I/P (CO2300333 S STRL OTHER MISC 251-300 $1,314.00 $1,239.00 23 SURGICAL SUPPLIES I/P (CO2300341 S STRL OTHER MISC 301-350 $1,552.00 $1,464.00 23 SURGICAL SUPPLIES I/P (CO2300358 S STRL OTHER MISC 351-400 $1,791.00 $1,690.00 23 SURGICAL SUPPLIES I/P (CO2300366 S STRL OTHER MISC 401-450 $2,029.00 $1,914.00 23 SURGICAL SUPPLIES I/P (CO2300374 S STRL OTHER MISC 451-500 $2,269.00 $2,140.00 23 SURGICAL SUPPLIES I/P (CO2300382 S STRL OTHER MISC 501-550 $2,065.00 $1,948.00 23 SURGICAL SUPPLIES I/P (CO2300390 S STRL OTHER MISC 51-100 $358.00 $338.00 23 SURGICAL SUPPLIES I/P (CO2300408 S STRL OTHER MISC 551-600 $2,262.00 $2,134.00 23 SURGICAL SUPPLIES I/P (CO2300416 S STRL OTHER MISC 601-650 $2,458.00 $2,319.00 23 SURGICAL SUPPLIES I/P (CO2300424 S STRL OTHER MISC 651-700 $2,655.00 $2,505.00 23 SURGICAL SUPPLIES I/P (CO2300432 S STRL OTHER MISC 701-750 $2,852.00 $2,690.00 23 SURGICAL SUPPLIES I/P (CO2300440 S STRL OTHER MISC 751-800 $3,048.00 $2,876.00 23 SURGICAL SUPPLIES I/P (CO2300457 S STRL OTHER MISC 801-850 $3,245.00 $3,061.00 23 SURGICAL SUPPLIES I/P (CO2300465 S STRL OTHER MISC 851-900 $3,442.00 $3,247.00 23 SURGICAL SUPPLIES I/P (CO2300473 S STRL OTHER MISC 901-950 $3,638.00 $3,432.00 23 SURGICAL SUPPLIES I/P (CO2300762 S STRL PACKING OXYCEL C $217.00 $205.00 23 SURGICAL SUPPLIES I/P (CO2309789 S STRL PAD C-CLAMP $12.00 $11.00 23 SURGICAL SUPPLIES I/P (CO2309821 S STRL PAD ELECTRO GROUND $52.50 $52.50 23 SURGICAL SUPPLIES I/P (CO2300812 S STRL PAD GROUNDING $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2309854 S STRL PAD MAG INST LG $39.00 $36.00 23 SURGICAL SUPPLIES I/P (CO2309862 S STRL PAD MAG NDL SM $5.75 $5.75 23 SURGICAL SUPPLIES I/P (CO2309896 S STRL PADDING RESTON $15.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2309797 S STRL PADS DEFIB $97.00 $97.00 23 SURGICAL SUPPLIES I/P (CO2300945 S STRL PDS,0,27",CT-1 ( $14.25 $14.00 23 SURGICAL SUPPLIES I/P (CO2391423 S STRL PDS,0,27",CT-2 $15.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2305522 S STRL PDS,1,27",CT-1 ( $14.75 $14.25 23 SURGICAL SUPPLIES I/P (CO2305548 S STRL PDS,1,27"OS-6 $18.50 $16.75 23 SURGICAL SUPPLIES I/P (CO2305530 S STRL PDS,1,36",CTX $16.75 $16.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2305563 S STRL PDS,1,54",TPB-1 $29.50 $28.75 23 SURGICAL SUPPLIES I/P (CO2300960 S STRL PDS,2-0,27",CT-1 $14.25 $13.75 23 SURGICAL SUPPLIES I/P (CO2305555 S STRL PDS,3-0, 18",SH $84.50 $84.50 23 SURGICAL SUPPLIES I/P (CO2305514 S STRL PDS,3-0,27",CT-1 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2300986 S STRL PDS,4-0,27",FS-2 $19.50 $19.00 23 SURGICAL SUPPLIES I/P (CO2301034 S STRL PEG, UNIV FEEDUB $51.00 $49.00 23 SURGICAL SUPPLIES I/P (CO2301042 S STRL PEN SKIN REG TIP $3.75 $3.75 23 SURGICAL SUPPLIES I/P (CO2309904 S STRL PERFORATOR CRANI $947.75 $947.75 23 SURGICAL SUPPLIES I/P (CO2360808 S STRL PIN BEATH $101.00 $95.00 23 SURGICAL SUPPLIES I/P (CO2360832 S STRL PIN K-WIRE $35.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2360840 S STRL PIN K-WIRE $93.00 $93.00 23 SURGICAL SUPPLIES I/P (CO2360857 S STRL PIN MAYFIELD SKULL $119.25 $119.25 23 SURGICAL SUPPLIES I/P (CO2360931 S STRL PIN STNMAN PLAIN $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2360972 S STRL PIN, GUIDE ALPHA $75.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2319713 S STRL PIPE MICRLITE 20G $229.00 $216.00 23 SURGICAL SUPPLIES I/P (CO2300705 S STRL PK ADAPTIC 1/2" $22.50 $15.00 23 SURGICAL SUPPLIES I/P (CO2300721 S STRL PK IODO $12.75 $19.75 23 SURGICAL SUPPLIES I/P (CO2300770 S STRL PK OXYCEL GAUZE $164.00 $155.00 23 SURGICAL SUPPLIES I/P (CO2300788 S STRL PK PLN $11.25 $16.75 23 SURGICAL SUPPLIES I/P (CO2309755 S STRL PK RHINO ROCKET $119.25 $112.25 23 SURGICAL SUPPLIES I/P (CO2309771 S STRL PK VAG 2" $15.25 $15.25 23 SURGICAL SUPPLIES I/P (CO2301133 S STRL PLAIN GUT, 3-0,2 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2301141 S STRL PLAIN GUT,3-0,27 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2361053 S STRL PLASTER SPLINTS $4.25 $4.25 23 SURGICAL SUPPLIES I/P (CO2301166 S STRL PLEDGET OVAL 6X4.5 $57.75 $57.75 23 SURGICAL SUPPLIES I/P (CO2370393 S STRL PLN GUT 2-0 54 $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2301125 S STRL PLN GUT 2-0,27CT-1 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2305605 S STRL PLN GUT, 6-0 18" $30.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2305597 S STRL PLN GUT,6-0,18" $80.25 $80.25 23 SURGICAL SUPPLIES I/P (CO2301158 S STRL PLSTC ANEURO/CRANI $3,133.00 $3,133.00 23 SURGICAL SUPPLIES I/P (CO2301224 S STRL PORT INDWELLING $1,021.00 $963.00 23 SURGICAL SUPPLIES I/P (CO2309953 S STRL PORT INDWELLING $1,253.75 $1,253.75 23 SURGICAL SUPPLIES I/P (CO2312767 S STRL PORT INDWELLING $1,021.00 $963.00 23 SURGICAL SUPPLIES I/P (CO2309086 S STRL POUCH CLAMP $5.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2303683 S STRL PRO 2-0, 36", SH $25.50 $25.50 23 SURGICAL SUPPLIES I/P (CO2370252 S STRL PRO, 2-0, 30" $13.75 23 SURGICAL SUPPLIES I/P (CO2303758 S STRL PRO, 7-0, 18" $52.25 $52.25 23 SURGICAL SUPPLIES I/P (CO2301505 S STRL PRO, HS-7,5-0,24" $72.50 $72.50 23 SURGICAL SUPPLIES I/P (CO2301513 S STRL PRO,0,30",MO-6 $17.75 $17.75 23 SURGICAL SUPPLIES I/P (CO2301521 S STRL PRO,0,30",SH $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2305894 S STRL PRO,3-0,18",PC-5 $28.25 $28.25 23 SURGICAL SUPPLIES I/P (CO2391290 S STRL PRO,3-0,30",SH $13.00 $13.00 23 SURGICAL SUPPLIES I/P (CO2306009 S STRL PRO,4-0,30",C-1 $52.50 $46.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2305852 S STRL PRO,4-0,36",RB-1 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2305845 S STRL PRO,5-0,36",RB-1 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2303741 S STRL PRO,6-0, 30", C-1 $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2305969 S STRL PRO,7-0,24",CC $58.75 $58.75 23 SURGICAL SUPPLIES I/P (CO2307361 S STRL PROBE ABC W/3" TIP $433.50 $421.00 23 SURGICAL SUPPLIES I/P (CO2309995 S STRL PROBE CAUTERY $314.00 $297.00 23 SURGICAL SUPPLIES I/P (CO2301364 S STRL PROBE COHRNT ENDO $779.25 $779.25 23 SURGICAL SUPPLIES I/P (CO2309987 S STRL PROBE LAPSNC ABC $704.00 $704.00 23 SURGICAL SUPPLIES I/P (CO2301414 S STRL PROBE LITHO WOLF $1,076.00 $1,044.75 23 SURGICAL SUPPLIES I/P (CO2301448 S STRL PROBE NIM-2 FLUSH $403.25 $404.50 23 SURGICAL SUPPLIES I/P (CO2301562 S STRL PUMP SL ACTION $223.50 $219.50 23 SURGICAL SUPPLIES I/P (CO2362630 S STRL REAMER ARTHREX $871.25 $871.25 23 SURGICAL SUPPLIES I/P (CO2310134 S STRL RESER JP $31.00 $31.00 23 SURGICAL SUPPLIES I/P (CO2301679 S STRL RESER OMMAYA $1,670.25 $1,559.75 23 SURGICAL SUPPLIES I/P (CO2301737 S STRL RETRACTOR FISH M $109.75 $109.75 23 SURGICAL SUPPLIES I/P (CO2301745 S STRL RETRACTOR IRIS $127.00 $120.00 23 SURGICAL SUPPLIES I/P (CO2301869 S STRL SCISSOR VERT MICRO $315.00 $297.00 23 SURGICAL SUPPLIES I/P (CO2382380 S STRL SEALANT PULM LIQUI $890.75 23 SURGICAL SUPPLIES I/P (CO2382398 S STRL SEALANT PULM LIQUI $1,800.00 23 SURGICAL SUPPLIES I/P (CO2390607 S STRL SET CYSTO IRR $16.50 $19.25 23 SURGICAL SUPPLIES I/P (CO2301943 S STRL SET IRRIG CYSTO $45.00 $51.50 23 SURGICAL SUPPLIES I/P (CO2302008 S STRL SHEARS LAPAROSONIC $1,915.25 $1,487.50 23 SURGICAL SUPPLIES I/P (CO2322022 S STRL SHUNT $209.00 23 SURGICAL SUPPLIES I/P (CO2322006 S STRL SHUNT $229.50 $229.50 23 SURGICAL SUPPLIES I/P (CO2302479 S STRL SILK 2-0 12' REEL $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2302578 S STRL SILK 4-0 30"CV-331 $9.75 $9.75 23 SURGICAL SUPPLIES I/P (CO2325884 S STRL SILK ENDO 0 7" $99.75 23 SURGICAL SUPPLIES I/P (CO2325876 S STRL SILK ENDO 2-0 48" $99.75 23 SURGICAL SUPPLIES I/P (CO2391340 S STRL SILK, 0, 12' REEL $7.25 $7.25 23 SURGICAL SUPPLIES I/P (CO2302453 S STRL SILK, 0, 30", T-5 $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2391316 S STRL SILK, 4-0,18"TIES $10.00 $10.00 23 SURGICAL SUPPLIES I/P (CO2302586 S STRL SILK, 5-0, 30" $9.00 $9.00 23 SURGICAL SUPPLIES I/P (CO2306322 S STRL SILK,0,18"TIES $4.00 $4.00 23 SURGICAL SUPPLIES I/P (CO2306355 S STRL SILK,0,30",TIES, $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2306363 S STRL SILK,1,30"TIES $6.75 $6.75 23 SURGICAL SUPPLIES I/P (CO2302461 S STRL SILK,2,30",MH $10.25 $10.25 23 SURGICAL SUPPLIES I/P (CO2302487 S STRL SILK,2-0,18" TIES $8.50 $8.50 23 SURGICAL SUPPLIES I/P (CO2306074 S STRL SILK,2-0,18",FS $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2306348 S STRL SILK,2-0,30"TIES $13.25 $13.25 23 SURGICAL SUPPLIES I/P (CO2306082 S STRL SILK,3-0,30",KS $8.25 $8.25 23 SURGICAL SUPPLIES I/P (CO2302560 S STRL SILK,4-0,18",SH $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2302677 S STRL SMOOTH LIGAMENT $1,121.75 $1,121.75 23 SURGICAL SUPPLIES I/P (CO2302685 S STRL SNARE WIRE $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2381630 S STRL SOLUTION BSS PLU $246.00 $232.00 23 SURGICAL SUPPLIES I/P (CO2317402 S STRL SPLASH SHIELD $85.00 $80.00 23 SURGICAL SUPPLIES I/P (CO2361855 S STRL SPLINT NASAL REU $179.50 $179.50 23 SURGICAL SUPPLIES I/P (CO2303014 S STRL STAPLER VERSATAC $598.25 $598.25 23 SURGICAL SUPPLIES I/P (CO2303048 S STRL STAYS ELSTC $230.50 $230.50 23 SURGICAL SUPPLIES I/P (CO2303162 S STRL STENT URET CONTO $888.25 $888.25 23 SURGICAL SUPPLIES I/P (CO2303451 S STRL STONETOME 20MM $1,518.00 $1,432.00 23 SURGICAL SUPPLIES I/P (CO2302917 S STRL STPL CART $807.50 $807.50 23 SURGICAL SUPPLIES I/P (CO2303006 S STRL STPLR SKIN 35W $42.00 $40.00 23 SURGICAL SUPPLIES I/P (CO2303030 S STRL STPLS CTG TA $237.00 $237.00 23 SURGICAL SUPPLIES I/P (CO2303527 S STRL STRIPPER VEIN $130.75 $130.75 23 SURGICAL SUPPLIES I/P (CO2303600 S STRL SUC/COAGULATOR $55.25 $42.50 23 SURGICAL SUPPLIES I/P (CO2303642 S STRL SUPPLIES SURGERY 23 SURGICAL SUPPLIES I/P (CO2301265 S STRL SURGICAL TISSUE $218.50 $212.00 23 SURGICAL SUPPLIES I/P (CO2317113 S STRL SURGICEL FIBRILLAR $638.75 23 SURGICAL SUPPLIES I/P (CO2316990 S STRL SURGICEL FIBRILLAR $511.00 23 SURGICAL SUPPLIES I/P (CO2316891 S STRL SURGICEL FIBRILLAR $277.75 23 SURGICAL SUPPLIES I/P (CO2391282 S STRL SURGL,4-0,18" $15.25 $15.25 23 SURGICAL SUPPLIES I/P (CO2304293 S STRL SUT CHR 636 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304327 S STRL SUT CHR 790 $57.75 $57.75 23 SURGICAL SUPPLIES I/P (CO2304335 S STRL SUT CHR 794 $70.50 $70.50 23 SURGICAL SUPPLIES I/P (CO2304350 S STRL SUT CHR G121 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304400 S STRL SUT CHR U202 $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2304418 S STRL SUT CHR U203 $14.50 $14.50 23 SURGICAL SUPPLIES I/P (CO2304541 S STRL SUT DEX 1 60" TIES $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2304814 S STRL SUT ETL $23.50 $23.50 23 SURGICAL SUPPLIES I/P (CO2315091 S STRL SUT ETL 1629H $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315083 S STRL SUT ETL 1633G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304798 S STRL SUT ETL 1667/662 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304822 S STRL SUT ETL 1698 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304905 S STRL SUT ETL 470 $19.50 $19.50 23 SURGICAL SUPPLIES I/P (CO2304913 S STRL SUT ETL 490 $20.75 $20.75 23 SURGICAL SUPPLIES I/P (CO2304939 S STRL SUT ETL 661 $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315133 S STRL SUT ETL 698G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315117 S STRL SUT ETL 699G $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2304947 S STRL SUT ETL 7707 $98.25 $98.25 23 SURGICAL SUPPLIES I/P (CO2304954 S STRL SUT ETL 824 $16.25 $16.25 23 SURGICAL SUPPLIES I/P (CO2304988 S STRL SUT GORE-TEX 3N08 $91.75 $91.75 23 SURGICAL SUPPLIES I/P (CO2305027 S STRL SUT GORE-TEX 6K02 $112.00 $106.50 23 SURGICAL SUPPLIES I/P (CO2305357 S STRL SUT NUROLON C584 $72.75 $72.75 23 SURGICAL SUPPLIES I/P (CO2305449 S STRL SUT PASSER $218.50 $218.50 23 SURGICAL SUPPLIES I/P (CO2305498 S STRL SUT PDS Z316 $15.00 $14.50 23 SURGICAL SUPPLIES I/P (CO2305506 S STRL SUT PDS Z317 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2305571 S STRL SUT PDS Z880 $29.25 $28.50 23 SURGICAL SUPPLIES I/P (CO2305589 S STRL SUT PDS Z997 $72.00 $72.00 23 SURGICAL SUPPLIES I/P (CO2305662 S STRL SUT PLN 686 $27.50 $27.50 23 SURGICAL SUPPLIES I/P (CO2305670 S STRL SUT PLN 770 $57.75 $57.75 23 SURGICAL SUPPLIES I/P (CO2305837 S STRL SUT PRO 8424 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2303691 S STRL SUT PRO 8522H $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2305910 S STRL SUT PRO 8682 $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2305944 S STRL SUT PRO 8698 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2305951 S STRL SUT PRO 8699 $26.50 $26.50 23 SURGICAL SUPPLIES I/P (CO2303717 S STRL SUT PRO 8717H $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2303733 S STRL SUT PRO 8718H $33.50 $33.50 23 SURGICAL SUPPLIES I/P (CO2305993 S STRL SUT PRO 8806 $51.25 $51.25 23 SURGICAL SUPPLIES I/P (CO2303675 S STRL SUT PRO 8824G $21.50 $21.50 23 SURGICAL SUPPLIES I/P (CO2306025 S STRL SUT RETENT BOLSTER $39.50 $39.50 23 SURGICAL SUPPLIES I/P (CO2306041 S STRL SUT RETRIEVER $430.00 $405.00 23 SURGICAL SUPPLIES I/P (CO2302594 S STRL SUT SILK 639G $21.50 $21.50 23 SURGICAL SUPPLIES I/P (CO2306249 S STRL SUT SILK 683 $11.50 $11.50 23 SURGICAL SUPPLIES I/P (CO2306272 S STRL SUT SILK 735 $19.75 $19.75 23 SURGICAL SUPPLIES I/P (CO2306298 S STRL SUT SILK 768 $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2302511 S STRL SUT SILK C013D $47.50 $47.50 23 SURGICAL SUPPLIES I/P (CO2302552 S STRL SUT SILK C054T $54.75 $54.75 23 SURGICAL SUPPLIES I/P (CO2302529 S STRL SUT SILK K832H $8.75 $8.75 23 SURGICAL SUPPLIES I/P (CO2302495 S STRL SUT SILK K833H $8.75 $8.75 23 SURGICAL SUPPLIES I/P (CO2306405 S STRL SUT SILK K882 $10.50 $10.50 23 SURGICAL SUPPLIES I/P (CO2302545 S STRL SUT SILK LA53G $8.00 $8.00 23 SURGICAL SUPPLIES I/P (CO2302503 S STRL SUT SILK LA54G $7.75 $7.75 23 SURGICAL SUPPLIES I/P (CO2306488 S STRL SUT TEVDEK 7-946 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2306496 S STRL SUT TEVDEK 7-947 $14.00 $14.00 23 SURGICAL SUPPLIES I/P (CO2306504 S STRL SUT TEVDEK 7-950 $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2306546 S STRL SUT VIC 10-0 V960G $63.50 $63.50 23 SURGICAL SUPPLIES I/P (CO2315281 S STRL SUT VIC J110T $47.00 $47.00 23 SURGICAL SUPPLIES I/P (CO2315240 S STRL SUT VIC J111T $47.75 $47.75 23 SURGICAL SUPPLIES I/P (CO2315190 S STRL SUT VIC J112T $30.50 $30.50 23 SURGICAL SUPPLIES I/P (CO2306645 S STRL SUT VIC J270 $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315182 S STRL SUT VIC J415H $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2315299 S STRL SUT VIC J416H $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2315331 S STRL SUT VIC J426H $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2315265 S STRL SUT VIC J427H $24.75 $24.75 23 SURGICAL SUPPLIES I/P (CO2315356 S STRL SUT VIC J493G $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2315307 S STRL SUT VIC J494G $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2315232 S STRL SUT VIC J775 $58.50 $58.50 23 SURGICAL SUPPLIES I/P (CO2315224 S STRL SUT VIC J880T $21.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2315349 S STRL SUT VIC J935H $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2315208 S STRL SUT VIC J978H $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2306827 S STRL SUT VIC J979 $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2306835 S STRL SUT VIC J980 $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2304806 S STRL SUTURE ETHILON 1 $23.50 $23.50 23 SURGICAL SUPPLIES I/P (CO2305225 S STRL SUTURE MERSILENE $94.75 $94.75 23 SURGICAL SUPPLIES I/P (CO2305332 S STRL SUTURE MONOCRYL $29.75 $29.75 23 SURGICAL SUPPLIES I/P (CO2303725 S STRL SUTURE PROLENE 8 $34.00 $34.00 23 SURGICAL SUPPLIES I/P (CO2303709 S STRL SUTURE PROLENE 8 $25.75 $25.75 23 SURGICAL SUPPLIES I/P (CO2306033 S STRL SUTURE RETENT BR $34.75 $34.75 23 SURGICAL SUPPLIES I/P (CO2302537 S STRL SUTURE SILK A184 $8.50 $8.50 23 SURGICAL SUPPLIES I/P (CO2302602 S STRL SUTURE SILK K889 $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2315216 S STRL SUTURE VICRYL J1 $28.50 $28.50 23 SURGICAL SUPPLIES I/P (CO2315257 S STRL SUTURE VICRYL J4 $11.25 $11.25 23 SURGICAL SUPPLIES I/P (CO2391092 S STRL TIC,0,18"TIES $30.75 $23.75 23 SURGICAL SUPPLIES I/P (CO2307304 S STRL TIC,0,30"CV-305 $30.50 $29.75 23 SURGICAL SUPPLIES I/P (CO2306538 S STRL TIC,2,36",T-12 $52.25 $50.75 23 SURGICAL SUPPLIES I/P (CO2391084 S STRL TIC,2-0,18"TIES $30.75 $23.50 23 SURGICAL SUPPLIES I/P (CO2391076 S STRL TIC,3-0,18" $35.25 $29.50 23 SURGICAL SUPPLIES I/P (CO2307320 S STRL TIC,4-0,18"TIES $14.25 $14.25 23 SURGICAL SUPPLIES I/P (CO2306512 S STRL TIC,5,30",C-20 $54.25 $56.00 23 SURGICAL SUPPLIES I/P (CO2307312 S STRL TICRON,0,30"TIES $23.25 $18.00 23 SURGICAL SUPPLIES I/P (CO2307379 S STRL TIP IRRIG/SUC $60.75 $60.75 23 SURGICAL SUPPLIES I/P (CO2307353 S STRL TIP SIMPULSE $55.75 $55.75 23 SURGICAL SUPPLIES I/P (CO2307486 S STRL TRACH TUBE $410.25 $399.50 23 SURGICAL SUPPLIES I/P (CO2307502 S STRL TRACH TUBE $209.75 $209.75 23 SURGICAL SUPPLIES I/P (CO2307510 S STRL TRACH VENT $287.00 $270.00 23 SURGICAL SUPPLIES I/P (CO2307536 S STRL TRACT SHLD $180.50 $180.50 23 SURGICAL SUPPLIES I/P (CO2307528 S STRL TRACT SHLD KIT $299.75 $299.75 23 SURGICAL SUPPLIES I/P (CO2307544 S STRL TRACT STRIP $20.00 $19.00 23 SURGICAL SUPPLIES I/P (CO2307569 S STRL TRAP STONE CATCH $22.00 $21.00 23 SURGICAL SUPPLIES I/P (CO2307619 S STRL TRAY, COLLAGEN N $111.75 $111.75 23 SURGICAL SUPPLIES I/P (CO2325959 S STRL TROCAR ENDO 10-12M $219.50 23 SURGICAL SUPPLIES I/P (CO2325942 S STRL TROCAR ENDOPATH $197.00 23 SURGICAL SUPPLIES I/P (CO2307700 S STRL TROCAR THORACOPORT $218.75 $218.75 23 SURGICAL SUPPLIES I/P (CO2353381 S STRL TSRH STPL ANT $950.00 23 SURGICAL SUPPLIES I/P (CO2307718 S STRL TUBE BAKER $1,285.25 $1,261.25 23 SURGICAL SUPPLIES I/P (CO2307767 S STRL TUBE CONNECTING $3.00 $2.00 23 SURGICAL SUPPLIES I/P (CO2307809 S STRL TUBE GASTMY MIC $187.50 $187.50 23 SURGICAL SUPPLIES I/P (CO2307791 S STRL TUBE GASTRO $752.00 $752.00 23 SURGICAL SUPPLIES I/P (CO2307825 S STRL TUBE LARYNGECTOMY $221.25 $211.75 23 SURGICAL SUPPLIES I/P (CO2307866 S STRL TUBE LUKI ASPRT $34.00 $32.00 23 SURGICAL SUPPLIES I/P (CO2307882 S STRL TUBE SALUM SUMP $21.50 $27.00 23 SURGICAL SUPPLIES I/P (CO2307890 S STRL TUBE SET GAS FLUID $153.00 $144.00 23 SURGICAL SUPPLIES I/P (CO

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2325850 S STRL TUBE VENT DURAVENT $102.00 23 SURGICAL SUPPLIES I/P (CO2308203 S STRL UMBILICAL TAPE $10.75 $10.75 23 SURGICAL SUPPLIES I/P (CO2308229 S STRL UNISHUNT SYS $1,993.00 $1,993.00 23 SURGICAL SUPPLIES I/P (CO2352557 S STRL UNIV SPINE STPL $1,848.25 $1,848.25 23 SURGICAL SUPPLIES I/P (CO2390771 S STRL VALVE ANTI-REFLU $35.00 $33.00 23 SURGICAL SUPPLIES I/P (CO2308369 S STRL VIC 7-0 18 TG140-8 $62.25 $62.25 23 SURGICAL SUPPLIES I/P (CO2308377 S STRL VIC 8-0 8"TG140-8 $67.00 $67.00 23 SURGICAL SUPPLIES I/P (CO2391407 S STRL VIC, 2-0 36" V-34 $18.00 $18.00 23 SURGICAL SUPPLIES I/P (CO2308344 S STRL VIC, 2-0, 27"UR-6 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2308351 S STRL VIC, 4-0, 18" $27.75 $24.75 23 SURGICAL SUPPLIES I/P (CO2304640 S STRL VIC,0,27 $62.75 $62.75 23 SURGICAL SUPPLIES I/P (CO2304657 S STRL VIC,0,27",CT $60.75 $60.75 23 SURGICAL SUPPLIES I/P (CO2306694 S STRL VIC,0,27",SH $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2306751 S STRL VIC,0,27",UR-6 $13.50 $13.50 23 SURGICAL SUPPLIES I/P (CO2315380 S STRL VIC,0,27,CT-2 $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2306801 S STRL VIC,1,36",CT $12.50 $12.50 23 SURGICAL SUPPLIES I/P (CO2306819 S STRL VIC,1,36",CTX $12.75 $12.75 23 SURGICAL SUPPLIES I/P (CO2306702 S STRL VIC,2-0 27",FS-1 $15.50 $15.50 23 SURGICAL SUPPLIES I/P (CO2306785 S STRL VIC,2-0,18",CTX $60.00 $60.00 23 SURGICAL SUPPLIES I/P (CO2306769 S STRL VIC,2-0,18",OS-6 $38.75 $38.75 23 SURGICAL SUPPLIES I/P (CO2304632 S STRL VIC,2-0,27",CT-2 $12.25 $12.25 23 SURGICAL SUPPLIES I/P (CO2306686 S STRL VIC,2-0,27",UR-5 $13.75 $13.75 23 SURGICAL SUPPLIES I/P (CO2315273 S STRL VIC,3-0,18",SH $61.50 $61.50 23 SURGICAL SUPPLIES I/P (CO2306710 S STRL VIC,3-0,27",PSL $30.00 $30.00 23 SURGICAL SUPPLIES I/P (CO2307023 S STRL VIC,3-0,36",SH $22.75 $22.75 23 SURGICAL SUPPLIES I/P (CO2306595 S STRL VIC,4-0,27",SH-1 $11.75 $11.75 23 SURGICAL SUPPLIES I/P (CO2306728 S STRL VIC,6-0,18" $61.00 $61.00 23 SURGICAL SUPPLIES I/P (CO2315364 S STRL VICRYL,5-0,18"PS $25.00 $25.00 23 SURGICAL SUPPLIES I/P (CO2308401 S STRL VISIBILITY BACKG $46.00 $43.00 23 SURGICAL SUPPLIES I/P (CO2362390 S STRL WIRE SS 18-24 GA $36.00 $36.00 23 SURGICAL SUPPLIES I/P (CO2362408 S STRL WIRE SS 26-30 GA $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2315109 S STRL WIRE, 2-0,18",17PK $31.75 $31.75 23 SURGICAL SUPPLIES I/P (CO2302891 S STRL WIRE, 3-0, 18" $32.25 $32.25 23 SURGICAL SUPPLIES I/P (CO2302909 S STRL WIRE, 5, 18" $70.00 $70.00 23 SURGICAL SUPPLIES I/P (CO2326593 URINARY SPHINCTER PROSTH $2,048.00 23 SURGICAL SUPPLIES I/P (CO2013563 AD EVAL ABR $1,289.00 20 SURGICAL SVCS IP PROCEDUR2013480 AD EVAL ABR $1,390.00 20 SURGICAL SVCS IP PROCEDUR2013498 AD EVAL ABR $1,879.00 20 SURGICAL SVCS IP PROCEDUR2013506 AD EVAL ABR $2,542.00 20 SURGICAL SVCS IP PROCEDUR2013514 AD EVAL ABR $3,438.00 20 SURGICAL SVCS IP PROCEDUR2013522 AD EVAL ABR $1,141.00 20 SURGICAL SVCS IP PROCEDUR2013530 AD EVAL ABR $1,544.00 20 SURGICAL SVCS IP PROCEDUR2013555 AD EVAL ABR $2,824.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2013548 AD EVAL ABR $2,088.00 20 SURGICAL SVCS IP PROCEDUR2013472 AD EVAL ABR $1,027.00 20 SURGICAL SVCS IP PROCEDUR2040160 ANORECTAL MANOMETRY $1,919.00 $1,423.00 20 SURGICAL SVCS IP PROCEDUR2040335 BX LIVER $3,002.00 20 SURGICAL SVCS IP PROCEDUR2040301 CA ECHO TRANSESOPHAGEAL $1,849.00 20 SURGICAL SVCS IP PROCEDUR2040376 CAPSULE ENDOSCOPY $2,384.00 20 SURGICAL SVCS IP PROCEDUR2013183 CELL SAVER SERVICE $5,261.00 20 SURGICAL SVCS IP PROCEDUR2050607 COLONOSCOPY $970.00 20 SURGICAL SVCS IP PROCEDUR2040244 COLONOSCOPY $2,871.00 20 SURGICAL SVCS IP PROCEDUR2050615 COLONOSCOPY INTERVENTN $1,150.00 20 SURGICAL SVCS IP PROCEDUR2040251 COLONOSCOPY INTERVENTN $3,406.00 20 SURGICAL SVCS IP PROCEDUR2021459 CPLX GENRL ANES ADD 15M $702.00 $423.00 20 SURGICAL SVCS IP PROCEDUR2021442 CPLX GENRL ANES FIRST 30M $1,312.00 $790.00 20 SURGICAL SVCS IP PROCEDUR2013209 CX CASE OR $1,886.00 20 SURGICAL SVCS IP PROCEDUR2040053 EGD $2,775.00 $2,058.00 20 SURGICAL SVCS IP PROCEDUR2050623 EGD $698.00 20 SURGICAL SVCS IP PROCEDUR2050631 EGD INTERVENTN $1,006.00 20 SURGICAL SVCS IP PROCEDUR2040343 EGD INTERVENTN $2,979.00 20 SURGICAL SVCS IP PROCEDUR2013571 EMG ANAL/URETHRAL SPHNCTR $1,153.00 20 SURGICAL SVCS IP PROCEDUR2013456 EMG FOUR LIMBS $1,452.00 20 SURGICAL SVCS IP PROCEDUR2013290 EMG HEAD OR NECK BIL $2,408.00 20 SURGICAL SVCS IP PROCEDUR2013282 EMG HEAD OR NECK UNI $2,483.00 20 SURGICAL SVCS IP PROCEDUR2013308 EMG ONE FIBER $330.00 20 SURGICAL SVCS IP PROCEDUR2013316 EMG ONE LIMB $230.00 20 SURGICAL SVCS IP PROCEDUR2013449 EMG THREE LIMBS $1,282.00 20 SURGICAL SVCS IP PROCEDUR2013324 EMG TWO LIMBS $1,131.00 20 SURGICAL SVCS IP PROCEDUR2040178 ERCP $2,422.00 $1,797.00 20 SURGICAL SVCS IP PROCEDUR2050649 ERCP $606.00 20 SURGICAL SVCS IP PROCEDUR2040269 ERCP INTERVENTN $6,084.00 20 SURGICAL SVCS IP PROCEDUR2050656 ERCP INTERVENTN $2,054.00 20 SURGICAL SVCS IP PROCEDUR2050706 ESOPHAGEAL MOTLTY 2D DATA $829.00 20 SURGICAL SVCS IP PROCEDUR2040152 ESOPHAGEAL MOTLTY 2D DATA $3,311.00 $2,456.00 20 SURGICAL SVCS IP PROCEDUR2040079 ESOPHAGOSCOPY INTERVENTN $6,233.00 $4,624.00 20 SURGICAL SVCS IP PROCEDUR2040277 GASTROSCOPY $1,750.00 20 SURGICAL SVCS IP PROCEDUR2050664 GASTROSCOPY $591.00 20 SURGICAL SVCS IP PROCEDUR2050672 GASTROSCOPY INTERVENTN $1,182.00 20 SURGICAL SVCS IP PROCEDUR2040285 GASTROSCOPY INTERVENTN $3,500.00 20 SURGICAL SVCS IP PROCEDUR2013217 H REFLX TEST GSTR/SOL UNI $132.00 20 SURGICAL SVCS IP PROCEDUR2040145 INS PH CAPSULE GERD MUCOS $2,246.00 $1,666.00 20 SURGICAL SVCS IP PROCEDUR2050714 INS PH CAPSULE GERD MUCOS $758.00 20 SURGICAL SVCS IP PROCEDUR2040350 INS PH CAPSULE GERD MUCOS $2,246.00 20 SURGICAL SVCS IP PROCEDUR2021475 MAC/REG ADD 15M $535.00 $322.00 20 SURGICAL SVCS IP PROCEDUR2021491 MAC/REG ADD 15M NONOR $538.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2021467 MAC/REG FIRST 30M $1,105.00 $666.00 20 SURGICAL SVCS IP PROCEDUR2021483 MAC/REG FIRST 30M NONOR $1,085.00 20 SURGICAL SVCS IP PROCEDUR2013464 MTR NRV CNDCT STDY W/F EA $113.00 20 SURGICAL SVCS IP PROCEDUR2013274 NRV MOTOR CONDUCT STDY EA $100.00 20 SURGICAL SVCS IP PROCEDUR2013332 NRV SNSRY CONDUCT STDY EA $88.00 20 SURGICAL SVCS IP PROCEDUR2013233 NRV TEST IOP EA HOUR $2,814.00 20 SURGICAL SVCS IP PROCEDUR2013258 NRV TEST IOP EA HOUR $5,628.00 20 SURGICAL SVCS IP PROCEDUR2013241 NRV TEST IOP EA HOUR $4,221.00 20 SURGICAL SVCS IP PROCEDUR2013225 NRV TEST IOP EA HOUR $1,407.00 20 SURGICAL SVCS IP PROCEDUR2013266 NRV TEST IOP EA HOUR $7,036.00 20 SURGICAL SVCS IP PROCEDUR2040327 PARACENT ABD INI $1,328.00 20 SURGICAL SVCS IP PROCEDUR2030302 PERFUSION SERVICE $7,660.00 20 SURGICAL SVCS IP PROCEDUR2000016 REMV TUNN CV CATH W/O $906.00 20 SURGICAL SVCS IP PROCEDUR2013407 SEP LOWER LIMBS BIL $2,396.00 20 SURGICAL SVCS IP PROCEDUR2013399 SEP LOWER LIMBS BIL $1,968.00 20 SURGICAL SVCS IP PROCEDUR2013381 SEP LOWER LIMBS BIL $1,617.00 20 SURGICAL SVCS IP PROCEDUR2013423 SEP TRUNK/HEAD $1,772.00 20 SURGICAL SVCS IP PROCEDUR2013431 SEP TRUNK/HEAD $2,157.00 20 SURGICAL SVCS IP PROCEDUR2013415 SEP TRUNK/HEAD $1,455.00 20 SURGICAL SVCS IP PROCEDUR2013365 SEP UPPER LIMBS BIL $2,579.00 20 SURGICAL SVCS IP PROCEDUR2013373 SEP UPPER LIMBS BIL $3,142.00 20 SURGICAL SVCS IP PROCEDUR2013357 SEP UPPER LIMBS BIL $2,117.00 20 SURGICAL SVCS IP PROCEDUR2013340 SEP UPPER LIMBS BIL $1,737.00 20 SURGICAL SVCS IP PROCEDUR2050680 SIGMOIDOSCOPY $370.00 20 SURGICAL SVCS IP PROCEDUR2040038 SIGMOIDOSCOPY $1,476.00 $1,095.00 20 SURGICAL SVCS IP PROCEDUR2050698 SIGMOIDOSCOPY INTERVENTN $829.00 20 SURGICAL SVCS IP PROCEDUR2040293 SIGMOIDOSCOPY INTERVENTN $2,922.00 20 SURGICAL SVCS IP PROCEDUR2013589 STIMULUS EVOKED RESPONSE $803.00 20 SURGICAL SVCS IP PROCEDUR2021517 STND ANES ADD 15M NONOR $547.00 20 SURGICAL SVCS IP PROCEDUR2021509 STND ANES FIRST 30M NONOR $1,078.00 20 SURGICAL SVCS IP PROCEDUR2021525 STND GENRL ANES ADD 15M $566.00 $341.00 20 SURGICAL SVCS IP PROCEDUR2021434 STND GENRL ANES FIRST 30M $1,142.00 $688.00 20 SURGICAL SVCS IP PROCEDUR2010874 SURG LVL 1 ADD 15M $1,482.00 $1,355.00 20 SURGICAL SVCS IP PROCEDUR2050730 SURG LVL 1 ADD 15M $457.00 20 SURGICAL SVCS IP PROCEDUR2013118 SURG LVL 1 FIRST 30M $3,474.00 20 SURGICAL SVCS IP PROCEDUR2050722 SURG LVL 1 FIRST 30M $1,173.00 20 SURGICAL SVCS IP PROCEDUR2010940 SURG LVL 2 ADD 15M $1,757.00 $1,605.00 20 SURGICAL SVCS IP PROCEDUR2050755 SURG LVL 2 ADD 15M $543.00 20 SURGICAL SVCS IP PROCEDUR2013126 SURG LVL 2 FIRST 30M $4,376.00 20 SURGICAL SVCS IP PROCEDUR2050748 SURG LVL 2 FIRST 30M $1,478.00 20 SURGICAL SVCS IP PROCEDUR2010957 SURG LVL 3 ADD 15M $1,989.00 $1,818.00 20 SURGICAL SVCS IP PROCEDUR2050771 SURG LVL 3 ADD 15M $614.00 20 SURGICAL SVCS IP PROCEDUR2013134 SURG LVL 3 FIRST 30M $5,304.00 20 SURGICAL SVCS IP PROCEDUR

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2050763 SURG LVL 3 FIRST 30M $1,792.00 20 SURGICAL SVCS IP PROCEDUR2013159 SURG LVL 4 ADD 15M $2,111.00 20 SURGICAL SVCS IP PROCEDUR2013142 SURG LVL 4 FIRST 30M $6,219.00 20 SURGICAL SVCS IP PROCEDUR2013175 SURG LVL 5 ADD 15M $2,644.00 20 SURGICAL SVCS IP PROCEDUR2013167 SURG LVL 5 FIRST 30M $6,500.00 20 SURGICAL SVCS IP PROCEDUR2040319 THORACENTESIS $1,135.00 20 SURGICAL SVCS IP PROCEDUR2040368 US TRANSRECTAL $933.00 20 SURGICAL SVCS IP PROCEDUR2610137 CPLX PACU ADD 15M $1,400.00 $770.00 26 SURGICAL SVS O/P (CONTINU2610129 CPLX PACU FIRST 30M $2,820.00 $2,821.00 26 SURGICAL SVS O/P (CONTINU2630135 CYST/URETSCP/PYLSCP LITHO $5,273.00 26 SURGICAL SVS O/P (CONTINU2630150 LITHO ESWL BILAT $18,151.00 26 SURGICAL SVS O/P (CONTINU2630143 LITHO ESWL UNILAT $18,151.00 26 SURGICAL SVS O/P (CONTINU2610095 STND PACU LVL 1 ADD 15M $431.00 $237.00 26 SURGICAL SVS O/P (CONTINU2610087 STND PACU LVL 1 FIRST 30M $877.00 $482.00 26 SURGICAL SVS O/P (CONTINU2610111 STND PACU LVL 2 ADD 15M $493.00 $271.00 26 SURGICAL SVS O/P (CONTINU2610103 STND PACU LVL 2 FIRST 30M $1,304.00 $717.00 26 SURGICAL SVS O/P (CONTINU2610038 VENIPUNCTURE $28.00 26 SURGICAL SVS O/P (CONTINU5220504 KIDNEY ACQUISITION CADAV $42,135.00 $39,750.00 52 TRANSPLANT SERVICES2400315 CATH BLN DILATE NOVSC $616.25 242400034 CATH BLN DILATE NOVSC $1,117.00 242400331 CATH BLN DILATE NOVSC $973.25 242400422 CATH BLN DILATE NOVSC $255.00 242400968 CATH BLN DILATE NOVSC $956.25 242400760 CATH DRAINAGE $919.00 242420917 CON TISS HUMAN INC FASCIA $8,358.00 242421972 CON TISS HUMAN INC FASCIA $6,240.00 242420891 CON TISS HUMAN INC FASCIA $2,467.50 242421980 CON TISS HUMAN INC FASCIA $9,747.00 242421964 CON TISS HUMAN INC FASCIA $3,250.00 242420909 CON TISS HUMAN INC FASCIA $3,953.00 242421956 CONN TISS NON-HUMAN $11,844.00 242421048 CONN TISS NON-HUMAN $905.25 242421352 GEN NRSTIM RECHG BAT SY $26,250.00 242421345 GEN NRSTIM RECHG BAT SY $24,750.00 242421337 GEN NRSTIM RECHG BAT SY $23,250.00 242421360 GEN NRSTIM RECHG BAT SY $27,750.00 242421808 GENERATOR NEURO NO-RECHRG $27,735.00 242421295 GENERATOR NEURO NO-RECHRG $21,750.00 242421329 GENERATOR NEURO NO-RECHRG $26,250.00 242421303 GENERATOR NEURO NO-RECHRG $23,250.00 242421238 GENERATOR NEURO NO-RECHRG $12,750.00 242421188 GENERATOR NEURO NO-RECHRG $27,983.00 242421246 GENERATOR NEURO NO-RECHRG $14,250.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2421311 GENERATOR NEURO NO-RECHRG $24,750.00 242421287 GENERATOR NEURO NO-RECHRG $20,250.00 242421279 GENERATOR NEURO NO-RECHRG $18,750.00 242421253 GENERATOR NEURO NO-RECHRG $15,750.00 242420032 GENERATOR NEURO NO-RECHRG $15,570.00 242421261 GENERATOR NEURO NO-RECHRG $17,250.00 242400620 GUIDEWIRE $764.25 242400570 GUIDEWIRE $679.00 242421162 IMP GRAFT VASCULAR $3,008.00 242421196 IMP GRAFT VASCULAR $4,328.00 242421014 IMP GRAFT VASCULAR $5,908.00 242421022 IMP GRAFT VASCULAR $6,553.00 242421006 IMP GRAFT VASCULAR $2,535.00 242421675 IMP GRAFT VASCULAR $6,898.00 242421915 IMP GRAFT VASCULAR $2,184.00 $2,184.00 242420750 IMP GRAFT VASCULAR $17,250.00 242422012 IMP GRAFT VASCULAR $4,238.00 242422020 IMP GRAFT VASCULAR $2,783.00 242420990 IMP GRAFT VASCULAR $1,279.25 242422137 IMP GRAFT VASCULAR $5,208.00 242420321 IMP MESH $612.25 242420412 IMP MESH $1,908.00 242420354 IMP MESH $3,409.00 242420982 IMP MESH $2,058.00 242420347 IMP MESH $2,692.00 242420404 IMP MESH $1,594.00 242421030 IMP MESH $1,349.00 242420396 IMP MESH $3,648.00 242420339 IMP MESH $1,824.00 242421832 IMP MESH $4,508.00 242420735 IMP MESH $1,976.00 242420958 IMP MESH $968.25 242420370 IMP MESH $4,325.00 242420388 IMP MESH $5,403.00 242420966 IMP MESH $1,777.00 242421782 IMP MESH $1,185.75 242420362 IMP MESH $1,739.00 242421139 IMP MESH $2,191.00 242421121 IMP MESH $4,104.00 242421113 IMP MESH $3,002.00 242420313 IMP MESH $793.25 242421105 IMP MESH $2,765.00 242421097 IMP MESH $2,093.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2421089 IMP MESH $3,318.00 242421071 IMP MESH $2,256.00 242421063 IMP MESH $2,093.00 242421055 IMP MESH $1,526.00 242421154 IMP MESH $4,027.00 242420644 IMP MESH $2,069.00 242421683 IMP MESH $974.25 242421147 IMP MESH $3,376.00 242420305 IMP MESH $3,920.00 242420230 IMP MESH $805.75 242422038 IMP MESH $1,960.00 242422202 IMP MESH IMPLANT $1,750.00 242422210 IMP MESH IMPLANT $3,133.00 242422236 IMP MESH IMPLANT $3,313.00 242420875 IMP PORT INDWELLING $2,082.50 242420214 IMP PORT INDWELLING $1,466.25 242421618 IMP PT PROGR NEUROSTIM $2,875.00 242421634 IMP PT PROGR NEUROSTIM $3,375.00 242421568 IMP PT PROGR NEUROSTIM $2,275.00 242421816 IMP PT PROGR NEUROSTIM $2,433.00 242421667 IMP PT PROGR NEUROSTIM $6,125.00 242421659 IMP PT PROGR NEUROSTIM $5,875.00 242421642 IMP PT PROGR NEUROSTIM $3,625.00 242421626 IMP PT PROGR NEUROSTIM $3,125.00 242421600 IMP PT PROGR NEUROSTIM $2,625.00 242421592 IMP PT PROGR NEUROSTIM $3,325.00 242421576 IMP PT PROGR NEUROSTIM $2,625.00 242421584 IMP PT PROGR NEUROSTIM $2,975.00 242420784 IMP,BONE CEMENT $1,190.00 242422152 LD PCR NO TV VDD SNGL PAS $1,912.50 242421519 LEAD EXT PACING/NEUROSTIM $2,975.00 242421535 LEAD EXT PACING/NEUROSTIM $3,975.00 242421493 LEAD EXT PACING/NEUROSTIM $2,275.00 242421527 LEAD EXT PACING/NEUROSTIM $3,325.00 242421501 LEAD EXT PACING/NEUROSTIM $2,625.00 242421485 LEAD NEUROSTIMULATOR $9,225.00 242421469 LEAD NEUROSTIMULATOR $9,625.00 242421477 LEAD NEUROSTIMULATOR $8,925.00 242420016 LEAD NEUROSTIMULATOR $7,900.00 242421444 LEAD NEUROSTIMULATOR $7,625.00 242421436 LEAD NEUROSTIMULATOR $7,375.00 242421428 LEAD NEUROSTIMULATOR $6,875.00 242421410 LEAD NEUROSTIMULATOR $6,625.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2421402 LEAD NEUROSTIMULATOR $5,875.00 242421394 LEAD NEUROSTIMULATOR $5,125.00 242421386 LEAD NEUROSTIMULATOR $4,875.00 242421378 LEAD NEUROSTIMULATOR $3,375.00 242421451 LEAD NEUROSTIMULATOR $8,875.00 242421543 NEUROSTIM LEAD TEST KIT $3,375.00 242421550 NEUROSTIM LEAD TEST KIT $3,625.00 242420826 REP DEV URINARY W/SLING $3,025.00 242421790 REP DEV URINARY W/SLING $3,850.00 242421170 REP DEV URINARY W/SLING $2,590.00 242421725 S ANCHR $1,041.25 242420073 S IMP ACHILLES TNDN W/CAL $3,478.00 242422087 S IMP ADAPT $2,103.75 242422095 S IMP ADAPT $3,465.00 242421840 S IMP ANTERIOR VAG $4,588.00 242420222 S IMP AUTO CULT CHONDRCYS $32,640.00 242420636 S IMP BAHA ABUTMENT W/FLA $5,014.00 242420628 S IMP BAHA SOUND PROCESSO $7,023.00 242420842 S IMP BONE $2,793.00 242420867 S IMP BONE $3,024.00 242421741 S IMP BONE $3,455.00 242420859 S IMP BONE $2,690.00 242421220 S IMP BONE $2,663.50 242421212 S IMP BONE $2,303.00 242421758 S IMP BONE $3,025.00 242421691 S IMP BONE $2,975.00 242421204 S IMP BONE $2,166.50 242422178 S IMP BONE CEMENT $450.50 242422186 S IMP BONE CEMENT $1,103.25 242420586 S IMP BONE FIBULA SHAFT $2,083.00 242422194 S IMP BONE FILLER $2,800.00 242420925 S IMP BONE GRAFT $3,185.00 242420669 S IMP BONE GRAFT OP-1 $12,188.00 242421998 S IMP BONE MATRIX $3,476.00 242421824 S IMP BONE MATRIX $1,820.00 242420818 S IMP BONE MATRIX $3,310.00 242421899 S IMP BONE SPACER $3,330.00 $3,140.00 242422160 S IMP BONE SPACER $3,728.00 242421949 S IMP BONE SPACER $8,075.00 242421931 S IMP BONE SPACER $10,100.00 242421923 S IMP BONE SPACER $3,330.00 242420065 S IMP B-T-B-HEMI W/O QUAD $5,418.00 242420883 S IMP CATH LUMBAR $726.25 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2420594 S IMP CATH VENT EVD ANTIB $1,503.50 242422004 S IMP CEMENT $1,577.25 242420719 S IMP CEMENT BONE IMPACT $3,194.00 242420651 S IMP CEMENT SMART SET $1,103.25 242420743 S IMP EAR STAPES PISTON $896.50 242420768 S IMP FOAM PACK VITOSS 5C $2,608.00 242420776 S IMP FOAM PACK VITOSS10C $3,725.00 242420693 S IMP GRAFT CHAMBER I/C 1 $2,613.00 242420701 S IMP GRAFT CHAMBER I/C 1 $3,925.00 242420685 S IMP GRAFT CHAMBER I/C 5 $1,960.00 242420420 S IMP GRAFT TISSUE CELLEC $4,863.00 242420578 S IMP GRAFTON FLEX $3,350.00 242420008 S IMP GRANULES CERAMIC $2,410.00 242420248 S IMP HEALOS II 1-STRIP $2,856.00 242421709 S IMP INFUSE $3,066.00 242421717 S IMP INFUSE $4,315.00 242420172 S IMP LEAD ANCHOR SLEEVE $213.00 242422103 S IMP LEAD ECT $828.75 242422053 S IMP MASTERGRAFT $2,646.00 242422061 S IMP MASTERGRAFT $3,150.00 242422046 S IMP MASTERGRAFT $1,003.00 242422079 S IMP MASTERGRAFT $9,625.00 242421857 S IMP PELVIC FLOOR $5,450.00 242422111 S IMP PF REPAIR KIT $4,638.00 242420941 S IMP PUTTY $2,758.00 242421733 S IMP PUTTY $850.00 242420974 S IMP PUTTY $1,717.00 242421865 S IMP PUTTY 10CC $10,500.00 242421873 S IMP PUTTY 5CC $5,563.00 242420677 S IMP PUTTY TCP 15CC $2,975.00 242420800 S IMP SHUNT PROGRAMMABLE $9,996.00 242420529 S IMP SHUNT STRATA UNITIZ $9,465.00 242420164 S IMP SILO VENTRAL WALL $1,062.50 242420727 S IMP SLING SYS SPARC $3,025.00 242400026 S IMP STENT BLR FLEXIMA $510.00 242420461 S IMP STENT GRAFT ILIAC L $4,214.00 242420438 S IMP STENT GRAFT MAIN BO $12,472.00 242420479 S IMP STENT GRAFT MAIN BO $4,214.00 242420487 S IMP STENT GRAFT ZENITH $3,343.00 242420446 S IMP STENT GRAFT ZENITH $7,584.00 242420453 S IMP STENT GRAFT ZENITH $5,618.00 242420271 S IMP STENT GRFT EXT $6,523.00 242420503 S IMP STNT GRFT LEG CONTR $9,373.00 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2420495 S IMP STNT GRFT TRUNK IPI $12,179.00 242420834 S IMP TENDON $4,088.00 242422129 S IMP VAG SUPPORT $4,763.00 244605341 S STRL 462400083 S STRL BALLOON CATH $453.00 242400042 S STRL BALLOON DLTR CRE W $935.00 242401040 S STRL BASKET $315.50 242400646 S STRL BIOP FORCEP $171.00 242400190 S STRL BIOP FORCEP LYNX $57.25 242400232 S STRL CAN ERCP CONTOUR $213.75 242400927 S STRL CANNULA NASAL $4.75 242401065 S STRL CATH ACCESS $2,660.00 242400885 S STRL CATH ANAL MANOMETR $223.25 242400893 S STRL CATH BALLOON DIL $998.75 242400877 S STRL CATH BALLOON DIL $531.25 242400976 S STRL CATH MOTILITY $255.00 242400398 S STRL CATH PH 2-SENSOR $246.50 242400406 S STRL CATH PH SL SENSOR $185.25 242400257 S STRL CATH TANDEM XL $250.75 242400778 S STRL CLIP FIXING DEVICE $680.00 242400059 S STRL CLOTEST $37.50 242400356 S STRL COLON DECOMP SET $574.50 242400828 S STRL ENDO SMARTCAP $63.00 242400299 S STRL ERCP CAN METAL TIP $118.75 242400950 S STRL FORCEP $86.75 242401016 S STRL FORCEP $254.75 242400992 S STRL FORCEP $97.25 242401073 S STRL FORCEP $2,104.00 242401032 S STRL FORCEP $189.75 242401024 S STRL FORCEP $552.50 242401008 S STRL FORCEP $185.00 242400695 S STRL FTR MEMBRANE APC $53.00 242400125 S STRL GASTMY TUBE $235.50 242400562 S STRL GASTRIC LAVAGE KIT $45.00 242400539 S STRL GUIDE WIRE TRACE $387.00 242400901 S STRL GUIDEWIRE SUPRACOR $340.00 242400471 S STRL HEATER PROBE $510.00 242400380 S STRL INDIA INK IN SOL $104.50 242400984 S STRL INFLAT DVC $301.75 242400844 S STRL INJ GOLD PROBE $913.75 242400943 S STRL INTRO SYS $321.75 242400133 S STRL JEJUNAL FEED TUBE $573.75 242400273 S STRL LIGATOR 5-BAND $584.50 24

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2400679 S STRL LITHOTRIPTOR CABLE $567.75 242400166 S STRL LITHOTRIPTOR MECH $1,363.25 242400737 S STRL LOCKING DEV $49.00 242400430 S STRL NASAL BILIARY DR $476.00 242400463 S STRL NDL KNIFE HUIBR $573.75 242400935 S STRL OVERTUBE $701.25 242400596 S STRL PEG CLEANING BRUSH $52.50 242400075 S STRL PEG KIT $397.50 242400661 S STRL POLYP RETRIEVAL $382.50 242400109 S STRL POLYPECTOMY SNARE $99.00 242401057 S STRL PROBE $1,530.00 242400687 S STRL PROBE FLEXIBLE APC $882.75 242400711 S STRL RET BSKT TRAPEZOID $1,100.75 242400067 S STRL SCLEROTHERAPY NDL $171.00 242400786 S STRL SPHINCTEROME $1,936.00 242400240 S STRL STONETOME SHORTNOS $1,270.75 242400372 S STRL SUC POLYP TRAP $43.25 242400307 S STRL SYR/GAUGE ASSY $142.50 242401081 S STRL TUBING $133.00 242400489 S STRL WIRE BASKET MEMO $659.50 242401107 STENT COATD/COV W/DEL SYS $5,948.00 242401099 STENT COATD/COV W/DEL SYS $5,375.00 242422251 STENT COATD/COV W/DEL SYS $7,625.00 242422269 STENT COATD/COV W/DEL SYS $8,900.00 242401123 STENT NOCOAT W DEL SYS $548.25 242400703 STENT NOCOAT W DEL SYS $5,988.00 242401115 STENT NOCOAT W DEL SYS $4,125.00 242400851 STENT NOCOAT W DEL SYS $3,988.00 242400018 STENT NOCOAT W DEL SYS $3,475.00 242400869 STENT NOCOAT W DEL SYS $5,625.00 242400752 STENT NOCOAT W DEL SYS $476.00 242421881 SYNTHETIC IMP URINARY 1ML $1,352.75 242422145 SYNTHETIC IMP URINARY 1ML $1,105.00 242422244 SYNTHETIC IMP URINARY 1ML $841.50 242420537 SYNTHETIC IMP URINARY 1ML $4,523.00 240773002 US AMNIOCENTESIS $283.00 $201.00 070774604 US BIO PROFILE W NONSTRES $911.00 $646.00 070774745 US FETAL TRANSFUSION IUT $2,047.00 070774638 US OB AFTR 1ST TRI 1 GEST $1,286.00 $911.00 070774729 US OB AFTR 1ST TRI EA GES $633.00 $448.00 070774661 US OB FU/REEVAL EA FETUS $946.00 $671.00 070774695 US OB LTD 1/MORE FETUSES $769.00 $545.00 070721704 XR ABD 1V AP $286.00 07

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0721761 XR ABD CMPL DECUB ERECT $464.00 070721886 XR AC JNT $457.00 070721860 XR AC JNT $457.00 070721928 XR ANKLE 2V $341.00 070721902 XR ANKLE 3V OR MORE $402.00 070722843 XR BONE LENGTH STDY $416.00 070727602 XR CALCANEOUS 2V OR MORE $334.00 070723247 XR CHEST 1V $259.00 070723288 XR CHEST 2V $355.00 070723387 XR CHEST 2V W AP LORDOTIC $430.00 070723403 XR CHEST 2V W OBLIQUES $539.00 070723528 XR CHOL IN OR 070723767 XR CLAVICLE CMPL $348.00 070724047 XR ELBOW 2V $348.00 070724005 XR ELBOW 3V OR MORE $457.00 070724823 XR FACIAL BONE 3V OR MORE $518.00 070724849 XR FACIAL BONE LES 3V $355.00 070724906 XR FEMUR 2V $341.00 070725002 XR FINGER(S) 2V OR MORE $409.00 070725200 XR FLUORO 1HR OR LES 070725325 XR FOOT 2V $327.00 070725309 XR FOOT 3V OR MORE $396.00 070725408 XR FOREARM 2V $341.00 070725614 XR HAND 2V $334.00 070725606 XR HAND 3V OR MORE $402.00 070725705 XR HIP UNI 1V $293.00 070725671 XR HIP UNI 2V OR MORE $457.00 070725663 XR HIPS BIL 2V W PELV $464.00 070725812 XR HUMERUS 2V OR MORE $355.00 070722827 XR JNT SURVEY 1V $450.00 070726919 XR KNEE 1 OR 2V $355.00 070726901 XR KNEE 4V OR MORE $511.00 070726968 XR KNEES STANDING AP $396.00 070727404 XR NASAL BONES 3V OR MORE $416.00 070727446 XR NEC SOFT TISSUE $327.00 070727560 XR ORBITS 4V OR MORE $525.00 070727743 XR PELV 1 OR 2V $307.00 070727701 XR PELV 3V OR MORE $511.00 070727909 XR RIBS BIL 3V $477.00 070727941 XR RIBS UNI 2V $375.00 070728204 XR SCAPULA CMPL $355.00 070728287 XR SHOULDER 1V $280.00 070728261 XR SHOULDER 2V OR MORE $355.00 07

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SEQ 999 AMOUNT

SEQ 100 AMOUNT

SEQ 200 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0728105 XR SI JNT 1 OR 2V $361.00 070728006 XR SI JNT 3V OR MORE $436.00 070728121 XR SI JNT 3V OR MORE $436.00 070728907 XR SKULL 4V OR MORE $532.00 070728949 XR SKULL LES 4V $423.00 070729061 XR SPINE C 4V & FLEX/EXT $839.00 070729087 XR SPINE CERV 2-3V $457.00 070729046 XR SPINE CERV 4V OR MORE $641.00 070729244 XR SPINE LUMB 2-3V $491.00 070729160 XR SPINE LUMB 4V OR MORE $682.00 070729186 XR SPINE LUMB 4V W BEND $948.00 070729269 XR SPINE SCOLIOSIS STNDNG $430.00 070729285 XR SPINE SCOLIOSIS SUP ER $580.00 070729327 XR SPINE THOR 2V $396.00 070729368 XR SPINE THOR 4V OR MORE $586.00 070729400 XR SPINE THOR LUMB 2V $423.00 070729426 XR STERNOCLAVIC 3V MORE $464.00 070729442 XR STERNUM 2V OR MORE $389.00 070729608 XR TIBIA FIBULA 2V $327.00 070729665 XR TOE(S) 2V OR MORE $382.00 070729954 XR WRIST 2V $368.00 070729947 XR WRIST 3V OR MORE $464.00 07

A1


Sutter Medical Center Pharmacy Charge Master

Drug name Calculated Price

8209827 1.2 MIC LO PROTEIN BINDING FILTER $44.078121881 ABACAVIR 300MG TAB $36.408209835 ABATACEPT (ORENCIA) IVPB $183.598381147 ABCIXIMAB 10MG/5ML INJ $1,605.798381147 ABCIXIMAB DRIP $1,352.978381147 ABCIXIMAB INJ $1,352.978123036 ACAMPROSATE 333MG DR TAB (SCP) $18.998114787 ACARBOSE 50MG TAB $19.228213282 ACD-A ANTICOAGULANT CITRATE DEXTROS $182.318118507 ACEBUTOLOL 200MG CAP $19.048100117 ACEBUTOLOL 400MG CAP $19.718155764 ACETAMINOPHEN 100MG/ML DROPS $0.008190043 ACETAMINOPHEN 100MG/ML DROPS $17.818270043 ACETAMINOPHEN 120MG SUPP $0.008157083 ACETAMINOPHEN 160MG/5ML ORAL UD LIQ $0.008270050 ACETAMINOPHEN 325MG SUPP $0.008100414 ACETAMINOPHEN 325MG TAB $0.008209801 ACETAMINOPHEN 325MG TAB $0.008150039 ACETAMINOPHEN 325MG/10.15ML UDCUP $0.008190043 ACETAMINOPHEN 32MG/1ML LIQ (PEDS) $0.008270068 ACETAMINOPHEN 650MG SUPP $18.078100331 ACETAMINOPHEN 80MG CHEW TAB $0.008170029 ACETAMINOPHEN/CODEINE 300/15MG TAB $34.688170037 ACETAMINOPHEN-CODEINE 300/30MG TAB $34.728170052 ACETAMINOPHEN-CODEINE 300/60MG TAB $35.358300048 ACETAZOLAMIDE 100MG/ML PED SYRINGE $145.278100422 ACETAZOLAMIDE 125MG TAB $17.778100430 ACETAZOLAMIDE 250MG TAB $18.118155772 ACETAZOLAMIDE 25MG/ML SUSP PEDIPOD $17.908300048 ACETAZOLAMIDE 500MG INJ $244.278100448 ACETAZOLAMIDE 500MG SR $27.058300048 ACETAZOLAMIDE INJ $181.278252066 ACETIC ACID 2% OTIC SOLN 15ML $114.078210262 ACETIC ACID IRRIGATION SOLN0.25% 1L $74.348252074 ACETIC ACID-HC OTIC SOLN 10ML $486.658302317 ACETYLCYSTEINE 10% INHAL 4ML (RT) $27.238302341 ACETYLCYSTEINE 20% 600MG/3ML UD LIQ $26.878302341 ACETYLCYSTEINE 20% INHAL 4ML (RT) $30.158209819 ACETYLCYSTEINE 20% PEDIPOD (PEDS) $20.318309015 ACETYLCYSTEINE INJ $142.318118523 ACITRETIN 25MG CAP $52.418100141 ACYCLOVIR 200MG CAP $19.278123382 ACYCLOVIR 400MG TAB $20.928195091 ACYCLOVIR 40MG/1ML SUSP 120ML (RXE) $86.928118531 ACYCLOVIR 40MG/1ML SUSP PEDIPOD $17.588240046 ACYCLOVIR 5% OINT 15GM $389.378352700 ACYCLOVIR 5MG/ML SYRINGE (PEDS) $136.618100455 ACYCLOVIR 800MG TAB $25.46

Charge Code


Drug name Calculated PriceCharge Code

8352700 ACYCLOVIR INJ $136.618352700 ACYCLOVIR IVPB $136.618352700 ACYCLOVIR IVPB (NS) $136.618209835 ADALIMUMAB 40MG/0.8ML INJ $1,896.908122020 ADDERALL XR 10MG CAP (SCP) $40.468122012 ADDERALL XR 20MG CAP (SCP) $40.468122400 ADDERALL XR 5MG CAP (SCP) $40.468122491 ADEFOVIR 10MG TAB $54.978193484 ADEKS PEDIATRIC DROPS 60ML $53.618209835 ADENOSINE 60MG/20ML INJ $461.748302218 ADENOSINE 6MG/2ML INJ $89.988209835 ADENOSINE 90MG/30ML INJ $658.548209801 ADVAIR DISKUS 100/50 PWDR FOR INHAL $226.578209827 ADVAIR DISKUS 250/50 PWDR FOR INHAL $226.578209827 ADVAIR DISKUS 500/50 PWDR FOR INHAL $347.858253643 ADVAIR HFA 115/21MCG INHALER $445.678253650 ADVAIR HFA 230/21MCG INHALER 12GM $597.178253668 ADVAIR HFA 45/21MCG INHALER 12GM $365.378250011 AEROCHAMBER $107.478250011 AEROCHAMBER W/MASK KIT $140.918209835 AGALSIDASE BETA (FARAZYME) IVPB $444.918200214 ALBENDAZOLE 200MG TAB $20.198220030 ALBUMIN 25% (RUN w/NS TO = 5%) $556.688209835 ALBUMIN 25% 100ML $572.688220303 ALBUMIN 25% INJ 50ML $559.888361107 ALBUMIN 5% (SCN/PEDS) $420.688220030 ALBUMIN 5% (apheresis use only) $556.688220030 ALBUMIN 5% (each 500ml=2x250ml chg) $556.688220030 ALBUMIN 5% INJ (PEDS ONLY) $537.688280034 ALBUTEROL 2.5MG/0.5ML INHL UD $17.938156937 ALBUTEROL 2.5MG/3ML INHL UD $18.638100497 ALBUTEROL 2MG TAB $17.678122640 ALBUTEROL 4MG ER TABLET $19.198253478 ALBUTEROL HFA INHALER 8GM $111.218196492 ALBUTEROL ORAL LIQUID 120ML (RXE) $49.698151904 ALBUTEROL ORAL LIQUID PEDIPOD $17.168280034 ALBUTEROL RT $19.458252751 ALBUTEROL-IPRATROPIUM MDI 14.7GM $314.358307746 ALCOHOL (ETHYL) DEHYD. 100% INJ $151.878210460 ALCOHOL 5%/D5W $128.618155707 ALDACTAZIDE 5MG/ML SUSP 30ML (RXE) $43.688151631 ALDACTAZIDE 5MG/ML SUSP PEDIPOD $17.358381444 ALDESLEUKIN INJ $2,399.288381733 ALEMTUZUMAB (CAMPATH) IVPB $4,561.608381733 ALEMTUZUMAB (CAMPATH)*SUBQ* SYRINGE $1,826.808114647 ALENDRONATE 10MG TAB $23.708120313 ALENDRONATE 5MG TAB $23.718120321 ALENDRONATE 70MG TABLET $63.76



8320020 ALFENTANIL 2500MCG/5ML INJ (SCP) $118.778123200 ALISKIREN 150MG TAB $21.918100604 ALLOPURINOL 100MG TAB $17.488155798 ALLOPURINOL 20MG/ML SUSP PEDIPOD $17.158100620 ALLOPURINOL 300MG TAB $18.258209835 ALPHA-1 PROTEINASE INHIB (ARALAST) $350.688209835 ALPHA-1 PROTEINASE INHIB (PROLASTIN $349.888170102 ALPRAZOLAM (XANAX) 0.25MG TAB $35.348170086 ALPRAZOLAM (XANAX) 0.5MG TAB $35.598209801 ALPRAZOLAM (XANAX) 0.5MG XR TAB-SCP $38.578170078 ALPRAZOLAM (XANAX) 1MG TAB (SCP) $36.108300030 ALPROSTADIL 500MCG/1ML INJ $386.278300030 ALPROSTADIL INJ $386.278352726 ALTEPLASE (TPA) SYRINGE $200.518352726 ALTEPLASE INJ $348.938352726 ALTEPLASE LOAD DOSE $200.518190100 ALTERNAGEL SUSP 355ML $0.008244436 ALUM 1% IN SW FOR IRRIGATION 1000ML $148.148100646 ALUMINUM HYDROXIDE 400MG CAP $0.008100695 AMANTADINE 100MG CAP $18.528193468 AMANTADINE 10MG/ML SYRUP 120ML (RXE $69.578155806 AMANTADINE 10MG/ML SYRUP PEDIPOD $17.338308470 AMBISOME 1MG/ML (PEDS) SYRINGE $214.778381535 AMIFOSTINE INJ $1,348.028381535 AMIFOSTINE SYRINGE $1,157.608355836 AMIKACIN 250MG/ML IM SYRINGE $149.978355836 AMIKACIN INJ $149.978350019 AMIKACIN PER PHARMCY PROTOCOL $0.008155814 AMILORIDE 1MG/ML SUSP PEDIPOD $17.238100703 AMILORIDE 5MG TAB $19.618100711 AMINOCAPROIC 500MG TAB $22.288280620 AMINOCAPROIC ACID 20MG/ML SYRINGE $136.448190175 AMINOCAPROIC ACID 25% 120ML (RXE) $437.278155822 AMINOCAPROIC ACID 25% LQ (PEDIPOD) $18.778300196 AMINOCAPROIC ACID 5GM/20ML INJ $141.438300196 AMINOCAPROIC ACID INJ $139.638300196 AMINOCAPROIC ACID IVPB $139.638309171 AMINOPHYLLINE 125MG/50ML D5W IVPB $114.218152266 AMINOPHYLLINE 21MG/ML LIQ PEDIPOD $17.158300220 AMINOPHYLLINE 250MG/10ML VIAL $69.568209835 AMINOPHYLLINE 2MG/ML SYRINGE (PEDS) $136.368300220 AMINOPHYLLINE INJ $137.168194409 AMINOSALICYLC ACID 50MG/ML LIQ 60ML $130.078353625 AMIODARONE (BOLUS DOSE) IVPB $178.558307753 AMIODARONE 150MG/3ML INJ $347.698100570 AMIODARONE 200MG TAB $23.618353625 AMIODARONE 2MG/ML PEDS SYRINGE $183.498193237 AMIODARONE 40MG/ML SUSP 30ML $73.55



8211187 AMIODARONE 450MG/270ML D5W (GLASS) $770.598353625 AMIODARONE INJ $178.558100752 AMITRIPTYLINE 10MG TAB $17.398100778 AMITRIPTYLINE 25MG TAB $17.768100786 AMITRIPTYLINE 50MG TAB $18.338155830 AMITRIPTYLINE 5MG/ML SUSP PEDIPOD $17.218100794 AMITRIPTYLINE 75MG TAB $18.798108805 AMLODIPINE 10MG TAB $21.568194342 AMLODIPINE 1MG/ML SUSP 50ML (RXE) $56.748156895 AMLODIPINE 1MG/ML SUSP PEDIPOD $17.488108789 AMLODIPINE 2.5MG TAB $20.338108797 AMLODIPINE 5MG TAB $21.418252454 AMMONIA 2% INHALANT 0.33ML $17.238331480 AMMONIUM CHLORIDE 100MEQ/20ML INJ $74.128209835 AMOBARBITAL 500MG INJ $126.668100869 AMOXICILLIN 250MG CAP $17.568209827 AMOXICILLIN 500MG CAP $18.018190217 AMOXICILLIN 50MG/ML 150ML (RXE) $48.238151771 AMOXICILLIN 50MG/ML SUSP (ER) $17.128151771 AMOXICILLIN 50MG/ML SUSP PEDIPOD $17.128101073 AMOXICILLIN-CLAV 125-62.5MG CHEW $20.188101057 AMOXICILLIN-CLAV 250-125MG TAB $25.328101081 AMOXICILLIN-CLAV 250-62.5MG CHEW $23.048101065 AMOXICILLIN-CLAV 500-125MG TAB $29.238155855 AMOXICILLIN-CLAV 50MG/ML PEDIPOD $18.238155863 AMOXICILLIN-CLAV 80MG/ML PEDIPOD $18.618118408 AMOXICILLIN-CLAV 875-125MG TAB $33.328156887 AMOXICLLIN-CLAV ES 120MG/ML PEDIPOD $18.218171555 AMPHETAMINE-DEXTROAMPHET 10MG (SCP) $37.968171597 AMPHETAMINE-DEXTROAMPHET 20MG TAB $37.968171605 AMPHETAMINE-DEXTROAMPHETAMINE 5MG $37.968352742 AMPHO B (FUNGIZONE) PED SYRINGE $137.098190969 AMPHOJEL 480ML $0.008155871 AMPHOTERICIN 5MG/ML LIQ PEDIPOD $21.128350043 AMPHOTERICIN B (FUNGIZONE) INJ $177.178308470 AMPHOTERICIN B LIPOSOMAL (AMBISOME) $211.638353260 AMPHOTERICIN LIPID COMPLX (ABELCET) $184.278351272 AMPICILLIN 1G VIAL (PEDS) $119.498353427 AMPICILLIN 1GM/50ML 0.45%NS (ADV) $122.938100901 AMPICILLIN 250MG CAP $17.598350084 AMPICILLIN 250MG INJ (PEDS) $108.218351280 AMPICILLIN 2G INJ $129.218353419 AMPICILLIN 2GM/50ML 0.45%NS (ADV) $142.438351249 AMPICILLIN 30MG/ML (ER/MACU) SYRNGE $146.038100919 AMPICILLIN 500MG CAP $18.008351249 AMPICILLIN 500MG INJ (PEDS) $111.578190233 AMPICILLIN 50MG/ML SUSP 100ML (RXE) $59.998153454 AMPICILLIN 50MG/ML SUSP PEDIPOD $17.17



8351272 AMPICILLIN INJ $116.978351801 AMPICILLIN-SULBACTAM 1.5GM INJ $118.488351819 AMPICILLIN-SULBACTAM 3GM INJ $136.658351801 AMPICILLIN-SULBACTAM INJ $118.488252389 AMYL NITRATE INHALANT 0.3ML AMP $17.418119554 ANAGRELIDE 0.5MG CAP $30.548243636 ANALGESIC BALM OINT 30GM $0.008114589 ANASTROZOLE 1MG TAB $43.118361057 ANTI-INHIB COAG COMPLX (FEIBA) $722.688251373 ANTIPYRINE-BENZOCAINE OTIC 15ML $40.238361222 ANTITHROMBIN III INJ $344.988361016 ANTITHYMOCYTE GLOB (THYMOGLOBULIN) $1,203.208307233 ANTIVENIN LACTRODECTUS INJ $134.648300139 ANTIVENIN,CROTALIDAE FAB(OVIN) INJ $2,552.278252769 APRACLONIDINE 0.5% OPTH SOLN 5ML $215.158253445 APRACLONIDINE 1% OPHTH SOLN 0.1ML $64.168250078 APRACLONIDINE 1% OPTH SOLN 5ML $155.878122418 APREPITANT 125MG CAP $339.708209801 APREPITANT 40MG CAP $122.518122426 APREPITANT 80MG CAP $226.378209835 APREPITANT IVPB $136.278118952 AQUADEKS (MULTIVIT/MIN) PED SOFTGEL $18.198209801 AQUADEKS PEDI DROPS PEDIPOD $34.888209801 AQUADEKS PEDIATRIC DROPS 60ML $65.418240350 AQUAPHOR OINTMENT BASE 60GM $38.698253478 ARGATROBAN DRIP $192.928210270 ARGININE 10% (0.1GM/mL) IVPB $127.598121576 ARGININE 500MG TAB $17.218122178 ARIPIPRAZOLE 10MG TAB $40.058121964 ARIPIPRAZOLE 15MG TAB $40.068209801 ARIPIPRAZOLE 5MG TAB $49.368209835 ARIPIPRAZOLE 9.75MG INJ (SCP ONLY) $95.448381881 ARSENIC INJ $676.208250086 ARTIFICIAL TEARS OPHTH SOLN 15ML $50.858309023 ASCORBIC ACID 1000MG/2ML INJ $37.758155095 ASCORBIC ACID 100MG/ML LIQ PEDIPOD $17.118100950 ASCORBIC ACID 500MG TAB $0.008300287 ASCORBIC ACID INJ $36.198123408 ASENAPINE (SAPHRIS) 5MG SL TAB (SCP $36.838380701 ASPARAGINASE INJ $728.028380701 ASPARAGINASE SYRINGE $728.028380701 ASPARAGINASE TEST DOSE(intradermal) $728.028244808 ASPERCREME 1.25oz $38.358100224 ASPIRIN 20MG CHEW TAB (PEDS) $0.008270027 ASPIRIN 300MG SUPP $0.008100018 ASPIRIN 325MG E.C. TAB $0.008100018 ASPIRIN 325MG TAB $0.008121014 ASPIRIN 325MG TAB $0.00



8121014 ASPIRIN 325MG TAB (STAFF USE) $0.008100224 ASPIRIN 40.5MG CHEW TAB (PEDS) $0.008270035 ASPIRIN 600MG SUPP $0.008100224 ASPIRIN 81MG CHEW TAB $0.008100224 ASPIRIN 81MG EC TAB $0.008100224 ASPIRIN ENTERIC COATED 81MG TABL $0.008100018 ASPIRIN, ENTERIC COATED 325MG TAB $0.008122434 ATAZANAVIR 100MG CAP $44.638122442 ATAZANAVIR 150MG CAP $51.268122459 ATAZANAVIR 200MG CAP $44.638101024 ATENOLOL 100MG TAB $19.418101016 ATENOLOL 25MG TAB $18.978155889 ATENOLOL 2MG/ML SUSP PEDIPOD $17.218101008 ATENOLOL 50MG TAB $18.818303729 ATENOLOL 5MG/10ML INJ $90.708121915 ATOMOXETINE 18MG CAP (SCP ONLY) $23.928121907 ATOMOXETINE 25MG CAP (SCP ONLY) $23.928121899 ATOMOXETINE 40MG CAP (SCP ONLY) $23.928121923 ATOMOXETINE 60MG CAP (SCP ONLY) $23.928111163 ATORVASTATIN 10MG TAB $23.458119521 ATORVASTATIN 20MG TAB $26.658118556 ATOVAQUONE 150MG/ML SUSP 120ML $1,222.008352411 ATRACURIUM 10MG/ML 5ML INJ $78.708330029 ATRACURIUM 10MG/ML INJ 10ML $84.948330029 ATRACURIUM INJ $180.928121584 ATROPINE 0.4MG TABLET $17.658253494 ATROPINE 1% OPHTH SOLN 2ML $42.178250177 ATROPINE 1% OPTH OINT 3.5GM $39.118300295 ATROPINE 1MG/1ML INJ $71.028303174 ATROPINE SYRINGE 1MG $73.408190423 AUGMENTIN 50MG/ML SUSP 150ML (RXE) $316.318193526 AUGMENTIN 80MG/ML SUSP 75ML (RXE) $195.358194375 AUGMENTIN ES 120MG/ML SUSP 75ML(RXE $122.938101040 AURANOFIN 3MG CAP $28.998245557 AVITENE (COLLAGEN HEMOSTAT) $833.418243396 AVITENE 1GM HEMOSTAT $289.818381972 AZACITIDINE (VIDAZA) INJ $607.688101107 AZATHIOPRINE 25MG TAB $19.918101107 AZATHIOPRINE 50MG TAB $19.918101107 AZATHIOPRINE 50MG/ML SUSP PEDIPOD $19.918380065 AZATHIOPRINE INJECTION $766.208209827 AZELASTINE NASAL SPRAY 30ML $256.798253775 AZITHROMYCIN 1% EYE DROPS 2.5ML $191.298103210 AZITHROMYCIN 250MG TAB $38.418352759 AZITHROMYCIN 2MG/ML SYRINGE (PEDS) $136.508193542 AZITHROMYCIN 40MG/ML SUSP 30ML (RXE $124.598151060 AZITHROMYCIN 40MG/ML SUSP PEDIPOD $19.368301202 AZITHROMYCIN 500MG/250ML D5W IVPB $194.72



8301202 AZITHROMYCIN 500MG/250ML NS (ADV) $129.098120925 AZITHROMYCIN 600MG TAB $56.578301202 AZITHROMYCIN INJ $205.058301202 AZITHROMYCIN IVPB $205.058352767 AZTREONAM 10MG/ML SYRINGE (PEDS) $136.728355844 AZTREONAM INJ $158.968355844 AZTREONAM IVPB $160.508350092 BACITRACIN 50,000 UNIT INJ $162.898350092 BACITRACIN INJ $160.038242893 BACITRACIN OINT 30GM $45.328243404 BACITRACIN OINT PKT $17.318250193 BACITRACIN OPTH OINT 3.5GM $148.998243107 BACITRACIN-POLYMYXIN OINT 30GM $45.498251118 BACITRACIN-POLYMYXIN OPTH OINT 3.5G $100.358101206 BACLOFEN 10MG TAB $18.488101198 BACLOFEN 20MG TAB $19.638119257 BACLOFEN 5 MG/ML SUSP PEDIPOD $17.768355810 BACLOFEN INTRATHECAL 10MG/20ML INJ $560.148310120 BACLOFEN INTRATHECAL INJ $560.148310120 BACLOFEN INTRATHECAL SCREEN KIT $236.148122277 BALSALAZIDE 750MG CAP $20.228361008 BASILIXIMAB IVPB $3,678.698243917 BECAPLERMIN 0.01% GEL 15GM $1,426.038253221 BECLOMETHASONE 40MCG INHALER 7.3GM $191.538250219 BECLOMETHASONE AQ NAS 42MCG/SPY 25G $331.558209819 BELLADONNA ALK W/PB 10ML LIQ UD $17.648103616 BELLADONNA ALK/PB TAB $17.998101230 BENAZEPRIL 10MG TAB $18.938101248 BENAZEPRIL 20MG TAB $18.938101222 BENAZEPRIL 5MG TAB $19.058382012 BENDAMUSTINE INJ $639.408243206 BENZOCAINE 20% (DERMOPLAST) SPRAY $43.988243222 BENZOCAINE 7.5% GEL 7.2GM $41.698243743 BENZOIN CMPD TINC 60ML $39.078241622 BENZOIN TINCTURE AEROSOL 3.5OZ $75.638101313 BENZONATATE 100MG CAP $18.948241770 BENZOYL PEROXIDE 10% 45GM $68.698243230 BENZOYL PEROXIDE 10% LOT 30ML $40.978101289 BENZTROPINE 0.5MG TAB $17.718101297 BENZTROPINE 1MG TAB $17.798101305 BENZTROPINE 2MG TAB $17.638308678 BENZTROPINE 2MG/2ML INJ $84.588244907 BERACTANT INTRATRACHEAL SUSP $936.238280547 BERACTANT INTRATRACHEAL SUSP $1,643.958240160 BETAMETHASONE DIP 0.05% CRM 15GM $49.078244956 BETAMETHASONE DIP 0.05% LOTION 30ML $140.598244964 BETAMETHASONE DIP 0.05^ % OINT 15GM $49.078330037 BETAMETHASONE SOLU 6MG/ML 5ML MDV $145.06



8240137 BETAMETHASONE VALERATE .1% LOT 60ML $46.078240111 BETAMETHASONE VALERATE 0.1%OINT 15G $38.278252785 BETAXOLOL 0.5% OPTH SOLN 5ML $102.318253585 BETAXOLOL S O.25% OPHTH SUSP 10ML $263.998101339 BETHANECHOL 10MG TAB $20.328152894 BETHANECHOL 1MG/1ML SOLN PEDIPOD $19.288101347 BETHANECHOL 25MG TAB $22.078101321 BETHANECHOL 5MG TAB $19.058381899 BEVACIZUMAB (AVASTIN) INJ $730.188253544 BIAFINE TOPICAL EMULSION 45GM $97.538108185 BICALUTAMIDE 50MG TAB $56.628253692 BICARB MOUTHWASH (THERABREATH) 16oz $58.058253346 BIMATOPROST 0.03% OPSOL 2.5ML $203.198122913 BIOADHERENT ORAL GEL (GELCLAIR) PKT $33.718244816 BIOTENE MOUTHWASH 120ML (PEDS) $36.288193138 BIOTENE MOUTHWASH 480ML $42.898121618 BIOTIN 5MG CAPSULE $17.578209827 BIRTH CONTROL PILLS (PT OWN) $0.008270134 BISACODYL 10MG SUPP $0.008101370 BISACODYL 5MG TAB $0.008192734 BISMUTH SUBSALICYLATE SUSP 240ML $0.008101354 BISMUTH SUBSALICYLATE TAB $0.008121246 BISOPROLOL 5MG TAB $19.478341257 BIVALIRUDIN (ANGIOMAX) 250MG INJ $980.648381931 BIVALIRUDIN (ANGIOMAX) INJ $141.968380073 BLEOMYCIN (TEST DOSE) $680.828380073 BLEOMYCIN INJ $759.408380073 BLEOMYCIN SYRINGE $680.828250250 BLEPHAMIDE OPTH SOLN 5ML $159.098381865 BORTEZOMIB (VELCADE) INJ $691.608381865 BORTEZOMIB (VELCADE) Syringe $691.608122830 BOSENTAN 125MG TAB $146.538122160 BOSENTAN 62.5MG TAB $135.288307472 BOTULINUM TOXIN TYPE A INJ $1,328.148309098 BOTULISM IMMUNE GLOB HUMAN BIG-IV $45,300.008253254 BOUDREAUXS BUTT PASTE 120GM $47.088253627 BRIMONIDINE 0.1% OPHTH SOLN 5ML $165.958253114 BRIMONIDINE 0.15% OPHTH SOLN 5ML $180.578253452 BRIMONIDINE 0.2% OPHTH SOLN 5ML $99.378209827 BRINZOLAMIDE 1% EYE DROPS 10ML $227.878101404 BROMOCRIPTINE 2.5MG TAB $27.108250391 BSS OPTH SOLN 15ML $47.958252801 BSS OPTH SOLN 500ML $82.578250409 BSS PLUS OPHTH SOLN 500ML $84.378280703 BUDESONIDE 0.25MG/2ML RESPULE $30.758280711 BUDESONIDE 0.5MG/2ML RESPULE $33.198253486 BUDESONIDE 180MCG/PUFF FLEXHALER $333.238122558 BUDESONIDE 3MG CR CAP $21.98



8253700 BUDESONIDE 90MCG/PUFF FLEXHALER $257.498253262 BUDESONIDE AQUA 32MCG NASAL SPRAY $246.278114175 BUMETANIDE 0.5MG TAB $17.618300477 BUMETANIDE 0.5MG/2ML INJ $71.388300477 BUMETANIDE 12.5MG/50ML DRIP $139.658114183 BUMETANIDE 1MG TAB $17.858330052 BUMETANIDE 2.5MG/10ML INJ $80.148118580 BUMETANIDE 2MG TAB $18.418300477 BUMETANIDE INJ $71.528331746 BUPIVACAINE (NO PRESERVATIVES) $81.248209835 BUPIVACAINE 0.25% INJ 10ML $71.548331894 BUPIVACAINE 0.25% INJ 50ML $77.548331894 BUPIVACAINE 0.5% INJ 50ML $90.808331571 BUPIVACAINE MPF 0.75% IJ 10ML (SGH) $78.048331894 BUPIVACAINE PF 0.25% INJ 30ML $71.168331894 BUPIVACAINE PF 0.5% 30ML INJ $71.668331894 BUPIVACAINE PF 0.5% INJ 10ML $72.748300345 BUPIVACAINE PF 0.75% IN DEXTRSE 2ML $71.708209835 BUPIVACAINE PF 1/12% in NS 100ml $228.218209835 BUPIVACAINE W/EPI 0.25% INJ 10ML $73.768331365 BUPIVACAINE W/EPI 0.25% INJ 30ML $74.028331126 BUPIVACAINE W/EPI 0.25% INJ 50ML $93.128331746 BUPIVACAINE W/EPI 0.25% PF INJ 30ML $83.728209835 BUPIVACAINE W/EPI 0.5% INJ 10ML $74.428331134 BUPIVACAINE W/EPI 0.5% INJ 30ML $81.108330078 BUPIVACAINE W/EPI 0.5% INJ 50ML $94.868171902 BUPRENORPHINE 8MG TAB (SCP) $49.558115362 BUPROPION (WELLBUTRIN) 100MG SR TAB $23.998101461 BUPROPION (WELLBUTRIN) 100MG TAB $18.978118374 BUPROPION (WELLBUTRIN) 150MG SR TAB $24.498122228 BUPROPION (WELLBUTRIN) 15OMG XL TAB $29.968101453 BUPROPION (WELLBUTRIN) 75MG TAB $18.498101438 BUSPIRONE (BUSPAR) 10MG TAB $19.768101420 BUSPIRONE (BUSPAR) 5MG TAB $18.578101446 BUSULFAN 2MG TAB $21.978155905 BUSULFAN 2MG/ML SUSP (PEDS) $21.838381931 BUSULFAN INJ $621.878300451 BUTORPHANOL 2MG/1ML INJ $118.718242976 BUTORPHANOL NASAL SPRAY 2.5ML $253.758123499 CABAZITAXEL IVPB $19,796.208119562 CABERGOLINE 0.5MG TAB $95.248244949 CADEXOMER IODINE GEL 40GM $153.618253551 CADEXOMER IODINE GEL PAD 5GM $37.528308694 CAFFEINE CITRATE 10MG/ML SYRINGE $153.368155913 CAFFEINE CITRATE 20MG/ML PEDIPOD $17.878302390 CAFFEINE-SODIUM BENZOATE INJ $173.778242935 CALADRYL LOTION 180ML $0.008242950 CALAMINE-ZINC LOTION 120ML $0.00



8253320 CALCITONIN 200UNIT/SPRY NASAL 3.7ML $239.858308983 CALCITONIN SALMON 400UNIT/2ML INJ $184.108101594 CALCITRIOL 0.25MCG CAP $19.458101602 CALCITRIOL 0.5MCG CAP $20.908302762 CALCITRIOL 1MCG/1ML INJ $97.548194425 CALCITRIOL 1MCG/1ML LIQ 15ML (RXE) $392.078101594 CALCITRIOL 1MCG/1ML LIQ PEDIPOD $23.008105918 CALCIUM ACETATE 667MG CAP $18.618209801 CALCIUM CARBONATE 250MG/ML PEDIPOD $17.088101503 CALCIUM CARBONATE 500MG CHEW TAB $0.008300469 CALCIUM CHLORIDE 10% INJ 10ML $71.748303208 CALCIUM CHLORIDE 10% SYRINGE 10ML $73.748300469 CALCIUM CHLORIDE INJ $69.728300469 CALCIUM CHLORIDE INJ for PEDS CRRT $69.728300469 CALCIUM CL DRIP 100MG/ML (PEDS) $69.728300469 CALCIUM CL DRIP 20MG/ML *dilute-PED $137.858118606 CALCIUM GLUB 360MG/ML PEDIPOD $17.118300527 CALCIUM GLUCONATE 10% INJ 10ML $69.848300527 CALCIUM GLUCONATE INJ $35.858119570 CALCIUM POLYCARBOPHIL FIBER TAB $17.298244980 CALMOSEPTINE OINTMENT 113 GM $44.068120875 CANDESARTAN 16MG TAB $21.678122137 CANDESARTAN 8MG TAB $21.678121428 CAPECITABINE 500MG TAB $43.278209827 CAPHOSOL MOUTH RINSE-2x15ml pillows $21.038243974 CAPSAICIN 0.025% CRM 60GM $47.978243990 CAPSAICIN 0.075% CRM 60GM $58.058101628 CAPTOPRIL 12.5MG TAB $18.498155491 CAPTOPRIL 1MG/ML PEDIPOD $17.438193583 CAPTOPRIL 1MG/ML SOLN 30ML (RXE) $46.078101610 CAPTOPRIL 25MG TAB $19.678101644 CAPTOPRIL 50MG TAB $19.638101636 CAPTOPRIL 6.25MG TAB $18.498251449 CARBACHOL 1.5% OPTH SOLN 15ML $121.798251456 CARBACHOL 3% OPTH SOLN 15ML $134.398101669 CARBAMAZEPINE 100MG CHEW TAB $17.638118614 CARBAMAZEPINE 100MG ER CAP $17.948118622 CARBAMAZEPINE 200MG ER CAP $18.858101677 CARBAMAZEPINE 200MG TAB $17.948157034 CARBAMAZEPINE 200MG/10ML LIQ UDCUP $19.138192510 CARBAMAZEPINE 20MG/ML LIQ 120ML-RXE $67.438155228 CARBAMAZEPINE 20MG/ML PEDIPOD $17.178122095 CARBAMAZEPINE 300MG ER CAP $18.818250540 CARBAMIDE PEROXIDE 6.5% OTIC 15ML $43.838121444 CARBIDOPA 25MG TAB $18.278381170 CARBOPLATIN (PARAPLATIN) INJ $611.108381170 CARBOPLATIN (PARAPLATIN) TEST DOSE $621.208300550 CARBOPROST 250MCG INJ $272.50



8211195 CARBOPROST 250MCG/500ML NS IRRG $255.158341190 CARDIOPLEGIC SOLN #1 $1,135.888341190 CARDIOPLEGIC SOLN 500ML $991.028209827 CARMEX LIP BALM $0.008380057 CARMUSTINE INJECTION $1,007.588252827 CARTEOLOL 1% OPTH SOLN 5ML $73.358194490 CARVEDILOL 1.67MG/ML SUSP 30ML(RXE) $20.748209819 CARVEDILOL 1.67MG/ML SUSP PEDIPOD $20.748100208 CARVEDILOL 12.5MG TABLET $22.018121048 CARVEDILOL 25MG TABLET $21.308200081 CARVEDILOL 3.125MG TAB $22.018121055 CARVEDILOL 6.25MG TAB $22.018209801 CARVEDILOL CR 10MG CAP $25.378353187 CASPOFUNGIN (CANCIDAS) IVPB $217.328353187 CASPOFUNGIN 0.2MG/ML (PEDS) SYRINGE $217.328353187 CASPOFUNGIN INJ $217.328353187 CASPOFUNGIN IVPB $217.328150286 CASTOR OIL 60ML $38.578101750 CEFACLOR 250MG CAP $21.018101784 CEFACLOR 500MG CAP $24.828155939 CEFACLOR 50MG/ML PEDIPOD $17.808190316 CEFACLOR 50MG/ML SUSP 75ML (RXE) $92.148351439 CEFAZOLIN 1G VIAL $115.138353476 CEFAZOLIN 1GM/50ML 0.45%NS (ADV) $107.718353732 CEFAZOLIN 2GM in SW 20ML SYRINGE $136.138353724 CEFAZOLIN 2GM/50ML 0.9%NACL IVPB $136.138244006 CEFAZOLIN 50MG/ML OPSOL 10ML $40.558352775 CEFAZOLIN 50MG/ML SYRINGE (PEDS) $137.348351397 CEFAZOLIN in SW (IM syringe) $115.198351397 CEFAZOLIN INJ $108.678351397 CEFAZOLIN SYRINGE $108.678352569 CEFEPIME 100MG/ML SYR (PEDS) $140.338352544 CEFEPIME 1GM VIAL $145.618353534 CEFEPIME 1GM/50ML 0.45% NACL (ADV) $147.318353542 CEFEPIME 2GM/50ML 0.45% NACL (ADV) $190.058352544 CEFEPIME in SW IM syringe $142.818352544 CEFEPIME INJ $142.818352544 CEFEPIME IVPB $142.818123259 CEFIXIME 400MG TAB $41.178351470 CEFOTAXIME (CLAFORAN) SYRINGE $124.458351470 CEFOTAXIME 1GM INJ $108.118351470 CEFOTAXIME 300MG/ML IM SYRINGE $108.578352791 CEFOTAXIME 50MG/ML SYRINGE (PEDS) $139.158351470 CEFOTAXIME INJ $123.418355877 CEFOTETAN INJ $116.848352809 CEFOXITIN 100MG/ML SYR (PEDS) $138.528351454 CEFOXITIN 1GM INJ $124.718351454 CEFOXITIN 1GM/100ML NS MINIBAG PLUS $124.71



8351488 CEFOXITIN 2GM INJ $147.218351488 CEFOXITIN 2GM/100ML NS MINIBAG PLUS $147.218351454 CEFOXITIN INJ $124.718351454 CEFOXITIN IVPB $124.718101941 CEFPROZIL 250MG TAB $24.618154890 CEFPROZIL 50MG/ML PEDIPOD $18.678193591 CEFPROZIL 50MG/ML SUSP 100ML (RXE) $195.838351298 CEFTAZIDIME 1GM INJ $123.138353526 CEFTAZIDIME 1GM/50ML 0.45%NS (ADV) $131.628355885 CEFTAZIDIME 280MG/ML IM SYRINGE $116.448353518 CEFTAZIDIME 2GM/50ML 0.45%NS (ADV) $160.088352817 CEFTAZIDIME 50MG/ML SYRINGE (PEDS) $139.128351298 CEFTAZIDIME INJ $130.668351306 CEFTAZIDIME IVPB $159.128355885 CEFTAZIDIME SYRINGE $130.668351603 CEFTIZOXIME INJ $148.138352858 CEFTRIAXONE 100MG/ML SYR (PEDS) $145.478351322 CEFTRIAXONE 1GM INJ $194.218353591 CEFTRIAXONE 1GM/50ML 0.45%NS (ADV) $115.558351348 CEFTRIAXONE 250MG INJ (ER) $133.858351330 CEFTRIAXONE 2GM INJ $285.038353781 CEFTRIAXONE 2GM/50ML 0.45% NS (ADV) $131.898351348 CEFTRIAXONE 350MG/ML IM SYRINGE $129.098351363 CEFTRIAXONE 500MG INJ $165.238351322 CEFTRIAXONE INJ $194.218353500 CEFUROXIME 1.5GM/50ML 0.45%NS (ADV) $130.098351157 CEFUROXIME 200MG/ML IM SYRINGE $115.748101883 CEFUROXIME 250MG TAB $28.338101867 CEFUROXIME 500MG TAB $37.638353492 CEFUROXIME 750MG/50ML 0.45%NS (ADV) $116.718352866 CEFUROXIME 75MG/ML SYR (PEDS) $137.968351157 CEFUROXIME INJ $115.748119588 CELECOXIB (CELEBREX) 100MG CAP $22.188108011 CELECOXIB (CELEBREX) 200MG CAP $25.478101818 CEPACOL LOZ $0.008121063 CEPASTAT LOZ $0.008101842 CEPHALEXIN 250MG CAP $20.438101859 CEPHALEXIN 500MG CAP $24.008155954 CEPHALEXIN 50MG/ML PEDIPOD $17.338190456 CEPHALEXIN 50MG/ML SUSP 100ML (RXE) $71.878209835 CERTOLIZUMAB 200MG/1ML SYRINGE $1,823.338118648 CETIRIZINE (ZYRTEC) 10MG TAB $21.118156804 CETIRIZINE (ZYRTEC) 1MG/ML LIQ PEDS $17.578381873 CETUXIMAB 2MG/ML IVPB $716.208121451 CEVIMELINE 30MG CAP $20.458245540 CHAPSTICK B/C OVERNIGHT BALM 0.3OZ $0.008191181 CHARCOAL/WATER SUSP 120ML $56.468192767 CHARCOAL/WATER SUSP 240ML $78.33



8192759 CHARCOAL-SORBITOL SUSP 120ML $58.988192767 CHARCOAL-SORBITOL SUSP 240ML $78.338270951 CHLORAL HYDRATE 500MG SUPP (SMH) $23.598180614 CHLORAL HYDRATE 500MG/5ML UDCUP $36.078101909 CHLORAMBUCIL 2MG TAB $24.768350233 CHLORAMPHENICOL 1GM INJ $159.698350233 CHLORAMPHENICOL INJ $126.968101966 CHLORASEPTIC LOZ $0.008170268 CHLORDIAZEPOXIDE 10MG CAP $34.518170276 CHLORDIAZEPOXIDE 25MG CAP $34.538170250 CHLORDIAZEPOXIDE 5MG CAP $34.458190563 CHLORHEXIDINE 0.12% MOUTHWASH 480ML $66.138245011 CHLORHEXIDINE 4% 30ML/SW 1000ML $70.548244014 CHLORHEXIDINE 4% SOL 120ML $43.028101990 CHLOROPHYLL 3MG TAB $17.098331050 CHLOROPROCAINE 2% INJ 20ML $97.408331068 CHLOROPROCAINE 3% INJ 30ML $85.128101982 CHLOROQUINE 500MG TAB $27.878119281 CHLOROQUINE BASE 9MG/ML SUSP PEDS $17.278102014 CHLOROTHIAZIDE 250MG TAB $17.338352874 CHLOROTHIAZIDE 25MG/ML PED SYRINGE $69.248352239 CHLOROTHIAZIDE 500MG INJ $912.108102048 CHLOROTHIAZIDE 500MG TAB $17.568190464 CHLOROTHIAZIDE 50MG/ML LIQ 30ML(RXE $37.178151698 CHLOROTHIAZIDE 50MG/ML PEDIPOD $17.148352239 CHLOROTHIAZIDE INJ $158.358102063 CHLORPHENIRAMINE 4MG TAB $0.008102055 CHLORPHENIRAMINE SR 8MG TAB $17.218102154 CHLORPROMAZINE 10MG TAB $17.738308611 CHLORPROMAZINE 1MG/ML SYRINGE $136.328102147 CHLORPROMAZINE 200MG TAB $19.138102097 CHLORPROMAZINE 25MG TAB $17.608300626 CHLORPROMAZINE 25MG/1ML INJ-SGH/SMH $84.228102113 CHLORPROMAZINE 50MG TAB $17.628300626 CHLORPROMAZINE 50MG/2ML INJ (SCP) $85.948102162 CHLORPROPAMIDE 100MG TAB $17.718102188 CHLORPROPAMIDE 250MG TAB $18.438102220 CHLORTHALIDONE 25MG TAB (SMH ONLY) $17.508123424 CHOLECALCIFEROL (D3) 1000 UNIT TAB $17.098121071 CHOLESTYRAMINE LIGHT PWDR 4GM PKT $20.358110207 CHOLESTYRAMINE POWDER $22.618193633 CHOLINE-MAG SALICYLATE 120ML (RXE) $83.948193633 CHOLINE-MAG SALICYLATE LIQ PEDIPOD $17.458111841 CHOLINE-MAGNESIUM SALICYLATE 500MG $17.958253734 CICLESONIDE 160MCG INHALER 6.1g $359.078253759 CICLESONIDE 50MCG NASAL SPRAY $240.058253742 CICLESONIDE 80MCG INHALER 6.1g $359.078245029 CICLOPIROX 0.77% CREAM 15GM $98.09



8381832 CIDOFOVIR INJ $2,372.208381832 CIDOFOVIR IVPB $2,446.208121469 CILOSTAZOL 100MG TAB $21.318102303 CIMETIDINE 300MG TAB $19.088351793 CIMETIDINE IVPB $85.048122707 CINACALCET 30MG TAB $44.468122699 CINACALCET 60MG TAB $59.538253098 CIPROFLOXACIN 0.3% OPHTH OINT 3.5GM $192.838251415 CIPROFLOXACIN 0.3% OPSOL 5ML $161.038155749 CIPROFLOXACIN 100MG/ML PEDIPOD $19.668353609 CIPROFLOXACIN 200MG/100ML D5W IVPB $133.438102261 CIPROFLOXACIN 250MG TAB $27.608209835 CIPROFLOXACIN 2MG/ML PEDI SYRINGE $136.588353617 CIPROFLOXACIN 400MG/200ML D5W IVPB $162.258102279 CIPROFLOXACIN 500MG TAB $28.988102295 CIPROFLOXACIN 750MG TAB $29.988353302 CIPROFLOXACIN INJ $132.238253353 CIPROFLOXACIN-HC OTIC SUSP 10ML $266.158302309 CISATRACURIUM 20MG/10ML INJ $108.468302309 CISATRACURIUM INJ $176.598380099 CISPLATIN (PLATINOL-AQ) INJ $605.088381766 CISPLATIN (POWDER) INJ $692.208119414 CITALOPRAM (CELEXA) 20MG TAB $24.478119596 CITALOPRAM (CELEXA) 40MG TAB $23.098193997 CITRIC ACID/K-NA CITR. 120ML (RXE) $53.058153132 CITRIC ACID/K-NA CITRATES PEDIPOD $17.198150260 CITRIC ACID-NA CITRATE 30ML (RXE) $35.298150260 CITRIC ACID-NA CITRATE 30ML UDCUP $18.258155897 CITRIC ACID-NA CITRATE PEDIPOD $17.078381592 CLADRIBINE INJ $664.608106577 CLARITHROMYCIN 250MG TAB $29.508106585 CLARITHROMYCIN 500MG TAB $29.508193641 CLARITHROMYCIN 50MG/ML LIQ 100MLRXE $228.718152597 CLARITHROMYCIN 50MG/ML PEDIPOD $18.628102311 CLEMASTINE 2.68MG TAB $18.758209835 CLEVIDIPINE 25MG/50ML PREMIX $464.718240244 CLINDAMYCIN 1% TOPICAL 60ML $110.758102329 CLINDAMYCIN 150MG CAP $25.268350241 CLINDAMYCIN 150MG/ML IM SYRINGE $110.478190589 CLINDAMYCIN 15MG/ML SUSP 100ML (RXE $161.958156002 CLINDAMYCIN 15MG/ML SUSP PEDIPOD $17.588350241 CLINDAMYCIN 300MG/2ML INJ $110.138353567 CLINDAMYCIN 600MG/50ML 0.45%NS (ADV $119.178350241 CLINDAMYCIN 6MG/ML D5W IVPB (PEDS) $120.958209835 CLINDAMYCIN 6MG/ML D5W SYRINGE $136.618353559 CLINDAMYCIN 900MG/50ML 0.45%NS (ADV $114.558351702 CLINDAMYCIN 900MG/6ML INJ $127.698350241 CLINDAMYCIN INJ $110.13



8240327 CLOBETASOL 0.05% CRM 30GM $70.078250003 CLOBETASOL 0.05% OINT 45GM $134.498381923 CLOFARABINE INJ $877.458102345 CLOMIPHENE (CLOMID) 50MG TAB $30.878106734 CLOMIPRAMINE (ANAFRANIL) 25MG CAP $18.708102626 CLOMIPRAMINE (ANAFRANIL) 50MG CAP $19.168102634 CLOMIPRAMINE (ANAFRANIL) 75MG CAP $20.008170326 CLONAZEPAM (KLONOPIN) 0.1MG/ML (PED $35.888170292 CLONAZEPAM (KLONOPIN) 0.5MG TAB $35.678171712 CLONAZEPAM (KLONOPIN) 0.5MG WAFER $36.478170326 CLONAZEPAM (KLONOPIN) 1MG TAB $35.888171779 CLONAZEPAM (KLONOPIN) 1MG WAFER-SCP $36.818102386 CLONIDINE (CATAPRES) 0.1MG TAB $17.508156010 CLONIDINE (CATAPRES) 0.1MG/ML (PED) $17.508102402 CLONIDINE (CATAPRES) 0.2MG TAB $17.788102436 CLONIDINE (CATAPRES) 0.3MG TAB $17.988307787 CLONIDINE 1000 MCG/10ML INJ $424.278307787 CLONIDINE INJ $277.198240194 CLONIDINE-TTS 1 PATCH $59.398240228 CLONIDINE-TTS 2 PATCH $95.488240236 CLONIDINE-TTS 3 PATCH $160.588123135 CLOPIDOGREL 300MG TAB $59.648115248 CLOPIDOGREL 75MG TAB $28.558170342 CLORAZEPATE 3.75MG TAB (SCP ONLY) $36.958211112 CLORPACTIN 2GM/ST WATER IRRIG 1L $82.068241986 CLORPACTIN POWDER 2GM $43.678307472 CLOSTRIDIUM BOTULINUM TOXIN IM SYRG $1,188.148240269 CLOTRIMAZOLE 1% CRM 30GM $103.778240301 CLOTRIMAZOLE 1% LOT 30ML $96.198240319 CLOTRIMAZOLE 1% VAG. CREAM 45GM $48.478108037 CLOTRIMAZOLE 10MG LOZ $20.918241135 CLOTRIMAZOLE-BETAMETHASONE CRM 15GM $79.818105389 CLOZAPINE 100MG TAB $23.898105371 CLOZAPINE 25MG TAB $19.688105389 CLOZAPINE ODT 100MG TAB (SCP ONLY) $30.148245508 COAL TAR SHAMPOO 240ML $50.638180143 COCAINE 4% TOPICAL SOLN 4ML $84.438170375 CODEINE 15MG TAB $34.948170383 CODEINE 30MG TAB $35.108320582 CODEINE 60MG/1ML INJ (SGH) $104.738121592 CO-ENZYME Q-10 30MG CAP $17.808102550 COLCHICINE 0.6MG TAB $17.538102501 COLCHICINE-PROBENECID 0.5/500 TAB $18.728121410 COLESEVELAM 625MG TAB $19.658123028 COLESTIPOL 1GM TAB $18.438102527 COLESTIPOL 5GM GRANULES $21.038280471 COLFOSCERIL NEONATAL SUSP 8 ML $1,472.358245656 COLISTIMETHATE in SW for INHALATION $34.83



8331589 COLISTIMETHATE INJ $250.278243305 COLLAGENASE 250 UNIT/GM OINT 30GM $214.058245045 COLLODIAL OATMEAL LOTION 2.5OZ $37.178240285 COLLOIDAL OATMEAL BATH $35.198240087 COLLOIDAL OATMEAL SOAP $38.538240095 COLLOIDAL OILATED OATMEAL BATH $35.198308934 CONIVAPTAN 20MG/4ML INJ $923.778240533 CONJ ESTROGEN 0.625MG/G CRM 42.5GM $279.588104176 CONJUGATED ESTROGENS 0.3MG $19.498104184 CONJUGATED ESTROGENS 0.625MG $19.498104200 CONJUGATED ESTROGENS 1.25MG $19.708305930 CONJUGATED ESTROGENS 25MG INJ $272.988305930 CONJUGATED ESTROGENS INJ $204.648307795 COPPER TRACE ELEMENT ADDITIVE INJ. $68.648307100 CORTICORELIN 100MCG INJ $1,101.748300121 CORTICOTROPIN HP 80 UN/ML 5ML (RXE) $46,598.148308942 CORTICOTROPIN HP 80 UN/ML SYRINGE $0.008240368 CORTISPORIN OINT 15GM $168.998300683 COSYNTROPIN 0.25MG INJ $245.808209835 COSYNTROPIN 1MCG/ML SYRINGE $137.678300683 COSYNTROPIN TEST DOSE $245.808110512 COTRIMOXAZOLE 400-80MG TAB (SS) $18.368110504 COTRIMOXAZOLE DS TABLET $19.318308900 COTRIMOXAZOLE INJ $149.118308900 COTRIMOXAZOLE IVPB $149.118308900 COTRIMOXAZOLE IVPB (Fluid Restrict) $149.118194383 COTRIMOXAZOLE SUSP 100ML (RXE) $59.338155061 COTRIMOXAZOLE SUSP PEDIPOD $17.288118671 CREON 10 CAP $19.048118689 CREON 20 CAP $20.948123267 CREON DR 12,000unit MICROSPHERE CAP $20.448123275 CREON DR 24,000unit MICROSPHERE CAP $23.658123283 CREON DR 6,000unit MICROSPHERE CAP $18.898244063 CRITIC-AID SKIN PASTE 170GM $62.538280430 CROMOLYN 20MG/2ML INHL SOLN (RT) $18.438209827 CROMOLYN NASAL SPRAY 26ML $59.878251571 CROMOLYN SODIUM MDI 800MCG 8.1GM $197.258240384 CROTAMITON 10% CRM 60GM $66.658244071 CYANIDE ANTIDOTE KIT $617.268300717 CYANOCOBALAMIN 1000MCG/1ML INJ $70.548104515 CYANOCOBALAMIN 100MCG TAB $17.088118697 CYANOCOBALAMIN 250MCG TAB $17.108300717 CYANOCOBALAMIN INJ $69.428102584 CYCLOBENZAPRINE 10MG TAB $18.978250284 CYCLOMYDRIL OPHTH SOLN 2ML $69.838251597 CYCLOPENTOLATE 0.5% OPHTH SOLN 15ML $131.878250524 CYCLOPENTOLATE 1% OPTH SOLN 2ML $68.278250532 CYCLOPENTOLATE 2% OPHTH SOLN 2ML $78.83



8104572 CYCLOPHOSPHAMIDE 10MG/ML PEDIPOD $22.328102618 CYCLOPHOSPHAMIDE 25MG TAB $21.558380222 CYCLOPHOSPHAMIDE INJ $608.848104580 CYCLOSPORINE (SANDIMMUNE) 100MG CAP $35.358104572 CYCLOSPORINE (SANDIMMUNE) 25 MG CAP $21.628190712 CYCLOSPORINE 100MG/ML ELIXIR 50ML $923.718340366 CYCLOSPORINE INJ $189.078340366 CYCLOSPORINE IVPB (D5W) $191.278340366 CYCLOSPORINE IVPB (NS) $191.278104580 CYCLOSPORINE MICRO (GENGRAF) 100MG $28.028114563 CYCLOSPORINE MICRO (GENGRAF) 25MG $19.678104580 CYCLOSPORINE MICRO (NEORAL) 100MG $29.248114563 CYCLOSPORINE MICRO (NEORAL) 25MG $20.098193658 CYCLOSPORINE MICRO (NEORAL)LIQ 50ML $699.738155152 CYPROHEPTADINE 0.4 MG/ML PEDIPOD $17.218102675 CYPROHEPTADINE 4MG TAB $17.988307803 CYSTEINE INJ $69.928380354 CYTARABINE (ARA-C) INTRATHECAL INJ $603.208380354 CYTARABINE (ARA-C) INTRATHECAL SYRG $603.208380354 CYTARABINE 20 MG/mL in 0.9% NaCl $601.518380354 CYTARABINE INJ $629.808381725 CYTARABINE LIPOSOMAL (DEPOCYT) IT $1,441.408380354 CYTARABINE/ELLIOTS B INTRATHECAL SY $601.518380354 CYTARABINE/NS INTRATHECAL SYRG $601.518360497 CYTOMEGALOVIRUS IMMUNOGLOBULIN $2,878.708340515 D10-AMINOACID 2%-HEPARIN 125UNITS $851.918213258 D10W 250ML/HEPARIN PF 250 UNITS $115.218211120 D5/0.45%NACL/KCL 20MEQ/MGSULF 1GM $122.218340515 D5-AMINOACID 1.5%-HEPARIN 125UNITS $851.918213266 D5W 250ML/HEPARIN PF 250 UNITS $115.218209801 DABIGATRAN 150MG CAP $25.138209801 DABIGATRAN 75MG CAP $25.138380404 DACARBAZINE INJ $618.888381584 DACLIZUMAB INJ $1,115.158381584 DACLIZUMAB IVPB $1,068.538380453 DACTINOMYCIN INJ $625.408240418 DAKIN'S SOLN (1/4 STRENGTH) 1000ML $50.878240426 DAKIN'S SOLN (1/8 STRENGTH) 1000ML $50.878240392 DAKIN'S SOLN (FULL STRENGTH) 480ML $51.458240400 DAKIN'S SOLN (HALF STRENGTH) 480ML $51.458307167 DALTEPARIN 2500 UNIT/0.2ML INJ $104.028121329 DANTROLENE 100MG CAP $21.478302523 DANTROLENE 20MG INJ $280.888102709 DANTROLENE 25MG CAP $19.558156036 DANTROLENE 5MG/ML SUSP PEDIPOD $17.458302523 DANTROLENE INJ $257.568119604 DAPSONE 100MG TAB $17.468123218 DAPSONE 25MG TAB $17.42



8353245 DAPTOMYCIN IVPB $137.298209835 DARBEPOETIN ALFA 40 MCG/0.4ML INJ $554.268209835 DARBEPOETIN ALPHA 100 MCG/0.5ML INJ $1,283.508200935 DARBEPOETIN ALPHA 150MCG/0.3ML INJ $1,891.188209835 DARBEPOETIN ALPHA 200 MCG/0.4ML INJ $2,498.868209835 DARBEPOETIN ALPHA 25 MCG/0.42ML INJ $371.988209835 DARBEPOETIN ALPHA 300 MCG/0.6ML INJ $3,714.228209835 DARBEPOETIN ALPHA 500 MCG/1ML INJ $6,144.948209835 DARBEPOETIN ALPHA 60 MCG/0.3ML INJ $797.388209801 DARUNAVIR 600MG TAB $53.778122939 DASATINIB 20MG TAB $90.668122897 DASATINIB 70MG TAB $179.418381600 DAUNORUBICIN (CERUBIDINE) INJ $773.088308959 DECITABINE INJ $664.468122947 DEFERASIROX 250MG TAB $72.968304149 DEFEROXAMINE 500MG/VIAL INJ $158.918304149 DEFEROXAMINE INJ $158.918209843 DEGARELIX 20MG/ML in SWFI SYRINGE $952.278209843 DEGARELIX 40MG/ML in SWFI SYRINGE $1,360.278119612 DELAVIRDINE 100MG TAB $18.798103012 DEMECLOCYCLINE 150MG TAB $40.548102790 DEMECLOCYCLINE 300MG TAB $59.588209843 DENILEUKIN INJ $4,215.408209835 DENOSUMAB 120MG/1.7ML VIAL $1,932.828209835 DENOSUMAB 60MG/1ML INJ $2,048.148300782 DEPO-MEDROL 40MG/ML INJ $86.228300790 DEPO-MEDROL 80MG/ML INJ $99.488102808 DESIPRAMINE 10MG TAB $18.968102857 DESIPRAMINE 150MG TAB (SCP) $21.398102816 DESIPRAMINE 25MG TAB $19.348102824 DESIPRAMINE 50MG TAB (SCP) $18.838102832 DESIPRAMINE 75MG TAB (SCP) $19.328243024 DESITIN CREAMY OINTMENT 60GM $40.848243024 DESITIN OINT 57GM $39.878308462 DESMOPRESSIN (DDAVP) INJ $82.688308462 DESMOPRESSIN (DDAVP) IVPB $82.688253288 DESMOPRESSIN (STIMATE)1.5MG/ML NAS $1,321.578250581 DESMOPRESSIN 0.01% NASAL SPRAY 5ML $504.038250565 DESMOPRESSIN 0.01% RHINAL SOLN $218.078118705 DESMOPRESSIN 0.1MG TAB $23.078302549 DESMOPRESSIN 4MCG/1ML INJ 10ML $209.748302556 DESMOPRESSIN 4MCG/ML INJ $108.468251365 DESONIDE 0.05% CRM 15GM $65.018245060 DESONIDE 0.05% OINT 15GM $58.978123358 DESVENLAFAXINE 50MG CR TAB (SCP) $25.568250557 DEXAMETHASONE 0.1% OPTH SOLN 5ML $126.718102873 DEXAMETHASONE 0.5MG TAB $17.528102881 DEXAMETHASONE 0.75MG TAB $17.69



8102907 DEXAMETHASONE 1.5MG TAB $17.818304230 DEXAMETHASONE 10MG/1ML INJ $72.628102899 DEXAMETHASONE 1MG TAB $17.728193674 DEXAMETHASONE 1MG/ML CONC 30ML(RXE) $73.318150484 DEXAMETHASONE 1MG/ML LIQ PEDIPOD $18.308102915 DEXAMETHASONE 2MG TAB $18.338102949 DEXAMETHASONE 4MG TAB $18.278300824 DEXAMETHASONE 4MG/1ML INJ $70.788330144 DEXAMETHASONE 4MG/ML INJ 5ML $72.348308736 DEXAMETHASONE INJ $68.368309031 DEXMEDETOMIDINE 200MCG/2ML VIAL $293.938309031 DEXMEDETOMIDINE INJ $301.538171761 DEXMETHYLPHENIDATE 5MG TAB (SCP) $35.718171837 DEXMETHYLPHENIDATE XR 10MG CAP (SCP $41.228171845 DEXMETHYLPHENIDATE XR 5MG CAP (SCP) $41.128305880 DEXRAZOXANE (TOTECT) INJ $1,376.208305880 DEXRAZOXANE INJ $1,113.388305880 DEXRAZOXANE IVPB $1,113.388210122 DEXTRAN 40/0.9%NACL 500ML $152.418210114 DEXTRAN 40/D5W 500ML $168.818210106 DEXTRAN 6%/0.9% NACL 500ML $132.218210098 DEXTRAN 6%/D5W 500ML $164.718170425 DEXTROAMPHETAMINE 10MG SR CAP (SCP) $36.828170417 DEXTROAMPHETAMINE 5MG SR CAP (SCP) $36.288170409 DEXTROAMPHETAMINE 5MG TAB $34.718193682 DEXTROMETHORPHAN CR 6MG/ML SUS 89ML $48.688155574 DEXTROSE (GLUCOSE) 40% GEL 15GM $36.948210072 DEXTROSE 10% $106.118210080 DEXTROSE 10% $106.418210551 DEXTROSE 10%/0.225% NACL $139.618210569 DEXTROSE 10%/0.45% NACL $139.618210494 DEXTROSE 10%/0.9% NACL $117.818211203 DEXTROSE 12% 500ML $160.578210072 DEXTROSE 12.5% 500ML $160.578211211 DEXTROSE 15% 500ML $160.578211229 DEXTROSE 20% (Impella purge fluid) $126.518211229 DEXTROSE 20% 500ML $126.518300873 DEXTROSE 25% INJ 10ML SYRINGE $81.108210015 DEXTROSE 5% $3.008210023 DEXTROSE 5% $105.318210056 DEXTROSE 5% $106.218310005 DEXTROSE 5% $4.288310013 DEXTROSE 5% $4.288300022 DEXTROSE 5% (INVEST. USE) $0.008210015 DEXTROSE 5% (GLASS) $10.008210288 DEXTROSE 5% LACTATED RINGERS $106.218210296 DEXTROSE 5% LACTATED RINGERS $106.018310161 DEXTROSE 5% MINI-BAG PLUS 100ML $29.00



8310153 DEXTROSE 5% MINI-BAG PLUS 50ML $29.008210890 DEXTROSE 5% W/20MEQ KCL $108.218210916 DEXTROSE 5% W/40MEQ KCL $108.218210379 DEXTROSE 5%/0.225% NACL $105.818210692 DEXTROSE 5%/0.225% NACL W/10MEQ KCL $108.218210700 DEXTROSE 5%/0.225% NACL W/20MEQ KCL $108.218210726 DEXTROSE 5%/0.225% NACL W/30MEQ KCL $108.218210734 DEXTROSE 5%/0.225% NACL W/40MEQ KCL $108.218210387 DEXTROSE 5%/0.45% NACL $105.818210395 DEXTROSE 5%/0.45% NACL $105.818210403 DEXTROSE 5%/0.45% NACL $106.018210411 DEXTROSE 5%/0.45% NACL W/10MEQ KCL $108.218210429 DEXTROSE 5%/0.45% NACL W/20MEQ KCL $106.618210676 DEXTROSE 5%/0.45% NACL W/30MEQ KCL $108.218210684 DEXTROSE 5%/0.45% NACL W/40MEQ KCL $108.218210437 DEXTROSE 5%/0.9% NACL $105.818210452 DEXTROSE 5%/0.9% NACL $105.618210130 DEXTROSE 5%/0.9% NACL W/20MEQ KCL $110.618210163 DEXTROSE 5%/0.9% NACL W/40MEQ KCL $110.618210189 DEXTROSE 5%/LR W/20MEQ KCL $119.418210353 DEXTROSE 5%/O.225% NACL $105.818210361 DEXTROSE 5%/O.225% NACL $105.818210015 DEXTROSE 5%-WATER $3.008300865 DEXTROSE 50% INJ 50ML $70.428303232 DEXTROSE 50% INJ 50ML SYRINGE $77.748209835 DIALYSATE FOR ADMIX, RX TO ADD NAME $0.008211443 DIANEAL W/1.5% DEXTROSE $135.018260093 DIASTIX STRIPS $56.878270910 DIAZEPAM 10MG RECTAL GEL (SMH) $599.738170565 DIAZEPAM 10MG TAB $34.928320111 DIAZEPAM 10MG/2ML INJ $105.938170490 DIAZEPAM 2MG TAB $34.558170532 DIAZEPAM 5MG TAB $34.718181075 DIAZEPAM 5MG/5ML LIQ UDCUP $38.518320160 DIAZEPAM INJ $104.078193690 DIAZOXIDE 50MG/ML SUSP 30ML $368.238243610 DIBUCAINE 1% OINT 30GM $41.558244097 DICLOFENAC 0.1% OPTH SOLN 2.5ML $130.658103806 DICLOFENAC 50MG DELAYED RELEASE TAB $18.928103814 DICLOFENAC 75MG DELAYED RELEASE TAB $19.328103038 DICLOXACILLIN 250MG CAP $18.358103046 DICLOXACILLIN 500MG CAP $19.438103061 DICYCLOMINE 10MG CAP $17.568103079 DICYCLOMINE 20MG TAB $17.738307811 DICYCLOMINE 20MG/2ML INJ $115.068209819 DICYCLOMINE 2MG/ML PEDIPOD $17.218193716 DICYCLOMINE 2MG/ML SYRUP 120ML (RXE $55.488122657 DIDANOSINE 125MG SR CAP $24.07



8121550 DIDANOSINE 200MG ENTERIC COATED CAP $29.388103160 DIFLUNISAL 500MG TAB $19.678194433 DIGOXIN 0.05MG/ML ELIXIR 60ML (RXE) $61.158103194 DIGOXIN 0.125 MG TAB $17.878103202 DIGOXIN 0.25MG TAB $17.878300923 DIGOXIN 0.5MG/2ML INJ $71.908300931 DIGOXIN 100MCG/1ML INJ (PEDS) $150.098308645 DIGOXIN 25MCG/ML SYRINGE (PED/SCN) $139.738150682 DIGOXIN 50MCG/ML LIQ PEDIPOD $17.488360075 DIGOXIN IMMUNE FAB (DIGIBIND) $1,297.658308371 DIGOXIN IMMUNE FAB (DIGIFAB) $1,288.278305898 DIHYDROERGOTAMINE 1MG/ML INJ $162.668321291 DILAUDID 20mcg/mL BUPIV-PF 0.06%/NS $214.348211476 DILTIAZEM 100MG/100ML NS (ADV) $131.918302721 DILTIAZEM 25MG/5ML INJ $104.858103319 DILTIAZEM 30MG TAB $17.938103327 DILTIAZEM 60MG TAB $18.448103343 DILTIAZEM 90MG TAB $18.748121097 DILTIAZEM CD 120MG $19.918106312 DILTIAZEM CD 180MG $20.498106320 DILTIAZEM CD 240MG $21.958106338 DILTIAZEM CD 300MG $23.378302721 DILTIAZEM INJ $109.478103426 DILTIAZEM SR 120MG $19.518102105 DILTIAZEM SR 60MG $19.228103418 DILTIAZEM SR 90MG $18.938155384 DIMAPHEN ELIXIR PEDIPOD $17.098103301 DIMENHYDRINATE 50MG TAB $17.098305856 DIMERCAPROL 100MG/ML INJ 3ML $265.888194367 DIMETHYL SULFOXIDE (DMSO) 50% SOLN $149.278245078 DINOPROSTONE CERVICAL GEL 3GM $633.738244899 DIPHENHYDRAMINE 1% CREAM 28.3GM $40.918209827 DIPHENHYDRAMINE 2% CREAM 30GM $39.018190621 DIPHENHYDRAMINE 2.5MG/ML 120ML-STCC $36.258156051 DIPHENHYDRAMINE 2.5MG/ML PEDIPOD $17.088103467 DIPHENHYDRAMINE 25MG TAB $0.008156994 DIPHENHYDRAMINE 25MG/10ML LIQ UDCUP $18.298103475 DIPHENHYDRAMINE 50MG CAP $17.308303265 DIPHENHYDRAMINE 50MG/1ML INJ $70.108194441 DIPHENOXYLATE-ATROPINE LIQ 60ML $80.898170649 DIPHENOXYLATE-ATROPINE TAB $35.758209835 DIPHTH,PERTUSS,TETANUS VAC - ADACEL $156.408303307 DIPHTH,PERTUSS,TETANUS VAC-INFANRIX $120.508252488 DIPIVEFRIN 0.1% OPTH SOLN 5ML $62.278300691 DIPYRIDAMOLE 10MG/2ML INJ $82.688103483 DIPYRIDAMOLE 25MG TAB $17.788209835 DIPYRIDAMOLE 50MG/10ML INJ $94.548120370 DIPYRIDAMOLE SR 200MG/ASPIRIN 25MG $22.99



8103566 DISOPYRAMIDE 100MG CAP $18.428103509 DISOPYRAMIDE 100MG SR $19.708156069 DISOPYRAMIDE 10MG/ML SUSP PEDIPOD $17.178103574 DISOPYRAMIDE 150MG CAP $18.678103517 DISOPYRAMIDE 150MG SR $20.558103582 DISULFIRAM 250MG TAB $19.738119299 DISULFIRAM 25MG/ML SUSP 30ML (RXE) $42.168209801 DISULFIRAM 25MG/ML SUSP PEDIPOD $17.308114308 DIVALPROEX 125MG SPRINKLE CAP $19.208114274 DIVALPROEX 125MG TAB-DELAYED RELEAS $19.318122145 DIVALPROEX 250MG EXTEND RELEASE $21.078114282 DIVALPROEX 250MG TAB-DELAYED RELEAS $21.478120776 DIVALPROEX 500MG EXTEND RELEASE $21.908114290 DIVALPROEX 500MG TAB-DELAYED RELEAS $25.188211393 DOBUTAMINE 1000MG/250ML D5W $393.068300964 DOBUTAMINE 250MG/20ML INJ $121.998211419 DOBUTAMINE 250MG/250ML D5W DRIP-PED $122.618300964 DOBUTAMINE INJ $121.998381493 DOCETAXEL (TAXOTERE) INJ $1,525.248103442 DOCUSATE CALCIUM 240MG CAP $0.008103368 DOCUSATE SODIUM 100MG CAP $0.008156077 DOCUSATE SODIUM 100MG/10ML UDCUP $0.008103434 DOCUSATE SODIUM 250MG CAP $0.008103350 DOCUSATE SODIUM 50MG CAP $0.008270894 DOCUSATE SODIUM ENEMA AMPULE $38.878120388 DOFETILIDE 125MCG CAPSULE $23.658120396 DOFETILIDE 250MCG CAPSULE $23.658120404 DOFETILIDE 500MCG CAPSULE $21.258209835 DOLASETRON 100MG/5ML VIAL $161.748307639 DOLASETRON 12.5MG AMP INJ $104.948240186 DOMEBORO 2PKTS/WATER FOR IRRG 1L $40.998118713 DONEPEZIL 10MG TAB $27.408200099 DONEPEZIL 5MG TAB $33.098303331 DOPAMINE 200MG/5ML INJ $106.598211427 DOPAMINE DRIP 20MG/50ML D5W (PEDS) $106.598210510 DOPAMINE DRIP 400MG/250ML D5W $139.918211435 DOPAMINE DRIP 800MG/250ML D5W $145.368308454 DOPAMINE INJ $110.398303331 DOPAMINE PEDIATRIC INJ $106.418280596 DORNASE INHALATION SOLN $123.838253528 DORZOLAMIDE 2% OPHTH SOLN 10ML $186.478320541 DOXAPRAM INJ 20MG/ML INJ 20ML $262.908103715 DOXAZOSIN 1MG TAB $18.888103749 DOXAZOSIN 2MG TAB $18.888103699 DOXAZOSIN 4MG TAB $18.978103707 DOXEPIN 100MG CAP (SCP ONLY) $19.098103632 DOXEPIN 10MG CAP $17.768103665 DOXEPIN 150MG CAP (SCP) $21.19



8103640 DOXEPIN 25MG CAP $17.898123440 DOXERCALCIFEROL 0.5MCG CAP $31.918121642 DOXERCALCIFEROL 2.5MCG CAP $42.698308264 DOXERCALCIFEROL 4MCG/2ML INJ $116.368380537 DOXORUBICIN (ADRIAMYCIN) INJ $613.028380537 DOXORUBICIN (POWDER) INJ $599.578381782 DOXORUBICIN LIPOSOMAL (DOXIL) INJ $1,714.608121477 DOXYCYCLINE (PERIOSTAT) 20MG TAB $19.698103731 DOXYCYCLINE 100MG TAB $18.078350266 DOXYCYCLINE 100MG VIAL $164.598103780 DOXYCYCLINE 50MG CAP $18.528350266 DOXYCYCLINE INJ $165.778350266 DOXYCYCLINE INTRAPLEURAL $165.778350266 DOXYCYCLINE IVPB $165.778170573 DRONABINOL 2.5MG CAP $50.498123374 DRONEDARONE 400MG TAB $25.678301046 DROPERIDOL 2.5MG/ML 2ML INJ $76.648301046 DROPERIDOL 5MG/2ML INJ $76.308341232 DROTRECOGIN ALFA INJ $835.158341232 DROTRECOGIN ALFA PEDI SYRINGE $677.038209835 DRUG DILUENT/OVERFILL VOLUME $0.008122574 DULOXETINE DR 20MG CAP $23.388122608 DULOXETINE DR 30MG CAP $27.388122616 DULOXETINE DR 60MG CAP (SCP ONLY) $24.168242703 DUODERM CGF STERILE DRESSING $36.518253502 DUODERM EXTRA THIN DRESSING $34.998123002 DUTASTERIDE 0.5MG CAP $24.778243735 ECONAZOLE 1% CRM 30GM $98.358307183 EDETATE DISODIUM 150MG/ML INJ $133.028304305 EDROPHONIUM 10MG/ML INJ 15ML $88.788120420 EFAVIRENZ 200MG CAP $27.828123226 EFAVIRENZ 50MG CAP $20.118155293 ELEMENTAL IRON 15MG/0.6ML PEDIPOD $17.268155293 ELEMENTAL IRON 15MG/ML LIQ 50ML RXE $17.398155293 ELEMENTAL IRON 15MG/ML PEDIPOD $17.398308975 ELLIOTTS B SOLN $76.318122798 EMTRICITABINE 200MG CAP $41.438103889 ENALAPRIL 10MG TAB $19.178156838 ENALAPRIL 1MG/ML SUSP PEDIPOD $17.248103855 ENALAPRIL 2.5MG TAB $18.648103905 ENALAPRIL 5MG TAB $19.078307837 ENALAPRILAT 1.25MG/ML INJ $79.908352353 ENALAPRILAT 2.5MG/2ML INJ $75.148209827 ENDOSCOPY PRODCEDURE KIT $0.008209835 ENOXAPARIN *DILUTE* 20MG/ML SCN SYR $82.378307381 ENOXAPARIN 100MG/1ML INJ $240.188309114 ENOXAPARIN 100MG/ML PED SYRINGE $82.378209835 ENOXAPARIN 120MG/0.8ML INJ $274.64



8209835 ENOXAPARIN 150MG/1ML INJ $326.268300337 ENOXAPARIN 30MG/0.3ML INJ $119.708307191 ENOXAPARIN 40MG/0.4ML INJ $136.888307399 ENOXAPARIN 60MG/0.6ML INJ $171.368307522 ENOXAPARIN 80MG/0.8ML INJ $205.768121485 ENTACAPONE 200MG TAB $23.368351827 EPHEDRINE 25mg in NS 5mL SYRINGE $110.218301111 EPHEDRINE 50MG/1ML INJ $69.448301111 EPHEDRINE INJ $69.448330136 EPINEPHRINE 1:1000 INJ 30ML $86.648303398 EPINEPHRINE 1:10000 SYRINGE 10ML $141.558308397 EPINEPHRINE 100MCG/ML D5W PED SYRIN $137.678308405 EPINEPHRINE 10MCG/ML D5W PED SYRING $136.418252876 EPINEPHRINE 1MG/1ML FOR INHAL (PF) $25.798209835 EPINEPHRINE 8MG/250ML D5W $120.458307498 EPINEPHRINE AUTO JR 0.15MG (SCP) $172.708244121 EPINEPHRINE BITARTRATE PWD $55.678308397 EPINEPHRINE INJ $69.428301129 EPINEPHRINE INJ 1MG/1ML INJ $69.428245565 EPINEPHRINE-RACEMIC 2.25% INHL0.5ML $19.538307498 EPIPEN AUTO INJECTOR 0.3MG (SCP) $217.308381741 EPIRUBICIN INJ $612.528122319 EPLERENONE 25MG TAB $26.228122665 EPLERENONE 50MG TAB $24.538309064 EPOETIN (ESRD <10,000 units) INJ $71.788309072 EPOETIN (ESRD >10,000 units) INJ $71.788209835 EPOETIN 20,000 UNIT/1 ML VIAL $795.348305039 EPOETIN ALFA 10,000 UNIT/ML SYRINGE $104.508305039 EPOETIN ALFA 2,000 UNIT/ML SYRINGE $104.508305039 EPOETIN ALFA 20,000 UNIT/ML SYRINGE $104.508305039 EPOETIN ALFA 40,000 UNIT/ML SYRINGE $104.498305039 EPOETIN ALFA INJ (VIAL) $104.508353211 EPOPROSTENOL INJ $180.778211138 EPTIFIBATIDE (INTEGRELIN) 0.75MG/ML $842.058307654 EPTIFIBATIDE 20MG/10ML INJ $338.618103954 ERGOCALCIFEROL (D2) 50,000 UNIT CAP $17.758190704 ERGOCALCIFEROL 200unit/drop 60MLrxe $208.078157091 ERGOCALCIFEROL 8,000unit/mL LIQ $17.188157091 ERGOCALCIFEROL LIQ 400 UNIT/0.05ML $17.188270175 ERGOTAMINE-CAFFEINE 100-2MG SUPP $31.918101560 ERGOTAMINE-CAFFEINE TAB $19.738209835 ERTAPENEM (INVANZ) SYRINGE $205.678209835 ERTAPENEM 1GM/50ML 0.45% NACL (ADV) $246.218209843 ERWINIA ASPARAGINASE INJ $796.208244147 ERYTHROMYCIN 0.5% OP OINT 1g (SMH) $20.918250706 ERYTHROMYCIN 0.5% OP OINT 3.5g SGH $72.078241994 ERYTHROMYCIN 2% TOP SOLN 60ML $47.878104069 ERYTHROMYCIN 250MG EC TAB $17.56



8104077 ERYTHROMYCIN 333MG EC TAB $17.818104010 ERYTHROMYCIN 500MG EC TAB $17.938350316 ERYTHROMYCIN 500MG INJ $109.618352908 ERYTHROMYCIN 5MG/ML SYRING (PEDS) $136.298104085 ERYTHROMYCIN BASE 500MG TAB $17.608194458 ERYTHROMYCIN E.S. 40MG/ML 100ML RXE $43.608156911 ERYTHROMYCIN ETHSUC 40MG/ML PEDIPOD $17.128350316 ERYTHROMYCIN INJ $143.678350316 ERYTHROMYCIN IVPB (NS) $109.868192254 ERYTHROMYCIN-SULFISOXAZ 100ML (RXE) $64.418156408 ERYTHROMYCIN-SULFISOXAZOLE PEDIPOD $17.288121980 ESCITALOPRAM 10MG TAB $23.648301095 ESMOLOL (MAX CONC) PED DRIP $144.738301095 ESMOLOL 10MG/ML INJ 10ML $144.738211385 ESMOLOL 2000MG/100ML NS DRIP $409.218211146 ESMOLOL 2500MG/250ML 0.9% NACL $348.218301095 ESMOLOL INJ $144.738301095 ESMOLOL PEDIATRIC SYRINGE $178.798121790 ESOMEPRAZOLE 20MG CAP $29.418114696 EST. ESTROGEN 1.25-METHYLTEST 2.5MG $24.628240517 ESTRADIOL (CLIMARA) 0.05MG/24H PTCH $48.568240525 ESTRADIOL (CLIMARA) 0.1MG/24HR PTCH $48.568245094 ESTRADIOL (VIVELLE) 0.05MG/24H PTCH $30.758245102 ESTRADIOL (VIVELLE) 0.1MG/24H PTCH $26.078240541 ESTRADIOL 0.1MG/1G VAG CRM 42.5GM $278.378121139 ESTRADIOL 1MG TAB $17.728104168 ESTRADIOL 2MG TAB $19.428209835 ESTRADIOL CYPIONATE **IM SYRINGE** $80.308331779 ESTRADIOL CYPIONATE 5MG/ML INJ 5ML $147.028118747 ESTRADIOL O.5MG TAB $17.548337057 ESTRADIOL VALERATE ***IM SYRINGE*** $88.008331654 ESTRADIOL VALERATE 20MG/ML 5ML INJ $266.708118754 ESTROPIPATE 0.75MG TAB (OGEN 0.625) $17.898108649 ESTROPIPATE 1.5MG TAB (OGEN 1.25) $20.488171787 ESZOPICLONE 1MG TAB $41.488209801 ESZOPICLONE 3MG TAB $41.488307662 ETANERCEPT 25MG INJ $602.198209835 ETANERCEPT 50MG/0.98ML SYRINGE $1,018.988309106 ETHACRYNATE 1MG/ML SYRINGE (SCN) $137.228305948 ETHACRYNATE SODIUM 50MG INJ $296.148305948 ETHACRYNATE SODIUM INJ $115.748305948 ETHACRYNATE SODIUM IVPB $115.748104234 ETHACRYNIC ACID 25MG TAB $22.728104267 ETHAMBUTOL 100MG TAB $18.388104275 ETHAMBUTOL 400MG TAB $21.568307670 ETHANOLAMINE 5% 2ML INJ $220.648104325 ETHOSUXIMIDE 250MG CAP $20.008155459 ETHOSUXIMIDE 50MG/ML SYRUP PEDIPOD $17.53



8243503 ETHYL CHLORIDE AEROSOL 100ML $58.958106262 ETODOLAC 200MG CAP $20.138106270 ETODOLAC 300MG CAP $19.888118762 ETODOLAC 400MG TAB $19.978307845 ETOMIDATE 20MG/10ML INJ $97.668380958 ETOPOSIDE INJ $598.458382004 ETOPOSIDE PHOSPHATE (ETOPOPHOS) INJ $628.118123242 ETRAVIRINE 100MG TAB $30.668245110 EUCERIN CREAM 30GM (SCN) $36.608243040 EUCERIN EMOLIENT CREAM 120GM $44.158240202 EXACTACAINE AEROSOL 60GM $166.118121014 EXCEDRIN EXTRA STRENGTH TAB (SCP) $0.008121667 EXEMESTANE 25MG TAB $41.798209835 EXENATIDE (5mcg/0.02mL) INJ PEN $560.608250276 EYESTREAM OPHTH SOLN 30ML $63.478122525 E-Z GAS PKT $19.038120024 EZETIMIBE 10MG TAB $24.778341299 FACTOR 7 (NOVOSEVEN RT) SURG USE $343.318341299 FACTOR 7 (NOVOSEVEN RT) SYRINGE $343.318361115 FACTOR 8 (ALPHANATE) $343.188361123 FACTOR 8 (HEMOPHIL) $343.248361131 FACTOR 8 (HUMATE P) $343.188361149 FACTOR 8 (MONOCLATE-P) $342.788361164 FACTOR 8 RECOMBINANT (KOGENATE) $343.048361172 FACTOR 8 RECOMBINANT (RECOMBINATE) $343.948361180 FACTOR 9 (ALPHANINE SD) $343.648361263 FACTOR 9 (BEBULIN-VH) COMPLEX $342.768361198 FACTOR 9 (BENEFIX) HUMAN RECOMB $342.768361206 FACTOR 9 (MONONINE) $590.688120883 FAMCICLOVIR 500MG TAB $45.418104374 FAMOTIDINE 20MG TAB $20.518305955 FAMOTIDINE 20MG/2ML INJ $105.078307852 FAMOTIDINE 2MG/ML SYRINGE (PEDS) $136.578193773 FAMOTIDINE 8MG/ML LIQ 50ML (RXE) $249.498156754 FAMOTIDINE 8MG/ML SUSP PEDIPOD $24.898305955 FAMOTIDINE INJ $105.198193781 FELBAMATE 120MG/ML SUSP 240ML (RXE) $522.618154999 FELBAMATE 400MG TAB $20.968114423 FELBAMATE 600MG TAB $21.538156119 FELBAMATE SUSP PEDIPOD $19.078120438 FELODIPINE 2.5MG CR TABLET $20.328100323 FELODIPINE CR 5 MG TAB $20.328209801 FENOFIBRATE (TRICOR) 145MG TAB $26.228120990 FENOFIBRATE (TRICOR) 160MG TAB $21.788209801 FENOFIBRATE (TRICOR) 48MG TAB $19.548308157 FENOLDOPAM INJ $619.348104341 FENOPROFEN 200MG CAP $18.408104358 FENOPROFEN 600MG TAB $18.04



8321234 FENTANYL *DILUTE* 5mcg/mL VIAL(SCN) $112.518352130 FENTANYL 10 MCG/ML (EPIDURAL) $177.608355802 FENTANYL 10 MCG/ML (NS) PCA $182.348352130 FENTANYL 10 MCG/ML NS (SCN DRIP) $177.608243446 FENTANYL 100MCG PATCH $196.798209801 FENTANYL 12MCG PATCH $70.488211518 FENTANYL 2500MCG/250ML NS DRIP $197.368243412 FENTANYL 25MCG PATCH $78.038321283 FENTANYL 2mcg/mL BUPIV-PF0.0625% NS $237.868209835 FENTANYL 300MCG/BUPIV-PF 0.1% EPID $197.368243420 FENTANYL 50MCG PATCH $114.458321218 FENTANYL 50MCG/ML 2ML INJ $103.658320145 FENTANYL 50MCG/ML 5ML INJ $104.538321218 FENTANYL 50MCG/ML (ADULT) MAX DRIP $104.968321218 FENTANYL 50MCG/ML (MAX CONC) PCA $410.348320152 FENTANYL 50MCG/ML (PEDS) MAX DRIP $129.718320152 FENTANYL 50MCG/ML 20ML INJ $129.718209835 FENTANYL 50MCG/ML 50ML INJ $151.598243438 FENTANYL 75MCG PATCH $156.678321218 FENTANYL INJ $103.668352130 FENTANYL INJ (EPIDURAL) $177.608308769 FERRIC SUCROSE CMPLX (VENOFER) INJ $137.658308769 FERRIC SUCROSE CMPLX (VENOFER) IVPB $137.658308173 FERRIC SUCROSE-VENOFER 100MG/5ML IJ $268.278104440 FERROUS GLUCONATE 324MG TAB $17.218194524 FERROUS SULF 44MG/ML ELIX 120ML(RXE $36.528104481 FERROUS SULF CR 160MG (47.5MG FE)TB $0.008104481 FERROUS SULFATE 160MG TAB $0.008150757 FERROUS SULFATE 300MG/5ML LIQ UDCUP $18.018104473 FERROUS SULFATE 325MG TAB $0.008151508 FERROUS SULFATE 44MG/ML PEDIPOD $17.058209835 FERUMOXYTOL 510MG/17ML INJ $1,020.428115222 FEXOFENADINE 60MG TAB $20.308305682 FILGRASTIM (G-CSF) 300MCG INJ $602.628305690 FILGRASTIM (G-CSF) 480MCG INJ $919.308305682 FILGRASTIM *DILUTED* 20MCG/ML PEDS $593.908305682 FILGRASTIM 300MCG/ML PEDS SYRINGE $593.908305690 FILGRASTIM 480MCG/0.8ML INJ $968.908100273 FINASTERIDE (PROSCAR) 5MG TAB $23.718104150 FIORICET $19.408171662 FIORICET W/ CODEINE CAP 30MG CAP $39.038170631 FIORINAL CAPS $36.448170656 FIORINAL W/CODEINE #3 CAP $39.038209819 FISH OIL OMEGA-3 1000MG CAP $17.178104531 FLAVOXATE 100MG TAB $20.548121147 FLECAINIDE 50MG TAB $22.258119307 FLECAINIDE 5MG/ML SUSP PEDIPOD $17.478270712 FLEET MINERAL OIL ENEMA $37.93



8270720 FLEETS ADULT ENEMA $36.228270738 FLEETS PEDIATRIC ENEMA $36.638194516 FLEETS PHOSHOSODA LIQ 45ML $41.248243453 FLEXIBLE COLLODION SOLN 120ML $62.638380669 FLOXURIDINE INJ $881.808107864 FLUCONAZOLE 100MG TAB $41.008107880 FLUCONAZOLE 200MG TAB $56.258352924 FLUCONAZOLE 200MG/100ML NS $359.138352924 FLUCONAZOLE 2MG/ML NS IVPB $333.418352916 FLUCONAZOLE 2MG/ML PED SYRINGE $138.848352932 FLUCONAZOLE 400MG/200ML NS $123.898152753 FLUCONAZOLE 40MG/ML PEDIPOD $25.338193807 FLUCONAZOLE 40MG/ML SUSP 35ML (RXE) $407.048107856 FLUCONAZOLE 50MG TAB $29.488194300 FLUCYTOSINE 10MG/ML SUSP 30ML (PED) $330.118104556 FLUCYTOSINE 250MG CAP $66.378381212 FLUDARABINE INJ $1,296.208104614 FLUDROCORTISONE 0.1MG TAB $18.878303851 FLUMAZENIL INJ $265.448303869 FLUMAZENIL O.1MG/ML INJ 10ML $415.868303851 FLUMAZENIL O.1MG/ML INJ 5ML $275.308251001 FLUNISOLIDE 250MCG AER 7GM $230.138250938 FLUNISOLIDE NASAL SPRAY 25ML $127.058245128 FLUOCINOLONE ACETONID 0.01%SOL 60ML $58.078240566 FLUOCINOLONE ACETONIDE 0.01%CRM 15G $38.518240590 FLUOCINOLONE ACETONIDE 0.025%CR 15G $49.078245136 FLUOCINONIDE 0.05% CRM 30GM $61.878240657 FLUOCINONIDE 0.05% OINT 15GM $58.078245151 FLUOCINONIDE 0.05% SOLN 60ML $82.378305971 FLUORESCEIN 10% INJ 5ML $128.028252892 FLUORESCEIN 1MG STRIP $34.368252918 FLUORESCEIN 9MG STRIPS $34.598252926 FLUOROMETHOLONE 0.1% OPTH SOLN 15ML $104.438251290 FLUOROMETHOLONE 0.25% OPTH SOLN 5ML $83.498380677 FLUOROURACIL (5-FU) SYRINGE $602.408380677 FLUOROURACIL INJ $602.408118788 FLUOXETINE (PROZAC) 10MG CAP $22.238104648 FLUOXETINE (PROZAC) 20MG CAP $22.378156135 FLUOXETINE (PROZAC) 4MG/ML PEDIPOD $19.008120057 FLUOXETINE (PROZAC) 90MG CAP $66.738209801 FLUOXETINE 20MG/5ML UD LIQ (SCP) $26.868193815 FLUOXETINE 4MG/ML LIQ 120ML (RXE) $270.068104713 FLUPHENAZINE 10MG TAB $20.448104671 FLUPHENAZINE 2.5MG TAB $18.708156986 FLUPHENAZINE 2.5MG/5ML UD LIQ (SCP) $19.998104689 FLUPHENAZINE 5MG TAB $19.688303141 FLUPHENAZINE DECANOATE 25MG/ML 5ML $206.748330920 FLUPHENAZINE HCL 2.5MG/ML INJ 10ML $224.50



8170672 FLURAZEPAM 15MG CAP (SCP ONLY) $34.718170698 FLURAZEPAM 30MG CAP (SCP ONLY) $34.788250383 FLURBIPROFEN OPHTH SOLN 2.5ML $75.358104606 FLUTAMIDE 125MG CAP $21.218252199 FLUTICASONE 0.05% NASAL SPRAY 16GM $204.598253379 FLUTICASONE HFA 110MCG INHALER 12GM $274.158253387 FLUTICASONE HFA 220MCG INHALER 12GM $331.198253361 FLUTICASONE HFA 44MCG INHALER 10.6G $213.378114639 FLUVASTATIN 20MG CAP $23.058122590 FLUVASTATIN 80MG XL TAB $24.758110108 FLUVOXAMINE 100MG TAB (SCP ONLY) $23.918114845 FLUVOXAMINE 50MG TAB $23.698119638 FOLIC ACID 0.4MG TAB $17.078104747 FOLIC ACID 1MG TAB $17.358156713 FOLIC ACID 50 MCG/ML SOLN PEDIPOD $17.068307860 FOLIC ACID INJ $72.418353278 FOMEPIZOLE INJ $412.528353278 FOMEPIZOLE IVPB $412.528253205 FORMOTEROL AEROLIZER 12MCG CAP #12 $95.198122327 FOSAMPRENAVIR 700MG TAB $38.018209835 FOSAPREPITANT (EMEND) IVPB $140.328353682 FOSCARNET PREMIX $131.348100356 FOSINOPRIL 10MG TAB $20.328100364 FOSINOPRIL 20MG TAB $19.418301988 FOSPHENYTOIN 100MG PE/2ML INJ $125.708307589 FOSPHENYTOIN 25MG/ML SYR (PEDS) $79.428302093 FOSPHENYTOIN 500MG/10ML PE VIAL $192.408307589 FOSPHENYTOIN 50MG/ML PE INJ $73.788209835 FULVESTRANT (FASLODEX) 250MG/5ML IJ $1,994.748303489 FUROSEMIDE 100MG/10ML INJ $69.468153678 FUROSEMIDE 10MG/ML PEDIPOD $17.388209835 FUROSEMIDE 1MG/ML SYRINGE (SCN) $136.328104796 FUROSEMIDE 20MG TAB $17.348303422 FUROSEMIDE 20MG/2ML INJ $77.628104804 FUROSEMIDE 40MG TAB $17.388303430 FUROSEMIDE 40MG/4ML INJ $87.228153728 FUROSEMIDE 40MG/5ML UDCUP $20.278104846 FUROSEMIDE 80MG TAB $17.938303422 FUROSEMIDE INJ $69.228114498 GABAPENTIN 100MG CAP $18.828194359 GABAPENTIN 250MG/5ML LIQ 120ML (RXE $107.178114480 GABAPENTIN 300MG CAP $21.238115347 GABAPENTIN 400MG CAP $21.908156846 GABAPENTIN 50MG/ML LIQ PEDIPOD $17.508121949 GABAPENTIN 600MG TAB (SCP ONLY) $21.818121956 GABAPENTIN 800MG TAB (SCP ONLY) $22.778121493 GALANTAMINE 4MG TAB $22.758121501 GALANTAMINE 8MG TAB $22.75



8361255 GAMMAGARD 10% (IMMUNOGLOBULIN) INJ $469.378351710 GANCICLOVIR (CYTOVENE) IVPB $758.328115156 GANCICLOVIR 250MG CAP $26.678209843 GANCICLOVIR 5MG/ML (PEDS) SYRINGE $597.058352593 GATIFLOXACIN 400MG/200ML D5W $178.338104838 GAVISCON CHEW TABS $0.008190878 GAVISCON SUSP 360ML $0.008122509 GEFITINIB 250MG TAB $158.858209801 GELATIN OPTHALMIC DRESSING $112.718209827 GELATIN POWDER 1GM $200.798240798 GELFOAM 100 SPONGE $129.418209827 GELFOAM 12-7 SPONGE $51.808209801 GELFOAM DENTAL PACK (SIZE 4) $46.238200388 GEMCITABINE (GEMZAR) INJ $935.128105033 GEMFIBROZIL 600MG TAB $19.328240830 GENTAMICIN 0.1% TOP OINT 15GM $38.878250730 GENTAMICIN 0.3% OPHTH OINT 3.5GM $73.418250748 GENTAMICIN 0.3% OPHTH SOLN 5ML $73.578350407 GENTAMICIN 10MG/ML INJ (SCN) $145.878350340 GENTAMICIN 40MG/ML IM SYRINGE $141.438350399 GENTAMICIN 4MG/ML SYRINGE (PED/SCN) $136.928350340 GENTAMICIN 80MG/2ML VIAL $141.218356032 GENTAMICIN 80MG/50ML NS PREMIX $144.658350340 GENTAMICIN INJ $141.438350340 GENTAMICIN PER PHARMACY PROTOCOL $0.008350407 GENTAMICIN PF 20MG/2ML INJ (SCN) $141.268350407 GENTAMICIN PF INTRATHECAL SYRINGE $141.268350340 GENTAMICIN SYRINGE $141.438251464 GENTAMICIN-PREDNISOLONE OPH SUS 5ML $93.258243057 GENTIAN VIOLET 1% TOP SOL 30ML $41.238307209 GLATIRAMER 20MG SYRINGE $3,741.708360364 GLIADEL WAFER (BOX OF 8) $7,017.768118796 GLIMEPIRIDE (AMARYL) 2MG TAB $18.408120891 GLIMEPIRIDE (AMARYL) 4MG TAB $19.618104952 GLIPIZIDE 10MG TAB $18.378104986 GLIPIZIDE 5MG TAB $17.788119463 GLIPIZIDE XL 10MG TAB $19.548121816 GLIPIZIDE XL 2.5MG TAB $18.308114688 GLIPIZIDE XL 5MG TAB $18.308306037 GLUCAGON 1MG INJ $236.148306037 GLUCAGON INJ $216.868209835 GLUCARPIPDASE 1,000 UNIT/ML syringe $9,800.008120461 GLUCOSAMINE SULFATE 500MG CAPSULE $17.438150781 GLUCOSE TOLERANCE TEST 100GM $37.078122210 GLUTAMINE POWDER 10GM PKT $20.278253460 GLUTARALDEHYDE 0.6% 25ML (SURG CHG) $229.078104895 GLYBURIDE 2.5MG TAB $17.648105066 GLYBURIDE 3MG TAB $19.81



8104903 GLYBURIDE 5MG TAB $18.088270217 GLYCERIN ADULT SUPP $17.368270233 GLYCERIN PEDS SUPPS $17.308193831 GLYCERIN SOLN 480ML $41.178306052 GLYCOPYRROLATE 0.2MG/1ML INJ $69.848331852 GLYCOPYRROLATE 0.2MG/ML 5ML VIAL $74.168306052 GLYCOPYRROLATE 0.2MG/ML ORAL (PEDS) $18.818104945 GLYCOPYRROLATE 1MG TAB $24.808245169 GLY-OXIDE 10% LIQ 15ML $43.338209835 GOLD NA THIOMALATE 50MG/ML SYRINGE $136.428190910 GOLYTELY POWDER 4 LITER $75.678306144 GONADORELIN 100MCG/VIAL INJ $493.368301004 GOSERELIN 10.8MG IMPLANT $1,526.798301004 GOSERELIN 3.6MG INJ $1,498.588209843 GOSERELIN ACETATE 10.8MG IMPLANT $3,303.368352486 GRANISETRON 100MCG/ML SYR $107.188110835 GRANISETRON 1MG TAB $133.758352486 GRANISETRON INJ $73.668245177 GRANULEX AEROSOL 60GM $61.868209827 GRISEOFULVIN 25MG/ML 120ML (RXE) $171.978209801 GRISEOFULVIN 25MG/ML SUSP PEDIPOD $18.188104978 GRISEOFULVIN ULTR MCR 250MG TAB $19.108150849 GUAIFENESIN 200MG/10ML LIQ UDCUP $17.878190985 GUAIFENESIN DM LIQ SUGAR FREE 118ML $47.058156143 GUAIFENESIN DM SUGAR FREE PEDIPOD $17.148155194 GUAIFENESIN PEDIPOD $17.118112849 GUAIFENESIN SR 600MG TAB $17.618180861 GUAIFENESIN-CODEINE SYRUP (SCPonly) $34.158209801 GUAIFENESIN-CODEINE SYRUP 5ML UDCUP $35.058152951 GUAIFENESIN-DEXTROMETHOR 10ML UDCUP $17.938156150 GUAIFENESIN-DM PEDIPOD $17.108156168 GUAIFENESIN-PSEUODEPHED. PEDIPOD $17.088105009 GUANFACINE (TENEX) 1MG TAB $18.778123515 GUANFACINE ER (INTUNIV) 1MG TAB SCP $28.028209835 H1N1 (INFLUENZA A 2009) VACCINE $0.008209801 H1N1 INFLUENZA A VACCINE SPRAY $0.008306458 HAEMOPHILUS B CONJUGATE VACCINE $123.008105132 HALOPERIDOL 0.5MG TAB $17.628105173 HALOPERIDOL 10MG TAB (SCP ONLY) $20.318105140 HALOPERIDOL 1MG TAB $17.948105157 HALOPERIDOL 2MG TAB $18.238156176 HALOPERIDOL 2MG/1ML LIQ PEDIPOD $17.748156176 HALOPERIDOL 2MG/1ML UD LIQ (SCP) $17.748191025 HALOPERIDOL 2MG/ML LIQ 120ML (RXE) $118.678105165 HALOPERIDOL 5MG TAB $18.988306292 HALOPERIDOL DECANOATE 100MG/ML 1ML $246.628306128 HALOPERIDOL LACTATE 5MG/1ML INJ $70.788103863 HCTZ-TRIAMTERENE 25MG/37.5MG CAP $18.42



8107229 HCTZ-TRIAMTERENE 25MG/37.5MG TAB $18.298121113 HCTZ-TRIAMTERENE 25MG/50MG CAP $18.208121170 HCTZ-TRIAMTERENE 50MG/75MG TAB $21.148209827 HEART CATH KIT $0.008209827 HEART CATH PEDS KIT $0.008260127 HEMASTIX STRIPS $81.278270753 HEMORRHOIDAL OINTMENT 30GM $0.008270092 HEMORRHOIDAL SUPP $0.008209835 HEPAGAM B IMMUNE GLOBULIN 5ML VIAL $1,668.148307225 HEPARIN (PRESERVATIVE FREE) SCN $75.528370017 HEPARIN 100 UNITS/ 1ML INJ (PEDS) $36.138330219 HEPARIN 100 UNITS/ML INJ 10ML $69.748210833 HEPARIN 1000 UNITS/500ML 0.9% NACL $68.168330284 HEPARIN 1000 UNITS/ML 30ML $38.398330276 HEPARIN 1000 UNITS/ML INJ 10ML $85.588372005 HEPARIN 5,000 UNIT/0.5ML SYRINGE $70.228372005 HEPARIN 5,000 UNIT/1ML FLUSH $69.988209835 HEPARIN 5,000 UNIT/ML 10ML INJ $77.128210486 HEPARIN DRIP 25,000 UNITS/250ML D5W $310.568371965 HEPARIN FLUSH PF 30 UNIT/3ML SYRING $36.138307886 HEPARIN FOR INJECTION $68.448307886 HEPARIN PF 100 UNIT/ML 5ML INJ $41.498307225 HEPARIN PF 1000 UNITS/ML 2ML $99.808209835 HEPARIN PF FLUSH 5 UNIT/5ML SYR-SCN $35.278209835 HEPARIN PF-for Bone Marrow Aspirate $0.008308215 HEPATITIS A VACCINE $203.728306086 HEPATITIS B IMMUNE GLOBULIN SYRINGE $670.768361073 HEPATITIS B IMMUNE GLOBULIN SYRINGE $495.138352536 HEPATITIS B VACCINE (PEDIATRIC) $126.668209801 HERPES ZOSTER VIRUS VACC (ZOSTAVAX) $437.588211104 HETASTARCH (HEXTEND) 6%/LYTES/LR $187.218220139 HETASTARCH 6% IN NS (HESPAN) $159.818240905 HEXACHLOROPHENE 3% SOAP 148ML $85.168381964 HISTRELIN LA 50MG IMPLANT $35,596.208252959 HOMATROPINE 2% SOL 5ML $77.698250771 HOMATROPINE 5% OPTH SOLN 5ML $60.538209835 HUMAN PAPILLOMAVIRUS VACCINE 0.5ML $357.948308553 HYALURONIDASE 150 UNIT/1ML VIAL $118.148105272 HYDRALAZINE (APRESOLINE) 10MG TAB $17.478306318 HYDRALAZINE (APRESOLINE) 20MG/ML IJ $96.948105314 HYDRALAZINE (APRESOLINE) 25MG TAB $17.748105322 HYDRALAZINE (APRESOLINE) 50MG TAB $17.918209835 HYDRALAZINE 1 MG/ML SYRNG (PED/SCN) $137.778114225 HYDRALAZINE 4MG/ML LIQ 30ML RXE $214.078114233 HYDRALAZINE 4MG/ML LIQ PEDIPOD $23.038304016 HYDROCHLORIC ACID 0.1 NORMAL SYRING $146.278105355 HYDROCHLOROTHIAZIDE 25MG TAB $17.338105397 HYDROCHLOROTHIAZIDE 50MG TAB $17.38



8105355 HYDROCHLOROTHIAZIDE 5MG/ML SUSP $17.098181034 HYDROCODONE/APAP ELIXIR 15ML UDCUP $40.278171621 HYDROCODONE-APAP (LORTAB) 2.5-500MG $34.748171613 HYDROCODONE-APAP (NORCO) 10-325MG $37.898171738 HYDROCODONE-APAP (NORCO) 5MG-325MG $35.598171746 HYDROCODONE-APAP (NORCO) 7.5-325MG $36.838171670 HYDROCODONE-APAP (VICODIN) 10-500MG $36.988171480 HYDROCODONE-APAP (VICODIN) 5-500MG $36.588171480 HYDROCODONE-APAP 5-500MG TAB $35.878171522 HYDROCODONE-APAP 7.5-500MG TAB $36.078171522 HYDROCODONE-APAP 7.5MG/750MG ES TAB $35.988240681 HYDROCORTISONE 0.2% CRM 45GM $106.768240962 HYDROCORTISONE 0.5% CRM 30GM $0.008240954 HYDROCORTISONE 0.5% OINT 30GM $0.008209827 HYDROCORTISONE 1% CREAM UD PKT $17.458240939 HYDROCORTISONE 1% CRM 30GM $42.738240970 HYDROCORTISONE 1% OINT 30GM $37.688270704 HYDROCORTISONE 100MG ENEMA 60ML $57.358105454 HYDROCORTISONE 10MG TAB $17.538240988 HYDROCORTISONE 2.5% CRM 30GM $41.998245219 HYDROCORTISONE 2.5% OIN 28.35GM $41.998240079 HYDROCORTISONE 2.5% RECTAL CRM 30GM $120.258105496 HYDROCORTISONE 20MG TAB $17.308118804 HYDROCORTISONE 5MG TAB $17.528270209 HYDROCORTISONE ACETATE 25MG SUPP $18.918306391 HYDROCORTISONE SOD SUCC 100MG INJ $77.048306383 HYDROCORTISONE SOD SUCC 250MG INJ $83.888306375 HYDROCORTISONE SOD SUCC 500MG INJ $103.088306391 HYDROCORTISONE SOD SUCC INJ $77.428308538 HYDROCORTISONE SS 1MG/ML PEDIPOD $136.738307910 HYDROCORTISONE SS-PF 100MG INJ (SCN $72.508308538 HYDROCORTISONE SS-PF 1mg/mL SYRINGE $136.738308538 HYDROCORTISONE SS-PF INJ $136.738243073 HYDROGEN PEROXIDE 3% 480ML (SCP) $35.418352577 HYDROMORPHONE (DILAUDID) EPIDURAL $172.428352577 HYDROMORPHONE 0.02MG/ML EPIDURAL $172.428320491 HYDROMORPHONE 0.2MG/ML DRIP $171.488209835 HYDROMORPHONE 0.2MG/ML PCA (NS) $191.148321150 HYDROMORPHONE 1MG/1ML INJ $104.298209835 HYDROMORPHONE 1MG/ML (MAX CONC) PCA $180.748170730 HYDROMORPHONE 2MG TAB $35.378320483 HYDROMORPHONE 2MG/1ML INJ $105.058270258 HYDROMORPHONE 3MG SUPP $38.368170755 HYDROMORPHONE 4MG TAB $36.048320491 HYDROMORPHONE 4MG/1ML INJ $104.498320491 HYDROMORPHONE 4MG/1ML INJ-4WST/4BMT $105.698320491 HYDROMORPHONE INJ $104.498105520 HYDROXYCHLOROQUINE 200MG TAB $19.49



8121436 HYDROXYUREA 300MG CAP $18.928105538 HYDROXYUREA 500MG CAP $19.688156184 HYDROXYUREA 50MG/ML SOLN PEDIPOD $17.298303588 HYDROXYZINE 50MG/1ML INJ $69.438105611 HYDROXYZINE HCL (ATARAX) 10MG TAB $18.288105553 HYDROXYZINE HCL (ATARAX) 25MG TAB $18.868105652 HYDROXYZINE HCL (ATARAX) 50MG TAB $19.268151912 HYDROXYZINE HCL 2MG/ML 120ML (RXE) $46.818156192 HYDROXYZINE HCL 2MG/ML LIQ PEDIPOD $17.148105553 HYDROXYZINE PAMOATE 25MG CAP $17.638105652 HYDROXYZINE PAMOATE 50MG CAP $17.678102725 HYOSCYAMINE 0.125MG TAB $17.628102758 HYOSCYAMINE 0.375MG SR TAB $19.378250755 HYPROMELLOSE 2.5% OPTH SOLN 15ML $56.458209835 IBANDRONATE 3MG/3ML INJ $1,056.488105702 IBUPROFEN 200MG TAB $0.008209801 IBUPROFEN 200MG TAB $0.008209819 IBUPROFEN 200MG/10ML SUSP UDCUP $0.008156200 IBUPROFEN 20MG/ML SUSP (PEDS) $17.178105777 IBUPROFEN 400MG TAB $17.468105744 IBUPROFEN 600MG TAB $17.648105728 IBUPROFEN 800MG TAB $17.648209835 IBUPROFEN LYSINE 5MG/ML SYRINGE $1,286.148301251 IBUTILIDE 0.1MG/ML INJ 10ML $1,153.588381428 IDARUBICIN INJ $653.808381337 IFOSFAMIDE INJ $935.888381337 IFOSFAMIDE IVPB $935.888209801 ILOPERIDONE 2MG TAB (SCP ONLY) $38.038123507 ILOPERIDONE 6MG TAB (SCP ONLY) $38.038120909 IMATINIB 100MG TAB $82.798341273 IMIGLUCERASE IVPB $145.798352668 IMIPENEM-CILAS 250MG/100ML NS (ADV) $138.338352668 IMIPENEM-CILAS 250MG/ML IM SYRINGE $138.338350449 IMIPENEM-CILASTATIN 500MG INJ $180.578352973 IMIPENEM-CILASTATIN 5MG/ML SYRINGE $136.958350449 IMIPENEM-CILASTATIN INJ $170.218350449 IMIPENEM-CILASTATIN IVPB $170.218352668 IMIPENEM-CILASTATIN IVPB $170.278353484 IMIPENEM-CLIS 500MG/100ML NS (ADV) $171.558105801 IMIPRAMINE 10MG TAB $17.898105819 IMIPRAMINE 25MG TAB $18.788105827 IMIPRAMINE 50MG TAB $19.468105934 IMIPRAMINE PAMOATE SR 125MG CAP $50.788105850 IMIPRAMINE PAMOATE SR 75MG CAP $29.438209835 IMMUNOGLOBULIN (CARIMUNE NF) INJ $437.648209835 IMMUNOGLOBULIN 10% (GAMUNEX) INJ $456.688209835 IMMUNOGLOBULIN 10% (PRIVIGEN) INJ $448.748361099 IMMUNOGLOBULIN 5% (FLEBOGAMMA DIF) $437.45



8105793 INDAPAMIDE 2.5MG TAB $18.748306409 INDIGO CARMINE 0.8% INJ $84.848120487 INDINAVIR 200MG CAPSULE $20.208112344 INDINAVIR 400MG CAP $23.128209835 INDOCYANINE GREEN 25MG INJ $280.128156218 INDOMETHACIN 5MG/ML SUSP $17.468306011 INDOMETHACIN 0.5MG/ML NS-PF (SCN) $201.088105967 INDOMETHACIN 25MG CAP $17.838209801 INDOMETHACIN 50MG SUPPOSITORY $34.368106015 INDOMETHACIN 75MG SR $21.788306011 INDOMETHACIN INJ $132.958360513 INFLIXIMAB IVPB $286.788306185 INFLUENZA VACCINE PF 0.5ML SYRINGE $108.148306185 INFLUENZA VACCINE-PF (SYRINGE) $81.408306185 INFLUENZA VACC-PF (6-35 MONTHS) SYR $164.148331878 INSULIN ASPART RECOMB. (FLEX PEN) $136.008372021 INSULIN GLARGINE SYRINGE $8.738371973 INSULIN GLARGINE VIAL (RXE/IVC) $274.468371999 INSULIN LISPRO (humaLOG) (SCH B) $8.668371999 INSULIN LISPRO (humaLOG) INJ $8.668209827 INSULIN LISPRO 100unit/mL 3mL (RXE) $139.908330417 INSULIN NPH 100unit/mL 10mL $132.208209835 INSULIN NPL/LISPRO 75/25 MIX (ER SY $8.668331738 INSULIN NPL/LISPRO 75/25 MIX (VIAL) $307.308370132 INSULIN REG *DILUTE* 1UNIT/ML 10ML $73.468330409 INSULIN REGULAR 100unit/mL 10mL $166.688370249 INSULIN, HUMAN 70/30 MIX (ER SYRG) $8.588370256 INSULIN, HUMAN 70/30 MIX (VIAL) $132.208370132 INSULIN, HUMAN REGULAR $136.328306169 INTERFERON ALFA 2A 3MUN/0.5ML $140.148307597 INTERFERON ALFA 2B INJ (INTRON) $103.798307597 INTERFERON ALFA-2 B (INTRON-A) INJ $171.878307597 INTERFERON ALFA-2 B (INTRON-A) IVPB $171.878307597 INTERFERON ALFA-2 B (INTRON-A) SUBQ $171.928306169 INTERFERON ALPHA 2A 6MUN/0.5ML $140.148209835 INTERFERON BETA-1A(AVONEX) 30MCG IJ $1,550.148100034 INVESTIGATIONAL BULK MED $0.008300022 INVESTIGATIONAL IV ADDITIVE $0.008300022 INVESTIGATIONAL IV ADDITIVE (EACH) $0.008300022 INVESTIGATIONAL LVP $0.008300022 INVESTIGATIONAL MED-CHEMO $0.008300022 INVESTIGATIONAL MED-INJ $0.008300022 INVESTIGATIONAL MED-INJ (EACH) $0.008300022 INVESTIGATIONAL MED-IVPB $0.008100034 INVESTIGATIONAL ORAL MED $0.008300022 INVESTIGATIONAL SYRINGE $0.008193856 IODINE TINC 480ML BOTTLE $67.778151003 IPECAC 1.4MG/1ML ELIXIR 30ML BOTTLE $43.09



8244154 IPRATROPIUM 0.03% NASAL SPRAY 30ML $203.558244162 IPRATROPIUM 0.06% NASAL SPRAY 15ML $179.358280604 IPRATROPIUM BROMIDE 0.02% SOLN $20.558250367 IPRATROPIUM INHALER 12.9GM $288.938119406 IRBESARTAN 150MG TAB $22.048119653 IRBESARTAN 75MG TAB $21.798381683 IRINOTECAN (CAMPTOSAR) INJ $890.758209835 IRON DEXTRAN (DEXFERRUM) INJ $179.478209835 IRON DEXTRAN (DEXFERRUM) TEST DOSE $179.478308751 IRON DEXTRAN INJ $173.978106056 ISONIAZID 100MG TAB $17.238309148 ISONIAZID 100MG/ML SYRINGE $191.008106064 ISONIAZID 300MG TAB $17.338242877 ISOPROPYL 70% SOL 480ML $35.998307738 ISOPROTERENOL 0.2MG/1ML INJ $143.878308165 ISOPROTERENOL 0.2MG/ML 5ML INJ $147.678209835 ISOPROTERENOL 2MG/250ML D5W IV DRIP $121.968308165 ISOPROTERENOL INJ $147.678106130 ISOSORBIDE DINITRATE 10MG TAB $17.398106155 ISOSORBIDE DINITRATE 20MG TAB $17.488106122 ISOSORBIDE DINITRATE 5MG TAB $17.368106213 ISOSORBIDE DINITRATE CR 40MG TAB $18.728114431 ISOSORBIDE MONONITRATE 20MG TAB $20.478114456 ISOSORBIDE MONONITRATE 30MG CR TAB $21.528200297 ISOSORBIDE MONONITRATE 60MG CR TAB $19.768307928 ISOSULFAN BLUE 1% INJ 5ML $437.748123192 ISOTRETINOIN 20MG CAP $34.388103541 ISRADIPINE 2.5MG CAP $20.088105736 ITRACONAZOLE 100MG CAP $43.978199986 ITRACONAZOLE 10MG/1ML 150ML (RXE) $413.758155715 ITRACONAZOLE 10MG/1ML PEDIPOD $18.998121675 IVERMECTIN 3MG TAB $28.208209843 IXABEPILONE (IXEMPRA) INJ $728.968301319 K ACETATE 0.2MEQ/ML D5W INJ (SCN) $34.238121741 K CITRATE (UROCIT-K) 5MEQ TAB $17.838307977 K PHOSPHATE 3 MMOL/ML INJ -SCN ONLY $34.168307977 K PHOSPHATE 4.4MEQ/ML INJ -SCN ONLY $34.168122749 KALETRA 200/50MG TAB $31.068194326 KALETRA ORAL SOLN 160ML $737.568191124 KAOLIN-PECTIN SUSP (not avail) $0.008191124 KAOPECTATE = PEPTOBISMOL $0.008301418 KCL 0.05MEQ/ML D5W (PERIPHERAL) PED $102.798308777 KCL 0.2MEQ/ML INJ (SCN ONLY) $136.378301418 KCL 0.2MEQ/ML SW (CENTRAL LINE) PED $102.278301418 KCL 0.5MEQ/ML INJ (SCN ONLY) $136.388310138 KCL 10MEQ/ 50ML SW (CENTRAL LINE) $107.538310146 KCL 10MEQ/100ML STERILE WATER $108.098301426 KCL 10MEQ/20ML SW SYRINGE $102.75



8301475 KCL 2MEQ/ML 20ML INJ (CHG ONLY) $36.238156440 KCL 2MEQ/ML ORAL SOLN (SCN) PEDIPOD $17.148321275 KETAMINE 100MG/10ML NS SYRINGE $141.218330524 KETAMINE 500MG/5ML INJ $121.878330516 KETAMINE INJ $134.718241374 KETOCONAZOLE 2% CRM 15GM $66.998200412 KETOCONAZOLE 2% SHAMPOO 120ML $95.828106379 KETOCONAZOLE 200MG TAB $23.358105785 KETOROLAC 10MG TAB $18.898305074 KETOROLAC 15MG/1ML INJ $75.648305674 KETOROLAC 15MG/1ML INJ $75.348305666 KETOROLAC 30MG/1ML INJ $71.748305666 KETOROLAC 30MG/ML INJ $76.148250904 KETOROLAC O.5% OPTH SOLN 5ML $271.578106429 LABETALOL 100MG TAB $17.998156226 LABETALOL 10MG/ML SUSP PEDS $17.138106387 LABETALOL 200MG TAB $18.398331860 LABETALOL 20MG/4ML VIAL $77.668309189 LABETALOL 25MG/5ML SYRINGE $90.068330540 LABETALOL INJ $78.148157091 LACOSAMIDE 100MG TAB $47.958157133 LACOSAMIDE 10MG/ML LIQ $18.598209835 LACOSAMIDE 200MG/20ML VIAL (CII SAF $223.778171894 LACOSAMIDE 50MG TAB $42.958209835 LACOSAMIDE 5MG/ML SYRINGE (PEDS) $158.158321259 LACOSAMIDE INJ $136.718121691 LACTAID TABLET $17.258210205 LACTATED RINGERS $105.818210213 LACTATED RINGERS $105.418210205 LACTATED RINGERS (DEHP-FREE) EXCEL $106.518210197 LACTATED RINGERS 250ML $4.008245227 LACTIC ACID 12% CREAM 140GM $72.358245235 LACTIC ACID 12% LOTION 225ML $118.818244857 LACTOBACILLUS ACID. GRANULES PKT $18.568106403 LACTOBACILLUS CHEW TAB $17.348121287 LACTOBACILLUS GG (CULTURELLE) CAP $17.868156234 LACTULOSE 20GM/30ML SYRUP UDCUP $22.998151102 LACTULOSE LIQ PEDIPOD $20.018121709 LAMIVUDINE (EPIVIR) 100MG TAB $31.318114670 LAMIVUDINE (EPIVIR) 150MG TAB $31.458195026 LAMIVUDINE 10MG/ML 240ML (RXE) $264.718156242 LAMIVUDINE 10MG/ML PEDIPOD $17.778118820 LAMOTRIGINE (LAMICTAL) 100MG TAB $28.688118846 LAMOTRIGINE (LAMICTAL) 25MG TAB $27.238121402 LAMOTRIGINE (LAMICTAL) 5MG CHEW TAB $23.828209801 LANOLIN (TENDER CARE) 2ML $17.058114795 LANSOPRAZOLE 15MG CAP $29.038122681 LANSOPRAZOLE 15MG SOLUTAB $26.39



8118853 LANSOPRAZOLE 30MG CAP $29.038122673 LANSOPRAZOLE 30MG SOLUTAB $25.668156929 LANSOPRAZOLE 3MG/ML SUSP PEDIPOD $18.558195000 LANTHANUM 250MG CHEWTAB $19.238195018 LANTHANUM 500MG CHEWTAB $30.918308561 LARONIDASE INJ $195.048200453 LATANOPROST 0.005% OPHTH SOL 2.5ML $199.418209835 LC BEADS $0.008155442 L-CARNITINE 100MG/ML LIQ PEDIPOD $17.628305799 L-CARNITINE 200MG/ML INJ 5ML $144.948307936 L-CARNITINE 200MG/ML SYRINGE $114.078118630 L-CARNITINE 330MG TAB $18.968305799 L-CARNITINE INJ $114.078193864 L-CARNITINE 100MG/ML LIQ 118ML (RXE $99.878122194 LEFLUNOMIDE 10MG TAB $61.998120495 LEFLUNOMIDE 20MG TAB $61.998307415 LEPIRUDIN 50MG INJ $614.518307415 LEPIRUDIN 5MG/ML SYRINGE $614.518307415 LEPIRUDIN INJ $397.828121717 LETROZOLE 2.5MG TAB $45.738101545 LEUCOVORIN 25MG TAB $44.418101537 LEUCOVORIN 5MG TAB $23.538156259 LEUCOVORIN CA 10MG/ML LIQ PEDIPOD $18.538381634 LEUCOVORIN CA 10MG/ML SYR $75.648381634 LEUCOVORIN CALCIUM 50MG INJ $143.478381634 LEUCOVORIN CALCIUM INJ $143.778308413 LEUPROLIDE ACETATE SOLN SYRINGE $265.198331803 LEUPROLIDE DEPOT 1-MONTH 3.75MG INJ $1,444.708209835 LEUPROLIDE DEPOT 3-MONTH 11.25MG IJ $1,487.958209835 LEUPROLIDE DEPOT 3-MONTH 22.5MG INJ $4,989.348209835 LEUPROLIDE DEPOT 4-MONTH 30MG INJ $6,629.768306664 LEUPROLIDE DEPOT 7.5MG/1ML INJ $1,708.568253536 LEVABUTEROL HFA INHALER 15GM $133.578280695 LEVALBUTEROL 0.63MG/3ML (PEDS/SCN) $25.558280695 LEVALBUTEROL 1.25MG/0.5ML INHL SOLN $25.558123291 LEVETIRACETAM (KEPPRA) 1000MG TAB $20.398120503 LEVETIRACETAM (KEPPRA) 250MG TAB $20.858355984 LEVETIRACETAM (KEPPRA) IVPB $138.138194557 LEVETIRACETAM 100MG/ML LIQ 60ML(RXE $93.728209801 LEVETIRACETAM 100MG/ML LIQ PEDIPOD $18.028209819 LEVETIRACETAM 100MG/ML PEDIPOD $18.028355984 LEVETIRACETAM 5MG/ML (PEDS) SYRINGE $137.778123309 LEVETIRACETAM XR 500MG TAB $24.868123341 LEVETIRACETAM XR 750MG TAB $28.788250854 LEVOBUNOLOL 0.25% OPHTH SOLN 5ML $65.718250821 LEVOBUNOLOL 0.5% OPHTH SOL 5ML $67.358110561 LEVODOPA-CARBIDOPA 100-10 TAB $18.478119430 LEVODOPA-CARBIDOPA 100-25 CR TAB $19.23



8113540 LEVODOPA-CARBIDOPA 100-25 TAB $19.698113557 LEVODOPA-CARBIDOPA 200-50 CR TAB $21.298110587 LEVODOPA-CARBIDOPA 250-25 TAB $19.188118861 LEVOFLOXACIN 250MG TAB $45.218353005 LEVOFLOXACIN 250MG/50ML D5W PREMIX $146.038200172 LEVOFLOXACIN 500MG TAB $46.418353013 LEVOFLOXACIN 500MG/100ML D5W PREMIX $189.858209801 LEVOFLOXACIN 750MG TAB $64.838209801 LEVOFLOXACIN 750MG/150ML D5W PREMIX $239.198209835 LEVOFLOXACIN INJ $147.868121295 LEVONORGESTREL (PLAN B) 0.75MG TAB $57.658170706 LEVORPHANOL 2MG TAB (SGH) $36.218106502 LEVOTHYROXINE 100MCG TAB $17.588106510 LEVOTHYROXINE 112MCG TAB $17.638106528 LEVOTHYROXINE 125MCG TAB $17.678106536 LEVOTHYROXINE 150MCG TAB $17.438121162 LEVOTHYROXINE 175MCG TAB $17.778306490 LEVOTHYROXINE 200MCG INJ $135.228106551 LEVOTHYROXINE 200MCG TAB $17.528106478 LEVOTHYROXINE 25MCG TAB $17.688156267 LEVOTHYROXINE 25MCG/ML LIQ PEDIPOD $17.688306524 LEVOTHYROXINE 500MCG INJ $145.008106486 LEVOTHYROXINE 50MCG TAB $17.518106494 LEVOTHYROXINE 75MCG TAB $17.858106544 LEVOTHYROXINE 88MCG TAB $17.588306524 LEVOTHYROXINE INJ $145.008106593 LIBRAX CAP $27.548330565 LIDOCAINE 0.5% INJ 50ML $72.648330631 LIDOCAINE 0.5%-EPI 1:200,000 50ML $74.068209835 LIDOCAINE 1% INJ 10ML $79.368306532 LIDOCAINE 1% INJ 2ML VIAL $71.988330649 LIDOCAINE 1%-EPI 1:100,000 INJ 20ML $70.908330656 LIDOCAINE 1%-EPI 1:200,000 MPF 30ML $92.848308579 LIDOCAINE 1.5%EPI 1:200000 MPF 10ML $85.008303679 LIDOCAINE 100MG SYRINGE $72.668156853 LIDOCAINE 2% JELLY 30ML $74.878400384 LIDOCAINE 2% JELLY 5ML (RT) $51.058252637 LIDOCAINE 2% JELLY UROJECT 10ML $49.458306540 LIDOCAINE 2% MPF INJ (polyamp) 10ML $74.128156275 LIDOCAINE 2% VISCOUS LIQ 15ML UDCUP $19.558330664 LIDOCAINE 2%-EPI 1:100,000 INJ 20ML $71.368330664 LIDOCAINE 2%-EPI 1:200,000 MPF 20ML $97.948241093 LIDOCAINE 2.5% OINT 35GM $66.298245433 LIDOCAINE 4% (LMX-4) CREAM 5GM $52.048306557 LIDOCAINE 4% INJ 5 ML (SURG ONLY) $72.768209827 LIDOCAINE 4% LARYNGOTRACH SOLN KIT $46.138200537 LIDOCAINE 4% TOP SOLN (ER/RT)-BY ML $17.408241119 LIDOCAINE 4% TOP SOLN 50ML $52.39



8241119 LIDOCAINE 4% TOP SOLN 50ML (FOR RT) $52.398241101 LIDOCAINE 5% OINT 35 GM $58.078245599 LIDOCAINE 5% PATCH $31.738306599 LIDOCAINE 5%-GLUCOSE 7.5% INJ 2ML $73.548210346 LIDOCAINE DRIP 2GM/500ML D5W $124.118303661 LIDOCAINE INJ $147.838303679 LIDOCAINE INJ $72.668209835 LIDOCAINE MAX DRIP 4GM/500ML D5W $154.118306565 LIDOCAINE MPF 1% INJ 5ML $69.448306532 LIDOCAINE PF 1% INJ 2ML (AMP) $72.628307944 LIDOCAINE PF 2% INJ 5ML $72.348245243 LIDOCAINE/EPI/TETRACAINE SOLN $19.038243370 LIDOCAINE/PRILOCAINE (EMLA) CRM 5GM $37.658330581 LIDOCAINE-PF 1% INJ (STRL PKG) 30ML $69.448195117 LINEZOLID 20MG/ML SUSP 150ML (RXE) $1,118.038157026 LINEZOLID 20MG/ML SUSP PEDIPOD $24.378353179 LINEZOLID 2MG/ML IVPB $159.178353179 LINEZOLID 2MG/ML PEDS SYRINGE $193.238120834 LINEZOLID 600MG TAB $192.228353716 LINEZOLID 600MG/300ML IVPB $330.938353286 LIOTHYRONINE 10MCG/1ML INJ $1,078.498106668 LIOTHYRONINE 25MCG TAB $18.738106650 LIOTHYRONINE 5MCG TAB $18.328106700 LIOTRIX -1 TAB $18.558106692 LIOTRIX 1/2 TAB $18.208106718 LIOTRIX 2 TAB $18.828106726 LIOTRIX 3 TAB $19.228244865 LIP BALM 7.5GM $0.008220329 LIPID 20% (0.2GM/ML) PEDS $162.418220113 LIPIDS 10% (0.1GM/ML) $123.618220121 LIPIDS 10% (0.1GM/ML) $153.968220089 LIPIDS 20% (0.2GM/ML) $162.818220154 LIPIDS 20% (0.2GM/ML) $134.518171860 LISDEXAMFETAMINE 30MG CAP (SCP) $42.608105983 LISINOPRIL 10MG TAB $19.268118879 LISINOPRIL 2.5MG TAB $18.478105991 LISINOPRIL 20MG TAB $19.058105975 LISINOPRIL 5MG TAB $19.198106825 LITHIUM 150MG CAP $17.418106775 LITHIUM 450MG CR TABLET $18.178106767 LITHIUM CARBONATE 300MG CAP $17.458121931 LITHIUM CARBONATE 600MG CAP (SCP) $17.978209801 LITHIUM CIT. 300MG/5ML UD LIQ $18.478193872 LITHIUM CIT. 60MG/ML LIQ 120ML (RXE $67.628106783 LITHOBID (LITHIUM CR) 300MG TAB $18.178106874 LOMUSTINE 100MG CAP $120.688106841 LOMUSTINE 10MG CAP $35.148106858 LOMUSTINE 40MG CAP $71.56



8156283 LOPERAMIDE 0.2MG/ML PEDIPOD $17.308105900 LOPERAMIDE 2MG CAP $18.448155723 LOPERAMIDE 2MG/10ML LIQ UDCUP $19.778106882 LORATADINE 10MG TAB $18.748118895 LORATADINE 1MG/ML SYRUP $17.788170201 LORAZEPAM (ATIVAN) 0.5MG TAB $35.468170219 LORAZEPAM (ATIVAN) 1MG TAB $35.888320822 LORAZEPAM (ATIVAN) 2MG/1ML INJ $104.018320822 LORAZEPAM (ATIVAN) INJ $115.618352627 LORAZEPAM 100MG/100ML NS DRIP $285.848180812 LORAZEPAM 2MG/1ML LIQ (SMH/SCP) $37.278118903 LOSARTAN 25MG TAB $20.778114662 LOSARTAN 50MG TAB $21.828118911 LOVASTATIN 10MG TAB $19.728106924 LOVASTATIN 20MG TAB $22.408106890 LOXAPINE 10MG CAP (SCP ONLY) $19.578106916 LOXAPINE 25MG CAP $20.888106940 LOXAPINE 50MG CAP $22.178106908 LOXAPINE 5MG CAP (SCP/SMH ONLY) $19.028123010 LUBIPROSTONE 24MCG CAP $23.118245250 LUBRIDERM LOTION 10OZ $44.098245250 LUBRIDERM LOTION 6oz $40.088195042 LUGOL'S STRONG IODINE SOLN 8ML $44.748360273 LYMPHOCYTE IMMUNOGLOB. (ATGAM) INJ $1,520.888106932 LYSINE 500MG TAB $17.108156291 MAALOX MAX EXTRA STRENGTH SUSP $0.008156309 MAALOX SUSP $0.008193187 MAALOX/LIDO/DIPHENHYDRAMI LIQ 50ML $40.078107062 MAGNESIUM CHLORIDE CR 64MG TAB $17.278190571 MAGNESIUM CITRATE SOLN 300ML $37.438211450 MAGNESIUM DRIP 40GM/1000ML SW $117.818157000 MAGNESIUM ELEMENTAL 10.8MG/ML LIQ $17.128107070 MAGNESIUM GLUCONATE 500MG TAB $17.388107112 MAGNESIUM OXIDE 400MG TAB $17.488306615 MAGNESIUM SULFATE 0.5GM/ML 2ML INJ $35.198306615 MAGNESIUM SULFATE 1GM/2ML (FOR SS) $69.328209835 MAGNESIUM SULFATE 2GM/50ML SWFI $117.198308793 MAGNESIUM SULFATE 3GM/50ML NS DRIP $111.218308793 MAGNESIUM SULFATE 3GM/50ML NS IVPB $102.808209835 MAGNESIUM SULFATE 4GM/100ML SWFI $117.098241143 MAGNESIUM SULFATE CRYSTAL $34.088308793 MAGNESIUM SULFATE INJ $34.668241143 MAGNESUIM SULF TOP SOLN 500GM/L $54.078308439 MANNITOL (0.2GM/ML) IVPB $82.388211484 MANNITOL 20% (20gm/100mL) 250ML $163.768306623 MANNITOL 25% INJ $74.988308439 MANNITOL INJ $82.388107153 MAPROTILINE 25MG TAB $18.03



8107161 MAPROTILINE 50MG TAB $18.518107146 MAPROTILINE 75MG TAB $18.898157125 MD-GASTROVIEW oral contrast 30ML $56.638303273 MEASLES-MUMPS-RUBELLA INJ $178.698107237 MEBENDAZOLE 100MG CHEW TAB $27.678306631 MECHLORETHAMINE INJ $621.488107260 MECLIZINE 25MG TAB $18.768107278 MECLOFENAMATE 100MG CAP $23.828112179 MECLOFENAMATE 50MG CAP $20.698191413 MEDIUM CHAIN TRIGLYCERIDES OIL 30ML $37.528107294 MEDROXYPROGESTERONE 10MG TAB $17.978304065 MEDROXYPROGESTERONE 150MG/1ML INJ $197.528107286 MEDROXYPROGESTERONE 2.5MG TAB $17.638118929 MEDROXYPROGESTERONE 5MG TAB $17.938118937 MEFLOQUINE 250MG TAB $38.218209819 MEGESTROL 400MG/10ML UDCUP $25.498107328 MEGESTROL 40MG TAB $19.178194508 MEGESTROL 40MG/ML SUSP 120ML (RXE) $178.028123432 MELATONIN 5MG TAB $17.218121519 MELOXICAM 7.5MG TAB $23.378107344 MELPHALAN 2MG TAB $28.398381295 MELPHALAN INJECTION $1,517.488253304 MEMANTINE 5MG TABLET $23.678307241 MENINGOCOCCAL (MENOMUNE) VACCINE $319.328320574 MEPERIDINE 100MG/1ML INJ $103.838351025 MEPERIDINE 10MG/ML PCA (NS) $181.348320517 MEPERIDINE 25MG/1ML INJ $104.118320517 MEPERIDINE 25MG/ML INJ $104.118170789 MEPERIDINE 50MG TAB $35.468320533 MEPERIDINE 50MG/1ML INJ $103.778320533 MEPERIDINE 50MG/1ML VIAL $103.898320574 MEPERIDINE INJ $103.838331175 MEPIVACAINE 1% INJ 30ML $84.468330722 MEPIVACAINE 2% INJ 20ML $86.268112229 MERCAPTOPURINE 25MG TAB $25.218112229 MERCAPTOPURINE 50MG TAB $25.218156317 MERCAPTOPURINE 50MG/ML LIQ PEDIPOD $25.218243651 MERCUROCHROME 2% SOL 30ML $35.798353237 MEROPENEM 20MG/ML SYRINGE (PEDS) $142.878355919 MEROPENEM INJ $148.778355919 MEROPENEM IVPB $148.778270944 MESALAMINE 1000MG SUPP $45.328114753 MESALAMINE 250MG SR $18.648108359 MESALAMINE 400MG DR TAB $19.238270316 MESALAMINE ENEMA 60ML $85.798381360 MESNA 20MG/ML SYR (PED) $159.778381360 MESNA INJ $187.118245573 METAPROTERENOL 0.4% 2.5ML (RT) $19.49



8107401 METAPROTERENOL 10MG TAB $19.038152126 METAPROTERENOL 2MG/ML SYRUP $17.118122996 METAXALONE 800MG TAB $24.798114860 METFORMIN (GLUCOPHAGE) 500MG TAB $18.448120917 METFORMIN (GLUCOPHAGE) 500MG XR TAB $19.318114597 METFORMIN (GLUCOPHAGE) 850MG TAB $19.428253312 METHACHOLINE FOR INHALATION 100MG $122.078170870 METHADONE 10MG TAB $34.948180408 METHADONE 10MG/10ML UD LIQ (SMH/SCP $49.878320368 METHADONE 10MG/ML INJ $103.808181083 METHADONE 1MG/1ML UD LIQ (SMH ONLY) $49.978180945 METHADONE 1MG/ML ELIXIR (SMH RXE) $34.238180952 METHADONE 2MG/ML LIQ (SCP) $34.348209801 METHADONE 50 MG/5ML UD LIQ (SGH) $49.978171878 METHADONE 5MG TAB $34.848107427 METHAZOLAMIDE 50MG TAB $18.618107450 METHENAMINE HIPPURATE 1GM TAB $21.348107468 METHENAMINE MANDELATE 1GM TAB $18.098107476 METHENAMINE MANDELATE 500MG EC TAB $17.698112302 METHIMAZOLE 10MG TAB $18.578156325 METHIMAZOLE 3MG/ML SUSP (PEDS) $17.568107492 METHIMAZOLE 5MG TAB $17.928331217 METHOCARBAMOL 100MG/ML INJ 10ML $99.248107500 METHOCARBAMOL 500MG TAB $18.058107518 METHOCARBAMOL 750MG TAB $18.028320343 METHOHEXITAL (BREVITAL) INJ $167.038320343 METHOHEXITAL 500MG INJ $187.298107559 METHOTREXATE 1MG/ML SUSP (PEDS) $24.478107559 METHOTREXATE 2.5MG TAB $24.478381618 METHOTREXATE LPF INJ $596.708381618 METHOTREXATE LPF INTRATHECAL INJ $596.708381618 METHOTREXATE PF INTRATHECAL SY (NS) $597.208381618 METHOTREXATE PF INTRATHECAL SYRINGE $596.708381618 METHOTREXATE SYRINGE $596.708112351 METHSUXIMIDE 300MG CAP $19.288101974 METHYCELLULOSE POWDER $17.568112377 METHYCLOTHIAZIDE 5MG TAB $18.078209801 METHYLCELLULOSE 500MG CAPLET (SCP) $17.298121089 METHYLCELLULOSE POWDER SF $17.808107583 METHYLDOPA 250MG TAB $17.778352015 METHYLDOPA 250MG/5ML INJ $161.278156341 METHYLDOPA 25MG/ML SUSP (PEDS) $17.108107591 METHYLDOPA 500MG TAB $18.388352015 METHYLDOPA INJ $161.278352015 METHYLDOPA IVPB $161.278209801 METHYLENE BLUE 1% 0.5ML ORAL UD LIQ $24.038306748 METHYLENE BLUE 1% INJ 1ML $82.148107609 METHYLERGONOVINE 0.2MG TAB $19.61



8302903 METHYLERGONOVINE 0.2MG/1ML INJ $82.388209835 METHYLNALTREXONE 12MG/0.6mL INJ $164.148170953 METHYLPHENIDATE 10MG TAB $34.968170946 METHYLPHENIDATE 5MG TAB $34.718171647 METHYLPHENIDATE CR 18MG TAB (SCP) $40.428170961 METHYLPHENIDATE SR 20MG TAB (SCP) $37.558171704 METHYLPHENIDATE SR 27MG TAB (SCP) $40.578330797 METHYLPREDNISOLONE (LOAD DOSE) IVPB $74.868303802 METHYLPREDNISOLONE 10MG/ML PEDS SYR $75.688330797 METHYLPREDNISOLONE 125MG INJ $79.818209835 METHYLPREDNISOLONE 1GM INJ $134.428303802 METHYLPREDNISOLONE 40MG INJ $75.388107625 METHYLPREDNISOLONE 4MG TAB $18.008330755 METHYLPREDNISOLONE 500MG INJ $93.948330797 METHYLPREDNISOLONE INJ $73.388106296 METHYLTESTOSTERONE 10MG CAP $21.058244220 METIPRANOLOL 0.3% OPHTH SOLN 5ML $84.838306755 METOCLOPRAMIDE 0.5MG/ML SYRINGE-SCN $137.578107716 METOCLOPRAMIDE 10MG TAB $17.668153371 METOCLOPRAMIDE 10MG/10ML LIQ UDCUP $19.198153413 METOCLOPRAMIDE 1MG/ML PEDIPOD $17.118107708 METOCLOPRAMIDE 5MG TAB $17.848306755 METOCLOPRAMIDE INJ $137.578306755 METOCLOPRAMIDE INJ 10MG/2ML INJ $137.578306755 METOCLOPRAMIDE IVPB $137.578119331 METOLAZONE 1MG/ML SUSP PEDIPOD $18.708107740 METOLAZONE 2.5MG TAB $19.508107765 METOLAZONE 5MG TAB $21.168107823 METOPROLOL 100MG TAB $18.688157141 METOPROLOL 10MG/ML PEDIPOD $17.268107799 METOPROLOL 25MG TABLET $17.528107799 METOPROLOL 50MG TAB $18.178306763 METOPROLOL 5MG/5ML INJ $75.028306763 METOPROLOL INJ $75.028121626 METOPROLOL XL (TOPROL XL) 25MG TAB $19.398107773 METOPROLOL XL (TOPROL XL) 50MG TAB $19.398107849 METRONIDAZOLE (FLAGYL) 250MG TAB $17.998107831 METRONIDAZOLE (FLAGYL) 500MG TAB $18.698351512 METRONIDAZOLE (FLAGYL) 5MG/ML IVPB $107.118351512 METRONIDAZOLE (FLAGYL) PREMIX $107.118243263 METRONIDAZOLE 0.75% GEL 70GM $106.068156358 METRONIDAZOLE 50MG/ML LIQ PEDIPOD $17.228353021 METRONIDAZOLE 5MG/ML PED SYRINGE $136.328112393 METYRAPONE 250MG CAP (METOPIRONE) $23.318112385 METYROSINE 250MG CAP (DEMSER) $20.608107526 MEXILETINE 150MG CAP $18.418107534 MEXILETINE 200MG CAP $19.178107542 MEXILETINE 250MG CAP $19.69



8245284 MICONAZOLE 100MG VAG SUPP #7 $57.218241150 MICONAZOLE 2% CRM 30GM $41.148244790 MICONAZOLE 2% EX THICK CREAM 3.25OZ $34.308241200 MICONAZOLE 2% TINCTURE 30ML $76.078241184 MICONAZOLE 2% VAG. CREAM 45GM $53.278245292 MICONAZOLE 200MG VAG SUPP #3 $132.538211500 MIDAZOLAM 100MG/qs 100ML NS DRIP $310.348180754 MIDAZOLAM 10MG/5ML PO UD LIQ (SMH) $45.058320913 MIDAZOLAM 1MG/ML 2ML INJ $103.598320905 MIDAZOLAM 1MG/ML 5ML INJ $105.678180960 MIDAZOLAM 2MG/ML SYRUP (SMH) $36.268211377 MIDAZOLAM 50MG/qs 50ML NS (PED)DRIP $310.348320897 MIDAZOLAM 5MG/ML INJ 2ML (SMH) $115.758320913 MIDAZOLAM INJ $102.878115081 MIDODRINE 2.5MG TAB $19.978200271 MIDODRINE 5MG TABLET $22.948107872 MIDRIN CAPS $35.258151177 MILK OF MAGNESIA 30ML UDCUP $0.008211302 MILRINONE 20MG/100ML D5W DRIP $148.978307571 MILRINONE INJ $150.968300998 MILRINONE PED BOLUS $146.028253403 MINERAL OIL (LIGHT, STERILE) 25ML $38.478151243 MINERAL OIL (ORAL) 30ML UDCUP $18.298156366 MINERAL OIL PEDIPOD $17.078191488 MINERAL OIL TOPICAL 480ML $41.278107898 MINOCYCLINE 100MG CAP $23.828107922 MINOXIDIL 10MG TAB $19.618107906 MINOXIDIL 2.5MG TAB $18.218122251 MIRTAZAPINE 15MG SOLUTAB $23.938115198 MIRTAZAPINE 15MG TAB $23.348115206 MIRTAZAPINE 30MG TAB $23.538118945 MISOPROSTOL 100MCG TAB $19.638107054 MISOPROSTOL 200MCG TAB $21.018121188 MISOPROSTOL 25MCG TABLET $19.838118945 MISOPROSTOL 50MCG TABLET $19.048380867 MITOMYCIN INJ (MUTAMYCIN) $644.208107930 MITOTANE 500MG TAB $25.808381642 MITOXANTRONE INJ (NOVANTRONE) $806.208122111 MODAFINIL 100MG TAB (SCP) $44.078171654 MODAFINIL 200MG TAB $47.918121196 MOEXIPRIL 15MG TAB $19.698200248 MOEXIPRIL 7.5MG TAB $19.698245300 MOMETASONE 0.1% CRM 15GM $114.718243289 MOMETASONE 0.1% OINT 45GM $143.038252975 MOMETASONE NASAL SPRAY 17GM $189.238253510 MONSEL'S (FERRIC SUBSULF.) SOLN 8ML $42.078115180 MONTELUKAST 10MG TAB $25.788120529 MONTELUKAST 4MG CHEW TAB $25.78



8120537 MONTELUKAST 5MG CHEW TAB $25.788104408 MORICIZINE 200MG TAB $19.448104416 MORICIZINE 250MG TAB $20.218104424 MORICIZINE 300MG TAB $20.658320699 MORPHINE 10MG/1ML INJ $104.718320699 MORPHINE 10MG/1ML VIAL $103.798330805 MORPHINE 15MG/ML 20ML VIAL $109.098352049 MORPHINE 1MG/ML DRIP (PEDS) 55ML NS $220.578355794 MORPHINE 1MG/ML PCA (IN NS) $182.088209801 MORPHINE 20MG/1ML LIQ (UD) $37.938180424 MORPHINE 20MG/ML LIQ 30ML BTL (rxe) $35.318210882 MORPHINE 250MG/250ML 0.9%NACL (ADV) $198.668320566 MORPHINE 2MG/1ML INJ $104.368180549 MORPHINE 2MG/ML LIQ (SCN) $34.298320657 MORPHINE 4MG/1 ML INJ $104.478321168 MORPHINE 5MG/1ML INJ $103.698355794 MORPHINE 5MG/ML (MAX CONC) PCA $229.048320889 MORPHINE INJ (FOR DRIP) $104.718209835 MORPHINE PF 10MG/ML 20ML-PUMP REFIL $482.348330805 MORPHINE PF 25MG/ML 20ML-PUMP REFIL $664.218209801 MORPHINE SR (KADIAN) 20MG CAP $39.998170920 MORPHINE SR (MS CONTIN) 100MG TAB $45.018170912 MORPHINE SR (MS CONTIN) 15MG TAB $36.068170987 MORPHINE SR (MS CONTIN) 30MG TAB $37.868170680 MORPHINE SR (MS CONTIN) 60MG TAB $41.468320616 MORPHINE-PF 0.5MG/ML 10ML INJ $107.038211310 MORPHINE-PF 0.5MG/ML DRIP $239.148211328 MORPHINE-PF 5MG/50ML 0.9% NACL $187.548320616 MORPHINE-PF INJ $119.418122467 MOXIFLOXACIN 400MG TAB $38.438353799 MOXIFLOXACIN 400MG/250ML 0.8% NACL $136.618154429 MULT VIT W/FLUOR 0.25MG/ML DROP 50M $45.078192395 MULT VIT W/FLUOR 0.5MG/ML DROP 50ML $45.078192353 MULTIPLE VIT/IRON DROP 50ML $49.538118952 MULTIPLE VIT/MIN CHEW TAB (ADEKS) $0.008118952 MULTIPLE VIT/MIN PEDIATRIC CHEW TAB $17.258192346 MULTIPLE VITAMIN DROP (PEDS) 50ML $55.678108003 MULTIPLE VITAMIN THERAPEUTIC TAB $0.008121204 MULTIPLE VITAMIN W/MINERALS TAB $0.008301954 MULTITRACE ELEMENTS INJ $36.468307951 MULTITRACE ELEMENTS PED INJ $34.908209801 MULTIVIT/MIN/FE LIQ PEDIPOD $17.078303091 MULTIVITAMIN INJ $59.678209801 MULTIVITAMIN LQ (THERAVITE) PEDIPOD $17.128253726 MUPIROCIN 2% NASAL OINT 1GM $34.518241358 MUPIROCIN 2% TOPICAL OINT 22GM $182.178307613 MUROMONAB-CD3 (OKT3) 5MG/5ML INJ $2,103.978307613 MUROMONAB-CD3 (OKT3) SYRINGE $2,103.97



8307969 MVI PEDIATRIC INJ $73.308213274 MVI/THIAMINE/FOLATE/NS BANANA BAG $190.278307530 MYCOPHENOLATE (CELLCEPT) IVPB $209.508209827 MYCOPHENOLATE 200MG/ML 175ML * (RXE $1,029.868157059 MYCOPHENOLATE 200MG/ML LIQ PEDIPOD $22.728307530 MYCOPHENOLATE INJ $254.618112658 MYCOPHENOLATE MOFETIL 250MG CAP $26.338122954 MYCOPHENOLATE SODIUM 180MG DR TAB $22.308193963 MYLANTA SUSP 150ML $0.008209835 NA BENZOATE/NA PHENYLACETATE $5,566.278308066 NA PHOSPHATE 3MMO/ML INJ- SCN ONLY $34.268301756 NaBICARB 100 MEQ/1000mL D5W $134.418301756 NaBICARB(154meq/L) 190meq/1230ml D5 $168.478112914 NABUMETONE 500MG TAB $20.768118960 NABUMETONE 750MG TAB $20.578310187 NACL 0.9% 100ML (MINIBAG PLUS) $0.008308017 NACL 4MEQ/ML INJ (SCN USE ONLY) SYR $34.198118978 NADOLOL 20MG TAB $18.888108086 NADOLOL 40MG TAB $19.198108102 NADOLOL 80MG TAB $19.868353443 NAFCILLIN 1GM/50ML 0.45%NS (ADV) $129.438209835 NAFCILLIN 20MG/ML ISOTONIC -PED/SCN $137.168353435 NAFCILLIN 2GM/50ML 0.45%NS (ADV) $154.998351579 NAFCILLIN INJ $127.038351595 NAFCILLIN INJ $153.758302911 NALBUPHINE 10MG/1ML INJ $70.428302911 NALBUPHINE 10MG/ML INJ $70.428211336 NALBUPHINE 25MG/50ML D5W-0.45% NACL $176.048302911 NALBUPHINE INJ $70.428302937 NALOXONE 0.4MG/1ML INJ $70.948302937 NALOXONE 0.4MG/ML INJ $70.948306870 NALOXONE 1MG/ML INJ $78.628306870 NALOXONE DRIP $78.628306870 NALOXONE INJ $78.628112542 NALTREXONE 50MG TAB $25.588252025 NAPHAZOLINE 0.012% OPTH SOLN 15ML $40.298244238 NAPHAZOLINE 0.1% OPTH SOLN 15ML $79.478252033 NAPHAZOLINE-ANTAZOLINE OPH SOL 15ML $45.338251753 NAPHAZOLINE-PHENIRAMINE DROP 15ML $50.978108110 NAPROXEN 250MG TAB $18.638108136 NAPROXEN 375MG TAB $19.228108144 NAPROXEN 500MG TAB $19.718108128 NAPROXEN SODIUM 275MG TAB $18.728118499 NARATRIPTAN 2.5MG TAB $60.718209835 NATALIZUMAB (TYSABRI) IVPB $157.008250920 NATAMYCIN OPTH SUSP 5% 15ML $359.078122335 NATEGLINIDE 120MG TAB $19.518123416 NEBIVOLOL 5MG TAB $21.00



8252165 NEDOCROMIL INHALER 16.2GM $186.378105546 NEFAZODONE 100MG TAB $20.628118986 NEFAZODONE 150MG TAB $20.698114746 NEFAZODONE 200MG TAB (SCP ONLY) $20.768122103 NEFAZODONE 50MG TAB (SCP) $20.548209843 NELARABINE (ARRANON) in SW $796.208200107 NELFINAVIR 250MG TAB $22.348245318 NEOMYC/POLYMX/BACTR OINT PKT (SCP) $17.678193971 NEOMYCIN 25MG/ML LIQ 120ML (RXE) $61.728154049 NEOMYCIN 25MG/ML PEDIPOD $17.198108151 NEOMYCIN 500MG TAB $20.988253247 NEOMYCIN/POLYMIX B/HC OPSOL 7.5ML $187.558250953 NEOMYCIN-POLYMY-BACIT OPH OINT 3.5G $101.478250953 NEOMYCIN-POLYMYX/BACIT/HC OPH 3.5GM $121.158250847 NEOMYCIN-POLYMYX-DEXA OPH OINT 3.5G $193.918209827 NEOMYCIN-POLYMYX-DEXA OPTH SUSP 5ML $173.038250946 NEOMYCIN-POLYMYX-GRAMI OP SOLN 10ML $134.118250516 NEOMYCIN-POLYMYX-HC OTIC SOLN 10ML $95.678252983 NEOMYCIN-POLYMYX-HC OTIC SUSP 10ML $95.678211344 NEOMYCIN-POLYMYXIN IRRIG SOLN 1L $91.728241291 NEOMYCIN-POLYMYXIN-BACIT OINT 30GM $41.548350548 NEOSPORIN GU IRRG SOLN 1ML AMP $98.448306854 NEOSTIGMINE 0.5MG/1ML INJ $75.708108193 NEOSTIGMINE 15MG TAB $18.198330821 NEOSTIGMINE 1MG/ML INJ 10ML $90.088341281 NESIRITIDE (NATECOR) INJ $145.408341281 NESIRITIDE (NATRECOR) 6MCG/ML DRIP $145.408112575 NEUTRA PHOS K PWD (250MG PHOS) $18.278156374 NEUTRA-PHOS 10MG/ML PEDIPOD $17.078112591 NEUTRA-PHOS PWD (250MG PHOS) $18.088200164 NEVIRAPINE 200MG TAB $29.988122202 NIACIN (NIASPAN) 500MG ER TAB $19.918122269 NIACIN (NIASPAN) 750MG ER TAB $21.148120974 NIACIN 250MG SR CAP $17.158108201 NIACIN 50MG TAB $17.078108284 NICARDIPINE (CARDENE) 20MG TAB $17.828108276 NICARDIPINE (CARDENE) 30MG CAP $18.288209835 NICARDIPINE 100MCG/ML in NS 10ML SY $147.218309122 NICARDIPINE 20MG/200ML (HEART CATH) $382.738114332 NICARDIPINE 45MG SR CAP $20.868309130 NICARDIPINE DRIP 40MG/200ML NS $663.218308249 NICARDIPINE INJ $486.938121725 NICARDIPINE SR 30MG CAP $19.448241267 NICOTINE 14MG PATCH $23.808241325 NICOTINE 21MG PATCH $30.278108219 NICOTINE 2MG GUM $17.918123119 NICOTINE 4MG GUM (SCP ONLY) $17.998241259 NICOTINE 7MG PATCH $23.80



8108292 NIFEDIPINE 10MG CAP $18.368108300 NIFEDIPINE XL 30MG TAB $21.908108318 NIFEDIPINE XL 60MG TAB $25.468118994 NIFEDIPINE XL 90MG TAB $24.538108367 NIMODIPINE 30MG CAP $36.788157117 NIMODIPINE 30MG/1ML ORAL LIQ UD $40.478123184 NISOLDIPINE 8.5MG ER TAB $21.598108417 NITROFURANTOIN 100MG CAP $20.768156382 NITROFURANTOIN 5 MG/ML SUSP PEDIPOD $17.898108409 NITROFURANTOIN 50MG CAP $19.578119703 NITROFURANTOIN SR (MACROBID) CAP $22.748242240 NITROFURAZONE 0.2% CREAM 30GM $75.078242729 NITROGLYCERIN 0.1MG PATCH $23.838242737 NITROGLYCERIN 0.2MG PATCH $49.368242778 NITROGLYCERIN 0.3MG PATCH $24.778114985 NITROGLYCERIN 0.3MG SL TAB #100 $50.818242745 NITROGLYCERIN 0.4MG PATCH $20.728108466 NITROGLYCERIN 0.4MG SL TAB $17.408252991 NITROGLYCERIN 0.4MG SL TAB (25/BTL) $43.198242752 NITROGLYCERIN 0.6MG PATCH $21.108114936 NITROGLYCERIN 0.6MG SL TAB #100 $50.818308330 NITROGLYCERIN 100MCG/ML in D5W 20ML $107.818200545 NITROGLYCERIN 2% OINT UD PKT $18.498210874 NITROGLYCERIN 200mcg/mL DRIP in D5W $124.418306797 NITROGLYCERIN INJ $130.338241408 NITROGLYCERIN SPRAY 12GM $501.058108433 NITROGLYCERIN SR 2.5MG CAP $17.338108458 NITROGLYCERIN SR 6.5MG CAP $17.388108474 NITROGLYCERIN SR 9MG CAP $19.028301194 NITROPRUSSIDE 50MG INJ $149.798301194 NITROPRUSSIDE INJ $149.798108607 NIZATIDINE 150MG CAP $23.328400301 NO_CHG_PROC_NO_DISPENSE_RX $0.008209827 NON-FORMULARY BULK MED $34.078209843 NON-FORMULARY CHEMO $596.208209835 NON-FORMULARY INJ UD $136.278209835 NON-FORMULARY IV ADDITIVE $136.278209835 NON-FORMULARY IVPB $136.278209835 NON-FORMULARY LVP $102.618209819 NON-FORMULARY PEDIPOD $17.038209827 NON-FORMULARY RESP BULK MED $34.078209801 NON-FORMULARY RESP MEDICATION $17.038209835 NON-FORMULARY SYRINGE $136.278209827 NON-FORMULARY TOPICAL BULK MED $34.078209801 NON-FORMULARY UNIT DOSE MED $17.038209835 NOREPINEPHRINE 8MG/250ML D5W DRIP $175.238304297 NOREPINEPHRINE BITARTRATE 4MG/4ML $162.438304297 NOREPINEPHRINE BITARTRATE INJ $162.43



8112708 NORETHINDRONE 5MG TAB $21.318108581 NORFLOXACIN 400MG TAB $25.028108516 NORTRIPTYLINE 10MG CAP $17.928108532 NORTRIPTYLINE 25MG CAP $18.808108540 NORTRIPTYLINE 50MG CAP $20.078108557 NORTRIPTYLINE 75MG CAP $21.468209819 NOVOFINE AUTOCOVER NEEDLES #20 $0.008307225 NS 500ML/HEPARIN PF 500UNIT $115.218253395 NS/PHENOL 0.4% DILUENT (PULM USE) $36.138192411 NYSTAT/TCN/DPH/HYDROCORT SOLN 240ML $48.478244246 NYSTATIN 100,000 UN/GM CRM 30GM $46.078241416 NYSTATIN 100,000 UN/GM OINT 30GM $48.318241424 NYSTATIN 100,000 UN/GM POWDER 15GM $86.798270266 NYSTATIN 100,000 UNIT VAGINAL TAB $21.128153785 NYSTATIN 100,000 UNIT/ML PEDIPOD $17.598153801 NYSTATIN 500,000 UN/5ML SUSP UDCUP $19.438241226 NYSTATIN-TRIAMCINOLONE CREAM 15GM $42.698241234 NYSTATIN-TRIAMCINOLONE OINT 15GM $42.698302622 OCTREOTIDE 100 MCG/ML INJ $111.488302622 OCTREOTIDE 100 MCG/ML SYRINGE $116.308302630 OCTREOTIDE 500 MCG/ML INJ $300.408302630 OCTREOTIDE 500 MCG/ML SYRINGE $300.408209835 OCTREOTIDE ACETATE 20MG INJ $5,175.988209835 OCTREOTIDE ACETATE 30MG INJ $7,716.708209835 OCTREOTIDE DRIP $147.888253213 OFLOXACIN 0.3% EAR DROPS 5ML $200.398253635 OFLOXACIN 0.3% OPHTH SOLN 10ML $202.918308348 OLANZAPINE (ZYPREXA) 10MG INJ $134.228105769 OLANZAPINE (ZYPREXA) 10MG TAB $38.638121600 OLANZAPINE (ZYPREXA) 2.5MG TAB $34.578105751 OLANZAPINE (ZYPREXA) 5MG TAB $37.748120792 OLANZAPINE 10MG DISINTEGRAT TAB $50.588123069 OLANZAPINE 20MG DISINTEGRAT TAB-SCP $68.438120784 OLANZAPINE 5MG DISINTEGRAT TAB $40.098120032 OLMESARTAN 20MG TAB $21.618120040 OLMESARTAN 5MG TAB $21.258253429 OLOPATADINE 0.1% OPHTH DROPS $230.278109142 OLSALAZINE 250MG CAP $20.348209835 OMALIZUMAB 150MG INJ $1,457.308209892 OMEGAVEN FRESNIUS EMULS 50ML-RXE $66.008209892 OMEGAVEN FRESNIUS EMULSION SYRINGE $66.008119018 OMEPRAZOLE 10MG SR CAPSULE $25.308102360 OMEPRAZOLE 20MG SR $26.268156390 OMEPRAZOLE 2MG/ML SUSP PEDIPOD $18.688307605 ONDANSETRON (ZOFRAN) IVPB $102.848307605 ONDANSETRON (ZOFRAN) SYRINGE $102.848156861 ONDANSETRON 0.8MG/ML LIQ PEDIPOD $26.358307050 ONDANSETRON 2MG/ML 2ML INJ $103.17



8105116 ONDANSETRON 4MG TAB $64.298105124 ONDANSETRON 8MG TAB $93.528307605 ONDANSETRON INJ $102.848122715 ONDANSETRON ODT 8MG SOLUTAB $100.558307605 ONDANSETRON SYRINGE $102.848250813 OPHTHALMIC LUBRICANT OINT 3.5GM $48.238180978 OPIUM 10% TINCTURE (SGH/SCP) $35.968270126 OPIUM-BELLADONNA 30 SUPP $22.958270118 OPIUM-BELLADONNA 60 SUPP $36.788307092 OPRELVEKIN INJ $723.798108656 ORPHENADRINE 100MG SR TAB $21.388112773 OS-CAL 250 MG W/VIT D 125 IU $17.148108672 OS-CAL 500 TABLET (1.25GM CA CARB) $0.008122624 OSELTAMIVIR (TAMIFLU) 75MG CAP $36.568195075 OSELTAMIVIR 12MG/ML SUSP 25ML (RXE) $131.718157075 OSELTAMIVIR 12MG/ML SUSP PEDIPOD $20.738209835 OWN DILUENT $0.008381915 OXALIPLATIN INJ $615.038120552 OXANDROLONE 2.5MG TABLET $49.778107955 OXAPROZIN 600MG TAB $21.948120560 OXCARBAZEPINE 150MG TABLET $20.058120578 OXCARBAZEPINE 300MG TABLET $24.228195083 OXCARBAZEPINE 60MG/ML 120ML (RXE) $113.658156945 OXCARBAZEPINE 60MG/ML SUSP PEDIPOD $17.848155210 OXYBUTYNIN 1MG/ML SYRUP (PEDS) $17.258108771 OXYBUTYNIN 5MG TAB $17.928120842 OXYBUTYNIN 5MG XL TAB $25.288171563 OXYCODONE (OXYCONTIN) 10MG CR TAB $37.478171423 OXYCODONE (OXYCONTIN) 20MG CR TAB $40.598171589 OXYCODONE (OXYCONTIN) 80MG CR TAB $60.748171910 OXYCODONE 10MG/APAP 325MG TAB $35.708180820 OXYCODONE 20MG/1ML LIQ (UD) $38.618171415 OXYCODONE 5MG TAB $34.898171084 OXYCODONE 5MG/APAP 325MG TAB $36.768252298 OXYMETAZOLINE 0.025% OPTH SOLN 15ML $40.838252306 OXYMETAZOLINE 0.05% NASAL SPRY 30ML $42.178252306 OXYMETAZOLINE 0.05%NASAL SPRAY (RT) $39.378252306 OXYMETAZOLINE 0.05%NASAL SPRAY 30ML $39.378301236 OXYTOCIN 10 UNITS/ML INJ $77.148301236 OXYTOCIN 15 UNITS/LR 250ML $118.438211161 OXYTOCIN 20 UNITS/LR 1000ML $117.418209835 OXYTOCIN 30 UNITS in LR 500mL $122.218301236 OXYTOCIN INJ $74.148381246 PACLITAXEL (TAXOL) INJ $637.208209843 PACLITAXEL NAB (ABRAXANE) INJ $618.368209843 PACLITAXEL NAB (ABRAXANE) IVPB $618.368356008 PALIFERMIN 5MG/ML in SW syringe $170.658122970 PALIPERIDONE 3MG ER TAB-24HR (SCP) $41.43



8122988 PALIPERIDONE 6MG ER TAB-24HR (SCP) $41.438381758 PALIVIZUMAB 50MG INJ $2,426.278381758 PALIVIZUMAB SYRINGE $1,525.458209835 PALONOSETRON 0.25MG/5ML VIAL $905.748305823 PAMIDRONATE INJ $192.558305823 PAMIDRONATE IVPB $236.278119026 PANCREASE MT 10 CAP EC $19.698108854 PANCREASE MT 16 CAP EC $21.238119034 PANCREASE MT 4 CAP EC $18.088123457 PANCREAZE 10 DR CAP $20.198123465 PANCREAZE 16 DR CAP $22.108123481 PANCREAZE 21 DR CAP $23.348123473 PANCREAZE 4 DR CAP $18.298330870 PANCURONIUM 1MG/ML INJ 10ML $77.768209843 PANITUMUMAB (VECTIBIX) IVPB $796.208123317 PANTOPRAZOLE 20MG CR TAB $27.028120586 PANTOPRAZOLE 40MG SR TABLET $26.628352684 PANTOPRAZOLE 40MG VIAL $96.948352684 PANTOPRAZOLE 4MG/ML SYRINGE (PEDS) $71.028352684 PANTOPRAZOLE INJ $96.948243834 PAPAIN-UREA OINTMENT 30GM $132.278244931 PAPAIN-UREA-CHLOROPHYLLIN OINT $210.078108904 PAPAVERINE 150MG SR CAP $17.488301293 PAPAVERINE 60MG/2ML INJ $74.868301293 PAPAVERINE INJ $74.868180986 PAREGORIC (CAMPH. OPIUM 0.04%)-SMH $34.198180986 PAREGORIC (CAMPH. OPIUM)0.04%-SMH $34.678307506 PARICALCITOL 5MCG/1ML INJ $124.208122038 PAROXETINE 10MG TAB (SCP) $24.478209801 PAROXETINE 10MG/5ML UD LIQ (SCP) $23.408122343 PAROXETINE 12.5MG CR TAB (SCP ONLY) $23.868105215 PAROXETINE 20MG TAB $24.588122046 PAROXETINE 25MG CR TAB (SCP) $23.298199994 PAROXETINE 2MG/ML SUSP 120ML (RXE) $187.008155731 PAROXETINE 2MG/ML SUSP PEDIPOD $18.308105256 PAROXETINE 30MG TAB $25.038209835 PEDIARIX VACCINE $243.068356016 PEG INTERFERON ALFA-2A 180MCG/0.5ML $1,295.488381808 PEGASPARGASE 750UNITS/ML INJ $5,596.208360471 PEGFILGRASTIM SYRINGE $8,120.208381949 PEMETREXED (ALIMTA) IVPB $714.708381949 PEMETREXED INJ $714.708114472 PENBUTOLOL 20MG TAB $20.778243826 PENCICLOVIR 1% CRM 1.5GM $115.318108953 PENICILLAMINE 250MG CAP $26.368156416 PENICILLAMINE 50MG/ML SUSP PEDIPOD $17.688151359 PENICILLIN VK 50MG/ML PEDIPOD $17.098108961 PENICILLIN 250MG TAB $17.28



8108979 PENICILLIN 500MG TAB $17.838351140 PENICILLIN CR 900/300 INJ 2ML CART. $130.768351140 PENICILLIN G BENZATHINE 1.2MU INJ $140.228351199 PENICILLIN G BENZATHINE 2.4MU INJ $229.128350613 PENICILLIN G POT 100,000UNIT/ML SYR $136.468350647 PENICILLIN G POTASSIUM 5 MU VIAL $152.258350621 PENICILLIN G POTASSIUM INJ $138.128350621 PENICILLIN G POTASSIUM IVPB $138.128350647 PENICILLIN G POTASSIUM IVPB $145.528350647 PENICILLIN GK 5MU/100mL NS MINI-BAG $109.108350688 PENICILLIN-G SODIUM 5 MU INJ $232.098350688 PENICILLIN-G SODIUM INJ $220.638350688 PENICILLIN-G SODIUM IVPB $220.638309163 PENTACEL VACCINE $234.128280539 PENTAMIDINE 300MG INJ (RT) $223.678280539 PENTAMIDINE INHALATION SYRINGE $223.678280539 PENTAMIDINE INJ $325.878280539 PENTAMIDINE IVPB $325.878280539 PENTAMIDINE SYRINGE $325.878171688 PENTAZOCINE-NALOXONE TAB $37.818321184 PENTOBARBITAL 50MG/ML INJ (PER ML) $107.858211369 PENTOBARBITAL 5MG/ML DRIP (Peds) $102.708321184 PENTOBARBITAL INJ $107.128121527 PENTOSAN 100MG CAP $23.698307621 PENTOSTATIN INJ $4,429.748112955 PENTOXIFYLLINE 400MG CR TAB $18.348119042 PEPPERMINT ELIXIR 30ML $41.978209835 PERAMIVIR INJ $0.008242612 PERMETHRIN 1% LOTION 120ML $57.348242661 PERMETHRIN 5% CRM 60GM $90.158109035 PERPHENAZINE 16MG TAB $20.108109001 PERPHENAZINE 2MG TAB (SCP ONLY) $18.898109019 PERPHENAZINE 4MG TAB $19.578109027 PERPHENAZINE 8MG TAB (SCP ONLY) $19.328243099 PETROLATUM OINT 30GM $36.828109050 PHENAZOPYRIDINE 100MG TAB $17.938109076 PHENAZOPYRIDINE 200MG TAB $18.708109084 PHENELZINE 15MG TAB $18.118171159 PHENOBARBITAL 100MG TAB $34.248320335 PHENOBARBITAL 130MG/1ML INJ $110.858171126 PHENOBARBITAL 15MG TAB $34.168171134 PHENOBARBITAL 30MG TAB $34.208320327 PHENOBARBITAL 65MG/ML INJ $105.478320335 PHENOBARBITAL INJ $106.278181042 PHENOBARBITAL LIQ 30MG/7.5ML UDCUP $34.958245326 PHENOL 1.4% THROAT SPRAY 180ML $0.008109100 PHENOXYBENZAMINE 10MG CAP $32.498171720 PHENTERMINE 15MG CAP $36.58



8301335 PHENTOLAMINE 5MG INJ $236.148301335 PHENTOLAMINE INJ $138.148253577 PHENYLEPHRINE 0.125% NASAL SOL 15ML $48.038253007 PHENYLEPHRINE 0.25% NASAL SPRA 15ML $41.058253015 PHENYLEPHRINE 0.25% NOSE DROPS 15ML $41.058252231 PHENYLEPHRINE 0.5% NASAL SPRAY 15ML $41.678253031 PHENYLEPHRINE 1% NASAL SPRAY (RT) $41.978253031 PHENYLEPHRINE 1% NASAL SPRAY 15ML $42.618250995 PHENYLEPHRINE 10% OPTH SOLN 5ML $47.478306904 PHENYLEPHRINE 1000mcg/10mlNS (surg) $110.618306904 PHENYLEPHRINE 100mcg/mL PED SYRINGE $142.538306904 PHENYLEPHRINE 10MCG/ML PEDI SYRINGE $142.538306904 PHENYLEPHRINE 10MG/1ML INJ $142.278251100 PHENYLEPHRINE 2.5% OPTH SOLN 3ML $58.458306904 PHENYLEPHRINE 20MG/250ML D5W DRIP $152.078306904 PHENYLEPHRINE INJ $142.538109175 PHENYTOIN 100MG SR $17.898303901 PHENYTOIN 100MG/2ML INJ $75.508151409 PHENYTOIN 100MG/4ML ORAL SYRINGE $20.378303927 PHENYTOIN 250MG/5ML INJ $72.648156432 PHENYTOIN 25MG/ML PEDIPOD $17.318191637 PHENYTOIN 25MG/ML SUSP 120ML (RXE) $67.388109167 PHENYTOIN 30MG SR $17.818109225 PHENYTOIN 50MG TAB $18.238301350 PHYSOSTIGMINE 2MG/2ML INJ $77.868301384 PHYTONADIONE 10MG/1ML INJ $79.528301368 PHYTONADIONE 1MG/0.5ML PED INJ (SMH $74.068109241 PHYTONADIONE 5MG TAB $26.768301368 PHYTONADIONE INJ $69.288301368 PHYTONADIONE IVPB $79.528252462 PILOCARPINE 0.5% OPHTH SOLN 15ML $47.318251035 PILOCARPINE 1% OPHTH SOLN 15ML $52.478251050 PILOCARPINE 2% OPHTH SOLN 15ML $57.678253437 PILOCARPINE 2% OPHTH SOLN 2ML $44.958251068 PILOCARPINE 3% OPHTH SOLN 15ML $55.438252496 PILOCARPINE 4% OPHTH GEL 4GM $150.118251076 PILOCARPINE 4% OPHTH SOLN 15ML $56.378121733 PILOCARPINE 5MG TAB $21.068252470 PILOCARPINE 6% OPHTH SOLN 15ML $85.198109092 PIMOZIDE 2MG TAB $20.288109258 PINDOLOL 5MG TAB $18.498120594 PIOGLITAZONE (ACTOS) 15MG TAB $27.628120610 PIOGLITAZONE (ACTOS) 45MG TAB $30.128209835 PIPERACILLIN 40MG/ML-TAZOBAC/SW SYR $137.238353062 PIPERACILLIN 80MG/ML SYRINGE (PEDS) $139.228350746 PIPERACILLIN INJ $151.028355927 PIPERACILLIN SYRINGE $143.948351074 PIPERACILLIN-TAZOBACTAM INJ $160.20



8351074 PIPERACILLIN-TAZOBACTAM/SW SYRINGE $163.378253296 PIRBUTEROL INHALER 14GM $272.618113151 PIROXICAM 10MG CAP $19.859350000 PLERIXAFOR 24MG/1.2ML INJ $15,693.148301392 PNEUMOCOCCAL VACC ADULT 23 (VIAL) $159.198307688 PNEUMOCOCCAL VACC PEDS 13 VALENT $327.348301616 POLIOVIRUS VACCINE SYRINGE $122.268120016 POLYETHYLENE GLYCOL 3350 PKT 17GM $21.088353229 POLYMYXIN B INJ $98.628253049 POLYMYXIN-B/TRIMETHOPRIM OPSOL 10ML $68.918245524 PORACTANT INTRATRACHEAL SUSP $837.998245532 PORACTANT INTRATRACHEAL SUSP $1,607.898253684 POSACONAZOLE 40MG/ML SUSP 105mL(RXE $1,504.698209819 POSACONAZOLE 40MG/ML SUSP PEDIPOD $29.428153066 POTASSIUM ACETATE 2MEQ/ML PEDIPOD $17.198301400 POTASSIUM ACETATE INJ $37.278121212 POTASSIUM BICARB 25MEQ EFF TAB $17.878301426 POTASSIUM CHLORIDE INJ $34.618109357 POTASSIUM CL & SODIUM CL EFF. TAB $19.898151466 POTASSIUM CL 10% 20MEQ/15ML UDCUP $17.818151524 POTASSIUM CL 10% 40MEQ/30ML UDCUP $18.598109332 POTASSIUM CL 10MEQ SR $18.708119067 POTASSIUM CL 25MEQ PACKET $17.528109324 POTASSIUM CL 8MEQ SR $18.728301418 POTASSIUM CL INJ $34.138192692 POTASSIUM CL S-F 10% LIQ 120ML(RXE) $36.578156457 POTASSIUM CL S-F 10% PEDIPOD $17.408109381 POTASSIUM CL SR 20MEQ TAB $18.168191736 POTASSIUM IODIDE 1GM/ML 30ML (RXE) $64.478156465 POTASSIUM IODIDE 1GM/ML PEDIPOD $17.848154973 POTASSIUM PHOS 4.4MEQ/ML PEDIPOD $17.228307977 POTASSIUM PHOSPHATE INJ $34.168330896 POTASSIUM PHOSPHATE INJ $34.168330896 POTASSIUM PHOSPHATE IVPB $36.858243461 POVIDONE IODINE 10% OINT 30GM $40.318244279 POVIDONE IODINE 5% AEROSOL 88ML $51.118270787 POVIDONE IODINE DOUCHE 133ML $39.028209843 PRALATREXATE INJ $971.208301491 PRALIDOXIME 1G INJ $284.898118481 PRAMIPEXOLE 0.25MG TAB $23.918118465 PRAMIPEXOLE 1MG TAB $21.858243677 PRAMOXINE 1% AER 15GM $116.598241457 PRAMOXINE-HYDROCORTISONE 1% AER 10G $169.418123366 PRASUGREL 10MG TABLET $30.118112492 PRAVASTATIN 20MG TAB $22.928109415 PRAZIQUANTEL 600MG TAB $45.678155400 PRAZOSIN 0.1MG POWDER PAPER (PEDS) $17.628109423 PRAZOSIN 1MG CAP $17.62



8109431 PRAZOSIN 2MG CAP $17.798109472 PRAZOSIN 5MG CAP $18.348252140 PREDNISOLONE 0.12% OPHTH SUSP 5ML $83.638251910 PREDNISOLONE 1% OPTH SUSP 5ML $57.178153991 PREDNISOLONE NA PHOS 3MG/ML 120ML R $149.538153991 PREDNISOLONE NA PHOS 3MG/ML LIQ (ER $17.998153991 PREDNISOLONE NA PHOS 3MG/ML PEDIPOD $17.998109548 PREDNISONE 10MG TAB $17.308109514 PREDNISONE 1MG TAB $17.508151532 PREDNISONE 1MG/ML PEDIPOD $17.368109506 PREDNISONE 2.5MG TAB $17.248109563 PREDNISONE 20MG TAB $17.388109613 PREDNISONE 50MG TAB $17.718109522 PREDNISONE 5MG TAB $17.278153959 PREDNISONE 5MG/5ML LIQ UDCUP $19.058209801 PREGABALIN 25MG CAP $38.208171803 PREGABALIN 50MG CAP $39.218171795 PREGABALIN 75MG CAP (SCP ONLY)) $39.218109639 PRENATAL VITAMIN TAB $17.568209835 PRE-PEN 0.25ML INJ $212.148109647 PRIMAQUINE 15MG BASE (26.3MG PHOS) $19.828109654 PRIMIDONE 250MG TAB $20.768113144 PRIMIDONE 50MG TAB $18.048156739 PRIMIDONE 50MG/ML SUSP PEDIPOD $17.968209835 prismaSATE DIALYSATE (NOT FROM RX) $212.218109662 PROBENECID 500MG TAB $19.008209884 PROBIOTIC STUDY DRUG $0.008330946 PROCAINAMIDE 100MG/ML 10ML INJ $70.728156481 PROCAINAMIDE 50MG/ML PEDIPOD $17.368330946 PROCAINAMIDE INJ $70.748109787 PROCARBAZINE 50MG CAP $128.398109803 PROCHLORPERAZINE 10MG TAB $18.878301533 PROCHLORPERAZINE 10MG/2ML INJ $75.348270415 PROCHLORPERAZINE 25MG SUP $24.448109795 PROCHLORPERAZINE 5MG TAB $18.268121568 PROCYCLIDINE 5MG TAB $18.548121535 PROGESTERONE (MICRONIZED) 100MG CAP $19.488209819 PROGESTERONE 100MG VAG INSERT $30.098192296 PROMETHAZ/PHENYLEPHR LIQ 120ML (RXE $54.648209835 PROMETHAZINE 0.5MG/ML PEDS SYRINGE $68.388194078 PROMETHAZINE 1.25MG/ML 120ML (RXE) $45.338156499 PROMETHAZINE 1.25MG/ML PEDIPOD $17.098270431 PROMETHAZINE 12.5MG SUPP $25.788301574 PROMETHAZINE 12.5MG/50ML NS IVPB $70.508270423 PROMETHAZINE 25MG SUPP $26.278109837 PROMETHAZINE 25MG TAB $18.118301574 PROMETHAZINE 25MG/1ML INJ $71.308270449 PROMETHAZINE 50MG SUPP $31.19



8113292 PROMETHAZINE 50MG TAB $18.588194086 PROMETHAZINE DM LIQ 120ML (RXE) $44.928156507 PROMETHAZINE DM PEDIPOD $17.128301574 PROMETHAZINE IVPB $70.508171852 PROMETHAZINE-CODEINE LIQ 5ML UDCUP $36.278156515 PROMETHAZINE-PHENYLEPHRINE PEDIPOD $17.208109704 PROPAFENONE 150MG TAB $20.308109696 PROPAFENONE 300MG TAB $22.978119356 PROPANTHELINE BROM 3MG/ML LIQ 30ML $76.308109845 PROPANTHELINE BROMIDE 15MG TAB $18.448251134 PROPARACAINE 0.5% OPTH SOL 15ML $51.398331829 PROPOFOL 10MG/ML INJ $248.058301947 PROPOFOL 10MG/ML INJ 20ML $116.818301970 PROPOFOL 10MG/ML INJ 50ML $175.158171183 PROPOXYPHENE/APAP 100/650 TAB $35.198209835 PROPRANOLOL 0.1MG/ML (PEDS) SYRINGE $139.988109878 PROPRANOLOL 10MG TAB $17.448301608 PROPRANOLOL 1MG/1ML INJ $105.268109886 PROPRANOLOL 20MG TAB $17.578109894 PROPRANOLOL 40MG TAB $17.858194318 PROPRANOLOL 4MG/ML LIQ 120ML (RXE) $53.348155038 PROPRANOLOL 4MG/ML PEDIPOD $17.198109944 PROPRANOLOL SR 120MG CAP $27.748119075 PROPRANOLOL SR 60MG CAP $24.428109910 PROPRANOLOL SR 80MG CAP $25.668109951 PROPYLTHIOURACIL 50MG TAB $17.418119364 PROPYLTHIOURACIL 5MG/ML SUSP (PEDS) $17.068301632 PROTAMINE 10MG/ML INJ 25ML $119.988301624 PROTAMINE 10MG/ML INJ 5ML $85.428301640 PROTIRELIN 0.5MG/1 ML INJ $472.068109985 PROTRIPTYLINE 10MG TAB $20.188109977 PROTRIPTYLINE 5MG TAB $19.208155780 PSEUDOEPHED.-TRIPROLIDINE PEDIPOD $0.008113300 PSEUDOEPHEDRINE 120MG TAB CR $0.008110017 PSEUDOEPHEDRINE 30MG TAB $0.008152308 PSEUDOEPHEDRINE 6MG/ML PEDIPOD $0.008194102 PSEUDOEPHEDRINE SYRUP 120ML (RXE) $0.008193476 PSEUDOEPHEDRINE-TRIPROLID 120ML RXE $0.008100471 PSEUDOEPHEDRINE-TRIPROLIDINE TAB $17.128110058 PSYLLIUM POWDER $0.008156523 PYRAZINAMIDE 20MG/ML LIQ (PEDS) $17.128110074 PYRAZINAMIDE 500MG TAB $19.308301665 PYRIDOSTIGMINE 10MG/2ML INJ $71.528156531 PYRIDOSTIGMINE 12MG/ML LIQ PEDIPOD $17.278110082 PYRIDOSTIGMINE 60MG TAB $20.948110132 PYRIDOXINE 100MG TAB $17.118307985 PYRIDOXINE 100MG/1ML INJ $89.728110124 PYRIDOXINE 50MG TAB $17.08



8307985 PYRIDOXINE INJ $90.628103913 PYRIMETHAMINE 25MG TAB $18.198400251 Q.S. 0.45% SODIUM CHLORIDE $0.008400251 Q.S. 0.45% SODIUM CHLORIDE SYRINGE $0.008400301 Q.S. DEXTROSE 10% $0.008400301 Q.S. DEXTROSE 10% SYRINGE $0.008310005 Q.S. DEXTROSE 5% IN WATER $0.008310005 Q.S. DEXTROSE 5% IN WATER SYRINGE $0.008210379 Q.S. DEXTROSE 5%/0.225% NACL $103.718210379 Q.S. DEXTROSE 5%/0.225%NACL SYRINGE $0.008400269 Q.S. DEXTROSE 5%/0.45% NACL $0.008400269 Q.S. DEXTROSE 5%/0.45% NACL SYRINGE $0.008210452 Q.S. DEXTROSE 5%/0.9% NACL $0.008308975 Q.S. ELLIOTTS B SOLN $71.308306532 Q.S. LIDOCAINE 1% $0.008210668 Q.S. NACL 0.9% FOR IRRIGATION $42.678210536 Q.S. SODIUM CHLORIDE 0.9% $105.318400277 Q.S. SODIUM CHLORIDE 0.9% $0.008400277 Q.S. SODIUM CHLORIDE 0.9% EPIDURAL $0.008400277 Q.S. SODIUM CHLORIDE 0.9% SYRINGE $0.008210858 Q.S. SODIUM CHLORIDE 3% $0.008209835 Q.S. STERILE EPOPROSTENOL DILUENT $0.008302283 Q.S. STERILE WATER $0.008302283 Q.S. STERILE WATER SYRINGE $0.008209835 QS DILUENT $0.008115214 QUETIAPINE 100MG TAB $27.098115339 QUETIAPINE 200MG TAB $36.018115263 QUETIAPINE 25MG TAB $22.898209801 QUETIAPINE 300MG TAB $34.098122848 QUETIAPINE 50MG TAB $24.038123085 QUETIAPINE XR 200MG TAB (SCP) $32.388123093 QUETIAPINE XR 300MG TAB (SCP) $37.138123390 QUETIAPINE XR 50MG TAB (SCP ONLY) $25.728107211 QUINAPRIL 10MG TAB $20.728107187 QUINAPRIL 20MG TAB $20.728107195 QUINAPRIL 5MG TAB $20.728330979 QUINIDINE GLUCONATE 80MG/ML 10ML $111.268110223 QUINIDINE GLUCONATE ER 324MG TAB $19.778309007 QUINIDINE GLUCONATE INJ $72.638110272 QUINIDINE SULFATE 200MG TAB $17.438110280 QUINIDINE SULFATE 300MG TAB $17.808110215 QUINIDINE SULFATE SR 300MG TAB $18.798110330 QUININE (QUALAQUIN) 324MG CAP $28.358120628 RABEPRAZOLE 20MG TAB $30.728209835 RABIES IMMUNE GLOB 150 UNIT/ML 10ML $1,918.928209819 RABIES IMMUNE GLOBULIN 300 UNIT/2ML $690.688308181 RABIES VACCINE $691.748119083 RALOXIFENE 60MG TAB $25.10



8123127 RALTEGRAVIR 400MG TAB $50.738123051 RAMELTEON 8MG TAB (SCP ONLY) $23.218119091 RAMIPRIL 1.25MG CAP $19.398119109 RAMIPRIL 10MG CAP $21.778114407 RAMIPRIL 2.5MG CAP $21.738114415 RAMIPRIL 5MG CAP $21.968110355 RANITIDINE 150MG TAB $21.208156549 RANITIDINE 15MG/1ML PEDIPOD $18.188194128 RANITIDINE 15MG/ML SYRUP 120ML (RXE $221.018353096 RANITIDINE 2.5MG/ML SYRINGE (PEDS) $136.678304339 RANITIDINE 50MG/2ML INJ $110.218308876 RANITIDINE INJ $106.208308876 RANITIDINE SYRINGE $106.208209801 RANOLAZINE 500MG CR TAB $23.918209827 RAPID SEQ INDUCTION KIT (ER) $0.008353252 RASBURICASE SYRINGE $534.168209835 REGADENOSON (LEXISCAN) 0.4MG/5ML $573.428321176 REMIFENTANIL 1MG INJ (SCP CHG ONLY) $162.598245334 RENACIDIN IRRIG SOLN 500ML $124.648118432 REPAGLINIDE 0.5 MG TAB $21.308118424 REPAGLINIDE 1MG TAB $19.428110363 RESERPINE 0.1MG TAB $18.428110371 RESERPINE 0.25MG TAB $17.938244287 RID SHAMPOO 120ML $53.498110413 RIFABUTIN (MYCOBUTIN) 150MG CAP $40.438119117 RIFAMPIN (RIFADIN) 150MG CAP $21.798110405 RIFAMPIN (RIFADIN) 300MG CAP $23.118194482 RIFAMPIN 10MG/ML SUSP 240ML (RXE) $37.448155681 RIFAMPIN 10MG/ML SUSP PEDIPOD $17.248353104 RIFAMPIN 5MG/ML PEDS SYRINGE $137.568300956 RIFAMPIN 600MG INJ $414.678300956 RIFAMPIN INJ $291.278300956 RIFAMPIN IVPB $291.278122905 RIFAXIMIN (XIFAXAN) 200MG TAB $29.108209819 RIFAXIMIN (XIFAXAN) 20MG/ML PEDIPOD $19.438200230 RILUZOLE 50MG TAB $48.858113441 RIMANTADINE 100MG TAB $20.698156556 RIMANTADINE 10MG/ML PEDIPOD $17.408194144 RIMANTADINE 10MG/ML SYRUP 120ML RXE $78.978120818 RISEDRONATE (ACTONEL) 30MG TAB $54.398120800 RISEDRONATE (ACTONEL) 5MG TAB $24.868122004 RISPERIDONE 0.5MG TAB $24.388114506 RISPERIDONE 1MG TAB $27.708156564 RISPERIDONE 1MG/1ML LIQ PEDIPOD $25.518156564 RISPERIDONE 1MG/1ML UD LIQ (SCP) $25.518114514 RISPERIDONE 2MG TAB $29.268308512 RISPERIDONE DEPOT 25MG INJ (SCP) $637.228308520 RISPERIDONE DEPOT 37.5MG INJ (SCP) $921.80



8209835 RISPERIDONE DEPOT 50MG INJ (SCP) $1,297.268123150 RISPERIDONE DISINTEGRAT 0.5MG TAB $26.338122475 RISPERIDONE DISINTEGRATING 1MG TAB $26.008122541 RISPERIDONE DISINTEGRATING 2MG TAB $30.868209801 RITONAVIR 100MG CAP $37.608381667 RITUXIMAB INJ $1,924.848121261 RIVASTIGMINE (EXELON) 1.5MG CAP $25.208123077 RIVASTIGMINE (EXELON) 4.5MG CAP $23.538120636 RIZATRIPTAN 10MG ORAL DIS TAB $67.668209801 RIZATRIPTAN 5MG ORAL DIS TAB (SCP) $55.958308447 ROCURONIUM 10MG/ML INJ 5ML $114.308330672 ROCURONIUM INJ $132.048121758 ROPINIROLE 0.25MG TABLET $23.178121766 ROPINIROLE 1MG TAB $23.178121774 ROPINIROLE 5MG TAB $22.058209835 ROPIVAC 0.2% ON-Q PUMP 400ML (SGH) $0.008209835 ROPIVACAINE 0.75% 20ML POLY AMP $102.708209801 ROPIVACAINE 200MG/100ML INJ $120.308209801 ROPIVACAINE 400MG/200ML $144.588209801 ROPIVACAINE 40MG/20ML INJ $85.828307563 ROPIVACAINE 5MG/ML 30ML $105.368209801 ROPIVACAINE INJ $136.618120669 ROSIGLITAZONE (AVANDIA) 2MG TAB $22.938120677 ROSIGLITAZONE (AVANDIA) 4MG TAB $25.788122350 ROSUVASTATIN (CRESTOR) 10MG TAB $25.648122384 ROSUVASTATIN (CRESTOR) 5MG TAB $25.648304073 RUBELLA VACCINE $112.308123325 RUFINAMIDE 200MG TAB $23.288155392 RYNATAN-S PED SUSP PEDIPOD $17.948253239 SALMETEROL DISKUS INHALER #28 $163.458113482 SALSALATE 500MG TAB $17.708113490 SALSALATE 750MG TAB $17.728114720 SAQUINAVIR (INVIRASE) 200MG HGC $22.028122806 SAQUINAVIR (INVIRASE) 500MG TAB $30.748381675 SARGRAMOSTIM 500MCG/1ML INJ $197.458381675 SARGRAMOSTIM 500MCG/1ML PED SYRINGE $197.458251167 SCOPOLAMINE 0.25% OPHTH SOLN 5ML $87.358301715 SCOPOLAMINE 0.4MG/1ML INJ $78.948242794 SCOPOLAMINE 1.5MG PATCH $29.518209835 SECRETIN (HUMAN) 16MCG INJ $1,105.348209827 SECURE DRAWER (ANESTHESIA BIN) $0.008110447 SELEGILINE 5MG TAB $21.898245623 SELEGILINE 6MG/24HR PATCH (SCP) $50.038245342 SELENIUM 1% SHAMPOO 210ML $43.318304040 SELENIUM INJ $68.708241499 SELENIUM SULF 2.5% SHAMPOO/LOT120ML $56.878156572 SENNA 1.76MG/ML SYRUP PEDIPOD $17.208122822 SENNA 8.6MG TAB $0.00



8110181 SERTRALINE 100MG TAB $17.838121998 SERTRALINE 25MG TAB (SCP) $22.788110173 SERTRALINE 50MG TAB $22.788121873 SEVELAMER CARB (RENVELA) 800MG TAB $21.128121873 SEVELAMER HCL (RENAGEL) 800MG TAB $22.158209827 SILDENAFIL 2.5MG/ML LIQ $27.448123143 SILDENAFIL 20MG TAB $43.358122764 SILDENAFIL 25MG TAB $51.738245607 SILVER SULFADIAZINE 1% CREAM 25GM $44.478245359 SILVER SULFADIAZINE 1% CREAM 400GM $104.158156580 SIMETHICONE 20MG/0.3ML DROPS $17.278191876 SIMETHICONE 20MG/0.3ML DROPS $41.258110553 SIMETHICONE 80MG TAB $0.008112872 SIMVASTATIN 10MG TAB $22.088112880 SIMVASTATIN 20MG TAB $28.258303000 SINCALIDE 5MCG INJ $208.088121824 SIROLIMUS 1MG TAB $33.228209827 SIROLIMUS 1MG/1ML LIQ 60ML $1,292.038209801 SITAGLIPTIN (JANUVIA) 100MG TAB $29.188209801 SITAGLIPTIN (JANUVIA) 25MG TAB $30.758352676 SOD FERRIC GLUC (FERRLECIT) IVPB $215.778352676 SOD FERRIC GLUC COMPLEX (FERRLECIT) $212.598301731 SODIUM ACETATE 2MEQ/ML INJ-SCN ONLY $34.318154148 SODIUM ACETATE 2MEQ/ML PEDIPOD $17.278301731 SODIUM ACETATE INJ $38.858303935 SODIUM BICARB (PED) 8.4% SYR 10ML $73.928303943 SODIUM BICARB 4.2% (INFANT) 10ML $79.008153777 SODIUM BICARBONATE 1MEQ/ML PEDIPOD $17.068301749 SODIUM BICARBONATE 4% INJ $41.638301756 SODIUM BICARBONATE 50MEQ/50ML VIAL $35.938110660 SODIUM BICARBONATE 650MG TAB $17.068301756 SODIUM BICARBONATE 8.4% SYR 50ML $74.968301756 SODIUM BICARBONATE INJ $35.938252249 SODIUM CHLOR 0.65% NASAL SPRAY 45ML $38.368210247 SODIUM CHLORIDE 0.45% $105.118210254 SODIUM CHLORIDE 0.45% $105.418310104 SODIUM CHLORIDE 0.45% $3.058209835 SODIUM CHLORIDE 0.45% 50ML (ADV) $3.968209835 SODIUM CHLORIDE 0.45% W/20MEQ KCL $127.018209835 SODIUM CHLORIDE 0.9% $12.878210528 SODIUM CHLORIDE 0.9% $2.808210536 SODIUM CHLORIDE 0.9% $105.318210544 SODIUM CHLORIDE 0.9% $105.218310021 SODIUM CHLORIDE 0.9% $4.288310039 SODIUM CHLORIDE 0.9% $4.288300022 SODIUM CHLORIDE 0.9% (INV USE) $0.008210528 SODIUM CHLORIDE 0.9% (EXCEL) $4.208210536 SODIUM CHLORIDE 0.9% (EXCEL) $106.91



8210528 SODIUM CHLORIDE 0.9% (GLASS) $8.608210536 SODIUM CHLORIDE 0.9% 500ML $105.318308033 SODIUM CHLORIDE 0.9% FLUSH $40.338210668 SODIUM CHLORIDE 0.9% FOR IRRIG $42.678210668 SODIUM CHLORIDE 0.9% FOR IRRIGATION $42.678301772 SODIUM CHLORIDE 0.9% INJ 10ML $69.388310021 SODIUM CHLORIDE 0.9% VIAL $2.388211062 SODIUM CHLORIDE 0.9% W/20 MEQ KCL $119.418211054 SODIUM CHLORIDE 0.9% W/40 MEQ KCL $119.418209801 SODIUM CHLORIDE 10% (RESP USE) $18.638113615 SODIUM CHLORIDE 1GM TAB $17.218252256 SODIUM CHLORIDE 2% OPTH SOLN 15ML $70.698210858 SODIUM CHLORIDE 3% $128.618280463 SODIUM CHLORIDE 3% (RESP USE) $18.538308017 SODIUM CHLORIDE 4MEQ/ML LIQ PEDIPOD $17.158244303 SODIUM CHLORIDE 5% OPHTH SOLN 15ML $70.398122855 SODIUM CHLORIDE 7% (RESP USE) $18.238308017 SODIUM CHLORIDE INJ $34.198310021 SODIUM CHLORIDE PF 0.9% $42.808113631 SODIUM FLUORIDE 1.1MG TAB $17.148110694 SODIUM FLUORIDE 2.2MG TABLETS $17.148308041 SODIUM HYALURONAT 10MG/ML INJ 0.4ML $230.648308058 SODIUM HYALURONATE 8.5MG INJ $380.648308058 SODIUM HYALURONATE OPHTH INJ 0.8ML $343.148331019 SODIUM MORRHUATE 50MG/ML 30ML INJ $236.148156606 SODIUM PHOSPHATE 3MMO/ML PEDIPOD $17.228156606 SODIUM PHOSPHATE INJ $34.268308066 SODIUM PHOSPHATE INJ $34.268191157 SODIUM POLYSTYRENE SUSP 15GM/60ML $30.478304289 SODIUM TETRADECYL SULF 3% INJ 2ML $119.648303026 SODIUM THIOSULFATE 10% INJ $83.148303026 SODIUM THIOSULFATE 10% INJ 10ML $104.148302879 SODIUM THIOSULFATE 25% INJ $113.148302879 SODIUM THIOSULFATE 25% INJ 50ML $111.348210544 SOIDUM CHLORIDE 0.9% (EXCEL) $107.418156614 SORBITOL 70% LIQ 30ML UDCUP $20.158121303 SOTALOL 120MG TAB $25.578121220 SOTALOL 40MG TAB $23.608156952 SOTALOL 5MG/ML SUSP PEDIPOD $17.738107971 SOTALOL 80MG TAB $23.658110769 SPIRONOLACTONE 100MG TAB $19.988191884 SPIRONOLACTONE 10MG/ML LIQ 30ML-RXE $44.338154163 SPIRONOLACTONE 10MG/ML PEDIPOD $17.378110744 SPIRONOLACTONE 25MG TAB $17.898110751 SPIRONOLACTONE 50MG TAB $18.798121782 STAVUDINE 15MG CAP $28.148122814 STAVUDINE 20MG CAP $29.408114837 STAVUDINE 40MG CAP $31.65



8209835 STERILE NONIONIC CONTRAST MEDIUM $138.528210601 STERILE WATER $1.158302283 STERILE WATER $0.008302283 STERILE WATER FOR INJ $0.008302283 STERILE WATER FOR INJ 10ML VIAL $2.648380933 STREPTOZOCIN 1GM INJ $906.468171811 SUBOXONE 2MG SL TAB (SCP ONLY) $40.068209801 SUBOXONE 8MG SL TAB (SCP ONLY) $45.218331001 SUCCINYLCHOLINE 20MG/ML INJ 10ML $73.948156630 SUCRALFATE 0.1GM/ML SUSP PEDIPOD $17.278110793 SUCRALFATE 1GM TAB $18.578252645 SUCRALFATE 4% IN EUCERIN 4 OZ $62.538321192 SUFENTANIL 250MCG/5ML INJ $150.238251175 SULFACETAMIDE 10% OPTH SOLN 15ML $44.238251498 SULFACETAMIDE-PREDNISO OP OINT 3.5G $92.698113680 SULFADIAZINE 500MG TAB $19.648110850 SULFASALAZINE (AZULFIDINE) 500MG TB $17.548110918 SULINDAC 150MG TAB $19.058110926 SULINDAC 200MG TAB $19.518243933 SUMATRIPTAN 20MG NASAL SPRAY $121.178114704 SUMATRIPTAN 25MG TAB $59.188119133 SUMATRIPTAN 50MG TAB $73.358252686 SUMATRIPTAN 5MG NASAL SPRAY $121.178302713 SUMATRIPTAN 6MG/0.5ML INJ $271.648245615 SURGICEL ADSORBABLE HEMOSTAT 4X8 $149.738253601 SYMBICORT 160mcg/4.5mcg INHALER 6GM $328.558253619 SYMBICORT 80mcg/4.5mcg INHALER 6GM $256.688209827 SYRINGE, INSULIN 100 UNIT SIZE $17.238209827 SYRINGE, INSULIN 50 UNIT SIZE $17.238123333 TACROLIMUS 0.5MG CAPSULE $21.798209819 TACROLIMUS 0.5MG/ML LIQ 60ML (RXE) $271.468209819 TACROLIMUS 0.5MG/ML LIQ PEDIPOD $24.948105280 TACROLIMUS 1MG CAP $26.548121808 TACROLIMUS 5MG CAP $56.338307332 TACROLIMUS 5MG/1ML INJ $464.158307332 TACROLIMUS INJ $436.278244923 TALC AEROSOL 4GM $269.078352395 TALC POWDER 5GM VIAL $136.618352395 TALC SLURRY INTRAPLEURAL $156.278110942 TAMOXIFEN 10MG TAB $20.828115065 TAMSULOSIN 0.4MG CAP $26.408121279 TELMISARTAN 40MG TAB $20.488171241 TEMAZEPAM 15MG CAP $35.508171571 TEMAZEPAM 7.5MG CAP $57.428209801 TEMOZOLOMIDE 100MG CAP $375.578122079 TEMOZOLOMIDE 20MG CAPSULE $88.738122061 TEMOZOLOMIDE 5MG CAP $36.328382020 TEMOZOLOMIDE INJ $607.52



8381956 TEMSIROLIMUS INJ $711.338360463 TENECTEPLASE 50MG INJ $6,613.798381410 TENIPOSIDE INJ $1,240.188121857 TENOFOVIR 300MG TAB $64.708110538 TERAZOSIN 1MG CAP $20.248119158 TERAZOSIN 2MG CAP $20.248119166 TERAZOSIN 5MG CAP $20.248245367 TERBINAFINE (LAMISIL) 1% CREAM 12GM $50.378106676 TERBINAFINE (LAMISIL) 250MG TAB $50.728301863 TERBUTALINE 1MG/ML INJ $130.028110991 TERBUTALINE 2.5MG TAB $18.088111007 TERBUTALINE 5MG TAB $18.548301863 TERBUTALINE INJ $130.028241168 TERCONAZOLE 0.4% CRM 45GM $139.658241168 TERCONAZOLE 0.8% VAG CRM 20GM $139.658241176 TERCONAZOLE 80MG VAG SUPP $52.228209835 TERIPARATIDE 750MCG/3ML INJ PEN $1,666.048321226 TESTOSTERONE CYPIONATE 200MG/ML INJ $159.478244915 TESTOSTERONE TRANSDERMAL 5MG PATCH $54.208303968 TETANUS IMMUNE GLOBULIN 250UNIT INJ $603.188303992 TETANUS TOXOID ADSORBED INJ 0.5ML $114.268303299 TETANUS/DIPHTHERIA ADULT VACCINE $111.328303323 TETANUS/DIPHTHERIA PED. VACCINE $93.678251217 TETRACAINE 0.5% OPHTH SOLN 2ML $47.958308140 TETRACAINE 20MG INJ $77.408303059 TETRACAINE INJ $79.848111015 TETRACYCLINE 250MG CAP $17.198252272 TETRAHYDROZOLINE 0.05% OPHTH 15ML $39.698209801 THALIDOMIDE 200MG DS CAP $111.538103376 THALIDOMIDE 50MG CAP $52.848209801 THALIDOMIDE DS 100MG CAP $99.338308546 THEOPHYLLINE 1.6MG/ML in D5W SYRING $136.358152266 THEOPHYLLINE 18MG/ML LIQ PEDIPOD $17.068211492 THEOPHYLLINE 400MG/250ML D5W PREMIX $122.418194474 THEOPHYLLINE 80MG/15ML 240ML (RXE) $41.088111080 THEOPHYLLINE SR (UNIPHYL) 400MG TAB $19.408111056 THEOPHYLLINE SR 100MG TAB $18.138111072 THEOPHYLLINE SR 200MG TAB $17.768111098 THEOPHYLLINE SR 300MG TAB $17.658111270 THIAMINE 100MG TAB $0.008308074 THIAMINE 100MG/ML 2ML INJ $92.028301871 THIAMINE INJ $70.528111288 THIOGUANINE 20MG TAB $27.988111288 THIOGUANINE 40MG TAB $36.808111288 THIOGUANINE 40MG/ML SUSP PEDIPOD $36.808321085 THIOPENTAL 500MG INJ $110.138111338 THIORIDAZINE 100MG TAB (SCP ONLY) $18.408111296 THIORIDAZINE 10MG TAB $17.71



8111312 THIORIDAZINE 25MG TAB $17.998111320 THIORIDAZINE 50MG TAB $18.238381154 THIOTEPA INJ $872.208111403 THIOTHIXENE 10MG CAP (SCP ONLY) $18.378111361 THIOTHIXENE 1MG CAP $18.038111379 THIOTHIXENE 2MG CAP $17.648111387 THIOTHIXENE 5MG CAP $17.988242828 THROMBIN 5,000 UNIT POWDER $206.318111486 THYROID 120MG TAB $17.708111460 THYROID 30MG TAB $17.328111478 THYROID 60MG TAB $17.578308652 THYROTROPIN ALFA (RECOMB) 1.1MG INJ $2,460.948115271 TIAGABINE (GABITRIL) 16MG TAB $22.938119174 TIAGABINE (GABITRIL) 4MG TAB $26.758353120 TICARCILLIN 30MG/ML-CLAVULANATE SYR $102.528351629 TICARCILLIN-CLAVULANATE 3.1GM INJ $134.218351629 TICARCILLIN-CLAVULANATE IVPB $133.618110249 TICLOPIDINE 250MG TAB $20.958331944 TIGECYCLINE INJ $139.218251225 TIMOLOL 0.25% OPH SOLN 5ML $64.078251233 TIMOLOL 0.5% OPH SOLN 5ML $68.078253676 TIMOLOL 0.5%-DORZOLAMIDE 2% OP 10ML $306.578111544 TIMOLOL 10MG TAB $17.808244345 TIMOLOL-XE 0.25% GEL FORM OP 5ML $133.078253791 TIMOLOL-XE 0.5% GEL FORM OP 5ML $151.078253338 TIOTROPIUM HANDIHALER 18MCG CAP #5 $105.078118382 TIZANIDINE (ZANAFLEX) 4MG TAB $21.198350894 TOBRAMYCIN 40MG/ML IM SYRINGE $141.238252132 TOBRAMYCIN 0.3% OPHTH OINT 3.5GM $178.798252108 TOBRAMYCIN 0.3% OPHTH SOL 5ML $64.078331639 TOBRAMYCIN 1.2GM POWDER FOR INJ $708.108244881 TOBRAMYCIN 300MG/5ML INHAL SOLN $130.498350977 TOBRAMYCIN 4MG/ML SYRINGE (PEDS/SCN $139.928350894 TOBRAMYCIN 80MG/2ML (RT USE) $21.998350894 TOBRAMYCIN 80MG/2ML INJ $141.038350894 TOBRAMYCIN INJ $141.238350894 TOBRAMYCIN per PHARMACY PROTOCOL $0.008251506 TOBRAMYCIN-DEXAMETH OPTH OINT 3.5GM $257.518251514 TOBRAMYCIN-DEXAMETHASONE OPH 2.5ML $122.398209835 TOCILIZUMAB INJ $144.248111577 TOLAZAMIDE (TOLINASE) 250MG TAB $19.168111593 TOLBUTAMIDE (ORINASE) 500MG TAB $17.618113805 TOLMETIN 200MG TAB $18.338113813 TOLMETIN DS 400MG CAP $20.748243149 TOLNAFTATE 1% CREAM 15GM $39.578243131 TOLNAFTATE 1% SOLN 10ML $40.078120008 TOLTERODINE 1MG TAB $20.758122392 TOLTERODINE 2MG LA CAP $26.30



8119422 TOLTERODINE 2MG TAB $22.328121543 TOLTERODINE 4MG LA CAP $26.208200263 TOPIRAMATE (TOPAMAX) 100MG TAB $31.908120693 TOPIRAMATE (TOPAMAX) 15MG SPRINKLE $20.378120065 TOPIRAMATE (TOPAMAX) 25MG SPRINKLE $23.278120701 TOPIRAMATE (TOPAMAX) 25MG TAB $22.498387979 TOPOTECAN INJ $3,126.188105082 TORSEMIDE 10MG TAB $18.448119182 TORSEMIDE 20MG TAB $19.468209827 TOTAL VOLUME $0.008309056 TPA/ALTEPLASE 2MG VIAL $271.008340523 TPN (ADULT) <= 1 L (PER PHARMACY) $851.918340523 TPN (ADULT) <= 1 LITER $851.918340580 TPN (ADULT) <= 2 L (PER PHARMACY) $1,135.898340580 TPN (ADULT) <= 2 LITERS $1,135.898340523 TPN (ADULT) <= 3 L (PER PHARMACY) $1,419.868340606 TPN (ADULT) <= 3 LITERS $1,419.868340382 TPN (NEONATE) 1 BTL $851.918340382 TPN (NEONATE) 1 BTL (PER PHARMACY) $851.918340382 TPN (PEDS) 1 BTL $851.918340382 TPN (PEDS) 1 BTL (PER PHARMACY) $851.918340515 TPN PERIPHERAL <= 1 LITER $851.918340515 TPN PERIPHERAL <= 1L (PER PHARMACY) $851.918340663 TPN PERIPHERAL <= 2 LITERS $1,135.898340663 TPN PERIPHERAL <= 2L (PER PHARMACY) $1,135.898340689 TPN PERIPHERAL <= 3 LITERS $1,419.868340689 TPN PERIPHERAL <= 3L (PER PHARMACY) $1,419.868108169 TRAMADOL 50MG TAB $19.688120826 TRANDOLAPRIL 1MG TAB $19.438308207 TRANEXAMIC ACID 100MG/ML 10ML INJ $140.468245581 TRANEXAMIC ACID MOUTHWASH 100ML $395.678111635 TRANYLCYPROMINE 10MG TAB $20.098360489 TRASTUZUMAB INJ $797.778122517 TRAVOPROST 0.004% OP SOLN 2.5ML $203.998111650 TRAZODONE 100MG TAB $18.508111643 TRAZODONE 50MG TAB $17.888242422 TRETINOIN 0.05% CRM 20GM $106.038120107 TRETINOIN 10MG CAP $56.448241556 TRIAMCINOLONE 0.025% CRM 15GM $35.998241564 TRIAMCINOLONE 0.025% CRM 80GM $44.578253080 TRIAMCINOLONE 0.025% OINT 15GM $36.878241564 TRIAMCINOLONE 0.025% OINT 80GM $44.578241572 TRIAMCINOLONE 0.1% CRM 15GM $36.478245383 TRIAMCINOLONE 0.1% CRM 80GM $44.268242448 TRIAMCINOLONE 0.1% LOTION 60ML $118.918242471 TRIAMCINOLONE 0.1% OINT 15GM $36.478245391 TRIAMCINOLONE 0.1% OINT 80GM $46.578245409 TRIAMCINOLONE 0.5% CRM 15GM $40.67



8245417 TRIAMCINOLONE 0.5% OINT 15GM $45.678253270 TRIAMCINOLONE 55MCG NASAL 16.5GM $257.738209835 TRIAMCINOLONE ACET. 10MG/ML SYRINGE $71.758301962 TRIAMCINOLONE ACET. 40MG/ML INJ $86.128308082 TRIAMCINOLONE ACETAMIDE INJ $187.858209835 TRIAMCINOLONE HEXACT 20MG/ML INJ $94.048242505 TRIAMCINOLONE ORAL INHALER 20GM $226.958111734 TRIAMTERENE 100MG CAP $20.908111700 TRIAMTERENE 50MG CAP $19.698171456 TRIAZOLAM 0.125MG TAB (SCP ONLY) $35.358111817 TRIFLUOPERAZINE 10MG TAB $20.398111791 TRIFLUOPERAZINE 2MG TAB $18.808111809 TRIFLUOPERAZINE 5MG TAB $19.268251258 TRIFLURIDINE 1% OPHTH SOLN 7.5ML $321.758194169 TRIHEXYPHENIDYL 0.4MG/ML 120ML (RXE $49.798209801 TRIHEXYPHENIDYL 0.4MG/ML PEDIPOD $17.168111825 TRIHEXYPHENIDYL 2MG TAB $17.408111833 TRIHEXYPHENIDYL 5MG TAB $17.768302085 TRIMETHOBENZAMIDE 200MG/2ML INJ $81.568122632 TRIMETHOBENZAMIDE 300MG CAP (SCP) $19.068113904 TRIMETHOPRIM 100MG TAB (TRIMPEX) $18.408209843 TRIPTORELIN LA 11.25MG INJ $5,816.208122483 TRIZIVIR TABLET $67.668211468 TROMETHAMINE DRIP 18,000MG/500ML $513.118253072 TROPICAMIDE 1% OPHTH 3ML $44.078304503 TUBERCULIN 5TU INJ $73.458304503 TUBERCULIN 5TU INJ (EMP HEATH) $0.008302101 TUBOCURARINE 3MG/ML INJ 10ML $80.148181067 TYLENOL W/COD ELIXIR 12.5ML UDCUP $36.978120933 ULTRASE CAPSULE $17.998120941 ULTRASE MT 12 CAPSULE $19.018120958 ULTRASE MT 18 CAPSULE $20.138120966 ULTRASE MT 20 CAPSULE $20.458353401 UNASYN 1.5GM/50ML 0.45%NS (ADV) $119.478353393 UNASYN 3GM/50ML 0.45%NS (ADV) $133.918122723 URSODIOL 250MG TAB (SMH ONLY) $21.718110777 URSODIOL 300MG CAP $22.688157018 URSODIOL 50MG/ML SUSP PEDIPOD $19.378200222 VALACYCLOVIR (VALTREX) 500MG TAB $33.468209827 VALACYCLOVIR 50MG/ML SUSP 180ML RXE $329.788209827 VALACYCLOVIR 50MG/ML SUSP PEDIPOD $18.678122533 VALDECOXIB 10MG TAB $23.638123176 VALGANCICLOVIR (VALCYTE) 450MG TAB $106.538157042 VALPROATE 250MG/5ML LIQ UDCUP $18.438200362 VALPROATE 500MG INJ $174.298156655 VALPROATE 50MG/ML PEDIPOD $17.248192908 VALPROATE 50MG/ML SYRUP (RXE) $59.058200362 VALPROATE INJ $167.05



8114043 VALPROIC ACID 250MG CAP $18.628352635 VALPROIC ACID 5MG/ML PEDI SYRINGE $137.818200362 VALPROIC ACID IVPB $167.058121253 VALSARTAN 160MG TABLET $20.808123044 VALSARTAN 40MG TAB $20.398200115 VALSARTAN 80MG TAB $22.128353658 VANCOMYCIN 1250MG in 0.9%NaCl 250mL $130.218353658 VANCOMYCIN 1500mg in 0.9%NaCl 250mL $130.218353658 VANCOMYCIN 1750mg in NS 500mL $142.218351033 VANCOMYCIN 1GM INJ $118.098353658 VANCOMYCIN 1GM/250ML 0.9%NS (ADV) $118.998353658 VANCOMYCIN 2GM/500ML NS IVPB $169.638351017 VANCOMYCIN 500MG INJ (CHG ONLY) $110.098353666 VANCOMYCIN 500MG/100ML 0.9%NS (ADV) $110.598194185 VANCOMYCIN 50MG/ML LIQ 40ML (RXE) $64.928209801 VANCOMYCIN 50MG/ML LIQ PEDIPOD $17.348353161 VANCOMYCIN 5MG/ML D5W (PED/SCN) SYR $136.488353658 VANCOMYCIN 750mg in 0.9%NaCl 250mL $122.338351017 VANCOMYCIN INJ $111.618353666 VANCOMYCIN IVPB $152.038122921 VARENICLINE 0.5MG TAB $21.038307365 VARICELLA (VARIVAX) VACCINE INJ $224.728303166 VARICELLA ZOSTER IMMUNOGLOB 125UNIT $698.788302127 VASOPRESSIN 20UNIT/ML INJ 1ML $82.068302127 VASOPRESSIN INJ $82.648304271 VECURONIUM 10MG INJ $83.648304271 VECURONIUM INJ $83.648209835 VELAGLUCERASE INJ $3,376.278119208 VENLAFAXINE 100MG TAB $21.398119216 VENLAFAXINE 25MG TAB $20.698114548 VENLAFAXINE 37.5MG TAB $20.808114530 VENLAFAXINE 50MG TAB $20.758114555 VENLAFAXINE 75MG TAB $22.438115321 VENLAFAXINE XR 150MG CAP $24.458115305 VENLAFAXINE XR 37.5MG CAP $25.528115313 VENLAFAXINE XR 75MG CAP $26.548119448 VERAPAMIL 120MG SR TAB $18.908114068 VERAPAMIL 120MG TAB $17.828114092 VERAPAMIL 180MG SR TAB $19.438114084 VERAPAMIL 240MG SR TAB $20.308114035 VERAPAMIL 40MG TAB $17.588156663 VERAPAMIL 50MG/ML SUSP (PEDS) $17.728302184 VERAPAMIL 5MG/2ML INJ $73.028114050 VERAPAMIL 80MG TAB $18.178302184 VERAPAMIL INJ $73.028302184 VERAPAMIL IVPB $73.028381626 VINBLASTINE (VELBAN) IVPB $602.568380909 VINCRISTINE (ONCOVIN) INJ (PEDS) $615.20



8380909 VINCRISTINE (VINCASAR) IVPB-ADULT $615.208381659 VINORELBINE IVPB $651.408114365 VIT B CMPLX w/C & FOLATE (NEPHROVIT $17.368121311 VITAMIN A 10,000 UNIT CAP $17.098308124 VITAMIN A 100,000 UNIT/2ML INJ $136.288242810 VITAMIN A&D OINT 5GM $0.008101164 VITAMIN B COMPLEX CAPS $17.128101172 VITAMIN B COMPLEX W/C CAP $0.008121659 VITAMIN D3 400 UNIT TAB $17.088112005 VITAMIN E 200 UNIT CAP $17.138112013 VITAMIN E 400 UNIT CAP $17.168156671 VITAMIN E 50 UNIT/ML LIQ PEDIPOD $21.808209835 VIVAGLOBULIN 160MG/ML INJ $388.688121832 VORICONAZOLE 200MG TAB $109.918355935 VORICONAZOLE 5MG/ML PEDI SYRINGE $147.768355935 VORICONAZOLE INJ $149.948122731 VSL #3 PACKET $22.638112021 WARFARIN (COUMADIN) 1MG TAB $19.228156689 WARFARIN (COUMADIN) 1MG/ML PEDIPOD $18.628112047 WARFARIN (COUMADIN) 2.5MG TAB $19.398112039 WARFARIN (COUMADIN) 2MG TAB $19.318119224 WARFARIN (COUMADIN) 3MG TAB $19.408112104 WARFARIN (COUMADIN) 4MG TAB $19.408308132 WARFARIN (COUMADIN) 5MG INJ $181.438112054 WARFARIN (COUMADIN) 5MG TAB $19.498119232 WARFARIN (COUMADIN) 6MG TAB $20.198112062 WARFARIN (COUMADIN) 7.5MG TAB $20.308112054 WARFARIN 5MG TAB $18.828290199 WARFARIN PER PHARMACY PROTOCOL $0.008210593 WATER FOR IRRIGATION $37.878361248 WINRHO (IMMUNOBLOBULIN RHO D) INJ $402.688361248 WINRHO (IMMUNOGLOBULIN RHO D) INJ $402.128245516 XENADERM OINTMENT 60GM $179.678114910 ZAFIRLUKAST 20MG TAB $20.828171639 ZALEPLON 5MG CAP (SCP) $39.248253783 ZANAMIVIR 5MG DISKHALER (20 doses) $175.678300022 ZANAMIVIR IVPB *INVESTIGATIONAL USE $0.008209801 ZENPEP 15,000 UNITS DR CAP $21.628209801 ZENPEP 5,000 UNITS DR CAP $18.778122889 ZIDOVUDINE 100MG CAP $22.648156697 ZIDOVUDINE 10MG/ML PEDIPOD $17.468194201 ZIDOVUDINE 10MG/ML SYRUP 120ML (RXE $85.728119513 ZIDOVUDINE 300MG/LAMIVUDINE 150 MG $48.298303257 ZIDOVUDINE INJ $138.608303257 ZIDOVUDINE IVPB $138.608123168 ZILEUTON CR 600MG TAB $22.358243198 ZINC 20% OINT 30GM $37.358119380 ZINC ACET.-ELEMENTAL ZN 10MG/ML LIQ $17.15



8303216 ZINC CHLORIDE INJ $68.628120719 ZINC LOZENGES $17.528112120 ZINC SULFATE 220MG CAP $17.278156705 ZINC SULFATE-ELEMENTAL ZN 5MG/ML LQ $17.058120743 ZIPRASIDONE 20MG CAP (SCP) $31.958308223 ZIPRASIDONE 20MG INJ (SCP ONLY) $166.618120750 ZIPRASIDONE 40MG CAP (SCP) $31.958120735 ZIPRASIDONE 60MG CAP (SCP) $27.688120768 ZIPRASIDONE 80MG CAP (SCP) $35.148209835 ZOLEDRONIC ACID (RECLAST) 5MG/100ML $2,678.218353294 ZOLEDRONIC ACID IVPB $657.838120206 ZOLMITRIPTAN (ZOMIG) 2.5MG TAB $66.718120305 ZOLMITRIPTAN (ZOMIG) 5MG TAB $57.668170516 ZOLPIDEM (AMBIEN) 10MG TAB (SCP) $43.368171753 ZOLPIDEM (AMBIEN) 5MG TAB $39.828171829 ZOLPIDEM CR (AMBIEN) 6.25MG $41.508120727 ZONISAMIDE 100MG CAPSULE $21.638156960 ZONISAMIDE 10MG/ML PEDIPOD $17.498122566 ZONISAMIDE 25MG CAP $18.258351074 ZOSYN 2.25GM/50ML SW (PREMADE FRZN) $138.838351082 ZOSYN 3.375GM/50ML SW (PREMADE FRZ) $146.658353823 ZOSYN 4.5GM/100ML SW (PREMADE FRZ) $171.838280653 ZOSYN 45MG/ML in SW SYRINGE $137.23

Hospital Name: Sutter Medical Center, Sacramento

Column A Column B Column C Column D Column E

Estimated 2010 Revenue Estimated 2011 Revnue

$2,837,907,439 $2,930,608,205 ($12,179,622) $104,880,387 3.70%

Column A = 1/1/2010 to 5/31/2010 actual charges, annualized.Column B = 1/1/2011 to 5/31/2011 actual charges, annualized.Column C = Any changes due to volume variances including services provided in one year and not the other.Column D = Rate change only, based on analysis using 1/1/2011 - 5/31/2011 volumes.Column E = Rate Increase only for submission to OSHPD (Column D divided by Column A).

Adjustment for any change in volume or factor other than rate increase

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

Percentage Change in Gross Charges due to rate increase

(Column D divided by Column A)

[xls]sutter medical center general memorial - ca · web viewoxybutynin 1mg/ml syrup (peds)...

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