medical desc current rate # ir guidance stat charge $ - …...prof lungcx bx rpt docs class $ 0.01...

Medical_Desc Current_Rate# IR GUIDANCE STAT CHARGE $ - #BARTONELLA AB $ - #CALLBACK TECH NO CHARGE $ - #INFUSION REVISIT-NO CHARGE $ - #INT PM E/M NW PT 65+YRS 99387 $ - #MOBILE CARDIO TELEMETRY $ - #MOBILE CARDIO TELEMETRY 93229 $ - #NM SEED PLACEMENT $ - #NO CHG TRNSF ANCILLARY DEPT $ - #PM REVL EST PT INF<1YR 99391 $ - #PNEUMONCOCCAL ABS, IGG $ - #POST OP VISIT 99024 $ - #PPPS INITIAL VISIT G0438 $ - #PREV EXAM EKG INTR&RPT G0403 $ - #PREV EXAM NEW BEN G0402 $ - #PREV SUBSEQ VISIT G0439 $ - #PREV VISIT EST 12-17YRS 99394 $ - #PREV VISIT EST 18-39YRS 99395 $ - #PREV VISIT EST 40-64YRS 99396 $ - #PREV VISIT EST 65+YRS 99397 $ - #PREV VISIT EST AGE 1-4 99392 $ - #PREV VISIT EST AGE 5-11 99393 $ - #PREV VISIT NEW 18-39YRS 99385 $ - #PREV VISIT NEW AGE 1-4 99382 $ - #PREV VISIT NEW AGE 5-11 99383 $ - #PREV VISIT NEW AGE 65+ 99387 $ - #PREV VISIT NEW AGE12-17 99384 $ - #PREV VISIT NEW AGE40-64 99386 $ - #PREV VISIT NEW INF<1 YR 99381 $ - #RABIES VAC REVISIT NO CHARG $ - #SUTURE REMOVAL-NO CHARGE $ - #US GUIDANCE ONLY $ - #WOUND RECHECK NO CHARGE $ - #X-RAY EXAM CHEST 1 VIEW $ - #X-RAY EXAM CHEST 2 VIEWS $ - @ECHO TTE TEMPO RESEARCH $ - @MRI ORTHO FIX-RESEARCH $ - @PROF ECHO TTE TEMP RESRCH $ - @PROF MRI ORTHO FIX-RESEARCH $ - AFFIRM CAN/GAR/TRICH (P) $ - CT/GC AMP TESTING (P) $ - CT-CARDIAC TRIAL $ - CYTOLOGY PROF STAT $ - EKG OP SURGERY-STATS $ - EKG POST CARDIOVERSION-STATS $ - HBOT TREATMENT STATS $ -

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HISTOLOGY PROF STAT $ - IR*ELVS STATS ONLY $ - ISO*CHARGE ADJUSTMENT $ - ISO*TECH CALLBACK NO CHARGE $ - MAMM-TECH CALLBACK- NO CHARGE $ - MRI*TECH CALLBACK - NO CHARGE $ - MYCOPLASMA AB, TOTAL (P) $ - OBS SVCS STAT COUNT $ - PERCU GASTRO TUBE STATS ONLY $ - RRT RESPONSE-STATS ONLY $ - SMOKING CESSATION-STATS ONLY $ - ULT-S TECH CALLBACK NO CHARGE $ - US CALLBACK NO CHARGE $ - VENTILATOR MNGMNT ED-STAT ONLY $ - VENTILTR MNGMNT PACU-STAT ONLY $ - WOUND CARE STATS $ - XR*FLORO GUIDED - STAT ONLY $ - XR*INSRT PACEMKR FLUORO STAT $ - XR*TECH CALLBACK-NO CHARGE $ - XR-FLUORO GUIDED SI JOINT STAT $ - diphtheria/hepB/pertussis,acel/polio/tetanus SUSP (STATE) $ 0.01 diphtheria/pertussis,acel/tetanus/polio PEDI SYRINGE (STATE) $ 0.01 diphtheria/tetanus/pertussis (DTaP) PEDI 0.5 mL (STATE) $ 0.01 haemophilus b conjugate (PRP-OMP) vaccine 0.5 mL (STATE) $ 0.01 hepatitis A adult vaccine 1440 units/mL PF SYRINGE (STATE) $ 0.01 hepatitis A adult vaccine 50 units/mL SYRG (STATE) $ 0.01 hepatitis A pediatric 720 unit/0.5 mL SYRINGE (STATE) $ 0.01 hepatitis B adult vaccine 10 mcg/mL SYRG (STATE) $ 0.01 hepatitis B adult vaccine 20 mcg/mL SYRINGE (STATE) $ 0.01 hepatitis B vaccine pediatric 10 mcg/0.5 mL SYG (STATE) $ 0.01 HPV VACCINE 9-VALENT 0.5 ML $ 0.01 human papillomavirus vaccine 9-valent INJ (STATE) $ 0.01 human papillomavirus vaccine INJ 0.5 mL (STATE) $ 0.01 influenza virus vaccine (Fluzone HD) HIGH-DOSE PF 0.5 mL $ 0.01 influenza virus vaccine, *adult* (Flucelvax) SYRINGE 0.5 mL (STATE) $ 0.01 influenza virus vaccine, *adult* (Fluzone) SYRINGE 0.5 mL (STATE) $ 0.01 influenza virus vaccine, *pedi 6 months-18 years* (Flulaval) SYRINGE 0.5 mL (STATE) $ 0.01 intrauterine copper contraceptive-T 380A IUD GRANT SUPPLY $ 0.01 LEVONORGESTREL 52 MCG 3YR FREE $ 0.01 levonorgestrel 52 mg IUD-GRANT SUPPLY $ 0.01 measles/mumps/rubella virus vaccine PWDI (STATE) $ 0.01 measles/mumps/rubella/varicella virus vaccine PWDI (STATE) $ 0.01 meningococcal group B vaccine SUSP 0.5 mL (STATE) $ 0.01 meningococcal polysaccharide conjugate vaccine $ 0.01 pneumococcal 13-valent vaccine 0.5 mL SYRG (STATE) $ 0.01 pneumococcal 23-valent vaccine (STATE) adult $ 0.01 pneumococcal 23-valent vaccine (STATE) adult SYRINGE $ 0.01

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pneumococcal 23-valent vaccine (STATE) pedi $ 0.01 poliovirus vaccine, inactivated INJ (STATE) $ 0.01 PROF ESPH BX RPRT W/DYSPL INFO $ 0.01 PROF LUNGCX BX RPT DOCS CLASS $ 0.01 PROF MED REAS NT INCL HSTO TYP $ 0.01 PROF PT CT/PN CAT/HST GRD DOCD $ 0.01 PROF PT, PN, HIST GRADE DOC $ 0.01 PROF PTH RPRT W PT PN CT ET AL $ 0.01 PROF QNT HER2 IHC EVAL BRST CX $ 0.01 PROF RPT DOC CLASS HISTO TYPE $ 0.01 PROF RPT PT CAT AND PT1 $ 0.01 PROF SPECIMN SITE NOT PROSTATE $ 0.01 rotavirus vaccine monovalent PWDR (STATE) $ 0.01 tetanus/diphtheria/pertussis, acel (Tdap) susp (Boostrix) STATE $ 0.01 tetanus/diphtheria/pertussis, acel (Tdap) susp (STATE) $ 0.01 tetanus-diphtheria toxoids (Td) adult/adol SYRG 0.5 mL (STATE) $ 0.01 varicella virus vaccine - PWDI 0.5 mL (STATE) $ 0.01 acetaminophen 325 mg TAB UD $ 0.08 aspirin 81 mg CHEWTAB $ 0.08 aspirin 81 mg CHEWTAB (KPROV) $ 0.08 diphenhydrAMINE 25 mg CAP $ 0.08 diphenhydrAMINE 25 mg CAP (KPROV) $ 0.08 ibuprofen 200 mg TAB $ 0.14 ibuprofen 800 mg TAB $ 0.15 amoxicillin 500 mg CAP $ 0.16 aspirin 325 mg TAB (KPROV) $ 0.17 aspirin 325 mg TAB $ 0.20 XR HOCM up to 149 mg/ml Wasted $ 0.25 bacitracin topical OINT UD (KPROV) $ 0.30 bacitracin topical OINT UD $ 0.31 bacitracin/neomycin/polymyxin B topical OINT UD $ 0.31 albuterol 2.5 mg/3 mL (0.083%) INH SOLN NEB (KPROV) $ 0.34 sodium chloride 0.9% NEB 3 mL $ 0.34 predniSONE 10 mg TAB $ 0.40 clopidogrel 75 mg TAB $ 0.42 predniSONE 20 mg TAB (KPROV) $ 0.42 ipratropium 0.02% NEB 2.5 mL $ 0.43 clopidogrel 75 mg TAB (KPROV) $ 0.48 predniSONE 20 mg TAB $ 0.48 OUTSIDE PROVIDED DEVICE $ 0.50 albuterol 0.083% NEB 3 mL $ 0.51 albuterol-ipratropium 2.5 mg-0.5 mg/3 mL NEB (KPROV) $ 0.51 benzoin topical compound SWAB $ 0.65 labetalol 100 mg TAB $ 0.71 albuterol-ipratropium 2.5 mg-0.5 mg/3 mL NEB $ 0.85 proCHLORPERazine 10 mg TAB $ 0.87 ondansetron 4 mg TAB $ 0.88

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LOCM OXILAN PER ML $ 1.00 VAN MILEAGE CHARGE $ 1.00 heparin flush 50 units/5 mL SYRG (blue) $ 1.08 hePARIN flush 500 units/5 mL SYRINGE (KPROV) $ 1.13 nitroglycerin 0.4 mg TAB $ 1.13 ondansetron 4 mg/2 ml INJ (KPROV) $ 1.25 silver nitrate topical STICK (KPROV) $ 1.25 silver nitrate topical SWAB $ 1.25 guaiFENesin 600 mg TAB ER $ 1.27 ammonia inhalant $ 1.48 ammonia inhalant (KCARD) $ 1.48 ammonia inhalant (KPROV) $ 1.53 ibuprofen 100 mg/5 mL SUSP UDC $ 1.56 diphenhydrAMINE 50 mg/mL INJ $ 1.58 diphenhydrAMINE 50 mg/mL INJ (KCARD) $ 1.58 diphenhydrAMINE 50 mg/mL INJ (KPROV) $ 1.58 ondansetron 4 mg ODT $ 1.67 ondansetron 4 mg ODT (KPROV) $ 1.67 cefTRIAXone 250 mg PWDI $ 1.87 sodium chloride 0.9% INJ 10 mL $ 1.98 ACETAMINOPHEN IV PER 10 MG $ 2.00 INV HEPARIN PORCINE 1000 UNITS $ 2.00 KT IV $ 2.00 proMETHazine 25 mg/mL INJ $ 2.07 ketorolac 30 mg/mL INJ $ 2.18 NIFEdipine 30 mg TAB ER $ 2.21 amiodarone 150 mg/3 mL INJ $ 2.29 azithromycin 250 mg TAB $ 2.55 cefTRIAXone 500 mg PWDI $ 2.59 lidocaine 1% PF INJ 2 mL $ 2.73 lidocaine 1% PF INJ 2 mL (KPROV) $ 2.73 bupivacaine 0.25% PF INJ 10 mL $ 2.86 magnesium sulfate 50% INJ 2 mL $ 2.89 acetaminophen 160 mg/5 mL SUSP UDC $ 2.97 lidocaine 1% PF INJ 5 mL (KPROV) $ 2.97 metoprolol 5 mg/5 mL INJ $ 2.97 HPRN PORCNE LCKFLSH 10U/ML SRG $ 3.00 LOCM 300-399 MG/ML CONC PER $ 3.00 PROF VAG CRV CYTPTH THN PRP $ 3.00 SPECIMEN TRAP $ 3.00 SPNG LAP ST 18X18IN 5/PK $ 3.00 SPNG PATTIE 1/2 IN X 1 1/2 IN $ 3.00 magnesium sulfate 50% INJ 2 mL (KPROV) $ 3.06 sterile water INJ 20 mL $ 3.06 bupivacaine 0.5% PF INJ 10 mL $ 3.11 metoprolol 5 mg/5 ml INJ (KPROV) $ 3.18 lidocaine 2% INJ 20 mL (KPROV) $ 3.28

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hePARIN flush 100 u/mL INJ (1 mL) PF $ 3.31 miSOPROStol 200 mcg TAB $ 3.31 nitroglycerin 0.4 mg TAB (KPROV) $ 3.37 EPINEPHrine-lidocaine 1:100,000-1% INJ 20 mL (KPROV) $ 3.40 cefTRIAXone 1 g PWDI $ 3.48 IODIXANOL PER 1 ML $ 4.00 ISO*99M TC04 PERTECHNET P/MC $ 4.00 ONDANSETRON 4 MG/2 ML SOLN $ 4.00 PK STRP PLN 1/2IN X 5YD $ 4.00 SPECIALTY WALKER $ 4.00 TRAY CATH INTERM 14FR $ 4.00 hePARIN 1000 units/1 mL VIAL (KPROV) $ 4.22 bupivacaine 0.25% PF INJ 10 mL (KPROV) $ 4.27 EPINEPHrine-lidocaine 1:100,000-2% INJ 20 mL $ 4.28 lidocaine 2% PF INJ 2 mL $ 4.41 lidocaine 2% PF INJ 2 mL (KPROV) $ 4.41 lidocaine 1% PF INJ 30 mL (KPROV) $ 4.50 adenosine 6 mg/2 mL INJ $ 4.58 adenosine 6 mg/2 mL INJ (KPROV) $ 4.64 Sodium Fluoride Varnish 5% Paste 0.40 mL $ 4.72 azithromycin 500 mg TAB $ 4.75 diphenhydrAMINE 25 mg/10 mL LIQ UDC $ 4.81 18FR 5CC 2-WAY FOLEY $ 5.00 20FR 5CC 2-WAY FOLEY $ 5.00 22FR 5CC 2-WAY FOLEY $ 5.00 CATH,FOL 5CC 14FR SIL ELAS LTX $ 5.00 KNDL 7325 SCD 6629 $ 5.00 MEPILEX BORDER DRSNG 7.5X7.5CM $ 5.00 SCREW CORTICAL 3.5X14MM $ 5.00 TUBE CONNECTOR 3/16 X 12 FT__1 $ 5.00 bupivacaine 0.5% PF SDV 30 mL (KPROV) $ 5.09 furosemide 100 mg/10 mL INJ $ 5.09 nitroglycerin 2% topical OINT UD $ 5.26 nitroglycerin 2% topical OINT UD (KPROV) $ 5.26 amiodarone 150 mg/3 mL INJ (KPROV) $ 5.35 lidocaine 1% INJ 10 mL (KPROV) $ 5.38 lidocaine 2% PF INJ 10 mL (KPROV) $ 5.55 bupivacaine 0.5% INJ 50 mL (KPROV) $ 5.66 lidocaine 1% INJ 10 mL $ 5.66 lidocaine 2% PF INJ 5 mL $ 5.80 bupivacaine-epinephrine 0.5%-1:200,000 PF INJ 30 mL (KPROV) $ 5.94 16FR 30CC 2-WAY FOLEY $ 6.00 18FR 30CC 2-WAY FOLEY $ 6.00 20FR 30CC 2-WAY FOLEY $ 6.00 ACTMNPHN 160MG/5ML (5 ML) SUSP $ 6.00 ALBTRL 2.5 MG/3 ML 0.083% NEBU $ 6.00 BACITRACIN 500 UNIT/GRAM PACK $ 6.00

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CALCIUM GLUCONATE PER 10 ML $ 6.00 CEFAZOLIN PER 500 MG $ 6.00 CHLOROTHIAZIDE 250 MG/5ML SUSP $ 6.00 CIT ACD-SD CIT500-334MG/5ML SN $ 6.00 CLINDAMYCIN 15 MG/ML SYRG $ 6.00 CLINDAMYCIN 150 MG/ML SOLN $ 6.00 DEXMEDETOMIDINE 100MCG/ML SOLN $ 6.00 DIPHENHYDRAMINE PER 50 MG $ 6.00 EPHEDRINE 50 MG/ML SOLN $ 6.00 EPINEPHRINE PER 0.1 MG $ 6.00 GENTAMICIN SLFT PF 20MG/2ML SN $ 6.00 GLYCERIN (CHILD) SUPP $ 6.00 GLYCOPYRROLATE 1MG/5ML SOLN $ 6.00 INJ HYDRALAZINE HCL TO 20 MG $ 6.00 IR LOCM 200-299MG/ML IOD WASTE $ 6.00 IR LOCM 300-399MG/ML IOD WASTE $ 6.00 KETAMINE 50 MG/ML (1 ML) SYRG $ 6.00 LIDOCAINE 10 MG/ML (1 %) SOLN $ 6.00 METOPROLOL 5 MG/5 ML SOLN $ 6.00 MIN OIL-HYDPHL PETROL OINT 50G $ 6.00 MRI* GAD WASTED $ 6.00 MRI*GADOLINIUM CONTRAST PER $ 6.00 NYSTATIN 100,000 UNIT/ML SUSP $ 6.00 OXYCODONE 5 MG TAB $ 6.00 OXYMETAZOLINE 0.05% SPRY 15ML $ 6.00 OXYMETAZOLINE BTTLE 0.05% SPRY $ 6.00 PD GRND W/10FT CRD AD DISP $ 6.00 PHNLPHRN .5MG5ML 100MCG/ML SRG $ 6.00 PT PHS 15MMOL 15MMOL250ML SN $ 6.00 RANITIDINE 15 MG/ML SYRP $ 6.00 SLVR NTRT APPLCTRS 75-25% STCK $ 6.00 SPIRONOLACTONE 5 MG/ML SUSP $ 6.00 WRC-OASIS XENO PER SQ CM $ 6.00 lidocaine 2% PF 100 mg/5 mL SYRG $ 6.71 lidocaine 1% PF INJ 5 mL $ 6.79 AMPICILLIN 125 MG SOLR $ 7.00 ANCHOR DEV TRICOT FOL CATH $ 7.00 ANCHOR DEV TRICOT SIL FOL CATH $ 7.00 DUO DERM EXTRA THIN $ 7.00 FLOWTRON BOOT $ 7.00 IOHEXOL PER 1 ML $ 7.00 MICROAIRE 1.6MMX102MM K-WIRE $ 7.00 PAD,GROUND 10' $ 7.00 STANDARD INSTRUMENT WIPE $ 7.00 lidocaine 1% INJ 50 mL (KPROV) $ 7.08 dexamethasone 10 mg/mL PF INJ (KPROV) $ 7.47 lidocaine 0.4%-D5W 500 mL PM (KPROV) $ 7.87

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bupivacaine-epinephrine 0.5%-1:200,000 PF INJ 10 mL (KPROV) $ 7.92 EPINEPHrine-lidocaine 1:100,000-1% INJ 20 mL $ 7.92 10FR ALL-SILICONE FOLEY CATH $ 8.00 CATH FOL 2-W ALL SIL 5CC 14F $ 8.00 CATH FOL 2-W ALL SIL 5CC 16F $ 8.00 CATH FOL 2-W ALL SIL 5CC 20F $ 8.00 CATH FOL 2-W ALL SIL 5CC 24F $ 8.00 FOLEY 5CC 2-WAY LUBRICATH $ 8.00 KETAMNE 100MG/ML SLN 5 ML VIAL $ 8.00 SITZ BATH $ 8.00 STOCK COMPR KNEE HI KNEE 7071 $ 8.00 SUCCINYLCHOLINE PER 20 MG $ 8.00 sterile water INJ 10 mL $ 8.49 cyanocobalamin 1000 mcg/mL INJ $ 8.52 furosemide 100 mg/10 mL INJ (KPROV) $ 8.77 flumazenil 0.5 mg/5 mL INJ (KPROV) $ 8.79 CULTURE AFB ISOL & ID $ 9.00 HC PACU EA MIN $ 9.00 STOCK COMPR KNEE HI KNEE 7115 $ 9.00 STOCK COMPR KNEE HI KNEE 7203 $ 9.00 ropivacaine 0.2% 40 mg/20 mL INJ (KPROV) $ 9.06 dipyridamole 50 mg/10 mL INJ $ 9.75 18 FR. NG TUBE $ 10.00 22FR 2 WAY CATH $ 10.00 24FR ATRIUM THORACIC CATHETER $ 10.00 CEFAZOLIN IN DXTRS 2/50ML PGBK $ 10.00 DRSG MEPITEL NON-ADH 3X4IN $ 10.00 FETAL SCALP ELECTRODE $ 10.00 KWIRE TEMP FIX 2X150MM DBL TIP $ 10.00 SLNG ARM ENV LG COT CLTH LNG $ 10.00 SLNG ARM ENV MED COT CLTH LNG $ 10.00 VISCO EXP CAN CORY 25GX7/8IN $ 10.00 TX DEVICES; INTERMED $ 10.07 sodium bicarbonate 4.2% INJ 5 mL $ 10.46 AMPICILLIN PER 500 MG $ 11.00 ATRACURIUM 10 MG/ML SOLN $ 11.00 BPVCN PF .25% 2.5MG/ML 10MLVL $ 11.00 BPVCN PF .25% 2.5MGMLSN 30MLVL $ 11.00 BUPIVACAINE PF 0.5% 5MG/ML SLN $ 11.00 CEFAZOLIN SODIUM INJECT 500 MG $ 11.00 CEFAZOLIN2GR/50ML PGBK 1 E BAG $ 11.00 DEXMEDETOMIDINE 200MCG/2ML SLN $ 11.00 DRESSING MEPILEX BORDER 4X10 $ 11.00 ELECTRODE NEEDLE INSLATED 2.8" $ 11.00 FENTANYL PER 0.1 MG $ 11.00 FUROSEMIDE PER 20 MG $ 11.00 GENTAMICIN PER 80 MG $ 11.00

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GLUCOSE; BLOOD REAGENT STRIP $ 11.00 HYDROMORPHONE PER 4 MG $ 11.00 LIDOCNE 2%IV 100 MG/5ML 2%SYRG $ 11.00 MIDAZOLAM (PF) 1 MG/ML SOLN $ 11.00 MORPHINE 10 MG/ML CRTG $ 11.00 NERVE PROTECTOR, ULNAR $ 11.00 PHNLPHRN .9NACL .5 MG/5ML SYRG $ 11.00 PROF SEX CHROMATIN $ 11.00 PROPOFOL 10 MG/ML 50 ML VIAL $ 11.00 PROPOFOL 10 MG/ML EMUL $ 11.00 RS CHAT/OPTIFLEX LEG CPM P/D $ 11.00 VECURONIUM 10 MG SOLR $ 11.00 EPINEPHrine 1 mg/10 mL SYRINGE $ 11.60 glucose GEL 15 g $ 11.67 18FR 5CC SILASTIC FOLEY $ 12.00 20FR 2 WAY CATH $ 12.00 CIPROFLOXACIN 400MG/200ML PGBK $ 12.00 DESTRUCT PREMALG LES 2-14 $ 12.00 DRAIN CLOSED WOUND FLAT 7MM $ 12.00 INV NIFEDIPINE 10 MG CAP $ 12.00 ketorolac 30 mg/mL INJ (KPROV) $ 12.06 bupivacaine 0.5% PF INJ 10 mL (KPROV) $ 12.17 lidocaine 2% topical GEL 5 mL (KPROV) $ 12.45 lidocaine 2% PF 100 mg/5 mL SYRINGE (KPROV) $ 12.64 DRAIN SILICONE FLAT 7MM 8IN $ 13.00 DRAIN/TUBE ATTACHMENT DEVICE $ 13.00 LAB-PROTEIN BODY FLUID $ 13.00 LAB-PROTEIN SPINAL FL $ 13.00 tetracaine 0.5% ophth SOLN 4 mL $ 13.24 EPINEPHrine-lidocaine 1:100,000-1% INJ 30 mL $ 13.50 enoxaparin 60 mg/0.6 mL SYRINGE $ 13.96 CATH THOR PVC STRT 24FR $ 14.00 DEXAMETHASONE PER 1 MG $ 14.00 FBOP MD2000 WALLABY 4024 $ 14.00 INV LEVOFLXCN 750MG/150ML PGBK $ 14.00 NEEDLE ELECTRODES $ 14.00 POTASSIUM CHLORIDE PER 2 MEQ $ 14.00 SMEAR - INFECTIOUS WET MOUNT $ 14.00 TRAC DRESSING WHITE/LARGE $ 14.00 lidocaine 0.4%-dextrose 5% 500 mL PM $ 14.15 silver sulfADIAZINE 1% topical CREAM 50 g $ 14.15 X-RAYS FOR BONE AGE $ 14.22 DOBUTamine 250 mg/250 mL D5W PM $ 14.86 silver sulfADIAZINE 1% topical CREAM 25 g (KPROV) $ 14.89 5%DXTRSE/NRML SLN 500 ML 1UNIT $ 15.00 BAG DRN 2500ML W 350ML URN MTR $ 15.00 CELL COUNT NOT BLOOD $ 15.00

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CTH FOLEY UNV URO PRP SIL 16F $ 15.00 CTH FOLEY UNV URO PRP SIL 18F $ 15.00 HEMOLOK XL POLYMR LIGATING CLP $ 15.00 M&S FEMALE CATH KITS, EACH $ 15.00 N-AUTOM URINALYS WO MICRO $ 15.00 NM 99M TC EXAMETAZIME PER DOSE $ 15.00 STOCKING ANTI-EMBOLISM LG/REG $ 15.00 STOCKING ANTI-EMBOLISM MED/REG $ 15.00 STOCKING ANTIEMBOLISM XLG/REG $ 15.00 WIRE 150CM, STRAIGHT $ 15.00 ketorolac 60 mg/2 mL INJ $ 15.90 BACT CULTURE-URINE;QUAN COUNT $ 16.00 FOLEY TRAY 16FR EZ-LOK $ 16.00 LAB-SPECIMEN PROCUREMENT $ 16.00 LAB-UREA NITROGEN URINE $ 16.00 M&S PEDI CATH KITS, EACH $ 16.00 QUAL HETEROPHILE AB $ 16.00 ROCURONIUM 10 MG/ML SOLN $ 16.00 ROCURONIUM 10MG/ML SOLN 10MLVL $ 16.00 ROUTINE VENIPUNCTURE $ 16.00 URIN MTR PED 350ML STPCK SAMP $ 16.00 bupivacaine 0.25% PF SDV 30 mL (KPROV) $ 16.13 HC ANESTHESIA PER MINUTE $ 17.00 MACROSCOPIC EXAM ARTHROPOD $ 17.00 MACROSCOPIC EXAM PARASITE $ 17.00 NON-ROUTINE BL DRAW 3/> YRS $ 17.00 PINWORM EXAM $ 17.00 SMEAR FLUORESCENT OR AFB STAIN $ 17.00 aminophylline 500 mg/20 mL VIAL (KPROV) $ 17.43 DXA BONE DENSITY/PER 1+ SITES $ 17.99 BARIATRIC WALKER PER DAY $ 18.00 DANN 400I LEG CPM PER DAY $ 18.00 DRESSING MEPILEX BORDER 4X12 $ 18.00 LAB-RHEUMATOID ARTHRITIS LAT $ 18.00 MICONAZOLE 2 % POWD 43 G JAR $ 18.00 methylPREDNISolone DEPO 40 mg/mL SUSP (KPROV) $ 18.40 CEFOTETAN 2 GRAM/50 ML PGBK $ 19.00 IM ADMIN EACH ADDL COMPONENT $ 19.00 J-WIRE, 150CM $ 19.00 PIN COVERS $ 19.00 triamcinolone acetonide 40 mg/mL INJ $ 19.84 SPECIAL DOSIMETRY $ 19.88 triamcinolone acetonide 40 mg/mL INJ (KPROV) $ 19.89 CAPILLARY BLOOD DRAW $ 20.00 CATH FOL 2-W COUDE 5CC 14F $ 20.00 DRY NEEDLING $ 20.00 LAB-BODY FLUID CELL COUNT $ 20.00

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LAB-CALCIUM 24HR URINE $ 20.00 LAB-CALCIUM RANDOM URINE $ 20.00 LAB-CSF CELL COUNT $ 20.00 PTT; SUBST PLASMA FRACTION EA $ 20.00 EPINEPHrine 1 mg/10 mL SYRINGE (KPROV) $ 20.09 methylPREDNISolone PF 125 mg PWDI $ 20.46 methylPREDNISolone PF 125 mg PWDI (KPROV) $ 20.72 BARIATRIC SHOWER/COMMODE CHA $ 21.00 HANDSWITCHING SUCTION COAG 8FR $ 21.00 NEOSTIGMINE 0.5 MG/ML SOLN $ 21.00 REFERENCE ABO GROUP $ 21.00 SPECIALTY COMMODE $ 21.00 DOPamine 400 mg/250 mL in dextrose 5% PM $ 21.23 sodium bicarbonate 8.4% SYRG 50 mL (KPROV) $ 21.93 FAT EMULSION 20 % EMUL $ 22.00 FINGER SPLINT $ 22.00 LAB-TRIGLYCERIDE $ 22.00 LAB-TRIGLYCERIDE BF $ 22.00 M&S EYE PRESS PATCH, EACH $ 22.00 MICRO BLADE 160/162/163 $ 22.00 MICRO BLADE 169 $ 22.00 PLT SYNTH 1/3 TBLR CLR 10H 121 $ 22.00 REF CELL TRMT-DTT PER CELL $ 22.00 TRIGLYCERIDES $ 22.00 XRAY EXAM OF ELBOW 2 VIEWS $ 22.00 DOBUTamine 500 mg/250 mL D5W PM (KPROV) $ 22.02 dextrose 50% 25 g/50 mL SYRINGE (KPROV) $ 22.13 JOINT SURVEY SNG VIEW 2+ JOINT $ 22.14 X-RAYS BONE LENGTH STUDIES $ 22.52 dextrose 50% 50 mL SYRINGE $ 22.64 calcium chloride 100 mg/mL SYRINGE $ 22.92 22FR 5CC TIEMAN FOLEY $ 23.00 ALBUMIN HUMAN PER 250 ML $ 23.00 CATH TRAY FOLEY 16FR $ 23.00 CLNDMCN DXTRS 900MG/50ML PGBK $ 23.00 LAB-ACT POC $ 23.00 PULSTATE MATTRESS PER DAY $ 23.00 WRC-OASIS ULT TRI-LAY PER SQCM $ 23.00 dome-paste 4 in x 10 yd bandage $ 23.01 sodium bicarbonate 8.4% VIAL 50 mL (KPROV) $ 23.16 atropine 0.1 mg/mL SYRG $ 23.21 atropine 1 mg/10 ml INJ SYRINGE (KPROV) $ 23.21 20FR 5CC TIEMAN FOLEY $ 24.00 LAB-STOOL OCCULT BLOOD MULTI $ 24.00 OCCULT BLOOD FECES $ 24.00 SHOE POSTOP M LG $ 24.00 SHOE POSTOP M MED $ 24.00

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SHOE POSTOP M SM $ 24.00 SHOE POSTOP WOM LG $ 24.00 SHOE POSTOP WOM MED $ 24.00 SHOE POSTOP WOMENS SMALL $ 24.00 SPIKE/SYRINGE ADAPTER $ 24.00 SUGAMMADEX 100 MG/ML SOLN $ 24.00 sodium bicarbonate 8.4% VIAL 50 mL $ 24.06 ASSAY PH BODY FLUID NOS $ 25.00 AUTOM URINE DIP W MICRO $ 25.00 COUNSYL CELL FREE PRNTL SCREEN $ 25.00 DRSG SYS FOAM SM 11X8X1.8CM $ 25.00 LAB-ALBUMIN BODY FLUID $ 25.00 LAB-ALBUMIN, OTHER SOURCE $ 25.00 LAB-IGG SUBCLASSES $ 25.00 LAB-URIN MACRO & MICRO $ 25.00 LONG IOBAN INCISE DRAPE 35 $ 25.00 MYRIAD CARRIER SCREEN $ 25.00 SALEM SUMP TUBES $ 25.00 URINE BACTERIAL CULTURE $ 25.00 AUTOMATED WBC $ 26.00 GLUCOSE BLD BY MONITOR DEVICE $ 26.00 GLUCOSE; BLD BY MONITOR DEVICE $ 26.00 LAB-GLUCOSE MONITORING DEVIC $ 26.00 LAB-WBC-AUTO $ 26.00 SPL AVULSE NP EA ADDTL $ 26.00 T-TUBE, SOFT SILICONE RICHARDS $ 26.00 TUBING INSUFFLATION C02 10/BX $ 26.00 WRC-AVULSION-ADDITIONAL NAIL $ 26.00 WRC-AVULSION-SECOND NAIL $ 26.00 BREAST TOMOSYNTHESIS BI $ 26.77 sodium bicarbonate 8.4% SYRG 50 mL $ 26.89 BACTERIAL CULTURE OTHR SOURCE $ 27.00 HELICOBACTER PYLORI;DRUG ADM $ 27.00 LAB-OXIDANTS, RANDOM URINE $ 27.00 LAB-PH BODY FLUID $ 27.00 LAB-PH GASTRIC FLUID $ 27.00 LAB-PH RANDOM URINE $ 27.00 LAB-REDUCING SUBSTANCE URINE $ 27.00 LAB-SPECIFIC GRVITY RNDOM UR $ 27.00 PULSAVAC TIPS $ 27.00 COAGULATOR SUCT 10FR $ 28.00 FUNGUS CULTURE BLOOD $ 28.00 LAB-CHLORIDE 24HR URINE $ 28.00 LAB-CHLORIDE RANDOM URINE $ 28.00 REFERENCE DAT:ANTI-IGG $ 28.00 TRAC DRESSING WHITE/SMALL $ 28.00 FRACTURE ASSESSMENT VIA DXA $ 28.17

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aminophylline 250 mg/10 mL INJ $ 28.30 bupivacaine-epinephrine 0.5%-1:200,000 INJ 50 mL (KPROV) $ 28.30 nitroglycerin 50 mg/250 mL D5W PM $ 28.30 22FR 5CC COUNCIL TIP $ 29.00 E-TEST MIC GRADIENT STRIP $ 29.00 FECAL LEUKO CNT QUAL/SEMIQUAN $ 29.00 GUIDE WIRE ORTHOPRO SM $ 29.00 INFRARED THERAPY 1+ AREAS $ 29.00 KOH FOR FUNGI/PARASITES/MITES $ 29.00 LAB-GLUCOSE BF $ 29.00 LAB-GLUCOSE SPINL FLUID $ 29.00 LAB-URINE EOSINOPHIL $ 29.00 RETICYTE/HGB CONCENTRATE $ 29.00 SAW BLADE SP-105 $ 29.00 SAW BLADE SP-111 $ 29.00 SAW BLADE SP-225 $ 29.00 SAW BLADE SP-410 $ 29.00 SAW BLADE SP-412 $ 29.00 SMEAR - GRAM OR GIEMSA $ 29.00 SMEAR-GRAM OR GIEMSA $ 29.00 SOLOSITE GEL $ 29.00 5.0 OPEN ENDED CATHETER $ 30.00 AG DETECT NOS IA MULT $ 30.00 ASSAY OF SERUM ALBUMIN $ 30.00 ASSAY OF SERUM SODIUM $ 30.00 CATH OPEN END 5.0FR $ 30.00 CHLORIDE; BLOOD $ 30.00 CRTCH AD TALL ALUM $ 30.00 CRUTCHES ALUM $ 30.00 CRUTCHES ALUM PEDI $ 30.00 DOPAMINE PER 40 MG $ 30.00 FO STATIC RING SPINT NEOPRENE $ 30.00 GLUCOSE; QUAN BLOOD $ 30.00 K WIRE 0.8X100MM $ 30.00 LAB-ALBUMIN $ 30.00 LAB-ALBUMIN, SERUM $ 30.00 LAB-CHLORIDE $ 30.00 LAB-GLUCOSE $ 30.00 LAB-GLUCOSE 2 HR POST $ 30.00 LAB-ISTAT CHLORIDE POC $ 30.00 LAB-PNEUMOCYSTIS, SPUTUM SME $ 30.00 LAB-SODIUM 24HR URINE $ 30.00 LAB-SODIUM ISTAT POC $ 30.00 LAB-SODIUM RANDOM URINE $ 30.00 LAB-SODIUM SERUM $ 30.00 METATARSAL BAR $ 30.00 PLEURX REPLACEMENT VALVE CAP $ 30.00

�12

PNCL CAUT HND CTRL ROCK 10FT $ 30.00 REM SKIN TAGS ADD-ON =<10 LES $ 30.00 STPLR SKIN CLSR N ABSRB S STL $ 30.00 CARBON DIOXIDE (CO2) $ 31.00 IV * BURETROL $ 31.00 J-EXCHANGE WIRE, 260CM $ 31.00 LAB-CARBON DIOXIDE CO2 $ 31.00 LAB-ISTAT CO2 POC $ 31.00 LIDOCAINE 2 % JELP $ 31.00 2.7 X 12MM CORTICAL SCREW $ 32.00 AUTOMATED PLATELET COUNT $ 32.00 DANN 450/460 LEG CPM- PER DA $ 32.00 DRUG TEST DEF 1-7 CLASSES $ 32.00 LAB-CHOLESTEROL $ 32.00 LAB-CHOLESTEROL BF $ 32.00 LAB-PLATELET COUNT AUTO $ 32.00 LAB-PROTEIN QUANT - RANDOM U $ 32.00 LAB-PROTEIN, TOTAL; URINE $ 32.00 LAB-PROTEIN-24HR URINE $ 32.00 NUT FOR RING/ROD $ 32.00 OPIATE CONFIRMATION, URINE $ 32.00 OPIATES 1 OR MORE $ 32.00 SERUM/WB TOT CHOLEST $ 32.00 SIGMOIDASCOPE DISP SPECULUM $ 32.00 triamcinolone 50 mg/5 mL INJ $ 32.12 4.5 X 36MM SELF-TAP CORT SCREW $ 33.00 4.5 X 40MM SELF-TAP CORT SCREW $ 33.00 AB; ERLICHIA $ 33.00 BAG DRAIN UROLOGY $ 33.00 BARIATRIC WHEELCHAIR PER DAY $ 33.00 DRUG SCREENING PREGABALIN $ 33.00 SCR 4.5 CORT 32MM $ 33.00 SCR 4.5 CORT 34MM $ 33.00 SCR 4.5 CORT 36MM $ 33.00 SCR 4.5 CORT 38MM $ 33.00 SCR 4.5 CORT 40MM $ 33.00 SCR 4.5 CORT 42MM $ 33.00 SCR 4.5 CORT 44MM $ 33.00 SCR 4.5 CORT 46MM $ 33.00 SCR 4.5 CORT 50MM $ 33.00 SCR 4.5 CORT 54MM $ 33.00 SCR 4.5 CORT 70MM $ 33.00 SPECIALTY CHAIR $ 33.00 testosterone cypionate 200 mg/mL INJ $ 33.99 ANTIPSYCHOTICS NOS 1-3 $ 34.00 APHERISIS,THERAPEUTC AD 1/2 $ 34.00 ASSAY OF SERUM POTASSIUM $ 34.00

�13

DRUG TEST PRSMV DIR OPT OBS $ 34.00 LAB-ACETONE $ 34.00 LAB-ANTIBODY ENTEROVIROS $ 34.00 LAB-BODY FLUID POTASSIUM $ 34.00 LAB-GLUCOSE URINE (MACRO) $ 34.00 LAB-KETONES URINE (MACRO) $ 34.00 LAB-OCCULT BLOOD URINE $ 34.00 LAB-PH URINE (MACRO) $ 34.00 LAB-POTASSIUM SERUM $ 34.00 LAB-POTASSIUM HEPARINIZED $ 34.00 LAB-POTASSIUM ISTAT POC $ 34.00 LAB-SPEC GRAVITY URINE MACRO $ 34.00 LAB-URIC ACID $ 34.00 LAB-URIN MACR $ 34.00 PLEURX DRAINAGE LINE $ 34.00 SHEATH PINNACLE INTRO 5FRX10CM $ 34.00 URIC ACID; BLOOD $ 34.00 *NOTICE OF COMPENSABLE INJUR $ 35.00 BC - AEROBIC - ADDTL ID $ 35.00 BC - ANAEROBE - ADDTL ID $ 35.00 BC-AEROBIC-ADDTL ID $ 35.00 BEHAV CHNG SMOKING 3-10 MIN $ 35.00 DRUG SCREENING METHADONE $ 35.00 ELECTRIC BREAST PUMP $ 35.00 GLUCOSE; POST GLUCOSE DOSE $ 35.00 GUIDEWIRE .062 X 6 INCH $ 35.00 HC SURGERY TIER I EA MIN $ 35.00 LAB-GLUCOSE 1 HOUR POST $ 35.00 LAB-HEAVY METAL LEAD, SERUM $ 35.00 LAB-HEAVY METAL LEAD, URINE $ 35.00 LAB-LEAD $ 35.00 LAB-LEAD ADULT $ 35.00 LAB-PHOSPHORUS $ 35.00 LAB-PHOSPHORUS INORGANIC $ 35.00 LOWER BAIR HUGGER $ 35.00 M&S NASAL PACKAGING EACH $ 35.00 PHISOHEX $ 35.00 PHOSPHATE $ 35.00 THERABOND $ 35.00 DOPamine 400 mg/250 mL D5W PM (KPROV) $ 35.38 ACETONE ASSAY $ 36.00 ALKALINE PHOSPHATASE $ 36.00 ASSAY OF PROTEIN SERUM $ 36.00 BACT CULT; QUAN AEROBIC $ 36.00 CALCIUM; TOTAL $ 36.00 CANCELLOUS PART THREAD 4MMX34 $ 36.00 CANCELLOUS, FULL THRD 4.0MMX34 $ 36.00

�14

CANCELLOUS, PART THREAD 4.0MM $ 36.00 CORTICAL SELF TAPPING 3.5X38MM $ 36.00 CORTICAL SELF TAPPING 3.5X48MM $ 36.00 DBRD INFCTD SKN ADD-ON=<10% BS $ 36.00 LAB-ALK PHOS BF $ 36.00 LAB-ALKALINE PHOSPHATASE $ 36.00 LAB-ALKALINE PHOSPHATASE-TOT $ 36.00 LAB-BETA-HYDROXYBUTYRATE QU $ 36.00 LAB-BODY FLUID CALCIUM $ 36.00 LAB-CALCIUM (CA) $ 36.00 LAB-CALCUIM TOTAL $ 36.00 LAB-EOSINOPHIL SMEAR SPUTUM $ 36.00 LAB-NASAL SMEAR EOSINOPHILS $ 36.00 LAB-PLATELET-MANUAL $ 36.00 LAB-PROTEIN TOTAL $ 36.00 LAB-WBC MANUAL $ 36.00 PROF -SURG PATH LEVEL-I GROSS $ 36.00 REFERENCE DAT:ANTI-C3B,C3D $ 36.00 SCR 3.5 CORT 12MM $ 36.00 SCR 3.5 CORT 14MM $ 36.00 SCR 3.5 CORT 16MM $ 36.00 SCR 3.5 CORT 18MM $ 36.00 SCR 3.5 CORT 20MM $ 36.00 SCR 3.5 CORT 22MM $ 36.00 SCR 3.5 CORT 24MM $ 36.00 SCR 3.5 CORT 30MM $ 36.00 SCR 3.5 CORT 34MM $ 36.00 SCR 3.5 CORT 36MM $ 36.00 SCR 3.5 CORT 40MM $ 36.00 SCR 3.5 CORT 42MM $ 36.00 SCR 3.5 CORT 44MM $ 36.00 SCR 3.5 CORT 46MM $ 36.00 SCR 4.0 CANC FT 16MM $ 36.00 SCR 4.0 CANC FT 18MM $ 36.00 SCR 4.0 CANC PT 50MM $ 36.00 SPACING WASHER 2.0MM $ 36.00 TPN KITS $ 36.00 WRC-METAB ACTIVE TISS PER SQCM $ 36.00 WRIST BRACE $ 36.00 AB; COXIELLA BRUNETII $ 37.00 AGENT NOS ASSAY W/OPTIC $ 37.00 BLOOD TYPING SEROLOGIC ABO $ 37.00 BLOOD TYPING SEROLOGIC RH(D) $ 37.00 BLOOD TYPING, RH $ 37.00 CRYPTOSPORIDIUM AG IA $ 37.00 DIRECT BILIRUBIN $ 37.00 HAND SPLINT NOS $ 37.00

�15

INFLUENZA IA W DO $ 37.00 LAB-BILIRUBIN BODY FLUID $ 37.00 LAB-BILIRUBIN DIRECT $ 37.00 LAB-BILIRUBIN TOTAL $ 37.00 LAB-BLOOD TYPING, ABO $ 37.00 LAB-LUPUS ANTICOAGULENT $ 37.00 MEPILEX BORDER DRESSNG 10X10CM $ 37.00 POTASSM CHLRD 10MEQ/100ML PGBK $ 37.00 PROF ER*PHYSICIAN PHYSICAL FEE $ 37.00 REFERENCE WEAK D (DA) TEST $ 37.00 RESP SYNCYTIAL AG IA $ 37.00 RESTING HAND SPLINT WITH STRAP $ 37.00 RUSS VIPER VENOM TIME; DILUTED $ 37.00 RUSSELL VIPER VEN TIME DILUTED $ 37.00 STREP A AG IA $ 37.00 TOTAL BILIRUBIN $ 37.00 EPINEPHrine 1 mg/1 mL (1:1,000) INJ (KPROV) $ 37.24 ferric subsulfate topical SOLN 8 g $ 37.58 methylPREDNISolone DEPO 80 mg/mL SUSP (KPROV) $ 37.64 iohexol 180 mg/mL SOLN 10 mL (KPROV) $ 37.92 AST OR SGOT $ 38.00 BACT CULTURE URINE QUAN COUNT $ 38.00 BACT CULTURE-URINE QUAN CNT $ 38.00 CREATININE; BLOOD $ 38.00 CREATININE; NOT BLOOD $ 38.00 EO ELASTIC NEO LYCRA PREFAB $ 38.00 GWIRE ORTHO TRCR TIP 1.35MM $ 38.00 HEEL PAD $ 38.00 IM ADMIN 1ST/ONLY COMPONENT $ 38.00 LAB-ASPARATE AMINOTRANSFERAS $ 38.00 LAB-CREATINE, BLOOD $ 38.00 LAB-CREATININE 24 HR U $ 38.00 LAB-CREATININE BLOOD $ 38.00 LAB-CREATININE BODY FLUID $ 38.00 LAB-CREATININE RANDOM URINE $ 38.00 LAB-CREATININE-RANDOM URINE $ 38.00 LAB-ISTAT CREATININE POC $ 38.00 LAB-OSMOLALITY $ 38.00 LAB-PHENOB $ 38.00 LAB-PHENOBARBITAL $ 38.00 PANCREATIC ELASTASE FECAL $ 38.00 PHENOBARBITAL $ 38.00 CULTURE P PATHOG - SCREEN $ 39.00 CULTURE P PATHOG-SCREEN $ 39.00 ENDO JAW DSPSBLE BIOPSY FORCPS $ 39.00 FUNGUS CULTURE DEF ID MOLD $ 39.00 FUNGUS CULTURE NOT BLOOD $ 39.00

�16

HC SET UP OTHER EQUIP $ 39.00 LAB-ISTAT BUN POC $ 39.00 LAB-OSMOLALITY, URINE $ 39.00 LAB-SGPT/ALT $ 39.00 LAB-UREA NITROGEN BUN $ 39.00 NO STING PREP $ 39.00 OUTLET PORT CLAMP $ 39.00 STOMAHESIVE PASTE $ 39.00 TRANSFERASE; ALANINE AMINO $ 39.00 TRANSFERASE;ALANINE AMINO $ 39.00 UREA NITROGEN; QUAN $ 39.00 URINE BACTERIA CULTURE $ 39.00 etomidate 40 mg/20 mL SYRG $ 39.80 ASO ; TITER $ 40.00 ASPERGILLUS AG IA $ 40.00 BEHAV CHNG SMOKING > 10 MIN $ 40.00 DIALYSIS TRANSFER SET $ 40.00 ELECTRONIC CROSSMATCH $ 40.00 FECAL INCONTINENCE $ 40.00 GAIT TRAINING THERAPY EA 15MIN $ 40.00 GAIT TRAINING THRPY EA 15MINS $ 40.00 KWIRE TMP FX W/TRC TIP 2X150MM $ 40.00 LAB-ANTISTREPTOLYSIN O $ 40.00 LAB-LDH FRACTIONATION $ 40.00 M&S-NASO PHARYENGEAL $ 40.00 MASSAGE-30 MINUTES $ 40.00 OCCULT BLD IA SCRN $ 40.00 POLLOCK OPEN ENDED 5 FR $ 40.00 REFLEXOLOGY-30 MINUTES $ 40.00 REIKI-30 MINUTES $ 40.00 SAFE LOCK CONNECTOR $ 40.00 STRYKER TI CANCELLS SCR 4X60MM $ 40.00 STRYKR TI CANCLLOUS SCR 4X60MM $ 40.00 EPINEPHrine 1 mg/1 mL (1:1,000) INJ $ 40.38 3.5MM CORT SCR SLFTAP 42MM LEN $ 41.00 3.5MM CORT SCR SLFTAP 50MM LEN $ 41.00 3.5MM CORT SCR SLFTAP 55MM LEN $ 41.00 ACUCAIR 115V PER DAY $ 41.00 GLUTAMYLTRANSFERASE GAMMA $ 41.00 GWIRE ARTHROSCPIC HPERFLEX $ 41.00 LAB-ACTIV PARTIAL THROM TIME $ 41.00 LAB-DIBUCAINE $ 41.00 LAB-GGTP $ 41.00 LAB-PTT PLASMA OR WHOLE BLOO $ 41.00 LAB-VDRL SPINAL FLUID $ 41.00 PTT PLASMA OR WHOLE BLOOD $ 41.00 PTT;PLASMA OR WHOLE BLOOD $ 41.00

�17

STR TI SLFTP CRTCL SC 3.5 30MM $ 41.00 STR TI SLFTP CRTCL SC 3.5 32MM $ 41.00 STR TI SLFTP CRTCL SC 3.5 34MM $ 41.00 STR TI SLFTP CRTCL SC 3.5 36MM $ 41.00 STR TI SLFTP CRTCL SC 3.5 38MM $ 41.00 STR TI SLFTP CRTCL SC 3.5 40MM $ 41.00 SYPHILIS TEST NON-TREP QUAL $ 41.00 TI CANCELLOUS SCREW 4.0X16MM $ 41.00 TI SLF TAP CORTCL SCR 3.5X10MM $ 41.00 TI SLF TAP CORTCL SCR 3.5X14MM $ 41.00 TI SLF TAP CORTCL SCR 3.5X48MM $ 41.00 TREPONEMA PALLIDUM $ 41.00 BL SMEAR W/DIFF WBC COUNT $ 42.00 LAB-DIF(MANUAL) $ 42.00 MEROCEL LAMINATED NASAL DSG $ 42.00 STR SELF TAP CORT SCR 3.5X12MM $ 42.00 STR SELF TAP CORT SCR 3.5X16MM $ 42.00 STR SELF TAP CORT SCR 3.5X18MM $ 42.00 STR SELF TAP CORT SCR 3.5X24MM $ 42.00 STRYKER TI CANC SCREW 4.0X16MM $ 42.00 STRYKER TI CANC SCREW 4.0X50MM $ 42.00 THORACIC CATH $ 42.00 X-RAY OF MAMMARY DUCT $ 42.50 typhoid vaccine, live CAPSULE EC $ 42.97 ANAEROB BACT CULTURE W ID $ 43.00 COMPL AUTOM CBC W PLT $ 43.00 CULT FUNGUS W P ID SKIN HR NL $ 43.00 FO STATIC RING SPLINT PLASTIC $ 43.00 LAB-CBC & PLATELET $ 43.00 LAB-POC URINE PREGNANCY TEST $ 43.00 LAB-PREG QUAL URINE $ 43.00 LAB-PT POC $ 43.00 LAB-PTA-PROTHROMBIN TIME $ 43.00 LAB-URINE PREGNANCY TEST POC $ 43.00 PAPARELLA TYPE 1 TUBE $ 43.00 PROTHROMBIN TIME $ 43.00 SORBITOL 3000ML $ 43.00 URINE PREGNANCY VISUAL COLOR $ 43.00 WAFFLE CHAIR CUSHION $ 43.00 DXA BONE DENSITY STUDY $ 43.25 X-RAYS BONE SURVEY LIMITED $ 43.63 ASSAY OF DIGOXIN TOTAL $ 44.00 BACTERIAL CULTURE - OTHR SOURC $ 44.00 BACTERIAL CULTURE OTHR SOURCE $ 44.00 BACTERIAL CULTURE-OTHR SOURCE $ 44.00 COMPATIBILITY TEST ELECTRIC $ 44.00 CPK; TOTAL $ 44.00

�18

DRUG SCRN QUAN LEVETIRACETAM $ 44.00 DRUG SCRN QUANT OXCARBAZEPIN $ 44.00 GUIDE WIRE, SMOOTH 3.2X 300MM $ 44.00 LAB-CREATINE KINASE(CPK) TOT $ 44.00 LAB-CREATINE KINESE $ 44.00 LAB-DIGOXIN $ 44.00 LAB-DIRECT COOMBS, C3B C3D ( $ 44.00 LAB-LACTIC DEHYDROGENASE/LDH $ 44.00 LAB-LDH BF $ 44.00 LAB-MAGNESIUM $ 44.00 LAB-MAGNESIUM LEVEL 24HR URI $ 44.00 LACTATE DEHYDROGENASE $ 44.00 MAGNESIUM $ 44.00 SUPP SCROT XL SUSP 44 $ 44.00 aluminum chloride hexahydrate 50% topical SOLN 60 mL $ 44.57 lidocaine 2% topical GEL 30 mL (KPROV) $ 45.00 ADMIN FEE RBC $ 45.00 CY-CM SCRN DX W/MD INTERPRET $ 45.00 F/S SMALL VOLUME IV SOLUTION $ 45.00 IV-SOLUTION MINBAG $ 45.00 KWITMP FIX BLNT TRCR 1.1X150MM $ 45.00 LAB-A1A PHENOTYPING $ 45.00 LAB-RANDOM VANCOMYCIN $ 45.00 LAB-VANCOMYCIN-PEAK $ 45.00 LAB-VANCOMYCIN-TROUGH $ 45.00 REFERENCE WARM AUTOADSORPTIO $ 45.00 SKIN PREPS $ 45.00 STOM COMP COL KIT 45 1 3/4 IN $ 45.00 TOPIRAMATE $ 45.00 VANCOMYCIN $ 45.00 WRC-EPIFIX, MICRONIZED,INJ 1MG $ 45.00 AB HSV 1 $ 46.00 AB; HSV 1 $ 46.00 AERB STL CLTR ADTL PATH EA PLT $ 46.00 CATH COBRA C2 $ 46.00 CYTOPATH - MAT INDEX $ 46.00 E COLI 0157 AG IA $ 46.00 GIARDIA AG IA $ 46.00 INFUSABLE PRESSURE BAG $ 46.00 LAB-ANGIOTENSIN ENZYME $ 46.00 LAB-HERPES SIMPLEX VIRUS TYPE1 $ 46.00 LAB-HERPES SIMPLEX,TYPE 1 $ 46.00 LEGIONELLA P AG BY DFA $ 46.00 M&S WRIST SPLINTS, EACH $ 46.00 M&S-GEN ANESTH KIT (GAI-MAC) $ 46.00 THC CONFIRMATION, URINE $ 46.00 ASSAY CARBOXYHB QUANT $ 47.00

�19

CONTRAST BATH THERAPY EA 15 M $ 47.00 CONTRAST BATH THERAPY EA 15 MI $ 47.00 CONTRAST BATH THERAPY EA 15MIN $ 47.00 CULTURE AFB - ISOL & ID $ 47.00 HEMATOCRIT $ 47.00 HYDRAJAWS $ 47.00 K-WIRE $ 47.00 LAB-CARBOXYHEMOGLOBIN/CARBON $ 47.00 LAB-HCT ISTAT POC $ 47.00 LAB-HEMATOCRIT-HCT-AUTO $ 47.00 LAB-SPECIFIC GRAVITY BODY FL $ 47.00 MINERAL OIL OIL $ 47.00 OCEAN WET SUCTION CHST DRAIN $ 47.00 SUPPLY $ 47.00 WRGHT SNGL TRCR WIRE 1.6X150MM $ 47.00 2.4MM INBONE STEINMANN PIN $ 48.00 AEROB BACTERIA CULTURE STOOL $ 48.00 AUTOM URINALYSIS WO MICRO $ 48.00 CLOTTING INHIBITR PROTEIN C AG $ 48.00 HEMOGLOBIN $ 48.00 IRON $ 48.00 LAB-APOLIPOPROTEIN, IMMUNOAS $ 48.00 LAB-HEMOGLOBIN-HGB $ 48.00 LAB-IRON/FE ONLY $ 48.00 MICROBE SUSCEPTIBLE MIC $ 48.00 N-AUTOM URINE DIP W MICRO $ 48.00 RUSS VIPER VENOM TIME DILUTED $ 48.00 RUSS VIPER VENOM TIME UNDILUT $ 48.00 SCREW CANCELLOUS 4.0 X 35MM $ 48.00 SCREW CANCELLOUS 4.0 X 40MM $ 48.00 SCREW CANCELLOUS 4.0 X 55MM $ 48.00 SENSITIVITY - DISK PER PLATE $ 48.00 STAPLE REMOVER $ 48.00 STREP A ASSAY W/OPTIC $ 48.00 dipyridamole 50 mg/10 mL INJ (KPROV) $ 48.96 AMMONIA $ 49.00 CY CM SCRN W/MD INTERPRETATI $ 49.00 CY-CM SCREEN DX $ 49.00 CY-CM SCREENING $ 49.00 LAB-AMMONIA (NH4) $ 49.00 LAB-DIRECT COOMBS ANTI C3D $ 49.00 LAB-POTASSIUM - 24HR URINE $ 49.00 LAB-POTASSIUM RANDOM URINE $ 49.00 LAB-THYROGLOBULIN, SERUM $ 49.00 LAB-TRANSFERRIN $ 49.00 RADIAL JAW BIOPSY FORCEPS $ 49.00 REFERENCE RH (D) $ 49.00

�20

TRANSFERRIN $ 49.00 TRCR W/ SGL SHTH SET LAPSCP 5 $ 49.00 norepinephrine 4 mg/4 mL INJ $ 49.13 SCR MAMMO BI INCL CAD $ 49.28 AB ID; LEUKOCYTE AB $ 50.00 AMIKACIN $ 50.00 APP TOPICAL FLUORIDE VARNISH $ 50.00 COMPL CBC W PLT W AUTOM DIFF $ 50.00 COMPL CBC W PLT W AUTOM DIFF $ 50.00 FO PIP DIP STATIC RING PREFAB $ 50.00 HFO FLEXION GLOVE PREFAB $ 50.00 IV SOLUTION SORBITOL 3% $ 50.00 LAB-AMIKACIN RANDOM $ 50.00 LAB-AMIKACIN TROUGH (PRE DOS $ 50.00 LAB-ANTIBODY MYCOPLASMA ADD $ 50.00 LAB-CBC, AUTO DIF & PLAT $ 50.00 LAB-COAG & FIBR SCREEN/INTER $ 50.00 LAB-COAG INT FACTOR 8 INHIBITO $ 50.00 LAB-DAT ANTI IGG $ 50.00 LAB-DIRECT COOMBS $ 50.00 LAB-DIRECT COOMBS C3BC3D $ 50.00 LAB-EPSTEIN BARR IGG EARLY A $ 50.00 LAB-FIBRINOLYSIS SCREEN $ 50.00 LAB-HDL-CHOLESTEROL $ 50.00 LAB-TREPONEMA PALLIDUM $ 50.00 LAB-XVWP SPECIAL INTERPRETAT $ 50.00 LIPOPROTEIN; HDL $ 50.00 MARY BRA 2XL $ 50.00 PROF CYTOPATH - OTHER PROC $ 50.00 PROF CY-TP PAP PC SCREENING $ 50.00 REF DIR ANTIGLOB TEST- POLY $ 50.00 WHFO PREFAB ELASTIC NEO LYCRA $ 50.00 WHO WRIST EXT COCK-UP PREFAB $ 50.00 WO ELASTIC NEO LYCRA PREFAB $ 50.00 ALLERGEN SPECIF IGE QUANT/SEMI $ 51.00 FLUORESCENT AB; TITER EA AB $ 51.00 LAB-A.FUMIGATUS ALLERG, IGE $ 51.00 LAB-ALLERGEN IGE $ 51.00 LAB-ANTINEURNAL AB, TYPE 1 $ 51.00 LAB-ANTINEURONAL NUCL AB TYP $ 51.00 LAB-BIRCH $ 51.00 LAB-BOX ELDER MAPLE $ 51.00 LAB-CHILD ALLERGY PROF: WHEA $ 51.00 LAB-CHILD ALLRGY PROF: MILK $ 51.00 LAB-CHILD ALLRGY PROF: PEANU $ 51.00 LAB-CHILD ALLRGY PROF:CODFIS $ 51.00 LAB-CHILD ALLRGY PROF:DOG EP $ 51.00

�21

LAB-CHILD ALLRGY PROF:EGG WH $ 51.00 LAB-CHILD ALLRGY PROF:SOYBEA $ 51.00 LAB-COCKROACH $ 51.00 LAB-ELM $ 51.00 LAB-ENDOMYSIAL ANTIBODY $ 51.00 LAB-FEATHER PANEL $ 51.00 LAB-FLOURESCENT AB TITER $ 51.00 LAB-FOOD ALERGY $ 51.00 LAB-FOOD ALLERGY: CLAM $ 51.00 LAB-FOOD ALLERGY: CODFISH $ 51.00 LAB-FOOD ALLERGY: EGG WHITE $ 51.00 LAB-FOOD ALLERGY: MILK $ 51.00 LAB-FOOD ALLERGY: PEANUT $ 51.00 LAB-FOOD ALLERGY: SHRIMP $ 51.00 LAB-FOOD ALLERGY: SOYBEAN $ 51.00 LAB-FOOD ALLERGY: WALNUT $ 51.00 LAB-FOOD ALLERGY; WHEAT $ 51.00 LAB-HEAVY METAL MERCURY, URI $ 51.00 LAB-LAMB $ 51.00 LAB-LAMBS QUARTER $ 51.00 LAB-LATEX IGE ANTIBODY (RAST $ 51.00 LAB-LIPASE $ 51.00 LAB-MERCURY BLOOD $ 51.00 LAB-MOLD PANEL $ 51.00 LAB-NE REGION: ALTERNARIA $ 51.00 LAB-NE REGION: CLADOSPORIUM $ 51.00 LAB-NE REGION: D FARINAE $ 51.00 LAB-NE REGION: DOG $ 51.00 LAB-NE REGION: JUNE $ 51.00 LAB-NE REGION: OAK $ 51.00 LAB-NE REGION: TIMOTHY $ 51.00 LAB-NE REGION; CAT $ 51.00 LAB-ORCHARD GRASS $ 51.00 LAB-PEANUT RAST $ 51.00 LAB-PURKINJE CELL CYTO AB TY $ 51.00 LAB-RAGWEED $ 51.00 LAB-RESP SYNCYTIAL VIRUS AB $ 51.00 LAB-TREE PANEL $ 51.00 LAB-WHITE ASH $ 51.00 LAB-XENDOMYSIAL AB TITER $ 51.00 M&S CAUTERY, EACH $ 51.00 TRAC PAD ONLY $ 51.00 Fibrinogrn Antigen $ 52.00 HEEL ELEVATOR $ 52.00 LAB-MONONUCLEAR CELL ANTIGEN $ 52.00 LAB-THIN LAYER CHROMATOGRAPH $ 52.00 OSTEOPATHIC MANIP 7-8 BODY REG $ 52.00

�22

PROF CY-CM PAP PC SCREENING $ 52.00 PROF-TISSUE EXAM BY PATH 3 $ 52.00 BARIATRIC COMMODE $ 53.00 CAR SEAT CHALLENGE $ 53.00 CLOTTING INHBTR PROTN C ACTVTY $ 53.00 KW TMP FIX BLNT TRCR 1.4X150MM $ 53.00 LARGE OR SMALL SNARES $ 53.00 SCREW SYNTHES CORTEX 3.5X22MM $ 53.00 SCREW SYNTHES CORTEX 3.5X24MM $ 53.00 SCREW SYNTHES CORTEX 3.5X26MM $ 53.00 WASHER 13.0MM $ 53.00 norepinephrine 4 mg/4 mL INJ (KPROV) $ 53.20 CHEMILUMINESCENT ASSAY $ 54.00 FUNGUS CULTURE DEF I.D YEAST $ 54.00 LAB-ETHOSUXIMIDE, SERUM $ 54.00 LAB-NICOTINE $ 54.00 LAB-PTH RELATED PROTEIN $ 54.00 LAB-SERPINA 1 $ 54.00 XM ARCHIVE TISSUE MOLEC ANAL $ 54.00 X-SPAN DRESSING $ 54.00 FLUOROGUIDE FOR VEIN DEVICE $ 54.29 6.5MM CANCEL SCR 16MM THR 30MM $ 55.00 6.5MM CANCEL SCR FULL THR 20MM $ 55.00 ACCSS SET MICROPNCTR TRNSTNLSS $ 55.00 ASSAY OF SIROLIMUS $ 55.00 DARCO HEADED 3MM K-WIRE $ 55.00 DECALCIFICATION $ 55.00 GW ORTHO SGL TRCR SS .062X9IN $ 55.00 HC ANSTHSIA BLOCKNEURAXIAL KIT $ 55.00 IA INFECTIOUS AGENT AB QUAN $ 55.00 INDIR ANTI GLOB TEST B (IAT- $ 55.00 INDIR ANTIGLOB TEST A (IAT-A) $ 55.00 LAB-AMYLASE $ 55.00 LAB-AMYLASE 24HR UR $ 55.00 LAB-AMYLASE BF $ 55.00 LAB-AMYLASE PANCREATIC $ 55.00 LAB-AMYLASE RAND UR $ 55.00 LAB-REF ABO ADSORP/ELUT STUDY $ 55.00 POSTERIOR LEAF SPLINT $ 55.00 S&N GUIDE WIRE 1.2MMX9IN 23CM $ 55.00 SCREW CANN 6.5X70MM $ 55.00 VANCOMYCIN 5 MG/ML SYRG $ 55.00 VINYL PIN CAP 3.0MM $ 55.00 ADHESIVE MOLESKIN $ 56.00 ANABOLIC STEROID 1 OR 2 $ 56.00 COOK TDOC 1.5 $ 56.00 CVL KIT (CENTRAL LINE) $ 56.00

�23

DIHYDROTESTOSTERONE $ 56.00 EVAC BOTTLE $ 56.00 LAB-ALPHA 1 ANTITRYPSIN $ 56.00 LAB-OCCULT BLOOD GASTRIC $ 56.00 LAB-QUANT BY HPLC $ 56.00 PN 150 $ 56.00 QUINIDINE $ 56.00 YUEH CATHETER 20CM $ 56.00 DOBUTamine 250 mg/250 mL D5W PM (KPROV) $ 56.60 nitroglycerin 50 mg/250 mL D5W PM (KPROV) $ 56.60 X-RAY OF MAMMARY DUCTS $ 56.82 ETHYLENE GLYCOL $ 57.00 FRUCTOSE SEMEN $ 57.00 LAB-ETHYLENE GLYCOL $ 57.00 LAB-GLUCOSE TOL 4HR $ 57.00 LAB-GLUCOSE TOL 5HR $ 57.00 LAB-GLUCOSE TOLERANCE 3 HR $ 57.00 M6 SET SCREW $ 57.00 SCREENING PURE TONE AIR ONLY $ 57.00 DX MAMMO INCL CAD UNI $ 57.20 5% DEXTROSE/NORM SALINE 500 ML $ 58.00 5% DEXTROSE/WATER 500ML $ 58.00 ACTIVATED PROTEIN C RESISTANCE $ 58.00 CRYPTOSPOR AG BY IFA $ 58.00 DOME PASTE/UNNA BOOT $ 58.00 FIGURE 8 $ 58.00 FLEX5F CONETIP URETRL CATHBX20 $ 58.00 FLEXIMA 4F OPENEND URETRL CATH $ 58.00 FLEXIMA 5F OPENEND URETRL CATH $ 58.00 FLX5F SPIRLTIP URETRL CATHBX20 $ 58.00 INDIA INK $ 58.00 INF NORMAL SALINE 1000CC $ 58.00 INF NORMAL SALINE 250 CC $ 58.00 INF NORMAL SALINE 500 ML $ 58.00 LAB-BODY FLUID FOR LE $ 58.00 LAB-CRYPTOCOCCUS NEOFORMANS $ 58.00 LAB-URIC ACID RANDOM SAMPLE $ 58.00 LAB-URIC ACID SYNOVIAL FLUID $ 58.00 LACTATED RINGERS INF 1000 CC $ 58.00 PACK,LAPAROSCOPY #88222 6EA/CS $ 58.00 SCR CORT LP NLCK 3.5X24MM $ 58.00 THROMBIN TIME; PLASMA $ 58.00 FLUOROGUIDE FOR SPINE INJECT $ 58.33 CULTURE MYCOPLASMA $ 59.00 ECLIPSE ASSEMBLY PER DAY $ 59.00 ERTHROCYTE SED RATE-MANUAL $ 59.00 LAB-ARSENIC 24 HR URINE $ 59.00

�24

LAB-ARSENIC BLOOD $ 59.00 LAB-HEAVY METAL ARSENIC, SER $ 59.00 LAB-HEAVY METAL ARSENIC, URI $ 59.00 LAB-PROTEIN ELECTROPHORESIS $ 59.00 SCREW CANCELLOUS 4.0 X 16MM $ 59.00 SCREW CORTEX SLF TAP 3.5X32MM $ 59.00 SCREW CORTEX SLF TAP 3.5X40MM $ 59.00 SCREW CORTEX SLF TAP 3.5X50MM $ 59.00 TRANS VAN SERVICE $ 59.00 WRC-DERMAGRAFT PER SQ CM $ 59.00 albuterol HFA 90 mcg/inh MDI 8 g $ 59.09 BREASTFEED CLASSES PER SESSION $ 60.00 COLLECTION BOTTLE (THORADRAI $ 60.00 CYTO BRUSH $ 60.00 DRILL PIN FLEXIBLE RIGHTROPE $ 60.00 ISO*NM 99M TC TETRFSM PER DOSE $ 60.00 LAB-TRIIODOTHYRONINE (T3) $ 60.00 M8 CONNECTING NUT $ 60.00 O'HAUS SCALE $ 60.00 PROF CT CALCIUM SCORING $ 60.00 REFERENCE WARM ALLOADSORPTIO $ 60.00 SPEECH/HEARING THERAPY GROUP $ 60.00 SURFIT WAFERS $ 60.00 T3 OR T4 OR THBR $ 60.00 WASHERS 4.0MM $ 60.00 WASHERS 9.0MM $ 60.00 AG SCREEN PT SERUM $ 61.00 ANKLE/FOOT ORTHOSIS $ 61.00 KITTNER DISSECTING $ 61.00 LAB-ACYLCARNITINES, QUANT $ 61.00 PREFAB AFO $ 61.00 SHEATH PINNACLE ALL SIZES $ 61.00 THYROXINE; TOTAL $ 61.00 CANDIDA NA DIRECT PROBE $ 62.00 GARDNERELLA DIR NA PROBE $ 62.00 INJ FOR CYSTOGRAM $ 62.00 LAB-B2 MICROGLOBULIN $ 62.00 LAB-IMMUN EA SEP ANT/BLCK ADDL $ 62.00 LAB-OCCLT BL PEROXIDASE SING $ 62.00 LAB-PEAK GENTAMICIN $ 62.00 LAB-RANDOM GENTAMICIN $ 62.00 LAB-RAPID STREP A ANTIGEN TE $ 62.00 LAB-TROUGH GENTAMICIN $ 62.00 MERCURY QUAN $ 62.00 OCCULT BLD FECES 1-3 TESTS $ 62.00 TRICHOMONAS VAGIN DIR PROBE $ 62.00 6MM X 7CM TWIST-IN CANNULA $ 63.00

�25

AB; HELMINTH NES $ 63.00 ACUCAIR AC200 MODEL PER DAY $ 63.00 ADHESIVE DERMABOND $ 63.00 EBUS BALLOONS $ 63.00 ENDOMYSIAL AB IGA SCREEN $ 63.00 FO WITHOUT JOINTS CUSTOM $ 63.00 GLASSMAN VISCERA RETRACTOR $ 63.00 LAB-AUTO RETICULOCYTE COUNT $ 63.00 LAB-LITHIUM $ 63.00 LAB-VITAMIN B2 $ 63.00 LITHIUM $ 63.00 OMT 1-2 BODY REGIONS $ 63.00 OSTEOPATHIC MANIP 1-2 BODY REG $ 63.00 SCREW 10MM MDTP SILVER $ 63.00 SMALL OSC SAGIT SAW BLADE,THIN $ 63.00 SP*IR ANGIO US GUIDANCE ACCESS $ 63.00 SP*US GUIDANCE FOR VASC ACCE $ 63.00 THUMBLE THUMB TAB $ 63.00 US GUIDE VASCULAR ACCESS $ 63.00 WRC-PRIMATRIX PRDUCT PER SQ CM $ 63.00 X-RAYS BONE SURVEY COMPLETE $ 63.61 X-RAYS BONE SURVEY INFANT $ 63.99 AMPLATZ SUPER STIFF STRT TIP $ 64.00 CENTROMERE ANTIBODIES, S $ 64.00 FLUORESCENT AB; SCRN EA AB $ 64.00 HCG; QUAL $ 64.00 IRON BINDING CAPACITY $ 64.00 IV, NS45K20 FS $ 64.00 IV/PHARM D5K20 FS $ 64.00 LAB-CHLORIDE SPINAL FLUID $ 64.00 LAB-IRON BINDING & SAT $ 64.00 LAB-PREG QUAL SERUM $ 64.00 TDOC GUIDE WIRE 35X145X0X3 $ 64.00 WIRE AMPLT SUPSTIFF .035X145CM $ 64.00 WIRE GUIDE COONS $ 64.00 ACTICOAT 7 ANTI BARRIER 4X5IN $ 65.00 ARTHREX ACP KIT SERIES II $ 65.00 ARTHREX GUIDE WIRE $ 65.00 ASSAY FOR CALPROTECTIN FECAL $ 65.00 GLIDE WIRE-ANGLED 150CM $ 65.00 INNSUFLATION TUBING $ 65.00 IRRIGATION SET $ 65.00 LAB-DAT ANTI IGG PREADMIT $ 65.00 LACTOFERRIN FECAL (QUAL) $ 65.00 LIPID EMULSION 20 % EMUL $ 65.00 M&S MOORE SHOE BOOT $ 65.00 NEOMYCN-PLYMYXN-DXMSN 3.5MG/G $ 65.00

�26

PIN GUIDE COCR 2.8X230MM $ 65.00 PLASMINOGEN ACTIVATOR $ 65.00 PROF DOPPLR ECHO LMTD/ F-UP $ 65.00 RIB BELT $ 65.00 STRYKER TI K-WIRE 1.25X150MM $ 65.00 STRYKER TI K-WIRE 1.6 X 150MM $ 65.00 SURGICAL BOOT/SHOE EA $ 65.00 25G MEMBRANE PICK $ 66.00 ER*BLOOD DRAW $ 66.00 LAB-RETICULOCYTE COUNT $ 66.00 MANUAL RETICULOCYTE COUNT $ 66.00 PLLW SHLDR ABDCTN W/SLING MED $ 66.00 PNEUMO CHST DRAIN (HEIMLICH) $ 66.00 PROF BLOOD SMEAR I&R $ 66.00 PROF WASHINGS OR BRUSHINGS $ 66.00 SCR BONE 3.5 MM DIA 16 MM LEN $ 66.00 SCR BONE 3.5 MM DIA 18 MM LEN $ 66.00 SENSORY INTEGRATION $ 66.00 SP-COMPRESSION PANTYHOSE $ 66.00 WIRE ORTH OD1.6MM SS SMOOTH $ 66.00 CSS-MINICAP TRANSF SET $ 67.00 DISP TRANDUCER $ 67.00 FF PLASMA THAWING, EA UNIT $ 67.00 GEL FOAM PAD $ 67.00 KETAMINE 50 MG/ML SOLN $ 67.00 KMP CATH $ 67.00 LAB- REFERENCE ABSORPTION $ 67.00 LAB-MICROALBUMIN (24 HR-URIN $ 67.00 LAB-MICROALBUMIN(URINE)-RAND $ 67.00 LAB-THYROXINE (T4) $ 67.00 M&S RHINO ROCKET (NASAL) $ 67.00 OVA & PARASITES DIR SMR W ID $ 67.00 PROF FLOUR-MICRO $ 67.00 RIA NONANTIBODY $ 67.00 STERILE WATER 3000ML $ 67.00 TUBE TRACH CUFFFED FEN 8 $ 67.00 UR ALBUMIN QUANTITATIVE $ 67.00 URETERAL CATH $ 67.00 AB; LYME'S (WB) CONFIRM $ 68.00 ASSAY OF BLOOD LIPOPROTEIN LDL $ 68.00 AUTOM ERYTHROCYTE SED RATE $ 68.00 BLOOD CLOT FACTOR VIII TEST $ 68.00 CPM PAD/KIT $ 68.00 DISPOSABLE BIOPSY FORCEP $ 68.00 INSULIN; TOTAL $ 68.00 LAB-ERTHROCYTE SED RATE-AUTO $ 68.00 LAB-FACTOR VIII, 1 STAGE $ 68.00

�27

LAB-FACTOR VIII/BETHES K $ 68.00 LAB-LDL DIRECT CHOLESTEROL $ 68.00 LAB-LYME AB WESTERN BLOT IGG $ 68.00 LAB-LYMES WESTERN BLOT IGM $ 68.00 LAB-RENIN $ 68.00 MEPILEX BORDER AG 4 X 6 $ 68.00 PROF EKG HOLTER $ 68.00 THREADED ROD 80MM $ 68.00 NEEDLE LOCALIZATION BY XRAY $ 68.51 AMBU BAG $ 69.00 CADD-ADMIN & SPIKE SET $ 69.00 CYCLOSPORINE $ 69.00 DRUG SCREEN QUANT ZONISAMIDE $ 69.00 ELLIK-EVACUATOR $ 69.00 HC SURGERY TIER II EA MIN $ 69.00 HEADHUNTER 1 H1 65CM $ 69.00 LAB-HEMOGLOBIN VARIANT $ 69.00 LAB-HGB VARIANT OTHER $ 69.00 LAB-ZONISAMIDE $ 69.00 THORACENTENSIS TRAY $ 69.00 AEROB BACTERIAL BLOOD CULTURE $ 70.00 CT GUIDE FOR TISSUE ABLATION $ 70.00 INFLATOR PRESTO $ 70.00 KIT SUTURE SAVER $ 70.00 LAB-FUNGAL AB:HISTOPASMOSIS $ 70.00 LAB-HISTOPLASMA $ 70.00 LAB-HISTOPLASMA AB SCREEN $ 70.00 LAB-HISTOPLASMOSIS $ 70.00 PROF - CYTP FNA EVAL EA ADDL $ 70.00 PUMP, REFILL KIT $ 70.00 REPLACEMENT TUBE 18FR/20FR $ 70.00 SHOULDER IMMOBILIZER $ 70.00 SHOULDER IMMOBLIZER $ 70.00 CT SCAN FOR NEEDLE BIOPSY $ 70.77 1.27MM REUTER BOBBIN VENT TUBE $ 71.00 CULTURE TYPE IMMUNOLOGIC $ 71.00 FREE THYROXINE $ 71.00 KCI SM WHITE TRAC DRESSING $ 71.00 LAB-BILIRUBIN AMNIOTIC FLUID $ 71.00 LAB-FREE T4 $ 71.00 LAB-PHOS 24HR URINE $ 71.00 LAB-PHOS RANDOM URINE $ 71.00 LAB-REF CHLOROQUINE TX, PT CEL $ 71.00 LAB-SINGLE SITE CULTURE $ 71.00 M&S-LTA KIT $ 71.00 PROTHROMBINE TIME; $ 71.00 SCR BONE COMPR 3.5 MM DIA 14 $ 71.00

�28

SHEATH INTRODUCER 23CM $ 71.00 TRAC DRESSING WHITE LG KIT $ 71.00 BARTON ATLAS 660 W TB $ 72.00 CHOLANGIOGRAPHY ADDITIONAL S $ 72.00 GIVMOHR SLING $ 72.00 LAB-CARNITINE LEVEL $ 72.00 LAB-DIRECT COOMBS (PRE-ADMIT $ 72.00 LAB-LEGIONELLA PNEUM ANTI Ig $ 72.00 PN 120 $ 72.00 SPLINTS-PEDI $ 72.00 xStaclot LA, P $ 72.00 CATH YUEH 5-15CM $ 73.00 CATHETER OMNI FLUSH 5F X 90CM $ 73.00 Chromogenic Substrate Assay $ 73.00 HAPTOGLOBIN; QUAN $ 73.00 IV*20 MICRON BLOOD SET-IV $ 73.00 LAB-AB ELUTION PRE-ADMIT PAT $ 73.00 LAB-HAPTOGLOBIN $ 73.00 POUCHES SURFIT $ 73.00 REF-RETIC SEPERATION $ 73.00 SUSPENSORY SCROTAL $ 73.00 WIRE VICTORY .014 X 300 12GRAM $ 73.00 INTESTINAL BAG $ 74.00 LAB-DEOXYCORTISOL-11 $ 74.00 LAB-PHENYTOIN $ 74.00 M&S SLING $ 74.00 PHENYTOIN; TOTAL $ 74.00 PROF CYTOPATH - OTHER SOURCE $ 74.00 TROCAR 5MM 900-800 $ 74.00 URIMETER $ 74.00 BARTON ATLAS 660 PER DAY $ 75.00 CADMIUM $ 75.00 DRUG SCREEN QUANT GABAPENTIN $ 75.00 FINGER PIP DYNAMIC SPLINT $ 75.00 FO PIP DIP JNT/SPRNG PRE OTS $ 75.00 GENETIC COUNS EA15MIN MEDICA $ 75.00 GLYCOPYRROLATE 0.2 MG/ML SOLN $ 75.00 HIV-1 AG W/HIV-1 & HIV 2-AB $ 75.00 ISLET CELL AB $ 75.00 IV/PHARM NSK20 $ 75.00 IV/PHARM NSK40 $ 75.00 LAB-CADMIUM $ 75.00 LAB-HEAVY METAL CADMIUM, SER $ 75.00 LAB-HEAVY METAL CADMIUM, URI $ 75.00 LAB-HIV AG/AB $ 75.00 LAB-PORPHYRINS TOTAL $ 75.00 LS ORTHOSIS NOS $ 75.00

�29

M&S ANKLE SPLINTS, EACH $ 75.00 M&S MORGAN LENS, EACH $ 75.00 MASSAGE-60 MINUTES $ 75.00 NORPNPHRNE 1MG/ML SLN 4ML VIAL $ 75.00 PORPHYRINS, FRACT $ 75.00 PROF CYTOPATH C/V INTERPRET $ 75.00 PROF- SCR PATH AUT THIN LAYER $ 75.00 REFLEXOLOGY-60 MINUTES $ 75.00 REIKI-60 MINUTES $ 75.00 SICKLING OF RBC REDUCTION $ 75.00 SPECTROPHOTOMETRY ANALYTE NES $ 75.00 SPLIT UNIT $ 75.00 TUBE TRACH CUF/D CANN SZ.8 DCT $ 75.00 DX MAMMO INCL CAD BI $ 75.30 COLD AGGLUTININ; TITER $ 76.00 FIXATION BOLT WASHER 4MM $ 76.00 GWIRE ORTH L150MM OD1.4MM FT $ 76.00 LAB-CCP ANTIBODY $ 76.00 LAB-GLUCOSE 2 HOUR $ 76.00 LUMBAR PUNCTURE TRAY $ 76.00 SAW BLADE SP111 MHRI $ 76.00 SHEATH 7FR X 11CM $ 76.00 SHEATH ARROW SUPERFLEX 5FX24CM $ 76.00 SHEATH ARROW SUPERFLEX 6FX11CM $ 76.00 SHEATH ARROW SUPERFLEX 6FX24CM $ 76.00 SHEATH ARROW SUPERFLEX 7FX11CM $ 76.00 SHEATH ARROW SUPERFLEX 7FX24CM $ 76.00 SHEATH ARROW SUPERFLEX 8FX11CM $ 76.00 SHEATH ARROW SUPERFLEX 8FX24CM $ 76.00 TEDS * THIGH HIGH $ 76.00 TOOMEY SYRINGE $ 76.00 WIRE COPE .018 X 60CM $ 76.00 20FR TUBE FEED $ 77.00 ALUMINUM HAND $ 77.00 AMPLATZ EXTRA STIFF WIRE 180CM $ 77.00 ANTINUCLEAR AB (ANA); TITER $ 77.00 BASIN KIT $ 77.00 CP CERV/VAG; ATL; MANUAL SCRN $ 77.00 FETAL SCREEN DU $ 77.00 GLIDEWIRE .035 X 150CM $ 77.00 GLIDEWIRE .038 X 150CM $ 77.00 LAB-MANGANESE $ 77.00 M&S-BLOOD GAS ANESTH $ 77.00 M&S-ESOPHOGEAL STETH $ 77.00 MALLEOLOC $ 77.00 PROF -SURG PATH LVL 2 $ 77.00 TRAY CATH IC W/URIMETER 16FR $ 77.00

�30

TUBE TRACH 8 UNCUF DISP $ 77.00 VIRUS INOCULATE TISSUE ADDL $ 77.00 16FR FOLEY CATH TRAY ITH URMTR $ 78.00 45MM3.5MM TA STP W/DST SER TCH $ 78.00 CATHS MULTI PURPOSE $ 78.00 CYTP FNA EVAL EA ADDL $ 78.00 LAB-SODIUM BF $ 78.00 LAB-SODIUM, OTHER SOURCE $ 78.00 SM&NEP 5.5MM BONE BLADE PLAT $ 78.00 STENT UTERINE BALLON 8ML $ 78.00 THREADED ROD 120MM $ 78.00 VALVE REPLACEMENT PLEURX $ 78.00 poliovirus vaccine, inactivated SYRG 0.5 mL $ 78.45 ATRAU FNSTRTD MICROLINE GRASPR $ 79.00 CARDIOLIPIN AB EA IG CLASS $ 79.00 CHROMOGRANIN A $ 79.00 COMPLEMENT; AG EA $ 79.00 CURETTE #0 CVD $ 79.00 CURETTE #00 CVD $ 79.00 CURETTE #000 CVD $ 79.00 CURETTE #1 CVD $ 79.00 CURETTE #2 CVD $ 79.00 CURETTE #3 CVD $ 79.00 CURETTE #5 CVD $ 79.00 ELECTROLYTE PANEL $ 79.00 ENZYME PANEL ANTIBODY ID $ 79.00 ER*PPD TEST $ 79.00 HBG; METHEMOGLOBIN QUAN $ 79.00 HBOT-RHYTHM ECG, TRACING ONL $ 79.00 IA; OTHER TUMOR AG QUAN EA $ 79.00 LAB-C3 COMPLEMENT $ 79.00 LAB-C4 COMPLEMENT $ 79.00 LAB-CARDIOLIPIN AB $ 79.00 LAB-CARDIOLIPIN EACH IG CLAS $ 79.00 LAB-CARDIOLIPIN IGA AB $ 79.00 LAB-CARDIOLIPIN IGG AB $ 79.00 LAB-CARDIOLIPIN IGM AB $ 79.00 LAB-COMPLEMENT C5 $ 79.00 LAB-ELECTROLYTE PANEL $ 79.00 LAB-ROMA HE4 $ 79.00 LAB-SELENIUM $ 79.00 PROF IMMN EA SEP ANTB/BLCK ADL $ 79.00 REF CELL TRMT-REAG-CHLORO/CE $ 79.00 REFERENCE DRUG TRMNT-CEPHALOTH $ 79.00 REFERENCE DRUG TRMNT-OTHER $ 79.00 REFERENCE DRUG TRMNT-PENICILLI $ 79.00 REFERENCE-ELUTION-HEAT $ 79.00

�31

SURG PATH LEVEL-I GROSS ONLY $ 79.00 THREAD GUIDE WIRE 2.0MMX1.5MM $ 79.00 TUBE GSTR RPLCMNT 20FR RT ANGL $ 79.00 naloxone 2 mg/2 mL SYRG (KCARD) $ 79.07 naloxone 2 mg/2 mL SYRG (KPROV) $ 79.07 10MM X 4CM PASSPORT BUTTON CAN $ 80.00 7.0MM WASHER $ 80.00 LAB-GLIADIN ANTIBODIES-IGA $ 80.00 LAB-GLIADIN ANTIBODIES-IGG $ 80.00 LAB-PROTEIN III AB (PR3) $ 80.00 LAB-RHEUMATOID ARTHRITIS $ 80.00 LAB-THEOPHYLLINE $ 80.00 NITINOL CORE GUIDEWIRE W/HYDRO $ 80.00 PEAK PLATLT RCH PLSMA SYS 30ML $ 80.00 PROF CYTOGENCS & MOLECULAR CYT $ 80.00 QUAN RHEUM FACTOR $ 80.00 naloxone 2 mg/2 mL SYRG $ 80.15 DALE BINDER $ 81.00 KTMN 10MG/MLIV 1000MG100ML SLN $ 81.00 LAB-CARBAMAZEPINE $ 81.00 SHELL TRIDENT HEM ACETABULAR $ 81.00 AB; CHLAMYDIA $ 82.00 CATH URINARY $ 82.00 FERRITIN $ 82.00 INFLATION DEVICE $ 82.00 LAB-ARTERIAL BLOOD GASES $ 82.00 LAB-BLOOD GAS POC $ 82.00 LAB-CAPILLARY BLOOD GAS $ 82.00 LAB-CHL TRACH IGG $ 82.00 LAB-CORD BLOOD GAS $ 82.00 LAB-FERRITIN $ 82.00 LAB-METANEPHRINES, SERUM $ 82.00 LAB-METANEPHRINES, TOTAL 24H $ 82.00 LAB-METANEPHRINES, URINE $ 82.00 LAB-TISSUE PROCESSING $ 82.00 LAB-TOBRAMYCIN PEAK(POST DOS $ 82.00 LAB-TOBRAMYCIN TROUGH(PRE-DO $ 82.00 LAB-VENOUS BLOOD GASES $ 82.00 PROF CLINICAL PATH CONSULT LTD $ 82.00 VERALINK CASSETTE $ 82.00 DPMN IN 5%DXTRS 200MG/250ML SN $ 83.00 FORCEP RADIAL JAW 2.8MM 240CM $ 83.00 FORCEP RADIAL JAW 2MM PED160CM $ 83.00 LAB-ELECTROPHORETIC TECHNIQ $ 83.00 LAB-PROTEIN ELECTRO SERUM $ 83.00 LAB-SOMATOSTAIN $ 83.00 LAB-VARICELLA ZOSTER IGG TIT $ 83.00

�32

OBS PPD SKIN TEST $ 83.00 PROTEIN; EP FRACT & QUAN $ 83.00 SKIN TEST TB ID $ 83.00 SNARE CAPTIFLEX 13MM SMALLOVAL $ 83.00 WAFFLE BARIATRIC CUSHION $ 83.00 ASSAY IGA/IGD/IGG/IGM EACH $ 84.00 DNA AB $ 84.00 GAGE SYRINGE ASSEMBLY $ 84.00 GLIDEWIRE .035x80CM $ 84.00 HC FLUID WARMING SET $ 84.00 INF D5W 1000CC $ 84.00 LAB-ANTI TPO (THYROID PEROXI $ 84.00 LAB-CHLORIDE-OTHER $ 84.00 LAB-GAMMAGLOBULIN, EA $ 84.00 LAB-GAMMAGLOBULIN, EACH $ 84.00 LAB-IGG SPINAL FLUID $ 84.00 LAB-IMMUNOGLOBULIN QUAN-IGA $ 84.00 LAB-IMMUNOGLOBULIN QUAN-IGG $ 84.00 LAB-IMMUNOGLOBULIN QUAN-IGM $ 84.00 LAB-MICROSOMAL ANTIBODIES,EA $ 84.00 MICROSOMAL AB EACH $ 84.00 THREADED ROD 200MM $ 84.00 VARICELLA ZOSTER AG BY DFA $ 84.00 ADAPTER VALLEYLAB MONOPOLAR $ 85.00 COONS THSF-35-145 $ 85.00 C-REACTIVE PROTEIN $ 85.00 LAB-C REAT PROTEIN $ 85.00 LAB-PROCALCITONIN $ 85.00 POWER PULSE $ 85.00 REMOVE DRUG IMPLANT $ 85.00 REMOVE W INS DRUG IMPLANT $ 85.00 SNARE MED HEX $ 85.00 SNARE STIFF 13MM $ 85.00 TRAC SMALL DRESSING KIT $ 85.00 45MM SURGICAL BURR $ 86.00 COLLAGEN CROSS LINKS $ 86.00 C-REACTIVE PROTEIN HS $ 86.00 LAB-CITRIC ACID (CITRATE) $ 86.00 LAB-GASTRIN $ 86.00 LAB-HERCEP BY FISH,100-300CE $ 86.00 LAB-HIGH SENSITIVE CRP $ 86.00 LAB-NTX TELOPEPTIDE $ 86.00 LAB-ROTAVIRUS ANTIGEN, STOOL $ 86.00 LAB-SPECTROPHOTOMETRY $ 86.00 LAP WIRE J-HOOK ELECTRODE 36CM $ 86.00 NEEDLE CHIBA 18G X 20CM $ 86.00 NEEDLE CHIBA 22G X 20CM $ 86.00

�33

ROUND CARBIDE BUR (5.0MM) $ 86.00 SAG SAW BLD, X-WIDE, THIN SHRT $ 86.00 WIRE AMPLATZ SUPERSTIFF 260CM $ 86.00 1.5 X 10MM CORTEX SCREW $ 87.00 1.5 X 11MM CORTEX SCREW $ 87.00 AB: HBCAB - IGM AB $ 87.00 AB: HBCAB-IGM AB $ 87.00 AB; CHLAMYDIA IGM $ 87.00 BENZODIAZEPINES1-12 $ 87.00 COPPER $ 87.00 DISP JAMSHIDI $ 87.00 DRILL TWIST W/ STOP $ 87.00 LAB-B12 VITAMIN $ 87.00 LAB-BENZODIAZEPINE $ 87.00 LAB-COPPER $ 87.00 LAB-EPSTEIN BARR VIRUS NUC A $ 87.00 LAB-EPSTN BARR SCR NUCLEAR A $ 87.00 LAB-FEP-FREE ERYTH PROTOPORP $ 87.00 LAB-FLOW CYTO INTERPRET 9-15 $ 87.00 LAB-FLOW CYTO TECH INTERP 2 $ 87.00 LAB-HEP B CORE AB IGM $ 87.00 LAP FLAT L-HOOK ELECTRODE $ 87.00 M&S MIDLINE INFUSION CATH $ 87.00 NEEDLE BIOPSY PERCUCUT $ 87.00 REUNION RSA PILOT WIRE $ 87.00 VITAMIN B-12 LEVEL $ 87.00 WHIRLPOOL THERAPY 1+ AREAS $ 87.00 2.7 X 10MM CRUCIFORM SCREW $ 88.00 2.7 X 12MM CRUCIFORM SCREW $ 88.00 2.7 X 14MM CRUCIFORM SCREW $ 88.00 2.7 X 16MM CRUCIFORM SCREW $ 88.00 2.7 X 8MM CRUCIFORM SCREW $ 88.00 3.5 X 18MM NON-LOCKING SCREW $ 88.00 3.5 X 20MM CORTICAL SCREW $ 88.00 3.5 X14MM LOW PROFILE CORT SCR $ 88.00 3.5 X50MM LOW PROFILE CORT SCR $ 88.00 3.5X22MM NONLOCKING SCREW ARTH $ 88.00 4 X 12MM NON-LOCKING SCREW $ 88.00 4 X 14MM NON-LOCKING SCREW $ 88.00 4 X 18MM NON-LOCKING SCREW $ 88.00 4 X 50MM LONG THREADED SCREW $ 88.00 ARTHREX WASHER (4MM SCREW) $ 88.00 CATHETER OMNI FLUSH 4FR 90CM $ 88.00 DRN SYS SNGLE COLLECTION $ 88.00 FOOT ARCH SUPPORT INSERT REMOV $ 88.00 HEAVY DUTY ACL SAW BLADE $ 88.00 HEAVY DUTY SAG BLD STRAIGHT $ 88.00

�34

HFO WITHOUT JOINTS PREFAB $ 88.00 IV/PHARM D5NSK20 $ 88.00 LAB-CORTISOL 24 HR URINE $ 88.00 LAB-ENTEROVIRUS RNA BY PCR $ 88.00 LAB-HEMOSIDERIN-URINE $ 88.00 LAB-MYOGLOBIN-U $ 88.00 LO-PRO SCRW 4.0X20MM CNCLLS $ 88.00 LOW PRFLE CORT SCW 3.5X28MM $ 88.00 MYOGLOBIN $ 88.00 SAGITTAL SAW BLD 89.5 X 12.5MM $ 88.00 SCR CORT LP NLCK 3.5X12MM $ 88.00 SCR NON LCKNG 3.5 X 18MM $ 88.00 SCRW SYNT CORT SLFTAP 2.7X28MM $ 88.00 SCRW SYNT CORT SLFTAP 2.7X30MM $ 88.00 SCRW SYNT CORT SLFTAP 2.7X32MM $ 88.00 SHEATH PINNACLE PREC 5FRX10CM $ 88.00 SHOE LIFT ELEV INSIDE SHOE $ 88.00 STRYKER AVERAGE MEDIUM BLADE $ 88.00 SUTURE TAPE, 1.3MM $ 88.00 URETERAL CATH FLEXI-TIP 10FT $ 88.00 3.5 X 20MM CORT ST SCREW $ 89.00 3.5 X 26MM CORTICAL SCREW $ 89.00 3.5 X 28MM CORTICAL SCREW $ 89.00 3.5 X 36MM CORTICAL SCREW $ 89.00 3.5 X 38MM CORTICAL SCREW $ 89.00 3.5 X 40MM CORTICAL SCREW $ 89.00 3.5 X 42MM CORTICAL SCREW $ 89.00 3.5 X 44MM CORTICAL SCREW $ 89.00 3.5 X 46MM CORTICAL SCREW $ 89.00 3.5 X 48MM CORTICAL SCREW $ 89.00 3.5 X 50MM CORTICAL SCREW $ 89.00 3.5 X 70MM CORTICAL SCREW $ 89.00 3.5 X 80MM CORTICAL SCREW $ 89.00 3.5MM CRTCL SCRW SLFTPNG 30MM $ 89.00 3.5MM CRTX TI SCR 3.5MMXL34MM $ 89.00 4 X 50MM LOCKING SCREW $ 89.00 AB; CMV $ 89.00 AXSOS 3.5MM CRT SCR SLFTP L 24 $ 89.00 AXSOS 3.5MMX70MM COR SCR SLFTP $ 89.00 AXSOS 3.5X32MM CORT SCR SLFTAP $ 89.00 CERVICAL COLLAR $ 89.00 CMV TEST-IGG FOR BLOOD UNIT $ 89.00 ENA ANY METHOD $ 89.00 F/S INFUS NORMAL SALINE 250 ML $ 89.00 FLEXICAIR M4000 MC3 W/O SCAL $ 89.00 LAB-CALCULUS QUANT $ 89.00 LAB-FECAL FAT 24/48/72 HOUR $ 89.00

�35

LAB-INSULIN ANTIBODY LEVEL $ 89.00 LAB-VMA,URINE $ 89.00 MICRO PUNCTURE SETS $ 89.00 PROF EKG $ 89.00 SCR CORT LP NLCK 3.5X14MM $ 89.00 SCR LOW PRO CANC 4.0X16MM $ 89.00 ST 3.5MM COR TI SC 3.5MMXL38MM $ 89.00 STRYKR CORTX TI SCR 3.5MMX65MM $ 89.00 1.5 X 8MM CORTEX SF TAP SCREW $ 90.00 1.5 X 9MM CORTEX SCREW $ 90.00 2X10MM CORTICL SCREW (SYNTHES) $ 90.00 2X9MM CORTEX SELF-TAPPING SCR $ 90.00 ADD'L ATR AB FOR AF POST PULM $ 90.00 ADD'L DIS PRIM INCL REPEAT MAN $ 90.00 CONCENT FOR INFECT AGNT $ 90.00 CONCENTRATION FOR INFECT AGNT $ 90.00 DRAIN PERF 3/4 $ 90.00 F/S INFUS NORMAL SALINE 1000ML $ 90.00 F/S INFUS NORMAL SALINE 500 ML $ 90.00 F/S LARGE VOLUME IV SOLUTION $ 90.00 GLYCOSYLATED HEMOGLOBIN TEST $ 90.00 GUIDE WR W/TROCAR TIP THREAD 8 $ 90.00 ICU M&S-BIS SENSOR $ 90.00 INTRACARDIAC CATH MAP $ 90.00 IV-SOLUTION, LARGE VOLUME $ 90.00 LAB-ALUMINUM SERUM $ 90.00 LAB-GLYCOHEMOGLOBIN/HEMOGLOB $ 90.00 LAB-MEPHOBARBITAL $ 90.00 LAB-METHEMOGLOBIN $ 90.00 LAB-WEST NILE AB $ 90.00 LAB-WEST NILE AB IGM $ 90.00 LEFT ATRIAL PACING & RECORDING $ 90.00 LEFT VENT. PACING & RECORDING $ 90.00 MICROVASIVE SCELORSIS NEEDLE $ 90.00 PROF MLTPLX ISH W MN MRPH ANLY $ 90.00 PROF SNG P ISH W MAN MORPHOME $ 90.00 REPTILASE TEST $ 90.00 TRAC LARGE DRESSING KIT $ 90.00 VARIAX2 WASHER T8&T10 SCR $ 90.00 5.5MM CUTTER, FORMULA RESECTOR $ 91.00 GENERAL EA ADD 15MINS $ 91.00 ISO*PYP UP TO 25 MCI $ 91.00 ISO*PYP UP TO 25MCI $ 91.00 LAB-ANDROSTENEDIONE $ 91.00 LAB-OXALATE-U $ 91.00 LAB-PANCREATIC POLYPEPTIDE $ 91.00 LOCAL/REGIONAL/BLOCK EA ADD1 $ 91.00

�36

M&S TRANSDUCER SET $ 91.00 M&S-TRANSDUCER SET $ 91.00 MAC EA ADD 15 MINS $ 91.00 OSTEOCALCIN $ 91.00 PROF SURG PATHOLOGY $ 91.00 SPINAL/EPIDURAL EA ADD 15 MINS $ 91.00 TUBE TRACH UNCF 4DCFS $ 91.00 AB; LYME'S DISEASE $ 92.00 F/S 5% DEXTROSE/WATER 1000 ML $ 92.00 F/S 5% DEXTROSE/WATER 500 ML $ 92.00 F/S LACT RINGERS UP TO 1000 ML $ 92.00 F/S LARGE VOLUME IV SOLN W/ K $ 92.00 HEPATIC FUNCTION PANEL $ 92.00 LAB-B.BURGDORFERI AB $ 92.00 LAB-CORTISOL FREE URINE $ 92.00 LAB-HEPATIC PANEL $ 92.00 LAB-HTLV I $ 92.00 LAB-PH-BODY FLUID $ 92.00 LAB-SINGLE VIRUS CULTURE $ 92.00 NEEDLE LPN $ 92.00 Sodium Chloride 0.9% 1000 mL IV SOLN (KPROV) $ 92.00 TA 30-3.5 SGL USE LDINGUN $ 92.00 TA 30-4.8 SGL USE LDINGUN $ 92.00 TROCAR, 1.6 X 150MM $ 92.00 VIRUS ISOL SHELL VIAL TECHN $ 92.00 5.5X25X.064MM OSCILLTING BLADE $ 93.00 BLADE MICRO SAGITTAL OFFSET $ 93.00 BLADE SAW SAG 25X5.5MMX38MM $ 93.00 BLADE SAW SAGITTAL 18.5X9MM $ 93.00 CLEARTRAC FLX THREADED CANNULA $ 93.00 LAB-AB TO EXTRACT NUC AG $ 93.00 LAB-ACETYLCHOLINESTERASE $ 93.00 LAB-FUNGUS-NOT ELSEWHERE SPE $ 93.00 LAB-PYRIOXAL PHOSPHATE(B-6) $ 93.00 LAB-VITAMIN B-6 $ 93.00 M&S ORTHO GLASS SPLINT, EACH $ 93.00 MEDIUM BLADE 18.5MM X 9MM $ 93.00 MYELIN BASIC PROTEIN $ 93.00 COLLAR CERV W/PADS ADULT REG $ 94.00 COLLAR CERVICAL $ 94.00 DISPOSABLE SKIN STAPLER $ 94.00 HC ANESTHESIA ADULT KIT $ 94.00 HEPATITIS B SURFACE AG IA $ 94.00 HOT COLD PACKS THERAPY 1+ AREA $ 94.00 JACKSON PRATT $ 94.00 LAB-COLD AGGLUTININ $ 94.00 LAB-MURAMIDASE $ 94.00

�37

LAB-MURAMIDASE-URINE $ 94.00 LAB-NEPHELOMETRY, EACH ANALY $ 94.00 LAB-UROPORPHYRINS 24 HR URIN $ 94.00 LAB-VIRAL CULTURE $ 94.00 REFERENCE REST ABSORPTION $ 94.00 SCISSORS ENDOCUT 3142 $ 94.00 SP*FLOURO GUID CNTRL VEN ACC $ 94.00 THER IVNTJ 1ST 15 MIN $ 94.00 THER IVNTJ EA ADDL 15 MIN $ 94.00 THER IVNTJ W/FOCUS COG FUNCJ $ 94.00 VIRUS ISOLATE TISSUE CULT INOC $ 94.00 XR*FLOUROGUIDED CNTRL VEN AC $ 94.00 FOLIC ACID; SERUM $ 95.00 LAB-AB SCREEN PRE ADMIT/NATA $ 95.00 LAB-ANTIBODY SCREENING $ 95.00 LAB-BASIC METABOLIC $ 95.00 LAB-BASIC MP IONIZED CALCIUM $ 95.00 LAB-COCCIDIOMYCOSIS $ 95.00 LAB-CREATININE CLEARANCE $ 95.00 LAB-FOLIC ACID $ 95.00 LAB-FUNGAL AB: COCCIDIOIDES $ 95.00 METABOLIC PANEL IONIZED CA $ 95.00 METABOLIC PANEL TOTAL CA $ 95.00 RBC AB SCRN EA TECHIQ $ 95.00 SNARES STIFF 20MM $ 95.00 SUTURE PASSER, 12" $ 95.00 TOTAL VITAL CAPACITY $ 95.00 ulipristal 30 mg TAB $ 95.34 AB HELICOBACTER PYLORI $ 96.00 AB; HELICOBACTER PYLORI $ 96.00 ASSAY DIPROPYLACETIC ACD TOT $ 96.00 COVIDIEN 2-0 VLOC SUTURE $ 96.00 IMMUN ADM EA ADDTL VACCINE $ 96.00 IMMUNE ADMIN ORAL/NASAL 1 VACC $ 96.00 IMMUNE ADMIN ORAL/NASAL ADDL $ 96.00 IMMUNIZATION ADM EA ADD VACC $ 96.00 IMMUNIZATION ADM EA ADDTL VACC $ 96.00 LAB-AMNIOTIC FLUID AFP $ 96.00 LAB-CATECHOLAMINES $ 96.00 LAB-CHOLINESTERASE,PSEUDO PL $ 96.00 LAB-EPINEPHRINE-FRAC CATECHO $ 96.00 LAB-HELICOBACTER PYLORI QUAL $ 96.00 LAB-TOTAL T3 $ 96.00 LAB-VALPROIC ACID/DEPAKENE $ 96.00 LAB-VISCOSITY $ 96.00 PROF DOPPLER COLOR FLOW $ 96.00 T3; TOTAL $ 96.00

�38

WRC-METABOL ACTIV D/E PER SQ $ 96.00 ALPHA-FETOPROTEIN SERUM $ 97.00 GATEWAY ADVANTAGE Y ADAPTER $ 97.00 KNEE IMMOBILIZER $ 97.00 LAB-AFP QUAD MATERNAL SERUM $ 97.00 LAB-AFP TUMOR MARKER $ 97.00 LAB-BILE SERUM $ 97.00 LAB-ENTEROVIRUS, EACH $ 97.00 LAB-ORGANIC ACID URINE QUAN $ 97.00 LAB-POLIO TITRE TYPE 1 $ 97.00 LAB-POLIO TITRE TYPE 2 $ 97.00 LAB-POLIO TITRE TYPE 3 $ 97.00 LAB-SCRUB TYPHUS AB $ 97.00 PROF CARDIAC EVENT MNTORNG $ 97.00 PROF MOBLE CARDIO TELEMETRY $ 97.00 SELENIUM $ 97.00 TUBE TRACH CFD 6.0MM $ 97.00 2.0 X 10MM CORTEX SCREW $ 98.00 2.0 X 9MM CORTEX SCREW $ 98.00 4X125MM AGG PLUS CUTTER SH BLD $ 98.00 5.5MMX125MM STD 12FLT BRL BUR $ 98.00 AB; VARICELLA-ZOSTER $ 98.00 AGG PLUS SHAVER BLADE 5.0 $ 98.00 CABLE NEUROSTIM TEST $ 98.00 CATH LAB-ADMIN W/ HEMO MEASU $ 98.00 CLTTING FCTR VIII RISTCTN CFCT $ 98.00 IRRIGATING CATH $ 98.00 LAB-OLIGOCLONAL BANDS $ 98.00 LAB-RENAL FUNCTION PANEL $ 98.00 LAB-RISTOCETIN COFACTOR $ 98.00 LAB-TOPIRAMATE $ 98.00 LAB-VARICELLA ZOSTER IGM $ 98.00 PULSEVAC $ 98.00 TUBE TRACH 6/DIC/FEN SHILEY $ 98.00 TUBE TRACH CUFFD CANN SZ10 $ 98.00 AB; TOXOPLASMA $ 99.00 AB; TOXOPLASMA IGM $ 99.00 ANTITHROMBIN III ACTIVTY ASSAY $ 99.00 CRUTCHES $ 99.00 FLEXICAIR ECLIPSE-ULTRA $ 99.00 ISO*133 XE XENON PER 10 MCI $ 99.00 LAB-ANTITHROMBIN III $ 99.00 LAB-CYTOMEGALOVIRUS IGG AB $ 99.00 LAB-IODINE URINE $ 99.00 LAB-PKU $ 99.00 LAB-RUBELLA (GERMAN MEASLES) $ 99.00 LAB-RUBELLA IGG CONV TITRE $ 99.00

�39

LAB-RUBELLA IGM ACUTE TITRE $ 99.00 LAB-TOXOPLASMA-IGG ANTIBODY $ 99.00 LAB-TOXOPLASM-IGM ANTIBODY $ 99.00 MASS SPECTROMETRY QUAL/QUAN $ 99.00 PLATE BNE L90MM 7HOLE 1/3TUBLR $ 99.00 PLT 1/3 TUBE W/COL 77MM 6H $ 99.00 STAYS, LONESTAR DISPOSABLE 5MM $ 99.00 TUBE TRACH 6 UNCUF DISP $ 99.00 UNLISTED IMMUNOLOGY PROCEDURE $ 99.00 2.5 X 12MM NON-LOCKNG CORT SCR $ 100.00 3.5 X 10MM NON-LOCKING SCREW $ 100.00 3.5 X 14MM NON-LOCKING SCREW $ 100.00 3.5 X 16MM NON-LOCKNG CORT SCR $ 100.00 3.5 X 30MM NONLOCKING CORT SCR $ 100.00 3.5 X 45MM NON-LOCKING SCREW $ 100.00 ANKLE ORTHO ELASTIC NEO PREFAB $ 100.00 ANTIDEPRESSANT TRICYCLIC 1/2 $ 100.00 BHC SURGICAL COMPONENT $ 100.00 BLADE SAW $ 100.00 CARBAMAZEPINE; TOTAL $ 100.00 CHILDBIRTH EDUC $ 100.00 CPK: ISOENZYMES $ 100.00 DBL SIDED RECIP BLADE $ 100.00 EO ELASTIC WITH STAYS PREFAB $ 100.00 EZG8 AIR WALKER LG $ 100.00 KO ELASTIC WITH STAYS PREFAB $ 100.00 LAB-CARBAMAZEPINE TOTAL $ 100.00 LAB-CK FRACTIONATION $ 100.00 LAB-HSV BY PCR CSF $ 100.00 LAB-THIAMIN, B1 $ 100.00 LUMBAR SUPPORT PREFABRICATED $ 100.00 MA DIAGNOSTIC TOMO $ 100.00 MA SCREENING TOMO $ 100.00 MRI FOR TISSUE ABLATION $ 100.00 MULTIPLEX IHC STAIN $ 100.00 NUMBER 5 FBRWR W/CONV CUT NDL $ 100.00 POLARUS 3 PLT TACK $ 100.00 PROF LIMITED ECHO STUDY $ 100.00 PSYTX W PT 30 MINUTES $ 100.00 QUANTITATIVE ASSAY DRUG $ 100.00 SQ LIVE YELLOW FEVER VACCINE $ 100.00 STABILIZER AO SUPPORT $ 100.00 TTE F-UP OR LMTD $ 100.00 WHFO PREFAB THUMB SPICA $ 100.00 ABDUCT PILLOW $ 101.00 BLOOD TYPING RBC ANTIGENS $ 101.00 BLOOD TYP-RBC AG-PT-NOT ABO, $ 101.00

�40

CT SCAN-SURGICAL COMPONENT $ 101.00 DNA AB; NATIVE OR DS $ 101.00 GLIDEWIRE 035/150/3CM FLEX TIP $ 101.00 LAB-ANTI DNA AB-DBLE STRANDE $ 101.00 LAB-TACROLIMUS OR PROGRAPH $ 101.00 LAPRSCPC WR LHOOK ELECTRD 36CM $ 101.00 M&S A-LINE KIT $ 101.00 PROF EKG TREADMILL $ 101.00 PROF EKG TREADMILL NM $ 101.00 REF COLD ABSORPTION PER CELL $ 101.00 REF HPC ABSORPTION $ 101.00 RETRACTOR LEXUS MEDIUM 5/BX** $ 101.00 TACROLIMUS $ 101.00 VISUAL ACUITY SCREEN BIL-QUAN $ 101.00 4.5 X 26MM NON-LOCKING SCREW $ 102.00 4.5 X 28MM CORTICAL SCREW $ 102.00 4.5 X 30MM CORTICAL SCREW $ 102.00 4.5 X 32MM CORTICAL SCREW $ 102.00 4.5 X 34MM CORTICAL SCREW $ 102.00 4.5 X 36MM CORTEX SCREW $ 102.00 4.5 X 38MM CORTICAL SCREW $ 102.00 4.5 X 42MM CORTEX SCREW $ 102.00 4.5 X 48MM CORTICAL SCREW $ 102.00 4.5 X 50MM CORTICAL SCREW $ 102.00 4.5 X 60MM CORTEX SCREW $ 102.00 4.5 X 65MM CORTEX SCREW $ 102.00 4.5 X 75MM CORTICAL SCREW $ 102.00 ALKALINE PHOSPHATASE ISOENZYM $ 102.00 BALLOON INFLTRTN ALLIANCE 5060 $ 102.00 ISO*131 I CAPSULE, PER MCI $ 102.00 ISO*IN111 OXYQUINOLINE 0.5MCI $ 102.00 LAB-ALKALINE PHOSPHATASE FRA $ 102.00 LAB-FIBRINOGEN $ 102.00 LAB-HEPATITIS D (DELTA) $ 102.00 LAB-LIPID PANEL $ 102.00 LAB-OCCULT BLOOD IMMUNOASSAY $ 102.00 LAB-THYROID STIM HORMONE PRE $ 102.00 LAB-THYROID STIM HORMONE(TSH $ 102.00 LAB-THYROXINE BINDING GLOBUL $ 102.00 LIPID PANEL $ 102.00 OCCULT BLD FHG QUAL 1-3 $ 102.00 PLEURX DRAINAGE KIT, 500ML $ 102.00 SCREW 4.5X55MM CORTICAL $ 102.00 THYROID STIMULATING HORMONE $ 102.00 VIRAL NEUTRALIZATION $ 102.00 xFibrinogen, P $ 102.00 2.7MM CORTX SCR SLF TPNG 14MM $ 103.00

�41

BANNISH BOTTLE $ 103.00 INTRODUCER TRANSITIONLESS 4F $ 103.00 LAB-CULTURE, MYCOPLASMA $ 103.00 MICROPUNCTURE PEDAL ACCESS SET $ 103.00 SHAVER 3.5MM FULL RADIUS $ 103.00 SS GUIDEWIRE .91MM X 80MM $ 103.00 ASSAY OF RIBOFLAVIN VIT B-2 $ 104.00 AXS 3.5MM CORT SC SELFTAP 22MM $ 104.00 GENOTYPING $ 104.00 GLIDE WIRE 150CM STIFF SHAFT $ 104.00 INFRR TURBINATE BLADE 11CMX2MM $ 104.00 LAB-AB TITER PRENATAL $ 104.00 LAB-BETA 2 GLYCOPROTEIN AB E $ 104.00 LAB-FIFTH DISEASE (PARVOVIRU $ 104.00 REF RH PHENOTYPE, COMPLETE $ 104.00 TA 60-3.5 SGL USE LDINGUN $ 104.00 WASHER EXT FIX 7.0MM $ 104.00 #2 SUCTION FRAZIER 8FR $ 105.00 2.3MM GUIDEWIRE $ 105.00 AB: HBSAB $ 105.00 AB; HBCAB - TOTAL $ 105.00 ALEXIS WOUND RETRACTOR XXS $ 105.00 ALLIANCE II SINGLE USE SYRINGE $ 105.00 CITRATE $ 105.00 DRUG SCREEN QUANT CLOZAPINE $ 105.00 GLIDEWIRE ADVANTAGE .035X180CM $ 105.00 HEPB SCREEN HIGH RISK INDIV $ 105.00 LAB-AB TITER PREV PRE-NATAL $ 105.00 LAB-ANTIBODY TITER CURRENT $ 105.00 LAB-ANTIBODY TITER PREVIOUS $ 105.00 LAB-BRUCELLA ABORTUS ABS $ 105.00 LAB-BRUCELLA AB, AGGLUTINATION $ 105.00 LAB-CHROMIUM $ 105.00 LAB-EPSTEIN BARR NUCLEAR AB $ 105.00 LAB-HEP B CONFIRM $ 105.00 LAB-HEP B CORE AB $ 105.00 LAB-HEP B SURF AB $ 105.00 LAB-HEP B SURF AG $ 105.00 LAB-HEPATITIS BE (HBEAB) $ 105.00 LAB-IGE $ 105.00 LAB-IMMUNOGLOBULIN E $ 105.00 LAB-PLAC TEST $ 105.00 SCREW 3.5X14MM CORTICAL $ 105.00 SCREW 3.5X22MM CORTICAL $ 105.00 SCREW 3.5X24MM CORTICAL $ 105.00 SCREW 3.5X26MM CORTICAL $ 105.00 SCREW 3.5X28MM CORTICAL $ 105.00

�42

SCREW 3.5X30MM NONLOCKING $ 105.00 SCREW 3.5X32MM CORTICL SELFTP $ 105.00 SCREW 3.5X38MM CORTICAL $ 105.00 SCREW 3.5X40MM CORTICAL $ 105.00 SCREW 3.5X50MM CORTICAL $ 105.00 SCREW 3.5X55MM CORTICAL $ 105.00 SCREW3.5X36MM CORTICL SELFTAP $ 105.00 SHEATH 14F X 13CM $ 105.00 SHET SILI 50X50X1.6MM XOMED $ 105.00 TRAC MED DRESSING KIT $ 105.00 C REP S/A/L EA ADD 5 CM/< $ 106.00 FACTOR INHIBITOR TEST $ 106.00 FILTER VENA TECH $ 106.00 LAB-PYRUVATE KINASE $ 106.00 M&S ARTERIAL KIT $ 106.00 OSTEOPATHIC MANIP 9-10 REGIONS $ 106.00 PROF-PATH CONSULT INTRP ADDL $ 106.00 SHEATH TEAR AWAY 11F X 30CM $ 106.00 SHEATH TEAR AWAY 6FR X 30CM $ 106.00 SHEATH TEAR AWAY 8F X 30CM $ 106.00 SHEATH TEAR AWAY 9F X 30CM $ 106.00 STONE; IR SPECTROSCOPY $ 106.00 1.2MM X 12IN GUIDE WIRE $ 107.00 ANESTH M&S-BIS SENSOR $ 107.00 CALCIUM; IONIZED $ 107.00 CYTOPATH C/V AUTO FLUID REDO $ 107.00 LAB-CALCIUM IONIZED-BLOOD $ 107.00 LAB-FECAL FAT RANDOM $ 107.00 STERI - DRAPE 3MM $ 107.00 WRIGHT LISFRANC WASHER $ 107.00 CT BONE DENSITY AXIAL $ 107.35 HIP ARTHROGRAPHY INJ W ANESTH $ 108.00 LAB-LEPTOSPIRA AB $ 108.00 PROF -TISSUE EXAM BY PATH 3 $ 108.00 WASHER 7.0MM $ 108.00 BLUNT TIP TROCAR, 10MM $ 109.00 C DIFF AMPLIFIED PROBE $ 109.00 ICM/ILR REM TECH SERV =<30 DYS $ 109.00 ICM/ILR REMT TECH SRV=<30 DAYS $ 109.00 LAB-DESIPRAMINE (NORPRAMIN) $ 109.00 LAB-HPV HUMAN PAPILLOMAVIRUS $ 109.00 LAB-LAMICTAL $ 109.00 PROF PFT*6 MIN WALK TST $ 109.00 REASSESS NUTRITION THER EA 15M $ 109.00 RELOAD TA60-4.8 6/BX $ 109.00 REM INTERROG DEV EVAL ICPMS $ 109.00 REM INTERROG DEV EVAL SCRMS $ 109.00

�43

TA STPLR DST SERIES 30MM-4.8MM $ 109.00 THREADED ROD 300MM $ 109.00 ASSISTIVE TECHNOLOGY ASSESS $ 110.00 CHLAMYDIA CULTURE $ 110.00 ILR DEVICE EVAL PROGR $ 110.00 ILR DEVICE INTERROGATE $ 110.00 INTERROG DEVICE EVAL HEART $ 110.00 INTERROG EVL PM/LDLS PM IP $ 110.00 LAB-CHLAMYDIA CULTURE KH $ 110.00 LAB-EPSTEIN BARR VCA IGG $ 110.00 LAB-EPSTEIN BARR VCA IGM $ 110.00 LAB-EPSTEIN BARR VIRUS VCA I $ 110.00 PM DEVICE EVAL IN PERSON $ 110.00 PM DEVICE PROGR EVAL DUAL $ 110.00 PM DEVICE PROGR EVAL SNGL $ 110.00 PM PHONE R-STRIP DEVICE EVAL $ 110.00 PM/ICD REMOTE TECH SERV $ 110.00 PRGRMG EVAL IMPT DFB SGL LEAD $ 110.00 RADIOLOGY PORT IMAGES(S) $ 110.00 WHEELCHAIR MNGMENT TRAIN EA 15 $ 110.00 CYSTO TUBING $ 111.00 FLEXICAIR ECLIPSE THERAPY $ 111.00 IRRADIATION OF BLOOD $ 111.00 PROF PHYSCN INTERPRETATION PAP $ 111.00 PROF SCRNG TP W MD INTERP $ 111.00 CORTISOL; TOTAL $ 112.00 D-DIMER - QUAN $ 112.00 D-DIMER-QUAN $ 112.00 HD LONG RECIPROCATING BLADE $ 112.00 LAB-CA 125 $ 112.00 LAB-D-DIMER TEST-QUANTITATIV $ 112.00 LAB-ROMA CANCER ANTIGEN 125 $ 112.00 LAB-VIRUS, NOT ELSEWHERE SPE $ 112.00 LAUREATE WIRE NON STIFF ANGLED $ 112.00 STR RECIP BLADE HVY DTY OFFSET $ 112.00 STR RECIP BLADE HVY DUTY OFFST $ 112.00 SUMP SARATOGA (ARGYLE) $ 112.00 xD-Dimer, P $ 112.00 2.0MM GUIDEWIRE W/TROCAR TIP $ 113.00 2.7 X 14MM NON-LOCKING SCREW $ 113.00 2.7 X 16MM NON-LOCKING SCREW $ 113.00 2.7 X 18MM NON-LOCKING SCREW $ 113.00 2.7 X 20MM NON-LOCKING SCREW $ 113.00 2.7 X 22MM NON-LOCKING SCREW $ 113.00 2.7 X 26MM NON-LOCKING SCREW $ 113.00 AB HSV TYPE 2 $ 113.00 BRACE ANKLE GEL $ 113.00

�44

COBALT CO-57-UP TO 1 MICRCUR $ 113.00 CROSSFLO OUTFLO CASSETTE TUBNG $ 113.00 DORSIFLEXION NIGHT SPLINT $ 113.00 ELEC STIMULATION EA 15 MINS $ 113.00 ELECTRICAL STIMULATION EA 15 $ 113.00 ELECTRICAL STIMULATION EA 15 M $ 113.00 HFO NO JOINTS CUSTOM $ 113.00 KO CANVAS IMMOBILIZER PREFAB $ 113.00 LAB-ACETYLCHOLINESTERASE RBC $ 113.00 LAB-FUNGAL AB:CRYPTOCOCCUS A $ 113.00 LAB-HERPES SIMPLEX VIRUS TYPE2 $ 113.00 LAB-HLA TYPE II $ 113.00 ORTHOTIC MGMT&TRAINJ 1ST ENC $ 113.00 PA; SCREEN EA AB $ 113.00 PARAFFIN BATH THERAPY 1+ AREAS $ 113.00 PM DEVICE PROGR EVAL MULTI $ 113.00 PROF MYOCARDIAL PRFUSN IMAG-SI $ 113.00 SHEATH ANSEL 5F X 45CM $ 113.00 VISI FLOW $ 113.00 AB; RUBEOLA $ 114.00 CATHETER KUMPE 5FR/40CM $ 114.00 JOBST EXTREM PUMP RENT $ 114.00 LAB-ANTI PHOS SERINE AB IGA $ 114.00 LAB-ANTI PHOS SERINE IGG $ 114.00 LAB-ANTI PHOS SERINE IGM $ 114.00 LAB-OSMOTIC FRAGILITY $ 114.00 LAB-PRIMODINE LEVEL $ 114.00 STR ONE TRD TUB PLATE, 6 HOLE $ 114.00 TI ONE THIRD TUB PLATE 5 HOLE $ 114.00 TI ONE THIRD TUBU PLATE 7 HOLE $ 114.00 VAC CANISTER KIT W/ISO $ 114.00 VASOPNEUMATIC DEVICE THERAPY 1 $ 114.00 VASOPNEUMATIC DEVICE THERAPY1+ $ 114.00 AABR HEARING SCREEN $ 115.00 ALLIANCE INFILTRATION SYRINGE $ 115.00 INTRACARD ECHO DURING INTERVEN $ 115.00 LAB-FSH $ 115.00 LAB-FSP-SEMI QUANT $ 115.00 LAB-PREALBUMIN $ 115.00 PREALBUMIN $ 115.00 SCREW 4X60MM CANC FULLY THRD $ 115.00 AB; CMV IGM $ 116.00 AMINO ACIDS, QN (SINGLE) $ 116.00 HCG; QUAN $ 116.00 HEPATITIS A ANTIBODY $ 116.00 LAB-AFP QUAD BCHG QUANT $ 116.00 LAB-B HEXOSAMINIDASE $ 116.00

�45

LAB-CYTOMEGALOVIRUS IGM AB $ 116.00 LAB-HEP A PROFILE IGG & IGM $ 116.00 LAB-HEXO A & TOTAL $ 116.00 LAB-PREG QUAN SERUM $ 116.00 ZUMI CATH $ 116.00 FREEMAN WRIST SPLINT $ 117.00 GLIDEWIRE .035 X 80CM $ 117.00 GLIDEWIRE .035X150CM LONG TAPR $ 117.00 LO-PRO SCR TMSS 2.7X30MM CORTX $ 117.00 QUATT LINK SP 4.5MM KNTLS ANCH $ 117.00 TAUT CATHETER 4.5FR 10/BX $ 117.00 GLIDE WIRE EXCHANGE $ 118.00 HC ANESTHESIA PEDIATRIC KIT $ 118.00 HEPATITIS A IGM ANTIBODY $ 118.00 OSCILLATING SAW BLADE $ 118.00 WHO COCK-UP NONMOLDE PRE OTS $ 118.00 13CM SHEATH PULL AWAY $ 119.00 21G X 1.5IN 3ML SYRINGE NEEDLE $ 119.00 259 1 1/2" NEEDLE MHRI $ 119.00 25G X 5/8 1ML SYRINGE NEEDLE $ 119.00 4MM CNCL TI SCR 4.0 L24 FL THR $ 119.00 4MM CNCL TI SCR 4.0 L28 FL THR $ 119.00 4MM CNCL TI SCR 4.0 L28 TL14 $ 119.00 4MM CNCL TI SCR 4.0 L30 FL THR $ 119.00 4MM CNCL TI SCR 4.0 L30 TL14 $ 119.00 4MM CNCL TI SCR 4.0 L32 TL14 $ 119.00 4MM CNCL TI SCR 4.0 L42 TL14 $ 119.00 AB; HSV TYPE 2 $ 119.00 COMPREHEN METABOLIC PANEL $ 119.00 FLOW CYTOMETRY EA ADDTL MARKER $ 119.00 HYPOTHERMIA PAD/BLANKET $ 119.00 LAB-COMPREHENS METABOLIC PAN $ 119.00 LAB-FLOW CYTO TECH EA ADDL M $ 119.00 LAB-THROMBIN TIME $ 119.00 M & S SUPPLY- LEVEL 1 $ 119.00 M&S SUPPLY-LEVEL 1 $ 119.00 NEUROMUSC REEDUCATION EA 15MIN $ 119.00 NEUROMUSCULAR RDCTN EA 15 MINS $ 119.00 NEUROMUSCULAR RDCTN EA 15MINS $ 119.00 NEUROMUSCULAR REEDUCATION EA15 $ 119.00 QCFX CAN SCRST GWR W/TRO 0.045 $ 119.00 SAW BLADE SP105 MHRI $ 119.00 TCBARI BASE MODEL $ 119.00 TIP SUCT YANK W/O CTRL VENT__1 $ 119.00 VAMP TRANSDUCER $ 119.00 1.5 X 8MM NON-LOCKING SCREW $ 120.00 CONICAL WASHER SET $ 120.00

�46

DRUG TEST PRSMV CHEM ANLYZR $ 120.00 LAB-ANTITHROMBIN 3 ACTIVITY $ 120.00 LAB-LACTIC ACID $ 120.00 LACTATE $ 120.00 LIPASE $ 120.00 REFERENCE-ELUTION-ULUKIT II $ 120.00 SHAVE LES T/A/L 0.5CM/< $ 120.00 THORACENTESIS TRAY $ 120.00 TUBE GSTR RPLCMNT 16FR RT ANGL $ 120.00 TUBE GSTR RPLCMNT 18FR RT ANGL $ 120.00 WRC-SHAVING DERM LESION <=.5CM $ 120.00 25CM SHEATH PEEL AWAY $ 121.00 CURETTE #4 CVD $ 121.00 CURETTE #6 CVD $ 121.00 GLIDEWIRE .035 X 180CM $ 121.00 LAB-COXSAC B AB COX SEROTYPE $ 121.00 NEISSERIA AMPLIF NA PROBE $ 121.00 RELOAD GIA 60 - 3.8 $ 121.00 ST SRGLV PL HNDPC MLTP ORF TIP $ 121.00 APPLIER CLIP SURGICLIP III SM $ 122.00 BLOOD GASES W/02 SATURATION $ 122.00 CLIP APPL PREM SURGICLIP 9" SM $ 122.00 CY-TP SCREENING $ 122.00 CY-TP SCRN W/MD INTERPRETATI $ 122.00 GROUP THERAPY NOT MULTI-FAMILY $ 122.00 ISO*99M TC MDP-PER DOSE $ 122.00 LAB-CRYOFIBRINOGEN $ 122.00 5MM BLUNT TIP DISSECTOR $ 123.00 HEMODIALYSIS FLUSH PORT-A-CA $ 123.00 LAB-AFP QUAD ESTRIOL $ 123.00 LAB-ESTRIOL $ 123.00 MANUAL THERAPY EA 15 MINS $ 123.00 XR*CHOLANGIO- OR $ 123.00 BRACHYTX ISODOSE PLAN SIMPLE $ 123.35 FECAL MANAGEMENT SYSTEM BAG $ 124.00 FIRM URETERAL STENT 6FR X 24CM $ 124.00 INJ PARAVERT F JNT L/S 2 LEV $ 124.00 LAB-PLATELET FUNCTION ANAL-A $ 124.00 LAB-PLATELET FUNCTION ANAL-E $ 124.00 LAB-SEMAN ANALYSIS PRES/MOT $ 124.00 M&S-SPINAL ANESTH KIT $ 124.00 M&S-WARM COIL ANESTH $ 124.00 OSTEOPATHIC MANIP 3-4 BODY REG $ 124.00 OSTEOPATHIC MANIP 5-6 BODY REG $ 124.00 PACK MINOR INTERVENTIONAL RIH $ 124.00 PHNLPHRN .9NACL 20MG250 ML SLN $ 124.00 PLT AGGRGTION IN VITRO EA AGNT $ 124.00

�47

SELF CARE MNGMENT TRAINING $ 124.00 TUBESET DECLOG $ 124.00 0.76 X 14MM DRILL BIT $ 125.00 1.4MM SMOOTH TROCAR K-WIRE $ 125.00 2 FIBERSTICK FIBERWIRE 50IN $ 125.00 3.2 X 254MM GRAY DRILL BIT $ 125.00 ALLEN ARM POSITIONER $ 125.00 CHLAMYDIA T AMPLIF NA PROBE $ 125.00 COLD AGGLUTININ; SCREEN $ 125.00 DNA/RNA AMPLIFIED PROBE $ 125.00 FOLEY CATH/DRAIN $ 125.00 INV FLUOROGUIDE VEIN DEVICE SI $ 125.00 KCI WOUND VAC PER DAY $ 125.00 KNEE ARTHRO DIFF COMPARTMNT SK $ 125.00 LAB-SEX HORMONE BINDING GLOB $ 125.00 MILLER ABBOTT TUBE $ 125.00 SCRW ASISIII CNLT 6.5MMX105MM $ 125.00 SHEATH 5FR 13CM FLEXOR $ 125.00 WHO WITHOUT JOINTS CUSTOM $ 125.00 AB ID; PLATELET AB $ 126.00 AB ID; PLATELET IG ASSAY $ 126.00 AB MUMPS $ 126.00 DRUG SCREEN QUAN LAMOTRIGINE $ 126.00 INJ PARAVERT F JNT L/S 3 LEV $ 126.00 LAB - MUMPS AB $ 126.00 LAB-ANTIBODY,MUMPS $ 126.00 LAB-BLOOD ANTIGEN TYPING,DON $ 126.00 LAB-FREE T3 $ 126.00 LAB-HEMOPHILUS INFLUENZA AB $ 126.00 LAB-HEPARIN DEPENDENT AB $ 126.00 LAB-HIT AB REFLEX $ 126.00 LAB-HIT ANTIBODY $ 126.00 LAB-LAMOTRIGINE $ 126.00 NUTRITION VST INITL INDIV 15M $ 126.00 T3; FREE $ 126.00 GLIDECATH ANGLE TAPER 5FX100CM $ 127.00 GLIDECATH ANGLED TAPER 5FX65CM $ 127.00 PACE AID ELECTRODES $ 127.00 PREM SRGCLP L-13.0" TITNM $ 127.00 PRGRMG EVAL IMPL DFB DUAL LEAD $ 127.00 SHAVE LES T/A/L 0.6-1.0CM $ 127.00 SURGICLP PREM CLP APPLER - MED $ 127.00 WRC-SHAVNG DERM LESION .6-1CM $ 127.00 3-WAY CONTINUOUS CATHETER $ 128.00 4 X 32MM CANCELLOUS SCREW $ 128.00 4 X 40MM PARTIALLY THR CAN SCR $ 128.00 4 X 44MM CANCELLOUS SCREW $ 128.00

�48

4 X 46MM FULLY THREADD CAN SCR $ 128.00 4 X 60MM CANCELLOUS SCREW $ 128.00 AXSOS 4MM CAN SCR FLL THD 30MM $ 128.00 BAG URIN W/FOLEY $ 128.00 CAST BOOT $ 128.00 GENET VIRUS ISOLATE HSV $ 128.00 LAB-LIPOPROTEIN (A) $ 128.00 MAXI SPLINT $ 128.00 CENTROMERE ANTIBODY $ 129.00 GLIDEWIRE .035 X 260 REG SHAFT $ 129.00 GLIDEWIRE .035 X 260CM $ 129.00 IMMUNOASSAY NONANTIBODY $ 129.00 LAB- TISSUE TRANSLUTAMINAS I $ 129.00 LAB-GLIADIN IGA $ 129.00 LAB-HISTONE ANTIBODY $ 129.00 LAB-TISSUE TRANSGLUTAMINAS I $ 129.00 LAB-TISSUE TRANSGLUTAMINASE $ 129.00 MIXEVAC BONE CEMENT MIXER $ 129.00 PATH CONSULT INTRAOP ADDL $ 129.00 RIPENING BALLOON $ 129.00 UNV SFT URT STNT-PSTR 6FRX24CM $ 129.00 4.8MM RND FAST CUTTING BURR $ 130.00 LAB-ISOPROPYL ALCOHOL $ 130.00 LAB-METHANOL ALCOHOL $ 130.00 LAB-PLASMINOGEN ACTIVITY $ 130.00 PROF -INVEST TRANS REACTI $ 130.00 ROUND FAST CUTTING BURR 6.3MM $ 130.00 RTS INSTRUMENTS, SIZE 3-4 $ 130.00 DUAL CUT SAGITTAL BLADE WIDE $ 131.00 HC HIGH FLOW NASAL OXYGEN $ 131.00 LAB-METHYLMALONIC ACID $ 131.00 LAB-PSA SCREENING $ 131.00 LAB-T CELLS TOTAL COUNT $ 131.00 ORGANIC ACID SINGLE QUANT $ 131.00 T CELLS; TOTAL COUNT $ 131.00 ASSAY OF VOLATILES $ 132.00 LAB-AUTOANTIBODIES TO U 1 RN $ 132.00 LAB-ENA AB (ANTI-SM) $ 132.00 LAB-ENA ANTIBODY (ANTI-RNP) $ 132.00 LAB-JO-1 AB $ 132.00 LAB-PAPP-A $ 132.00 LAB-PORPHOBILINOGEN QUANT $ 132.00 LAB-PROLACTIN $ 132.00 LAB-SCL-70 AB $ 132.00 LAB-SJOGREN ANTIBODY (ANTI-L $ 132.00 LAB-SJORGEN ANTIBODY (ANTI R $ 132.00 LAB-ZINC $ 132.00

�49

PROLACTIN ASSAY $ 132.00 1.6MM K-WIRE $ 133.00 CARBOHYDRATE DEFICIENT TRANS $ 133.00 ENTEROVIRUS PROBE&REVRS TRNS $ 133.00 HEPATITIS C AB $ 133.00 K-WIRE (STRYKER) $ 133.00 LAB-ALDOLASE $ 133.00 LAB-CANDIDA $ 133.00 LAB-CERULOPLASMIN $ 133.00 LAB-HEP C ANTIBODY $ 133.00 LAB-HEPATITUS C AB $ 133.00 LAB-INSULIN $ 133.00 MR-STAPH DNA AMP PROBE $ 133.00 PROF -CYTP DX EVAL FNA 1ST EA $ 133.00 THREADED ROD 400MM $ 133.00 URTRL ACCSS SHTH20CM 10.7X12.7 $ 133.00 VANCOMYCIN DNA AMP PROBE $ 133.00 C REP TRUNK; EA ADDTL 5 CM/< $ 134.00 LAB - N. GONORRHOEAE AB $ 134.00 LAB-C PEPTIDE $ 134.00 LAB-CAROTENE $ 134.00 LAB-HYDROXYINDOLAECTIC ACID $ 134.00 LAB-NORTRIPTYLINE QN $ 134.00 LAB-PG PHOSPHATIDYLGYCEROL $ 134.00 VERAFLO SM DRESSING $ 134.00 11 X 90 DUAL CUT SAG SAW BLADE $ 135.00 FLEXION GLOVE $ 135.00 LAB-FREE PSA $ 135.00 LAB-HUMAN GROWTH HORMONE $ 135.00 LAB-PORPHOBILINOGEN $ 135.00 LAB-PROSTATIC SPECIFIC ANTIG $ 135.00 LAB-PSA WITH REFLEX $ 135.00 PSA; FREE $ 135.00 PSA; TOTAL $ 135.00 XR*TEETH, SINGLE VIEW $ 135.00 CATHETER PIGTAIL 130CM $ 136.00 GLIDEWIRE 035/180/3CM FLEX TIP $ 136.00 HEPARIN ASSAY $ 136.00 INJ PARAVERT F JNT C/T 2 LEV $ 136.00 LAB-ERYTHROPOIETIN $ 136.00 LAB-HEPARIN ASSAY $ 136.00 LAB-HEPARIN ASSAY XA $ 136.00 LAB-HEPATITIS BE ANTIGEN $ 136.00 POOLING OF PLATELETS OR OTHE $ 136.00 PROF RADIONUCLIDE VENTRCULOGRM $ 136.00 THERAPEUTC EXERCSES EA 15 MINS $ 136.00 THERPEUTC EXERCS EA 15 MINS PT $ 136.00

�50

UNLISTED REHAB MODALITY $ 136.00 ACTIVE LIFE $ 137.00 CROSSFLOW INFLW CASSETTE TUBNG $ 137.00 FOLIC ACID; rbc $ 137.00 LAB-RBC FOLATE $ 137.00 CLOTTING INHIBITR PROTN S FREE $ 138.00 CSTS/STS GUIDE PIN $ 138.00 FLEXOR CHECK-FLO 4FRX55CM $ 138.00 INJ PARAVERT F JNT C/T 3 LEV $ 138.00 LAB-CELL COUNT BF $ 138.00 LAB-CELL COUNT SPINAL FLUID $ 138.00 LAB-FRUCTOSAMINE $ 138.00 LAB-LEGIONELLA PNEUM, AB $ 138.00 LAB-NUCLEOTIDASE 5 $ 138.00 LAB-PLASMA HGB $ 138.00 LAB-PROCAINAMIDE PRONSTYLE N $ 138.00 PMI DISPSBL CHOLANGIO CATH 13" $ 138.00 PREVENA PLUS 150ML CANISTER $ 138.00 PROF -PATH CONSULT DURING SURG $ 138.00 SCR CORTICAL ACUMED 3.5 X 12MM $ 138.00 SHEATH 7 F X 55CM ANSEL $ 138.00 SHEATH 8 F X 55 CM ANSEL $ 138.00 SHEATH ANSEL 6FR X 55CM $ 138.00 SHEATH ANSEL 7F X 55CM $ 138.00 SHEATH FLEXOR 8FR 55CM $ 138.00 SMEAR SPECIAL STAIN $ 138.00 STRAPPING; ELBOW OR WRIST $ 138.00 STRAPPING; HAND OR FINGER $ 138.00 WHFO RIGID NO JOINTS REST CUST $ 138.00 WIRE TIP DEFLECTING .035X145CM $ 138.00 ANTINUCLEAR AB (ANA); $ 139.00 B CELLS TOTAL COUNT $ 139.00 CRUTCH W/PAD & TIP $ 139.00 GLIDEWIRE .018 X 180CM $ 139.00 INITIAL OBS HIGH SEVERITY $ 139.00 INITIAL OBS LOW SEVERITY $ 139.00 INITIAL OBS MODERATE SEVERITY $ 139.00 IRRIGATION KIT $ 139.00 LAB-B CELLS TOTAL COUNT $ 139.00 LAB-CARCINOEMBRYONIC ANTIGEN $ 139.00 LAB-NAT KILLER CELLS TOTAL C $ 139.00 LAB-SICKLE CELL SCREEN $ 139.00 NK CELLS TOTAL COUNT $ 139.00 OBS/HOSP SAME DATE HIGH SEVRTY $ 139.00 OBS/HOSP SAME DATE LOW SEVERTY $ 139.00 OBS/HOSP SAME DATE MOD SEVERTY $ 139.00 2.5 FULL RADIUS CUTTER SHAVER $ 140.00

�51

CANALITH REPOSITIONING PROC $ 140.00 CLIP APPLIER PRM SURGICLIP MED $ 140.00 INCAL BX SKN EA SEP/ADDL $ 140.00 LAB-LEUKOCYTE ALKALINE PHOSP $ 140.00 LAB-LIPOPROTEIN PHENOTYPE $ 140.00 LAB-MEASLES G/M AB $ 140.00 Lab-Prostatic Acid Phosphata $ 140.00 LAB-REVERSE T3 $ 140.00 LAB-VITAMIN E $ 140.00 PT; SUBS PLASMA FRACTION EACH $ 140.00 PUNCH BX SKIN EA SEP/ADDL $ 140.00 SHAVE LES T/A/L 1.1-2.0CM $ 140.00 TANGNTL BX SKIN EA SEP/ADDL $ 140.00 THERAPEUTIC ACTIVITIES $ 140.00 THERAPEUTIC ACTIVITIES OT $ 140.00 THERAPEUTIC ACTIVITIES PT $ 140.00 WASHER 7MM (RED) $ 140.00 WRC-SHAVE DERMAL LESIN 1.1-2CM $ 140.00 LAB-STRONGYLOIDES SEROLOGY $ 141.00 TESTOSTERONE; FREE $ 141.00 WND ABTHERA NEG PRESS THER UNT $ 141.00 xSoluble Fibrin Monomer $ 141.00 LAB-ACTH $ 142.00 LAB-HEMOGLOBIN ELETRO $ 142.00 LAB-TRNSCORTIN(CORT BIND GLO $ 142.00 LAB-VITAMIN A $ 142.00 SURG PATH LVL 2 $ 142.00 TYMPANOMETRY $ 142.00 2.7MM X 10.0MM CORTICAL SCREW $ 143.00 ANESTH M&S-FEM-A-LINE $ 143.00 CAST SPLINT SYS 4 INX15FT $ 143.00 IMMUNOASSAY QUANT NOS NONAB $ 143.00 LAB-C1 ESTERASE INHIBITOR $ 143.00 LAB-FREE LIGHT CHAINS $ 143.00 LAB-GLUCOSE (G6PD) $ 143.00 LAB-IGF BINDING PROTEIN 3 $ 143.00 LAB-IMMUNOASSAY, ANALYTE, QU $ 143.00 LAB-IMMUNOASSAY, ANALYTE,EAC $ 143.00 LAB-INHIBIN B $ 143.00 LAB-M TUBERCULOSIS QUANTIFERON $ 143.00 LAB-METHOTREXATE $ 143.00 LAB-MYELOPEROXIDASE ANTIB SE $ 143.00 LAB-S CEREVISIAE AB, I8A $ 143.00 LAB-S CEREVISIAE AB, I8G $ 143.00 LAB-VITAMIN C (ASCORBIC ACID $ 143.00 LAMBDA FREE LIGHT CHAINS $ 143.00 MED ACCESSORY KIT TORQUE $ 143.00

�52

NONLOCKING SCREW T10, 3.5X12MM $ 143.00 NOVASTEP FUSION BOLT 80MM $ 143.00 SCHANZ PIN 6.0 $ 143.00 SCR CORTICAL ACUMED 3.5 X 10MM $ 143.00 SCREW 3.5X12MM CORTICAL $ 143.00 SCREW 3.5X16MM CORTICAL $ 143.00 COLLAR CERV W/PADS ADULT SHORT $ 144.00 ELECTRIC CURRENT THERAPY EA 15 $ 144.00 FEEDING TUBES $ 144.00 INV CATH INTRO COOK 12 FR $ 144.00 LAB-SEMEN ANALYSIS-POST-VAS $ 144.00 MECHNCL TRCTN THRPY 1+ AREAS $ 144.00 PACK PEDI MINOR 8939994 $ 144.00 PHYSICAL PERFORM EA 15M $ 144.00 PROSTHETIC TRAINJ 1ST ENC $ 144.00 TRIPLE LUMEN CATH $ 144.00 ULTRASOUND THERAPY EA 15 MINS $ 144.00 BLD ARTSCPC INCI PLS CTR 3.5MM $ 145.00 BONE SCREW T10 3.5X12MM $ 145.00 DRUG SCREENING OXYCODONE $ 145.00 DRVR SURG L101.6MM OD2MM SS $ 145.00 LAB-DILANTIN (FREE) $ 145.00 MAGNUM II BARIATRIC BED / DA $ 145.00 NON-LOCKING SCREW T10 3.5X14MM $ 145.00 NON-LOCKING SCREW T10 3.5X42MM $ 145.00 NON-LOCKING SCREW T10 3.5X70MM $ 145.00 SCR BONE L14MM OD3.5MM TI FT $ 145.00 SCR TORX BONE T10 3.5X22MM $ 145.00 SCREW 3.5X10MM CORTICAL $ 145.00 STRY OSCIL BLD 79MMX8MMX1.27MM $ 145.00 VENOGRAM BALLOON $ 145.00 BREAST TOMOSYNTHESIS UNI $ 146.00 CLOTTNG FACTR VIII VW FACTR AG $ 146.00 LAB-CALCITONIN RIA $ 146.00 LAB-COAG & FIBR FUNCT ACTIVI $ 146.00 LAB-E.HISTOLYTICA AB $ 146.00 LAB-EHRLICHIA ANTIBODIES $ 146.00 LAB-EPSTEIN-BARR (EA) $ 146.00 LAB-FACTOR 8 ANTIGEN (VW) $ 146.00 LAB-TROPONIN $ 146.00 LAB-VONWILLIEBRAND FACTOR $ 146.00 MON DISP CORE BX INST 14GX10CM $ 146.00 INV SPECIAL PHYSICS CONSULT $ 147.00 ISO*GALLIUM GA 67 PER MILICU $ 147.00 THERPEUTC EXERCS EA 15 MINS OT $ 147.00 UROSTOMY KIT $ 147.00 3.5MM X 12.0MM CORTICAL SCREW $ 148.00

�53

BIOPSY NEEDLE $ 148.00 COMMUNITY/WORK REINTEGRATION $ 148.00 LAB-ANTI DNASE B TITER $ 148.00 LAB-FSP-FIBRIN SPLIT PRODUCT $ 148.00 PIN FIX OD1.1MM SM FT TEMP $ 148.00 SCREW CORTICAL 3.5X14MM ACUMED $ 148.00 SCREW CORTICAL ACUMED 3.5X12MM $ 148.00 STR 4MM CNCL TI SC 4MM 50MM FT $ 148.00 STR 4MM CNCL TI SC 4MM 55MM FT $ 148.00 17-HYDROXYPREGNENOLONE $ 149.00 4 IN 11GA PORTED VACLOK 20CC $ 149.00 CANCELLOUS SCREW $ 149.00 CANCELLOUS SCREWS $ 149.00 LAB-ACHR BINDING AB $ 149.00 LAB-FACTOR 10 $ 149.00 LAB-FACTOR 11 $ 149.00 LAB-FACTOR 12 (HAGEMAN FACTO $ 149.00 LAB-FACTOR 13 LEVEL $ 149.00 LAB-FACTOR 7 $ 149.00 LAB-FACTOR II $ 149.00 LAB-INSULIN GROWTH FACTOR $ 149.00 LAB-PROGESTERONE $ 149.00 LAB-SUGARS, SINGLE QUAL $ 149.00 PRGRMG EVAL IMPL DFB MULT LEAD $ 149.00 PROINSULIN $ 149.00 STR SHRP DRLBT DIA 2MM AO LG70 $ 149.00 2.5 X 34MM CORTICAL SCREW $ 150.00 3.5 X 12MM LOW PROF SCREW $ 150.00 3.5 X 13MM LOW PROF NL SCREW $ 150.00 3.5 X 14MM LOW PROF SCREW $ 150.00 3.5 X 34MM CORTICAL SCREW $ 150.00 3.5 X 36MM LOW PROFILE SCREW $ 150.00 3.5 X 40MM LOCKING SCREW $ 150.00 3.5 X 46MM LOW PROFILE SCREW $ 150.00 BB-TAK $ 150.00 EWHO WITHOUT JOINTS CUSTOM $ 150.00 HYDROXYPROGESTERONE 17-D $ 150.00 KO ELASTIC WITH JOINTS PREFAB $ 150.00 LAB-CRYSTALS SYNOVIAL FLUID $ 150.00 LAB-DHEA $ 150.00 LAB-FACTOR V ACTIVITY $ 150.00 LAB-FACTOR-9 (PTC/XMAS) $ 150.00 LAB-GLUCAGON $ 150.00 LAB-HYDROXYPROGESTRONE 17ALP $ 150.00 LAB-TRAZODONE LEVEL $ 150.00 MOD SED OTH PHYS/QHP <5 YRS $ 150.00 MOD SED OTH PHYS/QHP 5/>YRS $ 150.00

�54

MOD SED OTHER PHYS/QHP EA $ 150.00 MOD SED SAME PHYS/QHP <5 YRS $ 150.00 MOD SED SAME PHYS/QHP 5/>YRS $ 150.00 MOD SED SAME PHYS/QHP EA $ 150.00 MOD SEDAT ENDO SERVICE >5YRS $ 150.00 PASSPORT BUTTON CANULA 12MX3CM $ 150.00 PROF SLEEP STUDY UNATTENDED $ 150.00 SHEATH 12F X 30CM $ 150.00 SHEATH RAABE 5F X 70CM $ 150.00 SHEATH RAABE 6F X 70CM $ 150.00 SHEATH RAABE 6F X 90CM $ 150.00 2.7 X 14MM VARIAX SCREW $ 151.00 2.7 X 16MM VARIAX SCREW $ 151.00 3.5 X 16MM LOW PROFILE SCREW $ 151.00 3.5 X 20MM LOW PROFILE SCREW $ 151.00 6 X 35MM CANC TI FULL THD SCR $ 151.00 6 X 45MM CANC TI FULL THD SCR $ 151.00 6 X 50MM CANC TI FULL THD SCR $ 151.00 6 X 55MM CANC TI FULL THD SCR $ 151.00 6 X 60MM CANC TI FULL THD SCR $ 151.00 6 X 65MM CANC TI FULL THD SCR $ 151.00 6 X 70MM CANC TI FULL THD SCR $ 151.00 6 X 75MM CANCELLOUS SCREW $ 151.00 6 X 80MM CANC TI FULL THD SCR $ 151.00 ACJ BILATERAL W/WO WEIGHTS $ 151.00 BONE SCREW T10 3.5X16MM $ 151.00 KNEE BOTH KNEES STANDING AP $ 151.00 KNEE; BOTH KNEES STANDING AP $ 151.00 LAB-AMPHETAMINE OR METHAMPHE $ 151.00 LAB-CARBOHYDRATE ANTIGEN 19- $ 151.00 LAB-CH50 (COMPLEMENT) $ 151.00 LAB-CK-MB TOTAL $ 151.00 LAB-ESTRONE $ 151.00 LAB-NSA, INFLAM. BOWEL $ 151.00 LAB-OPIATE ANALYSIS $ 151.00 LAB-THYROGLOBULIN ANTIBODY $ 151.00 LAB-URINE COCAINE CONFIRMATI $ 151.00 NASOTRACHEAL SUCTIONING $ 151.00 NON-LOCKING SCREW T10 3.5X26MM $ 151.00 NOSE TO RECTUM FOR FB CHILD $ 151.00 PROF CYTOPATH CELL ENHANC TECH $ 151.00 SCR 2.0MM CORT SLF TAP 12MM $ 151.00 SGL VW SPINE XR $ 151.00 SHEATH INTRODUCERS 11/13CM $ 151.00 SP*UNLISTED DIAG RAD PROCEDU $ 151.00 TMJ JOINT - UNILATERAL $ 151.00 XR ACJ BILATERAL W/WO WEIGHTS $ 151.00

�55

XR EXAM HIP UNI 1 VIEW $ 151.00 XR EXAM OF ANKLE 2 VIEWS $ 151.00 XR EXAM OF BREASTBONE 2+ VIEWS $ 151.00 XR EXAM OF BREASTBONE 3+ VIEWS $ 151.00 XR EXAM OF ELBOW 2 VIEWS $ 151.00 XR EXAM OF HEEL 2+ VIEWS $ 151.00 XR EXAM OF NASAL BONES 3+VIEWS $ 151.00 XR EXAM OF SHOULDER 1 VIEW $ 151.00 XR EXAM OF TAILBONE 2+ VIEWS $ 151.00 XR EXAM OF TOE(S) 2+ VIEWS $ 151.00 XR EXAM OF WRIST 2 VIEWS $ 151.00 XR EXAM THORACOLMB 2/> VW $ 151.00 XR EXM OF FACIAL BONES <3VIEWS $ 151.00 XR FB IN EYE $ 151.00 XR NECK SOFT TISSUE $ 151.00 XR OPTIC FORAMINA $ 151.00 XR*ACROMIOCLAVICULAR JOINT, $ 151.00 XR*BIL HIP, UNI W/PELV 1V OR $ 151.00 XR*BILATERA, HIP, UNIL, 1 VIEW $ 151.00 XR*BILATERAL ANKLE, 2V $ 151.00 XR*BILATERAL ELBOW 2V $ 151.00 XR*BILATERAL HEEL, 2V MIN $ 151.00 XR*BILATERAL LEG, INFANT, 2V $ 151.00 XR*BILATERAL SHOULDER 1 VIEW $ 151.00 XR*BILATERAL TOES, 2V MIN $ 151.00 XR*BILATERAL WRIST 2V $ 151.00 XR*BOTH KNEES, STANDING AP $ 151.00 XR*CHILD,F.B. SINGLE FILM $ 151.00 XR*EYE/FOREIGN BODY $ 151.00 XR*FACIAL BONES < 3v $ 151.00 XR*LEFT HIP, UNI W/PELV 1V OR $ 151.00 XR*LEFT, HIP, UNIL, 1 VIEW $ 151.00 XR*LEFT-ANKLE, 2 VIEWS $ 151.00 XR*LEFT-ELBOW, 2 VIEWS $ 151.00 XR*LEFT-FOOT,FIFTH DIGIT,2V $ 151.00 XR*LEFT-FOOT,FOURTH DIGIT,2V $ 151.00 XR*LEFT-FOOT,GREAT TOE,2V MI $ 151.00 XR*LEFT-FOOT,SECOND DIGIT,2V $ 151.00 XR*LEFT-FOOT,THIRD DIGIT,2V $ 151.00 XR*LEFT-HEEL, 2V MIN $ 151.00 XR*LEFT-LEG,INFANT, 2V MIN $ 151.00 XR*LEFT-SHOULDER,1VIEW $ 151.00 XR*LEFT-WRIST, 2 VIEWS $ 151.00 XR*MANDIBLE <4V $ 151.00 XR*NASAL BONES 3V MIN $ 151.00 XR*NECK SOFT TISSUE $ 151.00 XR*RGHT HIP, UNI W/PELV 1V OR $ 151.00

�56

XR*RIGHT, HIP, UNIL, 1 VIEW $ 151.00 XR*RIGHT-ANKLE, 2 VIEWS $ 151.00 XR*RIGHT-ELBOW, 2 VIEWS $ 151.00 XR*RIGHT-FOOT,FIFTH DIGIT,2V $ 151.00 XR*RIGHT-FOOT,FOURTH DIGIT,2 $ 151.00 XR*RIGHT-FOOT,GREAT TOE,2V M $ 151.00 XR*RIGHT-FOOT,SECOND DIGIT,2 $ 151.00 XR*RIGHT-FOOT,THIRD DIGIT,2V $ 151.00 XR*RIGHT-HEEL, 2V MIN $ 151.00 XR*RIGHT-LEG,INFANT 2V MIN $ 151.00 XR*RIGHT-SHOULDER,1VIEW $ 151.00 XR*RIGHT-WRIST, 2 VIEWS $ 151.00 XR*SACRUM OR COCCYX $ 151.00 XR*SELLA TURCICA $ 151.00 XR*SINUSES,<3 VIEWS $ 151.00 XR*SPINE SINGLE VIEW SPEC LE $ 151.00 XR*SPINE,THORACOLUMBAR 2 VIE $ 151.00 XR*STERNOCLAVICULAR 3V MIN $ 151.00 XR*STERNUM 2V MIN $ 151.00 XR*TEMOROMANDIBULAR, UNILAT $ 151.00 XR*TOES LT, TWO OR MORE,2V M $ 151.00 XR*TOES RT, TWO OR MORE, 2V $ 151.00 X-RAY EXAM ABDOMEN 1 VIEW $ 151.00 X-RAY EXAM HIP UNI 1 VIEW $ 151.00 X-RAY EXAM OF ANKLE 2 VIEWS $ 151.00 X-RAY EXAM OF ELBOW 2 VIEWS $ 151.00 X-RAY EXAM OF HEEL 2+ VIEWS $ 151.00 X-RAY EXAM OF SINUSES <3 VIEWS $ 151.00 X-RAY EXAM OF TOE(S) 2+ VIEWS $ 151.00 X-RAY EXAM OF WRIST 2 VIEWS $ 151.00 X-RAY EXAM THORACOLMB 2/> VW $ 151.00 17-KS; FRACTIONATION $ 152.00 AB: HBCAB-TOTAL $ 152.00 AB; HTLV OR HIV WB $ 152.00 LAB-ANTIBODY BACTERIUM $ 152.00 LAB-HIV CONFRIMATORY $ 152.00 LAB-HTLV 1-2 ANTIBODY CONFIR $ 152.00 LAB-IMMUNODIFFUSION-KAPPA $ 152.00 LAB-IMMUNODIFFUSION-LAMDA $ 152.00 2 X 315MM K-WIRE DRILL TIP $ 153.00 AB; PROTOZOA NES $ 153.00 INTRO NDL ICATH UPR/LXTR ART $ 153.00 LAB-BABESIA MICROTI IGG AB $ 153.00 LAB-CRYPTOCOCCAL ANTIBODY $ 153.00 LAB-HERPES SIMPLEX TYPE 2 $ 153.00 LAB-PROTEIN S TOTAL $ 153.00 LAB-VON WILLEBRAND MULTIMERI $ 153.00

�57

WRIGHT TEMPORARY FIXATION PIN $ 153.00 AMYLASE $ 154.00 DISP INNER CANNULA $ 154.00 LAB-ALDOSTERONE $ 154.00 LAB-ALDOSTERONE 24 HR U $ 154.00 LAB-PYRUVATE ACID $ 154.00 LAB-TESTOSTERONE (TOTAL) $ 154.00 LAB-TESTOSTERONE TOTAL $ 154.00 SPLINTS-ADULT $ 154.00 TESTOSTERONE; TOTAL $ 154.00 1.7X20MM BN SCR CRSS PIN SLFTP $ 155.00 2.3X18MM BN SCR CRSPN SLF TPNG $ 155.00 2.3X20MM BN SCR CRSPN SLF TPNG $ 155.00 BAIR HUGGER BLANKET $ 155.00 COOK FLEXOR 7Fr X 45CM $ 155.00 EP DIAG/ABL CATH 4 POLE $ 155.00 INV RAD EXAM CHEST SING VIEW $ 155.00 LAB-ASPERGILLUS TITRE $ 155.00 LAB-INTRINSIC FACT AB $ 155.00 LAB-T CELLS T4 & T8 W/ RATIO $ 155.00 OBS IVF-NC EXC HYDR EA ADD H $ 155.00 OBS IVP-NC EACH ADDL SEQ SAM $ 155.00 OR IVP-NC EACH ADDL SEQ SAME $ 155.00 OR-IVF NC EXC HYDR EA ADDL H $ 155.00 OR-IVP-NC EACH ADDL SEQ SAME $ 155.00 SCR 2.3 BONE 10MM $ 155.00 SCR 2.3 BONE 12MM $ 155.00 SCR BONE 9X2.3MM SLFTAP NONLCK $ 155.00 SCREW 1.7MM BONE LEN MM: 11MM $ 155.00 SCREW 1.7MM BONE LEN MM: 12MM $ 155.00 SCREW 2.3X12MM NONLOCKING $ 155.00 SCREW BONE 2.3 X 10 $ 155.00 SHEATH BALKIN 6F X 40CM $ 155.00 SHEATH BALKIN 7F X 40CM $ 155.00 SHEATH BALKIN 8F X 40CM $ 155.00 SHEATH FLEXOR 12FR 45CM ANSEL $ 155.00 SP IVP-NC EACH ADD'L SEQ SAM $ 155.00 SP*IVF NC EXC HYDR EA ADDL H $ 155.00 STOP DRILL BIT DIA 2MM AO $ 155.00 T CELLS; ABSOL CD4 AND CD8 $ 155.00 THER/PROPH/DIAG IV INF ADDON $ 155.00 TRACH TUBE PEDI 3.5MM $ 155.00 TX/PRO/DX INJ SAME DRUG ADDON $ 155.00 BAXTER VIP SWAN GANZ CATH $ 156.00 BLACK MAXX $ 156.00 BNE SCR 2.3X24MM CRSSPN SLFTAP $ 156.00 LAB-BRUCELLA ANTIBODY TITER $ 156.00

�58

LAB-PARATHYROID HORMONE $ 156.00 LAB-PTH INTACT $ 156.00 LAB-THYROTROPIN RECEPTOR AB $ 156.00 LAB-VASO-INTEST-POLYPEPTIDE $ 156.00 M&S CVP/MONITOR KIT $ 156.00 PACK MAJOR INTERVENTIONAL RIH $ 156.00 PRLNG E&M/PSYCTX SRV O/P 1HR $ 156.00 PRLNG E&M/PSYCTX SRV O/P EA30M $ 156.00 PROF -INTROP CYTO PATH CONS 2 $ 156.00 PROLONG E&M/PSYCTX SERV O/P $ 156.00 PURAPLY 1 SQ CM $ 156.00 PURAPLY AM 1 SQ CM $ 156.00 PURAPLY XT 1 SQ CM $ 156.00 SOLO PLUS GUIDEWIRE .035 $ 156.00 cosyntropin 0.25 mg PWDI $ 156.24 CNTRLZR DST 13MM RELIANCE $ 157.00 EVOKED AUDITORY TEST QUAL $ 157.00 LAB-TOXACARA SEROLOGY $ 157.00 PROF VASC LAB-ARTRL U EXTR $ 157.00 ROBERTS UTERINE CURVE CATHETER $ 157.00 SPACER OMINIFIT DIST CMNT 14MM $ 157.00 XR EXAM OF FINGER(S) 2+ VIEWS $ 157.00 XR EXAM OF FINGER(S) 2+VIEWS $ 157.00 XR EXAM OF FOOT 2 VIEWS $ 157.00 XR EXAM OF FOOT; 2 VIEWS $ 157.00 XR EXAM OF FOREARM 2 VIEWS $ 157.00 XR*BILATERAL FOOT, 2V $ 157.00 XR*BILATERAL FOREARM 2V $ 157.00 XR*BILATERAL-FINGERS $ 157.00 XR*FINGERS LT, TWO OR MORE $ 157.00 XR*FINGERS RT, TWO OR MORE $ 157.00 XR*LEFT-FOOT, 2 VIEWS $ 157.00 XR*LEFT-FOREARM, 2 VIEWS $ 157.00 XR*LEFT-HAND,FIFTH DIGIT,2V $ 157.00 XR*LEFT-HAND,FOURTH DIGIT,2V $ 157.00 XR*LEFT-HAND,SECOND DIGIT,2V $ 157.00 XR*LEFT-HAND,THIRD DIGIT,2V $ 157.00 XR*LEFT-HAND,THUMB, 2V MIN $ 157.00 XR*RIGHT-FOOT, 2 VIEWS $ 157.00 XR*RIGHT-FOREARM, 2 VIEWS $ 157.00 XR*RIGHT-HAND,FIFTH DIGIT,2V $ 157.00 XR*RIGHT-HAND,FOURTH DIGIT,2 $ 157.00 XR*RIGHT-HAND,SECOND DIGIT,2 $ 157.00 XR*RIGHT-HAND,THIRD DIGIT,2V $ 157.00 XR*RIGHT-HAND,THUMB,2V MIN $ 157.00 X-RAY EXAM OF FOOT 2 VIEWS $ 157.00 X-RAY EXAM OF FOREARM 2 VIEWS $ 157.00

�59

3.5 X 16MM NL HEX SCREW $ 158.00 3.5 X 18MM NL HEXALOBE SCR $ 158.00 3.5 X 20MM NL HEXALOBE SCR $ 158.00 3.5 X 22MM NL HEXALOBE SCR $ 158.00 3.5 X 26MM NL HEXALOBE SCR $ 158.00 3.5 X 38MM NL HEXALOBE SCR $ 158.00 3.5 X 63MM NL HEXALOBE SCR $ 158.00 ENDO SHEARS $ 158.00 ENDO SHEARS 5MM $ 158.00 HERPES SIMPLEX 1 AG IF $ 158.00 HERPES SIMPLEX 2 AG BY IF $ 158.00 IMMUNOHISTO ANTIBODY ADDL SLID $ 158.00 LAB-EPSTEIN-BARR VIRUS IGG & $ 158.00 LAB-FRACTIONATED PORPHYRINS $ 158.00 LAB-STAIN-GROUP 1 * $ 158.00 NEEDLE JAMSHIDI $ 158.00 PROF -IMMUNHIST ANTBODY ADD $ 158.00 PROF-HISTO ANTIBODY ADD SLID $ 158.00 SCREW 3.5 X 10MM NL HEXALOBE $ 158.00 SCREW 3.5 X 14MM NL HEXALOBE $ 158.00 SCREW 3.5X20MM NONLOCKNG HEX $ 158.00 AB; RICKETTSIA $ 159.00 LAB-C1Q IMMUNO COMPLEX BIND/ $ 159.00 LAB-COLD AGGLUTININ;SCREEN $ 159.00 LAB-Q FEVER AB $ 159.00 LAB-RICKETTSIAL DISEASE AB $ 159.00 LAB-ROCKY MT SPOTTED FEVER $ 159.00 LAB-TULAREMIA AB $ 159.00 PROF BLOOD AUTH & RPT $ 159.00 PROF CROSS MATCH I&R $ 159.00 PROF CT ANGIO CORONARY $ 159.00 PROF MYOCARDIAL PRFUSN IMAG-MU $ 159.00 WIRE, DIAMOND POINT 1.8X450MM $ 159.00 LAB-CARBMEZAPINE, FREE $ 160.00 LAB-DHEA-SULFATE $ 160.00 LAB-GIARDIA LAMBLIA AB, IFA $ 160.00 LAB-ISH, AUTO $ 160.00 LAB-NEUTROPHIL CYTO AB (ANCA $ 160.00 LAB-THYROID STIMULATING IMMU $ 160.00 PROF - SPECIAL STAINS GROUP 2 $ 160.00 BRACHYTX ISODOSE INTERMED $ 160.19 LAB-ANTIBODY,ENCEPH EAST EQU $ 161.00 LAB-BLASTOMYCOSIS $ 161.00 LAB-CA 27.29 $ 161.00 LAB-CANCER ANTIGEN 15-3 $ 161.00 LAB-FUNGAL AB: BLASTOMYCES A $ 161.00 LAB-SURGICAL PATH CONSULT $ 161.00

�60

LAB-TRICHINELLA IGG & IGM $ 161.00 PACK PEDI MAJOR $ 161.00 30.5 X 26CM WOUND VAC DRAPE $ 162.00 LAB-ANTIBODY,ENCEP CALIFORNI $ 162.00 LAB-ANTIBODY,ENCEPH ST LOUIS $ 162.00 LAB-ANTIBODY,ENCEPH WEST EQU $ 162.00 LAB-DELTA AMINOLEVULINIC ACI $ 162.00 LAB-LYME C-6 PEPTIDE AB INDE $ 162.00 2.7 X 20MM NL HEXALOBE SCREW $ 163.00 2.7MM CORTX SCR SLF TAP 12MM $ 163.00 AB; BARTONELLA $ 163.00 CATHETER DAWSN MUELLR 10FX25CM $ 163.00 CATHETER DAWSN MUELLR 14FX25CM $ 163.00 CATHETR DAWSN MUELLR 8.5FX25CM $ 163.00 EO WITHOUT JOINTS CUSTOM $ 163.00 LAB-BARTONELLA ANTIBODY PANE $ 163.00 LAB-FATTY ACID PROFILE $ 163.00 LAB-SINGLE STRANDED DNA $ 163.00 SCREW 2.7X18MM CORTEX SELF TAP $ 163.00 SCREW 2.7X28MM NONLOCKING HEX $ 163.00 SCREW 2.7X8MM NONLOCKNG HEXLB $ 163.00 SCREW 3.5X12MM NLOCKING HEX $ 163.00 SCREW 3.5X12MM NONLOCKING HEX $ 163.00 TESTOSTERONE BIOAVAILABLE $ 163.00 VERSA1 BLNT TRO W THRANC 12MM $ 163.00 CUSTOM, HEAD & NECK 89-8620 $ 164.00 DRESSING HYDPHL POLYUR FOAM4IN $ 164.00 IMPLANT STRYKER DISTAL STEM $ 164.00 LAB-IMMUNOFIXATION SERUM $ 164.00 LAB-RIBA TEST - HCV CONFIRMA $ 164.00 LAB-X IMMUNOELECTROPHORESIS $ 164.00 REAMER 11MM RND $ 164.00 REAMER RND 12MM $ 164.00 SCR 2.3 LCK 18MM $ 164.00 SCREW 1.7MM LOK LEN MM: 7MM $ 164.00 SCREW 1.7MM LOK LEN MM: 8MM $ 164.00 SCREW 1.7X10MM LOCKING $ 164.00 SCREW 2.3X18MM LOCKING $ 164.00 SCREW 2.3X22MM LOCKING $ 164.00 SERUM IMMUNFIXATION ELECTRPHRS $ 164.00 STIM-III VARI 8562010 $ 164.00 XR EXAM OF KNEE 1 OR 2 $ 164.00 XR EXAM OF LOWER LEG 2 VIEWS $ 164.00 XR*BILATERAL KNEE, 1 OR 2V $ 164.00 XR*BILATERAL TIBIA/FIBULA, 2 $ 164.00 XR*LEFT-KNEE 1 OR 2V $ 164.00 XR*LEFT-TIBIA/FIBULA, 2 VIEW $ 164.00

�61

XR*RIGH-TIBIA/FIBULA, 2 VIEW $ 164.00 XR*RIGHT-KNEE 1 OR 2V $ 164.00 X-RAY EXAM OF KNEE 1 OR 2 $ 164.00 2.0MM DRILL $ 165.00 CATHETER MULTI 22F X 40CM $ 165.00 LAB-ADENOVIRUS $ 165.00 PLATELET NEUTRALIZATION $ 165.00 RAPTOR GRASPING FORCEPS $ 165.00 X-RAY EXAM ABDOMEN 2 VIEWS $ 165.00 COMP TEST EA UN, ANTIGLOB ME $ 166.00 COMPATIBILITY TEST SPIN $ 166.00 COMPATIBILITY TEST, EACH UNI $ 166.00 CP SMR OTHR; PREP SCRN INT $ 166.00 CROSSMATCH $ 166.00 DUAL LUMEN URETERAL CATHETER $ 166.00 ELEC STMLTION THERAPY 1+ AREAS $ 166.00 ELECTRIC STMLTN THRPY 1+ AREAS $ 166.00 EMBOLIZATION COIL $ 166.00 FLEXICAIR M4000(MC3) THERAPY $ 166.00 LAB-C1 ESTERASE QUAN FUNCTIO $ 166.00 LAB-GAD 65 AB ASSAY $ 166.00 LAB-LYMPHOCYTIC CHORIOMENING $ 166.00 LAB-SEROTONIN (HIAA BLOOD) $ 166.00 OT EVAL LOW COMPLEX 30 MIN $ 166.00 PT EVAL LOW COMPLEX 20 MIN $ 166.00 REF SERUM ACIDIFICATION $ 166.00 REF SERUM DRUG TRMNT $ 166.00 X-MATCH EACH ADD'L $ 166.00 XR*BILATERAL WRIST COMPLETE $ 166.00 XR*LEFT WRIST-COMPLETE 3V $ 166.00 XR*RIGHT WRIST-COMPLETE 3V $ 166.00 X-RAY EXAM OF WRIST 3+ VIEWS $ 166.00 CRYOPRECEPITATE, EA UNIT $ 167.00 LAB-ANTIBODY TITER $ 167.00 LAB-ANTIDIURETIC HORM (VASOP $ 167.00 LAB-INFLUENZA AB TYPE A&B $ 167.00 PIN APEX SD-ST 4.0X120 $ 167.00 POUCH LAPSAC SURGICAL TISSUE $ 167.00 PULSE OX SGL $ 167.00 PULSE OXIMETRY-SINGLE $ 167.00 REFERENCE TITRATION-INDIRECT $ 167.00 APSKIN LEGWOND<100CM<25CM EA $ 168.00 APSKN FOOTWOND<100CM<25CM EA $ 168.00 CY-TP IMAGING ROUTINE SCREEN $ 168.00 CY-TP IMG ROUTNE SCRN W/MD I $ 168.00 HEXA GENE $ 168.00 LAB-HIV DNA PCR QL AMPLICORE $ 168.00

�62

LAB-IMUNOFLUOR-ANTIBODY/ANTI $ 168.00 TL PAP W AUTO SCRN & MAN RS $ 168.00 10MMX2.7MM CRTXSC SLFTPPING T8 $ 169.00 6.5 X 25MM LOW PROF HEX SCREW $ 169.00 BN STPL SHRT FXSTPLS W SPKS MD $ 169.00 CAST SPLINT SYS 5 INX15' RL=BX $ 169.00 CATHETER SIZING PIG 5F X 100CM $ 169.00 FIXATIN STAPLE WITH SPIKES MED $ 169.00 LAB-AMINO ACID QUANTITATIVE $ 169.00 LAB-AMINO ACID SCREEN, URINE $ 169.00 SCR ACET L16MM OD6.5MM TI CANC $ 169.00 SCR BONE L20MM OD6.5MM TI CANC $ 169.00 SCR BONE L25MM OD6.5MM TI CANC $ 169.00 SCR BONE L30MM OD6.5MM TI CANC $ 169.00 SCR LCK T15 4.0X14MM $ 169.00 SCR LCK T15 4.0X16MM $ 169.00 SCR LCK T15 4.0X18MM $ 169.00 SCR LCK T15 4.0X24MM $ 169.00 SCREW 6.5 X 25MM LOW PROF HEX $ 169.00 SCREW 6.5 X 35MM LOW PROF HEX $ 169.00 SCREW LOK 4.0 X 20MM $ 169.00 SCREW,6.5 X 30MM LOW PROF HEX $ 169.00 SHEATH ANSEL 5FR X 55CM $ 169.00 TORX 6.5MM CANC BONE SCREW $ 169.00 UNIVERSAL SLING $ 169.00 CT SCAN FOR LOCALIZATION $ 169.55 2.3X20MM LCKSCR CROSSPN SLFTAP $ 170.00 2.5MM CALIBRATED DRILL BIT $ 170.00 30MM ACUTWIST ACUTRAK TAP $ 170.00 HERPES S AMPLIF NA PROBE $ 170.00 LAB-FACTOR XIII SCREEN $ 170.00 LAB-HELICOBACTER PYLORI AG.F $ 170.00 LAB-HERPES SIMPLEX $ 170.00 MUPIROCIN 2 % OINT 22 G TUBE $ 170.00 OSTOMY KIT $ 170.00 SCLERAL BUCKLING/BANDS $ 170.00 WC OT LIMITED TX $ 170.00 WC PT LIMITED TX $ 170.00 ACCUSTICK SYSTEM $ 171.00 CLAVICLE COMPLETE $ 171.00 EX FOR SPEECH DEV RX EA ADDL30 $ 171.00 EX SPEECH DEV RX EA ADD 30MIN $ 171.00 LAB-ISLET CELL ANTIBODY $ 171.00 LAB-STRONGYLOUDES SEROLOGY $ 171.00 PROF-TISSUE EXAM BY PATH 4 $ 171.00 XR EXAM OF ANKLE 3+ VIEWS $ 171.00 XR EXAM OF FOOT 3+ VIEWS $ 171.00

�63

XR EXAM OF FOOT; 3+ VIEWS $ 171.00 XR EXAM OF HUMERUS 2+ VIEWS $ 171.00 XR*BILATERAL ANKLE COMPLETE, $ 171.00 XR*BILATERAL CLAVICLE $ 171.00 XR*BILATERAL FOOT, 3V MIN $ 171.00 XR*BILATERAL HUMEROUS 2V MIN $ 171.00 XR*LEFT-ANKLE,COMPLETE 3V MI $ 171.00 XR*LEFT-CLAVICLE $ 171.00 XR*LEFT-FOOT,COMPLETE, 3V MI $ 171.00 XR*LEFT-HUMERUS 2V MIN $ 171.00 XR*RIGHT-ANKLE,COMPLETE 3V M $ 171.00 XR*RIGHT-CLAVICLE $ 171.00 XR*RIGHT-FOOT,COMPLETE 3V MI $ 171.00 XR*RIGHT-HUMERUS 2V MIN $ 171.00 X-RAY EXAM OF ANKLE 3+ VIEWS $ 171.00 X-RAY EXAM OF FOOT 3+ VIEWS $ 171.00 X-RAY EXAM OF HUMERUS 2+ VIEWS $ 171.00 LAB-ECHOVIRUS AB $ 172.00 SCAPULA COMPLETE $ 172.00 XR*BILATERAL SCAPULA $ 172.00 XR*LEFT-SCAPULA $ 172.00 XR*RIGHT-SCAPULA $ 172.00 CATH, HEMO, PERITONEAL,LONG TE $ 173.00 CATH,HEMO,PERITONEAL,LONG TE $ 173.00 ISO*99M TC MAA PER 10 MCI $ 173.00 LAB-ADDITIONAL KAROTYPES, EA $ 173.00 LAB-CHRO ANALY, ADD'L KARYOT $ 173.00 LAB-HISTOPLASMA ANTIGEN $ 173.00 LAB-PEROXISOMAL PANEL,SERUM $ 173.00 LAB-URINE HISTOPLASMA ANTIGE $ 173.00 PIN MEDTRONIC PLATE HOLDING $ 173.00 REAMER RND 10MM $ 173.00 SMEAR COMPLEX STAIN $ 173.00 3.5 X 12MM BONE SCREW $ 174.00 3.5 X 12MM NON-LOCKING SCREW $ 174.00 3.5 X 14MM BONE SCREW $ 174.00 3.5 X 16MM CORTICAL SCREW $ 174.00 3.5 X 18MM BONE SCREW $ 174.00 3.5 X 24MM CORTICAL SCREW $ 174.00 3.5 X 24MM SELF-TAP BONE SCREW $ 174.00 3.5 X 32MM BONE SCREW $ 174.00 3.5X20 SELF-TAPPING BONE SCREW $ 174.00 3.5X22 SELF-TAPPING BONE SCREW $ 174.00 CATHETER MULTI 10F X 25CM $ 174.00 CATHETER MULTI 12F X 25CM $ 174.00 CATHETER MULTI 14F X 25CM $ 174.00 CATHETER MULTI 18F X 40CM $ 174.00

�64

CATHETER MULTI 20F X 40CM $ 174.00 CATHETER MULTI 8.5F X 25CM $ 174.00 HYDRATE IV INFUSION ADD-ON $ 174.00 LAB-CHROMOSOME ANALYSIS, 20-25 $ 174.00 LAPAROTOMY DRAPE $ 174.00 NON-SPEECH DEVICE TX $ 174.00 O2 SATURATION REST&AFTER EXE $ 174.00 OBS IVF HYDRAT EA ADD HR $ 174.00 ORTHC/PROSTC MGMT SBSQ ENC $ 174.00 PULSE OX MULTIPLE $ 174.00 PULSE OXIMETRY-MULTI $ 174.00 SEMEN ANAL STRICT CRITERIA $ 174.00 EO RIGID NO JOINTS PREFAB $ 175.00 FULL ROOM ENV 30- PLATFORM B $ 175.00 INBONE DRILL TALAR PEG 4MM $ 175.00 LAB-STAIN GROUP II REF LAB $ 175.00 PEG DRIVER $ 175.00 PROF EEG MD FEE - SLEEP $ 175.00 REM SKIN TAGS <=15 LESIONS $ 175.00 REM SKIN TAGS; <=15 LESIONS $ 175.00 SCREW 2X12MM CORTEX $ 175.00 SPECIAL STAINS GROUP 2 $ 175.00 WASHER FOR 6.5/8.0 MM SCREW $ 175.00 WRC-REMOVE SKIN TAGS <=16 $ 175.00 GIA 80-3.8 SGL USE LOADINGUNIT $ 176.00 ISO*99MTC DTPA PER 25 MCI $ 176.00 PROF VASC LAB-ARTRL L EXTREMIT $ 176.00 SWAN GANZ PACEPORT CATH $ 177.00 DRILL 2MM FOR DISTAL RADIUS $ 178.00 LAB-CULTURE,BACTERIAL,SCREEN $ 178.00 LAB-HERPES AB I&II IGG $ 178.00 LAB-HERPES SIMPLEX TYPE 1-IG $ 178.00 LAB-LH $ 178.00 CATHETER BILIARY 10F X 40CM $ 179.00 CATHETER BILIARY 12F X 40CM $ 179.00 CATHETER BILIARY 8.5F X 40CM $ 179.00 EXCEL CARE BED FRAME $ 179.00 LAB-ALA DEHYDRATASE $ 179.00 LAB-COXSACKIE A VIRUS $ 179.00 LAB-ORGANIC ACID SERUM QUAL $ 179.00 SP*FLOURO GUIDANCE NEEDLE PL $ 179.00 XR EXAM OF ELBOW 3+ VIEWS $ 179.00 XR EXAM OF HAND 3+ VIEWS $ 179.00 XR EXAM OF KNEE 3 $ 179.00 XR*BILATERAL ELBOW COMPLETE $ 179.00 XR*BILATERAL HAND MIN 3 VIEW $ 179.00 XR*BILATERAL KNEE, 3V $ 179.00

�65

XR*FLURO LOACALIZATION NEEDL $ 179.00 XR*LEFT ELBOW-COMPLETE $ 179.00 XR*LEFT HAND MIN. 3VIEWS $ 179.00 XR*LEFT-KNEE, 3V $ 179.00 XR*RIGHT ELBOW-COMPLETE $ 179.00 XR*RIGHT HAND MIN.3VIEWS $ 179.00 XR*RIGHT-KNEE, 3V $ 179.00 X-RAY EXAM OF ELBOW 3+ VIEWS $ 179.00 X-RAY EXAM OF HAND 3+ VIEWS $ 179.00 X-RAY EXAM OF KNEE 3 $ 179.00 22FR ENDOVIVE STD BALLOON $ 180.00 INTRO SUPRAPUBIC ONE-STEP $ 180.00 M&S BREAST PUMP $ 180.00 PEAK FLOW METER,HAND HELD $ 180.00 PROPARACN .5% DRP 15ML DRP BTL $ 180.00 US PV RESIDUAL URINE $ 180.00 1.5X6MM NEURO SELF-TAPPING SCR $ 181.00 OFFICE CONSULTATION $ 181.00 XR EXAM CHEST 1 VIEW $ 181.00 X-RAY EXAM CHEST 1 VIEW $ 181.00 tuberculin purified protein derivative 50 TBunit/1 mL MDV $ 181.80 CHLAMYDIA P AMPLIF NA PROBE $ 182.00 GENERAL 1ST 30 MINS $ 182.00 LOCAL/PUDENDAL ANESTHESIA LDR $ 182.00 LOCAL/REGIONAL/BLOCK 1ST 30 MI $ 182.00 MAC 1ST 30 MINS $ 182.00 MYCOPLASMA AMPLIF NA PROBE $ 182.00 RESQPOD $ 182.00 SPINAL/EPIDURAL 1ST 30 MINS $ 182.00 TROCAR BLNT W ANCHOR 12MM $ 182.00 .020 RAYHACK SAW BLADE $ 183.00 6.5 X 50MM OSTEOLOCK CANC SCR $ 183.00 CATHETER DAWSN MUELLR 12FX25CM $ 183.00 COIL COMPLEX HELICAL 10MM $ 183.00 COIL COMPLEX HELICAL 4MM $ 183.00 COIL COMPLEX HELICAL 6MM $ 183.00 COIL COMPLEX HELICAL 8MM $ 183.00 COIL HELICAL 2 S's $ 183.00 COIL STRAIGHT PLATINUM 2MM $ 183.00 CY-NON GYN THIN PREP $ 183.00 CYTOPATH CELL ENHANCE TECH $ 183.00 FEEDING TUBE, NASAL JEJUNAL $ 183.00 LAB-PNEUMOCOCCAL ANTIBODY PA $ 183.00 LAB-TYROSINE $ 183.00 OSTEOLOCK 3.5 X12MM CANC SCREW $ 183.00 OSTEOLOCK 3.5 X30MM CANC SCREW $ 183.00 OSTEOLOCK 3.5 X40MM CANC SCREW $ 183.00

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REUNION NITINOL PILOT WIRE $ 183.00 TRACH TUBE SHILEY $ 183.00 AMPLATZ WIRE 75CM $ 184.00 CRUTCH PLATFORM $ 184.00 INJECTION FOR MYELOGRAM $ 184.00 PROF PATH PROF CHG - OTHER $ 184.00 SCR LOCK 2.3X24MM $ 184.00 SCREW BONE(CAT#203065251) $ 184.00 SHAVE LES F/E/N/L 0.5CM/< $ 184.00 1.0MM DRILL BIT $ 185.00 DM OP SMT INDIV PER 30 MIN $ 185.00 ETHI 511SD $ 185.00 LAB-BORDETELLA PERTUSSIS PAN $ 185.00 LAB-CYANIDE $ 185.00 MEGADYNE ADAPTER MONOPOLAR $ 185.00 PSYTX W PT 45 MINUTES $ 185.00 SCR AXSOS LOK 3.0MM X 18MM $ 185.00 SCR LOCK ST T8 3.0X18MM $ 185.00 SCREW LOK AXSOS 3.0MM / L14MM $ 185.00 SCREW LOK AXSOS 3.0MM / L16MM $ 185.00 SERRATED COMB WIRE FIX BOLT $ 185.00 STR SERTD CMB WIR FX BLT (UPG) $ 185.00 VERAFLO MD DRESSING $ 185.00 WHISPER WIRE 0.014x 190CM $ 185.00 BLADE SAW STAINLSS STEEL SIGMA $ 187.00 CLOTTING FUNCT ACTIVITY $ 187.00 INV LIQ BASE SLIDE PREP NONGYN $ 187.00 LAB-FETAL LUNG MATURITY $ 187.00 STR K-WIRE 3.2 X 450MM (STERL) $ 187.00 THAL-QUICK CHEST TUBE TRAY $ 187.00 4.0MM DUALEDGE CUTTER CRSSBLDE $ 188.00 5.5MM DUALEDGE CUTTER CRSSBLDE $ 188.00 POSTPARTUM CARE ONLY $ 188.00 SHEATH ANSEL 7F X 70CM $ 188.00 SHEATH FLEXOR 8FR 70CM $ 188.00 SHEATH FLEXOR 9FR 45CM $ 188.00 SHEATH RAABE 7F X 90CM $ 188.00 TRACH SPEAK VALVE $ 188.00 WHFO JOINTS BANDS SPRINGS CUST $ 188.00 XR EXAM OF SHOULDER 2+ VIEWS $ 188.00 XR*BILATERAL SHOULDER 2V MIN $ 188.00 XR*LEFT-SHOULDER 2VIEWS MIN $ 188.00 XR*RIGHT-SHOULDER 2VIEWS MIN $ 188.00 5 X 12MM LOCKING SCREW $ 189.00 5.0X20MM LOCKING SCREW $ 189.00 COIL COMPLEX HELICAL 11MM $ 189.00 KII BLUNT TRCR W BALLOON 5X100 $ 189.00

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2.3 X 16MM SMOOTH LCKNG PEG $ 190.00 2.3 X 22MM SMOOTH LCKNG PEG $ 190.00 2.3MM X 18 SMOOTH LCKNG PEG $ 190.00 2.3MM X 20 SMOOTH LCKNG PEG $ 190.00 2.7 X 16MM NL HEXALOBE SCREW $ 190.00 ASSAY OF HOMOCYSTINE $ 190.00 ECG UP TO 48 HRS RECORDING $ 190.00 HOLTER 24HR RECORDING $ 190.00 LAB-HEMOCYSTEINE $ 190.00 SCR LOCK 2.3X22MM $ 190.00 SCREW 2.3X10MM LOCKING CORT $ 190.00 SCREW 2.3X12MM LOCKING CORT $ 190.00 SCREW 2.3X14MM LOCKING CORT $ 190.00 SCREW 2.3X24MM LOCKING CORTCL $ 190.00 AEROSOL/NEBULIZER $ 191.00 AIRWAY INHALATION TREATMENT $ 191.00 CATHETER MULTI 16F X 40CM $ 191.00 CREP H/A/G/EXTR EA ADD 5 CM/< $ 191.00 INCENTIVE SPIROMETRY $ 191.00 IPPB $ 191.00 JET NEB INSTALLATION $ 191.00 MDI $ 191.00 SCREW 2.3X18MM LOCKING CORT $ 191.00 SCREW 2.3X20MM LOCKING CORT $ 191.00 AB; HSV NON-SPECIFIC $ 192.00 CLINITRON CII THER UNIT P/DA $ 192.00 CLINITRON RITE HITE PER DAY $ 192.00 LAB-OXYCODONE, U $ 192.00 SCREW 2.3X22MM LOCKING CORT $ 192.00 AL3 GUIDE CATHETER $ 193.00 BIVONA EXTEND LNGTH TRACH TU $ 193.00 CBT 1ST HOUR $ 193.00 DEMONSTRATION/EVALUATION $ 193.00 MAGNUM 2 BARIAT W/SCALES P/D $ 193.00 NITREX .014 X 300CM $ 193.00 PROF CLNCL PATH CONSULT,COMPR $ 193.00 SCREW 2.3X16MM LOCKING CORT $ 193.00 ARROW PACER & INTRODUCER COM $ 194.00 BALLOON CATHETER INFLATION $ 194.00 LAB-HLA-B27 ANTIGEN $ 194.00 AIRWY RESIST BY OSCILLOMETRY $ 195.00 DRILL 3.5MMX5" QUICK RELEASE $ 195.00 EST OFFICE/OP VISIT LVL 1 $ 195.00 HINGE LOW PROFILE $ 195.00 HINGE MALE STANDARD $ 195.00 NOVASTEP CLEANSTART DISPENSER $ 195.00 PASSING ELEVATOR $ 195.00

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PULM FUNCT TST PLETHYSMOGRAP $ 195.00 ALEXIS WOUND PROTECTOR - XL $ 196.00 AMPLIF NA PROBE NOS AGENT $ 196.00 CATHETER DAWS MUELL 6.3FRX25CM $ 196.00 NEW OFFICE/OP VISIT LVL 1 $ 196.00 TUBE FEEDING MCCLEAN $ 196.00 4.0MM DRILL BIT $ 197.00 AB HSV NON-SPECIFIC $ 197.00 BALECTRODE PACER $ 197.00 CATHETER MULTI 10F X 45CM $ 197.00 CATHETER MULTI 12F X 45CM $ 197.00 LAB-HERPES AB I&II IGM $ 197.00 LAB-STOOL REDUCING SUBSTANCE $ 197.00 PROF EEG $ 197.00 PROF EEG SLEEP $ 197.00 RESTING HAND SPLINT $ 197.00 SURFIT WAFER 4 INCH LOOP $ 197.00 1.7MM DRILL BIT (ARTHREX) $ 198.00 1.7MM SHORT DRILL BIT $ 198.00 2.3 X 30MM NON-TOGGLING SCREW $ 198.00 2.3 X 32MM NON-TOGGLING SCREW $ 198.00 2.3MM X 10MM LOCKING CORT SCR $ 198.00 3.5MM DRILL BIT (ARTHREX) $ 198.00 BALLOON DILATOR ESOPHAGEAL PET $ 198.00 LAB-APOLIPOPROTEIN E GENO $ 198.00 LAB-HISTAMINE-BLOOD OR URINE $ 198.00 SAW BLADE OSTEOTMY HUB STYLE S $ 198.00 SCREW 2.3X12MM LOCKING CORTICL $ 198.00 SCREW 2.3X14MM LOCKING CORTICL $ 198.00 SCREW 2.3X16MM LOCKING CORTICL $ 198.00 SCREW 2.3X18MM LOCKING CORTICL $ 198.00 SCREW 2.3X18MM LOCKNG CORTICAL $ 198.00 SCREW 2.3X20MM LOCKING CORTICL $ 198.00 THERAPEUTIC SP DEVICE SERVICE $ 198.00 TROCAR, 11MM SLEEVE BLADELESS $ 198.00 WIRE PLATINUM PLUS .018 X180CM $ 198.00 DRAW BLOOD OFF VENOUS DEVICE $ 199.00 PACING WIRE $ 199.00 PROF TSS EXM BY PTHOLOGST LVL3 $ 199.00 TISSUE EXAM BY PATH LVL 3 $ 199.00 ANTENNA NEUROSTIMULATOR 36IN $ 200.00 CORAL BLOOD SERVICE ER SERVC $ 200.00 LAB-IMMUNOELECTROPHORESIS UR $ 200.00 LO FLEX L1-BELOW L5 PRE OTS $ 200.00 SCREW 1.5MM CORTEX $ 200.00 STENT BILIARY CV 10X60 $ 200.00 TK5 TITNM KNOT QUICK LOAD UNIT $ 200.00

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TUBE TRACH CUFFED ADL TTS 7MM $ 200.00 XR EXAM HIP UNI 2-3 VIEWS $ 200.00 XR EXAM OF FEMUR 2/> $ 200.00 XR* FEMUR 1 VIEW, LEFT $ 200.00 XR* FEMUR 1 VIEW, RIGHT $ 200.00 XR*BIL FEMUR MIN 2 VIEWS $ 200.00 XR*HIP, UNIL 2-3VIEW INFANT $ 200.00 XR*LEFT FEMUR MIN 2 VIEWS $ 200.00 XR*LFT HIP, UNI, W/PEL 2-3VIEW $ 200.00 XR*RGT HIP, UNI, W/PEL 2-3VIEW $ 200.00 XR*RIGHT FEMUR MIN 2 VIEWS $ 200.00 X-RAY EXAM HIP UNI 2-3 VIEWS $ 200.00 X-RAY EXAM OF FEMUR 1 $ 200.00 X-RAY EXAM OF FEMUR 2/> $ 200.00 1.0 X6MM CORTEX SELF TAP SCREW $ 201.00 1.0 X9MM CORTEX SELF TAP SCREW $ 201.00 CHEST PHYSIO THY-SUBQ TX $ 201.00 CONNECTION PLATE, 3 HOLE $ 201.00 ISO*201 TL THALLIUM-PER MCI $ 201.00 MYCOBACTERIA T AMPLIF NA PROBE $ 201.00 OBS SVCS DIRECT ADMISSION $ 201.00 ONE THIRD TUBLAR PLTE W/COLLAR $ 201.00 LAB-HEREDITARY HEMOCHROMATOSIS $ 202.00 NA QUAN NOS AGENT $ 202.00 PROF ECHO DOPPLER $ 202.00 INV CATH INTRO COOK 10FR $ 203.00 PROF -CT HRT W/3D IMAGE $ 203.00 PSYCH DIAGNOSTIC EVALUATION $ 203.00 5 X 24 STENT $ 204.00 DESTROY VAGINAL LESION(S) SIMP $ 204.00 FIRM URETERAL STENT 5FR X 26CM $ 204.00 LAB-CRYOGLOBULIN $ 204.00 LAB-CYROGLOBULIN $ 204.00 SFT URT STNT AND PSTN 5FRX22CM $ 204.00 SP*IR SURGICAL COMPONENT $ 204.00 STAPLER GIA HANDLE $ 204.00 STENT 5X26 $ 204.00 1.1MM DRILL BIT (SYNTHES) $ 205.00 1.3MM DRILL BIT $ 205.00 1.5MM DRILL BIT (SYNTHES) $ 205.00 ALBUMIN HUMAN PER 50 ML $ 205.00 AMBL BP MNTR W/SW A/R $ 205.00 DETRGNT TX FROZ PLASMA EA UNIT $ 205.00 INFLATOR BLN ENCORE $ 205.00 J-TUBE 9FR $ 205.00 LAB-ESTRADIOL $ 205.00 LAB-HER2 BY FISH MANUAL $ 205.00

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MAMMO SURGICAL COMPONENT $ 205.00 OLYMPUS BALLOON APPLICATOR $ 205.00 PRIMEAIR ARS $ 205.00 THREADED ROD X120MM $ 205.00 ASNIS GUIDE PIN $ 206.00 CLIPPING DEVICE $ 206.00 INJ FORAMEN EPIDURAL ADD-ON $ 206.00 INSERT DRUG IMPLANT $ 206.00 ISO*I 123 PER 100 UP TO999 U $ 206.00 LAB-HERCEP TEST BY FISH $ 206.00 LAB-HERCEP/FISH $ 206.00 PTA AIR ONLY $ 206.00 SHEARS 1411/1412 $ 206.00 VACUUM HOSE 1 1/4 X 24IN $ 206.00 AIRWAY CARE $ 207.00 HF NASAL CANNULA < OR =.2L $ 207.00 LGSR MD LPRSCPC SEALER 5MM37CM $ 207.00 MIXED GAS THERAPY $ 207.00 O2 INSTALLATION $ 207.00 O2 TRANSPORT EXTERNAL $ 207.00 O2 TRANSPORT INTERNAL $ 207.00 PK CYSTO W/ CYSTO DRP 38X53IN $ 207.00 SPONTANEOUS BREATHING TRIAL $ 207.00 TENT THERAPY $ 207.00 UNLISTED PULMONARY SERVICE $ 207.00 VAPOTHERM $ 207.00 VENTI-MONITOR $ 207.00 2.4 X 10MM CORTEX ST SCREW $ 208.00 2.4 X 11MM CORTEX ST SCREW $ 208.00 2.4 X 12MM CORTEX ST SCREW $ 208.00 2.4 X 14MM CORTEX ST SCREW $ 208.00 ACCOLADE C DISTAL SPACER MED $ 208.00 BIPOLAR PACING CATHETER $ 208.00 COGNITIVE TEST BY HC PRO $ 208.00 FORCEPS DISP BIOPSY PEDI EGD 1 $ 208.00 PROF -BM SMR INTERP $ 208.00 SCREW 2.4X32MM CORTX SELF TAP $ 208.00 TRI-STAPLE 2.0 RELOAD 30MM $ 208.00 WRIGHT PLATE TACK $ 208.00 XR EXAM OF RIBS 2 VIEWS UNI $ 208.00 XR EXAM OF RIBS 2 VIEWS UNILAT $ 208.00 XR*LEFT RIBS, 2V MIN $ 208.00 XR*RIGHT RIBS, 2V MIN $ 208.00 4 X 120MM MOD HALF PIN $ 209.00 5.5MM LOCKING TROCAR $ 209.00 CHROM ANALY; ADDTL CELL COUNTS $ 209.00 1.3 X 10MM CORTEX SCREW $ 210.00

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1.3 X 13MM CORTEX SCREW $ 210.00 1.3 X 8MM CORTEX SCREW $ 210.00 1.3 X 9MM CORTEX SCREW $ 210.00 ANCHOR LIGAMENT FIBERTAK $ 210.00 LAB-MULTIPLX W MAN MORPH ANALY $ 210.00 LAB-SNG ISH MAN MORPHOME ANAL $ 210.00 STAPLER TA 60 - 4.8 $ 210.00 2.3MM DRILL BIT $ 211.00 2.5 X 12MM FULLY THREADED PEG $ 211.00 DRILL BIT 3.1X125MM $ 211.00 PEG BONE FIX L14MM OD2.5MM $ 211.00 PEG BONE FIX L18MM OD2.5MM DST $ 211.00 PEG BONE FIX L20MM OD2.5MM DST $ 211.00 PEG BONE FIX L20MM OD2MM TI $ 211.00 PEG BONE FIX L22MM OD2.5MM DST $ 211.00 PEG BONE FIX L22MM OD2MM TI $ 211.00 PEG BONE FIX L24MM OD2MM DST $ 211.00 PEG FULL THREAD 2.5X20MM $ 211.00 SCR BONE L10MM OD3.5MM TI CORT $ 211.00 SCR BONE L12MM OD3.5MM TI CORT $ 211.00 SCR BONE L14MM OD3.5MM TI CORT $ 211.00 TA 30MM - 3.5MM STAPLER $ 211.00 TA 30MM - 4.8MM STAPLER $ 211.00 OBS IVF-NC EXC HYDR SEQ TO 1 $ 212.00 OR-IVF-NC EXC HYDR SEQ TO 1 $ 212.00 PROF ECHO 2D $ 212.00 PROF -IMMUNHISTO ANTB 1ST STA $ 212.00 PROF -IMMUNOHISTO ANTB 1ST $ 212.00 SP*IVF NC EXC HYDR SEQUENTIA $ 212.00 TX/PROPH/DG ADDL SEQ IV INF $ 212.00 ULT-S INFANT HIPS STATIC, NO $ 212.00 ULT-S UNLSTD PROC-DIAG OR IN $ 212.00 UNLISTED ULTRASOUND $ 212.00 V-PACING PROBE $ 212.00 2.5MM DRILL BIT $ 213.00 2.7MM DRILL BIT (ARTHREX) $ 213.00 3.5 X 18MM LOCKNG CORTICAL SCR $ 213.00 3.5 X 26MM LOCKNG CORTICAL SCR $ 213.00 3.5 X 34MM LOCKNG CORTICAL SCR $ 213.00 3.5 X 36MM LOCKNG CORTICAL SCR $ 213.00 3MM DRILL BIT $ 213.00 DRILL BIT 2.2MM AR894422 $ 213.00 DRILL BIT SHRT 2.5MM $ 213.00 THREADED ROD - LENGTH: 100MM $ 213.00 THREADED ROD - LENGTH: 150MM $ 213.00 UNLISTED MOLECULAR PATHOLOGY $ 213.00 WIRE V-18 .018 X 110CM $ 213.00

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XR*TEETH < FULL MOUTH $ 213.00 BASKET STONE 12F X 24CM $ 214.00 CATHETER KUMPE 5F X 40CM $ 214.00 SCRW INTRFRNC 8X20MM KNEE CANN $ 214.00 TCR 75 $ 214.00 ULT-S AMNIOCENTESIS $ 214.00 2.5 X 20 FULLY THREADED PEG $ 215.00 COIL .018 NESTER 10mm X 14cm $ 215.00 COIL .018 NESTER 3MM X 14CM $ 215.00 COIL .018 NESTER 4MM X 14CM $ 215.00 COIL .018 NESTER 6MM X 14CM $ 215.00 COIL .018 NESTER 8mm X 14cm $ 215.00 COIL NESTER 12MM X 14CM $ 215.00 COIL NESTER 8MM X 14CM $ 215.00 DESTROY L/S FACET JNT ADDL $ 215.00 LAB-VITAMIN K $ 215.00 SCR BONE L20MM OD2.5MM ST LOK $ 215.00 VALVE SUCTION $ 215.00 typhoid vaccine, inactivated 0.5 mL INJ $ 215.11 HF RESECTION ELECTRD LOOP 28FR $ 216.00 HIP ARTHRGRPH INJ W ANESTH BIL $ 216.00 SCREW CORTICAL 3.5/16MM $ 216.00 STENT URETHERAL 6FR 24CM $ 216.00 LAB-URINE HISTOPLASMA $ 217.00 OT RE-EVAL EST PLAN CARE $ 217.00 BRACHYTX ISODOSE COMPLEX $ 217.29 tuberculin purified protein derivative 5 TBunit/0.1 mL MDV (Aplisol 10) $ 217.77 medroxyPROGESTERone 150 mg/mL INJ $ 217.99 6.0 X 50MM COMPRESSION SCREW $ 218.00 6MM SCREW WASHER $ 218.00 MIDLINE CATH $ 218.00 STAPLER TA 60 - 3.5 $ 218.00 XR EXAM CHEST 2 VIEWS $ 218.00 X-RAY EXAM CHEST 2 VIEWS $ 218.00 PROF ELECTRON MICRO $ 219.00 2.0MM QUICK RELEASE DRILL $ 220.00 2.3 X 12MM LOCKING SCREW $ 220.00 2.3 X 14MM LOCKING SCREW $ 220.00 2.3 X 16MM LOCKING SCREW $ 220.00 FLOW VOLUME LOOP $ 220.00 PROF PFT*DIFF CAP $ 220.00 gadobutrol 6047.2 mg/10 mL INJ (KPROV) $ 220.46 BEAD TIPPED GUIDEWIRE $ 221.00 FETAL HB $ 221.00 L&D RECOVERY EACH ADDL 30 MINS $ 221.00 SHAVE LES F/E/N/L; 1.1-2.0CM $ 221.00 SHEATH PEEL AWAY 20F X 13CM $ 221.00

�73

TRCHSTMY TUBE XLT CFF 6.0XLTCP $ 221.00 UNIV CMNT RESTRICT-DISP INSERT $ 221.00 Endo GIA Ultra Univ Shrt Stplr $ 222.00 EST OFFICE/OP VISIT LVL 2 $ 222.00 TA90-3.5 SGL USE RELOAD STPLR $ 222.00 2.7MM CANNULATED DRILL BIT $ 223.00 28MM ACUTRAK COMPRESSION SCREW $ 223.00 5.0X50MM ASNIS JFX SOLID SCREW $ 223.00 ACCESS PORT I KIT $ 223.00 PROF -REF CONSULT PREP ELSE $ 223.00 REF CONSULT PREP ELSEWHERE $ 223.00 SENSOR GUIDEWIRE TIP 0.035"X15 $ 223.00 ST DRLL BIT LCKNG SH 3.1X216MM $ 223.00 ST DRLL BT NLCKNG SH 2.5X216MM $ 223.00 1.0 X 22MM TWIST DRILL $ 224.00 2.0 X 11MM CORTEX SELF TAP SCR $ 224.00 2.0/2.5MM DRILL BIT $ 224.00 CATHETER- BRACHYTHERAPY $ 224.00 CATHETER-BRACHYTHERAPY $ 224.00 COIL DIAMOND 5MM $ 224.00 FINISHING WIRE $ 224.00 TWIST DRILL 1.9MM DIA $ 224.00 WHISPER VIEW 0.014x190CM $ 224.00 ADJUSTABLE STRINGER $ 225.00 APPLY SHORT ARM SPLINT DYNAMIC $ 225.00 CATH TRNS ANG NOLASER(BALLOON) $ 225.00 COIL DIAMOND 3MM $ 225.00 COIL DIAMOND 4MM $ 225.00 COIL DIAMOND 6MM $ 225.00 COIL TORNADO 3MM/2MM $ 225.00 COIL TORNADO 6MM/2MM $ 225.00 HPV HIGH-RISK TYPES $ 225.00 IUPC CABLE $ 225.00 K-WIRE WITH DRILL TIP 2X234MM $ 225.00 LOW PROFILE SCREW TI 4.5 X30MM $ 225.00 LOW PROFILE SCREW TI 4.5 X34MM $ 225.00 LOW PROFILE SCREW TI 4.5 X38MM $ 225.00 LOW PROFILE SCREW TI 4.5 X40MM $ 225.00 LOW PROFILE SCREW TI 4.5 X44MM $ 225.00 LOW PROFILE SCREW TI 4.5 X46MM $ 225.00 MCR INTRDCR SHTH ST 7FR/CHX7CM $ 225.00 PULMONARY STRESS TEST/SIMPLE $ 225.00 PULMONARY STRESS TESTING $ 225.00 TRACHEOSTOMY SPEAK VALVE $ 225.00 TRACHEOSTOMY SPEAKING VALVE $ 225.00 WIRE PLATINUM PLUS .014 X300CM $ 225.00 WIRE PLATINUM PLUS .018 X260CM $ 225.00

�74

CNTRL NASAL HEMORRH ANT CMPLX $ 226.00 EXCEL CARE BARIATRIC BED / D $ 226.00 LAB-HLA CLASS 1 $ 226.00 PONSKY PULL $ 226.00 PONSKY SKULL $ 226.00 STENT N-U 10.2F X 28CM $ 226.00 STENT N-U 8.5F X 24CM $ 226.00 STENT N-U 8.5F X 26CM $ 226.00 STENT N-U 8.5F X 28CM $ 226.00 miFEPRIStone 200 mg TAB $ 226.40 LAB-DENGUE FEVER $ 227.00 LAB-LYME AG DNA BY PCR U $ 227.00 LAB-LYME DISEASE PCR BLOOD $ 227.00 LAB-LYME PCR (SYNOVIAL) $ 227.00 LAB-LYME TITER SPINAL FLUID $ 227.00 LYMES AMPLIFIED NA PROBE $ 227.00 NONSLCT CATH SUP/INF VENA CAVA $ 227.00 NOSLCT CTH SUP/INF VNA CVA BIL $ 227.00 STAMEY PC CATH SET $ 227.00 7.0MM IRIS EXPANDER $ 228.00 COLON DECOMPRESSION KIT $ 228.00 ISO*99M TC SLFR CLLD PER 20M $ 228.00 NEPHROSTOMY 10.2 $ 228.00 SELF MGMT EDC & TRN EA 30 MINS $ 228.00 SELF-MGMT EDUC & TRAIN 1 PT $ 228.00 3 HOLE SS T-PLATE $ 229.00 5 HOLE T PLATE $ 229.00 DRILL BIT 2.0X125MM $ 229.00 DRILL BIT 2.5X125MM $ 229.00 DRILL BIT 2.7X125MM $ 229.00 DRILL BIT 3.5X125MM $ 229.00 IMMUNHISTO ANTIBODY ADDL SLIDE $ 229.00 KWIRE TEMP FIX 3X285MM $ 229.00 FRESH FROZEN PLASMA-PEDI PACK $ 230.00 PLASMA 1 DONOR FRZ W/IN 8 HR $ 230.00 PLASMA, FRESH FROZEN TRANSFU $ 230.00 PROF - SPECIAL STAINS GROUP 1 $ 230.00 SM. UNIV CEMNT RESTRICTOR W/DI $ 230.00 GENETC COUNS EA30MIN $ 231.00 HC US GUIDE VASC ACCESS SI $ 231.00 LAB-DIPTHERIA $ 231.00 M&S-CVP LINE ANESTH $ 231.00 TRACTION BOOT $ 231.00 X-RAY EXAM ABDOMEN 3+ VIEWS $ 231.00 sincalide 5 mcg PWDI (KPROV) $ 232.47 2.3MM QUICK RELEASE DRILL $ 233.00 2.3MM RAYHACK DRILL BIT $ 233.00

�75

2.5MM RAYHACK DRILL BIT $ 233.00 2.7 X 16MM RAYHACK CORT SCREW $ 233.00 2.7MM RAYHACK BONE TAP $ 233.00 2.7MM RAYHACK DRILL BIT $ 233.00 24 HOLE TEMPLATE $ 233.00 3.5 X 16MM RAYHACK CORT SCREW $ 233.00 3.5MM RAYHACK BONE TAP $ 233.00 DRILL 2.3MM QUICK RELEASE $ 233.00 DXMDTMDN 0.9% NACL 4MCG/ML SLN $ 233.00 REUNION PERIPH SCREW DRILL BIT $ 233.00 SCREW 3.5X14MM LCKNG CORTICL $ 233.00 SCREW 3.5X18MM LCKNG CORTICAL $ 233.00 SCREW CORT LOCK 3.5X10MM $ 233.00 SCREW LCKNG ACUME 14MM X 3.5MM $ 233.00 XR EXAM OF LOWER SPINE $ 233.00 XR*BONE LENGTH STUDY $ 233.00 XR*LUMBOSACRAL,BENDING 4V MI $ 233.00 XR*SINUSES,PARANASAL 3 V MIN $ 233.00 XR*TEETH FULL MOUTH $ 233.00 X-RAY EXAM OF LOWER SPINE $ 233.00 X-RAY EXAM OF SINUSES 3+ VIEWS $ 233.00 CIN CL TMP PAD FR LCL CLD THPY $ 234.00 CT SCAN-CALCIUM SCORING $ 234.00 GWIRE WI TROCAR TIP 0.034 86MM $ 234.00 SCREW 3.5X12MM LCKNG CORTICAL $ 234.00 DRILL BIT 5.5MM $ 235.00 M & S SUPPLY- LEVEL 2 $ 235.00 M&S SUPPLY-LEVEL 2 $ 235.00 SPLINT POSISEP ENT 0.6X2.0 $ 235.00 XR EXAM NECK SPINE 2-3 VW $ 235.00 XR*SPINE/CERVICL 3 VIEW OR LES $ 235.00 X-RAY EXAM NECK SPINE 2-3 VW $ 235.00 HIV-1 QUANT&REVRSE TRNSCRPJ $ 236.00 LEVEL 2 ANCHOR, SCREW, PIN,PEN $ 236.00 PEG PT 2.5X16MM $ 236.00 PEG PT 2.5X18MM $ 236.00 PEG PT 2.5X20MM $ 236.00 SCR CORT 3.5X12MM $ 236.00 SCR CORT LOCK 3.5X12MM $ 236.00 SCR CORT LOCK 3.5X14MM $ 236.00 TREAT SWALLOWING DYSFUNCTION $ 236.00 COIL NESTER .038 3MM $ 237.00 COIL NESTER .038 5MM $ 237.00 COIL NESTER .038 8MM $ 237.00 INS TEMP BLADDER CATH $ 237.00 NAIL SET $ 237.00 SCREW CUP BONE SLF TAP6.5X20MM $ 237.00

�76

SCREW CUP BONE SLF TAP6.5X25MM $ 237.00 SCREW CUP BONE SLF TAP6.5X30MM $ 237.00 SCREW CUP BONE SLF TAP6.5X35MM $ 237.00 SCREW CUP BONE SLF TAP6.5X40MM $ 237.00 12MM2.4MM CRTX SCR SLFTAP T8 $ 238.00 2.0MM DRILL BIT $ 238.00 2.4 X 64MM NL SCREW $ 238.00 2.4 X 70MM NL SCREW $ 238.00 3.5MM PIN TIP DRILL $ 238.00 8X25MM CANN INTERFERENCE SCREW $ 238.00 BIT DRL L4IN OD2MM SS FAST $ 238.00 BIT DRL L83MM OD2.5MM W/O STP $ 238.00 LAB-HELICOBACTER PYLORI QUAN $ 238.00 OLIVE WIRE 1.1MM DIA X 100MM $ 238.00 PEG BONE FIX L18MM OD2MM TI $ 238.00 SCR CAN TI INTERFERENCE 9X20MM $ 238.00 SCREW2.4X12MM SELF TAP CORTX $ 238.00 SPOT ENDOSCOPE MARKER INDIAINK $ 238.00 STRYKR OSC BLD 70MMX8MMX1.27MM $ 238.00 THERAPEUTIC REHAB GROUP $ 238.00 4 X 250MM APEX PIN $ 239.00 NJX PX DISCOGRAPHY LUMBAR $ 239.00 STR 5.5MM DL EDG CUT CROSSBLAD $ 239.00 THREADED ROD - LENGTH 300MM $ 239.00 THREADED ROD - LENGTH: 350MM $ 239.00 2.8MM QUICK RELEASE DRILL $ 240.00 3.5 X 14MM LOW PROFILE SCREW $ 240.00 3.5 X 18MM LOW PROFILE SCREW $ 240.00 3.5 X 20MM LOW PROF SCREW $ 240.00 3.5 X 22MM NON-LOCKING SCREW $ 240.00 COOL TROM ADVANCE $ 240.00 CREP E/N/E/L; EA ADDTL 5 CM/< $ 240.00 K WIRE 2MM $ 240.00 PLUG HERN L1.35INXW1.0IN SM $ 240.00 SCR BONE L14MM OD3.5MM BRNZ TI $ 240.00 SCR BONE L16MM OD3.5MM BRNZ TI $ 240.00 SCR BONE L20MM OD3.5MM BRNZ TI $ 240.00 SCR BONE L22MM OD3.5MM BRNZ TI $ 240.00 SCR BONE ORTHOLOC 3DI L16 MM $ 240.00 SCREW 3.5X10.0MM LOCKING CORTC $ 240.00 SCREW 3.5X10MM LOCKING CORTICL $ 240.00 SCREW 3.5X12MM LOCKING CORTICL $ 240.00 SCREW CANN INTERFERENCE 7X20MM $ 240.00 SCREW CANNINTERFERENCE 8 X20MM $ 240.00 SCREW LOCKING ACUMED 12X3.5MM $ 240.00 SCREW LOCKING ACUMED 14X3.5MM $ 240.00 SPECIALTY BED WITH MATTRESS $ 240.00

�77

STRYKER "3.5MM SMOOTH BITE CUT $ 240.00 WIRE V-18 .018 X 300CM $ 240.00 X-RAY EXAM CHEST 3 VIEWS $ 240.00 CYTOMEGALOV AMPLIF NA PROBE $ 241.00 LAB-BABESIA MICROTI DNA,PCR $ 241.00 LAB-CMV SERUM ANTIGEN BY PCR $ 241.00 LAB-CMV-PCR SEROLOGY $ 241.00 LAB-EHRLICHIOSIS DNA, PCR $ 241.00 LAB-ENTEROVIRUS, PCR $ 241.00 LAB-HCV AMPLIFICATION $ 241.00 LAB-HEPATITUS C AMPLIFICATIO $ 241.00 LAB-URINE, CMV BY RAPID PCR $ 241.00 LAB-VARICELLA-ZOSTER BY PCR $ 241.00 LAB-WEST NILE VIRUS RNA, PCR $ 241.00 LAB-WHIPPLES BY PCR $ 241.00 PROF -SP CONS; 1ST TB W FS SGL $ 241.00 PROF-SP CON 1ST TB W FS SGL SP $ 241.00 RAPID RSV ANTIGEN TEST $ 241.00 BLADE RECIP 5100-137-133 $ 242.00 KIT PNEUMOTHORAX 10.2F $ 242.00 10MM DISPOSBLE SOFT OVAL SNARE $ 243.00 4.0 X 285MM TEMP FIX K-WIRE $ 243.00 AB ID RBC EA PANEL EA TECHN $ 243.00 ANTIBODY ID-EXTENDED PANEL $ 243.00 ANTI-BODY-IDENT $ 243.00 FOOT PAD (WRIGHT) $ 243.00 IMMOBILIZER KNEE 19 IN $ 243.00 LAB-AB ID PRE ADMIT/NATAL $ 243.00 REF AB ID LOW ION $ 243.00 REF AB ID-SHORT COLD PANEL $ 243.00 REF SEL FROZEN CELLS,PER CE $ 243.00 REF SELECTD CELL PANEL,PER C $ 243.00 REFERENCE AB ID - FICIN $ 243.00 REFERENCE AB ID - PEG $ 243.00 REFERENCE AB ID- PREWARM $ 243.00 REFERENCE AD ID- ENHANCEMENT $ 243.00 REFERENCE ANTIBODY DETECTN I $ 243.00 SHEATH 16FR X 35CM $ 243.00 TUBE ARMSTRNG GROM VENTILATION $ 243.00 CATH BILIARY DRAINAGE 12 FR $ 244.00 2.8MM DRILL $ 245.00 ASNIS III DRILL BIT 3.2X300MM $ 245.00 BIT DRL 2.8MM $ 245.00 INSRT TIBIAL 4MM LOC IMP AXSOS $ 245.00 LAB-CYTOCHEM ENZYME EA CONST $ 246.00 LAB-FV LEIDEN MUTATION $ 246.00 LAB-PROTHROMBIN MUTATION $ 246.00

�78

18MM2.4MM CRTXSCR SLF TPPNG T8 $ 247.00 3 HOLE POST FEMALE $ 247.00 LAB-HLA TYPING DR/DQ MULTI $ 247.00 DRILL 2.0MM QUICK RELEASE $ 248.00 M&S-EPIDURAL CATH KIT $ 248.00 NM I-25 SEED W 7CM NEEDLE $ 248.00 OBS IVF-NC EXC HYDR CONCURRE $ 248.00 OR-IVF NC HYD CONCURRENT $ 248.00 OT EVAL MOD COMPLEX 45 MIN $ 248.00 SP*IVF NC EXC HYDR CONCURRENT $ 248.00 THER/DIAG CONCURRENT INF $ 248.00 US I-25 SEED W 7CM NEEDLE $ 248.00 40 X 150MM PIN $ 249.00 5 X 120MM APEX S/D HALF PIN $ 249.00 50 X 180MM PIN $ 249.00 ALEXIS WOUND PROTECTOR X-LG $ 249.00 BIT DRILL 4.3MM X 289MM $ 249.00 EVALUATE SWALLOWING FUNCTION $ 249.00 LAB-B NATRIURETIC PEPTIDE $ 249.00 NEW OFFICE/OP VISIT LVL 2 $ 249.00 PT EVAL MOD COMPLEX 30 MIN $ 249.00 DRILL PIN DISPOSABLES KIT $ 250.00 GUIDE CATHETERS $ 250.00 ICMN CLRCB W/UNV WRPONPD NS RH $ 250.00 LAB-SLIDES TYPE 2 REF LAB $ 250.00 OLIVE WIRE SMOOTH $ 250.00 OLIVE WIRE SMOOTH 1.4MM $ 250.00 PROBE,ESOPH 2CH -15-0CMX2.13MM $ 250.00 SHEATH SHUTTLE 4F X 110CM $ 250.00 SHEATH SHUTTLE 4F X 90CM $ 250.00 SHEATH SHUTTLE 5F X 110CM $ 250.00 SHEATH SHUTTLE 5F X 90 CM $ 250.00 SPECIAL STAINS GROUP 1 $ 250.00 1.1MM DRILL BIT $ 251.00 LAB-AFP QUAD INHIBIN $ 251.00 LAB-INHIBIN LEVEL A $ 251.00 COIL .018 NESTER 2MM X 7CM $ 252.00 COIL .018 NESTER 3MM X 7CM $ 252.00 COIL .018 NESTER 4MM X 7CM $ 252.00 COIL .018 NESTER 6MM X 7CM $ 252.00 EXC TR-EXT MAL+MARG 0.5<CM $ 252.00 FLO TRAC CONTINUOUS CATHETER $ 252.00 M&S -TUBAL LOOP $ 252.00 M&S-TUBAL LOOP $ 252.00 WRC-EXCIS MALIG LESION <=.5CM $ 252.00 HEPATITIS C REVRS TRNSCRPJ $ 253.00 ISO*99M TC DISOFENIN,PER DOS $ 253.00

�79

LAB-HEP C RNA-PCR QUANTITATI $ 253.00 COIL NESTER 6MM X 14CM $ 254.00 LARGE CEMENT BOWL $ 254.00 NOVASTEP AIRLOCK DRILL BIT 02 $ 254.00 ULT-S ECHO CHEST $ 254.00 ULT-S ECHOENCEPHALOGRAM $ 254.00 US EXAM CHEST $ 254.00 XR EXAM KNEE 4 OR MORE $ 254.00 XR EXAM NECK SPINE 4/5VWS $ 254.00 XR EXAM OF EYE SOCKETS 4+VIEWS $ 254.00 XR EXAM OF HAND 2 VIEWS $ 254.00 XR EXAM OF LOWER SPINE 2-3 VWS $ 254.00 XR EXAM OF LOWER SPINE 2-3VWS $ 254.00 XR EXAM OF LOWER SPINE 4+VIEWS $ 254.00 XR EXAM OF PELVIS 1-2 VIEWS $ 254.00 XR EXAM OF PELVIS 3+ VIEWS $ 254.00 XR EXAM OF RIBS 3 VIEWS BIL $ 254.00 XR EXAM OF RIBS 3 VIEWS BILAT $ 254.00 XR EXAM OF THORACIC SPINE 2VWS $ 254.00 XR EXAM OF THORACIC SPINE 3VWS $ 254.00 XR EXAM SACROILIAC JNTS <3VWS $ 254.00 XR EXAM SACROILIAC JNTS 3+ VWS $ 254.00 XR EXAM SACROILIAC JNTS 3+VWS $ 254.00 XR EXM OF FACIAL BONES 3+VIEWS $ 254.00 XR EXM OF RIBS/CHEST 3+VWS UNI $ 254.00 XR EXM OF RIBS/CHEST 4+VWS BIL $ 254.00 XR EXM OF THORACIC SPINE 4+VWS $ 254.00 XR*BILATERAL ARM-INFANT 2V M $ 254.00 XR*BILATERAL HANDS 2V MIN $ 254.00 XR*BILATERAL KNEE COMPLETE,4 $ 254.00 XR*BILATERAL MASTOIDS, 3V MI $ 254.00 XR*CERV SPINE 4 OR 5 VIEWS $ 254.00 XR*CERV SPINE 6 OR MORE VIEWS $ 254.00 XR*FACIAL BONES, 3 VIEWS MIN $ 254.00 XR*GALLBLADDER W/ORAL CONTR $ 254.00 XR*LEFT ARM-INFANT 2V MIN $ 254.00 XR*LEFT-HAND 2V $ 254.00 XR*LEFT-KNEE COMPLETE INC. $ 254.00 XR*LEFT-MASTOIDS,3VIEWS MIN $ 254.00 XR*LUMBOSACRAL 2 OR 3 VIEWS $ 254.00 XR*LUMBOSACRAL COMPLETE,BEND $ 254.00 XR*LUMBOSACRAL/OBLIQUE MIN 4 $ 254.00 XR*MANDIBLE, >4 VIEWS $ 254.00 XR*MASTOIDS < 3v $ 254.00 XR*ORBITS, 4 VIEWS MIN $ 254.00 XR*PELVIS, 1 OR 2 VIEWS $ 254.00 XR*PELVIS, COMPLETE MIN 3 VI $ 254.00

�80

XR*RIBS,BILAT 3 VIEWS MIN $ 254.00 XR*RIBS,CHEST, BILAT 4V MIN $ 254.00 XR*RIGHT ARM-INFANT 2V MIN $ 254.00 XR*RIGHT MASTOIDS, 3VIEW MIN $ 254.00 XR*RIGHT-HAND 2V $ 254.00 XR*RIGHT-KNEE COMPLETE, 4V $ 254.00 XR*SACROILIAC JOINTS 3V MIN $ 254.00 XR*SACROILIAC, <3 VIEWS $ 254.00 XR*SHUNTOGRAM $ 254.00 XR*SKULL <4 VIEWS $ 254.00 XR*SKULL 4 VIEWS MIN, COMPLE $ 254.00 XR*SPINE,THORACIC 3 VIEWS $ 254.00 XR*SPINE,THORACIC MIN 4 VIEW $ 254.00 XR*THORAX SPINE, 2 VIEWS $ 254.00 X-RAY EXAM COMPLETE ABDOMEN $ 254.00 X-RAY EXAM KNEE 4 OR MORE $ 254.00 X-RAY EXAM NECK SPINE 4/5VWS $ 254.00 X-RAY EXAM NECK SPINE 6/>VWS $ 254.00 X-RAY EXAM OF HAND 2 VIEWS $ 254.00 X-RAY EXAM OF JAW 4+ VIEWS $ 254.00 X-RAY EXAM OF PELVIS 1-2 VIEWS $ 254.00 X-RAY EXAM OF PELVIS 3+ VIEWS $ 254.00 X-RAY EXAM OF SKULL <4 VIEWS $ 254.00 X-RAY EXAM OF SKULL 4+ VIEWS $ 254.00 X-RAY XM ESOPHAGUS 1CNTRST $ 254.00 X-RAY XM SWLNG FUNCJ C+ $ 254.00 XRS BONE SURVEY COMPLETE $ 254.00 2.8MM DRILL BIT $ 255.00 3.0MM DRILL $ 255.00 PICC POWER 5F DOUBLE LUMEN $ 255.00 SCREW,2.5X14MM GOLD CRTX BONE $ 255.00 SCREW,2.5X15MM GOLD CORTX BONE $ 255.00 SCREW,2.5X24MM GOLD CORTX BONE $ 255.00 STENT N-U 10.2F X 22CM $ 255.00 STENT N-U 10.2F X 24 CM $ 255.00 STENT N-U 10.2F X 26CM $ 255.00 WRIGHT 1.6MM DRILL BIT $ 255.00 MIC-KEY LOW GAST 0120-18-4.5 $ 256.00 STENT BIL RX 10X7CM $ 256.00 STENT BIL RX 7X10CM $ 256.00 STENT BIL RX 7X7CM $ 256.00 LAB-FRAGILE X DNA DETECTION $ 257.00 PICC POWER 5F SINGLE LUMEN $ 257.00 PROF CYTOLOGIC EXM INTIAL SITE $ 257.00 PROF PFT*SPIROMETRY $ 257.00 INV ACCUSTICK II SYS .038 STRT $ 258.00 SHEATH 18F X 30CM $ 258.00

�81

WIRE LUNDERQUIST .035 X 260CM $ 258.00 INV CATH BALLOON FOGARTY 5F $ 259.00 SPEECH/HEARING THERAPY INDIV $ 259.00 STENT URETERAL 4.7F 26CM OPTIM $ 259.00 STENT URETERAL 6FR 28CM OPTIMA $ 259.00 ZIM IRRIGATING TUBE $ 259.00 C0 DIFFUSE CAPACITY $ 260.00 NXS CNLTD 2.7 DRBT FR 4.0MM SC $ 260.00 PFT * DIFFUSING CAPACITY $ 260.00 X-RAY EXAM CHEST 4+ VIEWS $ 260.00 DRLL 2.6MMX122MM WL70MM AOSHFT $ 261.00 PRESSURE MONITR QUICK SYS DISP $ 261.00 SHEATH PINNACLE 10F X 10CM $ 261.00 SHEATH PINNACLE 10F X 25CM $ 261.00 CARDIAC CATH-GUIDEWIRE $ 262.00 MAGNUM 2 W/TRAPZ/PT HELP P/D $ 262.00 PSYCL/NRPSYC TST TECH EA $ 262.00 XR*SURGICAL COMPONENT $ 262.00 COIL NESTER 18MM x 20CM $ 263.00 COIL TORNADO 5MM/2MM $ 263.00 INBONE SCREW BONE REMOVER $ 263.00 INBONE SCREW, BONE REMOVER $ 263.00 LAB-HIV 1 RNA PCR QUANTITATI $ 263.00 LAB-HIV I BY UHRASENS.PCR $ 263.00 STEP DRL 3MM KNOTLESS SUTR TAK $ 263.00 COIL NESTER 10MM X 14CM $ 264.00 US TO LOCALIZE FB IN EYE $ 264.00 12 LEAD EKG: TRACING ONLY $ 265.00 12 LEAD EKG; TRACING ONLY $ 265.00 2.7 X 16MM LCKNG HEXALOBE SCR $ 265.00 2.7 X18MM LOCKING HEXALOBE SCR $ 265.00 3 X 26MM LCKING HEXALOBE SCREW $ 265.00 3.0 X 20MM LCKNG HEXALOBE SCR $ 265.00 3.0 X 24MM LCKNG HEXALOBE SCR $ 265.00 3.5 X 14MM LCKNG HEXALOBE SCR $ 265.00 3.5 X 20MM LCKNG HEX SCREW $ 265.00 3.5 X 24MM LCKNG HEX SCREW $ 265.00 3.5 X 50MM LCKNG HEXALOBE SCR $ 265.00 3.5 X16MM LOCKING HEXALOBE SCR $ 265.00 3.5 X18MM LOCKING HEXALOBE SCR $ 265.00 3.5 X45MM LOCKING HEXALOBE SCR $ 265.00 EKG $ 265.00 LAB-VITAMIN D 1,25 DIHYDROXY $ 265.00 SCREW 3 X 26MM LCKNG HEXALOBE $ 265.00 SCREW 3 X 45MM LCKNG HEXALOBE $ 265.00 STRYKER 2 HOLE POST MALE $ 265.00 24FR LOW PROFILE G-TUBE $ 266.00

�82

ADMIN FLU VIRUS VACCINE $ 266.00 ADMIN HEPATITIS B VACCINE $ 266.00 ADMIN PNEUMONIA VACCINE $ 266.00 IMMUNIZATION ADMIN 1 VACCINE $ 266.00 OBS IM/SC-NC $ 266.00 OR-IM/SC NC $ 266.00 SHAVE LES S/N/H/F/G 0.5CM/< $ 266.00 SP*IM/SC NC $ 266.00 THER/PROPH/DIAG INJ SC/IM $ 266.00 VACCINE ADMIN-INFLUENZA $ 266.00 VACCINE ADMIN-PNEUMOCOCCAL $ 266.00 WRC-INJECTION SC OR IM $ 266.00 DX BONE MARROW ASPIRATIONS $ 267.00 4.5MM CANN TAP $ 268.00 COIL NESTER 10MM x 20CM $ 268.00 COIL NESTER 12MM x 20CM $ 268.00 COIL NESTER 14MM x 20CM $ 268.00 COIL NESTER 16MM X 20CM $ 268.00 COIL NESTER 3MM X 7CM .035 $ 268.00 LOCON-T DRILL BIT 2.0MM $ 268.00 LOCON-T DRILL BIT 2.5MM $ 268.00 PERINEAL PAD SUPINE $ 268.00 PFT * RESIDUAL AIR $ 269.00 PULM FUNCTION TEST BY GAS $ 269.00 SCREW 2.7X16MM LOCKING HEXALB $ 269.00 STRYKER TI T-PLATE 3/3 HOLE $ 269.00 TRICUT BLADE 13CM X 4MM $ 269.00 ABG DRAW $ 270.00 BILIARY CATH CHANGE $ 270.00 CENTER SLEEVE FOR 6MM HALF PIN $ 270.00 ENDO BAB-5BB $ 270.00 IR*PCNU TUBE CHG THRU ILEOSTOM $ 270.00 LAB-CHROMOSOME CULTURE, TISSUE $ 270.00 NEPHROSTOMY & TRANSCATH FOLL $ 270.00 SP*LEFT-NEPHROSTOMY & TRANSC $ 270.00 SP*RIGHT-NEPROSTOMY & TRANSC $ 270.00 XRAY CONTROL CATHETER CHANGE $ 270.00 PERC PLUS STENT 6X22 $ 271.00 PERC PLUS STENT 6X24 $ 271.00 PERC PLUS STENT 6X26 $ 271.00 2.7 X 122MM OVERDRILL $ 272.00 DRLL BT 03.6X122MM WT AO FTTNG $ 272.00 LAB-IMMUNOPEROXIDASE, EA $ 272.00 2.7 X 12MM LCKNG HEXALOBE SCR $ 273.00 2.7 X 14MM LCKNG HEXALOBE SCR $ 273.00 2.7 X 18MM LOW-PRO CORT SCREW $ 273.00 2.7 X 20MM LCKNG HEXALOBE SCR $ 273.00

�83

2.7 X 22MM LCKNG HEXALOBE SCR $ 273.00 3 HOLE POST MALE $ 273.00 3.5 X 22M LCKNG HEXALOBE SCREW $ 273.00 3.5 X12MM LCKNG HEXALOBE SCREW $ 273.00 DC COUNTER NUT $ 273.00 IRRIG DRUG DELIVERY DEVICE $ 273.00 NM I-25 SEED W 5CM NEEDLE $ 273.00 PARIETENE MESH 15CM X 15CM $ 273.00 PEDI GROUNDING PAD $ 273.00 PRTN MCROPOROUS MESH 15CMX10CM $ 273.00 SCREW 3.5X10MM LOCKING HEX $ 273.00 SCREW 3.5X12MM LOCKING HEX $ 273.00 SCREW LOW-PRO CORT 2.7 X 10MM $ 273.00 SCREW LOW-PRO CORT 2.7 X 12MM $ 273.00 US I-25 SEED W 5CM NEEDLE $ 273.00 END CAP STRL 11.5 PLUS 5MM $ 274.00 INSERT IUD $ 274.00 SCR 5.0 LCK 95MM FT $ 274.00 SCR LOK 5MM ID 80MML FT T2 $ 274.00 SCR LOK 5MM ID 95MML FT T2 $ 274.00 SCR T2 FLLY THRD LCKNG 5X55MM $ 274.00 SCREW 5 X 85 $ 274.00 SCREW FLLY THRD LCKNG 5 X 65MM $ 274.00 SCREW FLLY THRD LCKNG 5 X 70MM $ 274.00 SCREW LCKNG 5 X 60MM $ 274.00 T2 LCKG SCR FUL THR 5MMX47.5MM $ 274.00 T2LCKNGSCRW FLLTHRD 5MMX47.5MM $ 274.00 2.4 X 10MM CORTICAL SCREW $ 275.00 2.4 X 12MM LOW PROF SCREW $ 275.00 2.4 X 16MM LOW PROF SCREW $ 275.00 2.4 X 18MM LOW PROF SCREW $ 275.00 2.4 X 20MM LOW PROF SCREW $ 275.00 2.4 X 24MM LOW PROF SCREW $ 275.00 2.4 X 28MM TITANIUM SCREW $ 275.00 2.4 X 34MM TITANIUM SCREW $ 275.00 2.4 X 40MM TITANIUM SCREW $ 275.00 3 X 16MM LOCKING SCREW $ 275.00 3 X 20MM CORTICAL SCREW $ 275.00 3 X 24MM CORTICAL SCREW $ 275.00 3 X 26MM CORTICAL SCREW $ 275.00 BG NON LOCKING SCREW 2.0X12MM $ 275.00 BG NON LOCKING SCREW 2.5X12MM $ 275.00 BG NON LOCKING SCREW 2.5X14MM $ 275.00 DRILL BIT 2.0MM X 30MM $ 275.00 IMPL HINGE TOE W/GROM FLEX 5S $ 275.00 KIT ELVS 45CM new $ 275.00 KIT ELVS 65CM new $ 275.00

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MICRO ACUTRAK 2 LNG PROF DRILL $ 275.00 NON LOCKING SCREW $ 275.00 PLATE RECON NON LOCK 2.7X30MM $ 275.00 PUMP, SUTURELESS CONN REV KIT $ 275.00 SCR BONE STD 6.5 MM DIA 25 MM $ 275.00 SCR CORT LCK TI 3.0X20MM $ 275.00 SCREW RECON NONLCK PLT3.5X14MM $ 275.00 SCREW RECON NONLCK PLT3.5X16MM $ 275.00 SCREW RECON NONLCK PLT3.5X18MM $ 275.00 SCREW RECON NONLCK PLT3.5X20MM $ 275.00 SCREW RECON NONLCK PLT3.5X24MM $ 275.00 SCREW RECON NONLOCK PLT 3.5X12 $ 275.00 STRYKER RECIPROCATING BLADE $ 275.00 UNITRAX NECK ADJUSTMENT SLEEVE $ 275.00 4.8FR X 20CM PIGTAIL STENT $ 276.00 CATH LAB-ENDOMYOCARDIAL BX $ 276.00 ADHESIVE DERMABOND MINI 0.35ML $ 277.00 LAB-HELMINTH, NOT ELSEWHERE $ 277.00 MUSC TST DONE W/NERV TST LIM $ 277.00 LAB-SURGICAL PATH LEVEL IV $ 278.00 PROF -TISSUE EXAM BY PATH 4 $ 278.00 SCREW HEADED 2.0X10MM $ 278.00 STRAIGHTSHOT TUBING $ 278.00 STRGHTSHT XPS IRRIGATOR TUBING $ 278.00 TISSUE EXAM BY PATH LVL 4 $ 278.00 TISSUE EXAM BY PATHLGIST LVL 4 $ 278.00 TISSUE EXAM BY PATHOLGST LVL 4 $ 278.00 ARROW PERCUTANEOUS INTRODUCE $ 279.00 RHOGAM STD $ 279.00 DEBR EXZ/INF SKIN 10% BS $ 280.00 EVAC SU HEMATOMA $ 280.00 KNEE STRAPPING $ 280.00 REM IMPACTED EAR WAX UNI INSTR $ 280.00 REMOVE IMPACTED EAR WAX UNI $ 280.00 SCREW, 3.5 X 14MM LOCKING $ 280.00 STRAPPING OF TOES $ 280.00 STRAPPING SHOULDER $ 280.00 STRAPPING; SHOULDER $ 280.00 BASIC DOSIMETRY CALC $ 281.00 INFLUENZA DNA AMP PROBE $ 281.00 APPLY GAUNTLET CAST $ 282.00 CHEST PHYSIO-INITAL TX $ 282.00 LAMBS WOOL SLING $ 282.00 SP*ULT-S MONTRNG PAREN TIS A $ 282.00 STRAP ANKLE OR FOOT $ 282.00 VEST THERAPY $ 282.00 CARTER PILLOW $ 283.00

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ENTRL MINI ONE BUTTN 14FR X 10 $ 283.00 MUSC TEST DONE W/N TEST COMP $ 283.00 perflutren lipid microphere INJ 2 mL $ 283.00 perflutren lipid microphere INJ 2 mL (KPROV) $ 283.00 PILLOW CARTER $ 283.00 REM OBSTRUCTN FROM CVD $ 284.00 SP*MECH RMVL PERICATH FIB SH $ 284.00 BIT DRL L130MM OD4.2MM SS AO $ 285.00 ROYLON ARMSLING $ 285.00 SCR LOK 5MM ID 35MML FT T2 $ 285.00 T2 F/T LOCKING SCRW 5MMX52.5MM $ 285.00 T2 F/T LOCKING SCRW 5MMX57.5MM $ 285.00 BARD INLAY OPTIMA DOUBLE J $ 286.00 INS BLADDER CATH COMPLEX $ 286.00 IRRISEPT 2 STEP IRRIGATION SYS $ 286.00 NEUROMUSC JUNCTION TEST EA NER $ 286.00 NVR CNDJ TST 1-2 STUDIES $ 286.00 SCREW STRYKER LOCKING 5 X 35MM $ 286.00 SCREW STRYKER LOCKING 5 X 50MM $ 286.00 SCREW THREADED LOCKNG 4 X 45MM $ 286.00 SCRW 5M LOCK FULL TH TI 33.5M $ 286.00 CHEST X-RAY 2 VIEWS FR&LAT $ 287.00 COIL NESTER 14MM X 14CM $ 287.00 COIL NESTER 16MM X 14MM $ 287.00 COIL NESTER 18MM X 14CM $ 287.00 COIL NESTER 20MM X 14CM $ 287.00 COIL NESTER 20MM x 20CM $ 287.00 CONDLYE SCREW 6X80MM $ 287.00 PICC POWER 6F TRIPLE LUMEN $ 287.00 8 X 20MM CAN INTF SCR W/DIS SH $ 288.00 8X25MM CANN INT SCR W/DIS SHTH $ 288.00 COUNTERSINK 2.4MM CANNULATED $ 288.00 COUNTERSINK CANN 4MM $ 288.00 OBS INTRA-ARTERIAL NC $ 288.00 SCREW HEADED 2.5X30MM $ 288.00 SCREW HEADED 2.5X34MM $ 288.00 CRYOPR REDUCED PLASMA EA UNIT $ 289.00 IRIDEX 25G $ 290.00 MALE SUPPORT 2-HOLE $ 290.00 SNARE GOOSENECK ALL SIZES $ 290.00 V.A.C.ATS THERAPY UNIT PER D $ 290.00 1/8" PEG DRILL $ 291.00 ANTIBODY ELUTION $ 291.00 SP CONSULT; 1ST TB W FS SGL SP $ 291.00 WC OT EVAL LTD $ 291.00 WC OT EXPANDED TX $ 291.00 WC PT EVAL LTD $ 291.00

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WC PT EXPANDED TX $ 291.00 CATH OPEN-END FLEXI TIP $ 292.00 PLATELET LEUKO IRRAD EA UNIT $ 292.00 BATTERY $ 293.00 WIRE BOLT LONG $ 293.00 WIRE BOLT MEDIUM $ 293.00 WIRE BOLT SHORT $ 293.00 FAST TRACK J-TUBE 19FR/12FR $ 294.00 LAB-CYTOMEGALOVIRUS,QUANTIFC $ 294.00 LG TEAR CROSS CUT RASP $ 294.00 M&S SAPS SYRINGE $ 294.00 RASP SM TEAR CROSS CUT $ 294.00 SCR BONE L12MM OD3.5MM TI FT $ 294.00 SCREW LCKNG T20 5.0X 85MM $ 294.00 SCREW LCKNG T20 5.0X80MM $ 294.00 TOTAL CARE BASE MODEL PER DA $ 294.00 3.5MM DRILL BIT $ 295.00 NAVIGATOR HD SHEATH11/13FX28CM $ 295.00 NAVIGATOR HD SHEATH11/13FX36CM $ 295.00 NAVIGATOR HD SHEATH11/13FX46CM $ 295.00 NAVIGATOR HD SHEATH12/14FX28CM $ 295.00 NAVIGATOR HD SHEATH12/14FX36CM $ 295.00 PROF -CT HRT W/3D IMAGE CONGEN $ 295.00 STORZ PHACO PACK $ 295.00 1.5 X 10MM LOCKING SCREW $ 296.00 1.5 X 11MM LOCKING BONE SCREW $ 296.00 1.5 X 12MM LOCKING SCREW $ 296.00 1.5 X 13MM LOCKING BONE SCREW $ 296.00 1.5 X 14MM LOCKING BONE SCREW $ 296.00 1.5 X 16MM LOCKING SCREW $ 296.00 1.5 X 20MM LOCKING SCREW $ 296.00 1.5 X 7MM LOCKING SCREW $ 296.00 1.5 X 8MM LOCKING SCREW $ 296.00 1.5 X 9MM LOCKING SCREW $ 296.00 BONE BIOPSY DEVICE $ 296.00 K-WIRE 2MM X 450MM $ 296.00 DRILL BIT AO STRL 3.5X230MM $ 297.00 PFT * SPIROMETRY $ 297.00 SPIROMETRY $ 297.00 HYDRA JAGWIRE ST $ 298.00 LAB-BERYLLIUM BLOOD $ 298.00 3 HOLE POST FEMALE 954-2005 $ 299.00 CANNULA, DILATOR 5MM $ 299.00 DRILL, G11, 2.4MM $ 299.00 INV CATH PEEL AWAY $ 299.00 LAB-KRAS GENE ANLYS VAR CODO $ 299.00 LAB-MICRODISSECT MANUAL 26 $ 299.00

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LAB-MICRODISSECT MANUAL TC $ 299.00 ORTHLC 3.5 NLCKG SCR TI 3.5x22 $ 299.00 ORTHLC 3.5 NLCKG SCR TI 3.5x24 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X26 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X28 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X30 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X32 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X34 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X36 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X40 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X42 $ 299.00 ORTHOLOC TI NONLOCK SCW 3.5X44 $ 299.00 SET SCREW TI 8X17.5MM $ 299.00 T2 CONDYLE SCREW 5MMX70MM $ 299.00 UNITRAX C-TAPER NECK ADJ SLEVE $ 299.00 UNITRAX C-TAPER SLEEVE $ 299.00 .053 GUIDEWIRE W/TROCAR TIP $ 300.00 2.0 X 12MM MICRO ASNIS CAN SCR $ 300.00 2.7 X 10MM LOCKING SCREW $ 300.00 2.7 X 12MM LOCKING SCREW $ 300.00 2.7 X 14MM LOCKING SCREW $ 300.00 2.7 X 16MM LOCKING SCREW $ 300.00 2.7 X 18MM LOCKING SCREW $ 300.00 2.7 X 26MM LOCKING SCREW $ 300.00 2.7 X 28MM NON-LOCKING SCREW $ 300.00 3.5 X 12MM LOCKING SCREW $ 300.00 3.5 X 14MM LOCKING SCREW $ 300.00 3.5 X 16MM LOCKING SCREW $ 300.00 3.5MM ROTATE RAD60 BLADE $ 300.00 ACCUPORT END DELIVERY CANNULA $ 300.00 GW ORTHO TRCR TIP 1.35X150MM $ 300.00 GWIRE ORTHO 3.2X230CM $ 300.00 NEW OFFICE/OP VISIT LVL 3 $ 300.00 PERC NCIRCLE STONE BASKET $ 300.00 SCREW HEADED 2.5X16MM $ 300.00 SCREW HEADED 2.5X18MM $ 300.00 SCREW HEADED 2.5X24MM $ 300.00 UNTHREADED GUIDE WRE 2MMX150MM $ 300.00 XTRAFLO URETEL STENT 6 FRX26CM $ 300.00 2.5MM GUIDEWIRE- COCR $ 301.00 ENDO CLIP-ER 320 $ 302.00 LAB-BETHESDA TITER $ 302.00 LAB-COAG FACTVIIII ASSSAY SCRE $ 302.00 APPLY FINGER CAST $ 303.00 BRACE ROMX.FP $ 303.00 CRVD LNG INCISOR PLS ELIT BLDE $ 304.00 M&S OR CATH,THROMB/EMBOLECTO $ 304.00

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3.5 X 30MM LOCKING SCREW $ 305.00 6 X 80MM ASNIS SCREW $ 305.00 BIT DRL L180MM OD4.2MM SS AO $ 305.00 DRILL BIT 2.0MM/QC/100MM $ 305.00 LAB-TRH STIMULATION TEST $ 305.00 SCREW,4.3X32MM LOW PROF HEXALB $ 305.00 SCREW,4.3X34MM LOW PROF HEXALB $ 305.00 SCREW,4.3X36MM LOW PROF HEXALB $ 305.00 SCREW,4.3X38MM LOW PROF HEXALB $ 305.00 SCREW,4.3X42MM LOW PROF HEXALB $ 305.00 SCREW,4.3X44MM LOW PROF HEXALB $ 305.00 SCREW,4.3X46MM LOW PROF HEXALB $ 305.00 SCREW,4.3X48MM LOW PROF HEXALB $ 305.00 SCREW,4.3X50MM LOW PROF HEXALB $ 305.00 SCREW,4.3X54MM LOW PROF HEXALB $ 305.00 SET SCR SPNL 5.5 MM DIAM N BRK $ 305.00 UNNA BOOT STRAPPING $ 305.00 WRC-UNNA BOOT $ 305.00 LOCKING SCREW, T10, 3.5X14MM $ 306.00 LOCKING SCREW, T10, 3.5X18MM $ 306.00 M&S-STAPLE EQUIP $ 306.00 PROF PFT*RESIDUAL AIR $ 306.00 HELICOBATER PYLORI;BREATH TE $ 307.00 CATH BILIARY 10.2FR $ 308.00 DOPPLER ECHO LIMITED/ F-UP $ 308.00 SCREW HEADED 3.0X14MM $ 308.00 SCREW HEADED 3.0X16MM $ 308.00 SMN1 GENE DOS/DELETION ALYS $ 308.00 2.6MM DRILL BIT $ 309.00 3.5MM OVERDRILL $ 309.00 DRILL, 2.0MM X 122MM $ 309.00 GAP PLATE SCREWS 6.5MM X 20MM $ 309.00 GAP PLATE SCREWS 6.5MM X 25MM $ 309.00 INV POWER PICC $ 309.00 SHEATH INTRACARD NO PEEL FIXED $ 309.00 SHEATH INTRACARD PEEL FIXED $ 309.00 SHEATH INTRACARD STEER NO PEEL $ 309.00 2.7 X 24MM NON-LOCKING SCREW $ 310.00 2.7 X 26MM NON-LOCKING T10 SCR $ 310.00 2.7 X 28MM NL SCREW $ 310.00 2.7 X 28MM NL SCREW (STRYKER) $ 310.00 2.7 X 30MM NON-LOCKING SCREW $ 310.00 2.7 X 32MM NON-LOCKING SCREW $ 310.00 2.7 X 34MM FT BONE SCREW $ 310.00 2.7 X 34MM NON-LOCKING T10 SCR $ 310.00 2.7 X 36MM NON-LOCKING SCREW $ 310.00 2.7 X 40MM NON-LOCKING SCREW $ 310.00

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2.7 X 45MM NON-LOCKING SCREW $ 310.00 HEADED SCREW 3.0MM X 12MM $ 310.00 SCREW 2.7 X 10MM NL T8 $ 310.00 SCREW 2.7 X 32MM NL $ 310.00 SCREW 2.7X16MM NONLOCKING $ 310.00 SCREW 2.7X18MM NONLOCKING $ 310.00 SCREW HEADED 3.0X18MM $ 310.00 SCREW HEADED 3.0X26MM $ 310.00 SCREW HEADED 3.0X28MM $ 310.00 SCREW HEADED 3.0X38MM $ 310.00 STOCKINETTE 6x60 $ 310.00 CARDIAC EVENT MONITOR-INSTAL $ 311.00 PSYTX W PT 60 MINUTES $ 311.00 REMOTE PT 30 DAY ECG REV/REPOR $ 311.00 REMOTE PT 30 DAY ECG REV/REPT $ 311.00 4 HOLE POST $ 312.00 ASNISIII PART THREAD SS4X32 MM $ 312.00 DRILL 2.8MM QR W/DEPTH MARKS $ 312.00 FLOSEAL $ 312.00 GWIRE ORTHO 3.2X230MM $ 312.00 INSTRUMENT TRACKER $ 312.00 M & S SUPPLY- LEVEL 3 $ 312.00 M&S SUPPLY-LEVEL 3 $ 312.00 NS ARLK MT PL CL WDG TRL IM LT $ 312.00 NS ARLK MT PL OPWD 3 TRL IM RT $ 312.00 NS ARLK MT PL OPWDG 3 TR IM LT $ 312.00 NS ARLK MT PL OPWDG 4 TR IM LT $ 312.00 NS ARLK MT PL OPWDG 4 TR IM RT $ 312.00 NS ARLK MT PL OPWDG 5 TR IM LT $ 312.00 NS ARLK MT PL OPWDG 5 TR IM RT $ 312.00 NSTP ARLK MT PL CL WD TR IM RT $ 312.00 NVSTP ARLCK MTP PL TRL IMPL LT $ 312.00 NVSTP ARLCK MTP PL TRL IMPL RT $ 312.00 SCRW STYKR III SCWS 8.0MMX105M $ 312.00 XR*BONE STUDY LIMITED $ 312.00 XRS BONE SURVEY LIMITED $ 312.00 1.4MM ICONIX DRILL $ 313.00 2.4 X 12MM LOW PRFLE LCKNG SCR $ 313.00 2.4 X 14MM LOW PRFLE LCKNG SCR $ 313.00 2.4 X 16MM LOW PRFLE LCKNG SCR $ 313.00 2.4 X 18MM LOW PRFLE LCKNG SCR $ 313.00 2.4 X 28MM LOCKING SCREW $ 313.00 ALEXIS WOUND PROTECTOR - XXL $ 313.00 DRILL BIT 1.4MM ICONIX $ 313.00 DRILL TWIST ICONIX DISP 2.3MM $ 313.00 FLEXIBLE OBTURATOR $ 313.00 LENS INTRA OCULAR 21.5 LI61AO $ 313.00

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OBS IVP-NC EA ADD SEQ NEW DR $ 314.00 OR-IVP NC EA ADDL SEQ NEW DR $ 314.00 SP*IVP NC EA ADDL SEQ NEW DR $ 314.00 TX/PRO/DX INJ NEW DRUG ADDON $ 314.00 1.2MM K-WIRE $ 315.00 3.5 X 14 NON-LOCKING SCREW $ 315.00 3.5 X 16 NON-LOCKING SCREW $ 315.00 3.6 X 24MM CP SCREW, T8 $ 315.00 3.6 X 28MM ANCHORAGE 2 CP SCR $ 315.00 DRILL BIT 1.5MM 310.16 $ 315.00 EXC TR-EXT MAL+MARG 0.6-1 CM $ 315.00 EXCIS MALIG LESION .6-1CM $ 315.00 SHEATH FLEXOR URETERAL ACCESS $ 315.00 SHTH DILATOR URET ACCSS FLEXOR $ 315.00 WRC-EXCIS MALIG LESION .6-1CM $ 315.00 WRGHT 2.0 X 12MM CANNULATD SCR $ 315.00 IMPLATABLE, TISSUE MARKER $ 316.00 WRC-BIOPSY BONE,TROCAR/NDL/C $ 316.00 INTUBATING STYLET W/LITE-ORA $ 317.00 INV RAD TREAT DEL CUST 6-10M $ 317.00 SMALL TEAR CROSS CUT RASP $ 317.00 SMALL TEAR RASP 10.3 X 5.0MM $ 317.00 DRILL BIT 3.2MM PERIPHERAL SCR $ 318.00 SCREW AEQUALIS CENTER 6.5X40MM $ 318.00 LEVEL 3 ANCHOR, SCREW, PEN,PIN $ 319.00 SUB-SELECTION DELIVERY SYSTEM $ 319.00 TMJ JOINT - BILATERAL $ 319.00 XR*T & M JOINTS, BILAT $ 319.00 2.7 X 12MM NON-LOCKING SCREW $ 320.00 2.7 X 18MM CORTICAL SCREW $ 320.00 2.7 X 24MM CORTICAL SCREW $ 320.00 2.7 X 30MM NL SCREW $ 320.00 2.7X28MM NON-LOCKING SCR STRYK $ 320.00 3.5 X 10MM CORTICAL SCREW $ 320.00 3.5 X 32MM NON-LOCKING SCREW $ 320.00 3.5 X 34MM NL BONE SCREW $ 320.00 3.5 X 36MM NON-LOCKING SCREW $ 320.00 3.5 X 38MM NON-LOCKING SCREW $ 320.00 3.5 X 42MM NON-LOCKING SCREW $ 320.00 3.5 X 44MM NON-LOCKING SCREW $ 320.00 3.5 X 46MM NON-LOCKING SCREW $ 320.00 BNE SCR T10 FL THR 3.5MM/L50MM $ 320.00 BONE SCR T10 FULL THR3.5/L24MM $ 320.00 BONE SCR T10 FULL THR3.5/L28MM $ 320.00 BONE SCR T10 FULL THR3.5/L30MM $ 320.00 HEADED SCREW 3.5MM X 18MM $ 320.00 HEADED SCREW 3.5MM X 48MM $ 320.00

�91

LAB-ISHQUANT/SEMIQ $ 320.00 NLCK BNSCR T10 FLTHD 3.5MM20MM $ 320.00 N-LCKG BNESCR T10 FLTH 3.5/L18 $ 320.00 NLCKNG BNESCR T10 FLTH 3.5XL16 $ 320.00 NON-LOCKING BONE SCRW 3.5X40MM $ 320.00 NON-LOCKING BONE SCRW 3.5X48MM $ 320.00 PHAENICIA SERICAT LARV 250-5 $ 320.00 PROF-TUMOR IMMUN/MANUAL $ 320.00 S&N TIBIAL ANCHOR SCR 9MMX25MM $ 320.00 SCREW 2.7X14MM NONLOCKING $ 320.00 SCREW 2.7X20MM NONLOCKING $ 320.00 SCREW 2.7X26MM NONLOCKING $ 320.00 SCREW 2.7X28MM NONLOCKING $ 320.00 SCREW 2.7X8MM NONLOCKING $ 320.00 SCREW 3.5X10MM NONLOCKING $ 320.00 SCREW 3.5X12MM NONLOCKING $ 320.00 SCREW 3.5X14MM NONLOCKING $ 320.00 SCREW 3.5X20MM NONLOCKING $ 320.00 SCREW 3.5X22MM NONLOCKING $ 320.00 SCREW 3.5X24MM NONLOCKING $ 320.00 SCREW 3.5X26MM HEADED $ 320.00 SCREW 3.5X26MM NONLOCKING $ 320.00 SCREW 3.5X28MM HEADED $ 320.00 SCREW 3.5X28MM NONLOCKING $ 320.00 SCREW 3.5X32MM NONLOCKING $ 320.00 SCREW HEADED 3.5X14MM $ 320.00 SCREW HEADED 3.5X32MM $ 320.00 SCREW HEADED 3.5X32MM DARTFIRE $ 320.00 SCREW HEADED 3.5X36MM $ 320.00 SCREW HEADED 3.5X38MM DARTFIRE $ 320.00 SCREW HEADED 3.5X42MM $ 320.00 SCREW HEADED 3.5X46MM $ 320.00 SCREW3.5X18MM NONLOCKING $ 320.00 SHEARS 5MM CURV HARMNC SCALPEL $ 320.00 SHORT POST $ 320.00 ST NLCK BNSC T10 FLTHR 3.5/L26 $ 320.00 ST N-LKG BN SC T10 FT 3.5X14MM $ 320.00 ST N-LKG BN SC T10 FT 3.5X55MM $ 320.00 ST N-LKG BN SC T10 FT 3.5X60MM $ 320.00 WIRE FIX L150MM OD0.9MM BLNT $ 320.00 4.2MM CALIBDRIL RADIO TRGT DVC $ 321.00 FAN SPRAY TIP $ 321.00 PERC W SNT4.8X18 W/035 STFPTFE $ 322.00 PERC W SNT4.8X20 W/035 STFPTFE $ 322.00 PERC W SNT4.8X22 W/035 STFPTFE $ 322.00 PERC W SNT4.8X24 W/035 STFPTFE $ 322.00 PERC W SNT4.8X26 W/035 STFPTFE $ 322.00

�92

PERC W SNT4.8X28 W/035 STFPTFE $ 322.00 PERC W SNT4.8X30 W/035 STFPTFE $ 322.00 PROF MULTI SLEEP LATENCY $ 322.00 URETERAL STENT 6FR X 22CM $ 322.00 3.7MM DRILL $ 323.00 6 X 24 STENT $ 323.00 DRILL BIT 1.5MM 310.141 $ 323.00 EST OFFICE/OP VISIT LVL 3 $ 323.00 HOLTER 24HR SCANNING/REPORT $ 323.00 MICRO ACUTRAK2 DRILL $ 323.00 RIGHT ANGLE DISSECTOR 5MM $ 323.00 SCREW 3.5X24MM LOCKNG HEXALB $ 323.00 SCREW HEADED 2.5X28MM $ 323.00 SCREW HEADED 3.5X16MM $ 323.00 SCREW HEADED 3.5X34MM $ 323.00 SCREW HEADED 3.5X40MM $ 323.00 STR DUAL CUT SAGITL BLADE-THIN $ 323.00 VZ IMMUNE GLOBULIN PEDIATRIC $ 323.00 PAK NEEDLE 2 TROCAR TIPS $ 324.00 6FR X 22CM URETERAL STENT $ 325.00 CT SCAN-UNLISTED PROCEDURE $ 325.00 LAB-VITAMIN D 25 HYDROXY LEV $ 325.00 LAB-VITAMIN D 25HYD $ 325.00 NXS CNTSK RMR 3.7 FR 4.0MM SCR $ 325.00 OBS IVP-NC $ 325.00 OR-IVP NC SINGLE/INITIAL $ 325.00 SCREW CANNULATED 2.5 X 12MM SD $ 325.00 SP*IVP NC SINGLE/INITIAL $ 325.00 SUPER QUAD ANCHOR $ 325.00 THER/PROPH/DIAG INJ IV PUSH $ 325.00 VITAMIN D 25 HYDROXY $ 325.00 WHFO PREFAB WITHOUT JOINTS $ 325.00 WIRE MICRO CTO 6 $ 325.00 WIRE V-14 .014 X 182CM $ 325.00 ARTER LOWER EXT,UNI OR LTD,R $ 326.00 ARTER LOWER EXT,UNIL OR LTD, $ 326.00 CNSCR 4MM PTLTHRD TI 38MMX13MM $ 326.00 DIEGO ELITE BLADE $ 326.00 DUPLEX HEMODIALYSIS ACCESS $ 326.00 DUPLEX LE ART/BPG UNIL/LIMIT $ 326.00 DUPLEX UE ART/BPG UNIL/LIMIT $ 326.00 ULTRASONIC GUIDANCE INTRAOPE $ 326.00 ULT-S DUP SCAN HEMODIAL ACCE $ 326.00 ULT-S DUPLEX AORTA,IVC,ILIAC $ 326.00 ULT-S LEFT KIDNEY TRANSPLANT $ 326.00 ULT-S RETROPERIT,LTD,AORTA $ 326.00 ULT-S RIGHT KIDNEY TRANSPLAN $ 326.00

�93

ULT-S SCROTUM & CONTENTS $ 326.00 ULT-S SPINAL CANAL $ 326.00 US EXAM ABDO BACK WALL LIM $ 326.00 US SCROTUM AND CONTENTS $ 326.00 US-LEFT-DUPLEX SCAN UPPER EX $ 326.00 US-RIGHT-DUPLEX SCAN UPPER E $ 326.00 VASC*DUP SCAN HEMODIAL ACCE $ 326.00 VASC*DUPLEX AORTA,IVC,ILIAC $ 326.00 ISO*TC99M MEBROFENIN PER 15M $ 327.00 MAGNETIC IMAGE BONE MARROW $ 327.42 1.3 X 11MM CORTEX SCREW $ 328.00 2.7MM OVERDRILL $ 328.00 CHEMO IV PUSH ADDL DRUG $ 328.00 FOOT PAD SANDAL $ 328.00 NGAG NTNL STN EXTR 1.7FRX115CM $ 328.00 URETRAL SHTH 10.7FR X45X12.7FR $ 328.00 LAB-JAK2V617F MUT $ 329.00 LAB-TUMOR IMMUNO MORPH ANAL $ 329.00 NASOPHARYNGOSCOPY W ENDOSCOPE $ 329.00 PT RE-EVAL EST PLAN CARE $ 329.00 DIEG PWRD DIS BLD IRR 4MM 40DG $ 330.00 DRILL, POLARUS 3 2.8MM SHORT $ 330.00 SCISSORS FOMAN UPPER LATERAL $ 330.00 SMTH&NPH FLX PSS PN 13.5X2.4MM $ 330.00 TITANIUM MATRIX MDFACE SCR 4MM $ 330.00 TITANIUM MATRIX MDFACE SCR 5MM $ 330.00 OT EVAL HIGH COMPLEX 60 MIN $ 331.00 PSYCH DIAG EVAL W/O MED SVC $ 331.00 XR EXAM ENTIRE SPI 2/3 VW $ 331.00 XR EXAM HIPS BI 2 VIEWS $ 331.00 XR*HIPS,BI 2V OR MORE W/PELV $ 331.00 XR*SCOLIOSIS STUDY $ 331.00 XR*SPINE, SPINE 2 OR 3 VIEW $ 331.00 X-RAY EXAM ENTIRE SPI 2/3 VW $ 331.00 X-RAY EXAM HIPS BI 2 VIEWS $ 331.00 4 X 24MM PTL THD SCREW $ 332.00 4 X 34MM PTL THD SCREW $ 332.00 4.0 X 32MM TI CANNULATED SCREW $ 332.00 4.0 X 40MM TI CANNULATED SCREW $ 332.00 4.0 X 44MM TI CANNULATED SCREW $ 332.00 4.0 X 65MM TI CANNULATED SCREW $ 332.00 4.0MM X 28MM TI CANN SCREW $ 332.00 4.0X46MM TI CANNULATED SCREW $ 332.00 APPLY FINGER SPLINT $ 332.00 APPLY FINGER SPLINT STATIC $ 332.00 APPLY FINGER SPLINT; STATIC $ 332.00 CANNULATED SCREW 4.0 X 60MM $ 332.00

�94

SCREW 4.0 X 42MM TI CANNULATED $ 332.00 SCREW, CANNULATED 4.0MM X 55MM $ 332.00 TI ASNIS III CANLTD SCR 4X30MM $ 332.00 ULT-S FETAL GROWTH,FOLLOW-UP $ 332.00 ENDO LINEAR CUTTER RELOAD BLCK $ 333.00 PASSING PIN- 2.4MM $ 333.00 SCREW 4 FULL THREAD CANN 44MM $ 333.00 3.2MM CANN JONES DRILL $ 335.00 ACUTE HEPATITIS PANEL $ 335.00 DRILL BIT 2.0MM CANN $ 335.00 DRILL BIT 2.2MM CANN $ 335.00 DRILL BIT 3.0MM CANN $ 335.00 INFER TURBINATE BLADE 11CMX2MM $ 335.00 KW TMP FX BLNT TROCR 0.9X150MM $ 335.00 LAB-HEP A AB IGM $ 335.00 LAB-HEPATITIS PANEL- ACUTE $ 335.00 SCREW HEADED 2.5X14MM $ 335.00 ZEBRA 035/150 STRT (BX/5) $ 336.00 BICAP-PROBE $ 337.00 BIOCOMPOSITE SYSTEM KIT $ 337.00 THORADRAIN III KIT $ 337.00 20FR PEG KITS $ 338.00 2X100MM QUICK COUPLING $ 338.00 3.2MM GUIDEWIRE $ 338.00 DRILL BIT 2.0X1.5MM $ 338.00 DRILL BIT TWIST 1.4MM $ 338.00 STANDARD PEG KIT 20 FR $ 338.00 STAPLER GIA 80 - 3.8 $ 338.00 SURGMASTER HF LOOP, 24FR, 0.2 $ 338.00 SZ2 KYP EXP BONE BIOP DEV TPRD $ 338.00 10MM OPEN BOX END WRENCH $ 339.00 LAB-LS RATIO $ 339.00 XR*SALIVARY GLAND $ 339.00 sodium hyaluronate 20 mg/2mL SYRINGE (KPROV) $ 339.60 5X44MM ASNIS III CNLTD SCRW $ 340.00 ASN III SCR SS 5.0X40MM FL THD $ 340.00 WIRE AMPLATZ .035 X 75CM $ 340.00 SURGIFLO ENDOSCOPIC APPLICATOR $ 341.00 4 X 36MM ASNIS SCREW $ 342.00 EVAL FOR SPEECH DEVICE RX 1HR $ 342.00 CT SCAN-GUIDE FOR NEEDLE PLC $ 343.00 INSITU HYBRIDIZATION (FISH) $ 343.00 NEW OFFICE/OP VISIT LVL 4 $ 343.00 SP*CT GUIDE NEEDLE PLACEMENT $ 343.00 1.8MM K-WIRE (SYNTHES) $ 345.00 4.0X 48MM TI ASNIS III CAN SCR $ 345.00 CHEM CAUT GRANULATION TISS $ 345.00

�95

CHEM CAUT OF GRANLTJ TISSUE $ 345.00 DESTRUCT LESION 15 OR MORE $ 345.00 HBOT-WOUND CAUTERY-CHEMICAL $ 345.00 PSYCH DIAG EVAL W/MED SRVCS $ 345.00 PSYCH DIAG EVALUATION-W/MED SV $ 345.00 SCREW 3.5X16MM NONLOCKING $ 345.00 SINGLE INNER SET SCREW, TI $ 345.00 ST PRT THR TI CAN SCR 4.0X48MM $ 345.00 WC OT COMPR TX $ 345.00 WC PT COMPR TX $ 345.00 WRC-WOUND CAUTERY-CHEMICAL $ 345.00 3.0MM. DIAMOND NEURO $ 346.00 4 HOLE POST FEMALE $ 346.00 4.0 ASNIS MICRO CANN SCRW 50MM $ 346.00 CAN SC 4X26MM SCRSYS PRTHRD TI $ 346.00 JAK2 Mutation, Qual $ 346.00 URETR SHTH 45 CM 10.7FRX12.7FR $ 346.00 PROF PFT*BRONCHO $ 347.00 S.S. HALF PIN 6.0MMX120MMX40MM $ 347.00 MR GUIDANCE FOR NEEDLE PLACE $ 347.13 2.0MM QR DRILL $ 348.00 2.7 X 46MM LOCKING SCREW $ 348.00 2.8MM CANN DRILL BIT $ 348.00 3.2MM DRILL BIT $ 348.00 AXSOS TWST DRLL 3.5MM/195MM/AO $ 348.00 DRILL BIT 4.5MM $ 348.00 DRILL ENDO $ 348.00 FETAL BIOPHYS PROFILE W/O NS $ 348.00 NDL KNIFE MICRO XL 3 LUM $ 348.00 WRGHT LISFRANC DRILL BIT 4.5MM $ 348.00 WRGHT LISFRANC DRLL BIT 3.2MM $ 348.00 hyaluronan 30 mg/2 mL SYRINGE $ 348.15 3.0MM DRILL BITS $ 349.00 6.0MM DRILL BITS $ 349.00 7.0MM DRILL BITS $ 349.00 2.4 X 14MM VAL SCREW $ 350.00 2.4 X 18MM VAL SCREW $ 350.00 2.4 X 20MM VAL SCREW $ 350.00 4 X 30MM CAN LONG THREAD SCREW $ 350.00 AR2MM LOPROSCR CANPARTHRD 12MM $ 350.00 AR2MM LOPROSCR CANPARTHRD 14MM $ 350.00 GUIDEWIRE $ 350.00 MICRO SUTURE LASSO SM CRV $ 350.00 PEGS 2.5MM TREADED PART 16MM $ 350.00 S&N PASS PIN DRILL TIP 2.4X15 $ 350.00 SUTURE LASSO 45DEG CRVD 37 $ 350.00 SUTURE LASSO 45DEG CRVD RT $ 350.00

�96

SUTURELASSO SD 90 DEG STRAIGHT $ 350.00 COMPREHENSIVE INITIAL PLACEMEN $ 351.00 HBRD MTIN GUIDWR 0.035INX150CM $ 351.00 LAB-ABL1 $ 351.00 LAB-HEMOPHILIA A INVERSION $ 351.00 LAB-JAK2 EXON 12 MUTATION $ 351.00 SCREW 3.0 X 16 CANNULATED $ 351.00 VITRECTOMY PACK, ANTERIOR $ 351.00 ADHESIVE SKIN CLSR SYS 22CM $ 352.00 ANESTH M&S-ENDO BRONCHIAL TU $ 352.00 TLC 75 $ 352.00 WHOLE BLOOD TRANSFUSD,PER UNIT $ 352.00 3.5 X 10MM LOCKING SCREW $ 353.00 3.5 X 12 LOCKING SCREW $ 353.00 3.5X12 LCKNG SELF-TAPPING SCRW $ 353.00 3.5X16 LCKNG SELF-TAPPING SCRW $ 353.00 3.5X18 LCKNG SELF-TAPPING SCRW $ 353.00 3.5X20 LCKNG SELF-TAPPING SCRW $ 353.00 3.5X22 LCKNG SELF-TAPPING SCRW $ 353.00 CATHETER UNI FUSE 5FX10CMX45CM $ 353.00 CATHETER UNI FUSE 5FX10CMX90CM $ 353.00 CATHETER UNI FUSE 5FX20CMX45CM $ 353.00 CATHETER UNI FUSE 5FX20CMX90CM $ 353.00 CATHETER UNI FUSE 5FX30CMX90CM $ 353.00 CATHETER UNI FUSE 5FX40CMX90CM $ 353.00 CATHETER UNI FUSE 5FX5CMX135CM $ 353.00 CATHETER UNI FUSE 5FX5CMX45CM $ 353.00 CATHETER UNI FUSE 5FX5CMX90CM $ 353.00 CATHETR UNI FUSE 5FX10CMX135CM $ 353.00 CATHETR UNI FUSE 5FX15CMX135CM $ 353.00 CATHETR UNI FUSE 5FX20CMX135CM $ 353.00 CATHETR UNI FUSE 5FX30CMX135CM $ 353.00 CATHETR UNI FUSE 5FX40CMX135CM $ 353.00 LAB-INFECTIOUS AGENT ANTIGEN $ 353.00 LAB-PARAFFIN BLOCK CHARGE $ 353.00 REF CONSULT W SLIDE PREP $ 353.00 DRILL BIT, 2.0 X 40MM $ 354.00 LAB-PLASMODIUM- MALARIA $ 354.00 SCR ORTHO CANN 3.0MM X 14MM $ 354.00 SCR ORTHO CANN 3.0MM X 16MM $ 354.00 SCR ORTHO CANN 3.0MM X 18MM $ 354.00 SPRM-INJ FACET NERVE LUMB EA $ 354.00 3MM EZ CLIP POSITIONING PIN $ 355.00 EZ CLIP 2MM POSITIONING PIN $ 355.00 APEX HA COATD SLFDRILL HALFPIN $ 356.00 CANNULA, DISSECTOR 12MM $ 356.00 DRAINAGE BOTTLE PLEURX $ 356.00

�97

PROF -EVAL OF FNA; INT & REP $ 356.00 PROF- REF CONSULT W SLIDE PREP $ 356.00 SCREW PARTIAL THREAD 4X44MM $ 357.00 UNIV C-TPR +0MM ADPTR SLEEVE $ 358.00 NONLOCKING SCR T10 3.5X16MM $ 359.00 NONLOCKING SCR T10 3.5X20MM $ 359.00 ADHESIVE SKIN CLOSURE SYS 42CM $ 360.00 LAB-CHROMOSOME ANALY TISSUE $ 360.00 LAB-CHROMOSOME CULTURE, BLOOD $ 360.00 LAB-TISSUE CULT CHRO HIGH RE $ 360.00 GRAY REV INST SYS 120MM $ 361.00 GRAY REV INSTR SYS HOOK $ 361.00 GRY REV INSTR SYS FLX OSTEOTME $ 361.00 GUIDE FOR GI TUBE $ 361.00 US BREAST COMPLETE $ 361.00 US BREAST COMPLETE LEFT $ 361.00 US-BREAST COMPLETE RIGHT $ 361.00 US-DENSE BREAST LEFT $ 361.00 US-DENSE BREAST RIGHT $ 361.00 WIRE WITH OLIVE 2 X 450 $ 361.00 GUIDEWIRE STRK BALLTIP 3X1000M $ 362.00 3.0MM DRILL BIT $ 363.00 3.1MM DRILL BIT $ 363.00 ACL DSP KT TRNSTIB W/O SAW BLD $ 363.00 BARD MESH PREFIX PLUG SMALL $ 363.00 DRLL BT N-LCKNG SHRT 2.5X215MM $ 363.00 EXTRCT 3 LUM BLN 12-15MM 200CM $ 363.00 EXTRCT 3 LUM BLN 9-12MM 200CM $ 363.00 PROF PFT*BRONCHO EVAL $ 363.00 REAMER SHAFT, MODERATE TRINKLE $ 363.00 STRY S DRILL AO 04X360MM $ 363.00 2.4 MM VRBLE ANGL LCK SCR 14MM $ 364.00 2.4 MM VRBLE ANGL LCK SCR 16MM $ 364.00 2.4 MM VRBLE ANGL LCK SCR 18MM $ 364.00 2.4 MM VRBLE ANGL LCK SCR 20MM $ 364.00 AR 3MM LWPRF SC CAN PARTH 16MM $ 364.00 AR 3MM LWPRF SC CAN PARTH 18MM $ 364.00 ART 4MM SH TH CAN PART TH 22MM $ 364.00 ART 4MM SH TH CAN PART TH 24MM $ 364.00 DRILL ACUFEX ENDO CANN 4.5 $ 364.00 STRY K-WIRE DRILL 1.8MMX400MM $ 364.00 1.5MM DRILL BIT/KWIRE ATTCHMT $ 365.00 1.5MM DRILL BIT/K-WIRE ATTCHMT $ 365.00 DRILL BIT, 1.5MM $ 365.00 PRESEP CV OXIMETRY CATHETER $ 365.00 HBOT-TCOM SINGLE SITE $ 366.00 UPR/L XTREMITY ART 2 LEVELS $ 366.00

�98

LAB-5,10 MTHFR $ 368.00 NON-LOCKING SCREW,T10,3.5X16MM $ 368.00 WHFO PREFAB BANDS SPRINGS JOIN $ 368.00 BONE FENESTRATION PERFORATOR $ 369.00 CANN 2.4X140MM MEASURLONG AO $ 369.00 CANNULATED AO DRILL 1.7 X 120 $ 369.00 CANNULATED DRILL AO 2.3 X 120 $ 369.00 DRILL BIT PARAGON $ 369.00 DRILL BIT, PARAGON $ 369.00 PHAENICIA SERICA LARV 500-10 $ 370.00 US ABDL AORTA SCREEN AAA $ 370.00 HLA AB SCREEN $ 371.00 SHOULDER ABDUCTION RESTRAINE $ 371.00 2.5 X 18MM MDTP SCREW $ 372.00 6.5X 75MM ASNIS SCREW $ 373.00 HBOT-NEG PRESSURE TX <= 50SQ $ 373.00 NEG PRESS WOUND TX <=50 CM $ 373.00 PROF CHROMOSOME ANALYSIS $ 373.00 S&N SPIKED WASHER, 17MM X 6MM $ 373.00 WRC-NEG PRESSURE TX <=50 SQC $ 373.00 PT EVAL HIGH COMPLEX 45 MIN $ 374.00 RLD VSCLR 30MM MED TRSTPL 2.0 $ 374.00 SIMPLEX CEMENT & BOWL $ 374.00 .035 X 260 GUIDEWIRE $ 375.00 3.5MM CANNULATED DRILL $ 375.00 50-S SUCTION PROBE WAND $ 375.00 AR 4MM SH THR CAN PRT THR 40MM $ 375.00 AR 4MM SH THR CAN PRT THR 50MM $ 375.00 ARTH QCKFX CAN SCRST DRLBT 2.2 $ 375.00 DARCO HEADED COUNTERSINK $ 375.00 LAB-HIV-AIDS $ 375.00 MINI MONSTER CANN 3.5X14MM $ 375.00 MINI MONSTER CANN 3.5X16MM $ 375.00 MINI MONSTER CANN 3.5X36MM $ 375.00 MINI MONSTER CANN SHORT THREAD $ 375.00 MINI MONSTER SHORT $ 375.00 MINI MONSTER SHORT 3.0X14 $ 375.00 MINI MONSTER SHORT 3.0X16 $ 375.00 MINI MONSTER SHORT 3.5X46M $ 375.00 NEXIS SCREW SNAP-OFF 2MMX14MM $ 375.00 PEG 2.5X24MM PART THREADED $ 375.00 STR VRX 2MM K-W WSTP T10 SCRHD $ 375.00 XR*UNLSTD FLUOROSCOPIC PROC $ 375.00 STAPLER GIA 45 VASC $ 376.00 4.5MMX125MM ANG CUT FORM TOMCT $ 377.00 S&N DISPOS KIT 2.8MM Q-FIX IMP $ 377.00 EPINEPHrine 0.3 mg SYRG (Epi-pen) $ 377.18

�99

BARD MESH PREFIX PLUG LARGE $ 378.00 EPINEPHrine 0.3 mg SYRINGE (KPROV) $ 378.40 EPINEPHrine 0.15 mg SYRINGE (Epi-pen JR) (KPROV) $ 378.68 EPINEPHrine 0.15 mg SYRINGE (Epi-pen JR) $ 378.88 PROF ECHO STRESS $ 379.00 ANTI THROMBOTIC STOCKING $ 380.00 DARCO HEADED DRILL BIT 4.4MM $ 380.00 FIBERGLASS CAST $ 380.00 LAB-HUMAN HERPESVIRUS8 AB $ 380.00 PATIENT TRACKER, NON-INVASIVE $ 380.00 DEST LESN(S) PENIS SMPLE; CRYO $ 381.00 DESTR MLES S/N/H/F/G; 1.1-2.0 $ 381.00 DESTR MLES S/N/H/F/G;0.6-1 $ 381.00 DESTR MLES T/A/L; 2.1-3.0 CM $ 381.00 SN KNTPSHR/STRCTR SLT CAN SET $ 381.00 SREP S/N/A/G/TR/E;>30CM $ 381.00 SP*US GUIDE NEEDLE PLACEMENT $ 382.00 ULT-S GUIDANCE W/PLEX NERVE BL $ 382.00 US GUIDE FOR NEEDLE PLACEMENT $ 382.00 US GUIDED NEEDLE PLACEMENT $ 382.00 US-GUIDANCE NEEDLE PLACEM ASP $ 382.00 2 X 12MM AUTOFIX COMP SCREW $ 383.00 2 X 18MM HEADLESS SCREW $ 383.00 2 X 20MM SUTOFIX COMP SCREW $ 383.00 2.5 X 14MM HEADLESS SCREW $ 383.00 2.5 X 15MM AUTOFIX SCREW $ 383.00 2.5 X 16MM HEADLESS SCREW $ 383.00 2.5 X 29MM AUTOFIX SCREW $ 383.00 2.5 X 30MM AUTOFIX SCREW $ 383.00 CEMENT BONE HV-R W/MIXER PACK $ 383.00 NEW OFFICE/OP VISIT LVL 5 $ 383.00 SCREW AUTOFIX COMP T7 2X15MM $ 383.00 SCREW AUTOFIX COMP T7 2X16MM $ 383.00 CORONARY SINUS SHEATH $ 384.00 LEAD DELIVERY SYSTEM $ 384.00 SCR 6.5 CANN 85MM PT $ 384.00 SCREW 20MM THRD CANN 6.5X110MM $ 384.00 SCREW 20MM THRD CANN 6.5X115MM $ 384.00 RESPIRATOR MOTION MGMT SIMUL $ 385.48 zoster vaccine, inactivated 50 mcg/0.5 mL PWDI $ 385.90 BLOOD,LEUKO,CMV NEG,PRE-FILTRD $ 386.00 ONCONTROL BONE BIOPSY TRAY LNG $ 386.00 ONCONTROL BONE MARROW BX KIT $ 386.00 WRC-PROFORE 4 LAYER BANDAGING $ 386.00 WRC-SRG PREP TRNK ARM LGS ADD $ 386.00 WRC-SRG PRP ALL OTHER ADDL 100 $ 386.00 COIL PUSHER $ 387.00

�100

ER VISIT LEVEL 1 $ 388.00 WRIGHT TCP 2.7X20 NONLOCK SCW $ 388.00 WRIGHT TCP 2.7X22 NONLOCK SCW $ 388.00 CELL MARKER STUDY $ 389.00 LAB-FLOW CYTOMTRY DNA/CELL I $ 389.00 MENISCUS MENDER II SET DISP $ 389.00 TRANSCERV CATH/FALLOPIAN TUBE $ 389.00 3.5MM CALC NONLOCK 32MM SCREW $ 390.00 3.5MM CALC NONLOCK 34MM SCREW $ 390.00 3.5MM CALC NONLOCK 36MM SCREW $ 390.00 3.5MM CALC NONLOCK 38MM SCREW $ 390.00 3.5MM CALC NONLOCK 42MM SCREW $ 390.00 3.5MM CALC NONLOCK 44MM SCREW $ 390.00 3.5MM X 135MM SUCTION PROBE $ 390.00 LAB-TISS CULT NON-NEOPLAS DI $ 390.00 NEXIS SGL 2.3, 2.9, 3.5 SCWS $ 390.00 NOVASTEP AIR NONLCK SCW 3X14MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X08MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X10MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X12MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X18MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X20MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X22MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X24MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X26MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X28MM $ 390.00 NVSTP ARLCK N-LCKNG SCR 3X30MM $ 390.00 NVSTP NTNL COMP CLIP 1.6 X 2.5 $ 390.00 SNGL USE INSTR KIT FOR 4.0 SCR $ 390.00 VISICLEAR BUFF FLTR PLUME EVAC $ 390.00 alteplase 2 mg PWDI (KPROV) $ 390.46 BANDING KITS $ 391.00 EVAL OF FNA; INT & REP $ 391.00 LAB-RUPTURE OF MEMBRANE CONF $ 391.00 STRYKER SURGILAV $ 392.00 26MM ACUTWIST COMP SCREW $ 393.00 DRILL BIT 2.8XMMX165 $ 393.00 SLF DRILLNG CORT PIN 3X60X25MM $ 393.00 SLF DRLLNG CORT PIN 3X80X30MM $ 393.00 WND PREP F/N/HF/G 100 SQ CM $ 393.00 WRC-SRG PRP ALL OTHER 100 CM $ 393.00 DISP ENDOSCOPIC GLIDEWIRE $ 394.00 HLA PHENOTYPE ABC $ 396.00 PROF ECHO 2D DPPLR CLR FLW $ 396.00 MENISCAL REPAIR SYS TRUESPAN $ 397.00 yellow fever vaccine PWDI $ 398.07 IVUS EACH ADD'L VESSEL $ 399.00

�101

DISP KIT FOR 3MM SUTURETAK $ 400.00 DISP KT FOR 3MM SUTURE TAKS $ 400.00 GUIDE WIRE 2MM WITH TROCAR $ 400.00 KIT PEEL-AWAY 8FR INTRODUCER $ 400.00 LIGATOR MULTIPLE BND $ 400.00 OBTURATOR FOR 5.8MM CANNULA $ 400.00 SCREW CANNULATED 6.5MM X 90MM $ 400.00 SCREW CANNULATED 8.0MM X 85MM $ 400.00 STENT RX 10 X 7 CM -DOD $ 400.00 EX FOR NONSPEECH DEVICE RX $ 401.00 BIOPSY OF LIP $ 402.00 TRACH TB CHG BEFR FISTULA TRCT $ 402.00 2 HOLE HALF PIN POSTS $ 403.00 2.4 X 22MM VAL NEAR CORTEX SCR $ 403.00 2.4 X 24MM VAL NEAR CORTEX SCR $ 403.00 HOHN PERCUTANEOUS $ 403.00 IH BRONCH CHALLNGE W HISTAMINE $ 404.00 PFT * INHAL BRONCHIAL CHALLE $ 404.00 TIP DRILL 2-PIN PASSER $ 404.00 TWIN PASSER TROCAR TIP $ 404.00 XR*UPPER GI AIR,BARIUM W/KUB $ 404.00 XR*UPPER GI W/KUB $ 404.00 X-RAY SM INT F-THRU STD $ 404.00 X-RAY XM COLON 1CNTRST STD $ 404.00 X-RAY XM COLON 2CNTRST STD $ 404.00 X-RAY XM SM INT 2CNTRST STD $ 404.00 X-RAY XM UPR GI TRC 1CNTRST $ 404.00 X-RAY XM UPR GI TRC 2CNTRST $ 404.00 3.7X16MM CERVICAL SPINE SCREW $ 405.00 PERMA CATH $ 405.00 TAP FOR 3.5MM SCREWS $ 406.00 INV ENTUIT GI SUTUR ANCHOR SET $ 407.00 EVAL TO USE/FIT VOICE PROSTH $ 408.00 GUIDE WIRE $ 409.00 PLATE/SELF COMP $ 409.00 DEB SUBQ TISSUE ADDON=<20 SQCM $ 410.00 ECHO 2D IMAGE LIMITED STUDY $ 410.00 HBOT-DEBRID, SUBCT EA ADD 20SQ $ 410.00 PATIENT TRACKER $ 410.00 SCREW 3.5x13MM ZEVO $ 410.00 SCREW 4X13MM ZEVO $ 410.00 SCREW MEDTRONIC ZERO 15MM $ 410.00 WCR-DEBRID MUS/FAS EA ADD 20 $ 410.00 WRC-DEBRID SUBCT EA ADD 20SQ $ 410.00 PROF ECHO TRNSTH,CNGN PEDI $ 411.00 STAR 10 DRIVER $ 411.00 SCREW, 2.5 X 14MM BLUE LCKG $ 412.00

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SCREW, 2.5 X 22MM BLUE LCKG $ 412.00 VITAMIN NOS $ 412.00 4 X 36MM CANN SCREW $ 413.00 4 X 40MM SHORT THREAD SCREW $ 413.00 4 X 45MM LOW PROFILE SCREW $ 413.00 4 X 45MM LT SCREW $ 413.00 4.0 X 55MM CANNULATED SCREW $ 413.00 4MM SHRTHRD CNLTDPRTLYTHRD26MM $ 413.00 4X30MM SHRT CNNLTD SCRW $ 413.00 AR 4MM SHT CAN PART THRDD 40MM $ 413.00 AR 4MM SHT CAN PART THRDD 50MM $ 413.00 CVSLR STRESS TEST TRACING $ 413.00 EKG TREADMILL $ 413.00 EKG TREADMILL/NUC MED STRESS $ 413.00 MOTION FLUORO SWALLOW FCN $ 413.00 SINGLE USE REPOSITIONABLE CLIP $ 413.00 DRILL TIP SCREW $ 414.00 M & S SUPPLY- LEVEL 4 $ 414.00 M&S SUPPLY-LEVEL 4 $ 414.00 SCREW 2.0 ASNIS MICRO CANN10MM $ 414.00 SCREW 2.0 ASNIS MICRO CANN11MM $ 414.00 3 X16MM CANN MICRO ASNIS SCREW $ 415.00 ASNIS MICRO CANN SCW 3X16MM $ 415.00 SCR BONE L15MM L4MM OD3MM TI $ 415.00 SCR BONE L18MM L5MM OD3MM MIC $ 415.00 SCREW HEADED 3.0X22MM $ 415.00 SCREW HEADLESS 2.5MM X 12MM $ 415.00 SCREW HEADLESS 2.5MM X 16MM $ 415.00 SCREW HEADLESS 2.5MM X 18MM $ 415.00 BONE MARRW ASPIRATION BMA KIT $ 416.00 XR*ENTEROCLYSIS TUBE PLACEME $ 416.00 2.7MM DRILL BIT $ 417.00 2MM DRILL BIT $ 417.00 SCR BNE CANN NONLCK 2.0 11X5MM $ 417.00 SCREW AEQUALIS PERIPHRL 5X22MM $ 417.00 SCREW AEQUALIS PERIPHRL 5X34MM $ 417.00 SCREW AEQUALIS PERIPHRL 5X38MM $ 417.00 WIRE MICRO CTO 12 $ 417.00 CATHETER QUICK CROSS .035X90CM $ 418.00 CATHETER QUICK CRSS .014X150CM $ 418.00 CATHETER QUICK CRSS .018X150CM $ 418.00 CATHETER QUICK CRSS .035X135CM $ 418.00 penicillin G benzathine 1,200,000 units/2 mL INJ $ 418.16 OB US LIMITED 1+ FETUS(S) $ 420.00 SYS 3 HL HLF PIN PST 100.783+ $ 420.00 TUBE MYRINGOTOMY PPRLLA TYPE 1 $ 420.00 ULT-S PREG LIMTD VIABILITY P $ 420.00

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FAMILY PSYTX W/O PT 50 MIN $ 421.00 FAMILY PSYTX W/PT 50 MIN $ 421.00 PLATELET, LEUKOREDUCED,EA UN $ 421.00 PLATELETS RECONCENTRATED $ 421.00 9.5 X 330 END MILL $ 422.00 ENDO GIA 30MM ART VAS/MED RLD $ 422.00 ENDO GIA 45MM ART VAS RELOAD $ 422.00 ROS-INTENSITY MOD TREATMENT $ 422.98 5MM FLUTED DRUM CYLINDRCL BURR $ 423.00 DRUM 4X8.9MM FLUTED SIDE CUT $ 423.00 EST OFFICE/OP VISIT LVL 4 $ 423.00 LAB-CYSTINE, URINE $ 424.00 BG LOCKING SCREW 2.5X10 $ 425.00 BG LOCKING SCREW 2.5X12 $ 425.00 BONE SCR T10 FULL THR3.5/L50MM $ 425.00 M&S-GEN ANESTH KIT (GA-II) $ 425.00 SUTURE CUTTER 1-0 KNOT PUSHER $ 425.00 SWAN GANZ CATH THERMO $ 426.00 3D MAPPING $ 427.00 INTPLS HANDPC SET W/SCTN TBNG $ 427.00 30 DEG 11MM POST $ 428.00 POST 30DEG ANGLED 11MM $ 428.00 LAB-CYTO P450 2D6 GENO $ 429.00 WIRE AMPLATZ SUPERSTIFF 180CM $ 429.00 5MM FLUTED BALL BURR $ 430.00 BUR BULLET DIAMOND 30K $ 430.00 OBS IVF-NC EXCEPT HYDR INIT $ 431.00 OR-IVF NC EXC HYDR INITIAL H $ 431.00 SP*IVF NC EXC HYDR INITIAL H $ 431.00 THER/DIAG IV INF INIT =<1 HR $ 431.00 THER/PRPH/DG IV INF INIT=<1 HR $ 431.00 3.0 ASNIS MICRO CANN SCR 11MM $ 432.00 3.0 ASNIS MICRO CANN SCREW 12M $ 432.00 3.0 ASNIS MICRO CANN SCREW 14M $ 432.00 3.0 ASNIS MICRO CANN SCREW 15M $ 432.00 3.0 ASNIS MICRO CANN SCREW 16M $ 432.00 3.0 ASNIS MICRO CANN SCRW 14MM $ 432.00 LAB-SEROTONIN TRANS GENO $ 432.00 2.0 ASNIS MICRO CANN SCREW 12M $ 434.00 2.0 ASNIS MICRO CANN SCRW 12MM $ 434.00 3.0MM MIC SOLID SCRDRIVR 3.0MM $ 434.00 BHC ASPIRATE BRST CYST-EA AD $ 435.00 CT SCAN-GUIDE PERC DRNG W/CA $ 435.00 DRAINAGE CATH UNDER XR $ 435.00 IR PLEURX CATH TUNNELED $ 435.00 LONG POST $ 435.00 ULT-S GUIDANCE/ABSCESS OR DR $ 435.00

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XR*BILE/PANCREAS ENDO CATH F $ 435.00 XR*ENDO CATH BILIARY FLURO & $ 435.00 XR*ENDO CATH PANCREATIC FLUR $ 435.00 XR*ERCP BILIARY $ 435.00 XR*ERCP PANCREATIC $ 435.00 XR*ERCP-BILIARY/PANCREATIC $ 435.00 PROF ECHO TRNSESOPHAGEAL $ 436.00 LAB-CYSTIC FIBROSIS $ 437.00 SP*PORT/PICC TPA INJECTION $ 437.00 2.4MM BIO-SUTURE TAK DISP KIT $ 438.00 2.5MM CANNULATED DRILL BIT $ 438.00 4.7MM DRILL BIT $ 438.00 ARTHREX DRILL 1.7MM $ 438.00 DRILL BIT CANN 2.6MM $ 438.00 PUSHLOCK DISPOSA KIT FOR 2.9MM $ 438.00 HBOT-NON-SELECTIVE DEBRIDEMENT $ 439.00 LARVAE THERAPY PER SESSION $ 439.00 NON-SELECTIVE DEBRIDEMENT $ 439.00 WRC-PINCH GRAFT $ 439.00 XR*BONE AGE STUDY $ 439.00 XR*BONE EVALUATION, INFANT $ 439.00 XR*BONE STUDY, COMPLETE $ 439.00 1.6MM DRILL TIP K-WIRE, 150MM $ 442.00 EXC TR-EXT MAL+MARG 2.1-3 CM $ 442.00 K WIRE, ARTHREX 2.8MM $ 442.00 WRC-EXCIS MALIG LESION 2-3CM $ 442.00 4MM FLUTED BALL BURR $ 443.00 AUTOLOG RBC EA U $ 443.00 MRI*SURGICAL COMPONENT $ 443.00 RED BLOOD CELL FEE, EA UNIT $ 443.00 CONN AXOGUARD NERVE 3X15MM $ 445.00 GUIED PIN SCREW $ 445.00 RADIOLUCENT TARGETING DEVICE $ 445.00 GWIRE ENDO 270CM STRT TIP $ 446.00 CLOSURE DEVICE $ 447.00 BCR/ABL1 GENE MINOR BP $ 448.00 LAB-BCR/ABL TRANSLOC ANALY M $ 448.00 SCREW 2.7X34MM NONLOCKING $ 448.00 SCREW 3.5X40MM NONLOCKING $ 448.00 SCREW 3.5X44MM NONLOCKING $ 448.00 SCREW 3.5X46MM NONLOCKING $ 448.00 SCREW 3.5X48MM NONLOCKING $ 448.00 SCREW 3.5X50MM NONLOCKING $ 448.00 SELECT CATH ART - BRACH-CEPH; $ 448.00 1.4MM PIN $ 450.00 2.7 X 14MM RAYHACK LCKNG SCREW $ 450.00 2.7 X16MM RAYHACK LCKNG SCREW $ 450.00

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4.0X40MM TI ASNIS IIICANNL SCR $ 450.00 4.0X46MM TI ASNIS III CANN SCR $ 450.00 4.0X50MM TI CANNUALTED SCREW $ 450.00 BEHAVRAL QUALIT ANALYS VOICE $ 450.00 CBL PT 12FT MP-12 RD SET $ 450.00 CBL PT 5FT MP-05 RD SET $ 450.00 CL TX CMC DISL W M EA $ 450.00 CLSD TX PELVIC RING FX $ 450.00 EP DIAG/AB CATH 10POLE(BOSSCI) $ 450.00 EVALUATE SPEECH PRODUCTION $ 450.00 EVALUATION OF SPEECH FLUENCY $ 450.00 NEEDLE BONE MARROW ASPIRATION $ 450.00 SCREW LOW PROFILE 4.3 X 30MM $ 450.00 SPEECH SOUND LANG COMPREHEN $ 450.00 STARCLOSE $ 450.00 OB US < 14 WKS ADDL FETUS $ 451.00 OB US < 14 WKS SINGLE FETUS $ 451.00 ULT-S EA ADD'L GEST,UP TO 14 $ 451.00 WC OT EVAL COMPR $ 452.00 WC PT EVAL COMPR $ 452.00 NARROW SAW BLADE $ 453.00 SAW BLD STRYKER UNIV NRW $ 453.00 SAW BLD STRYKER UNIV WIDE $ 453.00 STAR 10 DRIVER SELF RETAINING $ 453.00 VACUUM MIXING BOWL $ 453.00 WIDE SAW BLADE $ 453.00 DEVELOPMENTAL SCREEN W/SCORE $ 454.00 PRESEP CATH $ 454.00 PRESEP KIT $ 454.00 CUSTOM LAP CHOLE AUTO KIT $ 455.00 STEINMAN PIN 2MM $ 455.00 STRYKER 5 HOLE HALF PIN POSTS $ 455.00 APPLY SHORT ARM SPLINT STATIC $ 456.00 APPLY SHORT ARM SPLINT; STATIC $ 456.00 ARTERIAL PUNCTURE BLOOD FOR DX $ 456.00 CONTROL NASAL HEMORRH ANT SIMP $ 456.00 DR ABSC CYST HEM-DENTOALVEOLAR $ 456.00 INS TEMP BLADDER CATHETER $ 456.00 INSERT BLADDER CATH $ 456.00 INSERT BLADDER CATHETER $ 456.00 PLACE NEEDLE INTRAOSSEOS INFUS $ 456.00 REM FB CONEAL W SLIT LAMP $ 456.00 REM FB CONJUNCTIVA;SUPERFICIAL $ 456.00 REM FB EXT AUDIT CANAL;WO ANES $ 456.00 REM FB EXT AUDITRY CNL WO ANES $ 456.00 REM FB EXT EYE;CORN WO SLIT LP $ 456.00 REM FB INTRANASAL; OFFICE $ 456.00

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CELON PROBREATH $ 457.00 3.5 X 14 LOCKING SCREW $ 458.00 2.9MM X 22MM HEADED SCREW $ 460.00 ANTERIOR CHAMBER IOL LENS $ 460.00 INTRAMEDULLARY SCREW, 0 DEGREE $ 460.00 IOL LENS $ 460.00 LATEX FREE FOLEY $ 460.00 NEXIS HEADED SCREW 2.9 X 14MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X08MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X10MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X12MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X14MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X16MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X18MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X22MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X24MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X26MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X28MM $ 460.00 NVSTP ARLCK LCKNG SCR 3X30MM $ 460.00 POSTERIOR CHAMBER IOL LENS $ 460.00 SCREW SOFTSILK HA 8MM X 20MM $ 460.00 SCREW SOFTSILK HA 9MM X 20MM $ 460.00 vasopressin 20 units/mL INJ (KPROV) $ 460.33 IMMUNOHISTO ANTB 1ST STAIN $ 461.00 ECHO EXAM OF ABDOMEN $ 462.00 HBOT-TCOM MULTIPLE SITES $ 462.00 HYDRA IV INFUS INIT 31-60 MINS $ 462.00 HYDRATE IV INF INIT 31-60 MINS $ 462.00 HYDRATN IV INF INIT 31-60 MINS $ 462.00 OBS IVF-HYDRATION INIT 1 HOU $ 462.00 ULT-S ABDOMEN LTD-SINGLE ORG $ 462.00 UPR/LXTR ART STDY 3+ LVLS $ 462.00 4 X 40MM LONG THREAD SCREW $ 463.00 4MM FLUTED DRUM CYLINDRCL BURR $ 463.00 LOCKING SCREW $ 463.00 RECON LOCKING PLATE 3.5 X 12MM $ 463.00 SCREW RECON LOCK PLATE 3.58X20 $ 463.00 SCREW RECON LOCK PLATE3.5X10MM $ 463.00 SCREW RECON LOCK PLT 3.5X24MM $ 463.00 SCREW RECON LOCKING PLT 3.5X14 $ 463.00 2.0MM CONDYLAR PLATE $ 464.00 CTRL POST EPISTAX SQ $ 464.00 4.3MM CALIBRATED DRILL BIT $ 465.00 GW VIPERWIRE 0.14INCH 335CM $ 465.00 GW VIPERWIRE ADV 0.18INCH335CM $ 465.00 CL TX FX PHALANX/PHLNG W MANIP $ 466.00 CL TX FX PHALNX/PHALANG WO MNP $ 466.00

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CL TX MC FX SGL WO MNP EA BONE $ 466.00 CL TX MCP DISLOC SGL W MANIP $ 466.00 CL TX METATARSAL FX W MANIP $ 466.00 CL TX METATARSAL FX WO MANIP $ 466.00 CL TX PHAL SHAFT FX WO MANIP $ 466.00 CL TX RDL HD/NECK FX WO MANIP $ 466.00 CL TX RDL&ULNR SHFT FX WO MNP $ 466.00 CLTX CARPAL SCAPHOID FX WO MNP $ 466.00 CLTX CARPL BN FX WO MNP EA BN $ 466.00 CLTX D PHAL FX FGR/THMB WO MNP $ 466.00 CLTX DSTL RDL FX/EPI SP WO MNP $ 466.00 CLTX DSTL RDLFX/EPHYSLSP WOMNP $ 466.00 DIAGNOSTIC ANOSCOPY SPX $ 466.00 DRESS/DEBRID P-THICK BURN M $ 466.00 WRC-BURN DEBRIDMNT MED W/O A $ 466.00 DESTRUCT B9 LESION 1-14 $ 467.00 SP*EPIDUROGRAPHY $ 467.00 SREP F/E/N/L/MM 7.6-12.5CM $ 467.00 4.0MM LONG THREADED SCREW 35MM $ 468.00 4.0MM LONG THREADED SCREW 42MM $ 468.00 CANNULATED SCREW 4.0 X 32MM $ 468.00 CATH BLN DIL 10-12X8X180 $ 468.00 COLPOSCOPY OF VULVA $ 468.00 CURVED ROD, 5.5MM X 65MM $ 468.00 ESOPH BALLN DILAT 12X13.5X15MM $ 468.00 INFLATOR/ MON ACHALASIA PNEUMO $ 468.00 SCREW ASNIS III CANN 8.0MX65M $ 468.00 SNARES $ 468.00 SCREW 1.5MM LOCKING 8MM $ 470.00 SCREW, 7 X 20MM SOFSILK $ 470.00 LAB-CHROMOSOME ANALYSIS $ 471.00 LAB-CHROMOSOME ANALYSIS 15-2 $ 471.00 LAB-CHROMOSOME BONE MARROW $ 471.00 LAB-HEPATITIS B,QUANTIFICATI $ 471.00 1/3 TUBULAR 3 HOLE PLATE $ 473.00 30MM TRI-STAPLE 2.0 $ 473.00 5.6MM ASNIS III CANN DRILL $ 473.00 7.0X45MM FIXOS SHORT THRED SCR $ 473.00 ALEX LPRSCPC SYS FIRST ENTRY M $ 473.00 ENDO GIA RELOAD TRISTAPLE $ 473.00 MULTFRE ENDO GIA 30-2.5 LDG UN $ 473.00 VITAMESH SQUARE 30X30 $ 473.00 24FR RIGHT ANGLE CHEST TUBE $ 475.00 3.5 X 18MM LOCKING SCREW $ 475.00 3.5 X 20MM LOCKING SCREW $ 475.00 3.5 X 22MM LCKNG SCREW $ 475.00 3.5 X 24MM LCKNG SCREW $ 475.00

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3.5 X 28MM LCKNG SCREW $ 475.00 3.5 X 32MM LAG SCREW $ 475.00 7 X 50MM SHORT THREAD SCREW $ 475.00 LOCKING SCREW 3.5 X 14MM $ 475.00 MINI CANN LONG THREAD 4X40MM $ 475.00 MINI MONSTER CANNULATED 4X42MM $ 475.00 MINI MONSTER CANNULATED 4X44MM $ 475.00 MINI MONSTER CANNULATED 4X46MM $ 475.00 MINI MONSTER LONG $ 475.00 SCR BONE L16MM OD3.5MM PUR TI $ 475.00 EPINEPHrine 0.3 mg SYRINGE (KCARD) $ 475.24 2.5MM PILOT DRILL $ 478.00 4.5X20MM REUNION PERIPHERL SCR $ 479.00 6.5 X 36MM REUNION CENTER SCR $ 479.00 BARD INLAY URET STENT 6FRX28CM $ 479.00 LAB-HIV 1 $ 479.00 REUNION 4.5MM PERIPHR SCR 24MM $ 479.00 REUNION 4.5MM PERIPHR SCR 28MM $ 479.00 REUNION 6.5MM CENTER SCRW 24MM $ 479.00 STENT PIGTAIL 6FRX26CM DOUBLE $ 479.00 STENT URETERAL 6 FR x 26 CM $ 479.00 STENT URETERAL 6FR x 24CM $ 479.00 STENT URETERAL 6FR x22CM $ 479.00 CHEMO IV INFUSION ADDL HR $ 480.00 CT SCAN-LTD,FOLLOW-UP STUDY $ 482.00 3.5 X 36MM SHORT THREAD SCR $ 483.00 3.5 X 46MM DARCO HEADED SCR SH $ 483.00 3.5X38MM SHRT DARCO HEADED SCR $ 483.00 CL TX ART FX MCP/IP JNT WO MAN $ 484.00 CL TX ART FX MCP/IP JNT;WO MAN $ 484.00 CL TX CALCANEAL FX;WO MANIP $ 484.00 CL TX CALCNEAL FX;W MANIP $ 484.00 CL TX DSTL RADULN DISLC W MANP $ 484.00 CL TX OF RADIL SHFT FX;WO MANP $ 484.00 CL TX SC/TC HUMRUS FX WO MANIP $ 484.00 CL X TALTRSL JOINT DIS;WO ANES $ 484.00 CLOSED TX OF ULNAR STYLOID FX $ 484.00 WRIGHT TCP 1.7MM DRILL $ 484.00 BIOPSY OF BREAST, CORE NEEDL $ 485.00 FLOW CYTOMETRY TC 1ST MARKER $ 485.00 LAB-FLOW CYTO TECH ONLY 1ST $ 485.00 LAB-IMMUNO-STAIN $ 485.00 PERC NDL CORE BRST BX WO GUID $ 485.00 TUMOR IMMUNOHISTOCHEM/MANUAL $ 485.00 CLOVERLEAF PLT 66M 3 HOLE PLT $ 486.00 K-WIRE, SMALL FRAGMENT SET $ 486.00 LAB-HEPATITIS B VIRUS GENO $ 486.00

�109

SIMPLE BLDR IRRIG LVGE/INSTILL $ 486.00 ZERO TIP 1.9F X 12MM 120CM $ 487.00 3.5 X 2MM SUTURE ANCH CORKSCRW $ 488.00 4.0MM TOMCAT SHAVER HEAD $ 488.00 4.5MM CANN DRILL $ 488.00 4.5MM CANNULATED DRILL $ 488.00 5.0MM RESECTOR $ 488.00 5.5MM CANNULATED DRILL $ 488.00 5MM CANNULATED DRILL $ 488.00 7.5MM CANNULATED DRILL $ 488.00 7MM CANNULATED DRILL $ 488.00 8MM CANN DRILL $ 488.00 ARTHRSCPC 4.5MM TOMCT ANGLD $ 488.00 BLDE SHV OD4MM 6 FLUT AGG HLLW $ 488.00 BURR SLAP 4.0MM $ 488.00 CUT 5.5MM BLACK/TAN FRMLA BLDE $ 488.00 CUT AGG + 0375544000 4.0MM $ 488.00 CUT AGG 2.5MM SM JT CUT W/J $ 488.00 CUT TOMCAT 0375545000 4.0MM $ 488.00 EO DYNAMIC W LOCK MECH PREFAB $ 488.00 GUARDUS ESOPHAGEAL OVERTUBE $ 488.00 GUARDUS GASTRIC OVERTUBE $ 488.00 SCORPION NEEDLE, KNEE $ 488.00 SHV BLDE ENDO AGG CUT 3.5 MM $ 488.00 IV-TRIPLE LUMEN CVP $ 489.00 3 X 12MM NON-LOCKING SCREW $ 490.00 3 X 14MM NON-LOCKING SCREW $ 490.00 3 X 16 NON-LOCKING SCREW $ 490.00 3 X 16MM NON-LOCKING SCREW $ 490.00 3 X 24MM NON-LOCKING SCREW $ 490.00 3.0 X 18MM NON-LOCKING SCREW $ 490.00 3.0 X 22 NON-LOCKING SCREW $ 490.00 3.0 X 26MM NON-LOCKING SCREW $ 490.00 3.5 X 20MM NON-LOCKING SCREW $ 490.00 3.5 X 24MM NON-LOCKING SCREW $ 490.00 3.5 X 26MM NON-LOCKING SCREW $ 490.00 3.5 X 30MM NON-LOCKING SCREW $ 490.00 ANCHORAGE STANDRD SCR 3MMX20MM $ 490.00 SCREW NON-LOCKING, T7 2.7X10MM $ 490.00 DESTR MLES T/A/L; 1.1-2.0 CM $ 491.00 APSKIN FEETWOUND>100CM,EA100CM $ 492.00 APSKIN LEGWOUND>100CM,E/A100CM $ 492.00 PLT 1.7 LCK 6H NAR T-PLATE $ 492.00 WIRE MICRO CTO 25 $ 492.00 10MM SCREW $ 493.00 8MM SCREW $ 493.00 BLOOD LEUKOREDUCEDPEDI PACK $ 493.00

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FETAL STRESS TEST $ 493.00 FRESH FROZEN PLASMA ALIQUOT $ 493.00 LAB-GEL IMMUNODIFFUSION $ 493.00 VENT MGMT INPAT SUBQ DAY $ 494.00 VENT THY-HOSP IP/OBSO EACH S $ 494.00 CEMENT INJECTION SYSTEM $ 495.00 ELECTRON MICROSCOPY $ 495.00 HANA PATIENT CARE KIT $ 495.00 PEDIATRC INFNT CYCLIC 2IN1 TPN $ 495.00 WCR-OPEN BONE BIOPSY $ 495.00 WRC-WOUND BIOPSY-PUNCH $ 495.00 BREATH HYDROGEN/METHANE TEST $ 496.00 APPLY LONG ARM CAST $ 497.00 APPLY LONG LEG CAST $ 497.00 APPLY SH LEG CAST $ 497.00 APPLY SHORT ARM CAST $ 497.00 APPLY WLKR SH LEG CAST $ 497.00 DX OPHTHAL B-SCAN US $ 497.00 REM GAUNTLET BOOT OR BODY CAST $ 497.00 REMOVE FULL ARM OR LEG CAST $ 497.00 1.8MM LCP BUTTRESS PIN $ 498.00 2.4 X 18MM LOCKING SCREW $ 498.00 2.4 X 20MM LOCKING SCREW $ 498.00 2.4 X 22MM LOCKING SCREW $ 498.00 4.5MM PERIPHERAL SCREW - 32MM $ 498.00 4.5MM PERIPHERAL SCREW - 36MM $ 498.00 5.5 X 55 TITANIUM CURVED ROD $ 498.00 6.5MM CENTER SCREW - 32MM $ 498.00 GRAFT .8X8CM PATCH VASCUGUARD $ 498.00 REUNION 4.5MM PERIPHR SCR 16MM $ 498.00 TIT MTRX CURVED ROD 5.5MMX45MM $ 498.00 DAKOTA 1.9F X 8MM X 120CM $ 499.00 ORTHOSORB RESORBABLE PIN $ 499.00 TUBE BLAKEMORE $ 499.00 EO PREFAB ELASTIC W METAL JOIN $ 500.00 HALF HINGE $ 500.00 INSTR, CNTRLN CRPL TNL RLS DSP $ 500.00 KNIFE MICRO XL $ 500.00 POSITIONING SET PINK PAD $ 500.00 ENDO CATCH POUCH $ 501.00 ENDO CATH POUCH $ 501.00 MASTOTOMY W/EXPLOR, DRAIN DEEP $ 502.00 WIRE TRANSEND .014 X 190CM $ 502.00 SCREW 2.7X18MM LOCKNG SLF TAP $ 503.00 SCREW 3.5X08 LOCKING $ 503.00 SCREW 4X60MM LOCKING $ 503.00 SCREW 4X70MM LOCKING $ 503.00

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INJECT TRIGGER POINTS 3/> $ 504.00 MUSCLE TEST 1 LIMB $ 505.00 OLIV WIRE DRILL PT 1.8MMX400MM $ 505.00 SWAN GANZ(MONITORING) $ 506.00 ARTHREX BIOCARTILAGE $ 507.00 BOS SCIE SENSOR 0.035INX150CM $ 507.00 CANNULATED DRILL BIT 4.0MM $ 507.00 CL TX C HUMERUS FX WO MANIP $ 507.00 CYTP DX EVAL FNA 1ST EA SITE $ 507.00 PALM W SGL DIGIT RELEASE $ 507.00 PICO NEGATIVE PRES DSG 10X20CM $ 507.00 CAROTID DUPLEX SCAN UNIL/LIMIT $ 508.00 CATH PEDI CTPNS-3.0-65-REDO $ 508.00 DESTROY PREMAL LESIONS 15/> $ 508.00 PFXL PIN KIT $ 508.00 ULT-S DUPLEX CAROTID-LT $ 508.00 ULT-S DUPLEX CARTOTID-RT $ 508.00 VITAMESH 15 X 15 $ 508.00 X-RAY XM SM INT 1CNTRST STD $ 508.00 ARTER UPPER EXTREM COMPLT BI $ 509.00 CARD CATH-FLUOROSCOPY <1HR $ 509.00 CAROTID DUPLEX SCAN BILAT $ 509.00 CAROTID DUPLEX SCAN; BILAT $ 509.00 DPLX A IVC IL/BPG COMPL MSNTRC $ 509.00 DPLX EXT VEINS BIL LE GSV/LSV $ 509.00 DPLX EXT VEINS BIL UE BSL/CPHL $ 509.00 DUPLEX A IVC IL/BPG COMPL $ 509.00 DUPLEX A IVC IL/BPG COMPL AAA $ 509.00 DUPLEX EXT VEINS BILAT $ 509.00 DUPLEX EXT VEINS BILAT LE DVT $ 509.00 DUPLEX EXT VEINS BILAT UE $ 509.00 DUPLEX LE ART/BPG BILAT $ 509.00 DUPLEX LE ART/BPG; BILAT $ 509.00 DUPLEX SCAN LOWER EXT ART CO $ 509.00 DUPLEX UE ART/BPG BILAT $ 509.00 DUPLX EXT VNS BIL LE INSUFCNCY $ 509.00 FLUOR. LEAD EVAL UP TO 1HR $ 509.00 LE DUPLEX EXT VEINS; BILAT $ 509.00 SALINE INFUSED SONOHYSTEROGRAM $ 509.00 SP*IR FLUOROSCOPY UP TO 1 HO $ 509.00 SP*IR US LE VENOUS DUP BILAT $ 509.00 SP*IR US UE VENOUS DUP BILAT $ 509.00 SYVEK PATCH $ 509.00 ULT-DUPLEX AORTA,IVC,COMPLT $ 509.00 ULT-DUPLEX CAROTID,COMPLETE $ 509.00 ULT-S VENOUS LOWER EXT,COMP $ 509.00 ULT-S VENOUS UPPER EXT,COMP $ 509.00

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XR*FLUOROSCOPY, <1 HR $ 509.00 XR*UPPER GI,W/SM BOWEL $ 509.00 ANCHORAGE STANDRD SCR 3MMX28MM $ 510.00 ANCHORGE STNDRD SCR 3.5MMX22MM $ 510.00 GIA STAPLER 100MM-3.8MM $ 510.00 ULT-S-PELVIS,LTD/FU (EG,FOLL $ 510.00 US EXAM PELVIC LIMITED $ 510.00 candida albicans extract MDV 1 mL $ 510.22 EST OFFICE/OP VISIT LVL 5 $ 511.00 DESTR MLES F/E/E/N/L/MM; 0.5/< $ 512.00 ISO*RADIOPHARM INJECTION $ 512.00 ACNE SURGERY MILIA CYSTS $ 513.00 ADJ GSTRC BND DIAM INJ/ASP SLN $ 513.00 CL TX D PHL FX FGRR/THMB W MAN $ 513.00 CL TX FX GT PHALANX(S) W MANIP $ 513.00 CL TX IP JOINT DISL WO ANESTH $ 513.00 CL TX MTP JNT DISLOC WO ANESTH $ 513.00 CL TX SC/TC FEMUR FX WO MANIP $ 513.00 CL TX ULNAR SHAFT FX WO MANIP $ 513.00 DESTR MLES T/A/L; 0.6-1.0 CM $ 513.00 DESTRUCT PREMALG LESION $ 513.00 DIAGNOSTIC ANOSCOPY $ 513.00 DIAGNOSTIC LARYNGOSCOPY FLEX $ 513.00 DR ABSC/HEMATOMA NASAL INT $ 513.00 INJ INTO SKIN LESIONS =<7 $ 513.00 INJECTION INTO SKIN LESIONS=<7 $ 513.00 REAMER FLEX FLEX GUIDE PIN 9MM $ 513.00 SCREW HEADED 4.0X32MM $ 513.00 SCREW HEADED 4.0X46MM $ 513.00 SCREW HEADED 4.0X48MM $ 513.00 SHAVE LES S/N/H/F/G; 0.6-1.0CM $ 513.00 SHAVE LES S/N/H/F/G; 1.1-2.0CM $ 513.00 SHAVE LES S/N/H/F/G;0.6-1.0CM $ 513.00 TX TARSAL BONE FX ; WO MANIPU $ 513.00 COLPOSCOPY OF CERVIX $ 514.00 DEBRIDE NAIL 1-5 $ 514.00 PARE BENIGN LES SGL $ 514.00 PARING-BENIGN->4 $ 514.00 WCR-DEBRID OF ADDL NAILS $ 514.00 WRC-APP MULTI-LAYER WRAP $ 514.00 WRC-DEBRID NAILS, 5 OR LESS $ 514.00 WRC-DEBRID NAILS, 6 OR MORE $ 514.00 WRC-PARING-BENIGN $ 514.00 WRC-PARING-BENIGN->4 $ 514.00 WRC-PARING-BENIGN-2-4 $ 514.00 4.3MM X 13CM QUADCUT BLADE $ 515.00 INS CATH ABD/L-EXT ART 1ST $ 515.00

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PATCH BIOLOGICAL VASC 0.8X8CM $ 515.00 WIRE PROSTREAM ALL SIZES $ 515.00 SYSTEM INTRODUCER ACCUSTICK $ 516.00 CPAP MGM'T FEE $ 518.00 HF NASAL CANNULA >.2L $ 518.00 KYPHON XPEDE BONE CEMENT $ 518.00 MEDTRONIC SOFAMOR DANEK $ 518.00 10MM INBONE TALAR REAMER $ 520.00 2.0 X 10MM VA-LCKING SCREW $ 520.00 2.0 X 11MM VA-LCKING SCREW $ 520.00 2.0 X 9MM VA-LCKING SCREW $ 520.00 CARPAL TUNNEL TX INJ $ 520.00 DRILL BIT 2X165MM $ 520.00 GUIDEWIRE HIGH PERF .035X260CM $ 520.00 INJ ANES SPHENOPALATINE GANGLI $ 520.00 INJ SGL TENDN SHTH OR LIGAMENT $ 520.00 INJ SGL TENDON SHTH OR LIGAMNT $ 520.00 INJ SGL TENDON SHTH/LIGAMENT $ 520.00 INJ TRIGGER POINT 1/2 MUSCL $ 520.00 M & S SUPPLY- LEVEL 5 $ 520.00 M&S SUPPLY-LEVEL 5 $ 520.00 MEDTRONIC ACCESSORY KIT $ 520.00 POST, HOFFMAN 3 STRAIGHT 11MM $ 520.00 STNDRD ACUTRAK 2 PROFILE DRILL $ 520.00 MRI-BIOPSY SURGICAL PROCEDUR $ 522.00 CARDIOPULMONARY RESUSCITATION $ 523.00 CPR $ 523.00 FASCIAL DILATOR SET POLY 8.0 T $ 523.00 FLUORO EXAM OF G/COLON TUBE $ 523.00 NRPSYC TST EVAL PHYS/QHP 1ST $ 523.00 NRV CNDJ TEST 7-8 STUDIES $ 523.00 NRV CNDJ TST 3-4 STUDIES $ 523.00 NRV CNDJ TST 5-6 STUDIES $ 523.00 PSYCL/NRPSYC TECH 1ST $ 523.00 TX GASTRO INTUB W/ASP $ 523.00 VERSASTEP, 12MM $ 523.00 1.5MM 6 HOLE PLATE $ 525.00 APEX PIN 5/6MM 300X40MM $ 525.00 BREAST TISSUE EXPANDER 400CC $ 525.00 WIRE PROSTREAM 12CM X 145CM $ 525.00 WIRE PROSTREAM 12CM X 175CM $ 525.00 WIRE PROSTREAM 6CM X 145CM $ 525.00 WIRE PROSTREAM 6CM X 175CM $ 525.00 WIRE PROSTREAM 9CM X 145CM $ 525.00 WIRE PROSTREAM 9CM X 175CM $ 525.00 PERCLOSE $ 529.00 PSYTX COMPLEX INTERACTIVE $ 529.00

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2.4 X 12MM LOCKING SCREW $ 530.00 2.4 X 16MM LOCKING SCREW $ 530.00 2.7 X 14MM T8 LOCKING SCREW $ 530.00 2.7 X 20MM LOCKING SCREW $ 530.00 2.7 X 22MM LOCKING SCREW $ 530.00 2.7 X 24MM LOCKING SCREW $ 530.00 2.7 X 28MM LOCKING SCREW $ 530.00 2.7 X 30MM LOCKING SCREW $ 530.00 2.7 X 34MM LOCKING SCREW $ 530.00 2.7 X 38MM LOCKING SCREW $ 530.00 2.7X28MM LCKNG SCREW (STRYKER) $ 530.00 PARIETEX MESH $ 530.00 SCREW 2.7X 10MM LCKNG SCREW T8 $ 530.00 ENDO CATCH $ 531.00 OBS IVF-C EA ADDL SEQ UP TO $ 532.00 WAND $ 532.00 3.0 CANNULATED SCREWDRIVER $ 533.00 ROTH NET STANDRD RETRIEV 3X6CM $ 533.00 STENT URETERAL 6F X 22CM $ 533.00 STENT URETERAL 6F X 24CM $ 533.00 STENT URETERAL 6F X 26CM $ 533.00 STENT URETERAL 6F X 28CM $ 533.00 ARTHREX BTB TIGHTROPE $ 535.00 BABCOCK ENDO 5MM/RATCHET HNDL $ 535.00 LAB-BCELL GENE REARRANGE PCR $ 535.00 SPRM-INJ FACET JT NERVE LUMBAR $ 535.00 035 X 260CM HYDRA JAGWIRE $ 538.00 DREAMWIRE ST STFF .035 X 450CM $ 538.00 DREAMWIRE STRAIGHT TIP .035X45 $ 538.00 RBC,LEUKO,CMV NEG,IRRADIATED $ 538.00 WRC-CONTACT CAST APPLICATION $ 538.00 ULT-S LOWER NONVASC LIMITED $ 539.00 ULT-S UPPER NONVASC LIMITED $ 539.00 US LE LMTD JT NONVSC XTR STRUX $ 539.00 US LMTD JT/NONVASC XTR STRUX $ 539.00 VG STRT 0.035"/450CM G2403545S $ 539.00 PARIETEX MESH AUTO $ 540.00 WASHER 3.0 ASNIS MICRO $ 540.00 2.0MM CANN DRILL $ 541.00 2.0MM CANNULATED SCREWDRIVER $ 541.00 BCR/ABL1 GENE MAJOR BP $ 541.00 TILT-TABLE EVALUATION $ 542.00 4.3 X 216MM LCKNG DRILL BIT $ 544.00 AUTOL NON-TRNSFSD SVC FEE EA $ 544.00 CANNULATED SYNTHES LG $ 544.00 CATH BLN DIL WG 8-10X180MM $ 544.00 HEADED SCREW 4.0MM X 26MM $ 545.00

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1.7 X 115 CM BASKET $ 546.00 DEP SPINE SCR VAR LRG DIA 12MM $ 546.00 DEPUY SPINE SCW VAR LG DI 12MM $ 546.00 NGAGE NITINOL STONE EXTRACTOR $ 546.00 PRUITT OCCLUSION CATH 4FR $ 548.00 RBC,FRZN,DEGLYC,WSHD,LEUKO,IRR $ 548.00 RESOLUTION CLIP $ 548.00 01.4X150MM UNTHRDED GUIDEWIRE $ 550.00 PCO SNG USE NEG PRE WD THR SYS $ 550.00 PUSHLCK,PERCTNS INS KIT 2.9MM $ 550.00 SCREW 20MM THRD CANN 6.5X100MM $ 550.00 SCREW 20MM THRD CANN 6.5X105MM $ 550.00 SCREW 20MM THRD CANN 6.5X40MM $ 550.00 SCREW 20MM THRD CANN 6.5X70MM $ 550.00 SCREW 20MM THRD CANN 6.5X75MM $ 550.00 DRILL 3.2MM $ 551.00 N BLOCK INJ PLANTAR DIGIT $ 551.00 LC-APSKIN LEGWOND<100CM<25CMEA $ 552.00 LC-APSKN FOOTWOND<100CM<25CMEA $ 552.00 OR ADDITIONAL HRS $ 552.00 INJECT SACROILIAC JOINT $ 553.00 DRILL, TIBIAL ANCHOR 4.5MM $ 555.00 DRILL 2X3 MIC3 CANN1.7MM CPLNG $ 556.00 DRILL BIT CANN 2X17MM $ 556.00 PROF-TISSUE EXAM BY PATH 5 $ 556.00 FECAL MANAGEMENT SYSTEM $ 557.00 MUSCLE BX; SUPERF $ 557.00 OB US >= 14 WKS ADDL FETUS $ 557.00 ULT-S EA ADD'L GESTATION>14W $ 557.00 INTERNAL CARDIOVERSION $ 558.00 BONE MARROW BIOPSY $ 559.00 1.5MM DRILL BIT (ACUMED) $ 560.00 EVALUATION OF WHEEZING $ 560.00 PFT * BRONCHOSPASM PROVOCATI $ 560.00 4 X 18MM LCKNG SCREW (STRYKER) $ 561.00 4 X 20MM LOCKING SCREW $ 561.00 4 X 22MM LOCKING SCREW $ 561.00 4 X 24MM LOCKING SCREW $ 561.00 4 X 26MM LOCKING SCREW $ 561.00 4 X 28MM LOCKING SCREW $ 561.00 4 X 32MM LOCKING SCREW $ 561.00 4 X 36MM LOCKING SCREW $ 561.00 4 X 38MM LOCKING SCREW $ 561.00 4 X 40MM LOCKING SCREW $ 561.00 4 X 42MM LOCKING SCREW $ 561.00 4 X 44MM LOCKING SCREW $ 561.00 4 X 46MM LOCKING SCREW $ 561.00

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4 X 48MM LOCKING SCREW $ 561.00 4 X 50MM CANCELLOUS SCREW $ 561.00 4 X 55MM LCKNG SCREW (STRYKER) $ 561.00 4.0 X 16MM LOCKING SCREW $ 561.00 4.0 X 18MM LOCKING SCREW $ 561.00 4.0 X 65MM LOCKING SCREW $ 561.00 4.0 X L30MM LOCKING SCREW $ 561.00 4.0 X L32MM LOCKING SCREW $ 561.00 4.0 X L70MM LOCKING SCREW $ 561.00 4MM LCKNG SCRW 4.0MMXL80MM $ 561.00 AXS 4.0MM LCK SCR SLF TAP 34MM $ 561.00 SPRM-MYEL CERV PUNCTURE $ 561.00 STRY 4MM 32MM CORT SCR SLFTAP $ 561.00 STRY 4MM LOCKING SCR 4.0XL75MM $ 561.00 PARIETEX MESH COVIDIEN $ 562.00 1.3MM DRILL BIT (ARTHREX) $ 563.00 4MM SHAVER BLADE ROTATABLE $ 563.00 5.5 HIGH VIS SHEATH ABRADER BU $ 563.00 ACL DSP KIT TRANSTIB W/SAW BLD $ 563.00 ASNIS III CANN SCR 8X80MM $ 563.00 COMMAND ES .014 300CM $ 563.00 COUNTER SINK 5.5 HEADED $ 563.00 LAB-BRAF MUTATION ASSAY $ 563.00 MONSTER CANN LONG 5.5X50MM $ 563.00 PARAGON COUNTERSINK $ 563.00 PLATE 1/3 TUBULAR 6 HOLE $ 563.00 REFLEX ULTRA 45 WAND $ 563.00 SCREW ASNIS III CANN 8.0MX75M $ 563.00 SCREW TORX CANCELLOUS BONE $ 563.00 EXC TR-EXT MAL+MARG > 4 CM $ 567.00 WRC-EXCIS MALIG LESION >=4.0 $ 567.00 NITINOL TIPLES STONE EXTRACTOR $ 568.00 OIL CARTRIDGE $ 568.00 WRC-SRG PRP TRNK ARM LGS 100 $ 568.00 HOCM UP TO 149MG/ML, PER ML $ 570.00 INFANT VENTILATOR, INITIAL DAY $ 570.00 regadenoson 0.4 mg/5 mL INJ PF $ 571.94 ASNIS III SS CAN SCR 6.5X120MM $ 572.00 PICO NEGATIVE PRES DSG 15X30CM $ 572.00 CATHETER, HEMODIALYS,SHRT TE $ 573.00 SEPTAL BUTTON $ 574.00 EMBOLIZATION CATHETER $ 575.00 GRAFT BIODESIGN SINONASAL REP $ 575.00 NRSRY-CIRCUM CLMP W/DOR PENI $ 575.00 PIN1.8X16MM VAR ANGL BUTTRSS $ 578.00 SCREW 2.4X18MM VARBL ANGL LCK $ 578.00 SCREW 2.4X20MM VARBL ANGL LCK $ 578.00

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TC99M MEBROFENIN =< 15 MCI $ 579.00 ULT-S HEAD AND NECK (SOFT TI $ 579.00 US EXAM OF HEAD AND NECK $ 579.00 4.5 X 36MM SHORT THRD SCREW $ 580.00 4.5 X 40MM SHORT THRD SCREW $ 580.00 4.5 X 50MM SHORT THRD SCREW $ 580.00 LIGATOR SUPER SEVEN SPEED BAND $ 580.00 ULTRASOUND BREAST LIMITED $ 580.00 US BREAST LIMITED $ 580.00 US BREAST LIMITED RIGHT $ 580.00 US-BREAST LIMITED LEFT $ 580.00 TITANIUM MATRIX LOCKING CAP $ 581.00 CALIBRATED DRILL BIT 3.0MM $ 582.00 DUPLEX ARTERIAL FLOW; LIMITED $ 582.00 LO-PRO LOCK SCRW TI 4.5 X18MM $ 582.00 PROF CY*TP IMG PC ROUTNE SCRNG $ 582.00 US DOPPLER ABDOMEN $ 582.00 ISO*99M TC SESTAMIBI PER DOS $ 583.00 MONSTER BITE BREAK OFF $ 584.00 LOCK THIRD TUBLR PLT SS 4 HOLE $ 585.00 PIN DRL PKT ST $ 585.00 CLOSURE MYNX 5F $ 586.00 CLOSURE MYNX 6F/7F $ 586.00 BIT DRL OD2.7MM AO CPL TWST $ 587.00 THORADRAIN $ 587.00 ULT-S SURGICAL COMPONENT $ 587.00 10X28MM BIOCOMP INTERFRNCE SCR $ 588.00 10X28MM BIOCOMPOSITE INT SCREW $ 588.00 7 X 28MM BICOMP INT SCREW FT $ 588.00 8 X 28MM BIOCOMP INT SCREW $ 588.00 9X28MM BIOCMP INTERFERENCE SCR $ 588.00 9X28MM BIOCOMPOSITE INT SCREW $ 588.00 BIOCOMP INT SCR 10 X 23MM $ 588.00 BIOCOMP INT SCR 8 X 23MM $ 588.00 BIOCOMP INT SCR FT 11 X 28MM $ 588.00 CRE FX WRE BLLN DIL 15/16.5/18 $ 588.00 HBOT-DEBRID SEL EA ADD 20 SQ $ 588.00 WRC-DEBRID SEL EA ADD 20 SQ $ 588.00 1.1MM DRILL BIT, 4MM $ 590.00 1.1MM DRILL BIT, 6MM $ 590.00 3.5 X 22MM LOCKING SCREW $ 590.00 3.5 X 24MM LOCKING SCREW $ 590.00 3.5 X 26MM LKG SCREW (STRYKER) $ 590.00 3.5 X 28MM LCKNG SCR (STRYKER) $ 590.00 3.5 X 30MM LKG SCREW (STRYKER) $ 590.00 3.5 X 32MM LOCKING SCREW $ 590.00 3.5 X 34MM LOCKING SCREW $ 590.00

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3.5 X 36MM LCKNG SCR (STRYKER) $ 590.00 3.5 X 38MM LKG SCREW (STRYKER) $ 590.00 3.5 X 40MM LKG SCREW (STRYKER) $ 590.00 3.5 X 46MM LCKG FT SCREW $ 590.00 3.5 X 8MM LOCKING SCREW $ 590.00 3.5X10MM LOCKING VARIAX SCREW $ 590.00 3.5X42MM LCKNG SCREW (STRYKER) $ 590.00 AVULSION-NAIL PLATE $ 590.00 COMPRESSION PLATE 4.0MM 5 HOLE $ 590.00 DRESS/DEBRID P-THICK BURN S $ 590.00 I & D ABSC SMPL OR SGL $ 590.00 I&D ABCESS, SIMPLE/SINGLE $ 590.00 I&D ABSC SMPL OR SGL $ 590.00 I&D ABSC; SMPL OR SGL $ 590.00 INIT TX 1ST DEGR BURN $ 590.00 INT WND REP N-HF/GENIT=<2.5CM $ 590.00 INTMD WND RPAR N-HF/GEN=<2.5CM $ 590.00 PLATE $ 590.00 RADIATION TREATMENT DELIVERY $ 590.00 SCREW 2.3X24MM LOCK SELF TAP $ 590.00 SCREW 3.5X12MM LOCKING $ 590.00 SCREW 3.5X18MM LOCKING $ 590.00 SCREW 3.5X20MM LOCKING $ 590.00 SCREW 3.5X24MM LOCKING $ 590.00 SPL AVULSE NP SGL $ 590.00 SPL AVULSE NP; SGL $ 590.00 SREP S/N/A/G/TR/E 12.6-20.0CM $ 590.00 SREP S/N/A/G/TR/E 2.5CM/< $ 590.00 SREP S/N/A/G/TR/E; 2.5CM/< $ 590.00 SREPS/N/A/G/TR/E 2.6-7.5CM $ 590.00 STR LCKG SCR T10 FTHR 3.5X12MM $ 590.00 STR LCKG SCR T10 FTHR 3.5X14MM $ 590.00 STR LCKG SCR T10 FTHR 3.5X16MM $ 590.00 WEDGE EXC NAIL FOLD $ 590.00 WRC-AVULSION-NAIL MATRIX $ 590.00 WRC-AVULSION-NAIL PLATE $ 590.00 WRC-BURN INITIAL-1ST DEGREE $ 590.00 WRC-DRESS/DEBRIDE SMALL W/O $ 590.00 WRC-EXCISION, WEDGE, NAIL $ 590.00 WRC-I & D SIMPLE $ 590.00 CATH ULT BALLOON DIL 12FRX10CM $ 593.00 GRAFTBONE15ML 4-10MM CAN CHIP $ 593.00 XR*SCREEN BAR ENEMA-ALT/SIGM $ 593.00 XR*SCREEN BAR ENEMA-NOT ALTERN $ 593.00 5 X 24MM LCKNG SCREW $ 595.00 5 X 32MM LCKNG SCREW $ 595.00 5 X 34MM LOCKING SCREW $ 595.00

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5 X 36MM LOCKING SCREW $ 595.00 5 X 38MM LOCKING SCREW $ 595.00 5 X 40MM LOCKING SCREW $ 595.00 5 X 42MM LOCKING SCREW $ 595.00 5 X 46MM LOCKING SCREW $ 595.00 5 X 48MM LOCKING SCREW $ 595.00 5 X 50MM LOCKING SCREW $ 595.00 5 X 55MM LOCKING SCREW $ 595.00 5 X 60MM LOCKING SCREW $ 595.00 5 X 65MM LOCKING SCREW $ 595.00 5 X 70MM LOCKING SCREW $ 595.00 5 X 75MM LOCKING SCREW $ 595.00 5 X 85MM LOCKING SCREW $ 595.00 5 X 90MM LOCKING SCREW $ 595.00 5 X 95MM LOCKING SCREW $ 595.00 5.0 X 80MM LOCKING SCREW $ 595.00 NON-OB TRANSVAG US $ 596.00 ULT-S PELVIS COMPLETE $ 596.00 ULT-S TRANSVAGINAL $ 596.00 US EXAM PELVIC COMPLETE $ 596.00 APPLY LONG ARM SPLINT $ 597.00 APPLY LONG LEG SPLINT $ 597.00 APPLY SHORT LEG SPLINT $ 597.00 EXC BEN LES T/A/L 1.1-2.0CM $ 597.00 EXC TR-EXT B9+MARG 1.1-2 CM $ 597.00 EXC TR-EXT B9+MARG 1.1-2 CM $ 597.00 ONCO (OVAR) TWO PROTEINS $ 597.00 WRC-EXC BEN LES-TRUNK 1.1-2. $ 597.00 CTH BLN DIL BIL RX 8MMX4X180CM $ 599.00 6 HOLE 1/3 TUBULAR PLATE $ 600.00 ARTHR QUICK-FIX SCREW 2MMX12MM $ 600.00 LAB-HISTOCHEMICAL STAIN $ 600.00 2.0MM VARIAX DRILL $ 603.00 2.7MM VARIAX DRILL $ 603.00 3.5MM VARIAX DRILL $ 603.00 EXC OF CHALAZION; SINGLE $ 603.00 REMOVE EMBEDDED FB EYELID $ 603.00 VAR 2 CLVDRLBT AO 2.6X135 SCLD $ 603.00 WHOLEY GUIDE WIRE $ 603.00 DIALYSIS-PLCMNT CNTRL VEN CA $ 604.00 VARIAX PLATE L-PLATE LEFT $ 604.00 TURBINATOR WAND $ 605.00 FNA BX W/US GDN EA ADDL $ 607.00 PNEUMOGRAM 2 CHANNEL $ 607.00 PNEUMOGRAM 6 CHANNEL $ 607.00 2.2MM DRILL BIT W/10MM STOP $ 608.00 2.2MM DRILL BIT W/12MM STOP $ 608.00

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4.8MM TIBIAL CORNER DRILL $ 608.00 ANCHOR SUT W40 W1.3MM DRILBIT $ 610.00 LEVEL 6 ANCHOR, SCREW, PEN,PIN $ 610.00 PLATE 1/3 TUBLR 3X102MM 8HOLES $ 610.00 PLT 4MM LOCK 1/3 TBLR 8H 102MM $ 610.00 SCR TENODESIS 8X12MM $ 610.00 UNNA BOOT STRAPPING BI $ 610.00 MINI QUICKANCHOR PLUS#0 SUTURE $ 611.00 STRY CANN TWST DRILL BIT 2.7MM $ 611.00 60MM ART MED THCK LOADING UNIT $ 612.00 US BX BREAST ADD LESION IMAG $ 612.00 90 DEG 11MM POST $ 613.00 sodium hyaluronate 25 mg/2.5 mL SYRINGE (KPROV) $ 613.76 POWERLINE CVP SINGLE LUMEN 5F $ 615.00 M&S OR ANCHOR/SCREW FOR OPPO $ 616.00 A1C CABLE CNNCTR WHT IMPELLA $ 619.00 BX BREAST ADD LESION STRTCTC $ 620.00 COLP CERVIX W BX & CURETT $ 620.00 LAB-TCELL AG RECEPTOR GAMMA $ 622.00 BASK RETRIEV 1.9X120 $ 624.00 BASK RETRV 1.9X120 $ 624.00 DISPOS CANNULATED REAMER 5.0MM $ 624.00 DRILL BIT FOOT 4.9MM CNN $ 624.00 HOME SLEEP TEST/TYPE 3 PORTA $ 624.00 INTRAVASCULAR ULTRASOUND $ 624.00 M & S SUPPLY- LEVEL 6 $ 624.00 M&S SUPPLY-LEVEL 6 $ 624.00 MESH PAR PROGRIP 12X8CM ANA RT $ 624.00 RETRCT WAVEGUIDE EIGR NARROW/F $ 624.00 RETRCT WAVEGUIDE EIGR WIDE/FLA $ 624.00 MONSTER SCREW $ 625.00 NATRELLE BREAST SIZER 450CC $ 625.00 NATRELLE BREAST SIZER 495CC $ 625.00 PORT CLEARVUE STANDARD $ 625.00 SCREW LONG THREAD HEAD5.5X50 $ 625.00 HFFMNN LRF SPANNR WRNCH 7/10MM $ 627.00 THROMBOLYSIS CORON IV INFUS $ 629.00 TPA ADMIN $ 629.00 EXAM/BIOPSY OF VAG W/SCOPE $ 630.00 AX 55 B OR G $ 631.00 SCREW 3.5X14MM LOCKING $ 632.00 S&N GUIDE WIRE, 1.2MM X 18IN $ 634.00 2.9X10MM MATRIX RIB LCKG SCREW $ 635.00 2.9X12MM MATRIX RIB LCKG SCREW $ 635.00 SCREW 3.5X16MM LOCKING $ 635.00 SLEEP STUDY UNATT&RESP EFFT $ 636.00 SLEEP STUDY UNATTENDED $ 636.00

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7 HOLE LCKNG THRD TBLR PLT $ 638.00 MICROSPHERE EMBOSPHERE 500-700 $ 638.00 MICROSPHERE EMBOSPHERE 700-900 $ 638.00 PLATE 7 HOLE LCKNG THRD TBLR $ 638.00 NEPHROMAX HP BALLOON 30-17 KIT $ 639.00 RADIATION PHYSICS CONSULT $ 639.00 PROF STRESS TTE COMPLETE $ 641.00 5.5MM QUICK RELEASE AWL $ 643.00 LWR XTR VASC STDY BILAT $ 644.00 VASC*DUPLEX CAROTID $ 644.00 LAB-TCELL AG RECEPTOR BETA $ 645.00 POWERLINE CVP DUAL LUMEN 5F $ 646.00 CNTRL POST EPISTAX INIT $ 647.00 INTUBATION $ 647.00 INTUBATION ET EMERGENT $ 647.00 1.8MMDRLL DPTHMRK QCKCPNG110MM $ 648.00 DRILL BIT 1.8X110MM $ 648.00 DRILL BIT 2X140MM W/DEPTH MARK $ 648.00 ESOPHAGEAL BANDING KIT $ 648.00 CT SCAN-ORBIT,SELLA,EAR W/O $ 650.00 CT SCAN-SOFT TISSUE NECK W/O $ 650.00 FETAL BIOPHYSICL PROFILE W/N $ 650.00 PEAK PRP DISPOSABLE $ 650.00 TISSUE CULTURE; BM BLD CELLS $ 650.00 LAB-HLA DR TYPING $ 652.00 HEAD UNITRAX ENDO COMP 46MM $ 653.00 UNTRX ENDOPROSTH HEAD COMP45MM $ 653.00 UROMAX BALLOON KIT 15FX4CM $ 657.00 BHC LYMPH NODE ASPIRATION $ 658.00 EXC BEN LES T/A/L 0.6-1.0CM $ 658.00 EXC TR-EXT B9+MARG 0.6-1 CM $ 658.00 EXC TR-EXT B9+MARG 0.6-1 CM $ 658.00 FNA W/O IMAGE $ 658.00 WRC-DEBRID, BONE EA ADD 20SQ $ 658.00 .WRC-EXCIS MALIG LESION 1-2C $ 659.00 BHC ASPIRATION HEMATOMA/CYST $ 659.00 EXC ML LSN TRNK/ARM/LG 1.1-2CM $ 659.00 EXC TR-EXT MAL+MARG 1.1-2 CM $ 659.00 PUNCT ASP - ABSC HEMAT CYST $ 659.00 WRC-PUNCTURE ASPIRATION ABCE $ 659.00 BIORAPTOR 2.3PK SUTURE ANCHOR $ 660.00 PROF - TISSUE EXAM BY PATHOLOG $ 660.00 TISSUGLU $ 660.00 CT-3D POST PROCESS W/O WORKS $ 661.00 MRI*3D POST PROC W/O WORKSTA $ 661.00 LAB-VHL FULL GENE ANALYSIS $ 662.00 VASCULAR CLOSURE DEVICE $ 662.00

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10 HOLE LOCKING THIRD TUB PLT $ 663.00 8 HOLE LOCKING THIRD TUBLR PLT $ 663.00 BARREL BUR 6-FLUTE 5.5MM $ 663.00 S&N BONE TUNNEL PLUG CANNULATD $ 663.00 TX DEVICES; COMPLEX $ 663.00 SILO BAG 3CM $ 665.00 ESPHG/PYLRC/BLRY 12-15MM/180CM $ 666.00 HBOT TREATMENT 30M INTERVAL $ 668.00 DRILL BIT FOOT 3.5MM CNN $ 669.00 SP*FLOURO GUIDE NEEDLE/CATH $ 669.00 XR*FLOURO GUID LOCAL NEEDLE $ 669.00 ARROW INTRODUCER $ 670.00 CHEMO IV INFUSION 1 HR $ 670.00 OBS IVF-C 1HR SNGL/INIT DRU $ 670.00 INJ ANESTH; FACIAL NERVE $ 673.00 WRC-I & D BURSA FOOT $ 673.00 2.6MM SPEEDGUIDE DRILL AO $ 675.00 XENOSURE BIOLOGIC PATCH $ 675.00 STAPLER GIA 60 - 3.8 $ 676.00 4.0 PART THRD CANN SCREW 60MM $ 680.00 SCR BONE L40MM OD4MM STD TI $ 680.00 SCR CANN 4X46MM $ 680.00 SCR CANN 4X50MM $ 680.00 SCR SS 4.0X48MM PT NSTRL $ 680.00 2.0MM T-PLATE $ 681.00 STPLR INT STD TIS LNAR TA6048S $ 681.00 BALLOON DILATION SET $ 682.00 CT SCAN-BILAT LOWER EXT W/O $ 682.00 CT SCAN-LT LOWER EXTRM W/O C $ 682.00 CT SCAN-RT LOWER EXTRM W/O C $ 682.00 2.4 X 10MM TI LCKNG SCREW $ 683.00 2.4 X 16MM TI LCKNG SCREW $ 683.00 2.4 X 18MM TI LCKNG SCREW $ 683.00 2.7 X 16MM LCKG SCREW $ 683.00 2.7 X 18MM LCKG SCREW $ 683.00 DRAINAGE LINE PLEURX $ 683.00 ORTHLC FOREFT 2.0X18MM LCK SCR $ 683.00 ORTHLC FOREFT 2.4X14MM LCK SCR $ 683.00 ORTHLC FRFT 2.0 X 14MM LCK SCR $ 683.00 PLEURX STARTER KIT 1000mL $ 683.00 PLEURX STARTER KIT 500mL $ 683.00 SCREW 2.7 X 10MM LCKING $ 683.00 WIRE FATHAM .016 X 180CM $ 683.00 WR ORTHLC FRF 2.4X12MM LCK SCR $ 683.00 4.5MMX125MM ANGLD FORMLA CUTR $ 684.00 5 X 14MM PERI PROSTHETIC SCREW $ 684.00 5 X 20MM PERI PROSTHETIC SCREW $ 684.00

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5.0 X 10MM LOCKING SCREW $ 684.00 5.0 X 12MM LOCKING SCREW $ 684.00 INV CT 3D W INDEPENDNT WK STAT $ 684.00 2.0 DRILL BIT $ 685.00 2.0MM DRILL (STRYKER) $ 685.00 2.5MM DRILL (STRYKER) $ 685.00 ANCHRG DRILLBIT 2.0MM L11MM AO $ 685.00 DPLX EXT VEIN UNI/LMT BSL/CPHL $ 687.00 DPLX EXT VEINS UNI/LMT GSV/LSV $ 687.00 DPLX EXT VN UNI/LMT INSUFCNCY $ 687.00 DUPLEX EXT VEINS UNIL/LIMIT $ 687.00 3MM CANNULATED DRILL (ARTHREX) $ 688.00 CYSTOGRAPHY MIN 3V, S&I $ 688.00 CYSTOGRAPHY, RETROGRADE $ 688.00 CYSTOGRAPHY, VOIDING $ 688.00 DISP KIT FOR DX SWIVELOCK SL $ 688.00 DSPSBL KIT FOR DX SWIVELOCK SL $ 688.00 KIT FOR FIBER TAK DX SUTURE AN $ 688.00 ROD PRE-LORDOSED W/LINE 45MM $ 688.00 ROD SPNL 5.5 MM DIAM 40 MM LEN $ 688.00 ROD SPNL 5.5 MM DIAM 45 MM LEN $ 688.00 ROD SPNL L55MM OD5.5MM TI POST $ 688.00 ROD SPNL L75MM OD5.5MM TI POST $ 688.00 SCLERAL PATCH GRAFT $ 688.00 SHEATH DRYSEAL 12F X 28CM $ 688.00 SHEATH DRYSEAL 16FR X 28CM $ 688.00 SHEATH DRYSEAL 18F X 28CM $ 688.00 SYNTHES ROD 55MM $ 688.00 VOIDING URETHROCYSTOGRAM $ 688.00 XR*URETHROCYSTOGRAPHY, S&I $ 688.00 XR*URETHROCYSTOGRPHY VOIDG S $ 688.00 EXC BLES S/N/EX G 0.5CM/< $ 690.00 EXC BLES S/N/EX G 1.1-2.0CM $ 690.00 EXC BLES S/N/EX G 2.1-3.0CM $ 690.00 EXC BLES S/N/EX G 3.1-4.0CM $ 690.00 EXC BLES S/N/EX G; 0.5CM/< $ 690.00 EXC BLES S/N/EX G; 1.1-2.0CM $ 690.00 EXC BLES S/N/EX G; 2.1-3.0CM $ 690.00 EXC BLES S/N/EX G; 3.1-4.0CM $ 690.00 EXC BLES S/N/EX G;>4.0 CM $ 690.00 WRC-EXCIS BENIGN LESION <.5C $ 690.00 WRC-EXCIS BENIGN LESION >4CM $ 690.00 WRC-EXCIS BENIGN LESION 1.1- $ 690.00 WRC-EXCIS BENIGN LESION 2-3C $ 690.00 WRC-EXCIS BENIGN LESION 3-4CM $ 690.00 CHROM ANALY; 20-25 CELLS $ 693.00 M&S-SOLCOTRANS/DRAINAGE $ 693.00

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BALLOON XFORCE (LITHO) $ 694.00 ROTH RETRIEVAL NET $ 694.00 DRL BT CN TWST W AO FTNG 6.5MM $ 696.00 AUTOLOG RBC LEUKO REDUCED EA $ 698.00 LEUKOCYTE POOR BLOOD PRE-FIL $ 698.00 POOR LEUKOCYTE BLOOD EA UNIT $ 698.00 SILO BAG 4CM $ 699.00 DEST MLES F/E/E/N/L/MM 0.6-1CM $ 700.00 DESTR MLES F/E/E/N/L/MM1.1-2CM $ 700.00 45 X 30CM PARIETENE MACRO MESH $ 701.00 OB US >= 14 WKS SNGL FETUS $ 701.00 TELETHX ISODOSE PLAN CPLX $ 701.00 ULT-S ABDOMEN $ 701.00 ULT-S PREGNANCY AFTER 14WKS $ 701.00 ULT-S RETROPERITONEAL COMPLE $ 701.00 US EXAM ABDO BACK WALL COMP $ 701.00 US EXAM ABDOM COMPLETE $ 701.00 ENDOMETRIAL BX WO CERVICAL DIL $ 703.00 PROBE LITHO $ 705.00 STR UNTRX ENDOPRO HD COMP 45MM $ 707.00 PROGRAM STIM POST IV DRUG INFU $ 709.00 SIMULATION; SIMPLE $ 709.00 18MM MINI ACUTRAK 2 BONE SCREW $ 710.00 J-VAC DRAIN $ 710.00 ORTHLC 3.5 LCKNG SCR TI 3.5x26 $ 710.00 ORTHOLOC TI LOCK SCREW 3.5X34M $ 710.00 ORTHOLOC TI LOCK SCREW 3.5X36M $ 710.00 ORTHOLOC TI LOCK SCREW 3.5X38M $ 710.00 ORTHOLOC TI LOCK SCREW 3.5X40M $ 710.00 UNITRAX ENDO HEAD COMP 44MM $ 710.00 UNITRAX ENDO HEAD COMP 52MM $ 710.00 UNITRAX ENDO HEAD COMP 53MM $ 710.00 WR 3.5MM ORT 3DSI PLYL SC 18MM $ 710.00 WR 3.5MM ORT 3DSI PLYL SC 22MM $ 710.00 3 X 14MM LOCKING SCREW $ 713.00 3 X 18MM LOCKING SCREW $ 713.00 3.0 X 14MM LOCKING SCREW $ 713.00 3MM LCKSCR FL THRD T8 3X10MM $ 713.00 ANCHOR SU CRVD TIP MNSCL CINCH $ 713.00 ANCHORAGE LOCKING SCREW 3X12MM $ 713.00 ARTHREX FLIPCUTTER III $ 713.00 BK-SKIN SQ/MM; SGL $ 713.00 HBOT-NEG PRESSURE TX >50 SQ $ 713.00 INCAL BX SKN SINGLE LES $ 713.00 NEG PRESS WND TX <=50 SQ CM $ 713.00 NEG PRESS WOUND TX >50 CM $ 713.00 PUNCH BX SKIN SINGLE LESION $ 713.00

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TANGNTL BX SKIN SINGLE LES $ 713.00 WRC-NEG PRESSURE TX > 50 SQ $ 713.00 COCR IMPLANT ROD $ 715.00 URETERAL PIGTAIL STENT $ 717.00 CURVED HIP BLADE $ 718.00 CWS 400 CLSD WOUND SUCTION KIT $ 719.00 SPRM-MYEL LUMBO PUNCTURE $ 722.00 US BREAST COMPLETE BIL $ 722.00 PROF -TISSUE EXAM BY PATH 5 $ 723.00 PROF-TISSUE EXAM BY PATH 7 $ 723.00 EXC S/N/H/F/G MAL+MRG 1.1-2 $ 725.00 POWER PORT ISP MRI IMPLANTABLE $ 725.00 LAB-AMNIOTIC FLUID CULTURE $ 727.00 2.4MM REDCTION TOOL, SELF DRIL $ 728.00 7 X 20MM BIOSURE PK SCREW $ 728.00 ANCHOR 2.5MM $ 728.00 ANCHOR SUT BIOCOMP 5.5X15MM 2 $ 728.00 ANCHOR SUT SM BONE 2-0 FIBRWIR $ 728.00 ANCHR SUT 2.3MM 2 STRAND FIBR $ 728.00 BIOSURE HA SCREW, 8MMX20MM $ 728.00 CLIP PISTOL GRIP ENDO II 10MM $ 728.00 FX ABSTACK 5MM 15 TACK DISP $ 728.00 M & S SUPPLY- LEVEL 7 $ 728.00 M&S SUPPLY-LEVEL 7 $ 728.00 PIN STL HDLSS 1/8 $ 728.00 SCREW 9 X 20MM BIOSURE HA $ 728.00 PARIETEX PROGRIP MESH 20X15CM $ 729.00 EEG * AWAKE $ 730.00 EEG * PORTABLE $ 730.00 EEA* 28MM SINGLE-USE STAPLER $ 731.00 EEA* 33MM SINGLE-USE STAPLER $ 731.00 3.6 X 22MM NON-LOCKING T10 SCR $ 733.00 SCREW PEEK TENODESIS 7X23 $ 733.00 CATH,CRE WRGUID BALLN 18/19/20 $ 735.00 CRE 12-13.5-15 ESO/PY BAL DIL $ 735.00 CRE PRO GUIDEWIRE 15MM $ 735.00 CRE WRGUID BALLOON DILCTH 8910 $ 735.00 GWR CRE 8-9-10 ESPH/PY BAL DIL $ 735.00 SCR BCMP INTRFRNC VNTD 10X30MM $ 738.00 SCR BCMP INTRFRNC VNTD 7X20MM $ 738.00 SCR SPNL L14MM CANC ANT CERV $ 738.00 SNARE 9MM - 15MM $ 738.00 COUNTERSNK CANN DRLL BIT 1.7MM $ 740.00 DRESSNG CHG NOT FOR BURN $ 740.00 INJ TENDON ORIGIN/INSERT $ 740.00 THRMOMTR MED TEMPORAL ART DISP $ 740.00 2.2MM SUTURE ANCHOR $ 741.00

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2.7MM ANCHOR $ 741.00 BIOSURE HA SCREW 11MM X 30MM $ 742.00 HIP PAC DISPOSABLE $ 743.00 NJX PLATELET PLASMA $ 743.00 ANCHOR SUT W/ 2 ORTHOCORD $ 744.00 LEVEL 7 ANCHOR, SCREW, PEN,PIN $ 744.00 5.0MM CABLE PLUG $ 745.00 BIOSURE HA SCREW 10MMX20MM $ 745.00 BONE CHIPS CANCLLS 4-10MM 15CC $ 745.00 MYOSURE REACH EXT TISSUE REMVL $ 746.00 SNARE GOOSENECK 10MM X 120CM $ 747.00 SNARE GOOSENECK 15MM X 120CM $ 747.00 SNARE GOOSENECK 20MM X 120CM $ 747.00 SNARE GOOSENECK 30MM X 120CM $ 747.00 SNARE GOOSENECK 35MM X 120CM $ 747.00 5.5 X 40MM SHORT THREAD SCREW $ 748.00 ACU-LOC VDR PLATE, STANDARD LT $ 748.00 LW PR SCR T16.7X65MM CANN 18MM $ 749.00 DRILL SET $ 750.00 ISO*LUNG SCAN PERFUSION $ 750.00 ISO*THYROID IMG SINGLE OR MULT $ 750.00 ISO*THYROID IMG VSC FLOW PRFRM $ 750.00 ISO*THYROID UPTAKE SING OR MUL $ 750.00 NM PARATHYROID NO IMAGING INJE $ 750.00 NM PULM VENT IMAGE-AERO OR GAS $ 750.00 NM-PULM PERFUSION, INC IMAGI $ 750.00 PARATHY PLANAR IMAG INCL SUBTR $ 750.00 TAP 6.0 $ 750.00 1.25 PLT REDUCTION WIRE L STOP $ 754.00 SL CBL OD2MM SM VIT HIP BEAD $ 758.00 BIPOLAR HEMOSTASIS PROBE $ 760.00 FETAL MONITOR $ 762.00 FETAL NON STRESS TEST $ 762.00 3 X 14.5MM SUTURE ANCHOR $ 763.00 BX DONE W/COLPOSCOPY ADD-ON $ 763.00 DEXA BONE DENSITY STUDY $ 764.00 DXA BONE DENSITY AXIAL 1+SITES $ 764.00 120MM ROD $ 765.00 rabies vaccine, purified chick embryo cell 2.5 Intnl Units PWDI $ 765.29 PORT STD 1LUM 8.5F POLY/TI $ 766.00 1.8MM Q-FIX ALL SUTURE ANCHOR $ 767.00 DUPLEX ARTERIAL FLOW COMPL $ 767.00 DUPLEX ARTERIAL FLOW; COMPL $ 767.00 SN 2.8 MM Q IMP BL BLK CO-BRAI $ 767.00 ULT-DUPLEX SCROTAL ABD ETC,C $ 767.00 TEMPORARY FIXATION SCREW $ 768.00 28MM STAPLER W/3.5MM STAPLES $ 769.00

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INV FIS/SINUS TRACT STUDY S&I $ 772.00 CT SCAN-BILAT UPPER EXT W/O $ 774.00 CT SCAN-LEFT-UPPER EXTREM W/ $ 774.00 CT SCAN-RIGHT-UPPER EXTREM W $ 774.00 8-10MM X 30MM TAPERED SCREW $ 775.00 25X4.8MM EEA CIRSTPWDST SERTCH $ 777.00 DPLX EXT VEINS UNIL/LIMIT DVT $ 777.00 DUPLEX EXT VEINS; UNIL/LIMIT $ 777.00 ISO*RADIOPHARM THPY, ORAL AD $ 777.00 LE DPLX EXT VEINS UNIL LMT $ 777.00 SP*IR US LE VENOUS DUPLEX LE $ 777.00 SP*IR US LE VENOUS DUPLEX RT $ 777.00 SP*IR US UE VENOUS DUPLEX LE $ 777.00 SP*IR US UE VENOUS DUPLEX RT $ 777.00 ULT-S VENOUS LOWER EXT,LTD,R $ 777.00 ULT-S VENOUS LOWER EXT-LTD,L $ 777.00 ULT-S VENOUS UPPER EXT, LTD, $ 777.00 ULT-S VENOUS UPPER EXT,LTD, $ 777.00 CT SCAN-ABDOMEN W/O CONTRAST $ 780.00 CT SCAN-HEAD OR BRAIN W/CONT $ 780.00 CT SCAN-MAXI FACIAL WITH CON $ 780.00 CT SCAN-ORBIT,SELLA,EAR W/CO $ 780.00 35MM POWERED VASCULAR STAPLER $ 782.00 PLATE BNE 1MM LCK BILAT 16HOLE $ 782.00 PLT 1.7 LCK 16H STRT $ 782.00 PML/RARALPHA COM BREAKPOINTS $ 783.00 UNIVERSAL CANNULA $ 783.00 1.1MMX135CM PIRANHA BX FORCEPS $ 785.00 3.6 X 26MM CP SCREW, T8 $ 785.00 7X10MM TENODESIS SCR PEEK VENT $ 788.00 DRILL BIT CANNULATED 3MM $ 788.00 MDPR TIT ORB FLRWL IMPL MTB RT $ 788.00 PEEK TENODESIS SCRW 5.5MMX15MM $ 788.00 SCR PEEK TENODESIS 5.5X10MM $ 788.00 SCR TENODESIS 4.75X15MM $ 788.00 SCR TENODESIS 4X10MM $ 788.00 SCR TENODESIS 6.25X15MM $ 788.00 SCREW INTERFRNC 15X6.25MM DISP $ 788.00 DXA BONE DENSITY AXIAL 1+ SITE $ 790.00 TISSUE EXAM BY PATH LVL 5 $ 790.00 TISSUE EXM BY PATHLOGIST LVL 5 $ 790.00 TRUNODE S-10 $ 790.00 SET ORTHOPEDIC OD.045 IN SMALL $ 792.00 SYS SM BONE FIX 1.6MM $ 792.00 ANCHOR SUT W ORTHCORD LUPNE BR $ 793.00 SB PROD PHM-9101 PHYS MOLD 1cc $ 793.00 LAB-HEPATITUS C GENOTYPE $ 795.00

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ANCHOR 2.3PK SUPR W ULTRABRAID $ 796.00 SEGURA BASKET $ 796.00 US- VACUUM DEVICE PROCEDURE $ 797.00 SCREW LAG HIP 10.5MM DIA 90MML $ 798.00 10.5 X 115MM LAG SCREW $ 799.00 SCR TI LAG 10.5X105MM $ 799.00 SCR TI LAG 10.5X85MM $ 799.00 ST TI LGSCR HP 10.5 DIA 100MML $ 799.00 SINUS GUIDE CATHETER TIP $ 800.00 SINUS GUIDE CATHETER TIP, MAXI $ 800.00 WRC-SPLT THCK AUTO EA ADD100SQ $ 800.00 OVAL CUP FORCEPS $ 804.00 MESH SYMBOTEX 9CM ROUND $ 805.00 30MM INTRAFIX TIBIAL SHEATH $ 806.00 INV ERCP BILIARY DUCT S&I $ 807.00 VICTRECTOMY PACK, POSTERIOR $ 808.00 VITRECTOMY PACK, POSTERIOR $ 808.00 TRANSVAGINAL OB US $ 809.00 TRANSVAGINAL OB US $ 809.00 ULT-S PREG UTERUS,REAL X,TRV $ 809.00 8-10MMX30MM BIO-INTRFX TPR SCR $ 810.00 8-10X30MM BIOINTRAFIX TPRD SCR $ 810.00 8X10MM BIO-INTRAFIX TAPERD SCR $ 810.00 ARTH 3MM PROF SCRW CANN 16MM $ 812.00 ARTH 3MM PROF SCRW CANN 18MM $ 812.00 ARTHREX 4MM SHORT CANN 22MM $ 812.00 ARTHREX 4MM SHORT CANN 24MM $ 812.00 ARTHREX 4MM SHORT CANN 26MM $ 812.00 2.3MM ANCHOR W/2.0MM XBRAID TT $ 813.00 3X14MM S JOINT BIOCOMP SUTRTAK $ 813.00 8.5MM FLIPCUTTER $ 813.00 ANCH ST BIOCMPST FT STRL 5.5X1 $ 813.00 ANCHOR 5.5MM PEEK SOFT EYELET $ 813.00 ARTHREX FLIPCUTTER II 8MM $ 813.00 CORDLESS U/S DISSECTOR 26CM $ 813.00 FIBER TAK SUTURE ANCHOR $ 813.00 FLIP CUTTER 9.5 $ 813.00 FLIPCUTTER II 10MM $ 813.00 FLIPCUTTER II 8.5MM $ 813.00 FLIPCUTTER, 9MM $ 813.00 ICONIX 1.4MM ANCHOR W/NEEDLES $ 813.00 ICONIX 2.3MM ANCHOR W/NEEDLES $ 813.00 SMALL JOINT BIO-COMP SUTURETAK $ 813.00 SUT ANC BICOMP CRKSCR FT VNTED $ 813.00 CAT SCAN*BILAT LOWER EXT W/C $ 814.00 CT SCAN*BILAT UPPER EXT W/CO $ 814.00 CT SCAN-LEFT-LOWER EXTREM,W/ $ 814.00

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CT SCAN-LEFT-UPPER EXTRM WIT $ 814.00 CT SCAN-LUMBAR SPINE W/O CON $ 814.00 CT SCAN-PELVIS W/O CONTRAST $ 814.00 CT SCAN-RIGHT UPPER EXTREM W $ 814.00 CT SCAN-RIGHT-LOWER EXTREM,W $ 814.00 CT SCAN-THORACIC SPINE W/O C $ 814.00 CEMENT, SMARTMIX TOWER $ 820.00 CT-3D POST PROCESS W/WORKSTA $ 822.00 MRI*3D POST PROC W/WORKSTATI $ 822.00 SPRM-MYEL THOR PUNCTURE $ 822.00 ANCHOR SUT 5.5MM ORTH HLX ADV $ 825.00 RETRIEVAL DEVICE TULIP $ 825.00 SCREWDRIVER BIT $ 825.00 estradiol valerate 200 mg/ 5mL INJ (KPAWT) $ 826.93 SNARE 18MM - 30MM $ 828.00 SNARE 6MM - 10MM $ 828.00 LEVEL 8 ANCHOR,SCREW,PEN,PIN $ 829.00 SCR UNIPLATE SELFDRLL SCW 12MM $ 829.00 SCR UNIPLATE SELFDRLL SCW 14MM $ 829.00 SCREW SELF DRILL $ 829.00 INTERFERENCE SCREWS $ 830.00 CERV COLP W EC CURETT $ 832.00 CERVIC COLP W CERVIX BX $ 832.00 LAG SCREW TI 95MM $ 832.00 ROD 3.5 60MM $ 832.00 LEVEL 8 PLATE & ROD IMPLANTS $ 833.00 ROD PRE-LORDOSED W/LINE 35MM $ 833.00 ROD PRE-LORDOSED W/LINE 40MM $ 833.00 ROD PRE-LORDOSED W/LINE 65MM $ 833.00 SYNTHES ROD 50MM $ 833.00 APPLIER CLIP ENDO 5MM $ 834.00 CABLE SLV SET TI VITL BEAD 2MM $ 834.00 CLIP APPLIER ENDO CLIP III 5MM $ 834.00 FRCP URET BIOP 3FR $ 834.00 M & S SUPPLY- LEVEL 8 $ 834.00 M&S SUPPLY-LEVEL 8 $ 834.00 BULKING AGENT 1ML W/NEEDLE $ 836.00 rabies human diploid cell cultures 2.5 IntnlUnit PWDI $ 836.80 SET TRACH INTRO PERC $ 837.00 BIPOLAR CUTTNG LOOP POINT 21FR $ 839.00 HYSTEROSALPINGOGRAM $ 839.00 MAMMARY DUCTOGRAM SINGLE,RIG $ 839.00 MAMMARY DUCTOGRAM,MULTI,LEFT $ 839.00 MAMMARY DUCTOGRAM,MULTI,RIGH $ 839.00 MAMMARY DUCTOGRAM,SINGLE,LEF $ 839.00 XR*SIALOGRAPHY $ 839.00 BILIARY DUCT STRICTURE W/STE $ 841.00

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ISO*BOWEL/MECKEL'S $ 843.00 ISO*GASTRIC EMPTYING STUDY $ 843.00 ISO*GI BLEED SCAN $ 843.00 ISO*LEVEEN SHUNT $ 843.00 ISO*SALIVARY GLAND $ 843.00 ANATOEMC PHALANGEAL PROST 17MM $ 845.00 L SOCKET WRENCH $ 845.00 PROSTHESIS, PHAL 20MM ARTHREX $ 845.00 OPEN CHEST HEART MASSAGE $ 846.00 BLOOD PATCH $ 849.00 INJ EPIDURAL BLOOD/CLOT PATCH $ 849.00 SENSOR WIRE $ 851.00 ELECTROCONVULSIVE THERAPY $ 852.00 XR*GI W/SM BOWEL $ 852.00 CORTICAL STRUTS FEMORAL $ 853.00 penicillin G benzathine 2,400,000 units/4 mL SYRG $ 853.64 EEG * SLEEP $ 856.00 PLT COMPR RECTANG SZ1 $ 856.00 DOPPLER COLOR FLOW $ 857.00 ECHO COLOR FLOW VELOSITY $ 857.00 ISO*BONE SCAN ( WHOLE BODY ) $ 859.00 ISO*BONE SCAN 3 PHASE $ 859.00 ISO*BONE SCAN LIMITED $ 859.00 ISO*BONE SCAN MULTIPLE AREAS $ 859.00 CL TX IP JNT D W MAN WO ANES $ 862.00 CL TX SHLD DISL W MANI WO ANES $ 862.00 BIOCOM TENODESIS SCREW 8X12 $ 863.00 SCR TENODESIS 7X10MM $ 863.00 SCREW INTERFRNC 10X7MM BIOCOMP $ 863.00 BLADE TRICUT 4MMX13CM M4 $ 864.00 2.0 CORTX SELF TAP SCREW X40MM $ 865.00 2.4 CORTX SELF TAP SCREW X32MM $ 865.00 3.5 CORTX SELF TAP SCREW X42MM $ 865.00 3.5 CORTX SELF TAP SCREW X44MM $ 865.00 3.5 CORTX SELF TAP SCREW X48MM $ 865.00 6.5MM CANNULATED DRILL STRYKER $ 865.00 SILO VENTRAL WALL DEFECT 7.5 $ 865.00 DOPPLER ECHO COMPLETE $ 866.00 ECHO DOPPLER $ 866.00 PERMCATH PALINDROME 23CM SPORT $ 867.00 PERMCATH PALINDROME 28CM SPORT $ 867.00 ULT-S CMP PSEUDO ANUE RT GRO $ 867.00 ULT-S COMP PSEUDO-ANE,LT GRO $ 867.00 ICNX SPEED ANCH 2.3MM2STR XBRD $ 868.00 MILAGRO INTER SCREW 10 X 30MM $ 868.00 PROF -PATH CONSULT DUR SURG $ 868.00 INSERTION CERVICAL DILATOR $ 869.00

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VX PLATE REC LOCKING PLATE S2 $ 869.00 HERNIA PLUG (SMALL) $ 873.00 ICONIX SPEED ANCHOR 2.3MM $ 873.00 10 X 60MM BILIARY STENT $ 875.00 6.5 X 50MM DARCO HEADED SCREW $ 875.00 6.5MM SCR FLLY THRD 80MM 32MM $ 875.00 7.5 X 75 16MM DARCO HEADED SCR $ 875.00 BALLOON (4MM) $ 875.00 BUTTON, DOG BONE $ 875.00 HOLMIUM LASER FIBER 365 MICRON $ 875.00 NUVASIVE MONITORING $ 875.00 SCRW DARCO HEADED CAN 6.5X55MM $ 875.00 TIKNOT PLACEMENT DEVICE $ 875.00 3.0MM ASNIS MICRO, TAP, CANNUL $ 878.00 10 X 30 MILAGRO INTERFRNCE SCR $ 880.00 2.5 X 16MM S-FIX SCREW $ 881.00 M&S OR ADHESION BARRIER $ 881.00 Japanese encephalitis virus vaccine SA14-14-2 6 mcg/0.5 mL INJ $ 881.18 DIAMOND CHOANAL ATRESIA BUR $ 884.00 HD FEM OD26MM 0MM NK COCR $ 885.00 HEAD FEM TAPR +0 26MM $ 885.00 HEAD FEM TAPR +4 26MM $ 885.00 HEAD FEM TAPR -3 26MM $ 885.00 HEAD FEMORAL OD26MM +4MM V40 $ 885.00 HEAD FEMORAL OD26MM 0MM V40 $ 885.00 HEAD FEMORAL OD26MM -3MM V40 $ 885.00 L&D RECOVERY FIRST 2 HOURS $ 885.00 RECOVERY ROOM $ 885.00 5.5 FULL RADIUS SHAVER $ 886.00 2.3MM M VARIAX HAND LCK 2X2+2H $ 888.00 2.3MM M VRX HND LCK 3D PLT3X2H $ 888.00 4.5 X 55MM LOW PROFILE SCREW $ 888.00 PLATE 2.3MM LOCKING 2X2 2 $ 888.00 FATHOM .016 WIRE $ 890.00 LITHOTRIPTER DISP $ 892.00 SHEATH 20F X 40CM $ 898.00 10X30MM INTRAFIX SCREW $ 900.00 2.5MM SUT ANCH MINI BIO PSHLCK $ 900.00 9 X 30MM INTRAFIX ADV PEEK SCR $ 900.00 INTRAFIX ADV PEEK SCR 10 X30MM $ 900.00 CATHETER MICRO RENEGADE BLACK $ 901.00 HLA COMPATABILITY $ 905.00 BASKET STONE 8.5F X 50CM $ 910.00 DRCO HDD SCRWS 6.5 X 60 X 16MM $ 910.00 DRCO HDD SCRWS 6.5 X 65 X 16MM $ 910.00 S&N SOFTSILK 1.5 SCW 10MMX25MM $ 910.00 BALLOON ATLAS 14 X 2 X 75CM $ 913.00

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SCREW, 2 X 18MM CORTEX $ 913.00 SET LIVER ACCESS AND BIOPSY $ 913.00 VARIAX PLT CURVD PLT 5 HOLE RT $ 913.00 PLASMA LOOP $ 917.00 MAMM- STEREO VACUUM DEVICE P $ 918.00 PORT CLEARVUE LARGE $ 918.00 NM BONE MARROW IMAG MULTIPLE $ 919.00 NM BONE MARROW IMAG WHOLE BODY $ 919.00 NM BONE MARROW IMG LIMITED $ 919.00 MRI BX BRST ADD LESION MR IMAG $ 921.00 PROF IMMUNO STAIN $ 921.00 PROF PATH-IHC SEMI-QT/QT $ 921.00 PROF -TUMOR IMMNHISTCHEM/MAN $ 921.00 HEALICOIL 4.5 ANCHOR $ 922.00 HEALICOIL PK 5.5MM SUT ANCHOR $ 922.00 PARAGON DRILL $ 922.00 8.0 x 7.2MM THREADED CANNULA $ 924.00 2.6 FBRTK SUT ANCH TRPL LOADED $ 925.00 2.6 FIBERTAK SUT ANCH TRIPLE L $ 925.00 ACL TGTRP RDBLDPSG SUT W UHMWP $ 925.00 FIBERTAK RC SUT ANC DBL LOADED $ 925.00 MCP RT FUSION PLATE $ 925.00 ICONIX ANCHORS 2.3 $ 926.00 DISKOGRAPHY CERVICAL $ 928.00 ICONX 3 ANCHR 2.3MM W/3 STRNDS $ 931.00 DEV PROS MAT ABS 5MM 30 TACKS $ 932.00 M & S SUPPLY- LEVEL 9 $ 932.00 M&S SUPPLY-LEVEL 9 $ 932.00 PLT 4MM LOCK RECON 6H 72MM $ 932.00 STAPLER EEA XL AQUA 21MM $ 932.00 SHOULDER ARTHROSCOPY/SURGERY $ 933.00 NRV CNDJ TEST 11-12 STUDIES $ 936.00 NRV CNDJ TEST 13/> STUDIES $ 936.00 NRV CNDJ TEST 9-10 STUDIES $ 936.00 30MM INTRAFIX ADVANCE SHEATHLG $ 938.00 ARTHRSCPC SHVR BLDE CTTR 4MM $ 938.00 ARTHRSCPC SHVR BLDE CTTR 5.5MM $ 938.00 KIT PERFORATOR ELVS $ 938.00 PROGRIP LAP SELF-FIX MESH $ 938.00 VARIAX RECTANGLAR COMP PLT SZ2 $ 942.00 IADNA-DNA/RNA PROBE TQ 12-25 $ 944.00 7.5 X 80MM ST HEADED SCREW $ 945.00 BLEDOSE BRACE $ 946.00 BLEDSOE BRACE $ 946.00 LAPARSCOPIC WRE L-HOOK ELCTRDE $ 946.00 CLTX OF ACETABULUM X(S) WO MAN $ 947.00 11X180 HOFFMAN III CNNCTNG ROD $ 948.00

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3MM MIC CAN CNTRSNK 3.8MM AO $ 948.00 ULT-S PREG UTERUS,REAL X,<14 $ 952.00 PERMCATH PALINDROME 19CM HEPRN $ 956.00 PERMCATH PALINDROME 23CM HEPRN $ 956.00 PERMCATH PALINDROME 28CM HEPRN $ 956.00 ESCAPE STONE RETRIVAL $ 957.00 11MM MICRO ACUTRAK 2 BONE SCRW $ 960.00 18MM ACUTRAK 2 BONE SCREW $ 960.00 20MM ACUTRAK 2 BONE SCREW $ 960.00 20MM MICRO ACUTRAK2 BONE SCREW $ 960.00 22MM ACUTRAK 2 BONE SCREW $ 960.00 30MM MICRO ACUTRAK 2 BONE SCR $ 960.00 ACUTRAK 2 FIXATION SYST 16.0MM $ 960.00 ACUTRAK 2 FIXATION SYSTEM $ 960.00 CT SCAN-CERVICAL SPINE WITH $ 960.00 CT SCAN-LUMBAR W/CONTRAST $ 960.00 MICRO ACUTRAK 2 BONE SCR 28MM $ 960.00 SCREW 24MM MICRO ACTRK 2 BONE $ 960.00 SCREW 26MM STD ACUTRAK 2BONE $ 960.00 SCREW28MM MINI ACUTRAK 2BONE $ 960.00 TIGHT ROPE ABS $ 962.00 TIGHT ROPE ABS BUTTON $ 962.00 AMNIOFIX SPORTS MED 20.0MG $ 965.00 ANCHR ST 2.3 2 STRND 2 FRC FBR $ 965.00 IS0*WHOLE BODY SCAN (I-131) $ 966.00 ISO*BONE SCAN {SPECT} $ 966.00 ISO*LYMPHOSCINTIGRAPHY $ 966.00 ISO-CSF SHUNT EVAL-NOT INC INJ $ 966.00 NM-HEPATO IMAG GALL MED & ME $ 966.00 ESOPHAGEAL BALLON DILATOR $ 969.00 ENDO HEATER PROBE $ 970.00 FOOTPRNT ULT PK SUT ANCH 4.5MM $ 972.00 11 X 240MM CONNECTING ROD $ 974.00 11X250MM CONNECTING ROD $ 974.00 200MM ROD $ 974.00 250MM ROD $ 974.00 COUPLING 220MM ROD $ 974.00 CT SCAN-MAXI FACIAL W/O & WI $ 974.00 CT SCAN-THORACIC SPINE W/CON $ 974.00 ROD 11X250MM CONNECTING $ 974.00 16MM X 2MM SNAP-OFF SCREW $ 975.00 2.2MM 90DEG DRLL BT W/12MM STP $ 975.00 2.9 X 16MM SCREW $ 975.00 2.9MM X 32MM COMPRESSIVE SCREW $ 975.00 COMPRESSIVE SCREW 4MM X 26MM $ 975.00 NEXIS COMPRESSIVE SCREW 4X28MM $ 975.00 NOVASTEP NEXIS COMP SCR 4X30MM $ 975.00

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PORT CLEARVUE SLIM $ 975.00 SNAP-OFF SCREW, 2MM X L13MM $ 975.00 CATH LAB-AORTOGRAM IMAGE BYPAS $ 977.00 CATH LAB-LT VENT/LT ATRIAL A $ 977.00 CATH LAB-PULMONARY ANGIOGRAPHY $ 977.00 CATH LAB-RT VENT/RT ATRIAL ANG $ 977.00 CATH LAB-SPRVALVULAR AORTGRA $ 977.00 OMNIFIT HFX HIP STEM SZ 10 $ 980.00 SCR STRL 24MM $ 980.00 SHOULDER ARTHROGRAM $ 981.00 XR*BILATERAL SHOULDER, ARTHROS $ 981.00 XR*LEFT-ARTHROGRAPHY/SHO $ 981.00 XR*RIGHT-ARTHROGRAPHY/SHO $ 981.00 CEMENT EXTRACTOR $ 983.00 DARCO HEADED SCREW 7.5X50 16MM $ 983.00 BUNDLE HIS RECORDING $ 985.00 INTRA-ATRIAL PACING $ 985.00 INTRA-ATRIAL RECORDING $ 985.00 INTRA-VENTRICULAR PACING $ 985.00 ISO*THYROID CA MET $ 985.00 RP LOCLZJ TUM 1 AREA 1 D IMG $ 985.00 RV RECORDING $ 985.00 BLOOD LEUKO IRRADIATED EA UN $ 987.00 NUSHIELD 1.6 SQ CM $ 988.00 DECLOT VASCULAR DEVICE $ 991.00 BALLOON PDB (KIDNEY SHAPE) 5/B $ 994.00 DR ABSC/HEMATOMA NASAL SEPTUM $ 996.00 11X300 HOFFMAN III CNNCTNG ROD $ 998.00 7 X 85MM SHORT THREAD SCREW $ 998.00 7 X 90MM SHORT THREAD SCREW $ 998.00 STR HOF III CNCTNG RD 11X350MM $ 998.00 STRY HOFF III CON ROD 11X350MM $ 998.00 RPLC GTUBE NO REVJ TRC $ 999.00 RPLC GTUBE REVJ GSTRST TRC $ 999.00 2.0 X 135MM DRILL BIT $ 1,000.00 2.9INX15.5MM STR ACHR BCP PLCK $ 1,000.00 2.9INX15.5MM SUT ANCH PSHLCK $ 1,000.00 BMS STENT $ 1,000.00 EPIDURAL ANESTHESIA LDR $ 1,000.00 ESOPHAGUS MOTILITY STUDY $ 1,000.00 GASTROESOPH REFLUX W NASAL PH $ 1,000.00 G-ESOPH REFLUX W MUCOSAL PH $ 1,000.00 HOLMIUM LASER FIBER 200 MICRON $ 1,000.00 ICONX 2.3MM FRC FIB SUT W/NDLS $ 1,000.00 SP*IR THORACENTESIS W/O GUIDAN $ 1,000.00 LAB-IN-SITU ANALYSIS $ 1,002.00 LAB-IN-SITU ANALYSIS W&I $ 1,002.00

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COMP PAT OD35MM THICKNESS 10MM $ 1,005.00 PLATE1/3 TUBULAR 23MM 2-HOLE $ 1,005.00 5.5X12.7MM ANCHOR $ 1,010.00 ANCHOR PEEK KNOTLESS $ 1,010.00 ANCHOR SUT2.3MM 2STRND 2FRCFBR $ 1,010.00 TRLUML BALO ANGIOP ADDL ART $ 1,011.00 ABCESS, FISTULA OR SINUS TRA $ 1,012.00 CONTRST X-RAY URINARY TRACT $ 1,012.00 FISTULA/SINUS TRACT STUDY $ 1,012.00 HIP ARTHROGRAM $ 1,012.00 SP* IR N/U CHECK UROG ANTEGRAD $ 1,012.00 SP*LEFT-ANTEGRADE UROGRAPHY $ 1,012.00 SP*RIGHT-ANTEGRADE UROGRAPHY $ 1,012.00 ULT-S SPECIMEN $ 1,012.00 XR*BILATERAL HIP, ARTHROGRAP $ 1,012.00 XR*BILATERAL NEPHROSTGRAM $ 1,012.00 XR*BILATERAL WRIST ARTHROGRAPH $ 1,012.00 XR*LEFT NEPHROSTGRAM-LOOPOGR $ 1,012.00 XR*LEFT-ARTHROGRAPHY/HIP $ 1,012.00 XR*LEFT-ARTHROGRAPHY/WRI $ 1,012.00 XR*LEFT-BREAST,SURGICAL $ 1,012.00 XR*RIGHT NEPHROSTOGRAM-LOOPO $ 1,012.00 XR*RIGHT-ARTHROGRAPHY/HIP $ 1,012.00 XR*RIGHT-ARTHROGRAPHY/WRI $ 1,012.00 XR*RIGHT-BREAST,SURGICAL $ 1,012.00 XR*UROGRAPHY RETRO W/O OR W/ $ 1,012.00 INFANT VENTILATOR, SUBSEQUENT $ 1,013.00 SET TRANSJUG LIVER ACCESS TIPS $ 1,013.00 CT ABD&PELVIS,W&W/O CONT W I $ 1,014.00 PROGRIP MESH $ 1,016.00 PLATELT,PHER,LEUKO,CMV NEG,I $ 1,017.00 HYDROXYprogesterone 250 mg/mL INJ $ 1,018.86 2.8MM CANN COUNTERSINK $ 1,020.00 DVNCI 8MM BLDELSS OBTRATOR LNG $ 1,020.00 DVNCI BLADELESS OBTURATOR 8MM $ 1,020.00 MESH PROLENE 12 X 12" $ 1,021.00 CT SCAN*BILAT LOWER EXT W/&W $ 1,022.00 CT SCAN*BILAT UPPR EXT W/& W/O $ 1,022.00 CT SCAN*LT UPPER EXTRM W/O&W $ 1,022.00 CT SCAN*RT UPPER EXTRM W/O&W $ 1,022.00 CT SCAN-LT LOWER EXTRM W/O&W $ 1,022.00 CT SCAN-RT LOWER EXTRM W/O&W $ 1,022.00 CHIPS CANCELLOUS $ 1,025.00 HC ANESTHESIA ARTRIAL LINE KIT $ 1,026.00 VARIAX PLATE 3-D PLATE LEFT $ 1,027.00 VARIAX PLATE 3-D PLATE RIGHT $ 1,027.00 APP MULTLAY COMP LWR LEG BI $ 1,028.00

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INS CATH ABD/L-EXT ART 1ST BIL $ 1,030.00 KIT COLON DECOMPRESSION 7 FR $ 1,030.00 KIT DECOMPRESSION COLON 8.5FR $ 1,030.00 CT ANGIO CONGENITAL W&W/O CONT $ 1,032.00 CT ANGIO HRT W/3D IMAGE $ 1,032.00 CT ANGIO PULM VEIN W&W/O CONTR $ 1,032.00 CT SCAN-ANGIO CORONARY $ 1,032.00 ISO*LIVER & SPLEEN SCAN $ 1,032.00 ISO*LIVER/SPLEEN FLOW $ 1,032.00 ORTHINOX FEMORAL HEAD 26MM+4MM $ 1,033.00 CHANGE OF CYSTOSTOMY TUBE SIM $ 1,034.00 INCISE THROMBOSED HEMOR EXT $ 1,034.00 INCTHROMBOSED HEMORRHOID EXT $ 1,034.00 IVUS CATHETER $ 1,034.00 BX EXTERNAL EAR $ 1,035.00 REP LAC TNGU FL MOUTH>2.6/CPLX $ 1,035.00 TRACHEOSTOMY EMRG;CRICOTHYROID $ 1,035.00 OTSC SYSTEM SET 11/6T $ 1,038.00 RECIPROCATING SAW BLADE $ 1,038.00 ROS-IMRT PLAN $ 1,038.12 ANCHOR SUT BIO SWIVEL LOCK $ 1,039.00 FRCP ELEC SEAL G2 5MM 35CM CRV $ 1,039.00 GELPORT LAP SYS 120MM WND RETR $ 1,039.00 M & S SUPPLY- LEVEL 10 $ 1,039.00 M&S SUPPLY-LEVEL 10 $ 1,039.00 RELTACK3X10 $ 1,039.00 SEALER ELEC G2 5MM 35CM CRV JA $ 1,039.00 SEALER LIG 5MM VBLUNT TIP 37CM $ 1,039.00 SEALER LIGASURE SM JAW $ 1,039.00 SHEAR LAP 5MM 36CM $ 1,039.00 STAPL HEMOR PROLP W STPL 3.5MM $ 1,039.00 STR HII 7MM T-WRNCH, 5=6MM SKT $ 1,040.00 ECHO 2D STUDY $ 1,041.00 ASPIRATE/INJ GANGLION CYST $ 1,042.00 CL TX TRSL BONE DISLO WO ANSTH $ 1,042.00 NJX AA&/STRD GR OCPL NRV $ 1,042.00 REMOVAL FOREIGN BODY PHARYNX $ 1,042.00 BILARY STENT SET $ 1,048.00 4.5MM REELX STT KNOTLS ANCHOR $ 1,050.00 4.75MMX24.5 BIOCOMP SWIVLCK SP $ 1,050.00 12MM UNIPLATE $ 1,053.00 PROF CONSULT COMPREHENSIVE $ 1,057.00 9.5MM TAPR POST ARTHROSURF $ 1,058.00 3 X12.7MM KNOTLESS SUTR ANCHR $ 1,063.00 3.5 X 8.5MM DX SWIVELOCK SL $ 1,063.00 3X12.7MM KNOTLSS SUTURE ANCHOR $ 1,063.00 ANCHOR FIBER TAX DX SUTURE $ 1,063.00

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PIVT NANOTACK TT SUTURE ANCHOR $ 1,063.00 CYTODEPLETION, BEDSIDE $ 1,064.00 1.5MM LCP 4 HOLE T-PLATE $ 1,065.00 DBM GEL $ 1,066.00 OSTEOSYNTHESIS COMPRSSION STPL $ 1,067.00 PERQ ACCESS & CLSR FEM ART $ 1,067.00 PROGRIP 16 X 12 FLAT SHEET $ 1,069.00 WASHED CELLS TRANSFUSED $ 1,071.00 CT SCAN-SOFT TISSUE NECK WIT $ 1,072.00 PROBE 375CM BILIARY LITHOTRPTR $ 1,073.00 4.3MM CANN DRILL $ 1,075.00 BIT DRL OD4.9MM CANN LG ADD ON $ 1,075.00 SET TRANSJUG INTRAHEP TIPS PAO $ 1,075.00 ULT-S LOW NONVASC LIMTED BIL $ 1,078.00 ULT-S UPR NONVASC LIMTED BIL $ 1,078.00 US LMTD JT/NONVSC XTR STRX BIL $ 1,078.00 1/3 TUBULAR PLATE 4 HOLE $ 1,082.00 1/3 TUBULAR VARIAX 2 PLATE $ 1,082.00 CT SCAN-GUIDE FOR TISSUE ABL $ 1,082.00 PLATE 1/3 TUBULAR 8 HOLE $ 1,082.00 PLATE 5HOLE VRIAX 1/3 TUBULAR $ 1,082.00 PLATE 6-HOLE 1/3 TUBULAR $ 1,082.00 BONE BIOP TRAY COAXL NDLS SHRT $ 1,085.00 CT SCAN-HEAD OR BRAIN W/O&W/ $ 1,087.00 7X19.5 SUT ANC SWIV TENO BICMP $ 1,088.00 LAB-HIGH RESOLUTION DR TYPIN $ 1,088.00 SCREW 8X20MM FAST THRD BIOCOMP $ 1,088.00 ISO*REN SCAN W/O & WITH PHAR $ 1,093.00 ISO*REN SCAN-FLOW&FUNCT-SING $ 1,093.00 ISO*RENAL SCAN(SINGLE W/PHAR $ 1,093.00 ISO*TESTISCULAR SCAN WITH FL $ 1,093.00 ISO-URETERAL REFLUX $ 1,093.00 PROF - TISSUE EXAM BY PATH 6 $ 1,094.00 PROF-TISSUE EXAM BY PATH LVL 6 $ 1,094.00 SHORT BEVEL 35 $ 1,098.00 C REP S/A/L;1.1-2.5CM $ 1,099.00 4 X 28MM HEADLESS SCREW $ 1,100.00 4 X 32MM HEADLESS SCREW $ 1,100.00 4 X 36MM HDLS COMP SCREW $ 1,100.00 4 X 44MM HDLS COMP SCREW $ 1,100.00 4 X 46MM FIXOS MIDFOOT SCR $ 1,100.00 4.0 X 24MM HEADLESS SCREW $ 1,100.00 4.0X40MM HDLS CMPRSN SCRW $ 1,100.00 5 X 22MM HEADLESS COMP SCREW $ 1,100.00 5 X 34MM TITANIUM SCREW $ 1,100.00 5 X 40 HEADLESS COMP SCREW $ 1,100.00 5 X 50MM HEADLESS COMP SCREW $ 1,100.00

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5 X 55MM HEADLESS COMP SCREW $ 1,100.00 5X32MM HDLS CMPRSN SCRW $ 1,100.00 5X38MM HDLS CMPRSN SCRW $ 1,100.00 HOLMIUM LASER FIBER 550 MICRON $ 1,100.00 SCREW 5 X 30MM HEADLESS COMP $ 1,100.00 SCREW 5 X 48MM HEADLESS COMP $ 1,100.00 SCREW HEADLESS CMPRSS 5.0X46MM $ 1,100.00 SCREW HEADLESS COMPRESS 5.0X36 $ 1,100.00 3.2MM CANN DRILL $ 1,103.00 MESH SYMBOTEX 12CM ROUND $ 1,103.00 LC-APSKINSUB FEETWOND<100CM<25 $ 1,104.00 LC-APSKINSUB LEGWOUND<100CM<25 $ 1,104.00 NM-PULM PERFUSION+VENT, W/ IMG $ 1,104.00 NM-PULM VENT W/ PERUSION IMG $ 1,104.00 PROSTP SBTLR ARTHROEREISIS IMP $ 1,105.00 ER VISIT LEVEL 2 $ 1,109.00 HERNIA PLUG (LARGE) $ 1,111.00 BALLOON RELINT 10MM-46MMX100CM $ 1,113.00 NJX AA&/STRD OTHER PN/BRANCH $ 1,119.00 NJX AA&/STRD TRIGEMINAL NRV $ 1,119.00 HEAD 22 MM X 5 $ 1,121.00 HEAD FEMORAL OD26MM +0MM V40 $ 1,121.00 HEAD FEMORAL OD32MM +0 V40 $ 1,121.00 HEAD FEMORAL OD32MM +4MM V40 $ 1,121.00 HEAD FEMORAL OD32MM +8MM V40 $ 1,121.00 HEAD V40 TAPR 26MM 0 OFST $ 1,121.00 LFIT V40 FEM HEAD SZ22 2MM $ 1,121.00 LFIT V40 FEMORAL HEAD 28MM $ 1,121.00 EXPLORE/REPAIR CHEST $ 1,122.00 PLATELETS PHERESIS,IRR EA UN $ 1,123.00 FIBULAR PLATE 8 STRAIGHT $ 1,125.00 FIBULAR PLATE STRAIGHT 8 HOLE $ 1,125.00 PACK AFI W/WF LIGHT 25G $ 1,125.00 TRIMANO BEACH CHAIR KIT $ 1,125.00 HBOT-DEDBRID SEL W/O ANES <=20 $ 1,128.00 IMD WND RPR N-HF/GENT2.6-7.5CM $ 1,128.00 IMD WND RPR S/A/T/EXT2.6-7.5CM $ 1,128.00 INC & REM FB SQ SMPL $ 1,128.00 INC & REM FB SQ; SMPL $ 1,128.00 INT WND REP FACE/MM 2.6-5.0 CM $ 1,128.00 INT WND REPAIR FACE/MM=< 2.5CM $ 1,128.00 INTMD WND REPAIR S/A/T/EXT $ 1,128.00 SLCTV WND DEBRIDEM 20 CM OR < $ 1,128.00 WRC-DEBRID SEL W/O ANES <=20 $ 1,128.00 WRC-INCIS & REMOVAL FB,SUB T $ 1,128.00 TTNM MTX MDFC OBQ PT 2X3 0.7MM $ 1,134.00 FST FIX 360 STR NEEDLE DEL SYS $ 1,135.00

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2.7MM CANNULATED DRILL $ 1,138.00 BIT DRILL4.9MM CANN FR 7MMSCR $ 1,138.00 ILIAC ARTERY ANGIO $ 1,139.00 SRS LINEAR BASED 1 SESSION $ 1,139.55 NJX AA&/STRD II IH NERVES $ 1,141.00 11X400 HOFFMAN III CNNCTNG ROD $ 1,142.00 DRAIN FINGER ABSC SIMPLE $ 1,142.00 I&D ABCESS, COMPLICATED/MULTI $ 1,142.00 I&D ABSC COMPL OR MULTI $ 1,142.00 I&D ABSC COMPL OR MULTI $ 1,142.00 I&D OF SIMPLE PILONIDAL SINU $ 1,142.00 I&D PILONID CYS SMPL $ 1,142.00 I&D PILONID CYS;SMPL $ 1,142.00 REMOVAL OF NAIL BED $ 1,142.00 WRC-EXCISION, NAIL MATRIX $ 1,142.00 WRC-I & D COMPLEX $ 1,142.00 FIBER HOLMIUM 200 MICRON $ 1,143.00 M & S SUPPLY- LEVEL 11 $ 1,143.00 M&S SUPPLY-LEVEL 11 $ 1,143.00 SUT IMPL KIT PARS $ 1,143.00 ICONX2 2.3MM ANCHR W/2MMXBRAID $ 1,145.00 INV HC INJ SINUS TRCT DIAGNSTC $ 1,145.00 ELECTRD BUTTON W CABLE BIPOLAR $ 1,147.00 HINGE COUPLING $ 1,148.00 JKNOT 1MM MINI 3-0 W NDLS DRLL $ 1,150.00 FETAL FIBRONECTIN CV SEMIQUAN $ 1,155.00 LAB-FETAL FIBRONECTIN FFN $ 1,155.00 MRI*VACUUM DEVICE PROCEDURE $ 1,155.00 C TX PATELLAR DISLOC WO ANES $ 1,156.00 SREP F/E/N/L/MM 2.5CM/< $ 1,156.00 SREP F/E/N/L/MM 2.6-5.0CM $ 1,156.00 SREP S/N/A/G/TR/E 7.6-12.5CM $ 1,156.00 TOOTH EXTRACTION $ 1,158.00 US BREAST LIMITED BIL $ 1,160.00 BRONCHOSPASM - PRE & POST BD $ 1,162.00 EVAL BRONCHOSPASM $ 1,162.00 LAB-HERCEP TEST/FISH 25-99CE $ 1,162.00 LAB-HERCEP/FISH 25-99 $ 1,162.00 LAB-NUCLEAR INSITU HYBRID25- $ 1,162.00 PFT * BRONCHODILATION RESPON $ 1,162.00 TTNM MTX MDFC OBQ PT 3X4 0.8MM $ 1,162.00 levonorgestrel 52 mg IUD-5 YR $ 1,166.44 CT SCAN-ABDOMEN W/O & WITH C $ 1,167.00 CT SCAN-PELVIS W/O & WITH CO $ 1,167.00 QUICK ANCHOR SCREW $ 1,168.00 SCR STRYK ASN III CANN 6.5MMX8 $ 1,168.00 APEX PIN ADAPTOR SHORT $ 1,170.00

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VARIAX STRAIGHT PLATE 6 HOLE $ 1,170.00 VARIAX STRAIGHT PLATE, 5 HOLES $ 1,170.00 VARIAX STRAIGHT PLATE, 8 HOLE $ 1,170.00 LFIT V40 FEMORAL HEAD $ 1,171.00 LFIT V40 FEMORAL HEAD 22.2MM $ 1,171.00 STRYKER LFIT V40 FEMORAL HEAD $ 1,171.00 INTRA-AORTIC BALLOON CATHETE $ 1,173.00 LIGASURE BLUNT TIP 37CM $ 1,173.00 DEVICE MENISCAL REPAIR STRYKER $ 1,176.00 MESH PCO6VP $ 1,176.00 PATCH PARTEX VENT 6.6CM RD $ 1,177.00 DRILL BIT2.5X216MM LOCKING SH $ 1,178.00 2 X 15MM AUTOFIX COMP SCREW $ 1,180.00 2 X 16MM AUTOFIX COMP SCREW $ 1,180.00 2 X 21MM AUTOFIX COMP SCREW $ 1,180.00 RMVL SUBQ CAR RHYTHM MNTR $ 1,180.00 APHERESIS, THERAPEUTIC BEDSI $ 1,182.00 PLATE SYNTHS LCDCP 14HOLE3.5MM $ 1,182.00 RETRACTOR HENLEY POPLITEAL $ 1,185.00 TEMP TRANSCUTAN PACING $ 1,185.00 HERNIA PLUG (MED) $ 1,187.00 SN FSTFX 360 CURV NDLE DEL SYS $ 1,187.00 4.5 HEALX ADV PEEK ANCH WPCORD $ 1,188.00 CL TX KNEE DISL WO ANESTH $ 1,188.00 CL TX MC FX SGL W MANIP $ 1,188.00 CL TX NURSEMAID ELBOW W MANIP $ 1,188.00 DVNCI 8MM HARMC SHEARS INSERT $ 1,188.00 FIBER HOLMIUM 600 MICRON $ 1,188.00 FIBER,HOLMIUM 600 MICRON $ 1,188.00 HEMSTAT AGNT VITAGEL 4.5 ML $ 1,188.00 VRX ANK TR SC SFRT BL T10AO2IN $ 1,188.00 MESH PARIE LAP PROGRIP 15X10 $ 1,189.00 PLATE BNE 101MM 5HOLE LAT FIB $ 1,193.00 PLATE BNE L77MM 3HOLE LAT FIB $ 1,193.00 PLATE BONE L89MM 4HOLE LAT FIB $ 1,193.00 PLT BONE L77MM 3 H LAT DST $ 1,193.00 PLT FIB 5H 101MM $ 1,193.00 1.5 LCP PLATE 6 HOLE $ 1,194.00 1.5MM LCP ADAPTATION 6 HLE PLT $ 1,194.00 APEX PIN ADAPTOR LONG $ 1,195.00 LOOP ELECTRODE 24FR MED 12 DEG $ 1,195.00 REVOLVE FAT GRAFT KIT SINGLE $ 1,195.00 TISSUE PROCUREMENT $ 1,195.00 ERCP BALLOON EXTRACTOR $ 1,196.00 7.0MM COUNTERSINK $ 1,200.00 DX BONE MARROW BX & ASPIR $ 1,201.00 VIDEOSTROBOSCOPY $ 1,201.00

�141

FLX 1ST MPJ IMPLNT W GRMTS SZ2 $ 1,204.00 IMPLANT SIZER, SIZE 1-4 $ 1,204.00 INSTRUMENTS, SIZE 1-2 $ 1,204.00 1.5MM LCP Y-PLATE 3 X 8 HOLE $ 1,207.00 DIALYSIS, ONE EVAL (CRRT) $ 1,210.00 DIALYSIS, REPEATED EVAL (CRR $ 1,210.00 HEMODIALYSIS PROC W/REPEAT E $ 1,210.00 HEMODIALYSIS PROC-SNGL PHYS $ 1,210.00 STR CHK PNS HF 3 UNV 04/5/6 MM $ 1,212.00 30 DEG ROD COUPLER $ 1,213.00 BHC ASPIRATE BREAST CYST $ 1,213.00 DR ABSC CYST HEMAT-MOUTH SIMPL $ 1,213.00 DR EXT EAR ABSCS/HMTMA SMPL $ 1,213.00 DRAIN EXT AUDITORY CANL ABSCSS $ 1,213.00 EXC BLES S/N/EX G; 0.6-1.0CM $ 1,213.00 EXC FACE-MM B9+MARG 1.1-2 CM $ 1,213.00 EXC TR-EXT B9+MARG 0.5CM/< $ 1,213.00 EXC TR-EXT B9+MARG 2.1-3CM $ 1,213.00 EXC TR-EXT B9+MARG 2.1-3CM $ 1,213.00 FNA BX W/US GDN 1ST LES $ 1,213.00 MONITOR INTERST FLD PRESSURE $ 1,213.00 PUNCT ASP ABSC HEMAT CYST $ 1,213.00 PUNCT ASP BRST CYST INITIAL $ 1,213.00 Q50 PLUS STENT GR BALLOON CATH $ 1,213.00 REM FB FOOT; SQ $ 1,213.00 WRC-EXCIS BENIGN LESION .6-1 $ 1,213.00 1.5 JUGGERKNOT SZ 2 $ 1,217.00 VARIAX STRAIGHT PLATE, 7 HOLE $ 1,217.00 BM SMR INTERP $ 1,218.00 CT SCAN-CERVICAL SPINE W/O & $ 1,218.00 CT SCAN-LUMBAR W/O & WITH CO $ 1,218.00 CT SCAN-THORACIC SPINE W/O & $ 1,218.00 CT SCAN-THORAX W/O & W/CONTR $ 1,218.00 C-TPR L FRIC ION TX 32MM/-5 $ 1,218.00 PLT 4MM LOCK RECON 8H 96MM $ 1,219.00 XR*ARTHROGRAPHY- TMJ $ 1,220.00 NJX AA&/STRD SPRSCAP NRV $ 1,223.00 NJX INTERLAMINAR CRV/THRC $ 1,223.00 NJX INTERLAMINAR LMBR/SAC $ 1,223.00 SP* IR THORACENTESIS W/GUIDANC $ 1,223.00 SP*ABD. PARACENTESIS W/ IMAG $ 1,223.00 NTSTY MODUL RAD TX DLVR CPLX $ 1,224.00 CLOSURE DEVICE PLACEMENT $ 1,228.00 PLACEMENT CLOSURE DEVICE $ 1,228.00 CUTTER LINEAR ENDO 35MM REG $ 1,235.00 DYNA HEADED CORT SCR 5MMX40MM $ 1,235.00 DYNA HEADED CORT SCR 5MMX45MM $ 1,235.00

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CYSTOURETHROSCOPY $ 1,236.00 GRAFIXPL PRIME 2 SQ CM $ 1,237.00 3.5MM 4-HOLE T PLATE $ 1,238.00 4.5MM REELX STT KNOTLESS ANCHR $ 1,238.00 4MM ENDOSCOPIC RELEASE SYSTEM $ 1,238.00 AFFINITY 1.5X1.5 SQ CM $ 1,238.00 BASE PLATE 25MM STNDRD Ti6AI4V $ 1,238.00 BASKET SPYGLASS RETRIEVAL $ 1,238.00 SMALL JOINT OATS SET 10MM $ 1,238.00 SNARE RETRIEVAL 9MM X 286CM $ 1,238.00 CAPIO SLIM SUT CAPTURNG DEVICE $ 1,240.00 SP*NASO/ORO GSTRC TB PLCMT&F $ 1,240.00 STR ROD COUP 30DG HOF III 11MM $ 1,240.00 STR ROD CPLR 30DG HOF III 11MM $ 1,240.00 VARIAX FIBULA PLATE 3 HOLE $ 1,241.00 VARIAX FIBULA PLATE 4 HOLE $ 1,241.00 VARIAX FIBULA PLATE 6 HOLE $ 1,241.00 6.0X45 TITANIUM MATRIX SCREW $ 1,244.00 6.0X50 TITANIUM MATRIX SCREW $ 1,244.00 ELEC HF RESCT FOR PLASMA VAPOR $ 1,247.00 MINOR SURGERY EA ADDL 15 MIN $ 1,247.00 MINOR SURGERY EA ADD'L 15 MIN $ 1,247.00 BONE SUB VOID FILLER INJ 3CC $ 1,248.00 BUMPER INSERT NEUT UNIV $ 1,248.00 CARTRIDGE NOVOSTITCH PLUS 2-0 $ 1,248.00 HEAD BIPO UH1 26X43MM $ 1,248.00 HEAD C-TAPER 26MM PLUS 10 OFST $ 1,248.00 M & S SUPPLY- LEVEL 12 $ 1,248.00 SEALER DAVINCI ROBOTIC VESSEL $ 1,248.00 STAPLER PREMIUM PLUS CEEA 28MM $ 1,248.00 VARIAX COMP PLT 4 HOLE $ 1,248.00 TISSUE EXAM BY PATH LVL 6 $ 1,249.00 REMOVE IUD $ 1,255.00 VARIAX STRAIGHT PLATE, 10 HOLE $ 1,264.00 hyaluronan 30 mg/2 mL SYRINGE (KPROV) $ 1,269.31 11 X 220 SEMI-CIRC CRVD ROD $ 1,270.00 ROD CRBN CONNCTNG SEMI CIRC $ 1,270.00 6 HOLE PLATE $ 1,273.00 MESH PAR PROGRIP 15X9CM FLAT $ 1,274.00 HBOT-INITIAL VENTILATOR MGT $ 1,279.00 VENT MGMT INPAT INIT DAY $ 1,279.00 VENT THY-HOSP IP/OBSO INIT D $ 1,279.00 JGRKNT 2.9 MM $ 1,285.00 9MM CANNULATED DRILL $ 1,287.00 SREP S/N/A/G/TR/E 20.1-30.0CM $ 1,287.00 EXC FACE-MM B9+MARG 0.5CM/< $ 1,289.00 EXC FACE-MM B9+MARG 0.6-1 CM $ 1,289.00

�143

REM IMPL CONTRACEP CAPS $ 1,289.00 ERCP W/SPYGLASS-KENT $ 1,290.00 CATHETER MICRO RENEGADE GRAY $ 1,293.00 BIOPSY OF CERVIX $ 1,296.00 HEPATOBILIARY SYSTEM IMAGING $ 1,298.00 ISO*MUGA $ 1,298.00 NM-HEPATOB IMAG GALL W/0 INT $ 1,298.00 SURG HF ELEC NEEDLE 24-28FR $ 1,299.00 VENTRICULAR LEAD $ 1,299.00 DISP KIT -FIBER TAK SUT ANCHOR $ 1,300.00 OSTEOCHONDRAL AUTO TRFR SYS $ 1,300.00 SMART TOE 10 deg SZ 15 $ 1,300.00 SMART TOE 10 deg SZ 16 $ 1,300.00 SMART TOE 10 deg SZ 19 $ 1,300.00 TAP AO FOR 2.7MM SCREW $ 1,300.00 CYCLPN-PHNYLP .2-1%DP 2ML DPBT $ 1,303.00 EXC F/E/E/N/L MAL+MRG 0.6-1 $ 1,304.00 2.5 X 12MM CANN COMPRESS SCREW $ 1,308.00 2.5 X 18MM CANN COMP SCREW $ 1,308.00 4 X 30MM TITANIUM FIXOS SCREW $ 1,308.00 4 X 36MM TITANIUM FIXOS SCREW $ 1,308.00 SCREW S-FIX 2.5LG 16MM $ 1,308.00 SCREW S-FIX 2.5LG 18MM $ 1,308.00 SCRW CNNLTD CMPRSSION 2.5 X 14 $ 1,308.00 SURGIMEND 1.0 4CM X 7CM $ 1,310.00 PACEMAKER LEADS(ATRIAL/VENT) $ 1,312.00 REPAIR SYSTEM PLUS MENISCAL $ 1,313.00 SYSTEM NOVOSTTCH MEN ROOT REP $ 1,313.00 1.0MM CABLE W/CRIMP $ 1,314.00 CARD CATH OR COMPON ADD 15MIN $ 1,321.00 CT SCAN-HEAD OR BRAIN W/O CO $ 1,321.00 RX HYDRATOME 44 X 20MM $ 1,321.00 DALL MILES/CABLE SLEEVE $ 1,324.00 FLNGE CAGE PROV 62/64 SHELL 54 $ 1,325.00 ENDO BI-CAP $ 1,330.00 EXC F/E/E/N/L MAL+MRG 0.5CM< $ 1,334.00 SIMULATION; COMPLEX $ 1,334.00 BALLOON PYLORC/COLONC 10/11/12 $ 1,335.00 BALLOON PYLORC/COLONC 12/13/15 $ 1,335.00 RIGIDLOOP ADJUSTABLE CORT IMP $ 1,340.00 LC-APSKIN FEETWND>100CMEA100CM $ 1,341.00 WRC-I & D LEG/ANKLE DEEP ABC $ 1,341.00 DRILL GUIDE FOR COMP PLT $ 1,342.00 DEV TISS REM MYOSRE LITE HYSCP $ 1,346.00 M & S SUPPLY- LEVEL 13 $ 1,346.00 AUTO SUTURE EEA $ 1,348.00 EP DEVICE PROC CCL ADD 15MIN $ 1,349.00

�144

SURGIMEND 1.0 5CM X 6CM $ 1,350.00 ANCHOR SUT SM BONE 2-0 FBRWIRE $ 1,354.00 2.7MM SNAP OFF SCREW 14MM $ 1,360.00 FIXOS SCR SYS13MM 2X13X0.87MM $ 1,360.00 HERNIA PLUG (XLARGE) $ 1,360.00 STR SNAP OFF SCR DIAM 2 LG 11 $ 1,360.00 SV24 S-FIX SCREW 2.5LG 24MM $ 1,360.00 SV30 S-FIX SCREW 2.5LG X 30MM $ 1,360.00 CONTINUOUS PULSE OX $ 1,361.00 PULSE OXIMETRY/OVERNIGHT MON $ 1,361.00 DISPOSABLE DRILL PACK $ 1,365.00 EP DIAG/AB CATH 10PLE(BIOSENS) $ 1,365.00 ISO*IN111 PENTETATE PER 0.5M $ 1,365.00 VARIAX PLATE CALCANEUS MESH PL $ 1,365.00 EPIDURAL STEROID INJECTION $ 1,366.00 FACET INJECTION $ 1,366.00 NERVE BLOCK $ 1,366.00 OR SUITE - BLOCKS $ 1,366.00 OR-SUITE BLOCKS $ 1,366.00 SACROILIAC INJECTION $ 1,366.00 TRANSFORAMINAL INJECTION $ 1,366.00 ASC SURGERY MINOR >20MINUTES $ 1,372.00 OPD SURGERY MINOR >20MINUTES $ 1,372.00 EGD CAUTERY TUMOR POLYP $ 1,373.00 SMALL BOWEL ENDOSCOPY BR/WA $ 1,373.00 RESP VIRUS 12-25 TARGETS $ 1,374.00 4-HOLE LCKNG DSTL FBLA PLT RT $ 1,375.00 REM TUNNELED CVAD W PORT/PUMP $ 1,379.00 VZ IMMUNE GLOBULIN 625IU $ 1,382.00 CARDIOVERSION $ 1,385.00 CARDIOVERSION ELECTRIC EXT $ 1,385.00 CARDIOVERSION-ENDO $ 1,385.00 CUTTER LINEAR PROXIMATE 55MMTH $ 1,385.00 PACU CARDIOVERSION $ 1,385.00 ER VISIT LEVEL 3 $ 1,386.00 MAJOR ROBOTIC SURGERY ADDL 15M $ 1,387.00 MAJOR SURGERY EA ADD'L 15 MI $ 1,387.00 MAJOR SURGERY EA ADD'L 15 MIN $ 1,387.00 MESH SYMBOTEX 15CM ROUND $ 1,389.00 CT THORAX W/O CONTRST MATERIAL $ 1,398.00 AMNIOGRAFT 1.5 X 1.0CM $ 1,400.00 PLATELETS PHERESIS PATH REDU $ 1,406.00 TITAN MATRIX TOP LOADING POLY $ 1,409.00 ANCHOR MENISCAL CINCH II $ 1,413.00 COMP HEMIPRO 18.5MM $ 1,413.00 ALT BIRTH CENTER NURSERY $ 1,414.00 REGULAR NURSERY $ 1,414.00

�145

DYNANAIL HDLES PA SCR 5MMX75MM $ 1,417.00 DYNANAIL HDLES PA SCR 5MMX80MM $ 1,417.00 INBONE TIBIAL MID STEM SZ14MM $ 1,418.00 INBONE TIBIAL TOP STEM SZ14MM $ 1,418.00 DBM GEL 5CC $ 1,425.00 OPEN/PERQ PLACE STENT EA ADD $ 1,430.00 MRA BILATERAL LOWER EXTR W/O $ 1,432.00 MRA LT LOWER EXTR W/O CONTRA $ 1,432.00 MRA*RT LOWER EXTR W/O CONTRA $ 1,432.00 MRV*LE W/CONTRAST LEFT $ 1,432.00 MRV*LE W/CONTRAST RIGHT $ 1,432.00 MRV*LE W/O CONTRAST LEFT $ 1,432.00 MRV*LE W/O CONTRAST RIGHT $ 1,432.00 PULSE OXIMETRY OVERNIGHT $ 1,432.00 EGD, BOTOX INJECTION $ 1,435.00 ASYMMETRIC PATELLA A29MM $ 1,436.00 COMP PAT OD27MM THK8MM X3 $ 1,436.00 COMPONENT PATELLAR 27X8MM X3 $ 1,436.00 COMPONENT PATELLAR 29MM X 9MM $ 1,436.00 PATELLA SYMMETRIC 29X8MM $ 1,436.00 TRI TRITNM ASYMTRC PAT S A38MM $ 1,436.00 TRIATHLON X3 ASYMTRC PAT A29MM $ 1,436.00 TRTNM ASMTRC MTLBKD PAT A32X10 $ 1,436.00 CATHETER PERITONEAL PLEURX $ 1,438.00 CATHETER PLEURAL PLEURX $ 1,438.00 MRI*UNLISTED PROCEDURE $ 1,439.00 DBX PUTTY MIX 2.5CC $ 1,441.00 HALF RING ALUMINUM 160MM $ 1,441.00 STEERABLE SHEATH $ 1,442.00 EFLEX ABLATOR PROBE INTEG CBLE $ 1,445.00 SBRT DELIVERY PER FRACTION $ 1,448.66 1/3 TUBULAR PLATE $ 1,451.00 PARATHY PLANAR IMG WITH SPECT $ 1,452.00 SP*IR PERITONEOGRAM $ 1,452.00 SP*LEFT NEPHROSTOMY RENAL ST $ 1,452.00 SP*RIGHT-NEPHROSTOMY RENAL S $ 1,452.00 XR*CVP LINE INSERT $ 1,454.00 HD FEM OD47MM ID26MM HIP BPLR $ 1,456.00 HD FEM OD48MM ID26MM HIP BPLR $ 1,456.00 HEAD BIPO UH1 26X44MM $ 1,456.00 HEAD BIPO UH1 26X45MM $ 1,456.00 HEAD BIPO UH1 26X46MM $ 1,456.00 HEAD BIPO UH1 26X47MM $ 1,456.00 HEAD BIPO UH1 26X48MM $ 1,456.00 HEAD FEM 42X26MM HIP BIPLR UHR $ 1,456.00 HEAD FEMORAL OD43MM ID26MM $ 1,456.00 HEAD FEMORAL OD44MM ID26MM $ 1,456.00

�146

HEAD FEMORAL OD45MM ID26MM $ 1,456.00 HEAD FEMORAL OD46MM ID26MM $ 1,456.00 HEAD FEMORAL OD47MM ID26MM $ 1,456.00 HEAD FEMORAL OD48MM ID26MM $ 1,456.00 HEAD FEMORAL OD49MM ID26MM $ 1,456.00 UHR UNIV HD BIPOLAR COMP 50MM $ 1,456.00 ANCHOR SUT 32X5.5MM 2 CP-2 NDL $ 1,460.00 CT SCAN-MAXI FACIAL W/O CONT $ 1,460.00 M & S SUPPLY- LEVEL 14 $ 1,461.00 SEALER LIGASR IMPACT OPEN 18CM $ 1,461.00 COVIDIEN PARIETENE $ 1,462.00 CT-ANGIO W/CONTRAST, HEAD $ 1,462.00 CT-CTA HEAD W/CON INC W/O & $ 1,462.00 CT-CTA NECK W/CON INC W/O & $ 1,462.00 LEVEL 14 ANCHOR,SCREW,PEN,PIN $ 1,464.00 PLT NARW SHRT LT $ 1,464.00 PLATE LOCKING HAND COMP 1.5MM $ 1,471.00 epoetin alfa 40,000 units/mL INJ (ESRD) $ 1,471.37 epoetin alfa 40,000 units/mL INJ (NON-ESRD) $ 1,471.37 6 HOLE STRAIGHT PLATE $ 1,475.00 ILIAC REVASC ADD-ON $ 1,478.00 INCSN MGMT SYS PEEL & PLC 35CM $ 1,479.00 COLONSCOPY THROUGH STOMA/CT $ 1,480.00 ILEOSCOPY WITH TRANS ENDO STNT $ 1,480.00 SURGIMEND 2.0 5CM X 6CM $ 1,482.00 CT ANG LE W/CON INC W/O&PP L $ 1,488.00 CT ANG LE W/CON INC W/O&PP R $ 1,488.00 CT ANG UE W/CON INC W/O&PP R $ 1,488.00 CT-ANG LE W/CON INC W/O&PP B $ 1,488.00 CT-ANG UE W/CON INC W/O&PP BIL $ 1,488.00 CT-ANG UE W/CON INC W/O&PP L $ 1,488.00 INTRAVASC FSR DOPP VEL EA ADDL $ 1,493.00 DURASL EXACT SPNE SEAL SYS 5ML $ 1,498.00 BX VAGINAL MUCOSA SIMPLE $ 1,499.00 5.0MM SCHANZ PIN $ 1,500.00 IMPLANT SYS ACL/PCL W SWIVLCK $ 1,500.00 PATEL STRYKER SYMMETRIC 27X8MM $ 1,500.00 TRI X3 ASYMTRC PAT SZ-A32 10MM $ 1,500.00 LIGATION OF HEMORRHOID(S) $ 1,502.00 PROCTOSIGMOIDOSCOPY RIGID DX $ 1,502.00 4.3 X 13CM QUADCUT BLADE $ 1,503.00 ISO*BRAIN SCAN W/VASC FLOW $ 1,504.00 ISO*CISTERNOGRAM;CSF FLOW ST $ 1,504.00 ISO*99M TC MAG3 PER DSE<=15M $ 1,512.00 DSTR W NEURLYTC;INTRCOSTAL NRV $ 1,513.00 DSTR W NEURLYTC;OTHR PERPH NRV $ 1,513.00 INJ FORAMEN EPIDURAL L/S $ 1,513.00

�147

INJ PARAVERT F JNT C/T 1 LEV $ 1,513.00 INJ PARAVERT F JNT L/S 1 LEV $ 1,513.00 OR RECOVERY ROOM $ 1,516.00 BIOPREP BONE PREP KIT $ 1,517.00 MRA*RIGHT-UPPER EXTR W/O &W/ $ 1,517.00 MRA*UE W/&W/O CONTRAST LT $ 1,517.00 MRA*UE W/O CONTRAST LT $ 1,517.00 MRA*UE W/O CONTRAST RT $ 1,517.00 MRV*UE W&W/O CONTRAST LEFT $ 1,517.00 MRV*UE W&W/O CONTRAST RIGHT $ 1,517.00 MRV*UE W/O CONTRAST LEFT $ 1,517.00 MRV*UE W/O CONTRAST RIGHT $ 1,517.00 CT SCAN-CERVICAL SPINE W/O C $ 1,518.00 MRI UE NON JOINT W/O CON BIL $ 1,519.00 MRI*BIL LOWER EXTR W/O CONT $ 1,519.00 MRI*BILAT LOWER JOINT W/O CO $ 1,519.00 MRI*BILATERAL UPPER JT W/O C $ 1,519.00 MRI*LEFT LOWER JOINT W/O CON $ 1,519.00 MRI*LT LOWER EXTR W/O CONTR $ 1,519.00 MRI*LT UPPER EXTREM W/O CONT $ 1,519.00 MRI*LT UPPER JT W/O CONTR $ 1,519.00 MRI*ORBIT,FACE&OR NECK W/O C $ 1,519.00 MRI*RT LOWER EXTR W/O CONTR $ 1,519.00 MRI*RT LOWER JOINT W/O CONTR $ 1,519.00 MRI*RT UPPER EXTREM W/O CONT $ 1,519.00 MRI*RT UPPER JT W/O CONTR $ 1,519.00 PROF POLYSOMNOGRAPHY $ 1,519.00 BIOPSY OF BREAST, INCISIONAL $ 1,526.00 MRI ABDOMEN W/O CNTRST MRCP $ 1,526.00 MRI*ABDOMEN W/O CONTRAST $ 1,526.00 MRI*CHEST W/O CONTR $ 1,526.00 HALF RING ALUMINUM 180MM $ 1,528.00 SPECIAL PROCEDURES INJECTION $ 1,531.00 HD FEM OD36MM +10MM OFFSET $ 1,535.00 HEAD FEMORAL OD36MM +0MM V40 $ 1,535.00 HEAD FEMORAL OD36MM +10MM V40 $ 1,535.00 HEAD FEMORAL OD36MM +5MM V40 $ 1,535.00 HEAD V40 36MM 0MM OFST $ 1,535.00 HEAD V40 36MM PLUS 5MM OFST $ 1,535.00 IR MYELO SAME MD 2 OR MORE LVL $ 1,535.00 IR MYELO SAME MD CERVICAL $ 1,535.00 IR MYELO SAME MD THORACIC $ 1,535.00 IR MYLEO SAME MD LUMBAR $ 1,535.00 CATH BLN DIL RFLEX II ABD 30MM $ 1,537.00 CATH BLN DIL RFLEX II ABD 35MM $ 1,537.00 DRILL BIT3.1X216MM LOCKING SH $ 1,538.00 SP*LEFT-ANGIOGRAM,THR EXT,CA $ 1,540.00

�148

SP*RIGHT-ANGIOGRA,THR EXT,CA $ 1,540.00 MRA*NECK W/O CONTRAST $ 1,542.00 MRI*TMJ $ 1,542.00 APPLIER 5MM MED/LGE ROBOT CLIP $ 1,544.00 M & S SUPPLY- LEVEL 15 $ 1,544.00 STEM EXTND CMNTD 80MM $ 1,544.00 INBONE TIBIAL BASE STEM SZ16MM $ 1,545.00 EGD, ABLATION $ 1,546.00 PLATELETS,PH,LEUKO RED,IRR,E $ 1,547.00 ENDSCPC FSCTMY DSPSBL EPF XPRS $ 1,560.00 TRIA X3 ASYM PATELA SZA35 10MM $ 1,560.00 TRIATH X3 ASYM PATELLA A29 9MM $ 1,560.00 TRITAN ASYM METAL BK PAT A29X9 $ 1,560.00 SIGMOIDOSCOPY, FLEX, CONTROL B $ 1,561.00 VOCAL FOLD IMPL 1.0CC $ 1,563.00 HALF RING ALUMINUM 140MM $ 1,566.00 EGD BALLOON DIL ESOPH30 MM/> $ 1,571.00 EGD US FINE NEEDLE BX/ASPIR $ 1,571.00 ENDOSCOPIC US EXAM ESOPH $ 1,571.00 ESOPHAGOSCOPY FLEX BIOPSY $ 1,571.00 ESOPHAGOSCOPY FLEX REMOVE FB $ 1,571.00 SI ENDO W BLEED CNTRL $ 1,571.00 SM INT ENDO W REM HT BX/BP CAT $ 1,571.00 SM INT ENDO W REM T/P/L W SNR $ 1,571.00 REPLACE G/C TUBE PERC $ 1,575.00 REPLACE G-J TUBE PERC $ 1,575.00 BOARDER NURSERY $ 1,577.00 SIGMOIDOSCOPY, RIGID, DX $ 1,583.00 ASC SURGICAL SUITE 1ST 20 MI $ 1,586.00 OPD SURGICAL SUITE 1ST 20 MI $ 1,586.00 TRANSCATHETER BIOPSY $ 1,588.00 LIGATOR MULTIBAND SIX SHOOTER $ 1,595.00 C-TAPER COCR LFIT HEAD 36MM/-5 $ 1,596.00 COLONOSCOPY THRU STOMA SPX $ 1,598.00 DIAGNOSTIC COLONOSCOPY $ 1,598.00 ENDOSCOPY BOWEL POUCH/BIOP $ 1,598.00 FLEX SIGM CANCER SCREENING $ 1,598.00 PLATELET PHERESIS,LEUKO,EA U $ 1,598.00 SCRN COLONOSCOPY NOT HI RISK $ 1,598.00 SIGMOIDOSCOPE W/SUBMUC INJ $ 1,598.00 SIGMOIDOSCOPY FLEX W BX $ 1,598.00 UNLISTED PROCEDURE ANUS $ 1,598.00 MRA*RT LOWER EXTR W/CONTRAST $ 1,599.00 STRAP FIXTION DEVCE 5MM SECURE $ 1,604.00 PROF POLYSOMNOGRAPHY W/CPAP $ 1,605.00 SWAN GANZ INSERTION $ 1,614.00 SWAN-GAZ INST/FLOW DIR MONITOR $ 1,614.00

�149

GENOTYPE DNA HIV REVERSE T $ 1,619.00 PLATELETS,LEUKO,HLA, EA UNIT $ 1,621.00 EP DIAG/ABL OTH. THAN 3D(20PO) $ 1,622.00 PROSTALAC ACETABLR CUP 42MM OD $ 1,624.00 5 HOLE LOCKING DISTAL FIB PLAT $ 1,625.00 5-HOLE LCKNG DSTL FBL PLTE LT $ 1,625.00 BALLOON CUTTING 5 X 2 X 50CM $ 1,625.00 BALLOON CUTTING 5 X 2 X 90CM $ 1,625.00 BALLOON CUTTING 6 X 2 X 50CM $ 1,625.00 BALLOON CUTTING 6 X 2 X 90CM $ 1,625.00 BALLOON CUTTING 7 X 2 X 50CM $ 1,625.00 BALLOON CUTTING 7 X 2 X 90CM $ 1,625.00 BALLOON CUTTING 8 X 2 X 90CM $ 1,625.00 PREVENA PLUS INCISION MGMT SYS $ 1,625.00 ASPIRATE PLEURA W/O IMAGING $ 1,626.00 CL LCRTION MOUTH VESTIB >2.5CM $ 1,626.00 CL LCRTION MOUTH VESTIB 2.5CM/ $ 1,626.00 CL TX CLAVICULAR FX WO MANIP $ 1,626.00 CL TX DSTL FIB FX WO MANIP $ 1,626.00 CL TX GR TUBEROSTY FX WO MANIP $ 1,626.00 CL TX POST HIP DISLOC WO ANSTH $ 1,626.00 CL TX PROX FIB/SHAFT FX WO MNP $ 1,626.00 CL TX PROX HUMERAL FX WO MANIP $ 1,626.00 CL TX PROX TIBIAL FX WO MANIP $ 1,626.00 CL TX ULNR FX PRXML END WO MNP $ 1,626.00 CL TX WB DSTL TIB WO MANIP $ 1,626.00 CLOSED TX PATELLAR FX WO MANIP $ 1,626.00 CLTX POST HIP DISLOC WO ANESTH $ 1,626.00 DEB SUBQ TISSUE 20 SQ CM/< $ 1,626.00 EGD BIOPSY SINGLE/MULTIPLE $ 1,626.00 HBOT-DEBRID, SUBCT <=20 SQ CM $ 1,626.00 TX S WND DEHIS W PACK $ 1,626.00 WRC-DEBRID, SUBCT <=20 SQ CM $ 1,626.00 CL TX PHALANG SHFT FX W MANIP $ 1,627.00 CL TX PHALANG SHFT FX; W MANIP $ 1,627.00 CL TX RADIAL SHFT FX W MANIP $ 1,627.00 DEBRIDE SKIN AT FX SITE $ 1,627.00 I&D ABSCESS PERITONSILLAR $ 1,627.00 NJX AA&/STRD PUDENDAL NERVE $ 1,627.00 REM EMBDD FB MOUTH VESTIB SMPL $ 1,627.00 RX CL ELBOW DISLOC WO ANESTH $ 1,627.00 SREP F/E/N/L/MM 5.1-7.5CM $ 1,627.00 THROMBOLYSIS CRBRL BY IV INF $ 1,627.00 CT-CTA ABD W/CON INC W/O & P $ 1,628.00 CT-CTA PELV W/CON INC W/O & $ 1,628.00 COLONSCOPY W/DILATION/BALLO $ 1,636.00 CURVED LG JAW OPEN SEALER $ 1,638.00

�150

DEMINRLZD GRND CORT BONE GRAFT $ 1,638.00 ENDOSCOPY PROCEDURE $ 1,638.00 STAPLER ENDOPATH 45 RELOAD $ 1,638.00 botulinum toxin type A 100 unit PWDI $ 1,638.57 botulinum toxin type A 200 units PWDI $ 1,638.57 COLONSCOPY, ABLATION $ 1,641.00 BONE CEMENT $ 1,644.00 ISO*LOCAL OF ABSCESS-SPECT $ 1,650.00 RP LOCLZJ TUM 2+AREA 1+D IMG $ 1,650.00 RP LOCLZJ TUM SPECT 1 AREA $ 1,650.00 11MM TAPER POST $ 1,653.00 EGD, W/PEG $ 1,653.00 OR PEG REMOVAL REPLACEMENT $ 1,653.00 7 HOLE VARIAX COMP PLATE $ 1,655.00 LT NARROW CDR PLATE $ 1,655.00 PLATE 6 HOLE NARROW $ 1,655.00 URINARY INCONTINENCE SLING $ 1,655.00 VARIAX COMP PLT 7 HOLE $ 1,655.00 INSRT CRVD XLK 2 15MM SIGMA $ 1,664.00 M & S SUPPLY- LEVEL 16 $ 1,664.00 MYELOGRAPHY-SPINAL CANAL $ 1,666.00 SP*IR MYELOGRAM LUMBAR SPINE $ 1,666.00 SP*IR MYELOGRAPHY THORAC SPI $ 1,666.00 SP*MYELOGRAM CERVICAL SPINE $ 1,666.00 XR*MYELOGRAPHY, ENTIRE SPINE $ 1,666.00 LFIT ANAT C-TAPER FEM HEAD 36M $ 1,668.00 BIOPSY OF BOWEL 1+ SPECIMENS $ 1,673.00 EGD DIAGNOSTIC BRUSH WASH $ 1,673.00 EGD GUIDE WIRE INSERTION $ 1,673.00 EGD REMOVE FOREIGN BODY $ 1,673.00 ESOPHAGOSCOPY FLEXIBLE BRUSH $ 1,673.00 FIX G/COLON TUBE W/DEVICE $ 1,673.00 UPPR GI SCOPE W/SUBMUC INJ $ 1,673.00 CT-CTA CHST W/CON INC W/O & $ 1,674.00 TEMPORARY PACEMAKER CC $ 1,674.00 ECL SOFT TISS ANCHOR 7MMX12MM $ 1,677.00 ECLIPSE SFT TISSUE ANCH 4X 7MM $ 1,677.00 CT SCAN-THORAX W/O CONTRAST $ 1,678.00 CT-CHEST LOW DOSE-LUNG CANCER $ 1,678.00 DISP HIP KIT-1.8MM Q-FIX IMPL $ 1,688.00 PRESSURE WIRE $ 1,690.00 PLATELET LEUKO CMV NEG,PH,EACH $ 1,697.00 STRESS TTE COMPLETE $ 1,700.00 MRI*CERVICAL W/O CONTR $ 1,702.00 EGD W/DILATION $ 1,703.00 HFMN PIN 4,5,6MM DIA 5,8,11 MM $ 1,704.00 ERCP PAPILLATOME BASKET $ 1,705.00

�151

9 HOLE 1/3 TUBULAR PLATE $ 1,708.00 VARIAX 12 HOLE PLATE $ 1,708.00 MRI*LUMBAR W/O CONTR $ 1,711.00 MRI*THORACIC W/O CONTR $ 1,711.00 VARIAX 12 HOLE STRAIGHT PLATE $ 1,712.00 EGD W/INSERTGUIDEWIRE/DILAT $ 1,713.00 SIGMOIDSCOPY, DX, FLEXIBLE $ 1,713.00 ERCP PAPILLATOME SUPPLY $ 1,718.00 SIGMOIDSCOPY, FLEX W/POLYPEC $ 1,731.00 DEGLYC'D RBC LEUKOREDUCED,EA $ 1,733.00 SIGMOID, FLEXIBLE, SCREENING $ 1,737.00 2.4MM 4 HOLE LOW PROF STR PLAT $ 1,738.00 2.4MM LOPRO PLT 7 HOLE T-PLT $ 1,738.00 ANOTOEMIC PHALANGEAL PROSTHESI $ 1,738.00 IMPLANT KIT MONT THYROIDPLASTY $ 1,738.00 ACU-LOC VDR PLATE LONG LT $ 1,740.00 ACU-LOC VDR PLT STD RT $ 1,740.00 MRI BREAST W/O CON UNILATERAL $ 1,740.00 NRRW DISTAL RADIAL PLATE RIGHT $ 1,740.00 STD RT VDR PLATE XL $ 1,740.00 VDR PLATE NARROW RT $ 1,740.00 VDR PLATE WIDE LT $ 1,740.00 LAB-SURG NERV TEASING PREP $ 1,746.00 OBS TRANS, BLOOD OR BLOOD CO $ 1,746.00 OR- TRANSFUSION,BLOOD,ETC $ 1,746.00 SP*TRANSFUSION, BLOOD, ETC $ 1,746.00 TRANS BLOOD OR BLOOD COMPONENT $ 1,746.00 TRANSFSN BLOOD OR BLOOD CMPNTS $ 1,746.00 TRANSFUSION BLOOD OR BLOOD CMP $ 1,746.00 I & D OF BARTHOLIN'S GLAND ABS $ 1,749.00 I & D OF VULVA OR PERINEAL ABS $ 1,749.00 I&D OF BARTHOLIN'S GLAND ABSC $ 1,749.00 I&D OF VULVA OR PERINEAL ABSC $ 1,749.00 I&D VULVA OR PERINEAL ABSCESS $ 1,749.00 SIGMOIDSCOPY, FLEXIBLE W/BIO $ 1,749.00 CATHETER AVX 6F X 50CM $ 1,750.00 CATHETER XVG 5F X 140CM $ 1,750.00 WRIST ARTHROGRAM $ 1,751.00 VERSAJET II $ 1,755.00 ERBE PROBE $ 1,757.00 MRA*CHEST W/O CONTRAST $ 1,758.00 BALLOON CUTTING 3 X 1.5 X140CM $ 1,759.00 TRIATHLON CEM STEM 12 X 50 MM $ 1,759.00 SIGMOIDSCOPY, RIGID, DILATIO $ 1,766.00 MRA PELVIS W/CONTRAST $ 1,767.00 MRI*LT BREAST W/CONTRAST $ 1,769.00 MRI*RT BREAST W/CONTRAST $ 1,769.00

�152

APPLIER CLIP ENDO 5MM MED $ 1,776.00 FIBER,LASER 1000 $ 1,776.00 M & S SUPPLY- LEVEL 17 $ 1,776.00 NAIL T2 STD TIB 10.0X345MM $ 1,776.00 NAIL T2 STD TIB 11.0X360MM $ 1,776.00 EGD $ 1,779.00 28MM COCR FEMORAL HEAD $ 1,781.00 EGD, W/BIOPSY $ 1,784.00 CL TX DISTL FIB FX W MANIP $ 1,788.00 CL TX TMJ DISLOCATION; INITIAL $ 1,788.00 CL TX TRAUM HIP DICLOC WO ANES $ 1,788.00 CNTRL OROPHARYNGEAL HEMOR SMPL $ 1,788.00 DEBRIDE SKIN MUSC AT FX SITE $ 1,788.00 INT WND RPR S/A/T/EXT=<2.5CM $ 1,788.00 INTMD WND RPR FCE/MM 5.1-7.5CM $ 1,788.00 IRRGT CRPR CVRNSA FOR PRIAPISM $ 1,788.00 TX S WND DEHISC SMPL $ 1,788.00 TX S WND DEHISC; SMPL $ 1,788.00 WRC-REPAIR INTR WND <=2.5 SQCM $ 1,788.00 BLEPHAROTOMY DRAIN ABSC EYELID $ 1,789.00 CL TX ANKLE DISLOCAT WO ANES $ 1,789.00 CL TX D FEM FX WO MANIP $ 1,789.00 CL TX GTR TROCHNTRC FX WO MAN $ 1,789.00 CL TX HUMERUS FX WO MANIP $ 1,789.00 CL TX TIB SHFT FX WO MANIP $ 1,789.00 CL TX ULNAR SHFT FX W MANIP $ 1,789.00 CL TX VERTEBRAL BODY FX WO MAN $ 1,789.00 CLOSED RX FEMUR DISTAL $ 1,789.00 CREP S/A/L 2.6-7.5CM $ 1,789.00 DEB SUB TISSUE 20 SQ CM/< $ 1,789.00 DRESS/DEBRID P-THICK BURN L $ 1,789.00 FRSKN MNJ W/LS PPTL ADS&STRTCH $ 1,789.00 LYSE CHEST FIBRIN INIT DAY $ 1,789.00 NJX AA&/STRD FEMORAL NERVE $ 1,789.00 WRC-BURN DEBRIDEMNT LG W/O A $ 1,789.00 XR*SCREEN BARIUM ENEMA-ALT/COL $ 1,789.00 5MM PIN $ 1,790.00 HOFFMAN III PIN TO ROD $ 1,790.00 PIN EXT FIX ROD TO ROD CPL $ 1,790.00 ENTEROSCOPY $ 1,791.00 ENTEROSCOPY, W/BIOPSY $ 1,793.00 ACU-LOC VDU PLATE LT $ 1,795.00 PLATE 6 HOLE VOLAR $ 1,795.00 PLATE 8 HOLE VOLAR $ 1,795.00 COLONSCOPY THROUGH STOMA/SN $ 1,797.00 ILEOSCOPY WITH BIOPSY $ 1,798.00 MET NIT INTRA FIX SCAFFOLD SYS $ 1,807.00

�153

NI INMED FIXSCSYS 2.5X8.5X17.5 $ 1,807.00 NIT INTMEDUL FIX SCFSYS 2.5MM $ 1,807.00 NIT INTRMED FIX SCF SYS 2565L3 $ 1,807.00 PLATE 1.5MM LCP $ 1,808.00 SIGMOIDSCOPY, RIGID W/POLYPE $ 1,818.00 NJX PX NFROSGRM &/URTRGRM $ 1,819.00 XR INJECTION $ 1,819.00 MRI*BILAT LOWER JOINT W/CONTR $ 1,823.00 MRI*BILATERAL UPPER JT W/CONT $ 1,823.00 MRI*LEFT LOWER JOINT W/CONTR $ 1,823.00 MRI*LT UPPER EXTREM W/CONTR $ 1,823.00 MRI*LT UPPER JT W/CONTRAST $ 1,823.00 MRI*RT LOWER JOINT W/CONTRAS $ 1,823.00 MRI*RT UPPER EXTREM W/CONTR $ 1,823.00 MRI*RT UPPER JT W/CONTRAST $ 1,823.00 EGD W/POLYPECTOMY(SNARE) $ 1,828.00 MRI*ABDOMEN W/CONTRAST $ 1,829.00 MRI*PELVIS W/CONTRAST $ 1,829.00 ANATOMIC MENISCAL BEARING 4MM $ 1,838.00 ANATOMICAL MENISCAL BEARING LG $ 1,838.00 ANATOMICAL MENISCAL BEARING SM $ 1,838.00 ESOPHAGUS REFLUX TEST W/CATH $ 1,840.00 25MM PATELLA $ 1,843.00 ANATOMIC PATELLA 25MM 1X5MM $ 1,843.00 MRI*BRAIN W/CONTRAST $ 1,850.00 MRI*CERVICAL W/CONTRAST $ 1,850.00 MRI*LUMBAR W/CONTRAST $ 1,850.00 MRI*THORACIC W/CONTRAST $ 1,850.00 INJECT FOR SACROILIAC JOINT $ 1,860.00 SIJ ANESTH/STEROID INJ $ 1,860.00 MRA LT LOWER EXTR W/CONTRAST $ 1,862.00 BALLOON CATH INFLATION DEVICE $ 1,864.00 CT HIGH RESOLUTION CHEST/CONTR $ 1,864.00 CT SCAN-ABDOMEN WITH CONTRAS $ 1,864.00 CT SCAN-PELVIS W/CONTRAST $ 1,864.00 CT SCAN-THORAX W/CONTRAST $ 1,864.00 L PLATE 6 HOLE COMPRESSION L2 $ 1,869.00 L PLATE 7 HOLE COMPRESSION $ 1,869.00 ALGRFT SPACER CERV 6MM $ 1,871.00 ALGRFT SPACER CERV 7MM $ 1,871.00 AXLE FEM DIST MRH GMRS STD $ 1,871.00 CATH ENDOVENOUS RF 7FR 3CM $ 1,871.00 M & S SUPPLY- LEVEL 18 $ 1,871.00 M&S SUPPLY-LEVEL 18 $ 1,871.00 NAIL TROCR TI 125°×180MM $ 1,871.00 NAIL TROCR TI 130°×180MM $ 1,871.00 SHELL HEMI CLUST 58MM $ 1,871.00

�154

DES STENT $ 1,875.00 MRA CHEST W/CONTRAST $ 1,875.00 SIGMOIDSCOPY, FLEX W/POLPEC C $ 1,881.00 MEDPOR TITAN $ 1,882.00 TRANSFUSION BLOOD/BLOOD CMPT $ 1,883.00 1.5MM VA DRILL GUIDE $ 1,886.00 MRA*ABDOMEN W/O CONTRAST $ 1,907.00 COLONOSCOPY, REMOVAL FOREIGN $ 1,913.00 1.5MM LCP T-PLATE 3 HOLE $ 1,915.00 INV DRAIN CATH TRANSVAG/REC $ 1,917.00 6 TAB ALUMINUM RING 180MM $ 1,920.00 TRI-STAPLE 2.0 BLK RELOAD 60MM $ 1,922.00 COLONOSCOPY THROUGH STOMA $ 1,938.00 LAB-CFTR FULL GENE SEQ $ 1,938.00 SMOOTH ROUND MOD CLASSC PRFILE $ 1,938.00 6 TAB ALUMINUM RING 140MM $ 1,950.00 7 X 105MM HEADLESS COMP SCREW $ 1,950.00 7 X 60MM LT COMP SCREW $ 1,950.00 7 X 70MM SHORT THREAD SCREW $ 1,950.00 7 X 80MM FIXOS SCREW $ 1,950.00 7 X 85MM HEADLESS COMP SCREW $ 1,950.00 7 X 95MM SHORT THREAD SCREW $ 1,950.00 7.0 X 100MM SHORT THREAD SCREW $ 1,950.00 7.0 X 110MM SHORT THREAD SCREW $ 1,950.00 7.0 X 45MM SHORT THREAD SCREW $ 1,950.00 7.0 X 70MM LONG THREAD SCREW $ 1,950.00 7.0 X 95MM SHORT THREAD SCREW $ 1,950.00 7.0X75MM SH THR HDLSS COMP SCR $ 1,950.00 7X50 HEADLESS COMPRESSION SCRW $ 1,950.00 7X55 HEADLESS COMPRESSION SCRW $ 1,950.00 7X75HEADLESS COMPRESSION SCREW $ 1,950.00 7X85MM HDLS CMPRSN SCRW $ 1,950.00 7X90MM HDLS CMPRSN SCRW $ 1,950.00 HDLS CMPR SCR 7MM/70MM SHT THR $ 1,950.00 HDLSS COMPR SCR 7 L65 SHRT THR $ 1,950.00 LCK SCR T10 FL THRD 3.5MML20MM $ 1,950.00 SCR 7.0MM L70MM HDLSS COMPR SH $ 1,950.00 SCREW BONE 95X7MM HEADLSS COMP $ 1,950.00 SCREW HDLSS COMPRESSION 7.0X90 $ 1,950.00 SCREW HEADLESS COMPRS 7.0X60MM $ 1,950.00 SCREW, HEADLESS COMP 7.0 X 80 $ 1,950.00 SCREW, HEADLESS COMPR 7.0X40MM $ 1,950.00 SCREW, HEADLESS COMPR 7.0X50MM $ 1,950.00 SCREW, HEADLESS COMPR 7.0X55MM $ 1,950.00 SCREW, HEADLESS COMPR 7.0X80 $ 1,950.00 SCRW, HDLSS CMPRSSN 7.0X35MM $ 1,950.00 PLT BONE L49.9XW21.6MM SH 2 $ 1,952.00

�155

PLT BONE L51XW24.4MM SH R HND $ 1,952.00 MRA ABDOMEN W/CONTRAST $ 1,953.00 MRA SPINAL CANAL W/O OR W/CONT $ 1,953.00 MRA*HEAD W/O CONTRAST $ 1,958.00 BIOLOX DELTA FEM HEAD 28MM $ 1,960.00 HD FEM OD36MM +0MM OFFSET $ 1,960.00 HD FEM OD36MM +2.5MM OFFSET $ 1,960.00 HD FEM OD36MM +5MM OFFSET $ 1,960.00 HEAD FEM TAPR 36MM +0 $ 1,960.00 HEAD FEM TAPR 36MM +2.5 $ 1,960.00 HEAD FEM TAPR 36MM +7.5 $ 1,960.00 HEAD FEMORAL OD36MM +2.5MM V40 $ 1,960.00 HEAD FEMORAL OD36MM +7.5MM V40 $ 1,960.00 CARDIAC EVNT SCAN AND ANALYS $ 1,961.00 CERAMIC V40 FEMORAL HEAD 28MM $ 1,961.00 CATHETER CLOSURE FAST 7F $ 1,963.00 END RFA CAT 7CM HTEL 7FR/CHX60 $ 1,963.00 TIBIAL,TRI PKR X3 INS RM/LL S3 $ 1,963.00 ENTEROSCOPY W/CAUTERY $ 1,970.00 TRIATHLON FEM DIST FIX PEG $ 1,970.00 TIB/PER REVASC ADD-ON $ 1,972.00 M & S SUPPLY- LEVEL 19 $ 1,974.00 SHELL HEMI CLUST 52MM $ 1,974.00 ANOSCOPY W BX SINGLE/MULTI $ 1,975.00 EXCISE ANAL EXT TAG/PAPILLA $ 1,975.00 REMOVAL OF HEMORRHOID CLOT $ 1,975.00 MIMEDX AMNIOFIX 2.0X3.0CM $ 1,976.00 MRA BILATERAL LOWER EXTR W/C $ 1,978.00 FEMORAL HEAD 14/16 TAPER +3 $ 1,981.00 4.5X45MM LOW PRO PAR THRD SCRW $ 1,988.00 5.5 X 55 LOW PROFILE SCREW $ 1,988.00 6 X 50MM LOW PROF JONES SCREW $ 1,988.00 6X55MM LOW PRO PT THREADED SCR $ 1,988.00 8 HOLE LOCKING DIST FIB PLT LT $ 1,988.00 NUSHIELD 2X3 SQ CM $ 1,988.00 PERSONAL THERAPY MANAGER $ 1,988.00 PROPEL CONTOUR SINUS IMPL $ 1,988.00 PROPEL FURATE IMPLANT 370UG $ 1,988.00 PROPEL MINI SINUS IMPL $ 1,988.00 SHEARS FOCUS HARMONIC 9CM $ 1,988.00 MRI*PELVIS W/O CONTR $ 1,990.00 MRV-PELVIS W/O CONTRAST $ 1,990.00 WRC-EXC MALI LES, SCLP,NCK,HAN $ 1,991.00 COLONSCOPY STOMA/POLYP-FORC $ 1,995.00 ILEOSCOPY $ 1,995.00 3MM 4HOLE LOW PRO STRAIGHT PLT $ 2,000.00 ERCP W/CHANGE OF TUBE/STENT $ 2,000.00

�156

ESOPHAGEAL DILATION W/O EGD $ 2,000.00 ESYCL OSTEO COP STP 10X10X10MM $ 2,000.00 TIBIAL BEARING IMPL VIT E SZ3 $ 2,000.00 TWO HOLE SS PLATE $ 2,000.00 VITOSS BA2X FOAM PACK, 1.2CC $ 2,003.00 M&S INDIGO LASER FIBER $ 2,007.00 PLT NARW SHRT RT $ 2,007.00 2.5 X 45 FIXOS CANN REAMER $ 2,008.00 CROWN DRILL $ 2,016.00 ECHO TRANSTHOR,CONGENITL,PED $ 2,017.00 EXPLANT FULL BLADE 64MM $ 2,019.00 EXPLANT TRUNCATED BLADE 64MM $ 2,019.00 LEVLE 19 KNEE IMPLANT $ 2,019.00 6 TAB ALUMINUM RING 100MM $ 2,028.00 LC-APSKIN LEGWND>100CME/A100CM $ 2,031.00 MULTI SLEEP LATENCY $ 2,032.00 ANCHORAGE CP REAMER $ 2,033.00 VENOUS ASSAY THRU CATH $ 2,036.00 FEMORAL HEAD V40 36MM -5NECK $ 2,048.00 EGD, REMOVAL FOREIGN BODY $ 2,049.00 TRTHLN PKR FEM COMPONENT SZ 4 $ 2,050.00 TRTHLN PKR TIB INSERT LM/RL #5 $ 2,050.00 COLONOSCOPY $ 2,057.00 CUTTING BALLOON $ 2,060.00 CATHETER GUIDING $ 2,063.00 EASYCLIP FIX DEVICE 20X16X16MM $ 2,063.00 STAPLE OSTSYN COMP 25X22X22MM $ 2,063.00 STAR STERILE PKG INSTRUMENTS $ 2,064.00 ALGRFT DBM MIX 5CC $ 2,077.00 INSERT ACET X3 POLY 0DG 36MM E $ 2,077.00 INSERT ACET X3 POLY 0DG 36MM G $ 2,077.00 M & S SUPPLY- LEVEL 20 $ 2,077.00 PLT UNIPLT ONE LEVEL PLT 16MM $ 2,077.00 SHELL ACET HEMI SLD 50MM $ 2,077.00 AMPLATZER VASCULAR PLUG II $ 2,080.00 ARCAD "14x10x16mm CMPRSSV STPL $ 2,080.00 PLUG VASCULAR AMPLATZER 10MM $ 2,080.00 PLUG VASCULAR AMPLATZER 12MM $ 2,080.00 PLUG VASCULAR AMPLATZER 14MM $ 2,080.00 PLUG VASCULAR AMPLATZER 16MM $ 2,080.00 PLUG VASCULAR AMPLATZER 20MM $ 2,080.00 PLUG VASCULAR AMPLATZER 8MM $ 2,080.00 CATH EP DIAG/ABL 3D(ABL CATH) $ 2,086.00 CATH EP DIAG/ABL OTHER THAN 3D $ 2,086.00 6 HOLE VAL STRAIGHT PLATE $ 2,090.00 COLONSCOPY, W/POLYPECTOMY CA $ 2,092.00 EGD W/CAUTRY, SCLROSNG OR CLP $ 2,100.00

�157

PLATE 21MM ZEVO $ 2,105.00 FEMORAL HEAD WITHOUT CARTILAGE $ 2,106.00 COLONOSCOPY AND BIOPSY $ 2,107.00 COLONOSCOPY FOR BLEEDING $ 2,107.00 COLONOSCOPY STOMA W/REM SNARE $ 2,107.00 COLONOSCOPY SUBMUCOUS NJX $ 2,107.00 COLONOSCOPY THRU STOMA W BX $ 2,107.00 COLONOSCOPY W/CONTROL BLEED $ 2,107.00 COLONOSCOPY W/LESION REMOVAL $ 2,107.00 DIAGNOSTIC ANOSCOOY & BIOPSY $ 2,107.00 DIAGNOSTIC SIGMOIDOSCOPY $ 2,107.00 SIGMOIDOSCOPY FOR BLEEDING $ 2,107.00 SIGMOIDOSCOPY W REM T/P/LS SNR $ 2,107.00 SIGMOIDSCOPY, RIGID W/BIOPSY $ 2,108.00 DOMED TRI-PEG PATELLA SZ32MM $ 2,110.00 ADM NEC ADULT DAYS $ 2,111.00 GYN MED SURG $ 2,111.00 MED SURG UNIT SEMI PVT $ 2,111.00 IP HOSPICE $ 2,112.00 RELOAD W/10TACKS $ 2,115.00 GRAFT, HEMASHIELD KNITTED 14X7 $ 2,119.00 MRA*BILATERAL UPPER EXTREMITY $ 2,119.00 COLONSCOPY, W/BIOPSY $ 2,120.00 PLATE NRW PROF CLAV 8HLE LG RT $ 2,120.00 7 X 45MM POLYAXIAL SI SCREW $ 2,123.00 7.5 X 40MM EXP TI POLY SCREW $ 2,123.00 SCR SPNL L30MM THRD OD6MM TI $ 2,123.00 SCR SPNL L35MM THRD OD6MM TI $ 2,123.00 SCR SPNL L40MM THRD OD6MM TI $ 2,123.00 SCR SPNL L40MM THRD OD7MM TI $ 2,123.00 MRA*PELVIS W/O CONTRAST $ 2,124.00 END RFA CAT HT EL 7FR/CHX100CM $ 2,125.00 IMPL SYSTEM DIST BICEPS REPAIR $ 2,125.00 MIMEDX AMNIOFIX 4.0X4.0CM $ 2,132.00 PERQ ACCESS & CLSR FEM ART BIL $ 2,134.00 3.5 LFP DIST TIB TPLATE 5 HOLE $ 2,137.00 DISCOGRAPHY LUMBAR $ 2,137.00 CT-ANGIO ABD AORTA W/BILAT R $ 2,139.00 5 HOLE OLECRANON PLT RT $ 2,140.00 CREP E/N/E/L 2.6-7.5CM $ 2,144.00 CREP F/G/H/F 2.6-7.5CM $ 2,144.00 REPAIR NAIL BED $ 2,144.00 EASY CLIP FIXA DEVICE 15X15X15 $ 2,145.00 ESYCLP FXTION DVICE 18X17X15MM $ 2,145.00 BASEPLATE TIB 6 UNI STD KNEE $ 2,154.00 BASEPLATE TIB 3 STD LEFT KNEE $ 2,154.00 BASEPLATE4 TIB UNI LEFT KNEE $ 2,154.00

�158

BASEPLATE5 TIB UNISTD KNEE PRM $ 2,154.00 BASEPLT TIB 3 UNIV STD POLYETH $ 2,154.00 BASEPLT TIB 4 UNIV STD POLYETH $ 2,154.00 DBM PUTTY, 2.5CC $ 2,158.00 PLATE MEDTRONIC ZERO 41MM $ 2,158.00 COLONOSCOPY, SCREENING $ 2,163.00 FUSEFORCE NITINOL STAPLE 10X10 $ 2,163.00 BIOPSY $ 2,165.00 PROF -PATH CONSULT INTRAOP ADD $ 2,166.00 4 HOLE DIST LAT HUM PLT - RT $ 2,168.00 PLATE BONE L89MM LELBOW 4HOLE $ 2,168.00 intrauterine copper contraceptive-T 380A IUD $ 2,173.67 ANCHOR REPAIR KIT KNOTLESS SS $ 2,184.00 HEAD FEM TAPR 32MM +0 $ 2,184.00 INSERT ACET X3 POLY 0DG 32MM C $ 2,184.00 INSERT ACET X3 POLY 0DG 36MM F $ 2,184.00 M & S SUPPLY- LEVEL 21 $ 2,184.00 M&S SUPPLY-LEVEL 21 $ 2,184.00 HUMERAL PLATE 3 HOLE LEFT $ 2,188.00 INSTR KIT MINI BIO-SUT TAK $ 2,188.00 REHAB SEMI PRIVATE $ 2,191.00 EGD, SCLEROSING OF VARICES $ 2,194.00 GRAFT BONE5ML MIX FREEZ DRIED $ 2,194.00 DUAL ROW ALUM FOOT PLT 140MM $ 2,197.00 ANCHR SYNDSMSS RPR KT KNTLSS $ 2,200.00 GRAFIXPL PRIME 3 SQ CM $ 2,200.00 SCRN COLONOSCOPY HI RISK PT $ 2,210.00 LMN MECH REM OBSTR CVAD $ 2,212.00 REPLACE PICC CATH $ 2,212.00 4.5 X 45MM JONES SCREW $ 2,220.00 5.5 X 45MM JONES SCREW $ 2,220.00 DUAL ROW ALMNM FOOT PLTE 180MM $ 2,226.00 ESSURE STABILIZATION DEVICE $ 2,226.00 ESSURE STERILIZATION DEVICE $ 2,226.00 ALLOMATRIX INJECTABL PUTTY 5CC $ 2,229.00 LEVEL 21 PLATE & ROD IMPLANTS $ 2,233.00 ACU-LOC 2 VDR PLT NARROW RT $ 2,235.00 MRA*PELVIS W/ & W/O CONTRAST $ 2,241.00 12 HOLE VAL STRAIGHT PLATE $ 2,243.00 levonorgestrel 13.5 mg IUD $ 2,246.91 BASEPLT TIB CRUC RET SZ 3 L $ 2,247.00 MRA*UE W/CONTRAST LT $ 2,248.00 MRA*UE W/CONTRAST RT $ 2,248.00 MRV*UE W/CONTRAST LEFT $ 2,248.00 MRV*UE W/CONTRAST RIGHT $ 2,248.00 ALGRFT PLACENTAL TISS 2X2CM $ 2,250.00 BASEPLT TIB 5 UNIV STD POLYETH $ 2,250.00

�159

CRT IMPLLA ASMBLY PRG CASSETTE $ 2,250.00 FUSEFORCE NITINOL STAPLE 8X8 $ 2,250.00 TIBIAL BEARING IMPL SZ3 $ 2,250.00 CEMENTED STEM 12MM $ 2,251.00 STEM TRIATHLON TOT KNEE CEM $ 2,251.00 TRIATHLON TOTAL KNEE CEM STEM $ 2,251.00 METALLIC URET STENT 6 X 24 $ 2,253.00 OLECRANON PLATE 4 HOLE/RIGHT $ 2,254.00 STEM FEM CEM HIP 3 RELIANCE CM $ 2,256.00 STEM FEM SZ 1 115MM 132DG $ 2,256.00 STRAIGHT HIP SYSTEM SZ 0 $ 2,256.00 ECHO 2D DOPPLER COLOR FLOW $ 2,261.00 TTE W/DOPPLER COMPLETE $ 2,261.00 COLONSCOPY, W/POLYPECTOMY S $ 2,263.00 9 X 390MM TIBIAL NAIL STD $ 2,269.00 NAIL T2 STD TIB 11.0X285MM $ 2,269.00 NAIL T2 STD TIB 11.0X315MM $ 2,269.00 T2 STD TIBIAL NAIL 10X360MM $ 2,269.00 TIBIAL NAIL STANDARD 10X300MM $ 2,269.00 LEVEL 22 PLATE & ROD IMPLANT $ 2,271.00 UNIPLATE ONE LEVEL PLATE 14MM $ 2,271.00 CPR MINI SCORPION SYS $ 2,279.00 INS ACET X3 POLY X3 10DG36MM F $ 2,279.00 INST ACETX3 POLYX3 10DG 36MM E $ 2,279.00 M & S SUPPLY- LEVEL 22 $ 2,279.00 M&S SUPPLY-LEVEL 22 $ 2,279.00 SCOPE TISSUE REMOVL MYOSURE XL $ 2,279.00 TIB PLT DIST MED LT 172MM 10H $ 2,279.00 CATH, ANGIO, DRUG, NON LASER $ 2,280.00 SPECIAL RADIATION TREATMENT $ 2,280.00 ARTCL/EZ FEM HD 32MM 12/14 TPR $ 2,284.00 3 HOLE VOLAR DIST RAD PLT LT $ 2,285.00 KNTLSS TGHTRPE SYND REP IMP TI $ 2,288.00 BONE MATRIX 5CC GRAFTON DEMIN $ 2,293.00 NAIL IM FEM 11 MM AG 180 MM $ 2,296.00 ESOPHAGEAL MOTILITY STUDY $ 2,297.00 GAMMA3 TRO NAIL KT 180X120deg $ 2,297.00 PEDIATRIC UNIT $ 2,299.00 AM SURGICAL BLADE $ 2,306.00 UNIV 5TH METATARSAL HOOK PLATE $ 2,313.00 6 X 29MM PATELLA IMPL $ 2,318.00 8MM POLY INSERT $ 2,318.00 TOTAL FEMORAL IMPL $ 2,318.00 TOTAL TIBIAL TRAY $ 2,318.00 320CC MEM GEL SILI BREAST IMPL $ 2,325.00 EGD, BANDING OF VARICES $ 2,330.00 CL TX NASAL BONE FX WO STABILZ $ 2,337.00

�160

ILIAC CREST WEDGE 20 $ 2,338.00 CRITICAL CARE ADDL 30 MIN $ 2,340.00 NITINOL BONE IMPL 18X18X15MM $ 2,340.00 TRIATH PRIM TIBIAL BPLATE SZ 2 $ 2,340.00 TRIATH PRIM TIBIAL BPLATE SZ 3 $ 2,340.00 TRIATH PRIM TIBIAL BPLATE SZ 5 $ 2,340.00 TRIATH PRIM TIBIAL BPLATE SZ 6 $ 2,340.00 TRIATH PS FEMORAL COMP #5 $ 2,340.00 TRIATHLON TIBIAL BASEPLATE SZ4 $ 2,340.00 ER VISIT LEVEL 4 $ 2,347.00 HOLMIUM LASER FIBR 1000 MICRON $ 2,350.00 PERCUT TRANSHEPATIC W/O HEMO $ 2,350.00 SP*LEFT-VENOGRAPHY,EXTREM,UN $ 2,350.00 SP*RIGHT-VENOGRAPHY,EXTRE,UN $ 2,350.00 SP*VENOGRAPHY EXTREMITY, BIL $ 2,350.00 VENOGRAM EXTR INJ & INTERP $ 2,350.00 VENOGRAM EXTREMITY UNILATERAL $ 2,350.00 VENOGRAM, BILATERAL INTERP $ 2,350.00 VENOGRAPHY CAVAL SUPERIOR $ 2,350.00 XR*LEFT-VENOGRAPHY EXTREMITY $ 2,350.00 XR*RIGHT-VENOGRAPHY EXTREMITY $ 2,350.00 XR*VENOGRAPHY, BILATERAL $ 2,350.00 COMP OSTEOSYN STP ECLP 8X8X8MM $ 2,353.00 STPX SPRLSTC NTL STP FIX 9X8X8 $ 2,353.00 RELIANCE PF HIP SYSTEM #0 10MM $ 2,356.00 REUN SHL DL RAD HUM HD 45MX18M $ 2,357.00 T2 STD TIBIAL NAIL 11MMX375MM $ 2,359.00 MRA*NECK W/CONTRAST $ 2,367.00 FASCIA LATA MED $ 2,370.00 MED SURG PVT HOSP CONV $ 2,371.00 MED SURG PVT MED JUSTIFI $ 2,371.00 MED SURG PVT PT REQ $ 2,371.00 STENT BIL RX 80X80 CTRL $ 2,374.00 STENT VASC SE 10X60MM 80CM $ 2,374.00 STENT VASC SE 8X80MM 80CM $ 2,374.00 FUSEFORCE NTNOL IMPL KIT 20X20 $ 2,375.00 IMPLANT SYSTEM, CPR VIPER $ 2,375.00 NUSHIELD 2X4 SQ CM $ 2,375.00 ALT BIRTH CENTER ADULT $ 2,379.00 ROUTINE MATERNITY $ 2,379.00 10 X 380MM FEMORAL NAIL A/R $ 2,385.00 NAIL, IMPLANT STRYKER FEMORAL $ 2,385.00 ANOSCOPY W DILATION $ 2,391.00 FEM PLT DISTLAT 166MM LT 6/5H $ 2,393.00 INSERT TIBIAL 6 THK11MM CNDYL $ 2,393.00 LIGAMENT AUGMENT REPAIR KIT $ 2,393.00 M & S SUPPLY- LEVEL 23 $ 2,393.00

�161

M&S SUPPLY-LEVEL 23 $ 2,393.00 BEARING TIBIAL $ 2,394.00 ERCP W/LITHOTRIPSY $ 2,394.00 INSERT TIB 4 16MM X3 CS TRTHLN $ 2,394.00 INSERT TIBIAL 4 THK13MM CNDYL $ 2,394.00 INSERT TIBIAL 4 THK9MM POST $ 2,394.00 INSERT TIBIAL 2 THK9MM CNDYL $ 2,394.00 INSERT TIBIAL 3 THK11MM CNDYL $ 2,394.00 INSERT TIBIAL 3 THK11MM POST $ 2,394.00 INSERT TIBIAL 3 THK9MM CNDYL $ 2,394.00 INSERT TIBIAL 3 THK9MM POST $ 2,394.00 INSERT TIBIAL 4 THK11MM CNDYL $ 2,394.00 INSERT TIBIAL 4 THK9MM CNDYL $ 2,394.00 INSERT TIBIAL 5 THK11MM CNDYL $ 2,394.00 INSERT TIBIAL 5 THK11MM POST $ 2,394.00 INSERT TIBIAL 5 THK9MM CNDYL $ 2,394.00 INSERT TIBIAL 6 THK9MM CNDYL $ 2,394.00 INSRT TIB 3 THK11MM UNIV X3 $ 2,394.00 INSRT TIB 3 THK9MM UNIV X3 $ 2,394.00 INSRT TIB 4 THK9MM UNIV X3 $ 2,394.00 INSRT TIB SZ 6 THICKNESS 9MM $ 2,394.00 TIBIAL BEARING INS PS 6X13MM $ 2,394.00 TIBIAL, TRITHLN PKR BASEPLT S3 $ 2,394.00 TIBIAL,TRIATHLN X3 BEAR INS-S3 $ 2,394.00 TRI X3 TIB BEARING INS 16MM S6 $ 2,394.00 TRI X3 TIB BRING INS PS 5-13MM $ 2,394.00 TRIATHLN ALL POLYTIB COMPCS S6 $ 2,394.00 TRIATHLN PS X3 TIB INS 6 -11MM $ 2,394.00 TRIATHLN X3 TIB BEARNG INSCS 3 $ 2,394.00 TRIATHLON PS X3 TIB INS 7-9MM $ 2,394.00 TRITHLN PS X3 TIB INSRT #4-9MM $ 2,394.00 TRITHLN PS X3 TIB INSRT S2 9MM $ 2,394.00 TRIX3 TIB BEARING INSERT PS S4 $ 2,394.00 TRTHLN PSX3 TIB INSRT S 4X16MM $ 2,394.00 X3 TRIATHLON CS INS SIZE3 13MM $ 2,394.00 ECCU SEMI PRIVATE $ 2,400.00 TIBPER REVASC W/ATHER ADD-ON $ 2,406.00 6 HOLE DSTL PSTER LTERL PLATE $ 2,408.00 ISO*TC 99M APCITIDE PER DOSE $ 2,411.00 AUGMENT TRIATHLON FEM DIST -LT $ 2,417.00 TRIATHLON FEM POST AUGMENT $ 2,417.00 RESTORATION ADM/MDM X3 INSERT $ 2,418.00 RESTORATION X3 INSERT SZ42E $ 2,418.00 PLT UNIPLATEONE LEVEL PLT 18MM $ 2,425.00 8 HOLE STRAIGHT NARROW PLATE $ 2,428.00 MRI*ORBIT,FACE&OR NECK W/CON $ 2,429.00 ACHLLS KT MIDSUBSTANCE SPDBRDG $ 2,438.00

�162

5 HOLE CLAMP $ 2,443.00 5-HOLE PIN CLAMP H3 $ 2,443.00 PIN 5-HOLE CLAMP H3 $ 2,443.00 REHAB PVT HOSP CONVEN $ 2,449.00 REHAB PVT MED JUSTIFIED $ 2,449.00 REHAB PVT PT REQUEST $ 2,449.00 KIT BONE MARROW PROCESS $ 2,450.00 ANGIOGRAPHY, INTERNAL MAM $ 2,456.00 BONE BX TR/NDL; SUPERF $ 2,457.00 CHANGE OF URETER TUBE/STENT $ 2,457.00 DX LMBR SPI PNXR $ 2,457.00 MUSCLE BX; PERC NDL $ 2,457.00 NEEDLE BX LIVER; PERCUTANEOUS $ 2,457.00 NJX AA&/STRD NTRCOST NRV 1 $ 2,457.00 PERC ASP OR INJ RENAL CYST/PLV $ 2,457.00 PERC BX OR EXC LN; SUPERFICIAL $ 2,457.00 PERC N BX ABD OR RETPRTNL MASS $ 2,457.00 PERCUT BX LUNG/MEDIASTINUM $ 2,457.00 REMOVE TNL CV CATH $ 2,457.00 RENAL BIOPSY PERQ $ 2,457.00 TRI TIB AUG HLF BLOC SZ 6 10MM $ 2,457.00 REPOSIT CVC W FLUORO $ 2,461.00 I&D PERIANAL ABSCESS $ 2,463.00 INSERT 0DEG POLY 36MM $ 2,466.00 INSERT 0DEG POLY 32MM $ 2,466.00 INSERT 0DEG POLY 36MM $ 2,466.00 INSERT ACET X3 POLY 0DG 40MM E $ 2,466.00 INSERT ACET X3 POLY 0DG 40MM F $ 2,466.00 30MM UNIPLATE 2 2-LEVEL PLATE $ 2,471.00 TIT FLT D10MM L80MM ALPH CDE N $ 2,471.00 UNIPLATE 2 - 2 LEVEL PLAT 32MM $ 2,471.00 ALUMINUM FOOT PLATE 160MM $ 2,473.00 360CC MEMRY GEL SLCNE BRST IMP $ 2,475.00 EXC F/E/E/N/L MAL+MRG 2.1-3 $ 2,483.00 GRAFT BONE5ML CALC PHOS INJECT $ 2,487.00 28 PLATE 15MM 2HOLE LOCKING $ 2,488.00 AFFINITY 2.5X2.5 SQ CM $ 2,488.00 FUSEFORCE NITINOL STAPLE 20X20 $ 2,488.00 PARAGON 28 PLATE 2 HOLE $ 2,488.00 ERCP DILATION DUCT $ 2,490.00 ERCP W BRUSHING $ 2,490.00 ERCP W/BIOPSY $ 2,490.00 ERCP with Biopsy $ 2,490.00 ALGRFT SPACER CERV 8MM $ 2,496.00 GRAFT BONE 14.5X4X6X12MM 7DEG $ 2,496.00 GRAFT BONE 14.5X5X7X12MM 7DEG $ 2,496.00 GRAFT BONE 14.5X6X8X12MM 7DEG $ 2,496.00

�163

BIO4 2.5CC VIABLE BONE MATRIX $ 2,500.00 INSERT TIB CS X3 13MM SZ3 $ 2,500.00 PRFLX METACRPPHLNGEAL IMPL S30 $ 2,500.00 RN TSA SELF-PRESS GLENOID S56 $ 2,500.00 TRI X3 TIBI BEARING INSERT 9MM $ 2,500.00 TRIAT PS X3 TIBIAL INSERT 11MM $ 2,500.00 TRLN X3TB BRG INST PS SZ3X11MM $ 2,500.00 TRTHLN PKR TIB BASEPLATE SZ5 $ 2,500.00 BASEPLATE TIB CMNTD SZ7 $ 2,502.00 FEM AUGMENT POST 5MM SZ3 $ 2,502.00 HEAD FEM C-TAPER 36MM 5 OFF $ 2,502.00 M & S SUPPLY- LEVEL 24 $ 2,502.00 D&C (SUCTION CURTTAGE) $ 2,506.00 ECHO STRESS $ 2,507.00 STRESS TTE ONLY $ 2,507.00 COLONSCOPY, W/CAUTERY/SCLELO $ 2,511.00 ANCHOR SUT 15X6.5MM BIOCPMP2 $ 2,513.00 etonogestrel 68 mg IMPLANT $ 2,519.55 TRI FLD PRSSFIT STM 18MMX100MM $ 2,520.00 SIG FEM CRUCI RET POROCOAT SZ4 $ 2,523.00 TRIATHLON FEM DISTAL AUGMENT R $ 2,524.00 TRIATHLON POST AUGMNT SZ 4 5MM $ 2,524.00 MDM X3 INSERT $ 2,525.00 ST MDM X3 INSERT FOR MDM LINER $ 2,525.00 MULTI PLANAR CLAMP $ 2,528.00 24X20X20 STAPLE $ 2,535.00 STAPIX STAPLE 10X10X10 $ 2,535.00 TRI FEM DIS AUG 10MM S4 RIGHT $ 2,539.00 TRI TOT KNEE SYS OFST ADAP 4MM $ 2,541.00 EXTERNAL FIXATION LG $ 2,544.00 OMNI HFX HIP STM SIZE #07 127 $ 2,545.00 OMNI HFX HIP STM SIZE #08 127 $ 2,545.00 OMNIFIT HFX 127DEG HIP STEM $ 2,546.00 REM EMB FB FRM DNTOALV;SFT TIS $ 2,561.00 DASH SPHINCERATOME $ 2,562.00 ISO*BRAIN SCAN (SPECT) $ 2,563.00 ISO*LIVER SCAN {SPECT} $ 2,563.00 ISO*LOCALIZ ABSCESS WHOLE BO $ 2,563.00 ISO*LOCALIZATION -ABCESS LTD $ 2,563.00 ISO*PLANAR CARDIAC SCAN-MULTI $ 2,563.00 ISO*PLANAR CARDIAC SCAN-SINGLE $ 2,563.00 ISO-CARDIAC PYP SCAN-SPECT $ 2,563.00 RP LOCLZJ TUM WHBDY 1 D IMG $ 2,563.00 PATELLA OV DOME 3 PEG 32 $ 2,567.00 LAPIDUS PLATE, STANDARD $ 2,574.00 BLX DNTA CERAMIC C-TPR HD 36MM $ 2,575.00 CERAMIC C-TAPER FEM HEAD 32MM $ 2,575.00

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2.4MM LC-DCP PLATE 8HOLES/67MM $ 2,578.00 CL TX PROX FEM FX WO MANIP $ 2,580.00 CL TX SCAPULAR FX WO MANIP $ 2,580.00 CLTX BIMLLR ANKLE FRACT WO MNP $ 2,580.00 ERCP $ 2,580.00 HC UPPR GI W/ESPH BAL DIL < 30 $ 2,581.00 5cc HYDRO SET $ 2,586.00 MEDTRONIC PATIENT PROG $ 2,587.00 28MMX57MM SELF-CENT BIPOLAR HD $ 2,589.00 SCR SI POLYAXL 6X40MM $ 2,594.00 MET SUP STPL CL 11X10X10 1.5MM $ 2,600.00 NITINOL BONE IMPL 20X20X20 $ 2,600.00 NITINOL BONE IMPL 20X20X20 2MM $ 2,600.00 STAPIX $ 2,600.00 STAPIX 20X30X30 $ 2,600.00 TRI X3 TIB BRNG INST SZ 2 13MM $ 2,600.00 TRI X3 TIBIAL INSR CS SZ5 16MM $ 2,600.00 TRIA X3 CS TIBIAL INS SZ4 11MM $ 2,600.00 TRIAT PS X3 TIB INSRT SZ2 11MM $ 2,600.00 TRIATH X3 TIBAL BEAR INS 11M#5 $ 2,600.00 TRIATH X3 TIBIAL INSERT 9MM #4 $ 2,600.00 TRIATH X3 TIBIAL INSERT 9MM #6 $ 2,600.00 TRIATH X3 TIBIAL INSERT CS SZ $ 2,600.00 TRIATH X3 TIBIAL INSR SZ6X11MM $ 2,600.00 TRIATH X3 TIBIAL INSRT SZ4 9MM $ 2,600.00 TRIATH X3 TIBIAL PS SZ 5-11MM $ 2,600.00 TRIATHLN X3 TIBIAL INST 9MM #5 $ 2,600.00 TRIATHLON INSERT 13MM #3 $ 2,600.00 TRIATHLON PS X3 TIB INSRT 11MM $ 2,600.00 TRIATHLON PS X3 TIB INSRT 13MM $ 2,600.00 TRIATHLON PS X3 TIBIAL INSERT $ 2,600.00 M&S SUPPLY-LEVEL 25 $ 2,603.00 PLT 4.5MM PROX TIB 6H/118MM-RT $ 2,603.00 SWNSN FLEXI HINGETOE W/GROMETS $ 2,610.00 BIODESIGN FIST PLG 0.4CMX5.1CM $ 2,613.00 BIODESIGN FIST PLG 0.7CMX5.1CM $ 2,613.00 ERCP M&S GUIDE WIRE $ 2,613.00 REAMER FOR CROSS-PLATES $ 2,613.00 BONE GRFT SUBSTITUTE PASTE 5CC $ 2,625.00 TRI FEM DIST AUG 5MM SZE 5 RT $ 2,625.00 TRI FEM DIST AUGM 5MM SZ 6 RT $ 2,625.00 TRI FEM DISTAL AUG 5MM SZ 5 LT $ 2,625.00 TRI POST AUGMENT SZ5, 5MM $ 2,625.00 RD-RD COUP HOFF III 5,8,11MM $ 2,629.00 TRI PRESS-FIT STEM 16MM X 10MM $ 2,632.00 7 HOLE UTILITY PLATE $ 2,633.00 M&S SUPPLY-LEVEL 26 $ 2,643.00

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TRI TOT KNEE SYS OFFST ADP 2MM $ 2,643.00 TRI TOT KNEE SYS OFFST ADP 6MM $ 2,643.00 TRI TOT KNEE SYST OFST ADP 8MM $ 2,643.00 LEVEL 25 ANCHOR,SCREW,PEN,PI $ 2,656.00 SCR SI POLYAXL 6X30MM $ 2,656.00 SCR SI POLYAXL 6X35MM $ 2,656.00 SCR SI POLYAXL 7X40MM $ 2,656.00 ECCU PVT HOSPITAL CONV $ 2,659.00 ECCU PVT MED JUSTIFIED $ 2,659.00 ECCU PVT PT REQ $ 2,659.00 VG1 CERVICAL BONE GRAFT 10MM $ 2,662.00 FOOT ARCH 155MM $ 2,678.00 TRIDENT 0deg POLY INS 36m SZ D $ 2,679.00 LC-APSKINSUB FEETWND>100CM<100 $ 2,682.00 10 HOLE DISTL MEDIAL TIB PLT R $ 2,685.00 INV INS PICC W/O SUBC PORT >5Y $ 2,686.00 BUTLER KCMH UNIT $ 2,694.00 PSYCHIATRIC UNIT $ 2,694.00 INSERT 10DEG POLY 36MM $ 2,698.00 INSRT ACT X3 PLY X3 10DG 36MM $ 2,698.00 TRIDENT ELEVTD RIM INSERT 36MM $ 2,698.00 SLING TRANSOBTURATOR (OBTRYX) $ 2,709.00 DRVR ARTH 3.5MM HEX FIX FLX $ 2,714.00 IMPLANT HINGE TOE W/GROMMETS $ 2,714.00 SYNTHES 3.5X20 CORTICAL SCREW $ 2,715.00 COMPL RPLCMT PICC RS&I $ 2,718.00 DEEP BONE BX TRCR/NDL $ 2,718.00 INS PICC AGE 5 YRS/> $ 2,718.00 TRI PRESS-FIT STEM 17MM X100MM $ 2,738.00 TRIATH PRESS-FIT STEM 11X100MM $ 2,738.00 TRIATH PRESS-FIT STEM 13X100MM $ 2,738.00 CL TX CMC FX DISLOC THMB W MNP $ 2,739.00 CL TX HUMERUS FX W MANIP $ 2,739.00 CL TX PROX FIB/SHAFT FX W MANI $ 2,739.00 CL TX RADIAL HD/NECK FX W MANP $ 2,739.00 CL TX RADIAL HD/NECK FX; W MAN $ 2,739.00 CL TX SC/TX HMRS SHFT FX W MNP $ 2,739.00 CL TX TIB SHFT FX W MANIP $ 2,739.00 CL TX WB DSTL TIB FX W MANIP $ 2,739.00 CLTX BIMALLEOLAR ANKL FX W MNP $ 2,739.00 CLTX BMALLEOLR ANKL FRCT W MNP $ 2,739.00 CLTX POST ANKLE FX W/MNPJ $ 2,739.00 MANIPULATE KNEE JNT UNDR ANSTH $ 2,739.00 GRAFIXPL PRIME 6 SQ CM $ 2,750.00 INTRA-AORTIC BALLON CATH $ 2,750.00 OPTION IVC FILTER $ 2,750.00 TRANS SLNG SYS WI PREC BL DSGN $ 2,750.00

�166

TRI FEM DIST AUG 10MM SZE 5 RT $ 2,757.00 TRI POST AUGMENT SIZE 6, 10MM $ 2,757.00 OSTE COMPRES STAPLE 18X14X14MM $ 2,776.00 DRAIN FINGER ABSC COMPLICATED $ 2,782.00 DRAINAGE SCROTAL WALL ABSCESS $ 2,782.00 EXC BEN LES T/A/L 3.1-4.0CM $ 2,782.00 EXC S/N/H/F/G MAL+MRG 2.1-3 $ 2,782.00 EXC SKIN BENG 3.1-4 CM T/A/L $ 2,782.00 INC & REM FB SQ COMPL $ 2,782.00 INC & REM FB SQ; COMPL $ 2,782.00 REM FB MUSCLE; SMPL $ 2,782.00 REMOVAL OF SUPPORT IMPLANT $ 2,782.00 REMOVE SHOULDER FB DEEP $ 2,782.00 BX BREAST 1ST LESION STRTCTC $ 2,783.00 BX BREAST 1ST LESION US IMAG $ 2,783.00 MRI BX BRST 1ST LESION MR IMAG $ 2,783.00 US BX BREAST 1ST LESION IMAG $ 2,783.00 10 HOLE DIST LAT FEM - RT PLAT $ 2,785.00 KIT BIOCUE PLATELET CONCENTRTN $ 2,790.00 MRI BREAST W/O CON BILATERAL $ 2,792.00 NT BN IMP 20X30X30 2.0MMX3.0MM $ 2,798.00 M & S SUPPLY- LEVEL 27 $ 2,799.00 M&S SUPPLY-LEVEL 27 $ 2,799.00 PLT 3.5MM PROX HUM STD5H 114MM $ 2,799.00 PLT TROCR MED 100MM 2MM CABLES $ 2,799.00 SCR SI POLYAXL 6X45MM $ 2,799.00 LABOR ONLY $ 2,800.00 SHELL TRIDENT TRITAN HEMI 56MM $ 2,800.00 WRC-SPLIT THICK AUTO <=100SQCM $ 2,800.00 11 HOLE OLECRANON PLATE LT $ 2,803.00 7 HOLE STD OLECRANON PLT RT $ 2,803.00 PLATE PROF CLAV 8 HOLE LG RT $ 2,803.00 MRA*CHEST W/O & W/CONTRAST $ 2,815.00 MRA*ABDOMEN W/O & W/CONTRAST $ 2,816.00 BENGAL INTERBODY $ 2,818.00 TRDENT X3 ELEV RIM INSERT 36MM $ 2,818.00 NOVASURE ADVANCED $ 2,819.00 CATH LAB-CO ANGIO W BYPAS GR $ 2,821.00 PORT A CATH POWER PAC $ 2,822.00 PORT CATH $ 2,822.00 CORONARY SINUS LEAD $ 2,836.00 ERCP PAPILLOTOMY $ 2,837.00 MRI*LT BREAST W/O &W/CONTRAS $ 2,838.00 MRI*RT BREAST W/O &W/CONTRA $ 2,838.00 ER VISIT LEVEL 5 $ 2,842.00 DX LARYNGOSCOPY EXCL NB $ 2,858.00 XRAY EXAM OF SHOULDER 2+ VIEWS $ 2,860.00

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CLUS H SHELL TYPE: TRITANIUM $ 2,863.00 SHELL ACET OD50MM D TRITANIUM $ 2,863.00 SHELL ACET OD56MM E TRITANIUM $ 2,863.00 TRITANIUM HEM CLUSTR HLE SHELL $ 2,863.00 TRITANM CLUSTR HOLE SHELL 58MM $ 2,863.00 BLOCK LORD CORT-CANC 8X14X11MM $ 2,875.00 TRIDENT HEMI ACTBLR SHELL 48MM $ 2,876.00 RADIAL KERATOTOMY $ 2,877.00 INSERT SHOULDER REVERSD 36X6MM $ 2,885.00 MRI*CHEST W/CONTRAST $ 2,903.00 MRI*BREAST BILATERAL W/CONTR $ 2,908.00 M & S SUPPLY- LEVEL 28 $ 2,909.00 NAIL FEM R2TI 11X380MM 125D RT $ 2,909.00 WRIGHT LISFRANC SCR 3.7MMX30MM $ 2,912.00 WRIGHT LISFRANC SCR 3.7MMX32MM $ 2,912.00 WRIGHT LISFRANC SCR 4.5 X 32MM $ 2,912.00 10MM INBONE TALAR STEM LG $ 2,913.00 INBONE TALAR STEM 10MM $ 2,913.00 VG2 CERVICAL T46P BONE GRAFT $ 2,919.00 INJ EPIDURAL BLOOD OR CLOT PAT $ 2,926.00 THER SPI PNXR DRG CSF $ 2,926.00 HD FEM NK OD36MM 0MM OFFSET $ 2,930.00 HEAD FEMORAL NECK OD36MM 0MM $ 2,930.00 LINER E 36 MM. $ 2,931.00 ERCP W/REMOVAL STONES $ 2,936.00 ILIAC REVASC ADD-ON BIL $ 2,956.00 INTRAVASC FSR DOPP VELOCITY IN $ 2,966.00 34MM PLATE $ 2,977.00 BRNCHSC W/THER ASPIR 1ST $ 2,979.00 BRONCHOSCOPY W/BIOPSY(S) $ 2,979.00 DX BRONCHOSCOPE/BRUSH $ 2,979.00 DX BRONCHOSCOPE/LAVAGE $ 2,979.00 DX BRONCHOSCOPE/WASH $ 2,979.00 THROMBECTOMY CATHETERS $ 2,980.00 MRI*BRAIN W/O CONTR $ 2,983.00 IMP SYS INT BRC KNEE LIG AG RP $ 2,988.00 TRTNM CLSTR HOLE SHELL SZ48MM $ 2,990.00 TRTNM HMSPH CLSTR HL SHLL 50MM $ 2,990.00 5TH MET HOOK PLATE $ 2,998.00 DSTFL SM BED W/ST CUF 8MMX80CM $ 3,000.00 FIBULAR PLATE 11 HOLE $ 3,000.00 INSJ SUBQ CAR RHYTHM MNTR $ 3,000.00 MTP PLATE SHORT $ 3,000.00 PLATE FIB CLUSTER ANATM 13HOLE $ 3,000.00 PLATE FIB CLUSTER PLATE 11HOLE $ 3,000.00 PLATE FIB CLUSTR ANATOM 7 HOLE $ 3,000.00 INSERT CATH PLEURA W/O IMAGE $ 3,003.00

�168

PLACE GASTROSTOMY TUBE PERC $ 3,004.00 MRA*HEAD W/O AND W/CONTRAST $ 3,017.00 MRA*NECK W/O AND W/CONTRAST $ 3,017.00 MRI*BREAST BILAT W/O & W/CON $ 3,025.00 ARTHROT ACL SCL INF JNT $ 3,034.00 CORRECT RECTAL PROLAPSE PERI $ 3,034.00 EXC ABD LES SC<3 CM $ 3,034.00 EXC FACE LES SBQ 2 CM/> $ 3,034.00 EXC FOREARM LES SC 3 CM/> $ 3,034.00 EXC FOREARM LES SC<3 CM $ 3,034.00 EXC NECK LES SC<3 CM $ 3,034.00 EXC SHOULDER LES SC < 3 CM $ 3,034.00 EXC SHOULDER LES SC 3 CM/> $ 3,034.00 EXC THIGH/KNEE LES SC<3 CM $ 3,034.00 CL TX FEMORAL SHAFT FX W MANIP $ 3,038.00 CL TX FEMUR FX OR EPIPHYS SEP $ 3,038.00 CL TX MONTEGGIA ELB FX W MANIP $ 3,038.00 CL TX SHLD DISL W MANI W ANES $ 3,038.00 CL TX ULNAR FX PROX END W MNP $ 3,038.00 CLTX MED ANKLE FX W/MNPJ $ 3,038.00 GALEAZZI FX/DISLOC $ 3,038.00 TENOLYSIS FOOT FLEXOR; SINGLE $ 3,038.00 BIOLOX CER C-TAPER FEM HD 36MM $ 3,060.00 FILTER UNI-CELECT $ 3,062.00 11 X 360MM SUPRACONDYLAR NAIL $ 3,063.00 T2 SUPRA CONDYLAR NAIL 12X340M $ 3,063.00 MDM LINER - CEMENTLESS $ 3,069.00 MDM LINER CEMENTLESS SZ46MM $ 3,069.00 MDM LINER-CEMENTLESS SZ36MM $ 3,069.00 PLATE SHORT LEFT $ 3,075.00 EXC FACE-MM B9+MARG 2.1-3 CM $ 3,095.00 EXC FACE-MM B9+MARG 3.1-4 CM $ 3,095.00 ECLN PWRD PLS ART END LNR CTTR $ 3,101.00 BRONCHOSCOPY $ 3,104.00 MRA LT LOWER EXTR W/O & W/CO $ 3,104.00 MRA*BILATERAL LOW EXT W/O&W/ $ 3,104.00 MRA*RT LOWER EXTR W/O & W/CO $ 3,104.00 MRV*LE W&W/O CONTRAST LEFT $ 3,104.00 MRV*LE W&W/O CONTRAST RIGHT $ 3,104.00 HT MUSCLE IMAGE SPECT MULT $ 3,109.00 ISO*SPECT CARDIAC SCAN-MULTI $ 3,109.00 PRI TRI HEMI CLST HLE CUP 60MM $ 3,109.00 TRITAN HEMI CLST HOLE SHEL 54M $ 3,109.00 TRITAN HEMI CL HOLE SHELL 52MM $ 3,110.00 PHYSIO MOLDABLE 2.5CC $ 3,120.00 TRI HEM ACT SHL 46MM ALPH CD C $ 3,124.00 BIOCLEANSE GRACILIS TENDON $ 3,125.00

�169

BIOCLEANSE SEMITENDINOSUS TEND $ 3,125.00 GRAFIXPL PRIME 9 SQ CM $ 3,125.00 NATRELLE 410 215CC BREAST IMPL $ 3,125.00 NATRELLE 410 495CC BREAST IMPL $ 3,125.00 PROPHECY INBONE ALIGNMENT GUDE $ 3,125.00 PROPHECY INFINITY ALGNMNT BLCK $ 3,125.00 FIRST RAY PLATE SM $ 3,130.00 RP LOCLZJ TUM WHBDY 2+D IMG $ 3,136.00 ERCP INSERTION STENT/TUBE $ 3,137.00 3 HOLE DISTAL HUMERAL PLATE $ 3,146.00 5 HOLE LT MTP PLATE $ 3,161.00 5 HOLE RT PLATE $ 3,161.00 8 HOLE LONG RT PLATE $ 3,161.00 MRI*RT LOWER EXTR W/CONTRAST $ 3,163.00 DESTROY VULVA LESIONS SIMP $ 3,176.00 BIOL DEL C-TAP FEM HEAD 36M+0M $ 3,183.00 T2 LNG PRX HUM NAIL LEFT 220MM $ 3,186.00 PLATE, 6 HOLE RT POSTERIOR $ 3,193.00 NM 99M TC TCHMPAO WBC $ 3,200.00 STRYKER MDM LINER - CEMENTLESS $ 3,205.00 DEST ANAL LESION SIMPLE ELECT $ 3,212.00 EGD CONTROL BLEEDING ANY $ 3,212.00 EGD DILATE STRICTURE $ 3,212.00 EGD INJECTION VARICES $ 3,212.00 EGD PLACE GASTROSTOMY TUBE $ 3,212.00 EGD REMOVE LESION SNARE $ 3,212.00 EGD US TRANSMURAL INJXN/MARK $ 3,212.00 EGD VARICES LIGATION $ 3,212.00 ESOPH EGD DILATION <30 MM $ 3,212.00 ESOPHAGOSCOPY BALLOON <30MM $ 3,212.00 ESOPHAGOSCOPY CONTROL BLEED $ 3,212.00 ESOPHAGOSCOPY LESION REMOVAL $ 3,212.00 ESOPHAGOSCOPY SNARE LES REMV $ 3,212.00 SM INT ENDO W ILEUM; DX $ 3,212.00 SM INTESTINE ENDO W BX SGL/MLT $ 3,212.00 SMALL BOWEL ENDOSCOPY $ 3,212.00 STPLR RELOAD 45MM 6ROW BLU GST $ 3,215.00 LAPIDUS PLATE $ 3,225.00 LAPIDUS STEP PLATE PRECISION $ 3,225.00 PLATE LAPIDUS 3HOLE STAND COMP $ 3,225.00 denosumab 60 mg/mL INJ $ 3,226.74 ALGRFT DBM MIX 10CC $ 3,232.00 M & S SUPPLY- LEVEL 31 $ 3,232.00 STAPLE RELOAD ENDO 45 BLUE $ 3,232.00 STAPLE RELOAD ENDO 45 WHT $ 3,232.00 FASCIA LATA 5 X 19.2CM $ 3,238.00 THERASKIN $ 3,238.00

�170

BASEPLATE TIB S3 UNIKNEE STMD $ 3,250.00 BASEPLT TIB SZ 3 UNIV KNEE REV $ 3,250.00 NATRELLE BREAST IMPL 445CC $ 3,250.00 NATRELLE BREAST IMPL 550CC $ 3,250.00 NIT BONE 20X30X25 2.0MMX3.0MM $ 3,250.00 HAT-TRICK BILATERAL PROC PK $ 3,251.00 PLATE,2.5 DIST RAD LCKG LT 11H $ 3,260.00 RAYHACK LPL BONE PLATE $ 3,263.00 I&D COMPLCATED PILONIDAL SINUS $ 3,276.00 I&D PILONID CYST CPLX $ 3,276.00 NVSTP ARLCK MT PL CLSNG WDG LT $ 3,276.00 NVSTP ARLCK MT PL CLSNG WDG RT $ 3,276.00 NVSTP ARLCK MT PL OPN WDG 3 LT $ 3,276.00 NVSTP ARLCK MT PL OPN WDG 3 RT $ 3,276.00 NVSTP ARLCK MT PL OPN WDG 4 LT $ 3,276.00 NVSTP ARLCK MT PL OPN WDG 4 RT $ 3,276.00 NVSTP ARLCK MT PL OPN WDG 5 RT $ 3,276.00 FLX GRFT GRFTLNK SZ 8.5 L 70MM $ 3,289.00 MRI BREAST W/O&W CON W/CAD UNI $ 3,297.00 EXCHANGE NEPHROSTOMY CATH $ 3,304.00 M & S SUPPLY- LEVEL 32 $ 3,320.00 TIB INS 2 9MM KNX3 CNDRL STAB $ 3,320.00 TIB INS 7 9MM KN X3 CNDRL STAB $ 3,320.00 TIB INSERT 2 11MM KN X3 CNDRL $ 3,320.00 TIB INSRT CS X3 11MM SZ5 $ 3,320.00 TIB INSRT 4 16MM X3 CS TRTHLN $ 3,320.00 TIB INSRT CS X3 9MM SZ3 $ 3,320.00 TIB INSRT CS X3 9MM SZ5 $ 3,320.00 TIB INSRT CS X3 9MM SZ6 $ 3,320.00 TRANSCATH EMBOLIZATION EXTRA $ 3,322.00 TRANSCATH EMBOLIZATION INTRACR $ 3,322.00 TENDON PRE-SUTURED LATRL ANKLE $ 3,323.00 NAVISTAR-BIDIRECTIONAL 4MM TIP $ 3,325.00 ANCHORAGE CP PLATE 2MM LEFT $ 3,338.00 ANCHORAGE MTP CP PLATE LEFT $ 3,338.00 ANCHORAGE MTP CP PLATE RIGHT $ 3,338.00 LAPIDUS CP PLATE LT $ 3,338.00 MRI*CHEST W/O & W/CONTR $ 3,352.00 ACET SHELL, 56MM CLUSTER HOLE $ 3,363.00 TRIDENT II TRIT ACET SHELL S54 $ 3,363.00 TRIDENT PSL ACET SHELL SZ52MM $ 3,363.00 APLIGRAF SKIN SUBS 44 SQ CM $ 3,367.00 SURGIMEND 1.0 6CM X 12CM $ 3,370.00 MRI*BIL LOWER EXT W/O & W/CO $ 3,371.00 MRI*BILAT LOWER JT W/O & W/C $ 3,371.00 MRI*BILAT UPPER JT W/O & W/CON $ 3,371.00 MRI*LT LOWER EXTR W/O & W/CO $ 3,371.00

�171

MRI*LT LOWER JOINT W/O & W/C $ 3,371.00 MRI*LT UPPER EXTREM W/O & W/ $ 3,371.00 MRI*LT UPPER JT W/O & W/CONT $ 3,371.00 MRI*ORBIT,FACE&OR NEK W/O&W/ $ 3,371.00 MRI*RT LOWER EXTR W/O & W/CO $ 3,371.00 MRI*RT LOWER JOINT W/O & W/C $ 3,371.00 MRI*RT UPPER EXTREM W/O & W/ $ 3,371.00 MRI*RT UPPER JT W/O & W/CONT $ 3,371.00 MRI*UE NON-JT W&WO CONT BILAT $ 3,371.00 GRAFT BONE10ML MIX FREEZDRIED $ 3,373.00 6MM X40CM FUSION BIOLINE GRAFT $ 3,375.00 BONE GRAFT SPLIT FEMORAL SHAFT $ 3,375.00 FUSION BIOLINE $ 3,375.00 GRAFIXPL PRIME 12 SQ CM $ 3,375.00 Resp Prone Thrapy Bed ICU only $ 3,380.00 ESWL MACHINE RENT SRVC W/TEC $ 3,392.00 KYPHOPLASTY TRAY 15/3 FF W/OIS $ 3,418.00 M & S SUPPLY- LEVEL 33 $ 3,418.00 NM 99M TC TCHMPAO BRAIN $ 3,418.00 BASEPLATE TIB UNIV SZ5 $ 3,419.00 REMOVE TUNNELED IP CATH $ 3,425.00 MRI CERV SPINE W & WO CONTR $ 3,426.00 MRI THORAC SPINE W & WO CONTR $ 3,426.00 MRI*C SPINE, WITH AND W/O $ 3,426.00 MRI*LUMBAR W/O & W/CONTR $ 3,426.00 MRI*THORACIC W/O AND W/CON $ 3,426.00 VITOSS BA2X FOAM PACK 2.5CC $ 3,430.00 BLX DLTA UN TPR ANAT HD SZ36+0 $ 3,439.00 ENDURON ACET CUP 20DEG $ 3,439.00 WRIGHT TCP 30MM T PLATE (BLUE) $ 3,451.00 ANCHORAGE MTP RIGHT PLATE $ 3,471.00 RTS FLXB 1ST MPJ IMP W/GRMT S2 $ 3,473.00 APSKINSUB FEETWOND>100CM<100 $ 3,476.00 APSKINSUB FEETWOUND<100CM<25 $ 3,476.00 APSKINSUB LEGWOUND<100CM,<25 $ 3,476.00 T8 5 HOLE SLIM STRAIGHT PLATE $ 3,478.00 MRI BREAST W/O&W CON W/CAD BI $ 3,484.00 6 X 35MM CORTICAL FIXED SCREW $ 3,488.00 6 X 40MM CORTICAL SCREW $ 3,488.00 6X30MM CORTICAL FIXED SCREW $ 3,488.00 7 X 30MM CORTICAL FIXED SCREW $ 3,488.00 7 X 35MM CORTICAL FIXED SCREW $ 3,488.00 7 X 40MM CORTICAL FIXED SCREW $ 3,488.00 8 X 40MM CORTICAL FIXED SCREW $ 3,488.00 SYNTHES 6X45MM CRTCL FIXED SCR $ 3,488.00 SYNTHES 7X45MM CORT FIXED SCR $ 3,488.00 NUSHIELD 3X4 SQ CM $ 3,500.00

�172

QUADRANT ILLUM AND USAGE FEE $ 3,506.00 CT-ABD & PELVIS W/O CONTRAST $ 3,509.00 75MMX18MM UNIVRSAL FLUTED STEM $ 3,520.00 DELIVERY OF PLACENTA $ 3,528.00 ATT S/A/L;D 10 SQ CM/< $ 3,529.00 EXPL P WND;ABD/FLANK $ 3,529.00 8 HOLE TI MATRIX UNIV RIB PLT $ 3,530.00 RT MEDIAL TIBIAL TRAY SZ B $ 3,538.00 RT MEDIAL TIBIAL TRAY SZ D $ 3,538.00 HAT-TRICK PIP FUS IMP 3.2 X4MM $ 3,549.00 HAT-TRICK PIP FUS IMP 3.7 X4MM $ 3,549.00 MRI BRAIN W & WO CONTRAST $ 3,560.00 10.0MM X 4.0MM STEM $ 3,570.00 INS PICC DEVICE W PORT 5 YRS/> $ 3,570.00 INS TUNNELED CV CATH AGE 5/> $ 3,570.00 REPLACE TUNNELED CV CATH $ 3,570.00 ADJUSTMENT DRIVER(BLUE HANDLE) $ 3,574.00 MEDIUM RIGHT CALCANEAL PLATE $ 3,588.00 NOVASTEP AIRLCK MTP PT STAN LT $ 3,588.00 COMP FEM 4 L KNEE NP PRI CEM $ 3,591.00 COMP FEM 5 R KNEE NP PRI CEM $ 3,591.00 COMP FEM SZ 6 PERI-APATITE NP $ 3,591.00 COMPONENT FEM3 LEFT KNEE CMNT $ 3,591.00 COMPONENT FEM6 LKNEE NONBEADED $ 3,591.00 COMPONENT FEM6 RKNEE NONBEADED $ 3,591.00 COMPONNT FEM3 PERI-APTTE LKNEE $ 3,591.00 COMPONNT FEM3 PERI-APTTE RKNEE $ 3,591.00 COMPONNT FEM4 LKNEE NPORE CMNT $ 3,591.00 COMPONNT FEM4 PERI-APTTE LKNEE $ 3,591.00 COMPONNT FEM4 PERI-APTTE RKNEE $ 3,591.00 COMPONNT FEM5 LKNEE NPORE CMNT $ 3,591.00 COMPONNT FEM5 PERI-APTTE RKNEE $ 3,591.00 COMPONNT FEM5 RKNEE NPORE CMNT $ 3,591.00 FEMORAL POSTERIOR STABILZD S7 $ 3,591.00 FEMORAL,TRIATHLON POST STAB S2 $ 3,591.00 GLSPHR 36MMX2MM THK CNCNTRC $ 3,591.00 REUNION HUM CUP 32MMDX4MM THK $ 3,591.00 REUNION HUMERAL CUP 36MMX4MM $ 3,591.00 REUNION X3 HUM INS 32X4 CONSTR $ 3,591.00 REUNION X3 HUM INS 36MM X 4 $ 3,591.00 REUNN GLNSPHR 32X2MM THK CNCNT $ 3,591.00 STRYKER #3 FEMUR $ 3,591.00 STRYKER FEMUR PS #4 $ 3,591.00 TRI PS FEMORL COMP CEMENTED 6L $ 3,591.00 6 X 46MM ASNIS IF SCREW $ 3,600.00 RTS FLX 1ST MPJ IMP W GRMTS S4 $ 3,611.00 RTS FLX 1ST MPJ IMP W/ GMTS S3 $ 3,611.00

�173

EGD WITH PH PROBE PLACEMENT $ 3,619.00 MOBILE BEARING 8MM $ 3,620.00 DESTROY LUMB/SAC FACET JNT $ 3,624.00 250CC TISSUE EXPANDER $ 3,625.00 CPX4 BREAST TISSUE EXPANDER $ 3,625.00 CPX4 MED HGHT TISSUE EXPANDER $ 3,625.00 CPX4 SLTX CONT PRO TISEXP MHT $ 3,625.00 CPX4SLTEXCTRPRFLTSSEXPNDR750CC $ 3,625.00 LIGAMENT REPAIR SYS BROSTROM $ 3,625.00 TISSUE EXPANDER 350CC $ 3,625.00 SYNTHES 6 X 40MM CORT FIXD SCR $ 3,627.00 SYNTHES 6 X 50MM CORT FIXD SCR $ 3,627.00 ACHILLES KIT MIDSUBSPEEDBRIDGE $ 3,631.00 M & S SUPPLY- LEVEL 35 $ 3,631.00 M&S SUPPLY-LEVEL 35 $ 3,631.00 TIB BSPLT UNIV SZ5 $ 3,631.00 METAL HEMI IMPL - MED $ 3,653.00 INTENSIVE CARE NURS $ 3,655.00 LEVEL 2 NURSERY $ 3,655.00 SPECIAL CARE NURS $ 3,655.00 0MM LAPIDUS PLATE $ 3,663.00 1MM LAPIDUS PLATE $ 3,663.00 MTP FUSION PLATE, SM 0DEG LT $ 3,663.00 MTP FUSION PLATE, SM 0DEG RT $ 3,663.00 MTP FUSION PLATE, SM 5DEG LT $ 3,663.00 MTP FUSION PLT 5 DEG RT $ 3,663.00 PLATE BONE 6HOLE ORTHOLOC 3DI $ 3,663.00 PLT BONE THK0MM 10DEG 6 H FLAT $ 3,663.00 REVISE FINGER/TOE NERVE 1-2 $ 3,671.00 CL TX RADIAL & ULNA FX W MANIP $ 3,680.00 EXC HAND LES SC < 1.5 CM $ 3,680.00 EXC LEG/ANKLE TUM < 3 CM $ 3,680.00 INTMD WND RPR FC/MM 7.6-12.5CM $ 3,680.00 ITMD WNDRPR S/TR/EXT7.6-12.5CM $ 3,680.00 LIGATION OR BX TEMPORAL ART $ 3,680.00 NEURPLSTY MDN NERVE AT CRP TNL $ 3,680.00 NEURPLSTY ULNAR NERVE AT ELBOW $ 3,680.00 PERICARDIOCENTESIS INITIAL $ 3,680.00 PERICARDIOCENTESIS SUBSEQUENT $ 3,680.00 PERICARDIOCENTSIS $ 3,680.00 RP LCR 2.5CM/< FLR MTH/ANT 2/3 $ 3,680.00 TENDON SHEATH INCISION $ 3,680.00 ABD PARACENTESIS W/O IMAGING $ 3,681.00 CL TX ARTFX MCP/IP JNT W MANIP $ 3,681.00 CLTX SHDR DSLOC W NK FX W MNP $ 3,681.00 INSERTION OF CHEST TUBE $ 3,681.00 HC UPPER GI W/STENT PLACEMENT $ 3,685.00

�174

CATH LAB-LHC W/WO VGRAM & RH $ 3,687.00 SLIDING CORE 7MM $ 3,688.00 SLIDING CORE UHMPWE 6MM $ 3,688.00 TRANSEPTAL CATH $ 3,698.00 DRAIN BL W/CATH INSERTION $ 3,700.00 SLIT PRPCE DRSL/ LAT NOT NWBRN $ 3,700.00 SP*LEFT-DILATION OF NEPHROST $ 3,701.00 SP*RIGHT-DILATION OF NEPHROS $ 3,701.00 STPLR RELOAD 60MM 6ROW BLU GST $ 3,708.00 STAPLER ECHELON 60MM $ 3,722.00 X3 HUM INS 36MMX4 CONSTRAINED $ 3,734.00 HANDJACKET SCAFFOLD THIN 2X4CM $ 3,738.00 BALLOON LUTONIX 4 X 100 X 130 $ 3,750.00 BALLOON LUTONIX 4 X 40 X130 $ 3,750.00 BALLOON LUTONIX 4 X 60 X 130 $ 3,750.00 BALLOON LUTONIX 4 X 80 X 130 $ 3,750.00 BALLOON LUTONIX 5 X 100 X 130 $ 3,750.00 BALLOON LUTONIX 5 X 40 X 130 $ 3,750.00 BALLOON LUTONIX 5 X 60 X 130 $ 3,750.00 BALLOON LUTONIX 5 X 80 X 130 $ 3,750.00 BALLOON LUTONIX 6 X 100 X 130 $ 3,750.00 BALLOON LUTONIX 6 X 40 X 130 $ 3,750.00 BALLOON LUTONIX 6 X 60 X 130 $ 3,750.00 BALLOON LUTONIX 6 X 80 X 130 $ 3,750.00 HEMI FEMORAL SHAFT 166-202MM $ 3,750.00 TRI PS FEMORL COMP CEMENTED 5R $ 3,750.00 TRI PS FEMRAL COMP CEMENTED 4L $ 3,750.00 6 HOLE PLATE LEFT $ 3,758.00 6 HOLE SUPER MIDSHAFT PLATE RT $ 3,758.00 7 HOLE CLAVICLE PLATE $ 3,758.00 RT SUP DECREASED CURVTR PLATE $ 3,758.00 CATH LAB-INTRA AORTIC BALLON $ 3,769.00 PLMT NEPHROSTOMY CATHETER $ 3,775.00 WRGT MTP SM PLATE RIGHT AQUA $ 3,776.00 ECHO TRANSESOPHAGEAL $ 3,795.00 ECHO TRANSESOPHAGEAL COMPLETE $ 3,795.00 STS IMPLANT 10.5MM $ 3,799.00 3 HOLE DISTAL POST LAT HUM PLT $ 3,808.00 3 HOLE MEDIAL PLATE $ 3,808.00 3 HOLE OLECRANON PLT LT $ 3,808.00 3 HOLE VARIAX DIST MED HUM PLT $ 3,808.00 4 HOLE SLIM Y-PLATE $ 3,810.00 BASEPLATE4 TIBIAL UNI KNEE STD $ 3,813.00 CHANGE NEPHROURETERAL CATH $ 3,816.00 I & D EPIDIDYMIS TSTS/SCRTL SP $ 3,816.00 I&D EPIDIDYMS TSTIS/SCROTAL SP $ 3,816.00 OR*INTERVENTIONAL 1HR $ 3,819.00

�175

MRI*PELVIS W/O & W/CONTR $ 3,821.00 MRV*PELVIS W&W/O CONTRAST $ 3,821.00 BASEPLATE TIB S4 KEEL PEG CMT $ 3,830.00 TIBIAL COMPONENT SZ 4 $ 3,830.00 TIBIAL COMPONENT SZ 5 $ 3,830.00 TRIATHLON TRITANIUM BASEPLT S6 $ 3,830.00 TRIATHLON TRITNIUM BASEPLT SZ4 $ 3,830.00 TRITHLN TRITANIUM BASEPLATE S7 $ 3,830.00 M&S SUPPLY-LEVEL 37 $ 3,847.00 NAIL ANK RT 10X150MM $ 3,847.00 DBM PUTTY 5CC $ 3,850.00 GRAFTBONE PUTTY MTRX IMP 5ML $ 3,850.00 TOT OBTRYX II HALO $ 3,850.00 PERFRINGENS CLOST DBX PTY 10CC $ 3,865.00 GLBL ADV SHLDR HUM HD SZ 48X15 $ 3,875.00 HEAD HUM 52X18 GLBL ADVANTAGE $ 3,875.00 MINOR SURGERY 1ST HR $ 3,890.00 PERICARDIOCENTESIS W/IMAGING $ 3,892.00 PERQ PRCRD DRG INSJ CATH CT $ 3,892.00 PRCRD DRG 0-5YR OR W/ANOMLY $ 3,892.00 PRCRD DRG 6YR+ W/O CGEN CAR $ 3,892.00 POSTERIOR FEMORAL STRYKER SZ3 $ 3,900.00 PURAPLY 5X5 CM $ 3,900.00 STRYKER COMP FEMRL TRITN CMNTD $ 3,900.00 TRIAT CRUC RETAIN FMRL CR LT#3 $ 3,900.00 TRIAT CRUC RETAN FMRL CR LTSZ5 $ 3,900.00 TRIATH CRUCI RETAIN FML SZ3 RT $ 3,900.00 TRIATH PS FMRL COMP #7 RT CMNT $ 3,900.00 TRIATHLON PS FEM COMP CEMENTED $ 3,900.00 MRI*BRAIN W/O-W CONTRAST $ 3,915.00 STPLR RELOAD 60MM 6ROW GLD GST $ 3,932.00 RAD HEAD ANTMC SYS 9X2MM STEM $ 3,935.00 TIB/PER REVASC ADD-ON BIL $ 3,944.00 NAVISTAR BIDIRECTIONAL 8MM TIP $ 3,966.00 PROCEDURE SET HTA PROCERVA $ 3,968.00 ENDOVENOUS LASER VEIN ADDON $ 3,986.00 BREAST TISSUE EXPANDER 350CC $ 3,988.00 TISSUE EXPANDER 500CC $ 3,988.00 TRI TRITANIUM RADIAL COMP SZ 3 $ 4,000.00 ALLOGRAFT DBM PLUS PUTTY 5CC $ 4,004.00 INBONE TIBIAL TRAY LT SZ3L $ 4,005.00 2.4MM VA LCP DISTRAD PLT 6HOLE $ 4,018.00 CL TX TMJ DISLOCATION; COMPLIC $ 4,048.00 DEB MUSC/FASCIA 20 SQ CM/< $ 4,048.00 IMD WND RPR NHF GNT 12.6X20CM $ 4,048.00 INT WND RPR S/A/T/EXT20.1-30CM $ 4,048.00 INTMD WND REPAIR N-HF/GENIT $ 4,048.00

�176

WRC-DEBRID,MUSCLE/FASCIA<=20 $ 4,048.00 ABD PARACENTESIS W/IMAGING $ 4,049.00 ASPIRATE PLEURA W/ IMAGING $ 4,049.00 CL TX EC HUMERUS FX W MANIP $ 4,049.00 CL TX PROX HUMERAL FX W MANIP $ 4,049.00 CL TX PROX HUMERAL FX; W MANIP $ 4,049.00 CL TX SC/TC FEMUR FX W MANIP $ 4,049.00 CL TX SHLDR DISLOC&FX GT W MAN $ 4,049.00 CLOSED RX PROX HUMERUS FX $ 4,049.00 CREP F/G/H/F; 1-2.5CM $ 4,049.00 DEB BONE 20 SQ CM/< $ 4,049.00 EXC ARM/ELBOW LES SC < 3 CM $ 4,049.00 EXC ARM/ELBOW LEX SC < 3 CM $ 4,049.00 EXC BACK LES SC < 3 CM $ 4,049.00 EXC BEN LES T/A/L; > 4.0CM $ 4,049.00 EXC TR-EXT B9+MARG >4.0 CM $ 4,049.00 EXC TR-EXT MAL+MARG 3.1-4 CM $ 4,049.00 IMAGE CATH FLUID PERI/RETRO $ 4,049.00 INF BURSA I&D - FARM/WRIST $ 4,049.00 INF BURSA I&D - UA/ELBOW $ 4,049.00 INF BURSA I&D UA/ELBOW $ 4,049.00 INTMD WND RPR FC/MM12.6-20.0CM $ 4,049.00 LARYNGOSCOPY W/FB REMOVAL $ 4,049.00 LCL SURG WND/DEH EXTENS $ 4,049.00 SREP F/E/N/L/MM 12.6-20.0CM $ 4,049.00 TX CL ELBOW DISLOC W ANESTH $ 4,049.00 WRC-DEBRID, BONE <= 20 SQ CM $ 4,049.00 WRC-EXCIS MALIG LESION 3-4CM $ 4,049.00 CATHETER SOLENT PROXI 6F X90CM $ 4,050.00 FUSN BIOLINE VAS GRFT 6MMX60CM $ 4,050.00 ANGIO PULMONARY CATH, NONSEL $ 4,059.00 LC-APSKINSB LEGWND>100CM<100CM $ 4,062.00 EGD WITH MANOMETRY PROBE PLACE $ 4,076.00 TRIATHLON TK UNIV BASEPLATE S2 $ 4,094.00 TRIATHLON UNI TIB BASEPLATE S6 $ 4,094.00 UNIV TIB BASEPLATE SZ7 $ 4,094.00 INBONE POLY INSERT SZ2+ $ 4,105.00 REM IO FB ANTCHAMB/LENS $ 4,105.00 BIOCLEANSE SEMITENDINOSUS TNDN $ 4,125.00 IMPLANT DELIVRY SYS PEC REPAIR $ 4,125.00 ESOPHAGEAL MOT MAN PROB PLACEM $ 4,137.00 4 HOLE T10 STRAIGHT PLT $ 4,140.00 5 HOLE T10 STRAIGHT PLT $ 4,140.00 6 HOLE T10 STRAIGHT PLT $ 4,140.00 PLATE 7 HOLE NARROW $ 4,140.00 3D TIBIAL INSERT SZ4 $ 4,141.00 INTERMEDIATE CARE UNIT $ 4,143.00

�177

LPT REG GREAT TOE SZ 0 $ 4,145.00 LPT REGULAR GREAT TOE IMPL SZ1 $ 4,145.00 SP*LEFT-EA ADD'L VESSEL AFT $ 4,147.00 SP*RIGHT-EA ADD'L VESSE AFT $ 4,147.00 EGD, W/DILATION BALLOON $ 4,152.00 TRIATHLON TRITAN BASEPLATE SZ2 $ 4,160.00 PLATE, 8 HOLE MIDSHAFT $ 4,175.00 2.4MM 2CLM VLRDST PLT LFT 6H3S $ 4,178.00 DRAIN/INJ INT JNT/BURSA W/O US $ 4,178.00 DRAIN/INJ INTER JNT/BRS W/O US $ 4,178.00 DRAIN/INJ INTER JNT/BRSA W/US $ 4,178.00 DRAIN/INJ INTER JNT/BURSA W/US $ 4,178.00 DRAIN/INJ INTER JT/BUSA W/O US $ 4,178.00 DRAIN/INJ INTR JNT/BRSA W/O US $ 4,178.00 DRAIN/INJ MAJOR JNT/BRS W/O US $ 4,178.00 DRAIN/INJ MAJOR JNT/BUR W/O US $ 4,178.00 DRAIN/INJ MAJOR JNT/BURSA W/US $ 4,178.00 DRAIN/INJ MAJOR JOINT/BURSA W/ $ 4,178.00 DRAIN/INJ MAJOR JT/BUSA W/O US $ 4,178.00 DRAIN/INJ MJR JNT/BURSA W/O US $ 4,178.00 DRAIN/INJ SM JOINT/BRSA W/O US $ 4,178.00 DRAIN/INJ SML JNT/BRSA W/US $ 4,178.00 DRAIN/INJ SML JNT/BURSA W/O US $ 4,178.00 DRN/INJ INTER JNT/BURSA W/O US $ 4,178.00 DRN/INJ MAJR JNT/BURSA W/O US $ 4,178.00 DRN/INJ SML JNT/BURSA W/O US $ 4,178.00 IR DRAIN/INJ MJR JNT/BRSA W/US $ 4,178.00 IR DRAIN/INJ SML JNT/BRSA W/US $ 4,178.00 IR DRN/INJ MJR JNT/BRSA W/O US $ 4,178.00 ORTH CLCN FRCT LKNG PLT PER SM $ 4,183.00 ORTHO FRACT LK PLATE TAB X-SM $ 4,184.00 CATHETER ANGIOJET THROMBECTMY $ 4,188.00 FRONTAL SYSTEM F-70 $ 4,188.00 HEMI ACETABULAR SHELL 52MM $ 4,188.00 ILIAC REVASC W/STENT ADD-ON $ 4,188.00 TRDT HMSPHRCL ACTBLR SHLL 52MM $ 4,188.00 U PLATE SMALL, RT $ 4,208.00 CATH LAB-LEFT HEART W/WO VGRAM $ 4,211.00 ALGRFT BONE 2.5CC MATRX VIABLE $ 4,231.00 SET DISPOSABLE HIP CANNULA $ 4,235.00 ANCHORAGE PLT CUBOID RT $ 4,238.00 AMNION MATRIX THICK 2 X 3CM $ 4,250.00 INTRALUMINAL DILATION STRICT $ 4,261.00 NAVISTAR THERMCOOL SF W/CUR VI $ 4,275.00 TIBIAL BASEPLATE TRIATHLON SZ4 $ 4,276.00 TRI TOT KNEE UNIV TIB BPLT SZ3 $ 4,276.00 RNN SHOULDR DUAL RADHUM HD40MM $ 4,281.00

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OR*INTERVENTIONAL 2HRS $ 4,297.00 ACHILLES SPEEDBRIDGE IMP SYS $ 4,300.00 CATHETER SOLENT OMNI 6F X120CM $ 4,300.00 M & S SUPPLY- LEVEL 41 $ 4,300.00 M&S SUPPLY-LEVEL 41 $ 4,300.00 INS NON-TUNNEL CV CATH 5 YRS/> $ 4,313.00 CYTOGEN M ARRAY COPY NO&SNP $ 4,350.00 SPEEDBRIDGE 4.75 X 19.1MM $ 4,350.00 ARTELON STRIP 0.3X8CM $ 4,355.00 AUGMENT BONE GRAFT 1.5CC $ 4,369.00 LASER ABLTN EXT VEIN 1ST VEIN $ 4,421.00 PROGRESSIVE CARE SEMI $ 4,434.00 ISO*SPECT CARDIAC SCAN-SINGL $ 4,436.00 TOGGLELOC W/ZIPLOOP $ 4,438.00 SPDBRG W/BIOCOMP SWIVELOCK SP $ 4,450.00 CATH LAB-RIGHT HEART $ 4,469.00 3 HOLE BROAD WIDE PLATE $ 4,473.00 4 HOLE PLATE $ 4,473.00 MRI*ABDOMEN W/O & W/CONTRAST $ 4,474.00 STENT ZILVER PTX 6 X 100 X 125 $ 4,488.00 STENT ZILVER PTX 6 X 120 X 125 $ 4,488.00 STENT ZILVER PTX 6 X 40 X 125 $ 4,488.00 STENT ZILVER PTX 6 X 60 X 125 $ 4,488.00 STENT ZILVER PTX 6 X 80 X 125 $ 4,488.00 STENT ZILVER PTX 7 X 100 X 125 $ 4,488.00 STENT ZILVER PTX 7 X 120 X 125 $ 4,488.00 STENT ZILVER PTX 7 X 40 X 125 $ 4,488.00 STENT ZILVER PTX 7 X 60 X 125 $ 4,488.00 STENT ZILVER PTX 7 X 80 X 125 $ 4,488.00 STENT ZILVER PTX 8 X 100 X 125 $ 4,488.00 STENT ZILVER PTX 8 X 120 X 125 $ 4,488.00 STENT ZILVER PTX 8 X 40 X 125 $ 4,488.00 STENT ZILVER PTX 8 X 60 X 125 $ 4,488.00 STENT ZILVER PTX 8 X 80 X 125 $ 4,488.00 POLY LCKNG NAVICULAR PLT RT T8 $ 4,493.00 POLY LOCKING NAVICULAR PLT LT $ 4,493.00 CARD CATH OR COMPONENT 1ST HR $ 4,495.00 5 X 44MM SOLID SCREW $ 4,500.00 6 X 55MM SOLID SCREW $ 4,500.00 I-123 IOFLUPANE DATSCAN $ 4,500.00 TIBIAL, RT MED/LT LAT TRAY SZ3 $ 4,500.00 TIBL TRAY CEM S3 LT MED/RT LAT $ 4,500.00 TRAY SHOULDER THICK +0MM 1.5 $ 4,500.00 STRAVIX 2X4CM $ 4,512.00 NAIL POLARUS 240MM $ 4,520.00 SOUNDSTAR ULTRASOUND $ 4,532.00 INS TUNNEL CVAD W PORT 5 YRS/> $ 4,534.00

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LATERAL ANKLE RECONST IMPL SYS $ 4,550.00 CT-ABD & PELVIS W/ CONTRAST $ 4,557.00 CT-ABD & PELVIS WITH CONTRAS $ 4,557.00 SEMITENDINOSUS TENDON FF $ 4,568.00 NAIL ANK LT 11X150MM T2 $ 4,575.00 NAIL ANK RT 11X200MM $ 4,575.00 T2 ANKL ARTRDS NL 12X200MM LT $ 4,575.00 EP DEVICE PROC CCL 1 HOUR $ 4,590.00 ABSC CYST CONSTRAST INJ $ 4,596.00 ASPIR/INJ THYROID CYST $ 4,596.00 BALO ANGIOP CTR DIALYSIS SEG $ 4,596.00 BIOPSY SALIVARY GLAND; NEEDLE $ 4,596.00 BIOPSY THYROID PERC CORE NEEDL $ 4,596.00 CONVERT NEPHROSTOMY CATHETER $ 4,596.00 DIALYSIS CIRCUIT EMBOLJ $ 4,596.00 DX BONE MARROW BIOPSIES $ 4,596.00 EXCHANGE PREVIOUS DRAINGE CATH $ 4,596.00 EXTREM VENOGRAM INJ $ 4,596.00 GUIDE CATHET FLUID DRAINAGE $ 4,596.00 HIP ARTHROGRAPHY INJ WO ANESTH $ 4,596.00 INJ URETRGRM THRU INDWELL CATH $ 4,596.00 INJ W/FLUOR EVAL CV DEVICE $ 4,596.00 INJECTION FOR CHOLANGIOGRAM $ 4,596.00 INS CATH ABD/L-EXT ART 2ND $ 4,596.00 INS CATH ABD/L-EXT ART 3RD $ 4,596.00 INSERT CATH PLEURA W/ IMAGE $ 4,596.00 INTRO CATH DIALYSIS CIRCUIT $ 4,596.00 NJX SCLRSNT 1 INCMPTNT VEIN $ 4,596.00 NJX SCLRSNT MLT INCMPTNT VN $ 4,596.00 NONSELECTIVE CATH - AORTA $ 4,596.00 PHLEB VEINS EXTREM 20+ $ 4,596.00 PLMT NEPHROURETERAL CATHETER $ 4,596.00 PLMT URETERAL STENT PRQ $ 4,596.00 REMOVAL BILIARY DRG CATH $ 4,596.00 REMOVE INTRVAS FOREIGN BODY $ 4,596.00 REMOVE LUNG CATHETER $ 4,596.00 REMOVE RENAL TUBE W/FLUORO $ 4,596.00 REMOVE URETER STENT PERCUT $ 4,596.00 REPLACE DUOD/JEJ TUBE PERC $ 4,596.00 SA MECH REM OBSTR CVAD $ 4,596.00 SELECT CATH VEIN 2ND ORD FAMLY $ 4,596.00 SELECTVE CATH VEIN 1ST ORD FAM $ 4,596.00 SHOULDER ARTHROGRAM INJ $ 4,596.00 SINUS TRACT INJ DX $ 4,596.00 STAB PHLEB VEINS XTR 10-20 $ 4,596.00 TRANSCATHETER BX $ 4,596.00 WRIST ARTHROGRAPHY INJ $ 4,596.00

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INSERT PLEURAL CATH $ 4,597.00 INSERT TUN IP CATH PERC $ 4,597.00 140 FULL RINGS $ 4,635.00 210 FULL RINGS $ 4,635.00 SCREW 5 X 55MM CANN $ 4,635.00 SCREW 5 X 60MM COMPRESSION $ 4,635.00 SUMMIT PRESS-FIT STEM SZ8 $ 4,656.00 HEAD HUM REUNION TSA SR 52X23 $ 4,659.00 HEAD HUMERAL STANDRD 48X18MM $ 4,659.00 REUNION TSA SGL RAD HUM HD S52 $ 4,659.00 TSA SINGLE RAD HUM HEAD S40X14 $ 4,659.00 CRITICAL CARE 1ST HOUR $ 4,680.00 PROGRESS CARE PVT HOSP C $ 4,694.00 PROGRESS CARE PVT MED JU $ 4,694.00 PROGRESS CARE PVT PT REQ $ 4,694.00 OR-INTERVENTIONAL 4HRS $ 4,698.00 LONG TELESCOPIC STRUTS $ 4,700.00 EXPL P WND EXTREM $ 4,710.00 I&D HEMATOMA/FLUID $ 4,710.00 WRC-I & D HEMATOMA $ 4,710.00 MAJOR ROBOTIC SURGERY 1ST HR $ 4,719.00 MAJOR SURGERY 1ST HR $ 4,719.00 35MM STND ARTIC ENDSCPCLNR CUT $ 4,730.00 OR*INTERVENTIONAL 3HRS $ 4,732.00 ESOPHAGEAL COIL STENT $ 4,747.00 POLY LCKNG PLT-LT SHORT $ 4,750.00 POLY LOCKING PLT SHORT RT $ 4,750.00 7MM INFINITY POLY SZ3+ $ 4,780.00 COMP FEM KNEE CRUC RET SZ 4 R $ 4,788.00 COMP FEM KNEE CRUC RET SZ 5 R $ 4,788.00 COMPONENT FEM CR5 RT BEAD W/PA $ 4,788.00 COMPONENT FEM6 LEFTKNEE BEADED $ 4,788.00 COMPONENT FEM6 RKNEE BEADED $ 4,788.00 CR FEMCOMP 7 RIGHT BEADED W/PA $ 4,788.00 CRUCIATE RETAINING FEMORAL SZ $ 4,788.00 FEMORAL CRUCIATE RETAINING SZ $ 4,788.00 FEMORAL, TRIATHLON PKR COMP S4 $ 4,788.00 MSH BLYR MTRX 2INX2IN 5CMX5CM $ 4,788.00 REUNION GLENOID BASEPLATE 28MM $ 4,788.00 TRI CR FEM CMP 5 LFT BEAD W/PA $ 4,788.00 TRI CR FEM COMP 3 RT BEAD W/PA $ 4,788.00 TRI POST STABILIZD FEM S6 LEFT $ 4,788.00 TRI PS FEM COMP- BEADED W/PA $ 4,788.00 TRI PS FEM COMP BEADED W/PA 30 $ 4,788.00 TRI PS FEM COMP BEADED W/PA S6 $ 4,788.00 TRI PS FEM COMP-BEAD W/PA 5 RT $ 4,788.00 TRIAT CR FEM COMP #2 LT BEADED $ 4,788.00

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TRIATHLN POST STABILIZD FEMERL $ 4,788.00 TRIATHLON CR FEMORAL COMP SZ2 $ 4,788.00 REM ENDOVAS VENA CAVA FILTER $ 4,791.00 ARTELON STRIP 0.5X8CM $ 4,805.00 TIBPER REVASC W/ATHR ADDON BIL $ 4,812.00 EX ARM/ELBOW TUM DEEP < 5 CM $ 4,835.00 I&D CPLX POSTOP WND INF $ 4,835.00 I&D VAGINAL HEMATOMA NOT OB $ 4,835.00 REM IMPL DEEP $ 4,835.00 WRC-I & D ABCESS $ 4,835.00 HUM HEAD TSA SGL RAD 52/17MM $ 4,865.00 RADIUS HUMERAL HEAD $ 4,865.00 REUN HA FRAT STEM HUM COP 10M $ 4,865.00 HEAD HUMERAL 4MM OFFST48X18MM $ 4,866.00 RE TSA SNGL RAD HUM HD SZ44X19 $ 4,866.00 REUNION TSA - SR 4MM OFFSET HU $ 4,866.00 REUNION TSA SGL RAD HUM HD S44 $ 4,866.00 REUNION TSA SGL RD HM HEAD S52 $ 4,866.00 REUNION TSA SNGL RAD HUMHD S52 $ 4,866.00 REUNN TSA SNGL RAD HUM HD SZ48 $ 4,866.00 REUNON TSA SGL RAD HUM HD SZ40 $ 4,866.00 RN TSA SGL RAD HUM HEAD S48 $ 4,866.00 RN TSA SGL RAD HUM HEAD S56 $ 4,866.00 EVICEL FIBRIN SEALANT 5ML $ 4,870.00 CORONARY THROMBECTOMY $ 4,874.00 RELIEV SPNPLS BLLN SNPLSTY SYS $ 4,875.00 BX ANORECTAL WALL ANL APPROACH $ 4,876.00 DESTROY ANAL LES SMPL SURG EXC $ 4,877.00 CL TX NASAL BONE FX W STABILIZ $ 4,891.00 SIALOLITHOTOMY SM UNCMPLCTD $ 4,891.00 WRIGHT MED PRO-DENSE INJ 4CC $ 4,894.00 KT IMPL GUID PIN OD2.4MM 2 $ 4,900.00 ACCLDE C127 DEG CEM HIPSTEM S3 $ 4,914.00 ACCOLADE 127DEG CEM HIP STM S5 $ 4,914.00 ACCOLADE C CEM HIP STEM SZ2 $ 4,914.00 HIP STEM, ACCL C 127DEG CEM S6 $ 4,914.00 STEM HIP 127DEG CEMENTED SZ4 $ 4,914.00 BIO4 5CC VIABLE BONE MATRIX $ 4,950.00 PFC SIGMA CROSS-LINKED PLI INS $ 4,950.00 4 HOLE LOCKING COMPRESSION PLT $ 4,975.00 TOE TAC HAMMERTOE FIX SYS MED $ 4,975.00 TOE TAC HAMMERTOE FIX SYS SM $ 4,975.00 TOETAC XPRESS MED $ 4,975.00 OP TX OF NASAL FX UNCOMPLICATD $ 4,988.00 TYRX MED ABS ANTIBACTERIAL ENV $ 4,988.00 IMPLANT METAL HEMI GRT TOE MED $ 4,998.00 METAL HEMI TOE IMPL - LG $ 4,998.00

�182

ANC SUT BCMP PSHLCK 2.9X12.5MM $ 5,000.00 SLF CNT BI-PO HD 28MMID 56MMOD $ 5,000.00 SUT AN BCMP SWLK CE 5.5X19.1MM $ 5,000.00 TRLN PST STBL FM SZ3 SDRT TPPS $ 5,000.00 TRTHLN PSTRR STBLZD FEM SZ5 LT $ 5,000.00 TWIN PEG FEMORAL - MED $ 5,000.00 TWIN PEG FEMORAL SM $ 5,000.00 TWIN PEG FEMORAL SZ LG $ 5,000.00 2.5CMX10CM GRAFTON DBM MATRIX $ 5,003.00 BONE MATRIX DEMIN 2.5CMX5CM $ 5,003.00 POLY LCKNG NC PLT - RT LONG $ 5,008.00 REUNN TSA SR STND HUM HD 44X22 $ 5,061.00 8 X 19.5MM SUTURE ANCHOR $ 5,063.00 PLATE TIBIAL 2HOLE RIGHT LATRL $ 5,067.00 TIBIAL PROXMAL LATERAL PLATES $ 5,067.00 SMALL TRICORTICAL WEDGE $ 5,075.00 GRAFT, DECELLULARIZED DERMIS $ 5,082.00 REUNIN TSA SGL RAD HUM HD SZ48 $ 5,082.00 10 HOLE DIST POST LAT HUM PLT $ 5,100.00 TOTAL STABILIZER TIB INSERT S7 $ 5,105.00 TRI TOT STABILIZER+ TIB INS S5 $ 5,105.00 TRIATHLON X3 TIB INS - 25MM $ 5,105.00 TRIATHLON X3 TOT STAB+ TIB INS $ 5,105.00 EXT CEPHALIC VERSION $ 5,114.00 ACCLD C 127DEG CEM HIP STM SZ4 $ 5,132.00 BRONCHOSCOPY FLEXIBLE $ 5,142.00 TIBIAL INSERT ROTATING PLATFRM $ 5,151.00 11 X 360MM LONG NAIL KIT LT $ 5,160.00 11X340 LONG NAIL KIT $ 5,160.00 11X400MM LNG NL KT R1.5 TI RT $ 5,160.00 LG NLKT R1/5TI RT 11X360MMX125 $ 5,160.00 LGNLKIT R1/5 TI LT11X360MMX125 $ 5,160.00 IR KYPHOPLASTY/VA ADD LEVEL $ 5,191.00 DBX MIX 20CC $ 5,200.00 HYDROSET 15CC $ 5,200.00 TRI PS FEMCOMP BEAD WPA SZ7 LT $ 5,200.00 TRIA PS FEM COMP - BEADED W/PA $ 5,200.00 ARTELON STRIP 0.7X0.8CM $ 5,226.00 BONE BIOPSY OPEN DEEP $ 5,231.00 EXC ABD LES SC 3 CM/> $ 5,231.00 EXC ARM/ELBOW LES SC 3 CM/> $ 5,231.00 EXC ARM/ELBOW TUM DEEP 5CM/> $ 5,231.00 EXC BACK TUM DEEP 5 CM/> $ 5,231.00 EXC FACE TUM DEEP 2CM/> $ 5,231.00 EXC HIDRAD AXIL; S/I REP $ 5,231.00 EXC SHOULDER TUM DEEP 5 CM/> $ 5,231.00 BIOCLEANSE PERONEUS TENDON $ 5,250.00

�183

BONE ACHS TENDON FRESH FROZEN $ 5,276.00 CATHETER OUTBACK ELITE $ 5,287.00 POLYSOMNOGRAPHY $ 5,302.00 SP- JUGULAR VENOGRAM $ 5,312.00 THROMBOLYTIC VENOUS THERAPY $ 5,312.00 AGRAFT BNE 2.5CC MTRX VIBL B4 $ 5,313.00 4 X97MM COMPRESSION PLT 7 HOLE $ 5,318.00 TRIATHLON X3 TIBIAL INSERT SZ4 $ 5,332.00 POLYSOMNOGRAPHY W/CPAP $ 5,342.00 EXC PILONID CYST; EXTENS $ 5,352.00 RESECT LEG/ANKLE TUM < 5 CM $ 5,352.00 CARDIAC CARE UNIT $ 5,389.00 GAMMA 3 S NAIL RT 10X340MMX120 $ 5,403.00 CATH LAB-CO ANGIO W/RHC $ 5,405.00 4 HOLE DISTAL MEDIA TIBIA PLT $ 5,408.00 4 HOLE PROXIMAL PLATE $ 5,408.00 DISTAL MEDIAL TIBIA PLT 4 HOLE $ 5,408.00 CATH LAB-SWAN GANZ CATH $ 5,412.00 EVENT RECORDER $ 5,435.00 CT-ABD & PELVIS W&W/O CONTRA $ 5,469.00 CT-ABD W & PELVIS W&W/O CONTST $ 5,469.00 CT-ABD W & PELVIS W/O CONTRAST $ 5,469.00 CT-ABD W&W/O & PELVIS W CONT $ 5,469.00 CT-ABD W/O & PELVIS W CONTRAST $ 5,469.00 CT-ABD W/O,PELVIS W&W/O CONT $ 5,469.00 AVN W/OR W/OUT TEMPORARY WIRE $ 5,473.00 EP FOLLOW UP STUD W/PACING REC $ 5,473.00 INDUC OF ARRH, RA PACING & REC $ 5,473.00 W/OUT IND. OR ATTEMPT OF ARRHY $ 5,473.00 CL TX POSTOP HIP DISLOC W ANES $ 5,483.00 CL TX TRIMALL ANKLE FX W MANIP $ 5,483.00 CL TX TRIMALL ANKLE FX W MNPL $ 5,483.00 CLTX DSL RDL FX/EPIP SEP W MNP $ 5,483.00 CLTX DSTL RDLFX/EPHYSLSP W MNP $ 5,483.00 CLTX POSTOP HIP DISLOC W ANSTH $ 5,483.00 8 HOLE LOCKING COMPRESSION PLT $ 5,485.00 DEEP I&D ABSC - FARM/WRIST $ 5,486.00 DR TENDON SHTH 1 DIG AND/PALM $ 5,486.00 DRAIN PALMAR BURSA SGL $ 5,486.00 DRAINAGE OF PALM BURSAS $ 5,486.00 EXPL W DR/REM FB - MTP FT JNT $ 5,487.00 TX TARSAL BONE FX; W MANIP $ 5,487.00 EXC NECK LES SC 3 CM/> $ 5,489.00 LT SHRT NCM MED COL FUSION PLT $ 5,520.00 POLY LCKG PLATE SHORT - RT $ 5,520.00 POLY LKG PLT MED COL RT (T10) $ 5,520.00 TRI TS + TIB INSRT X3 PLY 16MM $ 5,545.00

�184

TRI TS PL TIB INS X3 POL 16MM $ 5,545.00 HUMAN CORNEA $ 5,556.00 AMNIO FIX 4CM X 6CM $ 5,577.00 PHYSIO MOLDABLE 5CC $ 5,590.00 PRX LAT TIB PLT F/LTIB 2HL/L95 $ 5,597.00 RT PROXIMAL LATERAL TIBIA PLAT $ 5,597.00 AXSOS TI 4MM DST ANT TIBIA PLT $ 5,608.00 INS CATH REN ART 1ST BILAT $ 5,609.00 INS CATH REN ART 1ST UNILAT $ 5,609.00 INS CATH REN ART 2ND+ BILAT $ 5,609.00 INSJ PICC RS&I 5 YR+ $ 5,609.00 PLACE CATH THORACIC AORTA $ 5,609.00 ALPR BICRT WDG EVNS 22X20X10MM $ 5,613.00 EXC BREAST LES BY N LOC SGL $ 5,624.00 NIPPLE EXPL W/WO EXC DUCT $ 5,624.00 REMOVAL OF BREAST LESION 1+ $ 5,624.00 3.5X40MM AXO GUARD NRVE PRTCTR $ 5,625.00 ICU $ 5,626.00 FEMORAL STEM 37.5MM OFFST NO.2 $ 5,628.00 INTMD WND REPR S/TR/EXT30.0+CM $ 5,635.00 SKN SPLT GRFT F/N/HF/G100SQCM $ 5,636.00 ACT ARTIC E1 HIP BRG 28X38MM $ 5,702.00 4 HOLE PLATE LEFT $ 5,714.00 GLOBAL ADV ECCENTRC HD 48X14MM $ 5,715.00 ALLOGRFT EVANS WEDGE 8X22X20MM $ 5,720.00 EVANS WEDGE 12X22X20MM $ 5,720.00 3 HOLE PROXIMAL HUMERAL PLT-RT $ 5,757.00 PROX LAT HUMERUS PLT LT $ 5,757.00 PROX LAT TIBIA PLT 4 HOLE $ 5,757.00 PROXIMAL LAT HUMERUS PLT LT $ 5,757.00 ISO*99M TC HMPAO WBC LABEL/D $ 5,821.00 6 HOLE PROX LAT TIB PLT-LT $ 5,831.00 G7 DUAL MOBILITY LINER 38MM $ 5,832.00 JAGTOME 39 SPHINCTEROTOME $ 5,845.00 26.0MM RADIAL HEAD LT $ 5,865.00 denosumab 120 mg/1.7 mL PF INJ $ 5,871.92 AMP FING/TH SGL; W DIR CLOSE $ 5,903.00 EGD WITH MANOMETRY PH PROB PLA $ 5,916.00 23X155MM FULL COVR ESOPH STENT $ 5,923.00 23X155MM PART COVR ESOPH STENT $ 5,923.00 OPN TX ART FRACT MCP/IP JNT EA $ 5,932.00 210 FOOT PLATE $ 5,933.00 TOTAL KNEE IMPLANT-DEPUY $ 5,948.00 GRAFTJACKET TISSUE MATRX 5X5CM $ 5,949.00 ACHILLES TENDON FF $ 5,950.00 AMP FING/TH SGL;W LOC ADV FLAP $ 5,952.00 ARTHRSCOPY ANKLE; EXT DEBRIDEM $ 5,952.00

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PARTL EXC ANKLE OR HEEL BONE $ 5,952.00 REPR FOOT EXTENSOR TENDON EA $ 5,952.00 TREAT FINGER DISLOCATION $ 5,952.00 ARTHROSCOPY SHLDR DEBRID LMTD $ 5,987.00 ARTHRSC KNEE W MEN REP-MED&LAT $ 5,987.00 ARTHRSCPY KNEE ABRAS ARTHROPL $ 5,987.00 ARTHRSCPY KNEE REM LOOSE OR FB $ 5,987.00 CREP E/N/E/L 1.1-2.5CM $ 5,987.00 DEEP I&D THIGH/KNEE $ 5,987.00 EXC FOOT/TOE TUM DEEP <1.5 CM $ 5,987.00 EXC PILONID CYST SMPL $ 5,987.00 EXC PILONID CYST; SMPL $ 5,987.00 EXCISION PREPATELLAR BURSA $ 5,987.00 OP REVISN TENDON ELB TO SHLDR $ 5,987.00 PLACE SETON $ 5,987.00 RELSE SGL TIB FIB ANKLE FLEXOR $ 5,987.00 REPAIR ELBOW DEB/ATTCH OPEN $ 5,987.00 2MM LAPIDUS PLATE $ 5,988.00 16 HOLE PLATE $ 5,993.00 CARDIAC LAB-CORONARY ANGIO $ 6,000.00 MED DIST TIB PLATE RT 12 HOLE $ 6,046.00 PROTECTOR AXGRD NERVE 4X70MM $ 6,063.00 APSKINSUB LEGWOND>100CM,<100CM $ 6,097.00 REVISE ILEOSTOMY; SIMPLE $ 6,099.00 RT DISTAL LATERAL FEMUR PLT $ 6,118.00 CATHETER SPYSCP ACCSS AND DELV $ 6,125.00 HEMOSTAT ENDO 7FRX220CM $ 6,125.00 KYPHOPAK EXPRESS TRAY $ 6,131.00 OPEN BX OR EXC LN;SUPERFICIAL $ 6,138.00 ENDOVENOUS RF 1ST VEIN $ 6,155.00 REUNION TSAX3 PEGGD GLNOID S44 $ 6,157.00 ARTHROSURFACE 15MM ART COMP $ 6,160.00 ERCP W/REMOVAL STENT TUBE-KENT $ 6,173.00 ERCP W/SPHINCTEROPLASTY-KENT $ 6,173.00 ANKLE FUSION PLATE LATERAL TT $ 6,204.00 TTNM MTX MIDFC ORBT PLT 0.4MM $ 6,211.00 HIP STEM NECK ANGLE SZ 7 $ 6,224.00 SCR-FT MX 127DG HP STM S6X25MM $ 6,224.00 SECURFIT ADV 132DG V40 HIPSTEM $ 6,224.00 SECUR-FIT HIP STEM SZ10 $ 6,224.00 SECUR-FIT HIP STEM SZ11 $ 6,224.00 SECUR-FIT HIP STEM SZ6 $ 6,224.00 SECUR-FIT MAX 127 HIP STEM #10 $ 6,224.00 STEM HIP 127DEG NECK AGLE S12 $ 6,224.00 STEM HIP 127DEG NECK ANGLE S8 $ 6,224.00 STEM HIP 127DEG NECK ANGLE S9 $ 6,224.00 STEM HIP 132DEG NECK ANGL S8 $ 6,224.00

�186

ARTELON PATCH 3X4CM $ 6,227.00 ARTELON STRIP 0.3X16CM $ 6,227.00 WRGHT MEDICAL CLAW II U PLT SM $ 6,269.00 CATH LAB-CO ANGIO W/RHC & GR $ 6,272.00 3-D RADIOTHERAPY PLAN $ 6,288.00 REVSC OPN/PRQ TIB/PERO STENT $ 6,296.00 PLATE POLY LCKNG 8 HOLE LT $ 6,347.00 ACETABULAR INSERT $ 6,356.00 TRIDENT 0 DEG ACETBLR INS SZ E $ 6,356.00 ICD ENDOCARDIAL NONSINGLE/DUAL $ 6,394.00 CORDLESS ULTRASONIC $ 6,406.00 PLATE 8-HOLE RIGHT $ 6,418.00 BLUE MEDIUM HEXAPOD STRUTS $ 6,422.00 REUNION TSA SLF-PRSS GLND SZ40 $ 6,430.00 VITOSS BA2X FOAM PACK 5.0CC $ 6,435.00 PLMT BILIARY DRAINAGE CATH $ 6,441.00 DISSOLVE CLOT, HEART VESSEL $ 6,461.00 RADIAL HEAD ANATMC SYS 24 HEAD $ 6,463.00 16 HOLE LCKING COMP PLT $ 6,485.00 ARTHROSCOPY KNEE DEBRID/SHV AC $ 6,489.00 ARTHROT KNEE W SYNOV ANT/POST $ 6,489.00 ARTHROTOMY W OP MENISCUS RPR $ 6,489.00 ARTHRSCPY KNEE LIM SYNOVECTOMY $ 6,489.00 CALCANEUS REMOVAL $ 6,489.00 EXC BACK LES SC 3 CM/> $ 6,489.00 KNEE ARTHRSCPY/SRGRY 2+COMPART $ 6,489.00 KNEE ARTHRSCPY/SURG MDL/LTRL $ 6,489.00 KNEE ARTHRSCPY/SURG MDL+LTRL $ 6,489.00 RESECT/TRANSPL BICEPS LG TNDN $ 6,489.00 TOTAL KNEE IMPLANT-STRYKER $ 6,489.00 TREAT FX DISTAL RADIAL $ 6,489.00 TREAT KNUCKLE DISLOCATION $ 6,489.00 EVASC RPR A-AO NDGFT $ 6,492.00 EVASC RPR A-UNILAC NDGFT $ 6,492.00 127DEG NECK ANGL HIP STEM SZ 8 $ 6,500.00 BIOCLEANSE TIBIALIS POST TENDN $ 6,500.00 DBM PLUS PUTTY WITH CANCELLOUS $ 6,500.00 SECRFT ADV 132 NKANG V40 HPSTM $ 6,500.00 SECUR-FIT HIP STEM SZ7 $ 6,500.00 SECUR-FIT HIP STEM SZ8 $ 6,500.00 SECUR-FIT HIP STEM SZ9 $ 6,500.00 SECUR-FIT MAX HIP STEM SZ9 $ 6,500.00 SZ8 SECRFT 127DG NCKANG HIPSTM $ 6,500.00 BONE SUB VOID FILLER INJ 5CC $ 6,515.00 M&S-CATH-TRANS ATHERECTOMY-D $ 6,550.00 EXCHANGE BILIARY DRG CATH $ 6,551.00 18MMX123MM WALLFLX ESOPH STENT $ 6,563.00

�187

22 X 60MM WALLFLEX DUODNL STNT $ 6,563.00 22 X 60MM WLFLX DUODENAL STENT $ 6,563.00 STENT,WALLFLX ESOPHGL 18X153MM $ 6,563.00 WLFLX FLY CVD ESOSTNT 18X123MM $ 6,563.00 TRIDNT TRITNIUM HEM SHELL 58MM $ 6,572.00 TRITANIUM REVIS ACETABULR 60MM $ 6,572.00 DUALMESH BIOMTRL 20CMX30CMX2MM $ 6,578.00 CREP TRUNK; 2.6-7.5 CM $ 6,585.00 CREP TRUNK; 2.6-7.5CM $ 6,585.00 REP ET HAND WO FG EA TENDON $ 6,585.00 REPAIR INTRINSIC MUSCLES HAND $ 6,585.00 REPAIR LIP FT VERMILION ONLY $ 6,585.00 RPR LIP FT >1/2 V HGT OR CMPLX $ 6,585.00 SKN FLL GRFT FC/GN/HF=< 20SQCM $ 6,585.00 DECOMPR FARM/WRIST W DEBRIDEM $ 6,586.00 REPAIR MALLET FINGER WO GRAFT $ 6,586.00 14MMX155MM MOD CEMENTLESS STEM $ 6,624.00 HIP SYS REST MODULAR 155X15MM $ 6,624.00 RESTORTN MOD HIP SYS 21MM +0MM $ 6,624.00 STEM ORTHO 17MMX155 STRAIGHT $ 6,624.00 10 HOLE PROX LAT HUM PLT LT $ 6,643.00 PLATE PROX LAT HUM RT 8 HOLE $ 6,643.00 ARTELON PATCH 4X6CM $ 6,682.00 REUNION TSA - X3 PEGGED GLENOI $ 6,687.00 ICD ENDOCARDIAL SINGLE COIL $ 6,696.00 ICD ENDOCARDIAL DUAL COIL $ 6,715.00 TIB/PER REVASC STNT & ATHER $ 6,722.00 BIOCLEANSE TIBIAL ANTER TENDON $ 6,760.00 BIOCLNS ACH TNDN W/L CLCN BLCK $ 6,760.00 INV ERCP W CANNULTN OF PD/CBD $ 6,760.00 INV ERCP W/BIOPSY $ 6,760.00 SECUR-FIT MAX 127 HIP STEM 11 $ 6,760.00 PERM. PACEMKR GEN.SINGLE CHA $ 6,827.00 INSTR JAW SM LIGASURE STERIL $ 6,842.00 ARTELON STRIP 0.5X16CM $ 6,851.00 STNT WLLFLX DUOD 22X120BS 6503 $ 6,861.00 GRAFT BONE15ML CALC PHOS INJC $ 6,863.00 CATH BRACHYTHERAPY 4.0-5.0CM $ 6,875.00 RES MOD CON DIST STMSTR 19X155 $ 6,918.00 RESTORATION HIP STM 155MMX16MM $ 6,918.00 PLATE 12 HOLE PROX LAT HUMERUS $ 6,936.00 WALLFLEX FULLY CVRD ESO STNT $ 6,956.00 6 HOLE DIST LAT PLATE LT $ 6,998.00 SURGIMEND 1.0 10CM X 15CM $ 7,020.00 ATT E/N/E/L D 10 SQ CM $ 7,057.00 ATT F/C/M/N/A/G/H/F 10 SQ CM $ 7,057.00 DEB SKIN BONE AT FX SITE $ 7,072.00

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INS ENDOVAS VENA CAVA FILTR $ 7,100.00 LONG NAIL KIT $ 7,124.00 LONG NAIL KIT R1.5,TI,RIGHT $ 7,124.00 EXC THIGH/KNEE LES SC 3 CM/> $ 7,137.00 FLEX TENDON REP ZONE 2 EACH $ 7,137.00 REDUCTION TORSION TESTIS SURGI $ 7,137.00 REM CERCLAGE SUTURE UNDER ANES $ 7,137.00 REP TENDN/MSCL - FARM.WRIST $ 7,137.00 SKIN TIS REARRNG 30.1-60.0 QCM $ 7,137.00 EXTENSOR TENDON REPAIR EACH $ 7,138.00 OP TX PHLNG SHFT FRCT PRX/MD E $ 7,138.00 REP MCP/IP JNT COLLAT LIGAMENT $ 7,138.00 9.0MM SUBFIX IMPLANT $ 7,140.00 VAG DELV AFTER CESRN INC PSTOP $ 7,155.00 VAGINAL DELIVERY ONLY INCL PP $ 7,155.00 DIST LAT FEMUR PLT - 8 HOLE LT $ 7,207.00 BIOCLEANSE ACHILLES TENDN 10MM $ 7,250.00 STEM REST MOD HIP CON 15X195MM $ 7,273.00 OPEN TX DISTAL PHALANG FRAC EA $ 7,277.00 ACCOLADE II HIP STEM SZ3 $ 7,284.00 ACCOLADE II HIP STEM SZ4 $ 7,284.00 ACCOLADE II HIP STEM SZ6 $ 7,284.00 ACCOLADE II HIP STEM SZ7 $ 7,284.00 STEM HIP 127 DEG NECK ANGL S3 $ 7,284.00 STEM HIP 127DEG NECK ANGL S5 $ 7,284.00 ABDOMINAL AORTOGRAM $ 7,285.00 ANGIO EXTREMITY BILAT $ 7,285.00 ANGIO PULMONARY BILAT SEL $ 7,285.00 HEPATIC VENO W/O HEMODYNAMIC $ 7,285.00 HEPATIC VENOGRAPHY WEDGE/FRE $ 7,285.00 PERCUT TRANSHEPATIC PORTO EV $ 7,285.00 SP* ANGIO ADRENAL BILATERAL $ 7,285.00 SP*LEFT ANGIO PULMONARY,UNIL $ 7,285.00 SP*LEFT-ANGIO ADRENAL,UNIL.S $ 7,285.00 SP*LEFT-ANGIO EXTREM.UNILATE $ 7,285.00 SP*LEFT-VENOGRAPHY ADRE,UNIL $ 7,285.00 SP*LEFT-VENOGRAPHY,RENAL,UNI $ 7,285.00 SP*RIGHT-ANGIO ADRENAL,UNIL.SE $ 7,285.00 SP*RIGHT-ANGIO EXTREM,UNIL. $ 7,285.00 SP*RIGHT-ANGIO PULMONARY,UNI $ 7,285.00 SP*RIGHT-VENOGRAPHY REN,UNIL $ 7,285.00 SP*RIGHT-VENOGRAPHY,ADR,UNIL,S $ 7,285.00 SPLENOPORTOGRAPHY $ 7,285.00 VENOGRAPHY CAVAL INFERIOR $ 7,285.00 VENOGRAPHY RENAL, BILAT, SEL $ 7,285.00 5.0 COMPRESSION PLATE $ 7,305.00 ISO*INDIUM 111 PENT UPTO 6 M $ 7,341.00

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MINI X-FIX ASSEMBLY 55MM $ 7,348.00 STEM CONICAL DISTAL 20X195MM $ 7,400.00 BODY CONE 21 MM $ 7,402.00 HIP SYSTEM RES V-40 23MM +10 $ 7,402.00 RSTRTN MD HIP SYS 195MM/14MM $ 7,402.00 RSTRTN MODULAR HIP SYSTEM 19MM $ 7,402.00 STEM MOD HIP SYS 21MM $ 7,402.00 STENT FLARE 7 X 50 X 80CM $ 7,408.00 STENT FLARE 8 X 50 X 80CM $ 7,408.00 INTEGRA WOUND MATRIX DRESS 2X2 $ 7,449.00 POLYAXIAL LOCKING PLATE MTP CR $ 7,468.00 ARTELON STRIP 0.7X16CM $ 7,475.00 12 HOLE PLATE - LEFT $ 7,476.00 FEM, CEMENTED S3 LT MED/RT LAT $ 7,500.00 FEMORAL, RT MED/LT LAT SZ4 $ 7,500.00 INSERT VAD ARTERY ACCESS $ 7,500.00 PATELLA TENDON HEMI FF $ 7,500.00 REMOVE VAD DIFFERENT SESSION $ 7,500.00 REPOSITION VAD DIFF SESSION $ 7,500.00 PERQ CERVICOTHORACIC INJECT $ 7,506.00 palivizumab 100 mg INJ $ 7,514.27 PLMT NEPHROSTOMY CATHETER BIL $ 7,550.00 MATRIX 4X8CM PROLYR ACELL DERM $ 7,565.00 SIG MOD TIBL CEMENTED-COCR SZ3 $ 7,571.00 TIBIAL TRAY CEMENTED COCR SZ 2 $ 7,571.00 ACCOLADE II HIP STEM SZ5 $ 7,607.00 1MM AVANCE NERVE GRAFT $ 7,625.00 GRAFT 2MM AVNCE NRVE 30MM L $ 7,625.00 CHANGE NEPHROURETERAL CATH BIL $ 7,632.00 PLATE 14 HOLE DIST LAT FEM LT $ 7,635.00 FOOT AND ANKLE KIT 11GA 3CC SD $ 7,650.00 KIT FOOT AND ANKLE 15 GA 3CC $ 7,650.00 ACROMIOPL/ACROMIONECT PARTIAL $ 7,673.00 PART EXC BONE FEMUR PROX TIBIA $ 7,673.00 SHOULDER MUMFORD PROC $ 7,673.00 REST MOD CONE BODY 25MMX10MM $ 7,730.00 STRYKER RESTO MODULAR HIP SYST $ 7,730.00 STEM MOD HIP SYS 235MM $ 7,792.00 CATH LAB-LHC CO ANGIO W/WO V $ 7,847.00 PPM GENERATOR DUAL CHAMBER $ 7,873.00 GLOBAL POROCAT STAND STEM SZ12 $ 7,880.00 GLENOSPHERE 36MM STANDARD $ 7,894.00 ALGRFT BONE 5CC MATRIX VIABLE $ 7,917.00 GLOBAL ADVANTAGE CTA HEAD $ 7,931.00 SECURFIT PLUS MX HIP STEM S7 $ 7,945.00 24 HOLE PLATE $ 7,948.00 4 HOLE RT DISTAL FEMUR $ 7,954.00

�190

PLATE SYNTHES 2.7MM DCP 2HOLE $ 7,997.00 BIOCLEANSE PRETRIMMED ACHILLES $ 8,000.00 RST MD HIP SYS 27MM +0TPRV40IN $ 8,039.00 CONT OROPHARYNG HEMOR REQ SURG $ 8,085.00 6 HOLE DISTAL LATERAL PLATE RT $ 8,113.00 CORETRAK STERIPACK D, 40MM KIT $ 8,125.00 PROSTALAC HIP STEM SZ3 $ 8,151.00 RPR UMBIL HERN BLOCK 5+ YR $ 8,154.00 FEM/POPL REVAS W/TLA $ 8,187.00 CATH LAB-LHC ANGIO,VGRAM & R $ 8,205.00 PATELLA TENDON HEMI FF 3X4.2CM $ 8,234.00 PRE-SHAPED PATELLA TENDON $ 8,234.00 ZERO-P VA IMPL 8MM HGHT LRDTIC $ 8,250.00 8 HOLE PLATE RT $ 8,273.00 AUGMENT BONE GRAFT - 3CC $ 8,300.00 I&D PERIRECTAL OR ISCHIAL ABS $ 8,308.00 I&D; PEIRCTAL OR ISCHAL ABSCES $ 8,308.00 PATELLAR LIGAMENT PRESHAPED $ 8,338.00 DRAIN/INJ INT JNT/BRS W/US BIL $ 8,356.00 DRAIN/INJ INT JNT/BRS WO USBIL $ 8,356.00 DRAIN/INJ MJR JNT/BRS W/US BIL $ 8,356.00 DRAIN/INJ SM JNT/BRS WO US BIL $ 8,356.00 DRAIN/INJ SM JNT/BRSA W/US BIL $ 8,356.00 DRN/INJ MJR JNT/BRS W/O US BIL $ 8,356.00 VASC CATH 120CM 15MMX10CM $ 8,365.00 ILIAC REVSC W/STENT ADD-ON BIL $ 8,376.00 PHYSIO MOLDABLE 10CC $ 8,450.00 CONCORDE BUL LOR 9X10X27 5DG $ 8,463.00 CONCORDE BUL PAR 9X7X27 $ 8,463.00 COMPONENT FEM2.5 59X63MM LKNEE $ 8,500.00 COMPONENT FEM3 61X66MM RKNEE $ 8,500.00 AXS 8-HL PROX HUM PLT LT 151MM $ 8,533.00 PERCUTANEOUS COR ANGIO EA ADDL $ 8,547.00 10CC BIO4 VIBLE BONE MATX-ORTH $ 8,625.00 KIT STABILIT KYPHOPLSTY FRACTR $ 8,625.00 GRACILIS TENDON FF $ 8,725.00 VITOSS BIOACTIVE FOAMPACK 10CC $ 8,736.00 ACCUPORT $ 8,750.00 REMEDY MODULAR HEAD MED $ 8,750.00 IMPLANT WHOLE PATELLA LIG FRZN $ 8,810.00 ARTELON STRIP 0.7X32CM $ 8,827.00 ANGIO PELVIC, SEL $ 8,830.00 ANGIO VISCERAL SEL OR SUPRAS $ 8,830.00 SP*SPINAL,SELECTIVE,EA VESSE $ 8,830.00 VENOGRAPHY ADRENAL, BILAT, S $ 8,830.00 MED SOF DANEK KYPHOPK EXP FRAC $ 8,880.00 CESAREAN SECTION $ 9,129.00

�191

G7 OSSEOTI 3 HOLE SHELL 48MM $ 9,170.00 EXCHANGE NEPHROSTOMY CATH BIL $ 9,192.00 FLNGE CAGE 62/64SHELL 54 LINER $ 9,212.00 11 X 420MM LONG NAIL KIT $ 9,230.00 11X320MM LONG NAIL KIT R1.5LT $ 9,230.00 11X380MMX125DEG LONG NAIL KIT $ 9,230.00 LNGNL KT R1/5 TI L 11X380 125D $ 9,230.00 LONG NAIL KIT 11 X 400MM LT $ 9,230.00 RT LONG NAIL KIT 11X320MMX125 $ 9,230.00 ST LNGNLKT R1.5TIRT 11X340X125 $ 9,230.00 TOTAL KNEE - CONFORMIS $ 9,273.00 D&C DIAGNOSTIC OR THERP NOT OB $ 9,306.00 SURG TX INCOMPL ABORTION $ 9,306.00 GRAFT 8X16CM RTU ALLODERM INA $ 9,308.00 ALLODERM CONTOUR MED PERF $ 9,318.00 ALLODERM MEDIUM PERFRTED THICK $ 9,318.00 IMPLANT SYSTEM MPFL BIOCOMPOS $ 9,360.00 ALLOGRAFT BONE $ 9,375.00 REUNION HA FX STEM HUM COMP S7 $ 9,416.00 LAP ING HERNIA REPAIR INIT $ 9,448.00 PRE-SHAPED PATELLA TENDON FF $ 9,498.00 HC INTENSIVE CARE UNIT PEDI $ 9,532.00 CATH LAB-LHC ANGIO W/VG & GR $ 9,562.00 INS CATH REN ART 2ND+ UNILAT $ 9,597.00 REP BLD VES GRFT NOT V LWR EXT $ 9,597.00 LNG NL KT R1/5 TI LT 11X340X12 $ 9,599.00 LNG NL KT R15 TI LT 11X440X120 $ 9,599.00 LNG NL KT R15 TI RT 11X340X120 $ 9,599.00 LNG NL KT R15 TI RT 11X380X120 $ 9,599.00 REPAIR ANORECTAL FIST W/PLUG $ 9,615.00 EGD ENDOSCOPIC STENT PLACE $ 9,661.00 VASC CATH 120CM 8MMX15CM $ 9,688.00 DECELLULARIZED DERMIS PATCH $ 9,723.00 REMEDY FEMORAL COMPONENT LARGE $ 9,750.00 ARTELON PATCH 6X9CM $ 9,802.00 TRU-FILL EMBOLIC LIQUID SYSTEM $ 9,818.00 INTRO CATH DLYS CRC W TRN BALL $ 9,819.00 TRLUML BALO ANGIOP 1ST ART $ 9,819.00 TRLUML BALO ANGIOP 1ST VEIN $ 9,819.00 CATH LAB-LHC ANGIO/VG/GRFT/R $ 9,916.00 STEM HUMERAL 4B 132.5 DEG 78MM $ 10,035.00 CARTIVA SYNTHETIC CARTLAGE IMP $ 10,125.00 INBONE TALAR DOME SZ3 $ 10,188.00 PLNDRM SI SLVR ION CATH 14.5FR $ 10,218.00 SPACER PROSTALAC HIP STEM SZ 3 $ 10,266.00 TRABCULAR METAL REVISION SHELL $ 10,465.00 STR TIB COMP SNGL CTD US VER M $ 10,474.00

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TIB COMP SNGL COATD/US VERS XL $ 10,474.00 FOOT ANKLE KIT 15GA 3CC DELIV $ 10,500.00 KIT SCP KNEE 5CC $ 10,500.00 ILIAC REVASC $ 10,527.00 CATH MICRO DIAMONDBACK 1.25 $ 10,536.00 CATH SOLID DIAMONDBACK 1.25 $ 10,536.00 CATH SOLID DIAMONDBACK 1.5 $ 10,536.00 CATH SOLID DIAMONDBACK 2.0 $ 10,536.00 REUNION TSA MOD HUM STEM 14MM $ 10,538.00 REUNION TSA MOD HUM STEM SZ11 $ 10,538.00 REUNION TSA MOD HUM STEM SZ13 $ 10,538.00 REUNION TSA MOD HUM STEM SZ8 $ 10,538.00 STEM HUM L10MM RM OD10MM SHLDR $ 10,538.00 TIBIAL COMP SINGLE COATED $ 10,587.00 REUNION TSA CMNTD HMRL STM 6MM $ 10,737.00 TSA PRESS FIT HUM STEM 15MM $ 10,960.00 TIBIAL TRAY ROTATING PLATFORM $ 10,975.00 INV ERCP INS STENT IN BIL PAN $ 10,988.00 DEVICE 12MMx50MM THREADED $ 11,000.00 REUNION TSA MOD HUM STEM SZ9 $ 11,006.00 REUNION TSA MOD HUMRL STEM SZ7 $ 11,006.00 REUNION TSA MOD HUMRL STEM SZ9 $ 11,006.00 REUNION TSA MOD HUMRL STM SZ10 $ 11,006.00 GLOBL FX POROCT STND STM SZ 12 $ 11,014.00 TOTAL HIP IMPLANT-STRYKER $ 11,047.00 REUNION TSA CMNTD HUM STEM 9MM $ 11,211.00 CARTIVA 8MM $ 11,250.00 STENT VIATORR 10 X 7 X 75CM $ 11,308.00 STENT VIATORR 10 X 8 X 75CM $ 11,308.00 STENT VIATORR 10X 4 X 75CM $ 11,308.00 TALAR COMPONENT - SMALL $ 11,365.00 REUNION TSA - PRESS-FIT HUMERA $ 11,446.00 TALAR COMP - MEDIUM LT $ 11,577.00 TALAR COMPONENT LT $ 11,577.00 TALAR COMPONENT - MEDIUM $ 11,604.00 PERCUTANEOUS COR ANGIO SINGLE $ 11,647.00 M&S OR EVENT RECORDER, CARD, I $ 11,698.00 M&S OR EVENT RECORDER,CARD,I $ 11,698.00 TALAR COMPONENT - SMALL RT $ 11,730.00 X-SM RT TALAR COMP SNGL COATED $ 11,730.00 ARTHROPLASTY PATELLA WO PROSTH $ 11,749.00 ARTHRSC ANT CRCTE LIG REP/AUGM $ 11,749.00 LIGAMENT AUGM KNEE EXTRA-ARTIC $ 11,749.00 OPEN REPAIR ROTATOR CUFF $ 11,749.00 OPN TX ULNR FX PROXIMAL END $ 11,749.00 RECONSTR DSLC PTLLA W MSCL ADV $ 11,749.00 RECONSTR RC AVULSION CHRONIC $ 11,749.00

�193

REINSERT RUPTRD BIC/TRIC TNDN $ 11,749.00 REP SHLDR SLAP LES $ 11,749.00 REPAIR KNEECAP TENDON $ 11,749.00 REPAIR ROTATOR CUFF CHRONIC $ 11,749.00 REPR TRN COLLATERAL KNEE LIGAM $ 11,749.00 ROTATOR CUFF REP ARTHROSCOPY $ 11,749.00 SHLDR CAPSULOR ARTHROSC $ 11,749.00 SUTRE QUAD/HAMSTRING MSCL RUPT $ 11,749.00 TREAT CLAVICLE FRACTURE $ 11,749.00 TREAT LOWER LEG JOINT $ 11,749.00 TREAT SCAPULA FRACTURE $ 11,749.00 GLOBAL ADV PORCT STND STM SZ10 $ 11,938.00 GLOBAL ADV POROCT STND STM SZ8 $ 11,938.00 PPM BIVENTRICLAR GENER(PACIN $ 11,990.00 VITOSS BA2X FOAM PACK 10CC $ 12,010.00 REVEAL LINQ CARDIAC MONITOR $ 12,113.00 TALAR COMP SINGLE XX-SMALL RT $ 12,340.00 TLR CMPNT SNG CTD/US VER XS LT $ 12,340.00 PERCUT TRNS INTRA STNT EA ADDL $ 12,505.00 REVSC OPN/PRQ TIB/PERO SNT BIL $ 12,592.00 13 X 15 BIODESIGN HERNIA GRAFT $ 12,625.00 BIODESIGN HERNIA GRAFT 13X15 $ 12,625.00 TOTAL HIP IMPLANT-DEPUY $ 12,746.00 URINARY INCONTINENC SLING MALE $ 12,750.00 URINARY INCONTINENCE SLNG MALE $ 12,750.00 COMP TOTAL STABILZR FEM S3 LFT $ 12,788.00 TOTAL STABILIZER FEM COMP SZ6 $ 12,788.00 TRI TOT STABILIZER FEM COMP S5 $ 12,788.00 REMEDY MODULARLONG STEM SM $ 12,875.00 collagenase clostridium histolyticum 0.9 mg PWDI (KPROV) $ 13,205.77 TRI PS FEMCOMP BEAD W/PA 34 RT $ 13,356.00 TRIATHLON TS FEMUR SZE 4 RIGHT $ 13,356.00 TIB/PER REVASC STNT ATHER BIL $ 13,444.00 INFINITY TIBIAL TRAY SZ4 $ 13,653.00 PERCUTAN RESVASC GRAFT EA ADDL $ 13,761.00 pegfilgrastim 6 mg/0.6 mL SYRINGE $ 13,771.24 TRI TS FEMUR SIZE 6 RIGHT $ 13,890.00 TRIATHLON TS FEMUR SZ5 RIGHT $ 13,890.00 FLOWABLE WOUND MATRIX $ 14,105.00 VASC EMBOLIZE/OCCLUDE ARTERY $ 14,192.00 VASC EMBOLIZE/OCCLUDE BLEED $ 14,192.00 VASC EMBOLIZE/OCCLUDE ORGAN $ 14,192.00 ARTISAN SURG LEAD KIT 50CM 2X8 $ 14,300.00 PERCUTAN TRANS REVAC OCCLS SIN $ 14,747.00 8.5 X 5 TROCHLEA $ 14,848.00 PERCUTAN TRANS OCCLUS EA ADDL $ 14,858.00 PERCUT TRAN DRUG ELUD EA ADDL $ 14,922.00

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THORACIC AORTOGRM W SERIALGRPH $ 15,281.00 AF/W TRANS CATH & COMP EP EVAL $ 15,554.00 SVT/AVRT SIN OR COMBO(IND ARR) $ 15,554.00 VT W/COMP EVAL & 3D MAPPING $ 15,554.00 PERCUT TRANS REVASC GRAFT SING $ 15,587.00 INSERT ELECTRD/PM CATH SNGL $ 15,695.00 TEMP PACEMAKER WIRE W/ CATH $ 15,695.00 PROTECTOR AXGRD NERVE 2X70MM $ 15,875.00 PERCUT TRANS INTRA STENT SING $ 15,943.00 PERCUTAN TRANS ACUTE THROM SIN $ 16,191.00 PERCUTAN TRNS RESV GRAFT SING $ 16,559.00 PERCUT TRNS GRFT ANGIO EA ADDL $ 16,836.00 GRAFT ADVANCE NERVE $ 17,063.00 PERC NEPHROSTOLITHOTMY TO 2 CM $ 17,092.00 PERC NEPHROSTOLITHOTOMY; > 2CM $ 17,092.00 ORGAN PROCUREMENT $ 17,292.00 ANKLE TALUS RT FRESH BONE GRFT $ 17,325.00 RESTORATION HEMI SHELL 66MM $ 17,575.00 RESTOR ANATOMIC SHLL SZ62 RT $ 17,576.00 FEM/POPL REVASC W/STENT $ 17,617.00 ILIAC REVASC W/STENT $ 17,617.00 OPEN/PERQ PLACE STENT 1ST $ 17,617.00 PERCUT TRANS OCCL MYOCARD SING $ 18,056.00 PERCUT TRAN DRUG ELU STNT SING $ 18,413.00 PERCUT TRANS COR ARTERY SINGLE $ 18,516.00 PERCUT TRANS ANGIO SINGLE VESS $ 18,535.00 8MM HUMERAL FRACTURE STEM $ 18,928.00 REUNION HUMERAL FX STEM 12MM $ 18,928.00 REUNION RFX HUM FRCT STM 9X118 $ 18,928.00 REUNION RFX HUM FX STEM 11MM $ 18,928.00 REUNION RFX HUMERAL FX STEM $ 18,928.00 CONE TRI TRIT TIB SYM AUG SZA $ 18,960.00 CONE,TRIATHLN TIB SYM AUG SZ C $ 18,960.00 IR KYPHOPLASTY/VA THOR $ 19,017.00 IR KYPHOPLASTY/VA LUMBAR $ 19,018.00 REP BLD VES GRFT LWR EXT BIL $ 19,194.00 INTRO CATH DLYS CRC TRNS CATH $ 19,846.00 THRMBC/NFS DIALYSIS CIRCUIT $ 19,846.00 LAPAROSCOPY APPENDECTOMY $ 20,006.00 LAPAROSCOPY CHOLECYSTECOMY $ 20,006.00 ILIAC REVASC BIL $ 21,054.00 ARTHRSC P CRUCIATE LIG REP/AUG $ 21,513.00 OPN OSTCHNDRL KNEE ALLOGRAFT $ 21,513.00 OPN TX FRCTRE DSTL TIBIA ONLY $ 21,513.00 REPR HMRS MALUNION W AUTOGRAFT $ 21,513.00 TX HUMERUS SH FX W IMLANT $ 21,513.00 FEM/POPL REVAS W/ATHER $ 21,756.00

�195

TIB/PER REVASC W/TLA $ 21,756.00 TOTAL KNEE $ 21,799.00 ALLODERM 16 X 20CM THICK $ 22,600.00 ALLODERM TISSUE MTRX 16CMX20CM $ 22,600.00 OP/PRCTX TB SHFT FX BY IM IMPL $ 22,777.00 X STOP $ 23,190.00 VASC EMBOLIZE/OCCLUDE VENOUS $ 23,649.00 ICD GENER. SINGLE CHAMBER $ 23,769.00 ICD GENER. DUAL CHAMBER $ 25,472.00 PUMP, SYNCHROMED II $ 28,000.00 PLACE PO BREAST CATH FOR RAD $ 28,328.00 PPM BIVENTRICULAR GENER(DEFI $ 31,173.00 IMPLANT 18CMX14MM AMBICOR $ 32,178.00 ICD BIVENTRICULAR GENERATOR $ 32,772.00 PERC NEPHROSTOLITHOTMY;>CM BIL $ 34,184.00 PERC NEPHRSTLTHTMY TO 2 CM BIL $ 34,184.00 FEM/POPL REVASC STNT ATHER $ 34,548.00 TIB/PER REVASC STENT ATHER $ 34,548.00 TIB/PER REVASC W/ATHER $ 34,548.00 TIB/PER REVASC W/STENT $ 34,548.00 FEM/POPL REVASC W/STENT BIL $ 35,234.00 ILIAC REVASC W/STENT BIL $ 35,234.00 OPEN/PERQ PLACE STENT 1ST BIL $ 35,234.00 DYNANAIL 10MMX220MM $ 37,700.00 MEDTRONIC RESTORESENSOR $ 40,300.00 FEM/POPL REVAS W/ATHER BIL $ 43,512.00 TIB/PER REVASC W/TLA BIL $ 43,512.00 CATHETER IMPELLA CP PUMP SET $ 56,250.00 FEM/POPL REVASC STNT ATHER BIL $ 69,096.00 TIB/PER REVASC STENT ATHER BIL $ 69,096.00 TIB/PER REVASC W/ATHER BIL $ 69,096.00 TIB/PER REVASC W/STENT BIL $ 69,096.00 abacavir 300 mg TAB $ 12.93 abatacept 250 mg PWDI $ 1,671.57 abciximab 10 mg/5 mL INJ $ 3,287.47 acarbose 50 mg TAB $ 1.47 acebutolol 200 mg CAP $ 0.37 acetaminophen 1000 mg/100 mL IV SOLN $ 81.14 acetaminophen 120 mg SUPP $ 0.59 acetaminophen 160 mg/5 mL LIQUID UDC $ 4.25 acetaminophen 32 mg/1 mL ORAL SOLN (NEONATAL) $ 21.00 acetaminophen 325 mg SUPP UD $ 1.90 acetaminophen 500 mg TAB UD $ 0.08 acetaminophen 650 mg SUPP $ 0.79 acetaminophen 650 mg/20.3 mL LIQUID UDC $ 4.60

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acetaminophen 80 mg DISINTEGRATING TAB $ 0.14 acetaminophen 80 mg SUPP $ 2.26 acetaminophen-codeine 120 mg-12 mg/5 ml LIQUID UDC $ 3.54 acetaminophen-codeine 300 mg-30 mg TAB UD $ 0.54 acetaminophen-HYDROcodone 325 mg-10 mg TAB UD $ 1.12 acetaminophen-HYDROcodone 325 mg-5 mg TAB UD $ 0.48 acetaminophen-HYDROcodone 325 mg-7.5 mg TAB UD $ 0.82 acetaminophen-HYDROcodone 325 mg-7.5 mg/15mL UDC $ 9.34 acetaminophen-oxyCODONE 325 mg-10 mg TAB $ 2.06 acetaminophen-oxyCODONE 325 mg-5 mg TAB $ 0.51 acetaminophen-traMADol 325 mg-37.5 mg TAB UD $ 1.10 acetaZOLAMIDE 250 mg TAB $ 6.14 acetaZOLAMIDE 500 mg CAP ER $ 8.98 acetaZOLAMIDE 500 mg PWDI $ 41.06 ace^c acid 0.25% irrigaôn soluôn 1000 mL $ 16.98 ace^c acid 2% o^c SOLN 15 mL $ 11.69 ace^c acid 3% compounding soluôn 500 mL $ 47.54 ace^c acid-hydrocor^sone 2%-1% o^c SOLN 10 mL $ 238.00 acetylcholine 1% intraocular PWDR $ 166.74 acetylcysteine 10% SOLN 4 mL $ 5.18 acetylcysteine 20% INJ 30 mL $ 160.46 acetylcysteine 20% 10 mL SOLN $ 32.26 acetylcysteine 20% 30 mL SOLN $ 27.17 acetylcysteine 20% 4 mL SOLN $ 13.13 acetylcysteine 300 mg/3 mL SYRG $ 1.14 acetylcysteine 600 mg/3 mL SYRG $ 2.01 acyclovir 200 mg CAP UD $ 0.34 acyclovir 400 mg TAB UD $ 0.65 acyclovir 400 mg/10 mL SUSP $ 19.24 acyclovir 5% topical OINT 15 g $ 202.49 acyclovir 500 mg/10 mL INJ $ 9.06 acyclovir 7 mg/mL SYRINGE (Neonatal) $ 0.88 acyclovir 800 mg TAB UD $ 1.25 adenosine 300 mcg/mL (Neonatal) $ 0.37 adenosine 90 mg/30mL INJ $ 427.90 Al hydroxide/Mg hydroxide/simethicone SUSP UDC $ 5.94 albendazole 200 mg TAB $ 277.17 albumin human 25% SOLN 100 mL $ 175.46 albumin human 25% SOLN 50 mL $ 87.73 albumin human 250 mg/mL SYRINGE (Neonatal) $ 2.04 albumin human 5% INJ 50 mL $ 84.90 albumin human 50 mg/mL SYRINGE (Neonatal) $ 1.34 albuterol 0.083% SOLN UD $ 0.59

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albuterol 0.5% SOLN 0.5 mL UD $ 1.02 albuterol 0.5% SOLN 20 mL $ 26.60 albuterol HFA 90 mcg MDI 8 g $ 55.89 albuterol sulfate 90 mcg HFA MDI 18 g $ 137.54 albuterol sulfate 90 mcg/inh 8.5 g (ANESTHESIA USE ONLY) $ 136.63 albuterol-ipratropium 100 mcg-20 mcg/inh MDI $ 886.70 albuterol-ipratropium 2.5 mg-0.5 mg/3 ml SOLN UD $ 0.85 alemtuzumab 30 mg/mL INJ $ 4,543.07 aliskiren 150 mg TAB $ 18.42 alkalol mucoly^c LIQUID 473 mL $ 26.77 allantoin/camphor/phenol 1%-0.5%-0.5% topical OINT 7 g $ 2.86 allopurinol 100 mg TAB UD $ 0.85 allopurinol 300 mg TAB UD $ 0.99 alpha 1-proteinase inhibitor 1000 mg PWDI $ 908.23 ALPRAZolam 0.125 mg/HALF-TAB $ 0.03 ALPRAZolam 0.25 mg TAB UD $ 0.23 ALPRAZolam 0.5 mg TAB UD $ 0.14 ALPRAZolam 1 mg TAB UD $ 0.14 ALPRAZolam 1 mg/mL CONC (Intensol) $ 164.76 alprostadil 500 mcg/ml INJ $ 302.41 alteplase 100 mg PWDI - (Stroke) $ 23,368.39 alteplase 2 mg PWDI $ 406.44 alteplase 50 mg PWDI $ 11,734.00 aluminum chloride hexahydrate topical 6.25% SOLN $ 16.70 aluminum hydroxide 320 mg/5 mL SUSP $ 8.29 aluminum hydroxide-magnesium carbonate 95 mg-358 mg/15 mL SUSP $ 10.19 aluminum hydroxide-magnesium trisilicate 80 mg-14.2 mg CHEWTAB $ 0.21 aluminum sulfate-calcium acetate topical PWDR $ 20.49 alvimopan 12 mg CAP UD $ 467.20 amantadine 100 mg CAP $ 3.08 amantadine 100 mg/10 mL SYRUP $ 0.57 amikacin 1000 mg/4 ml INJ $ 26.83 AMILoride 5 mg TAB $ 1.02 amiloride-hydrochlorothiazide 5/50 TAB UD $ 0.57 Amino Acids 4.25%-Dextrose 10% IV SOLN 1000 mL $ 58.07 Amino Acids 4.25%-Dextrose 10% IV SOLN 2000 mL $ 113.88 Amino Acids 4.25%-Dextrose 10% w/ lytes IV SOLN 1000 mL $ 141.42 Amino Acids 4.25%-Dextrose 10% w/ lytes IV SOLN 2000 mL $ 118.41 Amino Acids 5%-Dextrose 15% IV SOLN 1000 mL $ 68.17 Amino Acids 5%-Dextrose 15% IV SOLN 2000 mL $ 135.33 Amino Acids 5%-Dextrose 15% w/ lytes IV SOLN 1000 mL $ 71.71 Amino Acids 5%-Dextrose 15% w/ lytes IV SOLN 2000 mL $ 138.67 Amino Acids 5%-Dextrose 20% IV SOLN 1000 mL $ 69.11

�198

Amino Acids 5%-Dextrose 20% IV SOLN 1500 mL $ 102.90 Amino Acids 5%-Dextrose 20% IV SOLN 2000 mL $ 137.26 Amino Acids 5%-Dextrose 20% w/ lytes IV SOLN 1000 mL $ 72.28 Amino Acids 5%-Dextrose 20% w/ lytes IV SOLN 2000 mL $ 140.48 Amino Acids 5%-Dextrose 25% IV SOLN $ 200.00 Amino Acids 6%-Dextrose 15% IV SOLN $ 200.00 Amino Acids 6%-Dextrose 20% IV SOLN $ 200.00 aminocaproic acid 250 mg/ml INJ $ 15.28 aminocaproic acid in NS irriga^on 3000 mL $ 87.53 aminophylline 500 mg/20 mL VIAL $ 18.11 amiodarone 100 mg TAB $ 6.17 amiodarone 200 mg TAB UD $ 0.68 amiodarone-D5W 150 mg/100 mL PM $ 53.77 amiodarone-D5W 360 mg/200 mL PM $ 124.52 amitriptyline 10 mg TAB UD $ 0.28 amitriptyline 100 mg TAB UD $ 2.21 amitriptyline 100 mg/10 ml INJ $ 22.41 amitriptyline 25 mg TAB UD $ 0.57 amitriptyline 50 mg TAB UD $ 0.93 amitriptyline 75 mg TAB UD $ 1.64 amLODIPine 10 mg TAB UD $ 0.20 amLODIPine 2.5 mg TAB $ 0.25 amLODIPine 5 mg TAB UD $ 0.17 amlodipine-benazepril 5 mg-10 mg CAP $ 1.11 amlodipine-benazepril 5 mg-20 mg CAP $ 0.42 ammonium lactate 12% topical CREAM 140 g $ 47.54 ammonium lactate 12% topical LOTION 225 mL $ 12.85 amoxicillin 125 mg/5 ml PWDR 150 mL $ 8.49 amoxicillin 125 mg/5 mL PWDR 80 mL $ 6.79 amoxicillin 250 mg CAP $ 0.14 amoxicillin 250 mg CHEWTAB $ 0.79 amoxicillin 250 mg/5 mL PWDR $ 8.49 amoxicillin 50 mg/mL ORAL SUSP (Neonatal) $ 21.00 amoxicillin 500 mg CAP UD $ 0.25 amoxicillin-clavulanate 1000 mg-62.5 mg ERT $ 6.51 amoxicillin-clavulanate 250 mg-125 mg TAB UD $ 7.84 amoxicillin-clavulanate 250 mg-62.5 mg/5 mL PWDR $ 275.93 amoxicillin-clavulanate 400 mg-57 mg/5 mL SUSP $ 31.13 amoxicillin-clavulanate 500 mg-125 mg TAB UD $ 1.27 amoxicillin-clavulanate 600 mg-42.9 mg/5 mL PWDR 75 mL $ 12.74 amoxicillin-clavulanate 875 mg-125 mg TAB UD $ 4.60 amphetamine-dextroamphetamine 10 mg TAB $ 1.02 amphetamine-dextroamphetamine 20 mg TAB $ 1.02

�199

amphetamine-dextroamphetamine 5 mg TAB $ 1.02 amphetamine-dextroamphetamine XR 10 mg CAP $ 13.10 amphetamine-dextroamphetamine XR 25 mg CAP $ 11.88 amphotericin B 50 mg PWDI $ 40.75 amphotericin B in SW irriga^on 1000 mL $ 263.19 amphotericin B liposomal 50 mg PWDI $ 602.25 ampicillin 1 g PWDI $ 4.47 ampicillin 100 mg/mL SYRINGE (Neonatal) $ 6.71 ampicillin 2 g PWDI $ 9.45 ampicillin 250 mg PWDI $ 1.73 ampicillin 500 mg PWDI $ 8.57 ampicillin-sulbactam 1 g-0.5 g ADV PWDI $ 14.09 ampicillin-sulbactam 1g-0.5 g PWDI $ 3.74 ampicillin-sulbactam 2 g-1 g ADV PWDI $ 24.20 ampicillin-sulbactam 2 g-1 g PWDI $ 14.04 anastrozole 1 mg TAB $ 1.39 an^hemophilic factor human PWDI $ 2.07 apap/butalbital/caffeine 325 mg-50 mg-40 mg TAB UD $ 3.11 apixaban 2.5 mg TAB $ 3.99 apixaban 5 mg TAB $ 3.99 aprepitant 130 mg/18 mL INJ $ 644.39 argatroban 100 mg/ml INJ 2.5 mL $ 646.37 ARIPiprazole 10 mg TAB $ 1.50 ARIPiprazole 15 mg TAB $ 1.02 ARIPiprazole 2 mg TAB $ 6.34 ARIPiprazole 400 mg PWDI $ 5,800.09 ARIPiprazole 5 mg TAB $ 2.32 ASA/butalbital/caffeine 325 mg-50 mg-40 mg CAP $ 3.00 ascorbic acid 100 mg/ml LIQUID DROPS $ 34.02 ascorbic acid 500 mg TAB UD $ 0.08 ascorbic acid 500 mg/mL MDV 50 mL $ 240.69 aspirin 300 mg SUPP $ 4.27 aspirin 325 mg tab EC UD $ 0.06 aspirin 600 mg SUPP $ 4.41 aspirin 81 mg TAB (enteric coated) $ 0.17 aspirin-dipyridamole 25 mg-200 mg CAP ER $ 9.48 atazanavir 300 mg CAP $ 120.90 atenolol 100 mg TAB UD $ 0.48 atenolol 12.5 mg/HALF-TAB $ 0.03 atenolol 25 mg TAB UD $ 0.40 atenolol 50 mg TAB UD $ 0.17 atorvasta^n 10 mg TAB UD $ 0.57 atorvasta^n 20 mg TAB $ 0.62

�200

atorvasta^n 40 mg TAB $ 0.62 atorvasta^n 80 mg TAB $ 5.64 atovaquone 750 mg/5 mL SUSP UD $ 30.00 atropine 0.1 mg/mL SYRINGE 10 mL $ 23.21 atropine 0.4 mg/ml INJ $ 10.67 atropine 1% ophthalmic OINT 3.5 g $ 42.39 atropine 1% ophthalmic SOLN 5 mL $ 124.10 atropine/hyoscyamine/PB/scopolamine ELIX UDC $ 40.04 atropine/hyoscyamine/PB/scopolamine TAB UD $ 22.95 atropine-diphenoxylate 0.025 mg-2.5 mg TAB UD $ 0.79 avibactam-cehazidime 0.5 g-2 g PWDI $ 952.32 azaci^dine 100 mg PWDI $ 1,457.45 azaTHIOprine 50 mg TAB UD $ 1.25 azithromycin 200 mg/5 mL PWDR $ 41.60 azithromycin 500 mg PWDI $ 6.79 azithromycin-LR 500 mg/250 mL PB $ 99.11 azithromycin-NS 500 mg/250 mL PB $ 8.35 aztreonam 1 g-dextrose 5% PB 50 mL $ 93.22 aztreonam 1 gm PWDI $ 72.08 aztreonam 2 g-dextrose 5% PB 50 mL $ 186.70 aztreonam 2 gm PWDI $ 144.19 bacitracin 50,000 units PWDI $ 25.47 bacitracin ophthalmic OINT 3.5 gm $ 233.06 bacitracin topical OINT 14 g $ 5.15 bacitracin/HC/neomycin/polymyxin B topical OINT 15 g $ 268.71 bacitracin/neomycin/polymyxin B ophthalmic OINT 3.5 g $ 29.42 bacitracin/neomycin/polymyxin B topical OINT 30 g $ 7.64 bacitracin-polymyxin B ophthalmic 500 u-10000 u/gm OINT 3.5 g $ 23.67 bacitracin-polymyxin B topical 500 u-10000 u/g OINT 15 g $ 15.28 bacitracin-polymyxin B topical 500 u-10000 u/gm PWD 10 g $ 27.28 baclofen 10 mg TAB $ 0.88 baclofen 40 mg/20 mL intrathecal SYR $ 1,698.00 baclofen 5 mg/HALF-TAB $ 0.48 balsalazide 750 mg CAP $ 1.03 balsam Peru/castor oil/trypsin topical SPRAY 120 mL $ 25.25 barium sulfate 700 mg TAB $ 6.68 BCG vaccine 50 mg (IVES) PWDI $ 395.24 beclomethasone 40 mcg/inh MDI 8.7g $ 309.57 beclomethasone 80 mcg/inh MDI 8.7g $ 414.48 belimumab 120 mg PWDI $ 1,254.20 belimumab 400mg PWDI $ 4,180.65 belladonna-opium 16.2 mg-30 mg SUPP UD $ 51.93 benazepril 10 mg TAB UD $ 0.45

�201

benazepril 20 mg TAB UD $ 1.56 bendamus^ne 100 mg PWDI $ 5,584.52 benzocaine 20% GEL (mint) $ 23.77 benzocaine 20% mucous membrane GEL 15 g $ 5.94 benzocaine 20% mucous membrane GEL 7 g $ 11.86 benzocaine 20% topical SPRAY (Solarcaine) 85 g $ 10.16 benzocaine 20% topical mucosal SPRAY 0.5 mL $ 26.12 benzocaine 20% topical SPRAY (Dermoplast) $ 13.24 benzocaine topical (Maximum Strength) CR 30 g $ 12.99 benzocaine/phenol/povidone iodine topical 6.3% GEL 7.5 gm $ 13.75 benzocaine-menthol 15- mg-4 mg mucous membrane LOZ $ 0.34 benzoin topical compound TINCTURE 58 mL $ 8.21 benzonatate 100 mg CAP $ 1.02 benzoyl peroxide 10% topical GEL 42.5 gm $ 14.43 benzoyl peroxide 5% topical GEL 90 g $ 40.75 benzoyl peroxide-erythromycin 5%-3% topical GEL 46.6 gm $ 440.47 benztropine 0.5 mg TAB UD $ 2.66 benztropine 1 mg TAB UD $ 0.31 benztropine 2 mg/2 ml INJ $ 122.31 betamethasone 30 mg/5 mL INJ suspension $ 90.28 betamethasone dip 0.05% CREAM 15 g $ 81.50 betamethasone dip 0.05% OINT 15 g $ 70.50 betamethasone dip 0.05% OINT 45 g $ 169.94 betamethasone dip, aug 0.05% CREAM 50 g $ 16.98 betamethasone dip, aug 0.05% GEL 15 g $ 80.85 betamethasone dip, aug 0.05% OINT 15 g $ 242.62 betamethasone val 0.1% CREAM 15 g $ 47.54 betamethasone val 0.1% OINT 15 g $ 34.84 betamethasone-clotrim 0.05%-1% CR 45 g $ 40.75 betamethasone-clotrim 0.05%-1% LOTION 30 mL $ 257.25 betaxolol ophthalmic 0.25% SUSP $ 817.87 bethanechol 10mg TAB $ 0.76 bethanechol 25 mg TAB UD $ 1.13 bevacizumab 100 mg/4 ml INJ $ 1,725.34 bevacizumab 400 mg/16 ml INJ $ 6,901.58 bicalutamide 50 mg TAB $ 1.97 bisacodyl 10 mg SUPP $ 0.48 bisacodyl 5 mg ECT UD $ 0.08 bismuth subsalicylate 262 mg/15 mL SUSP $ 5.46 bisoprolol 2.5 mg/HALF-TAB $ 1.19 bisoprolol 5 mg TAB $ 0.85 bisoprolol-hydrochlorothiazide 10 mg-6.25 mg TAB $ 0.28 bisoprolol-hydrochlorothiazide 2.5 mg-6.25 mg TAB $ 0.22

�202

bisoprolol-hydrochlorothiazide 5 mg-6.25 mg TAB $ 0.34 bivalirudin 250 mg PWDI $ 1,391.60 bleomycin 15 u PWDI $ 48.45 bortezomib 3.5 mg/1.4 mL INJ (SC) $ 4,556.30 bortezomib 3.5 mg/3.5 ml INJ $ 4,556.30 botulinum toxin type A 100 unit INJ $ 1,579.14 brimonidine 0.15% ophthalmic SOLN 5 mL $ 368.69 brimonidine 0.2% ophthalmic SOLN 5 mL $ 15.85 brinzolamide 1% ophthalmic SUSP 10 mL $ 815.04 bromfenac 0.09% ophthalmic SOLN 1.7 mL $ 272.35 bromocrip^ne 2.5 mg TAB $ 8.01 budesonide 0.5 mg/2 mL respule $ 9.34 budesonide 3 mg CAP ER $ 5.58 budesonide-formoterol 160 mcg-4.5 mcg/inh MDI $ 132.78 budesonide-formoterol 80 mcg-4.5 mcg/inh MDI $ 132.98 bumetanide 0.25 mg/ml INJ 10 mL $ 5.09 bumetanide 0.25 mg/ml INJ 4 mL $ 4.98 bumetanide 1 mg TAB $ 1.08 bupivacaine 0.25% INJ 50 mL $ 5.66 bupivacaine 0.25% PF INJ 30 mL $ 18.81 bupivacaine 0.25% PF SDV 30 mL $ 4.25 bupivacaine 0.5% INJ 10 mL $ 3.11 bupivacaine 0.5% INJ 10 mL SYRINGE $ 1.42 bupivacaine 0.5% INJ 50 mL $ 5.66 bupivacaine 0.5% PF SDV 30 mL $ 16.98 bupivacaine 0.75% PF INJ 10 mL $ 5.38 bupivacaine 0.75% PF INJ 30 mL $ 17.83 bupivacaine 0.75%-Dextrose 8.25% PF INJ 2 mL $ 4.39 bupivacaine liposome 1.3% INJ 20 mL $ 918.62 bupivacaine-epinephrine 0.25%-1:200,000 INJ 50 mL $ 4.25 bupivacaine-epinephrine 0.25%-1:200,000 PF INJ 10 mL $ 3.48 bupivacaine-epinephrine 0.25%-1:200,000 PF INJ 30 mL $ 21.23 bupivacaine-epinephrine 0.5%-1:200,000 INJ 50 mL $ 11.32 bupivacaine-epinephrine 0.5%-1:200,000 PF INJ 10 mL $ 9.06 bupivacaine-epinephrine 0.5%-1:200,000 PF INJ 30 mL $ 16.98 bupivacaine-epinephrine 0.75%-1:200,000 PF INJ 30 mL $ 6.79 bupivacaine-fentaNYL 0.125%-2 mcg/mL in NS 250 mL $ 55.89 bupivacaine-fentaNYL 0.125%-2 mcg/mL in NS 500 mL $ 127.35 buprenorphine 0.3 mg/ml INJ $ 40.38 buprenorphine 2 mg SL tab $ 1.42 buprenorphine 8 mg SL tab $ 3.71 buprenorphine-naloxone 2 mg-0.5 mg DT $ 7.50 buprenorphine-naloxone 8 mg-2 mg DT $ 4.70

�203

buPROPion 100 mg TAB $ 3.68 buPROPion 75 mg TAB $ 2.49 buPROPion SR 100 mg TAB $ 1.39 buPROPion SR 150 mg TAB $ 1.19 buPROPion XL 150 mg TAB $ 1.08 buPROPion XL 300 mg TAB $ 6.88 busPIRone 10 mg TAB UD $ 0.14 busPIRone 15 mg TAB UD $ 0.24 busPIRone 5 mg TAB UD $ 0.14 busPIRone 7.5 mg TAB $ 1.25 butabarbital 30 mg TAB $ 4.98 butenafine 1% topical CREAM 30 gm $ 40.75 butorphanol 1 mg/ml INJ $ 7.87 butorphanol 10 mg/mL SPRAY 2.5 mL $ 73.72 butorphanol 2 mg/ml INJ $ 12.23 butorphanol 4 mg/2mL INJ $ 17.15 cabazitaxel 60 mg/6 mL INJ $ 22,678.15 cadexomer iodine 0.9% topical GEL 10 g $ 88.86 cadexomer iodine 0.9% topical GEL 40 g $ 311.30 cadexomer iodine 0.9% topical PAD 10 g $ 30.00 cadexomer iodine 0.9% topical PAD 5 g $ 37.36 caffeine citrate 20 mg/mL ORAL SOLN (Neonatal) $ 52.38 caffeine citrate 5 mg/mL IV SYRINGE (Neonate) $ 13.27 caffeine citrate 60mg / 3 ml INJ $ 53.06 caffeine-sodium benzoate 125 mg-125 mg/mL INJ $ 8.39 calamine 8% topical LOTION 177 mL $ 10.02 calamine-pramoxine 8%-1% topical LOTION 180 mL $ 15.28 calcipotriene 0.005% topical CREAM 60 gm $ 237.72 calcitonin 200 Intnl Unit/inh SPRAY 3.7 mL $ 48.06 calcitonin 400 IntnlUnit/2 mL INJ $ 16.51 calcitriol 0.25 mcg CAP $ 0.59 calcitriol 1 mcg/ml INJ $ 18.11 calcitriol 1 mcg/ml LIQUID 15 mL $ 157.91 calcium acetate 667 mg GELCAP $ 0.42 calcium and vitamin D combina^on 600 mg-400 u TAB $ 0.34 calcium carbonate 1250 mg (500 mg elem Ca) TAB UD $ 0.11 calcium carbonate 1250 mg/5 ml SUSP $ 4.81 calcium carbonate 500 mg CHEWTAB $ 0.23 calcium carbonate-magnesium chloride 112 mg-64 mg EC TAB $ 0.20 calcium gluconate 100 mg/mL INJ 10 mL $ 22.07 calcium gluconate 100 mg/mL SYRINGE (Neonatal) $ 0.28 calcium gluconate 2.5% topical GEL 25 g $ 76.41 calcium gluconate-NS 1 g-100 mL PB $ 27.17

�204

calfactant 105 mg/3 mL SUSP $ 1,158.89 calfactant 210 mg/6 mL SUSP $ 2,051.18 camphor-menthol 0.5% topical LOTION (Sarna) 225 mL $ 12.57 candesartan 16 mg TAB $ 5.55 capecitabine 500 mg TAB $ 90.52 capsaicin 0.025% topical CREAM 60 gm $ 10.19 captopril 1 mg/mL oral SUSP (Neonatal) $ 21.00 captopril 12.5 mg TAB UD $ 1.36 captopril 25 mg TAB UD $ 3.93 captopril 50 mg TAB $ 0.20 captopril 6.25 mg/HALF-TAB $ 1.36 carbachol 0.01% ophthalmic SOLN 1.5 mL $ 34.76 carBAMazepine 100 mg CHEWTAB UD $ 1.39 carBAMazepine 100 mg ERT $ 3.00 carBAMazepine 200 mg CAP ER $ 3.14 carBAMazepine 200 mg ERT $ 6.96 carBAMazepine 200 mg TAB UD $ 1.36 carbamide peroxide 6.5% o^c SOLN 15 mL $ 5.09 carbenicillin 382 mg TAB $ 0.62 carbidopa/entacapone/levodopa 12.25 mg-200 mg-50 mg TAB $ 7.84 carbidopa/entacapone/levodopa 18.75 mg-200 mg-75 mg TAB $ 7.87 carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg TAB $ 8.20 carbidopa/entacapone/levodopa 31.25 mg-200 mg-125 mg TAB $ 8.15 carbidopa/entacapone/levodopa 37.5 mg-200 mg-150 mg TAB $ 5.89 carbidopa/entacapone/levodopa 50 mg-200 mg-200 mg TAB $ 6.08 carbidopa-levodopa 10 mg-100 mg TAB UD $ 0.51 carbidopa-levodopa 12.5 mg-50 mg/HALF-TAB $ 0.25 carbidopa-levodopa 25 mg-100 mg DT $ 1.75 carbidopa-levodopa 25 mg-100 mg TAB UD $ 0.42 carbidopa-levodopa 25 mg-250 mg TAB UD $ 0.59 carbidopa-levodopa CR 25 mg-100 mg UD $ 1.02 carbidopa-levodopa CR 50 mg-200 mg UD $ 1.53 CARBOpla^n 150 mg/15 mL INJ $ 24.62 CARBOpla^n 450 mg/45 mL INJ $ 85.32 CARBOpla^n 50 mg/5 mL INJ $ 12.59 CARBOpla^n 600 mg/60 mL INJ $ 105.28 carboprost 250 mcg/ml INJ $ 941.80 carfilzomib 60mg PWDI $ 5,796.92 carisoprodol 350 mg TAB UD $ 0.19 carteolol 1% ophthalmic SOLN 10 mL $ 87.81 carvedilol 12.5 mg TAB $ 0.20 carvedilol 25 mg TAB $ 0.17 carvedilol 3.125 mg TAB $ 0.23

�205

carvedilol 6.25 mg TAB $ 0.20 carvedilol CR 10 mg CAP $ 22.50 carvedilol CR 20 mg CAP $ 22.41 carvedilol CR 40 mg cap $ 19.70 caspofungin 50 mg PWDI $ 897.56 caspofungin 70 mg PWDI $ 954.90 cefadroxil 500 mg CAP UD $ 0.48 ceFAZolin 1 g PWDI $ 1.90 ceFAZolin 1 g/50 mL dextrose 5% SOLN $ 8.82 ceFAZolin 500 mg PWDI $ 2.15 ceFAZolin-D5W 2g/100 mL PM $ 17.26 cefdinir 125 mg/5 mL PWDR 60 mL $ 52.64 cefdinir 300 mg CAP $ 1.13 cefepime 1 g PWDI $ 11.60 cefepime 2 g PWDI $ 12.37 cefoTAXime 2 gm PWDI $ 11.40 cefoTAXime 47.5 mg/mL SYRINGE (Neonate) $ 1.36 cefoTAXime 500 mg PWDI $ 4.10 cefoTAXime1 gm PWDI $ 6.00 cefOXi^n 1 g PWDI $ 7.67 cefOXi^n 2 g PWDI $ 15.23 ceharoline fosamil 600 mg PWDI MDV $ 6.88 cefTAZIDime 1 gm PWDI $ 31.55 cefTAZIDime 2 g PWDI $ 20.63 ceFTAZIDime-D4.4W 1 gm/50 ml IV SOLN $ 32.29 ceholozane-tazobactam 1 g-0.5 g INJ MDV $ 1,007.48 cefTRIAXone 1 gm PWDI $ 3.48 cefTRIAXone 1 gm/50 ml SOLN $ 22.02 cefTRIAXone 2 g PWDI $ 6.57 cefTRIAXone 25 mg/mL SYRINGE (Neonatal) $ 0.40 cefuroxime 1.5 gm PWDI $ 9.39 cefuroxime 250 mg TAB UD $ 4.95 cefuroxime 500 mg TAB UD $ 8.66 cefuroxime 750 mg PWDI $ 5.43 Celecoxib 100 mg CAP UD $ 1.50 Celecoxib 200 mg CAP $ 5.35 cellulose absorbable hemostat 1 x 2 gauze $ 324.12 cellulose absorbable hemostat 2 x 3 GAUZE $ 83.60 cellulose absorbable hemostat 2 x 4 gauze $ 258.38 cellulose absorbable hemostat 4 x 8 gauze $ 152.62 cephalexin 250 mg CAP UD $ 0.31 cephalexin 250 mg/5 ml PWDR $ 35.69 cephalexin 500 mg CAP UD $ 0.28

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certolizumab 200 mg INJ $ 2,353.67 ce^rizine 10 mg TAB $ 0.34 ce^rizine 5 mg TAB $ 0.37 ce^rizine 5 mg/5 ml SYRUP UD $ 0.42 cetuximab 100 mg/50 ml INJ $ 1,387.86 charcoal 25 gm SUSP $ 54.34 chlordiazePOXIDE 25 mg CAP UD $ 1.22 chlordiazePOXIDE 5 mg CAP UD $ 1.27 chlorhexidine 0.12% topical LIQUID UDC $ 5.09 chloroprocaine 2% INJ 20 mL $ 52.64 chloroprocaine 3% INJ 20 mL $ 56.03 chlorothiazide 0.5 gm PWDI $ 114.50 chlorothiazide 50 mg/mL ORAL SUSP (Neonatal) $ 21.00 chlorpheniramine 4 mg TAB $ 0.08 chlorpheniramine-HYDROcodone 8 mg-10 mg/5 ml SUSP ER $ 5.38 chlorproMAZINE 10 mg TAB k $ 7.05 chlorproMAZINE 100 mg TAB UD $ 15.96 chlorproMAZINE 25 mg TAB UD $ 13.71 chlorproMAZINE 25 mg/ml INJ $ 62.60 chlorproPAMIDE 250 mg TAB UD $ 4.53 chlorthalidone 25 mg TAB $ 4.30 cholecalciferol 1000 Intnl Unit TAB $ 0.09 cholecalciferol 400 Intnl Unit TAB $ 0.42 cholestyramine 4 gm/5 gm PWDR UD $ 5.49 cilostazol 100 mg TAB $ 0.37 cilostazol 50 mg TAB $ 0.99 cinacalcet 30 mg TAB $ 72.56 ciprofloxacin 0.3% ophthalmic OINT 3.5 g $ 568.77 ciprofloxacin 0.3% ophthalmic SOLN 2.5 mL $ 9.62 ciprofloxacin 200 mg/20 ml INJ $ 5.26 ciprofloxacin 250 mg TAB UD $ 0.40 ciprofloxacin 400 mg/40 ml INJ $ 4.08 ciprofloxacin 500 mg TAB UD $ 0.48 ciprofloxacin 500 mg/5 ml PWDR $ 387.71 ciprofloxacin 750 mg TAB UD $ 0.85 ciprofloxacin-dextrose 5% 200 mg/100 ml PB $ 5.66 ciprofloxacin-dextrose 5% 400 mg/200 ml PB $ 11.32 ciprofloxacin-hydrocor^sone 0.2%-1% o^c SUSP 10 mL $ 835.42 cisatracurium 200 mg/20 mL INJ SOLN $ 443.18 CISpla^n 100 mg/100 ml INJ $ 48.62 CISpla^n 50 mg/50 mL INJ $ 26.89 citalopram 10 mg tablet $ 0.17 citalopram 10 mg/ 5 mL SOLN 240 mL $ 64.52

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citalopram 20 mg TAB $ 0.17 citric acid-sodium citrate 640 mg-490 mg/5 ml SOLN UDC 30 ml $ 6.59 cladribine 10 mg/10 ml INJ $ 953.46 clarithromycin 250 mg TAB UD $ 9.28 clarithromycin 250 mg/5 ml PWDR $ 384.88 clarithromycin 500 mg TAB UD $ 2.60 clindamycin 1% topical GEL 30 gm $ 184.23 clindamycin 1% topical LOTION 60 mL $ 189.30 clindamycin 150 mg CAP UD $ 0.51 clindamycin 300 mg/2 ml INJ $ 4.70 clindamycin 6 mg/mL SYRINGE (Neonatal) $ 0.12 clindamycin 600 mg/4 ml INJ $ 6.91 clindamycin 75 mg/5 ml PWDR $ 110.37 clindamycin 900 mg/6 ml INJ $ 10.87 clindamycin-D5W 300 mg-50 mL IV SOLN $ 9.91 clindamycin-D5W 600 mg-50 mL IV SOLN $ 15.57 clindamycin-D5W 900 mg-50 mL IV SOLN $ 18.40 clobetasol 0.05% topical CREAM 15 gm $ 65.37 clobetasol 0.05% topical GEL 30 gm $ 596.85 clobetasol 0.05% topical OINT 15 g $ 22.50 clobetasol 0.05% topical SOLN 25 mL $ 133.01 clobetasol E 0.05% topical CREAM 30 gm $ 290.36 clomiPRAMINE 25 mg CAP $ 11.74 clomiPRAMINE 50 mg CAP $ 21.39 clonazePAM 0.25 mg/HALF-TAB $ 0.03 clonazePAM 0.5 mg TAB UD $ 0.06 clonazePAM 1 mg TAB UD $ 0.06 cloNIDine 0.1 mg TAB UD $ 0.14 cloNIDine 0.1 mg/24 hr PATCH $ 72.19 cloNIDine 0.2 mg TAB UD $ 0.20 cloNIDine 0.2 mg/24 hr PATCH $ 90.33 cloNIDine 0.3 mg/24 hr PATCH $ 111.28 cloNIDine 10 mcg/1 mL ORAL SUSP (Neonatal) $ 21.00 cloNIDine 100 mcg/mL INJ 10 mL $ 28.02 clopidogrel 300 mg TAB $ 27.79 clopidogrel 75 mg TAB UD $ 0.40 clorazepate 3.75 mg TAB $ 1.98 clotrimazole 1% topical CR 45 gm $ 6.37 clotrimazole 1% topical CREAM 30 gm $ 5.09 clotrimazole 10 mg LOZ UD $ 2.32 cloZAPine 100 mg TAB UD $ 2.12 cloZAPine 25 mg TAB UD $ 1.33 cloZAPine 50 mg TAB UD $ 2.12

�208

coal tar 0.5% topical SHAM 251 mL $ 28.41 cobicistat/elvitegravir/emtricitabine/tenofov 150 mg-150 mg-200 mg-300 mg TAB $ 273.92 cobicistat/elvitegravir/emtricitabine/tenofovir 150 mg-150 mg-200 mg-10 mg TAB $ 273.72 cocaine 4% 160 mg/4 mL topical SOLN $ 455.74 cocaine 4% 400 mg/10 mL topical SOLN $ 459.56 codeine-guaifenesin 10 mg-100 mg/5 mL S/F SYRUP UD 10 mL $ 1.70 codeine-proMETHazine 10 mg-6.25 mg/5 mL SYRUP UD $ 0.15 Coe-Pak peridontal dressing $ 263.05 colchicine 0.3 mg / HALF-TAB $ 18.56 colchicine 0.6 mg TAB $ 11.35 colesevelam 625 mg TAB $ 9.25 colis^methate 150 mg PWDI $ 74.43 collagen hemostat, microfibrillar topical PWD 1 gm $ 621.67 collagen hemostat, microfibrillar topical PWD 5 g $ 2,051.75 collagenase topical OINT 30 g $ 587.51 colloidal oatmeal topical (Aveeno) SOAP $ 6.62 copper chloride 4 mg/10 mL INJ $ 48.65 cromolyn 10 mg/ml SOLN 2 mL $ 3.62 cromolyn 4% ophthalmic SOLN 10 mL $ 11.89 cromolyn nasal 5.2 mg/inh SPRAY 13 mL $ 21.34 cyanocobalamin 100 mcg TAB $ 0.42 cyanocobalamin 1000 mcg TAB $ 0.40 cyclobenzaprine 10 mg TAB UD $ 0.17 cyclobenzaprine 5 mg TAB $ 0.11 cyclopentolate 1% ophthalmic SOLN 2 mL $ 3.54 cyclopentolate-phenylephrine 0.2%-1% ophthalmic SOLN 2 mL $ 74.71 cyclophosphamide 1 gm PWDI $ 1,317.51 cyclophosphamide 25 mg CAP $ 12.85 cyclophosphamide 500 mg PWDI $ 473.60 cycloSPORINE 0.05% ophthalmic emulsion UD $ 24.71 cycloSPORINE 100 mg CAP UD (Neoral) $ 18.99 cycloSPORINE 100 mg CAP UD (SandIMMUNE) $ 35.32 cycloSPORINE 100 mg/ml SOLN (SandIMMUNE) 50 mL $ 1,594.51 cycloSPORINE 25 mg CAP UD (Neoral) $ 5.01 cyproheptadine 4 mg TAB UD $ 0.71 cytarabine 1 gm PWDI $ 54.48 cytarabine 100 mg PWDI $ 7.15 cytarabine 100 mg/5 mL INJ $ 14.29 cytarabine 2000 mg/20 mL INJ $ 48.68 dabigatran 150 mg CAP UD $ 17.26 dabigatran 75 mg CAP UD $ 17.26 dacarbazine 200 mg PWDI $ 13.87 dantrolene 20 mg PWDI $ 29.09

�209

dantrolene 25 mg CAP UD $ 2.43 dantrolene 250 mg PWDI $ 0.01 dapsone 25 mg TAB $ 3.85 DAPTOmycin 350 mg MDV $ 0.37 darbepoe^n alfa 100 mcg/0.5 mL SYR $ 1,079.83 darbepoe^n alfa 100 mcg/0.5 mL SYR (ESRD) $ 1,122.99 darbepoe^n alfa 150 mcg/0.3 mL SYR $ 1,707.04 darbepoe^n alfa 150 mcg/0.3 mL SYR (ESRD) $ 1,707.04 darbepoe^n alfa 200 mcg/0.4 mL SYR $ 3,792.80 darbepoe^n alfa 25 mcg/0.42 mL SYR $ 280.65 darbepoe^n alfa 25 mcg/0.42 mL SYR (ESRD) $ 280.65 darbepoe^n alfa 40 mcg/0.4 mL SYR $ 449.19 darbepoe^n alfa 40 mcg/0.4 mL SYR (ESRD) $ 430.69 darbepoe^n alfa 60 mcg/0.3 mL SYR $ 647.90 darbepoe^n alfa 60 mcg/0.3 mL SYR (ESRD) $ 657.76 DAUNOrubicin 20 mg/4 mL INJ $ 65.44 decitabine 50 mg PWDI $ 3,845.80 deferoxamine 2 gm PWDI $ 83.37 deferoxamine 500 mg PWDI $ 41.46 demeclocycline 150 mg TAB $ 12.71 desflurane inhala^on LIQUID 240 mL $ 407.52 desipramine 25 mg TAB UD $ 1.92 desipramine 50 mg TAB UD $ 5.74 desmopressin 0.2 mg TAB $ 6.34 desmopressin 10 mcg/inh SPRAY 5 mL $ 262.62 desmopressin 4 mcg/1 mL INJ $ 149.03 desmopressin 4 mcg/1 mL INJ 10 mL MDV $ 2,190.99 desonide 0.05% topical CREAM 15 gm $ 131.71 desonide 0.05% topical LOTION 118 mL $ 767.79 desonide 0.05% topical OINT 60 g $ 50.63 desoximetasone 0.05% topical 60 gm $ 528.08 desoximetasone 0.25% topical CREAM 60 gm $ 370.16 dexamethasone 0.1% ophthalmic SOLN 5 mL $ 107.65 dexamethasone 0.5 mg TAB UD $ 0.19 dexamethasone 0.5 mg/5 ml ELIX UD $ 0.42 dexamethasone 1.5 mg TAB UD $ 0.33 dexamethasone 10 mg/ml INJ PF $ 15.20 dexamethasone 2 mg TAB UD $ 1.64 dexamethasone 20 mg/5 ml INJ $ 7.36 dexamethasone 4 mg TAB UD $ 2.35 dexamethasone 4 mg/ml INJ $ 1.33 dexamethasone/neomycin/polymyxin B ophthalmic OINT 3.5 g $ 41.40 dexamethasone/neomycin/polymyxin B ophthalmic SUSP 5 mL $ 48.11

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dexmedetomidine 1000 mcg/250 mL NS PM $ 145.00 dexmedetomidine 200 mcg/2 mL IV SOLN $ 13.47 dexmedetomidine 400 mcg/100 mL PM BAG $ 115.00 dexrazoxane 250 mg PWDI $ 367.76 dexrazoxane 500 mg PWDI $ 1,244.86 dextroamphetamine 5 mg TAB $ 3.68 dextromethorphan 60 mg/10 ml SUSP ER $ 1.98 dextromethorphan-guaiFENesin 30 mg-600 mg ERT $ 1.61 dextromethorphan-guaiFENesin SF 10 mg-100 mg/5 mL LIQUID $ 0.57 dextrose 10% in water 1000 ml $ 90.00 Dextrose 10% in Water 250 mL $ 90.00 dextrose 2.5% with 0.45% NaCl SOLN 1000ml $ 90.00 dextrose 2.5% with 0.45% NaCl SOLN 500 ml $ 90.00 dextrose 25% in Water SYRINGE (pedi) $ 17.83 dextrose 5% in Lactated Ringers Injec^on SOLN $ 90.00 dextrose 5% in Water (PAB) 100 ml $ 44.00 dextrose 5% in Water SOLN 100 ml $ 44.00 dextrose 5% in Water SOLN 1000 ml $ 92.00 dextrose 5% in Water SOLN 1000 ml (Non-DEHP) $ 89.00 dextrose 5% in Water SOLN 150 ml $ 43.50 dextrose 5% in Water SOLN 250 mL $ 90.00 dextrose 5% in Water SOLN 250 ml (Non-DEHP) $ 90.00 dextrose 5% in Water SOLN 50 ml $ 44.00 dextrose 5% in Water SOLN 500 ml $ 92.00 dextrose 5% in Water SOLN 500 ml (Non-DEHP) $ 90.00 dextrose 5% in Water with KCl 20 mEq/L SOLN $ 92.00 dextrose 5% with 0.2% NaCl 1000 ml $ 90.00 dextrose 5% with 0.2% NaCl SOLN 500 ml $ 90.00 dextrose 5% with 0.225% NaCl and KCl 20 mEq/L SOLN $ 90.00 dextrose 5% with 0.45% NaCl and KCl 10 mEq/L SOLN $ 92.00 dextrose 5% with 0.45% NaCl and KCl 20 mEq/L SOLN $ 92.00 dextrose 5% with 0.45% NaCl and KCl 30 mEq/L SOLN $ 90.00 dextrose 5% with 0.45% NaCl and KCl 40 mEq/L SOLN $ 62.00 dextrose 5% with 0.45% NaCl SOLN 1000 ml $ 90.00 dextrose 5% with 0.45% NaCl SOLN 500 ml $ 90.00 dextrose 5% with 0.9% NaCl and KCl 20 mEq/L SOLN $ 92.00 dextrose 5% with 0.9% NaCl and KCl 40 mEq/L SOLN $ 90.00 dextrose 5% with 0.9% NaCl SOLN 1000 mL $ 89.00 dextrose 5% with 0.9% NaCl SOLN 500 ml $ 89.00 dextrose 50% INJ $ 5.66 dextrose 50% SYRINGE $ 21.23 Diatrizoate Meglumine / Diatrizoate Sodium SOLN 120 mL $ 186.78 Diatrizoate Meglumine / Diatrizoate Sodium SOLN 30 mL $ 62.83

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diazePAM 10 mg TAB UD $ 0.10 diazePAM 10 mg/2 ml INJ $ 62.37 diazePAM 10mg/2 mL INJ (pre-pack) $ 16.64 diazePAM 2 mg TAB UD $ 0.16 diazePAM 5 mg TAB UD $ 0.17 diazePAM 50 mg/10 mL VIAL $ 91.13 dibucaine 1% topical OINT 56.7 g $ 20.86 diclofenac 0.1% ophthalmic SOLN 5 mL $ 27.88 diclofenac 1% topical GEL 100 g $ 56.60 dicyclomine 10 mg CAP $ 0.09 dicyclomine 10 mg/5 ml SYRUP $ 2.97 dicyclomine 20 mg TAB UD $ 0.40 dicyclomine 20 mg/2 ml INJ $ 108.67 diflorasone topical 0.05% CREAM 30 gm $ 58.72 digoxin 0.05 mg/ml ELIX UD $ 28.02 digoxin 0.1 mg/ml INJ pediatric $ 245.36 digoxin 0.125 mg TAB UD $ 2.32 digoxin 0.25 mg TAB UD $ 2.66 digoxin 0.25 mg/ml INJ $ 16.07 digoxin 10 mcg/mL SYRINGE (Neonatal) $ 10.03 digoxin immune FAB 40 mg PWDI $ 9,704.15 dihydroergotamine 1 mg/ml INJ $ 343.73 dilâZEM 100 mg PWDI $ 82.15 dilâZEM 125 mg/25 ml INJ $ 23.69 dilâZEM 25 mg/5 ml INJ $ 4.10 dilâZEM 30 mg TAB UD $ 0.31 dilâZEM 50 mg/10 ml INJ $ 7.92 dilâZEM 60 mg CAP ER $ 5.04 dilâZEM 60 mg TAB UD $ 0.48 dilâZEM 90 mg CAP SR $ 4.41 dilâZEM 90 mg TAB UD $ 0.62 dilâZEM CD 120 mg CAP UD $ 0.91 dilâZEM CD 180 mg CAP UD $ 0.65 dilâZEM CD 240 mg CAP UD $ 0.93 dilâZEM CD 300 mg CAP UD $ 3.31 dilâZEM-D5W 125 mg/125 mL PB $ 28.30 dimethyl sulfoxide 50% irrigaôn soln 50 mL $ 1,514.05 dinoprostone topical 10 mg SUPP $ 950.29 diphenhydrAMINE 12.5 mg/5 ml LIQUID (For Compounding Only) $ 29.88 diphenhydrAMINE 12.5 mg/5 ml LIQUID UD $ 6.08 diphenhydrAMINE 25 mg CAP UD $ 0.08 diphenhydrAMINE 50 mg CAP UD $ 0.11 diphenhydraMINE-zinc acetate CREAM 30 g $ 5.94

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diphtheria/pertussis,acel/tetanus/polio pediatric SYRINGE (STATE) $ 0.01 diphtheria-pertussis, acellular-tetanus PEDI 0.5 mL (STATE) $ 0.01 dipyridamole 25 mg TAB UD $ 0.74 dipyridamole 50 mg TAB UD $ 1.63 dipyridamole 75 mg TAB UD $ 2.18 disopyramide 100 mg CAP CR $ 10.65 disopyramide 100 mg CAP UD $ 0.65 disulfiram 250 mg TAB $ 4.47 divalproex sodium 125 mg SPRINKLES UD $ 1.84 divalproex sodium 250 mg ECT UD $ 0.40 divalproex sodium 250 mg ERT UD $ 3.91 divalproex sodium 500 mg ECT UD $ 0.79 divalproex sodium 500 mg ERT $ 3.74 DOBUTamine 250 mg/20 ml INJ $ 13.58 DOBUTamine 250 mg/250 mL in dextrose 5% PM $ 15.57 DOBUTamine 500 mg/250 ml SOLN $ 271.68 DOBUTamine-D5W 100 mg/ 50 mL PB $ 24.71 DOCEtaxel 80 mg/8 mL INJ MDV $ 123.93 DOCEtaxel 160 mg/16 mL INJ MDV $ 248.45 DOCEtaxel 20 mg INJ $ 866.46 DOCEtaxel 80 mg INJ $ 337.11 docusate SODIUM 100 mg CAP UD $ 0.08 docusate SODIUM 100 mg/10 ml Liquid UDC $ 1.42 docusate-senna 50 mg-8.6mg TAB UD $ 0.08 dofe^lide 125 mcg CAP UD $ 4.26 dofe^lide 250 mcg CAP UD $ 18.48 dofe^lide 500 mcg CAP $ 18.20 donepezil 5 mg TAB UD $ 0.31 DOPamine 400 mg/10 ml INJ $ 2.45 DOPamine 400 mg/250 mL D5W $ 209.42 DOPamine 800 mg/250 ml D5W $ 209.42 dornase alfa 2.5 mg/2.5 mL SOLN $ 291.26 dorzolamide 2% ophthalmic SOLN 10 mL $ 49.81 dorzolamide-^molol 2.23%-0.68% ophthalmic SOLN 10 mL $ 49.53 doxazosin 1 mg TAB UD $ 2.21 doxazosin 2 mg TAB UD $ 1.50 doxazosin 4 mg TAB UD $ 1.75 doxepin 10 mg CAP UD $ 1.36 doxepin 10 mg/ml CONC $ 16.98 doxepin 25 mg CAP UD $ 1.78 doxepin 5% topical CREAM 30 gm $ 1,073.14 doxepin 5% topical CREAM 45 gm $ 513.22 doxepin 50 mg CAP UD $ 2.46

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doxepin 75 mg CAP UD $ 3.57 doxercalciferol 2 mcg/mL INJ $ 33.22 DOXOrubicin 10 mg/5 ml INJ $ 17.91 DOXOrubicin 20 mg/10 mL INJ PFS $ 35.88 DOXOrubicin 200 mg/100 ml INJ $ 134.85 DOXOrubicin 50 mg PWDI $ 54.70 DOXOrubicin 50 mg/25 ml INJ $ 41.04 DOXOrubicin liposomal 20 mg/10 ml INJ $ 3,120.36 DOXOrubicin liposomal 50 mg/25 ml INJ $ 7,023.41 doxycycline 100 mg PWDI $ 53.54 doxycycline 25 mg/5 ml PWDR $ 47.54 doxycycline monohydrate 100 mg TAB $ 8.24 doxycycline monohydrate 50 mg CAP $ 0.42 Dr. Raimondo's Mouthwash SUSP 120 mL $ 19.53 dronabinol 2.5 mg CAP $ 5.32 dronedarone 400 mg TAB UD $ 25.19 droperidol 5 mg/2 ml INJ $ 8.72 Dry Socket Paste 30 g $ 446.86 DULoxe^ne 20 mg CAP DR $ 0.82 DULoxe^ne 30 mg CAP DR $ 1.02 DULoxe^ne 60 mg CAP DR $ 0.40 dutasteride 0.5 mg CAP UD $ 0.62 econazole 1% topical CREAM 15 gm $ 134.57 edrophonium 10 mg/ml INJ 15 mL $ 633.35 efavirenz 600 mg TAB $ 45.98 efavirenz/emtricitabine/tenofovir 600 mg-200 mg-300 mg TAB $ 195.98 emollients, topical (Aquaphor) OINT 50 g $ 12.45 emollients, topical (Astroglide) GEL 120 mL $ 8.49 emollients, topical (Cetaphil) CLEANSER 480 mL $ 33.11 emollients, topical (Cetaphil) LOTION 180 mL $ 34.21 emollients, topical (Eucerin) CREAM 113 g $ 15.99 emollients, topical (Eucerin) CREAM 480 g $ 25.70 emollients, topical (K-Y Jelly) 60 g $ 8.07 emollients, topical (Lubriderm) LOTION 180 mL $ 10.19 emollients, topical (Moisturel) LOTION 240 mL $ 20.38 empagliflozin 10 mg TAB $ 34.19 empagliflozin 25 mg TAB $ 34.19 emtricitabine 200 mg CAP $ 47.60 emtricitabine-tenofovir 200 mg/300 mg TAB $ 150.73 enalapril 10 mg TAB UD $ 1.10 enalapril 2.5 mg TAB UD $ 0.51 enalapril 20 mg tab UD $ 1.70 enalapril 5 mg TAB UD $ 0.96

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enalaprilat 1.25 mg/ml INJ $ 10.53 enalaprilat 2.5 mg/2 ml INJ $ 14.04 enoxaparin 100 mg/ml SYRINGE $ 24.37 enoxaparin 120 mg/0.8 ml SYRINGE $ 29.15 enoxaparin 150 mg/ml SYRINGE $ 36.59 enoxaparin 30 mg/0.3 ml SYRINGE $ 7.71 enoxaparin 40 mg/0.4 ml SYRINGE $ 9.64 enoxaparin 80 mg/0.8 ml SYRINGE $ 19.58 entacapone 200 mg TAB $ 10.95 ePHEDrine 25 mg/5 mL NS SYRINGE $ 68.77 ePHEDrine 50 mg/10 mL in 0.9% Sodium Chloride $ 114.05 ePHEDrine 50 mg/ml INJ $ 34.16 EPINEPHrine 0.3 mg SYRINGE (Epi-pen) $ 452.40 EPINEPHrine 1 mg/mL INJ 1mL $ 37.36 EPINEPHrine 1.5 mg/0.3 ml INJ (Susphrine) $ 7.64 EPINEPHrine 1:1000 INJ 30mL $ 509.40 EPINEPHrine topical 1:1000 SOLN 30 ml $ 137.43 EPINEPHrine-lidocaine 1:100,000-1% INJ 50 ml $ 149.99 EPINEPHrine-lidocaine 1:100,000-2% SYRINGE 1.8 mL (Dental) $ 2.26 EPINEPHrine-lidocaine 1:100,000-2% INJ 30 ml $ 9.19 EPINEPHrine-lidocaine 1:100,000-2% INJ 50 mL $ 8.49 EPINEPHrine-lidocaine 1:200,000-1% INJ 30 mL $ 11.21 EPINEPHrine-lidocaine 1:200,000-1.5% INJ 30 mL $ 36.51 EPINEPHrine-lidocaine 1:200,000-2% INJ 10 mL $ 9.06 EPINEPHrine-lidocaine 1:200,000-2% INJ 20 mL $ 41.88 EPINEPHrine-lidocaine 1:200,000-2% INJ 20 ml (Steri-Pak) $ 22.39 EPINEPHrine-lidocaine-tetracaine 0.05%-4%-0.5% SOLN 3 mL $ 22.50 epiRUBicin 50 mg/25 ml INJ $ 95.63 eplerenone 25 mg TAB $ 3.00 eplerenone 50 mg TAB $ 3.74 epoe^n alfa 10,000 u/ml INJ $ 370.76 epoe^n alfa 2,000 u/ml INJ $ 81.96 epoe^n alfa 20,000 u/mL INJ $ 780.43 epoe^n alfa 3,000 u/ml INJ $ 122.94 epoe^n alfa 4,000 u/mL INJ $ 163.91 epoe^n alfa epbx 10000 units/mL PF INJ $ 249.55 epoe^n alfa epbx 2000 units/mL PF INJ $ 50.71 epoe^n alfa epbx 3000 units/mL PF INJ $ 74.88 epoe^n alfa epbx 4000 units/mL PF INJ $ 99.84 epoe^n alfa epbx 40000 units/mL PF INJ $ 1,002.44 ep^fiba^de 20 mg/10 ml INJ $ 55.44 ep^fiba^de 75 mg/100 ml IV SOLN $ 135.87 ep^fiba^de 75 mg/100 mL PM $ 180.24

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ergocalciferol 50,000 Intnl Unit CAP $ 0.34 ergocalciferol 8,000 Intnl Unit/ml SOLN $ 84.90 eriBULin mesylate 1 mg INJ $ 2,629.07 ertapenem 1 gm PWDI $ 247.20 erythromycin 0.5% ophthalmic OINT 1 g UD $ 24.65 erythromycin 0.5% ophthalmic OINT 3.5 g $ 39.82 erythromycin 250 mg ECT UD $ 19.58 erythromycin 500 mg ECT UD $ 20.54 erythromycin ethylsuccinate 200 mg/5 mL SUSP $ 653.73 erythromycin lactobionate 500 mg PWDI $ 170.28 erythromycin-sulfiSOXAZOLE 200 mg-600 mg/5 ml GRAN $ 50.94 escitalopram 10 mg TAB UD $ 0.37 escitalopram 20 mg tab UD $ 0.40 escitalopram 5 mg TAB $ 0.21 esmolol 100 mg/10 ml INJ $ 6.79 esmolol 2.5 gm/250 ml NS pre-mix $ 1,046.82 esomeprazole 40 mg CAPLET EC $ 16.56 esomeprazole 40 mg PWDI $ 17.89 estradiol 0.0375 mg/24 hr TERF (Vivelle) $ 44.94 estradiol 0.05 mg/24 hr TERF (Vivelle) $ 21.00 estradiol 0.075 mg/24 hr TERF (Climara) $ 16.68 estradiol 0.5 mg TAB $ 0.54 estradiol 1 mg TAB $ 0.21 estradiol topical 0.1 mg/gm vaginal CREAM 42.5 gm $ 916.21 estrogens, conjugated 0.3 mg TAB $ 10.53 estrogens, conjugated 0.45 mg tab $ 9.03 estrogens, conjugated 0.625 mg TAB UD $ 10.53 estrogens, conjugated 1.25 mg TAB UD $ 3.41 estrogens, conjugated 25 mg PWDI $ 766.82 estrogens, conjugated topical 0.625 mg/gm vaginal CREAM 42.5 gm $ 991.94 ethacrynic acid 25 mg TAB $ 50.32 ethacrynic acid 50 mg PWDI $ 6,058.80 ethambutol 400 mg TAB $ 1.42 ethanol 98% INJ 5 ml $ 227.67 ethanolamine oleate 50 mg/ml INJ $ 1,135.23 ethyl chloride topical SPRAY $ 79.08 etodolac 400 mg TAB $ 2.75 etomidate 20 mg/10 ml INJ $ 7.64 etoposide 100 mg/5 ml INJ MDV $ 14.29 etoposide 1000 mg/50 ml INJ MDV $ 71.08 etoposide 500 mg/25 ml INJ MDV $ 35.62 exemestane 25 mg TAB $ 16.65 eze^mibe 10 mg TAB UD $ 1.19

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F/S dextrose 10% in water 1000 mL $ 90.00 F/S dextrose 10% in water 250 mL $ 90.00 F/S dextrose 10% in water neonatal bolus $ 90.00 F/S dextrose 2.5% with 0.45% NaCl SOLN 1000 mL $ 90.00 F/S dextrose 2.5% with 0.45% NaCl SOLN 500 mL $ 90.00 F/S dextrose 5% in Lactated Ringers SOLN 1000 mL $ 90.00 F/S dextrose 5% in Water SOLN 100 mL $ 45.00 F/S dextrose 5% in Water SOLN 1000 mL $ 92.00 F/S dextrose 5% in Water SOLN 150 mL $ 45.00 F/S dextrose 5% in Water SOLN 250 mL $ 90.00 F/S dextrose 5% in Water SOLN 50 mL $ 90.00 F/S dextrose 5% in Water SOLN 500 mL $ 92.00 F/S dextrose 5% in Water SOLN 500 mL (excel) $ 92.00 F/S dextrose 5% with 0.2% NaCl 1000 mL $ 90.00 F/S dextrose 5% with 0.2% NaCl SOLN 500 mL $ 90.00 F/S dextrose 5% with 0.45% NaCl SOLN 1000 mL $ 90.00 F/S dextrose 5% with 0.45% NaCl SOLN 500 mL $ 90.00 F/S dextrose 5% with 0.9% NaCl SOLN 1000 mL $ 89.00 F/S dextrose 5% with 0.9% NaCl SOLN 500 mL $ 89.00 F/S Lactated Ringers Injec^on SOLN 1000 mL $ 92.00 F/S Lactated Ringers Injec^on SOLN 500 mL $ 92.00 F/S Sodium Chloride 0.45% SOLN 1000 mL $ 90.00 F/S Sodium Chloride 0.45% SOLN 500 ml $ 90.00 F/S Sodium Chloride 0.9% 100 mL MINIBAG PLUS $ 45.00 F/S Sodium Chloride 0.9% 50 mL MINIBAG PLUS $ 90.00 F/S Sodium Chloride 0.9% IV 250 mL ADV $ 90.00 F/S sodium chloride 0.9% IV 50 mL ADV $ 42.50 F/S Sodium Chloride 0.9% SOLN 100 mL $ 45.00 F/S Sodium Chloride 0.9% SOLN 1000 mL $ 90.00 F/S Sodium Chloride 0.9% SOLN 250 mL $ 89.00 F/S Sodium Chloride 0.9% SOLN 50 mL $ 90.00 F/S Sodium Chloride 0.9% SOLN 500 mL $ 90.00 Factor IX Complex PWDI $ 2,207.40 famciclovir 125 mg TAB $ 12.21 famo^dine 10 mg TAB $ 0.71 famo^dine 20 mg TAB UD $ 0.28 famo^dine 20 mg/2 mL INJ $ 2.09 famo^dine 20 mg/50 mL NS PM $ 9.91 famo^dine 40 mg/4 mL INJ $ 5.58 famo^dine 40 mg/5 ml PWDR $ 192.44 fat emulsion, intravenous 20% EMUL $ 35.38 fat emulsion, intravenous 20% EMUL (Nursery) $ 35.38 felodipine 10 mg ERT UD $ 1.64

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felodipine 2.5 mg ERT UD $ 1.02 felodipine 5 mg ERT UD $ 2.89 fenofibrate 145 mg TAB $ 14.43 fenofibrate 48 mg TAB $ 3.51 fenofibric 45 mg CAP DR $ 1.02 fenofibric acid 135 mg CAP DR $ 3.32 fentaNYL 1 mcg/mL SYRINGE (Neonatal) $ 0.02 fentaNYL 100 mcg/2 mL INJ $ 1.58 fentaNYL 100 mcg/hr PATCH $ 24.66 fentaNYL 1000 mcg/20 mL INJ $ 4.47 fentaNYL 12 mcg/hr PATCH $ 18.99 fentaNYL 25 mcg/hr PATCH $ 6.80 fentaNYL 250 mcg/ 5mL PF INJ $ 0.99 fentaNYL 2500 mcg/50 mL INJ $ 11.32 fentaNYL 400 mcg LOZ $ 34.89 fentaNYL 50 mcg/hr PATCH $ 11.44 fentaNYL 50 mcg/ml INJ 10 ml $ 6.51 fentaNYL 75 mcg/hr PATCH $ 17.54 fentaNYL in NS 2500 mcg/250 mL SOLN $ 112.50 ferric subsulfate 13% topical paste 8 mL $ 50.49 ferrous sulfate 15 mg/0.6 ml LIQUID $ 7.08 ferrous sulfate 300 mg/5 ml LIQUID $ 3.65 ferrous sulfate 325 mg tab $ 0.08 fexofenadine 180 mg TAB $ 0.88 fexofenadine 60 mg tab UD $ 0.68 fexofenadine-pseudoephedrine 60 mg-120 mg ERT $ 3.62 fibrin sealant topical KIT 4 mL $ 738.91 fidaxomicin 200 mg TAB $ 521.48 filgras^m-sndz 300 mcg/0.5 mL SYRINGE $ 371.85 filgras^m-sndz 480 mcg/0.8 mL SYRINGE $ 550.20 finasteride 5 mg TAB UD $ 0.37 flecainide 50 mg TAB UD $ 1.56 fluconazole 100 mg TAB UD $ 2.58 fluconazole 100 mg/50 mL NS PM $ 15.57 fluconazole 200 mg TAB UD $ 4.41 fluconazole 200 mg/100 ml PB $ 22.64 fluconazole 40 mg/ml PWDR $ 73.30 fluconazole 400 mg/200 ml PB $ 16.98 fluconazole 50 mg TAB $ 2.66 flucytosine 500 mg CAP $ 264.66 fludarabine 50 mg PWDI $ 226.91 fludrocor^sone 0.1 mg TAB $ 1.22 flumazenil 0.5mg/5ml INJ $ 7.22

�218

flunisolide nasal 25 mcg/inh SPRAY 25 mL $ 84.42 fluocinolone 0.025% topical CREAM 60 gm $ 224.82 fluocinolone 0.025% topical OINT 60 g $ 225.83 fluocinonide 0.05% topical CREAM 60 gm $ 108.67 fluocinonide 0.05% topical OINT 60 g $ 314.13 fluorescein 0.6 mg ophth STRIP $ 0.23 fluorescein 1 mg ophth STRIP $ 0.18 fluorescein 10% ophthalmic INJ 5 mL $ 54.05 fluorometholone 0.1% ophthalmic SUSP 5 mL $ 189.47 fluorouracil 5% topical CREAM 40 gm $ 444.88 fluorouracil 50 mg/mL INJ 20 mL $ 13.24 fluorouracil 50 mg/ml INJ 50 ml $ 52.85 fluorouracil 500 mg/10 ml INJ $ 6.51 FLUoxe^ne 10 mg CAP $ 0.25 FLUoxe^ne 20 mg CAP UD $ 0.25 FLUoxe^ne 20 mg/5 ml SOLN $ 1.42 fluPHENAZine 1 mg TAB UD $ 0.48 fluPHENAZine 2.5 mg TAB $ 13.56 fluPHENAZine 5 mg TAB UD $ 18.34 fluPHENAZine decanoate 25 mg/mL MDV 5 mL $ 57.48 flurbiprofen 0.03% ophthalmic SOLN 2.5 mL $ 97.14 flu^casone 0.005% topical OINT 30 g $ 29.63 flu^casone 0.05% topical CREAM 15 g $ 29.72 flu^casone 110 mcg/inh MDI 12 g $ 632.67 flu^casone 220 mcg/inh MDI 12 g $ 838.81 flu^casone 44 mcg/inh MDI 10.6 g $ 403.47 flu^casone diskus 100 mcg PWD $ 233.42 flu^casone diskus 250 mcg PWD $ 313.00 flu^casone furoate 100 mcg/inh MDI $ 175.91 flu^casone furoate 200 mcg/inh MDI $ 221.87 flu^casone nasal 50 mcg/inh SPRAY $ 10.41 flu^casone-salmeterol 100 mcg-50 mcg PWD $ 315.23 flu^casone-salmeterol 250 mcg-50 mcg PWD $ 340.73 flu^casone-salmeterol 500 mcg-50 mcg PWD $ 376.53 flu^casone-vilanterol 100 mcg-25 mcg/inh MDI $ 194.53 flu^casone-vilanterol 200 mcg-25 mcg/inh MDI $ 183.44 fluvasta^n 20 mg CAP $ 6.90 fluvoxaMINE 50 mg TAB UD $ 1.13 foLiC acid 1 mg TAB UD $ 0.31 foLiC acid 50 mg/10 ml INJ $ 5.74 fomepizole 1.5 gm/1.5 ml INJ $ 2,430.01 fondaparinux 10 mg/0.8 mL PF SYRG $ 63.60 fondaparinux 2.5 mg/0.5 mL PF SYRG $ 125.74

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fondaparinux 5 mg/0.4 mL PF SYRG $ 155.50 fondaparinux 7.5 mg/0.6 mL PF SYRG $ 155.69 formoterol-glycopyrrolate 4.8 mcg-9 mcg/inh MDI 5.9 g $ 58.82 fosamprenavir 700 mg TAB $ 37.63 fosaprepitant dimeglumine 150 mg INJ $ 764.75 foscarnet 24 mg/1 mL SOLN 250 mL $ 156.71 fosfomycin tromethamine 3 g PKT $ 231.78 fosinopril 10 mg TAB UD $ 0.65 fosinopril 20 mg TAB UD $ 0.59 fosphenytoin 100 mg PE/2 ml INJ $ 17.43 fosphenytoin 5 mg PE/mL SYRINGE (Neonatal) $ 0.36 fulvestrant 250 mg/5 ml SYRINGE $ 2,494.48 furosemide 1 mg/mL IV SYRINGE (Neonatal) $ 0.06 furosemide 10 mg/ml oral SOLN $ 14.52 furosemide 10 mg/mL ORAL SOLN (Neonatal) $ 21.00 furosemide 20 mg TAB UD $ 0.14 furosemide 20 mg/2 mL INJ $ 10.92 furosemide 40 mg TAB UD $ 0.14 furosemide 40 mg/4 mL INJ $ 1.91 furosemide 40 mg/4 mL SOLN UD $ 5.32 furosemide 80 mg TAB UD $ 0.22 gabapen^n 100 mg CAP UD $ 0.25 gabapen^n 250 mg/5 mL soln UDC $ 4.53 gabapen^n 300 mg CAP UD $ 0.31 gabapen^n 400 mg CAP UD $ 0.31 gabapen^n 600 mg TAB UD $ 0.99 gadobutrol 6047.2 mg/10 mL INJ $ 117.16 gadobutrol 4535.4 mg/7.5mL INJ $ 87.66 gadobutrol 9070.8 mg/15mL INJ $ 175.74 gadoterate meglumine 376.9 mg /mL 10 mL SOLN $ 41.04 gadoterate meglumine 376.9 mg /mL 15 mL SOLN $ 60.70 gadoterate meglumine 376.9 mg /mL 20 mL SOLN $ 80.37 galantamine 4 mg TAB $ 1.75 galantamine 8 mg TAB $ 1.74 ganciclovir 500 mg PWDI $ 195.64 ganciclovir 500 mg/10 mL INJ $ 105.56 gela^n, absorbable 1 g topical PWD $ 155.11 gela^n, absorbable ophthalmic FILM (25X50mm) $ 544.24 gela^n, absorbable topical SPONGE (100) $ 51.25 gela^n, absorbable topical SPONGE (12-7MM) $ 10.22 gemcitabine 1 g/ 26.3 mL SOLN $ 115.78 gemcitabine 200 mg/5.26 mL SOLN $ 23.15 gemfibrozil 600 mg TAB UD $ 0.59

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gentamicin 0.1% topical CREAM 15 gm $ 105.28 gentamicin 0.1% topical OINT 15 g $ 105.28 gentamicin 0.3% ophthalmic OINT 3.5 g $ 21.49 gentamicin 0.3% ophthalmic SOLN 5 mL $ 8.77 gentamicin 20 mg/2 ml INJ $ 4.08 gentamicin 5 mg/mL SYRINGE (neonatal) $ 1.14 gentamicin 80 mg/ 2 mL INJ (20 mL) (IV Services Only) $ 57.73 gentamicin 80 mg/2 ml INJ $ 2.32 gentamicin-NS 60 mg/50 mL IVPB $ 8.49 gentamicin-NS 80 mg/100 mL PB $ 8.55 gentamicin-prednisoLONE 0.3%-1% ophthalmic SUSP 5 mL $ 307.20 gen^an violet 1% SOLN $ 15.51 glimepiride 1 mg TAB $ 0.34 glimepiride 4 mg TAB UD $ 0.13 glipiZIDE 10 mg ERT $ 0.74 glipiZIDE 10 mg TAB UD $ 0.08 glipiZIDE 2.5 mg / HALF-TAB $ 0.06 glipiZIDE 2.5 mg ERT $ 2.35 glipiZIDE 5 mg TAB UD $ 0.82 glipiZIDE ER 5 mg TAB UD $ 0.37 glucagon 1 mg PWDI $ 455.66 glucose 0.4 g/mL ORAL GEL (Neonatal) $ 21.00 glucose 40 % GEL 37.5 g $ 11.67 glyBURIDE 1.25 mg TAB $ 0.34 glyBURIDE 2.5 mg TAB UD $ 0.68 glyBURIDE 5 mg TAB UD $ 0.34 glycerin adult SUPP $ 0.31 glycerin pediatric SUPP $ 1.33 glycerin-witch hazel topical PAD $ 0.17 glycopyrrolate 0.2 mg/ml INJ $ 6.23 glycopyrrolate 1 mg TAB $ 1.19 goserelin 3.6 mg IMP $ 528.28 goserelin acetate 10.8 mg IMP $ 1,584.86 gramicidin/neomycin/polymyxin B ophthalmic SOLN 10 mL $ 90.22 griseofulvin 125 mg TAB $ 4.72 guaiFENesin 100 mg/5 ml LIQUID-SF $ 1.27 guaiFENesin 200 mg TAB $ 0.08 guaiFENesin 600 mg ERT $ 0.79 guanFACINE 1 mg TAB $ 1.50 guanFACINE 2 mg TAB $ 0.54 haemophilus b conjugate (PRP-OMP) vaccine 0.5 mL $ 59.83 haemophilus b conjugate (PRP-T) vaccine pwdi $ 28.30 haloperidol 0.5 mg TAB UD $ 0.71

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haloperidol 1 mg TAB UD $ 1.10 haloperidol 10 mg TAB UD $ 2.46 haloperidol 10 mg/5 mL oral CONC UDC $ 6.65 haloperidol 2 mg TAB UD $ 1.39 haloperidol 2 mg/mL CONC $ 0.23 haloperidol 5 mg TAB UD $ 1.50 haloperidol 5 mg/ml INJ $ 4.25 haloperidol 5 mg/ml INJ 10 ml $ 17.26 haloperidol decanoate 50 mg/ml INJ $ 56.91 hePARIN 100 u/mL INJ (1 mL) PF $ 7.47 hePARIN 100 u/ml SYR (5 ml) (De-access) $ 1.13 hePARIN 1000 u/ml INJ (10 ml) $ 10.47 hePARIN 1000 u/ml INJ (30 ml) $ 16.20 hePARIN 1000 u/ml INJ (For Dialysis) 10 ml $ 4.53 hePARIN 1000 units/500 mL-0.9% SOLN $ 14.15 hePARIN 1000 units/mL INJ (1 mL) $ 6.23 hePARIN 10000 u/ml INJ (1 ml) $ 5.19 hePARIN 10000 u/mL INJ (5 mL) (IV Room ONLY) $ 27.14 hePARIN 10000 u/ml INJ (For Dialysis) $ 5.82 hePARIN 25,000 units/500 mL NaCl 0.45% SOLN $ 14.15 hePARIN 25,000 units/500 mL-dextrose 5% SOLN $ 169.80 hePARIN 5000 u/ml INJ $ 2.86 hepatamine-fat nutri^on $ 1,136.00 hepa^^s A pediatric 720 unit/0.5 mL vaccine $ 80.33 hepa^^s A vaccine 1440 unit/1 mL SYRINGE Adult (State) $ 0.01 hepa^^s A-hepa^^s B vaccine 720 u-20 mcg/ml INJ $ 199.71 Hepa^^s B adult vaccine 20 mcg/1 ml SYRINGE (Engerix-B) (STATE) $ 0.01 hepa^^s B immune globulin - INJ (HepaGam B) 1 mL $ 337.68 hepa^^s B immune globulin - INJ (HepaGam B) 5 mL $ 1,499.90 hepa^^s B immune globulin SYRINGE (H-BIG) $ 216.33 hepa^^s B vaccine pediatric 10 mcg/0.5 mL SYG (Nursery-STATE) $ 0.01 hetastarch 6 gm/100 ml-0.9% SOLN 500 ml $ 42.45 homatropine-HYDROcodone 1.5 mg-5 mg/5 mL SYRUP $ 1.04 human papillomavirus vaccine 9-valent SYRINGE (STATE) $ 0.01 human papillomavirus vaccine 9-valent VIAL (STATE) $ 0.01 human papillomavirus vaccine susp 0.5 mL $ 362.10 hyaluronate sodium 16 mg/2 mL SYR $ 901.86 hyaluronate sodium 48 mg/6 mL SYR $ 1,663.36 hyaluronidase 15 u/mL SYRINGE (Neonate) $ 12.90 hyaluronidase 150 unit/ml vial $ 144.75 hydrALAZINE 10 mg TAB UD $ 0.28 hydrALAZINE 20 mg/ml INJ $ 9.03 hydrALAZINE 25 mg TAB UD $ 0.34

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hydrALAZINE 50 mg TAB UD $ 0.37 hydroCHLOROthiazide 12.5 mg CAP UD $ 0.34 hydroCHLOROthiazide 25 mg TAB UD $ 0.11 hydroCHLOROthiazide 50 mg TAB UD $ 0.11 hydrochlorothiazide-lisinopril 12.5 mg-10 mg TAB $ 0.08 hydrochlorothiazide-lisinopril 12.5 mg-20 mg TAB $ 0.11 hydrochlorothiazide-lisinopril 25 mg-20 mg TAB $ 0.45 hydrochlorothiazide-losartan 12.5 mg-50 mg TAB UD $ 10.90 hydrochlorothiazide-triamterene 25 mg-37.5 mg CAP UD $ 0.79 HYDROcodone-ibuprofen 7.5 mg-200 mg TAB $ 0.42 hydrocor^sone 0.5% topical CREAM 30 gm $ 13.66 hydrocor^sone 0.5% topical OINT 30 gm $ 8.89 hydrocor^sone 1% topical CREAM 30 gm $ 4.25 hydrocor^sone 1% topical CREAM UD $ 1.05 hydrocor^sone 1% topical OINT 30 g $ 5.09 hydrocor^sone 10 mg TAB $ 0.74 hydrocor^sone 10% FOAM 15 g $ 614.51 hydrocor^sone 100 mg/60 ml SUSP $ 13.58 hydrocor^sone 2.5% rectal CREAM 30 gm $ 40.75 hydrocor^sone 2.5% topical CREAM 28.35 gm $ 6.65 hydrocor^sone 2.5% topical LOTION 59 mL $ 26.72 hydrocor^sone PF 100 mg PWDI $ 25.84 hydrocor^sone PF 250 mg PWDI $ 32.57 hydrocor^sone topical 25 mg SUPP $ 30.93 hydrocor^sone valerate 0.2% topical CREAM 45 g $ 267.44 hydrocor^sone/neomycin/polymyxin B o^c SOLN 10 mL $ 32.32 hydrocor^sone/neomycin/polymyxin B o^c SUSP 10 mL $ 158.20 hydrocor^sone-pramoxine 1%-1% CR 30 g $ 262.34 hydrogel wound dressing $ 49.07 HYDROmorphone 0.5 mg/0.5 mL SYRINGE $ 2.53 HYDROmorphone 1 mg/HALF-TAB $ 0.12 HYDROmorphone 1 mg/ml SYRINGE $ 4.58 HYDROmorphone 10 mg/ml INJ $ 5.49 HYDROmorphone 2 mg TAB $ 0.40 HYDROmorphone 2 mg/ml SYRINGE $ 4.92 HYDROmorphone 30 mg/30 mL NS PCA $ 97.64 HYDROmorphone 4 mg TAB $ 0.45 HYDROmorphone 4 mg/ml SYRINGE $ 9.17 HYDROmorphone 40 mg/20 ml INJ $ 24.90 hydromorphone 50 mg/5 ml INJ $ 16.27 HYDROmorphone 500 mg/50 ml INJ $ 253.34 HYDROmorphone in NS 100 mg/100 mL SOLN $ 133.00 HYDROmorphone in NS 50 mg/50 mL SOLN $ 116.50

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hydroxocobalamin 5 g KIT $ 2,183.26 hydroxychloroquine 200 mg TAB $ 3.76 hydroxypropyl methylcellulose 2.5% ophthalmic SOLN $ 23.97 hydroxypropyl methylcellulose ophthalmic SYR 2mL $ 113.20 hydroxypropyl methylcellulose ophthalmic SYRINGE $ 113.20 hydroxyurea 500 mg CAP UD $ 1.81 hydrOXYzine hydrochloride 10 mg TAB UD $ 0.17 hydrOXYzine hydrochloride 25 mg TAB UD $ 0.42 hydrOXYzine hydrochloride 50 mg/ml INJ $ 35.74 hydrOXYzine hydrochloride 10 mg/5 ml SYRUP $ 0.99 hydrOXYzine pamoate 25 mg CAP UD $ 0.40 hyoscyamine 0.125 mg TAB $ 0.23 hyoscyamine 0.125 mg TAB SL $ 1.08 ibandronate 3 mg/3 mL INJ $ 1,327.24 ibuprofen 100 mg/5 mL SUSP (120 mL) (For High Doses Only) $ 20.38 ibuprofen 100 mg/5 ml SUSP UD $ 1.42 ibuprofen 400 mg TAB UD $ 0.17 ibuprofen 600 mg TAB UD $ 0.12 ibuprofen 800 mg TAB UD $ 0.17 ibu^lide 1 mg/10 ml INJ $ 195.67 IDArubicin 20 mg/20 ml INJ $ 2,406.15 idaruCIZUmab 2.5 g/50 mL INJ $ 5,224.18 ifosfamide 1 gm PWDI $ 79.98 ifosfamide 3 gm PWDI $ 279.01 ima^nib 400 mg TAB $ 895.13 imipenem-cilasta^n 500 mg-500 mg PWDI $ 25.07 imipramine 10 mg TAB UD $ 0.31 imipramine 25 mg TAB UD $ 0.36 imipramine 50 mg TAB UD $ 0.59 immune globulin IV 5 g/50 mL (Gammagard) $ 1,045.69 immune globulin 1000 mcg/4.4 mL liq, RHo(D) $ 2,402.70 immune globulin 500 mcg/2.2 mL liq, RHo(D) $ 1,073.73 immune globulin IV 10 g/100 mL INJ (Privigen) $ 1,876.29 immune globulin IV 10 g/200 mL INJ (Flebogamma) $ 2,023.17 immune globulin IV 10 gm PWDI (Gammagard S/D pwdi) $ 2,485.59 immune globulin IV 10 gm/100 ml INJ (Gamunex) $ 2,224.38 immune globulin IV 10% 10 g/100 mL (Gammagard) $ 2,091.37 immune globulin IV 10% 20 g/200 mL (Gammagard) $ 4,182.74 immune globulin IV 20 g/200 mL INJ (Privigen) $ 3,752.58 immune globulin IV 20 g/400 mL INJ (Flebogamma) $ 4,312.92 immune globulin IV 20 gm/200 ml INJ (Gamunex-C) $ 4,448.76 immune globulin IV 40 g/400 mL INJ (Privigen) $ 7,505.16 immune globulin IV 5 g/100 mL INJ (Flebogamma) $ 1,013.14

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immune globulin IV 5 g/50 mL INJ (Privigen) $ 938.15 immune globulin IV 5 gm PWDI (Gammagard S/D pwdi) $ 1,242.79 immune globulin IV 5 gm/50 ml INJ (Gamunex) $ 1,281.99 indigo carmine 8 mg/ml INJ $ 8.63 indocyanine green 25 mg PWDI $ 36.28 indomethacin 25 mg CAP UD $ 0.93 indomethacin 50 mg CAP UD $ 0.31 indomethacin 50 mg SUPP $ 453.37 inFLIXimab 100 mg PWDI $ 2,707.77 influenza virus vaccine (Fluzone) SYRINGE 0.5 mL (STATE) $ 0.01 influenza virus vaccine *adult 65+* (Fluzone HD) HIGH-DOSE PF 0.5 mL (STATE) $ 0.01 insulin aspart 100 u/mL INJ 10 mL $ 186.78 insulin aspart protamine-insulin aspart 70 u-30 u/mL SUSP $ 186.92 insulin detemir 100 u/mL INJ $ 226.54 insulin glargine 100 units/mL INJ $ 1.22 insulin HumaLOG Mix 75/25 $ 3.03 insulin HumuLIN 70/30 $ 14.94 insulin lispro 100 u/ml INJ $ 46.78 insulin lispro-insulin lispro protamine 50u-50u/mL SUSP $ 188.76 insulin NPH 100 unit/mL $ 14.94 insulin regular human recombinant 100 u/ml INJ $ 14.94 insulin regular in NS 100 units/100 mL SOLN $ 105.00 insulin regular U-500 INJ $ 1.99 interferon alfa-2b 10,000,000 iu PWDI $ 507.19 interferon alfa-2b 18000000 iu PWDI $ 676.12 interferon alfa-2b 6000000 IUnit/mL INJ 3 mL $ 649.57 interferon beta-1a 30 mcg SYRINGE $ 2,410.88 intravenous electrolyte soluôn - INJ 100 ml $ 11.01 intravenous electrolyte soluôn - INJ 20 ml $ 2.63 intravenous electrolyte soluôn - INJ 200 ml $ 27.76 iodine 5%-10% topical SOLN 14 mL $ 76.35 iodine 5%-10% topical SOLN 14 ml (For Endoscopy) $ 0.57 iohexol 180 mg/mL SOLN 10 mL $ 37.92 iohexol 240 mg/mL SOLN 50 mL $ 11.32 iohexol 300 mg/mL SOLN 100 mL $ 25.47 iohexol 300 mg/mL SOLN 50 mL $ 12.74 iohexol 350 mg/mL SOLN 100 mL $ 28.30 iohexol 350 mg/mL SOLN 150 mL $ 38.21 iohexol 350 mg/mL SOLN 50 mL $ 14.15 iohexol 9 mg/mL ORAL SOLN 500 mL $ 16.98 iopamidol 41% INJ 10 mL $ 176.05 iopamidol 41% INJ 20 mL $ 119.99 iopamidol 61% INJ 15 mL $ 233.92

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iothalamate meglumine 17.2% INJ 250 mL $ 56.60 iothalamate meglumine 60% INJ 50 mL $ 26.89 ioversol 68% INJ 50 mL $ 48.11 ipratropium 0.02% SOLN UD $ 0.42 ipratropium 0.03% nasal 21 mcg/inh SPRAY $ 72.17 ipratropium 0.06% nasal 42 mcg/inh SPRAY $ 56.03 ipratropium HFA 17 mcg/inh MDI $ 957.94 irbesartan 150 mg TAB $ 6.52 irbesartan 300 mg TAB $ 0.86 irbesartan 75 mg TAB $ 1.16 irinotecan 100 mg/5 ml INJ $ 55.50 iron dextran 100 mg/2 ml INJ $ 64.02 iron polysaccharide 150 mg CAP UD $ 0.25 isoflurane 100% LIQUID $ 18.56 isoniazid 300 mg TAB UD $ 0.45 isoproterenol 0.2 mg/mL INJ $ 2,242.63 isoproterenol 1 mg/5 mL AMP $ 4,288.30 isoproterenol 1 mg/5 mL INJ $ 4,864.77 isosorbide dinitrate 10 mg TAB UD $ 1.95 isosorbide dinitrate 20 mg TAB UD $ 2.69 isosorbide dinitrate 30 mg TAB $ 1.75 isosorbide dinitrate 5 mg TAB UD $ 1.44 isosorbide mononitrate 20 mg TAB UD $ 0.59 isosorbide mononitrate 30 mg ERT UD $ 0.68 isosorbide mononitrate 60 mg ERT UD $ 0.71 isosulfan blue 50 mg/5 ml INJ $ 2,335.03 itraconazole 100 mg CAP UD $ 4.44 ixabepilone 15 mg PWDI $ 2,718.98 ixabepilone 45 mg PWDI $ 8,036.46 ketamine 200 mg/20 ml INJ $ 30.00 ketamine 500 mg/10 ml INJ $ 6.79 ketoconazole 2% topical CREAM 15 gm $ 65.80 ketoconazole 2% topical CREAM 60 g $ 185.08 ketoconazole 2% topical SHAMPOO 120 mL $ 22.41 ketoconazole 200 mg TAB $ 2.77 ketorolac 0.5% ophthalmic SOLN 10 mL $ 62.26 ketorolac 0.5% ophthalmic SOLN 5 mL $ 16.13 ketorolac 10 mg TAB $ 1.50 labetalol 100 mg TAB UD $ 0.65 labetalol 100 mg/20 ml INJ $ 18.62 labetalol 20 mg/4 ml SYRINGE $ 17.09 labetalol 200 mg TAB UD $ 0.85 labetalol 200 mg/40 ml INJ $ 37.24

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lacosamide 100 mg TAB $ 42.28 lacosamide 150 mg TAB $ 42.08 lacosamide 50 mg TAB $ 26.94 lactase 3000 u TAB $ 0.20 Lactated Ringers Injecôn SOLN 1000 ml $ 90.00 Lactated Ringers Injecôn SOLN 250 mL (Non-DEHP) $ 92.50 Lactated Ringers Injecôn SOLN 500 ml $ 92.00 lactobacillus acidophilus and bulgaricus - GRANULE $ 3.51 lactulose 10 gm/15 ml SYRUP 480 ml $ 26.77 lactulose 20 g/30 mL SYRUP UDC $ 1.70 lamiVUDine 150 mg TAB $ 6.11 lamiVUDine 300 mg TAB $ 7.33 lamivudine-zidovudine 150 mg-300 mg TAB $ 4.10 lamoTRIgine 100 mg TAB $ 0.42 lamoTRIgine 150 mg TAB $ 0.17 lamoTRIgine 25 mg TAB $ 0.37 lanolin 1.5 g CREAM $ 0.74 lanolin topical - OINT $ 4.75 lansoprazole 15 mg DR ODT $ 27.56 lansoprazole 30 mg DR ODT $ 36.79 lanthanum carbonate 500 mg CHEWTAB $ 31.92 latanoprost ophthalmic 0.005% SOLN $ 17.76 ledipasvir-sofosbuvir 90 mg-400 mg TAB $ 3,064.38 letrozole 2.5 mg TAB $ 0.28 leucovorin 100 mg PWDI $ 51.79 leucovorin 200 mg PWDI $ 57.19 leucovorin 350 mg PWDI $ 44.09 leucovorin 5 mg TAB $ 2.32 leucovorin calcium 500 mg/50 mL SOLN $ 22.02 levalbuterol 1.25 mg/3 ml INH SOLN UD $ 3.65 levETIRAcetam 10 mg/mL SYRINGE (Neonatal) $ 0.31 levETIRAcetam 250 mg TAB $ 0.51 levETIRAcetam 500 mg TAB UD $ 0.42 levETIRAcetam 500 mg/5 mL INJ $ 4.53 levETIRAcetam 500 mg/5 mL UDC $ 9.76 levETIRAcetam 750 mg TAB $ 0.59 levobunolol ophthalmic 0.5% SOLN $ 38.63 levOCARNi^ne 1 g/5 mL INJ $ 47.83 levOCARNi^ne 330 mg TAB UD $ 1.25 levoFLOXacin 0.5% ophthalmic SOLN 5 mL $ 68.49 levoFLOXacin 250 mg TAB UD $ 0.40 levoFLOXacin 250 mg/50 ml PB $ 7.08 levoFLOXacin 500 mg TAB UD $ 0.61

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levoFLOXacin 500 mg/100 ml PB $ 9.45 levoFLOXacin 500 mg/20 ml VIAL $ 101.37 levoFLOXacin 750 mg TAB UD $ 1.10 levonorgestrel 1.5 mg TAB $ 29.80 levonorgestrel 19.5 mg IUD $ 2,698.43 levonorgestrel 52 mg IUD- 5 YR $ 2,572.39 levothyroxine 100 mcg PWDI $ 2.80 levothyroxine 100 mcg TAB UD $ 1.30 levothyroxine 112 mcg TAB $ 1.81 levothyroxine 125 mcg TAB UD $ 1.70 levothyroxine 137 mcg tab (Synthroid) $ 1.19 levothyroxine 150 mcg TAB UD $ 1.64 levothyroxine 175 mcg TAB $ 1.73 levothyroxine 20 mcg/mL SYRINGE (Neonatal) $ 145.75 levothyroxine 200 mcg TAB UD $ 3.37 levothyroxine 25 mcg TAB $ 1.02 levothyroxine 50 mcg TAB UD $ 1.16 levothyroxine 75 mcg TAB UD $ 3.31 levothyroxine 88 mcg TAB $ 1.22 lidocaine 0.5% PF INJ 50 ml (Brand) $ 7.08 lidocaine 1% INJ 20 mL $ 6.23 lidocaine 1% INJ 50 mL $ 7.08 lidocaine 1% PF 10,000 mcg/mL SYRINGE (Neonatal) $ 0.88 lidocaine 1% PF INJ 10 mL $ 13.02 lidocaine 1% PF INJ 30 mL $ 5.09 lidocaine 1% PF INJ 30 mL (Steri-Pak) $ 9.34 lidocaine 1% PF INJ 5 mL AMP $ 2.15 lidocaine 1.5% PF INJ 10 mL $ 9.68 lidocaine 1.5% PF INJ 20 mL $ 15.28 lidocaine 2% INJ 20 mL $ 3.96 lidocaine 2% INJ 50 mL $ 12.74 lidocaine 2% PF INJ 10 mL $ 7.92 lidocaine 2% topical GEL 30 mL $ 45.00 lidocaine 2% topical GEL 5 mL $ 8.91 lidocaine 2% viscous SOLN 100 mL $ 6.91 lidocaine 2% viscous UDC 15 mL $ 2.24 lidocaine 4% topical GEL 75 mL $ 23.35 lidocaine 4% topical SOLN 50 mL $ 26.89 lidocaine 5% topical PATCH $ 5.83 lidocaine topical 2% GEL 5 mL (UroJet) $ 11.83 lidocaine-dextrose in water 0.4%-5% SOLN 500 mL $ 234.89 lidocaine-dextrose in water 0.8%-5% SOLN 250 ml $ 234.89 lidocaine-prilocaine 2.5%-2.5% topical CREAM 5 g $ 12.17

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lidocaine-sodium bicarbonate 0.9%-8.4% SYR $ 14.43 lindane topical 1% LOTION $ 298.28 lindane topical 1% SHAMPOO $ 292.06 linezolid 600 mg TAB $ 9.00 linezolid 600 mg/300 mL PB $ 59.43 liothyronine 25 mcg TAB $ 1.92 liothyronine 5 mcg TAB $ 1.27 lisinopril 10 mg TAB $ 0.14 lisinopril 2.5 mg TAB $ 0.07 lisinopril 20 mg TAB UD $ 0.25 lisinopril 40 mg tab UD $ 0.34 lisinopril 5 mg TAB $ 0.37 lithium 150 mg CAP $ 0.40 lithium 300 mg CAP UD $ 0.45 lithium 300 mg ERT (LithoBid) $ 0.79 lithium 300 mg TAB $ 0.51 lithium 450 mg ERT $ 1.50 lodoxamide ophthalmic 0.1% SOLN $ 426.40 loperamide 2 mg CAP UD $ 1.84 loperamide 2 mg/15 mL UDC $ 1.27 lopinavir-ritonavir 200 mg-50 mg TAB $ 20.38 loratadine 10 mg TAB UD $ 1.02 loratadine-pseudoephedrine 5 mg-120 mg ERT $ 2.32 LORazepam 0.25 mg/HALF-TAB $ 0.08 LORazepam 0.5 mg TAB UD $ 0.13 LORazepam 1 mg TAB UD $ 0.18 LORazepam 2 mg TAB UD $ 0.11 LORazepam 2 mg/ml CONC (BULK) $ 23.86 LORazepam 2 mg/ml INJ $ 1.30 LORazepam 2 mg/mL ORAL SOLN $ 0.82 LORazepam 20 mg/10 mL INJ $ 26.57 LORazepam 4 mg/ml INJ $ 2.41 LORazepam 40 mg/10 ml INJ $ 28.02 LORazepam in NS 40 mg/250 mL SOLN $ 152.50 losartan 100 mg TAB UD $ 1.13 losartan 25 mg TAB UD $ 0.82 losartan 50 mg TAB UD $ 0.71 loxapine 10 mg CAP $ 1.30 lubiprostone 24 mcg CAP $ 15.37 lubiprostone 8 mcg CAP $ 15.54 lurasidone 20 mg TAB $ 108.70 lurasidone 40 mg TAB $ 91.98 mafenide topical 85 mg/gm CREAM 60 gm $ 138.56

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Magic Mouthwash SUSP (200 mL) $ 27.73 Magic Mouthwash with lidocaine $ 13.39 magnesium citrate 8.85% LIQUID 300 mL $ 3.40 magnesium gluconate 54 mg/5 ml LIQUID $ 0.42 magnesium hydroxide 8% SUSP UD $ 4.25 magnesium sulfate 1 gm/100 ml dextrose 5% PB $ 14.15 magnesium sulfate 100% SALT $ 3.48 magnesium sulfate 2 g/100 mL dextrose 5% PB $ 18.68 magnesium sulfate 4 gm/100 ml sterile water PB $ 14.15 magnesium sulfate 40 g/1 liter SOLN $ 18.45 magnesium sulfate 50% INJ 10 mL $ 3.11 magnesium sulfate 50% INJ 20 mL $ 3.45 magnesium sulfate 6 g/100 mL D5W PB $ 19.95 mannitol 20% SOLN 500 ml $ 325.45 mannitol 25% INJ 50 mL $ 4.25 measles/mumps/rubella virus vaccine (State) PWDI $ 0.01 meclizine 12.5 mg TAB UD $ 1.19 meclizine 25 mg TAB UD $ 1.27 medium chain triglycerides ORAL OIL (Neonatal) $ 21.00 medroxyPROGESTERone 10 mg TAB $ 0.74 medroxyPROGESTERone 2.5 mg TAB $ 0.31 megestrol 40 mg TAB UD $ 0.54 megestrol 400 mg/10 ml SUSP $ 5.38 melatonin 1 mg TAB $ 0.08 melatonin 3 mg TAB $ 0.42 melatonin 5 mg TAB $ 0.99 meloxicam 7.5 mg TAB $ 0.40 meman^ne 10 mg TAB $ 0.88 meman^ne 5 mg TAB $ 0.71 meningococcal polysaccharide conjugate vaccine 0.5 mL (STATE) $ 0.01 meperidine 25 mg/ml SYRINGE $ 5.43 meperidine 300 mg/30 ml (PCA) $ 18.23 meperidine 50 mg/ml SYRINGE $ 9.14 mercaptopurine 50 mg TAB $ 3.05 meropenem 1 gm PWDI $ 27.82 meropenem 500 mg PWDI $ 10.78 mesalamine 250 mg CAP ER $ 5.86 mesalamine 4 gm/60 ml ENEMA $ 22.07 mesalamine 400 mg ECT $ 4.16 mesalamine 500 mg cap ER $ 14.29 mesna 1000 mg/10 ml INJ $ 29.72 metFORMIN 1000 mg TAB $ 0.28 metFORMIN 500 mg TAB $ 0.14

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metFORMIN 850 mg TAB $ 0.51 metFORMIN XR 500 mg ERT $ 0.51 metFORMIN XR 750 mg ERT $ 0.18 methacholine 100 mg PWDR $ 199.18 methacholine for challenge test $ 64.24 methadone 10 mg TAB $ 0.57 methadone 10 mg/5 ml SOLN 500 mL $ 141.50 methadone 5 mg TAB $ 0.65 methenamine hippurate 1 gm TAB $ 3.25 methIMAzole 10 mg TAB $ 0.14 methIMAzole 5 mg TAB $ 0.93 methocarbamol 1 gm/10 mL INJ $ 22.92 methocarbamol 500 mg TAB UD $ 0.23 methocarbamol 750 mg TAB UD $ 0.28 methotrexate 1 gm PWDI $ 165.92 methotrexate 2.5 mg TAB UD $ 6.28 methotrexate 20 mg PF, lyophilized PWDI $ 10.10 methotrexate 250 mg/10 ml INJ $ 43.33 methotrexate 250 mg/10 ml INJ PF $ 16.89 methotrexate 50 mg/2 ml INJ $ 10.36 methyl salicylate topical - CREAM 90 g $ 5.09 methyldopa 250 mg TAB UD $ 0.40 methyldopa 500 mg TAB UD $ 0.71 methylene blue 10 mg/mL INJ $ 35.80 methylene blue 100 mg/10 mL INJ $ 480.25 methylene blue 50 mg/10 mL INJ $ 531.19 methylergonovine 0.2 mg TAB UD $ 145.12 methylergonovine 0.2 mg/ml INJ $ 43.21 methylnaltrexone 12 mg/0.6 mL INJ $ 265.40 methylnaltrexone 8 mg/0.4 mL INJ $ 266.11 methylphenidate 10 mg TAB $ 0.54 methylphenidate 5 mg TAB $ 0.40 methylPREDNISolone 1 gm PWDI $ 31.36 methylPREDNISolone 125 mg PWDI PF $ 20.46 methylPREDNISolone 16 mg TAB $ 6.64 methylPREDNISolone 2 mg TAB $ 4.30 methylPREDNISolone 4 mg TAB (DosePak) $ 3.10 methylPREDNISolone 4 mg TAB UD $ 3.57 methylPREDNISolone 40 mg PWDI PF $ 12.82 methylPREDNISolone 500 mg PWDI (Solu-Medrol) $ 54.25 methylPREDNISolone DEPO 40 mg/mL SUSP (Depo-Medrol) $ 18.37 methylPREDNISolone DEPO 80 mg/mL SUSP (Depo-Medrol) $ 38.23 metoclopramide 1 mg/mL ORAL SYRUP (Neonatal) $ 21.00

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metoclopramide 10 mg TAB UD $ 0.40 metoclopramide 10 mg/10 ml SYRUP UD $ 3.11 metoclopramide 10 mg/2 ml INJ $ 2.83 metoclopramide 5 mg TAB $ 0.31 metOLazone 2.5 mg TAB UD $ 2.63 metOLazone 5 mg TAB UD $ 7.87 metoprolol TARTRATE 12.5 mg/HALF-TAB $ 0.06 metoprolol IV 5 mg/5 ml INJ $ 1.70 metoprolol SUCCINATE 100 mg ERT $ 1.61 metoprolol SUCCINATE 12.5 mg/HALF-TAB $ 0.65 metoprolol SUCCINATE 25 mg ERT UD $ 1.30 metoprolol SUCCINATE 50 mg ERT $ 0.99 metoprolol TARTRATE 100 mg TAB UD $ 0.17 metoprolol TARTRATE 25 mg TAB $ 0.17 metoprolol TARTRATE 50 mg TAB UD $ 0.15 metroNIDAZOLE 0.75% topical CREAM 45 gm $ 225.41 metroNIDAZOLE 0.75% topical LOTION 59 mL $ 122.94 metroNIDAZOLE 0.75% vaginal GEL 70 g $ 49.53 metroNIDAZOLE 1% topical GEL 60 g $ 293.50 metroNIDAZOLE 250 mg TAB UD $ 0.79 metroNIDAZOLE 500 mg TAB UD $ 0.45 metroNIDAZOLE 500 mg/100 ml PB $ 35.00 metyroSINE 250 mg cap $ 90.05 mexile^ne 150 mg CAP UD $ 1.30 mexile^ne 200 mg CAP UD $ 1.81 mexile^ne 250 mg CAP UD $ 1.42 micafungin 100 mg PWDI $ 173.79 micafungin 50 mg PWDI $ 88.30 miconazole topical 100 mg SUPP $ 2.42 miconazole topical 2% CREAM 30 gm $ 11.89 miconazole topical 2% OINT 71g $ 12.06 miconazole topical 2% PWD 71 g $ 8.04 miconazole topical 2% vaginal CREAM w/ APPL 45 gm $ 12.74 midazolam 0.1 mg/mL SYRINGE (Neonatal) $ 0.11 midazolam 2 mg/2 mL INJ PF $ 1.75 midazolam 5 mg/1 mL INJ $ 2.43 midazolam 5 mg/5 mL INJ $ 3.82 midazolam 5 mg/5 ml INJ PF $ 2.12 midazolam 50 mg/10 ml INJ $ 5.38 midazolam in NS 100 mg/100 mL SOLN $ 110.80 midodrine 2.5 mg TAB $ 0.93 midodrine 5 mg TAB $ 1.73 milrinone 10 mg/10 mL INJ $ 13.02

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milrinone 5%-20 mg/100 ml PB $ 203.76 mineral oil 100% 133 mL ENEMA $ 6.02 mineral oil, lite, sterile, topical LIQUID UD $ 37.92 minocycline 100 mg CAP $ 0.76 minocycline 100 mg PWDI $ 512.80 minocycline 50 mg CAP $ 0.51 minoxidil 10 mg TAB $ 1.30 minoxidil 2.5 mg TAB $ 1.19 mirabegron ER 25 mg TAB $ 26.35 mirabegron ER 50 mg TAB $ 26.35 mirtazapine 15 mg SOLTAB $ 1.75 mirtazapine 15 mg TAB UD $ 0.34 mirtazapine 7.5 mg TAB $ 4.73 miSOPROStol 100 mcg TAB UD $ 2.21 miSOPROStol 200 mcg TAB UD $ 3.31 miSOPROStol 25 mcg/ QUARTER-TAB UD $ 0.45 mitomycin 20 mg PWDI $ 1,539.52 mitomycin 40 mg PWDI $ 1,767.17 mitomycin 5 mg PWDI $ 83.49 modafinil 100 mg TAB $ 4.68 modafinil 200 mg TAB $ 3.08 mometasone 220 mcg/inh 0.24 g MDI $ 138.05 mometasone topical 0.1% CREAM 15 gm $ 46.70 mometasone topical 0.1% CREAM 45 gm $ 72.59 mometasone topical 0.1% LOTION 60 ml $ 58.61 mometasone topical 0.1% OINT 15 gm $ 11.24 montelukast 10 mg TAB $ 0.85 morphine 0.1 mg/mL IV SYRINGE (neonatal) $ 2.58 morphine 0.4 mg/mL ORAL SOLN (neonatal) $ 21.00 morphine 10 mg/0.5 mL oral conc UD $ 0.52 morphine 10 mg/10 ml INJ (Astramorph) PF $ 47.83 morphine 10 mg/5 ml SOLN UD SF $ 3.11 morphine 10 mg/ml INJ $ 5.60 morphine 100 mg ERT $ 8.32 morphine 15 mg ERT UD $ 0.59 morphine 15 mg TAB (MSIR) $ 0.74 morphine 15 mg/ml INJ vial $ 2.78 morphine 150 mg/30 mL PCA $ 25.47 morphine 2 mg/ml SYRINGE $ 3.85 morphine 250 mg/10 mL PF INJ $ 16.98 morphine 30 mg ERT $ 2.39 morphine 30 mg/30 mL PCA $ 20.38 morphine 4 mg/mL SYRINGE PF $ 4.75

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morphine 5 mg/10 ml INJ (Duramorph PF) $ 51.79 morphine 500 mg/10 ml INJ $ 23.97 morphine 60 mg ERT UD $ 5.42 morphine 8 mg/ml SYRINGE $ 6.31 morphine in NS 100 mg/100 mL SOLN $ 126.00 morphine in NS 250 mg/250 mL SOLN $ 117.50 morphine sulfate 200 mg/ 20 mL INJ (Infumorph) $ 328.28 morrhuate sodium 50 mg/mL soln 30 mL $ 163.43 moxifloxacin 0.5 % ophthalmic SOLN 3 mL $ 34.98 moxifloxacin 400 mg TAB $ 6.23 moxifloxacin 400 mg/250 ml PB $ 120.28 Mul^ple Vitamins INJ 10 mL $ 18.68 Mul^ple Vitamins INJ 50 ml $ 12.85 mul^vitamin liq UDC 30 mL $ 1.70 mul^vitamin Vitamin B Complex with Iron and Intrinsic Factor CAP UD $ 0.37 mul^vitamin with iron Pediatric LIQUID 50 mL $ 24.59 mul^vitamins w/ minerals TAB UD $ 0.11 mupirocin 2% nasal OINT UD $ 34.02 mupirocin 2% topical CREAM 15 gm $ 382.73 mupirocin 2% topical OINT 22 gm $ 16.19 mycophenolate mofe^l 200 mg/1mL PWDR 160 mL $ 1,896.10 mycophenolate mofe^l 250 mg CAP $ 0.88 nabumetone 500 mg TAB $ 0.48 nabumetone 750 mg TAB $ 0.99 nadolol 20 mg TAB UD $ 7.62 nadolol 40 mg TAB UD $ 9.25 nafcillin 1 g PWDI $ 15.99 nafcillin 2 g PWDI $ 21.34 nafcillin 2 g/100 mL D5W PM $ 28.55 nahifine topical 1% CREAM 30 gm $ 119.74 naloxone 0.4 mg/ml INJ $ 11.86 naloxone 2 mg/ 2mL (IV Drips Only) $ 79.69 naloxone 2 mg/2 mL INJ $ 80.15 naloxone 4 mg/10 ml INJ $ 260.36 naloxone-pentazocine 0.5 mg-50 mg TAB $ 0.91 naltrexone 50 mg TAB $ 2.04 naphazoline-pheniramine 0.025%-0.3% ophth soln $ 9.62 naproxen 250 mg TAB UD $ 0.14 naproxen 375 mg TAB UD $ 0.20 naproxen 500 mg EC TAB UD $ 1.75 naproxen 500 mg TAB UD $ 0.51 naproxen sodium 375 mg ERT $ 3.03 natalizumab 300 mg/15 mL INJ $ 12,491.62

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nebivolol 5 mg TAB UD $ 12.93 nefazodone 100 mg TAB UD $ 2.41 nefazodone 250 mg TAB $ 2.55 nefazodone 50 mg TAB $ 2.32 nelfinavir 250 mg TAB $ 5.72 neomycin 250 mg/10 ml SOLN $ 1.54 neomycin 500 mg TAB UD $ 2.01 neomycin/polymyxin B/pramoxine topical CREAM 15 gm $ 13.95 neonatal parenteral nutri^on $ 300.00 neos^gmine 10 mg/10 ml INJ $ 38.77 neos^gmine 15 mg TAB $ 1.19 neos^gmine 5 mg/5 mL SYR $ 59.85 nesi^ride 1.5 mg PWDI $ 2,623.52 Neutrogena SOAP $ 6.54 nevirapine 200 mg TAB $ 33.93 niacin 100 mg TAB $ 0.05 niacin 250 mg CAP SA $ 0.10 niacin 250 mg TAB $ 0.14 niacinamide 500 mg TAB $ 0.07 niCARdipine 20 mg CAP $ 4.73 niCARdipine 25 mg/10 ml INJ $ 41.60 nico^ne 14 mg/24 hr PATCH $ 6.25 nico^ne 2 mg GUM $ 0.59 nico^ne 21 mg/24 hr PATCH $ 5.94 nico^ne 7 mg/24 hr PATCH $ 5.94 nico^ne polacrilex 2 mg LOZ $ 1.08 NIFEdipine 10 mg CAP UD $ 1.87 NIFEdipine 20 mg CAP $ 0.31 NIFEdipine 30 mg ERT UD (Procardia XL) $ 3.14 NIFEdipine 60 mg ERT UD (Procardia XL $ 6.00 NIFEdipine 90 mg ERT UD (Procardia XL) $ 5.12 nilutamide 50 mg TAB $ 6.59 niMODipine 30 mg CAP UD $ 13.73 nitrofurantoin macrocrystals 100 mg CAP UD $ 5.24 nitrofurantoin macrocrystals 50 mg CAP UD $ 2.66 nitrofurantoin macrocrystals-monohydrate 100 mg CAP (Macrobid) $ 2.38 nitroglycerin 0.1 mg/hr PATCH $ 1.42 nitroglycerin 0.2 mg/hr PATCH $ 1.15 nitroglycerin 0.3 mg TAB $ 1.05 nitroglycerin 0.3 mg/hr PATCH $ 55.59 nitroglycerin 0.4 mg/hr PATCH $ 1.16 nitroglycerin 0.6 mg/hr PATCH $ 2.06 nitroglycerin 2% transdermal OINT UD $ 5.35

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nitroglycerin 5%-50 mg/250 ml SOLN $ 144.33 nitroglycerin 50 mg/10 ml INJ $ 24.06 nitroglycerin 6.5 mg CAP ER $ 0.24 norepinephrine-NS 4 mg-250 mL PM $ 140.00 norepinephrine-NS 8 mg-250 mL PM $ 187.50 nortriptyline 10 mg CAP UD $ 0.76 nortriptyline 25 mg CAP UD $ 1.08 nysta^n 100,000 units/mL ORAL SUSP (Neonatal) $ 21.00 nysta^n 100000 u/ml SUSP 60 ml $ 15.28 nysta^n 500,000 unit/5 mL susp UDC $ 1.84 nysta^n topical 100,000 u/gm PWD 15 g $ 13.58 nysta^n topical CREAM 15 gm $ 13.16 nysta^n topical CREAM 30 g $ 55.19 nysta^n topical OINT 15 gm $ 12.25 nysta^n-triamcinolone topical 0.1% CREAM 30 g $ 243.66 nysta^n-triamcinolone topical CREAM 15 g $ 56.03 nysta^n-triamcinolone topical OINT 30 gm $ 190.18 octreo^de 100 mcg/ml INJ $ - octreo^de 1000 mcg/5 ml INJ $ 82.35 octreo^de LAR 10 mg PWDI $ 5,443.02 octreo^de LAR 20 mg PWDI $ 7,209.74 octreo^de LAR 30 mg PWDI $ 12,468.81 ocular lubricant - ophthalmic SOLN UD (Tears Natural Free) $ 0.86 ocular lubricant ophth SOLN 15 mL $ 7.22 ocular lubricant ophthalmic OINT (Puralube) $ 38.33 ofatumumab 100 mg/ 5 mL INJ $ 1,279.44 ofatumumab 1000 mg/ 50 mL INJ $ 12,986.36 ofloxacin 200 mg TAB $ 7.75 ofloxacin 300 mg TAB $ 9.34 ofloxacin 400 mg TAB $ 15.34 ofloxacin ophthalmic 0.3% SOLN $ 27.45 ofloxacin o^c 0.3% SOLN $ 73.72 OLANZapine 10 mg TAB UD $ 0.51 OLANZapine 15 mg TAB UD $ 1.39 OLANZapine 2.5 mg TAB $ 0.28 OLANZapine 5 mg ODT $ 1.95 OLANZapine 5 mg TAB UD $ 0.57 olmesartan 20 mg TAB UD $ 19.50 olmesartan 5 mg TAB $ 0.57 olopatadine ophthalmic 0.1% SOLN $ 106.13 olsalazine 250 mg CAP $ 1.36 omalizumab 150 mg PWDI $ 2,114.35 omega-3 polyunsaturated faqy acids ethyl esters 1 g CAP $ 0.68

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omeprazole 20 mg CAP DR $ 0.40 omeprazole-sodium bicarbonate 2 mg/1 mL ORAL SUSP (Neonatal) $ 268.93 ondansetron 4 mg TAB UD $ 0.74 ondansetron 4 mg/2 ml INJ $ 0.74 ondansetron 40 mg/20 mL INJ MDV $ 4.10 ondansetron 8 mg TAB UD $ 1.02 ondansetron-D5W 8 mg/50 mL PM $ 21.39 ondansetron-NS 8 mg/50 mL PM $ 21.39 ophth irrigaôn, extraocular - SOLN (Eye-Stream) $ 44.06 ophthalmic irrigaôn, intraocular Balanced Salt Soluôn Plus SOLN $ 224.87 ophthalmic irrigaôn, intraocular Balanced Salt Soluôn SOLN 15 ml $ 6.62 ophthalmic irrigaôn, intraocular Balanced Salt Soluôn SOLN 500 ml $ 32.09 opium 10% TINCTURE $ 6.96 oseltamivir 30 mg/5mL SUSP UDC $ 27.45 oseltamivir 6 mg/mL SUSP $ 268.28 oseltamivir 75 mg CAP $ 12.06 oseltamivir phosphate 30 mg CAP $ 13.98 oseltamivir phosphate 45 mg CAP $ 17.89 oxacillin 1 gm PWDI $ 22.89 oxacillin 2 g PWDI $ 27.65 oxacillin 50 mg/mL SYRINGE (Neonatal) $ 1.08 oxalipla^n 100 mg/20 mL soln $ 395.07 oxalipla^n 50 mg/10 mL soln $ 187.69 oxandrolone 10 mg TAB $ 18.65 oxazepam 10 mg CAP $ 4.05 OXcarbazepine 150 mg TAB $ 0.54 OXcarbazepine 300 mg TAB UD $ 1.22 oxiconazole topical 1% CREAM 30 g $ 899.94 oxiconazole topical 1% LOTION $ 92.14 oxybutynin 10 mg ERT $ 2.24 oxybutynin 5 mg ERT $ 6.79 oxybutynin 5 mg TAB UD $ 1.05 oxybutynin 5 mg/5 ml SYRUP $ 1.02 oxyCODONE 10 mg ERT UD $ 9.03 oxyCODONE 15 mg ERT UD $ 11.07 oxyCODONE 20 mg ERT UD $ 16.78 oxyCODONE 20 mg/ml 1 ml SYRG $ 15.57 oxyCODONE 40 mg ERT UD $ 28.72 oxyCODONE 5 mg/5 ml SOLN UD $ 14.43 oxyCODONE 80 mg ERT UD $ 41.83 oxyCODONE IR 10 mg TAB $ 1.50 oxyCODONE IR 15 mg TAB $ 1.10 oxyCODONE IR 2.5 mg HALF-TAB $ 0.33

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oxyCODONE IR 30 mg TAB $ 1.19 oxyCODONE IR 5 mg TAB $ 0.99 oxymetazoline 0.05% nasal SPRAY 15 mL $ 15.71 oxytetracycline-polymyxin B ophthalmic 5 mg-10000 u/gm OINT $ 21.85 oxytocin 10 Unit/ml INJ vial $ 1.75 oxytocin-lactated ringers 30 unit-500 mL IV SOLN $ 24.06 PACLitaxel 100 mg/16.7 ml INJ $ 69.00 PACLitaxel 30 mg/5 ml INJ $ 13.16 PACLitaxel 300 mg/50 mL INJ soln $ 108.96 PACLItaxel protein-bound 100 mg INJ $ 2,592.70 paliperidone 234 mg/1.5 mL INJ $ 9,318.92 paliperidone 3 mg TAB ER $ 104.77 paliperidone 9 mg TAB ER $ 67.41 palivizumab 50 mg INJ $ 3,900.96 palonosetron 0.25 mg/5 mL IV soln $ 60.00 pamidronate 30 mg INJ $ 37.07 pamidronate 30 mg PWDI $ 46.75 pamidronate 90 mg / 10 mL INJ $ 35.66 pancrelipase 15,000 units-47,000 units-63,000 units cap D $ 11.26 pancrelipase 24,000 u-5000 u-17,000 u CAP DR $ 4.30 pancrelipase 25,000 u-79,000 u-105,000 u CAP DR $ 18.82 pancrelipase 42,000 u-10,000 u-32,000 u CAP DR $ 8.46 pancrelipase 84,000 units-20,000 units-63,000 units CAP DR $ 15.96 pancuronium 10 mg/10 ml INJ $ 2.17 panitumumab 100 mg/5 mL INJ $ 2,424.40 panitumumab 400 mg/20 mL INJ $ 9,697.56 pantoprazole 40 mg ECT TAB $ 0.48 pantoprazole 40 mg PWDI $ 8.49 papaverine 300 mg/10 ml INJ $ 12.11 papaverine 60 mg/2 ml INJ $ 60.62 paricalcitol 1 mcg CAP UD $ 2.66 paricalcitol 5 mcg/ml INJ $ 19.73 PARoxe^ne 10 mg TAB $ 1.13 PARoxe^ne 12.5 mg ERT $ 3.23 PARoxe^ne 20 mg TAB UD $ 0.45 PARoxe^ne 30 mg TAB $ 1.78 pa^romer 8.4 g PWDR $ 72.65 Pediatric Mul^ple Vitamins LIQUID (Poly-Vi-Sol) $ 24.59 Pediatric Mul^ple Vitamins PWDI 25 ml $ 2.55 pemetrexed 100 mg PWDI $ 1,603.28 pemetrexed 500 mg PWDI $ 8,879.52 penicillin G benzathine 2,400,000 units/4 mL INJ $ 858.40 penicillin G benzathine 600,000 u/ml INJ 2 ml $ 259.28

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penicillin G potassium 20 million units PWDI $ 135.27 penicillin G potassium 3 MUnit/50 mL D5W PB $ 25.47 penicillin G POTASSIUM 5 million units PWDI $ 16.64 penicillin G POTASSIUM 50,000 units/mL SYRINGE (Neonatal) $ 0.08 penicillin G SODIUM 5 million units PWDI $ 104.57 penicillin V potassium 250 mg TAB UD $ 0.23 penicillin V potassium 250 mg/5 ml PWDR $ 16.98 penicillin V potassium 500 mg TAB UD $ 0.54 pentafluoropropane-tetrafluoroethane SPRAY $ 78.47 pentamidine 300 mg PWDI $ 340.45 pentamidine 300 mg PWDR $ 279.46 pentosta^n 10 mg PWDI $ 2,479.02 pentoxifylline 400 mg ERT UD $ 0.40 peppermint SPIRIT 30 ml $ 16.67 peramivir 200 mg/ 20 mL INJ $ 842.21 Periar^cular Joint Cocktail $ 49.53 permethrin topical 5% CREAM 60 gm $ 76.41 perphenazine 2 mg TAB UD $ 3.06 perphenazine 4 mg TAB UD $ 2.80 phenazopyridine 100 mg TAB $ 1.27 phenazopyridine 200 mg TAB $ 3.96 phenelzine 15 mg TAB $ 1.64 PHENobarbital 10 mg/mL IV SYRINGE (neonatal) $ 1.20 PHENobarbital 130 mg/ml INJ $ 133.58 PHENobarbital 130 mg/mL ORAL SOLN (Neonatal) $ 134.82 PHENobarbital 15 mg TAB UD $ 0.40 PHENobarbital 20 mg/5 ml ELIX UD $ 1.32 PHENobarbital 32.4 mg TAB $ 1.02 PHENobarbital 4 mg/mL ORAL SOLN (Neonatal) $ 21.00 PHENobarbital 60 mg TAB UD $ 0.62 PHENobarbital 65 mg/ml INJ $ 52.27 PHENobarbital 65 mg/mL ORAL SOLN (Neonatal) $ 52.27 phenol 1.4% topical spray $ 10.02 phentolamine 5 mg PWDI $ 1,127.22 PHENYLephrine 0.25% nasal SPRAY 15 mL $ 11.04 PHENYLephrine 0.5% nasal SPRAY 15 mL $ 9.11 PHENYLephrine 10 mg/ml INJ $ 3.98 PHENYLephrine 10% ophthalmic SOLN 5 ml $ 106.97 phenylephrine 1000 mcg/10 mL NS SYRINGE $ 12.17 PHENYLephrine 2.5% ophthalmic SOLN 15 mL $ 244.94 PHENYLephrine 200 mcg/mL INJ (for priapism) $ 2.65 PHENYLephrine 400 mcg/10 mL in 0.9% Sodium Chloride $ 14.15 phenytoin 100 mg CAP ER UD $ 1.19

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phenytoin 100 mg/2 ml INJ $ 2.26 phenytoin 100 mg/4 mL SUSP $ 12.90 phenytoin 250 mg/5 ml INJ $ 3.11 phenytoin 30 mg CAP ER $ 2.18 phenytoin 5 mg/mL SYRINGE (neonatal) $ 2.18 phenytoin 50 mg CHEWTAB UD $ 2.09 phosphorated carbohydrate soluôn - SOLN $ 20.04 physos^gmine 1 mg/ml INJ $ 94.81 phytonadione 1 mg/0.5 mL AMP $ 10.81 phytonadione 1 mg/0.5 ml SYRINGE $ 55.27 phytonadione 10 mg/ml INJ $ 106.75 phytonadione 5 mg TAB $ 156.27 pilocarpine 1% ophthalmic SOLN 15 mL $ 193.71 pilocarpine 2% ophthalmic SOLN 15 mL $ 210.55 pilocarpine 4% ophthalmic SOLN 15 mL $ 221.16 pilocarpine 5 mg TAB $ 3.20 pindolol 5 mg TAB k $ 1.90 pioglitazone 15 mg TAB $ 0.28 pioglitazone 30 mg TAB $ 0.45 pioglitazone 45 mg TAB $ 0.54 piperacillin-tazobactam 2 gm-0.25 gm PWDI $ 8.24 piperacillin-tazobactam 2 gm-0.25 gm/50 ml dextrose 5% PB $ 22.50 piperacillin-tazobactam 3 gm-0.375 gm PWDI $ 10.36 piperacillin-tazobactam 3 gm-0.375 gm/50 ml dextrose 5% PB $ 29.35 piperacillin-tazobactam 4 gm-0.5 gm PWDI $ 35.66 piperacillin-tazobactam 4 gm-0.5 gm/100 ml dextrose 5% PB $ 36.65 piperonyl butoxide-pyrethrins 4%-0.33% topical SHAMPOO $ 13.58 piroxicam 20 mg CAP $ 1.98 plasma protein fracôn 50 mg/1 mL (5%) 50 mL SYRINGE (Neonatal) $ 51.31 pneumococcal 13-valent vaccine 0.5 mL SYR (STATE) $ 0.01 pneumococcal 23-valent vaccine (STATE) $ 0.01 polycarbophil 625 mg TAB UD $ 0.20 polyethylene glycol 3350 PWDR 119 g $ 10.10 polyethylene glycol electrolyte soluôn - PWDR (Nulytely) $ 113.20 polyethylene glycol electrolyte soluôn 100% - PWDR (Miralax) $ 3.85 polymyxin B sulfate 500000 u PWDI $ 13.78 polymyxin B-trimethoprim ophthalmic SOLN (Polytrim) $ 27.45 posaconazole 40 mg/1 mL SUSP $ 1,872.10 potassium acetate 40 mEq/20 mL INJ $ 8.49 potassium bicarbonate-potassium citrate 25 mEq EFF $ 3.42 potassium chloride 1.3 mEq/ mL ORAL SOLN (Neonatal) $ 0.03 potassium chloride 10 mEq ERT UD $ 1.23 potassium chloride 20 mEq ERT UD $ 1.16

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potassium chloride 20 mEq PWDR $ 10.70 potassium chloride 20 mEq/10 ml INJ $ 2.83 potassium chloride 40 mEq/20 ml INJ MDV $ 10.75 potassium chloride 60 mEq/30 ml INJ $ 1.25 potassium chloride-sodium chloride 10 mEq/100 mL PB $ 44.86 potassium chloride-sterile water 10 mEq/100 mL PB $ 101.88 potassium chloride-sterile water 20 mEq/100 ml PB $ 57.92 potassium citrate 10 mEq TAB (1080 mg) $ 3.79 potassium iodide 130 mg TAB $ 1.73 potassium phosphate 15 mmol/5 ml INJ $ 32.83 potassium phosphate 150 mmol/50 ml MDV $ 99.70 potassium phosphate 45 mmol/15 ml MDV $ 36.51 potassium phosphate-NS 15 mmol/250 mL PB $ 118.72 potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg PWDR UD $ 0.93 povidone iodine 10% topical OINT 1 g $ 0.19 povidone iodine 5% ophthalmic SOLN 30 mL $ 35.66 pralidoxime 1 gm PWDI $ 235.63 pramipexole 0.125 mg TAB $ 0.14 pramipexole 0.25 mg TAB $ 0.40 pramipexole 1 mg TAB $ 0.38 pramoxine topical 1% FOAM $ 110.79 pramoxine-hydrocor^sone topical 1%-1% FOAM $ 356.58 pramoxine-hydrocor^sone topical 1%-2.5% LOTION $ 322.34 prasugrel 10 mg TAB $ 1.73 pravasta^n 10 mg TAB UD $ 1.05 pravasta^n 20 mg TAB UD $ 1.44 pravasta^n 40 mg TAB $ 1.61 prazosin 1 mg CAP UD $ 2.97 prazosin 5 mg CAP UD $ 7.87 prednisoLONE 15 mg/5 ml SYRUP UD $ 0.71 prednisoLONE acetate 0.12% ophthalmic SUSP 5 mL $ 336.83 prednisoLONE acetate 1% ophthalmic SUSP 5 mL $ 120.28 prednisoLONE acetate-sulfacetamide sodium SUSP 5 mL $ 306.80 predniSONE 1 mg TAB UD $ 0.31 predniSONE 10 mg TAB UD $ 0.40 predniSONE 2.5 mg TAB $ 0.40 predniSONE 20 mg TAB UD $ 0.45 predniSONE 5 mg TAB UD $ 0.34 predniSONE 50 mg TAB UD $ 0.59 pregabalin 100 mg CAP UD $ 0.44 pregabalin 150 mg CAP UD $ 0.42 pregabalin 25 mg CAP $ 0.41 pregabalin 50 mg CAP $ 0.44

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pregabalin 75 mg CAP $ 0.44 Prenatal Mul^vitamins with Folic Acid 1 mg TAB (Prenatal) $ 0.14 primaquine 26.3 mg TAB $ 3.20 primidone 250 mg TAB UD $ 0.42 primidone 50 mg TAB $ 1.25 probenecid 500 mg TAB $ 1.62 procainamide 1000 mg/10 ml INJ $ 157.63 procainamide 1000 mg/2 mL INJ $ 115.97 proCHLORPERazine 10 mg TAB UD $ 1.84 proCHLORPERazine 10 mg/2 ml INJ $ 25.41 proCHLORPERazine 25 mg SUPP $ 25.30 proCHLORPERazine 5 mg TAB UD $ 0.74 proMETHazine 12.5 mg SUPP $ 20.52 proMETHazine 25 mg SUPP $ 16.81 proMETHazine 25 mg TAB UD $ 0.31 proMETHazine 50 mg/ml INJ $ 6.25 proMETHazine 6.25 mg/5 ml SYRUP $ 0.42 propafenone 150 mg TAB $ 1.06 proparacaine 0.5% ophthalmic SOLN 15 mL $ 65.80 propofol 1000 mg/100 mL IV SUSP VIAL $ 31.13 propofol 200 mg/20 mL IV SUSP VIAL $ 6.23 propofol 500 mg/50 mL IV SUSP VIAL $ 10.50 propranolol 1 mg/ml INJ $ 5.24 propranolol 10 mg TAB UD $ 0.59 propranolol 120 mg CAP ER $ 5.38 propranolol 160 mg CAP ER UD $ 3.42 propranolol 20 mg TAB UD $ 0.42 propranolol 4 mg/1 ml SOLN (Nursery) $ 0.19 propranolol 40 mg TAB UD $ 2.29 propranolol 60 mg CAP ER $ 3.20 propranolol 80 mg CAP ER UD $ 3.91 propylthiouracil 50 mg TAB $ 1.75 protamine 50 mg/5 ml INJ $ 21.65 protamine 50 mg/5 ml INJ (For Dialysis) $ 19.81 Prothrombin Complex Concentrate (Human) 1,000 IntnlUnit $ 4.78 Prothrombin Complex Concentrate (Human) 500 IntnlUnit $ 4.78 pseudoephedrine 30 mg TAB UD $ 0.06 psyllium 12 g PWDR $ 1.19 psyllium 4.03 gm/6 gm PWDR (Perdeim) $ 25.81 psyllium 5.8 g PWDR SF $ 1.33 pyrazinamide 500 mg TAB $ 4.67 pyridos^gmine 60 mg TAB $ 2.86 pyridos^gmine 60 mg/5 ml SYRUP $ 3.37

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pyridoxine 100 mg/ml INJ $ 22.04 pyridoxine 50 mg TAB UD $ 0.31 QUEâpine XR 150mg TAB UD $ 1.36 QUEâpine XR 50 mg TAB UD $ 0.23 QUEâpine 100 mg TAB $ 0.42 QUEâpine 12.5 mg/HALF-TAB $ 0.11 QUEâpine 25 mg TAB $ 0.48 QUEâpine 300 mg TAB UD $ 1.22 QUEâpine 400 mg TAB $ 1.13 QUEâpine 50 mg TAB $ 0.62 QUEâpine XR 200 mg TAB $ 40.70 QUEâpine XR 400 mg TAB $ 3.06 quinapril 10 mg TAB UD $ 0.45 quinapril 20 mg TAB $ 0.45 quinapril 40 mg TAB $ 0.34 quinapril 5 mg TAB UD $ 0.45 quiNIDine 300 mg TAB UD $ 0.50 quiNIDine 324 mg ERT UD $ 19.41 quiNINE 324 mg CAP $ 15.40 rabies immune globulin, human 150 Intnl Unit/ml INJ 10 ml (Rig) $ 8,059.56 rabies immune globulin, human 300 Intnl Unit/mL INJ 1 ml (Rig) $ 1,322.83 racepinephrine 2.25% SOLN UD $ 2.22 raloxifene 60 mg TAB $ 6.17 raltegravir 400 mg TAB $ 66.45 ramipril 1.25 mg CAP $ 0.21 ramipril 10 mg CAP $ 0.17 ramipril 2.5 mg CAP $ 0.17 ramipril 5 mg CAP UD $ 0.14 raNITIdine 1 mg/mL IV SYRINGE (neonatal) $ 2.83 raNITIdine 15 mg/mL ORAL SYRUP (Neonatal) $ 21.00 raNITIdine 150 mg TAB $ 0.37 raNITIdine 150 mg/10 ml SYRUP (Nursery) $ 8.77 raNITIdine 300 mg TAB $ 1.84 raNITIdine 50 mg/2 ml INJ $ 32.94 ranolazine 500 mg TAB ER $ 1.78 rasburicase 1.5 mg PWDI $ 2,220.42 repaglinide 0.5 mg TAB $ 1.02 repaglinide 1 mg TAB $ 1.44 reteplase 10 unit KIT $ 5,075.46 RHo (D) immune globulin 15000 IU/13 mL SOLN $ 7,208.12 RHo (D) immune globulin 5000 IU/4.4 mL SOLN $ 2,402.69 rifabu^n 150 mg CAP $ 37.27 rifAMPin 150 mg CAP $ 1.92

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rifAMPin 300 mg CAP $ 1.84 rifAMPin 600 mg PWDI $ 196.49 riFAXIMin 200 mg TAB $ 51.19 riFAXIMin 550 mg TAB UD $ 105.28 risperiDONE 0.25 mg TAB $ 0.45 risperiDONE 0.5 mg TAB $ 0.48 risperiDONE 1 mg TAB UD $ 0.48 risperiDONE 2 mg TAB UD $ 0.48 risperiDONE 25 mg/2 weeks intramuscular INJ $ 1,107.49 risperiDONE 3 mg TAB UD $ 0.23 risperiDONE 50 mg/2 weeks intramuscular INJ $ 1,822.66 ritonavir 100 mg TAB $ 22.75 riTUXimab 100 mg/10 mL INJ SOLN $ 2,658.84 riTUXimab 500 mg/50 mL INJ SOLN $ 13,294.21 rivaroxaban 10 mg TAB $ 28.27 rivaroxaban 15 mg TAB $ 29.74 rivaroxaban 2.5 mg TAB $ 14.94 rivaroxaban 20 mg TAB $ 29.74 rivas^gmine 1.5 mg CAP $ 3.51 rivas^gmine 13.3 mg/24 hr PATCH $ 20.29 rivas^gmine 3 mg CAP $ 5.55 rivas^gmine 4.6 mg/24 hr PATCH $ 21.51 rivas^gmine 9.5 mg/24 hr PATCH $ 16.78 rocuronium 100 mg/10 mL INJ $ 13.02 rocuronium 50 mg/5 ml INJ $ 7.08 roflumilast 500 mcg TAB $ 25.58 romiplos^m 250 mcg PWDI $ 171.29 romiplos^m 500 mcg PWDI $ 171.29 rOPINIRole 0.25 mg TAB $ 1.10 rOPINIRole 1 mg TAB $ 0.99 rOPINIRole 4 mg TAB $ 0.34 ropivacaine 0.2% 400mg/200 mL INJ $ 79.69 rosuvasta^n 10 mg TAB UD $ 2.69 rosuvasta^n 20 mg TAB UD $ 0.51 rosuvasta^n 5 mg TAB $ 0.48 rotavirus vaccine monovalent PWDR (STATE) VIAL $ 0.01 saccharomyces boulardii lyo 250 mg CAP $ 2.04 sacubitril-valsartan 24 mg-26 mg TAB $ 22.33 sacubitril-valsartan 49 mg-51 mg TAB $ 17.73 sacubitril-valsartan 97 mg-103 mg TAB $ 17.73 salicylic acid-sulfur topical 2%-2% SHAMPOO 120 mL $ 10.19 saliva subs^tutes oral rinse 30 mL UD $ 16.22 saliva subs^tutes SPRAY $ 16.98

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salmeterol 50 mcg PWD DISKUS $ 611.73 scopolamine 1.5 mg PATCH $ 45.70 secre^n 16 mcg PWDI $ 1,174.45 selegiline 5 mg TAB UD $ 0.15 selenium 40 mcg/mL INJ 10 mL $ 1.13 selenium sulfide 2.5% topical LOTION $ 25.81 selenium sulfide topical 1% SHAMPOO (Selsun Blue) $ 11.72 senna 8.6 mg TAB UD $ 0.11 senna 8.8 mg/5 mL SYRUP UDC $ 0.57 sertraline 100 mg TAB UD $ 0.62 sertraline 20 mg/ml CONC 60 mL $ 110.71 sertraline 25 mg TAB $ 0.54 sertraline 50 mg TAB UD $ 0.57 sevelamer 400 mg TAB $ 5.97 sevelamer 800 mg tab $ 18.76 sevelamer carbonate 800 mg TAB $ 0.74 sevoflurane inhala^on LIQUID 250 mL $ 212.25 sildenafil 20 mg TAB $ 2.60 sildenafil 25 mg TAB $ 51.54 sildenafil 50 mg TAB $ 34.39 silver nitrate topical - STICK $ 1.13 silver sulfADIAZINE 1% topical CREAM 400 gm $ 147.16 silver sulfADIAZINE 1% topical CREAM (OR Use Only) 50 gm $ 25.47 silver sulfADIAZINE 1% topical CREAM 25 g $ 16.27 simethicone 125 mg chewable TAB $ 0.57 simethicone 40 mg/0.6 ml LIQUID $ 5.09 simethicone 80 mg CHEWTAB $ 0.14 simvasta^n 10 mg TAB UD $ 0.31 simvasta^n 20 mg TAB UD $ 0.25 simvasta^n 40 mg tab UD $ 0.28 simvasta^n 5 mg TAB $ 0.54 sincalide 5 mcg PWDI $ 282.09 sirolimus 1 mg TAB $ 27.48 sirolimus 1 mg/ml SOLN UD 1 ml $ 70.33 SITaglip^n 100 mg TAB $ 32.23 SITaglip^n 25 mg TAB $ 39.96 sodium acetate 40 mEq/20 ml INJ $ 7.92 sodium bicarbonate 1 mEq/mL SYR $ 0.42 sodium bicarbonate 4.2% - 0.5mEq/mL SYRINGE (Neonatal) $ 0.83 sodium bicarbonate 4.2% 5 mL VIAL $ 1.35 sodium bicarbonate 4.2% SYRINGE (infant) $ 24.34 sodium bicarbonate 650 mg TAB $ 0.25 sodium bicarbonate 8.4% SYRINGE 50 mL $ 26.89

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sodium bicarbonate 8.4% INJ $ 24.06 sodium bicarbonate 8.4% SYRINGE (pediatric) 10 ml $ 34.24 sodium biphosphate-sodium phosphate 133 mL ENEMA $ 3.39 Sodium Chloride 0.45% SOLN 1000 ml $ 90.00 Sodium Chloride 0.45% SOLN 500 ml $ 90.00 Sodium Chloride 0.45% with KCl 20 mEq/L SOLN $ 90.00 sodium chloride 0.65% nasal SOLN $ 2.49 sodium chloride 0.9% (bacteriosta^c) SOLN 30 ml $ 2.18 Sodium Chloride 0.9% 1,000 mL Non-DEHP $ 90.00 Sodium Chloride 0.9% 100 mL Non-DEHP $ 44.00 Sodium Chloride 0.9% 250 mL Non-DEHP $ 89.00 Sodium Chloride 0.9% 500 mL Non-DEHP $ 89.00 sodium chloride 0.9% for irrigaôn SOLN 1 liter $ 89.00 sodium chloride 0.9% for irrigaôn SOLN 250 mL $ 89.00 sodium chloride 0.9% INJ 20 mL $ 3.40 sodium chloride 0.9% irrigaôn SOLN 500 mL $ 90.00 Sodium Chloride 0.9% SOLN 100 mL $ 44.00 Sodium Chloride 0.9% SOLN 1000 mL $ 90.00 Sodium Chloride 0.9% SOLN 150 ml $ 43.50 Sodium Chloride 0.9% SOLN 250 ml $ 89.00 Sodium Chloride 0.9% SOLN 50 ml $ 44.00 Sodium Chloride 0.9% SOLN 500 ml $ 90.00 sodium chloride 0.9% SOLN UD $ 0.22 Sodium Chloride 0.9% with KCl 20 mEq/L SOLN $ 92.00 Sodium Chloride 0.9% with KCl 40 mEq/L SOLN $ 71.00 sodium chloride 1 gm TAB $ 0.28 sodium chloride 23.4% INJ 30 mL $ 12.74 sodium chloride 3% inhalaôn SOLN 15 mL $ 2.12 Sodium Chloride 3% IV SYRINGE (Neonatal) $ 25.00 Sodium Chloride 3% SOLN (Hypertonic) $ 25.00 sodium chloride 4 mEq/ml (23.4%) ORAL SOLN (Neonatal) $ 21.00 sodium chloride, hypertonic, ophthalmic 5% OINT $ 13.39 sodium chloride, hypertonic, ophthalmic 5% SOLN $ 25.47 sodium chondroi^n-hyaluronate ophthalmic 40 mg-30 mg/ml SYRINGE $ 190.66 sodium ferric gluconate complex 62.5 mg/5 ml INJ $ 21.23 sodium hyaluronate 20 mg/2mL SYRINGE $ 339.60 sodium hyaluronate ophthalmic 10 mg/ml SYRG 0.55 mL $ 118.24 sodium hypochlorite 0.125% topical SOLN $ 9.37 sodium hypochlorite 0.25% topical SOLN $ 26.77 sodium hypochlorite 0.5% topical SOLN $ 23.83 sodium lactate SOLN 1000 ml $ 84.90 sodium nitroprusside 50 mg PWDI $ 85.24 sodium phosphate 3 mmol/ml MDV 15 ml $ 3.96

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sodium phosphate 3 mmol/mL MDV 50 mL (Abboq) $ 6.54 sodium phosphate-NS 20 mmol/250 mL PB $ 608.45 sodium polystyrene sulfonate 15 gm/60 ml SUSP $ 20.38 sodium sulfacetamide ophthalmic 10% SOLN $ 93.28 sodium thiosulfate 25% 50 mL IV soln $ 251.87 sofosbuvir 400 mg TAB $ 2,723.88 solifenacin succinate 5 mg TAB $ 1.11 somatropin 5.8 mg INJ $ - sorbitol 70% LIQUID $ 1.70 sotalol 120 mg TAB $ 0.31 sotalol 40 mg/HALF-TAB $ 0.19 sotalol AF 80 mg TAB UD $ 1.33 spironolactone 12.5 mg/HALF-TAB $ 0.11 spironolactone 25 mg TAB UD $ 0.34 spironolactone 3 mg/mL ORAL SUSP (Neonatal) $ 21.00 spironolactone 50 mg tab UD $ 1.22 sterile talc aerosolized powder 30 g $ 356.58 sterile water - INJ 10 ml $ - sterile water - INJ 20 ml $ - sterile water - SOLN 100 ml $ 11.32 sterile water - SOLN 1000 ml $ 89.00 sterile water bacteriosta^c INJ 30 ml $ 2.55 sterile water for irriga^on - SOLN 1500 ml $ 16.98 sterile water for irriga^on - SOLN 250 ml $ 89.00 Sterile Water SOLN 50 mL $ 16.98 streptomycin 1 gm PWDI $ 49.92 Styp^c Pencil $ 9.42 succinylcholine 100 mg/5 mL INJ $ 49.53 succinylcholine 200 mg/10 ml INJ $ 51.79 sucralfate 1 gm TAB UD $ 0.59 sugammadex 100 mg/1mL INJ 2 mL $ 264.89 sulfamethoxazole-trimethoprim 200 mg-40 mg/5 ml SUSP UD $ 10.75 sulfamethoxazole-trimethoprim 400 mg-80 mg TAB $ 0.59 sulfamethoxazole-trimethoprim 80 mg-16 mg/ml INJ 10 ml $ 20.94 sulfamethoxazole-trimethoprim 80 mg-16 mg/ml INJ 5 ml $ 12.62 sulfamethoxazole-trimethoprim 800 mg-160 mg TAB UD $ 0.34 sulfaSALAzine 500 mg ECT $ 0.68 sulfaSALAzine 500 mg TAB UD $ 1.08 sulindac 150 mg TAB UD $ 0.37 sulindac 200 mg TAB UD $ 0.57 SUMAtriptan 25 mg TAB $ 2.80 SUMAtriptan 6 mg/0.5 mL INJ $ 21.37 tacrine 20 mg CAP $ 2.41

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tacrolimus 0.1% topical OINT 60 g $ 804.85 tacrolimus 0.5 mg CAP $ 3.73 tacrolimus 1 mg CAP UD $ 2.60 Talc (sterile)-lidocaine 1%-normal saline 5 g-20 mL-80 mL $ 283.00 Talc (sterile)-sodium chloride 0.9% 2.55 g-50 mL $ 159.90 tamoxifen 10 mg TAB $ 0.96 tamsulosin 0.4 mg CAP $ 0.68 tapentadol 50 mg TAB UD $ 5.64 telmisartan 20 mg TAB $ 1.16 telmisartan 40 mg TAB $ 1.08 telmisartan 80 mg TAB $ 2.24 temazepam 15 mg CAP UD $ 0.25 temazepam 7.5 mg CAP $ 9.08 temozolomide 100 mg CAP $ 225.49 temozolomide 20 mg CAP $ 122.06 temozolomide 5 mg CAP $ 8.18 temsirolimus 25 mg/2.5 mL INJ $ 3,363.46 tenofovir 300 mg TAB $ 79.10 terazosin 1 mg CAP UD $ 0.37 terazosin 10 mg CAP $ 0.13 terazosin 2 mg CAP UD $ 0.40 terazosin 5 mg CAP UD $ 0.40 terbinafine topical 1% CREAM 30 gm $ 25.47 terbutaline 1 mg/ml INJ $ 4.02 terbutaline 2.5 mg TAB UD $ 11.64 terconazole topical 0.4% vaginal CREAM 45 gm $ 87.87 terconazole topical 80 mg vaginal SUPP $ 72.11 testosterone 1% transdermal GEL 5 gm $ 17.12 tetanus immune globulin 250 unit SYRINGE $ 1,156.08 tetanus/diphtheria/pertussis, acel (Tdap) susp (Adacel Latex Free) $ 96.29 tetanus/diphtheria/pertussis, acel (Tdap) susp (Adacel) $ 0.01 tetanus/diphtheria/pertussis, acel (Tdap) susp (Boostrix) $ 0.01 tetanus-diphtheria (Td) 2 u-5 u/0.5 ml SYRINGE $ 75.36 tetanus-diphtheria toxoids (Td) adult/adol 2 units-2 units/0.5 mL VIAL (STATE) $ 0.01 tetracaine 0.5% ophthalmic SOLN 4 mL $ 13.36 tetracaine 1% 10 mg/1 mL INJ SOLN $ 88.01 tetracaine ophthalmic 0.5% SOLN 15 mL $ 19.53 tetracycline 250 mg CAP UD $ 0.78 tetracycline 500 mg CAP $ 0.12 tetrahydrozoline ophthalmic 0.05% SOLN $ 3.08 theophylline 100 mg 24 hour CAP ER $ 5.38 theophylline 100 mg ERT $ 1.05 theophylline 200 mg 24 hour CAP ER $ 6.54

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theophylline 300 mg ERT $ 9.23 theophylline 400 mg ERT (Uniphyl) $ 2.41 theophylline 450 mg ER TAB $ 6.88 theophylline 5%-400 mg/500 ml SOLN $ 40.00 theophylline 600 mg ERT (Uniphyl) $ 4.02 theophylline 80 mg/15 mL SOLN UDC $ 25.05 Therapeu^c Mul^ple Vitamins TAB UD $ 0.11 thiamine 100 mg TAB UD $ 0.14 thiamine 100 mg/mL (IV Room Use Only) $ 7.56 thiamine 200 mg/2 ml INJ $ 14.89 thioridazine 25 mg TAB UD $ 1.27 thiothixene 1 mg CAP UD $ 2.52 thiothixene 5 mg CAP UD $ 3.76 thiothixene 5 mg/ml CONC $ 99.84 thrombin 20,000 unit topical KIT $ 757.31 thrombin topical 5000 u PWDR $ 118.66 thyroid desiccated 15 mg TAB $ 0.99 thyroid desiccated 30 mg TAB $ 1.27 thyroid desiccated 60 mg TAB UD $ 0.35 âGABine 2 mg TAB $ 10.12 âGABine 4 mg TAB $ 5.38 ^cagrelor 60 mg TAB $ 16.50 ^cagrelor 90 mg TAB UD $ 16.56 ^gecycline 50 mg INJ $ 238.09 ^molol 0.25% ophthalmic SOLN $ 6.93 ^molol 0.5% ophthalmic SOLN $ 13.02 ^molol 10 mg TAB $ 3.74 ^molol XE 0.25% ophthalmic GELFS 5 ml $ 112.21 ^molol XE 0.5% ophthalmic GELFS 5 mL $ 98.48 ôtropium 18 mcg CAP (Box of 5) $ 14.21 ^ZANidine 2 mg TAB $ 0.37 ^ZANidine 4 mg TAB $ 1.27 tobramycin 0.3% ophthalmic 5 mL $ 9.06 tobramycin 0.3% ophthalmic OINT 3.5 g $ 284.44 tobramycin 1.2 gm PWDI $ 256.94 tobramycin 300 mg/5 mL inhalaôn SOLN $ 160.32 tobramycin 80 mg/2 ml INJ $ 3.74 tobramycin-dexamethasone 0.3%-0.1% ophthalmic SUSP 2.5 mL $ 99.79 tobramycin-dexamethasone ophth OINT 3.5 g $ 570.27 tocilizumab 200 mg/ 10 mL INJ $ 2,774.25 tocilizumab 80 mg/4 mL INJ $ 782.58 TOLBUTamide 500 mg TAB UD $ 2.58 tolcapone 200 mg TAB $ 10.18

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tolnahate topical 1% PWD $ 5.74 tolterodine 1 mg TAB $ 2.63 tolterodine 2 mg CAP ER $ 0.91 tolterodine 4 mg CAP ER $ 33.17 topiramate 100 mg TAB $ 0.51 topiramate 25 mg CAP $ 2.63 topiramate 25 mg TAB $ 0.34 topotecan 4 mg/4 mL INJ $ 94.07 torsemide 10 mg TAB UD $ 0.82 torsemide 100 mg TAB UD $ 1.25 torsemide 20 mg TAB UD $ 0.96 traMADol 25 mg/HALF-TAB $ 0.06 traMADol 50 mg TAB $ 0.06 tranexamic acid 1000 mg/10 mL INJ $ 16.13 tranylcypromine 10 mg TAB $ 5.09 trastuzumab 440 mg KIT $ 239.08 travoprost ophth 0.004% SOLN 2.5 mL $ 487.89 traZODone 100 mg TAB UD $ 0.48 traZODone 25 mg/HALF-TAB $ 0.17 traZODone 50 mg TAB UD $ 0.26 tre^noin 0.1% topical CREAM 20 gm $ 239.98 triamcinolone 0.025% topical CREAM 15 g $ 6.08 triamcinolone 0.1% topical CREAM 15 gm $ 4.64 triamcinolone 0.1% topical CREAM 80 gm $ 13.58 triamcinolone 0.1% topical LOTION 60 mL $ 49.75 triamcinolone 0.1% topical OINT 80 gm $ 14.49 triamcinolone 0.5% topical CREAM 15 gm $ 21.65 triamcinolone topical 0.1% PASTE 5 g $ 171.64 triamterene 50 mg CAP $ 25.50 triazolam 0.25 mg TAB UD $ 6.59 trifluoperazine 1 mg TAB $ 1.63 trifluoperazine 5 mg TAB $ 2.24 trifluridine ophthalmic 1% SOLN $ 350.30 trihexyphenidyl 2 mg TAB UD $ 0.42 trihexyphenidyl 5 mg TAB UD $ 0.26 trimethoprim 100 mg TAB $ 1.53 triple diaper CREAM 45 g $ 10.60 tropicamide 0.5% ophthalmic SOLN 15 mL $ 15.28 tropicamide 1% ophthalmic SOLN $ 27.08 tropicamide 1% ophthalmic SOLN 15 mL $ 22.92 trypan blue 0.06% ophthalmic soln 0.5 mL $ 155.37 tuberculin purified protein deriva^ve 5 tu/0.1 ml MDV $ 21.56 typhoid vaccine, live - CAPLET EC $ 104.48

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umeclidinium 62.5 mcg/ inh MDI $ 101.63 umeclidinium-vilanterol 62.5 mcg-25 mcg/inh MDI $ 210.18 urea topical 20% CREAM (Carmol) 85 gm $ 24.06 urea topical 40% LOTION 226.8 ml $ 231.06 ursodiol 300 mg CAP $ 7.22 valACYclovir 1 gm TAB $ 3.45 valACYclovir 500 mg TAB $ 1.10 valproic acid 250 mg CAP UD $ 0.51 valproic acid 250 mg/5 ml SYRUP UD $ 0.99 valproic acid 500 mg/5 ml INJ $ 6.37 valsartan 160 mg TAB UD $ 1.13 valsartan 40 mg TAB $ 0.74 valsartan 80 mg TAB UD $ 0.65 vancomycin 1000 mg PWDI $ 10.10 vancomycin 5 gm PWDI $ 4.70 vancomycin 5 mg/mL SYRINGE (Neonatal) $ 0.65 vancomycin 500 mg PWDI $ 6.57 vancomycin 500 mg PWDI (ORAL) $ 6.57 vancomycin in NS irrigaôn (bag) $ 260.36 vancomycin in sterile water 250 mg-10 mL OPHTH $ 21.23 vancomycin in SW irrigaôn (bag) $ 260.36 vancomycin-D5W 1250mg-250 mL PM $ 42.45 vancomycin-D5W 1g-200 mL PM $ 101.88 vancomycin-D5W 500 mg-100 mL PM $ 101.88 vancomycin-D5W 750 mg-150 mL PM $ 106.13 vancomycin-NS 1250 mg-250 mL PM $ 35.38 vancomycin-NS 1750mg-500 mL PM $ 44.71 vancomycin-sodium chloride 250 mg-10 ml OPHTH DROPS $ 21.23 varicella virus vaccine - PWDI (STATE) $ 0.01 vasopressin 20 u/ml INJ $ 461.49 vecuronium 10 mg PWDI $ 13.33 vegetable shortening OINT $ 7.08 Vein Tumescent Soluôn SC $ 100.00 Venlafaxine 100 mg TAB $ 0.99 venlafaxine 150 mg CAP ER UD $ 1.32 venlafaxine 25 mg TAB $ 0.34 venlafaxine 37.5 mg CAP ER $ 1.10 venlafaxine 37.5 mg TAB $ 1.61 Venlafaxine 50 mg TAB $ 0.51 venlafaxine 75 mg CAP ER UD $ 0.85 verapamil 100 mg CAP ER $ 3.91 verapamil 120 mg ERT UD (Calan SR) $ 0.42 verapamil 120 mg TAB UD $ 0.25

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verapamil 180 mg ERT UD (Calan SR) $ 0.23 verapamil 240 mg ERT UD (Calan SR) $ 0.45 verapamil 40 mg TAB $ 0.37 verapamil 5 mg/2 ml INJ vial $ 33.39 verapamil 80 mg TAB UD $ 0.20 vinBLAS^ne 10 mg/10 ml INJ $ 64.98 vinCRIS^ne 1 mg/ml INJ $ 14.52 vinorelbine 10 mg/ml INJ $ 23.32 vinorelbine 50 mg/5 ml INJ $ 272.42 vitamin A & D topical OINT 5 gm $ 0.57 Vitamin B Complex TAB $ 0.14 vitamin E 200 Intnl Unit CAP $ 0.07 vitamin E 400 IntnlUnit CAP $ 0.12 vitamin E topical CREAM 60 gm $ 4.10 vitamins A & D topical OINT 42.5 g $ 8.42 voriconazole 200 mg PWDI $ 79.72 voriconazole 200 mg TAB $ 17.86 warfarin 1 mg TAB UD $ 5.32 warfarin 10 mg tab UD $ 0.17 warfarin 2 mg TAB UD $ 0.11 warfarin 2.5 mg TAB UD $ 0.11 warfarin 3 mg TAB UD $ 0.11 warfarin 5 mg TAB UD $ 0.11 yeast - ac^ve 4 oz. $ 14.97 yellow fever vaccine - PWDI $ 229.37 zafirlukast 20 mg TAB $ 2.78 zanamivir 5 mg DISKHALER $ 157.04 zidovudine 1 mg/mL SYRINGE (Neonatal) $ 0.40 zidovudine 200 mg/20 ml INJ $ 78.11 zidovudine 50 mg/5 ml SYRUP $ 2.83 zinc chloride 10 mg/10 ml INJ $ 60.56 zinc oxide topical 15 % PWD (113 g) $ 9.59 zinc oxide topical 20% OINT $ 6.79 zinc oxide topical 20% OINT 454 gm $ 12.85 zinc sulfate 220 mg CAP $ 0.37 ziprasidone 20 mg CAP $ 1.08 ziprasidone 40 mg cap UD $ 5.55 zoledronic acid 4 mg/5 mL INJ $ 18.96 zoledronic acid 5 mg/100 mL PM $ 798.06 zolpidem 10 mg TAB UD $ 0.14 zolpidem 5 mg TAB UD $ 0.14 zonisamide 100 mg CAP $ 1.10 zonisamide 50 mg CAP $ 0.45

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medical desc current rate # ir guidance stat charge $ - …...prof lungcx bx rpt docs class $ 0.01...

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