Charge_Code Charge_DescriptionChargeAmount

11033402 MED/SURG UNIT PRIVATE ROOM $979.0011436002 PSYCH UNIT PRIVATE ROOM $1,560.0012033401 MED UNIT SEMI PRIVATE $927.0012133401 MED/SURG SEMI PRIVATE $927.0012231301 OB LABOR DELIVERY SEMI PRIVATE $1,030.0012231401 POST PARTUM SEMI PRIVATE $927.0012436001 PSYCH UNIT SEMI PRIVATE $1,560.0014133402 MED/SURG PRIVATE ROOM $979.0014231302 OB LABOR DELIVERY PRIVATE ROOM $1,365.0014231402 POST PARTUM PRIVATE ROOM $979.0017131204 WELL BABY $927.0017931105 NEWBORN SPECIAL BOARDER $1,365.0017931205 BOARDER BABY $979.0020032102 ICU ROOM $1,570.0020633403 MED/SURG TELEMETRY ROOM $979.0025000001 0.45 N.S. 500CC $63.0025000002 0.45 NS/WATER 1000ML $11.0025000003 10% MANNITOL USP 1000CC $79.0025000004 20% MANNIT USP 500CC $63.0025000005 5% DXN/ 45% SC USP 1000 $79.0025000006 D-10 WATER 1000CC $79.0025000007 D-10 WATER 500CC $63.0025000008 D-5 1/2 N.S. 1000CC $63.0025000009 D-5 1/2 N.S. 500CC $61.0025000010 D-5 1/3 N.S. 500CC $63.0025000011 D-5 1/4 N.S. 500CC $79.0025000012 D-5 L.R. 1000CC $79.0025000013 D-5 L.R. 500CC $63.0025000014 D-5 N.S. 1000CC $61.0025000015 D-5 N.S. 500CC $63.0025000016 DEX 2.5% .5L R 500ML $11.0025000017 DEX 5% 02 SALINE $8.0025000018 DEX WATER 5% 1000ML $13.0025000019 DEX WATER 5% 250ML $11.0025000020 DEX WATER 5% 500ML $12.0025000021 NORMAL SAL 1000ML $10.0025000022 NORMAL SAL 150ML $15.0025000023 NORMAL SAL 250ML $10.0025000024 NORMAL SAL 3000ML $60.0025000025 NORMAL SAL 500ML $10.0025000026 0.0 N.S. 250CC SOLUTION $79.0025000027 0.9 N.S. 1000CC SOLUTION $79.0025000028 0.9 N.S. 500CC SOLUTION $79.0025000029 STIFF NECK COLLAR $75.0025002403 GADAVIST 0.1ML $1.8025903840 LAB RHOGAM 300MCG INJECTION $215.00

25903841 LAB RHOGAM 300MCG INJECTION $215.0025996500 CT CONTRAST $103.0025996501 CT CONTRAST $103.0025996503 CT CONTRAST $103.0025996505 CT CONTRAST $103.0025996506 CT CONTRAST $103.0025996701 LOCM 300-399MG/ML IODINE,1ML $2.0026000001 FLU VACCINE $37.0026000005 FLU VACCINE $37.0026963600 HYDRATION IV INFUSION, INITIAL $212.0026963605 INIT HYDRATION 31M-1HOUR $212.0026963615 HYDRATE IV INFUSION, ADD-ON $37.0026963616 IV INF; HYD; EA ADD HR UP TO 8 $190.0026963655 INITIAL INFUSION UP TO ONE HR $360.0026963665 THER/PRO/DX IV EACH ADDTL HR (+31 $360.0026963675 TX/PRO/DX ADDL SEQ IV INF NEW SUB $360.0026963685 CONCURRENT INFUSION (1/VISIT) $31.0026963720 THER/PROPH/DIAG INJ, SC/IM $37.0026963725 IM/SQ INJECTION $37.0026963727 THER/PROPH/DIAG INJ, SC/IM $37.0026963735 MEDICATION ADMINISTRATION IA $211.0026963745 THER/PROPH/DIAG INJ IV PUSH $211.0026963755 TX/PRO/DX INJ NEW DRUG ADDON $211.0026963765 TX/PRO/DX INJ SAME DRUG ADDON $211.0027000001 1 1/2 INCH KARAYAD/STOMA $226.0027000002 1 1/2 INCH STOMA POUCH $200.0027000003 1 1/2 INCH UROSTOMY $185.0027000004 1 3/4 INCH KARAYA SEAL $226.0027000005 1 3/4 INCH UROSTOMY $161.0027000006 16FR SARATOGA SUMP $64.0027000007 2 1/2 INCH KARAYA STOMA $226.0027000008 2 INCH KARAYA STOMA $226.0027000009 3 INCH KARAYA STOMA $177.0027000010 3 INCH STARTER SET $136.0027000011 ABDOMINAL BINDERS $87.0027000012 ABDUCTION PILLOW MED $103.0027000013 ADULT GASTRIC LAVAGE KIT $99.0027000014 ALCOHOL BOTTLE $12.0027000015 ALUM. FINGER SPLINT $17.0027000016 ANESTHETIC SPRAY $19.0027000017 ANKLE BRACE $8.0027000018 ARM SLING LARGE $30.0027000019 ARM SLING MEDIUM $30.0027000020 ARM SLING -SMALL $43.0027000021 ARROW TWIN CATH $34.0027000022 ARTERIAL CATH RADIAL $48.0027000023 BAG 1 3/4 INCH STOMA $180.0027000024 BAG-KARAYA STOMA $177.00

27000025 BAG-UROSTOMY $161.0027000026 BAL-PACING KIT $421.0027000027 BANDAGE - COBAN 3 INCH $11.0027000028 BANDAGE - COBAN 4 INCH $14.0027000029 BANDAGE - ELASTIKON 4 INCH $31.0027000030 BDG-ACE 2IN $7.0027000031 BDG-ACE 3IN $10.0027000032 BDG-ACE 4IN $12.0027000033 BDG-ACE 6IN $18.0027000034 BDG-ADAPTIC 3X3 $6.0027000035 BDG-ADAPTIC 3X8 $9.0027000036 BDG-KLING 2 IN $7.0027000037 BDG-KLING 3IN $11.0027000038 BDG-KLING 4IN $17.0027000039 BDG-KLING 6IN $12.0027000040 BILE BAG $28.0027000041 CASSETTE/WARM INJECTION $117.0027000042 CATH QUAD LUMEN $431.0027000043 CATH SET ASH SPLIT $548.0027000044 CATH TROCAR $52.0027000045 CATH-3 WAY IRRIGATION $39.0027000046 CATH-FOLEY 30CC $33.0027000047 CATH-FOLEY 3CC BALL $17.0027000048 CATH-FOLEY 5CC BAG $17.0027000049 CATH-LOUDE $27.0027000050 CATH-MAHURKER $350.0027000051 CATH-MIDLINE STERILE $83.0027000052 CATH-SWAN GANZ $45.0027000053 CATH-THORACIC $30.0027000054 CATH-THROACIC RT ANGLE $37.0027000055 CATH-TRAY W/O CATH $47.0027000056 CATH-TRAY W/O CATH $39.0027000057 CERVICAL COLLAR $43.0027000058 CLAVICLE BRACE $63.0027000059 COUNCILL STYLET 6FR $58.0027000061 DISP ADULT SENSOR $124.0027000062 DERMOPLAST SPRAY $19.0027000063 DISP MONITOR KIT $129.0027000064 DISP PED OXYGEN SENSOR $21.0027000065 DISP STETHOSCOPE $4.0027000066 DOMES TRANSDUCER $31.0027000067 DRAINS PENROSE $8.0027000068 DRSD-MICROSPORE 3.5 X 8 $3.0027000069 DRSG-ADAPTIC 1"" BOTTLE $27.0027000070 DRSG-ADAPTIC 1/2"" BOTTLE $17.0027000071 DRSG-ADAPTIC 2"" BOTTLE $27.0027000072 DRSG-DUO-DERM 4X4 $18.0027000073 DRSG-DUO-DERM 8X8 $81.00

27000074 DRSG-INSTRUMENT SET DISP $31.0027000075 DRSG-TRANS LARGE $6.0027000076 DRSG-TRANS MEDIUM $11.0027000077 DRSG-TRANS SMALL $15.0027000078 EAR WICK 12.24 $20.0027000079 EAR WICK 9.15 $11.0027000080 EAR WICK 9.24 $14.0027000081 EPISTAXIS NASAL BALLOON $30.0027000083 FEED TUBE INFANT $19.0027000084 FINGER ANCHOR $15.0027000085 FINGER SPLINT $21.0027000086 FOOT DROP BOOT $165.0027000087 GASTROSTOMY TUBE $160.0027000088 GAUZE VASELINE 1.5""X72"" $33.0027000089 GELFOAM 100 $105.0027000090 GELFOAM 50 $70.0027000091 HEIMLICH VALVE $22.0027000092 HEMATERIA-CATH $30.0027000093 IMMOBILIZER KNEE POST OP $15.0027000094 IMMOBILIZER SHOULDER $55.0027000095 INTRAOSSEOUS NEEDLE $83.0027000096 IODOFOAM PACKING 1/4 INCH $21.0027000097 IRRIG W.W. 3000CC $8.0027000098 IRRIGATION 3000CC GYLCINE $10.0027000099 IRRIGATION DRAINAGE BAG $24.0027000100 IRRIGATION START SET $53.0027000101 IRRIGATION T.U.R. SET $46.0027000102 K PAD - LG, MED, SM $60.0027000103 K THERMIA PAD $113.0027000104 KNEE BRACE $12.0027000105 L.R. 1000CC $79.0027000106 L.R. 500CC $63.0027000107 MATTRESS; DISP W/AIR PUMP $78.0027000108 MINNESITA TUBE $322.0027000109 MISC-LARYNGOSCOPE $18.0027000110 MISC-URI-METER $101.0027000111 MONOMETER SET $76.0027000112 MULTI LUNEN KIT $33.0027000113 NASAL TAMPON MED $17.0027000114 NU GAUZE 1/4IN / 1/2 IN $18.0027000115 NU GAUZE 1IN / 2 IN $25.0027000116 NUGAUZE IODO 1 INCH $21.0027000117 NUGAUZE IODO 1/2 INCH $21.0027000118 O B PACK $106.0027000119 ORTHO SHOES $24.0027000120 PACE TD SWAN-GANZ $835.0027000121 PASTE/ADAPT HOLLISTER $15.0027000122 PEDS GASTRIC LAVAGE KIT $11.00

27000123 PENROSE DRAIN $8.0027000124 PLASTIC SUTURE $24.0027000125 PLEUR EVAC SET UP $40.0027000126 PNEUMATIC HOSE $296.0027000127 PNEUMOTHORAX KIT $129.0027000128 PORT A CATH HUBERT NEEDLE $28.0027000129 POSITIVE DISPLACEMENT VALVE $52.0027000130 PRESSURE MONT KIT $46.0027000131 PREVENOUS LEAD $68.0027000132 PUDENAL BLOCK $66.0027000133 RAPID RHINO LARGE $72.0027000134 RAPID RHINO MEDIUM $62.0027000135 RAPID RHINO SMALL $65.0027000136 RESI BAG PEDS $6.0027000137 RESSIC BAG DISP ADULT $80.0027000138 RHINO ROCKETT SM/MED $45.0027000139 SARATOGA SUMP 20X12 $77.0027000140 SCROTAL SUPPORT $19.0027000141 SECURITY POUCH 1 25 INCH $70.0027000142 SEQ COMPRESSION SLEEVE - LG $73.0027000143 SEQ. COMPRESSION SLEEVE - MED $62.0027000144 SET-SUTURE REMOVAL $10.0027000145 SKIN STAPLER SMALL $18.0027000146 STAPLE REMOVER $18.0027000147 STERI-STRIP 1/2 $12.0027000148 STERI-STRIP 1/4 $12.0027000149 STOMA BAG 1 25" I6MED $96.0027000150 T.E.D. HOSE $39.0027000151 THORACENTESIS/PARACENTESIS $83.0027000152 THOROCENTHESIS KIT $31.0027000153 THUMP SPICA $55.0027000154 TRACTION PELVIC BELT $6.0027000155 TRANS PACING KIT $387.0027000156 TRANSDUCER W/MONITOR $184.0027000157 TRAU-SPINALDISP. $109.0027000158 TRAY AMNIOCENTESIS $54.0027000159 TRAY BIOPSY $59.0027000160 TRAY BONE MARROW BIOPSY $50.0027000161 TRAY CATHETER SWAN GANZ DISP $45.0027000162 TRAY CVP $11.0027000163 TRAY CYSTO CATH $56.0027000164 TRAY DISP PNEUMOTHORAX $129.0027000165 TRAY ER SUTURE $59.0027000166 TRAY FOLEY 16 FR $42.0027000167 TRAY LACERATION $14.0027000168 TRAY PERCUTANEOUS $76.0027000169 TRAY UMBILICAL CATH $99.0027000170 TRAY/LUMBAR PUNCTURE $103.00

27000171 TRAY-PARACENTESIS $59.0027000172 TRAY-SIGMOIDSCOPE $54.0027000173 TRAY-THOROCENTESIS $70.0027000174 TUBE CONNECTING 18 INCH $3.0027000175 TUBE CONNECTING 72 INCH $5.0027000176 TUBE-ENOD TRACH $40.0027000177 TUBE-ESOPHAGEAL $436.0027000178 UNNA BOOT $17.0027000179 UROMETERS $19.0027000180 UROSTOMY BAG 16 MED $70.0027000181 V PADS $12.0027000182 WALL SUCTION CANISTER $94.0027000183 WRIST SPLINT $71.0027000184 QUINTON CATHETER-DUAL LUNAM $557.0027000185 SINGLE LUMEN CATHETER $73.0027000186 PER SHEATH INTRO KIT $106.0027000187 TRANSVENOUS PACING $612.0027000188 CATHETER DIAGNOSTIC BSI CCL $73.0027000189 CATHETER; THERMODILUTION $407.0027000190 SHEATH DIAGNOSTIC $29.0027000192 SUPRAPUBIC CATHETER SET $233.0027000206 FULL DAY OF OXYGEN $62.0027000210 PARTIAL DAY OF OXYGEN $38.0027000222 RESP PHYSICAL ASSESSMENT $0.0027000235 LOCAL TRAY $99.0027000236 E.STIM ELECTRODES $31.0027000237 LEUKOTAPE $44.0027000238 ORTHO CANE $23.0027000239 ORTHO CRUTCHES $118.0027000240 THERABAND/TUBING - YD $13.0027000241 THERAPUTTY $13.0027000242 E.STIM ELECTRODES $31.0027000243 LEUKOTAPE $44.0027000244 ORTHO CANE $23.0027000245 ORTHO CRUTCHES $118.0027000246 THERABAND/TUBING - YD $13.0027000247 THERAPUTTY $13.0027000248 E.STIM ELECTRODES $31.0027000249 LEUKOTAPE $44.0027000250 ORTHO CANE $23.0027000251 ORTHO CRUTCHES $118.0027000252 THERABAND/TUBING - YD $13.0027000253 THERAPUTTY $13.0027000257 L R 1000CC $79.0027000259 L R 500CC $63.0027000277 NORMAL SAL 1000ML $10.0027000279 NORMAL SAL 150ML $15.0027000281 NORMAL SAL 250ML $10.00

27000283 NORMAL SAL 3000ML $60.0027000285 NORMAL SAL 500ML $10.0027000300 ACCUGRID $47.0027000301 ADHESION BARRIER (INTERCEED) $680.0027000302 ARCH BARS $26.0027000303 ARTHROSCOPY STAPLE $541.0027000304 AUTOSUTURE CEEA-28 & 31 $1,246.0027000305 BALANCE SALT SOLUTION $7.0027000306 BALDE; RECIPROCATING $121.0027000307 BALDE;DERMATONE;SMAL $52.0027000308 BARD FOLEY 2 WAY $9.0027000309 BARD FOLEY 3 WAY $9.0027000310 BARD IMPLANTABLE MESH $1,491.0027000311 BARD MALECOTS DRAINS $21.0027000312 BARD POWER PORT $2,163.0027000313 BIFURCATED GRAFT $383.0027000314 BIGLIAN HUMERAL HEAD $2,135.0027000315 BIGLIAN HUMERAL STEM $4,528.0027000316 BIOCOAG BIPOLAR FORC $371.0027000317 BIOMET HUMERAL HEAD $2,163.0027000318 BIOMET HUMERAL STEM $4,557.0027000319 BIOPOLAR;CUP;MULITPO $2,853.0027000320 BLADE; OSCILLATING $170.0027000321 BLADES;OPTHALMIC;BEA $89.0027000322 BONE CEMENT $99.0027000323 BONE PLUG $99.0027000324 BONE STAPLE $8.0027000325 BUTTON; NASAL SEPTAL $439.0027000326 BUTTON; NASAL SINGLE $396.0027000327 CANCELLOUS BONE $340.0027000328 CANNULA; VESSEL $9.0027000329 CAST SPICA; HEAVY $462.0027000330 CAST;ARM;HV WITHOUT $219.0027000331 CAST;FIBERGLASS; 4 INCH $149.0027000332 CAST;LEG;HEAVY;WITH $365.0027000333 CAST;LEG;HEAVY;WITHO $208.0027000334 CATARACT PACK $229.0027000335 CATH: BALLOON DIALATION $347.0027000336 CATH: PERMA $557.0027000337 CATH: INFUSION; MIDLINE $2,425.0027000338 CATH: CHOLANGIOGRAM $277.0027000339 CATH: HEMATURIA $59.0027000341 CATH: HICKMAN $557.0027000342 CATH: MUSHROOM $27.0027000343 CATH: PICC LINE $284.0027000344 CATH: TEMP $407.0027000345 CATH: VASCULAR/CLOT $279.0027000346 CATH;ARM;HV WITH ELB $311.00

27000347 CATH-STAMEY URETER $7.0027000348 CAUTERY; EYE $33.0027000349 CAUTERY; LOOP TIP $84.0027000350 CEMENT;SURGICAL $303.0027000351 CLIP: LAPAROSCOPIC $638.0027000352 CLO TEST $22.0027000353 COLLOGRAFT; BONE GRA $2,015.0027000354 COMPERSSION PLATE $464.0027000355 CONVERTER; SITE STAB $56.0027000357 CRYOEXTRACTOR $81.0027000358 CUTTER;ARTHROSCOPY $279.0027000359 DAVOL SUMP DRAIN $62.0027000360 DEMATONE HEAD $44.0027000361 DILATOR; VESSEL $19.0027000362 DRILL BIT (FROM INVOICE) 2.5 X Invoice27000365 ELECTRO ROLLERBALL $217.0027000367 MIX SYSTEM; OSTEABON $347.0027000369 ESMARK STERILE BANDA $81.0027000371 NAIL; HUMERAL (IMPLANT) $3,378.0027000373 EXTERNAL FIXATOR $3,362.0027000375 NAIL; TIB/FIB (IMPLANT) $2,107.0027000377 FILERT; MONOMER FUME $65.0027000378 RP 360 FLEXIBLE NEEDLE $568.0027000379 NEEDLE (SURGI) $25.0027000381 FORCEP HOT BX $248.0027000383 NEEDLE CORE BIOPSY 1 $106.0027000385 GIA 80 $2,260.0027000387 NEXGEN ARTICULAR SUR $3,094.0027000389 GIA 80 RELOAD $662.0027000391 NEXGEN; COMPONET TIB $3,968.0027000393 GIGLI SAW BLADE $44.0027000395 NEXGEN; POLY PATELLA $1,604.0027000397 GLIDE WIRE $71.0027000399 NEXGENC COMPONET FEM $6,580.0027000401 GRAFT; BONE CRUSHED $804.0027000403 PACK LAPAROSCOPY $100.0027000405 GRAFT; BONE CUBES; C $680.0027000407 PACK; ARTHROSCOPY $230.0027000409 GRAFT; IMPRA $1,803.0027000411 PACK; BASIC $81.0027000413 GUIDE WIRE $263.0027000415 PACK; CUSTOM; C-SECT $531.0027000417 GUIDE WIRE (FROM INVOICE) 2.5 X Invoice27000419 PACK; CUSTOM; EYE $578.0027000421 HIP PROSTHESIS IMPLANT $702.0027000423 PACK; CUSTOM; TUBAL $292.0027000425 HOMOVAC; WOUND $237.0027000427 PACK; CYSTO $46.00

27000429 HYDOTHERM MACHINE $2,627.0027000431 PACK; GYN $56.0027000433 HYDROSET: 10ML $6,467.0027000435 PACK; LAPAROTOMY $76.0027000437 HYDROSET: 15ML $9,304.0027000439 PACK; ORTHOPEDIC $106.0027000441 HYDROSET: 3ML $2,395.0027000443 PENILE IMPLANT - INFLATABLE $15,376.0027000445 HYDROSET: 5ML $3,364.0027000447 PENILE IMPLANT - NONINFLAT $6,223.0027000449 I/A SET $226.0027000451 PHACO EMULSIFIER $482.0027000453 IM GUIDE PIN $436.0027000455 PIN ASSEMBLY $164.0027000457 IM NAIL FEMORAL $3,134.0027000459 PIN; ALIGNMENT $393.0027000461 IMPLANT (PATIENT-SPECIFIC) 2.5 X Invoice27000463 PIN; SMART 1.1MM $325.0027000465 IMPLANT LENS $1,236.0027000467 PIN; SMART 1.5MM $387.0027000469 INSTAT 1X2 $76.0027000471 PIN; STEINMAN $124.0027000473 INSTAT 3X4 $267.0027000475 PIN; STEINMAN (EACH) $68.0027000477 IRRIGATION; DISPOSAB $347.0027000479 PLASTIBELL $22.0027000481 JOINT (FROM INVOICE) 2.5 X Invoice27000483 PLATE; COMPRESSION $129.0027000485 KIT; CHOLECYSTECTOMY $1,051.0027000487 POLY PLUG $245.0027000489 KIT; FLEX-FLOW; GAST $519.0027000491 PORT-A-CATHETER (SPECIAL) $1,643.0027000493 KIT; INTRODUCER FOR $195.0027000495 POUCH; ENDOCATH $353.0027000497 KIT; LTA $51.0027000499 PROBE: SERFAS ENERGY SUPER 90S $327.0027000501 KIT; MIC TRANSGAST JEJUN FEED $1,089.0027000503 RADIAL HEAD (IMPLANT) $3,296.0027000505 KIT; MYRINGOTOMY $75.0027000506 16FR SARATOGA SUMP $64.0027000507 RADIAL STEM (IMPLATN) $2,060.0027000509 KITNERS; ENDOSCOPIC $53.0027000511 REG CENTERFLEX GRAFT $1,249.0027000513 KNIFE;OPTHALMIC;GRIE $185.0027000515 RESECTOSCOPE LOOP $159.0027000517 LIGACLIPS $186.0027000519 RETENTION BOLSTER $16.0027000521 LIGATING DISSECTING STAPLER $762.00

27000523 SCISSORS (SINGLE USE) LAP 5MM $160.0027000525 LIGATOR; HEMMORRHOID $510.0027000527 SCLEROTHERAPY NEEDLE $737.0027000529 LOOP; VESSEL $6.0027000531 SCP TUBE/PLATE $1,144.0027000533 MAJOR BASIN SET $38.0027000535 SCREW (FROM INVOICE) 2.5 X Invoice27000537 MANIPULATOR; UTERINE $112.0027000539 SCREW; BONE (IMPLANT) $655.0027000541 MENISCUS REPAIR SET $124.0027000543 SCREW; CANNULATED (IMPLANT) $655.0027000545 SCREW; COMPRESSION (IMPLANT) $655.0027000547 SCREW; CORITCAL (IMPLANT) $655.0027000549 SCREW; CORTICAL (EACH) $65.0027000551 SCREW; HERBERT/WIPPL $655.0027000553 SCREW; INTERLOCKING (IMPLANT) $655.0027000555 SCREW; LAG $362.0027000557 SCREW; M/V; 2.0 - 4.0MM $655.0027000559 SCREW; TI (IMPLANT) $655.0027000561 SHILED; NASAL $34.0027000563 SHUNT PERITONEO-VENO $2,723.0027000565 SILASTIC IMPLANT $28.0027000567 SKIN STAPLER $75.0027000569 SNARE; POLYPECTOMY BX $112.0027000571 SPLINT NASAL $107.0027000573 SPONGES: SPEAR EYE $12.0027000575 SPONGES: TONSIL (5) $26.0027000577 SPONGES; PEANUT $42.0027000579 SPONGES; RADIOPAQUE $52.0027000581 STAPLES: EEA $523.0027000583 STAPLES: FASCIA $248.0027000585 STAPLES: LDS 15 $659.0027000587 STAPLES: LDS 6 $491.0027000589 STAPLES: RELOAD $319.0027000591 STAPLES; GA $640.0027000593 STAPLES; SKIN $71.0027000595 STAPLES; TA-30 $676.0027000597 STAPLES; TA-55 $676.0027000599 STAPLES; TA-90 $397.0027000601 STAPLES; VERSITAK $306.0027000603 STENT; URETERAL $804.0027000605 STEPPED CENTERFLEX 45CM $884.0027000607 STERILE SUPPLY (PT-SPEC) ZIMME 2.5 X Invoice27000609 STOCKINETTE; BARRIER $26.0027000611 STRYKER DRILL/SAWS $243.0027000613 STRYKER SAW BLADES $163.0027000615 SUCTION CAUTERY $21.0027000617 SUPER-QUICK ARCHOR $234.00

27000619 SUPRAPUBIC INTRODUCER $134.0027000621 SURGICAL CLIP APPLIER $82.0027000623 SURGICEL 2X14 $21.0027000625 SURGICEL 2X3 $13.0027000627 SURGICEL 4X8 $19.0027000629 SURGICLIP $395.0027000631 SUTURE; MULTI-PACK $86.0027000633 SUTURE; STATAK $709.0027000635 SUTURE;EYE;DEXON/SIL $86.0027000637 SUTURE;PLAIN;SUB-Q-R $39.0027000639 TAPE: UMBILICAL $12.0027000641 TESTICULAR IMPL $111.0027000643 TRAY: EPIDURAL/SPINAL $149.0027000645 TRAY: SUPRA FOLEY $86.0027000647 TRICAR; DISP. 10/12 $288.0027000649 TUBE: ANESTHESIA M $394.0027000651 TUBE: ARTHROFLOW $81.0027000653 TUBE: ARTHROSCOPY $292.0027000655 TUBE: CYSTO $34.0027000657 TUBE: EXCHANGE $436.0027000659 TUBE: GASTRO/ENDO (PEG/MOSS) $632.0027000661 TUBE: HIGH FLOW CO2 $28.0027000663 TUBE: JUJUNOSTOMY $1,090.0027000665 TUBE: VENT $34.0027000667 TUBE; FLEXI FLOW REP $75.0027000669 VACURETTE $70.0027000671 VARI-STEM NERVE LOCA $163.0027000673 VENA CAVA FILTER $3,179.0027000675 VERSYS ;FEMORAL HEAD $1,672.0027000677 VERSYS FEMORAL STEM $8,508.0027000679 VERSYS; CENTRALIZER $248.0027000681 VITRECTOMY SET $482.0027000683 WIRE; KIRSCHNER $253.0027000685 WIRE; TONSIL SNARE $6.0027000708 2 INCH KARAYA STOMA $226.0027000809 3 INCH KARAYA STOMA $177.0027000910 3 INCH STARTER SET $136.0027001011 ABDOMINAL BINDERS $87.0027001112 ABDUCTION PILLOW MED $103.0027001213 ADULT GASTRIC LAVAGE KIT $99.0027001314 ALCOHOL BOTTLE $12.0027001415 SPLINT-ALUM FINGER $17.0027001516 ANESTHETIC SPRAY $19.0027001617 BRACE ANKLE $8.0027001718 ARM SLING LARGE $30.0027001819 ARM SLING MEDIUM $30.0027001920 ARM SLING SMALL $43.0027002021 ARROW TWIN CATH $34.00

27002122 ARTERIAL CATH RADIAL $48.0027002223 BAG 1 3/4 INCH STOMA $180.0027002324 BAG-KARAYA STOMA $177.0027002425 BAG-UROSTOMY $161.0027002526 BAL-PACING KIT $421.0027002627 BDG-COBAN 3 INCH $11.0027002728 BDG-COBAN 4 INCH $14.0027002829 BDG-ELASTIKON 4 INCH $31.0027002930 BDG-ACE 2 IN $7.0027003031 BDG-ACE 3 IN $10.0027003132 BDG-ACE 4 IN $12.0027003233 BDG-ACE 6 IN $18.0027003334 BDG-ADAPTIC 3X3 $6.0027003435 BDG-ADAPTIC 3X8 $9.0027003536 BDG-KLING 2 IN $7.0027003637 BDG-KLING 3 IN $11.0027003738 BDG-KLING 4 IN $17.0027003839 BDG-KLING 6 IN $12.0027003940 BILE BAG $28.0027004041 CASSETTE / WARM INJECTION $117.0027004142 CATH QUAD LUMEN $431.0027004143 24HR PINT SIZE ORAL CARE KIT WITH RINSE $3.0027004243 CATH SET ASH SPLIT $548.0027004344 CATH TROCAR $52.0027004445 CATH - 3 WAY IRRIGATION $39.0027004647 CATH-THERMODILUTION $407.0027004748 CATH-FOLEY 30CC $33.0027004849 CATH-FOLEY 3CC BALL $17.0027004950 CATH-FOLEY 5CC BAG $17.0027005051 CATH-LOUDE $27.0027005152 CATH-MAHURKER $350.0027005253 CATH-MIDLINE STERILE $83.0027005354 CATH-SWAN GANZ $45.0027005455 CATH-THORACIC $30.0027005556 CATH-THORACIC RT ANGLE $37.0027005657 CATH-TRAY W/ CATH $47.0027005758 CATH-TRAY W/O CATH $39.0027005859 CERVICAL COLLAR $43.0027005960 BRACE CLAVICLE $63.0027006061 COUNCILL STYLET 6FR $58.0027006263 DERMOPLAST SPRAY $19.0027006364 DISP ADULT SENSOR $124.0027006465 DISP MONITOR KIT $129.0027006566 DISP PED OXYGEN SENSOR $21.0027006768 DOMES TRANSDUCER $31.0027006869 DRAINS PENROSE $8.0027006970 DRSG-MICROSPORE 3.5X8 $3.0027007071 DRSG-ADAPTIC 1" BOTTLE $27.00

27007172 DRSG-ADAPTIC 1/2" BOTTLE $17.0027007273 DRSG-ADAPTIC 2" BOTTLE $27.0027007374 DRSG-DUO-DERM 4X4 $18.0027007475 DRSG-DUO-DERM 8X8 $81.0027007576 DRSG-INSTRUMENT SET DISP $31.0027007677 DRSG-TRANS LARGE $6.0027007778 DRSG-TRANS MEDIUM $11.0027007879 DRSG-TRANS SMALL $15.0027007980 EAR WICK 12.24 $20.0027008081 EAR WICK 9.15 $11.0027008182 EAR WICK 9.24 $14.0027008283 EPISTAXIS NASAL BALLOON $52.0027008485 FEED TUBE INFANT $19.0027008586 FINGER ANCHOR $15.0027008687 FINGER SPLINT $21.0027008788 FOOT DROP BOOT $165.0027008889 GASTROSTOMY TUBE $30.0027008990 GAUZE VASELINE 1.5"X72" $33.0027009091 GELFOAM 100 $105.0027009192 GELFOAM 50 $70.0027009293 HEIMLICH VALVE $22.0027009394 HEMATERIA CATH $30.0027009495 IMMOBILIZER KNEE POST OP $85.0027009596 IMMOBILIZER SHOULDER $55.0027009697 INTRAOSSEOUS NEEDLE $83.0027009798 IODOFOAM PACKING 1/4 INCH $21.0027009799 OPT FOAM GENTLE 4X4 $8.0027009800 OPT FOAM GENTLE 6X6 $13.0027009801 OPIFORM BEARDLESS 4X4 $11.0027009802 DRESSING MED HONEY HCS 4X4 $23.0027009803 DRESSING MED HONEYGEL $9.0027009804 GEL / WOUND SOLOSITE $14.0027009805 DRESSING ROPE ALGINATE $10.0027009806 NUTRA SHELD BLUE TOP $10.0027009807 SKIN REPAIR CREAM PURPLE TOP $8.0027009899 IRRIG W W 3000CC $8.0027010001 E.STIM ELECTRODES $31.0027010002 LEUKOTAPE $44.0027010003 ORTHO CANE $23.0027010004 ORTHO CRUTCHES $118.0027010005 THERABAND/TUBING - YD $13.0027010006 THERAPUTTY $13.0027020001 ACCUGRID $47.0027020002 CONN TISS HUMAN ALLOGRAFT $680.0027020003 ARCH BARS $26.0027020004 ARTHROSCOPY STAPLE $541.0027020005 BSS $7.0027020006 BSS $7.00

27020007 BLADE;RECIPROCATING $121.0027020008 BLADE;DERMATONE;SMAL $52.0027020009 BARD FOLEY 2 WAY $9.0027020010 BARD FOLEY 3 WAY $9.0027020011 BARD IMPLANTABLE MESH $1,491.0027020012 BARD MALECOTS DRAINS $21.0027020013 BARD POWER PORT $2,163.0027020014 BIFURCATED GRAFT $383.0027020015 BIGLIAN HUMERAL HEAD $2,135.0027020016 BIGLIAN HUMERAL STEM $4,528.0027020017 BIOCOAG BIPOLAR FORC $371.0027020018 BIOMET HUMERAL HEAD $2,163.0027020019 BIOMET HUMERAL STEM $4,557.0027020020 BIOPOLAR; CUP;MULTIPO $2,853.0027020021 BLADE;OSCILLATING $170.0027020022 BLADE;OPTHALMIC;BEA $89.0027020023 BONE CEMENT $247.0027020024 BONE PLUG $99.0027020025 BONE STAPLE $8.0027020026 BUTTON;NASAL SEPTAL $439.0027020027 BUTTON;NASAL SINGLE $396.0027020028 CANCELLOUS BONE $340.0027020029 CANNULA;VESSEL $9.0027020030 CAST;SPICA;HEAVY $462.0027020031 CAST;ARM;HV WITH ELBOW $311.0027020032 CAST;ARM;HV WITHOUT $219.0027020033 CAST;FIBERGLASS;4INCH $149.0027020034 CAST;LEG;HEAVY;WITH $365.0027020035 CAST;LEG;HEAVY;WITHOUT $208.0027020036 CATARACT PACK $229.0027020037 CATH:BALLOON DILATION $608.0027020038 CATH:PERMA $557.0027020039 CATH: ACCESS POINT $2,425.0027020040 CATH: CHOLANGIOGRAM $277.0027020041 CATH: HEMATURIA $59.0027020042 CATH:HICKMAN $557.0027020043 CATH:MUSHROOM $27.0027020044 CATH:PICC LINE $284.0027020045 PORT-A-CATHETER (SPECIAL) $1,643.0027020046 CATH:TEMP $407.0027020047 CATH:VASCULAR/CLOT $279.0027020048 CATH-STAMEY URETER $7.0027020049 CAUTERY;EYE $33.0027020050 CAUTERY; LOOP TIP $84.0027020051 CEMENT; SURGICAL $303.0027020052 CLIP: LAPARSCOPIC OR RESOLUTION $638.0027020054 COLLOGRAFT; BONE GRA $2,015.0027020055 COMPRESSION PLATE $515.00

27020056 CONVERTER; SITE STAB $56.0027020057 CRYO-ABLATION PROBE $14,194.0027020058 CRYOEXTRACTOR $81.0027020059 CUTTER; ARTHROSCOPY $279.0027020060 DAVOL SUMP DRAIN $62.0027020061 DEMATONE HEAD $44.0027020062 DILATOR; VESSEL $19.0027020063 DRILL BIT (FROM INVOICE) 2.5 X Invoice27020064 ELECTRO ROLLERBALL $217.0027020065 ESMARK STERILE BANDA $81.0027020066 EXTERNAL FIXATOR $3,362.0027020067 FILTER; MONOMER FUME $65.0027020068 BIOPSY FORCEP $248.0027020069 GIA GASTRO INTESTINAL STAPLET $2,260.0027020070 RELOAD GIA $662.0027020071 GIGLI SAW BLADE $44.0027020072 GLIDE WIRE $71.0027020073 GRAFT; BONE CRUSHED $804.0027020074 GRAFT; BONE CUBES; C $680.0027020075 GRAFT; IMPRA $1,803.0027020076 GUIDE WIRE $263.0027020077 GUIDE WIRE (FROM INVOICE) 2.5 X Invoice27020078 HIP PROSTHESIS IMPLANT $702.0027020079 HEMOVAC; WOUND $237.0027020080 HYDOTHERM MACHINE $2,627.0027020081 HYDROSET:10ML $6,467.0027020082 HYDROSET: 15ML $9,304.0027020083 HYDROSET: 3ML $2,395.0027020084 HYDROSET:5ML $3,364.0027020085 I/A SET $226.0027020086 IM GUIDE PIN $436.0027020087 IM NAIL FEMORAL $3,134.0027020088 IMPLANT (PATIENT-SPECIFIC) 2.5 X Invoice27020089 IMPLANT LENS $1,236.0027020091 INSTAT 1X2 $76.0027020092 INSTAT 3X4 $267.0027020093 IRRIGATION;DISPOSAB $347.0027020094 JOINT (FROM INVOICE) 2.5 X Invoice27020095 KIT; CHOLECYSTECTOMY $1,051.0027020096 KIT; FLEX-FLOW; GAST $519.0027020097 KIT; INTRODUCER FOR $195.0027020098 KIT; LTA $51.0027020099 KIT; MIC TRANSGAST JEJUN FEED $1,089.0027020100 KIT; MYRINGOTOMY $75.0027020101 KITNERS; ENDSCOPIC $53.0027020102 KNIFE; OPTHALMIC; GRIE $185.0027020103 STAPLES; LIGA CLIP $186.0027020104 PWRD LIGATING DISSECTING STAPLE $762.00

27020105 LIGATOR; HEMMORRHOID $510.0027020106 LOOP; VESSLE $6.0027020107 MAJOR BASIN SET $38.0027020108 MANIPULATOR; UTERINE $112.0027020109 MENISCUS REPAIR SET $124.0027020110 MESH 10X15 CM OBLONG/OVAL $967.0027020111 MESH 11X14CM OBLONG/OVAL $1,005.0027020112 MESH 12.5X12.5 CM/SQUARE/RN $1,070.0027020113 MESH 13.5X18CM OBLONG/OVAL $737.0027020114 MESH 15X20 CM OBLONG/OVAL $776.0027020115 MESH 15X23CM OBLONG/OVAL $824.0027020116 MESH 18X23 CM OBLONG/OVAL $2,718.0027020117 MESH 20.5X30.5 CM OBLONG/OVAL $3,542.0027020118 MESH 25.5X35.5 CM OBLONG/OVAL $4,623.0027020119 MESH 30.5X45.5 CM OBLONG/OVAL $7,159.0027020120 MESH 35.5X35.5 CM OBLONG/OVAL $6,489.0027020121 MESH 7.5X15CM OBLONG/OVAL $838.0027020122 MESH 9X9CM SQUARE/ROUND $773.0027020123 MESH 9CM X 9CM SQUARE/ROUND $773.0027020124 MESH IMPLANTABLE MARLEXT $936.0027020125 MESH 10X14 CM $663.0027020126 MESH 2X12 CM $325.0027020127 MESH 2X4 CM $308.0027020128 MESH 3X6 CM $343.0027020160 REF CENTERFLEXT GRAFT $1,249.0027020167 SCREW (FROM INVOICE) 2.5 X Invoice27020168 SCREW (SURGERY DPT STOCK ITEM) $65.0027020169 SCREW;BONE (IMPLANT) $655.0027020170 SCREW; CANNULATED (IMPLANT) $655.0027020171 SCREW;COMPRESSION (IMPLANT) $655.0027020172 SCREW;CORTICAL (EACH PER INVOICE) $81.0027020173 SCREW;CORTICAL (EACH) $81.0027020174 SCREW;HERBERT/WIPPL $655.0027020175 SCREW;INTERLOCKING (IMPLANT) $655.0027020176 SCREW;LAG $1,685.0027020177 SCREW;M/V;2.4-4.0MM $655.0027020183 SKIN SUBSTITUTE APLIGRAFSQ CM $2,575.0027020190 STAPLES, EEA $2,050.0027020211 SURGICEL 2X14 $21.0027020236 VENA CAVA FILTER $3,179.0027020237 10 HOLE PLATE $161.0027020238 3.5 FULL THREAD CORTEX SCREW 10MM $130.0027020239 3.5 FULL THREAD CORTEX SCREW 12MM $65.0027020240 3.5 FULL THREAD CORTEX SCREW 44MM $65.0027020241 3.5 FULL THREAD CORTEX SCREW 50MM $65.0027020242 4.0 FULL THREAD CANCELLOUS SCREW $65.0027020243 4.0 PARTIAL THREAD CANCELLOUS SCREW $55.0027021700 SIMPULSE SOLO SYSTEM WITH SHOWERHEAD $183.00

27021701 ACUCISE SYSTEM STARTER KIT $5,902.0027021702 THREADED GUIDE WIRE 3.2 X 300MM $13.0027021703 MESH 3 X 6 CM $343.0027021704 MESH PERFIX PLUG $815.0027021705 BIPOLAR GOLD PROBE $747.0027021706 BLADE TRICUT $418.0027021707 CALCANEAL PLATE $1,082.0027021708 FORCEFIBER WITH NEEDLES $70.0027021709 END CAP $615.0027021710 TUBULAR PLATE WITH COLLAR $201.0027021711 TROCHANTERIC NAIL KIT $4,459.0027021712 BALL TIP GUIDE WIRE $696.0027021713 SCREW; LOCKING $381.0027021714 SCREW; FULLY THREADED $381.0027021715 DRILL BIT $612.0027021716 DRILL $665.0027021717 SCREW; SET $612.0027021718 ACUCISE SYSTEM $3,979.0027021719 SCREW; CANCELLOUS $109.0027021720 DRILL; CANNULATED WITH COUPLING $897.0027021721 DRILL; CANNULATED WITH FITTING $1,322.0027021722 CLOVERLEAF PLATE $925.0027021723 CORE FAN BLADE $129.0027021724 CORPAK 6 TUBE PLACEMENT $160.0027021725 SCREW; CORTEX $68.0027021726 SCREW; CORTICAL SELF CUTTING $55.0027021727 COUNTERSINK WITH FITTING $529.0027021728 DREAM WIRE $578.0027021729 DISTAL MEDIAL TIBIA $4,255.0027021730 PROXIMAL LATERAL TIBIA $3,863.0027021731 ELECTROHYDRAULIC LITHTRIPSY PROBE $474.0027021732 BUTTRESS PLATE $1,227.0027021733 RECONSTRUCTION PLATE $1,234.0027021734 TB ASPIRATION NEEDLE $257.0027021735 EZ CLEAN NON STICK TIP FLAT L HOOK $142.0027021736 SUTURE PASSER $412.0027021737 INTERPULSE HANDPIECE SET $128.0027021738 MIXING BOWL $2,443.0027021739 NUT FOR CORTEX SCREWS $109.0027021740 HERNIA SYSTEM $1,225.0027021741 ESOPHAGEAL STENT (TEMPORARY) $6,824.0027021742 NET POLYP RETRIEVER $230.0027021743 SIMPULSE SOLO SYSTEM WITH SHOWERHEAD TIP $183.0027021744 REAMER WITH AO FITTING $529.0027021745 SIMPLEX P WITH TOBRAMYCIN $1,020.0027021746 SIMPLEX PRO HALF DOSE $188.0027021747 T5 HOOD WITH PEEL AWAY FACE SHIELD $97.0027021748 THREADED GUIDE WIRE $109.00

27021749 T-PLATE $876.0027021750 THREE PRONGED GRASPERS DISPOSIBLE $387.0027021751 TRANS VAGINAL OBTURATOR TAPE $2,949.0027021752 TWIST DRILL WITH AO FITTING $597.0027021753 WASHER $124.0027021754 ZANGER HEPARIN CANNULA $199.0027021755 TAP $581.0027021756 TAPS, AO QUICK COUPLING $441.0027021801 DOYLE II INTRANASAL AIRWAY SPLINT $124.0027021802 HEMADERM KIT $332.0027021803 MYOSURE $3,863.0027021804 ZIPLINE 24 #0005171 $275.0027021805 MARYLAND LIGASURE $1,865.0027021807 KUMAR CATHETER REF# CC-019 $84.0027123124 PER SHEATH INTRO KIT $106.0027133134 QUINTON CATHETER-DUAL LUNHAM $557.0027146147 SHEATH DIAGNOSTIC $29.0027147148 SINGLE LUMEN CATHETER $73.0027152153 STIFF NECK COLLAR $75.0027154155 SUPRAPUBIC CATHETER SET $233.0027160161 TRANS PACING KIT $387.0027161162 TRANSDUCER W/MONITOR $184.0027162163 TRANSVENOUS PACING $612.0027163164 TRAY-SPINALDISP $109.0027165166 TRAY BIOPSY $59.0027166167 TRAY BONE MARROW BIOPSY $50.0027167168 TRAY CATHETER SWAN GANZ DISP $45.0027167169 J INFERIOR TURBINALTE BLADE $573.0027178110 MESH 30.5 X 45.5CM OBLONG/OVAL $7,159.0027178111 MESH 10 x 15CM OBLONG/OVAL $967.0027178112 MESH 11 x 14CM OBLONG/OVAL $1,005.0027178113 MESH 12.5 x 12.5CM SQUARE/RND $1,070.0027178114 MESH 13.5 x 18CM OBLONG/OVAL $737.0027178115 MESH 15 x 20CM OBLONG/OVAL $776.0027178116 MESH 15 x 23CM OBLONG/OVAL $824.0027178117 MESH 18 x 23CM OBLONG/OVAL $2,718.0027178118 MESH 20.5 x 30.5CM OBLONG/OVAL $3,542.0027178119 MESH 25.5 x 35.5CM OBLONG/OVAL $4,623.0027178121 MESH 35.5 x 35.5CM OBLONG/OVAL $6,489.0027178122 MESH 7.5 x 15CM OBLONG/OVAL $838.0027178123 MESH 9 X 9CM SQUARE/ROUND $773.0027178124 MESH 9CM X 9CM SQ/RND $773.0027178125 MESH IMPLANTABLE MARLEX $936.0027178128 CARDIOVASCULAR GRAFT $1,116.0027178129 SEPRAMESH 4X8 REF# 5959480 $1,830.0027178130 SEPRAMESH 6X8 REF# 5959680 $1,900.0027178131 VENTRALEX S REF# 5950007 $1,552.0027178132 VENTRALEX M REF# 5950008 $1,552.00

27178133 VENTRALEX L REF# 5950009 $1,988.0027178134 3D MAX MEDIUM LEFT REF# 0115310 $800.0027178135 3D MAX MEDIUM RIGHT REF# 0115320 $800.0027178136 3D MAX LARGE LEFT REF# 0115311 $850.0027178137 3D MAX LARGE RIGHT REF# 0115321 $850.0027178138 3D MAX X-LARGE LEFT REF# 0115312 $938.0027178139 3D MAX X-LARGE RIGHT REF# 0115322 $938.0027178140 SORBAFIX REF# 0113116 $388.0027178141 SORBAFIX REF# 0113115 $250.0027188189 WALL SUCTION CANISTER $94.0027189190 WRIST SPLINT $71.0027190000 SURGICEL SNOW 4X4 $385.0028965217 REFILL/MAINTAIN PORTABLE PUMP $217.0028965227 REFILL/MAIN PUMP/RESVR SYSTEM $186.0028965237 PORT FLUSH $47.0030003000 ANTIPROTHROMBIN AB, EA IG CL $52.0030003009 ANTIPROTHROMBIN AB, EA IG CL $52.0030004819 TOXASSURE SELECT $1,191.0030004839 TOXASSURE COMPREHENSIVE PROFILE $1,300.0030010300 PSA; SCREENING $87.0030010309 PSA; SCREENING $87.0030364150 VENIPUNCTURE ROUTINE $27.0030365140 APHERESIS PLASMA $2,108.0030800480 BASIC METABOLIC PANEL TOTAL CALCIUM $124.0030800489 BASIC METABOLIC PANEL TOTAL CALCIUM $124.0030800510 ELECTROLYTE PANEL $94.0030800519 ELECTROLYTE PANEL $94.0030800530 LAB COMPREHENS METABOLIC PANEL $145.0030800539 LAB COMPREHENS METABOLIC PANEL $145.0030800610 LIPID PANEL (AUTOMATED) $101.0030800619 LIPID PANEL (AUTOMATED) $101.0030800690 RENAL FUNCTION PANEL $99.0030800699 RENAL FUNCTION PANEL $99.0030800740 ACUTE HEPATITIS PANEL $305.0030800749 ACUTE HEPATITIS PANEL $305.0030800760 HEPATIC FUNCTION PANEL $155.0030800769 HEPATIC FUNCTION PANEL $155.0030801010 DRUG SCREEN (EACH) $62.0030801019 DRUG SCREEN (EACH) $62.0030801020 DRUG CONFIRMATION (EACH) $103.0030801029 DRUG CONFIRMATION (EACH) $103.0030801040 DRUG SCREEN 1+ CLASS NONCHROMO $170.0030801049 DRUG SCREEN 1+ CLASS NONCHROMO $170.0030801500 AMIKACIN $47.0030801509 AMIKACIN $47.0030801520 AMITRIPTYLINE $109.0030801529 AMITRIPTYLINE $109.0030801540 BENZADIAZAPINES $125.00

30801549 BENZADIAZAPINES $125.0030801560 CARBAMAZEPINE; TOTAL (TEGRETOL $101.0030801569 CARBAMAZEPINE; TOTAL (TEGRETOL $101.0030801589 CYCLOSPORINE; A FPIA $46.0030801599 CLOZAPINE $62.0030801600 DESIPRAMINE $119.0030801609 DESIPRAMINE $119.0030801620 DIGOXIN $99.0030801629 DIGOXIN $99.0030801640 ASSAY; DIPROPYLACETIC ACID $101.0030801649 ASSAY; DIPROPYLACETIC ACID $101.0030801659 DIPROPYLACETIC ACID FREE $101.0030801660 DOXEPIN $52.0030801669 DOXEPIN $52.0030801680 ETHOSUXIMIDE (ZARATONIN) $31.0030801689 ETHOSUXIMIDE (ZARATONIN) $31.0030801700 GENTAMICIN $103.0030801709 GENTAMICIN $103.0030801719 DRUG SCREEN QUANT GABAPENTIN #LC R700827 $103.0030801739 HALOPERIDOL (HALDOL) $33.0030801740 IMIPRAMINE $48.0030801749 IMIPRAMINE $48.0030801759 LAMOTRIGINE, SERUM $120.0030801760 LICOCAINE (XYLOCAINE) $25.0030801769 LICOCAINE (XYLOCAINE) $25.0030801779 LEVETIRACETAM, SERUM OR PLASMA $67.0030801780 LITHIUM $67.0030801789 LITHIUM $67.0030801820 NORTRIPTYLINE $125.0030801829 NORTRIPTYLINE $125.0030801839 DRUG SCRN QUANT OXCARBAZEPIN $125.0030801840 PHENOBARBITAL $99.0030801849 PHENOBARBITAL $99.0030801850 PHENTYOIN; TOTAL $88.0030801859 PHENTYOIN; TOTAL $88.0030801880 PRIMIDONE $40.0030801889 PRIMIDONE $40.0030801920 PROCAINAMIDE W/METABOLITES $91.0030801929 PROCAINAMIDE W/METABOLITES $91.0030801940 QUINIDINE $100.0030801949 QUINIDINE $100.0030801960 SALICYLATE $75.0030801970 TACROLIMUS $248.0030801979 TACROLIMUS $248.0030801980 THEOPHYLLINE $93.0030801989 THEOPHYLLINE $93.0030802000 TOBRAMYCIN $142.0030802009 TOBRAMYCIN $142.00

30802019 TOPIRAMATE $72.0030802020 VANCOMYCIN $119.0030802029 VANCOMYCIN $119.0030802039 DRUG SCREEN QUANT ZONISAMIDE $60.0030802990 QUANT OF DRUG (EA) NOT ELSE SPEC $47.0030802999 QUANT OF DRUG (EA) NOT ELSE SPEC $47.0030803009 DRUG SCREEN NON TLC DEVICES $160.0030803010 DRUG SCREEN CLASS LIST A $160.0030803019 DRUG SCREEN CLASS LIST A $160.0030803029 DRUG SCREEN PRSMPTV 1 CLASS $160.0030803050 DRUG TEST PRSMV DIR OPT OBS $105.0030803059 DRUG TEST PRSMV DIR OPT OBS $105.0030803060 DRUG TEST PRSMV INSTRMNT $105.0030803069 DRUG TEST PRSMV INSTRMNT $105.0030803070 DRUG TEST PRSMV CHEM ANLYZR $105.0030803079 DRUG TEST PRSMV CHEM ANLYZR $105.0030803200 ETHANOL ALCOHOL $88.0030803209 ETHANOL ALCOHOL $88.0030803239 NICOTINE AND METABOLITE, QUANTITATIVE $85.0030803240 AMPHETAMINES $85.0030803249 AMPHETAMINES $85.0030803269 OPIOID &OPIATE ANALOG 5/MORE $88.0030803270 ANABOLIC STEROID 1 OR 2 (DHT) $119.0030803279 ANABOLIC STEROID 1 OR 2 (DHT) $119.0030803290 ANALGESICS NON-OPIOD 1 OR 2 $75.0030803319 ANALGESICS NON-OPIOID 6/MORE $109.0030803349 ANTIDEPRESSANTS CLASS 6/MORE $109.0030803350 ANTIDEPRESSANT TRICYCLIC 1/2 $109.0030803359 ANTIDEPRESSANT TRICYCLIC 1/2 $109.0030803379 TRICYCLIC & CYCLICALS 6/MORE $130.0030803389 ANTIDEPRESSANT NOT SPECIFIED $109.0030803419 ANTIEPILEPTICS NOS 7/MORE $289.0030803429 QUETIAPINE, SERUM OR PLASMA $100.0030803450 BARBITURATES; ASSAY $289.0030803459 BARBITURATES; ASSAY $289.0030803460 BENZODIAZEPINES 1-12 $125.0030803462 CLOZAPINE(CLOZARIL) $125.0030803464 CLONAZEPAM $125.0030803466 DIAZEPAM $125.0030803469 BENZODIAZEPINES 1-12 $125.0030803479 BENZODIAZEPINES,MS,WB/SP RFX $130.0030803489 DRUG SCREENING BUPRENORPHINE $80.0030803499 THC,MS,WB/SP RFX $120.0030803539 COCAINE $85.0030803549 DRUG SCREENING FENTANYL $80.0030803559 GABAPENTIN NON-BLOOD $85.0030803569 HEROIN METABOLITE $85.0030803579 KETAMINE AND NORKETAMINE $99.00

30803589 LAB METHADONE $99.0030803599 METHYLENEDIOXYAMPHETAMINES $80.0030803609 METHYLPHENIDATE $112.0030803619 OPIATES 1 OR MORE $112.0030803629 OPIOIDS & OPIATE ANALOGS 1/2 $210.0030803649 OPIOID &OPIATE ANALOG 5/MORE $112.0030803659 DRUG SCREENING OXYCODONE $80.0030803669 DRUG SCREENING PREGABALIN $112.0030803679 DRUG SCREENING PROPOXYPHENE $112.0030803689 SEDATIVE HYPNOTICS $112.0030803699 SKELETAL MUSCLE RELAXANT 1/2 $112.0030803709 SKEL MUSC RELAXANT 3 OR MORE $80.0030803719 STIMULANTS SYNTHETIC $80.0030803729 DRUG SCREENING TAPENTADOL $80.0030803739 DRUG SCREENING TRAMADOL $80.0030803759 HYDROXYZINE, SERUM OR PLASMA $100.0030803779 DRUG/SUBSTANCE NOS 7/MORE $80.0030810010 LAB URINALYSIS AUTO W/SCOPE $34.0030810019 LAB URINALYSIS AUTO W/SCOPE $34.0030810030 URINALYSIS, AUTO W/O SCOPE $16.0030810039 URINALYSIS, AUTO W/O SCOPE $16.0030810050 URINALYSIS MELANIN $16.0030810059 URINALYSIS MELANIN $16.0030810150 MICROSCOPIC EXAM OF URINE $26.0030810250 URINE PREGNANCY TEST $46.0030810500 URINALYSIS; VOLUME MEASURE $26.0030812069 BCR/ABL1 GENE MAJOR BP $103.0030812079 BCR/ABL1 GENE MINOR BP $103.0030812209 CYST FIBR TRANSMEM GENE ANALYSIS $580.0030812259 CYP2C19 GENE COM VARIANTS $900.0030812269 OPIOID CYP2D6 GENOTYPING $715.0030812409 PROTHROMBIN GENE ANALYSIS #LC511162 $103.0030812419 FACTOR V LEIDEN MUTATION ANALY #LC511154 $103.0030812439 FMR1 GENE DETECTION #LC511919 $103.0030812449 FMR1 GENE CHARACTERIZATION #LC511913 $103.0030812569 HEREDITARY HEMOCHROMATOSIS DNA #LC511345 $100.0030812919 MTHFR DNA ANALYSIS #LC511238 $103.0030813649 HBB FULL GENE SEQUENCE LC#252823 $400.0030813769 HLA DRB1 INTERMEDIATE RESOLUT LC#167259 $200.0030814019 EPI PROCOLON LC# 481160 $40.0030814069 GALACTOSEMIA LC# 252816 $1,162.0030820030 ACETAMINOPHEN $111.0030820090 ACETONE/KEYTONES $31.0030820099 ACETONE/KEYTONES $31.0030820100 BETAHYDROXYBUTYRIC ACID, URINE $42.0030820109 QUANT SERUM ACETONES/KETONES $42.0030820179 ACYLCARNITINES; QUAN $45.0030820240 ACTH; ASSAY $186.00

30820249 ACTH; ASSAY $186.0030820309 CYCLIC ADP OR AMP $70.0030820400 SERUM ALBUMIN $45.0030820409 SERUM ALBUMIN $45.0030820420 URINE ALBUMIN $16.0030820429 URINE ALBUMIN $16.0030820430 MICROALBUMIN; URINE QUAN $76.0030820439 MICROALBUMIN; URINE QUAN $76.0030820550 ETHANOL $88.0030820750 BREATH ETHANOL $26.0030820759 BREATH ETHANOL $26.0030820850 ALDOLASE $58.0030820859 ALDOLASE $58.0030820880 ALDOSTERONE; URINE $106.0030820889 ALDOSTERONE; URINE $106.0030821039 ALPHA 1 ANTITRYPSIN; TOTAL $106.0030821040 ALPHA-1 ANTITRYPSIN PHENOTYPE $88.0030821049 ALPHA-1 ANTITRYPSIN PHENOTYPE $88.0030821050 ALPHA FETOPROTEIN $99.0030821052 ALPHA FETOPROTEIN; MATERNAL $54.0030821059 ALPHA FETOPROTEIN $99.0030821079 ALPHA-FETOPROTEIN L3 $125.0030821080 ALUMINUM $66.0030821089 ALUMINUM $66.0030821280 TEST FOR MULTIPLE AMINO ACIDS $37.0030821289 TEST FOR MULTIPLE AMINO ACIDS $37.0030821310 SINGLE AMINO ACID $182.0030821319 SINGLE AMINO ACID $182.0030821350 AMINOLEVULINIC ACID $38.0030821359 AMINOLEVULINIC ACID $38.0030821390 AMINO ACIDS, 6/>, QUAN, EA $515.0030821399 AMINO ACIDS, 6/>, QUAN, EA $515.0030821400 AMMONIA $124.0030821409 AMMONIA, PLASMA LC# 007054 $124.0030821450 AMPHETAMINES $85.0030821459 AMPHETAMINES $85.0030821500 AMYLASE BODY FLUIDS $57.0030821509 AMYLASE BODY FLUIDS $57.0030821570 ANDROSTENEDIONE $77.0030821579 ANDROSTENEDIONE $77.0030821640 ANGIOTENSIN 1 ENZYME (ACE) $109.0030821649 ANGIOTENSIN 1 ENZYME (ACE) $109.0030821720 APOLIPOPROTEIN $118.0030821729 APOLIPOPROTEIN $118.0030821750 ARSENIC; ASSAY $185.0030821759 ARSENIC; ASSAY $185.0030821800 VITAMIN C (ASCORBIC) $73.0030821809 VITAMIN C (ASCORBIC) $73.00

30821900 SPECTROSCOPY; ATOMIC ABSORPTIO $185.0030821909 SPECTROSCOPY; ATOMIC ABSORPTIO $185.0030822050 BARBITURATES; ASSAY $289.0030822059 BARBITURATES; ASSAY $289.0030822320 BETA 2 PROTEIN $112.0030822329 BETA 2 PROTEIN $112.0030822470 BILIRUBIN; TOTAL $45.0030822479 BILIRUBIN; TOTAL #LC001099 $45.0030822480 BILIRUBIN; DIRECT $45.0030822489 BILIRUBIN; DIRECT #LC001222 $45.0030822610 BIOTINIDASE $38.0030822619 BIOTINIDASE $38.0030822700 OCCULT BLOOD, FECES SINGLE $33.0030822710 OCCULT BLOOD, OTHER SOURCES $26.0030822720 OCCULT BLOOD; FECES, 1-3 TESTS $31.0030822749 OCCULT BLD FHG QUAL 1-3 $31.0030823000 CADMIUM $60.0030823009 CADMIUM $60.0030823060 VITAMIN D-3 $232.0030823069 VITAMIN D-3 $232.0030823080 CALCITONIN $73.0030823089 CALCITONIN $73.0030823100 CALCIUM $54.0030823109 CALCIUM $54.0030823309 IONIZED CALCIUM $99.0030823400 URINE CALCIUM $17.0030823409 URINE CALCIUM $17.0030823550 STONE ANALYSIS; QUALITATIVE $103.0030823559 STONE ANALYSIS; QUALITATIVE $103.0030823600 URINARY CALCULI $114.0030823609 URINARY CALCULI $114.0030823740 ASSAY; BLOOD CARBON DIOXIDE $33.0030823750 ASSAY; BLOOD CARBON MONOXIDE $76.0030823780 CARCINOEMBRYONIC ANTIGEN (CEA) $127.0030823789 CARCINOEMBRYONIC ANTIGEN (CEA) $127.0030823790 CARNITINE $173.0030823799 CARNITINE $173.0030823800 CAROTENE $24.0030823809 CAROTENE $24.0030823840 FRACTIONATED CATECHOLAMINES;PL $183.0030823849 FRACTIONATED CATECHOLAMINES;PL $183.0030823900 CERULOPLASMIN $71.0030823909 CERULOPLASMIN $71.0030823970 CHEMILUMINESCENT ASSAY $37.0030823979 CHEMILUMINESCENT ASSAY $37.0030824350 BLOOD CHLORIDE $33.0030824359 BLOOD CHLORIDE $33.0030824360 URINE CHLORIDE; RANDOM $49.00

30824369 URINE CHLORIDE; RANDOM $49.0030824380 ASSAY; OTHER FLUID CHLORIDE $37.0030824389 ASSAY; OTHER FLUID CHLORIDE $37.0030824419 CHLORINATED HC SCREEN LC# 790890 $22.0030824650 SERUM CHOLOSTEROL $58.0030824659 SERUM CHOLOSTEROL $58.0030824800 SERUM CHOLINESTERASE PCHE(PSEU $21.0030824809 SERUM CHOLINESTERASE PCHE(PSEU $21.0030824820 CHOLINESTERASE; RBC $122.0030824829 RBC CHOLINESTERACE $21.0030824910 CHROMOTOGRAPHY; QUANT; SING $150.0030824919 CHROMOTOGRAPHY; QUANT; SING $150.0030824920 CHROMOTOGRAPHY; QUANT; MULT; P $137.0030824929 CHROMOTOGRAPHY; QUANT; MULT; P $137.0030824950 CHROMIUM $74.0030824959 CHROMIUM $74.0030825070 CITRATE $33.0030825079 CITRATE 24 HOUR URINE #LC016865 $33.0030825200 COCAINE $85.0030825209 COCAINE $85.0030825230 COLLAGEN CROSSLINKS $49.0030825239 COLLAGEN CROSSLINKS $49.0030825250 COPPER $47.0030825259 COPPER $47.0030825300 CORTISOL; FREE $206.0030825309 CORTISOL; FREE $206.0030825330 CORTISOL; TOTAL $90.0030825339 CORTISOL; TOTAL $90.0030825400 CREATININE $52.0030825420 LAB THIOPURINE METHYLTRANSFER $165.0030825429 LAB THIOPURINE METHYLTRANSFER #LC71656 $165.0030825500 CREATINE KINASE ISOENZYMES $61.0030825509 CREATINE KINASE ISOENZYMES $61.0030825520 CPK ISOENZYMES $84.0030825529 CPK ISOENZYMES $84.0030825530 CPT; MB FRACTION $82.0030825539 CPT; MB FRACTION $82.0030825650 BLOOD CREATININE $45.0030825659 BLOOD CREATININE $45.0030825700 URINE CREATININE $45.0030825709 URINE CREATININE $45.0030825750 CREATININE CLEARANCE TEST $70.0030825759 CREATININE CLEARANCE TEST $70.0030825850 CRYOFIBRINOGEN $66.0030825859 CRYOFIBRINOGEN $32.0030825950 CRYOGLOBULIN $232.0030825959 CRYOGLOBULIN $232.0030826000 CYANIDE (ASSAY OF) $43.00

30826070 VITAMIN B-12 $65.0030826079 VITAMIN B-12 $65.0030826080 TEST OF B-12 BINDING CAPACITY $38.0030826089 TEST OF B-12 BINDING CAPACITY $38.0030826260 DEHYDROEPIANDROSTERONE (DHEA) $103.0030826269 DEHYDROEPIANDROSTERONE (DHEA) $103.0030826270 DEHYDROEPIANDROSTERONE SULFATE $58.0030826279 DEHYDROEPIANDROSTERONE SULFATE $58.0030826380 DIBUCAINE NUMBER $33.0030826389 DIBUCAINE NUMBER $33.0030826510 DIHYDROTESTOSTERONE (DHT) $119.0030826519 DIHYDROTESTOSTERONE (DHT) $119.0030826520 DIHYDROXYVITAMIN D $99.0030826529 DIHYDROXYVITAMIN D $99.0030826569 PANCREATIC ELASTASE FECAL LC# R123234 $45.0030826640 ELECTROPHORESIS NES $103.0030826649 ELECTROPHORESIS NES $103.0030826680 ERYTHROPOIETIN $129.0030826689 ERYTHROPOIETIN $129.0030826700 ESTRADIOL $31.0030826709 ESTRADIOL $31.0030826710 ESTROGENS; FRACTIONATED $265.0030826719 ESTROGENS; FRACTIONATED $265.0030826720 ESTROGEN;TOTAL $56.0030826729 ESTROGEN;TOTAL $56.0030826770 ESTRIOL $36.0030826779 ESTRIOL $36.0030826790 ESTRONE $29.0030826799 ESTRONE $29.0030826930 ETHYLENE GLYCOL $40.0030826939 ETHYLENE GLYCOL $40.0030827050 FAT/LIPIDS, FECES; QUAL $21.0030827059 FAT/LIPIDS, FECES; QUAL $21.0030827100 FAT/LIPIDS, FECES; QUANTITATIVE $67.0030827109 FAT/LIPIDS, FECES; QUANTITATIVE $67.0030827250 BLOOD FATTY ACIDS $36.0030827259 BLOOD FATTY ACIDS $36.0030827280 FERRITIN $81.0030827289 FERRITIN $81.0030827310 FETAL FIBRONECTIN, CV SEMIQUAN $503.0030827319 FETAL FIBRONECTIN, CV SEMIQUAN $503.0030827420 FLURAZEPAM $52.0030827429 FLURAZEPAM $52.0030827460 FOLIC ACID; SERUM $62.0030827469 FOLIC ACID; SERUM $62.0030827470 FOLIC ACID; RBC $135.0030827479 FOLIC ACID; RBC $135.0030827590 RBC GLACTOKINASE $135.00

30827599 RBC GLACTOKINASE $135.0030827840 GAMMAGLOBULIN $86.0030827849 GAMMAGLOBULIN $86.0030827850 GAMMAGLOBULIN; IgE $97.0030827859 GAMMAGLOBULIN; IgE $97.0030828030 ARTERIAL BLOOD GAS $171.0030829410 GASTRIN $46.0030829419 GASTRIN $46.0030829450 GLUCOSE; OTHER THAN BLOOD $42.0030829459 GLUCOSE; OTHER THAN BLOOD $42.0030829470 BLOOD GLUCOSE; QUANT $42.0030829479 BLOOD GLUCOSE; QUANT $42.0030829500 GLUCOSE TEST $67.0030829509 GLUCOSE TEST $67.0030829510 GLUCOSE TOL TEST (GTT); 3 SAMP $150.0030829520 GLUCOSE TOL TEST (GTT); ADDITI $64.0030829550 ASSAY OF G6PD ENZYME $26.0030829559 ASSAY OF G6PD ENZYME $26.0030829600 TEST FOR G6PD ENYZME $78.0030829609 TEST FOR G6PD ENYZME $78.0030829620 GLUCOSE; BLD BY MONITOR DEVICE $31.0030829625 GLUCOSE; BLD BY MONITOR DEVICE $31.0030829770 GGT (GAMMA GLUTAMYL TRANS.) $44.0030829779 GGT (GAMMA GLUTAMYL TRANS.) $44.0030829859 GYCATED PROTEIN $40.0030830019 GONADOTROPIN; FSH $129.0030830029 GONADOTROPIN; LH $80.0030830039 GROWTH HORMONE (HGH) $43.0030830109 HAPTOGLOBIN; QUANT $89.0030830139 H PYLORI (C-13) BREATH TEST $191.0030830189 HEAVY METAL; QUANTITATIVE EACH $78.0030830219 HEMOGLOBIN CHROMOTOGRAPHY $38.0030830300 FETAL HEMOBLOBIN; CHEMICAL $103.0030830309 FETAL HEMOBLOBIN; CHEMICAL $103.0030830360 LAB GLYCATED HEMOGLOBIN (AIC) $67.0030830369 LAB GLYCATED HEMOGLOBIN (AIC) $67.0030830500 BLOOD METHEMOGLOBIN $101.0030830504 METHEMOGLOBIN $45.0030830509 BLOOD METHEMOGLOBIN $101.0030830510 PLASMA HEMOGLOBIN $34.0030830519 PLASMA HEMOGLOBIN $34.0030830700 TEST FOR HEMOSIDERIN $52.0030830909 HOMOCYSTEINE $402.0030831500 HOMOVALILLIC ACID, 24HR URINE $43.0030831509 HOMOVALILLIC ACID, 24HR URINE $43.0030834910 CORTICOSTEROIDS $46.0030834919 CORTICOSTEROIDS $46.0030834970 5-HIAA (HYDROXYINDOLACETIC ACI $34.00

30834979 5-HIAA (HYDROXYINDOLACETIC ACI $34.0030834980 HYDROXYPROGESTERONE; 17-D $71.0030834989 HYDROXYPROGESTERONE; 17-D $71.0030835050 TOTAL HYDROXYPROLINE $63.0030835059 TOTAL HYDROXYPROLINE $63.0030835160 IMM-ASSY; NNANTBDY $337.0030835169 IMM-ASSY; NNANTBDY $337.0030835190 IA NOT INFECT AGENT; RIA TECHN $103.0030835199 IA NOT INFECT AGENT; RIA TECHN $103.0030835200 IMM-ASSY; NNANTBDY; OTHERC1 ES $303.0030835209 IMM-ASSY; NNANTBDY; OTHERC1 ES $303.0030835250 LAB TOTAL INSULIN $78.0030835259 LAB TOTAL INSULIN $78.0030835279 LAB FREE INSULIN $90.0030835400 LAB IRON $57.0030835409 IRON $81.0030835500 LAB IRON BINDING CAPACITY $78.0030835509 LAB IRON BINDING CAPACITY $78.0030835860 LAB 17 KETOSTERIOIDS, TOTAL $34.0030835869 LAB 17 KETOSTERIOIDS, TOTAL $34.0030835930 LAB FRACTION KETOSTEROIDS $68.0030835939 LAB FRACTION KETOSTEROIDS $68.0030836050 LACTIC ACID $87.0030836059 LACTIC ACID $87.0030836150 LAB LACTIC ENZYME (LDH) $60.0030836159 LAB LACTIC ENZYME (LDH) $60.0030836250 LDH ISOENZYMES $82.0030836259 LDH ISOENZYMES $82.0030836310 LACTOFERRIN $103.0030836319 LACTOFERRIN $103.0030836550 LEAD $59.0030836559 LEAD $59.0030836610 L/S RATIO $211.0030836619 L/S RATIO $211.0030836700 LAP ENZYME $24.0030836709 LAP ENZYME $24.0030836900 LAB LIPASE $43.0030836909 LAB LIPASE $43.0030836959 ASSAY OF LIPOPROTEIN $31.0030836989 LIPOPROTEIN ASSOC PHOSPHOLIPAS $98.0030837010 LIPOPROTEIN BLD HR FRACTION $90.0030837040 LIPOPROTEIN PARTICLE NUMBER $155.0030837049 LIPOPROTEIN PARTICLE NUMBER $155.0030837180 LAB LIPOPROEIN; HDL $43.0030837210 BLOOD LIPOPORTEIN; LDL $43.0030837219 BLOOD LIPOPORTEIN; LDL $43.0030837270 LUTEINIZING RELEASING FACTOR $309.0030837279 LUTEINIZING RELEASING FACTOR $309.00

30837350 MAGNESIUM $57.0030837359 MAGNESIUM $57.0030837880 QUALLIT MASS SPECT EA SPECIMEN $67.0030837890 QUALLIT MASS SPECT EA SPECIMEN $67.0030838250 MERCURY; QUANT $127.0030838259 MERCURY; QUANT $127.0030838350 METANEPHRINES, FRACT 24HR URIN $118.0030838359 METANEPHRINES, FRACT 24HR URIN $118.0030838400 LAB METHADONE $99.0030838409 LAB METHADONE $99.0030838730 CSF MYELIN BASIC $52.0030838739 CSF MYELIN BASIC PROTEIN $52.0030838740 MYOGLOBIN $129.0030838749 MYOGLOBIN #LC010405 $129.0030838800 NATRIURETIC PEPTIDE $84.0030838809 NATRIURETIC PEPTIDE $84.0030838830 OTHER NEPHELOMETRY $37.0030838839 OTHER NEPHELOMETRY $37.0030838859 NICKEL #LC071571 $88.0030838910 MELECULE ISOLATE NUCLEIC $44.0030838919 MELECULE ISOLATE NUCLEIC $44.0030838920 MELECULAR ENZYMATIC $49.0030838929 MELECULAR ENZYMATIC $49.0030838930 MLCLR DX / SLOT BLOT $37.0030838939 MLCLR DX / SLOT BLOT $37.0030838940 MOLECULE GEL ELECTROPHORESIS $47.0030838949 MOLECULE GEL ELECTROPHORESIS $47.0030838960 MELECULAR NUCLEIC ACID PROBE $178.0030838969 MELECULAR NUCLEIC ACID PROBE $178.0030838980 MOLECULAR NUCLEIC AMPL SINGLE; $54.0030838989 MOLECULAR NUCLEIC AMPL SINGLE; $54.0030839000 MOLECULE NUCLEIC AMPLI 2 SEQ $73.0030839009 MOLECULE NUCLEIC AMPLI 2 SEQ $73.0030839010 MOLECULE NUCLEIC AMPLI ADDON $48.0030839019 MOLECULE NUCLEIC AMPLI ADDON $48.0030839020 MOLECULAR REVERSE TRANS $54.0030839029 MOLECULAR REVERSE TRANS $54.0030839030 MOLECULE MUTATION SCAN $47.0030839039 MOLECULE MUTATION SCAN $47.0030839080 NUCLEIC ACID, SIGNAL AMPL $38.0030839089 NUCLEIC ACID, SIGNAL AMPL $38.0030839090 NUCLEIC ACID, HIGH RESOLUTE $37.0030839099 NUCLEIC ACID, HIGH RESOLUTE $37.0030839120 GENETIC EXAMINATION AND REPORT $49.0030839129 GENETIC EXAMINATION AND REPORT $49.0030839140 MUTATINO IDENT OLA/SBCE/ASPE $37.0030839149 MUTATINO IDENT OLA/SBCE/ASPE $37.0030839150 ASSAY OF NUCLEOTIDASE $25.00

30839159 ASSAY OF NUCLEOTIDASE $25.0030839160 OLIGOCLONAL BANDS $58.0030839169 OLIGOCLONAL BANDS $58.0030839190 QUAL ORGANIC ACIDS EA SPECIMIN $67.0030839199 QUAL ORGANIC ACIDS EA SPECIMIN $67.0030839210 SINGLE ORGANIC ACID; QUANE (SE $217.0030839219 SINGLE ORGANIC ACID; QUANE (SE $217.0030839250 OPIATES $112.0030839259 OPIATES $112.0030839300 BLOOD OSMOLALITY $52.0030839309 BLOOD OSMOLALITY $52.0030839350 URINE OSMOLALITY $84.0030839359 URINE OSMOLALITY $84.0030839370 OSTEOCALCIN $102.0030839379 OSTEOCALCIN $102.0030839450 OXALATE $34.0030839459 OXALATE $34.0030839700 PARATHORMONE;PTH C TERMINAL $225.0030839709 PARATHORMONE;PTH C TERMINAL $225.0030839860 BODY FLUID ACIDITY; EXCEPT BLO $24.0030839869 BODY FLUID ACIDITY; EXCEPT BLOOD $24.0030839920 PHENCYCLIDINE (PCP) $85.0030839929 PHENCYCLIDINE (PCP) $85.0030839930 CALPROTECTIN $103.0030839939 CALPROTECTIN $103.0030840300 BLOOD PKU $93.0030840301 BLOOD PKU (STATE PROVIDED) NO CHARGE $0.0030840309 BLOOD PKU $93.0030840600 ACID PHOSPHATASE; TOTAL $70.0030840609 ACID PHOSPHATASE; TOTAL $70.0030840660 ACID PHOSPHATASE; PROSTATIC $26.0030840669 ACID PHOSPHATASE; PROSTATIC $26.0030840750 ALKALINE PHOSPHATASE $42.0030840759 ALKALINE PHOSPHATASE $42.0030840800 ALKALINE PHOSPHATASE ISOS $40.0030840809 ALKALINE PHOSPHATASE ISOS $40.0030840810 PHOSPHATIDYLGLYCEROL $37.0030840819 PHOSPHATIDYLGLYCEROL $37.0030841000 PHOSPHORUS $42.0030841009 PHOSPHORUS $42.0030841050 URINE PHOSPHORUS $78.0030841059 URINE PHOSPHORUS $78.0030841100 URINE PORPHOBILINOGEN $27.0030841109 URINE PORPHOBILINOGEN $27.0030841120 PLACENTA ALPHA MICRO IG C/V $155.0030841129 PLACENTA ALPHA MICRO IG C/V $155.0030841200 URINE PORPHYRINS $39.0030841209 URINE PORPHYRINS $39.00

30841260 FECAL PORPHYRINS $66.0030841269 FECAL PORPHYRINS $66.0030841320 SERUM POTASSIUM $45.0030841329 SERUM POTASSIUM $45.0030841330 URINE POTASSIUM $47.0030841339 URINE POTASSIUM $47.0030841340 PREALBUMIN $105.0030841349 PREALBUMIN $105.0030841409 PREGNENOLONE #LC 140707 $60.0030841440 PROGESTERONE $54.0030841449 PROGESTERONE $54.0030841459 PROCALCITONIN $75.0030841460 PROLACTIN $78.0030841469 PROLACTIN $78.0030841500 PROSTAGLANDIN; EACH $164.0030841520 PSA - COMPLEXED $83.0030841529 PSA - COMPLEXED LC#140674 $83.0030841530 PSA; TOTAL $87.0030841539 PSA LC 103202 480145 $84.0030841540 PSA; FREE $59.0030841549 PSA; FREE LC#480947 $59.0030841550 PROTEIN;SERUM $45.0030841559 PROTEIN;SERUM #LC001073 $45.0030841560 PROTEIN; URINE $19.0030841569 PROTEIN; URINE $19.0030841570 PROTEIN; OTHER $19.0030841630 FIRST TRIMESTER SCREEN $103.0030841639 FIRST TRIMESTER SCREEN $103.0030841650 PROTEIN E-PHORESIS;SERUM $83.0030841659 PROTEIN E-PHORESIS;SERUM $83.0030841660 PROTEIN E-PHORESIS/URINE/CSF $49.0030841669 PROTEIN E-PHORESIS/URINE/CSF $49.0030841810 WESTERN BLOT TEST; PROTEIN $259.0030841819 WESTERN BLOT TEST; PROTEIN $259.0030841820 WESTRN BLOT TST;PROTEIN BND ID $136.0030841829 WESTRN BLOT TST;PROTEIN BND ID $136.0030842020 RBC PROTOPORPHYRIN $38.0030842029 RBC PROTOPORPHYRIN $38.0030842070 VITAMIN B-6 $145.0030842079 VITAMIN B-6 $145.0030842100 PYRUVATE $155.0030842109 PYRUVATE $155.0030842330 ESTROGEN RECEPTOR $121.0030842340 PREGESTERONE RECEPTOR $106.0030842350 ENDROCRINE HORMONE $191.0030842359 ENDROCRINE HORMONE $191.0030842380 NONENDROCRINE RECEPTOR $266.0030842389 NONENDROCRINE RECEPTOR $266.00

30842440 RENIN $57.0030842449 RENIN $57.0030842559 SELENIUM LC# 716910 $57.0030842600 SEROTONIN $46.0030842609 SEROTONIN $46.0030842700 SEX HORMONE BINDING GLOBULIN $60.0030842709 SEX HORMONE BINDING GLOBULIN $60.0030842950 BLOOD SODIUM $45.0030842959 BLOOD SODIUM $45.0030843000 URINE SODIUM $45.0030843009 URINE SODIUM $45.0030843020 SODIUM; OTHER $57.0030843050 SOMATOMEDIN $242.0030843059 SOMATOMEDIN $242.0030843110 OTHER SPECTROPHOTOMETER $16.0030843119 OTHER SPECTROPHOTOMETER $16.0030843150 SPECIFIC GRAVITY; BODY FLUID $33.0030843789 SUGARS, SINGLE QUAN EA SPECIMEN $35.0030843920 LAB URINE SULFATE $62.0030843929 LAB URINE SULFATE $62.0030844020 TESTOSTERONE; FREE $203.0030844029 TESTOSTERONE; FREE $203.0030844030 TESTOSTERONE, TOTAL $147.0030844039 TESTOSTERONE, TOTAL $147.0030844250 VITAMIN B-1 $198.0030844259 VITAMIN B-1 $198.0030844300 THIOCYANATE $91.0030844309 THIOCYANATE #LC811331 $91.0030844320 THYROGLOBULIN $124.0030844329 THYROGLOBULIN $124.0030844360 TOTAL THYROXINE $57.0030844369 TOTAL THYROXINE $57.0030844370 NEONATE THYROXINE $18.0030844379 NEONATE THYROXINE $18.0030844390 T4 (THYROXINE); FREE $95.0030844399 T4 (THYROXINE); FREE $95.0030844420 THYROXINE BINDING GLOBULIN $39.0030844429 THYROXINE BINDING GLOBULIN $39.0030844430 THYROID STIMULATING HORMONE TS $112.0030844439 THYROID STIMULATING HORMONE TS $112.0030844450 THYROID STIM IMMUNOGLOBULINS $111.0030844459 THYROID STIM IMMUNOGLOBULINS $111.0030844460 VITAMIN E $38.0030844469 VITAMIN E $38.0030844500 TRANSFERASE (SGOT) (AST) $45.0030844509 TRANSFERASE (SGOT) (AST) $45.0030844600 TRANSFERASE (SGPT) (ALT) $45.0030844609 TRANSFERASE (SGPT) (ALT) $45.00

30844660 TRANSFERRIN $74.0030844669 TRANSFERRIN $74.0030844780 TRIGLYCERIDES $42.0030844789 TRIGLYCERIDES $42.0030844790 LAB THYROID HORMONE (T3) $52.0030844799 THYROID HORMONE UPTAKE (T3) #LC001156 $52.0030844800 TRI-IODOTHYRONINE (T30; TOTAL $39.0030844809 TRI-IODOTHYRONINE (T30; TOTAL $39.0030844810 TRI-IODOTHYRONINE (T3); FREE $160.0030844819 TRI-IODOTHYRONINE (T3); FREE $160.0030844820 TRI-IODOTHYRONINE; REVERSE (T3 $45.0030844829 TRI-IODOTHYRONINE; REVERSE (T3 $45.0030844840 TROPONIN QUANT $131.0030844849 TROPONIN QUANT $131.0030845200 BLOOD UREA NITROGEN (BUN) $42.0030845209 BLOOD UREA NITROGEN (BUN) $42.0030845500 BLOOD URIC ACID $42.0030845509 BLOOD URIC ACID $42.0030845600 OTHER SOURCE URIC ACID $39.0030845609 OTHER SOURCE URIC ACID $39.0030845850 URINE VMA (VANILLYMANDELIC ACI $91.0030845859 URINE VMA (VANILLYMANDELIC ACI $91.0030845860 VASOACTIVE INTESTINAL PEPTIDE $91.0030845869 VASOACTIVE INTESTINAL PEPTIDE $91.0030845880 VASOPRESSIN (ADH) $151.0030845889 VASOPRESSIN (ADH) $151.0030845900 VITAMIN A (RETINOL) $31.0030845909 VITAMIN A (RETINOL) $31.0030845979 VITAMIN K 1 LC# 121200 $40.0030846000 VOLATILES; ALCOHOL $101.0030846002 VOLATILES; ALCOHOL; METHYL (B) $101.0030846009 VOLATILES; ALCOHOL $101.0030846300 ZINC $31.0030846309 ZINC $31.0030846810 C-PEPTIDE $134.0030846819 C-PEPTIDE $134.0030847020 CHORIONIC GONADOTROPIN TEST $41.0030847029 CHORIONIC GONADOTROPIN TEST $41.0030847030 CHORIONIC GONADOTROPIN ASSAY $57.0030847039 HCG SERUM QL W/RFLX HCG QN $57.0030849990 UNLISTED CHEM $21.0030849999 UNLISTED CHEM $21.0030850020 BLEEDING TIME $46.0030850070 DIFFERENTIAL WBC; MANUAL $31.0030850140 HEMATOCRIT $23.0030850149 HEMATOCRIT $23.0030850180 HEMOGLOBIN $27.0030850184 HEMOGLOBIN $27.00

30850189 HEMOGLOBIN $27.0030850250 LAB CBC W/PLAT & AUTO COMPLETE $70.0030850259 LAB CBC W/PLAT & AUTO COMPLETE $70.0030850270 AUTO CBC W/ PLATELETS $45.0030850320 MANUAL CELL COUNT; EACH $37.0030850410 AUTOMATED RBC COUNT $21.0030850419 AUTOMATED RBC COUNT $21.0030850450 AUTOMATED RETICULOCYTE COUNT $57.0030850459 AUTOMATED RETICULOCYTE COUNT $57.0030850480 AUTOMATED WBC; EOSINOPHIL COUN $36.0030850489 AUTOMATED WBC; EOSINOPHIL COUN $36.0030850490 AUTOMATED PLATELET COUNT $52.0030850499 AUTOMATED PLATELET COUNT $52.0030852200 BLOOD CLOT FACTOR V $38.0030852209 BLOOD CLOT FACTOR V $38.0030852300 BLOOD CLOT FACTOR VII $40.0030852309 BLOOD CLOT FACTOR VII $40.0030852400 BLOOD CLOT FACTOR VIII (1 STG) $136.0030852409 BLOOD CLOT FACTOR VIII (1 STG) $136.0030852450 BLOOD CLOT FACOTR VIII; VW FAC $147.0030852459 BLOOD CLOT FACOTR VIII; VW FAC $147.0030852460 BLOOD CLOT FACOTR VIII; VW ANT $209.0030852469 BLOOD CLOT FACOTR VIII; VW ANT $209.0030852470 BLOOD CLOT FACTOR VIII; VW FAC $223.0030852479 BLOOD CLOT FACTOR VIII; VW FAC $223.0030852500 BLOOD CLOT FACTOR IX $37.0030852509 BLOOD CLOT FACTOR IX $37.0030852600 BLOOD CLOT FACOTR X $40.0030852609 BLOOD CLOT FACOTR X $40.0030852700 BLOOD CLOT FACTOR XI $40.0030852709 BLOOD CLOT FACTOR XI $40.0030852800 BLOOD CLOT FACOTR XII $101.0030852809 BLOOD CLOT FACOTR XII $101.0030852900 CLOTTING; FACOTR XIII - FS $103.0030852909 CLOTTING; FACOTR XIII - FS $103.0030852910 BLOOD CLOT FACTOR XIII SOLUBIL $107.0030852919 BLOOD CLOT FACTOR XIII SOLUBIL $107.0030853000 ANTITHROMBIN III; TEST FOR $404.0030853009 ANTITHROMBIN III; TEST FOR $404.0030853010 ANTITHROMBIN III; ASSAY OF $52.0030853019 ANTITHROMBIN III; ASSAY OF $52.0030853020 PROTEIN C ANTIGEN; TEST FOR $64.0030853029 PROTEIN C ANTIGEN; TEST FOR $64.0030853030 PROTEIN C ACTIVITY; ASSAY OF $433.0030853039 PROTEIN C ACTIVITY; ASSAY OF $433.0030853050 PROTEIN S; TOTAL; ASSAY OF $60.0030853059 PROTEIN S; TOTAL; ASSAY OF $60.0030853060 PROTEIN S; FREE; ASSAY OF $461.00

30853069 PROTEIN S; FREE; ASSAY OF $461.0030853070 ACTIVATED PROTEIN C RESISTANCE $103.0030853079 ACTIVATED PROTEIN C RESISTANCE $103.0030853350 FACTOR INHIBITOR TEST $28.0030853359 FACTOR INHIBITOR TEST $28.0030853620 FIBRIN DEGRADATION PRODUCTS $109.0030853629 FIBRIN DEGRADATION PRODUCTS $109.0030853790 FIBRIN DEGRADATION; QUANT $110.0030853799 FIBRIN DEGRADATION; QUANT $110.0030853840 FIBRINOGEN ACTIVITY $54.0030853849 FIBRINOGEN ACTIVITY $54.0030853859 FIBRINOGEN; ANTIGEN $54.0030854100 ALPHA-2-ANTIPLASMIN $531.0030854109 ALPHA-2-ANTIPLASMIN $531.0030854150 PLASMINOGEN ACTIVATOR $834.0030854159 PLASMINOGEN ACTIVATOR $834.0030854200 FIBRINOLYTIC PLASMINOGEN $206.0030854209 FIBRINOLYTIC PLASMINOGEN $206.0030854600 FETAL HEMOGLOBIN; ROSETTE $21.0030854609 FETAL HEMOGLOBIN; ROSETTE $21.0030854610 FETAL HEMOGLOBIN - ROSETTE $16.0030855209 HEPARIN ANTI-XA LC#117101 $47.0030855360 IRON STAIN; PERIPHERAL BLOOD $19.0030855400 WBC ALKALINE PHOSPHATASE $61.0030855490 MURAMIDASE- LYSOSME $49.0030855499 MURAMIDASE- LYSOSME $49.0030855970 PLATELET NEUTRALIZATION $115.0030855979 PLATELET NEUTRALIZATION $115.0030856100 PROTHROMBIN TIME (PT) $39.0030856109 PROTHROMBIN TIME (PT) $39.0030856110 PROTHROMBIN TIME MIXING STUDY $98.0030856119 PROTHROMBIN TIME MIXING STUDY $98.0030856130 VIPER VENOM; PT; W/DILUTED $115.0030856139 VIPER VENOM; PT; W/DILUTED $115.0030856510 MANUAL ASSAY OF RBC SED RATE $39.0030856529 AUTOM ERYTHROCYTE SED RATE $47.0030856600 RBC SICKLE CELL $33.0030856609 RBC SICKLE CELL $33.0030856700 THROMBIN TIME $42.0030856705 THROMBIN NEUTRALIZATION $42.0030856709 THROMBIN TIME $42.0030857050 THROMBOPLASTIN INHIBITION, TIS $140.0030857059 THROMBOPLASTIN INHIBITION, TIS $140.0030857300 PARTIAL THROMBOPLASTIN TIME $49.0030857309 PARTIAL THROMBOPLASTIN TIME $49.0030857320 THROMBOPLASTIN; PLASMA FRACTIO $162.0030857329 THROMBOPLASTIN; PLASMA FRACTIO $162.0030858100 BLOOD VISCOSITY $38.00

30858109 BLOOD VISCOSITY $38.0030860030 ALLERGEN SPECIFIC IGE $26.0030860039 ALLERGEN SPECIFIC IGE $26.0030860050 ALLERGEN PROFILE, BASIC FOOD $98.0030860059 ALLERGEN PROFILE, BASIC FOOD $98.0030860089 ALLG SPEC IGE RECOMB EA LC#60239 & 60435 $40.0030860210 WBC ANTIBODY I.D $347.0030860219 WBC ANTIBODY I.D $347.0030860220 PLATELET ANTIBODY I.D. $216.0030860229 PLATELET ANTIBODY I.D. $216.0030860230 IMMUNOGLOBULIN $28.0030860239 IMMUNOGLOBULIN $28.0030860380 ANTINUCLEAR ANTIB (ANA) $70.0030860389 ANTINUCLEAR ANTIB (ANA) $70.0030860390 ANTINUCLEAR ANTIB TITER (ANA) $58.0030860399 ANTINUCLEAR ANTIB TITER (ANA) $58.0030860600 ANTISTREPTOLYSIN O TITER $57.0030860609 ANTISTREPTOLYSIN O TITER $57.0030861400 C-REACTIVE PROTEIN $57.0030861409 C-REACTIVE PROTEIN $57.0030861410 HS C-REACT PROTEIN; S $75.0030861419 CARDIAC C-REACTIVE PROTEIN #LC120766 $75.0030861460 BETA 2 GLYCOPROTEIN I AB $77.0030861469 BETA 2 GLYCOPROTEIN I AB $77.0030861470 CARDIOLIPIN ANTIBODY $144.0030861479 CARDIOLIPIN ANTIBODY $144.0030861480 ANTI-PHOSPHATIDYLSERINE AB $52.0030861489 ANTI-PHOSPHATIDYLSERINE AB $52.0030861570 TITER OF COLD AGGLUTININ $23.0030861600 ANTIGEN COMPLEMENT $91.0030861609 ANTIGEN COMPLEMENT $91.0030861610 COMPLEMENT FUNCTIONAL ACTIVITY $192.0030861619 COMPLEMENT FUNCTIONAL ACTIVITY $192.0030861620 TOTAL COMPLEMENT (CH50) $136.0030861629 TOTAL COMPLEMENT (CH50) $136.0030862000 LAB CCP ANTIBODY $52.0030862009 LAB CCP ANTIBODY $52.0030862150 DEOXYRIBONUCLEASE ANTIBODY $84.0030862159 DEOXYRIBONUCLEASE ANTIBODY $84.0030862250 DNA ANITBODY; DOUBLE STRAND $147.0030862259 DNA ANITBODY; DOUBLE STRAND $147.0030862260 DNA AB; SS $45.0030862269 DNA AB; SS $45.0030862350 ANTICHROMATIN ANTIBODIES $305.0030862359 ANTICHROMATIN ANTIBODIES $305.0030862550 FLUORESCENT AB; SCREEN $100.0030862559 FLUORESCENT AB; SCREEN $100.0030862560 TEST BY FLUORESCENT AB; TITER $33.00

30862569 TEST BY FLUORESCENT AB; TITER $33.0030863000 IMMUNOASSAY CA 15-3 (27.29) $122.0030863009 IMMUNOASSAY CA 15-3 (27.29) $122.0030863010 IMMUNOASSAY CA 19-9 $129.0030863019 IMMUNOASSAY CA 19-9 $129.0030863040 IMMUNOASSAY CA 125 $129.0030863049 IMMUNOASSAY CA 125 $129.0030863059 HUMAN EPIDIDYMIS PROTEIN 4 $129.0030863080 HETEROPHILE ANTIBODIES $42.0030863089 HETEROPHILE ANTIBODIES $42.0030863160 OTHER TUMOR ANITGEN $129.0030863169 OTHER TUMOR ANITGEN $129.0030863170 DIPHTHERIA ANTITOXOID ANTIBODI $36.0030863179 DIPHTHERIA ANTITOXOID ANTIBODI $36.0030863200 IMMUNOELECTROPHORESIS; BLOOD $49.0030863209 IMMUNOELECTROPHORESIS; BLOOD $49.0030863250 IEP; NOT SERUM $150.0030863259 IEP; NOT SERUM $150.0030863310 IMMUNODIFFUSION; OUCTHERLONY $103.0030863319 IMMUNODIFFUSION; OUCTHERLONY $103.0030863320 IMMUNE COMPLEX $117.0030863329 IMMUNE COMPLEX $117.0030863340 IMMUNOFIXATION ELECTROPH $155.0030863349 IMMUNOFIXATION ELECTROPH $155.0030863359 IMMUNFIX E-PHORSIS/URINE/CSF $100.0030863360 INHIBIN A $248.0030863369 INHIBIN A $248.0030863370 INSULIN ANTIBODIES $56.0030863379 INSULIN ANTIBODIES $56.0030863410 ISLET CELL ANTIBODY $109.0030863419 ISLET CELL ANTIBODY $109.0030863590 T CELLS; TOTAL COUNT $132.0030863600 CD4 & CD8 CELLS; ABS COUNT $102.0030863609 CD4 & CD8 CELLS; ABS COUNT $102.0030863610 CD4 CELLS; ABS COUNT $124.0030863619 CD4 CELLS; ABS COUNT $124.0030863760 MICROSOMAL ANTIBODIES; THYROID $107.0030863769 MICROSOMAL ANTIBODIES; THYROID $107.0030864030 PARTICLE AGGLUT $90.0030864039 PARTICLE AGGLUT $90.0030864060 PARTICLE AGGLUTINATION TITER $31.0030864069 PARTICLE AGGLUTINATION TITER $31.0030864300 RHEUMATOID FACTOR; SCREEN $48.0030864309 RHEUMATOID FACTOR; SCREEN $48.0030864310 RHEUMATOID FACTOR; ASSAY $55.0030864319 RHEUMATOID FACTOR; ASSAY $55.0030864800 QUANTIFERON - TB GOLD $219.0030864809 QUANTIFERON - TB GOLD $219.00

30865920 SYPHILIS (VDRL) (RPR) $42.0030865929 SYPHILIS (VDRL)(RPR) $42.0030865930 SYPHILIS (ASSAY) TITER $67.0030865939 SYPHILIS (ASSAY) TITER $67.0030866020 ACTINOMYCES AB $27.0030866029 ACTINOMYCES AB $27.0030866030 ADENOVIRUS ANTIBODY $29.0030866039 ADENOVIRUS ANTIBODY $29.0030866060 AB; ASPERGILLUS $87.0030866069 ASPERGILLUS AB $41.0030866110 BARTONELLA AB; $42.0030866119 BARTONELLA AB; $42.0030866120 BLASTOMYCES ANTIBODY $33.0030866129 BLASTOMYCES ANTIBODY $33.0030866150 BORDETELLA ANTIBODY $523.0030866159 BORDETELLA ANTIBODY $523.0030866170 LYME DISEASE $63.0030866179 LYME DISEASE $63.0030866180 LYME DISEASE;AB;SCREEN $211.0030866189 LYME DISEASE;AB;SCREEN $211.0030866220 BRUCELLA; ANTIBODIES $24.0030866229 BRUCELLA; ANTIBODIES $24.0030866280 CANDIDA; ANTIBODY $31.0030866289 CANDIDA; ANTIBODY $31.0030866310 CHLAMYDIA AB $37.0030866319 CHLAMYDIA AB $37.0030866320 CHLAMYDIA IGM $52.0030866329 CHLAMYDIA IGM $52.0030866359 COCCIDIODES AB;IGG & IGM $20.0030866410 AB CRYPOTCOCCUS $114.0030866419 AB CRYPOTCOCCUS $114.0030866440 CMV ANTIBODY;IGG ABBY EIA $42.0030866449 CMV ANTIBODY;IGG ABBY EIA $42.0030866450 CMV IGM $44.0030866459 CMV IGM $44.0030866510 CALIFORNIA ENCEPHALITIS AB $42.0030866519 CALIFORNIA ENCEPHALITIS AB $42.0030866520 EASTERN EQUINE ENCEPHALITIS AB $42.0030866529 EASTERN EQUINE ENCEPHALITIS AB $42.0030866530 ST LOUIS ENCEPHALITIS AB $34.0030866539 ST LOUIS ENCEPHALITIS AB $34.0030866580 ENTEROVIRUS AB $42.0030866589 ENTEROVIRUS AB $42.0030866630 EPSTEIN BARR EARLY ANTIGEN $36.0030866639 EPSTEIN BARR EARLY ANTIGEN $36.0030866640 EPSTEIN BARR NUCLEAR ANTIGEN $25.0030866649 EPSTEIN BARR NUCLEAR ANTIGEN $25.0030866650 EPSTEIN BARR VIRAL CAPSID $48.00

30866659 EPSTEIN BARR AB VIRAL CAPSID $48.0030866710 OTHER FUNGUS AG $32.0030866719 OTHER FUNGUS AG $32.0030866770 H PYLORI AB; IGG $202.0030866779 H PYLORI AB; IGG $202.0030866890 HTLV/HIV AB (WESTERN BLOT) $50.0030866899 HTLV/HIV AB (WESTERN BLOT) $50.0030866920 AB; HEPATITIS D+ $38.0030866929 AB; HEPATITIS D+ $38.0030866940 HSV IGMAB $266.0030866949 HSV IGMAB #LC164806 $266.0030866950 HERPES SIMPLEX TYPE 1 AB $29.0030866959 HERPES SIMPLEX TYPE 1 AB $29.0030866960 HERPES SIMPLEX TYPE 2 AB $43.0030866969 HERPES SIMPLEX TYPE 2 AB $43.0030866980 HISTOPLASMA $33.0030866989 HISTOPLASMA $33.0030867010 TEST FOR HIV-1 ANTIBODY $24.0030867019 TEST FOR HIV-1 ANTIBODY $24.0030867020 TEST FOR HIV-2 ANTIBODY $24.0030867029 TEST FOR HIV-2 ANTIBODY $24.0030867030 HIV RAPID TEST $26.0030867035 RAPID HIV TEST-LABOR & DEL $26.0030867039 HIV RAPID TEST $26.0030867040 HEP B CORE ANTIBODY $66.0030867049 HEP B CORE ANTIBODY $66.0030867050 HEP B IGM ANTIBODY $95.0030867059 HEP B IGM ANTIBODY $95.0030867060 HEP B SURFACE ANTIBODY $62.0030867069 HEP B SURFACE ANTIBODY $62.0030867070 HEP BE ANTIBODY $80.0030867079 HEP BE ANTIBODY $80.0030867080 HEP A ANTIBODY $78.0030867089 HEP A ANTIBODY $78.0030867090 HEP A IGM ANTIBODY $87.0030867099 HEP A IGM ANTIBODY $87.0030867100 INFLUENZA ANTIBODY $115.0030867102 INFLUENZA ANTIBODY; B $115.0030867109 INFLUENZA ANTIBODY $115.0030867130 LEGIONELLA ANTIBODY $115.0030867139 LEGIONELLA ANTIBODY $115.0030867200 LEPTOSPIRA IGM ANTIBODIES $103.0030867209 LEPTOSPIRA IGM ANTIBODIES $103.0030867350 MUMPS ANTIBODY $105.0030867359 MUMPS ANTIBODY $105.0030867380 MYCOPLASMA AB $97.0030867382 MYCOPLASMA PNEUMONIAE ANTIBODIES, IGM $97.0030867389 MYCOPLASMA AB $97.00

30867440 NOCARDIA AB $31.0030867449 NOCARDIA AB $31.0030867470 PARVOVIRUS ANTIBODY $42.0030867479 PARVOVIRUS ANTIBODY $42.0030867530 AMEBIASIS ANTIBODIES $73.0030867539 AMEBIASIS ANTIBODIES $73.0030867560 RESP SYNCYTIAL VIRUS AB (RSV) $29.0030867569 RESP SYNCYTIAL VIRUS AB (RSV) $29.0030867620 RUBELLA $155.0030867629 RUBELLA $155.0030867659 RUBEOLA AB $34.0030867770 AB; TOXOPLASMA $147.0030867779 TOXOPLASMA ANTIBODY; IGG $38.0030867780 TOXOPLASMA ANTIBODY; IGM $38.0030867789 TOXOPLASMA ANTIBODY; IGM $38.0030867800 T PALLIDUM AB (TP-PA) $72.0030867809 T PALLIDUM AB (TP-PA) $72.0030867810 FTA-ABS(RPR REFLEX TEST) $72.0030867840 AB, TRICHINELLA $47.0030867849 AB, TRICHINELLA $47.0030867879 VARICELLA-ZOSTER AB $34.0030867880 WEST NILE VIRUS AB; IGM $52.0030867889 WEST NILE VIRUS AB; IGM $52.0030867890 WEST NILE VIRUS AB; IGG $52.0030867899 WEST NILE VIRUS AB; IGG $52.0030867900 HEPATITIS E. ANTIBODY $67.0030867909 HEPATITIS E. ANTIBODY $67.0030868000 THYROGLOBULIN ANTIBODY $97.0030868009 THYROGLOBULIN ANTIBODY $97.0030868030 HEP C ANTIBODY $102.0030868039 HEP C ANTIBODY $102.0030868040 HEP C CONFIRMATORY TEST $186.0030868049 HEP C CONFIRMATORY TEST $186.0030868050 LYMPHOCYTOTOX VC; W TITRATE $527.0030868070 PERCENT REACTIVE AB; PRA SCREEN $145.0030868120 HLA TYPING; A;B; OR C; SINGLE $66.0030868129 HLA TYPING; A;B; OR C; SINGLE $66.0030868490 ANTIPROTHROMBIN AB, EA IG CL $52.0030868499 ANTIPROTHROMBIN AB, EA IG CL $52.0030868500 RBC ANTIBODY SCREEN $85.0030868600 RBC ANTIBODY ELUTION $58.0030868700 RBC ANTIBODY IDENTIFICATION $145.0030868800 COOMBS TEST; DIRECT $41.0030868809 COOMBS TEST; DIRECT $41.0030868850 COOMBS TEST; INDIRECT; QUAL $44.0030868860 COOMBS TEST; INDIRECT; TITER $62.0030869000 BLOOD TYPING; ABO $38.0030869009 BLOOD TYPING; ABO $38.00

30869010 BLOOD TYPING; RH (D) $42.0030869019 BLOOD TYPING; RH (D) $42.0030869020 BLOOD TYPE ANTIGEN DONOR EA $54.0030869030 BLOOD TYPING; ANITGEN SCREEN $54.0030869040 BLOOD TYPING; PATIENT SERUM $34.0030869050 BLOOD TYPING; RBC ANTIGENS $23.0030869060 BLOOD TYPING; RH PHENOTYPE $36.0030869200 COMPATIBILITY TEST; SPIN $62.0030869210 COMPATIBILITY TEST; INCUBATE $36.0030869220 COMPATIBILITY TEST; ANTIGLOB $50.0030869270 THAW FFP $50.0030869700 PRETREAT RBC; CHEMICAL $103.0030869702 PRETREAT RBC; CHEMICAL $103.0030869710 PRETREAT RBC; ENZYME $103.0030869720 PRETREAT RBC;DGS $94.0030869750 SERUM PRETX; DRUG INCUBATE $83.0030869759 SERUM PRETX; DRUG INCUBATE $83.0030869760 PRETREAT RBC: SERUM; DILUTION $22.0030869770 SERUM PRETX; INHIBITOR INCUBATE $59.0030869780 PRETREAT RBC; SERUM; PT'S RBC $33.0030869850 SPLIT BLOOD OR PRODUCTS $85.0030869990 UNLISTED TRANSFUSION MED $212.0030869999 UNLISTED TRANSFUSION MED $212.0030870150 SPECIMEN CONCENTRATION $18.0030870159 SPECIMEN CONCENTRATION $18.0030870400 BLOOD CULTURE FOR BACTERIA $109.0030870409 BLOOD CULTURE FOR BACTERIA $109.0030870450 STOOL CULTURE FOR BACTERIA $97.0030870459 STOOL CULTURE FOR BACTERIA $97.0030870460 STOOL CULTURE FOR ADD AEROBIC $56.0030870469 STOOL CULTURE FOR ADD AEROBIC $56.0030870700 CULTURE BACT $70.0030870709 CULTURE BACT $70.0030870750 ANAEROBIC BACT CULTURE $120.0030870759 ANAEROBIC BACT CULTURE $120.0030870760 CULTURE ANAEROBIC IDENT; EACH $81.0030870770 AEROBIC I.D. CULTURE $26.0030870779 CULT ANAEROBIC ID; EA, WET MNT, STAIN & $81.0030870810 CULTURE P PATHOG - SCREEN $40.0030870819 CULTURE P PATHOG - SCREEN #LC R188135 $40.0030870840 BLOOD CULTURE PP; W ESTIM COUNT $52.0030870849 BLOOD CULTURE PP; W ESTIM COUNT $52.0030870860 URINE CULTURE/COLONY COUNT $70.0030870869 URINE CULTURE/COLONY COUNT $70.0030870880 URINE BACTERIA CULTURE $21.0030871010 SKIN FUNGI CULTURE $93.0030871019 SKIN FUNGI CULTURE $93.0030871020 FUNGAL ISOLATION CULTURE $23.00

30871029 FUNGAL ISOLATION CULTURE #LC 182493 $23.0030871030 BLOOD FUNGUS CULTURE $93.0030871039 BLOOD FUNGUS CULTURE $93.0030871069 YEAST FUNGI I.D. $52.0030871070 MOLD FUNGI I.D. $34.0030871079 MOLD FUNGI I.D. $34.0030871090 LAB CULTURE, MYCOPLASMA $140.0030871099 LAB CULTURE, MYCOPLASMA $140.0030871100 CHLAMYDIA CULTURE $119.0030871109 CHLAMYDIA CULTURE $119.0030871160 MYCOBACTERIA CULTURE; ACID FAS $148.0030871169 MYCOBACTERIA CULTURE; ACID FAS $148.0030871180 MYCOBACTERIC I.D.;MYCO; DEFINI $29.0030871189 MYCOBACTERIC I.D.;MYCO; DEFINI $29.0030871400 CULTURE TYPING; IMMUNOFLUORESC $16.0030871409 CULTURE TYPING; IMMUNOFLUORESC $16.0030871490 CULTURE; NA PROBE $165.0030871499 CULTURE; NA PROBE $165.0030871500 DNA/RNA AMPLIFIED PROBE $124.0030871720 PINWORM EXAM $37.0030871729 PINWORM EXAM $37.0030871770 OVA AND PARASITES EXAM $124.0030871779 OVA AND PARASITES EXAM $124.0030871840 ANTIBIOTIC SENSIVITY; DISK $33.0030871849 ANTIBIOTIC SENSIVITY; DISK $33.0030871859 BETA LACTAMASE $100.0030871860 ANTIBIOTIC SENSIVITY; MIC $100.0030871869 ANTIBIOTIC SENSIVITY; MIC $100.0030871970 SERUM BACT TITER (SCHLICHTER) $33.0030871979 SERUM BACT TITER (SCHLICHTER) $33.0030872050 GRAM/GIEMSA SMEAR; STAIN & INT $33.0030872059 GRAM/GIEMSA SMEAR; STAIN & INT $33.0030872060 ACID FAST STAIN; STAIN & INTER $16.0030872069 ACID FAST STAIN; STAIN & INTER $16.0030872079 PARASITE EXAM, WHOLE BLOOD SMEAR STAIN $33.0030872090 SMEAR, COMPLEX STAIN $42.0030872099 SMEAR, COMPLEX STAIN $42.0030872100 WET MOUNT; STAIN AND INTERPRET $38.0030872109 INTERPRET $38.0030872200 TISSUE EXAM FOR FUNGI; KOH PRE $67.0030872520 VIRUS INNOC TEST; TISSUE CULT $51.0030872529 VIRUS INNOC TEST; TISSUE CULT $51.0030872540 VIRUS I.D.; CENTRIFUGE ENHANCE $43.0030872549 VIRUS I.D.; CENTRIFUGE ENHANCE $43.0030872550 VIRUS I.D.; OTHER;CULTURE HERP $89.0030872559 VIRUS I.D.; OTHER;CULTURE HERP $89.0030872600 ADENOVIRUS ANITGEN; DFA $31.0030872609 ADENOVIRUS ANTIGEN; DFA $31.00

30872650 BORDATELLA P AG BY DFA $59.0030872659 BORDATELLA P AG BY DFA $59.0030872720 CRYPTOSPORIDUM ANTIGEN; DFA $62.0030872759 INFLUENZA B AG BY IF $40.0030872769 INFLUENZA A AG BY DFA $40.0030872780 LEGIONELLA PNEUMOPHILIA ANTIGE $41.0030872789 LEGIONELLA PNEUMOPHILIA ANTIGE $41.0030872799 PARAINFLUENZA AG BY DFA $40.0030872809 RSV AG BY IF $40.0030872810 PNEUMOCYSTIS CARINII ANTIGEN $31.0030872819 PNEUMOCYSTIS CARINII ANTIGEN #LC180232 $31.0030872900 VARCELLA ANTIGEN; DFA $31.0030872909 VARCELLA ANTIGEN; DFA $31.0030872999 NOS INFECTIOUS AG BY IF $40.0030873000 ANTIGEN DETECT; POLYVALENT; IF $159.0030873009 ANTIGEN DETECT; POLYVALENT; IF $159.0030873200 CHLAMYDIA TRACHOMATIS; EIA $31.0030873240 COLSTRIDIUM ANTIGEN; EIA $96.0030873249 COLSTRIDIUM ANTIGEN; EIA $96.0030873270 CRYPTCOCCUS NEOFORM AG; EIA $31.0030873279 CRYPTCOCCUS NEOFORM AG; EIA $31.0030873289 CRYPTOSPORIDIUM AG EIA $93.0030873290 LAB - GIARDIA AG, EIA $78.0030873299 LAB - GIARDIA AG, EIA $78.0030873380 H PYLORI STOOL ANITGEN; EIA $32.0030873389 H PYLORI STOOL ANITGEN; EIA $32.0030873390 H PYLORI ANTIGEN; EIA (CLO) $174.0030873400 HEP B SURFACE ANTIGEN; EIA $64.0030873409 HEP B SURFACE ANTIGEN; EIA $64.0030873500 HEP Be ANTIGEN; EIA $30.0030873509 HEP Be ANTIGEN; EIA $30.0030873800 HEPATITIS DELTA AG, EIA $37.0030873809 HEPATITIS DELTA AG, EIA $37.0030873850 HISTOPLASM CAPSUL AG BY EIA $155.0030873859 HISTOPLASM CAPSUL AG BY EIA $155.0030873890 HIV-1 AG W/HIV-1 & HIV-2 AB $85.0030873899 HIV-1 AG W/HIV-1 & HIV-2 AB $85.0030874000 INFLUENZA A/B ANITGEN; EIA; A $27.0030874002 INFLUENZA A/B ANTIGEN; EIA; B $27.0030874009 INFLUENZA A/B ANTIGEN; EIA $27.0030874200 RESP SYNCYTIAL AG; EIA $71.0030874250 ROTAVIRUS ANTIGEN;EIA $140.0030874259 ROTAVIRUS , DIRECT DETECTION IMMUNOASSAY $140.0030874270 SHIGA-LIKE TOXIN AG, EIA $81.0030874279 SHIGA-LIKE TOXIN AG, EIA $81.0030874300 STREP A AG; EIA $54.0030874490 OTHER AG DET; EIG; MULT;LEGION $142.0030874499 OTHER AG DET; EIG; MULT;LEGION $142.00

30874500 IA BY EIA - SINGLE STEP $78.0030874509 IA BY EIA - SINGLE STEP $78.0030874710 BARTONELLA AMPLIF NAP $129.0030874760 LYMES, AMPLIFIED NA PROBE $77.0030874819 CANDIDA NA AMPLIFIED PROBE $83.0030874869 CHLAMYDIA P AMPLIF NA PROBE $60.0030874900 CHLAMYDIA T, DIR NA PROBE $96.0030874909 CHLAMYDIA T, DIR NA PROBE $96.0030874910 CHLAMYDIA TRACH; DNA;AMP PROBE $156.0030874919 CHLAMYDIA TRACH; DNA; AMP PROBE $156.0030874939 C DIFF AMPLIFIED PROBE $103.0030874960 CMV BY PCR $173.0030874969 CMV BY PCR $173.0030874970 CMV DNA PCR, QT $206.0030874979 CMV DNA PCR, QT $206.0030875079 IADNA-DNA/RNA PROBE TQ 12-25 $200.0030875160 HEP-B DNA, QUALITATIVE PCR $170.0030875169 HEP-B DNA, QUALITATIVE PCR $170.0030875170 HEP B; DNA; QUANT $262.0030875179 HEP B; DNA; QUANT $262.0030875210 HEP C; RNA; AMP PROBE $696.0030875219 HEP C; RNA; AMP PROBE $696.0030875220 HEPATITIS C; RNA $412.0030875229 HEPATITIS C VIRAL RNA, QT BDNA #LC859797 $412.0030875290 HERPES SIMPLEX; DNA; AMP PROBE $72.0030875299 HERPES SIMPLEX; DNA; AMP PROBE $72.0030875350 HIV-1 DNA; AMP PROBE $201.0030875359 HIV-1 DNA; AMP PROBE $201.0030875360 HIV-1 DNA; QUANT $348.0030875369 HIV-1 DNA; QUANT $348.0030875380 HIV 2 QUALITATIVE PCR $121.0030875389 HIV 2 QUALITATIVE PCR $121.0030875410 LEGIONELLA, AMPLIF NA PROBE $175.0030875419 LEGIONELLA, AMPLIF NA PROBE $175.0030875520 MYCOBACTERIA NA QUAN (RNA/DNA) $165.0030875560 PCR TB - MYCOBACTERIA NA PROB $70.0030875569 PCR TB-MYCOBACTERIA NA PROB $70.0030875810 LAB-MYCOPLASMA PNEUMONIA, AMP $206.0030875819 LAB-MYCOPLASMA PNEUMONIA, AMP $206.0030875900 NEISSERIA, DIR NA PROBE $98.0030875909 NEISSERIA, DIR NA PROBE $98.0030875910 NEISSERIA, AMPLIF NA PROBE $156.0030875919 NEISSERIA, AMPLIF NA PROBE $156.0030876210 HPV, AMP PROBE (HIGH OR LOW) $83.0030876219 HPV, AMP PROBE (HIGH OR LOW) $83.0030876240 HPV, AMP PROBE (HIGH OR LOW) $83.0030876249 HPV, AMP PROBE (HIGH OR LOW) $83.0030876259 HPV TYPES 16 & 18 ONLY $83.00

30876339 RESP VIRUS 12-25 TARGETS $300.0030876509 STREP A DIR NA PROBE $70.0030876610 TRICHOMONAS VAGINALIS AMPLIF $83.0030876619 TRICHOMONAS VAGINALIS AMPLIF $83.0030877980 AMPLIF NA PROBE, NOS AGENT $205.0030877989 AMPLIF NA PROBE, NOS AGENT #LC P188052 $205.0030877999 BK VIRUS QUANT, DNA PCR #LC 138962 $151.0030878009 OTHER INF AGENT, MULT, DNA;DI $88.0030878010 DNA/RNA; MULTI ORG - AMP PR $309.0030878019 DNA/RNA;MULTI ORG-AMP PR $309.0030878029 STREP B IA W DIRECT OPTICAL OBS $73.0030878040 INFLUENZA IA W DOO $86.0030878049 INFLUENZA IA W DOO $86.0030878070 RSV IA W DIR OBSERV $81.0030878079 RSV IA W DIR OBSERV $81.0030878800 STREP GROUP A W DOO $59.0030878809 STREP GROUP A W DOO $59.0030878990 INF AGENT NOS BY IA - DOO $62.0030878999 INF AGENT NOS BY IA - DOO $62.0030879000 PHENOTYPE, INFECT AGENT DRUG $253.0030879009 PHENOTYPE, INFECT AGENT DRUG $253.0030879010 HIV 1 GENOTYPE BY NA $582.0030879019 HIV 1 GENOTYPE BY NA $582.0030879020 HEPATITUS C - DNA OR RNA $557.0030879029 HEPATITUS C - DNA OR RN $557.0030879030 PHENOTYPE, DNA HIV W/CULTURE $1,056.0030879039 PHENOTYPE, DNA HIV W/ CULTURE $1,056.0030879040 PHENOTYPE, DNA HIV W/CLT ADD $152.0030879049 PHENOTYPE, DNA HIV Q/ CLT ADD $152.0030879129 HEP B VIRUS (HBV) GENOTYPE $253.0030881559 CYTOPATH; C/V INDEX ADD-ON $16.0030882309 TISSUE CULTURE; LYMPHOCYTE $450.0030883129 SPECIAL STAINS GROUP 1 $151.0030887200 BILIRUBIN TOTAL TRANSCUTANEOUS $21.0030890500 BODY FLUID CELL COUNT $43.0030890509 BODY FLUID CELL COUNT $43.0030890510 BODY FLUID DIFFERENTIAL CELL C $57.0030890519 BODY FLUID DIFFERENTIAL CELL C $57.0030890550 FECAL LEUKO CNT, QUAL/SEMIQUAN $45.0030890559 FECAL LEUKO CNT, QUAL/SEMIQUAN $45.0030890600 EXAM; FLUID CRYSTALS $56.0030890609 EXAM; FLUID CRYSTALS $56.0030891250 FAT STAIN; FECES $57.0030891259 FAT STAIN;FECES $57.0030891600 EXAM FECES FOR MEAT FIBERS $49.0030891609 EXAM FECES FOR MEAT FIBERS $49.0030891900 NASAL SMEAR FOR EOSINOPHILS $16.0030891909 NASAL SMEAR FOR EOSINOPHILS $16.00

30893210 SEMEN ANALYSIS & MOTILITY $23.0030893250 SPERM ANTIBODY TEST $109.0030893259 SPERM ANTIBODY TEST $109.00318004619 IMMUNOHISTOCHEMISTRY EA ANTBDY $67.00318004629 IMMUNOHISTOCHEMISTRY EA ADD ANTBDY $67.0031850609 BLOOD SMEAR INTERPRETATION LC# 005300 $182.0031850970 BONE MARROW INTERPRETATION $85.0031850979 BONE MARROW INTERPRETATION $85.0031860780 PHYS BB SVC (TRANSF REAC INV) $196.0031860789 PHYS BB SVC (TRANSF REAC INV) $196.0031860790 PHYS BB SVC (DEVIATION AUTH) $93.0031860799 PHYS BB SVC (DEVIATION AUTH) $93.0031881040 CYTOPATHOLOGY; FLUIDS $55.0031881049 CYTOPATHOLOGY; FLUIDS $55.0031881080 CYTOPATH; CONCENTRATE TECH $40.0031881089 CYTOPATH; CONCENTRATE TECH $40.0031881120 CYTOPATH; CELL ENHANCE $70.0031881129 CYTOPATH; CELL ENHANCE $70.0031881250 CYTOPATHOLOGY; FORENSIC $141.0031881259 CYTOPATHOLOGY; FORENSIC $141.0031881420 CYTOPATH; C/V THIN LYR; MAN $45.0031881429 CP CERV/VAG; ATL; MANUAL SCREEN $103.0031881500 CYTOPATH; C/V; MANUAL $28.0031881559 CYTOPATH; C/V INDEX ADD-ON $16.0031881610 CYTOPATH SMEAR; OTHER SOURCE $171.0031881619 CYTOPATH SMEAR; OTHER SOURCE $171.0031881620 CYTOPATH SMEAR; OTHER SOURCE $165.0031881629 CYTOPATH SMEAR; OTHER SOURCE $165.0031881640 CYTOPATH BETHESDA; C/V; MANUAL $46.0031881649 CYTOPATH BETHESDA; C/V; MANUAL $46.0031881720 CYTOPATHOLOGY EVAL OF FNA $269.0031881729 CYTOPATHOLOGY EVAL OF FNA $269.0031881730 CYTOPATH EVA; FNA; REPORT $147.0031881739 CYTOPATH EVAL; FNA; REPORT $147.0031881750 CYTOPATH; C/V/ THIN PREP;AUTO $58.0031881759 CYTOPATH; C/V/ THIN PREP;AUTO $58.0031881820 CELL MARKER STUDY $186.0031881829 CELL MARKER STUDY $186.0031881840 FLOWCYTOMETRY 1 MARKER $25.0031881850 FLOWCYTOMETRY EA ADDTL MARKER $25.0031882300 TISSUE CULTURE; LYMPHOCYTE $253.0031882330 TISSUE CUTLURE; SKIN OR SOLID $396.0031882370 TISSUE CULTURE; BONE MARROW $320.0031882480 CHROMOSOME ANALYSIS; 50-100 $374.0031882488 CHROMOSOME ANALYSIS; 50-100 $477.0031882620 CHROMOSOME ANALYSIS; 15-20 $557.0031882640 CHROM ANALY; 20-25 CELLS $270.0031882800 CHROM ANALY; ADDTL KAYOT EA $158.00

31882809 CHROM ANALY; ADDTL KAYOT EA $158.0031883000 SURGICAL PATH;GROSS LEVEL 1 $73.0031883009 SURGICAL PATH; GROSS LEV 1 $73.0031883020 SURGICAL PATH;GROSS;MICRO II $107.0031883029 SURGICAL PATH; GROSS; MICRO II $107.0031883040 SURGICAL PATH GROSS;MICRO III $142.0031883049 SURGICAL PATH GROSS; MICRO III $142.0031883050 SURGICAL PATH;GROSS;MICRO IV $176.0031883059 SURGICAL PATH; GROSS; MICRO IV $176.0031883070 SURGICAL PATH;GROSS;MICRO V $313.0031883079 SURGICAL PATH; GROSS; MICRO V $313.0031883090 SURGICAL PATH;GROSS;MICRO VI $450.0031883099 SURGICAL PATH; GROSS; MICRO VI $450.0031883110 DECALCIFY TISSUE $74.0031883119 DECALCIFY TISSUE $74.0031883120 SPECIAL STAINS;GRP1 $68.0031883129 SPECIAL STAINS; GRP 1 $68.0031883130 SPECIAL STAINS;GRP2 $83.0031883139 SPECIAL STAINS; GRP 2 $83.0031883140 HISTO CHEMICAL STAIN ADD-ON $186.0031883149 HISTO CHEMICAL STAIN ADD-ON $186.0031883180 HISTO CHEM ID OF CHEMICALS $122.0031883189 HISTO CHEM ID OF CHEMICALS $122.0031883190 ENZYME HISTO CHEMISTRY $139.0031883199 ENZYME HISTO CHEMISTRY $139.0031883210 CONSULTATION & REPORT ON SLIDE $64.0031883219 CONSULTATION & REPORT ON SLIDE $64.0031883230 REF CONSULT WITH SLIDE PREP $185.0031883239 REF CONSULT WITH SLIDE PREP $185.0031883259 COMPREHENSIVE CONSULT $78.0031883310 PATH CONSULT INTRAOP;ADD'L $177.0031883319 PATH CONSULT INTRAOP; 1 BLOC $211.0031883329 PATH CONSULT INTRAOP; ADD'L $177.0031883330 INTRAOP CYTO PATH CONSULT, 1 $78.0031883339 INTRAOP CYTO PATH CONSULT, 1 $78.0031883340 INTRAOP CYTO PATH CONSULT, 2 $61.0031883349 INTRAOP CYTO PATH CONSULT, 2 $61.00318834109 IMMUNOHISTOCHEMISTRY EA ADD ANTBDY $67.0031883420 IMMUNOHISTOCHEMISTRY EA ANTBDY $67.0031883429 IMMUNOHISTOCHEMISTRY EA ANTBDY $67.0031883460 IMMUNOFLUORESCENT DIRECT EA AB $204.0031883469 IMMUNOFLUORESCENT DIRECT EA AB $204.0031883480 ELECTRON MICROSCOPY DIAGNOSTIC $449.0031883489 ELECTRON MICROSCOPY DIAGNOSTIC $449.0031883600 MANUAL TUMOR IM HISTOCHEM, EA $83.0031883609 MANUAL TUMOR IM HISTOCHEM, EA $83.0031883610 MORPHOMETRIC ANLYS EA AB QUANT $155.0031883619 MORPHOMETRIC ANLYS EA AB QUANT $155.00

31883650 INSITU HYBRIDATION (FISH) EA $57.0031883659 INSITU HYBRIDATION (FISH) EA $55.0031883680 MORPHOMETRIC ANALYSIS INSITU $206.0031883689 MORPHOMETRIC ANALYSIS INSITU $206.0032000900 CORONER'S CASE BASIC (1-2) $124.0032099910 CORONER'S CASE COMPLEX (3-UP) $161.0032475310 CHOLANGIOGRM BILE/PANCR $346.0032475440 CHOLANGIOGRM STONE REM $479.0032516000 INJ FOR CYSTOGRAM $680.0032701100 MANDIBLE MIN 4-VIEWS $260.0032701300 MASTOIDS MIN 3-VIEWS $190.0032701400 ZYGOMATIC ARCHES $126.0032701500 FACIAL BONES $252.0032701600 NASAL BONES $135.0032702000 ORBITS $198.0032702200 SINUSES $223.0032702400 SELLA TURCICA $164.0032702500 SKULL LIMITED $140.0032702600 SKULL $232.0032703300 T.M. JOINTS $182.0032703550 PANOGRAPH (DENTAL) $120.0032703600 NECK SOFT TISSUE $171.0032703900 SIALOGRAM $182.0032710100 CHEST SINGLE VIEW $161.0032710200 CHEST XRAY - 2 VIEW $201.0032710210 CHEST XRAY 2 VIEW W OBLIQUE $243.0032710350 CHEST INS/EXP $129.0032710351 CHEST SPECIAL STUDY $129.0032710352 CHEST SPECIAL STUDY $129.0032710400 BRONCHOGRAM $470.0032710401 BRONCHOGRAM $470.0032710402 BRONCHOGRAM $470.0032710450 CHEST SINGLE VIEW $161.0032710460 CHEST XRAY - 2 VIEW $201.0032710470 CHEST XRAY 3 VIEWS $243.0032710600 BRONCHOGRAM BILAT $515.0032710900 PACEMAKER INSERTION $1,622.0032711000 X-RAY EXAM OF RIBS $232.0032711001 RIBS UNIL - 2 VIEWS LEFT $232.0032711002 RIBS UNIL - 2 VIEWS RIGHT $232.0032711010 RIBS 3 VIEWS UNILATERAL $298.0032711100 RIBS-BILATERAL 3-VIEWS $298.0032711101 RIBS-LEFT 3-VIEWS $258.0032711102 RIBS-RIGHT 3-VIEWS $258.0032711200 STERNUM $141.0032711300 STERNOCLAVICULAR JOINT(S) $148.0032720200 SPINE 1 VIEW CC $164.0032720400 CERVICAL SPINE 2/3V $155.00

32720500 CERVICAL SPINE $255.0032720520 CERVICAL SPINE $224.0032720690 SCOLIOSIS SERIES $204.0032720700 THORACIS SPINE 2-VIEWS $161.0032720720 THORACIC SPINE 3-VIEWS $190.0032720810 X-RAY EXAM ENTIRE SPINE 1 VIEW $204.0032720820 X-RAY ENTIRE SPINE 2/3 VIEWS $204.0032720830 X-RAY EXAM ENTIRE SPINE 4/5 VIEWS $300.0032720840 X-RAY EXAM ENTIRE SPINE 6/> VIEWS $300.0032720900 SPINE/SCOLIOSIS STUDY $131.0032721000 LUMBAR SPINE 2-3 V $226.0032721100 LUMBOSACRAL SPINE MN 4VIE $296.0032721140 LUMBAR SPINE-COMPLETE AND $296.0032721200 LUMBAR SPINE-BENDING VIEW $155.0032721700 PELVIS $178.0032722020 SACROILIAC JOINTS $215.0032722200 SACRUM AND/OR COCCYX $239.0032722400 MYELOGRAPHY CERVICAL $1,133.0032722550 MYELOGRAPHY THORACIC $721.0032722650 MYELOGRAPHY LUMBOSACRAL $1,442.0032730000 CLAVICLE - BILAT $200.0032730001 CLAVICLE - LEFT $145.0032730002 CLAVICLE - RIGHT $145.0032730005 CLAVICLE-BILAT $200.0032730100 SCAPULA - BILAT $217.0032730101 SCAPULA - LEFT $170.0032730102 SCAPULA - RIGHT $170.0032730105 SCAPULA-BILAT $217.0032730201 SHOULDER - LEFT $117.0032730202 SHOULDER - RIGHT $117.0032730205 SHOULDER - BILAT $233.0032730300 SHOULDER - BILATERAL $252.0032730301 SHOULDER - LEFT $181.0032730302 SHOULDER - RIGHT $181.0032730305 SHOULDER-BILATERAL $252.0032730400 ARTHROGRAM - SHOULDER BILAT $824.0032730401 ARTHROGRAM - SHOULDER LEFT $442.0032730402 ARTHROGRAM - SHOULDER RT $442.0032730405 ARTHROGRAM-SHOULDER BILAT $876.0032730500 A C JOINTS $314.0032730600 HUMERUS - BILAT $217.0032730601 HUMERUS - LEFT $131.0032730602 HUMERUS - RIGHT $131.0032730605 HUMERUS - BILAT $217.0032730700 ELBOW 2V - BILAT $231.0032730701 ELBOW 2V - LEFT $145.0032730702 ELBOW 2V- RIGHT $145.0032730705 ELBOW 2V- BILAT $231.00

32730800 ELBOW 3V - BILAT $211.0032730801 ELBOW 3V - LEFT $145.0032730802 ELBOW 3V - RIGHT $145.0032730805 ELBOW 3V - BILAT $211.0032730851 ARTHROGRAM-ELBOW LEFT $618.0032730852 ARTHROGRAM-ELBOW RIGHT $618.0032730855 ARTHROGRAM-ELBOW BILATERAL $979.0032730856 ARTHROGRAM-ELBOW $618.0032730900 FOREARM $186.0032730901 FOREARM - LEFT $155.0032730902 FOREARM - RIGHT $155.0032730905 FOREARM - BILATERAL $186.0032731001 WRIST 2V - LEFT $116.0032731002 WRIST 2V - RIGHT $116.0032731005 WRIST 2V - BILAT $186.0032731100 WRIST 3V- BILAT $217.0032731101 WRIST 3V - LEFT $135.0032731102 WRIST 3V- RIGHT $135.0032731105 WRIST 3V-BILAT $217.0032731151 ARTHROGRAM-WRIST LEFT $979.0032731152 ARTHROGRAM-WRIST RIGHT $979.0032731155 ARTHROGRAM-WRIST BILATERAL $1,442.0032731300 HANDS (BOTH) $206.0032731301 HAND - LEFT $140.0032731302 HAND - RIGHT $140.0032731305 HANDS (BOTH) $186.0032731400 FINGER LEFT HAND-THUMB $103.0032731401 FINGER LEFT HAND - 2ND DIGIT $103.0032731402 FINGER LEFT HAND - 3RD DIGIT $103.0032731403 FINGER LEFT HAND-4TH DIGIT $103.0032731404 FINGER LEFT HAND-5TH DIGIT $103.0032731405 FINGER RIGHT HAND-THUMB $103.0032731406 FINGER RIGHT HAND-2ND DIGIT $103.0032731407 FINGER RIGHT HAND - 3RD DIGIT $103.0032731408 FINGER RIGHT HAND-4TH DIGIT $103.0032731409 FINGER RIGHT HAND-5TH DIGIT $103.0032735000 HIP-UNILATERAL ONE VIEW $186.0032735010 HIP-UNILATERAL ONE VIEW $186.0032735020 X-RAY HIP UNI 2-3 VIEWS - RIGHT $215.0032735021 X-RAY HIP UNI 2-3 VIEWS - LEFT $215.0032735101 HIP 2V- LEFT $215.0032735102 HIP 2V- RIGHT $215.0032735200 HIP-BILATERAL $356.0032735210 X-RAY HIPS BI 2 VIEWS $356.0032735250 HIP FLUOROSCOPY (NO INJ) RT $721.0032735251 ARTHROGRAM-HIP LEFT $721.0032735252 ARTHROGRAM-HIP RIGHT $721.0032735255 ARTHROGRAM-HIP BILATERAL $1,339.00

32735300 HIP NAILING $835.0032735301 HIP NAILING OR - LT $418.0032735302 HIP NAILING OR - RT $418.0032735305 HIP NAILING OR-BIL $835.0032735500 FEMUR $243.0032735501 FEMUR - 2V LEFT $136.0032735502 FEMUR - 2V RIGHT $136.0032735505 FEMUR - BILAT $243.0032735510 X-RAY OF FEMUR 1 VIEW $243.0032735520 X-RAY OF FEMUR 2 />VIEWS BILATERAL $243.0032735521 X-RAY OF FEMUR 2 />VIEWS LEFT $243.0032735522 X-RAY OF FEMUR 2 />VIEWS RIGHT $243.0032735601 KNEE - 2V LEFT $170.0032735602 KNEE - 2V RIGHT $170.0032735605 KNEE - 2V BILAT $272.0032735620 KNEE 3V - BILAT $301.0032735621 KNEE 3V - LEFT $175.0032735622 KNEE 3V - RIGHT $175.0032735625 KNEE 3V-BILAT $301.0032735650 KNEES STANDING BILATERAL $268.0032735800 ARTHROGRAM - KNEE BILAT $754.0032735801 ARTHROGRAM - KNEE LEFT $377.0032735802 ARTHROGRAM - KNEE RIGHT $377.0032735805 ARTHROGRAM -KNEE BILAT $754.0032735900 TIBIA & FIBULA BILAT $235.0032735901 TIBIA & FIBULA LEFT $148.0032735902 TIBIA & FIBULA RIGHT $148.0032735905 TIBIA & FIBULA BILATERAL $235.0032736100 ANKLE 3+VIEWS BILAT $239.0032736101 ANKLE 3+ VIEWS LEFT $150.0032736102 ANKLE 3+ VIEWS RIGHT $150.0032736105 ANKLE BILAT $239.0032736151 ARTHROGRAM-ANKLE LEFT $824.0032736152 ARTHROGRAM-ANKLE RIGHT $824.0032736155 ARTHROGRAM-ANKLE BILATERAL $1,442.0032736200 FOOT 2V BILAT $223.0032736201 FOOT - LEFT 2 VIEWS $137.0032736202 FOOT 2V RIGHT $137.0032736205 FOOT 2V BILAT $223.0032736300 FOOT 3V BILAT $223.0032736301 FOOT 3V LEFT $140.0032736302 FOOT 3V RIGHT $140.0032736305 FOOT 3V BILAT $223.0032736500 OSCALSIS BILAT $182.0032736501 OSCALSIS LEFT $114.0032736502 OSCALSIS RIGHT $114.0032736505 OSCALSIS BILAT $182.0032736600 TOE(S) $129.00

32736601 TOE - LEFT FOOT - 2ND $129.0032736602 TOE - LEFT FOOT - 3RD $129.0032736603 TOE-LEFT FOOT-4TH $129.0032736604 TOE-LEFT FOOT-5TH $129.0032736605 TOE-RIGHT FOOT-GREAT $129.0032736606 TOE-RIGHT FOOT-2ND $129.0032736607 TOE-RIGHT FOOT-3RD $129.0032736608 TOE-RIGHT FOOT-4TH $129.0032736609 TOE-RIGHT FOOT-5TH $129.0032740000 ABDOMEN (KUB) $182.0032740180 ABDOMEN 1 VIEW (KUB) $182.0032740190 ABDOMEN 2 VIEWS $270.0032740200 ABD SUP & UP/OBSTRCT $227.0032740210 ABDOMEN 3 VIEWS $270.0032740220 COMP ACUTE ABD (W CHEST) $227.0032742100 NASOPHARYNX $193.0032742200 ESOPHOGRAM $250.0032742300 BARIUM SWALLOW $368.0032742350 REM FB ESOPH W BALN CATH $52.0032742400 S.C. U.G.I. $451.0032742450 S.C. UGI/SM BOWEL $451.0032742460 UPPER GI SERIES $433.0032742500 SMALL BOWEL SERIES $361.0032742700 BARIUM ENEMA $361.0032742800 BARIUM ENEMA WITH AIR CONTRAST $518.0032742900 G. B. SERIES $227.0032743000 CHOLANGIOGRAM-OR $371.0032743050 CHOLANGIOGRM BILE/PANCR $346.0032743200 PERC. CHOLANGIOGRAPHY $346.0032743270 CHOLANGIOGRM STONE REM $479.0032743280 ERCPB W/BILIARY DUCTS $267.0032743290 ERCP-PANCREATIC DUCTS $631.0032743300 ERCP $496.0032744000 I.V. PYELOGRAM $515.0032744150 NEPHROTOMOGRAM $721.0032744200 CYSTO-RETROGRADE $426.0032744250 NEPHROSTOGRAM $269.0032744300 CYSTOGRAM $396.0032744500 URETHROCYSTOGRAPH $327.0032744550 CYSTOGRAM (VOIDING) $346.0032747400 HYSTERIOSALPINGOGRAM $470.0032756250 AORTOGRAM $3,107.0032757101 ARTERIOGRAM-UPPER LEFT $3,090.0032757102 ARTERIOGRAM-UPPER RIGHT $3,090.0032757160 ARTERIOGRAM-UPPER BILAT $3,474.0032757220 ARTERIO RENAL - LEFT $1,932.0032757240 ARTERIO RENAL BILAT $3,090.0032757910 A-V FISTULAGRAM-DIALYSIS $1,738.00

32758200 VENOGRAM EXTREMITY UNILATERAL $784.0032758201 VENOGRAM LEFT $773.0032758202 VENOGRAM RIGHT $773.0032758220 VENOGRAM BILATERAL $724.0032760000 FLUORO UP TO 1 HR $313.0032760010 FLOURO GREATER THAN 1 HOUR $620.0032760800 FISTULAGRAM-SINUS TRK STU $306.0032760980 MAMMOGRAM BIOPSY SPECIMEN $324.0032760981 MAMMOGRAM BIOPSY SPEC - LEFT $324.0032760982 MAMMOGRAM BIOPSY SPEC - RIGHT $324.0032761000 TOMOGRAPHY SNGPLNBDYSC $387.0032764990 ZYGOMATIC ARCHES $126.0032770010 FLUOROGUIDE FOR VEIN DEVICE $1,841.0032770020 NEEDLE BX/ASPIRATION FLUOROSC $315.0032770021 NEEDLE BX/ASPIRATION FLUOROSC $315.0032770022 NEEDLE BX/ASPIRATION FLUOROSC $315.0032770025 NEEDLE BX/ASPIRATION FLUOROSC $469.0032770030 FLUORO-GUIDANCE(ESI) INJ SPINE $258.0032770530 SINGLE GALACTOGRAM BILAT $431.0032770531 SINGLE INJ GALACTOGRAM LEFT $314.0032770532 SINGLE INJ GALACTOGRAM RIGHT $314.0032770535 SINGLE GALACTOGRAM BILAT $431.0032770540 MULT INJ-GALACTOGRAM BILAT $493.0032770541 MULT INJ GALACTOGRAM LT $392.0032770542 MULT INJ GALACTOGRAM RIGHT $392.0032770545 MULT INJ-GALACTOGRAM BILAT $493.0032770720 BONE AGE STUDIES $156.0032770730 SCANOGRAM $182.0032770740 LONG BONES (ADULT) $294.0032770750 METASTATIC SERIES $340.0032770760 JOINT SURVEY 1V 1+JOINTS $249.0032939230 UPR/LXTR ART STDY 3+ LVLS $454.0034000010 DIPYRIDAMOLE (PERSANTINE-10MG) $56.0034000020 I-123 SODIUM IODIDE CAPSULE $46.0034000040 TECHNETIUM TC 99M MEDRONATE $40.0034000060 TECHNETIUM TC 99M SESTAMIBI PER DOSE $206.0034000070 TECHNETIUM TC 99M TETRIFISMON $165.0034000090 TECHNETIUM TC99M (ULTRATAG) $75.0034000120 TECHNETIUM TC-99M MACROAG ALBU $165.0034000140 TECHNETIUM TC-99M MEBROFENIN $165.0034000160 TECHNETIUM TC99M MERTIATIDE $165.0034000161 TECHNETIUM TC99M AEROSOL =<75MCI $165.0034000170 TECHNETIUM TC-99M PER TECHNETA $165.0034000190 TECHNETIUM TC-99M SULFUR CLLD $165.0034000200 TECHNETIUM TC99M TETRO $165.0034000210 TESTICULAR SCAN $471.0034000230 THALLOUS CHLORIDE TL 201/MCI $81.0034000300 XENON XE133 10MCI (GAS) $75.00

34780060 THYROID SCAN W UPTK SNGL $431.0034780120 THYROID SCAN W UPTK SNGL $431.0034780130 THYROID SCAN TC $354.0034780140 THYROID IMAGING W/BLOOD FLOW $580.0034780700 PARATHYROID IMAGING $535.0034781850 SPLENN SCAN $309.0034781950 LYMPH NODE SCINTIGRAPHY $846.0034782010 LIVER IMAGING; STATIC ONLY $472.0034782050 HEMANGIOMA SCAN/LABLD RBC $598.0034782150 LIVER AND SPLEEN SCAN (STATIC) $657.0034782160 LIVER AND SPLEEN SCAN (VFLOW) $657.0034782230 HEPATOBILIARY SCAN (DUCT) $747.0034782260 HEPATOBILIARY SCAN W GALLBLADDER $747.0034782640 GASTRIC EMPTYING STUDY $927.0034782780 GI BLEEN (TAGGED RBC) $717.0034783000 BONE IMAGING; LIMITED AREA $393.0034783060 BONE SCAN; WHOLE BODY $785.0034783150 THREE PHASE BONE SCAN $1,011.0034783200 BONE SPECT $626.0034784510 CARD PERFUS; SPECT SGL $883.0034784520 HT MUSCLE IMAGE SPECT, MULTIPL $1,811.0034784660 PYROPHOSPHATE CARDIAC $464.0034784720 HEART-MUGA $766.0034784730 CARDIAC GATED BLOOD POOL/MULT $747.0034784780 CARDIAC PERFUSION W WM $464.0034784800 MYOCARDIAL PERFUSION EJEC $464.0034785790 LUNG VENTILATION IMAGING $1,000.0034785800 LUNG SCAN-PERFUSION $788.0034785820 LUNG VENT & PERF IMAGING $1,110.0034785930 LUNG VENT IMAGING; GAS; SINGLE $382.0034785940 LUNG VENT IMAGING; GAS; MULT $382.0034787010 KIDNEY IMAGING WITH FLOW $1,030.0034787070 RENAL SCAN W/VASCULAR FLO $762.0034787080 LASIX RENAL SCAN $1,030.0034787090 RENAL SCAN W/CAPTOPRIL-MU $902.0034787610 TESTICULAR SCAN $471.0034788000 TUMOR IMAGING; LIMITED AREA $382.0034788010 GALLIUM MULTIPLE RETURN $470.0034788030 GALLIUM SCAN - SPECT $829.0034788050 GALLIUM LIMITED RETURN $1,036.0034788060 GALLIUM WHOLE BODY $1,036.0034952101 TECHNETIUM TC-99M EXAMETAZIME $1,274.0034952102 TC99 TILMANOCEPT DIAGNOSTIC $1,274.0034996200 Z CON VISI 300-349MG ML $26.0034A95580 XENON XE133 10MCI (GAS) $75.0035002970 LDCT FOR LUNG CA SCREEN $1,250.0035704500 CT HEAD W/O CONTRAST $870.0035704600 CT HEAD W/CONTRAST $870.00

35704700 CT HEAD W/O & W/CONTRAST $870.0035704800 CT - ORBIT SELLA MID/INNER EAR WO CONT $870.0035704810 CT - ORBIT SELLA MID/INNER EAR W CONTR $1,164.0035704820 CT - ORBIT SELLA MID/INNER EAR W & WO $1,329.0035704860 CT FACIAL BONES W/O CNTR $870.0035704870 CT MAXILLOFACIAL WITH CONTRAST $870.0035704880 CT MAXILLOFACIAL W&W/O CONTRST $1,396.0035704900 CT NECK THYROID W/O CONTRAST $870.0035704910 CT NECK THYROID W/CONTRAST $870.0035704920 CT NECK THYROID W/O & W $870.0035704960 CTA-HEAD $1,815.0035704980 CTA-NECK $1,853.0035712500 CT CHEST W/O CONTRAST $870.0035712600 CT CHEST W/CONTRAST $870.0035712700 CT CHEST W/WO CONTRAST $870.0035712750 CT ANGIOGRAPHY CHEST $870.0035721250 CT C-SP W/O CONTRAST $870.0035721260 CT-C-SPINE WITH CONTRAST $1,854.0035721270 CT-C-SPINE W AND W/O CONTRAST $2,060.0035721280 CT T-SP W/O CONTRAST $870.0035721290 CT T-SP WITH CONTRAST $1,906.0035721300 CT T-SP W AND W/O CONTRAST $2,060.0035721310 CT LUMBAR SPINE W/O $870.0035721320 CT LUMBAR SPINE WITH CONTRAST $2,060.0035721330 CT-LUMBAR SP W AND W/O CONTRAS $2,060.0035721920 CT PELVIS W/O C $870.0035721930 CT PELVIS W C $870.0035721940 CT PELVIS W/O & W $1,906.0035732000 CT EXT UPPER W/O BILAT $1,051.0035732001 CT EXT UPPER W/O LT $870.0035732002 CT EXT UPPER W/O RT $870.0035732005 CT EXT UPPER W/O BILAT $1,051.0035732010 CT ARM WITH CONTRAST - BILAT $1,854.0035732011 CT ARM WITH CONTRAST - LEFT $870.0035732012 CT ARM WITH CONTRAST - RIGHT $870.0035732015 CT ARM WITH CONTRAST BILAT $1,854.0035732020 CT EXT UPPER WO & W BIL $2,100.0035732021 CT EXT UPPER WO & W LT $1,156.0035732022 CT EXT UPPER WO & W RT $1,156.0035732025 CT EXT UPPER W/O & W BIL $2,100.0035732060 CT STERNOCLAVICLE $1,545.0035732061 CTA-UPPER EXT-L $1,455.0035732062 CTA-UPPER EXT-R $1,455.0035732065 CTA-UPPER EXT BILAT $2,060.0035737000 CT EXT LOWER W/O BIL $1,809.0035737001 CT EXT LOWER W/O LT $870.0035737002 CT EXT LOWER W/O RT $870.0035737005 CT EXT LOWER W/O BIL $1,809.00

35737010 CT-LWR EXT W CONTRAST - BILAT $1,545.0035737011 CT-LWR EXT W CONTRAST - LEFT $870.0035737012 CT-LWR EXT W CONTRAST - RIGHT $870.0035737015 CT-LWR EXT W CONTRAST-BILAT $1,545.0035737020 CT EXT LOWER W/O&W BIL $2,124.0035737021 CT EXT LOWER W/O&W LT $1,062.0035737022 CT EXT LOWER W/O & W RT $1,062.0035737025 CT EXT LOWER W/O & W BIL $2,124.0035737060 CTA LOWER EXT BILAT $1,162.0035737061 CTA LOWER EXT LEFT $970.0035737062 CTA LOWER EXT RIGHT $970.0035737065 CTA LOWER EXT BILAT $1,162.0035741500 CT ABDOMEN W/O CONTRAST $870.0035741600 CT ABDOMEN W/CONTRAST $870.0035741700 CT ABD W/O & W $870.0035741740 CT ANGIO ABD & PELV W/WO DYE $870.0035741750 CT ANGIO ABDOMEN W/WO DYE $630.0035741760 CT ABD & PELVIS W/O CONTRAST $1,030.0035741770 CT ABD & PELVIS W/ CONTRAST $870.0035741780 CT ABD & PELVIS 1+SECTION/REG $870.0035742610 CT COLONOSCOPY - W/O DYE $1,236.0035759890 CT ABSCESS DRAIN KIDNEY $970.0035763760 3D RENDER W/O POSTPROCESS $314.0035763770 3D RENDER W POSTPROCESS $314.0035763800 CT LIMITED OR FOLLOW-UP STUDY $515.0035764970 UNLISTED CT $1,133.0035770120 CT GUIDED NEEDLE BIOPSY $500.0035770780 BONE DENSITY $412.0035770790 SINGLE INJ-GALACTOGRAM LT $361.0036000000 SURGERY PROC LEVEL 0 CXLD IN OR $125.0036000001 SURGERY PROCEDURE LEVEL 1 $773.0036000002 SURGERY PROCEDURE LEVEL 2 $1,545.0036000003 SURGERY PROCEDURE LEVEL 3 $2,060.0036000004 SURGERY PROCEDURE LEVEL 4 $3,090.0036000005 SURGERY PROCEDURE LEVEL 5 $4,120.0036000006 BREAST BIOPSY DEVICE $155.0036000007 TISSUE MARKER $180.0036000030 1 MIN - 30 MINS $309.0036000034 MINS - EACH ADDTL 30 MIN $309.0036000060 31 MINS - 60 MINS $1,379.0036000090 61 MINS - 90 MINS $1,706.0036000120 91 MINS - 120 MINS $1,969.0036000150 121 MINS - 150 MINS $2,297.0036000180 151 MINS - 180 MINS $2,494.0036000190 181 MINS - 210 MINS $2,756.0036190830 BX BREAST 1ST LESION U/S IMAGING $1,030.0036190840 BX BREAST EACH LESION AFTER 1ST ADD-ON $500.0036191030 PERC BRST BX - AUTO VA/DEVICE $1,339.00

36191200 REMOVAL OF BREAST LESION 1+ $4,823.0036191260 EXC BREAST LES BY N LOC; EA ADDTL $103.0036192810 PERQ DEVICE BREAST 1ST IMAGE $404.0036192820 PERQ DEVICE BREAST EACH IMAGE $103.0036192850 PERQ DEVICE BREAST 1ST US IMAGE $404.0036192950 PLACE BREAST CLIP PERCUT $309.0036202060 MUSCLE BX; PERC NDL $2,575.0036202200 BONE BX TR/NDL; SUPERF $2,022.0036206000 DRAIN/INJECT, SML JOINT/BURSA $251.0036206051 US GUIDE DRAIN/INJ WRIST/ELBOW/ANKLE LT $258.0036206052 US GUIDE DRAIN/INJ WRIST/ELBOW/ANKLE RT $258.0036206100 US GUIDE DRAIN/INJECT, MAJOR JOINT/BURS $251.0036206101 US GUIDE DRAIN/INJ SHOULDER/HIP/KNEE LT $258.0036206102 US GUIDE DRAIN/INJ SHOULDER/HIP/KNEE RT $258.0036206105 US GUIDE DRAIN/INJ SHOULDER/HIP/KNEE BIL $515.0036233500 SHOULDER ARTHROGRAM INJECTION $500.0036242200 ELBOW ARTHROGRAPHY INJECTION $309.0036252460 WRIST ARTHROGRAPHY INJECTION $309.0036270930 HIP ARTHROGRAPHY INJ WO ANES R $309.0036270931 HIP ARTHROGRAPHY INJ WO ANES L $680.0036270932 HIP ARTHROGRAPHY INJ WO ANES RT $680.0036270935 HIP ARTHROGRAPHY INJ WO ANES BILATERAL $515.0036270950 HIP ARTHROGRAPHY INJ W ANES RT $1,030.0036270951 HIP ARTHROGRAPHY INJ W ANES LT $1,030.0036270952 HIP ARTHROGRAPHY INJ W ANES RT $1,030.0036270960 INJECT SACROILIAC JOINT (LT) $824.0036270961 INJECT SACROILIAC JOINT (LT) $824.0036270962 INJECT SACROILIAC JOINT (RT) $824.0036270963 INJECT SACROILIAC JOINT (RT) $824.0036273700 KNEE ARTHROGRAPHY INJECTION $412.0036276480 ANKLE ARTHROOGRAPHY INJECTION $309.0036365690 INSERT PICC CATH (SUMMIT VAS) $1,178.0036365694 INSERT PICC CATH (SUMMIT VAS) $1,178.0036365840 REPLACE PICC CATH (SUMMIT VAS) $1,178.0036365844 REPLACE PICC, AGE 5 YRS/> $1,178.0036382200 BONE MARROW ASPIRATION ONLY $273.0036382210 BONE MARROW BIOPSY $273.0036387920 RA TRACER ID OF SENTINL NODE $350.0036410100 SKIN SUBSTITUTE APLIGRAF SQ CM $2,575.0036490834 ADBOMINAL PARACENTESIS W/IMAGING $780.0036494650 FLUORO EXAM OF G/COLON TUBE $361.0036505900 LITHOTRIPSY INVOICE - MIDWEST $5,279.0036505904 LITHOTRIPSY INVOICE-MIDWEST $5,279.0036526010 GREENLIGHT LASER $2,254.0036526011 GREENLIGHT FIBER $2,434.0036583400 CATH & INTRO OF SALINE OR CONTRAST $155.0036622840 MYLOGRAM INJ $515.0036963650 INFUSION UP TO 1 HOUR $188.00

36963660 IV INFUSION EACH ADDTL $112.0036963720 THER/PROPH/DIAG INJ, SC/IM $37.0036963724 THER/PROPH/DIAG INJ, SC/IM $37.0036963730 THER/PROPH/DIAG INJ, IA $141.0036963734 THER/PROHP/DIAG INJ, IA $141.0037000180 ANESTHESIA UP TO/INC FIRST 15 MINUTES $206.0037000200 ANESTHESIA EACH MIN AFTER 15 MINUTES $11.0038364305 BLOOD TRANSFUSION PER DAY $780.0039364300 BLOOD TRANSFUSION $760.0039869450 IRRADIATE BLD PRODUCT $127.0039869990 UNLISTED TRANSFUSION MED $212.0039901200 CRYOPRECIPITATE EACH UNIT $76.0039901600 RBC LEUKOCYTES REDUCED $253.0039901700 PLASMA 1 DONOR FRZ W/IN 8 HR $202.0039902100 RED BLOOD CELLS 1 UNIT $200.0039902200 WASHED RED BLOOD CELLS $1,024.0039903400 PLATELETS; PHERESES $721.0039903500 PLATELETS PHERESIS LR $1,211.0039903700 PLATELETS PHERESIS LR IRRAD $1,463.0039904000 RBC LR IRRADIATED $622.0039904400 CRYOPR REDUCED PLASMA $127.0039905400 WSH LR FROZ DW WB/RBC $1,162.0039905700 RBC FROZ LEUK REDUC IRRAD $1,288.0039905900 FFP 8-24 HRS OF COLLECTION $127.0039906000 FFP DONOR RETSTD $128.0040100220 FINE NEEDLE ASPIRATION W/IMAGE $1,100.0040206060 DRAIN/INJ INTER JOINT/BURSA W/US $518.0040206110 DRAIN/INJ MAJOR JOINT/BURSA W/US $518.0040765060 HEAD ULTRASOUND $363.0040765360 NECK - SOFT TISSUE $581.0040766040 CHEST ULTRASOUND $382.0040766410 BREAST COMPLETE - BILAT $340.0040766411 BREAST COMPLETE- LEFT $325.0040766412 BREAST COMPLETE - RIGHT $325.0040766421 BREAST LIMITED - LEFT $325.0040766422 BREAST LIMITED - RIGHT $325.0040766425 BREAST LIMITED - BILAT $340.0040766450 BREAST - BILAT $340.0040766451 BREAST - LEFT $325.0040766452 BREAST - RIGHT $325.0040767000 ABDOMEN MULTI ORGAN $454.0040767050 ABDOMEN LIMITED $454.0040767700 KIDNEY COMPLETE (ABDO) $468.0040767750 AORTA DUPLEX SCAN $605.0040768000 ULTRASOUND SPINAL CANAL (BACK) $567.0040768010 ULTRASOUND PREG SINGLE <14 WEEKS $294.0040768020 PREG <14 ADDTL GESTATION $454.0040768050 PREGNANCY > THAN 14 WKS 1 $406.00

40768100 PREG >= 14 ADDTL GESTATION $642.0040768110 OB COMPLETE $325.0040768120 OB COMPLETE ADDTL GESTATION $217.0040768150 OB LIMITED $308.0040768160 OB US FOLLOWUP - ABNORMAL PER FETUS $222.0040768170 TRANSVAGINAL OB $428.0040768180 BIOPHYSICAL PROFILE $637.0040768300 TRANSVAGINAL NON-OB ULTRASOUND $342.0040768310 HYSTEROSONOGRAM $282.0040768560 PELVIC GENERAL $433.0040768570 PELVIC LIMITED $280.0040768700 TESTICULAR US $395.0040768720 PROSTATE ULTRASOUND $348.0040768730 PROSTATE VOL STUDY $602.0040768811 EXTREMITY LEFT NON-VAS COMPLETE $363.0040768812 EXTREMITY RIGHT NON-VAS COMPLETE $363.0040768815 EXTREMITY-BILAT NON-VAS COMPLETE $377.0040768821 EXTREMITY LEFT NON-VAS, LIMITED, SPEC $258.0040768822 EXTREMITY RIGHT NON-VAS, LIMITED SPEC $258.0040768825 EXTREMITY NON-VAS, LIMITED $515.0040769370 US GUIDE, VASCULAR ACCESS PICC $340.0040769420 US GUIDED NEEDLE PLACEMENT SUP/INT $354.0040769460 AMNIOCENTESIS $340.0040769990 GENITALIA $174.0040770510 CAD DIAGNOSTIC MAMMOGRAPHY $169.0040770520 CAD SCREENING MAMMOGRAPHY $78.0040770550 MAMMOGRAM-UNILATERAL-DIGITIAL $165.0040770551 MAMMOGRAM DIAG LEFT - DIGITAL $165.0040770552 MAMMOGRAM DIAG - RIGHT - DIGITIAL $165.0040770560 MAMMOGRAM DIAG-BILATERAL - DIGITAL $243.0040770570 MAMMOGRAM SCREENING - DIGITIAL $206.0040770571 MAMMOGRAM SCREENING - LT ONLY - DIGITAL $119.0040770572 MAMMOGRAM SCREENING - RT ONLY - DIGITAL $119.0040770650 DIAG MAMM LEFT INCLUDING CAD $169.0040770651 DIAG MAMM RIGHT INCLUDING CAD $169.0040770660 DIAG MAMM BIL INCLUDING CAD $338.0040770670 SCREENING MAMM BILAT W CAD $338.0040770671 SCREENING MAMM BILAT W CAD $338.0041366000 ARTERIAL PUNCTURE $27.0041940020 VENT ASST DAY 1 ADJ & PRESSURE $995.0041940030 VENT ASST SUBSEQUENT DAYS $995.0041946200 PULMONARY STRESS TEST/SIMPLE $257.0041946201 PULMONARY STRESS TEST/SIMPLE $257.0041946400 AIRWAY INHALATION TREATMENT $62.0041946570 VENT ASST SUBSEQUETN DAYS $204.0041946600 CPAP INITIATION MANAGEMNT $170.0041946640 AEROSOL TX SPUTUM $45.0041946670 POSTURAL DRAINAGE $89.00

42089780 MOBILITY CURRENT STATUS $1.0042089781 MOBILITY CURRENT STATUS $1.0042089790 MOBILITY GOAL STATUS $1.0042089791 MOBILITY GOAL STATUS $1.0042089800 MOBILITY DC STATUS $1.0042089801 MOBILITY DC STATUS $1.0042089810 BODY POS CURRENT STATUS $1.0042089811 BODY POS CURRENT STATUS $1.0042089820 BODY POS GOAL STATUS $1.0042089821 BODY POS GOAL STATUS $1.0042089830 BODY POS D/C STATUS $1.0042089831 BODY POS D/C STATUS $1.0042089840 CARRY CURRENT STATUS $1.0042089841 CARRY CURRENT STATUS $1.0042089850 CARRY GOAL STATUS $1.0042089851 CARRY GOAL STATUS $1.0042089860 CARRY D/C STATUS $1.0042089861 CARRY D/C STATUS $1.0042089870 SELF CARE CURRENT STATUS $1.0042089871 SELF CARE CURRENT STATUS $1.0042089880 SELF CARE GOAL STATUS $1.0042089881 SELF CARE GOAL STATUS $1.0042089890 SELF CARE D/C STATUS $1.0042089891 SELF CARE D/C STATUS $1.0042089900 OTHER PT CURRENT STATUS $1.0042089901 OTHER PT CURRENT STATUS $1.0042089910 OTHER PT GOAL STATUS $1.0042089911 OTHER PT GOAL STATUS $1.0042089920 OTHER PT D/C STATUS $1.0042089921 OTHER PT D/C STATUS $1.0042089930 SUBSEQUENT PT CURRENT STATUS $1.0042089931 SUBSEQUENT PT CURRENT STATUS $1.0042089940 SUBSEQUENT PT GOAL STATUS $1.0042089941 SUBSEQUENT PT GOAL STATUS $1.0042089950 SUBSEQUENT PT D/C STATUS $1.0042089951 SUBSEQUENT PT D/C STATUS $1.0042645500 TENS $106.0042645501 TENS $106.0042909010 BIOFEEDBACK - M $81.0042909011 BIOFEEDBACK - M $81.0042958310 MANUAL MUSCLE TEST EXTREMITY $83.0042958311 MANUAL MUSCLE TEST EXTREMITY $83.0042958320 MUSCLE TST-MAN HAND $83.0042958321 MUSCLE TST-MAN HAND $83.0042958510 RANGE OF MOTION TEST EXTREMITY $83.0042958511 RANGE OF MOTION TEST EXTREMITY $83.0042958520 RANGE OF MOTION HAND $83.0042958521 RANGE OF MOTION HAND $83.00

42970010 PT EVALUATION $134.0042970011 PT EVALUATION $134.0042970020 PT RE-EVALUATION $83.0042970021 PT RE-EVALUATION $83.0042970100 PHYS THPY HOT/COLD PACKS $53.0042970101 PHYS THPY HOT/COLD PACKS $53.0042970120 TRACTION MECHANICAL $67.0042970121 TRACTION MECHANICAL $67.0042970140 E STIM UNATTENDED WO $78.0042970141 E STIM UNATTENDED WO $78.0042970160 VASOPNEUMATIC DEVIC $67.0042970161 VASOPNEUMATIC DEVIC $67.0042970180 PARAFFIN BATH $67.0042970181 PARAFFIN BATH $67.0042970220 PHYS THPY WHIRLPOOL $114.0042970221 PHYS THPY WHIRLPOOL $114.0042970240 DIATHERMY $78.0042970241 DIATHERMY $78.0042970320 ELEC STIMULATION MAN (15MIN) $120.0042970321 ELEC STIMULATION MAN (15MIN) $120.0042970330 IONTOPHORESIS 15 MIN $103.0042970331 IONTOPHORESIS 15 MIN $103.0042970340 CONTRAST BATH $56.0042970341 CONTRAST BATH $56.0042970350 PHONOPHORESIS $103.0042970351 PHONOPHORESIS $103.0042970390 PHYS THPY JOINT TAPING $62.0042970391 PHYS THPY JOINT TAPING $62.0042971100 PHYS THERAPY EXERCISE THERAPY $79.0042971101 PHYS THERAPY EXERCISE THERAPY $79.0042971120 NEUROMUSCULAR RE-EDU $73.0042971121 NEUROMUSCULAR REEDUCATION EA 15 MINS $73.0042971160 GAIT TRAINING $73.0042971161 GAIT TRAINING $73.0042971240 MASSAGE $73.0042971241 MASSAGE $73.0042971400 PHYS THPY MANUAL THERAPY $93.0042971401 PHYS THPY MANUAL THERAPY $93.0042971500 THERAPEUTIC REHAB GROUP $93.0042971501 THERAPEUTIC REHAB GROUP $93.0042971610 PT EVAL - LOW $134.0042971611 PT EVAL - LOW $134.0042971620 PT EVAL - MOD $134.0042971621 PT EVAL - MOD $134.0042971630 PT EVAL - HIGH $134.0042971631 PT EVAL - HIGH $134.0042971640 PT RE-EVALUATION $83.0042971641 PT RE-EVALUATION $83.00

42975300 THERAPEUTIC ACTIVITIES (15 MIN $73.0042975301 THERAPEUTIC ACTIVITIES (15 MIN $73.0042975330 SENSORY INTEGRATION $79.0042975331 SENSORY INTEGRATION $79.0042975370 COMMUNITY WORK REINTEGRATION $62.0042975371 COMMUNITY WORK REINTEGRATION $62.0042975420 WHEELCHAIR MANAGEMENT $67.0042975421 WHEELCHAIR MANAGEMENT $67.0042975970 DEBRIDE; DEVITAL TIS <20 CM CM $309.0042975971 DEBRIDE; DEVITAL TIS <20 CM CM $309.0042977500 FUNCTIONAL CAPACITY EVALUATION $78.0042977501 FUNCTIONAL CAPACITY EVALUATION $78.0042977600 ORTHO FITTING & TRAINING (15MI $81.0042977601 ORTHO FITTING & TRAINING (15MI $81.0042977610 PROSTHETIC TRAINING $71.0042977611 PROSTHETIC TRAINING $71.0042999991 PT THERAPY CXLD/RESCHEDULED $0.0042999999 PT THERAPY CXLD/RESCHEDULED $0.0042G02830 PT - UNATTENDED ELECT STIMULTN $78.0042G02831 PT - UNATTENDED ELECT STIMULTN $78.0043089780 MOBILITY CURRENT STATUS $1.0043089790 MOBILITY GOAL STATUS $1.0043089800 MOBILITY DC STATUS $1.0043089810 BODY POS CURRENT STATUS $1.0043089820 BODY POS GOAL STATUS $1.0043089830 BODY POS D/C STATUS $1.0043089840 CARRY CURRENT STATUS $1.0043089850 CARRY GOAL STATUS $1.0043089860 CARRY D/C STATUS $1.0043089870 SELF CARE CURRENT STATUS $1.0043089880 SELF CARE GOAL STATUS $1.0043089890 SELF CARE D/C STATUS $1.0043089900 OTHER PT CURRENT STATUS $1.0043089910 OTHER PT GOAL STATUS $1.0043089920 OTHER PT D/C STATUS $1.0043089930 SUBSEQUENT PT CURRENT STATUS $1.0043089940 SUBSEQUENT PT GOAL STATUS $1.0043089950 SUBSEQUENT PT D/C STATUS $1.0043410201 OCC MED SPLINT SUPPLY $721.0043970030 OCCUPATIONAL THERAPY EVALUATIO $265.0043975350 DAILY LIVING ACTIVITY TRAINING $62.0043977600 ORTHO FITTING & TRAINING (15MI $81.0043977620 C/O FOR ORTHOTIC/PROSTH USE EA 15 MINS $219.0044089960 SWALLOW CURRENT STATUS $1.0044089970 SWALLOW GOAL STATUS $1.0044089980 SWALLOW D/C STATUS $1.0044089990 MOTOR SPEECH CURRENT STATUS $1.0044091580 MOTOR SPEECH D/C STATUS $1.00

44091590 LANG COMP CURRENT STATUS $1.0044091600 LANG COMP GOAL STATUS $1.0044091610 LANG COMP D/C STATUS $1.0044091620 LANG EXPRESS CURRENT STATUS $1.0044091630 LANG EXPRESS GOAL STATUS $1.0044091640 LANG EXPRESS D/C STATUS $1.0044091650 ATTEN CURRENT STATUS $1.0044091660 ATTEN GOAL STATUS $1.0044091670 ATTEN D/C STATUS $1.0044091680 MEMORY CURRENT STATUS $1.0044091690 MEMORY GOAL STATUS $1.0044091700 MEMORY D/C STATUS $1.0044091710 VOICE CURRENT STATUS $1.0044091720 VOICE GOAL STATUS $1.0044091730 VOICE D/C STATUS $1.0044091740 OTHER SLP CURRENT STATUS $1.0044091750 OTHER SLP GOAL STATUS $1.0044091760 OTHER SLP D/C STATUS $1.0044091860 MOTOR SPEECH GOAL STATUS $1.0044925060 SPEECH/HEARING EVALUATION $168.0044925070 SPEECH/HEARING THERAPY $82.0044925080 SPEECH/HEARING THERAPY (GROUP) $60.0044925260 SP THPY ORAL FUNCTION THERAPY $85.0044926050 EVAL FOR NONSPEECH DEVICE RX $60.0044926060 SP THPY NON-SPEECH DEVICE SVC $60.0044926070 1 HR EXAM FOR SPEECH DVC RX $60.0044926090 SPEECH DEVICE SERVICE $60.0044926100 EVALUATE SWALLOWING FUNCTION $209.0044926110 SPCH THPY MODIFIED BARIUM SWAL $451.0044961050 ASSESSMENT OF APHASIA $195.0044961100 SP THPY DEVELOPMENTAL TEST $190.0044961110 SP THPY DEVELOPMENTAL TEST EXT $195.0044975320 COGNITIVE SKILLS DEVELOPMENT $87.0044975330 SPCH THPY SENSORY INTEGRATION $79.0044975350 SELF CARE MANAGEMENT TRAINING $62.0044975370 COMMUNITY/WORK INTEGRATION $60.0045090013 TREATMENT ROOM $62.0045100600 DRAINAGE SKIN ABSCESS (SIMPLE) $350.0045100610 DRAINAGE OF SKIN ABSCESS (MULT $397.0045100800 I&D PILONIDAL CYST SIMPLE $350.0045101200 INCISION & REM FB SQ - SIMPLE $350.0045101210 INC & REM FB, SQ; COMPLICATED $1,793.0045101400 DRAINAGE & INCISION OF HEMATOMA/FLUID $1,248.0045101600 PUNCT ASPIR ABSCESS/HEMA/CYST $350.0045110400 DEBRIDE; SKIN, PARTIAL THICKNS $412.0045110420 DEBRIDE SKIN/TISSUE $288.0045112000 REMOVAL SKIN TAGS $86.0045113000 SHAVE LES,T/A/L; 0.5CM/< $124.00

45113010 SHAVE LES,T/A/L; 0.6-1.0CM $93.0045113020 SHAVE LES,T/A/L; 1.1-2.0CM $155.0045113030 SHAVE LES,T/A/L; > 2.0CM $155.0045113050 SHAVE LES,S/N/H/F/G; 0.5CM $114.0045113060 SHAVE LES,S/N/H/F/G;0.6-1.0 $114.0045113070 SHAVE LES,S/N/H/F/G;1.1-2.0 $165.0045113080 SHAVE LES,S/N/H/F/G;> 2.0CM $114.0045113100 SHAVE LES,F/E/N/L; 0.5CM/< $145.0045113110 SHAVE LES,F/E/N/L;0.6-1.0CM $145.0045113120 SHAVE LES,F/E/N/L; 1.1-2.0CM $165.0045113130 SHAVE LES,F/E/N/L;>2.0CM $155.0045114030 EXC, BEN LES,T/A/L; 2.1-3.0CM $958.0045114040 EXC, BEN LES,T/A/L;3.1-4.0CM $1,236.0045114060 EXC, BEN LES,T/A/L; >4.0CM $1,545.0045114200 EXC, BLES,S/N/EX,G;0.5CM/< $927.0045114210 EXC, BLES,S/N/EX,G;0.6-1.0CM $876.0045114220 EXC, BLES,S/N/EX,G;1.1-2.0CM $927.0045114230 EXCISION 2.1-3.0 CM $1,738.0045114240 EXC, BLES,S/N/EX,G;3.1-4.0CM $1,288.0045114260 EXC, BLES,S/N/EX,G;> 4.0CM $1,829.0045114400 EXCISION FACE 0.5 CM OR LESS $465.0045114410 EXC FACE-MM B9+MARG 0.6-1 CM $618.0045114420 EXC FACE-MM B9+MARG 1.1-2 CM $824.0045114430 EXC FACE-MM B9+MARG 2.1-3 CM $876.0045114440 EXC FACE-MM B9+MARG 3.1-4 CM $876.0045114460 EXC FACE-MM B9+MARG > 4 CM $1,700.0045117300 REMOVAL OF NAIL PLATE $103.0045117400 DRAIN BLOOD FROM UNDER NAIL $32.0045117500 REMOVAL OF NAIL BED $465.0045117600 REPAIR NAIL BED $361.0045117650 EXCISION OF NAIL FOLD, TOE $158.0045120010 SREP S/N/A/G/TR/E 2.5CM< $225.0045120020 SREP S/N/A/G/TR/E 2.6-7.5CM $225.0045120040 SREP S/N/A/G/TR/E 7.6-12.5CM $225.0045120050 SREP S/N/A/G/TR/E 12.6-20.0CM $225.0045120060 REPAIR WOUND 20.1-30.0CM $139.0045120070 REPAIR SUPERFICIAL WOUND > 30C $248.0045120110 SREP F/E/N/L/MM 2.5CM OR LESS $225.0045120130 SREP F/E/N/L/MM 2.6-5.0CM $225.0045120140 SREP F/E/N/L/MM 5.1-7.5CM $225.0045120150 SREP F/E/N/L/MM 7.6-12.5CM $225.0045120160 REPAIR FACE WOUNDS 12.6-20.0CM $139.0045120170 REPAIR FACE WOUNDS 20.1-30.0CM $139.0045120180 REPAIR FACE WOUNDS >30.0CM $139.0045120200 TX SUPERF WND DEHISCENCE SMPLE $694.0045120210 SMPLE TX WOUND DEHIS C PACKING $227.0045120310 INTMD WND RPR S/A/T/EXT <= 2.5 CM $228.0045120320 INTMD WND RPR S/A/T/EXT 2.6-7.5CM $228.00

45120340 INTM WND REPR S/TR/EXT 7.6-12.5 CM $580.0045120350 LAYER CLOSE WOUND(S) 12.6-20.0 $228.0045120360 LAYER CLOSE WOUND(S) 20.1-30.0 $228.0045120370 LAYER CLOSE WOUND(S) >30.0CM $228.0045120410 LAYER CLOSE WOUND(S) 2.5CM>= $228.0045120420 LAYER CLOSE WOUND(S) 2.6-7.5CM $228.0045120440 LAYER CLOSE WOUND(S) 7.6-12.5C $228.0045120450 LAYER CLOSE WOUND(S) 12.6-20.0 $228.0045120460 LAYER CLOSE WOUND(S) 20.1-30.0 $228.0045120470 LAYER CLOSE WOUND(S) >30.0CM $228.0045120510 INTMD WND RPR FACE/MM =< 2.5 CM $228.0045120520 LAYER CLOSE WOUND(S) 2.6-5.0CM $228.0045120530 LAYER CLOSE WOUND(S) 5.1-7.5CM $228.0045120540 LAYER CLOSE WOUND(S) 7.6-12.5C $228.0045120550 LAYER CLOSE WOUND(S) 12.6-20.0 $228.0045120560 LAYER CLOSE WOUND(S) 20.1-30.0 $228.0045120570 LAYER CLOSE WOUND(S) >30.0CM $228.0045131000 REPAIR CMPLX TRUNK 1.1-2.5CM $706.0045131010 REPAIR CMPLX TRUNK 2.6-7.5CM $706.0045131020 REPAIR CMPLX TRUNK EA ADD 0-5C $363.0045131200 COMPLEX REPAIR 1.1-2.5CM $228.0045131210 CREP SCALP ARMS LEGS 2.6-7.5CM $489.0045131220 COMPLEX REPAIR EACH ADDTL <=5C $309.0045131310 COMPLEX REPAIR 1.1-2.5CM FACE HANDS FEET $489.0045131320 CREP F/G/H/F 2.6-7.5 CM $489.0045131330 COMPLEX REPAIR EA ADDTL <=5CM $489.0045131500 COMPLEX REPAIR FACE <=1.0CM $489.0045131510 COMPLEX REPAIR FACE 1.1-2.5CM $489.0045131520 COMPLEX REPAIR FACE 2.6-7.5CM $489.0045131530 CMPLX REPAIR FACE EA ADDTL <=5 $489.0045160000 INITIAL TREATMENT 1ST DEG BURN $86.0045160200 DRESS/DEBRID P-THICK BURN, SML $158.0045160250 DRESS/DEBRID P-THICK BURN, MED $288.0045160300 DRESS/DEBRID P-THICK BURN, LRG $288.0045160350 ESCHAROTOMY; INITIAL INCISION $150.0045171060 DESTR CUT VASC LES; 10 SQ CM/< $1,000.0045172500 CHEM CAUT GRANULATION TISSUE $181.0045179990 UNLISTED PROC SKIN MM & SUBQ TISSUE $52.0045190000 PUNCT ASP OF CYST OF BREAST $467.0045190010 PUNCT ASP OF CYST BREAST ADDTL $120.0045190200 EXPLORE BREAST WOUND OR ABSCES $1,977.0045201020 EXPLORE PENTR WND OF ABD/FLANK $2,487.0045201030 EXPLORE PENTR WOUND OF EXTREM $1,040.0045205200 REMOVAL FOREIGN BODY MUSCLE $465.0045205520 INJ TRIGGER POINT, 1/2 MUSCLE $309.0045206000 DRAIN/INJECT, SML JOINT/BURSA $251.0045206050 DRAIN/INJ INTER JOINT/BURSA WO US $251.0045206100 DRAIN/INJ, MAJOR JOINT/BURSA WO US $251.00

45206920 APPLY PINS OR WIRES $3,150.0045209500 MONITOR INTERST FLD PRESSURE $309.0045213100 CLOSED TX NOSE FRACTURE $270.0045213200 CL TX OF NASAL BONE FX; W STAB $1,741.0045213370 CL TX NASAL SEPTAL FX $1,545.0045214800 CL TX ANKLE DISLOCATION; WO AN $412.0045235000 CLOSED TX CLAVICAL FRACTURE $191.0045235050 CLAVICLE FX WITH MANIPULATION $1,941.0045235200 CLOSED TX STERNOCLAV FRACTURE $464.0045235250 CL TX SCCLAV DISLOC W MANIPULA $567.0045235400 CLSD TX ACROMIOCLAV DISLOC W/O $191.0045235450 CLSD TX ACROMIOCLAV DISLOC W M $464.0045235700 CLSD TX SCAPULA DISLOC W MANIP $191.0045235750 CLSD TX SCAPULA DISLOC W MANIP $464.0045236000 CLSD TX ARM W MANIPULATION $191.0045236050 CLSD TX ARM W MANIPULATION $1,648.0045236500 CL TX SHLDR DISL W MANI; WO ANESTH $550.0045236550 CLSD TX SHOULDER DISLOC $1,594.0045239310 DRAIN ARM, ELBOW BURSA $1,977.0045245000 CLSD TX HUMERUS FX WO MANIPULA $407.0045245050 CL TX HUMERUS FX W MANIPULATE $309.0045246000 TREAT ELBOW DISLOCATION $191.0045246050 TX CL ELBOW DISLOC W ANESTHESI $1,236.0045246200 TREAT ELBOW FRACTURE $1,648.0045246400 TREAT ELBOW DISLOCATION $191.0045246550 CL TX RADIAL HD/NECK FX; W MANIP $515.0045246750 TREAT ULNAR FRACTURE $412.0045255000 CLSD TX RADIAL SHFT FX WO MANI $258.0045255050 CL TX RADIAL SHFT FX W MANIPUL $721.0045255300 CLSD TX OF RADIAL SHFT FX WO M $284.0045255350 CL TX ULNAR SHFT FX W MANIPULA $237.0045255600 CL TX RADIAL&ULNAR SHFT FX WO $309.0045255650 CL TX RADIAL & ULNA FX W MANIP $515.0045256000 CLSD TX ARM FRACTURE $191.0045256050 CLSD TX ARM FRACTURE $567.0045256220 CLSD TX WRIST FRACTURE $191.0045256240 CL TX CARPL SCAPHOID FX W MANI $567.0045256300 TREAT WRIST BONE FRACTURE W/O $181.0045256350 TREAT WRIST BONE FRACTURE W MA $567.0045256500 TREAT WRIST BONE FRACTURE $191.0045256600 CL TX CARPAL DISLOC W MANIPULA $361.0045260100 DRAIN FINGER ABSCESS; SIMPLE $350.0045260110 DRAINAGE OF FINGER ABSCESS $1,248.0045264100 REPAIR HAND TENDON $1,777.0045264180 EXTENSOR TENDON REPAIR, EACH $1,545.0045266000 TREAT METACARPAL FRACTURE $191.0045266050 CLSD TX METACARPAL FX W MANIP $237.0045266410 CL TX THUMB WITH MANIPULATION $340.00

45266450 CL TX CMC FX DISLOC THUMB W MA $412.0045266700 CL TX CARPMETACRPL DISL W M EA $103.0045267000 TREAT KNUCKLE DISLOCATION $540.0045267200 CLOSED TX FINGER OR THUMB, EA $191.0045267250 TREAT FINGER FRACTURE, EACH $540.0045267420 CL TX ARTFX MCP/IP JNT; W MANIP $1,545.0045267500 CLOSED TX FINGER OR THUMB, EA $191.0045267550 TREAT FINGER FRACTURE, EACH $540.0045267700 TREAT FINGER DISLOCATION $540.0045267750 CL TX IP JT D, W MANIP; W ANES $1,515.0045267850 TREAT FINGER DISLOCATION $3,800.0045270860 REMOVE FOREIGN BODY PELVIS/HIP $938.0045272300 CL TX PROX FEM FX WO MANIPULAT $237.0045272500 CL TX TRAUMA HIP DICLOC WO ANE $309.0045272520 CL TX TRAUMA HIP DISLOC W ANES $1,082.0045272650 CL TX POST HIP DISLOC WO ANEST $361.0045275000 CL TX FEMORAL SHAFT FX, WO MAN $438.0045275020 CL TX FEMORAL SHAFT FX, W MANI $1,442.0045275080 CL TX DISTAL FEM FX WO MANIP $149.0045275100 CL TX FEMUR FX OR EPIPHYS SEP $438.0045275200 CLOSED TX PATELLAR FX, WO MANI $206.0045275500 CL TX KNEE DISL; WO ANESTHESIA $206.0045275600 TREAT KNEECAP DISLOCATION $191.0045275620 CL TX PATELLAR DISLOCATION; W $1,515.0045277500 TREATMENT TIB FRACTURE $273.0045277520 CL TX TIB SHAFT FX W MANIPULAT $1,545.0045277600 CLOSED TX MEDIAL ANKLE FX $191.0045277800 CL TX PROX FIB/SHAFT FX WO MAN $206.0045277810 CL TX PROX FIB/SHAFT FX W MANI $1,442.0045277860 CL TX DSTL FIB FX WO MANIPULAT $294.0045277880 CL TX DISTL FIB FX W MANIPULAT $610.0045278080 TREATMENT OF ANKLE FRACTURE $309.0045278100 TREATMENT OF ANKLE FRACTURE $618.0045278160 CL TX TRIMALL ANKLE FX; WO MAN $387.0045278180 TREATMENT OF ANKLE FRACTURE $515.0045278240 CL TX WT BRG DSTL TIB WO MANIP $114.0045278250 CL TX WT BRG DSTL TIB W MANIP $1,545.0045278400 CL TX ANKLE DISLOCATION; WO AN $412.0045278420 CL TX ANKLE DISLOCATION; W ANESTH $412.0045281900 REMOVAL OF FOOT FOREIGN BODY $721.0045284000 CLOSED TX HEEL FX $191.0045284500 TX TARSAL BONE FX ; WO MANIPU $268.0045284550 TX TARSAL BONE FX; W MANIP $222.0045284700 CLOSED TX TOE FRACTURE $191.0045284750 CL TX METATARSAL FX; WO MANIP $237.0045284900 CLOSED TX FINGER FRACTURE NO M $191.0045284950 CL TX FX GT PHALANX(S); W MANI $165.0045285100 CLOSED TX FINGER FRACTURE W/MA $191.00

45285150 CL TX FX GT PHALANX(S); W MANI $540.0045285700 CL TX TALOTARSAL JOINT DIS; WO $515.0045286300 TREAT TOE DISLOCATION $540.0045286350 CL TX MTP JNT DISLOC; W ANESTH $1,056.0045286600 CLOSED TX JOINT DISLOC NO ANES $191.0045290350 APPLICATION OF BODY CAST $248.0045290490 APPLICATION OF FIGURE EIGHT $119.0045290650 APPLICATION OF LONG ARM CAST $204.0045290750 APPLICATION OF SHORT ARM CAST $248.0045290850 CAST LWR HAND FOREARM GAUNTLET $109.0045291050 SPLINT APPLICATION - LONG ARM $206.0045291250 SPLINT APPLICATION - SHORT ARM $119.0045291260 APPLY FOREARM SPLINT $119.0045291300 SPLINT APPLICATION - FINGER $140.0045291310 APPLICATION OF FINGER SPLINT $119.0045292400 STRAPPING OF SHOULDER $119.0045292600 STRAPPING; ELBOW OR WRIST $155.0045292800 STRAPPING OF HAND OR FINGER $119.0045293450 APPLICATION OF LONG LEG CAST $197.0045293650 APPLY CYLINDER CAST $181.0045294050 APPLICATION OF SHORT LEG CAST $248.0045295050 SPLINT APPLICATION - LONG LEG $143.0045295150 SPLINT APPLICATION - SHORT LEG $119.0045295300 STRAPPING - KNEE $119.0045295400 STRAPPING - ANKLE/FOOT $119.0045295500 STRAPPING - TOES $119.0045295800 STRAPPING - UNNA BOOT $114.0045297000 REM GAUNTLET, BOOT OR BODY CAS $119.0045297050 REMOVE FULL ARM OR LEG CAST $119.0045297100 REM SHOULDER OR HIP SPICA $248.0045297400 WEDGING OF CAST NOT CLUBFOOT C $103.0045297990 CASTING & STRAPPING (NEC) $258.0045300000 DR ABSC/HEMATOMA NASAL INT $1,600.0045300200 DR ABSC/HEMATOMA, NASAL SEPTUM $1,314.0045303000 REMOVE NASAL FOREIGN BODY $68.0045309010 CONTROL OF NOSE BLEED $122.0045309030 CONTROL NASAL HEMORRH, ANT COM $227.0045309050 INITIAL CONTROL OF NOSE BLEED $122.0045315000 INSERT EMERGENCY AIRWAY $266.0045315020 CHANGE OF WINDPIPE AIRWAY $309.0045315050 LARYNGOSCOPY, IND; DIAGNOSTIC $145.0045315200 DX LARYNGOSCOPY, NEWBORN $155.0045315300 LARYNGOSCOPY W/FB REMOVAL $2,452.0045316030 TRACHEOSTOMY, EMERG; TRANSTRAC $721.0045316050 TRACHEOSTOMY, EMERG; CRICOTHYR $721.0045317200 CLEARANCE OF AIRWAYS $43.0045324210 THORACENTESIS FOR ASPIRATION $412.0045324220 THORACENTESIS W/TUBE INSERT $522.00

45325510 INSERTION OF CHEST TUBE $780.0045325540 THORACENTESIS FOR ASPIRATION $412.0045325550 THORACENTESIS W/TUBE INSERT $522.0045330100 PERICARDIOCENTESIS; INITIAL $562.0045332100 INS/REPL TEMP TRANSV SC CARD E $3,914.0045352010 REPAIR BLOOD VESSEL DIRECT; NECK $5,500.0045352060 REPAIR BLOOD VESSEL DIRECT; UPR EXTREMIT $3,451.0045352070 REPAIR BLOOD VESSEL DIRECT; HAND FINGER $3,451.0045352260 REPAIR BLOOD VESSEL DIRECT; LWR EXTREMIT $2,575.0045360050 EXTREMITY VENOGRAM INJ $26.0045361400 NS CATH - EXTREMITY ARTERY $26.0045364000 BLOOD DRAW < 3 YRS FEM/JUGULAR $19.0045364050 PHY BL DRAW < 3 YRS SCALP VEIN $16.0045364060 PHY BL DRAW < 3 YRS OTHER VEIN $16.0045364100 VENIPUNCTURE AGE 3 YRS/> PHYS $27.0045364200 VEIN ACCESS CUTDOWN < 1 YR $16.0045364250 VENIPUNCTURE, CUTDOWN; AGE 1+ $103.0045364300 BLOOD TRANSFUSION PER DAY $780.0045365550 INSERT NON-TUNNEL CV CATH $927.0045365560 INSERT NON-TUNNEL CV CATH $2,200.0045365690 INSERT PICC CATH $1,178.0045365890 REMOVE TUNNELED CV CATHETER $721.0045365900 REM TUNNELED CVAD W PORT/PUMP $1,082.0045366000 ARTERIAL PUNCTURE, BLOOD FOR D $26.0045366800 PLACE NEEDLE INTRAOSSEOUS INFU $309.0045371950 THROMBOLYSIS, CEREBRAL, BY IV $309.0045377850 LIGATE/DIVIDE/EXCISE VEIN 1 LEG $2,500.0045383000 DR LN ABSCESS/INFECTION; SIMPL $1,030.0045406500 REPAIR LIP $804.0045408000 DRAIN ABSCESS/CYST OF MOUTH $152.0045408040 REMOVAL, FOREIGN BODY, MOUTH $68.0045408300 CLSD LACERATION, MOUTH VESTIB $270.0045408310 CLSD LACERATION, MOUTH > 2.5CM $804.0045412500 REPAIR TONGUE LACERATION $270.0045412520 REP LACERAT-TONGUE FLR-MOUTH > 2.6/CPLX $1,250.0045418000 DR ABSC, CYST, HEMATOM - DENTO $337.0045418050 REM EMB FB FROM DENTOALV; SFT $2,060.0045420000 DRAINAGE OF ABSCESS OF PALATE $279.0045427000 I&D ABSCESS; PERITONSILLAR $270.0045428090 REMOVE PHARYNX FOREIGN BODY $68.0045432470 OPERATIVE UPPER GI ENDOSCOPY $918.0045432479 OPERATIVE UPPER GI ENDOSCOPY $918.0045432480 UPPR GI ENDOSCOPY/GUIDE WIRE $918.0045437530 GASTRIC INTUBATION/ASPIR/LAVAG $155.0045437600 CHANGE GASTROSTOMY TUBE $350.0045437610 REPOSITION GASTROSTOMY TUBE $918.0045453070 PROCTOSIG, RIGID; W REM FB $1,751.0045460400 INCISION OF RECTAL ABSCESS $2,455.00

45460500 INCISION OF ANAL ABSCESS $1,540.0045460830 INCISE EXTERNAL HEMORRHOID $217.0045469990 UNLISTED PROCEDURE ANUS $3,500.0045490800 PERITONEOCENTESIS; INITIAL $618.0045490810 PERITONEOCENTESIS; SUBSEQUENT $515.0045490820 PERITONEOCENTESIS; INITIAL $618.0045511000 DRAIN BLADDER BY NEEDLE $217.0045511010 DRAIN BLADDER BY TROCAR/CATH $98.0045511020 DRAIN BL W/CATH INSERTION $2,087.0045517010 INSERT BLADDER CATHETER $68.0045517020 INSERT TEMP BLADDER CATH $68.0045517030 INS BLADDER CATH, COMPLEX $82.0045517050 CHANGE OF CYSTOSTOMY TUBE; SIM $258.0045542200 IRRIGATE CORPORA CAVERNOSA FOR $183.0045544500 FORESKIN MANIPULATION $517.0045547000 I & D EPIDIDYMIS, TESTIS/SCROT $1,751.0045551000 DRAINAGE OF SCROTAL WALL ABSCE $1,206.0045564050 I & D OF VULVA/PERINEUM $298.0045564200 DRAINAGE OF GLAND ABSCESS $350.0045583010 REMOVE IUD $1,058.0045589990 UNLISTED PROC FEMALE GENITAL $155.0045590250 FETAL NON-STRESS TEST $200.0045593000 EPISIOTOMY OR VAGINAL REPAIR $1,339.0045594090 VAGINAL DELIVERY ONLY -IN ER $1,932.0045594140 DELIVERY OF PLACENTA $2,053.0045622700 SPINAL FLUID TAP, DIAGNOSTIC $442.0045622720 DRAIN CEREBRO SPINAL FLUID $442.0045644000 NERVE BLOCK INJECTION $251.0045644020 INJ ANESTH; FACIAL NERVE $309.0045644050 INJ ANESTH ; GREATER OCCIPITAL $412.0045644170 INJ ANESTH; AXILLARY NERVE $361.0045644200 INJ ANESTH; INTERCOSTAL NERVE $454.0045644210 INJ ANESTH; INTERCOST NRV, MUL $618.0045644500 INJ ANESTH; OTHR PERIPHERAL NR $442.0045652050 REMOVE FOREIGN BODY FROM EYE $94.0045652100 REMOVE FOREIGN BODY FROM EYE $94.0045652200 REMOVE FOREIGN BODY FROM EYE $94.0045652220 REMOVE FOREIGN BODY FROM EYE $94.0045677000 DRAIN ABSCESS, EYELID $412.0045679380 REMOVE EMBEDDED FB EYELID $135.0045690000 DRAIN EXTERNAL EAR LESION $340.0045690200 DRAIN EXTERNAL AUDITORY CANAL $152.0045692000 CLEAR OUTER EAR CANAL $68.0045692050 REM FB EXT AUDITORY CANAL; W A $1,803.0045692090 REMOVE IMPACTED EAR WAX UNILATERAL RINSE $132.0045692100 REMOVE IMPACTED EAR WAX $68.0045901680 WOUND CLOSURE BY ADHESIVE $145.0045904710 IMMUNIZATION ADM; 1 VACCINE $47.00

45904720 IMMUNIZATION ADMIN; EA ADDTL $45.0045907180 TD VACCINE >7, IM $57.0045911050 GASTRIC INTUBATION/ASPIR/LAVAG $155.0045924250 APPLY WALKER SHORT LEG CAST $309.0045929500 CPR-CARDIOPULMONARY RESUSCITAT $464.0045929530 TEMP TRANSCUTAN PACING $515.0045929600 CARDIOVERSION $589.0045929770 THROMBOLYSIS, CORON; IV INFUS $361.0045963600 HYDRATION IV INFUSION, INITIAL $350.0045963610 HYDRATE IV INFUSION, ADD-ON $360.0045963650 INFUSION UP TO 1 HOUR $360.0045963660 IV INFUSION EACH ADDTL $360.0045963670 ADDTL SEQ IV INFUSION $360.0045963680 THER/DIAG CONCURRENT INF $31.0045963710 SC THER INFUSION, RESET PUMP ADDTL $360.0045963720 THER/PROPH/DIAG INJ, SC/IM $37.0045963730 MEDICATION ADMINISTRATION IA $211.0045963740 IV PUSH INITIAL SUBSTANCE $211.0045963750 IV PUSH NEW SUBSTANCE $211.0045963760 TX/PRO/DX INJ NEW DRUG ADD-ON $211.0045975970 DEBRIDE; DEVITAL TIS <20 CM CM $309.0045991750 IPECAC ADMINISTRATION $114.0045992120 O/P VISIT, EST PATIENT - LEV 2 $83.0045992410 ER TRIAGE ASSESSMENT - OFFICE $73.0045992810 ER LEVEL 1 $183.0045992820 ER LEVEL 2 $268.0045992830 ER LEVEL 3 $335.0045992840 ER LEVEL 4 $472.0045992850 ER LEVEL 5 $773.0045992910 CRITICAL CARE; 30 - 74 MINUTES $927.0045992920 CRITICAL CARE; EA ADDTL 30 MIN $747.0045999999 PT LEFT WO SEEING PHYS / NO CHG $0.0046000001 PULSE OXIMETRY; MULTIPLE $0.0046000002 PULSE OXIMETRY; SINGLE $0.0046000012 PULSE OXIMETRY; SINGLE - OUTPATIENT ONLY $26.0046940100 SPIROMETRY $103.0046940106 PUL FUNCTION STUDY RD C SVCS $103.0046940600 SPIROMETRY, PRE & POST MEDICAL $355.0046940602 SPIROMETRY, PRE & POST MEDICAL (RDC SVC) $163.0046941500 TOTAL VITAL CAPACITY $98.0046942000 MAXIMAL BREATHING CAPACIT $62.0046942400 FUNCTIONAL RESIDUAL CAPAC $112.0046943750 FULL FLOW VOL LOOP $125.0046947200 CD DIFFUSING CAPACITY $191.0046947270 PULM FUNCTION TEST BY GAS $112.0046947620 PULSE OXIMETRY; CONTINUOUS $120.0046947700 CO2 EXPIRED GAS DETER $41.0047925510 HEARING SCREEN $67.00

47925515 HEARING SCREEN $67.0048929500 INITIAL RESUS/CODE BLUE/CPR $634.0048930170 STRESS TEST; TRACING $483.0048930176 STRESS TEST RDC SVC $483.0048933030 TTE CONG ABN; COMPLETE $857.0048933040 TTE CONG ABN; LIMITED/F-UP (BUBBLE) $464.0048933060 TTE W/DOPPLER, COMPLETE $1,536.0048933070 ECHO HEART; COMPLETE $857.0048933071 ECHO HEART; COMPLETE WITH CONTRAST $857.0048933120 ECHO TRANSESOPHAGEAL (OTH HOSP $1,774.0048933200 DOPPLER ECHO PULSED $366.0048933250 DOPPLER ECHO COLOR FLOW $314.0048934584 L HEART ARTERY/VENTRICLE $10,963.0048935100 LHC, RETROGR; PERCUTANEOUS $4,543.0048935390 INJ FOR ART CONDUIT PATENCY $325.0048935430 LV OR LA ANGIOGRAM DURING $254.0048935440 INJ AORTOGRAM $157.0048935450 INJ SEL COR ANGIOGRAPHY $747.0048935560 SI COR PULM AO BYPASS $1,397.0048935630 INJ SEL COR ANGIOGRAPHY $747.0048935650 INJ CARD CATH LFT VENT/ATRIAL $901.0048935660 INJ CARD CATH RGHT VENT/ATRIAL $901.0048994400 NEWBORN RESUSCITATION $347.0048994650 NEWBORN RESUSCITATION $347.0051000010 BREATH ALCOHOL CONTENT $46.0051000011 CORNELL BLOOD/URINE COLLECTION $20.0051000012 DOT-BREATH ALCOHOL TEST $46.0051000013 DOT-COLLECTION SITE $26.0051000014 DOT-DRUG & ALCOHOL TEST $103.0051000015 DOT-DRUG SCREEN $52.0051000016 DOT-ONSITE WITH URINE DRUG $162.0051000017 DOT-ONSITE WITHOUT UDT $123.0051000018 DOT-PHYSICAL ONLY $103.0051000019 DOT-PRE-EMPLOYMENT PHYS W/DRUG $149.0051000020 DOT-SPECIMEN COLLECTION $20.0051000021 DRUG SCREEN ON SITE $65.0051000022 DRUG SCREEN/ALCOHOL TEST COM $91.0051000023 FIT FOR WORK EXAM $188.0051000024 FLU SHOT $20.0051000025 HEPATITIS A $97.0051000026 HEPATITIS B ON SITE $85.0051000027 HEPATITIS B VACCINATION $78.0051000028 HEPATITIS-A ON SITE $136.0051000029 LEAD SCREENING $38.0051000030 NON DOT PHYSICAL W/DRUG SCREEN $149.0051000031 OFFICE VISIT $59.0051000032 ON SITE DRUG SCREEN ADDITIONAL $26.0051000033 POST ACCIDENT W/URING SCREEN $129.00

51000034 POST PLACEMENT PHYSICAL $65.0051000035 POST PLACEMENT PHYSICAL W/URIN $111.0051000036 RAPID DRUG SCREEN BATTERY $91.0051000037 RETURNS TO WORK $46.0051000038 TB-TEST ON SITE $20.0051000039 TB-TETANUS SHOT $16.0051000040 TWINRIX HEP A AND B $65.0051000041 URINE DRUG SCREEN $46.0051000042 WORKERS COMP INJURY EXAM $72.0051000510 BRZ - PRE EMPLOYMENT SCREENING $78.0051000511 BRZ - TEST DEVELPMNT 1/2 HR EA $52.0051000512 BRZ - PRE EMPLOYMENT SCREENING $78.0051000513 BRZ - TEST DEVELPMNT 1/2 HR EA $52.0051365937 DECLOT VASCULAR DEVICE $309.0051517200 ANITCARDINOGENIC INTO BLADDER $226.0051517207 ANTICARCINO GENIC INTO BLADDER $226.0051963607 IV INFUSION FOR HYDRATION $212.0051963617 HYDRATE IV INFUSION, ADD-ON $37.0051963657 INFUSION UP TO 1 HOUR $188.0051963727 THER/PROPH/DIAG INJECTION $37.0051992110 OUTPATIENT OFFICE VISIT - LEV1 $62.0051992117 OUTPATIENT OFFICE VISIT-LEV 1 $62.0061703360 MRI-TEMPOROMANDIBULAR JAW $1,118.0061705400 MRI-FACE W/O CONTRAST $876.0061705420 MRI ORBIT/FACE/NECK W/CONTRAST $841.0061705430 MRI-FACE W/WO CONTRAST $1,500.0061705440 MRA-HEAD WITHOUT CONTRAST $1,455.0061705450 MRA-HEAD W/CONTRAST $1,455.0061705460 MRA-HEAD W/WO CONTRAST $1,455.0061705470 MRA-NECK W/O CONTRAST $1,455.0061705480 MRA-NECK WITH CONTRAST $1,455.0061705490 MRA-NECK W/WO COSTRAST $2,050.0061705510 MRI-BRAIN WITHOUT CONTRAST $1,123.0061705520 MRI-BRAIN WITH CONTRAST $1,077.0061705530 MRI-BRAIN WITH & W/O CONTRAST $1,500.0061715500 MRI-CHEST W/O CONTRAST $1,455.0061715510 MRI-CHEST W/CONTRAST $1,455.0061715520 MRI-CHEST W/WO CONTRAST $1,921.0061715550 MRA-CHEST W/O CONTRAST $1,185.0061715551 MRA-CHEST W/WO CONTRAST $1,185.0061721410 MRI-CERVICAL SPINE W/O CONTRAST $1,117.0061721420 MRI-CERVICAL SPINE W/CONTRAST $1,077.0061721460 MRI-THORACIC SPINE W/O CONTRAST $1,117.0061721470 MRI-THORACIC SPINE W/CONTRAST $1,077.0061721480 MRI-LUMBAR SPINE W/O CONTRAST $1,072.0061721490 MRI-LUMBAR SPINE W/CONTRAST $1,247.0061721560 MRI-CERVICAL SPINE W&WO CONTRAST $1,500.0061721570 MRI-THORACIC SPINE W/WO CONTRAST $1,500.00

61721580 MRI-LUMBAR SPINE W/WO CONTRAST $1,500.0061721950 MRI-PELVIS W/O CONTRAST $1,097.0061721960 MRI-PELVIS W/CONTRAST $1,051.0061721970 MRI-PELVIS W/WO CONTRAST $1,500.0061721980 MRA-PELVIS $701.0061721981 MRA-PELVIS W/O CONTRAST $701.0061721982 MRA-PELVIS W/WO CONTRAST $701.0061721983 MRA-PELVIS WITH CONTRAST $701.0061732180 MRI-UPR EXT W/O $1,111.0061732181 MRI-UPPER EXTREMITY LEFT W/O C $1,111.0061732182 MRI-UPR EXT W/O RIGHT $1,111.0061732185 MRI-UPR EXT W/O BILATERAL $2,220.0061732190 MRI-UPPER EXTREMITY $1,607.0061732191 MRI-UPR EXT W LEFT $804.0061732192 MRI-UPR EXT W RIGHT $804.0061732195 MRI-UPPER EXTREMITY BILAT W/CO $1,607.0061732200 MRI-UPR EXT W/WO $1,508.0061732201 MRI-UPPER EXTREMITY LEFT W/WO $1,508.0061732202 MRI-UPR EXT W/WO RIGHT $1,508.0061732205 MRI-UPR EXT W/WO BILAT $3,016.0061732210 MRI-JOINT UPR EXT W/O $1,123.0061732211 MRI-JOINT UPR EXT W/O LT $1,123.0061732212 MRI-JOINT UPR EXT W/O RT $1,123.0061732215 MRI-JOINT UPR EXT W/O BILAT $1,793.0061732220 MRI-JOINT UPR EXT W BILAT $2,102.0061732221 MRI-JOINT UPR EXT W LT $1,307.0061732222 MRI-JOINT UPR EXT W RT $1,307.0061732225 MRI-JOINT UPR EXT W BILAT $2,102.0061732230 MRI-JOINT UPR EXT W/WO BILAT $1,545.0061732231 MRI-JOINT UPR EXT W/WO LT $1,500.0061732232 MRI-JOINT UPR EXT W/WO RT $1,508.0061732235 MRI-JOINT UPR EXT W/WO BILAT $1,545.0061732250 MRA-UPR EXT W/WO CNT $1,236.0061732251 MRA-UPR EXT W/WO CNT - LEFT $618.0061732252 MRA-UPR EXT W/WO CNT - RIGHT $618.0061732255 MRA-UPR EXT W/WO CNT-BILAT $1,236.0061737180 MRI-LWR EXT W/O BILAT $1,793.0061737181 MRI-LWR EXT W/O LEFT $1,120.0061737182 MRI-LWR EXT W/O RIGHT $1,120.0061737185 MRI-LWR EXT W/O BILAT $1,793.0061737190 MRI-LWR EXT W BILAT $1,681.0061737191 MRI-LWR EXT W LEFT $841.0061737192 MRI-LWR EXT W RIGHT $841.0061737195 MRI-LWR EXT W BILAT $1,681.0061737200 MRI-LWR EXT W/WO BILAT $3,770.0061737201 MRI-LOWER LEFT EXTREMITY W/WO $1,500.0061737202 MRI-LWR EXT W/WO RIGHT $1,500.0061737205 MRI-LWR EXT W/WO BILAT $3,770.00

61737210 MRI-JOINT LWR EXT W/O BIL $1,620.0061737211 MRI-JOINT LWR EXT W/O LT $1,120.0061737212 MRI - LOWER EXTREMITIES JNT W/O CONTRAST $1,120.0061737215 MRI-JOINT LWR EXT W/O BIL $1,620.0061737220 MRI-JOINT LWR EXT W BILAT $2,528.0061737221 MRI-JOINT LWR EXT W LT $1,264.0061737222 MRI-JOINT UPPER EXT W RT $1,264.0061737225 MRI-JOINT LWR EXT W BILAT $2,528.0061737230 MRI-JOINT LWR EXT W/WO BILAT $3,016.0061737231 MRI-JOINT LWR EXT W/WO LT $1,658.0061737232 MRI-JOINT LWR EXT W/WO RT $1,500.0061737235 MRI-JOINT LWR EXT W/ WO BILAT $3,016.0061737250 MRA-LWR EXT W / WO CONTRAST $1,360.0061737251 MRA-LWR EXT W/CNT - LEFT $1,360.0061737252 MRA-LWR EXT W/CNT - RIGHT $1,360.0061737253 MRA-LWR EXT W/O CNT - BILAT $1,360.0061737254 MRA-LWR EXT W/O CNT - LEFT $1,360.0061737255 MRA-LWR EXT W/CNT - BILAT $1,360.0061737256 MRA-LWR EXT W/O CNT - RIGHT $1,360.0061737257 MRA-LWR EXT W/WO CNT - BILAT $1,360.0061737258 MRA-LWR EXT W/WO CNT - LEFT $1,360.0061737259 MRA-LWR EXT W/WO CNT - RIGHT $1,360.0061741810 MRI-ABDOMEN W/O CONTRAST $1,500.0061741820 MRI-ABDOMEN W/CONTRAST $2,184.0061741830 MRI-ABDOMEN W/WO CONTRAST $1,500.0061741850 MRA-ABDOMEN W/CONTRAST $850.0061755520 MRI-CARDIAC MORPH W/O CON $717.0061755530 MRI-CARDIAC MORPH W/CONTR $717.0061755540 MRI-CARDIAC FUNC COMPLETE $717.0061755550 MRI-CARDIAC FUNC LIMITED $717.0061755560 MRI-CARDIAC FLOW MAPPING $717.0061763900 MRA-SPECTROSCOPY $717.0061770581 MRI-BREAST LEFT W/CONTRAS $680.0061770582 MRI-BREAST LEFT W/O CONTR $594.0061770583 MRI-BREAST LEFT W/WO CONT $810.0061770584 MRI-BREAST RIGHT W/CONTRA $680.0061770585 MRI-BREAST RIGHT W/O CONT $594.0061770586 MRI-BREAST RIGHT W/WO CON $810.0061770590 MRI-BREAST BIL W/ WO CONTRAST $680.0061770591 MRI-BREAST BIL W/CONTRAST $680.0061770592 MRI-BREAST BIL W/CONTRAST $680.0061770593 MRI-BREAST BIL W/O CONTRA $594.0061770594 MRI-BREAST BIL W/O CONTRA $594.0061770595 MRI-BREAST BIL W/WO CONTR $810.0061770596 MRI-BREAST BIL W/WO CONTR $810.0061770840 MRI-BM BLOOD SUPPLY $717.0063903840 LAB RHOGAM 300MCG INJECTION $215.0071000060 RECOVERY RM 1 - 60 MINS $217.00

71000120 RECOVERY RM 61-120 MINS $371.0071000150 RECOVERY RM 121-150 MINS $371.0071000180 RECOVERY RM 151-180 MINS $402.0071000360 RECOVERY RM 4 TO 6 HOURS $464.0071000390 EA ADDITOINAL 1/2 HR AFTER 6HR $44.0072000000 VAGINAL DELIVERY $796.0072000001 CESSARIAN DELIVERY $1,030.0072000002 HIGH RISK DELIVERY PRO FEE $129.0072594120 EXTERNAL CEPHALIC VERSION $1,932.0072594125 EXTERNAL CEPHALIC VERSION $1,932.0072994400 NEWBORN RESUSCITATION $347.0073930050 EKG $129.0073930056 EKG REPEAT SAME DAY SAME MD $129.0073930057 EKG REPEAT SAME DAY DIFF MD $129.0073930410 RHYTHM STRIP $62.0073932250 ECG UP TO 48 HRS RECORDING $356.0073932260 24 HR. ECG W/SCAN;ANALYSIS W/R $376.0074003990 HOME SLEEP TEST/TYPE 3 PORTABLE $190.0074946600 POS AIRWAY PRESSURE CPAP $260.0074957820 POLYSOM < 6 YRS 4> PARAMTRS $1,250.0074957821 POLYSOM < 6 YRS 4> PARAMTRS $1,100.0074957830 POLYSOM <6 YRS CPAP/BILVL $1,250.0074957831 POLYSOM <6 YRS CPAP/BILVL $1,100.0074958010 SLEEP STUDY UNATT W/ ANALYSIS $145.0074958050 MSLT/MWT (MULT SLEEP LAT/MTN WAKE) $1,250.0074958060 HSAT SLEEP STUDY UNAT & RESP EFF $190.0074958070 SLEEP STUDY; ATT < 6 HRS $500.0074958071 SLEEP STUDY; ATTENDED $600.0074958080 POLYSOMNOGRAPHY SLEEP 1-3 PARA $1,236.0074958100 POLYSOM < 6 HOURS $1,100.0074958101 POLYSOM > 6 HOURS $1,250.0074958110 POLYSOM CPAP 4 OR MORE < 6 HRS $1,100.0074958111 POLYSOM CPAP 4 OR MORE < 6 HRS $1,100.0074958112 POLYSOM CPAP 4 OR MORE PARM >6 HRS $1,250.0074958160 EEG AWAKE AND DROWSY $360.0074958190 EEG WHILE AWAKE & IN SLEEP $379.0074958220 EEG DURING SLEEP ONLY $311.0074958240 EEG ELECTROCEREBRAL SILENCE EVALUATION $201.0075432590 EGD ENDO ULTRASOUND (OUTSIDE) $1,799.0075432599 EGD ENDO ULTRASOUND (OUTSIDE) $1,799.0075910100 ESOPHAGUS MOTILITY STUDY $600.0075910340 GASTROESOPH REFLUX W NASAL PH $600.0076231301 OB OBSERVATION 1ST HOUR $284.0076231302 OB OBSERVATION ADDTL HOUR $26.0076231401 POST PARTUM OBSERVATION 1ST HR $284.0076231402 POST PARTUM OBSERVATION ADDTL HR $26.0076233401 MED/SURG UNIT OBSERVATION 1ST HOUR $284.0076233402 MED/SURG UNIT OBSERVATION ADDTL HOUR $26.00

76240701 LABOR & DELIVERY OBSERVATION 1ST HOUR $284.0076240702 LABOR & DELIVERY OBSERVATION ADDTL HOUR $26.0077000090 ADMIN PNEUMONIA VACCINE $37.0077904710 IMMUNIZATION ADM; 1 VACCINE $47.0077904715 IMMUNIZATION ADM; 1 VACCINE $47.0077904720 ADDTL IMMUNIZATION ADMINISTRAT $45.0077904725 IMMUNIZATION ADMIN; EA ADDTL $45.0077904730 IMMUNE ADMIN ORAL/NASAL $42.0077G00081 FLU VACCINE (INPATIENT) $37.0080100001 HEMODIALYSIS $618.0080100002 DIALYSIS OTHER THAN HEMODIALYSIS $618.0090907910 BEHAV HEALTH TRX/SVC PSYCH - NON PHYS $203.0090907917 BEHAV HEALTH TRX/SVC PSYCH - NON PHYS $203.0090907927 BEHAV HEALTH TRX/SVC PSYCH - PHYSICIAN $203.0091599999 INTENSIVE OP THERAPY NO SHOW $0.0091907910 DIAG INTERVENTION (INTAKE) $203.0091908060 INDIV PSYCHOTHERAPY 45-50 MINS $258.0091908340 PSYCH TX PATIENT & FAMILY 45 MINS $258.0091908347 INDIV THERAPY 45 MINS $258.0091908460 FAMILY TX WITHOUT PATIENT $191.0091908467 FAMILY TX WITHOUT PATIENT $191.0091908470 FAMILY TREATMENT WITH PATIENT $191.0091908477 FAMILY TREATMENT WITH PATIENT $191.0091908490 MULTI FAMILY GROUP THERAPY $0.0091908530 GROUP THERAPY $93.0091909110 BIOFEEDBACK-U $206.0091909111 BIOFEEDBACK - U $206.0091909112 BIOFEEDBACK - U $206.0091961160 NEUROBEHAVIOR STATUS EXAM $90.0091999909 IOP FAMILY/IND THPY PER HR NO CHG $0.0091999989 PHP FAMILY/IND THPY PER HR NO CHG $0.0091999999 INTENSIVE OP THERAPY NO SHOW $0.0092000000 OB ASSESSMENT $0.0092590205 CONTRACTION STRESS TEST $272.0092590250 FETAL MONITOR DAILY $309.0092590255 FETAL NON STRESS TEST $354.0092590505 FETAL MONITOR DAILY $309.0092938800 EXTRACRANIAL DUPLEX; BIL $704.0092939220 EXTREMITY ARTERY SING; BIL $194.0092939250 DUPLEX; LWR EXT ART; COMP-BIL $514.0092939261 DUPLEX; LWR EXT ART; LTD-LT $890.0092939262 DUPLEX; LWR EXT ART; LTD-RT $802.0092939300 DUPLEX; UPR EXT ART; COMP-BIL $1,109.0092939311 DUPLEX; UPR EXT ARTERY; LTD-LT $744.0092939312 DUPLEX; UPR EXT ART; LTD-RT $744.0092939700 DOPPLER-VENOUS EXT VEINS BILAT $1,332.0092939710 DUPLEX; UPR EXT VEIN;LTD-LT $882.0092939711 DUPLEX; LWR EXT VEIN; LTD-LT $882.00

92939712 DUPLEX; LWR EXT VEIN; LTD-RT $882.0092939715 DUPLEX; LWR EXT VEIN; LTD-BILAT $927.0092939750 DUPLEX; OTHER; COMP $1,212.0092939760 DUPLEX ARTERIAL FLOW; LIMITED $186.0092939780 DUPLEX A IVC IL/BPG; COMPLETE $492.0092939790 DUPLEX; OTHER; LTD $669.0092939800 DUPLEX FLOW PENILE V; COMPLETE $515.0092963720 THER/PROPH/DIAG INJ, SC/IM $37.0094000001 NO CHARGE; NUTRITION EDUCATION $0.0094000002 DIABETES INDIVIDUAL PER 30 MINUTES $83.0094000004 GROUP NUTRITION THPY; EACH 30M $62.0094000102 GROUP NUTRITION THPY; EACH 30M $62.0094000103 DIABETES INDIVIDUAL PER 30 MINUTES $83.0094000106 NO SHOW; COMPLETE CARE $0.0094021017 NEONATAL AIRWAY SUPPLY $10.0094021019 PARTIAL DAY OF OXYGEN $38.0094021027 RESP IPPB FILTER (SUPPLY) $7.0094021030 RESP PEAK FLOW METER $28.0094024052 NEBULIZER INITIAL TX $70.0094024054 NEBULIZER, SUPPLY $13.0094024077 PULSE OXIMETRY SETUP $31.0094050003 CRYOPRECIPITATE EACH UNIT $76.0094051089 UNLISTED CHEM; AMYLAST ISOENZY $15.0094070014 IV INFUSION THRPY UP TO 1 HR $212.0094110002 A IND. COUN 22 $99.0094110071 ACTIVITY THERAPY $93.0094110072 EDUCATIONAL TRAINING $93.0094110073 GROUP THERAPY $93.0094124009 MYOCARD PERSAN TINE W/O SP $649.0094140001 CATH:HICKMAN $535.0094140057 CONSCIOUS SEDATION $155.0094140058 CONSCIOUS SEDATION; $155.0094140125 INJECTION; INTRAVENE $52.0094140126 INJECTION;SUBCUT/IN $42.0094140129 IV PUSH INITIAL SUBSTANCE $211.0094140141 LITHOTRIPSY $4,986.0094140222 THER/PROPH/DIAG INJ, IA $141.0094140223 THER/PROPH/DIAG INJ, SC/IM $37.0094317200 PF/CATHETER ASPIRATION $162.0094365110 THERAP APHERESIS; WBC'S $1,863.0094365120 THERAP APHERESIS; RBC'S $1,863.0094365130 THERAP APHERESIS; PLATELETS $1,863.0094402024 BAG-CLAMP $6.0094402033 BENZOIN SWAB STICK $4.0094402042 BREAST PADS $6.0094402055 CATH-DISP A BAG $19.0094963607 IV INFUSION FOR HYDRATION $212.0094963617 IV INFUSION FOR HYDRA ADDTL $190.00

94963657 INFUSION UP TO 1 HOUR $188.0094963667 IV INFUSION EACH ADDTL $112.0094963677 ADDTL SEQ IV INFUSION $188.0094963687 CONCURRENT IV INFUSION 1+ HOUR $211.0094963720 THER/PROPH/DIAG INJ, SC/IM $37.0094963725 THER/PROPH/DIAG INJECTION $37.0094963727 THER/PROPH/DIAG INJECTION $37.0094963737 THER/PROPH/DIAG INJECTION $211.0094963740 IV PUSH INITIAL SUBSTANCE $211.0094963744 IV PUSH INITIAL SUBSTANCE $211.0094963747 IV PUSH INITIAL SUBSTANCE $211.0094963750 IV PUSH NEW SUBSTANCE $211.0094963754 IV PUSH NEW SUBSTANCE $211.0094963757 IV PUSH NEW SUBSTANCE $211.0094963760 TX/PRO/DX INJ NEW DRUG ADD-ON $211.0094963764 INJECTION IVP SAME DRUG ADD-ON $211.0094991950 THERAPEUTIC PHLEBOTOMY $63.0094991957 THERAPEUTIC PHLEBOTOMY $103.0096003990 PF/HOME SLEEP TEST/TYPE 3 PORTABLE $125.0096377850 PF/LIGATE/DIVIDE/EXCISE VEIN 1 LEG $150.0096910100 PF/ESOPHAGUS MOTILITY STUDY $100.0096910340 PF/GASTROESOPH REFLUX W NASAL PH $75.0096946600 PF/POS AIRWAY PRESSURE CPAP $60.0096957820 PF/POLYSOM < 6 YRS 4> PARAMTRS $188.0096957821 PF/POLYSOM < 6 YRS 4> PARAMTRS $188.0096957830 PF/POLYSOM <6 YRS CPAP/BILVL $195.0096957831 PF/POLYSOM <6 YRS CPAP/BILVL $188.0096958010 PF/SLEEP STUDY UNATT W/ ANALYSIS $75.0096958050 PF/MSLT/MWT (MULT SLEEP LAT/MTN WAKE) $90.0096958060 PF/HSAT SLEEP STUDY UNAT & RESP EFF $95.0096958070 PF/SLEEP STUDY; ATT < 6 HRS $95.0096958071 PF/SLEEP STUDY; ATTENDED $95.0096958100 PF/POLYSOM < 6 HOURS $188.0096958101 PF/POLYSOM > 6 HOURS $188.0096958111 PF/POLYSOM CPAP 4 OR MORE $195.0097002970 PF/ LDCT FOR LUNG CA SCREEN $145.0097100220 PF/FINE NEEDLE ASPIRATION W/IMAGE $200.0097190830 PF/BX BREAST 1ST LESION U/S IMAGING $401.0097190840 PF/BX BREAST EA LESION AFTER 1ST ADD-ON $250.0097191030 PF/PERC BRST BX - AUTO VA/DEVICE $417.0097191200 PF/REMOVAL OF BREAST LESION 1+ $871.0097191250 PF/EXC BREAST LES BY N LOC; SINGLE $964.0097191260 PF/EXC BREAST LES BY N LOC; EA ADDTL $327.0097192810 PF/PERQ DEVICE BREAST 1ST IMAGE $415.0097192820 PF/PERQ DEVICE BREAST EACH IMAGE $52.0097192950 PF/PLACE BREAST CLIP PERCUT $177.0097202060 PF/MUSCLE BX; PERC NDL $162.0097202200 PF/BONE BX TR/NDL; SUPERF $199.00

97206000 PF/DRAIN/INJECT, SML JOINT/BURSA $106.0097206051 PF/DRAIN/INJ WRIST/ELBOW/ANKLE LT $112.0097206052 PF/DRAIN/INJ WRIST/ELBOW/ANKLE RT $112.0097206060 PF/DRAIN/INJ INTER JOINT/BURSA W/US $103.0097206100 PF/DRAIN/INJECT, MAJOR JOINT/BURS $145.0097206101 PF/DRAIN/INJ SHOULDER/HIP/KNEE LT $145.0097206102 PF/DRAIN/INJ SHOULDER/HIP/KNEE RT $145.0097206105 PF/DRAIN/INJ SHOULDER/HIP/KNEE BILAT $145.0097206110 PF/DRAIN/INJ MAJOR JOINT/BURSA W/US $120.0097387920 PF/RA TRACER ID OF SENTINL NODE $150.0097469990 PF/UNLISTED PROCEDURE ANUS $628.0097475310 PF/CHOLANGIOGRM BILE/PANCR $45.0097475440 PF/CHOLANGIOGRM STONE REM $300.0097490834 PF/ADBOMINAL PARACENTESIS W/IMAGING $71.0097494650 PF/FLUORO EXAM OF G/COLON TUBE $38.0097516000 PF/INJ FOR CYSTOGRAM $377.0097583010 PF/REMOVE IUD $155.0097583400 PF/CATH & INTRO OF CONTRAST $78.0097701100 PF/MANDIBLE MIN 4-VIEWS $26.0097701300 PF/MASTOIDS MIN 3-VIEWS $37.0097701400 PF/ZYGOMATIC ARCHES $20.0097701500 PF/FACIAL BONES $27.0097701600 PF/NASAL BONES $19.0097702000 PF/ORBITS $29.0097702200 PF/SINUSES $26.0097702400 PF/SELLA TURCICA $25.0097702500 PF/SKULL LIMITED $25.0097702600 PF/SKULL $36.0097703300 PF/T.M. JOINTS $26.0097703360 PF/MRI-TEMPOROMANDIBULAR JAW $157.0097703550 PF/PANOGRAPH (DENTAL) $21.0097703600 PF/NECK SOFT TISSUE $19.0097704500 PF/CT HEAD W/O CONTRAST $120.0097704600 PF/CT HEAD W/CONTRAST $120.0097704700 PF/CT HEAD W/O & W/CONTRAST $200.0097704800 PF/CT - ORBIT SELLA MID/INNER EAR WO CON $135.0097704810 PF/CT - ORBIT SELLA MID/INNER EAR W CONT $79.0097704820 PF/CT - ORBIT SELLA MID/INNER EAR W & WO $114.0097704860 PF/CT FACIAL BONES W/O CNTR $121.0097704870 PF/CT MAXILLOFACIAL WITH CONTRAST $139.0097704880 PF/CT MAXILLOFACIAL W&W/O CONTRST $150.0097704900 PF/CT NECK THYROID W/O CONTRAST $136.0097704910 PF/CT NECK THYROID W/CONTRAST $146.0097704920 PF/CT NECK THYROID W/O & W $152.0097704960 PF/CTA-HEAD $256.0097704980 PF/CTA-NECK $187.0097705400 PF/MRI-FACE W/O CONTRAST $200.0097705420 PF/MRI ORBIT/FACE/NECK W/CONTRAST $307.00

97705430 PF/MRI-FACE W/WO CONTRAST $227.0097705440 PF/MRA-HEAD WITHOUT CONTRAST $126.0097705450 PF/MRA-HEAD W/CONTRAST $307.0097705460 PF/MRA-HEAD W/WO CONTRAST $423.0097705470 PF/MRA-NECK W/O CONTRAST $307.0097705480 PF/MRA-NECK WITH CONTRAST $307.0097705490 PF/MRA-NECK W/WO COSTRAST $423.0097705510 PF/MRI-BRAIN WITHOUT CONTRAST $157.0097705520 PF/MRI-BRAIN WITH CONTRAST $189.0097705530 PF/MRI-BRAIN WITH & W/O CONTRAST $249.0097710100 PF/CHEST SINGLE VIEW $19.0097710200 PF/CHEST XRAY - 2 VIEW $23.0097710210 PF/CHEST XRAY 2 VIEW W OBLIQUE $23.0097710350 PF/CHEST INS/EXP $20.0097710351 PF/CHEST SPECIAL STUDY $20.0097710450 PF/CHEST SINGLE VIEW $19.0097710460 PF/CHEST XRAY - 2 VIEW $23.0097710470 PF/CHEST XRAY 3 VIEWS $23.0097711001 PF/RIBS UNIL - 2 VIEWS LEFT $23.0097711002 PF/RIBS UNIL - 2 VIEWS RIGHT $23.0097711100 PF/RIBS-BILATERAL 3-VIEWS $28.0097711101 PF/RIBS-LEFT 3-VIEWS $28.0097711102 PF/RIBS-RIGHT 3-VIEWS $28.0097711200 PF/STERNUM $21.0097711300 PF/STERNOCLAVICULAR JOINT(S) $31.0097712500 PF/CT CHEST W/O CONTRAST $123.0097712600 PF/CT CHEST W/CONTRAST $55.0097712700 PF/CT CHEST W/WO CONTRAST $146.0097712750 PF/CT ANGIOGRAPHY CHEST $250.0097715500 PF/MRI-CHEST W/O CONTRAST $153.0097715510 PF/MRI-CHEST W/CONTRAST $307.0097715520 PF/MRI-CHEST W/WO CONTRAST $239.0097715551 PF/MRA-CHEST W/WO CONTRAST $307.0097720200 PF/SPINE 1 VIEW CC $17.0097720400 PF/CERVICAL SPINE 2/3V $23.0097720500 PF/CERVICAL SPINE $32.0097720520 PF/CERVICAL SPINE $39.0097720690 PF/SCOLIOSIS SERIES $23.0097720700 PF/THORACIS SPINE 2-VIEWS $23.0097720720 PF/THORACIC SPINE 3-VIEWS $23.0097720810 PF/X-RAY EXAM ENTIRE SPINE 1 VIEW $100.0097720820 PF/X-RAY ENTIRE SPINE 2/3 VIEWS $150.0097720830 PF/X-RAY EXAM ENTIRE SPINE 4/5 VIEWS $200.0097720840 PF/X-RAY EXAM ENTIRE SPINE 6/> VIEWS $200.0097721000 PF/LUMBAR SPINE 2-3 V $23.0097721100 PF/LUMBOSACRAL SPINE MN 4VIE $32.0097721200 PF/LUMBAR SPINE-BENDING VIEW $23.0097721250 PF/CT C-SP W/O CONTRAST $123.00

97721260 PF/CT-C-SPINE WITH CONTRAST $123.0097721280 PF/CT T-SP W/O CONTRAST $123.0097721290 PF/CT T-SP WITH CONTRAST $40.0097721300 PF/CT T-SP W AND W/O CONTRAST $135.0097721310 PF/CT LUMBAR SPINE W/O $123.0097721320 PF/CT LUMBAR SPINE WITH CONTRAST $129.0097721330 PF/CT-LUMBAR SP W AND W/O CONTRAS $114.0097721410 PF/MRI-CERVICAL SPINE W/O CONTRAST $168.0097721420 PF/MRI-CERVICAL SPINE W/CONTRAST $178.0097721460 PF/MRI-THORACIC SPINE W/O CONTRAST $169.0097721470 PF/MRI-THORACIC SPINE W/CONTRAST $178.0097721480 PF/MRI-LUMBAR SPINE W/O CONTRAST $157.0097721490 PF/MRI-LUMBAR SPINE W/CONTRAST $178.0097721560 PF/MRI-CERVICAL SPINE W&WO CONTRAST $270.0097721570 PF/MRI-THORACIC SPINE W/WO CONTRAST $271.0097721580 PF/MRI-LUMBAR SPINE W/WO CONTRAST $248.0097721700 PF/PELVIS $19.0097721920 PF/CT PELVIS W/O C $116.0097721930 PF/CT PELVIS W C $123.0097721940 PF/CT PELVIS W/O & W $128.0097721950 PF/MRI-PELVIS W/O CONTRAST $153.0097721960 PF/MRI-PELVIS W/CONTRAST $307.0097721970 PF/MRI-PELVIS W/WO CONTRAST $238.0097721980 PF/MRA-PELVIS $307.0097722020 PF/SACROILIAC JOINTS $21.0097722200 PF/SACRUM AND/OR COCCYX $19.0097722400 PF/MYELOGRAPHY CERVICAL $90.0097722550 PF/MYELOGRAPHY THORACIC $90.0097722650 PF/MYELOGRAPHY LUMBOSACRAL $90.0097730000 PF/CLAVICLE - BILAT $18.0097730001 PF/CLAVICLE - LEFT $18.0097730002 PF/CLAVICLE - RIGHT $18.0097730100 PF/SCAPULA - BILAT $19.0097730101 PF/SCAPULA - LEFT $19.0097730102 PF/SCAPULA - RIGHT $19.0097730300 PF/SHOULDER - BILATERAL $20.0097730301 PF/SHOULDER - LEFT $20.0097730302 PF/SHOULDER - RIGHT $20.0097730401 PF/ARTHROGRAM - SHOULDER LEFT $57.0097730402 PF/ARTHROGRAM - SHOULDER RT $57.0097730405 PF/ARTHROGRAM-SHOULDER BILAT $57.0097730500 PF/A C JOINTS $22.0097730600 PF/HUMERUS - BILAT $19.0097730601 PF/HUMERUS - LEFT $19.0097730602 PF/HUMERUS - RIGHT $19.0097730700 PF/ELBOW 2V - BILAT $16.0097730701 PF/ELBOW 2V - LEFT $16.0097730702 PF/ELBOW 2V- RIGHT $16.00

97730800 PF/ELBOW 3V - BILAT $19.0097730801 PF/ELBOW 3V - LEFT $19.0097730802 PF/ELBOW 3V - RIGHT $19.0097730855 PF/ARTHROGRAM-ELBOW $48.0097730900 PF/FOREARM $17.0097730901 PF/FOREARM - LEFT $17.0097730902 PF/FOREARM - RIGHT $17.0097731100 PF/WRIST 3V- BILAT $19.0097731101 PF/WRIST 3V - LEFT $19.0097731102 PF/WRIST 3V- RIGHT $19.0097731151 PF/ARTHROGRAM-WRIST LEFT $57.0097731152 PF/ARTHROGRAM-WRIST RIGHT $57.0097731155 PF/ARTHROGRAM-WRIST BILATERAL $57.0097731300 PF/HANDS (BOTH) $19.0097731301 PF/HAND - LEFT $19.0097731302 PF/HAND - RIGHT $19.0097731400 PF/FINGER LEFT HAND-THUMB $15.0097731401 PF/FINGER LEFT HAND - 2ND DIGIT $15.0097731402 PF/FINGER LEFT HAND - 3RD DIGIT $15.0097731403 PF/FINGER LEFT HAND-4TH DIGIT $15.0097731404 PF/FINGER LEFT HAND-5TH DIGIT $15.0097731405 PF/FINGER RIGHT HAND-THUMB $15.0097731406 PF/FINGER RIGHT HAND-2ND DIGIT $15.0097731407 PF/FINGER RIGHT HAND - 3RD DIGIT $15.0097731408 PF/FINGER RIGHT HAND-4TH DIGIT $15.0097731409 PF/FINGER RIGHT HAND-5TH DIGIT $15.0097732000 PF/CT EXT UPPER W/O BILAT $116.0097732001 PF/CT EXT UPPER W/O LT $116.0097732002 PF/CT EXT UPPER W/O RT $116.0097732010 PF/CT ARM WITH CONTRAST - BILAT $123.0097732011 PF/CT ARM WITH CONTRAST - LEFT $123.0097732012 PF/CT ARM WITH CONTRAST - RIGHT $123.0097732021 PF/CT EXT UPPER WO & W LT $128.0097732022 PF/CT EXT UPPER WO & W RT $128.0097732025 PF/CT EXT UPPER W/O & W BIL $128.0097732060 PF/CT STERNOCLAVICLE $239.0097732180 PF/MRI-UPR EXT W/O $142.0097732181 PF/MRI-UPPER EXTREMITY LEFT W/O C $200.0097732182 PF/MRI-UPR EXT W/O RIGHT $200.0097732185 PF/MRI-UPR EXT W/O BILATERAL $142.0097732190 PF/MRI-UPPER EXTREMITY $307.0097732200 PF/MRI-UPR EXT W/WO $227.0097732201 PF/MRI-UPPER EXTREMITY LEFT W/WO $227.0097732202 PF/MRI-UPR EXT W/WO RIGHT $227.0097732205 PF/MRI-UPR EXT W/WO BILAT $227.0097732210 PF/MRI-JOINT UPR EXT W/O $200.0097732211 PF/MRI-JOINT UPR EXT W/O LT $200.0097732212 PF/MRI-JOINT UPR EXT W/O RT $200.00

97732215 PF/MRI-JOINT UPR EXT W/O BILAT $143.0097732220 PF/MRI-JOINT UPR EXT W BILAT $170.0097732221 PF/MRI-JOINT UPR EXT W LT $170.0097732222 PF/MRI-JOINT UPR EXT W RT $170.0097732230 PF/MRI-JOINT UPR EXT W/WO BILAT $227.0097732231 PF/MRI-JOINT UPR EXT W/WO LT $227.0097732232 PF/MRI-JOINT UPR EXT W/WO RT $227.0097732250 PF/MRA-UPR EXT W/WO CNT $307.0097735010 PF/HIP-UNILATERAL ONE VIEW $145.0097735020 PF/X-RAY HIP UNI 2-3 VIEWS - RIGHT $100.0097735021 PF/X-RAY HIP UNI 2-3 VIEWS - LEFT $100.0097735101 PF/HIP 2V- LEFT $23.0097735102 PF/HIP 2V- RIGHT $23.0097735200 PF/HIP-BILATERAL $27.0097735210 PF/X-RAY HIPS BI 2 VIEWS $27.0097735251 PF/ARTHROGRAM-HIP LEFT $58.0097735252 PF/ARTHROGRAM-HIP RIGHT $58.0097735255 PF/ARTHROGRAM-HIP BILATERAL $19.0097735300 PF/HIP NAILING $52.0097735500 PF/FEMUR $23.0097735501 PF/FEMUR - 2V LEFT $19.0097735502 PF/FEMUR - 2V RIGHT $19.0097735505 PF/FEMUR - BILAT $19.0097735510 PF/X-RAY OF FEMUR 1 VIEW $100.0097735520 PF/X-RAY OF FEMUR 2 />VIEWS BILAERAL $100.0097735521 PF/X-RAY OF FEMUR 2 />VIEWS LEFT $100.0097735522 PF/X-RAY OF FEMUR 2 />VIEWS RIGHT $100.0097735601 PF/KNEE - 2V LEFT $19.0097735602 PF/KNEE - 2V RIGHT $19.0097735605 PF/KNEE - BILAT $19.0097735620 PF/KNEE 3V - BILAT $20.0097735621 PF/KNEE 3V - LEFT $20.0097735622 PF/KNEE 3V - RIGHT $20.0097735650 PF/KNEES STANDING BILATERAL $22.0097735800 PF/ARTHROGRAM - KNEE BILAT $58.0097735801 PF/ARTHROGRAM - KNEE LEFT $58.0097735802 PF/ARTHROGRAM - KNEE RIGHT $58.0097735900 PF/TIBIA & FIBULA BILAT $19.0097735901 PF/TIBIA & FIBULA LEFT $19.0097735902 PF/TIBIA & FIBULA RIGHT $19.0097736100 PF/ANKLE 3+VIEWS BILAT $19.0097736101 PF/ANKLE 3+ VIEWS LEFT $19.0097736102 PF/ANKLE 3+ VIEWS RIGHT $19.0097736150 PF/ARTHROGRAM-ANKLE $17.0097736200 PF/FOOT 2V BILAT $17.0097736201 PF/FOOT - LEFT 2 VIEWS $17.0097736202 PF/FOOT 2V RIGHT $17.0097736300 PF/FOOT 3V BILAT $19.00

97736301 PF/FOOT 3V LEFT $19.0097736302 PF/FOOT 3V RIGHT $19.0097736500 PF/OSCALSIS BILAT $17.0097736501 PF/OSCALSIS LEFT $17.0097736502 PF/OSCALSIS RIGHT $17.0097736600 PF/TOE(S) $14.0097736601 PF/TOE - LEFT FOOT - 2ND $14.0097736602 PF/TOE - LEFT FOOT - 3RD $14.0097736603 PF/TOE-LEFT FOOT-4TH $14.0097736604 PF/TOE-LEFT FOOT-5TH $14.0097736605 PF/TOE-RIGHT FOOT-GREAT $14.0097736606 PF/TOE-RIGHT FOOT-2ND $14.0097736607 PF/TOE-RIGHT FOOT-3RD $14.0097736608 PF/TOE-RIGHT FOOT-4TH $14.0097736609 PF/TOE-RIGHT FOOT-5TH $14.0097737000 PF/CT EXT LOWER W/O BIL $116.0097737001 PF/CT EXT LOWER W/O LT $116.0097737002 PF/CT EXT LOWER W/O RT $116.0097737010 PF/CT-LWR EXT W CONTRAST - BILAT $123.0097737011 PF/CT-LWR EXT W CONTRAST - LEFT $123.0097737012 PF/CT-LWR EXT W CONTRAST - RIGHT $123.0097737020 PF/CT EXT LOWER W/O&W BIL $129.0097737021 PF/CT EXT LOWER W/O&W LT $129.0097737022 PF/CT EXT LOWER W/O & W RT $129.0097737025 PF/CT EXT LOWER W/O & W BIL $129.0097737065 PF/CTA LOWER EXT $239.0097737180 PF/MRI-LWR EXT W/O BILAT $175.0097737181 PF/MRI-LWR EXT W/O LEFT $175.0097737182 PF/MRI-LWR EXT W/O RIGHT $175.0097737191 PF/MRI-LWR EXT W LEFT $307.0097737192 PF/MRI-LWR EXT W RIGHT $307.0097737200 PF/MRI-LWR EXT W/WO BILAT $227.0097737201 PF/MRI-LOWER LEFT EXTREMITY W/WO $227.0097737202 PF/MRI-LWR EXT W/WO RIGHT $227.0097737210 PF/MRI-JOINT LWR EXT W/O BIL $260.0097737211 PF/MRI-JOINT LWR EXT W/O LT $230.0097737212 PF/MRI-JOINT LWR EXT W/O RT $230.0097737220 PF/MRI-JOINT LWR EXT W BILAT $171.0097737221 PF/MRI-JOINT LWR EXT W LT $171.0097737222 PF/MRI-JOINT UPPER EXT W RT $171.0097737231 PF/MRI-JOINT LWR EXT W/WO LT $227.0097737232 PF/MRI-JOINT LWR EXT W/WO RT $227.0097737235 PF/MRI-JOINT LWR EXT W/ WO BILAT $227.0097740000 PF/ABDOMEN (KUB) $19.0097740180 PF/ABDOMEN 1 VIEW (KUB) $19.0097740190 PF/ABDOMEN 2 VIEWS $48.0097740200 PF/ABD SUP & UP/OBSTRCT $28.0097740210 PF/ABDOMEN 3 VIEWS $48.00

97740220 PF/COMP ACUTE ABD (W CHEST) $70.0097741500 PF/CT ABDOMEN W/O CONTRAST $125.0097741600 PF/CT ABDOMEN W/CONTRAST $135.0097741700 PF/CT ABD W/O & W $148.0097741749 PF/CT ANGIO ABD & PELV W/WO DYE $297.0097741750 PF/CT ANGIO ABDOMEN W/WO DYE $230.0097741760 PF/CT ABD & PELVIS W/O CONTRAST $179.0097741770 PF/CT ABD & PELVIS W/ CONTRAST $187.0097741780 PF/CT ABD & PELVIS 1+SECTION/REG $208.0097741810 PF/MRI-ABDOMEN W/O CONTRAST $154.0097741820 PF/MRI-ABDOMEN W/CONTRAST $184.0097741830 PF/MRI-ABDOMEN W/WO CONTRAST $238.0097742200 PF/ESOPHOGRAM $125.0097742300 PF/BARIUM SWALLOW $56.0097742460 PF/UPPER GI SERIES $74.0097742500 PF/SMALL BOWEL SERIES $50.0097742700 PF/BARIUM ENEMA $74.0097742800 PF/BARIUM ENEMA WITH AIR CONTRAST $105.0097743000 PF/CHOLANGIOGRAM-OR $50.0097743050 PF/CHOLANGIOGRM BILE/PANCR $45.0097744300 PF/CYSTOGRAM $36.0097744500 PF/URETHROCYSTOGRAPH $227.0097744550 PF/CYSTOGRAM (VOIDING) $37.0097747400 PF/HYSTERIOSALPINGOGRAM $41.0097759890 PF/CT ABSCESS DRAIN KIDNEY $160.0097760000 PF/C-ARM (FLUORO UP TO 1 HR) $19.0097760010 PF/C-ARM GREATER THAN 1 HOUR $74.0097760800 PF/FISTULAGRAM-SINUS TRK STU $60.0097760980 PF/MAMMOGRAM BIOPSY SPECIMEN $18.0097760981 PF/MAMMOGRAM BIOPSY SPEC - LEFT $18.0097760982 PF/MAMMOGRAM BIOPSY SPEC - RIGHT $18.0097761000 PF/TOMOGRAPHY SNGPLNBDYSC $62.0097763760 PF/3D RENDER W/O POSTPROCESS $23.0097763770 PF/3D RENDER W POSTPROCESS $90.0097763800 PF/CT LIMITED OR FOLLOW-UP STUDY $103.0097764970 PF/UNLISTED CT $153.0097765360 PF/NECK - SOFT TISSUE $58.0097766040 PF/CHEST ULTRASOUND $58.0097766410 PF/BREAST - BILAT $142.0097766411 PF/BREAST - LEFT $57.0097766412 PF/BREAST - RIGHT $57.0097766420 PF/BREAST - BILAT $57.0097766421 PF/BREAST - LEFT $57.0097766422 PF/BREAST - RIGHT $57.0097766450 PF/BREAST - BILAT $57.0097766451 PF/BREAST - LEFT $57.0097766452 PF/BREAST - RIGHT $57.0097767000 PF/ABDOMEN MULTI ORGAN $86.00

97767050 PF/ABDOMEN LIMITED $63.0097767700 PF/KIDNEY COMPLETE (ABDO) $78.0097767750 PF/AORTA DUPLEX SCAN $63.0097768010 PF/ULTRASOUND PREGNANCY <14 WEEKS $103.0097768050 PF/PREGNANCY > THAN 14 WKS 1 $102.0097768120 PF/OB COMPLETE ADDTL GESTATION $183.0097768150 PF/OB LIMITED $67.0097768160 PF/OB FOLLOWUP - ABNORMAL $88.0097768170 PF/TRANSVAGINAL OB $78.0097768180 PF/BIOPHYSICAL PROFILE $109.0097768300 PF/TRANSVAGINAL NON-OB ULTRASOUND $73.0097768560 PF/PELVIC GENERAL $73.0097768570 PF/PELVIC LIMITED $42.0097768700 PF/TESTICULAR US $68.0097768720 PF/PROSTATE ULTRASOUND $77.0097768811 PF/EXTREMITY LEFT NON-VAS COMPLETE $62.0097768812 PF/EXTREMITY RIGHT NON-VAS COMPLETE $62.0097768815 PF/EXTREMITY-BILAT NON-VAS COMPLETE $62.0097768825 PF/EXTREMITY NON-VAS, LIMITED $225.0097769420 PF/US GUIDED NEEDLE PLACEMENT $72.0097770010 PF/FLUOROGUIDE FOR VEIN DEVICE $206.0097770020 PF/NEEDLE BX/ASPIRATION FLUOROSC $58.0097770030 PF/FLUORO-GUIDANCE(ESI) $63.0097770120 PF/CT GUIDED NEEDLE BIOPSY $117.0097770510 PF/CAD DIAGNOSTIC MAMMOGRAPHY $78.0097770520 PF/CAD SCREENING MAMMOGRAPHY $78.0097770531 PF/SINGLE INJ GALACTOGRAM LEFT $130.0097770532 PF/SINGLE INJ GALACTOGRAM RIGHT $130.0097770535 PF/SINGLE GALACTOGRAM BILAT $130.0097770550 PF/MAMMOGRAM-UNILATERAL-DIGITIAL $72.0097770551 PF/MAMMOGRAM DIAG LEFT - DIGITAL $72.0097770552 PF/MAMMOGRAM DIAG - RIGHT - DIGITIAL $72.0097770560 PF/MAMMOGRAM DIAG-BILATERAL - DIGITAL $89.0097770570 PF/MAMMOGRAM SCREENING - DIGITIAL $75.0097770571 PF/MAMMOGRAM SCREENING - LT ONLY-DIGITAL $75.0097770572 PF/MAMMOGRAM SCREENING - RT ONLY-DIGITAL $75.0097770650 PF/DIAGNOSTIC MAMMOGRAPHY LEFT $78.0097770651 PF/DIAGNOSTIC MAMMOGRAPHY RIGHT $78.0097770660 PF/DIAGNOSTIC MAMMOGRAPHY BILATERAL $156.0097770670 PF/SCREENING MAMMOGRAPHY BILATERAL $156.0097770720 PF/BONE AGE STUDIES $20.0097770730 PF/SCANOGRAM $28.0097770750 PF/METASTATIC SERIES $57.0097770780 PF/BONE DENSITY $26.0097780120 PF/THYROID SCAN W UPTK SNGL $52.0097780140 PF/THYROID IMAGING W/BLOOD FLOW $54.0097780700 PF/PARATHYROID $88.0097781950 PF/LYMPH NODE SCINTIGRAPHY $250.00

97782050 PF/HEMANGIOMA SCAN/LABLD RBC $76.0097782150 PF/LIVER AND SPLEEN SCAN (STATIC) $52.0097782230 PF/HEPATOBILIARY SCAN (DUCT) $89.0097782260 PF/HEPATOBILIARY SCAN W GALLBLADDER $75.0097782640 PF/GASTRIC EMPTYING STUDY $82.0097783060 PF/BONE SCAN; WHOLE BODY $91.0097783150 PF/THREE PHASE BONE SCAN $108.0097784520 PF/HT MUSCLE IMAGE SPECT, MULTIPL $165.0097784720 PF/HEART-MUGA $107.0097785790 PF/ LUNG VENTILATION IMAGING $200.0097785800 PF/LUNG SCAN-PERFUSION $79.0097785820 PF/LUNG VENT & PERF IMAGING $111.0097785940 PF/LUNG VENT IMAGING; GAS; MULT $56.0097787070 PF/RENAL SCAN W/VASCULAR FLO $101.0097788050 PF/GALLIUM LIMITED RETURN $300.0097850978 PF/BONE MARROW INTERPRETATION $76.0097860788 PF/PHYS BB SVC (TRANS REAC) $78.0097860798 PF/PHYS BB SVC (DEVIAT AUTH) $78.0097881048 PF/CYTOPATHOLOGY;FLUIDS $57.0097881088 PF/CYTOPATH; CONCENTRATE TECH $47.0097881128 PF/CYTOPATH;CELL ENHANCE $83.0097881129 PF/CYTOPATH; CELL ENHANCE $80.0097881258 PF/CYTOPATHOLOGY; FORENSIC $88.0097881428 PF/CP CERV/VAGINAL ATL; MANUAL SCREEN $47.0097881618 PF/CYTOPATH SMEAR; OTHER SOURCE $47.0097881628 PF/CYTOPATH SMEAR;OTHER SOURCE $67.0097881728 PF/CYTOPATHOLOGY EVAL OF FNA $47.0097881729 PF/CYTOPATHOLOGY EVAL OF FNA $47.0097881738 PF/CYTOPATH EVAL;FNA;REPORT $103.0097881759 PF/CYTOPATH; C/V/ THIN PREP; A $55.0097881828 PF/CELL MARKER STUDY $57.0097882918 PF/CG;MCG;INT & REP $47.0097883008 PF/SURGICAL PATH;GROSS LEVEL 1 $26.0097883028 PF/SURGICAL PATH;GR;MICRO II $26.0097883048 PF/SURGICAL PATH;GR;MICRO III $37.0097883058 PF/SURGICAL PATH';GR;MIRCRO IV $57.0097883078 PF/SURGICAL PATH;GR;MICRO V $145.0097883098 PF/SURGICAL PATH;GR;MICRO VI $181.0097883118 PF/DECALCIFY TISSUE $26.0097883128 PF/SPECIAL STAINS;GRP 1 $52.0097883138 PF/SPECIAL STAINS;GRP 2 $26.0097883148 PF/HISTO CHEMICAL STAIN $37.0097883188 PF/CHEMICAL HISTO CHEMISTRY $47.0097883198 PF/ENZYME HISTO CHEMISTRY $47.0097883218 PF/CONSULTATION & REPORT ON SLIDE $140.0097883238 PF/REF CONSULT WITH SLIDE PREP $150.0097883258 PF/COMPREHENSIVE CONSULT $165.0097883318 PF/PATH CONSULT INTRA OP; 1 BLOC $98.00

97883328 PF/PATH CONSULT INTRAOP;ADD'L $57.0097883338 PF/INTRAOP CYTO PATH CONSULT, 1 $78.0097883428 PF/IMMUNOHISTOCHEMISTRY $73.0097883468 PF/IMMUNOFLUORESCENT DIRECT $78.0097883488 PF/ELECTRON MICROSCOPY $150.0097883608 PF/MANUAL TUMOR IM HISTOCHEM, EA $83.0097883618 PF/MORPHOMETRIC ANLYS EA AB QT $83.0097883658 PF/INSITU HYBRIDATION (FISH) $83.0097883688 PF/MORPHOMETRIC ANLYSIS INSITU $93.0097883888 PF/TISS EX MOLECUL STDY ADD-ON $37.0097938800 PF/EXTRACRANIAL DUPLEX; BIL $206.0097939220 PF/EXTREMITY ARTERY SING; BIL $129.0097939250 PF/DUPLEX; LWR EXT ART; COMP-BIL $227.0097939261 PF/DUPLEX; LWR EXT ART; LTD-LT $330.0097939262 PF/DUPLEX; LWR EXT ART; LTD-RT $330.0097939300 PF/DUPLEX; UPR EXT ART; COMP-BIL $464.0097939311 PF/DUPLEX; UPR EXT ARTERY; LTD-LT $330.0097939312 PF/DUPLEX; UPR EXT ART; LTD-RT $330.0097939700 PF/DOPPLER-VENOUS EXT VEINS BILAT $330.0097939711 PF/DUPLEX; LWR EXT VEIN; LTD-LT $330.0097939712 PF/DUPLEX; LWR EXT VEIN; LTD-RT $330.0097939715 PF/DUPLEX; LWR EXT VEIN; LTD-BILAT $330.0097939750 PF/DUPLEX; OTHER; COMP $464.0097939760 PF/DUPLEX ARTERIAL FLOW; LIMITED $103.0097939790 PF/DUPLEX; OTHER; LTD $330.0097940108 PF/PUL FUNCTIONS STUDIES $62.0097940608 PF/PUL FUNCTION W/BRONCHO $39.0097941508 PF/TOTAL VITAL CAPACITY $47.0097942008 PF/MAXIMA BREATHING CA $39.0097943758 PF/FUL FLOW VOL LOOP $36.0097946200 PF/PULMONARY STRESS TEST/SIMPLE $228.0097946201 PF/PULMONARY STRESS TEST/SIMPLE $228.0097947208 PF/CO DIFFUSING CAPACITY $191.0097947278 PF/PULM FUNCTION TEST BY GAS $37.0097947708 PF/CO2 EXP GAS DETER $31.0097963720 PF/THER/PROPH/DIAG INJ, SC/IM $42.0098100608 PF/DRAINAGE SKIN ABSCESS (SIMPLE) $152.0098100618 PF/DRAINAGE SKIN ABCESS (MULT) $273.0098100808 PF/DRAINAGE PILONDIDAL CYST $157.0098101208 PF/REMOVE FOREIGN BOBY; SIMPLE $150.0098101218 PF/INC & REM FB, SQ; COMPLICATED $270.0098101408 PF/DRAINAGE OF HEMATOMA/FLUID $199.0098101608 PF/PUNCTURE ABSCESS/HEMA/CYST $160.0098110428 PF/DEBRIDE SKIN/TISSUE $86.0098112008 PF/REMOVAL SKIN TAGS $107.0098113008 PF/SHAVE LES, T/A/L; 0.5CM/< $42.0098113018 PF/SHAVE LES, T/A/L; 0.6-1.0 CM $73.0098113028 PF/SHAVE LES, T/A/L; 1.1-2.0 CM $88.00

98113038 PF/SHAVE LES, T/A/L; > 2.0 CM $103.0098113058 PF/SHAVE LES, S/N/H/F/G; 0.5 CM $57.0098113068 PF/SHAVE LES, S/N/H/F/G; 0.6-1.0 $83.0098113078 PF/SHAVE LES, S/N/H/F/G; 1.1-2.0 $98.0098113088 PF/SHAVE LES, S/N/H/F/G; >2.0 CM $119.0098113108 PF/SHAVE LES, F/E/N/L; 0.5 CM $62.0098113118 PF/SHAVE LES, F/E/N/L; 0.6-1.0 CM $91.0098113128 PF/SHAVE LES, F/E/N/L; 1.1-2.0 CM $140.0098113138 PF/SHAVE LES, F/E/N/L; >2.0 CM $140.0098114038 PF/EXC, BEN LES, T/A/L; 2.1-3.0 CM $196.0098114048 PF/EXC, BEN LES, T/A/L; 3.1-4.0 CM $206.0098114068 PF/EXC, BEN LES, T/A/L; >4.0 CM $309.0098114208 PF/EXC, BLES, S/N/EX, G; 0.5CM/< $103.0098114218 PF/EXC, BLES, S/N/EX, G; 0.6-1.0 CM $153.0098114228 PF/EXC, BLES, S/N/EX, G; 1.1-2.0 CM $176.0098114238 PF/EXCISION 2.1-3.0 CM $247.0098114248 PF/EXC, BLES, S/N/EX, G; 3.1-4.0 CM $248.0098114268 PF/EXC, BLES, S/N/EX, G; >4.0 CM $387.0098114408 PF/EXCISION FACE 0.5 CM OR LESS $155.0098114418 PF/EXC FACE - MM B9+MARG 0.6-1 CM $176.0098114428 PF/EXC FACE-MM B9+MARG 1.1-2 CM $196.0098114438 PF/EXC FACE-MM B9+MARG 2.1-3 CM $243.0098114448 PF/EXC FACE-MM B9+MARG 3.1-4 CM $315.0098114468 PF/EXC FACE-MM B9+MARG > 4 CM $449.0098117308 PF/REMOVAL OF NAIL PLATE $107.0098117408 PF/DRAIN BLOOD FROM UNDER NAIL $53.0098117508 PF/REMOVAL OF NAIL BED $288.0098117608 PF/REPAIR NAIL BED $186.0098117658 PF/EXCISION OF NAIL FOLD, TOE $110.0098120018 PF/REPAIR WOUND 2.5CM OR LESS $170.0098120028 PF/REPAIR WOUND 2.6-7.5CM $96.0098120048 PF/REPAIR WOUND 7.6-12.5CM $224.0098120058 PF/REPAIR WOUND 12.6-20.0CM $280.0098120068 PF/REPAIR WOUND 20.1-30.0CM $355.0098120078 PF/REPAIR SUPERFICIAL WOUND > 30C $357.0098120118 PF/REPAIR FACE WOUNDS 2.5CM OR LS $177.0098120138 PF/REPAIR FACE WOUNDS 2.6-5.0CM $201.0098120148 PF/REPAIR FACE WOUNDS 5.1-7.5CM $243.0098120158 PF/REPAIR FACE WOUNDS 7.6-12.5CM $305.0098120168 PF/REPAIR FACE WOUNDS 12.6-20.0CM $372.0098120178 PF/REPAIR FACE WOUNDS 20.1-30.0CM $452.0098120188 PF/REPAIR FACE WOUNDS >30.0CM $546.0098120208 PF/TX SUPERF WND DEHISCENCE SMPLE $269.0098120218 PF/SIMPLE TX WOUND DEHIS C PACKING $227.0098120318 PF/LAYER CLOSE WOUND(S) 2.5CM>= $239.0098120328 PF/LAYER CLOSE WOUND(S) 2.6-7.5CM $300.0098120348 PF/INT REP S/A/T/EX; 7.6-12.5 CM $318.0098120358 PF/LAYER CLOSE WOUND(S) 12.6-20.0 $392.00

98120368 PF/LAYER CLOSE WOUND(S) 20.1-30.0 $465.0098120378 PF/LAYER CLOSE WOUND(S) >30.0CM $541.0098120418 PF/LAYER CLOSE WOUND(S) 2.5CM>= $260.0098120428 PF/LAYER CLOSE WOUND(S) 2.6-7.5CM $302.0098120448 PF/LAYER CLOSE WOUND(S) 7.6-12.5C $337.0098120458 PF/LAYER CLOSE WOUND(S) 12.6-20.0 $408.0098120468 PF/LAYER CLOSE WOUND(S) 20.1-30.0 $330.0098120478 PF/LAYER CLOSE WOUND(S) >30.0CM $535.0098120518 PF/LAYER CLOSE WOUND(S) 2.5CM>= $283.0098120528 PF/LAYER CLOSE WOUND(S) 2.6-5.0CM $318.0098120538 PF/LAYER CLOSE WOUND(S) 5.1-7.5CM $335.0098120548 PF/LAYER CLOSE WOUND(S) 7.6-12.5C $364.0098120558 PF/LAYER CLOSE WOUND(S) 12.6-20.0 $458.0098120568 PF/LAYER CLOSE WOUND(S) 20.1-30.0 $569.0098120578 PF/LAYER CLOSE WOUND(S) >30.0CM $642.0098131008 PF/REPAIR CMPLX TRUNK 1.1-2.5 CM $570.0098131018 PF/REPAIR CMPLX TRUNK 2.6-7.5CM $397.0098131028 PF/REPAIR CMPLX TRUNK EA ADD 0-5C $112.0098131208 PF/COMPLEX REPAIR 1.1-2.5CM $389.0098131218 PF/COMPLEX REPAIR 2.6-7.5CM $500.0098131228 PF/COMPLEX REPAIR EACH ADDTL <=5C $144.0098131318 PF/COMPLEX REPAIR 1.1-2.5CM $439.0098131328 PF/COMPLEX REPAIR 2.6-7.5CM $721.0098131338 PF/COMPLEX REPAIR EA ADDTL <=5CM $219.0098131508 PF/COMPLEX REPAIR FACE <=1.0CM $446.0098131518 PF/COMPLEX REPAIR FACE 1.1-2.5CM $446.0098131528 PF/COMPLEX REPAIR FACE 2.6-7.5CM $685.0098131538 PF/CMPLX REPAIR FACE EA ADDTL <=5 $243.0098160008 PF/INITIAL TREATMENT 1ST DEG BURN $80.0098160208 PF/DRESS/DEBRID P-THICK BURN, SML $94.0098160258 PF/DRESS/DEBRID P-THICK BURN, MED $193.0098160308 PF/DRESS/DEBRID P-THICK BURN, LRG $223.0098160358 PF/ESCHAROTOMY; INITIAL INCISION $325.0098171060 PF/DESTR CUT VASC LES; 10 SQ CM/< $500.0098172508 PF/CHEM CAUT GRANULATION TISSUE $52.0098179998 PF/UNLISTED PROC SKIN MM & SUBQ TISSUE $258.0098190008 PF/PUNCT ASP OF CYST OF BREAST $80.0098190018 PF/PUNCT ASP OF CYST BREAST ADDTL $40.0098190208 PF/EXPLORE BREAST WOUND OR ABSCES $463.0098201028 PF/EXPLORE PENTR WOUND OF EXTREM $400.0098201038 PF/EXPLORE PENTR WOUND OF EXTREM $609.0098205208 PF/REMOVAL FOREIGN BODY MUSCLE $242.0098205528 PF/INJ TRIGGER POINT, 1/2 MUSCLE $54.0098206008 PF/DRAIN/INJECT, SML JOINT/BURSA $71.0098206058 PF/DRAIN/INJECT, MED JOINT/BURSA $73.0098206108 PF/DRAIN/INJECT, MAJOR JOINT/BURS $88.0098206928 PF/APPLY PINS OR WIRES $1,528.0098209508 PF/MONITOR INTERST FLD PRESSURE $134.00

98213108 PF/CLOSED TX NOSE FRACTURE $50.0098213208 PF/CL TX OF NASAL BONE FX; W STAB $196.0098213378 PF/CL TX NASAL SEPTAL FX $392.0098214808 PF/CL TX TMJ DISLOCATION; INITIAL $52.0098218008 PF/CL TX RIB FX, UNCOMPL, EA $158.0098235008 PF/CL TX CLAVICULAR FX; WO MANIP $333.0098235058 PF/CL TX CLAVICULAR FX; W MANIPULA $458.0098235208 PF/CLOSED TX STERNOCLAV FRACTURE $258.0098235258 PF/CL TX SCCLAV DISLOC W MANIPULA $433.0098235408 PF/CLSD TX ACROMIOCLAV DISLOC W/O $336.0098235458 PF/CLSD TX ACROMIOCLAV DISLOC W M $455.0098235708 PF/CLSD TX SCAPULA DISLOC W MANIP $367.0098235758 PF/CLSD TX SCAPULA DISLOC W MANIP $589.0098236008 PF/CLSD TX ARM W MANIPULATION $469.0098236058 PF/CLSD TX ARM W MANIPULATION $710.0098236508 PF/CLSD TX SHOULDER DISLOC $423.0098236558 PF/CLSD TX SHOULDER DISLOC $630.0098239318 PF/DRAIN ARM, ELBOW BURSA $268.0098245008 PF/CLSD TX HUMERUS FX WO MANIPULA $428.0098245058 PF/CL TX HUMERUS FX W MANIPULATE $618.0098246008 PF/TREAT ELBOW DISLOCATION $536.0098246058 PF/TX CL ELBOW DISLOC W ANESTHESI $657.0098246208 PF/TREAT ELBOW FRACTURE $932.0098246408 PF/TREAT ELBOW DISLOCATION $932.0098246558 PF/CL TX RADIAL HD/NECK FX; W MANIP $618.0098246758 PF/TREAT ULNAR FRACTURE $567.0098255008 PF/CLSD TX RADIAL SHFT FX WO MANI $320.0098255058 PF/CL TX RADIAL SHFT FX W MANIPUL $644.0098255308 PF/CLSD TX OF RADIAL SHFT FX WO M $258.0098255358 PF/CL TX ULNAR SHFT FX W MANIPULA $618.0098255608 PF/CL TX RADIAL&ULNAR SHFT FX WO $315.0098255658 PF/CL TX RADIAL & ULNA FX W MANIP $670.0098256008 PF/CLSD TX ARM FRACTURE WO MANIPU $409.0098256058 PF/CLSD TX ARM FRACTURE W MANIPUL $940.0098256228 PF/CLSD TX WRIST FRACTURE $418.0098256248 PF/CL TX CARPL SCAPHOID FX W MANI $583.0098256308 PF/TREAT WRIST BONE FRACTURE W/O $371.0098256358 PF/TREAT WRIST BONE FRACTURE W MA $543.0098256508 PF/TREAT WRIST BONE FRACTURE $455.0098256608 PF/CL TX CARPAL DISLOC W MANIPULA $552.0098260108 PF/DRAINAGE OF FINGER ABSCESS $217.0098260118 PF/DRAINAGE OF FINGER ABSCESS $311.0098264108 PF/REPAIR HAND TENDON $995.0098264188 PF/EXTENSOR TENDON REPAIR, EACH $829.0098266008 PF/TREAT METACARPAL FRACTURE $383.0098266058 PF/CLSD TX METACARPAL FX W MANIP $330.0098266418 PF/CL TX THUMB WITH MANIPULATION $443.0098266458 PF/CL TX CMC FX DISLOC THUMB W MA $412.00

98267008 PF/TREAT KNUCKLE DISLOCATION $454.0098267208 PF/CLOSED TX FINGER OR THUMB, EA $233.0098267258 PF/TREAT FINGER FRACTURE, EACH $491.0098267420 PF/CL TX ARTFX MCP/IP JNT; W MANIP $300.0098267508 PF/CLOSED TX FINGER OR THUMB, EA $268.0098267558 PF/TREAT FINGER FRACTURE, EACH $431.0098267708 PF/TREAT FINGER DISLOCATION $279.0098267758 PF/CL TX IP JT D, W MANIP; W ANES $464.0098267850 PF/TREAT FINGER DISLOCATION $500.0098270868 PF/REMOVE FOREIGN BODY PELVIS/HIP $250.0098272308 PF/CL TX PROX FEM FX WO MANIPULAT $665.0098272508 PF/CL TX TRAUMA HIP DICLOC WO ANE $361.0098272528 PF/CL TX TRAUMA HIP DISLOC W ANES $1,082.0098272658 PF/CL TX POST HIP DISLOC WO ANEST $515.0098275008 PF/CL TX FEMORAL SHAFT FX, WO MAN $691.0098275028 PF/CL TX FEMORAL SHAFT FX, W MANI $1,175.0098275088 PF/CL TX DISTAL FEM FX WO MANIP $675.0098275108 PF/CL TX FEMUR FX OR EPIPHYS SEP $1,030.0098275208 PF/CLOSED TX PATELLAR FX, WO MANI $387.0098275508 PF/CL TX KNEE DISL; WO ANESTHESIA $618.0098275608 PF/TREAT KNEECAP DISLOCATION $503.0098275628 PF/CL TX PATELLAR DISLOCATION; W $670.0098277508 PF/TREATMENT TIB FRACTURE $430.0098277528 PF/CL TX TIB SHAFT FX W MANIPULAT $1,149.0098277818 PF/CL TX PROX FIB/SHAFT FX W MANI $546.0098277888 PF/CL TX DISTL FIB FX W MANIPULAT $721.0098278088 PF/TREATMENT OF ANKLE FRACTURE $382.0098278108 PF/TREATMENT OF ANKLE FRACTURE $629.0098278168 PF/CL TX TRIMALL ANKLE FX; WO MAN $376.0098278188 PF/TREATMENT OF ANKLE FRACTURE $742.0098278248 PF/CL TX WT BRG DSTL TIB WO MANIP $402.0098278258 PF/CL TX WT BRG DSTL TIB W MANIP $721.0098278428 PF/CL TX ANKLE DISLOCATION; W ANESTH $490.0098281908 PF/REMOVAL OF FOOT FOREIGN BODY $236.0098284008 PF/CLOSED TX HEEL FX $367.0098284508 PF/TX TARSAL BONE FX ; WO MANIPU $258.0098284558 PF/TX TARSAL BONE FX; W MANIP $371.0098284708 PF/CLOSED TX TOE FRACTURE $309.0098284758 PF/CL TX METATARSAL FX; WO MANIP $263.0098284908 PF/CLOSED TX FINGER FRACTURE NO M $191.0098284958 PF/CL TX FX GT PHALANX(S); W MANI $206.0098285108 PF/CLOSED TX FINGER FRACTURE W/MA $186.0098285158 PF/CL TX FX GT PHALANX(S); W MANI $191.0098285708 PF/CL TX TALOTARSAL JOINT DIS; WO $216.0098286308 PF/TREAT TOE DISLOCATION $189.0098286358 PF/CL TX MTP JNT DISLOC; W ANESTH $206.0098286608 PF/CLOSED TX JOINT DISLOC NO ANES $142.0098290358 PF/APPLICATION OF BODY CAST $239.00

98290498 PF/APPLICATION OF FIGURE EIGHT $106.0098290658 PF/APPLIC CAST LONG ARM $204.0098290758 PF/APPLICATION OF SHORT ARM CAST $106.0098290858 PF/CAST LWR HAND FOREARM GAUNTLET $98.0098291058 PF/SPLINT APPLICATION - LONG ARM $101.0098291258 PF/SPLINT APPLICATION - SHORT ARM $71.0098291268 PF/APPLY FOREARM SPLINT $86.0098291308 PF/SPLINT APPLICATION - FINGER $49.0098291318 PF/APPLICATION OF FINGER SPLINT $52.0098292408 PF/STRAPPING OF SHOULDER $76.0098292608 PF/STRAPPING; ELBOW OR WRIST $54.0098292808 PF/STRAPPING OF HAND OR FINGER $57.0098293458 PF/APPLIC CASH LONG LEG $197.0098293658 PF/APPLY CYLINDER CAST $129.0098294058 PF/APPLICATION OF SHORT LEG CAST $113.0098294258 PF/APPLY WALKER SHORT LEG CAST $83.0098295058 PF/SPLINT APPLICATION - LONG LEG $81.0098295158 PF/SPLINT APPLICATION - SHORT LEG $85.0098295308 PF/STRAPPING - KNEE $61.0098295408 PF/STRAPPING - ANKLE/FOOT $58.0098295508 PF/STRAPPING - TOES $54.0098295808 PF/STRAPPING UNNA BOOT $87.0098297008 PF/REM GAUNTLET, BOOT OR BODY CAS $61.0098297058 PF/REMOVE FULL ARM OR LEG CAST $86.0098297108 PF/REM SHOULDER OR HIP SPICA $146.0098297408 PF/WEDGING OF CAST NOT CLUBFOOT $103.0098297998 PF/CASTING & STRAPPING (NEC) $73.0098300008 PF/DR ABSC/HEMATOMA NASAL INT $175.0098300208 PF/DRAIN ABSC/HEMATOMA, NASAL SEPTUM $165.0098303008 PF/REMOVE NASAL FOREIGN BODY $194.0098309018 PF/CONTROL OF NOSE BLEED $107.0098309038 PF/CONTROL NASAL HEMORRH, ANT COM $124.0098309058 PF/INITIAL CONTROL OF NOSE BLEED $180.0098315008 PF/INSERT EMERGENCY AIRWAY $192.0098315028 PF/CHANGE OF WINDPIPE AIRWAY $54.0098315058 PF/LARYNGOSCOPY, IND; DIAGNOSTIC $71.0098315208 PF/DX LARYNGOSCOPY, NEWBORN $206.0098315308 PF/LARYNGOSCOPY W/FB REMOVAL $349.0098316038 PF/TRACHEOSTOMY, EMERG; TRANSTRAC $346.0098316058 PF/TRACHEOSTOMY, EMERG; CRICOTHYR $289.0098317208 PF/CLEARANCE OF AIRWAYS $92.0098324218 PF/THORACENTESIS FOR ASPIRATION $119.0098324228 PF/THORACENTESIS W/TUBE INSERT $191.0098325518 PF/INSERTION OF CHEST TUBE $325.0098325548 PF/THORACENTESIS FOR ASPIRATION $119.0098325558 PF/THORACENTESIS W/TUBE INSERT $191.0098330108 PF/PERICARDIOCENTESIS; INITIAL $211.0098332108 PF/INS/REPL TEMP TRANSV SC CARD E $289.00

98352010 PF/REPAIR BLOOD VESSEL DIRECT; NECK $1,200.0098352068 PF/REPAIR BLOOD VESSEL DIRECT; UPR EXTR $1,545.0098352078 PF/REPAIR BLOOD VESSEL DIRECT; HAND FNGR $1,545.0098352268 PF/REPAIR BLOOD VESSEL DIRECT; LWR EXT $1,545.0098360058 PF/EXTREMITY VENOGRAM INJ $73.0098361408 PF/NS CATH - EXTREMITY ARTERY $155.0098364008 PF/BLOOD DRAW <3 YRS FEM/JUGULAR $26.0098364058 PF/PHY BL DRAW < 3 YRS SCALP VEIN $26.0098364068 PF/PHY BL DRAW < 3 YRS OTHER VEIN $16.0098364108 PF/VENIPUNCTURE AGE 3 YRS/> PHYS $103.0098364208 PF/VEIN ACCESS CUTDOWN < 1 YR $73.0098364258 PF/VENIPUNCTURE, CUTDOWN; AGE 1 + $103.0098365558 PF/INSERT NON-TUNNEL CV CATH $191.0098365568 PF/INSERT NON-TUNNEL CV CATH $216.0098365698 PF/INSERT PICC CATH $173.0098365898 PF/REMOVE TUNNELED CV CATHETER $222.0098365908 PF/REM TUNNELED CVAD W PORT/PUMP $309.0098366008 PF/ARTERIAL PUNCTURE, BLOOD FOR D $26.0098366808 PF/PLACE NEEDLE INTRAOSSEOUS INFU $95.0098371958 PF/THROMBOLYSIS, CEREBRAL, BY IV $155.0098383008 PF/DRAIN ABSCESS/INFECTION; SIMPL $258.0098406508 PF/REPAIR LIP $475.0098408008 PF/DRAIN ABSCESS/CYST OF MOUTH $205.0098408048 PF/REMOVAL, FOREIGN BODY, MOUTH $211.0098408308 PF/CLSD LACERATION, MOUTH VESTIB $262.0098408318 PF/CLSD LACERATION, MOUTH > 2.5CM $371.0098412508 PF/REPAIR TONGUE LACERATION $227.0098412528 PF/REP LACERAT-TONGUE FLR-MOUTH > 2.6/CP $450.0098418008 PF/DRAIN ABSC, CYST, HEMATOM - DENTO $281.0098418058 PF/REM EMB FB FROM DENTOALV; SFT $222.0098420008 PF/DRAINAGE OF ABSCESS OF PALATE $145.0098427008 PF/I&D ABSCESS; PERITONSILLAR $222.0098428098 PF/REMOVE PHARYNX FOREIGN BODY $215.0098432478 PF/OPERATIVE UPPER GI ENDOSCOPY $338.0098432488 PF/UPPER GI ENDOSCOPY/GUIDE WIRE $317.0098437538 PF/GASTRIC INTUBATION/ASPIR/LAVAG $31.0098437608 PF/CHANGE GASTROSTOMY TUBE $90.0098437618 PF/REPOSITION GASTROSTOMY TUBE $181.0098453078 PF/PROCTOSIG, RIGID; W REM FB $134.0098460408 PF/INCISION OF RECTAL ABSCESS $634.0098460508 PF/INCISION OF ANAL ABSCESS $149.0098460838 PF/INCISE EXTERNAL HEMORRHOID $164.0098490808 PF/PERITONEOCENTESIS; INITIAL $109.0098490818 PF/PERITONEOCENTESIS; SUBSEQUENT $83.0098490820 PF/PERITONEOCENTESIS; INITIAL $109.0098511008 PF/DRAIN BLADDER BY NEEDLE $72.0098511018 PF/DRAIN BLADDER BY TROCAR/CATH $86.0098511028 PF/DRAIN BL W/CATH INSERTION $443.00

98517018 PF/INSERT BLADDER CATHETER $50.0098517028 PF/INSERT TEMP BLADDER CATH $54.0098517038 PF/INS BLADDER CATH, COMPLEX $129.0098517058 PF/CHANGE OF CYSTOSTOMY TUBE; SIM $129.0098542208 PF/IRRIGATE CORPORA CAVERNOSA FOR $205.0098547008 PF/I & D EPIDIDYMIS, TESTIS/SCROTUM $340.0098551008 PF/DRAINAGE OF SCROTAL WALL ABSCE $253.0098564058 PF/I & D OF VULVA/PERINEUM $183.0098564208 PF/DRAINAGE OF GLAND ABSCESS $163.0098589998 PF/UNLISTED PROC FEMALE GENITAL $155.0098590258 PF/FETAL NON-STRESS TEST $60.0098593008 PF/EPISIOTOMY OR VAGINAL REPAIR $237.0098594098 PF/VAGINAL DELIVERY ONLY -IN ER $1,288.0098594148 PF/DELIVERY OF PLACENTA $179.0098622708 PF/SPINAL FLUID TAP, DIAGNOSTIC $129.0098622728 PF/DRAIN CEREBRO SPINAL FLUID $146.0098644008 PF/NERVE BLOCK INJECTION $105.0098644028 PF/INJ ANESTH; FACIAL NERVE $103.0098644058 PF/NJ ANESTH ; GREATER OCCIPITAL $103.0098644178 PF/INJ ANESTH; AXILLARY NERVE $109.0098644208 PF/INJ ANESTH; INTERCOSTAL NERVE $96.0098644218 PF/INJ ANESTH; INTERCOST NRV, MUL $129.0098644508 PF/INJ ANESTH; OTHR PERIPHERAL NR $124.0098652058 PF/REMOVE FOREIGN BODY FROM EYE $66.0098652108 PF/REMOVE FOREIGN BODY FROM EYE $81.0098652208 PF/REMOVE FOREIGN BODY FROM EYE $81.0098652228 PF/REMOVE FOREIGN BODY FROM EYE $87.0098677008 PF/DRAIN ABSCESS, EYELID $206.0098690008 PF/DRAIN EXTERNAL EAR LESION $190.0098690208 PF/DRAIN EXTERNAL AUDITORY CANAL $232.0098692008 PF/CLEAR OUTER EAR CANAL $91.0098692058 PF/REM FB EXT AUDITORY CANAL; W A $140.0098692090 PF/REMOVE IMPACTED EAR UNILATERAL RINSE $25.0098692108 PF/REMOVE IMPACTED EAR WAX $56.0098901680 PF/WOUND CLOSURE BY ADHESIVE $50.0098904738 PF/IMMUNE ADMIN ORAL/NASAL $31.0098929508 PF/CPR-CARDIOPULMONARY RESUSCITAT $319.0098929538 PF/TEMP TRANSCUTAN PACING $19.0098929608 PF/CARDIOVERSION $228.0098929778 PF/THROMBOLYSIS, CORON; IV INFUS $34.0098930108 PF/EKG INTERPRETATION $26.0098930188 PF/INTERPRETATION - STRESS $93.0098932278 PF/INTERPRETATION HOLTER $106.0098933038 PF/TTE CONG ABN; COMPLETE $155.0098933068 PF/TTE W/DOPPLER, COMPLETE $569.0098933078 PF/INTR M MODE 2D $248.0098933208 PF/DOPPLER ECHO PULSED $167.0098933258 PF/DOPPLER ECHO COLOR FLO $155.00

98958168 PF/EEG $200.0098958198 PF/AWAKE & ASLEEP EEG $200.0098958228 PF/SLEEP ONLY EEG $200.0098958248 PF/ELECTRO CEREBRAL SILENCE $87.0098991758 PF/IPECAC ADMINISTRATION $114.0098992118 PF/OP VISIT LEVEL 1 PROCEDURE $62.0098992128 PF/OUTPATIENT EST PT VISIT - LEVEL 2 $83.0098992418 PF/ER TRIAGE PHYSICIAN ASSESSMENT $66.0098992818 PF/BRIEF SERVICE $71.0098992828 PF/LIMITED SERVICE $83.0098992838 PF/INTERMEDIATE SVC $145.0098992848 PF/EXTENDED SERVICE $227.0098992858 PF/COMPREHENSIVE SVC $309.0098992918 PF/CRITICAL CARE 1ST HR $412.0098992928 PF/CRITICAL CARE + 1/2 HR $361.0099033400 MAMMO ASSESS INCOMPL XRAY DOCD $0.0099033410 MAMMO ASSESS NEGATIVE DOCD $0.0099033430 MAMMO PROBABLY BENIGN DOCD $0.0099033440 MAMMO ASSESS SUSPICIOUS DOCD $0.0099033500 MAMMO BX PROVEN MALIG DOCD $0.0099034200 MAMMO ASSESS BENIGN DOCUMENTED $0.0099034500 MAMMO ASSESS HGHLY MALIG DOC $0.0099095790 GADOPENTETATE DIMEGLUMINE 15ML $109.00