Description Price HCPCS CodeANES FOR DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPHY 1620.00 1916FINE NEEDLE ASP W/O IMAGING PRO FEE 145.00 10021FINE NEEDLE ASP W/O IMAGING 224.00 10021FN ASPIR W/GUIDANCE 1159.50 10022LUNG BX FINE NDL ASP 1159.00 10022I&D ABSCESS SINGLE 175.80 10060OHC I&D ABSCESS SMPL 240.00 10060EP I&D ABCESS SIMPLE 199.20 10060ER I&D ABCESS SIMPLE 42.10 10060I&D ABSCESS CMP MLTP 319.50 10061EP I&D ABCESS MULTI 421.80 10061ER I&D ABCESS MULTI 64.00 10061EP I & D CYST SIMPLE 325.50 10080ER I&D CYST SIMPLE 168.60 10080EP INC REM FORGN BDY 339.50 10120ER INC RM FORGN BDY 129.50 10120INC REM FOREIGN BODY 294.90 10120EP I&R FB SUBQ COMPL 520.90 10121EP I&D HEMATOMA/SERO 258.40 10140ER I&D HEMATOMA/SERO 95.20 10140EP ASPIR ABCESS/HEMA 222.80 10160ER ASPIR ABCESS/HEMA 66.90 10160EP I&D COMP POST WND 512.20 10180EP DEBRID EXT ECZEMA 111.60 11000DEBRID SUBCU 20SQCM< 237.10 11042EP DEBRID SKIN SUBQ 200.20 11042ER DEBRID SUBQ TS 20 87.00 11042DEBRID SKIN SUBQ PF 121.20 11042DEB MUSC/FAS </=20CM 424.50 11043DEBRID TISS MUSCL PF 832.50 11043DEB BONE </=20CM2 554.00 11044DEBRID SUBQ EA +20CM 68.60 11045DEBRID MSCL FAS+20CM 81.10 11046BX SUBQ MUC MEM SNGL 143.70 11100EP BX SKIN SUBQ SIMP 151.00 11100EP REM SKIN TAG <=15 169.80 11200ER REM SKIN TAG <=15 175.30 11200EP EXC BENIGN LESION 272.50 11400ER EXC BENIGN LESION 109.20 11400EP EXC BEN LES .6/1 326.50 11401ER EXC BEN LES .6/1 95.10 11401ER EXC BENIGN LESION OVER 4CM 759.00 11406EP EXC BENIGN LESION OVER 4CM 190.00 11406EXC BENG LESION .5CM OR LESS 190.30 11420EXC BENG LESION .6 TO 1CM 218.40 11421EXC MALIGNANT LESION 1.1/2CM 496.10 11602

DEBRID NAIL 1 TO 5 49.30 11720DEBRID NAIL 6 OR MOR 74.80 11721OHC REMVL NAIL PLATE 240.00 11730EP AVULS NAIL PLATE 213.30 11730ER AVULS NAIL PLT SN 105.50 11730EP AVULS NAIL ADD'L 102.30 11732EP EVAC SUBUNGAL HEM 79.50 11740ER EVAC SUBUNGAL HEM 42.50 11740EP EXCI NAIL PAR COM 373.70 11750ER EXCI NAIL & MATRI 112.70 11750EP EXCIS NAIL/AMPUTA 563.40 11752REPAIR OF NAIL BED 345.00 11760REPAIR OF NAIL BED PF 210.00 11760EP EXC SKIN NAIL FLD 284.80 11765ER EXC SKIN NAIL FLD 129.90 11765OHC SIMPLE SUTURE2.5 245.50 12001EP WND REPAIR 2.5CM< 353.20 12001ER WND REPAIR 2.5CM< 136.00 12001ER CLS TX TOE DISLOCATION W/ANES 400.00 12001OHC SIMPLE SUTURE2.6 354.80 12002EP WND REPAIR2.6/7.5 394.70 12002ER WND REPAIR2.6/7.5 129.70 12002EP WND REPAI7.6/12.5 486.20 12004ER WND REPAI7.6/12.5 150.90 12004EP WND REPA12.6/20.0 583.10 12005ER WND REPA12.6/20.0 162.10 12005EP WND REPA20.1/30.0 753.20 12006ER WND REP 20.1/30.0 255.50 12006EP WND REPAIR >30CM 783.20 12007ER WND REPAIR >30CM 196.60 12007EP WND REPAIR 2.5CM< 321.90 12011ER WND REPAIR 2.5CM< 131.70 12011EP WND REPAIR2.6/5.0 433.80 12013ER WND REPAIR2.6/5.0 155.20 12013EP WND REPAIR5.1/7.5 527.90 12014ER WND REPAIR5.1/7.5 174.40 12014EP WND REPR 7.6/12.5 489.50 12015ER WND REPR 7.6/12.5 192.30 12015EP WND REPAR 12.6-20 856.90 12016ER WND REPAIR 12.6-20CM 396.00 12016EP SPRFCL WND SMPCLO 541.70 12020ER SPRFCL WND SMPCLO 191.10 12020EP SPRFCL WND W/PACK 346.90 12021EP LAYER CLOS 2.5CM< 422.00 12031ER LAYER CLOS 2.5CM< 174.10 12031EP LAYER CLOS2.6/7.5 417.80 12032ER LAYER CLOS2.6/7.5 285.40 12032

EP LAYER CLS7.6/12.5 638.70 12034ER LAYER CLS7.6/12.5 241.90 12034EP LAYER CL12.6/20.0 712.10 12035ER LAYER CL12.6/20.0 759.70 12035EP LAYER CL20.1/30.0 840.30 12036ER LAYER CL 20.1/30 296.40 12036EP LAYER CLOS 2.5CM< 463.80 12041ER LAYER CLOS 2.5CM< 208.90 12041EP LAYER CLOS2.6/7.5 516.20 12042ER LAYER CLOS2.6/7.5 217.40 12042EP LAYER CLO7.6/12.5 642.30 12044ER LAYER CLO7.6/12.5 299.00 12044EP LAYER CL12.6/20.0 765.10 12045ER LAYER CL12.6/20.0 338.30 12045EP LAYER CLOS 2.5CM< 458.70 12051ER LAYER CLOS 2.5CM< 178.10 12051EP LAYER CLOS2.6/5.0 549.80 12052ER LAYER CLOS2.6/5.0 214.90 12052EP LAYER CLOS5.1/7.5 640.70 12053ER LAYER CLOS5.1/7.5 757.10 12053EP LAYER CLO7.6/12.5 754.10 12054ER COMPLEX REPAIR TRUNK 2.6-7.5CM 770.80 13101EP COMPLEX REPAIR TRUNK 2.6-7.5CM 385.75 13101EP REP COMPLEX SCALP 616.20 13120ER REP COMPLEX SCALP 234.00 13120EP REP COMP 2.6/7.5C 1035.10 13121ER REP COM 2.6/7.5CM 818.00 13121COMPLX SUTURE REPAIR 432.50 13122EP REPAIR COMPLEX 375.20 13131ER REPAIR COMPLEX 546.00 13131EP WND REPAIR COMPLX 1241.00 13132ER WND REPAIR COMPLEX 965.00 13132SURG PREP 100SQCM 589.90 15002SURG PREP ADDL100CM2 174.10 15003TISSUE SKIN 25 SQ CM 571.90 15271APLI SKIN SBS 25C PF 725.70 15271TISSUE SKIN ADDL 25S 82.00 15272APLIGRAF ADDL 25 PF 80.10 15272EP DRSNG CHANGE/ANES 212.70 15852EP BURN TXR INITIAL 148.70 16000DRSG/DEBRID BURN <5% 150.00 16020EP DRSNG/DEBRIDEMENT 137.80 16020ER DRSG/DEBR PT BURN 69.30 16020DEBRID BURN 5 TO 10% 268.60 16025EP DRSG/DEBRID 5-10% 182.70 16025DEBRID BURN >10% 316.90 16030EP BURN TREATMENT 227.60 16030

EP DESTRC BENIGN LES 259.90 17110ER DESTRC BENIGN LES 104.00 17110CHEM CAUTERIZ TISSUE 121.40 17250EP CHEM CAUT GR TISS 131.80 17250ER CHEM CAUT GR TISS 100.60 17250BREAST CYST ASPIRAT 886.75 19000PUNC ASP CYST BRS EA 97.00 19001BIOPSY BREAST 1ST LS 760.75 19081PERC VAC ASSISTED BX 3161.00 19081BIOPSY BREAST EA ADD 535.75 19082BREAST CORE BX W/O G 1029.25 19100PL BREAST WIRE 1 LES 356.00 19281PL BREAST WIRE AD LS 88.00 19282EP EXP WND NECK 1422.20 20100EP EXP WND AB/FLNK 569.10 20102EP WND EXP EXTREMITY 876.20 20103ER WND EXP EXTREMITY 1068.20 20103BIOPSY MUSCLE PERC 270.50 20206BIOPSY MUSCLE PRC PF 769.50 20206INJ SINUS TRACT 403.00 20501INJ SINUS TRACT PF 229.50 20501EP REMOV FB MSCL TND 456.90 20520FOREIGN BODY REMOVAL 245.00 20520SNGL TNDN SH LIG INJ 31.20 20550INJ SINGLE TENDON PF 179.10 20550SNGL TNDN ORIG I INJ 33.30 20551EP INJ ERGR PT MSCLE 172.60 20552TRIGGER INJ 1 2 MUSC 32.20 20552ER INJ TRGR PT MSCLE 45.50 20552INJ KNLG TRIG PT PRO 54.75 20552INJ TRIG PT 1-2 PF 137.40 20552TRIGGER INJ 3 MUSCLE 38.50 20553INJ TRIG PT 3> PF 177.30 20553EP ARTHRO/ASPIR/INJ 124.00 20600ARTHO INJ ASP SM JT 22.40 20600ARTHROC ASP/IJ SJ PF 134.00 20600ARTHROC ASP/INJ SM J 183.25 20600SMALL JOINT INJECTION 33.00 20600ARTHROCENTESIS SMALL JOINT W/O US 110.60 20600ARTHROCENTESIS SMALL JOINT W/O US PF 34.80 20600EP ARTHRO ASPIR JNT 125.10 20605ARTHO INJ ASP MED JT 22.90 20605ARTHRO INTMED JT/BRS 275.50 20605INTERMEDIATE JOINT INJECTION 35.50 20605ER ARTHRO ASPIR JNT 35.75 20605ARTHR ASP INT JT PF 181.50 20605ARTHORCENTESIS INTERMEDIATE JOINT W/O US 114.80 20605

ARTHROCENTESIS INTERMEDIATE JOINT W/O US PF 36.70 20605EP ARTHR ASP MAJ JNT 133.80 20610ER ARTHR MAJOR JOINT 63.50 20610LARGE JOINT INJECTION 38.30 20610ARTHROC ASP/IJ MJ PF 233.75 20610ARTHROC ASP/INJ MJ 139.00 20610ARTHROCENTESIS MAJOR JOINT W/O US 141.80 20610ARTHROCENTESIS MAJOR JOINT W/O US PF 38.80 20610ARTHR ASPIR MJ JT PF 214.40 20610EP CLSD FX NASAL MAN 135.30 21310EP CLSD FX NASAL STB 389.50 21315EP CLSD DISLO TMPMAN 152.20 21480ER CLSD DISLO TMPMAN 161.10 21480EP CLSD FX VERTEBRAE 546.10 22305INJ SHLDR ARTHROGRAM 649.50 23350INJ ARTHROG SHLDR PF 246.00 23350EP CLS FX CLAV W/O M 537.00 23500EP CLS FX CLAV MANIP 903.90 23505EP CLS FX SCAP W/O M 568.70 23570EP CLS FX PROX HUMER 805.80 23600EP CLS DISLOC SHOULD 866.10 23650ER CLS DISLOC SHOULD 773.40 23650EP CLS DISL SHLDR MN 971.60 23655ER CLS DISL SHLDR MN 242.80 23655EP CLS DLC SHDLR FX 1233.20 23665ER CLS DLC SHDLR FX 91.70 23665OHC NEEDLE ASPIRATN 775.00 23931EP REMOV FB UPP ARM 428.40 24200INJ PRO ELBOW ARTHR 758.50 24220EP CLS FX HUMERALW/O 805.80 24500ER CLS FX HUMERALW/O 89.70 24500EP CLS FX HUMER MANI 1400.90 24505CLS TX SUPRACONDYLAR/TRANSCONDYLAR HUMERAL FX 1036.20 24530CLS TX SUPRACONDYLAR/TRANSCONDYLAR HUMERAL FX PF 96.00 24530CLS TX HUMERAL EPICONDYLAR FX W/O MANIP 864.40 24560CLS TX HUMERAL EPICONDYLAR FX W/O MANIP PF 100.40 24560EP CLS ELBOW DISLOCA 1006.30 24600ER CLS ELBOW DISLOCA 85.80 24600EP DISLOC ELBOW ANES 1322.40 24605ER DISLOC ELBOW ANES 96.20 24605EP CLS RADIAL SUBLUX 309.70 24640ER CLS TX RADL HDW/M 102.40 24640EP CLS FX RAD HEADWO 537.80 24650CLS TX OF RADIAL HEAD/NECK FX W/O MANIP 717.30 24650CLS TX OF RADIAL HEAD/NECK FX W/O MANIP PF 55.70 24650ER TREAT RADIUS FX W/MANIPULATION 1182.40 24655EP TREAT RADIUS FX W/MANIPULATION 108.25 24655

EP CLS FX ULNAR PROX 657.30 24670CLS TX ULNAR FX PROXIMAL END W/O MANIP 786.40 24670CLS TX ULNAR FX PROXIMAL END W/O MANIP PF 74.50 24670INJ PRO WRIST ARTH 780.50 25246EP REPAIR TENDON/MUS 1845.50 25260ER REPAIR TENDON/MUS 109.20 25260EP CLS FX RADIAL SHF 580.30 25500CLS TX RADIAL SHAFT FX W/O MANIP 747.30 25500CLS TX RADIAL SHAFT FX W/O MANIP PF 70.60 25500ER CLS TX RD SH FX W 1424.30 25505EP CLS FX ULNAR W/O 526.40 25530CLS TX ULNAR SHAFT FX W/O MANIP 707.80 25530CLS TX ULNAR SHAFT FX W/O MANIP PF 65.50 25530EP CLS FX RAD SHF MA 652.30 25560CLS TX RADIAL & ULNAR SHAFT FX W/O MANIP 753.20 25560CLS TX RADIAL & ULNAR SHAFT FX W/O MANIP PF 80.50 25560ER CLS TX ULN FX W/M 1471.60 25565EP CLS FX DISTAL RAD 635.80 25600CLS TX DISTAL RADIAL FX W/O MANIP 926.60 25600CLS TX DISTAL RADIAL FX W/O MANIP PF 46.70 25600EP CL FX DST RAD MNP 1524.20 25605ER CL FX DST RAD MNP 146.30 25605EP CLS FX CARPAL SCA 614.20 25622CLS TX CARPAL SCAPHOIS FX W/O MANIP 832.00 25622CLS TX CARPAL SCAPHOIS FX W/O MANIP PF 71.50 25622EP CL FX CRPL W/O MN 658.00 25630EP DRNG FINGER ABSCE 352.70 26010ER DRNG FINGER ABSCE 320.70 26010EP CLS FX METACARPAL 481.60 26600CLS TX METACARPAL FX W/O MANIP 825.10 26600CLS TX METACARPAL FX W/O MANIP PF 44.70 26600EP CLS FX MTCRPL W/M 727.80 26605ER CLS FX MTCRPL W/M 120.10 26605CLS TX METACARPAL FX W/MANIP 875.70 26605CLS TX METACARPAL FX W/MANIP PF 85.50 26605EP CLS FX MTCRPL W/M 1037.50 26607EP CLS DISLOC THUMB 897.00 26641EP CLS FX/DSL THUMB 1051.20 26645EP CLS TX META DISLC 831.30 26700ER CLS TX META DISLC 83.00 26700EP CL DSLC MTCP ANES 945.60 26705ER CL DSLC MTCP ANES 96.20 26705EP CLS FX PHALNG W/O 360.50 26720CLS TX PHALANGEAL SHAFT FX W/O MANIP 546.50 26720CLS TX PHALANGEAL SHAFT FX W/O MANIP PF 35.70 26720EP CLS FX PHALNG W/M 834.10 26725ER CLS FX PHALNG W/M 93.00 26725

EP CLS FX ARTCLR W/M 866.60 26742ER CLS FX ARTCLR W/M 91.70 26742EP CLS FX DSTL PHLNG 418.40 26750EP CLS FX FINGER MAN 802.70 26755ER CLS FX FINGER MAN 131.90 26755EP CLS DISL INTRP JT 678.80 26770ER CLS DISL INTRP JT 63.60 26770EP CL DSL INTRP ANES 872.60 26775ER CL DSL INTRP ANES 112.80 26775INJ PRO HIP ARTHR WO 915.00 27093EP CLS FX COCCYGEAL 453.50 27200EP CLS TX HIP DISLC 498.70 27250ER CLS TX HIP DISLC 124.70 27250EP CLS PT HIP DS W/A 1799.90 27266INJ PRO KNEE ARTHRO 649.50 27369INJ ARTHROG KNEE PF 246.50 27369EP CLS FX PATEL W/O 715.00 27520EP CLS TX KNEE DL WO 1613.00 27550ER CLS TX KNEE DL WO 104.00 27550EP CLS DSL KNEE W/AN 1683.20 27552ER CLS DSL KNEE W/AN 104.00 27552EP CLS DISL PATELLAR 858.50 27560ER CLS DISL PATELLAR 103.20 27560EP DISLOC PATEL ANES 1341.70 27562ER DISLOC PATEL ANES 1458.00 27562INJ PRO ANKLE ARTH 767.25 27648EP CLS FX TIBIAL SHF 895.30 27750CLS TX TIBIAL SHAFT FX W/O MANIP 953.70 27750CLS TX TIBIAL SHAFT FX W/O MANIP PF 75.50 27750EP CLS FX TIB SHF MA 1507.00 27752EP CLS FX MED MALLEO 725.40 27760CLS TX MEDIAL MALLEOLUS FX W/O MANIP 910.80 27760CLS TX MEDIAL MALLEOLUS FX W/O MANIP PF 77.50 27760EP CL FX MD MAL W/MN 1195.80 27762EP CLS FX PROX FIBUL 638.40 27780CLS TX PROXIMAL FIBULA/SHAFT FX 832.70 27780CLS TX PROXIMAL FIBULA/SHAFT FX PF 72.50 27780EP CLS FX DIST FIBUL 693.50 27786CLS TX DISTAL FIBULAR FX 853.80 27786CLS TX DISTAL FIBULAR FX 79.50 27786EP CLS FX BIMAL ANKL 826.90 27808CLS TX BIMALLEOLAR ANKLE FX W/O MANIP 899.60 27808CLS TX BIMALLEOLAR ANKLE FX W/O MANIP PF 90.40 27808EP CLS TX BIM ANK WM 1986.90 27810ER CLS TX BIM ANK WM 135.20 27810EP TRTMNT ANKLE FRAC 1048.00 27818ER TX ANKLE FRAC W/M 120.80 27818

CLS TX FX WEIGHT BEARING PORTION DISTAL TIBIA 912.50 27824CLS TX FX WEIGHT BEARING PORTION DISTAL TIBIA PF 30.90 27824ER CLS TX FX DIS TIB 140.40 27825EP TREAT DSTAL JOINT 1367.00 27829EP CLS TX ANKLE DISLOC W/O ANES 1128.00 27840EP ANKLE DISLOC W/AN 1548.20 27842EP REMOV FB FOOT SUB 466.00 28190ER REMV FB FOOT SUBQ 299.30 28190EP REMV FB FOOT DEEP 1055.20 28192TENOTOMY TOE SINGLE 497.60 28232RELEASE OF TOE JOINT 765.00 28272CLS TX CALCANEAL FX 679.00 28400CLS TX CALCANEAL FX PF 56.60 28400EP CLS FX TALUS W/O 600.60 28430CLS TX TALUS FX 626.90 28430CLS TX TALUS FX PF 79.50 28430EP FX TARSL BONE W/O 549.00 28450TX TARSAL BONE FX 569.70 28450TX TARSAL BONE FX PF 61.60 28450EP FX TRSL BONE W/MP 817.50 28455EP CLS FX METTRSLW/O 524.90 28470CLS TX METATARSAL FX 605.80 28470CLS TX METATARSAL FX PF 42.70 28470EP CLS FX META W/MNP 697.90 28475ER CLOSED FX META W/MANIP 678.00 28475EP CLS FX TOE W/O MN 292.40 28490EP CL FX TOE W/MANIP 372.10 28495EP CLS FX PHLNX W/OM 292.40 28510EP CL FX PHLNX W MNP 328.50 28515ER CL FX PHLNX W MNP 43.30 28515EP CLS DSLC METSPHLN 381.20 28630EP CLS TX JT D W/O A 316.50 28660ER CLS TX JT D W/O A 79.30 28660EP CLS TX TOE DISLOCATION W/ANES 67.00 28665EP APL CAST SHLD-HND 178.30 29065APPL CAST SHOULDER TO HAND 205.10 29065APPL CAST SHOULDER TO HAND PF 77.50 29065EP APL CAST ELB-FNGR 153.60 29075APPL SHORT ARM CAST 186.70 29075APPL SHORT ARM CAST PF 68.50 29075EP APL CAST HND-FORA 165.20 29085EP APL LONGARM SPLNT 159.40 29105ER APL LONGARM SPLNT 76.90 29105EP APL SHORTARM SPLN 99.80 29125ER APL SHORTARM SPLN 71.30 29125APPL SHORT ARM SPLIN 118.80 29125APPL SHORT ARM SPLINT PF 69.60 29125

EP APL FNGR SPLNT ST 86.10 29130ER APL FNGR SPLNT ST 31.10 29130EP STRAPPING THORAX 112.10 29200EP STRAPPING SHOULDE 130.70 29240EP STRAPPING ELB-WRS 95.40 29260EP STRAPPING HND-FNG 89.00 29280ER STRAPPING OF HAND/FINGER 63.00 29280EP APL CAST LONG LEG 278.20 29345EP APL CAST SHRT LEG 174.80 29405APPL SHORT LEG CAST 179.70 29405APPL SHORT LEG CAST PF 59.60 29405APPL TOTAL CONT LEG 196.60 29445EP APL LONG LEG SPLN 234.00 29505ER APL LONG LEG SPLN 87.00 29505EP APL SHRT LEG SPLN 146.20 29515ER APPL SHORT LEG SP 72.40 29515EP STRAPPING HIP 103.00 29520EP STRAPPING KNEE 113.30 29530EP STRAPPING ANKLE 91.10 29540EP STRAPPING TOE 85.80 29550UNNA BOOT 90.50 29580EP STRAPPING UNNA BT 106.10 29580APL COMPRESS SYS LEG 183.00 29581REMOVAL UNNA BOOT 107.00 29700EP REMOV GNTLT/CAST 106.50 29700EP REMOV ARM/LEG CST 140.10 29705EP WINDOWING OF CAST 134.80 29730HEALTH/BLOOD SCRNG 26.00 29999EMP HEP B IMMUNE GLB 492.00 29999MRO BACKUP 25.00 29999VARICELLA INJ OCH 110.00 29999PNEUMOCOCCAL INJ OCH 80.00 29999MENINGITIS INJ OCH 120.00 29999PREPLACEMENT TYPE A 0.00 29999FRA CERTIFICATION 0.00 29999TRANSFER A 0.00 29999BASIC PHYSICAL EXAM 0.00 29999DOT/CDL RECERT FMCSA 0.00 29999DOT/CDL RECERT 0.00 29999PREPLACEMNT NONAGRMN 0.00 29999FURLOUGH<1YR(NONFED) 0.00 29999DOT/CDL NEW CT FMCSA 0.00 29999DOT/CDL NEW CERT 0.00 29999PRE-PLCMNT SAFETY SS 0.00 29999POST OFFER W/SPIRO 0.00 29999PHA 0.00 29999PHA W/FOCUSED EXAM 0.00 29999

PHYSICAL EXAM MALE 0.00 29999OHC MRO REVIEW 20.00 29999OHC NO CHARGE VISIT 0.00 29999OHC LATEX SCREENING 8.00 29999RESP QUESTION REVIEW 11.00 29999NAL EXECUTIVE PHYS 656.00 29999EP REMOV FB INTRANAS 386.50 30300ER REMOV FB INTRANAS 310.50 30300EP ANT NASAL CTRY/PK 207.40 30901ER ANT NASAL CTRY/PK 121.50 30901EP NASAL CTRY PK CMP 263.70 30903ER NASAL CTRY PK CMP 270.30 30903EP POS NASAL CTRY/PK 293.50 30905ER POS NASAL CTRY/PK 331.10 30905EP INTUBATION/ENDOTR 402.20 31500ER INTUBATION/ENDOTR 155.90 31500EP LARYNGOSCOPY INDI 114.90 31505EP LRNGOSCOPY FB REM 417.70 31511EP LRNGSCP FLEX FB R 603.20 31577EP TRACHEOSTOMY TRAN 983.40 31603CATHETER ASPIRATION 153.00 31720LUNG BX PLAC NDL 278.75 32405EP TUBE THORACOSTOMY 825.60 32551ER TUBE THORACOSTOMY 54.60 32551THOR ASP PIR W/IMAG 2330.50 32555EP PERICARDIOCENTESI 479.90 33010ER PERICARDIOCENTESI 109.20 33010EP INTRACATH NDL VEI 34.60 36000EP VENIPUNCTURE VEIN 33.40 36406EP VENI >3YR PHD SKL 34.60 36410VENIPUNCTURE/OHS 13.00 36415VENIPUNCTURE/BLD DRW 0.00 36415VENIPUNCTURE 17.30 36415SPECIAL VENIPUNC.FEE 91.20 36415EP VENI UNDER AGE 1 198.00 36420BLOOD TRANSFUS 1 BAG 148.00 36430BLOOD TRANSFUS 2 BAG 222.00 36430BLOOD TRANSFUS 3 BAG 296.00 36430BLOOD TRANSFUS 1 BAG 148.00 36430BLOOD TRANSFUS 2 BAG 222.00 36430BLOOD TRANSFUS 3 BAG 296.00 36430TRANSFUSION CL/4 HRS 182.90 36430BLOOD TRANSFUSION 153.90 36430INSERT CENT VEN CATH 669.60 36556EP CNTR VEN CAT >2YR 264.70 36558EP CNTR VEN CAT >2YR 334.90 36558EP CENT VEN CAT 5+YR 604.70 36558

PICC WO SUB PRT PMP 694.50 36569EP INS PICC/PRT 5+YR 906.60 36571BLOOD COLL PORT/CL 99.50 36591BLOOD COLL IV/PICC 132.50 36592DECLOTTING OF A LINE 207.40 36593CONTR INJ EVL EX CVC 522.50 36598EP ART PUNC BLOOD 68.30 36600ARTERIAL PUNCTURE 54.80 36600ABG COLLECTION SPEC 30.10 36600LIGATION ARTY EXT PF 1338.30 37618LIGATION ARTERY EXT 109.20 37618ID OF SENTINEL NODE 161.00 38792EP REM EMBED FB MOUT 316.60 40804EP LAC REPAIR MOUTH 495.10 40830EP LAC REP TONG <2.5 357.80 41250EP LAC REPAIR TONGUE 500.40 41251EP LAC REPR TNG >2.6 917.00 41252ER LAC REPR TNG >2.6 233.40 41252EP DRNG ABSC DENT ST 298.70 41800ER DRNG ABSC DENT ST 238.90 41800EP DRAIN ABS PALATE 265.60 42000EP REMOV FB PHARYNX 383.80 42809EP ESOPHAGOSCPY W FB 612.80 43215EP GASTR INTUB/ASPIR 89.60 43753ER GASTR INTUB/ASPIR 246.80 43753EP CHG GASTROSTOMY 281.20 43760ER REPL GASTRONOMY TUBE 518.00 43762EP REPL GASTRONOMY TUBE 120.00 43762EP I&D ABCESS PERIRE 1002.80 46040ER I&D ABCESS PERIRE 283.90 46040EP I&D ABCES PERIANA 262.70 46050ER I&D ABCESS PERIANA 300.00 46050EP INC EXT HEMORRHOI 375.40 46083ER INC EXT HEMORRHOI 156.00 46083EP ANOSCOPY BRSH/WSH 88.80 46600LIVER BX 921.00 47000LIVER BX 1029.25 47000PANCREAS BX 921.00 48102PANCREAS BX 1029.25 48102EP ABD PARACENTESIS 266.40 49082ER ABD PARACENTESIS 206.10 49082EP PARACENTESIS W/IM 315.20 49083PARACENTESIS W/IMAG 1129.00 49083ER PARACENTESIS W/IM 452.80 49083ABD RETRO BX 1089.00 49180ABD RETRO BX 1029.25 49180PERC IMG DRAN VISCER 556.00 49405

PERC IMG GU DRN RETR 556.00 49406PERC IG DRN RETR V/R 556.00 49407FLUO EX G COLON TUBE 628.50 49465RENAL BIOPSY PERC TR 2762.50 50200RENAL CYST 921.00 50390US ASP RENAL CYST 1029.25 50390INJ PRO CYSTO/VCUG 439.00 51600EP IRRIG BLDR SIMPLE 146.80 51700ER IRRIG BLDR SIMPLE 154.00 51700EP INSERT INDWE CATH 152.80 51702ER INST TMP BLDR CTH 208.90 51702INSERT TEMP BLADDER CATH 208.90 51702INSERT TEMP BLADDER CATH 208.90 51702EP INST TMP BLD CT C 350.50 51703ER MEASUREMENT OF POST-VOIDING RESIDUAL URINE BY US 45.00 51798EP DRAIN SCROTAL ABS 511.70 55100ER INST TMP BLD CT C 202.90 55100ER DRAIN SCROTAL ABS 154.90 55100PROSTATE BX 886.75 55700EP I&D VULVA PER ABS 421.30 56405ER I&D VULVA PER ABS 10.40 56405EP I&D BARTHOLIN ABS 362.60 56420ER I&D BARTHOLIN ABS 76.40 56420EP BX ENDOMETRIAL 138.90 58100EP REM OF IUD 289.10 58301ER REM OF IUD 67.60 58301HYSTEROSALP CNTR INJ 421.00 58340EP VAGINAL DELIVERY 2818.30 59409THYROID BX 886.75 60100ASP/INJ THYROID CYST 886.75 60300EP SPINAL PUNCT LUMB 405.20 62270SPINAL PUNCTURE LMBR 542.50 62270SPINAL TAP ROOM CHRG 296.75 62270ER LUMBAR PUNCT DIAG 277.00 62270INJ CERVICAL/THOR W/IMAGING 382.00 62321INJ INTERLAMINAR 193.00 62322INJ LUMBAR/SPINE W/IMAGING 397.50 62323EP INJ ANES AG TR NV 280.80 64400ER INJ ANS AG TRG NV 136.40 64400EP FACIAL NERVE BLCK 410.20 64402ER INJ ANES FACL NRV 138.40 64402ER NERVE BLOCK OCCIPITAL 193.25 64405EP NERVE BLOCK OCCIPITAL 68.95 64405INJ CERVICAL PLEXUS 275.00 64413INJ BRACHIAL PLEXUS 341.70 64415INJ BRACHL PLEX CONT 372.60 64416AXILLARY NERVE INJ 166.40 64417

INJ SUPRASCAPULA NRV 198.00 64418INTERCOSTAL NERVE SG 305.60 64420INJ INTERCOSTAL ML 167.50 64421ILIOINGNL NRV INJ PF 393.00 64425INJ SCIATIC NERVE SG 329.70 64445INJ SCIATIC NERVE CO 366.00 64446INJ FEMORAL NERVE SG 506.40 64447INJ FEMORAL NRV CONT 373.50 64448EP OTH PERIPHRL NRVE 190.30 64450ER OTH PERIPHRL NRVE 117.00 64450INJ PERIPH NERVE 346.60 64450OHC DIGITAL BLOCK 200.00 64455TAP BLOCK UNILAT 174.60 64486TAP BLOCK BIL 460.90 64488TAP BLOCK CONTIN BIL 354.40 64489INJ SPHEN GANGLIO PF 353.50 64505CHEMODENERVATION OF MUSCLE; BILATERAL PF 66.40 64615EP REMOV FB EXT EYE 131.20 65205ER REMOV FB EXT EYE 119.10 65205EP REM FB CONJ EMBED 148.70 65210ER REM FB CONJ EMBED 39.30 65210EP REM FB CORNEA W/O 120.00 65220ER REM FB CORNEA W/O 38.40 65220IRIDOTOMY/IRIDECTOMY 2205.00 66761YAG UNILATERAL 1654.00 66821EP DRNG EYELID ABSCS 417.00 67700EP REM FB EYELID EMB 232.30 67938EP DRNG ABCESS EXEAR 246.00 69000ER DRNG ABCESS EXEAR 146.00 69000EP REM FB EX AUD CAN 150.40 69200ER REM FB EX AUD CAN 186.70 69200ER REMOVE IMPACTED EAR WAX UNI 26.00 69209EP REMOVE IMPACTED EAR WAX UNI 14.00 69209OHC REM CERUMEN IMPA 125.00 69210EP REM IMPACT CERUME 99.70 69210ER REM IMPACT CERUME 47.60 69210ORBITS FOR F.B./MRI 289.00 70030MANDIBLE PARTIAL <4V 67.50 70100MANDIBLE COMPLETE 556.75 70110MASTOIDS <3V 70.75 70120MASTOIDS COMPLETE 689.25 70130FACIAL BONES PARTIAL 54.25 70140FACIAL BONES MIN 3 V 707.75 70150NASAL BONES MIN 3 V 473.50 70160ORBITS MIN 4 VIEW 589.75 70200SINUSES PARTIAL 59.50 70210SINUSES MIN 3 VIEW 517.75 70220

SELLA TURCICA 56.50 70240SKULL LESS THAN 4 V 414.00 70250SKULL MIN 4 VIEW 642.50 70260TEMP MAND UNILATERAL 224.75 70328TEMP MAND BILATERAL 499.50 70330MRI TMPOMANDIB JOINT 2021.00 70336SOFT TISSUE NECK 313.50 70360COMPLETE SPEECH EVAL 136.00 70371SALIVARY GLAND 448.25 70380CT HEAD W/O 2080.00 70450CT HEAD WITH 2537.00 70460CT HEAD W W/O 3079.00 70470CT ORB PF IAC W/O 2276.00 70480CT ORB PR IAC W 2649.00 70481CT ORB PR IAC W W/O 2777.00 70482CT MAXIL W/O DENTAL 437.00 70486CT MAX-FACIAL W/O 2206.00 70486CT MAX FACIAL W 2614.00 70487CT MAX FACIAL W/W/O 2766.00 70488CT ST NECK W/O 2276.00 70490CT ST NECK W 2649.00 70491CT ST NECK W W/O 2777.00 70492CTA HEAD W/W/O 2293.00 70496CTA NECK W/W/O 2293.00 70498MRI ORB FAC NCK W/O 2021.00 70540MRI ORB FAC NCK CONT 2464.00 70542MRI ORB/NECK W/W/O 2644.00 70543MRI MRA HEAD W/O 2464.00 70544MRA HEAD W CONTRAST 2097.00 70545MRI MRA HEAD W/W/O 2908.00 70546MRI MRA NECK W/O 2464.00 70547MRA NECK W CONTRAST 2097.00 70548MRI MRA NECK W/W/O 2908.00 70549MRI BRAIN W/BRN STEM 2021.00 70551MRI BRAIN W/CONTRAST 2464.00 70552MRI BRAIN W & W/O CN 2908.00 70553CHEST PA/OHS 72.75 71010CHEST PA & LATER OHS 40.00 71010CHEST PA 1 VIEW 315.50 71045CHEST PA & LAT 386.00 71046CHEST 2V W/FLUORO 124.75 71046CHEST 3V FRT LAT LOR 551.00 71047CHEST 2V FRT/LAT OBL 490.50 71047CHEST 4 VIEW 646.50 71048CHEST CMP 4V W FLURO 869.25 71048RIBS 2 VIEW UNILATER 616.75 71100RIBS UNI MIN 3V CXR1 557.75 71101

RIBS 3 VIEW BILATERA 472.75 71110RIBS BIL MIN 4V CXR1 715.00 71111STERNUM MIN 2 VIEW 435.75 71120STERNOCLAVICUL JT 3V 551.00 71130CT CHEST W/O 2153.00 71250CT CHEST W 2517.00 71260CT CHEST W W/O 3079.00 71270CTA CHEST W/W/O 1941.00 71275MRI CHEST W/O 2021.00 71550MRI CHEST W CONTRAST 2464.00 71551MRI CHEST W W/O CNTR 2908.00 71552MRA CHEST W/W/O 2908.00 71555SPINE SINGLE VIEW 335.50 72020CERVICAL 2-3 VIEWS 556.75 72040CERVICAL MIN 4 VIEW 852.25 72050CERV COMP W FL/EXT 864.00 72052SPINE THORACIC 2V 384.50 72070T SPINE W SWIMMERS 616.75 72072T SPINE 4V 620.00 72074THORACOLUMBAR AP/LAT 443.00 72080SCOLIOSIS 1V 530.50 72081SCOLIOSIS 2-3V 562.00 72082SCOLIOSIS 4-5V 592.75 72083SCOLIOSIS 6V 613.50 72084L SPINE 2-3 VIEWS 707.75 72100LSPINE OHS 109.00 72100L SPINE MIN 4V 943.75 72110LSPINE MIN 4V OHS 318.50 72110LSPINE W BEND MIN 6V 904.50 72114LSPINE BENDING ONLY 729.00 72120CT C SPINE W/O 2640.00 72125CT C SPINE W 3077.00 72126CT C SPINE W W/O 3696.00 72127CT T SPINE W/O 2640.00 72128CT T SPINE W 3077.00 72129CT T SPINE W/W/O 3696.00 72130CT L-SPINE W/O 2640.00 72131CT L-SPINE W 3077.00 72132CT L-SPINE W W/0 3696.00 72133MRI CERVICAL SPINE 2021.00 72141MRI CRV SPNE CONTRAS 2464.00 72142MRI THORAC SPINE W/O 2021.00 72146MRI THORC SPN CNTRST 2464.00 72147MRI LUMBAR SPINE W/O 2021.00 72148MRI LMBR SPN CONTRAS 2710.00 72149MRI CERV SPN W & W/O 2908.00 72156MRI THRC SPN W & W/O 2908.00 72157

MRI LMBR SPN W & W/O 3153.00 72158MRA SPIN CANAL W/O C 1742.00 72159MRA SPIN CANAL CONTR 2097.00 72159PELVIS (1 VIEW) 444.75 72170PELVIS MIN 3 VIEW 486.25 72190CTA PELVIS W/W/O 2608.00 72191CT PELVIS W/O 2120.00 72192CT PELVIS W 2416.00 72193CT PELVIS W W/O 3079.00 72194MRI PELVIS W/O CNTRS 2021.00 72195MRI PELVIS W CONTRAS 2464.00 72196MRI PELVIS W/W/O 2908.00 72197MRA PELVIS W CONTRAS 2097.00 72198MRA PELVIS W/O CONTR 1742.00 72198SI JOINTS <3V 55.50 72200SI JOINTS MIN 3 VIEW 505.75 72202SACR & COCCYX MIN 2V 427.25 72220CLAVICLE 2 VIEW 399.50 73000SCAPULA MIN 2 VIEW 399.50 73010SHOULDER 1 VIEW 317.25 73020SHOULDER MIN 2 VIEW 517.75 73030ARTHROGRAM SHOULDER 1035.00 73040AC JOINTS COMP 501.25 73050HUMERUS MIN 2 VIEW 490.50 73060ELBOW 2V 297.50 73070ELBOW MIN 3 VIEW 399.50 73080ARTHROGRAM ELBOW 636.50 73085FOREARM 2V 442.50 73090UP EXT INFANT 2 VIEW 325.50 73092WRIST 2V 334.25 73100WRIST MIN 3 VIEW 393.50 73110ARTHROGRAM WRIST 481.75 73115HAND 2V 388.50 73120HAND MIN 3 VIEW 517.75 73130FINGER MIN 2 VIEW 345.00 73140CT UP EXT W/O 2260.00 73200CT UP EXT W 2677.00 73201CT UP EXT W/W/O 3203.00 73202CTA UPP EXT W/W/O 2312.00 73206MRI UPPER EXTREM W/O 2021.00 73218MRI UPP EXT W/CONTR 2464.00 73219MRI UPP EXT W/W/O 2908.00 73220MRI UP EXT JNT W/O 2021.00 73221MRI JNT UPP EXT W CN 2464.00 73222MRI JNT UPP EXT W/WO 2908.00 73223MRA UPPER EXT W/W/O 2155.00 73225HIP UNI W/PELVIS 1V 234.00 73501

HIP UNI W/PELV 2-3V 390.00 73502HIP UNI W/PLV MIN 4V 483.50 73503HIP BIL W/PELV 2V PR 124.25 73521HIPS BIL W/PELVIS 2V 493.00 73521HIP BIL W/PELVIS 3-4 519.00 73522HIP BIL W/PLV MIN 5V 545.00 73523ARTHROGRAM HIP 684.00 73525FEMUR 1V 379.50 73551FEMUR 2V 421.25 73552KNEE 1 OR 2 VIEWS 399.50 73560KNEE 3 VIEW 442.50 73562KNEE 4 VIEW 496.25 73564KNEES BIL STAND AP 315.50 73565ARTHROGRAM KNEE 963.00 73580TIBIA FIBULA 2V 473.50 73590LOW EXT INFANT 2V 377.00 73592ANKLE 2V 368.25 73600ANKLE MIN 3 VIEW 467.25 73610ARTHROGRAM ANKLE 636.50 73615FOOT 2V 399.50 73620FOOT MIN 3 VIEW 517.75 73630HEEL MIN 2 VIEW 399.50 73650TOE MIN 2 VIEW 277.75 73660CT LOW EXT W/O 2260.00 73700CT LOW EXT W 2677.00 73701CT LOW EXT W/W/O 3203.00 73702CTA LOW EXT W/W/O 2312.00 73706MRI LOWER EXTREM W/O 2021.00 73718MRI LOW EXT W/CONTR 2464.00 73719MRI LOW EXT W/W/O 2908.00 73720MRI LOW EXT JNT W/O 2021.00 73721MRI JNT LOW EXT W CN 2464.00 73722MRI JNT LOW EXT W/WO 2908.00 73723MRA LOWER EXT W/CONT 2155.00 73725ABDOMEN 1 VIEW 517.75 74018ABD FLAT/UPR/DECUB 547.25 74019ABD 3-4 VIEW 580.00 74021ACUTE ABD SERIE COMP 688.25 74022CT ABDOMEN W/O 2092.00 74150CT ABDOMEN W 2465.00 74160CT ABDOMEN W W/O 3079.00 74170CTA ABD PELVIS W/W/O 3629.00 74174CTA ABD W/W/O 3079.00 74175CT ABD PELVIS W/O 2931.00 74176CT ABD PELVIS W 3396.00 74177CT ABD PELVIS W/W/O 4285.00 74178MRI ABDOMEN W/O CNTR 2021.00 74181

MRI ABDOMEN W/CONTRA 2464.00 74182MRI ABDOMEN W/W/O 2908.00 74183MRA ABDOMEN WITH CNT 2464.00 74185MRA ABDOMEN W/O CNTR 2021.00 74185MRA ABDOMEN W/W/O 2908.00 74185ESOPHAGUS 622.25 74220SWALLOW FUNCT CINERA 287.00 74230UPPER GI W/O KUB 952.50 74240UPPER GI W KUB 1017.00 74241UPPER GI W SM BOWEL 1483.00 74245UPPER GI W AIR 1151.75 74246UPPER GI AIR W KUB 1175.50 74247UPPER GI AIR/SM BWEL 1592.50 74249SMALL BOWEL SERIES 734.75 74250CT COLONOGRAPHY W/0 3793.00 74261CT COLONOGRPHY W/W/O 4249.00 74262CT COLONOGRAPHY SCRN 5987.00 74263COLON (BE) 1132.75 74270COLON W/AIR CONTRAST 1218.50 74280ENEMA RED INTUSSUSCE 779.00 74283INTER OP CHOL 700.00 74300IV PYELOGRAM 943.75 74410IV PYELOGRAM W/TOMO 1885.25 74415RETROGRADE UROGRAPHY 531.00 74420CYSTOGRAM 711.50 74430URETHROGRAM VOIDING 774.75 74455HYSTEROSALPINGOGRAM 156.00 74740CT CORONARY CALCIUM SCORE 75.00 75571CTA AORTA/RUNOFF 5569.00 75635FLUOROSCOPY > 1 HR 561.00 76000FISTULA STUDY 700.00 76080XRAY MAMMO SURG SPEC 147.75 76098CT MR US 3D RECON 943.00 76376CT LTD STUDY FU 1699.00 76380US THYROID NECK 1059.50 76536US CHEST PL EFF 969.00 76604US BREAST EACH BRST 297.00 76641US BREAST LTD EACH 224.75 76642US ABDOMEN COMP 1296.25 76700US GALLBLADDER 1111.25 76705US LIVER DUCTS 1111.25 76705US SPLEEN 1111.25 76705US PANCREAS 1111.25 76705US RT UPPER QUAD 1111.25 76705ULTRASOUND AAA SCREN 452.00 76706US RETR/REN/AO CMP 1128.25 76770US RETRO/REN/AO/LTD 1034.00 76775

US SPINE 231.60 76800US FETAL 1ST TRIMEST 974.50 76801US FETAL 1ST TRI ADD 417.75 76802US FETAL >14 WEEKS 974.50 76805US FETAL >14WK ADD'L 451.50 76810US FETAL LTD 698.25 76815US FETAL FU 891.75 76816US TRANSVAG FETAL 974.50 76817US BPP W/NST 195.00 76818US BPP W/O NST 143.45 76819US TRANSVAG PELVIS 901.50 76830US SONOHYSTEROGRAPHY 895.75 76831US PELVIS 1053.75 76856US PELVIS FU 739.50 76857US PELVIS LTD 70.50 76857US SCROTUM 1011.75 76870US EXT NON VAS COMP 355.50 76881US EXT NON VAS LTD 80.75 76882US INFANT HIPS DYN 992.00 76885US INFANT HIPS STATC 174.75 76886US GUID VASCULAR ACS 115.75 76937US GUID NEEDLE PLACE 958.25 76942US GUIDANCE 153.80 76942FLUORO GUIDE CVC 432.00 77001FL GUID NEEDLE PLACE 784.75 77002FLUORO GUID LMBR PUN 248.50 77003CT GUID NEEDLE PLACE 1045.00 77012MAMMOGRAM EMPLOYEE 0.00 77057MAMMOGRAM UNILAT 159.00 77065MAMMOGRAM DIAG BILAT 257.00 77066MAMMOGRAM SCRN BILAT 194.00 77067MAMMO GRANT 80.00 77067STRESS VIEWS ANY JNT 599.75 77071BONE AGE STUDY 396.00 77072BONE LENGTH STUDY 449.00 77073BONE SURVEY LIMIT 747.75 77074BONE SURVEY 615.00 77075BONE SURVEY INFANT 514.75 77076CT BONE MINERAL DENS 550.00 77078CT BONE MINERAL DENS EMPLOYEE 0.00 77078THRYOID IMG W/UPTAKE 927.00 78014PARATHYROID IMAGING 742.25 78070PARATHYROID IMG SPEC 679.00 78071SPLEEN IMAGING 954.50 78185SENTINEL NODE IMAG 1195.00 78195LIVER IMAG SPECT 1965.75 78205LIVER\SPLEEN STATIC 1376.00 78215

NM LIVER/SPLN VSC FL 1638.00 78216HEPATOBIL W/O CCK 1309.50 78226HEPATOBIL W CCK 1967.25 78227GASTRIC EMPTY STUDY 1766.75 78264GASTRIC EMP W/SMBOWL 1043.75 78265ACUTE GI BLEED IMAG 1965.75 78278NUCLEAR SCAN OUTSIDE 0.00 78278INTESTIN IMAG MECKEL 1305.25 78290BONE JNT IMAG LTD 1255.50 78300BONE JNT IMAG MULTIP 1823.75 78305BONE JNT IMAG WH BDY 2087.50 78306BONE JNT IMAG 3 PHAS 1934.75 78315BONE JOINT IMAG SPEC 2311.25 78320HT MUSCLE IMAG SP SN 3187.50 78451HT MUSCLE IMAG SP ML 3693.25 78452CARD BLD POOL EF MUG 2139.25 78472PUL PERF IMAG PARTIC 1392.25 78580PUL VENT&PERF IMAGNG 1931.75 78582BRAIN IMAG STAT <4V 1155.00 78600BRAIN IMG ST/FLW <4V 1370.75 78601BRAIN IMAGING SPECT 846.00 78607KIDNEY IMG W FUNCTIO 1925.75 78707KIDNEY IMG FLW PHARM 2071.25 78708TESTICULAR IMG FLOW 1618.50 78761RADIONUC LOC ABSCESS 1702.75 78805RADIONUC LOC ABS WB 2684.25 78806RADIONUC LOC ABS SPT 2735.00 78807BASIC METABOLIC PANE 125.10 80048GENERAL HEALTH PANEL 206.90 80050ELECTROLYTES 242.90 80051COMP METABOLIC PANEL 180.35 80053OHC COMP METABOLIC PANEL 44.00 80053LIPID PANEL 189.10 80061RENAL FUNCTION PANEL 150.00 80069HEPATITIS COMPREHENS 957.00 80074HEPATITIS PANEL 392.40 80074LIVER FUNCTION PANEL 132.10 80076AMIKACIN 118.70 80150CARBAMAZIPINE TOTAL 216.00 80156CARBAMAZEPINE FREE 182.90 80157CYCLOSPORINE, SPECIF 198.40 80158CLOZAPINE (CLOZARIL) 418.40 80159DIGOXIN 147.30 80162VALPROIC ACID 174.40 80164VALPROIC ACID FREE 247.00 80165ETHOSUXIMIDE (ZARONT 191.20 80168GENTAMICIN TROUGH 175.40 80170

GENTAMICIN PEAK 175.40 80170HALOPERIDOL LEVEL 123.20 80173LAMOTRIGINE(LAMICTAL 105.00 80175LIDOCAINE, SERUM 127.00 80176LITHIUM, SERUM 80.50 80178MYCOPHENOLIC ACID 310.50 80180OXCARBAZEPINE 32.20 80183PHENOBARBITAL 215.70 80184PHENYTOIN (DILANTIN) 202.90 80185PHENYTOIN (DIL) FREE 224.20 80186PRIMIDONE--PHENOBARB 103.40 80188PROCAINAMIDE N-ACETY 232.80 80192QUINIDINE SERUM 214.00 80194RAPAMUNE(SIROLIMUS) 249.90 80195TACROLIMUS(PROGRAF) 142.00 80197THEOPHYLLINE, SERUM 163.10 80198TOBRAMYCIN LEVEL 487.40 80200TOPAMAX (TOPIRMATE) 301.30 80201VANCOMYCIN-PEAK 187.30 80202VANCOMYCIN-TROUGH 187.30 80202GABAPENTIN/NEURONTIN 108.40 80299LAMOTRIGINE LEVEL 82.20 80299METHOTREXATE LEVEL 87.00 80299ZONISAMIDE ZONEGRAN 362.50 80299OHS DRUG COL.HANDFEE 23.00 80300DRUGS OF ABUSE 5 PAN 86.30 80305DRUG SCRN BUS DRIVER 105.10 80305DRUG SCRN NO CONTRAC 89.10 80305DRUG SCRN (5) OHS 58.30 80305DRUG SCREEN (10) OHS 58.30 80305OHS 5 PANEL IN-HOUSE 51.60 80305EMPLOYEE DRUG SCREEN 82.80 80305DRUG SCREEN URINE RE 258.30 80305SINGL DRUG CLAS SCRN 34.40 80305OHS 6 PANEL IN HOUSE 34.00 80305OHS DRUG PANEL 11 PM 110.00 80305DRUG SCREEN 11 INHSE 37.00 80305BATH SALTS 75.00 80305BATH SALTS CONFIRM 50.00 80305DRUG COMPRE TOXASSUR 156.00 80307DRUG OF ABUSE SCREEN 154.00 80307DRUG PROFILE BLOOD 358.80 80307DRUG SCN FEDERAL DOT 98.30 80307DRUG SCREEN SERUM & 208.60 80307LYSERGIC ACID-URINE 401.00 80307FENTANYL/NORFENTANYL 120.60 80307GAMA HYDROXYBUTY ACI 576.20 80307

NICOTINE METABOLITE (CONTININE) SCREEN ONLY 119.10 80307DRUG SCRN 9 W/REFLEX CONFIRMATION 260.00 80307CANNABINOIDS, SYNTHETIC, K2 SCREEN 100.00 80307TRAMADOL, URINE SCRN, QUAL 116.00 80307GABAPENTIN, URINE, QUAL 355.00 80307DRUG SCRN COMP,SERUM 627.70 80307DRUG SCREEN 10, WHOLE BLOOD W/REFLEX TO CONFIRM 440.00 80307ALCOHOL (ETHANOL) 159.50 80320NICOTINE URINE LEVEL 60.60 80323NICOTINE BLOOD LEVEL 310.80 80323AMPHETAMINE CONFIRMATION, URINE 46.00 80324DIHYDROTESTOSTERONE 456.00 80327ACETAMINOPHEN 276.00 80329SALICYLATE SERUM 132.60 80329IBUPROFEN LEVEL 421.40 80329NORTRIPTYLINE LEVEL 122.90 80335NORDOXEPIN, SERUM 148.70 80335AMITRIPTYLINE LEVEL 122.90 80335DOXEPIN 126.40 80335IMIPRAMINE 140.30 80335NORDOXEPIN URINE 126.40 80335DESIPRAMINE 157.80 80335TRICYCLIC ANTIDEPRESSANTS CONFIRMATION, URINE 239.00 80337BUPROBION(WELLBUTRIN 505.10 80338METHSUXIMIDE LEVEL 121.40 80339CLOBAZAM 316.00 80339RUFINAMIDE (BANIEL) 270.00 80339CHLORPROMAZINE(THORA 150.30 80342QUETIAPINE(SEROQUEL) 248.20 80342BARBITURATE CONFIRMATION, URINE 46.00 80345LORAZEPAM (ATIVAN) 280.80 80346CHLORDIAZEPOXIDE-SER 157.80 80346CLONAZEPAM LEVEL 157.80 80346BENZODIAZEPINE CONFIRMATION, URINE 46.00 80346CANNABINOID CONFIRMATION, URINE 46.00 80349COCAINE METABOLITES CONFIRMATION, URINE 46.00 80353METHADONE CONFIRMATION, URINE 46.00 80358AMPHETAMINE, METHAMPHETAMINE MDMA, MDA 114.00 80359HYDROCODONE, QUANT. 304.90 80361OPIATES CONFIRMATION, URINE 46.00 80361MEPERIDINE/NORMEPERI 420.70 80362OXYCODONE CONFIRMATION, URINE 50.00 80365PROPOXYPHENE CONFIRMATION, URINE 50.00 80367DEXAMETHASONE 205.90 80375DRUG CONFIRM EACH 54.60 80375DRUG CONF(GS/MS)BLD 196.60 80375DURG 10 PANEL INHOUSE 28.00 80375

METOPROLOL(LOPRESSR) 285.00 80375WARFARIN LEVEL 59.30 80375HAIR DRUG SCREEN 44.00 80377HAIR SHIPMENT 9.50 80377PATH CONSULT LIMITED 10.40 80500PATH CONSULT COMPLEX 10.40 80502UA OHS 11.00 81001URINALYSIS, EMPL COM 0.00 81001URINALYSIS 47.15 81001URINE DIPSTICK 21.50 81002UA STICK OHS 10.00 81003SPECIF GRAVITY URINE 25.40 81003URINALYSIS W/O MICRO 16.65 81003INDICAN, URINE 120.00 81005PREGNANCY TEST URINE 79.60 81025URINE PREGNANCY 44.70 81025VOLUME MEASURE TIMED 28.10 81050BRCA 1/2 COMPREHENSIVE 4824.00 81162BCR-AB1 KINASE MUTAT 630.00 81170BCR/ABL1 ANALY MAJOR 468.00 81206BCR/ABL1 ANA MINR BP 884.00 81207BRAF GENE ANALYSIS 1500.00 81210CALR MUTATION ANAYSI 1029.60 81219CLOPIDOGREL CYP2C19 GENOTYPE 500.00 81225FACTOR II DNA ANALYS 263.10 81240FACTOR V(LEIDEN)MUTA 257.20 81241FRAGILE X SYND PCR 494.20 81243HEREDIT HEMOCH MUTAT 244.20 81256IGVH SOMATIC HYPERMUTATION 1870.00 81263JAK2V617F MUTAT QUAL 416.00 81270JAK2 GENE ANAYLSIS 832.00 81270JAK2(V617F) MUTATION 832.00 81270JAK2 MUTATION ANALYSIS W/REFLEX TO CALR AND MPL 800.00 81270KRAS GENE ANALYSIS 1350.00 81275METH(MTHFR) REDA DNA 204.80 81291ALPHA-A-TRYP DEF DNA 560.00 81332HLA-B27 ANTIGEN 269.50 81374HLA DR 1/3/4/5, DQ INTERMEDIATE RESOLUTION 1020.00 81375HLA II TYPE 1 ANTIGN 1020.80 81377HLA TYPING 626.20 81379HLA II TYPE 1 ALLELE 1020.80 81383PAI-1 GENE 4G/5G POL 728.00 81400MPL MUTATION ANAYLSI 1123.20 81402JAK2 EXON 12 MUTATN 900.00 81403BETA-THALASSEMIA: HBB 735.00 81404PRENATAL TEST (INFORMA SEQ) W/X,Y ANALYSIS 1790.00 81420ALPHA-FETOPROTEIN (AFP) TETRA PROFILE 92.00 81511

ACETONE URINE 20.20 82010ACETONE SERUM QUANT 51.50 82010B-HYDROXYBUTYRATE 279.60 82010ACYL CARNITINE 418.80 82017ACTH, PLASMA EXTRACT 420.50 82024ADRENOCORTICOTROPIC HORMONE (ACTH) EIGHT SPECIMENS 288.00 82024ALBUMIN SERUM 53.70 82040ALBUMIN, URINE QUANT 40.10 82042ALBUMIN BODY FLUID 59.50 82042MICROALBUMIN,24HR UR 88.80 82043MICROALBUMIN RANDOM 83.35 82043BREATH ALCOHOL TEST 29.00 82075NONDOT BAT TESTING 0.00 82075ALDOLASE 99.00 82085ALDOSTERONE URINE 270.60 82088ALDOSTERONE 403.50 82088FECAL ALPH-1-ANTITRY 344.40 82103ALPHA-1-ANTITRY TOTL 101.60 82103ALPHA-1-ANTITRY PHEN 137.80 82104ALPHAFETOPORTN-MATER 36.70 82105ALPHA FETOPROT TUMER 222.10 82105AMINO ACID-SCN-URINE 125.10 82128PHENYLALANINE QUANT 211.60 82131AMINO ACID QUANT URN 275.90 82131AMINOLEVUL ACID DELT 131.00 82135AMINO ACID SCR SERUM 116.70 82139AMMONIA, BLOOD 199.00 82140AMMONIA 24HR URINE 78.80 82140AMYLASE URINE 115.10 82150AMYLASE BODY FLUID 123.80 82150AMYLASE, SERUM 123.80 82150AMYLASE ISOENZYMES 174.70 82150ANDROSTENEDIONE 323.30 82157ANGIOT-1-CONV ENZYN 88.80 82164LIPOPROTEIN (A1) 94.70 82172APOLIPOPROTEIN B 32.20 82172ARSENIC URINE 299.50 82175ARSENIC HAIR 258.30 82175ARSENIC, BLOOD, QUAN 146.20 82175VITAMIN C, SERUM 76.00 82180BETA-2-MICROGLOBULIN 105.10 82232BILIRUBIN TOTAL 92.50 82247BILIRUBIN DIRECT 79.60 82248FECALOCULT SCN 3SPEC 93.30 82270FECAL OCCULT BLOOD 26.60 82270GASTROCCULT 27.80 82271FECAL OCULT BLD 1SPE 87.60 82272

FECAL IMMUNO OCCULT 57.10 82274CADMIUM 92.00 82300CADMIUM, URINE 125.00 82300VITAMIN-D-25-HYDROXY 233.00 82306CALCITONIN 247.10 82308CALCIUM, SERUM 67.70 82310CALCIUM URINE RANDOM 52.60 82310CALCIUM, IONIZED 218.50 82330CALCIUM 24 HR URINE 79.60 82340CALCULI QUANT ANALYS 169.00 82360URINE CALCULI ANALYS 132.00 82360CARBO DEFIC TRANSFER 479.90 82373CO2 63.00 82374CARBOXYHEMOGLOBIN 116.90 82375CARCINO-EMBRYONIC AG 277.70 82378CARNITINE 249.90 82379CAROTENE 87.00 82380CATECHOLAMIN,FRAC,PL 261.20 82383CATECHOLAMIN,FRAC,UR 280.80 82384CATECHOLAMINES FRACTIONATED PLASMA 55.20 82384CATECHOLAMINES, FRACTIONATED RANDOM URINE 60.00 82384CERULOPLASMIN SERUM 129.10 82390ANTI-MULLERIAN HORMO 212.20 82397PTH RELATED PEPTIDE 141.40 82397DIGITOXIN REFERRED 159.60 82397ANTI-ADALIMUMAB ANTIBODY 826.00 82397CHLORIDE, SERUM 59.50 82435CHLORIDE 24HR URINE 63.80 82436CHLORIDE URIN RANDOM 47.50 82436CHLORIDE CSF 50.00 82438CHOLESTEROL SERUM 74.30 82465CHOLINESTERASE PLASMA/SERUM 122.90 82480CHOLINESTERASE RBC 164.10 82482CHROMIUM 126.00 82495CITRATE, URINE 179.80 82507DEOXYPYRIDINOLINE 182.90 82523N-TELOPEPTIDE(NTX) 460.20 82523C-TELOPEPTIDE 397.30 82523COPPER SERUM 241.50 82525COPPER, 24 HR URINE 224.60 82525CORTISOL, URINE FREE 490.40 82530CORTISOL, FREE BY LC/MS 300.00 82530CORTISOL TOTAL SINGL 222.60 82533CORTISOL, ACTH STIMULATION 320.00 82533CORTISOL (DEXAMETHASONE SUPPRESSION) 160.00 82533CORTISOL, EIGHT SPECIMENS 96.00 82533BENZTROPINE LEVEL 353.40 82542

RISPERDAL LEVEL 426.80 82542FLECAINIDE LEVEL 96.30 82542IONAMIN(PHENTERMINE) 303.30 82542OLANZAPINE (ZYPREXA) 248.20 82542ITRACONAZOLE 261.70 82542LEVETIRACETAM(KEPPA) 224.00 82542ACETAZOLAMIDE 250.80 82542TRAZODONE (DESYREL) 397.30 82542CARBAMAZ-10,11-EPOX1 264.70 82542FELBAMATE LEVEL 101.30 82542LEVODOPA LEVEL 542.40 82542PROZAC(FLUOXETIN/NOR 188.60 82542CLOMIPRAMINE & NORCL 108.90 82542RISPERIDONE LEVEL 440.60 82542CAFFEINE SERUM 338.70 82542TIAGABINE (GABITRIL) 239.70 82542BILE ACID FRACT&TOT 343.50 82542THIOPURINE METHYLTRN 704.40 82542LACOSAMIDE (VIMPAT) 498.80 82542ZIPRASIDONE(ZELDOX) 331.00 82542VORICONAZOLE LEVEL 865.80 82542METHYLPHENIDATE 240.40 82542COENZYME Q10 TOTAL 62.80 82542CPK 73.70 82550CPK ISOENSYMES 119.00 82552CPK-MB 246.30 82553CREATININE SERUM 104.90 82565CREATININE 24HR URIN 110.90 82570CREATIN URINE RANDOM 110.90 82570CREATININE BOD FLUID 97.70 82570CREATININE CLEARANCE 204.00 82575CRYOGLOBULINS, QUAL 59.00 82595CYANIDE BLOOD 166.40 82600VITAMIN B-12 154.25 82607VIT B12 BIND CAPACI 174.30 82608CYSTATIN C 270.00 82610DEHYDROEPIANDRO. SUL 251.00 82627DIBUCAINE NUMBER 128.40 82638CALCITROL(1,25 DI-OH 312.60 82652PANCREAT ELAST FECAL 509.60 82656ERYTHROPOIETIN 371.20 82668ESTRADIOL, SERUM 351.60 82670ESTROGEN, TOTAL 118.70 82672ESTRIOL,UNCONJUGATED 72.20 82677ESTRONE 212.20 82679ETHYLENE GLYCOL 427.90 82693FECAL FAT 148.80 82705

FECAL FAT QUANTITATI 38.30 82710FATTY ACIDS(NONESTER 93.10 82725FERRITIN 149.75 82728FLUORIDE, URINE 216.50 82735FOLATE, SERUM 144.20 82746FOLATE, RBC 173.10 82747FRUCTOSE, SEMEN 637.00 82757IMMUNOGLOB A,D,G,M 185.00 82784IGG, SERUM 72.90 82784IGM, SERUM 63.20 82784IGA, TOTAL QUANTITAT 72.90 82784IGE, SERUM 185.80 82785IGG SUBCLASSES 534.70 82787IMMUNOGLOBULIN G, IGG, SUBCLASS 4 29.00 82787VENOUS BLOOD GASES 139.80 82803BLOOD GASES ARTERIAL 146.40 82803GASTRIN 146.40 82941GLUCAGON 151.40 82943GLUCOSE 24 HR URINE 99.80 82945GLUCOSE CSF 80.50 82945GLUCOSE BODY FLUID 14.50 82945GLUCOSE, SERUM QUANT 92.50 82947GLUCOSE POST DOSE 103.20 82950GLUCOSE TOLER 2 HOUR 118.80 82951GLUCOSE TOLER 3 HOUR 222.20 82951GLUCOSE TOLER 4 HOUR 263.70 82951GLUCOSE TOLER 5 HOUR 298.20 82951GLUCOSE TOLER 6 HOUR 366.50 82951GLUCOSE TOLER 1 HOUR 101.80 82951GLUCOSE TOL ADD SPEC 37.50 82952GLUCOSE-6-PHOS-DEHYD 112.50 82955GLUCOSE FSA 40.60 82962GLUCOSE, WHOLE BLOOD 35.60 82962BLOOD GLUCOSE 9.00 82962GGTP, SERUM 119.70 82977PROTEIN BOUND GLUCOS 117.80 82985FRUCTOSAMINE 132.10 82985FOLLICLE STIM HORMON 243.30 83001LUTEINIZING HORMONE 242.30 83002GROWTH HORMONE 197.00 83003HAPTOGLOBIN 150.60 83010HEAVY METAL SCREEN 190.50 83015COBALT PLASMA 125.10 83018BISMUTH 146.20 83018HEMOGLOBIN A2, BLOOD 189.30 83021HEMOGL FRACTIONATION 122.90 83021GLYCOHEM AGB A1C 97.25 83036

METHEMOGLOBIN-QUANT. 77.80 83050HEMOGLOBIN FREE PLASMA 27.00 83051HEMOSIDERIN URINE 201.80 83070TAY-SACHS B-HEXOSAMI 164.90 83080HISTAMINE LEVEL 294.50 83088HOMOCYSTINE SERUM 178.40 8309017 HYDROXYCORTICOSTE 115.90 834915 HYDROXYINDOLACETIC 114.70 8349717 HYDROXYPROGESTERO 403.80 83498HYDROXYPROL,FRE,URIN 209.40 83500HYDROXYPROL,TOT,URIN 267.90 83505GLIADIN ANTIBODY IGG 47.90 83516ANTIPARIETAL CELL 53.60 83516GLIADIN ANTIBODY IGA 99.90 83516GLIADIN ANTIBODY IGM 99.90 83516ANTI-GLIADIN,IGG,IGA 269.50 83516GLOM BASE MEMBR ANTI 205.70 83516MITOCHONDRIAL ANTIBO 114.00 83516ANTI-SMOOTH MUSCLE 179.10 83516TISSUE TRANSGLUTAMINASE, IGA 294.30 83516BULLOUS PEMPHIGOID 180 AND 230 444.00 83516ACETYLCHOLINE REC AB 403.10 83519PANCREATIC POLYPEPTI 224.60 83519GLUTAMIC ACID DECARB 495.90 83519ANTI-MUSCULAR RECEPT 1206.20 83519ACETYLCHOLINE RECEPTOR MODULATING 160.00 83519ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODIES 64.00 83519TSH RECEPTOR ANTIBOD 158.40 83520ANTIPROTEINASE 3 94.20 83520ANTIMYELOPEROXIDASE 94.20 83520TRYPTASE 174.80 835202-HYDROXYESTRONE 286.90 8352016ALPHA-HYDROXYESTRO 286.90 83520ALPHA SUBUNIT 182.70 83520THYROTROPIN RECEP AB 95.70 83520ANTI-OMPC IGA ELISA 132.60 83520ANTI-CBIR1 ELISA 132.60 83520IBD SPECIFIC PANCA 132.60 83520NEUROMYELITIS OPTICA 1298.20 83520ANTIMYELIN ANTIBODY 437.90 83520TISSUE TRANSGLUTAMINASE, IGG 306.60 83520INHIBIN B 330.00 83520INSULIN, SERUM 145.60 83525IRON, SERUM 75.60 83540TIBC TOTAL IRON BIND 94.90 8355017 KETOSTEROIDS 24 H 175.00 83586LACTATE, BLOOD 163.40 83605

LDH, SERUM 79.60 83615LDH, BODY FLUID 82.60 83615LDH ISOENZYMES 168.60 83625LACTOFERRIN FECAL 378.40 83630FECAL WBC LACTOFERIN 61.30 83630FECAL WBC LACTOFERRIN QUANTITATIVE 264.00 83631LEAD BLOOD 94.50 83655LEAD URINE 103.20 83655LIPASE, SERUM 54.50 83690LIPOPROTEIN(A) 85.90 83695LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 81.00 83698LIPOPROTEIN FRACTION 279.30 83701NMR LIPOPROTEINS 146.50 83704HDL HIGH DENSITY LIP 121.00 83718VERY LOW DENSITY LIP 156.50 83719LDL LOW DENSITY LIPO 170.10 83721MAGNESIUM, URINE 44.30 83735MAGNESIUM, RBC 199.00 83735MAGNESIUM, SERUM 70.15 83735MANGANESE LEVEL 128.10 83785IODINE SERUM 126.90 83789MERCURY,BLOOD,QUANT 170.70 83825MERCURY,24HR,UR,QUAN 128.10 83825METANEPHRINES PLASMA 622.90 83835METANEPHRINES 24H UR 227.10 83835MYELIN BASIC PRO CSF 73.20 83873MYOGLOBIN, URINE 101.80 83874MYOGLOBIN, SERUM 95.20 83874BRAIN NATRIU PEPTIDE 317.00 83880KAPPA/LAMBA CHN SERA 83.40 83883KAPP/LAMBA FREE LIGHT CHAIN PLUS RATIO, QUANT, URINE 60.00 83883OLIGOCLONAL BAND CSF 85.60 83916ORGANIC ACID QUALIT 347.70 83919METHYLMALONIC ACID 245.60 83921STYRENE METABOLITE 200.00 83921ETHYL BENZENE METABOLITE 152.50 83921OSMOLALITY, SERUM 73.10 83930OSMOLALITY, URINE 73.10 83935OSTEOCALCIN 208.60 83937OXALATE URINE 117.40 83945DES GAMMA CARBOXY PT 403.80 83951PARA-THYROID HORMONE 338.65 83970PH BODY FLUID 53.80 83986PH FECAL 30.10 83986PHENCYCLIDINE (PCP) CONFIRMATION, URINE 46.00 83992CALPROTECTIN 548.60 83993PKU NEWBORN SCREEN 208.90 84030

ACID PHOSPHATASE 143.30 84060ALKALINE PHOSPHATASE 86.40 84075ALK.PHOS.ISOENZY. 235.40 84080ALKALINE PHOSPHATASE BONE-SPECIFIC (BAP) 102.25 84080PHOSPHOROUS 91.10 84100PHOSPHATE URINE 39.00 84105PORPHOLINOGEN,QUANT 135.00 84110PORYPHRINS URINE QUA 204.90 84120POTASSIUM SERUM 85.20 84132POTASSIUM 24HR URINE 71.90 84133POTASSIUM RANDOM URINE 18.00 84133PREALBUMIN 173.80 84134PREGNENOLONE 148.50 84140PROGESTERONE SERUM 219.50 84144PROCALCITONIN 99.00 84145PROLACTIN, SERUM 263.10 84146PSA ULTRA SENSITIVE 148.20 84153PSA SERUM TOTAL 205.70 84153PROSTAT SPEC AG FREE 280.60 84154TOTAL PROTEIN 54.80 84155TOTAL PROT RAND URIN 81.40 84156TOTAL PROT 24 HR URN 62.20 84156TOTAL PROTEIN CSF 68.30 84157PROTEIN ELECTROPHORE 114.00 84165URINE PROT. ELECTROP 125.10 84166URINE PROTEIN ELECTROPH, RANDOM 40.50 84166PROTEIN ELECTROPHORESIS, CSF 80.00 84166RBC PROTOPORPHYRIN 111.10 84202ZINC PROTOPORPHYRIN 108.90 84202PROINSULIN 209.90 84206VITAMIN B-6 532.00 84207PYRUVATE 177.40 84210ESTROGEN RECEPTOR 613.20 84233PROGESTERONE RECEPTO 613.20 84234TRANSFERRIN RECEPTOR 156.80 84238RENIN, PLASMA 237.70 84244VITAMIN B-2 647.10 84252SELENIUM 157.10 84255SEROTONIN, SERUM 140.90 84260SEX HORMON BIND GLOB 147.30 84270SODIUM SERUM 74.20 84295SODIUM URINE 24 HR 96.70 84300SODIUM URINE RANDOM 96.70 84300INSULIN GROWTH FACTO 398.00 84305BROMIDES; BLOOD 214.30 84311PORPHYRINS, SERUM 156.00 84311PHOSPHOLIPIDS 62.40 84311

FECAL REDUCING SUBST 64.50 84377REDUCING SUBS.-STOOL 52.80 84377SULFATE QUANT URINE 177.40 84392TESTOSTERONE-FREE 278.00 84402TESTOSTERONE, TOTAL 369.60 84403VITAMIN B1 (THIAMINE 239.40 84425THIOCYANATE, SERUM 196.00 84430THYROBLOBULIN 170.50 84432T4 THYROXIN 104.90 84436FREE T4 BY DIALYSIS 694.80 84439FREE THYROXINE 135.30 84439THYROXINE-BDG GLOBUL 106.70 84442THYROID STIM HORMON 147.80 84443THYROID STIM IMM TSI 566.20 84445VITAMIN E 118.40 84446TRANSCORTIN (CBG) 89.60 84449AST/SGOT SERUM 79.60 84450ALT/SGPT SERUM 74.20 84460TRANSFERRIN 132.80 84466TRIGLYCERIDES 117.10 84478TRIGLYCER BODY FLUID 108.90 84478T3 UPTAKE, SERUM 104.90 84479T-3,TOTAL,TRIIODOTHR 80.60 84480T3, FREE 164.20 84481T3 REVERSE 92.20 84482TROPONIN-T QUANT 143.30 84484BLOOD UREA NITROGEN 79.60 84520URINE UREA NITROGEN 88.80 84540URIC ACID SERUM 58.10 84550URIC ACID 24 HOUR UR 69.50 84560UROBILINOGEN, QUAL. 143.30 84578VMA URINE RANDOM 47.80 84585VMA, URINE 24 HOUR 162.40 84585VASOACTIV INTES POLY 290.20 84586ARGININE VASOPRESSIN 655.50 84588ANTIDIURETIC HORMONE 349.40 84588VITAMIN A (RETINOL) 134.70 84590VITAMIN B3 (NIACIN & METABOLITE) 744.00 84591VITAMIN K1 551.80 84597URINE PHENOL 282.30 84600ALCOHOL (METHANOL) 135.00 84600ALCOHOL (ISOPROPYL) 145.70 84600XYLENE LEVEL 238.70 84600TOLUENE METABOLITE 152.50 84600XYLOSE ABSORP, URINE 218.00 84620XYLOSE ABSORP, BLOOD 108.90 84620ZINC, SERUM 119.30 84630

ZINC, URINE 27.60 84630ZINC, RBC'S 185.00 84630C-PEPTIDE 98.00 84681B-HCG, QUANT. SERUM 201.40 84702HUMAN CHORIONIC GONA 35.50 84702BETA-HCG AT LABCORP 133.60 84702HCG LOW, TURMOR MARK 216.40 84702PREGNANCY TEST SERUM 79.95 84703FECAL OSMOLALITY 45.00 84999BLEEDING TIME 102.10 85002WBC MICRO DIFFERENTI 46.50 85004DIFFERENTIAL 46.10 85007EOSINOPHIL COUNT 44.00 85008HEMATOCRIT 46.10 85014HEMOGLOBIN 34.60 85018HEMOGLOBIN 17.00 85018HEMOGLOBIN 26.60 85018CBC W/AUTO DIFF. 75.60 85025HEMOGRAM AUTOMATED 56.95 85027RETICULOCYTE COUNT 85.20 85045WHITE BLOOD CELL CT 34.60 85048PLATELET COUNT 57.40 85049FACTOR II 225.90 85210FACTOR VII 225.90 85230FACTOR VIII (AHG) 389.70 85240FACT VIII VONW ACTIV 273.80 85245FACTOR VIII VW ANTIG 273.80 85246VONWILLEB FACT MULTI 436.80 85247FACTOR IX 522.40 85250FACTOR X 225.90 85260FACTOR XI ACTIVITY 246.80 85270FACTOR XII ACTIVITY 246.80 85280PREKALLIKREIN ASSAY 343.20 85292KININOGEN ASSAY 343.20 85293ANTITHROMBIN III ACT 151.90 85300ANTITHROM III ANTIGE 141.10 85301PROTEIN C ANTIGEN 740.40 85302PROTEIN C, ACTIVITY 138.20 85303PROTEIN S ANTIGEN, TOTAL 761.00 85305PROTEIN S, ACTIVITY, FREE 153.50 85306ACT.PROTEIN C RESIST 172.30 85307FDP BY D-DIMER QUANT 204.00 85379FIBRINOGEN LEVEL 199.30 85384FIBRINOGEN ANTIGEN 160.00 85385ADAMTS 13 ACTIVITY 336.00 85397PLASMINOG ACT INHIBR 315.20 85415HEPARIN ANTI-XA 236.20 85520

L.A.P. SCORE 236.80 85540LYSOZYME(MURAMIDASE) 145.70 85549RBC OSMOTIC FRAG. 167.80 85555PLATELET PHOSPHOLIPID NEUTRALIZATION 216.00 85597HEXAG PHASE PHOSPHOL 147.90 85598PROTHROMBIN TIME(PT) 64.80 85610MIXING CORRECT STUDY 99.20 85611LUPUS ANTICOAG.EVAL 177.50 85613DIL RUSSELL VIPER VE 109.40 85613SED RATE RBC AUTOMAT 45.15 85652SICKLE CELL SCREEN 126.40 85660HEMOGLOBIN SOLUBILIT 69.00 85660THROMBIN TIME 86.00 85670PTT 91.10 85730MIXING SUBSTITUTION FRACTIONS 150.00 85732VISCOSITY, SERUM 89.00 85810FEBRILE ANTIGENS 62.90 86000TULAREMIA AGGLUTINAT 116.00 86000LATEX SPECIFIC IGE 36.30 86003RAST 6 ALLERGENS 1080.40 86003ALLERGEN PANEL, HAZELNUT, IGE 50.00 86003ALLERGEN, IGE, A. ALTERNATA 12.00 86003ALLERGEN, IGE, WHITE ASH 12.00 86003ALLERGEN, IGE, A. FUMIGATUS 12.00 86003ALLERGEN, IGE, BERMUDA GRASS 12.00 86003ALLERGEN, IGE, CAT DANDER 12.00 86003ALLERGEN, IGE, MTN. CEDAR 12.00 86003ALLERGEN, IGE, C. HERBARUM 12.00 86003ALLERGEN, IGE, GERMAN COCKROACH 12.00 86003ALLERGEN, IGE, COTTONWOOD 12.00 86003ALLERGEN, IGE, D. FARINAE 12.00 86003ALLERGEN, IGE, D. PTERONYSSINUS 12.00 86003ALLERGEN, IGE, DOG DANDER 12.00 86003ALLERGEN, IGE, AMERICAN ELM 12.00 86003ALLERGEN, IGE, MAPLE LEAF SYCAMORE 12.00 86003ALLERGEN, IGE, MAPLE/BOX ELDER 12.00 86003ALLERGEN, IGE, MOUSE URINE 12.00 86003ALLERGEN, IGE, WHITE OAK 12.00 86003ALLERGEN, IGE, PECAN, HICKORY 12.00 86003ALLERGEN, IGE, P. CHRYSOGENUM 12.00 86003ALLERGEN, IGE, PIG WEED 12.00 86003ALLERGEN, IGE, SHORT RAGWEED 12.00 86003ALLERGEN, IGE, ROUGH MARSHELDER 12.00 86003ALLERGEN, IGE, RUSSIAN THISTLE 12.00 86003ALLERGEN, IGE, TIMOTHY GRASS 12.00 86003ALLERGEN, IGE, WALNUT 12.00 86003ALLERGEN, IGE, WHITE MULBERRY 12.00 86003

ALLERGEN, IGE, EGG WHITE 13.00 86003ALLERGEN, IGE, MILK 13.00 86003ALLERGEN, IGE, WHEAT 13.00 86003ALLERGEN, IGE, SOYBEAN 13.00 86003ALLERGEN, IGE, CORN 13.00 86003ALLERGEN, IGE, CODFISH 13.00 86003ALLERGEN, IGE, SHRIMP 13.00 86003ALLERGEN, IGE, SCALLOP 13.00 86003ALLERGEN, IGE, SESAME SEED 13.00 86003ALLERGEN, IGE, CLAM 13.00 86003ALLERGEN IGE PEANUT 13.00 86003MYELOPEROXIDASE ANTI 206.20 86021HEPARIN INDU PLT ABS 330.30 86022PLATELET ANTIBODIES 158.10 86022ANA DIRECT 139.80 86038STREPTOZYME 115.10 86060ANTI-STREPTOLYSIN O 107.80 86060C-REACTIVE PROTEIN 74.20 86140HSCRP HIGH SENSITIVE 272.80 86141B-2 GLYCOPROTEIN IGA 107.10 86146B-2 BLYCOPROTEIN IGG 107.10 86146B-2 GLYCOPROTEIN IGM 107.10 86146ANTI-CARDIOLIPIN,COM 74.70 86147ANTIPHOSPHATIDYISERI 220.70 86148COLD AGGLUTININS SCR 141.90 86156COMPLEMENT (C3) 92.90 86160COMPLEMENT (C4) 211.80 86160COMPLEMENT C1Q QUANT 58.60 86160C1 ESTER INHIB FUNCT 214.00 86161COMPLEMENT-TOT-CH50 212.90 86162ANTI CYCLIC CIT PEPT 77.60 86200CYCLIC CITRU PEPTIDE 77.60 86200ANTI-DNASE 143.90 86215DNA ANTIBODIES,NATIV 136.10 86225ANTI-DNA DOUBLE STRD 196.40 86225ANTI DNA SINGLE STRD 90.30 86226CENTROMERE ANTIBODY 100.00 86235SJOGREN'S ANTI-SS-B 83.60 86235SJOGREN'S ANTI-SS-A 83.60 86235ANTI-JO-1 137.50 86235ANTIEXTRACTABLE NUCL 157.80 86235ANTI-SCLERODERMA 77.90 86235ANTIHISTONE 85.20 86235ANTICHROMATIN ANTIBO 83.60 86235RNP ANTIBODIES 82.00 86235SM (SMITH) ANTIBODY 82.00 86235ANTIENDOMYSIAL, IGA 507.40 86255

ANTISKIN AUTOANTIBOD 169.60 86255RETICULIN ANTI IGG 193.80 86255RETICULIN ANTI IGA 122.90 86255ANTIMUSCLE ANTIBODIES, QUANT. 119.60 86255INSU GRO FAC IGFBP-3 78.90 86256NEUTROPHIL CYTOPL AB 543.90 86256ANTINEUTROPHIL CYTOP 102.40 86256ANTI-HU (ANNA1) 280.80 86256CA 15-3 226.20 86300CA 27-29 388.80 86300CA 19-9 375.60 86301CA-125 SERUM 226.20 86304INFECT. MONO. QUANT. 108.90 86308HETEROPH ANTI TITER 77.80 86308INFECTOUS MONO 85.20 86308CA 72-4 239.90 86316CHROMOGRANIN A 378.60 86316PNEUMOCOCAL ANTIBODY 285.00 86317HEPATITIS B SURFACE ANTIBODY, QUANTITATIVE 35.00 86317STREP PNEUMONIAE IGG ANTIBODY SEROTYPES 45.00 86317IMMUNOELECTROPHORESI 226.80 86320TEICHOIC ACID ANTIBO 250.80 86329ANTI-PIGEON SERUM IG 51.00 86331IMMUNE COMPLEXES, C, Q BINDING 26.00 86332IMMUNOFIX ELECTROPHO 105.00 86334LIGHT CHAIN TYPING 216.40 86335IMMUNOFIX/ELECT URIN 220.70 86335IMMUNOFIXATION, CSF 72.00 86335INHIBIN A ULTRASENS 565.10 86336INSULIN ANTIBODIES 839.20 86337INTRINSIC FACT ANTIB 69.90 86340ZINC TRANSPORT ANTIB 634.40 86341ISLET CELL ANTIBODY 70.00 86341LYMPHOCYTE ACTIVATN 693.70 86353B LYMPHOCYTE COUNT 507.50 86355MONONUCL CEL ANTIGEN 53.70 86356LYMPH SUBSET 5PNL 108.60 86356NATURAL KILLER CELL 614.60 86357T LYMPHOCYTE COUNT 469.50 86359LYMPHOCYT SUBSET III 377.30 86360CD4 CD8 COUNT & RATO 191.60 86360ANTITHYROID PEROXIDA 107.30 86376RHEUMATOID FACTOR 74.20 86431T B QUANTIFERON 429.40 86480TB TEST 24.00 86580R.P.R., QUALITATIVE 68.30 86592RPR EMPLOYEE PHYSICA 0.00 86592

R.P.R., QUANTITATIVE 57.40 86593VDRL SERUM 45.70 86593ANTI-ACTIMOMYCES IGG 28.90 86602ADENOVIRUS ANTIBODY 99.70 86603ANTI-ASPERGILLUS IMM 85.00 86606ANTI-MICROPOLYSPORA 36.50 86609BARTNELLA AB(CAT SC) 53.60 86611BLASTOMYCES ANTI,IMM 90.70 86612B PERTUSIS IGA QUANT 87.20 86615BORDETELLA ANTIBODY 157.80 86615B PERTUS IGG/M QUANT 119.60 86615LYME WESTER BLOT IGM 52.00 86617LYME WESTER BLOT IGG 50.00 86617LYME DISEASE ANTIBOD 272.70 86618BRUCELLA ANTIBODY 93.70 86622CANDIDA ALBICANS AB 164.50 86628CHLAMYDIA ANTIBO IGG 82.80 86631CHLAMYDIA ANTI-IGM 135.00 86631CHLAMYDIA PNEUMONIAE, IGG, IGM, IGA 620.00 86631COCCIDIODES ANTI,IMM 100.50 86635Q FEVER ANTIBODIES 106.30 86638CYTOMEGALOVIRUS IGG 215.80 86644CYTOMEGALOVIRUS IGM 214.20 86645DIPHTHERIA ANTITOX 263.00 86648CALIF ENCEPHALITIS 205.70 86651EASTERN ENCEPHALITIS 174.60 86652ST LOUIS ENCEPHALITI 205.70 86653WESTERN ENCEPHALITIS 174.60 86654POLIOVIRUS ANTI-123 260.70 86658ECHOVIRUS ANTIBODY 203.80 86658COXSACKIE VIRUS ANTI 506.00 86658E-B VIRUS ERLY AG-AB 187.20 86663EBV NUCLEAR ANTI-IGG 50.20 86664E-B VIRUS CAPSID,IGG 176.00 86665E-B VIRUS CAPSID,IGM 114.40 86665EBV COMP PANEL 320.70 86665SACCH CEREVISIAE IGA 132.60 86671SACCH CEREVISIAE IGG 132.60 86671ANTI-AUREOBASIDIUM 34.70 86671INFLAM BOWEL DIS(IBD 635.50 86671H. PYLORI ANTI-IGM 96.10 86677H. PYLORI ANTI-IGG 96.10 86677H. PYLORI ANTI-IGA 96.10 86677HELICOBAC, PYLORI BX 128.60 86677ANTI-HELICOBAC PYLOR 109.20 86677ANTI-HELICOBACT-QUAN 125.10 86677STRONGYLOIDEA, IGG, QUALITATIVE, EIA 180.00 86682

ANTI H INFLUENZAE B 372.90 86684HIV CONFIRMATION TES 184.60 86689HEPATITIS D ANTIBODY 514.80 86692HERPES SIMPLEX IGG 145.20 86694HERPE SIMPLEX AB-IGM 167.80 86694HSV TYPE I SPEC IGG 86.70 86695HERPES SIMPLEX TYPE2 154.20 86696HSV TYPE II SPEC IGG 152.70 86696HSV TYPE 2 IGM 190.00 86696HISTOPLASMA ANTIBODY 522.20 86698HISTOPLASMA AB IMMUN 64.10 86698HIV-1 RAPID SCREEN 84.30 86701HEPAT. B CORE-AB-TOT 79.60 86704HEPATI B CORE AB IGM 224.40 86705HEP B SURF ANTIBODY 129.70 86706POST EXP HEP B SF AB 0.00 86706HEP B SURF ANTI 28.00 86706HEPATITIS BE ANTIBDY 115.90 86707HEPATITIS A ANTI TOT 141.90 86708HEPATITIS A AB-IGM 121.20 86709INFLUENZA AB. A+B 235.90 86710ANTI PARAINFLUENZA 312.10 86710LEGIONELLA ANTIBODY 216.70 86713LEPTOSPIRA AGGLUTIN 108.90 86720MUMPS ANTIBODIES,IGG 85.30 86735MUMPS ANTIBODIES IGM 86.10 86735MYCOPLASMA PNEUMONIAE ANTIBODY, IGG 114.00 86738MYCOPLASMA PNEUMONIAE ANTIBODY, IGM 22.00 86738PARVOVIRUS B19 ANBDY 225.50 86747RESP SYN VIRUS-AB 84.60 86756RICKETTSIA ANTIBODY 195.30 86757RUBELLA 107.80 86762RUBELLA EMPLOYEE PHY 0.00 86762RUBELLA AB TITER 108.30 86762RUBEOLA ANTIBODY 258.50 86765TETANUS ANTITOXIN 300.60 86774TOXOPLASMA GONDI IGG 132.50 86777TOXOPLASMA GONDI IGM 132.50 86778ANTI TREP. PALLIDUM 132.50 86780FTA-ABS,T.PALLIDUM 132.00 86780VARICELLA-ZOSTER IGG 217.60 86787VARICELLA-ZOSTER IGM 145.80 86787OHC VARICELLA TITER 75.00 86787WEST NILE VIRUS IGM 114.40 86788WEST NILE VIRUS, IGG 181.90 86789HERPES VIRUS 6 AB-PN 606.30 86790RABIES ANTIBODY 261.10 86790

HEPATITIS E IGM 93.80 86790HEPATITIS E IGG 93.80 86790HTLV-1/2 QUAL 59.10 86790YERSINIA ANTIBODY 219.00 86793ANTITHYROGLOBULIN AB 95.10 86800THYROGLOBULIN ANTIBODY AND THYROGLOBULIN BY IMA OR LS/MS 198.00 86800HEPATITIS C AB RIBA 319.10 86803POST EXPO HEP C AB 0.00 86803HEPATITIS C ANTIBODY 130.05 86803HLA CLASS I AND II ANTIBODY SCREEN 350.00 86828ANTI-PROTHROM IGG 185.30 86849ANTI-PROTHROM IGM 187.20 86849EOSINOPHIL CATIONIC PROTEIN 144.00 86849ANTIBODY SCREEN 172.70 86850ANTIBODY SCRN RBC AR 111.40 86850ANTIBODY ELUTION ECH 156.00 86860ANTIBODY IDENTIFICAT 310.80 86870SERUM ANTIBODY IDENT 140.10 86870DIRECT ANTIGLOB TEST 50.90 86880ANTIHUMAN GLOB TEST 73.60 86885ABO CELL TYPE 69.90 86900RH BLOOD TYPING 68.50 86901ANTIGEN SCREEND UNIT 86.80 86902RBC ANTIGEN(S) 66.60 86905M RED BLOOD CELL ANTIGEN TYPING 80.00 86905COMPATIBIL BY I.S.T. 260.40 86920COMPATIB BY INCUBATI 172.00 86921COMPATIBILITY BY AHG 305.10 86922FFP THAWING EA UNIT 79.60 86927ISOHEMAGGLUTININ 36.30 86940RBC ABSORPTION PREAT 135.20 86978CYCLOSPORA STAIN SMEAR STOOL 44.00 87015CULTURE BLOOD 171.60 87040CULTURE STOOL 40.10 87045CULTURE STOOL YERSIN 40.10 87046CULTURE STOOL CAMPY 40.10 87046CULTURE THROAT ALL P 141.90 87070CULTURE SPINAL FLUID 91.60 87070CULTURE BONE 90.70 87070CULT BORDETELLA PERT 144.70 87070CULTURE E-COLI 0157 120.80 87070CULTURE SPUTUM 147.30 87070ENVIROMENTAL CULTURE 96.10 87070CULTURE EAR 141.90 87070ENVIRONMENTAL SURVEY 0.00 87070CULTURE EYE 141.90 87070CULTURE BODY FLUID 138.90 87070

CULTURE GENITAL 141.90 87070CULTURE WOUND 216.90 87070CULTURE ANAEROBIC 238.20 87075AEROBIC DEFINITIV ID 34.30 87077CULTURE FOR GC 147.80 87081MRSA CULTURE SCREEN 43.40 87081CULTURE URINE 108.55 87086URINE PRESUMP ISOLAT 34.50 87088CULTURE FUNGAL 123.70 87101YEAST CULTURE 78.20 87102ID, YEAST 46.50 87106CULTURE MYCOPLASMA 255.30 87109CULTURE CHLAMYDIA 397.10 87110CULTURE TB-AFB ISOLA 197.20 87116PARASITE DIRECT EXAM 26.00 87169OVA AND PARASITES 141.90 87177SENSITIVITY, MIC 113.15 87186STAIN GRAM STAIN 46.80 87205WRIGHTS STAIN 44.80 87205EOSINOPHIL URINE 43.60 87205FECAL SMEAR, STAIN F 25.30 87205ACID FAST STAIN 96.70 87206CYCLOSPORA SMEAR 44.00 87206MALARIAL PARASITE SM 124.90 87207O&P DIRECT SMEAR 112.50 87207CRYPTOSPORIDIA SMEAR 41.40 87207MALARIAL PARASITE SM 48.00 87207TRICHROME STAIN O&P 76.50 87209FUNGAL KOH PREP 51.70 87210WET PREP SCREEN 51.20 87210INDIA INK PREP 58.00 87210CULTURE VIRAL 515.40 87252VIRUS ISO SHELL VIAL 386.00 87254HERPES VIRAL CULT. 199.00 87255CRYPTOSPORIDIUM, DIRECT EIA 157.00 87328GIARDIA ANTIGEN EIA 116.50 87329H PYLORI STL ANTIGEN 196.00 87338HELIC PYLORI ANTIGEN 112.00 87339POST EXP HEP B SF AG 0.00 87340HEPATITIS B SURF ANG 88.20 87340HEPATITIS BE ANTIGEN 123.80 87350HEPATITIS D ANTIGEN 402.50 87380HISTOPLAS ANTIGE EIA 244.50 87385HISTOPLAS ANTIGEN SE 222.60 87385HISTOPLASMA GALACTOMANNAN ANTIGEN, URINE 278.00 87385HIV-1 ANTIBODY 127.90 87389ROTAVIRUS AG, STOOL 74.40 87425

LEGIONELLA ANTGN URN 408.40 87449BACT MENING ANTIGENS 140.10 87449BLASTOMYC ANTIGE EIA 357.80 87449C PRARPSILOSIS NAA 315.90 87481C GLABRATA NAA 210.60 87481C ALBICANS NAA 210.60 87481C TROPICALIS NAA 315.90 87481C LUSITANIAE NAA 315.90 87481C KRUSEI NAA 315.90 87481CHLAMYD PNEUM AMPLIF 308.00 87486CHLAMYDIA DIRECT PRB 107.80 87490CHLAMYDIA TRACH PCR 186.00 87491CLOSTRIDIUM DIFF.TOX 365.10 87493C DIFF DNA AMPLIFIED 186.00 87493CYTOME CMV PCR QUANT 680.00 87497ENTEROVIRUS PCR 348.70 87498GI PATHOGENS PANEL 624.00 87507HEPAT B DNA QUAL PCR 499.10 87516HEPAT B DNA QUNT PCR 839.50 87517HEPATITIS C RNA PCR 543.90 87521HEPAT C HCV RNA QUAN 270.40 87522HERPES SIMPLEX VIRUS (HSV) TYPES 1&2, NAA 310.00 87529HERPES SIMPLEX VIRUS (HSV) TYPES 1/2, DNA PCR 330.00 87529HIV-1 RNA QUALITATIVE, SERUM/PLASMA 67.30 87535HTLV-I VIRUS, PCR 317.30 87536HIV-1 RNA QUANT PCRW 508.80 87536HTLV-II VIRUS, PCR 279.20 87536HIV-2 ANTIBODY PCR 261.10 87538MYCOPLAS PNEUMON PCR 282.85 87581N GONORHOEAE D PROBE 107.80 87590N GONORRHEAE DNA LCR 187.80 87591N GONORHOE AMP URINE 186.00 87591RESP VIRUS PANEL PCR 640.00 87633STREP A DNA AMPLIFIE 201.90 87651TRICHOMONA VAGIN PCR 284.10 87661JC VIRUS DNA, PCR 713.40 87798PLASMODIUM SPEC PCR 228.30 87798NOROVIUS PCR 670.40 87798HEPATITIS D RNA PCR 1074.40 87798TROPHERYMA WHIPPEL11 547.60 87798HISTOPLASMA PCR AG 452.50 87798EHRLICHIA ABS,IGG&M 525.30 87798MEGASPHAERA 1 187.20 87798BVAB 2 187.20 87798ATOPOBIUM VAGINAE 187.20 87798CHIKUNGUNYA VIRUS 832.00 87798B PERTUSIS DNA (PCR) 282.85 87798

VARICELLA ZOSTER (VZV), DNA PCR 260.00 87798EPSTEIN-BARR V PCR 509.00 87799BK VIRUS QUANT DNA 1144.50 87799INFLUENZA A/B DIRECT 115.90 87804RAPID INFLUENZA 73.10 87804R.S.V. DIRECT ANTIGN 115.90 87807STREP GRP A ANTIGEN 106.50 87880S PNEUMONIAE ANTIGEN 450.00 87899CYPTOCOCCUS ANTIGEN 79.10 87899HEPATITIS C GENOTYPE 826.70 87902PROCESSING AUTOPSY G 50.00 88000PROCESSING AUTOPSY L 124.90 88036TISSUE AUTOPSY N-COM 262.80 88045PROCESSING AUTOPSY T 199.30 88099TISSUE AUTOPSY COMPL 298.30 88099BRONCHIAL WASHING TC 91.60 88104C.S.F. WASHINGS TC 91.60 88104FLUIDS (NON-GYN) TC 91.60 88104G.I. WASHINGS TC 91.60 88104SPUTUM CYTOLOGY TC 91.60 88104URINE, CYTOLOGY 91.60 88104CYTO - CELL BLOCK 143.30 88108THIN PREP NON-GYN 152.90 88112CYTOLOGY MISCELLANEOUS FLUID 266.00 88112CYTOLOGY ABDOMINAL FLUID 166.00 88112CYTOLOGY, PLEURAL FLUID 266.00 88112CYTO, PAP SMEAR PROC 6.90 88150CYTO (PAP SMEAR) GYN 51.70 88150CYTOLOGY - NON-GYNE 65.80 88160FINE NEEDLE EVALUATE 116.50 88172FINE NEEDLE ASPIRATI 261.60 88173DNA HISTOGRAM 665.80 88182FLOW CYTOMETRY MARKR 132.50 88184EA ADDL FLOW MARKER 62.30 88185FLOW CYTOMETRY INTERP. 2-8 MARKERS 174.88 88187FLOW CYTO >16 INTER 349.40 88189NON NEOPLAST TIS CUL 434.20 88230CHROMOSOME ANALYSIS 660.70 88262KARYOTYPE CHROM BAND 464.50 88262BCR-AB1 ONCOLOGY, FISH 630.00 88271CHRONIC LYMPH LEUKEMIA BY FISH 702.00 88271MYELODYSPLASTIC CYNDROME 468.00 88271FISH INTER ANALYSIS 100-300 CEKKS 320.00 88275MYELODYSPLASTIC SYNDROME (MDS) 520.00 88275CYTOGEN MOLECUL RPRT 78.90 88291TISSUE PROCESSING GR 51.70 88300SURG.PATH. LEVEL I 79.90 88300

SURG.PATH. LEVEL II 155.10 88302TISSUE PROCESSING I. 136.10 88302TISSUE PROCESSING, D 43.70 88302SURG.PATH. LEVEL III 170.80 88304CELL BLOCK TECHNICAL 229.30 88305BONE MARROW REPORT O 370.20 88305PATH NEEDLE ASPIRATN 193.10 88305CELL BLOCK -F.N. ASP 73.80 88305BONE CORE 126.40 88305CELL BLOCK--BONE MRW 73.80 88305SURG.PATH. LEVEL IV 246.50 88305SURG.PATH. LEVEL V 491.90 88307CONSULTING PATHOLOGI 448.70 88309SURG.PATH. LEVEL VI 668.10 88309DECALCIFICATION 67.00 88311STAIN - GROUP I 269.20 88312STAIN TRICHROME 50.00 88313STAIN - GROUP II 81.10 88313CONSULT TO OR (REPOR 114.40 88329FROZN SECTN 1ST BLCK 149.20 88331ADD'L FROZEN SECTION 149.20 88332IMMUNO EACH ADDL STN 455.50 88341IMMUNOHISTOCHAM ADT 169.70 88341MUSCLE BIOPSY IMMUNO 871.70 88342IMMUNOHISTOCHEM EA 226.30 88342IMMUNOFLOR EA AB 242.00 88346IFA PERINUCLEAR PATT 381.00 88346DNASE SENSITIVITY 381.00 88346MUSCLE BIOPSY, ELECT 797.10 88348MORPHOMET IHC QUANT 260.00 88360MORPHOMETRIC ANALYSI 316.50 88361EACH ADD'L SINGLE PROBE STAIN PROCEDURE 244.00 88364IN SITU HYBRIDIZATION (FISH) 360.00 88365HER 2 MORPHOMETRIC SINGLE PROBE 576.00 88368CSF/FLUIDS CELL CNT 289.30 89050CSF DIFF COUNT 103.20 89051CRYSTAL ID BODY FLUI 98.20 89060FAT STAIN FECES,URIN 25.30 89125FECAL FIBERS 34.90 89160NASAL SMEAR FOR EOSI 55.30 89190SPUTUM COLLECT AEORO 57.10 89220SEMEN ANALYSIS FERTI 200.90 89320SEMEN ANALYSIS POST 57.40 89321SPERM ANTIBODIES 747.30 89325HEP B IMM. GLOB 1CC 95.45 90371HYPERAB 1UNIT 90375ADMIN IMMUNIZ 1 VACC 72.50 90471

ADMIN IMMUNIZ 1 VACC 72.50 90471HEPATITIS B VAC 59.00 90471HEPATITIS A INJECT 78.00 90471TB TEST VOLUNTEER 0.00 90471HEPATITIS B INJ EMP 0.00 90471TB TEST EMP 0.00 90471TB SKIN TEST W/READ 0.00 90471IMMUNI ADMIN 1 VACCI 51.80 90471ADMIN IMMUNZ VACCINE 75.40 90471IMMUNIZATION ADMIN 1 48.50 90471IMMUNIZATION ADMIN 1 16.17 90471IMMUNIZ ADM EA ADDL 25.00 90472HEPATITIS A 0.00 90632TWINRIX INJECTION 95.00 90636TWIN RIX 0.00 90636FLU SHOT 0.00 90658RABAVERT(RABIES VAC) 90675INFLUENZA VACCINE 90686TYPHOID INJ OHS 89.00 90690TYPHOID 0.00 90691MMR VAC 70.00 90707MMR VACCINE 0.00 90707POLIOVIRUS VAC (IPV) 37.00 90713POLIO 0.00 90713TETANUS/DIPTH INJ 31.00 90714EMP TD INJ 18.00 90714TETANUS-DIPTH. INJ 62.40 90714TDAP 7YRS> VAC 58.00 90715EMPLOYEE TDAP 33.00 90715TDAP INJ 0.00 90715ADACEL (TDAP) 90715VARICELLA VACCINE 0.00 90716PNEUMOCOCCAL VACCINE 0.00 90732MENINGITIS VACCINE 0.00 90734IXIARO JAPANESE ENCEPHALITIS VACCINE 495.00 90738IXIARO JE VAX 0.5ML 620.00 90738HEPATITIS B 0.00 90746HEPATITIS B PED DOSE 0.00 90746HEP-B VAC ADULT 90746EVALUATION ASSESSMNT 311.00 90791INDIV THERAPY 20-30M 84.00 90832INDIV THERAPY 45-50M 158.00 90834INDIV THERAPY 75-80M 320.00 90837FAMILY THRPY W/O PT 158.00 90846FAMILY THRPY W/PT 158.00 90847GROUP THERAPY 1 HOUR 218.00 90853VISION SCREEN 0.00 92499

AUDIOMETRY PURE TONE 15.00 92552AUDIOGRAM 0.00 92552EP CARDIOPULM RESUSC 731.50 92950ER CARDIOPULM RESUSC 363.70 92950CODE BLUE MED SURG/SCU 61.40 92950TEMP TRANSCUT PACING 47.80 92953CARDIOVERSION EXTERN 260.00 92960EP CPR EXTERNAL 355.30 92971EP THROMBOLYS COR IV 943.90 92977EKG 12 LEAD 0.00 93000ELECTROCARDIOGRAM 195.75 93005EKG FOR HOLTER 0.00 93005EKG / OHS 39.75 93005EKG PRO FEE 74.00 93010STRESS TEST SUPERVISION PF 238.00 93016STRESS TEST NONREHAB 1728.75 93017STRESS TEST INTERPRETATION PF 140.75 93018HOLTER MONITOR 410.00 93225HOLTER MON SCANNING 615.25 93226HOLTER MONITOR PRO 241.75 93227ECHO COMPLETE 1293.25 93306ECHO 2D 556.50 93307ECHO 2D LTD 424.50 93308TEE 2D PROBE IMG INR 834.00 93312ECHO DOP C/PW 423.25 93320ECHO DOP C/PW LTD 333.50 93321ECHO VELOCITY COLOR 302.50 93325STRESS ECHO 588.00 93350STRESS TTE COMPLETE 2606.25 93351PHASE 2 EXERCISE W/O ECG MONITORING 47.00 93797PHASE 2 EXERCISE 85.00 93798PHASE 2 EX INITIAL 145.00 93798DUP EXTC ART BIL COM 856.50 93880DUP EXTC ART UNI LIM 409.50 93882ARTL U OR L EXT-LMTD 268.50 93922ART U OR L EXT COMP 461.75 93923ABI/ABI W STRESS 427.50 93924DUP ART LE BIL COMP 856.50 93925DUP ART LE UNI LIMIT 486.00 93926DUP ART UE BIL COMP 810.75 93930DUP ART UE UNI LIMIT 495.50 93931DUPLX VEN UE/LE BIL 827.50 93970DUP VEN UE/LE UNI LM 519.50 93971US SCROT W COLORCOMP 1468.00 93975DUPLX ABD/PEL ORG CP 796.75 93975DUPLX ABD/PEL ORG LT 501.00 93976DUPLX VASC COMPLETE 528.50 93978

DUPLX VASC LIMITED 351.50 93979VENT MGMT FIRST DAY 586.20 94002VENT MGMT SUBSEQ DAY 246.70 94003SPIROMETRY 0.00 94010INCENT SPIROM PERDAY 0.00 94010PFS SPIROMETRY BASIC 256.80 94010OHC PFT 33.00 94060PFT COMPLETE 321.40 94060PULMON FUNC SCRN PF 76.20 94060MVV 59.60 94200FLO-VOL LOOP 59.60 94375AEROSOL RX INITIAL 73.80 94640PEAK FLOW W AEROSOL 73.90 94640NONPRES INHL ACUTE A 81.10 94640CONTIN AEROSOL INITIAL FIRST HOUR 48.00 94644CONTIN AEROSOL SUBS EACH ADDL HOUR 28.20 94645CPAP/BIPAP 303.40 94660EDUCATION INHAL NEBU 48.30 94664FLUTTER INSTR INITIAL PER DAY 218.20 94664METERED DOSE INHALOR - MDI 218.20 94664CHEST PHYSIO INITIAL 279.00 94667CHEST PHYSIO SUBSEQU 39.40 94668MECHANICAL CHEST WALL OSCILLATION 90.00 94669PFT GAS DILUTION 286.00 94727DIFFUSING CAPACITY 234.00 94729PULSE OXIMETRY 31.60 94760PULSE OX MULTIPLE 87.70 94761PULSE OX OVERNIGHT 71.00 94762CAPNOGRAPHY 33.80 94770RESPIRATORY FIT TEST 42.00 94799FIT TEST EVALUATION 11.00 94799RESP FIT TEST EMP 0.00 94799RESPIRATOR FIT QUANT 0.00 94799NITRIC OXIDE EXPIRED GAS MEASURE 57.00 95012GLUCOSE MONITRG-CONT 400.00 95250MSLT OR MWT 832.00 95805SLEEP STUDY UNATTEND 306.50 95806REGULAR SLEEP STUDY 1508.00 95810SPLIT NIGHT SLP STDY 1612.00 95811NASAL CPAP TITRATION 1612.00 95811NASAL BIPAP TITRATIO 1612.00 95811PARASPINAL W/1 EXTR. 259.75 95860PARASPINAL W/2 EXTR. 166.00 95861EMG W/NERVE COND STUDY 110.25 95885EMG NERVE CONDUCTION COMPLETE 5 OR MORE 140.00 95886NERVE CONDUCTION 5-6 301.75 95909NERVE CONDUCTION 7-8 STUDIES 325.00 95910

NERVE CONDUCTION 9-10 STUDIES 405.00 95911NERVE CONDUCTION 11-12 STUDIES 286.50 95912SOMATOSENSORY UPP EX 124.25 95925SOMATOSENSORY LOW EX 124.25 95926NM JXN TEST EA NERVE 69.75 95937ELECTRICAL STIMUL 69.75 95937IV HYDRATION 31-60MN 162.50 96360IV HYDRATION 31-60MN 162.50 96360IV HYDRATION INITIAL 31M-60M 198.60 96360IV HYDRATION 31-60 42.40 96360IV HYDRATION ADDL HR 43.00 96361IV HYDRATION ADDL HR 43.00 96361IV HYDRATION ADDL HR 59.70 96361IV HYDRATION ADDL HR 41.60 96361IV INFUSION INIT HR 209.20 96365IV INFUSION INIT HR 209.20 96365IV INFUSION 1ST HOUR 198.60 96365IV INFUSION INIT 1HR 197.80 96365IV INFUSION ADDL HR 61.50 96366IV INFUSION ADDL HR 61.50 96366MED INFUSION ADDL HR 59.70 96366IV INFUSION ADD'L HR 65.90 96366IV INFUS SEQ NEW DRU 89.40 96367IV INFUS SEQ NEW DRU 89.40 96367MED INFUSION ADDL 104.80 96367IV INFUSION SEQ NEW 89.40 96367IV INFUSION CONCURRE 53.00 96368IV INFUSION CONCURRE 53.00 96368MED INFUSION CONCURR 57.20 96368IV INFUSION CONCURRE 52.00 96368INJECTION SUBQ IM 72.50 96372INJECTION SUBQ IM 72.50 96372INJECT IM NON ANTIBI 20.30 96372INJ THER PROPH DIAG 31.00 96372INJECTION SUBQ/IM 80.00 96372INJECTION SUBQ/IM 75.40 96372INJECT ANTIBIOTIC IM 48.20 96372INJECTION SUBQ/IM 44.50 96372INJECTION SUBQ IM 48.50 96372INJECTION SUBQ IM PF 16.17 96372IV PUSH INITIAL 159.80 96374IV PUSH INITIAL 159.80 96374IV PUSH INITIAL 135.70 96374IV PUSH INITIAL 182.00 96374IV PUSH SEQ NEW DRUG 62.60 96375IV PUSH SEQ NEW DRUG 62.60 96375IV PUSH ADD'L DRUG 55.60 96375

IV PUSH SEQUENT NEW 60.30 96375IV PUSH SEQ SAME DRU 38.00 96376IV PUSH SEQ SAME DRU 38.00 96376IV PUSH AD'L SAME DR 28.60 96376IV PUSH SEQUENT SAME 37.40 96376CHEMO SUBQ/IM NONHOR 224.20 96401CHEMO SUBQ/IM HORMON 103.40 96402CHEMO IV PUSH 368.50 96409CHEMO IV PUSH ADD'L 192.80 96411CHEMO INFUSION/1 HR 397.40 96413CHEMO INF EA ADDL HR 119.20 96415CHEMO IV INF PROLONG 396.60 96416CHEMO IV INF SEQ 1HR 205.10 96417PORTABLE PUMP MTCE 344.30 96521FLUSHES VAD 95.90 96523MLS LASER 25.00 97026MLS LASER 25.00 97026MANUAL THERAPY 88.00 97140MOMENTUM PROGRAM 30.00 97530MOMENTUM PROGRAM (3 SESSION SPECIAL) 45.00 97530MOMENTUM PROGRAM (10 SESSIONS) 250.00 97530DEBRID 1ST </=20CM2 112.50 97597EP DEBRIDE SEL SKIN 135.60 97597ER DEBRID SKIN 75.70 97597REM DEV TS WND<20 PF 127.10 97597DEBRID SLCT ADL20CM2 56.20 97598WOUND THERAPY NEG PR 19.90 97605NEG PRES WD THPY>50C 36.50 97606WND THERAPY NEG PRESSURE DISP EQUIP. <50C 75.75 97607WND THERAPY NEG PRESSURE DISP EQUIP >50C 82.00 97608COLL/HNDLG URINE SPC 0.00 99000NONDOT COC UDS COLL 0.00 99000SPECIMEN HANDLING 23.00 99001SPECIAL SHIPPING PER 64.80 99001PRE OP GLOBAL PF 0.00 99002POST OP F/U VISIT PF 0.00 99024POST OP F/U VISIT GLOBAL PF 0.00 99024EP MOD SEC EACH ADDL 49.90 99150MODERATE SEDATION INITIAL 15 MINS OF INTRASERVICE TIME 5YR> 108.00 99152EP MODERATE SEDATION >5YR 105.00 99156COLOR VISION-14 PLAT 0.00 99172EP IPECAC INDUC EMES 181.00 99175PHLEBOTOMY THERAPEUT 218.80 99195PHLEBOTOMY THERAPEUT 280.80 99195NEW PT VISIT LEVEL 1 62.70 99201OHC PHYSICAL RE EVAL 30.00 99201OHC OFFICE NEW 10MN 89.00 99201

CLINIC OFFICE NEW 10 89.00 99201NEW PT INIT EXAM 10 99.50 99201NEW PATIENT SIMPLE 79.75 99201NEW PATIENT LEVEL 1 37.40 99201OFFICE VISIT FOCUS NEW PT 81.30 99201OFFICE VISIT FOCUS NEW PT PF 52.70 99201NEW PT VISIT LEVEL 2 130.00 99202OHC PHYSICAL SIMPLE 42.00 99202OHC OFFICE NEW 20MN 123.30 99202CLINIC OFFICE NEW 20 123.30 99202NEW PT INIT EXAM 20 99.50 99202NEW PATIENT LIMITED 20MN 150.70 99202NEW PT VISIT 20MN PF 114.00 99202OFFICE VISIT LOW CMP NEW PT 152.70 99202OFFICE VISIT LOW COMP NEW PT PF 71.60 99202NEW PT VISIT LEVEL 3 194.20 99203OHC OFFICE NEW 30MN 170.90 99203CLINIC OFFICE NEW 30 170.90 99203NEW PATIENT LOW 30MN 231.30 99203OFFICE VISIT COMPLEX NEW PT 230.40 99203OFFICE VISIT COMPLEX NEW PT PF 89.50 99203NEW PT VISIT LEVEL 4 248.60 99204OHC PHYSICAL COMPLEX 65.00 99204OHC OFFICE NEW 45MN 250.00 99204CLINIC OFFICE NEW 45 250.00 99204NEW PATIENT MOD 45MN 390.20 99204NEW PT VISIT 45MN PF 262.40 99204OFFICE VISIT MR COMP NEW PT 389.50 99204OFFICE VISIT MR COMP NEW PT PF 98.40 99204NEW PT VISIT LEVEL 5 326.80 99205OHC OFFICE NEW 60MN 295.00 99205CLINIC OFFICE NEW 60 295.00 99205NEW PT INIT EXAM 60 99.50 99205NEW PATIENT COMP 60MN 507.45 99205NEW PT VISIT 60MN PF 380.00 99205NURSING ASSESS/EDUCA 35.50 99211EST PT VISIT LEVEL 1 37.60 99211OHC OFFICE EST 5MN 37.60 99211CLINIC OFFICE EST 5 37.60 99211PFT EVALUATION 57.20 99211EST PATIENT SIMPLE 27.50 99211OTHER CLINIC 82.20 99212EST PT VISIT LEVEL 2 76.40 99212OHC OFFICE EST 10MN 79.10 99212CLINIC OFFICE EST 10 79.10 99212EST PATIENT LIMITED 10MN 75.50 99212OFFICE VISIT FOCUS EST 77.00 99212

OFFICE VISIT FOCUS EST PF 54.60 99212EST PT VISIT LEVEL 3 94.10 99213OHC OFFICE EST 15MN 108.00 99213CLINIC OFFICE EST 15 108.00 99213EST PATIENT LOW 15MN 152.65 99213EST PT 15MIN EXP PF 108.20 99213OFFICE VISIT COMPLEX EST 153.80 99213OFFICE VISIT COMPLEX EST PF 64.50 99213EST PT VISIT LEVEL 4 152.80 99214OHC OFFICE EST 25MN 155.00 99214CLINIC OFFICE EST 25 155.00 99214EST PATIENT MOD 25MN 234.15 99214RETURN EXTEND PRO 25 92.00 99214EST PT VISIT 25MN PF 208.90 99214OFFICE VISIT MR COMPLEX 236.90 99214OFFICE VISIT MR COMPLEX PF 83.40 99214EST PT VISIT LEVEL 5 224.00 99215OHC OFFICE EST 40MN 224.80 99215CLINIC OFFICE EST 40 244.80 99215RET PT COMPLEX EXAM 216.00 99215EST PATIENT COMP 40MN 331.75 99215OBS DISCHARGE 182.70 99217OBSERV INITIAL DETAI 159.10 99218OBSERV INIT COMP MOD 225.60 99219OBSERV INIT CMP HIGH 486.80 99220INITIAL IP H&P LOW 197.40 99221INITIAL IP H&P MODER 270.20 99222INITIAL IP H&P HIGH 577.40 99223SUBSEQ PROBLEM LOW OBS 120.60 99224PAIN F/U OBS 120.60 99224OBS VISIT MODER 77.80 99225OBS VISIT HIGH 145.50 99226SUBSEQ PROBLEM LOW (FOCUSED) 104.10 99231SUBSEQ PROBLEM MOD (EXPANDED) 141.20 99232SUBSEQ PROBLEM HIGH (DETAILED) 199.90 99233OBS/IP ADM DSCH LOW 298.60 99234OBS/IP ADM DSCH MOD 392.50 99235OBS/IP ADM DSCH HIGH 522.90 99236DISCHARGE DAY 30 MINUTES OR LESS 179.20 99238DISCHARGE DAY >30MIN IP 322.50 99239CONSULT NEW/EST 15 149.25 99241OP CONSULT LEVEL 1 149.25 99241OHC PHYS CMPLX W CC 90.00 99242OHC VISIT COORD CARE 204.00 99242CONSULT NEW/EST 30 149.25 99242OP CONSULT LEVEL 2 149.25 99242CONSULT NEW/EST 40 149.25 99243

OP CONSULT LEVEL 3 149.25 99243CONSULT NEW/EST 60 216.00 99244OP CONSULT LEVEL 4 216.00 99244CONSULT NEW/EST 80 216.00 99245OP CONSULT LEVEL 5 216.00 99245INIT IP CONSULT 20 54.50 99251IP CONSULT 20MNS 314.25 99251INIT IP CONSULT 40 97.50 99252INIT IP CONSULT 55 119.25 99253INIT IP CONSULT 80 140.25 99254INIT IP CONSULT 110 162.25 99255CRITICAL CARE 30-74M 663.90 99291CRITICAL CARE ADL 30 330.90 99292ER CRIT CARE ADDL 30 343.50 99292INIT FACILITY CARE 173.30 99304NURSING FACILITY VIS 0.00 99307PHYSICIAN SVC IP 1HR 228.20 99356SMOKING/TOBACCO USE CESSATION COUNSELING VISIT 3-10MN 37.50 99406CATH PLACEMENT GROSH 2977.60 00532,QZANESTH CAT/MRI SCAN 541.90 01922,QZBURN EXC DEBRID <4% 124.40 01951,QZINCOMP ABORT PROC PF 113.50 01965,QZI&D ABSCESS SIMPL PF 293.90 10060,26I&D ABCS CMP MLTP PF 428.50 10061,26I&D HEMATOMA 375.20 10140,26DEBRIDEMENT BONE PF 805.60 11044,26DEBD SK SBQ AD 20 PF 51.40 11045,26BIOPSY SKIN SNGLE PF 138.90 11100,26SHVG LESN .6/1 CM PF 193.40 11306,26EXC BENIGN LESION .5 291.60 11400,26EXC BENIGN LES3-4 PF 523.80 11404,26EXC BENIGN L >4.0 PF 776.90 11406,26EXC BENG LES .5CM PF 278.70 11420,26EXC LES .6/1.0CM PF 376.10 11421,26EXC LES 1.1/2.0CM PF 461.80 11422,26EXC LES 2.1/3.0CM PF 521.50 11423,26EXC MALIGNANT LESION 1.1/2CM PF 449.00 11602,26DEBRIDEMENT NAIL PF 50.00 11720,26DEBRID NAIL>5 PF 230.90 11721,26EXCISION OF NAIL 615.20 11750,26INJ INTRALESION<8 PF 113.20 11900,26WND REPAR 2.6 7.5 PF 634.20 12032,26WND REP 2.6CM/7.5CM 634.20 12042,26SKIN TISSUE REARG PF 1458.20 14040,26DRSG/DEBD BURN <5%PF 214.20 16020,26CHEM CAUT GRN TIS PF 85.20 17250,26PUNC ASP CY BR EA PF 75.00 19001,26

BIOPSY BREST 1 LS PF 359.75 19081,26BIOPSY BREAST ADL PF 249.50 19082,26PL BREST WIRE 1LS PF 156.00 19281,26PL BREST WIRE ADL PF 75.00 19282,26INJ CARPAL TUNNEL PF 256.90 20526,26INJ SNGL TENDON PF 179.10 20550,26ARTHR ASPIR SM JT PF 176.80 20600,26ARTHR INTMD JT/BR PF 189.25 20605,26INJ ARTHROG ELBOW PF 316.25 24220,26INJ ARTHROG WRIST PF 347.25 25246,26INJ ARTHROG HIP PF 353.50 27093,26SI JOINT INJ PRO FEE BILATERAL 727.20 27096,50,QZSI JOINT INJ PF 363.60 27096,QZI&D LEG OR ANKLE 1372.80 27603,26INJ ARTHROG ANKLE PF 243.25 27648,26REV LOWER LEG TENDON 578.00 27685,26OPN TX DST FB FRC PF 2242.10 27792,26FASCIOTOMY FT TOE PF 1157.00 28008,26REM NEUROMA FT PF 1248.10 28080,26EXC LESION TNDN FOOT 1185.60 28090,26EXC BONE CYST/TUMOR 1477.60 28104,26PART REM METATARS PF 1102.70 28110,26METATARSAL PR REM PF 517.70 28110,26OSTECTOMY 1ST META 1541.30 28111,26OSECTOMY METATARS PF 1214.00 28112,26OSTECTOMY COMP EXC 5 1969.80 28113,26OSTECTOMY ALL META 3889.60 28114,26REMOVAL HEEL SPUR PF 1382.50 28119,26PRTL EXC MET BONE PF 1925.70 28122,26REMOV FOOT BONE PF 1925.70 28122,26PRTL EXC PHALANX PF 1370.80 28124,26HEMIPHALANG JNT EXC 1241.80 28160,26REM FB FOOT DEEP PF 1241.20 28192,26REM FB FOOT SUBQ PF 1546.70 28193,26TENOTOMY TOE SNG TND 1265.60 28232,26TENOTOMY TOE SNG PF 1279.50 28232,26RELEASE OF TOE JOINT PF 405.00 28272,26REPAIR HAMMERTOE PF 1214.00 28285,26OSTECTOMY PARTIAL 1378.10 28288,26HALLUX RIGID CORR PF 2076.30 28289,26HALLUX VALGUS CORR 1556.40 28290,26PHALANX OSTEO DBL PF 2639.90 28299,26OSTEOTOMY N1 META PF 1315.60 28308,26OSTEOTOMY MULTPL PF 3127.80 28309,26SESAMOIDECTOM TOE PF 1245.30 28315,26TX METATARSAL FX PF 991.40 28485,26AMPUTATION TOE PF 1527.10 28810,26

AMPUTATION OF TOE 1294.20 28820,26APPL TL CT LEG CST P 366.20 29445,26STRAP ANKLE/FOOT PF 82.40 29540,26INTUBATION ENDO EMR 425.60 31500,QZLARYNGOSCOPY DIR OR 1051.00 31515,QZLARYNGOSCOPY FLEX OR 823.70 31575,QZLUNG BX PLAC NDL PRO 382.25 32405,26THOR ASP PIR W/IM PF 409.75 32555,26IV START 134.80 36000,QZVENIP (IV) > 3YR 166.90 36410,QZCENT VEN CATH>5Y NON 572.20 36556,QZCENT VENOUS CATH5+YR 1047.00 36558,QZINS PICC AGE 5+ PF 347.25 36569,26INSERT PICC >5 YR 457.50 36569,QZREPAIR TNLD CV CATH 544.30 36576,QZREPLACE TNLD CV CATH 868.20 36578,QZRPLC PICC CATH W/O P 344.80 36584,QZREPLC PIC CATH W/PRT 2495.00 36585,QZDECLOT VASCULAR DEVC 90.50 36593,QZREPOS VENOUS CATH 180.60 36597,QZCNT INJ EV EX CVC PF 193.50 36598,26BLOOD GAS-ARTERIAL S 396.80 36600,QZARTERIAL CATH PERCUT 776.40 36620,QZPLACEMENT INTRAOSSEO 982.60 36680,QZID SENTINEL NODE PF 227.75 38792,26DIL ESOPHAGUS BOUGIE 358.30 43450,QZLIVER BX PRO 847.75 47000,26PARACENTESIS PF 438.25 49083,26ABD RETRO BX CT PF 604.25 49180,26PERC IMG GD VISCR PF 251.75 49405,26PERC IMG GD RETRO PF 251.75 49406,26PERC IG DR RT V/R PF 251.75 49407,26FL EX G COLON TUB PF 112.25 49465,26RENAL BIOP PR T/N PF 773.75 50200,26PROSTATE BX PRO FEE 321.80 55700,26SALINE INJ HYSTER PF 340.75 58340,26SPINAL PNCTR LUMB PF 465.50 62270,26SPINAL TAP PRO FEE 296.75 62270,26SPINAL TAP/CRNA 479.20 62270,QZEPIDURAL BLOOD PATCH 387.00 62273,QZINJ CT EPIDURL-TX PF 589.50 62310,QZINJ L/S EPIDRL-TX PF 450.70 62311,QZINJ INDWLG CATH L/S 1309.30 62319,QZINJ ANES GR OCC NRV 294.70 64405,QZILIOINGNL NRV INJ PF BILATERAL 786.00 64425,50,QZINJ LUMBAR PLEXUS 269.40 64449,QZOTH PERIPHERAL BL PF 253.80 64450,26

INJ TF EPI CT 1 LEV 617.70 64479,QZINJ TF EPI LS 1LV PF 620.90 64483,QZINJ PARAV NERVE ADDL 247.50 64484,QZINJ ANES LMBR ADL PF 408.60 64484,QZINJ CRV/THR FACET PF BILATERAL 833.60 64490,50,QZINJ CRV/THR FACET PF 416.80 64490,QZINJ CERV/THOR SEC LV BILATERAL 486.40 64491,50,QZINJ CERV/THOR SEC LV 243.20 64491,QZINJ CRV/THR 3RD LV P BILATERAL 496.00 64492,50,QZINJ CRV/THR 3RD LV P 248.00 64492,QZINJ L/S FACET PF BILATERAL 675.20 64493,50,QZINJ L/S FACET PF 337.60 64493,QZINJ L/S 2ND FACET PF BILATERAL 436.40 64494,50,QZINJ L/S 2ND FACET PF 218.20 64494,QZINJ LUMBAR/SC 3RD LV PF BILATERAL 444.80 64495,50,QZINJ LMBR/SC 3RD LV P 222.40 64495,QZINJ SPENOPAL GANGLN 251.50 64505,QZLUMBAR/THORACIC SYMPATHECTOMY 288.00 64520,QZTENS 246.50 64550,GPDESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE 87.50 64620,QZDESTRUCT OF CERV/THORACIC FACET FIRST LEVEL BILATERAL 1080.00 64633,50,QZDESTRUCT OF CERV/THORACIC FACET FIRST LEVEL 540.00 64633,QZDESTR OF CERV/THORACIC FACET (ADD ON LEVEL) BILATERAL 672.00 64634,50,QZDESTR OF CERV/THORACIC FACET (ADD ON LEVEL) 336.00 64634,QZDES PV FAC NV LS BILATERAL PF 1257.40 64635,50,QZDES PV FAC NV LS PF 628.70 64635,QZDESTRUCT NRV ADDL BILATERAL PF 393.00 64636,50,QZDESTRUCT NRV ADDL PF 196.50 64636,QZINJECTION OTHER PERIPHERAL NERVE BILATERAL 214.50 64640,50,QZINJECTION OTHER PERIPHERAL NERVE 107.25 64640,QZORBITS F.B./MRI PRO 93.50 70030,26ORBITS F.B./MRI BIL 578.25 70030,50ORBITS FB/MRI BIL PF 187.25 70030,50MANDIBLE PRTL <4V PF 28.75 70100,26MANDIBLE COMPLETE PF 93.75 70110,26MASTOIDS <3V PF 28.75 70120,26MASTOIDS COMPLETE PF 151.25 70130,26MASTOID COMPLT BI PF 302.75 70130,50MASTOIDS COMPLETE BL 1378.50 70130,50FACIAL BONES PRTL PF 32.75 70140,26FACIAL BNS MIN 3 PRO 109.25 70150,26NASAL BNS MIN 3 PRO 68.75 70160,26ORBITS MIN 4 PRO 104.50 70200,26SINUSES PARTIAL PF 27.50 70210,26SINUSES MIN 3 PRO 122.50 70220,26SELLA TURCICA PF 32.25 70240,26SKULL LESS 4 PRO 82.50 70250,26

SKULL MIN 4 PRO 124.25 70260,26TEMP MANDIBLR UNI PF 73.25 70328,26TEMP MAND BILAT PRO 137.50 70330,26MRI TMPOMANDB JT PRO 558.25 70336,26SOFT TISSUE NECK PRO 76.75 70360,26COMPL SPEECH EVAL PF 132.00 70371,26CT HEAD W/O PRO 369.25 70450,26CT HEAD WITH PRO 397.00 70460,26CT HEAD W W/O PRO 516.25 70470,26CT ORB PF IAC WO PRO 356.00 70480,26CT ORB PR IAC W PRO 434.00 70481,26CT ORB PR IAC WWO PR 562.50 70482,26CT MAXIL WO DENTL PF 130.00 70486,26CT MAX-FACIAL WO PRO 397.75 70486,26CT MAX-FACIAL W PRO 419.00 70487,26CT MAX FAC W W/O PRO 547.00 70488,26CT ST NECK W/O PRO 462.25 70490,26CT ST NECK W PRO 451.25 70491,26CT ST NECK W W/O PRO 562.50 70492,26CTA HEAD W/W/O PF 368.00 70496,26CTA NECK W/W/O PRO 595.75 70498,26MRI ORB FC NCK WO PR 689.25 70540,26MRI ORB FC NC CN PRO 388.50 70542,26MRI ORB/NCK W/W/O PR 564.75 70543,26MRI MRA HEAD W/O PRO 435.50 70544,26MRA HEAD W CONT PRO 405.00 70545,26MRI MRA HEAD WWO PRO 597.50 70546,26MRI MRA NECK W/O PRO 342.00 70547,26MRI MRA NECK WWO PRO 597.50 70549,26MRI BRAIN W/BR ST PR 602.00 70551,26MRI BRAIN W/CONT PRO 745.25 70552,26MRI BRAIN W/W/O PRO 898.00 70553,26CHEST 2V FR/LT OB PF 60.25 71022,26CHEST 2V W/FLUORO PF 62.50 71023,26CHEST DECUB PRO 57.75 71035,26CHEST PA 1 VIEW PRO 67.00 71045,26CHEST PA & LAT PRO 85.00 71046,26CHEST 3V W AP LRD PRO 114.75 71047,26CHEST 4 VIEW PRO 140.50 71048,26RIBS 2V UNIL PRO 95.50 71100,26RIBS UNI MN 3V C PRO 111.25 71101,26RIBS 3V BIL PRO 106.50 71110,26RIBS BIL MN 4V CX PR 140.50 71111,26STERNUM MIN 2V PRO 85.00 71120,26STERNOCLAV JT 3V PRO 67.75 71130,26CT CHEST W/O PRO 434.50 71250,26CT CHEST W PRO 486.75 71260,26

CT CHEST W W/O PRO 620.00 71270,26CTA CHEST W/W/O PF 399.25 71275,26MRI CHEST W/O PRO 296.50 71550,26MRI CHEST W/CONT PRO 432.00 71551,26MRI CHEST W W/O PRO 564.25 71552,26MRA CHEST W/W/O PF 365.50 71555,26SPINE SINGLE VW PRO 71.25 72020,26CERVICAL 2-3 VW PRO 92.50 72040,26CERVICAL MIN 4V PRO 126.50 72050,26CERV COMP W FL/EX PR 151.50 72052,26SPINE THORACIC 2V PR 88.75 72070,26T SPINE W/SWIMMER PR 104.00 72072,26T SPINE 4V PF 45.00 72074,26THORACOLUMBR AP/L PR 88.25 72080,26SCOLIOSIS 1V PF 113.25 72081,26SCOLIOSIS 2-3V PF 124.25 72082,26SCOLIOSIS 4-5V PF 139.25 72083,26SCOLIOSIS 6V PF 155.00 72084,26L SPINE 2-3 V PRO 90.25 72100,26L SPINE MIN 4V PRO 132.50 72110,26SPINE LUMBSC BNDG PR 151.50 72114,26SPINE LUM BND 4V PRO 121.25 72120,26CT C SPINE W/O PRO 462.25 72125,26CT C SPINE W PRO 475.75 72126,26CT C SPINE W W/O PRO 560.50 72127,26CT T SPINE W/O PRO 448.50 72128,26CT T SPINE W PRO 188.25 72129,26CT T SPINE W/W/O PF 264.25 72130,26CT L-SPINE W/O PRO 462.25 72131,26CT L-SPINE W PRO 245.25 72132,26CT L-SPINE W W/O PRO 281.50 72133,26MRI CERV SPINE PRO 613.25 72141,26MRI CRV SPNE CON PRO 707.00 72142,26MRI THORACIC SPN PRO 591.50 72146,26MRI THORC SPN CNT PR 606.00 72147,26MRI LUMBAR SPINE PRO 833.75 72148,26MRI LMBR SPN CNT PRO 665.50 72149,26MRI C-SPINE W W/O PR 725.00 72156,26MRI THRC SP W W/O PR 914.00 72157,26MRI LMBR SP W W/O PR 866.50 72158,26PELVIS 1V PRO 77.00 72170,26PELVIS MIN 3V PRO 97.75 72190,26CT PELVIS W/O PRO 438.00 72192,26CT PELVIS W PRO 473.00 72193,26CT PELVIS W W/O PRO 511.50 72194,26MRI PELVIS W/O PRO 413.50 72195,26MRI PELVIS W/W/O 564.75 72197,26

MRA PELVIS W/O CT PF 412.25 72198,26SI JOINTS <3V PF 27.50 72200,26SI JOINTS MN 3V PRO 104.00 72202,26SACR&COCCYX MN 2V PR 81.00 72220,26CT EPIDUROGRAPHY PF 204.25 72275,26CLAVICLE 2V PRO 82.00 73000,26CLAVICLE COMP/BIL 799.25 73000,50CLAVICLE COMP/BIL PF 163.75 73000,50SCAPULA MIN 2V PRO 86.25 73010,26SCAPULA MIN 2V/BIL 799.25 73010,50SCAPULA MIN 2V/BI PF 172.75 73010,50SHOULDER 1V PRO 64.75 73020,26SHOULDER 1V/BIL 634.50 73020,50SHOULDER 1V/BIL PF 129.50 73020,50SHOULDER MN 2V PRO 93.50 73030,26SHOULDER 2V/BIL 1035.00 73030,50SHOULDER 2V/BIL PF 187.25 73030,50ARTHROGRAM SLDR PRO 222.25 73040,26AC JOINTS COMP PRO 85.00 73050,26HUMERUS MIN 2V PRO 77.75 73060,26HUMERUS MIN 2V/BIL 981.25 73060,50HUMERUS MIN 2V/BI PF 155.50 73060,50ELBOW 2V PRO 61.25 73070,26ELBOW 2V/BIL 594.50 73070,50ELBOW 2V/BIL PF 122.75 73070,50ELBOW MIN 3V PRO 77.75 73080,26ELBOW MIN 3 VIEW/BIL 799.25 73080,50ELBOW MIN 3V/BIL PRO 155.50 73080,50ARTHROGRAM ELBOW PF 110.25 73085,26ARTHROGR ELB/BIL 1272.75 73085,50ARTHROGR ELB/BIL PF 220.50 73085,50FOREARM 2V PRO 62.25 73090,26FOREARM 2V/BIL 885.25 73090,50FOREARM 2V/BIL PF 124.25 73090,50UP EXT INFANT 2V PRO 64.75 73092,26UP EXT INF 2V/BIL 651.00 73092,50UP EXT INF 2V/BIL PF 129.50 73092,50WRIST 2V PRO 55.75 73100,26WRIST 2V/BIL 668.75 73100,50WRIST 2V/BIL PF 111.25 73100,50WRIST MIN 3V PRO 67.75 73110,26WRIST MIN 3V/BIL 786.50 73110,50WRIST MIN 3V/BIL PF 135.75 73110,50ATHROGR WRST/BIL 963.50 73115,50HAND 2V PRO 64.50 73120,26HAND 2V/BIL 776.50 73120,50HAND 2V/BIL PF 129.00 73120,50

HAND MIN 3V PRO 75.25 73130,26HAND MIN 3V/BIL 1035.00 73130,50HAND MIN 3V/BIL PF 150.25 73130,50FINGER MIN 2V PRO 53.00 73140,26FINGER MIN 2V/BIL 690.00 73140,50FINGER MIN 2V/BIL PF 106.00 73140,50CT UP EXT W/O PRO 365.50 73200,26CT UP EXT WO/BIL 4520.00 73200,50CT UP EXT WO/BIL PF 731.00 73200,50CT UP EXT W PF 245.25 73201,26CT UP EXT W/BIL 5354.00 73201,50CT UP EXT W/BIL PF 490.25 73201,50CT UP EXT W W/O PF 362.50 73202,26CT UP EXT W/WO/BIL 6406.00 73202,50CT UP EXT W/WO/BI PF 725.00 73202,50CTA UPP EXT W/W/O PF 384.50 73206,26MRI UP EXT W/O PRO 351.50 73218,26MRI UP EXT WO/BIL 4041.00 73218,50MRI UP EXT WO/BIL PF 703.00 73218,50MRI UP EXT W/CNTR PF 376.25 73219,26MRI UP EXT W/CON BIL 4928.00 73219,50MRI UP EXT W BIL PF 752.50 73219,50MRI UPP EXT W/W/O PF 514.75 73220,26MRI UP EXT W/WO/BIL 5816.00 73220,50MRI UP EXT WWO/BI PF 1029.50 73220,50MRI UP EXT JT W/O PR 575.50 73221,26MRI UP EXT JNT WO/BI 4041.00 73221,50MRI UP EX JT WO/B PF 1150.75 73221,50MRI UP EXT JT W PRO 388.50 73222,26MRI JNT UP EXT W/C B 4928.00 73222,50MRI JNT UP EX W B PF 777.00 73222,50MRI JNT UP EX WWO PF 490.50 73223,26MRI JNT UP EXT WWO B 5816.00 73223,50MRI JT U/EX WWO B PF 981.25 73223,50HIP UNI W/PELV 1V PR 59.50 73501,26HIP UNI W/PLV 2-3V P 81.00 73502,26HIP UNI W/PL MN4V PF 95.75 73503,26HIP BIL W/PL 3-4V PF 134.75 73522,26HIP BIL W/PLV 5V PF 145.00 73523,26ARTHROGRAM HIP PF 186.25 73525,26FEMUR 1V PF 64.75 73551,26FEMUR 1V BIL 759.25 73551,50FEMUR 1V BIL PF 129.50 73551,50FEMUR 2V PRO 75.25 73552,26FEMUR 2V/BIL 842.50 73552,50FEMUR 2V/BIL PRO 150.25 73552,50KNEE 1 OR 2VIEW PRO 68.75 73560,26

KNEE 2V/BIL 799.25 73560,50KNEE 2V/BIL PF 137.25 73560,50KNEE 3V PRO 80.50 73562,26KNEE 3V/BIL 885.25 73562,50KNEE 3V/BIL 161.25 73562,50KNEE 4V PRO 91.00 73564,26KNEE 4V/BIL 992.75 73564,50KNEE 4V/BIL PF 182.00 73564,50KNEE BIL STD AP PRO 99.50 73565,26ARTHROGRAM KNEE PF 89.75 73580,26TIBIA FIBULA 2V PRO 75.25 73590,26TIBIA FIBULA 2V/BIL 947.00 73590,50TIBIA FIBLA 2V/BI PF 150.25 73590,50LOW EXT INFANT 2V PF 44.00 73592,26LOW EXT INF 2V/BIL 754.00 73592,50LOW EXT INF 2V/BI PF 88.00 73592,50ANKLE 2V PRO 63.50 73600,26ANKLE 2V/BIL 736.25 73600,50ANKLE 2V/BIL PF 127.00 73600,50ANKLE MIN 3V PRO 67.75 73610,26ANKLE MIN 3V/BIL 934.25 73610,50ANKLE MIN 3V/BIL PF 135.75 73610,50FOOT 2V PRO 75.25 73620,26FOOT 2V/BIL 799.25 73620,50FOOT 2V/BIL PF 150.25 73620,50FOOT MIN 3V PRO 73.25 73630,26FOOT MIN 3V/BIL 1035.00 73630,50FOOT MIN 3V/BIL PF 146.75 73630,50HEEL MIN 2V PRO 64.50 73650,26HEEL MIN 2V/BIL 799.25 73650,50HEEL MIN 2V/BIL PF 129.00 73650,50TOE MIN 2V PRO 56.00 73660,26CT LOW EXT W/O PRO 424.75 73700,26CT LOW EXT WO/BIL 4520.00 73700,50CT LOW EXT WO/BI PF 849.75 73700,50CT LOW EXT W PRO 364.00 73701,26CT LOW EXT W/BIL 5354.00 73701,50CT LOW EXT W/BIL PF 728.00 73701,50CT LOW EXT W/W/O PRO 410.75 73702,26CT LOW EXT W/WO/BIL 6406.00 73702,50CT LOW EXT WWO/BI PF 821.50 73702,50CTA LOW EXT W/W/O PF 434.00 73706,26CTA LW EXT WWO/BI PF 868.00 73706,50CTA LOW EXT W/WO/BIL 4624.00 73706,50MRI LOW EXT W/O PRO 351.50 73718,26MRI LOW EXT WO BIL 4041.00 73718,50MRI LOW EXT WO/BI PF 703.00 73718,50

MRI LOW EXT W/ PRO 388.50 73719,26MRI LOW EXT W BIL PF 777.00 73719,50MRI LOW EXT W/CON BI 4928.00 73719,50MRI LOW EXT WWO PRO 624.50 73720,26MRI LOW EXT W/WO BIL 5816.00 73720,50MRI LOW EXT WWO B PF 1249.00 73720,50MRI LOW EXT JT WO PR 575.50 73721,26MRI LOW EXT JNT WO B 4041.00 73721,50MRI LW EX JT WO B PF 1150.75 73721,50MRI JNT LOW EXT W PF 327.00 73722,26MRI JNT LE W/CON BIL 4928.00 73722,50MRI JNT LE W BIL PF 654.25 73722,50MRI JT LW EXT WWO PR 564.75 73723,26MRI JNT LE W/WO BIL 5816.00 73723,50MRI JNT LE WWO BI PF 1129.50 73723,50MRA LOWER EXT W/O PR 567.00 73725,26ABD/KUB AP BIL 1035.00 74000,50ABD/KUB AP BIL PF 152.25 74000,50ABDOMEN 1 VIEW PRO 76.25 74018,26ABD FL/UP/DECUB PRO 102.75 74019,26ABD 3-4 VIEW PRO FEE 95.00 74021,26ACUTE ABD COMP PRO 142.50 74022,26CT ABDOMEN W/O PRO 425.50 74150,26CT ABDOMEN W PRO 507.25 74160,26CT ABDOMEN W W/O PRO 604.25 74170,26CTA ABD PLV W/W/O PF 676.00 74174,26CTA ABD W/W/O PRO 411.50 74175,26CT ABD PELVIS W/O PF 600.25 74176,26CT ABD PELVIS W PF 590.00 74177,26CT ABD PEL W/W/O PF 743.75 74178,26MRI ABDOMEN W/O PRO 622.25 74181,26MRI ABDOMEN W/W/O PR 613.25 74183,26MRA ABDOMEN W/ PRO 752.00 74185,26ESOPHAGUS PRO 169.00 74220,26SWALLOW FNCT CNRA PR 200.75 74230,26UPPER GI W/O KUB PRO 221.00 74240,26UPPER GI W KUB PRO 227.50 74241,26UPPER GI W/SM BWL PR 286.75 74245,26UPPER GI W AIR PRO 257.75 74246,26UPR GI AIR W KUB PRO 268.75 74247,26UPR GI AIR/SM BWL PR 371.50 74249,26SMALL BOWEL SER PRO 184.25 74250,26CT COLONOGRPHY WO PF 499.25 74261,26CT COLONGRPHY WWO PF 520.00 74262,26CT COLONOGRPHY SC PF 486.75 74263,26COLON (BE) PRO 280.00 74270,26COLON W/AIR CONT PRO 340.00 74280,26

INTER OP CHOLANGI PR 141.00 74300,26IV PYELOGRAM PRO 190.75 74410,26IV PYELOGRM W/TOM PR 190.75 74415,26CYSTOGRAM PRO 126.00 74430,26URETHROGRAM VDG PRO 130.25 74455,26HYSTEROSALPINGOGRAM PF 57.00 74740,26CT CORONARY CALCIUM SCORE PF 87.00 75571,26CTA AORTA/RUNOFF PF 698.50 75635,26SHUNTOGRAM PRO 130.75 75809,26VEIN ARM/LEG UNIL PF 206.75 75820,26VEIN ARM/LEG BIL PF 310.25 75822,26VENOGRAPHY CAVAL PF 415.25 75827,26FLUOROSCOPY <1HR PRO 141.00 76000,26FLUORO UP TO 1 HOUR 376.75 76000,59FISTULA STUDY PF 112.50 76080,26XRY MAMMO SURG SP PR 99.50 76098,26TOMOGRAM (6CUTS) PF 113.50 76100,26CT/MR/US 3D RECO PRO 88.00 76376,26US THYROID NECK PRO 238.00 76536,26US CHEST PL EFF PRO 273.00 76604,26US BREAST EA BRST PF 161.50 76641,26US BREAST LTD EA PF 150.50 76642,26US ABDOMEN COMP PRO 320.00 76700,26US RT UPPER QUAD PRO 240.00 76705,26ULTRASOUND AAA SC PF 312.00 76706,26US RETRO/REN/AO/C PR 286.25 76770,26US RETR/REN/AO/LT PR 219.00 76775,26US SPINE PRO 184.20 76800,26US FETAL 1ST TRI PRO 248.50 76801,26US FETAL 1 TRI AD PR 221.00 76802,26US FETAL >14 WKS PRO 279.25 76805,26US FETAL>14WK ADL PR 357.75 76810,26US FETAL LTD PRO 225.75 76815,26US FETAL FU PRO 221.00 76816,26US TRANSVAG FETAL PR 248.50 76817,26US BPP W/NST PRO 165.00 76818,26US BPP W/O NST PF 120.00 76819,26US TRNSVAL PELVIS PR 298.25 76830,26SONOHYSTEROGRAPHY PF 349.75 76831,26US PELVIS PRO 277.00 76856,26US PELVIS LTD PRO 78.25 76857,26US SCROTUM PRO 264.00 76870,26US EXT NON VAS CM PF 78.25 76881,26US EXT NON VAS LTD P 55.00 76882,26US INFANT HIPS DYNPF 332.75 76885,26US INFANT HIPS ST PF 64.50 76886,26US VASCULAR ACCESS 106.20 76937,26,QZ

US GUID CYST ASP PRO 386.50 76942,26FLUORO GUIDE CVC PF 407.75 77001,26FL GUID NEEDLE PL PF 109.75 77002,26FLUORO GUID INJ PF 141.40 77002,26,QZFLOURO GUID LMBR PF 244.00 77003,26FLOURO GUID SPINE PF 139.60 77003,26,QZCT GUID NDL PLC PF 235.00 77012,26CAD DIAG MAMMO PF 29.50 77051,26CAD SCREEN MAMMO PF 29.50 77052,26MAMMOGRAM UNILAT PRO 153.75 77065,26MAMMOGRAM BILAT PRO 187.50 77066,26MAMMOGRAM SCREEN PRO 119.00 77067,26MAMMO SCREEN UNILAT 130.00 77067,52BONE AGE STUDY PF 67.75 77072,26BONE LENGTH STUDY PF 92.00 77073,26BONE SURVEY LMTD PF 93.00 77074,26BONE SURVEY COMP PRO 222.75 77075,26BONE SURVY INFANT PF 134.00 77076,26CT BONE MIN DENS PF 144.00 77078,26CT BONE MIN DENS EMPLOYEE PF 0.00 77078,26DEXA (BONE DEN) PRO 144.00 77080,26THYROID UPTK S M PF 56.25 78012,26THYROID IMAG FLOW PF 106.00 78013,26THYROID IMG UPTK PF 154.25 78014,26PARATHYROID IMAG PF 187.00 78070,26PARATHY IMG SPECT PF 125.75 78071,26SENTINEL NODE IMG PF 242.00 78195,26LIVER/SPLEEN SCN PRO 278.75 78215,26HEPATOBIL W/O CCK PF 160.75 78226,26HEPATOBIL W CCK PF 232.50 78227,26GASTRIC EMPTYG ST PF 311.50 78264,26GASTRIC EMP W/SB PF 151.00 78265,26ACUTE GI BLD IMG PRO 337.00 78278,26INTESTIN IMG MCKL PF 183.25 78290,26BONE JNT IMG LTD PRO 224.75 78300,26BONE JNT IMG MLT PRO 291.50 78305,26BONE JT IMG WH BD PR 321.50 78306,26BONE JT IMG 3 PH PRO 317.25 78315,26BONE JOINT SPEC PRO 395.25 78320,26MYO PRF IMG SP RT PF 661.75 78451,26MYO PERF IMG MULT PF 851.00 78452,26CARD BLD PL EF MG PR 425.50 78472,26PUL PERF IMAG PAR PF 172.50 78580,26PUL VENT&PERF IMG PF 225.00 78582,26BRAIN IMAG SPECT PRO 180.00 78607,26KIDNEY IMG W FUNC PF 259.00 78707,26KIDNEY IMG FL PHM PF 320.00 78708,26

TESTICULR IMG FLW PF 199.75 78761,26RADNUC LOC TUMOR PRO 301.75 78800,26RADNUC LOC TMR SP PF 240.75 78803,26RADNUC LOCAL ABS PRO 324.75 78805,26RADIONC LC ABS WB PF 245.25 78806,26GLUCOSE FSA APPV MON 40.60 82962,QWHEMOGLOBIN A1C 78.20 83036,QWRAPID STREP 19.80 87880,QWSPEECH LANGUAGE RX 301.75 92507,GNEVAL SPEECH FLUENCY 174.00 92521,GNEVAL SPEECH SND PROD 141.75 92522,GNEVAL SPEECH SND LANG 293.75 92523,GNBEHAV QUAL VOIC REAS 148.25 92524,GNTREATMNT OF SWALLOWI 278.25 92526,GNEVAL SPEECH DEV 1HR 413.50 92607,GNEVAL SPEECH DEV ADDL 170.75 92608,GNSPCHGEN DEV PROG/USE 319.75 92609,GNTRAIN SPEECH DEVICE 358.25 92609,GNEVAL OF SWALLOWING 373.00 92610,GNEVAL MOD BARIUM SWAL 354.50 92611,GNPHASE 3 EXERCISE 6.00 93797,GYDUPLX EXTC ART B PRO 404.75 93880,26DUPLX EXT ART U PRO 198.75 93882,26ARTL U L EXT LMT PRO 271.00 93922,26ARTL U OR LE EXT PRO 254.50 93923,26ABI/ABI W STRESS PF 78.00 93924,26DUPLX ART LE BIL PRO 382.25 93925,26DUPLX ART UE BIL PRO 350.00 93930,26DUPLX VEN UELE B PRO 369.50 93970,26DUPLX VEN UELE UN PR 230.00 93971,26DUPLX ABD/PEL OR PRO 376.00 93975,26DUPLX ABD/PEL O PRO 223.25 93976,26VENT INIT MGT 1STDAY 1013.80 94002,QZAEROSOL RX SUBSEQUE 72.90 94640,76CONT GLUCOSE MNTG PF 150.00 95251,26MSLT OR MWT PF 189.25 95805,26SLEEP STUDY UNATT PF 188.75 95806,26REG SLEEP STUDY PF 574.00 95810,26SPLIT NIGHT SLEEP PF 599.00 95811,26NASAL CPAP TITRA PF 599.00 95811,26NASAL BIPAP TITRA PF 599.00 95811,26EEG RT 304.50 95816,26EEG PRO RT 135.75 95816,26PARASPINAL W/1 PRO 189.25 95860,25PARASPINAL W/2 PRO 416.50 95861,26NERVE CONDUCTION 1-2 201.25 95907,25NERVE CONDUCTION 3-4 228.50 95908,25

SOMATOSENSORY UE PF 99.50 95925,25SOMATOSENSORY LE PF 99.50 95926,25NEUROMU JUNC TEST PF 124.25 95937,25ELECTRICAL STIMUL PF 124.25 95937,25RFL/MTNCE IMPLT PUMP 233.40 95991,QZASSESMENT OF APHASIA 504.25 96105,GNDEVELOPMENTAL TSTING 377.80 96111,GPMMSE MEMORY CHECK 86.50 96116,26NEUROBEHAVIORAL EXAM 504.25 96116,GNSTAND COGN PERF HR 366.00 96125,GNSTND COGN PERF P/HR 174.75 96125,GNTRACTION MECHANICAL 192.20 97012,GPVASOPNEUMATIC DEVICE THERAPY 162.40 97016,GPPARAFFIN 144.40 97018,GOPARAFFIN 143.70 97018,GPFLUIDOTHERAPY 226.30 97022,GOFLUIDOTHERAPY 225.50 97022,GPDIATHERMY 192.20 97024,GPELECTR ATND STM/15MN 155.50 97032,GOE STIM ATND EA 15MIN 154.90 97032,GPIONTOPHORESIS/15 MIN 241.70 97033,GOIONTOPHORESIS/15 MIN 240.80 97033,GPCONTRAST BATH 15 MIN 167.60 97034,GOULTRASOUND 15 MIN 192.90 97035,GOULTRASOUND 15 MIN 192.20 97035,GPTHERA EXERCISE/15MN 218.50 97110,GOTHERAPEUT EXRC/15MIN 217.70 97110,GPNEUROMUSC REED 15MIN 197.00 97112,GONEUROMUSC REEDU 15MN 196.20 97112,GPAQUATIC THERAPY 15MN 221.70 97113,GPGAIT TRAINING/15 MIN 176.40 97116,GPMANUAL THERAPY/15 MIN 217.70 97140,GOMANUAL THERAPY-LYMPHEDEMA 15MN 217.70 97140,GPMANUAL THERAPY/15 MN 217.70 97140,GPMANUAL THERAPY-LYMPHEDEMA 15 MN 244.41 97140,GPTHERAPUTIC PROC GRP 127.80 97150,GPEVAL LOW COMPLEXITY 20 MN 476.15 97161,GPEVAL MODERATE COMPLEXITY 30 MN 595.20 97162,GPEVAL HIGH COMPLEXITY 45 MN 714.25 97163,GPEVALUATION RE-EVAL 247.30 97164,GPOT EVAL LOW COMPLEXITY 476.15 97165,GOOT EVAL MODERATE COMPLEXITY 595.20 97166,GOOT EVAL HIGH COMPLEXITY 714.25 97167,GOOCCUP THER REEVAL 248.20 97168,GOTHERAPEUT ACTIV 15MN 185.10 97530,GOTHERAPEUT ACTV/15MIN 204.50 97530,GPSENS INTEGR PER 15MN 172.80 97533,GO

SENS INTEGR PER 15MN 172.20 97533,GPHOME PROGRAM/15 MIN 183.20 97535,GOSELF CARE/HOME 15MIN 181.40 97535,GOSELF CARE/HOME MGT15 180.60 97535,GPCOM WORK TRAIN/15MIN 169.60 97537,GOCOM WORK TRAIN/15MIN 169.00 97537,GPWHEELCHAIR MGT 15MIN 175.70 97542,GOWHEELCHAIR MGT 15MIN 174.90 97542,GPWORK CONDITION 2 HRS 852.60 97545,GOWORK CONDITION 2 HRS 849.40 97545,GPWORK CONDITION ADDL HR 199.00 97546,GOWORK COND ECH ADL HR 314.50 97546,GPDEBRID SKIN FULL PF 94.70 97597,26REM DV TX WND A20 PF 102.90 97598,26ST PERFORM TEST/15MN 151.50 97750,GNOT PERFORM TEST/15MN 199.30 97750,GOPT PERFORM TEST/15MN 198.50 97750,GPORTH MGMT TRAINING, INITIAL 15MIN 218.50 97760,GOORTHO MGMT TRAINING, INITIAL 15MN 217.70 97760,GPPROSTHETIC FIT 15MIN 200.20 97761,GOPROST TRAINING, INITIAL 15MIN 210.00 97761,GPORTHO PROSTHETIC USE EACH 15 MIN 172.80 97763,GOORTHO/PROS MGMT TRAIN, SUBS 15 MIN 141.00 97763,GPPOST OP F/U VISIT PF 0.00 99024,25ANES FOR PT EXT AGE 0.00 99100,QZANES COMP BY HYPOTEN 0.00 99135,QZANES FOR EMERGENCY 0.00 99140,QZNEW PT INIT 10 PF 74.50 99201,25NEW PT LEVEL 1 PF 53.90 99201,25NEW PATIENT SIMPLE 10 PRO FEE 76.60 99201,25NEW PT VISIT 10MN PF 54.80 99201,26NEW PATIENT LEVEL 2 45.80 99202,25NEW PT INIT 20 PF 155.50 99202,25NEW PT EXPANDED PF 123.90 99202,25NEW PATIENT LIMITED 20MN PRO FEE 145.40 99202,25NEW PATIENT LEVEL 3 60.30 99203,25NEW PT INIT 30 PF 260.75 99203,25NEW PT DETAILED PF 177.90 99203,25NEW PATIENT LOW 30MN PRO FEE 222.40 99203,25NEW PT VISIT 30MN PF 174.80 99203,25NEW PATIENT LEVEL 4 68.60 99204,25NEW PT INIT 45 PF 386.00 99204,25NEW PATIENT MODERATE 45MN PRO FEE 376.30 99204,25NEW PATIENT LEVEL 5 74.90 99205,25NEW PT INIT 60 PF 528.50 99205,25NEW PATIENT COMP 60MN PRO FEE 489.30 99205,25EST PATIENT LEVEL 1 25.00 99211,25

RET PT INIT EXAM 5PF 60.25 99211,25EST PT LEVEL 1 PF 22.00 99211,25EST PATIENT SIMPLE PRO FEE 26.70 99211,25EST PT VISIT 5MN PF 31.90 99211,25EST PATIENT LEVEL 2 35.40 99212,25RE PT INIT EX PRO 10 164.50 99212,25EST PT 10MIN PF 63.80 99212,25EST PATIENT LIMITED 10MN PRO FEE 72.90 99212,25EST PT VISIT 10MN PF 58.20 99212,25EST PATIENT LEVEL 3 39.50 99213,25RETURN INTERM PRO 15 66.00 99213,25EST PATIENT LOW 15MN PRO FEE 147.75 99213,25EST PT VISIT 15MN PF 77.70 99213,25EST PATIENT LEVEL 4 54.10 99214,25EST PATIENT MODERATE 25 PRO FEE 226.80 99214,25EST PT 25 MIN EXP PF 218.40 99214,26EST PATIENT LEVEL 5 68.60 99215,25COMPLEX RETURN PRO 102.00 99215,25EST PATIENT COMP 40MN PRO FEE 321.10 99215,25EST PT VISIT 40MN PF 253.30 99215,25EST PT 40MIN CMP PF 276.60 99215,26FOLLOW UP VISIT-PAIN 122.70 99231,QZSUBS HOSP CARE 25MNS 223.60 99232,QZSUBS HOSP CARE 35MNS 323.40 99233,QZOP CONSULT LEVEL 1 PRO FEE 247.00 99241,25CONSULT 15 MIN PF 76.50 99241,26CONSUL NEW/EST PRO15 247.00 99241,26OP CONSULT LEVEL 2 PRO FEE 428.75 99242,25CONSULT 30 MIN PF 153.20 99242,26CONSUL NEW/EST PRO30 428.75 99242,26OP CONSULT LEVEL 3 PRO FEE 564.00 99243,25CONSULT 40 MIN PF 206.20 99243,26CONSUL NEW/EST PRO40 564.00 99243,26OP CONSULT LEVEL 4 PRO FEE 676.00 99244,25CONSUL NEW/EST PRO60 676.00 99244,26OP CONSULT LEVEL 5 PRO FEE 901.00 99245,25CONSUL NEW/EST PRO80 901.00 99245,26IP CONSULT LEVEL 1 PRO FEE 314.25 99251,25INIT IP CONSUL PRO20 314.25 99251,26IP CONSULT LEVEL 2 PRO FEE 504.50 99252,25INIT IP CONSUL PRO40 504.50 99252,26IP CONSULT LEVEL 3 PRO FEE 560.75 99253,25INIT IP CONSUL PRO55 560.75 99253,26IP CONSULT LEVEL 4 PRO FEE 776.00 99254,25INIT IP CONSUL PRO80 776.00 99254,26IP CONSULT LEVEL 5 PRO FEE 1052.50 99255,25INIT IP CONSU PRO110 1052.50 99255,26

ER LEVEL 1 90.00 99281,25ER PHYS LEVEL 1 149.40 99281,25ER LEVEL 2 171.70 99282,25ER PHYS LEVEL 2 220.70 99282,25ER LEVEL 3 441.80 99283,25ER PHYS LEVEL 3 405.10 99283,25ER LEVEL 4 623.50 99284,25ER PHYS LEVEL 4 590.20 99284,25ER LEVEL 5 738.70 99285,25ER PHYS LEVEL 5 959.50 99285,25ER CRIT CARE 30-74MN 1481.20 99291,25EP CC 30-74MIN 1784.60 99291,25EP CRTCL CARE ADD30 513.10 99292,25PROLONGED SERVICE 1ST HOUR PRO FEE 268.90 99354,25PROLONGED SERVICE ADD'L 30MN PRO FEE 261.50 99355,25EXTENDED SERVICE 1ST HOUR PRO FEE 335.50 99358,25EXTENDED SERVICE ADD'L 30MN PRO FEE 161.20 99359,25CARDIOLYTE ISOTOPE 879.00 A9500TC 99M MDP 185.50 A9503TL-201 THALLOUS CHL 180.75 A9505TC99M PERT ISOTOPE 183.50 A9512I 123 CAPSULE 287.75 A9516CERETEC ISOTOPE 2579.75 A9521NEOTEC-TC 2505.25 A9536TC 99M MEMBRO CHOLTE 254.75 A9537TC 99M PYP ISOTOPE 263.75 A9538TC-99M PENTETATE DX 330.75 A9539TC 99 PENTETATE 25MI 183.50 A9539TC 99M MAA 181.75 A9540TC99M SULF COLL ISOT 197.25 A9541SULPHUR COLLOID FLTR 296.25 A9541TAGGED RED BLOOD CEL 190.00 A9560MAG 3 ISOTOPE 262.75 A9562TC 99M DTPA AERO 181.75 A9567TECENTRIQ 10MG 140.00 C9483RADICAVA 30 MG/100 ML BAG 1 mg, 100 mL C9493ADMIN INFLUENZA VACC 30.00 G0008ADMIN INFLUENZA VACC 30.00 G0008ADMIN PNEUMONIA VACC 31.20 G0009PNEUMOVAX G0009ADMIN PNEUMONIA VACC 30.00 G0009ADMIN PNEUMONIA VACC 30.00 G0009PSA SCREENING 217.40 G0103COLON CA-SCR BAR ENE 635.00 G0106COLON CA-SC BR EN PF 176.75 G0106,26COLON CA-SC BR EN HR 635.00 G0120COLON CA-SC BE HR PF 176.75 G0120,26

DERMABOND SKIN ADHES 67.65 G0168ER WND CLS DERMABOND 186.00 G0168MAMMO GRANT PRO FEE 40.00 G0202MAMMOGRAM EMPLOYEE PRO 0.00 G0202,26INDIVIDUAL EDUCATION 15MN 27.00 G0237INDIVIDUAL EXERCISE 15MN 30.00 G0238GROUP EXERCISE 33.00 G0239ELECTRICAL STIM UNAT 129.80 G0283,GOELECTRICAL STIM UNAT 130.60 G0283,GPCT LOW DOSE LUNG SCR 79.00 G0297CT LOW DOSE LUNG PF 20.00 G0297FECAL OCCULT SCN IMM 67.70 G0328OBSERV REG 1ST HOUR 270.00 G0378OBSERV REG 2-24 HOUR 25.00 G0378OBSERV REG ADD'L HRS 25.00 G0378OBSERV SCU 1ST HOUR 409.00 G0378OBSERV SCU 2-24 HOUR 42.00 G0378OBSERV SCU ADD'L HRS 45.00 G0378DIRECT ADMIT OBSERV 100.00 G0379DIRECT ADMIT OBSERV 100.00 G0379OBSERVATION MEDICAID 0.00 G0379PULMONARY REHAB W/EXERCISE 84.00 G0424EST PT VISIT 5 MIN 35.40 G0463EST PT VISIT 10 MIN 44.40 G0463EST PT VISIT 15 MIN 45.70 G0463EST PT VISIT 25MN 76.00 G0463EST PT VISIT 40MN 107.60 G0463NEW PT VISIT 10 MIN 41.30 G0463NEW PT VISIT 20 MIN 69.70 G0463NEW PT VISIT 30 MIN 114.00 G0463NEW PT VISIT 45MN 125.70 G0463NEW PT VISIT 60MN 152.00 G0463RET PT INIT EXAM 10 160.50 G0463RETURN INTERM EXAM15 145.75 G0463RETURN EXTEND EXAM25 232.25 G0463NEW PT INIT EXAM 30 107.00 G0463NEW PT INIT EXAM 45 96.75 G0463RET PT INIT EXAM 5 60.25 G0463HEPATITIS C ANTIBODY SCREENING 130.05 G0472DRUG SELECT TOXASSUR 130.00 G0479DRUG DEFINITIVE 8-14 130.00 G0481DRUG DEFINITIVE 22 156.00 G0483COGNITIVE TX PER 15MN 89.00 G0515,GNCOGNITIVE TX PER 15 MN 75.00 G0515,GOMOBILITY CURRENT 0.01 G8978,CH,GOMOBILITY CURRENT 0.01 G8978,CH,GPMOBILITY CURRENT 0.01 G8978,CI,GO

MOBILITY CURRENT 0.01 G8978,CI,GPMOBILITY CURRENT 0.01 G8978,CJ,GOMOBILITY CURRENT 0.01 G8978,CJ,GPMOBILITY CURRENT 0.01 G8978,CK,GOMOBILITY CURRENT 0.01 G8978,CK,GPMOBILITY CURRENT 0.01 G8978,CL,GOMOBILITY CURRENT 0.01 G8978,CL,GPMOBILITY CURRENT 0.01 G8978,CM,GOMOBILITY CURRENT 0.01 G8978,CM,GPMOBILITY CURRENT 0.01 G8978,CN,GOMOBILITY CURRENT 0.01 G8978,CN,GPMOBILITY GOAL 0.01 G8979,CH,GOMOBILITY GOAL 0.01 G8979,CH,GPMOBILTIY GOAL 0.01 G8979,CI,GOMOBILITY GOAL 0.01 G8979,CI,GPMOBILITY GOAL 0.01 G8979,CJ,GOMOBILITY GOAL 0.01 G8979,CJ,GPMOBILITY GOAL 0.01 G8979,CK,GOMOBILITY GOAL 0.01 G8979,CK,GPMOBILITY GOAL 0.01 G8979,CL,GOMOBILITY GOAL 0.01 G8979,CL,GPMOBILITY GOAL 0.01 G8979,CM,GOMOBILITY GOAL 0.01 G8979,CM,GPMOBILITY GOAL 0.01 G8979,CN,GOMOBILITY GOAL 0.01 G8979,CN,GPMOBILITY D/C 0.01 G8980,CH,GOMOBILITY D/C 0.01 G8980,CH,GPMOBILITY D/C 0.01 G8980,CI,GOMOBILITY D/C 0.01 G8980,CI,GPMOBILITY D/C 0.01 G8980,CJ,GOMOBILITY D/C 0.01 G8980,CJ,GPMOBILITY D/C 0.01 G8980,CK,GOMOBILITY D/C 0.01 G8980,CK,GPMOBILITY D/C 0.01 G8980,CL,GOMOBILITY D/C 0.01 G8980,CL,GPMOBILITY D/C 0.01 G8980,CM,GOMOBILITY D/C 0.01 G8980,CM,GPMOBILITY D/C 0.01 G8980,CN,GOMOBILITY D/C 0.01 G8980,CN,GPBODY POS CURRENT 0.01 G8981,CH,GOBODY POS CURRENT 0.01 G8981,CH,GPBODY POS CURENT 0.01 G8981,CI,GOBODY POS CURRENT 0.01 G8981,CI,GPBODY POS CURRENT 0.01 G8981,CJ,GOBODY POS CURRENT 0.01 G8981,CJ,GPBODY POS CURRENT 0.01 G8981,CK,GOBODY POS CURRENT 0.01 G8981,CK,GP

BODY POS CURRENT 0.01 G8981,CL,GOBODY POS CURRENT 0.01 G8981,CL,GPBODY POS CURRENT 0.01 G8981,CM,GOBODY POS CURRENT 0.01 G8981,CM,GPBODY POS CURRENT 0.01 G8981,CN,GOBODY POS CURRENT 0.01 G8981,CN,GPBODY POS GOAL 0.01 G8982,CH,GOBODY POS GOAL 0.01 G8982,CH,GPBODY POS GOAL 0.01 G8982,CI,GOBODY POS GOAL 0.01 G8982,CI,GPBODY POS GOAL 0.01 G8982,CJ,GOBODY POS GOAL 0.01 G8982,CJ,GPBODY POS GOAL 0.01 G8982,CK,GOBODY POS GOAL 0.01 G8982,CK,GPBODY POS GOAL 0.01 G8982,CL,GOBODY POS GOAL 0.01 G8982,CL,GPBODY POS GOAL 0.01 G8982,CM,GOBODY POS GOAL 0.01 G8982,CM,GPBODY POS GOAL 0.01 G8982,CN,GOBODY POS GOAL 0.01 G8982,CN,GPBODY POS D/C 0.01 G8983,CH,GOBODY POS D/C 0.01 G8983,CH,GPBODY POS D/C 0.01 G8983,CI,GOBODY POS D/C 0.01 G8983,CI,GPBODY POS D/C 0.01 G8983,CJ,GOBODY POS D/C 0.01 G8983,CJ,GPBODY POS D/C 0.01 G8983,CK,GOBODY POS D/C 0.01 G8983,CK,GPBODY POS D/C 0.01 G8983,CL,GOBODY POS D/C 0.01 G8983,CL,GPBODY POS D/C 0.01 G8983,CM,GOBODY POS D/C 0.01 G8983,CM,GPBODY POS D/C 0.01 G8983,CN,GOBODY POS D/C 0.01 G8983,CN,GPCARRY CURRENT 0.01 G8984,CH,GOCARRY CURRENT 0.01 G8984,CH,GPCARRY CURRENT 0.01 G8984,CI,GOCARRY CURRENT 0.01 G8984,CI,GPCARRY CURRENT 0.01 G8984,CJ,GOCARRY CURRENT 0.01 G8984,CJ,GPCARRY CURRENT 0.01 G8984,CK,GOCARRY CURRENT 0.01 G8984,CK,GPCARRY CURRENT 0.01 G8984,CL,GOCARRY CURRENT 0.01 G8984,CL,GPCARRY CURRENT 0.01 G8984,CM,GOCARRY CURRENT 0.01 G8984,CM,GPCARRY CURRENT 0.01 G8984,CN,GO

CARRY CURRENT 0.01 G8984,CN,GPCARRY GOAL 0.01 G8985,CH,GOCARRY GOAL 0.01 G8985,CH,GPCARRY GOAL 0.01 G8985,CI,GOCARRY GOAL 0.01 G8985,CI,GPCARRY GOAL 0.01 G8985,CJ,GOCARRY GOAL 0.01 G8985,CJ,GPCARRY GOAL 0.01 G8985,CK,GOCARRY GOAL 0.01 G8985,CK,GPCARRY GOAL 0.01 G8985,CL,GOCARRY GOAL 0.01 G8985,CL,GPCARRY GOAL 0.01 G8985,CM,GOCARRY GOAL 0.01 G8985,CM,GPCARRY GOAL 0.01 G8985,CN,GOCARRY GOAL 0.01 G8985,CN,GPCARRY D/C 0.01 G8986,CH,GOCARRY D/C 0.01 G8986,CH,GPCARRY D/C 0.01 G8986,CI,GOCARRY D/C 0.01 G8986,CI,GPCARRY D/C 0.01 G8986,CJ,GOCARRY D/C 0.01 G8986,CJ,GPCARRY D/C 0.01 G8986,CK,GOCARRY D/C 0.01 G8986,CK,GPCARRY D/C 0.01 G8986,CL,GOCARRY D/C 0.01 G8986,CL,GPCARRY D/C 0.01 G8986,CM,GOCARRY D/C 0.01 G8986,CM,GPCARRY D/C 0.01 G8986,CN,GOCARRY D/C 0.01 G8986,CN,GPSELF CARE CURRENT 0.01 G8987,CH,GOSELF CARE CURRENT 0.01 G8987,CH,GPSELF CARE CURRENT 0.01 G8987,CI,GOSELF CARE CURRENT 0.01 G8987,CI,GPSELF CARE CURRENT 0.01 G8987,CJ,GOSELF CARE CURRENT 0.01 G8987,CJ,GPSELF CARE CURRENT 0.01 G8987,CK,GOSELF CARE CURRENT 0.01 G8987,CK,GPSELF CARE CURRENT 0.01 G8987,CL,GOSELF CARE CURRENT 0.01 G8987,CL,GPSELF CARE CURRENT 0.01 G8987,CM,GOSELF CARE CURRENT 0.01 G8987,CM,GPSELF CARE CURRENT 0.01 G8987,CN,GOSELF CARE CURRENT 0.01 G8987,CN,GPSELF CARE GOAL 0.01 G8988,CH,GOSELF CARE GOAL 0.01 G8988,CH,GPSELF CARE GOAL 0.01 G8988,CI,GOSELF CARE GOAL 0.01 G8988,CI,GP

SELF CARE GOAL 0.01 G8988,CJ,GOSELF CARE GOAL 0.01 G8988,CJ,GPSELF CARE GOAL 0.01 G8988,CK,GOSELF CARE GOAL 0.01 G8988,CK,GPSELF CARE GOAL 0.01 G8988,CL,GOSELF CARE GOAL 0.01 G8988,CL,GPSELF CARE GOAL 0.01 G8988,CM,GOSELF CARE GOAL 0.01 G8988,CM,GPSELF CARE GOAL 0.01 G8988,CN,GOSELF CARE GOAL 0.01 G8988,CN,GPSELF CARE D/C 0.01 G8989,CH,GOSELF CARE D/C 0.01 G8989,CH,GPSELF CARE D/C 0.01 G8989,CI,GOSELF CARE D/C 0.01 G8989,CI,GPSELF CARE D/C 0.01 G8989,CJ,GOSELF CARE D/C 0.01 G8989,CJ,GPSELF CARE D/C 0.01 G8989,CK,GOSELF CARE D/C 0.01 G8989,CK,GPSELF CARE D/C 0.01 G8989,CL,GOSELF CARE D/C 0.01 G8989,CL,GPSELF CARE D/C 0.01 G8989,CM,GOSELF CARE D/C 0.01 G8989,CM,GPSELF CARE D/C 0.01 G8989,CN,GOSELF CARE D/C 0.01 G8989,CN,GPOTHER PT/OT CURRENT 0.01 G8990,CH,GOOTHER PT/OT CURRENT 0.01 G8990,CH,GPOTHER PT/OT CURRENT 0.01 G8990,CI,GOOTHER PT/OT CURRENT 0.01 G8990,CI,GPOTHER PT/OT CURRENT 0.01 G8990,CJ,GOOTHER PT/OT CURRENT 0.01 G8990,CJ,GPOTHER PT/OT CURRENT 0.01 G8990,CK,GOOTHER PT/OT CURRENT 0.01 G8990,CK,GPOTHER PT/OT CURRENT 0.01 G8990,CL,GOOTHER PT/OT CURRENT 0.01 G8990,CL,GPOTHER PT/OT CURRENT 0.01 G8990,CM,GOOTHER PT/OT CURRENT 0.01 G8990,CM,GPOTHER PT/OT CURRENT 0.01 G8990,CN,GOOTHER PT/OT CURRENT 0.01 G8990,CN,GPOTHER PT/OT GOAL 0.01 G8991,CH,GOOTHER PT/OT GOAL 0.01 G8991,CH,GPOTHER PT/OT GOAL 0.01 G8991,CI,GOOTHER PT/OT GOAL 0.01 G8991,CI,GPOTHER PT/OT GOAL 0.01 G8991,CJ,GOOTHER PT/OT GOAL 0.01 G8991,CJ,GPOTHER PT/OT GOAL 0.01 G8991,CK,GOOTHER PT/OT GOAL 0.01 G8991,CK,GPOTHER PT/OT GOAL 0.01 G8991,CL,GO

OTHER PT/OT GOAL 0.01 G8991,CL,GPOTHER PT/OT GOAL 0.01 G8991,CM,GOOTHER PT/OT GOAL 0.01 G8991,CM,GPOTHER PT/OT GOAL 0.01 G8991,CN,GOOTHER PT/OT GOAL 0.01 G8991,CN,GPOTHER PT/OT D/C 0.01 G8992,CH,GOOTHER PT/OT D/C 0.01 G8992,CH,GPOTHER PT/OT D/C 0.01 G8992,CI,GOOTHER PT/OT D/C 0.01 G8992,CI,GOOTHER PT/OT D/C 0.01 G8992,CI,GPOTHER PT/OT D/C 0.01 G8992,CJ,GPOTHER PT/OT D/C 0.01 G8992,CK,GOOTHER PT/OT D/C 0.01 G8992,CK,GPOTHER PT/OT D/C 0.01 G8992,CL,GOOTHER PT/OT D/C 0.01 G8992,CL,GPOTHER PT/OT D/C 0.01 G8992,CM,GOOTHER PT/OT D/C 0.01 G8992,CM,GPOTHER PT/OT D/C 0.01 G8992,CN,GOOTHER PT/OT D/C 0.01 G8992,CN,GPSUB PT/OT CURRENT 0.01 G8993,CH,GOSUB PT/OT CURRENT 0.01 G8993,CH,GPSUB PT/OT CURRENT 0.01 G8993,CI,GOSUB PT/OT CURRENT 0.01 G8993,CI,GPSUB PT/OT CURRENT 0.01 G8993,CJ,GOSUB PT/OT CURRENT 0.01 G8993,CJ,GPSUB PT/OT CURRENT 0.01 G8993,CK,GOSUB PT/OT CURRENT 0.01 G8993,CK,GPSUB PT/OT CURRENT 0.01 G8993,CL,GOSUB PT/OT CURRENT 0.01 G8993,CL,GPSUB PT/OT CURRENT 0.01 G8993,CM,GOSUB PT/OT CURRENT 0.01 G8993,CM,GPSUB PT/OT CURRENT 0.01 G8993,CN,GOSUB PT/OT CURRENT 0.01 G8993,CN,GPSUB PT/OT GOAL 0.01 G8994,CH,GOSUB PT/OT GOAL 0.01 G8994,CH,GPSUB PT/OT GOAL 0.01 G8994,CI,GOSUB PT/OT GOAL 0.01 G8994,CI,GPSUB PT/OT GOAL 0.01 G8994,CJ,GOSUB PT/OT GOAL 0.01 G8994,CJ,GPSUB PT/OT GOAL 0.01 G8994,CK,GOSUB PT/OT GOAL 0.01 G8994,CK,GPSUB PT/OT GOAL 0.01 G8994,CL,GOSUB PT/OT GOAL 0.01 G8994,CL,GPSUB PT/OT GOAL 0.01 G8994,CM,GOSUB PT/OT GOAL 0.01 G8994,CM,GPSUB PT/OT GOAL 0.01 G8994,CN,GOSUB PT/OT GOAL 0.01 G8994,CN,GP

SUB PT/OT D/C 0.01 G8995,CH,GOSUB PT/OT D/C 0.01 G8995,CH,GPSUB PT/OT D/C 0.01 G8995,CI,GOSUB PT/OT D/C 0.01 G8995,CI,GPSUB PT/OT D/C 0.01 G8995,CJ,GOSUB PT/OT D/C 0.01 G8995,CJ,GPSUB PT/OT D/C 0.01 G8995,CK,GOSUB PT/OT D/C 0.01 G8995,CK,GPSUB PT/OT D/C 0.01 G8995,CL,GOSUB PT/OT D/C 0.01 G8995,CL,GPSUB PT/OT D/C 0.01 G8995,CM,GOSUB PT/OT D/C 0.01 G8995,CM,GPSUB PT/OT D/C 0.01 G8995,CN,GOSUB PT/OT D/C 0.01 G8995,CN,GPSWALLOW CURRENT 0.01 G8996,CH,GNSWALLOW CURRENT 0.01 G8996,CI,GNSWALLOW CURRENT 0.01 G8996,CJ,GNSWALLOW CURRENT 0.01 G8996,CK,GNSWALLOW CURRENT 0.01 G8996,CL,GNSWALLOW CURRENT 0.01 G8996,CM,GNSWALLOW CURRENT 0.01 G8996,CN,GNSWALLOW GOAL 0.01 G8997,CH,GNSWALLOW GOAL 0.01 G8997,CI,GNSWALLOW GOAL 0.01 G8997,CJ,GNSWALLOW GOAL 0.01 G8997,CK,GNSWALLOW GOAL 0.01 G8997,CL,GNSWALLOW GOAL 0.01 G8997,CM,GNSWALLOW GOAL 0.01 G8997,CN,GNSWALLOW D/C 0.01 G8998,CH,GNSWALLOW D/C 0.01 G8998,CI,GNSWALLOW D/C 0.01 G8998,CJ,GNSWALLOW D/C 0.01 G8998,CK,GNSWALLOW D/C 0.01 G8998,CL,GNSWALLOW D/C 0.01 G8998,CM,GNSWALLOW D/C 0.01 G8998,CN,GNMOTOR SPEECH CURRENT 0.01 G8999,CH,GNMOTOR SPEECH CURRENT 0.01 G8999,CI,GNMOTOR SPEECH CURRENT 0.01 G8999,CJ,GNMOTOR SPEECH CURRENT 0.01 G8999,CK,GNMOTOR SPEECH CURRENT 0.01 G8999,CL,GNMOTOR SPEECH CURRENT 0.01 G8999,CM,GNMOTOR SPEECH CURRENT 0.01 G8999,CN,GNMOTOR SPEECH D/C 0.01 G9158,CH,GNMOTOR SPEECH D/C 0.01 G9158,CI,GNMOTOR SPEECH D/C 0.01 G9158,CJ,GNMOTOR SPEECH D/C 0.01 G9158,CK,GNMOTOR SPEECH D/C 0.01 G9158,CL,GN

MOTOR SPEECH D/C 0.01 G9158,CM,GNMOTOR SPEECH D/C 0.01 G9158,CN,GNLANG COMP CURRENT 0.01 G9159,CH,GNLANG COMP CURRENT 0.01 G9159,CI,GNLANG COMP CURRENT 0.01 G9159,CJ,GNLANG COMP CURRENT 0.01 G9159,CK,GNLANG COMP CURRENT 0.01 G9159,CL,GNLANG COMP CURRENT 0.01 G9159,CM,GNLANG COMP CURRENT 0.01 G9159,CN,GNLANG COMP GOAL 0.01 G9160,CH,GNLANG COMP GOAL 0.01 G9160,CI,GNLANG COMP GOAL 0.01 G9160,CJ,GNLANG COMP GOAL 0.01 G9160,CK,GNLANG COMP GOAL 0.01 G9160,CL,GNLANG COMP GOAL 0.01 G9160,CM,GNLANG COMP GOAL 0.01 G9160,CN,GNLANG COMP D/C 0.01 G9161,CH,GNLANG COMP D/C 0.01 G9161,CI,GNLANG COMP D/C 0.01 G9161,CJ,GNLANG COMP D/C 0.01 G9161,CK,GNLANG COMP D/C 0.01 G9161,CL,GNLANG COMP D/C 0.01 G9161,CM,GNLANG COMP D/C 0.01 G9161,CN,GNLANG EXPRESS CURRENT 0.01 G9162,CH,GNLANG EXPRESS CURRENT 0.01 G9162,CI,GNLANG EXPRESS CURRENT 0.01 G9162,CJ,GNLANG EXPRESS CURRENT 0.01 G9162,CK,GNLANG EXPRESS CURRENT 0.01 G9162,CL,GNLANG EXPRESS CURRENT 0.01 G9162,CM,GNLANG EXPRESS CURRENT 0.01 G9162,CN,GNLANG EXPRESS GOAL 0.01 G9163,CH,GNLANG EXPRESS GOAL 0.01 G9163,CI,GNLANG EXPRESS GOAL 0.01 G9163,CJ,GNLANG EXPRESS GOAL 0.01 G9163,CK,GNLANG EXPRESS GOAL 0.01 G9163,CL,GNLANG EXPRESS GOAL 0.01 G9163,CM,GNLANG EXPRESS GOAL 0.01 G9163,CN,GNLANG EXPRESS D/C 0.01 G9164,CH,GNLANG EXPRESS D/C 0.01 G9164,CI,GNLANG EXPRESS D/C 0.01 G9164,CJ,GNLANG EXPRESS D/C 0.01 G9164,CK,GNLANG EXPRESS D/C 0.01 G9164,CL,GNLANG EXPRESS D/C 0.01 G9164,CM,GNLANG EXPRESS D/C 0.01 G9164,CN,GNATTEN CURRENT 0.01 G9165,CH,GNATTEN CURRENT 0.01 G9165,CI,GNATTEN CURRENT 0.01 G9165,CJ,GN

ATTEN CURRENT 0.01 G9165,CK,GNATTEN CURRENT 0.01 G9165,CL,GNATTEN CURRENT 0.01 G9165,CM,GNATTEN CURRENT 0.01 G9165,CN,GNATTEN GOAL 0.01 G9166,CH,GNATTEN GOAL 0.01 G9166,CI,GNATTEN GOAL 0.01 G9166,CJ,GNATTEN GOAL 0.01 G9166,CK,GNATTEN GOAL 0.01 G9166,CL,GNATTEN GOAL 0.01 G9166,CM,GNATTEN GOAL 0.01 G9166,CN,GNATTEN D/C 0.01 G9167,CH,GNATTEN D/C 0.01 G9167,CI,GNATTEN D/C 0.01 G9167,CJ,GNATTEN D/C 0.01 G9167,CK,GNATTEN D/C 0.01 G9167,CL,GNATTEN D/C 0.01 G9167,CM,GNATTEN D/C 0.01 G9167,CN,GNMEMORY CURRENT 0.01 G9168,CH,GNMEMORY CURRENT 0.01 G9168,CI,GNMEMORY CURRENT 0.01 G9168,CJ,GNMEMORY CURRENT 0.01 G9168,CK,GNMEMORY CURRENT 0.01 G9168,CL,GNMEMORY CURRENT 0.01 G9168,CM,GNMEMORY CURRENT 0.01 G9168,CN,GNMEMORY GOAL 0.01 G9169,CH,GNMEMORY GOAL 0.01 G9169,CI,GNMEMORY GOAL 0.01 G9169,CJ,GNMEMORY GOAL 0.01 G9169,CK,GNMEMORY GOAL 0.01 G9169,CL,GNMEMORY GOAL 0.01 G9169,CM,GNMEMORY GOAL 0.01 G9169,CN,GNMEMORY D/C 0.01 G9170,CH,GNMEMORY D/C 0.01 G9170,CI,GNMEMORY D/C 0.01 G9170,CJ,GNMEMORY D/C 0.01 G9170,CK,GNMEMORY D/C 0.01 G9170,CL,GNMEMORY D/C 0.01 G9170,CM,GNMEMORY D/C 0.01 G9170,CN,GNVOICE CURRENT 0.01 G9171,CH,GNVOICE CURRENT 0.01 G9171,CI,GNVOICE CURRENT 0.01 G9171,CJ,GNVOICE CURRENT 0.01 G9171,CK,GNVOICE CURRENT 0.01 G9171,CL,GNVOICE CURRENT 0.01 G9171,CM,GNVOICE CURRENT 0.01 G9171,CN,GNVOICE GOAL 0.01 G9172,CH,GN

VOICE GOAL 0.01 G9172,CI,GNVOICE GOAL 0.01 G9172,CJ,GNVOICE GOAL 0.01 G9172,CK,GNVOICE GOAL 0.01 G9172,CL,GNVOICE GOAL 0.01 G9172,CM,GNVOICE GOAL 0.01 G9172,CN,GNVOICE D/C 0.01 G9173,CH,GNVOICE D/C 0.01 G9173,CI,GNVOICE D/C 0.01 G9173,CJ,GNVOICE D/C 0.01 G9173,CK,GNVOICE D/C 0.01 G9173,CL,GNVOICE D/C 0.01 G9173,CM,GNVOICE D/C 0.01 G9173,CN,GNSPEECH LANG CURRENT 0.01 G9174,CH,GNSPEECH LANG GOAL 0.01 G9174,CH,GNSPEECH LANG CURRENT 0.01 G9174,CI,GNSPEECH LANG CURRENT 0.01 G9174,CJ,GNSPEECH LANG CURRENT 0.01 G9174,CK,GNSPEECH LANG CURRENT 0.01 G9174,CL,GNSPEECH LANG CURRENT 0.01 G9174,CM,GNSPEECH LANG CURRENT 0.01 G9174,CN,GNSPEECH LANG GOAL 0.01 G9175,CI,GNSPEECH LANG GOAL 0.01 G9175,CJ,GNSPEECH LANG GOAL 0.01 G9175,CK,GNSPEECH LANG GOAL 0.01 G9175,CL,GNSPEECH LANG GOAL 0.01 G9175,CM,GNSPEECH LANG GOAL 0.01 G9175,CN,GNSPEECH LANG D/C 0.01 G9176,CH,GNSPEECH LANG D/C 0.01 G9176,CI,GNSPEECH LANG D/C 0.01 G9176,CJ,GNSPEECH LANG D/C 0.01 G9176,CK,GNSPEECH LANG D/C 0.01 G9176,CL,GNSPEECH LANG D/C 0.01 G9176,CM,GNSPEECH LANG D/C 0.01 G9176,CN,GNMOTOR SPEECH GOAL 0.01 G9186,CH,GNMOTOR SPEECH GOAL 0.01 G9186,CI,GNMOTOR SPEECH GOAL 0.01 G9186,CJ,GNMOTOR SPEECH GOAL 0.01 G9186,CK,GNMOTOR SPEECH GOAL 0.01 G9186,CL,GNMOTOR SPEECH GOAL 0.01 G9186,CM,GNMOTOR SPEECH GOAL 0.01 G9186,CN,GNORENCIA 10MG IV J0129OFIRMEV 1000/100MLIV J0131ACETADOTE 100 MG IV 5.70 J0132ZOVIRAX INJ 500MG J0133ADENOCARD IV 1MG GEN J0153PROLASTIN 10MG/ML IV 5.60 J0256

AMINOPHYLLIN IV500MG J0280CORDARONE IV 30MG(G) J0282AMPICILLIN IV 1GM J0290AMPICILLIN IV 500MG J0290UNASYN IV 3GM (GEN) J0295UNASYN IV 1.5GM (GN) J0295SUCCINYLCHOLINE INJ J0330HYDRALAZINE IV 20MG J0360ZITHROMAX IV (GEN) J0456ATROPINE 0.01MG/ML J0461ATROPINE .01MG/1ML J0461BENLYSTA 10MG/ML IV J0490DICYCLOMINE IM 10MG J0500BICILLIN LA 100000MU J0561BICILLIN LA 100000MU J0561BOTOX 200 UNIT VIAL 1 unit, 1 each J0585CALC GLUC INJ 1GM J0610LEUCOVORIN 50MG IV J0640KEFZOL-G IV 500MG J0690KEFZOL-G IV 1GM J0690cefTAZidime 2 GM VIAL 500 mcg, 1 each J0690CEFEPIME 2G J0692MEFOXIN IV 1GM (GEN) J0694cefOXitin 1 GM PIGGYBACK BAG 1 g, 1 each J0694ROCEPHIN INJ 250MG G J0696ROCEPHIN INJ 250MG G J0696ROCEPHIN INJ 250 (G) J0696ROCEPHIN INJ 250MG (G) J0696CELESTONE 3MG J0702FORTAZ INJ 500MG J0713CEFTAZIDIME 500 MG J0713CIPRO IV 200MG (GEN) J0744CIPRO 200MG IV (GEN) J0744ACTHREL 100 MCG VIAL 1 mcg, 1 each J0795CORTROSYN 0.25MG J0834DALVANCE 5MG J0875CUBICIN 1 IV (G) J0878CUBICIN 1 IV (G) J0878ARANESP 1 MCG J0881ARANESP 1 MCG 340B J0881EPOGEN 1000 UNITS J0885PROLIA 1MG INJ J0897XGEVA 1MG SQ J0897PROLIA 1 MG INJ J0897DEPO-MEDROL 40MG 1 G J1030TESTOSTERONE CYP200M J1071DEXAMETH 1MG/ML 1ML J1100

DEXAMETHASONE 1MG/ML J1100LANOXIN IV 0.5MG (G) J1160DIGIFAB 40MG IV J1162DILANTIN IV50MG/ML G 8.45 J1165HYDROMORPHONE 2MG IV J1170HYDROMORPHONE 10MG/ML J1170Dilaudid 0.5 MG/0.5 ML SYRINGE 0.5 mcg, 0.5 mL J1170HYDROmorphone 1 MG/ML CARPUJCT 1 mg, 1 mL J1170BENADRYL IV 50MG (G) J1200DRAMAMINE 50MG/ML(G) J1240DOBUTAMINE IV 250MG J1250DOPAMINE 400MG/250ML J1265DORIBAX 10MG IV 2.10 J1267INTEGRILIN 5MG/ML J1327INTEGRILIN 20MG J1327INVANZ 500MG J1335INVANZ 500 MG J1335INJECTAFER 750MG/15ML J1439INJECTAFER 750MG/15ML J1439NEUPOGEN INJ 300MCG J1442NEUPOGEN INJ 480MCG J1442NEUPOGEN INJ 480MCG J1442EMEND 1MG IV J1453GAMMA GLOBULIN 500MG J1569FLEBOGAMMA 500MG IV 78.00 J1572GENTAMYCIN 80MG J1580ISO gentamicin 120 MG/100 ML 80 mcg, 100 mL J1580SIMPONI ARIA 1MG IV J1602SIMPONI ARIA 1MG IV J1602GLUCAGON 1MG VIAL J1610GRANISETRON HCL 1MG J1626HALDOL INJ 5MG (GEN) J1630HEPARIN 10U/ML J1642HEPARIN 10U/ML-5ML J1642HEPARIN 25,000 UNITS J1644HEPARIN SOD 5000U J1644HEPARIN SOD 1000U J1644LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG J1650LOVENOX 10MG SC J1650LOVENOX 10MG J1650LOVENOX 10MG J1650A-HYDROCORT IV 100MG J1720SOLU-CORTEF 100MG IV J1720REMICADE 10MG J1745

INFED 50GM/ML J1750VENOFER 1MG J1756VENOFER 1MG J1756INDERAL INJ 1ML (GEN J1800NOVOLOG INSULIN J1815CRESEMBA 372 MG VIAL 1 mg, 1 each J1833TORADOL INJ 60MG (G) J1885KETOROLAC 15MG IV J1885LASIX IV 20MG (GEN) J1940LASIX IV 20MG (GEN) J1940LUPRON DEPOT 3.75MG J1950LUPRON DEPOT 3.75MG J1950KEPPRA 10MG/ML IV J1953LEVAQUIN 250MG INJ J1956LEVAQUIN 250MG INJ J1956LEVAQUIN 250MG INJ J1956LIDOCAINE 2% 10MG J2001ATIVAN IV 2MG/ML (G) J2060MANNITOL 25% 50ML J2150DEMEROL INJ 100MG 16.15 J2175DEMEROL INJ 25MG J2175DEMEROL INJ 50MG J2175MEROPENEM 1OOMG IV J2185MEROPENEM 100MG J2185MYCAMINE 100MG J2248VERSED 1MG/ML (GEN) J2250VERSED IV 1MG (GEN) J2250MILRINONE 5MG 16.00 J2260MORPHINE SO4 IM 4MG J2270morphine 0.5 MG/ML VIAL 5 mcg, 10 mL J2270AVELOX 100MG IV J2280NARCAN 1ML (GEN) J2310NALOXONE 1MG/ML J2310OCREVUS 300 MG/10 ML VIAL 1 mg, 10 mL J2350OCREVUS 300 MG/10 ML VIAL 1 MG, 10 ML J2350SANDOSTATIN LAR 25MC J2353SANDOSTATIN LAR 1MG J2353OCTREOTIDE 100MCG/ML J2354XOLAIR 5MG J2357XOLAIR 5MG J2357NORFLEX INJ 60MG(GEN J2360NEO-SYN INJ 1% (GEN) J2370ZOFRAN INJ 1MG (GEN) J2405AREDIA 30MG INJ J2430ALOXI 0.25MG/5ML J2469ALOXI 0.25MG/5ML J2469NEULASTA KIT 6MG J2505

NEULASTA 6MG SYRINGE J2505UDENYCA 6 MG/0.6 ML SYRINGE 6 mg, 0.6 mL J2505PENTOBARB. IM 50MG 52.00 J2515ZOSYN IV 3.375GM J2543ZOSYN 4.5GM J2543ZOSYN 2.25GM J2543PHENERGAN INJ25MG(G) J2550PITOCIN INJ 1ML (GN) J2590NEOSTIGMINE 1MG J2710REGLAN INJ 10MG (G) J2765LEXISCAN 0.4MG/5ML J2785LEXISCAN 0.4MG/5ML J2785RHOGAM IMMUNE GLOBUL J2790NAROPIN 0.5%-PER 1MG J2795FERRLECIT 12.5MG AMP J2916SOLU MEDROL 40 MG. J2920A-METHOPRED 125MG J2930SOLU MEDROL 125 MG. 72.30 J2930A-METHOPRED 125MG J2930SOLU MEDROL 500MG J2930CATHFLO 1MG/ML J2997ACTIVASE 100MG J2997CATHFLO 1MG/ML J2997FENTANYL TUBEX J3010FENTANYL 1ML J3010IMITREX INJ 6MG (GN) J3030TNKASE 1MG J3101BRETHINE INJ 1MG (G) J3105THYROGEN 1.1 MG VIAL 0.9 mcg, 1 each J3240TOBRAMYCIN 80MG J3260TOBRAMYCIN 1.2GM J3260ACTEMRA 1MG/ML IV J3262DEMADEX 10MG/ML I.V. 13.70 J3265KENALOG-G 10MG IM J3301VALIUM INJ 10MG (GN) J3360VANCOMYCIN IV 500MG J3370VANCOMYCN 500MG(1GM) J3370ENTYVIO 300 MG VIAL 1 mg, 1 each J3380THIAMINE HCL INJ. 1 J3411PYRIDOXINE INJ 100MG 14.40 J3415AQUA MEPH 1MG OB (G) J3430AQUA MEPHYTON 1MG(G) J3430MAGNESIUM SULFAT 500 J3475ZOMETA 1MG IV J3489ZOMETA 1MG IV J3489RECLAST 1MG IV J3489PRECEDEX 200MCG/50ML J3490

KCENTRA 1 UNIT J3490CINVANTI 130 MG/18 ML VIAL 130 mcg, 18 mL J3490EVENITY 210 MG DOSE-2 SYRINGES 1 ea, 1.17 mL J3490PERJETA 420MG IV J3590EUFLEXXA 20 MG/2 ML SYRINGE 1 ea, 2 mL J7323GEL-ONE 30 MG/3 ML SYRINGE 30 mcg, 3 mL J7326MEDROL MEDULES 4MG G J7509MUCOSIL 20% 1ML (GN) J7608CYTOXIN TAB 25MG (G) 8.25 J8530ADRIAMYCIN IV 10MG G J9000BCG TICE STRAIN VAC 476.20 J9031TREANDA 1MG/ML IV J9033BENDEKA 100 MG/4 ML VIAL 1 mg, 4 mL J9034AVASTIN 10MG/ML J9035BLEOMYCIN 15UNITS J9040VELCADE 0.1MG IV J9041ADCETRIS 1MG J9042PARAPLATIN IV 50MG G J9045KYPROLIS 1MG IV J9047PLATINOL 10MG J9060CYTOXIN IV 100MG (G) J9070CYTARABINE 100MG/5ML VIAL J9100DACARBAZINE 100MG IV J9130TAXOTERE 1MG J9171VEPESID IV 10MG J9181FLUDARA IV 50MG J9185FLUOROURACIL 500MG J9190GEMZAR 200MG J9201GEMZAR 200 MG J9201ZOLADEX 3.6MG SYRINGE J9202ONIVYDE 1MG J9205CAMPTOSAR 20 MG J9206INTRON-A 1MIL U 52.05 J9214LUPRON DEPOT INJ 7.5 J9217ELIGARD 7.5MG J9217ELIGARD 7.5MG J9217LUPRON DEPOT-4 MONTH KIT 7.5 mcg, 1 each J9217LUPRON DEPOT 45 MG 6MO KIT 7.5 mcg, 1 each J9217ELOXATIN 0.5MG J9263ABRAXANE 1MG IV J9264TAXOL INJ 1MG J9267KEYTRUDA 1MG J9271OPDIVO 1MG J9299GAZYVA 10 MG VL J9301ALIMTA 10MG IV J9305RITUXAN 100MG J9310TOPOTECAN HCL .1MG J9351

HERCEPTIN 10MG IV J9355VINBLASTINE 1MG 44.50 J9360VINBLASTINE 1MG/ML J9360VINCRISTINE IV 1MG J9370NAVELBINE 10MG/ML 100.35 J9390FASLODEX 25MG J9395ELBOW ORTHOSIS W/O J 773.20 L3702ELB/WR/HAND ORTH RGD 1260.50 L3763WR/HND/FG ORTH W/JT 810.80 L3806WRIST HAND FNGR ORTH 350.60 L3807WRST HAND FNGR OR RG 501.10 L3808WR/HAND ORTHO W/O JT 712.70 L3906HAND/FG ORTHO W/O JT 380.30 L3913FINGER ORTHO W/O JNT 299.30 L3933TRINITY ELITE MEDIUM 4736.30 L8699TRINITY ELITE LARGE 8504.20 L8699CRYOPRECIPITATED AHF 128.20 P9012RBC LEUKO REDUCED 426.80 P9016PLASMA FRESH FROZEN 115.40 P9017PLATLET PHERESIS 909.90 P9035CATH FOR URINE SPEC 6.20 P9612CATH FOR URINE SPEC 6.20 P9612CEREBYX 50MG PE/ML G Q2009DOXIL 10MG IV Q2049APLIGRAF EA SQ CM 172.20 Q4101EPI FIX GS-5180 18MM 520.00 Q4131EPI FIX 14MM GS-5140 780.00 Q4131EPI FIX 2X4CM GS5240 292.50 Q4131EPI FIX MESH 4X4.5CM 181.25 Q4131EPI FIX MESH 3.5X3.5 215.70 Q4131INFLECTRA 100MG VIAL Q5103DEFINITY CONTRAST 249.50 Q9957ISOSULFAN BLUE 1%INJ Q9968METHYLENE BLUE IV 1% Q9968