Item Number Description 2020 Price 99005 RETURNED CHECK FEE 35.00 99012 COLLECTION EXPENSE 29.00 232551 TUBE THORACOSTOMY INCLUDES WATER SEAL 616.00 530001 RL IGG 181.00 530002 RL IGA 181.00 530003 IGD 181.00 530004 RL IGM 181.00 533189 RL ETHYL GLUCURONIDE 277.00 699224 SUBSEQUENT OBS CARE FOCUSED 141.00 699225 SUBSEQUENT OBS CARE EXPANDED 223.00 699226 SUBSEQUENT OBS CARE DETAILED 327.00 707206 CTA UPPER EXT LT 2,984.00 2010059 DRAIN ABCESS-FAC CHG 92.00 2010060 DRAINAGE SKIN ABCESS 324.00 2010061 DRAINAGE SKIN ABCESS 527.00 2010080 DRAIN PILONIDAL CYST 258.00 2010081 I & D PILONIDAL CYST; COMPLICATED 509.00 2010120 REMOVAL OF FORG BODY SIMPLE 462.00 2010121 REMOVAL OF FRGN BODY COMP 543.00 2010140 DRNG OF HEMATOMA/FLD 527.00 2010160 PUNCT DRNG OF LESION 171.00 2011042 DEBRIDEMENT TISSUE 368.00 2011043 DEBRIDEMENT MUSCLE/FASCIA FIRST 20CM 566.00 2011200 SKIN TAG REMOVAL 193.00 2011301 SHAVE SKIN LESION TRNK 0.6-1.0 446.00 2011400 LESION REMOVAL 368.00 2011403 EXCISION OF LESION 582.00 2011406 EXCISION BNGN LESION OVER 4.0 CM 2,123.00 2011420 EXCISION OF LESION 471.00 2011443 EXCISION BNGN LESION 2.1-3.0 CM 309.00 2011600 Excision malignant lesion 0.5 cm or less 360.00 2011601 EXC LESION SKIN MALIGNANT TRUNK, ARMS, L 1,064.00 2011602 EXC LESION MAL 478.00 2011609 EXC LESION MAL-FAC CHG 181.00 2011721 NAIL DEBRIDEMENT 203.00 2011730 REMOVAL OF NAIL PLAT 264.00 2011732 AVULSION NAIL EACH ADDITIONAL 75.00 2011740 DRN BLD/UNDER NAIL 137.00 2011750 REMOVAL/NAIL BED 573.00 2011760 REPAIR OF NAIL BED 573.00 2011765 EXCISION/NAIL FLDTOE 257.00 2012001 REPAIR SPFICIAL WND 368.00 2012002 REPAIR SPFICIAL WND 471.00 2012004 REPAIR SPFICIAL WND 505.00 2012005 REPAIR SPFICIAL WND 586.00 2012006 REPAIR SPFICIAL WND 731.00 2012007 REPAIR SPFICIAL WND 942.00 2012011 REPAIR SPFICIAL WND 419.00 2012013 REPAIR SPFICIAL WND 453.00 2012014 REPAIR SPFICIAL WND 527.00 2012015 REPAIR SPFICIAL WND 505.00

2012016 REPAIR SPFICIAL WND 837.00 2012017 REPAIR SPFICIAL WND 1,068.00 2012018 REPAIR SPFICIAL WND 1,751.00 2012020 CLOSURE OF SPLIT WND 614.00 2012031 CLOSURE OF WOUND 612.00 2012032 CLOSURE OF WOUND 648.00 2012034 CLOSURE OF WOUND 794.00 2012035 CLOSURE OF WOUND 1,042.00 2012036 CLOSURE OF WOUND 1,260.00 2012037 CLOSURE OF WOUND 1,472.00 2012041 CLOSURE OF WOUND 555.00 2012042 CLOSURE OF WOUND 615.00 2012044 CLOSURE OF WOUND 786.00 2012045 CLOSURE OF WOUND 1,038.00 2012046 CLOSURE OF WOUND 1,395.00 2012047 CLOSURE OF WOUND 1,395.00 2012051 CLOSURE OF WOUND 658.00 2012052 CLOSURE OF WOUND 721.00 2012053 CLOSURE OF WOUND 991.00 2012054 CLOSURE OF WOUND 1,260.00 2012055 CLOSURE OF WOUND 1,487.00 2012056 CLOSURE OF WOUND 2,032.00 2012057 CLOSURE OF WOUND 2,111.00 2013100 REPAIR OF WND OR LSN 680.00 2013101 REPAIR OF WND OR LSN 920.00 2013120 REPAIR OF WND OR LSN 761.00 2013121 REPAIR OF WND OR LSN 1,088.00 2013122 REPAIR WOUND EACH 5 CM 372.00 2013131 REPAIR OF WND OR LSN 863.00 2013132 REPAIR OF WND OR LSN 1,239.00 2013133 RECONSTRUCTIVE PROC, COMP, ADD'L < = 5CM 864.00 2013151 REPAIR OF WND OR LSN 1,088.00 2013152 REPAIR OF WND OR LSN 1,783.00 2016000 INITIAL TRMT OF BURN 225.00 2016010 TREATMENT OF BURNS 221.00 2016015 TREATMENT OF BURNS 866.00 2016020 TREATMENTS OF BURNS 180.00 2016021 DRESSING OF BURNS 172.00 2016025 TREATMENTS OF BURNS 422.00 2016030 DRSG/DEBRIDEMENT PART THICKNESS BURNS 553.00 2016035 INCISION OF BRN SCAB 1,213.00 2017000 DEST BENIGN LESION 264.00 2020520 REMOVAL OF FGN BODY 1,118.00 2020525 REMOVAL OF FGN BODY 1,120.00 2020550 INJ TDN/LGMT/CYST 264.00 2020552 TRIGGER POINT INJECTION 558.00 2020553 TRIGGER POINT INJECTION 3 OR MORE MUSCLE 129.00 2020600 DRAIN/INJ JOINT BRSA 686.00 2020601 DRAIN/INJ JOINT BRSA-FAC 88.00 2020605 DRAIN/INJ JOINT/BRSA 305.00 2020610 DRAIN/INJ/JOINT/BRSA 686.00 2020611 DRAIN/INJ/JOINT/BRSA-FAC ONLY 673.00

2020950 FLUID PRESSURE/MUSCL 601.00 2021310 TRMT OF NOSE FX 277.00 2021315 TRMT OF NOSE FX 616.00 2021320 TRMT OF NOSE FX 1,045.00 2021337 REPAIR NASAL SEPT FX 888.00 2021450 TRM LOWER JAW FX 1,042.00 2021480 RESET DISLOCATN JAW 1,042.00 2021820 TRMT STERNUM FX 771.00 2023330 Removal of Foreign Body Shoulder Subcuta 488.00 2023500 TRMT CLAVICLE FX 907.00 2023520 TRMT CLAVICLE DISLOC 822.00 2023525 TRMT CLAVICLE DISLOC 1,038.00 2023540 TRMT CLAVICLE DISLOC 614.00 2023570 TRMT SHOULDER BLD FX 712.00 2023600 TRMT HUMERUS FX 647.00 2023620 TRMT HUMERUS FX 697.00 2023650 TRMT SHOULDER DISLOC 1,262.00 2023655 TRT SHOULDER DISLOC 1,262.00 2023665 TRMT SHOULDER DISLOC 1,705.00 2024500 TRMT HUMERUS FX 1,042.00 2024505 REDUCTION HUMERUS FX W/MANIP 1,198.00 2024560 TRMT HUMERUS FX 903.00 2024600 TRMT ELBOW DISLOC 1,021.00 2024605 TRMT ELBOW DISLOC 1,430.00 2024640 TRMT ELBOW DISLOC 731.00 2024650 TRMT RADIUS FX 771.00 2024670 TRMT ULNAR FX 819.00 2025500 TRMT RADIUS FX 857.00 2025505 Closed TX of radial shaft fracture w/ ma 1,341.00 2025530 TRMT ULNA FX 863.00 2025600 TRMT RADIUS/ULNA FX 700.00 2025605 TRMT RADIUS/ULNA FX 1,355.00 2025650 REPAIR WRIST BONE FX 1,042.00 2025675 CLOSED TREATMENT DISTAL RAIOULNA DISLOCA 1,850.00 2026010 DRAINAGE FINGER ABCS 265.00 2026011 DRAINAGE FINGER ABCS 857.00 2026600 TRMT METACARPAL FX 618.00 2026605 TRMT METACARPAL FX 876.00 2026641 TRMT DISLOCATION THM 1,163.00 2026700 TRMT DISL OF KNUCKLE 758.00 2026705 CLOSED TRT OF KNUCKLE DISL W/ANES 645.00 2026720 TRMT FINGER FX EACH 532.00 2026725 TRMT FINGER FX EACH 771.00 2026750 TRMT FINGER FX EACH 534.00 2026755 TRMT FINGER FX EACH 771.00 2026770 TRMT FINGER DISLOC 699.00 2026910 AMPUTATION, METACARPAL W/FINGER/THUMB 4,106.00 2027200 TRMT TAILBONE FX 582.00 2027250 TRMT HIP DISLOCATION 1,720.00 2027252 CLOSED TRT HIP DISLOCATION REQ ANES 3,934.00 2027256 TRMT SPONTANEOUS HIP DISLOCATION 605.00 2027265 CLOSED TRT HIP DISLOCATION POST ARTHROPL 1,306.00

2027372 INCISION & DRAINAGE 260.00 2027520 TRMT KNEECAP FX 1,195.00 2027550 TRMT KNEE DISLOCATIO 1,504.00 2027560 TRMT KNEECAP DISLOC 948.00 2027562 TRMT KNEECAP DISLOC 1,972.00 2027760 TRMT OF ANKLE FX 1,016.00 2027780 TRMT OF FIBULA FX 756.00 2027786 TRMT OF ANKLE FX 453.00 2027808 TRMT OF ANKLE FX 1,072.00 2027810 CLOSED TRT OF BIMALLEOLAR FX W/MANIPULAT 1,072.00 2027816 TRMT OF ANKLE FX 1,138.00 2027840 TRMT ANKLE DISLOC 1,116.00 2027842 TRMT ANKLE DISLOC 1,487.00 2028190 REMOV FGN BODY FOOT 527.00 2028192 REMOV FGN BODY FOOT 1,188.00 2028193 REMOV FGN BODY FOOT 1,504.00 2028400 TRMT HEEL FX 774.00 2028430 TRMT FOOT FX 794.00 2028435 TRT ANKLE FRACTURE W/MANIP 1,171.00 2028450 TRMT MIDFOOT FX 680.00 2028470 TRMT METATARSAL FX 721.00 2028475 TRMT METATARSAL FX WITH MANIPULATION 721.00 2028490 TRMT BIG TOE FX 321.00 2028495 TRMT BIG TOE FX 373.00 2028630 TRMT TOE DISLOCATION 532.00 2028635 TRMT TOE DISLOCATION 680.00 2028660 TRMT TOE DISLOCATION 375.00 2029055 APPLICATION, CAST; SHOULDER SPICA 586.00 2029075 APPL FOREARM CAST 248.00 2029085 APPL WRIST CAST 246.00 2029105 APPL LONG ARM SPLINT 160.00 2029125 APPL SHORT ARM SPLINT 181.00 2029130 FINGER SPLINT 171.00 2029240 STRAPPING OF SHOULDER 193.00 2029260 STRAP/ELBOW & WRIST 193.00 2029280 STRAPPING OF FINGER 193.00 2029405 APPLY SHORT LEG CAST 116.00 2029505 APPL OF LONG LEG SPL 225.00 2029515 APPL SHORT LEG SPLINT 224.00 2029530 STRAPPING OF KNEE 224.00 2029540 STRAPPING OF ANKLE 224.00 2029550 STRAPPING OF TOES 229.00 2029590 APPL FOOT SPLINT 180.00 2029700 REMOVAL OF GAUNTLET, BOOT OR BODY CAST 181.00 2029705 REMOVAL/REVSN CAST 229.00 2029730 WINDOWING OF CAST 176.00 2030300 REMOVAL NASAL FGN BD 264.00 2030901 CONTROL OF NOSEBLEED 340.00 2030902 CONTROL HEMORRHAGE FACILITY CHARGE 185.00 2030903 CONTROL OF NOSEBLEED 570.00 2030905 CONTROL OF NOSEBLEED 786.00 2030906 NASAL IMPACTION 1,002.00

2031500 INSERTION EMG AIRWAY 507.00 2031501 INSERTION EMG AIRWAY-TC 195.00 2031502 TRACHEOSTOMY TUBE CHG 377.00 2031505 DIAG LARYNGOSCOPY 438.00 2031511 REMOVAL FGN BD LARYN 719.00 2031525 DIAG LARYNGOSCOPY 1,363.00 2031603 INCISION OF WINDPIPE 2,111.00 2031605 INCISION OF WINDPIPE 2,111.00 2032000 THORACENTESIS; PUNCTURE OF PLEURAL CAVIT 675.00 2032002 THORACENTESIS THER 732.00 2032020 INSERTION CHEST TUBE 658.00 2032422 THORACENTESIS WITH TUBE 906.00 2033210 INSERTION HEART ELEC 10,094.00 2036000 Injection procedure for extremity venogr 79.00 2036400 BLOOD DRAWING 79.00 2036405 BLOOD DRAWING 137.00 2036406 BLOOD DRAWING 118.00 2036410 BLOOD DRAWING 51.00 2036420 ESTABL VEIN ACCESS 270.00 2036430 BLOOD TRANSFUSION SV 805.00 2036556 INS CENTRAL VENOUS CATH -NON TUNNELED 5+ 1,975.00 2036558 INS CENTRAL VENOUS CATH -TUNNELED 5+ YRS 2,134.00 2036589 REMV OF ACCESS PORT FC ONLY 454.00 2036680 PLACEMENT NEEDLE/INTRAOSSEOUS INFUSION 240.00 2041250 REPAIR TONGUE LAC 624.00 2041800 Drain abscess cyst hematoma Dentoalveola 473.00 2042000 Drain of abscess of palate uvula 257.00 2043752 NASO ORO GASTRIC TUBE 532.00 2046040 INCISION RECTAL ABC 1,092.00 2046050 I&D Perianal Abcess Superficial 263.00 2046080 INCISION ANAL SPHINC 1,133.00 2046083 INCISION OF HEMORRHD 302.00 2049080 ABDOMINAL PARACENTESIS 815.00 2051701 STRAIGHT CATHETER 148.00 2051702 FOLEY CATH INSERTION 171.00 2051705 FOLEY CATH CHANGE 505.00 2055100 I&D ABCESS SCROTUM 498.00 2056405 I&D VULVA/PERINEUM 406.00 2056420 DRAIN GLAND ABSCESS 406.00 2059409 VAGINAL DELIVERY 1,993.00 2059414 DELIVERY OF PLACENTA 224.00 2062270 SPINAL TAP 648.00 2063680 INTRAOSSEOUS PLACEMENT 240.00 2064400 INJ FOR NERVE BLOCK 402.00 2064450 INJ FOR NERVE BLOCK 411.00 2065205 REM FGN BODY FRM EYE 245.00 2065210 REM FGN BODY FRM EYE 224.00 2065220 REM FGN BODY FRM EYE 287.00 2065222 REM FGN BODY FRM EYE 327.00 2069200 CLEAR OUTER EAR CAN 264.00 2069209 REMOVAL CERUMEN w/irrigation unilat 201.00 2069210 REMOVAL CERUMEN w/Instrumentation 204.00

2082075 RL BREATH ALCOHOL LEVEL 51.00 2082962 GLUCOSE BY GLUCOMETER POC 8.00 2086580 PPD 60.00 2090471 IMMUNIZATION ADMIN 75.00 2090472 IMMUNIZATION ADMIN-ADD'L 46.00 2090473 IMMUNIZATION ADMIN BY INTRANASAL ROUTE 36.00 2090741 PASSIVE IMMUN 105.00 2091105 GASTRIC INTUBATION 309.00 2092192 OBSERVATION PROF FEE 573.00 2092811 PHYSICIAN ASST 1 194.00 2092812 PHYSICIAN FEE 1 207.00 2092821 PHYSICIAN ASST 2 270.00 2092822 PHYSICIAN FEE 2 291.00 2092831 PHYSICIAN ASST 3 359.00 2092832 PHYSICIAN FEE 3 527.00 2092841 PHYSICIAN ASST 4 601.00 2092842 PHYSICIAN FEE 4 700.00 2092851 PHYSICIAN ASST 5 1,194.00 2092852 PHYSICIAN FEE 5 1,194.00 2092882 PHYSICIAN FEE 1,061.00 2092911 CRITICAL CARE, FIRST HOUR PHYS ASST 1,323.00 2092912 CRITICAL CARE, FIRST HOUR PHYS FEE 1,394.00 2092921 CRITICAL CARE PA EACH ADD'L 30MIN 666.00 2092922 CRITICAL CARE; EACH ADDL 30 MIN PHYS FEE 700.00 2092950 CARDIOPULMONARY RESC 1,221.00 2092951 CARDIOPULMONARY RESC-TC 666.00 2092953 TEMP TRANSCUT PACING 774.00 2092960 CARDIOVERSION ELECTIVE EXTERN 1,602.00 2092961 CARDIOVERSION ELECTIVE EXTERN TC 1,214.00 2092977 THROMBOLYTIC THERAPY 1,159.00 2093041 CARDIAC MONITOR 92.00 2093745 SET UP CARDIOVERT DEFIBRILL 171.00 2093811 PHYSICIAN ASST 1 194.00 2093812 PHYSICIAN ASST 2 270.00 2093813 PHYSICIAN ASST 3 359.00 2093814 PHYSICIAN ASST 4 601.00 2093815 PHYSICIAN ASST 5 1,194.00 2094656 BIPAP INITIAL 759.00 2094657 BIPAP SUBSEQUENT 368.00 2094660 POSITIVE AIRWAY PRES 330.00 2094812 PHYSICIAN FEE 1 207.00 2094822 PHYSICIAN FEE 2 291.00 2094832 PHYSICIAN FEE 3 527.00 2094842 PHYSICIAN FEE 4 700.00 2094852 PHYSICIAN FEE 5 1,194.00 2096360 IV INFUSION HYDRATION 1ST HOUR 406.00 2096361 IV INFUSION HYDRATION EACH ADDL HOUR 60.00 2096365 IV INFUSION TX/PROPHYLAXIS/DX UP TO 1 HR 707.00 2096366 IF INFUSION EACH ADD'L HOUR 129.00 2096367 IV ADD'L SEQ INFUSION UP TO ONE HOUR 207.00 2096368 IV CONCURRENT INFUSION 171.00 2096369 SC INF TX/PROPHYLAXIS INITIAL UP TO 1 HR 421.00

2096370 SC INFUSION EACH ADD'L HOUR 207.00 2096371 ADD'L PUMP SETUP W/ESTAB NEW SUBCU SITE 148.00 2096372 TX, PROPHYLATIC/DX SC OR IM INJECTION 97.00 2096374 IV PUSH SINGLE INITIAL SUBSTANCE/DRUG 326.00 2096375 ADD'L SEQ IV PUSH OF NEW SUBSTANCE/DRUG 194.00 2096376 EACH ADD'L IV PUSH SEQ SAME SUBSTANCE/DR 194.00 2096523 IRRIGATION IMPLANTED VENOUS ACCESS DEVIC 205.00 2099195 PHLEBOTOMY THERAPUTIC 171.00 2099281 EMERGENCY ROOM 1 284.00 2099282 EMERGENCY ROOM 2 402.00 2099283 EMERGENCY ROOM 3 527.00 2099284 EMERGENCY ROOM 4 842.00 2099285 EMERGENCY ROOM 5 1,323.00 2099288 PHYS DIRECTION EMS 1,275.00 2099290 CRITICAL CARE TRANSPORT EACH ADDL30MIN 666.00 2099291 CRITICAL CARE FIRST HOUR 1,634.00 2099292 CRITICAL CARE; EACH ADD'L 30 MIN 820.00 2099381 EMERGENCY ROOM 1 284.00 2099382 EMERGENCY ROOM 2 402.00 2099383 EMERGENCY ROOM 3 527.00 2099384 EMERGENCY ROOM 4 842.00 2099385 EMERGENCY ROOM 5 1,323.00 2400014 INCISION & DRAINAGE 172.00 2400020 NEEDLE BIOPSY 203.00 2410040 REMOVAL INGROWN HAIR 119.00 2411401 EXCISION OF LESION 336.00 2411421 REMOVAL SKIN LESION 476.00 2411422 EXCISION OF LESION 476.00 2417003 LESIONS 2-14 83.00 2419020 DRAINAGEOFBREASTABES 139.00 2443249 ENDOSCOPY 2,258.00 2443250 GASTRO W HOT FORCEPS 2,258.00 2445381 COLONOSCOPY W/SNARE 2,013.00 2445384 COLONOSCOPY/HOT FORCEPS 1,972.00 2445385 COLONOSCOPY W/SNARE 2,013.00 2452004 CYSTO WITH BIOPSY 1,172.00 2452214 CYSTO/FULGURATION 1,643.00 2452224 CYSTOSCOPY THERAPEUTIC 1,643.00 2455000 HYDROCELE ASPIRATION 403.00 2458558 HYSTEROSCOPY 1,643.00 2460010 CARPAL TUNNEL 1,369.00 2470011 ELECTROCAUTERIZATION 155.00 2610043 FLEETS ENEMA-REG 18.00 2610053 INCENTIVE SPIROMETER 21.00 2610072 OXYGEN SET 59.00 2610084 TRACHEOSTOMY KIT 28.00 2610106 IV STARTER SET 117.00 2610109 POSTUARL DRAINAGE 54.00 2610110 DRESSING MAJOR-NSG 96.00 2610111 DRESSING MINOR-NSG 54.00 2610112 DRESSING MAJOR-ER 148.00 2610113 DRESSING MINOR-ER 65.00

2610116 SUTURE REMOVAL TRAY 83.00 2610117 CAST APPLICATION LG 301.00 2610118 CAST APPLICATION SM 240.00 2610122 TRAY SIGMOID 149.00 2610123 TRAY TRACH 149.00 2610124 TRAY THORACOTOMY 190.00 2610125 TRAY THORACENTESIS 169.00 2610126 TRAY PARACENTESIS 116.00 2610127 TRAY VASECTOMY 118.00 2610128 TRAY BONE MARROW 92.00 2610129 TRAY BRONCHOSCOPY 145.00 2610137 TRAY IUD 24.00 2610138 TRAY BIOPSY 131.00 2610141 UROSHEATH 54.00 2610145 INFUSION PUMP 75.00 2610162 SUPPLY 21.00 2610171 NEBULIZER 65.00 2610201 PLASTER SPLINT SUPPLY 87.00 2610228 SUPPLY 20.00 2610337 SUPPLY-SUTURE 117.00 2610338 SUPPLY-UROLOGY 139.00 2610339 ORTHO CAST LARGE 117.00 2610400 ORTHO CAST SMALL 59.00 2610402 PEAK FLOW METER 60.00 3400002 =>GUEST CELEBRATION TRAY<= 8.00 3500001 INITIAL ASSESSMENT & INTERVENTION 15 MIN 48.00 3500002 REASSESSMENT & INTERVENTION 15 MIN 40.00 3500003 GROUP THERAPY 30 MINUTES 40.00 4000003 PLATELET PHORESIS 2,191.00 4000004 COMPLETE BLOOD COUNT W/ DIFFERENTIAL 96.00 4000028 RL Q Fever Antibody IGg and IgM Serum 143.00 4000029 RL Gliadin Deamidated AB Eval IgG IgA Se 67.00 4000030 RL Parietal Cell Antibodies IgG Serum 34.00 4000031 RL Demyelinating Disease Eval Serum 111.00 4000033 RL RAST Kidney Bean IgE 16.00 4000034 RL RAST Sheep Wool Ige 16.00 4000035 RL RAST Fusarium Moniliforme IgE 16.00 4000036 RL RAST Cocklebur 16.00 4000037 RL RAST Mango IgE 16.00 4000038 RL RAST Aspergillus Fumigatus IgE 16.00 4000042 *RL PL-7, PL12, EJ, OJ, U2 snRNP, Anti-F 302.00 4000043 *RL Anti-Jo-1-Ab, Anti-SSA 52 kD Ab, IgG 420.00 4000050 *ANTINUCLEAR ANTIBODY 36.00 4000051 *Cyclic Citrullinated Peptide 38.00 4000052 *Immunoassay nonantibody 34.00 4000053 *DNA Antibody Native Double Stranded 40.00 4000054 *DNA Antibody Native Double Stranded X 6 315.00 4000060 RL RESPIRATORY PATHOGEN PANEL PCR NP 1,319.00 4081263 RL IGH Somatic Hypermutation B-Cell CLL 1,654.00 4081401 RL TPMT GENOTYPE 1,496.00 4082010 BETA HYDROXYBUTYRATE 88.00 4082397 *CHEMILUMINESCENT ASSAY x 4 489.00

4082492 RL TRAMADOL 225.00 4082533 RL ACTH STIMULATION TEST 248.00 4082542 RL HYDROXYCORTICOSTERONE 18 63.00 4082787 RL IGG SUBCLASS 4 103.00 4082805 VENOUS BLOOD GASES 202.00 4083520 RL VEGF Plasma 45.00 4084080 RL Bone Alkaline Phosphatase Serum 91.00 4085048 EOSINOPHIL COUNT 49.00 4085335 *RL Factor VIII Inhibitor Screen 743.00 4085520 RL HEPARIN AntiXa 57.00 4085597 *RL Platelet Neutralization Procedure 213.00 4085598 *RL Staclot Lupus Anticoagulant, Plasma 316.00 4086160 *RL COMP C3 & C4 168.00 4086235 RL SSB (ANTI-LA) 245.00 4086237 RL SCL-70 245.00 4086666 RL EHRLICHIA CHAFFEENSIS (EASTERN) 119.00 4086689 RL HIV-2 Antibody Confirmation, Serum 152.00 4086735 RL MUMPS VIRUS IGM 324.00 4087116 *RL Mycobacterial Culture 120.00 4087118 *RL MALDI-TOF Mass Spec AFB 313.00 4087150 *RL Mycobacteria Probe Ident Solid 174.00 4087153 *RL Mycobacteria Identification by Seque 294.00 4087252 RL VIRUS ISOLATION CULTURE INOCULATION 212.00 4087531 RL CULTURE STOOL E COLI O157 139.00 4087635 RL SARS Coronavirus with CoV-2 RNA - State Lab 0.01

4087635 RL SARS Coronavirus with CoV-2 RNA - Independent Lab 102.30 4087798 RL CULTURE STOOL SHIGA-TOXIN 1 AND 2 139.00 4087799 RL EPSTEIN BARR QUANTITATIVE 224.00 4087902 RL Hepatitis C Viral RNA genotype 1 NS5a 1,506.00 4088184 *FLOW CYTOMETRY 384.00 4183520 RL LEPTIN 292.00 4187150 *RL Mycobacteria Probe Ident Broth 174.00 4255656 RL HEMOCHROMATOSIS MUTATION DETECTION 394.00 4255657 RL FACTOR II GENE MUTATION 525.00 4258007 MANUAL DIFFERENTIAL 223.00 4280200 RL TOBRAMYCIN 272.00 4281243 RL FRAGILE X PCR 656.00 4281401 RL DPMK DNA TEST DM1 1,496.00 4282232 RL B2 MICROGLOBULIN 288.00 4283018 RL COBALT SERUM 64.00 4283516 RL MPO/PR-3 ANTIBODIES 53.00 4283520 RL ANTI-MULLERIAN HORMONE 247.00 4283701 VAP CHOLESTEROL, SERUM 132.00 4284153 RL Prostate Health Index(phh) Serum 299.00 4285002 BLEEDING TIME 124.00 4285004 WBC & AUTO DIFF ANC 49.00 4285014 HCT 56.00 4285018 HGB 56.00 4285044 RETICULOCYTE COUNT 116.00 4285048 WHITE BLOOD COUNT 53.00 4285060 DIFF-REVIEW BY PATH 82.00 4285210 RL FACTOR II ACTIVITY (PROTHROMBIN) 179.00

4285220 *RL Coagulation Factor V Activity Assay, 181.00 4285230 RL FACTOR VII 357.00 4285240 RL FACTOR VIII (AHG) 233.00 4285245 RL FACTOR VIII VW FACTO 159.00 4285246 RL VON WILL ANTIGEN 210.00 4285247 *RL von Willebrand factor multimer 183.00 4285250 *RL Coagulation Factor IX Activity Assay 203.00 4285260 RL FACTOR X (TEN) 484.00 4285270 *RL Coagulation Factor XI Activity Assay 227.00 4285280 *RL Coagulation Factor XII Activity Assa 234.00 4285300 RL ANTI-THROMBIN IIIPAN 288.00 4285301 RL ANITHROMBIN III AG A 93.00 4285302 RL PROTEIN C TOTAL 299.00 4285303 RL PROTEIN C FUNCTIONAL 435.00 4285305 RL PROTEIN S TOTAL 299.00 4285306 RL PROTEIN S FUNCTIONAL 365.00 4285307 *RL Activated Protein Resistance V 45.00 4285335 *RL Bethesda Titer 380.00 4285362 RL FDP SEMI-QUANT 92.00 4285366 *RL Soluble Fibrin Monomer 211.00 4285370 RL FIBRINOGEN QUANT 102.00 4285379 D DIMER 270.00 4285384 *RL FIBRINOGEN ACTIVITY 25.00 4285390 *RL Special Coagulation Interpretation 93.00 4285397 RL von Willebrand Activity 210.00 4285420 RL PLASMINOGEN 251.00 4285540 RL LAP WITH COUNT 137.00 4285541 RL LEUCOCYTE ALKALINE PHOSPHATASE SCORE 160.00 4285549 RL LYSOZYME 100.00 4285576 ASPIRIN PLATELET INHIBITION ASSAY 122.00 4285590 PLAT MANUAL 116.00 4285597 RL HEXAGONAL PHOSPHOLIPID 288.00 4285598 RL HEXAGONAL PHOSPHOLIPID 288.00 4285610 PT W/ INR 76.00 4285611 *RL Prothrombin Time Mix 1:1 182.00 4285613 RL LUPUS ANITCOAGULANT CASCADE 350.00 4285635 *RL Reptilase Time, Plasma 133.00 4285651 SEDIMENTATION RATE 91.00 4285660 RL SICKLE CELL SCREEN 210.00 4285670 RL THROMBIN TIME 112.00 4285675 RL THROMBIN TITER 112.00 4285730 PTT 131.00 4285732 *RL APTT Mix 1:1 153.00 4285810 RL VISCOSITY, SERUM 143.00 4285999 RL EOSINOPHIL RANDOM URINE 190.00 4286022 RL HEPARIN INDUCED AB 80.00 4286160 RL COMP C4 167.00 4286235 RL Sm SMITH Antibody 53.00 4286359 *T Cells Total Count 110.00 4286360 *Absolute CD4/CD8 Count with Ratio 138.00 4286790 RL CHIKUNGUNYA ANTIBODIES IgG AND M 56.00 4287150 *RL Mtb Speciation 309.00

4287798 RL NoroVirus Detection RT-PCR 707.00 4288888 COMPLETE BLOOD COUNT W/O DIFFERENTIAL 82.00 4289051 CELL COUNT BODY FLUID W/ DIFFERENTIAL 82.00 4289060 CRYSTAL IDENTIFICATION 131.00 4289190 NASAL SMEAR FOR EOS 82.00 4289310 SEMEN ANALYSIS 155.00 4297720 RL FACTOR V LEIDEN BY PCR 233.00 4380164 VALPROIC ACID TOTAL 66.00 4380165 RL VALPROIC ACID FREE 68.00 4380299 *Quantitative Assay Drug 49.00 4382570 CREATININE OTHER SOURCE 118.00 4383516 MITOCHONDRIAL ANTIBODIES M2 119.00 4383520 *Phospholipase A2 Receptor ELISA Serum 567.00 4384066 RL Prostatic Acid Phosphatase (PAP) Seru 58.00 4386022 RL HEPARIN PF4 IgG Antibody HIT Serum 119.00 4386235 RL Jo 1 Antibodies IgG Serum 53.00 4386606 RL ASPERGILLUS FUMIGATUS IgG ANTIBODIES 91.00 4387015 *MYCOBACTERIA CULTURE, CONCENTRATION 144.00 4387556 *MYCOBACTERIUM TB COMPLEX, MOLECULAR DET 443.00 4408631 RL IA2 ANTIBODY 366.00 4409016 BB LR PRBCS UNIT 978.00 4409017 RL BB FRESH FROZEN PLASMA UNIT 538.00 4409021 BB RBC UNIT 469.00 4409040 LEUKOREDUCED PACKED CELLS, IRRADIATED 2,119.00 4409768 RL HANTA VIRUS AB, IgG, IgM 350.00 4430461 RL VIPER VENOM DILUTE 66.00 4435819 RL PARATHYROID HORMONE RELATED PEPTIDE 663.00 4438519 RL 21 HYDROXYLASE AB 343.00 4444444 DO NOT USE RL LUPUS COMP REF PANEL 2 307.00 4450172 RL BLASTOMYCES DERMATITIDIS ANTIBODIES 43.00 4450483 RL GLUTEN SENSITIVITY PANEL 225.00 4450526 RL MYELOPEROXIDASE ANTIBODY 83.00 4450600 RL EPSTEIN BARR VIRUS ANTIBODY PANEL 137.00 4451359 RL GLIADIN (DEAMINATED) AB IGG 32.00 4462551 RL BARTONELLA HENSELAE AB IGG/IGM 149.00 4462552 RL SMOOTH MUSCLE AB 292.00 4462553 RL TYPHUS FEVER AB X 260.00 4467901 RL TYPHUS FEVER AB 119.00 4480299 RL SIROLIMUS 356.00 4481403 RL HEMOPHILIA A 1,005.00 4481405 RL HEMOPHILIA B 1,005.00 4482542 RL Prometheus Thiopurine Metabolites 730.00 4482784 RL CELIAC REFLECTIVE PANEL 225.00 4482785 RL PROMETHEUS CELIAC PANEL 48.00 4482955 RL GLUCOSE 6 PHOSPHATE DEHYDROGENASE 108.00 4483018 IODINE SERUM 144.00 4483516 RL GLIADIN/MITOCHONDRIA 225.00 4483517 RL ENDOMYSIAL IGA AB 189.00 4483518 RL GM1 ANTIBODY PANEL 671.00 4483519 RL TRYPSINOGEN 202.00 4483521 RL TSH RECEPTOR ANTIBODY 86.00 4483735 RLOBSOLETE MAGNESIUM RBC 188.00

4484302 RL SODIUM FECAL 28.00 4484305 RL INSULIN LIKE GROWTH FACTOR 108.00 4484999 RL POTASSIUM FECAL 142.00 4485049 PLATELET COUNT 49.00 4486003 RL RAST X 221.00 4486021 AB ID LEUKOCYTE 366.00 4486022 RL PLATELET AB 478.00 4486038 RL ANTINUCLEAR ANTIBODY 252.00 4486039 RL ANA TITER AB 204.00 4486060 RL ANTI-STREP O (ASO) 160.00 4486078 BB TRANSFUSION INVESTIG 566.00 4486140 CRP 124.00 4486146 RL BETA 2 GLYCOPROTEIN 1 AB 221.00 4486147 RL CARDIOLIPIN AB 221.00 4486157 RL COLD AGG TITER 160.00 4486160 RL COMPLEMENT TOTAL 164.00 4486161 RL C1-ESTERASE INHIBITOR FUNCTIONAL 155.00 4486162 RL COMPLEMENT CH50 324.00 4486165 RL COMPLEMENT C2 324.00 4486215 RL DNASE-B ANTIBODY 26.00 4486225 RL DNA ANTIBODY DS 252.00 4486226 OBSOLETE RL DNA ANTIBODY SS 350.00 4486235 RL EXTRACT NUC AG ABX 309.00 4486255 RL ANTI-GBM 292.00 4486256 RL RABIES TITRE 164.00 4486257 RL STREP PNEUMO AB IG G SEROTYPES 66.00 4486294 RL BLADDER TUMOR ANTIGEN 149.00 4486304 RL CA 125 298.00 4486308 MONONUCLEOSIS SCREEN 130.00 4486316 RL CA 50, 72-4,549 307.00 4486317 RL CHROMOGRANIN A 108.00 4486325 RL IMMUNOFIX URINE 365.00 4486331 RL HYPERSENSITIVE PNEUMONITIS PANEL 138.00 4486332 IMMUNE COMPLEX DETE 239.00 4486334 RL IMMUNOFIX SERUM 324.00 4486337 RL INSULIN AB 506.00 4486340 RL INTRINSIC FCT BLCKAB 265.00 4486341 RL ISLET CELL ANTIBODY 366.00 4486343 RL LEUKOCYTE HISTAMINE RELEASE 105.00 4486359 RL T-LYMPHOCYTES TOTAL 546.00 4486376 RL THYROID PEROXIDASE ANTIBODY 309.00 4486377 RL LIVER-KIDNEY MICROSOMAL ANTIBODIES 118.00 4486382 RL POLIOVIRUS TYPES 1 AND 3 AB NEUTR 556.00 4486430 RL RHEUMATOID FACTOR 145.00 4486431 RL RHEUMATOID TITER 172.00 4486480 RL QUANTIFERON TB 435.00 4486592 RL RPR 129.00 4486593 SYPHILIS SEROLOGY 139.00 4486606 RL ASPERGILLUS CF/ID 57.00 4486615 RL BORDETELLA AB 274.00 4486617 RL LYME BLOT 357.00 4486618 LYME AB W/ REFLEX TO BLOT 314.00

4486622 RL BRUCELLA AB 274.00 4486628 RL CANDIDA ANTIBODY 274.00 4486638 RL COXIELLA BRCH Q FEVE 257.00 4486644 RL CMV AB IGG 139.00 4486645 RL CMV IGM 345.00 4486658 RL COXSACKIE X 495.00 4486659 RL POLIOVIRUS ANTIBODIES 495.00 4486663 RL EPSTEIN-BARR VIRUS EARLY AG 170.00 4486664 RL EB VIRUS PANEL 137.00 4486665 RL EB VIRUS CAPSID 137.00 4486671 *RL SACCHAROMYCES CEREVISIAE AB IgA, S 194.00 4486674 RL GIARDIA AB SERUM 224.00 4486677 RL HELICOBACTER PYLORI AB 298.00 4486684 RL Haemophilus influenzae Type B Ab IgG 122.00 4486687 RL HTLV 48.00 4486692 RL HEP DELTA AB 194.00 4486694 RL HERPES NON-SPECIFIC 421.00 4486695 RL HSV TYPE1 235.00 4486696 RL HSV TYPE2 224.00 4486698 RL HISTOPLASMA 271.00 4486699 OBSOLETE TEST RL HSV 1/2 ANTIBODIES IgM 50.00 4486703 RL HIV Antibody Confirm/Differentiation 40.00 4486704 RL HEP B CORE AB 257.00 4486706 RL HEP B SUR AB 152.00 4486707 RL HEP BE AB 190.00 4486708 RL HEP A AB 189.00 4486710 RL INFLUENZA AB 258.00 4486713 RL LEGIONELLA AB 298.00 4486735 RL MUMPS VIRUS AB IGG 324.00 4486738 RL MYCOPLASMA ANTIBODY 190.00 4486747 RL PARVOVIRUS AB X 538.00 4486750 RL MALARIA IGG 131.00 4486753 RL PROTOZOA ANTIBODY 307.00 4486759 RL ROTAVIRUS 265.00 4486762 RL RUBELLA AB 179.00 4486765 RL RUBEOLA AB 260.00 4486774 RL TETANUS AB 168.00 4486777 RLTOXOPLASMA IGG 286.00 4486778 RL TOXOPLASMA IGM 286.00 4486781 RL FTA-ABS 190.00 4486787 RL VARICELLA ANTIBODY 189.00 4486788 RL WEST NILE VIRUS IGG/ IGM AB 159.00 4486789 *RL WEST NILE VIRUS ANTIBODY 42.00 4486790 RL VIRUS OTHER 286.00 4486799 RL RSV ABS, IgG & IgM 38.00 4486800 RL THYROGLOBULIN ANTIBODY 207.00 4486803 RL HEPATITIS C ANTIBODY 252.00 4486804 RL HEP C AB CONFIRM 364.00 4486812 RL HLA TYPING EACH X 386.00 4486850 BB AB SCREEN 148.00 4486860 ANTIBODY ELUTION 97.00 4486870 BB ANTIBODY ID 239.00

4486880 BB COOMBS DIRECT 128.00 4486886 BB COOMBS INDIRECT 148.00 4486900 BB BLOOD TYPE ABO 91.00 4486901 BB BLOOD TYPING RH 129.00 4486903 BB ANTIGEN SCREENING 112.00 4486904 BB COMP TEST ANTIGEN 112.00 4486920 BB COMPATIBILITY-IMMED SPIN 292.00 4486921 BB COMPAT INCUB 138.00 4486922 BB COMPAT TEST ANTI 152.00 4486927 BB FFP THAW 149.00 4487798 RL BABESIA PCR 357.00 4487902 RL HEP C GENOTYPE -PCR 1,339.00 4497860 RL DENGUE FEVER AB IGG IGM 350.00 4499336 RL CLOMIPRAMINE AND METABOLITES 356.00 4602838 STOOL FOR CLOSTRIDIUM DIFFICILE 362.00 4670322 RL LEGIONELLA AG URINE 197.00 4670401 CULTURE BODY FLUIDS 189.00 4670601 CULTURE THROAT 170.00 4670701 CULTURE EAR 189.00 4670702 CULTURE EYE 189.00 4670703 CULTURE OTHER 189.00 4670704 CULTURE SPUTUM 189.00 4670705 CULTURE GENITAL 189.00 4670706 CULTURE WOUND 189.00 4670707 CULTURE STERILITY 189.00 4670708 CULTURE NOSE OR NASAL 189.00 4670811 CULTURE STREP 119.00 4672051 STOOL FOR WHITE BLOOD CELLS 65.00 4680201 RL TOPIRAMATE LEVEL 128.00 4681381 RL HLA-B 5701 468.00 4683516 RL CYCLIC CITRULLINATED PEPTIDE AB 286.00 4686335 RL BETA-2 TRANSFERRIN 233.00 4686606 RL ASPERGILLUS ANTIBODIES IMMUNODIFFUSIO 152.00 4687040 CULTURE BLOOD 189.00 4687045 RL CULTURE STOOL(SALM&S 272.00 4687046 RL CULTURE STOOL 139.00 4687070 CULTURE, CSF 212.00 4687075 CULTURE ANAEROBIC 189.00 4687076 ID ANAEROBIC ORGANISM 189.00 4687077 ID AEROBIC ORGANISM 108.00 4687080 VRE SCREEN 139.00 4687081 CULTURE MRSA INFECTION CONTROL 139.00 4687083 CULTURE VRE-INF-CO 139.00 4687086 CULTURE URINE 163.00 4687088 ID URINE ORGANISM 129.00 4687101 RL CULTURE FUNGUS 129.00 4687106 RL FUNGI IDENT 129.00 4687110 RL CULTURE CHLAMYDIA 265.00 4687118 RL CULTURE ACID FAST & SMEAR 286.00 4687147 RL BACTERIAL TYP 88.00 4687176 *RL Tissue Processing 37.00 4687177 RL STOOL FOR OVA AND PARASITES 239.00

4687184 SENST 12 OR FEWER 88.00 4687186 RL MIC ANY NUMBER 129.00 4687205 GRAM STAIN 96.00 4687206 RL ACID FAST SMEAR 129.00 4687207 RL SMEAR(MALARIA ETC) 129.00 4687208 RL PARA TICK ID / SCABIES 108.00 4687210 WET PREP 108.00 4687220 RL KOH PREP 129.00 4687252 RL CULTURE HERPES 314.00 4687253 RL CULTURE INFLUENZA 119.00 4687254 RL VIRUS ISOLATION CENTRIFUGE ENHANCED 202.00 4687272 RL CRYPTOSPORIDIUM STOOL 129.00 4687274 RL HSV AG 152.00 4687280 RL RESPIRATORY SYNCYTICAL VIRUS 88.00 4687305 RL ASPERGILLUS ANTIGEN SERUM 166.00 4687324 DIFFICILE TOXIN A/B 264.00 4687327 RL CRYPTOCOCCAL ANTIGEN SERUM 70.00 4687328 RL STOOL GIARDIA 202.00 4687337 RL ENTAMOEBA HISTOLYTICA GROUP 71.00 4687338 RL HELICOBACTER PYLORI AG - STOOL 180.00 4687340 RL HEP B SUR AG 168.00 4687350 RL HEP BE AG 149.00 4687380 RL HEP DELTA AG 172.00 4687420 RL RSV DIR AG 88.00 4687425 RL ROTAVIRUS AG STOOL 287.00 4687449 RL Fungetell Serum 35.00 4687490 RL CHLAMYDIA AMPLIFIED 172.00 4687491 *CHLAMYDIA DIRECT 168.00 4687497 RL CMV DNA QUAN PCR (CYTOMEGALOVIRUS) 601.00 4687507 RL GASTROINTESTINAL PATHOGEN PANEL 1,418.00 4687517 RL HEP B VIRAL DNA BY PCR 224.00 4687521 RL HEP C VIRAL PCR QUAL 210.00 4687522 RL HEP C VIRAL RNA QUANT -PCR 468.00 4687531 RL CULTURE STOOL YERSINIA 139.00 4687532 RL CULTURE GRAM STAIN FUNGAL 102.00 4687591 RL N GONORRHEA AMPLIFIED 233.00 4687798 RL PERTUSSIS PCR 189.00 4687801 RL CULTURE INDIA INK FUNGAL CSF 225.00 4687802 RL CULTURE FUNGAL 129.00 4687804 INFLU SWAB (INFLUENZA A & B AG) 257.00 4687903 RL HIV PHENOTYPE COMPREHENSIVE 3,036.00 4688348 RL NORWALK VIRUS 900.00 4689050 BODY FLUID CELL COUNT 111.00 4810001 SPEC GRAVITY URINE MANUAL DIPSTICK ONLY 88.00 4881001 UA W/MICRO CHG 97.00 4881002 URINE ROUT W/O MICRO 57.00 4881003 AUTO UA W/O MICRO CHG 57.00 4881015 URINE MICRO ONLY 48.00 4881025 PREG TEST URINE 108.00 4884110 RL PORPHOBILINOBIN 24 HOUR 128.00 4884120 RL PORPHYRINS TOTAL 128.00 4884520 UREA - OTHER SOURCE 97.00

4888280 RL ADDITIONAL KARYOTYPE 128.00 5081611 RL TZANCK SMEAR 258.00 5088104 CYTO SMEAR & INTERP 286.00 5088108 CYTO CONC SM & INTE 286.00 5088121 UROVYSION FISH 299.00 5088142 RL CYTO PAP INPATIENT (THINPREP) 152.00 5088160 CYTO SCREEN & INTERP 286.00 5088161 CYTO PREP SCR INTER (SLIDE) 190.00 5088164 CYTO PAP INPATIENT (SLIDE) 71.00 5088173 RL CYTOLOGY-FNA 538.00 5088237 RL Blood/Bone Marrow Culture, Neoplastic 377.00 5088271 RL FISH DNA Probe 63.00 5088275 RL In Situ Hybridization Interphase BM B 134.00 5088291 RL FISH Intrp & Report Part B 101.00 5282222 GLUCOSE TOLERANCE TEST 2 HOUR 298.00 5283516 RL TISSUE TRANSGLUTAMINASE ANTIBODY IgA 286.00 5284134 RL PREALBUMIN 139.00 5288300 SURGICAL PATH LEV I 189.00 5288302 SURG PATH LEVEL II 237.00 5288304 SURG PATH LEVEL III 301.00 5288305 SURG PATH LEVEL IV 333.00 5288307 SURG PATH LEVEL V 525.00 5288309 SURG PATH LEVEL VI 707.00 5288311 DECALCIFICATION 139.00 5288312 SPEC STAIN GRP 1 207.00 5288313 SPEC STAIN GRP 2 179.00 5288342 IMMUNOHISTOCHEMISTRY, EACH AB 333.00 5300299 RL INFLIXIMAB QUANT WITH REFLEX TO AB TO 453.00 5300519 *AChR GANGLIONIC NEURONAL AB 50.00 5301519 *NEURONAL VGKC AUTOANTIBODY 50.00 5302992 RL CODEINE 300.00 5302994 RL FELBATOL (SELBATOL) 260.00 5302995 RL FELBAMATE 112.00 5303516 RL MYOSITIS ANTIBODY 2 PANEL 1,001.00 5303519 *ACH RECEPTOR MODULATING AB 175.00 5303520 *STRIATIONAL AB 174.00 5303521 *Immunoassay Quant NOS 45.00 5303522 *Immunoassay Quant NOS NONAB X 6 897.00 5306255 *RL INDIRECT IMMUNOFLUORESCENT ASSAY 194.00 5309019 BB PLATELET UNIT 638.00 5310108 RL URINE ETHANOL QUAL PRESUMPTIVE 118.00 5312345 .LDL DIR MEAS 129.00 5316255 *FLOURESCENT AB SCRN X 2 209.00 5321051 RL ALPHAFETOPROTEIN TUMOR MARKER 287.00 5326255 *Phospholipase A2 Receptor IFA Serum 395.00 5328480 RL PSEUDOCHOLINESTERASE, DIBUC INHIB 30.00 5328533 RL SALIVA CORTISOL 139.00 5331260 RL ANTI IGA AB 416.00 5333333 RL NEURONTIN/GABAPENTIN 160.00 5335201 RL GLIADIN AB 416.00 5336415 VENIPUNCTURE 46.00 5336600 ARTERIAL PUNCTURE 106.00

5343403 RL TESTOSTERONE BIO AND SEX HORMONE 103.00 5344444 RL QUAD MARKER 403.00 5348434 TSH W/ REFLEX FT4 240.00 5351537 RL INTERLEUKIN 6 273.00 5356040 RL CYSTIC FIBROSIS MUTATION PANEL 329.00 5361538 RL SOLUBLE LIVER ANTIGEN AB 46.00 5364151 VENIPUNCTURE OFF SIT 46.00 5366666 RL NEUTROPHIL CYTOPLASMIC AB 239.00 5368300 RL CA 27.29 298.00 5370211 RL GLUTAMIC ACID DECARBOXYLASE AB 111.00 5370212 RL DEOXYPYRIDINOLINE CROSSLINKS URINE 155.00 5370416 RL C TELOPEPTIDE B X LINKED 221.00 5377777 RL LAMICTAL 128.00 5380048 BASIC METABOLIC PANEL 186.00 5380050 GEN HEALTH PANEL 332.00 5380051 ELECTROLYTE PANEL 190.00 5380053 COMPREHENSIVE METABOLIC PANEL 237.00 5380061 LIPID PROFILE 203.00 5380069 RENAL FUNCTION 239.00 5380074 RL HEPATITIS PROFILE 615.00 5380076 HEPATIC FUNCTION 302.00 5380100 RL DRUG SCREEN BLOOD 411.00 5380101 RL SULFANYLUREA 426.00 5380102 RL DRUG CONFIRMATION 355.00 5380103 RL TRICYCLIC ANTIDEPRESSANT, TOTAL 426.00 5380104 DRUG SCREEN URINE 12 213.00 5380105 MEDTOX 13 PANEL 237.00 5380152 RL AMITRIPTYLINE 364.00 5380154 RL BENZODIAZEPINE 353.00 5380156 TEGRETOL (CARBAMAZEPINE) 233.00 5380158 RL CYCLOSPORINE 324.00 5380160 RL DESIPRAMINE 411.00 5380162 DIGOXIN LEVEL 180.00 5380164 VALPROIC ACID (DEPAKENE) 223.00 5380166 RL DOXEPIN 300.00 5380169 RL EVEROLIMUS 109.00 5380170 RL GENTAMICIN 371.00 5380173 RL HALOPERIDOL 239.00 5380174 RL IMIPRAMINE 65.00 5380176 RL LIDOCAINE 314.00 5380178 RL LITHIUM LEVEL 170.00 5380182 RL NORTRIPTYLINE 251.00 5380184 RL PHENOBARBITAL LEVEL 226.00 5380185 PHENYTOIN (DILANTIN) 215.00 5380186 RL PHENYTOIN FREE 207.00 5380188 RL PRIMIDONE 252.00 5380190 RL PROCAINAMIDE 345.00 5380192 RL PROCAINAMIDE NAPA 324.00 5380194 RL QUINIDINE 258.00 5380196 SALICYLATE LEVEL 168.00 5380197 RL TACROLIMUS 372.00 5380198 RL THEOPHYLLINE LEVEL 164.00

5380202 VANCOMYCIN TROUGH 292.00 5380291 VANCOMYCIN PEAK 292.00 5380293 VANCOMYCIN RANDOM 292.00 5380299 RL ZONISAMIDE 134.00 5380300 RL DEXAMETHASONE 248.00 5380323 RL Nicotine and Metabolites Urine 171.00 5380339 RL Clobazam Serum/Plasma 357.00 5380342 RL RISPERIDONE AND 9-HYDROXYRISPERIDONE 215.00 5380359 *RL METHYLENEDIOXYAMPHETAMINES 97.00 5380360 RL METHYLPHENIDATE RITALIN & MTB URINE 338.00 5380365 RL Oxycodone Free Serum 300.00 5381050 VOLUME MEASUREMENT 50.00 5381170 RL BCR/ABL190 RT-PCR 919.00 5381206 *BCR/ABL1 Translocation Major Breakpoint 478.00 5381207 *BCR/ABL1 Translocation Minor Breakpoint 422.00 5381208 *BCR/ABL1 Translocation Other Breakpoint 564.00 5381219 RL Myeloproliferative Neoplasm (MPN)CALR 1,570.00 5381252 RL CONNEXIN 26 GJB2 SEQUENCING 279.00 5381291 RL METHYLENETETRAHYDROFOLATE REDUCTASE 232.00 5381295 RL MSH2 GENE TESTING 2,815.00 5381372 RL HLA Class I Molecular Typing Disease 1,059.00 5381403 *RL MPL Exon 10 Sequencing, Reflex 765.00 5381479 *UNLISTED MOLECULAR PATHOLOGY 10.00 5381522 RL HEP C VIRAL RNA 345.00 5382003 ACETAMINOPHEN LEVEL 292.00 5382009 ACETONE QUAL 57.00 5382010 DO NOT USE KETONES SERUM 88.00 5382024 RL ACTH 252.00 5382040 ALBUMIN SERUM 112.00 5382042 ALBUMIN(OTHER) 88.00 5382043 MICROALBUMIN 155.00 5382044 MICROALBUMIN 24 HR 82.00 5382055 ALCOHOL ETHYL 239.00 5382085 RL ALDOLASE 148.00 5382088 RL ALDOSTERONE 559.00 5382103 RL ALPHA-1-ANTIT TOTAL 233.00 5382104 RL ALPHA-1-ANTITRP PHEN 314.00 5382105 RL AFP-MATERNAL 271.00 5382108 RL ALUMINUM SERUM 471.00 5382128 RL AMINO ACID SCREEN, QUAL, URINE 90.00 5382131 RL AMINO ACIDS QUANT 416.00 5382135 RL ALA 128.00 5382136 RL AMINO ACIDS 2-5 951.00 5382140 RL AMMONIA LEVEL 366.00 5382145 RL AMPHETAMINE CONF/QUANT 129.00 5382150 AMYLASE 118.00 5382151 RL AMYLASE URINE-24 HR 139.00 5382152 RL AMYLASE URINE RANDOM 139.00 5382157 RL ANDROSTENEDIONE 554.00 5382164 RL ANGIOTENSIN-1-CE 251.00 5382172 OBSOLETE RL LIPOPROTEIN A 57.00 5382173 RL APOLIPOPROTEIN B 79.00

5382175 RL ARSENIC 252.00 5382180 RL C VITAMIN - BLOOD 298.00 5382205 BARBITURATES CONF & QUAN 108.00 5382223 GTT 3 HR 298.00 5382224 GTT 4 HR 298.00 5382225 GTT 5 HR 298.00 5382247 BILIRUBIN TOTAL 111.00 5382248 BILIRUBIN DIRECT 111.00 5382273 BODY FLUID OCCULT BLOOD 75.00 5382274 STOOL OCCULT BLOOD 149.00 5382300 RL CADMIUM 390.00 5382306 VITAMIN D25 HYDROXY 298.00 5382307 RL 25 HYDROXYVITAMIN D2 AND D3 353.00 5382308 RL CALCITONIN 372.00 5382310 CALCIUM 106.00 5382330 RL CALCIUM IONIZED 317.00 5382340 CALCIUM URINE 160.00 5382341 CALCIUM URINE-24HR 160.00 5382360 RL STONE ANL CHEMICAL 217.00 5382365 RL STONE ANALYSIS 207.00 5382373 CARBO DEF TRANSFERRIN FOR ALC USE 106.00 5382374 TOTAL CARBON DIOXIDE 106.00 5382375 CARBOXY HEMOGLOBIN 221.00 5382378 RL CEA AG 298.00 5382379 RL CARNITINE SERUM 49.00 5382380 RL CAROTENE 159.00 5382382 RL CATECHOLAMINE TL UR 411.00 5382383 RL CATECHOLAMINE-BLOOD 525.00 5382384 RL CATECHOLAMINES-FRACT 478.00 5382390 RL CERULOPLASM 108.00 5382435 CHLORIDE 116.00 5382436 CHLORIDE URINE 155.00 5382441 RL POLYCHLORINATED BIPHENYLS 355.00 5382465 CHOLESTEROL 119.00 5382480 RL PSEUDOCHOLINESTERASE, TOTAL 36.00 5382482 RL CHOLINESTERASE RBC 110.00 5382491 RL WARFARIN 314.00 5382492 RL PROZAC 225.00 5382495 RL CHROMIUM 377.00 5382507 RL CITRATE 24HR URINE 142.00 5382520 RL COCAINE - CONFIRMATION 419.00 5382523 RL COLLEGEN X-LINK 221.00 5382524 RL N-TELOPEPTIDE X-LINKED URINE 221.00 5382525 RL COPPER 189.00 5382530 RL CORTISOL FREE URINE 248.00 5382533 RL CORTISOL TOTAL 248.00 5382540 RL CREATINE 142.00 5382542 RL THC CONFIRMATION & QUANTITATION 164.00 5382550 CREATINE KINASE 139.00 5382552 RL CPK ISOENZYMES 223.00 5382565 CREATININE SERUM 119.00 5382570 CREATININE URINE 168.00

5382571 CREATININE, URINE 24 HOUR 168.00 5382575 CREATININE CLEARANCE 285.00 5382585 RL CRYOFIBRINOGEN 152.00 5382595 RL CRYOGLOBULIN 123.00 5382600 RL CYANIDE 403.00 5382607 VITAMIN B12 LEVEL 257.00 5382610 RL CYSTATIN C LEVEL 153.00 5382626 RL DHEA 537.00 5382627 RL DHEA-S 314.00 5382652 RL D125 DIOH VITAMIN 507.00 5382668 RL ERYTHROPOIETIN 390.00 5382670 RL ESTRADIOL 357.00 5382671 RL ESTROGENS-FRACT 1,064.00 5382672 RL ESTROGENS-TOTAL 1,064.00 5382677 RL ESTRIOL SERUM 307.00 5382679 RL ESTRONE 377.00 5382705 RL FECAL FAT QUAL 65.00 5382710 RL FECAL FAT QUANT 320.00 5382728 FERRITIN 214.00 5382731 RL FETAL FIBRONECTIN 554.00 5382746 FOLATE 252.00 5382747 DO NOT USE RL RBC FOLATE 288.00 5382784 RL GAMMA GLOB AG-DM 301.00 5382785 RL IGE 223.00 5382787 RL IGG SUBCLASS 1 2 3 4 413.00 5382805 ARTERIAL BLOOD GAS 202.00 5382810 ABG O2 SAT ONLY 391.00 5382941 RL GASTRIN SERUM 288.00 5382943 RL Glucagon Plasma 123.00 5382945 CSF, GLUCOSE 100.00 5382947 GLUCOSE RANDOM SERUM 116.00 5382950 GLUCOSE TOLERANCE TEST 1 HOUR 124.00 5382951 GTT 3 SAMPLES & DOSE 298.00 5382952 GTT EACH ADD SAMPLE 106.00 5382954 GLUCOSE URINE-24HR 116.00 5382955 GLUCOSE URINE 116.00 5382962 GLUCOSE FINGERSTICK 8.00 5382977 Y-GLUTAMYL TRANSFERASE 139.00 5382985 RL FRUCTOSAMINE 123.00 5383001 RL FOLLICLE STIMULATING HORMONE 252.00 5383002 RL LUTEINIZING HORMONE 286.00 5383003 RL HUMAN GROWTH HORMONE 271.00 5383010 RL HAPTOGLOBIN 252.00 5383018 RL HEAVY METAL QUAN ECH 302.00 5383020 RL ELECTROPHORESIS HGB 221.00 5383036 HGB A1C 221.00 5383050 METHEMOGLOBIN 141.00 5383070 HEMOSIDERIN URINE 71.00 5383088 HISTAMINE PLASMA 124.00 5383090 RL HOMOCYSTEINE 396.00 5383150 RL HOMOVANILLIC ACID 390.00 5383491 RL 17-OH-CORTICOSTEROID 290.00

5383497 RL HIAA OR 5-HIAA 265.00 5383498 RL HYDROXYPROGESTERONE 205.00 5383499 RL 17 HYDROXY PROGESTERONE 88.00 5383505 RL HYDROXYPROLINE TOTAL 680.00 5383516 RL ANTI MITOCHONDRIAL 237.00 5383519 RL ACH RECPTOR BINDING AB 175.00 5383520 OBSOLETE RL TRYPTASE - SERUM 384.00 5383521 RL PANCREATIC ELASTASE - FECAL 236.00 5383522 RL INHIBIN B 169.00 5383525 RL INSULIN TOTAL 146.00 5383527 RL INSULIN FREE 100.00 5383540 IRON SERUM 155.00 5383550 IRON BINDING 163.00 5383582 RL 17 KETOGENIC STEROID 224.00 5383593 RL 17-KETOSTEROIDS FRAC 224.00 5383605 LACTIC ACID 221.00 5383615 RL LACTATE DEHYDROGENASE 106.00 5383625 RL LDH ISOENZYMES 265.00 5383630 RL LACTOFERRIN FECAL BY ELISA 263.00 5383655 RL LEAD 205.00 5383690 LIPASE 116.00 5383701 LDL SUBCLASSES 205.00 5383704 RL NMR LipoProfile w/IR Markers 92.00 5383718 HIGH DENSITY LIPOPROTEIN 164.00 5383721 LDL DIR MEAS 119.00 5383734 RL MAGNESIUM URINE RANDOM 142.00 5383735 RL MAGNESIUM URINE-24HR 142.00 5383736 MAGNESIUM 152.00 5383788 RL AMYLOIDOSIS FAMILIA REFLEX 755.00 5383789 RL THIOPURINE METHYLTRANSFERASE 792.00 5383825 RL MERCURY 189.00 5383835 RL METANEPHRINES URINE 302.00 5383836 RL METANEPHRINES PLASMA 302.00 5383840 RL METHADONE CONFIRMATION 172.00 5383874 RL MYOGLOBIN 91.00 5383880 BRAIN NUTRIURETIC PE 373.00 5383881 N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE 455.00 5383884 RL HCV FIBROSURE PANEL 683.00 5383885 RL ALPHA2 MACROGLOBULIN 153.00 5383886 RL KAPPA / LAMBDA QUANT FREE LIGHT CHAIN 116.00 5383887 RL NICOTINE SERUM 171.00 5383901 RL JAK2 GENE MUTATION QUALITATIVE 765.00 5383915 RL 5' NUCLEOTIDASE 36.00 5383918 RL METHYLMALONIC ACID 444.00 5383919 RL ORGANIC ACIDS SCREEN URINE 131.00 5383925 RL MORPHINE QUAN 365.00 5383926 RL FENTANYL URINE 261.00 5383927 RL BUPRENORPHINE URINE 229.00 5383928 RL OPIATES CONFIRMATION & QUANTITATION 172.00 5383929 RL PROPOXYPHENE/METABOLITE CONF 172.00 5383930 RL OSMO-SERUM MEASURED 160.00 5383935 RL OSMO-URINE MEASURED 160.00

5383937 RL OSTEOCALCIN 57.00 5383945 RL OXALATE URINE 226.00 5383970 RL PTH 502.00 5383986 RL PH-BODY FLUID 391.00 5383992 RL PHENCYCLIDINE CONFIRMATION 131.00 5383993 RL CALPROTECTIN, FECAL 544.00 5384022 RL CHLORPROMAZINE SERUM 340.00 5384030 PKU PHENYLALANINE 79.00 5384031 RL PHENYLALANINE 423.00 5384060 RL ACID PHOS TOTAL 168.00 5384075 ALK PHOS 124.00 5384080 RL ALK PHOS ISOENZYMES 294.00 5384100 PHOSPHORUS 92.00 5384105 PHOSPHORUS URINE 160.00 5384106 RL PHOSPHORUS URINE-24HR 160.00 5384131 POTASSIUM PLASMA 112.00 5384132 POTASSIUM 112.00 5384133 POTASSIUM URINE 131.00 5384134 POTASSIUM URINE-24HR 139.00 5384140 RL PREGNENOLONE 294.00 5384144 RL PROGESTERONE SERUM 294.00 5384145 RL PROCALCITONIN SERUM 78.00 5384146 RL PROLACTIN 298.00 5384151 PSA SCREENING 299.00 5384152 RL PSA COMPLEX 287.00 5384153 PSA DIAGNOSTIC 299.00 5384154 RL PSA FREE & TOTAL 345.00 5384155 TOTAL PROTEIN SERUM 139.00 5384156 PROTEIN URINE-24 HR 88.00 5384157 BODY FLUID PROTEIN 139.00 5384158 URINE PROTEIN RANDOM 139.00 5384159 RL PSA ULTRA SENSITIVE 65.00 5384165 RL PROTEIN ELECTROPHORESIS 176.00 5384181 RL MAG ANTIBODY, IGM WESTERN BLOT 233.00 5384182 *CRMP-5-IgG WESTERN BLOT 81.00 5384202 RL PROTOPORPHYRIN 190.00 5384206 RL PROINSULIN 123.00 5384207 RL B6 VITAMIN 443.00 5384233 RL ESTROGEN RECEPTOR 761.00 5384238 RL ACETYLCHOLINE RECPT 597.00 5384239 RL SOLUBLE TRANSFERRIN RECEPTOR 83.00 5384244 RL RENIN ACTIVITY\RESP 365.00 5384252 RL B2 RIBOFLAVIN VITAMIN 317.00 5384255 RL SELENIUM 431.00 5384260 RL SEROTONIN SERUM 260.00 5384270 SEX HORMONE BINDING GLOBULIN 160.00 5384295 SODIUM 106.00 5384300 URINE SODIUM, RANDOM 131.00 5384301 SODIUM URINE-24HR 131.00 5384307 RL SOMATOSTATIN 453.00 5384315 SPECIFIC GRAVITY OTH 57.00 5384376 RL FECAL REDUCING SUBSTANCE 25.00

5384402 RL TESTOSTERONE FREE 411.00 5384403 RL TESTOSTERONE TOTAL 372.00 5384425 RL B1 VITAMIN 364.00 5384432 RL THYROGLOBULIN 498.00 5384436 RL T4 (THYROXINE) 210.00 5384439 FREE THYROXINE 252.00 5384440 THYROXINE, FREE, BY DIALYSIS 252.00 5384442 RL TBG THYRO BIND GLOB 106.00 5384443 TSH 240.00 5384445 RL TSI THYROID STIM 610.00 5384446 RL E VITAMIN 317.00 5384450 AST 155.00 5384460 ALT 155.00 5384478 TRIGLYCERIDES 96.00 5384479 DO NOT ORDER RL T3 OR T4 UPTAKE 170.00 5384480 RL T3 239.00 5384481 RL T3 FREE 365.00 5384482 RL T3 REVERSE 525.00 5384484 TROPONIN 270.00 5384510 RL TYROSINE 423.00 5384520 BLOOD UREA NITROGEN 112.00 5384540 UREA URINE 106.00 5384541 UREA URINE-24HR 106.00 5384545 UREA CLEARANCE 112.00 5384550 URIC ACID 146.00 5384560 URIC ACID URINE 108.00 5384561 URINE URIC ACID-24HR 108.00 5384585 RL VMA URINE 309.00 5384588 RL VASOPRESSIN (ADH) 596.00 5384590 RL A VITAMIN 317.00 5384591 RL B3 VITAMIN 316.00 5384597 RL K VITAMIN 200.00 5384630 RL ZINC SERUM OR URINE 274.00 5384681 RL C-PEPTIDE 265.00 5384702 PREG TEST QUANT 272.00 5384703 PREG TEST SERUM 149.00 5385307 ACTIVATED PROFILE C RESISTANCE 71.00 5385520 RL HEPARIN 345.00 5386038 RL ANTINUCLEAR ANTIBODY 123.00 5386141 C-REACTIVE PROTEIN 139.00 5386160 RL COMP C3 167.00 5386235 RL SSA (ANTI-RO) 245.00 5386236 RL ANTI-RNP IgG 48.00 5386255 RL STRIATED MUSCLE AB 286.00 5386256 SMOOTH MUSCLE ANTIBODIES TITER-BILLING 123.00 5386294 RL BLADDER TUMOR ANTIGEN 149.00 5386300 RL CA 15-3 298.00 5386301 RL CA 19-9 233.00 5386317 RL STREP PNEUMO AB IG G 23 SEROTYPES 1,014.00 5386332 RL C1Q BINDING ASSAY 226.00 5386336 RL INHIBIN A 257.00 5386341 *ISLET CELL ANTIBODY 67.00

5386355 *B Cells Total Count 110.00 5386356 RL B-CELL IMMUNODEFICIENCY PANEL 832.00 5386357 *Natural Killer Cells Total Count 110.00 5386360 RL LYMPHOCYTE SUBSET PANEL 4 167.00 5386609 RL Listeria 38.00 5386631 RL CHLAMYDIA PANEL 104.00 5386632 *RL CHLAMYDIA PANEL 111.00 5386666 RL EHRLICHIA CHAFFEENSIS (EASTERN) 149.00 5386671 *RL SACCHAROMYCES CEREVISIAE AB IgG, S 194.00 5386689 RL WESTERN BLOT 48.00 5386701 RL HUMAN IMMUNODEFICIENCY VIRUS 210.00 5386705 RL HEP B CORE AB IGM 180.00 5386757 RL RICKETTSIA RICKETTSII AB (IGG &IGM) 119.00 5386965 BB POOLING PLTS 377.00 5387015 RL BABESIA MICROTI 117.00 5387116 AFB CULTURE 212.00 5387172 PINWORM EXAM 71.00 5387206 RL CRYPTOSPORIDIUM 129.00 5387290 RL VARICELLA ANTIGEN 345.00 5387529 RL HSV PCR 194.00 5387531 RL CULTURE STOOL CAMPYLOBACTER 139.00 5387532 RL Human Herpesvirus-6 Molecular Detect 102.00 5387536 RL HIV 1 RNA QUANTITATIVE PCR 537.00 5387591 *GC DIRECT PROBE 170.00 5387621 RL HPV PROBE 239.00 5387635 *RL SARS Coronavirus with CoV-2 RNA 413.00 5387651 RL GROUP A STREP DNA 153.00 5387662 RL Zika Virus PCR Serum 610.00 5387780 RL OLANZAPINE 260.00 5387798 RL EHRLICHIA & ANAPLASMA BY PCR 179.00 5387799 RL BK VIRUS, QUANTITATIVE, PCR 677.00 5387801 RL GONOCOCCUS / CHLAMYDIA URINE 225.00 5387802 RL CULTURE KOH PREP FUNGAL 129.00 5387880 RAPID STREP A WITH REFLEX TO CULTURE 71.00 5387899 RL STREP PNEUMO Ag - URINE 248.00 5387902 RL GENOTYPING HEP C 1,175.00 5388184 RL FLOW CYTOMETRY 356.00 5388185 *FLOW CYTOMETRY EA ADDITIONAL 142.00 5388230 RL ADD ON FOR 88262 95.00 5388262 RL CHROMOSOME ANALYSIS PERIPHERAL BLOOD 569.00 5388291 RL ADD ON FOR 88262 113.00 5388300 DO NOT USE M BLOOD TYPE ABO 65.00 5388302 DO NOT USE M BLOOD RH TYPE 45.00 5388304 M BLOOD ADMINISTRATION 624.00 5388308 M BLOOD LEUKOCYTE REDUCED 295.00 5388310 M FRESH FROZEN PLASMA 133.00 5389581 RL MYCOPLASMA PNEUMONIAE MOLECULAT DETE 568.00 5390299 RL KEPPRA 233.00 5393302 RL LEFLUNOMIDE 572.00 5397303 RL ERHLICIA EASTERN 119.00 5398389 RL CELIAC HLA GENOTYPING 868.00 5398834 RL OXCARBAZEPINE METABOLITE 86.00

5398835 RL GABAPENTIN LEVEL 128.00 5398836 RL ZIPRASIDONE (GEODEN) 179.00 5398837 RL AMIODARONE 86.00 5398838 RL LACOSAMIDE 357.00 5398930 RL CLOZAPINE 87.00 5400306 M COC URINE DRUG 25.00 5409016 M BB LR PRBCS UNIT 978.00 5409017 M RL BB FRESH FROZEN PLASMA UNIT 538.00 5483519 RL MUSCLE SPECIFIC KINASE MUSK AUTOANTIB 1,365.00 5486003 LATEX RAST PANEL 160.00 5486255 RL SMOOTH MUSCLE AB 41.00 5680362 M SMALL BOWEL SERIES HD AIR 434.00 5683883 RL C1 ESTERASE INHIBITOR ANTIGEN SERU 57.00 5684410 *RL TESTOSTERONE BIOAVAILIABLE 149.00 5684591 RL VITAMIN B7 H BIOTIN 275.00 6600004 TELEMETRY 406.00 6600005 LONG LEAD INTER & REPORT ONLY 106.00 6693000 EKG W/INTERPRET 12 LEAD 314.00 6693001 POC EKG W/INTERPRET 12 LEAD 245.00 6693005 EKG 12 LEAD 245.00 6693010 EKG INTERP 69.00 6693011 POC EKG INTERP 69.00 6693012 POC EKG INTERP 69.00 6693013 DEMURO EKG W/INTERPRET 12 LEAD 314.00 6693040 LONG LEAD W/INTERP & REPORT 106.00 6693041 LONG LEAD 53.00 6693225 HOLTER MONITOR 864.00 6800011 OPTIC FORAMINA LT 399.00 6800012 OPTIC FORAMINA RT 399.00 6800013 ORBITS COMP MIN 4 VW 423.00 6800014 SINUSES LTD LESS THAN 3 VW 271.00 6800015 SINUSES COMP MIN 3 VW 502.00 6800017 SKULL LTD LESS THAN 4 VW 354.00 6800018 SKULL COMP MIN 4 VW 604.00 6800019 TMJ OPEN AND CLOSED MOUTH LT 251.00 6800020 TMJ OPEN AND CLOSED MOUTH RT 251.00 6800021 TMJ OPEN AND CLOSED MOUTH BIL 564.00 6800022 CEPHALEMETRY 377.00 6800023 NECK SOFT TISSUE 377.00 6800024 PHARYNX/LARYNX 377.00 6800025 CMPLX DYN PHARYN & SPEECH EVAL 634.00 6800026 CHEST PORTABLE HNH 294.00 6800027 CHEST SINGLE VW 252.00 6800028 CHEST 2 VW 455.00 6800029 CHEST W/ API LOR 629.00 6800030 CHEST W/ OBLIQUES 634.00 6800031 CHEST W FLUOROSCOPY 508.00 6800032 CHEST COMP 507.00 6800033 CHEST COMP MIN4 VWS W FLUORO 570.00 6800034 CHEST DECUBS BUCKY 365.00 6800035 RIBS LT 507.00 6800036 RIBS RT 507.00

6800037 RIBS W/ PA CHEST RT 569.00 6800038 RIBS W/ PA CHEST LT 559.00 6800039 RIBS BIL 638.00 6800040 RIBS W/ PA CHEST BIL 618.00 6800041 STERNUM MIN 2 VW 396.00 6800042 STERNOCLAVICULAR JT MIN 3 VW LT 356.00 6800043 STERNOCLAVICULAR JT MIN 3 VW RT 356.00 6800044 THORACOLUMBAR 2-3 VW 649.00 6800045 SPINE SINGLE VW 314.00 6800046 CERVICAL SPINE AP LAT 353.00 6800047 CERVICAL SPINE COMP MIN 4 VW 690.00 6800048 CERVICAL SPINE W FLEX EXT 806.00 6800050 THORACIC SPINE AP LAT 569.00 6800051 THORACIC SPINE 3 VW 422.00 6800052 THORACIC W/ OBLIQUES 611.00 6800053 THORACOLUMBAR JUNCTION MIN 2 VW 699.00 6800055 LUMBOSACRAL SPINE 2-3 VW 396.00 6800056 LUMBOSACRAL W/ OBLIQUES 742.00 6800057 LUMBOSACRAL W/ BEND 739.00 6800058 SP LUMBOSAC BEND ONLY>4 VWS 739.00 6800059 PELVIS 1-2 VW 365.00 6800060 PELVIS COMP MIN 3 VW 444.00 6800061 SACROILIAC JT LESS THAN 3 VW 422.00 6800062 SACROILIAC JT 485.00 6800063 SACRUM COCCYX 422.00 6800064 CLAVICLE LT 422.00 6800065 CLAVICLE RT 422.00 6800066 SCAPULA LT 477.00 6800067 SCAPULA RT 477.00 6800068 SHOULDER SINGLE LT 333.00 6800069 SHOULDER SINGLE RT 333.00 6800070 SHOULDER MIN 2 VW LT 465.00 6800071 SHOULDER MIN 2 VW RT 465.00 6800072 AC JOINTS 416.00 6800073 HUMERUS 2 VW LT 386.00 6800074 HUMERUS 2 VW RT 386.00 6800075 ELBOW 2 VW LT 316.00 6800076 ELBOW 2 VW RT 316.00 6800077 ELBOW MIN 3 VW LT 443.00 6800078 ELBOW MIN 3 VW RT 443.00 6800079 FOREARM 2 VW LT 422.00 6800080 FOREARM 2 VW RT 422.00 6800081 UPPR EXT INFANT MIN 2 VW LT 294.00 6800082 UPPR EXTINFANT MIN 2 VW RT 294.00 6800083 WRIST AP LAT LT 422.00 6800084 WRIST AP LAT RT 422.00 6800085 WRIST MIN 3 VW LT 422.00 6800086 WRIST MIN 3 VW RT 422.00 6800087 HAND 2 VW LT 365.00 6800088 HAND 2 VW RT 365.00 6800089 HAND MIN 3 VW LT 422.00 6800090 HAND MIN 3 VW RT 422.00

6800091 FINGER(S) MIN 2 VW LT 333.00 6800092 FINGER(S) MIN 2 VW RT 333.00 6800093 HIP SINGLE VW LT 337.00 6800094 HIP SINGLE VW RT 337.00 6800095 HIP 2-3 VW LT 631.00 6800096 HIP 2-3 VW RT 631.00 6800097 HIP W/ AP PELVIS 2 VW BIL 815.00 6800100 FEMUR 2 VW LT 468.00 6800101 FEMUR 2 VW RT 468.00 6800102 KNEE 1-2 VW LT 386.00 6800103 KNEE 1-2 VW RT 386.00 6800104 KNEE 3 VW RT 455.00 6800105 KNEE 3 VW LT 455.00 6800106 KNEE W/ TUNN PAT STAND 601.00 6800107 KNEE MIN 4 VW RT 601.00 6800108 KNEE MIN 4 VW LT 601.00 6800109 KNEE STANDING BIL 357.00 6800110 TIBFIB 2 VW LT 422.00 6800111 TIBFIB 2 VW RIGHT 422.00 6800112 LOW EXT INFANT MIN 2 VW LT 288.00 6800113 LOW EXT INFANT MIN 2 VW RT 288.00 6800114 ANKLE 2 VW LT 333.00 6800115 ANKLE 2 VW RT 333.00 6800116 ANKLE MIN 3 VW LT 422.00 6800117 ANKLE MIN 3 VW RT 422.00 6800118 FOOT 2 VW LT 292.00 6800119 FOOT 2 VW RT 292.00 6800120 FOOT MIN 3 VW LT 485.00 6800121 FOOT MIN 3 VW RT 485.00 6800122 OS CALCIS LT 402.00 6800123 OS CALCIS RT 402.00 6800124 TOE (S) MIN 2 VW LT 314.00 6800125 TOE (S) MIN 2 VW RT 314.00 6800126 ABDOMEN SINGLE VW 421.00 6800127 ABDOMEN FLAT UPRIGHT 471.00 6800128 ABDOMEN FLAT UPRIGHT W/ PA CXR 546.00 6800129 ESOPHAGRAM 671.00 6800130 SWALLOWING FUNCTION 671.00 6800131 UPPER GI 878.00 6800132 UPPER GI TRACT W/ ABDOMEN 884.00 6800133 UPPER GI SMALL BOWEL 1,087.00 6800134 UPPER GI AIR CONTRAST 967.00 6800135 GI SERIES WITH KUB 863.00 6800136 UPPER GI AIR HD BARIUM SBFT 1,125.00 6800137 SMALL BOWEL SERIES 569.00 6800138 BARIUM ENEMA 884.00 6800139 BARIUM ENEMA W/ AIR 1,011.00 6800140 GALLBLADDER ORAL 468.00 6800142 IVU W WO TOMOS 878.00 6800143 LOOPOGRAM 674.00 6800144 CYSTOGRAPHY 538.00 6800145 URETHROCYSTO VOID 674.00

6800147 VENOGRAM UNILATERAL 1,222.00 6800148 VENOGRAM BILATERAL 1,369.00 6800149 FLUOROSCOPY UP TO 1 HOUR 634.00 6800150 STRESS VIEW(S) ANY JOINT 465.00 6800151 CHILD NOSE RECTUM FOREIGN BODY 609.00 6800152 BONE AGE STUDY 316.00 6800153 OSSEOUS SURVEY LTD 815.00 6800154 OSSEOUS SURVEY COMP 978.00 6800155 ABUSE SURVEY INFANT 735.00 6800156 JOINT SURVEY 1 VIEW 2+ JOINTS 373.00 6800157 DEXA 1 + SITES AXIAL SKELETON 626.00 6800158 DEXA PERI FOREARM 184.00 6800159 FISTULAGRAM 674.00 6800168 TOMOGRAPHY 583.00 6800170 US ECHOENCEPH COMPLETE 551.00 6800171 US THYROID 671.00 6800172 US PERICARDIAL EFFUSION 609.00 6800174 US BREAST COMP LT 569.00 6800175 US BREAST COMP RT 569.00 6800176 US ABDOMINAL COMP 967.00 6800177 US GALLBLADDER 784.00 6800178 US LIVER 784.00 6800179 US PANCREAS 784.00 6800180 US SPLEEN 784.00 6800181 US RUQ 784.00 6800182 US APPENDIX 784.00 6800183 US ABDOMEN LTD 784.00 6800184 US ABDOMINAL LTD F/U 784.00 6800185 US RETROPERITONEAL 853.00 6800186 US KIDNEY AND BLADDER 853.00 6800187 US KIDNEY 713.00 6800188 US BLADDER 713.00 6800189 US ABDOMINAL AORTA 713.00 6800190 US OB LESS THAN 14 WEEKS GESTATION 394.00 6800191 US OB <14 WEEKS EACH ADD GESTATION 394.00 6800192 US PREGNANCY DIAGNOSIS 634.00 6800193 US >14WEEKS PREGNANCY 525.00 6800194 US OB>14 WKS EA ADD GESTATION 883.00 6800195 US OB DETAILED SNGL GESTATION 702.00 6800196 US OB DETAILED EA ADD GESTATION 946.00 6800197 US FETAL AGE 512.00 6800198 US FETAL GROWTH 512.00 6800199 US PLACENTA LOCALIZATIO 512.00 6800200 US PREGNANCY LTD 394.00 6800201 US PREGNANCY FOLLOW UP 394.00 6800202 US ECTOPIC PREGNANCY 774.00 6800203 US OB TRANSVAGINAL 394.00 6800204 US BIOPHYSICAL PROFILE 835.00 6800205 US TRANSVAGINAL NON OB 849.00 6800206 US PELVIC NON OBSTETRIC 849.00 6800207 US PELVIC LTD FOR F/U 413.00 6800208 US SCROTUM AND CONTENTS 634.00

6800209 US TISSUE MASS EXT 569.00 6800210 US GUIDE PERICARDIOCENTESIS 634.00 6800211 US BIOPSY 634.00 6800212 US SOFT TISS HEAD AND NECK 569.00 6800213 US UNLISTED US PROC 569.00 6800214 US SOFT TISSUE MASS CHEST 507.00 6800215 US TISSUE MASS ABDOMEN 507.00 6800216 ECHOCARDIOGRAPHY - LIMITED 1,080.00 6800217 ECHO LTD 507.00 6800218 ECHO DOPP ECHOCARDIOGRAPH 502.00 6800219 US DOPP ECHO LIMITED 357.00 6800220 ECHO DOPP COLOR FLOW VEL 444.00 6800221 US CAROTID ARTERY BIL 1,235.00 6800222 US CAROTID UNIL LIMIT LEFT 601.00 6800223 US CAROTID UNIL LIMIT RIGHT 709.00 6800224 US LOWER EXT ARTERY LTD 823.00 6800225 US SINGLE UPPER EXT ARTERIAL 593.00 6800226 US ARM VEIN DUPLEX COMP BIL 971.00 6800227 US LEG VEIN BIL 849.00 6800228 US LEG VEIN LT 709.00 6800229 US LEG VEIN RT 709.00 6800230 US UPPER EXT VEINS RT 422.00 6800231 US UPPER EXT VEINS LT 422.00 6800232 US RENAL ARTERIES DUPL 1,028.00 6800233 US RENAL ARTERIES DUPL NOT COMPLETED 1,020.00 6800234 US VISCERAL ORGANS DUPLEX LIMITED 837.00 6800235 AORTA/IVC/ILLIA DUPLEX UNI/LTD 837.00 6800236 ISOVUE 84.00 6800237 ORBIT FOREIGN BODY LT 422.00 6800238 ORBIT FOREIGN BODY RT 422.00 6800240 MANDIBLE COMP MIN 4 VW 455.00 6800241 MASTOIDS LESS THAN 3 LT 316.00 6800242 MASTOIDS LESS THAN 3 RT 316.00 6800243 MASTOIDS COMP MIN 3 VW PER SIDE 564.00 6800244 FACIAL BONES LTD LESS THAN 3 VW 316.00 6800245 FACIAL BONES COMP MIN 3 VW 444.00 6800246 NASAL BONES COMP MIN 3 VW 377.00 6800247 US TRANSRECTAL 849.00 6800248 US ANKLE/BRACHIAL INDICIES 487.00 6800249 US LOWER EXT ARTERIES BIL 1,222.00 6800250 TOE GREAT LT 333.00 6800251 TOE SECOND LT 333.00 6800252 TOE THIRD LT 333.00 6800253 TOE FOURTH LT 333.00 6800254 TOE FIFTH LT 333.00 6800255 TOE GREAT RT 333.00 6800256 TOE SECOND RT 333.00 6800257 TOE THIRD RT 333.00 6800258 TOE FOURTH RT 333.00 6800259 TOE FIFTH RT 333.00 6800260 FINGER THUMB RT 333.00 6800261 FINGER SECOND RT 333.00

6800262 FINGER THIRD RT 333.00 6800263 FINGER FOURTH RT 333.00 6800264 FINGER FIFTH RT 333.00 6800265 FINGER THUMB LT 333.00 6800266 FINGER SECOND LT 333.00 6800267 FINGER THIRD LT 333.00 6800268 FINGER FOURTH LT 333.00 6800269 FINGER FIFTH LT 333.00 6800270 HIP W/AP PELVIS LT 897.00 6800271 HIP W/AP PELVIS RT 897.00 6800272 LUMBOSACRAL W/ FLEX EXT 806.00 6800273 MAMMO SCREENING DIGITAL BIL 510.00 6800274 MAMMO DIAG DIGITAL BIL 538.00 6800275 MAMMO DIAG DIGITAL RT 442.00 6800276 MAMMO DIAG DIGITAL LT 442.00 6800277 MAMMO SCREENING DIGITAL LT 510.00 6800278 MAMMO SCREENING DIGITAL RT 510.00 6800339 MANDIBLE PARTIAL LESS THAN 4 VW 314.00 6800340 DEXA BODY COMP 172.00 6800341 VERTEBRAL FRACTURE ASSESSMENT 224.00 6800342 ECHOCARDIOGRAPHY - COMPLETE 1,968.00 6800343 US LIVER TIPS 971.00 6800344 ORBITS FOREIGN BODY 422.00 6800345 US BREAST LTD RT 292.00 6800346 US BREAST LTD LT 292.00 6800350 FEMUR 1 VW RT 334.00 6800351 FEMUR 1 VW LT 334.00 6800352 HIP MIN 4 VW RT 730.00 6800353 HIP MIN 4 VW LT 730.00 6800354 HIP 3-4 VW BIL 897.00 6800355 HIP MIN 5 VW BIL 972.00 6800356 UGI/AIR HDBARIUM W KUB 863.00 6800357 THORACOLUMBAR 4-5 VW 791.00 6800358 THORACOLUMBAR 6 VW 881.00 6800359 LUM SPINE BENDING 2-3 VWS 554.00 6800361 SMALL BOWEL SERIES 114.00 6800362 SMALL BOWEL SERIES HD AIR 434.00 6800363 ESOPHAGRAM AIR HD 178.00 6800364 ESOPH CERVICAL 156.00 6801014 CERVICAL SPINE 2-3 VW 353.00 6801274 MAMMO DIAG TOMO BIL 538.00 6810022 FINE NEEDLE ASPIRATION US 397.00 6819000 PUNCTURE ASPIRATION BREAST CYST 3,270.00 6819001 EACH ADDITIONAL 1,549.00 6867001 GALL BLADDER SONO 611.00 6867942 CYST ASPIRATION RT BREAST 876.00 6876492 CYST ASPIRATION LT BREAST 876.00 6876536 US THYROID 570.00 6876706 US ABDOMINAL AORTA SCREENING 91.00 6876818 BIOPHYSICAL PROFILE 878.00 6876881 US SOFT TISSUE EXT COMP 569.00 6876882 US SOFT TISSUE EXT 596.00

6876883 US BLADDER URINE EVAL 54.00 6876924 US CORE BIOPSY RT BREAST 876.00 6876938 GUIDE CYST LOCATION 377.00 6877061 TOMO DX UNIL 78.00 6877062 TOMO DX BIL 78.00 6877063 TOMO SCREENING 78.00 6878306 WHOLE BODY IMAGING APG PURPOSES ONLY 1,946.00 7000236 ISOVUE 300 MG CT 100ML 194.00 7000237 ISOVUE 300 MG CT 150ML 290.00 7000238 ISOVUE 300 MG CT 50CC 100.00 7000496 CTV HEAD W/CONTRAST 2,984.00 7004175 CTV ABDOMEN PELVIS 2,984.00 7012345 CT HIP W/O CONTRAST RT 2,063.00 7012346 CT FEMUR W/O CONTRAST RT 2,063.00 7012347 CT KNEE W/O CONTRAST RT 2,063.00 7012348 CT TIBFIB W/O CONTRAST RT 2,063.00 7012349 CT ANKLE W/O CONTRAST RT 2,063.00 7012350 CT FOOT W/O CONTRAST RT 2,063.00 7012351 CT HIP W/O CONTRAST LT 2,063.00 7012352 CT FEMUR W/O CONTRAST LT 2,063.00 7012353 CT KNEE W/O CONTRAST LT 2,063.00 7012354 CT TIBFIB W/O CONTRAST LT 2,063.00 7012356 CT ANKLE W/O CONTRAST LT 2,063.00 7012357 CT FOOT W/O CONTRAST LT 2,063.00 7012358 CT HIP W/ CONTRAST LT 2,525.00 7012359 CT FEMUR W/ CONTRAST LT 2,525.00 7012360 CT KNEE W/ CONTRAST LT 2,525.00 7012361 CT TIBFIB W/ CONTRAST LT 2,525.00 7012362 CT ANKLE W/ CONTRAST LT 2,525.00 7012363 CT FOOT W/ CONTRAST LT 2,525.00 7012364 CT HIP W/ CONTRAST RT 2,525.00 7012365 CT FEMUR W/ CONTRAST RT 2,525.00 7012366 CT KNEE W/ CONTRAST RT 2,525.00 7012367 CT TIBFIB W/ CONTRAST RT 2,525.00 7012368 CT ANKLE W/ CONTRAST RT 2,525.00 7012369 CT FOOT W/ CONTRAST RT 2,525.00 7012370 CT HIP W/WO CONTRAST LT 1,821.00 7012371 CT FEMUR W/WO CONTRAST LT 1,821.00 7012372 CT KNEE W/WO CONTRAST LT 1,821.00 7012373 CT TIBFIB W/WO CONTRAST LT 1,821.00 7012374 CT ANKLE W/WO CONTRAST LT 1,821.00 7012375 CT FOOT W/WO CONTRAST LT 1,821.00 7012376 CT FEMUR W/WO CONTRAST RT 1,821.00 7012377 CT KNEE W/WO CONTRAST RT 1,821.00 7012378 CT TIBFIB W/WO CONTRAST RT 1,821.00 7012379 CT ANKLE W/WO CONTRAST RT 1,821.00 7012380 CT FOOT W/WO CONTRAST RT 1,821.00 7012381 CT HIP W/WO CONTRAST RT 1,821.00 7012382 CT SHOULDER W/WO CONTRAST LT 2,353.00 7012383 CT HUMERUS W/ WO CONTRAST LT 2,353.00 7012384 CT ELBOW W/WO CONTRAST LT 2,353.00 7012385 CT FOREARM W/WO CONTRAST LT 2,353.00

7012386 CT WRIST W/WO CONTRAST LT 2,353.00 7012387 CT HAND W/WO CONTRAST LT 2,353.00 7012388 CT SHOULDER W/WO CONTRAST RT 2,353.00 7012389 CT HUMERUS W/WO CONTRAST RT 2,353.00 7012390 CT ELBOW W/WO CONTRAST RT 2,353.00 7012391 CT FOREARM W/WO CONTRAST RT 2,353.00 7012392 CT WRIST W/WO CONTRAST RT 2,353.00 7012393 CT HAND W/WO CONTRAST RT 2,353.00 7012394 CT SHOULDER W/ CONTRAST RT 1,771.00 7012395 CT HUMERUS W/ CONTRAST RT 1,771.00 7012396 CT ELBOW W/ CONTRAST RT 1,771.00 7012397 CT FOREARM W/ CONTRAST RT 1,771.00 7012398 CT WRIST W/ CONTRAST RT 1,771.00 7012399 CT HAND W/ CONTRAST RT 1,771.00 7012400 CT SHOULDER W/ CONTRAST LT 1,771.00 7012401 CT HUMERUS W/ CONTRAST LT 1,771.00 7012402 CT ELBOW W/ CONTRAST LT 1,771.00 7012403 CT FOREARM W/ CONTRAST LT 1,771.00 7012404 CT WRIST W/ CONTRAST LT 1,771.00 7012405 CT HAND W/ CONTRAST LT 1,771.00 7012406 CT SHOULDER W/O CONTRAST RT 2,100.00 7012407 CT HUMERUS W/O CONTRAST RT 2,100.00 7012408 CT ELBOW W/O CONTRAST RT 2,100.00 7012409 CT FOREARM W/O CONTRAST RT 2,100.00 7012410 CT WRIST W/O CONTRAST RT 2,100.00 7012411 CT HAND W/O CONTRAST RT 2,100.00 7012412 CT SHOULDER W/O CONTRAST LT 2,100.00 7012413 CT HUMERUS W/O CONTRAST LT 2,100.00 7012414 CT ELBOW W/O CONTRAST LT 2,100.00 7012415 CT FOREARM W/O CONTRAST LT 2,100.00 7012416 CT WRIST W/O CONTRAST LT 2,100.00 7012417 CT HAND W/O CONTRAST LT 2,100.00 7037206 CTA UPPER EXT RT 2,984.00 7047000 BX NEEDLE LIVER PERQ 1,650.00 7048102 CT BX PANCREAS 2,150.00 7049180 CT BX ABD/RETRO KIDNEY 2,150.00 7060737 CTA LOWER EXT RT 2,525.00 7063657 CTA AORTA W/ RUNOFF 3,371.00 7067377 3D POST PROC UNIT 377.00 7070408 CT IACS W/O CONTRAST 2,100.00 7070418 CT IACS W/ CONTRAST 2,459.00 7070428 CT IACS W/WO CONTRAST 2,100.00 7070450 CT HEAD BRAIN W/O CONTRAST 2,166.00 7070460 CT HEAD BRAIN W/ CONTRAST 2,444.00 7070470 CT HEAD BRAIN W/WO CONTRAST 3,158.00 7070480 CT ORBITS W/O CONTRAST 2,100.00 7070481 CT ORBITS W/ CONTRAST 2,459.00 7070482 CT ORBITS W/WO CONTRAST 2,100.00 7070486 CT SINUS MAXILLOFACIAL W/O CONTRAST 2,429.00 7070487 CT SINUS MAXILLOFACIAL W/ CONTRAST 2,429.00 7070488 CT SINUS FACIAL W/WO CONTRAST 2,733.00 7070490 CT SOFT TISSUE NECK W/O CONTRAST 2,063.00

7070491 CT SOFT TISSUE NECK W/ CONTRAST 2,357.00 7070492 CT SOFT TISSUE NECK W/WO CONTRAST 2,490.00 7070496 CTA HEAD 2,984.00 7070498 CTA NECK 2,984.00 7070500 CT SINUS-LIMITED 1,833.00 7070842 CT SELLA W/WO CONTRAST 2,100.00 7071250 CT CHEST W/O CONTRAST 2,100.00 7071260 CT CHEST W/ CONTRAST 2,644.00 7071270 CT CHEST W/WO CONTRAST 2,906.00 7071275 CTA CHEST 3,431.00 7072119 CTA PELVIS 2,984.00 7072125 CT CERVICAL SPINE W/O CONTRAST 2,324.00 7072126 CT CERVICAL SPINE W/ CONTRAST 2,019.00 7072127 CT CERVICAL SPINE W/WO CONTRAST 2,140.00 7072128 CT THORACIC SPINE W/O CONTRAST 2,324.00 7072129 CT THORACIC SPINE W/ CONTRAST 1,937.00 7072130 CT THORACIC SPINE W/WO CONTRAST 2,140.00 7072131 CT LUMBAR SPINE W/O CONTRAST 2,324.00 7072132 CT LUMBAR SPINE W/ CONTRAST 1,937.00 7072133 CT LUMBAR W/WO CONTRAST 2,140.00 7072191 CAT PELVIS 2,984.00 7072192 CT PELVIS W/O CONTRAST 2,324.00 7072193 CT PELVIS W/ CONTRAST 2,644.00 7072194 CT PELVIS W/WO CONTRAST 2,749.00 7073200 CT UPPER EXTREMITY W/O CONTRAST 2,100.00 7073201 CT UPPER EXTREMITY W/CONTRAST 1,771.00 7073202 CT UPPER EXTREMITY W & WO CONTRAST 2,353.00 7073542 CT ARTHROGRAM SI JOINT 868.00 7073700 CT LOWER EXTREMITY W/O CONTRAST 2,063.00 7073701 CT LOWER EXTREMITY W/CONTRAST 2,525.00 7073702 CT LOWER EXTREMITY W/WO CONTRAST 1,821.00 7074080 CT SELLA W/O CONTRAST 2,100.00 7074081 CT SELLA W/ CONTRAST 2,459.00 7074150 CT ABDOMEN W/O CONTRAST 2,313.00 7074160 CT ABDOMEN W/ CONTRAST 2,644.00 7074170 CT ABDOMEN W/WO CONTRAST 3,723.00 7074174 CTA ABD PELVIS 2,984.00 7074175 CTA ABDOMEN 2,984.00 7074176 CT ABDOMEN PELVIS W/O CONTRAST 2,313.00 7074177 CT ABDOMEN PELVIS W/ CONTRAST 2,644.00 7074178 CT ABDOMEN PELVIS W/WO CONTRAST 3,723.00 7075989 CT FLUID DRAINAGE OR SPEC COLL 1,296.00 7076040 CT SCANOGRAM 534.00 7076360 CT GUIDE NEEDLE BX S&I 2,964.00 7076370 CT PLACEMENT RADIATION FIELD 1,673.00 7076377 3D POST PROCEDURE WORKSTATION 856.00 7076380 CT LMTD OR LOCALIZED FOLLOW UP 1,171.00 7077306 CTA LOWER EXT LT 2,525.00 7078032 CT LD LUNG SCREENING 2,100.00 8012345 MRA SHOULDER W/O CONTRAST RT 2,985.00 8012346 MRA HUMERUS W/O CONTRAST RT 2,985.00 8012347 MRA ELBOW W/O CONTRAST RT 2,985.00

8012348 MRA FOREARM W/O CONTRAST RT 2,985.00 8012349 MRA WRIST W/O CONTRAST RT 2,985.00 8012350 MRA HAND W/O CONTRAST RT 2,985.00 8012351 MRA SHOULDER W/W0 CONTRAST LT 2,985.00 8012352 MRA HUMERUS W/WO CONTRAST LT 2,985.00 8012353 MRA ELBOW W/WO CONTRAST LT 2,985.00 8012354 MRA FOREARM W/WO CONTRAST LT 2,985.00 8012356 MRA WRIST W/WO CONTRAST LT 2,985.00 8012357 MRA HAND W/WO CONTRAST LT 2,985.00 8012358 MRA SHOULDER W/ CONTRAST RT 2,985.00 8012359 MRA HUMERUS W/ CONTRAST RT 2,985.00 8012360 MRA ELBOW W/ CONTRAST RT 2,985.00 8012361 MRA FOREARM W/ CONTRAST RT 2,985.00 8012362 MRA WRIST W/ CONTRAST RT 2,985.00 8012363 MRA HAND W/ CONTRAST RT 2,985.00 8012364 MRA FEMUR W/WO CONTRAST LT 3,045.00 8012365 MRA TIBFIB W/WO CONTRAST LT 3,045.00 8012366 MRA FOOT W/WO CONTRAST LT 3,045.00 8012367 MRA HIP W/WO CONTRAST LT 3,045.00 8012368 MRA KNEE W/WO CONTRAST LT 3,045.00 8012369 MRA ANKLE W/WO CONTRAST LT 3,045.00 8012370 MRA FEMUR W/WO CONTRAST RT 3,045.00 8012371 MRA TIBFIB W/WO CONTRAST RT 3,045.00 8012372 MRA FOOT W/WO CONTRAST RT 3,045.00 8012373 MRA HIP W/WO CONTRAST RT 3,045.00 8012374 MRA KNEE W/WO CONTRAST RT 3,045.00 8012375 MRA ANKLE W/WO CONTRAST RT 3,045.00 8012376 MRA FEMUR W/ CONTRAST RT 3,045.00 8012377 MRA TIBFIB W/ CONTRAST RT 3,045.00 8012378 MRA FOOT W/ CONTRAST RT 3,045.00 8012379 MRA HIP W/ CONTRAST RT 3,045.00 8012380 MRA KNEE W/ CONTRAST RT 3,045.00 8012381 MRA ANKLE W/ CONTRAST RT 3,045.00 8012382 MRA FEMUR W/ CONTRAST LT 3,045.00 8012383 MRA TIBFIB W/ CONTRAST LT 3,045.00 8012384 MRA FOOT W/ CONTRAST LT 3,045.00 8012385 MRA HIP W/ CONTRAST LT 3,045.00 8012386 MRA KNEE W/ CONTRAST LT 3,045.00 8012387 MRA ANKLE W/ CONTRAST LT 3,045.00 8012388 MRA FEMUR W/O CONTRAST LT 3,045.00 8012389 MRA TIBFIB W/O CONTRAST LT 3,045.00 8012390 MRA FOOT W/O CONTRAST LT 3,045.00 8012391 MRA HIP W/O CONTRAST LT 3,045.00 8012392 MRA KNEE W/O CONTRAST LT 3,045.00 8012393 MRA ANKLE W/O CONTRAST LT 3,045.00 8012394 MRA FEMUR W/O CONTRAST RT 3,045.00 8012395 MRA TIBFIB W/O CONTRAST RT 3,045.00 8012396 MRA FOOT W/O CONTRAST RT 3,045.00 8012397 MRA HIP W/O CONTRAST RT 3,045.00 8012398 MRA KNEE W/O CONTRAST RT 3,045.00 8012399 MRA ANKLE W/O CONTRAST RT 3,045.00 8012400 MRI SHOULDER W/ CONTRAST RT 2,567.00

8012401 MRI ELBOW W/ CONTRAST RT 2,567.00 8012402 MRI WRIST W/ CONTRAST RT 2,567.00 8012406 MRI SHOULDER W/ CONTRAST LT 2,567.00 8012407 MRI ELBOW W/ CONTRAST LT 2,567.00 8012408 MRI WRIST W/ CONTRAST LT 2,567.00 8012409 MRI SHOULDER W/O CONTRAST RT 2,903.00 8012410 MRI ELBOW W/O CONTRAST RT 2,903.00 8012411 MRI WRIST W/O CONTRAST RT 2,903.00 8012412 MRI SHOULDER W/O CONTRAST LT 2,903.00 8012413 MRI ELBOW W/O CONTRAST LT 2,903.00 8012414 MRI WRIST W/O CONTRAST LT 2,903.00 8012415 MRI SHOULDER W/WO CONTRAST LT 4,013.00 8012416 MRI ELBOW W/WO CONTRAST LT 4,013.00 8012417 MRI WRIST W/WO CONTRAST LT 4,013.00 8012418 MRI SHOULDER W/WO CONTRAST RT 4,013.00 8012419 MRI ELBOW W/WO CONTRAST RT 4,013.00 8012420 MRI WRIST W/WO CONTRAST RT 4,013.00 8012421 MRI HUMERUS W/ CONTRAST LT 3,764.00 8012422 MRI FOREARM W/ CONTRAST LT 3,764.00 8012423 MRI HAND W/ CONTRAST LT 3,764.00 8012424 MRI HUMERUS W/ CONTRAST RT 3,764.00 8012425 MRI FOREARM W/ CONTRAST RT 3,764.00 8012426 MRI HAND W/ CONTRAST RT 3,764.00 8012427 MRI HUMERUS W/O CONTRAST LT 2,531.00 8012428 MRI FOREARM W/O CONTRAST LT 2,531.00 8012430 MRI HAND W/O CONTRAST LT 2,531.00 8012431 MRI HUMERUS W/O CONTRAST RT 2,531.00 8012432 MRI FOREARM W/O CONTRAST RT 2,531.00 8012433 MRI HAND W/O CONTRAST RT 2,531.00 8012434 MRI HUMERUS W/WO CONTRAST RT 3,573.00 8012435 MRI FOREARM W/WO CONTRAST RT 3,573.00 8012436 MRI HAND W/WO CONTRAST RT 3,573.00 8012437 MRI HUMERUS W/WO CONTRAST LT 3,573.00 8012438 MRI FOREARM W/WO CONTRAST LT 3,573.00 8012439 MRI HAND W/WO CONTRAST LT 3,573.00 8012440 MRI HIP W/WO CONTRAST LT 4,020.00 8012441 MRI KNEE W/WO CONTRAST LT 4,020.00 8012442 MRI ANKLE W/WO CONTRAST LT 4,020.00 8012443 MRI HIP W/WO CONTRAST RT 4,020.00 8012444 MRI KNEE W/WO CONTRAST RT 4,020.00 8012445 MRI ANKLE W/WO CONTRAST RT 4,020.00 8012446 MRI HIP W/ CONTRAST LT 3,338.00 8012447 MRI KNEE W/ CONTRAST LT 3,338.00 8012448 MRI ANKLE W/ CONTRAST LT 3,338.00 8012449 MRI HIP W/ CONTRAST RT 3,338.00 8012450 MRI KNEE W/ CONTRAST RT 3,338.00 8012451 MRI ANKLE W/ CONTRAST RT 3,338.00 8012452 MRI HIP W/O CONTRAST LT 2,914.00 8012453 MRI KNEE W/O CONTRAST LT 2,914.00 8012454 MRI ANKLE W/O CONTRAST LT 2,914.00 8012455 MRI HIP W/O CONTRAST RT 2,914.00 8012456 MRI KNEE W/O CONTRAST RT 2,914.00

8012457 MRI ANKLE W/O CONTRAST RT 2,914.00 8012458 MRI FEMUR W/ CONTRAST RT 3,338.00 8012459 MRI TIBFIB W/ CONTRAST RT 3,338.00 8012460 MRI FOOT W/ CONTRAST RT 3,338.00 8012461 MRI FEMUR W/ CONTRAST LT 3,338.00 8012462 MRI TIBFIB W/ CONTRAST LT 3,338.00 8012463 MRI FOOT W/ CONTRAST LT 3,338.00 8012464 MRI FEMUR W/O CONTRAST RT 2,984.00 8012465 MRI TIBFIB W/O CONTRAST RT 3,168.00 8012466 MRI FOOT W/O CONTRAST RT 3,168.00 8012467 MRI FEMUR W/O CONTRAST LT 3,168.00 8012468 MRI TIBFIB W/O CONTRAST LT 3,168.00 8012469 MRI FOOT W/O CONTRAST LT 3,168.00 8012470 MRI FEMUR W/WO CONTRAST LT 4,118.00 8012471 MRI TIBFIB W/WO CONTRAST LT 4,118.00 8012472 MRI FOOT W/WO CONTRAST LT 4,118.00 8012473 MRI FEMUR W/WO CONTRAST RT 4,118.00 8012474 MRI TIBFIB W/WO CONTRAST RT 4,118.00 8012475 MRI FOOT W/WO CONTRAST RT 4,118.00 8022345 MRA SHOULDER W/O CONTRAST LT 2,985.00 8022346 MRA HUMERUS W/O CONTRAST LT 2,985.00 8022347 MRA ELBOW W/O CONTRAST LT 2,985.00 8022348 MRA FOREARM W/O CONTRAST LT 2,985.00 8022349 MRA WRIST W/O CONTRAST LT 2,985.00 8022350 MRA HAND W/O CONTRAST LT 2,985.00 8022351 MRA SHOULDER W/W0 CONTRAST RT 2,985.00 8022352 MRA HUMERUS W/WO CONTRAST RT 2,985.00 8022353 MRA ELBOW W/WO CONTRAST RT 2,985.00 8022354 MRA FOREARM W/WO CONTRAST RT 2,985.00 8022356 MRA WRIST W/WO CONTRAST RT 2,985.00 8022357 MRA HAND W/WO CONTRAST RT 2,985.00 8022358 MRA SHOULDER W/ CONTRAST LT 2,985.00 8022359 MRA HUMERUS W/ CONTRAST LT 2,985.00 8022360 MRA ELBOW W/ CONTRAST LT 2,985.00 8022361 MRA FOREARM W/ CONTRAST LT 2,985.00 8022362 MRA WRIST W/ CONTRAST LT 2,985.00 8022363 MRA HAND W/ CONTRAST LT 2,985.00 8070336 MRI TMJ 2,972.00 8070540 MRI FACE NECK ORBIT W/O CONTRAST 3,774.00 8070542 MRI FACE NECK ORBIT W/ CONTRAST 4,342.00 8070543 MRI FACE NECK ORBIT W/WO CONTRAST 4,992.00 8070544 MRA HEAD W/O CONTRAST 3,057.00 8070545 MRA HEAD W/ CONTRAST 3,594.00 8070546 MRA HEAD W/WO CONTRAST 4,309.00 8070547 MRA NECK W/O CONTRAST 3,057.00 8070548 MRA NECK W/ CONTRAST 3,594.00 8070549 MRA NECK W/WO CONTRAST 4,309.00 8070551 MRI BRAIN W/O CONTRAST 3,522.00 8070552 MRI BRAIN W/ CONTRAST 4,053.00 8070553 MRI BRAIN W/WO CONTRAST 4,866.00 8071550 MRI CHEST W/O CONTRAST 4,885.00 8071551 MRI CHEST W/ CONTRAST 5,133.00

8071552 MRI CHEST W/WO CONTRAST 5,301.00 8071555 MRA CHEST W/WO CONTRAST 4,982.00 8071556 MRA CHEST W/O CONTRAST 4,106.00 8071557 MRA CHEST W/ CONTRAST 4,705.00 8072141 MRI CERVICAL W/O CONTRAST 3,801.00 8072142 MRI CERVICAL W/ CONTRAST 4,372.00 8072146 MRI THORACIC W/O CONTRAST 4,149.00 8072147 MRI THORACIC W/ CONTRAST 3,764.00 8072148 MRI LUMBAR W/O CONTRAST 3,939.00 8072149 MRI LUMBAR W/ CONTRAST 4,528.00 8072156 MRI CERVICAL W/WO CONTRAST 5,251.00 8072157 MRI THORACIC W/WO CONTRAST 5,719.00 8072158 MRI LUMBAR W/WO CONTRAST 5,437.00 8072159 MRA ANY SPINE W/WO CONTRAST 4,230.00 8072195 MRI PELVIS W/O CONTRAST 3,889.00 8072196 MRI PELVIS W/ CONTRAST 4,474.00 8072197 MRI PELVIS W/WO CONTRAST 5,367.00 8072198 MRA PELVIS W/ CONTRAST 3,965.00 8072199 MRA PELVIS W/O CONTRAST 3,338.00 8072200 MRA PELVIS W/WO CONTRAST 4,617.00 8073218 MRI UPPER EXT N/A JT W/O CONTRAST 2,531.00 8073219 MRI UPPER EXT NOT JT W/CONTRAST 3,764.00 8073220 MRI UPPER EXT NOT JT W/WO 3,573.00 8073221 MRI UPPER EXT ANY JOINT W/O 2,903.00 8073222 MRI UPPER EXT JT W/ CONTRAST RT 2,567.00 8073223 MRI UPPER EXT ANY JOINT W/WO CONTRAST 4,013.00 8073225 MRA UPPER EXT W/WO 2,985.00 8073226 MRA UPPER EXT W CONTRAST 2,985.00 8073227 MRA UPPER EXT W/O CONTRAST 2,985.00 8073270 MRI UPPER EXT W/O CONTRAST RT 3,764.00 8073271 MRI UPPER EXT W/O CONTRAST LT 3,764.00 8073274 MRI UPPER EXT W/WO CONTRAST RT 4,449.00 8073275 MRI UPPER EXT W/WO CONTRAST LT 4,449.00 8073276 MRI UPPER EXT JT W/O CONTRAST RT 3,594.00 8073277 MRI UPPER EXT JT W/O CONTRAST LT 3,594.00 8073279 MRI UPPER EXT JT W/ CONTRAST LT 2,567.00 8073280 MRI UPPER EXT JT W/WO CONTRAST RT 4,279.00 8073281 MRI UPPER EXT JT W/WO CONTRAST LT 4,279.00 8073282 MRA UPPER EXT W/WO CONTRAST RT 2,567.00 8073283 MRA UPPER EXT W/WO CONTRAST LT 2,567.00 8073287 MRI UPPER EXT W/ CONTRAST RT 3,764.00 8073288 MRI UPPER EXT W/ CONTRAST LT 3,764.00 8073718 MRI LOWER EXT NOT JOINT W/WO CONTRAST 2,984.00 8073719 MRI LOWER EXT W/ CONTRAST RT 3,338.00 8073720 MRI LOWER EXT ANY JOINT W/WO CONTRAST 4,118.00 8073721 MRI LOWER EXT JOINT W/O CONTRAST 2,914.00 8073722 MRI LOWER EXT JT W/CONTRAST 3,338.00 8073723 MRI LOWER EXT JOINT W/WO CONTRAST 4,020.00 8073725 MRA LOWER EXTREMITY W/WO CONTRAST 3,045.00 8073726 MRA LOWER EXTREMITY W/O CONTRAST 3,045.00 8073727 MRA LOWER EXTREMITY W CONTRAST 3,045.00 8073784 MRI LOWER EXT W/O CONTRAST RT 3,168.00

8073785 MRI LOWER EXT W/O CONTRAST LT 3,168.00 8073786 MRI LOWER EXT W/ CONTRAST LT 3,338.00 8073789 MRI LOWER EXT W/WO CONTRAST RT 4,118.00 8073790 MRI LOWER EXT W/WO CONTRAST LT 4,118.00 8073791 MRI LOWER EXT JT W/O CONTRAST RT 2,914.00 8073792 MRI LOWER EXT JT W/O CONTRAST LT 2,914.00 8073793 MRI LOWER EXT JT W/ CONTRAST RT 3,338.00 8073794 MRI LOWER EXT JT W/ CONTRAST LT 3,338.00 8073795 MRI LOWER EXT JT W/WO CONTRAST RT 4,020.00 8073796 MRI LOWER EXT JT W/WO CONTRAST LT 4,020.00 8073797 MRA LOWER EXT W/WO CONTRAST RT 3,045.00 8073798 MRA LOWER EXT W/WO CONTRAST LT 3,045.00 8074181 MRI ABDOMEN W/O CONTRAST 3,764.00 8074182 MRI ABDOMEN W/ CONTRAST 4,279.00 8074183 MRI ABDOMEN W/WO CONTRAST 5,047.00 8074185 MRA ABDOMEN W/WO CONTRAST 4,279.00 8074186 MRA ABDOMEN W/ CONTRAST 3,934.00 8074187 MRA ABDOMEN W/O CONTRAST 3,764.00 8076093 MRI BREAST UNI W/WO 3,423.00 8076094 MRI BREAST BILAT W/WO CONTRAST 5,047.00 8172195 MRI SACRUM W/O CONTRAST 3,889.00 8172196 MRI SACRUM W/ CONTRAST 4,474.00 8172197 MRI SACRUM W/WO CONTRAST 5,367.00 8174181 MRI MRCP 3,764.00 8200004 C-PAP 320.00 8200005 BIPAP 418.00 8200006 SUBSEQ BIPAP 411.00 8200007 INCENTIVE SPIROMETRY 192.00 8200008 PEAK FLOW METER 112.00 8200010 PULMONARY FUNCTION STUDY 292.00 8212345 RESPIRATORY STRENGTH AND ENDURANCE 15 132.00 8220006 OXYGEN DAILY 210.00 8220007 OXYGEN INTER 62.00 8220008 AEROSOL TREATMENT 75.00 8220010 NEBULIZATION CONT 155.00 8223456 RESPIRATORY FUNCTION 15 MINUTES 132.00 8234567 RESPIRATORY THERAPY GROUP MORE THAN 2 195.00 8294664 NEBULIZER TRMT 82.00 8494010 PULMONARY FUNCTION 290.00 8494760 PULSE OXIMETRY 148.00 8504250 TRANSPORTATION LOADED MILE 25.00 8504260 ALS LEVEL 1 - NON EMERGENT 887.00 8504270 ALS LEVEL 1 - EMERGENT 1,027.00 8504280 BLS - NON EMERGENT 657.00 8504290 BLS - EMERGENT 813.00 8504330 ALS LEVEL 2 1,329.00 8504340 SPECIALTY CARE TRANSPORT 1,950.00 8508880 AMBULANCE NON-COVERED PER MILE 8.00 8609472 CARDIAC REHAB PHASE 3a 300.00 8610001 RESPIRATORY THERAPY 15 MIN 49.00 8610003 RESPIRATORY THERAPY GROUP 49.00 8612345 PULMONARY REHAB ONE HOUR 130.00

8676942 US CORE BIOPSY LT BREAST 876.00 8693000 Peripheral Artery Disease Rehabilitation 92.00 8693668 Peripheral Artery Disease Rehabilitation 92.00 8693779 CARDIAC REHAB (MODIFIER KX) W/O ECG MONI 205.00 8693797 CARDIAC REHAB W/O ECG MONITORING 205.00 8693798 CARDIAC REHAB W ECG MONITORING 205.00 8693799 CARDIAC REHAB (MODIFIER KX) W ECG MON 205.00 8802958 UNNA BOOT LEFT 291.00 8812958 UNNA BOOT BILATERAL 583.00 8829260 ELBOW/WRIST STRAPPING 153.00 8829530 KNEE STRAPPING 181.00 8829540 ANKLE/FOOT STRAPPING 181.00 8829580 UNNA BOOT RIGHT 291.00 8850039 THERABAND (PER FOOT) 20.00 8870002 K PAD TRMT 24.00 8870321 FES 146.00 8871101 EXERCISE EACH 15 MIN 92.00 8875301 DIRECT DYNAMIC ACTV 138.00 8894761 NON INVASIVE O2 SAT 71.00 8895992 CANALITH REPOSITIONING 118.00 8897012 MECH TRACTION 86.00 8897014 UNATTENDED E'STIM 113.00 8897016 VASOPNEUMATIC DEVICE THERAPY 124.00 8897018 PARAFFIN 71.00 8897022 WHIRLPOOL 91.00 8897032 MANUAL E'STIM 15 MINS 113.00 8897033 IONTOPHORESIS 176.00 8897034 CONTRASTS BATHS 79.00 8897035 US/PHONOPHORESIS 15 MINS 100.00 8897110 THERAPUTIC EX 15 MIN 142.00 8897112 NEUROMUSC RE-ED 15 MIN 146.00 8897116 GAIT TRAINING 15 MIN 124.00 8897124 MASSAGE 15 MINS 123.00 8897139 POSTURAL DRAINAGE 137.00 8897140 MANUAL THER TECH 15 MINS 137.00 8897150 GROUP THER PROC 78.00 8897161 PT EVAL LOW COMPLEX 20 MIN 159.00 8897162 PT EVAL MOD COMPLEX 20 MINUTES 477.00 8897163 PT EVAL HIGH COMPLEX 45 MINUTES 632.00 8897164 PT RE-EVAL EST PLAN CARE 214.00 8897530 FUNCTIONAL TRN 15MIN 161.00 8897532 DEV/COGN SKILLS 15 MINS 124.00 8897533 SENSORY INTEGRATE 15 MINS 129.00 8897535 SELF CARE/HOME MGT 15 MINS 152.00 8897537 COMM/WORK REINT TRN 15 MINS 137.00 8897542 WHEELCHAIR MNGT 15 MINS 142.00 8897545 WORK HARDEN/COND INITIAL 300.00 8897546 WORK HARDEN/COND HR 214.00 8897601 SELECTIVE DEBRIDEMEN 113.00 8897602 NONSELECT DEBRIDEMENT 153.00 8897750 PHY PERFORM MEAS 15 MIN 151.00 8897760 ORTHOTICS FIT/TRN 15 MINS 189.00

8897761 PROSTH TRAINING 15 M 100.00 8897762 CHKOUT ORTH/PROSTH USE 15 MINS 113.00 8898960 EDUCATION & TRAINING INC. CAREGIVER 66.00 8898961 EDUCATION & TRAINING 2-4 PATIENTS 86.00 8898962 EDUCATION & TRAINING 5-8 PATIENTS 86.00 9029105 OT LONG ARM SPLINT 202.00 9029125 OT SHORT ARM SPLINT 181.00 9029130 FINGER SPLINT 171.00 9029260 ELBOW/WRIST STRAPPING 153.00 9029530 KNEE STRAPPING 181.00 9029540 ANKLE/FOOT STRAPPING 181.00 9050039 THERABAND (PER FOOT) 20.00 9070002 K PAD TRMT 24.00 9070321 FES 153.00 9071101 EXERCISE EACH 15 MIN 92.00 9075301 DIRECT DYNAMIC ACTV 138.00 9097012 MECH TRACTION 86.00 9097014 UNATTENDED E'STIM 113.00 9097016 VASOPNEUMATIC DEVICE THERAPY 124.00 9097018 PARAFFIN 71.00 9097022 WHIRLPOOL 91.00 9097032 MANUAL E'STIM 15 MINS 113.00 9097033 IONTOPHORESIS 176.00 9097034 CONTRASTS BATHS 79.00 9097035 US/PHONOPHORESIS 15 MINS 100.00 9097110 THERAPUTIC EX 15 MIN 142.00 9097112 NEUROMUSC RE-ED 15 MIN 146.00 9097116 GAIT TRAINING 15 MIN 124.00 9097124 MASSAGE 15 MINS 123.00 9097139 POSTURAL DRAINAGE 137.00 9097140 MANUAL THER TECH 15 MINS 137.00 9097150 GROUP THER PROC 78.00 9097165 OT EVAL LOW COMPLEX 30 MINUTES 316.00 9097166 OT EVAL MOD COMPLEX 45 MINUTES 477.00 9097167 OT EVAL HIGH COMPLEX 60 MINUTES 632.00 9097168 OT RE-EVAL EST PLAN CARE 214.00 9097530 FUNCTIONAL TRN 15MIN 161.00 9097532 DEV/COGN SKILLS 15 MINS 124.00 9097533 SENSORY INTEGRATE 15 MINS 129.00 9097535 SELF CARE/HOME MGT 15 MINS 152.00 9097537 COMM/WORK REINT TRN 15 MINS 137.00 9097542 WHEELCHAIR MNGT 15 MINS 142.00 9097545 WORK HARDEN/COND INITIAL 300.00 9097546 WORK HARDEN/COND HR 214.00 9097601 SELECTIVE DEBRIDEMEN 113.00 9097602 NONSELECT DEBRIDEMENT 153.00 9097750 PHY PERFORM MEAS 15 MIN 151.00 9097760 ORTHOTICS FIT/TRN 15 MINS 189.00 9097761 PROSTH TRAINING 15 M 100.00 9097762 CHKOUT ORTH/PROSTH USE 15 MINS 113.00 9098960 EDUCATION & TRAINING INC. CAREGIVER 66.00 9292507 SPEECH THERAPY 248.00

9292508 SPEECH THERAPY 2+ 205.00 9292520 CLINICAL EVALUATION OF SWALLOWING 284.00 9292522 SPEECH THERAPY EVALUATION 316.00 9292523 SPEECH EVAL W LANGUAGE COMP 316.00 9292526 DYSPHAGIA THERAPY 261.00 9292597 EVAL VOICE PROSTHETIC 355.00 9292607 EVAL SPEECH GENERATING DEVICE 632.00 9292609 USE OF SPEECH DEVICE SERVICE 258.00 9292610 EVAL SWALLOWING 185.00 9296105 APHASIA THERAPY 284.00 9297532 DEVELOP COGNATIVE SKILLS, EACH 15 MIN. 105.00 9297533 SENSORY INTEGRATE TECH EACH 15 MIN. 105.00 9297535 SELF CARE/HOME MGT 15 MINS 152.00 9298960 EDUCATION & TRAINING INC. CAREGIVER 66.00 9299366 SPEECH THERAPY - MED TEAM CONF >=30 139.00 10036415 VENIPUNCTURE OFF SIT WHC 46.00 10093005 EKG W/INTER-WHC 314.00 10511400 EXCISION OF LESION 731.00 10529580 APPLICATION UNNA BOOT 294.00 10536415 VENIPUNCTURE OFF SIT ECHC 46.00 10541100 EXCISION OF LESION 604.00 10581002 URINE DIPSTICK 46.00 10596110 DEVELOPMENTAL TESTING W INTER & REPORT 372.00 10599201 BRIEF NEW 179.00 10599202 LIMITED NEW 256.00 10599203 INTERMEDIATE NEW 354.00 10599204 EXTENDED NEW 417.00 10599205 COMPREHENSIVE NEW 564.00 10599211 MINIMAL SERV EST 145.00 10599212 BRIEF VISIT EST 164.00 10599213 OFFICE VISIT EST 194.00 10599214 EXTENDED VISIT EST 305.00 10599215 COMPREHENSIVE EST 453.00 10599217 OBSERVATION DISCHARGE 288.00 10599218 INITIAL OBSERVATION CARE 272.00 10599219 INITIAL OBSERVATION CARE 453.00 10599220 INITIAL OBSERVATION CARE 631.00 10599221 INITIAL HOSP CARE 301.00 10599222 INITIAL HOSP CARE 471.00 10599223 INITIAL HOSP CARE 642.00 10599231 SUBSEQUENT HOSP CARE 146.00 10599232 SUBSEQUENT HOSP CARE 233.00 10599233 SUBSEQUENT HOSP CARE 324.00 10599234 ADM/DSCH SAME DAY IP OR OBS HOSP CARE 553.00 10599235 ADM/DSCH SAME DAY IP OR OBS CARE 725.00 10599236 ADM/DSCH SAME DAY IP OR OBS CARE 897.00 10599238 DISCHARGE 288.00 10599239 DISCHARGE 377.00 10599291 CRITICAL CARE, FIRST HOUR PHYS FEE 1,387.00 10599304 SWING BED CARE 277.00 10599305 SWING BED CARE 359.00 10599306 SWING BED CARE 442.00

10599307 SUBSQ NURSING FC CAR 145.00 10599308 SBQ NURSING FC CARE 228.00 10599309 SBQ NURSING FC CARE 306.00 10599310 SBQ NURSING FC CARE 375.00 10599315 NURS FC DISCHARGE 264.00 10599316 NURS FC DISCHARGE 340.00 10599321 NEW PAT KVNH 195.00 10599322 NEW PAT KVNH 270.00 10599323 NEW PAT KVNH 353.00 10599341 HOME VST NP 20 MIN 233.00 10599342 HOME VST NP 30 MIN 340.00 10599347 HOME VIS EST 15 MIN 184.00 10599348 HOME VIS EST 25 MIN 288.00 10599358 OFFICE VISIT/RELATVE 215.00 10599381 PREVENTIVE VISIT NEW INFANT 320.00 10599382 PREVENTIVE VISIT NEW 1-4 331.00 10599383 PREVENTIVE VISIT 5-11 NEW PATIENT 320.00 10599384 PREVENTIVE VISIT 12-17 NEW PATIENT 392.00 10599385 PREVENTIVE VISIT 18-39 NEW 421.00 10599386 PREVENTIVE NEW 40-64 459.00 10599391 PREVENTIVE VISIT INFANT EST 249.00 10599392 PREVENTIVE EST 1-4 280.00 10599393 PREVENTIVE 5-11 EST 309.00 10599394 PREVENTIVE VISIT 12-17 ESTABLISHED 339.00 10599395 PREVENTIVE 18-39 EST 368.00 10599396 PREVENTIVE EST 40-64 398.00 10599397 PREVENTIVE VISIT EST 65+ 427.00 10599991 PNEUMO ADMIN 14.00 10599999 FLU ADMIN 14.00 10736415 VENIPUNCTURE OFF SIT AVHC 46.00 10936415 VENIPUNCTURE OFF SIT CPHC 46.00 11011642 EXCISION MALIGNANT LESION 1.1 - 2.0 CM 2,829.00 11036415 VENIPUNCTURE OFF SIT HPHC 46.00 11203056 AMOXICILLIN (AMOXIL) SUSP: 250 MG 5.03 11203080 AMOXICILLIN (AMOXIL) CAP: 250 MG 0.50 11203106 AMOXICILLIN/CLAVULANTE(AUGMENTIN)TAB:500 0.63 11203114 AMOXICILLIN/CLAVULANTE(AUGMENTIN)TAB:875 1.10 11203239 AMPICILLIN (PRINCIPEN) VIAL: 1 GRAM 3.68 11203478 AMPICILLIN/SULBACTAM (UNASYN) VIAL:1.5 G 6.12 11203486 AMPICILLIN/SULBACTAM (UNASYN) VIAL: 3 G 12.26 11203759 AZITHROMYCIN (ZITHROMAX) TAB: 250 MG 1.65 11203775 AZITHROMYCIN (ZITHROMAX) VIAL: 500 MG 7.28 11208709 CEFAZOLIN (ANCEF) VIAL: 1 GRAM 1.68 11208782 CEFTRIAXONE (ROCEPHIN) 1 GRAM VIAL 3.00 11208907 CEFUROXIME AXETIL (CEFTIN) TAB: 250 MG 0.95 11208931 CEFEPIME (MAXIPIME) VIAL: 2 GRAM 10.93 11208972 CEFTRIAXONE (ROCEPHIN) VIAL: 2 GRAM 5.65 11209079 CEPHALEXIN (KEFLEX) SUSP: 250 MG 25.98 11209137 CEPHALEXIN (KEFLEX) CAP: 250 MG 0.75 11209194 CEPHALEXIN (KEFLEX) CAP: 500 MG 0.50 11212073 CIPROFLOXACIN (CIPRO) TAB: 250 MG 0.50 11212081 CIPROFLOXACIN (CIPRO) TAB: 500 MG 0.50

11212180 *CLARITHROMYCIN (BIAXIN) TAB: 500 MG 2.28 11212198 *CLARITHROMYCIN (BIAXIN) TAB: 250 MG 2.55 11212248 CLINDAMYCIN (CLEOCIN) CAP: 150 MG 0.50 11212305 CLINDAMYCIN (CLEOCIN) IV: 600 MG/50 ML 13.33 11214509 DAPTOMYCIN (CUBICIN) VIAL: 500 MG 262.50 11221348 ERYTHROMYCIN BASE (ERYTAB) TAB: 250 MG 0.50 11222007 FAMCICLOVIR (FAMVIR) TAB: 500 MG 1.87 11223047 FLUCONAZOLE (DIFLUCAN) TAB: 100 MG 1.18 11224979 GENTAMICIN (GARAMYCIN) VIAL: 80 MG 1.53 11227626 HYDROXYCHLOROQUINE(PLAQUENIL)TAB: 200 MG 3.18 11232188 LEVOFLOXACIN (LEVAQUIN) TAB: 250 MG 0.50 11232196 LEVOFLOXACIN (LEVAQUIN) TAB:500 MG 19.55 11232246 LINEZOLID (ZYVOX) TAB: 600 MG 3.93 11234770 MEROPENEM (MERREM) VIAL: 1 GRAM 14.15 11236593 METRONIDAZOLE (FLAGYL) TAB: 250 MG 0.53 11236676 MOXIFLOXACIN (AVELOX) TAB: 400 MG 5.43 11238896 NEOMYCIN SULFATE (NEOMYCIN) TAB: 500 MG 1.60 11239431 NITROFUR MACROCRY(MACRODANTIN)CAP: 50 MG 0.90 11240546 NYSTATIN SUSP: 500,000 UNITS / 5ML 2.05 11240900 OXACILLIN (BACTOCIL) VIAL: 1 GRAM 27.60 11240926 OXACILLIN (BACTOCIL) VIAL: 2 GRAM 25.50 11242310 PENICILLIN G (PFIZERPEN) VIAL: 5 MU 9.40 11242559 PENICILLIN V POTASSIUM SUSP: 250 MG/5 ML 1,800.00 11242617 PENICILLIN V POTASSIUM TAB: 250 MG 0.50 11245198 PIPERACILLIN/TAZOBAC(ZOSYN)VIAL: 3.375 G 7.53 11250628 RIFAMPIN (RIFADIN) TAB: 300 MG 1.50 11251022 SULFAMETHOXAZOLE/TRIMETH SUSP: 800MG/160 11.90 11251196 SULFAMETHOXAZOLE/TRIMETHOPR (BACTRIM DS) 0.50 11252764 SULFASALAZINE (AZULFIDINE) TAB: 500 MG 0.50 11258613 VANCOMYCIN (VANCOCIN) VIAL: 1000 MG 7.90 11258621 VANCOMCYN (VANCOCIN) CAP: 125 MG 1.47 11299999 INSULIN ASPART(NOVOLOG U-100)VIAL:10 UNI 1.00 11301504 ANASTROZOLE (ARIMIDEX) TAB: 1 MG 1.19 11306008 BEVACIZUMAB (AVASTIN) VIAL: 100 MG 1,992.35 11314382 CYCLOPHOSPHAMIDE (CYTOXAN) VIAL: 1000 MG 891.23 11315009 DOCETAXEL (TAXOTERE) VIAL: 20 MG 40.60 11319944 DOXORUBICIN (ADRIAMYCIN) VIAL: 20 MG 29.93 11321965 ETOPOSIDE (TOPOSAR) VIAL: 10 MG 1.23 11323508 FLUOROURACIL VIAL: 500 MG 9.23 11323755 FULVESTRANT (FASLODEX) SYR: 250 MG/5 ML 1,955.30 11325362 GRANISETRON (KYTRIL) VIAL: 1 MG/ML 15.98 11325370 GRANISETRON (KYTRIL) TAB: 1 MG 2.78 11328309 IRINOTECAN (CAMPTOSAR) VIAL: 100 MG 29.78 11335155 METHOTREXATE (METHOTREXATE) TAB: 2.5 MG 2.20 11336864 PEMETREXED (ALIMTA) VIAL: 100 MG 1,644.65 11337102 OXALIPLATIN (ELOXATIN) VIAL: 50 MG 42.65 11341906 PACLITAXEL (PROTEIN BOUND) VIAL: 100 MG 3,345.25 11341930 PACLITAXEL (TAXOL) VIAL: 6 MG 2.18 11348000 RITUXIMAB (RITUXAN) VIAL: 100 MG 2,348.80 11353141 TAMOXIFEN (NOLVADEX) TAB: 10 MG 0.50 11354511 TRASTUZUMAB (HERCEPTIN): 10 MG 259.73 11358983 VINCRISTINE (VINCASAR) VIAL: 2 MG 23.55

11360005 ZOLEDRONIC ACID (ZOMETA) VIAL: 4 MG/5 ML 27.55 11401312 ALTEPLASE (CATHFLO) KIT: 2 MG 353.88 11401650 DARBEPOETIN (ARANESP) SYR: 60 MCG/0.3 ML 978.43 11401668 DARBEPOETIN (ARANESP) SYR:100 MCG/0.5 ML 1,723.29 11401684 DARBEPOETIN (ARANESP) SYR:200 MCG/0.4 ML 1,513.13 11401692 DARBEPOETIN (ARANESP) SYR:300 MCG/0.6 ML 5,165.43 11420981 EPOETIN ALFA (PROCRIT) VIAL: 20,000 UNIT 670.13 11422003 PEGFILGRASTIM (NEULASTA)SYR: 6 MG/0.6 ML 9,994.28 11422789 FILGRASTIM (NEUPOGEN) SYR: 300 MCG/ML 619.15 11422797 FILGRASTIM (NEUPOGEN) SYR: 480 MCG/ML 1,232.63 11445103 TENECTEPLASE (TNKASE) KIT: 50 MG 14,003.00 11500002 GI COCKTAIL 5.00 11500063 ACETAMINOPHEN (TYLENOL) TABLET: 325 MG 0.50 11500139 ACETAMINOPHEN (TYLENOL) TABLET: 500 MG 0.50 11500212 ACETAMINOPHEN (TYLENOL) SUSP: 160 MG 1.88 11500246 ACETAMINOPHEN (TYLENOL) SUPP: 120 MG 0.50 11500295 ACETAMINOPHEN/CODEINE(TYLENOL#3)TAB 0.50 11500329 ACETAMINOPHEN (TYLENOL) SUPP: 650 MG 0.53 11500360 ACETAMINOPHEN (TYLENOL) SUPP: 325 MG 1.09 11500774 FLUTICASONE 500/SALMETEROL 50 (ADVAIR) 354.45 11500782 FLUTICASONE 250/SALMETEROL 50 (ADVAIR) 269.53 11500790 *FLUTICASONE 100/SALMETEROL 50 (ADVAIR) 244.58 11500832 ASPIRIN25MG/DIPYRIDAMOL200MG (AGGRENOX) 11.55 11500865 ADENOSINE PHOS (ADENOCARD) VIAL: 6 MG 3.20 11500873 SPACER (EASIVENT) MISC 23.83 11500899 ACYCLOVIR 5% (ZOVIRAX) OINT 370.30 11500915 ALBUTEROL (PROVENTIL) SYRUP: 2 MG/5 ML 1.00 11500931 ALBUMIN HUMAN (ALBUTEIN)VIAL: 25 G 157.95 11501020 *ALBUTEROL (VENTOLIN) MDI 90MCG: 60 DOSE 48.73 11501046 ALBUTEROL 0.083% (PROVENTIL) NEB: 2.5 MG 0.50 11501251 ALLOPURINOL (ZYLOPRIM) TAB: 100 MG 0.50 11501368 ALPRAZOLAM (XANAX) TAB: 0.25 MG 0.50 11501939 *AMINOCAPROIC ACID (AMICAR) INJ: 5000 MG 1.75 11502051 *AMINOPHYLLINE VIAL: 250 MG/10 ML 1.15 11502150 AMIODARONE (CORDARONE) TAB: 200 MG 0.85 11502200 AMIODARONE (CORDARONE) INJ:150 2.08 11502457 AMITRIPTYLINE (ELAVIL) TAB: 10 MG 0.50 11502481 AMITRIPTYLINE (ELAVIL) TAB: 25 MG 0.50 11502580 AMITRIPTYLINE (ELAVIL) TAB:50 MG 0.50 11502663 AMLODIPINE (NORVASC) TAB: 5 MG 0.50 11503125 AMOXICILLIN (AMOXIL) CAP: 500 MG 0.50 11503695 APREPITANT (EMEND) CAP: 40 MG 111.05 11503703 APREPITANT (EMEND) CAP: 125 MG 287.52 11503711 APREPITANT (EMEND) CAP: 80 MG 287.52 11503737 *ARIPIPRAZOLE (ABILIFY) TAB: 10 MG 45.88 11503786 DERMAPHOR (AQUAPHOR) OINTMENT 6.75 11503984 ASCORBIC ACID (VITAMIN C) TAB: 500 MG 0.50 11504057 *ASPIRIN (ECOTRIN) TAB: 325 MG 0.50 11504180 ASPIRIN (ECOTRIN) ECTAB: 325 MG 0.50 11504198 ASPIRIN (HALFPRIN) ECTAB: 81 MG 0.50 11504248 ASPIRIN CHEWTAB (ECOTRIN): 81 MG 0.50 11504255 ATENOLOL (TENORMIN) TAB: 50 MG 0.50

11504263 ATORVASTATIN (LIPITOR) TAB: 10 MG 0.50 11504305 ATORVASTATIN (LIPITOR) TAB: 20 MG 0.50 11504370 *ATENOLOL (TENORMIN) TAB: 25 MG 0.50 11504388 ATROPINE 1% (ATROPINE) OPHTH SOL 107.98 11504453 ATROPINE SULFATE (ATROPINE) VIAL: 1 MG 16.68 11504461 ATROPINE SULFATE (ATROPINE) SYRING: 1 MG 20.03 11504495 *ANTIPRYNE/B-CAINE/GLY(AURODEX)OTIC DROP 8.00 11504644 AZATHIOPRINE (IMURAN) TAB: 50 MG 0.50 11504875 BACITRACIN (BACITRACIN) OINT 0.50 11504917 NEOMY SULF/BACITRA/PLYMXIN(TRIP ANTIBIO) 4.65 11505062 BACLOFEN (LIORESAL) TAB: 10 MG 0.75 11505120 BECLOMETHASONE DIPROP (QVAR) 40 MCG: MDI 404.55 11505138 BECLOMETHASONE DIPROP (QVAR) 80 MCG: MDI 571.15 11505443 BENZONATATE(TESSALON PERLES)CAP: 100 MG 0.75 11505609 *BENZTROPINE (COGENTIN) TAB: 1 MG 0.65 11505823 BETAMETHASONE ACET(CELESTONE SOLUSPAN) 85.05 11506227 BETAXOLOL 0.5% (BETOPTIC) OPHTH SOL 68.30 11506284 BISACODYL (DULCOLAX) ECTAB: 5 MG 0.50 11506474 BRIMONIDINE 0.15%(ALPHAGAN P) OPHTH SOL 322.03 11506490 BROMOCRIPTINE (PARLODEL) TAB: 2.5 MG 1.95 11506649 BUDESONIDE 80/FORMOTEROL 4.5 (SYMBICORT) 375.48 11506656 BUDESONIDE 160/FORMOTEROL 4.5(SYMBICORT) 115.60 11506664 BUDESONIDE NEB MULTI DOSE: 0.25 MG/2 ML 8.13 11506672 BUDESONIDE NEB MULTI DOSE: 0.5 MG/2 ML 20.13 11506680 BUDESONIDE AQUA(RHINOCORT)SPR:32 MCG 221.75 11506763 BUMETANIDE (BUMEX) TAB: 1 MG 2.75 11506862 BUPROPION SR (WELLBUTRIN SR)SRTAB:150 MG 0.88 11506888 BUPIVACAINE HCL(SENSORCAINE) VIAL: 0.5% 2.88 11507191 CALCITRIOL(ROCALTROL) CAP: 0.25 MCG 0.72 11507258 CALCIUM ACETATE (PHOSLO) CAP: 667 MG 1.85 11507282 CALCIUM CARB (TUMS) CHWTAB: 500 MG 0.50 11507316 CALCIUM CHLORIDE 10% SYRINGE: 1000 MG 18.53 11507373 *EDETATE CAL DISODIUM INJ: 200 MG/ML 229.20 11507464 CALCIUM GLUCONATE 10% VIAL: 0.465 MEQ/ML 9.92 11507605 LEUCOVORIN VIAL: 350 MG 31.48 11507639 CALMOSEPTINE (RISAMINE) OINT 13.03 11507654 CAPSAICIN 0.025% (ZOSTRIX) CREAM 8.18 11507662 CALCITONIN-SALMON(FORTICAL)SPRAY 41.65 11507720 CAPTOPRIL (CAPOTEN) TAB:12.5 MG 0.50 11507944 CARBAMAZEPINE (TEGRETOL) TAB: 200 MG 1.18 11508009 CARBAMIDE PEROXIDE 6.5% (DEBROX) OTIC 14.10 11508207 CELECOXIB (CELEBREX) CAP: 100 MG 1.75 11508256 CARVEDILOL (COREG) TAB: 6.25 MG 0.50 11508942 BENZOCAINE / MENTHOL (CEPACOL LOZENGE) 0.50 11509007 CETIRIZINE (ZRYTEC) TAB: 10 MG 0.50 11509502 ACTIVATED CHARCOAL (LIQUI-CHAR)SOLN: 50G 40.73 11511516 CHLORTHALIDONE (HYGROTON) TAB: 25 MG 3.75 11511649 CHOLESTYRAMINE LIGHT(QUESTRAN) PKT: 4 G 4.78 11512159 MAGNESIUM CITRATE(CIT OF MAG)SOL: 296 ML 3.70 11512167 CITALOPRAM (CELEXA) TAB: 20 MG 0.50 11512373 CLONAZEPAM (KLONOPIN) TAB: 0.5 MG 0.50 11512423 CLONIDINE (CATAPRES) TAB: 0.1 MG 0.50

11512498 CLONIDINE (CATAPRES-TTS 1) PATCH: 0.1 MG 24.26 11512506 *CLONIDINE (CATAPRES-TTS 2) PATCH:0.2 MG 65.33 11512522 *CLONIDINE (CATAPRES-TTS 3) PATCH:0.3 MG 92.90 11512530 CLOPIDOGREL BISULFATE(PLAVIX)TAB: 75 MG 0.50 11512605 CLOTRIMAZOLE 1% (LOTRIMIN) CREAM 6.80 11512662 CLOTRIMAZOLE/BETAMETHASONE(LOTRISONE)CRM 15.05 11512993 COLCHICINE (COLCRYS) TAB: 0.6 MG 10.37 11513108 COLLAGENASE (SANTYL) OINTMENT 511.50 11513157 *IPRATROPIUM/ALBUTEROL (COMBIVENT) MDI 461.33 11513173 ESTROGEN CONJUGATED (PREMARIN) VAG CREAM 269.55 11513207 ESTROGEN CONJUGATED(PREMARIN)TAB:0.3 MG 4.83 11513231 ESTROGEN CONJUG (PREMARIN) TAB: 0.625MG 4.05 11513777 NEO/SULF/PLYMX BSULF/HC(CORTISPORIN OTIC 124.50 11513801 COSYNTROPIN (CORTROSYN) VIAL: 0.25 MG 41.75 11514106 CYANOCOBALAMIN(VITAMIN B12)VIAL:1000 MCG 5.35 11514288 CYCLOBENZAPRINE (FLEXERIL) TAB: 10 MG 0.50 11514437 CYCLOSPORINE (SANDIMMUNE) CAP: 25 MG 1.00 11514478 CYCLOSPORINE 0.05% (RESTASIS) OPHTH SOL 21.58 11514585 CYPROHEPTADINE (PERIACTIN) TAB: 4 MG 0.50 11515608 ZINC OXIDE/COD LIVER OIL (DESITIN) OINT 14.08 11515814 *DEXAMETHASONE (DECADRON) TAB: 0.5 MG 0.50 11515939 DEXAMETHASONE (DECADRON) TAB: 4 MG 2.03 11515962 DEXAMETHASONE (DECADRON) VIAL: 10 MG 2.08 11515996 DEXAMETHASONE (DECADRON) VIAL:120MG/30ML 71.90 11516242 GLUTOSE 40% (GLUCOSE 40%) GEL 10.28 11516267 DEXTROSE 50%-WATER (D50W) SYRING: 25 G 22.43 11516390 DIAZEPAM (VALIUM) TAB: 5 MG 0.50 11516424 *SODIUM CHLORIDE 0.9%-40 KCL 1000 ML BAG 8.80 11516507 DIAZEPAM (VALIUM) SYRINGE: 10 MG 40.84 11516598 DIBUCAINE 1% (NUPERCAINAL) OINT 7.60 11517265 DIGIFAB (DIGIBIND) INJ: 40 MG/4 ML 1,235.20 11517281 DIGOXIN (LANOXIN) TAB: 0.125 MG 0.75 11517299 DIGOXIN (LANOXIN) INJ: 0.5 MG 11.84 11517356 DIGOXIN (LANOXIN) ELIXIR: 0.25 MG 0.80 11517380 DIHYDROERGOTAMINE MESYLATE(DHE45)INJ:1MG 47.55 11517448 DILTIAZEM (CARDIZEM) VIAL: 25 MG/5 ML 3.58 11517471 DILTIAZEM (CARDIZEM) TAB: 30 MG 0.50 11517612 DILTIAZEM CD (CARDIZEM) CAP: 180 MG 0.50 11517620 DILTIAZEM CD (CARDIZEM) CAP: 120 MG 0.53 11518008 DIPHENHYDRAMINE (BENADRYL) CAP: 25 MG 0.50 11518057 DIPHENHYDRAMINE/ZINC (BANOPHEN) CREAM 4.08 11518131 DIPHENHYDRAMINE (BENADRYL) VIAL: 50 MG 1.38 11518172 DIPHENHYDRAMINE ELIXIR: 12.5 MG/5 ML 3.53 11518313 *DIPHTH PERTUS TET (ADACEL) VACCINE VIAL 79.03 11518800 DIVALPROEX (DEPAKOTE) SPRINKLE: 125 MG 1.58 11518818 DIVALPROEX (DEPAKOTE ER) ERTAB: 500 MG 1.00 11518826 DIVALPROEX (DEPAKOTE) DRTAB:500 MG 0.60 11518834 DIVALPROEX (DEPAKOTE ER) ERTAB: 250 MG 2.03 11518842 DIVALPROEX (DEPAKOTE) DRTAB:125 MG 0.50 11518917 *DIVALPROEX (DEPAKOTE) DRTAB: 250 MG 0.50 11519162 DOCUSATE SODIUM (COLACE) CAP: 100 MG 0.50 11519170 DOCUSATE SODIUM (COLACE) SYRUP: 100 MG 1.11

11519220 DONEPEZIL (ARICEPT) TAB: 5 MG 0.50 11519238 DONEPEZIL (ARICEPT) TAB: 10 MG 0.50 11519451 *PHENOBARB/HYOSCYAMINE (DONNATAL) ELIXIR 21.55 11519519 DOPAMINE (INTROPIN) PMIX: 200 MG 23.15 11519527 DORZOLAMIDE 2% (TRUSOPT) OPHTH SOL 43.38 11519576 *DOXEPIN (SINEQUAN) CAP: 10 MG 0.50 11519584 DORZOLAMIDE/TIMOLOL (COSOPT) OPHTH SOL 43.25 11519600 DOXEPIN (SINEQUAN) CAP: 25 MG 1.55 11520137 DRONABINOL (MARINOL) CAP: 2.5 MG 7.15 11520145 DIPHTHER/PERTUSS/TETANUS (DAPTACEL) VACC 57.16 11520202 DROPERIDOL (INAPSINE) 2.5MG/ 1ML AMP 1.90 11520277 DULOXETINE (CYMBALTA) CAP: 30 MG 2.10 11520301 *DULOXETINE (CYMBALTA) CAP: 20 MG 9.30 11520350 ELETRIPTAN (RELPAX) TAB: 40 MG 64.98 11520368 *ELETRIPTAN (RELPAX) TAB: 20 MG 77.68 11520475 LIDOCAINE/PRILOCAINE (EMLA) CREAM 16.43 11520483 *ENALAPRIL (VASOTEC) TAB: 5 MG 0.50 11520491 ENOXAPARIN (LOVENOX) SYRINGE: 30 MG 13.80 11520541 ENOXAPARIN (LOVENOX) SYRINGE: 40 MG 8.55 11520558 ENOXAPARIN (LOVENOX) SYRINGE: 100 MG 21.30 11520574 ENALAPRILAT (VASOTEC ) VIAL: 1.25 MG 6.58 11520582 ENOXAPARIN (LOVENOX) SYRINGE: 120 MG 32.00 11520590 ENOXAPARIN (LOVENOX) SYRINGE: 150 MG 53.93 11520608 ENOXAPARIN (LOVENOX) SYRINGE: 60 MG 10.88 11520632 EPTIFIBATIDE (INTEGRILIN): 200 MG/100 ML 2,785.98 11520640 EPTIFIBATIDE (INTEGRILIN): 20 MG/10 ML 201.60 11520657 EPINEPHRINE (ADRENALIN) AMP: 1 MG 20.30 11520665 ENOXAPARIN (LOVENOX) SYRINGE: 80 MG 17.13 11520715 EPINEPHRINE (ADRENALIN) SYR: 1 MG/10 ML 17.38 11521432 ERYTHROMYCIN (ILOTYCIN) OPHTH OINT 25.43 11521465 *BUTALBITAL W ACETAMIN/CAFF(FIORICET)TAB 0.50 11522158 *EZETIMIBE (ZETIA) TAB: 10 MG 12.43 11522190 FAMOTIDINE (PEPCID) TAB: 20 MG 0.50 11522224 FAMOTIDINE (PEPCID) VIAL: 20 MG 1.20 11522299 FENOFIBRATE (TRICOR) TAB: 48 MG 1.68 11522448 FENTANYL 12 MCG/HR (DURAGESIC) PATCH 19.48 11522455 FENTANYL (SUBLIMAZE) VIAL: 100MCG/2ML 1.55 11522471 FENTANYL 25 MCG/HR (DURAGESIC) PATCH 5.95 11522489 FENTANYL 50 MCG/HR (DURAGESIC) PATCH 9.95 11522497 FENTANYL 75 MCG/HR (DURAGESIC) PATCH 12.70 11522505 FENTANYL 100 MCG/HR (DURAGESIC) PATCH 21.52 11522554 FERROUS GLUCONATE (FERGON)TAB: 324 MG 0.50 11522661 FERROUS SULFATE(IRON SUPLEMENT)TAB:325MG 0.50 11522687 FEXOFENADINE (ALLEGRA) TAB: 60 MG 1.43 11522729 POLYCARBOPHIL (FIBERCON) TAB: 625 MG 0.50 11522802 FINASTERIDE (PROSCAR) TAB: 5 MG 0.50 11522984 *FLUTICASONE PROPIONATE (FLOVENT):44 MCG 218.70 11523008 FLUTICASONE PROPIONATE(FLONASE)SPR:50MCG 8.13 11523016 FLUTICASONE PROPIONATE(FLOVENT) 110 MCG 540.25 11523024 FLUTICASONE PROPIONATE(FLOVENT) 220 MCG 836.53 11523032 FLUDROCORTISONE (FLORINEF) TAB: 0.1 MG 1.08 11523099 FLUMAZENIL (ROMAZICON) VIAL: 0.5 MG 6.38

11523560 FLUOXETINE (PROZAC) TAB: 10 MG 0.50 11523578 FLUOXETINE (PROZAC) CAP: 20 MG 0.50 11524063 FOLIC ACID (FOLVITE) TAB: 1 MG 0.50 11524303 FORMOTEROL (FORADIL AEROLIZER): 12 MCG 130.70 11524477 *FOSINOPRIL (MONOPRIL) TAB: 10 MG 1.20 11524485 FUROSEMIDE (LASIX) TAB: 20 MG 0.50 11524493 *FOSINOPRIL (MONOPRIL) TAB: 20 MG 1.25 11524576 FUROSEMIDE (LASIX) TAB: 40 MG 0.50 11524600 *FUROSEMIDE (LASIX) TAB: 80 MG 0.50 11524618 FUROSEMIDE (LASIX) VIAL: 20 MG 2.64 11524642 FUROSEMIDE (LASIX) VIAL: 40 MG 1.68 11524675 FUROSEMIDE (LASIX) VIAL: 100 MG 4.29 11524683 GABAPENTIN (NEURONTIN) CAP: 400 MG 0.50 11524709 *FUROSEMIDE (LASIX) SOL: 50 MG 3.00 11524717 GABAPENTIN (NEURONTIN) CAP: 100 MG 0.50 11524741 GABAPENTIN (NEURONTIN) CAP: 300 MG 0.50 11524808 GEMFIBROZIL (LOPID) TAB: 600 MG 0.50 11524881 GENTAMICIN 0.3% (GARAMYCIN) OPHTH OINT 14.03 11524915 GENTAMICIN 0.3% (GENOPTIC) OPHTH SOL 14.03 11524964 GLIMEPIRIDE (AMARYL) TAB: 2 MG 0.50 11525136 GLIPIZIDE XL (GLUCOTROL) SRTAB: 5 MG 1.23 11525151 GLUCAGEN HCL (GLUCAGON) VIAL: 1 MG 396.75 11525243 GLYBURIDE (DIABETA) TAB: 5 MG 0.70 11525482 *GUAIFENESIN (ROBITUSSIN) SYRUP: 100 MG 0.55 11525516 GUAIFENESIN DM (ROBITUSSIN DM) SYRUP 2.63 11525599 GUAIFENESIN/CODEINE SYRUP 1.28 11525664 *HALOPERIDOL (HALDOL) TAB: 0.5 MG 0.50 11525722 HALOPERIDOL (HALDOL) TAB: 1 MG 0.95 11525938 HALOPERIDOL LACTATE (HALDOL) VIAL: 5 MG 1.43 11526019 HEPARIN SODIUM (PORCINE) VIAL: 5000 UNIT 5.77 11526217 HEPATITIS A VACCINE(HAVRIX): 1440 UNITS 145.38 11526266 HEPATITIS B IMMUNE GLOBULIN(HEPAGAM)VIAL 272.65 11526282 HEPATITIS B VACCINE(ENGERIX B) PED SYR 51.23 11526597 HYDRALAZINE (APRESOLINE) TAB: 25 MG 0.50 11526753 HYDROCHLOROTHIAZIDE (ORETIC) TAB: 25 MG 0.50 11526936 HYDROCODONE 5 MG/APAP 325 MG (LORCET)TAB 0.50 11526977 HYDROCOD 5 MG/ACETAMIN 500 MG(LORCET)TAB 0.50 11526993 HYDROCOD 0.5MG/APAP 33MG/ML(LORCET0.5MG 0.50 11527025 HYDROCORTISONE 1% (HYDROCORT) CREAM 3.23 11527090 HYDROCORTISONE 2.5% (HYTONE) CREAM 34.90 11527264 HYDROCRT SOD SUCCINATE(SOLUCORTEF):100MG 28.42 11527603 HYDROMORPHONE (DILAUDID) TAB: 2 MG 0.50 11527710 *HYDROXYZINE (VISTARIL) VIAL:100 MG 7.85 11527884 HYDROXYZINE PAMOATE (VISTARIL) CAP:25 MG 0.50 11528056 IBUPROFEN (MOTRIN) SUSP: 100 MG 1.23 11528064 IBUPROFEN (ADVIL) TAB: 200 MG 0.50 11528221 IBUPROFEN (MOTRIN) TAB: 600 MG 0.50 11528247 *IBUPROFEN (MOTRIN) TAB: 800 MG 0.50 11528403 IMIPRAMINE (TOFRANIL) TAB: 25 MG 0.50 11528676 *IMMUNE GLOBLN (GAMUNEX) INJ: 500 MG 104.13 11528940 INDOMETHACIN (INDOCIN) CAP: 25 MG 0.50 11529120 *INFLUENZA (FLUZONE) VACCINE VIAL 20.00

11529187 INSULIN NPH HUM (NOVOLIN) VIAL: 5 UNITS 0.50 11529211 INSULIN REGULAR HUMAN VIAL: 5 UNITS 0.50 11529229 INSULIN HUMULIN70/30(HUMULIN70/30) PER U 0.20 11529260 *INSULIN DETEM(LEVEMIR)SYR:10 UNIT/0.1ML 86.95 11529310 INSULIN LISPRO PR/I(HUMALOG MIX) 75/25 0.18 11529328 INSULIN GLARGINE (LANTUS)VL:10 UNIT/0.1M 0.25 11529849 IRON SUCROSE (VENOFER) VIAL: 100 MG 76.58 11529898 *IPRATROPIUM (ATROVENT) 2 PFF/36 MCG AER 312.75 11529922 IPRATROPIUM/ALBUTEROL (DUONEB) 0.60 11530557 *ISOSORBIDE DINITRATE(ISORDIL)TAB: 20 MG 1.68 11530573 *ISOSORBIDE MONONITRATE(IMDUR)SRTAB:60MG 1.25 11530672 KETOROLAC (TORADOL) VIAL: 30 MG 2.08 11530938 KETOCONAZOLE 2% (NIZORAL) CREAM 56.90 11530946 LABETALOL (TRANDATE) TAB: 100 MG 0.68 11530953 *LACTASE (LACTAID) TAB: 3000 UNITS 0.55 11530987 LUBRICANT OPHTH (LUBRIFRESH PM) OINT 4.35 11531035 LABETALOL (TRANDATE) INJ: 100 MG 8.45 11531043 LATANOPROST 0.005% (XALATAN) OPHTH SOL 17.80 11531050 AMMONIUM LACTATE (LAC-HYDRIN) 12% LOTION 7.55 11531068 *LANSOPRAZOLE (PREVACID) SRCAP:15 MG 4.20 11531084 LANSOPRAZOLE (PREVACID) SRCAP: 30 MG 12.05 11531092 LEVOBUNOLOL 0.5% (BETAGAN) OPHTH SOL 34.80 11531100 LACTULOSE (CHRONULAC) SYRUP: 20 GRAM 0.90 11531118 *LAMOTRIGINE (LAMICTAL) TAB: 100 MG 0.50 11531126 LAMOTRIGINE (LAMICTAL) TAB: 25 MG 0.50 11531134 LANOLIN (EMOLL) OINT 2.55 11531167 *LANSOPRAZOLE (PREVACID) STAB:30 MG 4.75 11531209 LEVETIRACETAM (KEPPRA) TAB: 500 MG 0.50 11531316 LEVOTHYROXINE (SYNTHROID) TAB: 0.05 MG 0.85 11531357 LEVOTHYROXINE (SYNTHROID) TAB: 0.088 MG 1.03 11531423 LEVOTHYROXINE (SYNTHROID) TAB: 0.1 MG 1.25 11531464 LEVOTHYROXINE (SYNTHROID) TAB: 0.125 MG 1.45 11531498 *LEVOTHYROXINE (SYNTHROID) TAB: 0.15 MG 0.50 11531597 CHLORDIAZEPOXIDE/CLIDINIUM(LIBRAX)CAP:1 1.75 11531704 LIDOCAINE 2% (ANTI-ARR) SYRINGE: 100 MG 5.53 11531712 LIDOCAINE 2% (UROJECT) SYRINGE 11.08 11531746 LIDOCAINE 2%(VISCOUS) ORAL SOLUTION 15ML 2.10 11531761 LIDOCAINE 2% (TOPICAL) JELLY: 30 GRAMS 177.20 11531779 LIDOCAINE (LIDODERM) 5% PATCH: 700 MG 5.05 11531860 LISINOPRIL (ZESTRIL) TAB: 5 MG 0.50 11531878 LISINOPRIL (ZESTRIL) TAB: 10 MG 0.50 11531910 LITHIUM CARBONATE (ESKALITH)CAP: 300 MG 0.50 11531936 LIDOCAINE (XYLOCAINE) 1% MDV (20ML) 2.23 11531977 DIPHENOXYLATE 2.5MG/ATROPINE 0.025MG TAB 0.65 11532108 LOPERAMIDE (IMODIUM) SOL: 1 MG/5 ML 0.50 11532124 LOPERAMIDE (IMODIUM) CAP: 2 MG 1.43 11532157 LORATADINE (CLARITIN) TAB: 10 MG 0.55 11532181 LORAZEPAM (ATIVAN) TAB: 0.5 MG 0.50 11532249 LORAZEPAM (ATIVAN) VIAL: 2 MG 1.13 11532314 LOSARTAN POTASSIUM (COZAAR) TAB: 50 MG 0.85 11532488 MOISTURIZING (LUBRIDERM) LOTION 14.43 11532504 MEASLES MUMPS&RUBELLA (MMR) VACCINE 166.35

11532850 MAGNESIUM HYDROX LAX (MOM) SUSP: 2400 MG 4.17 11533205 NEO/PLYMX BSULF/DEXAMETH(DEXACIDIN)OPHTH 21.75 11533213 TRIAMTERENE 37.5/HCTZ 25 MG (DYAZIDE)CAP 0.68 11533320 MECLIZINE (ANTIVERT) TAB: 12.5 MG 0.73 11533403 *MECLIZINE (ANTIVERT) TAB:25 MG 0.50 11533627 MEDROXYPROGESTERONE(PROVERA)TAB: 2.5 MG 0.50 11534195 MESALAMINE (ASACOL) DR TAB: 400 MG 4.60 11534666 METHYLPHENIDATE HCL (RITALIN) TAB: 5 MG 0.72 11534674 METHADONE (DOLOPHINE) TAB: 5 MG 0.50 11534708 METFORMIN (GLUCOPHAGE) TAB: 500 MG 0.50 11534716 *METFORMIN (GLUCOPHAGE) TAB: 850 MG 0.50 11534757 TAPAZOLE (METHIMAZOLE) TAB: 5 MG 0.50 11535028 METHOCARBAMOL (ROBAXIN) TAB: 500 MG 0.50 11535663 METHYLPRED (SOLU-MED) VIAL: 40 MG 11.15 11535697 METHYLPRED (SOLU-MED) VIAL: 125 MG 17.73 11535747 METHYLPRED (SOLU-MED) VIAL:1000 MG 97.03 11535820 METHYLPREDNISOLONE(MEDROL DS-PK)TAB:4 MG 13.08 11535937 DEPO-MEDROL (DEPO-MEDROL) VIAL: 40 MG 16.08 11536166 METOCLOPRAMIDE (REGLAN) TAB: 10 MG 0.50 11536208 METOCLOPRAMIDE (REGLAN) VIAL: 10 MG 2.43 11536240 *METOCLOPRAMIDE (REGLAN) SOL: 10 MG/10 M 2.41 11536299 METOLAZONE (ZAROXOLYN) TAB: 2.5 MG 2.03 11536364 METOPROLOL TARTRATE (LOPRESSOR)INJ: 5 MG 1.58 11536448 METOPROLOL TART (LOPRESSOR)TAB: 50 MG 0.50 11536471 METOPROLOL SUCC (TOPROL)XLTAB: 25 MG 0.50 11536489 METOPROLOL SUCC (TOPROL)XLTAB: 50 MG 0.85 11536703 MICONAZOLE NITRATE (LOTRIMIN AF)2% CREAM 15.80 11536711 MICONAZOLE-7 (MONISTAT) VAG CREAM 7.80 11536844 MINOXIDIL (LONITEN) TAB: 10 MG 1.15 11536877 MIRTAZAPINE (REMERON) TAB: 15 MG 0.50 11536885 MONTELUKAST (SINGULAIR) TAB: 10 MG 0.65 11536901 MODAFINIL (PROVIGIL) TAB: 100 MG 28.00 11536984 MORPHINE SULFATE (MS CONTIN) SRTAB: 15MG 1.28 11537016 MORPHINE SULFATE VIAL: 1000MG / 20ML 24.43 11537024 MORPHINE SULF (ROXANOL) SOLN: 20 MG/ML 4.85 11537057 *MORPHINE SULFATE (MS CONTIN) SRTAB:60MG 1.88 11537065 *MORPHINE SULFATE (MS CONTIN) SRTAB:30MG 1.00 11537123 MORPHINE SULFATE (MORPHINE) VIAL: 10 MG 4.90 11537164 *MORPHINE SULFATE (CONT IV) : 5 MG/ML 21.63 11537248 MORPHINE SULFATE (PCA) SOLN:30 MG/30 ML 16.65 11537594 MULTIVITAMIN (THERAVITE) SOLUTION 0.50 11537719 MULTIVITAMIN WITH MINERAL (THERAGRAN)TAB 0.50 11538030 MUPIROCIN 2% (BACTROBAN) OINT 10.53 11538089 NYSTATIN/TRIAM (MYCOLOG) CREAM 39.65 11538204 MAG HYDROX/AL HYDROX/SIMETH-MAALOX PLUS 4.58 11538295 NADOLOL (CORGARD) TAB: 40 MG 7.70 11538386 NALOXONE (NARCAN) INJ:0.4 MG 1.50 11538790 NATEGLINIDE (STARLIX) TAB: 60 MG 1.28 11538873 DIALYSIS VITAMIN (RENA-VITE RX) TAB 0.50 11539269 NICOTINE (NICODERM CQ) PATCH: 21 MG 3.28 11539277 NICOTINE (NICODERM CQ) PATCH: 14 MG 3.28 11539285 NICOTINE (NICODERM CQ) PATCH: 7 MG 5.53

11539392 NIFEDIPINE (PROCARDIA XL) TAB: 30 MG 1.68 11539434 IRON POLYSACCARIDE CPLX FRTE 150MG 0.50 11539590 NITROGLYCERIN 2% (NITRO-BID) OINT 4.65 11539640 NITROGLYCERIN (NITROSTAT) SLTAB: 0.4 MG 3.00 11539731 NITROGLYCERIN 0.2 MG/HR (NITRO-DUR)PATCH 0.93 11539764 NITROGLYCERIN 0.4 MG/HR (NITRO-DUR)PATCH 0.98 11539806 *NITROGLYCERIN 0.6 MG/HR(NITRO-DUR)PATCH 1.85 11539830 *NITROGLYCERIN (NITROGLYCERIN) VIAL:50MG 8.70 11540002 NITROPRUSSIDE (NITROPRESS) VIAL: 50 MG 188.93 11540069 NORTRIPTYLINE (PAMELOR) CAP: 10 MG 0.50 11540093 NORTRIPTYLINE (PAMELOR) CAP: 25 MG 0.93 11540366 OCTREOTIDE ACET (SANDOSTATIN) LAR: 30 MG 7,947.75 11540408 INSULIN ASPART(NOVOLOG)SYR:10 UNIT/0.1ML 36.20 11540481 NYSTATIN (MYOSTATIN) CREAM: 100000 UNITS 14.45 11540507 ONDANSETRON (ZOFRAN) ODT TAB: 4 MG 0.50 11540523 NYSTATIN (MYOSTATIN) POWDER: 100000 UNIT 7.85 11540549 OFLOXACIN OTIC (FLOXIN OTIC) 0.3% 4.35 11540606 OFLOXACIN 0.3% (OCUFLOX) OPHTH SOL 25.08 11540614 OLANZAPINE (ZYPREXA) TAB: 5 MG 0.50 11540655 PEG-3350 & ELECT (GOLYTELY) ORAL SOL 15.83 11540689 OMEPRAZOLE (PRILOSEC) SRCAP: 20 MG 0.50 11540721 *OLANZAPINE (ZYPREXA) TAB: 2.5 MG 18.85 11540739 *ONDANSETRON (ZOFRAN) TAB: 4 MG 0.85 11540747 ONDANSETRON (ZOFRAN) VIAL: 4 MG 1.05 11540804 CALCIUM CARB (OSCAL 500) TAB: 500 MG 0.50 11541257 OXCARBAZEPINE (TRILEPTAL) TAB: 150 MG 0.50 11541505 OXYBUTYNIN (DITROPAN) TAB: 5 MG 0.80 11541562 OXYCODONE (ROXICODONE) TAB: 5 MG 0.58 11541570 OXYCODONE (OXYCONTIN) SRTAB: 10 MG 8.23 11541588 OXYCODONE (OXYCONTIN) SRTAB: 20 MG 13.30 11541596 *OXYCODONE (OXYCONTIN) SRTAB: 40 MG 13.98 11541620 OXYTOCIN (PITOCIN) VIAL: 10 UNITS 1.53 11541653 PALONOSETRON (ALOXI) VIAL: 0.25 MG/5 ML 20.38 11541711 AMYLASE/LIPASE/PROTEASE(PANCREASE) CAP 0.95 11541760 PANTOPRAZOLE SOD (PROTONIX) TAB: 40 MG 0.50 11541778 PANTOPRAZOLE SOD (PROTONIX) VIAL: 40 MG 11.35 11541810 PANTOPRAZOLE (PROTONIX) PACKET: 40 MG 32.93 11541893 PAROXETINE (PAXIL) TAB: 20 MG 0.50 11541901 PAROXETINE (PAXIL) TAB: 10 MG 0.50 11542941 PENTOXIFYLLINE (TRENTAL) SRTAB: 400 MG 0.50 11543428 HYDROCERIN (EUCERIN) CREAM 6.85 11543519 *PHENAZOPYRIDINE (PYRIDIUM) TAB: 100 MG 4.08 11543741 PHENOBARBITAL (PHENOBARBITAL)TAB:32.4 MG 0.55 11543816 *PHENOBARBITAL (PHENOBARBITAL)SYR: 60MG 3.20 11543873 PHENOBARBITAL ELIXIR: 20 MG 0.75 11544384 *PHENYTOIN (DILANTIN) CHWTAB: 50 MG 1.30 11544459 PHENYTOIN (DILANTIN) ER CAP: 100 MG 1.08 11544509 *PHENYTOIN (DILANTIN) VIAL: 100 MG 1.85 11544533 PHENYTOIN (DILANTIN) VIAL: 250 MG 2.60 11544566 *PHENYTOIN (DILANTIN-125) SUSP: 125 MG 0.80 11544681 PHYTONADIONE (VITAMIN K) INJ: 10 MG 86.13 11544715 PHYTONADIONE(AQUA-MEPH NEONATAL)INJ:1 MG 5.00

11544749 *PHYTONADIONE (MEPHYTON) TAB: 5 MG 24.63 11545050 *PIOGLITAZONE (ACTOS) TAB: 15 MG 14.15 11545282 *PNEUMOCOCCAL (PNEUMOVAX 23) VACCINE 211.59 11545464 *POTASS CARBONATE-CA (KLYTE)EFFTAB:25ME 0.50 11545555 POTASSIUM CHLORIDE(K-LOR) PKT: 20 MEQ 7.25 11545696 POTASSIUM CHLR(KLOR-CON) SRTABS: 10 MEQ 0.68 11545704 POTASSIUM CHLORIDE(K-DUR) SRTAB: 20 MEQ 0.78 11545738 *POTASSIUM CHLR (KCL) VIAL: 20 MEQ/10 ML 5.75 11545829 POTASSIUM IODIDE (SSKI) SOLN:1 G 10.65 11545944 POVIDONE-IODINE 10%(BETADINE) OINT 11.65 11546009 TUBERCULIN PUR PROT DERIV VIAL: 5 TU 19.03 11546132 *PRAMIPEXOLE (MIRAPEX) TAB: 0.125 MG 5.20 11546157 PRAVASTATIN (PRAVACHOL) TAB: 20 MG 0.80 11546264 *PREGABALIN (LYRICA) CAP: 100 MG 11.58 11546272 PREGABALIN (LYRICA) CAP: 50 MG 0.50 11546280 PREGABALIN (LYRICA) CAP: 75 MG 1.00 11546298 *PREGABALIN (LYRICA) CAP: 25 MG 5.45 11546470 PREDNISOLONE ACET 1% (PRED FORTE) OPHTH 89.15 11546512 PREDNISONE (DELTASONE) TAB: 1 MG 0.50 11546579 PREDNISONE (DELTASONE) TAB: 5 MG 0.50 11546637 PREDNISONE (DELTASONE) TAB: 10 MG 0.50 11546728 PREDNISONE (DELTASONE) TAB: 20 MG 0.50 11546819 PRIMIDONE (MYSOLINE) TAB: 50 MG 1.08 11546876 PRIMIDONE (MYSOLINE) TAB: 250 MG 1.10 11547593 PROCHLORPERAZINE (COMPAZINE) TAB: 5 MG 1.80 11547809 PROCHLORPERAZINE (COMPAZINE) VIAL: 10 MG 15.48 11548229 PROMETHAZINE (PHENERGAN) TAB: 25 MG 0.50 11548286 PROMETHAZINE (PHENERGAN) INJ: 25 MG 1.78 11548799 PROPRANOLOL (INDERAL) TAB: 10 MG 0.50 11548971 *PROPRANOLOL (INDERAL) TAB: 40 MG 0.50 11549110 PROPRANOLOL LA (INDERAL) ERCAP: 60 MG 1.80 11549128 PROPRANOLOL LA (INDERAL) ERCAP: 80 MG 2.98 11549219 PROPYLTHIOURACIL (PTU) TAB: 50 MG 0.50 11549276 PROTAMINE SULFATE VIAL: 250MG/25ML 59.45 11549458 PSEUDOEPHEDRINE (SUDAFED) TAB: 30 MG 0.50 11549557 PSYLLIUM (METAMUCIL SUG FREE)PACKET: 6 G 1.18 11549656 PYRIDOSTIGMINE (MESTINON) TAB: 60 MG 1.13 11549755 PYRIDOXINE (VITAMIN B-6) TAB: 50 MG 0.50 11549862 QUETIAPINE (SEROQUEL) TAB: 100 MG 0.50 11549896 QUETIAPINE (SEROQUEL) TAB: 25 MG 0.50 11549979 RISPERIDONE (RISPERDAL) TAB: 0.25 MG 0.50 11550001 SENNA CONCENTRATE (SENOKOT) TAB: 8.6 MG 0.50 11550324 RABIES IMM GLOBULN (IMOGAM): 300 I-UNITS 1,759.55 11550340 EPINEPHRINE (RACEMIC): 1MG 1.93 11550357 RABIES VAC DIPLOID (IMOVAX): 2.5 I-UNITS 720.93 11550365 RAMIPRIL (ALTACE) CAP: 2.5 MG 0.50 11550381 RALOXIFENE HCL (EVISTA) TAB: 60 MG 11.10 11550399 RAMIPRIL (ALTACE) CAP:5 MG 0.50 11550415 RANITIDINE (ZANTAC) TAB: 150 MG 0.70 11550522 *ROSUVASTATIN (CRESTOR) TAB: 10 MG 16.43 11550571 *RISEDRONATE (ACTONEL) TABLET: 35 MG 56.65 11550647 RISPERIDONE (RISPERDAL) TAB: 1 MG 0.50

11550670 ROSIGLITAZONE MALEATE(AVANDIA) TAB: 4 MG 9.35 11550704 ROPINIROLE (REQUIP) TAB: 0.25 MG 0.50 11550712 *SALMETEROL XINA (SEREVENT) MDI: 50 MCG 206.55 11550720 SODIUM CHLORIDE NASAL SPRAY 1.70 11550787 SENNA/DOCUSATE SOD (SENOKOT-S) TAB 0.50 11550811 SCOPOLAMINE(TRANSDERM SCOP): 1.5 MG/72HR 43.30 11550902 SELEGILINE (ELDEPRYL) TAB: 5 MG 0.50 11551207 SERTRALINE (ZOLOFT) TAB: 50 MG 0.60 11551314 SEVELAMER HCL (RENAGEL) TAB: 800 MG 16.20 11551371 SILVER SULFADIAZINE 1%(THERMAZENE): 50 G 15.60 11551405 SILVER SULFADIAZINE 1%(SILVADENE): 400 G 69.73 11551447 SIMETHICONE (MYLICON) CHWTAB: 80 MG 0.50 11551496 CARBID/LEVOD (SINEMET) TAB 10-100 MG 0.50 11551553 CARBID/LEVOD (SINEMET) TAB 25-250 MG 0.55 11551611 CARBID/LEVOD (SINEMET) TAB 25-100 MG 0.50 11551629 CARBID/LEVOD (SINEMET)CRTAB 50-200 1.38 11551645 SIMVASTATIN (ZOCOR) TAB:10 MG 0.50 11551652 *SIMVASTATIN (ZOCOR) TAB: 20 MG 0.50 11551694 SITAGLIPTIN (JANUVIA) TAB: 100 MG 34.88 11551850 SOD BICARB 8.4% SYRINGE: 50 MEQ 22.65 11551900 CELLUVISC 0.75 11552155 SULFACETAMIDE 10% (BLEPH-10) OPHTH SOL 80.85 11552197 SULFACETAMIDE 10% (CETAMIDE) OPHTH OINT 126.65 11552262 SOTALOL (BETAPACE) TAB: 80 MG 0.50 11552270 SORBITOL SOL 70% (SORBITOL) SOL: 30 ML 4.18 11552387 SPIRONOLACTONE (ALDACTONE) TAB: 25 MG 0.50 11552544 SUCRALFATE (CARAFATE) TAB: 1000 MG 0.58 11553146 TAMSULOSIN (FLOMAX) CAP: 0.4 MG 0.58 11553179 ARTIFICIAL TEARS (LIQUIFILM) OPHTH SOL 14.33 11553203 TEMAZEPAM (RESTORIL) CAP: 15 MG 0.50 11553278 TERAZOSIN (HYTRIN) CAP: 1 MG 0.50 11553286 TERBUTALINE (BRETHINE) INJ:1 MG 3.10 11553294 TERAZOSIN (HYTRIN) CAP: 5 MG 0.50 11553336 SUMATRIPTAN (IMITREX) VIAL: 6 MG 15.03 11553468 TERBINAFINE (LAMISIL) TAB: 250 MG 0.50 11553591 TETANUS DIPH TOX (DECAVAC) VACCINE 44.88 11553625 TETANUS IMMU GLOBULIN (HYPERTET) SYRINGE 1,080.73 11553682 TETRACAINE 0.5% (PONTOCAINE) OPHTH SOL 10.84 11554854 THIAMINE (VITAMIN B1) VIAL: 100 MG 13.02 11554904 THIAMINE (VITAMIN B1) TAB: 100 MG 0.50 11555596 TIOTROPIUM (SPIRIVA) CAP: 18 MCG 39.10 11555786 THYROID (ARMOUR THYROID) TAB: 30 MG 0.50 11556073 TIMOLOL 0.5% (TIMOPTIC) OPHTH SOL 8.25 11556388 TOBRAMYCIN 0.3% (TOBREX) OPHTH SOL 26.78 11556438 TOBRAMYCIN/DEXAMETH (TOBRADEX) OPHTH SOL 93.82 11556610 VECURONIUM BROMIDE VIAL: 10 MG 18.08 11556842 TRAMADOL (ULTRAM) TAB: 50 MG 0.50 11556859 *TOLTERODINE TARTRATE (DETROL) TAB: 2 MG 10.20 11556891 TRAZODONE (DESYREL) TAB: 50 MG 0.50 11556909 TOPIRAMATE (TOPAMAX) TAB: 25 MG 0.50 11556917 *TOPIRAMATE (TOPAMAX) TAB: 100 MG 0.50 11556933 TRAVOPROST 0.004% (TRAVATAN Z) OPHTH SOL 424.30

11557014 TRIAMCINOLONE ACETONIDE 0.1%(KENALOG) CR 10.93 11557857 TRIHEXYPHENIDYL (ARTANE) TAB: 2 MG 0.50 11558384 OXYCODONE/APAP (PERCOCET) TAB 5/325 MG 0.50 11558483 VALACYCLOVIR (VALTREX) TAB: 500 MG 5.40 11558566 *VALPROATE SOD (DEPAKENE) SYRUP: 250 MG 0.50 11558574 VARICELLA (VARIVAX) VACCINE 339.30 11558673 MIDAZOLAM (VERSED) VIAL: 5 MG/1ML 2.10 11558749 *VENLAFAXINE (EFFEXOR ER) ERCAP: 37.5 MG 1.18 11558814 VENLAFAXINE (EFFEXOR XR) ERCAP: 75 MG 0.50 11558822 VERAPAMIL ER(ISOPTIN/CALAN)ERTAB: 180 MG 4.58 11558848 VERAPAMIL ER(ISOPTIN/CALAN)ERTAB: 120 MG 0.52 11559127 *VITAMINS A & D OINT 4.05 11559135 VITAMIN D(CHOLECALCIFERL)TAB:400 I-UNIT 0.50 11559200 VITAMIN E (AQUASOL E) CAP: 400 I-UNIT 0.50 11559226 WARFARIN (COUMADIN) TAB: 1 MG 0.50 11559259 WARFARIN (COUMADIN) TAB: 2 MG 0.50 11559283 WARFARIN (COUMADIN) TAB: 2.5 MG 0.50 11559291 WARFARIN (COUMADIN) TAB: 3 MG 0.50 11559309 *WARFARIN (COUMADIN) TAB: 4 MG 0.50 11559317 WARFARIN (COUMADIN) TAB: 5 MG 0.50 11559580 ZINC SULFATE (ZINCATE) CAP: 220 MG 0.50 11559689 ZINC OXIDE 20% (ZINC OXIDE) OINT 2.45 11559713 ZIPRASIDONE (GEODON) CAP: 20 MG 3.28 11559721 ZOLPIDEM (AMBIEN) TAB: 5 MG 0.50 11559861 HYDROCORTSONE (ANUSOL HC)SUPP: 25 MG 19.18 11559895 BISACODYL (DULCOLAX) SUPP: 10 MG 0.50 11560976 IPRATROPIUM (ATROVENT) SOLN:0.5 MG 0.50 11560984 LEVALBUTEROL HCL (XOPENEX) SOL: 0.63 MG 2.26 11560992 STERILE WATER FOR INJECTION 1.88 11570009 LEVALBUTEROL HCL SOL: 1.25 MG MULTIPACK 2.75 11583895 GLYCERIN ADULT (LAXATIVE) SUPP 5.35 11583978 PROCHLORPERAZINE (COMPAZINE) SUPP: 25 MG 13.89 11584190 HEPARIN SODIUM PREMIX: 25000 UNITS 32.60 11584430 PROMETHAZINE (PHENERGAN) SUPP: 25 MG 13.60 11584513 SOD CHLOR FOR INH 0.9% (NS INHALATION) 0.50 11584554 SODIUM CHLORIDE 0.9% (MINIBAG+) 100 ML 11.55 11587995 ZOLEDRONIC ACID(RECLAST)INJ: 5 MG/100 ML 197.13 11588019 LEVOFLOXACIN (LEVAQUIN)PM: 500 MG/100 ML 25.50 11588027 METRONIDAZOLE/NACL (FLAGYL) PMIX: 500 MG 3.68 11588043 *ARIPIPRAZOLE (ABILIFY) TAB: 15 MG 40.40 11588050 TEGASEROD (ZELNORM) TAB:6 MG 6.93 11588076 COLESTIPOL (COLESTID) TAB: 1000 MG 1.70 11588084 SODIUM CHLORIDE 0.9% (NS) VIAL: 20 ML 1.73 11588092 GLUCOSAMINE/CHONDROITIN CAP 0.78 11588100 ACIDOPHILUS (ACIDOPHILUS) TAB 0.50 11588118 METFORMIN XR(GLUCOPHAGE) TAB: 500 MG 0.50 11588126 FLUCONAZOLE (DIFLUCAN) TAB: 150 MG 2.58 11588134 POTASSUIM CHL PMIX: 20 MEQ/100 ML 6.93 11588142 TEGASEROD (ZELNORM) TAB:2 MG 5.25 11588159 HYDROCODON 10 MG/APAP 325 MG (NORCO) TAB 0.75 11588175 AMOXICILLIN/CLAV(AUGMENTIN) SUSP: 200 MG 7.95 11588183 *BUDESONIDE (PULMICORT) MDI: 90 MCG 312.60

11588191 SALINE FLUSH SYRINGE: 5 ML 0.95 11588209 MENINGOCOCCAL (MENACTRA) VACCINE 267.25 11588217 ACTHIB (HAEMOPHILUS B/TETANUS) VACCINE 24.88 11588225 MEMANTINE (NAMENDA) TAB: 5 MG 0.95 11588241 OSELTAMIVIR (TAMIFLU) CAP: 75 MG 87.00 11588266 PEDIARIX VACCINE SYRINGE 165.79 11588274 *BIMATOPROST 0.03% (LUMIGAN) OPHTH SOL 232.40 11588282 DICYCLOMINE (BENTYL) TAB: 20 MG 0.93 11588290 ESCITALOPRAM (LEXAPRO): 10 MG 0.50 11588316 CEFEPIME (MAXIPIME) VIAL: 1 GRAM 13.23 11590221 DOXAZOSIN (CARDURA) TAB: 4 MG 1.89 11590254 *PHENYTOIN (DILANTIN) CAP: 30 MG 0.90 11590262 *OXYBUTYNIN CHLOR (DITROPAN) SRTAB: 5 MG 5.18 11590288 RIVASTIGMINE TARTRATE(EXELON)CAP: 1.5 MG 9.40 11590304 *RIVASTIGMINE TARTRATE(EXELON)CAP:4.5 MG 9.40 11590312 *RIVASTIGMINE TARTRATE(EXELON)CAP: 6 MG 9.40 11590320 GLIPIZIDE XL (GLUCOTROL) SRTAB: 2.5 MG 2.50 11590353 POLIOMYELITIS KILLED (IPOL) VACCINE 77.70 11590361 SOD POLYSTY SULF (KAYEXALATE) SUSP: 15 G 17.58 11590429 MAGNESIUM SULFATE VIAL: 1 GRAM 2.68 11590445 PROMETHAZINE (PHENERGAN) SUPP: 12.5 MG 9.33 11590452 POTASSIUM CHLR10MEQ/100ML(KCL 10MEQ/100M 5.85 11590478 THEOPHYLLINE (THEO-DUR) SRCAP:300 MG 0.50 11590486 *THEOPHYLLINE (THEO-DUR) SRTAB: 200 MG 1.15 11590536 *IRBESARTAN (AVAPRO) TAB: 150 MG 5.45 11590544 BUSPIRONE (BUSPAR) TAB: 15 MG 1.05 11590551 CIPROFLOXACIN (CIPRO) PMIX: 200 MG 3.45 11590569 TOLTERODINE TARTRATE(DETROL)LA CAP: 2 MG 13.30 11590585 GUAIFENESIN (MUCINEX) TAB: 600 MG 1.95 11590601 SOD PHOS MD/SOD PHOS DB(FLEETS ENEMA) 2.75 11590619 MICONAZOLE NITRATE 2% (LOTRIMIN) POWDER 14.65 11590627 NITROFURANTON (MACROBID) CAP: 100 MG 3.81 11590635 MAGNESIUM OXIDE (MAG-OXIDE) TAB: 400 MG 0.50 11590643 POLYETHYLENE GLYCOL 3350(MIRALAX) PACKET 2.55 11590650 SODIUM CHLORIDE 5% (MURO 128) OPHTH SOL 9.75 11590668 SODIUM CHLORIDE 5% (MURO 128) OPHTH OINT 10.70 11590684 GALANTAMINE (RAZADYNE) TAB: 4 MG 3.23 11590692 RIMEXOLONE 1% (VEXOL 1%) SOLN:5 ML 78.15 11590700 LEVOFLOXACIN (LEVAQUIN) PM: 250 MG/50 ML 3.83 11590726 DOXYCYCLINE (VIBRATAB) TAB: 100 MG 2.73 11590742 MIDODRINE (PROAMATINE) TAB: 5 MG 1.50 11590759 NALOXONE (NARCAN) SYRINGE: 1 MG/ML 68.93 11590767 AZITHROMYCIN (ZITHROMAX) SUSP: 100 MG 29.75 11590775 CALCIUM CARBONATE/VITAMIN D(OSCAL) TAB 0.50 11590783 *RANITIDINE (ZANTAC PM) PMIX: 50 MG 10.98 11590791 CYANOCOBALAMIN(VITAMIN B12)TAB: 1000 MCG 0.50 11590809 POTASSIUM CHLR 20MEQ - NS 1000 ML BAG 6.35 11590817 DEXTROSE 5%-0.45% SALINE-40 KCL 1000 ML 4.50 11590825 DEXTROSE 5%-0.45% SALINE-20 KCL 1000 ML 4.91 11590833 ANUMED RECTAL (ANUSOL HC) 2.5% CREAM 34.90 11590858 DEXTROMETHORPHAN/GUAIFENESIN(DIABETIC) 3.30 11590866 MEGESTROL ACETATE(MEGACE)SUSP:400MG/10ML 4.73

11590874 PREDNISOLONE (PEDIAPRED) SOL: 5 MG/5 ML 1.15 11590882 DEXAMETHASONE(DEXAMETHASONE)SOLN:0.5MG 2.23 11590908 *CARVEDILOL (COREG) TAB: 25 MG 0.50 11590916 HYDROCOD PSX/CHLOR-POLI(TUSSIONEX) SUSP 0.65 11590932 LIDOCAINE HCL TOPICAL SOL BOTTLE: 4% 13.15 11590940 HEPARIN SOD VIAL: 500 UNITS / 5 ML 1.35 11590957 HEPATITIS A VACCINE(HAVRIX): 720 UNITS 59.45 11590965 MOXIFLOXACIN (AVELOX) PMIX: 400 MG 77.78 11600011 CHLORHEXIDINE GLUC 0.12% (PERIDEX) SOL 5.15 11600012 VITAMIN D (CHOLECALCIF)CAP: 2000 I-UNIT 0.50 11600013 VITAMIN D (ERGOCALCIFEROL) CAP: 50000 0.50 11600014 CARBAMAZEPINE (CARBATROL ER) CAP: 200MG 3.70 11600015 CARBAMAZEPINE (CARBATROL ER) CAP: 300MG 3.70 11600016 *INFLUENZA (FLUMIST) SYRAY: SPRAY 46.88 11600017 INSULIN GLARGIN(LANTUS)SYR:10 UNIT/0.1ML 175.75 11600018 INSULIN 70/30(NOVOLOG MIX)SYR:10UNIT/0.1 36.33 11600019 MOMETASONE (ASMANEX) MDI: 220 MCG 171.60 11600020 POTASSIUM CHLR 20MEQ - 0.45% NS 1000ML 17.15 11600021 TESTOSTERONE 1% (ANDROGEL) GEL: 5 G 21.25 11600022 LEVOTHYROXINE (SYNTHROID) TAB: 0.112 MG 2.88 11600023 LIDOCAINE (XYLOCAINE) PMIX: 1 G/250 ML 12.84 11600024 ASPIRIN SUPP: 600 MG 3.77 11600025 HEMORRHOIDAL WIPES (TUCKS PADS) PKG 10.98 11600026 METRONIDAZOLE (METROGEL) GEL: 0.75% 146.13 11600027 OSELTAMIVIR (TAMIFLU) SOL: 12 MG/ML 224.65 11600028 LIDOCAINE (XYLOCAINE) 2% MDV 6.60 11600029 LIP TREATMENT (CARMEX) OINT: TUBE 2.45 11600030 RIVASTIGMINE (EXELON) PATCH: 4.6 MG 10.73 11600031 DICLOFENAC 1% (VOLTAREN) GEL TUBE 47.85 11600032 *ALFUZOSIN (UROXATRAL) TAB: 10 MG 0.50 11600033 FERROUS SULFATE SOL: 300 MG/5 ML 0.60 11600034 HYDROXYZINE HCl (ATARAX) TAB: 10 MG 0.50 11600035 *MINOCYCLINE (MINOCIN) CAP: 100 MG 0.65 11600036 *ENTACAPONE (COMTAN) TAB: 200 MG 12.50 11600037 ERTAPENEM (INVANZ) VIAL: 1000 MG 149.25 11600038 PROPOXYPHENE (DARVON)CAP: 65MG 0.50 11600040 *HALOPERIDOL (HALDOL) TAB: 5 MG 0.50 11600041 RIFAXIMIN (XIFAXAN) TAB: 200 MG 47.88 11600042 *EXENATIDE (BYETTA) SYRINGE: 5 MCG 919.18 11600043 COBAN WRAP 4.88 11600045 *EXENATIDE (BYETTA) SYRINGE: 10 MCG 992.73 11600046 AMOXICILLIN/CLAVULANTE XR TAB: 1000 MG 8.70 11600047 *INFLUENZA PEDIATRIC (FLUZONE)PF 0.25 ML 35.55 11600048 UNNAFLEX (UNNA BOOT): 1 PKG 15.78 11600052 SODIUM CHLORIDE 0.9% 500 ML NON-PVC BAG 2.80 11600053 DEXTROSE 5% 500 ML NON-PVC BAG 2.75 11600055 SODIUM CHLORIDE 0.9% 100 ML NON-PVC BAG 3.11 11600056 SODIUM CHLORIDE 0.9% 250 ML NON-PVC BAG 4.83 11600057 DEXTROSE 5% 250 ML NON-PVC BAG 2.35 11600058 SODIUM CHLORIDE 0.9% 50 ML NON-PVC BAG 3.11 11600059 DEXTROSE 5% 50 ML BAG 3.45 11600060 DEXTROSE 5% 1/2 NS 1000 ML BAG 4.45

11600061 SODIUM CHLORIDE 0.9% 50 ML BAG 4.61 11600062 SODIUM CHLORIDE 0.9% 100 ML BAG 4.47 11600063 SODIUM CHLORIDE 0.9% 250 ML BAG 11.54 11600064 SODIUM CHLORIDE 0.9% 500 ML BAG 3.53 11600065 DEXTROSE 10% 1000 ML 4.45 11600066 MANNITOL 20% 500 ML BAG 48.18 11600067 SODIUM CHLORIDE 0.45% 1000 ML BAG 12.30 11600068 SODIUM CHLORIDE 0.9% 1000 ML BAG 4.25 11600069 DEXTROSE 5% 1000 ML BAG 4.20 11600070 DEXTROSE 5%/NS 0.9% 1000 ML BAG 10.76 11600071 LACTATED RINGERS 500 ML BAG 3.80 11600072 DEXTROSE 5% 500 ML BAG 3.80 11600073 LACTATED RINGERS 1000 ML BAG 4.50 11600074 DEXTROSE 5% 100 ML BAG 2.69 11600075 DEXTROSE 5% 250 ML BAG 3.15 11600091 *LV 5 INFUSOR 90.45 11600093 CETUXIMAB (ERBITUX) VIAL: 100 MG 1,518.13 11600102 FISH OIL (OMEGA-3) CAPSULE: 1000 MG 0.50 11600104 NF-BICALUTAMIDE ORAL TABLET 50MG 72.08 11600107 FOSAPREPITANT (EMEND) VIAL: 115 MG 467.65 11600111 NF-SULFASALAZINE TAB 500MG 0.50 11600125 HYDROCORTISONE TAB: 10 MG 1.85 11600127 NF-LOVAZA LIQ CAP 1GM 3.23 11600133 LEVOFLOXACIN (LEVAQUIN)PM: 750 MG/150 ML 8.30 11600146 TUSSIONEX SUSP 5ML 8.80 11600155 *LV 1.5 INFUSOR 90.45 11600156 EPIRUBICIN (ELLENCE) VIAL: 50 MG 113.60 11600157 ISONIAZID TAB: 300 MG 0.50 11600166 EYE VITAMIN TAB (AREDS FORMULA) 0.53 11600178 TRIAMCINOLONE (KENALOG-10) VIAL: 10 MG 28.08 11600180 LUBIPROSTONE (AMITIZA) CAP: 24 MCG 14.20 11600181 NF-CONCERTA TAB ER 36MG 11.30 11600185 FOSAPREPITANT (EMEND) VIAL: 150 MG 187.85 11600188 CLOTRIMAZOLE (MYCELEX) TROCHE: 10 MG 1.70 11600214 NF-CEFPODOXIME PROXETIL ORAL TABLET 200M 14.28 11600228 NF-LANACANE ANTI-ITCH CREAM CREAM 20%-0. 8.93 11600229 NF-AMITIZA LIQ CAP 24MCG 851.70 11600235 NF-DESMOPRESSIN ACETATE TAB 0.1MG 2.25 11600244 *DABIGATRAN ETEXILATE(PRADAXA)CAP:150 MG 11.98 11600246 ROMIPLOSTIM (NPLATE) VIAL: 250 MCG 3,995.93 11600262 SALINE FLUSH SYRINGE: 10 ML 0.50 11600263 INTERFERON ALFA 2B(INTRON A): 1 MM UNITS 39.35 11600265 NF-FLUOCINONIDE SOLN 0.05% 16.65 11600286 PENICILLIN G BENZ(BICILLIN L-A): 1.2 MU 120.20 11600294 NF-PATANOL OPHTH SOLUTION 0.1% 255.18 11600299 SODIUM CHLORIDE 0.9% 150 ML BAG 11.54 11600301 PRAMIPEXOLE (MIRAPEX) TAB: 0.25 MG 0.50 11600317 SUNTAN LOTION 10.00 11600331 FERRIC SUBSULFATE SOLUTION (MONSEL'S) 44.45 11600333 NF-COMBIGAN OPHTH SOLN 0.2%-0.5% 181.25 11600336 CALCIUM CARBONATE ORAL SUSP 1250MG/5M 0.90 11600349 ANALGESIC BALM (BENGAY) OINT 4.15

11600356 FLUDARABINE (FLUDARA) VIAL: 50 MG 147.18 11600369 LEUPROLIDE (ELIGARD) INJ: 7.5 MG 333.63 11600380 PAMIDRONATE DISODIUM (AREDIA) INJ: 60 MG 54.55 11600390 NF-DANTROLENE ORAL CAPSULE 25 MG 3.20 11600407 LINEZOLID (ZYVOX) PMIX: 600 MG/300 ML 50.88 11600426 BORTEZOMIB (VELCADE) VIAL: 3.5 MG 4,007.50 11600431 ROPINIROLE (REQUIP) TAB: 1 MG 0.85 11600444 C1 ESTERACE INHIBITOR(BERINERT) 500 UNIT 6,071.28 11600445 CYANIDE ANTIDOTE KIT 1,903.20 11600463 *OMEPRAZOLE (PRILOSEC) SUSP: 20 MG/10 ML 3.60 11600464 AMIKACIN SULFATE VIAL: 1 GRAM 11.58 11600465 SEVELAMER CARB (RENVELA) TAB: 800 MG 5.23 11600467 CIDOFOVIR (VISTIDE) VIAL: 375 MG 1,785.25 11600472 DEXTROSE 10% 250 ML BAG 4.52 11600473 HYDRALAZINE (APRESOLINE) TAB: 10 MG 0.50 11600474 INSULIN ASPAR(NOVOLOG)VIAL:5 UNIT/0.05ML 0.56 11600475 *RABIES VACCINE (RABAVERT): 2.5 I-UNITS 571.73 11600478 PIPERACILLIN/TAZOBAC(ZOSYN)VIAL: 4.5 G 10.55 11600479 PIPERACILLIN/TAZOBAC(ZOSYN)VIAL: 2.25 G 16.98 11600484 CABAZITAXEL (JEVTANA) VIAL: 60 MG 23,605.53 11600487 K-PHOS NEUTRAL TAB: 250 MG 0.50 11600490 GEMCITABINE (GEMZAR) VIAL: 1000 MG 50.30 11600491 VANCOMYCIN ORAL SOLUTION 125 MG/5 ML 5.00 11600494 IBANDRONATE SOD (BONIVA) INJ: 3 MG/3 ML 1,225.80 11600495 DARBEPOETIN (ARANESP) SYR: 40 MCG/0.4 ML 312.90 11600504 NITROGLYCERIN/D5W PMIX: 100 MCG/ML 40.60 11600509 NF-NORPACE ORAL CAPSULE 150MG 0.62 11600510 CARBOPLATIN VIAL: 150 MG 22.90 11600513 DOXORUBICIN (ADRIAMYCIN) VIAL: 50 MG 28.08 11600521 BLEOMYCIN VIAL: 30 UNITS 85.80 11600522 VINBLASTINE SULFATE VIAL: 10 MG 79.33 11600523 DACARBAZINE VIAL: 200 MG 21.35 11600545 NICOTINE GUM (NICORETTE) CHEWTAB: 4 MG 0.70 11600553 PALIPERIDONE (INVEGA SUST) INJ: 117 MG 2,841.70 11600554 *ALENDRONATE (FOSAMAX) TAB: 35 MG 1.13 11600565 MESALAMINE (PENTASA) CRCAP: 500 MG 6.95 11600566 TETANUS DIPH TOX (TENIVAC) VACCINE 66.85 11600567 CIPROFLOXACIN (CIPRO) PMIX: 400 MG 6.83 11600568 DIPH-TET-ACEL PERT-POLIO-HAEMO VACCINE 213.38 11600569 DIPH-TET-ACEL PERT-POLIO VACCINE 97.55 11600570 *HUMAN PAPILLOMAVIRUS (GARDASIL) VACCINE 318.65 11600571 ZOSTER (ZOSTAVAX) VACCINE 425.90 11600572 M-M-R VARICELLA VACCINE 534.60 11600573 PNEUMOCOCCAL 13 VALENT VACCINE 468.63 11600574 ROTAVIRUS LIVE ORAL 177.51 11600582 *LAMOTRIGINE (LAMICTAL) TABLET: 150 MG 0.63 11600585 RITUXIMAB (RITUXAN) VIAL: 500 MG 11,744.00 11600588 *Naproxen Oral Tab 220 MG 0.50 11600589 VANCOMYCIN (VANCOCIN) VIAL: 1750 MG 14.55 11600590 VANCOMYCIN (VANCOCIN) VIAL: 1500 MG 14.55 11600591 VANCOMYCIN (VANCOCIN) VIAL: 1250 MG 14.55 11600592 VANCOMYCIN (VANCOCIN) VIAL: 750 MG 7.28

11600593 VANCOMYCIN (VANCOCIN) VIAL: 2000 MG 14.55 11600595 NF-BETAMETHASONE DIPROPIONATE LOTION 0.0 75.33 11600597 NF-CIPROFLOXACIN HCL OPHTH SOLN 0.3% 7.20 11600598 AZTREONAM (AZACTAM) VIAL: 1 GRAM 62.65 11600599 NF-KENALOG IN ORABASE PASTE 0.1% 88.55 11600601 NF-NEO/POLY-B/DEX 3.5MG-10000U-1MG/1GM 21.30 11600610 VANCOMYCIN ORAL SOLUTION 250 MG/5 ML 5.00 11600615 NF-ORAJEL MOUTH SORE MEDICINE 11.00 11600616 CLINDAMYCIN (CLEOCIN) VIAL: 300 MG 4.90 11600626 FEBUXOSTAT (ULORIC) TAB: 80 MG 25.25 11600631 GEMCITABINE (GEMZAR) VIAL: 200 MG 14.53 11600633 METHOTREXATE VIAL: 1 GRAM 150.88 11600636 METHOTREXATE VIAL: 250 MG 12.83 11600644 MAGNESIUM SULFATE VIAL: 2 GRAM 4.06 11600646 BUPRENORPHINE 5 MCG/HR (BUTRANS) PATCH 86.63 11600653 OXYMETAZOLINE (AFRIN) NASAL SPRAY 0.05% 5.00 11600654 *INFLUENZA (FLUZONE) VACCINE PF 0.5 ML 30.73 11600655 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 67.98 11600663 NF-FELODIPINE ORAL TAB ER 5MG 1.35 11600669 NF-CENTRUM LIQUID 1.00 11600671 ACYCLOVIR (ZOVIRAX) VIAL: 1000 MG/20 ML 15.33 11600680 *DIPHTH PERTUS TET (BOOSTRIX) VAC VIAL 89.38 11600681 DENOSUMAB (PROLIA) INJ: 60 MG/ML 2,967.10 11600698 DARBEPOETIN (ARANESP) SYR:150 MCG/0.3 ML 1,252.00 11600699 ALBUTEROL (VENTOLIN) MDI: 200 DOSE 127.40 11600706 *RABIES IMM GLOB (HYPERRAB): 300 I-UNITS 542.50 11600711 *RANITIDINE (ZANTAC) VIAL: 50 MG 6.06 11600720 LIDOCAINE (XYLOCAINE) PMIX: 2 G/500 ML 10.05 11600721 DIPH/PERTUSS/TETANUS (INFANRIX) VAC VIAL 50.05 11600724 HYDRALAZINE (APRESOLINE) VIAL: 20 MG/ML 7.88 11600725 *SOLIFENACIN (VESICARE) TAB : 5 MG 22.35 11600743 CETUXIMAB (ERBITUX) VIAL: 200 MG 3,036.25 11600749 RIVAROXABAN (XARELTO) TABLET: 10 MG 25.98 11600751 VANCOMYCIN (VANCOCIN) VIAL: 500 MG 6.57 11600755 LACOSAMIDE (VIMPAT) TAB: 50 MG 16.28 11600759 *INFLUENZA (FLUZONE INTRADERMAL) 0.1 ML 38.65 11600762 TACROLIMUS (PROGRAF) CAP: 0.5 MG 0.71 11600763 MYCOPHENOLATE (CELLCEPT) CAP: 250 MG 0.56 11600769 TORSEMIDE (DEMADEX) TAB: 20 MG 0.50 11600774 OSELTAMIVIR (TAMIFLU) SOL: 6 MG/ML 131.10 11600782 NAFCILLIN (NALLPEN) VIAL: 2 GRAM 22.13 11600785 VITAMIN D(CHOLECALCIFER)TAB:1000 I-UNIT 0.50 11600788 ISOSORBIDE MONONITRATE(IMDUR)SRTAB:30 MG 0.60 11600789 PAMIDRONATE DISODIUM (AREDIA) INJ: 30 MG 21.38 11600790 MICONAZOLE NITRATE 2% (DESENEX) POWDER 14.68 11600796 NF-BYSTOLIC 5MG ORAL TABLET 7.10 11600798 BUMETANIDE (BUMEX) VIAL: 2.5 MG 4.40 11600804 NF-SODIUM CHLORIDE INJECTION 3% 5.00 11600808 SODIUM CHLORIDE 3% (HYPERTONIC): 500 ML 5.64 11600815 DICYCLOMINE HCL (BENTYL) AMP: 20 MG 155.50 11600818 *LITHIUM CARBONATE (LITHOBID)TAB: 300 MG 0.70 11600819 *FENTANYL (SUBLIMAZE) AMP-20ML:50 MCG/ML 8.25

11600820 VINORELBINE (NAVELBINE) VIAL: 50 MG 111.53 11600821 VINORELBINE (NAVELBINE) VIAL: 10 MG 24.45 11600824 VORICONAZOLE (VFEND) VIAL: 200 MG 191.70 11600825 CEFTRIAXONE (ROCEPHIN) IM: 1 GRAM 3.08 11600826 CEFTRIAXONE (ROCEPHIN) IM: 1 GRAM 3.00 11600827 VORICONAZOLE (VFEND) TAB: 200 MG 100.65 11600839 BIMATOPROST 0.01% (LUMIGAN) OPHTH SOL 456.60 11600841 ERTAPENEM (INVANZ) VIAL: 500 MG 159.93 11600849 MAGNESIUM SULF/D5W PREMIX: 1 GRAM 10.73 11600855 PYRIDOSTIGMINE (MESTINON) TS-TAB: 180 MG 11.38 11600859 DIPHTH PERTUS TET (ADACEL) VACCINE SYR 87.83 11600860 RANOLAZINE (RANEXA) ERTAB: 500 MG 1.06 11600870 METOPROLOL SUSPENSION 6.25 MG/1.25 ML 1.00 11600871 IPRATROPIUM/ALBUTEROL (COMBIVENT) RESP 793.10 11600885 NF-HUMULIN 70-30 SUBQ SUSP 70U/1ML-30U/1 31.00 11600888 NF-FLUOROMETHOLONE ACETATE OPHTH SUSP 0. 106.97 11600894 AMPICILLIN (PRINCIPEN) VIAL: 4 GRAM 9.00 11600900 *FENTANYL(SUBLIMAZE)VIAL-10 ML:50 MCG/ML 5.28 11600902 PANCRELIPASE 120000U-24000U-76000 CAP 9.65 11600904 NF-CREON ORAL DELAYED RELEASE CAPSULE 4.65 11600913 NF-PREPARATION H 0.25%-3% TOPICAL APPLIC 17.07 11600917 *DAPTOMYCIN (CUBICIN) IVPB: 650 MG 1,773.60 11600933 DIPHTH PERTUS TET (BOOSTRIX) VAC SYR 79.45 11600934 ARIPIPRAZOLE (ABILIFY) TAB: 5 MG 0.70 11600940 DIPH/PERTUSS/TETANUS (INFANRIX) VAC SYR 45.28 11600941 *INFLUENZA (FLUZONE)VACCINE PF 0.5 ML 27.63 11600942 *INFLUENZA (FLUMIST) SYRAY: NASAL SPRAY 51.63 11600943 *INFLUENZA PEDIATRIC (FLUZONE)PF 0.25 ML 35.55 11600944 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 39.35 11600945 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 69.95 11600946 *INFLUENZA (FLUZONE INTRADERMAL) 0.1 ML 40.53 11600949 CEFOTAXIME (CLAFORAN) VIAL: 1 GRAM 3.64 11600952 METOPROLOL TART (LOPRESSOR)TAB: 25 MG 0.50 11600953 NF-LISINOPRIL 40MG ORAL TABLET 0.50 11600957 NF-TRIAMCINOLONE ACETONIDE OINTMENT 0.1% 15.88 11600962 MELATONIN TABLET: 5 MG 0.85 11600966 VANCOMYCIN (VANCOCIN) VIAL: 2750 MG 21.84 11600967 VANCOMYCIN (VANCOCIN) VIAL: 2250 MG 21.84 11600968 VANCOMYCIN (VANCOCIN) VIAL: 2500 MG 21.84 11600969 VANCOMYCIN (VANCOCIN) VIAL: 3000 MG 21.84 11600973 *BUPROPION XL (WELLBUTRIN XL)TAB: 300 MG 3.95 11600980 LACTASE (LACTAID) TAB: 9000 UNITS 0.56 11600993 DOXYCYCLINE VIAL: 100 MG 42.95 11600998 NF-TRIAMCINOLONE ACETONIDE OINT 0.1% 37.18 11600999 IRINOTECAN (CAMPTOSAR) VIAL: 40 MG 16.00 11601023 TETRACYCLINE CAP: 250 MG 10.00 11601024 *DAPTOMYCIN (CUBICIN) IVPB: 300 MG 886.80 11601027 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 81.88 11601033 INFLIXIMAB (REMICADE) VIAL: 100 MG 2,707.13 11601034 *DAPTOMYCIN (CUBICIN) IVPB: 350 MG 886.80 11601048 FENTANYL (SUBLIMAZE) PMIX: 2500 MCG 33.60 11601067 NF-BIOTENE DRY MOUTH MOUTHWASH MM SOLUTI 8.97

11601068 *DAPTOMYCIN (CUBICIN) IVPB: 750 MG 1,773.60 11601074 ADENOSINE PHOS (ADENOCARD) SYRINGE: 6 MG 20.23 11601086 ACLIDINIUM BROMIDE (TUDORZA): 400 MCG 310.50 11601087 FOSFOMYCIN (MONUROL) PACKET: 3 GRAMS 144.93 11601101 CAPTOPRIL (CAPOTEN) TAB: 12.5 MG 0.05 11601110 *NEBIVOLOL (BYSTOLIC) TAB: 2.5 MG 6.20 11601120 LEUCOVORIN VIAL: 100 MG 17.50 11601140 APIXABAN (ELIQUIS) TAB: 5 MG 12.88 11601145 EPINEPHRINE (ADRENALIN) MDV: 30 MG 125.70 11601155 TICAGRELOR (BRILINTA) TAB: 90 MG 11.35 11601169 BUDESONIDE (ENTOCORT EC) DRCAP: 3 MG 19.05 11601186 RAMIPRIL (ALTACE) CAP: 1.25 MG 2.36 11601188 MELOXICAM (MOBIC) TAB: 7.5 MG 0.50 11601189 VANCOMYCIN - DOSED BY PHARMACY 1.00 11601190 *DAPTOMYCIN (CUBICIN) IVPB: 400 MG 886.80 11601192 CEFAZOLIN (ANCEF) PMIX: 500 MG 2.03 11601195 NAPROXEN (NAPROSYN) TAB: 250 MG 0.60 11601204 SUMATRIPTAN (IMITREX) TAB: 50 MG 0.80 11601206 I-FLOW INFUSOR 6 ML/HR 80.33 11601208 *LINACLOTIDE (LINZESS) CAP: 145 MCG 20.00 11601217 CYCLOPHOSPHAMIDE (CYTOXAN) VIAL: 500 MG 405.88 11601245 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 39.38 11601246 *INFLUENZA (FLUZONE)VACCINE QUADRAVALENT 40.85 11601247 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 73.35 11601248 *INFLUENZA (FLUZONE INTRADERMAL) 0.1 ML 37.95 11601249 *INFLUENZA PEDIATRIC(FLUZONE) PF 0.25 ML 50.60 11601250 *INFLUENZA (FLUMIST) SYRAY: NASAL SPRAY 54.00 11601251 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 81.88 11601269 *HUMAN PAPILLOMAVIRUS (GARDASIL) VACCINE 334.60 11601270 PNEUMOCOCCAL (PNEUMOVAX 23) VACCINE 243.20 11601284 DENOSUMAB (XGEVA) INJ: 120 MG/1.7 ML 5,296.58 11601299 MEGESTROL (MEGACE) TAB: 40 MG 0.50 11601303 BUPRENORPHINE 20 MCG/HR (BUTRANS) PATCH 230.00 11601304 CISPLATIN VIAL: 50 MG 4.24 11601305 MANNITOL 25% VIAL: 12.5 GRAMS 4.03 11601309 FORMOTEROL (PERFOROMIST) NEB: 20 MCG/2ML 10.40 11601322 NF-BREO ELLIPTA 100MCG-25MCG/1ACTUAT INH 18.49 11601332 VERAPAMIL (CALAN) TAB: 80 MG 0.50 11601347 *OSELTAMIVIR (TAMIFLU) CAP: 30 MG 26.53 11601349 CINACALCET (SENSIPAR) TAB: 30 MG 43.85 11601356 MAGNESIUM SULF/WATER PREMIX: 2 GRAM 23.17 11601373 *DAPTOMYCIN (CUBICIN) IVPB: 175 MG 886.80 11601382 ROFLUMILAST (DALIRESP) TAB: 500 MCG 25.60 11601386 *ESOMEPRAZOLE SOD (NEXIUM) VIAL: 40 MG 44.65 11601391 *RIVAROXABAN (XARELTO) TABLET: 15 MG 22.35 11601392 DOLUTEGRAVIR (TIVICAY) TABLET: 50 MG 105.23 11601393 BENZTROPINE (COGENTIN) TAB: 0.5 MG 0.75 11601398 RAMUCIRUMAB (CYRAMZA) VIAL: 100 MG 2,550.00 11601399 RAMUCIRUMAB (CYRAMZA) VIAL: 500 MG 12,750.00 11601403 *ABACAVIR/LAMIVUDINE (EPZICOM):600/300MG 94.25 11601410 NF-DAKIN\'S SOLUTION HALF STRENGTH 0.25% 21.25 11601415 NF-BENZ-O-STHETIC MUCOUS MEMBRANE GEL 20 11.48

11601421 INSULIN DETEMI(LEVEMIR)SYR:10 UNIT/0.1ML 65.70 11601422 *DOXORUBICIN (ADRIAMYCIN) VIAL: 20 MG 40.15 11601425 NIVOLUMAB (OPDIVO) VIAL: 40 MG 2,622.07 11601426 NIVOLUMAB (OPDIVO) VIAL: 100 MG 6,176.20 11601428 MORPHINE SULFATE DRIP 5 MG/ML 21.63 11601430 PEGFILGRASTIM (NEULASTA)ONP: 6 MG/0.6 ML 12,137.80 11601432 ALTEPLASE (ACTIVASE) VIAL: 100 MG 20,410.23 11601442 AMPICILLIN (PRINCIPEN) VIAL: 2 GRAM 5.90 11601443 NF-ACETIC ACID SOLUTION 0.25% 8.38 11601444 MICONAZOLE ANTIFUNGAL OINTMENT 2% 5.65 11601457 NOREPINEPHRINE (LEVOFED) INJ: 4 MG 16.68 11601459 OXYCODONE (OXYCONTIN) SRTAB: 15 MG 7.70 11601464 NF-Patanol Ophth Solution 0.1% 568.88 11601486 VANCOMYCIN ORAL SOLUTION 500 MG/5 ML 7.50 11601489 LABETALOL (TRANDATE) TAB: 300 MG 1.68 11601504 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 39.75 11601505 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 81.88 11601506 *INFLUENZA (FLUMIST) SYRAY: NASAL SPRAY 54.50 11601507 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 79.78 11601508 *INFLUENZA (FLUZONE INTRADERMAL) 0.1 ML 48.35 11601509 *INFLUENZA PEDIATRIC(FLUZONE) PF 0.25 ML 52.08 11601510 *INFLUENZA (FLUZONE)VACCINE QUADRAVALENT 42.08 11601529 GENTAMICIN - DOSED BY PHARMACY 1.00 11601546 NF-PHOS-NAKPWD FOR SUSP 0.88 11601555 NF-Fluocinolone Acetonide Cream 0.01% 1.92 11601568 DESMOPRESSIN ACET VIAL: 40 MCG / 10 ML 1,379.23 11601587 DOCETAXEL (TAXOTERE) VIAL: 80 MG 189.38 11601593 HUMAN PAPILLOMAVIRUS (GARDASIL-9)VACCINE 512.95 11601613 PROPAFENONE HCL ER CAP: 225 MG 12.13 11601647 BISOPROLOL FUMARATE (ZEBETA) TAB: 5 MG 2.26 11601657 NF-Glucosamine & Chondroitin Plus Oral T 0.50 11601671 ABATACEPT (ORENCIA) VIAL: 250 MG 1,972.40 11601680 MEROPENEM (MERREM) VIAL: 500 MG 11.05 11601704 BRENTUXIMAB (ADCETRIS) VIAL: 50 MG 16,437.50 11601714 GI COCKTAIL 5.15 11601716 TICAGRELOR (BRILINTA) TAB: 60 MG 14.83 11601737 ACETYLCYSTEINE (MUCOMYST) INH: 200 MG 11.60 11601740 ACETYLCYSTEINE (ACETADOTE) VIAL: 6 GRAMS 245.50 11601748 SACUBITRIL/VALSARTAN (ENTRESTO) 24-26 MG 19.43 11601749 ERIBULIN MESYLATE (HALAVEN) INJ: 1 MG 2,545.00 11601757 IDARUCIZUMAB (PRAXBIND) VIAL: 2500 MG 4,614.33 11601765 MIRABEGRON (MYRBETRIQ) ER TAB: 25 MG 29.77 11601766 FLUOROMETHOLONE (FML) 0.1% OPHTH 164.65 11601767 OXACILLIN (BACTOCIL) VIAL: 12 GRAM 303.00 11601780 PHENAZOPYRIDINE (PYRIDIUM) TAB: 95 MG 0.50 11601796 EPTIFIBATIDE (INTEGRILIN): 75 MG/100 ML 504.23 11601806 MORPHINE SULFATE (MORPHINE) VIAL: 4 MG 4.80 11601831 TOPOTECAN (HYCAMTIN) VIAL: 4 MG 92.70 11601867 *INFLUENZA (FLUZONE) VACCINE QUADRIVALEN 44.08 11601868 *INFLUENZA (FLUZONE INTRADERMAL) 0.1 ML 44.08 11601869 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 93.80 11601870 *INFLUENZA PEDIATRIC (FLUZONE) PF 0.25 M 55.58

11601871 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 44.08 11601872 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 89.38 11601877 *DAPTOMYCIN (CUBICIN) IVPB: 380 MG 886.80 11601907 *FEXOFENADINE (ALLEGRA) TAB: 180 MG 1.03 11602003 LEVETIRACETAM (KEPPRA) VIAL: 500 MG 5.20 11602004 FERUMOXYTOL (FERAHEME) NON-ESRD: 510 MG 2,320.13 11602021 LEVONORGESTREL (MIRENA) IUD: 52 MG 2,383.78 11602079 POTASSIUM CHLR 40MEQ - NS 1000 ML BAG 21.45 11602080 POTASSIUM CHLR 40MEQ - 0.45% NS 1000ML 14.03 11602081 DANTROLENE (RYANODEX) VIAL: 250 MG 3,585.00 11602097 BEVACIZUMAB (AVASTIN) VIAL: 400 MG 7,969.40 11602098 VITAMIN D (CHOLECALCIF)CAP: 5000 I-UNIT 0.60 11602101 *DAPTOMYCIN (CUBICIN) IVPB: 600 MG 2,064.60 11602113 OXACILLIN (BACTOCIL) VIAL: 10 GRAM 110.12 11602138 ELECTROLYTE ORAL (PEDIALYTE) SOLUTION 6.60 11602147 DABIGATRAN ETEXILATE(PRADAXA)CAP: 75 MG 15.90 11602150 ENALAPRILAT (VASOTEC ) VIAL: 2.5 MG 6.28 11602154 POTASSIUM CHLR (KCL) VIAL: 40 MEQ/20 ML 2.69 11602160 NF-Incruse Ellipta Inh Pwd 62.5MCG/1ACT 17.00 11602193 DEXTROAMPHETAMINE SULF (DEXEDRINE): 5 MG 40.92 11602200 IMMUNE GLOBLN (GAMMAGARD) INJ: 500 MG 105.53 11602206 MENINGOCOCCAL GROUP B VACCINE SYR 325.45 11602234 ROMIPLOSTIM (NPLATE) VIAL: 500 MCG 8,270.00 11602235 LEVETIRACETAM (KEPPRA) VIAL: 1000 MG 5.23 11602248 DILTIAZEM DRIP: 125 MG/125 ML 26.28 11602276 TRANEXAMIC ACID (CYCLOKAPRON)1000MG VIAL 33.14 11602283 DIHYDROERGOTAMINE MESYLATE VIAL: 1 MG/ML 180.57 11602306 LEUPROLIDE (ELIGARD) INJ 45 MG 1,377.63 11602320 EMTRICITABINE/TENOFOVIR TAB: 200/300 MG 136.05 11602321 RALTEGRAVIR TAB: 400 MG 53.67 11602322 HIV POST EXPOSURE PROPHYLAXIS KIT 1,598.95 11602328 TETRABENAZINE TABLET: 12.5 MG 76.01 11602352 LETS SOLUTION 1.08 11602431 ETOMIDATE VIAL 20MG/10ML 6.05 11602432 KETAMINE 500MG/10ML 11.03 11602439 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 41.65 11602440 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 95.75 11602441 *INFLUENZA (FLUZONE) VACCINE PF 0.5 ML 42.40 11602442 *INFLUENZA PEDIATRIC (FLUZONE) PF 0.25 42.40 11602443 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 101.88 11602463 ERYTHROMYCIN BASE CAP: 250 MG 15.00 11602464 DOPAMINE (INTROPIN) PMIX: 400 MG 17.48 11602485 AMOXICILLIN (AMOXIL) CHEW TAB: 250 MG 0.67 11602486 BENAZEPRIL (LOTENSIN) TAB: 10 MG 1.33 11602487 NF-acetaZOLAMIDE Capsule ER 500MG 7.64 11602488 CARBAMAZEPINE ER (TEGRETOL XR) TAB:100MG 1.75 11602495 NF-Biotene PBF Dry Mouth Mouthwash MM So 14.35 11602496 NF-Amantadine HCl Oral Capsule 100MG 2.88 11602508 NF-Sodium Bicarbonate Tablet 650MG 16.48 11602527 NF-Venlafaxine HCl Oral Tablet 37.5MG 1.18 11602530 NF-VENLAFAXINE HCL ORAL TABLET 37.5MG 1.18 11602533 NF-Thioridazine HCl Tablet 100MG 1.52

11602534 NF-MAGNESIUM GLUCONATE TABLET 500MG 0.50 11602536 *CEFTRIAXONE 1 GRAM IV PUSH 11.60 11602537 *CEFTRIAXONE 2 GRAM IV PUSH 5.63 11602541 MEROPENEM 1 GRAM IV PUSH 15.08 11602542 CEFEPIME 1 GRAM IV PUSH 13.23 11602543 CEFEPIME 2 GRAM IV PUSH 9.35 11602553 NF-Venlafaxine HCl Oral Tablet 37.5MG 2.36 11602582 NF-Venlafaxine HCl Oral Tablet 37.5MG 1.18 11602586 NF-Venlafaxine HCl Oral Tablet 37.5MG 1.18 11602594 NF-Biotene Dry Mouth Mouthwash MM Soluti 14.35 11602603 *MICAFUNGIN VIAL 100 MG 151.68 11602606 FERRIC CARBOXYMALTOSE 750 MG IV PUSH 2,071.78 11602608 TIZANIDINE TAB 4 MG 0.90 11602644 LEUPROLIDE (ELIGARD) INJ 30 MG 1,084.48 11602670 ARIPIPRAZOLE ER INJ: 300 MG 3,662.30 11602671 ZOSTER (SHINGRIX) VACCINE RECOMBINANT 321.17 11602672 CEFAZOLIN 2 GRAM IV PUSH 4.75 11602676 NF-Cyproheptadine HCl Oral Tablet 4MG 0.60 11602737 NAFCILLIN 2 GRAM IV PUSH 22.13 11602756 NF-Venlafaxine HCl Oral Tablet 37.5MG 2.36 11602765 NF-Venlafaxine HCl Oral Tablet 37.5MG 1.18 11602776 NF-Biotene Moisturizing Mouth Oral Spray 13.60 11602781 BENDAMUSTINE (BENDEKA) VIAL 100 MG 5,565.25 11602783 IMMUNE GLOBLN (PRIVIGEN) INJ: 500 MG 98.50 11602785 DO 5.28 11602786 DOBUTAMINE INJ 250MG/250ML PREMIX 19.20 11602787 CEFAZOLIN 2GM 50ML PREMIX 15.83 11602790 CEFPROZIL 250MG/5ML 50ML SUSPENSION 59.67 11602791 PHYTONADIONE 1MG/0.5ML INJ. 42.99 11602792 MAGNESIUM HYDROX LAX (MOM) SUSP: 80 MEQ 3.49 11602793 MILK OF MAGNESIA 2400MG/30ML CUP 3.77 11602794 DEEP SEA NASAL MOISTURIZING SPRAY 44ML 1.70 11602795 DEXTROSE 5%/20MEQ KCL 1000ML BAG 3.08 11602796 SILVER NITRATE APPLICATORS 1.20 11602797 SOD BICARB 4.2% 10ML 19.23 11602798 CLOZAPINE 25MG TABLET 1.59 11602799 HALOPERIDOL 2MG TABLET 0.50 11602800 SUMATRIPTAN 100MG TAB 1.76 11602801 FLUORESCEIN 1MG OPTH STRIPS 2.10 11602802 METRONIDAZOLE 500MG TAB 1.10 11602803 DILANTIN 30MG CAPSULE 2.60 11602804 KETOROLAC 10MG TAB 1.95 11602805 MISOPROSTOL 200MCG TABLET 1.72 11602806 MINOCYCLINE HCL 50MG CAP 0.57 11602808 NALOXONE 0.4MG/ML 1ML VIAL 28.25 11602810 ESMOLOL HCL 100MG/10ML VIAL 1.37 11602811 NALBUPHINE 10MG/ML AMP 8.47 11602813 RIFAMPIN 300MG CAP 2.60 11602815 CEFAZOLIN 1GM 50ML PREMIX 8.73 11602816 RIFAMPIN 300MG CAP 1.60 11602817 THIORIDAZINE HCL 25MG TAB 1.12 11602819 CEFTRIAXONE 2GM 50ML PREMIX 38.67

11602820 NITROFURANTOIN 50MG CAPSULE 1.50 11602821 CEFTRIAXONE 1GM 50ML PREMIX 25.82 11602822 OLANZAPINE 2.5 MG TABLET 0.74 11602824 DILTIAZEM ER 240MG CAP 0.82 11602825 NF-Venlafaxine HCl Oral Tablet 37.5MG 1.18 11602826 HYDROXYZINE 25MG TAB 0.50 11602827 PHENYTOIN 50MG CHEWABLE TAB 0.83 11602829 GLYBURIDE 2.5MG TAB 0.50 11602830 NEO-SYNEPHRINE 0.5% NASAL SPRAY 15ML 8.42 11602831 DILTIAZEM HCL 60MG TAB 0.50 11602832 DIVALPROEX 500MG DELAYED RELEASE TAB 0.60 11602833 AMANTADINE HCL 100MG CAP 1.00 11602835 AMOXICILLIN/CLAV 400MG/57MG SUSP 5ML 10.45 11602846 BUPROPION HCL 100MG TAB 1.00 11602847 VERAPAMIL HCL 40MG TAB 0.50 11602848 PROPOFOL 10MG/ML 100ML VIAL 20.80 11602849 ELIQUIS 2.5MG TAB 12.90 11602850 LABETALOL HCL (5MG/ML) 20MG/4ML INJ 13.93 11602851 EYE WASH 118ML 8.02 11602852 ISOSORBIDE DINITRATE 10MG TAB 1.40 11602853 NIFEDIPINE 10MG CAP 2.08 11602856 TERBUTALINE 1MG/ML 1ML VIAL 3.07 11602857 AMMONIA (15%) INHALANT 0.81 11602858 GAS RELIEF DROPS 30ML SUSP 4.47 11602859 LEVOTHYROXINE (SYNTHROID) TAB: 0.025MG 0.85 11602860 FOLIC ACID( 5MG/1ML) 10ML VIAL 56.65 11602861 OCTREOTIDE (0.1MG/ML) 1ML INJ 6.86 11602862 LIDOCAINE (XYLOCAINE) 1% SDV (5ML) 3.81 11602863 LIDOCAINE (XYLOCAINE) 2% SDV 5.18 11602864 CIPRODEX(CIPRO 0.3%/DEX 0.1%) 7.5ML OTIC 534.72 11602866 CIPROFLOXACIN 0.3% OPTH 2.5ML BOTTLE 8.50 11602867 BUPIVACAINE HCL 0.5% 10ML SDV 2.55 11602868 BUPIVACAINE HCL 0.25% 10ML SDV 2.41 11602869 SENSORCAINE 0.5%/EPI 0.0005% 10ML SDV 4.35 11602871 LEVALBUTEROL 1.25MG/0.5ML UNIT DOSE 2.45 11602872 VERAPAMIL 2.5MG/ML 2ML AMP 38.50 11602873 FENOFIBRATE 145MG TAB 4.55 11602877 *AZITHROMYCIN (ZITHROMAX) SUSP: 200MG 31.42 11602878 SODIUM CHLORIDE 1000MG TAB 0.50 11602879 SULFAMETH 800MG/TRIMETH 160MG/10ML VIAL 22.37 11602880 PEDIATRIC ELECTROLYTE 8OZ BOTTLE 1.75 11602881 RANITIDINE 50MG/2ML (25MG/ML) INJ 14.77 11602882 PYRIDOXINE HCL 100MG/ML INJ 19.98 11602884 PHENYLEPHRINE HCL 10MG/ML 1ML INJ 10.27 11602885 PHYSOSTIGMINE 1MG/ML 2ML INJ 87.55 11602887 NAPROXEN (NAPROSYN) TAB: 500MG 0.50 11602889 GUAIFENESIN 200MG/10ML UD CUP 1.28 11602890 HURRICAINE 20% BENZOCAINE 0.5ML UD SPRAY 51.74 11602891 HYDROMORPHONE 2MG/ML 1ML INJ 2.31 11602892 HYDROXYZINE 50MG/ML 1ML INJ 33.55 11602893 HEPARIN LOCK FLUSH 500UNITS/5ML SYR 0.80 11602895 LOLLICAINE 20% BENZOCAINE TOPICAL GEL 0.50

11602896 DEBACTEROL SINGLE USE APPLICATOR 10.24 11602902 DEXTROSE 5%-0.9% SALINE-20 KCL 1000 ML 3.08 11602903 LEVONORGESTREL ONE-STEP 1.5MG TAB 37.50 11602904 AMOXICILLIN 400MG/5ML(100ML) SUSP 5.10 11602905 HEMORRHOIDAL OINTMENT 2OZ TUBE 4.65 11602906 ACETAMIN/CODEINE 120MG/12MG:5ML UD CUP 1.88 11602907 ACETAZOLAMIDE 500MG INJ 34.85 11602908 ACYCLOVIR (ZOVIRAX) 500MG/10ML INJ 15.35 11602909 BUMETANIDE 0.25MG/ML(1MG/4ML) VIAL 2.41 11602910 BUSPIRONE 5MG TAB 0.50 11602911 CEFTAZIDIME 1GM VIAL 9.40 11602912 CEFTRIAXONE 250MG INJ 1.74 11602913 DEXAMETHASONE 4MG/ML 1ML VIAL 1.62 11602915 MIDAZOLAM (VERSED) 2MG/2ML VIAL 1.13 11602916 MIDAZOLAM (VERSED) 50MG/10ML VIAL 4.76 11602917 METHERGINE 0.2MG/ML AMP 21.50 11602918 BUTORPHANOL(STADOL) 1MG/ML INJ 9.32 11602919 HEPARIN LOCK FLUSH 10UNITS/ML(3ML SYG) 0.91 11602920 GLUCOSE 4GM TAB (CHEWABLE) 0.50 11602921 SODIUM CHLORIDE 0.9% (NS) VIAL:10ML 0.98 11602922 LIDOCAINE HCL 4%(40MG.ML) 5ML UD SYG 1.72 11602923 SULFA/TRIMETH 200MG/40MG/5ML(20MLSYG) 18.65 11602924 DIPHENHYDRAMINE 12.5MG 5ML SYG 0.50 11602925 AMINOCAPROIC ACID 5G/20ML INJ 14.01 11602926 BRIMONIDINE 0.2% OPHTH SOLN 5ML BTL 8.42 11602927 CARBIDOPA LEVO(ER)25MG/100MG TAB 0.64 11602928 CEFPODOXIME(VANTIN) 200MG TAB 13.11 11602929 INSULIN DRIP 100 UNITS / 100ML 3.45 11602930 CETIRIZINE 5MG/5ML UD CUP 4.71 11602931 CHLORDIAZEPOXIDE(LIBRIUM) 5MG CAP 1.30 11602932 CYCLOPENTOLATE 1% OPHTH 2ML 10.00 11602933 DICYCLOMINE (BENTYL) 10MG CAP 1.08 11602934 DIVALPROEX DR (DEPAKOTE DR) 125MG TAB 1.55 11602935 DAPTACEL(PEDIATRIC) 0.5ML INJ 68.32 11602936 HYDROCODONE 10MG/APAP 325 MG TAB 0.50 11602937 LEVETIRACETAM 500MG/5ML UD SOLN 9.82 11602938 IBUPROFEN 100MG/5ML (5ML) UD SUSP 1.23 11602939 NEO/POLY/BAC ZINC 3.5GM OINT 27.17 11602940 NICARDIPINE(2.5MG/ML)25MG/10ML INJ 39.29 11602946 RHOGAM UF 300MCG SYG 207.50 11602947 ROCURONIUM BROMIDE 100MG/10ML INJ 12.10 11602948 BUPIVACAINE/EPI 0.5%/1:200,000 10ML INJ 4.35 11602950 PREDNISOLONE (15MG/5ML) 5ML UD SYG 0.76 11602951 PHENYTOIN 125MG/5ML SUSP 5ML UD SYG 0.67 11602952 LIDO/EPI 2%/1:200,000 10ML SDV 6.60 11602953 LIDO/EPI 1%/1:200,000(200MG/10ML) SDV 2.79 11602954 NEO/POLY/HC 7.5ML OPHTH SUSP 273.70 11602955 NEO/POLY/DEX 3.5GM OPHTH OINT 32.25 11602956 GLYCERIN SUPPOSITORY (PEDIATRIC) 0.50 11602957 FLUTICASONE 100/VILANTEROL 25 (BREO) 206.23 11602958 UMECLIDINIUM 62.5 MCG (INCRUSE) 92.88 11602959 UMECLIDINIUM 62.5MCG / VILANTEROL 25MCG 133.35

11602961 TETRACAINE 0.5% (4ML) OPHTH SOLN 11.53 11602962 INFUVITE MULTI VIT 2X5ML VIALS (ADULT) 18.34 11602963 HEPATITIS B VACCINE 20MCG/ML (0.5ML) INJ 51.33 11602964 MORPHINE 0.5MG/ML(5MG/10ML) INJ 13.86 11602968 I-FLOW INFUSOR 5 ML/HR 80.33 11602972 NF-Acamprosate Calcium Oral Tab DR 333MG 1.41 11602978 NF-Sucralfate Oral Suspension 1GM/10ML 9.13 11603007 VALPROATE SODIUM VIAL 500MG/5ML 6.18 11603008 NABUMETONE TAB: 500 MG 1.48 11603009 *CARVEDILOL (COREG) TAB: 12.5 MG 0.50 11603042 GUAIFENESIN DM 200MG (ROBITUSSIN DM) SYR 2.63 11603044 OMALIZUMAB (XOLAIR) VIAL: 150 MG 2,711.65 11603057 NF-Betamethasone Dipropionate Lotion 0.0 165.02 11603060 NF-Preparation H Rectal Cream 17.08 11603125 NF-Amantadine HCL Oral Capsule 100MG 2.87 11603160 NF-Rozerem Oral Tablet 8MG 28.77 11603177 CROTALIDAE POLYVALENT IMMUNE FAB: 1 GRAM 5,956.49 11603182 CARISOPRODOL (SOMA) TAB: 350 MG 0.50 11603197 NIVOLUMAB (OPDIVO) VIAL: 240 MG 16,451.13 11603206 ATEZOLIZUMAB (TECENTRIQ) VIAL: 1200 MG 22,534.38 11603254 DIAZEPAM (VALIUM) VIAL: 50 MG 79.37 11603268 *INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 108.20 11603272 *INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 108.20 11603273 *INFLUENZA (FLUZONE) VACCINE PF 0.5 ML 39.70 11603274 *INFLUENZA PEDIATRIC (FLUZONE) PF 0.25ML 39.70 11603275 *INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 40.85 11603280 LIDOCAINE (XYLOCAINE) 1% MDV (50ML) 3.92 11603290 MORPHINE SULFATE IMMEDIATE RELEASE: 15MG 1.76 11603298 PROTHROMBIN COMPLEX CONCENTRATE: 1 UNIT 4.19 11603309 DURVALUMAB (IMFINZI) VIAL: 120 MG 2,199.00 11603310 DURVALUMAB (IMFINZI) VIAL: 500 MG 9,162.50 11603311 AZACITIDINE (VIDAZA) VIAL SUBQ: 100 MG 195.83 11603328 FAT EMULSION 20% 250 ML BAG 30.25 11603358 NF-Thioridazine HCl Tablet 100MG 7.65 11603359 LEUPROLIDE (ELIGARD) INJ 22.5 MG 814.05 11603360 PALIVIZUMAB (SYNAGIS) VIAL: 50 MG 3,478.68 11603386 PEMBROLIZUMAB (KEYTRUDA) VIAL: 100 MG 11,975.50 11603437 NF-Dermoplast Spray 10.69 11603442 TYPHOID VACCINE 25MCG/0.5ML SYR 232.93 11603444 VERAPAMIL SR CAP 180 MG 2.66 11603449 OBINUTUZUMAB VIAL: 1000 MG 16,377.50 11603450 PALIVIZUMAB (SYNAGIS) VIAL: 100 MG 6,568.75 11603458 KETAMINE INFUSION 500MG/500ML 6.18 11603491 NF-Urea Topical Cream 10% 16.73 11603539 NF-Ethambutol HCl Tablet 400MG 1.82 11603552 NF-Ethambutol HCl Tablet 400MG 1.82 11603580 NF-Ethambutol HCl Tablet 400MG 1.80 11603584 PEGFILGRASTIM-CBQV SYR: 6 MG/0.6 ML 8,133.60 11603585 CEFTRIAXONE (ROCEPHIN) IM: 2 GRAM 5.63 11603586 AZACITIDINE (VIDAZA) VIAL IV: 100 MG 1,463.10 11603614 NF-Urea Topical Cream 10% 16.73 11603618 NF-Xifaxan Oral Tablet 550MG 84.92

11603619 NF-Biotene Dry Mouth Mouthwash MM Soluti 14.35 11603620 NF-Biotene Dry Mouth Mouthwash MM Soluti 14.35 11603644 LEVALBUTEROL 1.25MG/3ML UNIT DOSE 2.88 11603657 NF-Rozerem Oral Tablet 8MG 28.77 11603665 BUDESONIDE NEB UNIT DOSE: 0.25 MG/2 ML 8.10 11603666 BUDESONIDE NEB UNIT DOSE: 0.5 MG/2 ML 8.13 11603681 DARATUMUMAB (DARZALEX) VIAL: 400 MG 5,270.72 11603695 NF-acetaZOLAMIDE Oral Tablet 250MG 6.78 11603712 INFLIXIMAB-dyyb (INFLECTRA) VIAL: 100 MG 1,297.03 11603719 FILGRASTIM-sndz SYR: 480 MCG/0.8ML 758.50 11603720 RABIES IMM GLOBULN (KEDRAB): 300 I-UNITS 1,200.00 11603727 FILGRASTIM-sndz SYR: 300 MCG/0.5ML 474.05 11603742 TOBRAMYCIN INH SOLUTION 300MG/5ML AMP 80.68 11603744 MIDAZOLAM (VERSED) VIAL 10 MG/2ML 2.32 11603752 LEVONORGESTREL (LILETTA) IUD: 52 MG 1,873.50 11603753 INFLIXIMAB-abda (RENFLEXIS) VIAL: 100 MG 1,624.98 11603754 NF-Vicks VapoRub Ointment 4.8%-1.2%-2.6% 11.93 11603759 NF-Urea Powder 9.28 11603761 NF-niMODipine Capsule, Liquid Filled 30M 3.68 11603775 NF-Nucynta Oral Tablet 100MG 23.02 11603776 TAPENTADOL (NUCYNTA) TAB: 100 MG 23.02 11603800 BUPRENORPHINE/NALOXONE 4MG/1MG FILM 14.70 11603803 ASPIRIN SUPP: 300 MG 3.76 11603804 NF-Alpha Lipoic Tablet 300MG 0.71 11603806 INFLUENZA (FLUARIX) VACCINE PF 0.5 ML 34.25 11603807 INFLUENZA (FLUBLOK) VACCINE PF 0.5 ML 113.53 11603808 INFLUENZA (FLUZONE HIGH-DOSE) PF 0.5 ML 113.52 11603809 INFLUENZA (FLUZONE) VACCINE PF 0.5 ML 40.47 11603815 OXALIPLATIN (ELOXATIN) VIAL: 100 MG 50.30 11603820 NF-Simvastatin Oral Tablet 40MG 0.50 11603850 NF-Calamine Topical Suspension 8%-8% 5.28 11603906 NF-Metamucil Oral Wafer 17.30 11603930 INFLUENZA (FLULAVAL) VACCINE PF 0.5 ML 43.93 11603949 DARBEPOETIN (ARANESP) VIAL:200 MCG/1 ML 3,454.03 11603959 NF-Biotene Dry Mouth Mouthwash MM Soluti 15.58 11603972 NF-Sodium Bicarbonate Oral Tablet 650MG 17.03 11603985 NF-NAC Oral Capsule 600MG 20.43 11603986 OXALIPLATIN (ELOXATIN) VIAL: 100 MG 47.15 11603990 NF-Fiber Laxative Oral Tablet 625MG 10.10 11603993 NF-CEFTAROLINE FOSAMIL IV PWD FOR SOLN 6 389.88 11604010 DARBEPOETIN (ARANESP) VIAL:25 MCG/1 ML 430.83 11604034 NF-Ramelteon Oral Tablet 8MG 29.77 11604036 NF-Urea Powder 9.28 11604069 NF-Venlafaxine HCl Oral Tablet 37.5MG 0.95 11604070 NF-Venlafaxine HCl Oral Tablet 37.5MG 0.95 11604094 NF-Dakin's Solution Quarter Strength Sol 22.48 11604101 NF-levETIRAcetam Oral Solution 100MG/1ML 34.65 11604103 NF-Armour Thyroid Tablet 120MG 3.73 11604104 NF-Letrozole Oral Tablet 2.5MG 1.40 11604114 LEUPROLIDE (LUPRON) INJ 22.5 MG 11,543.33 11604144 LEUPROLIDE (LUPRON) INJ 30 MG 15,391.13 12011301 SHAVE SKIN LESION TRNK 0.6-1.0 434.00

12099211 STEPDOWN MINIMAL SERV 145.00 12236415 VENIPUNCTURE OFF SITE SH 46.00 12300001 CLINIC CONSULT 139.00 12300041 SPEECH THERP 1/2 HR 217.00 12300081 INFUSION CODE 161.00 12311200 REMOVAL SKIN TAG FC 151.00 12311402 EXCISION OF LESION 761.00 12320600 DRAIN/INJ JOINT BRSA FC 326.00 12320602 REMOVE NON BIODEGRADABLE DRUG DEL IMPLT 268.00 12322704 DIAG LUMBAR PUNCT 314.00 12337765 PLEBECTOMY VARICOSE VIENS 1,163.00 12340105 COLONOSCOPY SCREENING MEDICARE HIGH RISK 1,934.00 12340121 COLONOSCOPY SCREENING MEDICARE 1,934.00 12343239 GASTROSCOPY THERAPEUTIC 2,258.00 12343249 GASTROSCOPY W/ DILITATION 2,258.00 12345300 FLEX SIGMOID-DIAG 1,603.00 12345331 FLEX SIGMOID W/ BIOP 1,335.00 12345378 COLONOSCOPY DIAG 1,934.00 12345380 COLONOSCOPY W BIOPSY 2,165.00 12345383 COLONOSCOPY WITH ABLATION 1,934.00 12345390 COLONOSCOPY w/ ENDO MUCOSAL RESECTION 1,382.00 12356351 HYSTEROSCOPY BIOPSY 1,128.00 12364504 INTRATHECAL CHEMO 542.00 12380001 NUTRITION CONSULT 84.00 12380002 NUTRITION CONSULT 2 46.00 12380003 NUTRITION CLINIC 65.00 12380004 SPEECH THERAPY 454.00 12390473 IMMUNIZATION ADMIN BY INTRANASAL ROUTE 36.00 12390804 DIAG ABD PARACENT 456.00 12392014 OFFICE NEW PATIENT 179.00 12392044 OFFICE NEW PT COMP 417.00 12392194 OBSERVATION EACH HOUR 63.00 12392196 OBSERVATION DIRECT ADMIT 174.00 12392506 SPEECH THERAPY EVAL 554.00 12392507 SPEECH THERAPY 455.00 12392508 SPEECH THERAPY GROUP 4,474.00 12393017 STRESS TEST 713.00 12397802 MED NUTRI THERAPY INITIAL ASSESS 53.00 12397803 MED NUTRI THERAPY REASSESSMENT 42.00 12397804 MED NUTRI THERAPY GPR 30 MIN 42.00 12397810 DIABETES MGMT IND, 30 MIN 53.00 12397812 DIABETES MGMT GRP, 30 MIN 42.00 12397813 RENAL DISEASE MGMT, IND 30 MIN 42.00 12397814 RENAL DISEASE MGMT, GROUP 30 MIN 42.00 12399406 SMOKING & TOBACCO CESSATION 3 - 10 119.00 12593017 EXERCISE STRESS TEST 713.00 12593299 INTEROGATION OF DEVICES 501.00 13540002 EXCISION OF LESION 139.00 14010403 MED CAST 83.00 14060002 INCISION/DRAINAGE 139.00 14060003 BIOPSY(ORTHO) 139.00 14060004 ELECTROCAUTERIZATION 139.00

14060005 REMOVAL/FOREIGN BODY 139.00 14060006 EXCISION 139.00 14060007 MINOR SURGERY ROOM 527.00 14060012 UNIVERSAL WRIST LT 44.00 14060013 UNIVERSAL WRIST RT 44.00 14060014 EQUALIZER WALKER SM 106.00 14060015 EQUALIZER WALKER MED 106.00 14060016 EQUALIZER WALKER LG 106.00 14060017 COVPADHINGED KNEE SM 105.00 14060018 COVPADHIGNEDKNEE MED 105.00 14060019 COVPADHIGNEDKNEE LG 105.00 14060020 COVPADHINGEDKNEE XL 105.00 14060021 COVPADHINGEDKNEEXXL 105.00 14060022 COVPADHINGEDKNEEXXXL 105.00 14060023 CASTING TAPE 2 GREE 91.00 14064721 CARPAL TUNNEL REL 1,172.00 14500033 ORAL MED ADMIN/DIRECT OBS - CLINIC 488.00 14570006 PARACENTESIS 468.00 14599212 BRIEF VISIT EST - DRUG REHAB CLINIC 164.00 15000019 INTRA CORPORAL INJ 49.00 15052204 CYSTOSCOPY 730.00 15080002 CATH CHANGE 144.00 15080003 VASECTOMY 730.00 15080004 EXCISION FOR BIOPSY 139.00 15080006 CIRCUMCISION (NB) 83.00 15080009 BLADDER INSTILL BCG 1,476.00 15503253 SUCCINYLCHOLINE (QUELICIN) VIAL: 200 MG 24.35 16000004 WHIRLPOOL 79.00 16560001 AUDIOLOGY 112.00 16560002 AUDIOLOGICAL EVALUAT 366.00 16560003 AUDIOLOGY CONSULT 131.00 16592567 TYMPANOMETRY 139.00 17036430 BLOOD TRANSF SVC 805.00 17036591 COLLECT BLOOD VENOUS DEVICE 251.00 17036592 COLLECT FROM PICC 251.00 17036593 DECLOTTING BY THROMBOLYTIC AGENT 696.00 17090471 OTHER IMMUNIZATION ADMIN 1ST 75.00 17090472 OTHER IMMUNIZATION ADMIN-ADD'L EA 46.00 17090658 CHEMO FLU VACC >=3 YRS IM 42.00 17094760 MEAS BLOOD OXY LEVEL 56.00 17094761 MEAS BLOOD OXY LEVEL 142.00 17094762 MEAS BLOOD OXY LEVEL 236.00 17096360 IV INFUSION NON-CHEMO HYDRATE 1ST HR 406.00 17096361 IV INFUSION NON-CHEMO EA ADD'L HOUR 60.00 17096365 IV INFUSION NON-CHEMO TX 1ST HOUR 707.00 17096366 IV INFUSION NON-CHEMO EACH ADDL HOUR 129.00 17096367 TX/PROPH/DX ADD'L SEQ IV INFUSION 202.00 17096368 TX/PROP/DX CONCURRENT INFUSION 171.00 17096369 SC THERAPY INF UP TO 1 HOUR 421.00 17096370 SC THERAPY INF, ADD'L HR 207.00 17096371 SC THERAPY INF, RESET PUMP 148.00 17096372 THER/PROPH/DIAG INJ, SC OR IM 129.00

17096373 INJ NON-CHEMO IA 202.00 17096374 IV INJ NON-CHEMO INITIAL (PUSH) 202.00 17096375 IV INJ NON-CHEMO EA ADD'L (PUSH) 202.00 17096377 EA ADD SEQUENTIAL IV PUSH SAME DRUG 60.00 17096378 ADD SEQUENTIAL IV PUSH NEW DRUG 202.00 17096379 THER/PROPH/DIAG INJ/INF PROC 60.00 17096400 CHEMOTHERAPY SC/IM 28.00 17096401 CHEMOTHERAPY, NON-HORMONAL IM/SC 202.00 17096402 CHEMOTHERAPY, HORMONAL IM/SC 202.00 17096405 CHEMO INTERALESIONAL <=7 LESIONS 202.00 17096406 CHEMO INTERALESIONAL >7 LESIONS 406.00 17096408 CHEMO PUSH TECHNIQU 195.00 17096409 CHEMO IV PUSH INITIAL 707.00 17096410 CHEMO INFUSION METH 306.00 17096411 CHEMO IV PUSH EACH ADD'L 406.00 17096412 CHEMOTX IFN METH ADD 236.00 17096413 CHEMO IV INFUSION INITIAL (PRIMARY) 1,032.00 17096414 CHEMOTX INF METH ADD 264.00 17096415 CHEMO IV INFUSION EACH ADDITIONAL HOUR 202.00 17096416 CHEMO IV INFUSION PUMP INITIATION 1,032.00 17096417 CHEMO IV INFUSION SQL, UP TO 1 HR 406.00 17096420 CHEMO PUSH TECHNIQUE 707.00 17096422 CHEMO IA INFUSION UP TO 1 HR 1,032.00 17096423 CHEMO IA INFUSE EACH ADD'L HR 406.00 17096425 CHEMO IA INFUSION PUMP INITIATION 1,032.00 17096440 CHEMO INTRACAVITARY 287.00 17096445 CHEMO INTRACAVITARY 1,032.00 17096450 CHEMO INJECTION INTO CNS 1,032.00 17096520 PUMP REFILLING MNT 184.00 17096521 CHEMO PUMP REFILL/MAINT PORTABLE 1,032.00 17096522 CHEMO PUMP REFILL/MAINT IMPLANT 707.00 17096523 IRRIGATION IMPLANTED VENOUS ACCESS DEVIC 223.00 17096530 PUMP REFILLING MNT 214.00 17096542 CHEMO INJECTION 813.00 17096549 CHEMO INFUSION CONCURRENT 103.00 17096999 CHEMO IV PUSH INITIAL 707.00 17099195 PHLEBOTOMY THERAPUTIC 171.00 17099201 OFFICE OP VISIT NEW 148.00 17099202 OFFICE OP VISIT NEW 221.00 17099203 OFFICE/OP VISIT NEW 306.00 17099204 OFFICE/OP VISIT NEW 364.00 17099205 OFFICE/OP VISIT NEW 488.00 17099211 CHEMO/INFUSION MINIMAL SRV EST 145.00 17099212 BRIEF CHEMO OP VISIT EST 269.00 17099213 CHEMO OP VISIT EST 269.00 17099214 EXTENDED CHEMO OP VISIT EST 256.00 17099215 COMPREHENSIVE CHEMO OP VISIT EST 338.00 17099221 INITIAL HOSP CARE 236.00 17099222 INITIAL HOSP CARE 372.00 17099223 INITIAL HOSP CARE 505.00 17099231 SUBSQNT HOSPITAL CAR 113.00 17099232 SUBSQNT HOSP CARE 179.00

17099233 SUBSQNT HOSP CARE 256.00 17099238 HOSPITAL DISH DAY 223.00 17099239 HOSPITAL DISH DAY 294.00 17099243 OFFICE VISIT 226.00 17099991 PNEUMOCOCCAL ADMIN 14.00 17099995 TELEHEALTH ORIGINATING SITE FACILITY FEE 71.00 17099999 INFLUENZA ADMINISTRATION 14.00 18099201 BRIEF NEW - GASTRO ML 132.00 18099202 LIMITED NEW - GASTRO ML 154.00 18099203 INTERMEDIATE NEW - GASTRO ML 176.00 18099204 EXTENDED NEW - GASTRO ML 221.00 18099205 COMPREHENSIVE NEW - GASTRO ML 276.00 18099211 MINIMAL SERV - GASTRO ML 66.00 18099212 BRIEF VISIT EST- GASTRO ML 110.00 18099213 INTERMEDIATE EST - GASTRO ML 132.00 18099214 EXTENDED EST - GASTRO ML 176.00 18099215 COMPREHENSIVE EST - GASTRO ML 198.00 19500500 MOD SEDATATION ENDO SERVICE >5YRS 93.00 19510081 I & D PILONIDAL CYST; COMPLICATED 492.00 19510160 PUNCT DRNG OF LESION 54.00 19511042 DEBRIDE/NECROTIZING SOFT TISSUE INFECTIO 368.00 19511403 EXCISION OF LESION FC 1,657.00 19511421 EXCISION BENIGN LESION FC 1,497.00 19511601 EXC LESION SKIN MALIGNANT TRUNK, ARMS, L 543.00 19511721 NAIL DEBRIDEMENT 124.00 19517000 DEST PREMALIGNANT LESIONS, 1ST LESION 237.00 19517003 DEST PREMALIGNANT LESIONS 2-14, EACH 78.00 19520550 INJ TDN/LGMT/CYST FAC ONLY 481.00 19520551 INJ; SINGLE TENDON; ORIGINAL INSERTION 426.00 19520552 TRIGGER POINT INJECTION - FC ONLY 82.00 19520610 DRAIN/INJ BURSA-FAC CHG ONLY 673.00 19525605 CLOSED TRT DISTAL RADIAL FRACTURE W/MANI 1,833.00 19543235 GASTROSCOPY 2,159.00 19543239 GASTROSCOPY THERAPEUTIC 2,258.00 19543247 GI ENDOSCOPY W/REMOVAL OF FB 2,258.00 19543249 GASTROSCOPY W/ DILATION 2,258.00 19543251 GASTRO/BIOPSY 2,329.00 19543255 GASTRO - CONTROL BLEEDING 3,566.00 19545330 FLEX SIGMOID-DIAG W/O COLLECT SPECIMENS 1,603.00 19545378 COLONOSCOPY DIAG 1,934.00 19545381 COLONOSCOPY WITH SUBMUCOSAL INJECTIONS 2,464.00 19545382 COLONOSCOPY W/CONTROL OF BLEEDING 2,464.00 19545384 COLONOSCOPY/HOT FORCEPS 1,972.00 19545385 COLONOSCOPY W/SNARE 2,013.00 19551702 FOLEY CATH INSERTION FC 161.00 19551705 FOLEY CATH CHANGE 225.00 19552005 CYSTOSCOPY DIAGNOSTIC TC 921.00 19552310 CYSTOSCOPY THERAPEUTIC 1,134.00 19569210 REMOVAL CERUMEN FC w/Instrumentation 49.00 19582962 FINGERSTICK GLUCOSE 8.00 19590471 IMMUNIZATION ADMIN 76.00 19599211 SPECIALTY CLINIC MINIMAL SERVICE 145.00

19599212 SPECIALTY CLINIC BRIEF SERVICE 145.00 20170001 DEST OF LESION-FAC CHG ONLY 87.00 20170004 DEST OF LESION(2-14)-FAC CHG ONLY 53.00 20170031 EXCISION OF LESION FACILITY CHG ONLY 80.00 44200311 RL METHYLPHENIDATE- SERUM 261.00 52440105 COLONOSCOPY SCREENING HIGH RISK ML 2,242.00 52440121 COLONOSCOPY SCREENING MEDICARE ML 2,242.00 52443235 GASTROSCOPY ML 2,364.00 52443239 GASTROSCOPY W/BIOPSY ML 2,489.00 52443249 GASTROSCOPY W/ DILATION ML 2,513.00 52443250 GASTRO W HOT FORCEPS ML 2,540.00 52443251 GASTROSCOPY W BIOPSY ML 2,655.00 52443255 GASTRO - CONTROL BLEEDING ML 3,901.00 52445330 FLEX SIGMOID DIAG W/O COLLECT SPECIMEN M 1,696.00 52445378 COLONOSCOPY DIAG ML 2,242.00 52445380 COLONOSCOPY W BIOPSY ML 2,500.00 52445381 COLONOSCOPY W SUBMUCOSAL INJ ML 2,799.00 52445382 COLONOSCOPY W/CONTROL OF BLEEDING ML 2,896.00 52445384 COLONOSCOPY W HOT FORCEPS ML 2,351.00 52445385 COLONOSCOPY W/SNARE ML 2,438.00 52445388 COLONOSCOPY W ABLATION ML 2,384.00 52445390 COLONOSCOPY w/ ENDO MUCOSAL RESECTION ML 1,937.00 54000004 M COMPLETE BLOOD COUNT W/ DIFFERENTIAL 96.00 54009040 M LEUKOREDUCED PACKED CELLS, IRRADIATED 2,119.00 54012345 .M LDL DIR MEAS 129.00 54036415 M VENIPUNCTURE 46.00 54048434 M TSH W/ REFLEX FT4 240.00 54058007 M MANUAL DIFFERENTIAL 223.00 54070322 M LEGIONELLA AG URINE 197.00 54080048 M BASIC METABOLIC PANEL 186.00 54080051 M ELECTROLYTE PANEL 190.00 54080053 M CMP 237.00 54080061 M LIPID PROFILE 203.00 54080076 M HEPATIC FUNCTION 302.00 54080104 M DRUG SCREEN URINE 212.00 54080156 M TEGRETOL (CARBAMAZEPINE) 233.00 54080162 M DIGOXIN LEVEL 180.00 54080164 M VALPROIC ACID (DEPAKENE) 223.00 54080178 M LITHIUM LEVEL 170.00 54080185 M PHENYTOIN (DILANTIN) 215.00 54080196 M SALICYLATE LEVEL 168.00 54080202 M VANCOMYCIN TROUGH 292.00 54080291 M VANCOMYCIN PEAK 292.00 54080293 M VANCOMYCIN RANDOM 292.00 54081001 M UA W/MICRO CHG 97.00 54081003 M AUTO UA W/O MICRO CHG 57.00 54081025 M PREGNANCY TEST URINE 108.00 54082003 M ACETAMINOPHEN LEVEL 292.00 54082010 M BETA HYDROXYBUTYRATE 88.00 54082040 M ALBUMIN SERUM 112.00 54082043 M MICROALBUMIN 155.00 54082055 M ALCOHOL ETHYL 239.00

54082150 M AMYLASE 118.00 54082222 M GLUCOSE TOLERANCE TEST 2 HOUR 298.00 54082247 M BILIRUBIN TOTAL 111.00 54082248 M BILIRUBIN DIRECT 111.00 54082273 M GASTRIC FLUID OCCULT BLOOD 75.00 54082274 M STOOL OCCULT BLOOD 149.00 54082310 M CALCIUM 106.00 54082374 M TOTAL CARBON DIOXIDE 106.00 54082375 M CARBOXY HEMOGLOBIN 221.00 54082435 M CHLORIDE 116.00 54082465 M CHOLESTEROL 119.00 54082550 M CPK 139.00 54082553 M CKMB ISOENZYME 236.00 54082565 M CREATININE SERUM 119.00 54082570 M CREATININE URINE 168.00 54082571 M CREATININE, URINE 24 HOUR 168.00 54082575 M CREATININE CLEARANCE 285.00 54082607 M VITAMIN B12 LEVEL 257.00 54082728 M FERRITIN 214.00 54082746 M FOLATE 252.00 54082805 M ARTERIAL BLOOD GAS 202.00 54082806 M VENOUS BLOOD GASES 202.00 54082947 M GLUCOSE RANDOM SERUM 116.00 54082950 M GLUCOSE TOLERANCE TEST 1 HOUR 124.00 54082962 M GLUCOSE FINGERSTICK 8.00 54082977 M Y-GLUTAMYL TRANSFERASE 139.00 54083036 M HGB A1C 221.00 54083605 M LACTIC ACID 221.00 54083615 M LACTATE DEHYDROGENASE 106.00 54083690 M LIPASE 116.00 54083718 M HDL 164.00 54083721 M LDL DIR MEAS 119.00 54083736 M MAGNESIUM 152.00 54083881 M N-TERMINAL PRO-BRAIN NATRIURETIC PEPTI 455.00 54084100 M PHOSPHORUS 92.00 54084132 M POTASSIUM 112.00 54084133 M POTASSIUM URINE 131.00 54084151 M PSA SCREENING 299.00 54084153 M PSA DIAGNOSTIC 299.00 54084155 M TOTAL PROTEIN SERUM 139.00 54084295 M SODIUM 106.00 54084300 M URINE SODIUM, RANDOM 131.00 54084439 M FREE THYROXINE 252.00 54084443 M TSH 240.00 54084450 M AST 155.00 54084460 M ALT 155.00 54084478 M TRIGLYCERIDES 96.00 54084484 M TROPONIN 270.00 54084520 M BUN 112.00 54084550 M URIC ACID 146.00 54084702 M PREGNANCY TEST QUANTITAVE 272.00 54084703 M PREGNANCY TEST SERUM 149.00

54085004 M WBC & AUTO DIFF ANC 49.00 54085014 M HCT 56.00 54085018 M HGB 56.00 54085044 M RETICULOCYTE COUNT 116.00 54085048 M WHITE BLOOD COUNT 53.00 54085049 M PLATELET COUNT 49.00 54085379 M D DIMER 270.00 54085610 M PT W/INR 76.00 54085651 M SEDIMENTATION RATE 91.00 54085730 M PTT 131.00 54086141 M C-REACTIVE PROTEIN 139.00 54086308 M MONONUCLEOSIS SCREEN 130.00 54086756 M RSV VIRUS 226.00 54086850 M BB AB SCREEN-RH 148.00 54086900 M BLOOD TYPE ABO 91.00 54086901 M BLOOD TYPING RH 129.00 54086920 M BB COMPATIBILITY-IMMED SPIN 292.00 54087210 M WET PREP 108.00 54087324 DO NOR USE M DIFFICILE TOXIN A/B 264.00 54087804 M INFLUENZA SWAB (INFLU A & B ANTIGEN) 257.00 54087880 M RAPID STREP A WITH REFLEX TO CULTURE 71.00 54088888 M COMPLETE BLOOD COUNT W/O DIFFERENTIAL 82.00 54486850 M BLOOD ANTIBODY SCREEN 148.00 54486880 M BLOOD COOMBS DIRECT 128.00 54486920 M BLOOD COMPATIBILITY TEST - EACH UNIT 292.00 55382223 M GTT 3 HR 298.00 55382306 M VITAMIN D25 HYDROXY 298.00 55384075 M ALK PHOS 124.00 56800011 M OPTIC FORAMINA LT 399.00 56800012 M OPTIC FORAMINA RT 399.00 56800013 M ORBITS COMP MIN 4 VW 423.00 56800014 M SINUSES LTD LESS THAN 3 VW 271.00 56800015 M SINUSES COMP MIN 3 VW 502.00 56800017 M SKULL LTD LESS THAN 4 VW 354.00 56800018 M SKULL COMP MIN 4 VW 604.00 56800019 M TMJ OPEN AND CLOSED MOUTH LT 251.00 56800020 M TMJ OPEN AND CLOSED MOUTH RT 251.00 56800021 M TMJ OPEN AND CLOSED MOUTH BIL 564.00 56800023 M NECK SOFT TISSUE 377.00 56800027 M CHEST SINGLE VW 252.00 56800028 M CHEST 2 VW 455.00 56800029 M CHEST W/ API LOR 629.00 56800030 M CHEST W/ OBLIQUES 634.00 56800032 M CHEST COMP 507.00 56800035 M RIBS LT 507.00 56800036 M RIBS RT 507.00 56800037 M RIBS W/ PA CHEST RT 569.00 56800038 M RIBS W/ PA CHEST LT 559.00 56800039 M RIBS BIL 638.00 56800040 M RIBS W/ PA CHEST BIL 618.00 56800041 M STERNUM MIN 2 VW 396.00 56800042 M STERNOCLAVICULAR JT MIN 3 VW LT 356.00

56800043 M STERNOCLAVICULAR JT MIN 3 VW RT 356.00 56800044 M THORACOLUMBAR 2-3 VW 649.00 56800045 M SPINE SINGLE VW 314.00 56800046 M CERVICAL SPINE AP LAT 353.00 56800047 M CERVICAL SPINE COMP MIN 4 VW 690.00 56800048 M CERVICAL SPINE W FLEX EXT 806.00 56800050 M THORACIC SPINE AP LAT 569.00 56800051 M THORACIC SPINE 3 VW 422.00 56800052 M THORACIC W/ OBLIQUES 611.00 56800053 M THORACOLUMBAR JUNCTION MIN 2 VW 699.00 56800055 M LUMBOSACRAL SPINE 2-3 VW 396.00 56800056 M LUMBOSACRAL W/ OBLIQUES 742.00 56800057 M LUMBOSACRAL W/ BEND 739.00 56800059 M PELVIS 1-2 VW 365.00 56800060 M PELVIS COMP MIN 3 VW 444.00 56800061 M SACROILIAC JT LESS THAN 3 VW 422.00 56800062 M SACROILIAC JT 485.00 56800063 M SACRUM COCCYX 422.00 56800064 M CLAVICLE LT 422.00 56800065 M CLAVICLE RT 422.00 56800066 M SCAPULA LT 477.00 56800067 M SCAPULA RT 477.00 56800068 M SHOULDER SINGLE LT 333.00 56800069 M SHOULDER SINGLE RT 333.00 56800070 M SHOULDER MIN 2 VW LT 465.00 56800071 M SHOULDER MIN 2 VW RT 465.00 56800072 M AC JOINTS 416.00 56800073 M HUMERUS 2 VW LT 386.00 56800074 M HUMERUS 2 VW RT 386.00 56800075 M ELBOW 2 VW LT 316.00 56800076 M ELBOW 2 VW RT 316.00 56800077 M ELBOW MIN 3 VW LT 443.00 56800078 M ELBOW MIN 3 VW RT 443.00 56800079 M FOREARM 2 VW LT 422.00 56800080 M FOREARM 2 VW RT 422.00 56800081 M UPPR EXT INFANT MIN 2 VW LT 294.00 56800082 M UPPR EXTINFANT MIN 2 VW RT 294.00 56800083 M WRIST AP LAT LT 422.00 56800084 M WRIST AP LAT RT 422.00 56800085 M WRIST MIN 3 VW LT 422.00 56800086 M WRIST MIN 3 VW RT 422.00 56800087 M HAND 2 VW LT 365.00 56800088 M HAND 2 VW RT 365.00 56800089 M HAND MIN 3 VW LT 422.00 56800090 M HAND MIN 3 VW RT 422.00 56800091 M FINGER(S) MIN 2 VW LT 333.00 56800092 M FINGER(S) MIN 2 VW RT 333.00 56800093 M HIP SINGLE VW LT 337.00 56800094 M HIP SINGLE VW RT 337.00 56800095 M HIP 2-3 VW LT 631.00 56800096 M HIP 2-3 VW RT 631.00 56800097 M HIP W/ AP PELVIS 2 VW BIL 815.00

56800100 M FEMUR 2 VW LT 468.00 56800101 M FEMUR 2 VW RT 468.00 56800102 M KNEE 1-2 VW LT 386.00 56800103 M KNEE 1-2 VW RT 386.00 56800104 M KNEE 3 VW RT 455.00 56800105 M KNEE 3 VW LT 455.00 56800106 M KNEE W/ TUNN PAT STAND 601.00 56800107 M KNEE MIN 4 VW RT 601.00 56800108 M KNEE MIN 4 VW LT 601.00 56800109 M KNEE STANDING BIL 357.00 56800110 M TIBFIB 2 VW LT 422.00 56800111 M TIBFIB 2 VW RIGHT 422.00 56800112 M LOW EXT INFANT MIN 2 VW LT 288.00 56800113 M LOW EXT INFANT MIN 2 VW RT 288.00 56800114 M ANKLE 2 VW LT 333.00 56800115 M ANKLE 2 VW RT 333.00 56800116 M ANKLE MIN 3 VW LT 422.00 56800117 M ANKLE MIN 3 VW RT 422.00 56800118 M FOOT 2 VW LT 292.00 56800119 M FOOT 2 VW RT 292.00 56800120 M FOOT MIN 3 VW LT 485.00 56800121 M FOOT MIN 3 VW RT 485.00 56800122 M OS CALCIS LT 402.00 56800123 M OS CALCIS RT 402.00 56800124 M TOE (S) MIN 2 VW LT 314.00 56800125 M TOE (S) MIN 2 VW RT 314.00 56800126 M ABDOMEN SINGLE VW 421.00 56800127 M ABDOMEN FLAT UPRIGHT 471.00 56800128 M ABDOMEN FLAT UPRIGHT W/ PA CXR 546.00 56800129 M ESOPHAGRAM 671.00 56800131 M UPPER GI 878.00 56800132 M UPPER GI TRACT W/ ABDOMEN 884.00 56800133 M UPPER GI SMALL BOWEL 1,087.00 56800134 M UPPER GI AIR CONTRAST 967.00 56800136 M UPPER GI AIR HD BARIUM SBFT 1,125.00 56800137 M SMALL BOWEL SERIES 569.00 56800138 M BARIUM ENEMA 884.00 56800139 M BARIUM ENEMA W/ AIR 1,011.00 56800151 M CHILD NOSE RECTUM FOREIGN BODY 609.00 56800152 M BONE AGE STUDY 316.00 56800153 M OSSEOUS SURVEY LTD 815.00 56800154 M OSSEOUS SURVEY COMP 978.00 56800155 M ABUSE SURVEY INFANT 735.00 56800157 M DEXA 1 + SITES AXIAL SKELETON 626.00 56800158 M DEXA PERI FOREARM 184.00 56800159 M FISTULAGRAM 674.00 56800171 M US THYROID 671.00 56800172 M US PERICARDIAL EFFUSION 609.00 56800174 M US BREAST COMP LT 569.00 56800175 M US BREAST COMP RT 569.00 56800176 M US ABDOMINAL COMP 967.00 56800177 M US GALLBLADDER 784.00

56800178 M US LIVER 784.00 56800179 M US PANCREAS 784.00 56800180 M US SPLEEN 784.00 56800181 M US RUQ 784.00 56800182 M US APPENDIX 784.00 56800183 M US ABDOMEN LTD 784.00 56800185 M US RETROPERITONEAL 853.00 56800186 M US KIDNEY AND BLADDER 853.00 56800187 M US KIDNEY 713.00 56800188 M US BLADDER 713.00 56800189 M US ABDOMINAL AORTA 713.00 56800190 M US OB LESS THAN 14 WEEKS GESTATION 394.00 56800200 M US PREGNANCY LTD 394.00 56800203 M US OB TRANSVAGINAL 394.00 56800205 M US TRANSVAGINAL NON OB 849.00 56800206 M US PELVIC NON OBSTETRIC 849.00 56800207 M US PELVIC LTD FOR F/U 413.00 56800208 M US SCROTUM AND CONTENTS 634.00 56800209 M US TISSUE MASS EXT 569.00 56800212 M US SOFT TISS HEAD AND NECK 569.00 56800214 M US SOFT TISSUE MASS CHEST 507.00 56800215 M US TISSUE MASS ABDOMEN 507.00 56800221 M US CAROTID ARTERY BIL 1,235.00 56800224 M US LOWER EXT ARTERY LTD 823.00 56800225 M US SINGLE UPPER EXT ARTERIAL 593.00 56800226 M US ARM VEIN DUPLEX COMP BIL 971.00 56800227 M US LEG VEIN BIL 849.00 56800228 M US LEG VEIN LT 709.00 56800229 M US LEG VEIN RT 709.00 56800230 M US UPPER EXT VEINS RT 422.00 56800231 M US UPPER EXT VEINS LT 422.00 56800240 M MANDIBLE COMP MIN 4 VW 455.00 56800241 M MASTOIDS LESS THAN 3 LT 316.00 56800242 M MASTOIDS LESS THAN 3 RT 316.00 56800243 M MASTOIDS COMP MIN 3 VW PER SIDE 564.00 56800244 M FACIAL BONES LTD LESS THAN 3 VW 316.00 56800245 M FACIAL BONES COMP MIN 3 VW 444.00 56800246 M NASAL BONES COMP MIN 3 VW 377.00 56800247 M US TRANSRECTAL 849.00 56800249 M US LOWER EXT ARTERIES BIL 1,222.00 56800250 M TOE GREAT LT 333.00 56800251 M TOE SECOND LT 333.00 56800252 M TOE THIRD LT 333.00 56800253 M TOE FOURTH LT 333.00 56800254 M TOE FIFTH LT 333.00 56800255 M TOE GREAT RT 333.00 56800256 M TOE SECOND RT 333.00 56800257 M TOE THIRD RT 333.00 56800258 M TOE FOURTH RT 333.00 56800259 M TOE FIFTH RT 333.00 56800260 M FINGER THUMB RT 333.00 56800261 M FINGER SECOND RT 333.00

56800262 M FINGER THIRD RT 333.00 56800263 M FINGER FOURTH RT 333.00 56800264 M FINGER FIFTH RT 333.00 56800265 M FINGER THUMB LT 333.00 56800266 M FINGER SECOND LT 333.00 56800267 M FINGER THIRD LT 333.00 56800268 M FINGER FOURTH LT 333.00 56800269 M FINGER FIFTH LT 333.00 56800270 M HIP W/AP PELVIS LT 897.00 56800271 M HIP W/AP PELVIS RT 897.00 56800272 M LUMBOSACRAL W/ FLEX EXT 806.00 56800273 M MAMMO SCREENING DIGITAL BIL 510.00 56800274 M MAMMO DIAG DIGITAL BIL 538.00 56800275 M MAMMO DIAG DIGITAL RT 442.00 56800276 M MAMMO DIAG DIGITAL LT 442.00 56800277 M MAMMO SCREENING DIGITAL LT 510.00 56800278 M MAMMO SCREENING DIGITAL RT 510.00 56800339 M MANDIBLE PARTIAL LESS THAN 4 VW 314.00 56800342 M ECHOCARDIOGRAPHY - COMPLETE 1,968.00 56800343 M US LIVER TIPS 971.00 56800344 M ORBITS FOREIGN BODY 422.00 56800345 M US BREAST LTD RT 292.00 56800346 M US BREAST LTD LT 292.00 56800350 M FEMUR 1 VW RT 334.00 56800351 M FEMUR 1 VW LT 334.00 56800352 M HIP MIN 4 VW RT 730.00 56800353 M HIP MIN 4 VW LT 730.00 56800354 M HIP 3-4 VW BIL 897.00 56800355 M HIP MIN 5 VW BIL 972.00 56800357 M THORACOLUMBAR 4-5 VW 791.00 56800358 M THORACOLUMBAR 6 VW 881.00 56800361 M SMALL BOWEL SERIES 114.00 56800363 M ESOPHAGRAM AIR HD 178.00 56800364 M ESOPH CERVICAL 156.00 56801014 M CERVICAL SPINE 2-3 VW 353.00 56801274 M MAMMO DIAG TOMO BIL 538.00 56876706 M US ABDOMINAL AORTA SCREENING 91.00 56876881 M US SOFT TISSUE EXT COMP 569.00 56876882 M US SOFT TISSUE EXT 596.00 57000496 M CTV HEAD W/CONTRAST 2,984.00 57004175 M CTV ABDOMEN PELVIS 2,984.00 57012345 M CT HIP W/O CONTRAST RT 2,063.00 57012346 M CT FEMUR W/O CONTRAST RT 2,063.00 57012347 M CT KNEE W/O CONTRAST RT 2,063.00 57012348 M CT TIBFIB W/O CONTRAST RT 2,063.00 57012349 M CT ANKLE W/O CONTRAST RT 2,063.00 57012350 M CT FOOT W/O CONTRAST RT 2,063.00 57012351 M CT HIP W/O CONTRAST LT 2,063.00 57012352 M CT FEMUR W/O CONTRAST LT 2,063.00 57012353 M CT KNEE W/O CONTRAST LT 2,063.00 57012354 M CT TIBFIB W/O CONTRAST LT 2,063.00 57012356 M CT ANKLE W/O CONTRAST LT 2,063.00

57012357 M CT FOOT W/O CONTRAST LT 2,063.00 57012358 M CT HIP W/ CONTRAST LT 2,525.00 57012359 M CT FEMUR W/ CONTRAST LT 2,525.00 57012360 M CT KNEE W/ CONTRAST LT 2,525.00 57012361 M CT TIBFIB W/ CONTRAST LT 2,525.00 57012362 M CT ANKLE W/ CONTRAST LT 2,525.00 57012363 M CT FOOT W/ CONTRAST LT 2,525.00 57012364 M CT HIP W/ CONTRAST RT 2,525.00 57012365 M CT FEMUR W/ CONTRAST RT 2,525.00 57012366 M CT KNEE W/ CONTRAST RT 2,525.00 57012367 M CT TIBFIB W/ CONTRAST RT 2,525.00 57012368 M CT ANKLE W/ CONTRAST RT 2,525.00 57012369 M CT FOOT W/ CONTRAST RT 2,525.00 57012370 M CT HIP W/WO CONTRAST LT 1,821.00 57012371 M CT FEMUR W/WO CONTRAST LT 1,821.00 57012372 M CT KNEE W/WO CONTRAST LT 1,821.00 57012373 M CT TIBFIB W/WO CONTRAST LT 1,821.00 57012374 M CT ANKLE W/WO CONTRAST LT 1,821.00 57012375 M CT FOOT W/WO CONTRAST LT 1,821.00 57012376 M CT FEMUR W/WO CONTRAST RT 1,821.00 57012377 M CT KNEE W/WO CONTRAST RT 1,821.00 57012378 M CT TIBFIB W/WO CONTRAST RT 1,821.00 57012379 M CT ANKLE W/WO CONTRAST RT 1,821.00 57012380 M CT FOOT W/WO CONTRAST RT 1,821.00 57012381 M CT HIP W/WO CONTRAST RT 1,821.00 57012382 M CT SHOULDER W/WO CONTRAST LT 2,353.00 57012383 M CT HUMERUS W/ WO CONTRAST LT 2,353.00 57012384 M CT ELBOW W/WO CONTRAST LT 2,353.00 57012385 M CT FOREARM W/WO CONTRAST LT 2,353.00 57012386 M CT WRIST W/WO CONTRAST LT 2,353.00 57012387 M CT HAND W/WO CONTRAST LT 2,353.00 57012388 M CT SHOULDER W/WO CONTRAST RT 2,353.00 57012389 M CT HUMERUS W/WO CONTRAST RT 2,353.00 57012390 M CT ELBOW W/WO CONTRAST RT 2,353.00 57012391 M CT FOREARM W/WO CONTRAST RT 2,353.00 57012392 M CT WRIST W/WO CONTRAST RT 2,353.00 57012393 M CT HAND W/WO CONTRAST RT 2,353.00 57012394 M CT SHOULDER W/ CONTRAST RT 1,771.00 57012395 M CT HUMERUS W/ CONTRAST RT 1,771.00 57012396 M CT ELBOW W/ CONTRAST RT 1,771.00 57012397 M CT FOREARM W/ CONTRAST RT 1,771.00 57012398 M CT WRIST W/ CONTRAST RT 1,771.00 57012399 M CT HAND W/ CONTRAST RT 1,771.00 57012400 M CT SHOULDER W/ CONTRAST LT 1,771.00 57012401 M CT HUMERUS W/ CONTRAST LT 1,771.00 57012402 M CT ELBOW W/ CONTRAST LT 1,771.00 57012403 M CT FOREARM W/ CONTRAST LT 1,771.00 57012404 M CT WRIST W/ CONTRAST LT 1,771.00 57012405 M CT HAND W/ CONTRAST LT 1,771.00 57012406 M CT SHOULDER W/O CONTRAST RT 2,100.00 57012407 M CT HUMERUS W/O CONTRAST RT 2,100.00 57012408 M CT ELBOW W/O CONTRAST RT 2,100.00

57012409 M CT FOREARM W/O CONTRAST RT 2,100.00 57012410 M CT WRIST W/O CONTRAST RT 2,100.00 57012411 M CT HAND W/O CONTRAST RT 2,100.00 57012412 M CT SHOULDER W/O CONTRAST LT 2,100.00 57012413 M CT HUMERUS W/O CONTRAST LT 2,100.00 57012414 M CT ELBOW W/O CONTRAST LT 2,100.00 57012415 M CT FOREARM W/O CONTRAST LT 2,100.00 57012416 M CT WRIST W/O CONTRAST LT 2,100.00 57012417 M CT HAND W/O CONTRAST LT 2,100.00 57037206 M CTA UPPER EXT RT 2,984.00 57060737 M CTA LOWER EXT RT 2,525.00 57063657 M CTA AORTA W/ RUNOFF 3,371.00 57070408 M CT IACS W/O CONTRAST 2,100.00 57070418 M CT IACS W/ CONTRAST 2,459.00 57070428 M CT IACS W/WO CONTRAST 2,100.00 57070450 M CT HEAD BRAIN W/O CONTRAST 2,166.00 57070460 M CT HEAD BRAIN W/ CONTRAST 2,444.00 57070470 M CT HEAD BRAIN W/WO CONTRAST 3,158.00 57070480 M CT ORBITS W/O CONTRAST 2,100.00 57070481 M CT ORBITS W/ CONTRAST 2,459.00 57070482 M CT ORBITS W/WO CONTRAST 2,100.00 57070486 M CT SINUS MAXILLOFACIAL W/O CONTRAST 2,429.00 57070487 M CT SINUS MAXILLOFACIAL W/ CONTRAST 2,429.00 57070488 M CT SINUS FACIAL W/WO CONTRAST 2,733.00 57070490 M CT SOFT TISSUE NECK W/O CONTRAST 2,063.00 57070491 M CT SOFT TISSUE NECK W/ CONTRAST 2,357.00 57070492 M CT SOFT TISSUE NECK W/WO CONTRAST 2,490.00 57070496 M CTA HEAD 2,984.00 57070498 M CTA NECK 2,984.00 57070842 M CT SELLA W/WO CONTRAST 2,100.00 57071250 M CT CHEST W/O CONTRAST 2,100.00 57071260 M CT CHEST W/ CONTRAST 2,644.00 57071270 M CT CHEST W/WO CONTRAST 2,906.00 57071275 M CTA CHEST 3,431.00 57072119 M CTA PELVIS 2,984.00 57072125 M CT CERVICAL SPINE W/O CONTRAST 2,324.00 57072126 M CT CERVICAL SPINE W/ CONTRAST 2,019.00 57072127 M CT CERVICAL SPINE W/WO CONTRAST 2,140.00 57072128 M CT THORACIC SPINE W/O CONTRAST 2,324.00 57072129 M CT THORACIC SPINE W/ CONTRAST 1,937.00 57072130 M CT THORACIC SPINE W/WO CONTRAST 2,140.00 57072131 M CT LUMBAR SPINE W/O CONTRAST 2,324.00 57072132 M CT LUMBAR SPINE W/ CONTRAST 1,937.00 57072133 M CT LUMBAR W/WO CONTRAST 2,140.00 57072192 M CT PELVIS W/O CONTRAST 2,324.00 57072193 M CT PELVIS W/ CONTRAST 2,644.00 57072194 M CT PELVIS W/WO CONTRAST 2,749.00 57073206 M CTA UPPER EXT LT 2,984.00 57074080 M CT SELLA W/O CONTRAST 2,100.00 57074081 M CT SELLA W/ CONTRAST 2,459.00 57074150 M CT ABDOMEN W/O CONTRAST 2,313.00 57074160 M CT ABDOMEN W/ CONTRAST 2,644.00

57074170 M CT ABDOMEN W/WO CONTRAST 3,723.00 57074175 M CTA ABDOMEN 2,984.00 57074176 M CT ABDOMEN PELVIS W/O CONTRAST 2,313.00 57074177 M CT ABDOMEN PELVIS W/ CONTRAST 2,644.00 57074178 M CT ABDOMEN PELVIS W/WO CONTRAST 3,723.00 57076040 M CT SCANOGRAM 534.00 57077306 M CTA LOWER EXT LT 2,525.00 57078032 M CT LD LUNG SCREENING 2,100.00 58012345 M MRA SHOULDER W/O CONTRAST RT 2,985.00 58012346 M MRA HUMERUS W/O CONTRAST RT 2,985.00 58012347 M MRA ELBOW W/O CONTRAST RT 2,985.00 58012348 M MRA FOREARM W/O CONTRAST RT 2,985.00 58012349 M MRA WRIST W/O CONTRAST RT 2,985.00 58012350 M MRA HAND W/O CONTRAST RT 2,985.00 58012351 M MRA SHOULDER W/W0 CONTRAST LT 2,985.00 58012352 M MRA HUMERUS W/WO CONTRAST LT 2,985.00 58012353 M MRA ELBOW W/WO CONTRAST LT 2,985.00 58012354 M MRA FOREARM W/WO CONTRAST LT 2,985.00 58012356 M MRA WRIST W/WO CONTRAST LT 2,985.00 58012357 M MRA HAND W/WO CONTRAST LT 2,985.00 58012358 M MRA SHOULDER W/ CONTRAST RT 2,985.00 58012359 M MRA HUMERUS W/ CONTRAST RT 2,985.00 58012360 M MRA ELBOW W/ CONTRAST RT 2,985.00 58012361 M MRA FOREARM W/ CONTRAST RT 2,985.00 58012362 M MRA WRIST W/ CONTRAST RT 2,985.00 58012363 M MRA HAND W/ CONTRAST RT 2,985.00 58012364 M MRA FEMUR W/WO CONTRAST LT 3,045.00 58012365 M MRA TIBFIB W/WO CONTRAST LT 3,045.00 58012366 M MRA FOOT W/WO CONTRAST LT 3,045.00 58012367 M MRA HIP W/WO CONTRAST LT 3,045.00 58012368 M MRA KNEE W/WO CONTRAST LT 3,045.00 58012369 M MRA ANKLE W/WO CONTRAST LT 3,045.00 58012370 M MRA FEMUR W/WO CONTRAST RT 3,045.00 58012371 M MRA TIBFIB W/WO CONTRAST RT 3,045.00 58012372 M MRA FOOT W/WO CONTRAST RT 3,045.00 58012373 M MRA HIP W/WO CONTRAST RT 3,045.00 58012374 M MRA KNEE W/WO CONTRAST RT 3,045.00 58012375 M MRA ANKLE W/WO CONTRAST RT 3,045.00 58012376 M MRA FEMUR W/ CONTRAST RT 3,045.00 58012377 M MRA TIBFIB W/ CONTRAST RT 3,045.00 58012378 M MRA FOOT W/ CONTRAST RT 3,045.00 58012379 M MRA HIP W/ CONTRAST RT 3,045.00 58012380 M MRA KNEE W/ CONTRAST RT 3,045.00 58012381 M MRA ANKLE W/ CONTRAST RT 3,045.00 58012382 M MRA FEMUR W/ CONTRAST LT 3,045.00 58012383 M MRA TIBFIB W/ CONTRAST LT 3,045.00 58012384 M MRA FOOT W/ CONTRAST LT 3,045.00 58012385 M MRA HIP W/ CONTRAST LT 3,045.00 58012386 M MRA KNEE W/ CONTRAST LT 3,045.00 58012387 M MRA ANKLE W/ CONTRAST LT 3,045.00 58012388 M MRA FEMUR W/O CONTRAST LT 3,045.00 58012389 M MRA TIBFIB W/O CONTRAST LT 3,045.00

58012390 M MRA FOOT W/O CONTRAST LT 3,045.00 58012391 M MRA HIP W/O CONTRAST LT 3,045.00 58012392 M MRA KNEE W/O CONTRAST LT 3,045.00 58012393 M MRA ANKLE W/O CONTRAST LT 3,045.00 58012394 M MRA FEMUR W/O CONTRAST RT 3,045.00 58012395 M MRA TIBFIB W/O CONTRAST RT 3,045.00 58012396 M MRA FOOT W/O CONTRAST RT 3,045.00 58012397 M MRA HIP W/O CONTRAST RT 3,045.00 58012398 M MRA KNEE W/O CONTRAST RT 3,045.00 58012399 M MRA ANKLE W/O CONTRAST RT 3,045.00 58012400 M MRI SHOULDER W/ CONTRAST RT 2,567.00 58012401 M MRI ELBOW W/ CONTRAST RT 2,567.00 58012402 M MRI WRIST W/ CONTRAST RT 2,567.00 58012406 M MRI SHOULDER W/ CONTRAST LT 2,567.00 58012407 M MRI ELBOW W/ CONTRAST LT 2,567.00 58012408 M MRI WRIST W/ CONTRAST LT 2,567.00 58012409 M MRI SHOULDER W/O CONTRAST RT 2,903.00 58012410 M MRI ELBOW W/O CONTRAST RT 2,903.00 58012411 M MRI WRIST W/O CONTRAST RT 2,903.00 58012412 M MRI SHOULDER W/O CONTRAST LT 2,903.00 58012413 M MRI ELBOW W/O CONTRAST LT 2,903.00 58012414 M MRI WRIST W/O CONTRAST LT 2,903.00 58012415 M MRI SHOULDER W/WO CONTRAST LT 4,013.00 58012416 M MRI ELBOW W/WO CONTRAST LT 4,013.00 58012417 M MRI WRIST W/WO CONTRAST LT 4,013.00 58012418 M MRI SHOULDER W/WO CONTRAST RT 4,013.00 58012419 M MRI ELBOW W/WO CONTRAST RT 4,013.00 58012420 M MRI WRIST W/WO CONTRAST RT 4,013.00 58012421 M MRI HUMERUS W/ CONTRAST LT 3,764.00 58012422 M MRI FOREARM W/ CONTRAST LT 3,764.00 58012423 M MRI HAND W/ CONTRAST LT 3,764.00 58012424 M MRI HUMERUS W/ CONTRAST RT 3,764.00 58012425 M MRI FOREARM W/ CONTRAST RT 3,764.00 58012426 M MRI HAND W/ CONTRAST RT 3,764.00 58012427 M MRI HUMERUS W/O CONTRAST LT 2,531.00 58012428 M MRI FOREARM W/O CONTRAST LT 2,531.00 58012430 M MRI HAND W/O CONTRAST LT 2,531.00 58012431 M MRI HUMERUS W/O CONTRAST RT 2,531.00 58012432 M MRI FOREARM W/O CONTRAST RT 2,531.00 58012433 M MRI HAND W/O CONTRAST RT 2,531.00 58012434 M MRI HUMERUS W/WO CONTRAST RT 3,573.00 58012435 M MRI FOREARM W/WO CONTRAST RT 3,573.00 58012436 M MRI HAND W/WO CONTRAST RT 3,573.00 58012437 M MRI HUMERUS W/WO CONTRAST LT 3,573.00 58012438 M MRI FOREARM W/WO CONTRAST LT 3,573.00 58012439 M MRI HAND W/WO CONTRAST LT 3,573.00 58012440 M MRI HIP W/WO CONTRAST LT 4,020.00 58012441 M MRI KNEE W/WO CONTRAST LT 4,020.00 58012442 M MRI ANKLE W/WO CONTRAST LT 4,020.00 58012443 M MRI HIP W/WO CONTRAST RT 4,020.00 58012444 M MRI KNEE W/WO CONTRAST RT 4,020.00 58012445 M MRI ANKLE W/WO CONTRAST RT 4,020.00

58012446 M MRI HIP W/ CONTRAST LT 3,338.00 58012447 M MRI KNEE W/ CONTRAST LT 3,338.00 58012448 M MRI ANKLE W/ CONTRAST LT 3,338.00 58012449 M MRI HIP W/ CONTRAST RT 3,338.00 58012450 M MRI KNEE W/ CONTRAST RT 3,338.00 58012451 M MRI ANKLE W/ CONTRAST RT 3,338.00 58012452 M MRI HIP W/O CONTRAST LT 2,914.00 58012453 M MRI KNEE W/O CONTRAST LT 2,914.00 58012454 M MRI ANKLE W/O CONTRAST LT 2,914.00 58012455 M MRI HIP W/O CONTRAST RT 2,914.00 58012456 M MRI KNEE W/O CONTRAST RT 2,914.00 58012457 M MRI ANKLE W/O CONTRAST RT 2,914.00 58012458 M MRI FEMUR W/ CONTRAST RT 3,338.00 58012459 M MRI TIBFIB W/ CONTRAST RT 3,338.00 58012460 M MRI FOOT W/ CONTRAST RT 3,338.00 58012461 M MRI FEMUR W/ CONTRAST LT 3,338.00 58012462 M MRI TIBFIB W/ CONTRAST LT 3,338.00 58012463 M MRI FOOT W/ CONTRAST LT 3,338.00 58012464 M MRI FEMUR W/O CONTRAST RT 2,984.00 58012465 M MRI TIBFIB W/O CONTRAST RT 3,168.00 58012466 M MRI FOOT W/O CONTRAST RT 3,168.00 58012467 M MRI FEMUR W/O CONTRAST LT 3,168.00 58012468 M MRI TIBFIB W/O CONTRAST LT 3,168.00 58012469 M MRI FOOT W/O CONTRAST LT 3,168.00 58012470 M MRI FEMUR W/WO CONTRAST LT 4,118.00 58012471 M MRI TIBFIB W/WO CONTRAST LT 4,118.00 58012472 M MRI FOOT W/WO CONTRAST LT 4,118.00 58012473 M MRI FEMUR W/WO CONTRAST RT 4,118.00 58012474 M MRI TIBFIB W/WO CONTRAST RT 4,118.00 58012475 M MRI FOOT W/WO CONTRAST RT 4,118.00 58022345 M MRA SHOULDER W/O CONTRAST LT 2,985.00 58022346 M MRA HUMERUS W/O CONTRAST LT 2,985.00 58022347 M MRA ELBOW W/O CONTRAST LT 2,985.00 58022348 M MRA FOREARM W/O CONTRAST LT 2,985.00 58022349 M MRA WRIST W/O CONTRAST LT 2,985.00 58022350 M MRA HAND W/O CONTRAST LT 2,985.00 58022351 M MRA SHOULDER W/W0 CONTRAST RT 2,985.00 58022352 M MRA HUMERUS W/WO CONTRAST RT 2,985.00 58022353 M MRA ELBOW W/WO CONTRAST RT 2,985.00 58022354 M MRA FOREARM W/WO CONTRAST RT 2,985.00 58022356 M MRA WRIST W/WO CONTRAST RT 2,985.00 58022357 M MRA HAND W/WO CONTRAST RT 2,985.00 58022358 M MRA SHOULDER W/ CONTRAST LT 2,985.00 58022359 M MRA HUMERUS W/ CONTRAST LT 2,985.00 58022360 M MRA ELBOW W/ CONTRAST LT 2,985.00 58022361 M MRA FOREARM W/ CONTRAST LT 2,985.00 58022362 M MRA WRIST W/ CONTRAST LT 2,985.00 58022363 M MRA HAND W/ CONTRAST LT 2,985.00 58070336 M MRI TMJ 2,972.00 58070540 M MRI FACE NECK ORBIT W/O CONTRAST 3,774.00 58070542 M MRI FACE NECK ORBIT W/ CONTRAST 4,342.00 58070543 M MRI FACE NECK ORBIT W/WO CONTRAST 4,992.00

58070544 M MRA HEAD W/O CONTRAST 3,057.00 58070545 M MRA HEAD W/ CONTRAST 3,594.00 58070546 M MRA HEAD W/WO CONTRAST 4,309.00 58070547 M MRA NECK W/O CONTRAST 3,057.00 58070548 M MRA NECK W/ CONTRAST 3,594.00 58070549 M MRA NECK W/WO CONTRAST 4,309.00 58070551 M MRI BRAIN W/O CONTRAST 3,522.00 58070552 M MRI BRAIN W/ CONTRAST 4,053.00 58070553 M MRI BRAIN W/WO CONTRAST 4,866.00 58071550 M MRI CHEST W/O CONTRAST 4,885.00 58071551 M MRI CHEST W/ CONTRAST 5,133.00 58071552 M MRI CHEST W/WO CONTRAST 5,301.00 58071555 M MRA CHEST W/WO CONTRAST 4,982.00 58071556 M MRA CHEST W/O CONTRAST 4,106.00 58071557 M MRA CHEST W/ CONTRAST 4,705.00 58072141 M MRI CERVICAL W/O CONTRAST 3,801.00 58072142 M MRI CERVICAL W/ CONTRAST 4,372.00 58072146 M MRI THORACIC W/O CONTRAST 4,149.00 58072147 M MRI THORACIC W/ CONTRAST 3,764.00 58072148 M MRI LUMBAR W/O CONTRAST 3,939.00 58072149 M MRI LUMBAR W/ CONTRAST 4,528.00 58072156 M MRI CERVICAL W/WO CONTRAST 5,251.00 58072157 M MRI THORACIC W/WO CONTRAST 5,719.00 58072158 M MRI LUMBAR W/WO CONTRAST 5,437.00 58072159 M MRA ANY SPINE W/WO CONTRAST 4,230.00 58072195 M MRI PELVIS W/O CONTRAST 3,889.00 58072196 M MRI PELVIS W/ CONTRAST 4,474.00 58072197 M MRI PELVIS W/WO CONTRAST 5,367.00 58072198 M MRA PELVIS W/ CONTRAST 3,965.00 58072199 M MRA PELVIS W/O CONTRAST 3,338.00 58072200 M MRA PELVIS W/WO CONTRAST 4,617.00 58073222 M MRI UPPER EXT JT W/ CONTRAST RT 2,567.00 58073270 M MRI UPPER EXT W/O CONTRAST RT 3,764.00 58073271 M MRI UPPER EXT W/O CONTRAST LT 3,764.00 58073274 M MRI UPPER EXT W/WO CONTRAST RT 4,449.00 58073275 M MRI UPPER EXT W/WO CONTRAST LT 4,449.00 58073276 M MRI UPPER EXT JT W/O CONTRAST RT 3,594.00 58073277 M MRI UPPER EXT JT W/O CONTRAST LT 3,594.00 58073279 M MRI UPPER EXT JT W/ CONTRAST LT 2,567.00 58073280 M MRI UPPER EXT JT W/WO CONTRAST RT 4,279.00 58073281 M MRI UPPER EXT JT W/WO CONTRAST LT 4,279.00 58073282 M MRA UPPER EXT W/WO CONTRAST RT 2,567.00 58073283 M MRA UPPER EXT W/WO CONTRAST LT 2,567.00 58073287 M MRI UPPER EXT W/ CONTRAST RT 3,764.00 58073288 M MRI UPPER EXT W/ CONTRAST LT 3,764.00 58073719 M MRI LOWER EXT W/ CONTRAST RT 3,338.00 58073784 M MRI LOWER EXT W/O CONTRAST RT 3,168.00 58073785 M MRI LOWER EXT W/O CONTRAST LT 3,168.00 58073786 M MRI LOWER EXT W/ CONTRAST LT 3,338.00 58073789 M MRI LOWER EXT W/WO CONTRAST RT 4,118.00 58073790 M MRI LOWER EXT W/WO CONTRAST LT 4,118.00 58073791 M MRI LOWER EXT JT W/O CONTRAST RT 2,914.00

58073792 M MRI LOWER EXT JT W/O CONTRAST LT 2,914.00 58073793 M MRI LOWER EXT JT W/ CONTRAST RT 3,338.00 58073794 M MRI LOWER EXT JT W/ CONTRAST LT 3,338.00 58073795 M MRI LOWER EXT JT W/WO CONTRAST RT 4,020.00 58073796 M MRI LOWER EXT JT W/WO CONTRAST LT 4,020.00 58073797 M MRA LOWER EXT W/WO CONTRAST RT 3,045.00 58073798 M MRA LOWER EXT W/WO CONTRAST LT 3,045.00 58074181 M MRI ABDOMEN W/O CONTRAST 3,764.00 58074182 M MRI ABDOMEN W/ CONTRAST 4,279.00 58074183 M MRI ABDOMEN W/WO CONTRAST 5,047.00 58074185 M MRA ABDOMEN W/WO CONTRAST 4,279.00 58074186 M MRA ABDOMEN W/ CONTRAST 3,934.00 58074187 M MRA ABDOMEN W/O CONTRAST 3,764.00 58172195 M MRI SACRUM W/O CONTRAST 3,889.00 58172196 M MRI SACRUM W/CONTRAST 4,474.00 58172197 M MRI SACRUM W/WO CONTRAST 5,367.00 58174181 M MRI MRCP 3,764.00 99990471 FLU ADMIN 14.00 99990472 FLU ADMIN 14.00