Description Amount PROCEDURE ON SALIVARY GLANDS, INC BIOPS 94 Anes for reconstruction of eyelid 81 PROC ON EXT/MIDDLE/INNER/EAR INC BIOPSY 76 Anesthesia Ex/ Mdl /Inner Ear Otoscopy 81 ANESTHESIA FOR TYMPANOTOMY 94 PROCEDURES ON EYE NOS 76 ANESTHESIA FOR LENS SURGERY 76 ANESTHESIA FOR VITREORETINAL SURGERY 81 ANESTHESIA FOR OPHTHALMOSCOPY 81 PROCEDURES ON NOSE AND ACCESSORY SINUSES 94 ANESTH FOR RAD SURG NOSE/ACCESSORY SINUS 81 FOR BIOPSY SOFT TISSUE NOSE/ACCESS SINUS 76 FOR INTRAORAL PROC INCLUDING BIOPSY NOS 94 FOR PROC ON FACIAL BONES OR SKULL NOS 81 INTEGUMENTARY SYSTEM MUSCLES/NERVES HEAD 76 ESOPHA THYROID LARYNX TRACHEA LYMPH>AGE1 94 INTEGUMENTARY SYSTEM EXT ANT TRUNK PERIN 76 ANESTH RECONSTR BREAST EG MAMMOPLASTY 81 ANESTH RAD OR MOD PROC BREAST 76 ANESTH RAD/MOD BREAST INTERNAL MAM NODE 81 Cardioversion, Electrical, Elective 77 ANESTH PROC ON CLAVICLE/SCAPULA NOS 94 ANESTH RADICAL SURG CLAVICLE AND SCAPULA 81 ANESTHESIA FOR ALL PROC ON ESOPHAGUS 81 ANESTH CLOSED CHEST PROC INC BRONCH NOS 94 ANESTH FOR NEEDLE BIOPSY OF PLEURA 81 ANESTHESIA FOR PNEUMOCENTESIS 81 ANESTH FOR MEDIASTINOSCOPY/DIAG THORACOS 81 ANESTH MEDIASTINOSCOPY USING 1 LONG VENT 81 ANESTH PERMAN TRANSVENOUS PACEMAKER INS 76 ANESTH FOR ACCESS TO CENT. VENOUS CIRCUL 76 ANESTH TRANSVENOUS INS/REPLACE PACING CA 76 ANESTH THORACOTOMY PROCEDURES 81 ANESTHESIA FOR PROC IN LUMBAR REGION NOS 76 ANESTH FOR DIAG/THERAPEUTIC LUMBAR PUNCT 94 ANESTH EXTENSIVE SPINE /SPINAL CORD PROC 81 CT VIRTUAL COLONOSCOPY 1,914 ANESTH PROCEDURES UPPER ANT ABD WALL NOS 76 ANESTH PERCUTANEOUS LIVER BIOPSY 94 ANESTH PROC UPPER POST ABD WALL 81 ANES UPPER GI ENDO PROCEDURES SCOPE INTR 94 ANES ENDO RETROGRADE CHOLANGIOPANC GRAPH 94 ANESTH UPPER GASTROINTESTINAL ENDO PROC 76 ANESTH HERNIA REPAIRS UPPER ABD NOS 94 ANESTH LUMBAR/VENTRAL INCISIONAL HERNIAS 76 ANESTH TRANS ABD REP DIAPHRAGMATIC HERNI 81

Page 1 of 92 ANESTH ALL PROC MAJOR ABD BLOOD VESSELS 81 ANEST INTRAPERITONEAL PROC UPPER ABD INC 94 ANESTH PARTIAL HEPATECTOMY/LIVER HEMMORH 81 ANESTH PROC ON LOWER ANTERIOR ABD WALL 76 ANESTH FOR PANNICULECTOMY 76 ANESTH LOWER INTESTINAL ENDOSCOPIC PRO 94 Anes for lower intest endo proced scope 94 ANES FOR SCREENONG COLONOSCOPY 94 ANES COMBINED UPPER/LOWER GI ENDO PROC 94 ANESTH PROC LOWER POSTERIOR ABD WALL 76 ANESTH FOR HERNIA REP IN LOWER ABD INCL 76 ANESTH FOR VENTRAL AND INCISIONAL HERNIA 94 ANESTH INTRAPERITONEAL PROC LOWER ABD 94 ANESTH ABDOMINOPERINEAL RESECTION 94 ANESTH FOR RADICAL 94 ANESTH FOR 81 ANESTHESIA TUBAL LIGATION/TRANSECTION 76 ANEST EXTRAPERITONEAL PROC LOWER ABD 94 Renal procedure upper 1/3 Ureter 81 ANESTH FOR TOTAL CYSTECTOMY 81 ANESTH RADICAL SUPRA/RETRO 76 ANESTH FOR CYSTOLITHOTOMY 76 ANESTH FOR LITHOTRIPSY,EXTCORPOREAL SHO 76 ANESTH FOR LITHOTRIPSY EXTRACORPOREAL 76 ANESTHESIA FOR ANORECTAL PROCEDURE 94 ANESTHESIA FOR RADICAL PERINEAL PROCEDUR 81 ANESTH FOR PERINEAL PROSTATECTOMY 81 ANESTH TRANSURETHRAL PROC INC URETHROCYS 76 ANESTH TRANSURETHRAL RESECT BLADDER TUMO 76 ANESTH TRANSURETHRAL RESECT OF PROSTRATE 76 ANESTH FOR POST‐TRANSURETHRAL RESECT BLE 81 ANESTH PROC WITH FRAG/MANIP/REMOV/URETER 76 ANESTH PROC MALE GENITALIA NOS 76 ANESTH FOR /UNILATERAL/BILATERA 81 ANESTH PROC UNDESCENDED TESTIS UNI/BI 81 Radical Ingiunal Approach 94 ANESTH FOR , UNILATER/BILATER 94 ANESTH INSERTION OF PENILE PROSTHESIS 81 ANESTH VAG PROC BX OF LABIA/VAGINA/CERVI 94 ANESTH COLPOTOMY,COLPECTOMY, COLPORRHAP 76 ANESTH VAGINAL HYSTERECTOMY 94 ANESTH FOR CERVICAL CERCLAGE 81 ANESTH FOR CULDOSCOPY 81 ANESTH AND/OR HYSTEROSALPIN 94 Bone Marrow Aspiration 81 Anesthesia Bony Pelvis Procedures 81 ANESTH FOR BODY CAST APPLICATION OR REV 81

Page 2 of 92 ANESTH CLOSED PROC SYMPHYSIS PUBIS/SACRO 81 ANESTHESIA,OPEN FX, PELVIS OR ACETABULU 81 ANESTH CLOSED PROCEDURES HIP JOINTS 94 ANESTH OPEN PROC INVOLVING HIP JOINT NOS 76 ANESTH TOTAL HIP ARTHROPLASTY 76 ANESTH REVISION OF TOTAL HIP ARTHROPLAST 76 ANESTH CLOSED PROCEDURES UPPER 2/3 FEMUR 76 ANESTH OPEN PROC INVOLV UPPER 2/3 FEMUR 76 ANESTH PROC ON NERVES/MUSCLES/TENDONS/FA 94 ANESTH ALL PROC INVOLV VEINS/UPPER LEG 81 ANESTH PROC INVOLV ARTERIES UPPER LEG 81 PROC NERVES/MUSCLES/TENDONS/FASCIA KNEE 94 ANES ALL CLOSED PROC ON LOWER 1/3 FEMUR 76 ANESTH ALL OPEN PROC LOWER 1/3 FEMUR 94 ANESTH CLOSED PROC ON KNEE JOINT 94 ANESTH DIAG ARTHROSCOPIC PROC KNEE JOINT 76 ANESTH CLOSED PROC UPPER INDS OF TIBIA/F 81 ANESTH OPEN PROC UPPER ENDS TIBIA/FIBULA 76 ANES OPEN/SURG ARTHRO PROC KNEE JT NOS 94 ANESTH TOTAL KNEE REPLACEMENT 76 ANESTH PROC VEINS OF KNEE/POPLITEAL AREA 81 ANESTH PROC ON VEINS OF KNEE POLITEAL AR 81 ANESTH CLOSED PROC LOWER LEG/ANKLE/FOOT 94 ANESTH ARTHRO PROC OF ANKLE/AND OR FOOT 94 ANESTH PROC NERV/MUSC/TEND/FASCIA LOW LE 94 ANESTH REPAIR RUPTURED ACHILLES TENDON 94 ANESTH OPEN PROC BONES LOWER LEG/ANK/FOO 94 ANESTH RAD RESECTION INC BELOW KNEE AMP 76 ANESTH OSTEOTOMY/OSTEOPLASTY TIBIA/FIBUL 76 ANESTH TOTAL ANKLE REPLACEMENT 81 CT CARDIAC CORONARIES/MORPHOLOGY 2,828 ANESTH LOWER LEG CAST APP/REMOVAL/REPAIR 81 ANESTH PROC LOWER LEG/INC BYPASS GRAFT N 81 ANESTH PROC ON VEINS OF LOWER LEG NOS 94 ANESTH PROC NER/MUSC/TEND/FAS/BURS/SHOUL 76 CLOSED PROC HUMERAL HEAD NECK STERNOCLAV 76 ANESTH DIAG ARTHROSCOPIC PROC SHLDER JT 81 OPEN/SURG PROC HUM HEAD/NECK/STERNOCLAVI 94 ANESTH RADICAL RESECTION, SHOULDER 81 ANESTH SHOULDER DISARTICULATION 76 ANESTH TOTAL SHOULDER REPLACEMENT 76 ANESTH PROC NERV/MUSC/TEND/FAS/UPPER ARM 94 ANESTH TENOTOMY ELBOW TO SHOULDER OPEN 76 ANESTHESIA FOR TENOPLATY ELBOW TO SHOULD 81 ANESTH TENODESIS RUPTURE LONG TENDON BIC 94 ANESTH CLOSED PROC HUMERUS AND ELBOW 81 ANES OPEN/SURG ARTRO PROC HUMERUS/ELBOW 76

Page 3 of 92 ANESTHESIA OSTEOTOMY OF HUMERUS 81 ANESTH REPAIR NONUNION/MALUNION HUMERUS 94 ANESTH FOR RADICAL PRECED HUMERUS/ELBOW 75 ANESTHESIA TOTAL ELBOW REPLACEMENT 81 ANESTH PROC ARTERIES UPPER ARM/ELBOW NOS 81 ANESTH PROC ON VEIN OF UPPER ARM/ELBOW 81 PROC NERV/MUSC/TEND/FAS/BURS/FOREARM WRI 76 ANESTH CLOSED PROC RADIUS/ULNA/WRIST/HAN 94 ANESTH FOR DIAG ARTHROSCOPIC PROC WRIST 81 ANESTH OPEN PROC RADIUS/ULNA/WRIST/HAND 76 ANESTH PROC ARTERIES FOREARM/WRIST/HAND 81 ANESTH PHLEBORRHAPHY FOREARM WRIST HAND0 81 ANESTH NON‐INVASIVE IMAGING/RADIATION TH 94 ANESTH FOR VAGINAL DELIVERY 76 ANESTH FOR CESAREAN DELIVERY ONLY 94 ANES CESAREAN HYSTER W/O LABOR ANALGESI 81 ANESTH FOR INCOMPLETE/MISSED ABORTION 94 NEURAXIAL ANALGESIA LABOR ENDING IN VAG 76 NEURAXIAL ANALGESIA/ANESTH FOR LABOR END 76 ANESTH CESAREAN/HYSTERECTOMY NEURAXIAL L 81 UNLISTED ANESTHESIA PROCEDURES 81 NJX PLATELET PLASMA 2,000 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE 351 FINE NEEDLE ASPIRATION W/IMAGE GUIDANCE 364 ACNE SURGERY 196 INCISION/DRAINAGE OF ABSCESS; SIMPLE, SINGLE 298 INCISION/DRAINAGE OF ABSCESS; COMPLICATED/MU 529 INCISION/DRAINAGE PILONIDAL CYST; SIMPLE 309 INCISION/DRAINAGE PILONIDAL CYST; COMPLICATED 712 REMOVE FOREIGN BODY 405 INCISION/REMOVAL FOREIGN BODY; COMPLICATED 396 INCISION & DRAINAGE OF HEMATOMA, SEROMA OR 655 PUNCTURE ASPIRATION OF ABSCESS HEMOTOMA BU 297 INCISION & DRAIN COMPLEX POSTOP WOUND INFEC 1,575 DEBRIDE OF EXTENSIVE ECZEMATOUS OR INFECTED S 183 DEBRIDE GENITALIA & PERINEUM 1,388 DEBRIDE OF SKIN, ABDOMINAL WALL W OR W/O FAS 1,900 DEBRIDE GENIT/PERINEUM/ABDOM WALL 1,749 REMOVE MESH FROM ABDOMINAL WALL FOR INFEC 602 DEBRIDE INCL REMOVE FOREIGN MAT AT SITE 668 DEBRIDE SKIN/MUSCLE, FX 1,276 DEBRIDE SKIN/MUSCLE/BONE, FX 1,610 DEBRIDGEMENT SKIN PARTIAL THICKNESS 111 DEBRIDE SKIN FULL THICKNESS 156 DEBRIDE SKIN/TISSUE 1st 20 SQ CM OR LESS 310 DEBRIDE SUB‐Q TISSUE MUSCLE 507 DEBRIDE SUB‐Q TISS MUSC BONE 693

Page 4 of 92 DEB SUBQ TISSUE ADD‐ON 92 DEB MUSC/FASCIA ADD‐ON 103 DEB BONE ADD‐ON 227 TRIM SKIN LESION 80 PARING CUTTING BENIGN 102 BIOPSY OF SKIN SINGLE LESION 157 BIOPSY OF SKIN EA ADDTL LESION 55 SKIN TAGS REMOVAL UP TO/INCLUDING 15 LESIONS 183 REMOVAL OF SKIN TAGS U 74 SHAVE TRUNK/EXT <.5CM 149 SHAVE TRUNK/EXT 0.6‐1.0CM 196 SHAVE TRUNK/EXT 1.1‐2.0CM 198 SHAVE TRUNK/EXT >2.0CM 237 SHAVE S/N/H/F/G <.5CM 129 SHAVE S/N/H/F/G .6 ‐ 1.0CM 190 SHAVE S/N/H/F/G 1.1 ‐ 2.0CM 203 SHAVE S/N/H/F/G >2.0CM 284 SHAVE FACE <.5 CM 175 SHAVE FACE .6 ‐ 1.0 CM 222 SHAVE FACE 1.1‐2 CM 284 SHAVE FACE >2 CM 352 EXCISION BENIGN LESION 445 EXCISION BENIGN LESION 0.6‐1.0 CM 345 EXCISION BENIGN LESION 1.1‐2.0 CM 377 EXCISION BENIGN LESION 2.1‐3.0 CM 422 EXCISION BENIGN LESION 3.1‐4.0 CM 472 EXCISION BENIGN LESION > 4.0 CM 588 EXCISION BENIGN LESION 651 EXCISION BENIGN LESION 704 EXCISION BENIGN LESION 693 EXCISN BEN LESION DIAM 2.1‐3.0CM 1,307 EXCISN BENLESION;DIAM 3.1‐4.0CM 1,305 EXCISN BEN LESION DIAM >4.0CM 1,751 EXCISION BENIGN LESION <0.5CM 324 EXCISION BENIGN LESION 0.6‐1.0CM 383 EXCISION BENIGN LESION 1.1‐2.0CM 422 EXCISION BENIGN LESION 2.1‐3.0CM 519 EXCISION BENIGN LESION 3.1‐4.0CM 575 EXCISION BENIGN LESION >4.0CM 739 EXCISION SKIN & SUBCUT TISSUE FOR HIDRADENITIS; 614 REMOVAL, SWEAT GLAND LESION 388 EXCISION FOR HIDRADENIS; SIMPLE OR INTERMEDIA 471 REMOVAL, SWEAT GLAND LESION 390 EXCISION FOR HIDRADENIS/PERIANAL/UMBILICAL; SI 554 EXCISION FOR HIDRADENIS/PERIANAL/UMBILICAL; C 772 EXCISION MAL LESION <=0.5CM 324 EXCISION MAL LESION 0.6‐1.0CM 448

Page 5 of 92 EXCISION MAL LESION 1.1‐2.0CM 472 EXCISION MAL LESION 2.1‐3.0CM 530 EXCISION MAL LESION 3.1‐4.0CM 563 EXCISION MAL LESION >4.0CM 750 EXCISION MAL LESION <=0.5CM 383 EXCISION MAL LESION 0.6‐1.0CM 367 EXCISION MAL LESION 1.1‐2.0CM 421 EXCISION MAL LESION 2.1‐3.0CM 588 EXCISION MAL LESION 3.1‐4.0CM 754 EXCISION MAL LESION >4.0CM 889 EXCISION MAL LESION <=0.5CM 409 EXCISION MAL LESION 0.6‐1.0CM 512 EXCISION MAL LESION 1.1‐2.0CM 596 EXCISION MAL LESION 2.1‐3.0CM 685 EXCISION MAL LESION 3.1‐4.0CM 874 EXCISION MAL LESION >4.0CM 1,170 TRIM NAILS 54 DEBRIDEMENT OF NAILS 1‐5 74 DEBRIDEMENT OF NAILS 6+ 76 EXCISION NAIL PLATE SIMPLE SINGLE 234 EXCISION NAIL PLATE SIMPLE EA ADDTL 62 EVACUATION OF SUBUNGUAL HEMATOMA 130 EXCISION NAIL & MATRIX 523 EXCISION NAIL & MATRIX W/AMPUTATION OF TUFT 621 BIOPSY OF NAIL UNIT 203 REPAIR NAIL BED 297 RECONSTRUCTION OF NAIL BED W/GRAFT 443 WEDGE EXCIAION OF FLAP FOLD 176 EXCISION PILONIDAL CYST/SINUS; SIMPLE 608 EXCISION PILONIDAL CYST/SINUS; EXTENSIVE 960 EXCISION PILONIDAL CYST/SINUS; COMPLICATED 1,215 INJECTION INTRALESIONAL <=7 LESIONS 100 ADDED SKIN LESIONS INJECTION 58 INSERT TISSUE EXPANDER(S) 2,035 INSERT CONTRACEPTIVE C 252 REMOVAL, IMPLANTABLE, CONTRACEPTIVE CAPSULE 292 REMOVAL/REINSERT CONTRA CAP 483 INSERTION NON‐BIODEGRADABLE DRUG DELIVERY IM 280 REMOVAL NON‐BIODEGRADABLE DRUG DELIVERY IM 368 REMOVAL W/REINSERTION NON‐BIODEGRADABLE D 519 ANESTH, HIP JOINT PROCEDURE per unit 91 REPAIR SIMPLE <=2.5CM 370 REPAIR SIMPLE 2.6‐7.5CM 429 REPAIR SIMPLE 7.6‐12.5CM 521 REPAIR SIMPLE 12.6‐20.0CM 629 REPAIR SIMPLE 20.1‐30.0CM 773 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER 30.0CM 528

Page 6 of 92 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER <=2.5CM 384 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER 2.6‐5.0C 427 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER 5.1‐7.5C 479 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER 7.6‐12.5 621 REPAIR SIMPLE SUPERFICIAL WOUNDS OVER 12.6‐20 751 TREATMENT SUPERFICIAL WOUND DEHISCENCE; SIM 659 TREATMENT SUPERFICIAL WOUND DEHISCENCE W/P 318 REPAIR INTERMEDIATE WOUNDS <=2.5CM 569 REPAIR INTERMEDIATE WOUNDS 2.6‐7.5CM 796 REPAIR INTERMEDIATE WOUNDS 7.6‐12.5CM 779 REPAIR INTERMEDIATE WOUNDS 12.6‐20.0CM 803 REPAIR INTERMEDIATE WOUNDS 20.1‐30.0CM 766 REPAIR INTERMEDIATE WOUNDS OVER 30.0CM 863 REPAIR INTERMEDIATE WOUNDS <=2.5CM 492 REPAIR INTERMEDIATE WOUNDS 2.6‐7.5CM 603 REPAIR INTERMEDIATE WOUNDS 7.6‐12.5CM 552 REPAIR INTERMEDIATE WOUNDS 12.6‐20.0CM 518 LAYER CLOSURE OF WOUND(S) 371 REPAIR INTERMEDIATE WOUNDS OVER 30.0CM 748 REPAIR INTERMEDIATE WOUNDS <=2.5CM 602 REPAIR INTERMEDIATE WOUNDS 2.6‐5.0CM 653 REPAIR INTERMEDIATE WOUNDS DIAM 5.1‐7.5CM 702 REPAIR INTERMEDIATE WOUND DIAM 7.6‐12.5CM 711 REPAIR INTERMEDIATE WOUNDS DIAM 12.6‐20.0CM 913 REPAIR INTERMEDIATE WOUNDS 20.1‐30.0CM 821 REPAIR INTERMEDIATE WOUNDS OVER 30.0CM 848 REPAIR COMPLEX TRUNK 1.1‐2.5 CM 557 REPAIR COMPLEX TRUNK 2.6‐7.5 CM 937 REPAIR COMPLEX TRUNK ADDTL 5 CM OR LESS 144 REPAIR COMPLEX 1.1‐2.5 CM 622 REPAIR COMPLEX 2.6‐7.5 CM 899 REPAIR COMPLEX EA ADDTL 5 CM OR LESS 223 REPAIR COMPLEX 1.1‐2.5 CM 808 REPAIR COMPLEX 2.6‐7.5 CM 1,157 REPAIR COMPLEX EA ADDTL 5CM OR LESS 310 REPAIR COMPLEX 865 REPAIR COMPLEX 1.1‐2.5 CM 944 REPAIR COMPLEX 2.6‐7.5 CM 1,038 REPAIR WOUND EA ADDTL 5 CM OR LESS 337 LATE CLOSURE OF WOUND 1,453 ADJ TISSUE TRANSFER RE 2,229 SKIN TISSUE REARRANGEMENT 1,834 SKIN TISSUE REARRANGEM 1,241 SKIN TISSUE REARRANGME 1,473 SKIN TISSUE REARRANGEM 1,405 SKIN TISSUE REARRANGEMENT 2,184 ADVANCEMENT FLAP FACE 1,452

Page 7 of 92 SKIN TISSUE REARRANGEMENT 2,438 ADJACENT TISSUE TRANSF 1,104 SKIN TISSUE REARRANGEMENT 2,560 SKIN TISSUE REARRANGE ADD‐ON 458 FILLETED FINGER OR TOE 1,379 WOUND PREP 520 WOUND PREP ADDITIONAL 108 WND PREP CH/INF, F/N/HF/G 900 HARVEST CULTURED SKIN GRAFT 565 SKIN PINCH GRAFT 1,329 SPLIT THICK SKIN GRAFT 1,693 SPLIT THICKNESS ADD ON 272 EPIDRM AUTOGRFT T/A/L ADD‐ON 283 EPIDERMAL AUTOGRAF FIR 2,978 EPIDRM A‐GRFT F/N/HF/G ADDL 382 SKIN SPLIT GRAFT 1,495 DERM AUTOGRAFT FACE/NCK/HF/G 1,936 ACELL GRAFT TRUNK/ARMS/LEGS 955 FULL THICKNESS GRAFT T 1,634 SKIN FULL GRAFT ADD‐ON 353 FULL THICKNESS GRAFT 1,222 FULL THICKNESS GRAFT 1,422 SKIN FULL GRAFT ADD‐ON 234 SKIN FULL GRAFT 2,398 SKIN FULL GRAFT ADD‐ON 300 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK 312 SKIN SUB GRAFT FACE/NK/HF/G 348 APPLY SKINALLOGRFT, T/ARM/LG 769 APLY ACELL ALOGRFT T/ARM/LEG 712 TISSUE CULTURED ALLOGE 750 SKIN HETEROGRAFT 881 SKIN HETEROGRAFT ADD‐ON 214 APPLY SKN XGRFT F/N/HF/G ADD 261 APPLY ACELLULAR XENOGRAFT 1,170 APPLY ACELLULAR XGRAFT ADD 585 FORM SKIN PEDICLE FLAP 2,134 FORM SKIN PEDICLE FLAP 1,895 SKIN GRAFT 700 SKIN GRAFT 747 MUSCLE MYOCUTANEOUS OR FASCIOCUTANEOUS FL 2,508 FASCIAL CUTANEOUS FLAP 2,743 COMPOSITE SKIN GRAFT 1,523 ABRASION TREATMENT OF SKIN 1,312 REVISION OF LOWER EYELID 1,180 REVISION OF UPPER EYELID 819 REVISION OF UPPER EYELID 1,550 EXCISION OF EXCESSIVE 2,707

Page 8 of 92 EXCISE EXCESSIVE SKIN 2,087 EXC SKIN ABD ADD‐ON 1,068 DRESSING CHANGE,NOT FOR BURN 113 EXCISION, SACRAL PRESSURE ULCER W/PRIMARY SUT 1,844 INITIAL TX 1‐BURN 167 TREATMENT OF BURNS 363 TREATMENT OF BURN 243 TREATMENT OF BURNS 292 DEBRIDE BURN W O ANEST 383 ESCARECTOMY 453 DESTRUCTION PREMALIG, FIRST LESION 194 DESTRUCTION PREMALIG 2‐14 LESIONS 24 DESTRUCTION PREMALIG 15+ LESIONS 434 Yag Laser Condylomata 782 DESTRUCTION OF SKIN LESIONS 990 DESTRUCTION OF SKIN LESIONS 1,437 DESTRUCT BENIGN LESIONS 1‐14 198 DESTRUCT BENIGN LESIONS 15+ 224 CAUTERIZATION OF GRAN 145 DESTRUCTION SKIN LESIONS 1.1‐2.0CM 219 DESTRUCTION SKIN LESIONS 2.1‐3.0 CM 369 DESTRUCTION MALIG LESION DIAM 0.5 CM OR LESS 259 MOHS, 1 STAGE, H/N/HF/G 1,532 MOHS ADDL STAGE 918 CRYOTHERAPY OF ACNE 111 PUNCTURE ASPIRATION OF 405 PUNCTURE ASPIRATON‐EAC 109 INCISION OF BREAST LES 901 BX BREAST 1ST LESION STEREOTACTIC GUIDE 1,271 BX BREAST ADD LESION STEROTACTIC GUIDE 925 BX BREAST 1ST LESION ULTRASOUND GUIDANCE 1,130 BX BREAST ADD LESION ULTRASOUND GUIDANCE 913 BX BREAST 1ST LESION MAGNETIC GUIDANCE 1,718 BX BREAST ADD LESION MAGNETIC GUIDANCE 1,378 CORE BIOPSY BREAST 391 BIOPSY OF BREAST 706 BX BREAST PERCUT W/IMAGE 575 BX BREAST PERCUT W/DEVICE 1,281 NIPPLE EXPLORATION 1,123 EXCISE BREAST DUCT FISTULA 932 EXCISION CYST FIBROADENOMA BENIGN/MALIG TUM 916 EXCISIONAL BREAST BIOP 972 EXCISIONAL BREAST BIOP 351 REMOVAL OF CHEST WALL 2,778 BREAST LOCAL DEVICE PERQ 1ST LESION MAMMOGR 408 BREAST LOCAL DEVICE PERQ ADD LESION MAMMOG 286 BREAST LOCAL DEVICE 1ST LESION STEROTACTIC GUI 464

Page 9 of 92 BREAST LOCAL DEVICE PERQ ADD LESION STEREOTAC 343 BREAST LOCAL DEVICE PERQ FIRST LESION ULTRASOU 793 BREAST LOCAL DEV PERQ ADD LESION ULTRASOUND 668 BREAST LOCAL DEVICE PERQ 1ST LESION MAGNETIC 1,467 BREAST LOCAL DEVICE PERQ ADD LESION MAGNETIC 1,175 PLACE NEEDLE WIRE BREA 543 PLACE BREAST CLIP, PERCUT 387 MASTECTOMY FOR GYNECOM 853 PART MASTECTOMY 1,235 PART MASTECTOMY WITH A 1,968 MASTECTOMY SIMPLE COMP 3,072 MASTECTOMY SUBCUTANEIO 1,234 MODIFIED RADICAL MASTE 2,260 REMOVAL OF BREAST IMPLANT 1,123 REMOVAL MAMMARY IMPLAN 1,125 CORRECT INVERTED NIPPLE(S) 1,320 UNLISTED PROCEDURE BRE 646 ANESTH, INDUCED AB PROCEDURE 81 ANESTH, NERVE BLOCK/INJ 79 ANESTH, N BLOCK/INJ, PRONE 79 HOSP MANAGE CONT DRUG ADMIN 221 INCISION, SOFT TISSUE ABSCESS; SUPERFICIAL 464 INCISION OF SOFT TISSU 888 WOUND EXPLORATION ABDO 649 EXPLORE WOUND EXTREMI 647 SUTURE REMOVAL TRAY 8 MUSCLE BIOPSY 430 DEEP MUSCLE BIOPSY 349 NEEDLE BIOPSY, MUSCLE 971 BONE BIOPSY, TROCAR/NEEDLE 385 BONE BIOPSY, TROCAR/NEEDLE 1,453 BONE BIOPSY, EXCISIONAL 528 BONE BIOPSY, EXCISIONAL 1,482 REMOVAL OF FOREIGN BOD 656 REMOVAL OF FOREIGN BOD 916 CARPAL TUNNEL,THER INJECTION, 177 INJ DUPUYTREN CORD W/ENZYME 177 INJECTION SINGLE TENDON SHEATH/LIGAMENT 232 INJECTION SINGLE TENDO 151 INJECTION MULTIPLE 1‐2 215 INJECTIONS SINGLE OR M 148 ARTHROCENTESIS SMALL J 157 DRAIN/INJ JOINT/BURSA W/US 187 ARTHROCENTESIS INTERME 198 DRAIN/INJ JOINT/BURSA W/US 285 ARTHROCENTESIS MAJOR J 345 DRAIN/INJ JOINT/BURSA W/US 385

Page 10 of 92 GANGLION CYST ASPIRATE/INJ 137 TREATMENT OF BONE CYST 544 REMOVAL OF SUPPORT IMPLANT 892 REMOVAL OF SUPPORT IMPLANT 1,321 APPLY BONE FIXATION DEVICE 1,218 APPLY BONE FIXATION DEVICE 2,303 ADJUST BONE FIXATION DEVICE 1,036 REMOVE BONE FIXATION DEVICE 959 REMOVAL OF BONE FOR GRAFT 966 BONE GRAFT MAJOR OR LA 1,259 REMOVE CARTILAGE FOR GRAFT 1,138 REMOVAL OF TENDON FOR 1,261 TISSUE GRAFT 1,071 SPINAL BONE ALLOGRAFT 316 SPINAL BONE ALLOGRAFT 244 SPINAL BONE AUTOGRAFT 337 FLUID PRESSURE, MUSCLE 557 CPTR‐ASST DIR MS PX 141 EXC FACE LES SC < 2 CM 797 EXC FACE LES SC = 2 CM 827 EXC FACE TUM DEEP < 2 CM 1,223 EXC FACE TUM DEEP = 2 CM 1,272 RESECTION OF FACIAL TUMOR 974 RESECT FACE TUM = 2 CM 2,334 EXCISION OF BENIGN TUMOR/CYST OF MANDIBLE, B 1,212 EAR CARTILAGE GRAFT 1,756 Close trmnt nasal fract w/o manipulation 241 TREATMENT OF NOSE FRACTURE 586 TREATMENT OF NOSE FRACTURE/SPLINTING 563 TREAT NASAL SEPTAL FRACTURE 1,547 RESET DISLOCATED JAW 226 DRAIN NECK/CHEST LESION 1,009 BIOPSY OF NECK/CHEST 556 EXC NECK LES SC = 3 CM 1,052 EXC NECK TUM DEEP = 5 CM 1,758 EXCISION TUMOR SOFT T 907 DEEP EXPLORATION OF NE 976 RADICAL RESECTION OF TUMOR, NECK/ANTERIOR TH 2,070 RESECT NECK TUM = 5 CM 3,257 PARTIAL REMOVAL OF RIB 1,163 FX RIB NO MANIPULATION 308 REMOVE LESION BACK OR 982 EXC BACK LES SC = 3 CM 1,097 EXC BACK TUM DEEP < 5 CM 1,592 EXC BACK TUM DEEP = 5 CM 1,749 REVISION OF THORAX SPI 3,149 TREAT SPINE FRACTURE 574

Page 11 of 92 LUMBAR SPINE FUSION 3,560 SPINE FUSION, EXTRA SEGMENT 884 LUMBAR SPINE FUSION 3,286 INSERT SPINE FIXATION DEVICE 1,671 EXCISION BEN NEO ABDOM 899 EXC BACK TUM DEEP = 5 CM 1,485 EXC ABD LES SC < 3 CM 915 EXC ABD LES SC > 3 CM 1,030 DRAIN SHOULDER LESION 522 EXPLORATORY SHOULDER SURGERY 1,200 BIOPSY SHOULDER TISSUES 476 EXC SHOULDER LES SC > 3 CM 978 EXC SHOULDER TUM DEEP > 5 CM 1,616 REMOVAL OF SHOULDER LESION 942 REMOVAL OF SHOULDER LE 1,289 INCISION OF COLLARBONE JOINT 1,082 EXPLORE TREAT SHOULDER JOINT 1,850 PARTIAL REMOVAL, COLLAR BONE 680 REMOVE SHOULDER BONE, PART 1,417 REMOVE SHOULDER FOREIGN BODY 1,378 REMOV FB SHOULDER DEEP 758 REMOV PROSTHESIS INC DEBRIDE/SYNOVECTOMY; H 1,782 REMOV PROSTHESIS INC DEBRIDE/SYNOVECTOMY; H 2,122 INJECTION FOR SHOULDER X‐RAY 533 REPAIR ROTATOR CUFF, ACUTE 1,864 REPAIR ROTATOR CUFF, CHRONIC 2,021 REPAIR OF SHOULDER 2,258 REPAIR BICEPS TENDON 1,664 REMOVE/TRANSPLANT TENDON 1,699 REPAIR SHOULDER CAPSULE 2,615 REPAIR SHOULDER CAPSULE 2,516 RECONSTRUCT SHOULDER JOINT 2,789 RECONSTRUCT SHOULDER JOINT 3,278 REVIS RECONST SHOULDER JOINT 3,634 REVIS RECONST SHOULDER JOINT 3,924 REVISION OF COLLAR BONE 1,847 FX CLAVICLE NO MANIPUL 501 TREAT CLAVICLE FRACTURE 766 TREAT CLAVICLE FRACTURE 1,566 TREAT CLAVICLE DISLOCATION 1,181 TREAT CLAVICLE DISLOCATION 1,419 TREAT CLAVICLE DISLOCATION 540 Clsd TX Acroimclav disloc W/ manipulatio 483 TREAT CLAVICLE DISLOCATION 1,286 TREAT CLAVICLE DISLOCATION 1,490 TREAT SHOULDER BLADE FX 364 TREAT SCAPULA FRACTURE 1,850

Page 12 of 92 FX HUMERUS‐NECK NO MAN 787 FRACT DISLOCATION W WI 1,975 TREAT HUMERUS FRACTURE 1,989 TREAT HUMERUS FRACTURE 2,749 TREAT HUMERUS FRACTURE 301 TREAT HUMERUS FRACTURE 1,803 DISLOCATION SHOULDER W/O ANESTHESIA 778 TREAT SHOULDER DISLOCATION 1,048 TREAT DISLOCATION/FRACTURE 1,032 CLOSED TX SHOULDER DISLOCATION 824 FIXATION OF SHOULDER 437 DRAINAGE OF ARM LESION 797 I&D BURSA 685 EXPLORATORY ELBOW SURGERY 1,110 EXC ARM/ELBOW LES SC = 3 CM 974 EX ARM/ELBOW TUM DEEP > 5 CM 1,657 EXCISION TUMOR SOFT TI 1,002 EXCISE DEEP TUMOR SOFT 1,014 ARTHROTOMY WITH JOINT 1,177 REMOVAL OF ELBOW BURSA 757 REMOVE ELBOW LESION 1,178 REMOVE ELBOW BONE LESION 1,497 PARTIAL REMOVAL OF ELBOW 1,300 REMOVAL FOREIGN BODY 1,197 REVISION OF ARM MUSCLES 1,653 REPAIR OF BICEPS TENDON 1,418 REPAIR ARM TENDON/MUSCLE 1,729 REPAIR OF RUPTURED TENDON 1,811 REPR ELBOW LAT LIGMNT W/TISS 1,646 REPR ELBW MED LIGMNT W/TISSU 1,635 REPAIR ELBOW W/DEB, OPEN 485 REPAIR ELBOW DEB/ATTCH OPEN 1,471 REPLACE ELBOW JOINT 3,078 REVISE RECONST ELBOW JOINT 3,438 REVISE RECONST ELBOW JOINT 3,960 REPAIR OF HUMERUS 2,240 FX HUMERUS‐SHAFT NO MA 610 TREAT HUMERUS FRACTURE 1,709 TREAT HUMERUS FRACTURE 2,047 TREAT HUMERUS FRACTURE 1,816 TREAT HUMERUS FRACTURE 823 CLSD TRMNT CONDYLAR FRACT W OR W/OUT TRA 307 TREAT HUMERUS FRACTURE 1,668 TREAT HUMERUS FRACTURE 2,077 TREAT HUMERUS FRACTURE 2,455 TREAT HUMERUS FRACTURE 676 TREAT HUMERUS FRACTURE 708

Page 13 of 92 TREAT HUMERUS FRACTURE 392 TREAT HUMERUS FRACTURE 1,929 TREAT ELBOW FRACTURE 2,548 DISLOCATION ELBOW W/O ANESTHESIA 924 TREAT ELBOW DISLOCATION 956 TREAT ELBOW FRACTURE 1,878 TREATMNT SUBLAXATION R 459 FX RADIAL HEAD NECK NO 592 Closed TX Radial Head FX w/Manipulation 846 TREAT RADIUS FRACTURE 1,519 TREAT ULNAR FRACTURE 630 TREAT ULNAR FRACTURE 685 TREAT ULNAR FRACTURE 1,489 Humerous or Elbow Unlisted Procedure 231 INCISION OF TENDON SHEATH 783 DECOMPRESS FOREARM 1 SPACE 935 DECOMPRESS FOREARM 2 SPACES 1,808 DRAINAGE OF FOREARM LESION 1,217 EXC FOREARM LES SC > 3 CM 998 EXC FOREARM TUM DEEP = 3 CM 1,138 REMOVAL FOREARM LESION 982 REMOVEL FOREARM LESION DEEP 1,211 EXPLORE/TREAT WRIST JOINT 848 REMOVE WRIST JOINT LINING 1,061 REMOVE WRIST JOINT CARTILAGE 1,400 EXCISE TENDON FOREARM/WRIST 1,186 REMOVE WRIST TENDON LESION 823 GANGLION EXCISION WRIS 892 REREMOVE WRIST TENDON LESION 830 REMOVE WRIST/FOREARM LESION 1,847 REMOVE WRIST/FOREARM LESION 1,393 EXCISE WRIST TENDON SHEATH 830 REMOVE/GRAFT FOREARM LESION 1,327 REMOVAL OF WRIST LESION 420 REMOVAL OF WRIST BONE 1,153 REMOVAL OF WRIST BONES 1,612 PARTIAL REMOVAL OF ULNA 1,131 INJECTION FOR WRIST X‐RAY 786 EXPLORATION W REM OF D 1,710 REPAIR FOREARM TENDON/MUSCLE 1,435 REPAIR TENDON OR MUSCL 2,183 REPAIR FOREARM TENDON SHEATH 1,424 REVISE WRIST/FOREARM TENDON 1,282 RELEASE WRIST/FOREARM TENDON 1,098 TENODESIS AT WRIST; FEEXORS OF FINGERS 1,458 TRANSPLANT FOREARM TENDON 1,494 TRANSPLANT FOREARM TENDON 1,760

Page 14 of 92 REPAIR/REVISE WRIST JOINT 2,308 RECONSTRUCT ULNA/RADIOULNAR 1,620 REVISION OF RADIUS 1,431 SHORTEN RADIUS OR ULNA 1,350 REPAIR/GRAFT RADIUS OR ULNA 2,176 REPAIR/GRAFT WRIST BONE 1,614 RECONSTRUCT WRIST JOINT 2,053 REPAIR WRIST JOINT(S) 1,849 FX RADIUS NO MANIPULAT 610 TREAT FRACTURE OF RADIUS 1,147 TREAT FRACTURE OF RADIUS 1,311 TREAT FRACTURE OF RADIUS 2,202 FX ULNA NO MANIPULATIO 579 TREAT FRACTURE OF ULNA 1,023 TREAT FRACTURE OF ULNA 1,455 FX RADIUS AND ULNA NO 486 TREAT FRACTURE RADIUS & ULNA 1,251 TREAT FRACTURE RADIUS & ULNA 1,498 TREAT FRACTURE RADIUS/ULNA 1,805 TREAT FRACTURE RADIUS/ULNA 728 TREAT FRACTURE RADIUS/ULNA 1,347 TREAT FX DISTAL RADIAL 1,504 TREAT FX RAD EXTRA‐ARTICUL 1,623 TREAT FX RAD INTRA‐ARTICUL 2,372 TREAT FX RADIAL 3+ FRAG 2,372 CLOSED REDUCTION‐INT F 1,627 FX CARPAL‐SCAPHOID NAV 650 TREAT WRIST BONE FRACTURE 1,552 FX CARPAL NO MANIPULAT 692 TREAT WRIST BONE FRACTURE 1,309 TREAT WRIST BONE FRACTURE 548 PIN ULNAR STYLOID FRACTURE 1,029 TREAT FRACTURE ULNAR STYLOID 1,437 FUSION/GRAFT OF WRIST JOINT 1,254 FUSION OF HAND BONES 1,431 FUSE HAND BONES WITH GRAFT 1,761 DRAINAGE OF FINGER ABSCESS, SIMPLE 300 DRAINAGE OF FINGER ABSCESS, COMPLICATED 865 DRAIN HAND TENDON SHEATH 955 DRAINAGE OF PALM BURSA 936 TREAT HAND BONE LESION 1,428 DECOMPRESS FINGERS/HAND 1,332 RELEASE PALM CONTRACTURE 1,241 INCISE FINGER TENDON SHEATH 1,230 EXPLORE/TREAT HAND JOINT 649 EXPLORETREAT FINGER JOINT 882 EXPLORE/TREAT FINGER JOINT 904

Page 15 of 92 BIOPSY FINGER JOINT LINING 714 EXC HAND LES SC > 1.5 CM 974 EXC HAND TUM DEEP > 1.5 CM 1,321 REMOVEL HAND LESION SUBCUT 1,352 EXCISION TUMOR VASCULA 1,679 RELEASE PALM CONTRACTURE 936 RELEASE PALM CONTRACTURE 1,854 RELEASE PALM CONTRACTURE 612 REVISE FINGER JOINT, EACH 1,186 REVISE FINGER JOINT, EACH 1,069 TENDON EXCISION, PALM/FINGER 1,194 REMOVAL TENDON SHEATH 723 REMOVAL OF FINGER TENDON 692 PARTIAL REMOVAL, FINGER BONE 925 MANIPULATE FINGER W/ANESTH 719 MANIPULAT PALM CORD POST INJ 232 REPAIR FINGER/HAND TENDON 1,677 REPAIR FINGER/HAND TENDON 2,549 REPAIR FINGER/HAND TENDON 1,566 REPAIRGRAFT HAND TENDON 1,365 REVISE HAND/FINGER TENDON 2,100 REPAIRGRAFT HAND TENDON 2,020 REPAIR HAND TENDON 1,279 REPAIR EXTENSOR TENDON 1,808 REPAIR/GRAFT FINGER TENDON 1,665 REPAIR FINGER/HAND TENDON 1,264 REPAIR FINGER TENDON 1,171 REALIGNMENT OF TENDONS 1,282 RELEASE PALM/FINGER TENDON 1,469 RELEASE PALM & FINGER TENDON 1,690 RELEASE HAND/FINGER TENDON 1,307 INCISION OF FINGER TENDON 939 INCISE HAND/FINGER TENDON 919 TENDON LENGTHENING 1,361 LENGTHENING OF HAND TENDON 1,299 TRANSPLANT HAND TENDON 1,694 FUSION OF KNUCKLE JOINT 1,628 RELEASE FINGER CONTRACTURE 1,542 REVISE KNUCKLE JOINT 1,141 REVISE KNUCKLE WITH IMPLANT 1,488 REVISE FINGER JOINT 903 REVISE/IMPLANT FINGER JOINT 1,563 REPAIR HAND JOINT 1,481 REPAIR HAND JOINT WITH GRAFT 1,350 RECONSTRUCT FINGER JOINT 1,471 REPAIR NONUNION HAND 2,283 RECONSTRUCT FINGER JOINT 1,720

Page 16 of 92 CORRECT METACARPAL FLAW 1,050 CORRECT FINGER DEFORMITY 1,406 FX METACARPAL 562 TREAT METACARPAL FRACTURE 641 TREAT METACARPAL FRACTURE 1,112 TREAT METACARPAL FRACTURE 1,251 CLOSED TREATMENT CARPOMETACARPAL DISLOCAT 852 TREAT THUMB FRACTURE 788 TREAT THUMB FRACTURE 1,063 TREAT THUMB FRACTURE 1,272 TREAT HAND DISLOCATION 1,434 TREAT KNUCKLE DISLOCATION 549 FX PHALANX FINGER NO M 433 TREAT FINGER FRACTURE, EACH 733 TREAT FINGER FRACTURE, EACH 433 TREAT FINGER FRACTURE, EACH 1,268 TREAT FINGER FRACTURE, EACH 534 TREAT FINGER FRACTURE, EACH 771 TREAT FINGER FRACTURE, EACH 1,698 TREAT FINGER FRACTURE, EACH 398 CLOSED TREATMENT DISTA 711 PIN FINGER FRACTURE, EACH 872 TREAT FINGER FRACTURE, EACH 1,027 TREAT FINGER DISLOCATI 626 TREAT FINGER DISLOCATION 1,065 TREAT FINGER DISLOCATION 1,196 FUSION/GRAFT OF HAND JOINT 2,106 FUSION OF KNUCKLE 772 FUSION OF FINGER JOINT 1,323 FUSION OF FINGER JNT, ADD‐ON 875 FUSIONGRAFT OF FINGER JOINT 1,525 AMPUTATE METACARPAL BONE 1,244 AMPUTATION OF FINGER/THUMB 1,367 AMPUTATION OF FINGER/THUMB 1,462 DRAINAGE OF PELVIS LESION 976 INCISION OF HIP TENDONS 1,721 BUTTOCK FASCIOTOMY 1,985 DENERVATION OF HIP JOINT 1,715 EXCISION OF HIP JOINT/MUSCLE 2,353 BIOPSY OF SOFT TISSUES 418 BIOPSY SOFT TISSE PELV 2,540 EXC HIP PELVIS LES SC > 3 CM 1,054 REMOVE HIP/PELVIS LESION 880 REMOVE FEMUR LESION/BURSA 1,013 REMOVE HIP FOREIGN BODY 1,373 INJECTION FOR HIP X‐RAY 945 INJECTION FOR HIP X‐RAY 224

Page 17 of 92 INJECT SACROILIAC JOINT 410 PARTIAL HIP REPLACEMENT 2,649 TOTAL HIP REPLACEMENT 3,058 TOTAL HIP ARTHROPLASTY 3,682 REVISE HIP JOINT REPLACEMENT 4,243 REVISE HIP JOINT REPLACEMENT 3,375 REVISE HIP JOINT REPLACEMENT 4,664 TREAT PELVIC RING FRACTURE 1,055 FX SACRUM NO MANIPULAT 454 TREAT HIP SOCKET FRACTURE 1,428 TREAT HIP SOCKET FRACTURE 2,196 TREAT FEMORAL FRACTURE 1,000 Closed TX Femoral FX Prox. W/Manipulat 1,838 TREAT THIGH FRACTURE 2,115 TREAT THIGH FRACTURE 2,667 TREAT THIGH FRACTURE 2,011 TREATMENT OF FEMORAL F 2,639 TX INTERTROCH;PERITROCH;SUBTROCH FEM FRACTU 2,967 TREAT THIGH FRACTURE 1,446 TREAT HIP DISLOCATION 1,527 TREAT HIP DISLOCATION 1,721 TREAT HIP DISLOCATION 680 TREAT HIP DISLOCATION 1,327 MANIPULATION OF HIP JOINT 486 DRAIN THIGH/KNEE LESION 1,473 INCISE THIGH TENDON & FASCIA 758 EXPLORATION OF KNEE JOINT 1,450 BIOPSY, THIGH SOFT TISSUES 607 BIOPSY SOFT TISSUE KNE 874 EXCISION TUMOR THIGH O 874 EXCISION TUMOR THIGH D 788 EXPLORE/TREAT KNEE JOINT 1,061 EXC THIGH/KNEE LES SC > 3 CM 981 EXC THIGH/KNEE TUM DEEP >5CM 1,758 REMOVAL OF KNEECAP BURSA 802 REMOVAL OF KNEE CYST 1,222 EXCISION OF LESION OF 1,143 REMOVAL OF KNEECAP 1,356 REMOVE FEMUR LESION 1,266 PARTIAL REMOVAL, LEG BONE(S) 1,951 RESECT THIGH/KNEE TUM >5 CM 3,325 REMOVAL OF FOREIGN BOD 1,221 SUTURE OF INFRAPELLAR 1,423 REPAIR OF THIGH MUSCLE 1,445 LENGTHENING OF THIGH TENDON 1,180 REPAIR OF KNEE CARTILAGE 1,567 REPAIR OF KNEE LIGAMENT 1,416

Page 18 of 92 OSTEOCHONDRAL KNEE ALLOGRAFT 2,972 OSTEOCHONDRAL KNEE AUTOGRAFT 2,760 REPAIR DEGENERATED KNEECAP 1,880 REVISION OF UNSTABLE KNEECAP 1,724 REVISION OF KNEECAP 1,785 LAT RETINACULAR RELEASE OPEN 725 RECONSTRUCTION, KNEE 1,675 REVISE KNEECAP 1,500 REVISE KNEECAP WITH IMPLANT 1,772 REVISION OF KNEE JOINT 1,752 ARTHROPLASTY FEMORAL C 1,901 TOTAL KNEE REPLACEMENT 3,290 REALIGNMENT OF KNEE 1,977 REALIGNMENT OF KNEE 2,173 REVISE/REPLACE KNEE JOINT 3,252 REVISE/REPLACE KNEE JOINT 3,985 TREATMENT OF THIGH FRACTURE 3,094 TREATMENT OF THIGH FRACTURE 2,290 TREATMENT OF THIGH FRACTURE 1,102 TREATMENT OF THIGH FRACTURE 2,377 TREATMENT OF THIGH FRACTURE 2,770 TREATMENT OF THIGH FRACTURE 917 TREAT THIGH FX GROWTH PLATE 1,017 TREAT KNEECAP FRACTURE 699 TREAT KNEECAP FRACTURE 1,742 TREAT KNEE FRACTURE 944 TREAT KNEE FRACTURE 1,272 TREAT KNEE FRACTURE 2,119 TREAT KNEE FRACTURE 2,759 TREAT KNEE FRACTURE 1,705 TREAT KNEECAP DISLOCATION 948 FIXATION OF KNEE JOINT 834 AMPUTATE LEG AT THIGH 1,681 LEG SURGERY PROCEDURE 1,401 DECOMPRESSION OF LOWER LEG 978 DECOMPRESSION FASCIOTO 1,543 DECOMPRESSION OF LOWER LEG 1,183 INCISION & DRAINAGE, LEG/ANKLE; DEEP ABSCESS/H 1,848 DRAIN LOWER LEG BURSA 1,012 INCISION OF ACHILLES TENDON 811 INCISION OF ACHILLES TENDON 692 TREAT LOWER LEG BONE LESION 1,390 EXPLORE/TREAT ANKLE JOINT 1,534 EXPLORATION OF ANKLE JOINT 1,295 BIOPSY LOWER LEG 710 BIOPSY DEEP SOFT TISSU 1,521 REMOVE LOWER LEG LESION 953

Page 19 of 92 EXCISION DEEP TUMOR LE 1,935 EXPLORE/TREAT ANKLE JOINT 1,058 REMOVAL OF TENDON LESION 1,248 EXC LEG/ANKLE LES SC 3+ CM 954 REMOVE LOWER LEG BONE LESION 560 REPAIR ACHILLES TENDON 1,528 REPAIR/GRAFT ACHILLES TENDON 1,585 REPAIR OF ACHILLES TENDON 1,487 REPAIR OF LEG TENDON, EACH 871 REPAIR OF LEG TENDON, EACH 1,004 REPAIR OF LEG TENDON, EACH 1,250 REPAIR OF LEG TENDON, EACH 970 REPAIR LOWER LEG TENDONS 1,148 REPAIR LOWER LEG TENDONS 1,398 REVISION OF LOWER LEG TENDON 1,526 REVISION OF CALF TENDON 1,052 REVISE LOWER LEG TENDON 1,481 REVISE LOWER LEG TENDON 1,739 REPAIR OF ANKLE LIGAMENT 1,121 REPAIR OF ANKLE LIGAMENTS 1,287 REPAIR OF ANKLE LIGAMENT 1,539 RECONSTRUCT ANKLE JOINT 2,244 REPAIR OF TIBIA 1,800 REPAIR/GRAFT OF TIBIA 2,874 REPAIR FIBULA NONUNION 2,143 FX TIBIA NO MANIPULATI 813 TREATMENT OF TIBIA FRACTURE 1,196 TREATMENT OF TIBIA FRACTURE 1,333 TREATMENT OF TIBIA FRACTURE 1,986 TREATMENT OF TIBIA FRACTURE 2,336 FX MEDIAL MALLEOLUS NO 637 TREATMENT OF ANKLE FRACTURE 1,403 CLTX POST ANKLE FX 600 FX PROXIMAL FIBULA NO 611 TREATMENT OF FIBULA FRACTURE 1,200 FX DISTAL FIBULA NO MA 838 TREATMENT OF ANKLE FRACTURE 805 TREATMENT OF ANKLE FRACTURE 1,611 TREATMENT OF ANKLE FRACTURE 706 TREATMENT OF ANKLE FRACTURE 990 TREATMENT OF ANKLE FRACTURE 1,767 TREATMENT OF ANKLE FRACTURE 362 TREATMENT OF ANKLE FRACTURE 1,081 TREATMENT OF ANKLE FRACTURE 1,921 TREATMENT OF ANKLE FRACTURE 2,242 TREAT LOWER LEG FRACTURE 284 TREAT LOWER LEG FRACTURE 1,325

Page 20 of 92 TREAT LOWER LEG FRACTURE 2,514 TREAT LOWER LEG FRACTURE 3,050 TREAT LOWER LEG JOINT 1,462 TREAT ANKLE DISLOCATION 1,079 TREAT ANKLE DISLOCATION 1,517 FUSION OF ANKLE JOINT, OPEN 2,452 AMPUTATION OF LOWER LEG 2,149 AMPUTATION OF LOWER LEG 1,366 AMPUTATION FOLLOW‐UP SURGERY 1,300 AMPUTATION OF FOOT AT ANKLE 1,380 DECOMPRESSION OF LEG 1,242 DECOMPRESSION OF LEG 1,952 DRAINAGE OF BURSA OF FOOT 603 TREATMENT OF FOOT 1,126 INCISION AND DRAINAGE 1,757 TREAT FOOT BONE LESION 1,540 INCISION OF FOOT FASCIA 948 EXPLORATION OF FOOT JOINT 1,137 DECOMPRESSION OF TIBIA NERVE 1,142 EXC FOOT/TOE TUM SC > 1.5 CM 1,104 EXC FOOT/TOE TUM DEEP >1.5CM 1,023 EXCISION OF FOOT LESION 913 BIOPSY OF FOOT JOINT LINING 970 ARTHROTOMY W BIOPSY I 1,249 EXCISION NEUROMA/REMOVAL OF FOOT LESION 1,074 REMOVAL OF FOOT LESION 1,012 PART REMOVAL OF METATARSAL 1,078 PART REMOVAL OF METATARSAL 1,263 REVISION OF FOOT 1,762 REMOVAL OF HEEL BONE 1,270 REMOVAL OF HEEL SPUR 1,216 PART REMOVAL OF ANKLE/HEEL 1,544 PARTIAL REMOVAL OF FOOT BONE 1,480 PARTIAL REMOVAL OF TOE 1,113 PARTIAL REMOVAL OF TOE 916 RADICAL RESECTION TUMO 1,620 REMOVAL OF FOOT FOREIG 735 REMOVAL FB FOOT DEEP 711 REMOVAL OF FB COMPLICA 871 REPAIR OF FOOT TENDON 1,010 REPAIR OF FOOT TENDON 580 REVISION OF FOOT TENDON 1,456 RELEASE OF BIG TOE 1,030 RELEASE OF FOOT CONTRACTURE 1,053 RELEASE OF TOE JOINT, EACH 918 FUSION OF TOES 1,221 REPAIR OF HAMMERTOE 1,021

Page 21 of 92 PARTIAL REMOVAL OF FOOT BONE 1,324 REPAIR HALLUX RIGIDUS 1,618 CORRECTION OF BUNION 930 CORRECTION OF BUNION 1,604 CORRECTION OF BUNION 1,605 CORRECTION OF BUNION 1,600 CORRECTION OF BUNION 2,042 INCISION OF HEEL BONE 1,571 INCISION OF MIDFOOT BONES 1,773 INCISION OF METATARSAL 1,310 INCISION OF METATARSAL 1,557 INCISION OF METATARSAL 1,197 INCISION OF METATARSALS 2,119 REPAIR WEBBED TOE(S) 1,273 TREATMENT OF HEEL FRACTURE 535 TREAT HEEL FRACTURE 2,572 TREAT/GRAFT HEEL FRACTURE 2,655 TREATMENT OF ANKLE FRACTURE 502 TREATMENT OF ANKLE FRACTURE 687 TREATMENT OF ANKLE FRACTURE 944 TREAT ANKLE FRACTURE 2,499 OSTEOCHONDRAL TALUS AUTOGRFT 2,834 FX TARSAL NO MANIPULAT 660 TREAT MIDFOOT FRACTURE, EACH 1,386 FX METATARSAL NO MANIP 577 TREAT METATARSAL FRACTURE 825 TREAT METATARSAL FRACTURE 812 TREAT METATARSAL FRACTURE 1,222 FX GREAT TOE NO MANIPU 355 TREAT BIG TOE FRACTURE 436 TREAT BIG TOE FRACTURE 1,506 FX PHALANX TOE NO MANI 336 TREATMENT OF TOE FRACTURE 483 TREAT TOE FRACTURE 1,282 TREAT FOOT DISLOCATION 918 REPAIR FOOT DISLOCATION 1,748 CLSD TX METATARSOPHALANGEAL JOINT 258 TREAT TOE DISLOCATION 394 CLSD TRMNT INTERPHALANGEAL JOINT W/MANIP 197 REPAIR OF TOE DISLOCATION 1,312 FUSION OF FOOT BONES 2,419 FUSION OF FOOT BONES 1,819 FUSION OF FOOT BONES 1,912 FUSION OF FOOT BONES 1,838 FUSION OF FOOT BONES 1,886 FUSION OF BIG TOE JOINT 1,793 AMPUTATION THRU METATARSAL 1,761

Page 22 of 92 AMPUTATION TOE SINGLE 1,262 AMPUTATION OF TOE META 1,380 AMPUTATION TOE INTERPH 1,611 APPLICATION CAST FIGURE‐OF‐EIGHT 179 APPLICATION CAST SHOULDER SPICA 387 APPLICATION CAST PLASTER VELPEAU 238 APPLICATION CAST LONG ARM 183 APPLICATION CAST SHORT ARM 134 APPLICATION CAST GAUNTLET 179 APPLY FINGER CAST 117 APPLICATION OF LONG ARM SPLINT 190 APPLICATION OF SHORT ARM SPLINT; STATIC 148 APPLICATION OF SHORT ARM SPLINT; DYNAMIC 168 APPLICATION OF FINGER 91 APPLICATION OF FINGER SPLINT; DYNAMIC 111 STRAPPING OF ELBOW OR 117 TAPE FINGER HAND 117 APPLICATION OF LONG LEG CAST 266 APPLICATION OF LONG LEG CAST 322 APPLICATION OF CYLINDER CAST 236 APPLICATION OF SHORT LEG CAST 174 APPLICATION OF SHORT LEG CAST; WALKING/AMBU 191 APPLICATION OF PATELLAR TENDON BEARING CAST 231 ADDITION OF WALKER TO 109 APPLICATION OF RIGID TOTAL CONTACT LEG CAST 309 APPLICATION OF CLUBFOOT CAST W/MOLDING/MAN 305 APPLICATION OF LONG LEG SPLINT 169 APPLICATION LOWER LEG 150 TAPE ANKLE 80 APPLICATION UNNA BOOT 127 APPLY MULTLAY COMPRS LWR LEG 219 REMOVAL/BIVALVING; GAUNTLET/BOOT/BODY CAST 136 SHOULDER ARTHROSCOPY, DX 1,102 SHOULDER ARTHROSCOPY/SURGERY 2,467 SHOULDER ARTHROSCOPY/SURGERY 2,369 SHOULDER ARTHROSCOPY/SURGERY 1,769 SHOULDER ARTHROSCOPY/SURGERY 1,215 SHOULDER ARTHROSCOPY/SURGERY 1,322 SHOULDER ARTHROSCOPY/SURGERY 1,417 SHOULDER ARTHROSCOPY/SURGERY 1,539 SHOULDER ARTHROSCOPY/SURGERY 1,349 SHOULDER ARTHROSCOPY/SURGERY 1,548 ARTHROSCOP ROTATOR CUFF REPR 2,531 ARTHROSCOPY BICEPS TENODESIS 2,042 ELBOW ARTHROSCOPY 1,006 ELBOW ARTHROSCOPY/SURGERY 1,111 ELBOW ARTHROSCOPY/SURGERY 1,140

Page 23 of 92 ELBOW ARTHROSCOPY/SURGERY 1,740 ELBOW ARTHROSCOPY/SURGERY 1,575 ELBOW ARTHROSCOPY/SURGERY 1,763 WRIST ARTHROSCOPY/SURGERY 1,235 WRIST ARTHROSCOPY/SURGERY 534 WRIST ARTHROSCOPY/SURGERY 487 TIBIAL ARTHROSCOPY/SURGERY 1,842 TIBIAL ARTHROSCOPY/SURGERY 2,150 AUTGRFT IMPLNT, KNEE W/SCOPE 2,765 KNEE ARTHROSCOPY, DX 1,330 KNEE ARTHROSCOPY/DRAINAGE 1,139 ARTHROSCOPY KNEE WITH 1,124 ARTHROSCOPY KNEE REMOV 1,196 KNEE ARTHROSCOPY SURGE 1,109 KNEE ARTHROSCOPY 1,357 KNEE ARTHROSCOPY/SURGERY 1,396 KNEE ARTHROSCOPY 1,379 KNEE ARTHROSCOPY/SURGERY 1,604 KNEE ARTHROSCOPY/SURGERY 1,469 KNEE ARTHROSCOPY/SURGERY 1,569 KNEE ARTHROSCOPY/SURGERY 1,903 KNEE ARTHROSCOPY/SURGERY 1,452 KNEE ARTHROSCOPY/SURGERY 1,706 KNEE ARTHROSCOPY/SURGERY 1,688 KNEE ARTHROSCOPY SURGE 2,203 KNEE ARTHROSCOPYSURGERY 1,143 ANKLE ARTHROSCOPY/SURGERY 1,598 ANKLE ARTHROSCOPY/SURGERY 1,550 ANKLE ARTHROSCOPY/SURGERY 1,213 ANKLE ARTHROSCOPY/SURGERY 1,163 ANKLE ARTHROSCOPY/SURGERY 1,218 ANKLE ARTHROSCOPY/SURGERY 1,359 UNLISTED PROCEDURE ARTHROSCOPY OF JOINT 1,539 DRAINAGE OF NOSE LESION 534 INTRANASAL BIOPSY 312 REMOVAL OF NOSE POLYP(S) 485 REMOVAL OF INTRANASAL LESION 1,925 REMOVAL OF NOSE LESION 672 REMOVAL OF TURBINATE BONES 884 REMOVAL OF TURBINATE BONES 965 INSERT NASAL SEPTAL BUTTON 631 REMOVE NASAL 223 REMOVE NASAL FOREIGN BODY 494 Remove FB Intrnasal by lateral rhinotomy 5,015 RECONSTRUCTION OF NOSE 2,323 RECONSTRUCTION OF NOSE 3,085 REVISION OF NOSE 2,227

Page 24 of 92 REPAIR NASAL STENOSIS 2,354 REPAIR OF NASAL SEPTUM 1,352 RELEASE OF NASAL ADHESIONS 590 INTRANASAL RECONSTRUCTION 1,625 REPAIR NASAL SEPTUM DEFECT 1,502 CAUTERIZATION, INNER NOSE 496 CAUTERIZATION, INNER NOSE 642 CONTROL OF NOSEBLEED SIMPLE 238 CONTROL OF NOSEBLEED COMPLEX 429 INIT POST CONTROL OF NOSEBLEED 496 REPEAT CONTROL OF NOSEBLEED 636 EXPLORATION, MAXILLARY SINUS 1,073 EXPLORATION, MAXILLARY SINUS 1,265 EXPLORATION, SPHENOID SINUS 1,130 REMOVAL OF ETHMOID SINUS 1,337 REMOVAL OF ETHMOID SINUS 1,749 NASAL , DX 430 NASAL/SINUS ENDOSCOPY, SURG 741 NASAL/SINUS ENDOSCOPY, SURG 1,424 NASAL/SINUS ENDOSCOPY, SURG 379 NSL/SINS NDSC W/ARTERY LIG 935 NSL/SINS NDSC TOTAL 1,047 REVISION OF ETHMOID SINUS 644 REMOVAL OF ETHMOID SINUS 949 EXPLORATION MAXILLARY SINUS 467 NSL/SINS NDSC TOT W/SPHENDT 932 NSL/SINS NDSC SPHN TISS RMVL 988 ENDOSCOPY, MAXILLARY SINUS 751 SINUS ENDOSCOPY, SURGICAL 1,197 NASAL/SINUS ENDOSCOPY, SURG 549 NASAL/SINUS ENDOSCOPY, SURG 614 SINUS ENDO W/BALLOON DIL 529 SINUS ENDO W/BALLOON DIL 633 SINUS ENDO W/BALLOON DIL 521 PARTIAL REMOVAL OF LARYNX 4,895 EMERGENCY INTUBATION 345 CHANGE OF WINDPIPE AIR 382 DIAGNOSTIC LARYNGOSCOPY 136 LARYNGOSCOPY WITH BIOPSY 470 DIAGNOSTIC LARYNGOSCOPY 571 DIAGNOSTIC LARYNGOSCOPY 385 OPERATIVE LARYNGOSCOPY 498 OPERATIVE LARYNGOSCOPY 501 OPERATIVE LARYNGOSCOPY 448 OPERATIVE LARYNGOSCOPY 498 OPERATIVE LARYNGOSCOPY ‐ DIRECT 505 OPERATIVE LARYNGOSCOPY 634

Page 25 of 92 LARYNGOSCOPY WITH INJECTION 575 DIAGNOSTIC FLEXIBLE LARYNGOSCOPY 208 LARYNGOSCOPY WITH BIOPSY 551 REMOVE FOREIGN BODY, LARYNX 524 DIAGNOSTIC LARYNGOSCOPY 505 INCISION OF WIND PIPE 951 TRACHEOSTOMY EMERGENC 805 INCISION OF WINDPIPE 779 BRONCHSCOPY DIAG W/CELL WASHING 716 BRONCHOSCOPY WITH BRUSHING 409 BRONCHOSCOPY W BRONCHIAL ALVEOLAR LAVAGE 679 BRONCHOSCOPY W BRONCHIAL/ENDOBRONCHIAL B 860 BRONCHOSCOPY W/MARKERS 418 BRONCHOSCOPY/LUNG BX, EACH 1,073 BRONCHOSCOPY W/TRANSBRONCHIAL NEEDLE ASPI 492 BRONCHOSCOPY W/FB REMOVAL 808 BRONCHOSCOPY, CLEAR AIRWAYS 734 SURGICAL CLOSURE TRACH 1,240 CHEST TUBE INSERTION 454 THORACENTESIS WITH CHE 314 THORACOTOMY MAJOR WITH 1,938 EXPLORE/REPAIR CHEST 3,286 REMOVAL OF LUNG LESION(S) 2,492 ANESTH, BIOPSY OF THYROID 81 PNEUMONOSTOMY WITH PER 476 RELEASE OF LUNG 3,823 DECORTICATION PULMONAR 2,455 DECORTICATION AND PARI 3,811 NEEDLE BIOPSY CHEST LINING 662 BIOPSY PLEURA OPEN 1,356 BIOPSY LUNG OR MEDIAST 225 PUNCTURE/CLEAR LUNG 264 THORACENTESIS FOR ASPI 227 THORACENTESIS W/TUBE INSERT 543 SEGMENTECTOMY 3,478 INSERTION OF INDWELLIN 646 TUBE THORACOSTOMY 704 REMOVE LUNG CATHETER 443 INS MARK THOR FOR RT PERQ 459 ASPIRATE PLEURA W/O IMAGING 313 ASPIRATE PLEURA W/ IMAGING 633 THORACOSCOPY DIAGNOSTI 891 THORACOSCOPY WITH PLEU 1,912 THORACOSCOPY, SURGICAL 2,549 THORACOSCOPY, SURGICAL 3,864 SURGICAL THORACOSCOPY 1,938 THORACOSCOPY, SURGICAL 1,927

Page 26 of 92 AJCC STAGE DOCD B/4 THXPY 2 DRAINAGE OF HEART SAC 305 CANCER STAGE DOCD‐METAST 2 CREATION OF PERICARDIA 1,898 INSERTION OF HEART PACEMAKER 1,009 INSERTION OF HEART PACEMAKER 1,072 INSERTION OF HEART PACEMAKER 1,269 INSERTION OF HEART ELECTRODE 452 INSERTION OF PULSE GENERATOR 804 INSERTION OF PULSE GENERATOR 979 REPOSITION PACING‐DEFIB LEAD 1,985 INSERT LEAD PACE‐DEFIB, DUAL 947 REVISE POCKET, PACEMAKER 865 INSERTION OF PACING ELECTRODE CARDIAC VENOUS 1,069 REMOVE&REPLACE PM GEN SINGL 765 REMV&REPLC PM GEN DUAL LEAD 816 REMOVAL OF PACEMAKER SYSTEM 606 REMOVAL PACEMAKER ELECTRODE 1,528 IMPLANT PAT‐ACTIVE HT RECORD 713 REMOVE PAT‐ACTIVE HT RECORD 587 REPAIR OF HEART WOUND 5,495 THROMBECTOMY AXILLARY 1,563 REPAIR DEFECT OF ARM ARTERY 1,499 ANESTH, NECK VESSEL SURGERY 369 REPAIR OF BLOOD VESSEL 1,627 Repair Blood Vessel, Direct, Hand/Finger 893 REPAIR BLOOD VESSEL LESION 3,279 REPAIR BLOOD VESSEL LESION 1,898 REPAIR BLOOD VESSEL UP 2,104 EXPLORATION OF FEMORAL 1,229 EXPLORATION OF OTHER V 970 EXPLORE NECK VESSELS 1,182 EXPLORE ABDOMINAL VESSELS 1,547 EXPLORATION VESS OF EX 1,098 REMOVAL OF CLOT IN GRAFT 1,495 EXCISION, GRAFT, THORAX 4,413 INTRO INTRACA 60 INJECTION EXT VENOGRAPHY 1,289 PLACE CATHETER IN VEIN 230 ARTERY TO VEIN SHUNT 121 VENIPUNCT, NON‐ROUT* 30 VENIPUNCTURE 19 CAPILLARY BLOOD DRAW 23 VENIPUNCTURE CUTDOWN O 52 BLOOD TRANSFUSION SERV 371 INJECT SPIDER VEINS 94 INJECTION OF SCLEROSIN 544

Page 27 of 92 INJECTION, SCLEROSING SOLUTION; MULTIPLE VEINS 467 ENDOVENOUS ABLATION TH 7,562 ENDOVENOUS ABLATION TH 1,528 IV ACCESS PLACEMENT 204 CATHETER INSERTION 134 REVISION VENOUS ACCESS 422 PORT‐A‐CATH REMOVAL 454 CATHETER NON TUNNELED 312 CATHETER NON TUNNELED 1,088 CATHETER TUNNELED W OU 685 INSERTED CENTRAL VENOUS CATHETER W/O SUBCUT 1,052 TUNNELED VENOUS ACCESS 815 TUNNELED ACCESS DEVICE 2,719 TUNNELED ACCESS DEVICE 821 2 CATHETERS VIA 2 ACCE 782 2 CATHETERS VIA 2 ACCE 841 PICC WITHOUT PORT OR P 227 PICC WITHOUT PORT OR P 625 PERIPHERAL ACCESS DEVI 711 PERIPHERAL ACCESS DEVI 821 REPAIR OF VENOUS CATH 132 REPAIR OF VENOUS DEVIC 465 PARTIAL REPLACE CATHET 524 REPLACE NON TUNNELED C 164 REPLACE TUNNELED CATHE 492 REPLACE TUNNELED ACCES 718 REPLACE TUNNELED ACCES 724 REPLACE PICC WITHOUT P 196 REPLACE PERIPHERAL ACC 672 REMOVAL IMPLANT VENOUS ACCESS 465 REMOVE TUNNELED ACCESS 699 DRAW BLOOD OFF VENOUS DEVICE 214 DECLOT VASCULAR DEVICE 217 REPOSITION VENOUS CATH 154 ART PUNCTURE FOR DX* 61 INSERTION CATHETER, ARTERY 130 INSERT VAC 132 Placemnt of needle, intraosseous infusn 144 INS ENDOVAS VENA CAVA FILTR 14,500 VASCULAR ENDOSCOPY SUR 2,588 TEMPORAL ARTERY BIOPSY 544 LIGATION OF ABDOMEN 2,757 LIGATION OF EXTREMITY ARTERY 810 LIGATION & DIVISION LO 621 LIGATE AND STRIP SHORT 957 LIGATE STRIP LONG LEG 1,143 LIGATION & DIVISION LO 1,648

Page 28 of 92 LIGATION PERFORATOR VS 2,287 LIGATE LEG VEINS OPEN 1,318 STAB PHLEBECTOMY 10‐20 1,098 STAB PHLEBECTOMY OVER 1,357 LIGATION DIVISION SAPH 958 LIGATIONDIVISION AND 1,060 SPLENECTOMY 2,131 REMOVAL OF SPLEEN 721 REPAIR OF RUPTURED SPLEEN 2,830 BONE MARROW ASPIRATION 492 BONE MARROW BIOPSY 532 DRAINAGE OF LYMPH NODE ABSCESS; SIMPLE 363 LYMPHANGIOTOMY OR OTHE 865 EXCISION LYMPH NODE SU 608 NEEDLE BIOSPY SUP CERV 292 BIOPSY OPEN DEEP CERV 1,163 BIOPSY EXCISION LYMPHN 907 AXILLARY NODE DISECTIO 1,040 EXPLORE DEEP NODE(S), NECK 1,160 REMOVAL, PELVIC LYMPH NODES 1,606 ‐SURGICAL W 1,410 REMOVAL OF LYMPH NODES, NECK 1,812 LYMPHADENECTOMY CERVIC 3,229 REMOVAL OF LYMPH NODES 3,038 AXILLARY LYMPHADENECTO 1,563 AXILLARY LYMPHADENECTO 1,900 REMOVE ABDOMINAL LYMPH NODES 627 INGUINOFEMORAL LYMPHAD 2,041 REMOVE GROIN LYMPH NODES 2,748 INJECT FOR LYMPHATIC X‐RAY 185 INJECTION FOR ID SENTI 213 IO MAP OF SENT LYMPH NODE 1,174 EXPLORATION OF CHEST 1,989 MEDIASTINOSCOPY WITH O 1,014 REPAIR PARAESOPHAGEAL HERNIA 2,347 BIOPSY OF LIP 314 PARTIAL EXCISION OF LIP 1,196 PARTIAL EXCISION OF LIP 1,108 PARTIAL EXCISION OF LIP 1,140 RECONSTRUCT LIP WITH FLAP 1,334 PARTIAL REMOVAL OF LIP 840 REPAIR LIP, FULL THICKNESS, VERMILLION ONLY 1,053 REPAIR LIP, FULL THICKNESS, UP TO HALF VERTICAL H 1,116 REPAIR LIP 1,371 DRAINAGE OF MOUTH LESION 415 DRAINAGE OF MOUTH LESION 717 REMOVAL, FOREIGN BODY, MOUTH 524

Page 29 of 92 REMOVAL, FOREIGN BODY, MOUTH 945 INCISION OF LIP FOLD 234 BIOPSY OF MOUTH LESION 449 EXCISION OF MOUTH LESI 415 EXCISE/REPAIR MOUTH LESION 625 EXCISE/REPAIR MOUTH LESION 864 EXCISION OF MOUTH LESION 953 FRENULECTOMY 735 TREATMENT OF MOUTH LESION 580 REPAIR MOUTH LACERATION 358 REPAIR MOUTH LACERATION 799 RECONSTRUCTION OF MOUTH 1,883 Closure of laceration vestibule of mouth, Complex 3,366 DRAINAGE OF MOUTH LESION 391 INCISION OF TONGUE FOLD 537 BIOPSY OF TONGUE 370 BIOPSY OF TONGUE 396 BIOPSY OF FLOOR OF MOUTH ‐ DONE IN THE OR 204 EXCISION TOUNG LESION 311 EXCISION OF TONGUE LESION 754 EXCISION OF TONGUE LESION 826 FRENECTOMY 427 EXCISION OF MOUTH LESION 797 REPAIR TONGUE LACERATI 456 REPAIR TONGUE LACERATION 886 TONGUE TIE 554 DRAINAGE OF GUM LESION 561 EXCISION OF GUM LESION 404 EXCISION OF GUM LESION 672 DRAINAGE MOUTH ROOF LESION 632 BIOPSY ROOF OF MOUTH 363 EXCISION LESION, MOUTH ROOF 463 EXCISION LESION, MOUTH ROOF 649 EXCISION OF UVULA 556 REPAIR PALATE, PHARYNX/UVULA 1,646 TREATMENT MOUTH ROOF LESION 314 PARTOTID ABCESS DRAINA 1,119 REMOVAL OF SALIVARY STONE 535 REMOVAL OF SALIVARY STONE 562 BIOPSY OF SALIVARY GLAND 188 BIOPSY OF SALIVARY GLAND 515 EXCISION OF SALIVARY CYST 1,073 EXCISE PAROTID GLAND/LESION 1,384 EXCISION PAROTID GLAND 2,887 EXCISION SUBMAXILLARY 1,272 EXCISION OF SUBLINGUAL GLAND 1,072 DILATION OF SALIVARY DUCT 202

Page 30 of 92 DRAINAGE OF TONSIL ABSCESS 525 DRAINAGE OF THROAT ABSCESS 902 BIOPSY OF THROAT 260 BIOPSY OF THROAT 533 BIOPSY OF UPPER NOSE/THROAT 511 EXCISE PHARYNX LESION 422 REMOVE PHARYNX FOREIGN BODY 557 EXCISION OF NECK CYST 506 EXCISION OF NECK CYST 1,266 REMOVE TONSILS AND ADENOIDS <12 yrs 668 REMOVE TONSILS AND ADENOIDS, AGE 12+ YRS 697 REMOVAL OF TONSILS < 12 yrs 601 REMOVAL OF TONSILS 12 YRS > 578 REMOVAL OF ADENOIDS < AGE 12 472 ADENOIDECTOMY AGE 12 OR OVER 511 REMOVAL OF ADENOIDS 443 REMOVAL OF ADENOIDS 557 EXCISION OF LINGUAL TONSIL 1,422 CONTROL THROAT BLEEDING 404 CONTROL THROAT BLEEDING 986 CONTROL THROAT BLEEDING 1,262 NASAL PACKING 860 CONTROL NOSE/THROAT BLEEDING 1,175 THROAT MUSCLE SURGERY 1,388 ESOPHAGOSCOPY RIGID TRNSO DX INCL SPECIMEN(S 213 ESOPHAGOSCOPY RIGID TRNSO DIRECT SUBMUCOSA 253 ESOPHAGOSCOPY RIGID TRNSO W/BX 300 ESOPHAGOSCOPY RIGID TRNSO W/REMOV FB 272 ESOPHAGOSCOPY RIGID W/BALLOON DILATION <30 302 ESOPHAGOSCOPY RIGID TRNSO W/INSERT GUIDE WI 330 ESOPHAGOSCOPY FLEX TRNSNSL DIAG INCLUDES CO 313 ESOPHAGOSCOPY FLEX TRNSNSL DIAG W/BX 348 ESOPHAGUS ENDOSCOPY 564 ESOPHAGUS ENDOSCOPY, BIOPSY 786 ESOPHAGUS ENDOSCOPY/LIGATION 307 ESOPHAGOSCOPY FLEX TRNSO MUCOSAL RESECT 409 ESOPHAGOSCOPY FLEX TRNSO W/STENT PLACEMENT 322 ESOPHAGOSCOPY FLEX TRNSO W/DILATION OF ESOP 2,099 ESOPHAGOSCOPY FLEX TRNSO W/DILATION OF ESOP 329 ESOPHAGOSCOPY WITH REM 519 ESOPH ENDOSCOPY, DILATION 288 EGD FLEX TRNSO W/DIL OF ESOPHAGUS W/BALLOON 390 UPPER GI ENDOSCOPY, EXAM 657 ESOPHAGOGASTRODUODENOS 875 UPPR GI SCOPE W/SUBMUC INJ 342 EGD WITH BIOPSYS 1,012 UPPER GI ENDOSCOPY WITH TUBE 337

Page 31 of 92 UPPER GI ENDOSCOPY & INJECT 638 UPPER GI ENDOSCOPY/LIGATION 932 UPPR GI SCOPE DILATE STRICTR 670 PLACEMENT OF GASTROSTO 758 OPERATIVE UPPER GI ENDOSCOPY 743 ESOPH ENDOSCOPY, DILATION 421 UPPER ENDOSCOPY WITH R 563 EGD WITH REMOVAL TUMOR/POLYP.LESION BY SNA 581 EGD FLEX TRNSO W/US TRANSMURAL INJXN OF DX O 453 EGD FLEX TRNSO W/ENDO MUCOSAL RESECTION 470 OPERATIVE UPPER GI ENDOSCOPY 681 EGD w/polypectomy ‐ cold biopsy 575 ENDO CHOLANGIOPANCREATOGRAPH 9,688 EGD W/PLACE ENDOSCOPIC STENT 389 EGD FLEX TRNSO W/ABLATION OF TUMOR POLYP LES 1,228 LAPAROSCOPY, FUNDOPLASTY 2,447 LAP PARAESOPHAG HERN REPAIR 3,627 LAP PARAESOPH HER RPR W/MESH 4,078 ESOPHAGEAL FUNDOPLASTY 2,362 THORABD DIAPHR HERN REPAIR 3,456 REPAIR ESOPHAGUS WOUND 3,985 DILATE ESOPHAGUS 206 DILATE ESOPHAGUS 913 EXCISION OF STOMACH LE 2,188 REMOVAL OF STOMACH 3,703 REMOVAL OF STOMACH, PARTIAL 4,600 REMOVAL OF STOMACH, PARTIAL 6,503 REMOVAL OF STOMACH, PARTIAL 406 LAPAROSCOPY, GASTROSTOMY 1,307 NASAL/OROGASTRIC W/STENT 96 TX GASTRO INTUB W/ASP 302 CHANGE GASTROSTOMY TUBE 1,058 RECONSTRUCTION OF PYLORUS 2,125 FUSION OF STOMACH AND BOWEL 3,038 PLACE GASTROSTOMY TUBE 1,500 REPAIR OF STOMACH LESION 2,986 REPAIR STOMACH OPENING 1,297 ESOPHAGEAL HERNIA REPA 2,712 LYSIS OF ADHESIONS 2,356 INSERT NEEDLE CATH BOW 305 DECOMPRESS SMALL BOWEL 2,125 INCISION OF LARGE BOWE 2,119 REDUCE BOWEL OBSTRUCTI 2,099 CORRECT MALROTATION OF BOWEL 2,450 EXCISE INTENSTINE LESI 1,782 EXCIS. ENTERECTOMY RES 2,455 REMOVAL OF SMALL INTESTINE 549

Page 32 of 92 ENTEROENTEROSTOMY ANAS 2,036 MOBILIZATION OF COLON 331 COLECTOMY PARTIAL W A 3,015 COLECTOMY WITH SKIN WI 2,551 COLECTOMY W COLOSTOMY 3,454 COLECTOMY PARTIAL W R 2,667 PATIAL REMOVAL COLON 3,192 PARTIAL REMOVAL OF COLON 4,825 PARTIAL REMOVAL OF COLON 4,037 REMOVAL OF COLON/ILEOSTOMY 4,628 COLECTOMY W REMOV. OF 2,712 LAPAROSCOPY ENTEROLYSI 1,957 LAPAROSCOPIC JEJUNOSTO 1,378 LAPAROSCOPIC ILEO JEJU 2,273 LAPAROSCOPIC COLOSTOMY 2,492 LAP RESECT S/INTESTINE SINGL 3,090 LAPAROSCOPY SURGICAL COLECTOMY, PARTIAL W/A 3,485 COLECTOMY PART WITH AN 4,229 LAPARO TOTAL PROCTOCOLECTOMY 3,962 LAP, MOBIL SPLENIC FL ADD‐ON 426 LAP, CLOSE ENTEROSTOMY 3,680 OPEN BOWEL TO SKIN 1,818 ILEOSTOMY JEJUNOSTOMY 1,933 REVISION OF ILEOSTOMY 1,301 REVISION OF ILEOSTOMY 2,264 COLOSTOMY 2,157 REVISION OF COLOSTOMY 1,367 REPAIR OF COLOSTOMY W 2,075 SMALL BOWEL ENDOSCOPY 308 SMALL BOWEL ENDOSCOPY/BIOPSY 354 SMALL BOWEL ENDOSCOPY 613 SMALL BOWEL ENDOSCOPY 495 ILEOSCOPY 161 ENDOSCOPIC EVAL SM INT 881 COLON ENDOSCOPY 811 COLONOSCOPY WITH BIOPSY 898 ENDOSCOPYSM INT STOMA 908 COLONOSCOPY & POLYPECTOMY 977 COLONOSCOPY W/SNARE 1,169 SUTURE SMALL INTESTINE 2,306 SUTURE SMALL INTESTINE 3,422 SUTURE LARGE INTESTINE 2,313 INTESTINAL STRICTUROPLASTY 2,401 ENTEROSTOMY CLOSURE 1,510 SMALL BOWEL REPAIR WIT 1,840 REPAIR BOWEL OPENING 3,620 REPAIR BOWEL SKIN FIST 3,229

Page 33 of 92 REPAIR BOWEL‐BLADDER FISTULA 3,179 CLOSURE OF ENTEROVESIC 3,081 SURGICAL REVISION OF I 1,884 ABDOMINAL WALL FISTULO 1,946 EXCISION OF BOWEL POUC 1,712 EXCISION OF MESENTERY LESION 1,922 DRAIN APP ABSCESS, OPEN 1,694 DRAINAGE OF APPENDICEA 662 APPENDECTOMY OPEN 1,518 APPENDECTOMY DURING OT 227 APPENDECTOMY OPEN W R 1,841 APPENDECTOMY LAP 1,454 DRAINAGE OF PELVIC ABSCESS 917 DRAINAGE OF RECTAL ABSCESS 556 DRAINAGE OF RECTAL ABSCESS 1,415 BIOPSY OF RECTUM 612 REMOVAL OF ANORECTAL LESION 834 PROCTECTOMY COMPLETE C 6,314 EXC RECTAL PROCIDENTIA 2,025 EXCISION OF RECTAL PROLAPSE 2,992 EXCISION OF RECTAL TUM 2,184 EXC RECT TUM TRANSANAL PART 1,406 EXC RECT TUM TRANSANAL FULL 1,932 PROCTOSIGMOIDOSCOPY WI 305 PROCTOSIGMOIDOSCOPY FB 273 PROCTOSIGMOIDOSCPOY W 520 PROCTOSIGMOIDOSCOPY W 227 SIGMOIDOSCOPY DIAGNOST 394 SIGMOIDOSCOPY W BIOPS 434 SIGMOIDOSCOPY W REMOV 738 SIGMOIDOSCOPY W POLYP 689 SIGMOIDOSCOPY; FLEXIBLE; WITH CONTROL OF BLEE 510 SIGMOIDOSCOPY FLEXIBLE W/DIRECTED SUBMUCOS 612 SIGMOIDOSCOPY WITH DEC 426 SIGMOIDOSCPY W/TUMR REMOVE 260 COLONSCOPY RIGID FLEXI 719 COLONOSCOPY DIAGNOSTIC 925 COLONOSCOPY W/FB REMOVAL 1,177 COLONOSCOPY AND BIOPSY 1,467 COLONOSCOPE, SUBMUCOUS INJ 1,081 COLONOSCOPY TO CONTROL 1,458 COLONOSCOPY W COLD BX 1,323 COLONOSCOPY 1,537 COLONOSCOPY SNARE POLYPEC 1,249 COLONOSCOPY WITH DILAT 2,206 COLONOSCOPY WITH TRANS 1,281 COLONOSCOPY W/ABLATION 974

Page 34 of 92 COLONOSCOPY W/ENDOSCOPE US 1,110 COLONOSCOPY W/ENDOSCOPIC FNB 1,398 COLONOSCOPY W/DECOMPRESSION 545 LAPAROSCOPIC REMOVAL O 4,152 LAPAROSCOPIC REMOVAL O 4,507 COLONOSCOPY W/BAND LIGATION 506 LAPAROSCOPIC PROC 2,647 PROCTOPEXY FOR PROLAPS 3,118 RECTOCELE REPAIR‐SEP P 2,122 DIL OF ANAL SPHINCTER 377 REMOVE RECTAL OBSTRUCTION 709 SURG DX EXAM, ANORECTAL 248 PLACEMENT OF SETON 505 REMOVAL OF RECTAL MARK 227 INCISION/DRAIN ISCHIORECTAL/PERIRECTAL ABSCESS 919 INCISION AND DRAINAG I 646 I&D PERIANAL ABSCESS 864 FISTULECTOMY ANAL 944 INCISION OF ANAL SPHINCTER 511 I&D THROMBOSED HEMORRO 674 REMOVAL OF ANAL FISSURE 853 PAPILLECTOMY OR EXCISI 259 HEMORRHOIDECTOMY SIMPL 522 EXCISION EXTERNAL HEMO 460 HEMORRHOIDECTOMY EXTER 693 HEMORRHOIDECTOMY INT A 755 REMOVE HEMORRHOIDS & FISSURE 950 HEMORRHOIDECTOMY WITH 765 HEMORRHOIDECTOMY INT & 1,034 HEMORRHOIDECTOMY INT & 1,119 REMOVAL OF ANAL FISTUL 860 FISTULECTOMY 912 FISTULECTOMY FISTULOTO 964 REPAIR ANAL FISTUAL 997 I&D THOMB HEMORRHOID 372 ANOSCOPY 188 ANOSCOPY AND BIOPSY 532 ANOSCOPY, REMOVE FOR BODY 1,337 ANOSCOPY, REMOVE LESION 506 ANOSOCOPY W REMOVAL L 324 ANOSCOPY W REMOVAL OF 379 ANOPLASTY ADULT 1,159 SPHINCTEROPLASTY 1,343 DESTRUCTION, ANAL LESION(S) 525 SURGICAL EXCISION ANAL 291 HEMORRHOIDAL IRC 663 DESTRUCTION OF HEMORRH 822

Page 35 of 92 HEMORRHOID DESTRUCTION 812 HEMORROIDAL LIGATION S 490 LIGATION OF HEMORRHOID 524 HEMORRHOIDOPEXY WITH S 815 LIVER BIOPSY 2,976 LIVER BX SEPARATE PRO 236 HEPATOTOMY FOR OPEN DR 2,273 PERCUT DRAIN, LIVER LESION 444 LAPAROTOMY WITH ASPIRA 2,048 WEDGE BIOPSY OF LIVER 1,854 PARTIAL REMOVAL OF LIVER 5,222 LIVER WOUND REPAIR 2,581 LAPAROSCOPE PROCEDURE, LIVER 1,345 INCISION OF BILE DUCT 3,063 INCISION OF GALLBLADDER 1,262 INJECTION FOR LIVER X‐RAYS 88 CHOLECYSTECTOMY LAPARO 2,273 CHOLECYSTECTOMY WITH C 2,534 CHOLECYSTECTOMY W COMM 2,099 LAPAROSCOPIC CHOLECYST 1,699 CHOLECYSTECTOMY OPEN 2,809 CHOLECYSTECTOMY OPEN W 2,162 CHOLECYSTECTOMY OPEN W 2,744 FUSE GALLBLADDER & BOWEL 2,532 PARTIAL REMOVAL OF PANCREAS 3,377 PARTIAL REMOVAL OF PANCREAS 6,912 EXPLORATORY LAPAROTOMY 1,836 LAPAROTOMY REOPENING 1,413 EXPLORATION LAP BIOPSY 1,650 OPEN DRAINAGE OF PERIT 2,875 OPEN DRAINAGE PERITONE 725 DRAINAGE OF SUBDIAPHRA 1,829 DRAIN, PERCUT, ABDOM ABSCESS 434 DRAINAGE OF RETROPERIT 2,127 DRAINAGE OF RETROPERIT 3,506 PERITONEOCENTESIS 569 REMOVAL OF ABDOMINAL F 164 ABDOMINAL PARACENTESIS W/O IMAGING GUIDANC 389 ABD PARACENTESIS W/IMAGING 768 BIOPSY, ABDOMINAL MASS 559 REMOVAL OF ABDOMINAL L 1,411 EXC ABD TUM 5 CM OR LESS 2,597 EXCISION DESTRUCTION O 5,095 STAGING LAPAROTOMY FOR 1,935 UMBILECTOMY OMPHALECTO 1,282 OMENTECTOMY 1,514 DIAGNOSTIC LAPAROSCOPY 815

Page 36 of 92 LAPAROSCOPY W BX 912 LAPAROSCOPY W ASPIRAT 949 LAP INSERTION PERM IP CATH 866 LAPARO PROC, ABDM/PER/OMENT 1,208 REMOVAL OF PERITONEAL 1,840 IMAGE GUIDED FLUID COLLECTION DRAINAGE BY CA 1,484 IMAGE GUIDED FLUID COLLECTION DRAINAGE BY CA 2,635 IMAGE GUIDED FLUID COLLECTION DRAINAGE BY CA 1,249 INS MARK ABD/PEL FOR RT PERQ 1,193 INSERT TUN IP CATH PERC 431 PERITONEAL LAVAGE 269 REMOVAL OF PERM INTRAP 738 PLACE GASTROSTOMY TUBE PERC 2,348 PLACE DUOD/JEJ TUBE PERC 625 REPLACE G/C TUBE PERC 1,767 REPLACE DUOD/JEJ TUBE PERC 192 HERNIA REPAIR ‐ PEDI 931 INGUINAL HERNIA REPAIR 1,310 HERNIA REPAIR INGUINAL 1,208 HERNIA REPAIR INGUINAL 1,473 HERIA REPAIR UNILATERA 1,648 REPAIR REC ING HERNIA 1,964 REPAIR INGUINAL HERNIA 1,186 FEMORAL HERNIA REPAIR 1,518 REPAIR FEMORAL HERNIA 1,324 REREPAIR FEM HERNIA, REDUCE 1,256 REREPAIR FEM HERNIA, BLOCKED 1,603 HERNIA REPAIR INCISION 1,900 REPAIR INCARC. INCIS. 2,162 RE‐REPAIR VENTRI HERN 1,469 REREPAIR VENTRL HERN B 1,791 IMPLANTATION OF MESH O 743 HERNIA REPAIR EPIGASTR 964 HERNIA REPAIR EPIGASTR 1,086 REPAIR UMBILIBAL HERNI 1,098 HERNIA REPAIR UMBILICA 944 HERNIA REPAIR SPIGELIA 1,142 LIGATION OF HEMOORHOID 530 LAPARO HERNIA REPAIR INITIAL 950 LAPARO HERNIA REPAIR RECUR 1,227 LAP VENT/ABD HERNIA REPAIR 1,781 LAP VENT/ABD HERN PROC COMP 2,222 LAP INC HERNIA REPAIR 1,965 LAP INC HERN REPAIR COMP 2,460 LAP INC HERNIA REPAIR RECUR 1,896 LAP INC HERN RECUR COMP 2,658 UNLISTED LAPAROSCOPY P 1,809

Page 37 of 92 REPAIR OF ABDOMINAL WALL 1,726 OMENTAL FLAP, INTRA‐ABDOM 828 Abdominal Fasciotomy 1,242 DRAINAGE OF KIDNEY 2,153 PCN 2.5 CM 4,774 PCN 2.5 CM 6,985 OPEN RENAL BIOPSY 1,524 NEPHRECTOMY SIMPLE 2,219 NEPHRECTOMY RADICAL 3,035 Nephroureterectomy 2,799 NEPHROURETERECTOMY 3,273 NEPHRECTOMY PARTIAL 2,951 Cryo Ablation 1 > renal mass lesions 10,081 EXCISION OR UNROOFING 2,035 ASPIRATION OF CYST 235 NEPHROSTOGRAM 276 CYSTO ANTEGRADE 386 CHANGE KIDNEY TUBE 227 PYELOPLASTY 2,467 LAPAROSCOPIC ABLATION 2,196 LAPARO ABLATE RENAL MASS 2,716 LAPAROSCOPY RADICAL NE 3,390 LAP NEPHRECTOMY WITH P 2,455 HAND ASSISTED LAPAROSC 3,293 RENAL ENDOSCOPY THRU N 1,157 RENAL ENDO THRU NEPHRO 1,938 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE 3,714 URETEROTOMY OF INSERT 2,152 URETHERECTOMY 2,257 CHANGE OF URETER TUB 248 INJECTION FOR URETER X‐RAY 211 URETEROLYSIS WITH OR W 2,667 URETEROURETEROSTOMY 2,712 URETERONEOCYSTOSTOMY U 2,377 URETHERONEOCYSTOSTOMY 2,623 SUPRAPUBIC TA 228 OPEN CYSTOTOMY 707 INCISE BLADDER/DRAIN URETER 1,038 REMOVAL OF BLADDER STONE 1,028 DRAIN BLADDER WITH CAT 802 EXCISION OF CYT OR SIN 1,542 REMOVAL OF BLADDER LES 1,814 PARTIAL CYSTECTOMY 2,039 CYSTECTOMYPARTIALCOM 2,707 CYSTECTOMY W ILEAL CON 4,092 CYSTECTOMY WITH PELVIC 4,595 CYSTOGRAM 540

Page 38 of 92 INJ PROC RETROGRADE URETHROCYSTOGRAPHY 324 BLADDER IRRIGATION SIMPLE 222 INSERT OF NON‐INDWELLING BLADDER CATHETER 196 INSERT TEMP INDWELLING CATH, SIMPLE 254 INSERT TEMP INDWELLING CATHETER COMPLICATED 409 CHANGE OF CYSTOSTOMY TUBE, SIMPLE 358 CHNG OF CYSTOSTOMY TUBE, COMPLICATED 463 ENDO INJECT OF IMPLANT MATERIAL 693 BLADDER INSTILLATION OF ANTICARCINOGENIC AGE 373 CYSTOMETROGRAM SIMPLE 883 Complex Cystometrogram 1,283 CYSTOMETROGRAM W/UP 551 CYSTOMETROGRAM W/VP 659 CYSTOMETROGRAM W/VP&UP 715 SIMPLE UROFLOWMETRY 34 UROFLOW 139 UPP 1,003 EMG ELECTROMYOGRAPHY S 745 ANAL URINARY MUSCLE ST 285 VP STUDY 1,241 AP STUDY 700 BLADDER SCAN 112 BURCH PROCEDURE LIGAMENT FIXATION 1,480 STAMEY‐RAZ PROCEDURE 1,365 CYSTORRHAPHY 1,675 CYSTORRHAPHY COMPLICAT 2,131 CLOSURE OF CYSTOSTOMY 1,157 REPAIR BLADDER/VAGINA LESION 2,092 ENTEROCYSTOPLASTY W IN 3,029 CYSTOURETHROSCOPY 581 CYSTO, MULT CLOT EVACUATION 846 CYSTOSCOPY W/URETERAL CATH 751 CYSTO W/URETERAL CATH & BIOPSY 1,328 CYSTO W/BIOPSY(S) 1,126 CYSTO W FULGURATION OF TRIGONE 941 CYSTO W FULGARATION <.5CM 2,139 CYSTO TURBT SMALL .5‐2 640 CYSTO TURBT MED 2‐5 CM 750 CYSTO TURBT LARGE 5CM 1,330 CYSTO HYDRODILITATION 524 CYSTOSCOPY AND TREATMENT 789 CYSTO CKU 743 CYSTOSCOPY W DILATION 797 CYSTOSCOPY AND TREATMENT 579 CYSTOSCOPY AND TREATMENT 990 CYSTO STENT REMOVAL 724 CYSTOSCOPY AND TREATMENT 1,154

Page 39 of 92 LITHOPAXY 2.5 885 LITHOPAXY 2.5 1,208 CYSTO BASKET EXTRACTIO 551 CYSTOSCOPY, STONE REMOVAL 775 CYSTOSCOPY WITH COLLAG 724 CYSTO STONE MANIPULATI 553 CYSTO STENT INSERT 1,229 CYSTO RETROGRADE ACESS 572 CYSTOURETHROSCOPY W/URETERAL STRICTURE TX 606 CYSTOURTHROSCOPY W URE 1,024 CYSTOURETERO & OR PYEL 841 CYSTOURETHROSCOPY 923 URETEROSCOPY W EHL LAS 1,104 CYSTOURETHROSCOPY WITH 1,022 CYSTOURETHROSCOPY W/URETEROSCOPY A/O PYELO 905 CYSTOURETHRO CUT EJACUL DUCT 569 TRANSURETHRAL INCISION 970 TURBNC 1,196 TRANSURETHRAL ELECTROSURGICAL RESECTION OF 1,940 PROSTATECTOMY FIRST S 1,015 TURP 90 DAYS 834 TURP 1 YEAR 900 TURBNC POST OP 835 CONTACT LASER VAPORIZA 3,913 MEATOTOMY EXC INFANT 415 MEATOTOMY INFANT 415 DRAINAGE OF ABSCESS 395 CYSTO BX URETHRA 634 MALE 2,035 EXC URETHRAL DIVERTIC 1,323 EXC URETHRAL DIVERTIC 1,386 EXCISION OR FULGURATION; URETHRAL CARUNCLE 405 MALE SLING PROCEDURE 1,646 PLACEMENT ART URINARY 1,875 REMOVAL INFLATE URETHR 1,518 REMOVE/REPLACE UR SPHINCTER 1,815 REMOV/REPLC UR SPHINCTR COMP 2,865 REVISION OF URETHRA 870 DILATE URETHRA STRICTURE 152 DILATE URETHRAL SUBSEQUENT 125 URETHRAL DIL MALE 169 DIL STRICTURE FILIFORM 253 DIL STRICTURE FILIFORM 231 URETHRAL DILATION 148 DILATION OF URETHRA 145 URETHRAL DIL FEMALE 88 CATH URETHRA 164

Page 40 of 92 CATHETERIZATIONCOMPLI 596 HCFA PROSTATIC MICRO THERAPY 5,832 UNLISTED CLOT EVAC. 454 DORSAL SLIT 649 DESTRUCTION, PENIS LESION(S) 286 EXCISION OF PENIS LESION(S) 404 DESTRUCTION OF PENILE 331 BIOPSY OF PENIS 470 BIOPSY OF PENIS 738 628 CIRCUMCISION 640 CIRCUMCISION EX > 28 days old 472 LYSIS OR EXCISION OF P 259 REPAIR OF CIRCUMCISION 515 FRENULOTOMY OF PENIS 454 Irrigation of corpora cavernosa for priapism 288 PENILE INJECTION, CORPORA CAVERNOSA 213 REVISION OF PENIS 1,393 MAGPI 1,854 PENILE PROTHESIS MALLE 1,261 PENILE PROTHESIS INFLA 1,873 REMOVE REPLAC COMPONEN 1,916 REMOVAL NON AND INFLAT 1,081 REMOVE REPLACE NONINFL 1,616 PREPUTIAL STRETCHING 190 TESTES BX W GRAM 494 EXCISION OF LESION OF 1,128 ORCHIECTOMY SIMPLE 730 ORCHIECTOMY, PARTIAL 1,220 ORCHIECTOMY RADICAL 1,157 REDUCTION OF TORSION 1,034 ORCHIDOPEXY UNILATERAL 1,054 INSERT TEST PROTHESIS 710 INCISION AND DRAINAGE 581 REMOVE LESION 919 SPERMATOCELECTOMY 725 EPIDIDECTOMY 871 EPI‐VAS UNI 1,706 EPI‐VAS BIL 2,323 ASPIRATION OF A HYDROC 297 HYDROCELECTOMY 815 REMOVAL OF HYDROCELES 1,060 REPAIR OF HYDROCELE 901 DRAINAGE OF SCROTAL WA 305 EXPLORE SCROTUM 841 REMOVAL OF SCROTUM LESION 844 BIL. VASECTOMY 1,550

Page 41 of 92 VASO‐VAS UNI 1,142 REMOVAL OF HYDROCELE 946 REMOVAL OF SPERM CORD LESION 943 VARICOCELECTOMY 783 REVISE SPERMATIC CORD 1,034 NEEDLE BIOPSY 829 PROSTATOMY WITH DRAINA 1,034 REMOVAL OF PROSTATE 2,071 OPEN PROSTATECOMY 2,013 PROSTATECTOMY RETROPUB 3,099 EXTENSIVE PROSTATE SUR 3,358 RAD PROSTATECTOMY W BP 3,873 CRYOABLATE PROSTATE 6,022 SNAP GAUGE 1,567 Proc. on Heart,pericrdl sac,grt ves chst 81 I&D OF VULVAR ABSCESS 376 I&D OF BARTHOLINS GLA 419 MARSUPIALIZATION OF BARTHOLIN'S GLAND 434 LYSIS OF LABIAL ADHESIONS 286 VULVAR LESION SIMPLE DESTRUCTION W/LASER TCA 331 VULVAR BX‐1LESION 227 VULVAR BIOPSY‐EACH ADD 94 PARTIAL VULVECTOMY 1,081 HYMENECTOMY OR REV OF 368 EXCISION OF BARTHOLINS 613 REPAIR OF VAGINA 544 PERINEOPLASTY REPAIR NON OBSTETRICAL 551 VULVA 271 COLPOSCOPY OF VULVA WI 282 COLPOTOMY WITH DRAINAG 1,852 INCISION&DRAINAGE VAGI 1,103 DESTRUCTION OF VAGINAL LESION 296 DESTROY VAG LESIONS, COMPLEX 438 BX, VAGINAL MUCOSA; SIMPLE (SEP PROC) 163 BIOPSY OF VAGINAL MUCO 322 REMOVE VAGINAL WALL P 892 VAGINECTOMY 2,177 CLOSURE OF VAGINA COLP 1,208 EXCISION VAGINAL CYST 454 PESSARY FITTING 185 DIAPHRAGM FITTING 200 Treatment of Vaginal Bleeding 353 REPAIR OF VAGINA 711 ANTERIOR COLPORRHAPHY 982 POSTERIOR COLPORRHAPHY 1,552 A & P REPAIR 1,319 A&P W ENTEROCELE REP 1,555

Page 42 of 92 MESH FOR REPAIR OF PEL 635 ENTEROCELE REP‐VAGINAL 1,067 ENTEROCELE REPAIR‐ABDO 1,637 SUSPENSION OF VAGINA A 2,290 MAYO MCCALL VAULT SUSPENSION/SACROSPINOUS 1,264 UTEROSACRAL COLPOPEXY 1,492 REMOVAL REVISE BLADDER 1,628 PUBOVAGINAL SLING 1,873 REVISION OF PROSTHETIC VAGINAL GRAFT; VAGINAL 1,033 REPAIR RECTUM‐VAGINA FISTULA 1,251 REPAIR RECTUM‐VAGINA FISTULA 2,097 FISTULA REPAIR & COLOSTOMY 2,336 REPAIR FISTULA TRANSPE 1,383 PELVIC EXAMINATION UNDER ANESTHESIA, SEPARAT 238 REMOVE VAGINAL FOREIGN 466 COLPOSCOPY ENTIRE VAGI 237 COLPOSCOPY OF VAGINA/CERVIX W/BX OF VAGINA/ 298 LAPAROSCOPIC COLPOPEXY (VAULT SUSP) 2,274 COLPOSCOPY CERVIX AND UPPER VAGINA 280 COLPOSCOPY WITH BIOPSY(S) AND ECC 326 COLPOSCOPY W/BIOPSY(S) OF CERVIX 377 COLPOSCOPY W/ECC ONLY 278 LOOP ELECTRODE BIOPSY 681 COLPOSCOPY W/LEEP (SEE & TREAT) 757 POLYPECTOMY 288 ENDOCERVICAL CURETTAGE 217 CAUTERIZATION OF CERVIX 194 CAUTERY OF CERVIX, CRYOCAUTERY 370 COLD KNIFE CONIZATION OF CERVIX 713 LEEP 652 REMOVAL OF RESIDUAL CERVIX 921 DILATION OF CERVICAL CANAL 127 ENDOMETRIAL BIOPSY W/O CERVICAL DILATION 306 ENDOMETRIAL SAMPLING W 106 D&C 493 ABD MYOMECTOMY <250G 2,021 MYOMECTOMY‐VAGINAL APP 1,129 ABD MYOMECTOMY >250G 2,692 TAH W/ OR W/O BSO 2,364 TAH W/ BURCH 2,674 SUPRACERVICAL HYST W/ OR W/O BSO 2,162 HYSTERECTOMY ABDOMINAL 2,823 RADICAL HYSTERECTOMY 3,758 TVH <250G 1,905 TVH <250G W/ BSO 1,970 TVH <250G W/ BSO AND ENTEROCOELE 2,712 TVHMMK 3,229

Page 43 of 92 TVH W/ ENTEROCELE REPAIR 1,952 TVH >250G 2,538 TVH >250G W/ BSO 2,686 IUD INSERTION 239 IUD REMOVAL 208 ARTIFICIAL INSEMINATIO 165 ARTIFICAL INSEMINATION 185 SPERM WASH CAPACITATIO 67 HYSTEROSALPINGOGRAM HY 415 CHROMOTUBATION OF OVID 248 ENDOMETRIAL ABLATION T 596 LAPAROSCOPIC MYOMECTOMY 2,007 LAP ASSISTED VAGINAL H 1,860 LAVH <250G WITH BSO 1,890 LAPAROSCOPIC VAGINAL H 2,569 LAVH >250G WITH BSO 3,050 DIAGNOSTIC HYSTEROSCOP 473 HYSTEROSCOPY WITH BIOP 606 HYST.LYSIS OF ADHESION 772 HYSTEROSCOPYRESECTSE 884 HYSTMYOMECTOMY 907 HYSTEROSCOPY, REMOVE FB 817 HYSTERECTOMY ENDOMETRI 3,811 TLH, UTERUS 250 G OR LESS 1,880 TLH W/T/O 250 G OR LESS 1,880 ABDOMINAL OR VAGINAL BTL 769 LIGATION OF FALLOPIAN 815 BTL WITH CESAREAN 206 LAP LYSIS OF ADHESIONS 1,484 LAP SURG LYSIS OF ADH 1,616 LAP WITH EXCISION OF L 1,776 LS FULG OF TUBES 808 LAP WITH OCCLUSION OF 912 LAPAROSCOPIC SALPINGOS 1,841 OPEN 1,528 OPEN USO/BSO COMP/PARTIAL 1,829 LYSIS OF ADHESIONS 1,785 DRAINAGE PELVIC ABSCES 490 OVARIAN CYSTECTOMY UNI 1,724 PART OR T 1,222 REMOVAL OF OVARYS 2,447 RESECTION OVARIAN MALI 2,264 RESECTION OV. MALIG‐TA 2,957 RESECTION OV. MALIG B 3,289 BSO W OMENTECTOMY TAH 4,139 BSO, OMENTECTOMY W/TAH 2,883 LAPAROTOMY FOR STAGING 1,997

Page 44 of 92 UNLISTED, COMPARISON TO COLPOTOMY W/EXPLOR 420 AMNIOCENTESIS DIAGNOST 381 FETAL NONSTRESS TEST 180 SURGICAL TREATMENT OF 1,744 TREATMENT OF ECTOPIC 1,776 ECTOPIC, LS APPROACH 1,539 LAP TREATMENT OF ECTOP 1,673 D&C PLACENTAL REMOVAL 487 INSERT CERVICAL DILATOR 92 EPISIOTOMY OR VAGINAL REPAIR 426 CERCLAGE 382 ROUTINE OB CARE VAGINA 5,012 VAGINAL DELIVERY ONLY 1,938 DELIVERY VAGINAL POS 2,152 EXTERNAL CEPHALIC VERS 910 DELIVERY OF PLACENTA 711 OB CARE ANTEPARTUM CAR 704 OB CARE ANTEPARTUM CAR 1,544 POST PARTUM CARE 331 CESAREAN DELIVERY GLOBAL (OUR PT) 4,133 CESAREAN DELIVERY ONLY 2,208 C‐SECTION W POST CARE 2,499 HYSTERECTOMY AT TIME O 1,215 ROUTINE OB CARE VBAC 4,595 VBAC DELIVERY ONLY 2,157 DELIVERY VBAC POSTPA 2,377 OB CARE C‐SECTION FAI 4,520 C‐SECTION FAILED VBAC 2,484 SURGICAL COMPLETION OF 517 D&E, 1ST TRIMESTER 1,882 D&E, 2ND TRIMESTER 853 TREATMENT OF SEPTIC AB 1,022 INDUCED ABORTION BY D& 519 SUCTION CURETTAGE AB 797 ABORTION 1,150 INDUCED AB 1,170 D&E, MOLAR 797 COLL OF UMBILICAL CORD BLOOD AT TIME OF DELIV 1,085 BIOPSY OF THYROID 192 PARTIAL THYROID LOBECT 1,731 PARTIAL REMOVAL OF THY 2,808 REMOVAL OF THYROID GLA 2,480 EXCISION REMAINING TYR 4,115 REMOVE THYROID DUCT LESION 984 ASPIR/INJ THYROID CYST 256 EXPLORE PARATHYROID GLANDS 2,213 SCAN PROC CRANIAL EXTRA 444

Page 45 of 92 SPINAL PUNCTURE‐ LUMBA 438 SPINAL TAP THERAPEUTIC DRAINAGE CSP NEED 538 TREAT EPIDURAL SPINE LESION 181 INJECTION FOR MYELOGRAM 1,108 INJECT SPINE C/T 740 INJ SINGLE LUMBAR SACR 419 NJX INTERLAMINAR CRV/THRC 189 NJX INTERLAMINAR CRV/THRC 256 NJX INTERLAMINAR LMBR/SAC 189 NJX INTERLAMINAR LMBR/SAC 363 NJX INTERLAMINAR CRV/THRC 204 NJX INTERLAMINAR LMBR/SAC 201 IMPLANTREPOSITION TUN 1,130 REMOVE SPINAL CANAL CATHETER 599 ANALYZE SPINE INFUSION PUMP 72 ANALYZE SPINE INFUSION PUMP 144 ANL SP INF PMP W/MDREPRG&FIL 253 LOW BACK DISK SURGERY 2,216 SPINAL DISK SURGERY ADD‐ON 437 LAMINOTOMY, SINGLE LUMBAR 3,036 LAMINOTOMY, ADDL LUMBAR 865 REMOVAL OF SPINAL LAMINA 2,676 REMOVAL OF SPINAL LAMINA 2,521 REMOVE SPINAL LAMINA ADD‐ON 509 INJECTION FOR NERVE BL 345 N BLOCK INJ, FACIAL 345 GREATER OCCIPITAL NERV 313 N BLOCK INJ, SPINAL ACCESSOR 164 INJECTION OF ANESTH AGENT CERVICAL PLEX 278 N BLOCK INJ, BRACHIAL PLEXUS 443 N BLOCK INJ, AXILLARY 154 ANESTHETIC SUPRASCAPUL 351 N BLOCK INJ, INTERCOST, SNG 225 INJECTION ANESTHETIC A 547 N BLOCK INJ ILIO‐ING/HYPOGI 253 N BLOCK INJ, PUDENDAL 290 N BLOCK INJ, PARACERVICAL 285 N BLOCK INJ, SCIATIC, SNG 659 N BLOCK INJ FEM, SINGLE 570 N BLOCK INJ FEM, CONT INF 226 N BLOCK INJ, LUMBAR PLEXUS 81 INJECTION OTHER PERIPH 520 N BLOCK INJ, PLANTAR DIGIT 85 PVB THORACIC SINGLE INJ SITE 219 PVB THORACIC 2ND+ INJ SITE 120 INJ FORAMEN EPIDURAL C/T 454 INJ FORAMEN EPIDURAL ADD‐ON 218

Page 46 of 92 INJ FORAMEN EPIDURAL L/S 249 INJ FORAMEN EPIDURAL ADD‐ON 189 TAP BLOCK UNIL BY INJECTION 255 TAP BLOCK BI INJECTION 173 INJ PARAVERT F JNT C/T 1 LEV 330 INJ PARAVERT F JNT C/T 2 LEV 175 INJ PARAVERT F JNT C/T 3 LEV 179 INJ PARAVERT F JNT L/S 1 LEV 1,861 INJ PARAVERT F JNT L/S 2 LEV 968 INJ PARAVERT F JNT L/S 3 LEV 968 N BLOCK, SPENOPALATINE GANGL 142 N BLOCK, STELLATE GANGLION 216 N BLOCK INJ, HYPOGAS PLXS 328 N BLOCK, LUMBAR/THORACIC 214 N BLOCK INJ, CELIAC PELUS 302 IMPLANT NEUROELECTRODE 1,712 REVISE/REMOVE NEUROELECTRODE 641 INSERT REDO PERIPHERAL 797 REVISE/REMOVE NEURORECEIVER 608 CHEMODENERV SALIV GLANDS 238 CHEMODENERVATION, MUSCLE(S); INNERVATED, FA 401 DESTROY NERVE, SPINE MUSCLE 385 DESTROY NERVE, EXTREM MUSC 418 CHEMODENERVATION OF MUSCLE, MIGRAINE 261 CHEMODENERVATION OF MUSCLE, NECK MUSCLE, E 267 DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL 454 DESTR PARAVERTEBRL NERVE L/S 488 DESTR PARAVERTEBRAL N ADD‐ON 141 DESTR PARAVERTEBRL NERVE C/T 684 DESTR PARAVERTEBRAL N ADD‐ON 177 DESTROY CERV/THOR FACET JNT 616 DESTROY C/TH FACET JNT ADDL 282 DESTROY LUMB/SAC FACET JNT 604 DESTROY L/S FACET JNT ADDL 254 INJECTION TREATMENT OF NERVE 288 CHEMODENERV 1 EXTREMITY 1‐4 305 CHEMODENERV 1 EXTREM 5/> MUS 343 CHEMODENERV 1 EXTREM 5/> EA 191 CHEMODENERV TRUNK MUSC 1‐5 317 CHEMODENERV ECCRINE GLANDS 168 REVISE FINGER/TOE NERVE 1,081 REVISE HAND/FOOT NERVE 720 REVISE ARM/LEG NERVE 1,050 REVISE ULNAR NERVE AT ELBOW 1,287 REVISE ULNAR NERVE AT WRIST 931 CARPAL TUNNEL SURGERY 942 INCISION OF SPINAL NERVE 1,325

Page 47 of 92 REMOVE SKIN NEUROMA 982 REMOVE DIGIT NERVE LESION 828 REMOVE LIMB NERVE LESION 1,047 REMOVE NERVE LESION 1,698 REMOVE SKIN NERVE LESION 703 REMOVAL OF NERVE LESION 1,346 BIOPSY OF NERVE 459 REMOVE SYMPATHETIC NERVES 1,200 REPAIR OF DIGIT NERVE 1,533 REPAIR NERVE ADD‐ON 700 REPAIR OF HAND OR FOOT NERVE 1,677 REPAIR ARM/LEG NERVE 1,647 REPAIR OF LOW BACK NERVES 2,230 NERVE REPAIR W/ALLOGRAFT 1,880 REMOVE FOREIGN BODY FR 140 REMOVE FOREIGN BODY FR 117 REMOVE FOREIGN BODY FR 503 REMOVE FOREIGN BODY FR 169 DRAIN ABSCESS OF EYE LID 615 REMOVE EYELID LESION(S) 858 REMOVE EYELID LESION 333 REPAIR BROW DEFECT 1,403 REPAIR EYELID DEFECT 1,204 REMOVE EYELID FOREIGN BODY 483 REVISION OF EYELID 1,935 REVISION OF EYELID 1,721 EXPLORE/IRRIGATE TEAR DUCTS 267 DRAIN EXTERNAL EAR LESION 396 DRAIN EXTERNAL EAR LESION 496 DRAIN OUTER EAR CANAL LESION 535 BIOPSY OF EXTERNAL EAR 242 BIOPSY OF EXTERNAL EAR CANAL 242 REMOVE EXTERNAL EAR, PARTIAL 1,015 REMOVE EAR CANAL LESION(S) 2,064 REMOVE EAR CANAL LESION(S) 898 REMOVAL FOREIGN BODY EX Auditory Canal w/o Ane 164 REMOVAL FOREIGN BODY EX Auditory Canal w/Anes 231 REMOVE IMPACTED EAR WAX UNI 59 CERUMEN DEBRIDE ‐ UNILATERIAL 117 DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE 311 CLEAN OUT MASTOID CAVITY 482 REVISE EXTERNAL EAR 1,057 INCISION OF EARDRUM 375 INCISION OF EARDRUM 345 REMOVE VENTILATING TUBE 292 CREATE EARDRUM OPENING 446 CREATE EARDRUM OPENING 374

Page 48 of 92 EXPLORATION OF MIDDLE EAR 1,496 REMOVE MASTOID STRUCTURES 2,736 REPAIR OF EARDRUM 888 REPAIR OF EARDRUM 1,694 TYMPANOPLASTY 1,991 REVISE MIDDLE EAR & MASTOID 2,364 REVISE MIDDLE EAR & MASTOID 3,046 REVISE MIDDLE EAR BONE 2,115 MIDDLE EAR SURGERY PROCEDURE 354 INCISE INNER EAR 505 MICROSURGICAL TECHNIQU 679 X‐RAY EYE FOR FOREIGN BODY 167 X‐RAY EXAM OF JAW 442 X‐RAY EXAM OF FACIAL BONES 485 X‐RAY EXAM OF NASAL BONES 390 X‐RAY EXAM OF EYE SOCKETS 406 X‐RAY EXAM OF SINUSES 431 X‐RAY EXAM OF SKULL 503 X‐RAY EXAM OF JAW JOINTS 499 MAGNETIC IMAGE, JAW JOINT 2,956 X‐RAY EXAM OF NECK 307 CT HEAD/BRAIN W/O DYE 1,189 CT HEAD/BRAIN W/DYE 1,734 CT HEAD/BRAIN W/O&W DYE 1,888 CT ORBIT/EAR/FOSSA W/O DYE 1,972 CT ORBIT/EAR/FOSSA W/DYE 2,061 CT ORBIT/EAR/FOSSA W/O&W DYE 2,328 CT MAXILLOFACIAL W/O DYE 1,676 CT MAXILLOFACIAL W/DYE 1,877 CT MAXILLOFACIAL W/O&W DYE 2,469 CT SOFT TISSUE NECK W/O DYE 1,458 CT SOFT TISSUE NECK W/DYE 1,811 CT SFT TSUE NCK W/O & W/DYE 2,761 CT ANGIOGRAPHY, HEAD 3,831 CT ANGIOGRAPHY, NECK 3,851 MRI ORBIT/FACE/NECK W/O DYE 3,380 MRI ORBIT/FACE/NECK W/DYE 4,213 MRI ORBT/FAC/NCK W/O&W DYE 4,452 MR ANGIOGRAPHY HEAD W/O DYE 1,832 MR ANGIOGRAPHY HEAD W/DYE 1,979 MR ANGIOGRAPH HEAD W/O&W DYE 2,419 MR ANGIOGRAPHY NECK W/O DYE 1,645 MR ANGIOGRAPHY NECK W/DYE 1,695 MR ANGIOGRAPH NECK W/O&W DYE 3,340 MRI BRAIN W/O DYE 3,131 MRI BRAIN W/DYE 4,452 MRI BRAIN W/O&W DYE 4,973

Page 49 of 92 CHEST X‐RAY ‐ 1 VIEW 234 CHEST X‐RAY 304 X‐RAY EXAM CHEST 1 VIEW 200 X‐RAY EXAM CHEST 2 VIEWS 250 X‐RAY EXAM CHEST 3 VIEWS 354 X‐RAY EXAM CHEST 4+ VIEWS 465 X‐RAY 618 X‐RAY EXAM OF RIBS 313 X‐RAY EXAM OF RIBS/CHEST 382 X‐RAY EXAM OF RIBS 521 X‐RAY EXAM OF RIBS/ CHEST 623 X‐RAY EXAM OF BREASTBONE 390 X‐RAY EXAM OF BREASTBONE 399 CT THORAX W/O DYE 1,722 CT THORAX W/DYE 2,166 CT THORAX W/O&W DYE 2,583 CT ANGIOGRAPHY, CHEST 2,911 MRI CHEST W/O DYE 2,259 MRI CHEST W/DYE 2,771 MRI CHEST W/O&W/DYE 6,975 MRI ANGIO CHEST W OR W/O DYE 1,617 X‐RAY EXAM OF SPINE 170 X‐RAY EXAM OF SPINE 265 X‐RAY EXAM CERVICAL 2 OR 3 VIEWS 442 X‐RAY EXAM OF CERV SPINE 4+ VIEWS 524 X‐RAY EXAM CERV SPINE COMPLETE 678 X‐RAY EXAM SPINE; THORACOLUMBAR 429 X‐RAY EXAM THORACIC SPINE 2 VIEWS 328 X‐RAY EXAM OF THORACIC SPINE 3 VIEWS 92 X‐RAY EXAM OF THORACIC SPINE 4 VIEWS 100 X‐RAY EXAM SPINE; THORACOLUMBAR 2 VIEWS 78 X‐RAY EXAM ENTIRE SPI 1 VW 395 X‐RAY EXAM SPINE; SCOLIOSIS STUDY; AP/LAT 115 X‐RAY EXAM LUMBOSACRAL; 2 OR 3 VIEWS 389 X‐RAY EXAM LUMBOSACRAL 4+ VIEWS 550 X‐RAY EXAM LUMBOSACRAL;COMPLETE W/BENDING 292 X‐RAY LUMBOSACRAL SPINE;BENDING VIEWS ONLY; 117 CT NECK SPINE W/O DYE 1,542 CT NECK SPINE W/DYE 1,833 CT NECK SPINE W/O&W/DYE 2,525 CT CHEST SPINE W/O DYE 1,538 CT CHEST SPINE W/DYE 1,930 CT CHEST SPINE W/O&W/DYE 2,350 CT LUMBAR SPINE W/O DYE 1,535 CT LUMBAR SPINE W/DYE 1,914 CT LUMBAR SPINE W/O&W/DYE 2,818 MRI NECK SPINE WO DYE 3,033

Page 50 of 92 MRI NECK SPINE W/DYE 4,318 MRI DORSAL/THORACIC SPINE W/O DYE 3,245 MRI CHEST SPINE W/DYE 3,622 MRI LUMBAR SPINE WO DYE 3,181 MRI LUMBAR SPINE W/DYE 4,169 MRI NECK SPINE W/O 4,600 MRI CHEST SPINE W/O&W/DYE 4,672 MRI LUMBAR SPINE W/O&W/DYE 4,646 X‐RAY EXAM PELVIS; 1 OR 2 VIEWS 257 X‐RAY EXAM OF PELVIS 98 CT ANGIOGRAPH PELV W/O&W/DYE 2,842 CT PELVIS W/O DYE 1,464 CT PELVIS W/DYE 2,192 CT PELVIS W/O&W/DYE 2,915 MRI PELVIS W/O DYE 4,048 MRI PELVIS W/DYE 4,060 MRI PELVIS W/O & W/DYE 5,232 MR ANGIO PELVIS W/O&W/DYE 1,617 X‐RAY EXAM SACRUM/COCCYX < 3 VIEWS 186 X‐RAY EXAM SACROILIAC JOINTS 3 + VIEWS 434 X‐RAY EXAM OF TAILBONE 2 + VIEWS 299 CONTRAST X‐RAY OF NECK SPINE 1,133 CONTRAST X‐RAY, LOWER SPINE 986 X‐RAY EXAM OF CLAVICLE COMPLETE 334 X‐RAY EXAM OF SHOULDER BLADE 344 X‐RAY EXAM OF SHOULDER, 1 VIEW 277 X‐RAY EXAM OF SHOULDER, 2+ VIEWS 297 CONTRAST X‐RAY OF SHOULDER 1,092 X‐RAY EXAM OF SHOULDERS 437 X‐RAY EXAM OF HUMERUS, 2 + VIEWS 293 X‐RAY EXAM OF ELBOW; 2 VIEWS 278 X‐RAY EXAM OF ELBOW; 3+ VIEWS 437 CONTRAST X‐RAY OF ELBOW 559 X‐RAY EXAM OF FOREARM; 2 VIEWS 334 X‐RAY EXAM OF ARM, INFANT 71 X‐RAY EXAM OF WRIST; 2 VIEWS 347 X‐RAY EXAM OF WRIST; 3+ VIEWS 437 CONTRAST X‐RAY OF WRIST 559 X‐RAY EXAM OF HAND; 2 VIEWS 275 X‐RAY EXAM OF HAND; 3+ VIEWS 323 X‐RAY EXAM OF FINGER(S); 2+ VIEWS 313 CT UPPER EXTREMITY W/O DYE 1,471 CT UPPER EXTREMITY W/DYE 1,716 CT UPPR EXTREMITY W/O&W/DYE 2,350 CT ANGIO UPR EXTRM W/O&W/DYE 3,171 MRI UPPER EXTREMITY WO DYE 3,932 MRI UPPER EXTREMITY W/DYE 306

Page 51 of 92 MRI UPPR EXTREMITY W/O&W/DYE 5,529 MRI JOINT UPR EXTREM WO DYE 3,162 MRI JOINT UPR EXTREM W/DYE 3,394 MRI JOINT UPR EXTR W/O&W/DYE 5,247 X‐RAY EXAM OF HIP 65 X‐RAY EXAM HIP UNI 1 VIEW 42 X‐RAY EXAM HIP UNI 2‐3 VIEWS 221 X‐RAY EXAM HIP UNI 4/> VIEWS 105 X‐RAY EXAM HIP; COMPLETE, 2+ VIEWS 381 X‐RAY EXAM BIL HIPS; 2+ VIEWS 399 X‐RAY EXAM HIPS BI 2 VIEWS 357 CONTRAST X‐RAY OF HIP 559 X‐RAY EXAM FEMUR; 2 VIEWS 292 X‐RAY EXAM FEMUR MIN 2 VIEWS 165 X‐RAY EXAM OF KNEE, 1 OR 2 VIEWS 288 X‐RAY EXAM OF KNEE, 3 VIEWS 420 X‐RAY EXAM, KNEE, 4 OR MORE 406 X‐RAY EXAM OF KNEES; STANDING, AP 309 CONTRAST X‐RAY OF KNEE JOINT 103 X‐RAY EXAM TIB/FIB; 2 VIEWS 325 X‐RAY EXAM OF ANKLE; 2 VIEWS 330 X‐RAY EXAM OF ANKLE; 3+ VIEWS 323 X‐RAY EXAM OF FOOT; 2 VIEWS 317 X‐RAY EXAM OF FOOT 3+ VIEWS 382 X‐RAY EXAM OF HEEL, 2+ VIEWS 325 X‐RAY EXAM OF TOE(S), 2+ VIEWS 300 CT LOWER EXTREMITY W/O DYE 1,784 CT LOWER EXTREMITY W/DYE 2,191 CT LWR EXTREMITY W/O&W/DYE 2,350 CT ANGIO LWR EXTR W/O&W/DYE 3,080 MRI LOWER EXTREMITY WO DYE 3,349 MRI LOWER EXTREMITY W/DYE 306 MRI LWR EXTREMITY W/O&W/DYE 4,526 MRI JNT OF LWR EXTRE WO DYE 3,144 MRI JOINT OF LWR EXTR W/DYE 3,826 MRI JOINT LWR EXTR W/O&W/DYE 4,969 MR ANG LWR EXT W OR W/O DYE 1,617 X‐RAY EXAM OF ABDOMEN 36 X‐RAY EXAM ABDOMEN 1 VIEW 228 X‐RAY EXAM ABDOMEN 2 VIEWS 357 X‐RAY EXAM ABDOMEN 3+ VIEWS 378 CT ABDOMEN W/O DYE 1,447 CT ABDOMEN W/DYE 2,044 CT ABDOMEN W/O&W/DYE 2,799 CT ANGIO ABD&PELV W/O&W/DYE 3,027 CT ANGIO ABDOM W/O&W/DYE 2,991 CT ABD & PELVIS W/O CONTRAST 2,893

Page 52 of 92 CT ABDOMEN&PELVIS W/CONTRAST 3,781 CT ABD&PELV 1+ SECTION/REGNS 5,114 MRI ABDOMEN W/O DYE 3,079 MRI ABDOMEN W/DYE 4,244 MRI ABDOMEN W/O&W/DYE 5,237 MRI ANGIO, ABDOM W OR W/O DY 3,672 CONTRAST X‐RAY, ESOPHAGUS 846 X‐RAY EXAM, UPPER GI TRACT 1,159 CONTRST X‐RAY UPPR GI TRACT 2,215 X‐RAY EXAM OF SMALL BOWEL 1,032 CONTRAST X‐RAY EXAM OF COLON 2,430 X‐RAY BILE DUCTS/PANCREAS 298 X‐RAYS AT SURGERY ADD‐ON 26 X‐RAY BILE DUCTS/PANCREAS 299 X‐RAY BILE DUCT ENDOSCOPY 356 X‐RAY FOR PANCREAS ENDOSCOPY 484 X‐RAY BILE/PANC ENDOSCOPY 447 UROGRAPHY INFUSION DRIP/BOLUS TECH 1,238 UROGRAPHY RETROGRADE 1,891 CONTRST X‐RAY, URINARY TRACT 629 CYSTOGRAPHY MIN 3 VIEWS 476 URETHROCYSTOGRAPHY RETROGRADE 477 X‐RAY, URETHRA/BLADDER 1,022 X‐RAY EXAM OF KIDNEY LESION 103 INTRODUCTION OF A NT 858 X‐RAY CONTROL, CATH INSERT 807 DILATION OF NT TRACT 933 X‐RAY MEASUREMENT OF PELVIS 335 X‐RAY, FEMALE GENITAL TRACT 937 CT HRT W/O DYE W/CA TEST 111 CT HRT W/3D IMAGE, CONGEN 3,798 CT ANGIO HRT W/3D IMAGE 3,610 CT ANGIO ABDOMINAL ARTERIES 3,316 VEIN X‐RAY, ARM/LEG 454 VEIN X‐RAY, CHEST 129 X‐RAYS, TRANSCATH THERAPY 163 CHANGE OF PERCUTANEOUS 433 RADIOLOGICAL GUIDANCE 1,980 FLUOROSCOPY EXAM UP TO 1 HR 774 FLUOROSCOPE EXAM, EXTENSIVE 1,179 X‐RAY, NOSE TO RECTUM 221 EXAM OF FISTULA 261 X‐RAY EXAM, BREAST SPECIMEN 161 CT BIOPSY ABD OR RETROPERITINEUM 1,039 3D RENDER W/O POSTPROCESS 491 3D RENDERING W/POSTPROCESS 491 CAT SCAN FOLLOW‐UP STUDY 1,290

Page 53 of 92 ECHO EXAM OF HEAD 673 ULTRASOUND HEAD AND NECK 717 ULTRASOUND BREAST COMPLETE 545 ULTRASOUND BREAST LIMITED 516 ULTRASOUND BREAST UNIL 617 ULTRASOUND ABDOMINAL 957 ULTRASOUND ABDOMINAL LIMITED 590 US ABDL AORTA SCREEN AAA 462 US EXAM ABDO BACK WALL, COMP 681 ULTRASOUND RETROPENITO 649 US EXAM, SPINAL CANAL 595 OB ULTRASOUND 14 WEEK 816 OB ULTRASOUND ADD FETU 306 OB ULTRASOUND GREATER THEN 14 WEEKS 920 OB US >/= 14 WKS, ADDL FETUS 404 OB US NUCHAL MEAS, 1 GEST 701 OB US NUCHAL MEAS, ADD‐ON 205 ULTRASOUND PREGNANT UTERUS 557 FOLLOWUP OB US GREATER 14 WEEKS 606 ULTRASOUND TRANSVAGINAL 620 BIOPHYSICAL PROFILE WI 711 FETAL BIOPHYS PROFIL W/O NST 82 TRANSVAGINAL ULTRASOUND 814 ECHO EXAM, UTERUS 748 PELVIC ULTASOUND (NON OB)COMPL 803 PELVIC ULTRASOUND LIMI 422 ULTRASOUND OF SCROTUM 794 TRANSRECTAL ULTRASOUND 1,000 ULTRASOUND EXTREMITY N 457 US XTR NON‐VASC COMPLETE 857 US XTR NON‐VASC LMTD 405 US EXAM INFANT HIPS, DYNAMIC 731 ECHO GUIDE, CARDIOCENTESIS 280 ULTRASOUND GUIDANCE VA 180 US GUIDANCE FOR NEEDLE PLACEMENT 797 ULTRASOUND GUIDANCE 375 US GUIDE, INTRAOP 151 ECHO EXAMINATION PROCEDURE 677 FLUOROSCOPIC GUIDANCE 265 FLUORO GUIDE FOR NEEDLE 549 FLUOROGUIDE FOR SPINE INJECT 317 CT SCAN FOR NEEDLE BIOPSY 404 STEREOTACT GUIDE FOR BRST BX 1,629 GUIDANCE FOR NEEDLE, BREAST 124 COMPUTER DX MAMMOGRAM ADD‐ON 69 COMP SCREEN MAMMOGRAM ADD‐ON 69 MAMMOGRAM, ONE BREAST 135

Page 54 of 92 MRI, ONE BREAST 3,058 MRI, BOTH BREASTS 3,058 BREAST TOMOSYNTHESIS UNI 58 BREAST TOMOSYNTHESIS BI 58 BREAST TOMOSYNTHESIS BI 58 DX MAMMO INCL CAD UNI 648 DX MAMMO INCL CAD BI 826 SCR MAMMO BI INCL CAD 684 X‐RAYS FOR BONE AGE 200 X‐RAYS, BONE LENGTH STUDIES 337 X‐RAYS, BONE SURVEY COMPLETE 1,006 JOINT SURVEY, SINGLE VIEW 2 OR MORE JOINTS 103 DXA BONE DENSITY, AXIAL 450 DXA BONE DENSITY/PERIPHERAL 259 THYROID, SINGLE UPTAKE 492 THYROID IMAGING 1,086 THYROID UPTAKE MEASUREMENT 511 THYROID IMAGING W/BLOOD FLOW 1,086 THYROID IMAGING W/BLOOD FLOW 1,541 PARATHYROID NUCLEAR IMAGING 563 SPLEEN IMAGING 870 LYMPH SYSTEM IMAGING 2,243 LIVER IMAGING 1,078 LIVER IMAGE (3D) WITH FLOW 1,445 HEPATOBILIARY SYSTEM IMAGING 2,092 HEPATOBIL SYST IMAGE W/DRUG 2,868 GASTRIC EMPTYING STUDY 2,112 ACUTE GI BLOOD LOSS IMAGING 2,133 MECKEL'S DIVERT EXAM 2,114 BONE IMAGING, LIMITED AREA 929 BONE IMAGING, MULTIPLE AREAS 1,492 BONE IMAGING, WHOLE BODY 1,857 BONE IMAGING, 3 PHASE 2,107 BONE IMAGING (3D) 1,227 VASCULAR FLOW IMAGING 1,365 HT MUSCLE IMAGE SPECT, SING 3,508 HT MUSCLE IMAGE SPECT, MULT 2,900 HT MUSC IMAGE, PLANAR, MULT 1,274 HEART IMAGE (3D), MULTIPLE 2,894 GATED HEART, PLANAR, SINGLE 811 HEART WALL MOTION ADD‐ON 309 HEART FUNCTION ADD‐ON 309 LUNG PERFUSION IMAGING 1,154 LUNG VENTILAT&PERFUS IMAGING 2,003 PET CT BRAIN ONLY 4,869 KIDNEY IMAGING, STATIC 1,069 KIDNEY IMAGING WITH FLOW 1,356

Page 55 of 92 KIDNEY FLOW/FUNCTION IMAGE 1,619 URETERAL REFLUX STUDY 870 TUMOR IMAGING, MULT AREAS 1,457 TUMOR IMAGING, WHOLE BODY 2,043 TUMOR IMAGING, WHOLE BODY 2,043 ABSCESS IMAGING, LTD AREA 1,675 ABSCESS IMAGING, WHOLE BODY 2,076 METABOLIC PANEL IONIZED CA 174 BASIC METABOLIC PANEL 63 GENERAL HEALTH PANEL 343 ELECTROLYTE PANEL 50 COMPREHEN METABOLIC PANEL 84 OBSTETRIC PANEL 349 LIPID PANEL 112 RENAL FUNCTION PANEL 57 ACUTE HEPATITIS PANEL 474 HEPATIC FUNCTION PANEL 57 OBSTETRIC PANEL 539 LAB DRUG SCREEN 132 DRUG SCREEN, SINGLE 112 ASSAY OF AMIKACIN 181 ASSAY, CARBAMAZEPINE, TOTAL 155 ASSAY OF CYCLOSPORINE 169 DRUG SCREEN QUANT CLOZAPINE 159 ASSAY OF DIGOXIN 48 ASSAY, DIPROPYLACETIC ACID 145 DIPROPYLACETIC ACID FREE 145 ASSAY OF ETHOSUXIMIDE 133 ASSAY OF GENTAMICIN 180 ASSAY OF HALOPERIDOL 132 DRUG SCREEN QUAN LAMOTRIGINE 164 DRUG SCRN QUAN LEVETIRACETAM 199 ASSAY OF LITHIUM 83 DRUG SCRN QUAN MYCOPHENOLATE 124 DRUG SCRN QUANT OXCARBAZEPIN 184 ASSAY OF PHENOBARBITAL 137 ASSAY OF PHENYTOIN, TOTAL 143 ASSAY OF PHENYTOIN, FREE 140 ASSAY OF PRIMIDONE 169 ASSAY OF PROCAINAMIDE 186 ASSAY OF QUINIDINE 128 ASSAY OF SIROLIMUS 208 ASSAY OF TACROLIMUS 225 ASSAY OF THEOPHYLLINE 144 ASSAY OF TOBRAMYCIN 165 ASSAY OF TOPIRAMATE 155 ASSAY OF VANCOMYCIN 173

Page 56 of 92 DRUG SCREEN QUANT ZONISAMIDE 184 QUANTITATIVE ASSAY, DRUG 258 DRUG TEST PRSMV INSTRMNT 179 DRUG TEST PRSMV CHEM ANLYZR 302 METHYLPHENIDATE 189 LAB PATHOLOGY CONSULTATION 696 URINALYSIS, DIPSTICK W/MICROSCOP 16 URINALYSIS, AUTO W/SCOPE 22 URINALYSIS NONAUTO W/O SCOPE 10 URINALYSIS AUTOMATED W 18 URINALYSIS 74 UA (MICRO ONLY) 36 URINE PREGNANCY TEST 39 URINALYSIS, VOLUME MEASURE 32 BRCA1&2 SEQ & FULL DUP/DEL 3,764 BCR/ABL1 GENE MAJOR BP 1,078 BCR/ABL1 GENE MINOR BP 953 BRAF GENE 432 BRCA1&2 SEQ & COM DUP/DEL 2,681 BRCA1&2 UNCOM DUP/DEL VAR 1,238 BRCA1 GENE KNOWN FAM VARIANT 670 CALR GENE COM VARIANTS 801 CFTR GENE COM VARIANTS 2,955 CYP2C19 GENE COM VARIANTS 563 CYP2D6 GENE COM VARIANTS 1,125 CYTOGEN M ARRAY COPY NO&SNP 2,813 EGFR GENE COM VARIANTS 730 F2 GENE 406 F5 GENE 405 FMR1 GENE DETECTION 817 FMR1 GENE CHARACTERIZATION 427 FLT3 GENE ANALYSIS 445 HFE GENE 540 IGH VARI REGIONAL MUTATION 1,430 STR MARKERS SPECIMEN ANAL 212 JAK2 GENE 605 KRAS GENE 632 MTHFR GENE 440 MICROSATELLITE INSTABILITY 659 PCA3/KLK3 ANTIGEN 764 PMS2 GENE FULL SEQ ANALYSIS 1,576 SNRPN/UBE3A GENE 394 SERPINA1 GENE 91 HLA I TYPING 1 ANTIGEN LR 481 HLA II TYPING AG EQUIV LR 1,449 HLA II TYPE 1 AG EQUIV LR 297 HLA II TYPING 1 ALLELE HR 719

Page 57 of 92 MOPATH PROCEDURE LEVEL 1 547 MOPATH PROCEDURE LEVEL 2 769 MOPATH PROCEDURE LEVEL 3 802 MOPATH PROCEDURE LEVEL 7 2,411 FETAL CHRMOML ANEUPLOIDY 4,219 UNLISTED MOLECULAR PATHOLOGY 568 FETAL ANEUPLOIDY TRISOM RISK 4,219 UNLISTED MAAA 768 TEST FOR ACETONE/KETONES 61 ACETONE ASSAY 115 ACYLCARNITINES, QUANT 129 ASSAY OF ACTH 312 ASSAY OF SERUM ALBUMIN 49 ASSAY OF URINE ALBUMIN 77 MICROALBUMIN, QUANTITATIVE 82 MICROALBUMIN, SEMIQUANT 37 ASSAY OF ALDOLASE 94 ASSAY OF ALDOSTERONE 272 ALPHA‐1‐ANTITRYPSIN, TOTAL 115 ALPHA‐1‐ANTITRYPSIN, PHENO 140 ALPHA‐FETOPROTEIN, SERUM 162 ALPHA‐FETOPROTEIN L3 426 ASSAY OF ALUMINUM 177 AMINO ACIDS, SINGLE QUANT 255 ASSAY, AMINOLEVULINIC ACID 255 AMINO ACIDS, QUANT, 2‐5 130 AMINO ACIDS, QUAN, 6 OR MORE 255 ASSAY OF AMMONIA 299 ASSAY OF AMYLASE 63 ASSAY OF ANDROSTENEDIONE 242 ANGIOTENSIN I ENZYME TEST 129 ASSAY OF APOLIPOPROTEIN 117 ASSAY OF ARSENIC 184 ASSAY OF ASCORBIC ACID 118 ASSAY OF BETA‐2 PROTEIN 162 BILIRUBIN, TOTAL 44 BILIRUBIN, DIRECT 46 LAB OCCULT BLOOD Sceening 3 sample 13 OCCULT BLOOD, OTHER SOURCES 46 OCCULT BLOOD TEST SING Diagnostic 26 BLOOD OCCULT BY FECAL HEMOGLOBIN DETERMINA 65 ASSAY OF CADMIUM 181 ASSAY OF VITAMIN D 291 ASSAY OF CALCITONIN 226 ASSAY OF CALCIUM 46 ASSAY OF CALCIUM 105 ASSAY OF CALCIUM IN URINE 59

Page 58 of 92 CALCULUS ASSAY, QUANT 132 CALCULUS SPECTROSCOPY 132 ASSAY, C‐D TRANSFER MEASURE 431 ASSAY, BLOOD CARBON DIOXIDE 47 ASSAY, BLOOD CARBON MONOXIDE 114 CARCINOEMBRYONIC ANTIGEN 182 ASSAY OF CARNITINE 178 ASSAY OF CAROTENE 267 ASSAY, URINE CATECHOLAMINES 198 ASSAY, THREE CATECHOLAMINES 265 ASSAY OF CERULOPLASMIN 95 CHEMILUMINESCENT ASSAY 162 ASSAY OF BLOOD CHLORIDE 44 ASSAY OF URINE CHLORIDE 44 ASSAY, OTHER FLUID CHLORIDES 44 TEST FOR CHLOROHYDROCARBONS 157 ASSAY, BLD/SERUM CHOLESTEROL 46 ASSAY, SERUM CHOLINESTERASE 100 GAS/LIQUID CHROMATOGRAPHY 193 THIN LAYER CHROMATOGRAPHY 107 CHROMOTOGRAPHY, QUANT, SING 329 CHROMOTOGRAPHY, QUANT, MULT 256 ASSAY OF CHROMIUM 159 ASSAY OF CITRATE 242 COLLAGEN CROSSLINKS 301 ASSAY OF COPPER 106 CORTISOL, FREE 225 TOTAL CORTISOL 157 ASSAY OF CREATINE 63 COLUMN CHROMOTOGRAPHY, QUAL 181 COLUMN CHROMOTOGRAPHY, QUANT 364 COLUMN CHROMOTOGRAPH/ISOTOPE 890 ASSAY OF CK (CPK) 48 ASSAY OF CPK IN BLOOD 130 CREATINE, MB FRACTION 177 ASSAY OF CREATININE 46 ASSAY OF URINE CREATININE 51 CREATININE CLEARANCE TEST 92 ASSAY OF CRYOGLOBULIN 69 VITAMIN B‐12 94 B‐12 BINDING CAPACITY 115 CYSTATIN C 180 DEHYDROEPIANDROSTERONE 235 DEHYDROEPIANDROSTERONE 179 DEOXYCORTISOL 139 ASSAY OF DIHYDROXYVITAMIN D 367 PANCREATIC ELASTASE, FECAL 424

Page 59 of 92 ENZYME CELL ACTIVITY 395 ASSAY OF ERYTHROPOIETIN 156 ASSAY OF 270 ASSAY OF ESTROGEN 209 ASSAY OF ESTRIOL 163 ASSAY OF ESTRONE 209 ASSAY OF ETHYLENE GLYCOL 157 FATS/LIPIDS, FECES, QUAL 105 FATS/LIPIDS, FECES, QUANT 209 LONG CHAIN FATTY ACIDS 276 ASSAY OF FERRITIN 132 ASSAY OF FETAL FIBRONECTIN 862 BLOOD FOLIC ACID SERUM 120 ASSAY OF FOLIC ACID, RBC 177 ASSAY OF FRUCTOSE 118 GALECTIN 3 155 ASSAY OF GAMMAGLOBULIN IGM 90 ASSAY OF GAMMAGLOBULIN IGE 114 IGG 1, 2, 3 OR 4, EACH 135 BLOOD PH 101 BLOOD GASES: PH, PO2 & PCO2 250 ASSAY OF GASTRIN 136 ASSAY OF GLUCAGON 204 GLUCOSE OTHER FLUID 74 GLUCOSE TOLERANCE TEST 28 ASSAY, GLUCOSE, BLOOD QUANT 29 GLUCOSE BLOOD REAGENT 33 GLUCOSE; POST GLUCOSE DOSE 23 GLUCOSE TOLERANCE TEST (GTT) 142 GTT‐ADDED SAMPLES 46 ASSAY OF G6PD ENZYME 102 ASSAY OF GGT 69 ASSAY OF GLUTATHIONE 112 GLYCATED PROTEIN 104 GONADOTROPIN (FSH) 180 GONADOTROPIN (LH) 179 ASSAY, GROWTH HORMONE (HGH) 120 ASSAY OF HAPTOGLOBIN, QUANT 123 QUANTITATIVE SCREEN, METALS 189 HEMOGLOBIN ELECTROPHORESIS 124 HEMOGLOBIN CHROMOTOGRAPHY 175 GLYCATED HEMOGLOBIN TEST 86 GLYCOSYLATED HB, HOME DEVICE 22 BLOOD METHEMOGLOBIN ASSAY 70 ASSAY OF HEMOSIDERIN, QUAL 70 ASSAY OF B HEXOSAMINIDASE 392 ASSAY OF HISTAMINE 324

Page 60 of 92 ASSAY OF HOMOCYSTINE 199 ASSAY OF FOR HVA 52 ASSAY OF CORTICOSTEROIDS 178 ASSAY OF 5‐HIAA 125 ASSAY OF PROGESTERONE 159 IMMUNOASSAY, NONANTIBODY 141 IMMUNOASSAY, NONANTIBODY 659 IMMUNOASSAY, RIA 518 ASSAY OF INSULIN 109 ASSAY OF INSULIN 80 ASSAY OF IRON 63 IRON BINDING TEST 86 FRACTIONATION, KETOSTEROIDS 379 ASSAY OF LACTIC ACID 103 LACTATE (LD) (LDH) ENZYME 59 ASSAY OF LDH ENZYMES 130 LACTOFERRIN, FECAL (QUAL) 133 LACTOFERRIN, FECAL (QUANT) 210 ASSAY OF LEAD 55 LAMELLAR BDY, FETAL LUNG 82 ASSAY OF LIPASE 61 ASSAY OF LIPOPROTEIN(A) 154 LIPOPROTEIN BLD, HR FRACTION 250 LIPOPROTEIN, BLD, BY NMR 211 ASSAY OF LIPOPROTEIN 70 ASSAY OF BLOOD LIPOPROTEIN 100 ASSAY OF MAGNESIUM 61 ASSAY OF MANGANESE 189 MASS SPECTROMETRY QUANT 189 ASSAY OF MERCURY 157 ASSAY OF METANEPHRINES 237 MUCOPOLYSACCHARIDES 174 ASSAY OF CSF PROTEIN 180 ASSAY OF MYOGLOBIN 150 NATRIURETIC PEPTIDE 295 ASSAY, NEPHELOMETRY NOT SPEC 130 ASSAY OF NICKEL 176 ASSAY OF NUCLEOTIDASE 124 OLIGOCLONAL BANDS 194 ORGANIC ACIDS, TOTAL, QUANT 224 ORGANIC ACIDS, QUAL, EACH 268 ORGANIC ACID, SINGLE, QUANT 204 ASSAY OF BLOOD OSMOLALITY 80 ASSAY OF URINE OSMOLALITY 80 ASSAY OF OXALATE 110 ONCOPROTEIN, HER‐2/NEU 426 ONCOPROTEIN, DCP 273

Page 61 of 92 ASSAY OF PARATHORMONE 321 ASSAY OF BODY FLUID ACIDITY 68 ASSAY FOR PHENCYCLIDINE 162 ASSAY FOR CALPROTECTIN FECAL 267 PKU W/OUT CARD 742 ASSAY ACID PHOSPHATASE 73 ASSAY PROSTATE PHOSPHATASE 95 ASSAY ALKALINE PHOSPHATASE 95 ASSAY ALKALINE PHOSPHATASES 131 AMNIOTIC FLUID ENZYME TEST 160 ASSAY OF PHOSPHORUS 46 ASSAY OF URINE PHOSPHORUS 48 ASSAY OF PORPHOBILINOGEN 108 PLACENTA ALPHA MICRO IG C/V 525 ASSAY OF URINE PORPHYRINS 137 ASSAY OF FECES PORPHYRINS 939 ASSAY OF SERUM POTASSIUM 44 ASSAY OF URINE POTASSIUM 48 ASSAY OF PREALBUMIN 108 ASSAY OF PREGNENOLONE 143 ASSAY OF PROGESTERONE 200 PROCALCITONIN (PCT) 267 ASSAY OF PROLACTIN 187 ASSAY OF PROSTAGLANDIN 317 ASSAY OF PSA, COMPLEXED 151 ASSAY OF PSA, TOTAL 125 ASSAY OF PSA, FREE 125 ASSAY OF PROTEIN 48 ASSAY OF PROTEIN, URINE 48 ASSAY OF PROTEIN, OTHER 44 PAPPA, SERUM 104 ASSAY OF SERUM PROTEINS 106 PROTEIN E‐PHORESIS/URINE/CSF 124 WESTERN BLOT TEST 182 PROTEIN, WESTERN BLOT TEST 518 ASSAY RBC PROTOPORPHYRIN 138 ASSAY OF PROINSULIN 389 ASSAY OF VITAMIN B‐6 235 ASSAY OF PYRUVATE 101 ASSAY, NONENDOCRINE RECEPTOR 255 ASSAY OF RENIN 161 ASSAY OF VITAMIN B‐2 225 ASSAY OF SELENIUM 214 ASSAY OF SEROTONIN 320 ASSAY OF SEX HORMONE GLOBUL 151 ASSAY OF SIALIC ACID 225 ASSAY OF SERUM SODIUM 44

Page 62 of 92 ASSAY OF URINE SODIUM 47 ASSAY OF SWEAT SODIUM 87 ASSAY OF SOMATOMEDIN 177 ASSAY OF SOMATOSTATIN 295 SPECTROPHOTOMETRY 90 SUGARS, MULTIPLE, QUAL 589 SUGARS SINGLE QUANT 96 ASSAY OF URINE SULFATE 86 ASSAY OF TESTOSTERONE 172 ASSAY OF TOTAL TESTOSTERONE 174 TESTOSTERONE BIOAVAILABLE 172 ASSAY OF VITAMIN B‐1 162 ASSAY OF THYROGLOBULIN 196 ASSAY OF TOTAL THYROXINE 56 ASSAY OF FREE THYROXINE 125 ASSAY OF THYROID ACTIVITY 138 ASSAY THYROID STIM HORMONE 144 ASSAY OF TSI 346 ASSAY OF VITAMIN E 137 ASSAY OF TRANSCORTIN 125 TRANSFERASE (AST) (SGOT) 46 ALANINE AMINO (ALT) (SGPT) 51 ASSAY OF TRANSFERRIN 99 ASSAY OF TRIGLYCERIDES 48 ASSAY OF THYROID (T3 OR T4) 56 ASSAY, TRIIODOTHYRONINE (T3) 137 FREE ASSAY (FT‐3) 235 T3 REVERSE 296 ASSAY OF TROPONIN, QUANT 171 ASSAY OF UREA NITROGEN 43 ASSAY OF URINE/UREA‐N 44 ASSAY OF BLOOD/URIC ACID 44 ASSAY OF URINE/URIC ACID 48 ASSAY OF URINE VMA 142 ASSAY OF VIP 359 ASSAY OF VASOPRESSIN 328 ASSAY OF VITAMIN A 119 ASSAY OF NOS VITAMIN 267 ASSAY OF VITAMIN K 237 XYLOSE TOLERANCE TEST 399 ASSAY OF ZINC 108 ASSAY OF C‐PEPTIDE 146 CHORIONIC GONADOTROPIN TEST 115 GONADOTROPING CHORIONI 56 CLINICAL CHEMISTRY TEST 143 BLEEDING TIME TEST 131 BL SMEAR W/DIFF WBC COUNT 45

Page 63 of 92 BL SMEAR W/O DIFF WBC COUNT 19 HEMATOCRIT 22 BLOOD COUNT, HEMATOCRIT 28 BLOOD COUNT HEMOGLOBIN 18 COMPLETE CBC W/AUTO DIFF WBC 73 COMPLETE CBC, AUTOMATED 59 AUTOMATED RBC COUNT 44 AUTOMATED RETICULOCYTE COUNT 62 AUTOMATED LEUKOCYTE COUNT 39 AUTOMATED PLATELET COUNT 39 BLOOD SMEAR INTERPRETATION 141 BLOOD CLOT FACTOR V TEST 294 BLOOD CLOT FACTOR VII TEST 294 BLOOD CLOT FACTOR VIII TEST 294 BLOOD CLOT FACTOR VIII TEST 233 BLOOD CLOT FACTOR VIII TEST 233 BLOOD CLOT FACTOR VIII TEST 233 BLOOD CLOT FACTOR IX TEST 294 BLOOD CLOT FACTOR X TEST 294 BLOOD CLOT FACTOR XI TEST 294 BLOOD CLOT FACTOR XII TEST 294 BLOOD CLOT FACTOR XIII TEST 249 ANTITHROMBIN III TEST 231 ANTITHROMBIN III TEST 270 BLOOD CLOT INHIBITOR ANTIGEN 238 BLOOD CLOT INHIBITOR TEST 203 BLOOD CLOT INHIBITOR ASSAY 243 BLOOD CLOT INHIBITOR TEST 277 ASSAY ACTIVATED PROTEIN C 183 FACTOR INHIBITOR TEST 131 FIBRIN DEGRADATION PRODUCTS 145 FIBRIN DEGRADATION, QUANT 263 FIBRINOGEN 116 FIBRINOLYTIC ANTIPLASMIN 293 FIBRINOLYTIC PLASMINOGEN 145 HEMOGLOBIN, FETAL 189 HEMOGLOBIN, FETAL 92 HEPARIN ASSAY 351 WBC ALKALINE PHOSPHATASE 124 MURAMIDASE 152 RBC OSMOTIC FRAGILITY 314 BLOOD PLATELET AGGREGATION 164 PLATELET NEUTRALIZATION 200 HEXAGNAL PHOSPH PLTLT NEUTRL 189 PROTHROMBIN TIME 50 PROTHROMBIN TEST 58 RUSSELL VIPER VENOM, DILUTED 140

Page 64 of 92 RBC SED RATE, AUTOMATED 43 RBC SICKLE CELL TEST 93 THROMBIN TIME, PLASMA 95 THROMBOPLASTIN INHIBITION 203 THROMBOPLASTIN TIME, PARTIAL 59 THROMBOPLASTIN TIME, PARTIAL 123 BLOOD VISCOSITY EXAMINATION 120 AGGLUTININS, FEBRILE 126 ALLERGEN SPECIFIC IGG 46 ALLERGEN SPECIFIC IGE 48 ALLERGEN SPECIFIC IGE 91 WBC ANTIBODY IDENTIFICATION 203 PLATELET ANTIBODIES 369 ANTINUCLEAR ANTIBODIES 124 ANTINUCLEAR ANTIBODIES (ANA) 117 ANTISTREPTOLYSIN O, TITER 79 C‐REACTIVE PROTEIN 91 C‐REACTIVE PROTEIN, HS 132 GLYCOPROTEIN ANTIBODY 172 CARDIOLIPIN ANTIBODY 172 PHOSPHOLIPID ANTIBODY 160 COLD AGGLUTININ, TITER 102 COMPLEMENT, ANTIGEN 123 COMPLEMENT/FUNCTION ACTIVITY 123 COMPLEMENT, TOTAL (CH50) 180 CCP ANTIBODY 140 DEOXYRIBONUCLEASE, ANTIBODY 155 DNA ANTIBODY 73 DNA ANTIBODY, SINGLE STRAND 180 NUCLEAR ANTIGEN ANTIBODY 183 FLUORESCENT ANTIBODY, SCREEN 704 FLUORESCENT ANTIBODY, TITER 141 IMMUNOASSAY, TUMOR CA 15‐3 197 IMMUNOASSAY, TUMOR CA 19‐9 162 IMMUNOASSAY, TUMOR, CA 125 197 HETEROPHILE ANTIBODIES 72 IMMUNOASSAY, TUMOR OTHER 303 IMMUNOASSAY,INFECTIOUS AGENT 153 IMMUNODIFFUSION OUCHTERLONY 123 IMMUNE COMPLEX ASSAY 207 IMMUNOFIXATION PROCEDURE 225 IMMUNFIX E‐PHORSIS/URINE/CSF 228 INHIBIN A 116 INSULIN ANTIBODIES 201 INTRINSIC FACTOR ANTIBODY 205 ISLET CELL ANTIBODY 191 B CELLS, TOTAL COUNT 252

Page 65 of 92 MONONUCLEAR CELL ANTIGEN 149 NK CELLS, TOTAL COUNT 279 T CELLS, TOTAL COUNT 252 T CELL, ABSOLUTE COUNT/RATIO 312 T CELL, ABSOLUTE COUNT 204 MICROSOMAL ANTIBODY 111 NEUTRALIZATION TEST, VIRAL 165 PARTICLE AGGLUTINATION TEST 104 RHEUMATOID FACTOR TEST 62 RHEUMATOID FACTOR, QUANT 62 TB TEST, CELL IMMUN MEASURE 411 TB AG RESPONSE T‐CELL SUSP 236 TB INTRADERMAL 27 BLOOD SEROLOGY, QUALITATIVE 49 BLOOD SEROLOGY, QUANTITATIVE 49 ANTINOMYCES ANTIBODY 108 ADENOVIRUS ANTIBODY 156 ASPERGILLUS ANTIBODY 151 BACTERIUM ANTIBODY 60 BARTONELLA ANTIBODY 100 BLASTOMYCES ANTIBODY 156 BORDETELLA ANTIBODY 180 LYME DISEASE ANTIBODY 132 LYME DISEASE ANTIBODY 117 BRUCELLA ANTIBODY 108 CANDIDA ANTIBODY 81 ANTIBODY 149 CHLAMYDIA IGM ANTIBODY 139 COCCIDIOIDES ANTIBODY 175 Q FEVER ANTIBODY 146 CRYPTOCOCCUS ANTIBODY 156 CMV ANTIBODY 126 CMV ANTIBODY, IGM 131 ENCEPHALITIS ANTIBODY 129 ENCEPHALITIS ANTIBODY 129 ENTEROVIRUS ANTIBODY 210 EPSTEIN‐BARR ANTIBODY 117 EPSTEIN‐BARR ANTIBODY 117 EPSTEIN‐BARR ANTIBODY 124 EHRLICHIA ANTIBODY 184 FUNGUS ANTIBODY 99 GIARDIA LAMBLIA ANTIBODY 145 HELICOBACTER PYLORI 132 HELMINTH ANTIBODY 265 HEMOPHILUS INFLUENZA 145 HTLV‐I ANTIBODY 204 HTLV‐II ANTIBODY 214

Page 66 of 92 HTLV/HIV CONFIRMATORY TEST 284 HEPATITIS, DELTA AGENT 375 HERPES SIMPLEX TEST 147 HERPES SIMPLEX TEST 136 HERPES SIMPLEX TYPE 2 145 HISTOPLASMA 189 HIV‐1 63 HIV‐2 215 HIV‐1/HIV‐2, SINGLE ASSAY 190 HEP B CORE ANTIBODY, TOTAL 108 HEP B CORE ANTIBODY, IGM 133 HEP B SURFACE ANTIBODY 109 HEP BE ANTIBODY 110 HEP A ANTIBODYHAAB T 72 HEP A ANTIBODY, IGM 107 INFLUENZA VIRUS ANTIBODY 28 JOHN CUNNINGHAM ANTIBODY 2,408 LEGIONELLA ANTIBODY 167 LEPTOSPIRA ANTIBODY 125 MUMPS ANTIBODY 133 MYCOPLASMA ANTIBODY 133 PARVOVIRUS ANTIBODY 128 PROTOZOA ANTIBODY NOS 115 RESPIRATORY VIRUS ANTIBODY 132 RICKETTSIA ANTIBODY 163 RUBELLA ANTIBODY 112 RUBEOLA ANTIBODY 106 TETANUS ANTIBODY 120 TOXOPLASMA ANTIBODY 147 TOXOPLASMA ANTIBODY, IGM 147 TREPONEMA PALLIDUM 136 TREPONEMA PALLIDUM, CONFIRM 136 VARICELLA‐ZOSTER ANTIBODY 131 WEST NILE VIRUS AB, IGM 145 WEST NILE VIRUS ANTIBODY 147 VIRUS ANTIBODY NOS 139 YERSINIA ANTIBODY 139 THYROGLOBULIN ANTIBODY 142 HEPATITIS C AB TEST 136 INFLUENZA TEST 181 HLA TYPING, A, B, OR C 589 IMMUNOLOGY PROCEDURE 115 RBC ANTIBODY SCREEN 65 RBC ANTIBODY ELUTION 221 RBC ANTIBODY IDENTIFICATION 285 COOMBS TEST, DIRECT 78 COOMBS TEST, INDIRECT, QUAL 52

Page 67 of 92 COOMBS TEST, INDIRECT, TITER 271 AUTOLOGOUS BLOOD PROCESS 558 BLOOD TYPING, ABO 71 BLOOD TYPING, RH (D) 71 BLOOD TYPE ANTIGEN DONOR EA 138 BLOOD TYPING, RBC ANTIGENS 104 BLOOD TYPING, RH PHENOTYPE 191 COMPATIBILITY TEST 139 COMPATIBILITY TEST 152 PLASMA, FRESH FROZEN 90 BLOOD PRODUCT/IRRADIATION 168 RBC PRETREATMENT, SERUM 198 SPECIMEN CONCENTRATION 68 BLOOD CULTURE FOR BACTERIA 165 FECES CULTURE, BACTERIA 124 STOOL CULTR, BACTERIA, EACH 97 CULTURE, BACTERIA, OTHER 124 CULTURE BACTERI AEROBIC OTHR 123 CULTURE BACTERIA ANAEROBIC 163 CULTURE ANAEROBE IDENT, EACH 184 CULTURE AEROBIC IDENTIFY 113 STREP CULTURE 84 URINE CULTURE/COLONY COUNT 66 URINE BACTERIA CULTURE 60 SKIN FUNGI CULTURE 148 FUNGUS ISOLATION CULTURE 96 BLOOD FUNGUS CULTURE 113 FUNGI IDENTIFICATION, YEAST 146 FUNGI IDENTIFICATION, MOLD 98 MYCOPLASMA 200 CHLAMYDIA 112 MYCOBACTERIA CULTURE 143 MYCOBACTERIC IDENTIFICATION 91 CULTURE TYPE IMMUNOFLUORESC 57 CULTURE TYPE, IMMUNOLOGIC 57 CULTURE TYPE, NUCLEIC ACID 136 DNA/RNA, AMPLIFIED PROBE 200 DNA/RNA SEQUENCING 430 MACROSCOPIC EXAM ARTHROPOD 46 MACROSCOPIC EXAM PARASITE 73 PINWORM EXAM 38 TISSUE HOMOGENIZATION, CULTR 55 OVA AND PARASITES SMEARS 105 MICROBE SUSCEPTIBLE, DIFFUSE 57 MICROBE SUSCEPTIBLE, DISK 72 MICROBE SUSCEPTIBLE, MIC 99 MICROBE SUSCEPT, MACROBROTH 122

Page 68 of 92 SMEAR, GRAM STAIN 59 SMEAR, FLUORESCENT/ACID STAI 113 SMEAR, SPECIAL STAIN 133 SMEAR, COMPLEX STAIN 183 KOH/WET MOUNT VAGINAL 15 KOH/SKIN AND NAILS 28 ASSAY, TOXIN OR ANTITOXIN 476 VIRUS INOCULATION, TISSUE 319 VIRUS INOCULATION, SHELL VIA 201 GENET VIRUS ISOLATE, HSV 344 ADENOVIRUS AG, IF 152 CHLAMYDIA TRACHOMATIS AG, IF 115 CRYPTOSPORIDUM/GARDIA AG, IF 115 HERPES SIMPLEX 2, AG, IF 115 INFLUENZA B, AG, IF 115 INFLUENZA A, AG, IF 115 LEGION PNEUMOPHILIA AG, IF 115 PARAINFLUENZA, AG, IF 115 RESPIRATORY SYNCYTIAL AG, IF 115 PNEUMOCYSTIS CARINII, AG, IF 197 TREPONEMA PALLIDUM, AG, IF 115 VARICELLA ZOSTER, AG, IF 132 ANTIBODY DETECTION, NOS, IF 346 ADENOVIRUS AG, EIA 279 ASPERGILLUS AG, EIA 169 CHYLMD TRACH AG, EIA 192 CLOSTRIDIUM AG, EIA 145 CRYPTOSPOR AG, EIA 175 GIARDIA AG, EIA 156 ENTAMOEB HIST GROUP, AG, EIA 115 HPYLORI, STOOL, EIA 249 HEPATITIS B SURFACE AG, EIA 101 HEPATITIS B SURFACE, AG, EIA 101 HEPATITIS BE AG, EIA 117 HIV‐1 AG W/HIV‐1 & HIV‐2 AB 190 ROTAVIRUS AG, EIA 159 SHIGA‐LIKE TOXIN AG, EIA 115 AG DETECT NOS, EIA, MULT 156 BARTONELLA, DNA, AMP PROBE 425 LYME DIS, DNA, AMP PROBE 664 CANDIDA, DNA, DIR PROBE 136 CNS DNA AMP PROBE TYPE 12‐25 2,578 CHYLMD TRACH, DNA, DIR PROBE 117 IH CHLMD TRACH, DNA, AMP PROBE 235 C DIFF AMPLIFIED PROBE 360 CYTOMEG, DNA, QUANT 1,043 ENTEROVIRUS, DNA, AMP PROBE 431

Page 69 of 92 VANOMYCIN, DNA, AMP PROBE 265 INFLUENZA DNA AMP PROB 1+ 387 IADNA‐DNA/RNA PROBE TQ 6‐11 1,401 GARDNER VAG, DNA, DIR PROBE 136 HEPATITIS B, DNA, AMP PROBE 605 HEPATITIS B, DNA, QUANT 704 HEPATITIS C, RNA, AMP PROBE 469 HEPATITIS C, RNA, QUANT 875 HSV, DNA, AMP PROBE 418 HSV, DNA, QUANT 434 HHV‐6, DNA, AMP PROBE 381 HIV‐1, DNA, AMP PROBE 235 HIV‐1, DNA, QUANT 570 M.TUBERCULO, DNA, AMP PROBE 266 M.PNEUMON, DNA, AMP PROBE 509 N.GONORRHOEAE, DNA, DIR PROB 143 N.GONORRHOEAE, DNA, AMP PROB 235 HPV, DNA, AMP PROBE 265 HPV HIGH‐RISK TYPES 265 STAPH A, DNA, AMP PROBE 265 MR‐STAPH, DNA, AMP PROBE 265 STREP A, DNA, DIR PROBE 66 STREP B, DNA, AMP PROBE 265 TRICHOMONAS VAGIN, DIR PROBE 136 TRICHOMONAS VAGINALIS AMPLIF 155 DETECT AGENT NOS, DNA, AMP 384 DETECT AGENT NOS, DNA, QUANT 435 DETECT AGNT MULT, DNA, DIREC 371 RAPID INFLUENZA TEST 78 RSV ASSAY W/OPTIC 66 RAPID STREP TEST CLIA 56 AGENT NOS ASSAY W/OPTIC 128 PHENOTYPE, INFECT AGENT DRUG 854 GENOTYPE, DNA, HIV REVERSE T 1,065 GENOTYPE, DNA, HEPATITIS C 1,690 AUTOPSY (NECROPSY), COMPLETE 3,120 AUTOPSY (NECROPSY), COMPLETE 2,563 CYTOPATHOLOGY, FLUIDS 188 CYTOPATH, CONCENTRATE TECH 165 CYTOPATH, CELL ENHANCE TECH 196 CYTOPATH, C/V, INTERPRET 99 PAP SMEAR ONLY 102 CYTOPATH, C/V, MANUAL 141 CYTOPATH SMEAR, OTHER SOURCE 141 CYTOPATH SMEAR, OTHER SOURCE 141 CYTOPATH TBS, C/V, MANUAL 49 CYTOPATH EVAL, FNA, REPORT 258

Page 70 of 92 CYTOPATH C/V AUTO FLUID REDO 169 CELL MARKER STUDY 319 FLOWCYTOMETRY/ TC, 1 MARKER 202 FLOWCYTOMETRY/TC, ADD‐ON 97 FLOWCYTOMETRY/READ, 2‐8 158 FLOWCYTOMETRY/READ, 16 & > 281 TISSUE CULTURE, LYMPHOCYTE 767 TISSUE CULTURE, SKIN/BIOPSY 889 TISSUE CULTURE, BONE MARROW 84 CHROMOSOME ANALYSIS, 15‐20 1,265 CHROMOSOME ANALYSIS, 20‐25 1,013 CYTOGENETICS, DNA PROBE 216 CYTOGENETICS, 25‐99 730 CYTOGENETICS, 100‐300 276 CHROMOSOME KARYOTYPE STUDY 236 CHROMOSOME STUDY, ADDITIONAL 211 CYTO/MOLECULAR REPORT 234 SURGICAL PATH, GROSS 119 TISSUE EXAM BY PATHOLOGIST 272 TISSUE EXAM BY PATHOLOGIST 344 TISSUE EXAM BY PATHOLOGIST 242 TISSUE EXAM BY PATHOLOGIST 696 TISSUE EXAM BY PATHOLOGIST 957 DECALCIFY TISSUE 110 SPECIAL STAINS 293 SPECIAL STAINS 186 HISTOCHEMICAL STAIN 186 ENZYME HISTOCHEMISTRY 253 PATH CONSULT INTROP 214 PATH CONSULT INTRAOP, 1 BLOC 293 PATH CONSULT INTRAOP, ADDL 132 INTRAOP CYTO PATH CONSULT, 1 168 IMMUNOHISTO ANTIBODY SLIDE 222 IMMUNOCYTOCHEMISTRY 222 IMMUNOFLUORESCENT STUDY 567 IMMUNOFLUORESCENT STUDY 492 ELECTRON MICROSCOPY 1,760 IMMUNOFLUOR ANTB ADDL STAIN 105 ANALYSIS, NERVE 427 TUMOR IMMUNOHISTOCHEM/MANUAL 249 IMMUNOHISTOCHEMISTRY, TUMOR 421 NERVE TEASING PREPARATIONS 700 INSITU HYBRIDIZATION, MANUAL 427 M/PHMTRC ALYS ISHQUANT/SEMIQ 451 MICRODISSECTION, MANUAL 235 BILIRUBIN TOTAL TRANSCUT 48 BODY FLUID CELL COUNT 82

Page 71 of 92 BODY FLUID CELL COUNT 174 LEUKOCYTE COUNT, FECAL 66 EXAM,SYNOVIAL FLUID CRYSTALS 84 NASAL SMEAR 74 SEMEN ANALYSIS 34 SEMEN ANALYSIS, COMPLETE 194 SEMEN ANALYSIS 123 IMMUNE GLOBULIN IG HUM 2 RABIES IMMUNE GLOBULII 205 RABIES IG HEAT TREATED per ml 2,945 RSV IG, IM, 50MG ‐ SYNAGIS 2,877 RHO(D) IMMUNE GLOBULIN (RHIG), HUBAN, FULL‐DO 151 VARICELLA‐ZOSTER IG, IM 2,009 IMADM ANY ROUTE 1ST VAC/TOX 58 INADM ANY ROUTE ADDL VAC/TOX 29 IMMUN ADMIN 8 W PHYS 40 IMMUN ADMIN EACH ADDIT 25 H1N1 Vaccine 2 IMMUNIZATION ADMINISTRATION 59 IMMUNIZATION ADMIN, EACH ADD 24 IMMUNIZATION ADMIN INT 27 IMMUNE ADMIN ORAL/NASAL ADDL 24 Meningococcal B (Trumenba)‐adult 497 ADULT HEP A 82 HEP A VACCINE PEDIATRIC 66 HEP A & HEP B INJ ADU TWINRIX 136 HPV VACCINE PER 5ML 226 HPV VIRUS VACCINE 9 VAL IM 397 FLU VACCINE NO PRESERV 23 FLU VACCINE 152 Flu Vacc HIGH DOSE Fluzone 85 FLU VACC PANDEMIC 3 PNEUMOCOCCAL CONJUGATE (5YRS AND YOUNGER) 2 PREVNAR 13 ADULT 341 RABIES VACCINE INTRAM 757 Flu Adult 29 TYPHOID VACCINE INTRAM 79 DPT 32 TETANUS TOXOIDINTRAMU 27 RUBELLA VIRUS VACCINE 34 Adult MMR 62 MMRV VACCINE SC 9 TD VACCINE NO PRSRV >/= 7 IM 39 TDaP (TT REDUCED DT AND ACEL) 108 Varicella Adult 158 TD VACCINE ‐ Adults 80 Pneumovax PPSV23‐adult 197

Page 72 of 92 MENINGOCOCCAL VACCINE, SC 115 MENNIGOCOCCAL VACCINE 155 JAPANESE ENCEPHALITIS 486 ZOSTER VACCINE 183 Hepatitis B (adult) 114 SHINGRIX HZV VACC RECOMBINANT IM NJX 357 HYDRATION IV INFUSION, INIT 431 HYDRATE IV INFUSION, ADD‐ON 80 IM OR SUBQ INJECTION 59 INTRA ARTERIAL INJECTI 40 EACH ADDITION IV PUSH 56 IV THERAPY FIRST HOUR 124 INJECTION 40 PSYTX COMPLEX INTERACTIVE 21 PSYCHIATRIC DIAGNOSTIC EVALUATION 287 PSYCH DIAG EVAL W/MED SRVCS 308 PSYTX PT&/FAMILY 30 MINUTES 131 PSYTX PT&/FAM W/E&M 30 MIN 72 PSYTX PT&/FAMILY 45 MINUTES 176 PSYTX PT&/FAM W/E&M 45 MIN 180 PSYTX PT&/FAMILY 60 MINUTES 255 PSYCHOTHERAPY 60 MIN W/PT A/O FAMILY WHEN P 235 REPORT WITH ADVISE 166 BRAVO STUDY INTERPRETATION 1,953 ANESTH, STONE REMOVAL 81 VISUAL EXAM INTERMEDIATE 121 EAR AND THROAT EXAMINATION 224 EAR MICROSCOPY EXAMINATION 74 SPEECH/HEARING THERAPY 351 ORAL FUNCTION THERAPY 349 BASIC VESTIBULAR EVALUATION 226 SPONTANEOUS NYSTAGMUS TEST 376 POSITIONAL NYSTAGMUS TEST 153 CALORIC VESTIBULAR TEST 72 OPTOKINETIC NYSTAGMUS TEST 122 OSCILLATING TRACKING TEST 115 TYMPANOMETRY WITH REFLEX THRESH 45 AUDIO TEST 22 PURE TONE AUDIOMETRY‐A 88 PURE TONE‐AIR AND BONE 121 SPEECH AUDIOMETRY THRE 71 SPEECH AUDIOMETRY 86 COMPREHENSIVE AUDIOMET 215 LOUDNESS BALANCE TEST 86 TOOTH DECAY TEST 80 SHORT INCREMENT SENSIT 82 STENGER 58

Page 73 of 92 TYMPANOMETRY SCREEN 87 ACOUSTIC REFLEX TESTIN 84 ACOUSTIC REFLEX DECAY 74 ACOUSTIC IMMITTANCE TESTING WITH TYMPANOM 70 FILTERED SPEECH TEST 72 STAGGERED SPONDAIC WOR 57 SENSORINEURAL ACUITY L 119 TEST 87 STENGER TEST SPEECH 86 VISUAL REINFORCEMENT A 191 CONDITIONED PLAY AUDIO 162 AUDIOGRAM 140 ELECTROCOCHLEOGRAPHY 332 BRAINSTEM EVOKED EEG 707 EVOKED POTENTIAL EVOKE 233 LIMITED OTOACOUSTIC EM 193 EVOKED OTOACOUSTIC EMI 202 HEARING AID EXAM SELEC 96 HEARING AID EXAM SELEC 121 HEARING AID CHECK‐MONA 40 HEARING AID CHECK‐BIAU 63 ELECTROACOUSTIC EVAL. 38 ELECTROACOUSTIC EVAL F 80 EAR PROTECTION ATTEN M 136 ORAL SPEECH DEVICE EVAL 397 EVALUATE SWALLOWING FUNCTION 397 MOTION FLUOROSCOPY/SWALLOW 905 EVAL CENTRAL AUDITORY 255 EVAL CENTRAL AUDITORY 62 ASSESSMENT OF TINNITUS 254 CPR 473 TEMPORARY EXTERNAL PACING 42 CARDIOVERSION ELECTRIC 458 ELECTROCARDIOGRAM COMP 74 ELECTROCARDIOGRAM TRA 72 ELECTROCARDIOGRAM READ 27 STRESS TEST WITH INTER 307 STRESS TEST SUPERVISIO 66 CARDIOVASCULAR STRESS TEST 311 STRESS TEST INTERPRETA 66 HOLTER MONITOR HOOKUP 175 ECG MONITOR/REPORT, 24 HRS 128 ECG MONITOR/REPORT, 24 HRS 376 ECG RECORD/REVIEW 570 ECG RECORDING 140 ECG/MONITORING AND ANALYSIS 900 PM PHONE R‐STRIP DEVICE EVAL 124

Page 74 of 92 TTE W/DOPPLER, COMPLETE 1,411 ECHO EXAM OF HEART 1,011 ECHO EXAM OF HEART 564 ECHO TRANSESOPHAGEAL 1,537 DOPPLER ECHO EXAM, HEART 364 DOPPLER COLOR FLOW ADD‐ON 285 ECHO TRANSTHORACIC 349 TILT TABLE EVALUATION 715 BIOIMPEDANCE, THORACIC 74 AMBULATORY BP MONITORI 190 ABPM RECORDING ONLY 39 ABPM PHYSICIAN INTEERP 151 CARDIAC REHAB/MONITOR 175 CARDIOVASCULAR PROCEDURE 5 EXTRACRANIAL STUDY 1,505 ABI EXTREMITY STUDY LIMITED 1‐2 LEVELS 450 EXTREMITY STUDY COMPLETE 3 LEVEL 604 EXTREMITY STUDY 1,461 LOWER EXTREMITY STUDY 1,920 LOWER EXTREMITY STUDY 1,443 UPPER EXTREMITY STUDY 1,610 UPPER EXTREMITY STUDY 1,079 NONINVASICE PHYSIOLOGI 504 DUPLEX SCAN EXTREMITY 773 DUPLEX SCAN EXTREMITY 514 VASCULAR STUDY 1,079 VASCULAR STUDY 988 VENT MGMT INPAT, INIT DAY 1,085 VENT MGMT INPAT, SUBQ DAY 960 SPIROMETRY 167 PATIENT RECORDED SPIROMETRY 112 REVIEW PATIENT SPIROMETRY 46 SPIROMETRY CHALLENGE 317 EVALUATION OF WHEEZING 165 VITAL CAPACITY TEST 83 LUNG NITROGEN WASHOUT CURVE 99 BREATH AIRWAY CLOSING VOLUME 87 RESPIRATORY FLOW VOLUME LOOP 74 EXERCISE TST BRNCSPSM 200 PULMONARY STRESS TESTING 71 PULMONARY STRESS TEST/SIMPLE PROFESSIONAL CO 262 PRESSURIZED NON PRESSU 90 AEROSOL INHAL FOR PNEU 297 POS AIRWAY PRESSURE, CPAP 211 NEBULIZER INT EVAL DEM 45 CHEST WALL MANIPULATION 185 CHEST WALL MANIPULATION 116

Page 75 of 92 EXHALED AIR ANALYSIS, O2 414 PULM FUNCT TST PLETHYSMOGRAP 133 C02/MEMBANE DIFFUSE CAPACITY 142 NONINVASIVE PULSE EAR 24 PULSE OXIMETRY‐MULTIPL 12 MEASURE BLOOD OXYGEN LEVEL 49 EXHALED CARBON DIOXIDE TEST 267 PRICK TESTS 19 ID ALLERGY TITRATE‐DRUG/BUG 34 PERQ & ICUT ALLG TEST VENOMS 21 PERQ&IC ALLG TEST DRUGS/BIOL 50 INTRADERMAL TESTS 20 ID ALLERGY TITRATE‐AIRBORNE 12 ALLERGY SHOT 29 ALLERGY INJ MULT 37 IMMUNOTHERAPY, ONE INJECTION 51 IMMUNOTHERAPY, MANY ANTIGENS 63 P ANTIGEN THERAPY SERV (.5ml=1 unit) 39 GLUCOSE MONITORING, CONT 424 PSG PEDIATRIC < 6 / 26 2,886 ACTIGRAPHY 270 MULTIPLE SLEEP LATENCY TEST 1,231 APNEALINK 501 POLYSOMNOGRAPHY, 1‐3 ADD PARAMETERS OF SLE 2,701 POLYSOMNOGRAPH 6 YR > 4 > ADD PRMETR SLP 2,701 SPLIT NIGHT PAP TITRATION OR POSITIVE AIRWAY PR 2,701 EEG EXTENED 41‐60 MINU 371 EEG EXTENDED MONITORIN 186 EEG ROUTINE AWAKE AND 681 EEG ROUTINE AWAKE AND 779 EEG, COMA OR SLEEP ONLY 476 EEG, CEREBRAL DEATH ONLY 100 MUSCLE TESTING MANUAL 80 MUSCLE TESTING HAND 80 MUSCLE TESTING TOTAL B 161 MUSCLE TESTING BODY IN 191 EMG ONE EXTREMITITY 263 EMG TWO EXTREMITIES 395 EMG THREE EXTREMITIES 474 EMG FOUR EXTREMITIES 633 UNILATERAL CRANIAL 194 EMG THORACIC PARASP 198 MUSCLE TESTING 99 MUSC TST DONE W/NERV TST LIM 98 MUSC TEST DONE W/N TEST COMP 168 MUSC TST DONE W/N TST NONEXT 152 MOTOR NERVE CONDUCTUIB 151

Page 76 of 92 MOTOR NERVE WITH F WAV 198 NERVE COND.STUDYEACH 140 NRV CNDJ TST 1‐2 STUDIES 182 NRV CNDJ TST 3‐4 STUDIES 224 NRV CNDJ TST 5‐6 STUDIES 269 NRV CNDJ TEST 7‐8 STUDIES 355 NRV CNDJ TEST 9‐10 STUDIES 432 NRV CNDJ TEST 11‐12 STUDIES 510 NRV CNDJ TEST 13/> STUDIES 592 INTRAOP NERVE TEST ADD‐ON 376 AUTONOMIC NERV FUNCTION TEST 198 AUTONOMIC FUNCTION TEST ‐ SYMPATHETIC ADREN 238 AUTONOMIC FCN TEST QUANTITATIVE SUDOMOTOR 579 AUTONOMIC FCN TEST COMBINED PARASYMPATHET 321 SOMATOSENSORY ONE OR M 564 SOMATOSENSORY ONE OR M 563 VISUAL EVOKED POTENTIA 302 BLINK REFLEX 204 H REFLEX 129 REPETITIVE NEUROMUSCUL 161 IONM IN OPERATNG ROOM 15 MIN 61 IONM REMOTE/>1 PT OR PER HR 502 AMBULATORY EEG MONITORING 186 EEG MONITORING, EACH 24 HOURS 1,975 ANALYZE NEUROSTIM, COMPLEX 244 SPIN/BRAIN PUMP REFIL & MAIN 214 CANALITH REPOSITIONING PROC 96 PSYCHO TESTING BY PSYCH/PHYS 166 DEVELOPMENTAL TEST, LIM 15 DEVELOPMENTAL TEST, EXTEND 177 NEUROBEHAVIORAL STATUS 233 NEUROPSYCH TST BY PSYCH/PHYS 208 COGNITIVE TEST BY HC PRO 620 BRIEF EMOTIONAL/BEHAV ASSMT 14 HYDRATION IV INFUSION, INIT 494 HYDRATE IV INFUSION, ADD‐ON 92 THER/PROPH/DIAG IV INF, INIT 407 THER/PROPH/DIAG IV INF ADDON 94 TX/PROPH/DG ADDL SEQ IV INF 155 THER/DIAG CONCURRENT INF 112 THER/PROPH/DIAG INJ, SC/IM 72 THER/PROPH/DIAG INJ, IV PUSH 128 TX/PRO/DX INJ NEW DRUG ADDON 97 TX/PRO/DX INJ NEW DRUG ADON 97 THER/PROP/DIAG INJ/INF PROC 103 CHEMO INJ ANTINEOP NON 189 CHEMO INJECTION ANTINE 155

Page 77 of 92 CHEMO, IV PUSH, SNGL DRUG 232 CHEMO, IV PUSH, ADDL DRUG 232 CHEMO, IV INFUSION, 1 HR 637 CHEMO, IV INFUSION, ADDL HR 144 Chemo Admi.,IV Infus, Prolong 8hr 511 CHEMO IV INFUS EACH ADDL SEQ 307 CHEMOTHERAPY INTO CNS 667 IRRIG DRUG DELIVERY DEVICE 101 PT EVALUATION 356 PT RE‐EVALUATION 175 OT EVALUATION 382 OT RE‐EVALUATION 319 MECHANICAL TRACTION THERAPY 135 ELECTRIC STIMULATION THERAPY 110 VASOPNEUMATIC DEVICE THERAPY 147 PARAFFIN BATH THERAPY 63 WHIRLPOOL THERAPY 97 ELECTRICAL STIMULATION 154 ELECTRIC CURRENT THERAPY 152 CONTRAST BATH THERAPY 50 ULTRASOUND THERAPY 127 THERAPEUTIC EXERCISES 147 NEUROMUSCULAR REEDUCATION 99 AQUATIC THERAPY/EXERCISES 144 GAIT TRAINING THERAPY 103 OMT LYMPHATIC SYSTEM 114 PT EVAL LOW COMPLEX 20 MIN 306 PT EVAL MOD COMPLEX 30 MIN 382 PT EVAL HIGH COMPLEX 45 MIN 458 PT RE‐EVAL EST PLAN CARE 319 OT EVAL LOW COMPLEX 30 MIN 306 OT EVAL MOD COMPLEX 45 MIN 382 OT EVAL HIGH COMPLEX 60 MIN 458 THERAPEUTIC ACTIVITIES 125 COGNITIVE SKILLS DEVELOPMENT 106 SELF CARE MNGMENT TRAINING 108 WHEELCHAIR MNGMENT TRAINING 104 WORK HARDENING 409 WORK HARDENING ADD‐ON 159 ACTIVE WOUND CARE 20 C 193 DEBRIDEMENT ‐ SELECTIVE EACH ADDITIONAL 20 SQ 186 REMOVAL DIVITALIZED TI 175 REMOVAL OF DEVITALIZED 193 NEGATIVE PRESSURE WOUN 252 NEG PRESS WOUND TX > THAN 50 CM 442 NEG PRESS WND TX 50 CM 622

Page 78 of 92 PHYSICAL PERFORMANCE TEST 121 ORTHOTIC MGMT AND TRAINING 133 PROSTHETIC TRAINING 104 CO FOR ORTHOTIC/PROSTH USE 104 ORTHC/PROSTC MGMT SBSQ ENC 109 PHYSICAL MEDICINE PROCEDURE 132 MEDICAL NUTRITION, INDIV, IN 53 MED NUTRITION, INDIV, SUBSEQ 45 ACUPUNCT W/O STIMUL 15 MIN 76 ACUPUNCT W/O STIMUL ADDL 15M 38 ACUPUNCT W/STIMUL 15 MIN 113 ACUPUNCT W/STIMUL ADDL 15M 63 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 1 74 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 3 105 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 5 136 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 7 167 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 9 200 HANDLING SPECIMEN FROM 13 SPECIMEN HANDLING 67 SERVICES PROV IN OFFICE AFTER HOURS 149 HOLIDAY 149 SPECIAL REQUEST OF SER 27 EMER OFFICE C 215 SITZMARK 149 SUPPLIES PATIENT EDUCA 34 GROUP EDUCATION 99 SPECIAL REPORTS 34 MILEAGE 8 COMPUTER DATA ANALYSIS 140 MOD CS BY SAME PHYS, < 5 YRS 121 MOD CS BY SAME PHYS, 5 YRS + 166 MOD CS DIFF PHYS 5 YRS + 290 MODERATE SEDATION BY PHYS 15 MIN < 5YR 29 MODERATE SEDATION BY PHYS 15 MIN 5YR > 15 MODERATE SEDATION BY PHYS 15 MIN 5YR > 13 MOD SEDATION OTHER PHYS 15 MIN 5 YR > 88 MOD SEDATION BY OTHER PHYS ADD 15 MIN 67 VISUAL SCREENING TEST 22 APP TOPICAL FLUORIDE VARNISH 30 PHLEBOTOMY 116 OFFICE/OUTPATIENT VISIT, NEW LEVEL 1 ‐ 10 MINUT 80 OFFICE/OUTPATIENT VISIT, NEW LEVEL 2 ‐ 20 MINUT 156 OFFICE/OUTPATIENT VISIT, NEW LEVEL 3 ‐ 30 MINUT 213 OFFICE/OUTPATIENT VISIT, NEW LEVEL 4 ‐ 45 MINUT 313 OFFICE/OUTPATIENT VISIT, NEW LEVEL 5 ‐ 60 MINUT 390 NURSE OFFICE VISIT EST. PT. LEVEL 1 ‐ 5 MINUTES 65 PMR OFFICE VISIT EST PT LEVEL 2 ‐10 MINUTES 129

Page 79 of 92 OFFICE VISIT EST PT LEVEL 3 ‐ 15 MINUTES 161 OFFICE VISIT EST PT LEVEL 4 ‐ 25 MINUTES 217 OFFICE VISIT EST PT LEVEL 5 ‐ 40 MINUTES 330 OBSERVATION CARE DISCH 117 INITIAL OBSERVATION CA ‐ 30 MINUTES 117 INITIAL OBSERVATION CA ‐ 50 MINUTES 200 OBSERVATION CARE 3 275 DAILY CARE INITIAL LEV ‐ 30 MINUTES 226 DAILY CARE INITIAL LEV ‐ 50 MINUTES 272 DAILY CARE INITIAL LEV ‐ 70 MINUTES 378 SUBSEQUENT OBSERVATION CARE ‐ 15 MINUTES 73 SUBSEQUENT OBSERVATION ‐ 25 MINUTES 122 SUBSEQUENT OBSERVATION CARE ‐ 35 MINUTES 183 DAILY CARE SUB LEVEL 1 ‐ 15 MINUTES 131 DAILY CARE SUB LEVEL 2 ‐ 25 MINUTES 146 DAILY CARE SUB LEVEL 3 ‐ 35 MINUTES 180 OBSERVATION HOSPITAL S 237 OBSERVATION HOSPITAL S 315 ADMIT AND DISCHARGE SA ‐ 55 MINUTES 399 DAILY CARE DISCHARGE 161 DAILY CARE DISCHARGE L 238 CONSULT OFFICE LEVEL 1 ‐ 15 MINUTES 136 CONSULT OFFICE LEVEL 2 ‐ 30 MINUTES 185 CONSULT OFFICE LEVEL 3 ‐ 40 MINUTES 246 CONSULT OFFICE LEVEL 4 ‐ 60 MINUTES 341 CONSULT OFFICE LEVEL 5 ‐ 80 MINUTES 439 CONSULT INPT INITIAL L 241 CONSULT INPT INITIAL L 263 CONSULT INPT INITIAL L 285 CONSULT INPT INITIAL L 322 CONSULT INPT INITIAL L 411 EMERGENCY DEPT VISIT 114 EMERGENCY DEPT VISIT 177 EMERGENCY DEPT VISIT 232 EMERGENCY DEPT VISIT 422 EMERGENCY DEPT VISIT 525 CRITICAL CARE FIRST 30 ‐ 74 min 846 ICU‐ADD'L 15MIN 377 INTENSIVE CARE NICU 1,627 INTENSIVE CARE SUBSEQU 716 SUBSEQ IC ST 381 INITIAL NURSING FAC PE 213 INITIAL NURSING FAC PE 292 INITIAL NURSING FAC PE 383 SUBSEQUENT NURSING FAC 102 SUBSEQ NURSING FAC DAY 155 SUBSEQ NURSING FAC DAY 206

Page 80 of 92 SUBSEQ NURSING FAC DAY 310 NURSING FACILITY SUBSE 76 SNF DISCHARGE 148 NURSING FACILITY DISCH 193 ANNUAL NURSING FAC ASS 116 DOMICIL/R‐HOME VISIT NEW PAT 292 DOMICIL/R‐HOME VISIT NEW PAT 383 DOMICIL/R‐HOME VISIT EST PAT 87 DOMICIL/R‐HOME VISIT EST PAT 139 DOMICIL/R‐HOME VISIT EST PAT 212 DOMICIL/R‐HOME VISIT EST PAT 311 HOME VISIT ‐ NEW PATIE 144 HOME VISIT ‐ NEW PATIE 207 HOME VISITNEW PT 314 NEW PT HV COMPREHENSIV 429 HOME VISIT ‐ NEW PATIE 492 HOME VISIT EP FOCUSED 121 HOME VISIT, EP EXPANDED 187 HOME VISIT EP DETAILED 280 HOME VISIT EP COMPREHEN 416 OUTPATIENT PROLONG SERVICE FIRST HOUR 225 PROLONGED PHYSICIAN SERVICE, OFFICE/OP W/DIRE 224 PROLONGED PHYSICIAN SERVICE, INPT W/DIRECT CO 184 INPT PROLONGED SERVICE 185 PROLONGED E&M SERVICE, BEFORE &/OR AFTER DIR 324 PROLONGED E&M SERVICE, BEFORE &/OR AFTER DIR 156 MD STANDBY EA 66 CASE MANAGEME 99 CASE MANAGEME 196 NEW PT WCC UNDER 1 YEAR 227 NEW PATIENT WCC 1‐4 YR 250 NEW PT WCC 5‐11 YRS 249 PREVENTIVE MED. NEW PT AGE 12‐17 269 PREVENTIVE MED. NEW PT AGE 18‐39 197 PREVENTIVE MED. NEW PT AGE 40‐64 273 PREVENTIVE MED. NEW PT AGE 65 AND OVER 347 PREVENTIVE VISIT EST PT UNDER 1 YEAR OF AGE 196 WELLCHILD EXAM 1‐4 YRS 214 WELL CHILD EXAM 5‐11 Y 215 PREVENTIVE MED EST PT AGE 12‐17 233 PREVENTIVE MED EST PT AGE 18‐39 218 PREVENTIVE MED EST PT AGE 40‐64 205 PREVENTIVE MED EST PT AGE 65 AND OLDER 213 PREVENTIVE COUNSELING APP 15 MINUTES 90 PREVENTIVE COUNSELING APP 30 MINUTES 149 RISK FACTOR COUSEL 45 174 RISK FACTOR COUNSELING 60 MINUTES 224

Page 81 of 92 SMOKING AND TOBACCO USE CESSATION COUNSELIN 31 BEHAV CHNG SMOKING > 10 MIN 48 NEWBORN CARE ADMIT 108 NEWBORN EXAM OUTSIDE O 144 NEWBORN CARE SUBSEQUEN 57 NB ADMIT DISC 137 ATTEND DELIVERY 136 NEWBORN RESUSCITATION 264 PHONE E/M BY PHYS 5‐10 MIN 37 WK RELATED MED DIS. EX 389 WORK OR DISAB RELATED 646 Initial hospital or birthing center care, per day, for ev 108 Subsequent hospital care, per day, for evaluation and 57 Initial hospital or birthing center care, per day, for ev 137 Attendance at Delivery 136 NEWBORN RESUSCITATION 264 Initial Pediatric Criticle Care 1,133 Initial Pediac Critical Care 2 ‐ 5 yrs 712 CMPLX CHRON CARE W/O PT VSIT 193 COMPLX CHRON CARE ADDL30 MIN 97 CHRON CARE MGMT SRVC 20 MIN 66 1ST PSYC COLLAB CARE MGMT 182 SBSQ PSYC COLLAB CARE MGMT 165 1ST/SBSQ PSYC COLLAB CARE 88 TRANS CARE MGMT 14 DAY DISCH 171 TRANS CARE MGMT 7 DAY DISCH 247 ADVNCD CARE PLAN 30 MIN 174 ADVNCD CARE PLAN ADDL 30 MIN 147 Acupuncture Initial 900 SCLEROTHERAPY 1 HOUR 206 SCLEROTHERAPY ADDITIONAL VIAL 52 SCLEROTHERAPY ADDITIONAL 1/2 HOUR 78 Rhinoplasty ‐ Cash Pricing 50 Blepharoplasy,Upper Lid ‐ Cash Pricing 50 Blepharoplasy,Lower Lid ‐ Cash Pricing 50 Face Lift Mini, Cash Pricing 50 Face Lift, Full ‐ Cash Pricing 50 Neck Lift ‐ Cash Pricing 50 Liposuction ‐ Cash Pricing 50 LASER SERVICE 50 FACIAL FILLER 1/2 SYRINGE 400 DYSPORT/BOTOX FIRST SEGMENT 350 DYSPORT/BOTOX SECOND SEGMENT 300 DYSPORT/BOTOX THIRD SEGMENT 250 EAR PLUGS 10 MISC PROCEDURE 50 FACIAL FILLERS (Restylane, Juvederm UltraPlus) 650

Page 82 of 92 PONARIS OIL 20 PLASTICS CONSULTATION FEE 150 SCHOOL PHYSICALS 9 URINE TEST/REAGENT STRIPS/TABLETS 17 DIAPHRAGM FOR CONTRACEPTIVE USE 86 INTERMIT URIN CATH; COUDE TIP EA 20 GARMENT BELT SLEEVE OTH ELASTIC EA 111 PESSARY RUBBER ANY TYPE 21 PESSARY NON RUBBER ANY TYPE 75 SLING 9 SPLINT COLLES 110 PEAK FLOW METER 87 AEROCHAMBER 19 RADIOPHARMACEUTICAL DIAGNOSTIC NOC 195 COLL BASED WND FIL GEL/PASTE‐GM PER GRAM 9 ACE BANDAGE 4 6 VAC DRAIN BOTTLE 33 NM CARDIOLITE 269 RADPHRM DX TC 99M MEDRONAT TO 30MCI 223 RADPHRM DX THALLUS CHLORD TL‐201MCI 284 RADOPHRM DX TC‐99M PERTECHNETAT‐MCI 226 RADPHRM DX I‐123 SODIM IOD‐100 UCI 223 NM CHOLETEC 261 NM DTPA 216 NM MAA 216 NM SULFUR COLLOID 261 NM DMSA 226 F18 FDG 269 GA67 GALLIUM 195 NM ULTRATAG 216 NM MAG ‐ 3 383 P32 NA PHOSPHATE 19 TECHNETIUM TC‐99M AUTO WBC 2,376 INDIUM IN‐111 PENTETREOTIDE 5,451 ACUPUNCTURE INITIAL EVALUATION 126 ATTORNEY 2ND REQUEST 970 Conn tiss, non‐human 6,740 Lens, intraocular (new tech) 689 Pmkr, single, rate‐resp 9,261 Intro/sheath,fixed,peel‐away 135 MR ANGIO W/O CONTRST W/CONTRST ABD 723 INJECTION PANTOPRAZOLE SODIUM‐VIAL 44 PRT CC KCENTRA PER I.U. FCT IX ACTV 2,856 INJECTION BUPIVACAINE LIPOSOME 1 MG 1,036 INJECTION DALBAVANCIN 10 MG 3,757 ZILRETTA TRIAMCINOLONE ACETONIDE 19 Injection, durvalumab 2,059

Page 83 of 92 EPS GAST CARDIA PLIC 2,447 EXTRACTION OF ERUPTED TOOTH/EXSPOSD ROOT 1,255 Dental Procedure Tooth Extraction 1,255 Dental Procedure Tooth Extraction 1,255 Dental Procedure Tooth Extraction 1,255 Dental Procedure Tooth Extraction 1,255 Dental Procedure Tooth Extraction 1,255 Dental Procedure Tooth Extraction 1,255 HEEL OR ELBOW PROTECTOR EACH 13 APNEA MONITOR W/RECORDING FEATURE 501 LOOP TOE EACH 24 ADMN FLU VAC 57 ADMN PNEUMCOC VAC 55 ADMN HEP B VAC 56 CERVICAL OR VAGINAL CANCER SCREENING 74 PROS CANCR SCR; PROS ANTIG TST TOT 125 COLOREC CANCER SCREENING; FLEXSIG 382 COLOREC CANCR SCR; COLNSCPY HI RISK 925 DM OP SLF‐MGMT TRN SRVC IND‐30 MIN 61 DM SLF‐MGMT TRN SRVC GRP‐30 MIN 39 COLOREC CNCR SCR;COLNSCPY NO HI RSK 925 DERMA BOND MEDICARE ONLY 281 DX MAMMO PRODUC DIR DIGTL IMAG BIL 546 TX PROC IMPRV RESP NOT G0237 15 MIN 117 Oth resp proc, group 117 REMV IMP CERUMN SAME DATE FUNCT TST 72 E‐STIM 1/>NOT WND CARE PART TX PLAN 149 SCPE KNEE REMV FB TM SURG DIFF COMP 1,263 COLORECTAL CANCER SCREENING; FECAL OCCULT BL 30 BN MARROW ASPIR PRFRM BX SAME INCI 88 ULTRASOUND EXAM AAA SCREEN 553 HST TYPE III PRTBLE MON MIN 4 CH 139 INIT PREV PE LTD DUR 1ST 12 MOS MCR 236 PULM REHAB EXER 1 HR SESS 2 PER DAY 94 DRUG SCR NOT CGC: ANY NUMBER PT ENC 431 SMOKING/TOBACCO CESSATION COUNSELING INTER 32 SMOKING/TOBACCO CESSATION COUNSELING INTEN 62 ANNUAL WELLNES VST; PERSNL PPS INIT 392 ANNUAL WELLNESS VST; PPS SUBSQT VST 263 FCE‐FCE BEHAVRL CNSL OBESITY 15 MIN 129 HOS OP CLIN VISIT ASSESS & MGMT PT 386 HEP C ABO SC IND HI RSK&OTH COV IND 251 DR TST PRESUMP;INSTR‐AST DC OPT OBV 179 DR TST PRESUMP;INSTR CHEMISTRY ANLZ 120 DR TST DEFIN DR ID M P D 1‐7 DR CL 425 DR TST DEFIN DR ID M P D 8‐14 DR CL 835 Ccm/bhi by rhc/fqhc 20min mo 66

Page 84 of 92 Cognitive skills development 106 COLO FLX; PRX SP F;ABL TU P/OTH LES 974 ASSAY OF BENZODIAZEPINES 159 ASSAY OF DESIPRAMINE 174 ASSAY OF DOXEPIN 163 ASSAY OF SALICYLATE 111 ASSAY OF ACETAMINOPHEN 216 ASSAY OF BARBITURATES NES 171 ASSAY OF DIHYDROCODEINONE 210 OPIATE DRUG & METABOLITES EA PROC 171 SRVC PROV ORIENTATN & MOBIL SPCLIST 75 H1N1 adult vaccine (Medicare) 25 INFLUENZA A H1N1 VACCINE ANY ROUTE 2 INSUFFICIENT CHECK FEE 39 INJECTION ABATACEPT ‐ ORENCIA 10 MG 2,561 ACYCLOVIR INJECTION 116 INJECTION ADENOSINE 1 MG 662 INJ ADRENALIN EPINEPHRINE 0.1 MG 1,001 INJECTION AMIFOSTINE 500 MG 1,275 INJECTION ALPROSTADIL 1.25 MCG 2 INJ AMIODARONE HYDROCHLORID 30 MG 33 INJECTION AMPHOTERICIN B 50 MG 126 INJECTION AMPICILLIN SODIUM 500 MG 75 INJ AMPCLLN SODIM/SULBACTAM‐1.5 G 79 INJ SUCCINYLCHOLINE CHLORID UP 20MG 119 INJECTION AZITHROMYCIN 500 MG 309 INJECTION ATROPINE SULFATE 0.01 MG 29 INJECTION BENZTROPINE MESYLATE‐1 MG 256 BICILLIN 100,000 UN 1=$16 243 INJECTION PCN G BENZ 100000 UNITS 54 IM 1.2 MIL BICILLIN 54 INJ PCN G BENZ UP 2400000 UNITS 168 BOTOX/DYSPORT 744 BOTOX/DYSPORT 2ND FACIAL SEGMENT 298 BOTOX/DYSPORT 3RD FACIAL SEGMENT 239 INJ BUPRENORPHINE HYDROCHLOR 0.1 MG 94 INJECTION CALCM GLUCONATE PER 10 ML 43 INJECTION LEUCOVORIN CALCM‐50 MG 322 INJ CEFEPIME HYDROCHLORID 500 MG 105 ROCEPHIN IM 250MG 46 CEFOTAXIME SODIUM PER G 87 CELESTONE 3MG 76 INJECTION CERTOLIZUMAB PEGOL 1 MG 9,444 INJ CIPROFLOXACIN IV INFUS 200 MG 18 INJ COLLAGENASE CHC 0.01 MG 58 INJECTION PROCHLORPERAZINE UP 10 MG 115 INJECTION COSYNTROPIN 0.25 MG 2,892

Page 85 of 92 INJECTION COSYNTROPIN PER 0.25 MG 112 INJECTION DAPTOMYCIN 1 MG 1,091 DARBEPOETIN ALFA, NON‐ESRD 4,743 EPOETIN ALFA, NON‐ESRD 1,613 DECITABINE INJECTION 3,199 INJ DEFEROXAMINE MESYLATE 500 MG 158 INJECTION DENOSUMAB 1 MG 2,726 DEPO MEDROL INJ 20 MG 9 INJ METHYLPRDNISOLONE ACTAT 40 MG 24 Depo Provera 150 mg 44 INJ MDRXYPRGESTRON CNTRACPT 150 MG 86 INJ DEXETHOSONE SODIM PHOSHATE 1 MG 28 INJ DIHYDROERGOTAMINE MESYLATE‐1 MG 114 INJECTION DIGOXIN UP TO 0.5 MG 5 DIGOXIN IMMUNE FAB (OVINE) 8,908 INJECTION PHENYTOIN SODIUM‐50 MG 10 INJECTION HYDROMORPHONE UP TO 4 MG 17 INJ DEXRAZOXANE HYDROCHLORID‐250 MG 1,198 INJ DMSO DIMETHYL SULFOXID 50% 50ML 274 INJECTION DOBUTAMINE HCI PER 250 MG 93 DOPAMINE INJECTION 5 INJECTION EPTIFIBATIDE 5 MG 504 Ertapenem injection 423 INJECTION FILGRASTIM G‐CSF 1 MIC 1,264 INJECTION FLUCONAZOLE 200 MG 123 INJECTION FOSAPREPITANT 1 MG 1,008 INJECTION GAMMA GLOB IM 1 CC 336 Immune globulin 500 mg 11,003 IMMUNE GLOBULIN, POWDER 4,130 GAMMAGARD LIQUID INJECTION 9,593 INJECTION GENTAMICIN TO 80 MG 14 INJ GLUCAGON HYDROCHLORID 1 MG 564 INJ HEPARIN SODIUM PER 1000 UNITS 24 INJECTION ENOXAPARIN SODIUM 10 MG 246 INJ TETNS IMMUN GLOB HUMN TO 250 US 1,119 INJ HYDROCORTSON SOD SUCC TO 100 MG 41 Makena, 10 mg 79 IBANDRONATE SODIUM INJECTION 1,093 INJ IBUTILIDE FUMARATE 1 MG 1,022 INJECTION IRON DEXTRAN 50 MG 153 INJECTION DROPERIDOL UP TO 5 MG 24 INJECTION PROPRANOLOL HCL TO 1 MG 52 KETOROLAC TROMETHAMINE INJ 15 MG 15 Propiomazine injection 17,746 INJECTION FUROSEMIDE UP TO 20 MG 36 INJECTION LEVOCARNITINE PER 1 G 160 INJ LIDOCAINE HCI FOR INTRAVENOUS INFUSION 10M 12

Page 86 of 92 INJECTION LORAZEPAM 2 MG 46 INJECTION MEPERIDINE HCL PER 100 MG 33 INJECTION MEPOLIZUMAB 1 MG 7,022 Meropenem 240 INJ METHYLRGONOVIN MALATE TO 0.2 MG 3 INJECTION METHYLNALTREXONE 0.1 MG 409 INJECTION MIDAZOLAM HCL PER 1 MG 110 INJECTION MINOCYCLINE HCL 1 MG 484 INJ MORPHINE SULFATE UP TO 10 MG 67 INJ MS PRS‐FREE EPID/INTH USE 10 MG 52 INJECTION NALBUPHINE HCL PER 10 MG 20 INJECTION NALOXONE HCL PER 1 MG 135 NESIRITIDE INJECTION 1,714 Niacinamide/niacin injection 39,780 Octreotide inj, non‐depot 5,461 INJECTION OMALIZUMAB 5 MG 1,223 INJECTION PHENYLEPHRINE HCL TO 1 ML 74 INJECTION CHLOROPROCAINE HC 30 ML 112 INJECTION ONDANSETRON HCL PER 1 MG 49 INJ PALIPERIDONE PALM EXT RLSE 1 MG 6,124 INJ PAMIDRONATE DISODIUM 30 MG 39 INJECTION PALONOSETRON HCL 25 MCG 921 Injection, pegfilgrastim 6mg 15,254 INJECTION PCN G K+ TO 600000 UNITS 47 INJ PIP/TZ 1 GRAM/0.125 GRAMS 112 PHENERGAN INJECTION IM 9 INJ PHENOBARBITAL SODIUM TO 120 MG 129 INJECTION PLERIXAFOR 1 MG 21,417 INJECTION OXYTOCIN UP TO 10 UNITS 658 INJ PREDNISOLONE ACETATE TO 1 ML 21 INJ FLUPHENAZINE DECANOATE TO 25 MG 30 INJECTION PROCAINAMIDE HCL TO 1 G 353 INJ NEOSTIGMINE METHYLSULFAT‐0.5 MG 60 INJ METOCLOPRAMIDE HCL TO 10 MG 8 INJ QUINUPRISTIN/DALFOPRISTN 500 MG 6 INJ RANITIDINE HYDROCHLORID 25 MG 80 INJECTION REGADENOSON 0.1 MG 799 INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FUL 316 SINCALIDE INJECTION 414 INJ METHYLPREDNISOLONE SODIMIUM SUCCINATE T 3 INJ METHYLPRDNISOLONE SODIUM SUCCINATE 5 INJ ALTEPLASE RECOMBINANT 1 MG 21,543 INJECTION SUMATRIPTAN SUCCNAT 6 MG 197 INJECTION TENECTEPLASE 1 MG 14,350 INJ TERBUTALINE SULFATE TO 1 MG 116 INJ TOBRAMYCIN SULFATE TO 80 MG 13 INJECTION TOCILIZUMAB 1 MG 447

Page 87 of 92 KENALOG ‐ INJ TRIAMCINOLONE ACETONIDE 10 MG 174 INJ TRIAMCINOLONE HEXACETONIDE 5 MG 4 INJECTION DIAZEPAM UP TO 5 MG 94 INJECTION VANCOMYCIN HCL 500 MG 301 INJECTION VEDOLIZUMAB 1 MG 14,927 Thiamine hcl 100 mg 37 INJ VIT B‐12 CYNOCOBLMN TO 1000 MCG 34 INJECTION VIT K, PHYTONADIONE PER 1 MG 111 INJECTION MG SULPHATE PER 500 MG 99 INJECTION K+ CHLORID PER 2 MEQ 10 Ziprasidone mesylate 106 INJECTION ZOLEDRONIC ACID 1 MG 2,192 KYLEENA IUD UNCLASSIFIED DRUGS 6,424 UNCLASSIFIED BIOLOGICS 3,576 FACTOR VIIA 18,246 Kyleena, 19.5 mg IUD 572 LNG‐RELEASING IUC SYS 52MG 5 YR DUR 1,254 INTRAUTERINE COPPER CONTRACEPTIVE 982 LEVONORGESTREL‐IUD SKYLA 13.5 MG 1,028 IUD DEVICE 1,226 ETONOGESTREL IMPLANT SYSTEM 1,100 HYALGAN/SUPARTZ INJ PER DOSE 156 SYNVISC INJ PER DOSE 435 EUFLEXXA INJ PER DOSE 192 ORTHOVISC INJ PER DOSE 258 HYALURONAN SYNVISC 16 U/DOSE 28 HYAL/DERIV GEL‐ONE INTRA‐ARTICULAR INJ PER DOS 1,006 MONOVISC, HYALURONAN OR DERIVATIVE, FOR INTR 1,377 LYMPHCYT GLOB RABBIT PARNTRAL 25MG 1,928 ALBUTEROL INH NON‐COMP U D 5 ALBUTEROL COMP UNIT 5 Acetylcysteine 10% injection 100 ALBUTEROL INHAL NON‐CP CONC 1 MG 5 LEVALBUTEROL INHAL CONC FORM 0.5 MG 20 ALBUTEROL INHALATION ADMIN 7 Albuterol sulfate .083%/ml 11 Budesonide inhalation sol 57 BUDESONIDE INHAL SOL DME‐0.25 MG 31 METHACHOLINE CHLORID INHAL PER 1 MG 1,041 ORAL DEXAMETHASONE 0.25 MG 4 PRSC DRUG ORAL CHEMOTHAPEUTIC NOS 22 DOXORUBICIN HCL 10 MG 226 BCG 483 INJECTION, BENDAMUSTINE HCL, 1 MG 6,008 INJECTION BEVACIZUMAB 10 MG 7,804 BLEOMYCIN SULFATE 15 UNITS 457 INJECTION BORTEZOMIB 0.1 MG 3,924

Page 88 of 92 CARBOPLATIN 50 MG 266 INJECTION CARFILZOMIB 1 MG 4,690 INJECTION CETUXIMAB 10 MG 1,404 CISPLATIN POWDER/SOLUTION PER 10 MG 295 INJECTION CLADRIBINE PER 1 MG 2,318 CYCLOPHOSPHAMIDE 100 MG 1,233 CYTARABINE 100 MG 25 DACTINOMYCIN 0.5 MG 1,419 DACARBAZINE 100 MG 119 Degarelix 1,869 INJECTION DOCETAXEL 1 MG 4,646 Inj, epirubicin hcl, 2 mg 250 INJECTION ERIBULIN MESYLATE 0.1 MG 2,610 ETOPOSIDE 10 MG 92 FLUOROURACIL 500 MG 136 GEMCITABINE HCL 200 MG 1,814 ZOLADEX PER 3.6 MGS 2,807 IRINOTECAN 20 MG 617 MESNA 200 MG 212 LEUPROLIDE ACETATE 7.5 MG SUSPENSION 1,982 INJECTION IPILIMUMAB 1 MG 1,655 METHOTREXATE SODIUM 5 MG 44 Oxaliplatin 1,028 PACLITAXEL PROTEIN BOUND 3,259 INJECTION PEMBROLIZUMAB 1 MG 2,888 MITOMYCIN 5 MG 2,888 INJECTION MITOXANTRONE HCL PER 5 MG 1,170 INJECTION NIVOLUMAB 1 MG 15,405 PANITUMUMAB INJECTION 8,449 INJECTION PEMETREXED 10 MG 1,568 INJECTION PERTUZUMAB 1 MG 12,271 INJECTION TEMSIROLIMUS 1 MG 4,279 INJECTION TOPOTECAN 0.1 MG 253 VINCRISTINE SULFATE 1 MG 66 Injection, Fulvestrant 4,677 NOT OTHWISE CLASS ANTINEOPLSTC DRUG 4,530 CERVICAL FLEXIBLE NONADJUSTABLE 47 KO IMMOBLIZR CANVAS LNGTUDNL PRFAB 122 KO DBL UPRT W/ADJ FLX&EXT JNT PRFAB 989 AFO ANK GAUNTLT PREFAB W/FIT&ADJ 239 FOOT INSRT REMV MOLD PT SPENCO EA 46 FOOT ARCH SUPP PREMOLD LNGTUDNL EA 55 Ambulatory surgical boot eac 63 PLASTAZOTE SANDAL EACH 37 SO FIG 8 DESN ABDUCT RESTRNER PRFAB 67 SO ACROMIO/CLAVICULR PRFAB FIT&ADJ 128 AIR CAST ELBOW 85

Page 89 of 92 ELB ORTHOS RIGD W/O JNT W/INTERFCE 117 WHFO W/O JNT PRFAB W/FIT&ADJS TYPE 243 WHO EXT CNTRL COCK‐UP NONMOLD PRFB 145 Prefab metacarpl fx orthosis 102 FO W/O JOINTS CF 231 UPPER LIMB ORTHOSIS NOS 24 ANKLE BRACE 102 Pneumati walking boot prefab 185 WALKING BOOT PNEUMATIC AND/OR VAC 499 TRACHEO‐ESOPH VOICE PROS INSRT PROV 12 MM/14 806 LEGAL FEES 180 SCR PAP SMER UP TO 3 TECH W/MD SUPV 85 CRYOPRECIPITATE EACH UNIT 256 RBCS LEUKOCYTES REDUCED EACH UNIT 770 PLATELETS PHERESIS EACH UNIT 2,015 PLATELETS PHERESIS IRRADATD EA UNIT 2,028 RBCS LEUKOCYTES RDUC IRRADATD EA U 751 INFUSION ALBUMIN 25% 50 ML 373 Blood, l/r, cmv‐neg 818 Plt, pher, l/r cmv‐neg, irr 2,099 Plt, aph/pher, l/r, cmv‐neg 2,025 RBC, l/r, cmv‐neg, irrad 1,003 Plasma, frz between 8‐24hour 281 INFUS TX OTH THAN CHEMO RX VISIT 99 20 SCR PAP SMER; OBTAIN PREP&CONVY‐LAB 100 WET MOUNTS W/PREP VAG CERV/SKN SPEC 9 ALL K+ HYDROXIDE PREPARATIONS 9 PROMETHAZINE HCL 12.5 MG ORAL 3 PERPHENZAINE 4 MG ORAL 5 FLU VACC SPLIT 3 YR & > IM FLULAVAL 23 INJ DOXORUBICIN HCL LIPO NOS 10 MG 2,750 CAST BDY CAST ADLT W/WO HEAD PLAST 102 CAST BDY CAST ADLT W/WO HEAD F‐GLSS 386 CAST SPL SHLDR CAST ADULT PLASTR 74 CAST SPL SHLDR CAST ADULT FIBRGLS 254 CAST SPL LONG ARM CAST ADULT PLASTR 27 CAST SPL LONG ARM CAST ADLT FIBRGLS 60 CAST SPL LNG ARM CAST PED PLASTR 55 CAST SPL LNG ARM CAST PED FIBRGLS 30 CAST SPL SHORT ARM CAST ADLT PLASTR 18 CAST SPL SHRT ARM CAST ADLT FIBRGLS 40 CAST SPL SHORT ARM CAST PED PLASTR 12 CAST SPL SHORT ARM CAST PED FIBRGLS 20 CAST SPL GAUNTLT CAST ADULT PLASTR 32 CAST SPL GAUNTLET CAST ADLT F‐GLASS 54 CAST SPL GAUNTLT CAST PED PLASTR 17 CAST SPL GAUNTLET CAST PED F‐GLASS 28

Page 90 of 92 CAST SPL LNG ARM SPLINT ADLT PLASTR 40 CAST SPL LNG ARM SPLNT ADLT FIBRGLS 42 CAST SPL LNG ARM SPLINT PED PLASTR 20 CAST SPL LNG ARM SPLINT PED FIBRGLS 21 CAST SPL SHRT ARM SPLNT ADLT F‐GLSS 35 CAST SPL LONG LEG CAST ADLT FIBRGLS 74 CAST SPL LNG LEG CAST PED FIBRGLS 74 CAST LNG LEG CYCLE CAST ADLT F‐GLSS 260 CAST SPL SHRT LEG CAST ADLT FIBRGLS 165 CAST SPL SHORT LEG CAST PED PLASTR 27 CAST SPL SHORT LEG CAST PED FIBRGLS 83 CAST SPL LNG LEG SPLINT ADLT PLASTR 40 FINGER SPLINT STATIC 103 INJ PERFLUTREN LIP MICROS,ML 452 LOCM 200‐299MG/ML IODINE,1ML 363 LOCM 300‐399MG/ML IODINE,1ML 43 INJ NONRA NONCNTRST VIZ ADJNCT 1 MG 103 KYLEENA IUD 572 ZILRETTA ‐ TRIAMCINOLONE ACETONIDE 1 MG 19 RECORD COPYING CHARGE 22 RETURNED CHECK FEE 27 INJ BUPIVICAINE HYDROCHLORID 30 ML 32 INJ HYDROCHLORID 300 MG 307 INJ SULFMETHOXAZL&TRIMETHOPRM 10 ML 39 INJ CLINDAMYCIN PHOSPHATE 300 MG 112 Imatinib 100 mg 225 METHADONE ORAL 5MG 3 INJECTION BUMETANIDE 0.5 MG 9 LOMUSTINE ORAL 10 MG 56 PROCHLORPERAZINE MALEATE ORAL 5 MG 3 TAMOXIFEN CITRATE ORAL 10 MG 12 MISOPROSTOL ORAL 200 MCG 10 CORD BLD HARVEST TPLNT ALLOGENEIC 1,085 NEWBORN METABOLIC SCREENING PANEL 147 EAR MOLD INSERT NOT D 95 BATTERY FOR HA 6 HEARING AID SUPPLIES/ACCESSORIES 10 BATTERY CLUB (ALD NOS) 40 EAR MOLD IMPRESSION 30 EXTENDED WARRANTY (HA SERVICE, MISC) 185 VT MEDICAID W1040 3 THERAPEUTIC FOREARM BAND 34 UROSTOMY POUCH 1 1/2 15 OSTOMY BELT 27 COHESIVE SEAL SLIM 32 COHESIVE SEAL SMALL 24 STOMAHESIVE POWDER 18

Page 91 of 92 ILLEOSTOMY FLEX. WAFER W/2 3/4 FLANGE 10 COLOSTOMY FLEX.WAFER 2 3/4 STOMAHESIVE 12 WAFER W/FLANGE 2 1/4 9 POUCH HI OUTPUT 45MM 1 3/4 FLANGE 21 UROSTOMY POUCH NATURA(UNSTERILE)1 3/4 14 UROSTOMY FLEX WAFFER W/FLANGE 1 3/4 15 WAFER W/FLANGE 1 3/4 11 WAFER W/FLANGE 1 1/2 14 WAFER W/FLANGE 1 1/4 23 DRAIN POUCH 2 12 DRAIN POUCH 2 1/4 11 DRAIN POUCH 1 3/4 14 DRAIN POUCH 1 1/2 10 DRAIN POUCH 1 1/4 10 OSTOMY POUCH CLAMP 10 MEDI‐BEADS PACK 9 X 12 29 OBSTETRICS 1,553 CAUTERY HI TEMP DISPOSABLE STICK 74 PEDIATRICS PRIVATE 1,484 ROOM AND BED CHARGE PRIVATE 1,281 UROSTOMY KIT 116 COLOSTOMY/ILLEO POST OP KIT 2 3/4 68 COLOSTOMY/IL. SET 1 3/4 (GENTLETOUCH) 16 POUCH SURFIT NATURAL 14 TRAN FLOCKING 24 WAFFER SURFIT NATURA STOMAHESIVE 6X6 FLA 24 SEAL COHESIVE EAKIN LG 4 WAFFER BARRIER 31 DRAINAGE PLEURAL KIT ASPIRA 11,750 CHEST DRAIN DUAL OASIS DRY SUCTION 496 CHEST DRAIN SINGLE DRY SUCTION OASIS 275 CATHETER PLEURX 2,523 PLEURX DRAINAGE KIT 507 GASTRIC TUBE 34F. 403

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